CMS-10164 Supporting Statement9.7.12

Statement for Medicare Electronic Data Interchange (EDI) Registration and Electronic Data
Interchange Enrollment Form
A.

Background
The purpose of this collection is to obtain information that will be subsequently used during
transaction exchange for identification of Medicare providers/suppliers and authorization of
requested electronic data interchange (EDI) functions. The EDI Enrollment Form and the
Medicare Registration Forms are completed by Medicare providers/suppliers and submitted to
Medicare contractors.
Authorization is needed for providers/suppliers to send/receive Health Insurance Portability and
Accountability Act (HIPAA) standard transactions directly (or through a designated 3rd party)
to/from Medicare contractors. Medicare contractors will use the information for initial set-up and
maintenance of the access privileges. The use of the standard form provides an efficient uniform
means by which Medicare could capture information necessary to drive Medicare EDI security and
EDI access privileges. All EDI providers will complete and sign the EDI Enrollment Form along
with the Medicare EDI Registration Form. They will also reconfirm their access privileges
annually. The signature and contact information provides a level of attestation as to the supplied
information in the form.
The Medicare contractor will ensure that the forms are complete, authenticated, and if requested
EDI services are appropriate, update the Medicare EDI Registration File and send a confirmation to
the requester. If the request is inappropriate, it will be returned with an explanation.
The lack of uniformity for EDI Registration has made it difficult to exchange information
efficiently thereby reducing the efficiencies and savings for health care providers and health plans
that could be realized if this information was standardized. Adopting a standard form for Medicare
EDI Registration and Enrollment forms greatly decreases the burden on health care providers and
their billing services and standardizes the data content needed to drive Medicare EDI security and
EDI access privileges.
The Medicare EDI Registration Form captures information necessary to support implementation of
the full suite of HIPAA transactions used by Medicare fee-for-service contractors, and automates
the application of Medicare EDI security and EDI access privileges. Providers/suppliers must
register with Medicare contractors, via the Form, to send/receive HIPAA standard transactions
directly (or through a designated 3rd party) to/from Medicare contractors.

B.

Justification
1. Need and Legal Basis
The Congress, recognizing the need to simplify the administration of health care transactions,
enacted the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law
104-191, on August 21, 1996. Title II, Subtitle F of this legislation directs the Secretary of the
Department of Health and Human Services to develop unique standards for specified electronic
transactions and code sets for those transactions. The purpose of this Subtitle is to improve the
Medicare and Medicaid programs in particular and the efficiency and effectiveness of the health
care industry in general through the establishment of standards and requirements to facilitate the
electronic transmission of certain health information.

This Subtitle also requires that the Secretary adopt standards for financial and administrative
transactions, and data elements for those transactions to enable health information to be exchanged
electronically.
The Standards for Electronic Transactions final rule, 45 CFR Part 162 Subpart K §162.1101
through Subpart R §162.1802, (hereinafter referred to as “Transactions Rule”) published August 17,
2000 adopted standards for health care transactions and code sets. Subsequent to the Transactions
Rule, CMS-0003-P and CMS-0005-P proposed modifications to the adopted standards essential to
permit initial implementation of the standards throughout the entire healthcare industry.
Currently, Medicare contractors have a process in place to enroll providers for electronic billing and
other EDI transactions. In support of the HIPAA Transactions Rule, the purpose of this Paperwork
Reduction Act (PRA) request is to establish a common form that is sufficient to address all HIPAA
transactions.

2. Information Users
The information collected by this form will be uploaded into Medicare contractor computer
systems. Medicare contractors will store this information in a database accessed at the time of
provider connection to the Medicare Data Contractor Network (MDCN). When authentication is
successful and connectivity is established, transactions may be exchanged.
3. Use of Information Technology
The information will be stored in a computer data base and used to authenticate the user on day-today electronic commerce, support the submitter and password administration function, and validate
access relationships between providers/suppliers and their designated EDI submitter/receiver on a
per transaction basis.
4. Duplication of Similar Information
This is not a duplicative collection of information. No other collections can substitute for this.
5. Small Businesses
This has no impact or burden to small businesses.
6. Less Frequent Collection
The frequency of collecting this information is determined by the provider/supplier as their business
needs change, such as revisions to their relationship with business associates, application software
and/or transactions they select to exchange electronically. Providers/suppliers will then
communicate such changes to the appropriate contractor via this Form. The security and privacy of
our Medicare electronic commerce remains potentially at risk without this collection or with less
frequent collections.
7. Special Circumstances

No special circumstances.
8. Federal Register Notice/Outside Consultation
The 60-day Federal Register notice for this collection published on [TBD]______________.
9. Payment/Gift to Respondent
There will be no payments/gifts to respondents.
10. Confidentiality
Respondent information will be kept in a physically secured area (electronic and paper). The
computer system will be password protected for electronic information. Files containing the actual
forms or information from these forms will be safeguarded. The information will be kept private to
the extent provided by law.
11. Sensitive Questions
There are no sensitive questions arising from this data collection.
12. Burden Estimate (Hours & Wages)
We estimate that the time to complete and forward the forms for Medicare EDI Registration and
Electronic Data Interchange (EDI) Enrollment is 20 minutes per EDI provider/supplier. Initially,
this information collection required all existing EDI providers/suppliers to enroll and register (1.2
million providers/suppliers). After the initial enrollment, on an ongoing basis annually, we expect
to see changes to existing enrollments/registrations and new enrollments occurring at a frequency of
240,000 provider/suppliers or 20 percent.
Thus initially we estimated 1.2 million registrations for the first year, for a total of 400,000 annual
hours per year @ $10.50 per hour= $4,200,000.
For the current submission, we estimate 240,000 registrations per year, for a total of 80,000 annual
hours per year @ $11.00 per hour= $880,000.
13. Capital Costs
There are no additional capital costs to respondents or to record keepers.
14. Cost to Federal Government
Forms completion and recordkeeping does not place additional costs on the Federal Government.
15. Program/Burden Changes
This is an extension of the currently approved information collection request. The burden has been
adjusted as stated in section 12 of this document. After the initial implementation of this
information collection request, the number of respondents decreased by 80% or (insert value) to
240,000 providers.

16. Publication and Tabulation Dates
There are no publication and tabulation dates associated with this collection.
17. Expiration Date
This form does not lend itself to the displaying of an expiration date. To include an expiration date
will result in Medicare having to discard a potentially large number of forms.

18. Certification Statement
There are no exceptions to the certification statement.

C.

Collections of Information Employing Statistical Methods
This collection of information does not employ statistical methods