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Printed Date: 9/22/2015
The Network Service Agreement should be completed in order to submit and receive EDI transactions on behalf or providers. Network Service Vendors (NSVs) can submit or receive EDI Medicare transactions for providers who have filed and EDI Enrollment Agreement and EDI forms that authorize the NSV to conduct specified transactions on their behalf. An NSV will be in violation of CMS and HIPAA privacy and security requirements for the following actions:
Violators may be subject to penalties established by HIPAA and could lose all access rights to Medicare contractor systems nationally.
NSVs who do not translate non-HIPAA transactions or prepare claims are not permitted to read the content of data transmitted between a provider and Medicare, beyond accessing basic fields needed to determine inbound or outbound routing.
The field descriptions listed below will aid in completing the form properly.
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Last Updated: 04/09/2020