HOSPICE Billing Information

Software Access and Information

Please retrieve your PECOS or current CMS855-A form.

► These are important when you complete the EDI/LOA applications.

• Name and title of Registered Official in CMS.
• Registered Address declared in CMS (if different from above).

Authorization for Billing Access Application

EDI applications vary depending on NGS' current processing time. If information provided are incorrect, applications will be rejected. We will attempt to re-apply following NGS' current timeframe.

I understand that for Medicare, we, the Hospice Agency, will apply for Zirmed and LOA to authorize and provide our Business Associate (NEBI), billing access. As it is time sensitive, we will promptly forward the PIN & confirmation email from Medicare to NEBI upon receipt. This will enable NEBI to proceed with the next steps of the application,

Please note: TPID (Trading Partner ID) is needed for electronic claims or to receive electronic remittance advice (ERA) while ZIRMED is to be used as back up for claims submission.

Selecting this option also means that the agency is authorizing NEBI to send TPID applications on their behalf.

For non-Medicare, we, the Hospice Agency, will apply for Medi-Cal portal access.

I understand that billing will commence after these applications are approved, software access is provided, and contracts (sent separately) are signed.

NEBI will not be held liable should these applications get rejected because of wrong information or any other reasons that only the agency is expected to provide or complete.