Filling out the Electronic PDF Remittance Advice Request Form

Medicaid has mandated that all providers get their payments by Direct Deposit AND THEY
GET THEIR EOBs (Explanation of Benefts) via their e-mail system, which is called eXchange.
They will discontinue sending you these by mail For you to continue to get reports on the
claims that you have sent You NEED to enroll in Medicaids ePACES and eXchange.
ePACES: Lets you access their Internet Web Site.
It provides a VERY GOOD way of checking Patient Eligibility
To Do This, you need a USER Name And Password.
eXchange: Is their e-mail system, where you will download a PDF Version of your
Remittance Advice. (You should print a copy for your records.)
To Do This, you will need and ETIN Number and User I.D.
SOME ISSUES THAT COME UP: Since WE Submit your claims, we have our own Submitter I.D.
If you call Medicaid, they will often tell you to use Our ETIN I.D. (which is 0kc).. however, since
we do not want hundreds of reports coming to OUR mailbox you need to get a Submitter I.D.
(Also Known as and E.T.I.N. NUMBER) OF YOUR OWN Which is not hard to get.
----------------------------------------------------------------------------------------------------------------------
You Will Need 2 Forms.
They are on Medicaids Website, or Easier to Find on OUR Website.
Go To: WWW.JSKLAR.WEEBLY.COM
Click On: MEDICAID RESOURCES (On Top)
Click On: Medicaid PDF Remit Instructions
Click On: ETIN Request Form
Print The FORMS UNDER: STEP ONE.
----------------------------------------------------------------------------------------------------------------------
Step ONE:
First Fill out the PROVIDER Electronic / Paper Identification Number (ETIN) Application
This is 2 pages.
Fill out these pages and have the Second Page Notarized.
Mail ONLY THESE 2 P!ES to the address on Page ". #$o%puter Sciences&.
'ait a(out 2 )ee*s and +ou )ill get an !ETIN N"#$ER %OR &O"R O%%I'E(
----------------------------------------------------------------------------------------------------------------------
J. Sklar Medical Billing Dr. Joel F. Sklar
Ophthalmic Claims Billing Service 1096 Strathmore Street
16!"91!6#0 $. %oodmere& $.'. 11(1
Step T)O:
Once +ou receive +our ET,N nu%(er- +ou %ust 'A** #EDI'AID + ,--./0/.1--- 234 T5EN 23
.E/0EST N ePA'ES / e6c7an8e A''O"NT
T7e9 :ill ;end 9ou ;e<eral e.mail; to do t7i;= (;orr9)
>>> NO #ATTER )5AT4 DO NOT AD#IT T5AT &O" "SE A $I**IN? SERVI'E@@@@>>>
(Reall9 @)
----------------------------------------------------------------------------------------------------------------------
ON'E &O" ?ET &O"R EPA'ES "SER ID
'ee*s have passed (+ this ti%e12
NO' +ou can do the Final Step.
!O 3$4 TO O0. 'E3S,TE5 '''.6S4L..'EE3LY.$OM
Click On: MEDICAID RESOURCES (On Top)
'licA On: %INA* STEP
'licA On: #edicaid PD% Remittance %orm;
7o)nload and print the Electronic or P7F .e%ittance dvice .e8uest #E.& For%.
7o)nload O0. 7irection Sheet.
999 Follo) O0. 7irection Sheet2 not theirs2.
----------------------------------------------------------------------------------------------------------------------
Fill Out the Paper)or* and M,L to the address on the :or%.
You re 7ONE 111
$ON!.TS 1
Ne;t ti%e +ou spea* to .oseann2 tell her Than* YO0 :or )or*ing so hard on these directions and the
)e(site111
< 7r. S*lar