New EDI Enrollment Form
All fields are required except where marked (optional).
For questions about this form, please call the EDI Help Desk at 1-800-472-6481, option 1.
- Setup will be completed within 3-5 business days.
- To enroll for the 835s complete the Electronic Remittance (ERA) form
- NPI must be reported to all payers before completing this form.
Please provide in writing to ASK any future changes to the information contained in this EDI Setup form with in 5 business days of the change.
ASK will make every attempt to give 60 days' notice of any material changes to the EDI System that may effect trading partners' data transmissions. Updates to any system changes will be made through email notification on the ASK website. Trading partners are strongly encouraged to sign up for email notification.
Kansas law applies to this business relationship.
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