Registration
Form Question |
Recommended Response |
Certification Plans: |
|
Please select the type of software that you intend to use to submit
and receive HIPAA transactions: (Required)
|
Purchased Software (vendor supplied) |
What is your preferred Certification Begin Date?: (Require date
starting 11/1/2002)
|
May 15, 2003 |
Select all transaction types for which you need to be certified.
Please, read the certification documents carefully before selecting:(Required) |
837/835 Professional - select Yes option |
What date do you plan on sending DPW OMAP Production HIPAA formatted
transactions?: (Required)
|
July 1, 2003 |
Organization or Submitter Information: |
|
If you selected Individual Provider or Group Provider for the organization
type above, will your HIPAA transactions be submitted through a billing
service/clearinghouse to EDS? |
No |
Transaction Transmission Information: |
|
DPW OMAP provides Provider
Electronic Solutions (PES) software at no cost to the user. The
PES software will be pre-certified. The
certification process will be less comprehensive for PES users. Check
here if you are you interested in using the PES software. Selecting "Yes" will
ensure that you are notified when PES is available to the provider
community. |
Yes |
Software Name |
R/Client for Children |
Software Vendor Name |
SymServe
|
Address |
4932 Library Road, 2nd Floor |
City |
Bethel Park |
State |
PA |
Zip Code |
15102 |
Vendor Contact Information
|
|
Contact First Name |
Gary
|
Contact Last Name |
Kammeraad |
Phone Number |
412-851-1374 |
Fax Number |
412-851-1375 |
E-Mail Address |
gkammeraad@symserve.com |
Transmissions and Communications |
|
Which medium will be used to submit test and production transactions
to Pennsylvania Medical Assistance?: (Required)
|
Interactive or bulletin board system (BBS) |
Which medium will be used to receive test and production transaction
results and error reports from Pennsylvania Medical Assistance: (Required) |
Interactive or bulletin board system (BBS) |
Select a method in which to receive the Certification Packet: (Required)
|
Email |
Select a method in which to receive the certification transaction
status results: (Required)
|
Email |