Apex

EDI Registration Forms

If you are interested in submitting any of the HIPAA transactions to Apex Benefits Services, please complete the appropriate form below.

Please return completed forms to: Apex Benefits Services, Attn: Compliance Department, 10 N. Main Street, Akron, Ohio, 44308. You may FAX the form to: 330-996-8726.

For Trading Partners: Each direct submitter must complete a Trading Partner Agreement.  This Agreement includes trading partner obligations, term and termination, verification of eligibility, proprietary information, etc. that you must abide by in submitting information directly to Apex Benefit Services.

For Providers: Each provider must submit a Provider Registration form.

For Employers: Each employer must submit an Employer Registration form.

For Vendors: Each vendor must submit a Vendor FTP Registration form.

• 835 Registration Form
• Trading Partner 837 Provider Registration Form
• Vendor FTP Registration Form
• Employer Registration Form
• Provider Registration Form
• Trading Partner Agreement
• Electronic Funds Transfer Form

HIPAA Companion Guides

• Communications Companion Guide
• 277CA Companion Guide
• 837 Professional 4010
• 837 Institutional 4010
• 835 Companion Guide 4010
• 837 Professional DRAFT 5010
• 837 Institutional DRAFT 5010
• 835 Companion Guide DRAFT 5010
• 834 Companion Guide 5010