In order to submit X12N transactions to Florida Medicaid, you must complete the appropriate enrollment form.

If you are not already enrolled with Florida Medicaid, you will find the enrollment forms available on the Enrollment Forms page. All trading partners, whether a provider, billing agent, or clearinghouse, must be enrolled as a provider in order to submit electronic transactions. An application must be submitted to EDS and will be processed by Provider Enrollment. Please review the Provider Enrollment page for additional information on enrolling as a Medicaid provider.

If you are already enrolled and would like to make a change, or you wish to designate or change a billing agent to submit claims for reimbursement by Florida Medicaid on your behalf, please complete the Electronic Data Interchange Agreement available below.

If you have questions regarding the Electronic Data Interchange Agreement form, or how to complete them, please call EDI at 1-866-586-0961.

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