What is a Vendor Submitter ID in Medical Billing

Understanding the term Vendor Submitter ID

To understand the term Vendor Submitter ID is it important to understand the terms—submitter, vendor, software vendor, and submitter ID as they are closely associated.

• • Submitter: The Centers for Medicare and Medicaid Services (CMS) defines a submitter as an “entity that owns the submitter ID associated with the health care data being submitted. It is most likely the provider, hospital, clinic, supplier, etc., but could also be a third party submitting on behalf of one of these entities. However, a submitter must be directly linked to each billing NPI.”

CMS also clarifies that “often the terms submitter and trading partner are used interchangeably because a Trading Partner is defined as the entity engaged in the exchange or transmission of electronic transactions. Thus, the entity that is submitting electronic administrative transactions to [MAC name] is a Medicare FFS trading partner.”

• Vendor: CMS defines a vendor as “an entity that provides hardware, software, and/or ongoing technical support for covered entities. In EDI, a vendor can be classified as a software vendor, billing, or network service vendor or clearinghouse.”
• Software Vendor: Furthermore the term software vendor is defined as “an entity that creates software used by billing services, clearinghouses, and providers/suppliers to conduct the exchange of electronic transactions with Medicare FFS.”
• Submitter ID: In medical billing, the term Submitter ID refers to an identification number used to submit medical claims electronically. The purpose of this number is to identify electronic submitters to make the claim process efficient. Every Submitter ID has one or more NPI numbers linked to it.

Based on the above definitions, it may be said that the term Vendor Submitter ID is another term for Submitter ID. The word ‘vendor’ may simply indicate that the submitter is a vendor or a clearinghouse who is submitting claims on a provider’s behalf.

Submitting Claims using Submitter Id

If you are a health care provider then you must know that there are two ways to submit claims:

• Directly to the payer: To submit claims directly to the payer, you (the provider) must request a Submitter ID from the payer. For example, if you are trying to submit Medicare Claim via a contractor for the Centers for Medicare & Medicaid Services, then you request the contractor for the Submitter ID as the contractor is associated with CMS. Here ‘contractor’ refers to CMS-approved EDI vendors.
• Via a clearinghouse/trading partner/vendor:  If you (the provider) are submitting claims via a clearinghouse then you don’t need to request the Submitter ID. In such a case, the clearinghouse needs the submitter ID, for it is submitting the claim to the payer on your behalf. Clearinghouse clients do not need Submitter ID.

It is important to note that both provider and clearinghouse are required to fill the Electronic Data Interchange (EDI) form to request Submitter ID.

Role of Submitter ID

In medical billing, Submitter ID acts as a non-transferable electronic signature carrying submitter’s information like name, number, etc. To prevent the misuse of the EDI it is requested not to share the Submitter ID and password with anyone.