SCDHHS
Trading Partner Agreement Enrollment Instructions for Providers The Trading Partner Agreement Enrollment (TPA) form may be found online at http://www.dhhs.state.sc.us/dhhsnew/hipaa/webfiles/TradingPartnerEnrollmentForm.pdf Please use the instructions below to fill out the TPA. Incomplete or incorrect TPAs will not be processed. FIELD Date Action Requested Trading Partner Name INSTRUCTIONS Enter today's date. Leave Blank Provider or Group Organization name. Some providers have both. In this case, you will complete a separate TPA for each provider or group SC Medicaid Provider Number MoreIndicate, in mm/dd/ccyy format, the date the trading partner plans to begin transaction testing with SCDHHS. End Date. If this form is being used to cancel an ... Less
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