Fillable submitter action request form medicare

Description
Document Name: EDI Part A Submitter Action Request Form Release Date 11/10/2011 NHIC, Corp Doc. Number: FRM-EDI-0031 Version: 5.0 NHIC, Corp MEDICARE PART A SUBMITTER ACTION REQUEST FORM This form is used to request a new submitter ID, request a new transaction for an existing submitter ID, or report a software vendor change. SECTION I: ACTION NEW ID MODIFY EXISTING ID Software Vendor Change CURRENT ID: SECTION...
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submitter action request form medicare
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