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EDI 835 (ERA) Enrollment Form (To Receive Electronic Remits) Date 1 Submitter Information (to be filled out by the clearinghouse) CLEARINGHOUSE Contact Name Email Note: PHP will send enrollment confirmation

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What is magellan edi enrollment form?

The magellan edi enrollment form is a form that providers must complete in order to enroll in the Electronic Data Interchange (EDI) system with Magellan Healthcare.

Who is required to file magellan edi enrollment form?

Any healthcare provider who wants to submit claims electronically to Magellan Healthcare is required to file the magellan edi enrollment form.

How to fill out magellan edi enrollment form?

To fill out the magellan edi enrollment form, providers need to provide their contact information, practice details, banking information, and any other required information as specified by Magellan Healthcare.

What is the purpose of magellan edi enrollment form?

The purpose of the magellan edi enrollment form is to allow healthcare providers to efficiently submit electronic claims to Magellan Healthcare and receive electronic remittance advice.

What information must be reported on magellan edi enrollment form?

Providers must report their contact information, practice details, banking information, and any other required information as specified by Magellan Healthcare on the magellan edi enrollment form.

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