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PAYER ID: SB621/12B08 SUBMITTER ID: ILSB000415 Eden ERA Provider Information Form *This form is to ensure accuracy in updating the appropriate account 1 Provider Organization Practice/ Facility Name
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What is submitter id ilsb000415?
Submitter ID ilsb000415 is a unique identifier assigned to a submitter.
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Only the designated submitter assigned the ID ilsb000415 is required to file it.
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Submitter ID ilsb000415 should be filled out using the assigned unique identifier.
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The purpose of submitter ID ilsb000415 is to track submissions from a specific submitter.
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The submitter ID ilsb000415 may require information related to the submission or the submitter.
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