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PAYER ID SX086 SUBMITTER ID UNI899 Emdeon Claims Provider Information Form This form is to ensure accuracy in updating the appropriate account Provider Organization Practice/ Facility Name Provider Name Tax ID Client ID Site ID Address City/State Zip Code Contact Name E-mail Address Telephone Fax Vendor Emdeon certified vendor used to submit files to Emdeon Vendor Submitter ID Vendor Name Division ID Payer UNIVERA HEALTHCARE Group ID Individual P...
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