Get the free Emdeon ERA Provider Setup Form

This form is used for provider organizations to set up electronic remittance advice (ERA) with Emdeon, requiring detailed information about the provider facilities and billing practices.

How to fill out emdeon era provider setup

How to fill out Emdeon ERA Provider Setup Form

1. Obtain the Emdeon ERA Provider Setup Form from the Emdeon website or your provider.
2. Fill in the provider's name and NPI number in the appropriate fields.
3. Enter the tax identification number (TIN) and business address of the provider.
4. Provide billing contact information, including name, phone number, and email address.
5. Indicate your preferred payment method (e.g., electronic funds transfer).
6. Specify the types of claims you want to receive ERAs for (e.g., medical, dental).
7. Review the form for accuracy and completeness.
8. Sign and date the form where indicated.
9. Submit the completed form to Emdeon via the specified method (email, fax, or mail).

Who needs Emdeon ERA Provider Setup Form?

1. Healthcare providers who wish to receive electronic remittance advice (ERA) from Emdeon.
2. Billing professionals and administrative staff managing claims for healthcare providers.
3. Organizations that need to streamline their payment reconciliation process.

For pdfFiller’s FAQs

What is Emdeon ERA Provider Setup Form?

The Emdeon ERA Provider Setup Form is a document used by healthcare providers to enroll in the Electronic Remittance Advice (ERA) program offered by Emdeon, allowing providers to receive electronic payments and remittance information.

Who is required to file Emdeon ERA Provider Setup Form?

Healthcare providers, including physicians, hospitals, and other medical facilities that wish to receive electronic remittance advice from Emdeon, are required to file the Emdeon ERA Provider Setup Form.

How to fill out Emdeon ERA Provider Setup Form?

To fill out the Emdeon ERA Provider Setup Form, providers must provide their practice information, including tax identification number, contact details, and preferred payment methods. Clear instructions are typically included with the form to guide users through the completion process.

What is the purpose of Emdeon ERA Provider Setup Form?

The purpose of the Emdeon ERA Provider Setup Form is to facilitate the enrollment of healthcare providers in the ERA program, enabling them to receive electronic payment notifications and manage their financial transactions efficiently.

What information must be reported on Emdeon ERA Provider Setup Form?

The Emdeon ERA Provider Setup Form requires providers to report essential information such as their NPI (National Provider Identifier), tax identification number, contact information, practice location, and chosen delivery method for the remittance advice.