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PAYER ID: 19305 SUBMITTER ID: Eden ERA Provider Information Form *This form is to ensure accuracy in updating the appropriate account 1 Provider Organization Practice/ Facility Name Provider Name
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What is payor id 19305 form?
Payor ID 19305 form is a form used for reporting information about payors who made payments in settlement of payment card transactions or third-party network transactions.
Who is required to file payor id 19305 form?
Payors who made payments in settlement of payment card transactions or third-party network transactions are required to file payor ID 19305 form.
How to fill out payor id 19305 form?
To fill out payor ID 19305 form, you need to provide information about the payor, payment card transactions, third-party network transactions, and any other required details as specified in the form. The form should be completed accurately and in accordance with the instructions provided.
What is the purpose of payor id 19305 form?
The purpose of payor ID 19305 form is to gather information about payment card transactions and third-party network transactions for reporting and compliance purposes.
What information must be reported on payor id 19305 form?
On payor ID 19305 form, you must report information such as the payor's identification details, payment card transaction amounts, third-party network transaction amounts, and any other required information as specified in the form.
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