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EDI ENROLLMENT FORM A. The provider agrees to the following provisions for submitting Medicare claims electronically to CMS or to CMS carriers, Macs, or FI's: 1. That it will be responsible for all
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The party who is providing the service or product is required to file form provider agrees to.
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The purpose of form provider agrees to is to establish the terms and conditions of the agreement between the parties involved.
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Form provider agrees to must include the details of the service or product being provided, payment terms, and any other relevant information.
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