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Directions Department of Vermont Health Access 835 ERA Enrollment Form Provider Information (Completion Required) Provider Name: Enter the individual provider name or group name, if billing under
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The Department of Vermont Health is part of the Vermont state government responsible for overseeing public health initiatives and programs.
Healthcare providers, facilities, and organizations in Vermont are required to file with the Department of Vermont Health.
Healthcare providers can fill out the Department of Vermont Health forms online or by mail, following the instructions provided by the department.
The purpose of the Department of Vermont Health is to monitor and protect public health, ensure healthcare quality, and promote wellness in the state.
Information such as healthcare provider credentials, facility certifications, and healthcare quality metrics must be reported on the Department of Vermont Health forms.
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