Get the free For your convenience the Emdeon Form used to connect to Passport Health Plan ERAs is...

1755 Telstar Drive Ste 400 Colorado Springs CO 80920 www. optum.com 61129 Thank you for choosing Electronic Network Systems Clearinghouse a division of Optum to submit your Claims/ERAs. This form is for Optum use only and will not be forwarded on to the payer with your Optum user ID Group Name Group Billing TIN Group Legacy ID Please list all providers for this Payer below Individual PTAN or Legacy ID if applicable Individual NPI Payer Name. 885. 3713 This COV must be attached to a ERA...

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