Get the free The ERA enrollment form for Kansas City/Missouri West Medicare is attached and can b...

O. Box 8128 1717 West Broadway Madison WI 53713 WPS Medicare EDI Fax 608 223-3824 Phone 800 782-2680 Email edi wpsic.com Phone 866 503-9670 Email Medicare part A edimedicarea wpsic.com For further updates visit our website at http //www. 1755 Telstar Drive Ste 400 Colorado Springs CO 80920 www. optum.com KCMCR Thank you for choosing Electronic Network Systems Clearinghouse a division of Optum to submit your Claims/ERAs. Wpsic.com/edi/tools. shtml OPTUM ERA Setup Form Please complete the...

How to fill out the era enrollment form

How to fill out the era enrollment form

1. Read the instructions provided with the era enrollment form.
2. Gather all the necessary information and documents required for the form.
3. Start by filling out the personal information section, including your name, address, and contact details.
4. Provide any additional information requested, such as social security number or date of birth.
5. If applicable, fill out the employment history section, including details of your previous employers.
6. Carefully review all the sections of the form to ensure accuracy and completeness.
7. Make sure to sign and date the form where required.
8. Submit the completed era enrollment form to the designated institution or authority.

Who needs the era enrollment form?

1. Individuals who are applying for enrollment in the era program.
2. Employers who need to enroll their employees in the era program.
3. Government agencies or institutions responsible for managing the era program.

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What is the era enrollment form?

The era enrollment form is a form that must be filled out by individuals or entities looking to enroll in the Electronic Registration Authority (ERA) system.

Who is required to file the era enrollment form?

Any individual or entity looking to enroll in the ERA system is required to file the era enrollment form.

How to fill out the era enrollment form?

The era enrollment form can be filled out online on the ERA system website by providing the requested information and following the instructions provided.

What is the purpose of the era enrollment form?

The purpose of the era enrollment form is to gather information about individuals or entities looking to enroll in the ERA system for security and identification purposes.

What information must be reported on the era enrollment form?

The era enrollment form may require information such as name, contact information, identification documents, and any other relevant details requested by the ERA system.