Get the free We have attached the Blue Shield of New Hampshire ERA Instructions and Enrollment Form
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1755 Telstar Drive Ste 400 Colorado Springs CO 80920 www. optum.com NHBLS 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 Provider Name Individual PTAN or Legacy ID if applicable Individual NPI Payer Name. Ste. 400 Town/City Contact Name State...
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