Get the free The ERA enrollment form for Blue Shield of South Carolina is attached for you to print
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1755 Telstar Drive Ste 400 Colorado Springs CO 80920 www. optum.com SCBLS 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 Contact Name 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. Please submit the...
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Who needs the era enrollment form?
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Individuals who wish to enroll in the era program.
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Employers who need to enroll their employees in the era program.
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Organizations that require era enrollment for their members or participants.
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What is the era enrollment form?
The era enrollment form is a document used to enroll in the Electronic Remittance Advice (ERA) program for receiving electronic payments and remittance advice.
Who is required to file the era enrollment form?
Healthcare providers who wish to receive electronic payments and remittance advice are required to file the era enrollment form.
How to fill out the era enrollment form?
The era enrollment form can be filled out online or submitted through a designated portal provided by the healthcare organization or insurance company.
What is the purpose of the era enrollment form?
The purpose of the era enrollment form is to streamline the payment process and reduce paperwork by receiving electronic payments and remittance advice.
What information must be reported on the era enrollment form?
The era enrollment form typically requires information such as provider name, contact information, banking details for electronic payments, and individual preferences for receiving remittance advice.
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