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1755 Telstar Drive Ste 400 Colorado Springs CO 80920 www. optum.com VAMCD 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. Electronic Remittance...
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What is form era enrollment for?
Form era enrollment is for enrolling in the Affordable Care Act's premium tax credit program.
Who is required to file form era enrollment for?
Individuals who are seeking financial assistance to help pay for health insurance premiums.
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You can fill out form era enrollment online through the healthcare marketplace or by mail.
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The purpose of form era enrollment is to determine eligibility for premium tax credits.
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Information such as household income, family size, and any employer-sponsored health insurance.
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