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HEALTHIEST (80141) ERA ENROLLMENT FORM INSTRUCTIONS WHICH FORM SHOULD I DO? Eden ERA Enrollment Form o NOTE: This form is emailed to Office Ally, not to Eden. Health first EFT Authorization Form o
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How to fill out emdeon era enrollment form
How to fill out emdeon era enrollment form:
01
Ensure you have all necessary information and documents handy, including your practice's tax ID number, NPI number, and banking information.
02
Begin by entering your practice's contact information, including the business name, address, phone number, and email address.
03
Provide the necessary information about your practice, such as the practice type, specialty, and number of providers.
04
Next, fill in the billing office details, including the name, address, phone number, and email address.
05
Enter your practice's banking information, including the bank name, routing number, and account number for electronic funds transfer.
06
Indicate whether you will be submitting claims directly or through a clearinghouse, and provide the necessary details accordingly.
07
If you will be using a clearinghouse, provide the clearinghouse name, contact information, and payer enrollment ID.
08
Review the terms and conditions of the enrollment form and agree to them.
09
Sign and date the form, and ensure all relevant parties also sign if necessary.
10
Finally, gather any additional supporting documents required, such as voided checks or bank letters, and submit the completed emdeon era enrollment form.
Who needs emdeon era enrollment form:
01
Medical practices and healthcare providers looking to streamline their claims and payment processes.
02
Billing offices and administrators responsible for managing financial transactions for healthcare providers.
03
Clearinghouses or intermediaries facilitating claims submission and processing on behalf of healthcare providers.
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