Get the free UHIN ERA ENROLLMENT FORM - Office Ally

THIN ERA ENROLLMENT FORM Email this form to Support@officeally.com. The Email Subject should read: THIN ERA Enrollment. Please make sure to print legibly and to complete this form in its entirety.

How to fill out uhin era enrollment form

How to fill out uhin era enrollment form

1. Step 1: Obtain a copy of the UHIN ERA Enrollment form.
2. Step 2: Begin by filling out the top portion of the form, including your name, address, phone number, and email address.
3. Step 3: Provide your Tax ID and NPI numbers, as well as your billing provider number and your servicing provider number.
4. Step 4: Indicate the name of your practice or organization and the address where ERA files should be sent.
5. Step 5: Fill out the bank information section, including your bank name, account name, account number, and ACH routing number.
6. Step 6: Specify the payer information you wish to enroll for ERA services, including the payer name, payer ID, and any additional information requested.
7. Step 7: Sign and date the form, certifying that all information provided is accurate and complete.
8. Step 8: Submit the completed UHIN ERA Enrollment form to the appropriate UHIN contact or office.

Who needs uhin era enrollment form?

1. Healthcare providers and organizations who need to receive electronic remittance advice (ERA) files from payers through the UHIN (Utah Health Information Network) system need to fill out the UHIN ERA Enrollment form.

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What is uhin era enrollment form?

The UHIN ERA Enrollment Form is a document used to enroll healthcare providers in the Universal Health Information Network's electronic remittance advice (ERA) system.

Who is required to file uhin era enrollment form?

Healthcare providers, including hospitals, physicians, and organizations that wish to receive electronic remittance advice from payers must file the UHIN ERA Enrollment Form.

How to fill out uhin era enrollment form?

To fill out the UHIN ERA Enrollment Form, providers must complete their identifying information, such as National Provider Identifier (NPI), practice details, and select their preferred delivery methods for ERA notifications.

What is the purpose of uhin era enrollment form?

The purpose of the UHIN ERA Enrollment Form is to facilitate the enrollment of healthcare providers in the electronic remittance advice system, improving the efficiency of claims processing and payment reconciliation.

What information must be reported on uhin era enrollment form?

The information required on the UHIN ERA Enrollment Form includes provider identification details (like NPI), practice address, contact information, and the chosen electronic transmission methods.