Payer Enrollment can be complicated, please follow the instructions below for the appropriate line of business. Payer specific forms are available using the links at left for those payers that require enrollment.
CMS requires Emdeon to have an authorized Electronic Data Interchange (EDI) Enrollment Form or Medicare Remittance Advice on file for every Provider accessing the Medicare 270/271 Eligibility Transaction. Any new or existing customer must provide Emdeon with a copy of either of these forms. CMS's requirement can be found on page 6 in transmittal 991 with the Subject Line "Rules of Behavior". View the CMS rule.
Emdeon Enrollment is required to set up your system with access to the payers and transactions you need. This may include both Emdeon Enrollment and Payer Enrollment. The steps below are provided to assist you in completing these processes with minimal delays.
Step 1: Check the Payer List to determine if the transaction type you are interested in is available from the payers desired. The Payer List will also indicate what, if any, Payer enrollment is required.
Step 2: Emdeon Enrollment is accomplished with Provider Setup Forms (PSF) available for Batch Claim transactions and ERA's. Select the form from the link at left that applies to your transactions:
If changes are needed to your enrollment information please complete the appropriate form from the Emdeon Setup Forms links at left for your transaction types:
Step 3: Payer Agreements are needed when payers require a separate enrollment process. As a service to our customers, Emdeon provides these agreements and will forward complete forms to the payer as well as track the payer approval process. Please select the transaction type from the Payer Enrollment Forms links listed at top left then locate the payer name on the resulting page. Please report broken links or incorrect agreements by email to email@example.com.
For Additional Enrollment information, please use the links below.
Please ensure that you have completed the appropriate Emdeon Provider Setup form and emailed it to: firstname.lastname@example.org before submitting your Payer Enrollment forms.
If you are unable to email you may fax forms to:
or Mail to:
PO Box 148850
Nashville TN 37214
The listed payers require Dental providers to complete additional enrollment paperwork before they may submit their claims electronically. For each payer listed that you would like to submit electronic claims to please click on the carrier name, download the additional enrollment form(s) and once complete return the form to the fax number or address listed on the instruction sheet. Please ensure all necessary information is accurate and all required signatures are present. If you require assistance completing an enrollment form or have questions please contact Emdeon Dental Provider Enrollment at 888-255-7293 option 1.