Payer Enrollment Forms

Announcement:
CMS is requiring Emdeon to have an authorized Electronic Data Interchange (EDI) Enrollment Form or Medicare Remittance Advice on file for every Provider accessing the Medicare 270/271Eligibility 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”. Click Here for the specific language regarding Clearinghouses.

Click Here for a list of recent Payer Enrollment additions and updates

Enrollment 1-2-3

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 Emdeon Setup Forms drop-down box above that applies to your transactions:

Batch Claims Provider Setup Form - new enrollments, additions to existing enrollments
ERA Provider Setup Form – new enrollments for remittance files

If changes are needed to your enrollment information please complete the appropriate form from the Emdeon Setup Forms drop-down box above for your transaction types:

Batch Claims Change/Delete Form - Changes to or deletions from existing enrollments
ERA Add/Change/Delete Form – additions, changes or deletions to existing ERA enrollments.

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 drop-down list above then locate the payer name on the resulting page.

Please report broken links or incorrect agreements by email to payercontact@emdeon.com.

For Additional Enrollment information, please use the links below.

Emdeon Business Services Enrollment Guide
Enrollment Frequently Asked Questions

Please ensure that you have completed the appropriate Emdeon Provider Setup form and emailed it to: batchenrollment@emdeon.com before submitting your Payer Enrollment forms.

If you are unable to email you may fax forms to:

615-885-3713

or Mail to:

PO Box 148850

Nashville TN 37214

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