Electronic enrollment just got easier. The Electronic Provider Profile replaces all our previous registration forms, contracts and addendums. And original signatures have been eliminated. For questions call (800) 924-7141 and speak "Enrollment".
To enroll in electronic claims filing, to add a provider to an existing electronic practice or make any changes in your electronic filing process you must complete an Electronic Provider Profile Form.
If you are a new Billing Agent, Clearinghouse or Vendor you must complete an Electronic Vendor Profile Form. Also if you are making any changes or migrating to the new EC Gateway Bulletin Board System a profile is also required.
If you would like to make changes to your current electronic mailbox(s), or migrate to the EC Gateway Bulletin Board System, you must complete the EC-Gateway Request for Access form.
The following is a list of approved vendors from whom we are currently receiving production files in a valid format. If you are trying to determine if you will purchase a software package or use a billing agent or clearinghouse this may help in your decision. If the company you are considering is not listed on the approved vendor list, they will be required to submit a test before you can submit production claims. For questions please call the eBusiness Service Center (800) 924-7141 or email us at firstname.lastname@example.org.
In order to protect your secure access to our systems, each individual who will be accessing our systems is required to submit the Provider Account Security Form.