Documents
PROTOCOLS
| PROTOCOLS | DESCRIPTION | DOCUMENT |
|---|---|---|
|
Medicare Part B |
Puerto Rico Submitters |
|
|
Medicare Part B |
U.S. Virgin Island Submitters |
|
|
Medicare Part A |
EDI Enrollment Form (MA) |
|
|
Medicare Part A VI |
U.S. Virgin Island Submitters |
|
|
CIGNA |
Dental EFT Authorization |
|
|
AETNA |
AETNA ERA-835 |
|
|
HUMANA |
ERA-835 (Hawaii, PR & VI) |
|
|
SES-INMEDIATA |
Providers & Hospital |
|
|
CEDI-DME |
CEDI Enrollment Agreement Instructions |
|
|
MAPFRE |
ACH-Electronic Payments |
|
|
Delta Dental |
Secure EDI ERA Enrollment |
|
|
Molina Healthcare |
Molina ERA Enrollment |
|
|
RR Medicare |
Agreement |
|
|
Humana Medicare |
Application process |
FORMS
| FORMS | DESCRIPTION | DOCUMENT |
|---|---|---|
|
Installation Form |
English |
|
|
Formulario de Instalación |
Español |
|
|
Account Configuration Form |
English |
|
|
Formulario de configuración de la cuenta |
Español |
|
|
Accouting – Direct Debit Form |
English |
|
|
SecureEMR - Formulario para Cambios y Configuraciones |
English |