Get Owcp Claring House Form

Filling out the Owcp Claring House Form online can streamline your process and ensure that all necessary information is accurately submitted. This guide provides comprehensive, step-by-step instructions to help you complete the form with confidence and ease.

Follow the steps to effectively complete the form.

1. Click the ‘Get Form’ button to obtain the document and open it in your online editor.
2. Indicate your classification by selecting one of the options: Software Vendor, Switch Vendor, Provider, Clearinghouse, or Billing Agent.
3. In the submitter/vendor/provider name section, enter the complete name along with the address, city, state, and zip code. Ensure that you provide a valid telephone number and fax number.
4. Fill in the provider number, EIN, group provider number, and email address as required.
5. If applicable, provide the contact information different from section A1, including the contact name, title, business address, phone number, fax number, and email address.
6. If you are a Software Vendor, provide the software name and version, and indicate whether you have clients submitting to ACS.
7. Choose the electronic submission method, indicating whether you are submitting as a vendor software or clearinghouse. Select the format type (Proprietary or X12N) and specify the transaction type (Professional, Dental, or Institutional).
8. Indicate your submission method, which can be WEB, NDM, or ASYNC, and provide information for the protocol used.
9. If interested, answer whether you would like to retrieve your electronic transaction reports. Indicate who will retrieve the reports and specify which reports you would like to access electronically.
10. Carefully review all entries to ensure completeness and accuracy. Save your changes and proceed to download or print the form. Finally, submit the complete form via mail or fax to the provided address.

Take action now to complete and submit your Owcp Claring House Form online for expedited processing.