Get Electronic Data Interchange Transaction Request Form - Rmhp - Rmhp
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How to use or fill out the Electronic Data Interchange Transaction Request Form - RMHP - Rmhp online
Filling out the Electronic Data Interchange Transaction Request Form - RMHP - Rmhp can seem daunting, but with clear guidance, you can complete it effectively. This guide provides step-by-step instructions to help you navigate each section of the form with ease.
Follow the steps to complete the form accurately.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In Section 1, select your option for EDI enrollment: either ‘New EDI Enrollment’ or indicate any changes that need to be made. Be sure to choose from the available options clearly.
- Proceed to Section 2 and fill out the Office/Submitter Profile. Provide the office name, address, city, state, zip, phone number, fax number, contact name, and email address.
- In the Provider/Group Profile area, enter the name of the physician, group, or hospital, along with their Tax ID and NPI. If more providers need to be listed, attach additional documentation.
- For Section 3, fill in the Clearinghouse/Direct Submitter contact information. This is crucial if data will be submitted by a third party. Include their name and contact details as specified.
- In Section 4, indicate the types of transactions you will be submitting. Mark the appropriate options for inbound and outbound transactions, ensuring accuracy to avoid issues.
- Complete Section 5 by providing the contact information for the Electronic Claims Transmittal Report. This section needs to be filled for reports that provide data on accepted and rejected claims.
- List the individuals needing access to the RMHP website in the User Profile section and specify their permissions. Ensure that each person has a unique email address for access.
- Once all sections are filled out, review the information for accuracy. Make any necessary adjustments.
- Save your changes, then download, print, or share the completed form as needed. Finally, fax the form to 970-244-7880, Attention: IT/EDI.
Complete your documents online today for efficient processing!
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Rocky Mountain Health Plan operates under the umbrella of UnitedHealthcare but retains its identity. They provide unique services tailored to the needs of members in Colorado, while benefiting from the larger network of UnitedHealthcare. For transactions and forms specific to Rocky Mountain Health Plan, you'll want to use the Electronic Data Interchange Transaction Request Form - RMHP - Rmhp. Uslegalforms can help you find the correct documents efficiently.
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