Get Form 8292

Filling out Form 8292 online can streamline the process of updating your provider information with Change Healthcare. This guide provides clear, step-by-step instructions to help you accurately complete each section of the form.

Follow the steps to complete Form 8292 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your provider organization information. Fill in the practice or facility name, provider name, tax ID, client ID, address, city, state, and ZIP code in the designated fields.
3. Complete the contact information section by providing the contact person's name, email address, telephone number, and fax number.
4. Next, input the vendor information if applicable. Enter the vendor name, submitter ID, and the contact details.
5. For the payer section, fill in the payer ID, which is 12005 for New Jersey Medicare. Include group ID and individual provider ID as required.
6. Complete the NPI ID and additional confirmations section to indicate where to send Change Healthcare claim confirmations.
7. Select any applicable options regarding the enrollment type, such as 'New Enrollment' or 'Change Enrollment,' and ensure that all relevant boxes are checked.
8. Fill in your Provider Transaction Access Number (PTAN) and National Provider Identifier (NPI), ensuring they match with your billing information.
9. After completing all sections, review the form for accuracy. Ensure all required fields marked with an asterisk are filled out.
10. Once satisfied, you can save changes, download, print, or share the completed form as needed before submission.

Complete your Form 8292 online today to ensure your provider information is up to date!