Get Sxcfill

This guide provides a clear, step-by-step approach to filling out the Sxcfill form online. Whether you are familiar with digital forms or new to the process, this comprehensive guide will help users navigate through each section with ease.

Follow the steps to complete your Sxcfill form online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Complete the Professional Services Representative section by entering the representative's name, along with the client details, including client name and client ID.
3. Fill in the payee ID, often referred to as the chain code. Make sure to also include the date you completed the request worksheet.
4. In the Payer section, input the name ‘PBM Plus, Inc.’ along with the federal tax ID number provided (39-1789830). Optionally, you can add additional tax ID information.
5. Enter the communication details, including the email address (ProviderServices@PBMPlus.com) as well as the provided phone and fax numbers.
6. In the Payee section, fill in the payee name and the NCPDP or chain code, followed by the payee tax ID.
7. If applicable, provide the technical or EDI contact information, including their phone number, fax number, and email address.
8. Specify the production notification email and receiver ID, selecting from the options: Duns Number, Phone Number, or Mutually Defined.
9. Indicate the receiver ID qualifier and specify the encryption method if needed. If you are using zip with a password or PGP, provide the necessary password or PGP key.
10. Once all fields are completed, review the form for accuracy and then save your changes. You can download, print, or share the form as needed.

Complete your Sxcfill form online today for a seamless experience.