Get Payer Id: Smin0 Submitter Id: Zd9g0000 Emdeon Claims Provider Information Form *this Form Is To

This guide will assist users in accurately completing the PAYER ID: SMIN0 SUBMITTER ID: ZD9G0000 Emdeon Claims Provider Information Form. By following the comprehensive steps outlined below, users can effectively navigate the fields and ensure their claims are submitted correctly.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. In the first section, input the provider organization details. This includes the practice or facility name, provider name, tax ID, client ID, site ID, full address, city/state, zip code, contact name, and email address.
3. Next, provide the telephone and fax numbers of the provider organization. Include the vendor information, such as the Emdeon certified vendor used for file submission and the associated vendor submitter ID and name.
4. In the payer section, specify the payer information. Fill in the payer ID (SMIN0 INDIANA MEDICARE), group ID, and individual provider ID.
5. Include the National Provider Identifier (NPI ID) and indicate where to send Emdeon claim confirmations. Any special instructions can also be added in this section.
6. Ensure that any required signatures are obtained, as stamped signatures or photocopies are accepted.
7. Finally, submit the completed form either by faxing it to (615) 231-4843 or emailing it to batchenrollment@Emdeon.com.

Start completing your Emdeon Claims Provider Information Form online today.