Get Era Agreement Submission Instructions - Tmhp.com

Filling out the ERA Agreement Submission Instructions is an essential step for providers wishing to receive Electronic Remittance and Status information. This guide provides clear steps to help you navigate the form and submit it correctly for processing.

Follow the steps to complete and submit your ERA Agreement form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering the provider's legal name in the 'Provider Name' field as it appears on the Internal Revenue Service (IRS) records.
3. Fill in the provider's address, ensuring you include the street, city, state/province, and ZIP code/postal code.
4. Input the provider's Federal Tax Identification Number (TIN) or Employer Identification Number (EIN) in the designated field.
5. Enter the provider's National Provider Identifier (NPI) accurately.
6. Complete the 'Other Identifier(s)' by specifying the Billing TPI, noting that each TPI requires a separate request form.
7. In 'Trading Partner ID,' provide the submitter/production ID as required.
8. Select your preference for how to aggregate remittance data and indicate how you wish to receive the Electronic Remittance and Status information.
9. Select the reason for submission (New Enrollment, Change Enrollment, or Cancel Enrollment) to clarify your intent with this form.
10. Have the authorized individual sign the form, and include their printed name, title, and the submission date below the signature.
11. Review all entered information for accuracy before proceeding to the last step.
12. Finally, save changes, and proceed to download, print, or share the completed form as necessary.

Start filling out your ERA Agreement form online today for efficient processing.