EDI Enrollment Instructions Guide Module

Published 11/16/2022

Do you need help completing your EDI Enrollment packet? This updated guide will give you all the information you need to get started.


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Please answer the questions below. Additional fields may appear based on previous answers. Fields with a red asterisk (*) are required.
Your InformationClear
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Patient InformationClear
Patient Name must exactly match the information submitted on the claim, including suffix if applicable.
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Appeal InformationClear
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Claim InformationClear
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Denial InformationClear
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Rejection InformationClear
DDE InformationClear
Restore InformationClear
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Prior Authorization InformationClear
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Application InformationClear
Product InformationClear
OtherClear
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