Billing Agent/Clearinghouse
Use these steps to begin an application on behalf of a billing agent or clearinghouse.
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From the Provider tab, select the New Enrollment hyperlink.
The System displays the New Enrollment page.
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Select the Billing Agent/Clearinghouse radio button.
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Select the Submit button.
The System displays the Basic Information page.
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Select a Tax Identifier Type.
Note: The Tax Identifier Type that you select may change which fields are required.
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Enter the required information based on your previous selection.
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Select the Next button.
The System displays the Provider Address Detail page.
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Select the Address button.
The System displays the Address details page.
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Enter the appropriate address in the Address Line 1 field.
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Enter the appropriate Zip Code.
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Select the Validate Address button.
The System auto-populates the remaining fields with the appropriate information.
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Confirm the auto-populated information is correct and select the OK button.
The System saves the address details and displays the Provider Address Detail page updated with the address details.
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Enter a Phone Number. (Required)
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Select the Finish button.
The System displays the Basic Information page.
Important Note: The System displays a message providing the Application #. Make note of this number as it, along with the SSN or FEIN, is required to track the enrollment application.
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Select the OK button.
The System displays the Enroll Provider -Billing Agent/Clearinghouse/Submitter page.