Billing Agent/Clearinghouse
Use these steps to begin an application on behalf of a billing agent or clearinghouse.
- Select the Billing Agent/Clearinghouse radio button.
- Select the Submit button.
The System displays the Basic Information page.
- Select a Tax Identifier Type.
Note: The Tax Identifier Type that you select may change which fields are required.
- Enter the required information based on your previous selection.
- Select the Next button.
The System displays the Provider Address Detail page.
- Select the Address button.
The System displays the Address details page.
- Enter the appropriate address in the Address Line 1 field.
- Enter the appropriate Zip Code.
- Select the Validate Address button.
The System auto-populates the remaining fields with the appropriate information.
- 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.
- Enter a Phone Number. (Required)
- 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.
- Select the OK button.
The System displays the Enroll Provider -Billing Agent/Clearinghouse/Submitter page.