Billing Agent/Clearinghouse

Use these steps to begin an application on behalf of a billing agent or clearinghouse.

  1. From the Provider tab, select the New Enrollment hyperlink.

The System displays the New Enrollment page.

  1. Select the Billing Agent/Clearinghouse radio button.

  2. Select the Submit button.

The System displays the Basic Information page.

  1. Select a Tax Identifier Type.

Note: The Tax Identifier Type that you select may change which fields are required.

  1. Enter the required information based on your previous selection.

  2. Select the Next button.

The System displays the Provider Address Detail page.

  1. Select the Address button.

The System displays the Address details page.

  1. Enter the appropriate address in the Address Line 1 field.

  2. Enter the appropriate Zip Code.

  3. Select the Validate Address button.

The System auto-populates the remaining fields with the appropriate information.

  1. 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.

  1. Enter a Phone Number. (Required)

  2. 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.

  1. Select the OK button.

The System displays the Enroll Provider -Billing Agent/Clearinghouse/Submitter page.

Related Topics

New Enrollment

Add Identifiers

Add EDI Submission Method

Add EDI Contact Information

View/Upload Attachments

Submit Enrollment Application for Review