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How do I fill this out?
To fill out this form correctly, start by gathering your provider information and identifiers. Next, complete each section carefully, providing accurate details. Finally, review the form before submission to ensure all information is correct.
How to fill out the Healthfirst ERA Enrollment Instructions?
1
Gather all necessary provider information and identifiers.
2
Complete the Emdeon ERA Enrollment Form and Healthfirst EFT Authorization Form.
3
Double-check for missing or incorrect information.
4
Submit the forms via the indicated methods.
5
Contact support for any clarification or assistance needed.
Who needs the Healthfirst ERA Enrollment Instructions?
1
Healthcare providers who bill Healthfirst need this form to receive electronic payments.
2
Billing specialists must complete this form to set up ERA for their practice.
3
Administrative staff at healthcare offices need this to ensure timely payment processing.
4
Providers transitioning to electronic payments must submit this to initiate the ERA process.
5
New Healthfirst providers require this form to enroll for ERA and EFT services.
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What are the instructions for submitting this form?
Completed forms must be submitted via email to Support@officeally.com for the Emdeon ERA Enrollment Form, or mailed to Provider Operations and Reimbursement, P.O. Box 5168, New York, NY 10274-5168. For the Healthfirst EFT Authorization Form, use HFEFTERA@Healthfirst.org or fax to 1-646-313-4635. Make sure to include correct subject lines and details to avoid delays.
What are the important dates for this form in 2024 and 2025?
For 2024 and 2025, important dates include submission deadlines for the forms and processing timelines which can vary by payer. Ensure to keep track of any updates directly from Healthfirst. Generally, expect processing to take between 14 and 45 days.
What is the purpose of this form?
The purpose of this form is to facilitate the enrollment of healthcare providers for receiving electronic remittance advice from Healthfirst. It allows providers to transition from paper-based payments to electronic methods, promoting efficiency in payment processing. Additionally, successful completion of the form ensures compliance with Healthfirst’s payment protocols.
Tell me about this form and its components and fields line-by-line.
- 1. Provider Name: The official name of the healthcare provider.
- 2. Provider Address: The physical location of the healthcare provider.
- 3. TIN/EIN: Tax identification number or employer identification number.
- 4. NPI: National Provider Identifier, required for enrollment.
- 5. Contact Information: Phone number and email address for provider contact.
- 6. Financial Institution Information: Details about the bank account for electronic fund transfers.
- 7. Authorized Signature: Signature or typed name of the individual submitting the form.
What happens if I fail to submit this form?
If you fail to submit this form, you will not be able to receive electronic remittance advice from Healthfirst. This can lead to delays in payment processing and potential cash flow issues. It is crucial to complete and submit the form to ensure timely payments.
- Payment Delays: Missing enrollment can cause significant delays in receiving payments.
- Compliance Issues: Not submitting may result in non-compliance with billing regulations.
- Increased Administrative Work: Incorrect submissions can increase manual billing efforts.
How do I know when to use this form?
- 1. New Provider Enrollment: When a new provider begins to offer services to Healthfirst patients.
- 2. Transitioning to Electronic Payments: If an established provider is switching from paper checks to electronic payments.
- 3. Updating Provider Information: When there are changes to the provider's information that affect payment.
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