EDI Claims Enrollment Form
IDENTIFICATION OF PROVIDER/TRADING PARTNER AND TRANSACTION INFORMATION
All Trading Partners, whether covered entities or business associates of covered entities, agree to abide by all HIPAA Privacy and Security requirements as they apply to communications with The Alliance.
Reminder: Prior to setting up Electronic Data Interchange (EDI) claims submission with the Alliance, a minimum of one paper claim must have been submitted to the Alliance so that a record for the office can be configured.
Note: please use Microsoft Edge or Google Chrome browsers when submitting requests
Contact Provider Services
Billing questions, claims status, general claims information
General authorization information or questions
Checking the status of submitted authorizations
Authorizations, general pharmacy information or questions