Serving Physician and Chiropractic Offices
Payor Enrollment Forms
To initiate the EDI enrollment process, please fill out the Provider Profile and fax to 888-202-2140.
Note: To avoid processing delays and additional administration charges, you must include your Medicare enrollment letter and the 1st page of a Medicare EOB.
PHI Business Associate Agreement
Print Business Associate Agreement, sign and fax our copy to 888-202-2140.
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