SOFTWARE PRODUCT RELEASE DATE. Please enter the release date of the software product you are installing for submission of the HIPAA transaction sets indicated in Section 3 above. Via U.S. Mail Other Carriers Page 5 of 5 Submitter/Provider EDI Agreement DOCTYPE Submitter ID Submitter & Provider Name ο― 837-I-D-P SECTION 1: SUBMITTER INFORMATION A separate agreement is required for each New Jersey Medicaid Billing Provider Number. 1) Submitter Name: Office Ally 2) Submitter ID: 9904204
Appears in 2 contracts
Sources: Pre Enrollment Instructions, Submitter/Provider Relationship Edi Agreement, Electronic Remittance Advice (Era) Edi Agreement
SOFTWARE PRODUCT RELEASE DATE. Please enter the release date of the software product you are installing for submission of the HIPAA transaction sets indicated in Section 3 above. Return the completed EDI Agreement to Gainwell Technologies at the following address: Via U.S. Mail Other Carriers Page 5 of 5 Submitter/Provider EDI Agreement DOCTYPE Submitter ID Submitter & Provider Name ο― π 837-I-D-P
SECTION 1: SUBMITTER INFORMATION A separate agreement is required for each New Jersey Medicaid Billing Provider Number.
1) Submitter Name: Office Ally 2) Submitter ID: 9904204
Appears in 1 contract
Sources: Pre Enrollment Instructions
SOFTWARE PRODUCT RELEASE DATE. Please enter the release date of the software product you are installing for submission of the HIPAA transaction sets indicated in Section 3 above. Return the completed EDI Agreement to Gainwell Technologies at the following address: Via U.S. Mail Other Carriers Page 5 of 5 Submitter/Provider EDI Agreement DOCTYPE Submitter ID Submitter & Provider Name ο― π 837-I-D-P
SECTION 1: SUBMITTER INFORMATION A separate agreement is required for each New Jersey Medicaid Billing Provider Number.
1) Submitter Name: Office Ally 2) Submitter ID: 9904204:
Appears in 1 contract
Sources: Edi Agreement