Edi Enrollment Agreement

December 7, 2020 by eklose

Use the supplier`s next electronic extra table if you submit on behalf of more than 25 suppliers. Please call the Montana Medicaid Provider Relation Unit at 1.800.987.6719 to receive instructions to submit this table with your registration forms. . If you are a new electronic depositor in the State of Montana, an Electronic Billing Agreement (EBA) form may be required before sending electronic transactions. EDI Submitter Enrollment Packet for X12N Transactions Please contact Montana Medicaid Provider Unit for more information on the electronic billing agreement and proxy forms at .800.624.3958 (In-State) or 406.442.1837 (Helena or Out-of-State)..



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