- Entry Process Questions
- General Information
- Choose Transaction Status
- Submitting the Packet
- EDI Enrollment Agreement Form
- EDI ERA Enrollment Form
- EDI Registration Form
- Part A Logon Request Form: Provider/Facility Requesting Access
- Provider Letter of Authorization
- Part A Logon Request Form: Billing Service Using a Letter of Authorization PIN
- Tracking my Enrollment Packet and Checking Status
- EDI Gateway Self-Service Password Portal
Provider Letter of Authorization
This form is completed by the provider/facility that is authorizing access to a third party billing service to perform FISS/DDE functions on their behalf.
- What is the Billing Service Name?
This is the official name of the billing service that you have contracted with to perform DDE functions on your behalf.