SOFTWARE PRODUCT RELEASE DATE Sample Clauses

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  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

SOFTWARE PRODUCT RELEASE DATE. Please enter the release date of the software product you are installing for NCPDP D.0/1.2. Via U.S. Mail Other Carriers  POS  BATCH  E-RA  SIGN  ADD  TERM

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 2 above. Via U.S. Mail Other Carriers DOCTYPE Submitter ID Submitter & Provider Name 🞏 837-I-D-P All services will be furnished in full compliance with the non-discrimination requirements of Title VI of the Federal Civil Rights Act, Section 504 of the Rehabilitation Act of 1973 and the Standards of Privacy of Individual Identifiable Health Information, the Electronic Transactions Standards and the Security Standards under the Health Insurance Portability and Accountability Act of 1996 as enacted, promulgated and amended from time to time. I understand that payment and satisfaction of all claims will be from Federal and State funds and that any false claims, statements, or documents, or concealment of a material fact, may be prosecuted under applicable Federal or State laws, or both. 1) Submitter Name: 2) Submitter Street Address: (P.O. Boxes not accepted. Agreement will be rejected and returned if P.O. Box is listed. This must be the physical street address of the submitter.) 3) City, State, Zip Code: 4) XXX Contact Person: 5) Phone/Ext:( ) /