Submitter Information. For the claims for which you will CHARITY CARE check boxes located at the top of the form, indicate the type of be submitting electronic claims. Check one box only. A separate New Jersey Medicaid HIPAA EDI Agreement is required for each provider number you will be electronically submitting claims for unless the provider is a group practice and the group is responsible for the billing of the individual providers associated with the provider group.
Appears in 4 contracts
Samples: Submitter/Provider Relationship Edi Agreement, Electronic Remittance Advice (Era) Edi Agreement, Pre Enrollment Instructions, Pre Enrollment Instructions
