Forms
Use this form to:
Receive the HIPAA compliant electronic remittance (835 transaction). This format is designed for auto-posting through a practice management software or for sites using software to translate the electronic file into a readable format.
Use this form to:
- Apply for a new trading partner number to begin submitting claims directly to ASK.
Application for New Trading Partner Number and Claim (837) Enrollment
NOTE: Providers who will be sending claims through a clearinghouse should check with the enrollment department of their clearinghouse.
The following options are available to add additional contact names, or to change the contact person: Please include the Trading Partner number on the request.
Email – Email address must contain the organization name.
- Email to [email protected]
This Change of Information Form is only used for a change in Trading Partner information (ie: address, contact, email) and Vendor changes. This form is no longer used to add additional NPI numbers or 837 and 27X Transactions.
Secure Question Submission Form
If you have questions, please contact us.