In order to submit your claims electronically to payors, you must be enrolled with each payor to do so. This process can take 6-8 weeks to complete and once that phase is done, there is almost always a testing phase that needs to take place. During the testing phase, claims will be submitted to the payor in hopes of resolving any issues that may occur. Once testing is done, you will be approved by the payor and set to an Active status.
Because this process is time consuming, it is important that you get a jump on this process quickly. Delaying the process or not starting at all may cause any training you might have with JB Medical to be postponed. By completing this form now, it will allow us to take the first step in your electroncic enrollment process.
* required fields
* Practice or Company Name:
* Specialty:
* Address:
* City: * State: * Zip:
* Phone: Fax:
* Email:
Do you currently own Medisoft Yes No
Do you wish to send your claims direct to the payor or through a clearinghouse? Direct to Payor Clearinghouse
If clearinghouse, which clearinghouse will you be using?
If sending direct to payor, have you purchased Direct Claim Modules for Medisoft? Yes No
If Yes, which module will you be using?
Are you currrently enrolled to submit electonically to your payors? Yes No
If not currently enrolled, have you submitted your enrollment paperwork to the payors? Yes No
How many Providers / Doctors are in your practice?
On average, how many claims do you submit monthly?
How did you hear about us? Please Select Google Yahoo Magazine Tradeshow Referral Website Link Other
Additional comments related to submitting electronically: (Insurances you will be submitting to, etc.)