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RelayHealth Billing service sales order and contract form.
Medicare EDI Enrollment Forms
Electronic Data Interchange Enrollment form for Medicare. Must be completed in order to file medicare claims electronically. Instructions for completing this form can be found at the CahabaGBA website
Alabama BCBS EDI Sign-On Request for New (To FlexMedical) Submitters
Electronic Data Interchange request for client sign-on for BCBS AL.
Alabama BCBS EDI Sign-On Request for Existing FlexMedical Submitters
Alabama BCBS EDI Enrollment Request for 835 Remittance File
EDI enrollment form to receive electronic remittances through FlexMedical.
Georgia BCBS EDI Trading Partner Agreement
Electronic Data Interchange Agreement for Georgia Blue Cross.
Georgia BCBS EDI Trading Partner Enrollment Form
Electronic Data Interchange Enrollment Form for Georgia Blue Cross.
Georgia BCBS EFT Enrollment Form
Electronic Funds Transfer Enrollment Form for Georgia Blue Cross. Note: This can only be filled out after sending in the EDI trading partner agreement and enrollment form and receiving approval from BC of GA on these two forms.
Mississippi BCBS Agreement & Enrollment Forms
Agreements and Enrollment forms for BCBS Mississippi.
Tennessee BCBS EDI Form
Electronic Provider Profile form for Blue Cross Tennessee.
OCERIS Remote Access Authorization Form
Authorization form for clients when providing OCERIS with remote access to one of the computers at their office.
OCERIS Credit Card Authorization Form
Authorization form for clients when purchasing direct from OCERIS with a credit card, or when OCERIS orders products on behalf of a client using the client's credit card.
FlexMedical End User License Agreement.
OCERIS Software Support Agreement.
Electronic Statements Sign-On Agreement
Sign-on agreement for utilizing OCERIS electronic statement service.
Employee Authorization Form
Form for detailing the name(s) of one or more people at the client site that will be capable of authorizing any charges outside the scope of normal monthly software support.
Patient Portal Agreement
Sign-on agreement for the FlexMedical Patient Portal.
HIPAA-Related Code Lists
View HIPAA-Related Code Lists at the Washington Publishing Company. Of particular interest is the link entitled "Claim Adjustment Reason Codes".
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