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New CMS / EDI / HIPAA Documents

The following files are in Portable Document Format (PDF) and require the Acrobat Reader. If you do not have the Acrobat Reader, you can download a free copy from the Adobe web site. 

Unless otherwise directed below (or in a mailbox broadcast), print the applicable forms, fill them out and mail them to:
ET&T ClearingHouse
  Attn: Enrollment Supervisor
PO Box 14150
Mesa, AZ 85216-4150



Noridian [Fargo,ND]: Medicare (OR,WA,AK,AZ,NV,HI,IA,CO,ND,SD,WY)
BCBS (ND,WY) ... MEDICAID (ND)

 
Noridian's 837P Claim Registration - Form that will register your providers for ANSI production claims. You may be assigned a new submitter# by Noridian
 
Noridian's new CMS agreement - Form that supersedes your prior HCFA agreements with Noridian.



Champus TRICARE (prior to 07/01/2004 or if NOT in the new "West" Region)
New REQUIRED agreement - Form that supersedes your prior agreement(s) with Tricare.
Please list ET&T as the Vendor on page 3.




Champus "West" Region to be handled by WPS after 07/01/2004
NEW REQUIRED agreement - Form that will link your offices with WPS through ET&T.



ANSI ReportCode Listings
you may right click and Save Target As to your computer.
 .doc  Useful document - Full documentation of "Claim Status" codes.
 .doc  Useful document - Full documentation of "Claim Adjustment Reason" codes.
 .doc  Useful document - Full documentation of "Remittance Advice Remark" codes.
 .doc  Useful document - Full documentation of "Healthcare Decision" reason codes.

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ET&T
4838 E. Baseline Rd #118
Mesa, AZ 85206


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ET&T
P.O. Box 14150
Mesa, AZ 85216-4150

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