Electronic Remit Request
Please complete the form below for ERA requests.
Please note: Any missing or incorrect information could delay processing of your request. A claims enrollment team member will contact you regarding any additional information required to process your request.
Once the ERA form has been submitted or the online enrollment completed, ERA requests have an average 2-4 week processing time, depending on payer requirements and response time.
To ensure enrollment information is sent for the correct payer, please include the payer ID.