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Forms Information about PDF Files

Change of Information Forms

Use this form to:

  • Add or Remove a Billing Provider NPI for Professional, Institutional or Dental claims or Eligibility and Claim Status requests.
  • Notify ASK of changes in software support vendors
  • Add a new transaction
  • Updates to Trading Partner information (see below for contact person updates)

Web-based change of information form

Electronic Remittance (ERA) Form

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.

New Trading Partner Enrollment Form

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.

Contact Person Updates

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.

Fax – Request must be made on company letterhead & signed by current contact or office manager.

Email – Email address must contain the organization name.

Secure Question Submission Form

If you have questions, please contact us.


  • New Trading Partner Enrollment Form (Claims)- For a Provider office, Clinic or Hospital to apply for a new trading partner number and begin submitting claims (837) electronically to ASK.

To request status of an ERA Enrollment, send an email to

Change of Information
For existing electronic submitters (trading partners) who are changing software support vendors, formats or transactions, adding or removing NPI, or changing trading partner information other than contact name.

NOTE:  Change in Contact name – If it is necessary to add or change contact information the following options are available for reporting this to ASK.  You must include your trading partner number on these requests.

    • New contact information may be emailed to, if the email address contains the name of the organization.
    • New contact information may be faxed to ASK on company letterhead.  Faxes may be sent to 785-290-0720.

Secure Question Submission Form

* If you have questions, please contact us.

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