keyboard with SUBMIT button


    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.

    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.

    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.

    Email – Email address must contain the organization name.

    This Change of Information Form is only used for a change in Trading Partner information (ie: address, contact, email) and Vendor changes. This form is no longer used to add additional NPI numbers or 837 and 27X Transactions.

    Web-based change of information form

    Secure Question Submission Form

    If you have questions, please contact us.