The following Payer and Hcrnet Forms are available in Adobe Acrobat Portable Document Format (PDF)

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Payer Forms
The Payer Forms contain Medicaid 2004 Service center Authorization, Medicare 837p, Professional Claim, Medicare Termination change, RailRoad medicare enrollment and TriWest provider Agreement.
Medicaid 2004 Service Center Authorization	October 25, 2004
Medicare 837p, Professional Claim	May 03, 2005
Medicare EDI Enrollment form	December 16, 2004
Medicare Termination Change	March 24, 2005
RailRoad Medicare Enrollement	October 25, 2004
TriWest Provider Agreement	October 25, 2004
HCRnet Forms
Hcrnet Forms include Business Associate contract, Enrollment and submitter agreement.
Business Associate Contract	October 28, 2005
Enrollment Part One	March 15, 2004
Enrollment Part Two	March 15, 2004
Enrollment Part Three	March 15, 2004
Submitter Agreement	October 28, 2005
General Information
The General information contains information about the benefits of elecronic billing, sales letter and reference lists.
Benefits of Electronic Billing	October 25, 2004
Sales Letter	October 25, 2004
Reference Lists	October 25, 2004

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