Form 2678 Request for Electronic Remittance Advice - New Hampshire

Form 2678 Request for Electronic Remittance Advice - New Hampshire

What Is Form 2678?

This is a legal form that was released by the New Hampshire Department of Health and Human Services - a government authority operating within New Hampshire. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 2678?
A: Form 2678 is the Request for Electronic Remittance Advice.

Q: What is Electronic Remittance Advice (ERA)?
A: Electronic Remittance Advice (ERA) is an electronic version of a paper Explanation of Benefits (EOB) or Remittance Advice (RA).

Q: Who should use Form 2678?
A: Form 2678 should be used by healthcare providers or other entities who want to receive their Remittance Advice electronically.

Q: Is Form 2678 specific to New Hampshire?
A: No, Form 2678 is a federal form and is not specific to any particular state.

Q: Is there a fee to submit Form 2678?
A: No, there is no fee to submit Form 2678.

Q: Can I submit Form 2678 electronically?
A: Yes, you can submit Form 2678 electronically.

Q: What is the purpose of submitting Form 2678?
A: The purpose of submitting Form 2678 is to request electronic delivery of Remittance Advices.

Q: Are there any specific requirements for submitting Form 2678?
A: Yes, there are specific requirements regarding software, connectivity, and testing that must be met.

Q: Can I opt out of receiving electronic Remittance Advices?
A: Yes, you can opt out of receiving electronic Remittance Advices by submitting a written request.

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Form Details:

  • Released on February 1, 2017;
  • The latest edition provided by the New Hampshire Department of Health and Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form 2678 by clicking the link below or browse more documents and templates provided by the New Hampshire Department of Health and Human Services.

Download Form 2678 Request for Electronic Remittance Advice - New Hampshire

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