• Security Packet A Real-Time (PC-to-Host, CPU-to-CPU)
• Security Packet B Batch (FTP, Electronic Gateway(BBS))

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• Certified Asthma Educator Enrollment Questionnaire
• Certified Diabetes Educator Enrollment Questionnaire
• Change of Category and / or Address Form
• Collaborating Physician Certification
• CLIA Information
• DEA Update Form
• Employment Certification for Certified Asthma Educator
• Employment Certification for Certified Diabetes Educator
• Fee for Service Address Change

• Laboratory Director’s Agreement
• Medicare Info Update Form
• Office Based Surgery
• Personal Identification Number (Pharmacy ONLY)
• Prescription Footwear Form
• Prior Conduct Questionnaire
• Provider Participation in a Group
• Specialty Certification
• Supervising Pharmacist Agreement
• Supervising Physician Certification
• Tax Update Form

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• Clinic Certification of Staff Certified as Asthma Educators
• Clinic Certification of Staff Certified as Diabetes Educators
• Out-of-State Hospital Enrollment Package Request Form

• Pharmacy Personal Identification Number
• Rate Based Change of Address Form
• Request to Enroll New NPI Form

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• Default Electronic Transmitter Identification Number (ETIN) Selection Form
• EFT-PDF Paper Remittance Request Form
• Electronic Funds Transfer (EFT) Enrollment Form
• Electronic Prior Approval Request Form
• Electronic Remittance Request Form
• Paper Remittance Sort Request Form
• Pended Claim Recycle Request Form

• Provider Electronic/Paper Transmitter Identification Number (ETIN)
• Provider ID Request Form (Fee for Service Only)
• Request For Provider Reports
• Request to Disaffiliate/Delete an ETIN
• Service Bureau Electronic/Paper Transmitter Identification Number (ETIN)
• Trading Partner Agreement