Completing Enrollment Form(s)

Select a row from the Search Enrollment Forms List.

note: In some cases, a single row may display multiple payer names. This occurs when payers share the same enrollment form, requiring it to only be completed once for all payers. Any edit made to this form affects all payers.
Once the Enrollment Form launches, review the instructions at the top of the form.
note: If multiple payers share the same form, Multiple Payers displays in the upper right corner above the form. Clicking on it displays the payers' names and information.
Data on the form is prepopulated if the Prepopulate data check box is checked for the selected account.
Complete the Enrollment Form by filling in all pertinent information. Hovering over a field with the ToolTip shows the value or instructions.

note: The Client Code, Payer ID, and Payer Name fields are display only and can not be edited.
Select Save as Draft if you want the form to be saved in draft status.
Select Finalize after filling in the Enrollment Form.

note: Missing required fields and incorrect data are checked and are highlighted for correction.
Once the form passes field validation, a pop-up message appears confirming that the form was successfully finalized, the number of forms finalized, the number of forms remaining to be completed, and options to Download, Print, Continue, Skip All, Email, or Close.
- Select Print to print the Enrollment Form.
- Select Download to download the Enrollment Form.
- Select Continue to continue filling out the next Enrollment Form.
- Select Skip All to skip filling out subsequent Enrollment Forms.
- Select Email to e-mail the Enrollment Form. The Enrollment Form is e-mailed to the logged-in user's e-mail ID.
- Select Close to exit out of the screen without performing any further actions.