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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.
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;
- Fill out the form in our online filing application.
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.
