Electronic Eligibility Verification Payer Connection Request Form

Use this form to select the insurance carriers to whom you would like to send electronic eligibility verfication requests. Our Electronic Data Interchange (EDI) team will be automatically notified to begin setup.

Your Name: *

Practice Name: *

PCC Acronym: *

Your Phone Number: *

Your E-mail Address:

Payer List

PCC offers two types of eligibility processing, Batch and Real-Time. For Batch processing, Partner automatically submits patient eligibility verification requests to payors en masse and the grouped payor responses arrive later. Using Real-Time means, you can submit a single patient eligibility verification request to a payor and the single payor response arrives immediately. When you choose a participating payer that can do both types of transactions, PCC configure both options for you.

Non-Participating Payers:

None! Currently, all eligibility payers are Participating.

Submitting eligibility requests to non-participating payers costs 20 cents per transaction. PCC will invoice your office monthly for non-participating eligiblity verification transactions.

Additional Comments:

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Math Question: * 19 + 0 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

Printer-friendly version

Electronic Eligibility Verification Payer Connection Request Form

Login/Logout