ems billing procedures, ambulance insurance claims billing, emergency medical codes

Authorization Agreement For Electronic Funds Transfers

- PDF file (428 kb)

Business Associate Confidentiality Agreement
(Addendum C)

- PDF file (52 kb)

Electronic Data Interchange (EDI) Enrollment Form

- PDF file (24 kb)

Texas Ems/Trauma Registry System Entity Application Packet

- PDF file (860 kb)
NOTE: You will also need to download these two Microsoft Word files. Fill them out in Word, then insert them in the printouts from the rest of the packet.
1_3 Entity Form | 1_4 Entity Form

Medicare: Federal Health Care Provider/Supplier Enrollment Application

- PDF file (1.4 mb)

W-9: Request for Taxpayer Identification Number and Certification

- PDF file (52 kb)

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