EDI E-MAIL INQUIRY FORM

EDI E-MAIL INQUIRY FORM

Please tell us about your inquiry

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Inquiry Information


Inquiry Information

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IMPORTANT NOTE:

Response time for email inquiries is within ten (10) business days of receipt.

Please do not resubmit your inquiry unless it has been more than ten business days.

IMPORTANT NOTE:

Response time for email inquiries is within ten (10) business days of receipt.

Please do not resubmit your inquiry unless it has been more than ten business days.

Reason for Inquiry NOTE: Response time for email inquiries is within ten business days of receipt null
Please provide a detailed description of issue

Provider Information


Provider Information

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Fax Number

Once you submit your completed form, you should receive an automated acknowledgement stating your email inquiry has been received by EDI.

Please make sure you include file names, dates, and a description of the problem to avoid a delay in response time.

Please do not complete this email inquiry form if an EDI Help Desk ticket number has been assigned to your inquiry through a telephone contact. This will duplicate the efforts of our EDI staff and may cause our response time to be longer than stated above.

Once you submit your completed form, you should receive an automated acknowledgement stating your email inquiry has been received by EDI.

Please make sure you include file names, dates, and a description of the problem to avoid a delay in response time.

Please do not complete this email inquiry form if an EDI Help Desk ticket number has been assigned to your inquiry through a telephone contact. This will duplicate the efforts of our EDI staff and may cause our response time to be longer than stated above.