Forms
To understand how to begin submitting claims electronically please visit our Getting Started page. For assistance in determining which forms are needed, check out our EDISS Interactive Registration Tool.
Paperwork Timeframes
EDISS takes pride in completing paperwork requests as soon as possible. Once we have received the paperwork please allow 10-14 business days for completion. Upon completion, a fax is distributed to the Trading Partner and/or the Provider.
Note: Please submit complete and current forms. Forms with insufficient information and/or outdated forms cannot be processed.
Registration
Termination/Change
- Provider Transaction Termination Form - Interactive Form*
- Employer Group Electronic Termination/Change Form
Blanket Approval/Vendor Forms
*Interactive Form Information
The interactive forms on the EDISS site require Adobe Acrobat Reader 6.0 or higher. The Get Adobe Acrobat link below provides a link to the most recent version of Adobe Acrobat Reader which is compatible with all EDISS interactive forms.
Interactive Form Tips:
- Content entered within this form can only be printed; the content entered can not be saved. The interactive form allows ease in completion by the provider as well as clarity when received at EDISS.
- Select the "Highlight fields" and/or "Highlight required fields" box to view editable fields and assure the form is completed in its entirety.
Once the form is completed select Print Form and it will validate fields that are required. Then sign the form and send into EDISS.
Some of the documents located on this page are in PDF format and can be opened in Adobe Acrobat Reader. If you do not already have this application, follow the Get Adobe Acrobat link to download a free copy of the software.