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HIPAA-AS For Providers

Use this section to find information for health care practitioners and facilities:

    
Format 835: Electronic Remittance Advice  Format 837: Health Care Claims
    
  

Quick Links

Authorization to Use or Disclose Protected Health Information
»   Individual Authorization - Iowa - #S-53258 (206KB)
»   Individual Authorization - South Dakota - #S-3315 (207KB)
»   Designation of Authorized Representative - Iowa
- #S-53257 (159KB)
»   Designation of Authorized Representative - South Dakota - #S-3316 (161KB)
Authorized Representative Appointment and Authorization for Release of Information
»   Iowa - #C-5674 (41KB)
»   South Dakota - #C-3617 (37KB)

See Also

»   Electronic Transaction & HIPAA Guides
»   Electronic Transaction Registration Packet
- #S-53260 (563KB)
»   Submitting Electronic Claims
»   Testing Toolkit (199KB)
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Wellmark Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association doing business in Iowa and South Dakota.
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