Power of Attorney for Electronic Remittance Advice
 

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Title Power of Attorney for Electronic Remittance Advice (A fillable form - 95 KB PDF)
Description Providers complete this form to authorize a clearinghouse or third party to receive the EDI 835 Electronic Remittance Advice file from L&I's Provider Express Billing (PEB).
Detail
Form number F248-355-000
Availability Online only
Keywords attorney, billing, bills, electronic billing, power of attorney, provider
Languages English
Valid dates 04-2007
Contact information Fee Schedules

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