EAC  SUBMISSIONS
EAC  SUBMISSIONS
Your solution for electronic ambulance claim submissions

 

Home
Clearinghouse Basics
EAC Submissions Fees
EAC Submissions Enrollment

 

 

EAC Submissions Enrollment

To enroll, please print and complete the enrollment form.

Please indicate the business name that will properly identify you with the insurance carriers.  We need your NPI number and Federal Tax ID # as a minimum.  If you have any other carrier's provider numbers (legacy numbers) please indicated them as well.

Please fax the form to EAC Submissions at 815-385-4022.  You will be contacted within 3 business days with information regarding the status of your enrollment.