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Electronic Enrollment Form

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Electronic Transaction Enrollment Process

Deseret Mutual’s clearinghouse is Utah Health Information Network (UHIN). UHIN assigns Trading Partner

Numbers (TPN) to groups or individuals for identification purposes.

Deseret Mutual will enroll a group or individual provider under the TPN assigned to them by UHIN for

electronic transactions. Enrolling the group or individual provider under the TPN ensures all electronic

transactions through UHIN are received by Deseret Mutual.

If Deseret Mutual does not have a TPN on file, the group or individual provider wanting to submit electronic

transactions, must go through submission testing to pass HIPAA edits.

Deseret Mutual’s TPN is HT000006-001

Electronic Billing Enrollment Form Instructions

To send HIPAA transactions to Deseret Mutual electronically, please complete the Electronic Billing

Enrollment Form and return it to Deseret Mutual by Email, Postal Mail, or Fax.

All enrollment forms must have a TPN listed for a Group, Individual Provider, or Clearinghouse. If



UHIN is not the clearinghouse you use for electronic transactions, please contact your

clearinghouse and ask them for their TPN. Your clearinghouse may ask for Deseret Mutual’s TPN

for verification.

Only one enrollment form per Tax Identification Number (TIN) can be submitted.



All group and individual National Provider Identifier (NPI) numbers must be included for enrollment



purposes. Any claims submitted without NPI numbers will be rejected. Your only notice of rejection

will be a returned 277CA.

Electronic Remittance Advice / 835

When you sign up to receive 835 transmissions (Electronic Remittance Advice), you will also receive a

paper Explanation of Payment (EOP). To send 835 transmissions, we need to have the group or individual

TIN. Please note: An 835 transmission will not be sent for paper or manually entered claims, however, a

paper EOP will be generated and mailed.

Contact Information

If you have any questions about EDI enrollment, please contact Deseret Mutual

or by calling our Provider Maintenance Team at 1-800-777-3622 press Options

1, 3, and then 4.

If you would like to contact UHIN

you may visit their Web site at

, or call the Help Desk at

801-466-7705.

Electronic Enrollment Form

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