Dental Provider Newsletter
March 2021
Are you adding or changing a TIN? Here's what you need to know.
We are committed to processing your claims as quickly and accurately as possible. In order to do that, EMI Health should be notified as soon as possible of upcoming Tax Identification Number (TIN) additions or changes, so we can update our system prior to the change.
Three easy steps
1. Notify your provider relations representative, who will email you the proper form.
2. Fill out the form in its entirety. All fields must be complete in order to process the request.
- Let us know the date on which you will begin practicing under the the new TIN. The effective date with EMI Health will be the first day of the month following approval of your request.
3. Include the following documents with your form:
- Signed Participating Provider Agreement for the new TIN/EIN. EMI Health requires an Agreement for each TIN. The Agreement must be endorsed with an original authorized signature. This may be an inked signature or a certified electronic signature. Stamps or typed names are not acceptable.
- IRS Form CP 575 or 147C letter.
- Certificate of Insurance (COI).
We appreciate the service you provide to our members and strive to provide the same top-notch service to you. Thank you for your help making that possible with timely updates regarding changes at your practice. If you have contracting questions, please contact your provider relations representative.