The following EDI Enrollment Forms can be used to set your practice up for electronic claims submission. Please check that all signature pages are signed and that each form is completely filled out before submission. If you have any questions or concerns please contact the Help Desk.
If you are a new user to the ConnxtMD application or need to change your access privileges, please review the TeamPraxis Physician Practice Management & End User Confidentiality Agreement. Then print and complete the System Access Form and fax it to the attention of the TeamPraxis Help Desk at (808) 949-0483. Please confirm you have selected all of the privileges you will need on the System Access Form and that it has been signed by both you and your office’s physician. Please allow 48 hours for the changes to take effect.
TeamPraxis System Access Form.
TeamPraxis Physician Practice Management & End User Confidentiality Agreement, released on 2/9/12.
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