First Name *
Last Name *
Email *
Phone *
Office Name *
Address *
Address 2
City *
State * AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA VI WA WV WI WY
Zip *
Group NPI *
TIN *
Monthly Claim Volume *
Vendor/Practice Management System *
Are you able to send batch claim files? * Yes No
Comments
If you are an atypical provider and don’t have an NPI, please contact TTPS Support at TTPSsupport@Cognizant.com.