Power of Attorney for Electronic Remittance Advice

Power of Attorney for Electronic Remittance Advice - (Forms/Publications)
Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Power of Attorney for Electronic Remittance Advice (A fillable form - 95 KB PDF)
Description Providers complete this form to authorize a clearinghouse or third party to receive the EDI 835 Electronic Remittance Advice file from L&I's Provider Express Billing (PEB).
Detail
Form number F248-355-000
Availability
Online only. See document above to download.
Keywords attorney, billing, bills, electronic billing, power of attorney, provider
Languages English
Valid dates 04-2007
Contact information Fee Schedules

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.