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UPMC Electronic Remittance(835) Direct Provider Request Form

*required fields

  • DEG1 Provider Information
  • DEG2 Provider Identifiers Information
  • DEG3 Provider Contact Information
  • DEG 8 Electronic Remittance Advice Information.
  • DEG 10 Submission Information.

Submitting this electronic remittance request does not automatically stop your paper EOPs from being sent to you via US mail. We strongly encourage paper-free processes, so please email when you are ready to stop receiving paper remittances. Due to UPMC's paper-free initiatives, we may additionally follow-up with you regarding turning paper off.

*You may also receive your remittance through a clearinghouse or vendor. To do so, please contact your clearinghouse or vendor and ask them to submit on 835 remittance request to UPMC on your behalf.

ex.(4124545112) x ex.(9021)

DEG 7 Electronic remittance advice information

seal reading Certified CORE Phase III Health Plan, a CAQH initiative