What is This Form?

This provider information form is used to capture key information about your provider account with your payer (HFS). This information allows us to send your claims electronically with the correct billing and coding information to avoid rejected claims.

When to Use This?

Use this form after your initial sign-up to Vylet, or when something changes in your provider account with your payor such as:

  • Rates
  • Provider Name or Number
  • Provider Address
  • FEIN Number or Tax ID
  • Tax Status (LLC, Corp. etc)
  • and any other billing related info

  • Provider Information
    ...an important part of your electronic billing process.
    Learn More