Ladies First/EDS Provider Enrollment Forms
If you need screening cards
Please call our Provider Support Line at 1-800-510-2282.
- Ladies First Enrollment Form
- Authorization for Electronic Funds Transfer
- EDI Registration
- Electronic Data Interchange Trading Partner Agreement
- Breast and Cervical Cancer Screening Card
- Cardiovascular Disease Risk Factor Screening Card
Billing for covered services is simple if you follow these basic guidelines
- Remember Electronic Data Systems (EDS) should not be billed until a Screening Report Form has been submitted for the patient.
- Be certain that you are billing for services that are covered by the program. (See the current Annual Schedule of Fees for Covered Services.)
- Keep in mind reimbursement for covered services is at the Medicare Part B rate.
- Note that Ladies First is the payer of last resort, that is, the program pays for net charges after all third-party payments have been received.