GHI Medicare is making many of its forms available electronically to expedite the process of obtaining critical forms. Hard copies of these forms are still available by contacting GHI Medicare customer service.

Please mail all enrollment and Electronic Data Interchange (EDI) forms to:

GHI Medicare
25 Broadway, 13 FL
New York, NY 10004-1010
Attn: Provider Enrollment

Electronic Data Interchange

• Request for Biller ID
• Biller ID Agreement
• EDI Enrollment Application
• Request for Electronic Remittance
• Request for Electronic Funds Transfer

• Inquiry/Review Request Form

Provider Enrollment

• CMS 855
• Participation Agreement

Voluntary Refunds

• Voluntary Refund Form