TriClip™ Patient Access Program

New Office Enrollment Form

 

Provider Enrollment - TriClip

Portal User Information

User Contact Name
User Contact Name
First
Last

Practice/Physician Office Information

Practice Address
Practice Address
City
State
ZIP Code

Physician Information

Facility/Hospital Information

Facility Address
Facility Address
City
State
ZIP Code

Onboarding Call Availability

Please select your timezone:
Time EST (Option 1)
Time EST (Option 2)
Time CST (Option 1)
Time CST (Option 2)
Time MST (Option 1)
Time MST (Option 2)
Time PST (Option 1)
Time PST (Option 2)

PROGRAM SUPPORT:

MONDAY–FRIDAY 8:30AM–5:00PM EST
PHONE: 860-999-9133  FAX: 860-497-7099
EMAIL: triclip@priahealthcare.com

 

Disclaimer:

This material and the information contained herein is for general information purposes only and is not intended, and does not constitute, legal, reimbursement, business, clinical, or other advice. Furthermore, it is not intended to and does not constitute a representation or guarantee of reimbursement, payment, or charge, or that reimbursement or other payment will be received. It is not intended to increase or maximize payment by any payer. Abbott makes no express or implied warranty or guarantee that the list of codes and narratives in this document is complete or error-free. Similarly, nothing in this document should be viewed as instructions for selecting any particular code, and Abbott does not advocate or warrant the appropriateness of the use of any particular code. The ultimate responsibility for coding and obtaining payment/reimbursement remains with the customer. This includes the responsibility for accuracy and veracity of all coding and claims submitted to third-party payers. In addition, the customer should note that laws, regulations, and coverage policies are complex and are updated frequently and is subject to change without notice. The customer should check with its local carriers or intermediaries often and should consult with legal counsel or a financial, coding, or reimbursement specialist for any questions related to coding, billing, reimbursement, or any related issues. This material reproduces information for reference purposes only. It is not provided or authorized for marketing use.

 

 

Information contained herein for DISTRIBUTION in the U.S. ONLY.
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