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Cahaba GBA E-mail Subscription Form

Complete this form to sign up for e-mail updates from Cahaba GBA. Your information will not be shared with others. Please review our privacy policy for details.

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About You
* E-mail Address
* Re-enter Your E-mail Address
* First Name

* Last Name

Title/Position

About Your Organization
*Are you a Medicare provider/facility?

Yes, Medicare Part A  
Yes, Medicare Part B
No, not a provider

If yes, tell us your Medicare Provider Number/s:

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If no, not a provider select a category below:

* Facility/Organization Name
* Facility/Agency Type

* Address One
Address Two
* City
* State

* ZIP Code
* Phone Number
(123) 555-1234
FAX Number
(123) 555-1234
* Do you submit Medicare claims electronically?
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If yes, provide your EDI Submitter number:
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* How many employees are in your location?
1-10
11-25
26 or more

NOTE:
You must select at least one topic under Medicare A or Medicare B below
Send Me News About the Following Medicare A Topics
Send me News on ALL Medicare A Topics Listed Below

Acute Care Hospital
Community Mental Health Center
Comprehensive Outpatient Rehabilitation Facility
Critical Access Hospital
Electronic Data Interchange/HIPAA News
Electronic Data Interchange Vendor News
Electronic Remittance Advice
Home Health Agency
Hospice Agency
Inpatient Psychiatric Facility
Inpatient Rehabilitation Facility

Local Coverage Determinations
Long Stay or Long Term Care Hospital
Medicare Secondary Payer
Outpatient Physical Therapy
PC ACE Pro 32 Software News
Rehabilitation Drug Facility
Renal Dialysis Facility
Rural Health Clinic
Skilled Nursing Facility
Swing Bed Unit

Send Me News About the Following Medicare B Topics
Send me News on ALL Medicare B Topics Listed Below

Ambulance
Ambulatory Surgery Center
Anesthesiology
Cardiology
Chiropractor
Dermatology
Ear, Nose and Throat
Electronic Data Interchange/HIPAA News
Electronic Data Interchange Vendor News
Electronic Remittance Advice
Gastroenterology
Hematology/Oncology
Independent Diagnostic Testing Facility
Lab
Local Coverage Determinations

Medicare Secondary Payer
Nephrology
Neurology
Obstetrics/Gynecology
Ophthalmology, Optician, Optometry
Pathology
PC ACE Pro 32 Software News
Podiatry
Psychiatry
Radiation Therapy
Radiology
Surgery
Therapy (Occupational/Physical/Speech)
Urology