Change of Vendor form?

Hi, how do I create a "change of vendor" (COV) form/letter?  Please see context below.  I am trying to receive ERAs for United HealthCare/Optum through Simple practice instead of through my former online billing service.



Hi Sarah Parsons,

Your payment report enrollment for payer 'United HealthCare' was rejected for the following reason(s):

  • The payer rejected the enrollment due to the provider is linked to another clearinghouse to receive ERAs. Please ask the provider to submit the COV (change of vendor).

Please correct this information. If necessary, contact this payer to verify the information on your enrollment and re-submit.

Our support team doesn't have the ability to provide more information for rejected enrollments.

The enrollment transaction reference ID is 247198513 with NPI number 1679729677.