---
title: "MNDHS: How to Request Electronic Remittance Advice in Billiyo"
description: How to request your ERA from the MNDHS.
---
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# MNDHS: How to Request Electronic Remittance Advice in Billiyo
## In order to see your payment details in Billiyo, we will need to request your ERA from the Minnesota Department of Human Services.
This article only concerns Minnesota agenicies.
To receive your electronic remittance advice in Billiyo, we will need to request it from the Minnesota Department of Human Services. To do this, please complete [this form](https://edocs.dhs.state.mn.us/lfserver/Public/DHS-4087-ENG).
When filling our the form, please enter the following information:
### Clearinghouse and Billing Organization Information
- CLEARINGHOUSE OR BILLING ORGANIZATION UNIQUE MINNESOTA PROVIDER IDENTIFIER (UMPI)
- A477415400
- CLEARINGHOUSE OR BILLING ORGANIZATION NAME
- Billiyo Health Inc.
- NAME OF PERSON COMPLETING THIS FORM
- Your Customer Sucsess manager's name
- ADDRESS
- 400 S 4th St Suite 401
- PHONE NUMBER
- (612) 517-1990
- CITY
- Minneapolis
- STATE
- Minnesota
- ZIP
- 55414
### MHCP Pay-To Provider Information
- PROVIDER NAME
- Your Agency Name
- NPI oe UMPI
- You agency UMPI/NPI
- You have multiple UMPIs with the DHS, then you will need to complete this form multiple times One for each ID.
- AFFILIATE TO CLEARINGHOUSE OR BILLING ORGANIZATION EFFECTIVE DATE
- Today's Date
- REMOVE AFFILIATION TO CLEARINGHOUSE OR BILLING ORGANIZATION
EFFECTIVE DATE
- Leave Blank
- CONTACT NAME
- Your Name
- PHONE NUMBER
- Your phone number
- SELECT THE TYPE OF ACCESS FOR
- BOTH
- ADD REMITTANCE MEDIA TYPE
- 835x12
- REQUESTED START DATE
- Today's Date
- REMOVE REMITTANCE MEDIA TYPE (if applicable)
- Leave blank
- REQUESTED END DATE
- Leave blank
- PAY-TO PROVIDER PRINTED NAME
- Your name
- PAY-TO PROVIDER SIGNATURE
- Leave Blank
- DATE
- Today's Date
Make sure to check off the box titled: "I am signing this form electronically."
### Submitting the Form
After completing this form, please FAX it to the Minnesota Department of Human Services. You can fax this document to **651-431-7462**
It will take about 30 days after submitting this form for your request to be processed and your ERAs to appear in Billiyo.
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