Payer Enrollment Forms

Some payers require pre-enrollment before permitting the provider to/ submit electronic claims to them.  Typically payers such as Medicare, Medicaid, Blue Cross, and Blue Shield require pre-enrollment.  Payers that require pre-enrollment are indicated on our Payer Lists (PreEnr column).  As a service to our customers, Office Ally provides these agreements and forms below, pre-filled with Office Ally’s information where ever required.  Below is a list of all Pre-Enrollment forms available (sorted by state and payer). 

Be sure to complete the form(s) as indicated on the Instructions Cover Page to ensure applications are not denied for incorrect/missing information.

ALL or Multiple States Payer Enrollment Forms 

Payer Enrollment Forms for State Specific Payers:
AL | AK | AZ | AR | CA | CO | CT | DE | FL | GA | HI | ID | IL | IN | IA | KS | KY | LA | ME | MD
MA | MI | MN | MS | MO | MT | NE | NV | NH | NJ | NM | NY | NC | ND | OH | OK | OR | PA | RI | SC
SD | TN | TX | UT | VT | VA | WA | DC | WV | WI | WY

Electronic Remittance / ERA / 835 Enrollment Forms

All or Multiple States Payer Enrollment Forms

• Adaptis
• Cahaba GBA Part A – 10301
• DMERC Region A (CT, DE, DISTRICT OF COLUMBIA, ME, MD, MA, NH, NJ, NY, PA, RI, VT)
• DMERC Region B (IL, IN, KY, MI, MN, OH, WI)
• DMERC Region C (AL, AR, CO, GA, FL, LA, MS, NC, NM, OK, SC, TN, TX, VA, WV)
• DMERC Region D (AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA,WY)
• Global Health
• Indian Health Services/Veteran Affairs Part A
• Indian Health Services/Veteran Affairs Part B
• Intercommunity Health Net
• Managed Healthcare Administration
• Medicare HHH J11 (Palmetto)
• Medicare HHH J15 (CGS)
• Medicare J04901
• Railroad Medicare
• TriCare for Life
• TriCare Overseas
• US Department of Labor
• Value Options
• VAPCCC Region 3 (AL, AR, FL, IL, IN, KS, KY, LA, MS, MO, OK, TN, TX, WV)
• VAPCCC Region 5A (AZ, CA, CO, ID, NV, NM, OR, West TX, WA)
• VAPCCC Region 5B (HI, American Samoa, Guam, Northern Mariana Islands)
• VAPCCC Recion 6 (AK)

Alabama

• Medicare Part A - AL
• Medicare Part B - AL

Alaska

• Medicaid – AK
• Medicare Part B – AK
• Premera Blue Cross Blue Shield – AK

Arizona

• Medicare Part B – AZ

Arkansas

• Blue Cross Blue Shield – AR
• Medicare – AR
   

California

• Alameda Alliance for Health
• Central California Alliance for Health
• Denti-Cal / Medi-Cal Dental
• Medi-Cal
• Medicare – California EFT Form
• Medicare Part A – CA
• Medicare Part B – CA NORTH
• Medicare Part B – CA SOUTH
• Partnership HealthPlan of California
• Sharp Community Medical Group
• Sharp Health Plan
• Sharp Rees-Stealy Medical Group
• Valley Health Plan (Commercial and Medi-Cal)

Colorado

• Medicaid – CO
• Medicaid Behavioral Health – CO
• Medicare (Part A) – CO
• Medicare (Part B) – CO
• Rocky Mountain HMO – CO

Connecticut

• Medicare – CT

Delaware

• Amerihealth (HMO) – DE
• Amerihealth (Non-HMO) – DE
• Blue Cross Blue Shield – DE
• Medicaid – DE
• Medicare – DE

Back to top Florida

• Medicaid – FL
• Medicare Part A – FL
• Medicare Part B – FL

Georgia

• Medicaid - GA
• Medicare Part A - GA
• Medicare Part B - GA

Hawaii

• Aloha Care - HI
• Blue Cross Blue Shield – HI
• Medicaid - HI
• Medicare – HI
• Medicare EFT Form – HI
• University Health Alliance (UHA) Part A - HI
• University Health Alliance (UHA) Part B - HI

Idaho

• Medicare - ID

Illinois

• Medicaid - IL
• Medicare - IL

Indiana

• Medicare - IN

Iowa

• Blue Cross Blue Shield - IA
• Medicare - IA
• Medicaid Part B- IA

Kansas

• Blue Cross Blue Shield - KS & KC 
• Medicare - KS

Kentucky

• Medicaid - KY
• Medicare - KY

Louisiana

• Blue Cross Blue Shield - LA
• Medicaid - LA
• Medicare Part A - LA
• Medicare Part B - LA

Maine

• Medicare - ME

Maryland

• Medicaid MHS (PMHS) - MD
• Medicaid Part A - MD
• Medicaid Part B - MD
• Medicare - MD

Massachusetts

• Blue Cross Blue Shield - MA
• Medicare - MA
• Medicaid Behavioral Health - MA
• TUFTS Health Plan - MA

Michigan

• Blue Cross Blue Shield Part A  - MI
• Blue Cross Blue Shield Part B - MI
• HealthPlus of Michigan - MI
• Medicaid - MI
• Medicare - MI

Minnesota

• HealthPartners of Minnesota
• Medicaid - MN 
• Medicare - MN

Mississippi

• Blue Cross Blue Shield - MS
• Medicaid - MS
• Medicare - MS

Missouri

• Blue Cross Blue Shield Kansas City - MO
• Medicare (East & West) - MO

Montana

• Medicare - MT

Nebraska

• Medicaid - NE
• Medicare - NE

Nevada

• Medicaid - NV
• Medicare - NV
• Medicare - NV (EFT Form)

New Hampshire

• Medicaid  - NH
• Medicare  - NH

New Jersey

• Amerihealth (HMO)
• Amerihealth (Non-HMO)
• Medicaid - NJ
• Medicare - NJ

New Mexico

• Medicare - NM

Back to top New York

• Blue Cross Blue Shield Excellus – Central Region NY
• Blue Cross Blue Shield Excellus – Rochester NY
• Blue Cross Blue Shield Excellus – Utica Region NY
• Blue Cross Blue Shield of Western New York (NOT same as Empire BCBS) - NY
• Blue Shield of Northeastern New York (NOT same as Empire BCBS) - NY
• HealthNow - NY
• Independent Health - NY
• Medicare (Downstate Region) - NY
• Medicare (Queens County) - NY
• Medicare (Upstate County) - NY
• Medicaid - NY
• Univera Healthcare - NY

North Carolina

• Alliance Behavioral Health - NC
• CenterPoint Human Services - NC
• Medicaid - NC
• Medicare - NC
• Partners Behavioral Health - NC
• Sandhills Center - NC
• Smoky Mountain Center - NC

North Dakota

• Blue Shield - ND
• Medicare Part B - ND

Ohio

• Medicare - OH

Oklahoma

• Medicare - OK

Oregon

• Lifewise Health Plan of Oregon
• Medicaid - OR
• Medicare Part B - OR
• Trillium Community Health Plans (LIPA)
• Western Oregon Advanced HealthSW Oregon IPA

Pennsylvania

• Amerihealth/Independence Administrators
• Blue Cross Blue Shield (Highmark) - PA
• Capital Blue Cross/Keystone Health Plan Central
• Highmark Senior Health Company - PA
• IBC Personal Choice
• Independence Blue Cross
• Keystone Health Plan East
• Medicare - PA

Rhode Island

• Blue Cross Blue Shield - RI
• Medicare - RI
• Medicaid - RI

South Carolina

• Medicaid - SC
• Medicare - SC

South Dakota

• Blue Cross Blue Shield - SD
• Medicaid - SD
• Medicare Part B - SD

Tennessee

• Blue Cross Blue Shield - TN
• Medicare Part A - TN
• Medicare Part B - TN

Texas

• Medicare Part A - TX
• Medicare Part B - TX

Utah

• Deseret Mutual Benefit Administrators - UT
• EMI Health - UT
• Medicaid Part A&B - UT
• Medicaid Crossovers - UT
• Medicare Part B - UT
• Public Employees Health Plan (PEHP) - UT
• University of Utah - UT

Vermont

• Medicaid - VT
• Medicare - VT

Virginia

• Amerigroup of Virginia - VA
• Medicare - Northern VA
• Medicare - VA (All Cities/Counties, Except Alexandria, Arlington & Fairfax)
• Virginia Premier CompleteCare
• Virginia Premier Health Plan (Institutional)

Virgin Islands              

• Medicare - VI

Washington

• Lifewise Health Plan of Washington
• Medicaid (ProviderOne) - WA
• Medicare Parts A & B - WA
• Premera

Washington DC

• Medicaid - WA DC
• Medicare - WA DC

West Virginia

• Blue Cross Blue Shield/Mountain States - WV
• Freedom Blue - WV
• Highmark Senior Solutions Company - WV
• Medicare - WV

Wisconsin

• Medicare (Part A) - WI
• Medicare (Part B) - WI

Wyoming

• Blue Shield  - WY
• Medicaid - WY
• Medicare Part B  - WY

Back to top Electronic Remittance / ERA / 835 Enrollment Forms  

• 1199 National Benefit 835 ERA
• 3P Administrators 835 ERA
• AARP 835 ERA
• Access Medicare (Cuatro LLC) 835 ERA
• Administrative Concepts, Inc. 835 ERA
• Advantek Benefit Administrators 835 ERA
• Aetna 835 ERA & EFT
• Aetna Better Health of Illinois (Medicaid) 835 ERA
• Aetna Better Health of Michigan 835 ERA
• Aetna Better Health of Nebraska 835 ERA
• Aetna Better Health of New Jersey 835 ERA
• Aetna Better Health of New York 835 ERA
• Aetna Better Health of Pennsylvania (Medicaid) 835 ERA
• Aetna Better Health of Ohio 835 ERA
• Aetna Dental 835 ERA
• Aetna TX Medicaid and CHIP 835 ERA
• Affinity Health Plan 835 ERA
• Affinity Health Plan (Medicare Advantage) 835 ERA
• AgeWell New York 835 ERA
• Allegiance Benefit Plan Managment 835 ERA
• Alliant Health Plans of Georgia 835 ERA
• Allied Benefit Systems 835 ERA
• Amalgamated Insurance Company 835 ERA
• AmeriBen Solutions 835 ERA
• American National Insurance Company 835 ERA
• Amerigroup Corporation (FL, GA, IL, MD, NM, NV, OH, TX, WA) 835 ERA
• Amerigroup - Virginia (INTotal Health) 835 ERA
• AmeriHealth Administrators 835 ERA
• AmeriHealth Connect 835 ERA
• AmeriHealth Delaware (HMO) 835 ERA
• AmeriHealth Delaware (Non HMO) 835 ERA
• AmeriHealth District of Columbia 835 ERA
• AmeriHealth New Jersey (HMO) 835 ERA
• AmeriHealth New Jersey (Non HMO) 835 ERA
• AmeriHealth NorthEast 835 ERA
• Amfirst Insurance Company 835 ERA
• Arbor Health Plan 835 ERA
• Arkansas Best Corp - Choice Benefits 835 ERA
• ASRM Corporation 835 ERA
• Assurant Health 835 ERA
• Asuris Northwest Health 835 ERA
• Automated Benefit Services 835 ERA
• Avera Health Plans 835 ERA
• Beacon Health Strategies 835 ERA
• Benefit Administrative Systems 835 ERA
• Benefit Coordinators Corporation 835 ERA
• Benefit Management Systems, Inc. 835 ERA
• BeneSys, Inc. 835 ERA
• Blue Benefit Administrators of MA 835 ERA
• Blue Choice of South Carolina 835 ERA
• Blue Cross Blue Shield Alabama 835 ERA
• Blue Cross Blue Shield Arizona 835 ERA
• Blue Cross Blue Shield Arkansas 835 ERA
• Blue Cross Blue Shield CareFirst DC/NCA 835 ERA
• Blue Cross Blue Shield CareFirst MD 835 ERA
• Blue Cross Blue Shield Colorado 835 ERA
• Blue Cross Blue Shield Connecticut 835 ERA
• Blue Cross Blue Shield Delaware 835 ERA
• Blue Cross Blue Shield Florida 835 ERA
• Blue Cross Blue Shield Georgia 835 ERA
• Blue Cross Blue Shield Hawaii 835 ERA
• Blue Cross Blue Shield Horizon New Jersey/New York 835 ERA
• Blue Cross Blue Shield Illinois 835 ERA
• Blue Cross Blue Shield Indiana 835 ERA
• Blue Cross Blue Shield Iowa 835 ERA and EFT
• Blue Cross Blue Shield Kansas 835 ERA
• Blue Cross Blue Shield Kansas City 835 ERA
• Blue Cross Blue Shield Kentucky 835 ERA
• Blue Cross Blue Shield Louisiana 835 ERA
• Blue Cross Blue Shield Maine 835 ERA
• Blue Cross Blue Shield Massachusetts 835 ERA
• Blue Cross Blue Shield Michigan Part A 835 ERA
• Blue Cross Blue Shield Michigan Part B 835 ERA
• Blue Cross Blue Shield Minnesota 835 ERA
• Blue Cross Blue Shield Mississippi 835 ERA
• Blue Cross Blue Shield Missouri 835 ERA
• Blue Cross Blue Shield Montana 835 ERA
• Blue Cross Blue Shield Nebraska 835 ERA
• Blue Cross Blue Shield Nevada 835 ERA
• Blue Cross Blue Shield New York - Central Region 835 ERA
• Blue Cross Blue Shield New York - Empire 835 ERA
• Blue Cross Blue Shield New York - Rochester Region 835 ERA
• Blue Cross Blue Shield New York - Utica Region 835 ERA
• Blue Cross Blue Shield New Hampshire 835 ERA
• Blue Cross Blue Shield New Mexico 835 ERA
• Blue Cross Blue Shield North Carolina 835 ERA
• Blue Cross Blue Shield Western New York 835 ERA
• Blue Cross Blue Shield Ohio 835 ERA
• Blue Cross Blue Shield Oklahoma 835 ERA
• Blue Cross Blue Shield Pennsylvania 835 ERA
• Blue Cross Blue Shield Rhode Island 835 ERA
• Blue Cross Blue Shield South Carolina 835 ERA
• Blue Cross Blue Shield South Dakota 835 ERA and EFT
• Blue Cross Blue Shield Tennessee 835 ERA
• Blue Cross Blue Shield Texas 835 ERA
• Blue Cross Blue Shield Vermont 835 ERA
• Blue Cross Blue Shield Virginia 835 ERA
• Blue Cross Blue Shield Wisconsin 835 ERA
• Blue Cross Blue Shield West Vigrinia/ Mountain States 835 ERA
• Blue Cross California 835 ERA
• Blue Shield of California EFT & ERA
• Blue Shield of North Dakota 835 ERA
• Blue Shield Northeastern New York 835 ERA
• Blue Shield of Wyoming 835 ERA
• BMC HealthNet Plan 835 ERA
• Boon Chapman Administrators 835 ERA
• BridgeSpan 835 ERA
• Brokerage Concepts 835 ERA
• Brown & Toland Medical Group
• Capital Blue Cross 835 ERA
• Capital Dental 835 ERA
• Capital District Physicians Health Plan (CDPHP) 835 ERA
• Capital Health Plan 835 ERA
• CapRock HealthPlans 835 ERA
• Caremore 835 ERA
• Carepoint Health Plan 835 ERA
• CareSource of Kentucky 835 ERA
• CareSource of Ohio 835 ERA
• Care Improvement Plus (CIP) 835 ERA
• Care Wisconsin Health Plan 835 ERA
• Cariten 835 ERA
• Cariten Senior Health 835 ERA
• CenCal Health 835 ERA
• Centene Corporation (68069) 835 ERA
• Central California Alliance for Health 835 ERA
• Chiropractic Health Plans 835 ERA
• Cigna 835 ERA
• Cigna EFT
• C.L. Frates and Company 835 ERA
• Colorado Access 835 ERA
• Common Ground Healthcare 835 ERA
• Community Health Choice 835 ERA
• Community Health Plan of Washington 835 ERA
• Complementary Healthcare Plan 835 ERA
• Connecticare Medicare 835 ERA
• Consolidated Health Plans 835 ERA
• Consumer Mutual of Michigan 835 ERA
• Continental General Insurance Company 835 ERA
• Convent Administrators Inc 835 ERA
• Co-ordinated Benefit Plans LLC 835 ERA
• CoreSource (AZ, IL, IN, MN, MD, NC,PA) 835 ERA
• Cornerstone Benefits Administrator Inc 835 ERA
• Coventry Healthcare (25133) 835 ERA
• Cox Health Plan 835 ERA
• CWIBenefits, Inc 835 ERA
• Dean Health Plan 835 ERA
• Delta Health Systems 835 ERA
• Deseret Mutual Benefit Administrators 835 ERA
• DMERC Region A 835 ERA
• DMERC Region B 835 ERA
• DMERC Region C 835 ERA
• DMERC Region D 835 ERA
• East Carolina Behavioral Health 835 ERA
• EDS Healthchoice (OK State Employees & Educators) 835 ERA
• ElderPlan, Inc. 835 ERA
• EMI Health 835 ERA
• Employee Benefit Management Services 835 ERA
• E.S. Beveridge & Associates, Inc. 835 ERA
• Equitable Plan Services 835 ERA
• Everence 835 ERA
• Fallon Community Health 835 ERA
• Family Care Medicare 835 ERA
• Federated Mutual Health Insurance Company 835 ERA
• Fidelis Care of New York 835 ERA
• First Choice Health Administrators (FCHA) 835 ERA
• Firstcare and Firstcare Medicaid 835 ERA
• Florida Healthcare Plan 835 ERA
• FMH Benefit Services 835 ERA
• Fox-Everett, Inc 835 ERA
• Freedom Blue 835 ERA
• Gateway Health Plan - Medicaid PA 835 ERA
• Gateway Health Plan - Medicare Assured 835 ERA
• GEHA / Texas Dental Plan 835 ERA
• Geisinger Health Plans 835 ERA
• GHI - New York (Group Health Inc.) 835 ERA
• Gilsbar, LLC 835 ERA
• Great Oregon Behavioral Health Inc 835 ERA
• Great-West Healthcare 835 ERA
• Group Benefit Services 835 ERA
• Group Health Cooperative 835 ERA
• Group Health Cooperative (Pacific Northwest) 835 ERA
• Gundersen Lutheran Health Plan 835 ERA
• Harvard Pilgrim 835 ERA
• Hawaii Medical Alliance Association (HMAA) 835 ERA
• HealthCare Partners - CA & AZ 835 ERA
• HealthCare Solutions Group 835 ERA
• HealthFirst 835 ERA
• HealthNow New York 835 ERA
• HealthSCOPE Benefits, Inc. 835 ERA
• HealthSmart Benefit Solutions (formerly JSL) 835 ERA
• Health Alliance 835 ERA
• Health Choice Arizona 835 ERA
• Health Net Arizona 835 ERA
• Health Net of CA, OR 835 ERA
• Health Net of the Northeast 835 ERA
• Health New England 835 ERA
• Health Partners MN 835 ERA
• HealthPartners of MN (Dental) 835 ERA
• Health Partners of Philadelphia 835 ERA
• Health Plan Services 835 ERA
• Health Plans, Inc. 835 ERA
• Health Services Management (HSM) 835 ERA
• Healthy CT 835 ERA
• HealthSpring (formerly Bravo) 835 ERA
• Highmark Health Options 835 ERA
• Highmark Senior Health Company PA 835 ERA
• Highmark Senior Health Company WV 835 ERA
• HIP Health Plan of NY 835 ERA
• Hometown Health Plan Nevada 835 ERA
• Horizon New Jersey Health Plan 835 ERA
• Humana 835 ERA
• IBC Personal Choice 835 ERA
• IE Shaffer & Company 835 ERA
• Independence Administrators 835 ERA
• Independence Blue Cross 835 ERA
• Independent Health 835 ERA
• InnovAge 835 ERA
• Insurance Administrator of America, Inc. 835 ERA
• Insurance Design Administrators 835 ERA
• Johns Hopkins Healthcare 835 ERA
• Johns Hopkins Healthcare (USFHP) 835 ERA
• John Muir Physician Network 835 ERA
• Kaiser Foundation Health Plan of Colorado 835 ERA
• Kaiser Foundation Health Plan of Georgia 835 ERA
• Kaiser Health Plan of the Mid-Atlantic States (MD, VA, DC) 835 ERA
• Kaiser Northern California 835 ERA
• Kaiser Southern California 835 ERA
• Kaiser NW Region 835 ERA
• Kaweah Delta Medicare Advantage 835 ERA
• Kempton Group 835 ERA
• Key Medical Group 835 ERA
• Key Medical Group - Medicare Advantage 835 ERA
• Keystone Health Plan (East) 835 ERA
• Keystone VIP Choice 835 ERA
• KPS HealthPlans 835 ERA
• LA Care 835 ERA
• Landmark Healthcare 835 ERA
• Land of Lincoln Health 835 ERA
• Lifetime Benefit Solutions 835 ERA
• Lifewise Health Plan of OR Part A 835 ERA
• Lifewise Health Plan of OR Part B 835 ERA
• Lifewise Health Plan of WA Part A 835 ERA
• Lifewise Health Plan of WA Part B 835 ERA
• Lockard & Williams 835 ERA
• Magellan Behavioral Health 835 ERA
• Maine Community Health Options 835 ERA
• Managed Health Network (MHN) 835 ERA
• Maryland Physicians Care 835 ERA
• Mdwise Hoosier Alliance 835 ERA
• MED3000 CMS Early Steps 835 ERA
• MED3000 CMS Title 21 835 ERA
• MED3000 PED Title 21 835 ERA
• Medica2 835 ERA
• Medical Mutual of Ohio 835 ERA
• Medical Associates Health Plan 835 ERA
• Medica and Medica UnitedHealthcare 835 ERA
• Medica HealthCare Plans 835 ERA
• Medicaid Alabama 835 ERA
• Medicaid Alaska 835 ERA
• Medicaid Arkansas 835 ERA
• Medicaid Arizona 835 ERA
• Medicaid Colorado 835 ERA
• Medicaid Connecticut 835 ERA
• Medicaid Delaware 835 ERA
• Medicaid Florida 835 ERA
• Medicaid Georgia Dental 835 ERA
• Medicaid Georgia 835 ERA
• Medicaid Hawaii 835 ERA
• Medicaid Idaho 835 ERA
• Medicaid Illinois 835 ERA
• Medicaid Indiana 835 ERA
• Medicaid Iowa 835 ERA
• Medicaid Kansas 835 ERA
• Medicaid Kentucky 835 ERA
• Medicaid Louisiana 835 ERA
• Medicaid Maine 835 ERA
• Medicaid Massachusetts 835 ERA
• Medicaid Michigan 835 ERA
• Medicaid Minnesota 835 ERA
• Medicaid Mississippi 835 ERA
• Medicaid Missouri 835 ERA
• Medicaid Montana 835 ERA
• Medicaid Nebraska 835 ERA
• Medicaid Nevada 835 ERA
• Medicaid New Jersey 835 ERA
• Medicaid New Hampshire 835 ERA
• Medicaid New Mexico 835 ERA
• Medicaid New York 835 ERA
• Medicaid North Carolina 835 ERA
• Medicaid North Dakota 835 ERA
• Medicaid Ohio 835 ERA
• Medicaid Oklahoma 835 ERA
• Medicaid Oregon 835 ERA
• Medicaid Pennsylvania 835 ERA
• Medicaid Rhode Island 835 ERA
• Medicaid South Carolina 835 ERA
• Medicaid Texas 835 ERA
• Medicaid Vermont 835 ERA
• Medicaid Virginia 835 ERA
• Medicaid Washington (ProviderOne) 835 ERA
• Medicaid Washington DC 835 ERA
• Medicaid West Virginia 835 ERA
• Medicaid Wisconsin 835 ERA
• Medi-Cal 835 ERA
• Medicare Alaska 835 ERA
• Medicare Arizona 835 ERA
• Medicare Arkansas 835 ERA
• Medicare CA North Part B 835 ERA
• Medicare CA Part A 835 ERA
• Medicare CA South Part B 835 ERA
• Medicare Colorado (Part A) 835 ERA
• Medicare Colorado (Part B) 835 ERA
• Medicare Connecticut 835 ERA
• Medicare Delaware 835 ERA
• Medicare Florida (Part A) 835 ERA
• Medicare Florida (Part B) 835 ERA
• Medicare Hawaii 835 ERA
• Medicare HHH J11 (Palmetto)
• Medicare HHH J15 (CGS) 835 ERA
• Medicare Idaho 835 ERA
• Medicare Illinois 835 ERA
• Medicare Indiana 835 ERA
• Medicare Iowa 835 ERA
• Medicare Kansas 835 ERA
• Medicare Kentucky 835 ERA
• Medicare Louisiana (Part A) 835 ERA
• Medicare Louisiana (Part B) 835 ERA
• Medicare Maine 835 ERA
• Medicare Maryland 835 ERA
• Medicare Massachusetts 835 ERA
• Medicare Michigan 835 ERA
• Medicare Minnesota 835 ERA
• Medicare Mississippi 835 ERA
• Medicare Missouri East and West 835 ERA
• Medicare Montana 835 ERA
• Medicare Nebraska 835 ERA
• Medicare Nevada 835 ERA
• Medicare New Hampshire 835 ERA
• Medicare New Jersey 835 ERA
• Medicare New Mexico 835 ERA
• Medicare New York (Downstate) 835 ERA
• Medicare New York (Queens) 835 ERA
• Medicare New York (Upstate) 835 ERA
• Medicare North Carolina 835 ERA
• Medicare North Dakota 835 ERA
• Medicare Northern Virginia 835 ERA
• Medicare Ohio 835 ERA
• Medicare Oklahoma 835 ERA
• Medicare Oregon 835 ERA
• Medicare Pennsylvania 835 ERA
• Medicare Railroad 835 ERA
• Medicare Rhode Island 835 ERA
• Medicare South Carolina 835 ERA
• Medicare South Dakota 835 ERA
• Medicare Texas (Part A) 835 ERA
• Medicare Texas (Part B) 835 ERA
• Medicare Utah 835 ERA
• Medicare Vermont 835 ERA
• Medicare Virginia (Palmetto) 835 ERA
• Medicare Virgin Islands 835 ERA
• Medicare Washington 835 ERA
• Medicare Washington DC 835 ERA
• Medicare West Virginia (Palmetto) 835 ERA
• Medicare Wisconsin (Part A) 835 ERA
• Medicare Wisconsin (Part B) 835 ERA
• Medicare Wyoming 835 ERA
• MedSolutions, Inc 835 ERA
• Medstar Select 835 ERA
• Mercy Maricopa Integrated Care 835 ERA
• Mercy Physicians Medical Group (NAMM) 835 ERA
• Meridian Health Plan 835 ERA
• Meritage Medical Network 835 ERA
• Metropolitan Health Plan (MHP) 835 ERA
• Metro Plus HealthPlan 835 ERA
• MHNet 835 ERA
• Mid-America Associates, Inc. 835 ERA
• Midwest Group Benefits 835 ERA
• MMSI 835 ERA
• Moda Health (Formerly ODS Health Plan) 835 ERA
• Mohawk Valley (MVP) Health Plan 835 ERA
• Molina Healthcare of Illinois 835 ERA
• Molina Healthcare of New Mexico 835 ERA
• Molina Healthcare of Ohio 835 ERA
• Molina Healthcare of South Carolina 835 ERA
• Molina Healthcare of Wisconsin 835 ERA
• Mutual Health Services (Antares) 835 ERA
• Mutual of Omaha Ins. Company 835 ERA
• NAMM Partners, Inc 835 ERA
• Nationwide Health Plan 835 ERA
• Neighborhood Health Partnership 835 ERA
• Network Health 835 ERA
• Network Health Plan of Wisconsin 835 ERA
• NGS America, Inc 835 ERA
• NHIC (Network Health Insurance Corporation)- Medicare 835 ERA
• Nippon Life Insurance Company of America 835 ERA
• North America Administrators (NAA) 835 ERA
• North American Medical Management (NAMM) 835 ERA
• North Shore - LIJ CareConnect Insurance Company 835 ERA
• Nova Healthcare Administrators 835 ERA
• Ogden Benefits Administration (EBC) 835 ERA
• OptiCare Managed Vision 835 ERA
• Optima Insurance Company 835 ERA
• OptumHealth Physical (Includes Oxford) 835 ERA
• Optum Medical Network / Lifeprint Network 835 ERA
• Optum Salt Lake County (SLC) 835 ERA
• Oregon's Health CO-OP 835 ERA
• PacificSource Health Plans 835 ERA
• Partnership HealthPlan of California 835 ERA
• Passport Health Plan 835 ERA
• PatientPay 835 ERA
• Pekin Life Insurance 835 ERA
• Peoples Health Network 835 ERA
• PHCS Savility Payers 835 ERA
• Physician Associates of Greater San Gabriel Valley 835 ERA
• Physicians Health Plan (PHP) - Northern Indiana 835 ERA
• Piedmont WellStar Health Plan 835 ERA
• PIH Health 835 ERA
• Planned Administrators, Inc. 835 ERA
• POMCO 835 ERA
• Prairie States Enterprises 835 ERA
• PreferredOne 835 ERA
• Preferred Health Plan (PHP) 835 ERA
• Premera Blue Cross of WA Institutional 835 ERA
• Premera Blue Cross of WA Professional 835 ERA
• Premera Blue Cross Blue Shield of AK Institutional 835 ERA
• Premera Blue Cross Blue Shield of AK Professional 835 ERA
• Presbyterian Health Plan 835 ERA
• Prestige Health Choice Medicaid 835 ERA
• PrimeWest Health Systems 835 ERA
• Professional Benefit Administrators 835 ERA
• Providence Health Plan 835 ERA
• Providence Risk & Insurance 835 ERA
• Regence Blue Cross Blue Shield OR 835 ERA
• Regence Blue Cross Blue Shield UT 835 ERA
• Regence Blue Shield ID 835 ERA
• Regence Blue Shield WA 835 ERA
• Right Care from Scott and White 835 ERA
• Rocky Mountain Health Plan 835 ERA
• Sandhills Center 835 ERA
• Sanford Health Plan 835 ERA
• Santa Barbara Select IPA (Mckesson) 835 ERA
• SCAN AZ, CA 835 ERA
• Select Health of SC 835 ERA
• Select Health of UT 835 ERA
• Self Insured Plans LLC 835 ERA
• Self Insured Services Company 835 ERA
• Sendora Health 835 ERA
• Sentara Family Health Plan / Sentara Health Management 835 ERA
• Shasta Administrative Services 835 ERA
• Sierra Health Services 835 ERA
• SoundPath Health 835 ERA
• Southeastern Indiana Health Organization (SIHO) 835 ERA
• South Florida Community Care Network / Memorial Integrated Healthcare 835 ERA
• State Farm Payer 31053 835 ERA
• State Farm Property & Casualty Payer 31059 835 ERA
• Summit Administration Services, Inc. 835 ERA
• Texas Agricultural Cooperative Trust 835 ERA
• Texas Municipal League 835 ERA
• TLC Benefit Solutions 835 ERA
• Total Plan Services 835 ERA
• Tricare for Life 835 ERA
• Tricare North 835 ERA
• Tricare South 835 ERA
• Tricare West 835 ERA
• Tricare Overseas 835 ERA
• TriState Benefit Solutions 835 ERA
• Trillium Community Health Plans (LIPA) 835 ERA
• Trusted Health Plan 835 ERA
• Trustmark Insurance Company 835 ERA
• Tufts Health Plan 835 ERA
• Ucare of Minnesota 835 ERA
• Ultra Benefits 835 ERA
• UMR (Formerly UMR Onalaska) 835 ERA
• UMR Wausau UHIS 835 ERA
• Unified Group Services, Inc. 835 ERA
• United Concordia - Blue Shield of PA (UCCI) 835 ERA
• United Concordia – Blue Shield of PA – Dental Plus- (UCCI) 835 ERA
• United Concordia – Fee for Service (UCCI) 835 ERA
• United Concordia – FMDP (Champus)- (UCCI) 835 ERA
• UnitedHealthcare Commercial / UnitedHealthcare West 835 ERA
• UnitedHealthcare Community Plan - AZ (APIPA) 835 ERA
• UnitedHealthcare Community Plan - DE, LA, MD, OH, PA, WA 835 ERA
• UnitedHealthcare Community Plan - IA and TN 835 ERA
• UnitedHealthcare Community Plan - KS (KanCare) 835 ERA
• UnitedHealthcare Community Plan - MI (Great Lakes) 835 ERA
• UnitedHealthcare Community Plan - MS CAN & CHIP 835 ERA
• UnitedHealthcare Community Plan - NE 835 ERA
• UnitedHealthcare Community Plan - NJ 835 ERA
• UnitedHealthcare Community Plan - NYU 835 ERA
• UnitedHealthcare Community Plan - TX 835 ERA
• UnitedHealthcare Community Plan - WI 835 ERA
• UnitedHealthcare / Golden Rule 835 ERA
• UnitedHealthcare / MAHP - MD IPA - Optimum - MLH (MAMSI) 835 ERA
• UnitedHealthcare Military & Veterans 835 ERA
• UnitedHeathcare of the River Valley 835 ERA
• UnitedHealthcare / Oxford 835 ERA
• UnitedHealthcare / Spectera Eyecare Networks 835 ERA
• UnitedHealthcare StudentResources 835 ERA
• United HealthOne / UnitedHealthcare Life / UnitedHealthcare Pacificare Life 835 ERA
• United of Omaha 835 ERA
• Unity Health Insurance 835 ERA
• Univera Healthcare 835 ERA
• University Health Alliance (UHA) 835 ERA
• University of Utah 835 ERA & EFT
• University Physicians Healthcare 835 ERA
• UPMC Health Plan 835 ERA
• Upper Peninsula Health Plan 835 ERA
• US Benefits 835 ERA
• US Family Health Plan 835 ERA
• US Imaging Network 835 ERA
• Valley Care IPA (Mckesson) 835 ERA
• Value Options 835 ERA
• Vantage Health Plan Inc 835 ERA
• VAPCCC Region 3 835 ERA
• VAPCCC Region 5A 835 ERA
• VAPCCC Region 5B 835 ERA
• VAPCCC Region 6 835 ERA
• Virginia Premier Health 835 ERA
• Volusia Health Network 835 ERA
• WEA Insurance Group 835 ERA
• WellCare (14163) 835 ERA
• Western Oregon Advanced Helath CCO (Behavioral Health Claims Only) 835 ERA
• WINhealth Partners/Wyoming Health Solutions 835 ERA
• Wisconsin Physicians Services (WPS) 835 ERA
• WPS Arise 835 ERA
• Yamhill CCO 835 ERA

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