Payer List - Enrollments Required

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Payer ID Payer Name Transaction Type Description Enrollment Forms
60054 Aetna Dental Plans 835 ERA ERA Application
68246 Aetna DMO 835 ERA ERA Application
61301 Ameritas Life Insurance Corp. 835 ERA ERA Instructions
65358 Anthem - Blue Cross Blue Shield of Connecticut 835 ERA ERA Application
84105 Anthem - Blue Cross Blue Shield of Missouri 835 ERA ERA Application
84101 Anthem - Blue Cross Blue Shield of Nevada 835 ERA ERA Application
47198 Anthem - Blue Cross of California 835 ERA ERA Application
60054 Bell Atlantic 835 ERA ERA Application
CBAL1 Blue Cross Blue Shield of Alabama 837 Claims Provider Instructions
CBAL1 Blue Cross Blue Shield of Alabama 835 ERA ERA Application
CBAL1 Blue Cross Blue Shield of Alabama 270 Eligibility Request Provider Instructions
53589 Blue Cross Blue Shield of Arizona 835 ERA ERA Instructions
84099 Blue Cross Blue Shield of Colorado - Anthem 835 ERA ERA Application
84103 Blue Cross Blue Shield of Colorado - Trigon 835 ERA ERA Application
65358 Blue Cross Blue Shield of Connecticut - Anthem 835 ERA ERA Application
SB601 Blue Cross Blue Shield of Georgia - Anthem 835 ERA ERA Application
84105 Blue Cross Blue Shield of Indiana - Anthem 835 ERA ERA Application
CBKS1 Blue Cross Blue Shield of Kansas 837 Claims Enrollment Application
CBKS1 Blue Cross Blue Shield of Kansas 835 ERA ERA Application
DX067 Blue Cross Blue Shield of Kansas City (MO) 837 Claims Enrollment Application
DX067 Blue Cross Blue Shield of Kansas City (MO) 835 ERA ERA Application
84105 Blue Cross Blue Shield of Kentucky - Anthem 835 ERA ERA Application
23739 Blue Cross Blue Shield of Louisiana 835 ERA ERA Application
BME01 Blue Cross Blue Shield of Maine - Anthem 835 ERA ERA Application
CBMA1 Blue Cross Blue Shield of Massachusetts 837 Claims Provider Application
BCBSM Blue Cross Blue Shield of Michigan 835 ERA ERA Instructions
CBMS1 Blue Cross Blue Shield of Mississippi 837 Claims Provider Instructions "In State Providers Only"
CBMS1 Blue Cross Blue Shield of Mississippi 837 Claims Provider Instructions " Out of State Providers"
84105 Blue Cross Blue Shield of Missouri - Anthem 835 ERA ERA Application
CBNE1 Blue Cross Blue Shield of Nebraska 837 Claims Provider Instructions for "OUT OF STATE PROVIDERS"
CBNE1 Blue Cross Blue Shield of Nebraska 837 Claims Provider Instructions "In State Providers Only"
84101 Blue Cross Blue Shield of Nevada - Anthem 835 ERA ERA Application
BNH01 Blue Cross Blue Shield of New Hampshire - Anthem 835 ERA ERA Application
22099 Blue Cross Blue Shield of New Jersey - Horizon 837 Claims Provider Application
CX004 Blue Cross Blue Shield of North Dakota 837 Claims Provider Instructions
84105 Blue Cross Blue Shield of Ohio - Anthem 835 ERA ERA Application
BCSSC Blue Cross Blue Shield of South Carolina 835 ERA ERA Application
CBTN1 Blue Cross Blue Shield of Tennessee 837 Claims Provider Application
CBTN1 Blue Cross Blue Shield of Tennessee 835 ERA ERA Application
DX088 Blue Cross Blue Shield of Utah - Regence 837 Claims Provider Application
DX088 Blue Cross Blue Shield of Utah - Regence 835 ERA ERA Application
CB923 Blue Cross Blue Shield of Virginia - Anthem 835 ERA ERA Application
CB923 Blue Cross Blue Shield of Virginia - Trigon 835 ERA ERA Application
CB950 Blue Cross Blue Shield of Wisconsin (United of Wisconsin) 835 ERA ERA Application
CB950 Blue Cross Blue Shield of Wisconsin - Anthem 835 ERA ERA Application
47198 Blue Cross of California - Anthem 835 ERA ERA Application
CBID1 Blue Cross of Idaho 837 Claims Providor Instructions
60054 Choice Plus 835 ERA ERA Application
DX014 Companion Life (SC) 835 ERA ERA Application
60054 CustomCare (Southwestern Bell - Exec) 835 ERA ERA Application
77033 DC Medicaid 837 Claims Provider Application
07035 DeCare Dental Health Insurance 835 ERA ERA Application
07035 Decare Dental Health International (DDHI) 835 ERA Enrollment Application
55093 DeCare, Empire Claims 835 ERA ERA Application
55093 DeCare, Empire Encounters 835 ERA ERA Application
99010 Delta Dental of Hawaii 835 ERA ERA Instructions
DDPM Delta Dental of Michigan 835 ERA ERA Instructions
07000 Delta Dental of Minnesota 835 ERA ERA Application
94146 Denti-Cal 837 Claims Enrollment Application
DX214 Deseret Mutual Benefit Administrators (DMBA) 837 Claims Provider Application
54771 Federal Employees Program 837 Claims Provider Instructions
54771 Federal Employees Program 835 ERA ERA Instructions
60054 FlexCare 835 ERA ERA Application
DX004 Florida Combined Life (Dental) 835 ERA ERA Application
60054 Florida Power & Light 835 ERA ERA Application
CX009 Health Partners of Minnesota 835 ERA ERA Application
22099 Horizon (BC / BS of NJ) 837 Claims Provider Application
60054 Marriott 835 ERA ERA Application
CKAL1 Medicaid of Alabama 835 ERA ERA Application
CKCT1 Medicaid of Connecticut 837 Claims Provider Instructions
CKDE1 Medicaid of Delaware 837 Claims Provider Instructions
CKFL1 Medicaid of Florida 837 Claims Provider Instructions
CKGA1 Medicaid of Georgia 837 Claims Provider Instructions
CKGA1 Medicaid of Georgia 835 ERA ERA Instructions
CKID1 Medicaid of Idaho 837 Claims Provider Instructions
CKIA1 Medicaid of Iowa 837 Claims Provider Instructions
CKIA1 Medicaid of Iowa 835 ERA ERA Application
CKKS1 Medicaid of Kansas 835 ERA ERA Application
CKKY1 Medicaid of Kentucky 837 Claims Provider Instructions
CKLA1 Medicaid of Louisiana EPSDT 837 Claims Provider Application
CKLA1 Medicaid of Louisiana EPSDT 835 ERA ERA Application
CKME1 Medicaid of Maine (MaineCare) 837 Claims Enrollment Application
CKMI1 Medicaid of Michigan 837 Claims Provider Instructions
CKMI1 Medicaid of Michigan 835 ERA ERA Application
CKMN1 Medicaid of Minnesota 837 Claims Provider Instructions
CKMN1 Medicaid of Minnesota 835 ERA ERA Application
CKMS1 Medicaid of Mississippi 837 Claims Provider Instructions
CKMT1 Medicaid of Montana 837 Claims Provider Application
CKMT1 Medicaid of Montana 835 ERA ERA Application
CKMT1 Medicaid of Montana 270 Eligibility Request Provider Application
CKNV1 Medicaid of Nevada 837 Claims Provider Instructions
CKNJ1 Medicaid of New Jersey 837 Claims Enrollment Application
CKNJ1 Medicaid of New Jersey 835 ERA ERA Application
CKNY1 Medicaid of New York 837 Claims Provider Application
CKPA1 Medicaid of Pennsylvania 837 Claims Provider Instructions
CKTX1 Medicaid of Texas 837 Claims Provider Instructions
CKTX1 Medicaid of Texas 835 ERA ERA Application
CKUT1 Medicaid of Utah 837 Claims Provider Instructions
CKUT1 Medicaid of Utah 835 ERA ERA Instructions
CKWA1 Medicaid of Washington 837 Claims Provider Instructions
CKWA1 Medicaid of Washington 835 ERA ERA Application
65978 MetLife 835 ERA ERA Instructions
60054 Preferred Dental Organization (PDO) 835 ERA ERA Application
41147 Preferred One 835 ERA ERA Application
60054 Prudential 835 ERA ERA Application
60054 Southwestern Bell 835 ERA ERA Application
60054 Southwestern Bell Exec. - Custom Care 835 ERA ERA Application
60054 Southwestern Bell Exec. - Southwest Bell 835 ERA ERA Application
DX033 SRC - Strategic Resource Company (SC) 835 ERA ERA Application
84103 Trigon Blue Cross/Blue Shield of Colorado 835 ERA ERA Application
84103 Trigon Blue Cross/Blue Shield of Virginia 835 ERA ERA Application
84103 Trigon Insurance Company 835 ERA ERA Application
60054 TRW 835 ERA ERA Application
80314 UNICARE 835 ERA ERA Application
65099 UNICARE Special Accounts 835 ERA ERA Application
99997 United Concordia - Dental Plus - PA Blue Shield 835 ERA ERA Instructions
54771 United Concordia - Federal Employees Program 835 ERA ERA Instructions
89070 United Concordia - Tricare Dental Plan 835 ERA ERA Instructions
89070 United Concordia Companies, Inc. 835 ERA ERA Instructions
60054 Varian Health Care Plan 835 ERA ERA Application






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