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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
60054 Bell Atlantic 835 ERA ERA Application
CBID1 Blue Cross of Idaho 837 Claims Provider Instructions
CBAL1 Blue Cross/Blue Shield of Alabama 837 Claims Provider Instructions
53589 Blue Cross/Blue Shield of Arizona 835 ERA Provider Instructions
CBKS1 Blue Cross/Blue Shield of Kansas 837 Claims Provider Instructions " In State Providers Only "
CBMA1 Blue Cross/Blue Shield of Massachusetts 837 Claims Provider Instructions
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 "
CBNE1 Blue Cross/Blue Shield of Nebraska 837 Claims Provider Instructions "In State Providers Only"
CBNE1 Blue Cross/Blue Shield of Nebraska 837 Claims Provider Instructions for "OUT OF STATE PROVIDERS"
22099 Blue Cross/Blue Shield of New Jersey - Horizon 837 Claims Provider Instructions
BCSSC Blue Cross/Blue Shield of South Carolina 835 ERA ERA Application
CBTN1 Blue Cross/Blue Shield of Tennessee 837 Claims Provider Instructions
DX088 Blue Cross/Blue Shield of Utah - Regence 837 Claims Provider Instructions
99996 Blue Shield of Pennsylvania (Camp Hill) 837 Claims Provider 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
94146 Denti-Cal 837 Claims Enrollment Application
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
60054 Marriott 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
CKID1 Medicaid of Idaho 837 Claims Provider Instructions
CKIA1 Medicaid of Iowa 837 Claims Provider Instructions
CKKY1 Medicaid of Kentucky 837 Claims Provider Instructions
CKLA2 Medicaid of Louisiana ADULT 837 Claims Provider Enrollment Application
CKLA1 Medicaid of Louisiana EPSDT 837 Claims Provider Enrollment Application
CKME1 Medicaid of Maine (MaineCare) 837 Claims Enrollment Application
CKMI1 Medicaid of Michigan 837 Claims Provider Instructions
CKMN1 Medicaid of Minnesota 837 Claims Provider Instructions 10.5.09
CKMS1 Medicaid of Mississippi 837 Claims Provider Instructions
CKMT1 Medicaid of Montana 837 Claims Provider Instructions
CKMT1 Medicaid of Montana 835 ERA Enrollment Application
CKMT1 Medicaid of Montana 270 Eligibility Request Enrollment Application
CKNV1 Medicaid of Nevada 837 Claims Provider Instructions
CKNJ1 Medicaid of New Jersey 837 Claims Provider Instructions
CKNY1 Medicaid of New York 837 Claims Provider Instructions
CKOH1 Medicaid of Ohio (Medicaid claims administered by Quadax) 837 Claims Provider Instructions
CKPA1 Medicaid of Pennsylvania 837 Claims Provider Instructions
CKUT1 Medicaid of Utah 837 Claims Provider Instructions
CKWA1 Medicaid of Washington 837 Claims Provider Instructions
60054 Preferred Dental Organization (PDO) 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
97300 Triple-S 837 Claims Enrollment Application
60054 TRW 835 ERA ERA Application
99996 United Concordia - Dental - PA Blue Shield 837 Claims Provider Instructions
99997 United Concordia - Dental Plus - PA Blue Shield 837 Claims Provider Instructions
99994 United Concordia - Fee-For-Service (UCCI) 837 Claims Provider Instructions
99995 United Concordia - FMDP (Champus) 837 Claims Provider Instructions
99995 United Concordia - FMDP (Champus) 837 Claims Provider Instructions
60054 Varian Health Care Plan 835 ERA ERA Application

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