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ERA Enrollment

Participation in Dental Electronic Remittance Advice (ERA) is limited to those providers whose practice management software vendor is participating in ERA with Change Healthcare or to those providers who have a Dental Connect (DC) account. Please contact your software vendor to verify participation or register for a DC account at https://dental.changehealthcare.com/.


All Dental ERA Enrollment Forms

  Title Payer ID State(s)
  MAPFRE PRFRE
  MEDICAID OF FLORIDA CKFL1
  MEDICAID OF CALIFORNIA 94146
  MEDICAID OF WEST VIRGINIA CKWV1
  WEST VIRGINIA MEDICAID CKWV1
  WELFARE & PENSION ADMINISTRATION SERVICES 91136
  WISCONSIN MEDICAID CKWI1
  WilsonMcShane R7002
  DELTA DENTAL OF WISCONSIN 39069
  WELLS FARGO THIRD PARTYT ADMINISTRATORS 87815
  WELLS FARGO TPA 37272
  WEBTPA 59332
  DELTA DENTAL OF WASHINGTON 91062
  WASHINGTON BLUE CROSS BLUE SHIELD (PREMERA) 47570
  WASHINGTON, D.C. MEDICAID CKDC1
  VA FEE BASIS PROGRAMS 12116
  DELTA DENTAL OF VIRGINIA CDVA1
  UPMC DENTAL ADVANTAGE 23281
  UNITED HEALTHCARE COMMUNITY PLAN GP133
  UMWA Health & Retirement Funds 52180
  UNITEDHEALTH GROUP 52133
  UNITED CONCORDIA CX007
  TRANSCHOICE 37284
  Renaissance Life and Health RLHA1
  Change Healthcare Dental Provider Enrollment Form
  TOTAL DENTAL ADMINISTRATORS CX112
  SURENCY LIFE AND HEALTH CX088
  SUN LIFE AND HEALTH INSURANCE COMPANY 67814
  SOUTHERN BENEFITS ADMINISTRATION INC 38242
  SIERRA HEALTH AND LIFE 76342
  SHEFFIELD / OLSON AND MCQUEEN 41143
  SELECT HEALTH CX107
  Securian 93742
  SECURE HEALTHPLANS OF GEORGIA 28530
  RHODE ISLAND BLUE CROSS BLUE SHIELD FEP CB870
  REGENCE CB850
  PRINCIPAL FINANCIAL 61271
  PRIME WEST HEALTH LX049
  PREFFEREDONE 41147
  PREFERRED CARE PARTNERS 65088
  POMCO 16111
  HSBS MEMPHIS 37224
  PUBLIC EMPLOYEES HEALTH PROGRAM (PEHP) CX080
  MEDICAID OF PENNSYLVANIA CKPA1
  PACIFICSOURCE HEALTH PLANS 93029
  Oklahoma Medicaid CKOK1
  DELTA DENTAL OF OKLAHOMA CDOK1
  OK STATE EMPLOYEES & EDUCATORS 22521
  MEDICAID OF OHIO CKOH1
  MEDICAL MUTUAL OF OHIO CB833
  NYS DOH UCP 14142
  DELTA DENTAL OF NEW JERSEY 22189
  HORIZON HEALTHCARE DENTAL SERVICES 22099
  NIPPON LIFE INSURANCE COMPANY OF AMERICA 81264
  NEW HAMPSHIRE MEDICAID CKNH1
  NORTHEAST DELTA DENTAL 02027
  BLUE CROSS OF NEBRASKA CBNE1
  MEDICAID OF NORTH CAROLINA CKNC1
  NATIONAL ELEVATOR INDUSTRY HEALTH BENEFIT PLAN CX045
  MUTUAL OF OMAHA INSURANCE COMPANY 71412
  MUNICIPAL HEALTH BENEFIT FUND 81883
  MONTANA MEDICAID CKMT1
  MONTANA BLUE CROSS BLUE SHIELD CBMT1
  BLUE CROSS BLUE SHIELD OF MISSISSIPPI CBMS1
  MISSOURI MEDICAID CKMO1
  MAYO CLINIC HEALTH SOLUTIONS 41154
  DELTA DENTAL OF MICHIGAN AND AFFILIATED PAYERS CDMI0
  MI UFCW UNIONS AND EMPLOYERS HEALTH AND WELFARE FUND 27401
  MetLife and SafeGuard PPO 65978
  MERCY MARICOPA 33628
  MERCY CARE PLAN 86052
  MAINE MEDICAID (MAINECARE) CKME1
  HEALTHMARKETS 59226
  MEDICO INSURANCE COMPANY 23160
  MEDCOST BENEFIT SERVICES (MBS) 56205
  MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. dba MEDBEN 74323
  MED3000 EM205
  MEDICAL ASSOCIATES HEALTH PLAN / PREFERRED HEALTH CHOICE MAHC1
  MASS HEALTH AND HEALTH SAFETY NET CKMA1
  DELTA DENTAL MA 04614
  MASSACHUSETTS BLUE CROSS BLUE SHIELD CBMA1
  LOUISIANA BLUE CROSS BLUE SHIELD 23739
  KANSAS MEDICAID CKKS1
  DELTA DENTAL OF KANSAS CDKS1
  BLUE CROSS BLUE SHIELD OF KANSAS CITY MISSOURI 47171
  BLUE CROSS OF KANSAS CBKS1
  JOPARI CAREWORKS J1410
  JOHN ALDEN LIFE INSURANCE CO 41099
  INSURANCE PROGRAM MANAGERS GROUP 36342
  DELTA DENTAL OF ILLINOIS GROUP PLANS 05030
  BLUE CROSS BLUE SHIELD ILLINOIS CB621
  DELTA DENTAL OF IDAHO 82029
  INDIANA MEDICAID AND INDIANA CHILDREN’S SPECIAL HEALTHCARE PROGRAM CX070
  HUMANA INC. 61101
  ASSURANT HEALTH / TIME INSURANCE COMPANY 39065
  ARKANSAS MEDICAID CKAR1
  AETNA BETTER HEALTH® OF KENTUCKY 128KY
  AETNA BETTER HEALTH ® OF NEW JERSEY 46320
  ACS BENEFIT SERVICES, INC. 61473