Skip to Main Content

Medical/Hospital Enrollment -
Institutional ERA Enrollment Forms

  Title Payer ID State(s)
  Element Care - 04326 - Inst ERA 04326
  PRIME WEST HEALTH - 61604 - Inst ERA 61604
  PacificSource - 93029 - Inst ERA 93029
  Indiana Pro Health dba Community Pro Health - Inst ERA 35161
  EON Health - 73780 - Inst ERA 73780
  ERA Provider Setup Form
  ERA Change Delete Form
  ERA Merge Group COV - PSF
  Blue Choice Medicaid - 00403 - Inst ERA 00403
  Amerigroup - 27514 - Inst ERA 27514
  District of Columbia Medicaid - 12001 - Inst ERA 12001
  • District of Columbia
  Blue Cross Medicare Advantage - Montana - 66006 - Inst ERA 66006
  • Montana
  VillageCare Max- 26545 - Inst ERA 26545
  CenterLight Healthcare - 13360 - Inst ERA 13360
  Extended Care MLTC - 46166 - Inst ERA 46166
  Maryland Medicare - 12010 - Inst ERA 12010
  • Maryland
  J12 Highmark for DC, DE, MD, NJ, and PA – J12901 - Legacy - 12M99 - Inst ERA 12M99
  • Delaware
  • District of Columbia
  • Maryland
  • New Jersey
  • Pennsylvania
  DC Medicare - 12M63 - Inst ERA 12M63
  • District of Columbia
  Idaho Medicaid - 12K07 - Inst ERA 12K07
  • Idaho
  Kansas BCBS - 57325 - Inst – ERA 57325
  • Kansas
  Health New England - 04286 - Inst ERA 04286
  North Carolina Medicare - 12M23 - Inst ERA 12M23
  • North Carolina
  South Carolina Medicare - 12M55 - Inst ERA 12M55
  • South Carolina
  Home Health & Hospice J11 - 12M80 - Inst ERA 12M80
  Medicare Home Health & Hospice - 12HHA - Inst ERA 12HHA
  Virginia Premier Health Plan- 54176 - Inst ERA 54176
  • Virginia
  Virginia BCBS - 12002 - Inst ERA 12002
  • Virginia
  Ohio BCBS - 12B24 - Inst ERA 12B4
  • Ohio
  New York City Empire Omnipro - 12B36 - Inst ERA 12B36
  • New York
  New Hampshire BCBS – 12B21 – Inst ERA 12B21
  • New Hampshire
  Indiana BCBS - 12B09 - Inst ERA 12B09
  • Indiana
  Connecticut BCBS - 12B04 - Inst ERA 12B04
  • Connecticut
  Anthem California Blue Cross – 47198 – Inst ERA 47198
  • California
  BCBS Western New York Medicaid/CHP – 44911 – Inst ERA 44911
  • New York
  Blue Cross Medicare Advantage Illinois - Inst ERA 66006
  • Illinois
  Blue Cross Medicare Advantage New Mexico - 66006 - Inst ERA 66006
  • New Mexico
  Blue Cross Medicare Advantage - Texas - 66006 - Inst ERA 66006
  • Texas
  Blue Cross Medicare Advantage - 66006 - Oklahoma - Inst ERA 66006
  • Oklahoma
  Georgia Medicare - 12M05 - Inst ERA 12M05
  • Georgia
  Alabama Medicare - 12M01 - Inst ERA 12M01
  • Alabama
  Rural Health - 12M53 - Inst ERA 12M53
  • Tennessee
  Tennessee Medicare - 12M53 - Inst ERA 12M53
  • Tennessee
  Utah Medicaid - 12K42 - Inst ERA 12K42
  • Utah
  Arkansas Medicare - 12022 - Inst ERA 12022
  • Arkansas
  Louisiana Medicare - 12M12 - Inst ERA 12M12
  • Louisiana
  Mississippi Medicare - 12M17 - Inst ERA 12M17
  • Mississippi
  Legacy Medicare - CO - TX - NM - OK – J40911 - 12M88 - Inst ERA 12M88
  • Colorado
  • New Mexico
  • Oklahoma
  • Texas
  New Mexico Medicare - 12M22 - Inst ERA 12M22
  • New Mexico
  Colorado Medicare - 12M03 - Inst ERA 12M03
  • Colorado
  Texas Medicare - 12M31 - Inst ERA 12M31
  • Texas
  Oklahoma Medicare - 12M37 - Inst ERA 12M37
  • Oklahoma
  New Jersey Medicare - 12005 - Inst ERA 12005
  • New Jersey
  Delaware Medicare - 12M76 - Inst ERA 12M76
  • Delaware
  Pennsylvania Medicare - 12M60 - Inst ERA 12M60
  • Pennsylvania
  Aetna Better Health of West Virginia - 128WV - Inst ERA 128WV
  • West Virginia
  Georgia BCBS - 12015 - Inst ERA 12015
  • Georgia
  Qual Choice of Arkansas - 35174 - Inst ERA 35174
  • Arkansas
  Arise - 39185 - Inst ERA 39185
  TriWest -VAPC3 Region 6 - 55917 - Inst ERA 55917
  TriWest VAPC3 Region 5B - 55916 - Inst ERA 55916
  TriWest VAPC3 Region 5A - 55915 - Inst ERA 55915
  TriWest VAPC3 Region 3 - 55912 - Inst ERA 55912
  WPS Health Insurance - 12X29 - Inst ERA 12X29
  Tricare For Life - 12X43 - Inst ERA 12X43
  Michigan Medicare - 12M18 - Inst ERA 12M18
  • Michigan
  Indiana Medicare - 12M09 - Inst ERA 12M09
  • Indiana
  Missouri Medicare - 12M15 - Inst ERA 12M15
  • Missouri
  Kansas Medicare - 57324 - Inst ERA 57324
  • Kansas
  Iowa Medicare - 12M10 - Inst ERA 12M10
  • Iowa
  Security Health Plan - 39045 - Inst ERA 39045
  Healthsmart Information Systems - 52180 - Inst ERA 52180
  Blue Cross Blue Shield of Texas - Medicaid (TMG Health) - 66001 - Inst ERA 66001
  Blue Cross Community Options - 66005 - Inst ERA 66005
  Connecticut Medicare - 12M04 - Inst ERA 12M04
  • Connecticut
  Virginia Medicare - 12004 – Inst ERA 12004
  • Virginia
  West Virginia Medicare - 12M28 - Inst ERA 12M28
  • West Virginia
  Illinois Medicare - 12M08 - Inst ERA 12M08
  • Illinois
  CA Home Health & Hospice - 12M98 Inst ERA 12M98
  • California
  Wisconsin Medicare & FQHC - 12M29 - Inst ERA 12M29
  • Wisconsin
  Minnesota Medicare - 12M16 - Inst ERA 12M16
  • Minnesota
  New Hampshire Medicare - 12M21 - Inst ERA 12M21
  • New Hampshire
  Massachusetts Medicare - 12M14 - Inst ERA 12M14
  • Massachusetts
  Maine Medicare - 12M13 - Inst ERA 12M13
  • Maine
  Rhode Island Medicare - 12M74 - Inst ERA 12M74
  • Rhode Island
  Vermont Medicare - 12M26 - Inst ERA 12M26
  • Vermont
  Aetna Better Health of New Jersey - 46320 - Inst ERA 46320
  • New Jersey
  Health Economic Livelihood Partnership (HELP) - 66004 - INST ERA 66004
  Kaiser Foundation Health Plan of Southern CA Region - 94134 - Inst ERA 94134
  • California
  Kaiser Permanente of Colorado - 91617 - Inst ERA 91617
  • Colorado
  Tennessee BCBS - 12B45 -12B53 - Inst ERA 12B45
  • Tennessee
  Kaiser Foundation Health Plan of the Mid-Atlantic – 52095 Inst ERA 52095
  Kaiser Foundation Helth Plan of Northern CA Region – 94135 – Inst ERA 94135
  • California
  North Dakota Medicaid - 12K78 - Inst ERA 12K78
  • North Dakota
  Kansas City BCBS - 12B66 - Inst ERA 12B66
  Centene LA Healthcare Connection - 68069 - Inst ERA 68069
  Centene Cenpatico - 68068 - Inst ERA 68068
  Aetna - 60054 - Inst ERA 60054
  • ~All States
  CGS Home Health - 12M97 - Inst ERA 12M97
  • Alabama
  • Colorado
  • Delaware
  • District of Columbia
  • Iowa
  • Kansas
  • Maryland
  • Missouri
  • Montana
  • Nebraska
  • North Dakota
  • Pennsylvania
  • South Dakota
  • Utah
  • Virginia
  • West Virginia
  • Wyoming
  Ohio Medicare – 12M24 – Inst ERA 12M24
  • Ohio
  Kentucky Medicare - 12M11 - Inst ERA 12M11
  • Kentucky
  Trillium Health Resources - 56089 - Inst ERA 56089
  Mdwise - 12K81 - Inst ERA 12K81
  US Virgin Islands Medicare - 12M52 - Inst ERA 12M52
  • Virgin Islands
  Puerto Rico Medicare - 12M49 - Inst ERA 12M49
  • Puerto Rico
  Florida Medicare - 12M34 - Inst ERA 12M34
  • Florida
  Coventry Healthcare of Florida - 128FL - Inst ERA 128FL
  • Florida
  Community Care Managed Health Care Of OK - 73143 - Inst ERA 73143
  Premier Health Plan - 251PR - Inst ERA 251PR
  MedStar Select /MedStar Medicare Choice - 251MS - Inst ERA 251MS
  Communtiy Care BHO - 23282 - Inst ERA 23282
  UPMC Health Plan - 23281 - Inst ERA 23281
  New York Medicare - 12M35 - Inst ERA 12M35
  • New York
  Legacy Medicare - CA - NV - HI - 12M65 - Inst ERA 12M65
  • California
  • Hawaii
  • Nevada
  California Medicare - 12M64 - Inst ERA 12M64
  • California
  Nevada Medicare - 12M64 - Inst ERA 12M64
  • Nevada
  Hawaii Medicare - 12M64 - Inst ERA 12M64
  • Hawaii
  Aetna Better Health of Kentucky - 128KY - Inst ERA 128KY
  • Kentucky
  Legacy Medciare WPS J5 - 52280 - Inst ERA 52280
  • Indiana
  • Iowa
  • Kansas
  • Michigan
  • Missouri
  • Nebraska
  Connecticut Medicaid - 12K04 - Inst ERA 12K04
  • Connecticut
  Pennsylvania Medicaid - 12008 - Inst ERA 12008
  • Pennsylvania
  JOHN MUIR MT. DIABLO HEALTH SYSTEMS - 68036 - INST ERA 68036
  Pennsylvania BCBS Central Highmark - 12B81 - Inst ERA 12B81
  • Pennsylvania
  Physicians of Southwest Washington - 91171 - Inst ERA 91171
  HealthPartners - 12X51 -- Inst ERA 12X51
  • Minnesota
  Tricare Overseas - 12X46 - Inst ERA 12X46
  Mercy Care - 86052 - Inst ERA 86052
  Samba - 37259 - Inst ERA 37259
  Aetna Better Health of Ohio - 50023 - Inst ERA 50023
  • Ohio
  Aetna Better Health of Louisiana - 128LA - Inst ERA 128LA
  • Louisiana
  Mercy Maricopa Integrated Care - 33628 - Inst ERA 33628
  • Arizona
  Aetna Better Health of Virginia - 128VA - Inst ERA 128VA
  • Virginia
  Aetna Better Health of Missouri - 128MO - Inst ERA 128MO
  • Missouri
  Healthnet of CA and OR - 95567 - Inst ERA 95567
  • California
  • Oregon
  Unicare ERA - 80314 - Inst ERA 80314
  Georgia Medicaid - 12K05 - Inst ERA 12K05
  • Georgia
  Seasode Health Plan - 46187 - Inst ERA 46187
  Captial Blue Cross - Facility - 12B61 - Inst ERA 12B61
  VGM Homelink - 50701 - Inst ERA 50701
  North American Medical Management (NAMM) Northern Californaia - E3510 - Inst ERA E3510
  Wyoming BC - 12B30 - Inst ERA 12B30
  • Wyoming
  Wyoming Medicare - 12M30 - Inst ERA 12M30
  • Wyoming
  Washington Medicare - 12M45 - Inst ERA 12M45
  • Washington
  Utah Medicare - 12M84 - Inst ERA 12M84
  • Utah
  South Dakota Medicare - 12M83 - Inst ERA 12M83
  • South Dakota
  Oregon Medicare - 12M41 - Inst ERA 12M41
  • Oregon
  North Dakota BC - 12B78 - Inst ERA 12B78
  • North Dakota
  North Dakota Medicare - 12M82 - Inst ERA 12M82
  • North Dakota
  Montana Medicare - 12M77 - Inst ERA 12M77
  • Montana
  Iowa Medicaid - 12K10 - Inst ERA 12K10
  • Iowa
  AK & ID Medicare - 12M07 - Inst ERA 12M07
  • Alaska
  • Idaho
  Arizona Medicare - 12M02 - Inst ERA 12M02
  • Arizona
  West Virginia BCBS - 12B28 - Inst ERA 12B28
  • West Virginia
  Highmark Senior Solutions - 95461 - Inst ERA 95461
  Nebraska Medicaid - 12K19 - Inst ERA 12K19
  • Nebraska
  New Jersey Medicaid Hospital ERA - 12006 - Inst ERA 12006
  • New Jersey
  Aetna Better Health of New York - 34734 - Inst ERA 34734
  • New York
  Illinois BCBS - 12B08 - Inst ERA 12B08
  • Illinois
  Tricare South - 61125 - Inst ERA 61125
  • Alabama
  • Arkansas
  • Florida
  • Georgia
  • Louisiana
  • Mississippi
  • Oklahoma
  • South Carolina
  • Tennessee
  • Texas
  Kaiser Permanente of Georgia - 21313 - Inst ERA 21313
  • Georgia
  Kaiser Permanente of Hawaii -94123 - Inst ERA 94123
  • Hawaii
  Delaware Physicians Care - 27009 - Inst 27009
  • Delaware
  Aetna Better Health of Michigan - 128MI - Inst ERA 128MI
  • Michigan
  Nebraska BCBS - 12B19 - Inst ERA 12B19
  • Nebraska
  CarePlus Health Plan - 65031 - Inst 65031
  Aetna Better Health of Illinois - 26337 - Inst ERA 26337
  • Illinois
  Alabama Medicaid - 12K01 - Inst ERA 12K01
  • Alabama
  1199 National Benefit Fund - 13162 - Inst ERA 13162
  Texas Medicaid - 12K64 - Inst ERA 12K64
  • Texas
  South Dakota Medicaid - 12K36 - Inst ERA 12K36
  • South Dakota
  Deseret Mutual - 12X35 - Inst 12X35
  Aetna TX Medicaid & CHIP - 38692 - Inst ERA 38692
  • Texas
  Texas BCBS - 12B31 - Inst ERA 12B31
  • Texas
  Montana BC ERA - 12B77 - Inst ERA 12B77
  • Montana
  Alabama BCBS - 12B54 - Inst ERA 12B54
  • Alabama
  Tricare West - 12C01 - Inst ERA 12C01
  • Arizona
  • California
  • Colorado
  • Idaho
  • Louisiana
  • Minnesota
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Mexico
  • North Dakota
  • Oregon
  • South Dakota
  • Washington
  • Wyoming
  Magellan - 01260 - Inst ERA 01260
  South Carolina Medicaid ERA - 12K55 - Inst ERA 12K55
  • South Carolina
  Kentucky Medicaid - 12K11 - Inst ERA 12K11
  • Kentucky
  Aetna Better Health of Nebraska - 42130 - Inst ERA 42130
  • Nebraska
  Maryland Physicians Care - 22348 - Inst ERA 22348
  • Maryland
  Majesta Care - 26372 - Inst ERA 26372
  HealthScope Benefits - 71063 - Inst ERA 71063
  Cigna - 62308 - Inst ERA 62308
  • ~All States
  Parkland Community Health Plan - 66917 - Inst ERA 66917
  • Texas
  CareCentrix - 11345 - Inst ERA 11345
  Michigan BCBS - 12B18 - Inst ERA 12B18
  • Michigan
  Aetna Better Health - 23228 - Inst ERA 23228
  • Pennsylvania
  Humana - 61101 - Inst ERA 61101
  • ~All States
  Arkanss BCBS - 12021 - Inst ERA 12021
  • Arkansas
  California BS - 94036 - Inst ERA 94036
  • California
  Highmark Senior Health - 95462 - Inst ERA 95462
  SELECT ADVANTAGE - SX055 - INST ERA SX055
  NEW JERSEY BCBS - 22099 - Inst ERA 22099
  • New Jersey
  Missouri Medicaid - 12K15 - Inst ERA 12K15
  • Missouri
  Iowa BCBS - 12B10 - Inst ERA 12B10
  • Iowa
  Washington BCBS Institutional ERA - 12B27 12B27
  • Washington
  Vermont Medicaid - 12K26 - Inst ERA 12K26
  • Vermont
  Louisiana BCBS - 12B12 - Inst ERA 12B12
  • Louisiana
  Minnesota Department of Health - MNDH1 - Inst ERA MND1
  • Minnesota
  Massachusetts BCBS - 12B14 - Inst ERA 12B14
  • Massachusetts
  Mississippi Medicaid - 12K17 - Inst ERA 12K17
  • Mississippi
  Oklahoma BCBS - 12B59 - Inst ERA 12B59
  • Oklahoma
  Group Health Cooperative of South Central WI - 39167 - Inst ERA 39167
  • Wisconsin
  Ohio Medicaid - 12K24 - Inst ERA 12K24
  • Ohio
  California Medicaid - 57016 - Inst ERA 57016
  • California
  Tennessee Medicaid Institutional ERA - 12K46 12K46
  • Tennessee
  Tricare North - 57106 - Inst ERA 57106
  • Connecticut
  • Delaware
  • District of Columbia
  • Illinois
  • Indiana
  • Kentucky
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • New Hampshire
  • New Jersey
  • New York
  • North Carolina
  • Ohio
  • Pennsylvania
  • Rhode Island
  • Vermont
  • Virginia
  • West Virginia
  • Wisconsin
  OK State Employees Educators - 22521 - Inst ERA 22521
  • Oklahoma
  Avmed Inc - 59274 - Inst ERA 59274
  Florida Medicaid - 12K34 - Inst ERA 12K34
  • Florida
  Arizona BCBS Hospital ERA - 12B02 - Inst ERA 12B02
  • Arizona
  Delaware BC - 12B76 - Inst ERA 12B76
  • Delaware
  Wyoming Medicaid - 12K30 - Inst ERA 12K30
  • Wyoming
  Rhode Island BC - 12B74 - 12B75 - Inst ERA 12B74
  • Rhode Island
  Bridgestone Americas INC - 88033 - Inst ERA 88023
  Louisiana Medicaid - 12K12 - Inst ERA 12K12
  • Louisiana
  Florida BCBS - 12B34/SB590 - Inst ERA 12B34
  • Florida
  MetroPlus Health Plan - 13265 - Inst ERA 13265
  New Hampshire Medicaid - 12K90 - Inst ERA 12K90
  • New Hampshire
  North Carolina Medicaid - 12K23 - Inst ERA 12K23
  • North Carolina
  South Carolina BCBS - 12B55 - Inst ERA 12B55
  • South Carolina
  North Carolina BCBS - 12B23 - Inst ERA 12B23
  • North Carolina
  AMERIHEALTH ADMINSTRATORS - SX055 - INST ERA SX055
  AMERIHEALTH HMO OF NJ - SX055- INST ERA SX055
  • New Jersey
  AMERIHEALTH HMO OF DE - SX055 - INST ERA SX055
  • Delaware
  AMERIHEALTH NON - HMO (PPO) NJ - SX055 -INST ERA SX055
  • New Jersey
  AMERIHEALTH NON - HMO (PPO) OF DE - SX055 - INST ERA SX055
  IBC PERSONAL CHOICE - SX055 - INST ERA SX055
  KEYSTONE HEALTH PLAN EAST - SX055 - INST ERA SX055