Enrollment Services

Medical and Hospital

Please make your selection from the following available transaction types:

Provider Quick Reference User Guide

Claims Enrollment Forms
To submit claims for patient visits, providers must first be set up in the Change Healthcare system. The provider can submit an enrollment form themselves, or instruct their vendor to access the Change Healthcare self-service enrollment portal to create a direct linkage.

ERA Enrollment Forms
To receive ERA files directly from your vendor, providers must be set up in the Change Healthcare system to receive ERAs. This is completed by the submission of either an enrollment form or direct link by a vendor who has access to the Change Healthcare self-service enrollment portal.

Real-time Enrollment Forms
Real-time functions provide the ability to verify eligibility, check claims status, locate providers, review requests and responses, and make claim-related financial inquiries.

EFT Enrollment Forms
ePayment/EFT allows providers to receive payments electronically from payers that have contracted with Change Healthcare to perform this service.

Dental

Please make your selection from the available transaction types listed below.

Claims Enrollment Forms
Check to see if additional enrollment/registration tasks are required by the payer prior to accepting claims electronically.

ERA Enrollment Forms
Check to see if additional enrollment/registration tasks are required by Change Healthcare and/or the payer prior to delivery of ERA/835 transactions.

Real-time Enrollment Forms
Check to see if additional enrollment/registration tasks are required by the payer prior to accepting 270 Real-time Eligibility Inquiry transactions.

EFT Enrollment Forms
Dental providers may enroll to receive EFT payments from the numerous payers who have partnered with Change Healthcare within their Dental Connect for Providers account. If you do not currently have an account and wish to establish one please click here.