Dental ERA Enrollment Forms

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 States
MUNICIPAL HEALTH BENEFIT FUND 81883 States unavailable for MUNICIPAL HEALTH BENEFIT FUND
Wyoming Medicaid - ERA CKWY1 States unavailable for Wyoming Medicaid - ERA
NEW MEXICO MEDICAID - CKNM1 CKNM1 States unavailable for NEW MEXICO MEDICAID - CKNM1
Aetna - 60054 60054 States unavailable for Aetna - 60054
Iowa Medicaid ERA Payer ID unavailable for Iowa Medicaid ERA States unavailable for Iowa Medicaid ERA
How to Un-Enroll from ERA Payer ID unavailable for How to Un-Enroll from ERA States unavailable for How to Un-Enroll from ERA
Wyoming Blue Cross - CBWY1 - Dental ERA Payer ID unavailable for Wyoming Blue Cross - CBWY1 - Dental ERA States unavailable for Wyoming Blue Cross - CBWY1 - Dental ERA
QC Test Claims Enrollment QC123 Illinois
DELTA DENTAL OF VIRGINIA CDVA1 States unavailable for DELTA DENTAL OF VIRGINIA
BLUE CROSS OF KANSAS CBKS1 States unavailable for BLUE CROSS OF KANSAS
JOHN ALDEN LIFE INSURANCE CO 41099 States unavailable for JOHN ALDEN LIFE INSURANCE CO
BLUE CROSS OF NEBRASKA CBNE1 States unavailable for BLUE CROSS OF NEBRASKA
HSBS MEMPHIS 37224 States unavailable for HSBS MEMPHIS
REGENCE CB850 States unavailable for REGENCE
DELTA DENTAL OF MICHIGAN AND AFFILIATED PAYERS CDMI0 States unavailable for DELTA DENTAL OF MICHIGAN AND AFFILIATED PAYERS
DELTA DENTAL OF OKLAHOMA CDOK1 States unavailable for DELTA DENTAL OF OKLAHOMA
SUN LIFE AND HEALTH INSURANCE COMPANY 67814 States unavailable for SUN LIFE AND HEALTH INSURANCE COMPANY
Renaissance Life and Health RLHA1 States unavailable for Renaissance Life and Health
PACIFICSOURCE HEALTH PLANS 93029 States unavailable for PACIFICSOURCE HEALTH PLANS
WASHINGTON, D.C. MEDICAID CKDC1 States unavailable for WASHINGTON, D.C. MEDICAID
PUBLIC EMPLOYEES HEALTH PROGRAM (PEHP) CX080 States unavailable for PUBLIC EMPLOYEES HEALTH PROGRAM (PEHP)
WEST VIRGINIA MEDICAID CKWV1 States unavailable for WEST VIRGINIA MEDICAID
MEDICAID OF NORTH CAROLINA CKNC1 States unavailable for MEDICAID OF NORTH CAROLINA
WEBTPA 59332 States unavailable for WEBTPA
Oklahoma Medicaid CKOK1 States unavailable for Oklahoma Medicaid
OK STATE EMPLOYEES & EDUCATORS 22521 States unavailable for OK STATE EMPLOYEES & EDUCATORS
NORTHEAST DELTA DENTAL 02027 States unavailable for NORTHEAST DELTA DENTAL
MERCY MARICOPA 33628 States unavailable for MERCY MARICOPA
MUTUAL OF OMAHA INSURANCE COMPANY 71412 States unavailable for MUTUAL OF OMAHA INSURANCE COMPANY
INDIANA MEDICAID AND INDIANA CHILDREN’S SPECIAL HEALTHCARE PROGRAM CX070 States unavailable for INDIANA MEDICAID AND INDIANA CHILDREN’S SPECIAL HEALTHCARE PROGRAM
AETNA BETTER HEALTH ® OF NEW JERSEY 46320 States unavailable for AETNA BETTER HEALTH ® OF NEW JERSEY
PRINCIPAL FINANCIAL 61271 States unavailable for PRINCIPAL FINANCIAL
MEDICAID OF WEST VIRGINIA CKWV1 States unavailable for MEDICAID OF WEST VIRGINIA
MASSACHUSETTS BLUE CROSS BLUE SHIELD CBMA1 States unavailable for MASSACHUSETTS BLUE CROSS BLUE SHIELD
DELTA DENTAL OF ILLINOIS GROUP PLANS 05030 States unavailable for DELTA DENTAL OF ILLINOIS GROUP PLANS
DELTA DENTAL OF WISCONSIN 39069 States unavailable for DELTA DENTAL OF WISCONSIN
DELTA DENTAL OF NEW JERSEY 22189 States unavailable for DELTA DENTAL OF NEW JERSEY
ACS BENEFIT SERVICES, INC. 61473 States unavailable for ACS BENEFIT SERVICES, INC.
DELTA DENTAL OF WASHINGTON 91062 States unavailable for DELTA DENTAL OF WASHINGTON
MERCY CARE PLAN 86052 States unavailable for MERCY CARE PLAN
UNITEDHEALTH GROUP 52133 States unavailable for UNITEDHEALTH GROUP
NYS DOH UCP 14142 States unavailable for NYS DOH UCP
DELTA DENTAL OF KANSAS CDKS1 States unavailable for DELTA DENTAL OF KANSAS
HEALTHMARKETS 59226 States unavailable for HEALTHMARKETS
PREFERRED CARE PARTNERS 65088 States unavailable for PREFERRED CARE PARTNERS
MEDICAID OF PENNSYLVANIA CKPA1 States unavailable for MEDICAID OF PENNSYLVANIA
UNITED CONCORDIA CX007 States unavailable for UNITED CONCORDIA
VA FEE BASIS PROGRAMS 12116 States unavailable for VA FEE BASIS PROGRAMS
INSURANCE PROGRAM MANAGERS GROUP 36342 States unavailable for INSURANCE PROGRAM MANAGERS GROUP
HUMANA INC. 61101 States unavailable for HUMANA INC.
SELECT HEALTH CX107 States unavailable for SELECT HEALTH
MetLife and SafeGuard PPO 65978 States unavailable for MetLife and SafeGuard PPO
KANSAS MEDICAID CKKS1 States unavailable for KANSAS MEDICAID
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. dba MEDBEN 74323 States unavailable for MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. dba MEDBEN
MEDCOST BENEFIT SERVICES (MBS) 56205 States unavailable for MEDCOST BENEFIT SERVICES (MBS)
MEDICAL MUTUAL OF OHIO CB833 States unavailable for MEDICAL MUTUAL OF OHIO
Securian 93742 States unavailable for Securian
BLUE CROSS BLUE SHIELD ILLINOIS CB621 States unavailable for BLUE CROSS BLUE SHIELD ILLINOIS
DELTA DENTAL MA 04614 States unavailable for DELTA DENTAL MA
RHODE ISLAND BLUE CROSS BLUE SHIELD FEP CB870 States unavailable for RHODE ISLAND BLUE CROSS BLUE SHIELD FEP
MISSOURI MEDICAID CKMO1 States unavailable for MISSOURI MEDICAID
WELLS FARGO TPA 37272 States unavailable for WELLS FARGO TPA
HORIZON HEALTHCARE DENTAL SERVICES 22099 States unavailable for HORIZON HEALTHCARE DENTAL SERVICES
MONTANA BLUE CROSS BLUE SHIELD CBMT1 States unavailable for MONTANA BLUE CROSS BLUE SHIELD
WISCONSIN MEDICAID CKWI1 States unavailable for WISCONSIN MEDICAID
JOPARI CAREWORKS J1410 States unavailable for JOPARI CAREWORKS
UPMC DENTAL ADVANTAGE 23281 States unavailable for UPMC DENTAL ADVANTAGE
MI UFCW UNIONS AND EMPLOYERS HEALTH AND WELFARE FUND 27401 States unavailable for MI UFCW UNIONS AND EMPLOYERS HEALTH AND WELFARE FUND
MEDICAID OF OHIO CKOH1 States unavailable for MEDICAID OF OHIO
PRIME WEST HEALTH LX049 States unavailable for PRIME WEST HEALTH
MASS HEALTH AND HEALTH SAFETY NET CKMA1 States unavailable for MASS HEALTH AND HEALTH SAFETY NET
TRANSCHOICE 37284 States unavailable for TRANSCHOICE
MAINE MEDICAID (MAINECARE) CKME1 States unavailable for MAINE MEDICAID (MAINECARE)
UMWA Health & Retirement Funds 52180 States unavailable for UMWA Health & Retirement Funds
MEDICAL ASSOCIATES HEALTH PLAN / PREFERRED HEALTH CHOICE MAHC1 States unavailable for MEDICAL ASSOCIATES HEALTH PLAN / PREFERRED HEALTH CHOICE
WELLS FARGO THIRD PARTYT ADMINISTRATORS 87815 States unavailable for WELLS FARGO THIRD PARTYT ADMINISTRATORS
DELTA DENTAL OF IDAHO 82029 States unavailable for DELTA DENTAL OF IDAHO
MEDICAID OF CALIFORNIA 94146 States unavailable for MEDICAID OF CALIFORNIA
BLUE CROSS BLUE SHIELD OF MISSISSIPPI CBMS1 States unavailable for BLUE CROSS BLUE SHIELD OF MISSISSIPPI
POMCO 16111 States unavailable for POMCO
MEDICAID OF FLORIDA CKFL1 States unavailable for MEDICAID OF FLORIDA
SURENCY LIFE AND HEALTH CX088 States unavailable for SURENCY LIFE AND HEALTH
PREFFEREDONE 41147 States unavailable for PREFFEREDONE
MAPFRE PRFRE States unavailable for MAPFRE
WilsonMcShane R7002 States unavailable for WilsonMcShane
UNITED HEALTHCARE COMMUNITY PLAN GP133 States unavailable for UNITED HEALTHCARE COMMUNITY PLAN
WELFARE & PENSION ADMINISTRATION SERVICES 91136 States unavailable for WELFARE & PENSION ADMINISTRATION SERVICES
SHEFFIELD / OLSON AND MCQUEEN 41143 States unavailable for SHEFFIELD / OLSON AND MCQUEEN
MEDICO INSURANCE COMPANY 23160 States unavailable for MEDICO INSURANCE COMPANY
ARKANSAS MEDICAID CKAR1 States unavailable for ARKANSAS MEDICAID
TOTAL DENTAL ADMINISTRATORS CX112 States unavailable for TOTAL DENTAL ADMINISTRATORS
SOUTHERN BENEFITS ADMINISTRATION INC 38242 States unavailable for SOUTHERN BENEFITS ADMINISTRATION INC
MAYO CLINIC HEALTH SOLUTIONS 41154 States unavailable for MAYO CLINIC HEALTH SOLUTIONS
SECURE HEALTHPLANS OF GEORGIA 28530 States unavailable for SECURE HEALTHPLANS OF GEORGIA
LOUISIANA BLUE CROSS BLUE SHIELD 23739 States unavailable for LOUISIANA BLUE CROSS BLUE SHIELD
ASSURANT HEALTH / TIME INSURANCE COMPANY 39065 States unavailable for ASSURANT HEALTH / TIME INSURANCE COMPANY
NIPPON LIFE INSURANCE COMPANY OF AMERICA 81264 States unavailable for NIPPON LIFE INSURANCE COMPANY OF AMERICA
BLUE CROSS BLUE SHIELD OF KANSAS CITY MISSOURI 47171 States unavailable for BLUE CROSS BLUE SHIELD OF KANSAS CITY MISSOURI
AETNA BETTER HEALTH® OF KENTUCKY 128KY States unavailable for AETNA BETTER HEALTH® OF KENTUCKY
MONTANA MEDICAID CKMT1 States unavailable for MONTANA MEDICAID
NATIONAL ELEVATOR INDUSTRY HEALTH BENEFIT PLAN CX045 States unavailable for NATIONAL ELEVATOR INDUSTRY HEALTH BENEFIT PLAN
WASHINGTON BLUE CROSS BLUE SHIELD (PREMERA) 47570 States unavailable for WASHINGTON BLUE CROSS BLUE SHIELD (PREMERA)
NEW HAMPSHIRE MEDICAID CKNH1 States unavailable for NEW HAMPSHIRE MEDICAID
MED3000 EM205 States unavailable for MED3000
SIERRA HEALTH AND LIFE 76342 States unavailable for SIERRA HEALTH AND LIFE