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
WASHINGTON MEDICAID CKWA1 States unavailable for WASHINGTON MEDICAID
VERMONT MEDICAID CKVT1 States unavailable for VERMONT MEDICAID
UTAH MEDICAID CKTU1 States unavailable for UTAH MEDICAID
TEXAS MEDICAID CKTX1 States unavailable for TEXAS MEDICAID
Triple-S CBPR1 States unavailable for Triple-S
SHEFFIELD / OLSON AND MCQUEEN 41143 States unavailable for SHEFFIELD / OLSON AND MCQUEEN
NEW YORK MEDICAID CKNY1 States unavailable for NEW YORK MEDICAID
NEVADA MEDICAID CKNV1 States unavailable for NEVADA MEDICAID
NEBRASKA MEDICAID CKNE1 States unavailable for NEBRASKA MEDICAID
NORTH DAKOTA BLUE CROSS CX004 States unavailable for NORTH DAKOTA BLUE CROSS
MINNESOTA MEDICAID CKMN1 States unavailable for MINNESOTA MEDICAID
MICHIGAN MEDICAID CKMI1 States unavailable for MICHIGAN MEDICAID
Kentucky Medicaid CKKY1 States unavailable for Kentucky Medicaid
Idaho Medicaid CKID1 States unavailable for Idaho Medicaid
HEALTH PARTNERS CX009 States unavailable for HEALTH PARTNERS
GEORGIA MEDICAID CKGA1 States unavailable for GEORGIA MEDICAID
Florida Medicaid CKFL1 States unavailable for Florida Medicaid
ENVOLVE HEALTH 46278 States unavailable for ENVOLVE HEALTH
ECHO Health Inc. 58379 States unavailable for ECHO Health Inc.
DESERET MUTUAL BENEFIT ADMINISTRATORS CX089 States unavailable for DESERET MUTUAL BENEFIT ADMINISTRATORS
Delaware Medicaid CKDE1 States unavailable for Delaware Medicaid
Alabama Medicaid CKAL1 States unavailable for Alabama Medicaid
Adventist Health 95340 States unavailable for Adventist Health
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
Assertus Payers PRADV States unavailable for Assertus Payers
MAPFRE PRFRE States unavailable for MAPFRE
WEST VIRGINIA MEDICAID CKWV1 States unavailable for WEST VIRGINIA MEDICAID
WELFARE & PENSION ADMINISTRATION SERVICES 91136 States unavailable for WELFARE & PENSION ADMINISTRATION SERVICES
WISCONSIN MEDICAID CKWI1 States unavailable for WISCONSIN MEDICAID
WilsonMcShane R7002 States unavailable for WilsonMcShane
DELTA DENTAL OF WISCONSIN 39069 States unavailable for DELTA DENTAL OF WISCONSIN
WELLS FARGO THIRD PARTYT ADMINISTRATORS 87815 States unavailable for WELLS FARGO THIRD PARTYT ADMINISTRATORS
WELLS FARGO TPA 37272 States unavailable for WELLS FARGO TPA
WEBTPA 59332 States unavailable for WEBTPA
DELTA DENTAL OF WASHINGTON 91062 States unavailable for DELTA DENTAL OF WASHINGTON
WASHINGTON BLUE CROSS BLUE SHIELD (PREMERA) 47570 States unavailable for WASHINGTON BLUE CROSS BLUE SHIELD (PREMERA)
WASHINGTON, D.C. MEDICAID CKDC1 States unavailable for WASHINGTON, D.C. MEDICAID
VA FEE BASIS PROGRAMS 12116 States unavailable for VA FEE BASIS PROGRAMS
DELTA DENTAL OF VIRGINIA CDVA1 States unavailable for DELTA DENTAL OF VIRGINIA
UPMC DENTAL ADVANTAGE 23281 States unavailable for UPMC DENTAL ADVANTAGE
UNITED HEALTHCARE COMMUNITY PLAN GP133 States unavailable for UNITED HEALTHCARE COMMUNITY PLAN
UMWA Health & Retirement Funds 52180 States unavailable for UMWA Health & Retirement Funds
UNITEDHEALTH GROUP 52133 States unavailable for UNITEDHEALTH GROUP
UNITED CONCORDIA CX007 States unavailable for UNITED CONCORDIA
TRANSCHOICE 37284 States unavailable for TRANSCHOICE
Renaissance Life and Health RLHA1 States unavailable for Renaissance Life and Health
TOTAL DENTAL ADMINISTRATORS CX112 States unavailable for TOTAL DENTAL ADMINISTRATORS
SURENCY LIFE AND HEALTH CX088 States unavailable for SURENCY LIFE AND HEALTH
SUN LIFE AND HEALTH INSURANCE COMPANY 67814 States unavailable for SUN LIFE AND HEALTH INSURANCE COMPANY
SOUTHERN BENEFITS ADMINISTRATION INC 38242 States unavailable for SOUTHERN BENEFITS ADMINISTRATION INC
SIERRA HEALTH AND LIFE 76342 States unavailable for SIERRA HEALTH AND LIFE
SELECT HEALTH CX107 States unavailable for SELECT HEALTH
Securian 93742 States unavailable for Securian
SECURE HEALTHPLANS OF GEORGIA 28530 States unavailable for SECURE HEALTHPLANS OF GEORGIA
BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA 38520 States unavailable for BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA
REGENCE CB850 States unavailable for REGENCE
PRIORITY HEALTH 38217 States unavailable for PRIORITY HEALTH
PRINCIPAL FINANCIAL 61271 States unavailable for PRINCIPAL FINANCIAL
PRIME WEST HEALTH LX049 States unavailable for PRIME WEST HEALTH
PREFERRED CARE PARTNERS 65088 States unavailable for PREFERRED CARE PARTNERS
POMCO 16111 States unavailable for POMCO
HSBS MEMPHIS 37224 States unavailable for HSBS MEMPHIS
PUBLIC EMPLOYEES HEALTH PROGRAM (PEHP) CX080 States unavailable for PUBLIC EMPLOYEES HEALTH PROGRAM (PEHP)
MEDICAID OF PENNSYLVANIA CKPA1 States unavailable for MEDICAID OF PENNSYLVANIA
Oklahoma Medicaid CKOK1 States unavailable for Oklahoma Medicaid
DELTA DENTAL OF OKLAHOMA CDOK1 States unavailable for DELTA DENTAL OF OKLAHOMA
OK STATE EMPLOYEES & EDUCATORS 22521 States unavailable for OK STATE EMPLOYEES & EDUCATORS
MEDICAID OF OHIO CKOH1 States unavailable for MEDICAID OF OHIO
MEDICAL MUTUAL OF OHIO CB833 States unavailable for MEDICAL MUTUAL OF OHIO
NYS DOH UCP 14142 States unavailable for NYS DOH UCP
DELTA DENTAL OF NEW JERSEY 22189 States unavailable for DELTA DENTAL OF NEW JERSEY
HORIZON HEALTHCARE DENTAL SERVICES 22099 States unavailable for HORIZON HEALTHCARE DENTAL SERVICES
NIPPON LIFE INSURANCE COMPANY OF AMERICA 81264 States unavailable for NIPPON LIFE INSURANCE COMPANY OF AMERICA
NEW HAMPSHIRE MEDICAID CKNH1 States unavailable for NEW HAMPSHIRE MEDICAID
BLUE CROSS OF NEBRASKA CBNE1 States unavailable for BLUE CROSS OF NEBRASKA
NATIONAL ELEVATOR INDUSTRY HEALTH BENEFIT PLAN CX045 States unavailable for NATIONAL ELEVATOR INDUSTRY HEALTH BENEFIT PLAN
MUTUAL OF OMAHA INSURANCE COMPANY 71412 States unavailable for MUTUAL OF OMAHA INSURANCE COMPANY
MUNICIPAL HEALTH BENEFIT FUND 81883 States unavailable for MUNICIPAL HEALTH BENEFIT FUND
MONTANA MEDICAID CKMT1 States unavailable for MONTANA MEDICAID
BLUE CROSS BLUE SHIELD OF MISSISSIPPI CBMS1 States unavailable for BLUE CROSS BLUE SHIELD OF MISSISSIPPI
MISSOURI MEDICAID CKMO1 States unavailable for MISSOURI MEDICAID
MAYO CLINIC HEALTH SOLUTIONS 41154 States unavailable for MAYO CLINIC HEALTH SOLUTIONS
DELTA DENTAL OF MICHIGAN AND AFFILIATED PAYERS CDMI0 States unavailable for DELTA DENTAL OF MICHIGAN AND AFFILIATED PAYERS
MI UFCW UNIONS AND EMPLOYERS HEALTH AND WELFARE FUND 27401 States unavailable for MI UFCW UNIONS AND EMPLOYERS HEALTH AND WELFARE FUND
MetLife and SafeGuard PPO 65978 States unavailable for MetLife and SafeGuard PPO
MERCY MARICOPA 33628 States unavailable for MERCY MARICOPA
MAINE MEDICAID (MAINECARE) CKME1 States unavailable for MAINE MEDICAID (MAINECARE)
HEALTHMARKETS 59226 States unavailable for HEALTHMARKETS
MEDICO INSURANCE COMPANY 23160 States unavailable for MEDICO INSURANCE COMPANY
MEDCOST BENEFIT SERVICES (MBS) 56205 States unavailable for MEDCOST BENEFIT SERVICES (MBS)
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. dba MEDBEN 74323 States unavailable for MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. dba MEDBEN
MED3000 EM205 States unavailable for MED3000
MEDICAL ASSOCIATES HEALTH PLAN / PREFERRED HEALTH CHOICE MAHC1 States unavailable for MEDICAL ASSOCIATES HEALTH PLAN / PREFERRED HEALTH CHOICE
MASS HEALTH AND HEALTH SAFETY NET CKMA1 States unavailable for MASS HEALTH AND HEALTH SAFETY NET
DELTA DENTAL MA 04614 States unavailable for DELTA DENTAL MA
MASSACHUSETTS BLUE CROSS BLUE SHIELD CBMA1 States unavailable for MASSACHUSETTS BLUE CROSS BLUE SHIELD
KANSAS MEDICAID CKKS1 States unavailable for KANSAS MEDICAID
DELTA DENTAL OF KANSAS CDKS1 States unavailable for DELTA DENTAL OF KANSAS
BLUE CROSS BLUE SHIELD OF KANSAS CITY MISSOURI 47171 States unavailable for BLUE CROSS BLUE SHIELD OF KANSAS CITY MISSOURI
BLUE CROSS OF KANSAS CBKS1 States unavailable for BLUE CROSS OF KANSAS
JOPARI CAREWORKS J1410 States unavailable for JOPARI CAREWORKS
JOHN ALDEN LIFE INSURANCE CO 41099 States unavailable for JOHN ALDEN LIFE INSURANCE CO
INSURANCE PROGRAM MANAGERS GROUP 36342 States unavailable for INSURANCE PROGRAM MANAGERS GROUP
DELTA DENTAL OF ILLINOIS GROUP PLANS 05030 States unavailable for DELTA DENTAL OF ILLINOIS GROUP PLANS
BLUE CROSS BLUE SHIELD ILLINOIS CB621 States unavailable for BLUE CROSS BLUE SHIELD ILLINOIS
DELTA DENTAL OF IDAHO 82029 States unavailable for DELTA DENTAL OF IDAHO
INDIANA MEDICAID AND INDIANA CHILDREN’S SPECIAL HEALTHCARE PROGRAM CX070 States unavailable for INDIANA MEDICAID AND INDIANA CHILDREN’S SPECIAL HEALTHCARE PROGRAM
DELTA DENTAL OF IOWA CDIA1 States unavailable for DELTA DENTAL OF IOWA
BLUE CROSS OF IOWA CBIA2 States unavailable for BLUE CROSS OF IOWA
HAWAII WESTERN MANAGEMENT ASSOCIATION 99208 States unavailable for HAWAII WESTERN MANAGEMENT ASSOCIATION
HUMANA INC. 61101 States unavailable for HUMANA INC.
HAWAII-MAINLAND ADMINISTRATORS, LLC 86066 States unavailable for HAWAII-MAINLAND ADMINISTRATORS, LLC
HEALTHSCOPE BENEFITS, INC 71063 States unavailable for HEALTHSCOPE BENEFITS, INC
HEALTHPLEX 11271 States unavailable for HEALTHPLEX
HEALTHGRAM a.k.a. PRIMARY PHYSICIANS CARE 56144 States unavailable for HEALTHGRAM a.k.a. PRIMARY PHYSICIANS CARE
HEALTH CHOICE 62179 States unavailable for HEALTH CHOICE
CIGNA HEALTHCARE / CONNECTICUT GENERAL / EQUICOR / GREAT-WEST HEALTHCARE 80705 States unavailable for CIGNA HEALTHCARE / CONNECTICUT GENERAL / EQUICOR / GREAT-WEST HEALTHCARE
GUARDIAN LIFE INSURANCE COMPANY 64246 States unavailable for GUARDIAN LIFE INSURANCE COMPANY
GILSBAR, INC. 07205 States unavailable for GILSBAR, INC.
GOVERNMENT EMPLOYEES HOSPITAL ASSOCIATION (GEHA) 44054 States unavailable for GOVERNMENT EMPLOYEES HOSPITAL ASSOCIATION (GEHA)
FISERV HEALTH – WAUSAU BENEFITS / BENESIGHT 39026 States unavailable for FISERV HEALTH – WAUSAU BENEFITS / BENESIGHT
EVERGREEN HEALTH CO-OP 93240 States unavailable for EVERGREEN HEALTH CO-OP
EMI HEALTH CX079 States unavailable for EMI HEALTH
ELECTRICAL WORKERS WELFARE TRUST 52611 States unavailable for ELECTRICAL WORKERS WELFARE TRUST
Dental Network of American (DNoA) 36123 States unavailable for Dental Network of American (DNoA)
DISTRICT 9 MACHINISTS WELFARE TRUST MWELT States unavailable for DISTRICT 9 MACHINISTS WELFARE TRUST
DENTI-CAL / MEDICAID OF CALIFORNIA 94146 States unavailable for DENTI-CAL / MEDICAID OF CALIFORNIA
DENTAQUEST CX014 States unavailable for DENTAQUEST
DENTAL SELECT CX093 States unavailable for DENTAL SELECT
DECARE NETWORKS 7035 States unavailable for DECARE NETWORKS
DART CONTAINER CORP., DELTA DENTAL OF MI, OH, IN, TN, NM, NC, GROUP BENEFITS ADMIN OF TN, MUTUAL O OMAHA, RENAISSANCE LIFE & HEALTH AND DELTA DENTAL OF CALIFORNIA/TRICARE RETIREE DENTAL 06172 States unavailable for DART CONTAINER CORP., DELTA DENTAL OF MI, OH, IN, TN, NM, NC, GROUP BENEFITS ADMIN OF TN, MUTUAL O OMAHA, RENAISSANCE LIFE & HEALTH AND DELTA DENTAL OF CALIFORNIA/TRICARE RETIREE DENTAL
CTI ADMINISTRATORS 42141 States unavailable for CTI ADMINISTRATORS
COVENTRY HEALTH CARE NATIONAL NETWORK 25133 States unavailable for COVENTRY HEALTH CARE NATIONAL NETWORK
Coventry Health Care of Florida 128FL States unavailable for Coventry Health Care of Florida
CORESOURCE MD PA IL 35182 States unavailable for CORESOURCE MD PA IL
CORESOURCE LITTLE ROCK 75136 States unavailable for CORESOURCE LITTLE ROCK
CORESOURCE AZ MN / CORESTAR / REALISTAR 41045 States unavailable for CORESOURCE AZ MN / CORESTAR / REALISTAR
CNIC HEALTH SOLUTIONS, INC 37227 States unavailable for CNIC HEALTH SOLUTIONS, INC
CHRISTUS HEALTH PLAN 45210 States unavailable for CHRISTUS HEALTH PLAN
CHAMPVA / SPINA BIFIDA – VA HAC 84147 States unavailable for CHAMPVA / SPINA BIFIDA – VA HAC
CENTRAL RESERVE LIFE 34097 States unavailable for CENTRAL RESERVE LIFE
COOPERATIVE BENEFIT ADMINISTRATORS 52132 States unavailable for COOPERATIVE BENEFIT ADMINISTRATORS
CAREFIRST 00580 States unavailable for CAREFIRST
DELTA DENTAL OF CALIFORNIA AND AFFILIATES 77777 States unavailable for DELTA DENTAL OF CALIFORNIA AND AFFILIATES
BOON ADMINISTRATIVE SERVICES, INC. BOONG States unavailable for BOON ADMINISTRATIVE SERVICES, INC.
BENEFITS ADMINISTRATION CORPORATION INC 44357 States unavailable for BENEFITS ADMINISTRATION CORPORATION INC
DELTA DENTAL OF MINNESOTA CDMN1 States unavailable for DELTA DENTAL OF MINNESOTA
DELTA DENTAL OF ARIZONA 86027 States unavailable for DELTA DENTAL OF ARIZONA
ARIZONA BCBS 53589 States unavailable for ARIZONA BCBS
ASSURANT HEALTH / TIME INSURANCE COMPANY 39065 States unavailable for ASSURANT HEALTH / TIME INSURANCE COMPANY
ARKANSAS MEDICAID CKAR1 States unavailable for ARKANSAS MEDICAID
DART CONTAINER CORP., DELTA DENTAL OF MI, OH, IN, TN, NM, NC, NE,GROUP BENEFITS ADMIN OF TN, MUTUAL O OMAHA, AND RENAISSANCE LIFE & HEALTH 06172 States unavailable for DART CONTAINER CORP., DELTA DENTAL OF MI, OH, IN, TN, NM, NC, NE,GROUP BENEFITS ADMIN OF TN, MUTUAL O OMAHA, AND RENAISSANCE LIFE & HEALTH
ANTHEM BCBS INS. COMPANIES 84105 States unavailable for ANTHEM BCBS INS. COMPANIES
AMERITAS 47009 States unavailable for AMERITAS
BLUE CROSS OF ALABAMA CBAL1 States unavailable for BLUE CROSS OF ALABAMA
ALASKA BLUE CROSS BLUE SHIELD (PREMERA) 47570 States unavailable for ALASKA BLUE CROSS BLUE SHIELD (PREMERA)
AETNA GDS 18014 States unavailable for AETNA GDS
AETNA BETTER HEALTH® OF WEST VIRGINIA 128WV States unavailable for AETNA BETTER HEALTH® OF WEST VIRGINIA
AETNA BETTER HEALTH® OF VIRGINIA 128VA States unavailable for AETNA BETTER HEALTH® OF VIRGINIA
AETNA BETTER HEALTH® OF OHIO 50023 States unavailable for AETNA BETTER HEALTH® OF OHIO
AETNA BETTER HEALTH® OF NEW YORK 34734 States unavailable for AETNA BETTER HEALTH® OF NEW YORK
AETNA BETTER HEALTH® OF NEBRASKA 42130 States unavailable for AETNA BETTER HEALTH® OF NEBRASKA
AETNA BETTER HEALTH® OF MICHIGAN 128MI States unavailable for AETNA BETTER HEALTH® OF MICHIGAN
AETNA BETTER HEALTH® OF LOUISIANA 128LA States unavailable for AETNA BETTER HEALTH® OF LOUISIANA
AETNA BETTER HEALTH® OF KENTUCKY 128KY States unavailable for AETNA BETTER HEALTH® OF KENTUCKY
AETNA BETTER HEALTH® OF ILLINOIS 26337 States unavailable for AETNA BETTER HEALTH® OF ILLINOIS
ACS BENEFIT SERVICES, INC. 61473 States unavailable for ACS BENEFIT SERVICES, INC.
PACIFICSOURCE HEALTH PLANS 93029 States unavailable for PACIFICSOURCE HEALTH PLANS
MEDICAID OF NORTH CAROLINA CKNC1 States unavailable for MEDICAID OF NORTH CAROLINA
NORTHEAST DELTA DENTAL 02027 States unavailable for NORTHEAST DELTA DENTAL
AETNA BETTER HEALTH ® OF NEW JERSEY 46320 States unavailable for AETNA BETTER HEALTH ® OF NEW JERSEY
MEDICAID OF WEST VIRGINIA CKWV1 States unavailable for MEDICAID OF WEST VIRGINIA
MERCY CARE PLAN 86052 States unavailable for MERCY CARE PLAN
RHODE ISLAND BLUE CROSS BLUE SHIELD FEP CB870 States unavailable for RHODE ISLAND BLUE CROSS BLUE SHIELD FEP
MONTANA BLUE CROSS BLUE SHIELD CBMT1 States unavailable for MONTANA BLUE CROSS BLUE SHIELD
MEDICAID OF CALIFORNIA 94146 States unavailable for MEDICAID OF CALIFORNIA
MEDICAID OF FLORIDA CKFL1 States unavailable for MEDICAID OF FLORIDA
PREFFEREDONE 41147 States unavailable for PREFFEREDONE
LOUISIANA BLUE CROSS BLUE SHIELD 23739 States unavailable for LOUISIANA BLUE CROSS BLUE SHIELD