Medical & Hospital Claims Enrollment Forms

​Each provider must be set up in the Change Healthcare system to submit claims. A provider can submit an enrollment form themselves, or instruct their vendor to use our self-service enrollment portal to link you to the payer(s). If your vendor does not have access to the self-service portal, please see our category table below.

Step One: Specific payers require additional EDI enrollment paperwork to be completed for submission of claims. Please check the Change Healthcare Payer List for each payers EDI Enrollment Requirements.
Step Two: If EDI paperwork is required by a payer, you must receive an approval from the payer prior to submitting claims. Claims submitted without prior approval will be rejected.

***NOTE: If hard-copy forms are submitted by a vendor that has on-line access to the Change Healthcare portal, the hard-copy forms will be rejected.


Claims Payer Enrollment Forms

Title Payer ID States
PRIMARY CARE ASSOCIATES of CALIFORNIA - PCACZ - PROF CLAIMS PCACZ California
ALAMITOS IPA COASTAL HEALTHCARE MANAGEMENT - AIPAZ - PROF CLAIMS AIPAZ States unavailable for ALAMITOS IPA COASTAL HEALTHCARE MANAGEMENT - AIPAZ - PROF CLAIMS
VIRGINIA PREMIER MEDICARE ADVANTAGE - MAPD - VPMAD - PROF CLAIMS VPMAD Virginia
VIRGINIA PREMIER MEDICARE ADVANTAGE - MAPD - VPMAD - INST CLAIM VPMAD Virginia
California Medicaid "Claimmaster Clients Only" - 57016 - Inst Claim 57016 California
California Medicaid - 57016 - Inst Claims 57016 California
VIRGINIA PREMIER COMPLETECARE - VPCCI - PROF CLAIM VP[CCI Virginia
VIRGINIA PREMIER COMPLETECARE - VPCCI - INST CLAIMS VPCCI Virginia
Utah Medicaid - SKUT0 - Prof Claims SKUT0 Utah
DMERC Region A - SDMEA - Prof Claims SDMEA Connecticut , Maine , Massachusetts , New Hampshire , New Jersey , New York , Pennsylvania , Rhode Island , Vermont
DMERC Region B - SDMEB - Prof Claims SDMEB Illinois , Indiana , Michigan , Minnesota , Ohio , Virginia , West Virginia , Wisconsin
DMERC Region C - SDMEC - Prof Claim SDMEC Alabama , Arkansas , Colorado , Florida , Georgia , Kentucky , Louisiana , Mississippi , New Mexico , North Carolina , Oklahoma , Puerto Rico , South Carolina , Tennessee , Texas
DMERC Region D - SDMED - Prof Clams SDMED Arizona , California , Idaho , Iowa , Kansas , Missouri , Montana , Nebraska , Nevada , North Dakota , Oregon , South Dakota , Utah , Washington , Wyoming
HUMAN ARC - 34818 - INST CLAIMS 34818 States unavailable for HUMAN ARC - 34818 - INST CLAIMS
CONTRA COSTA HEALTH PLAN - CNTRA - PROF CLAIMS CNTRA States unavailable for CONTRA COSTA HEALTH PLAN - CNTRA - PROF CLAIMS
CONTRA COSTA HEALTH PLAN - CNTRA - INST CLAIMS CNTRA States unavailable for CONTRA COSTA HEALTH PLAN - CNTRA - INST CLAIMS
NEW YORK HOTEL FUND - 7707C - PROF CLAIMS 7707C New York
Nebraska Medicaid - 12K19 - Inst Claims 12K19 Nebraska
Pennsylvania Blue Card Par Point of Service - SX168 - Prof Claim SX168 Pennsylvania
Highmark Senior Solution - 95461 - Inst Claims 95461 West Virginia
Highmark Senior Solution - 95461 - Prof Claim 95461 States unavailable for Highmark Senior Solution - 95461 - Prof Claim
Nebraska Medicaid - SKNE0 - Prof Claim SKNE0 Nebraska
Tricare Overseas - SX163 - Prof Claims SX163 States unavailable for Tricare Overseas - SX163 - Prof Claims
Tennessee BCBS (Memphis) - SB892 - PROF CLAIMS SB892 Tennessee
HUMAN ARC - 34818 - PROF Claims 34818 States unavailable for HUMAN ARC - 34818 - PROF Claims
HIGHMARK SENIOR HEALTH - 95462 - INST CLAIM 95462 States unavailable for HIGHMARK SENIOR HEALTH - 95462 - INST CLAIM
EYEMED VISION CARE - 85431 - PROF CLAIMS 85431 States unavailable for EYEMED VISION CARE - 85431 - PROF CLAIMS
VIRGINIA PREMIER ELITE PLUS (MLTSS) - MLTSS - PROF CLAIMS MLTSS Virginia
VIRGINIA PREMIER ELITE PLUS (MLTSS) - MLTSS - INST CLAIMS MLTSS Virginia
WA State Dept of Labor and Industry - SX063 - INST Claims SX063 Washington
Tricare East - 68299 - Institutional Claims 68299 Alabama , Arkansas , Connecticut , Delaware , Florida , Georgia , Illinois , Indiana , Kentucky , Louisiana , Maine , Maryland , Massachusetts , Michigan , Mississippi , New Hampshire , New Jersey , New York , North Carolina , Ohio , Oklahoma , Pennsylvania , Rhode Island , South Carolina , Tennessee , Texas , Vermont , Virginia , West Virginia , Wisconsin
Tricare East - 68299 - Professional Claims 68299 Alabama , Arkansas , Connecticut , Delaware , Florida , Georgia , Illinois , Indiana , Kentucky , Louisiana , Maine , Maryland , Massachusetts , Michigan , Mississippi , New Hampshire , New Jersey , New York , North Carolina , Ohio , Oklahoma , Pennsylvania , Rhode Island , South Carolina , Tennessee , Texas , Vermont , Virginia , West Virginia , Wisconsin
Deseret Mutual - 12X35 - INST Claims 12X35 States unavailable for Deseret Mutual - 12X35 - INST Claims
GUILDNET - GLDNT - INST CLAIMS GLDNT States unavailable for GUILDNET - GLDNT - INST CLAIMS
ALOHACARE ADVANTAGE - ALOHA - INST CLAIMS ALOHA Hawaii
Georgia Medicare - SMGA0 - Prof Claim SMGA0 Georgia
Tennessee Blue Cross Blue Sheild - SB890 - Prof Claims SB890 Tennessee
Alabama Medicare - SMAL0 - Prof Claim SMAL0 Alabama
Tennessee Medicare - SMTN0 - Prof Claim SMTN0 Tennessee
Vermont Medicaid - SKVT0 - Prof Claims SKVT0 Vermont
Triple-S - SB980 - Prof Claim SB980 Puerto Rico
Hawaii BCBS - 12B62 - Inst Claims 12B62 States unavailable for Hawaii BCBS - 12B62 - Inst Claims
Deseret Mutual - SX105 - Prof Claims SX105 States unavailable for Deseret Mutual - SX105 - Prof Claims
Colorado Medicaid - 12K03 - Inst Claims 12K03 Colorado
Louisiana Medicaid - Ambulance claims - SKLA2 - PROF CLAIMS SKLA2 States unavailable for Louisiana Medicaid - Ambulance claims - SKLA2 - PROF CLAIMS
Louisiana Medicaid - DME Claims - SKLA1 - PROF CLAIMS SKLA1 Louisiana
South Dakota Medicare - 12M83 - Inst Claim 12M83 South Dakota
New Jersey Medicare - 12005 - Inst Claim 12005 New Jersey
Vermont Medicare - 12M26 - Inst Claims 12M26 Vermont
TriWest VAPC3 Region 3 - 55912 - Inst Claims 55912 States unavailable for TriWest VAPC3 Region 3 - 55912 - Inst Claims
Mississippi Medicare – SMMS0 – Prof Claim SMMS0 Mississippi
Massachusetts Medicare - SMMA0 - Prof Claims SMMA0 Massachusetts
Legacy Medicare WPS J5 - 52280 - Inst Claims 52280 Iowa , Kansas , Michigan , Missouri , Nebraska
Indiana State Dept of Health/CSHCS - 35600 - Prof Claims 35600 Indiana
HealthPlus of Michigan - 38216 - Prof Claims 38216 Michigan
Florida Medicaid - SKFL0 - Prof Claims SKFL0 Florida
Colorado Medicaid - SKCO0 - Prof Claims SKCO0 Colorado
AK & ID Medicare - 12M07 - Inst Claim 12M07 Alaska , Idaho
J1 MUTUAL of OMAHA CA, HI, NV - 12M64 - INST CLAIM 12M64 California , Hawaii , Nevada
RHHI Home Health Region V - Service Area 7 - 12HHA - Inst Claims 12HHA States unavailable for RHHI Home Health Region V - Service Area 7 - 12HHA - Inst Claims
TriWest VAPC3 Region 6 - 55917 - Prof Claims 55917 States unavailable for TriWest VAPC3 Region 6 - 55917 - Prof Claims
TriWest VAPC3 Region 6 - 55917 - Inst Claims 55917 States unavailable for TriWest VAPC3 Region 6 - 55917 - Inst Claims
Aloha Advantage - ALOHA - Prof Claims ALOHA Hawaii
Alliance Behavioral Healthcare - 23071- Institutional Claims 23071 States unavailable for Alliance Behavioral Healthcare - 23071- Institutional Claims
Tricare West - 12C01 - Inst Claims 12C01 States unavailable for Tricare West - 12C01 - Inst Claims
Massachusetts Medicaid - 12K14 - Inst Claims 12K14 Massachusetts
New Mexico Medicare - 12M22 - Inst Claim 12M22 New Mexico
FTP TSO Request Form Payer ID unavailable for FTP TSO Request Form States unavailable for FTP TSO Request Form
South Carolina Medicare - SMSC0 - Prof Claims SMSC0 South Carolina
West Virginia Medicare - SMWV0 - Prof Claims SMWV0 West Virginia
North Carolina Medicare - SMNC0 - Prof Claims SMNC0 North Carolina
Virginia Medicare - SMVA0 - Prof Claims SMVA0 Virginia
California Medi-Cal Vision - SKCA1 - Prof Claim SKCA1 California
District of Columbia Medicaid - SKDC0 - Prof Claim SKDC0 District of Columbia
Louisiana Medicare - SMLA0 - Prof Claims SMLA0 Louisiana
Arkansas Medicare - SMAR0 - Prof Claim SMAR0 Arkansas
Delaware Medicare - SMDE0 - Prof Claim SMDE0 Delaware
District of Columbia Medicare - SMDC0 - Prof Claim SMDC0 District of Columbia
Maryland Medicare - SMMD0 - Prof Claim SMMD0 Maryland
New Jersey Medicare - SMNJ0 - Prof Claim SMNJ0 New Jersey
Pennsylvania Medicare – SMPA0 – Prof Claim SMPA0 Pennsylvania
Blue Care Network - SB711 - Prof Claims SB711 Michigan
Blue Cross Blue Shield Mississippi State and Teacher Employees - SB731 - Prof Claims SB731 Mississippi
Mississippi BCBS - SB730 - Prof Claims SB730 Mississippi
Penn Behavioral Health - 53226 - Prof Claims 53226 States unavailable for Penn Behavioral Health - 53226 - Prof Claims
Amerihealth HMO New Jersey and Delaware - 23037 - Prof Claims 23037 Delaware , New Jersey
Amerihealth New Jersey Non HMO - SX075 - Prof Claims SX075 New Jersey
Amerihealth Delaware Non HMO - SX074 - Prof Claims SX074 States unavailable for Amerihealth Delaware Non HMO - SX074 - Prof Claims
Oregon Medicaid - SKOR0 - Prof Claim SKOR0 Oregon
Louisiana Medicaid - SKLA0 - Prof Claims SKLA0 Louisiana
Nevada Medicaid - SKNV0 - Prof Claims SKNV0 Nevada
Virgin Island Medicare - SMVI0 - Prof Claims SMVI0 Virgin Islands
Puerto Rico Medicare - SMPR0 - Prof Claim SMPR0 Puerto Rico
WA State Dept of Labor and Industry - SX063 - Prof Claims SX063 Washington
New York Medicare Upstate - Western - SMNY1 - Prof Claim SMNY1 New York
Connecticut Medicare - SMCT0 - Prof Claim SMCT0 Connecticut
Illinois Medicare - SMIL0 - Prof Claim SMIL0 Illinois
Vermont Medicare - SMVT0 - Prof Claims SMVT0 Vermont
New Hampshire Medicare - SMNH0 - Prof Claims SMNH0 New Hampshire
Michigan Medicare - SMMI0 - Prof Claim SMMI0 Michigan
Iowa Medicare - SMIA0 - Prof Claim SMIA0 Iowa
Kansas Medicare - SMKS0 - Prof Claim SMKS0 Kansas
Missouri Medicare - SMMO0 - Prof Claim SMMO0 Missouri
Indiana Medicare - SMIN0 - Prof Claim SMIN0 Indiana
WPS Commercial - SX022 - Prof Claims SX022 States unavailable for WPS Commercial - SX022 - Prof Claims
TriCare West - SCWI0 - Prof Claims SCWI0 Alaska , Arizona , California , Colorado , Hawaii , Idaho , Iowa , Kansas , Minnesota , Missouri , Montana , Nebraska , Nevada , North Dakota , Oregon , South Dakota , Utah , Washington , Wyoming
Inter-County Health Plan - SX079 - Prof Claims SX079 Pennsylvania
Ohio Medicare - SMOH0 - Prof Claims SMOHO Ohio
Kentucky Medicare - SMKY0 - Prof Claims SMKY0 Kentucky
Maryland Behavioral Health - SX069 - Prof Claims SX069 Maryland
Hawaii Medicaid Waivers - 77059 - Prof Claims 77059 Hawaii
California Medicare South - SMCA2 - Prof Claims SMCA2 California
California Medicare - SMCA1 - Prof Claims SMCA1 California
Kentucky Medicaid - SKKY0 - Prof Claims SKKY0 Kentucky
HealthPartners Minnesota - SX009 - Prof Claims SX009 Minnesota
Nebraska Medicare - SMNE0 - Prof Claim SMNE0 States unavailable for Nebraska Medicare - SMNE0 - Prof Claim
South Dakota Medicaid - SKSD0 - Prof Claim SKSD0 South Dakota
Georgia Medicaid - SKGA0 - Professional Claims SKGA0 Georgia
South Dakota BCBS - SB889 - Prof Claims SB889 South Dakota
South Dakota Medicare - SMSD0 - Prof Claims SMSD0 South Dakota
Montana Medicare - SMMT0 - Prof Claim SMMT0 Montana
Michigan BCBS - SB710 - Prof Claim SB710 Michigan
Mississippi Medicaid - SKMS0 - Prof Claims SKMS0 Mississippi
Arkansas BCBS - SB520 - Prof Claims SB520 Arkansas
Medicare Plus Blue - SX170 - Prof Claim SX170 States unavailable for Medicare Plus Blue - SX170 - Prof Claim
West Virginia BCBS - SB941 - Prof Claims SB941 West Virginia
Pennsylvania BCBS - SB865 - Prof Claims SB865 Pennsylvania
Rhode Island Medicaid Enrollment - SKRI0 - Prof Claims SKRI0 Rhode Island
Independence Administrators - TA720- Prof Claims TA720 States unavailable for Independence Administrators - TA720- Prof Claims
IBC Personal Choice - SX083 - Prof Claim SX083 States unavailable for IBC Personal Choice - SX083 - Prof Claim
Keystone Health Plan East - SX055 - Prof Claims SX055 States unavailable for Keystone Health Plan East - SX055 - Prof Claims
Massachusetts Medicaid - SKMA0 - Pro Claims SKMA0 Massachusetts
Minnesota Medicaid - SKMN0 - Prof Claims SKMN0 Minnesota
Delaware BCBS - SB570 - Prof Claim SB570 Delaware
PEHP - SX106 - Prof Claims SX106 States unavailable for PEHP - SX106 - Prof Claims
North Carolina Medicaid - SKNC0 - Prof Claim SKNC0 North Carolina
Idaho Blue Cross - SB612 - Prof Claims SB612 Idaho
Louisiana BCBS - 23738 - Prof Claims 23738 Louisiana
University Health Alliance - 99026 - Prof Claims 99026 States unavailable for University Health Alliance - 99026 - Prof Claims
Partnership Health Plan of CA CAPHP - SX140 - Prof Claims SX140 California
Alaska Medicaid - SKAK0 - Prof Claims SKAK0 Alaska
Tennessee Medicaid - SKTN2 - Prof Claims SKTN2 Tennessee
Maryland Medicare - 12010 - Inst Claim 12010 Maryland
DC Medicare - 12M63 - Inst Claims 12M63 District of Columbia
Delaware Medicare - 12M76 - Inst Claims 12M76 Delaware
Pennsylvania Medicare - 12M60 - Inst Claim 12M60 Pennsylvania
Mississippi BLUE CROSS - 12B17 - Inst Claims 12B17 Mississippi
Home Health & Hospice J11 - 12M80 - Inst Claim 12M80 Alabama , Arkansas , Florida , Georgia , Illinois , Indiana , Kentucky , Louisiana , Mississippi , New Mexico , North Carolina , Ohio , Oklahoma , South Carolina , Tennessee , Texas
South Carolina Medicare - 12M55 - Inst Claims 12M55 South Carolina
District of Columbia Medicaid - 12001 - Inst Claim 12001 District of Columbia
Amerihealth HMO Administrators NJ and DE - 23037 - Inst Claims 23037 Delaware , New Jersey
Oregon Medicaid - 12K41 - Inst Claims 12K41 Oregon
Louisiana Medicaid - 12K12 - Inst Claim 12K12 Louisiana
Tennessee Medicare - 12M53 - Inst Claims 12M53 Tennessee
Georgia Medicare - 12M05 - Inst Claim 12M05 Georgia
Alabama Medicare - 12M01 - Inst Claim 12M01 Alabama
Arkansas Medicare - 12022 - Inst Claim 12022 Arkansas
Mississippi Medicare - 12M17 - Inst Claim 12M17 Mississippi
Oklahoma Medicare - 12M37 - Inst Claims 12M37 Oklahoma
Colorado Medicare - 12M03 - Inst Claim 12M03 Colorado
Texas Medicare - 12M31 - Inst Claim 12M31 Texas
Louisiana Medicare - 12M12 - Inst Claims 12M12 Louisiana
Legacy Medicare - CO - TX - NM - OK – J40911 - 12M88 - Inst Claim 12M88 Colorado , New Mexico , Oklahoma , Texas
Virginia Medicare - 12004 – Inst Claims 12004 Virginia
Wisconsin Medicare & FQHC - 12M29 - Inst Claims 12M29 Wisconsin
Medicare Home Health & Hospice - 12HHA - Inst Claims 12HHA Alaska , American Samoa , Arizona , California , Guam , Hawaii , Idaho , Michigan , Minnesota , Nevada , New Jersey , New York , Northern Marianas , Oregon , Puerto Rico , Virgin Islands , Washington , Wisconsin
Massachusetts Medicare - 12M14 - Inst Claims 12M14 Massachusetts
Amerihealth PPO NJ - 12X28 - Inst Claims 12X28 New Jersey
WPS Health Insurance - 12X29 - Inst Claim 12X29 States unavailable for WPS Health Insurance - 12X29 - Inst Claim
PEHP - 12X36 - Inst Claims 12X36 States unavailable for PEHP - 12X36 - Inst Claims
CGS Home Health - 12M97 - Inst Claim 12M97 Alabama , Colorado , Delaware , District of Columbia , Iowa , Kansas , Maryland , Missouri , Montana , Nebraska , North Dakota , Pennsylvania , South Dakota , Utah , Virginia , West Virginia , Wyoming
Kentucky Medicare - 12M11 - Inst Claim 12M11 Kentucky
Hawaii Medicare - 12M64 - Inst Claim 12M64 Hawaii
California Medicare - 12M64 - Inst Claim 12M64 California
Nevada Medicare - 12M64 - Inst Claim 12M64 Nevada
Kentucky Medicaid - 12K11 - Inst Claims 12K11 Kentucky
Michigan Medicare - 12M18 - Inst Claim 12M18 Michigan
Indiana Medicare - 12M09 - Inst Claims 12M09 Indiana
Nebraska Medicare - 12M19 - Inst Claims 12M19 Nebraska
Missouri Medicare - 12M15 - Inst Claim 12M15 Missouri
Kansas Medicare - 57324 - Inst Claim 57324 Kansas
Iowa Medicare - 12M10 - Inst Claim 12M10 Iowa
IBC Personal Choice - 12X26 - Inst Claims 12X26 States unavailable for IBC Personal Choice - 12X26 - Inst Claims
Keystone Health Plan East /IBC - 12X25 - Inst Claims 12X25 States unavailable for Keystone Health Plan East /IBC - 12X25 - Inst Claims
South Dakota Medicaid - 12K36 - Inst Claims 12K36 South Dakota
Georgia Medicaid - 12K05 - Inst Claims 12K05 Georgia
Florida Medicaid - 12K34 - Inst Claims 12K34 Florida
Iowa BCBS - 12B10 - Inst Claims 12B10 Iowa
HealthPartners of Minnesota - 12X51 - Inst Claims 12X51 States unavailable for HealthPartners of Minnesota - 12X51 - Inst Claims
Alaska Medicaid - 12K86 - Inst Claims 12K86 Alaska
Idaho Blue Cross - 12B07 - Inst Claims 12B07 Idaho
South Carolina Medicaid - 12K55 - Inst Claims 12K55 South Carolina
Puerto Rico BCBS - 12B48 -Inst Claim 12B48 Puerto Rico
Michigan BC - 12B18 - Inst Claim 12B18 Michigan
Mississippi Medicaid - 12K17 - Inst Claims 12K17 Mississippi
Arkansas Blue Cross - 12021 - Inst Claims 12021 Arkansas
Tennessee Medicaid - 12K46 - Inst Claims 12K46 Tennessee
West Virginia Blue Cross - 12B28 - Inst Claims 12B28 West Virginia
Washington Medicaid Hospital - 12K27 - Inst Claims 12K27 Washington
Delaware BC - 12B76 - Inst Claim 12B76 Delaware
Independent Health - 12X01 - Inst Claim 12X01 States unavailable for Independent Health - 12X01 - Inst Claim
HealthPlus of Michigan - 38216 - Inst Claims 38216 Michigan
North Carolina Medicaid - 12K23 - Inst Claim 12K23 North Carolina
Vermont Medicaid - 12K26 - Inst Claim 12K26 Vermont
Michigan Blue Care Network - 12B58 - Inst Claims 12B58 Michigan
New Jersey BCBS - 22099 - Inst Claims 22099 New Jersey
Tennessee BC - 12B45 - Inst Claims 12B45 Tennessee
Louisiana BCBS - 12B12 - Inst Claims 12B12 Louisiana
Minnesota Medicaid - 12K16 - Inst Claims 12K16 Minnesota
Partnership Health Plan of CA - 12M81 - Inst Claims 12M81 California
Nevada Medicaid - 12K20 - Inst Claims 12K20 Nevada
MISSISSIPPI BLUE CROSS - 12B82 - INST CLAIMS 12B82 Mississippi
TriWest VAPC3 Region 5B - 55916 - Prof Claims 55916 States unavailable for TriWest VAPC3 Region 5B - 55916 - Prof Claims
TriWest VAPC3 Region 5A - 55915 - Prof Claims 55915 States unavailable for TriWest VAPC3 Region 5A - 55915 - Prof Claims
TriWest VAPC3 Region 3 - 55912 - Prof Claims 55912 States unavailable for TriWest VAPC3 Region 3 - 55912 - Prof Claims
TriWest VAPC3 Region 5B - 55916 - Inst Claims 55916 States unavailable for TriWest VAPC3 Region 5B - 55916 - Inst Claims
TriWest VAPC3 Region 5A - 55915 - Inst Claims 55915 States unavailable for TriWest VAPC3 Region 5A - 55915 - Inst Claims
GUILDNET - GLDNT - PROF CLAIMS GLDNT States unavailable for GUILDNET - GLDNT - PROF CLAIMS
Alliance Behavioral Healthcare - 23071- Professional Claims 23071 States unavailable for Alliance Behavioral Healthcare - 23071- Professional Claims
Arizona Medicare - SMAZ0 - Prof Claim SMAZ0 Arizona
Partners Behavioral Health Management - 52613 - Inst Claim 52613 States unavailable for Partners Behavioral Health Management - 52613 - Inst Claim
Security Health Plan - 39045 - Inst Claims 39045 States unavailable for Security Health Plan - 39045 - Inst Claims
Maine Medicaid - 12K13 - Inst Claim 12K13 Maine
Health Services Management -41150 - Prof Claims 41150 States unavailable for Health Services Management -41150 - Prof Claims
Connecticut Medicare - 12M04 - Inst Claims 12M04 Connecticut
Hawaii BCBS - SB971 - Prof Claims SB971 Hawaii
Minnesota Medicare - 12M16 - Inst Claims 12M16 Minnesota
North Dakota Medicare - 12M82 - Inst Claim 12M82 North Dakota
Puerto Rico Medicare - 12M49 - Inst Claims 12M49 Puerto Rico
US Virgin Islands Medicare - 12M52 - Inst Claim 12M52 Virgin Islands
Amerihealth Administrators - 54763 - Inst Claims 54763 States unavailable for Amerihealth Administrators - 54763 - Inst Claims
Texas Medicaid Long Term Care - SKTX1 - Prof Claims SKTX1 Texas
New Jersey Medicaid - 12006 - Inst Claims 12006 New Jersey
Florida Medicare - 12M34 - Inst Claim 12M34 Florida
Tricare Overseas - 12X46 - Inst Claims 12X46 States unavailable for Tricare Overseas - 12X46 - Inst Claims
Florida Medicare - SMFL0 - Prof Claim SMFL0 Florida
Washington Medicare - SMWA0 - Prof Claim SMWA0 Washington
South Dakota BCBS - 12B33 - Inst Claims 12B33 South Dakota
Maryland Medicaid -- 12007 - Inst Claims 12007 Maryland
Maine Medicare - 12M13 - Inst Claims 12M13 Maine
Amerihealth Administrators - 54763 - Prof Claims 54763 States unavailable for Amerihealth Administrators - 54763 - Prof Claims
Independent Health - SX073 - Prof Claim SX073 States unavailable for Independent Health - SX073 - Prof Claim
Utah Medicaid - 12K42 - Inst Claims 12K42 Utah
Wyoming Medicare - 12M30 - Inst Claim 12M30 Wyoming
New York Medicaid - SKNY0 - Prof Claim SKNY0 New York
Washington Medicare - 12M45 - Inst Claim 12M45 Washington
New Hampshire Medicare - 12M21 - Inst Claims 12M21 New Hampshire
Ohio Medicare – 12M24 – Inst Claims 12M24 Ohio
Alaska Medicare - SMAK0 - Prof Claim SMAK0 Alaska
Hawaii Medicare - SMHI0 - Prof Claims SMHI0 Hawaii
Maryland Medicaid - SKMD0 - Prof Claims SKMD0 Maryland
J12 Highmark for DC, DE, MD, NJ, and PA – J12901 - Legacy - 12M99 - Inst Claim 12M99 Delaware , District of Columbia , Maryland , New Jersey , Pennsylvania
Illinois Medicaid - SKIL0 - Prof Claims SKIL0 Illinois
Pennsylvania BCBS Central Highmark - 12B81 - Inst Claims 12B81 Pennsylvania
West Virginia Medicare - 12M28 - Inst Claims 12M28 West Virginia
Partners Behavioral Health Management - 52613 - Prof Claim 52613 States unavailable for Partners Behavioral Health Management - 52613 - Prof Claim
Delaware Medicaid - SKDE0 - Prof Claims SKDE0 Delaware
Arizona Medicare - 12M02 - Inst Claim 12M02 Arizona
Penn Behavioral Health - 53226 - Inst Claims 53226 States unavailable for Penn Behavioral Health - 53226 - Inst Claims
Security Health Plan - 39045 - Prof Claims 39045 States unavailable for Security Health Plan - 39045 - Prof Claims
Hawaii Medicaid Hospital - 12K62 - Inst Claims 12K62 Hawaii
New York Medicare - 12M35 - Inst Claims 12M35 New York
Pennsylvania Western BC - 12B60 - Inst Claims 12B60 Pennsylvania
Highmark Senior Health - - 95462 - Prof Claim 95462 States unavailable for Highmark Senior Health - - 95462 - Prof Claim
Carolina Crescent - 12K85 - Inst Claims 12K85 States unavailable for Carolina Crescent - 12K85 - Inst Claims
Railroad Medicare - SRRGA - Prof Claims SRRGA ~All States
Health Adv/US Able/First Pyramid Life/Arkansas Blue Cross - 12049 - Inst Claims 12049 Arkansas
Tricare for Life - SX176 - Prof Claim SX176 States unavailable for Tricare for Life - SX176 - Prof Claim
Wisconsin Medicare - SMWI0 - Prof Claim SMWI0 Wisconsin
New Jersey BCBS - 22099 - Prof Claims 22099 New Jersey
Michigan Medicaid Hospital - 12K37 - Inst Claims 12K37 Michigan
Rhode Island Medicare - 12M74 - Inst Claims 12M74 Rhode Island
Wyoming Medicaid - 12K30 - Inst Claim 12K30 Wyoming
California Medicaid - SKCA0 - Prof Claims SKCA0 California
Idaho True Blue - 12B84 - Inst Claims 12B84 Idaho
Iowa Medicaid - SKIA0 - Prof Claim SKIA0 Iowa
Maine Medicare - SMME0 - Prof Claims SMME0 Maine
Maine Medicaid - SKME0 - Prof Claim SKME0 Maine
Montana Medicare - 12M77 - Inst Claim 12M77 Montana
Utah Medicare - SMUT0 - Prof Claim SMUT0 Utah
Oregon Medicare - SMOR0 - Prof Claim SMOR0 Oregon
Minnesota Medicare - SMMN0 - Prof Claim SMMN0 Minnesota
Iowa Medicaid - 12K10 - Inst Claim 12K10 Iowa
Keystone Health Plan West - SX056 - Prof Claims SX056 States unavailable for Keystone Health Plan West - SX056 - Prof Claims
North Dakota Medicare - SMND0 - Prof Claim SMND0 North Dakota
CA Home Health & Hospice - 12M98 Inst Claims 12M98 California
Utah Medicare - 12M84 - Inst Claim 12M84 Utah
Montana BCBS Medical - SB751 - Prof Claims SB751 Montana
New York Medicare GHI - SMNY2 - Prof Claim SMNY2 New York
Wyoming Medicare - SMWY0 - Prof Claim SMWY0 Wyoming
Oregon Medicare - 12M41 - Inst Claim 12M41 Oregon
Rhode Island Medicare - SMRI0 - Prof Claims SMRI0 Rhode Island
Legacy Part A - CA - HI- NV - 12M65 - Inst Claim 12M65 California , Hawaii , Nevada
Washington Medicaid - SKWA0 - Prof Claims SKWA0 Washington
Tricare for Life - 12X43 - Inst Claim 12X43 States unavailable for Tricare for Life - 12X43 - Inst Claim
Illinois Medicare - 12M08 - Inst Claims 12M08 Illinois
South Carolina Medicaid - SKSC0 - Prof Claims SKSC0 South Carolina
Rhode Island Medicaid Enrollment- 12K74 - Inst Claims 12K74 Rhode Island
Michigan Medicaid Medical - SKMI0 - Prof Claims SKMI0 Michigan
New York State Medicaid - 12K35 - Inst Claims 12K35 New York
Hawaii Medicaid - SKHI0 - Prof Claims SKHI0 Hawaii
Montana BCBS Hospital - 12B77 - Inst Claims 12B77 Montana
New York Medicare Empire - SMNY0 - Prof Claim SMNY0 New York
New Jersey Medicaid - SKNJ0 - Prof Claims SKNJ0 New Jersey
Wyoming Medicaid - SKWY0 - Prof Claims SKWY0 Wyoming
Idaho Medicare - SMID0 - Prof Claims SMID0 Idaho
Health Safety Network / MASS. Health Medicaid- 12K48 - Inst Claims 12K48 Massachusetts
Nevada Medicare - SMNV0 - Prof Claims SMNV0 Nevada