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.

Commonly Used Claims Enrollment Forms


Claims Payer Enrollment Forms

Title Payer ID States
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
Puerto Rico BCBS - SB980 - Prof Claim SB980 Puerto Rico
New Jersey Medicare - 12005 - Inst Claim 12005 New Jersey
Vermont Medicare - 12M26 - Inst Claims 12M26 Vermont
Wyoming BCBS - SB960 - Prof Claim SB960 Wyoming
TriWest VAPC3 Region 3 - 55912 - Inst Claims 55912 States unavailable for TriWest VAPC3 Region 3 - 55912 - Inst Claims
Oklahoma Medicare - SMOK0 - Prof Claim SMOK0 Oklahoma
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
California Medicaid - 57016 - Inst Claims 57016 California
AK & ID Medicare - 12M07 - Inst Claim 12M07 Alaska , Idaho
District of Columbia Medicaid - SKDC0 - Prof Claim SKDC0 District of Columbia
South Carolina Medicare - SMSC0 - Prof Claims SMSC0 South Carolina
Maryland Medicare - SMMD0 - Prof Claim SMMD0 Maryland
District of Columbia Medicare - SMDC0 - Prof Claim SMDC0 District of Columbia
Delaware Medicare - SMDE0 - Prof Claim SMDE0 Delaware
Virginia Premier Health Plan - 54176 - Prof Claims 54176 Virginia
Mississippi BCBS - SB730 - Prof Claims SB730 Mississippi
Blue Care Network - SB711 - Prof Claims SB711 Michigan
New Jersey Medicare - SMNJ0 - Prof Claim SMNJ0 New Jersey
Pennsylvania Medicare – SMPA0 – Prof Claim SMPA0 Pennsylvania
Louisiana Medicaid - SKLA0 - Prof Claims SKLA0 Louisiana
Nevada Medicaid - SKNV0 - Prof Claims SKNV0 Nevada
Puerto Rico Medicare - SMPR0 - Prof Claim SMPR0 Puerto Rico
Virgin Island Medicare - SMVI0 - Prof Claims SMVI0 Virgin Islands
Ohio Medicare - SMOH0 - Prof Claims SMOHO Ohio
Kentucky Medicare - SMKY0 - Prof Claims SMKY0 Kentucky
Kentucky Medicaid - SKKY0 - Prof Claims SKKY0 Kentucky
HealthPartners Minnesota - SX009 - Prof Claims SX009 Minnesota
South Dakota BCBS - SB889 - Prof Claims SB889 South Dakota
Capital Blue Cross - 23045 - Prof Claims 23045 States unavailable for Capital Blue Cross - 23045 - Prof Claims
Capital Blue Cross Facility - 24705 - Prof Claims 24705 States unavailable for Capital Blue Cross Facility - 24705 - Prof Claims
Georgia Medicaid - SKGA0 - Professional Claims SKGA0 Georgia
Arkansas BCBS - SB520 - Prof Claims SB520 Arkansas
Michigan BCBS - SB710 - Prof Claim SB710 Michigan
Medicare Plus Blue - SX170 - Prof Claim SX170 States unavailable for Medicare Plus Blue - SX170 - Prof Claim
Idaho Blue Cross - SB612 - Prof Claims SB612 Idaho
PEHP - SX106 - Prof Claims SX106 States unavailable for PEHP - SX106 - Prof Claims
University Health Alliance - 99026 - Prof Claims 99026 States unavailable for University Health Alliance - 99026 - Prof Claims
Louisiana BCBS - 23738 - Prof Claims 23738 Louisiana
Colorado Medicaid - 12K03 - Inst Claims 12K03 Colorado
DC Medicare - 12M63 - Inst Claims 12M63 District of Columbia
Delaware Medicare - 12M76 - Inst Claims 12M76 Delaware
Pennsylvania Medicare - 12M60 - Inst Claim 12M60 Pennsylvania
Maryland Medicare - 12010 - Inst Claim 12010 Maryland
Georgia Medicare - 12M05 - Inst Claim 12M05 Georgia
Lousiana Medicaid - 12K12 - Inst Claim 12K12 Louisiana
Alabama Medicare - 12M01 - Inst Claim 12M01 Alabama
District of Columbia Medicaid - 12001 - Inst Claim 12001 District of Columbia
Tennessee Medicare - 12M53 - Inst Claims 12M53 Tennessee
Oklahoma Medicare - 12M37 - Inst Claims 12M37 Oklahoma
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
Kentucky Medicaid - 12K11 - Inst Claims 12K11 Kentucky
Florida Medicaid - 12K34 - Inst Claims 12K34 Florida
Capital Blue Cross - 12B61 - Inst Claim 12B61 States unavailable for Capital Blue Cross - 12B61 - Inst Claim
Georgia Medicaid - 12K05 - Inst Claims 12K05 Georgia
HealthPartners - 12X51 - Inst Claims 12X51 States unavailable for HealthPartners - 12X51 - Inst Claims
Puerto Rico BCBS - 12B48 -Inst Claim 12B48 Puerto Rico
Idaho Blue Cross - 12B07 - Inst Claims 12B07 Idaho
Virginia Premier - 12K83 - Inst Claims 12K83 Virginia
Arkansas Blue Cross - 12021 - Inst Claims 12021 Arkansas
Michigan Blue Care Network - 12B58 - Inst Claims 12B58 Michigan
Louisiana BCBS - 12B12 - Inst Claims 12B12 Louisiana
Vermont Medicaid - 12K26 - Inst Claim 12K26 Vermont
Nevada Medicaid - 12K20 - Inst Claims 12K20 Nevada
J1 MUTUAL of OMAHA CA, HI, NV - 12M64 - INST CLAIM 12M64 California , Hawaii , Nevada
MISSISSIPPI BLUE CROSS - 12B82 - INST CLAIMS 12B82 Mississippi
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
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
Federally Qualified Healthcare Clinics - 12M29 - INST CLAIMS 12M29 States unavailable for Federally Qualified Healthcare Clinics - 12M29 - INST CLAIMS
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
TriWest VAPC3 Region 5B - 55916 - Prof Claims 55916 States unavailable for TriWest VAPC3 Region 5B - 55916 - Prof Claims
TriWest VAPC3 Region 6 - 55917 - Prof Claims 55917 States unavailable for TriWest VAPC3 Region 6 - 55917 - Prof Claims
TriWest VAPC3 Region 5A - 55915 - Prof Claims 55915 States unavailable for TriWest VAPC3 Region 5A - 55915 - Prof Claims
TriWest VAPC3 Region 5A - 55915 - Inst Claims 55915 States unavailable for TriWest VAPC3 Region 5A - 55915 - Inst Claims
TriWest VAPC3 Region 5B - 55916 - Inst Claims 55916 States unavailable for TriWest VAPC3 Region 5B - 55916 - Inst Claims
TriWest VAPC3 Region 6 - 55917 - Inst Claims 55917 States unavailable for TriWest VAPC3 Region 6 - 55917 - Inst Claims
TriWest VAPC3 Region 3 - 55912 - Prof Claims 55912 States unavailable for TriWest VAPC3 Region 3 - 55912 - Prof Claims
GUILDNET - GLDNT - PROF CLAIMS GLDNT States unavailable for GUILDNET - GLDNT - PROF CLAIMS
Aloha Advantage - ALOHA - Prof Claims ALOHA Hawaii
Alliance Behavioral Healthcare - 23071- Professional Claims 23071 States unavailable for Alliance Behavioral Healthcare - 23071- Professional Claims
ATRIO FKA MARION POLK - MPCHA - PROF CLAIMS MPCHA Oregon
Tricare West - 12C01 - Inst Claims 12C01 States unavailable for Tricare West - 12C01 - Inst Claims
Alliance Behavioral Healthcare - 23071- Institutional Claims 23071 States unavailable for Alliance Behavioral Healthcare - 23071- Institutional Claims
Massachusetts Medicaid - 12K14 - Inst Claims 12K14 Massachusetts
New Mexico Medicare - 12M22 - Inst Claim 12M22 New Mexico
Mississippi BCBS & Teachers Blue - 12B17_12B82 - Inst Claims 12B17 Mississippi
Arizona Medicare - SMAZ0 - Prof Claim SMAZ0 Arizona
HealthPlus of Michigan - 38216 - Inst Claims 38216 Michigan
South Carolina Medicaid - 12K55 - Inst Claims 12K55 South Carolina
Minnesota Medicaid - 12K16 - Inst Claims 12K16 Minnesota
FTP TSO Request Form Payer ID unavailable for FTP TSO Request Form States unavailable for FTP TSO Request Form
West Virginia Blue Cross - 12B28 - Inst Claims 12B28 West Virginia
Partners Behavioral Health Management - 52613 - Inst Claim 52613 States unavailable for Partners Behavioral Health Management - 52613 - Inst Claim
DMERC Region D - SDMED - Prof Clams SDMED Arizona , California , Idaho , Iowa , Kansas , Missouri , Montana , Nebraska , Nevada , North Dakota , Oregon , South Dakota , Utah , Washington , Wyoming
Security Health Plan - 39045 - Inst Claims 39045 States unavailable for Security Health Plan - 39045 - Inst Claims
Maine Medicaid - 12K13 - Inst Claim 12K13 Maine
Hawaii Medicare - 12M64 - Inst Claim 12M64 Hawaii
WPS Commercial - SX022 - Prof Claims SX022 States unavailable for WPS Commercial - SX022 - Prof Claims
Colorado Medicare - 12M03 - Inst Claim 12M03 Colorado
North Carolina Medicare - SMNC0 - Prof Claims SMNC0 North Carolina
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
Health Services Management -41150 - Prof Claims 41150 States unavailable for Health Services Management -41150 - Prof Claims
Pennsylvania Blue Card Par Point of Service - SX168 - Prof Claim SX168 Pennsylvania
Rhode Island Medicaid Deactivation - 12K74 - Inst Claims 12K74 Rhode Island
Hawaii Medicaid Waviers - 77059 - Prof Claims 77059 Hawaii
Hawaii BCBS - SB971 - Prof Claims SB971 Hawaii
Connecticut Medicare - 12M04 - Inst Claims 12M04 Connecticut
Minnesota Medicare - 12M16 - Inst Claims 12M16 Minnesota
North Dakota Medicare - 12M82 - Inst Claim 12M82 North Dakota
Oregon Medicaid - 12K41 - Inst Claims 12K41 Oregon
Puerto Rico Medicare - 12M49 - Inst Claims 12M49 Puerto Rico
Mississippi Medicaid - 12K17 - Inst Claims 12K17 Mississippi
WA State Dept of Labor and Industry - SX063 - Prof Claims SX063 Washington
South Dakota Medicare - SMSD0 - Prof Claims SMSD0 South Dakota
Hawaii BCBS - 12B62 - Inst Claims 12B62 Hawaii
US Virgin Islands Medicare - 12M52 - Inst Claim 12M52 Virgin Islands
Amerihealth Administrators - 54763 - Inst Claims 54763 States unavailable for Amerihealth Administrators - 54763 - Inst Claims
Amerihealth Delaware Non HMO - SX074 - Prof Claims SX074 States unavailable for Amerihealth Delaware Non HMO - SX074 - Prof Claims
Texas Medicaid Long Term Care - SKTX1 - Prof Claims SKTX1 Texas
Delaware BCBS - SB570 - Prof Claim SB570 Delaware
Iowa BCBS - SB640 - Prof Claims SB640 Iowa
North Carolina Medicaid - 12K23 - Inst Claim 12K23 North Carolina
California Medicare - SMCA1 - Prof Claims SMCA1 California
Illinois Medicare - SMIL0 - Prof Claim SMIL0 Illinois
New Jersey Medicaid - 12006 - Inst Claims 12006 New Jersey
Florida Medicare - 12M34 - Inst Claim 12M34 Florida
Independence Administrators - TA720- Prof Claims TA720 States unavailable for Independence Administrators - TA720- Prof Claims
Tricare Overseas - 12X46 - Inst Claims 12X46 States unavailable for Tricare Overseas - 12X46 - Inst Claims
Vermont Medicaid - SKVT0 - Prof Claims SKVT0 Vermont
Massachusetts Medicare - 12M14 - Inst Claims 12M14 Massachusetts
Pensylvania BC - SX079 - Prof Claims SX079 Pennsylvania
Oregon Medicaid - SKOR0 - Prof Claim SKOR0 Oregon
California Medi-Cal Vision - SKCA1 - Prof Claim SKCA1 California
Nebraska Medicaid - SKNE0 - Prof Claim SKNE0 Nebraska
North Carolina Medicare - 12M23 - Inst Claims 12M23 North Carolina
Washington Medicare - SMWA0 - Prof Claim SMWA0 Washington
Florida Medicare - SMFL0 - Prof Claim SMFL0 Florida
DMERC Region A - SDMEA - Prof Claims SDMEA Connecticut , Maine , Massachusetts , New Hampshire , New Jersey , New York , Pennsylvania , Rhode Island , Vermont
Maryland Medicaid -- 12007 - Inst Claims 12007 Maryland
South Dakota BCBS - 12B33 - Inst Claims 12B33 South Dakota
Maryland Behavioral Health - SX069 - Prof Claims SX069 Maryland
Maine Medicare - 12M13 - Inst Claims 12M13 Maine
Independent Health - SX073 - Prof Claim SX073 States unavailable for Independent Health - SX073 - Prof Claim
Iowa Medicare - 12M10 - Inst Claim 12M10 Iowa
Amerihealth Administrators - 54763 - Prof Claims 54763 States unavailable for Amerihealth Administrators - 54763 - Prof Claims
Amerihealth New Jersey Non HMO - SX075 - Prof Claims SX075 New Jersey
Utah Medicaid - 12K42 - Inst Claims 12K42 Utah
North Carolina Medicaid - SKNC0 - Prof Claim SKNC0 North Carolina
Wyoming BC - 12B30 - Inst Claim 12B30 Wyoming
Pennsylvania BCBS - SB865 - Prof Claims SB865 Pennsylvania
Wyoming Medicare - 12M30 - Inst Claim 12M30 Wyoming
New York Medicaid - SKNY0 - Prof Claim SKNY0 New York
Vermont Medicare - SMVT0 - Prof Claims SMVT0 Vermont
Mississippi Medicare - 12M17 - Inst Claim 12M17 Mississippi
Washington Medicare - 12M45 - Inst Claim 12M45 Washington
New Hampshire Medicare - 12M21 - Inst Claims 12M21 New Hampshire
Illinois Medicaid - 12K08 - Inst Claims 12K08 Illinois
Alaska Medicare - SMAK0 - Prof Claim SMAK0 Alaska
Ohio Medicare – 12M24 – Inst Claims 12M24 Ohio
Hawaii Medicare - SMHI0 - Prof Claims SMHI0 Hawaii
Colorado Medicare – SMCO0 – Prof Claim SMCO0 Colorado
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
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
Value Options - SX173 - Prof Claims SX173 States unavailable for Value Options - SX173 - Prof Claims
Illinois Medicaid - SKIL0 - Prof Claims SKIL0 Illinois
Wisconsin Medicare & FQHC - 12M29 - Inst Claims 12M29 Wisconsin
Value Optiosn (TX NorthStar) - 99297 - Inst Claims 99297 Texas
Montana Medicare - SMMT0 - Prof Claim SMMT0 Montana
Pennsylvania BCBS Central Highmark - 12B81 - Inst Claims 12B81 Pennsylvania
West Virginia Medicare - 12M28 - Inst Claims 12M28 West Virginia
Nebraska Medicare - 12M19 - Inst Claims 12M19 Nebraska
Partners Behavioral Health Management - 52613 - Prof Claim 52613 States unavailable for Partners Behavioral Health Management - 52613 - Prof Claim
New Mexico Medicare - SMNM0 - Prof Claims SMNM0 New Mexico
Missouri Medicare - SMMO0 - Prof Claim SMMO0 Missouri
Indiana Medicare - SMIN0 - Prof Claim SMIN0 Indiana
Nebraska Medicaid - 12K19 - Inst Claims 12K19 Nebraska
Delaware Medicaid - SKDE0 - Prof Claims SKDE0 Delaware
Highmark Senior Solution - 95461 - Inst Claims 95461 West Virginia
Arizona Medicare - 12M02 - Inst Claim 12M02 Arizona
South Dakota Medicaid - 12K36 - Inst Claims 12K36 South Dakota
Rhode Island Medicaid Deactivation- SKRI0 - Prof Claims SKRI0 States unavailable for Rhode Island Medicaid Deactivation- SKRI0 - Prof Claims
Penn Behavioral Health - 53226 - Inst Claims 53226 States unavailable for Penn Behavioral Health - 53226 - Inst Claims
Minnesota Medicaid - SKMN0 - Prof Claims SKMN0 Minnesota
Security Health Plan - 39045 - Prof Claims 39045 States unavailable for Security Health Plan - 39045 - Prof Claims
Virginia Medicare - SMVA0 - Prof Claims SMVA0 Virginia
IBC Personal Choice - SX083 - Prof Claim SX083 States unavailable for IBC Personal Choice - SX083 - Prof Claim
Hawaii Medicaid Hospital - 12K62 - Inst Claims 12K62 Hawaii
New York Medicare - 12M35 - Inst Claims 12M35 New York
Value Options/ MBHP (MA Behavioral Health Partnership) - 43307 - Prof Claims 43307 States unavailable for Value Options/ MBHP (MA Behavioral Health Partnership) - 43307 - Prof Claims
ValueOptions/MBHP (MA Behavioral Health Partnership - 43307 - Inst Claims 43307 Massachusetts
Pennsylvania Western BC - 12B60 - Inst Claims 12B60 Pennsylvania
Arkansas Medicare - 12022 - Inst Claim 12022 Arkansas
Claims Provider Setup Form Payer ID unavailable for Claims Provider Setup Form States unavailable for Claims Provider Setup Form
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
Tennessee BCBS - SB890, SB891, SB892- Prof Claims SB890 Tennessee
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
Texas Medicare - SMTX0 - Prof Claim SMTX0 Texas
Tennessee Medicaid - SKTN2 - Prof Claims SKTN2 Tennessee
Blue Cross Blue Shield Mississippi State and Teacher Employees - SB731 - Prof Claims SB731 Mississippi
New Jersey BCBS - 22099 - Prof Claims 22099 New Jersey
Tennessee BC - 12B45-12B53 - Inst Claims 12B45 Tennessee
Wisconsin Medicare - SMWI0 - Prof Claim SMWI0 Wisconsin
Rhode Island Medicare - 12M74 - Inst Claims 12M74 Rhode Island
Tennessee Medicaid - 12K46 - Inst Claims 12K46 Tennessee
Nevada Medicare - 12M64 - Inst Claim 12M64 Nevada
Michigan Medicaid Hospital - 12K37 - Inst Claims 12K37 Michigan
Penn Behavioral Health - 53226 - Prof Claims 53226 States unavailable for Penn Behavioral Health - 53226 - Prof Claims
Legacy Medicare - CO - TX - NM - OK – J40911 - 12M88 - Inst Claim 12M88 Colorado , New Mexico , Oklahoma , Texas
California Medicaid - SKCA0 - Prof Claims SKCA0 California
Idaho True Blue - 12B84 - Inst Claims 12B84 Idaho
Missouri Medicare - 12M15 - Inst Claim 12M15 Missouri
Wyoming Medicaid - 12K30 - Inst Claim 12K30 Wyoming
Iowa Medicaid - SKIA0 - Prof Claim SKIA0 Iowa
Amerihealth HMO New Jersey and Delaware - 23037 - Prof Claims 23037 Delaware , New Jersey
Independent Health - 12X01 - Inst Claim 12X01 States unavailable for Independent Health - 12X01 - Inst Claim
Maryland Behavioral Health - 22322 - Inst Claims 22322 Maryland
Alaska Medicaid - 12K86 - Inst Claims 12K86 Alaska
Louisiana Medicare - SMLA0 - Prof Claims SMLA0 Louisiana
Indiana Medicare - 12M09 - Inst Claims 12M09 Indiana
Maine Medicaid - SKME0 - Prof Claim SKME0 Maine
Value Options - 12X56 - Inst Claim 12X56 States unavailable for Value Options - 12X56 - Inst Claim
Maine Medicare - SMME0 - Prof Claims SMME0 Maine
New Hampshire Medicare - SMNH0 - Prof Claims SMNH0 New Hampshire
Montana Medicare - 12M77 - Inst Claim 12M77 Montana
Oregon Medicare - SMOR0 - Prof Claim SMOR0 Oregon
Utah Medicare - SMUT0 - Prof Claim SMUT0 Utah
Washington Medicaid Hospital - 12K27 - Inst Claims 12K27 Washington
Tricare Overseas - SX163 - Prof Claims SX163 States unavailable for Tricare Overseas - SX163 - Prof Claims
Minnesota Medicare - SMMN0 - Prof Claim SMMN0 Minnesota
Iowa BCBS - 12B10 - Inst Claims 12B10 Iowa
Deseret Mutual - SX105 - Prof Claims SX105 States unavailable for Deseret Mutual - SX105 - Prof Claims
Amerihealth PPO NJ - 12X28 - Inst Claims 12X28 New Jersey
Keystone Health Plan West - SX056 - Prof Claims SX056 States unavailable for Keystone Health Plan West - SX056 - Prof Claims
IBC Personal Choice - 12X26 - Inst Claims 12X26 States unavailable for IBC Personal Choice - 12X26 - Inst Claims
Iowa Medicaid - 12K10 - Inst Claim 12K10 Iowa
North Dakota Medicare - SMND0 - Prof Claim SMND0 North Dakota
New Jersey BCBS - 22099 - Inst Claims 22099 New Jersey
West Virginia BCBS - SB941 - Prof Claims SB941 West Virginia
Michigan Medicare - SMMI0 - Prof Claim SMMI0 Michigan
North Dakota BC - 12B78 - Inst Claim 12B78 North Dakota
Kansas Medicare - SMKS0 - Prof Claim SMKS0 Kansas
Arkansas Medicare - SMAR0 - Prof Claim SMAR0 Arkansas
CA Home Health & Hospice - 12M98 Inst Claims 12M98 California
South Dakota Medicaid - SKSD0 - Prof Claim SKSD0 South Dakota
Utah Medicare - 12M84 - Inst Claim 12M84 Utah
South Carolina Medicare - 12M55 - Inst Claims 12M55 South Carolina
Connecticut Medicare - SMCT0 - Prof Claim SMCT0 Connecticut
Montana BCBS Medical - SB751 - Prof Claims SB751 Montana
Massachusetts Medicaid - SKMA0 - Pro Claims SKMA0 Massachusetts
Nebraska Medicare - SMNE0 - Prof Claim SMNE0 States unavailable for Nebraska Medicare - SMNE0 - Prof Claim
New York Medicare GHI - SMNY2 - Prof Claim SMNY2 New York
Delaware BC - 12B76 - Inst Claim 12B76 Delaware
Louisiana Medicare - 12M12 - Inst Claims 12M12 Louisiana
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
Wyoming Medicare - SMWY0 - Prof Claim SMWY0 Wyoming
Mississippi Medicaid - SKMS0 - Prof Claims SKMS0 Mississippi
Amerihealth HMO Administrators NJ and DE - 23037 - Inst Claims 23037 Delaware , New Jersey
Oregon Medicare - 12M41 - Inst Claim 12M41 Oregon
Partnership Health Plan of CA CAPHP - SX140 - Prof Claims SX140 California
Partnership Health Plan of CA - 12M81 - Inst Claims 12M81 California
West Virginia Medicare - SMWV0 - Prof Claims SMWV0 West Virginia
DMERC Region B - SDMEB - Prof Claims SDMEB Illinois , Indiana , Michigan , Minnesota , Ohio , Virginia , West Virginia , Wisconsin
Rhode Island Medicare - SMRI0 - Prof Claims SMRI0 Rhode Island
Washington Medicaid - SKWA0 - Prof Claims SKWA0 Washington
Legacy Part A - CA - HI- NV - 12M65 - Inst Claim 12M65 California , Hawaii , Nevada
Keystone Health Plan East /IBC - 12X25 - Inst Claims 12X25 States unavailable for Keystone Health Plan East /IBC - 12X25 - Inst Claims
Texas Medicare - 12M31 - Inst Claim 12M31 Texas
Tennessee Medicare - SMTN0 - Prof Claim SMTN0 Tennessee
Iowa Medicare - SMIA0 - Prof Claim SMIA0 Iowa
WPS Health Insurance - 12X29 - Inst Claim 12X29 States unavailable for WPS Health Insurance - 12X29 - Inst Claim
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
California Medicare South - SMCA2 - Prof Claims SMCA2 California
New York Medicare Upstate - Western - SMNY1 - Prof Claim SMNY1 New York
North Dakota BCBS - SB820 - Prof Claim SB820 North Dakota
Rhode Island Medicaid Enrollment - SKRI0 - Prof Claims SKRI0 Rhode Island
Michigan BC - 12B18 - Inst Claim 12B18 Michigan
Tricare for Life - 12X43 - Inst Claim 12X43 States unavailable for Tricare for Life - 12X43 - Inst Claim
Michigan Medicare - 12M18 - Inst Claim 12M18 Michigan
Illinois Medicare - 12M08 - Inst Claims 12M08 Illinois
Rhode Island Medicaid Enrollment- 12K74 - Inst Claims 12K74 Rhode Island
Alabama Medicare - SMAL0 - Prof Claim SMAL0 Alabama
Virginia Medicare - 12004 – Inst Claims 12004 Virginia
South Carolina Medicaid - SKSC0 - Prof Claims SKSC0 South Carolina
New York State Medicaid - 12K35 - Inst Claims 12K35 New York
Highmark Senior Solution - 95461 - Prof Claim 95461 States unavailable for Highmark Senior Solution - 95461 - Prof Claim
Michigan Medicaid Medical - SKMI0 - Prof Claims SKMI0 Michigan
Hawaii Medicaid - SKHI0 - Prof Claims SKHI0 Hawaii
Georgia Medicare - SMGA0 - Prof Claim SMGA0 Georgia
Alaska Medicaid - SKAK0 - Prof Claims SKAK0 Alaska
Montana BCBS Hospital - 12B77 - Inst Claims 12B77 Montana
Kansas Medicare - 57324 - Inst Claim 57324 Kansas
Keystone Health Plan East - SX055 - Prof Claims SX055 States unavailable for Keystone Health Plan East - SX055 - Prof Claims
New York Medicare Empire - SMNY0 - Prof Claim SMNY0 New York
New Jersey Medicaid - SKNJ0 - Prof Claims SKNJ0 New Jersey
Value Options - 12K1A - Inst Claims 12K1A States unavailable for Value Options - 12K1A - Inst Claims
Utah Medicaid - SKUT0 - Prof Claims SKUT0 Utah
Idaho Medicare - SMID0 - Prof Claims SMID0 Idaho
Wyoming Medicaid - SKWY0 - Prof Claims SKWY0 Wyoming
Nevada Medicare - SMNV0 - Prof Claims SMNV0 Nevada
Health Safety Network / MASS. Health Medicaid- 12K48 - Inst Claims 12K48 Massachusetts
Cimarron Medical - 09823 - Prof Claims 09823 States unavailable for Cimarron Medical - 09823 - Prof Claims
California Medicaid "Claimmaster Clients Only" - 57016 - Inst Claim 57016 California
California Medicare - 12M64 - Inst Claim 12M64 California