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
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
Federally Qualified Healthcare Clinics - 12M29 - INST CLAIMS 12M29 States unavailable for Federally Qualified Healthcare Clinics - 12M29 - 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
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 6 - 55917 - Prof Claims 55917 States unavailable for TriWest VAPC3 Region 6 - 55917 - Prof Claims
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 6 - 55917 - Inst Claims 55917 States unavailable for TriWest VAPC3 Region 6 - 55917 - Inst 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
TriWest VAPC3 Region 3 - 55912 - Inst Claims 55912 States unavailable for TriWest VAPC3 Region 3 - 55912 - Inst Claims
GUILDNET - GLDNT - PROF CLAIMS GLDNT States unavailable for GUILDNET - GLDNT - PROF CLAIMS
ATRIO FKA MARION POLK - MPCHA - PROF CLAIMS MPCHA Oregon
Aloha Advantage - ALOHA - Prof Claims ALOHA Hawaii
Alliance Behavioral Healthcare - 23071- Professional Claims 23071 States unavailable for Alliance Behavioral Healthcare - 23071- Professional Claims
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
Nevada Medicaid CKNV1 Nevada
North Carolina Medicaid CKNC1 North Carolina
New Jersey Medicaid - 12006 - Inst Claims 12006 New Jersey
FTP TSO Request Form Payer ID unavailable for FTP TSO Request Form States unavailable for FTP TSO Request Form
Claims Provider Setup Form Payer ID unavailable for Claims Provider Setup Form States unavailable for Claims Provider Setup 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
California Medicaid - SKCA0 - Prof Claims SKCA0 California
District of Columbia Medicaid - SKDC0 - Prof Claim SKDC0 District of Columbia
Georgia Medicare - SMGA0 - Prof Claim SMGA0 Georgia
Alabama Medicare - SMAL0 - Prof Claim SMAL0 Alabama
Utah Medicaid - SKUT0 - Prof Claims SKUT0 Utah
Maine Medicaid - SKME0 - Prof Claim SKME0 Maine
Louisiana Medicare - SMLA0 - Prof Claims SMLA0 Louisiana
Texas Medicare - SMTX0 - Prof Claim SMTX0 Texas
Colorado Medicare – SMCO0 – Prof Claim SMCO0 Colorado
Oklahoma Medicare - SMOK0 - Prof Claim SMOK0 Oklahoma
Arkansas Medicare - SMAR0 - Prof Claim SMAR0 Arkansas
Mississippi Medicare – SMMS0 – Prof Claim SMMS0 Mississippi
New Mexico Medicare - SMNM0 - Prof Claims SMNM0 New Mexico
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
Colorado Medicaid - SKCO0 - Prof Claims SKCO0 Colorado
Blue Cross Blue Shield Mississippi State and Teacher Employees - SB731 - Prof Claims SB731 Mississippi
Mississippi BCBS - SB730 - Prof Claims SB730 Mississippi
Massachusetts Medicare - SMMA0 - Prof Claims SMMA0 Massachusetts
Maine Medicare - SMME0 - Prof Claims SMME0 Maine
Rhode Island Medicare - SMRI0 - Prof Claims SMRI0 Rhode Island
Railroad Medicare - SRRGA - Prof Claims SRRGA ~All States
Virginia Premier Health Plan - 54176 - Prof Claims 54176 Virginia
Penn Behavioral Health - 53226 - Prof Claims 53226 States unavailable for Penn Behavioral Health - 53226 - Prof Claims
Amerihealth Administrators - 54763 - Prof Claims 54763 States unavailable for Amerihealth Administrators - 54763 - 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,_SKLA1, SKLA2, SKLA3 - Prof Claims SKLA0 Louisiana
Security Health Plan - 39045 - Prof Claims 39045 States unavailable for Security Health Plan - 39045 - Prof Claims
Tricare South - 61125 - Prof Claims 61125 Alabama , Arkansas , Florida , Georgia , Louisiana , Mississippi , Oklahoma , South Carolina , Tennessee , Texas
Delaware Medicaid - SKDE0 - Prof Claims SKDE0 Delaware
Tennessee Medicare - SMTN0 - Prof Claim SMTN0 Tennessee
Maryland Medicaid - SKMD0 - Prof Claims SKMD0 Maryland
Hawaii Medicaid - SKHI0 - Prof Claims SKHI0 Hawaii
Tricare Overseas - SX163 - Prof Claims SX163 States unavailable for Tricare Overseas - SX163 - Prof Claims
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
Florida Medicare - SMFL0 - Prof Claim SMFL0 Florida
Value Options/ MBHP (MA Behavioral Health Partnership) - 43307 - Prof Claims 43307 States unavailable for Value Options/ MBHP (MA Behavioral Health Partnership) - 43307 - Prof Claims
Value Options - SX173 - Prof Claims SX173 States unavailable for Value Options - SX173 - Prof Claims
WA State Dept of Labor and Industry - SX063 - Prof Claims SX063 Washington
New York Medicare Empire - SMNY0 - Prof Claim SMNY0 New York
New York Medicare Upstate - Western - SMNY1 - Prof Claim SMNY1 New York
New York Medicare GHI - SMNY2 - Prof Claim SMNY2 New York
Connecticut Medicare - SMCT0 - Prof Claim SMCT0 Connecticut
Illinois Medicare - SMIL0 - Prof Claim SMIL0 Illinois
Minnesota Medicare - SMMN0 - Prof Claim SMMN0 Minnesota
Wisconsin Medicare - SMWI0 - Prof Claim SMWI0 Wisconsin
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
Hawaii BCBS - SB971 - Prof Claims SB971 Hawaii
Iowa BCBS - SB640 - Prof Claims SB640 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 for Life - SX176 - Prof Claim SX176 States unavailable for Tricare for Life - SX176 - Prof Claim
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
Pensylvania BC - SX079 - Prof Claims SX079 Pennsylvania
Ohio Medicare - SMOH0 - Prof Claims SMOHO Ohio
Kentucky Medicare - SMKY0 - Prof Claims SMKY0 Kentucky
HealthPlus of Michigan - 38216 - Prof Claims 38216 Michigan
Health Services Management -41150 - Prof Claims 41150 States unavailable for Health Services Management -41150 - Prof Claims
Maryland Behavioral Health - SX069 - Prof Claims SX069 Maryland
Hawaii Medicaid Waviers - 77059 - Prof Claims 77059 Hawaii
Wyoming Medicaid - SKWY0 - Prof Claims SKWY0 Wyoming
New Jersey Medicaid - SKNJ0 - Prof Claims SKNJ0 New Jersey
Idaho Medicare - SMID0 - Prof Claims SMID0 Idaho
California Medicare South - SMCA2 - Prof Claims SMCA2 California
California Medicare - SMCA1 - Prof Claims SMCA1 California
Alaska Medicare - SMAK0 - Prof Claim SMAK0 Alaska
Arizona Medicare - SMAZ0 - Prof Claim SMAZ0 Arizona
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
Kentucky Medicaid - SKKY0 - Prof Claims SKKY0 Kentucky
Hawaii Medicare - SMHI0 - Prof Claims SMHI0 Hawaii
Texas Medicaid Long Term Care - SKTX1 - Prof Claims SKTX1 Texas
HealthPartners Minnesota - SX009 - Prof Claims SX009 Minnesota
Tricare North - 57106 - Prof Claim 57106 Connecticut , Delaware , District of Columbia , Illinois , Indiana , Kentucky , Maine , Maryland , Massachusetts , Michigan , New Hampshire , New Jersey , New York , North Carolina , Ohio , Pennsylvania , Rhode Island , Vermont , Virginia , West Virginia , Wyoming
Nebraska Medicare - SMNE0 - Prof Claim SMNE0 States unavailable for Nebraska Medicare - SMNE0 - Prof Claim
Keystone Health Plan West - SX056 - Prof Claims SX056 States unavailable for Keystone Health Plan West - SX056 - Prof Claims
South Dakota Medicaid - SKSD0 - Prof Claim SKSD0 South Dakota
Independent Health - SX073 - Prof Claim SX073 States unavailable for Independent Health - SX073 - Prof Claim
Georgia Medicaid - SKGA0 - Professional Claims SKGA0 Georgia
Florida Medicaid - SKFL0 - Prof Claims SKFL0 Florida
South Dakota BCBS - SB889 - Prof Claims SB889 South Dakota
Nebraska Medicaid - SKNE0 - Prof Claim SKNE0 Nebraska
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
Nevada Medicare - SMNV0 - Prof Claims SMNV0 Nevada
Wyoming BCBS - SB960 - Prof Claim SB960 Wyoming
Wyoming Medicare - SMWY0 - Prof Claim SMWY0 Wyoming
Washington Medicare - SMWA0 - Prof Claim SMWA0 Washington
Utah Medicare - SMUT0 - Prof Claim SMUT0 Utah
South Dakota Medicare - SMSD0 - Prof Claims SMSD0 South Dakota
Oregon Medicare - SMOR0 - Prof Claim SMOR0 Oregon
North Dakota BCBS - SB820 - Prof Claim SB820 North Dakota
North Dakota Medicare - SMND0 - Prof Claim SMND0 North Dakota
Montana Medicare - SMMT0 - Prof Claim SMMT0 Montana
Iowa Medicaid - SKIA0 - Prof Claim SKIA0 Iowa
Puerto Rico BCBS - SB980 - Prof Claim SB980 Puerto Rico
Michigan BCBS - SB710 - Prof Claim SB710 Michigan
Mississippi Medicaid - SKMS0 - Prof Claims SKMS0 Mississippi
Arkansas BCBS - SB520 - Prof Claims SB520 Arkansas
Rhode Island Medicaid Deactivation- SKRI0 - Prof Claims SKRI0 States unavailable for Rhode Island Medicaid Deactivation- SKRI0 - Prof Claims
Medicare Plus Blue - SX170 - Prof Claim SX170 States unavailable for Medicare Plus Blue - SX170 - Prof Claim
Highmark Senior Health - - 95462 - Prof Claim 95462 States unavailable for Highmark Senior Health - - 95462 - Prof Claim
West Virginia BCBS - SB941 - Prof Claims SB941 West Virginia
Pennsylvania BCBS - SB865 - Prof Claims SB865 Pennsylvania
Highmark Senior Solution - 95461 - Prof Claim 95461 States unavailable for Highmark Senior Solution - 95461 - Prof Claim
Rhode Island Medicaid Enrollment - SKRI0 - Prof Claims SKRI0 Rhode Island
Partners Behavioral Health Management - 52613 - Prof Claim 52613 States unavailable for Partners Behavioral Health Management - 52613 - Prof Claim
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
Tennessee BCBS - SB890, SB891, SB892- Prof Claims SB890 Tennessee
Illinois Medicaid - SKIL0 - Prof Claims SKIL0 Illinois
Cimarron Medical - 09823 - Prof Claims 09823 States unavailable for Cimarron Medical - 09823 - Prof Claims
Michigan Medicaid Medical - SKMI0 - Prof Claims SKMI0 Michigan
Washington Medicaid - SKWA0 - Prof Claims SKWA0 Washington
Delaware BCBS - SB570 - Prof Claim SB570 Delaware
Pennsylvania Blue Card Par Point of Service - SX168 - Prof Claim SX168 Pennsylvania
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
Vermont Medicaid - SKVT0 - Prof Claims SKVT0 Vermont
New Jersey BCBS - 22099 - Prof Claims 22099 New Jersey
Deseret Mutual - SX105 - Prof Claims SX105 States unavailable for Deseret Mutual - SX105 - Prof Claims
Montana BCBS Medical - SB751 - Prof Claims SB751 Montana
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
Indiana State Dept of Health/CSHCS - 35600 - Prof Claims 35600 Indiana
New York Medicaid - SKNY0 - Prof Claim SKNY0 New York
Tennessee Medicaid - SKTN2 - Prof Claims SKTN2 Tennessee
South Carolina Medicaid - SKSC0 - Prof Claims SKSC0 South Carolina
New Jersey Medicare - 12005 - Inst Claim 12005 New Jersey
Maryland Medicare - 12010 - Inst Claim 12010 Maryland
J12 Highmark for DC, DE, MD, NJ, and PA – J12901 - Legacy - 12M99 - Inst Claim 12M99 Delaware , District of Columbia , Maryland , New Jersey , Pennsylvania
DC Medicare - 12M63 - Inst Claims 12M63 District of Columbia
Delaware Medicare - 12M76 - Inst Claims 12M76 Delaware
Pennsylvania Medicare - 12M60 - Inst Claim 12M60 Pennsylvania
Colorado Medicaid - 12K03 - Inst Claims 12K03 Colorado
Mississippi BCBS & Teachers Blue - 12B17_12B82 - 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
North Carolina Medicare - 12M23 - Inst Claims 12M23 North Carolina
CA Home Health & Hospice - 12M98 Inst Claims 12M98 California
California Medicaid - 57016 - Inst Claims 57016 California
California Medicaid "Claimmaster Clients Only" - 57016 - Inst Claim 57016 California
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
Lousiana Medicaid - 12K12 - Inst Claim 12K12 Louisiana
Security Health Plan - 39045 - Inst Claims 39045 States unavailable for Security Health Plan - 39045 - Inst Claims
Tricare South - 61125 - Inst Claims 61125 Alabama , Arkansas , Florida , Georgia , Louisiana , Mississippi , Oklahoma , South Carolina , Tennessee , Texas
Tennessee Medicare - 12M53 - Inst Claims 12M53 Tennessee
Georgia Medicare - 12M05 - Inst Claim 12M05 Georgia
Alabama Medicare - 12M01 - Inst Claim 12M01 Alabama
Utah Medicaid - 12K42 - Inst Claims 12K42 Utah
Maine Medicaid - 12K13 - Inst Claim 12K13 Maine
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
New York Medicare - 12M35 - Inst Claims 12M35 New York
Connecticut Medicare - 12M04 - Inst Claims 12M04 Connecticut
West Virginia Medicare - 12M28 - Inst Claims 12M28 West Virginia
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
Minnesota Medicare - 12M16 - Inst Claims 12M16 Minnesota
New Hampshire Medicare - 12M21 - Inst Claims 12M21 New Hampshire
Massachusetts Medicare - 12M14 - Inst Claims 12M14 Massachusetts
Maine Medicare - 12M13 - Inst Claims 12M13 Maine
Rhode Island Medicare - 12M74 - Inst Claims 12M74 Rhode Island
Vermont Medicare - 12M26 - Inst Claims 12M26 Vermont
Illinois Medicare - 12M08 - Inst Claims 12M08 Illinois
Penn Behavioral Health - 53226 - Inst Claims 53226 States unavailable for Penn Behavioral Health - 53226 - Inst Claims
Amerihealth PPO NJ - 12X28 - Inst Claims 12X28 New Jersey
Amerihealth Administrators - 54763 - Inst Claims 54763 States unavailable for Amerihealth Administrators - 54763 - Inst Claims
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
Hawaii BCBS - 12B62 - Inst Claims 12B62 Hawaii
Tricare Overseas - 12X46 - Inst Claims 12X46 States unavailable for Tricare Overseas - 12X46 - Inst Claims
Tricare North - 57106 - Inst Claim 57106 Connecticut , Delaware , District of Columbia , Illinois , Indiana , Kentucky , Maine , Maryland , Massachusetts , Michigan , New Hampshire , New Jersey , North Carolina , Ohio , Rhode Island , Vermont , Virginia , West Virginia , Wisconsin
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
Ohio Medicare – 12M24 – Inst Claims 12M24 Ohio
Kentucky Medicare - 12M11 - Inst Claim 12M11 Kentucky
Florida Medicare - 12M34 - Inst Claim 12M34 Florida
Puerto Rico Medicare - 12M49 - Inst Claims 12M49 Puerto Rico
US Virgin Islands Medicare - 12M52 - Inst Claim 12M52 Virgin Islands
ValueOptions/MBHP (MA Behavioral Health Partnership - 43307 - Inst Claims 43307 Massachusetts
Value Optiosn (TX NorthStar) - 99297 - Inst Claims 99297 Texas
Value Options - 12X56 - Inst Claim 12X56 States unavailable for Value Options - 12X56 - Inst Claim
Value Options - 12K1A - Inst Claims 12K1A States unavailable for Value Options - 12K1A - Inst Claims
Oregon Medicare - 12M41 - Inst Claim 12M41 Oregon
North Dakota BC - 12B78 - Inst Claim 12B78 North Dakota
North Dakota Medicare - 12M82 - Inst Claim 12M82 North Dakota
Montana Medicare - 12M77 - Inst Claim 12M77 Montana
Iowa Medicaid - 12K10 - Inst Claim 12K10 Iowa
Arizona Medicare - 12M02 - Inst Claim 12M02 Arizona
AK & ID Medicare - 12M07 - Inst Claim 12M07 Alaska , Idaho
Legacy Part A - CA - HI- NV - 12M65 - Inst Claim 12M65 California , Hawaii , Nevada
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
Tricare for Life - 12X43 - Inst Claim 12X43 States unavailable for Tricare for Life - 12X43 - Inst Claim
Michigan Medicare - 12M18 - Inst Claim 12M18 Michigan
Indiana Medicare - 12M09 - Inst Claims 12M09 Indiana
Legacy Medicare WPS J5 - 52280 - Inst Claims 52280 Iowa , Kansas , Michigan , Missouri , Nebraska
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
Health Safety Network / MASS. Health Medicaid- 12K48 - Inst Claims 12K48 Massachusetts
Partners Behavioral Health Management - 52613 - Inst Claim 52613 States unavailable for Partners Behavioral Health Management - 52613 - Inst Claim
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
Illinois Medicaid - 12K08 - Inst Claims 12K08 Illinois
South Dakota Medicaid - 12K36 - Inst Claims 12K36 South Dakota
Wyoming Medicaid - 12K30 - Inst Claim 12K30 Wyoming
Georgia Medicaid - 12K05 - Inst Claims 12K05 Georgia
Florida Medicaid - 12K34 - Inst Claims 12K34 Florida
Iowa BCBS - 12B10 - Inst Claims 12B10 Iowa
South Dakota BCBS - 12B33 - Inst Claims 12B33 South Dakota
Nebraska Medicaid - 12K19 - Inst Claims 12K19 Nebraska
Capital Blue Cross - 12B61 - Inst Claim 12B61 States unavailable for Capital Blue Cross - 12B61 - Inst Claim
HealthPartners - 12X51 - Inst Claims 12X51 States unavailable for HealthPartners - 12X51 - Inst Claims
Wyoming BC - 12B30 - Inst Claim 12B30 Wyoming
Wyoming Medicare - 12M30 - Inst Claim 12M30 Wyoming
Washington Medicare - 12M45 - Inst Claim 12M45 Washington
Utah Medicare - 12M84 - Inst Claim 12M84 Utah
South Dakota Medicare - 12M83 - Inst Claim 12M83 South Dakota
Michigan Medicaid Hospital - 12K37 - Inst Claims 12K37 Michigan
Alaska Medicaid - 12K86 - Inst Claims 12K86 Alaska
New York State Medicaid - 12K35 - Inst Claims 12K35 New York
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
Idaho True Blue - 12B84 - Inst Claims 12B84 Idaho
Mississippi Medicaid - 12K17 - Inst Claims 12K17 Mississippi
Health Adv/US Able/First Pyramid Life/Arkansas Blue Cross - 12049 - Inst Claims 12049 Arkansas
Arkansas Blue Cross - 12021 - Inst Claims 12021 Arkansas
Rhode Island Medicaid Deactivation - 12K74 - Inst Claims 12K74 Rhode Island
Tennessee Medicaid - 12K46 - Inst Claims 12K46 Tennessee
Pennsylvania Western BC - 12B60 - Inst Claims 12B60 Pennsylvania
Pennsylvania BCBS Central Highmark - 12B81 - Inst Claims 12B81 Pennsylvania
West Virginia Blue Cross - 12B28 - Inst Claims 12B28 West Virginia
Highmark Senior Solution - 95461 - Inst Claims 95461 West Virginia
Rhode Island Medicaid Enrollment- 12K74 - Inst Claims 12K74 Rhode Island
Virginia Premier - 12K83 - Inst Claims 12K83 Virginia
Washington Medicaid Hospital - 12K27 - Inst Claims 12K27 Washington
Carolina Crescent - 12K85 - Inst Claims 12K85 States unavailable for Carolina Crescent - 12K85 - Inst Claims
Maryland Behavioral Health - 22322 - Inst Claims 22322 Maryland
Delaware BC - 12B76 - Inst Claim 12B76 Delaware
Hawaii Medicaid Hospital - 12K62 - Inst Claims 12K62 Hawaii
Independent Health - 12X01 - Inst Claim 12X01 States unavailable for Independent Health - 12X01 - Inst Claim
Maryland Medicaid -- 12007 - Inst Claims 12007 Maryland
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 - 12B45-12B53 - Inst Claims 12B45 Tennessee
Louisiana BCBS - 12B12 - Inst Claims 12B12 Louisiana
Montana BCBS Hospital - 12B77 - Inst Claims 12B77 Montana
Minnesota Medicaid - 12K16 - Inst Claims 12K16 Minnesota
Partnership Health Plan of CA - 12M81 - Inst Claims 12M81 California
Nevada Medicaid - 12K20 - Inst Claims 12K20 Nevada