Medical & Hospital ERA Enrollment Forms

Each provider must be set up in the Change Healthcare system to receive ERA files. 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.

  1. Step One: Specific payers require additional ERA enrollment paperwork to be completed for submission of claims. Please check the Change Healthcare Payer List for each payer's ERA Enrollment Requirements.
  2. Step Two: If ERA paperwork is required by a payer, you must receive an approval from the payer prior to ERAs being received.

***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 ERA Enrollment Forms

ERA Payer Enrollment Forms