Payer Enrollment can be complicated, please follow the instructions below for the appropriate line of business. Payer specific forms are available using the links at left for those payers that require enrollment.
Medical Payer Enrollment:
CMS requires Change Healthcare to have an authorized Electronic Data Interchange (EDI) Enrollment Form or Medicare Remittance Advice on file for every Provider accessing the Medicare 270/271 Eligibility Transaction. Any new or existing customer must provide Change Healthcare with a copy of either of these forms. CMS's requirement can be found on page 6 in transmittal 991 with the Subject Line "Rules of Behavior". View the CMS rule.
Medical Enrollment 1-2-3:
Change Healthcare Enrollment is required to set up your system with access to the payers and transactions you need. This may include both Change Healthcare Enrollment and Payer Enrollment. The steps below are provided to assist you in completing these processes with minimal delays.
Step 1: Check the Payer List to determine if the transaction type you are interested in is available from the payers desired. The Payer List will also indicate what, if any, Payer enrollment is required.
Step 2: Change Healthcare Enrollment is accomplished with Provider Setup Forms (PSF) available for Batch Claim transactions and ERA's. Select the form from the link at left that applies to your transactions:
- Batch Claims Provider Setup Form - new enrollments, additions to existing enrollments
- ERA Provider Setup Form - new enrollments for remittance files
If changes are needed to your enrollment information please complete the appropriate form from the Change Healthcare Setup Forms links at left for your transaction types:
- Batch Claims Change/Delete Form - Changes to or deletions from existing enrollments
- ERA Add/Change/Delete Form - additions, changes or deletions to existing ERA enrollments.
Step 3: Payer Agreements are needed when payers require a separate enrollment process. As a service to our customers, Change Healthcare provides these agreements and will forward complete forms to the payer as well as track the payer approval process. Please select the transaction type from the Payer Enrollment Forms links listed at top left then locate the payer name on the resulting page. Please report broken links or incorrect agreements by email to firstname.lastname@example.org.
For Additional Enrollment information, please use the link below.
Please ensure that you have completed the appropriate Change Healthcare Provider Setup form and emailed it to: email@example.com before submitting your Payer Enrollment forms.
If you are unable to email you may use one of the following options:
PO Box 148850
Nashville TN 37214
The listed payers require Dental providers to complete additional enrollment paperwork before they may submit their claims electronically. For each payer listed to which you would like to submit electronic claims please click on the carrier name, download the additional enrollment form(s), complete, and return the form to the fax number or address listed on the instruction sheet. Please ensure all necessary information is accurate and all required signatures are present. If you require assistance completing an enrollment form or have questions please contact Change Healthcare Dental Provider Enrollment at 888-255-7293 option 1.