Additional Enrollment Emdeon Payer Enrollment is required for the payers listed below. Please follow the steps outlined on the main Enrollment Forms page to ensure a smooth process. All enrollment forms are in Adobe Acrobat® format (.pdf). Ifyou do not have Adobe Acrobat® Reader™, you may download it here. |
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ALL DOCUMENTS MUST BE PRINTED WITH 'DOCUMENTS AND MARKUPS' OPTION IN PRINT DIALOG (DEFAULT IS ONLY 'DOCUMENT') TO ENSURE PROPER PRE-FILLING OF FORM DATA |
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Agreement Records
SB510 -- Alabama BCBS Medical
SMAL0 -- Alabama Medicare Medical
SKAK0 -- Alaska Medicaid
SMAK0 -- Alaska Medicare
SB930 -- Alaska _ Washington BCBS Medical
SMAZ0 -- Arizona Medicare
SB520 -- Arkansas BCBS Medical
SMAR0 -- Arkansas Medicare Medical
SX067 -- BrickStreet Mutual Insurance aka West Virginia Workman's Comp
SKCA0 -- California Medicaid
SMCA1 -- California Medicare (Northern)
SMCA2 -- California Medicare (Southern)
09823 -- Cimarron Medical
SKCO0 -- Colorado Medicaid
SMCO0 -- Colorado Medicare
SKCT0 -- Connecticut Medicaid
SMCT0 -- Connecticut Medicare
SKDC0 -- DC Medicaid
SMDC0 -- DC Medicare
SDMEA -- DME Region A Medical
SDMEB -- DME Region B Medical
SDMEC -- DME Region C Medical
SDMED -- DME Region D Medical
SB570 -- Delaware BCBS
SKDE0 -- Delaware Medicaid
SMDE0 -- Delaware Medicare
SX105 -- Deseret Mutual
75273 -- Geisinger Health Plan
SKGA0 -- Georgia Medicaid
SMGA0 -- Georgia Medicare
SB971 -- Hawaii BCBS
SKHI0 -- Hawaii Medicaid
SMHI0 -- Hawaii Medicare
SX009 -- Health Partners Minnesota
41150 -- Health Services Management
38216 -- HealthPlus of Michigan
55204 -- Healthnow Division
13335 -- Hudson Health Plan
SB612 -- Idaho Blue Shield
SKID0 -- Idaho Medicaid
SMID0 -- Idaho Medicare
SMIL0 -- Illinois Medicare
SX073 -- Independent Health
SMIN0 -- Indiana Medicare
SB640 -- Iowa BCBS
SKIA0 -- Iowa Medicaid
SMIA0 -- Iowa Medicare
SB650 -- Kansas Blue Shield
SB740 -- Kansas City Blue Shield
SMKC0 -- Kansas City Medicare
SMKS0 -- Kansas Medicare
SKKY0 -- Kentucky Medicaid
SMKY0 -- Kentucky Medicare
91155 -- Lifewise of AZ
23738 -- Louisiana BCBS
SKLA0 -- Louisiana Medicaid
SMLA0 -- Louisiana Medicare
SKME0 -- Maine Medicaid
SMME0 -- Maine Medicare
SX069 -- Maryland Behavioral Health
SKMD0 -- Maryland Medicaid
SMMD0 -- Maryland Medicare
SKMA0 -- Massachusetts Medicaid
SMMA0 -- Massachusetts Medicare
39190 -- MedStar Family Choice - Medicaid Claims
SB710 -- Michigan BCBS
SKMI0 -- Michigan Medicaid Medical
SMMI0 -- Michigan Medicare
SB720 -- Minnesota BCBS
SKMN0 -- Minnesota Medicaid
SMMN0 -- Minnesota Medicare
SB730 SB731 -- Mississippi BCBS
SKMS0 -- Mississippi Medicaid
SMMS0 -- Mississippi Medicare
SMMO0 -- Missouri Medicare
SB751 -- Montana BCBS Medical
SMMT0 -- Montana Medicare
SMNY2 -- NY - MEDICARE B QUEENS
SB760 -- Nebraska BCBS
SMNE0 -- Nebraska Medicare
SKNE0 -- Nebrasks Medicaid
SKNV0 -- Nevada Medicaid
SMNV0 -- Nevada Medicare
SKNH0 -- New Hampshire Medicaid
SMNH0 -- New Hampshire Medicare
22099 -- New Jersey BCBS
SKNJ0 -- New Jersey Medicaid
SMNJ0 -- New Jersey Medicare
SMNM0 -- New Mexico Medicare
SB805 -- New York BCBS Central
SB800 -- New York BCBS Northeastern
SB804 -- New York BCBS Rochester
SB801 -- New York BCBS Western
SKNY0 -- New York Medicaid
SMNY0 -- New York Medicare
SX089 -- New York Rochester Preferred Care
SMNY1 -- New York UpstateWestern Medicare
SB806 -- New York Utica
SB810 -- North Carolina BCBS
SKNC0 -- North Carolina Medicaid
SMNC0 -- North Carolina Medicare
SB820 -- North Dakota BCBS
SMND0 -- North Dakota Medicare
SMOH0 -- Ohio Medicare
SMOK0 -- Oklahoma Medicare
93093 -- Oregon LifeWise Health Plan
SKOR0 -- Oregon Medicaid
SMOR0 -- Oregon Medicare
SX140 -- Partnership Health Plan
SB865 -- Pennsylvania BS
SX078
SX079
SMPA0 -- Pennsylvania Medicare
09861 -- Pima Health Plan
SX131,SX132,SX133,SX134,SX135,SX136,SX137,SX138,SX139 -- Providence Plan
SMPR0 -- Puerto Rico Medicare Medical
SRRGA -- Railroad Medicare (All States)
SB870 -- Rhode Island BCBS
SKRI0 -- Rhode Island Medicaid
SMRI0 -- Rhode Island Medicare
SX141 -- Rocky Mtn Health Plans
SKSC0 -- South Carolina Medicaid
SMSC0 -- South Carolina Medicare
SB889 -- South Dakota BCBS
SKSD0 -- South Dakota Medicaid
SMSD0 -- South Dakota Medicare
77318 -- Sutter Connect
SB890 -- Tennessee BCBS
SKTN2 -- Tennessee Medicaid
SMTN0 -- Tennessee Medicare
SMTX0 -- Texas Medicare and Indian Health Services
SX176 -- TriCare For Life
57106 -- TriCare North
SCWI0 -- TriCare Western Region
SX086 SX087 SX088 SX090 SX091 -- Univera Healthcare
SB910 -- Utah BCBS
SKUT0 -- Utah Medicaid
SMUT0 -- Utah Medicare
SX173 -- Value Options
SB915 -- Vermont BCBS
SKVT0 -- Vermont Medicaid
SMVT0 -- Vermont Medicare
SMVI0 -- Virgin Islands Medicare
SMVA0 -- Virginia Medicare Medical
54176 -- Virginia Premier Health Plan
SX022 -- WPS Commercial
SX063 -- Washington Dept of Labor & Industries
SKWA0 -- Washington Medicaid
SMWA0 -- Washington Medicare
SB941 -- West Virginia BCBS Mountain State
SMWV0 -- West Virginia Medicare
SX067 -- West Virginia Workmans Comp
74101 -- Wisconsin Department of Corrections
SMWI0 -- Wisconsin Medicare
SB960 -- Wyoming BCBS
SKWY0 -- Wyoming Medicaid
