Carrier Documentation
Following are the answers to some of the frequently asked questions about electronic claims to insurance carriers, as well as the documentation that we have collected for each carrier. You may need either a word processing program, or Adobe Acrobat Reader to read some of these forms.
Please note that these forms are provided as a courtesy and convenience to our Validator users, and while we try to keep the forms as up to date as possible, carriers often change the forms without any notice, so it might not be a bad idea to contact the carrier before mailing your enrollment forms in to assure you have the correct form.
Blue Cross of California
| Web Site | Payer ID: |
47198 |
|
| EDI Contact |
800-227-3983 |
State(s) |
CA |
|
Documentation: |
|||
Blue Shield of California
| Web Site | Payer ID: |
940360524 |
|
| EDI Contact |
800-480-1221 |
State(s) |
CA |
| Documentation: |
|
||
BCBS of Florida Medicare
| Web Site | Payer ID: | ||
| EDI Contact |
909-791-8767 |
State(s) |
Florida |
| Documentation: | Forms not available | ||
Empire BCBS NEIC Quick Link
| Web Site | Payer ID: |
NEIC |
|
| EDI Contact |
315-488-0080 |
State(s) |
New York |
| Documentation: | Forms not available | ||
Empire Blue Cross Blue Shield
| Web Site | Payer ID: |
BS803 |
|
| EDI Contact |
315-488-0080 |
State(s) |
New York |
| Documentation: | Forms not available | ||
Empire Blue Cross Medicare
| Web Site | Payer ID: |
00803 |
|
| EDI Contact |
315-488-0080 |
State(s) |
New York, District of Columbia and Delaware |
| Documentation: | Forms not available | ||
GHI Medicare NY
| Web Site | Payer ID: |
14330 |
|
| EDI Contact |
646-458-6721 |
State(s) |
New York |
| Documentation: | Forms not available | ||
Novitas Solutions New Jersey
| Web Site | Payer ID: |
12402 |
|
| EDI Contact |
717-763-6722 |
State(s) |
New Jersey |
| Documentation: | |||
Novitas Solutions Pennsylvania
| Web Site |
https:// |
Payer ID: |
12502 |
| EDI Contact |
717-763-6722 |
State(s) |
Pennsylvania |
| Documentation: | |||
Medi-CAL: California Medicaid
| Web Site | Payer ID: |
610442 |
|
| Web Site | Payer ID: |
610442 |
|
| EDI Contact |
916-636-1100 |
State(s) |
California |
| Documentation: | Medi-Cal Telecommunications Provider and Biller Application | ||
Medicaid : New York
| Web Site | Payer ID: |
141797357 |
|
| EDI Contact |
518-447-9256 |
State(s) |
New York |
| Documentation: | Forms not available | ||
National Heritage Insurance Company
| Web Site | Payer ID: |
31140 |
|
| EDI Contact |
781-749-7745 |
State(s) |
Massachusetts Maine, New Hampshire, and Vermont |
| Documentation: | Forms not available | ||
NHIC Medicare (CAN)
| Web Site | Payer ID: |
31140 |
|
| EDI Contact |
530-743-1587 |
State(s) |
Northern CA, Riverside and San Berndandio Counties |
| Documentation: | Service Enrollment Form | ||
NHIC Medicare (CAS)
| Web Site | Payer ID: |
31146 |
|
| EDI Contact |
213-593-6950 |
State(s) |
Southern CA, Imperial, LA, Orange, Santa Barbara, San Diego, San Luis Obispo and Ventura counties |
| Documentation: | Service Enrollment Form | ||
Noridian Medicare
| Web Site | Payer ID: |
0011 |
|
| EDI Contact |
800-967-7902 |
State(s) |
North Dakota, Sout Dakota, Colorado, and Wyoming |
| Documentation: | Forms not available | ||
Noridian Medicare
| Web Site | https://www.noridianmedicare.com | Payer ID: |
0012 |
| EDI Contact |
800-967-7902 |
State(s) |
Arkansas, Oregon, and Washington |
| Documentation: | Forms not available | ||
Noridian Medicare
| Web Site | Payer ID: |
0016 |
|
| EDI Contact |
800-967-7902 |
State(s) |
Arizona, Hawaii, and Nevada |
| Documentation: | Forms not available | ||
Palmetto GBA Medicare
| Web Site |
www. |
Payer ID: |
00833 |
| EDI Contact |
614-249-0340 |
State(s) |
Ohio and West Virginia |
| Documentation: | Forms not available | ||
Availity – Commercial Claims
| Web Site | Payer ID: |
See THIN list |
|
| EDI Contact | State(s) |
All |
|
| Documentation: | |||
Tricare – Champus
| Web Site | Payer ID: |
571132733 |
|
| EDI Contact |
803-763-1459 |
State(s) |
All |
| Documentation: | Forms not available | ||
Wisconsin Physicians Services – Champus
| Web Site | Payer ID: |
WESTR |
|
| EDI Contact |
803-763-1459 |
State(s) |
All |
| Documentation: | Forms not available | ||

