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

http://www.bluecrossca.com/

Payer ID:

47198

EDI Contact

800-227-3983

State(s)

CA

Documentation:

Blue Shield of California

Web Site

http://www.blueshieldca.com/

Payer ID:

940360524

EDI Contact

800-480-1221

State(s)

CA

Documentation:
  • Currently not Accepting direct submissions

BCBS of Florida Medicare

Web Site

https://

Payer ID:
EDI Contact

909-791-8767

State(s)

Florida

Documentation: Forms not available


Empire BCBS NEIC Quick Link

Web Site

https://

Payer ID:

NEIC

EDI Contact

315-488-0080

State(s)

New York

Documentation: Forms not available

Empire Blue Cross Blue Shield

Web Site

https://www.empireblue.com/

Payer ID:

BS803

EDI Contact

315-488-0080

State(s)

New York

Documentation: Forms not available

Empire Blue Cross Medicare

Web Site

https://www.empiremedicare.com/

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

https://www.ghimedicare.com/

Payer ID:

14330

EDI Contact

646-458-6721

State(s)

New York

Documentation: Forms not available

Novitas Solutions New Jersey 

Web Site

https://www.novitas-solutions.com/partb/index.html

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

http://www.medi-cal.ca.gov/

Payer ID:

610442

Web Site

https://sysdev.medi-cal.ca.gov/Eligibility/Login.asp

Payer ID:

610442

EDI Contact

916-636-1100

State(s)

California

Documentation: Medi-Cal Telecommunications Provider and Biller Application

Medicaid : New York

Web Site

http://www.nyhipaadesk.com

Payer ID:

141797357

EDI Contact

518-447-9256

State(s)

New York

Documentation: Forms not available

National Heritage Insurance Company

Web Site

http://www.nhicmedicare.com

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

http://www.medicarenhic.com

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

http://www.medicarenhic.com

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

http://www.noridianmedicare.com

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 http://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

http://www.noridianmedicare.com

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

http://www.availity.com

Payer ID:

See THIN list

EDI Contact State(s)

All

Documentation:

Tricare – Champus

Web Site

http://www.southcarolinablues.com

Payer ID:

571132733

EDI Contact

803-763-1459

State(s)

All

Documentation: Forms not available

Wisconsin Physicians Services – Champus

Web Site

http://www.southcarolinablues.com

Payer ID:

WESTR

EDI Contact

803-763-1459

State(s)

All

Documentation: Forms not available