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Availity® Health Information Network Electronic Data Interchange (EDI) & Web Solutions Companion Guides Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name Payer ID Additional Information Availity Required Forms (links) Payer Specific Forms (links) BRIDGEWAY HEALTH SOLUTIONS 68069 Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form Centene_ERA_835_enrollment BUCKEYE COMMUNITY HEALTH PLAN 68069 Centene for further instructions. Both NPI number and Tax ID/SSN are required on Availity Multi-payer Form Centene_ERA_835_enrollment CAREFIRST BCBS OF DC/NCA SB580 the Multi-Payer Registration Form for processing. Both NPI number and Tax ID/SSN are required on Availity Multi-payer Form CAREFIRST BCBS OF MARYLAND SB690 the Multi-Payer Registration Form for processing. Availity Multi-payer Form ERA/EFT Setup-Maintenance Request CARITEN HEALTHCARE 61101 System ERA/EFT Setup-Maintenance Request CARITEN SENIOR HEALTH 61101 System CCSTPA 00220/00720 Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact CCStpa ERA Enrollment CELTICARE HEALTH PLAN 68069 Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form Centene_ERA_835_enrollment CENPATICO - AZ 68068 Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form Centene_ERA_835_enrollment CENPATICO - FL 68068 Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form Centene_ERA_835_enrollment CENPATICO - GA 68068 Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form Centene_ERA_835_enrollment CENPATICO - IL 68068 Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form Centene_ERA_835_enrollment CENPATICO - IN 68068 Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form Centene_ERA_835_enrollment CENPATICO - KS 68068 Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form Centene_ERA_835_enrollment CENPATICO - KY 68068 Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form Centene_ERA_835_enrollment CENPATICO - MA 68068 Centene for further instructions. Availity Multi-payer Form Centene_ERA_835_enrollment 30 of 124 Visit our web site: www.availity.com
Availity® Health Information Network Electronic Data Interchange (EDI) & Web Solutions Companion Guides Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name Payer ID Additional Information Availity Required Forms (links) Payer Specific Forms (links) CENPATICO - MS 68068 Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form Centene_ERA_835_enrollment CENPATICO - OH 68068 Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form Centene_ERA_835_enrollment CENPATICO - SC 68068 Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form Centene_ERA_835_enrollment CENPATICO - TX 68068 Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form Centene_ERA_835_enrollment CENPATICO - WI 68068 Centene for further instructions. Option available for ERA only providers. EFT providers must contact Centene for further Availity Multi-payer Form Centene_ERA_835_enrollment CENTENE MEDICARE 68069 instructions. Availity Multi-payer Form CENTRAL SENIOR CARE CIPA1 Please use payer id HPN11 to register. Availity Multi-payer Form CIGNA 62308 Cigna_ERA_835_Enrollment COMMUNITY HEALTH PLAN OF WASHINGTON CHPWA Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Availity Multi-payer Form COORDINATED CARE 68068 Centene for further instructions. Availity Multi-payer Form Metropolitan Health Plan Electronic Centene_ERA_835_enrollment CORNERSTONE BENEFIT ADMINISTRATORS 10850 NPI and UMPI numbers are required for processing. NPI number is required on the Multi-Payer Remittance Advice Enrollment From DEFINITY SERVICES 87726 Registration Form for processing. Availity Multi-payer Form ERA/EFT Setup-Maintenance Request EAGLE CREEK MEDICAL PLAZA 61101 System Please contact Provider Relations at (915)- EL PASO FIRST HEALTH PLANS - CHIP EPF03 532-3778 x1507 to enroll. EL PASO FIRST HEALTH PLANS - HCO Please contact Provider Relations at (915)- (HEALTHCARE OPTIONS) EPF37 532-3778 x1507 to enroll. EL PASO FIRST HEALTH PLANS - PREMIER PLAN Please contact Provider Relations at (915)- (STAR MEDICAID HMO) EPF02 532-3778 x1507 to enroll. ERA/EFT Setup-Maintenance Request EMPHESYS 61101 System Electronic Remittance Advice (ERA) FEDERAL EMPLOYEE PROGRAM (TX FEP) 84980 Enrollment Form FIRSTCARE 94999 Availity Multi-payer Form FIRSTCARE “STAR” MEDICAID 94998 Availity Multi-payer Form FIRST SOLUTIONS FS802 Availity Multi-payer Form 835 Health Care Electronic Remittance FLORIDA BLUE 00590 NPI number is required on the Multi-Payer Form for processing. Contact FHCP at EDISupport@fhcp.com to complete your ERA enrollment after you complete the Availity Multi- Advice (ERA) Request Form FLORIDA HEALTH CARE PLANS (FHCP) 59322 payer Form. Availity Multi-payer Form 31 of 124 Visit our web site: www.availity.com
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