Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI).

Required Documents for those applying for new Submitter ID's

The following documents are required enrollment documents that must be completed, signed and returned to the BCBS office prior to initiation of electronic claims submission or inquiry. 1. Trading Partner Agreement 2. Electronic Connectivity Request Form:
  • ECR-837, 27X, 835
  • If the links above do not work properly, you can download them from:

    Enrollment Instructions

    Thank you for your interest in Electronic Data Interchange (EDI).

    Required Documents for those applying for new Submitter IDs

    The following documents are required enrollment documents that must be completed, signed and returned to the ASK office prior to initiation of electronic claims submission or inquiry. 1. EDI Enrollment Form (New Trading Partner number, 837 Claims) 2. EDI Enrollment Form (Electronic Remittances 835) If the above links do not work properly, please download the forms from here: http://www.ask-edi.com/forms.htm

    Enrollment Instructions

    Thank you for your interest in Electronic Data Interchange (EDI).

    Required Documents for those applying for new Submitter IDs

    The following documents are required enrollment documents that must be completed, signed and returned to the Lifetime Health care Co office prior to initiation of electronic claims submission or inquiry. Univera 1. Electronic Consent (Trading Partner Agreement) 2. Schedule C Remit Excellus 1. Electronic Consent (Trading Partner Agreement)

    Enrollment Instructions

    Thank you for your interest in Electronic Data Interchange (EDI).

    Required Documents for those applying for new Submitter IDs

    The following documents are required enrollment documents that must be completed, signed and returned to the Lifetime Healthcare Co office prior to initiation of electronic claims submission or inquiry. Univera 1. Electronic Consent (Trading Partner Agreement) 2. Schedule C Remit Excellus

    Enrollment Instructions

    Thank you for your interest in Electronic Data Interchange (EDI).

    Required Documents for those applying for new Submitter IDs

    The following documents are required enrollment documents that must be completed, signed and returned to the BCBS office prior to initiation of electronic claims submission or inquiry. 1. Trading Partner Registration Form 2. Trading Partner Agreement (2 copies) If the links above to not work properly please download them from: http://www.bcbsne.com/Providers/Forms/

    Enrollment Instructions

    Thank you for your interest in Electronic Data Interchange (EDI).

    Enrolling for a Submitter ID

    To enroll for a Submitter ID with VT Blue Cross Blue Shield please call 1-800-334-3441 or email them at editechsupport@bcbsvt.com In the email/call you must let them know your monthly claim volume and they will determine if it is large enough to allow for a direct connection. If not, you will need to submit through a clearinghouse and would be able to go through Availity using SolAce EMC. If a Direct connection is allowed, you will need to complete the following forms: 1. EDI Enrollment Form

    Enrollment Instructions

    Thank you for your interest in Electronic Data Interchange (EDI).

    Required Documents for those applying for new Submitter IDs

    The following documents are required enrollment documents that must be completed, signed and returned to the Highmark office prior to initiation of electronic claims submission or inquiry. 1. 5010 EDI Transaction Application to Create New Trading Partner If the above link does not work properly, follow these steps: To apply for a Highmark Blue Shield Submitter ID please go to the following site: www.highmark.com/edi -Click on Sign Up Under the Related Links Section:

    Enrollment Instructions

    Thank you for your interest in Electronic Data Interchange (EDI).

    Required Documents for those applying for new Submitter IDs

    The following documents are required enrollment documents that must be completeed signed, and returned to the Rhode Island BCBS office prior to initiation of electronic claims submission or inquiry. 1. Trading Partner Registration Form 2. Trading Partner Agreement If the above links do not work properly, please download these forms from:

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