If you are enrolling in EFT you must contact your Financial Institution to arrange for the delivery of the CORE required minimum CCD+ Data elements necessary for successful reassociation of the EFT files to their corresponding ERA files. For additional information regarding these fields please click here.
It is always recommended that you make sure that the payer has the appropriate Tax ID, NPI(s), and pay-to address on file.
As part of our commitment to you, the HeW Enrollment Department will assist you in completing all Payer EDI Enrollment forms. Please contact HeW Enrollment staff at 877-565-5457
, or hewenrollment@availity.com.
|
PAYER
|
PAYER ID
|
Forms
|
|
Medicare CA (Part A - Institutional)
|
01111
|
Claims & ERAs
|
| Medicare CA North (Part B - Professional) |
01112
|
Claims & ERAs
|
| Medicare CA South (Part B - Professional) |
01182
|
Claims & ERAs
|
| DME MAC Jurisdictions |
05655
|
Claims & ERAs
|
| Railroad Medicare |
00882
|
Claims & ERAs
|
|
Medicaid CA/Medi-Cal
(For Providers in LA County, please also call 916-636-1000 and ask for the LA County Unit for additional enrollment.)
|
610442
|
Claims
ERAs
EFT
Medi-Cal accepts electronic claims that need attachments. Call Medi-Cal at 800-541-5555 to order form ACF-001.
|
|
Blue Cross of CA
|
47198
|
Claims - There is no enrollment necessary.
Credentialed providers can submit electronic claims right away.
ERAs
|
| Blue Shield of CA (Institutional) |
94036
|
Claims - There is no enrollment necessary. Credentialed providers can submit electronic claims right away.
ERAs & EFT
|
|
Blue Shield of CA (Professional)
|
ET059
|
Claims - There is no enrollment necessary. Credentialed providers can submit electronic claims right away.
ERAs & EFT
|
| Department of Labor |
77044
|
Claims & ERAs
|
| Champus Tricare West |
99726
|
Claims
ERAs
|
| Tricare for Life |
TDDIR
|
Claims
ERAs
|
| VA Region 5A | VAPCCC5A |
Claims
ERAs
EFT
|
| Kaiser Foundation Health Plan of N. CA |
94135
|
ERAs
|
| Central CA Alliance | SX169 | ERAs |
| Healthnet of California |
95567
|
ERAs
|
| Other Carriers |
|
COMMERCIAL CARRIERS
|
HeW provides this paperwork as a courtesy. Although we try to make sure all forms are up-to-date, we cannot guarantee that they are the most recent. If you do identify a more up-to-date form, please bring this to our attention.
