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
|
| WPS Medicare Part A (Institutional) |
05901
|
Claims & ERAs
|
| Medicare NH (Part B - Professional) |
14312
|
Claims & ERAs
|
| DME MAC Jurisdiction |
05655
|
Claims & ERAs
|
| Railroad Medicare |
00882
|
Claims & ERAs
|
| Medicaid NH |
SKNH0
|
Claims & ERAs
|
| BCBS NH |
00770
|
Claims - There is no enrollment necessary. Credentialed providers can submit electronic claims right away.
ERA & EFT
|
| Carefirst BCBS of Maryland (Professional) |
SB690
|
Claims - There is no enrollment necessary. Credentialed providers can submit electronic claims right away.
|
| Department of Labor |
77044
|
Claims & ERAs
|
| Champus Tricare North |
57106
|
Claims
ERAs
|
| Tricare for Life |
TDDIR
|
Claims
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.
