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 TX (Part A - Institutional) |
00400
|
Claims & ERAs
|
| Medicare TX (Part B - Professional) |
04402
|
Claims & ERAs
|
| HHH J11 - Medicare |
11001
|
Claims & ERAs
|
| DME MAC Jurisdictions |
05655
|
Claims & ERAs
|
| Railroad Medicare |
00882
|
Claims & ERAs
|
| J04911 Medicare (Part A - Instiitutional) |
04911
|
Claims & ERAs
|
| Medicaid TX |
86916
|
Claims - No EDI Enrollment is necessary for Credentialed Providers.
ERAs - Not available to clearinghouse, but may be available through payer's website.
|
| BCBS TX |
84980
|
Claims - No EDI Enrollment is necessary for Credentialed Providers.
ERAs
|
Champus Tricare South
(excludes the El Paso area) |
61125
|
Claims
ERAs
|
Champus Tricare West
(southwestern corner including the El Paso area) |
99726
|
Claims
ERAs
|
| Tricare for Life |
TDDIR
|
Claims
ERAs
|
VA Region 5A
(West Texas) | VAPCCC5A |
Claims
ERAs
EFT
|
| Department of Labor |
77044
|
Claims & ERAs
|
| PacifiCare of TX |
95959
|
Claims - No enrollment necessary.
ERAs
|
| Superior Health Plan of Texas |
68069
|
ERAs (Note: EFT cannot be selected
if you wish to received ERAs through HeW)
|
| 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.
