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Claims Enrollment

A small subset of payers require additional enrollment tasks be completed prior to accepting claims electronically. Those payers are denoted with a ‘Y’ in the ENROLL column of the Change Healthcare payer list located at Change Healthcare Payer List. If claims are submitted for a payer requiring the additional enrollment tasks prior to the approval being received by Change Healthcare, these claims will be rejected.

All Dental Claims Enrollment Forms

  Title Payer ID State(s)
  Wyoming Blue Cross - CBWY1
  Alaska Medicaid CKAK1
  Alabama Medicaid CKAL1
  Alabama Medicaid Tax ID Change CKAL1
  Florida Medicaid CKFL1
  Star Plus Value Added CPPSP
  Maine Medicaid CKME1
  Deseret Mutual Benefit Administrators CX089
  Delaware Medicaid CKDE1
  Georgia Medicaid CKGA1
  Health Partners CX009
  Wellmark Iowa Blue Dental Blue Cross of South Dakota CBIA2
  Iowa Medicaid CKIA1
  Kentucky Medicaid CKKY1
  Idaho Medicaid CKID1
  Idaho Blue Cross CBID1
  Kentucky Medicaid - Dental Provider Change to Group Practice Enrollment CKKY1
  Assertus Payers PRADV
  Michigan Medicaid CKMI1
  North Dakota Blue Cross Blue Shield CX004
  North Carolina Medicaid CKNC1
  Medi Cal (California Medicaid) 57016
  Minnesota Medicaid CKMN1
  Lousiana Blue Cross Blue Shield 23739
  Mississippi Blue Cross Blue Shield CBMS1
  Mississippi Medicaid CKMS1
  New Jersey Medicaid CKNJ1
  New Jersey Medicaid - Charity Care CKNJ2
  New Mexico Medicaid CKNM1
  National Provider Identifier
  Tennesee Blue Cross Blue Shield CBTN1
  Nevada Medicaid CKNV1
  New York Medicaid CKNY1
  New York Medicaid - Trading Partner Agreement CKNY1
  Oregon Medicaid CKOR1
  Oregon Medicaid Exhibit C 837D Update Requests CKOR1
  PEHP (Public Employees Health Program) CX080
  South Dakota Blue Cross Blue Shield CBSD1
  Superior Star Pregnant Women CPPSW
  Wyoming Medicaid CKWY1
  Washington Medicaid CKWA1
  Washington DC Medicaid CKDC1
  Vermont Medicaid CKVT1
  Utah Medicaid CKUT1
  Texas Medicaid CKTX1
  Triple-S CBPR1
  Triple Medicare Advantage PRADV