EClaims - Indiana Enrollment Information

You must follow these steps to ensure your enrollments are processed as quickly as possible.

Forms must be completed in blue ink, and signed by the Provider.

Please complete only the Provider related sections.

EClaims must be notified once you have received approval to submit claims electronically. Failure to

do so will cause your claims to be processed as paper claims.

You must complete the Provider Setup Form for EClaims, even if the Payer requires no enrollment

forms.

Complete two copies and return them via US Mail to:

EClaims, Inc.

Attn: Enrollment Dept

P.O. Box 9

Kearney, NE 68848

For Overnight or other expedited delivery please send to:

EClaims, Inc.

Attn: Enrollment Dept

2201 Central Avenue Suite D

Kearney, NE 68847

Name	Payer ID	Transactions Available	Enrollment Forms Required
ASH Plans (American Specialty Health Plans)	00001	Claims
Commercial	View List	Claims
Commercial	View List	ERA
Blue Cross Blue Shield	00630	Claims
Medicare	SMIN0	Claims
Medicaid	SKIN0	Claims
DME	SDMEB	Claims
RailRoad Medicare	SRRGA	Claims
TriCare		Claims	Not Available Online Please call Client Services 626.549.4517
Please contact Client Services if you have any questions. 626.549.4517