Payer Enrollments
- This page contains the Payer Codes and all necessary Payer Enrollment forms required to submit claims to BlueCross/BlueShield, Medicare, Medicaid and select Commercial Payers.
- Please follow the steps outlined on the Enrollment Forms Cover Page to ensure a smooth process.
- Click on the payer below to download the enrollment form. If a payer is not listed, no enrollment forms are necessary to submit claims to that payer.
- All enrollment forms are in Adobe Acrobat® format (.pdf). If you do not have Adobe Acrobat® Reader™, you may download it here.
Payer ID | Payer Name
Payer Enrollment Tips:
To avoid delays, please follow all instructions on cover page.
Complete only Provider related sections.
Verify the accuracy of all provider numbers.
Sign all forms in BLUE INK.
Mail Completed forms to:EClaims
Attn:Payer Enrollments
PO Box 9
Kearney NE 68848
For Overnight or other expedited delivery:
EClaims
Attn:Payer Enrollments
2201 Central Ave STE D
Kearney NE 68847
EClaims must be notified once you have
received approval from the payer to
submit electronically. Failure to do so will cause your claims to either reject, or to be processed as paper.
