Electronic Remittance / ERA / 835 Enrollment Forms

Some payers require pre-enrollment before permitting the provider to submit electronic claims to them. Typically payers such as Medicare, Medicaid, Blue Cross, and Blue Shield require pre-enrollment. Payers that require pre-enrollment are indicated on our Payer Lists (ENR column). As a service to our customers, Office Ally provides these agreements and forms below, pre-filled with Office Ally’s information where ever required. Below is a list of all Pre-Enrollment forms available (sorted by state).

Be sure to complete the form(s) as indicated on the Instructions Cover Page to ensure applications are not denied.

Payer ERA Enrollment Forms (A-Z)

Click here to view Non-ERA Payer Enrollment Forms


AARP (Insured by UHC)
Access Medical Group
Acclaim, Inc.
ACS Benefit Services
Activia Benefit Services
Administrative Concepts, Inc.
Advantek Benefit Administrators
Advocate Health
Aetna Better Health of California
Aetna Better Health of Florida
Aetna Better Health of Illinois
Aetna Better Health of Kansas
Aetna Better Health of Kentucky
Aetna Better Health of Louisiana
Aetna Better Health of Maryland
Aetna Better Health of Michigan
Aetna Better Health of New Jersey
Aetna Better Health of New York
Aetna Better Health of Ohio
Aetna Better Health of Pennsylvania
Aetna Better Health - Parkland (TX)
Aetna Better Health of Texas / TX Medicaid & CHIP
Aetna Better Health of Virginia
Aetna Better Health of West Virginia
Aetna Genworth Life Insurance
Aetna Healthcare
Aetna Healthcare (Dental)
Affinity Health Plan
AgeWell New York
Albuquerque Public Schools
Alignment HealthCare (Citizens Choice)
Allegiance Benefit Plan Management
Alliant Health Plans of Georgia
Allied Benefit Systems
Allways Health Partners
Amalgamated Insurance Company
AmeriBen Solutions
American Insurance Administrators
American National Insurance Company
American Postal Workers Union
American Specialty Health (ASH)
America's Choice Healthplan
Amerigroup Corporation
AmeriHealth Administrators
Amerihealth Caritas
AmeriHealth Delaware (HMO)
AmeriHealth Delaware (Non-HMO)
AmeriHealth New Jersey (HMO)
AmeriHealth New Jersey (Non-HMO)
Amfirst Insurance Company
Arrowhead Regional Medical Center
Asian American Medical Group
ASRM Corporation
Assured Benefits Administrators
Asuris Northwest Health
Atrio Health Plans
Automated Benefit Services
Avalon Healthcare Solutions
Avera Health Plans


Bankers Life
BayCare Select Health Plans Inc
BCBS Alabama
BCBS Arizona
BCBS Arkansas
BCBS Colorado
BCBS Connecticut
BCBS Delaware
BCBS District of Columbia / NCA (Carefirst)
BCBS Florida
BCBS Georgia
BCBS Hawaii (HMSA)
BCBS Illinois
BCBS Indiana
BCBS Kansas
BCBS Kansas City
BCBS Kentucky
BCBS Louisiana
BCBS Maine
BCBS Maryland (CareFirst)
BCBS Massachusetts
BCBS Michigan (Part A)
BCBS Michigan (Part B)
BCBS Minnesota
BCBS Mississippi
BCBS Missouri
BCBS Montana
BCBS Nebraska
BCBS Nevada
BCBS New Hampshire
BCBS New Mexico
BCBS New York (Central Region)
BCBS New York (Empire)
BCBS New York (Rochester Region)
BCBS New York (Utica Region)
BCBS North Carolina
BCBS North Dakota
BCBS Oklahoma
BCBS Pennsylvania (Listed as Highmark Health - Payer ID: 0025)
BCBS Rhode Island
BCBS South Carolina
BCBS Tennessee
BCBS Texas
BCBS Vermont
BCBS Virginia
BCBS West Virginia / Mountain States (Listed as Highmark Health - Payer ID: 0025)
BCBS Western New York
BCBS Western New York - Medicaid/CHP
BCBS Wisconsin
BCBS Wyoming
BCBSMN Blue Plus Medicaid
Beacon Health Options (Value Options)
Beacon Health Strategies
Benefit & Risk Management Services (BRMS)
Benefit Administration Services, LTD
Benefit Administrative Systems
Benefit Coordinators Corporation
Benefit Management, Inc. (Joplin)
Benefit Plan Administrators (WI)
BeneSys, Inc.
Blue Benefit Administrators of MA
Blue Cross Community Centennial (New Mexico)
Blue Cross Community Options of Illinois
Blue Cross of California
Blue Cross of Idaho
Blue Shield of CA Promise Health Plan
Blue Shield of California (ERA & EFT)
Blue Shield of North Dakota
Blue Shield of NorthEastern New YorkBMC HealthNet Plan
Boon Chapman Administrators
Boulder Administration Services
Braven Health
Bright Health Medicare Advantage
Brokerage Concepts
Brown & Toland Medical Group


C.L. Frates and Company
California Health and Wellness
Capital Blue Cross
Capital Dental
Capital District Physicians Health Plan (CDPHP)Capital Health Plan
Capitol Administrators
Cardinal Innovations (Piedmont Behavioral)
Cardiovascular Care Providers
Care Improvement Plus (CIP) / XL Health
Care Wisconsin Health Plan
CareMore Health Plan
CarePartners of Connecticut
CarePlus Health Plans
CareSource of Georgia
CareSource of Kentucky
CareSource of Ohio
CareSource Marketplace
CAS Coastal Administrative Services
CBHNP - Health
Cedar Valley Community Health
Celtic Insurance
CenCal Health
Centene Corporation
Central California Alliance for Health (CCAH)
Chesterfield Technologies
Children's Community Health Plan of WI
Children's Medical Center Health Plan
CHOC Health Alliance
Christian Brothers Services
Christus Health Medicare Advantage
Cigna Healthcare
Cigna Healthcare (EFT)
Citizens Security Life Insurance Company
City of Minneapolis
Clackamas County Mental Health
Clover Health (Formerly CarePoint)
Coastal Administrative Services
Colorado Access
Colorado Community Health Alliance
Commercial Travelers (PHX)Common Ground Healthcare
Commonwealth Care Alliance
Community Care BHO
Community Care Plan
Community Health Alliance
Community Health Choice
Community Health Group of SD
Community Health Plan of Washington
Care Oklahoma (CCOK)
Complementary Healthcare Plan (The CHP Group)
Connecticare Medicare
Connecticut Carpenters Health Fund
Consolidated Health Plans
Consumers Choice Health
Continental Benefits
Continental General Insurance Company
Contra Costa Health Plan
Convent Administrators Inc
Cook Childrens Health Plan
Cook Childrens Star Plan
Co-ordinated Benefit Plans LLC
Core Benefits
CoreSource KC (FMH)
Cornerstone Benefits Administrator Inc
Covenant Administrators
Coventry Healthcare
Cox Health Plan
Custom Benefit Administrators
Custom Design Benefits
CWI Benefits, Inc.


Hamaspik Choice
Harvard Pilgrim
Hawaii Medical Alliance Association (HMAA)
Health Alliance Medical Plan
Health Alliance Plan of Michigan
Health Choice Arizona
Health Choice Generations
Health Choice of Utah
Health Cost Solutions
Health Exchange (Cerner Corp)Health Net Arizona
Health Net of CA and OR
Health Network One
Health New England
Health Partners of Minnesota
Health Partners of Minnesota (Dental)
Health Partners Plans (PA)
Health Plan of San Joaquin
Health Plan of San Mateo
Health Plan Services
Health Plans, Inc.
Health Services for Children with Special Needs (HSCSN)
Health Services Management (HSM - Magellan)
Healthcare Highways
HealthCare Management Administrators (HMA)
Healthcare Options
HealthCare Partners of Nevada
HealthCare Solutions Group
HealthCare's Finest Network (HFN)
HealthChoice of Oklahoma / DRS DOC
Healthlink HMO
HealthNow New York
HealthPlex (Dental)
HealthSCOPE Benefits, Inc.
HealthScope UMR
HealthSmart Benefit Solutions
Healthy Blue LA
Healthy Blue Missouri
Healthy Blue North Carolina
Hennepin Health
Heritage Physicians Network / SelectCare TX
Highmark Health Options
Highmark Senior Health Company - Pennsylvania (Listed as Highmark Health - Payer ID: 0025)
Highmark Senior Solutions Company - West Virginia (Listed as Highmark Health - Payer ID: 0025)
Hill Physicians Medical Group
HIP Health Plan of NYHMA of Hawaii
HMO Louisiana Blue
Hometown Health Plan Nevada
Horizon BCBS of New Jersey
Horizon NJ Health


MacNeal Health Providers - CHS
Magellan Behavioral Health
MagnacareMaine Community Health Options
Managed Care Systems (MCS)
Managed Health Network (MHN)
Marrick Medical Finance
Martins Point Healthcare
Maryland Physicians Care (Aetna)
Mashantucket Pequot Tribal Nation
Masonry Welfare (Industry) Trust Fund
MCA Administrators
McLaren Health Plan - Commercial
MDwise Cooperative Managed Care Services
MDwise Health Indiana Plan
MDwise Hoosier Healthwise
MDX HawaiiMED3000 CMS Early Steps
MedCost Benefit Services
Medica and Medica UnitedHealthcare
Medica Government Programs
Medica HealthCare Plan
Medica Health Plan Solutions
Medicaid Alabama
Medicaid Alaska
Medicaid Arizona
Medicaid Arkansas
Medicaid Colorado
Medicaid Connecticut
Medicaid Delaware
Medicaid Florida
Medicaid Georgia
Medicaid Hawaii
Medicaid Idaho
Medicaid Illinois
Medicaid Indiana
Medicaid Iowa
Medicaid Kansas
Medicaid Kentucky
Medicaid Louisiana
Medicaid Maine
Medicaid Maryland (Part A)
Medicaid Maryland (Part B)
Medicaid Massachusetts
Medicaid Michigan
Medicaid Minnesota
Medicaid Mississippi
Medicaid Missouri
Medicaid Montana
Medicaid Nebraska
Medicaid Nevada
Medicaid New Jersey
Medicaid New Hampshire
Medicaid New Mexico
Medicaid New York
Medicaid North Carolina
Medicaid North Dakota
Medicaid Ohio
Medicaid Oklahoma
Medicaid Oregon
Medicaid Pennsylvania
Medicaid Rhode Island
Medicaid South Carolina
Medicaid South Dakota
Medicaid Texas
Medicaid TX Premier Plan
Medicaid Utah
Medicaid Vermont
Medicaid Virginia
Medicaid Washington (ProviderOne)
Medicaid Washington DC
Medicaid West Virginia
Medicaid Wisconsin
Medicaid Wyoming
Medical Associates Health Plan
Medical Benefits Mutual
Medical Mutual of Ohio
Medicare Alabama (Part A)
Medicare Alabama (Part B)
Medicare Alaska
Medicare Arizona
Medicare Arkansas (Part A)
Medicare Arkansas (Part B)
Medicare California - North (Part A)
Medicare California - North (Part B)
Medicare California - South (Part A)
Medicare California - South (Part B)
Medicare Colorado (Part A)
Medicare Colorado (Part B)
Medicare Connecticut
Medicare Delaware (Part A)
Medicare Delaware (Part B)
Medicare Florida (Part A)
Medicare Florida (Part B)
Medicare Georgia (Part A)
Medicare Georgia (Part B)
Medicare Hawaii
Medicare HHH (J11)Medicare HHH (J15)Medicare Idaho
Medicare Illinois
Medicare Indiana
Medicare Iowa
Medicare J04911
Medicare J12901 WPS Legacy (Part A)
Medicare Kansas
Medicare Kentucky
Medicare Louisiana (Part A)
Medicare Louisiana (Part B)
Medicare Maine
Medicare Maryland (Part A)
Medicare Maryland (Part B)
Medicare Massachusetts
Medicare Michigan (Part A)Medicare Michigan (Part B)Medicare Minnesota
Medicare Mississippi (Part A)
Medicare Mississippi (Part B)
Medicare Missouri
Medicare Montana
Medicare Nebraska
Medicare Nevada
Medicare New Hampshire
Medicare New Jersey (Part A)
Medicare New Jersey (Part B)
Medicare New Mexico (Part A)
Medicare New Mexico (Part B)
Medicare North Carolina
Medicare North Dakota
Medicare Northern Virginia
Medicare New York (Downstate)
Medicare New York (Queens)
Medicare New York (Upstate)
Medicare Ohio
Medicare Oklahoma (Part A)
Medicare Oklahoma (Part B)
Medicare Oregon
Medicare Pennsylvania (Part A)
Medicare Pennsylvania (Part B)
Medicare Railroad
Medicare Rhode Island
Medicare South Carolina
Medicare South Dakota
Medicare Tennessee (Part A)
Medicare Tennessee (Part B)
Medicare Texas (Part A)
Medicare Texas (Part B)
Medicare Utah
Medicare Vermont
Medicare Virginia
Medicare Virgin Islands
Medicare Washington
Medicare Washington DC (Part A)
Medicare Washington DC (Part B)
Medicare West Virginia
Medicare Wisconsin (Part A)
Medicare Wisconsin (Part B)
Medicare Wyoming
Med-Pay Inc. (PHX)
MedSolutions, Inc
MedStar Family Choice DC
Medstar Select
Mercy Maricopa Integrated Care
Mercy Physicians Medical Group (NAMM)Meridian Health Plan
Meridian Health Plan IL Complete
Meritain Health (MN)
Meritain Health (Weyco)
Metro Plus Health Plan
Mid-America Associates, Inc.
Mid-American Benefits
Mid Rogue Oregon Health Plan
Midwest Group Benefits
MidWest Physician Admin Services
Minnesota Department of Health
Minnesota Department of Labor
Mississippi Public Entity Employee Benefit Trust
MN Counties Intergovernmental Trust
Moda Health (Formerly ODS Health Plan)
Molina Healthcare
Molina Healthcare of Nevada
Montefiore CMO
Mutual Assurance Administrators
Mutual Health Services (Antares)Mutual of Omaha
Mutual of Omaha Medicare Advantage
MVP Health Care (Mohawk Valley)
MyNexus - Aetna Home Health
myNEXUS Anthem


Pacific Southwest Administrators
Pan American Life Insurance Group
Paramount Healthcare
Park District Risk Management Agency
Partnership HealthPlan of California
Partners Behavioral Health
Passport Health Plan
Patient Advocates, LLC
PCA Health Plan of Texas
Peak Pace Solutions
Pekin Life Insurance
Peoples Health Network
Personal Insurance Administrators, Inc.
Physician Associates of Greater San Gabriel Valley
Physicians Choice Medical Group of San Luis Obispo
Physicians Choice Medical Group of Santa Maria
Physicians Data Trust (PDT)
Physicians Health Plan (PHP) - Global Care
Physicians Health Plan (PHP) - Michigan
Physicians Health Plan (PHP) - Northern Indiana
PIH Health (Bright Health)
Pioneer Provider Network (Mckesson)
Pittman & Associates (HealthSmart Benefit)
Planned Administrators, Inc.
Prairie States Enterprises
Preferred Admin Childrens Hospital
Preferred Administrator
Preferred Care Partners / FL
Preferred Health Plan of the Carolinas
Premera Blue Cross Blue Shield of Alaska (Part A)
Premera Blue Cross Blue Shield of Alaska (Part B)
Premera Blue Cross of Washington (Part A)
Premera Blue Cross of Washington (Part B)
Premier Eye Care
Premier Health Plan
Premier HealthCare Exchange (PHX) - BMI Kansas
Premier HealthCare Exchange (PHX) - CDS of Nevada
Presbyterian Health Plan
Primary Physician Care
PrimeWest Health Systems
Priority Health
ProCare Health Plan Medicaid
Professional Benefit Administrators
Providence Health Plan
Providence Risk & Insurance
Public Employees Health Plan (PEHP)

Have More Questions?
Chat with one of our qualified representatives!