Provider Enrollment – Real Time Eligibility 270 Transaction

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COMMERCIAL PAYERS Most commercial payers do not require registration for the Eligibility transaction, however, there are a few. Please check the table of Special Payers below.

GOVERNMENT PAYERS Complete this form, Practice Insight 270/271 Eligibility Registration, and fax to the Practice Insight Enrollment Dept. for processing. Registration takes 2-5 days—an email will be sent from enrollment@practiceinsight.net to confirm completion of the provider’s account setup. In addition, check the table of Special Payers below. Please allow extra processing time for Special Payers.

MEDICARE-CMS (extra) Enrollment includes both CMS Medicare A/B and Railroad Medicare. All Medicare providers must FAX a copy of the Provider’s signed CMS Medicare EDI Agreement to Practice Insight Enrollment at: 713-333-0138, and wait for confirmation from Practice Insight before sending Medicare Eligibility Requests.

Special Payer Enrollment Forms – Real Time Eligibility

Payers by Name Government by State	ELIGIBILTY REQUESTS (270)
Alabama	Alabama BCBS Complete EXISTING SUBMITTER enrollment form. Fax completed form to Practice Insight. Allow 2 weeks.
Arkansas	Arkansas BCBS Complete enrollment form. Fax completed form to Practice Insight. NOTE: Providers submitting claims should already have a BCBSAR submitter ID# assigned (ex: E1234). Allow 2 weeks.
California	California Medicaid MCD CA requires that the provider obtain a Medi-Cal Provider PIN # and  this  PIN # must be sent out on the 270 request.  (This is NOT the Provider’s Legacy ID #.) 1- To obtain the 7-digit Pin #, providers can call Medi-Cal Telephone Service Center (TSC) 1.800.541.5555 or go to  http://www.medi-cal.ca.gov/default.asp 2- The Provider’s Medicaid 7-digit PIN # must be added onto the Provider Record(s) in EDI.  Add Payer ID Type of “MCDCA” with 7-digit Pin #.
Careplus Health Plan (95092)	NOTE: No special form is required—list payer on Practice Insight 270/271 Registration Form. Include CarePlus Health Plan legacy provider ID (2-16 digits). Be advised that enrollment for this payer takes 10-15 business days longer than basic setup.
Delaware	Delaware Medicaid Complete enrollment form (pg 3 and 4 only). Note: Billing Provider NPI# and Taxonomy# are required. Fax completed paperwork to Practice Insight. Allow 2-3 weeks.
Florida	Florida Medicaid NOTE: No special form is required—list payer on Practice Insight 270/271 Registration Form. Be advised that enrollment for this payer takes 10-15 business days longer than basic setup.
Health Partners	Health Partners NOTE: No special form is required—list payer on Practice Insight 270/271 Registration Form. Be advised that enrollment for this payer takes 10-15 business days longer than basic setup.
Kaiser (All)	Kaiser NOTE: No special form is required—list payer on Practice Insight 270/271 Registration Form. Be advised that enrollment for this payer takes 10-15 business days longer than basic setup.
Maryland	Maryland Medicaid Complete the 2-page form.  Mail the completed, signed document pages to ACS EDI Enrollment.  Allow 4 weeks for processing.
Michigan	Michigan BCBS and Michigan Medicaid See instructions on hyperlink to complete online enrollment on BCBS website. Provider must use BCBSMI user ID and password to login. If a provider does not know or does not have a user ID, they should call BCBSMI at (248) 486-2292 (1). After online enrollment is submitted, payer requires approx. 48 hours to process.
New Hampshire	New Hampshire Medicaid Complete the 2-page form.  Mail the completed, signed document pages to ACS EDI Enrollment.  Allow 4 weeks for processing.
North Carolina	North Carolina BCBS Complete the 1-page form (leave BLANK the Vendor/Clearinghouse section). Fax to Practice Insight at: 713.333.0138
North Dakota	North Dakota BCBS Complete the 2-page EDI Support Services Form. Fax to Practice Insight at: 713.333.0138. Allow 20 business days for processing.
Pennsylvania	Pennsylvania Highmark BCBS NOTE: No special form required—list payer on Practice Insight 270/271 Registration Form. Be advised that enrollment for this payer takes 10-15 business days longer than basic setup. Capital Blue Cross Complete the 1-page form. Fax to Practice Insight at: 713.333.013.
Rocky Mountain Health Plan	Rocky Mountain HMO (RMHM1) NOTE: No special form required—list payer on Practice Insight 270/271 Registration Form. Be advised that enrollment for this payer takes 10-15 business days longer than basic setup.
West Virginia	West Virginia BCBS NOTE: No special form required—list payer on Practice Insight 270/271 Registration Form. Be advised that enrollment for this payer takes 10-15 business days longer than basic setup.
Wyoming	Wyoming BCBS Complete the 2-page EDI Support Services Form. Fax to Practice Insight at: 713.333.0138. Allow 20 business days for processing