Payer Enrollment Forms
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
CBAL1 -- Alabama BCBS
CKAL1 -- Alabama Medicaid
CKAL1 -- Alabama Medicaid Tax ID Change
CKAK1 -- Alaska Medicaid
CKAR1 -- Arkansas Medicaid
CX052 -- Atlantic Dental Inc
61472 -- Blue Cross of North Carolina Federal Employee Claims
10050 -- Cigna Dental Health
CKCO1 -- Colorado Medicaid
CKCO1 -- Colorado Medicaid EDI Update
77828 -- Companion Life
CKCT1 -- Connecticut Medicaid
CPPCH -- Cook Children's Health Plan
CKDE1 -- Delaware Medicaid
CDCAP -- Delta Care USA
CX014 -- Doral Dental
CX050 -- First Care / Southwest Life and Health
CKFL1 -- Florida Medicaid
CBID1 -- Idaho BC
CBID2 -- Idaho BS
CKID1 -- Idaho Medicaid
CX070 -- Indiana Children's Special Healthcare
CKIN1 -- Indiana Medicaid
CBIA1 -- Iowa Blue Dental - Wellmark
CBIA1 CBIA2
CKIA1 -- Iowa Medicaid
CBKS1 -- Kansas BS
06126 -- Kansas City BCBS of Missouri
CKKS1 -- Kansas Medicaid
CKKY1 -- Kentucky Medicaid
CKKY1 -- Kentucky Medicaid 2
23739 -- Louisiana BCBS
CKLA1 -- Louisiana Medicaid
CKLA1 -- Louisiana Medicaid Yearly Certification Statement
CKME1 -- Maine Medicaid
CKMD1 -- Maryland Medicaid
CBMA1 -- Massachusetts BCBS
CKMA1 -- Massachusetts Medicaid
CKMI1 -- Michigan Medicaid
CKMN1 -- Minnesota Medicaid
CBMS1 -- Mississippi BCBS
CKMS1 -- Mississippi Medicaid
CKMO1 -- Missouri Medicaid
CKMT1 -- Montana Medicaid
National Provider Identifier (NPI)
CBNE1 -- Nebraska BCBS
CKNE1 -- Nebraska Medicaid
CKNV1 -- Nevada Medicaid
CKNH1 -- New Hampshire Medicaid
22099 -- New Jersey BCBS
CKNJ1 -- New Jersey Medicaid
CKNM1 -- New Mexico Medicaid
CKNY1 -- New York Medicaid
CKNY1 -- New York Medicaid TPA
61472 -- North Carolina Health Choice for Children
CKNC1 -- North Carolina Medicaid
CX004 -- North Dakota BCBS
CKOH1 -- Ohio Medicaid
CKOK1 -- Oklahoma Medicaid
CB850 -- Oregon BCBS
CKOR1 -- Oregon Medicaid
93200 -- Regence BS / Regence Northwest Health
CB870 -- Rhode Island BCBS
CKRI1 -- Rhode Island Medicaid
38520 -- South Carolina BCBS
CKSC1 -- South Carolina Medicaid
CBTN1 -- Tennessee BCBS
CB900 -- Texas BCBS
CPPTX -- Texas Children's Health Insurance (TX CHIPS)
CKTX1 -- Texas Medicaid
25175 -- Three Rivers Health Plan of Monroe PA
89070 -- United Concordia
54771 -- United Concordia
83470 -- United Concordia
CKUT1 -- Utah Medicaid
CKVT1 -- Vermont Medicaid
CB923 -- Virginia BCBS
CKVA1 -- Virginia Medicaid
CKWA1 -- Washington Medicaid
CKWV1 -- West Virginia Medicaid
CB950 -- Wisconsin BCBS
CKWI1 -- Wisconsin Medicaid
CKWY1 -- Wyoming Medicaid


