EDI Claims Enrollment Form
This application is used to enroll providers as Trading Partners for various EDI transactions, such as 837 Electronic Claims Submission, 835 Electronic Remittance Advice and others.
Submit a EDI Claims Enrollment Form online or click image below to open a PDF form:
Contact Provider Services
| General | 831-430-5504 |
| Reclamos Billing questions, claims status, general claims information |
831-430-5503 |
| Authorizations General authorization information or questions |
831-430-5506 |
| Authorization Status Checking the status of submitted authorizations |
831-430-5511 |
| Farmacia Authorizations, general pharmacy information or questions |
831-430-5507 |
Provider Resources
Claims Resources
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