Experian Health - Partner Payer Enrollment

          

 
 

Please request only those payers which are applicable to your state or geographic region. It is only necessary that you complete and submit this online enrollment if you are requesting a payer with a checkbox.
 

Payers with a checkbox located to the left of the payer name require Passport to enroll on your behalf.
Please select the checkbox for the payer(s) you are requesting access to, enter your contact information below, and submit.
 

For those payers listed without a checkbox require an enrollment form to be completed and submitted to Passport Health. Please download the required form, complete and return according to the instructions listed on page 1 of the attached.
 

If you have questions, please contact us at csenrollment@experianhealth.com or 888-661-5657 and one of our enrollment specialists will be happy to assist you.
 

 

AmeriHealth (Elig.)

AmeriHealth (Claim Status)

AmeriHealth Administrators

AmeriHealth Caritas Pennsylvania

BCBS of Arkansas (Elig.)

Provider Instructions

BCBS of Delaware (Elig.)

BCBS of Michigan (Elig.)

Provider Instructions

Boston Medical Center HealthNet (Elig.)

CarePlus Health Plan Medicare (Elig.)

Required Provider ID:  

Florida Medicaid (Elig.)

Required Form

Health Partners MN (Comm, Mcaid, Mcare (Elig.)

Highmark BCBS (Elig.)

Highmark Senior Solutions (Elig.)

Independence Blue Cross FOC (Elig.)

Keystone First (Elig.)

Keystone Health Plan East (Elig.)

MediCal (Elig.)   

Required PIN#  

 

 

 

 

 

 

 

Michigan Medicaid (Elig.)

Provider Instructions

Mountain State BCBS (Elig.)

 

Nebraska Medicaid (Elig.)

Required Form

Nevada Medicaid

Required Form

South Dakota Medicaid (Elig.)

 

 

 

 

 

 

 

 

 

 

 

 

Texas Medicaid Long Term Care (Elig.)

"Providers must have a NPI registered with Texas Medicaid as a long term care provider before they can access this connection”.
 

 

Vermont Medicaid (Elig.)

Required Form

      

Wellmark BCBS (Elig.)

Required Form

 

Partner Name (Client ID):

Database Code (If Applicable):

Facility Name:

Street Address:

City:

State:

  

Zip Code:

Contact Name:

Contact Telephone:

Email:

Tax ID:

Facility/Group NPI:

Additional NPIs (Optional):

NPI Name:

NPI Number:

 

Demographic, payer selections, and NPI information are not saved until the application is completed and submitted using the Submit Enrollment button.