Payers


The payers listed below require Special Enrollment, and are not immediately available to providers. Special Enrollment involves submitting information and/or paperwork via email, fax or online and is the only way providers can enroll to use eligibility EDI services for these payers. Please be advised that special enrollment is a process that is separate from a provider registering their NPI with the payer (see ‘Note about your NPI’ below). Contact and mailing information for enrollment submission is located at the bottom of the Special Enrollment section.
 
A note about NPI: Register Your NPI with your health plans. Providers must ensure they have correctly registered their Group Level NPI (National Provider Identifier) with any applicable health plans. TransUnion Healthcare is not responsible for registering individual NPI numbers or verifying the accuracy of the NPI registered for a given provider.
 
BCBS Plans: Enrollment through any BCBS plan outside of your provider’s state will not be required as the enrollment will likely reject. All providers should submit through the local BCBS plan for their state as the Blue Exchange network allows transactions for out-of-state members to route to the appropriate destination.
Payer Instructions Estimated Timeframe Documentation
Aetna

Aetna requires specific NPI registration for all electronic transactions. Please submit the NPI directly via the NPI Submission Form on the Aetna website and view the attached documents which define this requirement and process in detail.

Questions regarding the NPI registration and enrollment process should be directed to Aetna's provider line at 1-888-632-3862.

 2-5 business days
AgeWell NewYork *

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 3-5 business days
Alameda Alliance Health Plan *

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 3-5 business days
AmeriHealth

Please provide the following fields to tupartnersupport@transunion.com

  • Provider name
  • Group level NPI
 1-2 weeks
AmeriHealth Administrators

Please provide the following fields to tupartnersupport@transunion.com

  • Provider name
  • Group level NPI
 1-2 weeks
BCBS of Arkansas

Follow the below instructions:

  1. Visit https://secure.ediservices.net/EDIS.Web/Login/Login.aspx Providers and facilities will be required to register to create a user name and password.
  2. Complete the online enrollment form by submitting the following required information in the fields provided:
    1. Enrollment Type: Select "Arkansas Provider Only" (out of state providers should submit via their home state BCBS connection)

       

    2. NPI: Enter the Group NPI. Individual provider NPIs can be submitted if a Group NPI has not been assigned.

       

    3. Provider Name and Submitter ID: This will auto populate once the NPI has been entered.

       

    4. Contact Information: Enter the contact information of the provider (or individual submitting the form on the provider’s behalf).

       

    5. Add another contact: Add TransUnion as an alternate contact so that we may receive a copy of the approval/rejection notice.

                  Contact name:

                  TransUnion

                  Contact email:                        

                  tupartnersupport@transunion.com

                  Contact phone number:

                  877-732-6853

    6. Transactions: Select "Using a Clearinghouse/Billing Agent" Select "MedData" or "MedData/Transunion Healthcare" from the Clearinghouse dropdown list when prompted

       

    7. Available Electronic Transactions: You may select 270/271 Eligibility and/or 276/277 Claim Status. MedData/Transunion Healthcare does not provide ERA, 837 or 835 services.

       

    8. Trading Partner Agreement: Read the TPA pdf form and select “I Agree".
  3. Select “Submit" to complete the enrollment.

 

Notification of approval/denial should be sent to the provider and the clearinghouse (MedData/Transunion Healthcare) within one business day. If approved, please submit a test transaction for BCBS AR and notify TransUnion of any provider validation issues as this payer may require additional mapping.

**If you do not have a submitter ID please complete the following:
Arkansas Blue Cross Blue Shield EDI Trading Partner Agreement



 		1 business day
BCBS of Delaware

Please provide the following fields to tupartnersupport@transunion.com

  • Provider name
  • Group level NPI
 1-2 weeks
BCBS of Michigan (Professional)

Follow the below BCBS of Michigan (Professional & Institutional) enrollment instructions:

  1. Visit https://editest.bcbsm.com/tpalogon.html
  2. Enter your TPA User ID and password.
    1. Note: If a provider is unable to login, that means the user ID and password are invalid. Provider should call BCBS MI to obtain their correct user ID and password – 800.542.0945, option 3 or email EDISupport@bcbsm.com.
    2. Note: If a provider doesn’t know their User ID and password, they can contact BCBS MI at 800.542.0945, option 3 or email EDISupport@bcbsm.com to obtain their TPA User ID and PW.
  3. Once you are logged in, choose Professional Provider Authorization or Institutional Provider Authorization.
  4. Then enter the following information:
    • Provider ID (PIN) = Leave this field blank
    • NPI = Provider or Organization’s NPI
    • Source of Payment = Blue Cross Blue Shield
    • Submitter ID = c0ina (note the zero) for Professional Providers
    • Submitter ID = 204202692 for Institutional Providers
    • Unique Receiver ID = Leave this field blank
    • Provider email address = Confirmation will go to this email

     5. Click Submit

After completing the steps above, BCBS MI will send a confirmation email that the enrollment will become effective in 48 hours. The payer will not send another email. Transactions should work in 48 hours.

 2 business days
BCBS of Pennsylvania (Highmark) [Professional]

Please provide the following fields to tupartnersupport@transunion.com

  • Provider name
  • Group level NPI
 1-3 weeks
BCBS of West Virginia

Please provide the following fields to tupartnersupport@transunion.com

  • Provider name
  • Group level NPI
 1 week
Beacon Health Strategies *

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 3-5 business days
Blue Cross Independence (Pennsylvania)

Please provide the following fields to tupartnersupport@transunion.com

  • Provider name
  • Group level NPI
 1 week
Blue Cross Pennsylvania (Capital)

Email completed enrollment forms to tupartnersupport@transunion.com

2 weeks
California Children Services *

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 
 3-5 business days
California Medicaid (Medi-Cal) No special enrollment, but the provider's pin (6, 7, or 8 digits) must be sent on ALL transactions.

You can validate the NPI/PIN combination by entering them as UserID and password, at https://www.medi-cal.ca.gov/ 		N/A
Care1st of California *

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 
 3-5 business days
Central Health Medicare Plan

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 3-5 business days
Consolidated Health Plan*

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 3-5 business days
Crystal Run Health Plans*

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 3-5 business days
Gold Coast Health Plan *

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 3-5 business days
Health Partners of MN

Please provide the following fields to tupartnersupport@transunion.com

  • Provider Name (Group)
  • Physical Address
  • NPI (Group level)
  • TIN (Group level)
  • Effective Date (Go live date)
 1 week
Highmark Senior Solutions

Please provide the following fields to tupartnersupport@transunion.com

  • Provider name
  • Group level NPI

 *WV providers only

 

 1 week
Independence Administrators

Please provide the following fields to tupartnersupport@transunion.com

  • Provider name
  • Group level NPI
 1-3 weeks
Iowa Medicaid

Iowa Medicaid enrollment instructions:

Providers will need to logon to the EDISS Connect Portal to complete the enrollment:

Visit https://connect.edisseb.com

Follow the instructions in the attached document. 

 1 Business day
Kaiser Foundation Health Plan of Colorado

Enrollment Requirement for ALL Kaiser Health Plans:

New Providers Only must be enrolled. Providers that are already submitting are exempt.

Please provide the following fields to tupartnersupport@transunion.com

  • Name of Provider
  • Physical Address
  • Contact Name
  • Contact Phone
  • Contact Email
  • Provider ID / NPI
  • Tax ID
 2 weeks
Managed Care Systems*

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 
 3-5 business days
Martins Point Health Care

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 3-5 business days
Maryland Medicaid

Enrollment form must be filled out with original/physical signature.

Mail completed form to:
TransUnion
Attn:Enrollment
6100 Fairview Rd Suite 1200
Charlotte, NC 28210 		2-3 business days
Medicare (Part A & B)

Before submitting to Medicare, TransUnion Healthcare must verify your NPI with CMS.

If you have already selected Medicare as a payer, we have been alerted to validate your NPI with Medicare; if you receive a rejection on Medicare transactions, please email tupartnersupport@transunion.com for assistance.

 2-3 business days
Michigan Medicaid

Providers will need to logon to Michigan Medicaid’s CHAMPS system and associate both Billing Agent ID's 2243495 and 1630780 with their group level NPI.

How to Questions for the website should be referred to Michigan Medicaid, Provider Enrollment Support, 800-292-2550 option #4

CHAMPS website:

https://milogintp.michigan.gov


. 		2 business days
Michigan Medicaid Pending Eligibility

Providers will need to logon to Michigan Medicaid’s CHAMPS system and associate both Billing Agent ID's 2243495 and 1630780 with their group level NPI.

How to Questions for the website should be referred to Michigan Medicaid, Provider Enrollment Support, 800-292-2550 option #4

CHAMPS website: https://sso.state.mi.us/

2 business days
Nebraska Medicaid

Email completed enrollment forms to tupartnersupport@transunion.com

Please note, due to extended processing times with this payer, enrollments may take up to six weeks for completion. To ensure there are no additional delays, please confirm that the provider taxonomy and zip+4 included on the enrollment forms are identical to the taxonomy and zip+4 the payer has on file for that particular provider. Incorrect or inaccurate information included on enrollment forms will result in a payer rejection.

Please also note that Nebraska Medicaid enrollment forms should be completed with group level information only.

4-6 weeks
North Carolina Medicaid

While 270/271 eligibility transactions do not require special enrollment for NC Medicaid, a special enrollment process is required for 276/277 claim status transactions. 

To complete the enrollment for 276/277 transactions, credentialed providers will need to log into the NCTracks portal and associate TransUnion's numeric billing agent ID (50300605) to their NPI via the "Manage Change Request" section of the portal. Please see the attached instructions regarding how to associate your NPI to the TransUnion Clearinghouse billing agent ID.
Presbyterian Health Plan *

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 3-5 business days
Rhode Island Medicaid *

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 3-5 business days
Riverlink Health*

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 3-5 business days
Texas Medicaid - Long Term Care

Texas Medicaid – Long Term Care

Texas Medicaid - Long Term Care requires a three-step enrollment process for EDI transactions. If the provider has completed any of the earlier steps, they may simply skip to the next relevant step.

Step 1 (Contracting with Texas Medicaid - Long Term Care):

Providers must be contracted with this payer before submitting an enrollment. To contract with Texas Medicaid - Long Term Care, providers can visit the DADS website at: http://www.dads.state.tx.us/providers/. Providers can also contact DADS Provider Enrollment at Texas.Medicaid.Enrollment@dads.state.tx.us. Once DADS processes the contract application, the provider will be given a “Contract Number”.

Step 2 (Completing the EDI Agreement):

The provider is required to submit an EDI Agreement form to Texas Medicaid. Providers with a valid Contract Number that have not completed the EDI agreement form must do so by completing the following Electronic Data Interchange Agreement for Long Term Care Providers: Texas Medicaid EDI Trading Partner Agreement.  Once completed, the form must be mail it to TMHP at the following address:

Texas Medicaid & Healthcare Partnership

Attention: EDI Help Desk, MC–B14

PO Box 204270

Austin, TX 78720-4270

Step 3 (Completing the Submitter ID Linking Form):

Providers with a valid Contract Number will then need to fill out a Submitter ID linking form: TX Medicaid Submitter ID Linking Form. The provider will need to fill out all sections on this form.

Section I. Provider Number field must contain the providers “Contract Number” not the provider’s NPI.

Section II, Submitter ID: is 146215201 and “I want to link this Submitter ID and Provider Number” box should be checked

*Please note, the Submitter ID Linking form is annexed to the EDI Agreement and can, therefore, be submitted to the payer concurrently with the EDI Agreement if the provider has not completed step 2.

If the provider has any questions/issues about any of the steps during this enrollment process, they can get help directly from Texas Medicaid EDI by calling The TMHP EDI Helpdesk at 1-888-863-3638 option 4.

 

 Up to 2 months for new providers & 30 days providers completing step 3 only.
University Health Alliance*

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 3-5 business days
Utah Medicaid

Utah Medicaid requires providers to enroll directly via their PRISM system. For providers that are already enrolled with Utah Medicaid but submitting to a different Trading Partner/Clearinghouse, the enrollment process will need to be completed again and the new Trading Partner/Clearinghouse information entered during step 10 of the application process.

To enroll with the Utah Medicaid PRISM system please visit: https://medicaid.utah.gov/accessing-prism

If you have questions, please call Provider Enrollment at (801) 538-6155, or toll-free 1-800-662-9651 (option 3 then 4) or by email: providerenroll@utah.gov. 

For a step by step walk through of submitting the enrollment application through PRISM please visit: https://medicaid.utah.gov/pe-training

Enrollment Process Notes:

      During the application process, when completing step 9 of the application, please select EDI Submission Details – UHIN as well  as check the UHIN mode of submission option. You will be able to select your desired Trading Partner during step 10.

·     When adding the TransUnion Trading Partner ID, please use the following:

Utah Medicaid Trading Partner ID (TPID): HT006748-001

Contact Information: TransUnion Healthcare, Inc. 555 West Adams Street Chicago, IL 60661

 2 - 4 weeks
Value Options *

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 3-5 business days
WINhealth Partners *

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 3-5 business days
 
Enrollment Information:

TransUnion Healthcare
Attn: Enrollment
6100 Fairview Rd Suite 1200
Charlotte, NC 28210

Email: TUPartnerSupport@transunion.com
Phone: 877-732-6853
Fax: 704-970-1436


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