ECHO Electronic Remittance Advice ERA 835 - eSolutions

1 Payer: Per the payer list 2020-08-18 ECHO Electronic Remittance Advice ERA 835 ERA Enrollment Instructions: Please save this document to your computer. Open the file and type directly onto the form. Complete the form using the provider s billing/group information as credentialed with this payer. EDI enrollment applies to ERA only and is not necessary prior to sending claims. Once completed, save for your records, print and obtain appropriate signature(s). EDI enrollment processing timeframe is approximately 30-45 business days. To check status of EDI enrollment, please contact ECHO at 440-835-3511. 835 Electronic Remittance Advice : ECHO ANSI 835 Enrollment Form Complete the form as appropriate. Complete one form per Tax ID to include all 835 payers offered by ECHO. Submit Completed Document: Email to ECHO Healthcare Systems 835 Payer List Access health Services - Arkansas Superior Select CoreSource All Plans ACS Benefit Services Corporate Benefit Services of America (CBSA) Aetna Senior Medicare Supplement Covenant Administrators, Inc.

2 Affinity health plan Custom Design Benefits Affinity Medicare & Medicaid Advantage Delano Regional Medical Group AFLAC of Georgia (Am. Family Life Assurance) Diversified Group Administration AllCare EBC, Inc. Alliance Coal health plan EBSO Inc. - Expert Benefit Services Allways health Partners Employee Benefit Consultants AltaMed Employee Benefit Services, Inc. (EBSI) AMA Insurance (Am. Medical Associates) Evolutions Healthcare Systems AmeraPlan Family health Network (IL) American Healthcare Alliance FMH Benefit Services - CoreSource American Postal Workers Union health Fresenius Medical Care health plan American Progressive Gateway health plan - Medicare America s Choice healthplan GemCare Managed Care Systems AmeriHealth Caritas Delaware Global Care Boulder Administration AmeriHealth Caritas District of Columbia Employers Retiree Trust AmeriHealth Caritas Louisiana GMS, Inc. AmeriHealth Caritas Pennsylvania Group health Inc (GHI) Emblem health AmeriHealth Caritas New Hampshire health Cost Solutions AmeriHealth Caritas Northeast health Ins.

3 plan of New York - HIP AmeriHealth Caritas VIP Care health Partners - Pennsylvania AmeriHealth Caritas VIP Care Plus (Michigan Healthcare Highways Ameritas Life Insurance Co Healthcare Management Admin. HMA AmFirst Insurance Co. HealthChoice Oklahoma, DSR, DOC Atlantic Coast Life Ins. HealthSCOPE Benefits AvMed, Inc. Healthscope Community HA Banner health Co All plans HealthSmart All Plans BCBS - Delaware Hoag Clinic (Hoag Physician Partners) BCBS Pennsylvania HSBS Memphis BCBS Pennsylvania Western InHealth Mutual of Ohio BCBS West Virginia Insurance Management Services Benefit plan Administrators INTEGRA Admin. Group Boulder Administration Services Kalos Gold health plan Capitol Administrators Key Medical Group Caprock health plan Key Medical Group Medicare Advantage CareMore health Plans Keystone First Community health Choice CareNCare Keystone First health plan CareSource- All States Keystone First VIP Choices Catholic Life Insurance United Financial Liberty Dental plan , Inc.)

4 Central California Alliance for health (CCAH) Lifestyle health plan Medova Healthcare CHCS Services, Inc. Magellan Behavioral health Clear Spring health Managed Care Systems (MCS03) Coastal TPA Inc. Maricopa health plan Community Care Alliance of Illinois Marion health Services - CHW Community health Choice Marrick Medical Finance ConnectiCare Commercial and Medicare Adv. MCA Administrators, Inc. Constitution Life Insurance Co. Consumers Choice health 835 Payer List Meritain health Union Pacific Railroad Employees Michigan Blue Cross Complete University Care Advantage Mid-American Benefits, Inc. University Family Care Maricopa health Monitor Life Insurance Co. of New York USAA (United States Automobile Assoc.) Multiplan WI Preferred Provider Network Valley Care IPA Valley Care Select IPA Municipal health Benefit plan Wabash Memorial Hospital Association Mutual health Services WellMed Native Care health William C. Earhart Company, Inc. Nippon Life Benefits North American Administrators, Inc.

5 Ohio PPO Connect One Call Medical Pan American Life Ins. Group Parkland Community health plan Pennsylvania's Preferred health Networks Physicians Mutual Insurance Co. PerformCare - HealthChoices Pittman & Associates Polish Falcons of America Preferred health plan of the Carolinas Presbyterian health plan Prestige health Choice Pyramid Life Insurance Co. QualChoice Regence Group Administrators Renaissance Life and health Ins Co of America ResourceOne Administrators Santa Clara Family health plan SCAN health plan Scott & White Select health of South Carolina Sentinel Security Life Significa Benefits Services Simply Healthcare South Central Preferred/Wellspan Standard Life and Accident Insurance Co. Student Resources - UHC Symetra Life Ins. Co. Bellevue, WA TriStar Benefit Administrators Trusteed Plans Services Corp. Trust Mark / Starmark