Forms

Enrollment

• New Trading Partner Enrollment Form (Claims) *- For a Provider office, Clinic or Hospital to apply for a new trading partner number and begin submitting claims (837) electronically to ASK.

• Enrollment (Electronic Remittance) * – For a provider office, clinic or hospital to begin receiving the electronic remittance (835) electronically from ASK.
  

Change of Information
For existing electronic submitters (trading partners) who are changing software support vendors, formats or transactions, adding or removing provider numbers, or changing trading partner information other than contact name.

• Change Form (e-form)
• Change Form  *(PDF)

NOTE:  Change in Contact name – If it is necessary to add or change contact information the following options are available for reporting this to ASK.  You must include your trading partner number on these requests.

• New contact information may be emailed to askedi@ask-edi.com, if the email address contains the name of the organization.
• New contact information may be faxed to ASK on company letterhead.  Faxes may be sent to 785-290-0720.

EDI Employer Groups

• Enrollment Form (PDF)
  • For 834 - Employer Groups wanting to transfer enrollment information to the payer (BCBSKS). *May be used to change or maintain existing 834 information from the employer group
  • For 820- Entities wanting to send Payroll deductions or Premium payments

Secure Question Submission Form

* If you have questions, please contact us.

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