EDI Enrollment Form for BlueExchange Medicare Crossover 835s
Application for BlueExchange Medicare Crossover 835s
All fields are required except where marked (optional).
For questions about this form, please call the EDI Help Desk at 1-800-472-6481, option 1.
- BlueExchange setup will be completed within 3 weeks.
- New Trading Partners must also complete the New Trading Partner Enrollment Form.
Reporting a Missing or Late Electronic Remittance Advice (ERA)
To report a missing or late 835 transaction (ERA), please contact the EDI Help Desk at 1-800-472-6481, option 1.
The following items are needed to track a missing electronic remit(s):
- Trading Partner ID
- Date of Check / EFT
- Check / EFT Number
- NPI on Check / EFT
- Amount of Check / EFT
Kansas law applies to this business relationship.
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