Application for Highmark Blue Cross Blue Shield of Western New York and Highmark Blue Shield of Northeastern New York Electronic Remits
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.
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):
Kansas law applies to this business relationship.
- back -