Michigan Medical

Medicare of Michigan      

  • Direct- WPS Part B Legacy
  • Needs to be entered in Claimstaker
  • Submitter ID: 17680
  • Payer ID – 00953
  • Fax to WPS Medicare EDI at 618-998-5170
  • Attach Cover Sheet- attention to EDI Department
  • Approval Time- 10 Business days

Medicare Enrollment Form

Change of Submitter Form

ERA Enrollment Form

Medicare of Michigan Plus Blues    

  • Emdeon Link
  • Needs to be entered into GEMS
  • Provider needs to submit TPA Agreement  
  • Vendor Submitter ID: C2YW Vendor Name: Apex EDI Site ID: 0001 Division ID: 17011
  • Payer ID – SX170

Plus Blues Enrollment Form

Medicaid of Michigan    

  • Emdeon Link
  • Needs to be entered into GEMS
  • Vendor Submitter ID: C2YW Vendor Name: Apex EDI Site ID: 0001 Division ID: 17011
  • Payer ID – SKMI0

Medicaid Enrollment Form

BCBS of Michigan    

  • Emdeon Link
  • Needs to be entered into GEMS
  • Vendor Submitter ID: C2YW Vendor Name: Apex EDI Site ID: 0001 Division ID: 17011
  • Payer ID – SB710

BCBS Enrollment Form

National Payers Requiring Enrollment

  • Railroad Medicare
  • DMERC (Region B)
  • ASHN

National Enrollment Forms