Washington Medical

Medicare of Washington

  • Direct Link
  • Claims processed through Noridian (800) 967-7902
  • Must have Submitter ID in Claimstaker
  • Both forms need to be filled out
  • These forms include claims and ERA’s
  • Payer ID – 00831

Online Registration (login required)

Online Registration Instructions

OLD Medicare Enrollment Form
OLD CMS Enrollment Form

Medicaid of Washington (DSHS)

  • Direct Link
  • Claims Processed through ACS EDI Gateway
  • Call (800) 833-2051 as early as 6 business days after form submission to check status of enrollment      
  • Both ACS forms below must be completed in order to set up electronically
  • Payer ID – WAMCD

ACS Authorization Form

Medicaid of Washington (DSHS)-ProviderOne

  • Direct Link
  • Provider’s must complete the ProviderOne online registration  
  • Must enter Apex’s ProviderOne ID- 1054099


Premera Blue Cross  

  • Direct Link
  • No provider ID required.   Use tax ID
  • Submitter ID required in Claimstaker
  • Call (800) 435-2715 to follow-up on the status of the form
  • Payer ID – 00430

Premera BC Enrollment Form

Premera BC ERA Enrollment Form

Regence Blue Shield

  • Direct Link
  • No forms required
  • Payer ID – 00934

Regence BS ERA Enrollment Form

Washington L&I (Labor and Industries)

  • Direct Link
  • Call (360) 902-6511 to follow-up on forms
  • Payer ID – WALNI

L&I Enrollment Form

L&I ERA Enrollment Form

National Payers Requiring Enrollment

  • Railroad Medicare
  • DMERC (Region D)
  • ASHN

National Enrollment Forms