West Virginia Medical

Medicare of West Virginia  

  • Direct- Palmetto GBA
  • Needs to be entered in Claimstaker
  • Vendor Submitter ID: N10155
  • Payer ID – 00884
  • ALL pages need to be mailed to Palmetto  
  • Approval Time- Up to 10 Business Days

Medicare Enrollment Form

Medicare Change Form (To be used if provider is changing clearinghouses)

Medicaid of West Virginia      

  • Emdeon Link
  • No Enrollment Forms
  • Needs to be entered into GEMS
  • Needs to be entered in Claimstaker
  • Payer ID – SKWV0

 

BCBS of West Virginia (Also known as Mountain State)      

  • Emdeon Link
  • Needs to be entered into GEMS
  • Vendor Submitter ID: C2YW Vendor Name: Apex EDI Site ID: 0001 Division ID: 17011
  • Payer ID – SB941

BCBS Enrollment Form

West Virginia Workman’s Comp (Also known as BrickStreet Mutual Ins)

  • Emdeon Link
  • No Enrollment Forms
  • Needs to be entered into GEMS
  • Needs to be entered in Claimstaker
  • Payer ID – SX067

 

National Payers Requiring Enrollment

  • Railroad Medicare
  • DMERC (Region C)
  • ASHN

National Enrollment Forms