Electronic Data Interchange (EDI)

Forms

Trading Partners

Enrollment

• New Trading Partner Enrollment Form*- For a Provider office, Clinic or Hospital to apply for a new trading partner number and begin submitting claims (837) electronically.
• Enrollment (Electronic Remittance)*–For a provider office, clinic or hospital to begin receiving the electronic remittance (835) electronically.

Change of Information

For existing electronic submitters (trading partners) who are changing software support vendors, formats or transactions, adding or removing provider numbers, or changing trading partner information other than contact name.

• Change Form (e-form)
• Change Form (PDF)

NOTE:  Change in Contact name – If it is necessary to add or change contact information the following options are available for reporting this to us. You must include your trading partner number on these requests.

• New contact information may be emailed to askedi@bcbsks.com, if the email address contains the name of the organization.
• New contact information may be faxed on company letterhead.  Faxes may be sent to 785-290-0720.

* Please fax completed forms to 785-290-0720.
* If you have questions, please contact us.