PayerEDI Enrollment Forms

EDI Enrollment Forms

As part of our commitment to you, the HeW Enrollment Department will assist you in completing all Payer EDI Enrollment forms.  Please contact HeW Enrollment staff at
877-565-5457, option 6 or enrollment@hewedi.com.
 


Add/Update Providers

Online Form
 


Commercial Payer & Non-State Specific Enrollment Forms

All
 


State Specific Payer Enrollment Forms
 

A

Alabama
Alaska
Arizona
Arkansas

C

California
Colorado
Connecticut

D

Delaware

F

Florida

G

Georgia

H

Hawaii

I

Idaho
Illinois
Indiana
Iowa

K

Kansas
Kentucky

L

Louisiana

M

Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana

N

Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota

O

Ohio
Oklahoma
Oregon

P

Pennsylvania

R

Rhode Island

S

South Carolina
South Dakota

T

Tennessee
Texas

U

Utah

V

Vermont
Virginia

W

Washington DC
Washington (state)
West Virginia
Wisconsin
Wyoming