Payer Lists
Office Ally Payer Lists
Downloadable Forms
Office Ally Forms
NPI Information
All or Multiple States
CHAMPUS (TriCare) - North & South States
DMERC Region A STATES: CT, DE, DISTRICT OF COLUMBIA, ME, MD, MA, NH, NJ, NY, PA, RI, VT
DMERC Region B STATES: IL, IN, KY, MI, MN, OH, WI
DMERC Region C STATES: AL, AR, CO, GA, FL, LA, MS, NC, NM, OK, SC, TN, TX, VA, WV
DMERC Region D STATES: AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA,WY
Railroad Medicare Change Form
Railroad Medicare EDI Enrollment Form
TriCare for Life
TriWest / WPS (Western States)
Value Options
Arizona
Alaska
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington DC
West Virginia
Wisconsin
Wyoming
835 ERA Enrollment Forms
You must have Adobe Acrobat Reader installed on your computer to view these
documents. If Acrobat Reader is not installed you can download it from
Adobe .