Enrollment forms

Optum has developed processes to allow payers and providers to electronically exchange sensitive information. Find forms for medical claims, patient eligibility, ERA and EFT payment information.

If you don't see the form you’re looking for, please refer to the Optum Pro Portal.

EFT Enrollment Forms (currently unavailable, coming soon)
ePayment/EFT allows providers to receive payments electronically from payers that have contracted with Change Healthcare to perform this service.

Real-time enrollment forms
Real-time functions provide the ability to verify eligibility, check claims status, locate providers, review requests and responses and make claim-related financial inquiries. 

Each provider must be set up in the system to access real-time functions.

  1. New customers: Please contact the sales team regarding real-time products.
  2. Current customers: Please contact your vendor for assistance.

Commonly used real-time enrollment forms

Full list of enrollment forms

Auxilio Plan de Socios
Auxilio Salud Plus
Association de Maestros Puerto Rico
Blue Cross & Blue Shield of Delaware 
California Medi-Cal
First Medical Health Plan (IMC)
First Medical Health Plan (REFORM)
HealthPartners MN
Highmark Blue Cross & Blue Shield of Pennsylvania
Highmark Blue Cross Blue Shield of West Virginia
Highmark Blue Cross Shield DE
 Mapfre
Medical Card System (MCS)
Medicare Medex
Michigan Medicaid
MMM Healthcare (Reform)
Mountain State Blue Cross of West Virginia
Nebraska Medicaid
Nevada Medicaid
Medicare
Plan de Salud Hospital Menonita
Plan de Salud Menonita Vital
PMC Medicare Choice (reform)
Preferred Medicare Choice
Triple-S Advantage
Triple-S Salud
Utah Medicaid
Vermont Medicaid VT

Claim Status Enrollment Forms

Nebraska Medicaid
New York Medicaid
North Carolina Medicaid
Utah Medicaid

BBMDQ - Blue Cross of MI - CLAIMS

BBMDQ - Blue Cross of MI - ERA

70408 - Assurant Employee Benefits - ERA

70408 - Assurant Employee Benefits - CLAIMS

CX058 - Kansas City Life Insurance Company - ERA

CX058 - Kansas City Life Insurance Company - CLAIMS

CX093 - Dental Select - ERA

84147 - CHAMPVA Dental - ERA

94146 - Medi-Cal Dental - Claims

94146 - Medi-Cal Dental - ERA

36215 - CENTRAL STATES HEALTH AND WELFARE FUNDS TEAMCARE - ERA

VAICE - DIVISION OF IMMIGRATION HEALTH SERVICES - ERA

CKME1 - Maine Medicaid - ERA

52133 - United Healthcare Dental - ERA

25849 - EAST BOSTON NEIGHBORHOOD PACE - ERA

BEAM1 - BEAM DENTAL INSURANCE - ERA

41101 - MIDWEST DENTAL BENEFITS - ERA

CBAL1 - BLUE CROSS AND BLUE SHIELD OF ALABAMA - ERA

65978 - METLIFE DENTAL – ERA

CKNC1 - NCTRACKS (NC MEDICAID DIRECT) - ERA

CKNH1 - NEW HAMPSHIRE MEDICAID – ERA

94267 - HEALTHPARTNERS (MN) – Eligibility

94267 - HEALTHPARTNERS (MN) – ERA

94267 - HEALTHPARTNERS (MN) – CLAIMS

CKME1 - MAINE MEDICAID - Claims

CDCA1 - CALIFORNIA DELTA – TRICARE -  ERA

TNCMS - DELTA DENTAL OF TN - ERA

CDMN1 - MINNESOTA DELTA DENTAL DELTA USA - ERA

CDNE1 - NEBRASKA DELTA DENTAL - ERA

56101 - NORTH CAROLINA DELTA DENTAL – ERA

CDIN1 - INDIANA DELTA DENTAL - ERA

85022 - NEW MEXICO DELTA – ERA

R7004 - FLEX COMPENSATION - ERA

CDKY1 - KENTUCKY DELTA DENTAL - ERA

R7005 - MN POWER - ERA

R7002 - WILSON MCSHANE - ERA

86027 - ARIZONA DELTA DENTAL - ERA

06172 - DART CORPORATION - ERA

SDCMS - DDSD MEDICARE ADVANTAGE - ERA

CDOH1 - OHIO DELTA DENTAL - ERA

CDAR1 - DELTA DENTAL OF ARKANSAS - ERA

CDTN1 - TENNESSEE DELTA DENTAL - ERA

R7001 - ZENITH ADMIN – ERA

CDND1 - NORTH DAKOTA DELTA DENTAL - ERA

72153 - GROUP BENEFIT ADMINISTRATORS, INC - ERA

ARCMS - AR MEDICARE ADV - ERA

R7003 - BENEFIT INC – ERA

CDMI0 - MICHIGAN DELTA DENTAL - ERA

WIMAN - WI MEDICARE ADV - ERA

CX026 - MEDICA OF MN – ERA

CKNC1 - NCTRACKS (NC MEDICAID DIRECT) – CLAIMS

31117 - SUPERIOR DENTAL -ERA

CKND1 - NORTH DAKOTA MEDICAID - ERA

SKYGN - SKYGEN USA - ERA

96938 - SCION GATEWAY - ERA

SCION - SCION DENTAL - ERA

23281 – UPMC - ERA

MGDBP - MOONLIGHT GRAHAM - ERA

SDCOM - SCION COMMERCIAL - ERA

PACLF - PACIFIC LIFE - ERA

GHP22 - GEISINGER SKYGEN - ERA

UPMCD - UPMCD VIA SKYGEN - ERA

TLZ04 - CYPRESS ANCILLARY - ERA

22099 - HORIZON HEALTHCARE DENTAL SERVICES - ERA

CKNV1 - MEDICAID OF NEVADA - ERA

CKNV1 - MEDICAID OF NEVADA - CLAIMS

CKNJ1 - NEW JERSEY MEDICAID - ERA

CKNJ1 - NEW JERSEY MEDICAID - CLAIMS

CKDE1 - DELAWARE MEDICAID - ERA

CKKY1 - KENTUCKY MEDICAID - ERA

CKKS1 - KANSAS MEDICAID - ERA

37275 - Missoula County Medical Benefits Plan - ERA

D3551 - GHI Emblem - New York (Group Health Inc.) - ERA

CKMS1 - MISSISSIPPI DIVISION OF MEDICAID - ERA

CKMS1 - MISSISSIPPI DIVISION OF MEDICAID - CLAIMS

CX070 - INDIANA DEPARTMENT OF HEALTH - CHILDREN'S HEALTH – ERA

CX070 - INDIANA DEPARTMENT OF HEALTH - CHILDREN'S HEALTH – CLAIMS

CKDC1 - District of Columbia Medicaid - ERA

CKMN1 - MINNESOTA MEDICAID - ERA

CKMN1 - MINNESOTA MEDICAID - Claims

00390 - BCBS Tennessee - CLAIMS

00230 - BCBS Mississippi - CLAIMS

CKIN1 - Indiana Medicaid - ERA

00066 - WYOMING MEDICAID - ERA

00066 - WYOMING MEDICAID - CLAIMS

38520 - South Carolina Blue Cross Blue Shield - ERA

68246- AETNA ENCOUNTERS- ERA

60054 - AETNA - ERA

ZELIS - Zelis - ERA

ABHK1 - Aetna Better Health of Kentucky - ERA

SX110 – EMI HEALTH - CLAIMS

SX110 – EMI HEALTH - ERA

SX105 – DESERET MUTUAL BENEFIT ASSOCIATES (DMBA) - CLAIMS

SX105 – DESERET MUTUAL BENEFIT ASSOCIATES (DMBA) - ERA

SX106 – PUBLIC EMPLOYEE HEALTH PLAN (PEHP) - CLAIMS

SX106 – PUBLIC EMPLOYEE HEALTH PLAN (PEHP) - ERA

75261 – WEBTPA - ERA

56205 – MEDCOST BENEFIT SERVICES - ERA

CKKY3 - Kentucky Medicaid - Doral Dental - Region 3 - Claims

CKMD1 - Maryland Medicaid - Claims

CKSC1 - South Carolina Medicaid - Claims

CKVA1 - Virginia Medicaid - Claims

CX035 - Dental Care Plus of OH - Claims

04356 - DentaQuest - Claims

CX014 - Doral of Wisconsin - Claims

CX052 - ADI FDMG OF FL - Claims

62154 - Xantus Health Plan of Nashville TN - Claims

CKID1 - Idaho Medicaid - Claims

CKIL1 - Illinois Medicaid - Doral - Claims

CKKY3 - Kentucky Medicaid - Doral Dental - Region 3 - ERA

CKMD1 - Maryland Medicaid - ERA

CKSC1 - South Carolina Medicaid - ERA

CKVA1 - Virginia Medicaid - ERA

04356 - DENTAQUEST - ERA

CX014 - DORAL OF WISCONSIN - ERA

CX035 - DENTAL CARE PLUS OF OH - ERA

CX052 - ADI FDMG OF FL - ERA

CKIL1 - Illinois Medicaid - Doral - ERA

62154 - Xantus Health Plan of Nashville TN - ERA

CKID1 - Idaho Medicaid - ERA

CX030 - Safeguard PPO - ERA

CX048 -Safeguard HMO - ERA

70123 - SUN LIFE WV PEIA - CLAIMS

70123 - SUN LIFE WV PEIA - ERA

67814 - SUN LIFE AND HEALTH INSURANCE COMPANY - CLAIMS

67814 - SUN LIFE AND HEALTH INSURANCE COMPANY - ERA

CKMA1 - MASSHEALTH - CLAIMS

CKMA1 - MASSHEALTH - ERA

 

 

 

001553-First Health-ERA

001553-Optum-RX-ERA

002286-First Medicaid of Virginia-ERA

002286-Medicaid of Oregon-ERA

002286-Pace of Pennsylvania FirstHlth-ERA

002286-Propar Serv Prime Therapeutics-ERA

002453-Medicaid of Maine-ERA

002538-TMESYS-ERA

003241-EDS-Medicaid of Arkansas-ERA

003241-Employer Health Options-ERA

003452-Optum-RX-ERA

003573-EDS-Medicaid of Wisconsin-ERA

003573-Medicaid of Maine-ERA

003573-Third-Party Solutions-ERA

003585-DST-Health Solutions-ERA

003585-Express Scripts Value RX-DPS-ERA

003585-Medimpact-ERA

003585-Medone-ERA

003585-Optum RX-ERA

003585-Opus Health Information System-ERA

003585-Procare RX-ERA

003592-Express Scripts Value RX-DPS-ERA

003650-Optum-RX-ERA

003858-BCBS of Massachusetts-ERA

003858-BCBS of Michigan-ERA

003858-Express Scripts Value RX-DPS-ERA

003858-McKesson Healthcare Del Syst-ERA

003858-Mutual of Omaha Paper-ERA

003858-Optum RX-ERA

004047-Express Scripts Value RX-DPS-ERA

004047-Infocrossing Hlthcr Serv MMO Missouri Medicaid-ERA

004146-Alabama-Medicaid-ERA

004204-Maxor Plus-ERA

004245-Capital RX-ERA

004261-TMESYS-ERA

004303-Omnisys-ERA

004336-Anthem-Prescription-Management-ERA

004336-BC-BS-Texas-ERA

004336-Blue-Cross-Blue-Shield-Arkansas-ERA

004336-DST Health Solutions-ERA

004336-Express Scripts-Valud RX-DPS-ERA

004336-Horizon-BCBS-NJ-ERA

004336-Mede America-Healtheon-WEBMD-ERA

004336-Medicare Split Billing-ERA

004336-Medimpact-ERA

004336-Optum RX-ERA

004336-Propar Serv-Prime-Therapeutics-ERA

004336-Script Care-INC-ERA

004410-Script Care Inc-ERA

004469-Optum RX-ERA

004519-Optum RX-ERA

004519-Prof Mgmt Development Corp-ERA

004527-Employer Health Options-ERA

004583-BCBS of Mississippi-ERA

004626-Express Scripts Value RX-DPS-ERA

004682-Express Scripts Value RX-DPS-ERA

004682-Independent Health Plan-ERA

004682-Mede America Healtheon WEBMD-ERA

004682-Pharmacy Data Management-ERA

004682-Tmesys-ERA

004740-CSC Medicaid of New York-ERA

004758-Optum-RX-ERA

004766 - BKS-Medicaid of Kansas - ERA

004766 - EDS-Medicaid of Arkansas - ERA

004766 - EDS-Medicaid of California - ERA

004766 - EDS-Medicaid of Indiana - ERA

004766 - EDS-Medicaid of Wisconsin - ERA

004766 - Medicare Split Billing - ERA

004880-Employer Health Options-ERA

004915-Propar Serv Prime Therapeutics-ERA

005260-First Health Medicaid Ohio-ERA

005260-New York Epic-ERA

005260-Optum RX-ERA

005285-Optum RX-ERA

005285-Procare RX-ERA

005377-Data RX Management-ERA

005377-Express Scripts Value RX-DPS-ERA

005377-Maxor Plus-ERA

005500-Medimpact-ERA

005518-Medimpact-ERA

005526-Medicaid of Maine-ERA

005567-Third-Party Solutions-ERA

005757-Optum RX-ERA

005947-BCBS Texas-ERA

005947-Elixir Solutions-ERA

005947-Optum RX-ERA

006012-Pharmacy Data Management-ERA

006053-Medimpact-ERA

006053-Save RX-ERA

006086-Mede America-Healtheon WEBMD-ERA

006524-Optum RX-ERA

006558-Save RX-ERA

007110-Optum RX-ERA

007382-Optum RX-ERA

007417-Optum RX-ERA

007887-Optum RX-ERA

008035-Procare RX-ERA

008266-Procare RX-ERA

008316-Optum RX Maine Medicaid-MDEEDS-ERA

008324-Express Scripts-Value-RX-DPS-ERA

008324-Optum-RX-ERA

008514-Propar Serv-Prime Therapeutics-ERA

008563-Save RX-ERA

008878-EDS-Medicaid of Wisconsin-ERA

008878-Medicaid of Illinois-ERA

008878-Optum RX-ERA

008985-Optum RX-ERA

009075-Maxor Plus-ERA

009083-Maxor Plus-ERA

009117-Optum-RX-ERA

009265-DST-Health Solutions-ERA

009265-Procare Rx-ERA

009299-Optum RX-ERA

009430-Procare Rx-ERA

009513-First Health-ERA

009555-ACS Consultec-ERA

009620-Third-Party Solutions-ERA

009661-Medicaid of Alaska-ERA

009704-New York Epic-ERA

009737-Medicaid Michigan First Health-ERA

009745-First Health-ERA

009803-Elixir Solutions-ERA

009803-Maxor Plus-ERA

009893-Elixir Solutions-ERA

010439-Data RX Management-ERA

010553-Optum RX-ERA

010579-Oklahoma Medicaid-ERA

010868-Optum RX-ERA

010876-Optum RX-ERA

010900-First Medicaid of Virginia-ERA

010991-Medimpact-ERA

011065-Procare RX-ERA

011073-Procare RX-ERA

011131-Optum RX-ERA

011222-Optum RX-ERA

011255-Optum RX-ERA

011289-Elixir Solutions-ERA

011552-BCBS Texas-ERA

011552-Propar Serv Prime Therapeutics-ERA

011669-Procare RX-ERA

011677-Optum RX-ERA

011792-Optum RX-ERA

011800-Express Scripts Value RX-DPS-ERA

011818-Anthem Prescription Management-ERA

011818-Magellan-ERA

011818-Mede America Healtheon Webmd-ERA

011834-DST-Health Solutions-ERA

011842-Optum RX-ERA

011859-Optum RX-ERA

011867-DST Health Solutions-ERA

011867-Express Scripts-Value RX-DPS-ERA

011867-Optum RX-ERA

011875-Procare RX-ERA

011883-Optum RX-ERA

011891-Optum RX-ERA

011917-Medimpact-ERA

011933-Medicaid of Iowa Noridian-ERA

012155-Optum RX-ERA

012163-McKesson-Healthcare Del Syst-ERA

012189-Express Scripts-Valud RX-DPS-ERA

012189-Optum RX-ERA

012304-Express Scripts-Value RX-DPS-ERA

012304-Optum RX-ERA

012312-DST Health Solutions-ERA

012312-Elixir Solutions-ERA

012312-Medimpact-ERA

012323-DST-Health Solutions-ERA

012345-New York Epic-ERA

012353-Anthem Prescription Management-ERA

012353-DST-Health Solutions-ERA

012353-Express Scripts Value RX-DPS

012353-Medimpact-ERA

012353-Optum RX-ERA

012478-Maxor Plus-ERA

012486-Independent Health Plan-ERA

012493-Procare RX-ERA

012510-Optum RX-ERA

012528-Ventegra-ERA

012592-Optum RX Ohio Workers Comp Plan OptumRX-API-ERA

012635-Independent Health Plan-ERA

012642-Aetna Pharmacy Management-ERA

012684-Intermountian Health Care-ERA

012684-Save RX-ERA

012833-McKesson Healthcare Del Syst-ERA

012833-Propar Serv Prime Therapeutics-ERA

012874-Healthsystems Wellpoint Anthem-ERA

012882-Medimpact-ERA

012924-Optum RX-ERA

012957-Anthem Prescription Management-ERA

012957-Express Scripts-Value RX-DPS-ERA

012957-Optum RX-ERA

012965-Procare RX-ERA

013071-TMESYS-ERA

013089-Anthem Prescription Management-ERA

013105-Medimpact-ERA

013113-DST-Health Solutions-ERA

013170-Optum RX-ERA

013344-Optum RX-ERA

013352-Consu Medicaid of Florida-ERA

013469-Prof Mgmt Development Corp-ERA

013477-Elixir Solutions-ERA

013492-Elixir Solutions-ERA

013535-Pharmacy Data Management-ERA

013550-Anthem Prescription Management-ERA

013550-Optum RX-ERA

013824-DST-Health Solutions-ERA

013832-Procare RX-ERA

013907-Navitus Hlth-ERA

013907-Optum RX-ERA

014179-Express Scripts Value RX-DPS-ERA

014186-Optum RX-ERA

014203-Oregon Medicaid-ERA

014211-Express Scripts Value RX-DPS-ERA

014236-DST-Health Solutions-ERA

014244-Medtrack Services-ERA

014252-Data RX Management-ERA

014293-Medicaid Wyoming ACS-INC-ERA

014310-Procare RX-ERA

014559-Optum RX-ERA

014575-Procare RX-ERA

014582-Navitus Hlth-ERA

014632-Navitus Hlth-ERA

014658-Integrated Prescription Mgmt-ERA

014681-Optum RX-ERA

014848-Optum RX-ERA

014856-Optum RX-ERA

014864-EDS-Medicaid of Idaho-ERA

014897-Propar Serv Prime Therapeutics-ERA

014947-Mede America Healtheon WEBMD-ERA

014947-Optum RX-ERA

014955-Data RX Management-ERA

014955-Pharmacy Data Management-ERA

015012-Optum RX-ERA

015094-Express Scripts Value RX-DPS-ERA

015185-Elixir Solutions-ERA

015202-Scriptguide RX-ERA

015235-Procare RX-ERA

015243-Optum RX-ERA

015251-Mede America Healtheon WEBMD-ERA

015327-Scriptguide RX-ERA

015334-Data RX Management-ERA

015342-Elixir Solutions-ERA

015433-Express Scripts Value RX-DPS-ERA

015342-Opus Health Information System-ERA

015383-Navitus Hlth-ERA

015433-Southern Scripts-ERA

015441-Medimpact-ERA

015517-Medimpact-ERA

015558-Optum RX-ERA

015566-Navitus Hlth-ERA

015574-Medimpact-ERA

015581-DST-Health Solutions-ERA

015599-Express Scripts Value RX-DPS-ERA

015707-Mede America Healtheon WEBMD-ERA

015723-Optum RX-ERA

015748-Express Scripts Value RX-DPS-ERA

015756-Optum RX-ERA

015764-DST-Health Solutions-ERA

015764-Optum RX-ERA

015789-Optum RX-ERA

015814-Optum RX-ERA

015839-Optum RX-ERA

015855-Medicaid of Utah-ERA

015888-Relay Health Pharmacy Solution-ERA

015905-Propar Serv Prime Therapeutics-ERA

015921-Medimpact-ERA

015921-Optum RX-ERA

015938-Scriptguide RX-ERA

015954-DST-Health Solutions-ERA

015962-Optum RX-ERA

015995-Express Scripts Value RX-DPS-ERA

016085-Medimpact-ERA

016110-Pharmacy Data Management-ERA

016127-Navitus Hlth-ERA

016151-DST-Health Solutions-ERA

016184-Mede America Healtheon WEBMD-ERA

016359-Data RX Management-ERA

016390-Optum RX-ERA

016424-Optum RX-ERA

016432-Prof Mgmt Development Corp-ERA

016466-Scriptcycle-ERA

016473-Elixir Solutions-ERA

016499-Horizon BCBS NJ-ERA

016499-Propar Serv Prime Therapeutics-ERA

016516-Medimpact-ERA

016523-Magellan-ERA

016549-Medimpact-ERA

016557-Independent Health Plan-ERA

016580-Optum RX-ERA

016607-DST-Health Solutions-ERA

016671-Medimpact-ERA

016689-Medimpact-ERA

016796-Medimpact-ERA

016862-Propar Serv Prime Therapeutics-ERA

016912-Express Scripts Value RX-DPS-ERA

016929-Wisconsin Medicaid-ERA

016961-DST-Health Solutions-ERA

016978-DST-Health Solutions-ERA

017010-Express Scripts Value RX-DPS-ERA

017010-Optum RX-ERA

017035-Magellan-ERA

017043-Procare RX-ERA

017051-Script Care Inc-ERA

017076-Script Care Inc-ERA

017134-Elixir Solutions-ERA

017142-Medimpact-ERA

017200-Elixir Solutions-ERA

017218-Procare RX-ERA

017267-DST Health Solutions-ERA

017274-Pharmacy Data Management-ERA

017290-Relay Health Pharmacy Solution-ERA

017309-DST-Health Solutions-ERA

017309-Optum RX-ERA

017317-DST-Health Solutions-ERA

017324-Optum RX-ERA

017373-Scriptcycle-ERA

017423-Optum RX-ERA

017449-Magellan-ERA

017449-Medicare Split Billing-ERA

017449-Propar Serv Prime Therapeutics-ERA

017480-DST-Health Solutions-ERA

017498-Data RX Management-ERA

017515-Procare RX-ERA

017522-Simple Save RX-ERA

017564-Navitus Hlth-ERA

017606-EDS-Medicaid of Arkansas-ERA

017639-Script Care Inc-ERA

017688-EDS-Medicaid of Connecticut-ERA

017696-Medimpact-ERA

017713-Medimpact-ERA

017795-EDS-Medicaid of Vermont-ERA

017804-Medicaid of Illinois-ERA

017812-Procare RX-ERA

017845-Scriptclaim Pharmacy Network-ERA

017853-Script Care Inc-ERA

017878-DST-Health Solutions-ERA

017944-DST-Health Solutions-ERA

018034-Optum RX-ERA

018042-Data RX Management-ERA

018050-Blue Eagle Health-ERA

018050-Medimpact-ERA

018117-DST-Health Solutions-ERA

018141-Optum RX-ERA

018224-Procare RX-ERA

018232-DST-Health Solutions-ERA

018240-Maxor Plus-ERA

018265-DST-Health Solutions-ERA

018273-Script Care Inc-ERA

018299-Procare RX-ERA

018308-DST-Health Solutions-ERA

018315-Procare RX-ERA

018323-DST-Health Solutions-ERA

018331-EDS-Medicaid of Idaho-ERA

018331-Magellan-ERA

018364-Procare RX-ERA

018407-Magellan-ERA

018422-Ventegra-ERA

018448-Simple Save RX-ERA

018471-Pharmacy Data Management-ERA

018506-Optum RX-ERA

018562-Data RX Management-ERA

018570-Script Care Inc-ERA

018596-Medimpact-ERA

018605-Medimpact-ERA

018612-DST-Health Solutions-ERA

018643-Optum RX-ERA

018661-Navitus Hlth-ERA

018679-DST-Health Solutions-ERA

018687-Elixir Solutions-ERA

018695-Data RX Management-ERA

018704-Optum RX-ERA

018711-Script Care Inc-ERA

018753-Procare RX-ERA

018778-Procare RX-ERA

018786-DST-Health Solutions-ERA

018786-Magellan-ERA

018794-Optum RX-ERA

018803-DST-Health Solutions-ERA

018844-Optum RX-ERA

018893-Ventegra-ERA

018902-Colorado ACS Consultec-ERA

018927-DST-Health Solutions-ERA

018951-Script Care Inc-ERA

019025-Elixir Solutions-ERA

019059-DST-Health Solutions-ERA

019059-Optum RX-ERA

019074-Medone-ERA

019082-Sav RX-ERA

019090-Script Care Inc-ERA

019116-Script Care Inc-ERA

019132-Script Care Inc-ERA

019158-DST-Health Solutions-ERA

019231-Script Care Inc-ERA

019272-Elixir Solutions-ERA

019298-Script Care Inc-ERA

019330-Data RX Management-ERA

019363-DST-Health Solutions-ERA

019363-Express Scripts Value RX-DPS-ERA

019389-Navitus Hlth-ERA

019439-DST-Health Solutions-ERA

019439-Magellan-ERA

019455-Script Care Inc-ERA

019462-Script Care Inc-ERA

019505-Data RX Management-ERA

019520-DST-Health Solutions-ERA

019520-Medimpact-ERA

019538-Medone-ERA

019546-Optum RX-ERA

019587-Abarca Health-ERA

019595-Abarca Health-ERA

019595-DST Health Solutions-ERA

019629-Pharmacy Data Management-ERA

019653-DST-Health Solutions-ERA

019660-DST-Health Solutions-ERA

019678-DST-Health Solutions-ERA

019710-Employer Health Options-ERA

019786-Mede America Healtheon Webmd-ERA

019802-Elixir Solutions-ERA

019819-Elixir Solutions-ERA

019926-Elixir Solutions-ERA

019934-Optum RX-ERA

019950-Medtrak Services-ERA

019975-Optum RX-ERA

019983-Data RX Management-ERA

020032-Elixir Solutions-ERA

020040-Employer Health Options-ERA

020073-Elixir Solutions-ERA

020099-Express Scripts-Valud RX-DPS-ERA

020099-Medone-ERA

020123-Express Scripts-Valud RX-DPS-ERA

020149-Optum RX-ERA

020206-Data RX Management-ERA

020206-DST Health Solutions-ERA

020214-DST Health Solutions-ERA

020271-Procare RX-ERA

020289-Propar Serv Prime Therapeutics-ERA

020313-Procare RX-ERA

020321-Optum RX-ERA

020396-DST Health Solutions-ERA

020503-Simple Save RX-ERA

020545-First Health Medicaid Ohio-ERA

020578-Data RX Management-ERA

020586-Optum RX-ERA

020594-Elixir Solutions-ERA

020610-Script Care-Inc-ERA

020628-Script Care-Inc-ERA

020685-Propar Serv Prime Therapeutics-ERA

020701-Magellan-ERA

020750-Medimpact-ERA

020768-Optum RX-ERA

020818-Data RX Management-ERA

020826-Procare RX-ERA

020859-Procare RX-ERA

020867-DST-Health Solutions-ERA

020933-Script Care-Inc-ERA

020941-Script Care-Inc-ERA

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