Update Software Vendor
This Trading Partner Business Center web form provides capabilities for the following Payers:
Highmark BlueCross BlueShield West Virginia
(54828),
Highmark Senior Solutions Company
(15459), and
West Virginia Family Health - Medicaid
(45276)
Changes made on this form will update your trading partner information used for conducting business with only the Payer which is linked to the Trading Partner ID you submit on this form. You may have multiple Trading Partner IDs for use with Highmark and the payers it serves but this form applies only to the Trading Partner ID that you enter below.
Requester Information
Your Name*:
Your Title*:
Your Company*:
Your Telephone Number*:
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Extension:
Your Email Address*:
Trading Partner Information
Trading Partner Number*:
Trading Partner Name*:
Software Vendor Information
Name of Software*:
Vendor Name*:
Contact Name*:
Contact Telephone Number*:
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Contact Email Address:
Please check this box if you do your own EDI Software programming.
Additional Comments
Please use this space for additional description or instruction.
