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Trading Partner Enrollment Form

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Below is information on how you can register to submit electronically to Empire.   
Please complete the required registration form and submit by fax or email:  

Empire BlueCross BlueShield
Fax: (877) 287-1410
Email: EDI_NY_ENROLLMENT@EMPIREBLUE.COM

 

EDI Registration Form
This form is used to record submitter and software vendor information and it is required to establish a submitter ID. Only one form is needed per facility, practice or group. Alternatively, only one form is needed per trading partner.

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The documents on this page are available in Adobe Acrobat format. Adobe Acrobat can be downloaded here.

 
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