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Provider Registration for Electronic Billing

The completion of the EDI Registration Form is required for providers (professional/institutional) who wish to file claims electronically either through a clearinghouse or with a direct connection to Blue Cross of Northeastern Pa (BCNEPA). Eligible providers will need to have a practice location in one of the counties listed below. If your practice or facility is located outside of these counties, please contact your local BCBS plan for assistance.

Required fields are indicated with a red asterisk. All other fields are optional, however, it is encouraged to complete as much information as possible to aid in the processing and expediting of your request for electronic connectivity.

  • Bradford (Within PA 13 county)
  • Broome (NY Contiguous County)
  • Cameron (PA Contiguous County)
  • Carbon (Within PA 13 county)
  • Centre (PA Contiguous County)
  • Chemung (NY Contiguous County)
  • Clearfield (PA Contiguous County)
  • Clinton (Within PA 13 county)
  • Columbia (PA Contiguous County)
  • Delaware (NY Contiguous County)
  • Lackawanna (Within PA 13 county)
  • Lehigh (PA Contiguous County)
  • Luzerne (Within PA 13 county)
  • Lycoming (Within PA 13 county)
  • Monroe (Within PA 13 county)
  • Montour (PA Contiguous County)
  • Northampton (PA Contiguous County)
  • Northumberland (PA Contiguous County)
  • Orange (NY Contiguous County)
  • Pike (Within PA 13 county)
  • Potter (PA Contiguous County)
  • Schuykill (PA Contiguous County)
  • Steuben (NY Contiguous County)
  • Sullivan (Within PA 13 county)
  • Sullivan (NY Contiguous County)
  • Susquehanna (Within PA 13 county)
  • Tioga (Within PA 13 county)
  • Tioga (NY Contiguous County)
  • Union (PA Contiguous County)
  • Wayne (Within PA 13 county)
  • Wyoming (Within PA 13 county)