Secure File Transfer
Your Profile
 
Trading Partner Registration
8:48 PM, November 20, 2009

CareFirst Trading Partner Registration:
Important - The information you provide in your registration will be used for transmitting production files.
Please provide information for all users, groups etc at this time to prevent a delay in processing your registration
and/or your migration from test to production.
Please choose a plan:
Please choose a Transaction Type:

Please Contact hipaa.partner@carefirst.com to register for this transaction.
Please choose a Submitter Type:
Please choose a Submitter Type:
Please choose a Submitter Type:
* indicates a required field


000000000 (9 digit Federal assigned number)
  Contact me to arrange a number
* Address:
  Address 2:
* City:
* State:
* Zip: -
00000 or 00000 1234

* First Name:
* Last Name:
* Title:
* Phone: x
  Fax:
* E-mail:
* Confirm E-mail:
Technical Contact Information:
* First Name:
* Last Name:
* Title:
  Company:
* Phone: x
  Fax:
* E-mail:
* Confirm E-mail:
Practice Management software vendor:
* Requested Effective Date:
Date where Trading Partner
arrangement is effective
   (mm/dd/yyyy)
User Registration:
The Primary User will become a Delegated Administrator
* Primary User First Name:
* Primary User Last Name:
* Please enter a 5 digit Verification Number:
(i.e. the last 5 digits of your telephone number)
This number will be used to verify your identity if you need to call the help desk to reset your password.
Additional User 2? No Yes
Is this user a Delegated Administrator? No Yes
User 2 First Name:
User 2 Last Name:
Please enter a 5 digit Verification Number:
(i.e. the last 5 digits of your telephone number)
This number will be used to verify your identity if you need to call the help desk to reset your password.
Additional User 3? No Yes
Is this user a Delegated Administrator? No Yes
User 3 First Name:
User 3 Last Name:
Please enter a 5 digit Verification Number:
(i.e. the last 5 digits of your telephone number)
This number will be used to verify your identity if you need to call the help desk to reset your password.
Additional User 4? No Yes
Is this user a Delegated Administrator? No Yes
User 4 First Name:
User 4 Last Name:
Please enter a 5 digit Verification Number:
(i.e. the last 5 digits of your telephone number)
This number will be used to verify your identity if you need to call the help desk to reset your password.
Additional User 5? No Yes
Is this user a Delegated Administrator? No Yes
User 5 First Name:
User 5 Last Name:
Please enter a 5 digit Verification Number:
(i.e. the last 5 digits of your telephone number)
This number will be used to verify your identity if you need to call the help desk to reset your password.
Are you receiving files for multiple Pay-to Providers? No Yes


000000000 (9 digit Federal assigned number)
  Contact me to arrange a number

* Phone: x


   (mm/dd/yyyy)
* What is your monthly transaction volume?
Are you submitting for multiple
Pay-to Providers?		 No Yes
Do you require more than one mailbox to drop off EDI files
and pickup responses?		 No Yes
Version and Delimiters:
* GS08 Version Code:
Please enter the GS08 Version Code you are using:
* ISA05 Sender ID Qualifier:
Please consult the Implementation Guide
for code descriptions
* ISA07 Sender ID Qualifier:
Please consult the Implementation Guide
for code descriptions
* ISA06 Sender ID:
* ISA08 Sender ID:
* GS02 Application Sender's Code:
* GS03 Application Receiver's Code:
You will be contacted by CareFirst if you use any delimiter other than these dafault values.
* ISA16 Subelement Separator:
* Segment Terminator:
* Data Element Separator:
Thank you for initiating your 835 Registration request.
A CareFirst representative will contact you to complete this registration.
Terms of Use: This website is for contracted providers, vendors, employer groups and their staffs only. Through this registration, you agree that your organization is/will be a contracted business entity and that the same terms outlined in your contract related to patient/member confidentiality, privacy and business practices also apply to all information found on the Secure File Transfer (SFT) website.
I accept the terms of use