| Line of Business | Payer Code | Payer Name | Enrollment Required Claims | Enrollment Required Remits |
|---|
| Payer Code | Payer Name | Alternate Payer Codes |
|---|
| Line of Business | Payer Code | Payer Name | Enrollment Required Claims | Enrollment Required Remits |
|---|
| Payer Code | Payer Name | Alternate Payer Codes |
|---|