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Employer Changes

This Trading Partner Business Center web form provides capabilities for Highmark Delaware (00570 & 00070) and Highmark Delaware Health Options - Medicaid (47181).

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.

Request Type*
Please select what type of request this application is to be completed for.
Add Employer Delete Employer
Requester Information
Your Name*:
Your Title*:
Your Company*:
Your Telephone Number*: -- Extension:
Your Email Address*:
Trading Partner Information
Trading Partner Number*:
Trading Partner Name*:
Employer Information*

Please fill in the appropriate employer related fields and click the 'Add Employer' button to record the employer.

Tax ID Employer Name

Additional Comments
Please use this space for additional description or instructions.