COMMERCIAL PAYERS Enrollment Attachment Payer Name Payer ID

COMMERCIAL PAYERS

Payer Name Payer IDEnrollment Required

Attachment availability Eligibility

1 Point Solutions TFQ321199 National Benefit Fund (NY) TLU1221st Century Health & Benefits Inc. 590693P Admin 20413AAG - American Administrative Group (Formerly GBA) 37283AAG - Benefit Plan Administrators Inc (UICI) 75240AARP (Mechanicsburg, PA) AARP1A & I Benefit Plan Administrators 93044A & I Benefit Plan Administrators (Portland, OR) CX044Abrazo Healthcare (Phoenix, AZ) PHP01Abri Health Plan AHP01Access Administrators (El Paso, TX) AHS01Access Administrators (CA ONLY) TLZ17Accident Fund Insurance Company of America TLU13Acclaim 64071Accordia National (Charleston, WV) 87815Acceptius (Benefit Management Inc. of MO) (BMI) 43178ACEC Health Plans TLX81ACMG of South Carolina TLX92ACS Benefit Services (f.k.a. ACS Consulting Services) 72468ACS Benefit Services (Winston- Salem, NC) 61474ACS Benefit Solutions (NC) 61473Activa Benefit Services LLC/Dental 38255ADENTA TLU14Americhoice** 52133 X **Admin One Corporation TLX93Administration Services (ASI) TLU87Administration Systems Research Corporation (Grand Rapids, MI) TLU02Administrative Concepts TLU86Administrative Enterprises Inc. TLX82Administrative Services Only Inc. (Lynbrook, NY) CX076 XAdministrative Solutions Inc. (GA) TLX94Administrative Solutions Inc. (CA) TLZ40Administrators West (OR) TLX95Administrators West (WA) TLX96ADN Administrators (MI) TLX97Advanced Benefit Administrators (OR) TLX98Advanced Benefit Resources (NY) TLY02Advanced Benefit Solutions (AZ) TLY01Advanced Insurance (AR) TLY04Advantage Dental Plan 93524Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section

Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions. More On Next Page 1/21/2009

COMMERCIAL PAYERS



Advantage Health Solutions 52133Adventis Health (CA) TLY05Adventis Health Claims Central (Roseville, CA) 95340Adventist Health System West (Roseville, CA) 95340AEBS TLY07Aetna Affordable Health Choices (SM)- SRC 57604Aetna DMO 68246 XAetna Life & Casualty 60054 X XAetna Health Plans 60054 X XAetna Select 60054 X XAffordable Benefit Administrators Inc. TLW02AFLAC (of Georgia) 58066AFLAC - NY Plan 52080AHCP-American Healthcare Partnership TLW03AIG (American General US Life) 13545Alaska Laborers Construction Industry (Grp#F23) 91136Alaska Children's Services Inc. (Grp#P68) 91136Alaska Electrical Health & Welfare Fund 92600Alaska Pipe Trades Local 375 (Grp#F24) 91136Alaska Teamster Employer Welfare Plan (ATEWE) TLY08

Alaska United Food & Commercial Workers Health & Welfare Trust (Grp#F45) 91136Alaska UFCW TLX15ALICARE TLU15Allegiance Benefit Plan Management TLU11Allen Lund Co. (La Canada, CA) ALMC1Allen Medical Claims Administrator CX016Allied Administrators (San Francisco, CA) 94177Allied Benefit Systems TLX56Allied Benefit Systems (Chicago, IL) 37308Allied Building Inspectors (NY) TFQ23Altus (RI) 50503Always Care Benefits STR01Amalgamated Life / Alicare (King of Prussia, PA) 13343Amalgamated Life Ins. (NY) TLY53Ameriben Solutions (formerly IEC Insurance) TLU23American Administrators (West Des Moines, IA) 42112American Administrators/dba Select Benefit Admin. (W. Des Moines, IA) 42137American Administrative Group Inc. (AAG) 74223American Association of Orthodontics (AAO-TPA) TLU21American Benefit Corporation (Huntington, WV) CX084American Benefits Management (North Canton, OH) 34187American Benefit Plan Administrators TLU24American Community Mutual Insurance TLW04American Dental Plan CX021 XAmerican Dental Plan of GA Inc. CX021 XPaper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



American Dental Plan of NC Inc. CX021 XAmerican Dental Payer of WI ADP01American Dental Professional Services (Milwaukee, WI) TAD01American Dental Professional Services (Milwaukee, WI) TAD02American Dental Providers of AR Inc. CX021 XAmerican DentiCare (AR) TLY03American Healthcare TLU25American Health Group AHG01American Heritage Life Insurance Co. TLW75American Insurance Administrators (AIA)- Alumni Dent Program ONLY TFQ43American Medical Securities CX001American National Insurance Co. 74048American Pioneer Life Insurance TLU26American Postal Workers Union Health Plan (APWU) 44444American Prepaid Dental Plan of OH Inc CX021 XAmerican Prepaid Professional Services. Inc CX021 XAmerican Sentinel Insurance Inc. TLX55America's Choice Health plans LLC TLX65Ameritas Life Insurance Corp. 47009 X XAMLICO- American Medical & Life Insurance Co. (Hicksville, NY) AML01Amway Corporation 38255Anchor Benefit Consulting Inc. (Maitland, FL) 53085Antares Management Solutions (Westlake, OH) 34192APA Partners of NY 16140Apex Benefit Services 34196 XAPIPA (Arizona Physicians IPA) TLW68Appalachian Benefit Administrators (ABA) TLW65Arizona Physician Individual Physician Association 52133Arizona Pipe Trades Trust Fund TLY85Arkansas Best Corp- Choice Benefits 75278ARM LTD TLY52Ascent Benefits (Phoenix, AZ) CX072 XASEA/ AFSCME Local 52 Health Benefit Trust TLX61ASI TLU29ASR Corporation 38265ASR Health Benefits (Grand Rapids, MI) TLU02Associated Administrators TPA (AAI) TLU30Associated Benefits (IA) TLU28Assure Care (IL) TLW69Assure Care (MI) TLW70Assure Care (MN) TLW72Assure Care (OH) TLW71Assurant Employee Benefits 70408 XAssurant Health (f.k.a Protective Health) 39065 XAssurant Inc. (f.k.a First Fortis Life Insurance) 70408 XAssured Benefit Administrators TLX83Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Asuris 93221ASW / Lifewise 37294Athens Area Health Plan Select (Athens, GA) 95691Atlanta Plumbers & Steam Fitters Local 72 TLU32Atlantic Dental Inc. / ADI (Medicaid Claims) (Coral Gables, FL) CX052 XAtlantic Dental Inc. / ADI (Commercial Claims) (Coral Gables, FL) CX085Atlanticare 22304Atlas Administrators TLU33Alternative Risk Management (IL) TLY90Alternative Risk Management (OR) TLY89ATPA (Associated Third Party Administrators) (Pasadena, CA) ATPA1ATPA (Associated Third Party Administrators) (OR) TFQ47AultCare Dental (Canton, OH) AULTCAutomated Benefits Services (ABS) TLX91Automotive Machinists Local 289 (Grp#F32) 91136Auxiant TLY51Avesta Group Insurance TLU34Avesis 86098 XAZ Dept. of Health Services TLX87BAC Local 15 Welfare Fund (Kansas) A2051Bankers United Life 74227Banner Health (AZ) TLY50BCI Administrators Inc. 49153Bell Atlantic 60054 X XBencomp National Corporation 33192BeneCare Dental Plans 23210Benefirst TLY88BeneMax BMX01Benefit & Risk Management Services Inc. TLY45Benefit Administration Services (Jackson, MS) TLU36Benefit Administrators Inc. (Erie, PA) 62121Benefit Administrative Systems (Homewood, IL) 36149Benefit Coordinators Corporation (Pittsburgh, PA) 25145Benefit Concepts- EBD & A (RI) TFQ22Benefit Group (NE) TLU37Benefits Management Inc. TLW73Benefit Management Services (NC) 56139Benefit Management Services (LA) TLU04Benefit Management Services- FEP Claims ( Baton Rouge, LA) TLU05Benefit Management Systems (Madison. MS) 37212Benefit Plan Administrators Co. (Eau Claire WI) 39081Benefit Planners (TX) 74223Benefit Services Inc. TLU03Benefit Services of Hawaii TLZ27 XBenefit Source (MI) TLU39Benefit Systems (IN) TLU40Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Benefit Systems & Services Inc. (BSSI) 36342Benefits Inc. (Construction Suppliers Group Only) (Minneapolis, MN) 07000Benemark (Mississippi) BNMK1Benesight 87265Benesys Inc. (Lafayette, LA) 37248Benesys Inc. (GA) 58102Benicorp Insurance (IN) TLY48Benicorp Insurance (MS) TLY49Best Life & Health Insurance Company (Irvine, CA) 95604Better Health Plans of South California (Monroeville, PA) 32006Big Lots Associate Benefit Plan (EBMC) (OH) CX025Blue Bell Benefit Trust TLU42Blue Care Dental Traditional TBT01Blue Care Family Plan GWD01Bollinger Insurance (Short Hills, NJ) TLX71Boilermakers National Health & Welfare Fund 36609Boon Chapman (Benefit Administrators) 74237Boston University Dental Health Plan (Boston, MA) 04210Bridgeport LLC of Missouri (St. Charles, MO) CX028 XBrokerage Concepts 51037Brokerage Concepts Inc. (PA) TFQ18Brokers National CX032 XBrokers National Life Assurance Company CX032 XBroward Health 37314Businessmen's Assurance (BMA) (NE) 47009 XButler Benefits (Davenport, LA) 42150Cadent Administrators 33192Cadent Underwriters 33192CAI Insurance TLY06Canada Life Assurance Company (Atlanta, GA) 80659Cannon Cochran Management Services (Metairie, LA) 71057Capital Administrators (Rancho Cordova, CA) 68011Capital Dental of Houston, TX CX037Caprock Health Plan TLU47Careington Corporation TLY44Carolina Summit TLU48Carpenters Combined Funds (PA) TFQ25Carpenters Health & Welfare (Los Angeles, CA) TLU49Carpenters Health & Welfare (Philadelphia, PA) TLW16Carpenters Health & Welfare Trust Fund of St. Louis 25125Caterpillar Inc.** 37060 X **CBCA Administrators (Fort Worth, TX) 55438CBCA Administrators (Formerly HRM) 41170CBCA- Comprehensive Benefit & Claims Administrators TLW14CBSA-Corporate Benefit Services of America (Minneapolis, MN) 41124CCEA Welfare Benefit Trust (Las Vegas, NV) 88019Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



CCPOA TLZ03CDO Technologies 87065CDPHP- Capitol District Physicians Health Plan (NY) TLW07CDS Group Health (Sparks, NV) 88022Cement Mason's Union Local 502 TLW85Cement Masons & Plasterers Health (Grp#F16) 91136Cement Masons & Plasterers Local 518 (Kansas) A2005Central Laborers Local 703 (FL) TLZ15Central PA Teamsters Health & Welfare Fund TLU51Central Reserve (Latham, NY) TLZ08Central Reserve Life Insurance Company TLW76Central States Health & Welfare Fund (IL) 36215Central United Life Insurance TLY42Century Planners TLY39Champva-HAC 84147CHEC (Subsidiary of Sprint) TLX40Cherokee Insurance Co. (MI) TLY41Chesterfield Companies (OH) TLA11Chesterfield Resources Inc (Akron, OH) TLU92Chesterfield Resources Inc (Uniontown, OH) (a.k.a. Salvation Army) 34154Chicago Regional Council of Carpenters TLY40Children of Women Vietnam Veterans - VA HAC 84147Choice Plus (TRW) 60054 X XChristian Brothers Services 61271 XCIGNA (Connecticut General) 62308 X XCIGNA Dental Health (CDH DMO) 10050 X XCIGNA Flex Care (NM Only) (Phoenix, AZ) TLX70Citizens Security Life Insurance CX071Citizens Security Life Insurance (Louisville, KY) TLU52City of Blair TLW99City of Crown Point TFQ07City of Lafayette TFQ06City of Mesa TLW43Civil Service Employees Association (CSEA) CX054CL Frates and Company - OSMA Health CX075Claim Management Services (WI) CMS01Clarendon's Healthy Kids 33192Claredons Kids CHIP Program (EPO) TLX41Clayton County Self Funded Dental Plan CCS01CNA Health Partners of Arkansas 71063CNIC Health Solutions (Colorado Springs, CO) TLZ05CNIC Health Solutions (Englewood, CO) TLZ06Coast Hotels & Casino Inc. / DBA Coast Benefits (Las Vegas, NV) 37310Columbian Life Insurance Company TLX77Columbian Mutual Insurance Company TLX77Combined Insurance Claims (FL) TLU53Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Combined Insurance Services (Ocala, FL) TCC01Commonwealth Admin LLC 37237Community Connection (Phoenix, AZ) PHP01Community Health Choice TLX42Community Health Electronic Claims/CHEC/Web Tap 75261Comp Benefits Dental & Vision Company CX021 XComp Benefits Direct Inc CX021 XComp Benefits of AL Inc. CX021 XComp Benefits of GA Inc CX021 XCOMP- Ohio (Austintown, OH) 34177Comp Dent USA/ Comp benefits (Chicago, IL) CX021 XComp Dent of AL Inc CX021 XComp Dent of GA Inc CX021 XComp Dent of IL Inc CX021 XComp Dent Preferred Networks Inc CX021 XCompanion Life (Columbia, SC) 77828Complete Benefit Solutions (SC) TSCS1Comprehensive Benefits Administrator Inc. 03036Compensation Programs of Ohio 34177Compton Inc. TLX25Community Claims Administration 26231Concordia Plus CX007 X XConcordia Preferred CX007 X XConexis (CA) TFQ13CONN EN Life Insurance Co. TLX09Connecticut Carpenters Health Fund (Hamden, CT) 37307Connecticut General (see CIGNA) 62308 X XContinental Dental 62308 XContinental General (Latham, NY) TLZ07Consolidated Group Dental 61305Cook Group Health Plan 35149Cooperative Benefit Administrators (CBA) 52132CORE Administrative Services TLX80Core Management Resources Group (Macon, GA) 58231Core Source (Little Rock, AR) 75136 XCore Source (AZ, MN) 41045Core Source (IA) TFQ37Core Source (NC, IN) 35180Core Source (OH) 35183 XCore source (PA, MD, IL) 35182 XCorestar 41045Corporate Benefit Services of America (CBSA) 41124Corporate Benefit Services Inc. (Charlotte, NC) 56116Countrywide Info Services TFQ35Covenant Administrators (Atlanta, GA) 58102Coventry Health Care National Network (f.k.a First Health) 87043Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Coventry Health Care of Georgia 25148Creative Plan Administrators 37320Crescent Dental TLU54Crescent Dental- Meritain Health CX074CT Carpenters Health Fund TLU56CT Pipe Trades Health Fund Local 77 TLU55Custom Benefit Administrators (La Crosse, WI) 39170Custom Care (Southwestern Bell-Exec) 60054 X XCustom Design Benefits Inc of OH 82056D Edward Wright TPA DEW01Dakota Care TFQ60Dart Container Corporation TLX43Dart Management Corporation (Madison, MI) 06172Delta Claim Payers (NY) TFQ14Delta Health Systems 94235Denex Dental/Sg CX049 XDenta Benefits CX007 X X XDentaQuest (DC&MD) 04356 XDental Benefit Providers** 52133 X **Dental CPM TLU57Delta Care USA CDCAP XDelta Premier (MA) TLZ37Dental Care Plus Management Corp. CX035 XDental Comp Inc (WI) TLX01Dental Comp CX017Dental Guard Preferred 64246 XDental Health Associates (N. Hollywood, CA) DHA01Dental Management Inc. CX035 XDental Network (MD) CX034 XDental Network of America (DNOA) CX034 XDental Pay Inc. / The Dental Shop TLW24Dental Select** DSL01 X **Denti-Cal 94146 X XDentiCare Inc CX021 XDentiLease CX021 XDesert Mutual Benefit Administrators TFQ56Destiny Health Plan TLX84Detroit Laborers (Metropolitan) A1004DC37 HSP01DDS insurance TLW96DH Evans CX065DHS (A MN Medical Assistance Plan) (St. Paul, MN) DHS01Diamond Dental of Arkansas Inc CX021 XDirect Reimbursement Plan (Newman, GA) TLX69District 1199 Health & Welfare TLW78District Council 37 Health & Welfare Fund HSP01Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



District Council 57 Benefit Fund TLW34Diversified Administration Corp (Maryland) CX040 XDiversified Group Administrators TLW78Dominion Dental (DHMO & Commercial) DOM01 XDSCC (Div. of Special Care Children) TLX44Dunn & Associate Benefits Administrators (Columbus, IN) 35186Dutcher Insurance TLZ04E3 Health Inc. 75232Eastern Life & Health** TLZ28 X **EBC Mid America Inc (KY) TLZ42EBS Benefit Solutions CX043ECIT Dental Plans TLU58Educators Life Ins. / Educators Mutual (UT)** TLU59 X **Educators Mutual Insurance Assoc. (EMIA) CX079EHI/ EMPHESYS/ Employers Health** 73288 X **Electrical Workers Benefit Fund #369/ IBEW Local 369 TLW28Electrical Workers Benefit Fund #369/ IBEW Local 481 EWF01Elder Health 52192Elmco Insurance TLW86Employee Benefit Administrators (Pembroke, MA) CX012Employee Benefits Claims of Wisconsin Inc. TLW29Employee Benefit Concepts (Farmington Hills, MI) 38241Employee Benefit Consultants Inc. (EBC) (OH, WI, NM, KY)) 37257Employee Benefits Corporation TLW79Employee Benefits Management Corp of Ohio (EBMC) CX025 XEmployee Benefit Management Services Inc. (EBMS) 81039Employee Benefit Services of LA (EBS) 41198 XEmployee Benefit Services (NE) 47009Employee Benefits Plan Administration Inc. (EBPA) 03036Employee Group Services (EGS) CX022Employee Plans LLC 35112Employee Security Inc. (Columbia, MD) 54098Employer Plan Services Inc. (Houston, TX) CX031 XEmployers Dental Trust TLW30Employers Direct Health 75232Employers Direct Health- Employee Plan 75236Employers Health Insurance** 73288 X **Employers Life Insurance Corp. (SC) TLW32Employers Mutual Inc. (Jacksonville, IL) 59297Encore Health Network (IN) TLY86ENH Medical Group IPA 36364Engineers Joint Welfare Fund/ IUOE (NY) TLW87Enstar Natural Gas (Grp#P61) 91136EPOCH Group LC (Overland Park, KS) TLU60EPOCH Group LC (St. Louis) TLX13EQUICORE (Cigna) 62308 XPaper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Equitable Plan Services (Oklahoma City, OK) 73126Erin Group Administrators (PA) CX046ERISA/ Compusys (Austin, TX) 74234E.S. Beveridge & Associates 34108Essex Dental Benefits 43168E-V Benefits Management Inc. (Columbus, OH) 34159Evans DH Associates Inc. 25172ExclusiCare 71412 XFamily Care Claims (TX) TLX14Family Health Administrators TLU61Family Members Dental Plan (FMDP) (Military) CX002 X X XFara Benefit Services TLU62FCE Benefit Administrators (TX) TLY84Fed Ex Freight Health Benefit TLU64Federated Mutual Insurance Company 41041Fidelo Insurance Co. TLU69First Administrators (IA) TLU67First Ameritas Life Insurance Corp. of NY 72630 X XFirst Care Health Plans TLX17First Care/ Southwest Life & Health CX050 XFirst Choice Benefits TLU68First Choice Health Administrators TLY83First Commonwealth (IL) TLZ41 XFirst Concord Group Inc. TLU65First Dental Health (FDH) TLU63First Fortis Benefits 70408 XFirst Health (Downers Grove, IL) 87043First Reliance Standard (NY Business) 13317 X XFiserv Health- Wausau Benefits/ Benesight 39026 XFitz Harris & Company Inc. (Farmington, NY) 11244FL League of Cities TLX53Flexible Benefit Fund TLU70Flex Care 60054 X XFlorida Benefit Administrators TLW93Florida Hospital Waterman 48116Florida Power & Light 60054 X XFMH Benefit Services Inc. 48117Foreign Service Benefit Plan TLW97Fortis Insurance Company (Formerly Time Insurance) 39065 XFoundation Benefit Admin. (FBA) - Boon Group BOONGFourth District IBEW TLX90Fox Everett Inc. TLY81Fox Everett Inc. (Jackson, MS) 64069Fox Valley Welfare Fund (Elgin) TLU71Fox Valley Welfare Fund (Geneva) TFQ71Fraternal Order of Police- Dental Division (Philadelphia, PA) CX041Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Fringe Benefit Management (Formerly United Benefits) 59069GCU Local 8-M & 96B Health & Welfare Fund GCU01GE Financial Assurance TLW17GE Group Life Assurance 67814 XGeneral Electrical Pensioners TLX72Genworth Life & Health Insurance Co. (GLHIC) 67814 XGettysburg CX064Gettysburg Insurance Services TLU74GHI New York (Group Health Inc.) 13551 X XGIC Ademnity Plan 80314 XGilsbar INC. 07205Glassworkers Health & Welfare Fund (GRP#F29) 91136Global Healthcare (c/o People 1st) TLX45Golden Rule Insurance Company (Lawrenceville, IL) TLW18Golden West Dental (Woodland Hills, CA) (Blue Care Family Plan) GWD01Government Employee Hospital Association Inc. (GEHA) 44054 XGreat-West Health Care (f.k.a. American General) 63665Group & Pension Administrators (GPA) (Richardson, TX) 48143Group Administrators LTD 36338Group Benefit Administrators (Hendersonville, TN) 72153Group Benefit Administrators (Salt Lake City, UT) TFQ50Group Benefit Services (practices in MI, IN, IL & OH only) CX011Group Dental Services of Houston CX036 XGroup Health Insurance (New York, NY) 13551 X XGroup Health Managers (Redford, MI) 38194Group Insurance Services Center Inc. (MA) 37276Group Link of Indiana (Indianapolis, IN) CX015Group Resources Inc. (Atlanta, GA) TLY74Group Resources Inc. (Dallas, TX) TLZ21Group Resources Inc. (Houston, TX) TLU76Guardian Life Insurance Co. of America 64246 XGuarantee Trust Life Ins. Co. (Medicare Supplement Policies ONLY) TLW81G.W. Lisk Co. TLX20Harrington Benefit Services (formerly R.E. Harrington Inc.) (OH) 95266 XHarrington Benefit Services (Westerville, OH) 75196Harrington Benefit Services (OK) 59142Harrington Benefit Services (Formerly TPC Management) 06131Harvard Pilgrim Healthcare (Quincy, MA) TLW11Hawaii Dental Service (HDS) (requires HDS#) DEHI1Hawaii Medical Assurance Association (HMAA) TFQ61HCH Administration (NM) TLU97HDM Benefit Solutions Inc. TLU98Health Benefit Claims Dept. TLX24Health Alliance (IL) TLW88Health Choice of AZ- Claims ONLY TLW19Health Choice Inc. (Newton, NJ) 22345Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Health Claims Service / HCS (Boise, ID) 82018 XHealth Comp TPA (Fresno, CA) 85729Health Cost Solutions (TN) TLA18Health Economics Group Inc. CX039 XHealth First TPA TLW61Health Future LLC (Medford, OR) 30946Health Link (MO) TFQ27Health Management Systems- AKA- Managed Dental Care Network 84097Health Net (CA) TLW20Health Net (OR) 52133Health Network America 20199Health Now ( Buffalo, NY) 55204 XHealth Partners (Jackson, TN) 62157Health Partners of Minnesota- Commercial CX009Health Partners of Minnesota- Medicaid (MN) CX010Health Plan Inc. (Westborough, MA) CX055Health Plan of Nevada TLY56Health Plan Services (Tampa, FL) 59140Health Plan Services of OK 59142Health Plex Inc. (Uniondale, NY) 11271 XHealth Plex Inc.- Child Health Plus (CHP)/ Family Health Plus (PHP) Claims ONLY TLZ11Health Resources Incorporated (HRI) CX019Health Risk Management (HRM) (CBCA Administrators) 41170Health Traditions- MMSI (Rochester, MN) HTD99Healthcare Management Administrators Inc. HMA01Healthcare Partners /MD America TLU93Health SCOPE Benefits Inc. 71063Healthspan TFQ59Healthsource Provident Administrators (Cigna) 62308 XHealthy Families (CA) TLZ34Heller Associates TFQ40Hewitt Coleman & Associates (SC) TFQ15HMSA (Hawaii Medical Services)- Commercial HMSA1 XHMSA (Hawaii Medical Services)- Federal HMSA2 XHometown Health Plan Nevada (Reno, NV) 88023Hotel Employees & Restaurant Employees Health Trust 91136HRM Claim Management 41170Humana (non military) (WI)** 73288 X **IATSE (International Assoc. of Theatrical Stage Employees) IAT01IBA Self Funded Group (Kalamazoo, MI) 38234IBEW Local Union 270 (Oak Ridge, TN) TLZ16IBEW Local 38 A1317IBEW Local 117 A1117Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



IBEW Local 176 (In State Only) TLW90IBEW Local 176 (Out of State) TLW91IBEW Local 461 A1461IBEW Local 464 A1464IBEW Local 481 A4681IBEW Local 1249 TLW62IBEW Welfare Trust Fund (IL) TLX59I.B.P.A.T District Council # 11 TLW82I.E. Shaffer (West Trenton, NJ) 22175Illinois Central Hospital Association (Tinley Park, IL) 36600IUOE Local 211 TFQ24IMA Management Inc. (LA) TLW83Indian Health Services CDOK1Indiana Carpenters Welfare & Pension Fund (Indianapolis, IN) ICW01Indiana State Council of Roofers TFQ03Indiana Teamsters Health Benefits Fund (Indianapolis, IN) 35107InforMed LLC (Annapolis, MD) 52196Insurance Administrator of America Inc. TLY73Insurance Claim Services (AL) TLY72Insurance Claim Services (IL) TLY71Insurance Design Administrators (Oakland, NJ) 13315Insurance Management Administrators of Louisiana TLW83Insurance Management Services (Elko, NV) 88006Insurance Programmers Inc. TLW82Insurers Administrative Corporation 86304Insurex Benefit Administrators TLY70Integra Administrative Group (Seaford, DE) 51020Interactive Medical Systems Inc. TLW56Intercare Benefit Systems Inc. TLY69International Brotherhood of Boilermakers 36609Iowa Benefits Inc. (IBI) 41124Iron Workers District (NY) TLX28Jenkins & Associates (Jonesboro, GA) JEN01J.F. Molloy & Associates 61271 XJFP Benefit Management Inc. TLY67JI Specialty Services Company (Austin, TX) TLW64JJ Stanis Inc. 55438JMH Health Plan (FL) TFQ12John Alden Life Insurance Co. 41099 XJohn Hopkins EMS TFQ66John Morrell Company- AHBPA (Birmingham AL) 38310JP Farley Corporation (Westlake, OH) 34136JSL Administrators (GA) TLY66Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



JSL Administrators (NC) TLY65JW Terrill TLY94Kaiser Permanente Dental Choice (Rockville, MD) CX073 XKanawha Insurance Co. (Lancaster & Greenville, SC) 57038Kansas Building Trades (Topeka, KS) KBT01Kansas City Laborers Welfare Fund A2032Kansas City Life Insurance Company (Kansas City, MO) CX058Kesley Seybold TLX46Kempton Co./Kempton Group Admin. 73100Key Benefit Administrators Inc. TLX29Keylink Solutions TPA01Klais & Company 34145La Cruz Azul de Puerto Rico 95325Laborers Southeast Health & Welfare Plan LSH01Lafayette Life Insurance TFQ05Lawrence Paper Company (KS) TLU99LBA Health Plans (Timonium, MD) 52193Liberty Dental Plan (Santa Ana, CA) CX083Life Insurance Co. of Boston and New York 78140LifeRe CX047Life Wise /Washington Employers Trust 37294Lincoln National (WI)** 73288 X **Lincoln Financial Group (f.k.a. Jefferson Pilot) (NE) CX061Line Construction Benefit Fund LCB01Local 63 Health & Welfare (IL) TLZ22Local 135 Health Benefits (Indianapolis, IN) 35107Local 148 Health & Welfare Fund PCM01Local 1149 Baldwinsville, NY NYT01 XLocal 118 Rochester, NY NYT01 XLocal 182 Utica, NY NYT01 XLocal 264 Cheektowaga, NY NYT01 XLocal 294 Albany, NY NYT01 XLocal 295 Welfare Fund TFQ17Local 317 Syracuse, NY NYT01 XLocal 375 Buffalo, NY NYT01 XLocal 388 Dental Fund TLX08Local 449 Buffalo, NY NYT01 XLocal 529 Elmira, NY NYT01 XLocal 669 Albany, NY NYT01 XLocal 687 Potsdam, NY NYT01 XLocal 693 Binghamton, NY NYT01 XLocal 791 Rochester, NY NYT01 XLogistics Health (WI) TFQ26Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Los Angeles Fireman's Relief Association (LAFRA) LAF01Lovelace Sandia Health Plan 90328M- Plan Dental 52133Machigonne Benefit Administrators 10317MAG Employee Benefits TLW30Mahoney Benefit Administration LLC of TX CX042Mailhandlers Benefit Plan/ CAC 62413Maloney Associates TLX08MAMSI (Frederick, MD) CX033Managed Care of North America (MCNA) 65030Manulife W.J. Sutton Co. 98010Marsh Advantage CX023Marsh Advantage America TFQ31Mashantucket Pequot TLU77MBA Benefit Administrators Inc (SLC, UT) 87065MBA of Wyoming (Worland, WY) 87065MedCost Benefit Services (MBS) 56205MEDICA (Minneapolis, MN) CX026Medical Benefits Adm. Inc./ Medben (Newark, OH) 74323Medical Benefits Administrators CX024Medical Benefits Companies (OH) 74323Medical Benefits Mutual (MedBen) 74323Medical Mutual of Ohio (MMO) (only OH residents) CB833Medical Mutual of Ohio 29076Medical Network of Colorado Springs 84600MEGA Life & Health Co. (Student Ins. Div.) 74227MEGA Life & Health Insurance Co. 59226Memorial Herman Health Network MHHNPMemorial Hospital System 84600Mennonite Mutual Aid MNM01Mercer Administrators CX023Mercy Care TLW15Methodist First Choice (Rockford, IL) 23550MetLife (formerly Travelers) 65978 X XMetro Health Plan (Minneapolis, MN) MHP01Metropolitan Detroit Laborers A1004MFC & Health Plus Peoria 23550MGM Mirage Health Plan TFQ70Michigan Conference of Teamsters DELTAMichigan Laborers Healthcare Fund (Kalamazoo, MI) A1432Michigan Regional Council of Carpenters Employee Benefits 38238Michigan State Painters A1404Mid-America Associates Inc. 37281Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Mid American Health (NE) TLX73Midland Benefit Administrators Inc. (MI) TLU93Midland Benefit Administrators Inc. (NE) TLZ43Midlands Choice TLZ10Midwest Dental Benefits (St. Paul MN) 41101Midwest National Life Insurance Co. TLY93Midwest Security Administrators Inc. TLZ36Millrights Local 1102 Health & Welfare Fund A1402Mississippi Administrative Services (MAS) (MS) TLY96Mississippi Select Health Care (Gulfport, MS) 64088Missoula County Medical Benefits Plan 37275MPEEBT/ MPE Services Inc. (Jackson, MS) 37233MO-KAN Welfare Fund TFQ20Morgan White Ins. 52133Morris Associates TLU78Morris Associates (Indianapolis, IN) 35092Motorola Inc. 36111 XMountain Claims Management TLU79Mountain States Administrative Services (AZ) 86040MS Administrative Services (ID) TLY97Mutual Assurance (Oklahoma City, OK) 37256Mutual of Omaha Ins. Co./ Mutually Preferred 71412 XMVP Health Care TLX30N.W. International Association of Machinists (Grp#F39) 91136N.W. Ironworkers Health & Security Trust (Grp#F15) 91136N.W. Roofers & Employers Health & Security (Grp#F26) 91136N.W. Textile Processors (Grp#F14) 91136NAA (North American Administrators L.P.) (Nashville, TN) 65085NABN (Cleveland, OH) 34159National Association of Letter Carriers/ NALC 53011National Automatic Sprinkler Industry TLX23National Benefit Administrators - NC 56176National Benefit Administrators - NJ 56175National Employee Benefit Administrations of PA TLW49National Elevator Industry Benefit Plans (NEIB) CX045National Pacific Dental 06128National Pacific of TX (NCFLEX) CX057National Rural Letter Carrier Association 71412 XNational Telecommunications Cooperative Association 52120Nationwide Health Plans (Dublin, OH) 31417NCAS (Charlotte, NC) 75191NCAS (Harrisburg, PA) TLX64NCAS (Fairfax, VA) 75190Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Neighborhood Health TLZ25Netcare of Life & Health Insurance (NLH) (Hagatna, GU) 66055Neman Company TNC01New England Dental Administrators 43351New England Financial 66893New World Claims Services (Niles, MI) 38332New York Life Insurance Co. 66915New York Teamsters Union NYT01 XNewman Company TFQ30NGS American Inc. TLX31NGS American (Lake Forest, IL) 38225Nippon Life Insurance 81264 XNorth America Administrators (NY) TLX02North America Administrators LP (TN) 65085North American Benefit Network/ NABN (Cleveland, OH) 34159North American Health Plans TLX02North Broward Hospital District 37314North Carolina Health Choice TLY55North Carolina Health Choice for Children (Durham, NC) 61472North Star Administrators 47570Northern California Pipe Trades Trust TLW42Northern Illinois Health Plan 36347Northwest Administrators Inc. 91060Northwest Suburban IPA (Illinois) 36346Northern Nevada Trust Fund 88027Northwest Dental Services 93525NOVA Healthcare Administrators Inc. (Grand Island, NY) 16644

NW Int. Assoc. of Machinists & Aerospace Eng. Benefit Trust Dental Program 91136Nyhart (Indianapolis, IN) 37299OBA Midwest TPA TLY87Ogden Benefits Administration (CA) TFQ39Ogden Benefits Administration (NV) TFQ41Ogden Benefits Administration (OH) TFQ42Ohio AFSCME Care Plan OAC01Oklahoma Operating Engineers TFQ36OK State Employees & Educators (EDS) 22521Omaha Industry Construction TLW92Operating Engineers Local 37 TLZ35Operating Engineers Locals 302 & 612 Health (Grp#F12) 91136Operating Engineers- Region 20(CA) TLY57Oregon Dental Services (DD of Oregon)** CDOR1 X **Oregon Health Plan (OHP) 93525Oregon Medical Assistance Program (OMAP) 93525Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



OSMA Health (CL Frates & Company) CX075Oxford Health Plans (Colorado) 84104Oxford Life Insurance (AZ) TLX34PA Faculty Health & Welfare CX066Pacific Dental Benefits (Concord, CA) TLW59Pacific Dental Benefits (Las Vegas, NV) TLW58Pacific Dental Benefits (Houston, TX) TLW57Pacific Source Health Plans 93029 XPacific Union (CA) CX056 XPacifiCare Dental & Vision HMO (Santa Ana, CA) CX060PacifiCare Dental & Vision PPO (Santa Ana, CA) CX053Paid Dental (TX) TLX26Painters Trust Association TLY91Paramount Advantage- HMO Elite Advantage Claims TLY63Paramount Advantage- Preferred Choices TLY61Paramount Advantage- Preferred Option TLY62Paragon Benefits TFQ63Patient Advocates LLC (Portland, ME) 10525Patriot Mutual Dental Programs (Minneapolis, MN) 32069Paul Revere/ Provident 47009 XPavers & Road Builders Welfare Fund PRW01PDO 68241 XPearl Insurance TLW79PEHP CX080 XPeoples Benefit Life Insurance Company 52133Peoples Health Inc. TFQ29Pequot Plus Health Benefit Administrators 37121Pequot Pharmaceutical 37121Performax Inc (NY) TLZ45Performax Inc. (PA) TLX32Personal Choice (PA) TLX74Phoenix Health Plan (PHP) (AZ) PHP01Physicians Care (Grand Rapids, MI) TLU02Physicians Care Network (Rockford, IL) 36345Physicians Health Association of Illinois 37136Physicians Health Partners/ CDOC (CO) TLX05Physicians Health Plan (IN) TLZ23Physicians Health Plan of Northern Indiana (Ft. Wayne, IN) 12399Physicians Mutual (Lincoln, NE) CX068 XPiedmont Insurance Group TFQ33PIMA Health Systems TLX76Pinnacle Claims Management Inc. 24735Pipe Fitters 597 (Chicago, IL) PIP02Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Pipe Traders Industry Health & Welfare Fund PIP01Pittman & Associates 37224Planned Administrators Inc. TLX33Plasterers & Cement Masons Local 148 Health & Welfare Fund PCM01Plumbers & Steamfitters Local 440 TLX04Plumbers & Steamfitters Local 486 TLW98Poly America Medical & Dental Benefits Plans 32680POMCO 16111Porter County Government TFQ04Postal Supervisors (MD) TFQ10Prairie States Enterprises Inc. 36373Preferred Care 16112 XPreferred Care (FL) 59291Preferred Care (NC) 56178Preferred Dental Organization 60054 X XPreferred Health Plan (KY) TFQ28Preferred Health Professionals (Freedom Dental) 31478Premier Access Insurance (Sacramento, CA) TLY54Premier Access Dental Insurance Co (Sacramento, CA) CX078Premier Dental Plan (MN) CX029 XPrimary Physician Care Inc. 56144P.R.I.M.E. DX109Principal Financial Group 61271 X XPrincipal Mutual Life Insurance Co. 61271 X XPriority Health (Grand Rapids, MI) 38217Professional Benefit Administrators Inc. (Oak Brook, IL) 36331Professional Claim Administrators 41163Provident Life 62308 XPrudential for Health 68241 XPrudential Health Care HMO for Small Business's 68241 XPrudential Health Care Health Maintenance Organization 68241 XPrudential Health Care & Life Ins. Co. of America 68241 XPrudential Health Care of America 68241 XPrudential Health Care POS for Small Business's 68241 XPrudential Health Care PPO for Small Business's 68241 XPSC CUNY Welfare Fund TFQ38Public Employees Health Program (PEHP) CX080 XPuget Sound Benefits Trust (Grp#F25) 91136Puget Sound Electrical Workers Trust (Grp#F33) 91136Quad-Med LLC (Pewaukee, WI) 39197Quality Benefits LLC TLW95Quality Plan Administrators Inc. (Washington DC) CX077Qualmed- New Mexico TLX48Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Oxford Health Plans** 52133 X**RBMS LLC (Anchorage, AK) 91176RE Harrington Inc. (Columbus, OH) 95266 XRegence Blue Shield of Washington Health 93200 XRegence Northwest Health 93200 XRegency Employee Benefits 38221Regional Care Inc. (Scottsdale, AZ) 47076Reliance Standard Life 36088 X XReliaStar (CA) 80314 XReliaStar (Known as Core Star, formerly NW National Life) (MN) 41045Renaissance Life & Health (Indianapolis, IN) RLHA1Resource ONE Corp. TLX93Reynolds & Reynolds TLU81RH Administrators TLX22Risk & Benefit Management Services TLU80Riverside San Bernardino County Indian Health Inc. (Banning, CA) 50664RMSCO Inc. (Syracuse, NY) 16117Rochester Laborers Welfare Fund TLX19Rochester Public Schools (Rochester, MN) 41625Rocky Mountain Life Dental 84102Roofers & Waterproofs Local 136 H&W Fund TRW01S & S Healthcare Inc. TLW46Safeguard (PPO) CX030Safeguard (HMO) CX048Sage Technologies (fka Progressive Benefit Services) (Rockford, IL) 37137Sage Technologies (fka Cannon Cochran Management Srvs.) 37105Salvation Army (Uniontown, OH) 34154SAMBA 37259Samba Federal Employee Benefit Assoc. (KY) TFQ67Sanford Health Plan (Sioux Falls, SD) 91184Santa Barbara Cottage Hospital 37288SBA Atlantic Coast Health Plan TLU82Scan Health Plans Arizona 73172

Scan Long Term Care (Phoenix, AZ) 20460School Claims Services LLC (PA) TLW27School District #1 Health & Welfare Fund TLW26Scott & White TLX49Seabury & Smith CX023Secure Care Dental 89057Secure Health Plan TLY64Securian Dental Plan (Minneapolis, MN) 93742Security Life Insurance Co. of America TLX77Secures Group Inc. TLW45Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Select Administrative Services (SAS) 64088Select Benefit Administrators (Portland, OR) CX018Select Care (Coca-Cola) 60054 X XSele- Dent Inc. TLU20Self Funded Plans LLC (Naples, FL) 36404Self Funded Plans Inc. (Cleveland, OH) 34131Self Insured Benefit Administrators (Clearwater, FL) 59111Self Insured Dental Services (SIDS) CX076 XSelf Insured Plans Inc. (FL) TLX16Self Insured Services Company (Sisco) CX020Sentry Life Insurance Company (Stevens Point, WI) 39033Serentas Dental Care Solutions CX038 XSet Seg. Inc. 38610Shasta Administrative Services (OR) TLW25Sheet Metal Workers Local 20 (Zenith) 30920Sheet Metal Workers Local 46 TLW54Sheet Metal Workers Local 85 TLW55Sheet Metal Workers Local 91 SMW01Shenandoah Life Insurance CX067SHN Employee Dental TLX11Sierra Health Services 76342SIHO TLY60Sinclair Health Plan 84076Smith Administrators (TX office) TLW21Smith Administrators (UT office) TLX63South Central Preferred-PPO York PA (HIS Gateway payer) 23266South FL Community Care Network- NBHD 37314South Point Hotel & Casino (Las Vegas, NV) 35227Southern Alaska Carpenters Trust TLX62Southern Benefit Services 37318Southern California Pipe Traders TLW41Southern Electrical Health Fund (Chattanooga, TN) SEF01Southern Group Administrators 56131Southland National Insurance Corp (AL) TLX75Southwest Benefits CX051 XSouthwest Preferred Dental Org SPD01Southwestern Bell (Exec. & Custom Care) 60054 X XSoutheastern Service Employees International Union (SEIU) SEI01Spina Bifida VA-HAC 84147SRC (Strategic Resource Company) TLW40SRT Administrators TLY99St. Tammany Federation of Teachers TLU84St. Therese Physician Association (Rockford, IL) 37116Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Standard Insurance (OR) 93024 X XStandard Insurance Company (NY) 13411 XStanislaus Foundation TLZ01StarHRG (Phoenix, AZ) 59225Starmount Life Insurance Company STR01State of Texas Dental Plan 57254 XStewart C Miller Co. TFQ08Stirling & Stirling TLW31Stoner and Associates (Cincinnati, OH) 31121Stowe & Associates (Atlanta, GA) 58128Strategic Outsourcing Inc. (SOI) TLX60Student Insurance 74227Student Insurance - Boston Mutual Life Ins. Co 74227Student Insurance - Life Ins. Co of Boston & NY 74227Student Insurance - MEGA Life & Health Ins. Co 74227Student Insurance - Mid-West National Life Ins. Co of TN 74227Student Insurance - Reliance Ins. Company 74227Student Insurance - Reliance National Ins. Co 74227SummaCare (Akron, OH) 95202 XSun Life & Health Insurance Co. (US) (formerly GLHIC) 67814 XSun Life of Canada 47009 X Superior Dental Care Preferred Plan** 31117 X **Sure Circle TPA TLZ44Symetra (Latham, NY) TLX77TDC (Greenbay, WI )** 73288 X**Teachers Health Trust (Las Vegas, NV) 88020Teamster Construction Industry Welfare Trust TCWT1Teamster Health Welfare TLW39Teamsters Local 72 Health Fund TLW36Teamsters Local 377 TFQ54Teamsters Local 618 Health Fund TLW37Teamsters Local 671 Health Fund TLW38Teamsters Local 677 Health Fund TLW35Teamsters Welfare Fund (MI) DELTATexas CHIP Dental Services CPPTX XThe Alumni Insurance Program TFQ44The Benefit Group (TBG) TFQ62The Boon Group TLX67The Chesapeake Life Insurance Company 74227The Dental Companies (Greenbay, WI )** 73288 X **The Dental Concern (Greenbay, WI )** 73288 X **The Dental Network (Townson, MD) In State providers TDN01The Dental Network (MD or DC) Out of State providers TDN02Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



The Loomis Company-TPA (Wyomissing, PA) 23223The Mega Life & Health Insurance Co. (N. Richland, TX) 59226The Plan Handlers Inc TLW84The Union Labor Life Insurance Company (King of Purssia , PA) 13142Third Party Administrator (Tucker, GA) TLX54Three Rivers Health Plans Inc. (Unison Health)** 25175 X X **TIC International Inc. (Carmel, IN) TIC01TICUA Benefit Consortium TLX02Time Insurance (a Fortis company) 39065 XTLC Administrators (CA) TLY38TML Group Benefits Inc. TLU96Total Administrative Inc. / North Broward Hospital District (FL) 37314Total Administrative Services Corp. TLX01Total Benefit Services (IL) TLZ14Total Benefit Services (LA) TLU07Total Claims Solution CMS01Total Dental Administrators (AZ) TLY36Total Dental Administrators (UT) TLY35Total Plan Services (TX) TLY37Tower Life Insurance (San Antonio, TX) 69493TR Paul Inc. 37230TranSmile (Sherwood, AR) CX069Transwestern Insurance TLY33Travelers (MetLife) 65978 X XTribal Health Partners (AZ) TLX99Tricare Active Reservists (Military) CX002 X X XTriCare Family Member Dental Plan- TFMDP CX007 X X XTrident Plan Administrators TLY32Trigon Insurance Co. (BC/BS of VA) CB923Trusteed Plans Services Corporation (Tacoma, WA) 91078Trustmark Insurance 61425 XTrustmark Insurance (Lake Forest, IL) 47009 XTrustmark Insurance (Clinton, IA) TLW23TSRDP Dental Claims (Green Bay, WI) ** 73288 X **Tube Light Company Inc. TLW09Tufts Health Plan TLZ24UCCI CX007 X X XUFCW of Central Ohio UFC01UFCW of Cleveland UFC02UFCW Health & Welfare Fund of NE Pennsylvania TFQ09UFCW Health & Welfare Fund of PA TLW49UFCW Local 1 UFW01 XUFCW Local 8 TLZ02Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



UFCW Local 1996 TLW52UFCW Local 400 Welfare Fund TLW94UFCW Local 400-5205 (Charleston, WV) A5205UFCW Local 534 Welfare Fund TLW94UFCW Local 555 Health & Trust Fund TFQ48UFCW Local 56 TLW67UFCW Local 655 Welfare Fund TLW94UFCW Local 881 Welfare Fund TLW94UFT Welfare Fund 62308 XUICI Administrators - State of Nevada (Nevada Residents) 74223UniCARE Major Accounts (Mass Mutual) 80314 XUniCARE Special Accounts (formerly John Hancock) 80314 XUnifi Companies 47009Unified Group Services 35198Uniform Medical Plan 75243Uniform Medical Plan/ Harrington Benefit Services 75243Unimerica Dental** 52133 XUnion Labor Life Insurance Co. 13142Union Security Insurance Company 70408 XUnique Dentacare 52133Unison Health Plan (Monroeville, PA)** 25175 X X **United Administrative Services TLY58United Benefits (FBMC) 59069United Concordia (Fee for service) CX007 X X XUnited Concordia (TRICARE FMDP & TDP) (Military) CX002 X X XUnited Concordia Dental Plus CX013 X X XUnited Health Care** 52133 X **United Healthcare of River Valley ( John Deere Health) 95378 XUnited Food & Commercial Workers Union of Central OH (UFCW of Central OH) UFC01

United Food & Commercial Workers Union of Central OH (UFCW of Cleveland) UFC02

United Medical Alliance (CO) 84132United Medical Resources (OH) 33108United of Omaha 71412 XUnited Security Life TLW89United States Life Insurance Company 13545Unity Health Insurance Corp. (Sauk City, WI) (Oral Surgery TMJ or Accident Claims ONLY) 66705Unity Health Plan UNT01Univera (NY) 16105 X University of Denver TFQ52University of Washington Students & Grad. (Grp#P67) 91136Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Upper Peninsula Health Group (TPA) 37324Upstate Admin TLU73Upstate Administrative Services Inc. TLW47US Benefits TLW48US Plan Administrators TLW22Utah - Idaho Teamsters Union (UT) TFQ51Usable Life 76031Valley Health Plan (WI) VHP01Valley Welfare Fund TFQ68Varian Health Care Plan 60054 X XVerity National Group 75256Veterans Administration Fee Basis Program 12116Via Care TLX51Virtual Benefits Administrators Inc TLY94Washington Dental Service 91062 XWashington Employers Trust 37294Washington National (AZ) TFQ11

Washington State Council of County & City Employees Dental Trust (Grp#F36) 91136Wausau Benefits (aka Employers Insurance of Wausau) 39026Waterstone Benefit Administrators 73155Watkins Associated Industries TLU85WEA Insurance Group 39151Web TPA ( Community Health Electronic Claims) 75261Webster Dental (Cigna) 10050 XWelfare Fund of the Int'l Union of Operating Engineers Local (NY) TLX10Wells Fargo TPA (Formerly JSL Administrators) (Newman, GA) 37272Wells Fargo Third Party Administrators Inc. (Charleston, WV) 87815Wen- Neb Inc. TLW51West Coast Stationary Engineers Health (Grp#F13) 91136Westlake Financial Group Inc. (Buffalo Grove, IL) 90560West Lake TPA (Buffalo Grove, IL) TLX18Western Growers Assurance Trust/ Insurance Co. 24735Western PA Electrical Employees Insurance Trust TLW34Western PA Teamsters Fund TLW33Western Teamsters Welfare Trust 91060Westport Benefits TLW08Whatcom Medical Bureau 84098William C Earhart (Portland, OR) 93050William J Sutton & Co. LTD (Ontario) 98010Woods & Grooms Benefit Services (Columbus, IN) TLA06Worksite Benefit Services 20333WPS Health Insurance TLY31

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


COMMERCIAL PAYERS



Zenith Administrators (AZ) TLY10Zenith Administrators (San Francisco, CA) TLX36Zenith Administrators (Los Angeles, CA) TLY11Zenith Administrators (CO) TLY12Zenith Administrators (IL) TLY14Zenith Administrators (IN) TLY15Zenith Administrators (KY- Louisville 1) TLY16Zenith Administrators (KY- Louisville 2) TLY17Zenith Administrators (LA) TLY18Zenith Administrators (MA) TLY19Zenith Administrators (MI) TLY20Zenith Administrators (MN) TLY21Zenith Administrators (MO) TLY13Zenith Administrators (MO-Earth City) TLY23Zenith Administrators (MO-Kansas City) TLY22Zenith Administrators (NV) TLY24Zenith Administrators (OK) TLY25Zenith Administrators (TX) TLZ33Zenith Administrators (WA- Seattle) TLY27Zenith Administrators (WA- Spokane) TLY28Zenith Administrators (WI- Deforest) TLY29Zenith Administrators (WI- Milwaukee) TLY30DORAL DENTAL Doral Dental USA** CX014 X ** XDoral Dental of WI (Policy # 0003)** CX014 X ** XGeorgia Medicaid, Grady Healthcare, Inc. (Policy #0041)** CX014 X ** XIllinois Medicaid (Policy # 0054)** CKIL1 X **Kentucky Medicaid, Passport Plan Region #3 (Plcy # 0030)** CKKY3 X **Managed Health Services WI State Employees (Policy # 0013)** CX014 X ** XMaryland Medicaid, MD Physicians Care MCO (Plcy # 0026)** CX014 X ** XMissouri Medicaid, Blue Advantage (Policy # 0006)** CX014 X ** XMissouri Medicaid, Community Care Plus St Louis (Policy # 0028)** CX014 X ** XMissouri Medicaid, Community Health Plan (Policy # 0009)** CX014 X ** XMissouri Medicaid, First Guard Health Plan ( Policy # 0008)** CX014 X ** XMissouri Medicaid, HealthCare USA, St Louis (Policy # 0027)** CX014 X ** XMissouri Medicaid, Health Net (Policy # 0007)** CX014 X ** X

Missouri Medicaid, Truman Care, Family Health Partners (Policy # 0010)** CX014 X ** X

Nebraska Medicare United Health Care of the Midlands (Policy # 0001)** CX014 X ** XAnthem Partnership Plan in Nevada CX014 X ** XNew Mexico Medicaid, Cimmeron Health Plan (Plcy # 0025)** CX014 X ** X



DORAL DENTAL



New Mexico Medicaid Lovelace Community Health Plan (Policy # 0023)** CX014 X ** XNew Mexico Medicaid, Presbyterian Salud (Policy # 0024)** CX014 X ** X

Ohio Medicaid and Medicare Emerald HMO, Cincinnati, OH (Policy #0039)** CX014 X ** XOhio Medicaid Health Power HMO Cincinnati, OH (Policy # 0019)** CX014 X ** X

Ohio Medicaid, Personal Physicians Care Cleveland, OH (Policy # 0002)** CX014 X ** X

Ohio Medicaid, United Healthcare, Inc. Medicare Complete (Policy # 0021)** CX014 X ** X

Pennsylvania Medicaid, Best Health Care Pittsburg, PA (Policy # 0031)** CX014 X ** X

Pennsylvania Medicaid, Gateway Health Plan Pittsburg, PA (Policy # 0017)** CX014 X ** XPennsylvania Medicaid and Medicare Health Partners, Philadelphia, PA (Policy # 0005)** CX014 X ** XPennsylvania Medicaid and Medicare, Oak tree (Plcy # 0038)** CX014 X ** X

Physicians Plus Insurance Co. WI State Employees (Policy # 0040)** CX014 X ** X

PimeCare, Wisconsin State & Federal Employees & Medicaid Policy # 0011)** CX014 X ** XTennessee Medicaid, Bluecare (Policy # 0033)** CX014 X ** XVirginia Medicaid, Health Keepers Plus (Policy # 0037)** CX014 X ** XWisconsin Medicaid, Humana/TDC (Policy # 0042)** CX014 X ** XXantus Health Plan Ten** CX014 X ** XDELTA DENTAL PAYERSAARP (Mechanicsburg, PA) AARP1AARP (Administrated by DD of Washington DC) 52147 X XDelta Dental Insurance Company (DDIC) 94276 XDelta Dental of Alaska** 94276 X ** XDelta Dental of Alabama 94276 XDelta Dental of Arizona 86027 X XDelta Dental of Arkansas CDAR1 XDelta Dental of California (CA00 claim office) 77777 X XDelta Dental of California - Tricare Retiree CDCA1 XDelta Dental of Colorado 84056 XDelta Dental of Connecticut 22189 X XDelta Dental of Delaware 51022 X XDelta Dental of Florida 94276 XDelta Dental of Georgia 94276 XDelta Dental of Hawaii DEHI1Delta Dental of Idaho 82029 XDelta Dental of Indiana CDIN1 X XDelta Dental of Iowa CDIA1 XPaper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section


DELTA DENTAL PAYERS



Delta Dental of Illinois 05030 X XDelta Dental of Kansas CDKS1 X XDelta Dental of Kentucky CDKY1 XDelta Dental of Louisiana 94276 XDelta Dental of Maine (Northeast) 02027Delta Dental of Maryland (Pennsylvania) 23166 X XDelta Dental of Massachusetts 04614 X XDentaQuest (MA) 04356 XDelta Dental of Michigan CDMI0 X XDelta Dental of Minnesota CDMN1Delta Dental of Mississippi 94276 XDelta Dental of Missouri 43090 X XDelta Dental in Missouri of South Carolina 43091 XDelta Dental of Montana 94276 XDelta Dental of Nebraska CDNE1Delta Dental of Nevada 94276 XDelta Dental of New Hampshire (Northeast) 02027Delta Dental of New Jersey & Connecticut 22189 X XDelta Dental of New Mexico 85022 X XDelta Dental of New York 11198 X XDelta Dental of North Carolina 56101 XDelta Dental of North Dakota CDND1Delta Dental Northeast (ME, NH, VT) 02027Delta Dental of Ohio CDOH1 X XDelta Dental of Oklahoma CDOK1 X XDelta Dental of Oregon (Oregon Dental Services)** CDOR1 X **Delta Dental of Pennsylvania 23166 X XDelta Dental of Rhode Island 05029Delta Dental of South Carolina 43091 XDelta Dental of South Dakota** 54097 X **Delta Dental of Tennessee CDTN1 X XDelta Dental of Texas 94276 XDelta Dental of Utah 94276 XDelta Dental of Virginia** (Attachment is electronic, claim submitted by paper) 54084 X **Delta Dental of West Virginia 31096 XDelta Dental Vermont (Northeast) 02027Delta Dental of Washington 91062 XDelta Dental of Washington DC 52147 X XDelta Dental of Wisconsin 39069 X XDelta Dental of Wyoming CDWY1Anthem BC/BS (IN, OH, KY, CT, & NH) 84105



BLUE CROSS BLUE SHIELD PAYERS



Anthem Blue Cross Blue Shield of Connecticut 84105 XBlue Cross Blue Shield of Alabama CBAL1 X XBlue Cross Blue Shield of Alaska (Premera) 47570Blue Cross Blue Shield of Arizona TBX01Blue Cross Blue Shield of Arizona- FEP Claims TLZ14Blue Cross Blue Shield of Arkansas (Blue Advantage) TLY26Blue Cross Blue Shield of Arkansas-FEP TFQ45Blue Cross of California (WellPoint Dental) (Anthem) 47198 X XBlue Cross Blue Shield of Colorado Dental 84099Blue Care Family Plan (BC/BS of CT) 00700Blue Cross Blue Shield of Delaware 53287Blue Cross Blue Shield of Florida BFL01Florida Combined Life (BCBS of FL) BFL01Blue Cross Blue Shield of Florida (Federal Claims) TFL02Florida Combined Life (BCBS of FL) (Federal Claims) TFL02Blue Cross Blue Shield of Georgia CBGA1 X XBlue Cross Blue Shield of Hawaii- Commercial Claims HMSA1 XBlue Cross Blue Shield of Hawaii- Federal Claims-FEP HMSA2 XBlue Cross of Idaho (Only Idaho Residents may submit) CBID1 X XBlue Shield of Idaho (Only Idaho Residents may submit) CBID2 XBlue Cross Blue Shield of Illinois CB621 XBlue Cross Blue Shield of Illinois (FEDERAL Claims) TLW12 XBlue Cross Blue Shield Indiana (Anthem) 84105 XBlue Cross Blue Shield Indiana (FEP Claims) TLU89Blue Cross Blue Shield of Iowa (Wellmark Blue Dental) CBIA2 XBlue Cross Blue Shield of Iowa- Fep & Farm Bureau CBIA1 XBlue Cross Blue Shield of Kansas (Kansas providers. only) CBKS1 XBlue Cross Blue Shield of Kentucky (Anthem) 84105 XBlue Cross Blue Shield of Kentucky (FEP Claims) TLU90Blue Cross Blue Shield of Louisiana 23739 XBlue Cross Blue Shield of Maine (Anthem) BME01 XBlue Cross Blue Shield of Maryland- Care First TLX88Blue Cross Blue Shield of Maryland - Care First- Preferred Provider Claims ONLY TLU18Blue Cross Blue Shield of Maryland- Care First- FEP ONLY TLX85

Blue Cross Blue Shield of Maryland- Care First- BLUE CHOICE ONLY TLX86

Blue Cross Blue Shield of Massachusetts (Participating providers only) CBMA1 X XBlue Cross Blue Shield of Michigan** CBMI1 X **Blue Cross Blue Shield of Minnesota BXMN1Blue Cross Blue Shield of Minnesota (Federal FEP) TLU22Blue Cross Blue Shield of Mississippi TBS01 XBlue Cross Blue Shield of Mississippi (FEP Claims) TBS02 XPaper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section





Blue Cross Blue Shield of Mississippi (CHIPS Claims) TBS03 XBlue Cross Blue Shield of Missouri TLX52 XBlue Cross of Missouri (St. Louis) TSBM1Blue Cross Blue Shield Montana CBMT1Blue Cross Blue Shield of Nebraska CBNE1Blue Cross Blue Shield of Nevada 84101 XBlue Cross Blue Shield of New Hampshire (Anthem) 84105 XBlue Cross Blue Shield of New Mexico CBNM1 XBlue Cross Blue Shield of NY- Central NY (Excellus) EXC02 XBlue Cross Blue Shield of Rochester NY (Excellus) EXC01 XBlue Cross Blue Shield of NY (Excellus)- FEDERAL ONLY EXC03Blue Cross Blue Shield of New York (Finger Lakes Region) EXC01 XBlue Cross Blue Shield of NY- Syracuse (Excellus) EXC02 XBlue Cross Blue Shield of NY- Utica Watertown (Excellus) EXC01 XBlue Cross Blue Shield of Northern NY (NENY) 00800 XBlue Cross Blue Shield of North East NY CBNYE XBlue Cross Blue Shield of Western NY CBNYW XBlue Cross Blue Shield of NC (Winston-Salem, NC) 61473 XBlue Cross Blue Shield of NC Federal Employee Program 61472Blue Cross Blue Shield of NC-DBS (a.k.a. ACS Benefit Services) 61474 XBlue Cross Blue Shield of North Dakota (ND Dental Service) CX004 XBlue Cross Blue Shield of Ohio (Anthem) 84105 XBlue Cross Blue Shield of Ohio (FEP Claims) TLU91Blue Cross Blue Shield of Oklahoma TBOK1 XBlue Cross Blue Shield of Oregon (Regence) CB850 XBlue Cross Blue Shield of Oregon (Regence) - FEP CLAIMS TLW13Blue Cross Blue Shield of PA (Dental Plus) CBPA2 X XBlue Cross Blue Shield of Pennsylvania (Camp Hill) (Federal) CB865 X XBlue Cross Blue Shield of Pennsylvania (Federal) 54771 XBlue Cross Blue Shield of Rhode Island CB870 XBlue Cross Blue Shield of South Carolina BSC01 XBlue Cross Blue Shield of South Carolina (Federal ONLY) TLW74Blue Cross Blue Shield of South Dakota TLY09Blue Cross Blue Shield of Tennessee CBTN1 X XBlue Cross Blue Shield of Texas CB900 XBlue Cross Blue Shield of Utah (UHIN) CBUT1 XBlue Cross of Utah (Regence) - FEP CBUTF XBlue Cross Blue Shield of Vermont TLX57Blue Cross of Virginia (Trigon) CB923Blue Cross of West Virginia TLY46 XBlue Cross of Washington and Alaska (Premera Blue Cross) 47570Blue Cross Blue Shield of Washington DC TLY47Blue Cross Blue Shield of Wisconsin CB950 XPaper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section





Blue Cross Blue Shield of Wyoming TLX12

Empire Blue Cross & Blue Shield of New York (Participating providers only) CBNY1Horizon Blue Cross Blue Shield of New Jersey 22099 X XHorizon Health Care of NY 22099 X XHorizon Healthcare Dental Services 22099 XPremera Blue Cross (AK) 47570Regence Blue Shield of Washington 93200 XRegence Northwest Health (BCBS WA) 92300 XTrigon Blue Cross Blue Shield - CO Dental Office 84103 XWellPoint Dental (Blue Care Family) 47198 X XMEDICAID PAYERSMedicaid of Alabama CKAL1 XMedicaid of Alaska CKAK1 XMedicaid of Arizona (APIPA ONLY) TLW68Medicaid of Arizona (APIPA-CRS) APCRSMedicaid of Arizona TLU09Medicaid of Arkansas CKAR1 XMedicaid of California (Denti-Cal) 94146 X XMedicaid of Colorado (ACS) CKCO1 XMedicaid of Connecticut CKCT1 XMedicaid of Delaware CKDE1 XMedicaid of Florida (ACS) CKFL1 XMedicaid of Georgia (ACS)** CKGA1 X X **Medicaid of Georgia (HFP) CKGA2Medicaid of Georgia (Peach Care for Kids) CKGA3Medicaid of Hawaii (ACS Consulting Services) ACSH1Medicaid of Idaho CKID1 XMedicaid of Illinois** CKIL1 X **Medicaid of Indiana CKIN1Indiana Children's Special Health Care CX070 XMedicaid of Iowa (Noridian) CKIA1 XMedicaid of Kansas (Kansas providers only) CKKS1 XMedicaid of Kentucky CKKY1 X XMedicaid of Kentucky Doral/Region 3** CKKY3 X **Medicaid of Louisiana (Adult Dental) CKLA2 XMedicaid of Louisiana (EPSDT) CKLA1 XMedicaid of Maine CKME1 XMedicaid of Maryland Dep. Of Health & Mental Hygiene CKMD1 XMedicaid of Massachusetts / Mass Health (Unisys) CKMA1 XMedicaid of Michigan CKMI1 XHealth Partners of Minnesota-Medicaid CX010Medicaid of Minnesota CKMN1 X



MEDICAID PAYERS



Medicaid of Mississippi CKMS1 XMedicaid of Missouri (administrated by GTE Data Services) CKMO1 XMedicaid of Missouri (a.k.a. MO Healthnet) CKMO1 XMedicaid of Montana CKMT1Medicaid of Nebraska MCNE1 XMedicaid of Nevada CKNV1 XMedicaid of New Hampshire CKNH1 XMedicaid of New Jersey (Unisys) CKNJ1 XMedicaid of New Mexico (ACS/Consultec) CKNM1 XMedicaid of New York (All categories of service except 0287) CKNY1 XMedicaid of New York (Category of service 0287 ONLY) CKNY2 XMedicaid of North Carolina CKNC1 XMedicaid of North Dakota CKND1Medicaid of Ohio CKOH1 XMedicaid of Ohio (Care Source) CKOH2Medicaid of Oklahoma (Provider # Required at Clearinghouse) CKOK1 XMedicaid of Oregon CKOR1 XMedicaid of Pennsylvania CKPA1 XMedicaid of Rhode Island CKRI1 XMedicaid of South Carolina CKSC1 XMedicaid of South Dakota TLZ29Medicaid of Texas (ACS) CKTX1 XMedicaid of Utah CKUT1 XMedicaid of Vermont CKVT1 XMedicaid of Virginia (Richmond, VA)** CKVA1 X **Medicaid of Washington (DSHS)** CKWA1 X X **Medicaid of West Virginia (Unisys) CKWV1 XMedicaid of Wisconsin CKWI1Medicaid of Wyoming (ACS) CKWY1 X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes sectionPlease contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions. 1/21/2009

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COMMERCIAL PAYERS Enrollment Attachment Payer Name Payer ID