eClaims Medical Payer List Information

eClaims Medical Payer List Information

For any questions please contact PTOS Support at 800.475.5036.

Payer List Includes: Commercial Payers Blue Cross Blue Shield Payers Medicaid Payers Medicare Payers Champus Payers Automobile Medical Payers Workers Compensation Payers

Payer ID SPRNT: Use this eClaim payer id for those insurance companies that are not on the eClaim Payer List

Enroll Column: This column indicates whether or not the payer requires enrollment P, R, and A = Provider registration is required

1. Within PTOS go to Help – Online Center- FAQ 2. Under the Search by Keyword field type 13138 3. Click on the eClaims Insurance Enrollment Link

N = No paperwork is required

Additional Information Column: This column includes important information specific to the insurance companies

eClaims Medical Payer List

March 2012

Payer ID State Model Enroll Additional Information

Americas 1st Choice Health Plans of North Carolina Inc. 26078 COMMERCIAL N

Americas 1st Choice Health Plans of South Carolina Inc. 20553 COMMERCIAL N

Arroyo Vista Family Health Center NMM01 COMMERCIAL N

Lakeside Medical Group 66125 COMMERCIAL N

Optimum Healthcare Inc. 20133 COMMERCIAL N

Primary Care Associates Medical Group IP079 COMMERCIAL N

Texas First Health Plans (TIOPA) 76046 COMMERCIAL N

1-888-OHIOCOMP (Ohio BWC) 31147 COMMERCIAL N

For Ohio Worker's Comp

Claims ONLY.

1199 National Benefit Fund 13162 COMMERCIAL N

1st MN--Atlanta GA 29076 COMMERCIAL N

1st Medical Network is part

of the Medical Mutual Family

of Companies. Former payer

ID 58203.

1st Medical Network - Atlanta GA 29076 COMMERCIAL N




ID 58203.

21st Century Health and Benefits 59069 COMMERCIAL N

21st Century Insurance and Financial Services 51028 COMMERCIAL N For Minnesota Only

3-Hab (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

3P ADMIN 20413 COMMERCIAL N

A & I Benefit Plan Administrators 93044 COMMERCIAL N

A.G.I.A. Inc. 95241 COMMERCIAL N

Claims are printed and mailed

to the payer.

AAG Benefit Plan Administrators Inc. 75240 COMMERCIAL N

AAG-American Administravie Group ( Formerly Icon Benefit Admin)75185 COMMERCIAL N

ABMA (Alta Bates Medical Assocs) Medical Corp (Hnet Sr. and Secure Horizon)E3510 COMMERCIAL P

Only claims from providers in

Northern California. Please

contact the EDI Dept for

North American Medical

Management (NAMM) -

Northern California

Lead/Supervisor at 1-800-956-

8000 prior to initial

submission of claims.

ACMG 37118 COMMERCIAL N

Claims are processed by

Benefit Plan Administrators

ACMG COMMERCIAL N

For an updated payer list please visit our website https://pattersonsupport.custhelp.com

Page 1


March 2012


ACS Benefit Services Inc. 72467 COMMERCIAL N

DO NOT send ACS/Health Net

or ACS Inc. Medicaid claims

to this payer ID. This payer ID

is for ACS Benefit Services.

Inc. ONLY.

ADOC (Affiliated Doctor's of Orange County) ADOCS COMMERCIAL N

ADVANCED DATA SOLUTIONS 58202 COMMERCIAL N

ADVANTICA BENEFITS 59374 COMMERCIAL N

AFFINITY MEDICAL GROUP 46594 COMMERCIAL N

AFTRA Health Fund 13346 COMMERCIAL N

AGA 37280 COMMERCIAL N

AHPO (Cleveland OH) 31138 COMMERCIAL N

AKM Medical Group CAPMN COMMERCIAL N

ALICARE 13550 COMMERCIAL N

ALPS CompCare (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

AMA Insurance Agency TH071 COMMERCIAL N

AMCO 62176 COMMERCIAL N

AMERIGROUP Community Care of New Mexico 27514 COMMERCIAL N

AMERIGROUP Georgia 27514 COMMERCIAL N

AMVI CAPMN COMMERCIAL N

AMVI/Prospect Health Network (Prospect Medical Group)PROSP COMMERCIAL N

APAC (Pinnacle Health Resources) (Prospect Medical Group)PROSP COMMERCIAL N

APS Healthcare Inc. 54160 COMMERCIAL N

APS Paper Claim 54100 COMMERCIAL N

Claims will be printed and

mailed to APS Paper Claim

54100.

ARAZ Group 16120 COMMERCIAL N

ARM Grp 88035 COMMERCIAL N

ASC of Oho Call COMMERCIAL N

To obtain the payer ID please

call (440) 262-1160.

ASR 38265 COMMERCIAL N

ASR Corporation 38265 COMMERCIAL N

ASR Health Benefits 38265 COMMERCIAL N


Page 2


March 2012


ATA-FL 65064 COMMERCIAL N

ONLY Physical Occupational

and Speech Therapy Claims

for the following FLORIDA

Health Plans should be

submitted to this payer ID:

Aetna Health Plan CarePlus

JMH Health Plan Sunshine

State Health Plan WellCare

Health Plan

AXA Assistance_USA 65101 COMMERCIAL N

Abrazo Advantage Health Plan 3443 COMMERCIAL N

Absolute Total Care 68055 COMMERCIAL N

Prior to submitting claims

please call Provider Relations

Dept at 1-866-433-6041 to

verify your provider info is on

file in the claim system. This

will prevent rejections and

allow payments to be made

in a timely manner.

Access Administrators TH067 COMMERCIAL N

Access IPA CM001 COMMERCIAL N

Access IPA REGAL COMMERCIAL N

Acclaim 64071 COMMERCIAL N

Acclaim Repricing 21356 COMMERCIAL N

Activa Benefit Services 88056 COMMERCIAL N

Administration Systems Research Corporation 38265 COMMERCIAL N

Administrative Concepts Inc. 22384 COMMERCIAL N

Administrative Services Inc. 59141 COMMERCIAL N

Advanced Medical Management AMM01 COMMERCIAL N

Advantage Health Solutions 35209 COMMERCIAL N

Advantage Med Grp NMM01 COMMERCIAL N

Advantage Preferred Plus 77070 COMMERCIAL N

Advantage by Bridgeway Health Solutions 68056 COMMERCIAL N

Advantage by Buckeye Community Health Plan 68056 COMMERCIAL N

Advantage by Managed Health Services 68056 COMMERCIAL N

Advantage by Superior HealthPlan 68056 COMMERCIAL N

Advantek Benefit Administrators 83077 COMMERCIAL N

Advantra Freedom 25133 COMMERCIAL N

Formerly payer ID 25152.

Now part of Coventry

Consolidated payer ID.

Advantra Savings 25133 COMMERCIAL N





Page 3


March 2012


Adventist Health System West - Roseville CA 95340 COMMERCIAL N

AdvoCare Incorporated (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Advocate Health Centers 36320 COMMERCIAL N

Please contact Advocate

Physician Partners Debbie

Motz at (847)635-4182 for

questions or more

information for both payer

IDs.

Advocate Physician Partners 65093 COMMERCIAL N

Please contact Advocate

Physician Partners Debbie

Motz at (847)635-4182 for

questions or more

information for both payer

IDs.

Aetna 60054 COMMERCIAL N

Aetna Affordable Health Choices (SM) - SRC 57604 COMMERCIAL N

Affiliated Doctors of Orange County (ADOC) ADOCS COMMERCIAL N

Affiliated Physicians Group APG01 COMMERCIAL N

Affinity Health Plan 13334 COMMERCIAL P

Please contact Affinity's EDI

Coordinator before

submitting claims

electronically at

[email protected] or call

(718)794-7592.

Affinity Medicare Advantage 13333 COMMERCIAL N

When submitting to this

payer ID please ensure the

following: The claim is for a

Medicare Advantage Member

the date of service is equal to

or greater than 1/1/10 and

the subscriber ID you submit

is 9 characters in length.

Affordable Benefit Administrators Inc. 95426 COMMERCIAL N

Claims with the following

address should only be sent

to this payer id. ABA P.O. Box

10787 Burbank CA 91510-

0787

Agate Resources Inc. (LIPA) 20048 COMMERCIAL N

Please contact Risa Rhodes at

(514) 762-2165 for the Agate

Resources Inc. (LIPA) Payer ID

Agency Services Inc 64158 COMMERCIAL N

Now known as Meritain

Health

Alaska Carpenters Trust 91136 COMMERCIAL N

Please enter Group Number

(F40) when submitting claims.


Page 4


March 2012


Alaska Children's Services Inc. 91136 COMMERCIAL N


(P68) when submitting

claims.

Alaska Electrical Health & Welfare Fund 92600 COMMERCIAL N

Alaska Laborers Construction Industry Trust 91136 COMMERCIAL N



Alaska Pipe Trades Local 375 91136 COMMERCIAL N



Alaska United Food & Commercial Workers Health & Welfare Trust91136 COMMERCIAL N



Allegiance Benefit Plan Management Inc. 81040 COMMERCIAL N

Alliance Healthcare/Florida for Stones River Regional IPA13079 COMMERCIAL N

This Payer ID should be used

for Stones River Regional IPA -

Alliance Healthcare Florida

claims only.

Alliance The (A Wisconsin provider network) Call COMMERCIAL N

ID cards should show mailing

address of PO Box 44365

Madison WI 53744. Call Dave

Sell at 608-210-6656 to

obtain Payer ID.

Alliant Health Plans of Georgia 58234 COMMERCIAL N

Allied Administrators (San Francisco CA) 94177 COMMERCIAL N

Allied Benefit Systems 37308 COMMERCIAL N

Allied Health Systems Chiropractic SX156 COMMERCIAL N

Allied Physicians NMM01 COMMERCIAL N

Alpha Data TH085 COMMERCIAL N

Alta Bates Medical Group A0701 COMMERCIAL N

Payer ID is only for dates of

service after 7/1/2010.

Alta Bates Medical Group Call COMMERCIAL P

Network ID required on all

claims. Call Sutter Connect

EDI Department at (800) 611-

5191 to obtain Network ID

prior to first submission.


Page 5


March 2012


Alta Senior Care (Hnet Sr and Secure Horizons only) E3510 COMMERCIAL P





Management (NAMM) -

Northern California




Altius (Utah) 25133 COMMERCIAL N

Formerly Payer ID SX113.

Now part of the Consolidated

payer ID.

Amalgamated Life 13550 COMMERCIAL N

Amalgamated Life - PA / Alicare 13343 COMMERCIAL N

AmeraPlan 38219 COMMERCIAL N


to the payer.

AmeriBen Solutions Inc. 75137 COMMERCIAL N

AmeriChoice of New Jersey Personal Care Plus (Medicare)86001 COMMERCIAL N

All claims submitted require

your AmeriChoice assigned

Provider ID Number. Please

contact AmeriChoice at (888)

362-3368 for your Provider ID

Number.

AmeriChoice of New Jersey Inc. (Medicaid NJ) 86047 COMMERCIAL N

AmeriChoice of New York Personal Care Plus (Medicare)86002 COMMERCIAL N






Number.

AmeriChoice of New York Inc. (Medicaid NY) 86048 COMMERCIAL N

AmeriChoice of Pennsylvania Personal Care Plus (Medicare)86003 COMMERCIAL N






Number.

AmeriChoice of Pennsylvania Inc. (Medicaid PA) 86049 COMMERCIAL N

AmeriHealth Administrators 54763 COMMERCIAL N

AmeriHealth HMO New Jersey and Delaware 23037 COMMERCIAL N

AmeriHealth Mercy Health Plan 22248 COMMERCIAL N

Medicaid managed care. For

EDI support please e-mail

[email protected].


Page 6


March 2012


America's PPO 16120 COMMERCIAL N

America's TPA 41178 COMMERCIAL N

Americaid Community Care (Maryland) 27517 COMMERCIAL N

Americaid Community Care (New Jersey) 27516 COMMERCIAL N

American Administrative Group 75240 COMMERCIAL N

American Administrators (West Des Moines Iowa) 42112 COMMERCIAL N

Please check the Insured ID

card to verify the Payer ID

before submitting claims. If

you have questions please

contact Provider Relations at

800-456-4584.

American Administrators dba Select Benefit Administrators (W.DesMoines IA)42137 COMMERCIAL N

Please check the Insured ID

card to verify the Payer ID

before submitting claims. If


contact Provider Relations at

800-456-4584.

American Behavioral 63103 COMMERCIAL N

American Behavioral FEP/ITS 63106 COMMERCIAL N

American Behavioral-LifeSynch 63101 COMMERCIAL N

American Benefit Plan Administrators 95170 COMMERCIAL N

American Benefits Management (North Canton OH) 34187 COMMERCIAL N

Payer ID valid only for claims

with a billing submission

address of P.O. Box 35008 N.

Canton OH 44735

American Chiropractic Network (ACN) 41161 COMMERCIAL N

American Chiropractic Network IPA of NY (ACNIPA) 41160 COMMERCIAL N

American Community Mutual Insurance 60305 COMMERCIAL N

American Family Health Providers CAPMN COMMERCIAL N

American Family Insurance TH095 COMMERCIAL N

American Family PPO Policies Administered by Am Rep 56071 COMMERCIAL N

American General 62030 COMMERCIAL N

American Healthcare Alliance 1066 COMMERCIAL N

American Imaging Management Inc. 36369 COMMERCIAL N

Assigned Group Policy Plan ID

is required. To obtain please

call American Imaging

Management Inc. at (800)

252-2021.

American International Group Inc. (AIG) 87726 COMMERCIAL N Plan of UnitedHealthcare

American Medical Security Inc. 81400 COMMERCIAL N

American Medical and Life Insurance 23212 COMMERCIAL N

American National Ins. Co. (ANICO) 74048 COMMERCIAL N


Page 7


March 2012


American Postal Workers Union Health Plan 44444 COMMERCIAL N

Claims for the state of Maine

ONLY must be sent on paper

to MedNet P. O. Box 15440

Portland ME 04112.

American Progressive Life and Health Insurance Company48055 COMMERCIAL N

American Republic Insurance 42011 COMMERCIAL N

Payer does not accept

Secondary/Tertiary claims

electronically.

American Whole Health Networks TH117 COMMERCIAL N

American Worker Health Plan 37322 COMMERCIAL N

Amerigroup Community Care 27514 COMMERCIAL N

Amerigroup Corporation (Ft Worth) 27514 COMMERCIAL N

Formally Americaid

Community Care (Dallas/Ft.

Worth).

Amerigroup Corporation (Houston) 27515 COMMERCIAL N

Formerly Americaid

Community Care (Houston).

Amerigroup Florida 27519 COMMERCIAL N

Amerigroup Illinois 27518 COMMERCIAL N

Amerigroup Ohio 27518 COMMERCIAL N

Amida Care 24818 COMMERCIAL N Formerly known as VidaCare

Anchor Benefit Consulting Inc. 53085 COMMERCIAL N

Ancillary Benefit Services (ABS) 86062 COMMERCIAL N

Ancillary Care Management/ACM 3172 COMMERCIAL N

Angeles IPA (SynerMed) SYMED COMMERCIAL N

Antares Management Solutions 34192 COMMERCIAL N

Apex Benefit Services 34196 COMMERCIAL N

Apex is also a Medicaid payer

and will accept claims with

either a Medicaid or

Commercial classification

AppleCare Medical Management APP01 COMMERCIAL N

Arcadian Management Services Inc 77045 COMMERCIAL N

Arizona Foundation for Medical Care (AFMC) 86062 COMMERCIAL N

Arizona Physicians IPA 3432 COMMERCIAL N

Arizona Priority Care Plus 27154 COMMERCIAL N

Arkansas Best Corporation - Choice Benefits 75278 COMMERCIAL N

Associates for Health Care Inc. (AHC) 36326 COMMERCIAL N


Page 8


March 2012


Association Benefit Plan 25133 COMMERCIAL N

Formerly payer ID 62413 Now

part of Coventry


Including Combined

Government Health Plan &

Contract Health Insurance

Plan.

Assurant Health 39065 COMMERCIAL N

Assurant Health Self-Funded (Ft. Mill SC) 37313 COMMERCIAL N

MUST VERIFY ALL CLAIMS

SHOULD GO TO PAYER IN FT.

MILL SC

Assured Benefits Administrators 74240 COMMERCIAL N

Asuris Northwest/MedAdvantage SX179 COMMERCIAL N

Payer must receive

REF*1B*Provider ID in Billing

and Rendering even when

NPI is submitted.

Athens Area Health Plan Select 95691 COMMERCIAL N

Atlantic Medical Insurance 22285 COMMERCIAL N

Atlantis Health Plan 13853 COMMERCIAL N

Atlantis Health is now doing

business as Easy Choice

Health plan of New York

Atlas Administrators TH004 COMMERCIAL N

Currently only accepts UCO

Providers. The group number

must be 8 characters in

length. Only one of the

characters can be a dash. If

the group number is entered

then the group name must

also be entered.

AultComp Managed Care Organization (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Aultra Administrative Group 37242 COMMERCIAL N



address of P.O. Box 35276

Canton OH 44735-5276

Automated Benefit Services 38259 COMMERCIAL N

Automated Group Administration Inc. 37280 COMMERCIAL N

Please send these EDI claims

to the Payer ID of the PPO

shown on the Member's ID

Card. If you have any

questions please call 260-489-

6447 (703).

AvMed Inc. 59274 COMMERCIAL N

The Insured ID and Patient ID

fro this payer must be the 11-

digit Member ID.


Page 9


March 2012


Avalon IPA CAPMN COMMERCIAL N

Avalon Medical Group CAPMN COMMERCIAL N

AvatarComp (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Avera Health Plans 46045 COMMERCIAL N

AveraAdvantage 48055 COMMERCIAL N

Averde Health 26355 COMMERCIAL N

Avesis Third Party Administrators 87098 COMMERCIAL N

These payer is live for VISION

CLAIMS ONLY.

BCI Administrators Inc. 49153 COMMERCIAL N

BEACON HEALTH STRATEGIES 43324 COMMERCIAL N

Beacon requires submission

of the member's Plan ID.

Please follow the link to our

payer fact sheet for ID's and

further instructions.

BENEFIT MANAGEMENT ADMINISTRATORS 74266 COMMERCIAL N

BENEFIT MANAGEMENT SERVICES Call COMMERCIAL N

Please contact Chris Burak at

(704) 321-3156 for payer id

information.

BHP-Unity 44219 COMMERCIAL N

BHSG of Tennessee SX002 COMMERCIAL N

BMC HealthNet Plan 13337 COMMERCIAL N

Submissions to BMCHP must

include the correct 12 digit

BMCHP Provider ID #

including all leading zeros.

BPA/Benefit Plan Administrators (North Dakota) 37286 COMMERCIAL N

BPS Inc. COMMERCIAL N

BSI Call COMMERCIAL N


call (440) 262-1160.

Bakersfield Family Medical Center BKRFM COMMERCIAL N

Banner Health AZ SX145 COMMERCIAL N

Banner Health Co - ROCKY MOUNTAIN HMO GREELEYSX145 COMMERCIAL N

Banner Health Co. - ANTERO GREELEY SX145 COMMERCIAL N

Banner Health Co. - ANTERO HIGH PLAINS SX145 COMMERCIAL N

Banner Health Co. - ANTERO MOUNTAIN SHADOWSSX145 COMMERCIAL N

Banner Health Co. - CHOICE PLUS SX145 COMMERCIAL N

Banner Health Co. - HMO GREELEY SX145 COMMERCIAL N

Banner Health Co. - HMO HIGH PLAINS SX145 COMMERCIAL N

Banner Health Co. - HMO MOUNTAIN SHADOWS SX145 COMMERCIAL N

Banner Health Co. - PACIFICARE GREELEY SX145 COMMERCIAL N

Banner Health Co. - PACIFICARE HIGH PLAINS SX145 COMMERCIAL N

Banner Health Co. - PACIFICARE MOUNTAIN SHADOWSSX145 COMMERCIAL N


Page 10


March 2012


Banner Health Co. - ROCKY MOUNTAIN HMO HIGH PLAINSSX145 COMMERCIAL N

Banner Health Co. - SECURE HORIZONS GREELEY SX145 COMMERCIAL N

Banner Health Co. - SECURE HORIZONS HIGH PLAINSSX145 COMMERCIAL N

Banner Health Co. - SECURE HORIZONS MOUNTAIN SHADOWSSX145 COMMERCIAL N

Banner Medisun 77078 COMMERCIAL N

Bascom Palmer Eye Care Network - New Century HealthNCH06 COMMERCIAL N

Bass Administrators Inc. 37248 COMMERCIAL N

Beech Street 95377 COMMERCIAL N

Behavioral Health Systems 63100 COMMERCIAL N

Bellflower Hospital (Synermed) SYMED COMMERCIAL N

Bencomp National Corporation 33192 COMMERCIAL N

Benefit Admin Services 88055 COMMERCIAL N

Benefit Administrative Systems 36149 COMMERCIAL N

Benefit Coordinators Corporation (Pittsburgh PA) 25145 COMMERCIAL N



address of 111 Ryan Court

Suite 300 Pittsburgh PA

15205.

Benefit Management Services Inc. 999 COMMERCIAL N

Benefit Management Systems Inc 37212 COMMERCIAL N

Benefit Management Inc. of KS 48611 COMMERCIAL N

This payer will only accept

medical and hospital claims

for these groups listed:

BMI187BMI219BMI234BMI23

6BMI214.BMI241BMI617

BMI245.BMI246

Benefit Plan Administrators 88052 COMMERCIAL N

Benefit Plan Administrators Co. (Eau Claire WI) 39081 COMMERCIAL N



address of P.O. Box 1128 Eau

Claire WI 54702-1128.

Benefit Plan Administrators Inc 37118 COMMERCIAL N

Benefit Planners Inc. 74223 COMMERCIAL N

Benefit Systems & Services Inc. 36342 COMMERCIAL N

Now known as Total Broker

Benefits Payer ID 36342

Benesight 87265 COMMERCIAL N (Formerly known as The TPA)

Benesys 37248 COMMERCIAL N

Benesys Inc. 37248 COMMERCIAL N

Berkshire Health Partners - PPO Wyomissing PA (IHS Gateway Payer)23243 COMMERCIAL N

Berkshire Intergroup 10956 COMMERCIAL N

Berkshire Lehigh Partners 95606 COMMERCIAL N

Best Life & Health Insurance Co. 95604 COMMERCIAL N


Page 11


March 2012


Better Health Plans of South Carolina 32006 COMMERCIAL N

Better Health Plans Inc. 62183 COMMERCIAL N

Now known as Unison Health

Plan

Blue Benefit Administrators of MA 3036 COMMERCIAL N

Blue Grass Family Health/SRRIPA ONLY 15754 COMMERCIAL N



Blue Grass Family Health

claims

Bluegrass Family Health 61124 COMMERCIAL N

Boilermakers National Health & Welfare Fund 36609 COMMERCIAL N

Boon-Chapman Benefit Administrators Inc. 74238 COMMERCIAL N

Boston Medical Center Health Plan Inc. 13337 COMMERCIAL N

Submissions to BMCHP must

include the correct 12 digit

BMCHP Provider ID #

including all leading zeros.

Boulder Administration Services 20381 COMMERCIAL N

Bravo Health 52192 COMMERCIAL N

Bravo Health 52192 COMMERCIAL N

Bravo Health Star Plus 52192 COMMERCIAL N

Bridgestone/Firestone See Comments COMMERCIAL N

Please call Bridgestone

Customer Service Center at

330-379-4500 for Customer

Support.

Bridgeway Arizona 68054 COMMERCIAL N



Dept. at 1-866-475-3129 to


file in the Health Plans claim

system. This will prevent

rejections and allow

payments to be made in a

timely manner.

BritCay 22286 COMMERCIAL N

Brockerage Concepts Inc. 51037 COMMERCIAL N

Brodart 35182 COMMERCIAL N

Brokerage Service Inc Call COMMERCIAL N


call (440) 262-1160.

Broward Health 37314 COMMERCIAL N

Brown & Toland Medical Group 94316 COMMERCIAL N

Brown and Toland Medical Group BTSS1 COMMERCIAL N


Page 12


March 2012


Buckeye Community Health 32004 COMMERCIAL N



Dept at 1-866-296-8731 to





in a timely manner.

Butler Benefit 42150 COMMERCIAL N

C&O Employees Hospital Association 23708 COMMERCIAL N

C. L. Frates & Co - OSMA Health 73071 COMMERCIAL N

CAP Management CAPMN COMMERCIAL N

CAP Management Systems 95399 COMMERCIAL N

CAPSTONE HEALTH PLAN INC 86044 COMMERCIAL N

CARE 1ST HEALTH PLAN OF CA 57115 COMMERCIAL N

CBA Blue 3036 COMMERCIAL N

Formerly known as

Comprehensive Benefits

Administrator Inc.

CBCA Administrators 55438 COMMERCIAL N

CDO Technologies 83028 COMMERCIAL N

CDPHP SX065 COMMERCIAL N Par for Billing

CDS Group Health 88022 COMMERCIAL N

CHA Health 23171 COMMERCIAL N

CHAMPVA - HAC 84146 COMMERCIAL N

CHAMPVA - HAC is not

associated with and does not

process claims for TRICARE

(formerly CHAMPUS).

CHCcares of South Carolina 25151 COMMERCIAL N

CHOC - Children's Hospital Of Orange County Health Alliance33065 COMMERCIAL N

CHP DIRECT SUPERMED 90441 COMMERCIAL N

CHP/RPU (FABOH) Call COMMERCIAL N

Payer ID rendering provider

and location number

required to submit claims.

Please call Dave Sell at (608)

210-6656 to obtain.

CIGNA 62308 COMMERCIAL N

CIGNA - PPA 62308 COMMERCIAL N

CIGNA - PPO 62308 COMMERCIAL N

CIGNA Behavioral Health SX071 COMMERCIAL N

CIGNA Health Plan - HMO 62308 COMMERCIAL N

CIGNA Medicare Advantage 86033 COMMERCIAL N

CM Administrators Inc 56211 COMMERCIAL N


Page 13


March 2012


COOPERATIVE MANAGED CARE SERVICES 35199 COMMERCIAL N

To obtain the payer ID for

this payer please contact

CMCS Customer Service at

(800) 352-7502

CRA Managed Care (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

CTI ADMINISTRATORS INC. 42141 COMMERCIAL N

CWIBENEFITS INC. 57080 COMMERCIAL N

Cadent Administrators 33192 COMMERCIAL N

Cadent Underwriters 33192 COMMERCIAL N

Cal-Optima Direct CALOP COMMERCIAL N

California Eye Care - New Century Health NCH05 COMMERCIAL N

Cannon Cochran Management Services Inc. Metairie LA 71057 COMMERCIAL N

Capital Community Health Plan 87726 COMMERCIAL N

Capital District Physician's Health Plan SX065 COMMERCIAL N Par for Billing

Capital Health Plan 95112 COMMERCIAL N

Payer will accept either

rendering provider UPIN or

NPI on claims. Before

submitting NPI please call

Capital Health Plan at 850-

523-7361 to register your NPI

numbers with them.

Capitol Administrators 68011 COMMERCIAL N

Care 1st Health Plan of Arizona 57116 COMMERCIAL N

Care Improvement Plus 77082 COMMERCIAL N

Care To Care 41222 COMMERCIAL N

Care Wisconsin Health Plan (Trizetto) 27004 COMMERCIAL N

CareCentrix 11345 COMMERCIAL P

Enrollment required prior to

claim submission. Please

contact

[email protected]

CareCore National 14182 COMMERCIAL N

CareCore National LLC (Aetna Radiology Claims) 14179 COMMERCIAL N

CareCore National LLC (Oxford Radiology Claims) 14180 COMMERCIAL N

CareCore/WCNY RAD 14188 COMMERCIAL N

WellCare New York POS 11

Radiology Claims Only. Claims

for members in the following

counties should be submitted

to WellCare: Monroe Erie

Wayne and Onondaga.

CareFirst Administrators/NCAS 75191 COMMERCIAL N

CareFlorida 65088 COMMERCIAL N

CareOregon Inc. 93975 COMMERCIAL N

CarePlus Cardiology - New Century Health NCH04 COMMERCIAL N

CarePlus Dermatology - New Century Health NCH01 COMMERCIAL N


Page 14


March 2012


CarePlus Health Plans Inc. 65031 COMMERCIAL N

(Formerly Physicians

Healthcare Plans Inc)

CarePlus Oncology - New Century Infusion SolutionsNCH07 COMMERCIAL N

CarePlus Urology - New Century Health NCH03 COMMERCIAL N

CareSource OH 31114 COMMERCIAL N

CareWorks (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Carelink Health Plan 25133 COMMERCIAL N




Carelink Commercial &

Advantra claims only. For

Carelink Medicaid send

claims to payer ID 25140

Carelink Medicaid 25133 COMMERCIAL N

Formerly Payer ID 25140.




The go forward payer ID for

this plan is 25133. Please see

new entry under that ID on

the payer list.





the payer list.

Caremore CM001 COMMERCIAL N

Carenet 25133 COMMERCIAL N








the payer list.





the payer list.

Careworks 10010 COMMERCIAL N

Payer is receiving NSF 3.0.

eMCDS file is sent to OKC and

then translated to NSF3.0.

Files are then pushed to

Careworks' Production

Server.

Carilion Clinic Medicare Health Plan 77015 COMMERCIAL N


Page 15


March 2012


Carolina Care Plan 29076 COMMERCIAL N

Carolina Care Plan is part of

the Medical Mutual Family of

Companies. Former payer ID

57105.

Carolina Crescent Health Plan Inc. SX191 COMMERCIAL N

Enrollment forms are

available on our website

Carolina Summit Healthcare Inc. 56195 COMMERCIAL N

Carpenter's Health and Welfare Trust Fund of St. Louis 25125 COMMERCIAL N Utilizes the CMR Network.

Carpenters Health and Welfare Fund of PhiladelphiaCX101 COMMERCIAL N

Cedars-Sinai Medical Network Services 95166 COMMERCIAL N

CeltiCare 68060 COMMERCIAL N

Celtic Insurance 68063 COMMERCIAL N

Cement Masons & Plasterers Health & Welfare Trust 91136 COMMERCIAL N



Cenpatico - Arizona 68048 COMMERCIAL N



Dept at 1-866-495-6748 to





in a timely manner.

Cenpatico - FL 68058 COMMERCIAL N

Cenpatico - Georgia 68050 COMMERCIAL N



Dept at 1-800-947-0633 to





in a timely manner.

Cenpatico - Indiana 68052 COMMERCIAL N



Dept at 1-877-647-4848 to





in a timely manner.


Page 16


March 2012


Cenpatico - Kansas 68047 COMMERCIAL P



Dept at 1-866-896-7293 to





in a timely manner.

Cenpatico - OHIO 68051 COMMERCIAL N

Cenpatico Behavioral Health - Wisconsin 68046 COMMERCIAL N

Cenpatico Behavioral Health Texas 68053 COMMERCIAL N



Dept at 1-800-716-5650 to





in a timely manner.

Cenpatico Kentucky 68068 COMMERCIAL N

Cenpatico Massachuetts 68061 COMMERCIAL N

Cenpatico South Carolina 68059 COMMERCIAL N

Centene Advantage Plans 68056 COMMERCIAL N

Central Benefits Life 31118 COMMERCIAL N

Central Benefits Mutual 31118 COMMERCIAL N

Central Benefits National 31118 COMMERCIAL N

Central Reserve Life 34097 COMMERCIAL N

Non Medicare Supplement



electronically.

Central SeniorCare 62218 COMMERCIAL N

Central States Health & Welfare Funds 36215 COMMERCIAL N

Central Susquehanna Healthcare Providers (CSHP) 55731 COMMERCIAL N

Central Valley Medical Group 77035 COMMERCIAL N

Central Valley Medical Group E3510 COMMERCIAL P





Management (NAMM) -

Northern California





Page 17


March 2012


Centre for Health Care Call COMMERCIAL N

To obtain Payer ID and enroll

with payer California

providers should contact

Tristin Rausche 858-824-7100

[email protected]

Century Health Solutions 48120 COMMERCIAL N

Cerner HealthPlan Services 20356 COMMERCIAL N

Chautauqua County Healthcare Plan (Mayville NY) 16600 COMMERCIAL N

Chesapeake Life Insurance Company - Insurance Center 59223 COMMERCIAL N

Payer ID valid only if the

address on the Health ID Card

matches the following: P.O.

Box 982017 North Richland

Hills TX 76182.

Chesterfield Resources Inc. 34154 COMMERCIAL N

Child Health and Disability Prevention Treatment AMM03 COMMERCIAL N

Children First Medical Group 94321 COMMERCIAL N

For questions regarding claim

status providers will need to

contact payer: CFMG

Provider Customer Service

510-428-3154.

Children of Women Vietnam Veterans-VA HAC 84146 COMMERCIAL N

Children's Medical Services - Broward NORTH 37314 COMMERCIAL N

Childrens Physician Medical Group CPMG1 COMMERCIAL N

Childrens Specialist of San Diego CSSD2 COMMERCIAL N

Chinese Community Health Plan 94302 COMMERCIAL N

Choice One/UTMB CHIP Health Plan 76049 COMMERCIAL N

Christian Brothers Services 38308 COMMERCIAL N

Christian Brothers Services 61271 COMMERCIAL N

Cincinnati Financial Corporation 46871 COMMERCIAL N

Citrus Health TH130 COMMERCIAL N

Citrus Valley Physicians Medical Group CMSI1 COMMERCIAL N

Citrus Valley Physicians Medical Group CVPG1 COMMERCIAL N

City of Amarillo TH107 COMMERCIAL N

City of Visalia TKFMC COMMERCIAL N

Claims Management Services 39141 COMMERCIAL N

ClaimsWare Inc. dba ManageMed 57080 COMMERCIAL N

Claimsbridge West 11752 COMMERCIAL N

Claimshop- Employers Coalition on Health 27008 COMMERCIAL N

Clarendon's Healthy Kids 33192 COMMERCIAL N

Clarian Health Plans Inc. 95444 COMMERCIAL N

Clearchoice Health Plan / COIHS 77201 COMMERCIAL N

ClubMD 37272 COMMERCIAL N

Coastal Administrative Services 77052 COMMERCIAL N


Page 18


March 2012


Cofinity 38335 COMMERCIAL N

Colonial Healthcare 37123 COMMERCIAL N

Colonial Medical 22284 COMMERCIAL N

Colorado Access 84129 COMMERCIAL N

Columbia United Providers 91162 COMMERCIAL N

Combined Management Services CMSI1 COMMERCIAL N

Commerce Benefits Group 34181 COMMERCIAL N

Commonwealth Care Alliance 14315 COMMERCIAL N

Community Care BHO 23282 COMMERCIAL N

Community Care Inc. - Family Care (Wisconsin) 60995 COMMERCIAL N

Community Care Inc. (Wisconsin) 39126 COMMERCIAL N

Community Care Managed Health Care Plans of Oklahoma73143 COMMERCIAL N

Community Choice of Michigan 38325 COMMERCIAL N

Community Family Care (SynerMed) SYMED COMMERCIAL N

Community First TH005 COMMERCIAL N

Community Health Alliance 35193 COMMERCIAL N

Community Health Choice 48145 COMMERCIAL N

Community Health Electronic Claims/CHEC/webTPA 75261 COMMERCIAL N

Community Health Network of CT 62149 COMMERCIAL N

Community Health Plan Washington SB613 COMMERCIAL N

Community Medical Group of the West Valley Inc. 66121 COMMERCIAL N

CommunityConnect HealthPlan 95192 COMMERCIAL N

Provider Services: (877) 350-

6074

Comp - Ohio (Austintown OH) 34177 COMMERCIAL N

Comp One (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

CompBenefits Corporation 37297 COMMERCIAL N

CompManagement Health Systems Inc. (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

CompManagement/Integrated Comp (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Compcare (Wisconsin BadgerCare only) 95192 COMMERCIAL N


3020

Complimentary Health Plan Call COMMERCIAL N

Comprehensive Behavioral Care 59314 COMMERCIAL N

Comprehensive Medical Care (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

ConnectiCare Inc 6105 COMMERCIAL N

Connecticare - Medicare 78375 COMMERCIAL N

Connecticut Carpenters Health Fund 37307 COMMERCIAL N

Connecticut General (CIGNA) 62308 COMMERCIAL N

Consociate Group 37135 COMMERCIAL N

Consolidated Associates Railroad 75284 COMMERCIAL N

Consolidated Health Plans 87843 COMMERCIAL N


Page 19


March 2012


Consumers Life Insurance Company 29076 COMMERCIAL N

Consumers Life insurance

Company is part of the

Medical Mutual Family of

Companies.

Continental General Insurance Company 71404 COMMERCIAL N

Non Medicare Supplement



electronically.

Continental Key Family 35315 COMMERCIAL N

Contractors Laborers Teamsters & Engineers 47046 COMMERCIAL N

Conversion Plan-APWU 55544 COMMERCIAL N


to the payer.; For conversion

plan members only. If filing a

claim for a federal plan

member please use payer ID

44444.

Cook Children's Health Group TH104 COMMERCIAL N

Cook Group Health Plan 35149 COMMERCIAL N

Cooperative Benefit Administrators (CBA) 52132 COMMERCIAL N

Coordinated Medical Specialists 58204 COMMERCIAL N

Core Administrative Services 58231 COMMERCIAL N

CoreSource AZ MN 35182 COMMERCIAL N For assistance 800-689-0106

CoreSource Little Rock 75136 COMMERCIAL N

Only for claims where the

"submit claims to address" on

the medical ID card is a

CoreSource address in Little

Rock Arkansas. For assistance

call 800-689-0106.

CoreSource MD PA IL 35182 COMMERCIAL N For assistance 800-689-0106

CoreSource NC IN 35182 COMMERCIAL N For assistance 800-689-0106

CoreSource OH 35183 COMMERCIAL N

Only for claims where the

"submit claims to address" on

the medical ID card is a

CoreSource address in the

state of Ohio. For assistance

call 800-689-0106.

CoreSource-Internal 35187 COMMERCIAL N

Corizon Health Inc. CORIZ COMMERCIAL N

Corizon Inc. 43160 COMMERCIAL N

Cornerstone Benefit Adminstrators 35202 COMMERCIAL N


Page 20


March 2012


Corporate Benefits Service Inc. (NC) 56116 COMMERCIAL N


with a claims submission


Charlotte NC 28220.

Corporate Systems Administration 37246 COMMERCIAL N

Corvel Corporation (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Country Life Insurance Company 62553 COMMERCIAL N

Covenant Administrators Inc. (Atlanta GA) 58102 COMMERCIAL N

Covenant Management Systems TH108 COMMERCIAL N

Coventry Advantra Texas 25133 COMMERCIAL N

Coventry Health & Life (Oklahoma) 25133 COMMERCIAL N

Coventry Health & Life (Oklahoma) 25133 COMMERCIAL N


Consolidated payer ID

Coventry Health Care 25133 COMMERCIAL N

Coventry's consolidated

payer ID. Claims for all of

these legacy payer IDs may

now be submitted to this

payer ID. 25126 25127 25128

25129 25130 25132 25135

25136 25139 25141 25146

25149 25152 62413 87043.

Coventry Health Care National Network 25133 COMMERCIAL N


part of Coventry


Coventry Health Care National Network 25133 COMMERCIAL N



consolidated payer ID.

Coventry Health Care Nevada 25133 COMMERCIAL N



payer ID.

Coventry Health Care of Florida Inc. 25133 COMMERCIAL N

Formerly Vista Health Plan

Inc. Now part of Coventry

Consolidated Payer ID.

Coventry Health Care of Georgia Inc. 25133 COMMERCIAL N




Coventry Health Care of Iowa Inc. 25133 COMMERCIAL N




Coventry Health Care of Kansas Inc. 25133 COMMERCIAL N



Coventry Health Care of Kansas Inc. 25133 COMMERCIAL N


Page 21


March 2012


Coventry Health Care of Louisiana Inc. 25133 COMMERCIAL N




Coventry Health Care of Nebraska Inc. 25133 COMMERCIAL N




Coventry Health Plan of Florida 25133 COMMERCIAL N

Formerly Vista Health Plan of

South Florida Inc. Now part

of Coventry Consolidated

Payer ID.

Coventry Health and Life Insurance Company administered by PersonalCare25133 COMMERCIAL N

Coventry Health and Life Insureance (Tennessee) 25133 COMMERCIAL N


part of Coventry


Coventry Missouri 25133 COMMERCIAL N


part of Coventry


Coventry Nebraska 25133 COMMERCIAL N

Coventry Summitt Health Plan Inc. 25133 COMMERCIAL N

Formerly Summitt Health

Plan Inc. Now part of

Coventry Consolidated Payer

ID.

Coventry of Health Care Delaware Inc. 25133 COMMERCIAL N




CoventryCares 25133 COMMERCIAL N



CoventryCares of Kentucky 25133 COMMERCIAL N

Crawford & Company (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Creative Medical Systems 64068 COMMERCIAL N

Creative Plan Administrators 37320 COMMERCIAL N

Crescent PPO Inc. See Comments COMMERCIAL N

Please register at

www.crescenths.com prior to

claim submission.

Croy-Hall Mgmt. Inc. 37266 COMMERCIAL N

Please enter the unique

policy number or ID card

when submitting claims.



address of PO Box 982005 Ft.

Worth TX 76182.

Custom Design Benefits Inc. 82056 COMMERCIAL N

D.H. EVANS & ASSOC. Call COMMERCIAL N

Call Jessica Picarde @ 410-

349-3222 for Payer id.


Page 22


March 2012


DC Chartered Health Plan Inc. (Medicaid & Alliance) 95748 COMMERCIAL N

PLEASE CONTACT Ronald

Gray at 202-408-2229 TO

JOIN CHARTERED HEALTH

PLANS EDI NETWORK

DELANO IPA 77124 COMMERCIAL N

DRISCOLL CHILDREN'S HEALTH PLAN 74284 COMMERCIAL N

Dart Container Corporation DARTC COMMERCIAL N

Dart Container Corporation TH073 COMMERCIAL N

Dart Management Corporation 6172 COMMERCIAL N

Dean Health Plan 39113 COMMERCIAL N

Definity Health 64159 COMMERCIAL N

Delaware Physicians Care Inc. 27009 COMMERCIAL N

Delta Health Systems 94235 COMMERCIAL N

Denver Health - Indigent 84134 COMMERCIAL N

Denver Health Medical Plan 84135 COMMERCIAL N

Denver Health Medical Plan Inc. - Medicare Choice 84131 COMMERCIAL N

Denver Health and Hospital Authority 84133 COMMERCIAL N

Deseret Mutual SX105 COMMERCIAL R

Desert Medical Group DESRT COMMERCIAL N

Detroit Medical Center 56240 COMMERCIAL N

DiaTri LLC 36439 COMMERCIAL N

Diamond Plan 25131 COMMERCIAL N




the payer list.

Diamond Plan 25131 COMMERCIAL N




the payer list.

Diamond Plan (Maryland Medicaid) 25133 COMMERCIAL N




Directors Guild of America - Producer Health Plan 23706 COMMERCIAL N

Diversified Administration Corporation 6102 COMMERCIAL N

Please verify the Payer ID on

the Member ID card in

addition to the Payer City and

State before submitting

claims to Diversified Admin

(Payer ID 06102)

Doctor's Choice 39044 COMMERCIAL N

Downey Select IPA (Applecare Medical Managment)APP01 COMMERCIAL N


Page 23


March 2012


Dr. Rivera Call COMMERCIAL N





[email protected]

Dreyer Health DREYR COMMERCIAL N

Dunn and Associates Benefits Administrators Inc. 35186 COMMERCIAL N

E-V Benefits Management Inc (Columbus OH) 34159 COMMERCIAL N


Health.

E.S. BEVERIDGE & ASSOCIATES 34108 COMMERCIAL N

EBC Mid-America Call COMMERCIAL N


call (440) 262-1160.

EBC Inc. Call COMMERCIAL N


call (440) 262-1160.

EBMC 31074 COMMERCIAL N

EBMS SX182 COMMERCIAL N

EMI-KP Ambulance Claims 59299 COMMERCIAL N

EQUICOR 62308 COMMERCIAL N

EQUICOR - PPO 62308 COMMERCIAL N

ERISA TH110 COMMERCIAL N

ESSENCE HEALTHCARE 20818 COMMERCIAL N

Early Intervention Central TH084 COMMERCIAL N

East Bay Medical Network Call COMMERCIAL P

Network ID required on all

claims. Call Sutter Connect

EDI Department at (800) 611-

5191 to obtain Network ID

prior to first submission.

Eastland Medical Group 66122 COMMERCIAL N

Eastland Medical Group CMSI1 COMMERCIAL N

Educators Mutual (EMIA) SX110 COMMERCIAL N

El Paso First - Chip TH090 COMMERCIAL N

ElderPlan Inc. 31625 COMMERCIAL N

Elderplan no longer requires

enrollment & individual

provider testing; However

Elderplan Provider ID is

necessary on all claim

submissions. If you do not

know your provider Id

contact (718) 921-7979.

Elmcare LLC 36399 COMMERCIAL N

Elmco 37253 COMMERCIAL N

Emerald Health Network Inc. (All PPO Business) 34167 COMMERCIAL N


Page 24


March 2012


Emergency Medical Services Fund (EMSF) AMM03 COMMERCIAL N

Empire Physician's Medical Group EMP01 COMMERCIAL N

Employee Benefit Administration & Management CorporationPilot COMMERCIAL N

Employee Benefit Claims - Mid-America Call COMMERCIAL N


call (440) 262-1160.

Employee Benefit Claims of WI Call COMMERCIAL N


call (440) 262-1160.

Employee Benefit Claims of Wisconsin Call COMMERCIAL N


call (440) 262-1160.

Employee Benefit Concepts (Farmington Hills MI) 38241 COMMERCIAL N

Employee Benefit Consultants Inc. Call COMMERCIAL N


call (440) 262-1160.

Employee Benefit Management Corp (EBMC) 31074 COMMERCIAL N

Employee Benefit Services (Ft. Mill SC) 37216 COMMERCIAL N

MUST VERIFY ALL CLAIMS

SHOULD GO TO PAYER IN FT.

MILL SC

Employee Benefit Services of Louisiana Inc (EBS) 41198 COMMERCIAL N

Employee Benefit Services of San Antonio TH109 COMMERCIAL N

Employee Benefit Systems 42149 COMMERCIAL N

Employee Benefits Administration and Management Corp.22262 COMMERCIAL N

Employee Benefits Plan Administration Inc. (E.B.P.A.) 3036 COMMERCIAL N

Employee Health System SYMED COMMERCIAL N

Employee Plans LLC 35112 COMMERCIAL N

Employer Plan Services 74212 COMMERCIAL N

Employer's Direct Health - Employee Plan 75236 COMMERCIAL N

Employer's Direct Health - FI 75235 COMMERCIAL N

Employer's Direct Health - SF 75233 COMMERCIAL N

Employers Direct Health 75232 COMMERCIAL N

Employers Mutual Inc (Jacksonville Florida) 59298 COMMERCIAL N

Employers Mutual Inc. (Stuart Florida) 59331 COMMERCIAL N

For plan and claim

requirements please contact

the Employers Mutual Inc.

(Stuart FL) Customer Service

Department at (772) 287-

7650 ext. 4052.

Encircle PPO 35206 COMMERCIAL N

Encore Health Network 35206 COMMERCIAL N

Enstar Natural Gas 91136 COMMERCIAL N


(P61) when submitting

claims.


Page 25


March 2012


Entrust 36878 COMMERCIAL N

Electronic Payer ID for Claims

printed and mailed to payer.

Equitable Plan Services (Oklahoma City OK) 73126 COMMERCIAL N




Oklahoma City OK 73172.

Evercare 87726 COMMERCIAL N

Everence 35605 COMMERCIAL N

Evolutions Healthcare Systems (New Port Richey FL) 59313 COMMERCIAL N

Payer ID valid for claims with

a submission address of PO

Box 5001 New Port Richey FL

34656.

Excel MSO EXC01 COMMERCIAL N

Exceptional Care Medical CAPMN COMMERCIAL N

ExclusiCare 71412 COMMERCIAL N

FABOH (CHP/RPU) Call COMMERCIAL N

Payer ID rendering provider

and location number

required to submit claims.

Please call Dave Sell at (608)

210-6656 to obtain.

FACS Group 37300 COMMERCIAL N

FCE Benefit Administrators 33033 COMMERCIAL N

FIRST ADMINISTRATORS INC FAMR1 COMMERCIAL N

FMH Benefit Services Inc. 48117 COMMERCIAL N

For assistance send email to

[email protected]

FOUNDATION BENEFIT ADMINISTRATORS/CONTRACTOR EMPLOYEE BENEFITS ADMINBOONG COMMERCIAL N

Facey Medical Foundation 95432 COMMERCIAL N

Fallon Community Health Plan 22254 COMMERCIAL N

Family Health Alliance CAPMN COMMERCIAL N

Family Health Partners - Healthwave of Kansas 31472 COMMERCIAL N

Family Health Partners/MC+ Missouri 43173 COMMERCIAL N

Family Health Plan TH045 COMMERCIAL N

Family Health Plan (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Farm Family Life 14140 COMMERCIAL N

Federated Benefits 37300 COMMERCIAL N

Federated HR Services 37300 COMMERCIAL N

Federated Mutual Insurance 41041 COMMERCIAL N

Fidelis Care New York 11315 COMMERCIAL N

Fidelis Secure Care 77054 COMMERCIAL N

First Carolina Care 56196 COMMERCIAL N


Page 26


March 2012


First Choice Health Administrators 91131 COMMERCIAL N

First Choice Health Network 91131 COMMERCIAL N

First Choice of Midwest (PPO) 75138 COMMERCIAL N

First Health Network (f.k.a. CCN Managed Care Inc. & PPO Oklahoma)73159 COMMERCIAL N

First Health Network (f.k.a. CCN Managed Care Inc. & PPO Oklahoma)73159 COMMERCIAL N

First Medical Network (FMN) - Atlanta GA 29076 COMMERCIAL N




ID 58203.

First Priority 23241 COMMERCIAL P

Beginning 1/8/2007 all new

providers must enroll with

First Priority Health/Blue

Cross of Northeastern PA

prior to submitting electronic

claims. Enrollment form

available at:

http://www.bcnepa.com/EDI

/registrationForm.aspx

First Service Administrator's Inc Lakeland Florida 59276 COMMERCIAL N

Third Party Administrator's

Also formally known as

Florida 1st Florida First

FirstCare TH003 COMMERCIAL N

Fitzharris & Company Inc. 11244 COMMERCIAL N

Florida Health Care Plan 59322 COMMERCIAL N

Florida Hospital Healthcare Systems 59321 COMMERCIAL N

If Bill Prov NPI not present

Render Prov NPI required -or-

If Render Prov NPI is not

present either Render Prov

Network ID (REF*N5) or

Commercial Num (REF*G2) is

required. FHHS member ID

must be 11 digits.

Florida Hospital Waterman 48116 COMMERCIAL N

For assistance send email to

[email protected]

Florida League of Cities Inc. 59698 COMMERCIAL N

Foreign Service Benefit Plan 25133 COMMERCIAL N


part of Coventry


Including AFSPA Staff Plan

Foundation for Medical Care of Tulare & Kings CountyTKFMC COMMERCIAL N

Fox-Everett Inc. 64069 COMMERCIAL N

Freedom First 31313 COMMERCIAL N

Freedom Health Plan 41212 COMMERCIAL N


Page 27


March 2012


Fresenius Medical Care 23130 COMMERCIAL N

Friant Water Users TKFMC COMMERCIAL N

Fringe Benefit Management 59069 COMMERCIAL N

Fringe Benefits Coordinators 59204 COMMERCIAL N

FrontPath Health Coalition 34171 COMMERCIAL N

GATES MCDONALD HEALTH PLUS INC 31147 COMMERCIAL N


Claims ONLY.

GEMCare (Golden Empire Managed Care System) MCS01 COMMERCIAL N

GENEX Care of Ohio (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

GHI - Medicare Private Fee for Service 22937 COMMERCIAL N

GHI - New York (Group Health Inc.) 13551 COMMERCIAL N

GHI HMO 25531 COMMERCIAL N

GHP (Group Health Plan) 25133 COMMERCIAL N


part of Coventry


GIC Indemnity Plan 80314 COMMERCIAL N

GMS Inc. 47083 COMMERCIAL N

GOOD SHEPHERD HOSPICE INC 76923 COMMERCIAL N

Galveston County Indigent Health Care 30005 COMMERCIAL N

Gates McDonald Health Plus Inc. (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Gateway Health Plan - Medicare Assured 60550 COMMERCIAL N

Gateway Health Plan -

Medicare Assured; 60550

(Yellow Card). Please check

the ID card to verify the Payer

ID before submitting claims. If


contact Gateway Provider

Servicing Department at 1-

800-685-5205.

Gateway Health Plan Medicaid PA 25169 COMMERCIAL N

Caution: Gateway Health Plan

has several different Payer ID

numbers please look for the

Payer ID on the ID card

before submitting. PA

Medicaid 25169(Green Card).

If you have questions contact

Gateway Provider Servicing

Department at 1-800-685-

5205.

Gateway IPA (Pinnacle Health Resources) (Prospect Medical Group)PROSP COMMERCIAL N


Page 28


March 2012


Geisinger Health Plan 75273 COMMERCIAL P

Prior enrollment required.

Please contact Geisinger

Health Plan at 1-888-281-

5338 option 3 to confirm

credentialing prior to

completing EDI Enrollment

Forms.

Gemcare Health Plan 20376 COMMERCIAL N

Gemcare Health Plan MCS03 COMMERCIAL N

Gemcare IPA 27133 COMMERCIAL N

Generations Healthcare 46050 COMMERCIAL N

Generations-Hillcrest 46051 COMMERCIAL N

Genesis Healthcare PROSP COMMERCIAL N

Gilsbar Inc. 7205 COMMERCIAL N

Glendale Physician's Alliance AMM02 COMMERCIAL N

Global Care Inc. 7689 COMMERCIAL N

Global Excel Management GEM01 COMMERCIAL N

Golden Rule Insurance Company 37602 COMMERCIAL N

Golden State Medical Group MBA01 COMMERCIAL N

Golden Triangle Physician Alliance/SelectCare of Texas (GTPA)72189 COMMERCIAL N

Good Samaritan Medical Practice Association AMM01 COMMERCIAL N

Government Employees Hospital Association (GEHA) 44054 COMMERCIAL N

Great Lakes Health Plan 95467 COMMERCIAL N

Great-West Healthcare 80705 COMMERCIAL N

Great-West Healthcare (formerly American General) 63665 COMMERCIAL N

Greater L.A. Health CAPMN COMMERCIAL N

Greater Orange County Medical Group NMM01 COMMERCIAL N

Greater San Gabriel Med Grp NMM01 COMMERCIAL N

Greater San Gabriel Valley Physicians CAPMN COMMERCIAL N

Group Administrators Ltd. 36338 COMMERCIAL N

Group Health Cooperative - WA State 91051 COMMERCIAL N

All GHC products; GHC Group

Individual Medicare + Choice

and Healthy Options can be

submitted electronically

Group Health Cooperative of Eau Claire 95192 COMMERCIAL N


3020

Group Health Cooperative of South Central Wisconsin 39167 COMMERCIAL N

Group Health Cooperative of South Central Wisconsin 39168 COMMERCIAL N

Group Health Inc. 22937 COMMERCIAL N

Group Health Managers 38194 COMMERCIAL N

Group Health Options - WA State 91051 COMMERCIAL N

All GHO products; Options

and Alliant can be submitted

electronically

Group Insurance Service Center Inc. 37276 COMMERCIAL N


Page 29


March 2012


Group and Pension Administrators 48143 COMMERCIAL N

Guardian Healthcare INC. (SC) 77010 COMMERCIAL N

Guardian Life Insurance Company of America 64246 COMMERCIAL N

H.E.R.E.I.U Welfare Pension Funds 37114 COMMERCIAL N

HAA Preferred Partners 65101 COMMERCIAL N

HAP/AHL/Curanet 38224 COMMERCIAL N

HCHA Albq-Self Funded 37329 COMMERCIAL N

HCS - Health Claims Service (Boise ID) 82018 COMMERCIAL N

HDPC - Premier Healthcare 90023 COMMERCIAL N

HDPC/Alliance Physicians 20257 COMMERCIAL N

HEALTH CARE DISTRICT Call COMMERCIAL N

Call Provider Services at 866-

930-1002 for EDI Enrollment

HFN Inc. 36335 COMMERCIAL N

HIP - Health Insurance Plan of Greater New York 55247 COMMERCIAL N

HMA Hawaii 86066 COMMERCIAL N

HPS Paradigm Inc. 58227 COMMERCIAL N

HSHS Medical Group IPA 37137 COMMERCIAL N

Harrington Health Non-EPO 59143 COMMERCIAL N

Harrington Health-Kansas (formerly known as Fiserv Health-Kansas)62061 COMMERCIAL N

(Formerly Willis

Administrative Services

Corporation)

Harvard Pilgrim Health Care 4271 COMMERCIAL N

Hawaii Medical Assurance Association (HMAA/HWMG) 99208 COMMERCIAL N

Health America Inc./Health Assurance/Advantra 25133 COMMERCIAL N




Health Care Network of Wisconsin (HCN) 42102 COMMERCIAL N

Health Choice Arizona 62179 COMMERCIAL N

Health Choice Generations 62180 COMMERCIAL N

Health Cost Solutions 62111 COMMERCIAL N

Health Design Plus (Hudson OH) 34158 COMMERCIAL N

Health Management Administrators (HMA) TH049 COMMERCIAL N

Health Management Solutions (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Health Net of Arizona 38309 COMMERCIAL N Payer requires NPI

Health Net of California and Oregon - Claims 95567 COMMERCIAL N

Health Net of the Northeast Inc. 6108 COMMERCIAL N Payer requires NPI.

Health Network One 65062 COMMERCIAL N

Health New England Call COMMERCIAL N

To obtain payer id please

contact Joanne Shaw 413-233-

3444 [email protected]

Health Options of Florida SX030 COMMERCIAL N

Health Options of Illinois 36368 COMMERCIAL N


Page 30


March 2012


Health Partners - Jackson TN 62157 COMMERCIAL N

Health Partners PA 80142 COMMERCIAL N

Health Payment Systems Inc. 20270 COMMERCIAL N

Health Plan Management Services (HPMS) 63719 COMMERCIAL N

Health Plan of Michigan 83253 COMMERCIAL N

Health Plan of San Joaquin 68035 COMMERCIAL N

Health Plan of San Mateo Call COMMERCIAL N

CONTACT PAYER FOR

REGISTRATION AND PAYER

ID. Endry Lo: 650-616-2017 or

Ken Cottrell: 650-616-2021

Health Plans Inc. 44273 COMMERCIAL N

Health Plus PHSP (Brooklyn NY) 11324 COMMERCIAL P

Providers must contact

Health Plus at 718-491-8355

prior to submitting claims.

Health Services Consulting Group Inc. 20896 COMMERCIAL N

Health Services Management 41150 COMMERCIAL R

Health Services Preferred (HSP) by Emerald Health 34167 COMMERCIAL N

Health Services for Children with Special Needs 37290 COMMERCIAL N

Health Strategies SX044 COMMERCIAL N

HealthCare Partners IPA 11328 COMMERCIAL N

Formerly Heritage New York

Medical Group.

HealthEZ 41178 COMMERCIAL N

HealthEdge Administrators (Bakersfield CA) 95213 COMMERCIAL N



Box 11210 Bakersfield CA

93389.

HealthFirst TPA (Houston TX) 34185 COMMERCIAL N

HealthGroup Limited 23274 COMMERCIAL N

HealthPartners MN SX009 COMMERCIAL R

Payer must be requested via

the Provider Setup Form and

Payer Reqistration completed

prior to electronic claims

submission. Provider Forms

can be found:

www.emdeon.com/enrollme

nt

HealthPlan Services 59140 COMMERCIAL N


Page 31


March 2012


HealthPlus of Michigan 38216 COMMERCIAL R

HealthPlus requires a Trading

Partner Agreement. Providers

should contact the EDI

department at (810-230-

2084) upon billing via

Emdeon to request a TPA

form.

HealthSCOPE Benefits Inc. 71063 COMMERCIAL N

HealthSmart -Noble Mid Orange HSM01 COMMERCIAL N

HealthSmart Benefit Solutions 37283 COMMERCIAL N

HealthSmart Preferred Care Inc. 75250 COMMERCIAL N

HealthSpan Network Repricing HSPAN COMMERCIAL N

HealthSpring HMO/HealthSpring Medicare+Choice 63092 COMMERCIAL N

It is no longer necessary to

notify HealthSpring before

submitting claims

electronically. HealthSpring

encourages electronic

submission of all claims. Be

sure to submit only the

HealthSpring

subscriber/member ID

number found on the

HealthSpring ID card

HealthStar Inc. 36332 COMMERCIAL N

Healthcare Partners HCP01 COMMERCIAL N

Healthcare Resources NW 56731 COMMERCIAL N

Healthcare Solutions Group 73147 COMMERCIAL N

Healthcare Transaction Processing Inc (HTP) 31147 COMMERCIAL N


Claims ONLY.

Healthcare USA 25133 COMMERCIAL N






Healthcomp Inc. 85729 COMMERCIAL N

Healthfirst Health Plan of New Jersey 80141 COMMERCIAL N

Healthfirst TPA (Tyler TX) 75234 COMMERCIAL N

Healthfirst of Austin 75289 COMMERCIAL N

Healthfirst Inc. (New York) 80141 COMMERCIAL N

Healthlink HMO 96475 COMMERCIAL N

Please call Provider Relations

Dept at (800) 624-2356 for

unique provider number.

Healthlink PPO 90001 COMMERCIAL N

Customer Service phone

number: (800 624-2356)


Page 32


March 2012


Healthnow Division 55204 COMMERCIAL R

Provider id = 12 digits with G2

qualifier

Healthscope Benefits - EHC Repricing 52429 COMMERCIAL N

Healthsmart Accel 75237 COMMERCIAL N

Healthsource CMHC 2041 COMMERCIAL N

Healthsource Massachusetts Inc. 2041 COMMERCIAL N

Healthsource Provident 68195 COMMERCIAL N

Claims are edited under

CIGNA's payer specific edits

Payer ID 62308.

Healthsource AR (Med) (CIGNA) 71075 COMMERCIAL N



Payer ID 62308.

Healthsource GA (CIGNA) 58210 COMMERCIAL N



Payer ID 62308.

Healthsource KY 61127 COMMERCIAL N

Healthsource ME 1041 COMMERCIAL P

Healthsource N. TX (CIGNA) 75255 COMMERCIAL N



Payer ID 62308.

Healthsource NC (CIGNA) 56147 COMMERCIAL N



Payer ID 62308.

Healthsource NH 2038 COMMERCIAL N

Healthsource OH 31141 COMMERCIAL N

Healthsource SC 6119 COMMERCIAL N

Healthsource Network

Providers Only

Healthsource TN (CIGNA) 62129 COMMERCIAL N



Payer ID 62308.

Healthspring EM216 COMMERCIAL N

Healthways WholeHealth Networks 58213 COMMERCIAL N

Healthy Palm Beaches Call COMMERCIAL N

Call Provider Services at 866-

930-1002 for EDI Enrollment.

Healthy Texas 68064 COMMERCIAL N

Heritage Consultants 59230 COMMERCIAL N

For faster payment please be

sure to use only the 9-digit

subscriber ID on all claims.

Heritage Physician Network TH011 COMMERCIAL N

Heritage Provider Network DESRT COMMERCIAL N

Heritage Provider Network REGAL COMMERCIAL N

High Desert Primary Care 33069 COMMERCIAL N

Highmark- Key Family 35145 COMMERCIAL N

Hill Physicians Medical Group 46 COMMERCIAL N


Page 33


March 2012


Hinsdale Physician Healthcare 36385 COMMERCIAL N

Hispanic Physicians IPA HPIPA COMMERCIAL N

Hollywood Presbyterian (Synermed) SYMED COMMERCIAL N

Holy Cross Health Partners 36412 COMMERCIAL N

Hometown Health Plan Nevada 88023 COMMERCIAL N

Hometown Health Providers 88537 COMMERCIAL N

Horizon Inner Circle Tier 1/Rayant 22304 COMMERCIAL N

Horizon NJ Health 22326 COMMERCIAL N



[email protected]

om ; Formerly Horizon Mercy

Health Plan

Hospital Benefits Inc. 37274 COMMERCIAL N

Hotel Employees & Restaurant Employees Health Trust 91136 COMMERCIAL N



Hudson Health Plan 13335 COMMERCIAL R

Humana Dermatology - New Century Health NCH02 COMMERCIAL N

Humana Emphesys 61101 COMMERCIAL N

Humana Employers Health Insurance 61101 COMMERCIAL N

Humana Inc. 61101 COMMERCIAL N

Humana Insurance Company Choice Care Network 61101 COMMERCIAL N

Does not include Humana

ChoiceCare of Cincinnati -

(Humana Health Plans of

Ohio)

Humana Veterans Healthcare Services 61160 COMMERCIAL N

Humboldt-Del Norte Foundation for Medical Care 94154 COMMERCIAL N

Huntington Park Mission Medical Group CAPMN COMMERCIAL N

I'Mcare 41600 COMMERCIAL N

I. E. Shaffer (West Trenton NJ) 22175 COMMERCIAL N

IAA 37279 COMMERCIAL N

IHG Direct 75274 COMMERCIAL N

Valid for claims with the

following mailing address:

P.O. Box 2388 Stow OH

44224

ILCBH 68065 COMMERCIAL N

IMS Management Services TH099 COMMERCIAL N

IMX Easy 86070 COMMERCIAL N

INDECS Corporation 40585 COMMERCIAL N

INETICO INC. 43471 COMMERCIAL N

IU Medical Group Primary Care SX172 COMMERCIAL N

IlliniCare 68066 COMMERCIAL N

Illinois Health Solutions 86069 COMMERCIAL N


Page 34


March 2012


Imperial County Physicians Medical Group Call COMMERCIAL N





[email protected]

Independence Medical Group MHM01 COMMERCIAL N

Independence Medical Group - Tulare 26274 COMMERCIAL N

Independent Health SX073 COMMERCIAL P

Indian Health Services SX171 COMMERCIAL N

Enrollment is required.

Providers should contact

BCBSNM Customer Service

Department at 1-800-225-

0241

Indiana Department of Health - Children's Health - Claims35600 COMMERCIAL R

Indiana ProHealth Network 35161 COMMERCIAL N

Indiana Teamsters Health Benefits Fund (Indianapolis IN)35107 COMMERCIAL N

Formerly known as Local 135

Health Benefits Fund

(Indianapolis IN)

Individual Health Insurance Companies 31053 COMMERCIAL N

Payer ID 31053 is for State

Farm - Health line of

business.

InforMed LLC 96490 COMMERCIAL N

Informed UHC 50946 COMMERCIAL N

Informed LLC 52196 COMMERCIAL N

Ingalls Provider Group 36348 COMMERCIAL N

Injured Workers Insurance Fund 52212 COMMERCIAL N

Injured Workers Insurance

Fund requires first time

submitters to contact Grace

Sobrio at (410) 494-2045

prior to submitting claims.

Inland Empire Health Plan IEHP1 COMMERCIAL N

Innovante Benefit Administrators 31172 COMMERCIAL N

Innovative Healthware Services Inc. Call COMMERCIAL N

Before submitting contact

Jessica Picarde at (410) 349-

3222

Insurance Administrators of America Inc. 37279 COMMERCIAL N

Insurance Design Administrators 13315 COMMERCIAL N

Insurance Management Services (Amarillo TX) 15688 COMMERCIAL N

This Payer ID is only valid for

claims with submission

address of P.O. Box 15688;

Amarillo TX 79105

Insurance Services of Lubbock TH012 COMMERCIAL N

InsuranceTPA.com 39182 COMMERCIAL N

Insurdata/Insurnational SX011 COMMERCIAL N


Page 35


March 2012


Insurers Administrative Corp. 86304 COMMERCIAL N

Please visit website prior to

submitting claims:

edihelp.iacusa.com

Integra Administrative Group (Seaford DE) 51020 COMMERCIAL N



address of 110 S. Shipley

Street Seaford DE 19973.

Integra Group 31127 COMMERCIAL N

Integra Group-CHA 31129 COMMERCIAL N

Integrated Care Network (ICN) by Emerald Health 34167 COMMERCIAL N

InterCare Health Plans Inc. 37227 COMMERCIAL N

InterWest Health (Acceptius Gateway payer) 84137 COMMERCIAL N

Interactive Medical Systems 56132 COMMERCIAL N

Interface EAP (IEAP) 60280 COMMERCIAL N

Intergroup Services Corporation 23287 COMMERCIAL N

International Brotherhood of Boilermakers 36609 COMMERCIAL N

International Brotherhood of Boilermakers Employee Health Care Plan(IBBEHC)48603 COMMERCIAL N

International Educational Exchange Services Inc. (IEES) 16158 COMMERCIAL N

International Medical Group TH105 COMMERCIAL N

Iowa Health Solutions 86068 COMMERCIAL N

J. F. Molloy and Associates Inc. 61271 COMMERCIAL N

J. Smith Lanier & Co. Administrators 37272 COMMERCIAL N

JI Specialties TH033 COMMERCIAL N

JMH - SFCCN PHT (PSN CMSN) 9822 COMMERCIAL N

JMH HEALTH PLAN COMMERCIAL HMO 5014 COMMERCIAL N

JOHN MORRELL COMPANY CO. - AHPBA 38310 COMMERCIAL N

JOHN MUIR TRAUMA PHYSICIANS Call COMMERCIAL N

Please contact John Muir

Trauma Physicians at 925-947-

5288 for Payer id

information.

JP Farley Corporation 34136 COMMERCIAL N

JSL Administrators 37272 COMMERCIAL N

John Alden Life Insurance Co. 41099 COMMERCIAL N

John Muir Mt. Diablo Health System 68036 COMMERCIAL N

Providers who have never

submitted claims to John

Muir are required to register

Tax ID prior to initial claims

submission. Please fax W-9

along with contact name and

number to the attention of

Patty Kan at (925) 941-2026.

Allow 2 days for processing

bef


Page 36


March 2012


John Muir Physician Network 68036 COMMERCIAL N

Providers who have never

submitted claims to John

Muir are required to register

Tax ID prior to initial claims

submission. Please fax W-9

along with contact name and

number to the attention of

Patty Kan at (925) 941-2026.

Allow 2 days for processing

bef

Johns Hopkins Healthcare (EHP/PP) 52189 COMMERCIAL P

New submitters should send

in their Billing NPI and

Rending/Servicing NPI.

Johns Hopkins Healthcare (USFHP) 52123 COMMERCIAL N

New submitters should send

in their Billing NPI and

Rending/Servicing NPI.

Joplin Claims / Benefit Management Inc 43178 COMMERCIAL N

KEY GAP 35317 COMMERCIAL N

KPS-Kitsap Physician Services KPS01 COMMERCIAL N

Kaiser CSI-California Select for Individuals (formerly known as Kaiser PPO)94320 COMMERCIAL N

Kaiser Foundation Health Plan of Colorado 91617 COMMERCIAL N

Kaiser Foundation Health Plan of Northern CA Region 94135 COMMERCIAL N

Please call (510) 987-4639 for

approval prior to submitting

Northern California referral

claims.

Kaiser Foundation Health Plan of Ohio 34092 COMMERCIAL N

Kaiser Ohio will be receiving

Extend Content. E-tactic

Billing Service participating in

Pilot.

Kaiser Foundation Health Plan of Southern CA Region 94134 COMMERCIAL N

For more information please

call (866) 285-0361

Kaiser Foundation Health Plan of the Mid-Atlantic States Inc.52095 COMMERCIAL N

For more information please

contact Kenya Neal at Kaiser

at (301) 625-2264.

Kaiser Foundation of the Northwest 93079 COMMERCIAL N

This payer id can only be

used to submit claims for

Oregon and Washington

Kaiser Permanente members.

Kaiser Permanente of Georgia 21313 COMMERCIAL N

Kanawha HealthCare Solutions Inc. 57038 COMMERCIAL N

Kanawha Insurance Co. 57038 COMMERCIAL N

Katy Medical Claims 81812 COMMERCIAL N


Page 37


March 2012


Kaweah Delta TKFMC COMMERCIAL N

Kempton Company 73100 COMMERCIAL N

Kempton Group Administrators 73100 COMMERCIAL N

Kentucky Health Administrators Inc. 27215 COMMERCIAL N

Kentucky Spirit Health Plan 68067 COMMERCIAL N

Kern County CDCR 28021 COMMERCIAL N

Kern Health Systems 77039 COMMERCIAL N

Key Benefit Administrators (Indianapolis IN) 37217 COMMERCIAL N

MUST VERIFY AL CLAIMS

SHOULD GO TO PAYER IN

INDIANAPOLIS IN

Key Health Pilot COMMERCIAL N

Key Medical Group IP082 COMMERCIAL N

Key Select 37321 COMMERCIAL N

Keystone Mercy Health Plan 23284 COMMERCIAL N



[email protected].

Klais & Company 34145 COMMERCIAL N

Klais & Company (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Korean American Medical Group KAMG1 COMMERCIAL N

LA Care Health Plan LACAR COMMERCIAL N

LACare 27357 COMMERCIAL N

LBA Health Plans 52193 COMMERCIAL N

LHP Claims Unit 37248 COMMERCIAL N

LIFE Pittsburgh 25181 COMMERCIAL N

LIPA/Agate Resources TH106 COMMERCIAL N

Lake County Physicians Association 37116 COMMERCIAL N

Lakeside Comprehensive Healthcare 66127 COMMERCIAL N

Lakeside Health Services LMG11 COMMERCIAL N

Lancaster General Health Group - Preferred Health Care (IHS Payer)Call COMMERCIAL N

Contact Sherry Wolgemuth

Vice President of Claims

Operations for Preferred

Health Care at (717) 560-

9290 ext. 124 for approval

and the Payer ID.

Landmark Healthcare Inc LNDMK COMMERCIAL N

Lawndale Christian Health Center 36333 COMMERCIAL N

Leon Medical Center Health Plan 37316 COMMERCIAL N

Liberty Health Advantage 87071 COMMERCIAL N

Liberty Union 37281 COMMERCIAL N

Life Assurance Company 37281 COMMERCIAL N

Life Gift Cards 33LGC COMMERCIAL N

Life Investors Insurance TH120 COMMERCIAL N


Page 38


March 2012


Life Investors of America - Long Term Care TH093 COMMERCIAL N

Life Trac 41136 COMMERCIAL N

LifePath Hospice Inc 76870 COMMERCIAL N

LifeWise Healthplan of Oregon 93093 COMMERCIAL R

Payer EDI agreement must be

processed thru Emdeon's

Enrollment Dpt. Do not send

EDI Agreement to Payer.

Applies to all providers

(including those adding site

id's) enrolling for Electronic

submission thru WebMD.

Questions: (800) 845-6592

Local 135 Health Benefits Fund (Indianapolis IN) 35107 COMMERCIAL N

Loma Linda University Adventist Health Sciences Center Employee Health Plan37267 COMMERCIAL N

Loma Linda University Adventist Health Sciences Centers37267 COMMERCIAL N

Loma Linda University Behavioral Medicine Center Employee Health Plan37267 COMMERCIAL N

Loma Linda University Employee Health Plan 37267 COMMERCIAL N

Loma Linda University Health Care Employee Health Plan37267 COMMERCIAL N

Loma Linda University Healthcare - ManagedCare Claims33036 COMMERCIAL N


to the payer.

Loma Linda University Medical Center Employee Health Plan37267 COMMERCIAL N

Loma Linda University Medical Center Residents Health Plan37267 COMMERCIAL N

Loma Linda University Student Health Plan 37267 COMMERCIAL N

Lone Star TPA 45289 COMMERCIAL N

Louisiana Healthcare Connections 68069 COMMERCIAL N

Lovelace Salud SX159 COMMERCIAL N

Lovelace Sandia Health Plan 90328 COMMERCIAL N

MAMSI Life and Health Insurance Co. (MLH) 52148 COMMERCIAL N

MBA of Wyoming (Worland WY) 87065 COMMERCIAL N



Box 98 Worland WY 82401

MBS 56205 COMMERCIAL N Formerly Payer ID 56151

MCA ADMINISTRATORS 25160 COMMERCIAL N

MD - Individual Practice Association Inc. (M.D. IPA) 52148 COMMERCIAL N

MDI Custom Provider Network (Formerly MPA - Custom Provider Network)80900 COMMERCIAL N

MDI Holdings (Formerly Medical Partners of America) 80026 COMMERCIAL N

MDWise Hoosier Alliance 20475 COMMERCIAL N

MED PAY 88058 COMMERCIAL N

MED3000 CMS EARLY STEPS EM350 COMMERCIAL N

MED3000 CMS SAFETY NET EM284 COMMERCIAL N

MED3000 CMS TITLE 19 REFORM EM843 COMMERCIAL N

MED3000 CMS TITLE 21 EM205 COMMERCIAL N


Page 39


March 2012


MED3000 COVENTRY HEALTHY KIDS EM521 COMMERCIAL N

MED3000 PEDICARE TITLE 19 EM039 COMMERCIAL N

MED3000 PEDICARE TITLE 21 EM522 COMMERCIAL N

MEDICA HEALTH CARE PLAN INC. 78857 COMMERCIAL N

MEDICAL ASSOCIATES HEALTH PLAN MAHC1 COMMERCIAL N

MEDICAL DEVELOPMENT INTERNATIONAL 52181 COMMERCIAL N

MEMIC 1047 COMMERCIAL N

MEMORIAL INTEGRATED HEALTHCARE Call COMMERCIAL N

PLEASE EMAIL TRACY

HARSWICK AT

[email protected] FOR

PAYER ID INFORMATION

MFC & HealthPlus Peoria 23550 COMMERCIAL N

MHNET 74289 COMMERCIAL N

MHP Systems 64068 COMMERCIAL N

MIPS COMMERCIAL N

MMA 35316 COMMERCIAL N

MMAC (Managed Medical Assurance Co. Ltd.) (Ohio BWC)31147 COMMERCIAL N


Claims ONLY.

MMSI 41154 COMMERCIAL N

Mayo Management Services

Inc.

MOLINA HEALTHCARE Of WI ABRI1 COMMERCIAL N

MORRIS ASSOCIATES 35092 COMMERCIAL N

MPE Services Inc. 37233 COMMERCIAL N

MPEEBT 37233 COMMERCIAL N

MVP Health Plan of NY 14165 COMMERCIAL N

MVP Health Rochester SX089 COMMERCIAL N

Formerly known as Preferred

Care NY

Mabuhay Medical Group CAPMN COMMERCIAL N

MacNeal Health Providers- CHS 36334 COMMERCIAL N

Magellan Health Services 1260 COMMERCIAL N

Magnacare 11303 COMMERCIAL N

Magnolia 68062 COMMERCIAL N

Mail Handlers Benefit Plan 25133 COMMERCIAL N


part of Coventry


Including AFSPA Staff Plan.

a.k.a. Mailhandlers CAC.

Maksin Management Corporation 22195 COMMERCIAL N

Managed Care Services LLC 35162 COMMERCIAL N

Managed Care Systems (Delano Regional Medical Group)MCS02 COMMERCIAL N

Managed Care Systems (Gemcare) MCS01 COMMERCIAL N

Managed Health Network 22771 COMMERCIAL N


Page 40


March 2012


Managed Health Services Indiana (Medicaid HMO) 39186 COMMERCIAL P



Dept at 877.647.4848 to





in a timely manner.

Managed Health Services Wisconsin 39187 COMMERCIAL P



Dept at 1-800-547-1647 to





in a timely manner.

Manatee Service Center (Bradenton FL) 41555 COMMERCIAL N

Manulife W. J. Sutton Company 98010 COMMERCIAL N

Marquette Life Insurance Company 48055 COMMERCIAL N

Marsh Advantage COMMERCIAL N

Maryland Physicians Care 22348 COMMERCIAL N

Rendering provider id must

contain 1D qualifier. Payer

accepts zero dollar service

line charges. Payer

Registration not required.

Autoenroll payer.

Mashantucket Pequot Tribal Nation 37121 COMMERCIAL N

Master Mates & Pilots Program TH111 COMMERCIAL N

McKinley Medical Group MHM02 COMMERCIAL N

MedAdmin Solutions 58202 COMMERCIAL N

MedAdmin Solutions 58204 COMMERCIAL N

MedBen (Newark OH) 74323 COMMERCIAL N

MedCom 59231 COMMERCIAL N

MedCost Inc. 56162 COMMERCIAL N

For questions on claim

submission please contact

Customer Service 800-824-

7406

MedDirect 38353 COMMERCIAL N

MedPartners Administrative Services 35205 COMMERCIAL N

Payer ID is only for claims

with mailing address of: PO

Box 2602 Fort Wayne IN

46801

MedSolutions Inc 62160 COMMERCIAL N


Page 41


March 2012


Medfocus 95321 COMMERCIAL N

Medica 94265 COMMERCIAL N

Medicaid Hawaii Waivers 77059 COMMERCIAL R

Medical Administrators Inc. (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Medical Benefit Administrators Inc/dba MBA of MD Inc 37298 COMMERCIAL N

Medical Benefits Administration MBA01 COMMERCIAL N

Medical Benefits Administrators Inc. (Newark OH) 74323 COMMERCIAL N

Medical Benefits Companies (Newark OH) 74323 COMMERCIAL N

Medical Benefits Mutual (Newark OH) 74323 COMMERCIAL N

Medical Benefits Mutual Life Insrance Co. 74323 COMMERCIAL N

Medical Mutual of Ohio 29076 COMMERCIAL N

Medical Network of Colorado Springs 84600 COMMERCIAL N

Medical Reimbursements of America 62177 COMMERCIAL N

Medical Services Initiative 12057 COMMERCIAL N

Medical Value Plan - Ohio (MVP) 38224 COMMERCIAL N

Medicina Familiar Medical Group CAPMN COMMERCIAL N

Mega Life & Health Insurance Company - Insurance Center59221 COMMERCIAL N





Hills TX 76182.

Memorial Clinical Associates/ SelectCare of Texas (MCA)62181 COMMERCIAL N

Memorial Herman Health Network Providers TH092 COMMERCIAL N

Memorial PSN/CMS Call COMMERCIAL N

Please contact Memorial

Enrollment department at

954-276-3176 for payer ID

information.

Mercer Administrators COMMERCIAL N

Mercy Care Plan (AHCCCS) 86052 COMMERCIAL N

Mercy Health Plans 43166 COMMERCIAL N

MercyCare Call COMMERCIAL N

Please call 608-758-7739 for

payer id.

Meridian Health Plan 13189 COMMERCIAL N

Meritain Health / Agency Services 64158 COMMERCIAL N

Formerly know as Agency

Services Inc.

Meritain Health Minneapolis 41124 COMMERCIAL N

Meritain Health/North American Administrators 64157 COMMERCIAL N

Formerly know as North

American Administrators Inc.

Methodist Associate Health Plan Pilot COMMERCIAL N


Page 42


March 2012


MetroPlus Health Plan 13265 COMMERCIAL N

Registration and submission

of the Billing Provider's NPI is

required. If you have not

registered please contact

MHP Customer Service at

(800) 303-9626. Claims will

reject if the NPI is not

registered and/or submitted

on claims sent electronically.

Metropolitan Health Plan 10850 COMMERCIAL N

Metrowest HealthPlan TH068 COMMERCIAL N

Metrowest Star Medicaid TH069 COMMERCIAL N

Michael Reese Physicians Group 37127 COMMERCIAL N

Mid America Benefits Call COMMERCIAL N

Please call Jessica Picarde

Manager of Claims

Operations (410) 349-3222

for Payer ID information.

Mid Atlantic Psychiatric Services Inc. (MAPSI) 52149 COMMERCIAL N

Mid-America Associates Inc. 37281 COMMERCIAL N

Mid-County Physicians Medical Group (San Diego) (Synermed)SYMED COMMERCIAL N

Mid-West National Life Insurance Co. of Tennessee - Insurance Center59224 COMMERCIAL N





Hills TX 76182.

Mid-West National Life Insurance Co. of Tennessee - Student Insurance74227 COMMERCIAL N

Payer ID only valid if the P.O.

Box on the Health ID Card

matches one of the following

P.O. Boxes: P.O. Box 890025

809067 809079 809066

809036 809081 Dallas Tx

75380-9025.

MidCities IPA CAPMN COMMERCIAL N

MidCoast IPA 77012 COMMERCIAL N

Midlands Choice Inc. 47080 COMMERCIAL N

Midwest Health Partners 76079 COMMERCIAL N


Page 43


March 2012


Midwest Health Plans Inc. TH074 COMMERCIAL P

Accepts NPI only. Require

the billing NPI to be the

group NPI if using a Business

Tax id. Service provider NPI

required in servicing provider

loop. No longer require 6

digit provider identifier.

Provider must complete

enrollment form on payers

website.

Mills Peninsula Health Services MPHS1 COMMERCIAL N

Mills Peninsula Medical Group MPMG1 COMMERCIAL N

Mission (St. Joseph Heritage Healthcare) STJOE COMMERCIAL N

Mississippi Health Partners 64068 COMMERCIAL N

Mississippi Physicians Care Network 64084 COMMERCIAL N

Mississippi Public Entity Employee Benefit Trust 37233 COMMERCIAL N

Mississippi Select Health Care 64088 COMMERCIAL N

Also doing business as Select

Administrative Services (SAS).

Missoula County Medical Benefits Plan 37275 COMMERCIAL N

Missouri Care/MC 43179 COMMERCIAL N

Molina Healthcare Utah (aka: American Family Care)SX109 COMMERCIAL N

Molina Healthcare of CALIFORNIA 38333 COMMERCIAL N

Molina Healthcare of Florida 51062 COMMERCIAL N

Molina Healthcare of MICHIGAN 38334 COMMERCIAL N

Molina Healthcare of Missouri 71079 COMMERCIAL N

Please note the payer name

changed effective 4/1/10.

For questions please contact

Molina Healthcare of

Missouri. Please refer to the

Member ID cards for payer

contact information.

Molina Healthcare of Nevada 20676 COMMERCIAL N

Molina Healthcare of New Mexico - Salud 9824 COMMERCIAL N

Molina Healthcare of New Mexico -SCI 4423 COMMERCIAL N

Molina Healthcare of Ohio 20149 COMMERCIAL N

Molina Healthcare of Texas 20554 COMMERCIAL N

Molina Healthcare of WASHINGTON 38336 COMMERCIAL N

Monarch IPA IP095 COMMERCIAL N

Mondial Assistance 50749 COMMERCIAL N

Montefiore Contract Management Organization 13174 COMMERCIAL N

Monumental Life Insurance Company TH094 COMMERCIAL N

Monumental Life Insurance Company TH121 COMMERCIAL N


Page 44


March 2012


Mosaic IPA Medical Group IP083 COMMERCIAL N

Motion Pictures Industry 99282 COMMERCIAL N

Mountain States Administrative Services (Tucson AZ) 86040 COMMERCIAL N

Multicultural Primary Care Medical Group (San Diego) (Synermed)SYMED COMMERCIAL N

Multiplan Wisconsin Preferred Provider Network 34080 COMMERCIAL N

Municipal Health Benefit Fund 81883 COMMERCIAL N

Mutual Assurance Administrators 37256 COMMERCIAL N

Mutual Group (The) (US) 59140 COMMERCIAL N

Mutual of Omaha Insurance Company 71412 COMMERCIAL N

Mutually Preferred 71412 COMMERCIAL N

N.W. Ironworkers Health & Security Trust Fund 91136 COMMERCIAL N



N.W. Roofers & Employers Health & Security Trust Fund91136 COMMERCIAL N



N.W. Textile Processors 91136 COMMERCIAL N



NAA (North America Administrators L.P.) (Nashville TN) 65085 COMMERCIAL N

NABN (Cleveland OH) 34159 COMMERCIAL N


Health. Payer ID valid only

for claims with billing

submission address of P.O.

Box 94928 Cleveland OH

44101-4928 or P.O. Box

89476 Cleveland OH 44101-

5476.

NALC/Affordable 53011 COMMERCIAL N

NCAS - Fairfax VA 75190 COMMERCIAL N

NEW AVENUES INC. 95998 COMMERCIAL N

NGS American Inc 38225 COMMERCIAL N

NHBCAUX 88050 COMMERCIAL N

NHP/SHP (Neighborhood Health Providers and Suffolk Health Plan)11325 COMMERCIAL P

NJ Carpenters Health Fund 22603 COMMERCIAL N

NMCI Pilot COMMERCIAL N

NORTHWEST COMMUNITY HEALTH PARTNERS 36234 COMMERCIAL N

Naperville Healthcare TH088 COMMERCIAL N

National Association of Letter Carriers 53011 COMMERCIAL N

National Association of Letter Carriers/NALC 53011 COMMERCIAL N

National Benefit Administrators - New Jersey 56175 COMMERCIAL N

National Benefit Administrators - North Carolina 56176 COMMERCIAL N

National Capital Preferred Provider Organization (NCPPO)90001 COMMERCIAL N

Customer Service phone

number: (800 272-5911)


Page 45


March 2012


National Imaging Associates SX190 COMMERCIAL N

National Rural Electric Coop (NRECA) 52132 COMMERCIAL N

National Telecommunications Cooperative Association 52120 COMMERCIAL N

National Telecommunications Cooperative Association (NTCA - Staff)52104 COMMERCIAL N

National Telecommunications Cooperative Association (NTCA)52103 COMMERCIAL N

Nationwide Health Plans 31417 COMMERCIAL N

Neighborhood Health Partnership of Florida 96107 COMMERCIAL N

Payer ID is valid for claims

submission address PO Box

025680 Miami FL 33102-

5680. Any questions should

be directed to (305)715-4334.

Neighborhood Health Plan (Boston MA) 4293 COMMERCIAL N

Neighborhood Health Plan of Rhode Island (NHPRI) 5047 COMMERCIAL N

Please call NHPRI at 1-401-

459-6020 to obtain or

confirm your provider and

vendor number prior to your

initial claims submission.

Nesika Health Group 37255 COMMERCIAL N

Netcare Life and Health Insurance (Hagatna Guam) 66055 COMMERCIAL N

Network Health 4332 COMMERCIAL P

Before initiating submissions

please go to www.network-

health.org and go to the

Providers Tab then forms

then Claims Forms and then

EDI setup forms or email

Network Health at

[email protected] for

an EDI setup form.

Network Health Insurance Corp-Medicare 77076 COMMERCIAL N

Network Health Plan of Wisconsin Inc. 39144 COMMERCIAL N

Payer id is valid only if the

claim submission address on

the back of the member's

card is PO Box 568 Menasha

WI 54952.

Network Medical Management NMM01 COMMERCIAL N

Network TPA LLC 58204 COMMERCIAL N

NevadaCare 86067 COMMERCIAL N

New Century Health - IEHP Oncology NCH11 COMMERCIAL N

New Century Health - Vista Cardiology NCH09 COMMERCIAL N

New Era Employee Welfare Benefit Plan Trust 76031 COMMERCIAL N

New Era Life Insurance Company 75281 COMMERCIAL N

New Market Dimensions 65056 COMMERCIAL N

New West Health Services SX164 COMMERCIAL N


Page 46


March 2012


New York Life TH122 COMMERCIAL N

New York Network Management 11334 COMMERCIAL N

New York Presbyterian System Select Health 24819 COMMERCIAL N

Nippon Life Insurance Company of America 81264 COMMERCIAL N

Noble AMA Select IPA PDT01 COMMERCIAL N

Noble Community Medical Associates LA CAPMN COMMERCIAL N

North American Administrators Inc. 64157 COMMERCIAL N


Health

North American Benefits Network (Cleveland OH) 34159 COMMERCIAL N


Health. Payer ID valid only

for claims with billing

submission address of P.O.

Box 94928 Cleveland OH

44101-4928 or P.O. Box

89476 Cleveland OH 44101-

5476.

North American Health Plan 64157 COMMERCIAL N


Health

North American Medical Management (NAMM) - Northern CaliforniaE3510 COMMERCIAL P

Please contact the EDI Dept

for North American Medical

Management (NAMM) -

Northern California




North American Medical Management (NAMM) - Southern CaliforniaE3510 COMMERCIAL P

North American Preferred 64157 COMMERCIAL N


Health

North Broward Hospital District 37314 COMMERCIAL N

North County Health Services Call COMMERCIAL N





[email protected]

North Suburban Associated Physicians 36392 COMMERCIAL N

North Texas Healthcare Network 35212 COMMERCIAL N

North West Orange County Medical Group PROSP COMMERCIAL N

NorthShore University Health System Medical Group 36364 COMMERCIAL N

NorthStar Advantage NSA01 COMMERCIAL N

Northern California Sheet Metal Workers Health Care Plan38238 COMMERCIAL N



Box 1138 San Ramon CA

94583.

Northern Illinois Health Plan 36347 COMMERCIAL N


Page 47


March 2012


Northern Nevada Trust Fund 88027 COMMERCIAL N

Please call (775) 826-7200 to

verfiy if you should be

sending claims to Northern

Nevada Trust Fund.

Northridge Medical Group NMG01 COMMERCIAL N

Northstar Advantage 60058 COMMERCIAL N

Northwest Administrators Inc. See Comments COMMERCIAL N


to the payer.

Northwest Diagnostic Clinic/SelectCare of Texas (NWDC)62119 COMMERCIAL N

Northwest Suburban IPA (Illinois) 36346 COMMERCIAL N

Nova Casualty Company 16114 COMMERCIAL N

Novanet 6226 COMMERCIAL N

Novasys Health Network 71080 COMMERCIAL N

Nuestra Familia Medical Group (Prospect Medical Group)PROSP COMMERCIAL N

Nyhart 37299 COMMERCIAL N

OAK WEST PRIMARY PHYSICIAN ASSOCIATION 36402 COMMERCIAL N

ODS Health Plan 13350 COMMERCIAL N

OK State Employees & Educators (EDS) 22521 COMMERCIAL N

OMNI/Medicore HP 68037 COMMERCIAL N

OSF Health Plans 62171 COMMERCIAL N

OSMA Health - C. L. Frates 73071 COMMERCIAL N

Oasis IPA DESRT COMMERCIAL N

Occupational Health Mgmt Inc. (HealthManage) (Ohio BWC)31147 COMMERCIAL N


Claims ONLY.

Office of Group Benefits- Louisiana 72087 COMMERCIAL N

Office of Group Benefits is

located in the state of

Louisiana. This payer is

currently not sending 997's.

Syntax errors will be worked

on with payer tech.

Ohio BWC 31147 COMMERCIAL N


Claims ONLY.

Ohio Comp Choice Inc. (HMS) (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Ohio Employee Health Partnership (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Ohio Health Choice PPO 34189 COMMERCIAL N



address of PO Box 3619

Akron OH 44309-3619 or PO

Box 93538

Ohio Health Group 95435 COMMERCIAL N

Ohio PPO Connect 74431 COMMERCIAL N


Page 48


March 2012


Omnicare 25133 COMMERCIAL N




Omnicare Medical Group (OMNI) IP088 COMMERCIAL N

Omnicare A Coventry Health Plan 25150 COMMERCIAL N




the payer list.

Omnicare A Coventry Health Plan 25150 COMMERCIAL N




the payer list.

OneNet PPO LLC. 52149 COMMERCIAL N

Name effective from

9/1/2006. Previous name

Alliance PPO LLC.

Operating Engineers Locals 302 & 612 Health & Security Fund91136 COMMERCIAL N



OptiCare Managed Vision 56190 COMMERCIAL N

Optima Health Plan 54154 COMMERCIAL N

Note: Rendering Provider

Network ID (E6-14) field is

reqd. Field must be 5-7 chars

positions 1-5 must be

numeric only and positions

6&7 (if applicable) must be

alpha only. Please contact

Ydsia Slagle-Provider

Relations at (757) 552-7477.

Optima Insurance Company 54154 COMMERCIAL N









Relations at (757) 552-7477.

Optimum Choice of the Carolinas Inc. (OCCI) 52152 COMMERCIAL N

Optimum Choice Inc. (OCI) 52148 COMMERCIAL N

OptumHealth - CMC 41194 COMMERCIAL N


Page 49


March 2012


Orthonet - Uniformed Services Family Health Plan 13382 COMMERCIAL N


to the payer. For Payable

USFHP (NY & NJ) outpatient

therapy claims only. Contact

Theresa Malgioglio at (914)

681-8800.

Orthonet Corporation - CIGNA 13381 COMMERCIAL N

Orthonet- Aetna 13383 COMMERCIAL N

Orthonet-HealthNet 25681 COMMERCIAL N

Oxford Health Plans 6111 COMMERCIAL N

P5 Health Plan Solutions of Utah 87068 COMMERCIAL N

PAI 37287 COMMERCIAL N

PEHP - Utah Public Employee Health Plan Call COMMERCIAL P

Call EDI at 801-366-7544 or

email [email protected]

to obtain the payer id.

PHCS Claims (formerly American LIFECARE) 72099 COMMERCIAL N

Please enter the Group

Number from ID card when

submitting claims. Payer ID

only valid for claims with a

billing submission address of

PO Box 5007 DePere WI

54115 (1100 Poydras Street

Suite 2600 New Orleans LA

70163-2602 is no longer an

active claim

PHCS Savility Payers 13306 COMMERCIAL N

PHP of South Michigan 87726 COMMERCIAL N

PHP of Southwest Michigan 87726 COMMERCIAL N

PHP of West Michigan 87726 COMMERCIAL N

PIMA Health 9861 COMMERCIAL R

PODIATRY NETWORK FL 59324 COMMERCIAL N

POMCO 16111 COMMERCIAL N

PPOM LLC 38335 COMMERCIAL N

PPOPlus LLC 72148 COMMERCIAL N

PSYCHCARE LLC 51052 COMMERCIAL N

PacifiCare Behavioral Health 33053 COMMERCIAL N

PacifiCare PPO - All States 95999 COMMERCIAL N

For payable PPO claims only.

NOT for Pacificare/Secure

Horizons HMO claims. For

further questions you may

inquire via email at

[email protected].


Page 50


March 2012


PacifiCare of Arizona - Claims 95964 COMMERCIAL N

For payable PacifiCare/Secure

Horizons HMO and POS

claims only. Not for PPO

claims. For further questions

you may inquire via email at

[email protected]

PacifiCare of California - Claims 95959 COMMERCIAL N

For Payable Pacificare/Secure

Horizon HMO claims only.

NOT for PPO claims. For



[email protected].

PacifiCare of Colorado - Claims 95962 COMMERCIAL N






[email protected]

PacifiCare of Oklahoma - Claims 95959 COMMERCIAL N






[email protected].

PacifiCare of Oregon - Claims 95959 COMMERCIAL N






[email protected].

PacifiCare of Texas - Claims 95959 COMMERCIAL N






[email protected].


Page 51


March 2012


PacifiCare of Washington - Claims 95959 COMMERCIAL N






[email protected].

Pacific Alliance Medical Group and Hospital (Synermed)SYMED COMMERCIAL N

Pacific IPA PCFCI COMMERCIAL N

PacificSource Health Plans 93029 COMMERCIAL N

Payer does not accept COB

claims electronically

Paragon Benefits Inc. 58174 COMMERCIAL N

Paramount SX158 COMMERCIAL N

Paramount Preferred Network (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Park Terrace/Encompass Medical Group Call COMMERCIAL N


with payer please contact

Tristin Rausche 858-824-

7100 [email protected]

Parkland Community Health Plan 66917 COMMERCIAL N

Pasadena Primary Care Physicians CAPMN COMMERCIAL N

Passport Advantage 76569 COMMERCIAL N

Only claims with a DOS

and/or Admit Date on or

after 1/1/2010 shall be

submitted to this new Payer

ID.

Passport Health Plan 61129 COMMERCIAL N



[email protected].

Patient Advocates LLC 10525 COMMERCIAL N

Peach State Health Plan 68049 COMMERCIAL P



Dept at 1-866-874-0633 to





in a timely manner.

Pegasus Medical Group PROSP COMMERCIAL N

Pennsylvania Pace 20172 COMMERCIAL N

Pennsylvania's Preferred Health Network Call COMMERCIAL N

Call Jessica Picarde Manager

of PPHN Claims

Operations(410) 349-3222

Peoples Health Network 72126 COMMERCIAL N


Page 52


March 2012


PerformCare-Select Health MH/SA 25176 COMMERCIAL N

For Behavioral Health EDI

support please e-mail

[email protected]

Personal Insurance Administrators Inc. (Agoura Hills CA)95397 COMMERCIAL N

PersonalCare 25133 COMMERCIAL N


part of Coventry


Phoenix Health Plan 3440 COMMERCIAL N

Phyicians Health Plan (PHP) Mid-Michigan 37330 COMMERCIAL N

Physician Associates of Louisiana 58204 COMMERCIAL N

Physician Associates of the Greater San Gabriel ValleyCall COMMERCIAL N

Please call David McGee 626-

817-8354 or Art Tarin 626-

817-8318 to obtain the Payer

Id

Physician Associates of the Greater San Gabriel ValleyPA513 COMMERCIAL N

Physician Care Network LLC 58204 COMMERCIAL N

Physician's Data Trust PDT01 COMMERCIAL N

Physicians Alliance/Stones River Regional IPA 15749 COMMERCIAL N

Physicians Care (ASR Corporation) 38265 COMMERCIAL N

Note: This is Physicians Care

Network located in Michigan

Physicians Care Health Plans (ASR Corporation) 38265 COMMERCIAL N



Physicians Care Network (ASR Corporation) 38265 COMMERCIAL N



Physicians Care Network (Rockford IL only) 36345 COMMERCIAL N

Physicians Health Association of Illinois 37136 COMMERCIAL N

Physicians Health Choice - Encounters TH114 COMMERCIAL N

Physicians Health Claims - Claims TH113 COMMERCIAL N

Physicians Health Collaborative 20398 COMMERCIAL N

Physicians Health Network MHM03 COMMERCIAL N

Physicians Health Plan (PHP) - SC 9173 COMMERCIAL N

Physicians Health Plan PHP South Michigan 37330 COMMERCIAL N

Physicians Medical Group of San Jose EXC01 COMMERCIAL N

Physicians Mutual Insurance Company 47027 COMMERCIAL N

Please send all PPO and

dental claims to the address

on the back of the insured's

ID Card

Physicians Plus Insurance Corporation 39156 COMMERCIAL N

Physicians United Plan TH131 COMMERCIAL N

Piedmont Behavioral Health 6607 COMMERCIAL N

Pinnacle Claims Management Inc. 24735 COMMERCIAL N

Pinnacle Health Resources (Prospect Medical Group)PROSP COMMERCIAL N

Pinnacle Physician Management ORG 45985 COMMERCIAL N


Page 53


March 2012


Pinnacol Assurance 84109 COMMERCIAL N

Pioneer Medical Group PIONR COMMERCIAL N

Pittman & Associates 37224 COMMERCIAL N

Pittsburgh Care Partnership Inc. 23283 COMMERCIAL N

Pivotal Plan 64160 COMMERCIAL N

Planned Administrators Inc. 37287 COMMERCIAL N

Providers submitting claims

as a Preferred Blue provider

should not submit claims

using payer ID 37287

Podi Care Managed Care 58204 COMMERCIAL N

Pomona Valley Medical Group IP057 COMMERCIAL N

Practicare Inc 4334 COMMERCIAL N

Prairie States Enterprises Inc. 36373 COMMERCIAL N

Preferred Benefits Administrator 61665 COMMERCIAL N

Preferred Care Partners Florida 65088 COMMERCIAL N

Preferred Community Choice/PCCSelect/CompMed 73145 COMMERCIAL N

Preferred Health Care - PPO Lancaster PA (IHS Gateway Payer)Call COMMERCIAL N

Contact Sherry Wolgemuth

Vice President of Claims

Operations for Preferred

Health Care at (717) 560-

9290 ext. 124 for approval

and the Payer ID.

Preferred Health Plan (Louisville KY) 61106 COMMERCIAL N

Preferred Health Professionals 31478 COMMERCIAL N

Preferred Health Systems Insurance Company 60110 COMMERCIAL N

Preferred IPA PFIPA COMMERCIAL N

Preferred Network Access Inc. 36401 COMMERCIAL N

Preferred Plus of Kansas 60110 COMMERCIAL N

PreferredOne (MN) 41147 COMMERCIAL N

Premier Benefits Inc. 43166 COMMERCIAL N

Premier Comp of Hometown Health Network (Ohio BWC)31147 COMMERCIAL N


Claims ONLY.

Premier Eye Care 65054 COMMERCIAL N

Participating Providers WITH

a signed ECS agreement ONLY

Premier Health Plans 43166 COMMERCIAL N


Page 54


March 2012


Premier Health Systems Inc 90440 COMMERCIAL N

Premier Health Systems Inc.

is part of the Medical Mutual

Family of Companies. For

claims with DOS prior to

4/1/09 use payer ID 90440.

Claims with DOS 4/1/09 and

after use their new payer ID

29076.

Premier Health Systems Inc. 29076 COMMERCIAL N

Premier Health Systems Inc.

is part of the Medical Mutual

Family of Companies. Former

payer ID 90040. Use Payer ID

20976 for claims with DOS

4/1/09 and after. For claims

with DOS prior to 4/1/09 use

former payer ID 90440.

Premier Managed Care Inc. (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Premier Physicians Network & Valley Division (PPN) CAPMN COMMERCIAL N

Presbyterian (NM) 5003 COMMERCIAL N

Prestige Health Choice 45056 COMMERCIAL N

Prevea Health Plan 39185 COMMERCIAL N

Prima Health IPA IP096 COMMERCIAL N

Primary Care & Pediatrics IPA (PCPIPA) CAPMN COMMERCIAL N

Primary Health Network 82048 COMMERCIAL N

Primary PhysicianCare Inc. 56144 COMMERCIAL N

Prime West Health Plan 61604 COMMERCIAL N

PrimeSource Health Network (PSHN) - PPO Harrisburg PA (IHS Gateway Payer)Call COMMERCIAL N



3222

Principal Financial Group 61271 COMMERCIAL N

Priority Health 38217 COMMERCIAL N

Prism Network Inc. 37268 COMMERCIAL N

Prism-First Health 37303 COMMERCIAL N

Prism-Univera 37315 COMMERCIAL N

Pro Care Health Plan Inc. (Detroit MI) 38329 COMMERCIAL N


the following submission

addresses: PO Box 3160

Detroit MI 48203 AND PO Box

3590 Detroit MI 48203.

ProCare (Prospect) PROSP COMMERCIAL N

ProCare Health Plan Medicaid 70259 COMMERCIAL N

ProMed HealthCare Administrators IP057 COMMERCIAL N


Page 55


March 2012


Professional Benefit Administrators (Winter Park FL) 59296 COMMERCIAL N

Professional Benefit Administrators Inc. (Oak Brook IL) 36331 COMMERCIAL N

Payer ID is valid only for

claims with billing submission

name city and state of

Professional Benefit

Administrators Inc. Oak Brook

IL.

Professional Risk Management 34134 COMMERCIAL N

Prospect Health Network PROSP COMMERCIAL N

Prospect Medical Group PROSP COMMERCIAL N

Prospect Sherman Oaks Medical Group (Prospect Medical Group)PROSP COMMERCIAL N

Protective Life Insurance Company 37309 COMMERCIAL N

Protegrity Services (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

ProviDRs Care Network 48100 COMMERCIAL N

Providence PPO SX187 COMMERCIAL N

For Claims Status please

contact Susan Naanes @ 503-

574-7441 or Debra

Wallenstein at 503-574-7450

.

Providence of Oregon Health Plan SX133 COMMERCIAL N

For Claims Status please

contact Susan Naanes @ 503-

574-7441 or Debra

Wallenstein at 503-574-7450.

Puget Sound Benefits Trust 91136 COMMERCIAL N



Puget Sound Electrical Workers Trust 91136 COMMERCIAL N



Pyramid Life Insurance Company 48055 COMMERCIAL N

QUALITY HEALTH PLANS INC. 59375 COMMERCIAL N

QVI Risk Solutions Inc. 57117 COMMERCIAL N

Quad Med LLC (Pewaukee WI) 39197 COMMERCIAL N

Qual Choice of Arkansas 35174 COMMERCIAL N

QualCare Inc. 23342 COMMERCIAL P

New Providers must enroll

with QualCare at (800) 992-

6613 option 5.

Quality Care Partners 89461 COMMERCIAL N

QuikTrip 73067 COMMERCIAL N

E-print address: QuikTrip P.O.

Box 733 Buckeystown MD

21717

R&N Market TKFMC COMMERCIAL N

RADCON INC. Call COMMERCIAL N

Please contact Kathy King @

(856) 608-1350 for Payer Id

information.


Page 56


March 2012


RBMS LLC 91176 COMMERCIAL N

RIVERSIDE SAN BERNARDINO COUNTY INDIAN HEALTH INC.Call COMMERCIAL N

RMSCO INC. 16117 COMMERCIAL N

RWDSU BENEFIT FUND 63070 COMMERCIAL N

Redlands IPA (Synermed) SYMED COMMERCIAL N

Regal Medical Group REGAL COMMERCIAL N

Regency Employee Benefits 38221 COMMERCIAL N

Regional Care Inc. 47076 COMMERCIAL N

Renaissance Physicians Organization 76066 COMMERCIAL N

Reserve National Insurance 73066 COMMERCIAL N

For claims rejections please

contact Reserve National

Customer Service at (405)

848-7931

ResourceOne Administrators 37278 COMMERCIAL N

Resurrection Health Care Preferred/FKA Family Medical Network36396 COMMERCIAL N

Please call (773) 572-8311 or(

773) 572-8309 prior to your

first submission of claims

Retiree Health Trust 26316 COMMERCIAL N

Right Care from Scott & White 74205 COMMERCIAL N

RightChoice Benefit Administrators 37331 COMMERCIAL N

Rocky Mountain Health Plan - Grand Junction SX141 COMMERCIAL R

Rooney Life Inc. 37602 COMMERCIAL N

Rural Carrier Benefit Plan 25133 COMMERCIAL N


part of Coventry


Including NRLCA Staff Plan.

Rush Prudential Health Plans (HMO Only) 36389 COMMERCIAL N

Ryan White Network AMM03 COMMERCIAL N

S & S Healthcare Strategies 31441 COMMERCIAL N

SAINT MARY'S HEALTH PLAN 88029 COMMERCIAL N

SANFORD HEALTH PLANS - Repriced Claims TP984 COMMERCIAL N

SANTA CLARA FAMILY HEALTH PLAN 24077 COMMERCIAL N

SCAN ENCOUNTERS 99157 COMMERCIAL N Diversified Data Design (DDD)

SCAN Health Plan 72261 COMMERCIAL N

SCAN Long Term Care 20460 COMMERCIAL N

SCHC Total Care Inc. Claimsnet is the Gateway 16146 COMMERCIAL N

SENIOR WHOLE HEALTH 83035 COMMERCIAL N

Sagamore Health Network 35164 COMMERCIAL N

Sage Technologies 37105 COMMERCIAL N

Samaritan Health Plans CP001 COMMERCIAL N

San Diego County Coverage Initiative (CI) MSO77 COMMERCIAL N

San Diego County Medical Services (CMS) MSO11 COMMERCIAL N


Page 57


March 2012


San Diego County Ryan White Care Act MSO33 COMMERCIAL N

San Diego Physicians Call COMMERCIAL N





[email protected]

San Diego Physicians Medical Group Central Region Call COMMERCIAL N





[email protected]

San Joaquin Health Administrators 68035 COMMERCIAL N

San Judas Medical Group IPA HSM01 COMMERCIAL N

San Louis Obispo Select 33072 COMMERCIAL N

Sanford Health Plan 91184 COMMERCIAL N

Sante Health System and Affiliates 77038 COMMERCIAL N

Scan Health Plan Arizona 73172 COMMERCIAL N

Scott & White TH002 COMMERCIAL N

Seabury & Smith COMMERCIAL N

Seaview IPA SVIPA COMMERCIAL N

Secure Health Plans of Georgia LLC 28530 COMMERCIAL N

Secure Horizons Arizona - Claims 95964 COMMERCIAL N






[email protected]

Secure Horizons California - Claims 95959 COMMERCIAL N






[email protected].

Secure Horizons Colorado - Claims 95962 COMMERCIAL N






[email protected]

Secure Horizons Lifeprint Arizona LIFE1 COMMERCIAL N


Page 58


March 2012


Secure Horizons Washington - Claims 95959 COMMERCIAL N






[email protected].

Secure Horizons of Oklahoma - Claims 95959 COMMERCIAL N






[email protected].

Secure Horizons of Oregon - Claims 95959 COMMERCIAL N






[email protected].

Secure Horizons of Texas - Claims 95959 COMMERCIAL N






[email protected].

Security Health Plan 39045 COMMERCIAL N

SeeChange 77024 COMMERCIAL N

Select Administrative Services (SAS) 64088 COMMERCIAL N

Also known as Mississippi

Select Health Care.

Select Benefit Administrators of America 37282 COMMERCIAL N




Ashland WI 54806.

Select Benefit Administrators Inc. 93031 COMMERCIAL N

Select Health of South Carolina 23285 COMMERCIAL N

For EDI support please e-mail

[email protected].

Select Senior Clinic 20415 COMMERCIAL N

SelectCare 14 COMMERCIAL N

SelectCare of Texas (HPN) Heritage Physicians Network 76045 COMMERCIAL N

SelectCare of Texas (Kelsey-Seybold) 61225 COMMERCIAL N

SelectHealth SX107 COMMERCIAL N

SelectHealth was formerly

Intermountain Healthcare

(IHC)


Page 59


March 2012


Self Insured Benefit Administrators (Clearwater FL) 59111 COMMERCIAL N


with a submission address of

18167 US Highway 19 North

Suite 300 Clearwater FL

33764.

Self Insured Plans (Naples FL) 36404 COMMERCIAL N


with a submission address of

1016 Collier Center Way Suite

200 Naples FL 34110. Please

call Customer Service at (239)

403-7884 to verify claims

submission to Self Insured

Plans - Payer ID 36404

(Naples FL).

Self-Funded Plans Inc. 34131 COMMERCIAL N

Sendero Health 36426 COMMERCIAL N

Senior Care Partners 36390 COMMERCIAL N

Senior Health Partners (SHP) 80141 COMMERCIAL N

Senior Health Partners is

effective 05/01/2011.

Sentara Family Care 54154 COMMERCIAL N









Relations at (757) 552-7477.

Sentara Health Management 54154 COMMERCIAL N









Relations at (757) 552-7477.

Sentinel Management Services 23249 COMMERCIAL N


Page 60


March 2012


Sentry Insurance a Mutual Company 39033 COMMERCIAL N

Claims must have the Sentry

Life Insurance Co. Group and

Subscriber Numbers. To

verify you are using the

correct number you may

contact Sentry's Customer

Service Department at 1-800-

426-7234

Sentry Life Insurance Company 39033 COMMERCIAL N








426-7234

Sentry Life of New York 39033 COMMERCIAL N








426-7234

Seoul Medical Group CAPMN COMMERCIAL N

Sequoia Beverage TKFMC COMMERCIAL N

Seton CHIP 76056 COMMERCIAL N

Seton Employee Plan TH080 COMMERCIAL N

Seton Health Plan - Exclusive TH079 COMMERCIAL N

Seton MAP Program TH081 COMMERCIAL N

Seven Corners 25404 COMMERCIAL N

Shasta Administrative Services 75280 COMMERCIAL N Jeld-Wen Claims Only

Sheakley UNICOMP (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Sheet Metal Workers Local 104 Health Care Plan (San Ramon CA)38238 COMMERCIAL N



Box 1618 San Ramon CA

94583.

Sheffield Olson & McQueen Inc Call COMMERCIAL N

Please contact Cate Ahlquist

at Sheffield Olson &

McQueen Inc. prior to

submitting claims

electronically. Phone number

is 651-695-2602

Sierra Family Network (Prospect Medical Group) PROSP COMMERCIAL N


Page 61


March 2012


Sierra Health Services 76342 COMMERCIAL N

Sierra Nevada Medical Association MBA01 COMMERCIAL N

Signature Health Alliance 62159 COMMERCIAL N

Valid only for HCFA-1500

claims currently mailed to

Signature Health Alliance P.O.

Box 22419 Nashville TN

37202-2419.

Significa Benefits Services Inc. 23250 COMMERCIAL N

Silver Cross Managed Care Organization 36387 COMMERCIAL N

Sinclair Health Plan 84076 COMMERCIAL N

Sloans Lake Preferred Health Networks 84096 COMMERCIAL N

Smith Administrators 2057 COMMERCIAL N

Solano Regional Medical Group Call COMMERCIAL P

Sutter Connect requires the

providers to complete an

application & get approval

from us prior to sending

claims to a clearinghouse.

Contact Sutter Connect EDI

Dept @ (800)611-5191 for

payer ID.

Solidarity Managed Care Organization (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Solstice Benefits 76578 COMMERCIAL N

Sound Health (now known as First Choice Health Network)91131 COMMERCIAL N

Soundpath Health 42172 COMMERCIAL N

Formerly known as Puget

Sound Health Partners Inc.

South Central Preferred - PPO York PA (IHS Gateway Payer)Call COMMERCIAL N

Call Jane Grove at Provider

Relations for South Central

Preferred (717) 851-6715

South FL Community Care Network - NBHD 37314 COMMERCIAL N

South Haven Community Hospital Call COMMERCIAL N

South Indiana Health Operations - HMO SX142 COMMERCIAL N

South Indiana Health Options - Prime Care Choice SX143 COMMERCIAL N

South Indiana Health Options - TPA SX144 COMMERCIAL N

South Point Hotel & Casino 35227 COMMERCIAL N

SouthCare/Healthcare Preferred 25147 COMMERCIAL N

SouthCare/Healthcare Preferred 25147 COMMERCIAL N

Southeast Texas Govt Employees Benefit Pool TH116 COMMERCIAL N

Southern Benefit Services 37318 COMMERCIAL N

Southern Benefit Services will

no longer process claims from

the following Provider

Groups: Brockman

Enterprises and SPS

International.


Page 62


March 2012


Southern CA Children's Network (SynerMed) SYMED COMMERCIAL N

Southern Cal Physicians Managed Care Services SCP01 COMMERCIAL N

Southern Health Service Inc. 25133 COMMERCIAL N




Southwest Administrators California SWSTA COMMERCIAL N

Southwest Administrators Nevada SWSTA COMMERCIAL N

Southwest Service Life 37266 COMMERCIAL N

Please enter the unique

policy number or ID card

when submitting claims.



address of PO Box 982005 Ft.

Worth TX 76182.

Special Risk International 52190 COMMERCIAL N

Spectrum Administrators Inc. - TPA Allentown PA (IHS Gateway Payer)23253 COMMERCIAL N

Spina Bifida - VA HAC 84146 COMMERCIAL N

Spohn Health TH100 COMMERCIAL N

St Francis IPA APP01 COMMERCIAL N

St Joseph IPA STJOE COMMERCIAL N

St Jude Yorba Linda STJOE COMMERCIAL N

St. Anthony Memorial Healthcare Centers - MDWISE 35199 COMMERCIAL N




(800) 352-7502

St. Barnabas System Health Plan 22240 COMMERCIAL N

St. Catherine Hospital PHO - MDWISE 35199 COMMERCIAL N




(800) 352-7502

St. Francis Health Network 35199 COMMERCIAL N




(800) 352-7502

St. John's Claims Administration 37264 COMMERCIAL N

St. Joseph Heritage Healthcare STJOE COMMERCIAL N

St. Jude (St. Joseph Heritage Healthcare) STJOE COMMERCIAL N

St. Margaret Mercy Healthcare Centers - MDWISE 35199 COMMERCIAL N




(800) 352-7502

St. Vincent IPA PDT01 COMMERCIAL N


Page 63


March 2012


Star HRG 59225 COMMERCIAL N





30870 30888 54150 30069

55400 Phoenix AZ 85270-

5270.

Starmark 61425 COMMERCIAL N

Starmark 61425 COMMERCIAL N

State Auto Insurance Companies 46450 COMMERCIAL N

State Farm (Casualty & Property Claims) 31059 COMMERCIAL N

State Farm - Property &

Casualty line of business is

Payer ID 31059.

State Farm Insurance Companies 31053 COMMERCIAL N

Payer ID 31053 is for State

Farm - Health line of

business.

State of Texas Dental Plan 57254 COMMERCIAL N

States General Life Insurance 75087 COMMERCIAL N

Sterling Medicare Advantage 67829 COMMERCIAL N

Sterling Option 1 91151 COMMERCIAL N

To register for ERA (sent

directly from Sterling to the

provider) please go to

https://providernet.adminiso

urce.com/. If you have any

questions support is available

by phone at 877-389-1160.

Stoner and Associates (Cincinnati OH) 31121 COMMERCIAL N

Stones River Regional IPA- Windsor 15752 COMMERCIAL N

Student Insurance - Mid-West National Life Insurance Co. of Tenessee74227 COMMERCIAL N





809067 809079 809066

809036 809081 Dallas Tx

75380-9025.

Student Insurance - The MEGA Life & Health Insurance Company74227 COMMERCIAL N





809067 809079 809066

809036 809081 Dallas Tx

75380-9025.


Page 64


March 2012


Suburban Health Organization 35199 COMMERCIAL N




(800) 352-7502

SummaCare Health Plan 95202 COMMERCIAL N

Summerlin Life & Health Insurance 86071 COMMERCIAL N

Summit America Insurance Services Inc. 37301 COMMERCIAL N

Student Accident and

Sickness College Sports and

NASCC claims only

SummitCorp (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Sunshine State Health Plan 68057 COMMERCIAL N

Superior Administrators Inc (Santa Ana CA) 23218 COMMERCIAL N


a submission address of P.O.

Box 27730 Santa Ana CA

92799-7730

Superior Health Plan Texas 39188 COMMERCIAL P



Dept at 1-800-218-7453 to





in a timely manner.

Sutter Delta Medical Group 77318 COMMERCIAL N

Sutter East Bay Medical Foundation 94269 COMMERCIAL N

Sutter Gould Medical Foundation Call COMMERCIAL P







Dept @ (800)611-5191 for

payer ID.

Sutter Independent Physicians Call COMMERCIAL P







Dept @ (800)611-5191 for

payer ID


Page 65


March 2012


Sutter Medical Foundation Call COMMERCIAL P







Dept @ (800)611-5191 for

payer ID.

Sutter Medical Group of the Redwoods Call COMMERCIAL P







Dept @ (800)611-5191 for

payer ID.

Swedish Covenant Hospital 36411 COMMERCIAL N

Synermed SYMED COMMERCIAL N

TASEBA TKFMC COMMERCIAL N

TBT 94304 COMMERCIAL N

TEXAS CHILDRENS HEALTH TXCSM COMMERCIAL N

TN IPA 15750 COMMERCIAL N



BC/BS Tennessee claims.

TOUCHSTONE HEALTH/HEALTH NET SMART CHOICE 13402 COMMERCIAL N

TPAC/Employee Benefit Management Corp 31074 COMMERCIAL N

TR Paul Inc. 37230 COMMERCIAL N

TRIHEALTH PHYSICIAN SOLUTIONS 31144 COMMERCIAL R

Payer registration is required

prior to claims submission.

Forms are located at


nt.

TRIHEALTH PHYSICIAN SOLUTIONS - CONCERN 31143 COMMERCIAL N

TRLHN/AS 98514 COMMERCIAL N

TRLHN/EB 62777 COMMERCIAL N

Talbert Medical Group TALMG COMMERCIAL N

Tall Tree Administrators 88067 COMMERCIAL N

Tarrant Health Services 37228 COMMERCIAL N

Teachers Health Trust 88019 COMMERCIAL N

Team Choice Gold 75139 COMMERCIAL N

Team Choice PNS 75133 COMMERCIAL N

Teamcare 36215 COMMERCIAL N


Page 66


March 2012


Teamster Construction Industry Welfare Trust See Comments COMMERCIAL N


to the payer.

Teamsters Benefit Trust 94304 COMMERCIAL N

Tethys Health Ventures 20212 COMMERCIAL N

Texas Children's Health Plan 76048 COMMERCIAL N

Texas Children's Star Call COMMERCIAL N

Provider ID required for all

THIN payers.

Texas Childrens Health Plan (Medicaid) 75228 COMMERCIAL N

Texas Christus 45210 COMMERCIAL N

Texas HealthSpring 33104 COMMERCIAL N

Texas Premier Plan TH089 COMMERCIAL N

Texas True Choice TH055 COMMERCIAL N

TexasFirst Health Plan (NTX) 13185 COMMERCIAL N

The Care Network/The Savannah Business Group 68423 COMMERCIAL N

The Chesapeake Life Insurance Company - Student Insurance74227 COMMERCIAL N





809067 809079 809066

809036 809081 Dallas Tx

75380-9025.

The City of Odessa 75600 COMMERCIAL N

The Ford Meter Box Company Inc. 37305 COMMERCIAL N

The Health Exchange (Cerner Corporation) 20356 COMMERCIAL N

The Health Plan (Massillon Ohio and St. Clairsville Ohio only)34150 COMMERCIAL N

Services ordered by outside

provider require referring

provider on a HCFA and

attending physician on a UB.

Pease provide physician

name and UPIN if available.

The Health Plan (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

The Healthcare Group 35206 COMMERCIAL N

The Integrity Benefit Group Inc. 58200 COMMERCIAL N

The Loomis Company - TPA Wyomissing PA (IHS Gateway Payer)23223 COMMERCIAL N

The MEGA Life & Health Insurance Company - Insurance Center59221 COMMERCIAL N

Payer ID valid only if the P.O.

Box on the Health ID card

matches the following P.O.

Box: P.O. Box 982009 North

Richland Hills TX 76182


Page 67


March 2012


The MEGA Life & Health Insurance Company - Starbridge StarHRG59225 COMMERCIAL N





30870 30888 54150 30069

55400 Phoenix AZ 85270-

5270.

The MEGA Life & Health Insurance Company - Student Insurance74227 COMMERCIAL N





809067 809079 809066

809036 809081 Dallas Tx

75380-9025.

The MEGA Life & Health Insurance Company-OKC 59227 COMMERCIAL N

If the P.O. Box on the health

ID card matches the following

P.O. Box: P.O. Box 548801

Oklahoma City OK 73154

The National Radiology Network 59087 COMMERCIAL N

Electronic Payer ID for Claims

printed and mailed to payer

The Perfect Health Insurance Co. 13522 COMMERCIAL N

The Physicians Assurance Corp (TPAC) /Employee Benefit Management Corp (EBM31074 COMMERCIAL N

The Preferred Healthcare System (TPHS) - PPO Altoona PA (IHS GatewayPayer)Call COMMERCIAL N



3222

Therapy Review Systems 75305 COMMERCIAL N

This payer id is valid for

contracted Therapy Review

Systems Georgia providers

only.

Thomas H. Cooper SX160 COMMERCIAL N

Three Rivers Health Plans Inc 25175 COMMERCIAL N

Now known as Unison Health

Plan

Time Insurance Company 39065 COMMERCIAL N

Today's Health Wisconsin 20081 COMMERCIAL N

Today's Options (American Progressive and Pyramid Life)48055 COMMERCIAL N

Today's Options powered by CCRX 48055 COMMERCIAL N

Tongass Timber Trust 92620 COMMERCIAL N

Tooling & Manufacturing Association 61425 COMMERCIAL N

Torrance Hospital IPA THIPA COMMERCIAL N

Total Broker Benefits 36342 COMMERCIAL N

f.k.a. Benefit Systems &

Services Inc.

Total Claims Administration 37314 COMMERCIAL N

Total Community Care 31182 COMMERCIAL N

Total Health Management - PBM (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.


Page 68


March 2012


Total Healthcare Inc. 38201 COMMERCIAL N

Touchpoint Health Plan HMO 97910 COMMERCIAL N

Touchstone Health PSO 23856 COMMERCIAL N

Tower Life Insurance Co. 69493 COMMERCIAL N

Town & Country TKFMC COMMERCIAL N

TransAmerica Assurance Company (TLIN3) TH127 COMMERCIAL N

TransAmerica Assurance Company (TLINS) TH126 COMMERCIAL N

TransAmerica Assurance Company (TSAA2) TH124 COMMERCIAL N

TransAmerica Assurance Company (TSAAC) TH125 COMMERCIAL N

TransAmerica Life Insurance Company 59222 COMMERCIAL N





Hills TX 76182.

TransAmerica Occidental Life Insurance (TOLIC) TH128 COMMERCIAL N

TransChoice-Key Benefit Administrators 37284 COMMERCIAL N

Transchoice or TransSmile - First Service Administrator's Inc20807 COMMERCIAL N

Trellis Health Partners 36397 COMMERCIAL N

TriCities IPA PDT01 COMMERCIAL N

Tribute /SelectCare of Oklahoma 73117 COMMERCIAL N

True Choice USA 54210 COMMERCIAL N

True Choice USA TH083 COMMERCIAL N

Trusteed Plans Service Corporation 91078 COMMERCIAL N

Trustmark Insurance Company 61425 COMMERCIAL N

Tufts Health Plan Call COMMERCIAL P

Please contact the Tufts

Health Plan EDI Operations

Department at 888-880-8699

ext. 4042. for payer id.

UBH - United Behavioral Health (Health Plan - HMO) 87726 COMMERCIAL N

UBH - United Behavioral Health (former MetraHealth - UNET)87726 COMMERCIAL N

UCARE of Minnesota SX178 COMMERCIAL N

UICI - Administrators - State of Nevada 74223 COMMERCIAL N

Accepting claims only for the

State of Nevada.

UMC HEALTH PLAN 75130 COMMERCIAL N

UMR - Cincinnati (formerly known as United Medical Resources)31107 COMMERCIAL N

This Payer ID is valid for all

claims addresses on UMR

Member ID cards with a listed

Payer ID of 31107.

UMR - Harrington (formerly known as Harrington Benefit Services-Columbus)95266 COMMERCIAL N Harrington; RE Harrington

UMR - Lexington (formerly known as CommonWealth Administrative Group)37237 COMMERCIAL N

UMR - Onalaska (formerly known as Midwest Security of WI)79480 COMMERCIAL N

UMR - Wausau/UHIS (formerly Fiserv Health - Wausau Benefits/Benesight)39026 COMMERCIAL N


Page 69


March 2012


UMR -Harrington (formerly known as Harrington Benefit Services-Westerville)75196 COMMERCIAL N

Centra; Centra Benefit

Services

UMWA Health & Retirement Funds 52180 COMMERCIAL N

UNICARE 80314 COMMERCIAL N

UNION PACIFIC RAILROAD EMPLOYES Health Systems 87042 COMMERCIAL N

UNITED FOOD & COMM. WORKERS MIDWEST UNIONS 36659 COMMERCIAL N

UNIVERSITY OF MIAMI BEHAVIORAL HEALTH 92579 COMMERCIAL N

UPMC Health Plan 23281 COMMERCIAL N

UPMC Vision Advantage 25184 COMMERCIAL N

US Benefits 93092 COMMERCIAL N

US Family Health Plan (USFHP) TH103 COMMERCIAL N

USAA (United Services Automobile Association) 74095 COMMERCIAL N

Property and Casualty

Division Only

USC Health Services TH021 COMMERCIAL N

USFHP - St. Vincent Catholic Medical Centers of New York13407 COMMERCIAL N

Serving parts of New York

NYC all of New Jersey

Southeastern Pennsylvania

and Western Connecticut.

For member eligibility call 1-

800-241-4848

UT- Altius (UHIN) 25133 COMMERCIAL N

Formerly Payer ID 12X38.


payer ID.

UW Graduate Appointee Plan 91136 COMMERCIAL N



Unified Group Services 35198 COMMERCIAL N

Unified Health Services 62170 COMMERCIAL N

Worker's Compensation

Claims Only.

Unified Physicians Network 34638 COMMERCIAL N


contact Unified Physicians

Claims Department at 847-

763-1700

Uniform Medical Plan/Harrington Benefit Services 75243 COMMERCIAL N

Harrington; Uniform Medical

Plan; Centra

Union Pacific IPA Call COMMERCIAL N





[email protected]

Union Security Insurance Company 70408 COMMERCIAL N

Unison Health Plan/Better Health Plans 62183 COMMERCIAL N

Unison Health Plan/Three Rivers 25175 COMMERCIAL N

United Agriculture Benefit Trust UAGBT COMMERCIAL N


Page 70


March 2012


United Care Medical Network CAPMN COMMERCIAL N

United Healthcare Ovations Insurance Solutions (AARP) 36273 COMMERCIAL N

United Healthcare of River Valley 95378 COMMERCIAL P

Prior to initial submission

provider must first contact

John Deere at (309) 765-1593

- toll free (866) 509-1593 - to

verify NPI registration is

complete

United Medical Alliance 84132 COMMERCIAL N

United Security Life & Health Ins Co 36362 COMMERCIAL N

Please do not submit claims

on or after 1/1/2011 using

payer ID 36362. Claims will

need to be submitted on

paper to United Security Life

and Health PO Box 24655

Seattle WA 98124-0655. For

questions call 1-800-875-

4422.

United of Omaha 71412 COMMERCIAL N

UnitedHealthcare 87726 COMMERCIAL N


[former The Travelers

Travelers Health Network

(HMO & Care Option

Travelers/CGT - PPO

MetraHealth - UNET]


[former MetraHealth

Healthcare Network PPO

New York State Employees

(Empire) Travelers Ins Co

Travelers Plan

Administrators]

UnitedHealthcare Plans of Puerto Rico 87726 COMMERCIAL N

UnitedHealthcare of Alabama 87726 COMMERCIAL N

UnitedHealthcare of Arizona Inc. 87726 COMMERCIAL N

UnitedHealthcare of Arkansas 87726 COMMERCIAL N

UnitedHealthcare of California - Northern California 87726 COMMERCIAL N

UnitedHealthcare of California - Southern California 87726 COMMERCIAL N

UnitedHealthcare of Colorado Inc. 87726 COMMERCIAL N

UnitedHealthcare of Florida 87726 COMMERCIAL N

UnitedHealthcare of Georgia 87726 COMMERCIAL N

UnitedHealthcare of Illinois 87726 COMMERCIAL N

UnitedHealthcare of Kentucky Ltd. 87726 COMMERCIAL N

UnitedHealthcare of Louisiana 87726 COMMERCIAL N

UnitedHealthcare of Mississippi 87726 COMMERCIAL N

UnitedHealthcare of New England 87726 COMMERCIAL N


Page 71


March 2012


UnitedHealthcare of New York (includes New York and New Jersey)87726 COMMERCIAL N

UnitedHealthcare of North Carolina Inc. 87726 COMMERCIAL N

UnitedHealthcare of Ohio 87726 COMMERCIAL N

UnitedHealthcare of Tennessee 87726 COMMERCIAL N

UnitedHealthcare of Texas - Dallas 87726 COMMERCIAL N

UnitedHealthcare of Texas - Houston 87726 COMMERCIAL N

UnitedHealthcare of Upstate New York 87726 COMMERCIAL N

UnitedHealthcare of Utah 87726 COMMERCIAL N

UnitedHealthcare of Virginia 87726 COMMERCIAL N

UnitedHealthcare of Wisconsin Inc. 87726 COMMERCIAL N

UnitedHealthcare of the Mid-Atlantic 87726 COMMERCIAL N

UnitedHealthcare of the Midlands - HMO (Choice Select)87726 COMMERCIAL N

UnitedHealthcare of the Midlands - PPO(Choice PlusSelect PlusSelf Funded)87726 COMMERCIAL N

UnitedHealthcare of the Midwest - Choice Choice Plus Select Select Plus87726 COMMERCIAL N

UnitedHealthcare of the Midwest - Medicare Complete 87726 COMMERCIAL N

Unity Health Insurance 66705 COMMERCIAL N

Before submitting claims

please go to

http://www.unityhealth.com

/Providers/AdminResources/

EDI/index.htm and complete

EDI Sign Up Form and NPI

Appendix A documents.

Univera - Health Care Plan/ChoiceCare Buffalo SX087 COMMERCIAL R

Univera - Pre Paid Health Plan of NY SX086 COMMERCIAL R

Univera - Univera Health Southern Tier SX088 COMMERCIAL R

Univera SSA ENY SX090 COMMERCIAL R

Univera SSA WNY SX091 COMMERCIAL R

Universal Care - California 33001 COMMERCIAL N

Universal Health Care Inc 50528 COMMERCIAL N

The payer ID's of the TH057

and 12t36 will no longer be

active please use the new

payer ID of the 50528 for all

EDI submissions to Emdeon.

University Comp Care (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

University Family Care 9830 COMMERCIAL N

University Family Care - Healthcare Group 7503 COMMERCIAL N

University Family Care - Maricopa Health Plan 9908 COMMERCIAL N

University Health Alliance 99026 COMMERCIAL R

Payer Registration is

required. EDI Enrollment

form is available at

www.emdeon.com

University of Illinois at Chicago Div of Specialized Care for Children37601 COMMERCIAL N


Page 72


March 2012


University of Missouri 25133 COMMERCIAL N


part of Coventry


University of Utah Health Plans SX155 COMMERCIAL N

Upland Medical Group IP056 COMMERCIAL N

Upper Peninsula Health Group (TPA) 37324 COMMERCIAL N

Upper Peninsula Health Plan (Medicaid) 38337 COMMERCIAL N

VA Fee Basis Programs 12115 COMMERCIAL N

VHAMA-WATERSTONE BENEFITS Call COMMERCIAL N

VNS CHOICE Medicare 77073 COMMERCIAL N

Formerly listed as Visiting

Nurses Service

VOLUSIA HEALTH NETWORK 59266 COMMERCIAL N

Valley Baptist Health Plan TH022 COMMERCIAL N

Valley Care IPA VCIPA COMMERCIAL N

Valley Mental Health 94293 COMMERCIAL N

Valley Preferred - PPO Allentown PA (IHS Gateway Payer)23253 COMMERCIAL N

Value Options - Commercial SX173 COMMERCIAL R

Enrollment is required and

forms can be located on


nt

Vantage Health Plan Inc. 72128 COMMERCIAL N

Vantage Health Plan Inc. (Ohio BWC) 31147 COMMERCIAL N


Claims ONLY.

Vantage Medical Group PPM01 COMMERCIAL N

VentureNet Healthcare 86062 COMMERCIAL N

Verdugo Hills Medical Group 66126 COMMERCIAL N

Verity National Group 75256 COMMERCIAL N

Victor Valley IPA VVIPA COMMERCIAL N

Victor Valley IPA VVMG1 COMMERCIAL N

Village Family Practice 73743 COMMERCIAL N

Virginia Medicaid CVAK1 COMMERCIAL N

Virginia Premier Health Plan 54176 COMMERCIAL R

Virginia Premier enrollment

forms located on


nt

Vison Care Incorporated 37297 COMMERCIAL N

Vista Health Plan 25133 COMMERCIAL N



Consolidated payer ID. Plan

name is now Coventry Health

Care of Florida Inc.

Vista Oncology - New Century Infusion Solutions NCH08 COMMERCIAL N


Page 73


March 2012


Viva Health Plan 63114 COMMERCIAL N

VIVA Health requires a

complete member ID number

including suffix on all claim

submissions. Pls use the

following site to verify

member information:

https://estepp.cschcg.com/T

RI_provider/doEntry.jsp

Vytra Healthcare 22264 COMMERCIAL N

WEA Insurance Group 39151 COMMERCIAL N

On 24/7 SR ticket needs to be

opened in order to add

submitter id to approved

table in order to send claims

to this payer

WINhealth Partners/Wyoming Health Solutions 27327 COMMERCIAL N

WPP-ElderCare Wisconsin 77080 COMMERCIAL N

WPS - Tricare for Life SX176 COMMERCIAL N

WPS Commercial SX022 COMMERCIAL R

Subscriber id = 9 digits

Provider id qualifier = G2

WRHN BEECHSTREET COMMERCIAL N

Wabash Memorial Hospital Association 85256 COMMERCIAL N

Washington Teamster Welfare Trust See Comments COMMERCIAL N


to the payer.

Waterstone Benefit Administrators 73155 COMMERCIAL N

Weiss Health Providers 36337 COMMERCIAL N

WellMed TH023 COMMERCIAL N

WellNet Health Plans Call COMMERCIAL N

Please call 1-800-442-1101

for approval and the Payer ID

WellPath 25133 COMMERCIAL N




Wellcare Private Fee for Service Plans 77072 COMMERCIAL N

Wells Fargo Third Party Administrators Inc. 87815 COMMERCIAL N

Wells Fargo Third Party Administrators Inc. (Formerly JSL Administrators)37272 COMMERCIAL N Newnan GA & Fayetteville NC

Wenatchee Valley Medical Center 91064 COMMERCIAL N

West Covina Medical Group 66124 COMMERCIAL N

West Covina Medical Group CMSI1 COMMERCIAL N

West Suburban Health Providers 80942 COMMERCIAL N

WestLake Financial Group Inc. 90560 COMMERCIAL N

Western Grower's Assurance Trust 24735 COMMERCIAL N

Western Grower's Insurance Company 24735 COMMERCIAL N

Western Health Advantage 68039 COMMERCIAL N

Western Health Inc 37306 COMMERCIAL N


Page 74


March 2012


Western Mutual Insurance 37247 COMMERCIAL N

Western Southern Financial Group (Cincinnati OH) 31048 COMMERCIAL N

Western Teamster Welfare Trust See Comments COMMERCIAL N


to the payer.

Weyco Inc. 38232 COMMERCIAL N

William C. Earhart 93050 COMMERCIAL N

Wilson-McShane 41095 COMMERCIAL N

Windsor Medicare Extra 62153 COMMERCIAL N

Wisconsin Auto and Truck Dealers 39200 COMMERCIAL N

Wisconsin Department of Corrections 74101 COMMERCIAL R

Wisconsin Physicians Service - Third Party Pricing SX162 COMMERCIAL N

Women's Integrated Network Inc. (WIN Fertility) 13413 COMMERCIAL N WIN Healthcare

Workers Comp of West Virginia SX067 COMMERCIAL A

Worksite Benefit Services LLC 20333 COMMERCIAL N

World Insurance Company 75276 COMMERCIAL N



electronically

Writers' Guild - Industry Health Plan 23710 COMMERCIAL N

Yale University Heath Plan 60646 COMMERCIAL N

Yavapai County 9829 COMMERCIAL N

Yorba Park STJOE COMMERCIAL N

Yorba Park (St. Joseph Heritage HealthCare) STJOE COMMERCIAL N

iCare Health Options TPA 26054 COMMERCIAL N

webTPA/Community Health Electronic Claims/CHEC 75261 COMMERCIAL N

AmeriHealth - Delaware (Non-HMO Claims) SX074 DE BLUE CROSS/BLUE SHIELD N

AmeriHealth - New Jersey (Non-HMO Claims) SX075 NJ BLUE CROSS/BLUE SHIELD N

Anthem Blue Cross 47198 CA BLUE CROSS/BLUE SHIELD N

California License number

required.

Anthem Blue Cross Blue Shield of Connecticut SB560 CT BLUE CROSS/BLUE SHIELD N

Anthem Blue Cross and Blue Shield (Virginia) SB923 VA BLUE CROSS/BLUE SHIELD N

Always bill with type 1 npi

however there are some

exceptions. Please refer back

to credentialing with Anthem.

Please call Provider

enrollment for credentialing

@ 800-533-1120.

Anthem Blue Cross and Blue Shield - Indiana SB630 IN BLUE CROSS/BLUE SHIELD N

This is for secondary Claim

volume

Anthem Blue Cross and Blue Shield - Kentucky SB660 KY BLUE CROSS/BLUE SHIELD N

This is for secondary Claim

volume

Anthem Blue Cross and Blue Shield of Ohio SB338 OH BLUE CROSS/BLUE SHIELD N

Arkansas Blue Cross and Blue Shield SB520 AR BLUE CROSS/BLUE SHIELD R


Page 75


March 2012


BCBSPA - BlueCard Par Point of Service (POS) SX168 BLUE CROSS/BLUE SHIELD R

No special enrollment

required on Synaptek but

must have the BCBSPA step in

production in provider's

enrollment for claims to go

electronically. This payer id is

to be used for member id

alpha prefixes of:AMS ATS

NJP NRG or YHF.

BLUE CARE NETWORK (BLUE CROSS BLUE SHIELD OF MICHIGAN)SB711 MI BLUE CROSS/BLUE SHIELD N

Blue CHiP of Rhode Island SB871 RI BLUE CROSS/BLUE SHIELD A

Blue Care Family/Anthem Medicaid SB562 CT BLUE CROSS/BLUE SHIELD N

Blue Choice Network SB900 TX BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield - Montana SB751 MT BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield Mississippi State and Teacher EmployeesSB731 MS BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield NC BlueMedicare HMO/PPO Call NC BLUE CROSS/BLUE SHIELD P

This is Blue Cross Blue Shield

NC Medicare Advantage Plan.

Please call BCBSNC

BlueMedicare HMO/PPO

Provider Services Department

at (888)296-9790 option 0 for

electronic claims set up.

Blue Cross Blue Shield Wyoming SB960 WY BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield of Alabama SB510 AL BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield of Arizona SB530 AZ BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of Colorado SB550 CO BLUE CROSS/BLUE SHIELD N

Secondary claims accepted

electronically only when

Medicare is primary.

Blue Cross Blue Shield of Connecticut SB563 CT BLUE CROSS/BLUE SHIELD N (FEP Product)

Blue Cross Blue Shield of Delaware SB570 DE BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of Florida SB590 FL BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of Georgia (Atlanta) SB600 GA BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of Illinois SB621 IL BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of Kansas SB650 KS BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield of Kansas City SB740 MO BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield of Kansas HMO FEP SB651 KS BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield of Kansas HMO Regular SB652 KS BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield of Kansas HMO Senior Plan SB653 KS BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield of Louisiana 23738 LA BLUE CROSS/BLUE SHIELD P

For enrollment information

call (225) 295-2427.


Page 76


March 2012


Blue Cross Blue Shield of Maine SB680 ME BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of Massachusetts SB700 MA BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of Michigan SB710 MI BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of Minnesota SB720 MN BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of Mississippi SB730 MS BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield of Missouri SB741 MO BLUE CROSS/BLUE SHIELD N

NPI only is required when

submitting claims to

BCBSMO. Emdeon requires a

provider set up form to be

completed before initial

claims submission.

Blue Cross Blue Shield of Missouri (Blue Choice) SB742 MO BLUE CROSS/BLUE SHIELD N

NPI only is required when

submitting claims to

BCBSMO. Emdeon requires a

provider set up form to be

completed before initial

claims submission.

Blue Cross Blue Shield of Nebraska SB760 NE BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of Nevada SB765 NV BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of New Hampshire SB770 NH BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of New Mexico SB790 NM BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of North Carolina SB810 NC BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield of North Dakota SB820 ND BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield of Oklahoma SB840 OK BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of Rhode Island SB870 RI BLUE CROSS/BLUE SHIELD A

Blue Cross Blue Shield of South Carolina - Companion HealthcareSX085 SC BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of South Carolina - Companion TechnologiesSB880 SC BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of South Carolina - Consolidated Benefits Inc.SX108 SC BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of South Carolina - Federal Employee Program (FEP)SX084 SC BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of South Carolina - Planned Administrators Inc.SX104 SC BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of South Carolina - State Health PlanSX103 SC BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of South Dakota (Sioux Falls) SB889 SD BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield of Tennessee (Chattanooga HMO Plans)SB891 TN BLUE CROSS/BLUE SHIELD R

Multiple plans. Please call

(423) 755-5717 for plan code

information. Single

Enrollment with BCBSTN

enables electronic claim

submission for all BCBSTN

payer ID's listed (enrollment

is not 'plan specific').


Page 77


March 2012


Blue Cross Blue Shield of Tennessee (Chattanooga) SB890 TN BLUE CROSS/BLUE SHIELD R

Single Enrollment with

BCBSTN enables electronic

claim submission for all

BCBSTN payer ID's listed

(enrollment is not 'plan

specific').

Blue Cross Blue Shield of Tennessee (Memphis) SB892 TN BLUE CROSS/BLUE SHIELD R

Single Enrollment with

BCBSTN enables electronic

claim submission for all

BCBSTN payer ID's listed

(enrollment is not 'plan

specific').

Blue Cross Blue Shield of Texas SB900 TX BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of Vermont SB915 VT BLUE CROSS/BLUE SHIELD N

Blue Cross and Blue Shield United of Wisconsin/Comp CareSB950 WI BLUE CROSS/BLUE SHIELD N

Blue Cross and Blue Shield of Arizona 53589 AZ BLUE CROSS/BLUE SHIELD N

Blue Cross of Idaho Health Services Inc SB612 ID BLUE CROSS/BLUE SHIELD R

Capital Blue Cross - Facility 24705 PA BLUE CROSS/BLUE SHIELD P

Capital Blue Cross/CAIC 23045 PA BLUE CROSS/BLUE SHIELD N

Providers must contact

Capital Blue Cross to enroll at

(800) 874-8433 or by email at

provider.automation@capblu

ecross.com.

CareFirst BlueCross BlueShield MD Region SB690 MD BLUE CROSS/BLUE SHIELD N

CareFirst BlueCross BlueShield NCA Region SB580 DC BLUE CROSS/BLUE SHIELD N

Includes coverage for DC and

Northern Virginia.

Empire Blue Cross and Blue Shield of New York SB803 NY BLUE CROSS/BLUE SHIELD N

Excellus - BCBS Utica Watertown SB806 NY BLUE CROSS/BLUE SHIELD R

Excellus - Blue Cross Blue Shield of Central New YorkSB805 NY BLUE CROSS/BLUE SHIELD R

Excellus - Blue Cross/Blue Shield Rochester Area SB804 NY BLUE CROSS/BLUE SHIELD R

Freedom Blue Medicare Advantage Claims SB942 BLUE CROSS/BLUE SHIELD N

Gateway SX078 PA BLUE CROSS/BLUE SHIELD R

Hawaii Medical Service Association (HMSA) SB971 HI BLUE CROSS/BLUE SHIELD R

Payer requires provider level

testing.

HealthNow - BCBS Northeastern NY SB800 NY BLUE CROSS/BLUE SHIELD R

HealthNow - Blue Cross Blue Shield of Western NY SB801 NY BLUE CROSS/BLUE SHIELD R

Highmark Blue Cross & Blue Shield of Pennsylvania SB865 PA BLUE CROSS/BLUE SHIELD R

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ)22099 NY BLUE CROSS/BLUE SHIELD P

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ)22099 NJ BLUE CROSS/BLUE SHIELD P

Horizon Healthcare of NY 22099 NJ BLUE CROSS/BLUE SHIELD P

Participating Payer - see last

page for definition.

Horizon Healthcare of NY 22099 NY BLUE CROSS/BLUE SHIELD P

Participating Payer - see last

page for definition.

IBC Personal Choice SX083 PA BLUE CROSS/BLUE SHIELD N

Independence Administrators TA720 BLUE CROSS/BLUE SHIELD N


Page 78


March 2012


Inter-County Health Plan SX079 PA BLUE CROSS/BLUE SHIELD R

Keystone Health Plan East SX055 PA BLUE CROSS/BLUE SHIELD N

Keystone Health Plan West SX056 PA BLUE CROSS/BLUE SHIELD R

Medicare Blue SX263 BLUE CROSS/BLUE SHIELD N

Medicare Blue Private SX262 BLUE CROSS/BLUE SHIELD N

Mountain State Blue Cross and Blue Shield SB941 WV BLUE CROSS/BLUE SHIELD P

Testing Required: 25 Claims.

Test claims should be

representative of production

claims.

Regence Blue Cross Blue Shield of Oregon SB850 OR BLUE CROSS/BLUE SHIELD N

Regence Blue Cross Blue Shield of Utah SB910 UT BLUE CROSS/BLUE SHIELD P

Regence Blue Shield of Idaho SB611 ID BLUE CROSS/BLUE SHIELD N

Regence Blue Shield of Washington SB931 WA BLUE CROSS/BLUE SHIELD N

Select Advantage SA704 BLUE CROSS/BLUE SHIELD N

Texas Health Insurance Risk Pool SB900 TX BLUE CROSS/BLUE SHIELD N

Trigon Blue Cross and Blue Shield (Virginia) SB924 VA BLUE CROSS/BLUE SHIELD N

Triple-S Inc. SB980 BLUE CROSS/BLUE SHIELD P

Payer requires enrollment via

forms or by calling 1-787-479-

4067.

WA - Premera Blue Cross SB930 AK BLUE CROSS/BLUE SHIELD R

Payer Enrollment form is

listed under the Alaska BCBS

http://www.emdeon.com/en

rollment/MED/SB930CLMP_2

.pdf

WA - Premera Blue Cross SB930 WA BLUE CROSS/BLUE SHIELD R

Payer Enrollment form is

listed under the Alaska BCBS

http://www.emdeon.com/en

rollment/MED/SB930CLMP_2

.pdf

WellChoice of NJ SB803 NY BLUE CROSS/BLUE SHIELD N

Wellmark BCBS - Medicare COB SB645 BLUE CROSS/BLUE SHIELD N

Use payer id when Medicare

has processed as Primary

Wellmark Blue Cross and Blue Shield of Iowa (IASD) SB640 IA BLUE CROSS/BLUE SHIELD R

Aetna - IL Medicaid 26337 MEDICAID N

Aetna Better Health - PA Medicaid 23228 MEDICAID N

Aetna Better Health Connecticut Medicaid 23225 MEDICAID N

Aetna TX Medicaid & CHIP 38692 MEDICAID N

Alabama Medicaid SKAL0 AL MEDICAID N

Alaska Medicaid SKAK0 AK MEDICAID R

Arizona Medicaid SKAZ0 AZ MEDICAID N

Arkansas Medicaid SKAR0 AR MEDICAID N

Azeros Health Plans Inc. 16644 NY MEDICAID N


Page 79


March 2012


Better Health Plan of Florida 20488 MEDICAID N

Please note for claims

rejections please contact

Better Health of Florida at 1-

800-514-4561 and select the

provider services option.

Blue Choice Medicaid Managed Care 403 MEDICAID N

CBHNP - HealthChoices 65391 MEDICAID N

CHS of America - LA Medicaid plan 61733 MEDICAID N

California Medicaid (Medi-Cal) SKCA0 CA MEDICAID R

Additional Enrollment

Requirement for Providers in

LA County. Please call (916)

636-1000 and ask for LA

County Unit.

Central California Alliance for Health SX169 CA MEDICAID N

Alliance EDI Support Unit -

831-430-5510

Colorado Medicaid SKCO0 CO MEDICAID R

Connecticut Medicaid SKCT0 CT MEDICAID P

DC Medicaid SKDC0 DC MEDICAID N

DC Medicaid SKDC0 MD MEDICAID N

Delaware Medicaid SKDE0 DE MEDICAID R

Florida Medicaid SKFL0 FL MEDICAID R

Georgia Medicaid SKGA0 GA MEDICAID R

Providers must delegate

Emdeon to receive payer

reports by selecting the Trade

Files Download option on the

payer's web portal.

Hawaii Medicaid SKHI0 HI MEDICAID R

Health Network One 65063 MEDICAID N

Idaho Medicaid SKID0 ID MEDICAID P

Illinois Medicaid SKIL0 IL MEDICAID N

Indiana Medicaid SKIN0 IN MEDICAID N

Integral Quality Care 23229 MEDICAID N

Iowa Medicaid SKIA0 IA MEDICAID R

JMH Health Plan Medicaid HMO 16001 MEDICAID N

Kansas Medicaid SKKS0 KS MEDICAID N

Kentucky Medicaid SKKY0 KY MEDICAID P

Unysis is fiscal agent until

11/30/05. After 12/1/05 fiscl

agent will be EDS.

Louisiana Medicaid SKLA0 LA MEDICAID P

Louisiana Medicaid - Ambulance claims SKLA2 LA MEDICAID R

Payer Enrollment required

utilize form for SKLA0 to

complete enrollment for

SKLA2 and SKLA3


Page 80


March 2012


Louisiana Medicaid - DME Claims SKLA1 MEDICAID R




SKLA1

Louisiana Medicaid - KidMed Claims SKLA3 LA MEDICAID R




SKLA2 and SKLA3

MEDICAID ILLINOIS IDPA 621 MEDICAID N

MPlan (Medicaid) 35177 IN MEDICAID N

Edits to mirror current edits

submitted for 1st payer id

95444.

Maine Medicaid SKME0 ME MEDICAID N

MaineCare asks all providers

to re-enroll in MIHMS.

Enrollment forms can be

found

at:https://mainecare.maine.g

ov/Default.aspx

MajestaCare Virginia 26372 MEDICAID N

Maryland Medicaid SKMD0 MD MEDICAID A

Maryland Public Mental Health SX069 MD MEDICAID A

Massachusetts Medicaid SKMA0 MA MEDICAID P

Providers must email

([email protected]

) or fax (617-988-8971) a

letter stating they would like

to submit claims to payer via

Emdeon/WebMD. They must

include their provider ID and

Emdeon's Trading Partner #

of 9900756

MedStar Family Choice 39190 MEDICAID R

Medi-Cal (Vision) SKCA1 CA MEDICAID R

Medicaid New York (eMedNY Test System) SKNYT MEDICAID N

NY Medicaid offers a provider

test enviroment as a platform

to enable providers to test

claims using the same

validation and adjudication

methods as the NY Medicaid

production enviroment.

Michigan Medicaid SKMI0 MI MEDICAID P

Minnesota Medicaid SKMN0 MN MEDICAID P

Mississippi Medicaid SKMS0 MS MEDICAID A

Missouri Medicaid SKMO0 MO MEDICAID N

Montana Medicaid SKMT0 MT MEDICAID N

NYS DOH UCP 14142 MEDICAID N


Page 81


March 2012


Nebraska Medicaid SKNE0 NE MEDICAID R

Nevada Medicaid: First Health Services SKNV0 NV MEDICAID A

New Hampshire Medicaid SKNH0 NH MEDICAID R

New Jersey Medicaid SKNJ0 NJ MEDICAID R

New Mexico Medicaid SKNM0 NM MEDICAID N

New York Medicaid SKNY0 NY MEDICAID R

North Carolina Medicaid SKNC0 NC MEDICAID P

North Dakota Medicaid (Medical) SKND0 ND MEDICAID N

Ohio Medicaid SKOH0 OH MEDICAID N

Oklahoma Medicaid SKOK0 OK MEDICAID N

Oregon Medicaid SKOR0 OR MEDICAID R

Partnership Health of California-CAPHP SX140 CA MEDICAID R

NEW PROVIDERS ONLY: Payer

requires EDI enrollment and

testing. Please see the

following link for more

information:


nt/MED/SX140CLMP.pdf

Pennsylvania Medicaid SKPA0 PA MEDICAID N

Rhode Island Medicaid SKRI0 RI MEDICAID R

Simply Healthcare 27094 MEDICAID N

South Carolina Medicaid SKSC0 SC MEDICAID N

South Dakota Medicaid SKSD0 SD MEDICAID R

Secondary claims note: Only

accepts Medicare Crossover

claims

Tennessee Medicaid SKTN2 TN MEDICAID N

Texas Medicaid SKTX0 TX MEDICAID N

Utah Medicaid SKUT0 UT MEDICAID P

ValueOptions/MBHP (MA Behavioral Health Partnership)43307 MEDICAID R


contact e-

support.Services@valueoptio

ns.com or 888-247-9311

(8am-6pm M-F)

Vermont Medicaid SKVT0 VT MEDICAID P

Virginia Medicaid SKVA0 VA MEDICAID N

WASHINGTON State Dept of LABOR & INDUSTRY SX063 WA MEDICAID R

Provider must reside in the

state of WA

Washington Medicaid (Provider One) SKWA0 WA MEDICAID R

West Virginia Medicaid SKWV0 WV MEDICAID N

Wisconsin Medicaid SKWI0 WI MEDICAID N

Any questions about provider

enrollment should be

directed to the Medicaid WI's

provider helpdesk: 800-947-

9627

Wyoming Medicaid SKWY0 WY MEDICAID R


Page 82


March 2012


ZEPHERELLA 26335 MEDICAID N

AK Medicare Part B (J2) SMAK0 AK MEDICARE R

AL Medicare Part B (J10 - Cahaba) SMAL0 AL MEDICARE R

AR Medicare Part B (J7) SMAR0 AR MEDICARE R

AZ Medicare Part B (J3 - Noridian) SMAZ0 AZ MEDICARE R

CA Medicare Part B North (J1 - PGBA) SMCA1 CA MEDICARE R

CA Medicare Part B South (J1 - PGBA) SMCA2 CA MEDICARE R

Includes coverage for

Southern CA. Please indicate

Southern CA on the WebMD

Envoy Set Up Form.

CO Medicare Part B (J4 - Trailblazer) SMCO0 CO MEDICARE R

CT Medicare Part B (J13 - NGS) SMCT0 CT MEDICARE R

DC Medicare Part B (J12 - Highmark) SMDC0 DC MEDICARE P

Includes coverage for DC and

Northern Virginia.

DE Medicare Part B (J12 - Highmark) SMDE0 DE MEDICARE P

DME Region D (DMERC D) SDMED US MEDICARE P

Educators Mututal Medicare Advantage SX111 MEDICARE N

FL Medicare Part B (J9 First Coast) SMFL0 FL MEDICARE R

FamilyCare Inc 93087 MEDICARE N

GA Medicare Part B (J10 - Cahaba) SMGA0 GA MEDICARE R

HI Medicare Part B (J1 - PGBA) SMHI0 HI MEDICARE R

HMSO-Highline Medical Service Organization 91164 MEDICARE N

Highline Medical Service Organization - PSHP 91161 MEDICARE N

IA Medicare Part B (J5 - WPS) SMIA0 IA MEDICARE R

ID Medicare Part B (J2) SMID0 ID MEDICARE R

IL Medicare Part B (J6) SMIL0 IL MEDICARE P

IN Medicare Part B (J8) SMIN0 IN MEDICARE P

JMH Medicare Advantage 59171 MEDICARE N

KS Medicare Part B (J5 - WPS) SMKS0 KS MEDICARE R

KY Medicare Part B (J15) SMKY0 KY MEDICARE R

LA Medicare Part B (J7) SMLA0 LA MEDICARE R

MA Medicare Part B (J14 - NHIC) SMMA0 MA MEDICARE R

MD Medicare Part B (J12 - Highmark) SMMD0 MD MEDICARE P

ME Medicare Part B (J14 - NHIC) SMME0 ME MEDICARE R

MI Medicare Part B (J8) SMMI0 MI MEDICARE R

MN Medicare Part B (J6) SMMN0 MN MEDICARE R

MO Medicare Part B East (J5 - WPS) SMMO0 MO MEDICARE R

MO Medicare Part B West (J5 - WPS) SMKC0 MO MEDICARE R

New Provider Enrollments

please complete payer

enrollment forms for

SMMO0.


Page 83


March 2012


MO Medicare Part B West (J5 - WPS) SMKC0 KS MEDICARE R

New Provider Enrollments

please complete payer

enrollment forms for

SMMO0.

MS Medicare Part B (J7) SMMS0 MS MEDICARE R

MT Medicare Part B (J3 - Noridian) SMMT0 MT MEDICARE R

Medicare DME (JA - CEDI/NHIC) SDMEA US MEDICARE P

Medicare DME (JB - CEDI/NGS) SDMEB US MEDICARE P

Medicare DME (JC - CEDI/CGS) SDMEC US MEDICARE P

Medicare Plus Blue SX170 MI MEDICARE R

Provider enrolls at

https://editest.bcbsm.com/tp

aLogon.html OR by calling

248-486-2292 opt 1. Emdeon

PSF required.

NC Medicare Part B (J11) SMNC0 NC MEDICARE R

ND Medicare Part B (J3 - Noridian) SMND0 ND MEDICARE R

NE Medicare Part B (J5 - WPS) SMNE0 NE MEDICARE R

NH Medicare Part B (J14 - NHIC) SMNH0 NH MEDICARE R

NJ Medicare Part B (J12 - Highmark) SMNJ0 NJ MEDICARE R

NM Medicare Part B (J4 - Trailblazer) SMNM0 NM MEDICARE R

NV Medicare Part B (J1 - PGBA) SMNV0 NV MEDICARE R

NY Medicare Part B Downstate (J13 - NGS) SMNY0 NY MEDICARE P

NY Medicare Part B Queens (J13 - NGS) SMNY2 NY MEDICARE P

NY Medicare Part B Upstate (J13 - NGS) SMNY1 NY MEDICARE P

OH Medicare Part B (J15) SMOH0 OH MEDICARE R

OK Medicare Part B (J4 - Trailblazer) SMOK0 OK MEDICARE R

OR Medicare Part B (J2 - Noridian) SMOR0 OR MEDICARE R

PA Medicare Part B (J12 - Highmark) SMPA0 PA MEDICARE R

PR Medicare Part B (J9 - First Coast) SMPR0 MEDICARE R

Payer approval required prior

to submitting claims.

PacificSource Medicare 20377 MEDICARE N

RI Medicare Part B (J14 - NHIC) SMRI0 RI MEDICARE R

Railroad Medicare (PGBA) SRRGA US MEDICARE P

RailRoad Medicare requires

EDI registration available

online.

SC Medicare Part B (J11) SMSC0 SC MEDICARE R

SD Medicare Part B (J3 - Noridian) SMSD0 SD MEDICARE R

TN Medicare Part B (J10 - Cahaba) SMTN0 TN MEDICARE R

TX Medicare Part B and Indian Health Services (J4 - Trailblazer)SMTX0 TX MEDICARE A

UT Medicare Part B (J3 - Noridian) SMUT0 UT MEDICARE R

VA Medicare Part B (J11) SMVA0 VA MEDICARE R

Includes coverage for All

Regions (except Northern

Virginia).


Page 84


March 2012


VI Medicare Part B (J9 - First Coast) SMVI0 MEDICARE R

Payer approval required prior

to submitting claims.

VT Medicare Part B (J14 - NHIC) SMVT0 VT MEDICARE R

Virginia Premier Gold SX198 MEDICARE N

WA Medicare Part B (J2 - Noridian) SMWA0 WA MEDICARE R

WI Medicare Part B (J6) SMWI0 WI MEDICARE R

WV Medicare Part B (J11) SMWV0 MEDICARE R

Enrollment is required and

forms and can be located at

www.emdeon.com

WY Medicare Part B (J3 - Noridian) SMWY0 WY MEDICARE R

Humana Military - Tricare South 61125 US CHAMPUS N

Participating Payer for Tricare

South including AL AR FL GA

LA MS OK SC TN and East TX.

Tricare North Region 57106 US CHAMPUS N

TRICARE North Region

includes - CT DE IL IN KY MA

MD ME MI NC NH NJ NY OH

PA RI VA VT WI WV and some

zip codes in IA/MO/TN -

contact Tricare North at (877)

874-2273 for details.

WPS Tricare TriWest SCWI0 US CHAMPUS N West Region

Auto Club Association (ACG) 11983 AUTOMOBILE MEDICAL N

Payer id is for Automobile

Medical MN claims Only. You

and/or your vendor must be

contracted for this

transaction service (Emdeon

Office customers excluded).

Please visit

www.transact.emdeon.com

for info.

Uvalde CISD J1204 WORKERS COMPENSATION N

Payer id is for Workers Comp

TX MN claims Only. You


contracted for this



Please visit


for info.


Page 85


March 2012


''Nova Pro Risk Solutions (San Diego) J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

'Hortica Florist Mutual Insurance 13978 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

AAA Chicago 11983 AUTOMOBILE MEDICAL N

This payer id is for

Automobile Medical claims

Only. You and/or your

vendor must be contracted

for the Automobile Medical



Please visit Emdeon's

transact Website for contacts

and additional informati

AAA Chicago Motor Club 11983 AUTOMOBILE MEDICAL N












Page 86


March 2012


AAA Michigan 11983 AUTOMOBILE MEDICAL N











AAA Minnesota/Iowa 11983 AUTOMOBILE MEDICAL N











AAA Nebraska 11983 AUTOMOBILE MEDICAL N











AAA North Dakota 11983 AUTOMOBILE MEDICAL N


Medical claims Only. You


contracted for this



Please visit


for info.


Page 87


March 2012


AAA Wisconsin 11983 AUTOMOBILE MEDICAL N


Medical claims Only. You


contracted for this



Please visit


for info.

ACIA 11983 AUTOMOBILE MEDICAL N




contracted for this



Please visit


for info.

AIG 19402 WORKERS COMPENSATION N

The above Payer Name(s)

may represent multiple

Accounts (employers). For a

complete list please refer

directly to Emdeon's

published Payer List

at:www.emdeon.com/PayerLi

sts/payerlists.phpSearch the

Payer List using the above

Payer ID(s) to identify them

Abilene ISD Run-Off J1204 WORKERS COMPENSATION N

This payer id is for Workers

Compensation claims in the

State of Texas Only. You


contracted for the Workers

Compensation transaction

service (Emdeon Office

customers excluded). Please

visit

http://transact.emdeon.com/

for conta

Abilene ISD Self-Insured J1121 WORKERS COMPENSATION N


TX claims Only. You and/or

your vendor must be

contracted for this



Please visit


for info.


Page 88


March 2012


Abilene Independent School District J1204 WORKERS COMPENSATION N









visit


for conta

Accuride Corporation TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Alamo Heights I.S.D. J1204 WORKERS COMPENSATION N









visit


for contac

Aledo I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta


Page 89


March 2012


Allianz Global Risk US Insurance Company TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Alvey Systems (AON Risk) TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

America First J1427 WORKERS COMPENSATION N











American Coin Merchandising Inc TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

American Cyanamid TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 90


March 2012


American Hardware Mutual Insurance J1203 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

American National Property and Casualty Company (ANPAC)See Comments AUTOMOBILE MEDICAL N

Please call 1-800-333-2860 if

you would like to submit

claims to ANPAC.

American Specialty Companies TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

American Specialty Ins. / MIB TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Ameriprise Auto & Home Ins. C1004 AUTOMOBILE MEDICAL N




contracted for this



Please visit


for info.

Amica 12287 AUTOMOBILE MEDICAL N




contracted for this



Please visit


for info.


Page 91


March 2012


Atlantic Mutual Insurance 19895 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Auto Club Group 11983 AUTOMOBILE MEDICAL N




contracted for this



Please visit


for info.

Auto Club Group Insurance Company 11983 AUTOMOBILE MEDICAL N




contracted for this



Please visit


for info.

Auto Club Property-Casualty Insurance Company 11983 AUTOMOBILE MEDICAL N




contracted for this



Please visit


for info.

Ayers Trucking J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 92


March 2012


Beall's Inc / Midwest Employers TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Bellville I.S.D. J1204 WORKERS COMPENSATION N









visit


for contac

Benavides I.S.D. J1204 WORKERS COMPENSATION N









visit


for contac

Berkley Specialty Underwriters 25224 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 93


March 2012


Berwind Corporation TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Big Spring I.S.D. J1204 WORKERS COMPENSATION N









visit


for contac

Birdville Independendent School District J1204 WORKERS COMPENSATION N









visit


for conta

Brackett I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta


Page 94


March 2012


Brady I.S.D. J1204 WORKERS COMPENSATION N









visit


for contac

Breckenridge ISD J1204 WORKERS COMPENSATION N









visit


for conta

Brooks County I.S.D. J1204 WORKERS COMPENSATION N









visit


for contac

Brownfield I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta


Page 95


March 2012


Brownfield ISD J1123 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Brownyard Group Inc. (Arch Insurance) TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Brunswick Corporation TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Burleson County Alternative School J1204 WORKERS COMPENSATION N









visit


for contac


Page 96


March 2012


Burleson-Milam Special Svcs Co-Op J1204 WORKERS COMPENSATION N









visit


for contac

Burlington Coat Factory Wareho TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

CAREWORKS ODRC ONLY J1410 WORKERS COMPENSATION N






published Payer List at:

www.emdeon.com/PayerLists

/payerlists.php Search the


Payer ID(s) to identify the

CCMSI J1010 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

CNA Insurance 20443 WORKERS COMPENSATION N


claims Only. You and/or your


for this transaction service

(Emdeon Office customers

excluded). Please visit


for info.


Page 97


March 2012


CVS Pharmacy TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Caldwell I.S.D. J1204 WORKERS COMPENSATION N









visit


for contac

Canyon I.S.D. J1204 WORKERS COMPENSATION N









visit


for contac

Carrizo Springs CISD J1204 WORKERS COMPENSATION N









visit


for contac


Page 98


March 2012


Cendant Corporation TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Centennial Insurance Company 19895 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Center Point ISD J1204 WORKERS COMPENSATION N









visit


for contac

Central Hockey League TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Charming Shoppes Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 99


March 2012


City Of Arlington J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

City Of El Paso J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

City of Plano 13978 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Clarksville ISD J1204 WORKERS COMPENSATION N









visit


for contac

Classic Residence By Hyatt TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 100


March 2012


Coca-Cola Enterprises Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Columbia Sussex Corporation TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

CompTech 13978 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Compass Group Usa Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Contech Construction Products TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 101


March 2012


Continental Airlines TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Convergys Corporation TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Correctional Management Service TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Corrections Corp of America TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Cotulla ISD J1204 WORKERS COMPENSATION N









visit


for contac


Page 102


March 2012


Coworx Staffing LLC TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Crum & Forster Indemnity Company 31348 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Crystal City ISD J1204 WORKERS COMPENSATION N









visit


for contac

Dalhart ISD J1204 WORKERS COMPENSATION N









visit


for conta


Page 103


March 2012


Danaher Corporation TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

De Bartolos Inc TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

De Soto ISD J1204 WORKERS COMPENSATION N









visit


for contac

Del Valle ISD J1204 WORKERS COMPENSATION N









visit


for conta


Page 104


March 2012


Denver City I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Denver City ISD J1124 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Dilley ISD J1204 WORKERS COMPENSATION N









visit


for contac

Directory Distributing Assoc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 105


March 2012


Discover Re (Burger King) TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Dumas I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Dunn-Edwards Corporation TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Dustrol 21407 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Dynamex Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 106


March 2012


EMC Insurance Companies 21407 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

ERMC J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

ESIS TP043 WORKERS COMPENSATION N








for info.

ESIS (First American Insurance Co) TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Eagle Mt-Saginaw ISD J1204 WORKERS COMPENSATION N









visit


for contac


Page 107


March 2012


Edinburg CISD J1204 WORKERS COMPENSATION N









visit


for conta

Edwards Claim Administration J1204 WORKERS COMPENSATION N









visit


for conta

El Paso Community College (Tx Jur) J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

El Paso Water Util Tx Jur J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 108


March 2012


Electric Insurance (EIC) 21261 WORKERS COMPENSATION N








for info.

Employers Insurance Group J1232 WORKERS COMPENSATION N











Employers Mutual Casualty 21407 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Envirosource TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Esurance Inc. 30210 AUTOMOBILE MEDICAL N




contracted for this



Please visit


for info.


Page 109


March 2012


Evolution Insurance Company TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

F.A. Richard & Associates (FARA) TP044 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

FARMERS INSURANCE C1025 WORKERS COMPENSATION N


MN claims Only. You and/or

your vendor must be

contracted for this



Please visit


for info.

FKI Industries Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Factory 2 U J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 110


March 2012


Federated J1297 WORKERS COMPENSATION N











Federated Rural Electric (TX) 13978 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Federated Services Insurance Company 13935 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Fireman's Fund Insurance Company 21873 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Fireman's Fund Insurance Company C1019 AUTOMOBILE MEDICAL N




contracted for this



Please visit


for info.


Page 111


March 2012


Firstcomp J1011 WORKERS COMPENSATION N








for info.

Floresville ISD J1204 WORKERS COMPENSATION N









visit


for contac

Forney ISD J1204 WORKERS COMPENSATION N









visit


for contac

Frank Gates Service Company TP056 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.


Page 112


March 2012


Frenship I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Frenship ISD J1125 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Frio County J1204 WORKERS COMPENSATION N









visit


for conta

Ft Sam Houston ISD J1204 WORKERS COMPENSATION N









visit


for contac


Page 113


March 2012


GAB Robbins Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Gainesville ISD J1204 WORKERS COMPENSATION N









visit


for contac

Gallagher Bassett TP057 WORKERS COMPENSATION N








for info.

Garner I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta


Page 114


March 2012


Gates Corp Dba Gates Rubber Co TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Georgetown ISD J1204 WORKERS COMPENSATION N









visit


for contac

Godley ISD J1204 WORKERS COMPENSATION N









visit


for conta

Golden Corral Corporation TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 115


March 2012


Graford ISD J1204 WORKERS COMPENSATION N









visit


for conta

Grange 10322 AUTOMOBILE MEDICAL N




contracted for this



Please visit


for info.

Graphic Arts Mutual 25984 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Great American Alliance Ins Co. 26832 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Great American Assurance Company 26344 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 116


March 2012


Great American Ins. Co. of N.Y. 22136 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Great American Ins. Company 16691 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Great Divide Insurance 25224 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Gruver I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Gse Lining Technology Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 117


March 2012


Health Partners Managed Care 44547 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Heritage Group TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Hidalgo ISD J1204 WORKERS COMPENSATION N









visit


for conta

Holly Farms Corp. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Household Merch Nni TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 118


March 2012


Housing Authority El Paso (TX) J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Houston Hunters Patrol Inc J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Howard County J1204 WORKERS COMPENSATION N









visit


for conta

Hudspeth County J1204 WORKERS COMPENSATION N









visit


for conta


Page 119


March 2012


Huffman ISD J1204 WORKERS COMPENSATION N









visit


for conta

Hughes Tool Company TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

IDS PROPERTY CASUALTY INSURANCE COMPANY 12504 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Insilco Corp TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Integrity Mutual Insurance Company 10322 AUTOMOBILE MEDICAL N




contracted for this



Please visit


for info.


Page 120


March 2012


Irex Corporation TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Ironworking Contract I.P. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

J B Hunt Transport Inc. J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

JI Specialty Services J1006 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Jones Truck LinesInc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 121


March 2012


Junction ISD J1204 WORKERS COMPENSATION N









visit


for contac

Juvenile Jail Facility Managem TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

KCI Holdings USA TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Karnes City ISD J1204 WORKERS COMPENSATION N









visit


for conta


Page 122


March 2012


Ken Davis Industries Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Kennedale ISD J1204 WORKERS COMPENSATION N









visit


for conta

La Vernia ISD J1204 WORKERS COMPENSATION N









visit


for contac

La Villa ISD J1204 WORKERS COMPENSATION N









visit


for contac


Page 123


March 2012


Lackland ISD J1204 WORKERS COMPENSATION N









visit


for contac

Lago Vista I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Landstar Bco Wc Program TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Levelland I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta


Page 124


March 2012


Levelland ISD J1126 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Lewisville ISD Self-Insured J1122 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Lewisville Independent School District J1204 WORKERS COMPENSATION N









visit


for conta

Liberty Mutual 33600 WORKERS COMPENSATION N












Page 125


March 2012


Liberty-Eylau ISD J1204 WORKERS COMPENSATION N









visit


for conta

Lsg Sky Chefs International TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

MCMC LLC J1007 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Major League Baseball 8 TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 126


March 2012


Marble Falls I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Marlin ISD J1204 WORKERS COMPENSATION N









visit


for contac

Matrix Absence Management TP075 WORKERS COMPENSATION N








for info.

Maxim Crane Works TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 127


March 2012


Mc Donald'S-Mcopco TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Member Select Insurance Company 11983 AUTOMOBILE MEDICAL N




contracted for this



Please visit


for info.

Mendota Insurance Company 33650 AUTOMOBILE MEDICAL N




contracted for this



Please visit


for info.

Mercedes ISD J1204 WORKERS COMPENSATION N









visit


for conta

Metropolitan Property and Casualty Insurance CompanyC1011 AUTOMOBILE MEDICAL N



your vendor must be

contracted for this



Please visit


for info.


Page 128


March 2012


Metropolitan Transit Athority J1238 WORKERS COMPENSATION N











Mexia I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Midland County J1204 WORKERS COMPENSATION N









visit


for conta

Midwest Drywall 21407 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 129


March 2012


Midwest Insurance 10895 WORKERS COMPENSATION N








for info.

Millsap I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Mission CISD J1204 WORKERS COMPENSATION N









visit


for conta

Mission Consolidated Independent School District J1204 WORKERS COMPENSATION N









visit


for conta


Page 130


March 2012


Mitchell Energy & Devel TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Montgomery County Texas J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Moody ISD J1204 WORKERS COMPENSATION N









visit


for contac

Morris Material Handling TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Morrison Health Care Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 131


March 2012


Morton ISD J1127 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Motorist Mutual Insurance J1203 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Muleshoe I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Muleshoe ISD J1128 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Munford Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 132


March 2012


Nacogdoches ISD J1204 WORKERS COMPENSATION N









visit


for conta

Nap Tools 21407 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Natalia ISD J1204 WORKERS COMPENSATION N









visit


for conta

National Interstate (TX) 13978 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 133


March 2012


National Loss Prevention Inc J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

New Caney ISD J1204 WORKERS COMPENSATION N









visit


for conta

New Caney ISD Self-Insured J1204 WORKERS COMPENSATION N









visit


for conta

New York State Insurance Fund (NYSIF) 45052 WORKERS COMPENSATION N


NY claims Only. You and/or

your vendor must be

contracted for this



Please visit


for info.


Page 134


March 2012


Norwood TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Nova Pro Risk Solutions J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Old Republic Insurance Co TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

One Beacon Insurance 20621 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

One Call Medical 22321 WORKERS COMPENSATION N

Orica Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 135


March 2012


Papa John's International Inc TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Paradigm J1001 WORKERS COMPENSATION N








for info.

Pearsall ISD J1204 WORKERS COMPENSATION N









visit


for contac

Peg Discover Re TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Peg Discover Re( Food Merchant) TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 136


March 2012


Pegi-Family Dining TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Perryton I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Phh Fleetamerica TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Plains I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta


Page 137


March 2012


Plemons-Stinnett-Phillips CISD J1204 WORKERS COMPENSATION N









visit


for conta

Poolville ISD J1204 WORKERS COMPENSATION N









visit


for conta

Poth ISD J1204 WORKERS COMPENSATION N









visit


for contac

Potter County J1204 WORKERS COMPENSATION N









visit


for conta


Page 138


March 2012


Preferred Employers TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Preferred Employers Group TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

RIver Road ISD J1204 WORKERS COMPENSATION N









visit


for contac

RSC Insurance Services Ltd. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

RTW (Return to Work) J1202 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.


Page 139


March 2012


Rampart Insurance Company TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Randall County J1204 WORKERS COMPENSATION N









visit


for conta

Recovery & Claim Services AKA Mayo Clinic 41193 WORKERS COMPENSATION N








for info.

Red Oak Independent School District J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Republic Franklin Insurance 12475 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.


Page 140


March 2012


Republic Indemnity J1008 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Residential Services Group TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Restaurant Reinsurance Limited TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Rhone-PoulencInc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Rieth-Riley Construction Company TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 141


March 2012


Risk Transfer Technologies Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Roth Staffing Companies J1056 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Ryder Services Inc. J1009 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

SRS Hilton Worldwide Inc J1237 WORKERS COMPENSATION N











SUA Insurance Company 40134 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.


Page 142


March 2012


SafeCo Insurance 24740 WORKERS COMPENSATION N








for info.

Safety-Kleen Corporation TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

San Angelo ISD J1204 WORKERS COMPENSATION N









visit


for contac

Schlumberger Technology TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Scotts Miracle-Gro Company TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 143


March 2012


Secura J1379 WORKERS COMPENSATION N











Selective 39926 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Seminole I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Silsbee ISD J1204 WORKERS COMPENSATION N









visit


for contac


Page 144


March 2012


Slaton I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Snap-On Incorporated TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Solvay America Inc TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Somerset ISD J1204 WORKERS COMPENSATION N









visit


for contac


Page 145


March 2012


South Plains School WC Program J1204 WORKERS COMPENSATION N









visit


for conta

Southland ISD J1204 WORKERS COMPENSATION N









visit


for conta

Southside ISD J1204 WORKERS COMPENSATION N









visit


for contac

Southwest Airlines J1233 WORKERS COMPENSATION N












Page 146


March 2012


Spearman I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Springtown I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Stant Corporation TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Stockdale ISD J1204 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 147


March 2012


Stratford I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Summit Health Ltd TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Sunray I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta

Swift Transportation TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 148


March 2012


Synder ISD J1204 WORKERS COMPENSATION N









visit


for contac

Tarrant Appraisal District J1204 WORKERS COMPENSATION N









visit


for conta

Texas A&M TAMU A0235 WORKERS COMPENSATION N








for info.

Texas Association of School Boards A0234 WORKERS COMPENSATION N








for info.


Page 149


March 2012


Texas Municipal League IRP A0245 WORKERS COMPENSATION N








for info.

Texas Mutual Insurance Company 22945 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Texas Small Business Pool TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

The Auto Club Group 11983 AUTOMOBILE MEDICAL N




contracted for this



Please visit


for info.

The Beacon Mutual Ins Co J1234 WORKERS COMPENSATION N












Page 150


March 2012


The Hartford J1422 WORKERS COMPENSATION N








for info.

The Scotts Company TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

The Zenith 13269 WORKERS COMPENSATION N








for info.

Total Petroleum Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Travelers 19046 WORKERS COMPENSATION N

Triple A 11983 AUTOMOBILE MEDICAL N




contracted for this



Please visit


for info.


Page 151


March 2012


US Foodservice Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

US National Resources (Aigrm) TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

UTICA (C1027) C1027 AUTOMOBILE MEDICAL N











Underwriters Safety and Claims TP108 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Union Insurance Company of Providence 21407 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 152


March 2012


United Dominion Realty Trust TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

United States Cold Storage TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Unitrin Direct Property & Casualty Company 16063 AUTOMOBILE MEDICAL N




contracted for this



Please visit


for info.

Utica Mutual Insurance Company 25976 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Utica National Insurance Co of Texas 43478 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.


Page 153


March 2012


Vanliners Insurance Company 21172 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.

Vicorp Restaurants Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

WC Solutions J1204 WORKERS COMPENSATION N









visit


for conta

Wal-Mart J1004 WORKERS COMPENSATION N



your vendor must be

contracted for this



Please visit


for info.


Page 154


March 2012


Weatherford I.S.D. J1204 WORKERS COMPENSATION N









visit


for contac

Weimer ISD J1204 WORKERS COMPENSATION N









visit


for contac

White Deer I.S.D J1204 WORKERS COMPENSATION N









visit


for contac

Whiteface C.I.S.D. J1204 WORKERS COMPENSATION N









visit


for conta


Page 155


March 2012


Wyman-Gordon Companies TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Xl Environmental Inc. TP117 WORKERS COMPENSATION N




contracted for this



Please visit


for info.

Yorkstown ISD J1204 WORKERS COMPENSATION N









visit


for contac

Znat Insurance (Zenith National Insurance) 30120 WORKERS COMPENSATION N








for info.

Zurich Farmers J1015 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 156


March 2012


Zurich Insurance NA 16535 WORKERS COMPENSATION N




contracted for this



Please visit


for info.


Page 157

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eClaims Medical Payer List Information