Health-e-Web Payer List Updated: 4/6/2016 - Availity · ADV HUMANA GOLD CHOICE 61101 X X X X X See Humana ... AETNA ASA PPO (SIGNATURE ADMIN) ... Health-e-Web Payer List Updated:

Health-e-Web Payer ListUpdated: 4/6/2016

UPDATED PAYER NAME PAYER ID CODE MEDICAL HOSPITAL DENTAL COB ERA ENROLLMENT REQ

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COMMENTS

1199 NATIONAL BENEFIT

FUND13162 X X X X

360 ALLIANCE PPO GILSBAR 07205 X X

3M CIGNA 62308 X X X X X See Cigna

8th Electrical District 74234 X

A&I BENEFT PLAN ADMIN 93044 X X

AAG BENEFIT PLAN ADMIN 75240 X X X

AARP MEDICARE COMPLETE -

UHC87726 X X X X X See United Healthcare

AARP MEDICARE

SUPPLEMENT - UHC36273 X X X X X See AARP

ABC HEALTH PLAN OF NY 48185 X X

ABRAZO ADVANTAGE

HEALTH PLAN03443 X X

ABRI HEALTHPLAN ABRI1 X

ACCESS ADMINISTRATORS AHS01 X X

ACCESS BEHAVIORAL CARE COACC X

ACCESS IPA CM001 X

ACCESS IPA REGAL X

ACCESS MEDICAL GROUP 95424 X X

ACCESS MEDICARE 19305 X X X

ACCESS ONLY AR BCBS 00520 X X XACCESS PLUS UTMB 76049 X X

ACCLAIM 64071 X X X

ACCLAIM REPRICING 21356 X X X

02/23/2016 Accountable IPA MPM23 X X

ACORDIA NATIONAL 87815 X X X X X See Wells Fargo TPA

ACS CONSULTING SERVICES

INC72467 X

ACS MEDICAID ADDED FEE 77039 X X X X X

ACS MEDICAID ELECTRONIC 77039 X X X X X

ACTIVA BENEFIT SERVICES

LLC38254 X

ADMIN ENTERPRISES,INC 53589 X X XADMINISTRATION SYSTEMS

RESEARCH ASR38265 X X

ADMINISTRATIVE CONCEPTS

INC22384 X X

ADMINONE 37278 X X

ADV HUMANA 61101 X X X X X See Humana

ADV HUMANA GOLD CHOICE 61101 X X X X X See Humana

ADVANCED DATA SOLUTIONS

INC58202 X X

ADVANCED MEDICAL

MANAGEMENTAMM01 X X

COB = Coordination of Benefits: HeW has been informed that any carriers marked with an X in this column will accept secondary electronic claims.

ERA = Electronic Remittance Advice: HeW can receive ERAs on behalf of your organization from any carriers marked with an X in this column.

Enrollment Required = Any carrier with an X marked in this column has an enrollment process, whether for claims and ERAs, or ERAs only.

Updated = Indicates that the recent date the payer was added or updated.

1 www.hewedi.com | 877.565.5457

http://support.availity.com/articles/FAQ/Commercial-1/

http://support.availity.com/articles/FAQ/Commercial-C/

http://support.availity.com/articles/FAQ/Commercial-U/

http://support.availity.com/articles/FAQ/Commercial-A/


http://support.availity.com/articles/FAQ/Arkansas-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Commercial-W/

http://support.availity.com/articles/FAQ/Montana-Payer-EDI-Enrollment/


http://support.availity.com/articles/FAQ/Arizona-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Commercial-H/




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COMMENTS





ADVANTAGE BUCKEYE

COMM HLTH PLAN68056 X X X

ADVANTAGE BY BRIDGEWAY

HLTH SOL68056 X X X

ADVANTAGE HEALTH

SOLUTION35209 X X

ADVANTAGE MED GRP NMM01 X

ADVANTICA 59374 X X

ADVANTRA FREEDOM 25133 X X X X X See Coventry Health Care

ADVANTRA/HEALTH

AMERICA, INC25133 X X X X X

See Coventry Health Care

ADVICA/NORTHEAST

GEORGIA HEALTH13376 X X

ADVICARE 45423 X X

ADVOCATE HEALTH

CENTERS36320 X X X X

ADVOCATE HEALTH

PARTNERS OPERATIONS65093 X X X X

AETNA 60054 X X X X XAETNA AFFORDABLE HEALTH

CHOICES57604 X X X X

See Aetna (payer ID 60054)

AETNA AFFORDABLE HEALTH

CHOICES57604 X X X X

See Aetna (payer ID 60054)

AETNA ASA PPO

(SIGNATURE ADMIN)58730 X

AETNA BETTER HEALTH - PA

MEDICAID23228 X X X X

AETNA BETTER HEALTH (IL) 34734 X X

AETNA BETTER HEALTH

CONNECTICUT MED23225 X X

03/02/2016AETNA BETTER HEALTH OF

KY128KY

AETNA BETTER HEALTH OF

MISSOURI128MO X X X X


NEBRASKA42130 X X


OHIO50023 X X X

AETNA ILLINOIS MEDICAID 26337 X X

AETNA TX MEDICAID AND

CHIP38692 X X

AFFILIATATED DOCTORS OF

ORANGE COUNTYADOCS X

AFFINITY HEALTH PLAN 13334 X X X X

2 www.hewedi.com | 877.565.5457













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FEE APPLIES

COMMENTS





AFFINITY MEDICARE

ADVANTAGE13333 X X

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

ADMIN INC95426 X X

AFL CIO FOOD & BEVERAGE

DEALERS34444 X X

AFMC 86062 X X X

AFTRA HEALTH FUND 13346 X X

AGATE RESOURCES LIPA1 X

AGENCY SERVICES INC 64158 X X

AHPO (Cleveland, OH) 31138 X X

AIG LIFE INSURANCE CO 87726 X X X X X See United Healthcare

ALABAMA BCBS 00510 X X X

ALABAMA MEDICAID ET033 X XALABAMA MEDICAL

SURGICAL06311 X

ALABAMA MEDICARE 10102 X X X

ALAMEDA ALLIANCE 95321 X X XALASKA ELECTRICAL HEALTH

AND WELFARE92600 X X

ALASKA LABORERS

CONSTRUCTION INDU91136 X X

ALASKA MEDICAID ET344 X X X X

ALASKA MEDICARE 00831 X X X X X

ALASKA MEDICARE PART B 00831 X X X XALASKA PIPE TRADES LOCAL

37591136 X X

ALASKA UNITED FOOD &

COMMERCIAL91136 X X

ALICARE 13550 X X

ALIGNMENT HEALTHCARE CCHPC X X

ALL SAINTS COVENANT 39160 X

ALL SAVERS INSURANCE CO 37602 X X

ALLEGIANCE 81040 X X X X X X Does not accept Secondary Institutional Claims

ALLEGIANCE BENEFIT PLAN 81040 X X X X X XDoes not accept Secondary Institutional Claims

ALLEGIANCE BENEFIT PLAN

(INTERMOUNT81040 X X X X X X

Does not accept Secondary Institutional Claims

ALLIANCE ALPHA CARE GOLD ADSL1 X X

ALLIANCE BEHAVIORAL

HEALTHCARE23071 X X X

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http://support.availity.com/articles/FAQ/Alaska-Payer-EDI-Enrollment/








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COMMENTS





ALLIANCE HEALTHPLANS OF

WISCONSIN88461 X X

ALLIANCE PARTNERS 23172 X X

ALLIANCE PPO, INC 52149 X X

ALLIANCE SELECT 81400 X

ALLIANT HEALTH PLANS 58234 X X

ALLIED ADMINISTRATORS 94177 X X

ALLIED BENEFIT SYSTEMS 37308 X X

ALLIED PHYSICIANS NMM01 X

ALOHA CARE ALOHA X X

ALOHACARE ALOHA X XALPHA DATA SYSTEMS 75261 X X

ALTA BATES MEDICAL

GROUPA0701 X X

ALTA HEALTH STRATEGIES 25133 X X X X X See Coventry Health Care

ALTERNATIVE TECHNOLOGY

RESOURCES37231 X X

ALTIUS HEALTH PLANS 25133 X X X X X See Coventry Health Care

AMA INSURANCE AGENCY AMAIA X X

AMALGAMATED LIFE 13550 X X

AMERIBEN SOLUTIONS

BCBSAZ53589 X X X

AMERIBEN SOLUTIONS INC 75137 X X

AMERICAID COMMUNITY

CARE DALLAS FTW27514 X X X

AMERICAID COMMUNITY

CARE FORT WOR27514 X X X

AMERICAID COMMUNITY

CARE HOUSTON27515 X X X

AMERICAID COMMUNITY

CARE MARYLAND27517 X X X

AMERICAID COMMUNITY

CARE NEW JERSEY27516 X X X

AMERICAN ADMIN GROUP 75240 X X X

AMERICAN ADMINISTRATIVE

GROUP - AAG37283 X X X

AMERICAN ADMINISTRATIVE

GRP - AAG75185 X X X

AMERICAN BEHAVIORAL 63103 X X

AMERICAN BEHAVIORAL FEP

ITS63106 X

AMERICAN BENEFIT PLAN

ADMIN BCBSAZ53589 X X X

AMERICAN CHIRO IPA NY 41160 X

AMERICAN CHIRO NETWORK 41161 X

4 www.hewedi.com | 877.565.5457

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FEE APPLIES

COMMENTS





AMERICAN COMMERCIAL

BARGE LINES87726 X X X X X See United Healthcare

AMERICAN FAMILY INS TH095 X

AMERICAN FAMILY

INSURANCE COMPANYAMF11 X X

AMERICAN FAMILY

MEDICARE56071 X X X X

AMERICAN FAMILY PPO 56071 X X

AMERICAN GENERAL 62030 X X X X

AMERICAN HEALTH GROUP AHG99 X

AMERICAN HEALTHCARE

ALLIANCE01066 X X

AMERICAN HERITAGE 77083 X

AMERICAN IMAGING

MANAGEMENT36369 X X

AMERICAN INS ADMIN ET211 X

AMERICAN LIFECARE 72099 X X X

AMERICAN MEDICAL AND

LIFE INS23212 X X

AMERICAN MEDICAL

SECURITY81400 X

AMERICAN NATIONAL

INSURANCE74048 X X

AMERICAN PIONEER

BREVARD PHYSICIANSAPBPN X X

AMERICAN PIONEER SOUTH

FLORIDAAPSFL X X

AMERICAN POSTAL

WORKERS44444 X X

AMERICAN PROGRESSIVE 48055 X X

AMERICAN REPUBLIC INS CO 42011 X X X X

AMERICAN SERVICE LIFE

INSURANCE59227 X X X X

AMERICAN SPECIALTY

HEALTH NETWORKET393 X

AMERICAN WHOLEHEALTH

NETWORKS58213 X

AMERICAN WORKER HEALTH

PLUS37322 X X X

AMERICAS 1ST CHOICE HP

OF SC20553 X X

AMERICAS 1ST CHOICE PH

OF NC26078 X X

AMERICAS 1ST CHOICE S

CAROLINA20553 X X

AMERICAS CHOICE NMA 20029 X

AMERICAS HEALTH CHOICE 21810 X X

5 www.hewedi.com | 877.565.5457







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FEE APPLIES

COMMENTS





AMERICAS TPA 41178 X X

AMERICHOICE OF NEW

JERSEY86047 X X X X

AMERICHOICE OF NEW

YORK, INC86048 X X

AMERICHOICE OF NJ PERS

CARE PLUS86001 X X

AMERICHOICE OF NY PERS

CARE PLUS86002 X X

AMERICHOICE OF PA

MEDICAID AND KI86049 X X X X

AMERICHOICE OF PA PERS

CARE PLUS86003 X X

AMERIGROUP COMM CARE

NM27514 X X X

AMERIGROUP COMMUNITY

CARE27514 X X X

AMERIGROUP CORP AUSTIN

DALLAS FTWOR27514 X X X

AMERIGROUP CORP

GEORGIA27514 X X X

AMERIGROUP CORP

HOUSTON CCSA27515 X X X

AMERIGROUP FLORIDA INC 27519 X X X

AMERIGROUP ILLINOIS OHIO 27518 X X X

AMERIGROUP VIRGINIA 10262 X X

AMERIGROUP/AMERICAID -

FORT WORTH27514 X X X


HOUSTON26374 X X


HOUSTON27515 X X X

AMERIHEALTH DE HMO/PPO

INST23037 X

AMERIHEALTH - DELAWARE 93688 X X X

AMERIHEALTH DISTRICT OF

COLUMBIA77002 X X

For EDI support, please e-mail edi.dc@

amerihealthdc.com or call 1-888-656-2383

AMERIHEALTH - NEW JERSEY 60061 X X X

AMERIHEALTH

ADMINISTRATORS54763 X X X X X

02/10/2016AMERIHEALTH CARITAS

IOWA77075 X X

AMERIHEALTH HMO NEW

JERSEY23037 X X X

AMERIHEALTH MERCY

HEALTH PLAN22248 X X X X

6 www.hewedi.com | 877.565.5457

http://support.availity.com/articles/FAQ/New-Jersey-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Pennsylvania-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Delaware-Payer-EDI-Enrollment/


http://support.availity.com/articles/FAQ/Commercial-A




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FEE APPLIES

COMMENTS





AMERIHEALTH NORTHEAST 77001 X X X X X

Payer effective 3/1/2013 Managed Medicaid Plan part

of the AmeriHealth Caritas Family of Companies.

For EDI Support please email [email protected]

or call 1-877-234-4272

AMERIHEALTH VIP CARE - DC 77007 X X

Amerihealth VIP Select and Amerihealth VIP Care,

payer is effective 1/1/2014, Medicare Advantage Plan

part of the AmeriHealth Caritas Family of Companies.

All claims prior to 1/1/14 will be rejected.

AMERIHEALTH VIP CARE - LA 77006 X X

Amerihealth VIP Select and Amerihealth VIP Care,

payer is effective 1/1/2014, Medicare Advantage Plan

part of the AmeriHealth Caritas Family of Companies.

All claims prior to 1/1/14 will be rejected.

AMERIHEALTH VIP GROUP 22355 X X X X XAMERIKIDS - DALLAS/FT

WORTH26375 X X X X

AMIL/ARIA AMILR X X

ANCHOR BENEFIT

CONSULTING53085 X X X

ANCILLARY BENEFIT

SERVICES86062 X X X

ANGELES IPA 75299 X X

ANTARES MANAGEMENT

SOLUTIONS34192 X X X X

ANTHEM BCBS IN 00630 X X X X

ANTHEM BCBS ME 00680 X X X

ANTHEM BCBS OF NH 00770 X X X

ANTHEM BCBSCO 00050 X X X

ANTHEM BCBSCT 00060 X X X

ANTHEM BCBSNV 00265 X X X X

ANTHEM BCBSVA 00265 X X XANTHEM HEALTH & LIFE

INSURANCE80705 X X X X See Great West Life & Annuity

APA PARTNERS 16140 X X

APEX BENEFIT SVCS 34196 X

APIPA 03432 X X X

APPLECARE MEDICAL MGMT APP01 X

APS HEALTHCARE INC 54160 X X

APWU 44444 X X

AR MEDICARE 07102 X X X XARAZ 16120 X

ARBOR HEALTH PLAN 52312 X X X X

Medicaid Managed Care Plan, part of the

Amerihealth Caritas Family of Companies.For EDI

support, please e-mail

[email protected] or call 1-877-693-

8483.

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http://support.availity.com/articles/FAQ/Indiana-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Maine-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/New-Hampshire-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Colorado-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Connecticut-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Nevada-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Virgina-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Commercial-G/





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COMMENTS





ARCADIAN MANAGEMENT

SYSTEMS77045 X

ARDADIAN MANAGEMENT

SERVICES77045 X

ARIZONA BCBS 53589 X X XARIZONA FOUNDATION

(AFMC)ET352 X

ARIZONA MEDICAID AZMCD X X

ARIZONA MEDICARE 03102 X X X XARIZONA PHYSICIANS IPA 03432 X X

ARIZONA PRIORITY CARE

PLUS27154 X X

ARKANSAS BCBS 00520 X X XARKANSAS BEST

CORPORATION75278 X X X X

ARKANSAS MANAGED CARE

ORG62176 X

ARKANSAS MEDICARE 07102 X X X XARKANSAS MUNICIPAL

LEAGUE71603 X X

ARM GRP 88035 X X

ARNETT HEALTH PLANS 87726 X X X See United Healthcare

ARROYO VISTA FAMILY HLTH

CTRNMM01 X

ARTA HEALTH NETWORK WMM01 X X

ASAGEHA 06603 X X

ASCENDIA HEALTHCARE

MANAGEMENT56192 X

ASHNET ET393 X

ASRM CORPORATION ASRM1 X

ASSOCIATED BENEFITS

CORPORATIONFAABC X

ASSOCIATED THIRD PARTY

ADATPA1 X

ASSOCIATED THIRD PARTY

ADATPA1 X

ASSOCIATES FOR HEALTH

CARE36326 X X

ASSURANT HEALTH 39065 X X X X

ASSURANT HEALTH SULF

FUNDED75068 X X X

Must verify all claims should go Allied Benefit for

Assurant Health self funded groups with plan

effective dates after 5/1/2013

ASSURANT MINIMED-KEY

FAMILY37323 X X

ASSURED BENEFITS

ADMINISTRATORS74240 X X

ASURIS NORTHWEST

HEALTH93221 X X X X

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FEE APPLIES

COMMENTS





ATHENS AREA HEALTH PLAN

SELECT95691 X X

ATHENS AREA HEALTH PLAN

SELECT95961 X X

ATLANTIS HEALTH PLAN 13853 X

ATLAS ADMINISTRATORS ATLAD X X

ATLAS ADMINISTRATORS TH004 X

ATPA ATPA1 X

ATRIO HEALTH PLAN ATRIO X X

AULTCARE MNAUL X XAUSTIN REGIONAL CLINIC

EMPCMSEB X X

AUTOMATED BENEFIT

SERVICES (ABS)38259 X X X

AUTOMATED GROUP

ADMINISTRATION INC37280 X X

AUTOMOTIVE MACHINISTS

LOCAL 28991136 X X

AVALON IPA IP080 X

AVERA ADVANTAGE 48055 X X

AVERA HEALTH PLANS 46045 X X

AVESIS 3RD PARTY 87098 X

AVMED INC 59274 X X X X

Provider must enroll for EFT in order to receive

electronic remittance,

http://www.avmed.org/Providers/Tools/EOP

Enrollement/index.aspx

AWA INSURANCE COMPANY 62324 X

AXA ASSISTANCE USA HAA

PREFERRED PARTNERS65101 X X

AXIA HEALTH MANAGEMENT 58213 X

AXMINSTER MEDICAL GROUP AXM01 X

AZ FOUNDATION FOR

MEDICAL CARE86062 X X X

BAKERSFIELD FAMILY

MEDICAL CENTERBKRFM X

BANKERS UNITED LIFE 74227 X X X

BANKERS UNITED LIFE

STUDENT DIV74227 X X X

BANNER HEALTH OF AZ SX145 X X

BANNER MEDISUN 77078 X X X

BASS ADMINISTRATORS 37248 X X

BC BS MONTANA BCBS X X X X X X

BC BS WYOMING 00960 X X X X X

BC OF CA 47198 X X X

BC OF IDAHO BLUEC X X X X

BC PA 23045 X X X X

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http://support.availity.com/articles/FAQ/Wyoming-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/California-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Idaho-Payer-EDI-Enrollment/




PASS

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FEE APPLIES

COMMENTS





BCBS AL 00510 X X X

BCBS AR 00520 X X X

BCBS AR MEDIPAK 00520 X X X

BCBS AZ 53589 X X X

BCBS CO 00050 X X X

BCBS CT 00060 X X X

BCBS DE INSTITUTIONAL 12B76 X X X

BCBS DE PROFESSIONAL 00570 X X X

BCBS FL 00590 X X X

BCBS GA 00601 X X X

BCBS IA 88848 X X X X

BCBS IN 00630 X X X X

BCBS KANSAS CITY 47171 X X X

BCBS KS 47163 X X X

BCBS KY 00660 X X X

BCBS LA 53120 X X X

BCBS MA SB700 X X X

BCBS MD SB690 X X X

BCBS ME 00680 X X X

BCBS MI 00710 X X X X XBCBS MI BLUE CARE

NETWORK00710H X X X X

BCBS MI FEP 00710F X X X XBCBS MI MEDICARE

ADVANTAGE00710A X X X X

BCBS MN 00720 X X XBCBS MN INST CLAIMS 00220 X X

BCBS MN PROF CLAIMS 00720 X X X

BCBS MO 00241 X X X

BCBS MS 00230 X X X

BCBS NC ET095 X X XBCBS NC MEDICARE

ADVANTAGEET095 X X X

BCBS ND 00820 X X X X

BCBS NE PROFESSIONAL 00760 X X X

BCBS NH 00770 X X X

BCBS NJ 22099 X X X X X

BCBS NM 00790 X X X

BCBS NV 00265 X X X X

BCBS NY CENTRAL 00805 X X XBCBS NY CENTRAL -

FEDERAL 00805A X X X

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http://support.availity.com/articles/FAQ/Florida-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Georgia-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Iowa-Payer-EDI-Enrollment/


http://support.availity.com/articles/FAQ/Kansas-Payer-EDI-Enrollment/


http://support.availity.com/articles/FAQ/Kentucky-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Louisiana-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Massachusetts-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Maryland-Payer-EDI-Enrollment/


http://support.availity.com/articles/FAQ/Michigan-Payer-EDI-Enrollment/




http://support.availity.com/articles/FAQ/Minnesota-Payer-EDI-Enrollment/


http://support.availity.com/articles/FAQ/Missouri-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Mississippi-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/North-Carolina-Payer-EDI-Enrollment/


http://support.availity.com/articles/FAQ/North-Dakota-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Nebraska-Payer-EDI-Enrollment/



http://support.availity.com/articles/FAQ/New-Mexico-Payer-EDI-Enrollment/


http://support.availity.com/articles/FAQ/New-York-Payer-EDI-Enrollment/




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COMMENTS





BCBS NY EMPIRE 00803 X X X

BCBS NY ROCHESTER 00804 X X X(Taxonomy required at Rendering when Group;

required at Billing when Individual)

BCBS OF W NEW YORK 00801 X X XBCBS of WESTERN MO.

KANSAS CITY47171 X X X

BCBS OK 00840 X X X X

BCBS OR 00851 X X X X

BCBS RI RIBLS X X X

BCBS SC 401 X X X

BCBS SD ET099 X X X X01/05/2016 BCBS TEXAS MEDICAID 66001 X X

BCBS TN 00390 X X X

BCBS TX 84980 X X X X

BCBS UTICA WATERTOWN 00806 X X XBCBS UTICA WATERTOWN -

FEDERAL 00806A X X X

BCBS VA ET103 X X X

BCBS VT BCBSVT X X X

BCBS W NEWYORK 00801 X X X

BCBS WASH DC PROF SB580 X X X

BCBS WASHINGTON DC INST 12000 X

03/31/2016BCBS WESTERN NY

HEALTHNOW12M39 X

BCBS WI 00950 X X X

BCBS WNY 00801 X X X

BCBSAZ ZENTH ADMIN 53589 X X X

BCBSMT BCBS X X X X X X

BCBSWV 54828 X X XBCI ADMINISTRATORS INC 49153 X X

BEACON HEALTH

STRATEGIES43324 X X Payer requires group number on each claim.

BEECH STREET

CORPORATION95377 X X

BEHAVIORAL HEALTH

SYSTEMS63100 X X

BELL ATLANTIC 60054 X X X X X See Aetna

BELLA VISTA MED GRP IPA MPM10 X

BENEFIT ADMIN SERVICES 88055 X X

BENEFIT ADMINISTRATIVE

SRVCS (BAS)41205 X X

BENEFIT ADMINISTRATIVE

SYSTEMS36149 X X X X

BENEFIT CONCEPTS 51037 X X X

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http://support.availity.com/articles/FAQ/Oklahoma-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Oregon-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Rhode-Island-Payer-EDI-Enrollment/http:/support.availity.com/articles/FAQ/Rhode-Island-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/South-Carolina-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/South-Dakota-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Tennessee-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Texas-Payer-EDI-Enrollment/




http://support.availity.com/articles/FAQ/Vermont-Payer-EDI-Enrollment/


http://support.availity.com/articles/FAQ/Washington-DC-Payer-EDI-Enrollment/

http://support.availity.com/articles/FAQ/Wisconsin-Payer-EDI-Enrollment/




http://support.availity.com/articles/FAQ/West-Virginia-Payer-EDI-Enrollment/


http://support.availity.com/articles/FAQ/Commercial-B/



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BENEFIT COORDINATORS

CORP25145 X X

BENEFIT MANAGEMENT

ADMIN74266 X X

BENEFIT MANAGEMENT INC

(MO)43178 X X

BENEFIT MANAGEMENT INC

OF KS48611 X X

This payer will only accept medical and hospital

claims for these groups listed: BMI187, BMI219,

BMI234, BMI236, BMI214, BMI241, BMI617, BMI245,

BMI246

BENEFIT MANAGEMENT

SERVICES 56139 X X

BENEFIT MANAGEMENT

SERVICES INC00999 X

BENEFIT MANAGEMENT

SYSTEMS INC (MS)37212 X X

BENEFIT PLAN (CNA) 25133 X X X X X See Coventry Health Care

BENEFIT PLAN ADMIN OF

RENO88027 X X

BENEFIT PLAN ADMIN OF ST

LOUIS MO13310 X X

BENEFIT PLAN ADMIN OF WI 39081 X X

BENEFIT PLAN

ADMINISTRATOR INC37118 X X

BENEFIT PLAN C.N.A 25133 X X X See Coventry Health Care

BENEFIT PLAN MANAGEMENT 37222 X X

BENEFIT PLANNERS INC 74223 X X X

BENEFIT SERVICES INC 34178 X X

BENEFIT SOURCE INC 38257 X X

BENEFIT SYSTEMS AND

SERVICES36342 X X

BENEFIT TRUST LIFE

INSURANCE61425 X X X X See Trustmark Ins Co

BENEFITS, INC 42148 X X

BENESIGHT THE TPA 87265 X X X

BENESYS 37248 X X

BENESYS DENTAL 58102 X X

BEST LIFE & HEALTH INS CO 95604 X X

BETTER HEALTH PLANS INC 62183 X X

BHP - PREFERRED ONE

NETWORK19993 X

BIG LOTS ASSOCIATES

BENEFIT PLANS31074 X X X

BLAIR MILL BCBS PA ET190 X

BLEDSOE TRUST NWADMIN X X

BLOCK VISION INC BV001 X

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THROUGH

FEE APPLIES

COMMENTS





BLOCK VISION OF TEXAS BVTX1 X

BLUE BELL BENEFITS TRUST ECIBB X X

BLUE BENEFIT ADMIN OF MA 03036 X X

BLUE BONNET

ADMINISTRATORS37244 X

BLUE CHIP OF RHODE

ISLANDRICHP X X X

BLUE CHOICE EMPIRE BCBS 00803 X X X

BLUE CHOICE HEALTHPLAN

BCBSSC922 X X

BLUE CHOICE MEDICAID (SC) 00403 X X

BLUE CROSS BLUE SHIELD

MTBCBS X X X X X X

BLUE CROSS GEORGIA INST 3537I X

BLUE CROSS KANSAS CITY

INSTKCBLS X X

BLUE CROSS KANSAS INST KSBLS X X

BLUE CROSS NEBRASKA

INST00260 X X

BLUE CROSS SOUTH

DAKOTA12B33 X X

BLUE CROSS UTAH 12B42 X X

BLUE CROSS WEST VIRGINIA 12B28 X X

BLUE CROSS WNY

COMMUNITY00301 X

BLUE SHIELD HI HIBLS X XBLUE SHIELD ID 00611 X X X

BLUE SHIELD IL 00621 X X X

BLUE SHIELD of CA -INST 94036 X X X

BLUE SHIELD of CA -PROF ET059 X X XBLUE SHIELD of WA 00932 X X

BLUE SHIELD OH PROF 00834 X X X

BLUE SHIELD UT 00910 X X X

BLUEGRASS FAMILY HEALTH 61124 X X

BMC HEALTHNET PLAN 13337 X X

BOILERMAKERS NATIONAL 36609 X X X

BOLLINGER INC BOLL1 X X

BOON-CHAPMAN BENEFIT

ADMINISTRATO74238 X X

BOSTON MEDICAL CNTR

HEALTHPLAN13337 X X

13 www.hewedi.com | 877.565.5457

http://support.availity.com/articles/FAQ/Rhode-Island-Payer-EDI-Enrollment/







http://support.availity.com/articles/FAQ/Utah-Payer-EDI-Enrollment/



http://support.availity.com/articles/FAQ/Illinois-Payer-EDI-Enrollment/



http://support.availity.com/articles/FAQ/Ohio-Payer-EDI-Enrollment/




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FEE APPLIES

COMMENTS





BOTSFORD HEALTH PLAN 38324 X X

BPS, INC 13310 X X

BRAVO HEALTH 52192 X X

BREATHCO/CSL PULMONARY 65005 X

BRIDGESPAN BRIDG X X X XBRIDGESTONE CLAIMS

SERVICE37285 X X

BRIDGEWAY ARIZONA 68069 X X X X XBRITCAY 22286 X X

BROKERAGE CONCEPTS 51037 X X X

BROWN & TOLAND MEDICAL

GROUP94316 X X

BROWN AND TOLAND

MEDICAL GROUPBTSS1 X

BRYAN INDEPENDENT

SCHOOL DISTRICTBRISD X X

BS of NE NEW YORK 00800 X X XBS of PENNSYLVANIA 54771 X

BUCKEYE COMMUNITY

HEALTH PLAN68069 X X X X X

Prior to sending claims, contact payer to verify your

provider info is in their system.

C&0 EMPLOYEES HOSPITAL

ASSOCIATION23708 X

C.N.A MAILHANDLERS 25133 X X X See Coventry Health Care

CAC (CLAIMS ADMIN CORP) 25133 X X X X XSee Coventry Health Care

CAHABA GBA 00011 X X X Contact HeW Enrollment

CAHABA HOME HEALTH

MEDICARE00011 X X X Contact HeW Enrollment

CAL OMPTIMA DIRECT CALOP X X

CALIFORNIA BLUE CROSS 47198 X X X XCALIFORNIA BLUE SHIELD

INST94036 X X X

CALIFORNIA BLUE SHIELD

PROFET059 X

CALIFORNIA HEALTH &

WELLNESS68047 X X X See Comments

Call Provider Services # is 1-877-658-0305 before

sending claims

CALIFORNIA MEDICAID 610442 X X X XCALIFORNIA MEDICARE

NORTH01112 X X X X

CALIFORNIA MEDICARE PART

A01111 X X X

CALIFORNIA MEDICARE

SOUTH01192 X X X X

CANNON COCHRAN

MANAGEMENT37105 X X

CAP MANAGEMENT SYSTEMS 95399 X X X

CAPE HEALTH PLAN 38245 X X X

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FEE APPLIES

COMMENTS





CAPITAL BLUE CROSS 23045 X X

CAPITAL BLUE CROSS -

AMB/FAC24705 X

CAPITAL DISTRICT PHYS HP SX065 X

CAPITAL HEALTH PLAN 95112 X X

CAPITAL INTERNATIONAL

MANAGEMENT SE65067 X

CAPITOL ADMINISTRATORS 68011 X X

CARE 1ST HEALTH PLAN OF

ARIZONA57116 X X

CARE 1ST HEALTH PLAN OF

CA57115 X X

CARE ACCESS HEALTH PLAN

CAHP65062 X X X X See Health Network One

CARE FIRST BCBS MD 12011 X

CARE IMPROVEMENT PLUS 77082 X X

CARE MANAGEMENT GROUP

OF GREATER11331 X

CARECENTRIX 11345 X X X X

Click on the below link to learn more about the

ERA/EFT Enrollment process with CareCentrix.

https://www.carecentrixportal.com/ProviderPortal/ho

mePage.do

Enrollment required prior to claim submission. Please

contact [email protected]

CARECHOICES MICHIGAN

MERCY HLTH PLA38269 X X

CARECORE NATIONAL LLC 14182 X

CAREFIRST BCBS DC 12000 X

CAREFIRST BCBS OF DC/NCA SB580 X X X

CAREFIRST BCBS OF DC/NCA SB580 X X X

CAREFIRST BCBS OF

MARYLANDSB690 X

CARELINK ADVANTRA 25133 X X X X X See Coventry Health Care

CARELINK HEALTH PLAN 25133 X X X X X See Coventry Health Care

CARELINK MEDICAID 25140 X X X

CAREMORE CARMO X

CARENET 25142 X X X

CAREOREGON 93975 X X

CAREPLUS 95092 X X

CAREPLUS ENCOUNTERS 95093 X

CAREPLUS HEALTH PLANS 65031 X X

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FEE APPLIES

COMMENTS





CARESOURCE OF INDIANA 37311 X X

CARESOURCE OF OHIO 31114 X X

CARESOURCE OR 26160 X

CARILION CLINIC MEDICARE

HP77015 X X

CARITEN HEALTHCARE 62073 X X

CARITEN SENIOR HEALTH 62072 X X

CAROLINA CARE PLAN 29076 X X X X X See Medical Mutual of Ohio

CAROLINA HEALTH PLAN, INC 57105 X X

CAROLINA SUMMIT

HEALTHCARE INC56195 X X

CARPENTERS TRUST OF

WESTERN WASHINGTON91131 X X

CATERPILLAR INC 37060 X X

CBCA ADMINISTRATORS 55438 X X

CBHA CAROLINA BEHAV

HLTH ALLIANCE56215 X

CBHNP - HEALTHCHOICES 65391 X X

CCEA 88019 X

CCEA WELFARE BENEFIT

TRUST88019 X

CCN 73159 X X X

CDO TECHNOLOGIES 87065 X X

CDPHP SX065 X

CDS GROUP HEALTH 88022 X X

CEDAR VALLEY COMMUNITY


CEDARS-SINAI MEDICAL

ENCOUNTERS95167 X

CEDARS-SINAI MEDICAL

NETWORK95166 X

CEDI - DMERC ALL REGIONS 05655 X X X X

CELTIC INSURANCE CELTC X

CEMENT MASON &

PLASTERERS HEALTH91136 X X

CENCAL HEALTH INST 99111 X

CENCAL HEALTH PROF 98386 X

CENPATICO BEHAVIORAL

HEALTH AZ68048 X X X

CENPATICO GEORGIA 68050 X X X

CENPATICO INDIANA 68052 X X X

CENPATICO KENTUCKY 68068 X X X

CENPATICO MISSOURI 68068 X X X

CENPATICO SOUTH

CAROLINA68059 X X X

CENTENE ADVANTAGE

PLANS68056 X X X

16 www.hewedi.com | 877.565.5457

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http://www.availity.com/documents/hew/05655_P_C&E_DMERC_MAC_Jurisdiction_ABCD.pdf



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FEE APPLIES

COMMENTS





CENTERLIGHT HEALTHCARE 13360 X X

CENTINELA VALLEY IPA MPM03 X

CENTRA BENEFITS HOUSTON 75196 X X

CENTRAL BENEFITS DALLAS 75243 X X X

CENTRAL BENEFITS LIFE 31118 X X X X X

CENTRAL BENEFITS MUTUAL 31118 X X X X X

CENTRAL BENEFITS

NATIONAL31118 X X X X X

CENTRAL CA ALLIANCE OF

HEALTHCCA01 X X X X

CENTRAL MASS HEALTH

CARE02041 X X X

CENTRAL RESERVE LIFE 34097 X X X XCENTRAL STATES HEALTH 36215 X X

CENTRAL STATES JOINT

BOARD37214 X X

CENTURY HEALTH

SOLUTIONS48120 X X

CHA-COMMONWEALTH

HEALTH ALLIANCE23171 X X

CHAMPUS 99726 X X X X X See your specific state for enrollment forms

CHAMPUS TRICARE NORTH 57106 X X X XSee your specific state for enrollment forms

CHAMPUS TRICARE SOUTH 61125 X X X XSee your specific state for enrollment forms

CHAMPVA 84146 X X X X XCHATWINS HEALTHCARE

ADMINISTRATORSCHAT1 X X

CHAUTAUQUA COUNTY

HEALTHCARE PLAN16600 X X

CHEC 75261 X X

CHEC - A SUBSIDIARY OF

SPRINTCHECS X

CHESTERFIELD RESOURCES 34154 X X

CHICAGO LABORERS HEALTH

AND WELFARECLW99 X

CHILDREN FIRST MED

GROUP94321 X

For questions regarding claim status, providers will

need to contact payer: CFMG Provider Customer

Service 510-428-3154

CHILDRENS HOSPITAL

ORANGE COUNTY33065 X X

CHINESE COMMUNITY


CHINESE COMMUNITY


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FEE APPLIES

COMMENTS





CHIP- CHOICEONE UTMB UHSCH X X

CHIP DRISCOLL CHILDRENS

HEALTH PLANDCHCH X X

CHIP- SETON HP SHPCH X X

CHIPA - COLLEGA HEALTH

IPACHIPA X

CHIROPRACTIC CARE OF MN ACN01 X

CHN EBMS CHNEBMS X X

CHN MARSH CHNMARSH X X

CHN MBA CHNMBA X X

CHN NRECA CHNNRECA X X

CHN WCH CHNWCH X X

CHN WMI 91131 X X

CHOICE 65 (MEM SISTER OF

CHARITY)MSC22 X

CHOICE PLUS 60054 X X X X X See Aetna

CHP DIRECT SUPERMED 90441 X X

CHRISTIAN BROTHERS

SERVICES38308 X X

CHRISTIAN CARE MINISTRIES

- MEDISHARE59355 X X

CIGNA 62308 X X X X X

CIGNA - HEALTHSPRING 52192 X X X X See Bravo Health

CIGNA BEHAVIORAL HEALTH SX071 X X

CIGNA HOME HEALTH


CIGNA SENIOR HEALTH PLAN 86033 X X

CIMARRON SALUD 09824 X X X

CINCINNATI FINANCIAL CORP 46871 X

CITRUS HEALTH TH130 X X

CITY OF AMARILLO COA01 X

CITY OF ODESSA 75600 X X

CITY OF WICHITA FALLS 37251 X X

CL FRATES CLFR2 X

CLAIM MANAGEMENT

SERVICES INC39141 X X

CLAIMSWARE INC 57080 X X

CLARENDON KIDS CHIP

PROGSHP11 X X

CLEAR CHOICE 77201 X

CLEARCHOICE HEALTH PLAN 77201 X

CMCS ADVANTAGE HLTH

SOLUTIONS MCARE35219 X X

CMDP CMDP1 X

CMHC 02041 X X X

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FEE APPLIES

COMMENTS





CNA HEALTH PARTNERS

REPRICING48153 X X

CNA MAILHANDLERS 25133 X X X X X See Coventry Health Care

CNIC 37227 X X

CO ROCKY MTN HEALTH

PLANRMHMO X X X X

COAST HOTELS & CASINO

INC37310 X

COASTAL ADMINISTRATIVE

SVC77052 X X

COIHS 77201 X

COLONIAL HEALTHCARE 37123 X X X

COLORADO ACCESS 84129 X

COLORADO BCBS 00050 X X XCOLORADO HEALTH INS

COOPERATIVE49718 X

COLORADO KAISER

PERMANENTECOKSR X X X X

COLORADO MEDICAID 77016 X X XCOLORADO MEDICARE PART

A04111 X X

COLORADO MEDICARE PART

B04102 X X X X

COLUMBIA CORNELL CARE

LLC25351 X X

COLUMBIA UNITED

PROVIDERS91162 X X

COLUMBINE HEALTH PLAN CHP02 X

COMMERCE BENEFIT GROUP 34181 X X

COMMONWEALTH

ADMINISTRATORSCATPA X X

COMMONWEALTH CARE

ALLIANCE14315 X X

COMMUNITY CARE

BEHAVIORAL HEALTH25179 X X

COMMUNITY CARE BHO 23282 X X

COMMUNITY CARE MANAGED


COMMUNITY CARE

ORGANIZATION39126 X

COMMUNITY CARE PLUS 71079 X X

COMMUNITY CHOICE OF

MICHIGAN38325 X X

COMMUNITY FIRST COMMF X X

COMMUNITY FIRST TH005 X

COMMUNITY HEALTH

ALLIANCE TN27905 X X

COMMUNITY HEALTH CHOICE 48145 X X

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COMMENTS





COMMUNITY HEALTH ELEC

CLMS75261 X X

COMMUNITY HEALTH NTWRK

CT62149 X X

COMMUNITY HEALTH PLAN

NY23742 X

COMMUNITY HEALTH PLAN

WACHPWA X X X

COMMUNITY HEALTH

SOLUTIONS (LA)CLA11 X

COMMUNITY PREMIER FOR

NEIGHBORHOOD32481 X X

COMMUNITY PREMIER PLUS 32481 X X

COMP OHIO (AUSTINTOWN) 34177 X X

COMPANION HEALTHCARE 401 X

COMPCARE 95192 X X

COMPDATA 98919 X

COMPDATA MEDICAID CDATM X

COMPDATA ONLY AETNA,

CIGNA, UHC98920 X Used for MT COMPdata only claims

COMPDATA ONLY

ALLEGIANCE00012 X Used for MT COMPdata only claims

COMPDATA ONLY BCBSMT 751 X Used for MT COMPdata only claims

COMPDATA ONLY CHAMPUS 98914 Used for MT COMPdata only claims

COMPDATA ONLY

COMMERCIAL98919 X Used for MT COMPdata only claims

COMPDATA ONLY

COMMERCIAL HMO98925 X Used for MT COMPdata only claims

COMPDATA ONLY EBMS 00010 X Used for MT COMPdata only claims

COMPDATA ONLY INDIAN

HEALTH SVCS98940 X Used for MT COMPdata only claims

COMPDATA ONLY

INTERMOUNTAIN ADMINIS00012 X Used for MT COMPdata only claims

COMPDATA ONLY

MAILHANDLERS00019 X Used for MT COMPdata only claims

COMPDATA ONLY MEDICAID 98916 X Used for MT COMPdata only claims

COMPDATA ONLY MEDICAID

MANAGED CARE98935 X Used for MT COMPdata only claims

COMPDATA ONLY MEDICARE 98910 X Used for MT COMPdata only claims

COMPDATA ONLY MEDICARE

MANAGED CARE98945 X Used for MT COMPdata only claims

COMPDATA ONLY MISC

COMMERCIAL98919 X

COMPDATA ONLY MUST 00012 X Used for MT COMPdata only claims

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FEE APPLIES

COMMENTS





COMPDATA ONLY NEW WEST 00008 X Used for MT COMPdata only claims

COMPDATA ONLY SELFPAY 98918 X Used for MT COMPdata only claims

COMPDATA ONLY WORK

COMP98950 X Used for MT COMPdata only claims

COMPLEMENTARY

HEALTHCARE PLANS93101 X

COMPREHENSIVE

BEHAVIORAL CARE59314 X X

COMPREHENSVE BENEFITS

ADMIN03036 X X

COMPSYCH CHICAGO 37363 X

03/02/2016 CONCORDIA CARE INC 33632 X X

CONFEDERATION LIFE INS 80667 X X

CONNECTICARE INC 06105 X X

CONNECTICARE MEDICARE 78375 X X

CONNECTICUT BCBS 00060 X X XCONNECTICUT GENERAL

CIGNA62308 X X X X X See Cigna

CONNECTICUT GENERAL

MEDICAL CLAIMS62308 X X X X X See Cigna

CONNECTICUT GENERAL

MENTAL HEALTH02331 X

CONNECTICUT MEDICAID ET304 X X X

CONNECTICUT MEDICARE 13102 X X X XCONSOCIATE GROUP 37135 X X

CONSOLIDATED ASSOCIATES 75284 X X

CONSOLIDATED GROUP HPS 04274 X

CONSOLIDATED HEALTH

PLAN87843 X X

CONSUMER MUTUAL OF

MICHIGAN58112 X X

CONSUMERS CHOICE

HEALTH SC45321 X X

CONSUMERS LIFE

INSURANCE CO29076 X X X X X

See Medical Mutual of Ohio

CONTINENTAL GEN INS CO -

MEDICARE SUPPLEMENT13193 X X

CONTINENTAL GENERAL

INSURANCE CO71404 X X X X

CONTINUUM ABC MSO 13397 X

COOK CHILDRENS STAR

PLANCCHP1 X X

COOK CHILDRENS STAR

PLANCCHP9 X

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COOK GROUP HEALTH PLAN 35149 X X

COOPERATIVE BENEFIT

ADMINISTRATOR52132 X X X X X

COORDINATED BENEFIT

PLAN14829 X X X

COORDINATED MEDICAL

SPECIALISTS58204 X X

CORE ADMINISTRATIVE

SERVICES58231 X

CORE MANAGEMENT

RESOURCES GROUP58231 X

CORESOURCE OF AZ & MN 35182 X X X XCORESOURCE OF NC 35180 X X

CORESOURCE OF OHIO 35183 X X X

CORESOURCE OF PA MD IL 35182 X X X X X

CORESOURCE, LITTLE ROCK 75136 X X X X

CORNERSTONE BENEFIT

ADMIN35202 X X X

CORPORATE BENEFIT

SERVICES OF AMERI41124 X X

CORPORATE BENEFITS SERV 56116 X

CORPORATE BENEFITS

SERVICE56116 X

CORPORATE SYSTEMS

ADMINISTRATION37246 X

CORRECTCARE INTEGRATED

HEALTHCCIH X X

The abbreviation for the institution should be entered

as the patient’s address in Loop

2010BA, N3 segment. Institution’s city, state

and zip should be entered in Loop 2010BA,

N4 segment. Obtain info from the following

link:

https://www.correctcare.com/portal/Institution%20Ab

breviation%20List.pdf

CORRECTION HEALTH

PARTNERSPHPMC X X

CORRECTIONAL MEDICAL

SERVICES, IN43160 X

CORSOLUTIONS 48146 X

COUNTRY LIFE INSURANCE 62553 X X

COUNTY CARE 60827 X X

COVENANT


COVENANT MGMT SYSTEMS CMSEB X X

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COMMENTS





COVENTRY HEALTH AND LIFE

(OK)25133 X X X X X


COVENTRY HEALTH CARE OF

CAROLINA25133 X X X X



DELAWARE25133 X X X X X



FLORIDA 25133 X X X X X



GEORGIA25133 X X X X X



IOWA25133 X X X X X



KANSAS25133 X X X X X



LOUISIANA25133 X X X X X


COVENTRY HEALTH CARE

WICHITA25133 X X X X X


COVENTRY HEALTH

NEBRASKA25133 X X X X X


COVENTRY HEALTH WICHITA 25134 X X

COX HEALTH PLAN COXHP X

CREATIVE MEDICAL

SYSTEMS64068 X X

CREATIVE PLAN


CRESCENT HEALTH

SOLUTIONS56213 X X X

CROWN LIFE 80705 X X X X See Great West Life & Annuity

CROY HALL MGMT 37266 X X

CT GENERAL CIGNA 62308 X X X X See Cigna

CTI ADMINISTRATORS 42141 X X X

CUSTODY MEDICAL

SERVICESCMS01 X

CUSTOM DESIGN BENEFITS

INC82056 X X

CUSTOMCARE 60054 X X X X X See Aetna

DAKOTACARE DAK01 X

DART MANAGEMENT CORP 06172 X X

DART MEMBER CARE CB987 X X

DC CHARTERED HEALTH

PLAN95748 X

DEAN HEALTH PLAN 39113 X X

DEFINITY HEALTH 64159 X X

DEFINITY SERVICES 64159 X X

DELAWARE BCBS

INSTITUTIONAL12B76 X X

DELAWARE BCBS

PROFESSIONAL00570 X X X

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COMMENTS





DELAWARE CARE 25137 X X

DELAWARE HEALTH PLAN

CONSORTIUM63081 X X

DELAWARE MEDICAID DEMCD X X

DELAWARE MEDICARE 12102 X X X XDELAWARE PHYSICIANS

CARE27009 X X

DELTA HEALTH 94235 X X

DELTA HEALTH SYSTEMS DHS01 X

DENVER HEALTH MEDICAL 84135 X X

DESERET MUTUAL UH105 X X01/12/2016 DESERT MEDICAL GROUP DESRT

DESERT VALLEY MEDICAL

GRPDVMC1 X

DESTINY HEALTH PLAN 36436 X X

DIRECTORS GUILD OF

AMERICA23706 X X

DIVERSIFIED

ADMINISTRATION06102 X

DIVERSIFIED GROUP

ADMINISTRATION25160 X X

DIVERSIFIED GROUP


DIVISION OF SPECIALIZED

CARE FOR CH37600 X

DIVISION OF SPECIALIZED

CARE FOR CH37600 X

DMERC - ALL REGIONS 05655 X X X XDOWNEY SELECT IPA APP01 X

DRISCOLL CHILDRENS

HEALTH74284 X X

DRISCOLL CHILDRENS

HEALTH PLANDCHCH X X

DUNN AND ASSOCIATES

BENEFITS ADMINI35186 X X

E3 HEALTH INC 75232 X X

EAGLE CREEK MEDICAL

PLAZA61101 X X X X X

See Humana

EARLY INTERVENTION

CENTRAL BILLING36434 X

EATON BENEFITS OH 62308 X X X X XEBERLE VIVIAN EV001 X

EBMS 81039 X X X X Does not accept Secondary Institutional Claims

EBMS EBMS X X X Does not accept Secondary Claims

EDUCATORS MUTUAL (EMIA) SX110 X X See Comments Contact EMIA to enroll at 800-362-0533, Opt 2

EHS GROUP HEALTH PLAN 98006 X X

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EIGHTH ELECTRICAL

DISTRICT74234 X

EL PASO FIRST - CHIP EPF03 X X

EL PASO FIRST GROUP

HEALTHEPF08 X X

EL PROYECTO DEL BARRIO

INCMPM04 X

ELDERPLAN 31625 X X X X

ELECTRONIC TRANSMISSION

CORPORATI75260 X

ELLIS CONSULTANTS INC ECISF X X

ELMCO 37253 X X

EMBLEM HEALTH 13551 X X X See GHI New York on FAQ 564 for ERA Enrollment

EMCOMPASS 37110 X X

EMERALD HEALTH NETWORK 34167 X X

EMERGENCY MED SRVCS

FUND - AMMEMS01 X

EMI KP AMBULANCE CLAIMS 59299 X

EMORYCARE 60054 X X X X X See Aetna

EMPHESYS 61101 X X X X X See Humana

EMPIRE BCBS NY 00803 X X X

EMPIRE NY MEDICARE 13202 X X X X

EMPLOYEE BENE MGT CORP 31074 X X X

EMPLOYEE BENEFIT ADMIN &

MGMT95288 X

EMPLOYEE BENEFIT

CONCEPTS INC38241 X X

EMPLOYEE BENEFIT

CONSULTANTS37257 X

EMPLOYEE BENEFIT MGMT

CORP31074 X X X

EMPLOYEE BENEFIT SERV

OF SANANTONIOEBSSA X

EMPLOYEE BENEFIT

SERVICES (SOUTH CA37216 X X X

EMPLOYEE BENEFITS PLAN

ADMIN03036 X X

EMPLOYEE CLAIM ADJ 75184 X X

EMPLOYEE PLANS LLC 35112 X X

EMPLOYEE SECURITY INC 54098 X X

EMPLOYER PLAN SERVICES 74212 X X X

EMPLOYERS COALITION ON

HEALTHMIDSC X

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https://hewrnt.custhelp.com/app/answers/detail/a_id/564







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EMPLOYERS DIRECT HEALTH 75232 X X

EMPLOYERS DIRECT HEALTH

FI75235 X X

EMPLOYERS HEALTH 61101 X X X X X See Humana

EMPLOYERS HEALTH

COOPERATIVEMIDSC X

EMPLOYERS HEALTH

INSURANCE61101 X X X X X

See Humana

EMPLOYERS INS OF WAUSAU 39026 X X X X See UMREMPLOYERS INSURANCE OF

WAUSAU39026 X X X X See UMR

EMPLOYERS MUTUAL INC FL 59298 X X

ENCIRCLE PPO 35206 X X

ENCORE ENCORE GTPA1 X X

ENCORE HEALTH NETWORK 35206 X

ENH MEDICAL GROUP IPA 36364 X X

ENSTAT NATURAL GAS 91136 X X

EQUALITY CARE OF

WYOMING77046 X X X X X

EQUALITYCARE 77046 X X X X XEQUIFAX HEALTHCARE

ADMIN SERVICES75196 X X

EQUIOR 62308 X X X X X See Cigna

EQUITABLE CIGNA 62308 X X X X X See Cigna

EQUITABLE PLAN SERVICES 73126 X X

ERIN GROUP

ADMINISTRATORS, INC23250 X X

ESSENCE HEALTHCARE 20818 X X

EVERCARE 87726 X X X X X See United Healthcare

EVERGREEN HEALTH PLAN 58233 X X

EVOLUTIONS HEALTHCARE

SYSTEMS59313 X X

Payer id valid for only claims with a submission

address of PO Box 5001, Port Richey, FL 34656

EXCLUSICARE 71412 X X X X See Mutual of Omaha Insurance Co

EYE SPECIALISTS OF

ARIZONA75138 X X

F20199 51028 X X FOR MINNESOTA CLIENTS ONLY

FACEY MEDICAL

FOUNDATION95432 X

FACS GROUP 37300 X X

FALLON COMMUNITY HEALTH 22254 X X

FAMILY CARE 60995 X X

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COMMENTS





FAMILY CARE CCO PHD01 X X

FAMILY CARE MEDICAID FCD01 X X X

FAMILY CARE MEDICAID

MENTAL HEALTHFCM01 X X X

FAMILY CARE MEDICARE FCR01 X X X

FAMILY CHOICE MEDICAL IP080 X

FAMILY HEALTH PLAN 96865 X

FARA BENEFIT SERVICES 37289 X X

FARM FAMILY 14140 X X X

FBMC 59069 X X

FEDERATED MUTUAL

HEALTH INSURANCE41041 X X X X

FEP of SC BCBS 402 X

FIDELIS CARE NEW YORK 11315 X

FIDELIS SECURE CARE 77054 X X

FIRST ADMINISTRATORS INC FAMR1 X

FIRST CAROLINE CARE 56196 X X

FIRST CAROLINE CARE 56196 X X

FIRST CHOICE HEALTH

NETWORK91131 X X

FIRST CHOICE HEALTHPLANS

CT14163 X X

FIRST CHOICE MEDICAL

GROUPFCMG1 X

FIRST CHOICE OF MIDWEST 75138 X X

FIRST GREAT WEST LIFE &

ANNUITY80705 X X X X

FIRST HEALTH 25133 X X X X X See Coventry Health Care

FIRST OPTION HEALTH PLAN 22324 X

FIRST PRIORITY HEALTH 23241 X

FIRST PYRAMID LIFE 00520 X

FIRST SOURCE 00520 X

FIRSTCARE 94999 X X

FIRSTCARE TH003 X

FIRSTGUARD HEALTH PLAN 90060 X X

FIRSTGUARD HEALTH PLAN -

MISSOURI90061 X X

FISERV HEALTH -

KANSAS/TENNESSEE62061 X X

FITZHARRIS & COMPANY INC 11244 X

FLEXCARE 60054 X X X X X See Aetna

FLORIDA 1ST 59276 X X

FLORIDA BCBS 00590 X X XFLORIDA HEALTH CHOICE 81400 X

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COMMENTS





FLORIDA HOSPITAL HEALTH 59321 X X X

FLORIDA HOSPITAL


FLORIDA HOSPITAL

WATERMAN EMPLOYE48116 X X

FLORIDA MEDICAID 77027 X X X

FLORIDA MEDICARE 09102 X X X X

FLORIDA POWER AND LIGHT 60054 X X X X XSee Aetna

FLORIDIANCARE BPN APBPN X X

FLORIDIANCARE SOUTH

FLORIDAAPSFL X X

FMH BENEFIT SERVICES INC 48117 X X X X

FORTIS BENEFITS 70408 X X X X

FORTIS INS CO 39065 X X X X See Assurant Health

FORTIS INS CO 39065 X X

FORTIS INSURANCE

COMPANY39065 X X X X See Assurant Health

FOUNDATION HEALTH PLAN 55248 X X X

FOX EVERETT INC 64069 X X

FOX EVERETT LITTON

INGALLS SHIPBL64067 X X

FOX VALLEY MEDICINE SITE

199FVMCH X

FOX VALLEY MEDICINE SITE

451FVMC1 X

FREEDOM BLUE (WV

Providers)71768 X

FREEDOM FIRST 31313 X X

FREEDOM HEALTH PLAN 41212 X X

FREEDOM LIFE INSURANCE

CO62324 X

FRESENIUS MEDICAL CARE

HEALTH PLANFMCHP X X

FRONTPATH 34171 X X

FUTURE CARE IPA FCI01 X

G E H A 44054 X X X XGALVESTON COUNTY

INDIGENT HEALTH30005 X X

GATEWAY HEALTH PLAN 25169 X X X XGATEWAY HEALTH PLAN

MEDICARE ASSURE60550 X X X X

GBA 37283 X X X

GE GROUP


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COMMENTS





GE GROUP LIFE ASSURANCE 67815 X X

GEHA 44054 X X X XGEHA PCIP 57254 X

GEICO INSURANCE GEICO X

GEISINGER HEALTH PLAN 75273 X X X XGEMCARE HEALTH PLAN MCS03 X X

GENERAL AMERICAN LIFE

INS. CO.63665 X X

GENESEE COUNTY MEDICAL

PLAN16112 X

GENESIS HEALTHCARE PROSP X X

GEORGE WASHINGTON

HEALTH PLAN52098 X

GEORGIA BCBS PROF 00601 X X X

GEORGIA BLUE CROSS INST 3537I X

GEORGIA MEDICAID INST 12K05 X X

GEORGIA MEDICAID PROF 77034 X X X

GEORGIA MEDICARE PART B 10202 X X X X

GEORGIA POWER MEDICAL

BENEFITS PL61271 X X X X

GETTYSBURG HEALTH 23274 X

GHC EASTERN WASHINGTON 91121 X X

GHC WESTERN

WASHINGTON91051 X X X

GHI HMO SELECT 25531 X X X

GHI INC PRIVATE INS 13551 X X XGHI MEDICARE PRIVATE FEE

FOR SERVIC22937 X X

GHI NEW YORK 13551 X X X X

GHI NY MEDICARE 13292 X X X X

GHP GROUP HEALTH PLAN 25133 X X X X XSee Coventry Health Care

GIC INDEMNITY PLAN 80314 X X X See Unicare

GILSBAR 07205 X X

GILSBAR, INC 07205 X X X XGLASSWORKERS HEALTH &

WELFARE FUND91136 X X

GLOBAL CARE INC 07689 X X X

GLOBAL CARE MED GRP IPA MPM05 X

GLOBAL EXCEL

MANAGEMENTGEM01 X X

GLOBAL HEALTH GHOKC X X

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COMMENTS





GOLDEN RULE INSURANCE

COMPANY37602 X X

GOLDEN TRIANGLE

PHYSICIAN ALLIANCEGTPA1 X X

GOOD SAMARITAN MED

PRACTICE ASSOCIP086 X X

GOVERNMENT EMPLOYEES

HOSP ASSOCIA44054 X X X X

GOVT EMPLOYEES HEALTH

ASSC45235 X X

GOVT EMPLOYEES HEALTH

ASSOC45275 X X

GRADY HEALTHCARE 58204 X X

GRANT PHYSICIANS

PRACTICE37234 X X

GREAT AMERICAN LIFE INS

CO13193 X X

GREAT LAKES HEALTH PLAN 95467 X X

GREAT WEST HEALTHCARE 80705 X X X X

GREAT WEST LIFE &

ANNUITY INSURANC80705 X X X X

GREAT WEST LIFE &

ANNUITY80705 X X X X

GREATER ORANGE CO MED

GRPNMM01 X

GREATER SAN GABRIEL MED

GRPNMM01 X

GREENTREE 78521 X X

GREENTREE


GROUP ADMINISTRATORS

LTD36338 X X

GROUP AND PENSION

ADMINISTRATORS48143 X

GROUP BENEFIT


GROUP BENEFITS -

LOUISIANA72087 X X X

GROUP HEALTH COOP EAU

CLAIRE95192 X X

GROUP HEALTH COOP

MADISON ENCOUNT39168 X X

GROUP HEALTH

COOPERATIVE EAST91121 X X

GROUP HEALTH

COOPERATIVE MADISON39167 X X

GROUP HEALTH

COOPERATIVE WEST91051 X X X

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COMMENTS





GROUP HEALTH MANAGERS 38194 X X

GROUP HEALTH

NORTHWEST91051 X X X

GROUP HLTH COOP WEST 91051 X X X

GROUP INSURANCE SERVICE 37276 X X

GUARDIAN HEALTHCARE 77010 X X

GUARDIAN LIFE INS COMP OF

AMERICA64246 X X X X

GUNDERSON LUTHERAN

HEALTH PLAN INC39180 X X

H.A.C., INC. 61101 X X X X X See Humana

HAMMERMAN & GAINER 97258 X

HARKEN HEALTH 43313 X X

HARMONY HEALTH PLAN OF

INDIANA36405 X X X

HARRINGTON BEN SRV OK 95266 X X X

HARRINGTON BENEFIT SERV 75196 X X

HARRINGTON BENEFIT

SERVICES95266 X X X

HARRINGTON BENEFIT

SERVICES, INC59142 X X

HARRINGTON BENEFIT SRV 95266 X X X

HARRINGTON EMPLOYEE

BENEFIT SERVICE41198 X X

HARVARD COMMUNITY 04271 X X

HARVARD PILGRIM HEALTH

CARE04271 X X

HAWAII BLUE SHIELD HIBLS X XHAWAII MANAGEMENT

ALLIANCE ASSOCIAT48330 X X X

HAWAII MEDICAID HIMCD X X

HAWAII MEDICAL

ASSURANCE ASSOC/HWMG99208 X X

HAWAII MEDICARE 01202 X X X XHCC LIFE INSURANCE HCCMI X

HCH ADMIN ILLINOIS 37111 X X

HCH ADMINISTRATION 37215 X X

HCHA ALBQ NM SELF

FUNDED37329 X X

HCS HEALTH CLAIMS

SERVICE82018 X X

HDM BENEFIT SOLUTIONS HDMCO X X

HEALTH 1-2-3 INC 23173 X X

HEALTH ADMINISTRATION

SERVICES IN34185 X

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COMMENTS





HEALTH ADVANTAGE 00520 X

HEALTH ALLIANCE

EXCLUSIVE & PLUS23172 X X

04/06/2016 HEALTH ALLIANCE MEDICAL 77950 X X X X

HEALTH ALLIANCE PLAN 38224 X X

HEALTH AMERICA, INC 25126 X X X

HEALTH AND WELFARE FUND

OHIO34564 X

HEALTH

ASSURANCE/HEALTH

AMERICA

25126 X X X

HEALTH CARE ALLIANCE 60054 X X X X X See Aetna

HEALTH CARE NETWORK OF

WISCONSIN42102 X

HEALTH CARE PARTNERS -

AZHCP02 X X

HEALTH CARE PAYERS

COALITION (HCP34193 X X

HEALTH CARE SOLUTIONS

GROUP73147 X X X

HEALTH CARE'S FINEST

NETWORK36335 X X

HEALTH CHOICE

GENERATIONS OF AZ62180 X X X X

HEALTH CHOICE

INTEGRATED CARE OF N. AZ22100 X X

HEALTH CHOICE OF AZ 62179 X X X XHEALTH CONNECTICUT 37263 X X

HEALTH CONNECTIONS MBHC X X

HEALTH COST SOLUTIONS 62111 X X

HEALTH DESIGN PLUS 34158 X X

HEALTH ECONOMIC

LIVELIHOOD PARTNERSHIP

(HELP)

66004 X X X X Enrollment for ERA only

HEALTH ECONOMICS CORP 75196 X X

HEALTH ECONOMICS GROUP 16112 X

02/23/2016 Health Edge 95213 X X

HEALTH FIRST - TYLER, TX 75234 X

HEALTH FIRST HEALTH

PLANS95019 X X

HEALTH FUTURE 30946 X X

HEALTH INFONET HINPAPER X X

HEALTH INSURANCE PLAN

OF NEW YORK55247 X X X X X

HEALTH MARKET CARE

ASSURED62295 X X

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HEALTH MGMT ADMIN TH049 X

HEALTH NET - VA PATIENT

CENTERED COMMUNITY

CARE PROGRAM

68021 X X

The Payor ID 68021 facilitates claim submission to

Health Net Federal Services for services authorized

under the Veterans Affairs Patient-Centered

Community Care Program. Please include the VA

authorization number when submitting claims.

HEALTH NET CA

ENCOUNTERS95570 X

HEALTH NET CALIFORNIA &

OREGON95567 X X X X

See California or Oregon, which is applicable for your

state.

HEALTH NET OF ARIZONA 38309 X X

HEALTH NET PEARL SX185 X X

HEALTH NETWORK ONE 65062 X X X XHEALTH NEW ENGLAND 04286 X

HEALTH ONE BCBSPA 54720 X

HEALTH OPTIONS BCBSFL 00590 X X XHEALTH OPTIONS OF

ILLINOIS INCNAHOI X X

HEALTH PARTNERS - PA 80142 X X

HEALTH PARTNERS MN 00055 X X XHEALTH PARTNERS OF CT 06111 X X

HEALTH PARTNERS OF

KANSAS31478 X X

HEALTH PARTNERS,

JACKSON TN62157 X X

HEALTH PAYMENT SYSTEMS

INC20270 X X

HEALTH PLAN OF MICHIGAN 83253 X X

HEALTH PLAN OF NEVADA 76342 X X

HEALTH PLAN OF NEVADA

ENCOUNTERS76343 X X X

HEALTH PLAN OF SAN

JOAQUIN68035 X X

HEALTH PLAN OF SAN

MATEOSX174 X X

CONTACT PAYER FOR REGISTRATION : ENDRY

LO 650-616-2017 OR KEN COTTRELL 650-616-

2021

HEALTH PLAN SOLUTIONS OF

UTAH87068 X X

HEALTH PLANS INC 44273 X X

HEALTH PLEDGE HMO 95435 X

HEALTH PLUS MICHIGAN 38216 X

HEALTH PLUS PHSB

(BROOKLYN, NY)11324 X X X

HEALTH RISK MANAGEMENT

INC41170 X X

HEALTH SERVICES

MANAGEMENT (HSM)HSM01 X X

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HEALTH SERVICES

PREFERRED HSP BY34167 X X

HEALTH SVCS FOR

CHILDREN SPECIAL NE37290 X X

HEALTH SYSTEMS

INTERNATIONAL ECOH27008 X X

HEALTH VALUE

MANAGEMENT61101 X X X X X See Humana

HEALTHCARE BENEFITS INC 84980 X X

HEALTHCARE DISTRICT

PALM BEACHHCDPB X

HEALTHCARE LA IPA MPM06 X

HEALTHCARE MANAGEMENT

ADMHMA01 X X

HEALTHCARE OPTIONS EPF37 X

HEALTHCARE PARTNERS HCP01 X X

HEALTHCARE PARTNERS IPA 11328 X X

HEALTHCARE RESOURCES

NW56731 X X

HEALTHCARE SOLUTIONS

GROUP73147 X X X

HEALTHCARE USA 128MO X X X X X See AETNA BETTER HEALTH OF MISSOURI

HEALTHCHOICE OF

CONNECTICUT/YALE95376 X X

HEALTHCHOICE OF MEMPHIS 95376 X X

HEALTHCOMP, INC 85729 X X

HEALTHEASE 14163 X X XTaxonomy codes required at both the Billing and

Rendering Provider loops

HEALTHEASE TAMPA 59608 X X X

HEALTHFIRST INC NEW

YORK80141 X X X X X

HEALTHGUARD OF

LANCASTER23226 X X

HEALTHHELP NETWORK INC 59087 X X

HEALTHLINK HMO 96475 X X

HEALTHLINK PPO 90001 X X X

HEALTHNET CA

ENCOUNTERS95568 X

HEALTHNET EMPIRE BCBS 00803 X X XHEALTHNET OF ARIZONA 38309 X X

HEALTHNET OF THE

NORTHEAST06108 X X X X

HEALTHNOW NEW YORK,

INC.55204 X

HEALTHPARTNERS ADMIN 00055 X X X

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COMMENTS





HEALTHPLAN SERVICES

OKLAHOMA59142 X X

HEALTHPLAN SERVICES

TAMPA59140 X

HEALTHPLUS OF LOUISIANA 95009 X X

HEALTHPLUS OF MICHIGAN 38216 X

HEALTHPOWER HMO 31106 X X

HEALTHSCOPE BENEFITS

INC71063 X X

HEALTHSMART ACCEL 75237 X X X

HEALTHSMART PREFERRED

CARE HSPC75250 X X X

HEALTHSOURCE AR 71074 X X

HEALTHSOURCE AR

MEDICARE HMO71075 X X X

HEALTHSOURCE CMHC 02041 X X X

HEALTHSOURCE GA 58210 X X X

HEALTHSOURCE KY 61127 X X X

HEALTHSOURCE

MASSACHUSETTS INC02041 X X X

HEALTHSOURCE ME 01041 X X

HEALTHSOURCE NC 56147 X X X

HEALTHSOURCE NH 02038 X X X

HEALTHSOURCE NORTH

TEXAS75255 X X X

HEALTHSOURCE OH 31141 X X X

HEALTHSOURCE PROVIDENT 68195 X X X

HEALTHSOURCE SC 06119 X X X

HEALTHSOURCE TN 62129 X X X

HEALTHSOUTH MEDICAL

PLAN ADMINIST63086 X

HEALTHSPAN 34092 X X X X See Kaiser Foundation

HEALTHSPAN INC 31434 X X

HEALTHSPRING HMO 25193 X X

HEALTHSPRING HMO

MEDICARE CHOICE63092 X X

HEALTHSTAR INC 36332 X X X

HEALTHWAVE 31472 X X

HEALTHY CT INC 77180 X X

HEALTHY EQUATION HLTHQ X X

HEALTHY PALM BEACH 95827 X

HELP 66004 X X X X Enrollment for ERA only

HEREIU WELFARE PENSION

FUNDS37114 X X

HERITAGE CONSULTANTS 59230 X

HERITAGE IPA HER01 X

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COMMENTS





HERITAGE NEW YORK

MEDICAL GROUP11328 X X

HERITAGE PHYSICIAN

NETWORKTH011 X

HERITAGE PHYSICIAN

NETWORK (HOUSTONHPN11 X X

HERITAGE PROVIDER

NETWORKREGAL X

HFN, INC 36335 X X

HIGHMARK BCBSD HEALTH

OPTIONS INC47181 X X

HIGHMARK COMMERCIAL 37323 X X

HIGHMARK-KEY FAMILY 35145 X X

HILL PHYSICIANS 00046 X

HILLCREST BENEFIT


HIN HINPAPER X X

HIN AMERICAN TRUST

ADMINISTRATORS IHINPAPER X X

HIN BENEFIT CONCEPTS HIN51037 X X

HIN BENEFITS

ADMINISTRATION AND INSHINPAPER X X

HIN BENESIGHT HIN87265 X X

HIN CNIC HEALTH

SOLUTIONSHINPAPER X X

HIN COASTAL

ADMINISTRATIVE SERVICESHINPAPER X X

HIN CORPORATE BENEFIT

SERVICES OF AHIN41124 X X

HIN ECOM PPO HINPAPER X X

HIN INSURANCE

ADMINISTRATOR OF AMERHINPAPER X X

HIN JF MOLLOY &

ASSOCIATESHIN61271 X X

HIN KIPP COMPANY

ADMINISTRATORSHINPAPER X X

HIN MARSH ADVANTAGE

AMERICAHINPAPER X X

HIN MBA OF WY HINPAPER X X

HIN NATIONAL FOUNDATION

LIFE INSHINPAPER X X

HIN ODS HEALTH PLAN HIN13350 X X

HIN P5 E HEALTH SERVICES HINPAPER X X

HIN PEAK HEALTH PLAN HINALLEG X X

HIN PERFORMAX HIN51037 X X

HIN PRINCIPAL HIN61271 X X

HIN REGIONAL CARE INC HIN47076 X X

HIN WMI TPA HINPAPER X X

HIN WORLD INSURANCE HIN75276 X X

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HIP HEALTH INSURANCE

PLAN OF GREA55247 X X X X X

HISPANIC PHYSICIANS IPA HPFFS X

HISPANIC PHYSICIANS IPA HPIPA X

HMA HAWAII 86066 X

HMC HEALTHWORKS/HEALTH

MANAGEMENT CO75318 X X

HMO OREGON 00851 X X

HMPK, INC. 61101 X X X X X See Humana

HMSO - MOLINA 91164

HMSO - PSHP 91161 X X

HN1 THERAPY NETWORK 65062 X X X XHOMETOWN HEALTH

NETWORK34150 X X

HOMETOWN HEALTH PLAN

NEVADA88023 X X

HORIZON BCBSNJ 22099 X X X X X

HORIZON MERCY 22326 X X X X XHOTEL & RESTAURANT

EMPLOYEES HEALTH91136 X X

HPLAN, INC. 61101 X X X X X See Humana

HPS PARADIGM 58227 X X

HRM INC 41170 X X

HS1 MEDICAL MGMT 65062 X X

HSHS MEDICAL GROUP IPA 37137 X X

HUDSON HEALTH PLAN 13335 X X

HUMANA GOLD CHOICE 61101 X X X X XHUMANA HEALTH OHIO 95348 X

HUMANA HEALTH PLANS 61101 X X X X X

HUMANA INS CO 61101 X X X X X

HUMANA INS CO MSD 61101 X X X X X

HUMANA MEDICARE 61101 X X X X XHUMANA VETERANS

HEALTHCARE SERVICES61120 X X

HUMANA VETERANS

HEALTHCARE SERVICES61160 X X X

HUMCO, INC. 61101 X X X X X See Humana

HUMREALTY, INC. 61101 X X X X X See Humana

HUNT INSURANCE GROUP 37260 X X

HVHS VA HERO 61160 X X X

I E SHAFFER 22175 X X

IBA HEALTH AND LIFE

ASSURANCE, IN38234 X X

IBC PERSONAL CHOICE 12X26 X

IBC PERSONAL CHOICE BCBS

PASX083 X

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IBI 41124 X X

IBM MEDICAL PLANS 60054 X X X X X See Aetna

ICARE (INDEPENDENT CARE

HP)11695 X

ICARE HEALTH OPTIONS TPA 26054 X X

ICM 37296 X

ID MEDICAID AIDID X X X X

IDAHO BLUE CROSS BLUEC X X X XIDAHO BLUE SHIELD 00611 X X X

IDAHO BLUE SHIELD

REGENCE00611 X X X

IDAHO MEDICAID AIDID X X X

IDAHO MEDICARE PART A 02001 X X X X

IDAHO MEDICARE PART B 02202 X X X XIHC HEALTH SOLUTIONS IAC01 X X

ILLINOIS BLUE SHIELD 00621 X X XILLINOIS CENTRAL HOSPITAL

ASSOCIATI36600 X

ILLINOIS MEDICAID IL621 X

ILLINOIS MEDICARE 00952 X X X XIMA OF LOUISIANA INC 72091 X

IMCARE 41600 X X

INDECS CORPORATION 40585 X X

INDEPENDENCE BCBS PA 95044 X X XINDEPENDENCE CARE

SYSTEMS13396 X X

INDEPENDENCE MEDICAL

GROUPMHM01 X

INDEPENDENT HEALTH 95308 X X X Contact 716-635-3911 prior to sending claims

INDIAN HEALTH SERVICES 00290 X X

INDIANA BCBS 00630 X X X X

INDIANA HEALTH NETWORK 35204 X X X

INDIANA MEDICAID IHCP X

INDIANA MEDICARE ET116 X X X XINDIANA PROHEALTH

NETWORK35161 X

INETICO, INC 43471 X X

INFORMED UHC 50946 X X

INFORMED, LLC/SELF

FUNDING ADMINI52196 X X

INLAND EMPIRE HEALTH

PLANIEHP1 X

INLAND VALLEYS IPA 75299 X X

INNOVATION HEALTH 40025 X X

INNOVATIVE HEALTHWARE

SOLUTIONS04320 X X

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INS HEALTH SERVICES

(IMMIGRATION HEVAICE X X

INSTITUTES OF QUALITY 60054 X X X X X See Aetna

INSURANCE

ADMINISTRATORS OF

AMERICA

37279 X X

INSURANCE DESIGN


INSURANCE MANAGEMENT

SERVICES (TX)IMSMS X X


SERVICES OF TEXASIMSMS X X


SVCS AMARILLO15688 X X

Payer id is only valid for claims with submission

address of P.O. Box 15688, Amarillo, TX 79105

INSURANCE SVCS OF

LUBBOCKTH012 X

INSURANCE TPA.COM 39182 X X

INSURERS ADMINISTRATIVE

CORP86304 X X

INTEGRA ADMINISTRATIVE

GROUP51020 X X

INTEGRA GROUP 31127 X X

INTEGRA GROUP-CHA 31129 X

INTEGRANET INET1 X X

INTEGRATED CARE

NETWORK BY EMERAL34167 X X

INTEGRATED MENTAL

HEALTH SVCS68053 X X X

Prior to submitting claims, please call Provider

Relations Dept at 1-800-716-5650 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.

Payer requires Billing Provider Taxonomy on all

claims.

INTEGRITY BENEFIT

NETWORK58200 X X

INTERCARE HEALTH PLAN

INC37227 X X

INTERCOUNTY HEALTH PLAN 54763 X X X

INTERFACE EAP 60280 X X X

INTERGROUP AZ 38309 X X

INTERGROUP SERVICES PPO 23287 X

INTERMOUNTAIN

ADMINISTRATORS81040 X X X Does not accept Secondary Institutional Claims

INTERMOUNTAIN HEALTH

CAREUH107 X X Contact Payer before sending at 801-442-5442

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COMMENTS





INTERNATIONAL MEDICAL

GROUPIMGIN X X

INTERNATIONAL UNION

LOCAL 437241 X

INTERNATL UNION OPER

ENGINEERS37269 X X

INTERWEST 84137 X X

IOWA BCBS 88848 X X X XIOWA BENEFITS INC 41124 X X

IOWA BLUE CROSS

INSTITUTIONAL12B10 X X

IOWA MEDICAID

INSTITUTIONAL18049 X X X

IOWA MEDICAID


IOWA MEDICARE PART A 05101 X X

IOWA MEDICARE PART B 05102 X X X XIW ADVANCED BENEFIT

RESOURCES CORP84137 X X

IW AMERICAN COUNSEL OF

ENGINEERING84137 X X

IW OUTSOURCEONE

BENEFITS84137 X X

IW STARMARK 84137 X X

IW THE BENEFIT GROUP 84137 X X

IW TRUSTMARK 84137 X X

JACKSON MEMORIAL HEALTH

PLAN COMMERCIAL HMO05014 X X X

JACKSON MHP COMMERCIAL

HMO05014 X X X

JF MOLLOY 61271 X X X X See Principal Financial Group

JI SPECIALTIES TH033 X

JI SPECIALTY SERVICES JISSP X X

JI SPECIALTY SERVICES

WORKERS COMPWK006 X

JMH HP MEDICAID HMO 16001 X X

JMH MEDICARE ADVANTAGE 59171 X X

JMH SFCCN PHT 09822 X X

JOHN ALDEN LIFE

INSURANCE CO41099 X X X X

JOHN DEERE HEALTH CARE 95378 X X X X See UnitedHealthcare Community Plan MS - CAN

JOHN HANCOCK 80314 X X X X X See Unicare

JOHN MORREL CO. - AHPBA 38310 X X

JOHN MUIR JMH01 X

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JOHN P PEARL &

ASSOCIATES, LTD37215 X X

JOHNS HOPKINS

HEALTHCARE EHP PP52189 X X

JOHNS HOPKINS MEDICAL

SERVICES52123 X X X

JOPLIN CLAIMS 43178 X X

JP FARLEY CORPORATION 34136 X X

JSL ADMINISTRATORS 37272 X X X XKAISER CSI - CALIF SELECT

FOR INDIVIDUALS94320 X X

KAISER FOUNDATION

HEALTH PLAN NO CA94135 X X X X

KAISER FOUNDATION

HEALTH PLAN OF CO91617 X X

KAISER FOUNDATION

HEALTH PLAN SO CA94134 X X

KAISER FOUNDATION OF THE

NORTHWEST93079 X X

This payer ID can only be used to submit claims for

Oregon and Washington Kaiser Permanante

members.

KAISER OF GEORGIA 21313 X X X XKAISER OF MIDATLANTIC

STATES52095 X X X X

KAISER OHIO REGION KS005 X

KAISER PERMANENTE

COLORADO SPRINGSKSRCS X

KAISER PERMANENTE HP

HAWAII94123 X X

KAISER PERMANENTE

NORTHWESTKS007 X

KAISER PPO 94320 X X

KANAWHA INSURANCE CO 57038 X X

KANCARE 96385 X X X X

KANSAS BCBS 47163 X X

KANSAS BLUE CROSS INST KSBLS X X

KANSAS CITY BCBS 47171 X X XKANSAS CITY BLUE CROSS

INSTKCBLS X X

KANSAS MEDICAID ET024 X X X X

KANSAS MEDICARE PART A 05201 X X

KANSAS MEDICARE PART B 05202 X X X X

KELSEY SEYBOLD

INSTITUTIONALKELSI X

KELSEY SEYBOLD

PROFESSIONALKELSE X

KEMPTON COMPANY 73100 X X

KENTUCKY BCBS 00660 X X X

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FEE APPLIES

COMMENTS





KENTUCKY HEALTH

COOPERATIVE77894 X X

KENTUCKY HEALTH SELECT 63077 X X

KENTUCKY KARE 61101 X X X X X See Humana

KENTUCKY MEDICAID KYMCD X X

KENTUCKY MEDICARE ET217 X X X XKENTUCKY SPIRIT HEALTH

PLAN68067 X X

KERN HEALTH PLAN KERNS X X

KEY BENEFIT

ADMINISTRATORS37217 X X X

KEY MEDICAL GROUP IP082 X

KEY SELECT 37321 X X X

KEYSTONE CONNECT 77050 X X

KEYSTONE EAST HP SX055 X

KEYSTONE HEALTH PLAN 23239 X X

KEYSTONE HP EAST 12X25 X

KEYSTONE MERCY HEALTH

PLAN23284 X X X X X

KITSAP CTY BS of WA KPS01 X

KITSAP PHYSICIANS SERVICE KPS01 X

KLAIS & COMPANY 34145 X X

02/23/2016 KPIC CA KPIC1 X

02/23/2016 KPIC CO KPIC1 X

02/23/2016 KPIC DC KPIC1 X

02/23/2016 KPIC GA KPIC1 X

02/23/2016 KPIC HI KPIC1 X

02/23/2016 KPIC MD KPIC1 X

02/23/2016 KPIC OH KPIC1 X

02/23/2016 KPIC OR KPIC1 X

KPS HEALTH PLANS KPS01 X

KY MEDICARE ET217 X X X XLA CARE HEALTH PLAN LACAR X

LA MEDICARE 07202 X X X X01/12/2016 LA SALLE MEDICAL GROUP NMM02 X X

LABORERS AG TRUST ZNTHW X X

LAKE FOREST MANAGED

CARE37112 X

LAKESIDE HEALTH SERVICES 95415 X X

LAKESIDE IPA 95416 X

LAKESIDE MEDICAL GROUP 66125 X X

LAND OF LINCOLN HEALTH 90096 X X X X

LANDMARK HEALTHCARE LNDMK X

LBA HEALTH PLANS 52193 X X

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FEE APPLIES

COMMENTS





LEON MEDICAL CENTER


LHP CLAIMS UNIT 37248 X X

LIFE INVESTORS INS CO LIIC2 X X

LIFE INVESTORS INS CO OF

AMERICALIIC3 X X

LIFE INVESTORS INS CO OF

AMERICALIICA X X

LIFE TRAC 41136 X X

LIFEPRINT LIFE1 X X

LIFEWISE HEALTH PLAN OF

WA91049 X X

LIFEWISE HEALTH PLAN OR 93093 X X X X

LINCOLN NATIONAL 61101 X X X X X See Humana

LINN COUNTY 75283 X X

LOCAL 135 HEALTH BENEFITS

IN35107 X X

LOMA LINDA UNIV EMPLOYEE

HEALTH PLA37267 X X

LOMA LINDA UNIVERSITY

ADVENT37267 X X

LONE STAR TPA 45289 X X

LOOMIS COMPANY - TPA

WYOMISSING PA23223 X X X X

Call Provider Relations at 610-374-4040 x2438

before submitting first electronic claims

LOS ALAMOS TOTAL CARE 60054 X X X X X See Aetna

LOUISIANA BCBS 53120 X X XLOUISIANA HEALTHCARE

CONNECTIONS68069 X X X

LOUISIANA MEDICAID DME ET036 X XLOUISIANA MEDICAID

PROFESSIONALET399 X X

LOUISIANA MEDICARE 07202 X X X XLOVELACE HEALTH PLAN 90328 X X X

LOVELACE SALUD SX159 X X

LOVELACE SANDIA HEALTH 90328 X X X

LOVELACE SENIOR PLANS 90328 X X X

LOYAL AMERICAN LIFE INS

CO13193 X X

LUMENOS 54195 X X

MA BEHAV HLTH PRTNR ET394 X

MACNEAL HEALTH

PROVIDERS - CHS36334 X X

MACO HEALTHCARE TRUST 81040 X X X Does not accept Secondary Institutional Claims

MAGELLAN BEHAVIORAL

HEALTH01260 X X X X X

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COMMENTS





MAGELLAN HEALTH

SERVICES01260 X X X X X

MAGESTACARE VIRGINIA 26372 X X

MAGNACARE 11303 X X

MAGNOLIA 68062 X X X

MAHCP QCCMT X X

MAIL HANDLERS 25133 X X X X X See Coventry Health Care

MAINE BCBS 00680 X X X

MAINE MEDICAID MEMCD X X

MAINE MEDICARE 14102 X X X XMAKSIN MANAGEMENT

CORPORATION22195 X X X

MAMSI LIFE AND HEALTH

INSURANCE C52148 X X X X X See United Healthcare 87726

MANAGED CARE INDEMNITY 61101 X X X X X See Humana

MANAGED CARE SERVICES 35162 X X

MANAGED HEALTH

NETWORKS (MHN)22771 X

MANAGED HEALTH SERVICES

INDIANA68069 X X X X X

Prior to sending claims, contact payer to verify your

provider info is in their system.

MANAGED HEALTH SERVICES

WISCONSIN39187 X X X X X

MANAGED PHYSICAL

NETWORK87726 X X X See United Healthcare

MANAGED PHYSICIAN

NETWORK93900 X

MANAGED PRESCRIPTION

SERVICES, IN61101 X X X X X See Humana

MANATEE SERVICE CENTER 41555 X X

MAPCO, INC 75258 X X

MARCH VISION HEALTH PLAN 5246M X

MARICOPA FOUNDATION ET352 X

MARIN IPA IP097 X

MARION PARK COMM HP 33711 X

MARQUETTE LIFE INS CO 48055 X X

MARRIOTT 60054 X X X X X See Aetna

MARTINS POINT

HEALTHCAREMPHC2 X

MARYLAND BCBS SB690 X XMARYLAND BCBS CARE

FIRST12011 X

MARYLAND MEDICAID MDMCD X X

MARYLAND MEDICARE 12302 X X X XMARYLAND PHYS CARE 22348 X X

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COMMENTS





MASHANTUCKET PEQUOT

TRIBAL NATION37121 X X

MASSACHUSETTS BCBS SB700 X X X

MASSACHUSETTS MEDICAID DMA7384 X X

MASSACHUSETTS MEDICARE 14202 X X X X

MASSACHUSETTS MUTUAL 65935 X X

MASTERS MATES PILOTS

PLANMMPHB X X

MASTERS MATES PILOTS

PROGRAM12T52 X

MATTHEW THORNTON


MAYO MANAGEMENT

SERVICES, INC41154 X X X X X

MBA BENEFIT


MBA OF MD INC 37298 X X

MBA OF WYOMING 87065 X X

MBHP VALUE OPTIONS ET394 X

MCARE 38264 X X

MCARE OF COLORADO

SPRINGSCSMED X

MCC BEHAVIORAL CARE 02331 X

MCCREARY CORPORATION 59331 X

MCLAREN ADVANTAGE HMO

SNP3833R X X

MCLAREN HEALTH

ADVANTAGE3833A X X

MCLAREN HEALTH PLAN 38338 X X

MCLAREN MEDICAID 3833C X X

MCLAREN NORTHERN

HEALTH PLANS3833N X X

MCLAREN TENCON HEALTH

PLAN3833T X X

MD HAWAII MDXHI X X

MD HEALTH PLAN 06118 X

MDNY HEALTHCARE 11338 X X

MDWISE HOOSIER ALLIANCE 20475 X X X X X

MDWISE INC SX172 X X

MED3000 EM216 X X

MED3000 CMS EARLY STEPS EM350 X X

MED3000 CMS MMA

SPECIALTY PLANEM843 X X

MED3000 CMS SAFETY NET EM284 X X

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COMMENTS





MED3000 CMS TITLE 21 EM205 X X

MED3000 COVENTRY HEALTH

KIDSEM521 X X

MED3000 PEDICARE TITLE 19 EM039

MEDADMIN SOLUTIONS 58202 X X

MEDADMIN SOLUTIONS 58204 X X

MEDBEN NEWARK OH 74323 X X

MEDBENEFIXX, INC. 61101 X X X X X See Humana

MEDCONNECTION 60054 X X X X X See Aetna

MEDCOST BENEFITS

SERVICE56205 X X X

MEDCOST INC 56162 X X X

For questions on claim submission,

please contact Payer Customer Service

800-824-7406

MEDFOCUS 95321 X

MEDICA 94265 X X X X X

MEDICA CHOICE 94265 X X X X XMEDICA HEALTH CARE PLAN

INC MIAMI F78857 X

MEDICA2 12422 x x x X X

MEDICAID ACS ADDED FEE 77039 X X X X X

MEDICAID ACS WYOMING 77046 X X X x X

MEDICAID AK ET344 X X X

MEDICAID AL ET033 X X

MEDICAID AR ARMCD X X

MEDICAID AZ AZMCD X X

MEDICAID CA 610442 X X X X

MEDICAID CO 77016 X X X

MEDICAID CT ET304 X X X

MEDICAID DE DEMCD X X X

MEDICAID FL 77027 X X X

MEDICAID GA INSTITUTIONAL 12K05 X X

MEDICAID GA


MEDICAID HI HIMCD X X

MEDICAID IA INSTITUTIONAL 18049 X X X

MEDICAID IA PROFESSIONAL 18049 X X X

MEDICAID IL IL621 X

MEDICAID IN IHCP X

MEDICAID KS ET024 X X X X

MEDICAID KY KYMCD X X

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COMMENTS





MEDICAID LA DME ET036 X X

MEDICAID LA PROFESSIONAL ET399 X X

MEDICAID MA DMA7384 X X

MEDICAID MD MDMCD X X

MEDICAID ME MEMCD X X

MEDICAID MN INSTITUTIONAL 12K16 X X

MEDICAID MN

PROFESSIONALET025 X X X

MEDICAID MO ET028 X X X X

MEDICAID MS 77032 X X X

MEDICAID MT 77039 X X X X X

MEDICAID NC DNC00 X X X

MEDICAID NE INSTITUTIONAL 1520I X X

MEDICAID NE PROFESSIONAL ET194 X X

MEDICAID NH SKNH0 X X X

MEDICAID NJ INSTITUTIONAL 12006 X X

MEDICAID NJ PROFESSIONAL 610515 X X X

MEDICAID NM NMMCD X

MEDICAID NV DHCFP X X X

MEDICAID NY INSTITUTIONAL 12K35 X X

MEDICAID NY PROFESSIONAL ET044 X X

MEDICAID OH ET045 X X XMEDICAID OK OKMCD X

MEDICAID OR ORDHS X X XMEDICAID PA ET213 X

MEDICAID RI RIMCD X X X

MEDICAID SC 619 X X X

MEDICAID SD (INST) 12K36 X X

MEDICAID SD (PROF) SDMCD X X XMEDICAID TN XANTUS SKTN2 X

MEDICAID TX 86916 X X

MEDICAID UT UTMCD X X

MEDICAID VA ET042 X X X X

MEDICAID VT SKVT0 X X X

MEDICAID WA HCFA ONLY ET043 X X X

MEDICAID WA UB ONLY 12K27 X X

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MEDICAID WASHINGTON DC 77033 X X X

MEDICAID WI WIMCD X X

MEDICAID WV INSTIUTIONAL 12K28 X X

MEDICAID WV

PROFESSIONALWVMCD X

MEDI-CAL 610442 X X X XMEDICAL BENEFITS


MEDICAL BENEFITS

ADMINISTRATORS OF37298 X X

MEDI-CAL BY MEDPOINT MPM18 X

MEDICAL CLAIMS SERVICE 04258 X X

MEDICAL DEVELOPMENT

INTERNATIONAL52181 X X

MEDI-CAL MANAGED CARE 47198 X

MEDICAL MUTUAL OF OHIO 29076 X X X X XMEDICAL PATHWAYS 33029 X

MEDICAL PLAN OF KANSAS

CITY MO61101 X X X X X See Humana

MEDICAL RESOURCE

NETWORK58203 X X

MEDICAL SELECT

MANAGEMENT13375 X

MEDICAL SERVICES

INITIATIVE12057 X X

MEDICAL SVCS FOR

INDIGENTS12057 X X

MEDICAL VALUE PLAN OHIO 38224 X X

MEDICARE AK 00831 X X X X X

MEDICARE AL 10102 X X X

MEDICARE AR 07102 X X X X

MEDICARE AZ 03102 X X X X

MEDICARE CA NORTH 01102 X X X X

MEDICARE CA SOUTH 01192 X X X X

MEDICARE CO PART A 04111 X X

MEDICARE CO PART B 04102 X X X X

MEDICARE CT 13102 X X X X

MEDICARE DE 12102 X X X X

MEDICARE FL 09102 X X X X

MEDICARE GA PART B 10202 X X X X

MEDICARE HI 01202 X X X X

MEDICARE IA PART A 05101 X X

MEDICARE IA PART B 05102 X X X X

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MEDICARE ID PART A 02001 X X X X

MEDICARE ID PART B 02202 X X X X

MEDICARE IL 00952 X X X X

MEDICARE IN ET116 X X X X

MEDICARE KS PART A 05201 X X

MEDICARE KS PART B 05202 X X X X

MEDICARE MA 14202 X X X X

MEDICARE MD 12302 X X X X

MEDICARE ME 14102 X X X X

MEDICARE MI PART A 08201 X X X X

MEDICARE MI PART B 08202 X X X X

MEDICARE MN 00954 X X X X

MEDICARE MO PART A 05301 X X

MEDICARE MO PART B 05302 X X X X

MEDICARE MS 00512 X X X X

MEDICARE MT MCARE X X X X X

MEDICARE NC 11502 X X X X

MEDICARE ND PART A 03301 X X X X

MEDICARE ND PART B 03302 X X X X

MEDICARE NE PART A 05401 X X

MEDICARE NE PART B 05402 X X X X

MEDICARE NH 14302 X X X X

MEDICARE NJ 12402 X X X X

MEDICARE NM 04202 X X X X

MEDICARE NV 01302 X X X X

MEDICARE NY EMPIRE 13202 X X X X

MEDICARE NY GHI 13292 X X X X

MEDICARE NY WEST 13282 X X X X

MEDICARE NY WEST 13282 X X X X

MEDICARE OH 15202 X X X X

MEDICARE OK 04302 X X X X

MEDICARE OR 00835 X X X X

MEDICARE PA 12502 X X X X

MEDICARE RI 14402 X X X X

MEDICARE SC PART A 12M55 X X

MEDICARE SC PART B 11202 X X X X

MEDICARE SD PART A 03401 X X X X

MEDICARE TN PART A 10301 X X

MEDICARE TN PART B 10302 X X X X

MEDICARE TODAYS OPTION 48055 X X

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COMMENTS





MEDICARE TX PART A 00400 X X X

MEDICARE TX PART B 04402 X X X X

MEDICARE UT PART B 03502 X X X XMEDICARE VA PART A 11003

MEDICARE VA PART B 11302 X X X X

MEDICARE VT 14512 X X X X

MEDICARE WA 00836 X X X X

MEDICARE WI PART A 12M29 X X

MEDICARE WI PART B 06302 X X X X

MEDICARE WV PART A 11003 X X

MEDICARE WV PART B 11402 X X X XMEDIGOLD 95655 X X

01/01/2016 MEDITURE 20039 X X

MEDIVERSAL 37304 X X

MEDPARTNERS

ADMINISTRATIVE SRVCS35205 X X

Payer ID is only for claims with mailing address of:

PO Box 2602, Fort Wayne, IN 46801

MEDPLAN PPO 58216 X

MEDSOLUTIONS INC OF

GEORGIA62160 X X

MEDSPAN INC 82160 X

MEDSTAR FAMILY CHOICE 39190 X X

MEDSTAR PHYSICIAN

PARTNERS00243 X

MEGA LIFE & HLTH STUDENT 74227 X X X

MEGA LIFE AND HEALTH INS 59227 X X X X

MEMIC 01047 X X

MEMORIAL HERMANN

HEALTH SOLUTIONSMHHNP X X

MEMORIAL INTEGRATED

HEALTHCARE59064 X X

MEMPHIS MANAGED CARE 36193 X X

MENNONITE MUTUAL AID

ASSOC35605 X X

MERCY CARE AZ 86052 X X

MERCY CARE PLAN 86052 X X

MERCY HEALTHPLAN OF NJ 22326 X X X X X

MERCY HEALTHPLANS 43166 X

MERCY MARICOPA

INTEGRATED CARE33628 X X

MERIDIAN HEALTH PLAN 13189 X X

MERITAIN HEALTH 64157 X X

MERITAIN HEALTH

MINNEAPOLIS41124 X X

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MERITAIN HEALTH W N

AMERICAN AD64157 X X

MERTIAN HEALTH W FIRST

HEALTH41124 X X

MESA MENTAL HEALTH 85035 X

METCARE HEALTH PLANS 65113 X X

METHODIST ASSOCIATES 62168 X X

METHODIST CARE, INC 80314 X X X X X See Unicare

METRAHEALTH 65978 X

METRO ALLIANCE 82135 X

METROPLUS HEALTH PLAN 13265 X X

METROPOLITAN HEALTH

PLAN10850 X X X X

METROPOLITAN LIFE 87726 X X X X X See United Healthcare

METROPOLITIAN LIFE INS 87726 X X X X X See United Healthcare

METROWEST HEALTH PLAN MWP01 X

MHBP 25133 X X X X X See Coventry Health Care

MHN 22771 X

MHNET 74289 X X X X

MI BCBS 00710 X X X XMI BCBS BCN 00710H X X X

MI BCBS FEP 00710F X X X

MI BCBS INSTITUTIONAL 00210 X X X XMI BCBS MEDICARE

ADVANTAGE00710A X X X

MI MEDICAID D00111 X X X

MICHAEL REESE HMO 61101 X X X X X See Humana

MICHAEL REESE PHYSICIANS

GROUP37127 X X

MICHIGAN BCBS 00710 X X X X

MICHIGAN BCBS BCN 00710H X X X

MICHIGAN BCBS FEP 00710F X X XMICHIGAN BCBS

INSTITUTIONAL00210 X X X X

MICHIGAN BCBS MEDICARE

ADVANTAGE00710A X X X

MICHIGAN MEDICAID D00111 X X X

MICHIGAN MEDICARE PART A 08201 X X X X

MICHIGAN MEDICARE PART B 08202 X X X X

MID AMERICA ASSOCIATES 37281 X X

MID ATLANTIC HEALTH

SYSTEM63079 X X

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COMMENTS





MID ROGUE OREGON

HEALTH PLAN26161 X

MID VALLEY CARENET INC 31140 X X

MID WEST NATL LIFE AND

HEALTH INS59227 X X X X

MID WEST UNITED LIFE 74227 X X X

MID-AMERICAN BENEFITS 22823 X X

MIDLANDS CHOICE 47080 X X

MIDWEST GROUP BENEFITS 61146 X X

MIDWEST HEALTH PLAN MHP77 X X

MIDWEST HEALTH PLANS TH074 X

MIDWEST PREFERRED MIDSC X

MIDWEST SECURITIES MIDSC X

MIDWEST SECURITY 79480 X X X

MILLS PENINSULA MEDICAL

GROUPMPMG1 X

MILLS PENINSULA MEDICAL

GRP (SPS)94115 X

MINNEAPOLIS PRUDENTIAL 60054 X X X X XSee Aetna

MINNESOTA BCBS INST

CLAIMS00220 X X X X

MINNESOTA BCBS PROF

CLAIMS00720 X X X

MINNESOTA MEDICAID

INSTITUTIONAL12K16 X X

MINNESOTA MEDICAID

PROFESSIONALET025 X X X

MINNESOTA MEDICARE 00954 X X X X

MISSISSIPPI BCBS 00230 X X

MISSISSIPPI MEDICAID 77032 X X X

MISSISSIPPI MEDICARE 00512 X X X XMISSISSIPPI PHYSICIAN

CARE NETWORK64084 X

MISSISSIPPI SELECT

HEALTHCARE64088 X X

MISSOULA COUNTY MEDICAL

BENEFITS37275 X X

MISSOURI BCBS 00241 X X X XMISSOURI CARE MC 14163 X X

MISSOURI DEPT OF MENTAL

HEALTHMODMH X

MISSOURI HOME STATE

HEALTH CARE68069 X X X

MISSOURI MEDICAID ET028 X X X X

MISSOURI MEDICARE PART A 05301 X X X

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COMMENTS





MISSOURI MEDICARE PART B 05302 X X X X

MMA 35316 X X X

MMBP MBHC X X

MMS LLC 62178 X

MN DEPT OF HEALTH MNDH1 X X X X

03/02/2016 MODA HEALTH PLAN 13350 X X X X X See ODS for ERA enrollment

MOLINA HC OF NEW MEXICO 09824 X X X

MOLINA HC OF NM 09824 X X X

MOLINA HEALTHCARE OF

CALIFORNIA38333 X X X


FLORIDA51062 X X X


INDIANA00076 X


MICHIGAN38334 X X X


OHIO20149 X X X

MOLINA HEALTHCARE OF TX 20554 X X X


WASHINGTON38336 X X X

MOLINA HEALTHCARE SOUTH

CAROLINA46299 X X

MOLINA HEALTHCARE UTAH SX109 X X

MOMENTUM HEALTH

SERVICES72135 X

MONARCH HEALTHCARE IPA IP095 X

MONTANA ASSOC OF

COUNTIES81040 X X X Does not accept Secondary Institutional Claims

MONTANA BCBS BCBS X X X X X XMONTANA HEALTH CO-OP A

COVENTRY HP25133 X X X X X


MONTANA MED BENEFIT

PLANMBHC X X

MONTANA MEDICAID 77039 X X X X X

MONTANA MEDICARE MCARE X X X X XMONTANA RETAIL STORE

EMPLOYEES TRUSZNTHW X X

MONTANA UNIFIED 91131 X X Does not accept Secondary Claims

MONTANA UNIFIED SCHOOL

TRUST91131 X X Does not accept Secondary Claims

MONTEFIORE CONTRACT

MANAGEMENT13174 X X X

MONUMENTAL LIFE INS CO MMLI2 X X LOUISVILLE, KY

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COMMENTS





MONUMENTAL LIFE INS CO MMLI3 X X HURST, TX

MONUMENTAL LIFE INS CO MMLIC X X LITTLE ROCK, AR

MOSAIC IPA MEDICAL GROUP IP083 X

MOTION PICTURE HEALTH

PLAN99282 X

MOTOROLA INC 36111 X

MOUNTAIN MEDICAL COMMA X

MOUNTAIN STATES

ADMINISTRATION AZ86040 X X

MPE EMPLOYEE BENEFIT

SERV37233 X X

MPLAN 95444 X X

MPM PROSPECT MPM16 X

MT ASSOC OF COUNTIES 81040 X X X Does not accept Secondary Institutional Claims

MT BCBS BCBS X X X X X XMT BENEFITS AND HEALTH

CONNECTIONSMBHC X X

MT CARMEL HEALTH PLAN 95655 X X

MT LABORERS AG TRUST ZNTHW X X

MT MEDICAID 77039 X X X X XMT RETAIL STORE

EMPLOYEES TRUSTZNTHW X X

MT UNIFIED SCHOOL TRUST 91131 X X Does not accept Secondary Claims

MT. DIABLO JMH01 X

MULTIPLAN WISCONSIN

PREFERRED34080 X

MUNICIPAL HEALTH BENEFIT

FUND81883 X X

MUST 91131 X X Does not accept Secondary Claims

MUTUAL ASSURANCE


MUTUAL BENEFIT LIFE MBL 70408 X X X X See Fortis Benefits

MUTUAL BENEFIT WESTERN

LIFE39065 X X X X See Assurant Health

MUTUAL OF OMAHA 71412 X X X X

MUTUALLY PREFERRED 71412 X X X XMVP HEALTH PLAN OF NY 14165 X X X

N TEXAS HEALTHCARE

SYSTEMS35212 X X X

N.W. IRONWORKERS HEALTH

& SECURIT91136 X X

Please Enter Group Number (F15) when

Submitting Claims

N.W. ROOFERS &

EMPLOYERS HEALTH91136 X X

N.W. TEXTILE PROCESSORS 91136 X X

NACL AFFORDABLE 53011 X X X

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COMMENTS





NAMM - ILLIINOIS 36398 X

NAPHCARE INC 58182 X X X

NATIONAL ASSOC OF LETTER

CARRIERS53011 X X X

NATIONAL BENEFIT LIFE 00243 X

NATIONAL CLAIM


NATIONAL FINANCIAL LIFE

INS CO NFIC90956 X

NATIONAL HEALTH

INSURANCE COMPANY75275 X X

NATIONAL RURAL ELEC

COOP52132 X X X X X See Cooperative Benefit Administrator

NATIONAL RURAL ELECTRIC

COOP52132 X X X X X See Cooperative Benefit Administrator

NATIONAL RURAL ELECTRIC

COOPERATI52132 X X X X X See Cooperative Benefit Administrator

NATIONAL RURAL LETTER

CARRIER ASSOC71412 X X X X See Mutual of Omaha Insurance Co

NATIONAL TELEPHONE COOP 52103 X X

NATIONAL TELEPHONE COOP

ASSOC STAFF52104 X X

NATIONAL TRAVELERS 65978 X

NATIONAL TRAVELERS LIFE

CO37120 X X

NATIONWIDE GROUP 31417 X X X X XNATIONWIDE HEALTH PLANS

HMO PPO31112 X

NATIONWIDE INSURANCE 31417 X X X X XNATIONWIDE LIFE AND

HEALTH31417 X X X X X

NATL BENEFIT ADMIN NC 56176 X X

NATL BENEFIT ADMIN NJ 56175 X

NCAS 75190 X X

NCAS - OWINGS MILL, MD 75190 X X

NCAS CHARLOTTE NC 75191 X X

NCAS FAIRFAX 75190 X X

NCAS VIRGINIA 75190 X X

NCAS-CHARLOTTE 75191 X X

ND BS 00820 X X X XND MEDICAID NDDHSMED X X

NE NEW YORK BLUE SHIELD 00800 X X X

NEBRASKA BCBS


NEBRASKA BLUE CROSS

INST00260 X X

NEBRASKA MEDICAID INST 1520I X X

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FEE APPLIES

COMMENTS





NEBRASKA MEDICAID PROF ET194 X X

NEBRASKA MEDICARE PART

A05401 X X

NEBRASKA MEDICARE PART

B05402 X X X X

NEIGHBORHOOD HEALTH

PARTNERSHIP OF FL96107 X X

Payer ID is valid for claims submission for address

PO Box 02568, Miami FL 33102-5680. Any

questions should be directed to 305-715-4334

NEIGHBORHOOD HEALTH

PLAN - BOSTON04293 X X

NEIGHBORHOOD HEALTH

PLAN OF RHODE I05047 X X

NEIGHBORHOOD HEALTH

PROVIDERS11325 X X X

NESIKA HEALTH GROUP 37255 X X

NETCARE LIFE AND HEALTH 66055 X X

NETWORK HEALTH 04332 X X

NETWORK HEALTH INS CORP

MEDICARE77076 X X

NETWORK HEALTH

SOLUTIONS39144 X

NETWORK MEDICAL MGMT NMM01 X

NETWORK PLAN OF

WISCONSIN39111 X

NETWORK TPA LLC 58204 X X

NEVADA BCBS 00265 X X X XNEVADA HEALTH COOP 90091 X X

NEVADA MEDICAID DHCFP X X X

NEVADA MEDICARE 01302 X X X XNEW AVENUES INC 95998 X X

NEW ENGLAND FINANCIAL 80705 X X X X See Great West Life & Annuity

NEW ENGLAND MUTUAL LIFE

INSURANCE66893 X

NEW ERA LIFE 75281 X X

NEW HAMPSHIRE BCBS 00770 X X X

NEW HAMPSHIRE MEDICAID SKNH0 X X X

NEW HAMPSHIRE MEDICARE 14302 X X X X

NEW JERSEY BCBS 22099 X X X X XNEW JERSEY MEDICAID

(INST)12006 X X

NEW JERSEY MEDICAID

(PROF)610515 X X X

NEW JERSEY MEDICARE 12402 X X X X

NEW MEXICO BCBS 00790 X X X

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COMMENTS





NEW MEXICO HEALTH

CONNECTIONS45129 X X X X X

NEW MEXICO MEDICAID NMMCD X

NEW MEXICO MEDICARE 04202 X X X X

NEW WEST HEALTH 84141 X X X X Does not accept Secondary Claims

NEW WEST MEDICARE 84141 X X X X Does not accept Secondary ClaimsNEW WEST MEDICARE

ADVANTAGE84141 X X X X Does not accept Secondary Claims

NEW YORK LIFE - LTC NYL11 X X

NEW YORK MEDICAID

INSTITUTIONALET044 X X

NEW YORK MEDICAID

PROFESSIONALET044 X X

NEW YORK MEDICAL

IMAGING14179 X

NEW YORK MEDICARE

EMPIRE13202 X X X X

NEW YORK MEDICARE GHI 13292 X X X X

NEW YORK MEDICARE WEST 13282 X X X X

NEW YORK NETWORK

MANAGEMENT11334 X

NEW YORK PRESBYTERIAN

COMMUNITY48186 X X

NEW YORK STATE

EMPLOYEES65978 X

NEWMARKET DIMENSIONS 65056 X X

NGS AMERICAN 38225 X X X XNHBCAUX 88050 X X

NHC HEALTH BENEFIT PLAN 62124 X X

NHP/SHP (NEIGHBOORHOOD

HEALTH PRO11325 X X X

NIPPON LIFE INSURANCE

COMPANY OF81264 X X X X

NJ CARPENTERS HEALTH

FUND22603 X X X

NORTH AMERICA


NORTH AMERICAN


NORTH AMERICAN BENEFITS

NETWORK34159 X X

NORTH AMERICAN MEDICAL

CAE3510 X


IL36398 X

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COMMENTS






ILLINOIS36398 X

NORTH BROWARD HOSPITAL

DISTRICT37314 X X

NORTH CAROLINA BCBS ET095 X X X

NORTH CAROLINA MEDICAID DNC00 X X X

NORTH CAROLINA MEDICARE 11502 X X X X

NORTH DAKOTA BCBS 00820 X X X XNORTH DAKOTA MEDICAID NDDHSMED X X

NORTH DAKOTA MEDICARE

PART A03301 X X X X

NORTH DAKOTA MEDICARE

PART B03302 X X X X

NORTH SHORE LIJ

CARECONNECT INS46227 X X X

NORTH TEXAS HEALTHCARE

NETWORK75250 X X X

NORTH WEST LIFE PH018 X

NORTHERN CA SHEET METAL

WORKERS INS38238 X

NORTHERN ILLINOIS HEALTH

PLAN36347 X X

NORTHERN NEVADA TRUST

FUND88027 X X

NORTHERN REG TRICARE 57106 X X X X X See your specific state for enrollment forms

NORTHWEST ENERGY 81040 X X X Does not accept Secondary Institutional Claims

NORTHWEST ENERGY PLAN 81040 X X X Does not accept Secondary Institutional Claims

NORTHWEST SUBURBAN IPA

(ILLINOIS)36346 X X

NORTHWESTERN ENERGY

BENEFIT PLAN81040 X X X Does not accept Secondary Institutional Claims

NORTHWESTERN NATIONAL

LIFE INSURA41045 X X

NOVA CASUALTY COMPANY 16114 X X X

NOVA HEALTHCARE


NOVASYS 75080 X X

NOVASYS HEALTH NETWORK 71080 X X

NTCA STAFF MEMBERS 52104 X X

NTHC NTX11 X X

NW ADMINISTRATORS NWADM X X

NYHART 37299 X X

NYLCARE ETHIX

NORTHWEST91135 X

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COMMENTS





NYLCARE HEALTH PLANS NW 91166 X

NYMI OXFORD 14180 X

OCCUPATIONAL HEALTH

MGMT 31147 X X

OCHSNER HEALTH PLANS OCH01 X X

ODS HEALTH 13350 X X X X X

OHANA HEALTH PLAN 14163 X XTaxonomy codes required at both the Billing and


OHIO BCBS 00834 X X X XOHIO HEALTH CHOICE 34189 X X

OHIO MEDICAID ET045 X X X

OHIO MEDICARE 15202 X X X XOHIO PPO CONNECT 74431 X X

OHIO WORK COMP 31147 X X

OK STATE EMPLY AND

EDUCATORS22521 X X X

OKLAHOMA BCBS 00840 X X

OKLAHOMA MEDICAID OKMCD X

OKLAHOMA MEDICARE 04302 X X X XOLYMPIC HEALTH MGMT

SYSTEMS91150 X X

OLYMPUS MANAGED CARE 65074 X X

OMNI/MEDICORE HP 68037 X X

OMNICARE A COVENTRY

HLTH25150 X X X X X See Coventry Health Care

OMNICARE HEALTH PLAN OF

MICHIGAN38252 X X

ONE CALL MEDICAL 22321 X X

ONE HEALTH PLAN OF CA

INC95379 X

ONE HEALTH PLAN OF GA 95569 X

ONE HEALTH PLAN OF IL INC 95388 X

ONE HEALTH PLAN, INC 80705 X X X X See Great West Life & Annuity

OPERATING ENG LOCAL 234 OBAOE X X

OPERATING ENGINEERS

LOCAL 302 & 61291136 X X

OPTICARE EYE HEALTH

NETWORK56190 X

OPTIMUM CHOICE OF

CAROLINA52152 X X X

OPTIMUM CHOICE, INC. (OCI) 52148 X X X

OPTIMUM HEALTHCARE 20133 X X

03/23/2016OPTUM BEHAVIORAL HEALTH

SLCOU6885 X X X X

OPTUM HEALTH 41161 X

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COMMENTS





OPTUMHEALTH BEHAVIORAL

SOLUTIONS87726 X X X X X See United Healthcare

OREGON BCBS 00851 X X

OREGON HEALTH CO-OP 21455 X X

OREGON HEALTH CO-OP 45332 X X

OREGON HEALTH PLAN 00851 X X

OREGON MEDICAID ORDHS X X X

OREGON MEDICARE 00835 X X X XORTHONET AETNA 13383 X X X

ORTHONET CORPORATION -

CIGNA13381 X X

ORTHONET HEALTHNET 25681 X

ORTHONET UNIFORMED

SVCS FHP13382 X

OSF CARE ADVANTAGE OSFMC X

OSF HEALTH PLAN OSFIL X

OSF HEALTH PLANS 62171 X X

OSMA HEALTH CLFR2 X

OXFORD HEALTH PLANS 06111 X X X XP5 HEALTH PLAN SOLUTIONS

OF UTAH87068 X X

PACE EPF29 X

PACIFIC GAS AND ELECTRIC 60054 X X X X XSee Aetna

PACIFIC HEALTHCARE IPA PHI01 X

PACIFIC MUTUAL 67466 X X

PACIFICARE 87726 X X X X See United Healthcare

PACIFICARE BEHAVIORAL

HEALTH87726 X X X See United Healthcare

PACIFICARE OF ARIZONA 87726 X X X X See United Healthcare

PACIFICARE OF COLORADO 87726 X X X X See United Healthcare

PACIFICARE PPO 95999 X X

PACIFICSOURCE


PACIFICSOURCE HEALTH

PLANS93029 X X X X

PACIFICSOURCE MEDICARE 23077 X X

PACIFICSOURCE OHP COIHS X

PALMETTO GBA 00882 X X X XPALMETTO GBA RAILROAD


PAN AMERICAN LIFE INS GRP 04218 X X

PAPER PIPELINE BENEFIT

FUND73074 X

PARAMOUNT HEALTH SX158 X X

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FEE APPLIES

COMMENTS





PARKLAND COMMUNITY


PARKLAND HEALTHFIRST 66917 X X

PARTNERS BEHAVIORAL

HEALTH MGMT52613 X X X

PARTNERS NATIONAL

HEALTH56152 X X

PARTNERSHIP HEALTH PLAN PHP02 X X X X

PASSPORT HEALTH PLAN 61129 X X X X XPATIENT ADVOCATES LLC 10525 X X

PATIENT CHOICE 39026 X X X X See UMR

PATIENT PHYSICIAN

NETWORKPPN11 X

PAYER FUSION 27048 X X

PAYNET INC 37210 X X

PCA HEALTH PLAN OF

FLORIDA65018 X

PCA OF TEXAS HUMANA 61101 X X X X X See Humana

PCA STAR MEDICAID 61101 X X X X X See Humana

PCMC/ICSL CHIROPRACTIC 65007 X

PCMC/ICSL DERMATOLOGY 65001 X

PCMC/ICSL

GASTROENTEROLOGY65003 X

PCMC/ICSL PODIATRY 65002 X

PCMC/ISCL ALLERGY 65000 X

PEACH STATE HEALTH PLAN 68069 X X X X X

PENNSYLVANIA BLUE CROSS 23045 X X

PENNSYLVANIA BLUE SHIELD 54771 X

PENNSYLVANIA MEDICAID ET213 X

PENNSYLVANIA MEDICARE 12502 X X X X

PEOPLES BENEFIT LIFE INS PBLIC X X

PEOPLES HEALTH NETWORK 72126 X X X

PERFORMAX 41124 X X

PERSONAL CARE 25133 X X X X X See Coventry Health Care

PERSONAL INSURANCE


PERSONAL PHYSICIAN CARE 34173 X

PG&E 60054 X X X X X See Aetna

PHA ADMIN SERIVCES 95183 X X

PHCS 60054 X X X X X See Aetna

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FEE APPLIES

COMMENTS





PHCS SAVILITY PAYERS 13306 X X

PHIFER WIRE PRODUCTS INC PHIF4 X X

PHOENIX GROUP SERVICE 75238 X X

PHOENIX GROUP SERVICES,

INC06143 X X

PHOENIX HEALTH PLAN 03440 X X X

PHOENIX HEALTHCARE 62153 X X

PHOENIX HOME LIFE 67814 X

PHOENIX MUTUAL 67814 X

PHP OF MICHIGAN 87726 X X X X X See United Healthcare

PHP TENNCARE 62155 X X

PHX HEALTH PLAN 03440 X X X

PHYS ASSOC GRTR SAN

GABRIEL VALLEYPA513 X X

PHYSICIAN ASSOC OF

LOUISIANA58204 X X

PHYSICIAN CARE NETWORK

LLC58204 X X

PHYSICIAN HEALTH

PARTNERS MEDICAREPHPMD X X

PHYSICIAN HEALTH PLAN

PHP37330 X X X X

PHYSICIANS CARE NETWORK

ILLINOIS36345 X X


MICHIGAN38265 X X


MISSISSIPPI64084 X

PHYSICIANS CARE

NETWORK/ THE POLYCLINICPCN12 X

PHYSICIANS HEALTH

ASSOCIATION37136 X X

PHYSICIANS HEALTH CHOICE

- CLAIMSPHCS1 X X

PHYSICIANS HEALTH CHOICE

- ENCOUNTEPHCEN X X

PHYSICIANS HEALTHCARE

PLANS65031 X X

PHYSICIANS HEALTHWAYS

IPAPHIPA X X

PHYSICIANS HP OF N

INDIANA12399 X X X X

PHYSICIANS MUTUAL INS 47027 X X X XPHYSICIANS MUTUAL

INSURANCE COMPANY47027 X X X

PHYSICIANS OF SW

WASHINGTON91171 X X

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COMMENTS





PHYSICIANS PLUS

INSURANCE CORPORA39156 X X

PHYSICIANS UNITED PLAN 10775 X X

PIEDMONT BEHAVIORAL

HEALTH06607 X X X X

PIMA HEALTH SYSTEM PMA86 X XPINNACLE CLAIMS

MANAGEMENT, INC24735 X X

PINNACOL ASSURANCE 84109 X X

PIPEFITTERS LOCAL 597 59700 X

PIPELINE INDUSTRY BENEFIT

FUND73074 X X

PITTMAN & ASSOCIATES 37224 X X X XPITTSBURGH CARE

PARTNERSHIP INC23283 X X

PLANNED ADMIN SC 886 X

PLANNED ADMINISTRATORS

INC37287 X X

PM GROUP 67466 X X

PODI CARE MANAGED CARE 58204 X X

POLY AMERICA MEDICAL

BENEFITS32680 X X

POMCO 16111 X X X

PPO OKLAHOMA 73159 X X X

PPO PLUS LLC 72148 X X X

PPOM 38335 X X

PPOM COFINITY 38335 X X

PRACTICARE, INC 04334 X

PRAIRIE STATES

ENTERPRISE36373 X X

PREF ONE 41147 X X X X See Payer ID 00015

PREFERRED

ADMINISTRATORSEPF10 X X

PREFERRED BENEFITS

ADMIN WICHITA KS61665 X X

PREFERRED CARE

PARTNERS65088 X X

PREFERRED CARE ROCH,NY 14165 X

PREFERRED COMMUNITY

CHOICE/PCC SE73145 X X X

PREFERRED HEALTH PLAN 61106 X X

PREFERRED HEALTH

PROFESSIONALS31478 X X

PREFERRED HEALTH

SYSTEMS60110 X X X X X

PREFERRED HEALTH

SYSTEMS INS60110 X X X X X

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COMMENTS





PREFERRED IPA PFIPA X

PREFERRED NETWORK

ACCESS36401 X X

PREFERRED ONE 41147 X X X X X See Payer ID 00015

PREFERRED ONE OF MN 00015 X X XPREFERRED PLUS OF

KANSAS60110 X X X X X

PREFERRED PLUS OF

KANSAS PPK60110 X X X X X

PREFERRED PLUS OF KS 47163 X X

PREMERA BCBS 00430 X X XPREMIER BENEFITS 43166 X

PREMIER CARE IPA PCI01 X

PREMIER EYE CARE 65054

PREMIER HEALTH 90440

PREMIER HEALTH

EXCHANGE88056 X X

PREMIER HEALTH PLAN 251PR X X X X XPREMIER HEALTH PLANS 43166 X X

PREMIER HEALTH PLANS 251PR X X

PREMIER HEALTH SYSTEMS 29076 X X X X XSee Medical Mutual of Ohio on FAQ 641 for ERA

Enrollment

PREMIER HEALTHCARE

EXCHANGE INC PHX88051 X X

PREMIER PHYSICIANS

NETWORKCAPMN X

03/23/2016PRESBYTERIAN HEALTH

PLAN05003 X X X X X

PRESBYTERIAN HEALTH

PLAN COMMERCIALPREHP X

PRESCRIPTION BENEFITS,

INC.61101 X X X X X See Humana

PRESTIGE HEALTH CHOICE 77003 X X Formerly under payer ID 45056

PREVEA HEALTH INSURANCE

PLAN39185 X X

PRIMARY CARE ASSOCIATES

OF CAPCACZ X

PRIMARY HEALTH PLAN PRIME X X

PRIMARY PHYSICIAN CARE

INC56144 X X

PRIME BENEFITS SYSTEMS 61101 X X X X X See Humana

PRIME CARE HEALTH PLAN IP079 X

PRIME HEALTH 61101 X X X X X See Humana

PRIME VISION HEALTH PLAN 56190 X

PRIME WEST HEALTH PLAN 61604 X X X X X

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COMMENTS





PRIMESOURCE HEALTH

NETWORK04320 X X

PRINCIPAL FINANCIAL

GROUP61271 X X X X

PRINCIPAL LIFE INSURANCE

CO61271 X X X X

PRIORITY HEALTH 38217 X X X

PRISM - UNIVERA 37315 X X

PRISM FIRST HEALTH 37303 X

PRISM NETWORK 37296 X X

PRO CARE HEALTH PLAN,

INC38329 X X

PROCLAIM 41163 X X

PROF BENEFIT ADMIN

OAKBROOK IL36331 X X

PROFESSIONAL BENEFIT


PROFESSIONAL CLAIMS

MANAGEMENT37242 X X

PROFESSIONAL RISK

MANAGEMENT34134 X X

PROMINA 58226 X X

PROMINENCE HEALTH PLAN 93082 X

PROSPECT HEALTH

NETWORKPROSP X

PROSPECT MEDICAL GROUP PROSP X

PROVIDENCE CHOICE

OPTIONPHP01 X X X

For 2310A only the NPI is required; Loop 2310B the

NPI + tax ID is required

PROVIDENCE GOOD HEALTH

PLANPHP01 X X X

For 2310A only the NPI is required; Loop 2310B the

NPI + tax ID is required

PROVIDENCE HEALTH PLAN

PPOPHP00 X

PROVIDENCE OREGON

HEALTH PLANSX133 X X X X

PROVIDENCE PPO SX187 X

PROVIDENCE PREFERRED

OF WASHINGTO91131 X X

PROVIDENT AMERICAN LIFE

& HEALTH IN71404 X X X X

proviDRs CARE NETWORK 48100 X X X

PRU NET 60054 X X X X X See Aetna

PRU PLUS 60054 X X X X X See Aetna

PRUCARE 60054 X X X X X See Aetna

PRUCHOICE 60054 X X X X X See Aetna

PRUDENTIAL 60054 X X X X X See Aetna

PRUNET 60054 X X X X X See Aetna

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PRUPSYCH 60054 X X X X X See Aetna

PSYCHCARE LLC 51052 X X

PUGET SOUND BENEFITS

TRUST91136 X X

PUGET SOUND ELECTRICAL

WORKERS TR91136 X X

PUGET SOUND HEALTH

PARTNERS INC42172 X

PYRAMID HEALTH 48055 X X

PYRAMID LIFE INSURANCE

CO48055 X X

QUADMED (WEST ALLIS, WI) 39197 X X

QUAL CHOICE OF ARKANSAS 35174 X X X X

QUAL CHOICE OF NORTH

CAROLINA35172 X

QUAL CHOICE OF OHIO 01250 X

QUAL CHOICE OF VIRGINIA 35171 X X

QUALCARE INC 23342 X X

QUALITY CARE PARTNERS 89461

QUIKTRIP 73067 X X

Payer does not return a Claim Status or Report for

Inst claims. Providers will need to call QuikTrip 918-

615-7972 for Claim Status questions.

QUINCY HEALTH CARE

MANAGEMENT37129 X X

QVI RISK SOLUTIONS INC 57117 X

RAILROAD MEDICARE 00882 X X X X

RANDMARK, INC. 61101 X X X X X See Humana

RBMS LLC 91176 X X

RE HARRINGTON 95266 X X X

READING HOSPITAL

EMPLOYER GROUP44219 X X X

REDLANDS IPA (SYNERMED) SYMED X

REGAL MEDICAL GROUP REGAL X

REGENCE BLUE SHIELD of

IDAHO00611 X X X

REGENCE BLUE SHIELD

WASHINGTON00932 X X

REGENCE BLUECROSS

BLUESHIELD OREGON00851 X X

REGENCY EMPLOYEE

BENEFITS38221 X X

REGION A DMERC 05655 X X X

REGION B DMERC 05655 X X X

Region C DMERC 05655 X X X X

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REGIONAL CARE INC 47076 X X

REGIONAL HOME HEALTH

HOSPICE INTERMEDIARY12M55 X X

RESERVE NATIONAL INS CO 73066 X X X

RETIREES WELFARE TRUST NWADMIN X X

REUNION INDUSTRIES CHAT1 X X

RHODE ISLAND BCBS RIBLS X X X

RHODE ISLAND MEDICAID RIMCD X X X

RHODE ISLAND MEDICARE 14402 X X X XRIO GRANDE HMO 84980 X X

RIVER QUEST NETWORK, INC 37129 X X

RIVERSIDE FAMILY HEALTH

MED GRP IPAMPM08 X

RMSCO INC RMSCO X

ROCKWELL INTERNATIONAL 75196 X X

ROONEY LIFE INC 37602 X X

ROSEMONT OF DES PLAINES

IL36215 X X

RR MEDICARE 00882 X X X X

RUSH HEALTH ASSOCIATION 36339 X X

RUSH PRUDENTIAL HEALTH 60054 X X X X XSee Aetna

RUSH PRUDENTIAL HMO 36389 X X

S & S HEALTHCARE

STRATEGIES31441 X

S ATLANTIC MEDICAL GROUP SAMG1 X X

SAGAMORE HEALTH

NETWORK35164 X X

SAGE PROGRAM MNDH1 X X X XSAINT BARNABAS SYSTEM


SAMARITAN HEALTH PLANS CP001 X X

SAMBA 62308 X X X X X See Cigna

SAN FRANCISCO

ELECTRICAL WORKERS37236 X

SANDIA TRIPLE OPTION 60054 X X X X X See Aetna

SANFORD HEALTH PLAN 91184 X X

SANTA BARBARA COTTAGE

HOSPITAL35182 X X X X X See CoreSource

SANTA CLARA FAMILY


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SANTE HEALTH SYSTEM AND

AFFILIATES77038 X X X

SANUS PPO - ST. LOUIS 63665 X X

SC PLANNED

ADMINISTRATORS INC886 X

SCAN HEALTHPLAN 72261 X X

SCAN HEALTHPLAN AZ 73172 X X

SCAN LONG TERM CARE 20460 X X

SCOTT & WHITE 88030 X X X

Enrollment required. Contracted providers please

call 254-298-3278. Noncontracted providers please

call 254-298-3274.

SCOTT AND WHITE TH002 X

SEABURY AND SMITH 13310 X X

SEASIDE HEALTHPLAN 46187 X X

SECURE CARE OF IOWA 42142 X X

SECURE HEALTH PLAN OF

GA28530 X X

SECURE HORIZONS - UHC 87726 X X X X X See United Healthcare

SECURE HORIZONS -

WELLMEDWELM2 X X

SECURECARE OF IOWA 42142 X X

SECURITY HEALTH PLAN 39045 X X

SELECT ADMINISTRATIVE

SERVICES64088 X X

SELECT BENEFIT ADMIN OF

WI37282 X X

SELECT BENEFIT

ADMINISTRATORS IA42137 X X

SELECT BENEFIT

ADMINISTRATORS INC93031 X X

SELECT HEALTH OF SOUTH

CAROLINA23285 X X X X X

SELECTCARE 00014 X X X

SELECTCARE COCA COLA 60054 X X X X X See Aetna

SELECTCARE OF OKLAHOMA SCOK1 X X

SELECTCARE OF TX

(INTEGRANET)INET1 X X

SELECTCARE OF TX KELSEY

SEYBOLDKLSY1 X X

SELECTHEALTH UH107 X X Contact Payer before sending at 801-442-5442

SELF FUNDED PLANS IL PA

OH34131 X X

SELF INSURED BENEFIT ADM 59111 X X

SELF INSURED PLAN LLC 36404 X X

SENIOR CARE 60054 X X X X X See Aetna

SENIOR WHOLE HEALTH 83035 X X

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SENTARA HEALTH

MANAGEMENT54154 X X

SENTINEL MANAGEMENT

SERVICES23249 X X

SENTRY INSURANCE 39033 X X X XSEOUL MEDICAL GROUP SMG01 X

SETON EMPLOYEE PLAN SHEBP X X

SETON HEALTH PLAN EPNSH X X

SETON HEALTH PLAN CHIP SHPCH X X

SETON HEALTH PLAN MAP

PRGSHMAP X

SFCCN COMMERCIAL 59064 X X X XThis payer has no Paper EOB option. ERA

enrollment is required

SFCCN MEDICAID 59065 X X X XThis payer has no Paper EOB option. ERA

enrollment is required

SHARE HEALTH PLAN ILL

HMOUH005 X

SHARE HEALTH PLAN ILL PPO UH006 X

SHASTA ADMINISTRATIVE

SERVICES75280 X X

SHEFFIELD OLSON &

MCQUEEN, INC41143 X X

SIERRA HEALTH SERVICES 76342 X X X X

SIERRA HEALTH SERVICES

ENCOUNTERS76343 X X

SIGNATURE HEALTH

ALLIANCE (SHA)62159 X

SILVER CROSS MANAGED

CARE ORG36387 X X

SIMPLY HEALTHCARE 27094 X X X

SINCLAIR HEALTH PLAN 84076 X X

SISCO SISCO X X

SLOAN'S LAKE MANAGED

CARE84096 X X

SMITH ADMINISTRATORS 02057 X X X

SOONER HEALTH NETWORK

WI81400 X

SOUND HEALTH SISTERS OF

PROVIDENCE91131 X X

SOUTH CAROLINA BCBS 401 X

SOUTH CAROLINA BCBS FEP 402 X

SOUTH CAROLINA MEDICAID 619 X X X

SOUTH CAROLINA MEDICARE

PART A12M55 X X

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SOUTH CAROLINA MEDICARE

PART B11202 X X X X

SOUTH DAKOTA BCBS ET099 X X X XSOUTH DAKOTA MEDICAID

(INST)12K36 X X

SOUTH DAKOTA MEDICAID

(PROF)SDMCD X X

SOUTH DAKOTA MEDICARE

PART A03401 X X X X

SOUTH FLORIDA COMMUNITY

CARE NETWORK59065 X X X

SOUTHCARE/HEALTHCARE

PREFERRED25147 X X X

SOUTHEASTERN INDIANA

HEALTH77153 X X

SOUTHERN BENEFIT

SERVICES LLC37318 X X

SOUTHERN CALIFORNIA

MEDICAL COALITIONSCMC0 X

SOUTHERN DESERT HEALTH

WI81400 X

SOUTHERN GROUP


SOUTHERN HEALTH

SERVICES25133 X X X X X


SOUTHWEST SERVICE LIFE 37266 X X

SOUTHWESTERN BELL 60054 X X X X X See Aetna

SPECIAL RISK

INTERNATIONAL (SRI)52190 X X

SPECTRUM

ADMINISTRATORS INC23253 X X X

SPOHN HEALTH SPOHN X X

ST ANTHONY MEMORIAL

MDWISE35199

ST BARNABAS SYSTEM


ST CATHERINE HOSPITAL

MDWISE35199

ST FRANCIS IPA APP01 X

ST JOHNS CLAIMS ADMIN 37264 X X

ST JOSEPH 74128 X X

ST JOSEPH HERITAGE HC STJOE X X

ST THERESE PHYSICIANS

ASSOCIATES37116 X X

ST VINCENT CATHOLIC

MEDICAL13407 X X

STAR HEALTH PLAN COMMF X X

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STARBRIDGE STAR/HRG 59225 X X X

Payer ID valid only if the address on the Health ID

card matches one of the following PO Boxes: PO

Box 55270, 30870, 30888, 54150, 30069, 55400;

Phoenix AZ 85270

STARMARK 61425 X X X XSTATE FARM (CASUALTY

AND PROPERTY)31059 X

STATE FARM INSURANCE 31053 X X X X

STATE MERIT GA BCBS 00601 X X XSTATES GENERAL LIFE

INSURANCE75087 X

STAYWELL 14163 X X XTaxonomy codes required at both the Billing and


STAYWELL

HEALTH/WELLCARE14163 X X X

Taxonomy codes required at both the Billing and


STERLING MEDICARE

ADVANTAGE67829 X X

STERLING OPTION 1 91151 X X

STIRLING AND STIRLING 06089 X X

STONER AND ASSOCIATES 31121 X X

STOWE ASSOCIATES 58128 X X

STUDENT INSURANCE

DIVISION74227 X X X

SUFFOLK HEALTH PLAN 88331 X X

SUMMACARE HEALTH PLAN 95202 X X X

SUMMIT AMERICA

INSURANCE SERVICES37301 X X

SUN TRUST BANK, INC. 60054 X X X X X See Aetna

SUNSHINE STATE HEALTH

PLAN68057 X X X

SUPERIOR BENEFITS 23218 X X

SUPERIOR HEALTH PLAN 68069 X X X

Prior to submitting claims, contact your Health Plan

Provider Relations Department to verify your provider

information is on file in the Health Plans claim

system. This will prevent claim rejections and allow

payments to be made in a timely manner. You may

reach Provider Relations at 800.218.7453 or by

visiting www.superiorhealthplan.com.

SUPERIOR HEALTH PLAN OF

TEXAS39188 X X X X X

SURBURBAN HEALTH ORG 35199 X

SUTTER MEDICAL GROUP

REDWOODS77304 X X

Sutter Connect requires the providers to complete an

application & get approval prior to sending claims to

a clearinghouse. Contact Sutter Connect EDI Dept @

(800)611-5191

SYRACUSE COMMUNITY

HEALTH CENTER16146 X

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TALL TREE ADMINISTRATORS 88067 X X

TARRANT HEALTH SERVICES 37228 X

TBG ADMINISTRATIVE

SERVICE39157 X X

TEAM CHOICE ALPHA ADSL1 X X

TEAM CHOICE GOLD 75139 X X

TEAM CHOICE PPO 75133 X X

TEAM CHOICE UMC 75134 X X

TEAMCARE 36215 X X

TEAMSTERS (UT/ID/MT) - GRP

BENEFIT ADMIN88054 X X X

TEAMSTERS BENEFIT TRUST 94304 X X

TEAMSTERS CONSTRUCTION

INDUSTRY TRUNWADMIN X X

TEAMSTERS LOCAL UNION

30136612 X X

TENNCARE 36193 X X

TENNESSEE BCBS 00390 X X XTENNESSEE MEDICARE PART

A10301 X X X

TENNESSEE MEDICARE PART

B10302 X X X X

TEXAN PLUS (INTEGRANET) INET1 X X

TEXAN PLUS KELSEY BOLD KLSY1 X X

TEXAS BCBS 84980 X X

TEXAS CHILDRENS HEALTH

PLAN76048 X X

TEXAS CHILDRENS STAR TXCSM X

TEXAS FIRST HEALTH PLANS 76046 X X

TEXAS MEDICAID 86916 X X

TEXAS MEDICARE PART A 00400 X X X

TEXAS MEDICARE PART B 04402 X X X XTEXAS MUNICIPAL LEAGUE

GROUP74214 X X

TEXAS PLAN

ADMINISTRATORTXP11 X

TEXAS TRUE CHOICE TH055 X

03/09/2016 THE BENFIT GROUP TGBNE X X

THE BOON GROUP BOONG X X

THE CARE NETWORK /

SAVANNAH BUSINESS GRP68423 X X

THE CHESTERFIELD

COMPANIESCRI01 X

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COMMENTS





THE EMPIRE PLAN 87726 X X X X X See United Healthcare

THE EPOCH GROUP LC 28777 X X

THE EYE PA EYEPA X

THE FORD METER BOX CO 37305 X X

THE HEALTH EXCHANGE

CERNER CORP20356 X X

THE HEALTH PLAN 34150 X X

THE HEALTHCARE GROUP 35206 X X

THE INTEGRITY BENEFIT

NETWORK58200 X X

THE LOOMIS COMPANY 23223 X X

THE MUTUAL GROUP 70491 X X

THE OATH - HEALTH

PARTNERS FOR AL63092 X

THE PERFECT HEALTH INS

CO13522 X X X

THE PRUDENTIAL 60054 X X X X X See Aetna

THE SANDHILLS CENTER SHC303 X X X

THE WELLNESS PLAN 38200 X X

THE WILLAIM EARHART CO 93050 X X

THERAPHYSICS THERA X

THERAPHYSICS COLORADO COTHE X

THIRD PARTY


THIRD PARTY CLAIMS

MANAGE95266 X X X

THIRD PARTY CLAIMS

MANAGEMENT06131 X X

THOMAS H COOPER SX160 X X

THREE RIVERS HEALTH PLAN 25175 X X X X See Unison Health Plan

THREE RIVERS PREFERRED MP340 X

TIME INSURANCE CO 39065 X X X X See Assurant Health

TIME INSURANCE COMPANY 39065 X X X X See Assurant Health

TIOPA (TEXAS FIRST HEALTH

PLANS)76046 X X

TLC ADVANTAGE - SIOUX

FALLSTLC01 X X

TMG LIFE INSURANCE

COMPANY70491 X X

TODAYS OPTION 48055 X X

TODAYS OPTION MEDICARE 48055 X X

TONGASS TIMBER TRUST 92620 X X X

TORRANCE HOSPITAL IPA THIPA X X

TOTAL CARE (NEW YORK) TCARE X

TOTAL CARE CAROLINA 68055 X X X

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TOTAL COMMUNITY CARE 31182 X X

TOTAL HEALTH CARE INC 38201 X X

TOUCHSTONE HEALTH 11328 X X

TOUCHSTONE HEALTH PSO

PARTNERSHIP23856 X X

TOWER LIFE INSURANCE

COMPANY69493 X X

TPA TEXAS PLAN

ADMINISTRATORSTXP11 X

TPM 81040 X X X Does not accept Secondary Institutional Claims

TR PAUL INC 37230 X X

TRANSAMERICA 59222 X XPayer ID only valid if the patient ID card matches

P.O. Box 982009, North Richland Hills, TX 76182

TRANSAMERICA ASSURANCE

COMPANYTSAAC X X

TRANSAMERICA FINANCIAL TFLIC X X

TRANSAMERICA LIFE INS AR TLINS X X

TRANSAMERICA LIFE INS KY TLIN3 X X

TRANSAMERICA LIFE INS TX TLIN2 X X

TRANSAMERICA

OCCIDENTALTOLI2 X X

TRANSAMERICA

OCCIDENTAL LIFE INS COTOLIC X X

TRANSCHOICE KEY BENEFIT

ADMIN37284 X X X

TRICARE 99726 X X X X X See your specific state for enrollment forms

TRICARE FOR LIFE TDDIR X X X X See your specific state for enrollment forms

TRICARE WEST 99726 X X X X X See your specific state for enrollment forms

TRIHEALTH PHYSICIAN

SOLUTIONS31144 X X X X

TRUE CHOICE USA 54210 X X

TRUE CHOICE USA

CHRISTUSTCUCH X X

TRUE CHOICE USA

CHRISTUS HEALTH PLATCUCH X X

TRUSTED HEALTH PLAN L0230 X X

TRUSTED PLANS SERVICE 91078 X X

TRUSTMARK 61425 X X X X

TRUSTMARK INS CO 61425 X X X XTTPA CHIP 76055 X X

TTPA COMM VIA MEDIVEW 76054 X X

TUFTS HEALTH PLAN 04298 X XTUFTS HP MEDICARE

PREFERRED04298 X X

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COMMENTS





TX CHILDRENS HEALTH PLAN 76048 X X

TXEN ALTPROS 75206 X

UBH-RIOS 87726 X X X X X See United Healthcare

UC CARE 60054 X X X X X See Aetna

UCARE 52629 X X

UCARE OF MINNESOTA 19991 X X X

Please make sure that UCARE has your billing

provider NPI registered or they will reject your

enrollment.UCS MASONRY INDUSTRY

TRUST60230 X X

UCSF/CSL PULMONARY 65006 X

UFCW LOCAL 400-5205 ET059 X

UGS UGS X

UHC COMMUNITY PLAN

KANSAS96385 X X X X

UHIS - UNITED HLTH

INTEGRATED SRVCS39026 X X X X

UICI - ADMINISTRATORS NV 74223 X X X

UICI ADMINISTRATORS 75240 X X

ULTRA BENEFITS INC 41206 X X

UMR HARRINGTON 95266 X X X

UMR LEXINGTON 37237 X X XFormerly known as Common Wealth Administrative

Group

UMR LEXINGTON

COMMONWEALTH ADMIN

GROUP

37237 X XFormerly known as Common Wealth Administrative

Group

UMR ONALASKA 79480 X X

UMR WAUSAU 39026 X X X X See UMR

UMR WAUSAU UHIS 39026 X X X X See UMR

UMWA HEALTH AND

RETIREMENT FUNDS52180 X X X

UNICARE 80314 X X X X X

UNICARE INDIVIDUAL 80314 X X X X X See Unicare

UNICARE MAJOR ACCOUNTS 80314 X X X X X See Unicare

UNICARE OF CA 47198 X X X

UNIFIED GROUP SERVICES 35198 X X

UNIFIED HEALTH SERVICES 62170 X X

UNIFORM MEDICAL PLAN 75243 X X X

UNIFORM MEDICAL

SERVICES75243 X X X

UNIFORMED SERVICES

FAMILY13407 X X

UNION LABOR LIFE INS CO 13142 X X

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UNION LABOR LIFE

INSURANCE13142 X X

UNION PACIFIC RAILROAD

EMPLOYEES87042 X X X

UNITED AGRICULTURAL

BENEFITSUAGBT X

UNITED BEHAVIORAL

HEALTH87726 X X X X X See United Healthcare

UNITED BEHAVIORAL

HEALTH EMPLOYERUBHRI X

UNITED BEHAVIORAL

HEALTH NON HMOUBHRI X

UNITED FOOD COMM

WORKERS MIDWEST UN36659 X

UNITED FURNITURE

WORKERS INSURANCEUFWIF X X

UNITED GOVERNMENT

SERVICESUGS X

UNITED GROUP PROGRAMS UGP19 X X

UNITED HEALTH CARE 87726 X X X X XUNITED HEALTHCARE OF

RIVER VALLEY95378 X X X X See UnitedHealthcare Community Plan MS - CAN

UNITED HEALTHCARE VISION 00773 X X X

UNITED MEDICAL ALLIANCE 84132 X X

UNITED OF OMAHA 71412 X X X X See Mutual of Omaha Insurance Co

UNITED PHYSICIANS

INTERNATIONAL IPAMPM15 X

UNITED PHYSICIANS OF

NORTHER84132 X

UNITED RESOURCES GROUP 41194 X X X

UNITED RESOURCES

NETWORK41194 X X X

UNITED SECURITY LIFE AND

HEALTH36362 X X X

UNITED STATES LIFE

INSURANCE CO13545 X

UNITEDHEALTHCARE 87726 X X X X X See United Healthcare

UNITEDHEALTHCARE METRA 65978 X

UNITY HEALTH INSURANCE 66705 X

Before submitting claims, please go to

http://www.unityhealth.com/Providers/AdminResourc

es/EDI/index.htm and complete EDI Sign Up Form

and NPI Appendix A documents.

UNITY SECURITY LIFE &

HEALTH81108 X

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UNITY/PRECISION HEALTH

PLANS81400 X

UNIVERA HEALTHCARE

SOUTHERN TIER16108 X X

UNIVERA MANAGED CARE 16107 X

UNIVERA PPO UNINE X

UNIVERA PPO UNINW X

UNIVERSAL CARE OF

CALIFORNIA33001 X X

UNIVERSAL CARE OF

TENNESSEE33002 X X

UNIVERSITY FAMILY CARE

#983009830 X X X X

UNIVERSITY FAMILY CARE,

MARICOPA HP09908 X X

UNIVERSITY HEALTH

ALLIANCE99026 X X X X

UNIVERSITY HEALTH PLAN

MEDICAID58247 X X

UNIVERSITY HEALTH PLAN

NJ59000 X X

UNIVERSITY OF MIAMI

BEHAVIORAL HEALTH92579 X

UNIVERSITY OF UTAH

HEALTH PLANSSX155 X X

UNIVERSITY OF

WASHINGTON STUDENTS91136 X X

UNIVERSITY PHYSICIANS HC

GRP07503 X X

UNIVITA ATEND X X

UPMC HEALTH PLAN 23281 X X X XUPPER PENINSULA HEALTH

PLAN38337 X X

US BENEFITS 93092 X X X

US DEPARTMENT OF LABOR 77044 X X X

US FAMILY HEALTH PLAN TH103 X

US HEALTHCARE 23222 X X

US HEALTHCARE 60054 X X X X X See Aetna

US. DEPT OF LABOR 77044 X X XUSAA UNITED STATES AUTO

ASSOCIATI74095 X X

USC HEALTH SERVICES TH021 X

USFHP TH103 X

USFHP TEXAS AND

LOUISIANASHMAP X

UTAH BLUE CROSS 12B42 X X

UTAH BLUE SHIELD 00910 X X X

UTAH MEDICAID UTMCD X X X

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UTAH MEDICARE PART B 03502 X X X XUTAH PUBLIC EMPLOYEE

HEALTH PLANSX106 X X Call Provider Relations before sending 801-352-7270

UTMB 76049 X X

UTMB CHOICEONE CHIP UHSCH X X

VA - HAC 84146 X X X X X

VA FEE BASIS PROGRAMS 12115 X X X X XVA ROCKY MOUNTAIN

NETWORK PAYMENT12115 X X X X X

VA ROCKY MOUNTAIN NPC 12115 X X X X X

VA ROCKY MTN NMC CENTER 12115 X X X X X

VA VETERAN

ADMINISTRATION12115 X X X X X

VALLEY BAPTIST HEALTH

PLAN94999 X X

VALLEY BAPTIST HEALTH

PLANTH022 X

VALLEY PHYSICIANS INC 77004 X

VALUE OPTIONS - PROF ET308 X XVALUE OPTIONS -INST 12X56 X

VALUE OPTIONS MBHP ET394

VALUE OPTIONS MD MHA VALMD X X

VALUE OPTIONS PA

MEDICAIDET371 X

VANTAGE HEALTH PLAN, INC 72128 X

VANTAGE MEDICAL GROUP PPM01 X

VAPCCC REGION 3 VAPCCC3 X X X X See your specific state for enrollment forms

VAPCCC REGION 5A VAPCCC5A X X X X See your specific state for enrollment forms

VAPCCC REGION 5B VAPCCC5B X X X X See your specific state for enrollment forms

VAPCCC REGION 6 VAPCCC6 X X X X See your specific state for enrollment forms

VARIAN HEALTH CARE 60054 X X X X X See Aetna

VENTURENET HEALTHCARE 86062 X X X

VERITY NATIONAL GROUP

INCGASA1 X X

VERMONT BCBS BCBSVT X X X

VERMONT MEDICAID SKVT0 X X X

VERMONT MEDICARE 14512 X X X XVESTACARE VESTA X X

VHP COMMUNITY CARE 23173 X X

VICARE ADMINISTRATIVE

SERVICES54182 X

VICARE ADMINISTRATIVE

SERVICES54182 X

VILLAGECARE MAX 26545 X X

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VIPA BVVP1 X

VIPA BVVP1 X

VIRGINIA BCBS ET103 X X X X

VIRGINIA HEALTH NETWORK 54138 X

VIRGINIA MEDICAID ET042 X X X X

VIRGINIA MEDICARE 11302 X X X X

VIRGINIA PREMIER HEALTH 54176 X

VIRGINIA PREMIERE

COMPLETECAREVPCCP X X X

VISION CARE

INCORPORATED37297 X

VISITING NURSES SERVICE 77073 X X

VISTA HEALTH PLAN 55248 X X X

VIVA HEALTH PLAN 63114 X XVIVA Health requires complete member id including

suffix on all claims submissions

VNS CHOICE MEDICARE 77073 X X

VYTRA HEALTHCARE 22264 X X X

W NEW YORK COMM BLUE 00301 X

WASHINGTON BLUE SHIELD 00932 X X

WASHINGTON DC BCBS INST 12000 X

WASHINGTON DC BCBS

PROFSB580 X X X

WASHINGTON DC MEDICAID 77033 X X X

WASHINGTON DC MEDICARE 12202 X X X X

WASHINGTON DC MEDICARE 12202 X X X X

WASHINGTON L&I ET080 X XWASHINGTON MEDICAID

HCFA ONLYET043 X X X

WASHINGTON MEDICAID UB

ONLY12K27 X X

WASHINGTON MEDICARE 00836 X X X XWASHINGTON REGENCY 00932 X X

WASHINGTON TEAMSTERS

WELFARE TRUSTNWADMIN X X

WATERSTONE BENEFIT


WATKINS ASSOCIATED

INDUSTRIES58082 X X

WATTS HEALTH CARE CORP

IPAMPM09 X

WAUSAU 39026 X X X X See UMR

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WC BEELER & COMPANY 62111 X

WC EARHART 93050 X X

WEA INSURANCE GROUP 39151 X X

WEB TPA 75261 X X

WEISS HEALTH PROVIDERS 36337 X

WELLCARE CT 14163 X X XTaxonomy codes required at both the Billing and


WELLCARE HMO 14163 X X XTaxonomy codes required at both the Billing and


WELLCARE HP, INC

(ENCOUNTERS ONLY)59354 X X

WELLCARE OF CT INC 14164 X X X

WELLCARE OF FL 59608 X X X

WELLCARE OF GA 14163 X X XTaxonomy codes required at both the Billing and


WELLCARE OF GEORGIA 14163 X X XTaxonomy codes required at both the Billing and


WELLCARE OF LOUISIANA 14163 X X XTaxonomy codes required at both the Billing and


WELLCARE OF NEW YORK 14163 X X XTaxonomy codes required at both the Billing and


WELLMED TH023 X

WELLMED MEDICAL WELM2 X X

WELLPATH OF CAROLINA 25133 X X X X See Coventry Health Care

WELLS FARGO TPA 87815 X X X X X

WELS BENEFIT PLAN OFFICE 22925 X X

WENATCHEE VALLEY

MEDICAL CENTER91064 X X

WEST COAST STATIONARY

ENGINEERS91136 X X

WEST VIRGINIA BCBS 54828 X X

WEST VIRGINIA BLUE CROSS 12B28 X X

WEST VIRGINIA MEDICAID -

PROFWVMCD X

WEST VIRGINIA MEDICAID UB 12K28 X X

WEST VIRGINIA MEDICARE

PART A12M28 X X

WESTERN CARE 70408 X X X XWESTERN GROWERS

INSURANCE CO24735 X X

WESTERN HEALTH INC 37306 X X

WESTERN LIFE INS CO 70408 X X X XWESTERN MUTUAL 91131 X X

WESTERN MUTUAL INS

NONPAR PROVIDERS37247 X X

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WESTERN MUTUAL

INSURANCE91131 X X

WESTERN SOUTHERN

FINANCIAL GROUP31048 X X

WESTERN TEAMSTERS

WELFARE TRUSTNWADMIN X X

WESTLAKE FINANCIAL

GROUPWESTL X X

WEYCO INC 38232 X X

WILLIAM C EARHART 93050 X X

WILLIAM J SUTTON & CO 98010 X X

WILLIAMS AND COUNTY MAP WCMAP X X

WINDSOR MEDICARE EXTRA 62153 X X

WINHEALTH PARTNERS 27327 X X

WINTERBROOK HEALTHCARE 73159 X X X

WISCONSIN AUTO & TRUCK

DEALERS39200 X X

WISCONSIN BCBS 00950 X

WISCONSIN DEPT OF

CORRECTIONS74101 X X

WISCONSIN EMPLOYERS

GROUP61101 X X X X X See Humana

WISCONSIN MEDICAID WIMCD X X

WISCONSIN MEDICARE PART

A12M29 X X

WISCONSIN MEDICARE PART

B06302 X X X X

WISCONSIN PHYSICIANS

SERVICE GROUPSX022 X X

WM C EARHART 93050 X X

WM EARHART 93050 X X

WMI 91131 X X

WORKSITE BENEFIT

SERVICES, LLC20333 X X

WORKSITE BENEFIT

SERVICES, LLC20333 X X

WORLD INSURANCE 75276 X X

WORLD INSURANCE

COMPANY75276 X X

WPS CHAMPUS 99726 X X X X X See your specific state for enrollment forms

WPS HEALTH INSURANCE of

WISCONSINWPS X X X

WPS J5 NATIONAL MEDICARE

INSTITUTIONAL 05901 X X

WPS PREVEA HEALTH PLAN 10159 X X

WPS TRICARE 99726 X X X X X See your specific state for enrollment forms

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WRITERS GUILD 25133 X X X X X See Coventry Health Care

WV MEDICARE 11402 X X X X

WY BLUE CROSS 00460 X X X X

WY BLUE SHIELD 00960 X X X X X

WY MEDICAID 77046 X X X x X

WY MEDICARE PART A 03601 X X X X

WY MEDICARE PART B 00320 X X X X

WYOMING BLUE CROSS 00460 X X X X

WYOMING BLUE SHIELD 00960 X X XWYOMING MEDICAID 77046 X X

WYOMING MEDICARE PART A 03601 X X X X

WYOMING MEDICARE PART B 00320 X X X X

XANTUS HEALTHPLAN OF

TENNESSEE62153 X X

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Documents

Health-e-Web Payer List Updated: 4/6/2016 - Availity · ADV HUMANA GOLD CHOICE 61101 X X X X X See Humana ... AETNA ASA PPO (SIGNATURE ADMIN) ... Health-e-Web Payer List Updated: