OptumInsight Electronic Remittance Advice Payer … · OptumInsight Electronic Remittance Advice Payer List (ERA) (As of 08/20/2018) Alliant Health Plans of Georgia (837I & 837P)

OptumInsight Electronic Remittance Advice Payer List (ERA)(As of 08/20/2018)

For up-to-date payer information, visit http://www.ingenix.com/connectivityor contact OptumInsight Customer Service and Support at 866-367-9778

PAYER_NAME STATE PAYER_ID ENROLLMENT Payer Type

American Income Life Insurance Company (837I & P) ALL 60577 Y G1199 National Benefit Fund ALL 13162 Y GAARP Hospital Indemnity Plans insured by UnitedHealthcare Insurance Company ALL 36273 Y TAARP Medicare Supplement Plans insured by UnitedHealthcare Insurance Company ALL 36273 Y TABS - US Health (837I & 837P) ALL 38259 Y GAdministrative Concepts (837I & 837P) ALL 22384 Y GAdvantek Benefit Administrators (837I & 837P) ALL ADVTK Y GAdventist Health System West (837I & P) ALL 95340 Y GAdvocate Health Centers (AHC) (837P) ALL 36320 Y GAdvocate Physicians Partners (PHO) (837P) ALL 65093 Y GAetna - American Continental Insurance Company (837I & 837P) ALL 62118 Y GAetna (837D) ALL 60054 Y TAetna (837I & 837P) ALL 60054 Y TAetna Better Health - PA Medicaid (837P & 387I) ALL 23228 Y GAetna Better Health of NY (837P) NY 34734 Y GAetna Better Health of Florida (837I & 837P) FL 128FL Y GAetna Better Health of IL (837I & 837P) IL 26337 Y GAetna Better Health of KY (837I & 837P) KY 128KY Y GAetna Better Health of Louisiana (837I & 837P) LA 128LA Y GAetna Better Health of Michigan (837I & 837P) MI 128MI Y GAetna Better Health of New Jersey (837I & 837P) NJ 46320 Y GAetna Better Health of Ohio (837I & 837P) OH 50023 Y GAetna Better Health of Virginia VA 128VA Y GAetna Better Health of West Virginia (837I) WV 128WV Y GAetna Better Health Plan of Nebraska (837I & 837P) NE 42130 Y GAetna TX Medicaid & CHIP (837I & 837P) TX 38692 Y GAffinity Essentials (837I & 837P) ALL 23334 Y GAffinity Health Plans (837I & 837P) ALL 13334 Y GAffinity Medicare Advantage (837I & 837P) ALL 13333 Y GAGC International Union of Operating Engineers Local 701 (837I & 837P) ALL 91136 Y G

AK United Food and Commercial Workers (AK UFCW) (837I & 837P) ALL 91136 Y GAlaska Carpenters (837I & 837P) ALL 91136 Y GAlaska Hotel Employees Restaurant & Camp Employees (AK HERE) (837I & 837P) ALL 91136 Y GAlaska Laborers Construction Industry Health & Security Trust (837I & 837P) ALL 91136 Y GAlaska Pipe Trades U A Local 375 (837I & 837P) ALL 91136 Y GAlaska Public Employees Association (APEA/JESS Health & WelfareTrust) (837I & 837P) ALL 91136 Y GAllegiance Benefit Plan Management Inc (837I & P) ALL 81040 Y GAlliant Health Plans of Georgia (837I & 837P) GA 58234 Y GAllied Benefit Systems (837I & 837P) ALL 37308 Y G

Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for this payer



PAYER_NAME STATE PAYER_ID ENROLLMENT Payer TypeHighlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for this payer

Allied Metal Crafts Security Plan Trust Fund (837I & 837P) ALL 91136 Y GAlohaCare (837I & 837P) ALL ALOHA Y GAmalgamated (837I & 837P) ALL 13550 Y GAmeraplan (837I & 837P) ALL 38219 Y GAmeriben Solutions (837I & 837P) ALL 75137 Y G

American Administrative Group AAG (Gallagher Benefits) (837I & P) ALL 37283 Y GAmerican General (837I & 837P) ALL 62030 Y GAmerican Insurance Administrators (837I & 837P) ALL 26119 Y GAmerican National Insurance CO (ANICO) (837I & 837P) ALL 74048 Y GAmerican Postal Workers Union Health Plan (837I & P) ALL 44444 Y GAmerican Republic Insurance (837I & 837P) ALL 42011 Y GAmerican Republic Insurance Company (837I &P) ALL 56071 Y GAmerican Specialty Health (837I & 837P) ALL ASH01 Y GAmerigroup (837I & 837P) ALL 27514 Y GAmeriHealth Administrators (837I & 837P) (835s returned under PAKEY) ALL 54763 Y NAmerihealth Caritas Iowa (837I & 837P) IA 77075 Y GAmerihealth Caritas Louisiana (837I & 837P) LA 27357 Y GAmerihealth Caritas VIP Care (837I & P) ALL 77062 Y GAmeriHealth Caritas VIP Care Plus of MI (837I & 837P) MI 77013 Y GAmerihealth District of Columbia (837I & 837P) ALL 77002 Y GAmerihealth HMO (837I & 837P) ALL 23037 Y GAmerihealth HMO of Delaware and New Jersey (837I & P) DE, NJ 95044 Y GAmeriHealth Mercy Health Plan ALL 22248 Y GAmeriHealth NorthEast (837I & 837P) ALL 77001 Y GAmerihealth-NJ (Non-HMO Claims) (837P) NJ SX075 Y NAmFirst Insurance Company (837I & 837P) AL 64090 Y GAnthem BCBS Kentucky (837I) KY 00160 Y GAnthem BCBS of Indiana (837I) IN 00130 Y GAnthem BCBS of Virginia (837I &P) VA 00423 Y GAnthem BCBS Ohio (837I) OH 00332 Y GAnthem of Nevada NV NVBLS Y TAPEX Health Solutions (837I & 837P) ALL 34196 Y GAsian American Medical Group (837P) ALL AAMG1 Y GASRM LLC (837I & 837P) ALL ASRM1 Y GAssociated Administrators LLC (837I & 837P) ALL 13788 Y GAuxiant (837I & 837P) ALL AUX01 Y GAVERA (837I & 837P) ALL 46045 Y G

AvMed (837I & 837P) Provider must enroll for EFT in order to receive electronic remittance, http://www.avmed.org/Providers/Tools/EOP ALL 59274 Y GBankers Life And Casualty (837I & P) ALL 36066 Y GBanner Health (837I & 837P) ALL 12X42 Y GBC Illinois Medicare Advantage (837I & P) IL 66006 Y GBC Montana Medicare Advantage (837I & P) MT 66006 Y GBC New Mexico Medicare Advantage (837I & P) NM 66006 Y G




BC Oklahoma Medicare Advantage (837I & P) OK 66006 Y GBC Texas Medicare Advantage (837I & P) TX 66006 Y GBCBSTX Medicaid STAR/CHIP TX 66001 Y GBeacon Health Options (previously ValueOptions) (837I & 837P) ALL VALOP Y GBeacon Health Strategies (837I & 837P) ALL 43324 Y GBenefit Administrative Systems (837P & 837I) ALL 36149 Y GBenefit Management, Inc. (837I & 837P) ALL 48611 Y G

Benefit Plan Administrators Company (Eau Claire Wisconsin) (837P & I WI 39081 Y GBenefit Systems and Services, Inc. (837I & 837P) ALL 36342 Y GBeneSys, Inc. (837I & 837P) ALL 37248 Y GBetter Health Plan of Florida (837I & 837P) FL 20488 Y GBlue Advantage of Arkansas (837I & 837P) AR ARBLS Y TBlue Care Complete of Michigan (837I & 837P) MI 32002 Y GBlue Care of Virginia PPO VA VABLS Y TBlue Chip of Rhode Island RI RICHP Y TBlue Choice Medicaid (837I & 837P) SC 00403 Y NBlue Cross Blue Shield of Alabama (837I) AL 12B54 Y NBlue Cross Blue Shield of Arizona Advantage (Formerly Banner Health Medisum) (837I & 837P) AZ 77078 Y GBlue Cross Community Options (837I & 837P) ALL MCDIL Y GBlue Cross of California CA BC001 Y TBlue Cross of Georgia (837I) GA 3537I Y TBlue Cross of Idaho ID IDBLC Y TBlue Cross of Kansas (835s returned under KSBLS) KS 57325 Y NBlue Cross of Michigan MI 12B18 Y NBlue Cross of Nebraska (835s returned under NEBLS) NE 00260 Y TBlue Cross of New York, Western (835s returned under N1BLS) NY 12B39 Y TBlue Cross of North Carolina (835s returned under NCBLS) NC 12B23 Y TBlue Cross of Utah (835s returned under UTBLS) ALL 12B42 Y NBlue Cross of West Virginia (837I) WV SB941 Y NBlue Medicare of NC (837I & 837P)This is Blue Cross Blue Shield NC Medicare Advantage Plan (835s returned under NCBLS) ALL 56152 Y NBlue Shield of Alabama (837I & 837P) AL ALBLS Y TBlue Shield of Alaska (835s returned under AC032) AK AKBLC Y TBlue Shield of Arizona AZ AZBLS Y TBlue Shield of California (for 837P & 837I claims) CA BS001 Y TBlue Shield of Colorado CO COBLS Y TBlue Shield of Connecticut CT CTBLS Y TBlue Shield of Delaware DE DEBLS Y TBlue Shield of Florida FL FLBLS Y TBlue Shield of Georgia GA GABLS Y TBlue Shield of Hawaii HI HIBLS Y TBlue Shield of Idaho ID IDBLS Y TBlue Shield of Illinois IL ILBLS Y TBlue Shield of Indiana IN INBLS Y TBlue Shield of Iowa IA IABLS Y T




Blue Shield of Kansas KS KSBLS Y TBlue Shield of Kansas City KS KCBLS Y TBlue Shield of Kentucky KY KYBLS Y TBlue Shield of Lousiana (837I & 837P) LA LABLS Y TBlue Shield of Maine ME MEBLS Y TBlue Shield of Maryland MD SB690 Y NBlue Shield of Massachusetts (837I & 837P) MA MABLS Y TBlue Shield of Michigan MI MIBLS Y TBlue Shield of Minnesota MN MNBLS Y TBlue Shield of Mississippi MS MSBLS Y TBlue Shield of Missouri MO MOBLS Y TBlue Shield of Montana MT MTBLS Y TBlue Shield of Nebraska NE NEBLS Y TBlue Shield of Nevada NV NVBLS Y NBlue Shield of New Hampshire NH NHBLS Y TBlue Shield of New Jersey ALL 22099 Y NBlue Shield of New Mexico NM NMBLS Y TBlue Shield of New York (Empire) (837I & 837P) NY NYBLS Y TBlue Shield of New York, Central NY N2BLS Y TBlue Shield of New York, Utica NY N4BLS Y TBlue Shield of New York, Western NY N1BLS Y TBlue Shield of North Carolina NC NCBLS Y TBlue Shield of North Dakota ND NDBLS Y TBlue Shield of Ohio OH OHBLS Y TBlue Shield of Oklahoma (Remits will be returned with payerID OKBLS) OK 00840 Y TBlue Shield of Oregon OR ORBLS Y TBlue Shield of Pennsylvania PA PABLS Y TBlue Shield of Rhode Island RI RIBLS Y TBlue Shield of South Carolina SC SCBLS Y TBlue Shield of South Dakota SD SDBLS Y TBlue Shield of Tennessee (837I) TN 5513I Y TBlue Shield of Tennessee (837P) TN TNBLS Y TBlue Shield of Texas (includes Blue Cross of Texas) TX TXBLS Y TBlue Shield of Utah UT UTBLS Y NBlue Shield of Virginia VA VABLS Y TBlue Shield of West Virginia WV WVBLS Y TBlue Shield of Wisconsin WI WIBLS Y TBlue Shield of Wyoming WY WYBLS Y TBluegrass Family Health (837I & 837P) ALL 61124 Y GBMC HealthNet Plan (837I & 837P) ALL 13337 Y GBoonChapman (837I & 837P) ALL 74238 Y GBridgeSpan (837I & 837P) ALL BRIDG Y GBridgeway Arizona (837I & 837P) AZ 68069 Y GBright Health Plan (837I & 837P) ALL BHP01 Y GBroadspire, A Crawford Company (837I & 837P) ALL TP021 Y GBrown & Toland Medical Group (837I & 837P) ALL 94316 Y G




Buckeye Community Health (837I & 837P) ALL 68069 Y GCALOPTIMA DIRECT (837I & P) ALL CALOP Y GCamp Lejune Family Member Program (837I & 837P) ALL CLFM1 Y GCapital District PHP * ALL SX065 Y NCardinal Innovations (837I & 837P) ALL 06607 Y GCare Access PSN (837I & 837P) ALL 65062 Y GCare Wisconsin Health Plan (837I & 837P) ALL 27004 Y GCARE1ST Health Plan California (837P & I) CA C1SCA Y GCareCentrix (837I & 837P) ALL 11345 Y GCareConnect Insurance Company (837I & P) ALL 46227 Y GCarefirst BCBS District Of Columbia NCA (837P & I) DC SB580 Y GCarefirst BCBS Maryland MD SB690 Y GCaremore (837I & 837P) ALL CM001 Y NCareOregon (837I & 837P) ALL 93975 Y GCarePlus Health Plan (837I & 837P) ALL 65031 Y GCarepoint Health Plans (837I & 837P) ALL 77023 Y GCareSource Marketplace (837I & 837P) ALL INCS1 Y GCaresource of Georgia (837I & P) ALL GACS1 Y GCareSource of Kentucky (837I & 837P) KY KYCS1 Y GCareSource of Ohio (837P) OH 31114 Y GCBHNP - Health Choice (837I & 837P) ALL 65391 Y GCeltic Insurance Company (837I & 837P) ALL 68063 Y G

Cement Masons and Plasterers Health & Welfare Trust (837I & 837P) ALL 91136 Y GCenCal Health (837I & 837P) ALL 95386 Y NCenpatico Behaviioral Health of Arizona (837I & 837P) ALL 38048 Y GCenpatico Behavioral Health (837I & P) ALL 68068 Y GCenpatico Massachusetts (837I & 837P) MA 68069 Y GCentene (837I & 837P) ALL 68069 Y GCenterLight Healthcare (837I & 837P) ALL 13360 Y GCentral California Alliance for Health (837I & 837P) CA SX169 Y NCentral Pennsylvania Teamsters Fund (837I & 837P) ALL 23626 Y GCHAMPVA-HAC (CHAMPVA-HAC is not associated with and does not process claims for TRICARE (formerly CHAMPUS.) ) ALL

84146Y N

CHAMPVA-HAC Medicare Crossover (837I & 837P) ALL 80214 Y GCHCS Services Incorporated (837I & 837P) ALL 59295 Y GCHCS Services, Inc. (837I & 837P) ALL 75895 Y GChesterfield Resources (837I & P) ALL 34154 Y GChildrens Specialist of San Diego (837I & 837P) ALL CSSD2 Y GChiropractic Health Plans (CHP) (837P) UT U1439 Y NChristus Health Medicare Advantage (837I & 837P) ALL 10629 Y GChristus Health New Mexico HIX (8377I & 837P) NM 21062 Y GCigna ALL 62308 Y TCigna Behavioral Health (remits returned under 62308) ALL MCCBV Y TCigna Healthspring (Bravo Health Elder Health) 837I & 837P All 52192 Y GCigna Supplemental (837I & 837P) ALL 13193 Y GCMS MMA Specialty Plan (837I & 837P) ALL EM843 Y G




CNIC Health Solutions (837I & 837P) ALL 37227 Y GCofinity (837I & 837P) ALL 38335 Y GColonial Life (837I & 837P) ALL 37077 Y GColorado Access (837P & 837) CO COACC Y GCommunity Care BHO (837I & 837P) ALL 23282 Y GCommunity Care HMO (837I & 837P) WI 60995 Y G

Community Care Managed Health Care Plans of OK (837I & 837P) ALL 73143 Y GCommunity Care of Wisconsin (837I & 837P) WI 39126 Y GCommunity First Health Plan (837I & 837P) ALL 42723 Y GCommunity Health Center Network (837P) ALL CHCN1 Y GCommunity Health Choice (837I & 837P) ALL 48145 Y GCommunity Health Electronic Claims/CHEC/webTPA (837P, 837I, 837D) ALL 75261 Y GCommunity Health Group (837I & 837P) ALL 66170 Y NCommunity Health Plan Of Washington (837I & P) ALL CHPWA Y GComplementary Healthcare Plan (837I & 837P) ALL CHP01 Y GComprehensive Benefits (837I & 837P) ALL 03036 Y GComPsych (837P) ALL 37363 Y NConnecticare - Medicare (837I & 837P) ALL 78375 Y GConnectiCare, Inc ALL 06105 Y NConnecticut Bluecare Family Plan (835s returned under CTBLS) CT C3BLS Y TConnecticut Federal Employee Program (835s returned under CTBLS) CT

C2BLSY T

Connecticut Medicare Part A CT 12M04 Y GConseco Services, LLC (837I & 837P) ALL 11285 Y GConsolidated Health Plans (837I & 837P) ALL 87843 Y GCook Childrens Health Plan (837I & 837P) ALL CCHP1 Y GCooperative Managed Care Services (837I & 837P) ALL 35199 Y GCoordinated Benefit Plans (837I & 837P) ALL 14829 Y GCore Source ALL 35187 Y G

Core Source of AZ, IL, IN, MD, MN, NC, PA (837I & P)

AZ, IL, IN, MD, MN, NC, PA 35182 Y G

Core Source of Little Rock (837I & P) AR 75136 Y GCornerstone Benefit Administrators (837I & 837P) ALL 35202 Y GCounty Care (837I & 837P) ALL 06541 Y GCova- Commonwealth of Virginia VA VABLS Y TCovenant Administrators Incorporated (Atlanta, Georgia) (837I & 837P) ALL 58102 Y GCoventry Health Care ALL 25133 Y GCoventry Healthcare of Florida (837I & 837P) ALL 128FL Y GCox Health Plan (837I & 837P) ALL 00019 Y GDakotaCare (837I & 837P) SD DAK01 Y NDean Health Plan ALL 39113 Y GDell Childrens Health Plan (837P & I) ALL DCHPM Y GDepartment of Labor (837I & 837P) ALL J1438 Y G




Deseret Mutual (837I & 837P) UT SX105 Y NDiamond Health Plan (previously PID 25131) ALL 25133 Y GDignity Health - Sacramento Hospital claim shop for Mercy Medical Group, Woodland Clinic Medical Group and Hill Physicians Medical group (hospital risk) ALL HOSH1 Y TDignity Health Medical Foundation for Mercy Medical Group or Woodland Clinic Medical Group (professional risk) ALL PROH1 Y TDignity Health Medical Foundation for Sequoia Physicians Network (professional risk) ALL PROH2 Y TDignity Health Medical Group - Inland Empire (professional risk) ALL PROH4 Y TDignity Health Physician Network-Inland Empire (hospital risk) ALL HOSH4 Y T

DME Region A

CT, DE, ME, MD, MA, NH,

NJ, NY, PA, RI, VA, DC DMERA Y T

DME Region B

IL, IN, KY, MI, MN, OH, WI DMERB Y T

DME Region C

AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, PR, SC,

TN, TX, VI, VA, WV DMERC Y T

DME Region D

AK, AZ, CA, GU, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY DMERD Y T

Driscoll Childrens Health Plan (837I & 837P) ALL 74284 Y GDunn (837I & 837P) ALL 61364 Y GDupage Medical Group (837I & P) ALL DUPAG Y GECHO Health (837I & 837P) ALL 58379 Y NEl Paso First Health Plans - CHIP (837I & 837P) ALL EPF03 Y NElderPlan, Inc. ALL 31625 Y GEMIA (837P) UT SX110 Y NEmployee Benefit Management Systems (EBMS) (837I & 837P) ALL 81039 Y GEmployee Benefit Services South Carolina (837I & 837P) ALL 37216 Y GEssence Healthcare (837I & 837P) ALL 20818 Y G




Everence (837I & 837P) ALL 35605 Y GExclusiCare_United of Omaha (837P & 837I & 837D) ALL 71412 Y GFairbanks North Star Borough (837I & 837P) ALL 91136 Y GFairbanks North Star Borough School District Plan A (FNSBSD) (837I & 837P) ALL 91136 Y GFairbanks North Star Borough School District Plan B (FNSBSD) (837I & 837P) AL 91136 Y GFallon Community Health (837I & P) ALL 22254 Y GFarm Bureau Health Plans ALL 62045 Y GFederal Qualified Hlthcr Cntr via UGS ALL FQHC1 Y TFederated Mutual Insurance ALL 41041 Y GFidelis Care of New York (837I & 837P) ALL 11315 Y GFirst Carolina Care (837I & 837P) ALL 56196 Y NFirst Choice Health Network (837I & 837P) ALL 91131 Y GFirst Choice VIP Care Plus South Carolina (837I & P) SC 77009 Y GFirst Solution (837P) ALL FS802 Y GFirstCare ALL 94999 Y GFirstCare Medicaid ALL 94998 Y GFortis Benefits Ins. Co (837I & 837P) (Now known as Union Security Insurance Company) ALL 70408 Y GFoundation for Medical Care of Tulare and Kings Counties (837I & 837P) ALL 85362 Y NFox Everett Incorporated (837I & P) ALL 64069 Y GFox-Everett, Inc. (837I & 837P) (10-1-15 Re-enrollment needed.) ALL 64069 Y GFreedom Health Plan (837I & 837P) ALL 41212 Y GGateway Health Plan ALL 25169 Y GGateway Health Plan OH (837I & 837P) OH 91741 Y GGateway Health Plan-Medicare Assured (Yellow Card) ALL 60550 Y GGeisinger Health Plan ALL 75273 Y GGHI HMO (837I & 837P) ALL 25531 Y GGHI Medicare Part B of New York NY GHMCR Y TGilsbar, L.L.C. (837I & 837P) ALL 07205 Y GGlobal Care Incorporated (837I & 837P) ALL 07689 Y GGlobe Life And Accident Insurance Company (837I & P) ALL 91472 Y GGlobe Life Insurance Company Of New York (837I & P) ALL 74101 Y GGovernment Employees Health Assoc. (GEHA) ALL 44054 Y TGreat West Healthcare (Remits returned under 62308) ALL 80705 Y TGreek Catholic Union (administered by Equitable Life And Casualty Insurance) 837I & P ALL A7213 Y GGroup Health Cooperative of Eau Claire WI 95192 Y G

Group Health Cooperative of South Central Wisconsin (837I & 837P) WI 39167 Y GGroup Health Cooperative of Washington State (837I & 837P) WA 91051 Y GGroup Health, Inc. / GHI - New York ALL 13551 Y GGroup Plan Administrators (837I & 837P) ALL 48143 Y GGuardian Life Insurance Co of America ALL 64246 Y GGunderson Lutheran Health Plan ALL 39180 Y G




Harmony Health Plan of Illinois (837I) (Remits returned under 14163) IL 36406 Y G

Harmony Health Plan of Illinois (837p) (Remits returned under 14163) IL 36406 Y GHarmony Health Plan of Indiana (837I) (Remits returned under 14163) IN 36405 Y GHarmony Health Plan of Indiana (837p) (Remits returned under 14163) IN 36405 Y GHarvard Community Health Plan (837I & P) ALL 04245 Y GHarvard Pilgrim Healthcare (837I & 837P) ALL 04271 Y NHawaii Medical Assurance Association (HMAA_HWMG) (837I & 837P) HI 48330 Y GHealth Alliance Medical Plans ALL 77950 Y GHealth Alliance Plan of Michigan (HAP) (837I & 837P) ALL 38224 Y GHealth Care Partners of AZ (837I & 837P) ALL HCP02 Y NHealth Choice Generations ALL 62180 Y GHealth Choice Insurance (837I & 837P) ALL 46221 Y GHealth Choice Integrated Care (837I & 837P) ALL 22100 Y GHealth Choice of Arizona AZ 62179 Y GHealth Choice of Oklahoma OK 71064 Y GHealth Choice Utah (837I & 837P) ALL 45399 Y GHealth Cost Solutions (837I & 837P) ALL 62111 Y GHealth First Health Plan Inc. (837I & 837P) ALL 15064 Y GHealth First TPA Tyler (837P & I) ALL 75234 Y GHealth Insurance Plan of Greater New York (HIP) (837I & 837P) ALL 55247 Y GHealth Management Services – Magellan Health (837I & 837P) ALL 41150 Y GHealth Net (of California and Oregon) CA,OR 95567 Y NHealth New England (837P) ALL 04286 Y GHealth Now Administrative Services (837I & 837P) ALL 51037 Y GHealth Partners of PA (837I & 837P) PA 80142 Y NHealth Payment Systems (837I & 837P) ALL 20270 Y GHealth Plan of San Joaquin (837I & 837P) ALL 68035 Y GHealth Plan San Mateo (837I & P) ALL HPSM1 Y GHealth Plans, Inc. (837I & 837P) ALL 44273 Y GHealth Services for Children with Special Needs (837I & 837P) ALL 37290 Y GHealth Services Management (HSM) (837P) ALL HSM01 Y GHealthcare Management Administrator (837P) ALL HMA01 Y GHealthCare Solutions Group, Inc. (837I & 837P) ALL 73147 Y GHealthcare USA ALL 25133 Y GHealthease (837I) (Remits returned under 14163) FL 59608 Y GHealthease (837P) (Remits returned under 14163) FL 59608 Y GHealthfirst Health Plan of New Jersey ALL 80141 Y GHealthgram Inc (formerly known as Primary Physician Care) ALL 56144 Y GHealthkeeper HMO VA VABLS Y THealthlink HMO (837I & 837P) ALL 96475 Y GHealthnet of AZ AZ 38309 Y GHealthPartners of Minnesota (aka CoOportunity Health) MN 94267 Y N




HealthyCT Inc. ALL 77180 Y GHeartland National Life Insurance Company (837I & P) ALL A0001 Y GHighmark BCBSD Health Options, Inc (837I & 837P) ALL 47181 Y GHighmark Senior Health Company (a PA BlueShield Medicare plan)(837P) PA 15460 Y NHighmark Senior Solution Company (a WV Blue Shield Medicare plan)(837P) WV 15459 Y NHMA Hawaii (837I & 837P) ALL 86066 Y GHMO Louisiana (837I & 837P) ALL 84555 Y G

Home Health & Hospice J15 Cigna (837I)

CO, WV, VA, UT,

SD, PA,NE, ND, MT, MO, MD,

KS, IA, DE, DC and WY 12M97 Y N

Homelink (837I & 837P) ALL 50701 Y GHoosier Care (837I & 837P) ALL 00630 Y GHopkins Health Advantage (837I & 837P) ALL 66003 Y GHorizon NJ Health NJ 22326 Y GHotel Employees Restaurant Employees Health Trust (HERE) (837I & 837P) ALL 91136 Y GHSBS Memphis (837P) ALL 37224 Y GHumana ALL 61101 Y TI. E. Shaffer (837I & 837P) ALL 22175 Y GIAA (837I & 837P) ALL 37279 Y GICARE (Independent Care Health Plan) (837I & P) ALL 11695 Y GIDA (837I & 837P) ALL 13315 Y GIllinicare Health (837I & P) ALL 68069 Y GIMCare (837I & 837P) ALL 41600 Y GIndependence Administrators (837I & 837P) ALL TA720 Y GIndependent Health ALL SX073 Y GIndiana Department of Health (837I & 837P) ALL 35600 Y GIndiana Pro Health Network (837I & P) IN 35161 Y GIndiana University Health Plan (837I & 837P) IN 95444 Y GIngalls Provider Group (837I & 837P) ALL 85578 Y GInland Empire Health Plan (837I & 837P) ALL IEHP1 Y NInsurance Program Managers Group (837I & 837P) AL 36342 Y GInteractive Medical Systems (837I & P) ALL 56132 Y GINTotal Health (837I & 837P) ALL 35115 Y GJai Medical Systems (837I & 837P) ALL JAI01 Y GJohns Hopkins Healthcare (USFHP) ALL 52123 Y GJohns Hopkins Healthcare EHP PP (837I & 837P) ALL 52189 Y GJP Farley Corporation (837I & 837P) ALL 34136 Y TKaiser CSI California Select For Individuals (837I & P) CA 94320 Y G




Kaiser Foundation Health Plan of Colorado (Remits returned under KAISR) CO COKSR Y TKaiser Foundation Health Plan of Georgia (Remits returned under KAISR) ALL NG010 Y GKaiser Foundation Health Plan of Southern California CA KS001 Y NKaiser Foundation Health Plan of the Mid-Atlantic States (Remits returned under KAISR)

DC, MD, VA NG008 Y T

Kaiser Foundation Health Plan of the NW (Remits returned under KAISR) OR, WA NG009 Y TKaiser Foundation of Northern California (837I & 837P) ALL KS003 Y GKentucky Health Cooperative KY 77894 Y GKey Benefit Administrators (837I & 837P) ALL 37217 Y GKeyCare PPO VA VABLS Y TKeystone First ALL 23284 Y GKeystone First VIP Choice (837I & 837P) ALL 77741 Y GKeystone VIP Choice (837I & 837P) ALL 84223 Y GLand of Lincoln Health (837I & 837P) ALL 90096 Y G

Landmark Healthcare (ONLY Clients of ChiroCare of MN practicing in MN, WI, ND, SD, NE or IA can get electronic remits at this time.) Listed LNDMK Y T

Leon Medical Center Health Plan (837I & 837P) ALL LMCHP Y GLiberty National Life Insurance Company (837I & P) ALL 65331 Y GLifetime Benefit Solutions (837P) ALL EBSRM Y GLifewise Health Plan of Oregon A Premier Health Plan (835s returned under AC032) OR 93093 Y TLifewise Health Plan of Washington A Premier Health Plan (835s returned under AC032) WA 91049 Y TLocal Choice of Virginia VA VABLS Y TLocals 302 & 612 of the International Union of Operating Engineers (837I & 837P) ALL 91136 Y GLouisiana Healthcare Connections (837I & 837P) LA 68069 Y GMacNeal Health Providers-CHS (837P) ALL 36334 Y GMagellan Behavioral Health ALL 01260 Y GMaine Community Health Options (837I & P) ALL 45341 Y GManaged Health Network (837I & 837P) ALL 22771 Y GManaged Health Services Indiana (837P) ALL 68069 Y GManaged Health Services of Wisconsin WI 68069 Y NMartins Point Health Care (837I & P) ALL MPHC1 Y GMaryland Physicians Care (837I & 837P) ALL 22348 Y GMassachusetts Medicare Part A (837I) MA 12M14 Y GMayo Management Services, Inc. ALL 41154 Y GMcLaren Health Plan (837I & 837P) ALL 38338 Y GMDwise Health Indiana Plan (837I & 837P) IN 31354 Y GMDwise Hoosier (837I & 837P) IN 35191 Y GMDwise Hoosier Care Connect (837I & 837P) ALL 91313 Y GMDwise Marketplace (837I & 837P) IN 45627 Y GMDX Hawaii (837I & 837P) HI MDXHI Y G




Med Benefits Mutual Life ALL 74323 Y GMed3000 Early Steps (837I & 837P) ALL EM350 Y GMed3000 Pedicare Title 21 (837I & 837P) ALL EM205 Y GMed3000 Titlle 21 (837I & 837P) ALL EM205 Y GMedCost Benefit Services (837P, 837I & 837D) ALL 56205 Y GMedica ALL 94265 Y TMedica HealthCare Plan / FL FL 78857 Y GMedica2 ALL 12422 Y GMedicaid of Alabama (for 837P & 837I claims) AL ALMCD Y TMedicaid of Alaska AK AKMCD Y TMedicaid of Arizona (AHCCCS)(837I & 837P) AZ AZMCD Y TMedicaid of Arkansas AR ARMCD Y TMedicaid of Colorado CO COMCD Y TMedicaid of Connecticut (for 837P & 837I claims) CT CTMCD Y TMedicaid of DC DC DCMCD Y TMedicaid of Delaware DE DEMCD Y TMedicaid of Florida (for 837P & 837I claims) FL FLMCD Y TMedicaid of Georgia (for 837P & 837I claims). GA GAMCD Y TMedicaid of Idaho ID IDMCD Y TMedicaid of Illinois IL IL621 Y NMedicaid of Indiana IN INMCD Y TMedicaid of Iowa IA IAMCD Y TMedicaid of Kansas KS KSMCD Y TMedicaid of Kentucky KY KYMCD Y TMedicaid of Louisiana (837P, 837I & 837D) LA LAMCD Y TMedicaid of Louisiana Rehab (Remits returned under LAMCD) LA LAREH Y TMedicaid of Maine (837I & 837P) ME MEMCD Y NMedicaid of Maryland MD MDMCD Y TMedicaid of Massachusetts (Mass Health) MA MAMCD Y TMedicaid of Michigan MI MIMCD Y TMedicaid of Minnesota MN MNMCD Y TMedicaid of Mississippi (for 837P & 837I claims) MS MSMCD Y TMedicaid of Missouri MO MOMCD Y TMedicaid of Montana MT MTMCD Y TMedicaid of Nebraska NE NEMCD Y TMedicaid of Nevada NV NVMCD Y TMedicaid of New Hampshire NH NHMCD Y TMedicaid of New Jersey NJ NJMCD Y TMedicaid of New York JY NYMCD Y TMedicaid of North Carolina (for 837P and 837I claims) NC NCMCD Y TMedicaid of North Dakota ND NDMCD Y TMedicaid of Ohio OH OHMCD Y TMedicaid of Oklahoma OK OKMCD Y TMedicaid of Oregon OR ORMCD Y TMedicaid of Pennsylvania (837P, 835s returned under SKPA0) PA PAMCD Y TMedicaid of Rhode Island RI RIMCD Y TMedicaid of South Carolina SC SCMCD Y T




Medicaid of South Dakota SD SDMCD Y TMedicaid of Tennessee (TennCare) TN TNMCD Y TMedicaid of Texas (837I & 837P) TX TXMCD Y GMedicaid of Utah UT UTMCD Y NMedicaid of Vermont VT VTMCD Y TMedicaid of Virginia (837I & 837P) VA VAMCD Y TMedicaid of Washington (837P) WA WAMCD Y TMedicaid of West Virginia WV WVMCD Y TMedicaid of Wisconsin WI WIMCD Y TMedicaid of Wyoming WY WYMCD Y TMedical Associates Health Plan ALL MAHP1 Y GMedical Associates Health Plan (837I & 837P)(Remits returned under MAHP1) ALL MAHC1 Y GMedical Mutual of Ohio OH 29076 Y GMediCal of California CA MDCAL Y TMedicare Part A of Alabama AL 12M01 Y GMedicare Part A of California CA 01111 Y NMedicare Part A of Colorado CO 04111 Y GMedicare Part A of Florida FL 3518I Y GMedicare Part A of Indiana IN 12M09 Y TMedicare Part A of Iowa (835s returned under 05301) IA 05101 Y TMedicare Part A of Kansas (835s returned under 05301) KS 05201 Y TMedicare Part A of Kentucky KY 15101 Y NMedicare Part A of Michigan MI 08201 Y TMedicare Part A of Missouri MO 12M15 Y NMedicare Part A of Missouri J5 MO 05301 Y TMedicare Part A of Nebraska (835s returned under 05301) NE 05401 Y TMedicare Part A of New York NY 13201 Y NMedicare Part A of North Carolina NC NCMCR Y NMedicare Part A of North Dakota ND 12M82 Y GMedicare Part A of Ohio OH OHMCR Y NPMedicare Part A of Oklahoma OK 04311 Y NMedicare Part A of Pennsylvania PA 12M60 Y NMedicare Part A of Texas TX 04411 Y NMedicare Part A of Virginia VA 12004 Y NMedicare Part A of Wisconsin WI 00450 Y NMedicare Part B of Alabama AL ALMCR Y TMedicare Part B of Alaska AK AKMCR Y TMedicare Part B of Arizona AZ AZMCR Y TMedicare Part B of Arkansas AR ARMCR Y TMedicare Part B of Colorado CO COMCR Y TMedicare Part B of Connecticut CT CTMCR Y TMedicare Part B of DC DC 00903 Y TMedicare Part B of Delaware DE 00902 Y TMedicare Part B of Florida FL FLMCR Y TMedicare Part B of Georgia GA GAMCR Y TMedicare Part B of Hawaii HI HIMCR Y T




Medicare Part B of Idaho ID IDMCR Y TMedicare Part B of Illinois IL ILMCR Y NMedicare Part B of Indiana IN INMCR Y TMedicare Part B of Iowa IA IAMCR Y TMedicare Part B of Kansas KS KSMCR Y TMedicare Part B of Kansas City (ASK) KS KCMCR Y TMedicare Part B of Kentucky KY KYMCR Y TMedicare Part B of Louisiana LA LAMCR Y TMedicare Part B of Maine ME MEMCR Y TMedicare Part B of Maryland MD 00901 Y TMedicare Part B of Massachusetts MA MAMCR Y TMedicare Part B of Michigan MI MIMCR Y TMedicare Part B of Minnesota MN MNMCR Y TMedicare Part B of Missouri MO MOMCR Y TMedicare Part B of Montana MT MTMCR Y TMedicare Part B of Nebraska NE NEMCR Y TMedicare Part B of Nevada NV NVMCR Y TMedicare Part B of New Hampshire NH NHMCR Y TMedicare Part B of New Jersey NJ NJMCR Y TMedicare Part B of New Mexico NM NMMCR Y TMedicare Part B of New York (Empire) NY NYMCR Y TMedicare Part B of North Carolina NC NCMCR Y TMedicare Part B of North Dakota ND NDMCR Y TMedicare Part B of Northern California CA CNMCR Y TMedicare Part B of Ohio OH OHMCR Y TMedicare Part B of Oklahoma OK OKMCR Y TMedicare Part B of Oregon OR ORMCR Y TMedicare Part B of Pennsylvania PA PAMCR Y TMedicare Part B of Rhode Island RI RIMCR Y TMedicare Part B of South Carolina SC SCMCR Y TMedicare Part B of South Dakota SD SDMCR Y TMedicare Part B of Southern California CA CSMCR Y TMedicare Part B of Tennessee TN TNMCR Y TMedicare Part B of Texas TX TXMCR Y TMedicare Part B of the Virgin Islands VI 09203 Y TMedicare Part B of the Virgin Islands (837P) VI 09203 Y NMedicare Part B of Upstate NY NY N1MCR Y TMedicare Part B of Utah UT UTMCR Y TMedicare Part B of Vermont VT VTMCR Y TMedicare Part B of Virginia VA VAMCR Y TMedicare Part B of Washington WA WAMCR Y TMedicare Part B of West Virginia WV WVMCR Y TMedicare Part B of Wisconsin WI WIMCR Y TMedicare Part B of Wyoming WY WYMCR Y TMedicare Railroad * (MetraHealth Medicare) ALL RRWMC Y TMedico Insurance Company (837I & P) ALL 23160 Y GMediGold (837I & 837P) ALL 95655 Y G




Mediture (837I & 837P) ALL 20039 Y GMedSolutions, Inc. (837I & 837P) ALL 62160 Y NMedstar Select (837I & 837P) ALL 251MS Y GMental Health Network (837I & 837P) ALL 74289 Y GMercy Care (837I & 837P) ALL 86052 Y NMercy Maricopa Integrated Care (837I & 837P) ALL 33628 Y GMeridian Health Plan (837I & 837P) ALL 83253 Y GMeridian Health Plan of Illinois (837I & 837P) IL MHPIL Y GMeritain Health (837I & 837P) ALL 64157 Y GMeritain Health Minneapolis (837I & 837P) ALL 41124 Y NMetro Plus Health (837I & 837P) ALL 13265 Y GMetropolitan Health Plan ALL 10850 Y GMichigan Blue Care HMO (BCN of Michigan) (835s returned under MIBLS) MI MIBCN Y TMichigan Medicare PlusBlue (835s returned under MIBLS) MI MIMPB Y TMid-America Associates (837I & 837P) ALL 37281 Y GMidwest Group Benefits (837I & 837P) ALL 61146 Y GMissouri Care (DOS >4/30/13) (837I) MO 14164 Y GMissouri Care (DOS >4/30/13) (837P) MO 14163 Y GModa Health (837I & 837P) ALL 13350 Y GMolina Advantage (837I & 837P) CA 38333 Y NMolina Health Care of Illinois (837I & 837P) IL 20934 Y GMolina Health Care of Michigan (837I & 837P) MI 38334 Y NMolina Health Care of Texas (837I & 837P) TX 20554 Y NMolina Healthcare of Florida (837I & 837P) ALL 51062 Y NMolina Healthcare of New Mexico (837I & 837P) NM NM505 Y GMolina Healthcare of Ohio (837I & 837P) ALL 20149 Y GMolina Healthcare of South Carolina (837I & 837P) ALL 46299 Y GMolina Healthcare of Utah (837I) (835s returned under SX109) UT 12X09 Y NMolina Healthcare of Utah (837P) UT SX109 Y NMolina Healthcare of Washington (837I & 837P) ALL 38336 Y NMolina Healthcare of Wisconsin (837I & 837P) ALL ABRI1 Y GMontefiore Contract Management Organization (837I & 837) ALL 13174 Y GMunicipal Health Benefit Fund (837I & 837P) ALL 81883 Y GMutual Health Services (837I & 837P) ALL 34192 Y GMutual of Omaha ALL MUTOM Y TMVP Healthcare (837I & 837P) ALL 14165 Y GMWA Standard Life And Accident (837I & 837P) ALL 01758 Y GNAPHCARE (837P) ALL 58182 Y GNational Elevator (837I & 837P) ALL CX045 Y GNational Rural Letter Carrier Association (NALC) (837I & 837P) AL 53011 Y GNCAS - Fairfax, Virginia (837I & P) VA 75190 Y GNeighborhood Health Partnership ALL 87726 Y TNeighborhood Health Plan of Rhode Island. (837P & 837I) RI 05047 Y GNeighborhood Plan (Boston, MA)(837I & 837P) ALL 04293 Y NNetwork Health Insurance Corp - Medicare (837I & 837P) ALL 77076 Y GNetwork Health Massachusetts (TUFTS) (837I & 837P) ALL 04332 Y G




Network Health Plan of Wisconsin, Inc. (837I & 837P) ALL 39144 Y GNew Mexico Health Connections (837I & 837P) ALL 45129 Y GNew Mexico Medicaid (837I & 837P) NM NMMCD Y NNew Mexico Public Schools Insurance Authority (837I & 837P) ALL 85036 Y GNext Level Health (837I & 837P) ALL 69821 Y GNGS American, Inc. ALL 38225 Y GNiagara County Health Plan (administered by Nova) ALL 16644 Y GNippon Life Benefits (837I & 837P) ALL 81264 Y GNorth American Insurance (837I & 837P) ALL 76112 Y GNorth American Medical Management (837I & 837P) ALL E3510 Y GNortheast Georgia Health Services (837I & 837P) GA 58169 Y GNorthshore Physician Associates (837P) ALL 48026 Y GNorthwest Administrators (837I & 837P) ALL 91068 Y GNorthwest Ironworkers Health & Security Fund (837I & 837P) ALL 91136 Y GNorthwest Roofers & Employers Health & Security Trust Fund (837I & 837P) ALL 91136 Y GNorthwest Textile Processors and Service Trades (837I & 837P) ALL 91136 Y GNW Plumbers & Pipefitters Health & Welfare Trust (837I & 837P) ALL 91136 Y GNYS DOH UCP (837I & 837P) NY 14142 Y G

Oak West Physician Association (837I & P) ALL 36400 Y GOhio Connect (837I & 827P) ALL 74431 Y GOpticare Eye Health Network (837P) ALL 56190 Y GOptumCare / AZ, UT (formerly Lifeprint Network) AZ, UT LIFE1 Y GOptumHealth Complex Medical Conditions (CMC) (formerly OptumHealth Care Solutions and United Resource Networks) ALL 41194 Y TOptumHealth Physical (includes Oxford) ALL 41161 Y TOptumHealth SLC ALL U6885 Y GPA Capital Blue Cross PA 23045 Y TPacific Partners Management Services Inc (837I & P) ALL A0062 Y GPacific Source Medicare (837I & 837P) ALL 20377 Y G

PacificSource Administrators (837I & 837P) (Remits will be returned under payerID 93029 and some will still come back as paper EOB.) ALL 93031 Y GPacificsource Community Solutions (837I & P) ALL 20416 Y GPacificSource Health Plans (837I & 837P) ALL 93029 Y GPacificSource Medicare (837I & 837P) (Remits will be returned under payerID 93029) ALL 20377 Y GPan American Life Insurance Group (837I & P) ALL 04218 Y GParamount Healthcare (837I & 837P) ALL SX158 Y NParkland Community Health Plan (837I & 837P) ALL 66917 Y GPartners Behavioral Health Management (837P) ALL 13141 Y NPartnership Health Plan of CA (837I & 837P) CA PHP02 Y NPassport Health Plan (837I & P) ALL 61325 Y GPeach State Health Plan (837I & 837P) ALL 68069 Y GPEHP - Utah Public Employee Health Plan (837I & 837P) UT SX106 Y GPennsylvania Keystone Health Plan East (claims only) (835s returned under PAKEY) PA PCBLS Y T




Pennsylvania Keystone Health Plan East (encounters only) (835s returned under PAKEY) PA PEBLS Y TPeoples Health Network (837I & 837P) ALL 72126 Y GPersonal Choice PA SX055 Y GPersonal Choice PPO / Independent BLC (835s returned under PAKEY) PA 54704 Y TPhoenix Health Plan (837I & 837P) ALL 74647 Y GPhysician Associates of Greater San Gabriel Valley (837P) CA PA513 Y GPhysician Reimbursement Program (837I & 837P) ALL PSKW0 Y GPhysicians Health Plan (837I and 837P) ALL 37330 Y PPhysicians Health Plan of Northern Indiana (837P and 837I) ALL 12399 Y GPhysicians Medical Group Of San Jose (837P) ALL EXC01 Y GPhysicians Mutual ALL 47027 Y GPhysicians Plus (837I & 837P) ALL 39156 Y TPlanned Administrators, Inc. (837I & 837P) ALL 37287 Y GPopulytics (formerly Spectrum Administrators)(837I & 837P) ALL 23253 Y GPrairie States Enterprises(837I & 837P) ALL 36373 Y GPreferred Care Partners / FL (837I & 837P) FL 65088 Y GPreferred One ALL 41147 Y NPremier Eye Care (837P) ALL 65054 Y GPremier Health Plan (837I & P) ALL 251PR Y GPresbyterian Health Plan (837I & 837P) ALL PREHP Y GPrestige Health Choice (837I & 837P) ALL 77003 Y GPrime Community Care of Central Valley(837I & 837P) ALL MVCV1 Y GPrime West Health Plan ALL 61604 Y GPrincipal Financial Group (837I & 837P) ALL 61271 Y GPriority Health ALL 38217 Y NPriority Healthcare VA VABLS Y TProfessional Benefit Administrators (837I & 837P) ALL 36331 Y GProvidence Administrative Services (837I & 837P) ALL PAS01 Y GProvidence Health Plan ALL PHP01 Y NPuget Sound Benefits Trust (837I & 837P) ALL 91136 Y GPuget Sound Electrical Workers Healthcare Trust (PSEW) (837I & 837P) ALL 91136 Y GQual Choice Arkansas (837I & P) AR 35174 Y GQualcare (837I & 837P) ALL 23342 Y GQuikTrip Corporation (837I & 837P) ALL 73067 Y GRady Children's Network (837I & 837P) ALL RCHN1 Y GRegence BC BS Oregon (837I & P) OR 00851 Y GRegence Blue Shield of Washington WA 00932 Y GRegional Care Incorporated (837P & I) ALL 47076 Y GReserve National Insurance (837I & 837P) ALL 73066 Y GRight Care from Scott & White (837I & 837P) ALL 74205 Y GRiver City Medical Group (837I & 837P) ALL RCMG1 Y NRiverside Health Inc (837I & 837P) ALL 45281 Y GRocky Mountain Health Plan Grand Junction (837I & P) CO SX141 Y GRocky Mountain HMO (837P) CO RMHMO Y G




S&S Healthcare Strategies (837I & 837P) ALL 31441 Y GSage Plus/MN Dept. of Health (837P) ALL MNDH1 Y GSAMBA ALL 37259 Y GSanford Health Plan (837I & 837P) SD CASD2 Y GSanford Health Plan of North Dakota (837I & 837P) ND 91184 Y GSante Health Systems (837P) ALL 77038 Y GSC BCBS Companion Health SC SCBLS Y TSC BCBS Planned Administrators SC SCBLS Y TSC BCBS State Employee Health Plan SC SCBLS Y TSC FEP Blue Cross SC SCBLS Y TScott and White Health Plan (837I & 837P) ALL TH002 Y GSecure Health Plan of Georgia (837I & 837P) GA 28530 Y GSecurity Health Plan (837I & 837P) ALL 39045 Y NSelect Health of South Carolina SC 23285 Y GSelectCare of Texas (HPN) Heritage Physicians Network (837I & 837P) ALL 76045 Y GSelectHealth, formerly Intermountain Healthcare (IHC), (837P& I) ALL SX107 Y NSelf Insured Services Company (837I & 837P) ALL SISCO Y GSendero Health (837I & 837P) ALL 36426 Y GSendero Idealcare (837I & P) ALL 11440 Y GSenior Whole Health (837I & 837P) ALL 83035 Y GSentara Health Management (837P) ALL 54154 Y GSentinel Security Life (837I & 837P) ALL 87020 Y GSharp Community Medical Group (837I & 837P) CA SCMG1 Y GSharp Health Plan (837I & 837P) CA SHP01 Y GSharp Rees-Stealy Medical Group (837I & 837P) CA SRS83 Y GShasta Administrative Services (837I & 837P) ALL 75280 Y GSierra Health and Life CA,NV 76342 Y GSignifica Benefit Services, Inc ALL 23250 Y NSimply Healthcare (837I & 837P) ALL 27094 Y GSmoky Mountain Center (837I & 837P) NC 13010 Y GSoundPath Health (837I & 837P) ALL 42172 Y GSouth Bay Hotel Employees Restaurant Employees Health Trust (837I & 837P) ALL 91136 Y GSouth Florida Community Care Network Commercial (837I & 837P)

FL 59064 Y GSouth Florida Community Care Network Medicaid (837I & 837P) FL 59065 Y GSoutheastern Indiana Health Organization (SIHO) (837I & 837P) ALL 77153 Y GState Farm Group Medical (837I & 837P) MN 31053 Y NState Farm Property and Casualty (837I & 837P) (835s returned under 31053) (Coming Soon!) All 31059 Y NState Farm Workers Comp (837I & 837P) ALL 31053 Y NState of Texas Dental Plan (835’s returned under 44054) ALL 57254 Y TStirling Benefits (837I & 837P) ALL STL01 Y GSummaCare (837I & 837P) ALL 95202 Y NSummit Administrative Services (837P) ALL 86083 Y GSunshine State Health Plan (837I & 837P) ALL 68069 Y G




Superior Health Plan Texas (837I & 837P) ALL 68069 Y GSutter Connect Central Valley Medical Group (837I & P) ALL IP131 Y GSutter Connect Medical Group CA IP092 Y NTakecare Insurance Company (837I & 837P) ALL 98022 Y GTexas Childrens Health Plan (837I & 837P) TX 76048 Y GTexas Childrens Health Plan Medicaid (837I & 837P) TX 75228 Y GTexas Christus (837I & 837P) ALL 45210 Y GTexas First Health Plan (837I & 837P) TX TX1ST Y NTexas Plus (837I & 837P) TX HPN11 Y GThe Boon Group (837I & 837P) ALL BOONG Y GThe Health Plan (837I & 837P) ALL 34150 Y GThe Kempton Group (837I & 837P) ALL 73100 Y GTLC Benefit Solutions (837I & 837P) ALL TLC79 Y GTodays Option (837I & 837P) ALL 48055 Y GTotal Plan Services (837I & 837P) ALL 41202 Y GTouchstone Health PSO (837I & 837P) ALL 23856 Y GTransamerica Life Insurance Company (837I & 837P) ALL TRP1E Y GTribute Health (837I & P) ALL 31118 Y GTricare - North CT, DE, 57106 Y TTricare - South

AL, AR, FL, GA, LA, MS, OK, SC, TN, East TX

61125 Y T

Tricare East (837I & 837P) Effective 1-1-2018 Several TREST Y NTricare for Life (837P) ALL TDDIR Y TTricare West (837I & 837P) Effective 1-1-2018 Several 99726 Y NTriHealth Physician Solutions (837I & 837P) ALL 31144 Y GTrusted Health Plan (837I & 837P) ALL L0230 Y GTrusteed Plan Services Corporation (837I & P) ALL 91078 Y GUC Davis Health System (837I & P) ALL UCDMG Y GUcare of Minnesota (837I) ALL 52629 Y GUCare of Minnesota (837P) ALL 19991 Y GUltimate Health Plan (837I & P) ALL 77022 Y GUltra Benefits (837I & 837P) ALL 41206 Y GUMR ALL 39026 Y TUMWA Health and Retirement Funds (837I & 837P) AL 52180 Y GUnicare Life & Health Insurance Company TX, MA,

KS, WV, VA, RI, IL

80314 Y N

Unified Group Services (837I & 837P) ALL 35198 Y GUnified Physicians Network (837I & 837P) ALL 34638 Y GUnited American Insurance Company (837I & P) ALL 92916 Y GUnitedHealthcare ALL 87726 Y TUnitedHealthcare / All Savers Alternate Funding ALL 81400 Y T




UnitedHealthcare / UnitedHealthcare of the Mid-Atlantic, MD IPA, Optimum Choice and MAMSI Life and Health (formerly MAMSI 52148) ALL 87726 Y TUnitedHealthcare / UnitedHealthcare West (UnitedHealthcare of CA, OK, OR, TX, WA and PacifiCare of AZ, CO, NV)

AZ,CA,CO,NV,OK, OR, TX,

WA

95959 Y T

UnitedHealthcare Community Plan / AZ (formerly Arizona Physicians IPA and APIPA) AZ 03432 Y T

UnitedHealthcare Community Plan / DE, FL, HI, LA, MA, MD, NC, NM, OH, OK, PA, VA, WA (some are formerly AmeriChoice or Unison) NC and OK effective 1/1/2018

DE, FL, HI, LA, MA, MD, NC, NM, OH, OK, PA, VA, WA 04567 Y T

UnitedHealthcare Community Plan / IA, hawk-i, IA Health Link IA 95378 Y TUnitedHealthcare Community Plan / MI (formerly Great Lakes Health Plan, GLHP) MI 95467 Y TUnitedHealthcare Community Plan / MS CAN & CHIP MS 95378 Y TUnitedHealthcare Community Plan / NE (formerly Americhoice NE, ShareAdvantage, and UnitedHealthcare of the Midlands) NE UFNEP Y TUnitedHealthcare Community Plan / NJ (formerly AmeriChoice NJ Medicaid, NJ Family Care, NJ Personal Care Plus) NJ 86047 Y TUnitedHealthcare Community Plan / NM NM 04567 Y TUnitedHealthcare Community Plan / NYU (formerly AmeriChoice by UnitedHealthcare, AmeriChoice NY Medicaid & Child Health Plus, AmeriChoice NY Personal Care Plus) NY NYU01 Y TUnitedHealthcare Community Plan / TN (formerly AmeriChoice TN: TennCare, Secure Plus Complete) TN 95378 Y TUnitedHealthcare Community Plan / TX (formerly AmeriChoice) TX TEX01 Y TUnitedHealthcare Community Plan / WA (formerly AmeriChoice) WA 04567 Y TUnitedHealthcare Community Plan / WI (formerly AmeriChoice) WI WID01 Y TUnitedHealthcare Community Plan Kansas (KanCare) KS 96385 Y TUnitedHealthcare Community Plan Missouri MO 86050 Y TUnitedHealthcare Dental ALL 52133 Y TUnitedHealthcare Medicare Solutions / Care Improvement Plus (CIP), XLHealth ALL 87726 Y TUnitedHealthcare Plan of the River Valley ALL 95378 Y TUnitedHealthcare StudentResources ALL 74227 Y GUnitedHealthcare Vision ALL 00773 Y TUnitedHealthcare/Oxford ALL 06111 Y TUnitedHealthOne / All Savers Insurance ALL 81400 Y TUnitedHealthOne / Golden Rule (837I & 837P) ALL 37602 Y TUnitedHealthOne / UnitedHealthcare Life Insurance Company (formerly American Medical Security) ALL 81400 Y TUnity Health Insurance (837I & 837P) ALL 66705 Y GUnivera Healthcare WNY (837P) NY 16107 Y G




University Family Care - Maricopa Health Plan (837I & 837P) (ERAs returned under 09830) AZ 09908 Y GUniversity Family Care (837I & 837P) AZ 09830 Y GUniversity Health Alliance (837P) ALL 99026 Y GUniversity of Utah Health Plans (837P) UT SX155 Y NUPMC Health Plan ALL 23281 Y GUpper Peninsula Health Plan (837I & 837P) ALL 38337 Y GUS Benefits (837I & 837P) ALL 93092 Y GUS Department Of Labor (837I & 837P) ALL 77044 Y GUSAA ALL 58379 Y GVA Fee Basis Programs ALL 12115 Y GVA Patient Centered Community Care Program (VAPCCC) Region 3 ALL 55912 Y NVA Patient Centered Community Care, Regions 1,2 and 4(837I & ALL 68021 Y GVA Patient-Centered Community Care Program (VAPCCC) Region ALL VAP5A Y GValue Options Commercial (837I & 837P) ALL 00813 Y NVirginia Premier Elite Plus (837I & P) VA VPEP1 Y NVirginia Premier Health Plan VA 54176 Y GVirginia State Employer Funds VA VABLS Y TViva Health Plan (837I & 837P) ALL 63114 Y GVNSNY Choice Health Plans Medicare (837I & 837P) ALL 77073 Y GVytra Healthcare (837I & P) ALL 22264 Y GWashington Dept. of Labor & Industries (837I & 837P) WA WALAI Y NWashington State Premera Blue Cross (835s returned under AC032) WA WABLC Y TWEA Insurance Group (837I & 837P) WI 39151 Y GWelfare and Pension Administration Services (837P) ALL 91136 Y GWellcare Health Plan (837I & P) (Remits returned under 14163) CT 14164 Y GWellcare Health Plan of South Carolina (837P) SC 14163 Y GWellcare Health Plan of South Carolina (Encounters) SC 59354 Y GWellcare HMO (837I & 837P) ALL 14163 Y GWellMed (837I & 837P) ALL TH023 Y GWells Fargo Third Party Administrators, Inc ALL 87815 Y GWest Virginia Family Health (837I & 837P) WV 45276 Y GWestern Health Advantage (837I & 837P) ALL 68039 Y G

WPS Commercial (837I) (Remits returned under OOWPS) ALL 12X29 Y TWPS Commercial (837P) ALL OOWPS Y TLegendG = Gateway/TransitionalN = Non Direct Governmental or Commercial, Fees May ApplyT = Direct

Documents

OptumInsight Electronic Remittance Advice Payer … · OptumInsight Electronic Remittance Advice Payer List (ERA) (As of 08/20/2018) Alliant Health Plans of Georgia (837I & 837P)