commercial payers: claims & era - ivans · for claims with a billing submission ... prospect...

Commercial Payers: Claims & ERA

Payer ID Payer Name State Enrollment Required for Claims

Enrollment Required for ERA

Notes

27094 Simply Health Care Plan N N

13162 1199 National Benefit Fund N Y

Provider should submit claims with assigned Plan Provider ID as 2 digit suffix is no longer required. Call Renaud Dufresneat (646) 473-6960 for a list of Network ID's.)

13165 1199 SEIU National Benefit & Pension Fund N Y

59069 21st Century Health and Benefits N N

51028 21st Century Insurance and Financial Services MN N N For Minnesota only

20413 3P Admin N N

74234 8th District Elec UT N N

93044 A & I Benefit Plan Administrators N N

75240 AAG - American Administrative Group N N Formerly Icon Benefit Admin

75240 AAG Benefit Plan Administrators, Inc. N N

87726 AARP N Y

Pre Enrollment is required for Electronic Remittance Advice. Payer ID valid only for claims with a billing submission address of PO Box 30968 Salt Lake City, UT 84130; PO Box 31361 Salt Lake City, UT 84161; PO Box 31362 Salt Lake City, UT 84161

36273 AARP- Medicare Supplement- UnitedHealthcare Insurance Co N Y

Payer id valid only if members card matches this payer id. Pre Enrollment is required for Electronic Remittance Advice.

03443 ABRAZO Advantage Health Plan N N

68055 Absolute Total Care SC N N

AHS01 Access Administrators N N

COACC Access Behavioral Care CO N N

AMM06 Access Medical Group CA N N

AMM06 Access Santa Monica (Access Medical Group) CA N N

64071 Acclaim N N

21356 Acclaim Repricing N N

ABHA1 Accountable Behavioral Health OR N Y

AHP01 Accountable Health â€“ American Family of WI claims N N

AHP01 Accountable Health â€“American Family of IA claims N N




Notes

AHIPA Accountable IPA CA Y N

59140 ACEC NV N N

72467 ACS Benefit Services, Inc. N N

36112 ACS Rewards Administration Center N N

AHC01 ActivHealthCare N N

91173 Adaptis N N

Administration Concepts, Inc. N N

38265 Administration Systems Research Corp N N

38265 Administration Systems Research Health Benefits N N

22384 Administrative Concepts Inc N N

59141 Administrative Services Inc N N

Administrative Services, Inc. N N

Administrative Systems Research Corporation N N

37278 AdminOne N N

TMG01 Advanced Medical Associates N N

Testing of each provider is required by payer and done automatically by IVANS once you start submitting claims for this payer

AMM02 Advanced Medical Management MSI CA N N

Advanstaff, Inc. N N

68056 Advantage by Bridgeway Health Solutions N N

68056 Advantage by Buckeye Community Health Plan N N

68056 Advantage by Managed Health Services N N

68056 Advantage by Superior HealthPlan N N

ACIPA Advantage Care IPA CA N N

35209 Advantage Health Solutions N N

NMM01 Advantage Medical Group N N

ADVTK Advantek Benefit Administrators N N

25133 Advantra - Health Assurance - Health America, Inc. N N

25133 Advantra - Kansas City Medicare - Coventry KS N Y

Advantra Freedom N Y ERA - Requires Pre Enrollment

95340 Adventist Health System West CA N N Roseville, California

65093 Advocate Health Centers IL N N




Notes

65093 Advocate Health Partners IL N N

33898 Aegis Security Insurance Company PA N N

60054 Aetna N Y Pre Enrollment is required for Electronic Remittance Advice.

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

60054 Aetna Better Health N Y Pre Enrollment is required for Electronic Remittance Advice.

60054 Aetna Better Health - CT Medicaid CT N Y Pre Enrollment is required for Electronic Remittance Advice.

23228 Aetna Better Health PA Medicaid PA N N

60054 Aetna Student Health N Y Pre Enrollment is required for Electronic Remittance Advice.

60054 Aetna TX Medicaid TX N Y Pre Enrollment is required for Electronic Remittance Advice.

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

APG01 Affiliated Physicians Group (APG) IL N N

13334 Affinity Health Plan Y N

For Medicare claims with DOS prior to 1/1/2010 and for Medicaid, Child Health Plus and Family Health Plus claims regardless of DOS. Please contact before sending claims [email protected] or 718-794-7592

46594 Affinity Medical Group CA N N

Claim Status reports available at https://affinity-portals.ikaenterprise.com/Default.aspx

13333 Affinity Medicare Advantage N N For Medicare claims with DOS on or after 1/1/10.

95426 Affordable Benefit Administrators, Inc. N N

34444 AFL - CIO Food & Beverage Dealerï¿½s Trust Fund OH N N

13346 AFTRA Health Fund NY N N

37280 AGA N N

64158 Agency Services Inc. N N Now known as Meritain Health

MAP01 AIA- American Insurance Administrators CA N N

PO Box 2501 Bassett, CA and City of Industry addresses only

CAPMN AKM Medical Group (Cap Managements Systems) CA N N

06311 Alabama Medical Surgical Associates N N

95327 Alameda Alliance for Health CA N N




Notes

91136 Alaska Children''s Services, Inc. Group #P68 N N

92600 Alaska Electrical Health & Welfare Fund AK N N

91136 Alaska Laborers Construction Industry Trust Group # F23 AK N N

91136 Alaska Pipe Trades Local 375 Group # F24 AK N N

91136 Alaska UFCW Health & Welfare Trust Group # F45 AK N N

13550 ALICARE N N

58213 Alignis N N

37602 All Savers Insurance Company N N

81040 Allegiance Benefit Plan Management Inc. N N

13079 Alliance Healthcare - Stones River Regional IPA N N

HCP01 Alliance IPA CA N Y

23172 Alliance Partners OH N N

20257 Alliance Physicians (High Desert Primary Care Alliance) CA N N Hesperia, CA

APP01 Alliance Physicians Medical Group CA N N

Now known as Applecare Medical Management. Only for claims with DOS 12-1-10 and forward.

52149 Alliance PPO MD N N

Alliance, The N N A Wisconsin provider network. Call Dave Sell at 608-210-6656 to pre-enroll

Alliant Health Plan (FCHN) WA N N

58234 Alliant Health Plans of Georgia GA N N

94177 Allied Administrators CA N N San Francisco, California

37308 Allied Benefit Systems, Inc. N N

NMM01 Allied Physicians Medical Group N N

ACMG1 Alpha Care Medical Group CA N N

A0701 Alta Bates Medical Group CA N N

80705 ALTA Health & Life Insurance N N

25133 Altius Health Plan UT N Y

25133 Altius Health Plan- Coventry UT N Y

13550 Amalgamated Life CO N N

13343 Amalgamated Life IPA Alicare N N




Notes

COMPU Amalgamated Transit Union Division 1001 Health & Welfare Fund N N

75137 Ameriben Solutions, Inc. N N

27516 Americaid Community Care NJ N N

75240 American Administrative Group N N

42112 American Administrators IA N N West Des Moines, Iowa

63103 American Behavioral N N

63106 American Behavioral FEP/ITS N N

59140 American Benefit Plan Administrators - HealthPlan Services, Inc. N N

34187 American Benefits Management OH N N North Canton, Ohio

41161 American Chiropractic Network (ACN) N N

41160 American Chiropractic Network IPA of New York (ACNIPA) NY N N

41160 American Chiropractic Network IPA of NY NY N N

37128 American Commercial Barge Lines N N

60305 American Community Mutual Insurance N N

ACN01 American Complimentary Care Network N N

CAPMN American Family Health Providers - Cap Managements Systems CA N N

56071 American Family PPO Policies N N

62030 American General Life & Accident N N

01066 American Healthcare Alliance N N

36369 American Imaging Management, Inc. N N

81949 American Insurance Company of Texas TX N N

American International Group (AIG) Y Y Plan of United Healthcare

87726 American International Group, Inc. (AIG) N Y

ERA - Requires Pre Enrollment. Plan of United Healthcare.

72099 American Life Care N N

81400 American Medical Security N N

74048 American National Galvest N N

74048 American National Insurance Company (ANICO) N N

APSFL American Pioneer FL N N South Florida

APBPN American Pioneer Brevard PHY Net N N




Notes

44444 American Postal Workers Union N N

Only for claims with DOS prior to 1/1/10 should use Payer ID 44444. Claims with DOS on or after 1/1/2010 should use payer ID 62308.

14190 American PPO N N

42011 American Republic Insurance Company (ARIC) N N

17965 American Sentinel Insurance Company PA N N

ASHP1 American Specialty Health Plan N N

American WholeHealth (AWHN) N N

37322 American Worker Health Plan N N

26078 Americas 1st Choice Health Plans of NC NC N N

86001 AMERICAS CHOICE N N

20029 America's Choice N N

20029 America's Health Choice N N

16120 Americas PPO N N

41178 America's PPO/America's TPA N N

87726 AmeriChoice of Connecticut CT N N

87726 AmeriChoice of Florida FL N N

87726 AmeriChoice of Illinois IL N N

87726 AmeriChoice of Maryland MD N Y

87726 AmeriChoice of Nebraska NE N N

87726 AmeriChoice of New England NE N N

AmeriChoice of New Jersey (Medicaid) NJ N Y

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

All claims require AmeriChoice provider id - call 888-362-3368 to obtain

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

86048 AmeriChoice of New York (Medicaid) NY N N

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

All claims require AmeriChoice provider id - call 888-362-3368 to obtain.

87726 AmeriChoice of NYU N Y

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

All claims require AmeriChoice provider id - call 888-345-3627 to obtain.

87726 AmeriChoice of Rhode Island RI N N

87726 AmeriChoice of Texas N Y




Notes

87726 AmeriChoice of Wisconsin N Y

MSO77 AmeriChoice San Diego County Coverage Initiative (CI) CA N N

MSO11 AmeriChoice San Diego County Medical Services (CMS) CA N N

MSO22 AmeriChoice San Diego County Physician Emergency Services (PES) CA N N

MSO33 AmeriChoice San Diego County Ryan White Care Act CA N N

ASRM1 AmeriCorp N N

28808 Amerigroup - Illinois IL N N

27519 Amerigroup - Florida FL N N

28804 Amerigroup - Georgia GA N N

28807 Amerigroup - Maryland/Virginia/District of Columbia MD N N

27516 AmeriGroup - New Jersey NJ N N

28808 Amerigroup - Ohio OH N N

28804 Amerigroup Community Care NV N N

28804 Amerigroup Community Care of New Mexico NM N N

27515 Amerigroup Corporation TX N N Ft. Worth, Texas

28809 Amerigroup Florida FL N N Healthy Kid

54763 AmeriHealth Administrator Y N Must also be a Highmark provider

95044 Amerihealth Delaware - New Jersey HMO (Highmark) Y N

Delaware and New Jersey. Must also be a Highmark provider

93688 Amerihealth Delaware Non-HMO (Highmark) DE Y N Must also be a Highmark provider

22248 Amerihealth Mercy Health Plan N N

60061 Amerihealth New Jersey Non-HMO (Highmark) NJ Y N Must also be a Highmark provider

PPM01 Ameri-West Health Associates CA N N

Now known as Los Angeles Medical Center IPA. Fee for Service only and PAYER ID REQD

AMILR AMIL - ARIA - Via Mediview TX N N

PROSP AMVI - Prospect Health Network (Prospect Medical Group) CA N N

CAPMN AMVI Medical Group ( Cap Management Systems) CA N N

53085 Anchor Benefit Consulting Inc. N N

86062 Ancillary Benefit Systems - Arizona Foundation for Medical Care AZ N N




Notes

HSM01 Angel Medical Group DBA Superior Choice Medical Group CA N N

SYMED Angeles IPA CA N N

34192 Antares Management Solutions N N

SMG01 Antelope Valley Medical Associates CA N N

Anthem Health & Life Insurance Company of New Jersey NJ N N

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

34196 Apex Benefit Services N N

MPM11 Apollo Healthcare IPA CA N N Can send elec only for DOS on or after 8/1/10

APP01 AppleCare Medical Management CA N N

54100 APS N N Goes on paper

54160 APS Healthcare Inc. N N

44444 APWU - Affordable Network N N

16120 ARAZ AZ N N

AMS11 Arcadian Community Care LA N N

AMS11 Arcadian Health Plan OK N N

AMS11 Arcadian Management Services CA N N

77045 Arcadian Management Services, Inc. CA N N

AMS11 Arcadian of Washington (Arcadian Mgmt Serv) WA N N

SCP01 Arch Health Partners/Centre for Healthcare CA N N

36356 Argus Health Systems N N

86062 Arizona Foundation for Medical Care AZ N N

03432 Arizona Physicians IPA (APIPA) N Y

Arizona pipe Trades Health & Welfare Trust Fund Local Unions #469 & 741 Pipe Trades Health Plan AZ N N

75278 Arkansas Best Corporation - Choice Benefits N N

AMS11 Arkansas Community Care AR N N

NMM01 Arroyo Vista Family Health Center N N

HSM01 Asian Community Medical Group, Inc. CA N N

ASRM1 ASRM Corp N N

HSM01 Associated Physicians Medical Group, Inc. CA N N




Notes

ATPA1 Associated Third Party Admin N N

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

39065 Assurant Health N N

ASNTH Assurant Health (Repricing for HealthSpan Network Only) N N Via HealthSpan

37313 Assurant Health Self-Funded SC N N Ft. Mill, South Carolina

37323 Assurant Mini - Med Key Family N N

88035 AssureCare, Inc. N N

74240 Assured Benefits Administrators N N

00932 Asuris Northwest Health (Regence Blue Shield) WA N N

65064 ATA-FL (American Therapy Association) N N

95691 Athens Area Health Plan Select N N

22304 Atlanticare N N Also known as Horizon HealthCare Admin (HHA)

AEC01 Atlantis Eyecare N N

13853 Atlantis Health Plan NY N N

Pls include Network id (pin) on claims. Call Frank Bove @ Atlantis Health Plan to obtain a network id, 212-747-8393.

38259 Automated Benefit Services N N

37280 Automated Group Administration Inc. N N

37280 Automated Group Administration, Inc. N N

CAPMN Avalon IPA (Cap Managements Systems) CA N N

AH001 Avante Health N N

25133 Avantra Freedom N N

46045 Avera Health Plans N N

38310 Avera Health Plans for John Morrell N Y

AV001 AVMED Healthplan FL N N

59274 AvMed, Inc. FL N N

AXM01 Axminster Medical Group CA N N

BKRFM Bakersfield Family Medical Center (Regal) CA N N

74227 Bankers United Life (Student Division) N N

Payer ID only valid if the P.O. Box on the Health ID Card matches one of the following P.O. Boxes: 809025 890025 809067, 809079, 809066, 809036, 809081, Dallas, Tx 75380-9025.




Notes

SX145 Banner Health Company N N

77078 Banner Medisun N N

37248 Bass Administrators, Inc. N N

00803 BCBS Empire NY NY N Y

54828 BCBS Mountain States WV Y Y

54828 BCBS of West Virginia WV Y Y

49153 BCI Administrators, Inc. N N

43324 Beacon Health Strategies N N

Please use the following Plan IDs for block 11 on the 1500 form. Neighborhood Health Plan of MA=001; Hudson Health Plan=004;Fallon Community Plan=005; Neighborhood Health Plan of RI=006; Affinity Health Plan=009; DC Chartered Health Plan=013

95377 Beech Street N N

63100 Behavioral Health Systems N N

MPM10 Bella Vista Med Grp CA N N

33192 Bencomp National Corporation N N

99320 Benefit & Risk Management Services N N

41205 Benefit Administration Services, Ltd (BAS Ltd) MS N N

36149 Benefit Administrative Systems N N

25145 Benefit Coordinators Corporation PA N N Pittsburgh, Pennsylvania

BMATP Benefit Management Admin (BMA) N N

43178 Benefit Management Inc - Joplin Claims N N

00999 Benefit Management Services LA N N

37212 Benefit Management Systems, Inc. N N

39081 Benefit Plan Administrators Co. WI N N

Eau Claire, Wisconsin -Payer ID valid only for claims with a billing submission address of P.O. Box 1128, Eau Claire, WI 54702-1128

37118 Benefit Plan Administrators, Inc. VA N N Roanoke, Virginia

74223 Benefit Planners, Inc. N N

Benefit Services OH N N

34178 Benefit Services, Inc. OH N N Akron, OH

42148 Benefit Solutions N N

BSI01 Benefit Solutions, Inc. FL N N




Notes

36342 Benefit Systems & Services, Inc. (BSSI) N N

87265 Benesight N N Formerly The TPA

37248 Benesys Inc. N N

BNMK1 BenMark - Mississippi MS N N

23243 Berkshire Health Partners N N

95604 Best Life & Health Insurance Company N N

20488 Better Health of Florida FL N N

BVES1 Block Vision - Eye Specialists N N

BV001 Block Vision - VIPA N N

BV001 Block Vision Inc. N N

BV001 Block Vision of Texas N N

54704 Blue Choice (Highmark) PA Y N Must also be a Highmark provider

00922 Blue Choice of South Carolina SC N Y

00403 Blue Choice of South Carolina (Medicaid) SC N Y

Pre-enrollment is required for Electronic Remittance Advice.

BC001 Blue Cross (Cal-Optima - Medi-Cal) CA N N â€œSame as payer ID 47198â€•

00806 Blue Cross Blue Shield NY Excellus Utica Watertown Region NY Y Y

00520 Blue Cross Blue Shield Arkansas AR Y Y Health Advantage, Blue Advantage, FEP, ITS and First Source

SB590 Blue Cross Blue Shield DC National Region - CareFirst DC N N

00510 Blue Cross Blue Shield of Alabama AL Y Y

53589 Blue Cross Blue Shield of Arizona AZ N Y

00050 Blue Cross Blue Shield of Colorado CO N Y

Pre-enrollment is required for ERAs (835). See Resource Center / Payer Enrollment Forms / Electronic Remittance / ERA / 835 Enrollment Forms.

00060 Blue Cross Blue Shield of Connecticut CT N Y

SB580 Blue Cross Blue Shield of DC (Carefirst) DC N Y Pre-Enrollment is required for Electronic Remittance Advice.

00570 Blue Cross Blue Shield of Delaware DE Y Y

00590 Blue Cross Blue Shield of Florida FL N Y

00601 Blue Cross Blue Shield of Georgia (Anthem) GA N Y

HMSA1 Blue Cross Blue Shield of Hawaii (HMSA) HI Y Y

00621 Blue Cross Blue Shield of Illinois IL N Y




Notes

00630 Blue Cross Blue Shield of Indiana (Anthem) IN N Y

BCSIA Blue Cross Blue Shield of Iowa IA Y N

47163 Blue Cross Blue Shield of Kansas KS Y Y

47171 Blue Cross Blue Shield of Kansas City MO Y Y

00660 Blue Cross Blue Shield of Kentucky (Anthem) KY N Y

53120 Blue Cross Blue Shield of Louisiana LA Y Y

00680 Blue Cross Blue Shield of Maine (Anthem) ME N Y

SB690 Blue Cross Blue Shield of Maryland (CareFirst ) MD N Y

Pre-Enrollment is required for Electronic Remittance Advice.

BS059 Blue Cross Blue Shield of Massachusetts MA Y Y

00710 Blue Cross Blue Shield of Michigan MI Y Y

00720 Blue Cross Blue Shield of Minnesota MN N Y

00230 Blue Cross Blue Shield of Mississippi MS Y Y Pre-Enrollment is also required for Electronic Remittance Advice.

00241 Blue Cross Blue Shield of Missouri (Anthem) MO N Y

BCSMT Blue Cross Blue Shield of Montana MT Y N

Blue Cross Blue Shield of NCA Region DC N N Includes coverage for DC & Northern Virginia - CareFirst

23241 Blue Cross Blue Shield of NE Pennsylvania PA Y N

All new providers must enroll with First Priority Health/Blue Cross of Northeastern PA prior to submitting electronic claims. Enrollment form available at: http://www.bcnepa.com/EDI/registrationForm.aspx

00760 Blue Cross Blue Shield of Nebraska NE N Y

00265 Blue Cross Blue Shield of Nevada (Anthem) NV N Y

00770 Blue Cross Blue Shield of New Hampshire (Anthem) NH N Y

22099 Blue Cross Blue Shield of New Jersey (Horizon) NJ N N New York & New Jersey

00790 Blue Cross Blue Shield of New Mexico NM N Y

SB810 Blue Cross Blue Shield of North Carolina NC Y Y

00805 Blue Cross Blue Shield of NY - Excellus Central Region NY Y Y




Notes

00804 Blue Cross Blue Shield of NY ï¿½ Excellus Rochester NY Y Y

00806 Blue Cross Blue Shield of NY ï¿½ Excellus Utica Region NY Y Y

00834 Blue Cross Blue Shield of Ohio (Anthem) OH N Y

00840 Blue Cross Blue Shield of Oklahoma OK N Y

00851 Blue Cross Blue Shield of Oregon (Regence) OR N N

54771 Blue Cross Blue Shield of Pennsylvania (Highmark) PA Y Y

00870 Blue Cross Blue Shield of Rhode Island RI Y Y

BCSSC Blue Cross Blue Shield of South Carolina SC N Y

88848 Blue Cross Blue Shield of South Dakota SD Y Y

00890 Blue Cross Blue Shield of Tennessee TN Y Y

84980 Blue Cross Blue Shield of Texas TX N Y

00910 Blue Cross Blue Shield of Utah (Regence) UT N N

BCSVT Blue Cross Blue Shield of Vermont N Y pre enrollment required for ERA's

00923 Blue Cross Blue Shield of Virginia (Anthem) VA N Y

00950 Blue Cross Blue Shield of Wisconsin (Anthem) WI N Y

BC001 Blue Cross of CA â€“ Anthem/ Blue Cross (FEP) CA N Y â€œSame as payer ID 47198â€•

23045 Blue Cross of Pennsylvania (Capital / CAIC) PA N N

BS001 Blue Shield - California CA N N

BS001 Blue Shield - California / Blue Shield (FEP) CA N Y

00820 Blue Shield of North Dakota ND Y Y

00960 Blue Shield of Wyoming WY Y Y

00801 BlueCross BlueShield of Western New York NY Y Y Not the same as Empire BCBS

61124 Bluegrass Family Health KY N N

00800 BlueShield of Northeastern New York NY Y Y Not the same as Empire BCBS

13337 BMC Health Net Plan N N

36609 Boilermakers National & Health Welfare Fund N N

36609 Boilermakers National Health & Welfare Fund N N




Notes

74238 Boon Chapman Administrators, Inc. N N

BOONG Boon Group, The N N

13337 Boston Medical Center Health Plan, Inc. MA N N

38324 Botsford Health Plan MI N N Farmington Hills, Michigan

37286 BPA Benefit Plan Administrators ND N N

13310 BPS Inc. N N

52192 Bravo Health N N PA, MD, DE, TX and DC

38365 Bridge Benefits N N

37285 Bridgestone Claims Services N N

68054 Bridgeway Arizona N N

BHP01 Bright Health Physicians N N

51037 Brokerage Concepts N N

94316 Brown & Toland Medical Group CA N Y

BTSS1 Brown & Toland Sutter Select CA N N

32004 Buckeye Community Health Y N Please call Provider Relations before submitting claims 866-475-3129

42150 Butler Benefit N N

23708 C & O Employees Hospital Association N N

33192 Cadent Administrators N N

33192 Cadent Underwriters N N

REGAL Caduceus Medical Group (Regal) CA N N

10301 Cahaba GBA (Medicare Part A Rural) Y Y All States. Formerly known as Riverbend.

PPM01 Cal Care IPA CA N N Fee for Service only and PAYER ID REQD

PPM02 Cal Care IPA Encounters CA N N Encounters only and PAYER ID REQD

CWS99 Cal Water CA N N

HDNFC California Care (Humboldt Del Norte) CA N N

HSM01 California Pacific Physicians Medical Group, Inc. CA N N

IP055 Cal-Net Physicians IPA N N

CALOP CalOptima Direct CA N N

CAMAA Cameron & Associates N N

71057 Cannon Cochran Management Services LA N N

Metairie, Louisiana (Payer ID for claims with a mailing address of PO Box 6794, Metairie, LA 70009)

37105 Cannon Cochran Management Services, Inc. N N




Notes

CAPMN Cap Management CA N N

Cape Health Plan N N please route claims to Molina Healthcare of MI â€“ 38334

23045 Capital Blue Cross - CAIC PA N N

87726 Capital Community Health Plan N N

SX065 Capital District Physicians Health Plan (CDPHP) N N

95112 Capital Health Plan N N

65067 Capital International Management Services N N

68011 Capitol Administrators N N

CAPHP CapRock HealthPlans TX N N

GCVCP Cardiovascular Care Providers N N

57116 Care 1st Health Plan of Arizona AZ N N

HPSM1 Care Advantage N N

77082 Care Improvement Plus N N

00344 Care Management Resources N N

42148 Care Provider Network N N

11345 CareCentrix Y N

Enrollment required prior to claims submission. Please contact Rebecca Sweetman by email [email protected]

14182 CareCore National N N

14184 CareCore National - Health Net N N

14185 CareCore National LLC - Health Net New Jersey N N

14179 CareCore National LLC (Aetna Radiology) N N

14180 CareCore National LLC (Oxford Radiology) N N

14188 CareCore/WCNY RAD N N

WellCare New York, POS 11 Radiology Claims Only. Claims for members in the following counties should be submitted to WellCare: Monroe, Erie, Wayne, and Onondaga.

SB580 CareFirst BCBS NCA Region DC N Y Pre-Enrollment is required for Electronic Remittance Advice.

SB690 CareFirst BCBS of Maryland MD N Y Pre-Enrollment is required for Electronic Remittance Advice.

SB690 CareFirst Blue Cross Blue Shield MD N Y Pre-Enrollment is required for Electronic Remittance Advice.




Notes

16147 CareGuide N N

25133 Carelink Health Plan N Y

25133 Carelink Medicaid N N

CLUHS Carelink University Health System N N

91136 Caremark WPAS, Inc., Grp# P62 N N MUST HAVE GRP# ON CLAIM

CARMO CareMore IPA CA N N

CARMO CareMore Value Plus (CVP) N N

25133 Carenet N N

39280 CareOne Health Plan FL N N

93975 CareOregon Inc. OR N N

22248 CarePartners MO N N

95093 Careplus (Encounters) N N Encounters

95092 Careplus Health Plan N N

MRCHP Caresource Health Plan of Oregon OR N N

37311 CareSource of Indiana IN N N

31114 CareSource of Ohio OH N N

35167 Carewise N N

10010 Careworks N N

61101 Cariten Healthcare N Y

61101 Cariten Senior Health N N

56215 Carolina Behavioral Health Alliance NC N N

57105 Carolina Care Plan Inc. N N

56195 Carolina Summit Healthcare, Inc. N N

COMPU Carpenters' and Millwrights' Health Benefit Trust Fund CO N N

91131 Carpenters Health & Welfare (FCHN) WA N N

25125 Carpenter's Health & Welfare Trust Fund of St. Louis MO N N

25125 Carpenter's Health & Welfare Trust Fund of St. Louis MO N N

91131 Carpenters Trust (FCHN) WA Only WA N N

COMPU Carpet, Linoleum and Resilient Tile Layers Health and Welfare Fund CO N N

CASD1 CASD/Dakotacare (Chiropractic Associates of SD) SD N N

CASD2 CASD/Sanford (Chiropractic Associates of SD) SD N N

Caterpillar, Inc. N N




Notes

SX183 Catholic Healthcare West N N

03036 CBA BLUE VT N N Formerly Comprehensive Benefit Administrators

55438 CBCA Administrators N N

41170 CBCA Administrators (HRM) N N

88019 CCEA Welfare Benefit Trust N N

CCN Managed Care Inc. N N

87065 CDO Technologies N N

SX065 CDPHP - Capital District Physicians Health Plan N N

88022 CDS Group Health N N

HPIPA Cedars Towers Surgical Medical Group (Encounters Only, Payer ID Required) N N (Encounters Only, Payer ID Required)

95167 Cedars-Sinai Medical Group - Non - Payable Claims (Capitated) CA N N

95166 Cedars-Sinai Medical Group - Payable Claims CA N N

CELTC Celtic N N

68060 CeltiCare Health Plan MA N N

37250 Cemara Administrators N N

91136 Cement Masons & Plasterers Health & Welfare Trust Group #F16 N N

95386 CenCal Health CA N N

68048 Cenpatico Behavioral Health AZ Y N

Prior to submitting claims, please call Provider Relations Dept. at 866-495-6748.

68050 Cenpatico Behavioral Health - Georgia GA N N Prior to submitting claims, please call Provider Relations Dept at 800-947-0633

68052 Cenpatico Behavioral Health - Indiana IN N N

Prior to submitting claims, please call Provider Relations Dept at 1-877-647-4848 to verify your provider info is on file in the claim system.

68051 Cenpatico- OH OH N N

68056 Centene Advantage Plans N N

USC02 Center Care (Safety Claims) N N For Safety Claims

UNC01 Center Care (Unicare Claims) N N For Unicare Claims

13357 Center Care PPO (Meritain) N N

MPM03 Centinela Valley IPA CA N N




Notes

75243 Centra N N

31118 Central Benefits Life N N

31118 Central Benefits Mutual N N

31118 Central Benefits National N N

CCA01 Central California Alliance for Health Y Y

Before submitting claims go to http://www.ccah-alliance.org/claims_ecs.html to pre-enroll. Central California Alliance for Health will contact you with approval. (800-700-3874 ext 5510)

WH001 Central California Womens Health CA N N

02041 Central Mass. Health Care (CMHC) N N

34097 Central Reserve Life N N

CIPA1 Central SeniorCare N N

36215 Central States Health & Welfare Funds N N

36215 Central States Health & Welfare Funds N N

SC027 Central Valley Medical Group CA Y N Pre-enrollment is posted under Sutter Connect

SCP01 Centre for Healthcare/Arch Health Partners CA N N

48120 Century Health Solutions N N

36393 Centurypho N N

23171 CHA Health N N

CH002 CHAMPUS / TRICARE NORTH (Health Net Federal) Y Y

CT, DE, IL, IN, KT, MA, MD, ME MI, NH, NJ, NY, NC, OH, PA, RI, VT, VI, Wash DC,WV, WI - Payer ids 61125 and 38520 all go under our CH002 payer id

CH002 CHAMPUS / TRICARE SOUTH (Humana Military) Y Y

AL. AK, FL, GA, LA. MI, OK, SC,TN, TX - Payer ids 61125 and 38520 all go under our CH002 payer id

WPSTC CHAMPUS / TRIWEST (WPS) Y Y

Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa(Except for the Rock Island Arsenal Area), Kansas, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon South Dakota, The Extreme Western Portion of Texas, Utah, Washin

84146 CHAMPVA - HAC N N

Chartered Health Plan DC N N




Notes

16600 Chautauqua County Healthcare Plan NY N N Mayville, New York

25151 CHC Cares of South Carolina SC N N

25130 CHC OF DELAWARE N N

25132 CHC OF IOWA N N

CHECS CHEC - A Subsidiary of Sprint N N

59223 Chesapeake Life Insurance Company N N

34154 Chesterfield Technologies N N

86048 Child Health Plus and Americhoice of New York (Medicaid) NY N N

80141 Childhealth Plus by Healthfirst (CHP) NJ N Y

94321 Children First Medical Group N N

84146 Children of Women Vietnam Veterans - VA HAC N N

CPMG1 Childrenï¿½s Physicians Medical Group N Y No pre-enrollment required

CSSD2 Children's Specialists of San Diego II CA N Y No enrollment required

94302 Chinese Community Health Plan N N

CHIP N N

CHIPA CHIPA - College Health IPA N N

CM001 ChiroMetrics CA N N

LNDMK Chiropractic Care of Minnesota MN N N

33065 CHOC - Children's Hospital of Orange County Health Alliance N N

UHSCH Choice One UTMB CHIP Health Plan Y N Please contact payer before sending claims-1-877-238-8543

90441 CHP Direct Supermed N N

61271 Christian Brothers Services N N

SPOHN Christus Spohn Health Plan N N

62308 CIGNA N Y

62308 CIGNA - PPO N N

CIGBH CIGNA Behavioral Health N Y

62310 CIGNA Flex Care NM N N

86033 CIGNA For Seniors N Y

86033 CIGNA for Seniors - Arizona Medicare N N CA MN

62308 CIGNA Health Plan N Y

62308 CIGNA HealthCare N Y

86033 CIGNA Healthcare for Seniors (Medicare) AZ N N




Notes

62308 CIGNA PPA N Y

62308 CIGNA Premier Plus N Y

62308 CIGNA Private N Y

10207 Citrus Health Plan N N

IP055 Citrus Valley Physician's Group CA N N

COA01 City of Amarillo Group Health Plan N N

74234 City of Austin TX N N

75600 City of Odessa N N

TKFMC City of Visalia CA N N

CCMMH Clackamas County Mental Health OR N Y

Claims Administration Corp. N N

57080 Claimsware, Inc. DBA ManageMed N N

33192 Clarendon's Healthy Kids N N

CCS99 Clayton County Health Benefit Plan N N

77201 Clearchoice Health Plan (COIHS) OR N N

41201 Client First N N

CRGMN Clinical Resource Group MN N N

02041 CMHC N N

AMM03 CMS - Custody Medical Services N N C/O Advanced Medical Management

AMM03 CMS (Custody Medical Services) (Advanced Medical Management) CA N N

CNA Health Partners AR N N Formerly Coresource, AR

37227 CNIC Health Solutions N N

IP079 Coachella Valley Physicians CA N N

CCPN1 Coastal Communities Physician Network (CCPN) CA N N

38335 Cofinity N N

37123 Colonial Health Care Inc. N N

COACC Colorado Access CO N N

COBHI Colorado Behavioral Healthcare Inc CO N N

COKSR Colorado Kaiser Permanente CO N N Colorado plans only **EXCEPT COLORADO SPRINGS**

COMPU Colorado Laboreres Health & Welfare Fund CO N N

AMS11 Columbia Community Care WA N N

25351 Columbia Cornell Care N N

91162 Columbia United Providers N N




Notes

62308 CoMed - CIGNA N N

34181 Commerce Benefits Group N N Also, Commerce Benefits Group PPO

37237 Commonwealth Administrators, LLC N N

14315 Commonwealth Care Alliance N N

23171 Commonwealth Health Alliance (CHA) N N

25179 Community Care Behavioral Health Organization N N

23282 Community Care BHO N N

73143 Community Care HMO N N

73143 Community Care Managed Health Care Plans of OK OK N N

39126 Community Care Organization N N

71079 Community Care Plus N N

38325 Community Choice of Michigan MI N N

26231 Community Claims Administration N N

SYMED Community Family Care Medical Group CA N N

COMMF Community First N N

35193 Community Health Alliance N N

CHCN1 Community Health Center Network - CHCN N N

48145 Community Health Choice N N

CHG01 Community Health Group CA N N

62149 Community Health Network of Connecticut CT N N

CHPWA Community Health Plan of Washington N N

CMGWV Community Medical Group of the West Valley CA N N

32481 Community Premier Plus for Neighborhood Health Providers N N

34177 Comp OH N N Austintown, Ohio

50946 Compass Rose Health Plan/Informed UHC N N

37297 CompBenefits Corporation N N

CHP01 Complementary Healthcare Plan N N

Comprehensive Behavioral Care N N

59314 Comprehensive Behavorial Care N N

03036 Comprehensive Benefits Administrator, Inc. N N

CCMC1 Comprehensive Care Management NY N N




Notes

00720 Comprehensive Care Services MN N N claims are sent to BCBS of MN

CompuSys - Erisa Group TX N N

COMPU CompuSys (Incorporated) of Colorado CO N N

74234 CompuSys Inc NM N N

80705 Confederation Administration Services & Life Insurance N N

78375 Connecticare Medicare CT N N

06105 Connecticare, Inc. N N

37307 Connecticut Carpenters Health Fund CT N N

62308 Connecticut General N N

63208 Connecticut PRI N N

37135 Consociate Group N N

75284 Consolidated Associates Railroad N N

87843 Consolidated Health Plans N N

37295 Consumer Health Solutions N N

71404 Continental General Insurance Company N N

55544 Conversion Plan - APWU N N

CCHP1 Cook Childrens Health Plan N N

CCHP9 Cook Childrens Star Plan TX N N

35149 Cook Group Heath Plan N N

52132 Cooperative Benefit Administrators (CBA) N N

35199 Cooperative Managed Care Services N N

14829 Co-ordinated Benefit Plans LLC N N

58204 Coordinated Medical Specialists N N

58231 Core Management Resources N N

58231 Core Mgmt Resource N N Located in Macon, GA

35183 CoreSource - Ohio OH N N

35182 CoreSource AZ MN N N

75136 CoreSource Little Rock AR N N

35182 CoreSource MD PA IL N N

35182 CoreSource NC IN N N

35202 Cornerstone Benefit Adminstrators N N

41124 Corp. Benefit Services/CBSA/Fortis Self Funded Admin N N

Now known as Meritain. Payer ID valid only for claims with a billing submission address of P.O. Box 27267, Minneapolis, MN 55427-0267




Notes

56116 Corporate Benefits Service, Inc. (NC) NC N N

37246 Corporate Systems Administration N N

CCIH1 CorrectCare Integrated Health (CA Prison Health Care Services) CA N N

Patient address field needs to be 3-4 letter abbreviation of institution

43160 Correctional Medical Services, Inc. N N

62553 Country Life Insurance Company N N

MCS03 County of Kern POS CA N N

58102 Covenant Administrators Inc. GA N N Atlanta, GA

58102 Covenant Administrators, Inc. GA N N Atlanta, GA

CMSEB Covenant Mgnt Sys Employ Ben N N

25133 Coventry Advantra N N Texas, New Mexico, Arizona

25133 Coventry Health & Life OK N Y

25133 Coventry Health and Life (OK) OK N N

25133 Coventry Health Care - Nebraska NE N Y

25133 Coventry Health Care National Network N N

25133 Coventry Health Care of Delaware DE N N

25133 Coventry Health Care of Delaware, Inc. DE N N

25133 Coventry Health Care of Georgia GA N N

25133 Coventry Health Care of Georgia, Inc. GA N N

25133 Coventry Health Care of Iowa, Inc. IA N N

25133 Coventry Health Care of Kansas, Inc KS N N

25133 Coventry Health Care of Louisiana, Inc. LA N N

25133 Coventry Health Care of Nebraska NE N N

25133 Coventry Health Care of Nebraska, Inc. NE N N

25133 Coventry Health Care of Nevada NV N N

25133 Coventry Healthcare - Georgia GA N Y

25133 Coventry Healthcare - Louisiana LA N Y

25133 Coventry Healthcare - Wichita, Kansas KS N Y

25133 Coventry Healthcare of Missouri MO N N

CHCNT CoverColorado CO N N

64068 Creative Medical Systems N N

37320 Creative Plan Administrators N N

PPM01 Crown City Medical Group CA N N Fee for Service only and PAYER ID REQD

PPM02 Crown City Medical Group Encounters CA N N Encounters only and PAYER ID REQD

80705 Crown Life - Great West N N




Notes

37266 Croy - Hall Management, Inc. N N

34186 CSI NETWORK SERVICES N N

27136 CSI OF MICHIGAN N N

59140 Culinary Workers Union NV N N

82056 Custom Design Benefits, Inc. N N

57080 CWIBenefits, Inc. N N

DEW99 D. Edward Wright N N

DAK01 Dakotacare N Y

06172 Dart Container Corporation N N

95740 DC Chartered Health Plan, Inc. (Alliance) Y N

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

95748 DC HealthCare Alliance DC N N

39113 Dean Health Plan WI N N

87726 Definity Health N Y

63081 Delaware Health Plan Consortium N N

27009 Delaware Physicians Care N N

SB691 Delmarva Health Plan- Carefirst MD N N

DHS01 Delta Health Systems CA N N

84134 Denver Health - Indigent CO N N

84133 Denver Health and Hospital Authority CO N N

84135 Denver Health Medical Plan CO N N

84131 Denver Health Medical Plan, In. - Medicare Choice N N

MC006 Department of Social and Health Services - DSHS (Medicaid of WA) WA Y Y

DNS22 Dermatology Network Solutions, LLC BCBS N N

Payer requires 11 digit member ID Number

DNS77 Dermatology Network Solutions, LLC Humana N N


DNS44 Dermatology Network Solutions, LLC Vista N N


AMS11 Desert Canyon Community Care AZ N N

DESRT Desert Medical Group (Regal) CA N N

MDL99 Detroit Laborers (Metropolitan) MI N N

56240 Detroit Medical Center MI N N

25131 Diamond Plan N N




Notes

36439 DiaTri, LLC N N

23706 Director's Guild of America - Producer Health Plans N N

06102 Diversified Administration Corporation N N

25160 Diversified Group Administrators PA N N

25160 Diversified Group Brokerage CT N N Marlb, CT

06102 Diversified Group Brokerage/Healthplan Services N N

16003 DMERC Region A Medicare Y Y

17003 DMERC Region B Medicare Y Y

00885 DMERC Region C Medicare Y Y

05655 DMERC Region D Medicare Y Y

39044 Doctorâ€™s Choice N N Newton, MA

APP01 Downey Select IPA CA N N Now known as Applecare Medical Management

74284 Driscoll Children's Health Plan N N

37600 DSCC DIV Special Care Children N N

35186 Dunn & Associates Benefits Administrators, Inc N N

36434 Early Intervention Central Billing N N

DHS01 East Bay Drainage Drivers Security Fund CA N N

SYMED East LA Doctors Hospital CA N N

MPM13 East LA Doctors Hospital (Medpoint) CA N N

EMG11 Eastland Medical Group N N

EMG11 Eastland Medical Group IPA CA N N

Eaton Benefits, Ohio OH N N

22262 EBA & M Employee Benefits Administration and Management Corp CA N N

EBC01 EBC (Buffalo Rock) Birmingham AL N N

75277 eComm PPO N N

EPF03 El Paso First - CHIP N N

MPM04 El Proyecto De Barrio CA N N

52192 Elder Health HMO of Pennsylvania PA N N Now known as Bravo Health

52192 Elder Health Maryland HMO MD N N Now known as Bravo Health




Notes

31625 ElderPlan, Inc. N N

Elderplan Provider ID is necessary on all claim submissions. If you do not know your provider Id, contact (718) 921-7979.

NAELM ElmCare LLC N N

37253 Elmco N N

EMBC (Employee Benefit Management Corp) OH N N

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

AMM03

Emergency Medical Service Fund (EMSF) (Advanced Medical Management) CA N N

59299 EMI-KP Ambulance Claims N N

Empire Medicare New York NY Y N

EMP01 Empire Physicians Medical Group CA N N

87726 Empire Plan- United Healthcare N N

38241 Employee Benefit Concepts N N

37215 Employee Benefit Corporation N N

CX025 Employee Benefit Management Corp OH N N

31074 Employee Benefit Management Corp. (EBMC) aka Big Lots Assoc Benefit Plan N N

81039 Employee Benefit Management Services N N

37216 Employee Benefit Services - Ft. Mill, South Carolina SC N N

41198 Employee Benefit Services - Louisiana LA N N

EBSSA Employee Benefit Services (EBS of San Antonio) TX N N

37257 Employee Benefits Consultants N N

03036 Employee Benefits Plan Administration VT N N

03036 Employee Benefits Plan Administration (EBPA) VT N N

75184 Employee Claim ADJ N N

52429 Employee Health Coalition N N HealthScope Benefits

SYMED Employee Health Systems CA N N

35112 Employee Plans, LLC N N

74212 Employer Plan Services N N

MIDSC Employers Coalition on Health (ECOH) N N

75232 Employers Direct Health N N




Notes

75236 Employer's Direct Health - Employee Plan N N

75235 Employers Direct Health - Fully Insured N N

75233 Employer's Direct Health - Self N N

MIDSC Employers Health Cooperative (EHC) N N

37249 Employers Life Insurance Corporation N N

59298 Employers Mutual, Inc. (Jacksonville, FL) FL N N

59298 Employer's Mutual, Inc. (Jacksonville, FL) FL N N

35206 Encircle PPO N N

37110 Encompass N N

35206 Encore Health Network N N

36364 ENH Medical Group IPA N N

91136 Enstar Natural Gas, Group # P61 N N

EPNSH EPN (Seton Health Plan) N N

62308 Equicor N N

Equicor - Equitable N N

62308 Equicor - PPO N N

Equifax Healthcare Admin Service (EHAS) N N

73126 Equitable Plan Services OK N N Oklahoma City, OK

23250 Erin Group Administrators N N

74234 Erisa Administrative Services N N

34108 ES Beveridge & Associates N N

20818 Essence Healthcare N N

34159 E-V Benefits Management, Inc OH N N Columbus, OH. Now known as Meritain Health

34159 E-V Benefits Management, Inc. OH N N Columbus, Ohio; Now known as Meritain Health

87726 Evercare N N

87726 Evercare Star Plus N N

58233 Evergreen Health Plan N N

59313 Evolutions Healthcare Systems N N New Port Richey, Florida

EXC01 Excel MSO CA N N

CAPMN Exceptional Care Medical Group CA N N

71412 Exclusicare N N

37289 F.A. Richard & Associates, Inc. N N




Notes

91136 F40 Alaska Carpenters Trust N N

39112 FABOH (CHP RPU) N N

95432 Facey Medical Foundation N N

37300 FACS Group N N

22254 Fallon Community Health N N

60995 Family Care N N

FCD01 Family Care Medicaid OR N N

FCM01 Family Care Medicaid Mental Health OR N N

FCR01 Family Care Medicare OR N N

FCS01 Family Care Specialists CA N N

CAPMN Family Choice Medical Group CA N N

CAPMN Family Health Alliance CA N N

43173 Family Health Partners - MC + Missouri MO N N

31472 Family Health Partners Healthcare of Kansas KS N N

14140 Farm Family Life N N

59069 FBMC N N

33033 FCE Benefit Administrators N N

00402 Federal Employee Plan of South Carolina SC N N

00932 Federal Employees Plan WA (Regence Blue Shield) WA N N

37300 Federated Benefits N N

37300 Federated HR Services N N

Federated Insurance Company N N

41041 Federated Mutual Health Insurance Company MN N N

COFHP FHP of Colorado CO N N HMO Claims only. Trading Partner Number Required.

11315 Fidelis Care New York NY N N

77054 Fidelis Secure Care N N

FAMR1 First Administrators SD N N

First Ameritas of New York N N

56196 First Carolina Care NC N N

91131 First Choice Health Network N N

14162 First Choice HealthPlans of Connecticut CT N N

75138 First Choice of Midwest (PPO) N N




Notes

75138 First Choice of Midwest PPO N N

80705 First Great West Life & Annuity Ins. Co. N N

25133 First Health Y Y

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

06108 First Option Health Plan PHS Health Net of the NE N N

Please call the EDI Team at 866-334-4638 to verify Provider ID

23241 First Priority PA Y N

All new providers must enroll with First Priority Health/Blue Cross of Northeastern PA prior to submitting electronic claims. Enrollment form available at: http://www.bcnepa.com/EDI/registrationForm.aspx

87726 First Seniority Freedom/Harvard Pilgrim N N

59276 First Service Administrators N N Also known as Florida 1st

63080 First State Health Plan N N

94998 Firstcare (Medicaid) N N

94999 Firstcare and Firstcare Medicaid N Y

90061 FirstGuard MO N N

FirstGuard Health Plan N N

90061 FirstGuard Missouri MO Y N

FS802 FirstSolutions MN N N

62061 Fiserv Health N N Kansas & Tennessee

62061 Fiserv Health - Kansas & Tennessee N N

39026 Fiserv Health - Wausau Benefits - Benesight N Y

95266 Fiserv Health Harrington N N

11244 Fitzharris & Company, Inc. N N

60054 Flexcare N N

68058 Florida Cenpatico Behavioral Health N N

59321 Florida Hospital Healthcare Systems FL N N

48116 Florida Hospital Waterman FL N N

59698 Florida League of Cities N N

65063 Florida NetPass N N

60054 Florida Power & Light (Prudential) FL N N

APJAX Floridian Care - Jacksonville FL N N

48117 FMH Benefit Services, Inc. N N




Notes

FMH Coresource N N

37305 Ford Meter Box Company Inc., The N N

25133 Foreign Service Benefit Plan N N

87066 Formax, Inc. N N

Fortis N N Formerly Time Insurance

39065 Fortis Benefits Insurance Company N N

36065 Fortis Life Insurance Company N N

TKFMC Foundation for Medical Care of Tulare & Kings County CA N N

FVMCH Fox Valley Medicine Site 199 N N

FVMC1 Fox Valley Medicine Site 451 N N

64069 Fox-Everett, Inc. N N

31313 Freedom First Plan (Medicaid) N N Member ids begin with â€˜Mâ€™

41212 Freedom Health Plan (Medicare) N N Member ids begin with â€˜Pâ€™

62324 Freedom Life Insurance Company TX N N

DHS01 Fresno Unified CA N N

TKFMC Friant Water Users CA N N

59069 Fringe Benefit Management N N

59204 Fringe Benefits Coordinators N N

34171 FrontPath Health Coalition N N

AMM04 Future Care Medical Associates IPA CA N N

37283 Gallagher Benefit Administrators, Inc N N Now known as AAG-American Administrative Group

30005 Galveston County Indigent Health Care N N

25169 Gateway Health Plan PA N N

25169 Gateway Health Plan - Medicaid PA PA N N

60550 Gateway Health Plan - Medicare Assured N N

25169 Gateway Health Plan (Medicaid) PA N N

91741 Gateway Health Plan of Ohio OH N N

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

GE Group Administators N N

44054 GEHA N Y

57254 GEHA (aka State of Texas Dental Plan) N Y




Notes

75273 Geisinger Health Plans N N

Prior enrollment required. Please contact Geisinger Health Plan at 888-281-5338, option 3, to obtain an enrollment form; or download a PDF enrollment form at www.thehealthplan.com

MCS01 GEMCare (Golden Empire Managed Care System) CA N N

MCS03 GemCare Health Plan, Kern County EPO N N

80705 Gencare Health MO N N St. Louis, Missouri

80705 Genelco MO N N St. Louis , Missouri Only

HDNFC General Hospital (Humboldt Del Norte) CA N N

GHEDI GENERATIONS GLOBALHEALTH N N

46050 Generations Healthcare N N

46051 Generations- Hillcrest N N

PROSP Genesis Healthcare (EMG) (Prospect Medical Group) CA N N

11345 Gentiva Health Service N N

61271 Georgia Power Med. Benefits Pln (Health Care Services) GA N N

23212 Gettysburg Health Preferred N N

22937 GHI - Medicare Private FFS N N

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

25531 GHI HMO N N

25133 GHP Group Health Plan MO N N

58204 GI Innovative Management N N

80314 GIC Indemnity Plan N N

07205 Gilsbar N N

COMPU Glassworkers and Glaziers Health and Welfare Fund Trust CO N N

REGAL Glendale Physicians Alliance CA N N

07689 Global Care Inc. N N

MPM05 Global Care Medical Group IPA CA N N

75246 GM Southwest TX N N

47083 GMS, Inc. N N

37602 Golden Rule Insurance Company N N

MBA01 Golden State Medical Group CA N N

68041 Golden State Physicians Medical Group N N




Notes

GTPA1 Golden Triangle Physican Alliance N N

AMM01 Good Samaritan Medical Practice Association (GSMPA) CA N N

44054 Government Employees Hospital Association N Y

44054 Government Employees Hospital Association (GEHA) N Y

37234 Grant Physicians Practice Association N N

95467 Great Lakes Health Plan N N

80705 Great West Health Care N N

GCMG1 Greater Covina Medical Group CA N N

CAPMN Greater L.A. Healthcare (Cap Managements Systems) CA N N

NMM01 Greater Orange Medical Group N N

NMM01 Greater San Gabriel Medical Group N N

CAPMN Greater San Gabriel Valley Physicians CA N N

HCP01 Greater Valley CA N Y

80705 Great-West Life & Annuity Insurance Company N N

78521 Greentree Administrators TX N N

36338 Group Administrators Ltd. N N

48143 Group and Pension Administrators N N

72153 Group Benefit Administrators TN N N Hendersonville, TN

72087 Group Benefits - Louisiana LA N N

GE001 Group Health (Coventry GHP IL and MO) N N

91051 Group Health Cooperative WA N Y

91051 Group Health Cooperative - East N Y

91051 Group Health Cooperative - Puget Sound N Y

91051 Group Health Cooperative - Washington WA N Y

95192 Group Health Cooperative of Eau Claire WI N N

39167 Group Health Cooperative of South Central Wisconsin (Claims) WI N N

39168 Group Health Cooperative of South Central Wisconsin (encounters) WI N N

91051 Group Health Cooperative, Healthy Options N Y




Notes

91051 Group Health Cooperative, Medicare Plus Choice N Y

13551 Group Health Incorporated (GHI) N Y

91051 Group Health Northwest N Y

91051 Group Health Options WA N Y

91051 Group Health Options, Alliant N Y

25133 Group Health Plan - CMR MO N N

37276 Group Insurance Service Center N N

68046 Group Practice Affiliates N N

77010 Guardian Healthcare(SC) SC N N

64246 Guardian Life (The Guardian) N N

41203 Gulf Coast Physician Network (MedView) TX N N

41203 Gulf Coast Physicians Network TX N N

RENBL Gulf Quest IPA HMO Blue N N

39180 Gundersen Lutheran Health Plan WI N N

Gunderson Lutheran Health Plan WI N N

H.E.R.E Health Trust WA N N

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

HAP/AHL/Curanet MI N N

36405 Harmony Health Plan of Illinois IL N N

36405 Harmony Health Plan of Indiana IN Y N

HCP01 Harrimon Jones CA N Y

59152 Harrington Benefits Services OK N N

Oklahoma, State of Oklahoma-Healthchoice, City of Oklahoma City, Department of Rehabiltative Services, Department of Corrections, Mayes County Ja

95959 Harris Methodist Health Plan N Y

04271 Harvard Pilgrim Health Care N Y

48330 Hawaii Management Alliance Association (HMAA) HI N N

37111 HCH Administration - Illinois IL N N

37215 HCH Administration, Inc. N N

37329 HCHA Albq-Self Funded N N

82018 HCS - Health Claims Service ID N N Boise, Idaho

20257 HDPC - Alliance Physicians (High Desert Primary Care Alliance) CA N N




Notes

90023 HDPC - Premier Care (High Desert Primary Care Premier) CA N N

34654 Health & Welfare fund of the Plumbers & Pipefitters Local Union#396 OH N N

23173 Health 1-2-3, Inc. N N

77950 Health Alliance Medical Plan N N

38224 Health Alliance Plan of Michigan MI N N

Health Assurance N N

60054 Health Care Alliance (Sears) N N

HCDPB Health Care District Palm Beach Y N Before submitting claims please call to enroll 866-930-1002

MPM06 Health Care LA IPA CA N N

42102 Health Care Network of Wisconsin (HCN) WI N N

34193 Health Care Payer's Coalition (HCPC) OH N N

61271 Health Care Services, Georgia Power GA N N

62180 Health Choice Generations N N

62111 Health Cost Solutions N N

34158 Health Design Plus - Hudson, Ohio OH N N

16120 Health EZ N N

95019 Health First Health Plans FL N N

59087 Health Help Network, Inc. (HHNI) N N

55247 Health Insurance Plan of Greater NY (HIP) NY N N

Health Management N N

62295 Health Market Care Assured N N

95567 Health Net - California CA N Y

Pre-enrollment is required for Electronic Remittance Advice (ERA/835). See Resource center/payer enrollment forms for the correct 835 enrollment form.

95567 Health Net - Oregon OR N Y


95567 Health Net - Washington WA N Y





Notes

CH002 Health Net Federal Services (TRICARE for North Region) Y Y

Payer ids 61125 and 38520 all go under our CH002 payer id

38309 Health Net of Arizona AZ N Y

06108 Health Net of the Northeast N N

Payer requires unique provider ID; please call the Provider Call Unit at 800-438-7886

65062 Health Network One N N

55204 Health Now New York NY Y Y

NAHOI Health Options of Illinois IL N N

80142 Health Partners PA N N

All claims submitted require a valid HealthPartners, PA, provider ID in the Rendering Provider Network ID field.

HPAMN Health Partners of Minnesota MN Y Y

62157 Health Partners of Tennessee TN N N

20270 Health Payment Systems, Inc. N N

37221 Health Plan Management N N

52563 Health Plan of Michigan MI N N

76342 Health Plan of Nevada N Y California and Nevada.

HPSJ1 Health Plan of San Joaquin N N

HPSM1 Health Plan of San Mateo CA N N

Health Plan of the Redwoods (Mediprime) CA N N

59140 Health Plan Services N N

34150 Health Plan, The OH N N Massillon, Ohio & St. Clairsville, Ohio only

44273 Health Plans, Inc. N N

95435 Health Pledge HMO N N

11324 Health Plus PHSP NY N N Brooklyn, NY

55438 Health Risk Management N N

HSIPA Health Select IPA CA N N

20896 Health Services Consulting Group N N

37290 Health Services for Children with Special Needs N N

41150 Health Services Management â€“ HSM MN Y Y Pre Enrollment needed for ERA's only

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

37290 Health Servs for Children w-Special Needs N N

27008 Health Systems International - ECOH N N




Notes

35206 Healthcare Group, The N N

EPF37 Healthcare Options TX N N

HCP01 HealthCare Partners CA N Y

11328 HealthCare Partners IPA - New York N N

20501 HealthCare Partners of Nevada NV N N

56731 HealthCare Resources NW N N

73147 HealthCare Solutions Group N N

25133 HealthCare USA N N

36335 HealthCare's Finest Network (HFN) N N

62179 HealthChoice of Arizona AZ N Y Pre Enrollment needed for ERA's

95376 HealthChoice of Connecticut CT N N

85729 HealthComp CA N N

85729 Healthcomp Inc. N N

NAHOI Healthe Options of Illinois IL N N

59608 Healthease FL N N

41178 HealthEZ N N

80141 Healthfirst - New York NJ N Y

HCPHM HealthFirst (HMO) TX Y Y

80141 Healthfirst 65 Plus NJ N Y

80141 Healthfirst Family Health Plus (FHP) NJ N Y

80141 Healthfirst Health Plan of New Jersey NJ N Y

80141 Healthfirst Inc NJ N Y

80141 Healthfirst PHSP NJ N Y

75234 Healthfirst Tyler, Texas TX N N

23274 HealthGroup Limited N N

23226 HealthGuard of Lancaster, California CA N N

Healthhelp Networks, Inc. (HNNI) N N

96475 Healthlink HMO N N

Please call Provider Relations Dept at (800) 624-2356 for unique provider number.

90001 Healthlink PPO N N

Please call Provider Relations Dept at (800) 624-2356 for unique provider number.

59140 HealthPlan Services FL N N Tampa only

59140 HealthPlan Services, Inc. (American Benefit) N N

59256 Healthplan Southeast HPSE FL N N




Notes

95009 HealthPlus of Louisiana LA N N

38216 HealthPlus of Michigan MI N N

68195 Healthpoint Corp N N

71063 HealthSCOPE Benefits, Inc. N N

M3IL1 HealthSelect BCBS of Florida FL N N

HSHAR Healthshare N N

75250 HealthSmart Preferred Care N N

01041 Healthsource ME N N Payer requires unique provider ID; please contact (800) 909-2227 ext.5760

02038 Healthsource (CIGNA) NH N N

62308 Healthsource (Med) (CIGNA) AR N N

02041 Healthsource CMHC N N

02041 Healthsource Massachusetts, Inc. (CIGNA) N N

68195 Healthsource Provident N N

HSPAN HealthSpan Network Repricing N N

63092 HealthSpring HMO N N HealthSpring Medicare+Choice

63092 HealthSpring HMO/HealthSpring Medicare+Choice N N

63092 HealthSpring of Alabama N N

36332 HealthStar, Inc. N N

58213 Healthways WholeHealth Network N N

58213 Healthways WholeHealth Networks N N

HLTHQ Healthy Equation N N

95827 Healthy Palm Beaches, Inc. FL N N

59230 Heritage Consultants N N

REGAL Heritage Provider Network CA N N

VVMG1 Heritage Victor Valley Medical Group CA N N

HDMDG High Desert Medical Group CA N N Lancaster, California

33069 High Desert Primary Care CA N N Hesperia, California

91161 Highline MSO - PSHP N N

91164 HighlineMedicalServiceOrganizationï¿½Molina WA N N

35145 Highmark - Key Family N N

HIL01 Hill Physicians Medical Group CA N N

59347 Hillcrest Benefit Administrators N N




Notes

36385 Hinsdale Physicians Healthcare N N

HPIPA Hispanic Physician IPA (encounters only, Payer ID required) CA N N (Encounters Only, Payer ID Required)

HPFFS Hispanic Physicians IPA Fee For Service Only,Payer ID Required CA N N Fee For Service Only,Payer ID Required

CAPMN Hollywood Presbyterian Medical Group CA N N Now known as Prudent Medical Group

NAHLX Holy Cross Health Partners N N

VAICE Homeland Security (ATTN: Deportation) CA N N

88023 Hometown Health Network N N

88023 Hometown Health Plan Nevada NV N N

88537 Hometown Health Providers NV N N

22304 Horizon HealthCare Admin (HHA) N N

22099 Horizon Healthcare of New York NY N N

Horizon Healthcare of NJ N N

Horizon Healthcare of NY N N

22326 Horizon NJ Health NJ N N

37274 Hospital Benefits N N

91136 Hotel Employees & Restaurant Employees Health Trust, Group # F19 N N

HPR N N

58227 HPS Paradigm N N

41170 HRM Claim Management N N

HSI N N

41150 HSM - Health Services Management MN Y Y Pre Enrollment needed for ERA's only

13335 Hudson Health Plan Y N Please contact payer before sending claims at 914-631-1611

HBI01 Human Behavior Institute N N

61101 Humana N Y

61102 Humana Encounters N N

61101 Humana Gold Choice N Y

61101 Humana Gold Plus N Y

95348 Humana Health Plans of Ohio OH N N

61105 Humana HMO N N

CH002 Humana Military - Tricare South Y Y

CH002 Humana Military Healthcare Services (TRICARE for South Region) Y Y

Payer ids 61125 and 38520 all go under our CH002 payer id




Notes

Z0005 Humana Ohio 2 OH N N

65018 Humana Puerto Rico N N

61160 Humana Veterans Healthcare Services N N

HDNFC Humboldt - Del Norte Foundation IPA CA N N

HDNFC Humboldt-Del Norte Foundation IPA N N

37260 Hunt Insurance Group N N

CAPMN Huntington Park Mission Medical Group CA N N

SX172 I U Medical Group Primary Care N N

22175 I. E. Shaffer - West Trenton, New Jersey NJ N N

IAT99 IATSE Atlanta Health & Welfare Fund GA N N

31107 IBA Self Funded Group N N

BS001 IBEW Local 6 - San Francisco Electrical Workers N Y

They will all have a prefix code of "XEL" as their member ID on the BSC card.

74234 IBEW Local 640 & AZ Chapter NECA Health & Welfare Trust N N

IBEW Western Utilities or Local 57 N N

60054 IBM Medical Plans N N

11695 iCARE (Independent Care Health Plan) WI N N

26054 ICare Health Options FL N N

Pls include Network id (pin) on claims. Call Frank Bove @ Atlantis Health Plan to obtain a network id, 212-747-8393.

75185 ICON Benefit Admins N N

75274 IHG Direct N N

IHORG IHO (Inland Health Organization) N N

68065 Illinicare Behavioral Health IL N N

68066 Illinicare Group Health IL N N

ILWU Local 21 (FCHN) WA N N

41600 IMCARE N N

SCP01 Imperial County Physicians Med Group (SCPMCS) CA N N

40585 INDECS Corporation N N

54763 Independence Administrators Y N Must also be a Highmark provider

12X26 Independence BluCross&BluChoice-IBC N N

54704 Independence Blue Cross (Highmark) PA Y N Must also be a Highmark provider

IMG01 Independence Medical Group - Kern CA N N




Notes

County

IMG02 Independence Medical Group - Tulare County CA N N

35161 Indiana ProHealth Network N N

35107 Indiana Teamsters Health Benefits Fund IN N N Indianapolis, IN

31053 Individual Health Insurance Companies N Y

Pre Enrollment is required for Electronic Remittance Advice - listed under State Farm Insurance Company

COMPU Industrial Machine Specialties CO N N

52196 Informed, LLC N N

NAING Ingalls Provider Group N N

52212 Injured Workers Insurance Fund N N

Inland Empire Electrical Trust (FCHN) WA N N

IEHP1 Inland Empire Health Plan CA N N

IHORG Inland Health Organization (IHO) N N

31172 Innovante Benefit Administrator N N

04320 Innovative Healthware Solutions N N

93112 Inpronet, Portland, OR OR N N

VAICE INS Health Services DC N N

60054 Institutes of Quality N N

37279 Insurance Administrator of America, Inc. (IAA) N N

13315 Insurance Design Administrators N N

IMSMS Insurance Management Services TX N N

IAC01 Insurers Administrative Corp. N N

51020 Integra Administrative Group DE N N Seaford, Deleware

31127 Integra Group N N

31129 Integra Group - CHA N N

23229 Integral Quality Care FL N N

INET1 Integranet N N

74314 Integrant - SelectCare of Texas N N

37124 Integrated Benefit Services - Illinois IL N N

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




Notes

68053 Integrated Mental Health Service N N

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

92649 Inter-Americas Insurance N N

37227 InterCare Health Plans N N

60280 Interface EAP (IEAP) N N

23287 Intergroup Services Corporation N N

74234 Intermountain Ironworkers Trust Fund N N

36609 International Brotherhood of Boilermakers N N

IMGIN International Medica Group Inc N N

37269 International Union of Operating Engineers ~ Local 15, 15A, 15C & 15D N N

Interwest Health N N Acceptius Gateway Payer

84137 InterWest Health PPO N N

41124 Iowa Benefits N N

61271 J.F. Molloy & Associates N N

05014 Jackson Memorial Health Plan FL N N

JAI01 Jai Medical Systems MD N N

JEN99 Jenkins & Associates GA N N 1299 Battlecreek Rd. Ste 200, & PO Box 607, Jonesboro, GA 30237-0607

09822 JMH - SFCCN PHT (PSN CMSN) (Jackson Memorial Health Plan) FL N N

59171 JMH Medicare Advantage (Jackson Memorial Health Plan) N N

41099 John Alden Life Insurance Co. N N

95378 John Deere Health Care N Y

JMH01 John Muir Physician Network N N

If you have never submitted claims to John Muir before, please fax your W-9 with contact name and # to Patty Kan 925-941-2026

68013 John Muir Trauma Physicians N N

37215 John P. Pearl & Associates, Ltd. N N

52189 Johns Hopkins Healthcare N N

52123 Johns Hopkins Healthcare (USFHP) N N

34136 JP Farley Corporation N N

37272 JSL Administrators N N J. Smith Lanier

94320 Kaiser CSI - California Select for CA N N Formerly known as Kaiser PPO




Notes

Individuals

COKSR Kaiser Foundation Health Plan of Colorado CO N N Except Colorado Springs

NG010 Kaiser Foundation Health Plan of Georgia GA N N

94135 Kaiser Foundation Health Plan of Northern CA Region CA N Y

KS005 Kaiser Foundation Health Plan of Ohio OH N N

94134 Kaiser Foundation Health Plan of Southern CA Region CA N Y

94134 Kaiser Foundation Health Plan of Southern California CA N Y

52095 Kaiser Foundation Health Plan of the Mid-Atlantic States N Y

Maryland, Virginia and District of Columbia. Pre Enrollment is required for Electronic Remittance Advice

NW002 Kaiser Foundation Health Plan of the Northwest N Y Same as PayerID 93079

57038 Kanawha Healthcare Solutions N N

57038 Kanawha Insurance Company N N

KCIPA KANE COUNTY IPA IL N N

44030 Kansas City Life Insurance Company N N

HSM01 Karing Physicians Medical Group, Inc. CA N N

KMG11 Katy Medical Group N N

TKFMC Kaweah Delta CA N N

KEE01 Keenan & Associates CA N N

KELSE Kelsey Seybold N N

73100 Kempton Company N N

73100 Kempton Group Administrators N N

63077 Kentucky Health Select KY N N

37124 Kepple & Co. IL N N Formerly Integrated Benefit Svcs.

MCS03 Kern County EPO N N GemCare Health Plan

MCS03 Kern County EPO, (GemCare Health Plan) CA N N

77039 Kern Health Systems CA N N

KMCHP Kern Medical Center Health Plan CA N N

37217 Key Benefit Administrators IN N N Indianapolis, Indiana

IP082 Key Medical Group CA N N

37321 Key Select N N

23045 Keystone Health Plan Central PA N N




Notes

95056 Keystone Health Plan East (KHP) (Highmark) Y N Must also be a Highmark provider

23284 Keystone Mercy Health Plan PA N N

Keystone West N N

54771 Keystone West (Highmark) PA Y Y

34145 Klais & Company N N

3414A Klais & Company (Repricing for HealthSpan Network Only) N N

KAMG1 Korean American Medical Group CA N N

KPS01 KPS Health Plans WA N N

KPS01 KPS Healthplans WA N N

LACAR LA Care CA N N

72068 LA Carpenters Reg Council Health Benefit Trust Fund LA N N

72602 LA Carpenters Reg Council Welfare Fund LA N N

72603 LA Laborers Health & Welfare Fund WV N N

71037 Lafayette Consolidated Government LA N N

LCHC1 Lakeside Comprehensive Healthcare N N

For DOS prior to 11/30/2009. DOS 12/1/2009 please submit claims to Lakeside Medical Group with payer id LMG01.

LMG01 Lakeside Medical Group CA N N aka RegalLakeside, DOS after 12/1/2009

LMG11 Lakeside Medical Group2 CA N N aka Old Lakeside, DOS before 12/1/2009

LNDMK Landmark N Y

ONLY Clients of ChiroCare of MN practicing in MN, WI, ND, SD, NE or IA can get electronic remits at this time.

LCMMH LaneCare OR N Y

MPM14 LaSalle Medical Associates CA N N

BPA01 Laundry Workers N N

36333 Lawndale Christian Health Center N N

52193 LBA Health Plans N N

75279 Leggett & Platt N N

65055 Leon Medical Center Health Plan N N

37248 LHP Claims Unit N N

87071 Liberty Health Advantage N N

37281 Liberty Union N N




Notes

37281 Life Assurance Associates N N

37281 Life Assurance Company N N

33053 Life Strategies N N Behavioral Health for UT and CO only

41136 Life Trac N N

LFGRD Lifeguard N N

LIFE1 Lifeprint AZ N N

93093 LifeWise of Oregon, A Premera Healthplan OR Y Y

91049 LifeWise of Washington WA Y N A Premera Healthplan

61101 Lincoln National (Humana) AZ N Y Phoenix, AZ

LOBH1 Linden Oaks Behavioral Health N N

75283 Linn County N N

LIPA1 Lipa-Agate Resources Hcfa N N

LCM01 Little Company of Mary CA N N

35107 Local 135 Health Benefits IN N N Indianapolis, IN

37267 Loma Linda University Adventist Health Sciences Center N N

37267 Loma Linda University Adventist Health Sciences Center Employee Health Plan N N

37267 Loma Linda University Adventist Health Sciences Centers N N

37267 Loma Linda University Behavioral Medicine Center Employee Health Plan N N

37267 Loma Linda University Behavorial Medicine Center Employee Health Plan N N

37267 Loma Linda University Employee Health Plan N N

37267 Loma Linda University Health Care Employee Health Plan N N

33036 Loma Linda University Healthcare - ManagedCare Claims N N

37267 Loma Linda University Healthcare Employee Health Plan N N

37267 Loma Linda University Medical Center N N

London Health Administrators N N

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

PPM02 Los Angeles Medical Center Encounters CA N N Encounters only and PAYER ID REQD

PPM01 Los Angeles Medical Center IPA (LAMC) CA N N Fee for Service only and PAYER ID REQD




Notes

SX159 Lovelace Medicaid NM N N

SX159 Lovelace Salud (Medicaid) NM N N

SX159 Lovelace Salud (Medicaid claims only) N N

90328 Lovelace Sandia Health Plan N N

87726 M.D. Individual Practice Assoc. (M.D.IPA) N N

CAPMN Mabuhay Medical Group CA N N

36334 MacNeal Health Providers - CHS N N

HCP01 Magan Medical Clinic CA N Y

01260 Magellan Behavioral Health Services N Y

11303 Magnacare N N

68062 Magnolia Health Plan MS N N

25133 Mail Handlers Benefit Plan (CAC) N Y

Mailhandlers Benefit Plan (CAC) N N

22195 Maksin Management Corporation N N

87726 MAMSI N N

87726 MAMSI Life & Health Insurance Company (MLH) N N

MCS03 Managed Care GemCare Health Plan CA N N

35162 Managed Care Services N N

MCS02 Managed Care Systems (Delano Regional Med. Grp.) CA N N

MCS01 Managed Care Systems (GEMCARE) CA N N

22771 Managed Health Network (MHN) N N

39187 Managed Health Services WI N N

Managed Health Services - Centene N Y

39186 Managed Health Services (Medicaid HMO) IN N N

Priortosubmittingclaims,pleasecallProvider Relations Dept at 800-944-9661 to verify your provider info is on file.

39186 Managed Health Services Indiana (Medicaid HMO) IN Y N

Priortosubmittingclaims,pleasecallProvider Relations Dept at 800-944-9661 to verify your provider info is on file.

39187 Managed Health Services Wisconsin WI Y N

41159 Managed Physical Network N N

41555 Manatee Service Center - Bradenton, FL N N

75258 Mapco, Inc. N N




Notes

09908 Maricopa Care Advantage AZ N Y See University Physicians Healthcare 835 ERA enrollment form

09908 Maricopa Health Plan AZ N Y See University Physicians Healthcare 835 ERA enrollment form

IP097 Marin IPA CA N N

MCS03 Marion Health Services- CHW CA N N

MPCHP Marion Polk Community Health Plan OR N Y

MPCHA Marion Polk Community Health Plan Advantage OR N Y

13310 Marsh Advantage N N

MPHC1 Martins Point Health Care N Y

22347 Maryland Health Insurance Plan MD N N

00247 Maryland Physicians Care MD N N

37121 Mashantucket Pequot Tribal Nation N N

Mass Mutual N N

MMPHB Masters Mates and Pilots Plan N N

MMPHB Masters Mates and Pilots Program N N

41154 Mayo Management Services, Inc. (MMSI) N N

87065 MBA Benefit Administrators UT N N

Payer ID valid for claims with a submission address of PO Box 651109, Salt Lake City, UT 84115

87065 MBA Benefit Administrators, Inc. UT N N

Payer ID valid for claims with a submission address of PO Box 651109, Salt Lake City, UT 84115

87065 MBA of Wyoming WY N N Worland, WY

56205 MBS - Formerly MedCost Benefit Services N N

MCA Admin PA N N Formerly DGA

38264 Mcare N N

CSMED Mcare of Colorado Springs CO N N

59331 McCreary Corporation N N

{for plan and claim requirements please contact the payer @ 561-287-7650 ext 4052}

MHCM1 McKinley Medical Group (Magnolia Healthcare Mgmt) N N

38338 McLaren Health Plan N N

87726 MD - Individual Practice Association, Inc. (M.D. IPA) N N

MDAPN MD Anderson Physician Network N N




Notes

MDC01 MD Care Health Plan N N

MD-IndividualPractice Association, Inc. (M.D. IPA) N N

MDNY Healthcare Plan N N

20475 Mdwise Hoosier Alliance N N

58204 MedAdmin Solutions N N

58202 MedAdmin Solutions (Self funded plans) N N

74323 MedBen OH N N Newark, OH

59231 MedCom N N

60054 Medconnection (Marriot) N N

MDCOR MedCore N N

56162 MedCost, Inc. N N

38353 MedDirect N N

95321 Medfocus N N

94265 Medica N N Pre-enrollment is for ERA's only

78857 Medica Health Care Plan, Inc N N

78857 Medica Health Care Plan, INC. N N

68041 Medical Benefit Administration, Inc N N

MBA01 Medical Benefit Administrators CA N N

37298 Medical Benefit Administrators of Maryland MD N N

74323 Medical Benefits Administrators, Inc. OH N N Newark, OH

74323 Medical Benefits Companies OH N N Newark, OH

74323 Medical Benefits Mutual N N

74323 Medical Benefits Mutual Life Insurance Co. N N

Medical Control Inc. N N

75229 Medical Control, Inc. N N

52181 Medical Development International N N

BC004 Medical Mutual of Ohio OH N N

CSMED Medical Network of Colorado Springs CO N N

61101 Medical Plan of Kansas City, MO (Humana) MO N Y

62177 Medical Reimbursements of America N N

58203 Medical Resource Network (MRN) N N

IP186 Medical Services Initiative N N

MC051 MediCal Type 04 CA Y N




Notes

MC051 MediCal Type 05 CA Y N

38224 Medical Value Plan-MVP-OH OH N N

CAPMN Medicina Familiar Medical Group CA N N

95655 Medigold OH N N

13123 Medigold PPO OH N N

MediPrime N N

Mediversal N N

35205 MedPartners Administrative Services IN N N

MP001 MedPay Assurance N N

62160 MedSolutions, Inc GA N N

82160 Medspan, Inc. N N

00243 MedStar Family Choice N N

Mega Life & Health 2 N N

59221 Mega Life & Health Insurance - Insurance Center N Y

P.O. Box 982009, North Richland Hills, TX 76182. Pre-Enrollment is required for Electronic Remittance Advice.

59227 Mega Life & Health Insurance - OKC OK N N P.O. Box 548801, Oklahoma City, OK 73154

59225 Mega Life & Health Insurance Company, The - Starbridge Star HRG N N

Mega Life Health Insurance, The N N

74227 Mega-Life & Health Insurance Co (Student Division) N N

Payer ID only valid if the P.O. Box on the Health ID Card matches one of the following P.O. Boxes:809025 890025 809067, 809079, 809066, 809036, 809081, Dallas, Tx 75380-9025.

01047 MEMIC N N

MCA11 Memorial Clinical Associates / SelectCare of Texas (MCA) Y N

MHHNP Memorial Herman Health Net N N

MHHNP Memorial Hermann Health Net-Providers N N

MPM12 Memorial Hospital of Gardena CA N N

59065 Memorial Integrated Healthcare Y N

Please email Tracy Harswick at [email protected] before submitting claims.

HCP01 Memorial Medical Group CA N Y

74289 Mental Health Network (MHNet) N N

13310 Mercer Administrators N N




Notes

43166 Mercy Care Health Plan N N

MRC01 Mercy Care Plan (AHCCCS) AZ N N

MER11 Mercy Health Plan N N

IP079 Mercy Physicians Medical Group (MPMG) (NAMM Southern CA) CA N N

13189 Meridian Health Plan N N

34159 Meritain Health N N

Formerly known as North American Benefits Network, Cleveland, OH). Payer ID valid only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476

64157 MeritainHealth N N FormerlyknowasNorthAmericanAdministrators,Inc.

64157 MeritainHealth/NorthAmericanAdministrators N N

65113 Metcare Health Plans N N

23550 Methodist First Choice N N

95420 MethodistCare N N

87726 Metrahealth Network (HMO & Care Option) N N A United HealthCare Company

87726 Metrahealth Network (HMO & Care Option:A United HealthCare Co.) N N

87726 Metrahealth Plan Administrators N N A United HealthCare Company

87726 Metrahealth Plan Administrators (A United HealthCare Co.) N N

87726 Metrahealth/Metrahealth Railroad N N A United HealthCare Company

82135 Metro Alliance N N

13265 Metro Plus Health Plan N N

10850 Metropolitan Health Plan MN N Y

Michael Reese HMO Plan IL N N

37127 Michael Reese Physicians Group N N

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

CAPMN Mid Cities IPA CA N N

MRIPA Mid Rogue Oregon Health Plan OR N N

37281 Mid-America Associates Inc. N N




Notes

MCI01

Midcoast Care Inc. (now known as Physicians Choice Medical Group of Santa Maria) CA N N

SYMED Mid-County Physicians Medical Group CA N N San Diego, CA

47080 Midlands Choice, Inc. N N

MVBHN Mid-Valley Behavioral Health Network OR N Y

61146 Midwest Group Benefits N N

MHP77 Midwest Health Plans, Inc. N N

59224 Mid-West National Life Insurance Company of Tennessee TN N Y

MIDSC Midwest Preferred N N

79480 Midwest Security Administration N N

74227 Mid-West United Life (Student Division) N N


79480 Midwester Preferred N Y

MPHS1 Mills Peninsula Health Services CA Y N

MPMG1 Mills Peninsula Medical Group CA N N

MCDMN Minnesota Health Care Program MN N Y See Medicaid Minnesota

05018 MIPS N N

STJOE Mission (St. Joseph Heritage Healthcare) CA N N

MPM07 Mission Community IPA Medical Group CA N N

37233 Mississippi Public Entity Employee Benefit Trust (MPEEBT) MS N N

Mississippi Public Entity Employee Benefit Trust MS N N

64088 Mississippi Select Health Care MS N N Gulfport, MS

37275 Missoula County Medical Benefits Plan N N

43179 Missouri Care (MC) N N

37265 MLink N N

62178 MMS, LLC. N N

38333 Molina Healthcare of California CA N N

51062 Molina Healthcare of Florida FL N N

00076 Molina Healthcare of Indiana IN N N

38334 Molina Healthcare of Michigan MI N N

71079 Molina Healthcare of Missouri MO N N




Notes

20676 Molina Healthcare of Nevada NV N N

NM505 Molina Healthcare of New Mexico NM N N

20149 Molina Healthcare of Ohio OH N N

20554 Molina Healthcare of Texas TX N N

38336 Molina Healthcare of Washington WA N N

IP095 Monarch Healthcare IPA CA N N

50749 Mondial Assistance VA N N

13174 Montefiore Contract Management Organization (CMO) N N

35092 Morris Associates N N

IP083 Mosaic IPA Medical Group CA N N

IP083 Mosaic Medical Group CA N N

MPI01 Motion Picture Industry Health Plan CA N N

86040 Mountain States Administrative Services AZ N N Tucson, AZ

Mountain States Administrative Services Tucson, Arizona N N

MTNST Mountain States Administrators CO N N Colorado only

80900 MPA-Custom Provider Network N N

MPE Services Inc. MS N N

35177 MPLAN (Medicaid) N N

95444 MPLAN, Inc. - HealthCare Group N N

AMM02 MSI (Medical Services For Indigents) (Advanced Medical Management) CA N N

95655 Mt Carmel OH N N

SYMED Multicultural Primary Care Medical Group CA N N San Diego, California

34080 Multiplan Wisconsin Preferred Network N N

37256 Mutual Assurance OK N N

70491 Mutual Group (The) (US) N N

71412 Mutual of Omaha N Y

71412 Mutually Preferred N N

38224 MVP - Ohio OH N N

14165 MVP Health Plan (Mohawk Valley) NY N Y

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

91136 N.W. Ironworkers Health & Security Trust Fund, Group # F15 N N




Notes

91136 N.W. Roofers & Employers Health & Security Trust Fund N N

91136 N.W. Roofers & Employers Health & Security Trust Fund, Group# F26 N N

91136 N.W. Textile Processors N N

91136 N.W. Textile Processors Group # F14 N N

Cleveland, OH. Now known as Meritain Health. Payer ID valid only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476

34159 NABN OH N N

Columbus, OH. Now known as Meritain Health. Payer ID valid only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476

NOD01 Nacel Open Door MN N N Minnesota providers only

53011 NALC N N

NANPR NAMM Partners, Inc IL N N

NHCA1 Naperville Health Care N N

62308 National Association of Letter Carriers (NALC) N N

56175 National Benefit Administrators - New Jersey NJ N N

56176 National Benefit Administrators - North Carolina N N

90001 National Capital Preferred Provider Organization (NCPPO) N N

To obtain your provider ID number, please call the NCPPO Customer Service Department at (800) 272-5911.

National Financial Insurance Co TX N N

90956 National Financial Insurance Company TX N N

98205 National Foundation Life Insurance Company TX N N

NHAIN National Health Administrators, Inc. N N

75275 National Health Insurance Company N N

37231 National Healthcare Exchange N N

NIA11 National Imaging Assoc Inc MS N N

59087 National Radiology Network, The N N Formerly Health Help Network

52132 National Rural Electric Cooperative Assoc. N N




Notes

71412 National Rural Letter Carrier Assoc. N N

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

52103 National Telecommunications Cooperative Association (NTCA) N N

31417 Nationwide Health Plans Y Y

31417 Nationwide Insurance N N

75191 NCAS NC N N Charlotte, North Carolina

75191 NCAS - Charlotte, North Carolina NC N N

75190 NCAS - Fairfax, Virginia CA N N

95123 Neighborhood Health Partnership FL N N

04293 Neighborhood Health Plan MA N N Boston, Massachusettes

11325 Neighborhood Health Providers & Suffolk Health Plan (NHP - SHP) N N

Please call (631) 360-3102 for your unique NHP/SHP provider number.

37255 Nesika Health Group N N

66055 Netcare Life & Health Insurance - Hagatna, Guam N N

04332 Network Health Y N

Please contact Provider Relations at (617) 806-8104 or [email protected] for an EDI setup form.

77076 Network Health Insurance Corporation - Medicare N N

39144 Network Health Plan WI N N

39111 Network Health Plan - Wisconsin WI N N

NMM01 Network Medical Management N N

NCH06 New Century Health - Bascom Palmer Eye Care Network FL N N PAYER ID REQD

NCH05 New Century Health - California Eye Care CA N N PAYER ID REQD

NCH04 New Century Health - CarePlus Cardiology FL N N PAYER ID REQD

NCH01 New Century Health - CarePlus Dermatology FL N N PAYER ID REQD

NCH03 New Century Health - CarePlus Urology FL N N PAYER ID REQD

NCH11 New Century Health ï¿½ Humana Cardiology CA N N PAYER ID REQD

NCH02 New Century Health - Humana Dermatology FL N N PAYER ID REQD

NCH10 New Century Health - Humana Oncology FL N N PAYER ID REQD

NCH09 New Century Health ï¿½ Vista Cardiology - Summit N N PAYER ID REQD




Notes

NCH07 New Century Infusion Solutions - CarePlus Oncology FL N N PAYER ID REQD

NCH08 New Century Infusion Solutions - Vista Oncology N N PAYER ID REQD

New England, The N N

76031 New Era Employee Welfare Benefit N N

75281 New Era Life Insurance Company N N

HSM01 New Life Medical Group, Inc. CA N N DBA Healthy New Life Medical Corp.

65056 New Market Dimensions N N

74234 New Mexico District Council of Carpenters NM N N

74234 New Mexico Painters & Allied Trades Local #823 UT N N

74234 New Mexico West Texas Multi-Craft N N

37312 New Source Benefits, LLC N N

84141 New West Health Plan N N

24819 New York Presbyterian System Select Health NY N N

38225 NGS American N N

62124 NHC Health Benefit Plan N N

96107 NHP "Neighborborhood Health Partnership" FL N N

Only valid for PO Box 025680, Miami, Florida 33102-5680 address

81264 Nippon Life Insurance Company of America N N

22603 NJ Carpenters Health Fund NJ N N

PDT01 Noble AMA Select IPA CA N N

CAPMN Noble Community Medical Associates LA (Cap Managements Systems) CA N N

HSM01 Noble Mid OC Orange County (Health Smart) CA N N

65085 North America Administrators (NAA) - Nashville, Tennessee TN N N

North American Administrators N N

34159 North American Benefits Network OH N N

Cleveland, Ohio. Now known as Meritain Health. Payer ID valid only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476

64157 North American Health Plan (Now known as Meritain Health) N N Now known as Meritain Health




Notes

36398 North American Medical Management IL N N

E3510 North American Medical Management - Northern California CA N N

IP079 North American Medical Management - Southern California CA N N

64157 North American Preferred N N Now known as Meritain Health

37314 North Broward Hospital District FL N N

SCP01 North County Health Services CA N N

NSA01 North Star Advantage MN N N

35212 North Texas Healthcare Network TX N N

91131 North West Administrators (FCHN) WA N N

PROSP North West Orange County Medical Group CA N N

64157 NorthAmericanAdministrators N N Now known as Meritain Health

AMS11 Northeast Community Care ME,NY N N

HSM01 Northern Cal Advantage Medical Group CA N N

36347 Northern Illinois Health Plan IL N N

88027 Northern Nevada Trust Fund N N

NMG01 Northridge Medical Group CA N Y

36364 NorthShore University Health System N N

NANWC Northwest Community Health Partners N N

NWDC1 Northwest Diagnostic Clinic (NWDC) N N

NPN11 Northwest Physicians Network WA N N

36346 Northwest Suburban IPA (Illinois) IL N N

Nova N N

16644 Nova Healthcare Administrators, Inc. NY N N Grand Island, New York

06226 Novanet N N

71080 Novasys Health Network N N

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

NW National Life (Reliastar) N N

37299 Nyhart N N

NAOAK Oak West Primary Physician Assoc N N

95358 Oaktree Health Plan N N

DESRT Oasis IPA CA N N

72112 Oath For Louisiana, Inc., The N N Formerly Southeast Medical Alliance

61101 Ochsner Health Plan N N




Notes

13350 ODS Health Plan N N

14163 Ohana Health Plan HI N N

34189 Ohio Health Choice PPO OH N N

ONLY for claims with a billing submission address of PO Box 3619, Akron, OH 44309-3619 or PO Box 93538

95435 Ohio Health Group OH N N

AMS11 Ojai Dual Risk CA N N DOS BEFORE 05/31/10 only

AMS11 Ojai Valley Community Med. Group CA N N DOS BEFORE 05/31/10 only

22521 OK State Employees & Educators (EDS) N N

65074 Olympus Managed Health Care (OMHC) FL N N

HDNFC Omni Healthcare - Humboldt Del Norte, California CA N N

MDCOR Omni IPA - Medcore HP N N

25133 Omnicare - A Coventry Health Plan N N

OMN02 Omnicare Medical Group (OMNI) CA N N

22321 One Call Medical N N

80705 One Health Plan N N

80705 One Health Plan of Georgia, Inc. N N

80705 One Health Plan of Illinois, Inc. N N

52149 OneNet PPO, LLC MD N N Formerly known as Alliance PPO

BPA01 OPEIU Locals 30& 537 N N

74234 Operating Engineers Local #53 UT N N

BPA01 Operating Engineers Local 501 N N

91136 Operating Engineers Locals 302 & 612 Health & Security Fund, Group # F12 N N

52152 Optimum Choice of the Carolinaï¿½s (OCCI) N N

87726 Optimum Choice of the Carolina's, Inc. (OCCI) N N

87726 Optimum Choice, Inc. (OCI) N N

20133 Optimum Healthcare N N

37125 Option Services Group N N

91131 Options Health Plan WA N N

87726 OptumHealth Behavioral Solutions N N

41160 OptumHealth Care Solutions (ACN of NY) NY N N

41161 OptumHealth Care Solutions (ACN) N N

41194 OptumHealth CMC N N




Notes

HSM01 Orange County Advantage Medical Group CA N N

AMM03

Orange County Child Health & Disability Prevention Treatment (CTU) (Long Beach, CA) CA N N

OCFMC Orange County Foundation for Medical Care N N

13383 Orthonet - Aetna N N

25681 Orthonet - Health Net N N

Orthonet - Uniformed Services Family Health N N

13382 Orthonet - Uniformed Services Family Health Plan N N

13381 Orthonet Corporation - CIGNA N N

36365 Our Lady of the Resurrection Physician Association N N

06111 Oxford Health Plans N N Pre Enrollment required for Electronic Remittance Advice.

91131 P.S.E.W. Trust N N

87068 P5 Health Plan Solutions of Utah UT N N

SYMED Pacific Alliance Medical Center CA N N

SYMED Pacific Alliance Medical Group CA N N

HSM01 Pacific Healthcare IPA Medical Associates, Inc. CA N N

PCFCI Pacific IPA CA N N

PacifiCare - PPO claims only N N

95959 PacifiCare - Secure Horizon CA Y Y

87726 PacifiCare Behavioral Health N N Formerly PayerID 33053

95964 PacifiCare of Arizona (Commerical HMO Claims Only) AZ N Y

For payable PacifiCare - Secure Horizons HMO claims only. Not for PPO claims

95959 Pacificare of California - Claims CA N Y

COFHP PacifiCare of Colorado CO N Y

95999 PacifiCare of Oregon OR N N Secure Horizon/HMO claims only

Pacificare of Oregon -Secure Horizon/HMO claims only OR N N

95999 PacifiCare of TX (OK & TX) TX N N Secure Horizon/HMO claims only

95999 PacifiCare of Washington WA N N Secure Horizon/HMO claims only

95999 Pacificare PPO - All States N N

95964 PacificCare of Arizona - Claims AZ Y Y




Notes

PacificCare of Texas - Claims TX N N

PSCS3 PacificSource Community DJC CD OR N Y Deschutes, Jefferson, Crook Counties

PSCS1 PacificSource Community Solutions, Inc. â€“Medicaid OR N Y

PSCS2 PacificSource Community Solutions, Inc. â€“MHO OR N Y

93029 PacificSource Health Plans OR N Y

37287 PAI (Planned Administrators, Inc.) N N

CAPMN Palomar Pomerado Hospital CA N N

58174 Paragon Benefits, Inc. N N

58204 Parity Healthcare N N

66917 Parkland Community Health Plan N N

56152 Partners National Health Plan of NC N N

Partners National Health Plans N N

North Carolina (Contracted providers only. Please call Partners National Health Plan of NC provider services department at (888) 296-9790; option 2 for electronic claims set-up and payer id.)

Partners National Health Plans of North Carolina NC N N

Contracted providers only. Please call Partners National Health Plan of NC provider services department at (888) 296-9790; option 2 for electronic claims set-up and payer id.)

CAPMN Pasadena Primary Care Physicians Group CA N N

76569 Passport Advantage N N DOS 1-1-10 and forward only

76569 Passport Advantage (DOS 1-1-10 and forward only) N N

61129 Passport Health Plan Y N

10525 Patient Advocates, LLC N N

PRW99 Pavers & Road Builders Welfare Fund N N

PCA Health Plan N N

65018 PCA Health Plan of Florida FL N N

95885 PCA Health Plans of Texas (Humana) TX N N

68049 Peach State Health Plan N N

20472 Pediatric Associates N N

SMG01 Pegasus Medical Group CA N N

37086 Pekin Insurance IL N N




Notes

72126 Peoples Health Network N Y

13522 Perfect Health Insurance Company N N

Perfect Health Insurance Company, The N N

41124 Performax, Inc. MN N N

Now known as Meritain. PayerIDvalidonlyforclaimswithabillingsubmissionaddressofP.O.Box27267,Minneapolis,MN55427-0267)

54704 Personal Choice (Highmark) PA Y N Personal Choice (Highmark)

54704 Personal Choice 65 (Highmark) PA Y N Must also be a Highmark provider

34173 Personal Physician Care N N

25133 PersonalCare N N

60054 PG&E (Pacific Gas & Electric) N N

13306 PHCS Savility Payers N N

03440 Phoenix Health Plan N N

62155 PHP TennCare Y Y

Physician Associates - Louisiana N N

PA513 Physician Associates of Greater San Gabriel Valley CA N Y

58204 Physician Associates of Louisiana N N

PHPMC Physician Health Partners CO N N

Physician Healthcare Plan N N

15749 Physicians Alliance - SRR IPA N N

IP054 Physicians Alliance Network CA N N New payer id IP054 effective 6-1-11

PA513 Physicians Associates of San Gabriel Valley CA N N DOS 1-1-09

38265 Physicians Care N N

Physicians Care (CA) N N

57098 Physicians Care Network N N For participating providers only

SLOS1

Physicians Choice Medical Group of San Luis Obispo (formerly San Luis Obispo Select IPA) CA N N

MCI01

Physicians Choice Medical Group of Santa Maria (formerly Midcoast Care Inc.) CA N N

PDT01 Physician's Data Trust CA N N

75297 Physicians Direct N N

37136 Physicians Health Association IL N N

PHCS1 Physicians Health Choice - claims N N

PHCEN Physicians Health Choice - Encounters N N




Notes

PHCS1 Physicians Health Choice- HCFA Claims N N

20398 Physicians Health Collaborative N N

MHCM2 Physicians Health Network (PHN) CA N N

09173 Physicians Health Plan SC N N

37330 Physicians Health Plan - Mid Michigan MI N N

12399 Physicians Health Plan - Northern Indiana IN N N

Physicians Health Plan - TennCare N N

12399 Physicians Health Plan of Northern Indiana IN Y N

65031 Physicians Healthcare Plans N N

CPMG1 Physicians Management Group N Y No pre-enrollment required

EXC01 Physicians Medical Group of San Jose CA N N

47027 Physicians Mutual Insurance Company N N

Physicians Plus Health N N

39156 Physicians Plus Insurance Corporation N N

10775 Physicians United Plan N N

PHIPA Physiciansâ€™ Healthways IPA CA N N

06607 Piedmont Behavioral Health N N

PGLTC Pinal / Gila Long Term Care AZ N N

24735 Pinnacle Claims Management, Inc. N N Newport Beach, CA

PROSP Pinnacle Health Resources (Prospect Medical Group) CA N N

PPMO1 Pinnacle Physician Management Organization N N

84109 Pinnacol Assurance N N

COMPU Pipe Industry Health & Welfare CO N N

37224 Pittman and Associates N N

64160 Pivotal Plan N N

PCM99 Plasterersâ€™ & Cement Masonsâ€™ Health & Welfare Fund N N

72045 Plumbers & Steamfitters Health & Welfare Fund LA N N

59140 Plumbers and Pipefitters NV N N

58204 Podi Care Managed Care N N

POD1S Podiatry First N N

59324 Podiatry Network Florida N N

59069 Poe & Brown N N




Notes

32680 Poly America Medical & Dental Benefits Plan N N

16111 POMCO N N

IP057 Pomona Valley Medical Group (PVMG) ProMed CA N N

73159 PPO Oklahoma N N Now known as First Health Network

72148 PPO Plus LLC N N

38335 PPOM N N

36373 Prairie States Enterprises N N

EPF10 Prefered Administrator N N

53476 Preferred Benefit Administrators N N

61665 Preferred Benefits Administrator N N

00481 Preferred Blue of South Carolina SC N N

56178 Preferred Care - North Carolina N N

65090 Preferred Care Partners (Encounters) N N

65088 Preferred Care Partners (Miami , FL) FL N N

73145 Preferred Community Choice N N

73145 Preferred Community Choice - PCCSelect - CompMed N N

35173 Preferred Health Network (PHN) N N

61106 Preferred Health Plan, Inc. KY N N Louisville, Kentucky

31478 Preferred Health Professionals KS N N

60110 Preferred Health Systems Insurance Company (PHSIC) N N

04320 Preferred Healthcare System - PPO N N

PFIPA Preferred IPA CA N N

36401 Preferred Network Access, Inc. N N

14162 Preferred One (CT), a Division of First Choice CT N N

60110 Preferred Plus of Kansas KS Y N

41147 PreferredOne MN N Y

00430 Premera Blue Cross - Washington WA Y Y

00430 Premera Blue Cross Blue Shield - Alaska AK Y Y

43166 Premier Benefits Inc. N N

CAPMN Premier Care of Northern California CA N N

PREYE Premier Eye Care N N

43166 Premier Health Plans N N




Notes

90440 Premier Health Systems N N

CAPMN Premier Physician Alliance CA N N

CAPMN Premier Physician Network CA N N

PREHP Presbyterian Health Plan NM N N

PRESA Presbyterian Salud N N

PRESA Presbyterian Salud (NM) NM N N

45056 Prestige Health Choice N N

39185 Prevea Health Plan N N

25133 Prima Health IPA NC N N known as WellPath

CAPMN Primary Care & Pediatric IPA CA N N

IP079 Primary Care Associates Medical Group (PCAMG) CA N N For DOS 1-1-09 and beyond

PCACZ Primary Care Associates of California CA N N

82048 Primary Health Network N N

PRIME Primary Health Plan N N

56144 Primary Physician Care N N

PPM01 Primary Provider Management CA N N Fee for Service only and PAYER ID REQD

PPM02 Primary Provider Management Encounters CA N N Encounters only and PAYER ID REQD

61101 Prime Benefits Systems Inc. - Missouri (Humana) MO N Y

63088 Prime Health N Y

61101 Prime Health Kansas City Inc. - Missouri (Humana) MO N Y

61101 Prime Health Management Services - Missouri (Humana) MO N Y

61101 Prime Health of Kansas City - Missouri (Humana) MO N Y

56190 Prime Vision Health N N

61604 Prime West Health Systems MN N Y

Pre-Enrollment is required for Electronic Remittance Advice (835/ERA). See Resource Center/Payer Enrollment Forms for the correct form.

IP079 PrimeCare Medical Network CA N N

Chino, Citrus Valley, Corona, Hemet, Inland Valley, Moreno, Redlands, Riverside, San Bernardino, Sun City, & Temecula

IP079 PrimeCare Medical Network - Chino CA N N




Notes

IP079 PrimeCare Medical Network - Citrus Valley CA N N

IP079 PrimeCare Medical Network - Corona CA N N

IP079 PrimeCare Medical Network - Hemet CA N N

IP079 PrimeCare Medical Network - Inland Valley CA N N

IP079 PrimeCare Medical Network - Moreno Valley CA N N

IP079 PrimeCare Medical Network - Redlands CA N N

IP079 PrimeCare Medical Network - Riverside CA N N

IP079 Primecare Medical Network - San Bernardino CA N N

IP079 PrimeCare Medical Network - Sun City CA N N

IP079 PrimeCare Medical Network - Temecula CA N N

04320 PrimeSource Health Network N N

PRI01 Princeton Premier IPA N N

61271 Principal Financial Group N N

61271 Principal Life Insurance N N

61271 Principal Life Insurance (Principal Financial Group) N N

Principal Mutual Life Insurance Company (Principal Mutual Life Assurance) N N

38217 Priority Health N N

37303 Prism - First Health N N

37315 Prism - Univera N N

37268 Prism Health Networks N N

Pro Health Partner Medical Group N N

PROSP ProCare (Prospect) CA N N

38329 Procare Health Plan - Detroit, Michigan MI N N

59296 Professional Benefit Administrators FL N N Winter Park, Florida

36331 Professional Benefit Administrators, Inc. IL N N Oak Brook, Illinois ONLY

34176 Professional Benefits Administrators OH N N Cuyahoga Falls, Ohio

41163 Professional Claim Administrators N N

37242 Professional Claims Management - Canton, Ohio OH N N

34134 Professional Risk Management N N

25133 Project Access of Durham County N N Known as WellPath




Notes

IP057 ProMed Health Care Administrators CA N N

PROSP Prospect Medical Group CA N N

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

37309 Protective Life Insurance N N

PHP01 Providence Health Plan N Y

PHP00 Providence PPO N N

62308 Provident Healthsource (Cigna) N N

62308 Provident Life & Accident N N

62308 Provident Life & Casualty N N

62308 Provident Preferred Network N N

Provider Network Of USA N N

HM015 PruCare HMO (Encounters Only) N N

CAPMN Prudent Medical Group CA N N Formerly known as Hollywood Presbyterian Medical Group

51052 Psychcare, LLC N N

AMM03 Public Health Medical Services (Advanced Medical Management) CA N N

91136 Puget Sound Benefits Trust N N

91136 Puget Sound Benefits Trust, Group# F25 N N

91136 Puget Sound Electrical Workers Trust N N

91136 Puget Sound Electrical Workers Trust, Group# F33 N N

42172 Puget Sound Health Partners N N Now known as Soundpath Health

48055 Pyramid Life Insurance Company N N

Pyschcare, LLC N N

37330 Pysicians Health Plan - Mid Michigan MI N N

39197 Quad Med - Pewaukee, Wisconsin WI N N

35174 Qual Choice of Arkansas AR N N

23342 QualCare, Inc. N N New Providers must enroll with QualCare at (800) 992-6613, option 5.

QHP01 Quality Health Plans N N

QHPNY Quality Health Plans of New York N N

73067 Quick Trip Corporation OK N N

37129 Quincy Health Care Management N N

37129 Quincy Health Care Management. N N

57117 QVI Risk Solutions Inc N N




Notes

TKFMC R & N Market CA Y N

CSSD2 Radyâ€™s Childrenâ€™s Specialists of San Diego CA N Y No enrollment required

SYMED Redlands IPA CA N N San Bernardino, CA

REGAL Regal CA N N

00611 Regence Blue Shield - Idaho ID N N

00932 Regence Blue Shield of Washington State WA N N

00851 Regence BlueCross Blue Shield - Oregon OR N N

38221 Regency Employee Benefits N N

HSM01 Regent Medical Group, Inc. (Regent Family Practice of Glendale) CA N N

47076 Regional Care, Inc. N N

REH55 Rehab Network, LLC Humana N N Payer requires 11 digit member ID number

74227 Reliance Insurance Co (Student Division) N N


ASRM1 Reliance Standard NJ N N

Reliastar Employee Ben. (Northwestern Nat Life) N N

RENGQ Renaissance Gulf Quest N N

RENRO Renassaince - River Oaks N N

RENRB Renassaince Riveroaks Blue N N

73066 Reserve National Insurance N N

20481 Resolve Health Plan Administrators FL N N

Resource Administrators N N

37278 ResourceOne Administrators N N

Resurrection Health Care Preferred N N

AKA Family Medical Network. Please call (773) 572-8311 or ( 773) 572-8309 prior to your first submission of claims.

Resurrection Health Care Preferred/AKA Family Medical Network N N

Please call (773) 572-8311 or ( 773) 572-8309 prior to your first submission of claims.

RPPG1 Resurrection Physicians Group N N

Reynolds & Reynolds N N




Notes

91176 Risk Benefit Management Service N N

MPM08 Riverside Family Health Medical Grp CA N N

16117 RMSCO, Inc. N N

84065 Rocky Mountain Health Plan Y N

RMHMO Rocky Mountain Health Plan - Grand Junction Y N

37602 Rooney Life Inc. N N

36215 Rosemont of Des Plaines N N

Rosemont of Des Plaines, IL N N

Rosemont of Des Plaines, Illinois N N

25133 Rural Carrier Benefit Plan N Y

60054 Rush Prudential N N

36389 Rush Prudential Health Plans - HMO Only N N

63070 RWDSU Benefit Fund N N

AMM03 Ryan White Network - Advanced Medical Management CA N N

AMM03 Ryan White Network (Advanced Medical Management) CA N N

31441 S & S Healthcare Strategies N N

35164 Sagamore Health Network IN N N

HSM01 Saigon Medical Group, Inc. CA N N

62308 SAMBA N N

same as above - Metal Trades Health Plan N N

MSO77 San Diego County Coverage Initiative (CI) CA N N

MSO11 San Diego County Medical Services (CMS) CA N N

MSO22 San Diego County Physician Emergency Services (PES) CA N N

MSO33 San Diego County Ryan White Care Act CA N N

SCP01 San Diego Physicians Med Group (SCPMCS) CA N N

BS001 San Francisco Electrical Workers - IBEW Local 6 N Y

They will all have a prefix code of "XEL" as their member ID on the BSC card.

68035 San Joaquin Health Administrators N N

SLOS1

San Luis Obispo Select IPA (now known as Physicians Choice Medical Group of San Luis Obispo) CA N N




Notes

60054 Sandia Triple Option Plan (Sandia Top) N N

91184 Sanford Health Plan MN N Y

SBIPA Santa Barbara Select IPA Medical Group CA N N

10378 Santa Clara County IPA (SCCIPA) CA N N

24077 Santa Clara Family Health Plan CA N N

SANTE SANTE CA N N

Sante Health Systems and Affiliates N N

AMS11 SBSI Appeals (Arcadian Mgmt Serv) CA N N

SCAN1 SCAN Health Plan CA N Y

10378 SCCIPA CA N N

SCH01 Schaller Anderson - CHOC Health Alliance CA N N

16146 SCHC Total Care Inc N N

16146 SCHC Total Care Inc. N N Acceptius Gateway payer

88030 Scott & White Health Care Plan N N

60054 Scripps Medical Plan N N

91131 Seattle Area Plumbing WA N N

SVIPA Seaview IPA CA N N

28530 Secure Health Plans of Georgia, LLC N N

95959 Secure Horizon CA - Pacificare CA N Y

Secure Horizon California- Pacificare CA N N

87726 Secure Horizon Direct N Y

95964 Secure Horizons Arizona - Claims AZ Y Y

95962 Secure Horizons Colorado - Claims CO N Y

COFHP Secure Horizons of CO CO N N

95959 Secure Horizons Oklahoma - Claims OK N Y

95959 Secure Horizons Oregon - Claims OR N Y

95959 Secure Horizons Texas - Claims TX N Y

95959 Secure Horizons Washington - Claims WA N Y

42142 SecureCare of Iowa IA N N

42142 Securecare of Iowa-Infotrust N N

39045 Security Health Plan N N

SCHP1 SeeChange Health Plan N N

64088 Select Administrative Services (SAS) MS N N Gulfport, MS

Select Benefit Admin N N




Notes

42137 Select Benefit Administrators - Des Moines, Iowa IA N N

37282 Select Benefit Administrators of America N N

93031 Select Benefits Administrators OR N N Portland, Oregon

37282 Select Benefits Administrators of America N N

Submission address of P.O. Box 440, Ashland, Wisconsin 54806.

SCOK1 Select Care of Oklahoma - Tribute OK N N

23285 Select Health of South Carolina SC N N

SSC11 Select Senior Clinic N N

00014 Selectcare N N

59111 Self Insured Benefit Administrators FL N N Clearwater, FL

36404 Self Insured Plans FL N N Naples, FL

Self Insured Plans, LLC N N

34131 Self-Funded Plans, Inc. N N

83035 Senior Whole Health N N

60054 SeniorCare N N

23249 Sentinel Management Services N N

39033 Sentry Life Insurance Company N N

Sentry Insurance Company (Claims must have the Sentry Life Insurance Co. Group and Subscriber Numbers. To verify you are using the correct number, you may contact Sentry's Customer Service Department at 1-800-426-7234)

CAPMN Seoul Medical Group CA N N

TKFMC Sequoia Beverage CA N N

76056 Seton CHIP N N

SHEBP Seton Employee Plan N N

SHPCH Seton Health Plan N N

SHMAP Seton Map Program (Mediview) N N

87726 Share Health Plan - ILL - PPO N N

87726 Share Health Plan - ILX - HMO N N

SCMG1 Sharp Community Medical Group CA Y Y

75280 Shasta Administrative Services N N

SC359 ShermanChoice IL N N

PROSP Sierra Family Network (Prospect Medical Group) CA N N




Notes

76342 Sierra Health Services (claims) N Y California and Nevada. For encounters use payer ID 76343.

76343 Sierra Health Services (encounters) N N Encounters only

SMG01 Sierra Medical Group CA N N

MBA01 Sierra Nevada Medical Associates CA N N

62159 Signature Health Alliance N N

Only send claims with a billing address of P.O. Box 22419, Nashville, TN 37202-2419

NASCR Silver Cross Managed Care Org N N

84076 Sinclair Health Plan N N

20310 Skyland Benefits N N

84096 Sloans Lake Managed Care N N

02057 Smith Administrators N N

SCPCI Sonoma County Primary Care CA N N

91131 Sound Health ID N N

91131 Sound Health (now known as First Choic Health Network) ID N N

Sound Health (Sisters of Providence) ID N N

91131 Sound Health Wellness Trust WA N N

42172 Soundpath Health N N formerly known as Puget Sound

32266 South Central Preferred PA N N

25133 SouthCare - Healthcare Preferred N Y Coventry payer

AMS11 Southeast Community Care GA,SC,NC N N

72112 Southeast Medical Allience (The Oath For Louisiana, Inc.) N N

37318 Southern Benefit Services N N

SYMED Southern California Children's Healthcare Network CA N N

BPA01 Southern California Lumber N N

SCP01 Southern California Physicians Managed Care Services CA N N

25133 Southern Health Services, Inc. N N

HSM01 Southland Advantage Medical Group, Inc. CA N N

SIPA1 SOUTHLAND IPA IL N N

HSM01 Southland San Gabriel Valley Medical Group, Inc. CA N N

35227 SouthPoint Hotel & Casino N N

SWSTA Southwest Administrators N N




Notes

M3IL2 Southwest BCBS of Florida N N

SPA98 Southwest Physicians Associates TX N N

37266 Southwest Service Life TX N N

62308 Special Agents Mutual Benefit Association N N

52190 Special Risk International (SRI) N N

23253 Spectrum Admin, Inc. TPA N N

84146 Spina Bifida - VA HAC N N

SPOHN Spohn Health N N

AMS11 Spokane Community Care WA N N

STFMC St Francis Medical Center CA N N

SLCH1 St Lawrance Co Healthcare Plan NY N N

35199 St. Anthony Memorial Healthcare Centers - MDWISE N N

22240 St. Barnabas System Health Plan N N

35199 St. Catherine Hospital PHO - MDWISE N N

35199 St. Francis Health Network N N

APP01 St. Francis IPA CA N N Now known as Applecare Medical Management

37264 St. John's Claim Administration N N

STJOE St. Joseph Heritage Healthcare CA N N

STJOE St. Joseph IPA CA N N

STJOE St. Jude CA N N

STJOE St. Jude Hertiage HealthCare CA N N

35199 St. Margaret Mercy Healthcare Centers - MDWISE N N

88029 St. Mary's Health Plan NV N N

HSM01 St. Peter Medical Group, Inc. CA N N

37116 St. Therese Physician Associates IL N N

STM01 St. Thomas Med Ntwk Gulfquest N N

PDT01 St. Vincent IPA CA N N

Standard Ins. Co. N N

59225 Star HRG N N

61425 Starmark N N

31053 State Farm Insurance Companies N Y Pre Enrollment is required for Electronic Remittance Advice

31053 State Farm Insurance Company N Y Pre Enrollment is required for Electronic Remittance Advice




Notes

SB810 State Health Plan of North Carolina NC Y Y Pre Enrollment is the same as BCBS North Carolina.

00400 State Health Plan of SC SC N N

57254 State of Texas Dental Plan N Y

57254 State of Texas Dental Plan (aka GEHA) N Y

75087 States General Life Insurance N N

14163 Staywell Health Plan N N

67829 Sterling Medicare Advantage WA N N

91151 Sterling Option One WA N N

Stirling - Stirling Inc. N N

06089 Stirling Benefits (Stirling & Stirling) CT N N

31121 Stoner & Associates - Cincinnati, Ohio OH N N

58128 Stowe Associates N N

Student Insurance N N

74227 Student Insurance â€“ Boston Mutual Life Insurance Co. N N


88331 Suffolk Health Plan of New York N N

95202 Summacare Health Plan (HMO) N N

37301 Summit America Insurance Services, Inc. N N

SX186 Sun Health Corporation N N

68057 Sunshine State Health Plan N N

23218 Superior Administrators CA N N Santa Ana, CA

SHP11 Superior Health Centene Corp Y N

39188 Superior Health Plan Texas TX N N Priortosubmittingclaims,pleasecallProviderRelationsDeptat 1-800-218-7453

35199 Surburban Health Organization N N

SC016 Sutter Connect - Solano Regional Medical Foundation, (SRMF) CA Y N Claims/Encounters

SC018 Sutter Connect - Sutter Delta Medical Group CA Y N

SC003 Sutter Connect - Sutter Gould Medical Foundation CA Y N Claims/Encounters

SC004

Sutter Connect - Sutter Independent Physicians, Sutter Medical Group, Sutter West Medical Group CA Y N Claims/Encounters




Notes

(SIP/SMF/SWMG)

SC008

Sutter Connect - Sutter Medical Group of the Redwoods, Santa Rosa Network (SMGR/SRN) CA Y N Claims/Encounters

SC025 Sutter Connect - Sutter Select CA Y N

SC020 Sutter East Bay Medical Foundation CA Y N

SC028 Sutter Senior Care CA Y N

NASWD Swedish Covenant Managed Care N N

SYMED SynerMed CA N N

TMG01 Talbert Medical Group CA N Y For DOS 3-31-11 and prior only

88067 Tall Tree Administrators N N

37228 Tarrant Health Services TX N N

TKFMC TASEBA CA N N

COMPU Tattered Cover, Inc. CO N N

39157 TBG Administrative Services N N

BPA01 TCU-LA MTA N N

88019 Teachers Health Trust N N

ADSL1 Team Choice - Alpha Care Gold N N

Team Choice PNS N N

75134 Team Choice UMC N N

36215 Teamcare N N

Teamsters Misc. Security N N

Teamsters Welfare Trust WA N N

74234 Tech-Steel, Inc Y N

SYMED Temple Hospital CA N N

00890 TennCare Select/ BlueCare TN Y Y

Pre Enrollment Forms are the same as those for BCBS TN. Typically if enrolled with BCBS TN the provider will not need to enroll for TennCare Select/BlueCare. Contact the payer directly to confirm if pre-enrollment is required

KLSY1 Texan Plus/Select Care of Texas-Kelsey N N

AMS11 Texarkana Community Care N N Arkansas and Texas

TTASB Texas Association of School Boards TX N N

76048 Texas Children's Health Plan TX N N




Notes

75228 Texas Childrens Health Plan - Medicaid TX N N

AMS11 Texas Community Care TX N N

TX1ST Texas First Health Plans TX N N

TOPA1 Texas First Health Plans (TIOPA) TX N N

63092 Texas Healthspring TX N N

74214 Texas Municipal League (TML) TX N N

TTCEC Texas True Choice N N

88461 The Alliance N N

ID cards should show mailing address of PO Box 44365, Madison, WI 53744. Call Dave Sell at 608-210-6656 to obtain Payer ID.

BOONG The Boon Group N N

CRI01 The Chesterfield Companies N N

75600 The City of Odessa N N

20356 The Health Exchange (Cerner Corporation) N N

34150 The Health Plan OH N N Massillon and St. Clairsville, Ohio only

58200 The Integrity Benefit Network, Inc. (Marietta, GA) N N

72112 The Oath For Louisiana, Inc. N N Formerly known as Southeast Medical Alliance

04320 The Preferred Healthcare System - PPO N N

38200 The Wellness Plan N N

THERA Theraphysics N N All but Colorado

75305 Therapy Review Systems N N

FMCHP THIN - Fresenius Medical Care N N

THIPA THIPA CA N N

06131 Third Party Claims Management N N

00315 Thomas Cooper N N

39065 Time Insurance N N A Fortis Company

36193 TLC N N

TLC01 TLC Advantage of Sioux Falls SD N N

79480 TML Intergovernmental Employee Benefit Pool N N

74214 TML Intergovernmental Employee Benefits Pool TX N N

WITH1 Todays Health N N




Notes

48055 Todays Option (American Progressive and Pyramid Life) N N

92620 Tongass Timber Trust N N

61425 Tooling and Manufacturing Assocation N N

THIPA Torrance Hospital IPA (THIPA) CA N N

TMMC1 Torrance Memorial Medical Center CA N N

TCARE TOTAL CARE NY N N

68055 Total Carolina Care SC N N

31182 Total Community Care N N

38201 Total Health Care N N

41202 Total Plan Services (via SmartData) N N

87726 Touchpoint N Y

97910 Touchpoint Health Plan HMO N N

13402 Touchstone Health - Health Net SmartChoice N N

23856 Touchstone Health PSO N N

69493 Tower Life Insurance Company N N

TKFMC Town & Country CA N N

60054 TPA Health Plan N N

37230 TR Paul, Inc. N N

04901 Trailblazer J4901 TX Y Y EDI enrollment form under Payer Enrollment Forms - All or Multiple States

TransAmerica Life Insurance (Mega Life) N N

59222 TransAmerica Life Insurance Co N N

37284 TransChoice - Key Benefit Administrators N N

74234 Transwestern General Agency N N

TRAN1 Transwestern Insurance Administrators, Inc CA N N

Travelers Y Y

87726 Travelers - CGT - PPO N N

87726 Travelers Health Network - HMO (Metrahealth) N N

TCHD1 Travis County Hospital District MAP Y N

36397 Trellis Health Partners N N

TDDIR TriCare for Life Y Y




Notes

CH002 TRICARE NORTH (Health Net Federal) Y Y

Formerly known as CHAMPUS: CT, DE, IL, IN, KY, MA, MD, ME, MI, NH, NJ, NY, NC, OH PA, RI, VT, VI,WASH DC, WV - Payer ids 61125 and 38520 all go under our CH002 payer id

CH002 Tricare North Region Claims Y Y

Formerly known as CHAMPUS: CT, DE, IL, IN , KY, MA, MD, ME, MI, NH, NJ,NY, NC, OH, PA, RI,VT, VI, WASH DC, WV - Payer ids 61125 and 38520 all go under our CH002 payer id

FOREN Tricare Overseas Y Y

CH002 TRICARE SOUTH (Humana Military) Y Y

Formerly known as CHAMPUS: AL, AR, FL, GA, LA, MI, OK, SC, TN, TX - Payer ids 61125 and 38520 all go under our CH002 payer id

CH002 Tricare South Region Claims Y Y

AL, AR, FL, GA, LA, MI, OK, SC, TN, TX - Payer ids 61125 and 38520 all go under our CH002 payer id

PDT01 TriCities IPA CA N N

31143 Trihealth Physician Solutions- Concern N N

62061 Trilogy Health Insurance N N

34185 TriSurant TX N N Formerly Health Administration Services (HAS)

WPSTC TRIWEST (WPS) N Y

Formerly known as CHAMPUS: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa(Except for the Rock Island Arsenal Area), Kansas, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon South Dakota, The Extreme Western Por

37875 True Benefits Administrators N N

TCUSA True Choice USA N N

TCUCH True Choice USA - Christus N N

TCUCH True Choice USA - CRSTS Healthplan N N

91078 Trusted Plans Service Corp. (TPSC) (FCHN) WA N N

Trustee Plans (FCHN) WA N N

Trusteed Insurance (FCHN) WA N N

91078 Trusteed Plans Service Corporation N N

61425 Trustmark Insurance N N




Notes

04298 Tufts Health Plan Y N

Submitter must call the payer before submitting claims to to obtain payer id: 888-880-8699 ext 4042

RPF02 TX Premier Plan - Medicaid-THIN TX N N

87726 UBH Employer Division N N

87726 UBH Rios N N

60054 UC Care (University of California) CA N N

SX178 UCARE MN MN N N

For ERAâ€™s enroll at ucare. www.provider.ucare.org/pages/login.aspx and complete the Provider Portal Administration Registration Guide.

33056 UCMN - United Behavioral Health (Health Plan - HMO) N N

BS001 UFCW Northern California &Drug Employers H & W Trust Fund N N

UHP of New Jersey N N

74223 UICI - Administrators NV N N Through Benefit Planners, Inc.

75240 UICI Administrators N N

95266 UMR - Harrington (formerly OK N N

UMR - Wausau - UHIS N N

39026 UMR- Wausau - UHIS N N

UMRC1 UMR/Cincinnati (Repricing for HealthSpan Network Only) N N

75196 UMR-Harrington N N aka Harrington Benefit Services-Westerville and Centra Benefit Services.

52180 Umwa Health & Retirement Funds N N

80314 Unicare N Y

62170 Unified Health Services (Workman's Comp Only) N N

HCP01 Unified IPA CA N Y

00932 Uniform Medical Plan N N for DOS 1-1-11 and after. If DOS is prior send to payer ID 75243.

75243 Uniform Medical Plan (Harrington Benefit Services) N N

for DOS prior to 1-1-11. If DOS is after send to payer ID 00932

13407 Uniformed Services Family Health Plan N N

UNIGARD (FCHN) WA N N

SCP01 Union Pacific IPA (SCPMCS) CA N N




Notes

87042 Union Pacific Railroad Employees Health Systems N N

70408 Union Security Insurance Company N N

Unison Health Plan- Better Health Plans, Inc. N N

25175 Unison Health Plan/Three Rivers Health Plan N Y

Pre-Enrollment is required for Electronic Remittance Advice. Formerly known as Three Rivers

UAGBT United Agriculture Benefit Trust CA N N

87726 United Behavioral Health (RIOS) N N

87726 United Behavioral Health (UBH) N N

59069 United Benefits (formerly Brown & Brown Benefits) N N

CAPMN United Care Medical Group CA N N

United Employee Benefit Trust (FCHN) WA N N

SCUFW

United Food & Commercial Workers Unions and Food Employers Benefit Fund N Y Southern California, Cypress

87726 United HealthCare - All States N Y

95378 United HealthCare of the River Valley (John Deere) N Y

87726 United HealthCare Plans of Puerto Rico N Y

United Life N N

84132 United Medical Alliance (UMA) CO N N

31107 United Medical Resources, Inc. (UMR) N Y

Pre-enrollment is required for Electronic Remittance Advice. Some of UMR's new member cards no longer print the full SSN. When submitting electronically, the full SSN must be entered.

71412 United of Omaha N N

MPM15 United Physician International CA N N

74095 United States Automobile Association (USAA) N N

95378 UnitedHealthcare Community Plan TN N Y

86049 UnitedHealthcare of Pennsylvania PA N Y Formerly known as AmeriChoice of PA Childrens Health Insurance (Kids Choice)




Notes

66705 Unity Health Insurance Y N

Before submitting claims, please go to http://www.unityhealth.com/Providers/ AdminResources/EDI/index.htm and complete EDI Sign Up Form and NPI Appendix A documents.

16107 Univera Healthcare NY Y Y

UNINW Univera PPO NY Y Y

UC001 Universal Care - California CA N N

UC002 Universal Care Encounters N N

50528 Universal Healthcare N N

38298 Universal Standard Healthcare N N

09830 University Family Care AZ N Y See University Physicians Healthcare 835 ERA enrollment form

UHA01 University Health Alliance HI Y N

22329 University Health Plan of New Jersey NJ N N

25133 University of Missouri N N

09830 University Physicians Care Advantage AZ N Y See University Physicians Healthcare 835 ERA enrollment form

07503 University Physicians Healthcare Group AZ N Y See University Physicians Healthcare 835 ERA enrollment form

COACC University Trust N N

IP056 Upland Medical Group N N

23281 UPMC Health Plan N N

37324 Upper Peninsula Health Group (TPA) N N

38337 Upper Peninsula Health Plan N N

52190 URN Managed Transplant Program N N

US Behavioral Health Plan, California N N

93092 US Benefits N N

77044 US Department of Labor Y Y

USFHP US Family Health Plan N N

USFHP US Family Health Plan (USFHP) N N

60054 US Healthcare N N

50383 US Imaging Network NY N N

13407 USFHP - St. Vincent Catholic Medical Centers of New York N N

74234 Utah Carpenters UT N N

74234 Utah Laborers UT N N




Notes

74234 Utah Pipe Trades UT N N

12115 VA Fee Basis Programs N N

VAFSC VA Financial Services Center TX Y N

VCIPA Valley Care IPA CA N N

VSIPA Valley Care Select IPA CA N N For claims with DOS 1-1-11 and forward only

VHP01 Valley Health Plan (Commercial) CA Y N

Please email [email protected] with provider name/practice name, tax id, NPI and line of business (Commercial or Medi-Cal).

VHP02 Valley Health Plan (Medi-Cal) CA Y N

Please email [email protected] with Provider name/Practice name, tax id, NPI and line of business (Commercial or Medi-Cal).

77004 Valley Physician's IPA CA N N

Valley Physicians Medical Group N N

VALOP Value Options Y N For commercial claims only

23173 Vanderbilt Health Plan N N Formerly Health 1-2-3

72128 Vantage Health Plan, Inc. N N

PPM01 Vantage Medical Group CA N N Fee for Service only and PAYER ID REQD

PPM02 Vantage Medical Group Encounters CA N N Encounters only and PAYER ID REQD

Vantage Pro N N

60054 Varian Health Care Plan N N

86062 VentureNet Healthcare N N

VHMG1 Verdugo Hills Medical Group N N

VMMH1 Verity OR N Y

75256 Verity National Group N N

VMMH2 Verity Plus OR N Y

00243 Vestica Healthcare N N

23173 VHP Community Care N N

24818 Vida Care N N

VFP11 Village Family Practice N N

SCAN1 VILLAGE HEALTH PLAN CA N Y

91131 Virginia Mason Group Health N N

SX198 Virginia Premier Gold VA N N

54176 Virginia Premier Health Plan Y N

12K83 Virginia Premier Health Plan (Medicaid) N N




Notes

37297 Vison Care Incorporated N N

25133 Vista Health Plan FL N N

63114 Viva Health Plan N N

77073 VNS CHOICE Medicare N N

00890 Volunteer States Health Plan TN Y Y EDI enrollment same as BCBS TN

59266 Volusia Health Network N N

22264 Vytra Health Plans NY N N

62111 W.C. Beeler & Company TN N N

91131 WA Teamster WA N N

WCHHS Washington County Health and Human Services OR N Y

91131 Washington State Health Insurance Pool (WSHIP) WA N N

73155 Waterstone Benefit Administrators N N

MPM09 Watts Health Care CA N N

39026 Wausau Insurance N N

75261 Web TPA / Community Health Electronic claims / CHEC TX N N

36337 Weiss Health Providers N N

Well Fargo 3rd Party Administrators N N Formerly known as Acordia National

59354 Wellcare Health Plans - Encounters N N

14163 Wellcare HMO, Inc. N N

14164 Wellcare of Conneticut CT N N

59608 Wellcare of Florida FL N N

14163 Wellcare of Georgia GA N N

14163 Wellcare of Louisiana LA N N

14164 Wellcare of New York NY N N

14163 WellCare of Ohio OH N N

14163 Wellcare of Texas TX N N

77072 Wellcare Private Fee for Service Plans N N

WELM2 Wellmed Medical N N

WELMD Wellmed Medical Management N N

38200 Wellness Plan, The N N

25133 Wellpath N N

87815 Wells Fargo 3rd Party Administrators N N (formerly known as Acordia National)

87815 Wells Fargo 3rd Party Administrators, Inc. N N (formerly known as Acordia National)




Notes

22925 WELS Benefit Plan Office N N

WCMG1 West Covina Medical Group CA N N

24735 Western Growers Assurance Trust N N Newport Beach, CA

24735 Western Growers Insurance Company N N Newport Beach, CA

37306 Western Health, Inc. N N

37247 Western Mutual Insurance N N

31048 Western Southern Financial Group OH N N Cincinnati, Ohio

31048 Western Southern Financial Group - Cincinnati, Ohio OH N N

74234 Western Utilities or Local 57 N N

90560 Westlake Financial N N

38232 Weyco, Inc. N N

Now know as Meritain Health. Payer ID valid for claims with billing submission address of 2370 Science Parkway Okemos, Michigan 48864

93050 William C. Earhart N N

98010 William J Sutton & Co. Ltd (Toronto) N N

62061 Willis Administrative Services N N Now known as Fiserv Health - Kansas

Willis Corroon Admin Service N N

41095 Wilson-McShane N N

13413 Win Health (Womenï¿½s Integrated Network) N N

62153 Windsor Medicare Extra N N DOS after 6-1-10

WPS01 Wisconsin Assigned Risk Plan (HIRSP) N N

39200 Wisconsin Auto and Truck Dealers N N

WPS01 Wisconsin Physicians Service N N

20333 Worksite Benefit Services, LLC N N

75276 World Insurance Company N N

WPAS (FCHN) WA Y N

34080 WPPN - HPO (HealthEOS) N N

34080 WPPN- HPO (HealthEOS) N N

WPSTC WPS (TRIWEST for West Region) N Y

WPS01 WPS Commercial N N

23710 Writer's Guild Industry Health Plan N N

91131 WSHIP - Washington State Health Insurance Pool WA Y N

WVMC (FCNH) WA N N




Notes

09829 Yavapai County N N

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

91131 Zenith (FCHN) WA N N

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