CLAIMS & ERA PAYER LIST April 8, 2019 - experian.com · CLAIMS & ERA PAYER LIST April 8, 2019 Payer Code Claim Type Claim ENR Remit ENR COB NOTES Absolute Total Care 68069 P N Y Y

CLAIMS & ERA PAYER LIST

April 8, 2019Payer Code

Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Legend: Claim Type: I = Institutional, P = Professional

Claim ENR/Remit ENR: Indicates whether enrollment is required.

(N = No, Y = Yes, na = not available/not applicable)

COB: Indicates if payer accepts secondary claims electronically

1199 National Benefit Fund 13162 I N Y Y

1199 National Benefit Fund 13162 P N Y Y

1st Medical Network - Atlanta GA 29076 I N Y Y

1st Medical Network - Atlanta GA 29076 P N Y Y

1st MN--Atlanta GA 29076 I N Y Y

1st MN--Atlanta GA 29076 P N Y Y

21st Century Health and Benefits 59069 I N na N

21st Century Health and Benefits 59069 P N na N

3P ADMIN 20413 I N na Y

3P ADMIN 20413 P N na Y

A & I Benefit Plan Administrators 93044 I N na N

A & I Benefit Plan Administrators 93044 P N na N

A.G.I.A. Inc. 95241 I N na N

A.G.I.A. Inc. 95241 P N na N

AAG Benefit Plan Administrators Inc. 75240 I N na Y

AAG Benefit Plan Administrators Inc. 75240 P N na Y

AAG-American Administravie Group ( Formerly Icon Benefit Admin) 75185 I N na Y

Effective immediately, please send all claims for Payer 75185 to

HealthSmart Benefit Solutions (EDI Payer ID #37283). Claims

submitted under payer ID 75185 will be subject to claim

rejection effective Q1 2019.

AAG-American Administravie Group ( Formerly Icon Benefit Admin) 75185 P N na Y

Effective immediately, please send all claims for Payer 75185 to

HealthSmart Benefit Solutions (EDI Payer ID #37283). Claims

submitted under payer ID 75185 will be subject to claim

rejection effective Q1 2019.

AARP Medicare Supplement Plans 36273 I N Y Y

AARP Medicare Supplement Plans 36273 P N Y Y

AARP MedicareComplete through UnitedHealthcare/AARP MedicareComplete 87726 I N Y Y

AARP MedicareComplete through UnitedHealthcare/AARP MedicareComplete 87726 P N Y Y

AblePay Health ABLPY I N Y N

Absolute Total Care 68069 I N Y Y

Page 1 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Absolute Total Care 68069 P N Y Y

Accelerated Claims Inc. 99999-0748 I N na N

Accelerated Claims Inc. 99999-0748 P N na N

Access Medical Group 95424 P N na Y

Acclaim 64071 I N Y Y

Acclaim 64071 P N Y Y

Accountable Healthcare IPA (AHCIPA) AHIPA I N na Y

Accountable Healthcare IPA (AHCIPA) AHIPA P N na Y

ACMG 37118 I N na N

ACMG 37118 P N na N

ACS Benefit Services Inc. 72467 I N Y N

ACS Benefit Services Inc. 72467 P N Y N

Activa Benefit Services LLC 38254 I N na N

Activa Benefit Services LLC 38254 P N na N

Adaptis (ERA Only) 91173 I na Y ERA Only

Adaptis (ERA Only) 91173 P na Y ERA Only

Administration Systems Research Corporation 38265 I N Y N ERA Payer Code TLU02

Administration Systems Research Corporation 38265 P N Y N ERA Payer Code TLU02

Administrative Concepts Inc. 22384 I N Y N

Administrative Concepts Inc. 22384 P N Y N

Administrative Services Inc. 59141 I N na N

Administrative Services Inc. 59141 P N na N

ADVANCED DATA SOLUTIONS 58202 I N na N

ADVANCED DATA SOLUTIONS 58202 P N na N

Advantage by Bridgeway Health Solutions 68069 I N Y Y

Advantage by Bridgeway Health Solutions 68069 P N Y Y

Advantage by Buckeye Community Health Plan 68069 I N Y Y

Advantage by Buckeye Community Health Plan 68069 P N Y Y

Advantage by Managed Health Services 68069 I N Y Y

Advantage by Managed Health Services 68069 P N Y Y

Advantage by Peach State 68069 I N Y Y

Advantage by Peach State 68069 P N Y Y

Advantage by Sunshine State 68069 I N Y Y

Advantage by Sunshine State 68069 P N Y Y

Page 2 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Advantage by Superior HealthPlan 68069 I N Y Y

Advantage by Superior HealthPlan 68069 P N Y Y

Advantage Care IPA ACIPA I N na Y

Advantage Care IPA ACIPA P N na Y

Advantage Health Solutions 35209 I N na N

Advantage Health Solutions 35209 P N na N

Advantek Benefit Administrators 83077 I N na N

Advantek Benefit Administrators 83077 P N na N

ADVANTICA BENEFITS 59374 I N Y Y

ADVANTICA BENEFITS 59374 P N Y Y

Advanzeon Solutions 59314 I N na N

Advanzeon Solutions 59314 P N na N

Adventist Health Hanford AHP MPM36 I N na Y

Adventist Health System West - Roseville CA 95340 I N Y N

Adventist Health System West - Roseville CA 95340 P N Y N

Adventist White Memorial – Southland San Gabriel Valley MPM34 I N na Y

Adventist White Memorial – Southland San Gabriel Valley MPM34 P N na Y

Advocate Medical Group - AMG (Legacy AHC) 36320 I N Y N

Advocate Medical Group - AMG (Legacy AHC) 36320 P N Y N

Advocate Physician Partners 65093 I N Y N

Advocate Physician Partners 65093 P N Y N

Aetna 60054 I N Y Y

Aetna 60054 P N Y Y

Aetna Affordable Health Choices (SM) - SRC 60054 I N Y Y

Aetna Affordable Health Choices (SM) - SRC 60054 P N Y Y

Aetna Better Health of California 128CA I N Y Y

Aetna Better Health of California 128CA P N Y Y

Aetna Better Health of Florida 128FL I N Y Y

ERA Payer Code 25133; formerly known as Coventry Health

Care of Florida

Aetna Better Health of Florida 128FL P N Y Y

ERA Payer Code 25133; formerly known as Coventry Health

Care of Florida

Aetna Better Health of Illinois 26337 I N Y Y

Aetna Better Health of Illinois 26337 P N Y Y

Aetna Better Health of Kansas 128KS I N na Y

Aetna Better Health of Kansas 128KS P N na Y

Page 3 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Aetna Better Health of Kentucky 128KY I N y Y

Aetna Better Health of Kentucky 128KY P N y Y

Aetna Better Health of Louisiana 128LA I N y Y

Aetna Better Health of Louisiana 128LA P N y Y

Aetna Better Health of Maryland 128MD I N Y Y

Aetna Better Health of Maryland 128MD P N Y Y

Aetna Better Health of Michigan 128MI I N Y Y

Aetna Better Health of Michigan 128MI P N Y Y

Aetna Better Health of Nebraska (for claims with DOS prior to 1/1/17) 42130 I N Y Y ERA Payer Code 25133

Aetna Better Health of Nebraska (for claims with DOS prior to 1/1/17) 42130 P N Y Y ERA Payer Code 25133

Aetna Better Health of New Jersey 46320 I N Y Y

Aetna Better Health of New Jersey 46320 P N Y Y

Aetna Better Health of New York 34734 I N Y N

Aetna Better Health of New York 34734 P N Y N

Aetna Better Health of Ohio 50023 I N Y Y

Aetna Better Health of Ohio 50023 P N Y Y

Aetna Better Health of Pennsylvania 23228 I N Y Y

Aetna Better Health of Pennsylvania 23228 P N Y Y

Aetna Better Health of Texas (Medicaid & CHIP) 38692 I N Y N

Aetna Better Health of Texas (Medicaid & CHIP) 38692 P N Y N

Aetna Better Health of Virginia 128VA I N Y Y

Aetna Better Health of Virginia 128VA P N Y Y

Aetna Better Health of West Virginia 128WV I N Y Y

Aetna Better Health of West Virginia 128WV P N Y Y

Aetna Better Health Premier Plan (JVHL) M5JVH I Y Y Y Provider must be an approved JVHL lab

Aetna Better Health Premier Plan (JVHL) M5JVH P Y Y Y Provider must be an approved JVHL lab

Aetna Medicare 60054 I N Y Y

Aetna Medicare 60054 P N Y Y

Aetna U.S.Healthcare (JVHL) J1JVH I Y Y Y Provider must be an approved JVHL lab

Aetna U.S.Healthcare (JVHL) J1JVH P Y Y Y Provider must be an approved JVHL lab

Aetna-Senior Supplemental Insurance (ERA Only) 62118 I Y

ERA Only; Payer only accepts Medicare crossover claims

electronically.

Aetna-Senior Supplemental Insurance (ERA Only) 62118 P Y

ERA Only; Payer only accepts Medicare crossover claims

electronically.

Affiliated Doctor's of Orange County ADOCS I N na N

Page 4 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Affiliated Doctor's of Orange County ADOCS P N na N

Affilliated Physicians Group APG01 I N na N

Affilliated Physicians Group APG01 P N na N

Affinity Essentials 23334 I N Y Y

Effective March 1, 2018, the Payer will no longer accept claims

with a Date of Service (DOS) greater than 01/01/2018.

Providers will receive a rejection message "Service From Date:

Invalid, Service From date must be valid for Payer" if the DOS is

after 01/01/2018.

Affinity Essentials 23334 P N Y Y

Effective March 1, 2018, the Payer will no longer accept claims

with a Date of Service (DOS) greater than 01/01/2018.

Providers will receive a rejection message "Service From Date:

Invalid, Service From date must be valid for Payer" if the DOS is

after 01/01/2018.

Affinity Health Plan 13334 I N Y N

Affinity Health Plan 13334 P N Y N

AFFINITY MEDICAL GROUP 46594 I N na N

AFFINITY MEDICAL GROUP 46594 P N na Y

Affinity Medicare Advantage (For claims with dates of service prior to 1/1/2019) 13333 I N Y N

For claims with dates of service prior to 1/1/2019, please

continue to submit to Payer ID 13333.

All claims with a date of service of 1/1/2019 or later should be

submitted to Emblem Health using Payer ID 55247

Affinity Medicare Advantage (For claims with dates of service prior to 1/1/2019) 13333 P N Y N

For claims with dates of service prior to 1/1/2019, please

continue to submit to Payer ID 13333

All claims with a date of service of 1/1/2019 or later should be

submitted to Emblem Health using Payer ID 55247

Affordable Benefit Administrators Inc. 95426 I N na N

Affordable Benefit Administrators Inc. 95426 P N na N

AFLAC (ERA Only) 52080 na Y ERA Only

AFTRA Health Fund (claims with DOS on or after 1/1/2015) 62308 I N Y N Payer Requires Copy of EOB for Missing ERAs

AFTRA Health Fund (claims with DOS on or after 1/1/2015) 62308 P N Y N Payer Requires Copy of EOB for Missing ERAs

AGA 37280 I N na N

AGA 37280 P N na N

Agate Resources Inc. (LIPA) 20048 P N na N

Agency Services Inc 64158 I N na N

Page 5 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Agency Services Inc 64158 P N na N

AHP Provider Network MPM38 P N na Y

AHPO (Cleveland OH) 31138 I N na N

AHPO (Cleveland OH) 31138 P N na N

Alabama Medicaid 12K01 I N Y Y

Alabama Medicaid SKAL0 P N Y Y

Alameda Alliance for Health 95327 I Y na Y

Alameda Alliance for Health 95327 P Y na Y

Alamitos IPA AIPAZ I N na Y

Alamitos IPA AIPAZ P N na Y

Alaska Carpenters Trust 91136 P N na N

Alaska Children's Services Inc. 91136 I N Y N

Alaska Children's Services Inc. 91136 P N Y N

Alaska Electrical Trust Funds 60054 I N Y Y

Alaska Electrical Trust Funds 60054 P N Y Y

Alaska Laborers Construction Industry Trust 91136 I N na N

Alaska Laborers Construction Industry Trust 91136 P N na N

Alaska Medicaid 77200 I Y Y Y

Alaska Medicare SMAK0 P Y Y Y

Alaska Pipe Trades Local 375 91136 I N na N

Alaska Pipe Trades Local 375 91136 P N na N

Alaska United Food & Commercial Workers Health & Welfare Trust 91136 I N na N

Alaska United Food & Commercial Workers Health & Welfare Trust 91136 P N na N

Alexian Brothers Community Services of TN 44423 I N na N

Alexian Brothers Community Services of TN 44423 P N na N

ALICARE 13550 I N Y N

ALICARE 13550 P N Y N

Aliera Healthcare ALH01 I N Y Y

Aliera Healthcare ALH01 P N Y Y

Alignment Healthcare AHCA1 I N Y N

Alignment Healthcare AHCA1 P N Y N

All Savers/UHC 81400 I N Y Y

All Savers/UHC 81400 P N y Y

AllCare IPA AC101 P N Y N

Page 6 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Allcare PEBB 26158 I N na N

Allcare PEBB 26158 P N na N

Allegian Advantage 82238 I N na N

Allegian Advantage 82238 P N na N

Allegian Health Plan 82420 I N na N

Allegian Health Plan 82420 P N na N

Allegiance Benefit Plan Management Inc. 81040 I N Y N

Allegiance Benefit Plan Management Inc. 81040 P N Y N

Alliance Behavioral Health 23071 I Y Y Y

Alliance Behavioral Health 23071 P Y Y Y

Alliance Coal Health Plan 93658 I N na N

Alliance Coal Health Plan 93658 P N na N

Alliance IPA HCP01 I N na N

Alliant Health Plans of Georgia 58234 I N Y N

Alliant Health Plans of Georgia 58234 P N Y N

Allianz Global Assistance 50749 I N na N

Allianz Global Assistance 50749 P N na N

Allied Benefit Systems 37308 I N Y N

Allied Benefit Systems 37308 P N Y N

Allwell of Arkansas Health & Wellness 68069 I N Y Y

Allwell of Arkansas Health & Wellness 68069 P N Y Y

Alpha Care Medical Group MPM32 I N na N

Effective 12/1/17, all AlphaCare Medical Group claims should

be submitted to Payer ID MPM32. SynerMed no longer

manages AlphaCare.

Alpha Care Medical Group MPM32 P N na N

Effective 12/1/17, all AlphaCare Medical Group claims should

be submitted to Payer ID MPM32. SynerMed no longer

manages AlphaCare.

Alta Bates Medical Group A0701 I N na N

Alta Bates Medical Group A0701 P N na N

ALTA Health Strategies 25133 I N Y Y

ALTA Health Strategies 25133 P N Y Y

Altius Health Plans 25133 I N Y Y

Altius Health Plans 25133 P N Y Y

Alvarado IPA SYMED I N na N

Alvarado IPA SYMED P N na N

Page 7 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

AMA Insurance Agency AMAIA I N Y N

AMA Insurance Agency TH071 P N Y N

Amalgamated Life 13550 I N Y N

Amalgamated Life 13550 P N Y N

Amalgamated Life - PA / Alicare 13343 I N na N

Amalgamated Life - PA / Alicare 13343 P N na N

Ambay Health Network AMBHN I N na N

Ambay Health Network AMBHN P N na N

Ambetter of Illinois 68069 I N Y Y

Ambetter of Illinois 68069 P N Y Y

AMCO 62176 I N na N

AMCO 62176 P N na N

AmeraPlan 38219 I N Y N

AmeraPlan 38219 P N Y N

AmeriBen Solutions Inc. 75137 I N Y N

AmeriBen Solutions Inc. 75137 P N Y N

Americaid Community Care (New Jersey) 27516 I N na Y

Americaid Community Care (New Jersey) 27516 P N na Y

American Administrative Group 75240 I N na Y

American Administrative Group 75240 P N na Y

American Behavioral 63103 I N na N

American Behavioral 63103 P N na N

American Benefit Plan Administrators 95170 I N na N

American Benefit Plan Administrators 95170 P N na N

American Community Mutual Insurance 60305 I N Y N

American Community Mutual Insurance 60305 P N Y N

American Family Insurance 12T31 I N na N

American Family Insurance TH095 P N na N

American Family Medicare Sup and PPO Policies Administered by Am Rep 56071 I N Y N

American Family Medicare Sup and PPO Policies Administered by Am Rep 56071 P N Y N

American Fidelity Assurance Company 60801 I N na N

American Fidelity Assurance Company 60801 P N na N

American General 62030 I N Y N

American General 62030 P N Y N

Page 8 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

American Healthcare Alliance 01066 I N Y N

American Healthcare Alliance 01066 P N Y N

American Heritage 77083 P N na N

American Income Life Insurance Company (ERA Only) 60577 I na Y na ERA Only

American Income Life Insurance Company (ERA Only) 60577 P na Y na ERA Only

American Insurance Administrators (AIA) (ERA Only) 26119 I na Y na ERA Only

American Insurance Administrators (AIA) (ERA Only) 26119 P na Y na ERA Only

American National Ins. Co. (ANICO) 74048 I N Y N

American National Ins. Co. (ANICO) 74048 P N Y N

American Postal Workers Union Health Plan 44444 I N Y N

American Postal Workers Union Health Plan 44444 P N Y N

American Progressive Life and Health Insurance Company 48055 I N Y N

American Progressive Life and Health Insurance Company 48055 P N Y N

American Republic Insurance 42011 I N Y N

American Republic Insurance 42011 P N Y N

American Sentinel Co. 17965 P N na Y

American Specialty Health Plans 43146 P N na N

American Trust Administrators Inc. 56195 I N na N

American Trust Administrators Inc. 56195 P N na N

American Worker Health Plan 37322 I N na Y

American Worker Health Plan 37322 P N na Y

Americas 1st Choice of South Carolina, Inc 55349 I N na N

Americas 1st Choice of South Carolina, Inc 55349 P N na N

America's Choice Health Plans 20029 I N Y N

America's Choice Health Plans 20029 P N Y N

America's PPO 16120 I N na N

America's PPO 16120 P N na N

America's TPA 41178 I N na N

America's TPA 41178 P N na N

Americhoice Maryland and Washington (ERA Only) 04567 I na Y ERA Only

Americhoice Maryland and Washington (ERA Only) 04567 P na Y ERA Only

Americo (ERA Only) na Y ERA Only

Amerigroup Community Care 26375 I N Y Y

Amerigroup Community Care 27514 I N Y Y

Page 9 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Amerigroup Community Care 26375 P N Y Y

Amerigroup Community Care 27514 P N Y Y

Amerigroup Florida 27519 I N Y Y Era Payer Code 81237

Amerigroup Florida 27519 P N Y Y Era Payer Code 81237

Amerigroup Illinois 27518 I N na Y

Amerigroup Illinois 27518 P N na Y

Amerigroup Ohio 27518 I N na Y

Amerigroup Ohio 27518 P N na Y

AmeriHealth Administrators 54763 I N Y Y

AmeriHealth Administrators 54763 P N Y Y

AmeriHealth Caritas Delaware 77799 I N Y Y

AmeriHealth Caritas Delaware 77799 P N Y Y

AmeriHealth Caritas Iowa 77075 I N Y Y

AmeriHealth Caritas Iowa 77075 P N Y Y

AmeriHealth Caritas Louisiana (LACare) 27357 I N Y Y

AmeriHealth Caritas Louisiana (LACare) 27357 P N Y Y

AmeriHealth Caritas Pennsylvania 22248 I N Y Y

AmeriHealth Caritas Pennsylvania 22248 P N Y Y

Amerihealth Caritas VIP Care 77062 I N Y Y

Amerihealth Caritas VIP Care 77062 P N Y Y

AmeriHealth Caritus VIP Care Plus (Michigan) 77013 I N na N

AmeriHealth Caritus VIP Care Plus (Michigan) 77013 P N na N

AmeriHealth Delaware (Non-HMO) 93688 I Y Y Y ERA Payer Code SX055

AmeriHealth Delaware (Non-HMO) 93688 P Y Y Y ERA Payer Code SX055

Amerihealth District of Columbia 77002 I N Y N

Amerihealth District of Columbia 77002 P N Y N

Amerihealth HMO NJ/DE 95044 I Y Y Y ERA Payer Code SX055

Amerihealth HMO NJ/DE 95044 P Y Y Y ERA Payer Code SX055

AmeriHealth New Jersey (Non-HMO) 60061 I Y Y Y ERA Payer Code SX055

AmeriHealth New Jersey (Non-HMO) 60061 P Y Y Y ERA Payer Code SX055

AmeriHealth NorthEast 77001 I N Y Y

AmeriHealth NorthEast 77001 P N Y Y

Ameri-West Health Associates PPM01 I N na Y

Ameri-West Health Associates PPM01 P N na Y

Page 10 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

AmFirst Insurance Company (payer only accepts Secondary claims) 64090 I N Y Y

AmFirst Insurance Company (payer only accepts Secondary claims) 64090 P N Y Y

Amica Mutual Insurance 12287 I N Y N

Amica Mutual Insurance 12287 P N Y N

Amida Care 24818 I N na N

Amida Care 24818 P N na N

Amida Care Medicare 79966 I N na N

Amida Care Medicare 79966 P N na N

Anchor Benefit Consulting Inc. 53085 I N na Y

Anchor Benefit Consulting Inc. 53085 P N na Y

Ancillary Benefit Services (ABS) 86062 I N na Y

Ancillary Benefit Services (ABS) 86062 P N na Y

Ancillary Care Services (ERA Only) A2004 I na Y ERA Only

Ancillary Care Services (ERA Only) A2004 P na Y ERA Only

Angeles IPA HSM01 I N na N

Effective January 1, 2018, all Angeles IPA claims should be

submitted to Payer ID HSM01. SynerMed no longer manages

Angeles IPA.

Angeles IPA HSM01 P N na N

Effective January 1, 2018, all Angeles IPA claims should be

submitted to Payer ID HSM01. SynerMed no longer manages

Angeles IPA.

Antares Management Solutions 34192 I N Y Y Now known as Mutual Health Services

Antares Management Solutions 34192 P N Y Y Now known as Mutual Health Services

Anthem Blue Cross Blue Shield of Connecticut 12B04 I N Y Y

Anthem Blue Cross Blue Shield of Connecticut SB560 P N Y Y

Anthem Blue Cross Blue Shield of Georgia 12015 I N Y Y

Anthem Blue Cross Blue Shield of Georgia SB600 P N Y Y

Anthem Blue Cross Blue Shield of Indiana 12B09 I N Y Y

Anthem Blue Cross Blue Shield of Indiana SB630 P N Y Y

Anthem Blue Cross Blue Shield of Kentucky 12B11 I N Y Y

Anthem Blue Cross Blue Shield of Kentucky SB660 P N Y Y

Anthem Blue Cross Blue Shield of Maine 12B13 I N Y Y

Anthem Blue Cross Blue Shield of Maine SB680 P N Y Y

Anthem Blue Cross Blue Shield of Missouri 12B65 I N Y Y

Anthem Blue Cross Blue Shield of Missouri SB741 P N Y Y

Anthem Blue Cross Blue Shield of Nevada 12B20 I N Y Y

Page 11 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Anthem Blue Cross Blue Shield of Nevada SB765 P N Y Y

Anthem Blue Cross Blue Shield of New Hampshire 12B21 I N Y Y

Anthem Blue Cross Blue Shield of New Hampshire SB770 P N Y Y

Anthem Blue Cross Blue Shield of Ohio 12B24 I N Y Y

Anthem Blue Cross Blue Shield of Ohio SB338 P N Y Y

Anthem Blue Cross Blue Shield of Virginia 12002 I N Y Y

Anthem Blue Cross Blue Shield of Virginia SB923 P N Y Y

Anthem Blue Cross Blue Shield of Wisconsin 12B29 I N Y Y ERA Payer Code 00450

Anthem Blue Cross Blue Shield of Wisconsin SB950 P N Y Y ERA Payer Code 00950

Anthem Blue Cross of California 47198 I N Y Y

Anthem Blue Cross of California 47198 P N Y Y

Anthem Blue Cross of Colorado 12B03 I N Y Y

Anthem Blue Cross of Colorado SB550 P N Y Y

Apex Benefit Services 34196 I N na Y

Apex Benefit Services 34196 P N na Y

Apostrophe 81312 I N Y N

Apostrophe 81312 P N Y N

Araz Group 16120 I N na N

Araz Group 16120 P N na N

ARC Administrators CXARC I N na N

ARC Administrators CXARC P N na N

Arcadian Management Services Inc 77045 I N na N

Arcadian Management Services Inc 77045 P N na N

Arch Health Partners ARCH1 I N Y N

Arch Health Partners ARCH1 P N Y N

Argus Dental Plans, Inc. ARGUS I N na N

Argus Dental Plans, Inc. ARGUS P N na N

ARISE 39185 I N Y N

ARISE 39185 P N Y N

Arizona Foundation for Medical Care (AFMC) 86062 I N na Y

Arizona Foundation for Medical Care (AFMC) 86062 P N na Y

Arizona Medicaid AZMCD I N Y N ERA Payer Code MCDAZ

Arizona Medicaid AZMCD P N Y N ERA Payer Code MCDAZ

Arizona Medicare SMAZ0 P Y Y Y

Page 12 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Arizona Priority Care Plus 27154 I N na N

Arizona Priority Care Plus 27154 P N na N

Arkansas Best Corporation - Choice Benefits 62308 I N Y N Payer Requires Copy of EOB for Missing ERAs

Arkansas Best Corporation - Choice Benefits 62308 P N Y N Payer Requires Copy of EOB for Missing ERAs

Arkansas Medicaid 12023 I N Y Y

Arkansas Medicaid SKAR0 P N Y Y

Arkansas Medicare 12022 I Y Y Y

Arkansas Medicare SMAR0 P Y Y Y

ARM, Ltd. 63240 I N Y N

ARM, Ltd. 63240 P N Y N

Arta Health Network WMM01 P N na Y

ASAGEHA 06603 I N na N

ASAGEHA 06603 P N na N

Asian American Medical Group AAMG1 I N Y N

Asian American Medical Group AAMG1 P N Y N

Aspen Medical Associates 16180 I N na Y

Aspen Medical Associates 16180 P N na Y

Aspire Health Plan 46156 I N Y Y

Aspire Health Plan 46156 P N Y Y

ASR 38265 I N Y N ERA Payer Code TLU02

ASR 38265 P N Y N ERA Payer Code TLU02

ASR Corporation 38265 I N Y N ERA Payer Code TLU02

ASR Corporation 38265 P N Y N ERA Payer Code TLU02

ASR Health Benefits 38265 I N Y N ERA Payer Code TLU02

ASR Health Benefits 38265 P N Y N ERA Payer Code TLU02

ASRM Corporation ASRM1 I N Y N

ASRM Corporation ASRM1 P N Y N

Associates for Health Care Inc. (AHC) 36326 I N na N

Associates for Health Care Inc. (AHC) 36326 P N na N

Assurant Health Self Funded 75068 I N Y Y

Assurant Health Self Funded 75068 P N Y Y

Assured Benefits Administrators 74240 I N Y Y

Assured Benefits Administrators 74240 P N Y Y

Asuris NW Health 93221 I N Y Y

Page 13 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Asuris NW Health 93221 P N Y Y

Atlantic Medical Insurance 22285 I N na N

Atlantic Medical Insurance 22285 P N na N

Atlas Life Insurance Company 90956 P N na N

Atrio Health Plans ATRIO I N Y N

Atrio Health Plans ATRIO P N Y N

AultCare 341488123 I N Y Y

AultCare 341488123 P N Y Y

Aultra Administrative Group 37242 I N Y N

Aultra Administrative Group 37242 P N Y N

Automated Benefit Services 38259 I N Y Y

Automated Benefit Services 38259 P N Y Y

Automated Group Administration Inc. 37280 I N na N

Automated Group Administration Inc. 37280 P N na N

Auxiant (ERA Only) AUX01 I na Y ERA Only

Avalon Administrative Services AVA01 P Y Y N

Avalon IPA CAPMN I N na N

Avalon IPA CAPMN P N na N

Avante Health AH001 P N na Y

Avera Health Plans 46045 I N Y N

Avera Health Plans 46045 P N Y N

AveraAdvantage 48055 I N Y N

AveraAdvantage 48055 P N Y N

Avesis Third Party Administrators 87098 P N na Y

AvMed Inc. 59274 I N Y Y

AvMed Inc. 59274 P N Y Y

AXA Assistance_USA 65101 I N na N

AXA Assistance_USA 65101 P N na N

AZ Complete Health (for claim DOS on or after 10/01/18) 68069 I N Y Y For DOS on or after 10/01/18

AZ Complete Health (for claim DOS on or after 10/01/18) 68069 P N Y Y For DOS on or after 10/01/18

Azeros Health Plans Inc. 16644 I N Y N

Azeros Health Plans Inc. 16644 P N Y N

Bakersfield Family Medical Group 77005 I N na N

Bakersfield Family Medical Group 77005 P N na N

Page 14 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Banker's Life 99999-0178 P N Y N ERA Payer Code 36066

Banker's Life & Casualty (ERA Only) 36066 I na Y ERA Only

Banker's Life & Casualty (ERA Only) 36066 P na Y ERA Only

Banner Health 12X42 I N Y Y

Banner Health 12X42 P N Y Y

Banner Health AZ SX145 P N Y Y aka Banner Health Network

Banner Health Co - ROCKY MOUNTAIN HMO GREELEY SX145 P N Y Y aka Banner Health Network

Banner Health Co. - ANTERO GREELEY SX145 P N Y Y aka Banner Health Network

Banner Health Co. - ANTERO HIGH PLAINS SX145 P N Y Y aka Banner Health Network

Banner Health Co. - ANTERO MOUNTAIN SHADOWS SX145 P N Y Y aka Banner Health Network

Banner Health Co. - CHOICE PLUS SX145 P N Y Y aka Banner Health Network

Banner Health Co. - HMO GREELEY SX145 P N Y Y aka Banner Health Network

Banner Health Co. - HMO HIGH PLAINS SX145 P N Y Y aka Banner Health Network

Banner Health Co. - HMO MOUNTAIN SHADOWS SX145 P N Y Y aka Banner Health Network

Banner Health Co. - PACIFICARE GREELEY SX145 P N Y Y aka Banner Health Network

Banner Health Co. - PACIFICARE HIGH PLAINS SX145 P N Y Y aka Banner Health Network

Banner Health Co. - PACIFICARE MOUNTAIN SHADOWS SX145 P N Y Y aka Banner Health Network

Banner Health Co. - ROCKY MOUNTAIN HMO HIGH PLAINS SX145 P N Y Y aka Banner Health Network

Banner Health Co. - SECURE HORIZONS GREELEY SX145 P N Y Y aka Banner Health Network

Banner Health Co. - SECURE HORIZONS HIGH PLAINS SX145 P N Y Y aka Banner Health Network

Banner Health Co. - SECURE HORIZONS MOUNTAIN SHADOWS SX145 P N Y Y aka Banner Health Network

Baptist Health Plan Advantage BHPMA I N na N

Baptist Health Plan Advantage BHPMA P N na Y

Basic Plus 41204 I N na Y

Basic Plus 41204 P N na Y

Bay Bridge Administrators 06941 I N na N

Bay Bridge Administrators 06941 P N na N

Baycare Life Management 59279 I N na N

Baycare Life Management 59279 P N na N

BCBS of AZ Advantage 77078 I N Y Y

BCBS of AZ Advantage 77078 P N Y Y

BCBSM Medicare Plus Blue PPO (JVHL) KCJVH I Y Y Y Provider must be an approved JVHL lab

BCBSM Medicare Plus Blue PPO (JVHL) KCJVH P Y Y Y Provider must be an approved JVHL lab

BCBSMN Blue Plus Medicaid 00562 I N Y Y

Page 15 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

BCBSMN Blue Plus Medicaid 00562 P N Y Y

BCBSMN Blue Plus Medicaid Waiver FS802 P Y Y N

BCBSMN Non-Emergent Transportation A5143 P N Y N

Beacon Health Options (formerly Value Options) VALOP I Y Y Y Formerly Value Options

Beacon Health Options (formerly Value Options) VALOP P Y Y Y Formerly Value Options

BEACON HEALTH STRATEGIES 43324 I N Y Y

BEACON HEALTH STRATEGIES 43324 P N Y Y

Beaumont Employee Health Plan (JVHL) JEJVH I Y Y Y Provider must be an approved JVHL lab

Beaumont Employee Health Plan (JVHL) JEJVH P Y Y Y Provider must be an approved JVHL lab

Behavioral Health Systems 63100 I N na N

Behavioral Health Systems 63100 P N na N

Benefit & Risk Management Services 99320 I N Y N

Benefit & Risk Management Services 99320 P N Y N

Benefit Administration Services 41205 I N Y Y

Benefit Administration Services 41205 P N Y Y

Benefit Administrative Systems 36149 I N Y N

Benefit Administrative Systems 36149 P N Y N

Benefit Coordinators Corporation (Pittsburgh PA) 25145 I N na N

Benefit Coordinators Corporation (Pittsburgh PA) 25145 P N na N

Benefit Management Admin (BMA) BMATP I N Y N

Benefit Management Group-NV 36459 I N na Y

Benefit Management Group-NV 36459 P N na Y

Benefit Management Inc. of KS 48611 I N Y N

Benefit Management Inc. of KS 48611 P N Y N

Benefit Management LLC/VBA 88092 I N na Y

Benefit Management LLC/VBA 88092 P N na Y

BENEFIT MANAGEMENT SERVICES 56139 I N Y N

BENEFIT MANAGEMENT SERVICES 56139 P N Y N

Benefit Management Systems Inc 37212 I N na N

Payer Code 37212 is being deactivated; please send all claims to

payer code 87815.

Benefit Management Systems Inc 37212 P N na N

Payer Code 37212 is being deactivated; please send all claims to

payer code 87815.

Benefit Plan Administrators 88052 I N na N

Benefit Plan Administrators 88052 P N na N

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

Page 16 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

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

Benefit Plan Administrators Co. (Eau Claire WI)/UCS 46891 I N Y Y

Benefit Plan Administrators Co. (Eau Claire WI)/UCS 46891 P N Y Y

Benefit Plan Administrators Inc 37118 I N na N

Benefit Plan Administrators Inc 37118 P N na N

Benefit Systems & Services Inc. 36342 I N Y N

Benefit Systems & Services Inc. 36342 P N Y N

Ben-e-lect (ERA Only) EDHP1 I na Y na ERA Only

Ben-e-lect (ERA Only) EDHP1 P na Y na ERA Only

Benesight 87265 I N na Y

Benesight 87265 P N na Y

Benesys 37248 I N na N

Benesys 37248 P N na N

Benesys Inc. 37248 I N na N

Benesys Inc. 37248 P N na N

BeneSys, Inc. 38238 I N Y N

BeneSys, Inc. 38238 P N Y N

Berkshire Intergroup 10956 I N na Y

Berkshire Intergroup 10956 P N na Y

Berkshire Lehigh Partners 95606 I N na Y

Berkshire Lehigh Partners 95606 P N na Y

Better Health Plan of Florida 20488 I N Y N

Better Health Plan of Florida 20488 P N Y N

Better Health Plans Inc. 62183 I N na Y

Better Health Plans Inc. 62183 P N na Y

Better Health Plans of South Carolina 32006 I N na N

Better Health Plans of South Carolina 32006 P N na N

Beverly Hospital BEVAHISP MPM42 I N na Y

Beverly Hospital BEVAHISP MPM42 P N na Y

BIND Benefits, Inc. 25463 I N na N

BIND Benefits, Inc. 25463 P N na N

Blue Benefit Administrators of MA 03036 I N Y N

Blue Benefit Administrators of MA 03036 P N Y N

Blue Care Network (BCN Commercial Labs) (JVHL) JJJVH I Y Y Y Provider must be an approved JVHL lab

Page 17 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Blue Care Network (BCN Commercial Labs) (JVHL) JJJVH P Y Y Y Provider must be an approved JVHL lab

Blue Care Network (BCN Reimbursable Labs) (JVHL) JQJVH I Y Y Y Provider must be an approved JVHL lab

Blue Care Network (BCN Reimbursable Labs) (JVHL) JQJVH P Y Y Y Provider must be an approved JVHL lab

Blue Care Network (JVHL Network) (JVHL) J9JVH I Y Y Y Provider must be an approved JVHL lab

Blue Care Network (JVHL Network) (JVHL) J9JVH P Y Y Y Provider must be an approved JVHL lab

Blue Care Network Advantage of Michigan 00210 I Y Y Y

Blue Care Network Advantage of Michigan 00710 P Y Y Y

Blue Care Network of Michigan 00210 I Y Y Y

Blue Care Network of Michigan 00710 P Y Y Y

Blue Cross Blue Shield of Alabama 12B54 I Y Y Y

Blue Cross Blue Shield of Alabama SB510 P N Y Y

Blue Cross Blue Shield of Arizona 53589 I N Y Y

Blue Cross Blue Shield of Arizona 53589 P N Y Y

Blue Cross Blue Shield of Arkansas 12021 I Y Y Y

Blue Cross Blue Shield of Arkansas SB520 P Y Y Y

Blue Cross Blue Shield of Delaware 12B76 I Y Y Y

Blue Cross Blue Shield of Delaware SB570 P Y Y Y

Blue Cross Blue Shield of District of Columbia (Carefirst) 12000 I N Y Y

Blue Cross Blue Shield of District of Columbia (Carefirst) SB580 P Y Y Y

Blue Cross Blue Shield of Illinois 12B08 I N Y Y ERA Payer Code 00621

Blue Cross Blue Shield of Illinois SB621 P N Y Y ERA Payer Code 00621

Blue Cross Blue Shield of Kansas 47163 I Y Y Y

Blue Cross Blue Shield of Kansas 47163 P Y Y Y

Blue Cross Blue Shield of Kansas City 47171 I Y Y Y

Blue Cross Blue Shield of Kansas City 47171 P Y Y Y

Blue Cross Blue Shield of Louisiana 53120 I Y Y Y

Blue Cross Blue Shield of Louisiana 53120 P Y Y Y

Blue Cross Blue Shield of Maryland (Carefirst) 12011 I N Y Y

Blue Cross Blue Shield of Maryland (Carefirst) SB690 P N Y Y

Blue Cross Blue Shield of Massachusetts 12B14 I Y Y Y

Blue Cross Blue Shield of Massachusetts SB700 P Y Y Y

Blue Cross Blue Shield of Michigan 00210 I Y Y Y

Blue Cross Blue Shield of Michigan 00710 P Y Y Y

Blue Cross Blue Shield of Minnesota 00720 I N Y Y Payer Requires Copy of EOB for Missing ERAs

Page 18 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Blue Cross Blue Shield of Minnesota 00720 P N Y Y Payer Requires Copy of EOB for Missing ERAs

Blue Cross Blue Shield of Mississippi 12B17 I Y Y Y

Blue Cross Blue Shield of Mississippi SB730 P Y Y Y

Blue Cross Blue Shield of Montana (ERA Only) 00751 I na Y na ERA Only

Blue Cross Blue Shield of Montana (ERA Only) 00751 P na Y na ERA Only

Blue Cross Blue Shield of Nebraska 00760 I N Y Y

Blue Cross Blue Shield of Nebraska 00760 P N Y Y

Blue Cross Blue Shield of New Mexico 00790 I N Y Y

Blue Cross Blue Shield of New Mexico 00790 P N Y Y

Blue Cross Blue Shield of North Carolina 12B23 I N Y Y

Blue Cross Blue Shield of North Carolina SB810 P N Y Y

Blue Cross Blue Shield of North Dakota 55891 I N Y Y Former payer code 12B78

Blue Cross Blue Shield of North Dakota 55891 P N Y Y Former payer code 12B78

Blue Cross Blue Shield of Oklahoma 00840 I N Y Y

Blue Cross Blue Shield of Oklahoma 00840 P N Y Y

Blue Cross Blue Shield of Rhode Island 12B74 I Y Y Y

Blue Cross Blue Shield of Rhode Island SB870 P Y Y Y

Blue Cross Blue Shield of South Carolina 12B55 I N Y Y

Blue Cross Blue Shield of South Carolina SB880 P N Y Y

Blue Cross Blue Shield of Tennessee 00390 I Y Y Y

Blue Cross Blue Shield of Tennessee 00390 P Y Y Y

Blue Cross Blue Shield of Texas 84980 I N Y Y

Blue Cross Blue Shield of Texas 84980 P N Y Y

Blue Cross Blue Shield of Texas - Medicaid STAR Kids 66001 I N Y Y

Blue Cross Blue Shield of Texas - Medicaid STAR Kids 66001 P N Y Y

Blue Cross Blue Shield of Texas - Medicaid STAR/CHIP 66001 I N Y Y

Blue Cross Blue Shield of Texas - Medicaid STAR/CHIP 66001 P N Y Y

Blue Cross Blue Shield of Vermont BCSVT I N Y Y

Blue Cross Blue Shield of Vermont BCSVT P N Y Y

Blue Cross Blue Shield of Wyoming 53767 I N Y Y Former payer code 12B30

Blue Cross Blue Shield of Wyoming 53767 P N Y Y Former payer code SB960

Blue Cross Community Health Plans MCDIL I N Y Y Equivalent to payer code 66005

Blue Cross Community Health Plans MCDIL P N Y Y Equivalent to payer code 66005

Blue Cross Complete (JVHL) KPJVH I Y Y Y Provider must be an approved JVHL lab

Page 19 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Blue Cross Complete (JVHL) KPJVH P Y Y Y Provider must be an approved JVHL lab

Blue Cross Medicare Advantage (IL, MT, NM, OK, TX) 66006 I N Y N

Blue Cross Medicare Advantage (IL, MT, NM, OK, TX) 66006 P N Y N

Blue Shield of California BSCAI I N Y Y

Blue Shield of California BS001 P N Y Y

BlueChoice HealthPlan 00922 I N Y Y

BlueChoice HealthPlan 00922 P N Y Y

BlueChoice HealthPlan Medicaid of South Carolina 00403 I N Y Y

BlueChoice HealthPlan Medicaid of South Carolina 00403 P N Y Y

Bluegrass Family Health 61124 I N Y N

Bluegrass Family Health 61124 P N Y N

Boilermakers National Health & Welfare Fund 36609 I N na N

Boilermakers National Health & Welfare Fund 36609 P N na N

Bollinger, INC. - BOLLINGER BOLL1 I N Y N

Bollinger, INC. - BOLLINGER BOLL1 P N Y N

BookMD Inc 47405 I N na Y

BookMD Inc 47405 P N na Y

Boon-Chapman Benefit Administrators Inc. 74238 I N Y N

Boon-Chapman Benefit Administrators Inc. 74238 P N Y N

Boston Health Net 13337 I Y Y Y

Boston Health Net 13337 P Y Y Y

Brand New Day (FFS) UC001 I N na N

Brand New Day (FFS) UC001 P N na N

Bravo Health 52192 I N Y Y

Bravo Health 52192 P N Y Y

Bravo Health Star Plus 52192 I N Y Y

Bravo Health Star Plus 52192 P N Y Y

BridgeSpan BRIDG I N Y Y

BridgeSpan BRIDG P N Y Y

Bridgeway Arizona 68069 I N Y Y

Bridgeway Arizona 68069 P N Y Y

BritCay 22286 I N na N

BritCay 22286 P N na N

Brodart 35182 I N na Y Claim Mailing Address: PO Box 2920, Clinton, IA

Page 20 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Brodart 35182 P N na Y Claim Mailing Address: PO Box 2920, Clinton, IA

Brokerage Concepts 51037 I N Y Y

Brokerage Concepts 51037 P N Y Y

Brookshire IPA BIPAZ I N na Y

Brookshire IPA BIPAZ P N na Y

Broward Health 37314 I N na Y

Broward Health 37314 I N na Y

Brown & Toland Medical Group 94316 I N Y N

Brown & Toland Medical Group 94316 P N Y N

Brown and Toland Health Services BTHS1 I N na N

Brown and Toland Health Services BTHS1 P N na N

Brown and Toland Sutter Select BTSS1 P N na N

Buckeye Community Health 68069 I N Y Y

Buckeye Community Health 68069 P N Y Y

Butler Benefit 42150 I N na Y

Butler Benefit 42150 P N na Y

C&O Employees Hospital Association 23708 P N na N

C. L. Frates & Co - OSMA Health 73071 I N na N

C. L. Frates & Co - OSMA Health 73071 P N na N

Cal Care IPA PPM01 I N na Y

Cal Care IPA PPM02 I N na Y Encounters

Cal Care IPA PPM01 P N na Y

Cal Care IPA PPM02 P N na Y Encounters

California Health and Wellness 68047 I Y Y Y ERA Payer Code 68069

California Health and Wellness 68047 P Y Y Y ERA Payer Code 68069

California IPA CAIPA I N na N

California IPA CAIPA P N na N

California Medicaid (Medi-Cal) CAMC1 I Y Y N

California Medicaid (Medi-Cal) SKCA0 P Y Y Y

California Medicare 12M64 I Y Y Y

California Medicare - Northern Region SMCA1 P Y Y Y

California Medicare - Southern Region SMCA2 P Y Y Y

California Pacific Medical Center 94056 I N na Y

California Pacific Medical Center 94056 P N na Y

Page 21 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

CalOptima Direct CALOP I N Y Y

CalOptima Direct CALOP P N Y Y

Cannon Cochran Management Services Inc. Metairie LA 71057 I N na N

Cannon Cochran Management Services Inc. Metairie LA 71057 P N na N

Canopy Health 95399 I N Y Y ERA Payer Code 15821

Canopy Health 95399 P N Y Y ERA Payer Code 15821

CAP Management Systems 95399 I N Y Y ERA Payer Code 15821

CAP Management Systems 95399 P N Y Y ERA Payer Code 15821

Capital Blue Cross/CAIC 23045 I Y Y Y

Capital Blue Cross/CAIC 23045 P Y Y Y

Capital District Health Plan 12X03 I N Y N ERA Payer Code SX065

Capital District Health Plan SX065 P N Y N ERA Payer Code SX065

Capital Health Plan 95112 I N na N

Capital Health Plan 95112 P N na N

Capitol Administrators 68011 I N Y N

Capitol Administrators 68011 P N Y N

Caprock Health Plans CAPHP I N Y N

Caprock Health Plans CAPHP P N Y N

Cardinal Innovations (Formerly Piedmont Behavioral Health) 06607 I N Y Y

Cardinal Innovations (Formerly Piedmont Behavioral Health) 06607 P N Y Y

Cardon Outreach 99999-0911 I Y na N

Cardon Outreach 99999-0911 P Y na N

Care 1st Health Plan of Arizona/OneCare 57116 I N na N

Care 1st Health Plan of Arizona/OneCare 57116 P N na N

Care 1st Health Plan of CA (Commercial) 57115 I N na Y

Care 1st Health Plan of CA (Commercial) 57115 P N na Y

Care Access Health Plan (CAHP) 12K89 I N Y N ERA Payer Code 65062

Care Access Health Plan (CAHP) 65062 P N Y N

Care Access PSN 65063 P N na N

Care Improvement Plus (For DOS on or after 1/1/16.) 87726 I N Y Y

Care Improvement Plus (For DOS on or after 1/1/16.) 87726 P N Y Y

Care Improvement Plus (For DOS prior to 1/1/16.) 77082 I N Y N

ERA Payer Code 87726.

For DOS prior to 1/1/16. All other DOS should be submitted

under Payer ID 87726.

Page 22 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Care Improvement Plus (For DOS prior to 1/1/16.) 77082 P N Y N

ERA Payer Code 87726.

For DOS prior to 1/1/16. All other DOS should be submitted

under Payer ID 87726.

Care To Care 41222 I N na N

Care To Care 41222 P N na N

Care Wisconsin Health Plan (Trizetto) 27004 I N Y N

Care Wisconsin Health Plan (Trizetto) 27004 P N Y N

Care1st Health Plan of CA (Blue) C1SCA I N N Y

Care1st Health Plan of CA (Blue) C1SCA P N N Y

CareCentrix 11345 I Y Y N

CareCentrix 11345 P Y Y N

CareCore National 14182 P N na N

CareCore National LLC (Aetna Radiology Claims) 14179 I N na N

CareCore National LLC (Aetna Radiology Claims) 14179 P N na N

CareCore National LLC (Oxford Radiology Claims) 14180 P N na N

CareCore/WCNY RAD 14188 P N na N

CareFirst Administrators/NCAS (Charlotte, NC) 75191 I N Y N

CareFirst Administrators/NCAS (Charlotte, NC) 75191 P N Y N

CareFirst Administrators/NCAS (Fairfax, VA) 75190 I N Y N

CareFirst Administrators/NCAS (Fairfax, VA) 75190 P N Y N

CareFirst BlueCross BlueShield MD Region 12011 I N Y N ERA Payer Code SB690

CareFirst BlueCross BlueShield MD Region SB690 P N Y Y ERA Payer Code SB690

CareFirst BlueCross BlueShield NCA Region 12000 I N Y N ERA Payer Code SB580

CareFirst BlueCross BlueShield NCA Region SB580 P N Y Y ERA Payer Code SB580

CareFlorida 65088 I N na N

CareFlorida 65088 P N na N

Carelink Medicaid 25133 I N Y Y

Carelink Medicaid 25133 P N Y Y

Caremore (ERA Only) CM001 I na Y ERA Only

Caremore (ERA Only) CM001 P na Y ERA Only

Caremore Health Plan CARMO I N na Y

Caremore Health Plan CARMO P N na Y

Carenet (ERA Only) 25133 I na Y ERA Only

Carenet (ERA Only) 25133 P na Y ERA Only

Page 23 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

CareOregon Inc. 93975 I N Y N

CareOregon Inc. 93975 P N Y N

CarePlus Health Plans Inc. 95092 I N Y Y ERA Payer Code 65031

CarePlus Health Plans Inc. 65031 P N Y Y

CareSource 26160 I N na N

CareSource 26160 P N na N

CareSource GA GACS1 I N Y Y

CareSource GA GACS1 P N Y Y

CareSource Indiana INCS1 I N na N

CareSource Indiana INCS1 P N na N

CareSource KY KYCS1 I N Y Y

CareSource KY KYCS1 P N Y Y

CareSource OH 31114 I N Y Y

CareSource OH 31114 P N Y Y

Careworks 10010 I N Y N

Careworks 10010 P N Y N

Cariten Senior Health 62072 I N Y Y ERA Payer Code 61101

Cariten Senior Health 62072 P N Y Y ERA Payer Code 61101

Carolina Benefit Administrators 00498 I N na N

Carolina Benefit Administrators 00498 P N na N

Carolina Care Plan 29076 I N Y Y

Carolina Care Plan 29076 P N Y Y

Carpenters Health and Welfare Fund of Philadelphia CX101 P N na N

Carpenters Health and Welfare Trust Fund of St. Louis (ERA Only) 12174 I na Y ERA Only

Carpenters Health and Welfare Trust Fund of St. Louis (ERA Only) 12174 P na Y ERA Only

CBA Blue 03036 I N Y N

CBA Blue 03036 P N Y N

CBHNP - HealthChoices 65391 I N Y N aka PerformCare

CBHNP - HealthChoices 65391 P N Y N aka PerformCare

CDS Group Health 88022 I N na N

CDS Group Health 88022 P N na N

Cedars Sinai Medical Center 33010 I N na Y

Cedars-Sinai Medical Network Services 95166 I N na N

Cedars-Sinai Medical Network Services 95166 P N na N

Page 24 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Celtic Insurance 68063 I N Y Y

Celtic Insurance 68063 P N Y Y

CeltiCare 68069 I N Y Y

CeltiCare 68069 P N Y Y

Cement Masons & Plasterers Health & Welfare Trust 91136 I N na N

Cement Masons & Plasterers Health & Welfare Trust 91136 P N na N

Cencal Health 99111 I N Y Y ERA Payer Code 95386

Cencal Health 99111 P N Y Y ERA Payer Code 95386

Cenpatico - Arizona (for DOS prior to 10/01/18) 68068 I N Y Y Use Payer Code 68069 for DOS after 9/30/18

Cenpatico - Arizona (for DOS prior to 10/01/18) 68068 P N Y Y Use Payer Code 68069 for DOS after 9/30/18

Cenpatico - Florida 68068 I N Y Y

Cenpatico - Florida 68068 P N Y Y

Cenpatico - Georgia 68068 I N Y Y

Cenpatico - Georgia 68068 P N Y Y

Cenpatico - Illinois 68068 I N Y Y

Cenpatico - Illinois 68068 P N Y Y

Cenpatico - Indiana 68068 I N Y Y

Cenpatico - Indiana 68068 P N Y Y

Cenpatico - Kansas 68068 I N Y Y

Cenpatico - Kansas 68068 P N Y Y

Cenpatico - Kentucky 68068 I N Y Y

Cenpatico - Kentucky 68068 P N Y Y

Cenpatico - Massachuetts 68068 I N Y Y

Cenpatico - Massachuetts 68068 P N Y Y

Cenpatico - Mississippi 68068 I N Y Y

Cenpatico - Mississippi 68068 P N Y Y

Cenpatico - Missouri 68068 I N Y Y

Cenpatico - Missouri 68068 P N Y Y

Cenpatico - Ohio 68068 I N Y Y

Cenpatico - Ohio 68068 P N Y Y

Cenpatico - South Carolina 68068 I N Y Y

Cenpatico - South Carolina 68068 P N Y Y

Cenpatico - Texas 68068 I N Y Y

Cenpatico - Texas 68068 P N Y Y

Page 25 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Cenpatico - Wisconsin 68068 I N Y Y

Cenpatico - Wisconsin 68068 P N Y Y

Centene Advantage Plans 68068 I N Y Y

Centene Advantage Plans 68068 P N Y Y

Center for Elders Independence 94312 I N na Y

Center for Elders Independence 94312 P N na Y

CenterLight Healthcare 13360 I N Y Y

CenterLight Healthcare 13360 P N Y Y

Centivo 45564 I N na N

Centivo 45564 P N na N

CentraCare 66698 I N na N

CentraCare 66698 P N na N

Central & Southwest Services 75177 P N na Y

Central California Alliance for Health (CCAH) CCA01 I Y Y Y

Central California Alliance for Health (CCAH) CCA01 P Y Y Y

Central DuPage Physician Group 36314 I N na N

Central DuPage Physician Group 36314 P N na N

Central Health Medicare Plan CHCPI I N na Y

Central Health Medicare Plan CHCPI P N na Y

Central Health MSO CHCPI I N na Y

Central Health MSO CHCPI P N na Y

Central Mass Heath Care 02041 I N na Y

Central Pennsylvania Teamsters Fund (ERA Only) 23626 I na Y na

Central Pennsylvania Teamsters Fund (ERA Only) 23626 P na Y na

Central Reserve Life Ins Co-Medicare Supplement 13193 I N Y Y

Central Reserve Life Ins Co-Medicare Supplement 13193 P N Y Y

Central SeniorCare 62218 I N na N

Central SeniorCare 62218 P N na N

Central States Health & Welfare Funds 36215 I N na N

Central States Health & Welfare Funds 36215 P N na N

Central States Indemnity (ERA Only) na Y ERA Only

Central Susquehanna Healthcare Providers (CSHP) 55731 I N na Y

Central Susquehanna Healthcare Providers (CSHP) 55731 P N na Y

Central Valley Medical Group 77035 I N na Y

Page 26 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Central Valley Medical Group 77035 P N na N

Centurion 42140 I N Y N

Centurion 42140 P N Y N

Century PHO INC 36393 I N na Y

Century PHO INC 36393 P N na Y

Cerner HealthPlan Services 20356 I N Y N

Cerner HealthPlan Services 20356 P N Y N

CHAMPVA - HAC 84146 I N Y Y

CHAMPVA - HAC 84146 P N Y Y

CHAMPVA HAC MEDICARE CROSSOVER (ERA Only) 80214 I na Y ERA Only

CHAMPVA HAC MEDICARE CROSSOVER (ERA Only) 80214 P na Y ERA Only

Change Healthcare Accident Claims Solution 88446 I N na N

Change Healthcare Accident Claims Solution 88446 P N na N

Chautauqua County Healthcare Plan (Mayville NY) 16600 I N na N

Chautauqua County Healthcare Plan (Mayville NY) 16600 P N na N

CHCS Services, Inc (ERA Only) 75895 I na Y ERA Only

CHCS Services, Inc (ERA Only) 75895 P na Y ERA Only

Chesterfield Resources Inc. 34154 I N Y N

Chesterfield Resources Inc. 34154 P N Y N

Childhealth Plus by Healthfirst (CHP) 80141 I N na Y

Children First Medical Group 94321 P N na N

Children of Women Vietnam Veterans-VA HAC 84146 I N Y Y

Children of Women Vietnam Veterans-VA HAC 84146 P N Y Y

Children’s Hospital Orange County (CHOC) Health Alliance CHOC1 I N Y N

Children’s Hospital Orange County (CHOC) Health Alliance CHOC1 P N Y N

Children's Community Health Plan - Wisconsin 39113 I N Y N

Children's Community Health Plan - Wisconsin 39113 P N Y N

Childrens Medical Center Health Plan CMCHP I N Y N

Childrens Medical Center Health Plan CMCHP P N Y N

Children's Medical Security Plan of Massachusetts 12K14 I Y Y Y

Children's Medical Security Plan of Massachusetts SKMA0 P Y Y Y

Children's Medical Services - Broward NORTH 37314 I N na Y

Children's Medical Services - Broward NORTH 37314 I N na Y

Chinese Community Health Plan 94302 I N Y N

Page 27 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Chinese Community Health Plan 94302 P N Y N

CHOC - Children's Hospital Of Orange County Health Alliance 33065 I N na N

CHOC - Children's Hospital Of Orange County Health Alliance 33065 P N na N

Choice Medical Group CMG01 P N na Y

CHP DIRECT SUPERMED 90441 I N na N

CHP DIRECT SUPERMED 90441 P N na N

Christian Brothers Services 38308 I N Y N

Christian Brothers Services 38308 P N Y N

Christian Care Ministries 59355 I N na N

Christian Care Ministries 59355 P N na N

Christus Health Medicare Advantage 10629 I N Y N

Christus Health Medicare Advantage 10629 P N Y N

Christus Health New Mexico HIX 21062 I N Y N

Christus Health New Mexico HIX 21062 P N Y N

Christus Health TX HIX 52106 I N na N

Christus Health TX HIX 52106 P N na N

Christus Texas Medicaid 45210 I N na Y

Christus Texas Medicaid 45210 P N na Y

CIGNA 62308 I N Y Y Payer Requires Copy of EOB for Missing ERAs

CIGNA 62308 P N Y Y Payer Requires Copy of EOB for Missing ERAs

CIGNA – (Health Partners) (JVHL) KQJVH I Y Y Y Provider must be an approved JVHL lab

CIGNA – (Health Partners) (JVHL) KQJVH P Y Y Y Provider must be an approved JVHL lab

CIGNA - PPA 62308 I N Y Y Payer Requires Copy of EOB for Missing ERAs

CIGNA - PPA 62308 P N Y Y Payer Requires Copy of EOB for Missing ERAs

CIGNA - PPO 62308 I N Y Y Payer Requires Copy of EOB for Missing ERAs

CIGNA - PPO 62308 P N Y Y Payer Requires Copy of EOB for Missing ERAs

CIGNA (Non-HAP & CIGNA-HAP (JVHL) KDJVH I Y Y Y Provider must be an approved JVHL lab

CIGNA (Non-HAP & CIGNA-HAP (JVHL) KDJVH P Y Y Y Provider must be an approved JVHL lab

CIGNA Behavioral Health MCCBV I N Y N ERA Payer Code 62308

CIGNA Behavioral Health SX071 P N Y Y ERA Payer Code 62308

CIGNA Encounter Claims Only 99139 I N na N

CIGNA Health Plan - HMO 62308 I N Y Y Payer Requires Copy of EOB for Missing ERAs

CIGNA Health Plan - HMO 62308 P N Y Y Payer Requires Copy of EOB for Missing ERAs

Cigna HealthSpring 52192 I N Y N

Page 28 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Cigna HealthSpring 52192 P N Y N

CIGNA Medicare Advantage 86033 I N na N

CIGNA Medicare Advantage 86033 P N na N

Cincinnati Financial Corporation 46871 I N na Y Payer code being deactivated; send claims to payer code 37283

Cincinnati Financial Corporation 46871 P N na Y Payer code being deactivated; send claims to payer code 37283

Citrus Health Plan 10207 I N na Y

Citrus Health Plan 10207 P N na Y

Claims Development Corporation 43056 P N na N

ClaimsBridge HPN 11752 I N na Y

ClaimsBridge HPN 11752 P N na Y

Claimshop- Employers Coalition on Health - MULTIPLAN PHCS/ECOH 27008 I N na N

Claimshop- Employers Coalition on Health - MULTIPLAN PHCS/ECOH 27008 P N na N

ClaimsWare Inc. dba ManageMed 57080 I N Y Y

ClaimsWare Inc. dba ManageMed 57080 P N Y Y

Clear Spring Health 66009 I N na Y

Clear Spring Health 66009 P N na Y

Clearchoice Health Plan / COIHS 77201 P N Y Y

Client First 41201 I N na N

Client First 41201 P N na N

Clover Health (formerly Carepoint Health Plan) 77023 I N Y N

Clover Health (formerly Carepoint Health Plan) 77023 P N Y N

CMCS Advantage Health Solutions Medicare 35219 I N na N

CMCS Advantage Health Solutions Medicare 35219 P N na N

CMHC 02041 I N na Y

Coachella Valley Physicians IP079 I N Y N

Coachella Valley Physicians IP079 P N Y N

Coastal Administrative Services 77052 I N Y N

Coastal Administrative Services 77052 P N Y N

Coastal Care 43141 I Y Y N

Coastal Care 43141 P Y Y N

Coastal Care Services Inc 47394 P N na N

Coastal Communities Physician Network 51579 I N na N

Coastal Communities Physician Network 51579 P N na N

Page 29 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Cofinity 38335 I N na N

Cofinity 38335 P N na N

College Health IPA CHIPA P N na N

Colonial Life (ERA Only) 37077 I na Y ERA Only

Colonial Life (ERA Only) 37077 P na Y ERA Only

Colonial Medical 22284 I N na N

Colonial Medical 22284 P N na N

Colorado Access 84129 I N Y Y

Colorado Access 84129 P N Y Y

Colorado Community Health Alliance COCHA I N Y N

Colorado Community Health Alliance COCHA P N Y N

Colorado Health OP 49718 I N na N

Colorado Health OP 49718 P N na N

Colorado Medicaid 77016 I Y Y Y

Colorado Medicaid 77016 P Y Y Y

Colorado Medicare 12M03 I Y Y Y

Colorado Medicare SMCO0 P Y Y Y

Commerce Benefits Group 34181 I N na N

Commerce Benefits Group 34181 P N na N

Commercial Travelers/PHX 88091 I N Y N

Commercial Travelers/PHX 88091 P N Y N

Common Ground Healthcare Cooperative 77170 I N Y N

Common Ground Healthcare Cooperative 77170 P N Y N

Commonwealth Care Alliance 14315 I N na N

Commonwealth Care Alliance 14315 P N na N

Community Care Alliance of Illinois - CCAI 85468 I N Y N

Community Care Alliance of Illinois - CCAI 85468 P N Y N

Community Care Associates (Healthchoice) (JVHL) JWJVH I Y Y Y Provider must be an approved JVHL lab

Community Care Associates (Healthchoice) (JVHL) JWJVH P Y Y Y Provider must be an approved JVHL lab

Community Care BHO 23282 I N na N

Community Care BHO 23282 P N na N

Community Care Inc. - Family Care (Wisconsin) 60995 I N Y Y

Community Care Inc. - Family Care (Wisconsin) 60995 P N Y Y

Community Care Inc. (Wisconsin) 39126 I N Y Y

Page 30 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Community Care Inc. (Wisconsin) 39126 P N Y Y

Community Care IPA CCI01 I N na N

Community Care IPA CCI01 P N na N

Community Care Managed Health Care Plans of Oklahoma 73143 I N Y Y

Community Care Managed Health Care Plans of Oklahoma 73143 P N Y Y

Community Care Plan 59064 I N Y Y

formerly known as South Florida Community Care Network -

SFCCN

Community Care Plan 59064 P N Y Y

formerly known as South Florida Community Care Network -

SFCCN

Community Care Plan (Medicaid) 59065 I N Y Y

Formerly known as South FL Community Care Network - SFCCN

(Medicaid)

Community Care Plan (Medicaid) 59065 P N Y Y

Formerly known as South FL Community Care Network - SFCCN

(Medicaid)

Community First Health Plan, Inc. COMMF I N Y N ERA Payer Code 42723

Community First Health Plan, Inc. COMMF P N Y N ERA Payer Code 42723

Community Health Alliance 35193 I N Y Y

Community Health Alliance 35193 P N Y Y

Community Health Choice 48145 I N Y N

Community Health Choice 48145 P N Y N

Community Health Electronic Claims/CHEC/webTPA 75261 I N Y N

Community Health Electronic Claims/CHEC/webTPA 75261 P N Y N

Community Health Group 66170 I N Y Y

All providers must be entered into CHG's Claims system before

EDI claims can be submitted.

Community Health Group CHGRI I N Y Y

Community Health Group 66170 P N Y Y

All providers must be entered into CHG's Claims system before

EDI claims can be submitted.

Community Health Plan of Washington CHPWA I N Y Y

Community Health Plan of Washington CHPWA P N Y Y

Community Health Plan, Inc. 60495 I N na Y

Community Health Plan, Inc. 60495 P N na Y

Community Medical Group of the West Valley Inc. 66121 I N na N

Community Medical Group of the West Valley Inc. 66121 P N na N

CommunityConnect HealthPlan 95192 I N Y Y

CommunityConnect HealthPlan 95192 P N Y Y

Comp - Ohio (Austintown OH) 34177 I N na N

Comp - Ohio (Austintown OH) 34177 P N na N

Page 31 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Compcare (Wisconsin BadgerCare only) 95192 I N Y Y

Compcare (Wisconsin BadgerCare only) 95192 P N Y Y

Compsych 37363 I N Y Y

Compsych 37363 P N Y Y

Connecticare - Medicare 78375 I N Y N

Connecticare - Medicare 78375 P N Y N

ConnectiCare Inc 06105 I N Y Y

ConnectiCare Inc 06105 P N Y Y

Connecticut Carpenters Health Fund 37307 I N Y N

Connecticut Carpenters Health Fund 37307 P N Y N

Connecticut General (CIGNA) 62308 I N Y Y Payer Requires Copy of EOB for Missing ERAs

Connecticut General (CIGNA) 62308 P N Y Y Payer Requires Copy of EOB for Missing ERAs

Connecticut Medicaid 12K04 I N Y Y

Connecticut Medicaid SKCT0 P N Y Y

Connecticut Medicare 12M04 I Y Y Y

Connecticut Medicare SMCT0 P Y Y Y

Conseco Services LLC (ERA Only) 11285 I na Y ERA Only

Conseco Services LLC (ERA Only) 11285 P na Y ERA Only

Consociate Group 37135 I N Y Y

Consociate Group 37135 P N Y Y

Consolidated Associates Railroad 75284 I N na N

Consolidated Associates Railroad 75284 P N na N

Consolidated Health Plans 87843 I N Y N

Consolidated Health Plans 87843 P N Y N

Constellation Health L0260 P N na N

Consumer’s Mutual Insurance (JVHL) KWJVH I Y Y Y Provider must be an approved JVHL lab

Consumer’s Mutual Insurance (JVHL) KWJVH P Y Y Y Provider must be an approved JVHL lab

Consumers Choice Health SC 45321 I N Y Y

Consumers Choice Health SC 45321 P N Y Y

Consumers Life Insurance Company 29076 I N Y Y

Consumers Life Insurance Company 29076 P N Y Y

Container Graphics Corp 08680 I N na Y

Container Graphics Corp 08680 P N na Y

Continental General Ins Co-Medicare Supplement 13193 I N Y Y

Page 32 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Continental General Ins Co-Medicare Supplement 13193 P N Y Y

Continental General Insurance Company (non Medicare Supplement) 71404 I N Y N Claim Address: PO Box 21670 Eagan MN 55121

Continental General Insurance Company (non Medicare Supplement) 71404 P N Y N Claim Address: PO Box 21670 Eagan MN 55121

Continuum (formerly Marrick WRx) 46478 I N na N

Continuum (formerly Marrick WRx) 46478 P N na N

Contra Costa County Health Plan CNTRA I Y Y N

Contra Costa County Health Plan CNTRA P Y Y Y

Contractors Laborers Teamsters & Engineers (Local 14B) 47046 I N na Y

Contractors Laborers Teamsters & Engineers (Local 14B) 47046 P N na Y

Conversion Plan-APWU 55544 I N na N

Conversion Plan-APWU 55544 P N na N

Cook Children STAR Plan THCP9 I N na N

Cook Children STAR Plan THCP9 P N na N

Cook Children's Health 12T58 I N na N

Cook Children's Health TH104 P N na N

Cook Group Health Plan 35149 I N na Y

Cook Group Health Plan 35149 P N na Y

Cook Medical Group 60065 I N na N

Cook Medical Group 60065 P N na N

Cooperative Benefit Administrators (CBA) 39026 I N Y Y

Cooperative Benefit Administrators (CBA) 39026 P N Y Y

COOPERATIVE MANAGED CARE SERVICES 35199 I N Y N

COOPERATIVE MANAGED CARE SERVICES 35199 P N Y N

Coordinated Benefit Plan 14829 I N Y Y

Coordinated Benefit Plan 14829 P N Y Y

Coordinated Medical Specialists 58204 I N na N

Coordinated Medical Specialists 58204 P N na N

Core Administrative Services 58231 I N Y N

Core Administrative Services 58231 P N Y N

CoreSource AZ MN 35182 I N Y Y Claim Mailing Address: PO Box 2920, Clinton, IA

CoreSource AZ MN 35182 P N Y Y Claim Mailing Address: PO Box 2920, Clinton, IA

CoreSource Little Rock 75136 I N Y N

CoreSource Little Rock 75136 P N Y N

Page 33 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

CoreSource MD PA IL 35182 I N Y Y

Claim Mailing Address: PO Box 2920, Clinton, IA

aka Health Options Program

CoreSource MD PA IL 35182 P N Y Y

Claim Mailing Address: PO Box 2920, Clinton, IA

aka Health Options Program

CoreSource NC IN 35182 I N Y Y Claim Mailing Address: PO Box 2920, Clinton, IA

CoreSource NC IN 35182 P N Y Y Claim Mailing Address: PO Box 2920, Clinton, IA

CoreSource OH 35183 I N Y Y

CoreSource OH 35183 P N Y Y

CoreSource-Internal 35187 I N Y N

CoreSource-Internal 35187 P N Y N

Corizon Health Inc. CORIZ I N na N

Corizon Health Inc. CORIZ P N na N

Corizon Inc. 43160 I N na N

Corizon Inc. 43160 P N na N

Cornerstone Benefit Adminstrators 35202 I N na Y

Cornerstone Benefit Adminstrators 35202 P N na Y

Cornerstone Preferred Resources CB268 I N na N

Cornerstone Preferred Resources CB268 P N na N

Corporate Benefits Service 56116 I N na N

Corporate Benefits Service 56116 P N na N

Corporate Plan Management, Inc. 64270 I N na Y

Corporate Plan Management, Inc. 64270 P N na Y

CorrectCare CCIH I N na N

CorrectCare CCIH P N na N

Correctional Health Partners (ERA Only) I Y ERA Only

Correctional Health Partners (ERA Only) P Y ERA Only

Country Financial (ERA Only) na Y ERA Only

County of Riverside EC999 I N na N

County of Riverside EC999 P N na N

County Services Medical Program CMSP1 I N na N

County Services Medical Program CMSP1 P N na N

CountyCare 06541 I N Y N

CountyCare 06541 P N Y N

CountyCare (Cenpatico TPA) 42138 I N na N For claims with Dates of Services prior to 4/01/16

CountyCare (Cenpatico TPA) 42138 P N na N For claims with Dates of Services prior to 4/01/16

Page 34 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

CountyCare (Centene TPA) 42139 I N na N For claims with Dates of Services prior to 4/01/16

CountyCare (Centene TPA) 42139 P N na N For claims with Dates of Services prior to 4/01/16

Covenant Administrators Inc. (Atlanta GA) 58102 I N Y N

Covenant Administrators Inc. (Atlanta GA) 58102 P N Y N

Coventry Advantra Texas 25133 I N na Y

Coventry Advantra Texas 25133 P N na Y

Coventry Health & Life (Oklahoma) 25133 I N Y Y

Coventry Health & Life (Oklahoma) 25133 P N Y Y

Coventry Health Care National Network 25133 I N Y Y

Coventry Health Care National Network 25133 P N Y Y

Coventry Health Care of Delaware Inc 25133 I Y Y Y

Coventry Health Care of Delaware Inc 25133 P Y Y Y

Coventry Health Care of Georgia Inc. 25133 I N Y Y

Coventry Health Care of Georgia Inc. 25133 P N Y Y

Coventry Health Care of Illinois 25133 I N Y Y

Coventry Health Care of Illinois 25133 P N Y Y

Coventry Health Care of Iowa Inc 25133 I N Y Y

Coventry Health Care of Iowa Inc 25133 P N Y Y

Coventry Health Care of Kansas Inc 25133 I N Y Y

Coventry Health Care of Kansas Inc 25133 P N Y Y

Coventry Health Care of Louisiana Inc 25133 I N Y Y

Coventry Health Care of Louisiana Inc 25133 P N Y Y

Coventry Health Care of Missouri 25133 I N Y Y

Coventry Health Care of Missouri 25133 P N Y Y

Coventry Health Care of Nebraska Inc 25133 I N Y Y

Coventry Health Care of Nebraska Inc 25133 P N Y Y

Coventry Health Care of Nevada 25133 I N Y Y

Coventry Health Care of Nevada 25133 P N Y Y

Coventry Health Care of the Carolinas 25133 I N Y Y

Coventry Health Care of the Carolinas 25133 P N Y Y

Coventry Health Care of Virginia 25133 I N Y Y

Coventry Health Care of Virginia 25133 P N Y Y

Coventry Summitt Health Plan Inc. 25133 I N na Y

Coventry Summitt Health Plan Inc. 25133 P N na Y

Page 35 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

CoventryCares - Aetna Better Health of Michigan (JVHL) J8JVH I Y Y Y Provider must be an approved JVHL lab

CoventryCares - Aetna Better Health of Michigan (JVHL) J8JVH P Y Y Y Provider must be an approved JVHL lab

CoventryCares of Kentucky 25133 I N Y Y

CoventryCares of Kentucky 25133 P N Y Y

CoventryCares of Michigan 128MI I N Y Y ERA Payer Code 25133

CoventryCares of Michigan 128MI P N Y Y ERA Payer Code 25133

CoventryCares of Pennsylvania 23228 I N Y Y ERA Payer Code 25133

CoventryCares of Pennsylvania 23228 P N Y Y ERA Payer Code 25133

Cox Health Plan 00119 I N Y N

Cox Health Plan 00019 P N Y N

Creative Medical Systems 64068 I N na N

Creative Medical Systems 64068 P N na N

Creative Plan Administrators 37320 I N na N

Creative Plan Administrators 37320 P N na N

Crescent Health Solutions 56213 I N na N

Crescent Health Solutions 56213 P N na Y

Crown City Medical Group MPM35 I N na Y

Crown City Medical Group MPM35 P N na Y

Croy-Hall Mgmt. Inc. 37266 I N na N

Croy-Hall Mgmt. Inc. 37266 P N na N

Crystal Run Health Plans 46120 I N na Y

Crystal Run Health Plans 46430 I N Y Y Only valid for claims with DOS on or after 1/1/2018.

Crystal Run Health Plans 46120 P N na Y

Crystal Run Health Plans 46430 P N Y Y Only valid for claims with DOS on or after 1/1/2018.

CSI Life (ERA Only) na Y ERA Only

CTI ADMINISTRATORS INC. 42141 I N Y Y

CTI ADMINISTRATORS INC. 42141 P N Y Y

Current Health Solutions 77153 I N na N

Current Health Solutions 77153 P N na N

Custom Design Benefits 82056 I N Y N

Custom Design Benefits 82056 P N Y N

CWIBENEFITS INC. 57080 I N Y Y

CWIBENEFITS INC. 57080 P N Y Y

Dakotacare DAK01 I N na Y

Page 36 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Dakotacare DAK01 P N Y Y

Dart Member Care CB987 I N na N

Dart Member Care CB987 P N na N

Davis Vision 00157 P Y na N

Dean Health Plan 39113 I N Y N

Dean Health Plan 39113 P N Y N

DELANO IPA 77124 I N Y N

DELANO IPA 77124 P N Y N

Delaware Medicaid 12K87 I N Y Y

Delaware Medicaid SKDE0 P N Y Y

Delaware Medicare 12M76 I Y Y Y

Delaware Medicare SMDE0 P Y Y Y

Dell Children's Health Plan 74272 I N Y Y

Dell Children's Health Plan 74272 P N Y Y

Delta Dental Northeast (ME, NH, VT) (ERA Only) 02027 I na Y ERA Only

Delta Dental Northeast (ME, NH, VT) (ERA Only) 02027 P na Y ERA Only

Delta Dental of Wisconsin (ERA Only) 39069 I na Y ERA Only

Delta Dental of Wisconsin (ERA Only) 39069 P na Y ERA Only

Delta Health Systems DHS01 I N Y Y

Delta Health Systems DHS01 P N Y Y

DentaQuest Vision 63740 P N na Y

DentaQuest-Government Plans-Wisconsin (ERA Only) CX014 I na Y ERA Only

DentaQuest-Government Plans-Wisconsin (ERA Only) CX014 P na Y ERA Only

Denver Health - Indigent 84134 P N na N

Denver Health and Hospital Authority 84133 I N na N

Denver Health and Hospital Authority 84133 P N na N

Denver Health Medical Plan 84135 I N na N

Denver Health Medical Plan 84135 P N na N

Denver Health Medical Plan Inc. - Medicare Choice 84131 I N na N

Denver Health Medical Plan Inc. - Medicare Choice 84131 P N na N

Deseret Mutual 12X35 I Y Y N ERA Payer Code SX105

Deseret Mutual UH105 P Y Y N ERA Payer Code SX105

Desert Medical Group DESRT P N na N

Desert Oasis Healthcare 44006 P N na N

Page 37 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Diamond Plan (Maryland Medicaid) 25133 I N na Y

Diamond Plan (Maryland Medicaid) 25133 P N na Y

Dignity Health (ERA Only) na Y ERA Only

Direct Care Administrators DCA62 P N na Y

District of Columbia Medicaid 12001 I Y Y Y

District of Columbia Medicaid SKDC0 P Y Y Y

District of Columbia Medicare 12M63 I Y na Y

District of Columbia Medicare SMDC0 P Y Y Y

Diversified Administration Corporation 06102 I N na N

Diversified Administration Corporation 06102 P N na N

DMC Care (JVHL) JSJVH I Y Y Y Provider must be an approved JVHL lab

DMC Care (JVHL) JSJVH P Y Y Y Provider must be an approved JVHL lab

Downey Select IPA (Applecare Medical Managment) APP01 P N na Y

Dreyer Health DREYR P N na Y

DRISCOLL CHILDREN'S HEALTH PLAN 74284 I N Y N

DRISCOLL CHILDREN'S HEALTH PLAN 74284 P N Y N

Dunn and Associates Benefits Administrators Inc. 35186 I N Y Y

Dunn and Associates Benefits Administrators Inc. 35186 P N Y Y

E.S. BEVERIDGE & ASSOCIATES 34108 I N na N

E.S. BEVERIDGE & ASSOCIATES 34108 P N na N

Early Intervention Central TH084 P N na N

East Carolina Behavioral Health 56089 I N Y N

East Carolina Behavioral Health 56089 P N Y N

East Pointe Behavioral Health 08044 I N Y Y

Payer returns ERA's automatically once electronic claim

submission begins.

East Pointe Behavioral Health 08044 P N Y Y


submission begins.

Eastland Medical Group 66122 I N na N

Eastland Medical Group 66122 P N na N

Easy Care MSO ECMSO I N na N

Easy Care MSO ECMSO P N na N

Easy Choice Health Plan of California 20532 I N na Y

Easy Choice Health Plan of California 20532 P N na Y

Easy Choice Health Plan of New York 24770 I N na N

Easy Choice Health Plan of New York 24770 P N na N

Page 38 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

EBMC 31074 I N na Y

EBMC 31074 P N na Y

EBMS (Employee Benefit Management Services Inc.) 12X44 I N y N ERA Payer Code 81039

EBMS (Employee Benefit Management Services Inc.) 81039 P N y Y ERA Payer Code 81039

Educators Mutual (EMIA) SX110 P N Y N

EHI (Employers Health Insurance) 73288 I N na N

EHS Medical Group - Fresno SYMED I N na N

EHS Medical Group - Fresno SYMED P N na N

El Paso First - CHIP 12T27 I N na N

El Paso First - CHIP TH090 P N na N

ElderPlan Inc. 31625 I N Y N

ElderPlan Inc. 31625 P N Y N

Elderwood Health 03964 I N na N

Elderwood Health 03964 P N na N

Element Care Inc. 04326 I N Y N

Element Care Inc. 04326 P N Y N

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

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

Emergency Medical Services Fund - Orange County CA 95600 P N na N

EMHS Employee Health Plan 16565 I N Y Y

EMHS Employee Health Plan 16565 P N Y Y

EMI-KP Ambulance Claims 59299 P N na N

EMPHESYS 73288 I N na N

Empire Blue Cross and Blue Shield of New York 00303 I N Y Y

Empire Blue Cross and Blue Shield of New York 00803 P N Y Y

Empire Medicare Services 12M76 I Y na Y

Empire Omnipro (BC NY City) 12B36 I N na Y

Empire Omnipro (BC NY State) 12B35 I N na Y

Empire Physician's Medical Group EMP01 P N na N

Employee Benefit Concepts (Farmington Hills MI) 38241 I N na N

Employee Benefit Concepts (Farmington Hills MI) 38241 P N na N

Employee Benefit Consultants Inc. (aka EBSO) 37257 I N Y N

Employee Benefit Consultants Inc. (aka EBSO) 37257 P N Y Y

Employee Benefit Logistics 92135 I N na Y

Page 39 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Employee Benefit Logistics 92135 P N na Y

Employee Benefit Management Corp (EBMC) 31074 I N na Y

Employee Benefit Management Corp (EBMC) 31074 P N na Y

Employee Benefit Services 37216 I N Y Y

Employee Benefit Services 37216 P N Y Y

Employee Benefit Services of San Antonio TH109 P N na N

Employee Benefit Systems 42149 I N na N

Employee Benefit Systems 42149 P N na N

Employee Benefits Administration And Managment Company 22262 P N Y N

Employee Benefits Plan Administration Inc. (E.B.P.A.) 03036 I N Y N

Employee Benefits Plan Administration Inc. (E.B.P.A.) 03036 P N Y N

Employee Health Systems SYMED I N na N

Employee Health Systems SYMED P N na N

Employee Plans LLC 35112 I N na N

Employee Plans LLC 35112 P N na N

Employee Security, Inc. 54098 P N na Y

Employer Plan Services Inc 74212 I N Y Y aka Fringe Benefit Group - Houston

Employer Plan Services Inc 74212 P N Y Y aka Fringe Benefit Group - Houston

Employers Direct Health 75232 I N na N

Employers Direct Health 75232 P N na N

Employer's Direct Health - Employee Plan 75236 I N na N

Employer's Direct Health - Employee Plan 75236 P N na N

Employer's Direct Health - FI 75235 I N na N

Employer's Direct Health - FI 75235 P N na N

Employer's Direct Health - SF 75233 I N na N

Employer's Direct Health - SF 75233 P N na N

Employers Health 73288 I N na N

Employers Health Insurance 73288 I N na N

Employers Mutual Inc (Jacksonville Florida) 59298 I N na N

Employers Mutual Inc (Jacksonville Florida) 59298 P N na N

Employers Mutual Inc. (Stuart Florida) 59331 I N na N

Employers Mutual Inc. (Stuart Florida) 59331 P N na N

Encircle PPO 35206 I N na N

Encircle PPO 35206 P N na N

Page 40 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Encore Health Network 35206 I N na N

Encore Health Network 35206 P N na N

Enstar Natural Gas 91136 I N na N

Enstar Natural Gas 91136 P N na N

Entrust, Inc. 36878 I N na Y

Entrust, Inc. 36878 P N na Y

Envolve Benefit Options (formerly OptiCare Managed Vision) 56190 P N Y N

EQUICOR 62308 I N Y Y Payer Requires Copy of EOB for Missing ERAs

EQUICOR 62308 P N Y Y Payer Requires Copy of EOB for Missing ERAs

EQUICOR - PPO 62308 I N Y Y Payer Requires Copy of EOB for Missing ERAs

EQUICOR - PPO 62308 P N Y Y Payer Requires Copy of EOB for Missing ERAs

Equitable (ERA Only) A7213 I na Y ERA Only

Equitable (ERA Only) A7213 P na Y ERA Only

Erie Insurance Medicare Supplement (ERA Only) na Y ERA Only

ERISA TH110 P N na Y

ESSENCE HEALTHCARE 20818 I N Y N

ESSENCE HEALTHCARE 20818 P N Y N

Everence 35605 I N Y Y

Everence 35605 P N Y Y

Everest Reinsurance (ERA Only) na Y ERA Only

eviCore 62160 I N Y N

eviCore 62160 P N Y N

Evolutions Healthcare Systems (New Port Richey FL) 59313 I N Y N

Evolutions Healthcare Systems (New Port Richey FL) 59313 P N Y N

Exceedent LLC 22344 I N na Y

Exceedent LLC 22344 P N na Y

Excel MSO EXC01 P N na N

Excellus - BCBS Utica Watertown 12B38 I N Y Y

Excellus - BCBS Utica Watertown SB806 P N Y Y

Excellus - Blue Cross Blue Shield Central NY 12B37 I N Y Y

Excellus - Blue Cross Blue Shield Central NY SB805 P N Y Y

Excellus - Blue Cross Blue Shield Rochester Area 12B40 I N Y Y

Excellus - Blue Cross Blue Shield Rochester Area SB804 P N Y Y

ExclusiCare 71412 I N Y N

Page 41 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

ExclusiCare 71412 P N Y N

Extended Care MLTC 46166 I N na Y

Extended Care MLTC 46166 P N na Y

Eye Management, Inc. (EMI) 65062 P N Y N

EyeMed 31165 P N na N

F40 Alaska Carpenters Trust 91136 I N na N

FABOH (CHP/RPU) 39112 I N na Y

FABOH (CHP/RPU) 39112 P N na Y

Facey Medical Foundation 95432 P N na N

FACS Group 37300 I N na N

FACS Group 37300 P N na N

Fallon Community Health Plan 22254 I N Y Y

Fallon Community Health Plan 22254 P N Y Y

Family Care CCO 93121 I N Y N

Family Care CCO 93121 P N Y N

Family Care Specialists FCS01 I N na Y

Family Care Specialists FCS01 P N na Y

Family Choice Medical Group CAPMN I N na N

Family Choice Medical Group CAPMN P N na N

Family Health Network - FHN 85468 I N Y N

Family Health Network - FHN 85468 P N Y N

FARA TP044 P N na Y

Farm Bureau Health Plans (ERA Only) 62045 I na Y ERA Only

Farm Bureau Health Plans (ERA Only) 62045 P na Y ERA Only

Farm Family Life 14140 I N na Y

Farm Family Life 14140 P N na Y

FCE Benefit Administrators 33033 I N Y Y

FCE Benefit Administrators 33033 P N Y Y

FDNY World Trade Center Health Plan FDNYU I Y Y N

FDNY World Trade Center Health Plan FDNYP P Y Y N

Federal Employee Plan of South Carolina (BCBS SC) 00402 I N Y N

Federal Employee Plan of South Carolina (BCBS SC) 00402 P N Y N

Federal Employees Health Benefit Plan (MHBP) (ERA Only) 25133 I na Y ERA Only

Federal Employees Health Benefit Plan (MHBP) (ERA Only) 25133 P na Y ERA Only

Page 42 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Federated Benefits 37300 I N na N

Federated Benefits 37300 P N na N

Federated HR Services 37300 I N na N

Federated HR Services 37300 P N na N

Fidelis Care New York 11315 I N Y N Change of Vendor letter & EFT Enrollment is required for ERA

Fidelis Care New York 11315 P N Y N Change of Vendor letter & EFT Enrollment is required for ERA

First Agency 88055 I N na N

First Agency 88055 P N na N

First Carolina Care 56196 I N Y N

First Carolina Care 56196 P N Y N

First Choice Health Administrators 91131 I N Y Y

First Choice Health Administrators 91131 P N Y Y

First Choice Health Network 91131 I N Y Y

First Choice Health Network 91131 P N Y Y

First Choice Medical Group FCMG1 I N na Y

First Choice Medical Group FCMG1 P N na Y

First Choice of Midwest 75138 I N na Y

First Choice of Midwest 75138 P N na Y

First Choice VIP Care Plus 77009 I N Y N

First Choice VIP Care Plus 77009 P N Y N

First Health | The Lewer Agency 96708 I N na N

First Health | The Lewer Agency 96708 P N na N

First Health Network 73159 I N na Y

First Health Network 73159 P N na Y

First Medical Network (FMN) - Atlanta GA 29076 I N Y Y

First Medical Network (FMN) - Atlanta GA 29076 P N Y Y

First Source/Arkansas Blue Cross 12047 I Y na Y

First United American Life Insurance Company (ERA Only) I na Y na ERA Only

First United American Life Insurance Company (ERA Only) P na Y na ERA Only

FirstCare 94999 I N Y N

FirstCare 94999 P N Y N

Florida Blue 00590 I N Y Y

Florida Blue 00590 P N Y Y

Page 43 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Florida Community Care FLCCR I N Y Y

Florida Community Care FLCCR P N Y Y

Florida Health Care Plan 59322 I N na N

Florida Health Care Plan 59322 P N na N

Florida Hospital Waterman 48116 I N na N

Florida Hospital Waterman 48116 P N na N

Florida Medicaid 77027 I Y Y Y

Florida Medicaid 77027 P Y Y Y

Florida Medicare 09101 I Y Y N

Florida Medicare 09102 P Y Y Y

FMH Benefit Services Inc. 48117 I N Y N

FMH Benefit Services Inc. 48117 P N Y N

Foreign Service Benefit Plan 25133 I N Y Y

Foreign Service Benefit Plan 25133 P N Y Y

FOUNDATION BENEFIT ADMINISTRATORS/CONTRACTOR EMPLOYEE BENEFITS ADMIN BOONG I N Y N

FOUNDATION BENEFIT ADMINISTRATORS/CONTRACTOR EMPLOYEE BENEFITS ADMIN BOONG P N Y N

Foundation for Medical Care of Tulare & Kings County TKFMC P N na N

Fox Valley Medicine Site 199 FVMCH I N na N

Fox Valley Medicine Site 199 FVMCH P N na N

Fox-Everett Inc. 64069 I N Y N

Fox-Everett Inc. 64069 P N Y N

Freedom Blue Medicare Advantage (for Claims with DOS prior to 2015) 12B44 I Y na Y

Freedom Health Plan 41212 I N Y N

Freedom Health Plan 41212 P N Y N

Freedom Life Insurance 62324 I N na N

Freedom Life Insurance 62324 P N na N

Fresenius Health Partners 43197 I N na Y

Fresenius Health Partners 43197 P N na Y

Fresenius Medical Care 23130 I N na N

Fresenius Medical Care 23130 P N na N

Fresno PACE 99660 I N na N

Fresno PACE 99660 P N na N

Friant Water Users TKFMC P N na N

Fringe Benefit Group - Austin 45289 I N na N

Page 44 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Fringe Benefit Group - Austin 45289 P N na N

Fringe Benefit Management 59069 I N na N

Fringe Benefit Management 59069 P N na N

Fringe Benefits Coordinators 59204 I N na Y

Fringe Benefits Coordinators 59204 P N na Y

FrontPath Health Coalition 34171 I N na N

FrontPath Health Coalition 34171 P N na N

Galveston County Indigent Health Care 30005 I N na N

Galveston County Indigent Health Care 30005 P N na N

Gardena Memorial Medical Center SYMED I N na N

Gardena Memorial Medical Center SYMED P N na N

Gateway SX078 P N na Y

Gateway Health Plan - Medicare Assured 60550 I N Y N

Gateway Health Plan - Medicare Assured 60550 P N Y N

Gateway Health Plan Medicaid PA 25169 I N Y N

Gateway Health Plan Medicaid PA 25169 P N Y N

Gateway Health Plan OH - Medicare Assured 91741 I N Y N

Gateway Health Plan OH - Medicare Assured 91741 P N Y N

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

Gateway to Better Health Plan - MO Medicaid U317M I Y Y Y

Gateway to Better Health Plan - MO Medicaid 4317M P Y Y Y

GBS Group Benefit Services Incorporated 80241 I N na

GBS Group Benefit Services Incorporated 80241 P N na

Geisinger Health Plan 75273 I N Y Y

Geisinger Health Plan 75273 P N Y Y

GEMCare (Golden Empire Managed Care System) MCS01 P N Y N

Gemcare Health Plan 20376 I N na N

Gemcare Health Plan 20376 P N na N

Gemcare IPA 27133 I N na Y

Gemcare IPA 27133 P N na Y

Generations Healthcare 46050 I N na N

Generations Healthcare 46050 P N na N

Generations-Hillcrest 46051 I N na N

Generations-Hillcrest 46051 P N na N

Page 45 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Genesis Healthcare PROSP I N Y N

Genesis Healthcare PROSP P N Y N

Georgia Medicaid 12K05 I Y Y Y

Georgia Medicaid SKGA0 P Y Y Y

Georgia Medicare 12M05 I Y Y Y

Georgia Medicare SMGA0 P Y Y Y

Gerber Life (ERA Only) na Y ERA Only

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

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

GHI HMO 25531 I N Y Y

GHI HMO 25531 P N Y Y

GHP (Group Health Plan) - MULTIPLAN PHCS/GROUP HEALTH 25141 P N na N

Gilsbar Inc. 07205 I N Y N

Gilsbar Inc. 07205 P N Y N

Glendale Physician's Alliance AMM02 P N na N

Global Care Inc. 07689 I N Y Y

Global Care Inc. 07689 P N Y Y

Global Excel Management GEM01 I N na Y

Global Excel Management GEM01 P N na Y

Global Health GHOKC I N na Y

Global Health GHOKC P N na Y

Global Healthcare Alliance 12X59 I N na N

Globe Life and Accident Insurance Company (ERA Only) 91472 I na Y na ERA Only

Globe Life and Accident Insurance Company (ERA Only) 91472 P na Y na ERA Only

GMS Inc. 47083 I N Y Y

GMS Inc. 47083 P N Y Y

Gold Coast Health Plan 77160 I N Y N

Gold Coast Health Plan 77160 P N Y N

Golden Shore Medical Group (GSMG) NMM03 I N Y Y

Golden Shore Medical Group (GSMG) NMM03 P N Y Y

Golden State Medical Group MBA01 I N na Y ERA not available for this plan

Golden State Medical Group MBA01 P N na Y ERA not available for this plan

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

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

Page 46 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Good Samaritan Medical Practice Association PROSP I N na N

All claims for Good Samaritan Medical Practice Association

must be submitted using payer ID PROSP as of 11/1/2018.

Claims submitted using payer IP086 will not be accepted.

Good Samaritan Medical Practice Association PROSP P N na N

All claims for Good Samaritan Medical Practice Association

must be submitted using payer ID PROSP as of 11/1/2018.

Claims submitted using payer IP086 will not be accepted.

GOOD SHEPHERD HOSPICE INC 76923 I N na Y

GOOD SHEPHERD HOSPICE INC 76923 P N na Y

Government Employees Health Association (45235) 45235 P N na N

For dates of service prior to 12/31/2014 in the states of NJ and

NY

Government Employees Health Association (Multiplan) 45235 I N na N

For dates of service prior to 12/31/2014 in the states of NJ and

NY

Government Employees Hospital Association (GEHA) 44054 I N Y N

Government Employees Hospital Association (GEHA) 44054 P N Y N

Grand Valley Health Plan 95453 I N na N

Great American Life Ins. Co-Medicare Supplement 13193 I N Y Y

Great American Life Ins. Co-Medicare Supplement 13193 P N Y Y

Great Lakes PACE 39640 I N na N

Great Lakes PACE 39640 P N na N

Greater Covina Medical Group GCMG1 P N na N

Greater Newport Physicians GNPMG I N Y Y

Greater Newport Physicians GNPMG P N Y Y

Greater Orange County Medical Group NMM01 P N Y N

Greater San Gabriel Med Grp NMM01 P N Y N

Greater Valley HCP01 I N na N

Great-West Healthcare 80705 I N Y N ERA Payer Code 62308

Great-West Healthcare 80705 P N Y N ERA Payer Code 62308

Great-West Healthcare (formerly American General) 63665 I N na N

Great-West Healthcare (formerly American General) 63665 P N na N

Greek Catholic Union (ERA Only) A7213 I na Y ERA Only

Greek Catholic Union (ERA Only) A7213 P na Y ERA Only

Group Administrators Ltd. 36338 I N na N

Group Administrators Ltd. 36338 P N na N

Group and Pension Administrators 48143 I N Y N

Group and Pension Administrators 48143 P N Y N

Page 47 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Group Benefit Services Inc. CB951 I N Y N

Group Benefit Services Inc. CB951 P N Y N

Group Benefits - Louisiana 72087 P N na N

Group Health Co-op 12X16 I Y na Y

Group Health Cooperative of Eau Claire 95192 I N Y Y

Group Health Cooperative of Eau Claire 95192 P N Y Y

Group Health Cooperative of South Central Wisconsin 39167 I N Y N

Group Health Cooperative of South Central Wisconsin 39167 P N Y N

Group Insurance Service Center Inc. 37276 I N na N

Group Insurance Service Center Inc. 37276 P N na N

Group Resources 28680 I N na Y

Group Resources 28680 P N na Y

Guardian Life Insurance Company of America 64246 I N Y N

Guardian Life Insurance Company of America 64246 P N Y N

Gulf Stream-General Dynamics CB624 I N na Y

Gulf Stream-General Dynamics CB624 P N na Y

Gundersen Lutheran Health Plan 39180 I N Y N

Gundersen Lutheran Health Plan 39180 P N Y N

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

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

HAA Preferred Partners 65101 I N na N

HAA Preferred Partners 65101 P N na N

Hamaspik Choice 47738 I N na N

Hamaspik Choice 47738 P N na N

Hammerman and Gainer, Inc. 97258 I N na N

Hammerman and Gainer, Inc. 97258 P N na N

HAP Midwest Health Plan MHP77 I N na Y

HAP Midwest Health Plan MHP77 P N na Y

HAP Midwest Health Plan (JVHL) JBJVH I Y Y Y Provider must be an approved JVHL lab

HAP Midwest Health Plan (JVHL) JBJVH P Y Y Y Provider must be an approved JVHL lab

Harbor Health Plan (JVHL) M1JVH I Y Y Y Provider must be an approved JVHL lab

Harbor Health Plan (JVHL) M1JVH P Y Y Y Provider must be an approved JVHL lab

Harken Health 43313 I N na Y

Harken Health 43313 P N na Y

Page 48 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Harmony Health Plan of Illinois 36406 I N Y Y ERA Payer Code 14163

Harmony Health Plan of Illinois 36406 P N Y Y ERA Payer Code 14163

Harmony Health Plan of Indiana 36405 I N Y N ERA Payer Code 14163

Harmony Health Plan of Indiana 36405 P N Y Y ERA Payer Code 14163

Harpeth IPA - Amerivantage 75126 P N na Y

Harrimon Jones HCP01 I N na N

Harrington Health Non-EPO 59143 I N na N

Harrington Health Non-EPO 59143 P N na N

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

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

Harris Methodist Health Plan 75201 I N na N

Harvard Community Health Plan 04245 I N na Y

Harvard Community Health Plan 04245 P N na Y

Harvard Pilgrim Health Care 04271 I N Y Y

Harvard Pilgrim Health Care 04271 P N Y Y

Hawaii Blue Cross 12B62 I Y na Y

Hawaii Medicaid 12K62 I N na Y

Hawaii Medicaid SKHI0 P Y na Y

Hawaii Medical Assurance Association (HMAA/HWMG) 48330 I N Y N

Hawaii Medical Assurance Association (HMAA/HWMG) 48330 P N Y N

Hawaii Medical Service Association (HMSA) SB971 P Y Y Y ERA Payer Code HMSA1

Hawaii Medicare SMHI0 P Y Y Y

HCC Life Insurance UCCMI I N na N

HCC Life Insurance HCCMI P N na N

HCH Administration 37111 I N na N

HCH Administration 37111 P N na N

HCH Administration (formerly John P Pearl and Associates) 37215 I N Y N

HCH Administration (formerly John P Pearl and Associates) 37215 P N Y N

HCS - Health Claims Service (Boise ID) 82018 I N na N

HCS - Health Claims Service (Boise ID) 82018 P N na N

Health Alliance Medical Plans of Illinois 77950 I N Y Y

Health Alliance Medical Plans of Illinois 77950 P N Y Y

Health Alliance Plan (Capitated Contracts) (JVHL) JGJVH I Y Y Y Provider must be an approved JVHL lab

Health Alliance Plan (Capitated Contracts) (JVHL) JGJVH P Y Y Y Provider must be an approved JVHL lab

Page 49 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Health Alliance Plan (Fee for Service Contracts) (JVHL) JHJVH I Y Y Y Provider must be an approved JVHL lab

Health Alliance Plan (Fee for Service Contracts) (JVHL) JHJVH P Y Y Y Provider must be an approved JVHL lab

Health Alliance Plan (HAP) 38224 I N Y N

Health Alliance Plan (HAP) 38224 P N Y N

Health America Inc./Health Assurance/Advantra 25133 I N Y Y

Health America Inc./Health Assurance/Advantra 25133 P N Y Y

Health Care Network of Wisconsin (HCN) 42102 I N na N

Health Care Network of Wisconsin (HCN) 42102 P N na N

Health Care Savings 56142 I N na N

Health Choice Arizona 62179 I N Y N

Health Choice Arizona 62179 P N Y N

Health Choice Generations 62180 I N Y N

Health Choice Generations 62180 P N Y N

Health Choice Insurance Co 46221 I N Y Y

Health Choice Insurance Co 46221 P N Y Y

Health Choice Integrated Care 22100 I N na Y

Health Choice Integrated Care 22100 P N na Y

Health Choice Utah 45399 I N na N

Health Choice Utah 45399 P N na N

Health Cost Solutions 62111 I N Y N

Health Cost Solutions 62111 P N Y N

Health Design Plus (Hudson OH) 34158 I N na N

Health Design Plus (Hudson OH) 34158 P N na N

Health Economics Corp 39026 I N Y Y

Health Economics Corp 39026 P N Y Y

Health First Health Plan Inc. (ERA Only) A5234 I na Y ERA Only

Health First Health Plan Inc. (ERA Only) A5234 P na Y ERA Only

Health First Health Plan Inc. (ERA Only) 15064 Y ERA Only. EFT also required.

Health First TPA 95019 I N na N

Health First TPA 95019 P N na N

Health Management Administrators (HMA) TH049 P N na N

Health Net - VA Patient Centered Community Care Program 68021 I N Y N

Health Net - VA Patient Centered Community Care Program 68021 P N Y N

Health Net of Arizona (for DOS prior to 10/01/18) 38309 I N Y Y Use Payer Code 68069 for DOS after 9/30/18

Page 50 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Health Net of Arizona (for DOS prior to 10/01/18) 38309 P N Y Y Use Payer Code 68069 for DOS after 9/30/18

Health Net of California and Oregon - Claims 95567 I N Y Y

Health Net of California and Oregon - Claims 95567 P N Y Y

Health Network One 12K89 I N Y N ERA Payer Code 65062

Health Network One 65062 P N Y N

Health New England 04286 I N Y N

Health New England 04286 P N Y N

Health Options Inc (FL - BCBS HMO) 12B26 I N na Y

Health Options Inc (FL - BCBS HMO) SX030 P N na Y

Health Partners - Jackson TN 62157 I N na N

Health Partners - Jackson TN 62157 P N na N

Health Partners PA 80142 I N Y N

Health Partners PA 80142 P N Y N

Health Payment Systems Inc. 20270 I N Y N

Health Payment Systems Inc. 20270 P N Y N

Health Plan of Michigan 83253 I N Y N

Health Plan of Michigan 83253 P N Y N

Health Plan of Nevada 76342 I N Y Y

Health Plan of Nevada 76342 P N Y Y

Health Plan of San Joaquin 68035 I N Y Y

Health Plan of San Joaquin 68035 P N Y Y

Health Plan of San Mateo HPSM1 I N Y N

Health Plan of San Mateo HPSM1 P N Y N

Health Plans Inc. 44273 I N Y N

Health Plans Inc. 44273 P N Y N

Health Plus (JVHL) KEJVH I Y Y Y Provider must be an approved JVHL lab

Health Plus (JVHL) KEJVH P Y Y Y Provider must be an approved JVHL lab

Health Plus Physicians Organization 63363 I N na N

Health Plus Physicians Organization 63363 P N na N

Health Risk Management 41170 I N na N

Health Risk Management 41170 P N na N

Health Services for Children with Special Needs 37290 I N Y N

Health Services for Children with Special Needs 37290 P N Y N

Health Services Management 41150 P Y na N

Page 51 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

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

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

Health Special Risk 65449 I N na Y

Health Special Risk 65449 P N na Y

Health Tradition Health Plan HLTHT I N Y Y

Health Tradition Health Plan HLTHT P N Y Y

Healthamerica (ERA Only) 25133 I na Y ERA Only

Healthamerica (ERA Only) 25133 P na Y ERA Only

Healthcare District of Palm Beach County 95828 I Y na N

Healthcare District of Palm Beach County 95828 P Y na N

Healthcare Management Administrators (HMA) HMA01 I N Y Y

Healthcare Management Administrators (HMA) HMA01 P N Y Y

Healthcare Partners HCP01 I N Y N

Healthcare Partners HCP01 P N Y N

HealthCare Partners IPA 11328 I N Y Y

HealthCare Partners IPA 11328 P N Y Y

Healthcare Partners of Nevada 20501 I N na Y

Healthcare Partners of Nevada 20501 P N na Y

Healthcare Resources NW 56731 I N na N

Healthcare Resources NW 56731 P N na N

Healthcare Solutions Group 73147 I N Y Y

Healthcare Solutions Group 73147 P N Y Y

Healthcare USA (ERA Only) 25133 I na Y ERA Only

Healthcare USA (ERA Only) 25133 P na Y ERA Only

HealthChoice Oklahoma 71064 I N Y N Former payer code 22521

HealthChoice Oklahoma 71064 P N Y N Former payer code 22521

Healthcomp Inc. 85729 I N Y N

Healthcomp Inc. 85729 P N Y N

Healthease/Wellcare of FL 59608 I N Y N

Healthease/Wellcare of FL 59608 P N Y N

HealthEdge Administrators (Bakersfield CA) 95213 I N na N

HealthEdge Administrators (Bakersfield CA) 95213 P N na N

HealthEZ 41178 I N na N

HealthEZ 41178 P N na N

Page 52 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Healthfirst 65 Plus 80141 I N na Y

Healthfirst Family Health Plus (FHP) 80141 I N na Y

Healthfirst Health Plan of New Jersey 80141 I N Y Y

Healthfirst Health Plan of New Jersey 80141 P N Y Y

Healthfirst Inc. (New York) 80141 I N Y Y

Healthfirst Inc. (New York) 80141 P N Y Y

Healthfirst PHSP 80141 I N na Y

HealthFirst TPA 34185 P N na N

Healthfirst Tyler TX 75234 I N na Y

Healthfirst Tyler TX 75234 P N na Y

Healthgram Inc. 56144 I N Y N

Healthgram Inc. 56144 P N Y N

HealthGroup Limited 23274 I N na Y

HealthGroup Limited 23274 P N na Y

HealthGuard of Lancaster 23226 I N na Y

HealthGuard of Lancaster 23226 P N na Y

Healthlink HMO 96475 I N Y N

Healthlink HMO 96475 P N Y N

Healthlink PPO 90001 I N na Y

Healthlink PPO 90001 P N na Y

HealthNow - BCBS Northeastern NY 12B68 I Y na Y

HealthNow - BCBS Northeastern NY SB800 P Y Y Y

HealthNow - Blue Cross Blue Shield of Western NY 12B39 I Y Y Y

HealthNow - Blue Cross Blue Shield of Western NY SB801 P Y Y Y

Healthnow Division 55204 P Y Y Y

HealthPartners MN 12X51 I Y Y Y

HealthPartners MN SX009 P Y Y Y

HealthPlan Services 59140 I N Y N

HealthPlan Services 59140 P N Y Y

Healthscope Benefits - EHC Repricing 52429 I N na N

Healthscope Benefits - EHC Repricing 52429 P N na N

HealthSCOPE Benefits Inc. 71063 I N Y Y

HealthSCOPE Benefits Inc. 71063 P N Y N

HealthSelect IPA (IL) SB621 P N na Y

Page 53 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Healthsmart Accel 75237 I N na Y

Healthsmart Accel 75237 P N na Y

HealthSmart Benefit Solutions 37272 I N Y N

HealthSmart Benefit Solutions 37272 P N Y N

HealthSmart Benefit Solutions 37283 I N Y Y

HealthSmart Benefit Solutions 37283 P N Y Y

HealthSmart Benefit Solutions fka Wells Fargo TPA.Inc. 87815 I N Y Y

HealthSmart Benefit Solutions fka Wells Fargo TPA.Inc. 87815 P N Y Y

HealthSmart -Noble Mid Orange HSM01 I N na N

HealthSmart -Noble Mid Orange HSM01 P N na N

HealthSmart Preferred Care Inc. 75250 I N na Y

HealthSmart Preferred Care Inc. 75250 P N na Y

Healthsource AR (Med) (CIGNA) 71075 I N na Y

Healthsource AR (Med) (CIGNA) 71075 P N na Y

Healthsource CMHC 02041 I N na Y

Healthsource CMHC 02041 P N na Y

Healthsource GA (CIGNA) 58210 I N na Y

Healthsource GA (CIGNA) 58210 P N na Y

Healthsource KY 61127 I N na Y

Healthsource KY 61127 P N na Y

Healthsource Massachusetts Inc. 02041 I N na Y

Healthsource Massachusetts Inc. 02041 P N na Y

Healthsource ME 01041 I N na N

Healthsource ME 01041 P Y na N

Healthsource N. TX (CIGNA) 75255 I N na Y

Healthsource N. TX (CIGNA) 75255 P N na Y

Healthsource NC (CIGNA) 56147 I N na Y

Healthsource NC (CIGNA) 56147 P N na Y

Healthsource NH 02038 P N na Y

Healthsource OH 31141 I N na Y

Healthsource OH 31141 P N na Y

Healthsource Provident 68195 I N na Y

Healthsource Provident 68195 P N na Y

Healthsource SC 06119 I N na Y

Page 54 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Healthsource SC 06119 P N na Y

Healthsource TN (CIGNA) 62129 I N na Y

Healthsource TN (CIGNA) 62129 P N na Y

HealthSpring HMO/HealthSpring Medicare+Choice 63092 I N Y N

HealthSpring HMO/HealthSpring Medicare+Choice 63092 P N Y N

Healthsun Health Plans HESUN P N na N

HealthTeam Advantage 88250 I N na N

HealthTeam Advantage 88250 P N na N

Healthways WholeHealth Networks 58213 P N na N

Healthy Texas 68064 I N na Y

Healthy Texas 68064 P N na Y

Healthy York Network 22251 I N na Y

Healthy York Network 22251 P N na Y

HealthyBlue 00661 I N Y N

HealthyBlue 00661 P N Y N

Heartland National (ERA Only) A0001 I na Y ERA Only

Heartland National (ERA Only) A0001 P na Y ERA Only

Hennepin Health (formerly Metropolitan Health Plan) 10850 I N Y Y

Hennepin Health (formerly Metropolitan Health Plan) 10850 P N Y Y

Heritage Consultants 59230 P N na N

Heritage Provider Network DESRT P N na N

Heritage Victor Valley Medical Group 30862 I N na N

Heritage Victor Valley Medical Group 30862 P N na N

Heritage Victor Valley Medical Group (Regal) VVMG1 P N na N

HFN Inc. 36335 I N Y N

HFN Inc. 36335 P N Y N

High Desert Medical Group 95393 I N na N

High Desert Medical Group 95393 P N na N

Highmark BCBS Delaware Health Options 47181 I N Y N

Highmark BCBS Delaware Health Options 47181 P N Y N

Highmark Blue Cross & Blue Shield of Pennsylvania 54771 P Y Y Y

Highmark Blue Cross & Blue Shield of Pennsylvania Central 54771C I Y Y Y

Highmark Blue Cross & Blue Shield of Pennsylvania Western 54771W I Y Y Y

Highmark Senior Solutions PA (for Claims with DOS after to 2014) 95462 I Y Y Y (aka Freedom Blue Medicare Advantage)

Page 55 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Highmark Senior Solutions PA (for Claims with DOS after to 2014) 95462 P Y Y Y (aka Freedom Blue Medicare Advantage)

Highmark Senior Solutions WV (for Claims with DOS after to 2014) 95461 I Y Y Y (aka Freedom Blue Medicare Advantage)

Highmark Senior Solutions WV (for Claims with DOS after to 2014) 95461 P Y Y Y (aka Freedom Blue Medicare Advantage)

Hill Physicians Medical Group 00046 I N na N

Hill Physicians Medical Group 00046 P N na N

HIP - Health Insurance Plan of Greater New York 55247 I N Y N

HIP - Health Insurance Plan of Greater New York 55247 P N Y N

Hispanic Physicians IPA HPFFS P N na N

Hispanic Physicians IPA (Encounters Only) HPIPA P N na N

HMA - Health Management Admin 12T11 I N na Y

HMA Hawaii 86066 I N Y N

HMA Hawaii 86066 P N Y N

HMC HealthWorks aka Health Management Co 75318 I N na N

HMC HealthWorks aka Health Management Co 75318 P N na N

HMSO-Highline Medical Service Organization 91164 I N na Y

HMSO-Highline Medical Service Organization 91164 P N na Y

HN1 Therapy Network (HN1TN) 12K89 I N Y N ERA Payer Code 65062

HN1 Therapy Network (HN1TN) 65062 P N Y N

Home Health & Hospice J10 Cahaba 12M53 I Y Y Y

Home Health & Hospice J15 Cigna 12M97 I Y Y Y

Home Health & Hospice J6 NGS RHHWI I Y Y N

Home Health & Hospice JC Palmetto 12M80 I Y Y Y

Home Health & Hospice JK NGS JKHHH I Y Y Y

Homelink 30750 I N na Y

Homelink 30750 P N na Y

Hometown Health Plan Nevada 88023 I N Y Y

Hometown Health Plan Nevada 88023 P N Y Y

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) 22099 I Y Y Y

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) 22099 P Y Y Y

Horizon Healthcare of NY 22099 I Y na Y

Horizon Healthcare of NY 22099 P Y na Y

Horizon NJ Health 22326 I N Y Y

Horizon NJ Health 22326 P N Y Y

Hotel Employees & Restaurant Employees Health Trust 91136 I N Y N

Page 56 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Hotel Employees & Restaurant Employees Health Trust 91136 P N Y N

HS1 Medical Management 12K89 I N Y N ERA Payer Code 65062

HS1 Medical Management 65062 P N Y N

HSBS Memphis 37224 I N Y N

HSBS Memphis 37224 P N Y N

HSBS Oklahoma City 37256 I N Y N

HSBS Oklahoma City 37256 P N Y N

HSBS World Trade Center Health Program 31172 I N Y Y

HSBS World Trade Center Health Program 31172 P N Y Y

HSHS Medical Group IPA 37137 I N na N

HSHS Medical Group IPA 37137 P N na N

Humana (JVHL) KVJVH I Y Y Y Provider must be an approved JVHL lab

Humana (JVHL) KVJVH P Y Y Y Provider must be an approved JVHL lab

Humana Choice Care Network (Batch) 611X1 I N Y Y

Humana Choice Care Network (Batch) 611X1 P N Y Y

Humana Dermatology - New Century Health NCH02 P N na N

Humana Emphesys (Batch) 611X1 I N Y Y

Humana Emphesys (Batch) 611X1 P N Y Y

Humana Employers Health Insurance (Batch) 611X1 I N Y Y

Humana Employers Health Insurance (Batch) 611X1 P N Y Y

Humana Inc. (Batch) 611X1 I N Y Y

Humana Inc. (Batch) 611X1 P N Y Y

Humana Long Term Care 61115 I N na N

Humana Long Term Care 61115 P N na N

Humana of Puerto Rico 65018 I N na N

Humana of Puerto Rico 65018 P N na N

Humana Veterans Healthcare Services 61120 I N na N

Humana Veterans Healthcare Services 61120 P N na N

Humboldt-Del Norte Foundation for Medical Care 94154 P N na N

Huron PACE 54750 I N na N

Huron PACE 54750 P N na N

Hylton Payroll (Benefit Plan Administrators) 19753 I N Y N

Hylton Payroll (Benefit Plan Administrators) 19753 P N Y N

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

Page 57 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

I. E. Shaffer (West Trenton NJ) 22175 P N Y N

IBC Personal Choice 12X26 I Y Y Y ERA Payer Code SX055

IBC Personal Choice SX083 P Y Y Y ERA Payer Code SX055

IBEW Local 640 & Arizona Chapter NECA Health & Welfare Trust 74234 P N na N

IBG Administrators, LLC 81810 I N na N

IBG Administrators, LLC 81810 P N na N

IBM Business Transformation Outsourcing Insurance Services Corporate 19028 I N na N

IBM Business Transformation Outsourcing Insurance Services Corporate 19028 P N na N

iCare Health Solutions 26054 P N na Y

iCircle of New York 33884 I N na Y

iCircle of New York 33884 P N na Y

Idaho Medicaid 12K07 I N Y Y

Idaho Medicaid SKID0 P N Y Y

Idaho Medicare 12M07 I Y Y Y

Idaho Medicare SMID0 P Y Y Y

IdeaLife Insurance (ERA Only) na Y ERA Only

IEC Group - AmeriBen 97661 I N na N

IEC Group - AmeriBen 97661 P N na N

IHG Direct 75274 I N na N

IHG Direct 75274 P N na N

IlliniCare 68069 I N Y Y

IlliniCare 68069 P N Y Y

Illinois Health Plan DMG01 I N na N

Illinois Health Plan DMG01 P N na N

Illinois Medicaid SKIL0 I N Y Y

Illinois Medicaid SKIL0 P N Y Y

Illinois Medicare 12M08 I Y Y Y

Illinois Medicare SMIL0 P Y Y Y

Illinois Physicians Alliance IPA IPA99 I N na N

Illinois Physicians Alliance IPA IPA99 P N na N

IMA, Inc. 64556 I N na N

IMA, Inc. 64556 P N na N

Imagine Health 43123 I N na N

Imagine Health 43123 P N na N

Page 58 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

I'Mcare 41600 I N Y N

I'Mcare 41600 P N Y N

Imperial County Physicians Med Group (SCPMCS) SCP01 I N na N

Imperial County Physicians Med Group (SCPMCS) SCP01 P N na N

Imperial Insurance Company of Texas IICTX I N na Y

Imperial Insurance Company of Texas IICTX P N na Y

IMS Management Services TH099 P N na N

IMS Management Svcs - Texas 12T64 I N na N

IMX Easy 86070 I N na N

IMX Easy 86070 P N na N

INDECS Corporation 40585 I N na N

INDECS Corporation 40585 P N na N

Independence Administrators TA720 P N Y N ERA Payer Code 54763

Independence American Insurance Company CB231 I N na N

Independence American Insurance Company CB231 P N na N

Independence Medical Group MHM01 P N na N

If you have questions, please contact ICS at the mailing address

and phone number below.

Independence Medical Group - Kern County IMG01 I N na Y Mailing Address:

Independence Medical Group - Kern County IMG01 P N na Y 257 Park Avenue South, 2nd Floor

Independence Medical Group - Tulare County IMG02 I N na Y New York, NY 10010

Independence Medical Group - Tulare County IMG02 P N na Y Attention Claims

Independent Health 12X01 I Y Y Y

Independent Health SX073 P Y Y N

Independent Health Care Plan 11695 I Y Y Y

Independent Health Care Plan 11695 P Y Y Y

Independent Living Systems, LLC 45048 I N na Y

Independent Living Systems, LLC 45048 P N na Y

Independent Physicians at Mercy INDPM I N na N

Independent Physicians at Mercy INDPM P N na N

Indian Health Services 12X75 I N na Y

Indian Health Services SX171 P N na Y

Indiana Department of Health - Children's Health - Claims 35600 I Y Y Y

Indiana Department of Health - Children's Health - Claims 35600 P Y Y Y

Indiana Medicaid 12K09 I N Y Y

Page 59 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Indiana Medicaid SKIN0 P N Y Y

Indiana Medicare 12M09 I Y Y Y

Indiana Medicare SMIN0 P Y Y Y

Indiana ProHealth Network 35161 I N Y Y

Indiana ProHealth Network 35161 P N Y Y

Indiana Teamsters Health Benefits Fund (Indianapolis IN) 35107 I N na N

Indiana Teamsters Health Benefits Fund (Indianapolis IN) 35107 P N na N

Indiana University Health Plan (Commercial) 26212 I N na N

Indiana University Health Plan (Commercial) 26212 P N na N

Indiana University Health Plan (Medicare) 95444 I N Y N

Indiana University Health Plan (Medicare) 95444 P N Y N

Individual Assurance Company 30360 I N Y Y

Individual Assurance Company 30360 P N Y Y

Individual Health Insurance Companies 31053 I N Y N

Individual Health Insurance Companies 31053 P N Y N

INETICO INC. 43471 I N na Y

INETICO INC. 43471 P N na Y

Informed LLC 52196 I N na N

Informed LLC 52196 P N na N

Ingham Health Plan Corporation 38343 I N na N

Ingham Health Plan Corporation 38343 P N na N

Inland Empire Health Plan IEHP1 I N Y N

Inland Empire Health Plan IEHP1 P N Y N

Inland Valley - (Redlands IPA) SYMED I N na N

Inland Valley - (Redlands IPA) SYMED P N na N

InnovAge (ERA Only) 31182 I na Y ERA Only

InnovAge (ERA Only) 31182 P na Y ERA Only

Innovation Health 40025 I N na N

Innovation Health 40025 P N na N

Insurance Administrators of America Inc. 37279 I N Y N

Insurance Administrators of America Inc. 37279 P N Y N

Insurance Design Administrators 13315 I N Y N

Insurance Design Administrators 13315 P N Y N

Insurance Management Administrators 72091 P N Y N

Page 60 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Insurance Management Services (Amarillo TX) IMSMS I N Y N

Insurance Management Services (Amarillo TX) IMSMS P N Y N

Insurance Services of Lubbock TH012 P N na Y

Insurance Systems 11889 I N na Y

Insurance Systems 11889 P N na Y

InsuranceTPA.com 39182 I N na N

InsuranceTPA.com 39182 P N na N

Insurers Administrative Corp. 86304 I N na N

Insurers Administrative Corp. 86304 P N na N

Integra Administrative Group (Seaford DE) 51020 I N Y N

Integra Administrative Group (Seaford DE) 51020 P N Y N

Integra Group 31127 I Y na N

Integra Group 31127 P N na N

INTEGRA GROUP/HOME 31128 I N na N

Integra Group-CHA 31129 P N na N

Integra Managed Long Term Care 45302 I N na Y

Integra Managed Long Term Care 45302 P N na Y

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

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

Integrated Medical Solutions LLC 20050 I N na N

Integrated Medical Solutions LLC 20050 P N na N

Inter County Health Plan 54763 I N Y Y

Interactive Medical Systems (ERA Only) 56132 Y ERA Only

Inter-County Health Plan SX079 P Y na Y

Interface EAP (IEAP) 60280 I N na Y

Interface EAP (IEAP) 60280 P N na Y

Intergroup Services Corporation 23287 I N na N

Intergroup Services Corporation 23287 P N na N

Intermountain Healthcare (now known as SelectHealth) SX107 P N na N

International Benefit Administrator 11329 I N na Y

International Benefit Administrator 11329 P N na Y

International Brotherhood of Boilermakers 36609 I N na N

International Brotherhood of Boilermakers 36609 P N na N

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

Page 61 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

International Brotherhood of Boilermakers Employee Health Care Plan(IBBEHC) 48603 P N na Y

International Medical Group IMGIN I N na N

International Medical Group IMGIN P N na N

INTotal Health (claims with DOS on or after 7/01/2016) 35115 I N Y Y

INTotal Health (claims with DOS on or after 7/01/2016) 35115 P N Y Y

Iowa Medicaid 12K10 I Y Y Y

Iowa Medicaid SKIA0 P Y Y Y

Iowa Medicare SMIA0 I Y Y Y

Iowa Medicare SMIA0 P Y Y Y

IU Health Transplant Evaluation Program 47262 I N na Y

IU Health Transplant Evaluation Program 47262 P N na Y

Jencare Medical JCARE I N na N

Jencare Medical JCARE P N na N

JFP Benefit Management, Inc. 38217 na Y ERA Only

JI Specialties TH033 P N na N

JL Legacy Part A 12901 I Y Y Y

JLS Family Enterprises JLSFE I N na N

JLS Family Enterprises JLSFE P N na N

JOHN MORRELL COMPANY CO. - AHPBA 38310 I N na N

JOHN MORRELL COMPANY CO. - AHPBA 38310 P N na N

John Muir Mt. Diablo Health System 68036 I N Y N

John Muir Mt. Diablo Health System 68036 P N Y N

John Muir Physician Network 68036 P N na N

Johns Hopkins Health Advantage 66003 I N Y N

Johns Hopkins Health Advantage 66003 P N Y N

Johns Hopkins Healthcare (EHP/PP) 52189 I Y Y N

Johns Hopkins Healthcare (EHP/PP) 52189 P Y Y N

Johns Hopkins Healthcare (USFHP) 52123 I N Y N

Johns Hopkins Healthcare (USFHP) 52123 P N Y N

Joplin Claims / Benefit Management Inc 43178 I N na Y

Joplin Claims / Benefit Management Inc 43178 P N na Y

JP Farley Corporation 34136 I N na N

JP Farley Corporation 34136 P N na N

JP Specialties 12T47 I N na Y

Page 62 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

JPS Preferred Care MWP01 P N na N

Kaiser Foundation Health Plan of Colorado 91617 I N Y N

Kaiser Foundation Health Plan of Colorado 91617 P N Y N

Kaiser Foundation Health Plan of Hawaii 94123 I N na N

Kaiser Foundation Health Plan of Hawaii 94123 P N na N

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

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

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

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

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

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

Kaiser Foundation Health Plan of Washington (formerly Group Health of WA) 91051 I N Y Y

Kaiser Foundation Health Plan of Washington (formerly Group Health of WA) 91051 P N Y Y

Kaiser Foundation of the Northwest NW002 I N Y N

Kaiser Foundation of the Northwest NW002 P N Y N

Kaiser Permanente of Georgia 21313 I N Y N

Kaiser Permanente of Georgia 21313 P N Y N

Kaiser Self Funded 94320 I N na N

Kaiser Self Funded 94320 P N na N

Kane County BCBS KCIPA I N na N

Kane County BCBS KCIPA P N na N

Kane County Harmony Medicaid IPAK1 I N na N

Kane County Harmony Medicaid IPAK1 P N na N

Kansas City Life Insurance Company 44030 P N na Y

Kansas Medicaid MDKSI I N Y Y

Kansas Medicaid MDKSP P N Y Y

Kansas Medicare 57324 I Y Y Y

Kansas Medicare SMKS0 P Y Y Y

Katy Medical Claims 81812 I N na N

Katy Medical Claims 81812 P N na N

Kaweah Delta TKFMC P N na N

Keenan Associates (CA) 95279 I N na N

Keenan Associates (CA) 95279 P N na N

Kelseycare KELSE I N na N

Page 63 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Kelseycare KELSE P N na N

Kemberton KMBTN I N na N

Kemberton KMBTN P N na N

Kemper Benefits 61453 P N na Y

Kempton Company 73100 I N Y N

Kempton Company 73100 P N Y N

Kempton Group Administrators 73100 I N Y N

Kempton Group Administrators 73100 P N Y N

Kempton Group TPA: Kempton Group Administrators (UCS) 90210 I N na Y

Kempton Group TPA: Kempton Group Administrators (UCS) 90210 P N na Y

Kentucky Health Administrators Inc. 27215 I N na Y

Kentucky Health Administrators Inc. 27215 P N na Y

Kentucky Health Cooperative 77894 I N Y Y

Kentucky Health Cooperative 77894 P N Y Y

Kentucky Medicaid 12K11 I Y Y Y

Kentucky Medicaid SKKY0 P Y Y Y

Kentucky Medicare 12M11 I Y Y Y

Kentucky Medicare SMKY0 P Y Y Y

Kentucky Passport (DOS after 9/30/17) 61325 I N Y Y

Kentucky Passport (DOS after 9/30/17) 61325 P N Y Y

Kentucky Spirit Health Plan 68069 I N Y Y

Kentucky Spirit Health Plan 68069 P N Y Y

Kern County CDCR 28021 I N na N

Kern County CDCR 28021 P N na N

Kern Health Systems 77039 I N na N

Kern Health Systems 77039 P N na N

Key Benefit Administrators (Indianapolis IN) 37217 I N Y Y

Key Benefit Administrators (Indianapolis IN) 37217 P N Y Y

Key Gap 35317 I N na Y

Key Gap 35317 P N na Y

Key Health Medical Solutions Inc. 95460 P N na N

Key Medical Group IP082 I N Y N

Key Medical Group IP082 P N Y N

Key Select 37321 I N na Y

Page 64 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Key Select 37321 P N na Y

Key Solution 37323 I N Y Y

Key Solution 37323 P N Y Y

Keystone First 23284 I N Y Y

Keystone First 23284 P N Y Y

Keystone First Community HealthChoices 42344 I N Y Y

Keystone First Community HealthChoices 42344 P N Y Y

Keystone Health Plan East 12X25 I Y Y Y ERA Payer Code SX055

Keystone Health Plan East SX055 P Y Y Y ERA Payer Code SX055

Keystone Health Plan West SX056 P Y na Y

Klais & Company 34145 I N na Y aka HealthSmart

Klais & Company 34145 P N na Y aka HealthSmart

KPS-Kitsap Physician Services KPS01 I N na N

KPS-Kitsap Physician Services KPS01 P N na N

KS - Sunflower State Health 68069 I N Y Y

KS - Sunflower State Health 68069 P N Y Y

KSKJ Life (ERA Only) na Y ERA Only

LA Care Health Plan LACAR I N Y N

LA Care Health Plan LACAR P N Y N

Lake County Physicians Association 37116 I N na N

Lake County Physicians Association 37116 P N na N

Lakeside Community Healthcare LMG01 I N na N

Lakeside Community Healthcare LMG01 P N na N

Lakeside Comprehensive Healthcare 66127 I N na N

Lakeside Comprehensive Healthcare 66127 P N na N

Lakeside Health Services LMG11 P N na N

Lakeside Medical Group 66125 I N na N

Lakeside Medical Group 66125 P N na N

Lakewood Health Plan LIPAZ I N na Y

Lakewood Health Plan LIPAZ P N na Y

Lancaster General Health 16109 I N na Y

Lancaster General Health 16109 P N na Y

Landmark Healthcare Inc LNDMK P N Y Y

LaSalle Medical Associates NMM02 I N Y N

Page 65 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

LaSalle Medical Associates NMM02 P N Y N

Lawndale Christian Health Center LAWND I N na N

Lawndale Christian Health Center LAWND P N na N

Lawndale Christian Health Center (For DOS prior to 2017) 36333 I N na N

Lawndale Christian Health Center (For DOS prior to 2017) 36333 P N na N

LBA Health Plans 52193 I N Y N

LBA Health Plans 52193 P N Y N

Leading Edge Administrators (ERA Only) OMNIA na na Y na ERA Only

Leon Medical Center Health Plan 37316 I N na N

Leon Medical Center Health Plan 37316 P N na N

LHP Claims Unit 37248 I N na N

LHP Claims Unit 37248 P N na N

LHS Medcost Solutions LLC 90753 I N na N

LHS Medcost Solutions LLC 90753 P N na N

Liberty Advantage Health Plan (HMO SNP) LIB01 I N Y Y

Liberty Advantage Health Plan (HMO SNP) LIB01 P N Y Y

Liberty Health Advantage 87071 I N na N

Liberty Health Advantage 87071 P N na N

Liberty National Life Insurance Company (ERA Only) 65331 I na Y na ERA Only

Liberty National Life Insurance Company (ERA Only) 65331 P na Y na ERA Only

Liberty Union 37281 I N na N

Liberty Union 37281 P N na N

Life Assurance Company 37281 I N na N

Life Assurance Company 37281 P N na N

Life Gift Cards 33LGC I N na Y

Life Gift Cards 33LGC P N na Y

Life Investors Insurance 12T67 I N na N

Life Investors Insurance TH120 P N na Y

Life Investors Insurance of America - Long Term Care 12T39 I N na N

Life Investors of America - Long Term Care TH093 P N na N

LIFE Pittsburgh 25181 I N na N

LIFE Pittsburgh 25181 P N na N

LIFE St. Joseph of the Pines 59847 I N na N Effective 2/1/19, Send Claims using payer code TRNPC

LIFE St. Joseph of the Pines 59847 P N na N Effective 2/1/19, Send Claims using payer code TRNPC

Page 66 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Life Trac 41136 I N na N

Life Trac 41136 P N na N

LifeCircles PACE 71498 I N na N

LifeCircles PACE 71498 P N na N

Lifemap RLH01 I N Y N

Lifemap RLH01 P N Y N

LifePath Hospice Inc 76870 I N na Y

LifePath Hospice Inc 76870 P N na Y

Lifestyle Health Plans 2700U I N na Y

Lifestyle Health Plans 27005 P N na Y

Lifetime Benefit Solutions EBSRM I N Y N

Lifetime Benefit Solutions EBSRM P N Y N

LifeWise Healthplan of Oregon 93093 I N Y Y

LifeWise Healthplan of Oregon 93093 P N Y Y

LifeWise Healthplan of Washington (Premera) 91049 I N Y Y

LifeWise Healthplan of Washington (Premera) 91049 P N Y Y

Lincoln Financial Group (Dental ERA Only) CX061 I na Y na ERA Only

Lincoln Financial Group (Dental ERA Only) CX061 P na Y na ERA Only

Lincoln Heritage (ERA Only) na Y ERA Only

Lincoln National (EMPHESYS Green Bay and Madison WI only) 73288 I N na N

LIPA/Agate Resources TH106 P N na N

Little Company of Mary (For claims with a DOS on or after 1/1/17) LCM1 I N na N

Little Company of Mary (For claims with a DOS on or after 1/1/17) LCM1 P N na N

Little Company of Mary (For claims with a DOS prior to 1/1/17) LCM01 I N na N

Little Company of Mary (For claims with a DOS prior to 1/1/17) LCM01 P N na N

Local 135 Health Benefits Fund (Indianapolis IN) 35107 I N na N

Local 135 Health Benefits Fund (Indianapolis IN) 35107 P N na N

Local 137 Operating Engineers Welfare Fund 84041 I N na Y

Local 137 Operating Engineers Welfare Fund 84041 P N na Y

Lockard & Williams CB752 I N na N

Lockard & Williams CB752 P N na N

Loma Linda 99255 I N na Y

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

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

Page 67 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Loma Linda University Adventist Health Sciences Centers 37267 I N na N

Loma Linda University Adventist Health Sciences Centers 37267 P N na N

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

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

Loma Linda University Employee Health Plan 37267 I N na N

Loma Linda University Employee Health Plan 37267 P N na N

Loma Linda University Health Care Employee Health Plan 37267 I N na N

Loma Linda University Health Care Employee Health Plan 37267 P N na N

Loma Linda University Healthcare 33036 I N na N

Loma Linda University Healthcare 33036 P N na N

Loma Linda University Medical Center Employee Health Plan 37267 I N na N

Loma Linda University Medical Center Employee Health Plan 37267 P N na N

Loma Linda University Medical Center Residents Health Plan 37267 I N na N

Loma Linda University Medical Center Residents Health Plan 37267 P N na N

Loma Linda University Student Health Plan 37267 I N na N

Loma Linda University Student Health Plan 37267 P N na N

Los Angeles Medical Center (LAMC) PPM01 I N na Y

Los Angeles Medical Center (LAMC) PPM01 P N na Y

Louisiana Health Cooperative 88075 I N na N

Louisiana Health Cooperative 88075 P N na N

Louisiana Healthcare Connections 68069 I N Y Y

Louisiana Healthcare Connections 68069 P N Y Y

Louisiana Medicaid MCDLA I Y na Y

Louisiana Medicaid MCDLA P Y na Y

Louisiana Medicaid - Ambulance claims SKLA2 P Y na Y

Louisiana Medicaid - DME Claims SKLA1 P Y na Y

Louisiana Medicaid - KidMed Claims SKLA3 P Y na Y

Louisiana Medicaid - Rehab SKLA4 P N na N

Louisiana Medicaid-Home Health 12K94 I N na N

Louisiana Medicare 12M12 I Y Y Y

Louisiana Medicare SMLA0 P Y Y Y

Lovelace Sandia Health Plan (as of 9/27/14) 90328 I N na Y

Lovelace Sandia Health Plan (as of 9/27/14) 90328 P N na Y

Loyal American Life Ins Co-Medicare Supplement 13193 I N Y Y

Page 68 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Loyal American Life Ins Co-Medicare Supplement 13193 P N Y Y

Lumico (ERA Only) na Y ERA Only

MacNeal Health Providers- CHS 36334 I N na N

MacNeal Health Providers- CHS 36334 P N Y N

Magan Medical Clinic HCP01 I N na N

Magellan Complete Care of Virginia MCCVA I N Y Y

Magellan Complete Care of Virginia MCCVA P N Y Y

Magellan Health Services 12X27 I N Y Y ERA Payer Code 01260

Magellan Health Services 01260 P N Y Y ERA Payer Code 01260

Magnacare 11303 I N Y N

Magnacare 11303 P N Y N

Magnolia 68069 I N Y Y

Magnolia 68069 P N Y Y

Mail Handlers Benefit Plan 25133 I N Y Y

Mail Handlers Benefit Plan 25133 P N Y Y

Maine Community Health Options 45341 I N na Y

Maine Community Health Options 45341 P N na Y

Maine Medicaid 12K13 I Y Y Y

Maine Medicaid SKME0 P Y Y Y

Maine Medicare 12M13 I Y Y Y

Maine Medicare SMME0 P Y Y Y

Maksin Management Corporation 22195 I N na Y

Maksin Management Corporation 22195 P N na Y

Managed Care Services LLC 35162 I N na N aka Parkview Health Plan Services

Managed Care Services LLC 35162 P N na N aka Parkview Health Plan Services

Managed Care Systems (Delano Regional Medical Group) MCS02 P N Y N

Managed Care Systems (Gemcare) MCS01 I N na N

Managed Care Systems (Gemcare) MCS01 P N na N

MANAGED HEALTH CARE ASSOCIATES 36312 I N na N

MANAGED HEALTH CARE ASSOCIATES 36312 P N na N

Managed Health Network 22771 I N Y N

Managed Health Network 22771 P N Y N

Managed Health Services Indiana (Medicaid HMO) 68069 I N Y Y

Managed Health Services Indiana (Medicaid HMO) 68069 P N Y Y

Page 69 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Managed Health Services Wisconsin 68069 I N Y Y

Managed Health Services Wisconsin 68069 P N Y Y

Mapfre (Canada Life) L0160 I N na N

Mapfre (Canada Life) L0160 P N na N

March Vision Care Inc. 52461 P N na N

Marion Polk Community Health Plan 33711 P N na Y

Marquette Life Insurance Company 48055 I N Y N

Marquette Life Insurance Company 48055 P N Y N

Marrick Medical Finance LLC. 20805 I N na Y

Marrick Medical Finance LLC. 20805 P N na Y

MARTINS POINT HEALTH CARE 53275 I N Y N

MARTINS POINT HEALTH CARE 53275 P N Y N

Maryland Medicaid MCDMD I Y Y Y

Maryland Medicaid MCDMD P Y Y Y

Maryland Medicare 12010 I Y Y Y

Maryland Medicare SMMD0 P Y Y Y

Maryland Physicians Care 22348 I N Y N

Maryland Physicians Care 22348 P N Y N

Maryland Public Mental Health SX069 P Y na N

Mashantucket Pequot Tribal Nation 37121 I N na N

Mashantucket Pequot Tribal Nation 37121 P N na N

Massachusetts Medicaid 12K14 I Y Y Y

Massachusetts Medicaid SKMA0 P Y Y Y

Massachusetts Medicaid - Health Safety Net HSNMI I Y Y Y

Massachusetts Medicaid - Health Safety Net HSNMP P Y Y Y

Massachusetts Medicare 12M14 I Y Y Y

Massachusetts Medicare SMMA0 P Y Y Y

Massachusetts Mutual 80314 I N Y Y

Massachusetts Mutual 80314 P N Y Y

Masters Mates and Pilots Plan MMPHB I N na N

Masters Mates and Pilots Plan MMPHB P N na N

Masters Mates and Pilots Program 12T52 I N na N

Masters Mates and Pilots Program TH111 P N na Y

Max Specialty Benefits 27320 P N na N

Page 70 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Maxor Administrative Services 92805 I N na N

Maxor Administrative Services 92805 P N na N

Mayo Clinic FL/GA 88090 I N na N

Mayo Clinic FL/GA 88090 P N na N

MBA Benefit Administrators Inc (Salt Lake UT) 83028 I N na N

MBA Benefit Administrators Inc (Salt Lake UT) 83028 P N na N

MBA OF WYOMING INC 87065 I N na N

MBA OF WYOMING INC 87065 P N na N

MCA ADMINISTRATORS 25160 I N Y N

MCA ADMINISTRATORS 25160 P N Y N

Mcare Advantage Plan 12M85 I N na Y

McGregor PACE 31149 I N Y N

McGregor PACE 31149 P N Y N

McKinley Medical Group MHM02 P N na N

McLaren Health Plan (Commercial) 38338 I N Y Y

McLaren Health Plan (Commercial) 38338 P N Y Y

McLaren Health Plan (JVHL) K7JVH I Y Y Y Provider must be an approved JVHL lab

McLaren Health Plan (JVHL) K7JVH P Y Y Y Provider must be an approved JVHL lab

McLaren Medicaid 3833C I N Y Y

McLaren Medicaid 3833C P N Y Y

MD Anderson Physician Network MDAPN I N Y N

MD Anderson Physician Network MDAPN P N Y N

MDI Holdings (Formerly Medical Partners of America) 80026 I N na N

MDI Holdings (Formerly Medical Partners of America) 80026 P N na N

Mdwise Healthy Indiana Plan (for DOS after 12/31/18) 3135M I N Y Y

Mdwise Healthy Indiana Plan (for DOS after 12/31/18) 3135M P N Y Y

Mdwise Healthy Indiana Plan (for DOS prior to 1/1/19) 31354 I N Y Y

Mdwise Healthy Indiana Plan (for DOS prior to 1/1/19) 31354 P N Y Y

Mdwise Hoosier Healthwise (for DOS after 12/31/18) 3519M I N Y Y

Mdwise Hoosier Healthwise (for DOS after 12/31/18) 3519M P N Y Y

Mdwise Hoosier Healthwise (for DOS prior to 1/1/19) 35191 I N Y Y

Mdwise Hoosier Healthwise (for DOS prior to 1/1/19) 35191 P N Y Y

MDWise Select Health Network 35199 I N Y N

MDWise Select Health Network 35199 P N Y N

Page 71 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

MDX Hawaii MDXHI I N na Y

MDX Hawaii MDXHI P N na Y

MED PAY 88058 I N na Y

MED PAY 88058 P N na Y

MED3000 CMS SAFETY NET EM284 I N na N

MED3000 CMS SAFETY NET EM284 P N na N

MED3000 CMS TITLE 19 REFORM EM843 I N na N

MED3000 CMS TITLE 19 REFORM EM843 P N na N

MED3000 CMS TITLE 21 EM205 I N na N

MED3000 CMS TITLE 21 EM205 P N na N

MedAdmin Solutions 58202 I N na N

MedAdmin Solutions 58202 P N na N

MedBen (Newark OH) 74323 I N Y Y

MedBen (Newark OH) 74323 P N Y Y

MedCom 59231 I N na Y

MedCom 59231 P N na Y

MedCost Benefit Services 56205 I N Y Y

MedCost Benefit Services 56205 P N Y Y

MedCost Inc. 56162 I N Y Y

MedCost Inc. 56162 P N Y Y

Medfocus 95321 P N na N

Medica 94265 I N Y Y

Medica 94265 P N Y Y

MEDICA HEALTH CARE PLAN INC. 78857 I N Y Y

For claims with DOS prior to 1/1/18.

Use payer code WELM2 for DOS on or after 1/1/18 .

ERA Payer Code TH023.

MEDICA HEALTH CARE PLAN INC. 78857 P N Y Y

For claims with DOS prior to 1/1/18.

Use payer code WELM2 for DOS on or after 1/1/18.

ERA Payer Code TH023.

Medica2 12422 I N Y Y

Medica2 12422 P N Y Y

Medicaid Hawaii Waivers 77059 P Y na Y

Medi-Cal (Vision) SKCA1 P Y na N

MEDICAL ASSOCIATES HEALTH PLAN MAHC1 I N Y N

MEDICAL ASSOCIATES HEALTH PLAN MAHC1 P N Y N

Page 72 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Medical Benefits Administration MBA01 P N na Y ERA not available for this plan

Medical Benefits Administrators Inc. (Newark OH) 74323 I N Y Y

Medical Benefits Administrators Inc. (Newark OH) 74323 P N Y Y

Medical Benefits Companies (Newark OH) 74323 I N Y Y

Medical Benefits Companies (Newark OH) 74323 P N Y Y

Medical Benefits Mutual (Newark OH) 74323 I N Y Y

Medical Benefits Mutual (Newark OH) 74323 P N Y Y

Medical Benefits Mutual Life Insurance Co. 74323 I N Y Y

Medical Benefits Mutual Life Insurance Co. 74323 P N Y Y

Medical Card System ( MCS ) L0170 I N na N

Medical Card System ( MCS ) L0170 P N na N

MEDICAL DEVELOPMENT INTERNATIONAL 52181 I N na N

MEDICAL DEVELOPMENT INTERNATIONAL 52181 P N na N

Medical Mutual of Ohio 29076 I N Y Y

Medical Mutual of Ohio 29076 P N Y Y

Medical Reimbursements of America 62177 I N na N

Medical Reimbursements of America 62177 P N na Y

Medical Services for Indigents AMM02 I N na N

Medical Services Initiative 12057 I N na Y

Medical Services Initiative 12057 P N na Y

Medical Value Plan - Ohio (MVP) 38224 I N Y N

Medical Value Plan - Ohio (MVP) 38224 P N Y N

Medicare Blue Private SX262 P N na N

Medicare DME (All Jurisdictions) SDMEB P Y Y Y

Medicare Part A Legacy - JH 04911 I Y Y Y

Medicare Part A Legay (CA, HI, NV) 12M65 I Y na Y

Medicare Plus Blue Michigan 00210 I Y Y Y

Medicare Plus Blue Michigan 00710 P Y Y Y

Medicare PPO (BCBS SC) 00C63 I N Y N

Medicare PPO (BCBS SC) 00C63 P N Y N

Medicare y Mucho Mas ( MMM ) L0210 I N na N

Medicare y Mucho Mas ( MMM ) L0210 P N na N

Medico Insurance Company 23160 I N Y N

Medico Insurance Company 23160 P N Y N

Page 73 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Medi-Share 59355 I N na N

Medi-Share 59355 P N na N

Mediture 20039 I N na N

Mediture 20039 P N na N

Mediview Inc. STAR1 I N na N

Mediview Inc. STAR1 P N na N

MedPartners - Mary Black Health Network 412MP I N Y N

MedPartners - Mary Black Health Network 412MP P N Y N

MedPartners Administrative Services 35205 I N na Y ERA Payer Code MPAS1

MedPartners Administrative Services 35205 P N Y N ERA Payer Code MPAS1

MedSolutions Inc 62160 I N Y N

MedSolutions Inc 62160 P N Y N

MedStar Family Choice 39190 I N Y N

MedStar Family Choice 39190 P N Y N

Medstar Select/Medstar Medicare Choice 251MS I N na Y

Medstar Select/Medstar Medicare Choice 251MS P N na Y

MEGA Life & Health (United Ins. Div.) 97055 I N na N

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

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

Memorial Herman Health Network Providers MHHNP I N Y N

Memorial Herman Health Network Providers MHHNP P N Y N

Memorial Medical Group HCP01 I N na N

MemorialCare Medical Foundation MMFMC I N Y Y

MemorialCare Medical Foundation MMFMC P N Y Y

MemorialCare Medical Foundation UCI MMFUC I N Y Y

MemorialCare Medical Foundation UCI MMFUC P N Y Y

Menifee Valley Community Medical Group HCMG1 I N na Y

Menifee Valley Community Medical Group HCMG1 P N na Y

Mental Health Consultants Inc. 37050 I N na N

Mental Health Consultants Inc. 37050 P N na N

Mercy Benefit Administration 37264 I N Y N Formerly known as St. John’s Claims Administration

Mercy Benefit Administration 37264 P N Y N Formerly known as St. John’s Claims Administration

Mercy Care Plan (AHCCCS) 86052 I N Y N

Mercy Care Plan (AHCCCS) 86052 P N Y N

Page 74 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Mercy LIFE of Alabama 63002 I N na N

Mercy LIFE of Alabama 63002 P N na N

Mercy Maricopa Integrated Care 33628 I N na Y

Mercy Maricopa Integrated Care 33628 P N na Y

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

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

Mercy Provider Network 43185 I N na N

Mercy Provider Network 43185 P N na N

MercyCare 39114 I N Y N

MercyCare 39114 P N Y N

Meridian Health Plan of Michigan (JVHL) J2JVH I Y Y Y Provider must be an approved JVHL lab

Meridian Health Plan of Michigan (JVHL) J2JVH P Y Y Y Provider must be an approved JVHL lab

Meridian Health Plan, A WellCare Company 13189 I N Y N

Name changed to Meridian Health, A WellCare Company.

Use for MEDICAID claims with DOS on or after 1/1/19

Meridian Health Plan, A WellCare Company 13189 P N Y N

Name changed to Meridian Health, A WellCare Company.

Use for MEDICAID claims with DOS on or after 1/1/19

Meritain Health 64157 I N Y N

Meritain Health 64157 P N Y N

Meritain Health / Agency Services 64158 I N na N

Meritain Health / Agency Services 64158 P N na N

Meritain Health Minneapolis 41124 I N Y Y

Meritain Health Minneapolis 41124 P N Y Y

Methodist Associate Health Plan Pilot P N na N

MetroPlus Health Plan 13265 I N Y N

MetroPlus Health Plan 13265 P N Y N

Metrowest HealthPlan TH068 P N na N

Metrowest Star Medicaid TH069 P N na N

MFC & HealthPlus Peoria 23550 I N na N

MFC & HealthPlus Peoria 23550 P N na N

mhm 87726 I N na Y

MHNET 74289 I N Y Y

MHNET 74289 P N Y Y

MHP Systems 64068 I N na N

Page 75 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

MHP Systems 64068 P N na N

Miami Children's Health Plan 82832 I N Y Y

Miami Children's Health Plan 82832 P N Y Y

Michigan Medicaid 12K37 I Y Y Y

Michigan Medicaid SKMI0 P Y Y Y

Michigan Medicare SMMI0 I Y Y Y

Michigan Medicare SMMI0 P Y Y Y

Michigan UFCW (ERA Only) 27401 I na Y ERA Only

Michigan UFCW (ERA Only) 27401 P na Y ERA Only

Mid American Benefits 22823 I N na Y

Mid American Benefits 22823 P N na Y

Mid Rogue Oregon Health Plan 26161 I N na N

Mid Rogue Oregon Health Plan 26161 P N na N

Mid-America Associates Inc. 37281 I N na N

Mid-America Associates Inc. 37281 P N na N

MidCoast IPA 77012 I N na N

MidCoast IPA 77012 P N na N

Mid-County Physicians Medical Group SCP01 I N na N

Mid-County Physicians Medical Group SCP01 P N na N

Midland National Life Insurance Company 90956 P N na N

Midlands Choice Inc. 47080 I N na Y

Midlands Choice Inc. 47080 P N na Y

Midwest Health Partners 76079 I N na N

Midwest Health Partners 76079 P N na N

Midwest Operating Engineers Welfare Fund 45979 I N na Y

Midwest Operating Engineers Welfare Fund 45979 P N na Y

Midwest Physicians Administrative Systems 66727 I N Y N

Midwest Physicians Administrative Systems 66727 P N Y N

Mills Peninsula Medical Group MPMG1 P N na N

MINNESOTA DEPARTMENT OF HEALTH MNDH1 I N na N

MINNESOTA DEPARTMENT OF HEALTH MNDH1 P N na N

Minnesota Medicaid 12K16 I Y Y Y

Minnesota Medicaid SKMN0 P Y Y Y

Minnesota Medicare 12M16 I Y na Y

Page 76 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Minnesota Medicare SMMN0 P Y na Y

MinuteMan Health 01776 I N na N

MinuteMan Health 01776 P N na N

Mission (St. Joseph Heritage Healthcare) STJOE P N na N

Mississippi Health Partners 64068 I N na N

Mississippi Health Partners 64068 P N na N

Mississippi Medicaid 12K17 I Y Y Y ERA Payer Code SKMS0

Mississippi Medicaid SKMS0 P Y Y Y ERA Payer Code SKMS0

Mississippi Medicare 12M17 I Y Y Y

Mississippi Medicare SMMS0 P Y Y Y

Mississippi Physicians Care Network 64084 I N na N

Mississippi Physicians Care Network 64084 P N na N

Mississippi Public Entity Employee Benefit Trust 37233 I N na N

Mississippi Public Entity Employee Benefit Trust 37233 P N na N

Mississippi Select Health Care 64088 I N Y N

Mississippi Select Health Care 64088 P N Y N

Missoula County Medical Benefits Plan 37275 I N na N

Missoula County Medical Benefits Plan 37275 P N na N

Missouri Medicaid 12K15 I N Y Y

Missouri Medicaid SKMO0 P N Y Y

Missouri Medicare 12M15 I Y Y Y

Missouri Medicare SMMO0 P Y Y Y

Missouri Medicare Select MMS01 I N na N

Missouri Medicare Select MMS01 P N na N

MMSI 41154 I N Y Y

MMSI 41154 P N Y Y

MO - Missouri Home State Health Care 68069 I N Y Y

MO - Missouri Home State Health Care 68069 P N Y Y

Moda Health 13350 I N Y Y

Moda Health 13350 P N Y Y

Molina Healthcare 12X09 I N na N

Molina Healthcare of California 38333 I N Y Y

Molina Healthcare of California 38333 P N Y Y

Molina Healthcare of Florida 51062 I N Y Y

Page 77 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Molina Healthcare of Florida 51062 P N Y Y

Molina Healthcare of Illinois 20934 I N Y Y

Molina Healthcare of Illinois 20934 P N Y Y

Molina Healthcare of Michigan 38334 I N Y Y

Molina Healthcare of Michigan 38334 P N Y Y

Molina Healthcare of Michigan (JVHL) JIJVH I Y Y Y Provider must be an approved JVHL lab

Molina Healthcare of Michigan (JVHL) JIJVH P Y Y Y Provider must be an approved JVHL lab

Molina Healthcare of New Mexico - Salud 09824 I N Y N

Molina Healthcare of New Mexico - Salud 09824 P N Y Y

Molina Healthcare of New Mexico -SCI 04423 I N Y Y

Molina Healthcare of New Mexico -SCI 04423 P N Y Y

Molina Healthcare of Ohio 20149 I N Y Y

Molina Healthcare of Ohio 20149 P N Y Y

Molina Healthcare of Puerto Rico 81794 I N Y Y

Molina Healthcare of Puerto Rico 81794 P N Y Y

Molina Healthcare of South Carolina 46299 I N Y Y

Molina Healthcare of South Carolina 46299 P N Y Y

Molina Healthcare of Texas 20554 I N Y Y

Molina Healthcare of Texas 20554 P N Y Y

Molina Healthcare of Utah (aka American Family Care) SX109 P N Y Y

Molina Healthcare of Virginia 26176 I N na Y

Molina Healthcare of Virginia 26176 P N na Y

Molina Healthcare of Washington 38336 I N Y Y

Molina Healthcare of Washington 38336 P N Y Y

Molina Healthcare of Wisconsin ABRI1 I N Y Y

Molina Healthcare of Wisconsin ABRI1 P N Y Y

Monarch IPA IP095 P N na Y

Monitor Life Insurance Company (Secondary claims only) 16098 I Y Y Y

Monitor Life Insurance Company (Secondary claims only) 16098 P Y Y Y

Montana Medicaid 12K77 I N na Y

Montana Medicaid SKMT0 P N na Y

Montana Medicare 12M77 I Y Y Y

Montana Medicare SMMT0 P Y Y Y

Montefiore Contract Management Organization 13174 I N Y Y

Page 78 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Montefiore Contract Management Organization 13174 P N Y Y

Montifiore HMO 46161 I N Y Y

Montifiore HMO 46161 P N Y Y

Monumental Life Insurance Company MMLIC I N na N

Monumental Life Insurance Company MMLIC P N na N

Monumental Life Insurance Company (AR) TLINS I N na Y

Monumental Life Insurance Company (AR) TLINS P N na Y

Monumental Life Insurance Company (IA) TRCLF I N na Y

Monumental Life Insurance Company (IA) TRCLF P N na Y

Monumental Life Insurance Company (IA, MD, PA) TRP1E I N na Y

Monumental Life Insurance Company (IA, MD, PA) TRP1E P N na Y

Monumental Life Insurance Company (TX) TRLTC I N na Y

Monumental Life Insurance Company (TX) TRLTC P N na Y

MORRIS ASSOCIATES 35092 I N na N

MORRIS ASSOCIATES 35092 P N Y N

Mosaic IPA Medical Group IP083 P N na N

Mountain State Blue Cross and Blue Shield SB941 P Y na Y

Mountain State Blue Cross of West Virginia 12B28 I Y na Y

Mountain States Administrative Services 86040 I N na N

Mountain States Administrative Services 86040 P N na N

MPE Services Inc. 37233 I N na N

MPE Services Inc. 37233 P N na N

MPEEBT 37233 I N na N

MPEEBT 37233 P N na N

MSA Care Guard 20572 I N na Y

MSA Care Guard 20572 P N na Y

MSC (Medical Service Company) Group, Inc. 80019 I Y na N

MSC (Medical Service Company) Group, Inc. 80019 P Y na N

MSH Reimbursement 05887-NOCD I N na Y

MSH Reimbursement 05887-NOCD P N na Y

Mt. Carmel Health Plan 95655 I N Y Y

Mt. Carmel Health Plan 95655 P N Y Y

Page 79 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Multiplan Wisconsin Preferred Provider Network 34080 I N na N

Payer ID 34080 is active for only insurance plans accessing

MultiPlan HealthEOS for specific client groups in the state of WI.

PHCS and MultiPlan are PPO Networks accessed by many

insurance plans. Claims for individuals accessing these

networks should be directed to the insurance plans, using the

payer ID assigned to the insurer.

Multiplan Wisconsin Preferred Provider Network 34080 P N na N

Payer ID 34080 is active for only insurance plans accessing

MultiPlan HealthEOS for specific client groups in the state of WI.





Municipal Health Benefit Fund 81883 I N na N

Municipal Health Benefit Fund 81883 P N na N

Mutual Health Services 34192 I N Y Y Formerly knowns as Antares Management Solutions

Mutual Health Services 34192 P N Y Y Formerly knowns as Antares Management Solutions

Mutual of Omaha Insurance Company 71412 I N Y N

Mutual of Omaha Insurance Company 71412 P N Y N

Mutual of Omaha Medicare Advantage 82275 I N na Y

Mutual of Omaha Medicare Advantage 82275 P N na Y

Mutually Preferred 71412 I N Y N

Mutually Preferred 71412 P N Y N

MVP Health Plan (Mohawk Valley) 14165 I N Y Y

MVP Health Plan (Mohawk Valley) 14165 P N Y Y

MVP Health Rochester 12X04 I N na Y

My Family Medical Group 33020 I N na N

My Family Medical Group 33020 P N na N

MyDecision HealthSmart 18840 I N na Y

MyDecision HealthSmart 18840 P N na Y

myNEXUS Anthem 34009 I N Y N

myNEXUS Anthem 34009 P N Y N

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

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

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

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

Page 80 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

N.W. Textile Processors 91136 I N Y N

N.W. Textile Processors 91136 P N Y N

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

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

NALC/Affordable 53011 I N na Y

NALC/Affordable 53011 P N na Y

NAMCI/Global Care L0110 I N na Y

NAMCI/Global Care L0110 P N na Y

NAMM-IL (Senior Care Partners) (ERA Only) NANPR I na Y ERA Only

NAMM-IL (Senior Care Partners) (ERA Only) NANPR P na Y ERA Only

NAPHCARE INC. 58182 I N Y Y

NAPHCARE INC. 58182 P N Y Y

National Accident and Health General Agency Incorporated (NAGHA) 67788 I N na Y

National Accident and Health General Agency Incorporated (NAGHA) 67788 P N na Y

National Association of Letter Carriers/NALCHBP 53011 I N Y Y

National Association of Letter Carriers/NALCHBP 53011 P N Y Y

National Capital Preferred Provider Organization (NCPPO) 90001 I N na Y

National Capital Preferred Provider Organization (NCPPO) 90001 P N na Y

National Elevator Industry Benefit Plan (ERA Only) CX045 I na Y na ERA Only

National Elevator Industry Benefit Plan (ERA Only) CX045 P na Y na ERA Only

National Financial Insurance Company 90956 P N na N

National Foundation Life Insurance 98205 I N na N

National Foundation Life Insurance 98205 P N na N

National General ASHC1 I N na Y

National General ASHC1 P N na Y

National Imaging Assoc Inc / Magellan Health Services 12X27 I N na Y

National Imaging Associates SX190 I na Y

National Imaging Associates SX190 P N Y N

National Rural Electric Coop (NRECA) 39026 I N Y Y

National Rural Electric Coop (NRECA) 39026 P N Y Y

National Telecommunications Cooperative Association 52120 I N Y N

National Telecommunications Cooperative Association 52120 P N Y N

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

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

Page 81 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

National Telecommunications Cooperative Association (NTCA) 52103 I N na N

National Telecommunications Cooperative Association (NTCA) 52103 P N na N

Native Care Health 19191 I N na Y

Native Care Health 19191 P N na Y

NCDPS Correctional Claims 38520 I N na Y

NCDPS Correctional Claims 38520 P N na Y

Nebraska Medicaid 12K19 I Y Y Y

Nebraska Medicaid SKNE0 P Y Y Y

Nebraska Medicare 12M19 I Y na Y

Nebraska Medicare SMNE0 P Y Y Y

Nebraska Total Care 68069 I N Y Y

Nebraska Total Care 68069 P N Y Y

Neighborhood Health Partnership (NHP) 96107 I N na Y

Neighborhood Health Partnership (NHP) 96107 P N na Y

Neighborhood Health Plan (Boston MA) 04293 I N Y N

Payer Name is changing to Allways Health Partners effective

1/1/19.

Neighborhood Health Plan (Boston MA) 04293 P N Y N

Payer Name is changing to Allways Health Partners effective

1/1/19.

Neighborhood Health Plan Rhode Island 05047 I N Y Y

Neighborhood Health Plan Rhode Island 05047 P N Y Y

Neighborhood Health Plan Rhode Island - Exchange, Unity, Integrity 96240 I N Y N

Neighborhood Health Plan Rhode Island - Exchange, Unity, Integrity 96240 P N Y N

Netcare Life and Health Insurance (Hagatna Guam) 66055 I N na N

Netcare Life and Health Insurance (Hagatna Guam) 66055 P N na N

Network Health Insurance Corp-Medicare 77076 I N Y N

Network Health Insurance Corp-Medicare 77076 P N Y N

Network Health Plan of Wisconsin Inc. 39144 I N Y N

Network Health Plan of Wisconsin Inc. 39144 P N Y N

Network Medical Management NMM01 I N Y N

Network Medical Management NMM01 P N Y N

Network Solutions IPA NSIPA P N na Y

Network TPA LLC 58204 I N na N

Network TPA LLC 58204 P N na N

Nevada Medicaid NVMMIS I Y Y Y

Nevada Medicaid NVMMIS P Y Y Y

Page 82 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Nevada Medicare SMNV0 P Y na Y

NEW AVENUES INC. 95998 I N na Y

NEW AVENUES INC. 95998 P N na Y

New Century Health - IEHP Oncology NCH11 P N na N

New Century Health - Vista Cardiology NCH09 P N na N

New Directions Behavioral Health (NDBH) NDX99 I N na Y

New Directions Behavioral Health (NDBH) NDX99 P N na Y

New England Dental Administrators (ERA Only) 43351 I na Y ERA Only

New England Dental Administrators (ERA Only) 43351 P na Y ERA Only

New Era Life 98798 I N na N

New Era Life 98798 P N na N

New Era Life - Employee Benefit Plans 96396 I N na N

New Era Life - Employee Benefit Plans 96396 P N na N

New Hampshire Medicaid 12K90 I Y Y Y

New Hampshire Medicaid SKNH0 P Y Y Y

New Hampshire Medicare 12M21 I Y na Y

New Hampshire Medicare SMNH0 P Y na Y

New Jersey Medicaid MDNJI I Y Y Y

New Jersey Medicaid MDNJP P Y Y Y

New Jersey Medicaid-Charity Care CKNJ2 I Y Y Y

New Jersey Medicare 12005 I Y Y Y

New Jersey Medicare SMNJ0 P Y Y Y

New Mexico Health Connections 45129 I N Y Y

New Mexico Health Connections 45129 P N Y Y

New Mexico Medicaid 12K22 I Y na Y

New Mexico Medicaid SKNM0 P Y Y N

New Mexico Medicare 12M22 I Y Y Y

New Mexico Medicare SMNM0 P Y Y Y

New York Life 12T69 I N na N

New York Life TH122 P N na Y

New York Medicaid 12K35 I Y Y Y

New York Medicaid SKNY0 P Y Y Y

New York Medicare 12M35 I Y na Y

New York Medicare Downstate SMNY0 P Y Y Y

Page 83 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

New York Medicare Queens SMNY2 P Y Y Y

New York Medicare Upstate SMNY1 P Y Y Y

New York Network Management 11334 P N na N

Next Level Health Partners 69821 I N Y N

Next Level Health Partners 69821 P N Y N

NGS American Inc 38225 I N Y N

NGS American Inc 38225 P N Y N

NHBCAUX 88050 I N na N

NHBCAUX 88050 P N na N

NHI BILLING SERVICES INC 14043 I Y na Y

Claims enrollment not required; however, payer must be

notified prior to sending claims to a new provider.

Nippon Life Insurance Company of America 81264 I N Y N

Nippon Life Insurance Company of America 81264 P N Y N

Nivano Physicians Group MBA01 I N N Y


submission begins.

Nivano Physicians Group MBA01 P N N Y


submission begins.

NJ Carpenters Health Fund 22603 I N na Y

NJ Carpenters Health Fund 22603 P N na Y

Noble AMA Select IPA PDT01 I N Y N

Noble AMA Select IPA PDT01 P N Y N

North American Medical Management - Southern California IP079 I N Y N

North American Medical Management - Southern California IP079 P N Y N

North Broward Hospital District 37314 I N na Y

North Broward Hospital District 37314 I N na Y

North Carolina Medicaid 12K23 I Y Y Y Encounter Claims Accepted

North Carolina Medicaid SKNC0 P Y Y Y Encounter Claims Accepted

North Carolina Medicare 12M23 I Y Y Y

North Carolina Medicare SMNC0 P Y Y Y

North County Health Services SCP01 I N na N

North County Health Services SCP01 P N na N

North Dakota Medicaid 12K78 I N na Y

North Dakota Medicaid SKND0 P N na Y

North Dakota Medicare 12M82 I Y na Y

Page 84 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

North Dakota Medicare SMND0 P Y na Y

North Texas Healthcare Network 35212 I N na Y

Payer Code 35212 is being deactivated soon. Claims for this

plan should be sent using payer code 75250

North Texas Healthcare Network 35212 P N na Y


plan should be sent using payer code 75250

North West Orange County Medical Group PROSP P N Y N

Northern Illinois Health Plan 36347 I N na N

Northern Illinois Health Plan 36347 P N na N

Northern Nevada Trust Fund 88027 I N na N

Northern Nevada Trust Fund 88027 P N na N

Northridge Medical Group NMG01 P N na N

Northshore LIJ Insurance Company 46227 I N Y Y

Northshore LIJ Insurance Company 46227 P N y Y

NorthShore Physician Associates 48026 I N Y Y

NorthShore Physician Associates 48026 P N Y Y

Northstar Advantage 60058 I N na N

Northstar Advantage 60058 P N na N

Northwest Administrators Inc (ERA Only) 91068 I na Y ERA Only

Northwest Administrators Inc (ERA Only) 91068 P na Y ERA Only

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

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

Northwest Physicians Network NPN11 I N na Y

Northwest Physicians Network NPN11 P N na Y

Northwest Suburban IPA (Illinois) 36346 I N na N

Northwest Suburban IPA (Illinois) 36346 P N na N

Novanet OSCAR I N na N

Novanet 06226 P N na N

Novasys Health Network 71080 I N na N

Novasys Health Network 71080 P N na N

Nuestra Familia Medical Group (Prospect Medical Group) PROSP P N Y N

Nyhart 37299 I N na N

Nyhart 37299 P N na N

NYLCare Ethix Northwest 91135 I N na N

NYS DOH UCP 14142 I N Y Y

NYS DOH UCP 14142 P N Y Y

Page 85 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Oak Street Health OAKST I N na N

Oak Street Health OAKST P N na N

Oak West Physician Association 36400 I N Y N

Oak West Physician Association 36400 P N Y N

Oasis IPA DESRT P N na N

Occular Benefits L0140 I N na N

Occular Benefits L0140 P N na N

Ochsner Health Plan 72127 I N na N

Ochsner Health Plan 72127 P N na N

Ohio Health Choice PPO 34189 I N na N

Ohio Health Choice PPO 34189 P N na N

Ohio Medicaid SKOH0 I N Y Y

Ohio Medicaid SKOH0 P N Y Y

Ohio Medicare 12M24 I Y Y Y

Ohio Medicare SMOH0 P Y Y Y

Ohio PPO Connect 74431 I N Y Y

Ohio PPO Connect 74431 P N Y Y

Oklahoma DRS DOC 71065 I N Y N

Oklahoma DRS DOC 71065 P N Y N

Oklahoma Medicaid 12K25 I N Y Y

Oklahoma Medicaid SKOK0 P N Y Y

Oklahoma Medicare 12M37 I Y Y Y

Oklahoma Medicare SMOK0 P Y Y Y

Old Surety Life Insurance Company (ERA Only) 29237 I na Y na ERA Only

Old Surety Life Insurance Company (ERA Only) 29237 P na Y na ERA Only

Olympus Managed Health Care 65074 I N na Y

Olympus Managed Health Care 65074 P N na Y

OMNI/Medicore HP 68037 I N na N

OMNI/Medicore HP 68037 P N na N

One Call Medical 22321 I N Y N aka One Call Diagnostics

One Call Medical 22321 P N Y N aka One Call Diagnostics

OnLok Senior Health Services, Inc. 99485 I N na N

OnLok Senior Health Services, Inc. 99485 P N na N

OPEIU Locals 30 and 537 BPA01 P N na N

Page 86 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Operating Engineers Locals 302 & 612 Health & Security Fund 91136 I N Y N

Operating Engineers Locals 302 & 612 Health & Security Fund 91136 P N Y N

Optima Health Plan 54154 I N Y Y

Optima Health Plan 54154 P N Y Y

Optima Insurance Company 54154 I N Y Y

Optima Insurance Company 54154 P N Y Y

Optimum Choice of the Carolinas Inc. (OCCI) 52152 P N na Y

Optimum Healthcare Inc. 20133 I N Y N

Optimum Healthcare Inc. 20133 P N Y N

Optum Medical Network / AZ, UT (formerly Lifeprint Arizona) LIFE1 I N Y Y

Optum Medical Network / AZ, UT (formerly Lifeprint Arizona) LIFE1 P N Y Y

OptumCare Network of CT E3287 I N na N

OptumCare Network of CT E3287 P N na N

OptumHealth 87726 P N na Y

OptumHealth Behavioral Solutions (formerly Pacificare Behavioral Health) 87726 I N na N Former payer code 33053

OptumHealth Behavioral Solutions (formerly Pacificare Behavioral Health) 87726 P N na N Former payer code 33053

OptumHealth Behavioral Solutions (formerly United Behavioral Health) 87726 I N na Y

OptumHealth Behavioral Solutions (formerly United Behavioral Health) 87726 P N na Y

OptumHealth Care Solutions (formerly United Resource Networks) 41194 I N Y Y

OptumHealth Care Solutions (formerly United Resource Networks) 41194 P N Y Y

OptumHealth Physical Health - includes Oxford (formerly ACN & ACNIPA) 41160 P N na N

OptumHealth Vision 00773 P N na Y

Orange County Health Care Agency 65021 I N na Y

Orange County Health Care Agency 65021 P N na Y

Oregon Medicaid 12K41 I Y Y Y

Oregon Medicaid SKOR0 P Y Y Y

Oregon Medicare 12M41 I Y Y Y

Oregon Medicare SMOR0 P Y Y Y

Orthonet - Uniformed Services Family Health Plan 13382 P N na N

Orthonet- Aetna 13383 I N Y Y

Orthonet- Aetna 13383 P N Y Y

Oscar Health OSCAR I N Y Y

Oscar Health OSCAR P N Y Y

OSF Healthcare Central OSFC9 I N na N

Page 87 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

OSF Healthcare Central OSFC9 P N na N

OSF Healthcare East OSFE9 I N na N

OSF Healthcare East OSFE9 P N na N

OSMA Health - C. L. Frates 73071 I N na N

OSMA Health - C. L. Frates 73071 P N na N

OSU Center for Health Sciences 76619 P N na Y

Outpatient Services/ZeroOutofPocket 04430 I N na N

Outpatient Services/ZeroOutofPocket 04430 P N na N

Oxford Life Insurance Company (ERA Only) 76112 I na Y ERA Only

Oxford Life Insurance Company (ERA Only) 76112 P na Y ERA Only

PACE Central Iowa 72436 I N na N

PACE Central Iowa 72436 P N na N

PACE CNY 70454 I N na N

PACE CNY 70454 P N na N

PACE Nebraska 35416 I N na N

PACE Nebraska 35416 P N na N

PACE Southeast Michigan 86711 I N na N

PACE Southeast Michigan 86711 P N na N

PACE Southwest Iowa 53534 I N na N

PACE Southwest Iowa 53534 P N na N

Pace Suburban Bus Service (via IDPA) PACE1 P N na N

Pacific Alliance Medical Center SYMED I N na N

Pacific Alliance Medical Center SYMED P N na N

Pacific Alliance Medical Group SYMED I N na N

Pacific Alliance Medical Group SYMED P N na N

Pacific IPA PCFCI P N na N

Pacific Life & Annuity 67466 I N na N

PacificSource Community Solutions 20416 I N Y N ERA Payer Code 93029

PacificSource Community Solutions 20416 P N Y N ERA Payer Code 93029

PacificSource Health Plans 93029 I N Y Y

PacificSource Health Plans 93029 P N Y Y

PacificSource Medicare 20377 I N Y Y ERA Payer Code 93029

PacificSource Medicare 20377 P N Y Y ERA Payer Code 93029

Palo Alto Medical Foundation 94115 I N na Y

Page 88 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Palo Alto Medical Foundation 94115 P N na Y

Pan American Life Insurance Group 04218 I N Y N

Pan American Life Insurance Group 04218 P N Y N

Paragon Benefits Inc. 58174 P N na Y

Paramount Healthcare Services SX158 I N Y N ERA Payer Code PARHC

Paramount Healthcare Services SX158 P N Y N ERA Payer Code PARHC

Parkland Community Health Plan 66917 I N Y N

Parkland Community Health Plan 66917 P N Y N

PARTNERS BEHAVIORAL HEALTH MANAGEMENT 52613 I Y Y Y ERA Payer Code 13141

PARTNERS BEHAVIORAL HEALTH MANAGEMENT 52613 P Y Y Y ERA Payer Code 13141

Partners In Health PARTH I N na N

Partners In Health PARTH P N na N

Partnership Health of California 12M81 I Y na N Claim Enrollment AND Testing is Required for Every NPI.

Partnership Health of California SX140 P Y na N Claim Enrollment AND Testing is Required for Every NPI.

Passport Advantage 66008 I N Y Y

Passport Advantage 66008 P N Y Y

Passport Advantage (AmeriHealth) (ERA Only) SX055 I na Y ERA Only

Passport Advantage (AmeriHealth) (ERA Only) SX055 P na Y ERA Only

Patient Advocates LLC 10525 I N Y N

Patient Advocates LLC 10525 P N Y N

PATIENTPAY 26335 P N Y Y

Payer Fusion 27048 I N na N

Payer Fusion 27048 P N na N

Peach State Health Plan 68069 I N Y Y

Peach State Health Plan 68069 P N Y Y

Peak Pace Solutions U7034 I N na N

Peak Pace Solutions 27034 P N na N

PEF Clinic PEF01 I N na N

PEF Clinic PEF01 P N na N

Pegasus Medical Group PROSP P N Y N

PEHP - Utah Public Employee Health Plan SX106 I Y Y Y

PEHP - Utah Public Employee Health Plan SX106 P Y Y Y

Pekin Insurance 37086 I N Y N

Page 89 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Pekin Insurance 37086 P N Y N

Penn Behavioral Health 53226 I Y na Y

Penn Behavioral Health 53226 P Y na Y

Pennsylvania Health Care Plan (ERA Only) VALHLTH I na Y ERA Only

Pennsylvania Health Care Plan (ERA Only) VALHLTH P na Y ERA Only

Pennsylvania Medicaid 12008 I N Y Y

Pennsylvania Medicaid SKPA0 P N Y Y

Pennsylvania Medicare 12M60 I Y Y Y

Pennsylvania Medicare SMPA0 P Y Y Y

Pennsylvania Pace 20172 I N na N

Pennsylvania Pace 20172 P N na N

Peoples Health Network 72126 I N Y N

Peoples Health Network 72126 P N Y N

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

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

PHCS Claims (formerly American LIFECARE) 72099 I N na Y

Payer ID 72099 is active for only one insurance plan, Cigna West

with members accessing PHCS in KY, MI, PA, MO, NY and WV.





PHCS Claims (formerly American LIFECARE) 72099 P N na Y

Payer ID 72099 is active for only one insurance plan, Cigna West

with members accessing PHCS in KY, MI, PA, MO, NY and WV.





Philadelphia American Life Insurance Company 98798 I N na N

Philadelphia American Life Insurance Company 98798 P N na N

Phoenix Mutual Life 67814 I N na N

Phoenix Mutual Life 67814 P N na N

Physician Associates of Louisiana 58204 I N na N

Physician Associates of Louisiana 58204 P N na N

Physician Associates of the Greater San Gabriel Valley PA513 I N na N

Physician Associates of the Greater San Gabriel Valley PA513 P N na N

Page 90 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Physician Care Network LLC 58204 I N na N

Physician Care Network LLC 58204 P N na N

Physician Health Partners / Correction Health Partners PHPMC I N na Y

Physician Health Partners / Correction Health Partners PHPMC P N na Y

PHYSICIAN'S ACCOUNTABLE CARE ORG 28943 I N na N

PHYSICIAN'S ACCOUNTABLE CARE ORG 28943 P N na N

Physicians Care (ASR Corporation) 38265 I N Y N ERA Payer Code TLU02

Physicians Care (ASR Corporation) 38265 P N Y N ERA Payer Code TLU02

Physicians Care Health Plans (ASR Corporation) 38265 I N Y N ERA Payer Code TLU02

Physicians Care Health Plans (ASR Corporation) 38265 P N Y N ERA Payer Code TLU02

Physicians Care Network (ASR Corporation) 38265 I N Y N ERA Payer Code TLU02

Physicians Care Network (ASR Corporation) 38265 P N Y N ERA Payer Code TLU02

Physicians Care Network (Rockford IL only) 36345 I N na N

Physicians Care Network (Rockford IL only) 36345 P N na N

Physicians Care Network / The Polyclinic PCN12 I N na N

Physicians Care Network / The Polyclinic PCN12 P N na N

Physician's Data Trust PDT01 I N Y N

Physician's Data Trust PDT01 P N Y N

Physicians Health Association of Illinois 37136 I N na N

Physicians Health Association of Illinois 37136 P N na N

Physicians Health Collaborative 20398 I N na N

Physicians Health Collaborative 20398 P N na N

Physicians Health Network MHM03 P N na N

Physicians Health Plan 37330 I N Y Y

Physicians Health Plan 37330 P N Y Y

Physicians Health Plan of Northern Indiana, Inc 12399 I N Y N

Physicians Health Plan of Northern Indiana, Inc 12399 P N Y Y

Physicians Healthways IPA NMM01 I N Y N

Physicians Healthways IPA NMM01 P N Y N

Physicians Medical Group of San Jose EXC01 P N na N

Physicians Medical Group of Santa Cruz County PMGSC P N na N

Physicians Mutual Insurance Company 47027 I N Y N

Physicians Mutual Insurance Company 47027 P N Y N

Physicians of Southwest Washington 91171 I N na N

Page 91 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Physicians of Southwest Washington 91171 P N na N

Physicians Plus Insurance Corporation 39156 I N Y N

Physicians Plus Insurance Corporation 39156 P N Y N

PhysMetrics 48008 P N na N

PIH Health (ERA Only) PIH01 I na Y ERA Only

PIH Health (ERA Only) PIH01 P na Y ERA Only

PIH Health (formerly Bright Health) BHP01 I N Y N

PIH Health (formerly Bright Health) BHP01 P N Y N

Pinnacle Claims Management Inc. 24735 I N na N

Pinnacle Claims Management Inc. 24735 P N na N

Pinnacle Health Resources (Prospect Medical Group) PROSP P N Y N

Pinnacle Physician Management ORG 45985 I N na N

Pinnacle Physician Management ORG 45985 P N na N

Pioneer Medical Group PIONR P N na N

Pioneer Provider Network PPNZZ I N Y Y

Pioneer Provider Network PPNZZ P N Y Y

Pittsburgh Care Partnership Inc. 23283 I N Y N

Pittsburgh Care Partnership Inc. 23283 P N Y N

Plan de Salud Hospital Menonita L0190 I N na N

Plan de Salud Hospital Menonita L0190 P N na N

Planned Administrators, Inc. (PAI) 37287 I Y Y Y

Planned Administrators, Inc. (PAI) 37287 P Y Y Y

Podi Care Managed Care 58204 I N na N

Podi Care Managed Care 58204 P N na N

PODIATRY NETWORK FL 59324 I N na N

PODIATRY NETWORK FL 59324 P N na N

Point Comfort Underwriters PCU01 I N na N

Point Comfort Underwriters PCU01 P N na N

Pomona Valley Medical Group IP057 P N na N

Positive Healthcare Florida (FL MCO PHC/PHP) 95411 I N na Y

Positive Healthcare Florida (FL MCO PHC/PHP) 95411 P N na Y

PPOM LLC 38335 I N na N

PPOM LLC 38335 P N na N

PPOONE UHNDC P N na Y

Page 92 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

PPOPlus LLC 72148 I N na Y

PPOPlus LLC 72148 P N na Y

Prairie States Enterprises Inc. 36373 I N Y N

Prairie States Enterprises Inc. 36373 P N Y N

Preferred Benefit Administrators (Longwood FL) 53476 I N na Y

Preferred Benefit Administrators (Longwood FL) 53476 P N na Y

Preferred Blue (SC) 00481 I N Y N

Preferred Blue (SC) 00481 P N Y N

Preferred Care Partners Florida 65088 I N Y Y

Preferred Care Partners Florida 65088 P N Y Y

Preferred Community Choice/PCCSelect/CompMed 73145 I N na Y

Preferred Community Choice/PCCSelect/CompMed 73145 P N na Y

Preferred Health Partners 14966 I N na N

Preferred Health Partners 14966 P N na N

Preferred Health Plan (Louisville KY) 61106 I N na N


plan should be sent using payer code 87815.

Preferred Health Plan (Louisville KY) 61106 P N na N


plan should be sent using payer code 87815.

Preferred Health Plan of the Carolinas CB404 I N Y N

Preferred Health Plan of the Carolinas CB404 P N Y N

Preferred Health Professionals 31478 I N na N

Preferred Health Professionals 31478 P N na N

Preferred Health Systems Insurance Company 60110 P N na N

Preferred IPA PFIPA I N na N

Preferred IPA PFIPA P N na N

Preferred IPA PFIPA P N na N

Preferred Medical Claim Solutions (PMCS) (ERA Only) 21524 Y ERA Only

Preferred Network Access Inc. 36401 I N na N

Preferred Network Access Inc. 36401 P N na N

Preferred Plus of Kansas 60110 P N na N

PreferredOne (MN) 41147 I N Y Y

PreferredOne (MN) 41147 P N Y Y

Premera BCBS of Alaska 00430 I N Y Y

Premera BCBS of Alaska 00430 P N Y Y

Premera BCBS of Washington 00430 I N Y Y

Page 93 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Premera BCBS of Washington 00430 P N Y Y

Premier Administrative Solutions 65415 I N na N Underwritten by National Guardian Life

Premier Administrative Solutions 65415 P N na N Underwritten by National Guardian Life

Premier Care IPA PCI01 I N na N

Premier Eye Care 65054 P N na Y

Premier Health Plan 251PR I N Y Y

Premier Health Plan 251PR P N Y Y

Premier Health Systems Inc. 29076 I N Y Y

Premier Health Systems Inc. 29076 P N Y Y

Premier HealthCare Exchange 88056 I N Y N

Premier HealthCare Exchange 88056 P N Y N

Premier HealthCare Exchange, Inc. (PHX) 88051 I N na N

Premier HealthCare Exchange, Inc. (PHX) 88051 P N na N

Presbyterian (NM) 05003 I N Y Y ERA Payer Code TH061

Presbyterian (NM) 05003 P N Y Y ERA Payer Code TH061

Presence ERC 46311 I N na Y

Presence ERC 46311 P N na Y

Prestige Health Choice 77003 I N Y Y

Prestige Health Choice 77003 P N Y Y

Prevea 360 Health Plan 39113 I N Y N

Prevea 360 Health Plan 39113 P N Y N

Primary Care Associates Medical Group (PCAMG) IP079 I N Y N

Primary Care Associates Medical Group (PCAMG) IP079 P N Y N

Primary Care of Joliet PCJOL I N na N

Primary Care of Joliet PCJOL P N na N

Primary Care Practices Of Sacramento - EHS SYMED I N na N

Primary Care Practices Of Sacramento - EHS SYMED P N na N

Primary Care Services MSO44 I N na N

Primary Health Network 82048 I N na N

Primary Health Network 82048 P N na N

Primary PhysicianCare Inc. 56144 I N Y N

Primary PhysicianCare Inc. 56144 P N Y N

Primary Provider Management PPM01 I N na Y

Primary Provider Management PPM01 P N na Y

Page 94 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Prime Community Care Central Valley MVCV1 I N N N

Prime Community Care Central Valley MVCV1 P N N N

Prime West Health Plan 61604 I N Y Y

Prime West Health Plan 61604 P N Y Y

PrimeCare Medical Network IP079 I N Y N

PrimeCare Medical Network IP079 P N Y N

Principal Financial Group (Dental/Vision claims only) 61271 P N Y N

Principal Life (ERA Only) na Y ERA Only

Priority Health 38217 I N Y Y

Priority Health 38217 P N Y Y

Priority Health (JVHL) JZJVH I Y Y Y Provider must be an approved JVHL lab

Priority Health (JVHL) JZJVH P Y Y Y Provider must be an approved JVHL lab

Prism Network Inc. 37268 P N na N

Prism-Univera 37315 I N na N

Prism-Univera 37315 P N na N

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

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

ProCare (Prospect) PROSP P N Y N

ProCare Health Plan Medicaid 70259 I N na N

ProCare Health Plan Medicaid 70259 P N na N

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

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

ProMed HealthCare Administrators IP057 P N na N

Prominence Health Plan of Nevada 93082 I N na N

Prominence Health Plan of Nevada 93082 P N na N

Prominence Health Plan of Texas 80095 I N na N

Prominence Health Plan of Texas 80095 P N na N

Prospect Health Network PROSP P N Y N

Prospect Medical Group PROSP P N Y N

Prospect Medical Group (formerly Genesis Healthcare) PROSP I N Y Y

Prospect Medical Group (formerly Genesis Healthcare) PROSP P N Y Y

Prospect Sherman Oaks Medical Group (Prospect Medical Group) PROSP P N Y N

Protective Life Insurance Company 37309 I N na N

Protective Life Insurance Company 37309 P N na N

Page 95 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Providence Health Plan PHP01 P N Y Y

Providence of Oregon Health Plan SX133 I N Y N

Providence of Oregon Health Plan SX133 P N Y N

Providence PPO SX187 I N na Y

Providence PPO SX187 P N na N

Providence Preferred PHP00 P N na N

Provident American Life & Health Ins Co-Medicare Supplement 13193 I N Y Y

Provident American Life & Health Ins Co-Medicare Supplement 13193 P N Y Y

ProviDRs Care Network 48100 I N na Y

ProviDRs Care Network 48100 P N na Y

Prudential 68241 P N na N

Pruitt Health Premier PH001 I N na N

Pruitt Health Premier PH001 P N na N

PSKW Physician Reimbursement Program PSKW0 P N N Y

Puerto Rico Medicare SMPR0 P Y na Y

Puget Sound Benefits Trust 91136 I N N N

Puget Sound Benefits Trust 91136 P N N N

Puget Sound Electrical Workers Trust 91136 I N N N

Puget Sound Electrical Workers Trust 91136 P N N N

Puritan (formerly Admiral Life) (ERA Only) na Y ERA Only

Pyramid Life Insurance Company 48055 I N Y N

Pyramid Life Insurance Company 48055 P N Y N

Quad City Community Healthcare (QCCH) 40437 I N na Y

Quad City Community Healthcare (QCCH) 40437 P N na Y

QuadMed (West Allis, WI) 39197 I N na N

QuadMed (West Allis, WI) 39197 P N na N

Qual Choice of Arkansas 35174 I N Y Y

Qual Choice of Arkansas 35174 P N Y Y

QualCare Inc. 23342 I N Y N

QualCare Inc. 23342 P N Y N

QualCare, Inc. (dba QANI Administrators) A Cigna Company 22312 I N Y N

QualCare, Inc. (dba QANI Administrators) A Cigna Company 22312 P Y Y N

Quality Care Partners 89461 I N na Y

Quality Care Partners 22312 P N na Y

Page 96 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Quartz ASO 46571 I N Y Y ERA Payer Code QUARTZASO

Quartz ASO 46571 P N Y Y ERA Payer Code QUARTZASO

QuikTrip 73067 I N Y N

QuikTrip 73067 P N Y N

QVI Risk Solutions Inc. 57117 P N na N

R&N Market TKFMC P N na N

Railroad Medicare (PGBA) SRRGA P Y Y Y

Ravenswood Physician Associates, Inc. RPAWC I N Y N

Ravenswood Physician Associates, Inc. RPAWC P N Y N

Reading Hospital Employer Group 44219 I N na Y

Reading Hospital Employer Group 44219 P N na Y

Regal Medical Group 95449 I N na N

Regal Medical Group REGAL I N na N

Regal Medical Group REGAL P N na N

Regence Blue Cross Blue Shield of Oregon 00851 I N Y Y

Regence Blue Cross Blue Shield of Oregon 00851 P N Y Y

Regence Blue Cross Blue Shield of Utah 00910 I N Y Y

Regence Blue Cross Blue Shield of Utah 00910 P N Y Y

Regence Blue Shield Idaho 00611 I N Y Y

Regence Blue Shield Idaho 00611 P N Y Y

Regence Blue Shield of Washington 00932 I N Y Y

Regence Blue Shield of Washington 00932 P N Y Y

Regence Group Administrators RGA01 I N Y N

Regence Group Administrators RGA01 P N Y N

Regency Employee Benefits 38221 I N na N

Regency Employee Benefits 38221 P N na N

Regional Care Inc. 47076 I N na N

Regional Care Inc. 47076 P N na N

Religious Order of Jehovah's Witness ROJW1 P N na N

Renaissance Physicians Organization 76066 I N na N

Renaissance Physicians Organization 76066 P N na N

Reserve National Insurance 73066 I N Y Y

Reserve National Insurance 73066 P N Y Y

Resolve Health Plan Administrators LLC RHA01 I N na N

Page 97 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Resolve Health Plan Administrators LLC RHA01 P N na N

ResourceOne Administrators 37278 I N Y N

ResourceOne Administrators 37278 P N Y N

Resurrection Healthcare Preferred 36396 I N na N

Resurrection Healthcare Preferred 36396 P N na N

Resurrection Physician Provider Group RPPG1 I N na N

Resurrection Physician Provider Group RPPG1 P N na N

Retiree Health Trust 26316 P N na N

RevClaims RVC01 I N na Y

RevClaims RVC01 P N na Y

Rhode Island Medicaid 12K74 I Y Y Y

Rhode Island Medicaid SKRI0 P Y Y Y

Rhode Island Medicare 12M74 I Y Y Y

Rhode Island Medicare SMRI0 P Y Y Y

Right Care from Scott & White 74205 I N N Y

Right Care from Scott & White 74205 P N N Y

RightChoice Benefit Administrators 37331 I N na N

RightChoice Benefit Administrators 37331 P N na N

RIVER CITY MEDICAL GROUP RCMG1 I N Y N

RIVER CITY MEDICAL GROUP RCMG1 P N Y N

RiverLink Health 42172 I N Y N

RiverLink Health 42172 P N Y N

Riverside Medical Clinic RMC01 P N na N

RMSCO INC. 16117 I N na Y

RMSCO INC. 16117 P N na Y

Rocky Mountain Health Plan - Grand Junction 84065 I Y Y N ERA Payer Code RMHMO

Rocky Mountain Health Plan - Grand Junction SX141 P Y Y N ERA Payer Code RMHMO

Rosemont of Des Plaines IL 36215 I N na N

Royal Health Care 73780 I N na Y

Royal Health Care 73780 P N na Y

Royal Neighbors of America (ERA Only) na Y ERA Only

Rural Carrier Benefit Plan (for claims after to 12/31/17) 60054 I N Y Y

Rural Carrier Benefit Plan (for claims after to 12/31/17) 60054 P N Y Y

Rural Carrier Benefit Plan (for claims prior to 1/1/18) 25133 I N na Y

Page 98 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Rural Carrier Benefit Plan (for claims prior to 1/1/18) 25133 P N na Y

Rural Health Clinic - Cahaba GBA 12M53 I Y Y Y

Rush Prudential Health Plans (HMO Only) 36389 I N na N

Rush Prudential Health Plans (HMO Only) 36389 P N na N

Ryan White Network AMM03 P N na N

S & S Healthcare Strategies 31441 I N Y N

S & S Healthcare Strategies 31441 P N Y N

Sagamore Health Network 35164 I N na N

Sagamore Health Network 35164 P N na N

Sage Technologies 37105 I N na N

Sage Technologies 37105 P N na N

Saint Joseph PACE of IN (Mediture, LLC) 47312 I N na N

Saint Joseph PACE of IN (Mediture, LLC) 47312 P N na N

SAINT MARY'S HEALTH PLAN 88029 I N na N

SAINT MARY'S HEALTH PLAN 88029 P N na N

Saint Mary's Health Plan 88082 P N na N Encounters Only

Samaritan Health Plans CP001 I N Y N

Samaritan Health Plans CP001 P N Y N

San Diego County Coverage Initiative (CI) MSO77 I N na N

San Diego County Coverage Initiative (CI) MSO77 P N na Y

San Diego County Medical Services (CMS) MSO11 I N na N

San Diego County Medical Services (CMS) MSO11 P N na N

San Diego County Physician Emergency Services MSO22 I N na N

San Diego County Ryan White Care Act MSO33 I N na N

San Diego County Ryan White Care Act MSO33 P N na N

San Diego County Sheriff MSO55 I N na N

San Diego PACE 96400 I N na N

San Diego PACE 96400 P N na N

San Diego Physicians Med Group (SCPMCS) SCP01 I N na N

San Diego Physicians Med Group (SCPMCS) SCP01 P N na N

San Francisco Health Plan SFHP1 I N Y N

San Francisco Health Plan SFHP1 P N Y N

San Joaquin Health Administrators 68035 P N Y Y

San Judas Medical Group IPA HSM01 I N na N

Page 99 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

San Judas Medical Group IPA HSM01 P N na N

San Louis Obispo Select 33072 I N na N

San Louis Obispo Select 33072 P N na N

Sandhills Center SHC303 I Y Y Y

Sandhills Center SHC303 P Y Y Y

Sanford Health Plan 91184 I N Y Y

Sanford Health Plan 91184 P N Y Y

Santa Clara County IPA HMO 10378 I N Y N

Within Payspan’s portal, the payer is listed as Pacific Partners

Management Services, Inc.

Santa Clara County IPA HMO 10378 P N Y N

Within Payspan’s portal, the payer is listed as Pacific Partners

Management Services, Inc.

SANTA CLARA FAMILY HEALTH PLAN 24077 I N Y N

SANTA CLARA FAMILY HEALTH PLAN 24077 P N Y N

Sante Community Physicians Medical Group Corp SNTMC I N na N

Sante Community Physicians Medical Group Corp SNTMC P N na N

Sante Health System and Affiliates 77038 I N Y N

Sante Health System and Affiliates 77038 P N Y N

Satellite Health Plan, Inc. 45552 I N na N

Satellite Health Plan, Inc. 45552 P N na N

SCAN ENCOUNTERS 99157 I N na Y

SCAN ENCOUNTERS 99157 P N na Y

SCAN Health Plan 72261 I N Y N ERA Payer Code SCAN1

SCAN Health Plan 72261 P N Y N ERA Payer Code SCAN1

SCAN Health Plan - California SCAN1 I N Y Y

SCAN Health Plan - California SCAN1 P N Y Y

Scan Health Plan Arizona 73172 I N na N

Scan Health Plan Arizona 73172 P N na N

SCHC Total Care - ClaimsNet 16146 I N na N

SCHC Total Care - ClaimsNet 16146 P N na N

Scott & White Health Plan 12T05 I N Y Y

Scott & White Health Plan TH002 P N Y N

Scripps Health Plan Services SHPS1 I N N N

Scripps Health Plan Services SHPS1 P N N N

Seaside Health Plan 46187 I N na Y

Seaside Health Plan 46187 P N na Y

Page 100 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Seaview IPA SVIPA P N na N

Secure Health Plans of Georgia LLC 28530 I N Y N

Secure Health Plans of Georgia LLC 28530 P N Y N

Security Health Plan 39045 I N Y Y

Security Health Plan 39045 P N Y Y

Select Administrative Services (SAS) 64088 I N Y N

Select Administrative Services (SAS) 64088 P N Y N

Select Advantage SA704 I N na N ERA Payer Code SX055

Select Advantage SA704 P N na N ERA Payer Code SX055

Select Benefit Administrators Inc. 93031 I N na Y

Select Benefit Administrators Inc. 93031 P N na Y

Select Benefit Administrators of America 37282 I N na N

Select Benefit Administrators of America 37282 P N na N

Select Health of South Carolina 23285 I N Y Y

Select Health of South Carolina 23285 P N Y Y

Select Senior Clinic 20415 I N na N

Select Senior Clinic 20415 P N na N

SelectCare 00014 I N na Y

SelectCare 00014 P N na Y

SelectCare of Texas (HPN) Heritage Physicians Network 76045 I N Y N

SelectCare of Texas (HPN) Heritage Physicians Network 76045 P N Y N

SelectCare of Texas (Kelsey-Seybold) 61225 I N Y N ERA Payer Code KLSY1

SelectCare of Texas (Kelsey-Seybold) 61225 P N Y N ERA Payer Code KLSY1

SelectHealth 12X37 I N na N

SelectHealth SX107 P N na N

Self Insured Plans (Naples FL) 36404 I N na N

Self Insured Plans (Naples FL) 36404 P N na N

Self Insured Services Company (SISCO) 00540 I N Y N

Self Insured Services Company (SISCO) 00540 P N Y N

Self-Funded Plans Inc. 34131 I N na N

Self-Funded Plans Inc. 34131 P N na N

Selman Tricare Supp (DOS on or after 1/1/19) 52214 I N Y Y

Selman Tricare Supp (DOS on or after 1/1/19) 52214 P N Y Y

Selman Tricare Supp (DOS prior to 1/1/19) TRSEL I N na Y

Page 101 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Selman Tricare Supp (DOS prior to 1/1/19) TRSEL P N na Y

Sendero IdealCare (for Claims DOS after 12/31/18) UV440 I N Y N

Sendero IdealCare (for Claims DOS after 12/31/18) MV440 P N Y N

Sendero IdealCare (for Claims DOS prior to 1/1/19) 11440 I N Y N

Sendero IdealCare (for Claims DOS prior to 1/1/19) 11440 P N Y N

Sendero STAR and CHIP SCS17 I N Y N

Sendero STAR and CHIP SCS17 P N Y N

Senior Health Partners (SHP) 80141 I N Y Y

Senior Health Partners (SHP) 80141 P N Y Y

SENIOR WHOLE HEALTH 83035 I N Y N

SENIOR WHOLE HEALTH 83035 P N Y N

Sentara Family Care 54154 I N Y Y

Sentara Family Care 54154 P N Y Y

Sentara Health Management 54154 I N Y Y

Sentara Health Management 54154 P N Y Y

Sentinel Management Services 23249 I N na N

Sentinel Management Services 23249 P N na N

Sentinel Security Life Insurance Co (ERA Only) 87020 I na Y ERA Only

Sentinel Security Life Insurance Co (ERA Only) 87020 P na Y ERA Only

Sentry Insurance a Mutual Company 39033 I N na N

Sentry Insurance a Mutual Company 39033 P N na N

Sentry Life Insurance Company 39033 I N na N

Sentry Life Insurance Company 39033 P N na N

Sentry Life of New York 39033 I N na N

Sentry Life of New York 39033 P N na N

Seoul Medical Group SMG01 I N na Y

Seoul Medical Group SMG01 P N na Y

Sequoia Beverage TKFMC P N na N

Sequoia Health IPA AGL01 I N N Y

Sequoia Health IPA AGL01 P N N Y

Seton Health Plan - Exclusive 12T55 I N na Y

Seton Health Plan - Exclusive TH079 P N na N

Seton Health Plan (CHIP) SHPCH I N na N

Seton Health Plan (CHIP) SHPCH P N na N

Page 102 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Seton MAP Program TH081 P N na N

Seven Corners 25404 I N na N

Seven Corners 25404 P N na N

Sharp Community Medical Group SCMG1 I N N N Payer returns ERA automatically upon claim submission

Sharp Community Medical Group SCMG1 P N N N Payer returns ERA automatically upon claim submission

Sharp Health Plan SHP01 I N N N Payer returns ERA automatically upon claim submission

Sharp Health Plan SHP01 P N N N Payer returns ERA automatically upon claim submission

Sharp Rees-Sealy Medical Group SRS83 I N N N Payer returns ERA automatically upon claim submission

Sharp Rees-Sealy Medical Group SRS83 P N N N Payer returns ERA automatically upon claim submission

Shasta Administrative Services 75280 I N Y Y

Shasta Administrative Services 75280 P N Y Y

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

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

Shenandoah Life (ERA Only) na Y ERA Only

Sherman Choice - BLUE CROSS SHERMAN CHOICE SC359 I N na N

Sherman Choice - BLUE CROSS SHERMAN CHOICE SC359 P N na N

Sierra Family Network (Prospect Medical Group) PROSP P N Y N

Sierra Health and Life 76342 I N Y Y

Sierra Health and Life 76342 P N Y Y

Sierra Medical Group 30891 I N na N

Sierra Medical Group 30891 P N na N

Sierra Nevada Medical Association MBA01 P N na Y ERA not available for this plan

Signature Advantage SA002 I N na N

Signature Advantage SA002 P N na N

Significa Benefits Services Inc. 23250 I N na N

Significa Benefits Services Inc. 23250 P N na N

Silver Cross Health Connection 65093 I N Y N

Silver Cross Health Connection 65093 P N Y N

Silverback TPA 37228 I N na N

Silverback TPA 37228 P N na N

Page 103 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

SimplePay 27905 I N Y N Formerly known as Community Health Alliance TN

SimplePay 27905 P N Y N Formerly known as Community Health Alliance TN

Simply Healthcare 00199 I N Y Y Former payer code 27094

Simply Healthcare 27094 I N Y Y

Simply Healthcare SMPLY I N Y Y

Simply Healthcare 00199 P N Y Y Former payer code 27094

Simply Healthcare 27094 P N Y Y

Simply Healthcare SMPLY P N Y Y

Simpra Advantage Inc. SIM01 I N Y N

Simpra Advantage Inc. SIM01 P N Y N

Sinclair Health Plan 84076 I N na N

Sinclair Health Plan 84076 P N na N

Sloans Lake Preferred Health Networks 84096 I N na N

Sloans Lake Preferred Health Networks 84096 P N na N

Smith Administrators 02057 I N na Y

Smith Administrators 02057 P N na Y

Smokey Mountain Center (aka Vaya Health) 13010 I Y Y N

ERA's are activated as soon as the provider is approved for EDI

submissions.

Smokey Mountain Center (aka Vaya Health) 13010 P Y Y N

ERA's are activated as soon as the provider is approved for EDI

submissions.

Solidarity Healthshare 77721 I N na N

Solidarity Healthshare 77721 P N na N

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

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

Soundpath Health 42172 I N Y N

Soundpath Health 42172 P N Y N

South Carolina Medicaid 12K55 I Y Y Y

South Carolina Medicaid SKSC0 P N Y Y

South Carolina Medicare 12M55 I Y Y Y

South Carolina Medicare SMSC0 P Y Y Y

South Central Preferred 23266 I N Y Y

South Central Preferred 23266 P N Y Y

South Country Health Alliance 81600 I N Y Y

South Country Health Alliance 81600 P N Y Y

South Dakota Medicaid 12K36 I Y Y Y

Page 104 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

South Dakota Medicaid SKSD0 P Y Y Y

South Dakota Medicare 12M83 I Y na Y

South Dakota Medicare SMSD0 P Y na Y

South FL Community Care Network - NBHD 37314 I N na Y

South FL Community Care Network - NBHD 37314 P N na Y

South Florida Musculoskeletal Care 06294 I N na N

South Florida Musculoskeletal Care 06294 P N na N

South Indiana Health Operations - HMO 77153 I N Y Y

South Indiana Health Operations - HMO 77153 P N Y Y

South Point Hotel & Casino 35227 I N na N

South Point Hotel & Casino 35227 P N na N

SouthCare/Healthcare Preferred 25147 I N na Y

SouthCare/Healthcare Preferred 25147 P N na Y

Southeast Community Care (Arcadian) 77045 I N na N

Southeast Community Care (Arcadian) 77045 P N na N

Southeast Texas Govt Employees Benefit Pool TH116 P N na Y

Southern Benefit Administrators (ERA Only) 38242 I na Y ERA Only

Southern Benefit Administrators (ERA Only) 38242 P na Y ERA Only

Southern Cal Physicians Managed Care Services SCP01 P N na N

Southern California Physicians Managed Care Services SCP01 I N na N

Southern Illinois Health Care Association UIHCA I N na Y

Southern Illinois Health Care Association SIHCA P N na Y

Southland BCBS SIPA1 I N na N

Southland BCBS SIPA1 P N na N

Southwest Service Life 37266 I N na N

Southwest Service Life 37266 P N na N

Special Agents Mutual Benefits Association (SAMBA) (ERA Only) 37259 I na Y ERA Only

Special Agents Mutual Benefits Association (SAMBA) (ERA Only) 37259 P na Y ERA Only

Spectera 00773 P N na Y

Spectrum Administrators Inc. - TPA Allentown PA (IHS Gateway Payer) 23253 I N na Y

Spectrum Administrators Inc. - TPA Allentown PA (IHS Gateway Payer) 23253 P N na Y

Spencer Stuart (ARM, LTD) 38416 I N na Y

Spencer Stuart (ARM, LTD) 38416 P N na Y

Spina Bifida - VA HAC 84146 I N Y Y

Page 105 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Spina Bifida - VA HAC 84146 P N Y Y

Spohn Health 12T63 I N na N

Spohn Health TH100 P N na N

St. Anthony Memorial Healthcare Centers - MDWISE 35199 I N Y N

St. Anthony Memorial Healthcare Centers - MDWISE 35199 P N Y N

St. Barnabas System Health Plan 22240 I N na N

St. Barnabas System Health Plan 22240 P N na N

St. Catherine Hospital PHO - MDWISE 35199 I N Y N

St. Catherine Hospital PHO - MDWISE 35199 P N Y N

St. Francis Health Network 35199 I N Y N

St. Francis Health Network 35199 P N Y N

St. Francis IPA APP01 I N na Y

St. Francis IPA APP01 P N na Y

St. James PHO 11158 I N na Y

St. James PHO 11158 P N na Y

St. Joseph Heritage Healthcare STJOE I N na N

St. Joseph Heritage Healthcare STJOE P N na N

St. Joseph IPA STJOE P N na N

St. Jude (St. Joseph Heritage Healthcare) STJOE P N na N

St. Jude Yorba Linda STJOE P N na N

St. Margaret Mercy Healthcare Centers - MDWISE 35199 I N Y N

St. Margaret Mercy Healthcare Centers - MDWISE 35199 P N Y N

St. Mary's IPA SMIPA I N na Y

St. Mary's IPA SMIPA P N na Y

St. Vincent IPA PDT01 I N Y N

St. Vincent IPA PDT01 P N Y N

Standard Life and Accident MWG (Secondary claims only) 73099 I N N Y

Standard Life and Accident MWG (Secondary claims only) 73099 P N N Y

Starmark 61425 I N Y N

Starmark 61425 P N Y N

State Employee Plan (SC) 00400 I N Y N

State Employee Plan (SC) 00400 P N Y N

State Farm (Casualty & Property Claims) 31059 I N Y Y

State Farm (Casualty & Property Claims) 31059 P N Y Y

Page 106 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

State Farm Insurance Companies 31053 I N Y N

State Farm Insurance Companies 31053 P N Y N

State Mutual (ERA Only) na Y ERA Only

State Mutual LH Novated (ERA Only) na Y ERA Only

State of Idaho Department of Health & Welfare 12113 I Y Y Y Women’s Health Check and Children’s Special Health Program

State of Idaho Department of Health & Welfare 12113 P Y Y Y Women’s Health Check and Children’s Special Health Program

State of Texas Dental Plan 57254 I N Y N ERA Payer Code 44054

State of Texas Dental Plan 57254 P N Y N ERA Payer Code 44054

State Trust Group 42162 I N na N

State Trust Group 42162 P N na N

Sterling Option 1 91151 I N na N

Sterling Option 1 91151 P N na N

Stirling & Stirling 06089 P Y ERA Only

Stonebridge Life Insurance Company (IA, PA) TRP1E I N na Y

Stonebridge Life Insurance Company (IA, PA) TRP1E P N na Y

Stonebridge Life Insurance Company (TX) TRP1P I N na Y

Stonebridge Life Insurance Company (TX) TRP1P P N na Y

Stoner and Associates (Cincinnati OH) 31121 I N na N

Stoner and Associates (Cincinnati OH) 31121 P N na N

Stones River IPA - Amerivantage 57492 P N na Y

Stones River Regional IPA/BCBST 15750 P N na N

Stones River Regional IPA/BHFG 15754 P N na N

Stones River Regional IPA/Humana 57549 P N na Y

Stones River Regional IPA/Windsor 15752 P N na N

Student Assurance Services (ERA Only) SAS01 I na Y na ERA Only

Student Assurance Services (ERA Only) SAS01 P na Y na ERA Only

Suburban Health Organization 35199 I N Y N

Suburban Health Organization 35199 P N Y N

SummaCare Health Plan 95202 I N Y Y ERA Payer Code A5202

SummaCare Health Plan 95202 P N Y Y ERA Payer Code A5202

Summit Administration Services Inc. 86083 I N Y N

Summit Administration Services Inc. 86083 P N Y N

Summit America Insurance Services Inc. 37301 I N Y N

Page 107 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Summit America Insurance Services Inc. 37301 P N Y N

SunAmerica Life Insurance Company 90956 P N na N

Sunrise Advantage Plan of Illinois SIL01 I N Y N

Sunrise Advantage Plan of Illinois SIL01 P N Y N

Sunrise Advantage Plan of New York SNY01 I N Y N

Sunrise Advantage Plan of New York SNY01 P N Y N

Sunrise Advantage Plan of Pennsylvania SPA01 I N Y N

Sunrise Advantage Plan of Pennsylvania SPA01 P N Y N

Sunrise Advantage Plan of Virginia SVA01 I N Y N

Sunrise Advantage Plan of Virginia SVA01 P N Y N

Sunshine State Health Plan 68069 I N Y Y

Sunshine State Health Plan 68069 P N Y Y

Superior Choice Medical Group ECMSO I N na N

Superior Choice Medical Group ECMSO P N na N

Superior Health Plan Texas 68069 I N Y Y

Superior Health Plan Texas 68069 P N Y Y

Superior Vision Services 13305 P N Y N ERA Payer Code 13374

Sutter Connect (SIP/SMG/SWMG) SC004 P N na Y

Sutter Connect Medical Foundation 99308 I N na Y

Sutter Delta Medical Group 77318 P N na N

Sutter East Bay Medical Foundation 94269 I N na Y

Sutter East Bay Medical Foundation 94269 P N na N

Sutter East Bay Regional Hospital 96176 I N na Y

Sutter East Bay Regional Hospital 96176 P N na Y

Sutter East Bay Regional Hospital- Affinity 94119 I N na Y

Sutter East Bay Regional Hospital- Affinity 94119 P N na Y

Sutter Gould Medical Foundation 77302 I N na Y

Sutter Gould Medical Foundation 77302 P N na N

Sutter Medical Group of the Redwoods 77304 I N Y Y

Sutter Medical Group of the Redwoods 77304 P N Y Y

Sutter Senior Care 56621 I N na Y

Sutter Senior Care 56621 P N na Y

Swedish Covenant Hospital 36411 I N na N

Swedish Covenant Hospital 36411 P N na N

Page 108 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

SynerMed SYMED I N na N

SynerMed SYMED P N na N

Talbert Medical Group TALMG P N na N

Tall Tree Administrators 88067 I N na N

Tall Tree Administrators 88067 P N na N

TASEBA TKFMC P N na N

Taylor Benefits UAYLR I N Y N

Taylor Benefits TAYLR P N Y N

TCC Benefits Administrator TCC13 I N Y Y ERA Payer Code SX160

TCC Benefits Administrator TCC13 P N Y Y ERA Payer Code SX160

Teachers Health Trust 88019 P N na N

Team Choice PNS 75133 I N na N

Team Choice PNS 75133 P N na N

Teamcare 36215 I N na N

Teamcare 36215 P N na N

Teamsters Local Union #301 36612 I N na N

Teamsters Medicare Trust for Retired Employees 43619 I N Y Y

Teamsters Medicare Trust for Retired Employees 43619 P N Y Y

Tennessee Medicaid 12K46 I Y Y N

Tennessee Medicaid SKTN2 P Y Y N

Tennessee Medicare 12M53 I Y Y Y

Tennessee Medicare SMTN0 P Y Y Y

Tethys Health Ventures 20212 I N na N

Tethys Health Ventures 20212 P N na N

TEXAS CHILDRENS HEALTH TXCSM P N na N

Texas Children's Health Plan 76048 I N N N

Texas Children's Health Plan 76048 P N N N

Texas Childrens Health Plan (Medicaid) 75228 I N Y N

Texas Childrens Health Plan (Medicaid) 75228 P N Y N

Texas Christus 45210 I N na N

Texas Christus 45210 P N na N

Texas First Health Plans (TIOPA) 76046 I N na N

Texas First Health Plans (TIOPA) 76046 P N na N

Texas HealthSpring 33104 I N na N

Page 109 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Texas HealthSpring 33104 P N na N

Texas Medicaid 12K64 I N Y Y

Texas Medicaid SKTX0 P N Y Y

Texas Medicare 12M31 I Y Y Y

Texas Medicare SMTX0 P Y Y Y

Texas Municipal League Group (ERA Only) 74214 I na Y ERA Only

Texas Municipal League Group (ERA Only) 74214 P na Y ERA Only

Texas Mutual Insurance Company WK002 I N na N

Texas Mutual Insurance Company WK002 P N na N

Texas Premier Plan TH089 P N na N

TexasFirst Health Plan (NTX) 13185 I N Y N

TexasFirst Health Plan (NTX) 13185 P N Y N

The Alliance 88461 I N na N

The Alliance 88461 P N na N

The Care Network/The Savannah Business Group 68423 I N na Y

The Care Network/The Savannah Business Group 68423 P N na Y

The City of Odessa 75600 I N na N

The City of Odessa 75600 P N na N

The Health Exchange (Cerner Corporation) 20356 I N Y N

The Health Exchange (Cerner Corporation) 20356 P N Y N

The Health Plan of The Upper Ohio Valley 34150 I N Y N

The Health Plan of The Upper Ohio Valley 34150 P N Y N

The Health Plan/Hometown Health 34150 I N Y N

The Health Plan/Hometown Health 34150 P N Y N

The Healthcare Group 35206 I N na N

The Healthcare Group 35206 P N na N

The Integrity Benefit Group Inc. 58200 I N na N

The Integrity Benefit Group Inc. 58200 P N na N

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

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

The MEGA Life & Health Insurance Company-OKC 59227 P N na N

The National Radiology Network 59087 I N na N

The National Radiology Network 59087 P N na N

The New England 66893 P N na N

Page 110 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

The Physicians Assurance Corp (TPAC) /Employee Benefit Management Corp (EBMC) 31074 I N na Y

The Physicians Assurance Corp (TPAC) /Employee Benefit Management Corp (EBMC) 31074 P N na Y

Third Party Administrators 37225 I N na N

Thomas H. Cooper & Company SX160 P N na Y

Three Rivers Preferred MP340 P N na Y

Thrivent Financial THRIV I N Y N

Thrivent Financial THRIV P N Y N

TKSoftware (ERA Only) SX142 I na Y ERA Only

TKSoftware (ERA Only) SX142 P na Y ERA Only

TLC Benefit Solutions (Global Care) TLC79 I N Y N

TLC Benefit Solutions (Global Care) TLC79 P N Y N

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

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

Today's Options powered by CCRX 48055 I N Y N

Today's Options powered by CCRX 48055 P N Y N

Together with Children's Community Health Plan of Wisconsin 251CC I N Y N

Together with Children's Community Health Plan of Wisconsin 251CC P N Y N

Tongass Timber Trust 92620 I N na Y

Tongass Timber Trust 92620 P N na Y

Tooling & Manufacturing Association 61425 I N Y N

Tooling & Manufacturing Association 61425 P N Y N

Torrance Hospital IPA THIPA I N na N

Torrance Hospital IPA THIPA P N na N

Total Broker Benefits 36342 I N Y N

Total Broker Benefits 36342 P N Y N

Total Claims Administration 37314 I N na Y

Total Claims Administration 37314 I N na Y

Total Community Care 31182 I N na N

Total Community Care 31182 P N na N

Total Healthcare Inc. 38201 I N na N

Total Healthcare Inc. 38201 P N na N

Total Plan Services 41202 I N Y N

Total Plan Services 41202 P N Y N

Touchstone Health PSO 23856 I N na N

Page 111 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Touchstone Health PSO 23856 P N Y N

Town & Country TKFMC P N na N

TPAC/Employee Benefit Management Corp 31074 I N na Y

TPAC/Employee Benefit Management Corp 31074 P N na Y

TR Paul Inc. 37230 I N na N

TR Paul Inc. 37230 P N na N

Transact RX PARTD P N N N

TransAmerica Financial Life Insurance Company (AR) TLINS I N na Y

TransAmerica Financial Life Insurance Company (AR) TLINS P N na Y

TransAmerica Financial Life Insurance Company (TX) TRP1P I N na Y

TransAmerica Financial Life Insurance Company (TX) TRP1P P N na Y

TransAmerica Life Insurance Company (AR) TLINS I N na Y

TransAmerica Life Insurance Company (AR) TLINS P N na Y

TransAmerica Life Insurance Company (IA, MD, PA) TRP1E I N Y Y

TransAmerica Life Insurance Company (IA, MD, PA) TRP1E P N Y Y

TransAmerica Life Insurance Company (TX) TRP1P I N na Y

TransAmerica Life Insurance Company (TX) TRP1P P N na Y

TransAmerica Premier Life Insurance Company (AR) TLINS I N na Y

TransAmerica Premier Life Insurance Company (AR) TLINS P N na Y

TransAmerica Premier Life Insurance Company (IA) TRCLF I N na Y

TransAmerica Premier Life Insurance Company (IA) TRCLF P N na Y

TransAmerica Premier Life Insurance Company (IA, MD, PA) TRP1E I N na Y

TransAmerica Premier Life Insurance Company (IA, MD, PA) TRP1E P N na Y

TransAmerica Premier Life Insurance Company (TX) TRP1P I N na Y

TransAmerica Premier Life Insurance Company (TX) TRP1P P N na Y

TransChoice-Key Benefit Administrators 37284 I N na Y

TransChoice-Key Benefit Administrators 37284 P N na Y

Trellis Health Partners 36397 I N na N

Trellis Health Partners 36397 P N na N

Tribute /SelectCare of Oklahoma 73117 I N Y N

Tribute /SelectCare of Oklahoma 73117 P N Y N

Tribute Health Plan 31118 I N Y Y

Tribute Health Plan 31118 P N Y Y

Tricare East TREST I Y Y Y

Page 112 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Tricare East TREST P N Y Y

Tricare for Life 12X43 I Y Y Y

Tricare for Life SX176 P Y Y Y

Tricare for Overseas 12X46 I Y Y N

Tricare for Overseas SX163 P Y Y N

Tricare West 99726 I N Y Y

Tricare West 99726 P N Y Y

TriCities IPA PDT01 I N Y N

TriCities IPA PDT01 P N Y N

Trigon Blue Cross and Blue Shield (Virginia) SB924 P N na Y

TRIHEALTH PHYSICIAN SOLUTIONS 31144 I Y Y N

TRIHEALTH PHYSICIAN SOLUTIONS 31144 P Y Y N

TRIHEALTH PHYSICIAN SOLUTIONS - CONCERN 31143 I N na N

TRIHEALTH PHYSICIAN SOLUTIONS - CONCERN 31143 P N na N

Trillium Community Health Plan 68069 I N Y Y

Trillium Community Health Plan 68069 P N Y Y

Trilogy Network 62777 I N na Y

Trilogy Network 62777 P N na Y

Trinity Health Pace TRNPC I N na Y Formerly payer code 59847

Trinity Health Pace TRNPC P N na Y Formerly payer code 59847

TRIPLEFIN LLC 64300 I N na N

TRIPLEFIN LLC 64300 P N na N

Triple-S Inc. 12B48 I Y na N

Triple-S Inc. SB980 P Y Y N

TRISTAR Benefit Administrators 42137 I N Y N

TRISTAR Benefit Administrators 42137 P N Y N

TriWest VAPC3 Region 3 55912 I Y Y N

TriWest VAPC3 Region 3 55912 P Y Y N

TriWest VAPC3 Region 5A 55915 I Y Y N

TriWest VAPC3 Region 5A 55915 P Y Y N

TriWest VAPC3 Region 5B 55916 I Y Y N

TriWest VAPC3 Region 5B 55916 P Y Y N

TriWest VAPC3 Region 6 55917 I Y Y N

TriWest VAPC3 Region 6 55917 P Y Y N

Page 113 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

True Blue / Blue Cross of Idaho 12B84 I Y na Y

True Blue / Blue Cross of Idaho SB612 P Y na Y

True Health New Mexico 82288 I N Y Y

True Health New Mexico 82288 P N Y Y

TRUSTED HEALTH PLAN L0230 I N Y Y

TRUSTED HEALTH PLAN L0230 P N Y Y

Trusteed Insurance (FCHN) 91131 I N Y Y

Trusteed Insurance (FCHN) 91131 P N Y Y

Trusteed Plans Service Corporation 91078 I N Y N

Trusteed Plans Service Corporation 91078 P N Y N

Trustmark Insurance Company 61425 I N Y N

Trustmark Insurance Company 61425 P N Y N

Tuality Health Alliance 93112 I N na Y

Tuality Health Alliance 93112 P N na Y

Tufts Health Plan 04298 I Y Y Y

Tufts Health Plan 04298 P Y Y Y

Tufts Health Public Plans (aka Network Health) 04298 I Y Y N ERA Payer Code 04332

Tufts Health Public Plans (aka Network Health) 04298 P Y Y N ERA Payer Code 04332

TX Premier Plan - Medicaid 12T29 I N na N

Ucare Minnesota 12X50 I Y na N

Ucare Minnesota SX178 P N Y N

UC-Davis Health 94603 I N na Y

UC-Davis Health 94603 P N na Y

UCS (The City of East Chicago) 56001 I N na Y

UCS (The City of East Chicago) 56001 P N na Y

UCS BASI: Meter Group USA 16025 I N Y N

UCS BASI: Meter Group USA 16025 P N Y N

UCS NX Health Network 08354 I N na Y

UCS NX Health Network 08354 P N na Y

UHP Management UHP01 I N na Y

UHP Management UHP01 P N na Y

Ullico Inc. ULLIC I N na N

Ullico Inc. ULLIC P N na N

Ultimate Health Plan 77022 I N Y N

Page 114 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Ultimate Health Plan 77022 P N Y N

Ultra Benefits Inc. 41206 I N Y Y

Ultra Benefits Inc. 41206 P N Y Y

UMC HEALTH PLAN 75130 I N na Y

UMC HEALTH PLAN 75130 P N na Y

UMR (formerly Lexington / CommonWealth Administrative Group) 39026 I N Y Y

UMR (formerly Lexington / CommonWealth Administrative Group) 39026 P N Y Y

UMR (formerly UMR Onalaska) 79480 I N na Y

UMR (formerly UMR Onalaska) 79480 P N na Y

UMR (formerly UMR San Antonio Benefit Planners) 39026 I N Y Y

UMR (formerly UMR San Antonio Benefit Planners) 39026 P N Y Y

UMR (formerly UMR Wausau Fiserv Benesight) 39026 I N Y Y

UMR (formerly UMR Wausau Fiserv Benesight) 39026 P N Y Y

UMR Westerville (formerly Harrington Benefit Services - Columbus) 39026 I N Y Y

UMR Westerville (formerly Harrington Benefit Services - Columbus) 39026 P N Y Y

UMWA Health & Retirement Funds 52180 I N Y Y

UMWA Health & Retirement Funds 52180 P N Y Y

Unicare Life & Health 80314 I N Y Y

Unicare Life & Health 80314 P N Y Y

Unified Group Services 35198 I N Y N

Unified Group Services 35198 P N Y N

Unified Health Services 62170 I N na N

Unified Health Services 62170 P N na N

Unified IPA HCP01 I N na N

Unified Physicians Network 34638 I N Y Y

Unified Physicians Network 34638 P N Y Y

Uniform Medical Plan 39026 I N Y Y

Uniform Medical Plan 39026 P N Y Y

Union Labor Life Insurance Company (IA) TRP1E I N na Y

Union Labor Life Insurance Company (IA) TRP1E P N na Y

Union Pacific IPA (SCPMCS) SCP01 I N na N

Union Pacific IPA (SCPMCS) SCP01 P N na N

UNION PACIFIC RAILROAD EMPLOYES Health Systems 87042 I N Y Y

UNION PACIFIC RAILROAD EMPLOYES Health Systems 87042 P N Y Y

Page 115 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Unison Health Plan/Better Health Plans 87726 I N na Y Former payer code 62183

Unison Health Plan/Better Health Plans 87726 P N na Y Former payer code 62183

United Administrative Services, Inc. (ERA Only) 94174 I na Y ERA Only

United Administrative Services, Inc. (ERA Only) 94174 P na Y ERA Only

United Agriculture Benefit Trust UABT1 P N na Y

United American Insurance Company (ERA Only) 92916 I na Y na ERA Only

United American Insurance Company (ERA Only) 92916 P na Y na ERA Only

United Americhoice of Nebraska (ERA Only) UFNEP I na Y ERA Only

United Americhoice of Nebraska (ERA Only) UFNEP P na Y ERA Only

United AmeriChoice of Wisconsin (ERA Only) WID01 I na Y ERA Only

United AmeriChoice of Wisconsin (ERA Only) WID01 P na Y ERA Only

United Care Medical Group ADCUC I N na Y

United Care Medical Group ADCUC P N na Y

United Fire & Casualty (Workers Comp) J1401 I N Y N

United Fire & Casualty (Workers Comp) J1401 P N Y N

UNITED FOOD & COMM. WORKERS MIDWEST UNIONS 36659 P N na N

United Healthcare (Golden Rule) (JVHL) KRJVH I Y Y Y Provider must be an approved JVHL lab

United Healthcare (Golden Rule) (JVHL) KRJVH P Y Y Y Provider must be an approved JVHL lab

United Healthcare (non-Golden Rule) (JVHL) J5JVH I Y Y Y Provider must be an approved JVHL lab

United Healthcare (non-Golden Rule) (JVHL) J5JVH P Y Y Y Provider must be an approved JVHL lab

United Healthcare Community Plan (Great Lakes Health Plan) (JVHL) JRJVH I Y Y Y Provider must be an approved JVHL lab

United Healthcare Community Plan (Great Lakes Health Plan) (JVHL) JRJVH P Y Y Y Provider must be an approved JVHL lab

United Medical Alliance 84132 I N na N

United Medical Alliance 84132 P N na N

United of Omaha 71412 I N Y N

United of Omaha 71412 P N Y N

United Teacher Assoc Ins Co-Medicare Supplement 13193 I N Y Y

United Teacher Assoc Ins Co-Medicare Supplement 13193 P N Y Y

UnitedHealthcare 87726 I N Y Y

UnitedHealthcare 87726 P N Y Y

UnitedHealthcare (Definity Health Plan) 87726 I N na Y

UnitedHealthcare (Definity Health Plan) 87726 P N na Y

UnitedHealthcare (Empire Plan) 87726 P N na Y

UnitedHealthcare (MAHP MD IPA Optimum Choice MAMSI) 87726 I N na N

Page 116 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

UnitedHealthcare (MAHP MD IPA Optimum Choice MAMSI) 87726 P N na N

UnitedHealthcare (Oxford Health Plans) 06111 I N Y Y

UnitedHealthcare (Oxford Health Plans) 06111 P N Y Y

UnitedHealthcare / MAHP - MD IPA Optimum Choice MLH (formerly MAMSI) 87726 I N na Y

UnitedHealthcare / MAHP - MD IPA Optimum Choice MLH (formerly MAMSI) 87726 P N na Y

UnitedHealthcare / UHIS - UnitedHealth Integrated Services 39026 I N Y Y

UnitedHealthcare / UHIS - UnitedHealth Integrated Services 39026 P N Y Y

UnitedHealthcare / UnitedHealthcare Plan of the River Valley 87726 I N Y Y ERA Payer Code 95378

UnitedHealthcare / UnitedHealthcare Plan of the River Valley 87726 P N Y Y ERA Payer Code 95378

UnitedHealthcare / UnitedHealthcare StudentResources 74227 I N Y Y

UnitedHealthcare / UnitedHealthcare StudentResources 74227 P N Y Y

UnitedHealthcare / UnitedHealthcare West (formerly PacifiCare) 87726 P N na Y

UnitedHealthcare Community Plan (DE, FL, HI, LA, MA, MD, NC, NM, OH, OK, PA, VA, WA) 87726 I N Y Y ERA Payer Code 04567

UnitedHealthcare Community Plan (DE, FL, HI, LA, MA, MD, NC, NM, OH, OK, PA, VA, WA) 87726 P N Y Y ERA Payer Code 04567

UnitedHealthCare Community Plan (KS / KanCare) 96385 I N Y Y

UnitedHealthCare Community Plan (KS / KanCare) 96385 P N Y Y

UnitedHealthcare Community Plan / AZ 03432 I N Y Y Formerly AZ Physicians IPA APIPA

UnitedHealthcare Community Plan / AZ 03432 P N Y Y Formerly AZ Physicians IPA APIPA

UnitedHealthcare Community Plan / FLHI LA MD MS CAN OH RI WAWI 87726 I N na Y

UnitedHealthcare Community Plan / FLHI LA MD MS CAN OH RI WAWI 87726 P N na Y

UnitedHealthcare Community Plan / IA, hawk-I 87726 I N Y Y

ERA Payer Code 95378

Formerly AmeriChoice of Iowa

UnitedHealthcare Community Plan / IA, hawk-I 87726 P N Y Y


Formerly AmeriChoice of Iowa

UnitedHealthcare Community Plan / MI 95467 P N Y Y Formerly Great Lakes Health Plan

UnitedHealthcare Community Plan / MI 95467 I N Y Y Formerly Great Lakes Health Plan

UnitedHealthcare Community Plan / MO 86050 I N Y Y

UnitedHealthcare Community Plan / MO 86050 P N Y Y

UnitedHealthcare Community Plan / MS CHIP 87726 I N Y Y


Formerly AmeriChoice MS-CHIP

UnitedHealthcare Community Plan / MS CHIP 87726 P N Y Y


Formerly AmeriChoice MS-CHIP

UnitedHealthcare Community Plan / NE 87726 I N Y Y ERA Payer Code UFNEP

UnitedHealthcare Community Plan / NE 87726 P N Y Y ERA Payer Code UFNEP

UnitedHealthcare Community Plan / NJ 86047 I N Y Y Formerly Americhoice NJ Medicaid

UnitedHealthcare Community Plan / NJ 86047 P N Y Y Formerly Americhoice NJ Medicaid

Page 117 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

UnitedHealthcare Community Plan / NY 87726 I N Y Y ERA Payer Code NYU01

UnitedHealthcare Community Plan / NY 87726 I N Y Y

ERA Payer Code NYU01

Formerly AmeriChoice by UnitedHealthcare, AmeriChoice NY

Medicaid & Child Health Plus, AmeriChoice NY Personal Care

Plus

UnitedHealthcare Community Plan / NY 87726 P N Y Y ERA Payer Code NYU01

UnitedHealthcare Community Plan / PA 87726 I N Y Y ERA Payer Code 04567

UnitedHealthcare Community Plan / PA 87726 P N Y Y ERA Payer Code 04567

UnitedHealthcare Community Plan / TN 95378 I N Y Y Formerly AmeriChoice TN: TennCare

UnitedHealthcare Community Plan / TN 95378 P N Y Y Formerly AmeriChoice TN: TennCare

UnitedHealthcare Community Plan / TX 87726 I N Y Y ERA Payer Code TEX01

UnitedHealthcare Community Plan / TX 87726 P N Y Y ERA Payer Code TEX01

UnitedHealthcare Community Plan / UnitedHealthcare Dual Complete 87726 I N na

UnitedHealthcare Community Plan / UnitedHealthcare Dual Complete 87726 P N na Y

UnitedHealthcare Community Plan / UnitedHealthcare Long Term Care 87726 I N na Y

UnitedHealthcare Community Plan / UnitedHealthcare Long Term Care 87726 P N na Y

UnitedHealthcare Community Plan / WI 87726 I N Y Y ERA Payer Code WID01

UnitedHealthcare Community Plan / WI 87726 P N Y Y ERA Payer Code WID01

UnitedHealthcare Medicare Solutions / UnitedHealthcare Chronic Complete 87726 I N na Y

UnitedHealthcare Medicare Solutions / UnitedHealthcare Chronic Complete 87726 P N na Y

UnitedHealthcare Medicare Solutions / UnitedHealthcare Group Medicare Advan 87726 I N na Y

UnitedHealthcare Medicare Solutions / UnitedHealthcare Group Medicare Advan 87726 P N na Y

UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareComplete 87726 I N na Y

UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareComplete 87726 P N na Y

UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareDirect 87726 I N na Y

UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareDirect 87726 P N na Y

UnitedHealthcare Medicare Solutions / UnitedHealthcare Nursing Home Plan 87726 I N na Y

UnitedHealthcare Medicare Solutions / UnitedHealthcare Nursing Home Plan 87726 P N na Y

UnitedHealthcare Vision 00773 P N na Y

UnitedHealthcare West 87726 I N Y Y


Formerly PacifiCare of Arizona, PacifiCare of Colorado,

PacifiCare of CA, and PacifiCare PPO All States

UnitedHealthcare West 87726 P N Y Y


Formerly PacifiCare of Arizona, PacifiCare of Colorado,

PacifiCare of CA, and PacifiCare PPO All States

Page 118 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

UnitedHealthOne 37602 I N Y Y Formerly Golden Rule

UnitedHealthOne 81400 I N Y Y Formerly American Medical Security

UnitedHealthOne 37602 P N Y Y Formerly Golden Rule

UnitedHealthOne 81400 P N Y Y Formerly American Medical Security

UnitedHeathcare Community Plan 87726 I N na Y Formerly Unison Health Plan

UnitedHeathcare Community Plan 87726 P N na Y Formerly Unison Health Plan

Unity Health Insurance 66705 I N Y N

Unity Health Insurance 66705 P N Y N

Univera Healthcare UNINW P N Y Y

Universal Benefits (IA, MD) TRP1E I N na Y

Universal Benefits (IA, MD) TRP1E P N na Y

Universal Care - California 33001 I N na N

Universal Care - California 33001 P N na N

Universal Fidelity Administrators Company 93220 I N Y Y

Universal Fidelity Administrators Company 93220 P N Y Y

University Family Care 09830 I N Y Y

University Family Care 09830 P N Y Y

University Family Care - Maricopa Health Plan 09908 I N Y Y ERA Payer Code 09830

University Family Care - Maricopa Health Plan 09908 P N Y Y ERA Payer Code 09830

University Health Alliance 99026 P Y na Y

University Health Care Advantage 46407 I N na N

University Health Care Advantage 46407 P N na N

University Healthcare Marketplace 45437 I N na Y

University Healthcare Marketplace 45437 P N na Y

University of Illinois UIC67 I N na N

University of Illinois UIC67 P N na N

University of Illinois at Chicago Div of Specialized Care for Children 37601 I N na N

University of Illinois at Chicago Div of Specialized Care for Children 37601 P N na N

University of Maryland Health Advantage 45282 I N na Y

University of Maryland Health Advantage 45282 P N na Y

University of Maryland Health Partners (UMHP) 45281 I N Y N

Effective 1/1/17, Riverside Health will now be known as

University of Maryland Health Partners (UMHP).

University of Maryland Health Partners (UMHP) 45281 P N Y N

Effective 1/1/17, Riverside Health will now be known as

University of Maryland Health Partners (UMHP).

University of Missouri 25133 I N na Y

Page 119 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

University of Missouri 25133 P N na Y

University of Utah Health Plans SX155 I Y Y Y

University of Utah Health Plans SX155 P N Y N

Upland Medical Group IP056 P N na N

UPMC Health Plan 23281 I N Y Y

UPMC Health Plan 23281 P N Y Y

UPMC Vision Advantage 25184 I N Y N

UPMC Vision Advantage 25184 P N Y N

Upper Peninsula Health Group (TPA) 37324 I N na N

Upper Peninsula Health Group (TPA) 37324 P N na N

Upper Peninsula Health Plan (Medicaid) 38337 I N Y N

Upper Peninsula Health Plan (Medicaid) 38337 P N Y N

US Benefits 93092 I N Y Y

US Benefits 93092 P N Y Y

US Department of Labor 12X31 I N na Y

US Department of Labor 77044 P Y Y Y

US Department of Labor - Black Lung 77104 P Y Y Y

US Department of Labor - Energy 77103 P Y Y Y

US Family Health Plan 90551 I N na N

US Family Health Plan 90551 P N na N

US Family Health Plan (USFHP) TX AND LA USFHP I N Y Y

US Family Health Plan (USFHP) TX AND LA USFHP P N Y Y

US Imaging (ERA Only) 50383 I na Y ERA Only

US Imaging (ERA Only) 50383 P na Y ERA Only

USAA (United Services Automobile Association) 74095 I N na N

USAA (United Services Automobile Association) 74095 P N na N

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

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

UT- Altius (UHIN) 25133 I N na Y

UT- Altius (UHIN) 25133 P N na Y

Utah Medicaid 12K42 I Y na Y

Utah Medicaid SKUT0 P Y na Y

Utah Medicare 12M84 I Y Y Y ERA Payer Code MR046

Utah Medicare SMUT0 P Y Y Y ERA Payer Code MR046

Page 120 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

UW Graduate Appointee Plan 91136 I N N N

UW Graduate Appointee Plan 91136 P N N N

VA Fee Basis Programs 12115 I N Y Y Payer Requires Copy of EOB for Missing ERAs

VA Fee Basis Programs 12115 P N Y Y Payer Requires Copy of EOB for Missing ERAs

Valir Pace 64009 I N na N

Valir Pace 64009 P N na N

Valley Baptist Health Plan 12T06 I N na Y

Valley Baptist Health Plan TH022 P N na N

Valley Care IPA VCIPA P N na N

Valley Health Plan (Commercial) VHP01 I Y Y Y

Valley Health Plan (Commercial) VHP01 P Y Y Y

Valley Health Plan (Medi-Cal) VHP02 I Y Y Y

Valley Health Plan (Medi-Cal) VHP02 P Y Y Y

Valley Mental Health 94293 P N na N

Valley Preferred - PPO Allentown PA (IHS Gateway Payer) 23253 P N na Y

VALUE OPTIONS (TX NORTHSTAR) 99297 I N na N

Value Options PA 12K1A I N na N

ValueOptions (now known as Beacon Health Options) VALOP I Y Y Y Now known as Beacon Health Options

ValueOptions (now known as Beacon Health Options) VALOP P Y Y Y Now known as Beacon Health Options

ValueOptions Maryland Mental Hygiene Ad 22322 I Y na Y

Vantage Health Plan Inc. 72128 I N Y N

Vantage Health Plan Inc. 72128 P N Y N

Vantage Medical Group PPM01 I N na Y

Vantage Medical Group PPM01 P N na Y

VentureNet Healthcare 86062 I N na Y

VentureNet Healthcare 86062 P N na Y

Verdugo Hills Medical Group 66126 I N na N

Verdugo Hills Medical Group 66126 P N na N

Verity National Group 75256 I N na Y

Verity National Group 75256 P N na Y

Vermont Medicaid 12K26 I Y Y Y

Vermont Medicaid SKVT0 P Y Y Y

Vermont Medicare 12M26 I Y na Y

Vermont Medicare SMVT0 P Y na Y

Page 121 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

VGM Homelink 50701 P N Y N

Via Christi HOPE 48123 I N na N

Via Christi HOPE 48123 P N na N

Vibra Health Plan (ERA Only) 15976 I na Y na ERA Only

Vibra Health Plan (ERA Only) 15976 P na Y na ERA Only

Victor Valley IPA VVIPA P N na N

Village Family Practice 73743 I N na N

Village Family Practice 73743 P N na N

VillageCareMAX 26545 I N na N

VillageCareMAX 26545 P N na N

Virgin Islands Medicare 12M52 I Y na N

Virgin Islands Medicare SMVI0 P Y na Y

Virginia Coordinated Care-VCC 84806 P N na N

Virginia Health Network, Inc. 54138 P N na Y

Virginia Mason Group Health 91131 I N Y Y

Virginia Mason Group Health 91131 P N Y Y

Virginia Medicaid 12003 I N Y Y

Virginia Medicaid SKVA0 P N Y Y

Virginia Medicare 12004 I Y na Y

Virginia Medicare SMVA0 P Y Y Y

Virginia Premier CompleteCare VPCCI I Y na Y

Virginia Premier CompleteCare VPCCP P Y na Y

Virginia Premier Elite Plus VPEP1 I Y Y Y

Virginia Premier Elite Plus VPEP1 P Y Y Y

Virginia Premier Health Plan 12K83 I Y Y Y ERA Payer Code 54176

Virginia Premier Health Plan 54176 P Y Y Y

Virginia Premier Medallion 4 VAPRM I Y Y Y

Virginia Premier Medallion 4 VAPRM P Y Y Y

Vision Service Plan (VSP) 94163 P N na N

Vista Oncology - New Century Infusion Solutions NCH08 P N na N

Viva Health Plan 63114 I N Y N

Viva Health Plan 63114 P N Y N

VNA Homecare Options 31626 I N na Y

VNA Homecare Options 31626 P N na Y

Page 122 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

VNS CHOICE Medicare 77073 I N Y N

VNS CHOICE Medicare 77073 P N Y N

VOLUSIA HEALTH NETWORK 59266 I N Y N

VOLUSIA HEALTH NETWORK 59266 P N Y N

Vytra Healthcare 22264 I N na Y

Vytra Healthcare 22264 P N na Y

WA - Washington Coordinated Care 68069 I N Y Y

WA - Washington Coordinated Care 68069 P N Y Y

Wabash Memorial Hospital Association 85256 I N Y N

Wabash Memorial Hospital Association 85256 P N Y N

Washington Medicaid 12K27 I Y Y Y

Washington Medicaid SKWA0 P Y Y Y

Washington Medicare 12M45 I Y Y Y

Washington Medicare SMWA0 P Y Y Y

WASHINGTON State Dept of LABOR & INDUSTRY SX063 I N Y N

WASHINGTON State Dept of LABOR & INDUSTRY SX063 P Y Y N

Waterstone Benefit Administrators (Oklahoma Providers) 73155 I N na N

Waterstone Benefit Administrators (Oklahoma Providers) 73155 P N na N

Waterstone Benefit Administrators (Outside Oklahoma) 23051 I N na N

Waterstone Benefit Administrators (Outside Oklahoma) 23051 P N na N

Watts Health Care MPM09 I N na Y

Watts Health Care MPM09 P N na Y

WEA Insurance Group 39151 I N Y N

WEA Insurance Group 39151 P N Y N

webTPA/Community Health Electronic Claims/CHEC 75261 I N Y N

webTPA/Community Health Electronic Claims/CHEC 75261 P N Y N

Weiss Health Providers 36337 I N na N

Weiss Health Providers 36337 P N na N

Wellcare Health Plan, Inc. (Encounters Only) 59354 I N na Y

Wellcare Health Plan, Inc. (Encounters Only) 59354 P N na Y

Wellcare Health Plan, Inc. (Fee for Service) 14163 I N Y Y If MEDICAID - Claims with DOS on or before 12/31/18

Wellcare Health Plan, Inc. (Fee for Service) 14163 P N Y Y If MEDICAID - Claims with DOS on or before 12/31/18

WellChoice of NJ SB803 P N Y Y ERA Payer Code 00803.

Page 123 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Wellmark BCBS - Medicare COB 12B92 I N na Y

Wellmark BCBS - Medicare COB SB645 P N na Y

Wellmark Blue Cross and Blue Shield of Iowa 12B10 I Y Y Y

Wellmark Blue Cross and Blue Shield of Iowa SB640 P Y Y Y

Wellmed WELM2 I N Y Y ERA Payer Code TH023

Wellmed WELM2 P N Y Y ERA Payer Code TH023

WellSystems LLC 35245 I N Y N aka Continental Benefits

WellSystems LLC 35245 P N Y N aka Continental Benefits

Wenatchee Valley Medical Center 91064 I N na N

Wenatchee Valley Medical Center 91064 P N na N

West Covina Medical Group 66124 I N na N

West Covina Medical Group 66124 P N na N

West Suburban Health Providers 80942 I N na Y

West Suburban Health Providers 80942 P N na Y

West Virginia Family Health Plan 45276 I N Y N

West Virginia Family Health Plan 45276 P N Y N

West Virginia Medicaid 12K28 I N Y Y

West Virginia Medicaid SKWV0 P N Y Y

West Virginia Medicare 12M28 I Y na Y

West Virginia Medicare SMWV0 P Y na Y

Western Grower's Assurance Trust 24375 I N na Y

Western Grower's Assurance Trust 24375 P N na Y

Western Grower's Insurance Company 24735 I N na N

Western Grower's Insurance Company 24735 P N na N

Western Health Advantage 68039 I N na N

Western Health Advantage 68039 P N na N

Western Mutual Insurance 37247 I N na N

Western Mutual Insurance 37247 P N na N

Western Oregon Advanced Health UOCSO I Y Y Y

Western Oregon Advanced Health DOCSO P Y Y Y

Western Reserve Life Insurance Company (TX) TRLTC I N na Y

Western Reserve Life Insurance Company (TX) TRLTC P N na Y

Western Southern Financial Group (Cincinnati OH) 31048 I N Y N

Western Southern Financial Group (Cincinnati OH) 31048 P N Y N

Page 124 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Willamette Valley Community Health WVCH5 I N Y Y

Willamette Valley Community Health WVCH5 P N Y Y

William C. Earhart 93050 I N Y Y

William C. Earhart 93050 P N Y Y

Wilson-McShane 41095 I N na N

Wilson-McShane 41095 P N na N

Windsor Medicare Extra (as of 5/1/14) 14163 I N Y Y If MEDICAID - Claims with DOS on or before 12/31/18

Windsor Medicare Extra (as of 5/1/14) 14163 P N Y Y If MEDICAID - Claims with DOS on or before 12/31/18

Wisconsin Chronic Disease Program (WCDP) SKWID I N Y Y

Wisconsin Chronic Disease Program (WCDP) SKWID P N Y Y

Wisconsin Department of Corrections 74101 I N na N

Wisconsin Department of Corrections 74101 P N na N

Wisconsin Medicaid SKWI0 I N Y Y

Wisconsin Medicaid SKWI0 P N Y Y

Wisconsin Medicare 12M29 I Y Y Y

Wisconsin Medicare SMWI0 P Y Y Y

Wisconsin Well Woman Program (WWWP) SKWIW I N Y Y

Wisconsin Well Woman Program (WWWP) SKWIW P N Y Y

Women's Integrated Network Inc. (WIN Fertility) 13413 P N na N

Workers Comp of West Virginia SX067 P Y na N

Workers Comp/Arkansas Blue Cross 12048 I Y na Y

Worksite Benefit Services LLC 20333 I N na N

Worksite Benefit Services LLC 20333 P N na N

World Insurance Company (ERA Only) 75276 I na Y ERA Only

World Insurance Company (ERA Only) 75276 P na Y ERA Only

WPP-ElderCare Wisconsin 77080 I N na N

WPP-ElderCare Wisconsin 77080 P N na N

WPS Commercial 12X29 I Y Y Y

WPS Commercial SX022 P Y Y Y

WPS Medicare Part A National - Legacy Claims - J5 52280 I Y Y Y

Wyoming Medicaid 12K30 I Y Y Y

Wyoming Medicaid SKWY0 P Y Y Y

Wyoming Medicare 12M30 I Y Y Y

Wyoming Medicare SMWY0 P Y Y Y

Page 125 of 126



Claim

Type

Claim

ENR

Remit

ENR COB NOTES

Yale University Heath Plan 60646 I N Y Y

Yale University Heath Plan 60646 P N Y Y

YourCare Health Plan (ERA Only) 15003 I na Y na ERA Only

YourCare Health Plan (ERA Only) 15003 P na Y na ERA Only

Zelis Preferred Administrators 88057 I N Y Y

Zelis Preferred Administrators 88057 P N Y Y

Page 126 of 126

Documents

CLAIMS & ERA PAYER LIST April 8, 2019 - experian.com · CLAIMS & ERA PAYER LIST April 8, 2019 Payer Code Claim Type Claim ENR Remit ENR COB NOTES Absolute Total Care 68069 P N Y Y