eClaim Dental Payer List Information - patterson.eaglesoft.netpatterson.eaglesoft.net/pdfs/eClaims Payer List_OLD.pdf · eClaim Dental Payer List Information ... AARP Claims with

eClaim Dental Payer List Information

Payer List Includes (12 pgs): Commercial Payers (Pages 1-9) Blue Cross Blue Shield Payers (Pages 9-10) Delta Dental Payers (Pages 10-11) Medicaid Payers (Pages 11-12)

Payer ID 06126: Use this eClaim payer id for those insurance companies that are not on the eClaim Payer List

Group Number Column: Y = the payer requires group number N = the group number is optional

Enroll Column: This column indicates whether or not the payer requires enrollment Y = Payer requires enrollment please do the following for these payers:

1. Within EagleSoft go to Online _ FAQ 2. Under the Search by Keyword field type 4400 3. Click on the eClaims Additional Enrollment Paperwork

N = No paperwork is required

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

Obtaining Current Payer Lists: 1. Go to Online _ FAQ 2. Under the Search by Keyword field type 2453 3. Click on eClaims Payer List and Payer List Changes

Claims Status Inquiry: Feature within Eaglesoft used to quickly identify the status of any claim submitted electronically. These responses may contain information such as accepted, rejected, request for additional information and/or payment information. To utilize this feature please do the following:

1. Go to Online _ Electronic Claims 2. Uncheck “Unsubmitted Elec” view and check “Open” 3. Highlight the claim you would like to check the status on

(Note: In order for this feature to work, the Claim must be sent electronically to our preferred clearinghouse)

4. Click the “Check Status” button

For any questions please contact eServices Support at 800.475.5036.

eClaims Dental Payer ListJanuary 2009

St Payer ID Model Group # Enroll Service Additional Info

21st Century Health and Benefits 59069 COMMERCIAL Y N Claims3P Admin 20413 COMMERCIAL Y N ClaimsA & I Benefit Plan Administrators 93044 COMMERCIAL Y N ClaimsA & I Benefit Plan Administrators CX044 COMMERCIAL Y N ClaimsAAG Benefit Plan Administrators, Inc. 75240 COMMERCIAL Y N ClaimsAAG-American Administrative Group (Formerly Gallagher Benefit Admin) 37283 COMMERCIAL Y N Claims

AARP AARP1 COMMERCIAL Y N Claims AARP Claims with a mailing address of PO Box 2059, Mechanicsburg, PA

Acceptius (Benefit Management Inc of MO (BMI) 43178 COMMERCIAL Y N ClaimsAcClaims 64071 COMMERCIAL Y N ClaimsACS Benefit Services a.k.a. NCBCBS - DBS 61474 COMMERCIAL Y N ClaimsACS Benefit Services Inc. 72468 COMMERCIAL Y N Claims f.k.a. ACS Consulting Services, Inc.Activa Benefit Services, LLC/Dental 38255 COMMERCIAL Y N Claims (Formerly Amway Corporation/Dental)

Adminstrative Services Only, Inc. CX076 COMMERCIAL Y N Claims

Additional enrollment is not required by the payer, however, providers wishing to submit Claims electronically must be credentialed with the payer. Please ensure you have successfully process one paper Claims with the payer prior to submitting your first electronic Claims.

Advantage Dental Plan, Inc. 93524 COMMERCIAL N N ClaimsAdventist Health System West - Roseville, CA 95340 COMMERCIAL Y N ClaimsAetna 60054 COMMERCIAL Y N ClaimsAetna 60054 COMMERCIAL N Claims Status InquiryAetna Affordable Health Choices (SM) - SRC 57604 COMMERCIAL Y N ClaimsAFLAC 58066 COMMERCIAL Y N Claims

AFLAC - NY Plan 52080 COMMERCIAL Y N Claims

This plan also shares the same mailing address as payer ID 58066 and the only difference between the plans is that the insured ID for the NY based plan begins with "PN" as "PNxxxxxx" (followed by 6+ digits)

Alaska Children's Services, Inc. 91136 COMMERCIAL Y N Claims Please enter Group Number when submitting Claims.

Alaska Electrical Health & Welfare Fund 92600 COMMERCIAL Y N Claims

Alaska Laborers Construction Industry Trust 91136 COMMERCIAL Y N Claims Please enter Group Number when submitting Claims.

Alaska Pipe Trades Local 375 91136 COMMERCIAL Y N Claims Please enter Group Number when submitting Claims.

Alaska United Food & Commercial Workers Health & Welfare Trust 91136 COMMERCIAL Y N Claims Please enter Group Number when submitting Claims.

Allen Medical Claims Administrator CX016 COMMERCIAL Y N ClaimsAllied Administrators (San Francisco, CA) 94177 COMMERCIAL Y N ClaimsAllied Benefit Systems 37308 COMMERCIAL Y N ClaimsAmalgamated Life - PA Alicare 13343 COMMERCIAL Y N ClaimsAmerican Administrative Group, Inc (AAG) 74223 COMMERCIAL Y N Claims

American Administrators (West Des Moines, IA) 42112 COMMERCIAL Y N ClaimsPlease check the Insured ID card to verify the Payer ID before submitting claims. If you have questions, please contact Provider Relsations at 800-456-4584.

American Administrators dba Select Benefit Administrators (West Des Moines, IA) 42137 COMMERCIAL Y N Claims

Please check the Insured ID card to verify the Payer ID before submitting claims. If you have questions, please contact Provider Relsations at 800-456-4584.

American Benefit Corporation CX084 COMMERCIAL Y N Claims

Only limited plans may be sent electronically. Group name is required with one of the following plan names: Sheet Metal, Berekely, Boone, Carpenter, Cabell, Clarksbur, Doodridge, Hancock, Harrison, Marion, Monongalia, Mingo, Mineral, Morgan, Nicholas, PutnamTaylor, Tyler, Wetzel.

American Benefits Management (North Canton, OH) 34187 COMMERCIAL N N Claims

American Medical Security CX001 COMMERCIAL Y N ClaimsAmerican Postal Workers Union Health Plan 44444 COMMERCIAL Y N ClaimsAmeritas Life Insurance Corp. 47009 COMMERCIAL N Claims Status InquiryAmeritas Life Insurance Corp. 47009 COMMERCIAL Y N ClaimsAmway Corporation 38255 COMMERCIAL Y N Claims (Formerly Amway Corporation/Dental)Anchor Benefit 53085 COMMERCIAL Y N ClaimsAntares Management Solutions 34192 COMMERCIAL N N ClaimsAPA Partners, Inc. 16140 COMMERCIAL Y N ClaimsArkansas Best Corporation - Choice Benefits 75278 COMMERCIAL Y N ClaimsAscent Benefits CX072 COMMERCIAL Y N ClaimsASR Corporation 38265 COMMERCIAL Y N ClaimsAssurant Employee Benefits 70408 COMMERCIAL Y N Claims

For an updated payer list, please visit our website at www.eaglesoft.netPage 1



Assurant Health 39065 COMMERCIAL Y N Claims f.k.a. Protective LifeAssurant, Inc, 70408 COMMERCIAL Y N Claims f.k.a. First Fortis Life InsuranceAthens Area Health Plan Select 95691 COMMERCIAL Y N ClaimsAtlantic Dental Inc. (ADI) - Commercial CX085 COMMERCIAL Y N ClaimsAvesis 86098 COMMERCIAL Y N ClaimsBCI Administrators, Inc. 49153 COMMERCIAL Y N ClaimsBell Atlantic 68241 COMMERCIAL Y N ClaimsBencomp National Corporation 33192 COMMERCIAL Y N ClaimsBeneCare Dental Plans 23210 COMMERCIAL Y N ClaimsBenefit Adminstrative Systems 36149 COMMERCIAL Y N Claims

Benefit Coordinators Corporation (Pittsburgh, PA) 25145 COMMERCIAL Y N ClaimsPayer ID valid only for Claims with a submission address of 111 Ryan Court, Suite 300, Pittsburgh, PA 15205.

Benefit Management Services of MS 37212 COMMERCIAL Y N ClaimsBenefit Management Services, Inc. 56139 COMMERCIAL Y N Claims

Benefit Plan Administrators Co. (Eau Claire, WI) 39081 COMMERCIAL Y N Claims Payer ID valid only for Claims with a billing submission address of P.O. Box 1128, Eau Claire, WI 54702-1128.

Benefit Planners, Inc. 74223 COMMERCIAL Y N ClaimsBenefit Systems & Services, Inc. (BSSI) 36342 COMMERCIAL Y N ClaimsBenesys, Inc. 58102 COMMERCIAL Y N ClaimsBest Life & Health Insurance Co. 95604 COMMERCIAL Y N ClaimsBetter Health Plans of South Carolina 32006 COMMERCIAL Y N ClaimsBig Lots Associate Benefit Plan (EBMC) CX025 COMMERCIAL Y N ClaimsBlue Care Family Plan GWD01 COMMERCIAL N N Claims Administered by Golden West (Well point)Boilermakers National Health & Welfare Fund 36609 COMMERCIAL Y N ClaimsBoon Chapman Benefit Administrators 74237 COMMERCIAL Y N Claims

Boston University Dental Health Plan (Boston, MA) 04210 COMMERCIAL Y N Claims

Bridgeport LLC CX028 COMMERCIAL Y N Claims

Provider ID numbers must be 9 digits and is generally the Providers SSN or TIN. The recipient's ID number is 8 digits in length. Maximum of 13 procedure lines per Claims. Pre-determination Claims cannot be sent electronically. Claims where Bridgeport LLC i

Brokers National CX032 COMMERCIAL Y N ClaimsBroward Health 37314 COMMERCIAL Y N ClaimsButler Benefits 42150 COMMERCIAL Y N ClaimsC. L. Frates CX075 COMMERCIAL Y N ClaimsCadent Administrators 33192 COMMERCIAL Y N ClaimsCadent Underwriters 33192 COMMERCIAL Y N ClaimsCapital Dental CX037 COMMERCIAL Y N ClaimsCapitol Administrators 68011 COMMERCIAL Y N Claims

Carpenter's Health and Welfare Trust Fund of St. Louis 25125 COMMERCIAL Y N Claims

Caterpillar Inc. 37060 COMMERCIAL Y N ClaimsCBCA Administrators 55438 COMMERCIAL Y N ClaimsCBCA Administrators (HRM) 41170 COMMERCIAL Y N Claims [Formerly Health Risk Management (HRM)CBSA 41124 COMMERCIAL Y N ClaimsCDH (Cigna Dental Health) 10050 COMMERCIAL N Claims Status InquiryCDO Technologies 87065 COMMERCIAL Y N ClaimsCDS Group Health 88022 COMMERCIAL Y N Claims

Cement Masons & Plasterers Health & Welfare Trust 91136 COMMERCIAL Y N Claims

Central States Health and Welfare Fund 36215 COMMERCIAL Y N Claims

CHAMPVA - HAC 84147 COMMERCIAL Y N Claims CHAMPVA - HAC is not associated with and does not process Claims for TRICARE (formerly CHAMPUS)

Chesterfield Resources, Inc. (Uniontown, OH) 34154 COMMERCIAL Y N Claims a.k.a. Salvation ArmyChoice Plus (TRW) 68241 COMMERCIAL Y N ClaimsChristian Brothers Services 61271 COMMERCIAL N Claims Status InquiryChristian Brothers Services 61271 COMMERCIAL Y N ClaimsCIGNA 62308 COMMERCIAL N Claims Status InquiryCIGNA 62308 COMMERCIAL Y N ClaimsCitizens Security Life CX071 COMMERCIAL Y N Claims

Civil Service Employees Association (CSEA) CX054 COMMERCIAL Y N Claims

Provider ID number required. Max of 50 procedure linesper Claims. ID number must be 5 characters in lenght, numbers 6 in lenght & ending with a '1' are accepted when '1' is removed. Numbers with leading zeros will have leading zeros omitted. ID numbers cannot contain an "-".

Clarendon's Healthy Kids 33192 COMMERCIAL Y N ClaimsCommonWealth Administrative Group 37237 COMMERCIAL Y N Claims

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




Comp - Ohio (Austintown, OH) 34177 COMMERCIAL Y N ClaimsCompanion Life 77828 COMMERCIAL Y Y ClaimsCompBenefits CX021 COMMERCIAL Y N ClaimsComprehensive Benefits Administrator, Inc. 03036 COMMERCIAL Y N ClaimsConnecticut Carpenters Health Fund 37307 COMMERCIAL Y N ClaimsConnecticut General (CIGNA) 62308 COMMERCIAL Y N ClaimsConsolidated Group Dental 61305 COMMERCIAL Y N ClaimsCook Group Health Plan 35149 COMMERCIAL Y N ClaimsCooperative Benefit Administrators (CBA) 52132 COMMERCIAL Y N ClaimsCore Management Resources Group 58231 COMMERCIAL Y N Claims

CoreSource AZ MN 41045 COMMERCIAL Y N Claims

Only for Claims where the "submit Claims to address" on the medical ID card is a CoreSource address in the states of Arizona or Minnesota. For assistance call 800-698-0106.

CoreSource Little Rock 75136 COMMERCIAL Y N Claims

CoreSource MD PA IL 35182 COMMERCIAL Y N Claims

Only for Claims where the "submit Claims to address" on the medical ID card is a CoreSource address in the states of Maryland, Pennsylvania or Illinois. For assistance call 800-689-0106.

CoreSource NC IN 35180 COMMERCIAL Y N Claims

Only for Claims where the "submit Claims to address" on the medical ID card is a CoreSource address in the states of North Carolina or Indiana. For assistance call 800-689-0106.

CoreSource OH 35183 COMMERCIAL Y N Claims

CoreStar 41045 COMMERCIAL Y N Claims


Corporate Benefit Services of America 41124 COMMERCIAL Y N ClaimsCorporate Benefits Service, Inc. (NC) 56116 COMMERCIAL Y N ClaimsCovenant Administrators, Inc. (Atlanta, GA) 58102 COMMERCIAL Y N ClaimsCoventry Health Care National Network (f.k.a. First Health)

87043 COMMERCIAL Y N Claims

Coventry Health Care of Georgia 25148 COMMERCIAL Y N ClaimsCreative Plan Administrators 37320 COMMERCIAL N N ClaimsCrescent Dental - Meritain Health CX074 COMMERCIAL Y N ClaimsCustom Benefit Administrators 39170 COMMERCIAL Y N ClaimsCustom Design Benefits Inc. of OH 82056 COMMERCIAL Y N ClaimsCustomCare 68241 COMMERCIAL Y N ClaimsDart Management Corp. 06172 COMMERCIAL Y N ClaimsDeltaCare USA CDCAP COMMERCIAL Y N Claims f.k.a. PMIdeneX/SG CX049 COMMERCIAL Y N ClaimsDental Benefit Providers 52133 COMMERCIAL Y N ClaimsDental Care Plus CX035 COMMERCIAL Y N ClaimsDental Network CX034 COMMERCIAL Y N ClaimsDentalComp CX017 COMMERCIAL Y N ClaimsDH Evans CX065 COMMERCIAL Y N ClaimsDiversified Administration Corporation CX040 COMMERCIAL Y N Claims

Dunn and Associates Benefits Administrators, Inc. 35186 COMMERCIAL Y N Claims

EBC, Inc. 37257 COMMERCIAL N N Claims

Payer Id valid only for Claims with a billing submission address of Employee Benefit Consultants, located in Broadview Hts, OH, Appleton, WI, Albuquergue, NM, Findlay, OH, Louisville, KY and Milwaukee, WI

EBMS (Employee Benefit Management Services, Inc.) 81039 COMMERCIAL Y N Claims

EBS Benefit Solutions CX043 COMMERCIAL N N ClaimsEHI 73288 COMMERCIAL Y N Claims

EMIA (Educators Mutual Insurance Assoc) CX079 COMMERCIAL y N Claims

Prior to accepting claims electronically EMIA requires the provider to call 801-262-7476 or 800-662-5850. Providers should advise EMIA that they will be submitting their claims through Emdeon Business Services, Inc. UHIN submitter ID HT000214-001.

EMPHESYS 73288 COMMERCIAL Y N ClaimsEmployee Benefit Administrators CX012 COMMERCIAL Y N ClaimsEmployee Benefit Concepts (Farmington Hills, MI) 38241 COMMERCIAL Y N Claims

Employee Benefit Consultants 37257 COMMERCIAL N N Claims

Payer Id valid only for Claims with a billing submission address of Employee Benefit Consultants, located in Broadview Hts, OH, Appleton, WI, Albuquergue, NM, Findlay, OH, Louisville, KY and Milwaukee, WI

Employee Benefit Management Corporation of Ohio CX025 COMMERCIAL Y N Claims




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

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

Employee Group Services CX022 COMMERCIAL Y N ClaimsEmployee Plans, LLC 35112 COMMERCIAL Y N ClaimsEmployer Plan Services, Inc. CX031 COMMERCIAL Y N ClaimsEmployers Direct Health 75232 COMMERCIAL Y N ClaimsEmployers Health 73288 COMMERCIAL Y N ClaimsEmployers Health Insurance 73288 COMMERCIAL Y N ClaimsEmployers Mutual, Inc. 59297 COMMERCIAL Y N ClaimsEnstar Natural Gas 91136 COMMERCIAL Y N ClaimsEQUICOR 62308 COMMERCIAL Y N Claims

Equitable Plan Services (Oklahoma City, OK) 73126 COMMERCIAL Y N ClaimsPayer ID valid only for Claims with a billing submission address of P.O. Box 720460, Oklahoma City, OK 73172.

Erin Group Administrators CX046 COMMERCIAL Y N ClaimsES Beveridge and Associates 34108 COMMERCIAL Y N ClaimsEssex Dental Benefits 43168 COMMERCIAL Y N ClaimsE-V Benefits Management, Inc (Columbus, OH) 34159 COMMERCIAL Y N ClaimsExclusiCare 71412 COMMERCIAL Y N ClaimsFederated Mutual Insurance 41041 COMMERCIAL Y N Claims

First Ameritas Life Insurance Corporation of New York 72630 COMMERCIAL N Claims Status Inquiry

First Ameritas Life Insurance Corporation of New York 72630 COMMERCIAL Y N Claims

First Care/Southwest Life & Health CX050 COMMERCIAL Y N ClaimsFirst Health 87043 COMMERCIAL Y N Claims

First Reliance Standard Life Ins. Co. (NY Business) 13317 COMMERCIAL N Claims Status Inquiry

First Reliance Standard Life Ins. Co. (NY Business) 13317 COMMERCIAL Y N Claims

Fiserv Health - Wausau Benefits / Benesight 39026 COMMERCIAL Y N ClaimsFitzharris & Company, Inc. 11244 COMMERCIAL Y N ClaimsFlexCare 68241 COMMERCIAL Y N ClaimsFlorida Power & Light 68241 COMMERCIAL Y N ClaimsFMH Benefit Services, Inc. 48117 COMMERCIAL Y N ClaimsFoundation Benefit Admin (FBA) - Boon Group BOONG COMMERCIAL Y N ClaimsFox Everett, Inc. 64069 COMMERCIAL Y N ClaimsFraternal Order of Police - Dental Division (Philadelphia,PA) CX041 COMMERCIAL N N Claims

Fringe Benefit Management 59069 COMMERCIAL Y N Claims

Gerber Life Insurance Company - Student Insurance 74227 COMMERCIAL Y N Claims

Payer ID only valid if the P.O. Box on the Health ID Card matches one of the following P.O. Boxes: P.O. Box 890025, 809067, 809079, 809066, 809036, 809081, 809027 Dallas, Tx 75380-9025.

Gettysburg CX064 COMMERCIAL Y N ClaimsGHI - New York (Group Health Inc.) 13551 COMMERCIAL Y N ClaimsGIC Indemnity Plan 80314 COMMERCIAL Y N ClaimsGilsbar, Inc. 07205 COMMERCIAL Y N ClaimsGolden West Dental GWD01 COMMERCIAL N N Claims

Government Employees Hospital Association (GEHA) 44054 COMMERCIAL Y N Claims

Government Employees Hospital Association (GEHA) 44054 COMMERCIAL N Claims Status Inquiry

Great-West Healthcare 63665 COMMERCIAL Y N Claims f.k.a. General AmericanGreat-West Healthcare 63665 COMMERCIAL N Claims Status InquiryGreat-West Healthcare 80705 COMMERCIAL Y N ClaimsGreat-West Healthcare 80705 COMMERCIAL N Claims Status InquiryGroup Administrators Ltd. 36338 COMMERCIAL Y N ClaimsGroup and Pension Administrators 48143 COMMERCIAL Y N Claims

Group Benefit Administrators (Hendersonville, TN) 72153 COMMERCIAL Y N Claims

Group Benefit Services CX011 COMMERCIAL Y N ClaimsGroup Dental Services CX036 COMMERCIAL Y N ClaimsGroup Health Managers 38194 COMMERCIAL Y N ClaimsGroup Insurance Service Center, Inc 37276 COMMERCIAL Y N ClaimsGroup Link of Indiana CX015 COMMERCIAL Y N ClaimsGuardian Life Insurance Company of America 64246 COMMERCIAL Y N ClaimsHarrington Benefit Services, Inc. (Columbus, OH) 95266 COMMERCIAL Y N Claims a.k.a R. E. Harrington Inc.Harrington Benefit Services, Inc. (Oklahoma) 59142 COMMERCIAL Y N Claims

Harrington Benefit Services, Inc. (Westerville, OH) 75196 COMMERCIAL Y N Claims




Harvard Pilgrim Health Care (HPHC) - Student Insurance 74227 COMMERCIAL Y N Claims


HCS - Health Claims Service (Boise, ID) 82018 COMMERCIAL Y N ClaimsHealth Economics Group, Inc. CX039 COMMERCIAL N N ClaimsHealth Future LLC 30946 COMMERCIAL Y N ClaimsHealth Network America 20199 COMMERCIAL Y N ClaimsHealth Partners - Jackson, TN 62157 COMMERCIAL Y N ClaimsHealth Partners of Minnesota - Commercial CX009 COMMERCIAL Y N ClaimsHealth Plan Services 59140 COMMERCIAL Y N ClaimsHealth Plan Services of OK 59142 COMMERCIAL Y N ClaimsHealth Plans Inc. CX055 COMMERCIAL Y N ClaimsHealth Resources Incorporated (HRI) CX019 COMMERCIAL Y N ClaimsHealth Risk Management 41170 COMMERCIAL Y N Claims [Formerly Health Risk Management (HRM)

Healthcare Management Administrators, Inc. HMA01 COMMERCIAL Y N Claims

The insured ID number is required. Maximum of 25 procedure lines per Claims. Secondary Claims cannot be sent electronically. Claims remarks exceeding 80 bytes in length cannot besent electronically.

Healthcomp, Inc. 85729 COMMERCIAL Y N ClaimsHealthplex, Inc. 11271 COMMERCIAL Y N ClaimsHealthSCOPE Benefits, Inc.(Formerly CNA Health Partners of Arkansas) 71063 COMMERCIAL Y N Claims

Healthsource Provident 62308 COMMERCIAL Y N Claims Claims are edited under CIGNA's payer specific edits, Payer ID 62308.

Hometown Health Plans Nevada 88023 COMMERCIAL Y N ClaimsHoosier Dental (in Inidanapolis, Indiana) CX015 COMMERCIAL Y N Claims

Hotel Employees & Restaurant Employees Health Trust 91136 COMMERCIAL Y N Claims

HRM Claims Management 41170 COMMERCIAL Y N Claims [Formerly Health Risk Management (HRM)Humana 73288 COMMERCIAL Y N ClaimsI. E. Shaffer (West Trenton, NJ) 22175 COMMERCIAL Y N ClaimsIBI 41124 COMMERCIAL Y N ClaimsIndiana Teamsters Health Benefits Fund (Indianapolis, IN) 35107 COMMERCIAL Y N Claims Formerly known as Local 135 Health Benefits Fund

(Indianapolis, IN)Insurance Design Administrators 13315 COMMERCIAL Y N ClaimsInsurance Management Services (Elko, NV) 88006 COMMERCIAL Y N Claims

Insurers Administrative Corp. 86304 COMMERCIAL Y N Claims Please visit website prior to submitting Claims: edihelp.iacusa.com

Integra Administrative Group (Seaford, DE) 51020 COMMERCIAL Y N Claims Payer ID valid only for Claims with a billing submission address of 110 S. Shipley Street, Seaford, DE 19973.

International Brotherhood of Boilermakers 36609 COMMERCIAL Y N ClaimsIowa Benefits Inc. 41124 COMMERCIAL Y N ClaimsJohn Alden Life Insurance Co. 41099 COMMERCIAL Y N ClaimsJohn Morrell Company - AHBPA 38310 COMMERCIAL Y N Claims

JP Farley Corporation 34136 COMMERCIAL Y N Claims Payer ID valid only for Claims with a billing submission address of PO Box 458022, Westlake, OH 44145

Kaiser Permanente Dental Choice CX073 COMMERCIAL Y N Claims Payer ID valid only for claims with a billing submission address of PO Box 4360 Rockville, MD

Kanawha Insurance Co. 57038 COMMERCIAL Y N ClaimsKansas City Life CX058 COMMERCIAL N N ClaimsKempton Company 73100 COMMERCIAL Y N ClaimsKempton Group Administrators 73100 COMMERCIAL Y N ClaimsLBA Healthplans 52193 COMMERCIAL Y N ClaimsLiberty Dental Plan CX083 COMMERCIAL Y N ClaimsLife Insurance Company of Boston & New York 78140 COMMERCIAL Y N Claims

LifeRe CX047 COMMERCIAL Y N Claims The Insured ID number is required. A maximum of 20 procedure lines per Claims.

Lincoln Financial Group CX061 COMMERCIAL Y N Claims f.k.a. Jefferson PilotLincoln National (WI) 73288 COMMERCIAL Y N ClaimsLine Construction Benefit Fund LCB01 COMMERCIAL Y N ClaimsLocal 135 Health Benefits Fund (Indianapolis, IN) 35107 COMMERCIAL Y N ClaimsLovelace Sandia Health Plan 90328 COMMERCIAL Y N Claims

Machigonne Benefit Administrators 10317 COMMERCIAL Y N ClaimsPlease include the rendering provider information or the name of the dentist in RTE6. Payer will reject the Claims without this information.

Mail Handlers Benefit Plan 62413 COMMERCIAL Y N Claims Also known as Mailhandlers/CAC.MAMSI CX033 COMMERCIAL N N ClaimsManulife W. J. Sutton Company 98010 COMMERCIAL Y N ClaimsMarsh Advantage CX023 COMMERCIAL Y N Claims

MBA Benefit Administrators, Inc. (Salt Lake City, UT) 87065 COMMERCIAL Y N Claims




MBA of Wyoming (Worland, WY) 87065 COMMERCIAL Y N ClaimsMBS 56205 COMMERCIAL Y N Claims Formerly MedCost Benefit Services.MedBen (Newark, OH) 74323 COMMERCIAL Y N ClaimsMEDICA of Minnesota CX026 COMMERCIAL Y N ClaimsMedical Benefit Administrators CX024 COMMERCIAL Y N ClaimsMedical Benefits Mutual (Neward, OH) 74323 COMMERCIAL Y N ClaimsMedical Mutual of Ohio (MMO) 29076 COMMERCIAL N Claims Status InquiryMedical Mutual of Ohio (MMO) 29076 COMMERCIAL Y N ClaimsMedical Mutual of Ohio (MMO) CB833 COMMERCIAL Y N ClaimsMedical Mutual of Ohio (MMO) CB833 COMMERCIAL N Claims Status InquiryMedical Network of Colorado Springs 84600 COMMERCIAL Y N ClaimsMercer Administrators CX023 COMMERCIAL Y N ClaimsMethodist First Choice 23550 COMMERCIAL Y N ClaimsMetLife 65978 COMMERCIAL N Claims Status InquiryMetLife 65978 COMMERCIAL Y N Claims (formerly Travelers)Michigan Regional Council of Carpenters Employees Benefit Plan (Troy, MI) 38238 COMMERCIAL Y N Claims

Mid-America Associates, Inc. 37281 COMMERCIAL Y N ClaimsMidwest Dental Benefits 41101 COMMERCIAL Y N Claims

Mid-West National Life Insurance Co. of Tennessee - Student Instuance 74227 COMMERCIAL Y N Claims


Mississippi Select Health Care 64088 COMMERCIAL Y N ClaimsMissoula County Medical Benefits Plan 37275 COMMERCIAL Y N ClaimsMorris Associates 35092 COMMERCIAL Y N ClaimsMotorola 36111 COMMERCIAL Y N Claims

Mountain States Administrative Services (Tucson, AZ) 86040 COMMERCIAL Y N Claims

MPEEBT/ MPE Services, Inc. 37233 COMMERCIAL Y N ClaimsMutual of Omaha Insurance Company 71412 COMMERCIAL Y N ClaimsMutually Preferred 71412 COMMERCIAL Y N ClaimsN.W. Int Assoc of Machinists & Aerospace Eng Benefits Trust Dental Progam 91136 COMMERCIAL Y N Claims Please enter Group Number when submitting Claims.

N.W. Ironworkers Health & Security Trust Fund 91136 COMMERCIAL Y N Claims Please enter Group Number when submitting Claims.

N.W. Roofers & Employers Health & Security Trust Fund 91136 COMMERCIAL Y N Claims Please enter Group Number when submitting Claims.

N.W. Textile Processors 91136 COMMERCIAL Y N Claims Please enter Group Number when submitting Claims.

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

NABN (Cleveland, OH) 34159 COMMERCIAL Y N ClaimsPayer ID valid only for Claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476.

National Benefit Administrators - New Jersey 56175 COMMERCIAL N N ClaimsNational Benefit Administrators - North Carolina 56176 COMMERCIAL Y N ClaimsNational Elevator Industry Benefit Plan (NEIB) CX045 COMMERCIAL Y N ClaimsNational Pacific of TX (NCFLEX) CX057 COMMERCIAL Y N ClaimsNational Rural Letter Carrier Association 71412 COMMERCIAL Y N Claims

National Telecommunications Cooperative Association 52120 COMMERCIAL Y N Claims

Nationwide Health Plans 31417 COMMERCIAL Y N ClaimsNCAS - Charlotte 75191 COMMERCIAL Y N ClaimsNCAS - Fairfax, VA 75190 COMMERCIAL Y N ClaimsNCBCBS - DBS a.k.a. ACS Benefit Services 61474 COMMERCIAL Y N ClaimsNetcare Life and Health Insurance (NLH) 66055 COMMERCIAL Y N ClaimsNew England Dental Administrators 43351 COMMERCIAL Y N ClaimsNGS AMERICAN 38225 COMMERCIAL Y N ClaimsNippon Life Insurance Company of America 81264 COMMERCIAL Y N ClaimsNippon Life Insurance Company of America 81264 COMMERCIAL N Claims Status Inquiry

North American Benefits Network ((Cleveland, OH) 34159 COMMERCIAL Y N ClaimsPayer ID valid only for Claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476.

North Broward Hospital District 37314 COMMERCIAL Y N ClaimsNorthern Illinois Health Plan 36347 COMMERCIAL Y N Claims Northern Nevada Trust Fund 88027 COMMERCIAL Y N ClaimsNorthShore University Health System Medical Group 36364 COMMERCIAL Y N ClaimsNorthwest Dental Services 93525 COMMERCIAL N N ClaimsNorthwest Suburban IPA 36346 COMMERCIAL Y N ClaimsNova Healthcare Administrators, Inc. (Grand Island, NY) 16644 COMMERCIAL Y N Claims

Nyhart 37299 COMMERCIAL Y N Claims




OK State Employees & Educators (EDS) 22521 COMMERCIAL Y N ClaimsOperating Engineers Locals 302 & 612 Health & Security Fund 91136 COMMERCIAL Y N Claims Please enter Group Number when submitting Claims.

PA Faculty Health & Welfare CX066 COMMERCIAL Y N ClaimsPacific Union CX056 COMMERCIAL Y N ClaimsPacificare Dental and Vision HMO CX060 COMMERCIAL Y N ClaimsPacificare Dental and Vision PPO CX053 COMMERCIAL Y N ClaimsPacificSource Health Plans 93029 COMMERCIAL Y N ClaimsPatient Advocates, LLC 10525 COMMERCIAL Y N ClaimsPDO 68241 COMMERCIAL Y N Claims

PEHP (Public Employees Health Program) CX080 COMMERCIAL Y Y Claims

Prior to accepting claims electronically PEHP requires the provider to call EDI Support at 801-366-7544 or 800753-7818. Providers should advise PEHP that they will be submitting their claims through Emdeon Business Services, Inc UHIN submitter ID HT000158-001.

Pequot Pharmaceutical 37121 COMMERCIAL Y N ClaimsPhysicians Care Network 36345 COMMERCIAL Y N ClaimsPhysicians Health Associates of Illinois 37136 COMMERCIAL Y N ClaimsPhysicians Health Plan of Northern Indiana, Inc. 12399 COMMERCIAL Y N ClaimsPhysicians Mutual CX068 COMMERCIAL Y N ClaimsPinnacle Claims Management, Inc. 24735 COMMERCIAL Y N ClaimsPittman & Associates 37224 COMMERCIAL Y N ClaimsPoly America Medical & Dental Benefits Plan 32680 COMMERCIAL Y N Claims

POMCO 16111 COMMERCIAL Y N Claims Prior to submitting please contact Lynn Wilcox at (315) 432-9171 ext. 255

Prairie States Enterprises, Inc. 36373 COMMERCIAL Y N ClaimsPreferred Care FL 59291 COMMERCIAL Y N ClaimsPreferred Care NC 56178 COMMERCIAL Y N ClaimsPreferred Dental Organization 68241 COMMERCIAL Y N ClaimsPreferred Health Professionals 31478 COMMERCIAL Y N ClaimsPremier Access Insurance Company CX078 COMMERCIAL Y N ClaimsPremier Dental Plan of MN CX029 COMMERCIAL Y N ClaimsPrimary PhysicianCare, Inc. 56144 COMMERCIAL Y N ClaimsPrincipal Financial Group 61271 COMMERCIAL Y N ClaimsPrincipal Financial Group 61271 COMMERCIAL N Claims Status InquiryPrincipal Life Insurance Co. 61271 COMMERCIAL Y N ClaimsPrincipal Life Insurance Co. 61271 COMMERCIAL N Claims Status InquiryPriority Health 38217 COMMERCIAL Y N Claims

Professional Benefit Administrators, Inc. (Oak Brook, IL) 36331 COMMERCIAL Y N ClaimsPayer ID is valid only for Claims with billing submission name, city, and state of Professional Benefit Administrators, Inc., Oak Brook, IL.

Professional Claims Administrators 41163 COMMERCIAL Y N Claims

Provident Life 62308 COMMERCIAL Y N Claims Claims are edited under CIGNA's payer specific edits, Payer ID 62308.

Prudential for Health 68241 COMMERCIAL Y N ClaimsPrudential HealthCare & Life Ins. Co of America 68241 COMMERCIAL Y N ClaimsPrudential HealthCare Health Maintenance Organization 68241 COMMERCIAL Y N Claims

Prudential HealthCare HMO for Small Business 68241 COMMERCIAL Y N ClaimsPrudential Healthcare of America Inc. 68241 COMMERCIAL Y N ClaimsPrudential HealthCare POS for Small Business 68241 COMMERCIAL Y N ClaimsPrudential HealthCare PPO for Small Business 68241 COMMERCIAL Y N Claims

Puget Sound Benefits Trust 91136 COMMERCIAL Y N Claims Please enter Group Number when submitting Claims.

Puget Sound Electrical Workers Trust 91136 COMMERCIAL Y N Claims Please enter Group Number when submitting Claims.

Quad Med LLC (Pewaukee, WI) 39197 COMMERCIAL Y N ClaimsQuality Plan Administrators Inc CX077 COMMERCIAL Y N ClaimsRBMS, LLC 91176 COMMERCIAL Y N ClaimsRegency Employee Benefits 38221 COMMERCIAL Y N ClaimsRegional Care, Inc. 47076 COMMERCIAL Y N ClaimsReliance Standard Life Ins. Co. 36088 COMMERCIAL Y N ClaimsReliance Standard Life Ins. Co. 36088 COMMERCIAL N Claims Status InquiryReliastar 80314 COMMERCIAL Y N Claims

ReliaStar (now known as CoreStar formerly NW National Life) 41045 COMMERCIAL Y N Claims


Renaissance Life and Health RLHA1 COMMERCIAL Y N ClaimsRightChoice Benefit Administrators 37331 COMMERCIAL Y N Claims

Riverside San Bernardino County Indian Health Inc. 50664 COMMERCIAL Y N Claims

RMSCO, INC. 16117 COMMERCIAL Y N ClaimsRochester Public Schools 41625 COMMERCIAL Y N Claims




Rocky Mountain Life Dental 84102 COMMERCIAL Y N ClaimsSafeguard HMO CX048 COMMERCIAL N N ClaimsSafeGuard PPO CX030 COMMERCIAL Y N Claims

Sage Technologies 37105 COMMERCIAL Y N Claims

f.k.a. Cannon Cochran Management Services, Inc. Claims with a mailing address of PO Box 17009, Rockford, IL ONLY may be sent electronically with this payer ID.

Sage Technologies - PBS 37137 COMMERCIAL Y N Claimsf.k.a. Progressive Benefit Services, Inc. Claims with a mailing address of PO Box 4419, Rockford, IL ONLY may be sent electronically with this payer ID.

Salvation Army 34154 COMMERCIAL Y N Claims a.k.a. Chesterfield Resource, Inc.SAMBA 37259 COMMERCIAL Y N ClaimsSanford Health Plan 91184 COMMERCIAL Y N ClaimsScan Health Plan Arizona 73172 COMMERCIAL N N ClaimsScan Long Term Care 20460 COMMERCIAL Y N ClaimsSeabury & Smith CX023 COMMERCIAL Y N ClaimsSecureCare Dental 86057 COMMERCIAL Y N ClaimsSelect Administrative Services (SAS) 64088 COMMERCIAL Y N ClaimsSelectCare (Coca Cola) 68241 COMMERCIAL Y N Claims

Self Insured Benefit Administrators (Clearwater, FL) 59111 COMMERCIAL Y N ClaimsPayer ID valid only for Claims with a submission address of 18167 US Highway 19 North, Suite 300, Clearwater, FL 33764.

Self Insured Services Company (SISCO) CX020 COMMERCIAL Y N ClaimsSelf-Funded Plans, Inc. 34131 COMMERCIAL Y N Claims

Self-Insured Dental Services (SIDS) CX076 COMMERCIAL Y N Claims

Additional enrollment is not required by the payer, however, providers wishing to submit Claims electronically must be credentialed with the payer. Please ensure you have successfully process one paper Claims with the payer prior to submitting your first electronic Claims.

Self-Insured Plans, LLC 36404 COMMERCIAL Y N ClaimsSentry Life Insurance Company 39033 COMMERCIAL Y N ClaimsSerentas Dental Care Solutions CX038 COMMERCIAL Y N ClaimsSet Seg 38610 COMMERCIAL Y N ClaimsShenandoah Life Insurance CX067 COMMERCIAL Y N ClaimsSierra Health Services 76342 COMMERCIAL Y N ClaimsSinclair Health Plan 84076 COMMERCIAL Y N ClaimsSouth Central Preferred - PPO York, PA (I H S Gateway Payer) 23266 COMMERCIAL Y N Claims

South FL Community Care Network - NBHD 37314 COMMERCIAL Y N ClaimsSouth Point Hotel & Casino 35227 COMMERCIAL Y N ClaimsSouthern Benefit Services 37318 COMMERCIAL Y N ClaimsSouthWest Benefits CX051 COMMERCIAL N N ClaimsSouthwestern Bell 68241 COMMERCIAL Y N ClaimsSouthwestern Bell Exec 68241 COMMERCIAL Y N ClaimsSouthwestern Bell Exec. - Custom Care 68241 COMMERCIAL Y N ClaimsSouthwestern Bell Exec. - Southwestern Bell 68241 COMMERCIAL Y N ClaimsSpina Bifida - VA HAC 84147 COMMERCIAL Y N ClaimsSt. Therese Physician Association 37116 COMMERCIAL Y N ClaimsStandard Ins. Co. (OR Business) 93024 COMMERCIAL Y N ClaimsStandard Ins. Co. (OR Business) 93024 COMMERCIAL N Claims Status InquiryStandard Insurance Company (NY) 13411 COMMERCIAL Y N ClaimsStandard Insurance Company (NY) 13411 COMMERCIAL N Claims Status InquiryStarHRG 59225 COMMERCIAL Y N ClaimsState of Texas Dental Plan 57254 COMMERCIAL Y N ClaimsStoner and Associates (Cincinnati, OH) 31121 COMMERCIAL Y N ClaimsSun Life and Health Insurance Company (U.S.) (formerly GEGLAC) 67814 COMMERCIAL Y N Claims f.k.a Genworth Life and Health Insurance Company

(GLHIC) (Formerly GEGLAC)Superior Dental Care 31117 COMMERCIAL Y N ClaimsTDC 73288 COMMERCIAL Y N Claims

Texas CHIP Dental Services CPPTX COMMERCIAL Y Y Claims

Providers wishing to submit Claims electronically must be credentialed and register for EDI. Providers should call the Texas CHIP Provider Call Center at 866-561-5891.

The Chesapeake Life Insurance Company - Student Insurance 74227 COMMERCIAL Y N Claims


The Dental Companies 73288 COMMERCIAL Y N ClaimsThe Dental Concern 73288 COMMERCIAL Y N ClaimsThe Loomis Company - TPA Wyomissing, PA (IHS Gateway Payer) 23223 COMMERCIAL Y N Claims

The MEGA Life & Health Insurance Company - Insurance Center 59226 COMMERCIAL Y N Claims




The MEGA Life & Health Insurance Company - Student Insurance 74227 COMMERCIAL Y N Claims


The Union Labor Life Insurance Company 13142 COMMERCIAL Y N Claims Payer ID valid for Claims with a submission address of P.O. Box 61593, King of Prussia, PA 19406.

Three Rivers Health Plans, Inc 25175 COMMERCIAL Y Y Claims Now known as Unison Health PlanTime Insurance Company 39065 COMMERCIAL Y N Claims f.k.a. Fortis Insurance CompanyTower Life Insurance Co. 69493 COMMERCIAL Y N ClaimsTR Paul, Inc. 37230 COMMERCIAL Y N ClaimsTransSmile CX069 COMMERCIAL Y N Claims Administered by Arkansas Delta DentalTravelers (now MetLife) 65978 COMMERCIAL Y N ClaimsTrusteed Plans Service Corporation 91078 COMMERCIAL Y N ClaimsTrustmark Insurance Company 61425 COMMERCIAL Y N ClaimsTrustmark Insurance Company 61425 COMMERCIAL N Claims Status InquiryUICI - Administrators - State of Nevada 74223 COMMERCIAL Y N Claims Accepting Claims only for the State of Nevada.UMR (United Medical Resources) 33108 COMMERCIAL Y N ClaimsUNICARE 80314 COMMERCIAL Y N ClaimsUnified Group Services 35198 COMMERCIAL Y N ClaimsUniform Medical Plan/Harrington Benefit Services 75243 COMMERCIAL Y N ClaimsUnion Security Insurance Company 70408 COMMERCIAL Y N Claims f.k.a. Fortis Benefits Insurance CompanyUnison Health Plan/Three Rivers 25175 COMMERCIAL Y Y ClaimsUnited Concordia - Fee for Service CX007 COMMERCIAL Y Y ClaimsUnited Concordia - Fee for Service CX007 COMMERCIAL N Claims Status InquiryUnited Concordia (Tricare Dental Plan) CX002 COMMERCIAL Y Y ClaimsUnited Concordia (Tricare Dental Plan) CX002 COMMERCIAL N Claims Status InquiryUnited Concordia Dental Plus CX013 COMMERCIAL Y Y ClaimsUnited Concordia Dental Plus CX013 COMMERCIAL N Claims Status Inquiry

United HealthCare Insurance Company - Student Insurance 74227 COMMERCIAL Y N Claims


United HealthCare Insurance Company of New York - Student Insurance 74227 COMMERCIAL Y N Claims


United Healthcare of River Valley 95378 COMMERCIAL Y Y Claims formerly John Deere Health Care/Heritage National Healthplan

United Medical Alliance 84132 COMMERCIAL Y N Claims United of Omaha 71412 COMMERCIAL Y N ClaimsUnited States Life Insurance Company 13545 COMMERCIAL Y N Claims f.k.a. American General

Unity Health Insurance Corp 66705 COMMERCIAL Y N Claims Only claims for Oral Surgery, TMJ or Accidents can be sent electronically to this payer ID.

Upper Peninsula Health Group (TPA) 37324 COMMERCIAL Y N ClaimsVA Fee Basis Programs 12116 COMMERCIAL Y N ClaimsVarian Health Care Plan 68241 COMMERCIAL Y N ClaimsVerity National Group 75256 COMMERCIAL Y N ClaimsWashington Dental Service 91062 COMMERCIAL Y N ClaimsWashington Employers Trust 37294 COMMERCIAL Y N ClaimsWashington State Council of County & City Employees Dental Trust 91136 COMMERCIAL Y N Claims Please enter Group Number when submitting Claims.

Waterstone Benefit Administrators 73155 COMMERCIAL Y N Claims

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

Wells Fargo Third Party Administrators (f.k.a. JSL Administrators) 37272 COMMERCIAL Y N Claims

Wells Fargo Third Party Administrators, Inc (Charleston,WV) 87815 COMMERCIAL Y N Claims f.k.a. Acordia National

Western Grower's Assurance Trust 24735 COMMERCIAL Y N ClaimsWestern Grower's Insurance Company 24735 COMMERCIAL Y N ClaimsWestLake Financial Group, Inc. (Buffalo Grove, IL) 90560 COMMERCIAL Y N ClaimsWilliam C. Earhart 93050 COMMERCIAL N N ClaimsWorksite Benefit Services, LLC 20333 COMMERCIAL Y N ClaimsACS Benefit Solutions 61473 BCBS Y N ClaimsHorizon Healthcare Dental Services 22099 BCBS Y Y ClaimsHorizon Healthcare Dental Services 22099 BCBS N Claims Status InquiryNorthStar Administrators 47570 BCBS Y N ClaimsPremera Blue Cross 47570 BCBS Y N Claims

AK Blue Cross of Alaska and Washington 47570 BCBS Y N ClaimsAL Blue Cross of Alabama CBAL1 BCBS Y Y Claims

AR Blue Cross of Arkansas CBAR1 BCBS Y N Claims Mailing address for claims: Dental Claims AdministratorPO Box 1206 Elk Grove Village IL 60009-1206.

CA Anthem Blue Cross 47198 BCBS Y N Claims f.k.a. Blue Cross of California; Wellpoint




CO Blue Cross of Colorado 84099 BCBS Y N Claims No FEP Claims. Please send FEP Claims on paper or use Payer ID 06126.

CO Trigon Blue Cross Blue Shield - Colorado Dental Office 84103 BCBS Y N ClaimsClaims Mailing Address: Trigon Dental Admin, 555 Middle Creek Parkway, MS 400, Colorado Springs, CO 80921.

CT Anthem Blue Cross Blue Shield Connecticut 84105 BCBS Y N Claims No FEP Claims. Please send FEP on paper or use Payer ID 06126.

CT Blue Care Family Plan (BCBS of CT) 00700 BCBS Y N ClaimsDE Blue Cross of Delaware 53287 BCBS Y N ClaimsGA Blue Cross of Georgia CBGA1 BCBS Y Y ClaimsIA Blue Cross of Iowa CBIA2 BCBS Y Y ClaimsIA Blue Cross of Iowa (FEP Claims Only) CBIA1 BCBS Y Y Claims FEP Claims onlyID Blue Cross of Idaho CBID1 BCBS Y Y ClaimsID Blue Shield of Idaho CBID2 BCBS Y Y ClaimsIL Blue Cross of Illinois CB621 BCBS Y N Claims

IN Blue Cross of Indiana Anthem 84105 BCBS Y N Claims No FEP Claims. Please send FEP on paper or use Payer ID 06126.

KS Blue Cross of Kansas CBKS1 BCBS Y Y Claims

KY Blue Cross of Kentucky Anthem 84105 BCBS Y N Claims No FEP Claims. Please send FEP on paper or use Payer ID 06126.

LA Blue Cross Blue Shield of Louisiana 23739 BCBS Y Y ClaimsMA Blue Cross of Massachusetts CBMA1 BCBS Y Y ClaimsMA Blue Cross of Massachusetts CBMA1 BCBS N Claims Status InquiryMI Blue Cross Blue Shield of Michigan CBMI1 BCBS Y N ClaimsMS Mississippi BCBS CBMS1 BCBS Y Y ClaimsMT Blue Cross Blue Shield of Montana CBMT1 BCBS Y N ClaimsNC Blue Cross Blue Shield of North Carolina 61473 BCBS Y N Claims

NC Blue Cross of North Carolina Federal Employee Claims 61472 BCBS Y N Claims

NC North Carolina Health Choice for Children 61472 BCBS Y N ClaimsND Blue Cross of North Dakota (ND Dental Services) CX004 BCBS Y Y ClaimsND North Dakota Dental Service CX004 BCBS Y Y ClaimsNE Blue Cross of Nebraska CBNE1 BCBS N Y ClaimsNM Blue Cross of New Mexico CBNM1 BCBS N N Claims

NV Blue Cross of Nevada 84101 BCBS Y N Claims No FEP Claims. Please send FEP Claims on paper or use Payer ID 06126.

NY BCBS of Rochester New York CBNYR BCBS N N ClaimsNY Empire Blue Cross Blue Shield CBNY1 BCBS N N ClaimsNY NorthEast NY Blue Shield CBNYE BCBS Y Y ClaimsNY NY BCBS - Western CBNYW BCBS Y Y Claims

OH Blue Cross of Ohio Anthem 84105 BCBS Y N Claims No FEP Claims. Please send FEP on paper or use Payer ID 06126.

OR Blue Cross of Oregon CB850 BCBS Y Y ClaimsPA Blue Shield of Pennsylvania Dental Plus CBPA2 BCBS Y Y ClaimsPA Blue Shield of Pennsylvania Dental Plus CBPA2 BCBS N Claims Status InquiryPA Pennsylvania Blue Shield (Camp Hill) CB865 BCBS Y Y ClaimsPA Pennsylvania Blue Shield (Camp Hill) CB865 BCBS N Claims Status InquiryRI Blue Cross of Rhode Island CB870 BCBS Y Y ClaimsSC South Carolina BCBS 38520 BCBS Y Y ClaimsSC South Carolina BCBS 38520 BCBS N Claims Status InquiryTN Blue Cross of Tennessee CBTN1 BCBS Y Y ClaimsTX Blue Cross of Texas CB900 BCBS Y Y ClaimsUT Regence UT BCBS CBUT1 BCBS Y Y ClaimsUT Regence UT BCBS FEP CBUTF BCBS Y Y Claims

VA Trigon Blue Cross of Virginia (Anth BCBS-VA/ BCBS Anth-VA formerly Trigon) CB923 BCBS Y N Claims

WA Blue Cross of Alaska and Washington 47570 BCBS Y N Claims

WA Regence Blue Shield 93200 BCBS Y Y Claims Unique provider ID required; please call NDEX at (800) 373-1477.

WA Regence Blue Shield FEP 93200 BCBS Y Y ClaimsUnique provider ID required; please call NDEX at (800) 373-1477. Participating Payer - see last page for definition.

WA Regence Northwest Health 93200 BCBS Y Y ClaimsUnique provider ID required; please call NDEX at (800) 373-1477. Participating Payer - see last page for definition.

WI Blue Cross of Wisconsin CB950 BCBS Y N ClaimsAARP (administrated by Delta Dental of Washington, DC) 52147 DELTA DENTAL Y N Claims AARP Claims with a mailing address of 1 Delta Drive,

Mechanicsburg, PA Delta Dental Insurance Co. (DDIC) - All Payers 94276 DELTA DENTAL N N ClaimsDelta Health Systems 94235 DELTA DENTAL Y N ClaimsNortheast Delta Dental (ME, NH, VT) 02027 DELTA DENTAL Y N Claims

AK Delta Dental of Alaska (DDIC) DDAK1 DELTA DENTAL N N Claims

AL Delta Dental of Alabama (DDIC) DDAL1 DELTA DENTAL N N ClaimsAR Delta Dental of Arkansas CDAR1 DELTA DENTAL Y N Claims




AZ Delta Dental of Arizona 86027 DELTA DENTAL Y N ClaimsAZ Delta Dental of Arizona 86027 DELTA DENTAL N Claims Status InquiryCA Delta Dental of California - CA00 Claims Office 77777 DELTA DENTAL Y N ClaimsCA Delta Dental of California/Tricare Retiree Dental CDCA1 DELTA DENTAL Y N ClaimsCO Delta Dental of Colorado 84056 DELTA DENTAL Y N ClaimsDC Delta Dental of Washington DC 52147 DELTA DENTAL Y N ClaimsDE Delta Dental of Delaware 51022 DELTA DENTAL Y N ClaimsFL Delta Dental of Florida (DDIC) DDFL1 DELTA DENTAL N N ClaimsGA Delta Dental of Georgia (DDIC) DDGA1 DELTA DENTAL N N ClaimsIA Delta Dental of Iowa CDIA1 DELTA DENTAL Y N ClaimsIA Delta Dental of Iowa CDIA1 DELTA DENTAL N Claims Status InquiryID Delta Dental of Idaho 82029 DELTA DENTAL Y N ClaimsIL Delta Dental of Illinois 05030 DELTA DENTAL Y N ClaimsIL Delta Dental of Illinois 05030 DELTA DENTAL N Claims Status InquiryIN Delta Dental of Indiana CDIN1 DELTA DENTAL Y N ClaimsIN Delta Dental of Indiana CDIN1 DELTA DENTAL N Claims Status InquiryKS Delta Dental of Kansas CDKS1 DELTA DENTAL Y N ClaimsKS Delta Dental of Kansas CDKS1 DELTA DENTAL N Claims Status InquiryKY Delta Dental of Kentucky CDKY1 DELTA DENTAL Y N ClaimsLA Delta Dental of Louisiana (DDIC) DDLA1 DELTA DENTAL N N ClaimsMA DentaQuest 04356 DELTA DENTAL Y N ClaimsMA Delta Dental of Massachusetts 04614 DELTA DENTAL Y N ClaimsMA Delta Dental of Massachusetts 04614 DELTA DENTAL N Claims Status InquiryMD Delta Dental of Maryland (Pennsylvania) 23166 DELTA DENTAL Y N ClaimsMI Delta Dental of Michigan CDMI0 DELTA DENTAL Y N ClaimsMI Delta Dental of Michigan CDMI0 DELTA DENTAL N Claims Status InquiryMN Delta Dental of Minnesota CDMN1 DELTA DENTAL Y N ClaimsMO Delta Dental of Missouri 43090 DELTA DENTAL Y N ClaimsMO Delta Dental of Missouri 43090 DELTA DENTAL N Claims Status InquiryMS Delta Dental of Mississippi (DDIC) DDMS1 DELTA DENTAL N N ClaimsMT Delta Dental of Montana (DDIC) DDMT1 DELTA DENTAL N N ClaimsNC Delta Dental of North Carolina 56101 DELTA DENTAL Y N ClaimsND Delta Dental of North Dakota CDND1 DELTA DENTAL Y N ClaimsNE Delta Dental of Nebraska CDNE1 DELTA DENTAL Y N ClaimsNJ Delta Dental of New Jersey 22189 DELTA DENTAL Y N ClaimsNJ Delta Dental of New Jersey 22189 DELTA DENTAL N Claims Status InquiryNM Delta Dental of New Mexico 85022 DELTA DENTAL Y N ClaimsNM Delta Dental of New Mexico 85022 DELTA DENTAL N Claims Status InquiryNV Delta Dental of Nevada (DDIC) DDNV1 DELTA DENTAL N N ClaimsNY Delta Dental of New York 11198 DELTA DENTAL Y N ClaimsOH Delta Dental of Ohio CDOH1 DELTA DENTAL Y N ClaimsOH Delta Dental of Ohio CDOH1 DELTA DENTAL N Claims Status InquiryOK Delta Dental of Oklahoma CDOK1 DELTA DENTAL Y N ClaimsOK Delta Dental of Oklahoma CDOK1 DELTA DENTAL N Claims Status InquiryOR Delta Dental of Oregon (Oregon Dental Service) CDOR1 DELTA DENTAL Y N ClaimsPA Delta Dental of Pennsylvania 23166 DELTA DENTAL Y N Claims Incl. MarylandRI Delta Dental of Rhode Island 05029 DELTA DENTAL Y N ClaimsRI Altus 50503 DELTA DENTAL Y N ClaimsSC Delta Dental of South Carolina 43091 DELTA DENTAL Y N ClaimsSD Delta Dental of South Dakota 54097 DELTA DENTAL Y N ClaimsTN Delta Dental of Tennessee CDTN1 DELTA DENTAL Y N ClaimsTN Delta Dental of Tennessee CDTN1 DELTA DENTAL N Claims Status InquiryTX Delta Dental of Texas (DDIC) DDTX1 DELTA DENTAL N N ClaimsUT Delta Dental of Utah (DDIC) DDUT1 DELTA DENTAL N N Claims

VA Delta Dental of Virginia CDVA1 DELTA DENTAL N N Claims Effective 1-16-07: electronic payer ID for Claims printed and mailed to Delta Dental Virginia

WI Delta Dental of Wisconsin 39069 DELTA DENTAL Y N ClaimsWI Delta Dental of Wisconsin 39069 DELTA DENTAL N Claims Status InquiryWV Delta Dental of West Virginia 31096 DELTA DENTAL Y N ClaimsWY Delta Dental of Wyoming CDWY1 DELTA DENTAL Y N ClaimsAK Alaska Medicaid CKAK1 MEDICAID Y N ClaimsAL Medicaid of Alabama CKAL1 MEDICAID Y Y ClaimsAR Medicaid of Arkansas CKAR1 MEDICAID Y Y Claims

CA Denti-Cal 94146 MEDICAID Y Y ClaimsDenti-Cal requires provider enrollment and has special data requirements. Contact Denti-Cal EDI Support at (916) 853-7373.

CA Medicaid of California 94146 MEDICAID Y Y ClaimsDenti-Cal requires provider enrollment and has special data requirements. Contact Denti-Cal EDI Support at (916) 853-7373.

CO Medicaid of Colorado CKCO1 MEDICAID Y Y ClaimsCT Medicaid of Connecticut CKCT1 MEDICAID Y Y ClaimsDE Delaware Medicaid CKDE1 MEDICAID Y Y ClaimsFL Atlantic Dental Inc. (ADI) - Medicaid CX052 MEDICAID Y N Claims ADMINISTERED BY DORAL DENTALFL Medicaid of Florida (FL) CKFL1 MEDICAID Y Y Claims




FL Medicaid of Florida (FL) CKFL1 MEDICAID N Claims Status InquiryGA Medicaid of Georgia (GA) CKGA1 MEDICAID Y Y ClaimsIA Medicaid of Iowa CKIA1 MEDICAID Y Y ClaimsID Medicaid of Idaho CKID1 MEDICAID Y Y ClaimsIL Illinois Medicaid CKIL1 MEDICAID Y N Claims ADMINISTERED BY DORAL DENTAL. IN Indiana Childrens Special Healthcare CX070 MEDICAID Y Y ClaimsIN Medicaid of Indiana CKIN1 MEDICAID Y N ClaimsKS Kansas Medicaid CKKS1 MEDICAID Y Y ClaimsKY Kentucky Medicaid CKKY1 MEDICAID Y Y ClaimsKY Kentucky Medicaid CKKY1 MEDICAID N Claims Status Inquiry

KY Medicaid of Kentucky Region #3 (Doral Dental Services) CKKY3 MEDICAID Y N Claims ADMINISTERED BY DORAL DENTAL.

LA Louisiana Medicaid (EPSDT) CKLA1 MEDICAID Y Y ClaimsLA Louisiana Medicaid (Adult Dental) CKLA2 MEDICAID Y Y ClaimsMA Medicaid of Massachusetts CKMA1 MEDICAID Y N Claims ADMINISTERED BY DORAL DENTAL.

MD Medicaid of Maryland, DePartment of Health and Mental Hygiene CKMD1 MEDICAID N Y Claims

ME Medicaid of Maine CKME1 MEDICAID Y Y ClaimsMI Michigan Medicaid CKMI1 MEDICAID Y Y ClaimsMN Medicaid of Minnesota CKMN1 MEDICAID Y Y ClaimsMN Health Partners of Minnesota - Medicaid CX010 MEDICAID Y N ClaimsMO Medicaid of Missouri CKMO1 MEDICAID Y Y ClaimsMO Medicaid of Missouri CKMO1 MEDICAID N Claims Status InquiryMS Mississippi Medicaid CKMS1 MEDICAID Y Y ClaimsMT Montana Medicaid CKMT1 MEDICAID Y N ClaimsNC Medicaid of North Carolina CKNC1 MEDICAID Y Y Claims

ND North Dakota Medicaid CKND1 MEDICAID Y N Claims

Additional enrollment is not required by the payer, however, providers wishing to submit Claims electronically must submit their ND Medicaid assigned provider ID(s) within the Claims. Provider IDs are always 5 digits long and begin with the number 4.

NE Nebraska Medicaid CKNE1 MEDICAID Y Y ClaimsNH Medicaid of New Hampshire CKNH1 MEDICAID Y Y ClaimsNJ Medicaid of New Jersey CKNJ1 MEDICAID Y Y ClaimsNM New Mexico Medicaid CKNM1 MEDICAID Y Y ClaimsNV Medicaid of Nevada CKNV1 MEDICAID Y Y ClaimsNY New York Medicaid CKNY1 MEDICAID Y Y ClaimsNY Medicaid of New York (Dental Clinics Only) CKNY2 MEDICAID Y Y ClaimsOH Medicaid of Ohio CKOH1 MEDICAID Y Y ClaimsOH CareSource CKOH2 MEDICAID Y Y ClaimsOK Medicaid of Oklahoma CKOK1 MEDICAID Y Y ClaimsOR Medicaid of Oregon CKOR1 MEDICAID Y Y ClaimsPA Medicaid of Pennsylvania CKPA1 MEDICAID Y Y ClaimsRI Medicaid of Rhode Island CKRI1 MEDICAID Y Y ClaimsSC South Carolina Medicaid CKSC1 MEDICAID Y Y ClaimsTX Medicaid of Texas CKTX1 MEDICAID Y Y ClaimsUT Medicaid of Utah CKUT1 MEDICAID Y Y ClaimsVA Virginia Medicaid CKVA1 MEDICAID Y N Claims ADMINISTERED BY DORAL DENTAL.VT Medicaid of Vermont CKVT1 MEDICAID Y Y ClaimsWA Medicaid of Washington CKWA1 MEDICAID Y Y ClaimsWI Medicaid of Wisconsin CKWI1 MEDICAID Y N ClaimsWI Doral Dental Plan of Wisconsin CX014 MEDICAID Y N Claims ADMINISTERED BY DORAL DENTALWI Managed Health Services - WI State Employees CX014 MEDICAID Y N Claims ADMINISTERED BY DORAL DENTAL

WI Physicians Plus Insurance, Co., Wisconsin State Employees CX014 MEDICAID Y N Claims ADMINISTERED BY DORAL DENTAL

WI Prime Care Wisconsin State and Federal Employees and Medicaid CX014 MEDICAID Y N Claims ADMINISTERED BY DORAL DENTAL

WV Medicaid of West Virginia CKWV1 MEDICAID Y Y ClaimsWY Medicaid of Wyoming CKWY1 MEDICAID Y Y Claims


Documents

eClaim Dental Payer List Information - patterson.eaglesoft.netpatterson.eaglesoft.net/pdfs/eClaims Payer List_OLD.pdf · eClaim Dental Payer List Information ... AARP Claims with