Electronic Attachment Dental Payer List NEA Payer Namepatterson.eaglesoft.net/pdfs/Electronic Attachment Dental Payer... · Electronic Attachment Dental Payer List March 2010 Payer

Electronic Attachment Dental Payer ListMarch 2010

Payer Name

NEA

Payer ID Payer Name

NEA

Payer IDAdministrative Services Only, Inc 089002 BCBS of Texas 034004

AETNA 037001 BCBS of Wisconsin 026022

Aetna DMO 037018 Bell Atlantic 037007

AETNA Life and Casualty 037004 Benefits Inc. (Alan Sturm) 100013

AETNA Select 037003 Blue Cross (CA) Life and Health 026005

Alan Sturm & Associates 100001 Blue Cross of California - Wellpoint 026011

American Dental Plan of GA, Inc. 017006 Blue Cross of California- Anthem 026010

American Dental Plan of NC, Inc. 017007 Blue Cross of Colorado 026016

American Dental Plan, Inc. 017004 Blue Cross of Idaho 092001

American Dental Prov. of AR, Inc. 017005 Blue Cross of Indiana 026018

American Prepaid Dental Plan of OH, Inc 017027 Blue Cross of Kentucky 026020

American Prepaid Professional Svcs., Inc 017028 Blue Cross of Nevada 026017

America's TPA 150000 Blue Cross of Ohio 026019

Americhoice 005006 Blue Cross of WA and AK 016002

Ameritas 001001 Blue Cross of WV 022010

Anthem BCBS Colorado 026030 Blue Shield of California 005004

Anthem BCBS Connecticut 026031 Bridgeport Dental Services 032001

Anthem BCBS Indiana 026032 Brokers National Life Assurance Company 038002

Anthem BCBS Kentucky 026033 Businessmen's Assurance 001007

Anthem BCBS Maine 026026 CareFirst Blue Cross/Blue Sheild - MD 095001

Anthem BCBS Missouri 026027 CareFirst BlueChoice - DC 095002

Anthem BCBS Nevada 026035 Caterpillar Company 005005

Anthem BCBS New Hampshire 026025 CBS Health Benefits 088001

Anthem BCBS Ohio 026036 CDH (Cigna Dental Health) 002017

Anthem BCBS Virginia 026028 Chartered Medicaid - EPSDT (Under 21) 093002

Anthem BCBS Wisconsin 026029 Choice Care 008015

Anthem Blue Cross- (CA only) 026024 Choice Plus 037008

Anthem Health & Life Insurance Company 026037 Christian Brothers Employee Benefit Serv 088002

Ascent Benefits Company 086002 Christian Brothers Employee Benefit Trst 088000

ASO, Inc. 089001 CIGNA (All of Cigna) 002009

ASO/SIDS 089000 Cigna Health Plan - HMO 002011

Assurant Employee Benefits 009007 Claim Management Services - Wisconsin 026040

Assurant Health 009005 Commercial FL ADI - Choice PPO 006136

Assurant, Inc. 009008 Commercial FL ADI - Select 006133

Atlantic Dental Inc. (ADI) Medicaid 006101 Commercial FL ADI - Series 006131

Atlantic Dental Inc. (ADI) Medicaid 006102 Commercial FL ADI - UltraCare 006134

BCBS of Alabama 076001 Commercial FL ADI JMH Select Discount 006137

BCBS of Connecticut 026023 Commercial FL ADI Signature 006130

BCBS of Georgia 026006 Commercial FL ADI-Total Health Choice 006135

BCBS of Georgia - Federal 026015 CompBenefits Corporation 017001

BCBS of Illinois 034003 CompBenefits Dental and Vision Company 017015

BCBS of Massachusetts 051001 CompBenefits Direct, Inc. 017016

BCBS of Michigan 042001 CompBenefits of AL, Inc. 017030

BCBS of New Mexico 034001 CompBenefits of GA, Inc. 017031

BCBS of North Carolina - Dental Blue 078001 CompDent 017002

BCBS of North Carolina - Dental Blue Select 078002 CompDent of AL, Inc. 017008

BCBS of Oklahoma 034006 CompDent of GA, Inc. 017026

BCBS of Tennessee 091001 CompDent of IL, Inc. 017009

For an updated payer list, please visit our website www.eaglesoft.net

Page 1


Payer Name

NEA

Payer ID Payer Name

NEA

Payer IDCompDent Preferred Networks, Inc. 017025 Dental Network of America (DNOA) 034002

Concordia Plus 022007 Dental Select - Utah 061001

Concordia Preferred 022008 DentaPremier - Ohio 140002

Connecticut General 002010 DentaQuest Commercial 060001

Continental Dental 002015 DentaQuest Government (formarly Doral) 006218

CSEA Employee Benefit Plan 099001 DentaSelect - Ohio 140001

CustomCare (Southwestern Bell - Exec) 037009 Dentical 044001

DC Healthcare Alliance - Chartered 093003 DentiCare, Inc. 017010

DC Healthcare Alliance - HeathRight 093004 DentLease, Inc. 017017

DC Healthy Smiles 093007 Diamond Dental of Arkansas, Inc. 017020

Decare Dental 130000 Diversified Administrators 017018

Delta Dental CA - Tricare Retirees 039003 Doral Dental USA 006001

Delta Dental CA (Commercial) 019001 Eastern Life and Health 047002

Delta Dental CA Federal (TRDP) 039001 Educators Mutual Life 047001

Delta Dental of Arizona 086001 Emphesys 008002

Delta Dental of Colorado 020001 Employee Benefit Managment Corp 049001

Delta Dental of Idaho 036001 Employee Benefit Services 001014

Delta Dental of Illinois 087001 Employer Plan Services, Inc. 038001

Delta Dental of Iowa 080001 Employers Health Insurance 008003

Delta Dental of Kentucky 004001 Employers Health Insurance of Wisconsin 008012

Delta Dental of Massachusetts 024001 Equicor 002012

Delta Dental of Michigan 028001 Equitable Life 002013

Delta Dental of Minnesota 100000 First Ameritas Life Ins. Corp. 001002

Delta Dental of Missouri 027001 First Commonwealth Dental 007003

Delta Dental of New Jersey and CT 021001 First Dental Health 098001

Delta Dental of New Mexico 025001 First Fortis Benefits 009001

Delta Dental of North Carolina 055001 First Reliance Standard 001005

Delta Dental of Oklahoma 029001 Fiserv Health- Harrington 010006

Delta Dental of Virginia 014001 FlexCare 037010

Delta Dental of Wisconsin 082001 Florida Power & Lights 037011

Delta Dental of Wyoming 033003 Fort Dearborn Life 034007

Delta Dental Plan of Alaska 030003 Fortis Benefits 009002

Delta Dental Plan of Arkansas 018001 Fortis Insurance 009010

Delta Dental Plan of Indiana 028003 Fortis Self Funded Adm. Services 009009

Delta Dental Plan of Kansas 081001 GE Group Life Assurance 054001

Delta Dental Plan of Missouri in SC 027002 GEHA Connection Dental Choice 056006

Delta Dental Plan of Ohio 028002 GEHA Connection Dental Federal 056005

Delta Dental Plan of Oregon 030004 GEHA Connection Dental Plus 056003

Delta Dental Plan of South Carolina 027003 GEHA Employee Benefit Plan 056004

Delta Dental Plan of South Dakota 033001 Genworth Group Dental Benefits 054002

Delta Dental Plan of Tennessee 003001 GIC 026014

Delta Dental Plan of Washington 048002 Golden West Dental & Vison Plan 026038

Denex Dental 038003 Government Employees Hospital Assn. 056001

Dental Benefit Providers 005001 Group Dental Service 083001

Dental Care Plus Group - Ohio 140000 Group Health Incorporated (GHI) 045001

Dental Care Plus Management Corp. 017014 Guardian 007001

Dental Guard Preferred Network 007002 Harrington Benefit Services 010001

Dental Health Management, Inc. 017023 HCS, Inc. 017029


Page 2


Payer Name

NEA

Payer ID Payer Name

NEA

Payer IDHealth Care Systems, Inc. 017012 Medicaid FL - Amerigroup 006097

Health Resources Inc. 160000 Medicaid FL Better Health - Adults 006139

Health Services for Children with Special needs 093006 Medicaid FL Better Health-Children 006138

Health Services Group 030007 Medicaid FL Childrens - Charlee 006111

Healthplex 085001 Medicaid FL Childrens - Miami-Dade 0-5 006110

HealthRight Medicaid - EPSDT (Under 21) 093005 Medicaid FL Childrens - Miami-Dade 6-20 006112

Healthsource Provident 002014 Medicaid FL Healthy Kids 006113

HealthStream Services, Inc. 017019 Medicaid FL Humana - Children 0-5 006114

Hershey Health Smile 022006 Medicaid FL Humana - Children 6-20 006115

Highmark Blue Cross 022004 Medicaid FL Humana - Non-Reform - Adult 006117

Humana Choice Care 008016 Medicaid FL Humana - PW/H/A 006116

Humana Dental 008001 Medicaid FL Humana - SSI - Adult 006118

Humana Gold Choice 008014 Medicaid FL Humana - TANF - Adult 006119

Humana Military Healthcare 008011 Medicaid FL Independent Living - Adult 006120

Idaho Smiles 006096 Medicaid FL JMH - Health & Wellness 006129

JC Penney 037005 Medicaid FL Prestige Health Choice Adult 006121

John Alden 009006 Medicaid FL SFCCN-PSN Adult 006132

John Hancock 026008 Medicaid FL THC - Children 006122

Kaiser Permanente Dental Choice 083003 Medicaid FL THC - Non-Reform - Adult 006123

Liberty Dental Plan 110000 Medicaid FL THC - Reform - Adult 006124

LifeWise Health Plan of Oregon 016003 Medicaid FL THCAlternateIDProdt-no bnfit 006125

Managed Dental Care (CA) - Guardian 007004 Medicaid FL WC HealthEaseNon-Reform-Adlt 006126

Managed DentalGuard FL, NJ, NY, TX 007005 Medicaid FL WCHealthEase Non-Reform-Adlt 006128

Managed Health Services 006092 Medicaid FL WC-Staywell Non-Reform-Adult 006127

Marriott 037012 Medicaid GA - Amerigroup 006038

MassHealth Dental Medicaid 006091 Medicaid GA - GA Medicaid (ACS) 057001

MCNA Dental Plans 097001 Medicaid GA - Peachstate Health Plan 006104

Medica Commercial Program 100012 Medicaid GA - Wellcare 006039

Medica MN Public Program 100003 Medicaid IL 006003

Medicad NVAmerigroupCommunityCareChek-up 006178 Medicaid IL - Amerigroup IL 006044

Medicaid - MN Blue Plus 100004 Medicaid IL - Medical Assistance Program 006045

Medicaid - MN CivicSmiles 100008 Medicaid KS 006047

Medicaid - MN First Plan Blue 100007 Medicaid KS - Kansas Medical Assistance 006046

Medicaid - MN MHP (Metropolitan Health) 100005 Medicaid KY - FFS-KY 006048

Medicaid AZ - ALTCS 059002 Medicaid KY - Passport Health Plan 006004

Medicaid AZ - Maricopa Health 006040 Medicaid KY (Region 3) 006093

Medicaid CA - BC Life 006066 Medicaid MA - CeltiCare 006151

Medicaid CA - CMSP 006041 Medicaid MA - Network Health Forward 006150

Medicaid CT - Health Net 006042 Medicaid MA - NHP Commonwealth Care 006148

Medicaid DC - Amerigroup 006043 Medicaid MD - Amerigroup 006049

Medicaid DC Healthy Smiles Adult(21&up) 006108 Medicaid MD - Coventry Diamond Plan 006050

Medicaid DC Healthy Smiles Child(upto21) 006109 Medicaid MD - Helix 006051

Medicaid DC Mid - Atlantic Access/EPPO 006159 Medicaid MD - History Load 006143

Medicaid DC Mid - Atlantic Choice 006153 Medicaid MD - MD Physician Care - MCO 006005

Medicaid DC Mid - Atlantic DHMO 006157 Medicaid MD - Priority Partners 006053

Medicaid DC Unison-Capitol Area Child 006105 Medicaid MD Healthy Smiles REM 21andOver 006142

Medicaid DC-Unison CapitalAlliance Adult 006106 Medicaid MD Healthy Smiles Under 21 006140

Medicaid DC-Unison CapitalAlliance Child 006107 Medicaid MD Mid - Atlantic Access/EPPO 006160


Page 3


Payer Name

NEA

Payer ID Payer Name

NEA

Payer IDMedicaid MD Mid - Atlantic Choice 006154 Medicaid NY - CenterCare 006067

Medicaid MD Mid - Atlantic DHMO 006156 Medicaid NY - Empire BCBS 006068

Medicaid MD UnitedHealthcare PAC 006146 Medicaid NY - Fidelis Health 006069

Medicaid MD UnitedHealthcareHealthChoice 006145 Medicaid NY - GHI 006070

Medicaid MDHealthySmilesConfirmPregnancy 006144 Medicaid NY - Healthfirst 006071

Medicaid MN - UCare of MN 006054 Medicaid NY - Managed Health Inc. 006074

Medicaid MN SCHA - Ability Care 006171 Medicaid NY - Metro Plus 006072

Medicaid MN SCHA - MSHO 006164 Medicaid NY - NHP CHP (no co-pay) 006197

Medicaid MN SCHA (GA) - over 21 006163 Medicaid NY - NHP FHP (co-pay) 006195

Medicaid MN SCHA (MA) - over 21 006162 Medicaid NY - NHP FHP (no co-pay) 006196

Medicaid MN SCHA MA - under 21 006161 Medicaid NY - NHP Medicaid Adult 006193

Medicaid MN Senior Care Plus - SCHA 006165 Medicaid NY - NHP Medicaid Child 006194

Medicaid MNCare SCHA Basic Plus One(M3) 006168 Medicaid NY - Presbyterian Community 006073

Medicaid MNCare SCHA Basic Plus Two(M4) 006169 Medicaid NY - Suffolk County 006052

Medicaid MNCare SCHA Care Basic (M2) 006166 Medicaid NY Fidelis 1199 - Adult 006204

Medicaid MNCare SCHA Care Basic Plus(M5) 006167 Medicaid NY Fidelis 1199 - Child 006205

Medicaid MNCare SCHA Expanded (M1) 006170 Medicaid NY Fidelis 1199 CHP-Subsidized 006200

Medicaid MO - BCBS Kansas City 006055 Medicaid NY Fidelis 1199 FHP Sub. Copay 006199

Medicaid MO - Care Children 006172 Medicaid NY Fidelis1199 FHP SubNoCopay 006198

Medicaid MO - FirstGuard Health 006009 Medicaid NY Fidelis1199CHP-NonSubsidized 006203

Medicaid MO - HealthCareUSA 006058 Medicaid NY Fidelis1199FHPNonSub NoCopay 006201

Medicaid MO - Missouri, HealthNet 006090 Medicaid NY Fidelis1199FHP-Non-Sub-Copay 006202

Medicaid MO Care Adult 006174 Medicaid OH - Amerigroup 006075

Medicaid MO Care Eligibility History 006175 Medicaid OH - Buckeye Health 006076

Medicaid MO Care Pregnant Woman 006173 Medicaid OH - Molina OH 006079

Medicaid NJ - Aetna Medicare Advantage 006180 Medicaid OH - QualChoice 006077

Medicaid NJ - Amerigroup 006060 Medicaid OH - Unison 006078

Medicaid NJ - Health Net 006061 Medicaid OK - Heartland Health 006018

Medicaid NJ - University Health Plan 006062 Medicaid OK - Unicare Health Plan 006019

Medicaid NJ Healthfirst ABD 006187 Medicaid PA - Amerihealth Mercy 006082

Medicaid NJ Healthfirst DDD 006186 Medicaid PA - Health Partners Philadelph 006056

Medicaid NJ Healthfirst DDD - copay 006190 Medicaid PA - ION 006057

Medicaid NJ Healthfirst DYFS 006188 Medicaid PA - Keystone Mercy 006085

Medicaid NJ Healthfirst FamCare A 006181 Medicaid PA - Three Rivers Health Plans 041002

Medicaid NJ Healthfirst FamCare B 006182 Medicaid PA - UPMC Health Plan - Dental 059004

Medicaid NJ Healthfirst FamCare C 006184 Medicaid PA -KidzPartners -PA CHIP 006208

Medicaid NJ Healthfirst FamCare C-Copay 006183 Medicaid SD 033002

Medicaid NJ Healthfirst FamCare D 006189 Medicaid TN - Doral Health Plan 006099

Medicaid NJ Healthfirst FamCare D-Copay 006185 Medicaid TN - TennCare 006027

Medicaid NM - Amerigroup 006098 Medicaid VA 006094

Medicaid NM - Loveless Community Health 006026 Medicaid VA - Doral Health Plan 006100

Medicaid NM - Molina HealthCare of NM 006037 Medicaid VA - Smiles for Children 006088

Medicaid NM - Presbyterian Salud 006025 Medicaid VA Mid - Atlantic Access/EPPO 006158

Medicaid NM BlueSalud Adult 006192 Medicaid VA Mid - Atlantic Choice 006152

Medicaid NM BlueSalud Child 006191 Medicaid VA Mid - Atlantic DHMO 006155

Medicaid NV AmerigroupCommunityCare ADLT 006177 Medicaid Wellcare of Ohio, Inc - Adults 006207

Medicaid NV AmerigroupCommunityCareChild 006176 Medicaid Wellcare of Ohio, Inc-Children 006206

Medicaid NVAmerigroupCommunityCarePregnt 006179 Medicaid WI - Doral Health Plan 006064


Page 4


Payer Name

NEA

Payer ID Payer Name

NEA

Payer IDMedicaid WI - UHC of WI 006065 SIDS 089003

Medicaid WI BadgerCare 006216 Solstice Benefits, Inc 096001

Medicaid Wisconsin (2001) 006217 Southwest Benefit Administrators 086003

MetLife 012001 Southwestern Bell 037015

MN Power 100006 Standard Insurance 001004

Molina HealthCare of Florida 006103 Standard Insurance Company of New York 001012

Molina HealthCare of Ohio 006079 State of Texas Dental Plan (GEHA) 056002

Motorola 008017 Sun Life Financial Employee Benefits Group 054005

Mountain States (BC of WV) 022012 Superior Dental Care 015001

Mutual of Omaha 090002 Texas Dental Plan 017013

National Dental Plans, Inc. 017022 The Dental Companies (TDC, Inc.) 008005

National Rual Letter Carriers Assoc 001015 The Dental Concern (TDC, Ltd.) 008006

Nippon Life Insurance of America 040005 The Dental Network (TDN) 095003

ODS Community Health 030006 The ODS Companies 030005

ODS Health Plan 030002 Three Rivers Health Plans 041001

OHS of Georgia, Inc. 017024 Time Insurance 009003

Oral Health Services (OHS) 017003 TPA Benefits, INC 077001

Oral Health Services of Alabama, Inc. 017011 Transamerica Life (NM) 090001

Oregon Dental Service - ODS 030001 Travelers 012002

Oxford Health Plans 005007 Tricare Active Reservists (UCCI) 022009

Pacific Source 031001 Tricare Dental (UCCI) 022001

Pacific Union 005008 Tricare Family Member Dental Plan - TFMDP 022013

Paul Revere / Provident 001008 Tricare Retiree Dental Program 039002

Pennsylvania Blue Shield 022003 TRW 037017

Pennsylvania Blue Shield Dental Plus 022015 TSRDP Dental Claim 008013

Phoenix American 054004 UFT Welfare Fund 002016

Phoenix Home Life 054003 Unicare Health Insurance Co of the Midwest 026039

Physicians Mutual 001011 Unicare Health Insurance Company of the 026003

PMI Dental Health Plan -DeltaCare Claims 053001 Unicare Life and Health 026002

Preferred Dental Organization (PDO) 037013 UNICARE of Texas - HMO 026013

Premera Blue Cross (WA/AK) 016001 Unicare Special Accounts 026009

Premier Access Insurance Company 050001 Uniform Dental Service 048003

Premier Dental Group 084001 UniLife Insurance Company 017021

Primary Delivery Systems 008007 Union Security Insurance Company 009011

Prime Care Wisconsin 006095 Unison Health Plan 041003

Principal Financial Group 040004 Unistar 026007

Principal Life Insurance 040001 United Concordia 022002

Protective Life 009004 United HealthCare 005002

Prudential 037002 United of Omaha 090003

Quality Plan Administrators, Inc 093001 United Parcel Service 037006

Randmark 008004 VA Project Hero 094001

RE Harrington Benefit Services 010004 Varian Health Care Plan 037016

Reliance Standard 001003 Vencor/Kindred Healthcare 008008

ReliaStar 026004 Vistica Administrators 006035

Renaissance Life & Health Ins 028004 Washington Dental Service 048001

SelectCare (Coca Cola) 037014 WASHINGTON DEPARTMENT SOC. HEALTH SERV.068001

Self Insured Dental Services 089004 WellPoint Dental Services 026012


Page 5


Payer Name

NEA

Payer ID Payer Name

NEA

Payer IDSerentas Dental Solutions 004002 WellPoint Health Networks 026001

Xantus Health Plan 006034


Page 6

Documents

Electronic Attachment Dental Payer List NEA Payer Namepatterson.eaglesoft.net/pdfs/Electronic Attachment Dental Payer... · Electronic Attachment Dental Payer List March 2010 Payer