Payer Lists of Professional Claims

PAYER LISTINGS: Professional ClaimsPayer Name Payer ID State Reports Secondary Enrollment Submission

Type

1199 SEIU National Benefit Fund 13162 ALL Y Y No 5010A1

21st Century Insurance andFinancial Services 51028 MN Y Y No 5010A1

360 Alliance PPO Gilsbar 07205 ALL Y N No 5010A1

3P ADMIN 20413 ALL Y Y No 5010A1

8th Distric Electrical 74234 UT N N No 5010A1

A & I Benefit Plan Administrators 93044 ALL N Y No 5010A1

AARP Hospital Indemnity Plansinsured by UnitedHealthcareInsurance Company

36273 ALL Y Y No 5010A1

AARP Medicare Supplement Plansinsured by UnitedHealthcareInsurance Company

36273 ALL Y Y No 5010A1

AARP Medicare Supplement/FixedIndemity by UnitedHealthcare(UnitedHealthcare)

36273 ALL Y Y No 5010A1

AARP MedicareComplete (AARPMedicareComplete fromSecureHorizons)

87726 ALL Y Y No 5010A1

AARP MedicareComplete insuredthrough UnitedHealthcare 87726 ALL Y Y No 5010A1

ABMG A0701 CA Y N No DUAL

Abrazo Advantage Health Plan 03443 ALL Y Y No 5010A1

Abri Healthplan ABRI1 ALL N N No 5010A1

Access Administrators AHS01 ALL N N No 5010A1

Access Behavioral Care COACC CO S Y No 5010A1

Access Medical Group AMG01 All Y N No 4010A1

ACCLAIM 64071 All N Y No 5010A1

Acclaim IPA MHIPA CA N Y No 4010A1

Acclaim IPA (MHCAC) MHIPA CA N Y No 4010A1

Acordia National (Now known asWells Fargo TPA) 87815 ALL Y Y No DUAL

Acordia National (Now known asWells Fargo TPA) 87815 ALL Y Y No DUAL

ACS Benefit Services, inc. 72467 ALL Y Y No 5010A1

Activa Benefits Services, LLC(Formerly Amway Corporation) 38254 ALL Y N No 5010A1

Administrative Services, Inc. 59141 ALL Y Y No 5010A1

Adminone 37278 ALL N N No 5010A1

Adminstrative Concepts, Inc. 22384 ALL N Y No 5010A1

Advanced Data Solutions 58202 ALL Y Y No 5010A1

Advanced Medical Management AMM01 ALL A N No 5010A1

Advanstaff, Inc. 74234 ALL N N No 5010A1

Advantage Care IPA ACIPA CA N Y No 4010A1

Advantage Health Solutions, Inc. 35209 ALL N N No 5010A1

Advantage Preferred Plus 77070 ALL Y Y No 5010A1

Advantek Benefit Administrators 83077 ALL N N No 5010A1

Advantica Benefits 59374 ALL A Y No 5010A1

Adventist Health System 95340 ALL Y Y No 5010A1

Advocate Health Centers (AHC) 36320 ALL Y N No 5010A1

Advocate Physicians Partners (PHO) 65093 ALL Y N No 5010A1

Aetna Affordable Health Choices(SM) - SRC 57604 ALL Y Y No 5010A1

Aetna ASA PPO/Assurant Health(Signature Admin) 58730 ALL Y N No 5010A1

Aetna Better Health - PA Medicaid 23228 PA Y Y No 5010A1

Aetna Better Health Medicaid IL 26337 IL N Y No 5010A1

Aetna Health Plan - PPO 60054 All Y Y No 5010A1

Aetna Life & Casualty Company 60054 All Y Y No 5010A1




Aetna TX Medicaid & CHIP 38692 TX Y Y No 5010A1

Affiliated Doctors of Orange County ADOCS CA Y Y No 4010A1

Affinity Health Plans (ContactAffinity EDI Coordinator beforesubmitting claims electronically at E

13334 ALL Y Y No 5010A1

Affinity Health Plans (TMG Health)(Effective for Medicare claims withDOS on or after 01/01/2010)

13333 ALL Y Y No 5010A1

AFFINITY MEDICAL GROUP 46594 ALL N N No 4010A1

Affordable Benefit Administrators,Inc. (Claims with the followingaddress should only be sent to th

95426 ALL N N No 5010A1

AFL - CIO Food & Beverage DealersTrust Fund (Toledo, OH) 34444 OH Y Y No 5010A1

AFTRA Health Fund 13346 ALL Y Y No 5010A1

AGIA Inc (Claims are printed andmailed to the payer.) 95241 ALL N Y No PRINT

AH & L 80705 ALL N N No 5010A1

AHPO (Cleveland, OH) 31138 OH Y Y No 5010A1

AKM Medical Group IP080 CA N Y No DUAL

Alameda Alliance for Health(Provider must contact payer to beapproved. Contact at Alameda isAnet

95327 ALL Y N No 5010A1

Alaska Childrens Services, Inc 91136 AK Y Y No 5010A1

Alaska Electrical Health & WelfareFund 92600 ALL N Y No 5010A1

Alaska Laborers ConstructionIndustry Trust 91136 AK Y N No 5010A1

Alaska Pipe Trades Local 375 91136 AK Y N No 5010A1

Alaska United Food & CommercialWorkers Health & Welfare Trust 91136 AK Y N No 5010A1

All Savers Insurance(UnitedHealthOne) 81400 ALL Y N No 5010A1

AllCare (Must contact Kathy atAllcare, 209-550-5222 for setup andpayerID.)

CALL ALL N N No 5010A1

Allegiance Benefit PlanManagement, Inc. 81040 ALL Y Y No DUAL

Alliance PPO Inc.(Now known asOneNet PPO, LLC.) 52149 ALL Y N No 5010A1

Alliance, The (Only for ID Cardsshowing PO Box 44365 Madison WI53744 as mailing address. Call 608-

CALL ALL Y Y No 5010A1

Alliant Health Plans of Georgia 58234 GA Y N No 5010A1

Allied Administrators 94177 ALL N N No 5010A1

Allied Benefit Systems 37308 ALL Y Y No 5010A1

AlohaCare ALOHA HI N N Yes DUAL

Alpha Care Medical Group ACMG1 CA N N No 5010A1

ALPS CompCare (OH BWC) 10050 OH N N No 5010A1

Alta Bates Medical Group A0701 CA Y N No DUAL

ALTA Health and Life InsuranceCompany 80705 ALL N N No 5010A1

AM-First Insurance Morgan White 01757 ALL N Y No 5010A1

AMA Insurance Agency, INC AMAIA ALL N N No 5010A1

Amalgamated Life - PA/Alicare 13343 ALL Y Y No 5010A1

Amalgamated Life Insurance Co. 13550 All Y Y No 5010A1

Amalgamated Transit UnionDivision 1001 Health & WelfareFund

COMPU CO N N No 5010A1

AmeraPlan (Claims are printed andmailed to the payer.) 38219 ALL Y Y No 5010A1

Ameriben Solutions 75137 ALL Y N No 5010A1

America 1st Choice Plans of NorthCarolina 26078 NC N N No 5010A1

America’s Choice NMA 20029 ALL Y Y No 5010A1

America’s Health Choice 21810 ALL Y N No DUAL

America’s PPO (Formerly known asARAZ.) 16120 ALL Y Y No 5010A1

America’s PPO / America’s TPA 16120 ALL Y Y No 5010A1

Americaid Community Care(Dallas/Ft Worth) 27514 TX Y Y No DUAL

Americaid Community Care(Houston) 27515 TX Y Y No DUAL

Americaid Community Care(Maryland) 27517 MD Y Y No DUAL

Americaid Community Care (NewJersey) 27516 NJ Y Y No DUAL

American Administrative Group(formerly Gallagher Benefit) 37283 ALL A N No 5010A1

American Administrative Group -AAG (Formerly known as UICIAdministrators

75240 ALL Y N No 5010A1

American Behavior 63103 ALL N Y No 5010A1

American Behavioral FEP/ITS 63106 ALL N N No 5010A1

American Benefit PlanAdministrators 95170 ALL T Y No 5010A1

American Benefits Management 34187 ALL N N No 5010A1

American Benefits PlanAdministrators (Las Vegas, NV) 59140 NV A Y No DUAL

American Community MutualInsurance 60305 All N Y No 5010A1

American Family (administered byAmerican Republic) 56071 ALL N N No 5010A1

American Family Health Providers IP080 CA N Y No DUAL

American Family Insurance TH095 ALL Y N No 5010A1

American General 62030 ALL N Y No 5010A1

American Healthcare Alliance 01066 ALL N Y No 5010A1

American Heritage 77083 ALL Y N No DUAL

American Imaging Management,Inc. (Assigned Group Policy Plan IDrequired. To obtain, call AIM at 80

36369 All Y Y No 5010A1

American Insurance Company of TX 81949 ALL N N No 5010A1

American LIFECARE (Group Numberrequired. Valid only for claims witha billing address of 1100 Poydr

72099 ALL Y Y No DUAL

American Medical & Life 23212 ALL N Y No 5010A1

American Medical Security(UnitedHealthOne) 81400 ALL Y N No 5010A1

American National Insurance Co 74048 ALL Y N No 5010A1

American Postal Workers UnionHealth Plan 44444 All Y Y No DUAL

American Postal Workers UnionHealth Plan 44444 All Y Y No DUAL

American Republic InsuranceCompany 42011 ALL N N No 5010A1

American Sentinel InsuranceCompany 17965 ALL Y Y No 5010A1

American Specialty Health ASHP1 ALL Y N No 5010A1

American Therapy Administration ofFlorida aka ATA-FL (Only PT, OTand Speech Therapy claims for FL

65064 FL N Y No 5010A1

American Worker Health Plan 37322 ALL N Y No 5010A1

Americas 1st Choice Health Plans ofSouth Carolina 20553 ALL Y Y No 5010A1

AmeriChoice - CT, FL, MD, RI, TX,WI (UnitedHealthcare CommunityPlan)

87726 VARIOUS Y Y No 5010A1

AmeriChoice by UnitedHealthcare(NYU) (UnitedHealthcareCommunity Plan)

87726 ALL Y Y No 5010A1

AmeriChoice MS - CHIP & CAN(UnitedHealthcare Community Plan) 95378 MS Y Y No 5010A1

AmeriChoice NJ, Medicaid, NJ FamilyCare (UnitedHealthcare CommunityPlan)

86047 NJ Y Y No 5010A1

AmeriChoice NY Medicaid & ChildHealth Plus (UnitedHealthcareCommunity Plan)

86048 NY Y Y No 5010A1

AmeriChoice of Iowa(UnitedHealthcare Community Plan) 95375 IA Y Y No 5010A1

AmeriChoice of Nebraska(UnitedHealthcare Community Plan) 87726 NE Y Y No 5010A1

AmeriChoice of New Jersey PersonalCare Plus 86001 NJ Y Y No 5010A1

AmeriChoice of New York PersonalCare Plus 86002 NY Y Y No 5010A1

AmeriChoice of PA Children’sHealth Insurance Program(KidsChoice)

86049 PA Y Y No 5010A1

Americhoice Personal Care Plus PA(UnitedHealthcare Community Plan) 25175 ALL N Y No 5010A1

AmeriChoice TN: TennCare, SecurePlus Complete (UnitedHealthcareCommunity Plan)

95378 TN Y Y No 5010A1

Amerigroup - Illinois 28808 IL N Y No DUAL

Amerigroup - Maryland and Districtof Columbia 28807 MD,DC N N No DUAL

Amerigroup - New Jersey 28806 NJ N N No DUAL

Amerigroup / Americaid - Ft. Worth,New Mexico 28804 TX,NM Y Y No DUAL

Amerigroup / Americaid - Houston 28805 TX Y Y No DUAL

AMERIGROUP Georgia 27514 GA Y Y No DUAL

Amerigroup of Florida 28809 FL Y Y No DUAL

Amerigroup of Illinois 27518 IL Y Y No DUAL

Amerigroup of VA IHP02 VA Y N No 5010A1

AMERIGROUP Tennessee 27514 TN Y Y No DUAL

AmeriHealth - New Jersey (Non-HMO Claims) SX075 ALL Y Y Yes 5010A1

AmeriHealth Administrators 54763 ALL Y N No 5010A1

Amerihealth District of Columbia(This Payer ID is effective for DOSafter May 1, 2013.) (For EDI Su

77002 ALL Y N No 5010A1

AmeriHealth HMO New Jersey andDelaware 23037 NJ,DE Y Y No 5010A1

AmeriHealth Mercy Health Plan 22248 All Y Y No 5010A1

AmeriHealth NorthEast 77001 ALL Y Y No 5010A1

Amerikids-Dallas/Ft. Worth 26375 TX Y N No DUAL

Amida Care (Formerly Vida Care.) 24818 ALL N Y No 5010A1

AMVI IP080 CA N Y No DUAL

Amway Corporation 38254 All Y N No 5010A1

Anaheim Memorial IPA (MHCAN) MHIPA CA N Y No 4010A1

Anchor Benefit Consulting 53085 ALL A N No 5010A1

Ancillary Benefits/ArizonaFoundation for Medical Care AZFMC ALL Y Y No 5010A1

Anerican Founders Life Ins Co (NFLPlans only) 98205 ALL N N No 5010A1

Antares Management Solutions 34192 ALL R Y No 5010A1

Anthem Blue Cross of California BC001 CA Y Y No 5010A1

Anthem Health and Life InsuranceCompany of New Jersey 80705 NJ N N No 5010A1

Anthem of Colorado COBLS CO Y Y No 5010A1

Anthem of Nevada NVBLS NV N Y Yes 5010A1

Apex Benefit Services (Claims mustcontain the rendering provider ID orthe claim will reject.)

34196 ALL N Y No 5010A1

APS Healthcare Inc. 54160 ALL N Y No 5010A1

ARAZ (Now known as America’sPPO.) 16120 ALL Y Y No 5010A1

Arbor Health 52312 ALL N N No 5010A1

Arcadian Management Services, Inc(Group number should be entered ifavailable. )

77045 All Y Y No DUAL

Arizona Foundation for Medical Care AZFMC AZ Y Y No 5010A1

Arizona Medicaid (AHCCCS) AZMCD AZ Y Y Yes 5010A1

Arizona Physicians IPA (APIPA)(UnitedHealthcare ArizonaPhysicians IPA)

03432 AZ Y N No 5010A1

Arizona Pipe Trades Health andWelfare Trust Fund Local Union Nos.469 & 741 Metal Trades Health Pla

74234 AZ N N No 5010A1

Arizona Pipe Trades Health andWelfare Trust Fund Local Union Nos.469 & 741 Pipe Trades Health Plan

74234 AZ N N No 5010A1

Arizona Priority Care Plus 27154 ALL N N No 5010A1

Arkansas Best Corporation 75278 ALL Y Y No 5010A1

Arkansas Managed CareOrganization (AMCO) 62176 AR Y Y No 5010A1

Arnett Health Plan - former payer id95440 87726 ALL Y Y No 5010A1

ASR Corporation 38265 ALL Y Y No 5010A1

ASRM Corporation ASRM1 ALL Y N No 5010A1

Associated Benefits Corp. FAABC ALL Y Y No DUAL

Associated Third PartyAdministration (ATPA) ATPA1 ALL N Y No 4010A1

Associates for Healthcare 36326 ALL Y Y No 5010A1

Assurant Employee Benefits(Formerly Fortis Insurance) 39065 All N N No 5010A1

Assurant Health Re-Pricing viaHealthSpan ASNTH ALL N N No DUAL

Assurant Health Self Fund (Verifythat claims should go to Ft. Mill, SC) 37313 ALL Y Y No 5010A1

AssureCare, Inc. 88035 ALL T Y No 5010A1

Assured Benefits Administrators 74240 ALL Y Y No 5010A1

Asuris Northwest/MedAdvantage(REF*1B*Provider ID in Billing andRendering required even when NPIis

SX179 ALL Y Y No 5010A1

Asuris NW Health 93221 ALL Y Y No 5010A1

Athens Health Plan 95691 ALL Y Y No DUAL

Atlantic Medical 22285 ALL N N No 5010A1

Atlanticare Administrators, Inc 22304 ALL Y Y No 5010A1

Atlantis Health Plan 13853 ALL Y Y No 5010A1

Atlas Life Ins Co (NFIC Plan only) 90956 ALL N N No 5010A1

Aultcare MNAUL OH N N Yes DUAL

AultComp MCO (OH BWC) 10016 OH N N No 5010A1

Automated Benefit Services (ABS) 38259 ALL Y N No 5010A1

Automated Group Administration,Inc. 37280 ALL N Y No 5010A1

Automotive Machinists Local 289Health & Welfare Trust - Grp#F32 91136 ALL Y N No 5010A1

Avalon IPA IP080 CA N Y No DUAL

Avera Health Plans 46045 ALL Y Y No 5010A1

Averde Health 26355 ALL Y Y No 5010A1

Avesis Third Part Administrators 87098 ALL Y Y No 5010A1

AVMED 59274 FL Y Y No 5010A1

AVMED-Parity Healthcare (OB/GYNonly) 58204 FL Y Y No 5010A1

Axminister Medical Group AXM01 ALL N Y No 5010A1

AZ Integrated Physicians NCHON ALL N N No 5010A1

Bakersfield Family Medical Center BKRFM ALL N Y No 4010A1

Banner Health Co. (All BannerHealth Plans were consolidated tothe payerID of SX145.)

SX145 ALL N Y Yes 5010A1

Banner Medisun 77078 ALL N Y No 5010A1

Bass Administrators, Inc. 37248 ALL Y N No 5010A1

BCBS BlueCare Family Plan(Connecticut) To be used on all CTBlueCare claims with dates ofservice

C3BLS CT Y N Yes 5010A1

BCI Administrators, Inc 49153 ALL N Y No 5010A1

Beacon Health Strategies (Block 11on the HCFA 1500 form must usePlan specific IDs.)

43324 ALL Y Y No 5010A1

Beech Street Corp. (Payer requires

that payer and employerinformation in box11 be attached.)


Behavioral Healthcare, Inc. BHI00 CO Y Y No 5010A1

Bell Atlantic (Prudential) 68241 All Y N No 5010A1

Bella Vista Med Grp IPA MPM10 CA N N No DUAL

Benefit & Risk ManagementServices (Commercial Medicareunder Med3000)

99320 ALL N N No 5010A1

Benefit Administrative Systems 36149 ALL Y Y No 5010A1

Benefit Concepts 51037 ALL Y N No 5010A1

Benefit Coordinators Corporation 25145 ALL N N No 5010A1

Benefit Management Services(Please contact Chris Burak at 704-321-3156 for payerID information.)

CALL ALL N Y No 4010A1

Benefit Management Services, Incof Lousiana 00999 LA Y Y Yes 4010A1

Benefit Management Systems, Incof Mississippi 37212 MS Y Y No 5010A1

Benefit Management, Inc. of KS(Only accepts claims for thesegroupsBMI187,BMI219,BMI234,BMI236,BMI

48611 ALL N N No 5010A1

Benefit Plan Administrators Co.(Payer ID valid only for claims witha billing submission address of

39081 WI Y N No 5010A1

Benefit Plan Administrators, INC 37286 ALL N N No 5010A1

Benefit Plan Administrators, Inc (ForDOS prior to 10-1-12. Use 57080 forDOS after 10-1-12)

37118 ALL Y N No 5010A1

Benefit Services, Inc. (Akron, OH)(Payer name is now AntaresManagement Solutions)

34192 ALL R Y No 5010A1

Benefit Systems and Services, Inc. 36342 All Y Y No 5010A1

Benefit Trust Life InsuranceCompany 61425 All Y N No 5010A1

Benesight (formerly The TPA) 87265 ALL Y N No 5010A1

Benesys - LHP Claims Unit 37248 ALL Y N No 5010A1

Benesys Inc. (Located in Lafayette,LA) 37248 ALL Y N No 5010A1

BeneSys, Inc. (Located in Troy, MI)(Now known as Sheet MetalWorkers Local 104)

38238 ALL N N No 5010A1

Benmark BNMK1 ALL N N No 5010A1

Berkshire Health Partners 23243 ALL N Y No 5010A1

Best Life & Health Insurance Co. 95604 ALL N Y No 5010A1

Better Health Plan of Florida (Forclaims rejections, contact payer at800-514-4561 and select provi

20488 ALL N Y No 5010A1

BHP-Unity 44219 ALL R Y No 5010A1

Big Lots Associates Benefit Plans CX025 ALL N N No 5010A1

Block Vision of Texas BVTX1 TX Y Y No 5010A1

Block Vision, Inc. BV001 ALL Y Y No 5010A1

Blue Advantage of Arkansas ARBLS AR Y Y Yes 5010A1

Blue Bell Benefits Trunt ECIBB ALL N N No 5010A1

Blue Care PPO VABLS VA Y Y Yes 5010A1

Blue Chip of Rhode Island RICHP RI Y Y Yes 5010A1

Blue Choice Medicaid 00403 SC Y Y No DUAL

Blue Choice of Rochester NY N6BLS NY N Y Yes 5010A1

Blue Choice of South Carolina 00922 SC N N No 4010A1

Blue Cross Blue Shield of Arizona 53589 AZ Y Y No 5010A1

Blue Cross Blue Shield of Florida FLBLS FL Y Y Yes 5010A1

Blue Cross of California BC001 CA Y Y No 5010A1

Blue Cross of Idaho IDBLC ID Y N Yes 5010A1

Blue Grass Family Health (SRRIPA) 15754 ALL N Y No 5010A1

Blue Lake Rancheria IP061 CA N Y No DUAL

Blue Shield of Alabama ALBLS AL Y Y Yes 5010A1

Blue Shield of Alaska AKBLS AK N Y Yes 5010A1

Blue Shield of Arizona AZBLS AZ Y Y No 5010A1

Blue Shield of Arkansas ARBLS AR Y Y Yes 5010A1

Blue Shield of California 47198 CA Y Y Yes 5010A1

Blue Shield of Central NY HMO/PPO N2BLS NY Y Y Yes 5010A1

Blue Shield of Colorado 00050 CO Y Y No 5010A1

Blue Shield of Connecticut (NOTE:The DOS in Reports is 00060 CT Y Y Yes 5010A1

programmatically calculated and isnot actu

00060 CT Y Y Yes 5010A1

Blue Shield of Delaware DEBLS DE Y Y Yes 5010A1

Blue Shield of Georgia (State Healthof GA) 00601 GA Y Y Yes 5010A1

Blue Shield of Hawaii HIBLS HI N Y Yes 5010A1

Blue Shield of Idaho (Per ProviderTesting) IDBLS ID Y N Yes 5010A1

Blue Shield of Illinois ILBLS IL Y Y Yes 5010A1

Blue Shield of Indiana 00630 IN Y Y Yes 5010A1

Blue Shield of Iowa IABLS IA N Y Yes 5010A1

Blue Shield of Iowa (For Secondaryclaims only where Medicare isprimary)

IABLM IA N Y Yes 5010A1

Blue Shield of Kansas KSBLS KS Y N Yes 5010A1

Blue Shield of Kansas City KCBLS KS,MS Y N Yes 5010A1

Blue Shield of Kentucky 00660 KY Y Y Yes 5010A1

Blue Shield of Louisiana LABLS LA N Y Yes 5010A1

Blue Shield of Maine 00680 ME Y Y No 5010A1

Blue Shield of Maryland MDBLS MD Y Y Yes DUAL

Blue Shield of Massachusetts MABLS MA Y Y Yes 5010A1

Blue Shield of Michigan MIBLS MI Y Y Yes 5010A1

Blue Shield of Minnesota 00720 MN N Y Yes 5010A1

Blue Shield of Mississippi MSBLS MS Y Y Yes 5010A1

Blue Shield of Missouri 00241 MO Y Y Yes 5010A1

Blue Shield of Montana BCBS MT Y Y Yes 5010A1

Blue Shield of National Capital Area NCABS DC VA MD Y N Yes 5010A1

Blue Shield of Nebraska NEBLS NE Y Y Yes 5010A1

Blue Shield of Nevada 00265 NV Y Y Yes 5010A1

Blue Shield of New Hampshire 00770 NH Y Y Yes 5010A1

Blue Shield of New Jersey 22099 NJ Y Y Yes 5010A1

Blue Shield of New Mexico NMBLS NM Y Y Yes 5010A1

Blue Shield of New York (Empire) 00303 NY N Y No 5010A1

Blue Shield of North Carolina NCBLS NC Y Y Yes 5010A1

Blue Shield of North Dakota NDBLS ND N Y Yes 5010A1

Blue Shield of Northeast NY N5BLS NY Y Y Yes 5010A1

Blue Shield of Ohio 00834 OH Y Y No 5010A1

Blue Shield of Oklahoma OKBLS OK Y Y Yes 5010A1

Blue Shield of Oregon ORBLS OR Y Y Yes 5010A1

Blue Shield of Pennsylvania PABLS PA Y Y Yes 5010A1

Blue Shield of Rhode Island RIBLS RI Y Y Yes 5010A1

Blue Shield of Rochester NY N7BLS NY N Y Yes 5010A1

Blue Shield of South Carolina SCBLS SC Y Y Yes 5010A1

Blue Shield of South Dakota SDBLS SD N N Yes 5010A1

Blue Shield of Tennessee TNBLS TN Y Y Yes 5010A1

Blue Shield of Texas TXBLS TX Y Y Yes 5010A1

Blue Shield of Utah UTBLS UT Y Y Yes 5010A1

Blue Shield of Utica NY N4BLS NY Y Y Yes 5010A1

Blue Shield of Vermont VTBLS VT N N Yes 5010A1

Blue Shield of Virginia 058916206CMSCOS VA Y Y Yes 5010A1

Blue Shield of West Virginia WVBLS WV Y Y Yes 5010A1

Blue Shield of Western New York N1BLS NY Y Y Yes 5010A1

Blue Shield of Wisconsin 00950 WI N Y Yes 5010A1

Blue Shield of Wyoming WYBLS WY Y Y Yes 5010A1

Bluebonnet Administrators 37121 LA N Y No 5010A1

Bluegrass Family Health 61124 ALL Y N No 5010A1

Boilermakers national Health &Welfare Fund 36609 ALL Y Y No 5010A1

Bollinger, INC. BOLL1 ALL N Y No 5010A1

Boon-Chapman BenefitAdministrators, Inc. 74238 ALL Y N No 5010A1

Boston Medical Center Healthnet 13337 MA N Y No DUAL

BPS Inc 48964 ALL Y Y No 5010A1

Bravo Health (Formerly known asElder Health Inc. Serving membersin PA, MD, DE, TX and Washington 52192 ALL Y Y No 5010A1

D

Bridgestone/Firestone (Please callBridgestone Customer ServiceCenter at 330-379-4500 beforesendin

88033 ALL N Y No 5010A1

Bridgeway Arizona 68069 AZ Y Y No 5010A1

Brockerage Concepts, Inc (BenefitConcepts) 51037 ALL Y N No 5010A1

Brown & Brown Benefits 59069 All Y N No 5010A1

Brown & Toland Medical Group 94316 ALL Y Y No DUAL

Brown & Toland Sutter BTSS1 ALL N N No DUAL

Brown & Toland SutterSelect BTSS1 ALL Y Y No DUAL

Buckeye Community Health 68069 IA N Y No DUAL

Butler Benefits 42150 ALL Y N No 5010A1

C & O Employees HospitalAssociation 23708 ALL Y Y No 5010A1

Cal-Optima Direct CALOP ALL Y Y No 5010A1

California Anthem Blue Cross BC001 CA Y Y No 5010A1

California Blue Cross BC001 CA Y Y No 5010A1

Cameron and Associates CAMAA ALL N N No 4010A1

Cannon Cochran ManagementServices, Inc. LA (Claims for Payeraddress of Metairie, LA only.)

71057 LA N N No 5010A1

CAP Management 95399 ALL N Y No 5010A1

Cap Management Systems IP080 CA N Y No DUAL

Capital Advantage InsuranceCompany (CAIC) PROFESSIONAL(BCBS ProviderID and PerformingProviderID r

23045 PA Y Y No 5010A1

Capital Blue Cross PROFESSIONAL(BCBS ProviderID and PerformingProviderID required. Call 800-874-84

23045 PA Y Y Yes 5010A1

Capital District PHP SX065 ALL A Y Yes DUAL

Capital Health Plan 95112 All Y Y No DUAL

Capital International ManagementServices 65067 ALL Y Y No 5010A1

Capitol Administrators 68011 ALL Y Y No 5010A1

CapRock HealthPlans CAPHP ALL N Y No 5010A1

CapRock HealthPlans CAPHP ALL N Y No 5010A1

Care 1st Health Plan of Arizona 57116 AZ Y Y No 5010A1

Care 1st Health Plan of CA 57115 CA N N No 5010A1

Care Choices HMO HM037 ALL N Y No 5010A1

Care Core National 14182 ALL Y Y No DUAL

Care Improvement Plus 77082 ALL N N No 5010A1

Care Partners 43172 All Y Y No 5010A1

Care Plus 65031 ALL A N No 5010A1

Care Wisconsin Health Plan(Trizetto) 27004 ALL N Y No 5010A1

CareCentrix 11345 ALL Y Y Yes 5010A1

Carechoices Michigan - MercyHealthplans (Enrollment required

please contactNoreen at (248)489-5281.)

38269 MI Y Y No

CareCore - Healthnet 14184 ALL Y Y No DUAL

Carecore National Wellcare 14188 ALL N N No DUAL

CareCore National, LLC (AetnaRadiology Claims) 14179 ALL N N No DUAL

CareCore National, LLC (Radiologycharges for Oxford) (Provider mustcall Anthony Sampson at 845-298


CareCore National, LLC - Health NetNew Jersey 14185 ALL N Y No DUAL

CareFirst BCBS - DC, NationalCapital Area SB580 MD,DC Y N Yes 5010A1

Carelink Medicaid 25140 ALL Y Y No 5010A1

Caremore CM001 ALL Y N No 5010A1

Caremore IPA CARMO ALL N N No 4010A1

CareMore Value Plus (CVP) CARMO ALL N N No 4010A1

Carenet of Virginia (Prepare to useconsolidated Coventry payerID of25133.)

25142 VA Y Y No 5010A1

CareOregon, Inc. 93975 OR A Y No 5010A1

CarePlus Cardiology - New CenturyHealth NCH04 ALL N Y No 5010A1

CarePlus Health Plans 95092 ALL Y N No 5010A1

Carepoint Health Plan 77023 ALL Y N No 5010A1

CareSource 31114 ALL Y Y No 5010A1

Caresource Health Plan of Oregon MRCHP ALL N N No 5010A1

CareSource KY KYCS1 ALL Y Y No 5010A1

Careworks 10010 ALL N Y No 5010A1

Careworks (OH BWC) CAREW OH N N No 5010A1

Careworks of Ohio (OH BWC) CAREW OH N N No 5010A1

Carilion Clinic Medicare Health Plan 77015 ALL N N No 5010A1

Cariten Commercial 62073 ALL N Y No 5010A1

Cariten Senior Health 62072 ALL N Y No 5010A1

Carolina Care Plan (Part of theMedical Mutual Family ofcompanies. Former payerID was57105.)

29076 SC Y Y No 5010A1

Carolina Crescent 68069 ALL N Y No 5010A1

Carolina Summit Healthcare, Inc 56195 ALL Y Y No 5010A1

Carpenters Health and WelfareFund of Philadelphia CX101 ALL N N No 5010A1

Carpenters’ and Millwrights’ HealthBenefit Trust Fund COMPU CO N N No 5010A1

Carpet, Linoleum and Resilient TileLayers Health and Welfare Fund COMPU CO N N No 5010A1

Cascade East Health Plan CAS01 OR N Y No DUAL

Cascade Health Partners 93102 All Y Y No 5010A1

CBA Blue 03036 ALL Y N No 5010A1

CBA, Inc. (Cooperative BenefitsAdministrators, Inc.) 52132 All Y Y No 5010A1

CBCA (Formerly know as HealthRisk Management) 41170 All Y Y No 5010A1

CBCA Administrators of Ft. Worth,TX 55438 ALL Y Y No 5010A1

CBHA Carolina Behavioral HealthAlliance 56215 ALL Y Y No 5010A1

CBNHP Health Choices 65391 ALL Y N No 5010A1

CBSA (Corporation Benefit Servicesof America) 41124 ALL Y N No 5010A1

CCMC - Comprehensive CareManagement Corp CCMC1 NY Y N No 5010A1

CCS (aka Comprehensive CareSystems) MNBLS MN Y Y Yes 5010A1

CDO Technologies 87065 WY,UT Y N No 5010A1

CDS Group Health 88022 ALL Y Y No 5010A1

Cedars-Sinai Medical NetworkServices Claims 95166 ALL Y Y No DUAL

Cedars-Sinai Medical NetworkServices Encounters 95167 ALL Y Y No DUAL

Celtic Insurance CELTC ALL N Y No 5010A1

CeltiCare 68069 ALL N Y No 5010A1

Cement Masons & Plasterers Health& Welfare Trust - Grp#F16 91136 ALL Y N No 5010A1

CenCal Health 95386 CA N N No 5010A1

Cenpatico (For multiple states) 68068 ALL N Y No 5010A1

Cenpatico - Georgia 68069 GA Y Y No 5010A1

Cenpatico - Kansas (Prior tosubmitting claims please callProvider Relations Dept at 866-896-7293 t

68068 ALL Y Y No 5010A1

Cenpatico Behavioral Health -Wisconsin (Call 800-225-2573 ext25525 prior to submitting claims.)

68068 ALL N Y No 5010A1

Cenpatico Behavioral Health AZ(Prior to submission, contact 866-495-6748 to verify provider ID.)

68068 AZ Y Y No 5010A1

Cenpatico Florida Behavioral Health 68068 FL Y N No 5010A1

Cenpatico Indiana 68068 ALL Y Y No 5010A1

Cenpatico Massachusetts 68068 MA N Y No 5010A1

Cenpatico Ohio 68068 OH Y Y No 5010A1

Centene Advantage Plans 68069 ALL Y Y No 5010A1

CenterCare 13357 ALL Y Y No DUAL

CenterLight Healthcare 13360 ALL N Y No 5010A1

CenterPoint Human Services 56122 ALL Y Y No 5010A1

Centinela IPA IP080 CA N Y No DUAL

Central & Southwest Services 75177 All Y Y No 5010A1

Central Benefit National 31118 All Y Y No 5010A1

Central Benefits Life aka 31118 ALL Y Y No 5010A1

HealthScope Benefits 31118 ALL Y Y No 5010A1

Central Benefits Mutual 31118 ALL Y Y No 5010A1

Central California Alliance (Call theEDI Support Unit at 800-700-3874x5510 to obtain payerID.)

CALL CA Y Y No 4010A1

Central California ElectricialWorkers Health and Welfare Trust NWADM CA N Y No 5010A1

Central Health Medicare CHCPI ALL N Y No 5010A1

Central Reserve Life 34097 All Y N No 5010A1

Central States Southeast andSouthwest Areas Health andWelfare and Pensions Funds

36215 All Y Y No 5010A1

Century Health Solutions 48120 ALL N Y No 5010A1

CHA - Commonwealth HealthAlliance 23171 ALL Y Y No 5010A1

CHAMPVA-HAC (CHAMPVA-HAC isnot associated with and does notprocess claims for TRICARE(formerly CH

84146 ALL N Y No 5010A1

Chartered Health Plan. (Pleasecontact Payer at 202-408-2237 tojoin Chartered Health Plan’s EDI net

95748 ALL N N No 5010A1

Chatwins Healthcare Administrators CHAT1 ALL Y N No 5010A1

Chautauqua County Health Plan(Mayville,NY) 16600 NY Y N No 5010A1

Chesapeake Life Insurance Co.(PayerID valid for PO BOX 982017,North Richland Hills.)

59223 ALL N Y No 5010A1

Children First Medical Group (Forquestions regarding claim status,providers will need to contact p

94321 ALL N N No 5010A1

Children’s Community Health Plan 39113 ALL Y Y No 5010A1

Chinese Community Health Plan(Unique Provider ID must be onclaim.)


Chiropractic Association of SouthDakota CASD1 SD R Y No 5010A1

Chiropractic Care of Minnesota, Inc.(For Dates of service before 1-01-08, continue to use payerID o

LNDMK MN Y Y No 5010A1

CHOC - Childrens Hospital ofOrange County Health Alliance 33065 CA Y Y No 5010A1

Choice One/UTMB CHIP Health Plan(Call 281-652-8700 prior to 76049 ALL N Y No 5010A1

submitting claims.)

Choice Plus (TRW) 68241 All Y N No 5010A1

CHP Direct SuperMed 90441 ALL Y Y No 5010A1

CHP/DMBA (Enrollment required,please contact Provider Relations801-352-7270)(NOTE that this payer

UH133 UT N Y No 5010A1

CHP/EMIA (Enrollment required,please contact Provider Relations801-352-7270)(NOTE that this payer


CHP/MEDICAID (Enrollmentrequired, please contact ProviderRelations 801-352-7270)(NOTE thatthis pa


CHP/RPU (FABOH) (Facility physicaladdress required on claim.) 39112 ALL Y Y No 5010A1

CHP/UUHP (Enrollment required,please contact Provider Relations801-352-7270)(NOTE that this payer


CHP/WISE (Enrollment required,please contact Provider Relations801-352-7270)(NOTE that this payer


Christian Brothers Services 38308 ALL N N No 5010A1

Christus Spohn Health Network SPOHN ALL Y N No 5010A1

CIGNA - PPO 62308 All Y Y No 4010A1

CIGNA - PPO 62308 All Y Y No 4010A1

CIGNA Behavioral Health (We willalso accept PID SX071 for theseclaims: use of either ID accomplish

MCCBV All Y Y No 5010A1

CIGNA Health Plan - HMO 62308 All Y Y No 4010A1

CIGNA Healthcare for Seniors -Arizona Medicare 86033 AZ N Y No 5010A1

CIGNA Premier Plus 62308 ALL Y Y No 4010A1

Cimarron Salud (Receiver type ‘D’ -Claims are printed and mailed tothe Payer.)

PRINT NM N N No PRINT

Cinncinnati Financial Corporation 46871 ALL Y Y No 5010A1

Citrus Health Care 10207 ALL Y Y No 5010A1

City of Austin 74234 TX N N No 5010A1

CL Frates CLFR2 ALL Y N No 5010A1

ClaimsBridge HPN 11752 ALL N Y No 5010A1

ClaimsWare, Inc. DBA ManageMed 57080 ALL Y Y No 5010A1

Clarian Health Plans 95444 ALL N N No 5010A1

Clearchoice Health Plan / COIHS 77201 ALL Y Y No DUAL

Clinical Resource Group CRGMN ALL N N No 5010A1

CNIC Health Solutions, Inc. CHCNT All N N No 4010A1

Coastal Administrative Services 77052 ALL Y Y No 5010A1

Coastal Communities PhysicianNetwork (CCPN) CCPN1 CA N N No 4010A1

Cofinity (formerly Sloans Lake) SLOAN CO Y Y No 5010A1

Cofinity (formerly Sloans Lake) 38335 CO Y Y No 5010A1

Colonial Healthcare 37123 ALL A Y No 5010A1

Colonial Medical 22284 ALL N Y No 5010A1

Colorado Access HMO COACC CO S Y No 5010A1

Colorado Laborers Health andWelfare Fund COMPU CO N N No 5010A1

Columbia Cornell Care 25351 ALL Y Y No 5010A1

Columbia United Providers 91162 ALL N Y No 5010A1

Commerce Benefits Group 34181 ALL Y N No 5010A1

CommonWealth AdministrativeGroup 37237 ALL Y Y No 5010A1

Commonwealth Care Alliance 14315 ALL N Y No 5010A1

Community Care Associates 17902 MI N N No 5010A1

Community Care Behavioral HealthOrg. (For Dates of Service prior toOctober 1, 2007)

25179 All Y Y No 5010A1

Community Care BHO (For Dates ofService after October 1, 2007) 23282 ALL Y Y No DUAL

Community Care Managed HealthCare Plans of Oklahoma 73143 OK Y N No 5010A1

Community Care Organization 39126 ALL A Y No 5010A1

Community Care Plus (RequiresProvider ID in Box 33a. ContactCommunity Care for ID.)

00330 IL,MO N N No DUAL

Community Choice of Michigan 38325 MI N Y No 5010A1

Community Connect Medicaid 95192 ALL N N No 5010A1

Community First Health Plan, Inc. COMMF ALL Y N No 5010A1

Community Health Alliance 35193 ALL Y N No 5010A1

Community Health Center Network CHCN1 ALL N N No 5010A1

Community Health Choice (Pleaseinclude TPI Number (Texas MedicaidNumber) in Field FA0-23)

48145 ALL Y N No 5010A1

Community Health ElectronicClaims/CHEC/webTPA 75261 ALL N N No 5010A1

Community Health Network ofConnecticut (CHN of CT cannotaccept electronic claims forAnesthesia. C

62149 CT Y Y No DUAL

Community Health Plan ofWashington SB613 WA Y Y No DUAL

Community Health Solutions CLA11 LA Y N Yes 5010A1

Community Medical Group of theWest Valley CMGWV CA N Y No DUAL

CompBenefits Corporation 37297 ALL A N No 5010A1

Compensation Programs of Ohio,Inc. 34177 OH N N No 5010A1

CompFirst, LLC 23296 ALL Y Y No 5010A1

Complementary HealthCare Plans 93101 OR WA Y Y No 5010A1

CompManagement Health Systems,Inc. (OH BWC) 10005 OH N N No 5010A1

Comprehensive Behavioral Care 59314 ALL N Y No 5010A1

Comprehensive BenefitsAdministrator, Inc. (Now known asCBA Blue.)

03036 ALL Y N No 5010A1

ComPsych 37363 ALL N N No DUAL

CompuSys Incorporated (NewMexico) 74234 NM N N No 5010A1

CompuSys Incorporated of Arizona 74234 AZ N N No 5010A1

CompuSys Incorporated of Colorado COMPU CO N N No 5010A1

CompuSys Incorporated of Utah 74234 UT N N No 5010A1

Compusys of Colorado COMPU CO N N No 5010A1

CompuSys/Erisa Group,Incorporated (AZ) 74234 AZ N N No 5010A1

CompuSys/Erisa Group,Incorporated (NM) 74234 NM N N No 5010A1

CompuSys/Erisa Group,Incorporated (TX) 74234 TX N N No 5010A1

Confederation Admin Services 80705 ALL N N No 5010A1

Confederation Life Insurance 80705 ALL N N No 5010A1

Connecticare - Medicare 78375 ALL Y Y No 5010A1

Connecticare, Inc. 06105 All Y N No DUAL

Connecticare, Inc. 06105 All Y N No DUAL

Connecticut Carpenters Health Fund 37307 CT Y N No 5010A1

Consociate Group 37135 ALL Y Y No 5010A1

Consolidated Associates Railroad 75284 ALL Y Y No 5010A1

Consolidated Group 59140 All Y N No DUAL

Consolidated Health Plans 87843 ALL N Y No 5010A1

Continental General Insurance Co. 71404 ALL N N No 5010A1

Continental Key Family 35315 All N Y No 5010A1

Contractors, Laborers, Teamsters &Engineers 47046 ALL Y Y No 5010A1

Cook Children’s Health Plan CCHP1 ALL N N No 5010A1

Cook Children’s Star Plan CCHP9 ALL Y Y No 5010A1

Cook Group Health Plan 35149 ALL Y Y No 5010A1

Cooperative Benefit Administrators,Inc. 52132 All Y N No 5010A1

Cooperative Managed Care Services(This PID is for DOS after 1/1/2013 ,prior DOS should use NANWC)


Coordinated Benefit Plan 14829 ALL N Y No 5010A1

Coordinated Medical Specialists(CMS) 58204 ALL Y N No 5010A1

Core Administrative Services 58231 ALL N Y No 5010A1

Core Value (Part of GettysburgHealth.) 23274 ALL Y N No 5010A1

CoreSource 35187 ALL Y Y No 5010A1

CoreSource Little Rock (For claimswhere the ‘submit claims toaddress’ on the medical ID card isan

75136 AR A Y No 5010A1

CoreSource of Illinois 35182 IL Y Y Yes 5010A1

CoreSource of IOWA 35182 IA Y Y Yes 5010A1

CoreSource of Maryland 35182 MD Y N Yes 5010A1

CoreSource of North Carolina (Startusing new PayerID of 35182. OldpayerID will start rejecting soo

35180 NC Y Y No 5010A1

Coresource of OH 35183 OH N Y No 5010A1

CoreSource of Pennsylvania 35182 PA Y N Yes 5010A1

CoreStar AZ MN (Start using newPayerID of 35182. Old payerID willstart rejecting soon.)

41045 AZ, MN Y N No 5010A1

Corizon Health Inc.(Claims withaddress of Brentwood,TN should besubmitted to this Payer ID.)

CORIZ ALL Y N No 5010A1

Cornerstone Benefit Administrators 35202 ALL Y N No 5010A1

Corporate Benefits Service, Inc.(NC) (Only valid for payer addressof PO Box 12953, Charlotte, NC 2

56116 NC Y Y No 5010A1

Correction Health Partners PHPMC ALL N Y No 5010A1

Correctional Medical Services 43160 ALL Y N No 5010A1

CorSolutions 48146 ALL Y Y No 5010A1

Country Life Insurance Company 62553 All Y Y No 5010A1

County Care(CountyCare acceptsboth claims and encounters. CountyCare Provider help desk:312-864-8

60827 ALL Y Y No 5010A1

COVA (Commonwealth of VA) VABLS VA Y Y Yes 5010A1

Covenant Administrators, Inc. 58102 ALL N N No 5010A1

Covenant Management SystemsEmployee Benefit plan CMSEB ALL N N No 5010A1

Coventry Health Care (Coventry oldLegacy Payer ID’s are stillaccepted.)

25133 ALL Y Y No 5010A1

CoverColorado CHCNT CO N N No 4010A1

Cox Health Plan (Requires ProviderID in Box 33a. Contact Cox HealthPlan for ID.)

00019 AR,MO N N No DUAL

CRA managed Care (OH BWC) 10014 OH N N No 5010A1

Creative Medical Systems 64068 ALL Y Y No 5010A1

Creative Plan Administrators 37320 ALL N N No 5010A1

Crescent PPO Health Solutions. CALL ALL N Y No 4010A1

Crown Life 80705 ALL N N No 5010A1

CT General Life Insurance (FormerlySTAR HRG.) 59225 ALL Y Y No 5010A1

CTI Administrators Inc 42141 ALL N Y No 5010A1

Cuatro LLC 19305 ALL N N Yes 5010A1

Culinary Health & Welfare Fund(Las Vegas, NV) 59140 NV A Y No DUAL

CustomCare 68241 ALL Y N No 5010A1

CustomCare (Southwestern Bell -Exec.) 68241 ALL Y N No 5010A1

Custome Design Benefits, Inc. 82056 ALL Y Y No 5010A1

D. H. Evans and Associates (CallJessica Picarde @ 410-349-3222before sending this payerID.)

25172 ALL N Y No 5010A1

DakotaCare DAK01 SD Y Y Yes 5010A1

Dart Container Corporation 06172 ALL N N No 5010A1

Dean Health Plan DEAN1 WI N Y Yes 5010A1

Definity Health Plan(UnitedHealthcare) 87726 ALL Y Y No 5010A1

Delaware Health Plan Consortium 63081 All Y Y No DUAL

Delaware Physicians Care, Inc. 27009 DE N Y No DUAL

DelawareCare, Inc. 25137 DE Y Y No 5010A1

Delta Health Systems DHS01 ALL N Y No DUAL

Dentemax AMS01 MI N Y No DUAL

Dentemax/DPI (MI) AMS01 MI N Y No DUAL

Denver Health - Indigent 84134 CO Y Y No 5010A1

Denver Health and HospitalAuthority 84133 CO N Y No 5010A1

Denver Health Medical Plan 84135 CO N Y No 5010A1

Denver Health Medical Plan, Inc. -Medicare Choice 84131 CO Y Y No 5010A1

Department of Labor Black Lung 77044 ALL N N No 5010A1

Dermatology Network SolutionsBCBS for the Health Options HMO(Payer requires 11 digit member IDNum

58204 All Y Y No 5010A1

Dermatology Network Solutions,LLC BCBS (Payer requires 11 digitmember ID Number)

58204 All Y Y No 5010A1

Dermatology Network Solutions,LLC Humana (Payer requires 11digit member ID Number)

58204 All Y Y No 5010A1

Dermatology Network Solutions,LLC Vista (Payer requires 11 digitmember ID Number)

58204 All Y Y No 5010A1

Deseret Mutual UH105 UH N N Yes 5010A1

Desert Family Practice Association PPM01 ALL A Y No 4010A1

Desert Medical Group DESRT CA N N No 5010A1

Detroit Medical Center 56240 ALL N Y No 5010A1

DGA - Diversified GroupAdministrators 25160 ALL N N No 5010A1

DiaTri, LLC 36439 ALL N Y No 5010A1

Diversified Group Brokerage 06102 All Y Y No 5010A1

DMERC Region A (Testing isrequired for claims requiring CMNs.) DMERA REG A N Y Yes 5010A1

DMERC Region B (Testing isrequired for claims requiring CMNs.) DMERB REG B N Y Yes 5010A1

DMERC Region C (Testing isrequired for claims requiring CMNs.) DMERC REG CA N Y Yes 5010A1

DMERC Region D (Testing isrequired for claims requiring CMNs.) DMERD REG D N Y Yes 5010A1

Donley & Company DNLY1 ALL A N No 5010A1

Downey Select IPA (ApplecareMedical Mgmt) APP01 ALL Y N No DUAL

Dreyer Medical DREYR ALL Y Y No 5010A1

Driscoll Childrens Health Plan 74284 ALL N Y No 5010A1

Driscoll Childrens Health Plan(CHIP) 74284 TX Y N No 5010A1

Dunn and Associates BenefitsAdministrators, Inc. 35186 ALL N Y No 5010A1

E.S. Beveridge and Associates 34108 ALL A N No 5010A1

E3 Health, Inc (Formerly FirstIntegrated Health) 75232 ALL Y N No DUAL

Early Intervention Central Billing 36434 IL Y N No 5010A1

East Bay Medical Network IP130 ALL N Y No DUAL

EAST CAROLINA BEHAVIORALHEALTH 56089 ALL A N No 5010A1

Easy Choice Health Plan of NY 24770 ALL Y N No 5010A1

EBC Inc. (To obtain the payerID,please call (440) 262-1160) CALL ALL Y Y No 4010A1

EBMC CX025 ALL N N No 5010A1

EBMS (Employee BenefitManagement Services, Inc) 81039 ALL Y Y No 5010A1

eComPPO 75277 ALL Y N No DUAL

EDS Healthchoice 22521 OK Y Y No 5010A1

Educators Mutual (EMIA)(Enrollment required, contact EMIAto enroll 800-362-0533, Opt. 2)

SX110 ALL Y Y Yes 5010A1

EHI (Employers Health Insurance) 73288 ALL Y Y No 5010A1

El Paso First - CHIP EPF03 ALL N N No 5010A1

El Proyecto Del Barrio IPA MPM04 CA N N No DUAL

Elder Health Maryland HMO Inc.(Now known as Bravo Health.) 52192 ALL Y Y No 5010A1

ElderPlan, Inc. (Elderplan ProviderID necessary on all claims. Contact(718)921-7979 for Provider I

31625 ALL N Y No 5010A1

Ellis Consultants, INC. ECISF ALL N N No 5010A1

Elmcare NAELM ALL Y Y No 5010A1

Elmcare L.L.C. NAELM IL Y Y No 5010A1

Elmco 37253 NY Y Y No 5010A1

Emerald Health Network 34167 All Y Y No DUAL

Emerald Health Network, Inc. (AllHMO Business) 34167 ALL Y Y No DUAL

EMI (Eye Management Inc) 65062 ALL T Y No 5010A1

EmoryCare 68241 ALL Y N No 5010A1

Empire Physician’s Medical Group EMP01 ALL Y Y No 5010A1

Empire Plan (UnitedHealthcare) 87726 ALL Y Y No 5010A1

Employee Benefit Administration &Management (EBA&M) 95288 CA Y N No 5010A1

Employee Benefit Concepts 38241 ALL N N No 5010A1

Employee Benefit Consultants, Inc.(Call (440) 262-1160 for PayerID.) CALL ALL Y Y No 4010A1

Employee Benefit Corporation 37215 ALL N Y No DUAL

Employee Benefit ManagementCorp. 31074 OH N Y No 5010A1

Employee Benefit Svcs (EBS) of SanAntonio EBSSA TX Y Y No 5010A1

Employee Benefit System 42149 ALL Y N No 5010A1

Employee Benefit Systems 37216 ALL Y N No 5010A1

Employee Benefits PlanAdministration, Inc. (EBPA) (Nowknown as CBA Blue.)

03036 ALL Y N No 5010A1

Employee Plans, LLC 35112 ALL Y Y No 5010A1

Employee Security, Inc. 54098 ALL Y Y No 5010A1

Employer Plan Services, Inc. 74212 ALL N N No 5010A1

Employers Coalition On Health(ECOH) 27008 All Y N No 5010A1

Employers Direct Health -Employee Plan 75236 ALL Y Y No 5010A1

Employers Direct Health - FI 75235 ALL N Y No 5010A1

Employers Direct Health - SF 75233 ALL N Y No 5010A1

Employers Health Cooperative(EHC) 27008 All Y N No 5010A1

Employers Life Insurance Corp. 37249 ALL N Y No DUAL

Employers Mutual, Inc. (FloridaProviders only) 59298 FL Y Y No 5010A1

Encore Health Network (Note: GroupPolicy Number in HCFA Box 11 isrequired.)

35206 All N N No DUAL

ENH Medical Group IPA 36364 ALL Y N No 5010A1

Enstar Natural Gas - Grp# P61 91136 ALL Y N No 5010A1

Entrust (These claims will bedropped to paper and mailed to thepayor as they no longer accept clai

PRINT ALL N Y No PRINT

EPN - Seton Health Plan Exclusive(Provider ID required) EPNSH ALL N N No 5010A1

EQUICOR 62308 All Y Y No 4010A1

EQUICOR - PPO 62308 All Y Y No 4010A1

Equitable Plan Services 73126 ALL N N No 5010A1

Erin Group Administrators (Nowknown as Significa Benefit Services,Inc.)

23250 ALL Y Y No 5010A1

Erisa Administrative ServicesIncorporated 74234 AZ N N No 5010A1

Erisa Administrative Services, Inc. 74234 All N N No 5010A1

Essence Healthcare 57082 MO N N No DUAL

Evercare Special Needs (Evercare byUnitedHealthcare) 87726 ALL Y Y No 5010A1

Everence 35605 ALL N Y No 5010A1

Evolutions Healthcare 59313 ALL Y Y No 5010A1

Exceptional Care Medical IP080 CA N Y No DUAL

Eye Specialists (Provider ID numberrequired in Box33a or Box24J) BVES1 CO N Y No 5010A1

Facey Medical Foundation 95432 ALL Y Y No 5010A1

FACS Group 37300 ALL N N No 5010A1

Fallon Community Health 22254 ALL N Y No DUAL

Family Care - Milwaukee WI 60995 WI N N No 5010A1

Family Care CCO (Admin by PHTech. Use for claims with DOS of08/01/2012 and later.)

PHD01 ALL R Y No 5010A1

Family Care Medicaid (Admin by PHTech Use for claims with DOS of07/31/2012 and prior.)

FCD01 OR N Y No 5010A1

Family Care Medicaid MentalHealth FCM01 OR N Y No 5010A1

Family Care Medicare FCR01 OR N Y No 5010A1

Family Choice Medical IP080 CA N Y No DUAL

Family Health Alliance IP080 CA N Y No DUAL

Family HealthPartners/MC+Missouri 43173 MO A N No DUAL

Family Medical Network 36396 ALL Y Y No 5010A1

Farm Family 14140 ALL Y N No 5010A1

FCE Benefit Administrators 33033 ALL N Y No 5010A1

Federal Employee Program(Connecticut) C2BLS CT Y Y No 5010A1

Federated Mutual Insurance 41041 ALL Y Y No 5010A1

Fidelis Care New York 11315 ALL N Y No DUAL

Fidelis Secure Care 77054 ALL Y Y No 5010A1

First Administrators, Inc. (ProviderID and Group ID required on allclaims. Non-participating provi

FAMR1 SD A Y No DUAL

First Agency FSTAG ALL N N No 5010A1

First Carolina Care 56196 ALL Y Y No 5010A1

First Choice Health Network 91131 WA,OR,ID,AK Y Y No DUAL

First Choice of Midwest (PPO) 75138 ALL N Y No 5010A1

First Choice VIP Care 37510 ALL N N No 5010A1

First Great-West Life & Annuity 80705 ALL N N No 5010A1

First Health Network 73159 ALL Y Y No 5010A1

First Priority 23241 ALL Y Y No 5010A1

First Seniority Freedom 87726 ALL Y Y No 5010A1

First Service Administrators 59276 FL Y N No DUAL

First Services Medicaid MC104 ALL Y N No DUAL

First Solution FS802 ALL N N Yes 5010A1

FirstCare 94999 ALL N Y No 5010A1

FirstCare Star Medicaid 94998 ALL N Y No 5010A1

FirstGuard Health Plan of Kansas(Contact Karen Joslin at (816)922-7225 to verify Firstguard Provide

90060 KS Y Y No 5010A1

FirstGuard Health Plan of Missouri 90061 MO Y Y No 5010A1

Fitzharris & Company 11244 ALL N N No 5010A1

FlexCare 68241 ALL Y N No 5010A1

Florida 1st - Winterhaven, Florida 59276 FL Y N No DUAL

Florida Health Plan 59322 FL N Y No 5010A1

Florida Healthcare Plus 12611 FL N N No 5010A1

Florida Hospital HealthcareSystems (In network providers mustsubmit UP or FHHS ProviderID. Outof

59321 FL Y Y No 5010A1

Florida Hospital Waterman 48116 ALL Y Y No 5010A1

Florida League of Cities, Inc. 59698 FL T Y No 5010A1

Florida NetPass 65063 FL Y Y No 5010A1

Florida Power & Light 68241 FL Y N No 5010A1

Florida True Health 26492 ALL N N No 5010A1

FMH Benefit Services 48117 ALL Y Y No 5010A1

Formax, Inc. 87066 ALL Y N No 5010A1

FORTIS (Formerly Time Insurance) 39065 All N N No 5010A1

Fortis (Western Life Ins. BenefitPlan) 39065 ALL Y N No 5010A1

FORTIS BENEFITS (Kansas City) 70408 ALL N Y No 5010A1

Fortis Benefits, Inc. (Woodbury)PHCS Network Claims 39065 ALL Y N No 5010A1

Fortis Self Funded AdministrativeServices 41124 ALL Y N No 5010A1

FORTIS Western 39065 All Y N No 5010A1

Foundation Health - HMO of CA FH002 CA N Y No DUAL

Foundation Health Amerimed -HMO of CA FH002 CA N Y No DUAL

Foundation Health AmerimedSenior - HMO of CA FH002 CA N Y No DUAL

Foundation Health of CA FH001 CA N Y No DUAL

Foundation Health of Florida-Encounters FHFLE FL Y Y No 4010A1

Fox Valley Medicine Site 199 FVMCH ALL Y N No 5010A1

Fox Valley Medicine Site 451 FVMC1 ALL N N No 5010A1

Fox-Everett, Inc. 64069 ALL Y Y No 5010A1

FoxEverett - Ingalls Ship Building 64067 ALL Y Y No 5010A1

Freedom First 31313 ALL N N No 5010A1

Freedom Health Plan 41212 ALL T N No 5010A1

Freedom Life Insurance Company 62324 ALL N N No 5010A1

FreedomBlue HHIC 71768 ALL Y Y Yes 5010A1

Freeman IPA IP080 CA N Y No DUAL

Fresenius Medical Care TH118 TX Y Y No DUAL

Fringe Benefit Coordinators 59204 ALL Y N No 5010A1

FrontPath Health Coalition 34171 ALL Y Y No 5010A1

G.E. Group Life Assurance Company 67814 ALL Y N No 5010A1

Gates McDonald Health Plus, Inc.(OH BWC) 10009 OH N N No 5010A1

Gateway Health Plan 25169 All N N No DUAL

Gateway Health Plan ((YellowCard). Check the ID card to verifythe Payer ID before submitting)


Gateway Health Plan Medicaid PA 25169 All N N No DUAL

Gateway Health Plan of Ohio, Inc. 76028 OH Y Y No DUAL

Geisinger Health Plan 75273 PA Y Y Yes DUAL

GEMCare (Golden Empire ManagedCare System) MCS01 ALL Y Y No 4010A1

GenCare Health (St. Louis only) 63665 MO Y N No 4010A1

Gencare Health (St. Louis) 63665 MO N N No 4010A1

Genelco (St. Louis only) 63665 MO Y N No 4010A1

Genelco (St. Louis only) 63665 MO N N No 4010A1

General American (Sanus - East) 63665 MO N N No 4010A1

General American Life Ins. Co.(Sanus, St. Louis) 63665 MO N N No 4010A1

General American Life InsuranceCompany 63665 All Y N No 4010A1

Generations Health 46050 ALL N Y No 5010A1

Georgia Power Medical BenefitsPlan 61271 GA Y Y No DUAL

Georgia State Health Benefit Plan(Processed by GA BC/BS) GABLS GA Y Y Yes 5010A1

GettingUsCovered CHCNT CO N N No 4010A1

Gettysburg Health (Including CoreValue.) 23274 ALL Y N No 5010A1

GHI HMO Select 25531 All Y Y No 5010A1

GHI Medicare Part B of New York GHMCR NY N Y Yes 5010A1

GHP (Group Health Plan) 25141 ALL A N No DUAL

GI Innovative Management 58204 ALL Y N No 5010A1

Gilsbar, Inc 07205 ALL Y N No 5010A1

Glassworkers and Glaziers Healthand Welfare Fund Trust COMPU CO N N No 5010A1

Glassworkers Health & WelfareFund - Grp# F29 91136 ALL Y N No 5010A1

Global Care Inc 07689 ALL Y N No 5010A1

Global Care Med Grp IPA MPM05 ALL N N No DUAL

Global Excel Management GEM01 ALL Y Y No 5010A1

Global Health GHOKC ALL Y Y Yes 5010A1

GM Southwest 75246 TX Y Y No 5010A1

GMS, Inc. 47083 ALL A N No 5010A1

Gold Coast 77160 ALL N N No 5010A1

Golden Rule 37602 All N Y No 5010A1

Golden Triangle Physician Alliance GTPA1 ALL N N No 5010A1

Good Samaritan Medical PracticeAssociation (GSMPA) IP086 CA N Y No DUAL

Good Shepherd Hospice 76923 ALL Y Y No 5010A1

Government Employees HealthAssociation,Inc. (GEHA) 44054 ALL Y Y No 5010A1

Government Employees HealthAssociation,Inc. (GEHA) 57254 ALL Y Y No DUAL

Grand Valley Health Plan 95453 ALL N Y No DUAL

Great Lakes Health Plan(UnitedHealthcare Great LakesHealth Plan)

95467 ALL Y Y No 5010A1

Great West (SF) 80705 CA N N No 5010A1

Great West (WA) 80705 WA N N No 5010A1

Great West Care 80705 ALL N N No 5010A1

Great West Denver 80705 CO N N No 5010A1

Great West Life & Annuity (Claimsfor Kennett, Missouri ONLY) 63665 MO Y N No 4010A1

Great West Life Assurance 80705 ALL N N No 5010A1

Great West Life AssuranceCompany of America 80705 All N N No 5010A1

Great-West Bellevue 80705 WA N N No 5010A1

Greater Covina Medical Group GCMG1 CA N N No 5010A1

Greater L. A. Health IP080 CA N Y No DUAL

Greater San Gabriel IP080 CA N Y No DUAL

Greentree 78521 ALL N N No 5010A1

Greentree Administrators 78521 ALL A N No 5010A1

Group Administrators Ltd. 36338 ALL Y Y No 5010A1

Group Administrators Self-FundedAlternative GASA1 ALL Y N No 5010A1

Group and Pension Administrators 48143 ALL Y Y No 4010A1

Group Health Cooperative (WA) 91051 WA Y N No 5010A1

Group Health Cooperative of EauClaire 95192 ALL N N No 5010A1

Group Health Cooperative of SouthCentral Wisconsin Claims 39167 WI Y Y No 5010A1

Group Health Cooperative of SouthCentral Wisconsin Encounters 39168 WI Y Y No 5010A1

Group Health Incorporated (GHI)(New York) 13551 NY Y Y No 5010A1

Group Health Insurance - DE 61101 DE R Y No 5010A1

Group Health Northwest (Call Payerat 888-767-4670 prior to submittingelectronic claims.)

91121 ID,WA Y N No 5010A1

Group Insurance Service Center, INC 37276 ALL N N No 5010A1

Guardian Healthcare (For Dates ofService, 1/1/12 and earlier. For laterclaims use payerID 67829.)

77010 SC Y Y No 5010A1

Guardian Life Insurance Companyof America 64246 All Y N No 5010A1

GulfQuest 93100 ALL Y Y No 5010A1

Gunderson Lutheran Health Plan 39180 ALL Y N No 5010A1

GWL 80705 ALL N N No 5010A1

GWL & A 80705 ALL N N No 5010A1

H.E.R.E.I.U. Welfare Pension Funds 37114 ALL Y N No 5010A1

HAA Preferred Partners 65101 ALL N Y No 5010A1

Harmony Health Plan of Illinois(Wellcare Provider ID required, call(800) 960-2530 opt. 2 then 5)

36406 IL Y Y No DUAL

Harmony Health Plan of Indiana(Only claims for Indiana HoosierHealthwise members can be sent toth

36405 IN Y Y No DUAL

Harrington Health BPO 59143 ALL Y N Yes 5010A1

Harris Methodist Health Plan 95959 All Y N No 5010A1

Harvard Pilgrim 04271 ALL Y Y No DUAL

Harvard Pilgrim Passport Connect 87726 ALL Y Y No 5010A1

Hawaii Management AllianceAssociation (HMAA) 48330 HI N N No 5010A1

Hawki (Provider ID Required) 86068 ALL Y Y No DUAL

HCH Administration 37111 ALL Y N No DUAL

HCHA Albq - Self Funded 37329 ALL Y N No DUAL

HCP Nevada 20501 ALL N Y No 5010A1

HCSC Insurance Services Company 84980 ALL Y Y No 5010A1

HDM Benefit Solutions HDMCO ALL N N No 5010A1

HDPC - Premier Healthcare 90023 ALL Y Y No 5010A1

HDPC Alliance Physicians 20257 ALL N Y No 4010A1

Health Administration Services, Inc 34185 All N N No 5010A1

Health Advantage of Arkansas ARBLS AR Y Y Yes 5010A1

Health Alliance Exclusive & Plus 23172 All N N No 5010A1

Health Alliance Medical Plans ofIllinois 77950 IL Y Y No DUAL

Health Alliance Plan of Michigan 38224 All Y N No DUAL

Health Care Alliance (Sears) 68241 All Y N No 5010A1

Health Care District Palm Beach(Please contact HCDPBC to enrolland to obtain Payer ID 866-930-1002

CALL FL Y Y No 4010A1

Health Care Network of Wisconsin(HCN) 42102 ALL Y Y No 5010A1

Health Care Partners - AZ (ForDates of Service of 5-01-13 andlater.)

HCP02 AZ N Y No 5010A1

Health Choice Generations 62180 ALL Y Y No 5010A1

Health Choice of AZ 62179 AZ Y Y No 5010A1

Health Choice Utah 45399 UT Y N No 5010A1

Health Claims Service 82018 ALL N N No 5010A1

Health Cost Solutions 62111 ALL N Y No 5010A1

Health Design Plus 34158 ALL N N No 5010A1

Health EZ 16120 All Y N No 5010A1

Health First Health Plans 95019 ALL N N No 5010A1

Health First-Tyler, TX 75234 TX N N No 5010A1

Health Help Networks, Inc. 59087 All Y Y No 5010A1

Health Management Associates(HMA, servicing Southeastern andSouthwestern Regions) (Provider IDReq

86066 ALL Y Y No 5010A1

Health Management Solutions (OHBWC) 10006 OH N N No 5010A1

Health Net (California EncountersOnly.) HM001 CA Y Y No DUAL

Health Net (of California) 95567 CA Y N No DUAL

Health Net of Arizona AZHNT AZ Y N No 4010A1

Health Net of the North East, Inc.(Health Net six digit ID REQUIREDin B0X33a call 866-334-4638)


Health Net Oregon 22340 OR Y Y No DUAL

Health Network One 65062 ALL T Y No 5010A1

Health New England 04286 ALL N N No 5010A1

Health Options of Florida (BlueShield HMO) FLHLT FL N N Yes 5010A1

Health Options of Florida (BlueShield HMO) ENCOUNTERS ONLY!! FLENC FL N N Yes 5010A1

Health Options of Illinois NAHOI IL Y Y No 5010A1

Health Partners - Jackson,TN 62157 TN Y Y No 5010A1

Health Partners, PA 80142 PA Y Y No 5010A1

Health Payment Systems 20270 ALL Y Y No 5010A1

Health Plan Management 37221 ALL Y Y No 5010A1

Health Plan of Michigan 83253 MI Y Y No 5010A1

Health Plan of Nevada (Encounterclaims) 76343 NV R Y No 5010A1

Health Plan of Nevada (Encounter) 76342 NV R Y No 5010A1

Health Plan of San Joaquin 68035 ALL N Y No 5010A1

Health Plan of San Mateo HPSM1 CA Y Y No DUAL

Health Plan Services, Tampa Office 59140 All N Y No DUAL

Health Plans Inc. 44273 ALL Y Y No 5010A1

Health Pledge HMO 95435 ALL Y N No 5010A1

Health Plus of Michigan 38216 MI N N No DUAL

Health Plus PHSP (Brooklyn, NY) 11324 NY N Y No 5010A1

Health Risk Management 41170 All Y N No 5010A1

Health Select IPA (Enrollmentrequired. Contact 866-703-1444.) M3IL1 ALL Y N No 5010A1

Health Services for Children withSpecial Needs (HSCSN) 37290 ALL N Y No 5010A1

Health Services Management, Inc.(NOTE: ANSI submitters can alsosubmit to plans AHP, CMS, ONP,PCI,

41150 ALL Y Y No 5010A1

Health Services Management, Inc.for AHS 41150 ALL Y Y No 5010A1

Health Services Management, Inc.for BPA 41150 ALL Y Y No 5010A1

Health Services Management, Inc.for ECOH 41150 ALL Y Y No 5010A1

Health Services Management, Inc.for EHC 41150 ALL Y Y No 5010A1

Health Services Management, Inc.for ENCR 41150 ALL Y Y No 5010A1

Health Services Management, Inc.for FCM 41150 ALL Y Y No 5010A1

Health Services Management, Inc.for HF 41150 ALL Y Y No 5010A1

Health Services Management, Inc.for HT 41150 ALL Y Y No 5010A1

Health Services Management, Inc.for MMSI 41150 ALL Y Y No 5010A1

Health Services Management, Inc.for MSHO 41150 ALL Y Y No 5010A1

Health Services Management, Inc.for PNET 41150 ALL Y Y No 5010A1

Health Services Management, Inc.for PONE 41150 ALL Y Y No 5010A1

Health Services Management, Inc.for SC 41150 ALL Y Y No 5010A1

Health Services Management, Inc. 41150 ALL Y Y No 5010A1

for WEA 41150 ALL Y Y No 5010A1

Healthcare LA, IPA MPM06 CA N N No DUAL

Healthcare Management Admin TH049 ALL N Y No 5010A1

Healthcare ManagementAdministrators, Inc. (also known asHMA, servicing Western Region)

HMA01 WESTERN N N No 5010A1

Healthcare Partners HCP01 CA Y Y No 5010A1

HealthCare Partners, IPA 11328 All Y Y No 5010A1

Healthcare Resources NW 56731 ALL Y Y No 5010A1

HealthCare Solutions Group 73147 ALL A N No 5010A1

Healthcare USA 25133 ALL Y Y No 5010A1

HealthComp HCA77 ALL A N No 5010A1

Healthcomp 85729 ALL Y N No 5010A1

Healthease 59608 FL Y N No DUAL

HealthEdge Administrators (PayerIDvalid for claims with a submissionaddress of PO Box 11210, Baker

95213 ALL Y N No 5010A1

HealthEZ 41178 ALL Y Y No 5010A1

Healthfirst of Austin TPA 75289 ALL N N No 5010A1

Healthfirst, Inc. (NY) 80141 NY Y Y No 5010A1

HealthGuard of Lancaster 23226 PA N Y No 5010A1

Healthkeeper HMO VABLS VA Y Y Yes 5010A1

HEALTHLINK HMO 96475 All Y N No DUAL

HEALTHLINK PPO 90001 All Y Y No DUAL

Healthnet of AZ 38309 AZ Y N No 5010A1

HealthPartners of Minnesota 55764 ALL Y Y Yes 5010A1

HealthPlus of Lousiana 95009 ALL N N No 5010A1

Healthpoint Corporation 68195 All Y Y No 5010A1

HealthPower HMO 31106 All Y Y No 5010A1

HealthSCOPE Benefits, INC 71063 All Y N No 5010A1

Healthsmart Accel 75237 ALL Y Y No 5010A1

HealthSmart Preferred Care 75250 ALL A N No 5010A1

Healthsource Arkansas - Claims

must contain Healthsource specificVendor ID & specific Rendering Pro

71074 AR Y Y No 4010A1

Healthsource Indiana - Claims mustcontain Healthsource specificVendor ID & specific Rendering Prov

35167 IN Y Y No 5010A1

Healthsource Kentucky - Claimsmust contain Healthsource specificVendor ID & specific Rendering Pro

61127 KY Y Y No 5010A1

Healthsource Maine - Claims mustcontain Healthsource specificVendor ID & specific RenderingProvid

01041 ME Y Y No 5010A1

Healthsource New Hampshire -Claims must contain Healthsourcespecific Vendor ID & specificRenderin

02038 NH Y Y No DUAL

Healthsource North Carolina -Claims must contain Healthsourcespecific Vendor ID & specificRenderi

56147 NC Y Y No 4010A1

Healthsource North Texas - Claimsmust contain Healthsource specificVendor ID & specific Rendering

75255 TX Y Y No 4010A1

Healthsource Provident Ins. Co. 68195 All Y Y No 5010A1

Healthsource \ Hudson Health Plan(Provider enrollment is required bythe payer. Must call (914) 37

CALL ALL Y N No 4010A1

Healthsource, AR (Med) (CIGNA) 71075 AR Y Y No 5010A1

Healthsource, GA (CIGNA) 58210 GA Y Y No 5010A1

Healthsource, Mass 02041 MA Y Y No 5010A1

Healthsource, OH 31141 OH Y Y No 5010A1

Healthsource, TN (CIGNA) 62129 TN Y Y No 5010A1

HealthSpan Network Repricing HSPAN ALL N N No DUAL

HealthSpring HMO (No PPO claimsaccepted via this payerID.) HT001 ALL N Y Yes DUAL

HealthSpring HMO/HealthSpringMedicare+Choice 63092 ALL N Y No DUAL

HealthSun HESUN ALL N Y No DUAL

Healthwave of Kansas 31472 KS Y Y No DUAL

Healthways WholeHealth Networks 58213 ALL N N No 5010A1

Healthy Palm Beaches, Inc. 95827 FL Y Y No 5010A1

Helix Family Choice 00243 MD Y Y No DUAL

Heritage Consultants (Must use 9-digit subscriber ID on all claims) 59230 ALL Y Y No 5010A1

Heritage IPA HER01 ALL N N No 5010A1

HFN, Inc. 36335 ALL N Y No 5010A1

High Desert Medical Group(Lancaster, California) HDMDG CA N N No 5010A1

High Desert Primary Care 33069 ALL N Y No 4010A1

Highline Medical Services MOLINA 91164 ALL Y N No 5010A1

Highmark - Key Family 35145 ALL Y Y No 5010A1

Hill Physicians Medical Group HIL01 ALL Y Y Yes DUAL

Hillcrest Benefits Administrators 59347 ALL N N No 5010A1

Hinsdale Physicians Healthcare NAHIN All Y Y No 5010A1

HIP-Health Insurance Plan ofGreater NY 55247 NY Y Y Yes 5010A1

Hispanic Physicians IPA HPIPA ALL A N No 5010A1

HMA (servicing HI, AZ and NV)(Provider ID is required and is 1-6numeric characters in length. )

86066 LISTED Y N No 5010A1

Hollywood Presbyterian IP080 CA N Y No DUAL

Holy Cross Health Partners 36412 ALL Y Y No 5010A1

Holy Cross Health Partners NAHLX IL Y Y No 5010A1

Home State Health Plan 68069 LA N Y No 5010A1

Homeland Security (ATTN:Deportation) VAICE ALL N N No 5010A1

Hometown Health Plan Nevada 88023 NV Y Y No 5010A1

Hometown Health Plan of Ohio(Now known as The Health Plan) 30757 OH A N No DUAL

Horace Mann Life Insurance HMLIC ALL Y N No 5010A1

Horizon Blue Cross Blue Shield ofNew Jersey 22099 NJ R Y Yes 5010A1

Hotel Employees & RestaurantEmployees Health Trust - Grp#F19 91136 All Y N No 5010A1

HPMS (Send claims to payerIDlisted on patient’s insurance card.) CARD MI Y N No 4010A1

HPS Paradigm, Inc. 58227 All Y N No 5010A1

HRM 41170 All Y N No 5010A1

HRM Claim Management 41170 All Y N No 5010A1

Hudson Health Plan (Provider mustbe located in Duchess, Orange,Rockland, Sullivan or Westchester C

13335 NY N N Yes 5010A1

Humana Military Tricare 61125 ALL Y Y No 5010A1

Humana Veterans HealthcareServices 61120 ALL Y Y Yes 5010A1

HUMANA, Claims only 61101 ALL R Y No 5010A1

HUMANA, Encounters Only 61102 All R N No 5010A1

Huntington Park Medical Group IP080 CA N Y No DUAL

Huntington Park Mission IP080 CA N Y No DUAL

I. E. Shaffer 22175 ALL N N No 5010A1

IBA Self Funded Group 38234 ALL N Y No 5010A1

IBC Personal Choice SX083 PA Y Y Yes 5010A1

IBEW Local 640 & Arizona ChapterNECA Health & Welfare Trust 74234 AZ N N No 5010A1

IBEW Western Utilities or Local 57 74234 UT N N No 5010A1

IBI 41124 All Y N No 5010A1

IBM Medical Plans 68241 All Y N No 5010A1

iCARE (Independent Care HealthPlan) 11695 WI T Y No 5010A1

ICARE Health Options TPA 26054 ALL N Y No 5010A1

ICON Benefit Administrators 75185 ALL Y N No 5010A1

Idaho True Blue TRUEB ID Y N Yes 5010A1

Illinicare Behavioral Health 68068 ALL N Y No DUAL

Illinicare Group Health 68069 ALL N Y No DUAL

Illinois Health Plan (IHP) DMG01 ALL N N No 5010A1

Illinois Health Solutions ( ProviderIDRequired) 86069 IL Y Y No DUAL

IMA of Lousiana Inc. 72091 ALL N N No 5010A1

IMCARE 41600 ALL N Y No 5010A1

INDECS Corporation 40585 ALL Y Y No 5010A1

Independence Administrators TA720 ALL Y Y No 5010A1

Independence Medical Group MHM01 ALL Y Y No 5010A1

Independent BLC of PA (Also knownas Personal Choice PPO ofPennsylvania.)

54704 PA N Y Yes 5010A1

Independent Health (Enrollment andTesting Required, contact (716) 635-3911)

95308 ALL Y Y Yes DUAL

Indian Health Services 00290 ALL N N No 5010A1

Indiana Department of HealthChildren’s Health 35600 IN N Y Yes 5010A1

Indiana ProHealth Network 35161 IN Y N No 5010A1

Indiana Teamsters Health BenefitsFund (Formerly known as Local 135Health Benefits Fund)

35107 IN N N No 5010A1

Industrial Machine Specialties COMPU CO N N No 5010A1

INETICO, Inc. 43471 ALL N Y No 5010A1

Informed UHC Compass Rose 50946 ALL N N No 5010A1

InforMed, LLC 52196 ALL N N No 5010A1

Ingalls Provider Group NAING IL Y Y No 5010A1

InHealth, Inc. 31112 All Y N No 5010A1

Inland Empire Health Plan IEHP1 ALL A N No 4010A1

Innovative Physician Associates 80087 ALL A N No 5010A1

INS Health Services VAICE ALL N N No 5010A1

Institutes of Quality 68241 All Y N No 5010A1

Insurance Administrator of America 37279 ALL N N No 5010A1

Insurance Claims Services, Inc.(Birmingham, AL) 63082 AL Y Y No DUAL

Insurance Design Administrators 13315 ALL A Y No 5010A1

Insurance ManagementAdministrators 72091 ALL N N No 5010A1

Insurance Management Services ofTexas IMSMS TX Y N No 5010A1

Insurance Management Services,(Amarillo TX)(This payerID is onlyvalid for claims submission addres

15688 ALL N N No 5010A1

Insurance Service of Lubbock ISL11 All Y N No 5010A1

Insurer’s Administration Corporation IAC01 ALL N N No 5010A1

INTEGRA Administrative Group, Inc. 51020 ALL N N No 5010A1

Integra Group (Also known as RehabProvider Network, but not the sameas Colorado payer of same name

31127 ALL A Y No 5010A1

Integra Group - CHA 31129 ALL N Y No 5010A1

Integral Quality Care 23229 ALL Y Y No 5010A1

Integrated Comp (OH BWC) 10001 OH N N No 5010A1

Integrated Medical Solutions 20050 ALL Y N No 5010A1

Integrated Mental Health Services 68068 ALL Y Y No 5010A1

Interactive Medical Systems 56132 ALL Y N No 5010A1

Intercommunity Health Net INCHN ALL N Y Yes DUAL

Interface EAP 60280 ALL Y N No 5010A1

Intergroup Services Corporation 23287 ALL N Y No 5010A1

Intermountain Health Care (Contactpayer at 801-442-5442 beforesending claims to verify provider nu

UH107 UT Y Y Yes 5010A1

Intermountain Ironworkers TrustFund 74234 AZ,ID,UT N N No 5010A1

International Brotherhood ofBoilermakers Employee HealthCare Plan (IBBEHC)

48603 ALL Y Y No 5010A1

International Educational ExchangeServices, Inc. (IEES) 16158 ALL Y Y No 5010A1

International Funding Inc. 39182 ALL Y Y No 5010A1

International Medical Group, INC IMGIN ALL N N No 5010A1

International Union OperatingEngineers 37269 ALL N N No 5010A1

InterWest Health PPO (Montana) 84137 MT Y Y No 5010A1

Iowa Benefits, Inc. 41124 IA Y N No 5010A1

Iowa Health Solutions (Provider IDRequired) 86068 IA Y Y No DUAL

IU Medical Group Primary Care SX172 ALL Y Y No 5010A1

JF Molloy 61271 All Y Y No DUAL

JMH Medicare Advantage 59171 ALL N Y No 5010A1

JMHP Medicaid 09822 ALL Y Y No 5010A1

John Alden Life Ins. 41099 All N Y No 5010A1

John Hopkins Healthcare (EHP/PP)

(Submit Billing NPI andRendering/Servicing NPI)

52189 ALL N Y No DUAL

John Morrell Company - AHPBA 38310 ALL Y Y No 5010A1

John Muir Health Network JMH01 CA N Y No DUAL

John Muir Mt. Diablo Health System 68036 ALL Y Y No 5010A1

John Muir Trauma Physicians(Please call 925-947-5288 for PayerID information.)


John P Pearl and Associates 37215 ALL Y N No DUAL

Johns Hopkins (USFHP) (Newsubmitter should send in theirBilling NPI & Rendering servicingNPI)

52123 ALL Y N No 5010A1

Joplin Claims 43178 ALL Y Y No 5010A1

JP Farley Corporation 34136 ALL Y N No 5010A1

JPS Preferred Care MWP01 ALL N N No 5010A1

JSL Administrators AKA Wells FargoThird Party Administrators 37272 ALL N Y No 5010A1

Kaiser Foundation Health Plan ofColorado COKSR CO Y N Yes 5010A1

Kaiser Foundation Health Plan ofGeorgia NG010 GA Y Y No 5010A1

Kaiser Foundation Health Plan ofNorthern California KS003 CA A Y Yes DUAL

Kaiser Foundation Health Plan ofOhio NG007 OH Y Y No 5010A1

Kaiser Foundation Health Plan ofSouthern CA Region 94134 CA Y Y Yes DUAL

Kaiser Foundation Health Plan ofSouthern California KS001 CA N Y No DUAL

Kaiser Foundation Health Plan ofthe Mid-Atlantic NG008 ALL Y Y No 5010A1

Kaiser Foundation Health Plan ofthe NW NG009 OR,WA Y Y No 5010A1

Kaiser Foundation Health Plan PPO 94320 ALL Y Y No 5010A1

Kanawha Healthcare Solutions 57038 ALL Y Y No 5010A1

KanCare 96385 ALL Y Y No 5010A1

Kansas City Life InsuranceCompany 44030 ALL Y Y No 5010A1

Keenan & Associates KEE01 CA N Y No 5010A1

Kelsey Seybold KELSE ALL N N No 5010A1

Kempton Group 73100 ALL N N No 5010A1

Kentucky Health Administrators,Inc. 27215 ALL N Y No 5010A1

Kentucky Spirit Health Plan 68069 KY N Y No 5010A1

Kern County CDCR 28021 ALL A N No 5010A1

Kern Health Systems 77039 ALL N Y No DUAL

Key Benefit Administrators 37217 ALL Y N No 5010A1

Key Medical Group (Providersplease contact Brandi Guinn @ 559-735-3892 x233 for authorization.)

IP082 CA N Y No DUAL

Key Select 37321 ALL Y Y No 5010A1

Keycare PPO VABLS VA Y Y Yes 5010A1

Keystone Mercy Health Plan 23284 All Y Y No 5010A1

Keystone VIP Choice 84223 ALL N Y No 5010A1

Klais & Company (Repricing forHealthSpan Network Only.) 3414A ALL A N No DUAL

Klais and Company 34145 ALL Y N No 5010A1

Korean American Medical Group KAMG1 ALL N Y No 5010A1

KPIC - Kaiser Permanente (Valid inthe states of CA,CO, DC, GA, HI,MD, OH and OR)

KPIC1 LISTED N N No 5010A1

KPS Health Plans KPS01 ALL N N No 5010A1

LA Care 27357 LA Y N No 5010A1

LA Care Health Plan LACAR ALL Y Y No 4010A1

Lafayette ConsolidatedGovernment 71037 LA Y Y No 5010A1

Lakeside Health Services 95415 All Y Y No 4010A1

Lakeside Medical Group Inc. LMG11 ALL N N No DUAL

Lancaster General Health Group(Contact Sherry Wolgemuth VP ofClaims Operations at 717-560-9290ext


Landmark Healthcare Inc. LNDMK ALL Y Y Yes 5010A1

Las Vegas Fire Fighters Local No1285 Security Fund NWADM CA N Y No 5010A1

LaSalle Medical Associates NMM02 CA N N No 5010A1

Lawndale Christian Health Center 36333 ALL Y Y No 5010A1

LBA HealthPlans 52193 ALL N N No 5010A1

Leon Medical Center Health Plan 37316 ALL Y Y No 5010A1

Life & Health Ins Co of America(NFL Plan only) 98205 ALL N N No 5010A1

Life Investors Ins Co of America(Specialized claims only. Call 866-745-3545 with claim routing ques

LIICA ALL N N No 5010A1

Life Trac 41136 ALL N Y No 5010A1

LifePath Hospice Inc. 76870 ALL N Y No 5010A1

Lifeprint LIFE1 ALL R N No 5010A1

Lifewise A Premier Health Plan 93093 OR Y Y Yes 5010A1

Lifewise Health Plan of Oregon APremier Health Plan 93093 OR Y Y Yes 5010A1

Lifewise Health Plan of WashingtonA Premier Health Plan 91049 WA Y Y Yes 5010A1

Linn County 75283 ALL Y Y No DUAL

Lipa/Agate Resources LIPA1 ALL N N No 5010A1

Little Company of Mary Health 4725P ALL Y N Yes DUAL

Local Choice VABLS VA Y Y Yes 5010A1

Lockard & Williams CB752 ALL Y N No 5010A1

Loma Linda University Adventist 37267 ALL N N No 5010A1

Lone Star TPA 45289 ALL N Y No 5010A1

Long Beach Memorial IPA (MHCLB) MHIPA CA N Y No 4010A1

Lousiana Healthcare Connections 68069 LA N Y No 5010A1

Lovelace Medicaid SX159 NM N N Yes 5010A1

Lovelace Salud! (NM Medicaid) SX159 NM N N Yes 5010A1

Lovelace Sandia Health Plan 90328 All Y N No 5010A1

Loyal American Life (MedicareSupplement) 13193 ALL N Y No 5010A1

M-CARE (Payer no longer acceptingelectronic claims. Claim will beprinted and mailed to payer.)

MM001 MI N Y No PRINT

MacNeal Health Providers - CHS(Contact 708-783-7100 prior to first 36334 ALL N N No 5010A1

submission.)

Magellan Behavioral Health (AllNon-AETNA Subscribers - ProviderID Required)


Magellan Behavioral Health (ForDates of Service 1/1/2006 and After- Provider ID Required - AETNA S

60054 ALL Y N No 5010A1

MAGNACARE 11303 ALL N Y No 5010A1

Magnolia Mississippi 68069 ALL N Y No DUAL

MAHP (MD IPA, Optumun Choiceand MLH) UnitedHealthcare 87726 MD Y Y No 5010A1

Majesta Care 26372 ALL N N No 5010A1

Maksin Management Corporation 22195 ALL Y Y No 5010A1

MAMSI Life and Health InsuranceCo. (MLH) (Previously Payer ID52148)

87726 All Y N No 5010A1

Managed Care Services, LLC 35162 ALL Y Y No 5010A1

Managed Care Systems (DelangoRegional Medical) MCS02 ALL N Y No 4010A1

Managed Health Networks (MHN) 22771 ALL N Y No 5010A1

Managed Health Services Indiana 68069 IN A Y No DUAL

Managed Health Services ofWisconsin (Please contact the payer@ 800-225-2573, ext 25525 to getsetu

68069 WI Y Y Yes DUAL

Managed Healthcare AdministrationInc- Blue Choice MHCA2 AL N N Yes DUAL

MAPCO Inc. 75258 All Y Y No 5010A1

March Vision Health Plan 5246M ALL N N No DUAL

Marin IPA IP097 CA N Y No DUAL

Marion Polk Health Plan MPCHP ALL Y N Yes DUAL

Marion Polk Health Plan Advantage MPCHA ALL Y N Yes DUAL

Marrick Medical Finance, LLC 20805 ALL N Y No 5010A1

Marriott 68241 All Y N No 5010A1

Martin’s Point Health CareUSFHP/Generations Advantage MPHC2 ALL Y N No DUAL

Maryland Physicians Care 22348 ALL N Y No 5010A1

Maryland PMHS ValueOptions (Use 77063 MD N Y Yes 4010A1

for ALL Dates of Service) 77063 MD N Y Yes 4010A1

Mashantucket Pequot Tribal Nation 37121 ALL Y N No 5010A1

Mass Health (MA Medicaid) MAMCD MA Y Y Yes 5010A1

Massachusetts Mutual also knownas Mass Mutual 80314 All Y Y No 5010A1

Masters, Mates and Pilots Plan MMPHB ALL N N No 5010A1

Max Specialty Benefits 27320 ALL N N No 5010A1

Mayo Management Services, Inc. 41154 ALL N Y No 5010A1

MBA Benefit Administrators 83028 ALL Y N No 5010A1

MBA of MD, Inc. 37298 MD Y Y No 5010A1

MBA of Wyoming 87065 WY,UT Y N No 5010A1

Mcare of Colorado Springs CSMED CO N N Yes 4010A1

Mcare of Michigan (Payer no longeraccepting electronic claims. Claimwill be printed and mailed to

38264 MI Y Y No PRINT

MCC Behavioral Care (We will alsoaccept PID SX071 for these claims:use of either ID accomplishes t

MCCBV All Y Y Yes 5010A1

McCreary Corporation 59331 FL Y Y No 5010A1

McLaren ABW-NHP 3833N ALL N Y No 5010A1

McLaren ABW-THPC 3833T ALL N Y No 5010A1

McLaren Health Advantage 3833A ALL N Y No 5010A1

McLaren Health Plan 38338 ALL N Y No 5010A1

McLaren Medicaid 3833C ALL N Y No 5010A1

MD CARE HEALTH PLAN MDC01 ALL N N No 5010A1

MD Rogue Oregon Health Plan MRIPA ALL N N No 5010A1

MD-Individual Practice Association,Inc. (M.D. IPA) (Previously Payer ID52148)

87726 All Y N No 5010A1

MDWise Hoosier Alliance 20475 ALL Y Y No 5010A1

MDWise Select Health Network MWSHN ALL N N No DUAL

Med-Pay 00130 MO, IL Y N No DUAL

Med3000 CMS Early Steps EM350 ALL N N No 5010A1

Med3000 CMS Safety Net EM284 ALL N N No 5010A1

Med3000 CMS Title 19 Reform EM843 ALL N N No 5010A1

Med3000 CMS Title 21 EM205 ALL N N No 5010A1

Med3000 Coventry Health Kids EM521 ALL N N No 5010A1

Med3000 HealthSpring EM216 ALL N N No 5010A1

Med3000 Pedicare Title 19 EM039 ALL N N No 5010A1

Med3000 Pedicare Title 21 EM522 ALL N N No 5010A1

MedAdmin Sol Inc 58204 ALL Y N No 5010A1

MedCost 56162 All N Y No 5010A1

MedCost Benefit Services 56205 ALL Y Y No 5010A1

Medfocus 95321 ALL N Y No 5010A1

Medi-Cal by MedPoint MPM18 ALL N N No 5010A1

MEDICA 94265 ALL Y Y No DUAL

Medica Health Care Plan, Inc. 78857 All Y Y No 5010A1

Medicaid of Delaware DEMCD DE N Y Yes 5010A1

Medicaid - TX Premier Plan (ContactProvider Relations @ (915)532-2778, x1068)

EPF02 TX Y N Yes 5010A1

Medicaid of Alabama ALMCD AL Y Y Yes 5010A1

Medicaid of Alaska AKMCD AK N Y Yes 5010A1

Medicaid of Arizona (AHCCCS) AZMCD AZ Y Y Yes 5010A1

Medicaid of Arkansas ARMCD AR Y Y Yes 5010A1

Medicaid of Colorado 147078 CO Y Y Yes 5010A1

Medicaid of Connecticut CTMCD CT Y Y Yes 5010A1

Medicaid of Florida FLMCD FL N Y Yes 5010A1

Medicaid of GA GAMCD GA N Y Yes 5010A1

Medicaid of Hawaii HIMCD HI N Y Yes 5010A1

Medicaid of Idaho IDMCD ID Y Y Yes 5010A1

Medicaid of Illinois ILMCD IL Y Y Yes 5010A1

Medicaid of Indiana INMCD IN N Y Yes 5010A1

Medicaid of Iowa IAMCD IA N Y Yes 5010A1

Medicaid of Kansas KSMCD KS N Y Yes 5010A1

Medicaid of Kentucky KYMCD KY Y Y Yes 5010A1

Medicaid of Lousiana (IncludesKidMed claims.) LAMCD LA Y Y Yes 5010A1

Medicaid of Lousiana Rehab (forRehabilitation claims) LAREH LA Y Y Yes 5010A1

Medicaid of Maine MEMCD ME N N Yes 5010A1

Medicaid of Maryland MDMCD MD N Y Yes 5010A1

Medicaid of Massachusetts MAMCD MA Y Y Yes 5010A1

Medicaid of Michigan MIMCD MI Y Y Yes 5010A1

Medicaid of Minnesota MNMCD MN N Y Yes 5010A1

Medicaid of Mississippi MSMCD MS Y N Yes 5010A1

Medicaid of Missouri MOMCD MO Y Y Yes 5010A1

Medicaid of Montana MTMCD MT N Y No 5010A1

Medicaid of Nebraska NEMCD NE Y N Yes 5010A1

Medicaid of Nevada NVMCD NV N Y Yes 5010A1

Medicaid of New Hampshire NHMCD NH N N Yes 4010A1

Medicaid of New Jersey NJMCD NJ Y Y Yes 5010A1

Medicaid of New Mexico NMMCD NM Y Y Yes 5010A1

Medicaid of New York NYMCD NY Y Y Yes 5010A1

Medicaid of North Carolina NCMCD NC N Y Yes 5010A1

Medicaid of North Dakota NDMCD ND N Y Yes 5010A1

Medicaid of Ohio OHMCD OH Y Y Yes 5010A1

Medicaid of Oklahoma OKMCD OK N Y Yes 5010A1

Medicaid of Oregon ORMCD OR N N Yes 5010A1

Medicaid of Pennsylvania PAMCD PA Y Y Yes 5010A1

Medicaid of Rhode Island RIMCD RI N Y Yes 5010A1

Medicaid of South Carolina SCMCD SC Y Y Yes 5010A1

Medicaid of South Dakota SDMCD SD N Y Yes 5010A1

Medicaid of Tennessee (TennCare) TNMCD TN Y Y Yes 5010A1

Medicaid of Texas TXMCD TX Y Y No 5010A1

Medicaid of Utah UTMCD UT Y Y Yes 4010A1

Medicaid of Vermont VTMCD VT N Y Yes 5010A1

Medicaid of Virginia VAMCD VA N Y Yes 5010A1

Medicaid of Washington DC DCMCD DC Y Y Yes 5010A1

Medicaid of Washington State WAMCD WA Y Y Yes 5010A1

Medicaid of West Virginia WVMCD WV Y Y Yes 5010A1

Medicaid of Wisconsin WIMCD WI N Y No 5010A1

Medicaid of Wyoming WYMCD WY N N Yes 5010A1

Medical Associates Health Plan MAHP1 ALL Y N No 5010A1

Medical Benefit Administration, Inc. 68041 ALL Y Y No DUAL

Medical Benefits Mutual 74323 ALL Y Y No 5010A1

Medical Development International 52181 ALL Y Y No 5010A1

Medical Mutual of Ohio (Payerrequires a 12 digit renderingprovider ID#, which needs to beobtained

29076 OH Y Y No 5010A1

Medical Network of ColoradoSprings CSMED CO N N Yes 4010A1

MediCal of California MDCAL CA N Y Yes 5010A1

Medical Orange Coast Memorial IPA MHIPA CA N Y No 4010A1

Medical Reimbursements ofAmerica 62177 ALL Y Y No 5010A1

Medical Resource Network (MRN,INC) 58203 ALL Y Y No 5010A1

Medical Select Management 13375 ALL Y Y No 5010A1

Medical Services Initiative 12057 ALL Y Y No 5010A1

Medical Value Plan - Ohio (MVP) 38224 OH Y Y No DUAL

Medicare Blue Advantage of SouthCarolina SCBLS SC Y Y Yes 5010A1

Medicare of Missouri (Includes bothEastern and Western Missouri.) KCMCR KS,MS Y Y Yes 5010A1

Medicare of the Virgin Islands 09302 VI N N Yes DUAL

Medicare Part B GHI GHMCR NY N Y Yes 5010A1

Medicare Part B of Alabama ALMCR AL Y Y Yes 5010A1

Medicare Part B of Alaska AKMCR AK N Y Yes 5010A1

Medicare Part B of American Samoa HIMCR AM Samoa Y Y Yes 5010A1

Medicare Part B of Arizona AZMCR AZ Y Y Yes 5010A1

Medicare Part B of Arkansas ARMCR AR Y Y Yes 5010A1

Medicare Part B of Colorado COMCR CO Y Y Yes 5010A1

Medicare Part B of Connecticut CTMCR CT Y Y Yes 5010A1

Medicare Part B of DC 00903 DC R Y Yes 5010A1

Medicare Part B of Delaware 00902 DE R Y Yes 5010A1

Medicare Part B of Florida FLMCR FL Y Y Yes 5010A1

Medicare Part B of Georgia GAMCR GA Y Y Yes 5010A1

Medicare Part B of Guam HIMCR Guam Y Y Yes 5010A1

Medicare Part B of Hawaii HIMCR HI Y Y Yes 5010A1

Medicare Part B of Idaho IDMCR ID Y Y Yes 5010A1

Medicare Part B of Illinois ILMCR IL Y Y Yes 5010A1

Medicare Part B of Indiana INMCR IN N Y Yes 5010A1

Medicare Part B of Iowa IAMCR IA Y Y Yes 5010A1

Medicare Part B of Kansas KSMCR KS Y Y Yes 5010A1

Medicare Part B of Kentucky KYMCR KY Y Y Yes 5010A1

Medicare Part B of Louisiana LAMCR LA Y Y Yes 5010A1

Medicare Part B of Maine MEMCR ME Y Y Yes 5010A1

Medicare Part B of Maryland 00901 MD R Y Yes 5010A1

Medicare Part B of Massachusetts MAMCR MA Y Y Yes 5010A1

Medicare Part B of Michigan MIMCR MI Y Y Yes 5010A1

Medicare Part B of Minnesota MNMCR MN Y Y Yes 5010A1

Medicare Part B of Mississippi MSMCR MS Y Y Yes 5010A1

Medicare Part B of Missouri(Eastern) (Specialty testingrequired)

MOMCR MO N Y Yes 5010A1

Medicare Part B of Montana MTMCR MT Y Y Yes 5010A1

Medicare Part B of Nebraska NEMCR NE Y Y Yes 5010A1

Medicare Part B of Nevada NVMCR NV N Y Yes 5010A1

Medicare Part B of New Hampshire NHMCR NH Y Y Yes 5010A1

Medicare Part B of New Mexico NMMCR NM Y Y Yes 5010A1

Medicare Part B of New York(Empire) NYMCR NY Y Y Yes 5010A1

Medicare Part B of NJ (Specialtytesting required) NJMCR NJ Y Y Yes 5010A1

Medicare Part B of North Carolina NCMCR NC Y Y Yes 5010A1

Medicare Part B of North Dakota NDMCR ND N Y Yes 5010A1

Medicare Part B of NorthernCalifornia CNMCR CA Y Y Yes 5010A1

Medicare Part B of NorthernMariana Islands HIMCR CNMI Y Y Yes 5010A1

Medicare Part B of Northern Virginia(inc. Prince George, Montgomery,Fairfax and Arlington Counties

00903 VA N Y Yes 5010A1

Medicare Part B of Ohio OHMCR OH Y Y Yes 5010A1

Medicare Part B of Oklahoma OKMCR OK Y Y Yes 5010A1

Medicare Part B of Oregon ORMCR OR Y Y Yes 5010A1

Medicare Part B of PA (Specialtytesting required) PAMCR PA Y Y Yes 5010A1

Medicare Part B of Rhode Island RIMCR RI Y Y Yes 5010A1

Medicare Part B of South Carolina SCMCR SC Y Y Yes 5010A1

Medicare Part B of South Dakota SDMCR SD N Y Yes 5010A1

Medicare Part B of SouthernCalifornia CSMCR CA Y Y Yes 5010A1

Medicare Part B of Tennessee TNMCR TN Y Y Yes 5010A1

Medicare Part B of Texas TXMCR TX Y Y Yes 5010A1

Medicare Part B of Upstate NY N1MCR NY Y Y Yes 5010A1

Medicare Part B of Utah UTMCR UT Y Y Yes 5010A1

Medicare Part B of Vermont VTMCR VT Y Y Yes 5010A1

Medicare Part B of Virginia VAMCR VA Y Y Yes 5010A1

Medicare Part B of Washington WAMCR WA N Y Yes 5010A1

Medicare Part B of West Virginia WVMCR WV Y Y Yes 5010A1

Medicare Part B of Western Missouri MWMCR MS Y Y Yes 5010A1

Medicare Part B of Wisconsin WIMCR WI Y Y Yes 5010A1

Medicare Part B of Wyoming WYMCR WY Y Y Yes 5010A1

Medicare Railroad (MetraHealthMedicare) RRWMC All N Y Yes 5010A1

Medicare Supplemental VABLS VA Y Y Yes 5010A1

Medico Insurance Company HDM04 ALL N N No 5010A1

MEDIGOLD 95655 ALL N N No 5010A1

Mediture 20039 ALL Y N No 5010A1

MedPartners Admin Services 412MP ALL N N No 5010A1

MedPartners AdministrativeServices 35205 ALL N N No 5010A1

MedPay Assurance (Must be aMedpay Assurance Provider tosubmit. Call 888-9-MEDPAY.)

MP001 ALL N No 4010A1

MedSolutions, Inc. 62160 ALL Y Y No 5010A1

Medstar Physician Partners 00243 MD Y Y No DUAL

Mega Life & Health (UnitedInsurance Division) 97055 ALL Y Y No 5010A1

Mega Life & Health InsuranceCompany (SSN is not a valid InsuredID. Must be similar to 01234567899

59221 ALL Y N No 5010A1

Memorial Clinical Associates MCA11 ALL N N No 5010A1

Memorial Healthcare IPA MHIPA CA N Y No 4010A1

Memorial Hermann Health Network MHHNP ALL N N No 5010A1

Memorial Integrated Healthcare(Please email Tracy Harswick [email protected] for payer IDinform


Mendicina Familiar Medical Group IP080 CA N Y No DUAL

Mennonite Mutual MNM99 ALL Y Y No 5010A1

Mental Health Network (Only claimsfor PO Box 209010 Austin TX 78720) 74289 ALL Y Y No 5010A1

Mercy Care Plus (Now valid only forDOS prior to 7-1-12) 71079 ALL Y Y No 5010A1

Mercy Health Plan (AHCCCS) 86052 AZ Y N No DUAL

Mercy Health Plan of AZ 86052 AZ Y N No DUAL

Mercy Health Plan of New Jersey(Provider ID Required in Box33a -Contact (800) 682-9091 to obtain I

22326 All Y Y Yes 5010A1

MercyCare of WI. (Call 608-758-7739 for PayerID.) CALL ALL N N No 5010A1

Meridian Health Plan 13189 ALL Y Y No DUAL

Meritain Health (North AmericanHealth Plan.) 64157 ALL Y Y No DUAL

Meritain Health / Agency Services 64158 ALL Y Y No 5010A1

Meritain Health Minneapolis 41124 ALL Y N No 5010A1

MethodistCare, Inc. 95420 ALL Y Y No 5010A1

Metro Plus Health Plan 13265 ALL A Y No 5010A1

Metropolitan Health Plan 55765 ALL Y Y No DUAL

Michigan Blue Care HMO (BCN ofMichigan) MIBCN MI N Y Yes 5010A1

Michigan Medicare PlusBlue MIMPB MI Y Y Yes 5010A1

Micron Tech 96598 ALL Y Y No 4010A1

Mid-America Associates 37281 ALL N N No 5010A1

Mid-American Benefits 22823 ALL N Y No 5010A1

Mid-West National Life InsuranceCo. of Tennessee (ID valid only forfollowing: PO Box 982017, North

59224 TN N Y No 5010A1

Midland Management/MFC 23550 ALL Y Y No 5010A1

Midland National Life Ins Co (NFICPlan only) 90956 ALL N N No 5010A1

Midlands Choice 47080 NE,IA Y Y No 5010A1

Midlands Health Partners 47080 ALL Y Y No 5010A1

Midwest Group Benefits 61146 ALL Y N No 5010A1

Midwest Health Partners 76079 ALL N N No 5010A1

Midwest Health Plans, INC. MHP77 ALL N Y No 5010A1

Mills Penisula Medical Group MPMG1 CA Y Y No DUAL

Minneapolis Prudential Business 68241 MN Y N No 5010A1

Mission Community IPA Med Grp MPM07 CA N N No DUAL

Mission Hospital Affiliates STJOE CA Y Y No 4010A1

Mississippi Physicians Care Network 64084 ALL Y Y No 5010A1

Mississippi Select Healthcare(Mississippi Select Health Care) 64088 All Y N No 5010A1

Missoula County Medical Benefits 37275 MT N N No 5010A1

Missouri Care 43179 ALL N Y No 5010A1

Missouri Care (Requires Medicaid

Provider ID in Box 33a. Contact ENSenrollments at 800-341-6041 pri

00530 MO N N No DUAL

Molina Healcare of New Mexico -SCI 04423 ALL Y Y No 5010A1

Molina Healthcare of California(Rendering provider must use Medi-Cal ID number or State License Num

38333 CA Y Y No 5010A1

Molina Healthcare of Florida 51062 ALL Y Y No 5010A1

Molina Healthcare of Michigan 38334 MI Y Y No 5010A1

Molina Healthcare of Missouri (Nowvalid only for DOS prior to 7-1-12) 71079 ALL Y Y No 5010A1

Molina Healthcare of New Mexico NM505 NM Y Y No 5010A1

Molina Healthcare of Ohio 20149 OH Y Y No 5010A1

Molina Healthcare of Texas 20554 TX Y Y No 5010A1

Molina Healthcare of Washington(Rendering providers use DSHSMedicaid ID or State LicenceNumber.)

38336 WA Y Y No 5010A1

Molina Healthcare Utah SX109 ALL N Y No 5010A1

Monarch Healthcare IPA (Renderingprovider ID# required on all claims.) IP095 ALL Y N Yes DUAL

Montefiore Contract ManagementOrganization (Provider ID required,call 914-377-4400 for ID prior to

13174 ALL A Y No 5010A1

Monumental Life Ins Co. MMLIC ALL N N No 5010A1

Morris Associates aka HealthScopeBenefits 35092 ALL Y Y No 5010A1

Mosaic IPA Medical Group(Providers please contact BrandiGuinn @ 559-735-3892 x233 forauthorizatio

IP083 CA N Y No DUAL

Motion Picture Industry Health Plan(These claims now processed byAnthem BC of CA)

MPI01 CA Y N No DUAL

Mountain Medical Affiliates 84095 ALL N Y No 5010A1

Mountain States AdministrativeServices, Inc. (ARIZONA ONLY.) 86040 ALL Y N No 5010A1

Mountain States Administrators(COLORADO ONLY) MTNST CO N Y No 5010A1

MPE Employee Benefit Services 37233 ALL N N No 5010A1

MPLAN Inc. Healthcare Group 95444 ALL A Y No 5010A1

MS BCBS State Employees SB731 MS Y N Yes 5010A1

Mt. Carmel 95655 ALL N N No 5010A1

MultiPlan GEHA 45235 ALL N N No 5010A1

Multiplan Wisconsin PreferredProvider Network 34080 ALL Y Y No 5010A1

Municipal Health Benefits Fund 81883 ALL N N No 5010A1

Mutual Assurance Administrators 37256 ALL N N No 5010A1

Mutual Benefit 39065 All Y N No 5010A1

Mutual Benefit Life 39065 All Y N No 5010A1

Mutual Group, The (US) 70491 All Y Y No DUAL

Mutual of Omaha InsuranceCompany 71412 All N N No 5010A1

Mutual of Omaha InsuranceCompany 71412 All N N No 5010A1

Mutually Preferred 71412 All N N No 5010A1

MVP Health Plan of NY 14165 NY Y Y No DUAL

N.W. Ironworkers Health & SecurityTrust Fund - Grp#F15 91136 ALL Y N No 5010A1

N.W. Roofers & Employers Health &Security Trust Fund - Grp#F14 91136 ALL Y N No 5010A1

N.W. Textile Processors - Grp#F14 91136 ALL Y N No 5010A1

NAA (North America Administrators) 65085 ALL N N No 5010A1

NAMM Partners NANPR ALL Y N No 5010A1

Naphcare Inc 58182 ALL A Y No 5010A1

National Association of LetterCarriers 53011 All N Y No 4010A1

National Association of LetterCarriers 53011 All N Y No 4010A1

National Benefit Administrators -New Jersey 56175 NJ Y Y No 5010A1

National Benefits Administrators -North Carolina 56176 NC N Y No 5010A1

National Capital Area NCABS DC VA MD N N Yes 5010A1

National Capital Preferred ProviderOrganization (NCPPO) (To obtainyour provider ID number, please


National Financial Insurance 90956 ALL N N No 5010A1

Company 90956 ALL N N No 5010A1

National Foundation Life InsuranceCompany 98205 ALL N N No 5010A1

National Health Administrators Inc. NHAIN ALL N Y No 5010A1

National Health Benefit 88057 ALL Y Y No 5010A1

National Health BenefitsCorporation - NHBC02 88050 ALL Y Y No 5010A1

National Imaging Associates NIA11 ALL Y Y No DUAL

National Rural Electric 52132 All Y N No 5010A1

National Teachers Association (NTA) NTA11 ALL A N No 5010A1

National TelecommunicationsCooperative Association (NTCA) 52103 ALL Y Y No 5010A1

National TelecommunicationsCooperative Association (NTCSStaff)

52104 ALL Y Y No 5010A1

Nationwide Group 31417 All Y Y No 5010A1

Nationwide Health Plans - HMO,PPO, POS 31112 ALL Y N No 5010A1

Nationwide Insurance 31417 All Y N No 5010A1

Nationwide Life and Health 31417 All Y N No 5010A1

Nationwide Mutual Insurance 31417 All Y N No 5010A1

Nationwide Specialty Health(Formerly Nationwide Health Plans 31417 All Y Y No 5010A1

NCAS - Charlotte, VA 75191 VA Y Y No 5010A1

NCAS - Fairfax, VA 75190 VA Y Y No 5010A1

Neighborhood Doctors Organization 51909 ALL N N No 5010A1

Neighborhood Health Partnership(NHP) 95123 ALL Y N No 5010A1

Neighborhood Health Partnership(NHP) 96107 ALL Y N No 5010A1

Neighborhood Health Plan of RhodeIsland (Contact NHPRI 401-459-6030to verify provider and vendor n

05047 RI N Y No 5010A1

Neighborhood Health Providers (Usethis payer ID for Dates of Serviceprior to 6/1/13. For later cla

11325 ALL but FL Y Y No 5010A1

Neighborhood Plan (Boston, MA) 04293 ALL Y Y No DUAL

Nesika Health Group 37255 ALL N N No 5010A1

Netcare Life and Health Insurance 66055 ALL N N No 5010A1

Network Health (Before initiatingsubmissions, please call ProviderRelations at (617)806-8104 or ww

CALL ALL Y N No 4010A1

Network Health Insurance Corp -Medicare 77076 ALL T Y No 5010A1

Network Health Massachusetts 04332 ALL N Y No 5010A1

Network Health Plan of Wisconsin,Inc.(Prior to initial claimssubmission, please contact NetworkHe

39144 ALL N Y No 5010A1

Network Health PPO AMS01 ALL N Y No DUAL

Nevada Health Solutions (ProviderID Required) 86067 NV Y Y No DUAL

NevadaCare (Provider ID Required) 86067 NV R Y No DUAL

NevadaCare Kids (Provider IDRequired) 86067 NV R Y No DUAL

New Avenues, Inc. 95998 ALL N Y No 5010A1

New Century Health - VistaCardiology NCH09 ALL N Y No 5010A1

New Century Health ArizonaIntegrated Physicians NCHOR ALL N N No 5010A1

New England, The 66893 All Y N No 4010A1

New England, The 66893 All Y N No 4010A1

New ERA Life 75281 ALL N Y No 5010A1

New Market Dimensions 65056 ALL N Y No 5010A1

New Mexico District Council ofCarpenters 74234 NM N N No 5010A1

New Mexico Painters and AlliedTrades Local No 823 74234 UT N N No 5010A1

New Mexico-West Texas Multi-Craft(lso known as New Mexico Laborers) 74234 UT N N No 5010A1

New West Health Plan 84141 MT Y Y No 5010A1

New York Life - Long Term Care NYL11 ALL N N No 5010A1

New York Medical Imaging-MVP 14179 NY Y Y No DUAL

New York Network Management 11334 ALL Y Y No 5010A1

New York Presbyterian SystemSelect Health 24819 NY N Y No 5010A1

NGS American, Inc. 38225 ALL Y Y No DUAL

Nippon Life Insurance Company 81264 All Y N No 5010A1

NJ Carpenters Health Fund 22603 NJ N Y No 5010A1

Noble Community IP080 CA N Y No DUAL

North American Administrators, Inc. 64157 ALL Y Y No DUAL

North American Benefits Network(NABN) 34159 ALL N N No 5010A1

North American MedicalManagement (Provider numbermust be in box 33a)

IP079 All Y Y No DUAL

North Broward Hospital District 37314 FL Y Y No 5010A1

North Suburban AssociatedPhysicians 36392 ALL N Y No 5010A1

North Texas Healthcare Network 35212 All Y Y No DUAL

North West Life PH018 All Y Y No DUAL

Northern Illinois Health Plan 36347 IL Y Y No 5010A1

Northern Nevada Trust Funds (Call775-826-7200 prior to submittingclaims.)

88027 NV A Y No 5010A1

Northridge Medical Group NMG01 ALL N Y No 5010A1

NorthShore Physicians Associates 48026 ALL N Y No 5010A1

Northwest Community HealthPartners (PID only for DOS prior to1/1/2013. DOS 1/1/2013 and aftersen

NANWC IL Y Y No 5010A1

Northwest Physicians Network NPN11 ALL Y N No DUAL

Northwest Suburban IPA (IL) 36346 IL Y N No 5010A1

Northwestern National Life PH018 All Y Y No DUAL

Nova Casualty Company 16114 ALL Y Y No 5010A1

Nova Healthcare Administrators,Inc. (Grand Island, NY) 16644 ALL Y N No 5010A1

Novanet 06226 ALL N N No 5010A1

NOVASYS Health Network 71080 ALL Y N No 5010A1

NTL 37120 IA N Y No 5010A1

NY Central FEP (Federal EmployeeProgram) Blue Shield N2FEP NY Y Y Yes 5010A1

Nyhart 37299 ALL N N No 5010A1

NYS DOH UCP 14142 NY N Y No 5010A1

Oak West Primary PhysicianAssociation NAOAK ALL Y Y No 5010A1

Oak West Primary PhysicianAssociation NAOAK IL Y Y No 5010A1

Occupational Health Management,Inc. (OH BWC) 10070 OH N N No 5010A1

Ochsner Health Plan 72127 ALL Y Y No 5010A1

ODS Health Plan 13350 ALL A Y No 5010A1

OH Worker’s COMP 31147 OH y Y No 5010A1

Ohio Health Choice PPO 34189 OH Y N No 5010A1

Ohio PPO Connect 74431 ALL N Y No 5010A1

Olympic Health ManagementSystems, Inc. 91150 All Y Y No DUAL

OmniCare (For claims with Dates ofService after 10/01/04) 25150 ALL N Y No 5010A1

One Call Medical 22321 ALL N Y No 5010A1

One Health Plan Inc. 80705 ALL N N No 5010A1

One Health Plan Michigan, Inc. 80705 MI N N No 5010A1

One Health Plan New York, Inc. 80705 NY N N No 5010A1

One Health Plan of Alaska 80705 AK N N No 5010A1

One Health Plan of Arizona, Inc. 80705 AZ N N No 5010A1

One Health Plan of California 95379 CA Y N No 4010A1

One Health Plan of Colorado 95412 CO Y N No 4010A1

One Health Plan of DC Inc, 80705 DC N N No 5010A1

One Health Plan of Florida 80705 FL N N No 5010A1

One Health Plan of Georgia 95569 GA Y N No 4010A1

One Health Plan of Illinois 95388 IL Y N No 4010A1

One Health Plan of Indiana, Inc. 80705 IN N N No 5010A1

One Health Plan of Kansas andMissouri 80705 KS,MS N N No 5010A1

One Health Plan of Maine, Inc. 80705 ME N N No 5010A1

One Health Plan of Massachusetts,Inc. 80705 MA N N No 5010A1

One Health Plan of Minnesota, Inc. 80705 MN N N No 5010A1

One Health Plan of Nevada, Inc. 80705 NV N N No 5010A1

One Health Plan of New Jersey 80705 NJ N N No 5010A1

One Health Plan of North Carolina 80705 NC N N No 5010A1

One Health Plan of Ohio 80705 OH N N No 5010A1

One Health Plan of Pennsylvania 80705 PA N N No 5010A1

One Health Plan of South Carolina 80705 SC N N No 5010A1

One Health Plan of Tennessee 80705 TN N N No 5010A1

One Health Plan of Texas 80705 TX N N No 5010A1

One Health Plan of Virginia, Inc. 80705 VA N N No 5010A1

One Health Plan of Washington 80705 WA N N No 5010A1

One Health Plan of Wisconsin, Inc. 80705 WI N N No 5010A1

One Health Plan of Wyoming 80705 WY N N No 5010A1

OneNet PPO (formerly Alliance PPOand MAPSI) 52149 ALL Y N No 5010A1

Operating Engineers Local No 53 74234 UT N N No 5010A1

Operating Engineers Locals 302 &612 Health & Security Fund -Grp#F12

91136 ALL Y N No 5010A1

Opticare Eye Health Network 56190 ALL Y Y No 5010A1

Optimum Choice of the Carolina’s(MAMSI) 52152 NC,SC Y Y No 5010A1

Optimum Healthcare, Inc. 20133 ALL N Y No 5010A1

Optum Health - Physical Health(Includes Oxford) (formerly ACN,former payerIDs 41159, 41160,ACN01)

41161 ALL N Y No 5010A1

Optum Health - Physical Health(Includes Oxford) (OptumHealth) 41161 ALL N Y No 5010A1

OptumHealth (OptumHealthBehavior Solutions) formerly UnitedBehavioral Health and PacificareBehavi

87726 ALL Y Y No 5010A1

OptumHealth (OptumHealthBehavioral Solutions of NM) 87726 ALL Y Y No 5010A1

OptumHealth (OptumHealth CareSolutions), formerly UnitedResources Networks, formerpayerID 52190

41194 ALL Y Y No 5010A1

OptumHealth Behavior Solutions 87726 ALL N Y No 5010A1

OptumHealth Behavioral Solutionsof NM (OptumHealth) 87726 NM Y Y No 5010A1

OptumHealth Care Solutions(Formerly United ResourcesNetworks)(OptumHealth)

41194 ALL Y Y No 5010A1

OptumHealth New Mexico 87726 NM Y Y No 5010A1

OptumHealth Vision 00773 ALL Y N No 5010A1

Orange Coast Memorial IPA MHIPA CA N Y No 4010A1

Orange County Foundation forMedical Care OCFMC ALL Y Y No 5010A1

Oregon Health Mgmr OHMS akaPrimary Health OHMSP ALL N N No 5010A1

Orthonet - AETNA 13383 ALL Y Y No 5010A1

Orthonet Corporation 13381 ALL A Y No 5010A1

Orthonet-HealthNet 25681 ALL Y Y No 5010A1

OSF Health Plans 61101 IL Y N No 5010A1

OSG-Michael Reese 37127 IL N N No 5010A1

Oxford (UnitedHealthcare/Oxford) 06111 ALL Y N No 5010A1

Oxford Health Plans 06111 All Y N No 5010A1

Oxford Medicare Network - AARPMedicareComplete 87726 ALL Y Y No 5010A1

Oxford Medicare Network - AARPMedicareComplete Mosaic 87726 ALL Y Y No 5010A1

Oxford Medicare Network -UnitedHealthcare Dual Complete 87726 ALL Y Y No 5010A1

Oxford Mosaic Network - AARPMedicare Complete Mosaic 87726 ALL Y Y No 5010A1

P5 Health 87068 ALL N Y No 5010A1

PA Preferred Health (Call PPHNClaims Operations at 410-349-3222) CALL ALL N Y No 4010A1

PacifiCare Individual Business Plan(UnitedHealthOne) 81400 ALL T N No 5010A1

PacificSource Health Plans 93029 ALL Y Y No DUAL

Pacificsource Medicare 20377 ALL N N No 5010A1

Pacificsource OHP COIHS ALL N Y No DUAL

Palladian Muscular Skeletal Health(Formerly Prism Health Networks) 37268 ALL A N No 5010A1

Palmetto Tricare 38520 Various A Y No 5010A1

Paper Claims (ENS will print andmail the claims submitted with thepayerID of PRINT)

PRINT ALL N N No PRINT

Paragon Benefits, Inc. 58174 ALL N Y No 5010A1

Paramount Health SX158 ALL N N No DUAL

Parity Healthcare, Inc. 58204 ALL N N No 5010A1

Parkland Community Health Plan 66917 ALL N Y No 5010A1

Partner Care M3FL7 ALL Y Y No 5010A1

Partners Behavioral Health 13141 ALL N N Yes 5010A1

Partners National Health Plans ofNorth Carolina, Inc (Contractedproviders only. Call 888-296-9790)

56152 NC Y Y No DUAL

Partnership HealthPlan of CA PHP02 CA N N Yes DUAL

Pasadena Primary Care Physicians IP080 CA N Y No DUAL

Passport Advantage (For claimswith dates of service after12/31/2009. For earlier claims useSX154.

76569 ALL N Y No 5010A1

Passport Health Plan 61129 ALL Y Y No 5010A1

Patient Advocates, LLC 10525 ALL Y Y No 5010A1

Patient Services, Inc. CB733 ALL Y Y No 5010A1

PATIENTPAY 26335 ALL N Y No 5010A1

Peach State Health Plan (BehavioralHealth) 68069 GA Y Y No 5010A1

Peach State Health Plan (Medicaid)(Call 800-225-2573 ext 25525 priorto submitting claims.)

68069 GA Y Y No DUAL

Pediatric Associates of Broward 20472 ALL Y Y No 5010A1

PEHP - Utah Public Employee HealthPlan CALL UT Y Y Yes 4010A1

PEHP - Utah Public Employee HealthPlan (Enrollment required, pleasecontact Provider Relations 800-

SX106 UT Y Y No 5010A1

Peninsula Healthcare VABLS VA Y Y Yes 5010A1

Pennsylvania Keystone Health PlanEast (claims only) PCBLS PA Y Y Yes 5010A1

Pennsylvania Keystone Health PlanEast (encounters only) PEBLS PA Y Y Yes 5010A1

Pennsylvania Life Insurance 23130 PA Y Y No 5010A1

Pennsylvania Pace 20172 ALL Y N No 5010A1

Peoples Health Network (Tenet)(Network ID must be on [email protected])

72126 ALL N Y No 5010A1

Personal Choice PPO ofPennsylvania (Also know asIndependent BLC)

54704 PA N Y Yes 5010A1

Personal Insurance Administrators 95397 ALL N N No 5010A1

PHCS GEHA 45275 ALL N N No 5010A1

PHCS Savility (ONLY for Savilitycard members.) 13306 ALL N Y No 5010A1

Phifer Wire Insurance (Per requestfrom Payer, claims are printed andmailed.)

PHIF4 ALL N N No PRINT

Phoenix American Life 67814 All Y N No 5010A1

Phoenix Health Plan 03440 AZ Y Y No 5010A1

Phoenix Home Life 67814 ALL Y N No 5010A1

Phoenix Home Life Mutual Ins. Co. 67814 ALL Y N No 5010A1

Phoenix Mutual 67814 ALL Y N No 5010A1

Phycor (Ft Collins office only) PHYCR CO N Y Yes 4010A1

Physician Associates of Greater SanGabriel Valley PA513 CA Y Y Yes 4010A1

Physician Associates of Lousiana(PAL) 58204 LA Y N No 5010A1

Physician Health Partners Medicare PHPMD ALL N Y No 5010A1

Physician United Plan 10775 ALL N Y No 5010A1

Physicians Care Network 38265 ALL Y Y No 5010A1

Physicians Care Network (Rockford,IL Only) PayerID valid only forclaims with billing submission na

36345 IL Y N No 5010A1

Physicians Care Network/ThePolyclinic PCN12 ALL N N No 5010A1

Physicians Corporation of America(Florida Plan Only) 65018 FL Y Y No 5010A1

Physicians Health Association ofIllinois 37136 IL Y N No 5010A1

Physicians Health Choice - Claims(Administered by Wellmed) PHCS1 ALL N N No 5010A1

Physicians Health Collaborative 20398 ALL Y Y No 5010A1

Physicians Health Plan 37330 ALL N Y No 5010A1

Physicians Health Plan (PHP-SC) 09173 ALL Y Y No 5010A1

Physicians Health Plan of NorthernIndiana 12399 IN A Y No DUAL

Physicians Health Services (nowHealth Net of NE) (Health Net sixdigit ID REQUIRED in B0X33a call 8


Physicians Healthways IPA PHIPA CA N Y No 4010A1

Physicians Mutual InsuranceCompany 47027 ALL N Y No 5010A1

Physicians Plus Insurance Corp. 39156 ALL A Y No 5010A1

PIA 95397 ALL N N No 5010A1

Piedmont Behavioral Health 06607 ALL Y Y No 5010A1

Pima Health System PMA86 AZ N Y Yes 4010A1

Pinnacol Assurance CCIA1 CO Y Y No 5010A1

Pioneer Provider Network PPNZZ ALL N N Yes DUAL

Pipe Industry Health & WelfareFund of Colorado COMPU CO N N No 5010A1

Pipefitters Local 597 59700 ALL N N No 5010A1

Pittman and Associates 37224 ALL Y Y No 5010A1

Planned Administrators, Inc. (PAI) 37287 ALL N N No 5010A1

PMG of San Jose PMGSJ CA N N Yes 4010A1

Podiatry Network FL 59324 FL N N No 5010A1

POMCO 16111 ALL Y Y No 5010A1

Pomona Valley Medical Group(PVMG) ProMed IP057 CA N N No 4010A1

PPO Oklahoma (WinterBrookHealthCare Management) 73159 OK Y Y No 5010A1

PPO Plus, LLC 72148 ALL Y Y No 5010A1

Practicare 04334 ALL N Y No 5010A1

Prairie States Enterprises, Inc. 36373 ALL N Y No 5010A1

Preferred Administrator (ContactProvider Relations @ (915)532-2778, x1068)

EPF10 TX Y N No 5010A1

Preferred Benefit Administrators 53476 ALL Y N No 5010A1

Preferred Care NY SX089 NY Y Y Yes 5010A1

Preferred Care Partners (Encountersfrom delegated entities only. To getpayerID, call Jeff Nehms at

CALL FL N N No 4010A1

Preferred Care Partners(Miami,Florida) 65088 FL N Y No 5010A1

Preferred Community Choice 73145 ALL Y Y No 5010A1

Preferred Health Care - PPOLancaster, PA (IHS Gateway Payer)- Contact Sherry Wolgemuth at(717)560

CALL PA Y Y No 4010A1

Preferred Health Plan (Louisville,KY) 61106 KY Y Y No 5010A1

Preferred Health Professionals 31478 ALL Y Y No 5010A1

Preferred Health ProfessionalsKansas City 00036 KS,MO N N No DUAL

Preferred Health Systems InsuranceCo (PPO) 61665 ALL Y Y No 5010A1

Preferred Health Systems, Inc. 60110 ALL Y Y No 5010A1

Preferred IPA PFIPA ALL N Y No 5010A1

Preferred Network Access 36401 ALL N N No 5010A1

Preferred One 41147 ALL Y Y No 5010A1

Premier Eye Care (Please contactSteve Moran 1-800-738-1889 priorto claims submission.)


Premier Health Systems, Inc. 90440 ALL Y Y No 5010A1

Premier Physicians Network CAPMN ALL A Y No 5010A1

Presbyterian Health Plan(Commercial) (Provider ID isrequired. Contact (888) 923-5757,#6 then #2 t

PREHP NM Y N No 5010A1

Presbyterian Salud (Please addprovider number in 2010AA REF02or 2310B REF02 Number is 11 digitsor

PRESA NM N N No 5010A1

Presbyterian(NM) 05003 NM Y Y No 5010A1

Prestige Health Choice 45056 ALL Y Y No 5010A1

Prevea Health Insurance Plan 39185 ALL A N No 5010A1

Primary Choice (Aetna HP-NY/NJ) 60054 NY, NJ Y Y No 5010A1

Primary Delivery Systems 73288 ALL Y Y No 5010A1

Primary Health Network 82048 ALL Y Y No 5010A1

Primary Health Plan PRIME ALL Y N No 5010A1

Primary PhysicianCare, Inc. 56144 ALL Y Y No DUAL

Prime West Health Plan 11678 MN N Y No 5010A1

PrimeCare Health Plan IP079 CA Y N No DUAL

PrimeSource Health Network 04320 ALL Y Y No 5010A1

Principal Financial Group 61271 All Y Y No DUAL

Principal Mutual Life InsuranceCompany 61271 All Y Y No DUAL

Printing Ind Assoc of So CA (PIASC) 87056 All Y Y No 5010A1

Priority Health (Please contactPriority Health EDI Dept at 616-464-8686 or email EDISETUP@Priority-

38217 ALL N Y No 5010A1

Priority Healthcare VABLS VA Y Y Yes 5010A1

Prism First Health 37303 ALL N N No 5010A1

Prism Health Networks (Now knownas Palladian Muscular SkeletalHealth )

37268 ALL A N No 5010A1

Prism Univera 37315 ALL N N No 5010A1

Pro Care Health Plan, Inc. (Valid forPO Box 3160 and 3590, Detroit MIonly.)

38329 MI Y Y No 5010A1

ProCare Health Plan Medicaid 70259 ALL Y Y No 5010A1

Producer’s Exchange PEBSI ALL N N No 5010A1

Professional Benefit Administrators,Inc. (Oak Brook, IL) 36331 IL A N No 5010A1

Professional BenefitsAdministrators (Winter Park, FL) 59296 FL Y N No 5010A1

Professional Claims Management 37242 ALL Y Y No 5010A1

Professional Risk Management, Inc. 34134 ALL N N No 5010A1

Promina 58226 ALL Y Y No 5010A1

Prospect Medical Group PROSP CA Y Y No 4010A1

Protective Life Insurance Company 37309 ALL Y Y No 5010A1

Providence Choice Option PHP01 ALL Y Y Yes DUAL

Providence Good Health Plan PHP01 ALL Y Y Yes DUAL

Providence Preferred (PPO)(ProviderID and Enrollmentrequired.)

PHP00 ALL Y Y Yes DUAL

Provident Life & Accident InsuranceCompany 68195 All Y Y No 5010A1

Provident Life & Accident InsuranceCompany of America 68195 All Y Y No 5010A1

Provident Life & Casualty InsuranceCompany 68195 All Y Y No 5010A1

ProviDRs Care Network 48100 ALL N N No 5010A1

PruCare 68241 All Y N No 5010A1

PruCare HMO (Encounters Only) HM015 All Y N No 4010A1

Prucare Plus 68241 All Y N No 5010A1

Prudential 68241 All Y N No 5010A1

Prudential Encounters HM015 All Y N No 4010A1

Prudential Health Care Systems 68241 All Y N No 5010A1

PruNetwork 68241 All Y N No 5010A1

PSN FL Medicaid JMH 09822 ALL Y Y No 5010A1

Psychcare, LLC 51052 ALL Y Y No 5010A1

Puget Sound Benefits Trust -Grp#F25 91136 WA Y N No 5010A1

Puget Sound Electrical WorkersTrust - Grp#33 91136 WA Y N No 5010A1

Puget Sound Health Partners, Inc. 42172 WA Y Y No 5010A1

QuadMed (West Allis, WI) 39197 ALL Y N No 5010A1

Qual Choice of Arkansas 35174 AR Y N No 5010A1

Qual Choice of Ohio 01250 OH Y Y No 5010A1

Qualcare 23342 ALL Y Y No 5010A1

Quality Care Partners 89461 ALL R Y No 5010A1

QuantumCare (We Care HealthPlan) QCTPA ALL N N No 5010A1

Quicktrip Corporation 73067 ALL N Y No 5010A1

QVI Risk Solutions, Inc. 57117 ALL N Y No 5010A1

Radcon, Inc. (Please contact KathyKing @ 856-608-1350 for Payer IDinformation.)


RBMS, LLC 91176 ALL Y Y No 5010A1

Redlands IPA (Synermed) SYMED ALL N Y No 4010A1

Regal Medical Group REGAL ALL Y Y No 4010A1

Regence Blue Shield of Washington RGBLS WA Y Y No DUAL

Regional Care, Inc. 47076 ALL Y Y No 5010A1

Rehn and Associates REHNA ALL Y N No DUAL

RELIASTAR (Formerly NWNL) PH018 All Y Y No DUAL

Renaissance PhysiciansOrganization 76066 ALL Y Y No 5010A1

Reserve National Insurance (ForClaims rejections, please contactReserve national Customer Service

73066 ALL N Y No 5010A1

Resolve Health Plan Administrators(Authorization number required:begins with the number 5 and is 1

20481 ALL Y Y No 5010A1

Resurrection Physician ProviderGroup RPPG1 ALL N N No 5010A1

Revclaims (Provides TPL benefitsservices for Providers. Providersmust be contracted with RevClaims

RVC01 ALL N N No 5010A1

Right Care from Scott & White 74205 ALL N Y No 5010A1

RightChoice Benefits Administrators 37331 ALL N Y No 5010A1

RIVER CITY MEDICAL GROUP RCMG1 CA N Y No 5010A1

Riverside Family Health Med GrpIPA MPM08 CA N N No DUAL

Riverside Health, Inc 45281 ALL N N No 5010A1

RMSCO, Inc. 16117 ALL Y Y No 5010A1

Rocky Mountain Health Plan GrandJunction SX141 ALL Y N No 5010A1

Rocky Mountain HMO RMHMO CO Y Y Yes 5010A1

Rooney Life Ins. 37602 All N Y No 5010A1

Rush Prudential Health Plans (HMOOnly) 36389 ALL Y Y No 5010A1

Rush Prudential Insurance Co. (PPO& POS Only) 68241 ALL Y N No 5010A1

& POS Only)

S & S Healthcare Strategies 31441 ALL A Y No DUAL

SafeGuard SFG99 ALL Y N No 5010A1

Sagamore Health Network, Inc. 35164 All Y N No DUAL

Sage MNDH1 ALL Y Y No 5010A1

Sage Plus MNDH1 ALL Y Y No 5010A1

Sage Technologies (FormerlyCCMSI) (Claims for payer address ofRockford, IL ONLY.)

37105 ALL Y N No 5010A1

Sage Technologies - PBS 37137 ALL Y Y No 5010A1

Saint Marys Health Plan 88029 ALL Y Y No 5010A1

Samaritan Advantage SAMAD ALL N Y No DUAL

Samaritan Choice Plan SAMCP ALL N Y Yes DUAL

Samaritan Health Kids Connect SAMHK ALL N Y Yes DUAL

Samaritan Health Services SAMHS ALL N Y Yes DUAL

Samaritan Select SAMSE ALL N Y Yes DUAL

San Diego County Low IncomeHealth Program/Coverage Initiative MSO77 CA N Y No 5010A1

San Diego County Medical Services(CMS) MSO11 CA N Y No 5010A1

San Diego County PhysicianEmergency Services MSO22 CA N Y No 5010A1

San Diego County Primary CareServices MSO44 CA N Y No 5010A1

San Diego County Ryan WhitePrimary Care Program MSO33 CA N Y No 5010A1

San Luis Obispo Select IPA 33072 ALL N N No 5010A1

Sandhills Center SHC30 ALL N Y Yes 5010A1

Sandia Triple Option Plan (SandiaTOP) 68241 ALL Y N No 5010A1

Sanford Health Plan MNSHP ALL Y Y No 5010A1

Santa Clara Family Health Plans 24077 CA N N No 4010A1

Sante Health Systems 77038 ALL N N No 4010A1

Sanus HMO-St. Louis (GeneralAmerica) 63665 All Y N No 4010A1

Sanus PPO (General America) 63665 All Y N No 4010A1

SC BCBS Companion Health SC922 SC Y Y Yes 5010A1

SC BCBS Planned Administrators SC886 SC Y Y Yes 5010A1

SC BCBS State Employee HealthPlan SC400 SC Y Y Yes 5010A1

SC FEP Blue Cross SC402 SC Y Y Yes 5010A1

SCAN Encounters (Diversified DataDesign (DDD)) 99157 ALL N Y No 5010A1

SCAN Health Plan 72261 ALL Y Y No 5010A1

Scan Health Plan Arizona 73172 AZ Y Y No 5010A1

SCAN Long Term Care 20460 ALL N N No 5010A1

Schaller Anderson CHOC HealthAlliance SCH01 ALL N Y No 5010A1

SCHC Total Care 16146 ALL Y Y No 4010A1

Scott & White Health Care 88030 TX N N No 5010A1

Screen Actors Guild 99289 ALL N Y No 5010A1

Seaview IPA SVIPA ALL N N No 5010A1

Secure Health of Georgia 28530 GA Y Y No DUAL

SecureCare of Iowa 42142 IA Y Y No 5010A1

SecureHorizons MedicareComplete(SecureHorizons byUnitedHealthcare)

87726 ALL Y Y No 5010A1

SecureHorizons MedicareDirect(SecureHorixons byUnitedHealthcare)

87726 ALL Y Y No 5010A1

Security Health Plan 39045 ALL Y N No 5010A1

Select Benefit Administrators(PayerID valid for claimssubmission address of PO Box 8339,Des Moine

42137 IA A N No 5010A1

Select Benefit Administrators ofAmerica 37282 ALL N N No 5010A1

Select Benefit Administrators, Inc. 93031 ALL N Y No 5010A1

Select Choice 60054 All Y Y No 5010A1

Select Health of South Carolina(Provider ID required in Box33a.) 23285 SC N Y No 5010A1

SelectCare 00014 MO,IL A Y No 5010A1

SelectCare (Coca Cola) 68241 ALL Y N No 5010A1

SelectCare of OK - Tribute SCOK1 OK A N No 5010A1

SelectCare of Texas (HPN) HeritagePhysicians Network 76045 TX Y Y No 5010A1

SelectCare of TX (Beaumont)(Provider ID Required - Contact(713) 843-6780 to obtain ID.)

GTPA1 TX A N No 5010A1

SelectCare of TX (Houston)(Provider ID Required - Contact(713) 843-6780 to obtain ID.)

HPN11 TX A N No 5010A1

SelectCare of TX (Kelsey-Seybold)(Provider ID Required - Contact(713) 843-6780 to obtain ID.)

KLSY1 TX A N No 5010A1

SelectHealth (Formerly IHC)(Contact payer at 801-442-5442before sending claims to verifyprovider

UH107 UT Y Y Yes 5010A1

Self Insured Plans, LLC 36404 ALL Y Y No 5010A1

Self-Funded Plans (IL, PA, OH) 34131 IL,PA,OH Y Y No 5010A1

Sendero Health 36426 ALL N Y No 5010A1

Senior Care 68241 All Y N No 5010A1

Senior Care Partners NANPR ALL Y N No 5010A1

Senior Choice (Aetna HP-NY/NJ) 60054 All Y Y No 5010A1

Senior Smart Choice 95444 ALL N N No 5010A1

Senior Whole Health 83035 ALL N Y No 5010A1

Sentara Family Plan 54154 ALL Y Y No DUAL

Sentara Health Management 54154 ALL Y Y No DUAL

Sentara Mental Health Professional 5415M ALL N N No 5010A1

Sentinel Management Services 23249 ALL N Y No 5010A1

Sentry Insurance Co. (Sentry LIfeInsurance Co. Group and Subscribernumbers 800-426-7234)

39033 ALL Y Y No 5010A1

Seoul Medical Group IP080 CA N Y No DUAL

Seton CHIP (Provider ID required.) SHPCH ALL N N No 5010A1

Seton Employee Plan SHEBP ALL N N No 5010A1

Seton Map Program - Mediview(Provider ID required) SHMAP ALL N N No 5010A1

Seton Star STAR1 ALL N N No 5010A1

Seven Corners 25404 ALL N N No 5010A1

Sharp Community Medical Group SCMG1 CA N Y Yes 5010A1

Shasta Administrative Services,(Jeld-Wen Claims only) 75280 ALL A N No 5010A1

Sheakley UniComp (OH BWC) 10002 OH N N No 5010A1

Sheet Metal Workers Local 104(PayerID valid for submission add ofPO Box 1138, San Ramon, CA94583.

38238 CA N N No 5010A1

Sherman Choice SC359 ALL N N No 5010A1

Sierra Health and Life 76342 CA,NV R Y No 5010A1

Sierra Health and Life (Encounterclaims) (SecureHorizons byUnitedHealthcare)

76343 ALL R Y No 5010A1

Sierra Health and Life (EncounterClaims) (SecureHorizons byUnitedHealthcare)

76342 ALL R Y No 5010A1

Sierra Health and Life (Encounters) 76342 CA,NV R Y No 5010A1

Sierra Health and Life (FFS Claims)(SecureHorizons byUnitedHealthcare)

76342 ALL R Y No 5010A1

Sierra Health Services Encounters 76343 CA,NV R Y No 5010A1

Significa Benefit Services, Inc. 23250 ALL Y Y No 5010A1

SIHO NTWKS ALL N N No 5010A1

Silver Care Managed CareOrganization 36387 IL Y Y No 5010A1

Silver Cross Managed CareOrganization NASCR IL Y Y No 5010A1

Simply HealthCare Plans 27094 ALL N Y No 5010A1

Sinclair Health Plan 84076 ALL N Y No 5010A1

SISCO SISCO ALL N N No 5010A1

SMA 72112 All Y Y No 5010A1

SMA 65 72112 All Y N No 5010A1

SMA Health Plan 72112 All Y N No 5010A1

SMA HMO 72112 All Y N No 5010A1

SmartPlan 72112 All Y N No 5010A1

SmartPlan 65 72112 All Y N No 5010A1

Smith Administrators SMITH ALL A N No 5010A1

Smokey Mountain Center 13010 ALL Y N Yes 5010A1

Sound Health 91131 All Y N No DUAL

South Central Preferred - PPO York,PA (IHS Gateway Payer) ( ContactJane Grove for South Central Pr


South Dakota Chiropractic (SanfordHealth Plan) CASD2 SC R Y No 5010A1

South Indiana Health Options - HMO SX142 IN Y Y No 5010A1

Southcare / Healthcare Preferred 25147 ALL N Y No 5010A1

Southeast Iowa Health Plan(Provider ID Required) 86068 IA Y Y No DUAL

Southeast Medical Alliance 72112 All Y N No 5010A1

Southern Benefit Services 37318 ALL A Y No 5010A1

Southern Cal Physicians ManagedCare Services SCP01 CA N N No 4010A1

Southern California Bakery DriversSecurity Fund NWADM CA N Y 5010A1

Southwest Service Life 37266 ALL N N No 5010A1

Southwestern Bell 68241 All Y N No 5010A1

Southwestern Bell Executive -Custom Care 68241 All Y N No 5010A1

Southwestern Bell Executive -Southwestern Bell 68241 All Y N No 5010A1

Spectera 00773 ALL Y N No 5010A1

Spectrum Administrators 23253 ALL N Y No 5010A1

St Joseph Health IP062 CA N Y No DUAL

St. Barnabas System Health Plan 22240 ALL N Y No 5010A1

St. John’s Claims Administration 37264 ALL N N No 5010A1

St. Joseph Heritage Healthcare IP106 CA Y N No DUAL

St. Joseph HUMBOLT County IP059 CA A Y No DUAL

St. Therese Physician Association 37116 ALL Y N No 5010A1

Standard Life & Accident 01758 ALL N N No 5010A1

STAR HRG (Now part of CT GeneralLife Insurance.) 59225 ALL Y Y No 5010A1

Starmark 61425 All Y N No 5010A1

State Employees Group Benefits 72087 LA Y Y No 5010A1

State Farm (Casualty and Property) 31059 ALL N Y No 5010A1

State Farm Group Medical & IndHealth Ins Co (Note that payerrequires Insured’s ID of 11 or 12 digi

31053 ALL Y Y No 5010A1

State Merit GA GABLS GA Y Y No 5010A1

States General Life Insurance 75087 ALL Y Y No 5010A1

Sterling Medicare Advantage 67829 ALL Y N No DUAL

Sterling Option 1 91151 ALL N N No 5010A1

Stirling & Stirling 06089 ALL Y N No 5010A1

Stoner & Associates 31121 ALL N N No 5010A1

Stones River IPA 28943 CA N Y No 5010A1

Stones River IPA Amerivantage 57492 ALL Y Y No 5010A1

Stones River Regional IPA - Windsor 15752 ALL Y Y No 5010A1

Student Resources International(UnitedHealthcare) 74227 ALL Y N No 5010A1

SummaCare Health Plan 95202 ALL Y Y No 5010A1

Summerlin Life and Health 86071 NV HI Y Y No 5010A1

Summit America InsuranceServices, Inc. (Student Accident andSickness, College Sports and NASCCcla

37301 ALL Y Y No 5010A1

Sun Health Corporation SX186 ALL N Y No 5010A1

Sun Trust Bank, Inc. 68241 All Y N No 5010A1

SunAmerica Life Ins Co (NFIC Planonly) 90956 ALL N N No 5010A1

Sunshine Health Plan 68069 ALL A Y No DUAL

Superior Administrators, Inc. 23218 ALL N N No 5010A1

Superior Health Plan 68069 TX Y Y No DUAL

Sutter Connect - Central Valley MedGroup (Claims) 77035 CA Y Y No 5010A1

Sutter Connect - Delta - Claims IP100 CA Y Y No DUAL

Sutter Connect - SIP, SMG, SWMG -Encounters only HM059 CA Y Y No DUAL

Sutter Connect - Solano RegionalMedical Group - Claims IP099 CA Y Y No DUAL

Sutter Connect - Sutter GouldMedical Foundation - Claims IP091 CA Y Y No DUAL

Sutter Connect East Bay MedFoundation IP130 CA Y Y Yes DUAL

Sutter Connect Sutter MedicalGroup (SMG,SWMG,SIP) (Pleasecontact Sutter to get set up to sendclai

IP092 CA Y Y No DUAL

Sutter Medical Group of theRedwoods (SMGR) (Please contactSutter to get setup to sendEncounters,

HM057 CA Y Y No DUAL

SW Service Administrators 53589 AZ Y Y No 5010A1

Talbert Medical Group TALMG ALL Y Y No 5010A1

Tall Trees Administrators 88067 ALL Y Y No 5010A1

Tarrant 37228 TX N N No 5010A1

Tattered Cover, Inc. COMPU CO N N No 5010A1

Teachers Health Trust 88019 ALL Y Y No 5010A1

Team Health Care Partnership, Inc.(OH BWC) 10038 OH N N No 5010A1

Team Health Gold 75139 ALL Y N No 5010A1

Teamcare 36215 All Y N No 5010A1

Teamsters (UT/ID/MT) 88054 UT, ID, MT A Y No 5010A1

Teamsters Benefit Trust 94304 ALL N N No 5010A1

Teamsters Local 631 Security Fundfor Southern Nevada NWADM CA N Y No 5010A1

Teamsters Miscellaneous SecurityTrust Fund NWADM CA N Y No 5010A1

Tech-Steel, Inc. 74234 ALL N N No 5010A1

TennCare (Medicaid of Tennessee) TNMCD TN Y Y Yes 5010A1

Tethys Health Ventures 20212 ALL N Y No 5010A1

Texas Children’s Health Plan 76048 TX Y N No 5010A1

Texas Children’s Health Plan(Medicaid) 75228 TX Y Y No 5010A1

Texas Childrens Star Medicaid(Enrollment verification calls shouldbe directed to 800-990-TCHP (824

TXCSM TX Y N Yes 5010A1

Texas First Health Plans TX1ST TX Y Y No 5010A1

Texas HealthSpring THS01 TX Y N No 5010A1

Texas Municipal League GroupBenefits Risk Pool 74214 TX Y N No 5010A1

Texas True Choice TH055 TX Y Y No DUAL

TexasFirst Health Plan 13185 ALL Y N No 5010A1

The Boon Group BOONG ALL Y N No 5010A1

The Care Network 68423 ALL Y Y No 5010A1

The Chesterfield Companies 34154 ALL N N No 5010A1

The City of Amarillo COA01 TX Y N No 5010A1

The City of Odessa 75600 ALL N Y No 5010A1

The Ford Meter Box Company, INC 37305 ALL N N No 5010A1

The Health Exchange (CernerCorporation) 20356 ALL Y Y No 5010A1

The Health Plan (Formerly known asHometown Health Plan of Ohio.) 30757 OH A N No DUAL

The Health Plan (Upper Ohio Valley) 34150 ALL Y Y No DUAL

The Healthcare Group (THCG) 35206 ALL N N No DUAL

The Integrity Benefit Network, Inc. 58200 ALL N N No 5010A1

The Loomis Company (Call ProviderRelations at 610-374-4040 ext. 2438for procedures prior to submit

23223 ALL Y Y No 5010A1

The MEGA Life and HealthInsurance Company-OKC (Valid ifPO BOX 548801 Oklahoma City OK73154.)

59227 ALL N Y No 5010A1

The Oath - Health Partners ofAlabama (Now known asHealthSpring HMO/HealthSpringMedicare+Choice)


Therapy Review System 75305 ALL N T No 5010A1

Thomas Cooper (Provider must beenrolled with SC Blue Shield.) SC315 SC Y Y Yes 5010A1

Three Rivers Preferred MP340 ALL N Y No 5010A1

Three Rivers Provider Network (Nowknown as Unison Health Plan.) 25175 ALL N Y No 5010A1

Time Insurance (A Fortis Company) 39065 All Y N No 5010A1

TLC Advantage in Sioux Falls TLC01 SD R Y No 5010A1

Today’s Health WITH1 ALL Y Y No 5010A1

Today’s Health Wisconsin 20081 ALL Y N No 5010A1

Todays Option (AmericanProgressive and Pyramid Life) 48055 ALL N N No 5010A1

Tongass Timber Trust 92620 AK N N No 5010A1

Tooling & Manufacturing Assoc. 61425 All Y N No 5010A1

Total Care of NY TCARE NY N N No 5010A1

Total Carolina Care 68069 ALL Y Y No 5010A1

Total Community Care 31182 ALL Y Y No 5010A1

Total Health Management, Ltd. (OHBWC) 10019 OH N N No 5010A1

Total Healthcare, Inc. 38201 MI Y Y No 5010A1

Touchstone Health PSO 23856 ALL Y Y No 5010A1

Touchstone Health/Health NetSmart 13402 ALL Y N No 5010A1

Tower Life Insurance Company 69493 All Y N No 5010A1

TR Paul Inc. 37230 ALL N N No 5010A1

Transamerica Life Ins.Co.(Specialized claims only. Call501-277-1284 for information.)

TLINS ALL N N No 5010A1

TransAmerica Life InsuranceCompany (Valid for PO Box 982009,North Richland Hills, TX 76182)

59222 ALL Y Y No 5010A1

Transchoice - First Administrator’s 20807 ALL N Y No 5010A1

Transchoice - Key Benefit Admin 37284 ALL N N No 5010A1

Transchoice or TransSmile FirstService Administrators 20807 ALL N Y No 5010A1

Transwestern General Agency 74234 ALL N N No 5010A1

Transwestern InsuranceAdministrators, Inc. TRAN1 ALL N N No 5010A1

Tricare (Formerly known asTriWest) (To use for claims w/DOSon/after 4/1/13)

99726 MANY Y Y Yes 5010A1

Tricare (Formerly known asTriWest) (To use for claims w/DOSprior to 4/1/13)

WESTR MANY Y Y Yes 5010A1

Tricare for Life (All Regions 1-12) TDDIR ALL Y Y Yes 5010A1

Tricare North 38520 Various A Y No 5010A1

Tricare South 38520 VARIOUS A Y No 5010A1

TriHealth Physician Solutions 31144 ALL N N Yes 5010A1

Trilogy Health 98514 ALL N Y No 5010A1

TRLHN/EB 62777 ALL Y N No 5010A1

True Choice USA TCUSA ALL Y Y No 5010A1

Trusteed Plans Service Corporation 91078 ALL N N No 5010A1

Trustmark (Includes Starmark &TMA) 61425 All Y N No 5010A1

Tufts Associated Health 04298 ALL Y Y No DUAL

UC Care (University of CA) 68241 CA Y N No 5010A1

Ucare of Minnesota 52629 MN Y Y No 5010A1

UFCW Local 400-5205 (Submittersto UFCW must register with CA BlueShield at www.blueshieldca.com/pr

BS001 CA Y Y Yes 5010A1

UICI Administrators - State ofNevada 75245 NV Y N No DUAL

Ultra Benfits Inc. 41206 ALL N Y No 5010A1

UMC Health Plan 75130 ALL Y Y No 5010A1

UMR Cincinnati 31107 ALL N Y No DUAL

UMR Kansas (Formerly FiservHealth - Kansas) 62061 ALL Y N No 5010A1

UMR Onalaska 79480 ALL N N No 5010A1

UMR San Antonio 74223 All Y N No 5010A1

UMR Wausau 39026 All Y Y No 5010A1

UMR Westerville (HarringtonHealth) 75196 All Y N No 5010A1



UMWA Health & Retirement Funds 52180 All Y N No 5010A1

Unicare Life & Health InsuranceCompany 80314 All Y Y No 5010A1

Unified Group Services 35198 OH Y Y No 5010A1

Unified Health Services 62170 ALL Y Y No 5010A1

Unified Physicians Network (ForClaims rejections, please contact 34638 ALL N Y No 5010A1

Unified Physicians claim departmen

Uniformed Service Family HealthPlan 13407 ALL Y Y No 5010A1

Union Pacific Railroad EmployeesHealth Systems 87042 ALL Y Y No 5010A1

Unison DC, DE, NJ, OH, PA, SC, TN(UnitedHealthcare Community Plan) 25175 Various N Y No 5010A1

Unison Health Plan (Formerly ThreeRivers Provider Network.) 25175 ALL N Y No 5010A1

United Agriculture Benefit Trust UABT1 ALL N Y No 5010A1

United Benefits, Inc (a Brown &Brown Company) 59069 All Y N No 5010A1

United Care Medical Group ADCUC ALL N N No 5010A1

United Medical Alliance (UMA) 84132 CO N N Yes 4010A1

United Medical Resources, Inc.(Some of UMR’s new member cardsno longer print the full SSN. Whensu


United of Omaha 71412 All N N No 5010A1

United Physicians International IPA MPM15 CA N N No 4010A1

United Physicians of NorthernColorado 84132 CO N N Yes 4010A1

UnitedHealthcare 87726 All R Y No 5010A1

UnitedHealthcare((UnitedHealthcare River Valley(formerly known as John DeereHealthcare))

95378 ALL Y Y No 5010A1

UnitedHealthcare (Definity HealthPlan) former payer ID 64159 87726 ALL Y Y No 5010A1

UnitedHealthcare (Empire Plan) 87726 ALL Y Y No 5010A1

UnitedHealthcare (MAHP) (MD IPA,Optimum Choice and MLH)formerly MAMSI former payerID52148

87726 ALL Y Y No 5010A1

UnitedHealthcare (StudentResources International) 74227 TN Y N No 5010A1

UnitedHealthcare (UHIS-UnitedHealthcare IntegratedServices)

39026 ALL Y Y No 5010A1

UnitedHealthcare Community Plan(AmeriChoice by UnitedHealthcare(NYU))

87726 ALL Y Y No 5010A1

UnitedHealthcare Community Plan

(AmeriChoice CT, FL, LA, MD, RI,TX, WI)

87726 ALL Y Y No 5010A1

UnitedHealthcare Community Plan(AmeriChoice MS-CHIP and CAN) 95378 ALL Y Y No 5010A1

UnitedHealthcare Community Plan(AmeriChoice NE) 87726 ALL Y Y No 5010A1

UnitedHealthcare Community Plan(AmeriChoice NJ, Medicaid, NJFamily Care)

86047 NJ Y Y No 5010A1

UnitedHealthcare Community Plan(AmeriChoice of Iowa) 95375 IA Y Y No 5010A1

UnitedHealthcare Community Plan(AmeriChoice of NY Medicaid &Child Health Plus

86048 NY Y Y No 5010A1

UnitedHealthcare Community Plan(Americhoice Personal Care Plus -NJ)

86001 NJ Y Y No 5010A1

UnitedHealthcare Community Plan(AmeriChoice Personal Care Plus -NY)

86002 NY Y Y No 5010A1

UnitedHealthcare Community Plan(AmeriChoice Personal Care Plus -PA) former payer id 86003

86049 PA Y Y No 5010A1

UnitedHealthcare Community Plan(Americhoice Personal Care Plus PA)former payerID 86003

25175 Various N Y No 5010A1

UnitedHealthcare Community Plan(AmeriChoice TN: TennCare, SecurePlus Complete)

95378 ALL Y Y No 5010A1

UnitedHealthcare Community Plan(Unison DC, DE, PA, SC) 25175 Various N Y No 5010A1

UnitedHealthcare Community Plan(Unison OH) 87726 OH Y Y No 5010A1

UnitedHealthcare Community Plan(UnitedHealthcare hawk-i) 95378 ALL Y Y No 5010A1

UnitedHealthcare Community Plan(UnitedHealthcare Plan of the RiverValley)

95378 ALL Y Y No 5010A1

UnitedHealthcare Great LakesHealth Plan (Great Lakes HealthPlan)

95467 ALL Y Y No 5010A1

UnitedHealthcare Group MedicareAdvantage 87726 ALL Y Y No 5010A1

UnitedHealthcare hawk-I(UnitedHealthcare Community Plan) 95378 ALL Y Y No 5010A1

UnitedHealthcare MedicareSolutions (UnitedHealthcare Group 87726 ALL Y Y No 5010A1

Medicare Advantage)

UnitedHealthcare Medicare Solutons(UnitedHealthcare ChronicComplete) formerly Evercare

87726 ALL Y Y No 5010A1

UnitedHealthcare Medicare Solutons(UnitedHealthcare Nursing HomePlan) formerly Evercare

87726 ALL Y Y No 5010A1

UnitedHealthcareMedicareComplete (formerlySecureHorizons)

87726 ALL Y Y No 5010A1

UnitedHealthcare MedicareDirect(formerly SecureHorizons) 87726 ALL Y Y No 5010A1

UnitedHealthcare Plan of the RiverValley (UnitedHealthcareCommunity Plan)

95378 ALL Y Y No 5010A1

UnitedHealthcare River Valley(formerly known as John DeereHealthcare

95378 All Y Y Yes 5010A1

UnitedHealthcare Vision 00773 ALL Y N No 5010A1

UnitedHealthcare West (formerlyknow as PacifiCare)(UnitedHealthcare)

87726 ALL Y Y No 5010A1

UnitedHealthcare West (formerlyknown as PacifiCare) former payerids 95962, 95964, 95959, 95999

87726 ALL Y Y No 5010A1

UnitedHealthcare WestEncounters(Formerly know asPacifiCare)

95958 ALL N Y No 5010A1

UnitedHealthcare WestEncounters(Formerly know asPacifiCare) (UnitedHealthcare)

95958 ALL N Y No 5010A1

UnitedHealthOne (All SaversInsurance) 81400 ALL Y N No 5010A1

UnitedHealthOne (AmericanMedical Security) 81400 ALL Y N No 5010A1

UnitedHealthOne (PacifiCareIndividual Business) 81400 ALL Y N No 5010A1

Unity Health Insurance 66705 ALL Y N No 5010A1

Unity Health Insurance (Beforesubmitting claims, please call JoeBoerboom at 608-643-1531 for EDIS

66705 WI Y Y No 5010A1

Unity Security Life and Health 81108 ALL N N No DUAL

Univera Health CarePlan/ChoiceCare Buffalo SX087 ALL Y N Yes 5010A1

Univera Healthcare (SSA) SX091 ALL Y Y Yes 5010A1

Univera Healthcare - CNY HC001 NY Y Y No DUAL

Univera Traditional PPO UNINW ALL A N No DUAL

Universal Care - California(ProviderID required.) 33001 CA Y Y No 5010A1

Universal Health Care, Inc. 50528 ALL A N No 5010A1

University Family Care 09830 AZ Y Y No 5010A1

University Family Care 09830 ALL Y Y Yes 5010A1

University Family Care - HealthcareGroup 07503 ALL Y Y Yes DUAL

University Family Care - MaricopaHealth Plan 09908 AZ Y Y No 5010A1

University Family Care - MaricopaHealth Plan 09908 ALL Y Y No 5010A1

University Health Alliance 99026 ALL Y Y Yes 5010A1

University of Miami BehavioralHealth 92579 ALL N N No 5010A1

University of Utah Health Plans SX155 UT Y Y No 5010A1

University of Washington Students& Graduate Appts. - Grp#P67 91136 WA Y N No 5010A1

UPMC Health Plan 23281 ALL Y Y No DUAL

Upper Peninsula Health Plan 38337 ALL A Y No 5010A1

US Benefits 93092 ALL Y N No 5010A1

US Family Health Plan (USFHP) USFHP ALL N Y No 5010A1

USAA 74095 All Y Y No 5010A1

Utah Carpenters 74234 UT N N No 5010A1

Utah Laborers 74234 UT N N No 5010A1

Utah Pipe Trades 74234 UT N N No 5010A1

Utica NY FEP (Federal EmployeeProgram) Blue Shield N4FEP NY Y Y Yes 5010A1

UtiliMED, Inc. 36369 All Y N No 5010A1

VA Fee Basis Programs 12115 ALL N Y No 5010A1

VA State Employer Funds VABLS VA Y Y Yes 5010A1

Valley Health Administrators VHA11 ALL Y N No 5010A1

Value Options Arizona Medicaid 00814 AZ N N Yes DUAL

Value Options Colorado Medicaid 00815 CO N Y Yes DUAL

Value Options Commercial Claims 00813 ALL N N Yes DUAL

Value Options MassachusettsBehavioral Health Partnership 00816 MA N N Yes DUAL

Value Options PennsylvaniaMedicaid 00817 PA N N Yes DUAL

Value Options Texas Northstar 00818 TX N N Yes DUAL

ValueOptions/MBHP (For claimrejections please contact [email protected] 888-24

43307 MA Y Y Yes 5010A1

Vantage Health Plan, Inc. 72128 ALL N Y No 5010A1

Vantage Medical Group PPM01 ALL A N No 4010A1

Vantage Occupational Health Plan(OH BWC) 10061 OH N N No 5010A1

Varian Health Care Plan 68241 All Y N No 5010A1

VENCOR 73288 ALL Y Y No 5010A1

Verity National Group 75256 ALL Y Y No 5010A1

Vida Care (Now known as AmidaCare.) 24818 ALL N Y No 5010A1

VillageCareMAX 26545 ALL N N No 5010A1

VIPA BVVP1 ALL Y Y No 5010A1

Virginia Health Network,Inc (To getthe payerID, call payer at (804)320-3837)


Virginia Premier Health Plan 54176 VA Y Y Yes 5010A1

Vista Oncology New CenturyInfusion Solutions NCH08 ALL A N No 5010A1

Viva Health Plan 63114 ALL Y N No 5010A1

VNS Choice Medicare (FormerlyVisiting Nurse Service) 77073 ALL N Y No 5010A1

Volusia Health Network 59266 ALL N Y No 5010A1

VYTRA Healthcare (Provider IDnumber required. Please call 1-631-420-4100, opt 4, opt 4 for payer se

22264 All Y Y No 5010A1

Wabash Memorial HospitalAssociation 85256 ALL Y Y No 5010A1

Washington State Labor andIndustry WALAI WA N Y Yes 4010A1

Washington State Premera BlueCross WABLC WA Y Y Yes 5010A1

Waterstone Benefit Administrators 73155 OK Y Y No 5010A1

Watts Healthcare Corp IPA MPM09 CA N N No DUAL

WEA Insurance Group 39151 ALL Y N No 5010A1

Weiss Health Providers 36337 ALL N N No 5010A1

Wellcare Health Plan, Inc.(Encounters only) 59354 ALL Y Y No DUAL

Wellcare HMO, Inc. 14163 ALL Y Y No DUAL

Wellcare of CT 14164 CT Y Y No DUAL

Wellcare of NY 14164 NY Y Y No DUAL

WellMed WELM2 ALL A Y No 5010A1

Wells Fargo Third PartyAdministrators (Formerly JSLAdministrators)

37272 ALL N Y No 5010A1

Wells Fargo TPA 87815 ALL Y Y No DUAL

Wenatchee Valley Medical Center 91064 ALL N Y No 5010A1

West Coast Stationary EngineersHealth & Security Trust Fund -Grp#F13

91136 ALL Y N No 5010A1

West Suburban Health Providers 80942 ALL N Y No 5010A1

West Virginia Worker’sCompensation Program 77025 WV N Y Yes 4010A1

Western 39065 All Y N No 5010A1

Western Benefits, Inc. (Also knownas Western Grocers) 93128 ALL Y N No 5010A1

Western Care 39065 All Y N No 5010A1

Western Grower’s Assurance Trust 24735 ALL Y Y No DUAL

Western Grower’s InsuranceCompany 24735 ALL Y Y No DUAL

Western Life Ins. Benefit Plan(FORTIS) 39065 All Y N No 5010A1

Western Mutual Insurance 37247 ALL N N No 5010A1

Western Southern Financial Group 31048 ALL N N No 5010A1

WestLake Financial Group, Inc. 90560 ALL Y Y No 5010A1

Weyco Inc. 38232 ALL Y Y No 5010A1

William C. Earhart Co, Inc. 93050 GA Y Y No 5010A1

William J Sutton & Co. Ltd. 98010 ALL N N No 5010A1

Willis Administrative ServicesCorporation (Now UMR Kansas) 62061 ALL Y N No 5010A1

Wilson-McShane 41095 ALL N N No 5010A1

WIN Healthcare (Woman’sIntegrated Network, Inc.) 13413 ALL Y Y No 5010A1

Windsor Medicare Extra 62153 ALL Y Y No 5010A1

WINHealth Partners Medicare Planadministered by Rocky MountainHMO

RMWIN WY Y N Yes 5010A1

WinHealth Partners/WyomingHealth Solutions 27327 ALL A Y No 5010A1

Wisconsin Auto & Truck DealersInsurance Corporation 39200 WI N N No 5010A1

Wisconsin Dept of Corrections VEST1 WI N N No 5010A1

Woodman Accident and Life Co(AICT Plans only) 81949 ALL N N No 5010A1

Worksite Benefit Services 20333 ALL N Y No 5010A1

World Insurance Company 75276 ALL N N No 5010A1

WPP Eldercare Wisconsin 77080 ALL N Y No 5010A1

WPPA-ProviDRs Care Network WP481 ALL Y Y No DUAL

WPS Commercial OOWPS WI N N Yes 5010A1

Wyoming School Boards AssociationInsurance Trust WYSCH WY N Y No 4010A1

Yale University Health Plan 60646 ALL N Y No 5010A1