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WORKERS' COMPENSATION PAYER LIST
01/05/18Payer ID TX MN CA IL LA NY OR WI NC NM OK VA
All
States 1500 UB04 835
1st Auto & Casualty J1585 x x x x
21st Century Insurance 41556 x x x Rejects Only
22125 Roscoe Corp. 41556 x x x Rejects Only
AAA Northern California, Nevada & Utah Insurance Exchange 41556 x x x Rejects Only
ABC Const. Company 41556 x x x Rejects Only
Acadia Insurance Company * Paper Only
Accident Fund Insurance Co of America J1790 x x x x
Accuride Corporation J1024 x x x x x
Ace Property & Casualty Ins Co 41556 x x x Rejects Only
ACIG Insurance Company J1578 x x x x x
ACTS Retirement - Life Communities J2163 x x x x
Acuity, A Mutual Insurance Company J1240 x x x Rejects Only
AD-COMP J1667 x x x x
Adelanto Correctional Facility (CA) J1798 x x x x
Administaff J1241 x x x x x x x x x x
Administrative Claim Service, Inc J1005 x x x Rejects Only
Adminsure J2292 x x x Rejects Only
Admiral Linen & Uniform Service J2144 x x x Rejects Only
Advance America Cash Advance Centers J1843 x x x x
Advance Services, Inc. J1608 x x x x
Advanced Auto Parts - All states EXCEPT TX MN J2162 x x x x
Advanced Auto Parts - TX MN J2161 x x x x x
Adventist Health System (Bunch CareSolutions) J1973 ** x x x
Advocare MCO, Inc J1896 x x x x
Affiliated Foods, Inc. J1977 x x x
AG Facilities Operations, LLC 41556 x x x Rejects Only
Agri Beef Co. 41556 x x x Rejects Only
AIG-Chartis 19402 x x x Rejects Only
Alaska National Insurance J1577 x x x x
Alcoa Fasteners Systems J1244 x x Rejects Only
Alex Lee, Inc. J2166 x x x x
Allen Canning J1740 x x x x
Allergan W.C. Holding, INC. J2341 x x x Rejects Only
Alliant Energy J1619 x x x x x
Allianz J1452 x x x x
Allied Claims Administration, Inc. J1733 x x x x
Allied Construction (via EMC Risk Services) J1118 x x x x x x
Allied Insurance Companies J1550 x x x x x x x x
Allied Property and Casualty Ins Co J1550 x x x x x x x x
Allmerica Financial Benefits Insurance Company J1589 x x x x
Alta Healthcare 41556 x x x Rejects Only
Page 1 of 29
WORKERS' COMPENSATION PAYER LIST
01/05/18Payer ID TX MN CA IL LA NY OR WI NC NM OK VA
All
States 1500 UB04 835
Alternative Service Concepts (ASC) J2149 x x x Rejects Only
Aluminum Precision (Carl Warren) * Paper Only
Alvey Systems (AON Risk) J1025 x x x x
AMCO Ins Co J1550 x x x x x x x x
America First J1427 x x x Rejects Only
American Airlines - DOI after 9/1/2014 ONLY J2000 x x x x x x x x x x
American Apparel, LLC (DOI after 7/14/16) J2189 x x x x
American Claims Management (ACM) J1236 x x x Rejects Only
American Coin Merchandising, Inc J1026 x x x x
American Cyanamid J1027 x x x x
American Family Mutual Insurance Company J2134 x x x x
American Furniture Warehouse 41556 x x x Rejects Only
American Home Craft J1250 x x x Rejects Only
American Liberty Insurance Company 41556 x x x Rejects Only
American Mining Insurance Group, LLC J1524 x x x x
American Specialty Companies J1028 x x x x
American Specialty Ins. / MIB J1029 x x x x
Amerisure Insurance J1206 x x x Rejects Only
Amerisure Mutual Insurance J1205 x x x Rejects Only
AmGuard Insurance Company - Guard DBA J1453 x x x x
Amtrust North America J1868 x x x x x x
ANACO 41556 x x x Rejects Only
ANAIC Cibus 41556 x x x Rejects Only
Anchor Claims Management J1919 x x x Rejects Only
Anchor Glass Container Corporation J2136 x x x x
Anheuser Busch J1620 x x x x
Antelope Valley Community Hospital J2197 x x x x
Antelope Valley Ret. 41556 x x x Rejects Only
Antelope Valley Union High School District J2185 x x x x
Applied Materials J2160 x x x x
Applied Underwriters (Except AZ) J1775 x x x Rejects Only
Aramark J1502 x x x x
Archer Daniels Midland Company J1735 x x x x
Ardagh Group J2344 x x x Rejects Only
Areas USA, Inc. J1944 x x x x
Argent (Subsidiary of West Bend but this route is Argent only) J1420 x x x x
Argonaut Insurance Company(ARGO) 19801 x x x x
Arizona & 21st Corp. DBA Berkley East Conv. Hospital 41556 x x x Rejects Only
Arkansas Best J2142 x x x Rejects Only
Arrowpoint J1564 x x x x
Association Casualty Insurance Company J1254 x x x x
Page 2 of 29
WORKERS' COMPENSATION PAYER LIST
01/05/18Payer ID TX MN CA IL LA NY OR WI NC NM OK VA
All
States 1500 UB04 835
Association County Commissioners of Georgia (ACCG). J1869 x x x Rejects Only
Athens J1914 x x x Rejects Only
Athens - ABF Freight Systems, Inc J2096 x x x Rejects Only
Athens - Alemeda Health Systems J2097 x x x Rejects Only
Athens - American Apparel, Inc (DOI prior to 7/14/16) J2098 x x x Rejects Only
Athens - American Brass & Iron Foundry J2099 x x x Rejects Only
Athens - Angelus Block J2100 x x x Rejects Only
Athens - Bay Area Housing Authority Risk Management J2101 x x x Rejects Only
Athens - Central County Fire Department J2102 x x x Rejects Only
Athens - Children's Hospital Los Angeles J2103 x x x Rejects Only
Athens - City of Beverly Hills J2104 x x x Rejects Only
Athens - City of Mountain View J2105 x x x Rejects Only
Athens - City of San Jose J2106 x x x Rejects Only
Athens - City of Vernon J2107 x x x Rejects Only
Athens - County of Solano J2108 x x x Rejects Only
Athens - East Bay Municipal Utility District J2109 x x x Rejects Only
Athens - East Bay Regional Parks District J2110 x x x Rejects Only
Athens - Fairmont Hotel J2111 x x x Rejects Only
Athens - FASIS J2112 x x x Rejects Only
Athens - Golden Gate Bridge Highway & Transportation J2113 x x x Rejects Only
Athens - Goodwill Industries (San Francisco, San Mateo, Marin Counties) J2114 ** x x Rejects Only
Athens - H&S Venture J2335 x x x x
Athens - Household Industries Self Insured Group J2115 x x x Rejects Only
Athens - Kings Seafood Company J2116 x x x Rejects Only
Athens - KPC Healthcare J2117 x x x Rejects Only
Athens - Long Beach Public Transportation Company J2118 x x x Rejects Only
Athens - McKesson Corporation J2119 x x x Rejects Only
Athens - Orora North American J2120 x x x Rejects Only
Athens - Placentia-Yorba Linda Unified School District J2121 x x x Rejects Only
Athens - Presbyterian Intercommunity Hospital PIH J2122 x x x Rejects Only
Athens - San Francisco Unified School District J2124 x x x Rejects Only
Athens - Sony Corporation of America J2126 x x x Rejects Only
Athens - Sunsweet Growers, Inc. J2127 x x x Rejects Only
Athens - Temecula Valley Unified School District J2128 x x x Rejects Only
Athens - The Conco Companies - ARCH WC J2129 x x x Rejects Only
Athens - The Conco Companies - Zurich J2130 x x x Rejects Only
Athens - The Permanente Medical Group, Inc. J2131 x x x Rejects Only
Athens - Vintage Senior Living J2132 x x x Rejects Only
Atlantic PPO to Atlantic Imaging Group J2013 x x x Rejects Only
Atlantic PPO to Hartford Insurance J2035 x x x Rejects Only
Atlantic PPO to Merchants Mutual J2046 x x x Rejects Only
Page 3 of 29
WORKERS' COMPENSATION PAYER LIST
01/05/18Payer ID TX MN CA IL LA NY OR WI NC NM OK VA
All
States 1500 UB04 835
Atlantic PPO to New York City Law Department J2053 x x x Rejects Only
Atlantic PPO to NJ-PLIGA J2054 x x x Rejects Only
Atlantic PPO to NY City Transit J2055 x x x Rejects Only
Atlantic PPO to NYC Dept. of Sanitation J2056 x x x Rejects Only
Atlantic PPO to NYSIF J2057 x x x Rejects Only
Atlantic PPO TO QBE Insurance J2067 x x x Rejects Only
Atlantic PPO to Sedgwick WC Insurance J2071 x x x Rejects Only
Atlantic PPO to Sentry Insurance J2074 x x x Rejects Only
Atlantic PPO to Travelers J2079 x x x Rejects Only
Atlantic PPO to U.S. Department of Labor-PA J2081 x x x Rejects Only
Atlantic PPO to US DOL NJ claims J2083 x x x Rejects Only
Atlantic PPO to US DOL NY claims J2084 x x x Rejects Only
Aureon HR Solutions (via EMC Risk Services) J1118 x x x x
Austin Mutual Ins J1682 x x x x
Automobile Dealers Insurance Company Inc J1861 x x x Rejects Only
Auto-Owners \ Home-Owners Insurance Company J1580 x x x x
Auto-Owners \ Owners Insurance Company J1583 x x x x
Auto-Owners \ Property-Owners Insurance Co J1699 x x x x
Auto-Owners \ Southern-Owners Company J1688 x x x x
Auto-Owners Insurance Company J1556 x x x x
Auto-Owners Life Insurance Company J1596 x x x x
AVIR Inc. 41556 x x x Rejects Only
Avizent J1415 x x x Rejects Only
Ayers Trucking J1018 x x x x
Baker Tanks, Inc. 41556 x x x Rejects Only
Bank of America J1729 x x x x
Baptist Healthcare Systems, Inc (KY ONLY) J2164 x x x
Bardavon Health Innovations J2334 x x x Rejects Only
Barnes J1503 x x x x
Barrett Business Services Inc (BBSI) J1686 x x x x
BART - San Francisco Bay Area Rapid Transit J1770 x x x x
Basic Resources, Inc. 41556 x x x Rejects Only
Bass Pro Group, LLC J1958 x x x x
Bb&T Corporation (Branch Banking & Trust) J1995 x x x
Beacon Mutual J1234 x x x x
Beall's Inc / Midwest Employers J1030 x x x x
Bed Bath & Beyond J2167 x x x x
Beeville ISD 41556 x x x Rejects Only
Belk, Inc. J2168 x x x x
Benchmark Insurance J1257 x x x Rejects Only
Berkley Agribusiness Risk Specialists J2190 x x x x