payor list as of august 5, 2013 - freeclaims.com: an online medical … · · 2013-08-0658203 1st...

PAYORID NAME SERVICES ENROLL PERCLAIMFEE COMMENT

31147 1-888-OHIOCOMP (OHIO BWC) N 0.32

NON PARTICIPATING PAYOR. FOR OHIO WORKER'S COMP CLAIMS ONLY (ADDED FEB 2003)

13162 1199 NATIONAL BENEFIT FUND CLAIMS N

Provider should submit claims with assigned Plan Provider ID, as 2 digit suffix is no longer required. Call Renaud Dufresne at (646) 473-6960 for a list of Network ID's.

58203 1st Medical Network Atlanta GA CLAIMS N58203 1st MN Atlanta GA CLAIMS N

37225 3-HAB (OHIO BWC) N

NON PARTICIPATING PAYOR. FOR OHIO WORKER'S COMP CLAIMS ONLY (ADDED FEB 2003)

31147 3-HAB OHIO BWC CLAIMS N 0.32 For Ohio Worker's Comp Claims ONLY.20413 3P ADMIN CLAIMS N93044 A&I BENEFIT PLAN ADMINISTRATORS 0

95241 A.G.I.A. INC. CLAIMS N 0.15CLAIMS ARE PRINTED AND MAILED TO THE PAYER.

75240 AAG Benefit Plan Administrators Inc. CLAIMS N

37225 ABAS INC. N

ALSO KNOWN AS TPA INC. THIRD PART ADMINISTRATORS INC AND AMERICAN BENEFIT ADMINISTRATIVE SERVICES INC. (ADDED FEB 2003)

Payor List as of August 5, 2013

1. Non participating means the payor does not help paying for receiving claims electronically.2. PayorID of "CALL" means to call the payor to get the ID. Next, contact us and give us the ID.3. PILOT means the payor is not yet live or in production, please check back with us at a later time.4. Some payors require registration (noted in the "ENROLL" column). Please make sure you check with them.

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48185 ABC HEALTH PLAN CLAIMS N (ADDED FEB 2003)

E3510

ABMA (ALTA BATES MEDICAL ASSOCS) MEDICAL CORP (HNET SR. AND SECURE HORIZON) CLAIMS P 0.15

ONLY CLAIMS FROM PROVIDERS IN N CA. PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - N CA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

3443 Abrazo Advantage Health Plan CLAIMS68069 ABSOLUTE TOTAL CARETH067 ACCESS ADMINISTRATORS CLAIMS NREGAL ACCESS IPA CLAIMS64071 ACCLAIM CLAIMS N21356 ACCLAIM REPRICING CLAIMS N87815 ACORDIA NATIONAL CLAIMS N

72467 ACS BENEFIT SERVICES, INC. CLAIMS N 0.15

DO NOT SEND ACS/HEALTH NET OR ACS INC MEDICAID CLAIMS TO THIS PAYOR ID. THIS PAYOR ID IS FOR ACS BENEFIT SERVICES INC ONLY

36112 ACS Rewards Administration Center CLAIMS N38254 ACTIVA BENEFIT SERVICES, LLC Claims N (Formerly Amway Corporation)94323 ADESSO - SCOTTSDALE PHO CLAIMS N95285 ADMAR CORPORATION CLAIMS N

38265Administration Systems Research Corp (ASR) CLAIMS N

22384 ADMINISTRATIVE CONCEPTS INC 0.15

CALL ADMINISTRATIVE SERVICE CONSULTANTS CLAIMS NTO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

59141 Administrative Services Inc. CLAIMS N 0.1537278 ADMINONE CLAIMS N 0.1558202 ADVANCED DATA SOLUTIONS INC. CLAIMS N

68056ADVANTAGE BY BRIDGEWAY HEALTH SOLUTIONS CLAIMS N

CHECK WITH PAYOR FIRST AT [email protected]

35209 Advantage Health Solutions CLAIMS N 0.15

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77070 Advantage Preferred Plus CLAIMS 0.1525152 Advantra Freedom CLAIMS N 0.1525133 Advantra Savings CLAIMS N 0.15

25126ADVANTRA/HEALTH AMERICA, INC./HEALTH ASSURANCE CLAIMS N 0.15

CONTACT: RENEE CRUMLISH TEL:(302)283-6570. NETWORK ID REQUIRED. TYPICALLY USE PROV MEDICARE UPIN

13373ADVICA-NEW YORK HOSPITAL COMMUNITY HEALTH PLAN CLAIMS N

13376ADVICA/NORTHEAST GEORGIA HEALTH SYSTEM, INC CLAIMS N

31147 ADVOCARE INCORPORATED (OHIO BWC) CLAIMS N 0.32

NON-SPONSORED PAYER - SEE LAST PAGE FOR DEFINITION. FOR OHIO WORKERS COMP CLAIMS ONLY.

36320 ADVOCATE HEALTH CENTERS N ADDED 23-SEP-2002.65093 ADVOCATE HEALTH PARTNERS CLAIMS N60054 AETNA (15 CENTS PER CLAIM) CLAIMS N 0.1560054 AETNA (15 CENTS PER CLAIM) ENCOUNTERS N 0.1560054 AETNA (15 CENTS PER CLAIM) ROSTERS N 0.15

23228 AETNA BETTER HEALTH - PA MEDICAID CLAIMS23225 Aetna Better Health CT Claims N 0.1538692 Aetna TX Medicaid & CHIP CLAIMS 0.1526337 AETNA-IL MEDICAID 0.1513334 AFFINITY HEALTH PLAN CLAIMS N 0.1513333 AFFINITY HEALTH PLAN-MEDICARE CLAIMS 0.15

95426 AFFORDABLE BENEFIT ADMINISTRATORS CLAIMS N 0.15 No longer an availableElectronic

34444AFL-CIO FOOD & BEVERAGE DEALERS TRUST FUND (TOLEDO, OH) Claims N

Payer ID valid only for claims with a billing submission address of P. O. Box 457, Toledo, OH 43697-0457.

TH041 AFL-CIO TRUST FUND CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

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58066 AFLAC 0.15

13346 AFTRA HEALTH FUND NADDED 31-OCT-2002. PAYOR EDI: DEBORAH JANKOWSKI (212)499-4800 EXT 274

37280 AGA CLAIMS N 0.15

20048 Agate Resources Inc. (LIPA) CLAIMS NPlease contact Risa Rhodes at (514) 762-2165 for the Agate Resources Inc. (LIPA) Payer ID

64158 AGENCY SERVICES INC CLAIMS N80705 AH & L Claims N 0.15

23251 AHP (LANCASTER, PA) Claims N

Do NOT send Alliance PPO, Inc. claims to this payer ID. This payer ID is for Alliance Health Plan ONLY.

31138 AHPO (CLEVELAND, OH) CLAIMS

ALFED ALABAMA BLUE CROSS BLUE SHIELD N 0.15

ENROLLMENT NEEDED. SUBMITTERID NEEDED. NETWORK ID NEEDED. CONTACT PAYOR EDI AT 205-220-2533

ALBCS ALABAMA BLUE CROSS BLUE SHIELD Y 0.15

ENROLLMENT NEEDED. SUBMITTERID NEEDED. NETWORK ID NEEDED. CONTACT PAYOR EDI AT 205-220-2533

6311ALABAMA MEDICAL SURGICAL ASSOCIATES, LLC CLAIMS N

934 Alaska Blue Cross CLAIMS Y 0.15 Previously AKBCS

91136 ALASKA CHILDRENS SERVICES, INC. Claims NPlease enter Group Number (P68) when submitting claims.

92600ALASKA ELECTRICAL HEALTH & WELFARE FUND CLAIMS N 0.15

91136ALASKA LABORERS CONSTRUCTION INDUSTRY TRUST Claims N

Please enter Group Number (F23) when submitting claims.

AKMCDALASKA MEDICAID (FIRST HEALTH SERVICES) CLAIMS 0.15

91136 ALASKA PIPE TRADES LOCAL 375 Claims NPlease enter Group Number (F24) when submitting claims.

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91136ALASKA UNITED FOOD & COMMERCIAL WORKERS HEALTH & WELFARE TRUST Claims N


37117 ALEXIAN BROTHERS CLAIMS N13550 ALICARE Claims N

13550ALICARE (ALSO KNOWN AS AMALGAMATED LIFE) CLAIMS N

39160 ALL SAINTS/ COVENANT-MILWAUKEE, WI Y 0.15

81040 Allegiance Benefit Plan Management, Inc. CLAIMS N 0.15

23251 ALLIANCE HEALTH PLAN (PENNSYLVANIA) CLAIMS N

13079Alliance Healthcare/Stones River Regional IPA CLAIMS N

88461 ALLIANCE HEALTHPLANS OF WISCONSIN 0.1552149 ALLIANCE PPO, INC. (MARYLAND) Claims N81400 ALLIANCE SELECT N 0.1558234 ALLIANT HEALTH PLANS OF GEORGIA CLAIMS N 0.15

94177ALLIED ADMINISTRATORS (SAN FRANCISCO, CA) CLAIMS N

37308 ALLIED BENEFIT SYSTEMS CLAIMS N 0.15SX156 Allied Health Systes Chiropractic CLAIMS N 0.32 $0.32 per claim

31147 ALPS COMPCARE (OHIO BWC) CLAIMS N 0.32


CALL ALTA BATES MEDICAL GROUP CLAIMS P

NETWORK ID REQUIRED ON ALL CLAIMS. CALL SUTTER CONNECT EDI DEPARTMENT AT (800) 611-5191 TO OBTAIN NETWORK ID PRIOR TO FIRST SUBMISSION.

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94318 ALTA BATES MEDICAL GROUP CLAIMS N

NETWORK ID REQUIRED ON ALL CLAIMS. CALL MERCY AGUAS AT (510) 627-4763 TO OBTAIN NETWORK ID PRIOR TO FIRST SUBMISSION.

80705ALTA HEALTH & LIFE INSURANCE COMPANY Claims N 0.15

87043 ALTA HEALTH STRATEGIES CLAIMS N 0.15

E3510ALTA SENIOR CARE (HNET SR AND SECURE HORIZONS ONLY) CLAIMS P 0.15

ONLY CLAIMS FROM PROVIDERS IN N CA. PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - NORTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

37231ALTERNATIVE TECHNOLOGY RESOURCES, INC. Claims N

25133 Altius (Utah) CLAIMS N 0.1513550 AMALGAMATED LIFE Claims N13343 Amalgamated Life - PA / Alicare CLAIMS N37252 AMCARE N ADDED 23-SEP-2002.

38219 AMERAPLAN CLAIMS N 0.32Effective 11/01/2007, 32 cents per claim. NON-SPONSORED PLUS PAYER

75137 AMERIBEN SOLUTIONS, INC. N ADDED 23-SEP-2002.20029 AMERICA'S CHOICE 0.1541178 America's TPA CLAIMS N 0.15

27514AMERICAID COMMUNITY CARE (DALLAS/FT. WORTH) CLAIMS N 0.15

27515AMERICAID COMMUNITY CARE (HOUSTON) CLAIMS N 0.15

27517AMERICAID COMMUNITY CARE (MARYLAND) CLAIMS N 0.15

27516AMERICAID COMMUNITY CARE (NEW JERSEY) CLAIMS N 0.15

75240 AMERICAN ADMINISTRATIVE GROUP Claims N

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42112American Administrators (West Des Moines Iowa) CLAIMS N 0.15

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

63103 American Behavioral CLAIMS N 0.15

37225AMERICAN BENEFIT ADMINISTRATIVE SERVICES, INC. Claims N

Also known as Third Party Administrators, Inc., TPA Inc., and ABAS Inc.

34187American Benefits Management (North Canton, OH) CLAIMS N

Payer ID valid only for claims with a billing submission address of P.O. Box 35008, N. Canton, OH 44735

ACN01 AMERICAN CHIROPRACTIC NETWORK N 0.15

41161AMERICAN CHIROPRACTIC NETWORK (ACN) N

LOCATED IN MINNEAPOLIS, MINNESOTA. TEL:(800)236-9921.

41161AMERICAN CHIROPRACTIC NETWORK (PAN) 0.15

41160AMERICAN CHIROPRACTIC NETWORK IPA OF NEW YORK (ACNIPA) N

LOCATED IN KINGSTON, NEW YORK. TEL:(800)236-9921.

41160AMERICAN CHIROPRACTIC NETWORK IPA OF NY (ACNIPA) Claims N

ACN01 AMERICAN CHIROPRATIC NETWORK 0.15 COST:FREE

37128 AMERICAN COMMERCIAL BARGE LINES CLAIMS N

60305AMERICAN COMMUNITY MUTUAL INSURANCE CLAIMS N

TH095 AMERICAN FAMILY INSURANCE

62030 AMERICAN GENERAL CLAIMS NCLAIMS ARE PRINTED AND MAILED TO THE PAYER.

1066 AMERICAN HEALTHCARE ALLIANCE CLAIMS N

36369 AMERICAN IMAGING MANAGEMENT, INC. CLAIMS N

ASSIGNED GROUP POLICY PLAN ID IS REQUIRED. TO OBTAIN, CALL UTILIMED AT (800) 252-2021. (FORMERLY UTILIMED)

13311 AMERICAN INTERNATIONAL GROUP, INC. Claims N

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87726AMERICAN INTERNATIONAL GROUP, INC. (AIG) CLAIMS N 0.15 PLAN OF UNITEDHEALTHCARE

87726AMERICAN INTERNATIONAL GROUP, INC. (AIG) ERA N 0.15 PLAN OF UNITEDHEALTHCARE

72099 AMERICAN LIFECARE CLAIMS NCLAIMS ARE PRINTED AND MAILED TO THE PAYER.

AMS01 AMERICAN MEDICAL SECURITY CLAIMS N 0.15NON-SPONSORED PAYER - SEE LAST PAGE FOR DEFINITION.

AMS01AMERICAN MEDICAL SECURITY (USE PAYORID 81400) CLAIMS Y 0.15

81400 AMERICAN MEDICAL SECURITY, INC. Claims N74048 American National Ins. Co. (ANICO). CLAIMS 0.15APBPN AMERICAN PIONEER N 0.15

44444AMERICAN POSTAL WORKERS UNION HEALTH PLAN CLAIMS N

14190 AMERICAN PPO CLAIMS N

50844 American Progressive And Pyramid Life N

48055American Progressive and Pyramid Life (Todays Options) Claims 0.15

42011 AMERICAN REPUBLIC INSURANCE N ADDED 23-SEP-2002.

ASH01 AMERICAN SPECIALTY HEALTH NETWORK 0.1537322 American Worker Health Plan CLAIMS N 0.15

26078Americas 1st Choice Health Plans of NC, Inc. CLAIMS 0.15

20553Americas 1st Choice Health Plans of SC, Inc. CLAIMS 0.15

86001AMERICHOICE OF NEW JERSEY PERSONAL CARE PLUS (MEDICARE) N 0.15

NETWORK ID NEEDED ON BLK 33, PIN FIELD. CONTACT AMERICHOICE AT (888)362-3368 FOR YOUR PROVIDER ID NUMBER. ADDED 23-SEP-2002.

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86047AMERICHOICE OF NEW JERSEY, INC. (MEDICAID NJ) Claims N

86002AMERICHOICE OF NEW YORK PERSONAL CARE PLUS (MEDICARE) N 0.15


86048AMERICHOICE OF NEW YORK, INC. (MEDICAID NY) Claims N

86003AMERICHOICE OF PENNSYLVANIA PERSONAL CARE PLUS (MEDICARE) N 0.15


86049AMERICHOICE OF PENNSYLVANIA, INC. (MEDICAID PA) Claims N

27514 AMERIGROUP CORPORATION (FT WORTH) CLAIMS N 0.15FORMALLY AMERICAID COMMUNITY CARE (DALLAS/FT. WORTH).

27515 AMERIGROUP CORPORATION (HOUSTON) CLAIMS N 0.15FORMERLY AMERICAID COMMUNITY CARE (HOUSTON).

26378AMERIGROUP DC, FL, GA, IL, MD, NJ, OH, VA CLAIMS 0.15

27519 AMERIGROUP FLORIDA CLAIMS N 0.1527518 Amerigroup Illinois CLAIMS N 0.1510262 AMERIGROUP VA CLAIMS26374 AMERIGROUP/AMERICAID-HOUSTON N 0.15 ADDED 04/03/2002.SX075 AMERIHEALTH ADMINISTRATORS Y 0.32 ADDED 23-SEP-2002.54763 AmeriHealth Administrators N 0.15

23037AMERIHEALTH HMO NEW JERSEY AND DELAWARE CLAIMS N 0.15

23037 Amerihealth HMO NewJersey CLAIMS N 0.1522248 AMERIHEALTH MERCY HEALTH PLAN CLAIMS N MEDICAID MANAGED CARE

SX075AMERIHEALTH NEW JERSEY (NON HMO CLAIMS) CLAIMS 0.32

26375 AMERIKIDS-FORT WORTH N 0.15 ADDED 04/03/2002.

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26374 AMERIKIDS-HOUSTON N 0.15 ADDED 04/03/2002.76052 AMIL / ARIA N ADDED 23-SEP-2002.AMILR AMIL/ARIA N38254 AMWAY CORPORATION CLAIMS N53085 Anchor Benefit Consulting Inc. CLAIMS N53085 ANCHOR BENEFIT CONSULTING, INC CLAIMS N 0.153172 Ancillary Care Management/ACM CLAIMS NSYMED ANGELES IPA (SYNERMED) 0.3234192 Antares Management Solutions CLAIMS N 0.15

80705ANTHEM HEALTH & LIFE INSURANCE COMPANY OF NEW JERSEY Claims N 0.15

16140 APA PARTNERS, INC. CLAIMS N34196 APEX BENEFIT SERVICES Claims N54160 APS Healthcare Inc. CLAIMS N54160 APS HEALTHCARE, INC CLAIMS 0.15

54100 APS PAPER CLAIM CLAIMS CLAIMS WILL BE PRINTED AND MAILED TO APS16120 ARAZ CLAIMS N

77045 ARCADIAN MANAGEMENT SERVICES, INC N 0.15LOCATED IN COVINA, CALIFORNIA. CONTACT: DAVID LONTOK. TEL:(626)771-1448.

36356 Argus Health Systems CLAIMS N

86062ARIZONA FOUNDATION FOR MEDICAL CARE CLAIMS W

53589 ARIZONA BLUE CROSS BLUE SHIELD CLAIMS 0.15

TH001 ARIZONA HEALTH CONCEPTS CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

53172 ARIZONA HEALTH CONCEPTS N 0.15SKAZ0 ARIZONA MEDICAID CLAIMS Y 0.323432 ARIZONA PHYSICIANS IPA CLAIMS27154 Arizona Priority Care Plus Claims N 0.1575278 ARKANSAS BEST CORPORATION CLAIMS N 0.15

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75278ARKANSAS BEST CORPORATION - CHOICE BENEFITS CLAIMS N 0.15

ARBCS ARKANSAS BLUE CROSS Y 0.15

62176 ARKANSAS MANAGED CARE ORG (AMCO) 0.15ARMCD ARKANSAS MEDICAID N 0.15

95440 ARNETT HEALTH PLANS ERA P

PLEASE CONTACT SHANNON HEGEL AT ARNETT HEATLH PLANS AT (765) 448-7483 BEFORE ENROLLING FOR ERA WITH WEBMD ENVOY.

CALL ASC OF OHO CLAIMS NTO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

ASRM1 ASRM N 0.15

36326 ASSOCIATES FOR HEALTH CARE, INC. (AHC) CLAIMS N39065 Assurant Health CLAIMS N 0.15

37313 Assurant Health Self-Funded (Ft. Mill SC) CLAIMS N 0.1558730 ASSURANT HEALTH/ASA CLAIMS37323 Assurant MiniMed-Key Family 0.1588035 Assurecare CLAIMS N 0.1574240 ASSURED BENEFITS ADMINISTRATORS CLAIMS N

SX179 ASURIS NORTHWEST/ MEDADVANTAGE CLAIMS 0.32 PAYOR NEEDS OLD PROVIDER ID

65064 ATA-FL (American Therapy Association) CLAIMS 0.1595691 ATHENS AREA HEALTH PLAN SELECT CLAIMS N

22304ATLANTICARE [ALSO KNOWN AS HORIZON HEALTHCARE ADMIN (HHA)] Claims N 0.15

22304 ATLANTICARE ADMINISTRATORS, INC CLAIMS N 0.1513853 ATLANTIS HEALTH PLAN CLAIMS N 0.15ATLAD ATLAS ADMINISTRATORS N 0.15 USA MCO Provider Network

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TH004 ATLAS ADMINISTRATORS N

Currently only accepts UCO Providers. The group number must be 8 characters in length. Only one of the characters can be a dash. If the group number is entered, then the group name must also be entered.

31147AULTCOMP MANAGED CARE ORGANIZATION (OHIO BWC) CLAIMS N 0.32


PHD01 AURORA ASSOCIATED PHYSICIANS INC N (**12 max lines FA0)38259 AUTOMATED BENEFIT SERVICES

37280AUTOMATED GROUP ADMINISTRATION, INC. CLAIMS N 0.15

PLEASE SEND THESE EDI CLAIMS TO THE PAYER ID OF THE PPO SHOWN ON THE MEMBERS ID CARD. IF YOU HAVE ANY QUESTIONS, PLEASE CALL 260-489-6447 (703).

91136AUTOMOTIVE MACHINISTS LOCAL 289 HEALTH & WELFARE TRUST Claims N


31147 AVATARCOMP (OHIO BWC) CLAIMS N 0.32


46045 AVERA HEALTH PLANS CLAIMS N59274 AVMED, INC. Claims N

SKAZ0 AZ Health Care Cost Containment System CLAIMS Y 0.32SX145 BANNER HEALTH PLAN 0.3277078 BANNER MEDISUN CLAIMS 0.1574275 BAPTIST HEALTHCARE NETWORK CLAIMS N37248 BASS ADMINISTRATORS, INC. Claims NSB550 BCBS of Colorado CLAIMS N 0.32

720BCBS OF MINNESOTA-GOING THROUGH AVAILITY CLAIMS 0.15

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SX161BCBS SOUTH CAROLINA - INSTIL HEALTH PFFS 0.32 32 CENTS PER CLAIM

SX085BCBS SOUTH CAROLINA COMPANION HEALTHCARE 0.32 32 CENTS PER CLAIM

SB880BCBS SOUTH CAROLINA COMPANION TECHNOLOGIES Y 0.32 32 CENTS PER CLAIM

SX108BCBS SOUTH CAROLINA CONSOLIDATED BENEFITS INC 0.32 32 CENTS PER CLAIM

SX084BCBS SOUTH CAROLINA FEDERAL EMPLOYEE PROGRAM 0.32 32 CENTS PER CLAIM

SX104BCBS SOUTH CAROLINA PLANNED ADMINISTRATORS INC 0.32 32 CENTS PER CLAIM

SX103BCBS SOUTH CAROLINA STATE HEALTH PLAN 0.32 32 CENTS PER CLAIM

49153 BCI Administrators Inc. CLAIMS N 0.1543324 BEACON HEALTH STRATEGIES CLAIMS N 0.1595377 BEECH STREET CORPORATION N63100 Behavioral Health Systems CLAIMS N 0.1533192 Bencomp National Corporation CLAIMS N37125 BENEFIRST CLAIMS N PREVIOUS PAYER ID 3721536149 Benefit Administrative Systems CLAIMS N

25145BENEFIT COORDINATORS CORPORATION (PITTSBURGH, PA) Claims N

Payer ID valid only for claims with a billing submission address of 111 Ryan Court, Suite 300, Pittsburgh, PA 15205.

48611 Benefit Management Inc. of KS CLAIMS N 0.15

This payer will only accept medical and hospital claims for these groups listed: BMI187 - Ozarks Medical BMI219 - Ozarks AnesthesiaBMI234 - Stanion Wholesale Inc - they have one division that utilizes Cox Health NetworkBMI236 - Henry's Towing - utiliz

999 Benefit Management Services BCBS LA CLAIMS N 0.32

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37212 BENEFIT MANAGEMENT SYSTEMS, INC Claims N 0.15

39081BENEFIT PLAN ADMINISTRATORS CO. (EAU CLAIRE, WI) Claims N

Payer ID valid only for claims with a billing submission address of P.O. Box 1128, Eau Claire, WI 54702-1128.

88027 BENEFIT PLAN ADMINISTRATORS(BPA) CLAIMS N

37118 BENEFIT PLAN ADMINISTRATORS, INC. CLAIMS N 0.15

37118BENEFIT PLAN ADMINISTRATORS, INC. (ROANOKE, VA) Claims N 0.15

Please call Mary Bender at (940) 345-2721 to verify if you should be sending to the Benefit Plan Administrators, Inc., in Roanoke, VA.

37222 BENEFIT PLAN MANAGEMENT, INC. NDo not use Changed to Health Plans Inc. Payer Id 44273

74223 BENEFIT PLANNERS, INC. CLAIMS N 0.152053 BENEFIT RESOURCES CLAIMS N34178 BENEFIT SERVICES, INC (AKRON, OH) N ADDED 23-SEP-2002.34178 BENEFIT SERVICES, INC. (AKRON, OH) Claims N38257 BENEFIT SOURCE, INC CLAIMS 0.15

36342 BENEFIT SYSTEMS & SERVICES, INC. (BSSI) CLAIMS N 0.1537211 BENEFIT SYSTEMS, INC N ADDED 23-SEP-2002.87265 BENESIGHT CLAIMS N 0.15 (FORMERLY KNOWN AS THE TPA)37248 BENESYS Claims N

37248

BENESYS | BENESYS, INC. | BASS ADMINISTRATORS INC. | BENESYS-LHP CLAIMS UNIT N

LOCATE IN LAFAYETTE, LOUISIANA. TEL:(337)234-1790. NOTE: CLMS UTILIZING PPOPLUS NETWORK SHOULD CONTINUE TO BE SENT TO PPOPLUS. THESE GROUPS CAN BE IDENTIFIED BY THE PPOPLUS LOGO ON THE MEMBER ID CARD. PPOPLUS PAYORID IS 72148

37248 BENESYS, INC. Claims N95604 BEST LIFE & HEALTH INSURANCE CO. Claims N

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20488 BETTER HEALTH PLAN OF FLORIDA CLAIMS 0.15FOR REJECTIONS, CONTACT BETTER HEALTH OF FL AT 800.514.4561

32006 Better Health Plans of South Carolina CLAIMS N62183 BETTER HEALTH PLANS, INC. CLAIMS NCX025 BIG LOTS ASSOCIATES BENEFIT PLANS CLAIMS 0.15

CTBCFBLUE CARE FAMILY PLAN (CT-CONNECTICUT) Y 0.15 CLAIMS ARE SENT TO CTBCS AS MEDICAID TYPE

403 Blue Choice Medicaid Managed Care CLAIMS N 0.32

934 BLUE CROSS / WASHINGTON (PREMERA) CLAIMS Y 0.15

53120BLUE CROSS AND BLUE SHIELD OF LOUISIANA Claims N 0.15

84980BLUE CROSS AND BLUE SHIELD OF TEXAS, INC. Y 0.15

SB751 Blue Cross Blue Shield - Montana 0.32SB570 Blue Cross Blue Shield of Delaware Y 0.32 $0.32 per claim621 BLUE CROSS BLUE SHIELD OF ILLINOIS N 0.15KSBCS BLUE CROSS BLUE SHIELD OF KANSAS CLAIMS Y 0.15 TRUE PAYORID=47163

KCBCS BLUE CROSS BLUE SHIELD OF KANSAS CITY CLAIMS Y 0.15 TRUE PAYORID=47171

SB700Blue Cross Blue Shield of MA (Massachusetts) CLAIMS Y 0.32 $0.32 per claim

SB741 BLUE CROSS BLUE SHIELD OF MISSOURI Y 0.32 $0.32 per claimSB751 Blue Cross Blue Shield of Montana CLAIMS Y 0.32SB765 BLUE CROSS BLUE SHIELD OF NEVADA CLAIMS Y 0.32 $0.32 per claim

BCWNYBLUE CROSS BLUE SHIELD OF NORTH EASTERN NEW YORK CLAIMS Y 0.15 ANVICARE SUBID=6001787

SB871BLUE CROSS BLUE SHIELD OF RHODE ISLAND CLAIMS Y 0.32 32 CENTS PER CLAIM. NON PAR PLUS

38520BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA CLAIMS 0.15

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NYWBCBLUE CROSS BLUE SHIELD OF WESTERN NEW YORK CLAIMS Y 0.15

ANVICARE SUBID=6001787. ID SENT IS 00801. INHOUSE IS NYWBC

CALBC BLUE CROSS CALIFORNIA CLAIMS Y 0.15 $ 0.15 per claim

47198 BLUE CROSS OF CALIFORNIA CLAIMS Y 0.15CALIFORNIA LICENSE NUMBER REQUIRED.(NetworkId)

590 BLUE CROSS OF FLORIDA N 0.15

610 BLUE CROSS OF IDAHO CLAIMS Y 0.15

ENROLLMENT LINK https://www.bcidaho.com/edi_clearinghouse/index.asp

FCUBC BLUE CROSS UTICA NY Y 0.1515754 Blue Grass Family Health/SRRIPA CLAIMS NTXPPO BLUE MEDICARE PPO (TX) 0.1594036 BLUE SHIELD OF CA Rosters N 0.1594036 BLUE SHIELD OF CALIFORNIA CLAIMS N 0.15 GROUP NUMBER IS REQUIRED.CALL BLUE SHIELD OF CALIFORNIA ENCOUNTERS N PLEASE CALL (800) 480-1221.851 BLUE SHIELD OF OREGON (REGENCE) Y 0.15

932BLUE SHIELD WASHINGTON STATE (REGENCE) Y 0.15

NETWORKID AND/OR GROUP NETWORKID NEEDED

61124 BLUEGRASS FAMILY HEALTH CLAIMS N

13337 BMC HEALTHNET PLAN CLAIMS N

SUBMISSIONS TO BMCHP MUST INCLUDE THE CORRECT 12 DIGIT BMCHP PROVIDER ID #, INCLUDING ALL LEADING ZEROS.

20018 BMGI - Benefit Management Group Inc. CLAIMS N 0.15

36609BOILERMAKERS NATIONAL HEALTH & WELFARE FUND CLAIMS N

BOLL1 BOLLINGER, INC CLAIMS N 0.15Group number required for all claims; Policy holder

74238BOON-CHAPMAN BENEFIT ADMINISTRATORS, INC. CLAIMS N 0.15

13337BOSTON MEDICAL CENTER HEALTH PLAN INC. Claims N

LOCATE IN BOSTON, MA. PAYOR TEL:(617)414-6175. NETWORKID REQUIRED

16


13337BOSTON MEDICAL CENTER HEALTH PLAN, INC. CLAIMS N

SUBMISSIONS TO BMCHP MUST INCLUDE THE CORRECT 12 DIGIT BMCHP PROVIDER ID #, INCLUDING ALL LEADING ZEROS.

13337BOSTON MEDICAL CENTER HEALTH PLAN, INC. ENCOUNTERS N

38324BOTSFORD HEALTH PLAN (FARMINGTON HILLS, MI) Claims N

37273 BOYD BROS. TRANSPORTATION, INC. CLAIMS N37273 BOYDCARE CLAIMS N

37286BPA/BENEFIT PLAN ADMINISTRATORS (NORTH DAKOTA) CLAIMS N 0.15

48964 BPS, INC. CLAIMS NFORMERLY KNOWN AS BENEFIT PLAN SERVICES, INC.

65005 BREATHCO/ICSL PULMONARY CLAIMS NCLAIMS ARE PRINTED AND MAILED TO THE PAYER.

68054 BRIDGESTONE ARIZONA CLAIMS N

37285 BRIDGESTONE CLAIMS SERVICES CLAIMS N 0.15CLAIMS ARE PRINTED AND MAILED TO THE PAYER.

68069 BRIDGEWAY HEALTH SOLUTIONS22286 BritCay CLAIMS N51037 BROCKERAGE CONCEPTS, INC. CLAIMS N

CALL BROKERAGE SERVICE INC CLAIMS NTO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

59069 BROWN & BROWN BENEFITS CLAIMS N 0.1594316 BROWN & TOLAND MEDICAL GROUP CLAIMS N

CALL BSI CLAIMS NTO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

32004 BUCKEYE COMMUNITY HEALTH CLAIMS N 0.1568069 BUCKEYE COMMUNITY HEALTHPLAN

50240 BUENAVENTURA MEDICAL GROUP, INC. CLAIMS N CLAIMS ARE PRINTED AND MAILED TO PAYOR.42150 Butler Benefit CLAIMS N

17


23708 C&O EMPLOYEES HOSPITAL ASSOCIATION Claims NCLFR2 C.L. FRATES AND COMPANY CLAIMS N 0.15

37105CANNON COCHRAN MANAGEMENT SERVICES, INC. Claims N

38245 CAPE HEALTH PLAN CLAIMS N 0.1523045 CAPITAL BLUE CROSS/CAIC N 0.15 ADDED 23-SEP-2002.87726 CAPITAL COMMUNITY HEALTH PLAN Claims N 0.15SX065 Capital District Physicians Health Plan 0.32 $0.32 PER CLAIM

95112 CAPITAL HEALTH PLAN CLAIMS NCALL PAYOR AT (850)523-7361 TO REGISTER YOUR NPI

68011 CAPITOL ADMINISTRATORS CLAIMS N 0.15CAPHP CAPROCK HEALTH PLANS 0.1557115 CARE 1ST Health Plan of CA CLAIMS N 0.15HM037 CARE CHOICES HMO* Y 0.15 Call our HelpLine (972) 766-5480

77082 CARE IMPROVMENT (AVLTY) CLAIMSREDIRECTED FROM EMDEON TO AVLTY 01/30/2013

11331CARE MANAGEMENT GROUP OF GREATER NY, INC. CLAIMS N PREVIOUS PAYER ID 11311

43172 CARE PARTNERS CLAIMS N

MEDICAID MANAGED CARE. PAYER REQUIRES REGISTRATION AND TESTING, CALL (877) 234-4274.

41222 CARE TO CARE IPA 0.15

11345 CareCentrix CLAIMS N 0.15Enrollment required prior to claim submission. Please contact Tracy Greenlee at (813) 313-4226.

38269 Carechoices Michigan / Trinity Health CLAIMS YEnrollment required; please contact Noreen at (248) 489-5281.

14182 CARECORE NATIONAL CLAIMS NXXXXX CARECORE NATIONAL - HEALTHNET CLAIMS NETWORKID ID, REFER ID, FAC ID REQUIRED

XXXXXCareCore National LLC - Health Net New Jersey CLAIMS N

18


14179CARECORE NATIONAL, LLC (AETNA RADIOLOGY CLAIMS) CLAIMS N 0.15

14180CARECORE NATIONAL, LLC (OXFORD RADIOLOGY CLAIMS) CLAIMS N

SB690CareFirst BlueCross BlueShield MD Region (Maryland) CLAIMS N 0.15 $0.32 per claim

SB580 CareFirst BlueCross BlueShield NCA Region CLAIMS N 0.32 $0.32 per claim57116 CAREFIRST-AHCCCS CLAIMS N 0.1516147 CareGuide CLAIMS N 0.15

25133 CARELINK ADVANTRA (formerly 25133) CLAIMS N 0.15

PROVIDER NUMBER (NETWORKID REQUIRED). WEST VIRGINIA HEALTHASSURANCE AND CARELINK COMMERCIAL CLAIMS ONLY. FOR CARELINK MEDICAID, SEND ON PAPER TO P.O. BOX 7373, LONDON, KY 40742.

25133 CARELINK HEALTH PLAN ((formerly 25133) CLAIMS N 0.15

PROVIDER NUMBER (NETWORKID REQUIRED). WEST VIRGINIA HEALTHASSURANCE AND CARELINK COMMERCIAL CLAIMS ONLY. FOR CARELINK MEDICAID, SEND ON PAPER TO P.O. BOX 7373, LONDON, KY 40742.

25140 CARELINK MEDICAID CLAIMS N 0.1525133 Carelink Medicaid CLAIMS N 0.15CM001 CAREMORE CLAIMS 0.1525142 CARENET N 0.1593975 CAREOREGON INC CLAIMS N

65031 CAREPLUS HEALTH PLANS, INC. CLAIMS N(FORMERLY PHYSICIANS HEALTHCARE PLANS INC)

31114 CARESOURCE Claims NMRCHP CareSource Healthplan of Oregon Claims N 0.1537311 CareSource of Indiana N41742 CareSource-Mid Rogue Health Plan CLAIMS N

19


10010 Careworks 0.15

31147 CAREWORKS (OHIO BWC) CLAIMS N 0.32


62073 CARITEN HEALTHCARE N ADDED 23-SEP-2002.62072 CARITEN SENIOR HEALTH N ADDED 23-SEP-2002.57105 CAROLIAN CARE PLAN CLAIMS N FORMERLY PHP OF SOUTH CAROLINA.

56215 CAROLINA BEHAVIORAL HEALTH ALLIANCE 0.15

37245 CAROLINA BENEFIT ADMINISTRATORS INC. N ADDED 23-SEP-2002.57105 CAROLINA CARE PLAN Claims N

56195 CAROLINA SUMMIT HEALTHCARE, INC. CLAIMS N

25125CARPENTERS HEALTH AND WELFARE TRUST FUND OF ST. LOUIS CLAIMS N 0.15

UTILIZES THE CMR NETWORK. CLAIMS ARE PRINTED AND MAILED TO THE PAYER.

93040 CASCADE EAST HEALTH PLANS Claims N93040 CASCADE HEALTH PARTNERS CLAIMS N93102 CASCADE HEALTH PARTNERS CLAIMS N37060 CATERPILLAR INC. CLAIMS NSX183 CATHOLIC HEALTHCARE WEST CLAIMS 0.3255438 CBCA ADMINISTRATORS N 0.1541124 CBSA CLAIMS N88019 CCEA WELFARE BENEFIT TRUST CLAIMS N

33005 CCN CLAIMS N 0.15PLEASE INCLUDE GROUP NAME AND INSUREDS EMPLOYER NAME ON CLAIMS.

33005 CCN MANAGED CARE, INC. Claims N 0.15Please include Group Name and Insureds Employer Name on claims.

88022 CDS GROUP HEALTH CLAIMS 0.15

TH046 CEDAR RAPIDS ELECTRICAL WORKERS CLAIMS NTRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

95167CEDARS-SINAI MEDICAL NETWORK SERVICES ENCOUNTERS N

20


68063 Celtic Insurance CLAIMS N 0.1568069 CELTICARE HEALTH PLAN37250 CEMARA ADMINISTRATORS INC. N ADDED 23-SEP-2002.

91136CEMENT MASONS & PLASTERERS HEALTH & WELFARE TRUST Claims N


68068 CENPATICO CLAIMS 0.15 CALL 800-947-0633 TO REGISTER68069 CENPATICO - AZ

68047 Cenpatico - Kansas CLAIMS P 0.15

Prior to submitting claims, please call provider relation at 1-866-896-7293 to verify your provider info in the claim system.

68068 CENPATICO-ARIZONA CLAIMS 0.15 CALL 800-495-6748 TO REGISTER

68068 CENPATICO-BEHAVIORAL HEALTH TEXAS CLAIMS 0.15 CALL 800-716-5650 TO REGISTER68068 CENPATICO-FLORIDA CLAIMS 0.1568068 CENPATICO-GEORGIA CLAIMS 0.15 CALL 800-947-0633 TO REGISTER68068 CENPATICO-ILLINOIS (ILCBH) CLAIMS 0.1568068 CENPATICO-INDIANA CLAIMS 0.15 CALL 800-647-4848 TO REGISTER68068 CENPATICO-KANSAS CLAIMS 0.1568068 CENPATICO-KENTUCKY CLAIMS 0.1568068 CENPATICO-MASSACHUSETTS CLAIMS 0.1568068 CENPATICO-MISSISSIPPI CLAIMS 0.1568068 CENPATICO-MISSOURI CLAIMS 0.1568068 CENPATICO-OHIO CLAIMS 0.1568068 CENPATICO-SOUTH CAROLINA CLAIMS 0.1568068 CENPATICO-WISCONSIN CLAIMS 0.1568068 CENTENE ADVADTAGE PLANS CLAIMS 0.1568069 CENTENE MEDICARE13357 CENTER CARE CLAIMS N

75243 CENTRA CLAIMS N 0.15[FORMERLY CENTRA BENEFITS OF TEXAS (MS, TX, WA)]

75196CENTRA (FORMERLY HEALTH ECONOMICS CORP.) CLAIMS N 0.15 (FORMERLY HEALTH ECONOMICS CORP.)

21


31118 CENTRAL BENEFITS LIFE CLAIMS N31118 CENTRAL BENEFITS MUTUAL CLAIMS N31118 CENTRAL BENEFITS NATIONAL CLAIMS N34097 CENTRAL RESERVE LIFE CLAIMS N62218 Central SeniorCare CLAIMS N

36215CENTRAL STATES HEALTH & WELFARE FUNDS CLAIMS N

37214CENTRAL STATES JOINT BOARD HEALTH AND WELFARE FUND CLAIMS N

E3510 CENTRAL VALLEY MEDICAL GROUP CLAIMS P

ONLY CLAIMS FROM PROVIDERS IN NORTHERN CALIFORNIA. PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - NORTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

48120 Century Health Solutions CLAIMS N 0.15

23171CHA - COMMONWEALTH HEALTH ALLIANCE Claims N

99726 Champus Tricare West CLAIMS N 0.15

REG11 CHAMPUS: REGION 11 Y 0.15

080205 switched to THIN. "(**12 max lines FA0) **Receiver type ""F or H"" Contact our HelpLine or Marsha Green (608)221-5056) to enroll. Champus will notify provider w/Auth # within 5 days of agreement."

84146 CHAMPVA - HAC CLAIMS N 0.15

CHAMPVA - HAC IS NOT ASSOCIATED WITH AND DOES NOT PROCESS CLAIMS FOR TRICARE (FORMERLY CHAMPUS).

84146 CHAMPVA - HAC ERA N 0.1584147 CHAMPVA - HAC ERA N 0.15

16600CHAUTAUQUA COUNTY HEALTHCARE PLAN (MAYVILLE, NY) Claims N

25151 CHCcares of South Carolina CLAIMS N

22


59223 CHESAPEAKE LIFE INSURANCE COMPANY Claims N 0.15

59223CHESAPEAKE LIFE INSURANCE COMPANY - INSURANCE CENTER CLAIMS N 0.15

PAYER ID VALID ONLY IF THE ADDRESS ON THE HEALTH ID CARD MATCHES THE FOLLOWING: P.O. BOX 982017, NORTH RICHLAND HILLS, TX 76182.

59223CHESAPEAKE LIFE INSURANCE COMPANY - INSURANCE CENTER ERA N 0.15

34154 Chesterfield Resources, Inc. CLAIMS 0.15

CLW99CHICAGO LABORER'S HEALTH AND WELFARE 0.15

84146CHILDREN OF WOMEN VIETNAM VETERANS-VA HAC CLAIMS N

84146CHILDREN OF WOMEN VIETNAM VETERANS-VA HAC ERA N

94302 CHINESE COMMUNITY HEALTH PLANPAYER NEEDS LEGACY NO, CALL EDI AT 415.955.8800 EXT 3247 TO REGISTER FIRST

UHSCH CHIP - CHOICEONE UTMB N 0.15SHPCH CHIP- SETON HEALTH PLAN TX N 0.15

TTPCHCHIP-TEENS TO TOTS / TX UNIVERSITY HEALTH TX N

UPGCH CHIP-TX UNIVERSITY HEALTH PLAN UPG TX N

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

88822 CHOICE 65 (MEDICARE SUPPLEMENT) Y 0.15

76049 CHOICE ONE/UTMB CHIP HEALTH PLAN N ADDED 06/18/2002.

CALL CHP/RPU (FABOH) CLAIMS N

PAYER ID, RENDERING PROVIDER AND LOCATION NUMBER REQUIRED TO SUBMIT CLAIMS. PLEASE CALL DAVE SELL AT (608) 210-6656 TO OBTAIN.

38308 CHRISTIAN BROTHERS SERVICES CLAIMS N 0.15

23


61271 CHRISTIAN BROTHERS SERVICES CLAIMS N 0.1537288 CHS CLAIMS CLAIMS N62308 CIGNA CLAIMS N 0.1562308 CIGNA - PPA CLAIMS N 0.1562308 CIGNA - PPO CLAIMS N 0.1576051 CIGNA / ARIA N 0.15 ADDED 23-SEP-2002.2331 CIGNA BEHAVIORAL HEALTH N 0.15SX071 CIGNA BEHAVIORAL HEALTH CLAIMS N 0.32 $0.32 PER CLAIM62308 CIGNA HEALTH PLAN - HMO CLAIMS N 0.15

86033Cigna Healthcare for Seniors - Arizona Medicare N 0.15

CIGNR CIGNA/ ARIA PROVIDERS ONLY N ARIA PROVIDERS ONLY

TH058 CIMARRON HEALTH PLAN CLAIMS NTRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

TH059 CIMARRON SALUD CLAIMS NTRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

46871 Cincinnati Financial Corporation CLAIMS N

39141 CLAIM MANAGEMENT SERVICES N 0.32Effective 11/01/2007, 32 cents per claim. NON-SPONSORED PLUS PAYER.

39141 CLAIMS MANAGEMENT SERVICES CLAIMS N 0.32Effective 11/01/2007, 32 cents per claim. NON-SPONSORED PLUS PAYER.

57080 CLAIMSWARE, INC. DBA MANAGEMED CLAIMS N CLAIMS ARE PRINTED AND MAILED TO PAYOR.

TH006 CLARENDON KIDS CHIP PROGRAM CLAIMS NTRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

EPOTXCLARENDON KIDS CHIP PROGRAM (CKCP) EPO N 0.15

ADDED 03/22/2002. USA MCO NETWORK PROVIDERS ONLY

77201 Clearchoice Health Plan CLAIMS41201 CLIENT FIRST N 056211 CM Administrators Inc CLAIMS N71063 CNA HEALTH PARTNERS CLAIMS N

48153 CNA HEALTH PARTNERS REPRICING - AR CLAIMS N

24


36094 CNA INSURANCE COMPANY CLAIMS N16126 CNY MANAGED CARE CLAIMS N14829 CO-ORDINATED BENEFITS PLAN CLAIMS 0.15

CALL COALITION FOR CARE/MEDTREX PAYER HS CLAIMS NPLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE PAYER ID.

CALLCOALITION FOR CARE/MEDTREX PAYER WL CLAIMS N

PLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE PAYER ID.

CALL COALITION FOR CARE/MEDTREX PAYERTC CLAIMS NPLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE PAYER ID.

CALL COALITION FOR CARE/MEDTRX GH CLAIMS NPLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE PAYER ID.

CALL COALITION FOR CARE/MEDTRX IX CLAIMS NPLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE PAYER ID.

CALL COALITION FOR CARE/MEDTRX L8 CLAIMS NPLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE PAYER ID.

CALL COALITION FOR CARE/MEDTRX PAYER EM CLAIMS NPLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE PAYER ID.

CALL COALITION FOR CARE/MEDTRX PAYER FI CLAIMS NPLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE PAYER ID.

CALL COALITION FOR CARE/MEDTRX PAYER HP CLAIMS NPLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE PAYER ID.

38335 COFINITY CLAIMS N 0.1537123 COLONIAL HEALTHCARE N ADDED 23-SEP-2002.22284 Colonial Medical CLAIMS N 0.1584129 COLORADO ACCESSDELETED COLORADO ACCESS HMO N USED TO BE COACC

PHD02 COLORADO ASSOCIATED PRIMARY CARE NCOBCS COLORADO BLUE CROSS CLAIMS Y 0.15 LIVE 09/30/2005

CCHP1COLORADO CHOICE HEALTH PLANS-SAN LUIS VALLEY HMO CLAIMS N 0.15

SKCO0 COLORADO MEDICAID 0.32COMCR COLORADO MEDICARE PART B (JH) Y 0.15 NOVITAS

25


25351 COLUMBIA CORNELL CARE CLAIMS N91162 COLUMBIA UNITED PROVIDERS N ADDED 23-SEP-200237271 COMBINED BENEFITS, INC. CLAIMS N34181 COMMERCE BENEFITS GROUP CLAIMS N 0.15

37237COMMONWEALTH ADMINISTRATIVE GROUP N 0.15 ADDED 23-SEP-2002.

TH026 COMMONWEALTH ADMINISTRATORS CLAIMS NTRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

14315 Commonwealth Care Alliance CLAIMS N 0.15

23282COMMUNITY CARE BEHAVIORAL HEALTH ORGANIZATION CLAIMS N

73143COMMUNITY CARE MANAGED HEALTH CARE PLANS OF OKLAHOMA CLAIMS N

39126 Community Care Organization CLAIMS N

71079COMMUNITY CARE PLUS (MERCY CARE PLUS) CLAIMS 0.15

38325 Community Choice of Michigan CLAIMS N

TH027COMMUNITY CHOICE OF MICHIGAN (MEDICAID) CLAIMS E

TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

26231 Community Claims Administration CLAIMS N 0.15

TH005 COMMUNITY FIRST CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

COMMF COMMUNITY FIRST N 0.1535193 COMMUNITY HEALTH ALLIANCE CLAIMS N48145 Community Health Choice CLAIMS N

75261COMMUNITY HEALTH ELECTRONIC CLAIMS/CHEC/WEBTPA CLAIMS N 0.15

62149COMMUNITY HEALTH NETWORK OF CONNECTICUT N

ADDED 22-OCT-2002. PAYOR CONTACT 203-237-4000 EXT 3056

26


62149 COMMUNITY HEALTH NETWORK OF CT Claims N

Community Health Network of CT cannot accept electronic claims for Anesthesia. If you have questions on how to submit these claims, please contact LeAnn Olson, Director of Claims, at (203) 237-4000, ext. 3136.

61733 COMMUNITY HEALTH PLAN CLAIMS N

39162COMMUNITY HEALTH PLAN - MILWAUKEE, WI CLAIMS N

CALL KAREN MILLS AT (262) 787-2705 PRIOR TO SUBMITTING CLAIMS.

CHPWA COMMUNITY HEALTH PLAN OF WA N 0.1523742 COMMUNITY HEALTHPLAN - NY CLAIMS 0.15 CERT REQD 518.783.1864 X40422

66121Community Medical Group of the West Valley Inc. CLAIMS N

32481COMMUNITY PREMIER PLUS FOR NEIGHBORHOOD HEALTH PROVIDERS CLAIMS N

34177 COMP - OHIO (AUSTINTOWN, OH) CLAIMS N

31147 COMP ONE (OHIO BWC) CLAIMS N 0.32


37297 COMPBENEFITS CORPORATION CLAIMS N 0.15

23296 COMPFIRST CLAIMS NCLAIMS ARE PRINTED AND MAILED TO THE PAYER.

31147COMPMANAGEMENT HEALTH SYSTEMS, INC. (OHIO BWC) CLAIMS N 0.32


31147COMPMANAGEMENT/INTEGRATED COMP (OHIO BWC) CLAIMS N 0.32


59314 COMPREHENSIVE BEHAVIORAL CARE 0.15

3036COMPREHENSIVE BENEFITS ADMINISTRATOR, INC. Claims N

27


31147COMPREHENSIVE MEDICAL CARE (OHIO BWC) CLAIMS N 0.32


COMPU COMPUSYS OF COLORADO CO N80667 CONFED ADMIN SERVICES, INC. N 0.1580705 CONFEDERATION ADMIN SERVICES CLAIMS N 0.1580705 CONFEDERATION LIFE INSURANCE CLAIMS N 0.1578375 CONNECTICARE - MEDICARE CLAIMS 0.156105 CONNECTICARE, INC CLAIMS N

CTBCSCONNECTICUT BLUE CROSS (ANTHEM EAST) Y 0.15 LIVE 02/28/2006

37307 Connecticut Carpenters Health Fund CLAIMS N 0.1562308 CONNECTICUT GENERAL (CIGNA) CLAIMS N 0.15CTMCD CONNECTICUT MEDICAID Y 0.15 Anvicare TradingPartnerId=209000855

CTMCR CONNECTICUT MEDICARE PART-B Y 0.15LIVE 07/21/2006. ANVICARE SUBMITTER ID=009025598

35315 Connential Key Family CLAIMS N37135 CONSOCIATE GROUP CLAIMS N 0.1587843 Consolidate Health CLAIMS 0.15

75284 CONSOLIDATED ASSOCIATES RAILROAD CLAIMS N 0.154284 CONSOLIDATED GROUP CLAIMS N4284 CONSOLIDATED GROUP/TRAVELERS CLAIMS N37295 CONSUMER HEALTH SOLUTIONS CLAIMS N

71404CONTINENTAL GENERAL INSURANCE COMPANY CLAIMS N

CLAIMS ARE PRINTED AND MAILED TO THE PAYER.

13397 CONTINUUM ABC MSO CLAIMS N

55544 Conversion Plan-APWU CLAIMS N

Claims are printed and mailed to the payer.; For conversion plan members only. If filing a claim for a federal plan member please use payer ID 44444.

CCHP9 COOK CHILDREN'S STAR PLAN CLAIMS N 0.1535149 COOK GROUP HEALTHPLAN 0.15

28


CCHP1 COOKS CHILDREN HEALTHPLAN CLAIMS N 0.15

52132COOPERATIVE BENEFIT ADMINISTRATORS (CBA) Claims N 0.15

68069 COORDINATED CARE58204 COORDINATED MEDICAL SPECIALISTS Claims N58231 CORE ADMINISTRATIVE SERVICES CLAIMS N 0.15

58231CORE MANAGEMENT RESOURCES GROUP, INC. Claims N 0.15

41045 CORESOURCE AZ MN CLAIMS N 0.15

SWITCHED TO THIN 061705. ONLY FOR CLAIMS WHERE THE "SUBMIT CLAIMS TO ADDRESS" ON THE MEDICAL ID CARD IS A CORESOURCE ADDRESS IN THE STATES OF ARIZONA OR MINNESOTA. FOR ASSISTANCE CALL 800-698-0106.

75136 CORESOURCE LITTLE ROCK CLAIMS N 0.1535182 CORESOURCE MD PA IL N 0.1535180 CORESOURCE NC IN CLAIMS N 0.1535180 CORESOURCE OF NORTH CAROLINA CLAIMS N 0.1535183 CORESOURCE OH CLAIMS N 0.1535187 CoreSource-Internal CLAIMS N

41045 CORESTAR CLAIMS N 0.15SWITCHED TO THIN 061705. (FORMERLY NORTHWESTERN NATIONAL LIFE)

35202 Cornerstone Benefit Adminstrators

41124CORPORATE BENEFIT SERVICES OF AMERICA CLAIMS N

56116 CORPORATE BENEFITS SERVICE, INC. (NC) Claims N 0.15

Claims are printed and mailed to the payer. Payer ID valid only for claims with a claims submission address of P.O. Box 12953, Charlotte, NC 28220.

37246 CORPORATE SYSTEMS ADMINISTRATION N 0.15 ADDED 23-SEP-2002.43160 CORRECTIONAL MEDICAL SERVICES CLAIMS N 0.15

29


48146 CORSOLUTIONS NADDED 22-OCT-2002. PAYOR CONTACT 800-433-2183

31147 CORVEL CORPORATION (OHIO BWC) CLAIMS N 0.32


37288 COTTAGE HEALTH SYSTEM CLAIMS N37288 COTTAGE HOSPITAL CLAIMS N62553 COUNTRY LIFE INSURANCE COMPANY CLAIMS N 0.15COVAN COVANSYS -TESTING ONLY

58102COVENANT ADMINISTRATORS, INC. (ATLANTA, GA) N 0.15

LOCATED IN ATLANTA, GEORGIA. CONTACT: KATHY MYERS TEL:(440)720-0700 EXT. 222

62155 COVENANT HEALTH CLAIMS N25149 Coventry Health Care - Nevada CLAIMS N

25130COVENTRY HEALTH CARE OF DELAWARE, INC. CLAIMS N 0.15

25127COVENTRY HEALTH CARE OF GEORGIA, INC. Claims N 0.15

25131COVENTRY HEALTH CARE OF INDIANA, INC. CLAIMS N 0.15

25132 COVENTRY HEALTH CARE OF IOWA, INC. CLAIMS N 0.15

25133COVENTRY HEALTH CARE OF KANSAS, INC. - KANSAS CITY AND KENTUCKY CLAIMS N 0.15

25135COVENTRY HEALTH CARE OF LOUISIANA, INC. CLAIMS N 0.15

25136COVENTRY HEALTH CARE OF NEBRASKA, INC. CLAIMS N 0.15

25129COVENTRY HEALTH CARE OF THE CAROLINAS, INC./WELLPATH Claims N 0.15

31147 CRA MANAGED CARE (OHIO BWC) CLAIMS N 0.32


30


31147 CRAWFORD & COMPANY (OHIO BWC) CLAIMS N 0.32


64068 CREATIVE MEDICAL SYSTEMS CLAIMS N 0.1537320 Creative Plan Administrators CLAIMS N 0.1537266 CROY-HALL MGMT. INC. Claims N 0.1539170 Custom Benefit Administrators CLAIMS N82056 Custon Design Benefits Inc. (OH) Claims N 0.15DAK01 DAKOTACARE CLAIMS N 0.156172 Dart Management Corporation CLAIMS N 0.1533066 Davita Health CLAIMS N

95748DC CHARTERED HEALTH PLAN INC (MEDICAID AND ALLIANCE) CLAIMS 0.15

CALL RONALD GRAY 202.408.2229 TO JOIN NETWORK

39113 DEAN HEALTH PLAN CLAIMS N64159 DEFINITY HEALTH CLAIMS NSX055 DELAWARE BLUE CROSS BLUE SHIELD 0.32 $0.32 PER CLAIM

63081 DELAWARE HEALTH PLAN CONSORTIUM CLAIMS NSKDE0 Delaware Medicaid CLAIMS Y 0.32DEMCR DELAWARE MEDICARE PART B CLAIMS Y 0.1527009 DELAWARE PHYSICIANS CARE, INC 0.15

25137DELAWARECARE (CHC OF DELAWARE MEDICAID) CLAIMS N


DHS01 DELTA HEALTH SYSTEMS (GOTO AVLTY) CLAIMS N 0.1594235 DELTA HEALTH SYSTEMS (GOTO NEIC) CLAIMS 0.1584135 DENVER HEALTH MEDICAL PLAN CLAIMS N

58204 DERMATOLOGY NETWORK SOLUTIONS Claims N

SX105 DESERET MUTUAL 0.32PLEASE CALL DEBBIE HANSEN 800.777.3622 EXT 5838 FOR SETUP

36436 DESTINY HEALTH CLAIMS 0.1556240 Detroit Medical Center CLAIMS N

31


25131 DIAMOND PLAN CLAIMS N 0.15

23706 DIRECTORS GUILD OF AMERICA N 0.15LOCATED IN LOS ANGELES, CALIFORNIA. CONTACT:SHEA SAVASH TEL:(323)866-2200

23706DIRECTORS GUILD OF AMERICA - PRODUCER HEALTH PLAN Claims N 0.15

6102 DIVERSIFIED ADMINISTRATION Claims N

6102DIVERSIFIED ADMINISTRATION CORPORATION CLAIMS N

6102 DIVERSIFIED ADMINISTRATION CLAIMS N25160 DIVERSIFIED GROUP ADMIN CLAIMS 0.15

SDMEADMERC REG A - NHIC (SEND THROUGH NEIC) Y 0.32 $0.32 Per Claim

SDMEB DMERC REG B (SEND THROUGH NEIC) Y 0.32 $0.32 Per Claim

18003DMERC REG C ONLY (SEND THROUGH AVALITY) Y 0.15

$0.15 PER CLAIM - FLAT RATE OK.AL,AR,CO,FL,GA,KY,LA,MS,NM,NC,OK,PR,SC,TN,TX,Virgin Island

5655 DMERC REG D (SEND THROUGH AVAILITY) CLAIMS Y 0.15 $0.15 PER CLAIM - FLAT RATE OK74284 DRISCOLL CHILDRENS HALTHPLAN CLAIMS 0.15

35186Dunn and Associates Benefits Administrators Inc. CLAIMS N 0.15

34159 E-V BENEFITS MANAGEMENT, INC CLAIMS N

PAYER ID VALID ONLY FOR CLAIMS WITH BILLING SUBMISSION ADDRESS OF P.O. BOX 94928, CLEVELAND, OH 44101- 4928 OR P.O. BOX 89476, CLEVELAND, OH 44101-5476.

75232 E3 HEALTH, INC. CLAIMS N

65009 EAPPEAL SOLUTIONS CLAIMS N CLAIMS ARE PRINTED AND MAILED TO PAYOR.

36434 EARLY INTERVENTION CENTRAL BILLING CLAIMS 0.1566122 Easland Medical Group CLAIMS N

32


CALL EAST BAY MEDICAL NETWORK CLAIMS P

NETWORK ID REQUIRED ON ALL CLAIMS. CALL SUTTER CONNECT EDI DEPARTMENT AT (800) 611-5191 TO OBTAIN NETWORK ID PRIOR TO FIRST SUBMISSION.

94318 EAST BAY MEDICAL NETWORK CLAIMS N

NETWORK ID REQUIRED ON ALL CLAIMS. CALL MERCY AGUAS AT (510) 627-4763 TO OBTAIN NETWORK ID PRIOR TO FIRST SUBMISSION.

37257 EBC INC 0.15

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

CALL EBC MID-AMERICA CLAIMS NTO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

CALL EBC, INC. CLAIMS NTO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

SX182 EBMS CLAIMS 0.32Effective 11/01/2007, 32 cents per claim. NON-SPONSORED PLUS PAYER

34166 EBS OF OHIO CLAIMS N 0.15

SKMA0 EDS (MASSACHUSETTS MEDICAID) CLAIMS Y 0.32

Provider must email [email protected] or fax 617.988.8971 a letter stating that they want to do emc. They must include Provider Id and Endeon's Trading Partner # of 9900756

22521 EDS ADMIN SERVICES CLAIMS N 0.15SX110 EDUCATORS MUTUAL (EMIA) CLAIMS 0.32 NON PAR PLUS73288 EHI (EMPLOYERS HEALTH INSURANCE) CLAIMS N

98006EHS GROUP HEALTH PLAN (MILWAUKEE, WI) CLAIMS N

52192 ELDER HEALTH MARYLAND HMO INC. N 0.15CLAIMS ARE PRINTED AND MAILED TO PAYOR. ADDED 23-SEP-2002.

31625 ELDERPLAN, INC. CLAIMS N

33


36399 Elmcare LLC CLAIMS N

37253 ELMCO N 0.15LOCATE IN ELMIRA, NEW YORK. TEL:(607)734-5773.

34167EMERALD HEALTH NETWORK, INC. (ALL PPO BUSINESS) CLAIMS N

34555 EMERALD HMO (HMO CLAIMS ONLY) CLAIMS N59299 EMI-KP Ambulance Claims CLAIMS N 0.1573288 EMPHESYS CLAIMS N95288 EMPLOYEE BENEFIT ADMIN & MGNT CLAIMS N 0.15

CALLEMPLOYEE BENEFIT CLAIMS - MID-AMERICA CLAIMS N

TO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

CALL EMPLOYEE BENEFIT CLAIMS OF WI CLAIMS NTO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

CALLEMPLOYEE BENEFIT CLAIMS OF WISCONSIN CLAIMS N

TO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

38241EMPLOYEE BENEFIT CONCEPTS (FARMINGTON HILLS, MI) Claims N

CALL EMPLOYEE BENEFIT CONSULTANTS, INC. CLAIMS NTO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

37215 EMPLOYEE BENEFIT CORPORATION CLAIMS N 0.15 ROUTED FROM NEIC TO AVLTY 033111

31074EMPLOYEE BENEFIT MANAGEMENT CORP (EBMC) CLAIMS N

81039EMPLOYEE BENEFIT MANAGEMENT SYSTEM (EBMS) 0.15

37216 EMPLOYEE BENEFIT SERVICES CLAIMS N 0.15

41198

EMPLOYEE BENEFIT SERVICES OF LOUISIANA (A DIV OF HARRINGTON BENEFIT SRV) CLAIMS N 0.15

22262Employee Benefits Administration and Management Corp. CLAIMS N Trans

3036EMPLOYEE BENEFITS PLAN ADMINISTRATION, INC. (E.B.P.A.) Claims N

35112 EMPLOYEE PLANS, LLC CLAIMS N

34


54098 EMPLOYEE SECURITY INC. CLAIMS N74212 EMPLOYER PLAN SERVICES CLAIMS N 0.1575235 EMPLOYER'S DIRECT HEALTH - FL CLAIMS N75232 EMPLOYERS DIRECT HEALTH CLAIMS N75232 Employers Direct Health CLAIMS N 0.1575233 EMPLOYERS DIRECT HEALTH - SF CLAIMS N73288 EMPLOYERS HEALTH CLAIMS N73288 EMPLOYERS HEALTH INSURANCE CLAIMS N20508 Employers Health Network LLC CLAIMS N

39026EMPLOYERS INSURANCE OF WAUSAU - AKA WAUSAU CLAIMS N 0.15

37249 EMPLOYERS LIFE INSURANCE CORP. N ADDED 23-SEP-2002.

37249EMPLOYERS LIFE INSURANCE CORPORATION CLAIMS N

59298 EMPLOYERS MUTUAL, INC (FL) CLAIMS N 0.15

59298EMPLOYERS MUTUAL, INC (JACKSONVILLE, FLORIDA) CLAIMS N 0.15

59331EMPLOYERS MUTUAL, INC. (STUART, FLORIDA) CLAIMS N 0.15

FOR PLAN AND CLAIM REQUIREMENTS, PLEASE CONTACT THE EMPLOYERS MUTUAL, INC. (STUART, FL) CUSTOMER SERVICE DEPARTMENT AT (772) 287-7650, EXT. 4052.

35206 ENCIRCLE PPO Claims N37110 ENCOMPASS CLAIMS N 0.1535206 ENCORE HEALTH NETWORK Claims N36364 ENH MEDICAL GROUP IPA CLAIMS N

91136 ENSTAR NATURAL GAS Claims NPlease enter Group Number (P61) when submitting claims.

36878 Entrust CLAIMS NEPOTX EPO CHIP/MANAGED CARE N 0.1562308 EQUICOR CLAIMS N 0.1562308 EQUICOR - PPO CLAIMS N 0.15

75196EQUIFAX HEALTHCARE ADMIN. SERVICES (EHAS) CLAIMS N 0.15

35


62308 EQUITABLE (CIGNA) CLAIMS N 0.15

73126EQUITABLE PLAN SERVICES (OKLAHOMA CITY, OK) CLAIMS N

PAYER ID VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION ADDRESS OF P.O. BOX 720460, OKLAHOMA CITY, OK 73172.

23250 ERIN GROUP ADMINISTRATORS CLAIMS N74234 ERISA CLAIMS N 0.15 041306 switched to THIN34108 ES Beveridge and Associates CLAIMS N 0.1520818 ESSENCE HEALTHCARE CLAIMS N87726 EVERCARE Claims N 0.1587726 EVERCARE (ALL STATES) CLAIMS N 0.1558233 EVERGREEN HEALTH PLAN CLAIMS N59313 EVOLUTIONS HEALTHCARE SYSTEMS 0.15

59313Evolutions Healthcare Systems (New Port Richey FL) CLAIMS N 0.15

Payer ID valid for claims with a submission address of PO Box 5001 New Port Richey FL 34656.

806 EXCELLUS BCBS OF UTICA/WATERTOWN Y 0.15 CALL ANVICARE TO ENROLL

805 EXCELLUS BLUE CROSS OF CENTRAL NY Y 0.15 CALL ANVICARE TO ENROLLFCRBC EXCELLUS ROCHESTER BLUE CROSS Y 0.15 CALL ANVICARE TO ENROLL71412 EXCLUSICARE CLAIMS N37289 F.A. RICHARD & ASSOCIATES, INC. CLAIMS N 0.15

CALL FABOH (CHP/RPU) CLAIMS N

PAYER ID, RENDERING PROVIDER AND LOCATION NUMBER REQUIRED TO SUBMIT CLAIMS. PLEASE CALL DAVE SELL AT (608) 210-6656 TO OBTAIN.

95432 FACEY MEDICAL FOUNDATION CLAIMS37300 FACS GROUP CLAIMS N 0.1522254 FALLON COMMUNITY HEALTH PLAN CLAIMS60995 FAMILY CARE CLAIMS N

31472Family Health Partners - Healthwave of Kansas CLAIMS N

36


43173FAMILY HEALTH PARTNERS/MC+ MISSOURI N ADDED 23-SEP-2002.

TH045 FAMILY HEALTH PLAN CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

31147 FAMILY HEALTH PLAN (OHIO BWC) CLAIMS N 0.32


39158FAMILY HEALTH PLAN COOPERATIVE - MILWAUKEE, WI CLAIMS N


39162FAMILY HEALTH SYSTEMS - WI - COMMUNITY HEALTH PLAN CLAIMS N


39158FAMILY HEALTH SYSTEMS - WI - FAMILY HEALTH PLAN COOP. CLAIMS N


39164FAMILY HEALTH SYSTEMS - WI - NEIGHBORLY CARE PLAN CLAIMS N


39167FAMILY HEALTH SYSTEMS - WI/GROUP HEALTH COOPERATIVE CLAIMS N 0.15

NOW KNOWN AS GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN. (FORMERLY FAMILY HEALTH SYSTEMS - WI/GROUP HEALTH COOPERATIVE)

39168FAMILY HEALTH SYSTEMS - WI/GROUP HEALTH COOPERATIVE ENCOUNTERS N 0.15

NOW KNOWN AS GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN. (FORMERLY FAMILY HEALTH SYSTEMS - WI/GROUP HEALTH COOPERATIVE)

36396 FAMILY MEDICAL NETWORK CLAIMS 0.15PLS CALL 773.572.8311 OR 572.8309 BEFORE SENDING CLAIMS

TH007 FAMILY PRACTICE ASSOCIATES CLAIMS E

TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION. PROVIDER ID REQUIRED. PLEASE CALL (409) 721-5900 TO OBTAIN.

FPA11 FAMILY PRACTICE ASSOCIATES Y 0.1537289 FARA CLAIMS N 0.1537289 FARA BENEFIT SERVICES, INC. CLAIMS N 0.15

37


14140 Farm Family Life CLAIMS N33033 FCE Benefit Administrators CLAIMS N 0.1537300 FEDERATED BENEFITS CLAIMS N 0.1537300 FEDERATED HR SERVICES CLAIMS N 0.1541041 FEDERATED MUTUAL INSURANCE CLAIMS N11315 FIDELIS CARE NEW YORK CLAIMS N11315 FIDELIS CARE NY CLAIMS NFAMR1 FIRST ADMINISTRATORS CLAIMS N 0.15

69140 FIRST ALLMERICA FINANCIAL LIFE INS. CO. CLAIMS N (FORMERLY ALLMERICA FINANCIAL)56196 FIRST CAROLINA CARE CLAIMS N91131 FIRST CHOICE HEALTH NETWORK Claims N75138 FIRST CHOICE OF MIDWEST (PPO) CLAIMS N87043 FIRST HEALTH CLAIMS N 0.156108 FIRST OPTION HEALTH PLAN CLAIMS N Payer requires unique provider ID;please cal ll Unit at800-438-78

22324 FIRST OPTION HEALTH PLAN CLAIMS N

EFFECTIVE IMMEDIATELY. PLEASE USE PHS PAYER ID 06108. CLAIMS SUBMITTED AFTER SEPTEMBER 1ST USING THE FOHP PAYER ID(22324) WILL BE REJECTED. BEFORE SUBMITTING YOUR FIRST EDI CLAIMS, PLEASE CONTACT AN FOHP/PHS REPRESENTATIVE AT (800) 848-4747, EXT. 5680.

23241 FIRST PRIORITY CLAIMS N63080 FIRST STATE HEALTH PLAN CLAIMS N PREVIOUSLY PAYER ID 5103594999 FIRSTCARE Y 0.15

TH003 FIRSTCARE CLAIMS E

TRANSITIONAL PAYER PROVIDER ID REQUIRED. PLEASE CALL WebMD (800) 365-1051 EXT. 6456 FOR SUSAN OR EXT. 5141 FOR CHRIS TO OBTAIN.

38


TH003 FIRSTCARE "STAR" MEDICIAD CLAIMS E

TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION. PROVIDER ID REQUIRED. PLEASE CALL (800) 365-1051 TO OBTAIN. THE INSURED ID MUST BE 9 ALPHANUMERIC CHARACTERS AND 2 DIGITS.

90060 FIRSTGUARD HEALTH PLAN-KANSAS CLAIMS N 0.15CONTACT KAREN JOSLIN AT 816.922.7225 TO GET NETWORKID

90061 FIRSTGUARD HEALTH PLAN-MISSOURI CLAIMS N 0.1590061 FIRSTGUARD HEALTH PLAN-MISSOURI CLAIMS N 0.15

62061 FISERV HEALTH - KANSAS/TENNESSEE CLAIMS N 0.15(FORMERLY WILLIS ADMINISTRATIVE SERVICES CORPORATION)

11244 FITZHARRIS & COMPANY, INC. CLAIMS N59276 FLORIDA 1ST CLAIMS N68058 FLORIDA CENPATICO BEHAVORIAL CLAIMS 0.1559322 Florida Health Care Plan CLAIMS N 0.15

59321 FLORIDA HOSPITAL HEALTHCARE SYSTEMS CLAIMS N

IN-NETWORK FHHS PROVIDERS MUST SUBMIT EITHER THEIR UPIN NUMBER OR FHHS PROVIDER ID, AS THE RENDERING PROVIDER NUMBER. OUT-OF-NETWORK PROVIDERS MUST CONTACT FHHS AT (407) 741-4893. THE FHHS MEMBER MEMBER ID MUST BE 11 DIGITS IN LENGTH.

48116 FLORIDA HOSPITAL WATERMAN CLAIMS N 0.15 SWITCHED TO THIN 06170559698 Florida League of Cities Inc. CLAIMS N 0.15FLMCD FLORIDA MEDICAID N 0.1565063 Florida NetPass CLAIMS N 0.1568057 FLORIDA SUNSHINE ST HTH PLN CLAIMS 0.15APBPN FLORIDIANCARE (BPN) CLAIMS 0.15APSFL FLORIDIANCARE (SOUTH FLORIDA) CLAIMS 0.1548117 FMH BENEFIT SERVICES, INC. CLAIMS N 0.15 SWITCHED TO THIN 06170587066 FORMAX, INC. CLAIMS N70408 FORTIS BENEFITS CLAIMS N 0.15

39


70408 FORTIS BENEFITS INSURANCE COMPANY CLAIMS N 0.15FHFLC FOUNDATION HEALTH OF FLORIDA FL N

59257 FOUNDATION HEALTH PLAN (SUNRISE, FL) N ADDED 23-SEP-2002.

TH056 FOX VALLEY MEDICINE CLAIMS NTRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

64069 FOX-EVERETT, INC. CLAIMS N 0.15

64067 FOXEVERETT - INGALLS SHIP BUILDING CLAIMS N

MPI_REJECTFREECLAIMS INTERNAL CODE FOR REJECT CLAIMS N

SPRNTFREECLAIMS INTERNAL ID FOR PAPER CLAIMS - *** BILLABLE *** N 0.54 ADDED 03/01/2002

MPI_PAPERFREECLAIMS PAPER CLAIMS SERVICE (BILL TO SUBMITTER) N

FREECLAIM HARDCODED PAYOR FOR PAPER CLAIMS ONLY

PAPERFREECLAIMS PAPER CLAIMS SERVICE (BILL TO SUBMITTER) N FREECLAIMS HARDCODED FOR PAPER CLAIMS

SB942 FREEDOM BLUE BCBS Medicare Advantage CLAIMS Y 0.32Changed from Payer ID 71768 on 05/02/08 and now $0.32 Enrollment req.

31313 FREEDOM FIRST CLAIMS 0.1541212 Freedom Health Plan CLAIMS N 0.15

62324FREEDOM LIFE INSURANCE COMPANY OF AMERICA CLAIMS N 0.15

23130 Fresenius Medical Care CLAIMS N59204 FRINGE BENEFITS COORDINATORS CLAIMS N34171 FrontPath Health Coalition Claims N

67815 G.E. GROUP LIFE ASSURANCE COMPANY CLAIMS N

67814 G.E. GROUP LIFE ASSURANCE COMPANY Claims N

37283GALLAGHER BENEFIT ADMINISTRATORS, INC/GBA CLAIMS N


40


30005GALVESTON COUNTY INDIGENT HEALTH CARE CLAIMS N

31147GATES MCDONALD HEALTH PLUS, INC. (OHIO BWC) CLAIMS N 0.32


25169 GATEWAY HEALTH PLAN CLAIMS N

60550 Gateway Health Plan - Medicare Assured CLAIMS N

Gateway Health Plan - Medicare Assured; 60550 (Yellow Card). Please check the ID card to verify the Payer ID before submitting claims. If you have questions please contact Gateway Provider Servicing Department at 1-800-685-5205.

37283 GBA CLAIMS NCLAIMS ARE PRINTED AND MAILED TO THE PAYER.

6143 GE GROUP ADMINISTRATORS CLAIMS N (FORMERLY PHOENIX GROUP SERVICES, INC.)75238 GE GROUP ADMINISTRATORS CLAIMS N6143 GE GROUP ADMINISTRATORS Claims N (Formerly Phoenix Group Services, Inc.)

6143GE GROUP ADMINISTRATORS, SOUTH CAROLINA CLAIMS N (FORMERLY PHOENIX GROUP SERVICES, INC.)

75238 GE GROUP ADMINISTRATORS, TEXAS CLAIMS N (FORMERLY PHOENIX GROUP SERVICES - TEXAS)

75273 GEISINGER HEALTH PLAN CLAIMS Y

CONTACT THE PAYER AT 888-281-5338 Opt 3, FILL OUT FORM AT WWW.THEHEALTHPLAN.COM

63665 GENELCO (ST. LOUIS) CLAIMS N 0.15

63665GENERAL AMERICAN LIFE INSURANCE COMPANY Claims N 0.15

46050 Generations Healthcare CLAIMS N46051 Generations-Hillcrest CLAIMS N

31147 GENEX CARE OF OHIO (OHIO BWC) CLAIMS N 0.32


41


GABCS GEORGIA BLUE CROSS BLUE SHIELD Claims N 0.15No enrollment needed for claims. Enrollment needed for ERA (835)

58207 GEORGIA HEALTH PLUS CLAIMS N

GAMCD GEORGIA MEDICAID (ACS) Y 0.15CALL PAYOR AT 800.987.6391 TO REGISTER. ANVICARE TRADING PARTNER ID=129037

GAMCR GEORGIA MEDICARE PART-B Y 0.15

61271GEORGIA POWER MEDICAL BENEFITS PLAN CLAIMS N 0.15

23212GETTYSBURG HEALTH (EMDEON NAME: American Medical and Life ) CLAIMS 0.15

91051 GH BASIC HEALTH PLAN Claims N 0.15

Western Washington State. Please call (206) 901-6347 prior to first submission of production claims.

91051 GH INDIVIDUAL AND FAMILY PLAN Claims N 0.15


91051 GHC - COMMERCIAL Claims N 0.15


91051 GHC MEDICARE + CHOICE Claims N 0.15


13551 GHI - NEW YORK CLAIMS N 0.1525531 GHI HMO Claims N 0.1525531 GHI HMO SELECT CLAIMS N 0.15

25141 GHP (GROUP HEALTH PLAN) N 0.15

CONTACT: RENEE CRUMLISH TEL:(302)283-6570. NETWORKID AND GROUPNETWORKID NEEDED. CONTACT GHP PROVIDER REPS TO GET YOUR IDS.

58204 GI INNOVATIVE MANAGEMENT Claims N80314 GIC INDEMNITY PLAN Claims N 0.157205 GILSBAR, INC. Claims N 0.15

42


91136GLASSWORKERS HEALTH & WELFARE FUND Claims N


7689 Global Care Inc. CLAIMS N 0.1547083 GMS Inc. CLAIMS N37602 GOLDEN RULE INSURANCE COMPANY CLAIMS N68041 GOLDEN STATE MEDICAL GROUP CLAIMS N

72189 GOLDEN TRIANGE PHYSICIAN ASSOCIATES CLAIMS N

GTPA1 GOLDEN TRIANGLE PHYSICIAN SYSTEMS N 0.15

45235GOVERNMENT EMPLOYEES HEALTH ASSOCIATION 0.15

44054GOVERNMENT EMPLOYEES HOSPITAL ASSOCIATION (GEHA) CLAIMS N 0.15

37234GRANT PHYSICIANS PRACTICE ASSOCIATION N 0.15 ADDED 23-SEP-2002.

95467 GREAT LAKES HEALTH PLAN CLAIMS N80705 GREAT-WEST HEALTHCARE CLAIMS N 0.1580705 GREAT-WEST LIFE & ANNUITY INS. CO. CLAIMS N 0.1580705 GREAT-WEST LIFE & ANNUITY INS. CO. ERA N 0.1578521 GREE TREE ADMINISTRATORS CLAIMS N 0.15

TH010 GREENTREE ADMINISTRATORS CLAIMS NTRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

36338 GROUP ADMINISTRATORS LTD. CLAIMS N 0.15

48143GROUP AND PENSION ADMINISTRATORS (PHCS) CLAIMS N

72153GROUP BENEFIT ADMINISTRATORS (HENDERSONVILLE, TN) CLAIMS N

91121 GROUP HEALTH COOPERATIVE - EAST CLAIMS N

EASTERN WASHINGTON STATE AND NORTHERN IDAHO. SIGNED PROVIDER AGREEMENT REQUIRED - PLEASE CALL (509) 241-7317 PRIOR TO SUBMITTING CLAIMS.

43


91051 GROUP HEALTH COOPERATIVE - WEST CLAIMS N 0.15

WESTERN WASHINGTON STATE. PLEASE CALL (206) 901-6347 PRIOR TO FIRST SUBMISSION OF PRODUCTION CLAIMS.

39167GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN Claims N 0.15

39168GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN ENCOUNTERS N 0.15

22937 Group Health Inc. CLAIMS N 0.1561101 GROUP HEALTH INSURANCE - DE CLAIMS N 0.1538194 GROUP HEALTH MANAGERS CLAIMS N 0.15

91051GROUP HEALTH OPTIONS, INCORPORATED ALLIANT PLUS Claims N 0.15


91051GROUP HEALTH OPTIONS, INCORPORATED ALLIANT SELECT Claims N 0.15


91051GROUP HEALTH OPTIONS, INCORPORATED OPTIONS Claims N 0.15


91051GROUP HEALTH OPTIONS, INCORPORATED OPTIONS PRIME Claims N 0.15


91051GROUP HEALTH OPTIONS, INCORPORATED OPTIONS SELECT Claims N 0.15


37276 Group Insurance Service Center Inc. CLAIMS N 0.1516126 GUARDIAN CHOICE, THE CLAIMS N77010 Guardian Healthcare INC. CLAIMS 0.15

64246GUARDIAN LIFE INS CO OF AMERICA, THE GUARDIAN CLAIMS N 0.15

44


39180GUNDERSEN LUTHERAN HEALTH PLAN, INC. CLAIMS N

BEFORE SUBMITTING ELECTRONICALLY TO GUNDERSEN LUTHERAN HEALTH PLAN, INC., ALL PROVIDERS MUST CALL SHARI OELKE AT (608) 775-8026.

13335 H U D S O N CLAIMS Y 0.1537114 H.E.R.E.I.U WELFARE PENSION FUNDS Claims N 0.1595266 HARRINGTON BENEFIT SERVICES CLAIMS N 0.1595266 Harrington Benefit Services, Inc. N 0.1595266 HARRINGTON BENEFIT SERVICES, INC. CLAIMS N 0.15 Harrington; RE Harrington75196 HARRINGTON BENEFIT SERVICES, INC. CLAIMS N 0.15 Centra; Centra Benefit Services95266 HARRINGTON BENEFIT SERVICES, INC. CLAIMS N 0.154245 HARVARD COMMUNITY HEALTH PLAN N ADDED 23-SEP-2002.4271 HARVARD PILGRIM HEALTH CARE CLAIMS N 0.32HIMCD HAWAII MEDICAID Y 0.15

SB971HAWAII MEDICAL SERVICE ASSOCIATION (HMSA) CLAIMS Y 0.32 PAYER REQUIRES PROVIDER LEVEL TESTING

86065 HAWKI CLAIMS N37111 HCH ADMINISTRATION (ILLINOIS) Claims N 0.15 ROUTED FROM NEIC TO AVLTY 03311137329 HCHA ALBQ-SELF FUNDED Claims N 0.15 ROUTED FROM NEIC TO AVLTY 033111

82018 HCS - HEALTH CLAIMS SERVICE (BOISE, ID) CLAIMS N20257 HDPC/Alliance Physicians CLAIMS N

34185 HEALTH ADMINISTRATION SERVICE, INC. CLAIMS N23172 HEALTH ALLIANCE EXCLUSIVE & PLUS CLAIMS N77950 HEALTH ALLIANCE MEDICAL PLANS CLAIMS 0.15

38224 HEALTH ALLIANCE PLAN OF MICHIGAN CLAIMS N

25126HEALTH AMERICA INC./HEALTH ASSURANCE/ADVANTRA CLAIMS N 0.15


45


34654

HEALTH AND WELFARE FUND OF THE PLUMBERS AND PIPEFITTERS LOCAL UNION NO. 396, OHI CLAIMS N

PAYER ID VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION ADDRESS OF P.O. BOX 230, NILES, OH 44446.

25126HEALTH ASSURANCE/HEALTH AMERICA, INC./ADVANTRA CLAIMS N 0.15


42102 Health Care Network of Wisconsin (HCN) CLAIMS N

34193HEALTH CARE PAYERS COALITION (TOLEDO, OH) Claims N

Payer ID valid only for claims with a billing submission address of P.O. Box 741, Toledo, OH 43697-0741.

62180 HEALTH CHOICE GENERATIONS 0.1522345 HEALTH CHOICE INC. CLAIMS N37263 HEALTH CONNECTICUT CLAIMS N62111 HEALTH COST SOLUTIONS CLAIMS N34158 HEALTH DESIGN PLUS (HUDSON, OH) Claims N16120 HEALTH EZ Claims N75234 HEALTH FIRST - TYLER, TX CLAIMS N 0.1530946 HEALTH FUTURE, LLC. CLAIMS N 0.15

TH049HEALTH MANAGEMENT ADMINISTRATORS (HMA) CLAIMS N

TH049HEALTH MANAGEMENT ADMINISTRATORS (HMA) CLAIMS N

TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

31147HEALTH MANAGEMENT SOLUTIONS (OHIO BWC) CLAIMS N 0.32


62295 HEALTH MARKET CARE ASSURED CLAIMS N 0.1595567 HEALTH NET - CALIFORNIA CLAIMS N95567 HEALTH NET - CALIFORNIA ROSTERS N

95570HEALTH NET - CALIFORNIA (PROFESSIONAL ENCOUNTERS ONLY) Encounters N

Must submit with Health Net Submitter ID. Please contact Karen Campbell at (916) 935-1461 to obtain Health Net Submitter ID.

6108 Health Net NE 0.15

46


38309 HEALTH NET OF ARIZONA CLAIMS N

95567HEALTH NET OF CALIFORNIA AND OREGON - CLAIMS Claims N

Contact Health Nets EDI Department at (800) 977-3568 prior to first claims submission.

6108 HEALTH NET OF THE NORTHEAST Claims N Payer requires unique provider ID;please cal ll Unit at800-438-786108 HEALTH NET OF THE NORTHEAST, INC. CLAIMS N Payer requires unique provider ID;please cal ll Unit at800-438-7822340 HEALTH NET OREGON CLAIMS NSX185 HEALTH NET PEARL CLAIMS 0.32955670000 HEALTH NET-CALIFORNIA ROSTERS N20199 HEALTH NETWORK AMERICA CLAIMS N65062 Health Network One CLAIMS N 0.15

PHD05HEALTH NETWORKS OF COLORADO SPRINGS CO N

4286 HEALTH NEW ENGLAND Claims N4286 HEALTH NEW ENGLAND CLAIMS N 0.1558216 HEALTH ONE ALLIANCE CLAIMS N25138 HEALTH OPTIONS CONNECT N

FC001 HEALTH OPTIONS OF FLORIDA CLAIMS Y 0.15CHANGE FROM RCVID OF FC001 TO FLBCS ON 01/14/04

36368 Health Options of Illinois CLAIMS N6137 HEALTH PARTNERS - CONNECTICUT CT N80142 HEALTH PARTNERS - JACKSON, TN CLAIMS N 0.1562157 HEALTH PARTNERS - JACKSON, TN CLAIMS N

63092 HEALTH PARTNERS OF ALABAMA, INC. CLAIMS P 0.1563092 HEALTH PARTNERS SOUTHEAST CLAIMS P 0.15

80142 HEALTH PARTNERS, PA Claims N 0.15

All claims submitted require a valid Health Partners, PA, provider ID in the Rendering Provider Network ID field.

47


20270 Health Payment Services LLC CLAIMS N37221 HEALTH PLAN MANAGEMENT CLAIMS N52563 HEALTH PLAN OF MICHIGAN CLAIMS N 0.15

59256 HEALTH PLAN SOUTHEAST NADDED 31-OCT-2002. PAYOR CONTACT: CHRIS CHATELAIN (800)833-2169 EXT 603

59256HEALTH PLAN SOUTHEAST (TALLAHASSEE, FL) Claims N

44273 HEALTH PLANS INC. CLAIMS N Previously Benefit Plan Mgmt.95435 HEALTH PLEDGE HMO CLAIMS N

11324 HEALTH PLUS PHSP ( BROOKLYNM, NY) CLAIMS N 0.1552201 HEALTH RIGHT CLAIMS55438 HEALTH RISK MANAGEMENT CLAIMS N 0.1541170 HEALTH RISK MANAGEMENT, INC. CLAIMS N 0.1520896 Health Services Consulting Group Inc. CLAIMS N 0.15

37290Health Services for Children with Special Needs CLAIMS N

41150 Health Services Management CLAIMS Y

16105HEALTH SERVICES MEDICAL CORPORATION CLAIMS N

34167HEALTH SERVICES PREFERRED (HSP) BY EMERALD HEALTH CLAIMS N

TH044HEALTH SERVICES PURCHASING COALITION CLAIMS E


27008 Health Systems International - ECOH CLAIMS N 0.15

61101HEALTH VALUE MANAGEMENT - DE (HUMANA) CLAIMS N 0.15

84980HEALTHCARE BENEFITS, INC (HBI) 84980 HEALTHFIRST (HMO) N 0.15

HCP01 HEALTHCARE PARTNERS CLAIMS N 0.15

11328 HEALTHCARE PARTNERS, IPA CLAIMS N 0.15FORMERLY HERITAGE NEW YORK MEDICAL GROUP.

48


92468 HEALTHCARE RESOURCE GROUP (HRG) N 0.1556731 Healthcare Resources NW CLAIMS N 0.1573147 HEALTHCARE SOLUTIONS GROUP CLAIMS N 0.15

31147HEALTHCARE TRANSACTION PROCESSING, INC (HTP) CLAIMS N 0.32


25143 HEALTHCARE USA N 0.15HMA01 HEALTHCARE'S FINEST NETWORK CLAIMS N 0.1562179 HEALTHCHOICE OF AZ CLAIMS 0.1562168 HEALTHCHOICE OF MEMPHIS CLAIMS N85729 Healthcomp Inc. CLAIMS N ADDED 04/18/200675234 HEALTHFIRST - TYLER, TX Claims N 0.1595019 HEALTHFIRST HEALTHPLAN (FLORIDA) N 0.1575289 HEALTHFIRST TPA - AUSTIN 0.1580141 HEALTHFIRST, INC. Claims N 0.1523226 HEALTHGUARD OF LANCASTER CLAIMS N59087 HEALTHHELP NETWORK, INC. (HHNI) CLAIMS N

96475 HEALTHLINK HMO CLAIMS N

PLEASE CALL PROVIDER RELATIONS DEPT AT (800) 624-2356 FOR UNIQUE PROVIDER NUMBER. (Hcfa blk 33, PIN field)

90001 HEALTHLINK PPO CLAIMS N

PLEASE CALL PROVIDER RELATIONS DEPT AT (800) 624-2356 FOR UNIQUE PROVIDER NUMBER. (Hcfa blk 33, PIN field)

43132 HEALTHNET - KANSAS CITY, MO CLAIMS NAZHNT HEALTHNET OF ARIZONA AZ N55204 Healthnow Division CLAIMS Y 0.15 Provider id = 12 digits with G2 qualifier

SX009 HEALTHPARTNERS MN 0.32CONTACT 800.444.4558 TO GET HPFIN NO. BEFORE SENDING CLIAMS

SX009 HEALTHPARTNERS(MINNESOTA) CLAIMS Y 0.32

$0.32 per claim. PAYOR REQUIRES HPFIN(PROVIDER ID) AND TP NUMBER FOR EACH FACILITY SUBMITTING EDI CLAIMS. PLEASE CALL 952.883.7505 OPTION 2.

49


95266HEALTHPLAN SERVICE HARRINGTON (COLUMBUS, OH) CLAIMS N 0.15

59140 HEALTHPLAN SERVICES (TAMPA ONLY) CLAIMS N 0.15

38216 HEALTHPLUS OF MICHIGAN CLAIMS N 0.32

Effective 11/01/2007, 32 cents per claim. NON-SPONSORED PLUS PAYER. HEALTHPLUS NEEDED TPA (TRADING PARTNER AGREEMENT). CALL 810.230.2084 TO OBTAIN

31106 HEALTHPOWER HMO N 0.156142 HEALTHRIGHT, INC. CLAIMS N71063 HEALTHSCOPE BENEFITS, INC. Claims N

Call HEALTHSCOPE BENEFITS, INC. (PCP ONLY) Claims N Call Jonda Brown (800) 972-3025 for Payer ID.

48153HEALTHSCOPE BENEFITS, INC. (REPRICING AR) Claims N

HSPC1 HEALTHSMART PREFERRED CARE (HSPC) N 0.15 GROUP NAME AND ID IS REQUIRED BY HSPC75250 HEALTHSMART PREFERRED CARE, INC. CLAIMS N75237 HEALTHSMAT ACCEL CLAIMS N 0.152041 HEALTHSOURCE CMHC CLAIMS N 0.152041 HEALTHSOURCE CMHC Claims N 0.15

2041 HEALTHSOURCE MASSACHUSETTS INC. CLAIMS N 0.15

2041 HEALTHSOURCE MASSACHUSETTS, INC. CLAIMS N 0.15

68195 HEALTHSOURCE PROVIDENT CLAIMS N 0.15CLAIMS ARE EDITED UNDER CIGNAS PAYER SPECIFIC EDITS, PAYER ID 62308.

68195 HEALTHSOURCE PROVIDENT (CIGNA) CLAIMS N 0.15CLAIMS ARE EDITED UNDER CIGNAS PAYER SPECIFIC EDITS, PAYER ID 62308.

68195 HEALTHSOURCE PROVIDENT (CIGNA) ERA N 0.15

71074 HEALTHSOURCE, AR CLAIMS N 0.15PAYER REQUIRES PROVIDER ID NUMBER, CALL (800) 831-6654.

50


71075 HEALTHSOURCE, AR (MED) (CIGNA) CLAIMS N 0.15CLAIMS ARE EDITED UNDER CIGNAS PAYER SPECIFIC EDITS, PAYER ID 62308.

58210 HEALTHSOURCE, GA (CIGNA) CLAIMS N 0.15CLAIMS ARE EDITED UNDER CIGNAS PAYER SPECIFIC EDITS, PAYER ID 62308.

35167 HEALTHSOURCE, IN CLAIMS N 0.1561127 HEALTHSOURCE, KY CLAIMS N 0.151041 HEALTHSOURCE, ME CLAIMS N 0.15 Payer requires unique provider ID;please con 27, ext.5760

75255 HEALTHSOURCE, N. TX (CIGNA) CLAIMS N 0.15CLAIMS ARE EDITED UNDER CIGNAS PAYER SPECIFIC EDITS, PAYER ID 62308.

56147 HEALTHSOURCE, NC (CIGNA) CLAIMS N 0.15CLAIMS ARE EDITED UNDER CIGNAS PAYER SPECIFIC EDITS, PAYER ID 62308.

2038 HEALTHSOURCE, NH CLAIMS N 0.15 Payer requires unique provider ID fornew provid ct Donna16126 HEALTHSOURCE, NY CLAIMS N31141 HEALTHSOURCE, OH CLAIMS N 0.15

6119 HEALTHSOURCE, SC CLAIMS N 0.15 HEALTHSOURCE NETWORK PROVIDERS ONLY

62129 HEALTHSOURCE, TN (CIGNA) CLAIMS N 0.15CLAIMS ARE EDITED UNDER CIGNAS PAYER SPECIFIC EDITS, PAYER ID 62308.

63086HEALTHSOUTH MEDICAL PLAN ADMINISTRATORS CLAIMS N

HSPAN HealthSpan Network Repricing CLAIMS 0.15

63092 HEALTHSPRING OF ALABAMA CLAIMS P 0.15

FORMERLY THE OATH - A HEALTH PLAN FOR ALABAMA. PLEASE NOTE THAT ALL CLAIMS SUBMITTED REQUIRE A 4-6 DIGIT RENDERING PROVIDER ID. PLEASE CONTACT HEALTHSPRING OF ALABAMA PROVIDER CALL CENTER AT (800) 743-7141 FOR PROVIDER ENROLLMENT.

36332 HEALTHSTAR, INC. CLAIMS N58213 Healthways WholeHealth Networks CLAIMS N

51


69140 HEALTHY CHOICE, HEALTHY CHOICE PLUS CLAIMS NM3FL3 HEALTHY KIDS CLAIMS 0.15 ENROLL AT 866.703.1444

91051 HEALTHY OPTIONS (DSHS) Claims N 0.15


4286 HEATH NEW ENGLAND CLAIMS N 0.152041 HEATHSOURCE CMHC CLAIMS N 0.15

Call HEP ADMINISTRATORS, INC. (NON-PPO) Claims NPrior enrollment is required. Please call customer service at (262) 567-9695.

59230 HERITAGE CONSULTANTS CLAIMS N

FOR FASTER PAYMENT, PLEASE BE SURE TO USE ONLY THE 9-DIGIT SUBSCRIBER ID ON ALL CLAIMS.

11328 HERITAGE NEW YORK MEDICAL GROUP CLAIMS N 0.15

TH011 HERITAGE PHYSICIAN NETWORK CLAIMS E

TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION. PAYER- ASSIGNED PROVIDER ID REQUIRED. PLEASE CALL (409) 721- 5900 TO OBTAIN.

HPN11HERITAGE PHYSICIAN NETWORK (HOUSTON) Y 0.15

NETWORK ID REQUIRED (BOX 33,PIN FIELD). CALL 800-544-5428 TO OBTAIN ID

REGAL HERITAGE PROVIDER NETWORK CLAIMSM3FL5 HFN HEALTHEASE CLAIMS 0.15 ENROLL AT 866.703.144436335 HFN, INC. CLAIMS N33069 High Desert Primary Care CLAIMS N

SMPA0 Highmark (BCBS of Pennsylvania) MCARE CLAIMS N 0.32 $0.32 PER CLAIM

SB865

Highmark Blue Cross Blue Shield of Pennsylvania - NEW USER: USE PABCS INSTEAD CLAIMS Y 0.32

NEW USER:USE PAYORID PABCS. REGISTRATION REQUIRED. CONTACT ANVICARE

35145 Highmark- Key Family CLAIMS N 0.1546 HILL PHYSICIAN MEDICAL GROUP N

52


Call HILL PHYSICIANS MEDICAL GROUP Claims NPlease contact Tina Loftus at (800) 445-5747 for Payer ID.

59347 Hillcrest Benefit Administrators CLAIMS N36385 Hinsdale Physician Healthcare CLAIMS N37115 HINSDALE PHYSICIANS HEALTHCARE CLAIMS N

55247HIP - HEALTH INSURANCE PLAN OF GREATER NEW YORK CLAIMS N 0.15 Individual provider enrollment is

required b se call HIP ofNY Provide tain theenrollment 7-8386 ore-mail at .com.AXH01 HIP NY ANESTHESIA CLAIMS N Payer no longer Available86066 HMA-HAWAII CLAIMS 0.32

HMA01 HMA-HEALTHCARE MANAGEMENT ADM CLAIMS N 0.15

MDHMO HMO BLUE MEDICAID TX N 0.15 "(**27 max lines FA0) **Receiver Type ""D"""COHMO HMO OF COLORADO CO N (**12 max lines FA0)61101 HMPK, INC. CLAIMS N 0.1536412 Holy Cross Health Partners CLAIMS N68069 HOME STATE HEALTH PLAN34150 HOMETOWN HEALTH NETWORK CLAIMS N20475 HOOSIER ALLIANCE HEALTH PLAN CLAIMS 0.15

22099HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY (HORIZON BCBSNJ) Claims N 0.15

22304 HORIZON HEALTHCARE ADMIN (HHA) Claims N 0.1522326 HORIZON MERCY CLAIMS N22326 HORIZON NJ HEALTH (NEW JERSEY) CLAIMS FORMERLY MERCY HEALTH PLAN

91136HOTEL EMPLOYEES & RESTAURANT EMPLOYEES HEALTH TRUST Claims N


91136HOTEL EMPLOYEES & RESTAURANT EMPLOYEES HEALTH TRUST - GRP# F19 CLAIMS N

PLEASE INCLUDE GROUP NUMBER WHEN SUBMITTING CLAIMS.

61101 HPLAN, INC. CLAIMS N 0.15

53


58227 HPS PARADIGM, INC. CLAIMS N41170 HRM CLAIMS N 0.1541170 HRM CLAIM MANAGEMENT CLAIMS N 0.15HSM01 HSM N 0.15

13335 HUDSON HEALTH PLAN Claims Y 0.15REQUIRE ENROLLMENT REQUIRED BEFORE SUBMITTING CLAIMS

61102HUMANA (ENCOUNTERS ONLY) (CAPITATED) ENCOUNTERS N

73288HUMANA - EMPLOYERS HEALTH INSURANCE CLAIMS N

61101 HUMANA CARE PLAN CLAIMS N 0.1561101 HUMANA EMPHESYS CLAIMS N 0.15

61101HUMANA EMPLOYERS HEALTH INSURANCE CLAIMS N 0.15

61101 HUMANA GROUP HEALTH PLAN CLAIMS N 0.1561101 HUMANA HEALTH CHICAGO CLAIMS N 0.15

61101HUMANA HEALTH CHICAGO INSURANCE COMPANY CLAIMS N 0.15

61101 HUMANA HEALTH PLAN CLAIMS N 0.1561101 HUMANA INC. CLAIMS N 0.15

61102HUMANA INC. ENCOUNTERS ONLY (CAPITATED) Encounters N

Claims sent to payer id 61102 will NOT be paid. Payer ID 61102 is for ENCOUNTERS ONLY.

61101 HUMANA INSURANCE AGENCY CLAIMS N 0.1561101 HUMANA INSURANCE COMPANY CLAIMS N 0.15

61101HUMANA INSURANCE COMPANY CHOICE CARE NETWORK CLAIMS N 0.15

DOES NOT INCLUDE HUMANA CHOICECARE OF CINCINNATI - (HUMANA HEALTH PLANS OF OHIO)

61101 HUMANA MEDICAL PLAN - CA CLAIMS N 0.1561101 HUMANA MEDICAL PLAN - KY CLAIMS N 0.1565018 HUMANA PUERTO RICO Claims N

61160 Humana Veterans Healthcare Services CLAIMS N

54


61101HUMANA WISCONSIN HEALTH ORGANIZATION CLAIMS N 0.15

61103 HUMANA WORKERS COMP - OHIO NHUMAR HUMANA/ARIA N 0.1537260 HUNT INSURANCE GROUP Claims N 0.15

37260HUNT INSURANCE GROUP / HRH TPA SERVICES N 0.15

LOCATED IN TALLAHASSEE, FLORIDA. CONTACT: CINDY CLAWSON. TEL:(850)385-3636 EXT 227.

41600 I'MCARE CLAIMS N22175 I. E. SHAFFER (WEST TRENTON, NJ) CLAIMS N 0.1537279 IAA CLAIMS N

86304 IAC (INSURERS ADMINISTRATIVE CORP) CLAIMS38234 IBA SELF FUNDED GROUP N ADDED 23-SEP-2002.

SX083IBC PERSONAL CHOICE (INDEPENDENT BLUE CROSS PERSONAL CHOICE) CLAIMS Y 0.32 $0.32 PER CLAIM

41124 IBI CLAIMS N37296 ICM CLAIMS N 0.15AIDID IDAHO MEDICAID N 0.1568069 ILLINICARE HEALTH PLAN

36600ILLINOIS CENTRAL HOSPITAL ASSOCIATION (TINLEY PARK, IL) CLAIMS N

DMG01 ILLINOIS HEALTH PARTNERS CLAIMS 0.15IL621 ILLINOIS MEDICAID (IDPA) CLAIMS Y 0.15 CALL 312-653-7954 FOR ENROLLMENT41600 IMCARE CLAIMS N37319 IMSCO HEALTH SYSTEMS CLAIMS N40585 INDECS Corp CLAIMS N

FCIH1 Independent Health CLAIMS 0.15REGISTRATION NEEDED. PLS CONTACT IH AT 716-631-3001

INBCS INDIANA BLUE CROSS (ANTHEM) Y 0.15 ENROLLMENT REQUIRED WITH PAYOR (TC4679)35204 INDIANA HEALTH NETWORK N 0.15 ADDED 23-SEP-2002.

55


SKIN0 Indiana Medicaid N 0.32INMCR INDIANA MEDICARE PART B CLAIMS Y 0.1535161 INDIANA PROHEALTH NETWORK CLAIMS N

31053INDIVIDUAL HEALTH INSURANCE COMPANIES CLAIMS N

43471 INETICO, INC CLAIMS N 0.1550946 INFORMED UHC CLAIMS 0.1552196 INFORMED, LLC Claims N52196 INFORMED,LLC CLAIMS N36348 Ingalls Provider Group CLAIMS N

52212 Injured Workers Insurance Fund CLAIMS N

Injured Workers Insurance Fund requires first time submitters to contact Grace Sobrio at (410) 494-2045 prior to submitting claims.

4320 INNOVATIVE HEALTHCARE SOLUTIONS CLAIMS N 0.15

4320 INNOVATIVE HEALTHWARE SOLUTIONS Claims N 0.15

4320 INNOVATIVE HEALTHWARE SOLUTIONS CLAIMS N 0.15

37279INSURANCE ADMINISTRATORS OF AMERICA, INC. CLAIMS N

63082INSURANCE CLAIMS SERVICES, INC. (BIRMINGHAM, AL) Claims N

63082INSURANCE CLAIMS SERVICES, INC.(BIRMINGHAM, AL) CLAIMS N

13315 INSURANCE DESIGN ADMINISTRATORS CLAIMS N

15688Insurance Management Services (Amarillo TX) CLAIMS N

This Payer ID is only valid for claims with submission address of P.O. Box 15688; Amarillo TX 79105

88006INSURANCE MANAGEMENT SERVICES (ELKO, NV) CLAIMS N

56


IMSMSINSURANCE MANAGEMENT SERVICES (IMS) OF TEXAS CLAIMS N 0.15 LOCATED IN AMARILLO, TEXAS

ISL11 INSURANCE SERVICE OF LUBBOCK N 0.15

TH012 INSURANCE SERVICES OF LUBBOCK CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

IAC01INSURER'S ADMINISTRATIVE CORPORATION Y 0.15

51020INTEGRA ADMINISTRATIVE GROUP (SEAFORD, DE) CLAIMS N

PAYER ID VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION ADDRESS OF 110 S. SHIPLEY STREET, SEAFORD, DE 19973.

31127 INTEGRA GROUP CLAIMS N31129 INTEGRA GROUP-CHA CLAIMS NINET1 INTEGRANET CLAIMS Y 0.15

34167INTEGRATED CARE NETWORK (ICN) BY EMERALD HEALTH CLAIMS N

68053 Integrated Mental Health Services CLAIMS N37227 INTERCARE HEALTH PLANS INC. Claims N37227 INTERCARE HEALTH PLANS, INC. CLAIMS N60280 Interface EAP (IEAP) CLAIMS N

23287 INTERGROUP SERVICES CORPORATION CLAIMS N

36609INTERNATIONAL BROTHERHOOD OF BOILERMAKERS CLAIMS N

48603

International Brotherhood of Boilermakers Employee Health Care Plan(IBBEHC) CLAIMS N 0.32

16158International Educational Exchange Services Inc. (IEES) CLAIMS N 0.15

39182 INTERNATIONAL FUNDING LTD CLAIMS NIMGIN INTERNATIONAL MEDICAL GROUP CLAIMS 0.15TH105 International Medical Group CLAIMS

57


37269INTERNATIONAL UNION OF OPERATING ENGINEERS ~ LOCAL 15, 15A, 15C & 15D CLAIMS N 0.15 LOCATED IN NEW YORK, NY

37241

INTERNATIONAL UNION OF OPERATING ENGINEERS, LOCAL 4 HEALTH & WELFARE FUND N ADDED 23-SEP-2002.

37269INTERNATIONAL UNION OF OPERATION ENGINEERS ~ LOCAL 15, 15A, 15C & 15D Claims N 0.15

20435 INTGRITAS BENEFIT GROUP CLAIMS N 0.15 Claims are printed and mailed to Payer41124 IOWA BENEFITS INC. CLAIMS NIABCS IOWA BLUE CROSS (WELLMARK) CLAIMS Y 0.1586065 IOWA HEALTH SOLUTIONS CLAIMS N

TH043IOWA IRON WORKERS LOCAL 189 HEALTH PLAN CLAIMS E


TH043 IOWA LABORERS CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

IPAK1 IPA OF KANE COUNTY 0.15

37241 IUOE LOCAL 4 CLAIMS N

PAYER ID VALID ONLY IF BILLING SUBMISSION ADDRESS IS 177 BEDFORD STREET, P.O. BOX 4, LEXINGTON, MA 02420 AND GROUP NUMBER = 300. CONTACT JAMIE MACLAUCHLAN AT (781) 861-1600 EXT. 24 WITH QUESTIONS.

63719 J P Farley Corp Claims N 0.1561271 J. F. MOLLOY AND ASSOCIATES, INC. CLAIMS N 0.15

5014 JACKSON MEMORIAL HEALTH PLAN (FL) CLAIMS

TH033 JI SPECIALTIES CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

JISSP JI SPECIALTY N 0.1541099 JOHN ALDEN LIFE INSURANCE CO. CLAIMS N 0.15

58


95378JOHN DEERE HEALTH CARE/HERITAGE NATIONAL HEALTHPLAN CLAIMS Y 0.15 CERT. REQD - CALL (309) 765-1072.

52189 JOHN HOPKINS N ADDED 01/21/2002

38310 JOHN MORRELL COMPANY CO. - AHPBA CLAIMS N37215 JOHN P PEARL & ASSOCIATES CLAIMS N 0.15 ROUTED FROM NEIC TO AVLTY 033111

52123 Johns Hopkins Healthcare (USFHP) CLAIMS NNew submitters should send in their Billing NPI and Rending/Servicing NPI.

43178 JOPLIN CLAIMS CLAIMS N 0.1534136 JP FARLEY CORPORATION CLAIMS N

MWS01JPS METROWEST START MEDICAID (TEXAS) Y 0.15

37272 JSL ADMINISTRATORS CLAIMS N

91617KAISER FOUNDATION HEALTH PLAN OF Colorado N 0.15

21313KAISER FOUNDATION HEALTH PLAN OF GEORGIA CLAIMS N

CallKAISER FOUNDATION HEALTH PLAN OF NORTHERN CA REGION Claims N

Contact Tina Cheung at (626) 405-6404 prior to first submission of claims.

94135KAISER FOUNDATION HEALTH PLAN OF NORTHERN CA REGION CLAIMS N

COMMERCIAL PROVIDER ID REQUIRED BY KAISER. PLEASE CALL CATHY PLATTNER AT (626) 564-3725 PRIOR TO SUBMITTING CLAIMS.

34092KAISER FOUNDATION HEALTH PLAN OF OHIO CLAIMS

94134KAISER FOUNDATION HEALTH PLAN OF SOUTHERN CA REGION CLAIMS N

52095KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC. CLAIMS N

FOR MORE INFO, PLEASE CALL KENYA NEAL AT KAISER AT 301.625.2264

52095KAISER FOUNDATION HEALTH PLAN OF THE MID- ATLANTIC STATES, INC. CLAIMS N

FOR MORE INFORMATION, PLEASE CONTACT KENYA NEAL AT KAISER AT (301) 625-2264.

59


52095KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. Claims N

For more information, please contact Kenya Neal at Kaiser at (301) 625-2264.

93079 KAISER FOUNDATION OF THE NORTHWEST

57038 KANAWHA HEALTHCARE SOLUTIONS, INC. Claims N57038 KANAWHA INSURANCE CO. CLAIMS NKCIPA KANE COUNTY IPA 0.15SB740 Kansas City BCBS Claims Y 0.32 $0.32 per claim44030 KANSAS CITY LIFE INSURANCE CO. CLAIMS N95279 KEENAN ASSOCIATES (CA) CLAIMS NKELSE KELSEY-SEYBOLD CLAIMS N73100 KEMPTON COMPANY CLAIMS N 0.1573100 KEMPTON GROUP ADMINISTRATORS CLAIMS N 0.15KYBCS KENTUCKY BLUE CROSS (ANTHEM) Y 0.15 ENROLLMENT REQUIRED WITH PAYOR

27215 KENTUCKY HEALTH ADMINISTRATORS INC CLAIMS63077 KENTUCKY HEALTH SELECT CLAIMS N61101 KENTUCKY KARE CLAIMS N 0.15SKKY0 Kentucky Medicaid CLAIMS Y 0.32 $0.32 per claimKYMCR KENTUCKY MEDICARE PART B CLAIMS Y 0.1568069 KENTUCKY SPIRIT HEALTH PLAN68067 KENTUCKY SPIRIT HEALTH PLAN 0.15

37124 KEPPLE & COMPANY CLAIMS N (FORMERLY INTEGRATED BENEFIT SERVICES)37217 KEY BENEFIT ADMINISTRATORS CLAIMS N 0.1535317 KEY GAP CLAIMS N37321 Key Select CLAIMS N 0.15

SX055KEYSTONE HEALTH PLAN EAST (32 cents per claim) 0.32 32 cents per claim payor.

23284 KEYSTONE MERCY HEALTH PLAN CLAIMS N


60


KPS01 KIDSAP PHYSICIANS SERVICES N 0.1561101 KINDRED HEALTH CARE Claims N 0.15

73288 KINDRED HEALTH CARE CLAIMS N

(FORMERLY KNOWN AS VENCOR) AS OF DECEMBER 1, 2002, PLEASE SEND ALL MEDICAL AND HOSPITAL CLAIMS TO PAYER ID 61101. PLEASE SUBMIT ALL HUMANA ENCOUNTERS AND INFORMATIONAL CLAIMS TO PAYER ID 61102.

34145 KLAIS & COMPANY CLAIMS N

31147 KLAIS & COMPANY (OHIO BWC) CLAIMS N 0.32


66123 Korean American Medical Group CLAIMS N

LABOR LABOR & INDUSTRY (WASHINGTON) CLAIMS W 0.15 changed from NEIC to THIN 07/20/2004. Qdn27357 LACARE (Medicaid) CLAIMS N 0.15

37112LAKE FOREST MANAGED CARE ASSOCIATES CLAIMS N

66127 Lakeside Comprehensive Healthcare CLAIMS N95415 LAKESIDE HEALTH SERVICES CLAIMS N66125 Lakeside Medical Group CLAIMS NLNDMK LANDMARK HEALTHCARE CLAIMS N 0.15

LIPA1 LANE INDIVIDUAL PRACTICE ASSOCIATION CLAIMS 0.15

36333 LAWNDALE CHIRSTIAN HEALTH CENTER CLAIMS N 0.1552193 LBA Health Plans CLAIMS N 0.1575279 LEGGETT AND PLATT CLAIMS N37316 Leon Medical Center Health Plan CLAIMS N 0.1537248 LHP CLAIMS UNIT Claims N87071 LIBERTY HEALTH ADVANTAGE 0.15

11123 LIBERTY MUTUAL INSURANCE COMPANY CLAIMS N WORKERS COMP ONLY

61


37281 LIBERTY UNION CLAIMS N 0.1537281 LIFE ASSURANCE COMPANY CLAIMS N 0.1541136 LIFE TRAC CLAIMS N94245 LIFEGUARD CLAIMS NLFGRD LIFEGUARD (**12 max lines FA0)94245 LIFEGUARD (ADDED ON 12/27/2001) N

TH001 LIFEMARK CLAIMS E

TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION. PROVIDER ID REQUIRED. PLEASE CONTACT (602) 331-5100, EXT. 5563 TO OBTAIN.

LIFE1 LIFEPRINT CLAIMS N 0.1591155 LIFEWISE HEALTH PLAN OF ARIZONA CLAIMS N 0.1593093 LIFEWISE HEALTHPLAN OF OREGON CLAIMS N REGISTRATION REQUIRED TO EMDEOM.

37294LIFEWISE/WASHINGTON EMPLOYERS TRUST CLAIMS N 0.15


61101 LINCOLN NATIONAL Claims N 0.15

73288LINCOLN NATIONAL (EMPHESYS, GREEN BAY AND MADISON, WI ONLY) CLAIMS N

61101LINCOLN NATIONAL - PHOENIX, AZ (HUMANA) CLAIMS N 0.15

75283 LINN COUNTY CLAIMS N

35107LOCAL 135 HEALTH BENEFITS FUND (INDIANAPOLIS, IN) CLAIMS N

37267

LOMA LINDA UNIVERSITY ADVENTIST HEALTH SCIENCES CENTER EMPLOYEE HEALTH PLAN CLAIMS N 0.15

37267LOMA LINDA UNIVERSITY ADVENTIST HEALTH SCIENCES CENTERS CLAIMS N 0.15

37267

LOMA LINDA UNIVERSITY BEHAVIORAL MEDICINE CENTER EMPLOYEE HEALTH PLAN CLAIMS N 0.15

37267LOMA LINDA UNIVERSITY EMPLOYEE HEALTH PLAN CLAIMS N 0.15

62


37267LOMA LINDA UNIVERSITY HEALTH CARE EMPLOYEE HEALTH PLAN CLAIMS N 0.15

33036Loma Linda University Healthcare - ManagedCare Claims CLAIMS N Claims are printed and mailed to the payer.

37267LOMA LINDA UNIVERSITY MEDICAL CENTER EMPLOYEE HEALTH PLAN CLAIMS N 0.15

37267LOMA LINDA UNIVERSITY MEDICAL CENTER RESIDENTS HEALTH PLAN CLAIMS N 0.15

37267LOMA LINDA UNIVERSITY STUDENT HEALTH PLAN CLAIMS N 0.15

37226 LONDON HEALTH ADMINISTRATORS CLAIMS N

68069 LOUISIANA HEALTHCARE CONNECTIONS90328 LOVELACE SANDIA HEALTH PLAN CLAIMS 0.15

13193Loyal American Life - Medicare Supplement CLAIMS N 0.15

TH063 LUHR BROS INC. CLAIMS N PROVIDER ID REQUIRED FOR ALL THIN PAYERS.

TH062 LUHR BROS INC./ IL&MO CLAIMS N PROVIDER ID REQUIRED FOR ALL THIN PAYERS.54195 LUMENOS, INC. CLAIMS N37292 MACHINIST DISTRICT 9 WELFARE CLAIMS N36334 MACNEAL HEALTH PROVIDERS CHS 0.15

22445 MAG MUTUAL HEALTHCARE SOLUTIONS CLAIMS N1260 MAGELLAN HEALTH CLAIMS N 0.1511303 MAGNACARE CLAIMS N 0.1568069 MAGNOLIA HEALTH PLAN

34103

MAHONING AND TRUMBULL COUNTY BUILDING TRADES INSURANCE FUND, OHIO CLAIMS N


62413 MAIL HANDLERS BENEFIT PLAN CLAIMS N 0.15 ALSO KNOWN AS MAILHANDLERS/CAC.25133 Mail Handlers Benefit Plan CLAIMS N 0.15

63


MEBCS MAINE BLUE CROSS (ANTHEM EAST) Y 0.15 ADDED 07/03/2002.

MEMCR MAINE MEDICARE PART B (NHIC) Y 0.15REGISTRATION WITH MAMCR NEEDED. NETWORK ID/GRP ID NEEDED.

22195 Maksin Management Corporation CLAIMS N

52148MAMSI LIFE AND HEALTH INSURANCE CO. (MLH) CLAIMS N

35162 MANAGED CARE SERVICES, LLC Claims N35162 MANAGED CARE SERVICES,LLC CLAIMS N

68069 MANAGED HEALTH CARE SERVICES - IN22771 MANAGED HEALTH NETWORK CLAIMS N

39186MANAGED HEALTH SERVICES INDIANA (MEDICAID HMO) Claims N 0.15

SWITCHED TO THIN 061705 Please contact Debbi Sandberg at (800) 225-2573, ext. 25306, prior to sending claims.

39186MANAGED HEALTH SERVICES INDIANA/MAXICARE (MEDICAID HMO) CLAIMS N 0.15 SWITCHED TO THIN 061705

39187 MANAGED HEALTH SERVICES WISCONSIN CLAIMS N 0.1568069 MANAGED HETALTH SERVICES - WI

41555MANATEE SERVICE CENTER (BRADENTON, FL) CLAIMS N 0.15

75258 MAPCO, INC. NMDMCD MARYLAND MEDICAID CLAIMS Y 0.15 ANVICARE ID=129164 EDI=866.752.923322348 MARYLAND PHYSICIANS CARE CLAIMS

37121 MASHANTUCKET PEQUOT TRIBAL NATION CLAIMS N 0.1565935 MASSACHUSETTS MUTUAL N 0.15

MAMCR MASSACHUSSETTS MEDICARE (NHIC-EDS) Y 0.15REGISTRATION WITH MAMCR NEEDED. NETWORK ID/GRP ID NEEDED.

TH111 Master, Mates & Pilots Program CLAIMS N 0.15MMPHB MASTERS, MATES AND PILOTS PLAN CLAIMS N 0.152030 MATTHEW THORNTON HEALTH PLAN CLAIMS N Payer no longer Available

64


41154 MAYO MANAGEMENT SERVICES, INC. CLAIMS N87065 MBA CLAIMS 0.1556205 MBS (MEDCOST BENEFIT SERVICES) Claims N38264 MCARE CLAIMS N

59331 MCCREARY CORPORATION CLAIMS N 0.15

FOR PLAN AND CLAIM REQUIREMENTS, PLEASE CONTACT MCCREARY CORP. CUSTOMER SERVICE AT 561.287.7650 EXT 4052.

36328 MCHENRY MEDICAL ASSOCIATES (IL) N ADDED 23-SEP-2002.38338 MCLAREN HEALTH PLAN CLAIMS N 0.15

52148MD - INDIVIDUAL PRACTICE ASSOCIATION, INC. (M.D. IPA) CLAIMS N

11338 MDNY HEALTHCARE CLAIMS NM3FL0011 MED3000 CMS SAFETY NET CLAIMS 0.15M3FL0009 MED3000 HEALTHSPRINGS CLAIMS 0.15M3FL0014 MED3000 TITLE 21 CLAIMS 0.1558204 MEDADMIN SOLUTIONS CLAIMS N58202 MEDADMIN SOLUTIONS Claims N74323 MEDBEN (NEWARK, OH) CLAIMS N59231 MedCom CLAIMS N56205 MEDCOST BENEFIT SERVICES CLAIMS N

56162 MEDCOST, INC. CLAIMS N

PAYER REQUIRES UNIQUE PROVIDER ID FOR NEW PROVIDERS, PLEASE CONTACT PAYER AT (800) 433-9178 , EXT. 4189.

38353 MedDirect CLAIMS N 0.1595321 MEDFOCUS CLAIMS N

CAMCD MEDI-CAL (CALIFORNIA MEDICAID) 0.15REGISTER WITH EDI AT 916.636.1200. ANVICARE SUBID=N5U

94265 MEDICA CLAIMS NNETWORK ID REQUIRED. PLEASE CONTACT PAYOR

87726 MEDICA ERA N 0.15PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

78857 MEDICA Healthplan Inc. CLAIMS N 0.15

65


MDHMO MEDICAID - TX (HMO-BLUE) TX Y 0.15 "(**28 max lines FA0) **Receiver type ""D"""

AIDWA MEDICAID - WASHINGTON STATE CLAIMS Y 0.15DOWNLOAD ENROLLMENT FORM AT WWW.ACS-GCRO.COM OR CALL 866.545.0544

LAMCD MEDICAID OF LOUISIANA Y 0.15SKMN0 MEDICAID OF MINNESOTA Y 0.15 REGISTER WITH WEBMD (EMDEON)NJMCD MEDICAID OF NEW JERSEY Y 0.1586916 MEDICAID OF TEXAS Y 0.15

31147MEDICAL ADMINISTRATORS, INC. (OHIO BWC) CLAIMS N 0.32


MBA01

MEDICAL BENEFIT ADMINISTRATIONS - GOLDEN ST MED GRP -SIERRA NV MED ASSC. 0.15

37298MEDICAL BENEFIT ADMINISTRATORS INC (MBA OF MD) CLAIMS N 0.15

74323MEDICAL BENEFITS ADMINISTRATORS, INC. (NEWARK, OH) CLAIMS N

74323MEDICAL BENEFITS COMPANIES (NEWARK, OH) CLAIMS N

74323 MEDICAL BENEFITS MUTUAL CLAIMS N

74323MEDICAL BENEFITS MUTUAL (NEWARK, OH) CLAIMS N

74323MEDICAL BENEFITS MUTUAL LIFE INSRANCE CO. CLAIMS N

4258 MEDICAL CLAIMS SERVICE, INC. CLAIMS N

52181 MEDICAL DEVELOPMENT INTERNATIONAL CLAIMS N

29076 MEDICAL MUTUAL OF OHIO CLAIMS N 0.15TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

33029 MEDICAL PATHWAYS CLAIMS N

66


61101 MEDICAL PLAN OF KANSAS CITY, MO CLAIMS N 0.1513375 MEDICAL SELECT MANAGEMENT CLAIMS N38224 MEDICAL VALUE PLAN - OHIO (MVP) CLAIMS N

71768MEDICARE ADVANTAGE FREEDOM BLUE (HIGHMARK) (WV) CLAIMS Y 0.15

NYMCQMEDICARE PART B (GHI-QUEENS) NEW YORK Y 0.15

12202 MEDICARE PART B - DC METRO (J12) Y 0.15 Highmark

ALMCR MEDICARE PART B OF ALABAMA Y 0.15

REGISTER WITH MEDICARE FIRST. PROVIDER NUMBER REQUIRED. ANVICARE SUBMITTERID IS "ANVICARE"

AKMCR MEDICARE PART B OF ALASKA (NORIDIAN) Y 0.15ENROLL WITH EDI MEDICARE FIRST. PROVIDER NUMBER REQUIRED. ADDED 30-AUG-2002.

AZMCR MEDICARE PART B OF ARIZONA Y 0.15LIVE 02/25/2003. CONTACT PAYOR EDI DEPT TO ENROLL

ARMCR MEDICARE PART B OF ARKANSAS (JH) Y 0.15 NOVITAS

CAMCRMEDICARE PART B OF CALIFORNIA (SOUTHERN REGION ONLY) CLAIMS Y 0.15

LIVE 07-FEB-2003. SOUTHERN REGION ONLY. CONTACT PAYOR EDI TO ENROLL

CAMCNMEDICARE PART B OF CALIFORNIA (NORTHERN REGION) Y 0.15

DELETED MEDICARE PART B OF COLORADO (J4) Y 0.15 04102 Trailblazer

12102 MEDICARE PART B OF DELAWARE (J12) Y 0.15 HighmarkFLMCR MEDICARE PART B OF FLORIDA Y 0.15

HIMCR MEDICARE PART B OF HAWAII Y 0.15

ENROLLMENT NEEDED. CONTACT HIMCR EDI AT 866-849-7243. SUBMITTERID NEEDED. NETWORKID NEEDED.

ILMCR MEDICARE PART B OF ILLINOIS CLAIMS Y 0.15

REGISTRATION WITH MEDICARE FIRST. PROVIDER NUMBER REQUIRED. ADDED 05-AUG-2002

KSMCRMEDICARE PART B OF KANSAS (MAC J5-WPS) Y 0.15

67


LAMCR MEDICARE PART B OF LOUISIANA (JH) Y 0.15 NOVITAS

12302 MEDICARE PART B OF MARYLAND (J12) Y 0.15 Highmark

MNMCR MEDICARE PART B OF MINNESOTA CLAIMS Y 0.15

REGISTRATION WITH MEDICARE FIRST. PROVIDER NUMBER REQUIRED. ADDED 01/26/2005

MSMCR MEDICARE PART B OF MISSISSIPPI Y 0.15

REGISTER WITH MEDICARE FIRST. PROVIDER NUMBER REQUIRED. Anvicare Inc SubmitterId is 007020853

NJMCR MEDICARE PART B OF NEW JERSEY (J12) Y 0.15 Highmark

DELETEDMEDICARE PART B OF NEW MEXICO NM (J4) Y 0.15

04202 Trailblazer | AnvicareSubmitter Id=S04001

NCMCR MEDICARE PART B OF NORTH CAROLINA CLAIMS Y 0.15

Enrollment with Medicare is required. Please contact NC Medicare EDI dept. at 866.352.1608. You must fill out 2 forms and send original back to Medicare.

OHMCR MEDICARE PART B OF OHIO CLAIMS Y 0.15DELETED MEDICARE PART B OF OKLAHOMA (J4) Y 0.15 04302 TrailblazerORMCR MEDICARE PART B OF OREGON Y 0.15 ENROLLMENT REQUIRED WITH PAYOR

PAMCRMEDICARE PART B OF PENNSYLVANIA (J12) Y 0.15 Highmark

11302 MEDICARE PART B OF VIRGINIA Y 0.15

WAMCRMEDICARE PART B OF WASHINGTON STATE Y 0.15

LIVE 2/25/2003. CONTACT PAYOR EDI DEPT TO ENROLL

WVMCR MEDICARE PART B OF WEST VIRGINIA CLAIMS Y 0.15ADDED 07/15/2002. LIVE 08/27/2002. Register with WVMCR at 614-277-6100

NYMCUMEDICARE PART B UPSTATE NEW YORK (NGS) Y 0.15 LIVE 12/15/2005. 15 cents per claim

WIMCR MEDICARE PART B WISCONSIN Y 0.15REGISTER WITH MEDICARE FIRST. PROVIDER NUMBER REQUIRED. ADDED 05-AUG-2002.

IAMCRMEDICARE PART-B OF IOWA (MAC J5-WPS) Y 0.15 NETWORK ID, GROUP NETWORK ID NEEDED

68


MIMCR MEDICARE PART-B OF MICHIGAN Y 0.15 NETWORK ID, GROUP NETWORK ID NEEDED

NVMCRMEDICARE PART-B OF NEVADA (NORIDIAN) Y 0.15 NETWORK ID, GROUP NETWORK ID NEEDED

NDMCRMEDICARE PART-B OF NORTH DAKOTA (NORIDIAN) Y 0.15

NORIDIAN. ANVICARE SUBID=CH00012. USER SUBID NEEDED FROM NORIDIAN

ORMCRMEDICARE PART-B OF OREGON (NORIDIAN) Y 0.15 NETWORK ID, GROUP NETWORK ID NEEDED

SDMCRMEDICARE PART-B OF SOUTH DAKOTA (NORIDIAN) (CONTACT ANVICARE FIRST) Y 0.15

CLIENT MUST REGISTER AND TEST WITH PAYOR. PLEASE CONTACT ANVICARE FIRST

WYMCRMEDICARE PART-B OF WYOMING (NORIDIAN) Y 0.15 NETWORK ID, GROUP NETWORK ID NEEDED

MIMPBMEDICARE PLUS BLUE/MEDICARE ADVANTAGE (PRODUCT OF MIBCS) Y 0.15

MEDICARE PRODUCT OF MICHIGAN BCBS, USE MEDICARE PROV ID, NOT BLUE CROSS

882 MEDICARE RAILROAD Y 0.15

call RR Medicare Provider Enrollment at (866) 899-5227. For RR Medicare Customer Service call (866) 855-9884. Claims are sent to AVALITY. AVAILITY Subid=S00532

58228 MEDICARE SMART CLAIMS N 0.1537304 Mediversal CLAIMS N35205 MedPartners CLAIMS N412MP MEDPARTNERS ADMIN SERVICES 0.1558216 MEDPLAN CLAIMS N62160 MEDSOLUTIONS, INC CLAIMS N 0.1582160 MEDSPAN, INC. CLAIMS N

59221MEGA LIFE & HEALTH INSURANCE COMPANY Claims N 0.15

59221MEGA LIFE & HEALTH INSURANCE COMPANY - INSURANCE CENTER CLAIMS N 0.15


1047 MEMIC CLAIMS N 0.15

69


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

MHHNPMEMORIAL HERMANN HEALTH NETWORK PROVIDERS CLAIMS Y 0.15 MUST REGISTER WITH MHHNP FIRST

36193 MEMPHIS MANAGED CARE CLAIMS NCLAIMS ARE PRINTED AND MAILED TO THE PAYER.

39114 MERCY CARE Claims N86052 MERCY CARE PLAN (AHCCCS) CLAIMS 0.1543166 MERCY HEALTH PLANS CLAIMS N

38269MERCY HEALTHPLANS - CARECHOICES MICHIGAN CLAIMS N

33029 MERCY PHYSICIANS MEDICAL GROUP CLAIMS P

PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - SOUTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

77042 MERIDIAN HEALTH CARE MANAGEMENT CLAIMS N13189 Meridian Health Plan CLAIMS N

64157Meritain Health/North American Administrators CLAIMS N

85035 MESA MENTAL HEALTH Claims N Claims are printed and mailed to the payer.65113 METCARE HEALTH PLANS, INC CLAIMS N 0.1595420 METHODISTCARE, INC. CLAIMS N65978 METLIFE CLAIMS N Old payor id was 6597865978 METRAHEALTH CLAIMS N Old payor id was 6597865978 METRAHEALTH ELECT CLAIMS N Old payor id was 65978

65978METRAHEALTH HEALTHCARE NETWORK - PPO/HMO CLAIMS N Old payor id was 65978

87726 METRAHEALTH OR TRAVELERS CLAIMS N 0.1582135 METRO ALLIANCE CLAIMS N13265 METRO PLUS HEALTH PLAN CLAIMS N

70


10850 METROPOLITAN HEALTH PLAN CLAIMS N

65978METROPOLITAN LIFE INSURANCE COMPANY CLAIMS N Old payor id was 65978

MWP01METROWEST HEALTH PLAN-PREFERRED CARE Y 0.15

23550 MFC & HealthPlus Peoria CLAIMS N74289 MHNet ? Mental Health Network CLAIMS N 0.1561101 MICHAEL REESE HMO PLAN - IL CLAIMS N 0.1561101 MICHAEL REESE HMO PLAN - IN CLAIMS N 0.1537127 MICHAEL REESE PHYSICIANS GROUP CLAIMS N 0.15MIMYC MICHIGAN BC - MY CHILD PLAN N 0.16MIFEP MICHIGAN BC FEP N 0.15MIBCN MICHIGAN BLUE CARE NETWORK Y 0.15 ADDED 05/24/2002.710 MICHIGAN BLUE CROSS Y 0.15 ADDED 05/24/2002.111 MICHIGAN MEDICAID Y 0.15 ADDED 05/24/2002.

MHP77MICHIGAN MIDWEST MEDICAID HEALTH PLAN CLAIMS N 0.15

43132 MID AMERICA HEALTH Claims N

52149MID ATLANTIC PSYCHIATRIC SERVICES, INC. (MAPSI) CLAIMS N

MRIPA Mid Rogue Health Plan CLAIMS 0.1526158 Mid Rogue Oregon Health Plan CLAIMS N37281 MID-AMERICA ASSOCIATES, INC. CLAIMS N 0.1563079 MID-ATLANTIC HEALTH SYSTEM CLAIMS N PREVIOUSLY PAYER ID 5103531140 MID-VALLEY CARENET, INC. CLAIMS N

59224MID-WEST NATIONAL LIFE INSURANCE CO. OF TENNESSEE - INSURANCE CENTER CLAIMS N 0.15


59224MID-WEST NATIONAL LIFE INSURANCE CO. OF TENNESSEE - INSURANCE CENTER ERA N 0.15

71


74227MID-WEST NATIONAL LIFE INSURANCE CO. OF TENNESSEE - STUDENT INSURANCE CLAIMS N 0.15

PAYER ID ONLY VALID IF THE P.O. BOX ON THE HEALTH ID CARD MATCHES ONE OF THE FOLLOWING P.O. BOXES: P.O. BOX 890025, 809067, 809079, 809066, 809036, 809081, DALLAS, TX 75380-9025.

47081 MIDLANDS BENEFITS ADMINISTRATORS Claims N47080 MIDLANDS CHOICE, INC. Claims N47080 MIDLANDS HEALTH PARTNERS CLAIMS N62168 MIDSOUTH ADMINISTRATIVE GROUP CLAIMS N

59224MIDWEST NATIONAL LIFE INSURANCE CO. OF TENNESSEE N 0.15 ADDED 23-SEP-2002.

MIDSC MIDWEST SECURITIES N 0.15 (**12 max lines FA0)79480 MIDWEST SECURITY5018 MIPS CLAIMS N

MSBCS MISSISSIPPI BLUE CROSS BLUE SHIELD Y 0.15

ANVICARE SUBMITTERID = S2173. MSBCS EDI=800.826.4068. PLS REGISTER WITH MSBCS TO OBTAIN YOUR 3 ALPHA CHARACTERS SUBMITTERID AND TURN IT IN TO US BEFORE SENDING PRODUCTION CLAIMS

MSMCD MISSISSIPPI MEDICAID N 0.15ANVICARE SUBMITTERID=86387 EDI=866.225.2502

37233MISSISSIPPI PUBLIC ENTITY EMPLOYEE BENEFIT TRUST Claims N 0.15

64088 MISSISSIPPI SELECT HEALTH CARE Claims NAlso doing business as Select Administrative Services (SAS).

75203 MISSISSIPPI SELECT HEALTHCARE CLAIMS N

37275MISSOULA COUNTY MEDICAL BENEFITS PLAN CLAIMS N 0.15

MOBCS MISSOURI BLUE CROSS (ANTHEM) Y 0.15 ENROLLMENT REQUIRED WITH PAYOR (TC5241)43179 Missouri Care/MC CLAIMS N

72


MOMCD MISSOURI MEDICAID CLAIMS N 0.15 EDI=(573)635-3559

MOMCRMISSOURI MEDICARE EASTERN (MAC J5-WPS) Y 0.15

SAINT LOUIS CITY, SAINT LOUIS,JEFFERSON, SAINT CHARLES

MOMCRMISSOURI MEDICARE WESTERN (MAC J5-WPS) Y 0.15 CLAY, JACKSON, PALTTE

37265 MLINK NLOCATED IN INDIANAPOLIS, INDIANA. TEL:(859)226-1559

35316 MMA CLAIMS N

31147MMAC (MANAGED MEDICAL ASSURANCE CO., LTD.) (OHIO BWC) CLAIMS N 0.32


62178 MMS, LLC. Claims N20554 MOLINA HEALTHCARE OF TEXAS CLAIMS 0.1538333 MOLINA HEALTHCARE OF CALIFORNIA CLAIMS N 0.1551062 MOLINA HEALTHCARE OF FLORIDA CLAIMS 0.1576 MOLINA HEALTHCARE OF INDIANA CLAIMS 0.1538334 MOLINA HEALTHCARE OF MICHIGAN CLAIMS 0.1520676 MOLINA HEALTHCARE OF NEVADA CLAIMS 0.15

9824 MOLINA HEALTHCARE OF NEW MEXICO CLAIMS

4423 Molina Healthcare of New Mexico - SCI CLAIMS N 0.1520149 MOLINA HEALTHCARE OF OHIO CLAIMS 0.15SX019 MOLINA HEALTHCARE OF UTAH CLAIMS 0.32 (aka: American Family Care)

38336 MOLINA HEALTHCARE OF WASHINGTON CLAIMS N 0.15[FORMERLY QUAL-MED, SEATTLE (SE) AND QUAL-MED, SPOKANE (SP)]

91128 MOLINA OF WASHINGTON ASO CLAIMS 0.1572135 MOMENTUM HEALTH SERVICES CLAIMS N

13174MONTEFIORE CONTRACT MANAGEMENT ORGANIZATION CLAIMS N

PLEASE CONTACT PROVIDER RELATIONS OR CUSTOMER SERVICE AT 914.377.4400 FOR UNIQUE PROVIDER NUMBER (NetworkId)

35092 MORRIS ASSOCIATES CLAIMS N99282 MOTION PICTURES INDUSTRY CLAIMS

73


36111 MOTOROLA N ADDED 23-SEP-2002.COMMA MOUNTAIN MEDICAL (MMA) N 0.15COMMA MOUNTAIN MEDICAL (MMA) CLAIMS N 0.15

86040MOUNTAIN STATES ADMINISTRATIVE SERVICES (TUCSON, AZ) CLAIMS N

37233 MPE SERVICES INC. Claims N 0.1537233 MPEEBT Claims N 0.15

35177 MPlan (Medicaid) IN CLAIMS NEdits to mirror current edits submitted for 1st payer id 95444.

95444 MPLAN, INC. / HEALTHCARE GROUP, LLC N ADDED 23-SEP-2002

95444 MPLAN, INC./HEALTHCARE GROUP, LLC Claims N95655 MT CARMEL HEALTH PLAN 0.15

39634 Multiplan Inc. for American Family CLAIMS N

Payer ID 39634 only accepts claims for the states of AZ IL IN and OH. Claims for any other states should not be directed to Payer ID 39634 no exceptions please.

34080 MULTIPLAN WISCONSIN WPPN CLAIMS N81883 MUNICIPAL HEALTH BENEFIT FUND 0.1569140 MUTUAL ALLIANCE PLAN (MAP) CLAIMS N

37256 MUTUAL ASSURANCE ADMINISTRATORS CLAIMS N 0.1570491 MUTUAL GROUP (THE) (US) CLAIMS N

59140MUTUAL GROUP (THE) (US) MUTUAL GROUP (THE) (US) CLAIMS N 0.15

PLEASE SUBMIT CLAIMS TO PAYER ID 59140, HEALTHPLAN SERVICES (TAMPA ONLY).

71412MUTUAL OF OMAHA INSURANCE COMPANY CLAIMS N

71412 MUTUALLY PREFERRED CLAIMS N

14165 MVP HEALTH PLAN OF NY CLAIMS NFOR YOUR MVP PROVIDER NUMBER, CALL (800) 684-9286.

91136N.W. IRONWORKERS HEALTH & SECURITY TRUST FUND Claims N


74


91136N.W. IRONWORKERS HEALTH & SECURITY TRUST FUND - GRP# F15 CLAIMS N


91136N.W. ROOFERS & EMPLOYERS HEALTH & SECURITY TRUST FUND Claims N


91136N.W. ROOFERS & EMPLOYERS HEALTH & SECURITY TRUST FUND - GRP# F26 CLAIMS N


91136 N.W. TEXTILE PROCESSORS Claims NPlease enter Group Number (F14) when submitting claims.

91136 N.W. TEXTILE PROCESSORS - GRP# F14 CLAIMS NPLEASE INCLUDE GROUP NUMBER WHEN SUBMITTING CLAIMS.

65085NAA (NORTH AMERICA ADMINISTRATORS, L.P.) (NASHVILLE, TN) CLAIMS N

34159 NABN Claims N

Payer ID valid only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476.

53011 NALC/AFFORDABLE CLAIMS N

NHCA1 NAPERVILLE HEALTH CARE ASSOCIATES CLAIMS N 0.15

53011NATIONAL ASSOCIATION OF LETTER CARRIERS CLAIMS N

53011NATIONAL ASSOCIATION OF LETTER CARRIERS/NALC CLAIMS N

56175 NATIONAL BENEFIT ADMINISTRATORS N 0.15

ADDED 22-OCT-2002. PAYOR FROM PARSIPPANY, NEW JERSEY. PAYOR CONTACT (440)720-0700 EXT 215

56175NATIONAL BENEFIT ADMINISTRATORS - NEW JERSEY Claims N 0.15

56176NATIONAL BENEFIT ADMINISTRATORS - NORTH CAROLINA N 0.15 ADDED 23-SEP-2002.

75


90001NATIONAL CAPITAL PREFERRED PROVIDER ORGANIZATION (NCPPO) Claims N

To obtain your provider ID number, please call the NCPPO Customer Service Department at (800) 272-5911.

58204 NATIONAL CHIROPRACTIC NETWORK Claims N37126 NATIONAL CLAIM ADMINISTRATION N ADDED 23-SEP-2002.

75275 NATIONAL HEALTH INSURANCE COMPANY CLAIMS N 0.15

52132NATIONAL RURAL ELECTRIC COOP (NRECA) CLAIMS N 0.15

71412NATIONAL RURAL LETTER CARRIER ASSOCIATION Claims N Policy Number GMG1846

71412NATIONAL RURAL LETTER CARRIER ASSOCIATION (POLICY #GMG1846) CLAIMS N

52104National Telecommunications Cooperative Association (NTCA - Staff) CLAIMS N 0.15

52103National Telecommunications Cooperative Association (NTCA) CLAIMS N 0.15

52103NATIONAL TELEPHONE COOP ASSOC (NTCA) CLAIMS N 0.15

37120 NATIONAL TRAVELERS LIF CO. CLAIMS N37120 NATIONAL TRAVELERS LIFE CO. Claims N31417 NATIONWIDE GROUP CLAIMS N31417 NATIONWIDE HEALTH PLANS Claims N

31417NATIONWIDE INDIVIDUAL LIFE AND HEALTH Claims N

31417NATIONWIDE INSURANCE - NATIONWIDE HEALTH PLANS CLAIMS N

31417 NATIONWIDE LIFE AND HEALTH CLAIMS N75191 NCAS - CHARLOTTE CLAIMS N 0.1575190 NCAS - FAIRFAX, VA CLAIMS N 0.15

NEBCS NEBRASKA BLUE CROSS Claims Y 0.1515 cents per claim. LIVE 02-16-2006. Anvicare Id=1300760

76


SKNE0Nebraska Medicaid - Health and Human Services CLAIMS Y 0.32

NEMCRNEBRASKA MEDICARE PART B (MAC J5-WPS) Claims Y 0.15 LIVE 10/28/2005

95123 NEIGHBORHOOD HEALTH PARTNERSHIP 0.15

96107NEIGHBORHOOD HEALTH PARTNERSHIP OF FLORIDA CLAIMS N

Please call (305) 715-4334 for Payer Id. Payer Id is valid for claims submission address PO Box 025680, Miami, FL 33102-5680

4293 NEIGHBORHOOD HEALTH PLAN CLAIMS N

4293NEIGHBORHOOD HEALTH PLAN (BOSTON, MA) Claims N

4293NEIGHBORHOOD HEALTH PLAN (BOSTON, MA) CLAIMS N

5047Neighborhood Health Plan of Rhode Island (NHPRI) CLAIMS N

Please call NHPRI at 1-401-459-6020 to obtain or confirm your provider and vendor number prior to your initial claims submission.

11325 NEIGHBORHOOD HEALTH PROVIDERS CLAIMS N 0.15

39164NEIGHBORLY CARE PLAN - MILWAUKEE, WI CLAIMS N


37255 NESIKA HEALTH GROUP CLAIMS N 0.15

66055NETCARE LIFE AND HEALTH INSURANCE (HAGATNA, GUAM) CLAIMS N 0.15

4332 Network Health CLAIMS N

Before initiating submissions please contact Provider Relations at (617) 806-8104 or [email protected] for an EDI setup form.

39144NETWORK HEALTH PLAN OF WISCONSIN, INC. CLAIMS N 0.15

86065 NEVADA HEALTH SOLUTIONS CLAIMS N86065 NEVADACARE CLAIMS N

77


86065 NEVADACARE KIDS CLAIMS N

66893 NEW ENGLAND FINANCIAL CLAIMS NPLEASE BEGIN USING PAYER ID 80705 FOR THIS PAYER. (FORMERLY THE NEW ENGLAND)

80705 NEW ENGLAND FINANCIAL CLAIMS N 0.15

76031NEW ERA EMPLOYEE WELFARE BENEFIT PLAN TRUST CLAIMS N 0.15

75281 NEW ERA LIFE CLAIMS N 0.15

NHBCSNEW HAMPSHIRE BLUE CROSS (ANTHEM EAST) Y 0.15 ADDED 07/03/2002.

NHMCRNEW HAMPSHIRE MEDICARE PART B (NHIC) Y 0.15

REGISTRATION WITH MAMCR NEEDED. NETWORK ID/GRP ID NEEDED.

65056 New Market Dimensions CLAIMS N790 New Mexico Blue Cross (HCSC) CLAIMS N 0.15 $0.15 PER CLAIMNMMCR NEW MEXICO MEDICARE PART B (JH) Y 0.15 NOVITASSX164 NEW WEST HEALTH SERVICES

38332 NEW WORLD CLAIMS SERVICES CLAIMS N

PAYER ID VALID ONLY FOR CLAIMS WITH A SUBMISSION ADDRESS OF 2624 NORTH 5TH STREET, NILES, MI 49120.

NYBCS NEW YORK BLUE CROSS (EMPIRE) CLAIMS Y 0.15

SKNY0NEW YORK MEDICAID - SENT THROUGH NEIC (EMDEON) N 0.15 PAPER WORK NEEDED

14179 NEW YORK MEDICAL IMAGING - MVP CLAIMS N 0.15

14178NEW YORK MEDICAL IMAGING - WELLCARE ERA N

13202NEW YORK MEDICARE PART B -DOWN STATE (NGS) CLAIMS Y 0.15

11334 NEW YORK NETWORK MANAGEMENT CLAIMS N

48186NEW YORK PRESBYTERIAN COMMUNITY HEALTH PLAN N ADDED 23-SEP-2002.

24819New York Presbyterian System Select Health CLAIMS N 0.15

78


65978 NEW YORK STATE EMPLOYEES (EMPIRE) CLAIMS N Old payor id was 6597838225 NGS AMERICAN, INC CLAIMS N 0.15

62124 NHC HEALTH BENEFIT PLAN CLAIMS N

PLEASE CALL NHC HEALTH BENEFIT PLAN @ 615-278-1230 REGARDING YOUR NHC PROVIDER NUMBER PRIOR TO SUBMITTING CLAIMS ELECTRONICALLY.

11325NHP/SHP (NEIGHBORHOOD HEALTH PROVIDERS AND SUFFOLK HEALTH PLAN) Claims N 0.15

Please submit claims with your unique NHP/SHP provider number. Please call (631) 360-3102 for your unique NHP/SHP provider number.

81264NIPPON LIFE INSURANCE COMPANY OF AMERICA CLAIMS N

22603 NJ CARPERNTERS HEALTH FUND CLAIMS N

64157NORTH AMERICAN ADMINISTRATORS, INC. CLAIMS N

34159 NORTH AMERICAN BENEFITS NETWORK CLAIMS N

PAYER ID VALID ONLY FOR CLAIMS WITH BILLING SUBMISSION ADDRESS OF P.O. BOX 94928, CLEVELAND, OH 44101-4928.

64157 NORTH AMERICAN HEALTH PLAN CLAIMS N

93100NORTH AMERICAN MEDICAL MANAGEMENT CLAIMS N

ONLY CLAIMS FROM PROVIDERS IN HOUSTON, TX. PLEASE CONTACT YOUR IPA PROVIDER RELATIONS AT (713) 881-9600.

E3510

NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - NORTHERN CALIFORNIA CLAIMS N

ONLY CLAIMS FROM PROVIDERS IN NORTHERN CALIFORNIA. PLEASE CONTACT REED SMOLLER AT (510) 450-1500 FOR PROVIDER ENROLLMENT.

33029

NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - SOUTHERN CALIFORNIA CLAIMS P


79


36398NORTH AMERICAN MEDICAL MANAGEMENT - IL CLAIMS N

64157 NORTH AMERICAN PREFERRED CLAIMS N

37314 NORTH BROWARD HOSPITAL DISTRICT CLAIMS 0.15

NCBCSNORTH CAROLINA BLUE CROSS BLUE SHIELD CLAIMS Y 0.15 Enrollment with Blue Cross is required.

NCMCD NORTH CAROLINA MEDICAID N 0.15

36392 North Suburban Associated Physicians CLAIMS N 0.32

NTX11 NORTH TEXAS HEALTHCARE NETWORK N 0.15

35212 NORTH TEXAS HEALTHCARE NETWORK CLAIMS N

38238NORTHERN CALIFORNIA SHEET METAL WORKERS HEALTH CARE PLAN CLAIMS N

36347 Northern Illinois Health Plan CLAIMS N

88027 NORTHERN NEVADA TRUST FUND Claims N

Please call (775) 826-7200 to verfiy if you should be sending claims to Northern Nevada Trust Fund.

48026 NORTHSHORE PHYSICIAN ASSOCIATES CLAIMS 0.1560058 Northstar Advantage CLAIMS N91068 NORTHWEST ADMINISTRATORS CLAIMS N 0.15

36234NORTHWEST COMMUNITY HEALTH PARTNERS CLAIMS N

62119Northwest Diagnostic Clinic/SelectCare of Texas (NWDC) CLAIMS N

36346 NORTHWEST SUBURBAN IPA (ILLINOIS) Claims N

36346 NORTHWEST SUBURBAN IPA(ILLINOIS) CLAIMS N16114 NOVA CASUALTY COMPANY 0.15

80


16644NOVA HEALTH ADMINISTRATORS,INC (GRAND ISLAND,NY) CLAIMS N

16644NOVA HEALTHCARE ADMINISTRATORS, INC. (GRAND ISLAND, NY) Claims N

6226 Novanet CLAIMS N 0.1571080 NOVASYS HEALTH NETWORK N 0.1535197 NPPN\CONSECO CLAIMS NIEHP1 Inland Empire Health Plan CLAIMS N 0.1537299 NYHART CLAIMS N 0.1566916 NYLCARE HEALTH PLAN CLAIMS N 0.1514179 NYMI - AETNA RADIOLOGY CLAIMS Claims N 0.1514180 NYMI OXFORD CLAIMS N

36402OAK WEST PRIMARY PHYSICIAN ASSOCIATION CLAIMS N

DESRT OASIS IPA

31147OCCUPATIONAL HEALTH MGMT, INC. (HEALTHMANAGE) (OHIO BWC) CLAIMS N 0.32


72127 OCHSNER HEALTH PLAN CLAIMS NNETWORK ID SEEMS TO BE COMBO OF TAXID PLUS INITIAL OF PROV

13350 ODS HEALTH PLAN 0.1513310 ODS HEALTHPLAN CLAIMS Y 0.15 ENROLLMENT REQUIRED WITH PAYOR

72087 OFFICE OF GROUP BENEFITS- LOUISIANA Claims NOffice of Group Benefits is located in the state of Louisiana.

OHBCS OHIO BLUE CROSS (ANTHEM) Y 0.15 ENROLLMENT REQUIRED WITH PAYOR (TC5241)

31147 OHIO BWC CLAIMS N 0.32


31147OHIO COMP CHOICE, INC. (HMS) (OHIO BWC) CLAIMS N 0.32


81


31147OHIO EMPLOYEE HEALTH PARTNERSHIP (OHIO BWC) CLAIMS N 0.32


34189 OHIO HEALTH CHOICE CLAIMS N

PAYER ID VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION ADDRESS OF P.O. BOX 93538, CLEVELAND, OH 44101-5538

34189 OHIO HEALTH CHOICE, PPO Claims N

Payer ID valid only for claims with a billing submission address of P. O. Box 93538, Cleveland, OH 44101 or P. O. Box 6086, Cleveland, OH 44101.

OHMCDOHIO MEDICAID - NO REGISTRATION NEEDED - JUST SEND CLAIMS Y 0.15 LIVE 07/19/2005

74431 OHIO PPO CONNECT CLAIMS N 0.15840 OKLAHOMA BLUE CROSS Y 0.15 ENROLLMENT REQUIRED WITH PAYOROKMCD OKLAHOMA MEDICAID Y 0.15OKMCR OKLAHOMA MEDICARE PART B (JH) Y 0.15 NOVITAS

91150 OLYMPIC HLTH MANAGEMENT SYSTEMS N

25150 Omnicare A Coventry Health Plan CLAIMS N For claims with date of service AFTER 10/1/04.

38252 OMNICARE HEALTH PLAN OF MICHIGAN NADDED 22-OCT-2002. PAYOR CONTACT 313-393-4537

22321 ONE CALL MEDICAL CLAIMS N

80705 ONE HEALTH PLAN NEW HAMPSHIRE, INC. CLAIMS N 0.1580705 ONE HEALTH PLAN OF AK CLAIMS N 0.1580705 ONE HEALTH PLAN OF AZ CLAIMS N 0.1580705 ONE HEALTH PLAN OF CA CLAIMS N 0.15

80705 ONE HEALTH PLAN OF CALIFORNIA, INC. CLAIMS N 0.15

95379 ONE HEALTH PLAN OF CALIFORNIA, INC. CLAIMS NPLEASE BEGIN USING PAYER ID 80705 FOR THIS PAYER.

80705 ONE HEALTH PLAN OF CO CLAIMS N 0.15

82


80705 ONE HEALTH PLAN OF COLORADO, INC. CLAIMS N 0.15

95412 ONE HEALTH PLAN OF COLORADO, INC. CLAIMS NPLEASE BEGIN USING PAYER ID 80705 FOR THIS PAYER.

80705 ONE HEALTH PLAN OF FL CLAIMS N 0.1580705 ONE HEALTH PLAN OF GA CLAIMS N 0.1580705 ONE HEALTH PLAN OF GEORGIA, INC. CLAIMS N 0.15

96559 ONE HEALTH PLAN OF GEORGIA, INC. CLAIMS NPLEASE BEGIN USING PAYER ID 80705 FOR THIS PAYER.

80705 ONE HEALTH PLAN OF IL CLAIMS N 0.1580705 ONE HEALTH PLAN OF ILLINOIS, INC. CLAIMS N 0.15

95388 ONE HEALTH PLAN OF ILLINOIS, INC. CLAIMS NPLEASE BEGIN USING PAYER ID 80705 FOR THIS PAYER.

80705 ONE HEALTH PLAN OF IN CLAIMS N 0.1580705 ONE HEALTH PLAN OF MA CLAIMS N 0.1580705 ONE HEALTH PLAN OF ME CLAIMS N 0.15

80705 ONE HEALTH PLAN OF NEW JERSEY, INC. CLAIMS N 0.15

80705ONE HEALTH PLAN OF NORTH CAROLINA, INC. CLAIMS N 0.15

80705 ONE HEALTH PLAN OF OHIO, INC. CLAIMS N 0.1580705 ONE HEALTH PLAN OF OREGON, INC. CLAIMS N 0.15

80705ONE HEALTH PLAN OF PENNSYLVANIA, INC. CLAIMS N 0.15

80705ONE HEALTH PLAN OF SOUTH CAROLINA, INC. CLAIMS N 0.15

80705 ONE HEALTH PLAN OF TENNESSEE, INC. CLAIMS N 0.1580705 ONE HEALTH PLAN OF TEXAS, INC. CLAIMS N 0.15

51459 ONE HEALTH PLAN OF TEXAS, INC. CLAIMS NPLEASE BEGIN USING PAYER ID 80705 FOR THIS PAYER.

80705 ONE HEALTH PLAN OF TX CLAIMS N 0.15

83


80705 ONE HEALTH PLAN OF VERMONT, INC. CLAIMS N 0.1580705 ONE HEALTH PLAN OF VIRGINIA, INC. CLAIMS N 0.15

80705 ONE HEALTH PLAN OF WASHINGTON, INC. CLAIMS N 0.15

80705 ONE HEALTH PLAN OF WISCONSIN, INC. CLAIMS N 0.15

80705 ONE HEALTH PLAN OF WYOMING, INC. CLAIMS N 0.1580705 ONE HEALTH PLAN, INC. ERA N 0.15

91136OPERATING ENGINEERS LOCALS 302 & 612 HEALTH & SECURITY FUND Claims N


91136OPERATING ENGINEERS LOCALS 302 & 612 HEALTH & SECURITY FUND - GRP# F12 CLAIMS N


56190 OPTICARE EYE HEALTH NETWORK CLAIMS N

54154 OPTIMA HEALTH PLAN Claims N 0.32

Effective 11/01/2007, 32 cents per claim. NON-SPONSORED PLUS PAYER. Please note that the Rendering Provider Network ID field is required. Please contact the Ydsia Slagle-Provider Relations

54154 OPTIMA INSURANCE COMPANY Claims N 0.32


52151 OPTIMUM CHOICE OF PENNSYLVANIA N 0.1552152 OPTIMUM CHOICE OF THE CAROLINAS CLAIMS N

52152OPTIMUM CHOICE OF THE CAROLINAS, INC. (OCCI) Claims N

52148 OPTIMUM CHOICE, INC. (OCI) CLAIMS N37125 OPTION SERVICES GROUP CLAIMS N PREVIOUS PAYER ID 37215

84


OCFMCORANGE COUNTY FOUNDATION FOR MEDICAL CARE

851OREGON BLUE CROSS (REGENCE BLUECROSS BLUE SHIELD OF OREGON) Claims Y 0.15

ADDED 05/01/2002. PROVIDER MUST REGISTER WITH ORBCS AT (503) 220-3924 FIRST. NETWORKID REQUIRED, GROUPNETWORKID MAY BE NEEDED.

ORMCD OREGON MEDICAID N 0.1513383 Orthonet - Aetna CLAIMS 0.1513381 Orthonet - CIGNA CLAIMS 0.1525681 Orthonet - HealthNet CLAIMS 0.15

13382Orthonet - Uniformed Services Family Health Plan CLAIMS N

Claims are printed and mailed to the payer. For Payable USFHP (NY & NJ) outpatient therapy claims only. Contact Theresa Malgioglio at (914) 681-8800.

13381 ORTHONET CORPORATION CLAIMS NCLAIMS ARE PRINTED AND MAILED TO THE PAYOR

58204 ORTHOPEDIX NETWORK, INC. Claims N

TH053 OSF CARE ADVANTAGE CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

TH054 OSF HEALTH PLAN CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

OSFIL OSF HEALTH PLAN IL N **62171 OSF Health Plans CLAIMS N

36365OUR LADY OF THE RESURRECTION PHYSICIAN ASSOCIATION (ROCKFORD, IL) CLAIMS N

6111 OXFORD HEALTH PLANS CLAIMS N67466 PACIFIC LIFE & ANNUITY COMPANY CLAIMS N76050 PACIFICARE / ARIA N ADDED 23-SEP-2002.33053 PACIFICARE BEHAVIORAL HEALTH CLAIMS N

85


95962 PACIFICARE HMO - ALL STATES CLAIMS N

FOR PAYABLE HMO CLAIMS ONLY. NOT FOR PACIFICARE/SECURE HORIZONS HMO CLAIMS. FOR FURTHER QUESTIONS, YOU MAY INQUIRE VIA EMAIL AT [email protected].

95964PACIFICARE OF ARIZONA (CLAIMS ONLY NOT ENCOUNTERS) Claims N

Must first register with Pacificare before send claims. Contact Tishia Mendoza at (800) 344-3782, ext. 4313 to become eligible to initiate the EDI process.

CALL PACIFICARE OF ARIZONA - CLAIMS CLAIMS PPLEASE CONTACT COLETTE WARD AT (800) 877-6685 X42731 TO INITIATE THE EDI PROCESS.

95959 PACIFICARE OF CALIFORNIA CLAIMS N

FOR PAYABLE PACIFICARE/SECURE HORIZON HMO AND IN- AREA POS CLAIMS ONLY. NOT FOR PPO OR INDEMNITY CLAIMS. FOR MORE INFORMATION, PLEASE CALL THE PACFICARE CLAIMS EDI HOTLINE AT (714) 226-2442. EFFECTIVE 07/01/02, A SIGNED AGREEMENT IS NO LONGER

95958 PACIFICARE OF CALIFORNIA ENCOUNTERS N

MUST SUBMIT WITH PACIFICARE SUBMITTER ID CALL GINA GASILAN AT (714) 226-8832 TO OBTAIN.

95959 PACIFICARE OF CALIFORNIA - CLAIMS CLAIMS N

FOR PAYABLE PACIFICARE/SECURE HORIZON HMO CLAIMS ONLY. NOT FOR PPO CLAIMS. FOR FURTHER QUESTIONS, YOU MAY INQUIRE VIA EMAIL AT [email protected].

95958PACIFICARE OF CALIFORNIA - ENCOUNTERS ENCOUNTERS P

MUSMUST SUBMIT WITH PACIFICARE SUBMITTER ID. PLEASE CALL GINA GASILAN AT (714) 226-8609 TO OBTAIN.

Call PACIFICARE OF COLORADO Claims N

Please call Lela Nemmers at PacfiCare of Colorado at (719) 522-6928 to enroll and to obtain the payer id.

86


CALL PACIFICARE OF COLORADO - CLAIMS CLAIMS PPLEASE CALL COLETTE WARD AT (800) 877-6685 EXT.42731 TO INITIATE THE EDI PROCESS.

95959 PACIFICARE OF OKLAHOMA CLAIMS N

95973 PACIFICARE OF OKLAHOMA ENCOUNTERS N

MUST SUBMIT WITH PACIFICARE SUBMITTER ID. CALL KEN TENNISON AT (210) 524-2184 TO OBTAIN.

95959 PACIFICARE OF OKLAHOMA - CLAIMS CLAIMS N


95973PACIFICARE OF OKLAHOMA - ENCOUNTERS ENCOUNTERS P

MUST SUBMIT WITH PACIFICARE SUBMITTER ID. PLEASE CONTACT LORI CASTRO AT (714) 226-4959 TO OBTAIN.

95959 PACIFICARE OF OREGON CLAIMS N

FOR PAYABLE PACIFICARE/SECURE HORIZON HMO AND POS CLAIMS ONLY. NOT FOR PPO OR INDEMNITY CLAIMS. FOR MORE INFORMATION, PLEASE CALL THE PACIFICARE CLAIMS EDI HOTLINE AT (800) 203-7729 OR EMAIL: [email protected].

95975 PACIFICARE OF OREGON ENCOUNTERS N

MUST SUBMIT WITH PACIFICARE SUBMITTER ID. CALL CAROLYN M. ANDERSON AT (503) 603-7346 TO OBTAIN.

95959 PACIFICARE OF OREGON - CLAIMS CLAIMS N


95975 PACIFICARE OF OREGON - ENCOUNTERS ENCOUNTERS P

MUST SUBMIT WITH PACIFICARE SUBMITTER ID. PLEASE CALL GINA GASILAN AT (714) 226-8609 TO OBTAIN.

87


77042PACIFICARE OF OREGON/MERIDIAN HEALTH CARE MANAGEMENT Claims N

For information on how to decipher when this Payer ID should be used, please call PacifiCare EDI at (800) 203-7729 or send an e-mail to: [email protected].

95959 PACIFICARE OF TEXAS CLAIMS N

95969 PACIFICARE OF TEXAS ENCOUNTERS N

MUST SUBMIT WITH PACIFICARE SUBMITTER ID. CALL KEN TENNISON AT (210) 524-2184 TO OBTAIN.

95959 PACIFICARE OF TEXAS - CLAIMS CLAIMS N


95969 PACIFICARE OF TEXAS - ENCOUNTERS ENCOUNTERS P

MUST SUBMIT WITH PACIFICARE SUBMITTER ID. PLEASE CONTACT LORI CASTRO AT (714) 226-4959 TO OBTAIN.

95959 PACIFICARE OF WASHINGTON CLAIMS N

FOR PAYABLE PACIFICARE/SECURE HORIZON HMO AND POS CLAIMS ONLY. NOT FOR PPO OR INDEMNITY CLAIMS. FOR MORE INFORMATION, PLEASE CALL THE PACIFICARE CLAIMS EDI HOTLINE AT (800) 203-7729 OR EMAIL: [email protected].

95977 PACIFICARE OF WASHINGTON ENCOUNTERS N

MUST SUBMIT WITH PACIFICARE SUBMITTER ID. CALL LYNNE JACOBY AT (206) 230-7313 TO OBTAIN.

95959 PACIFICARE OF WASHINGTON - CLAIMS CLAIMS N


88


95977PACIFICARE OF WASHINGTON - ENCOUNTERS ENCOUNTERS P

MUST SUBMIT WITH PACIFICARE SUBMITTER ID. PLEASE CALL GINA GASILAN AT (714) 226-8609 TO OBTAIN.

77042PACIFICARE OF WASHINGTON/MERIDIAN HEALTH CARE MANAGEMENT Claims N

For information on how to decipher when this Payer ID should be used, please call PacifiCare EDI at (800) 203-7729 or send an e-mail to: [email protected]

95999 PACIFICARE PPO N

For payable PPO claims only. NOT for Pacificare/Secure Horizons HMO claims. For further questions, you may inquire via email at [email protected]

95999 PACIFICARE PPO - ALL STATES CLAIMS N

FOR PAYABLE PPO CLAIMS ONLY. NOT FOR PACIFICARE/SECURE HORIZONS HMO CLAIMS. FOR FURTHER QUESTIONS, YOU MAY INQUIRE VIA EMAIL AT [email protected].

96964 PACIFICARE-HORIZON CLAIMS NMUST REGISTER WITH PAYOR FIRST BEFORE SEND FIRST CLAIM

PACIR PACIFICARE/ARIA N20377 PACIFICSOURCE CLAIMS N 0.1593029 PACIFICSOURCE HEALTH PLANS CLAIMS N37287 PAI CLAIMS NSX158 Paramount health CLAIMS Y 0.32

31147PARAMOUNT PREFERRED NETWORK (OHIO BWC) CLAIMS N 0.32


58204 PARITY HEALTHCARE CLAIMS N58204 PARITY HEALTHCARE LLC Claims N

66917 PARKLAND COMMUNITY HEALTH PLAN CLAIMS N 0.15M3FL7 PARTNER CARE CLAIMS N 0.1556152 PARTNERS NATIONAL HEALTH N Network Id Needed. (Box 33, PIN field)

89


CallPARTNERS NATIONAL HEALTH PLANS OF NORTH CAROLINA, INC Claims N

Contracted Providers Only. Please call the Partners National Health Plans of North Carolina, Inc., customer service department at (800) 942-5695 or (336) 760-4822, ext. 12005, for electronic claims set up.

SX140 Partnership Health of CA - CAPHP CLAIMS Y 0.32 Provider Medi-Cal number required inthe BA0 po rovider is in2010AB or o Provideris same as then payto isidentified nd loop2010AB is al Id toidentify t

SX154PASSPORT ADVANTAGE (DOS after 01/01/2011 use Payor Id 76569) CLAIMS N 0.32

76569PASSPORT ADVANTAGE (DOS before 01/01/2011 use Payor Id SX154) CLAIMS N 0.15

61129 PASSPORT HEALTH PLAN CLAIMS N


10525 Patient Advocates LLC CLAIMS N 0.15

TH017 PATIENT-PHYSICIAN NETWORK CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

37210 PAYNET, INC. N ADDED 23-SEP-2002.

65018 PCA HEALTH PLAN OF FLORIDA CLAIMS Y

PROVIDERS THAT ARE CURRENTLY ENROLLED ONLY. NOT CURRENTLY ENROLLING ANY NEW PHYSICIANS.

65000 PCMC/ICSL ALLERGY CLAIMS NCLAIMS ARE PRINTED AND MAILED TO THE PAYER.

65007 PCMC/ICSL CHIROPRACTIC CLAIMS NCLAIMS ARE PRINTED AND MAILED TO THE PAYER.

65001 PCMC/ICSL DERMATOLOGY CLAIMS NCLAIMS ARE PRINTED AND MAILED TO THE PAYER.

90


65003 PCMC/ICSL GASTROENTEROLOGY CLAIMS NCLAIMS ARE PRINTED AND MAILED TO THE PAYER.

65004 PCMC/ICSL PHYSICAL THERAPY CLAIMS NCLAIMS ARE PRINTED AND MAILED TO THE PAYER.

65002 PCMC/ICSL PODIATRY CLAIMS NCLAIMS ARE PRINTED AND MAILED TO THE PAYER.

68049 PEACH STATE HEALTH PLAN CLAIMS Y68069 PEACH STATE HEALTH PLANM3FL8 PEDICARE TITLE 19 CLAIMS 0.15 ENROLL AT 866.703.1444M3FL0006 PEDICARE TITLE 21 CLAIMS 0.15 ENROLL AT 866.703.144437086 PEKIN INSURANCE CLAIMS N 0.15

PABCSPENNSYLVANIA BLUE CROSS BLUE SHIELD (HIGHMARK) CLAIMS N 0.15 REGISTRATION REQUIRED. CONTACT ANVICARE

72126 PEOPLES HEALTH NETWORK CLAIMS N34173 PERSONAL PHYSICIAN CARE N25146 PERSONALCARE CLAIMS N 0.1563088 PHA ADMIN. SERV CLAIMS N

95183 PHA INSURANCE SERVICES (ORLANDO, FL) CLAIMS N13306 PHCS Savility Payers CLAIMS N45275 PHCS/GEHA CLAIMS N 0.1567814 PHOENIX AMERICAN LIFE (PAL) CLAIMS N75238 PHOENIX GROUP SERVICES (TEXAS) CLAIMS N6143 PHOENIX GROUP SERVICES, INC. CLAIMS N3440 PHOENIX HEALTH PLAN CLAIMS N67814 PHOENIX HOME LIFE CLAIMS N

67814 PHOENIX HOME LIFE MUTUAL INS. CO. CLAIMS N67814 PHOENIX MUTUAL CLAIMS N87726 PHP OF MID MICHIGAN CLAIMS N 0.1587726 PHP OF MID-MICHIGAN Claims N 0.1587726 PHP OF SOUTH CAROLINA CLAIMS N 0.1587726 PHP OF SOUTH MICHIGAN CLAIMS N 0.15

91


87726 PHP OF SOUTHWEST MICHIGAN CLAIMS N 0.1587726 PHP OF WEST MICHIGAN CLAIMS N 0.1562155 PHP TENNCARE CLAIMS N6108 PHS HEALTH PLANS CLAIMS N Payer requires unique provider ID;please cal ll Unit at800-438-78

58204 PHYSICIAN ASSOCIATES OF LOUISIANA Claims N

95474PHYSICIAN ASSOCIATES OF THE GREATER SAN GABRIEL VALLEY N

CALL ARMANDO HERNANDEZ AT (626)817-8517 FOR PAYORID. EDI TEL:(626)817-8420

CALLPHYSICIAN ASSOCIATES OF THE GREATER SAN GABRIEL VALLEY CLAIMS N

PLEASE CALL ARMANDO HERNANDEZ AT (626) 817-8517 TO OBTAIN THE PAYER ID.

37330 Physician Health Plan (PHP) Mid-Michigan CLAIMS N

15749Physicians Alliance/Stones River Regional IPA CLAIMS N

57098 PHYSICIANS CARE NETWORK CLAIMS N

36345PHYSICIANS CARE NETWORK (ROCKFORD, IL ONLY) CLAIMS N

PAYOR ID VALID FOR BILLING ADDRESS OF PHYSICIAN CARE NETWORK, ROCKFORD, IL.

65018PHYSICIANS CORPORATION OF AMERICA (FLORIDA PLAN ONLY) CLAIMS Y

PROVIDERS THAT ARE CURRENTLY ENROLLED ONLY. NOT CURRENTLY ENROLLING ANY NEW PHYSICIANS.

75297 PHYSICIANS DIRECT CLAIMS N

37136PHYSICIANS HEALTH ASSOCIATION OF ILLINOIS CLAIMS N

20398 Physicians Health Collaborative CLAIMS N9173 Physicians Health Plan (PHP) - SC CLAIMS N

12399PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA N

CONTRACTED PROV. NEED PHP ID. CONTACT 260.432.6690 X549 W/ QUES

6108 PHYSICIANS HEALTH SERVICES CLAIMS N Payer requires unique provider ID;please cal ll Unit at800-438-7865031 PHYSICIANS HEALTHCARE PLANS INC Claims N

92


65031 PHYSICIANS HEALTHCARE PLANS INC. CLAIMS NPHCS1 PHYSICIANS HEALTHCHOICE - CLAIMS CLAIMS N 0.15

47027PHYSICIANS MUTUAL INSURANCE COMPANY CLAIMS N 0.15

SWITCHED TO THIN 061705. CLAIMS ARE PRINTED AND MAILED TO THE PAYER.

PHD03PHYSICIANS NETWORK OF COLORADO SPRINGS N

39156PHYSICIANS PLUS INSURANCE CORPORATION CLAIMS N

56151 PIEDMONT ADMINISTRATORS CLAIMS N6607 Piedmont Behavioral Health CLAIMS N 0.159861 PIMA Health CLAIMS Y 0.32

24735 PINNACLE CLAIMS MANAGEMENT, INC. CLAIMS N45985 Pinnacle Physician Management ORG CLAIMS N

73074PIPELINE INDUSTRY BENEFIT FUND (TULSA, OK) Claims N

73074PIPELINE INDUSTRY BENEFIT FUND(TULSA, OK) CLAIMS N

37224 PITTMAN & ASSOCIATES CLAIMS N 0.1564160 Pivotal Plan CLAIMS N

37287 PLANNED ADMINISTRATORS, INC. CLAIMS N

PROVIDERS SUBMITTING CLAIMS AS A PREFERRED BLUE PROVIDER SHOULD NOT SUBMIT CLAIMS USING PAYER ID 37287

67466 PM GROUP CLAIMS NPPN11 PMMR * PPN N 0.1558204 PODI CARE MANAGED CARE Claims N59324 PODIATRY NETWORK FL CLAIMS N58204 PODIATRY NETWORK SOLUTIONS Claims N

32680POLY AMERICA MEDICAL & DENTAL BENEFITS PLAN CLAIMS N

16111 POMCO CLAIMS N 0.1587068 POSTMASTER CLAIMS N 0.15

93


73159PPO OKLAHOMA (WINTERBROOK HEALTHCARE MANAGEMENT) Claims N 0.15

72148 PPO PLUS LLC N ADDED 23-SEP-2002.SX016 PPOM 0.32 $0.32 PER CLAIM38335 PPOM, LLC CLAIMS N 0.15

38335 PPOM, LLC PPOPLUS CLAIMS N 0.15

EFFECTIVE JANUARY 01, 2003, ALL PPOPLUS CLAIMS MUST BE SUBMITTED TO PAYER ID 72148, PPOPLUS LLC.

59333 PPOPLUS CLAIMS N72148 PPOPLUS LLC Claims N4334 PRACTICARE INC CLAIMS N36373 Prairie States Enterprise Inc. CLAIMS N 0.15

61665PREFERRED BENEFIT ADMINISTRATORS INC, Wichita Kansas CLAIMS Y

Required on medical/professional claims. The number can be obtained by contacting Provider Relations at PHS: 1.877.609.2467 or 316.609.2467

SX089 PREFERRED CARE CLAIMS N 0.32

SX089 PREFERRED CARE - Rochester NY CLAIMS 0.32Download Enrollment under Tools, Forms and select SX089 Enrollment

59291 PREFERRED CARE FL CLAiMS N 0.1556178 Preferred Care NC CLAIMS N 0.1565088 PREFERRED CARE PARTNERS CLAIMS N 0.15

73145PREFERRED COMMUNITY CHOICE/PCCSELECT/COMPMED CLAIMS N

35173 PREFERRED HEALTH NETWORK (PHN) CLAIMS N

61106PREFERRED HEALTH PLAN (LOUISVILLE, KY) CLAIMS N

31478 Preferred Health Professionals Claims N

60110PREFERRED HEALTH SYSTEMS INSURANCE COMPANY CLAIMS N

36401 PREFERRED NETWORK ACCESS, INC. CLAIMS N41147 PREFERRED ONE CLAIMS N60110 PREFERRED PLUS OF KANSAS Claims N

94


41147 PREFERREDONE (MN) Claims N43166 PREMIER BENEFITS, INC. Claims N

31147PREMIER COMP OF HOMETOWN HEALTH NETWORK (OHIO BWC) CLAIMS N 0.32


37119 PREMIER HEALTH NETWORK CLAIMS N43166 PREMIER HEALTH PLANS Claims N90440 Premier Health Systems, Inc. CLAIMS N 0.15

31147PREMIER MANAGED CARE, INC. (OHIO BWC) CLAIMS N 0.32


5003 Presbyterian (NM) CLAIMS NPREHP PRESBYTERIAN HEALTH PLAN CLAIMS 0.15

TH060 PRESBYTERIAN SALUD CLAIMS NTRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

45056 Prestige Health Choice CLAIMS N 0.1539185 PREVEA HEALTH INSURANCE PLAN CLAIMS N61101 PRIMARY DELIVERY SERVICES Claims N 0.1573288 PRIMARY DELIVERY SYSTEMS CLAIMS N

TH016 PRIMARY MEDICAL CARE CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

PMC11 PRIMARY MEDICAL CARE, INC. N 0.1556144 PRIMARY PHYSICIANCARE, INC. CLAIMS N PREVIOUS PAYER ID PPC61101 PRIME BENEFITS SYSTEMS, INC. - MO CLAIMS N 0.1563088 PRIME HEALTH Claims N

61101 PRIME HEALTH KANSAS CITY, INC. - MO CLAIMS N 0.15

61101PRIME HEALTH MANAGEMENT SERVICES - MO CLAIMS N 0.15

63088 PRIME HEALTH OF ALABAMA Claims N61101 PRIME HEALTH OF KANSAS, INC. - MO Claims N 0.15

61101 PRIME HEALTH OF KANSAS, INC., - MO CLAIMS N 0.15

95


56190PRIME VISION HEALTH PLAN/OPTICARE EYE HEALTH NETWORK CLAIMS N

61604 Prime West Health Plan CLAIMS N

33029 PRIMECARE OF CHINO VALLEY CLAIMS P


33029 PRIMECARE OF CORONA CLAIMS P


33029 PRIMECARE OF HEMET VALLEY CLAIMS P


33029 PRIMECARE OF INLAND VALLEY CLAIMS P


33029 PRIMECARE OF MORENO VALLEY CLAIMS P


96


33029 PRIMECARE OF REDLANDS CLAIMS P


33029 PRIMECARE OF RIVERSIDE CLAIMS P


33029 PRIMECARE OF SUN CITY CLAIMS P


33029 PRIMECARE OF TEMECULA CLAIMS P


4320 PRIMESOURCE HEALTH NETWORK CLAIMS N 0.154320 PRIMESOURCE HEALTH NETWORK Claims N 0.1561271 PRINCIPAL FINANCIAL GROUP CLAIMS N 0.1561271 PRINCIPAL FINANCIAL GROUP ERA N 0.1561271 PRINCIPAL LIFE INSURANCE CO. CLAIMS N 0.15

87056PRINTING INDUSTRIES ASSOCIATION OF SOUTHERN CALIFORNIA (PIASC) Claims N

87056PRINTING INDUSTRIES ASSOCIATION OF SOUTHERN CALIFORNIA/ PIASC CLAIMS N

87056PRINTING INDUSTRIES OF NORTHERN CALIFORNIA (PINC) Claims N

87056PRINTING INDUSTRIES OF NORTHERN CALIFORNIA/PINC CLAIMS N

97


38217 PRIORITY HEALTH Y

ADDED 05/15/2002. PLEASE CALL WENDELL BROOME AT (616)975-8284 PRIOR TO SUBMITTING CLAIMS

37315 PRISM - UNIVERA CLAIMS 0.1537268 PRISM NETWORK, INC. CLAIMS N 0.1537303 Prism-First Health CLAIMS N 0.15

38329 Pro Care Health Plan Inc. (Detroit MI) CLAIMS N

Payer ID valid for claims with the following submission addresses: PO Box 3160 Detroit MI 48203 AND PO Box 3590 Detroit MI 48203.

31132 PRO HEALTH COMPCARE N 0.15

59296PROFESSIONAL BENEFIT ADMINISTRATORS (WINTER PARK, FL) CLAIMS N

36331PROFESSIONAL BENEFIT ADMINISTRATORS, INC. (OAK BROOK, IL) CLAIMS N 0.15

PAYER ID IS VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION NAME, CITY, AND STATE OF PROFESSIONAL BENEFIT ADMINISTRATORS, INC., OAK BROOK, IL.

34176PROFESSIONAL BENEFITS ADMINISTRATORS (CUYAHOGA FALLS, OH) CLAIMS N

PAYER ID VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION ADDRESS OF 2040 FRONT STREET, CUYAHOGA FALLS, OH 44221.

41163 PROFESSIONAL CLAIM ADMINISTRATORS N ADDED 23-SEP-2002.

37242 PROFESSIONAL CLAIMS MANAGEMENT N 0.15 ADDED 23-SEP-2002.

37242PROFESSIONAL CLAIMS MANAGEMENT (CANTON, OH) CLAIMS N 0.15

PAYER ID VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION ADDRESS OF P.O. BOX 35276 CANTON, OH 44735-5276

59041Professional Insurance Company (PIC) (Formerly GE Voluntary Benefits PIC) CLAIMS N

34134 Professional Risk Management CLAIMS N58226 PROMINA CLAIMS N

98


37309 Protective Life Insurance Company CLAIMS N 0.15

31147 PROTEGRITY SERVICES (OHIO BWC) CLAIMS N 0.32


PHP01 PROVIDENCE GOOD HEALTH PLAN N 0.15PHP00 PROVIDENCE HEALTH PLAN (PPO) CLAIMS 0.15

SX131 PROVIDENCE OF OREGON CHOICE OPTION CLAIMS N 0.32 $0.32 PER CLAIM

SX132PROVIDENCE OF OREGON GOOD HEALTH PLAN CLAIMS N 0.32 $0.32 PER CLAIM

SX133 PROVIDENCE OF OREGON HEALTH PLAN CLAIMS N 0.32 $0.32 PER CLAIM

SX134PROVIDENCE OF OREGON HEALTH PLAN HMO CLAIMS N 0.32 $0.32 PER CLAIM

SX135 PROVIDENCE OF OREGON MEDICAID CLAIMS N 0.32 $0.32 PER CLAIM

SX136PROVIDENCE OF OREGON MEDICAID OPTION CLAIMS N 0.32 $0.32 PER CLAIM

SX137PROVIDENCE OF OREGON MEDICARE EXTRA CLAIMS Y 0.32 $0.32 PER CLAIM

SX138 PROVIDENCE OF OREGON OPTION CLAIMS N 0.32 $0.32 PER CLAIM

SX139PROVIDENCE OF OREGON TRADITIONAL OPTION CLAIMS N 0.32 $0.32 PER CLAIM

91131

PROVIDENCE PREFERRED OF WASHINGTON (SISTERS OF PROVIDENCE HEALTH PLANS) CLAIMS N

SX187 PROVIDENT Y 0.32

51032PROVIDER NETWORKS OF AMERICA (PRO-NET) CLAIMS N

48100 PROVIDRS CARE NETWORK 0.1568245 PRUDENTIAL ENCOUNTERS N9822 PSN - Florida Medicaid (JMH CLAIMS N51052 PSYCHCARE LLC CLAIMS N 0.15

99


91136 PUGET SOUND BENEFITS TRUST Claims NPlease enter Group Number (F25) when submitting claims.

91136PUGET SOUND BENEFITS TRUST - GRP# F25 CLAIMS N


91136PUGET SOUND ELECTRICAL WORKERS TRUST Claims N


91136PUGET SOUND ELECTRICAL WORKERS TRUST - GRP# 33 CLAIMS N


42172 PUGET SOUND HEALTH PARTNERS INC. CLAIMS N 0.1539197 Quad Med LLC (Pewaukee WI) CLAIMS N35174 QUAL CHOICE OF ARKANSAS CLAIMS N

35171 QUAL CHOICE OF VIRGINIA CLAIMS N

UNIQUE PROVIDER ID REQUIRED TO SUBMIT CLAIMS. CONTACT HELP DESK AT (804) 975-1212, EXT. 6333.

22300 QUAL-MED, ALBUQUERQUE (AL) CLAIMS N22320 QUAL-MED, COLORADO (CO) CLAIMS N22330 QUAL-MED, COLORADO EPO CLAIMS N

23342 QUALCARE, INC. CLAIMS N 0.15NEW PROVIDERS MUST ENROLL WITH QUALCARE AT (800) 992-6613, OPTION 5.

73067 QUIKTRIP CLAIMS 0.15

37129QUINCY HEALTH CARE MANAGEMENT INC. CLAIMS N 0.15 SWITCHED TO THIN 061705

57117 QVI Risk Solutions Inc. CLAIMS N 0.1595266 R. E. HARRINGTON, N 0.1595266 R. E. HARRINGTON, INC CLAIMS N 0.1595266 R.E. HARRINGTON CLAIMS N 0.1591176 RBMS, LLC. CLAIMS 0.15REGAL REGAL MEDICAL GROUP CLAIMSSB910 Regence BCBS of Utah CLAIMS Y 0.32 $0.32 per claim611 REGENCE BLUE SHIELD OF IDAHO CLAIMS Y 0.1538221 REGENCY EMPLOYEE BENEFITS CLAIMS N 0.1547076 Regional Care Inc. CLAIMS N 0.15

100


RENGQ RENAISSANCE 0.15

95203 RENAISSANCE ACHS SUMMIT MEDICAID CLAIMS N73066 RESERVE NATIONAL INSURANCE 0.15

37277RESURRECTION HEALTH CARE HEALTH PREFERRED CLAIMS N

RPPG1RESURRECTION PHYSICIAN PROVIDERS GROUP 0.15

26316 Retiree Health Trust CLAIMS N37270 REYNOLDS AND REYNOLDS CLAIMS N37331 RightChoice Benefit Administrators CLAIMS N37129 RIVER QUEST NETWORK, INC. CLAIMS N 0.15 ADDED 06170516117 RMSCO, INC. CLAIMS N75196 ROCKWELL INTERNATIONAL CLAIMS N 0.15

84065 ROCKY MOUNTAIN HEALTH PLAN CLAIMS 0.1584065 DEL 062812 NEIC HAS HOSP ONLY-ROCKY MOUNTAIN HEALTH PLAN GRAND JUNCTION

RMHMO ROCKY MOUNTAIN HMO CO N37602 ROONEY LIFE INC. CLAIMS N36339 Rush Health Association CLAIMS N 0.15

36389RUSH PRUDENTIAL HEALTH PLANS (HMO ONLY) CLAIMS N

63070 RWDSU BENEFIT FUND CLAIMS N 0.1531441 S & S HEALTHCARE STRATEGIES CLAIMS N PREVIOUS PAYER ID 3114235164 SAGAMORE HEALTH NETWORK CLAIMS N37137 Sage Technologies - PBS CLAIMS N88029 SAINT MARY'S HEALTH PLAN CLAIMS N 0.15

37259 SAMBA CLAIMS N 0.15DO NOT SEND MEDICARE PRIMARY CLAIMS. WE RECEIVE CLAIMS DIRECTLY FROM MEDICARE.

37236SAN FRANCISCO ELECTRICAL WORKERS HEALTH & WELFARE Claims N

37288 SANTA BARBARA COTTAGE HOSPITAL CLAIMS N

101


73172 SCAN HEALTH PLAN ARIZONA CLAIMS N20460 SCAN LONG TERM CARE CLAIMS N

16146SCHC Total Care Inc. (Acceptius Gateway payer) CLAIMS N

TH002 SCOTT & WHITE CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

88030SCOTT & WHITE HEALTH CARE PLAN -TEXAS Y 0.15

13310 SEABURY & SMITH CLAIMS N28530 SECURE HEALTH PLANS OF GEORGIA N ADDED 22-OCT-2002.

28530 SECURE HEALTH PLANS OF GEORGIA, LLC Claims N42142 SECURECARE OF IOWA CLAIMS N39045 SECURITY HEALTH PLAN CLAIMS N

64088 SELECT ADMINISTRATIVE SERVICES (SAS) Claims N Also known as Mississippi Select Health Care.

42137 SELECT BENEFIT ADMINISTRATORS CLAIMS N 0.15

041003- CHANGED FROM NEIC TO THIN. CHANGE PAYOR ID FROM 34855 TO 42137. LOCATED IN WEST DES MOINES, IOWA. NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

42137SELECT BENEFIT ADMINISTRATORS (DES MOINES, IOWA) CLAIMS N 0.15

37282SELECT BENEFIT ADMINISTRATORS OF AMERICA (ASHLAND, WI) CLAIMS N 0.15

23285 SELECT HEALTH OF SOUTH CAROLINA CLAIMS N20415 Select Senior Clinic CLAIMS N13377 SELECT/PACIFICARE CLAIMS N14 SELECTCARE CLAIMS N61225 SelectCare of Texas (Kelsey-Seybold) CLAIMS N38253 SELECTCARE, INC. OF MICHIGAN CLAIMS N38253 SELECTCARE, INC. OF MICHIGAN ERA N

102


SX107 SELECTHEALTH Y 0.32ENROLLMENT REQ. (FORMERLY INTERMOUNTAIN HEALTHCARE)

59111SELF INSURED BENEFIT ADMINISTRATORS (CLEARWATER, FL) CLAIMS N

PAYER ID VALID ONLY FOR CLAIMS WITH A SUBMISSION ADDRESS OF 18167 US HIGHWAY 19 NORTH, SUITE 300, CLEARWATER, FL 33764.

36404 SELF INSURED PLANS CLAIMS N 0.1534131 SELF-FUNDED PLANS, INC. CLAIMS N

TH018 SEMNET CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINTION.

54154 SENTARA FAMILY CARE Claims N 0.32


54154 SENTARA HEALTH MANAGEMENT CLAIMS N 0.32


23249 SENTINEL MANAGEMENT SERVICES N

LOCATED IN LANCASTER, PENNSYLVANIA. CONTACT: ROBERT HETTRICK. TEL:(800)432-887?. NOTE: MUST HAVE INSURED GROUP ID

39033 Sentry Insurance a Mutual Company CLAIMS N Claims must have the Sentry LifeInsurance scriberNumbers. using thecorrect nu tactSentry's C epartmentat 1-800-476056 SETON CHIP N ADDED 23-SEP-2002.

TH036 SETON HEALTH PLAN CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

103


SHPCH SETON HEALTH PLAN (CHIP) TX N 0.15

SET22 SETON HEALTH PLAN (STAR MEDICAID) Y 0.15

TH037 SETON HEALTH PLAN (STAR MEDICAID) CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

EPNSHSETON HEALTH PLAN-EXCLUSIVE PROVIDER NETWORKD CLAIMS N 0.15

25404 Seven Corners CLAIMS N

75280 SHASTA ADMINISTRATIVE SERVICES N 0.15LOCATED IN DALLAS, TEXAS. CONTACT: MICHAEL NEWMAN TEL:(214)561-6424

31147 SHEAKLEY UNICOMP (OHIO BWC) CLAIMS N 0.32


TH047 SHEET METAL WORKERS LOCAL 263 CLAIMS NTRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

34675

SHEET METAL WORKERS LOCAL 33 YOUNGSTOWN DISTRICT HEALTH AND WELFARE FUND, OHIO CLAIMS N


76342 SIERRA HEALTH SERVICES CLAIMS N76343 SIERRA HEALTH SERVICES INC. ENCOUNTERS N35206 SIGNATURE CARE HEALTH NETWORK CLAIMS N

62159 SIGNATURE HEALTH ALLIANCE CLAIMS NVALID FOR HCFA-1500 AT BILLING ADDRESS PO BOX 22419, NASHVILLE, TN 37202-2419.

36387 Silver Cross Managed Care Organization CLAIMS N27094 Simply Healthcare CLAIMS N 0.1584076 SINCLAIR HEALTH PLAN CLAIMS N 0.15

84096 SLOANS LAKE MANAGED CARE CLAIMS N

AS OF 12/27/2001, INSURED GROUP NUMBER MUST CONTAIN DOUBLE COLON "::" FOLLOWS BY NUMERIC SLOANS LAKE INTERNAL GROUP NUMBER

2057 SMITH ADMINISTRATORS CLAIMS N 0.15 ADDED 06/20/05

104


31147SOLIDARITY MANAGED CARE ORGANIZATION (OHIO BWC) CLAIMS N 0.32


91131SOUND HEALTH (NOW KNOWN AS FIRST CHOICE HEALTH NETWORK) Claims N

91131

SOUND HEALTH (SISTERS OF PROVIDENCE HEALTH PLANS) - NOW KNOWN AS PROVIDENCE PREF CLAIMS N

SB880 South Carolina BCBS CLAIMS Y 0.32 $0.32 per claimSCMCD SOUTH CAROLINA MEDICAID N 0.15

SCMCRSOUTH CAROLINA MEDICARE - PALMETTO GBA Y 0.15 GOTO TOOLS->FORMS FOR REGISTRATION FORM

SDBCS SOUTH DAKOTA BLUE CROSS (WELLMARK) CLAIMS 0.15SX142 South Indiana Health Options 0.32 $0.32 PER CLAIM35227 South Point Hotel & Casino CLAIMS N 0.1546114 SOUTHCARE CLAIMS N25147 SOUTHCARE/HEALTHCARE PREFERRED CLAIMS N 0.1586065 SOUTHEAST IOWA HEALTH PLAN CLAIMS N

37318 Southern Benefit Services CLAIMS N 0.15

Southern Benefit Services will no longer process claims from the following Provider Groups: Brockman Enterprises and SPS International.

25128 SOUTHERN HEALTH SERVICES, INC CLAIMS N 0.1525128 SOUTHERN HEALTH SERVICES, INC. Claims N 0.1537220 SOUTHERN NATIONAL LIFE Claims N

SWADMSOUTHWEST ADMINISTRATORS CALIFORNIA/NEVADA 0.32

37266 SOUTHWEST SERVICE LIFE Claims N 0.15

37259SPECIAL AGENTS MUTUAL BENEFIT ASSOCIATION CLAIMS N 0.15

52190 SPECIAL RISK INTERNATIONAL CLAIMS N23253 Spectrum Administrators N 0.15

105


84146 SPINA BIFIDA - VA HAC CLAIMS N84146 SPINA BIFIDA - VA HAC ERA N95286 SSM EXCLUSIVE CHOICE CLAIMS N

37264 ST JOHN'S CLAIMS ADMINISTRATION N 0.15LOCATED IN SPRINGFIELD, MISSOURI. CONTACT: RAY ZROBACK TEL:(630)428-5126

22240 ST. BARNABAS SYSTEM HEALTH PLAN CLAIMS N37264 ST. JOHNS CLAIMS ADMINISTRATION Claims N 0.15

68033ST. JOSEPTH HEALTH FOUNDATION OF NORTHERN CALIFORNIA CLAIMS N SONOMA COUNTY MANAGED CARE ONLY.

37116 ST. THERESE PHYSICIAN ASSOCIATION CLAIMS N

59225 STAR HRG CLAIMS N 0.15

CLAIMS ARE PRINTED AND MAILED TO THE PAYER. PAYER ID VALID ONLY IF THE ADDRESS ON THE HEALTH ID CARD MATCHES ONE OF THE FOLLOWING P.O. BOXES: P.O. BOX 55270, 30870, 30888, 54150, 30069, 55400, PHOENIX, AZ 85270-5270.

61425 STARMARK CLAIMS N 0.1572087 STATE EMPLOYEES GROUP BENEFITS CLAIMS N

31059 State Farm Casualty and Property Claim CLAIMS N 0.15

31053

STATE FARM GROUP MEDICAL & INDIVIDUAL HEALTH INSURANCE COMPANIES CLAIMS N

57254 State of Texas Dental Plan CLAIMS N 0.1575087 STATES GENERAL LIFE INSURANCE Claims N 0.1567829 STERLING MEDICARE ADVANTAGE CLAIMS N 0.1591151 STERLING OPTION 1 CLAIMS N

31121STONER AND ASSOCIATES (CINCINNATI, OH) CLAIMS N

15752 Stones River Regional IPA- Windsor CLAIMS N58128 STOWE ASSOCIATES CLAIMS N

106


57604STRATEGIC RESOURCES COMPANY (SRC) (AN AETNA COMP) CLAIMS N 0.15

FCSAS STUDENT ASSURANCE SERVICES CLAIMS 0.15

74227STUDENT INSURANCE - BOSTON MUTUAL LIFE INSURANCE COMPANY CLAIMS N 0.15

74227STUDENT INSURANCE - LIFE INSURANCE COMPANY OF BOSTON AND NEW YORK CLAIMS N 0.15

74227STUDENT INSURANCE - MEGA LIFE & HEALTH INSURANCE COMPANY CLAIMS N 0.15

74227

STUDENT INSURANCE - MID-WEST NATIONAL LIFE INSURANCE CO. OF TENESSEE CLAIMS N 0.15


74227

STUDENT INSURANCE - MID-WEST NATIONAL LIFE INSURANCE COMPANY OF TENNESSEE CLAIMS N 0.15

74227STUDENT INSURANCE - RELIANCE INSURANCE COMPANY CLAIMS N 0.15

74227STUDENT INSURANCE - RELIANCE NATIONAL INSURANCE COMPANY CLAIMS N 0.15

74227STUDENT INSURANCE - THE MEGA LIFE & HEALTH INSURANCE COMPANY CLAIMS N 0.15


35199 SUBURBAN HEALTH ORGANIZATION CLAIMS N88331 SUFFOLK HEALTH PLAN OF NEW YORK CLAIMS N 0.1595202 SUMMACARE HEALTH PLAN CLAIMS N

86071 SUMMERLIN LIFE & HEALTH INSURANCE CLAIMS 0.15

107


37301SUMMIT AMERICA INSURANCE SERVICES, INC. CLAIMS N 0.15

31147 SUMMITCORP (OHIO BWC) CLAIMS N 0.32


SX186 SUN HEALTH COROPORATION 0.15 $0.32 per claim68069 SUNSHINE STATE HEALTH PLAN23218 SUPERIOR BENEFITS CLAIMS N68069 SUPERIOR HEALTH PLANSHP11 SUPERIOR HEALTH PLAN CHIPS EPO CLAIMS Y 0.15 ENROLLMENT REQUIRED

39188 SUPERIOR HEALTH PLAN TEXAS CLAIMS Y 0.15

PAYOR REQUIREDS ENROLLEMENT. PLEASE CALL DEBBI SANDBERG AT 800.225.2573 EXT 25306 OR LEISA HAMLINAT AT 800.225.2573 EXT 25319.

TH024 SUPERIOR HEALTH PLANS CLAIMS NTRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

77306 SUTTER MEDICAL FOUNDATION CLAIMS Y MUST ENROLL FIRST WITH PAYOR36411 Swedish Covenant Hospital CLAIMS N

4298 T U F T S Y 0.15

ADDED 31-OCT-2002. CALL SUSAN HOFFMAN AT (617)972-9400, EXT 4648, THEN CONTACT FREECLAIMS AND LET US KNOW THE PAYOR ID

88067 Tall Tree Administrators CLAIMS37228 TARRANT HEALTH SERVICES CLAIMS N 0.1588019 TEACHERS HEALTH TRUST CLAIMS N

75139 TEAM CHOICE GOLD CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

75133 TEAM CHOICE PNS CLAIMS N 0.15TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

75133 TEAM CHOICE PPO CLAIMS N 0.1575134 TEAM CHOICE UMC CLAIMS N 0.1536215 TEAMCARE CLAIMS N36612 TEAMSTERS LOCAL UNION #301 N ADDED 23-SEP-2002.

108


37293TENNESSEE BENEFIT ADMINISTRATORS, LLC CLAIMS N

TNBCS TENNESSEE BLUE CROSS BLUE SHIELD Y 0.15

Download application from www.freeclaims.com/docs/forms, fill out and mail to TNBCS. They will notify you.

TNMCR TENNESSEE MEDICARE Y 0.15

HPN11 TEXAN PLUS (HOUSTON) CLAIMS 0.15PROVIDER ID NEEDED. CALL 713.843.6780 TO GET YOUR ID

TX1ST TEXAS 1ST HEALTH PLANS CLAIMS N 0.15

74249 TEXAS ASSOCIATION OF SCHOOL BOARDS CLAIMS N76048 TEXAS CHILDRENS HEALTH PLAN CLAIMS N 0.15TXCSM TEXAS CHILDRENS STAR MEDICAID N 0.1513185 TEXAS FIRST HEALTH PLAN (NTX) CLAIMS33104 Texas HealthSpring CLAIMS N 0.15

TH019 TEXAS MEDICAL ASSN INSURANCE (TMAIT) CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

TXMCR TEXAS MEDICARE PART B (JH) CLAIMS Y 0.15 NOVITAS TXMCR=INHOUSE ID. ID SENT IS 0441274214 TEXAS MUNICIPAL LEAGUE GROUP CLAIMS N 0.15TPG11 TEXAS PODIATRY GROUP N 0.15TH055 TEXAS TRUE CHOICE CLAIMS 0.15TTCEC TEXAS TRUE CHOICE CLAIMS N 0.15

BOONGTHE BOON GROUP (FOUNDATION BENEFITS ADMINISTRATORS) CLAIMS 0.15

59223 THE CHESAPEAKE LIFE INSURANCE CO. N 0.15 ADDED 23-SEP-2002.

74227THE CHESAPEAKE LIFE INSURANCE COMPANY - STUDENT INSURANCE CLAIMS N 0.15


25131 THE DIAMOND PLAN CLAIMS N 0.15

109


28777 THE EPOCH GROUP CLAIMS N 0.1575600 THE FAMILY HEALTH PROJECT CLAIMS N PO BOX 83, ODESSA, TX37305 The Ford Meter Box Company Inc. CLAIMS N 0.1516126 THE GUARDIAN CHOICE CLAIMS N20356 The Health Exchange Claims N Cerner Corporation

34150THE HEALTH PLAN (MASSILLON, OHIO AND ST CLEARSVILLE, OHIO ONLY) CLAIMS

31147 THE HEALTH PLAN (OHIO BWC) CLAIMS N 0.32


35206 THE HEALTHCARE GROUP CLAIMS N58200 THE INTEGRITY BENEFIT GROUP, INC. CLAIMS N

58200THE INTEGRITY BENEFIT NETWORK, INC (MARIETTA, GA) N ADDED 23-SEP-2002.

58200THE INTEGRITY BENEFIT NETWORK, INC. (MARIETTA, GA) Claims N

44066 THE LEWER AGENCY N

23223The Loomis Company - TPO Wyomissing, PA Claims N 0.15

59221 THE MEGA LIFE & HEALTH INS. CO. Claims N 0.15

59221THE MEGA LIFE & HEALTH INSURANCE COMPANY - INSURANCE CENTER CLAIMS N 0.15

PAYER ID VALID ONLY IF THE P.O. BOX ON THE HEALTH ID CARD MATCHES THE FOLLOWING P.O. BOX: P.O. BOX 982009, NORTH RICHLAND HILLS, TX 76182

59221THE MEGA LIFE & HEALTH INSURANCE COMPANY - INSURANCE CENTER ERA N 0.15

59225THE MEGA LIFE & HEALTH INSURANCE COMPANY - STARBRIDGE STARHRG CLAIMS N 0.15

CLAIMS ARE PRINTED AND MAILED TO THE PAYER. PAYER ID VALID ONLY IF THE ADDRESS ON THE HEALTH ID CARD MATCHES ONE OF THE FOLLOWING P.O. BOXES: P.O. BOX 55270, 30870, 30888, 54150, 30069, 55400, PHOENIX, AZ 85270-5270.

110


74227THE MEGA LIFE & HEALTH INSURANCE COMPANY - STUDENT INSURANCE (US) CLAIMS N 0.15


59227The MEGA Life & Health Insurance Company-OKC CLAIMS N

If the P.O. Box on the health ID card matches the following P.O. Box: P.O. Box 548801 Oklahoma City OK 73154

59221 THE MEGA LIFT & HEALTH INS CO. N 0.15 ADDED 23-SEP-2002.70491 THE MUTUAL GROUP (US) CLAIMS N72112 THE OATH CLAIMS N

63092THE OATH - A HEALTH PLAN FOR ALABAMA, INC. CLAIMS P 0.15

63092THE OATH - A HEALTH PLAN FOR ALABAMA CLAIMS N 0.15

NETWORK ID REQUIRED (4-6 DIGIT). PLEASE CONTACT THE OATH - A HEALTH PLAN FOR ALABAMA PROVIDER CALL CENTER AT 800.743.7141 FOR ENROLLMENT.(NetworkId)

72112 THE OATH FOR LOUISIANA Claims N63092 THE OATH OF ALABAMA CLAIMS P 0.1572112 THE OATH OF LOUISIANA CLAIMS N13522 The Perfect Health Insurance CLAIMS 0.15

4320THE PREFERRED HEALTHCARE SYSTEM - PPO CLAIMS N 0.15

4320THE PREFERRED HEALTHCARE SYSTEM - PPO Claims N 0.15

13142THE UNION LABOR LIFE INSURANCE COMPANY CLAIMS N

38200 THE WELLNESS PLAN CLAIMS NTHERA THERAPHYSICS N (**12 max lines FA0)COTHE THERAPHYSICS- COLORADO ONLY CO N (**12 max lines FA0)

111


75305 THERAPY REVIEW SYSTEMS CLAIMS 0.15

THIS PAYER ID IS VALID FOR CONTRACTED THERAPY REVIEW SYSTEMS GEORGIA PROVIDERS ONLY

37225 THIRD PARTY ADMINISTRATORS, INC. N ADDED 23-SEP-2002.6131 THIRD PARTY CLAIMS MANAGEMENT CLAIMS N25175 THREE RIVERS HEALTH PLANS, INC CLAIMS N NETWORK ID NEEDED25175 THREE RIVERS HEALTH PLANS, INC. Claims N

25175THREE RIVERS HEALTH PLANS, INC. TMG LIFE INSURANCE COMPANY CLAIMS N

EYEPA TMAIT TMA11 THE EYEPA N 0.1570491 TMG LIFE INSURANCE COMPANY CLAIMS N

74214TML INTERGOVERNMENTAL EMPLOYEE BENEFIT POOL Claims N 0.15

15750 TN IPA CLAIMS N20081 Today's Health Wisconsin CLAIMS N

TOPTNTODAY'S OPTION (AMERICAN PROGRESSIVE AND PYRAMID HEALTH) 0.15

TH041 TOLEDO PUBLIC SCHOOLS CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

61425TOOLING & MANUFACTURING ASSOCIATION CLAIMS N 0.15

16126 TOTAL CARE CHOICE CLAIMS N31182 Total Community Care CLAIMS N34153 TOTAL HEALTH CARE N

31147TOTAL HEALTH MANAGEMENT - PBM (OHIO BWC) CLAIMS N 0.32


38201 Total Healthcare Inc. CLAIMS N23856 Touchstone Health PSO CLAIMS N 0.15

13402TOUCHSTONE HEALTH/HEALTH NET SMART CHOICE CLAIMS N

TOUCHSTONE HEALTH/HEALTH NET SMART CHOICE

69493 TOWER LIFE INSURANCE CO. CLAIMS N 0.15

112


TH064 TOWER ROCK STONE CLAIMS N PROVIDER ID REQUIRED FOR ALL THIN PAYERS

TXP11 TPA (Texas Plan Administrators) TX Y 0.15Contact Amy Durham at 915-520-3865 to enroll for EDI

TH020 TPA (TX PLAN ADMINISTRATORS) CLAIMS E

TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION. PLEASE CALL AMY DURHAM AT (915) 520-3865 TO ENROLL IN EDI.

37225 TPA INC. Claims N

Also known as Third Party Administartors, Inc., ABAS Inc., and American Benefit Administrative Services, Inc.

37230 TR PAUL INC. Claims N59222 TRANSAMERICA N 0.15 ADDED 23-SEP-2002.

59222TRANSAMERICA LIFE INSURANCE COMPANY CLAIMS N 0.15


59222TRANSAMERICA LIFE INSURANCE COMPANY ERA N 0.15

37284TRANSCHOICE-KEY BENEFIT ADMINISTRATORS CLAIMS N 0.15

87726 TRAVELERS CLAIMS N 0.1587726 TRAVELERS ERA N 0.15

87726TRAVELERS HEALTH NETWORK (HMO & CARE OPTION) CLAIMS N 0.15

87726 TRAVELERS PLAN ADMINISTRATORS CLAIMS N 0.154284 TRAVELERS/CGT CLAIMS N87726 TRAVELERS/CGT - PPO CLAIMS N 0.1536397 Trellis Health Partners CLAIMS N

57106 TRICARE PALMETTO (NORTH) Claims N 0.15TRICARE claims for regions 1, 2, 5, 7, 8, 9, 10, and 12.

61125

TRICARE SOUTH CHAMPUS (AL,AR,FL,GA,LA,MS,OK,SC,TN and East TX) (OLD 38520) Y 0.15

113


WESTR

TRICARE WEST-TRIWEST HEALTHCARE ALLIAANCE CORP (OLD TRICARE REG 9 AND 10) CLAIMS N 0.15 TRICARE (OLD REG 9 AND 10) CAL, AK,HI

31144 TRIHEALTH PHYSICIAN SOLUTIONS CLAIMS N 0.1598514 TRLHN/AS N50884 TRLHN/AU CLAIMS N62777 TRLHN/EB CLAIMS N54210 True Choice USA CLAIMS NTCUSA TRUE CHOICE USA CLAIMS N 0.15

TH048 TRUE CHOICE USA - CHRISTUS HEALTH CLAIMS NTRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

TCUCHTRUE CHOICE USA-CHRISTUS HEALTH PLAN N 0.15

TCUSA TRUE CHOICE USA-CHRISTUS HEALTHPLAN CLAIMS N 0.15

91078 TRUSTEED PLANS SERVICE CORPORATION CLAIMS N61425 TRUSTMARK CLAIMS N 0.1561425 TRUSTMARK INSURANCE COMPANY CLAIMS N 0.1561425 TRUSTMARK INSURANCE COMPANY ERA N 0.15 SWITCHED TO THIN 06170576055 TTPA CHIP N ADDED 23-SEP-2002.76054 TTPA COMM N ADDED 23-SEP-2002.

4298 TUFTS HEALTH PLAN CLAIMS P 0.15

PLEASE CONTACT TUFTS EDI OPERATIONS AT (888) 880- 8699, EXT. 4042 OR E-MAIL EDI_OPERATIONS@TUFTS- HEALTH.COM PRIOR TO SUBMITTING EDI CLAIMS.

TTPCHTX UNIVERSITY HEALTH PLAN - TEENS TO TOTS TX N

TTPERTX UNIVERSITY HEALTH PLAN - TTPA COMMERCIAL TX N

UPGCHTX UNIVERSITY HEALTH PLAN - UPG CHIP PLAN TX N

114


UPGUTTX UNIVERSITY HEALTH PLAN - UPG COMMERCIAL TX N

87726UBH - UNITED BEHAVIORAL HEALTH (FORMER METRAHEALTH - UNET) Claims N 0.15

87726UBH - UNITED BEHAVIORAL HEALTH (HEALTH PLAN - HMO) Claims N 0.15

16412UBH Employer Division (United Behavior Health) CLAIMS N

Pol Id=9 digit SSN and employer is and EMPLOYER GROUP, not HMO or PPO and authorization states to mail claims to SALT LAKE CITY, UT

SX178 UCARE of Minnesota CLAIMS N 0.32 $0.32 per claim

65006 UCSF/ICSL UROLOGY CLAIMS NCLAIMS ARE PRINTED AND MAILED TO THE PAYER.

22329UHP OF NEW JERSEY (CENTENE) (UNIVERSITY HEALTH PLAN) Claims N 0.15

75245UICI - ADMINISTRATORS - STATE OF NEVADA CLAIMS N 0.15

ACCEPTING CLAIMS ONLY FOR THE STATE OF NEVADA.

74223

UICI - ADMINISTRATORS - STATE OF NEVADA UICI - ADMINISTRATORS - STATE OF NEVADA CLAIMS N 0.15

ACCEPTING CLAIMS ONLY FOR THE STATE OF NEVADA. PLEASE BEGIN USING PAYER ID 74223.

41206 ULTRA BENEFITS INC CLAIMS 0.1537292 UMMH CLAIMS N39026 UMR - Wausau/UHIS CLAIMS N 0.15

52180 UMWA HEALTH & RETIREMENT FUNDS CLAIMS NUNIQUE PROVIDER ID REQUIRED. PLEASE CALL (800) 606-5479.

80314 UNICARE Claims N 0.15x47195 UNICARE INDIVIDUAL-SMALL GROUP CLAIMS N 0.15 PLEASE USE PAYER ID 80314

80314 UNICARE MAJOR ACCOUNTS CLAIMS N 0.15

EFFECTIVE 6/1/98, PAYER ID 65935 WILL NO LONGER BE VALID. PLEASE BEGIN SENDING CLAIMS FOR UNICARE MAJOR ACCOUNTS, PAYER ID 65935, TO PAYER ID 80314. (FORMERLY UNICARE LIFE & HEALTH & MASS MUTUAL)

115


47195 UNICARE OF TEXAS CLAIMS N 0.15

65099 UNICARE SPECIAL ACCOUNTS CLAIMS N 0.15

(FORMERLY JOHN HANCOCK HEALTH SECURITY PLAN, JOHN HANCOCK PREFERRED HEALTH PLAN & JOHN HANCOCK HEALTH SECURITY PLAN)

65099 UNICARE SPECIAL ACCOUNTS ERA N 0.15(FORMERLY JOHN HANCOCK MUTUAL LIFE INS. CO.)

35198 Unified Group Services CLAIMS N 0.15 Trans62170 UNIFIED HEALTH SERVICES CLAIMS N WORKERS COMPENSATION CLAIMS ONLY.34638 Unified Physicians Network CLAIMS N 0.1575243 UNIFORM MEDICAL PLAN CLAIMS N 0.15

75243Uniform Medical Plan Harrigton Benefit Services Claims N 0.15 Harrington; Uniform Medical Plan;

Centra

75243UNIFORM MEDICAL PLAN/HARRINGTON BENEFIT SERVICES Claims N 0.15

87042 UNION PACIFIC RAILROAD EMPLOYEES N ADDED 23-SEP-2002

UBHRI

UNITED BEHAVIORAL HEALTH (EMPLOYERS DIVISION-FORMERLY METRAHEALTH)) N 0.15

59069 UNITED BENEFITS Claims N 0.15

36659

UNITED FOOD & COMM. WORKERS MIDWEST UNIONS & EMPLOYERS HEALTH BENEFITS FUND CLAIMS N

87726 UNITED HEALTH & LIFE CLAIMS N 0.15

65978UNITED HEALTHCARE - METRAHEALTH/METROPOLITAN CLAIMS N Old payor id was 65978

87726 UNITED HEALTHCARE - TRAVELERS CLAIMS N 0.15

59129UNITED HEALTHCARE OF FLORIDA (OLD CAC/RAMSAY/CORAL GABLES PLAN ONLY) CLAIMS N

CALL EDI SERVICES AT (813) 357-5483 WITH QUESTIONS.

116


36273United Healthcare Ovations Insurance Solutions (AARP) CLAIMS N

31107 UNITED MEDICAL RESOURCES CLAIMS N71412 UNITED OF OMAHA CLAIMS N

84132UNITED PHYSICIANS OF NORTHERN COLORADO CLAIMS N

41194 UNITED RESOURCES NETWORK CLAIMS N36362 United Security Life & Health Ins Co CLAIMS N 0.15

13545UNITED STATES LIFE INSURANCE COMPANY N

87726 UNITEDHEALTHCARE Claims N 0.15

87726UNITEDHEALTHCARE (FORMER METRAHEALTH) CLAIMS N 0.15

87726 UNITEDHEALTHCARE OF ALABAMA CLAIMS N 0.15

87726 UNITEDHEALTHCARE OF ARIZONA, INC. Claims N 0.1587726 UNITEDHEALTHCARE OF ARKANSAS CLAIMS N 0.15

87726UNITEDHEALTHCARE OF CALIFORNIA - NORTHERN CALIFORNIA Claims N 0.15

87726UNITEDHEALTHCARE OF CALIFORNIA - SOUTHERN CALIFORNIA Claims N 0.15

87726 UNITEDHEALTHCARE OF COLORADO, INC. Claims N 0.1587726 UNITEDHEALTHCARE OF FLORIDA CLAIMS N 0.1587726 UNITEDHEALTHCARE OF GEORGIA CLAIMS N 0.1587726 UNITEDHEALTHCARE OF ILLINOIS Claims N 0.15

87726 UNITEDHEALTHCARE OF KENTUCKY, LTD. Claims N 0.1587726 UNITEDHEALTHCARE OF LOUISIANA CLAIMS N 0.1587726 UNITEDHEALTHCARE OF MISSISSIPPI CLAIMS N 0.15

87726 UNITEDHEALTHCARE OF NEW ENGLAND CLAIMS N 0.15

117


87726UNITEDHEALTHCARE OF NEW YORK (INCLUDES NEW YORK AND NEW JERSEY) Claims N 0.15

87726UNITEDHEALTHCARE OF NORTH CAROLINA CLAIMS N 0.15

87726UNITEDHEALTHCARE OF NORTH CAROLINA, INC. Claims N 0.15

87726 UNITEDHEALTHCARE OF OHIO Claims N 0.1587726 UNITEDHEALTHCARE OF PUERTO RICO CLAIMS N 0.1587726 UNITEDHEALTHCARE OF TENNESSEE CLAIMS N 0.1587726 UNITEDHEALTHCARE OF TEXAS CLAIMS N 0.15

87726 UNITEDHEALTHCARE OF TEXAS - DALLAS Claims N 0.15

87726UNITEDHEALTHCARE OF TEXAS - HOUSTON Claims N 0.15

87726UNITEDHEALTHCARE OF THE MID-ATLANTIC Claims N 0.15

87726UNITEDHEALTHCARE OF THE MIDLANDS (NEBRASKA) CLAIMS N 0.15

87726UNITEDHEALTHCARE OF THE MIDLANDS - HMO (CHOICE, SELECT) Claims N 0.15

87726

UNITEDHEALTHCARE OF THE MIDLANDS - PPO(CHOICE PLUS,SELECT PLUS,SELF FUNDED) Claims N 0.15

87726UNITEDHEALTHCARE OF THE MIDWEST (MISSOURI) CLAIMS N 0.15

87726

UNITEDHEALTHCARE OF THE MIDWEST - CHOICE, CHOICE PLUS, SELECT, SELECT PLUS Claims N 0.15

87726UNITEDHEALTHCARE OF THE MIDWEST - MEDICARE COMPLETE Claims N 0.15

87726UNITEDHEALTHCARE OF UPSTATE NEW YORK CLAIMS N 0.15

118


87726 UNITEDHEALTHCARE OF UTAH CLAIMS N 0.1587726 UNITEDHEALTHCARE OF VIRGINIA CLAIMS N 0.15

87726 UNITEDHEALTHCARE OF WISCONSIN, INC. Claims N 0.15

87726UNITEDHEALTHCARE PLANS OF PUERTO RICO Claims N 0.15

66705 Unity Health Insurance CLAIMS N

Before submitting claims please go to http://www.unityhealth.com/Providers/EDI/index.htm and complete EDI Sign Up Form and NPI Appendix A documents. Or call Joe Boerboom at 608-643-1531 to request these forms.

SX088 UNIVERA - Health Southern Tier CLAIMS R 0.32

SX087UNIVERA - HealthCare Plan/ChoiceCare Buffalo CLAIMS R 0.32

SX086 UNIVERA - Pre Paid Health Plan of NY CLAIMS R 0.32SX090 UNIVERA - SSA ENY CLAIMS R 0.32SX091 UNIVERA - SSA WNY CLAIMS R 0.3233001 UNIVERSAL CARE - CALIFORNIA Claims N33002 UNIVERSAL CARE - TENNESSEE N ADDED 23-SEP-2002.

50528UNIVERSAL HEALTH CARE (ST. PETERSBURG, FL) CLAIMS N 0.15

CHANGED FROM UNIV1 TO 50528 ON 10/24/2007

50528 Universal Health Care Inc CLAIMS N 0.15

The payer ID's of the TH057 and 12t36 will no longer be active please use the new payer ID of the 50528 for all EDI submissions to Emdeon.

38298 UNIVERSAL STANDARD HEALTHCARE, INC. CLAIMS N

31147 UNIVERSITY COMP CARE (OHIO BWC) CLAIMS N 0.32


9830 UNIVERSITY FAMILY CARE CLAIMS N

119


9908UNIVERSITY FAMILY CARE - MARICOPA HEALTH PLAN CLAIMS N

7503

UNIVERSITY FAMILY CARE-HEALTHCARE GROUP (UNIVERSITY PHYSICIAN HEALTHCARE GROUP) CLAIMS

58248 UNIVERSITY HEALTH PLAN CLAIMS N

CALL UNIVERSITY HEALTH PLAN OF NEW JERSEY YCALL DEBBI SANDBERG AT (800)225-2573 EXT. 25306 FOR PAYORID. EDI TEL:(800)780-2438

59000UNIVERSITY HEALTH PLAN OF NEW JERSEY | INFOTRUST | TRIZETTO N

CONTACT: STEVE WALLERT AT (847)887-8088 OR JERI KAVANAUGH AT (847)887-8020

59000 UNIVERSITY HEALTH PLAN OF NJ Claims N

58246 UNIVERSITY HEALTH PLANS OF GEORGIA CLAIMS N13393 UNIVERSITY MSO CLAIMS N87043 UNIVERSITY OF MISSOURI CLAIMS N 0.15SX155 University of Utah Health Plan CLAIMS Y 0.32 $0.32 per claim

91136UNIVERSITY OF WASHINGTON STUDENTS & GRADUATE APPTS. Claims N

Please enter Group Number (P67) when submitting claims.

76053 UPG CHIP N ADDED 23-SEP-2002.23281 UPMC HEALTH PLAN CLAIMS N37324 Upper Peninsula Health Group (TPA) CLAIMS N 0.1538337 UPPER PENINSULA HEALTH PLAN N 0.15 ADDED 12/31/200193092 US Benefits23222 US HEALTHCARE CLAIMS N 0.1523222 US HEALTHCARE ENCOUNTERS N 0.15

TH041 USA HEALTH AND WELNESS CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

74095USAA (UNITED STATES AUTOMOBILE ASSOCIATION) CLAIMS N

USC11 USC HEALTH SERVICES N

120


TH021 USC HEALTH SERVICES CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

13407USFHP - ST VINCENT CATHOLIC MEDICAL CENTERS OF NEW YORK N ADDED 23-SEP-2002.

13407USFHP - ST. VINCENT CATHOLIC MEDICAL CENTERS OF NEW YORK Claims N

76049 UTMB HEALTHCARE SYSTEMS CLAIMS NPRIOR TO SUBMITTING PLEASE CALL PROVIDER RELATIONS AT (281) 652-8700.

12115 VA FEE BASIS PROGRAMS CLAIMS N12115 VA FEE BASIS PROGRAMS ERA N12116 VA FEE BASIS PROGRAMS ERA N

TH022 VALLEY BAPTIST HEALTH PLAN CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

77004 VALLEY PHYSICIANS, INC. CLAIMS N

FCVO3 VALUE OPTIONS - MARYLAND MEDICAID Y 0.15

FCVO1VALUE OPTIONS - NORTH STAR MEDICAID ONLY (NOT FREE) Y 0.15

- Provider Number Needed. EMC Submitter Number Needed. Contact Payor at 888-247-9311. ADDED 06/10/2002. LIVE 16-JAN-2003

FCVO2 VALUE OPTIONS COMMERCIAL (NOT FREE) Y 0.15

- Provider Number Needed. EMC Submitter Number Needed. Contact Payor at 888-247-9311. ADDED 06/10/2002. LIVE 16-JAN-2003

72128 VANTAGE HEALTH PLAN, INC. CLAIMS N 0.15

31147 VANTAGE HEALTH PLAN, INC. (OHIO BWC) CLAIMS N 0.32


PPM01 VANTAGE MEDICAL GROUP 0.1573288 VENCOR CLAIMS N

TH039 VENTANA HEALTH SYSTEMS CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

66126 Verdugo Hills Medical Group CLAIMS N

121


VTBCS VERMONT BLUE CROSS CLAIMS Y 0.15

VTMCD VERMONT MEDICAID (EDS) CLAIMS Y 0.15REGISTER WITH EDS 802.879.4450 ANVICARE SUBID=701100952

VTMCR VERMONT MEDICARE PART B (NHIC) Y 0.15REGISTRATION WITH MAMCR NEEDED. NETWORK ID/GRP ID NEEDED.

23173 VHP COMMUNITY CARE CLAIMS N54182 VICARE ADMINISTRATIVE SERVICES N ADDED 23-SEP-2002.24818 Vida Care CLAIMS N 0.15

VABCSVIRGINIA BLUE CROSS BLUE SHIELD (ANTHEM) Y 0.15

VAMCD

VIRGINIA MEDICAID 1692. VAMCD EDI=800.924.6741. FILL OUT FORM EDI-103 CLAIMS 0.15 ANVICARE INC SUBMITTERID =

SX198 VIRGINIA PREMIER GOLD CLAIMS Y 0.32 ENROLLMENT REQUIRED54176 VIRGINIA PREMIER HEALTH PLAN CLAIMS Y 0.15 ENROLLMENT REQUIRED37297 VISON CARE INCORPORATED CLAIMS N 0.15M3FL2 VISTA CLAIMS 0.15 ENROLL AT 866.703.144486079 VISTA DEL SOL HEALTH CARE CLAIMS N

55248 VISTA HEALTH PLAN NADDED 31-OCT-2002. PAYOR EDI: JIM GALLAGHER (850)668-3000 EXT 709

63114 VIVA HEALTH PLAN 0.15

USE HTTPS://ESTEPP.CSCHCG.COM/TRI_PROVIDER/LOGIN.JSP TO CHK MEMBERSHIP

VNAET VIVRA - AETNA CLAIMS N 0.15VNANT VIVRA - ANTERO CLAIMS NVNBCO VIVRA - BLUE CHOICE OF COLORADO CLAIMS N 0.15

VNCACVIVRA - CAC RAMSEY PLANS (CUBAN AMERICAN CLINICS) CLAIMS N

VNCIG VIVRA - CIGNA PLANS CLAIMS NVNFHP VIVRA - FAMILY HEALTH PLAN CLAIMS NVNFPL VIVRA - FAMILY PLUS PLANS CLAIMS N

VNFHC VIVRA - FLORIDA HEALTH CHOICE PLANS CLAIMS N

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VNCFLVIVRA - FOUNDATION HEALTH PLANS (CARE FLORIDA) CLAIMS N

VNHEL VIVRA - HELIXCARE PLANS CLAIMS N

VNHIPVIVRA - HIP PLANS (SUNRISE HEALTH PLAN) CLAIMS N

VNHUM VIVRA - HUMANA PLUS CLAIMS N

VNMCAVIVRA - MANAGED CARE OF AMERICA PLANS (PPO) CLAIMS N

VNMER VIVRA - MERIDIAN PLANS CLAIMS NVNMET VIVRA - METRAHEALTH PLANS CLAIMS N

VNNHPVIVRA - NEIGHBORHOOD HEALTH PARTNERSHIP PLANS CLAIMS N

VNNYL VIVRA - NYLCARE PLANS (HEALTH PLUS) CLAIMS NVNONE VIVRA - ONE SOURCE PLANS CLAIMS NVNPAC VIVRA - PACIFICARE CLAIMS NVNPHP VIVRA - PHP CLAIMS N

VNPCAVIVRA - PHYSICIANS CORPORATION OF AMERICA PLANS CLAIMS N

VNPRI VIVRA - PRINCIPAL PLANS CLAIMS NVNPRU VIVRA - PRUDENTIAL PLANS CLAIMS NVNRMN VIVRA - ROCKY MOUNTAIN CLAIMS NVNTHC VIVRA - TOTAL HEALTH CHOICE PLANS CLAIMS NVNUNI VIVRA - UNITED PLANS CLAIMS N77073 VNS Choice Medicare CLAIMS N 0.1559266 VOLUSIA Health Network CLAIMS N 0.1522264 VYTRA HEALTHCARE CLAIMS N 0.15 (FORMERLY CHOICECARE - LONG ISLAND)62111 W.C. BEELER & COMPANY Claims N

75257 WAL-MART CLAIMS NONLY STORES IN THE FOLLOWING STATES: AK, DE, ID, MT, ND, OR, SD, VT, WA, WI, WY

934 WASHINGTON BLUE CROSS CLAIMS Y 0.15

TH043WATERLOO MUNICIPAL EMPLOYEES HEALTH PLAN CLAIMS E


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73155 Waterstone Benefit Administrators CLAIMS N

58082WATKINS ASSOCIATED INDUSTRIES INC (ATLANTA,GA) N

ADDED 31-OCT-2002. PAYOR CONTACT: TIFFIANY BROWN (440)720-0700 EXT 215

58082 WATKINS ASSOCIATED INDUSTRIES, INC. Claims N39026 WAUSAU BENEFITS, INC. Claims N 0.15

39026WAUSAU INSURANCE COMPANIES - AKA EMPLOYERS INSURANCE OF WAUSAU CLAIMS N 0.15

39151 WEA TRUST CLAIMS N 0.1559332 Web TPA, Inc.of TX CLAIMS N 0.15

75261WEBTPA/COMMUNITY HEALTH ELECTRONIC CLAIMS/CHEC CLAIMS N 0.15

75261

WEBTPA/COMMUNITY HEALTH ELECTRONIC CLAIMS/CHEC WELL PATH OF CAROLINA, INC CLAIMS N 0.15

PLEASE SUBMIT CLAIMS TO PAYER ID 25129, COVENTRY HEALTH CARE OF THE CAROLINAS, INC./WELLPATH.

36337 Weiss Health Providers CLAIMS N 0.1514163 WELLCAREM3FL4 WELLCARE CHOICE CLAIMS 0.15 ENROLL AT 866.703.1444

59354WELLCARE HEALTH PLAN INC (ENCOUNTERS) CLAIMS 0.15 ENCOUNTERS ONLY-NOT FOR PAYMENT

77072 Wellcare Private Fee For Sevice Plans N 0.15

TH023 WELLMED CLAIMS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

TH040 WELLMED (ENCOUNTERS) ENCOUNTERS ETRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

WELMD WELLMED (ENCOUNTERS) N25129 WELLPATH CLAIMS N 0.15

25129 WELLPATH ERA E 0.15PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

87815 WELLS FARGO TPA INC CLAIMS N

91136WEST COAST STATIONARY ENGINEERS HEALTH & SECURITY TRUST FUND Claims N


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66124 West Covina Medical Group CLAIMS N

WVBCSWEST VIRGINIA BLUE CROSS (MOUNTAIN STATE BLUE CROSS) N 0.15

WVMCD WEST VIRGINIA MEDICAID CLAIMS 0.15 WWW.WVMMIS.COM

24735 WESTERN GROWERS ASSURANCE TRUST CLAIMS N

24735WESTERN GROWERS INSURANCE COMPANY CLAIMS N

37306 Western Health Inc CLAIMS N 0.1537247 WESTERN MUTUAL INSURANCE Claims N

31048WESTERN SOUTHERN FINANCIAL GROUP (CINCINNATI, OH) CLAIMS N 0.15

38232 WEYCO INC. CLAIMS N

98010WILLIAM J. SUTTON & COMPANY, LTD. (TORONTO, CANADA) CLAIMS N

62061WILLIS ADMINISTRATIVE SERVICES CORPORATION CLAIMS N 0.15 (FORMERLY WILLIS CORROON)

11696 Windsor Home Network CLAIMS N 0.15

Submitters please contact Windsor Billing department at (615) 371-0433 prior to submitting.

62153 Windsor Medicare Extra CLAIMS Y 0.15WNHLT WINHEALTH PARTNERS WY N

39200 WISCONSIN AUTO AND TRUCK DEALERS CLAIMS NWIBCS WISCONSIN BLUE CROSS Y 0.15 ANVICARE SUBID WITH WIBCS IS WI00164C

WIMCD WISCONSIN MEDICAID 0.15EDI PHONE=608.221.9036 ANVICARE SUBMITTERID=60305900

SX022WISCONSIN PHYSICIANS SERVICE INS CORP 0.32 $0.32 PER CLAIM

SCWI0WISCONSIN PHYSICIANS SERVICE INS CORP (TRICARE) CLAIMS N 0.32

SCWI0 VOIDED 04/25/2006.PAR PUT BACK TO PRODUCTION (QDN 051606)

TWCCP WORKERS' COMPENSATION N20333 Worksite Benefit Services LLC CLAIMS N

125


75276 WORLD INSURANCE COMPANY CLAIMS NWPS01 WPS Commercial Claims N 0.1562153 XANTUS HEALTHPLAN OF TENNESSEE CLAIMS N (FORMERLY PHOENIX HEALTHCARE)6121 YALE NEW HAVEN HEALTH - MSO INC. CLAIMS N

95376YALE PREFERRED HEALTH/HEALTHCHOICE OF CONNECTICUT CLAIMS N

9829 YAVAPAI COUNTY75285 YOUNG LIFE CLAIMS N 0.15

34083YOUNGSTOWN AREA ELECTRICAL WELFARE FUND, OHIO CLAIMS N


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