tuesday, february 14, 2006 - medexperts,...
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Emerging Medical Technologies – Payer ListLast Updated - Tuesday, February 14, 2006
Medical Payer List
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Payer Name EMC Type
Payer ID States Phone Contact
1199 Local Benefit Fund 009 13162 NY 646-473-6960 Renaud Dufresne
Located in New York, New York
ABC Health Plan of New York 009 48185 NY 800-298-2431 Customer Service
Located in New York New York. Unique Provider ID number required
Access Behavioral Care 009 COACC CO 800-984-9133 Customer Service
Located in Denver, Colorado
Accident Fund 866 WC141 IN, MI
WORK-COMP
Acclaim 009 64071 ALL 662-791-2970 Customer Service
Accountable Health Plan - Wisconsin Only 109 AMS01 WI 800-308-3344 Customer Service
Only claims with the address of Wisconsin can be submitted electronically.
ACE/ESIS 866 WC231 CA, CT, DC, DE, FL, GA, IL, MD, MT, NJ, OR, SC, TN, VA, WI
WORK COMP
Acordia National 109 87815 ALL 800-888-2565 Customer Service
Only claims with the City and State of Charleston, West Virgina
ACS Consulting Services, Inc. 666 72467 ALL 336-759-2013 Customer Service
Located in Winston-Salem, North Carolina
ACS Consulting Services, Inc. 372 72468 ALL 336-759-2013 Provider Relations
Located in Winston-Salem, North Carolina
Activa Benefit Services, LLC 099 38254 ALL 877-827-1414 Customer Service
Located in Grand Rapids, Michigan
AdminOne 940 37278 ALL 800-967-2077 Customer Service
Located in Rogers, Arkansas
Advantage Dental Plan 372 93524 OR 541-677-7624 Ken Achterfoff
Located in Roseburg, Oregon
Advantage Health Solutions 126 35209 IN 317-573-2719 Provider Services
Admnistrative office: Indianapolis, Indiana
Advantra GHP 340 00340 IL, MO 800-755-3901 Provider Services
Unique Provider# Required Claims address - PO Box 8052, London, KY
Payer Name EMC Type
Payer ID States Phone Contact
Advica - New York Community Health Plan 009 13373 NY
NO LONGER HAS ELECTRONIC CAPABILITY.
Advocate Bethany Health Partners 009 6509D IL 847-298-6000 Customer Service
Claims address: P.O. Box 0378 Mt Prospect, IL 60056-0378 - SEE NOTES
Advocate Christ Health Partners 009 6509F IL 847-298-6000 Customer Service
Claims address: P.O. Box 0379 Mt Prospect, IL 60056-0379, - SEE NOTES
Advocate Good Samaritan Health Partners 009 6509C IL 847-298-6000 Customer Service
Claims address: P.O. Box 0443 Mt Prospect, IL 60056-0443
Advocate Good Shepherd Health Partners 009 6509G IL 847-298-6000 Customer Service
Claims address: P.O. Box 0430 Mt Prospect, IL 60056-0430
Advocate Health Centers 009 36320 IL, MO 847-298-6000 Customer Service
Located in Mount Prospect, Illinois Claim office ID number required
Advocate Health Partners 009 65093 IL 847-298-6000 Customer Service
Claim office ID must contain the Payer Sub ID.
Advocate Illinois Masonic Health Partner 009 6509H IL 847-298-6000 Customer Service
Claim office ID must contain the Payer Sub ID.
Advocate Lutheran General Health Partners 009 6509A IL 847-298-6000 Customer Service
Claims address: P.O. Box 0546 Mt Prospect, IL 60056-0546 - See Notes
Aetna Health Plans 654 60054 ALL 800-599-2435 Customer Service
Affinity Health Plan 666 13334 NY 866-247-5678 Provider Relations
Located in Bronx, New York
AFL-CIO Food & Beverage Dealer's Trust Fund 009 34444 OH 440-720-0700 ext
222 Kathy Myers
only claims with the address: PO Box 457, Toledo, OH 43697-0457
AFTRA Health Fund 009 13346 NY 212-499-4800 ext 274 Deborah Jankowski
Located in New York, New York
Agency Services, Inc. 940 64158 ALL 716-319-5483 Christy Pidanick
Located in Amherst, New York
AH & L 057 80705 ALL 800-537-2033 Customer Service
One Health Plan - Kansas/Missouri
AIG 866 WC241 CT, DC, DE, MD, NJ, NY
WORK-COMP
AKM Medical Group 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
Payer Name EMC Type
Payer ID States Phone Contact
Alaska Children's Services, Inc (Group # P68) 372 91136 ALL 206-441-7574
Alaska Children's Services, Inc. 009 91136 AK, WA 206-441-7574 Customer Service
Group # P68 - Mailing address: PO Box 34203, Seattle, WA 98124
Alaska Children's Services, Inc. (Group #P68) 009 91136 AK, WA 206-441-7574 Customer Service
Group # P68 - Mailing address: PO Box 34203, Seattle, WA 98124
Alaska Laborers Construction Industry Trust 372 91136 ALL 206-441-7574
Group # F23
Alaska Laborers Construction Industry Trust 009 91136 AK, WA 206-441-7574 Customer Service
Group # F23 - Mailing address: PO Box 34567, Seattle, WA 98124
Alaska Pipe Trades Local 375 ( Group # F24 372 91136 ALL 206-441-7574
Alaska Pipe Trades Local 375 (Group # F24) 009 91136 AK, WA 206-441-7574 Customer Service
Group # F24 - Mailing address PO Box 34203, Seattle, WA 98124
Alaska United Food & Commercial Workers 372 91136 ALL 206-441-7474
Group # F45
Alicare 009 13550 ALL 212-539-5456 Nina Chalraborty
Located in New York, New York
Alignis 126 58213 ALL 440-720-0700 x205 Rebecca Karlinsky - EDI
Only claims with address: 45 Eisenhower Drive, Paramus, NJ 07652-1416.
All Savers Insurance Company 009 37602 ALL 317-297-4187 Client Services
Located in Lawrenceville, Illinois
Alliance Blue Cross/ Blue Shield of Missouri 012 00012 IL, MO 800-470-9630 Provider Services
Alliance Health Network 666 25126 PA 814-878-1771 Cathy Reichart
Located in Erie, PA - Effective 11/18 Payer ID 96218 was terminated.
Alliance Partners 800 23172 OH See member id card
Claims address: PO BOX 69319; HARRISBURG, PA 17106-9319
Alliance PPO, Inc. 109 52149 DE, MD, NC, PA, VA, WV 800-342-6141 Customer Service
Provider ID Number required
Alliance Select - Wisconsin Only 109 AMS01 ALL
Only claims with the address of Wisconsin can be submitted electronically.
Alliant Health Plans of Georgia 126 58234 AL, GA, TN 706-629-8848 Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
Only claims for Alliant Preferred and Select
Allied Administrators 126 94177 ALL 440-720-0700 x 222 Kathy Myers - EDI
Only claims with address: PO Box 2500, San Francisco, CA 94126-2500
Allied Administrators 372 94177 ALL 440-720-0700 ext 222 Kathy Myers
Only claims with address: PO Box 2500, San Francisco, California 94126-2500
Allied Benefit Systems, Inc. 666 37308 ALL 312-906-8050 Ray Zroback
Claims add: 208 LaSalle St., Suite 1300, PO Boxes 909786 & 909799 in Chicago, IL
Alternative Tech Resources 940 37231 CA
Located in Saremento, California
Altius Health Plan 666 SX113 UT 801-933-3130 Madalyn Jewkes
Located in South Jordan, Utah
Altus Dental 372 50503 ALL 877-223-0588 Customer Service
Located in Providence, Rhode Island
AMA Insurance Agency, Inc. 940 AMAIA ALL 800-458-5736 Customer Service
Located in Chicago, Illinois
Amalgamated Life 009 13550 ALL 212-539-5456 Nina Chalraborty
Located in New York, New York
Ameriben Solutions, Inc. 940 75137 ID 800-786-7930 Customer Service
Claims mailing address - P O Box 7186, Boise, ID 83707
Americaid Community Care (Houston) 109 27515 TX 800-590-5745 Customer Service
Claims address: Po Box 62947, Virginia Beach, VA - Unique Provider ID required
American Bankers Life Assurance Company 372 59067 ALL
American Benefits Management 126 34187 ALL 440-720-0700 ext205 Rebecca Karlinksy
Claims address: PO Box 35008, North Canton, Ohio 44735
American Capitol Insurance Company 940 AMC11 ALL 713-974-2242 Customer Service
Located in Houston, Texas
American Chiropractic Network (ACN) 009 41161 ALL 800-236-9921 Provider Services
Located in Minneapolis, Minnesota
American Chiropractic Network IPA of NY (ACNIPA) 009 41160 NY 800-236-9921 Provider Services
Located in Kingston, New York
American Commercial Barge Lines 109 37128 ALL 630-718-8230 Mandy Rak
Located in Jeffersonville, Indiana
American Community Mutual 009 60305 AR, AZ, GA, IA, IL, IN, KS, LA, MI, MO, 734-591- Cathy Shiek
Payer Name EMC Type
Payer ID States Phone Contact
Insurance NC, NE, OH, OK, PA, TN, SC, SD, UT, WI, WY 4120ext4361
American General 009 62030 ALL 615-749-1026 David James
Located in Nashville, Tennessee
American Health Group 373 AHG99 ALL 800-861-5770 Customer Service
Located in Maumee, Ohio
American Healthcare Plan Net - Wisconsin Only 109 AMS01 WI
Only claims with the address of Wisconsin can be submitted electronically.
American Imaging Management, Inc. 009 36369 ALL 847-559-6511 David Kakon
Assigned Group Policy ID is required.
American LIFECARE 009 72099 AL, AR, FL, LA, MS, OK, TN, TX 504-561-0600 Customer Service
Only claims with 1100 Poydras, Suite 2600, New Orleans, LA 70163-2602 -
American Medical Security 372 CX001 ALL 800-232-5432 Customer Service
Located in Green Bay, Wisconsin
American Medical Security, Inc. (AMS) 009 81400 ALL 800-232-5432
X15200 Customer Service
Located in Green Bay, Wisconsin
American National Insurance Company 940 74048 ALL 800-899-6806 Customer Service
Located in Galveston, Texas
American Postal Workers Union Health Plan (APWU) 372 44444 ALL 301-622-5739 Lynn Norris
American Postal Workers Union Health Plan (APWU) 109 44444 ALL 301-622-5706 Mr. Tom Backer
Located in Silver Springs, Maryland
American Republic Insurance Company 009 42011 ALL 800-641-0366 Customer Service
Located in Des Moines, Iowa
AmeriChoice of Florida 726 87726 FL 866-503-1380 Physician's Helpline
Located in Sunrise, FL
AmeriChoice of New Jersey Medicaid and Family C 009 86047 NJ 888-336-4842 Provider Service
Claims address: PO Box 7760, Phoenix, AZ 85011 - Provider ID required
AmeriChoice of New Jersey Medicare 009 86001 NJ 888-362-3368 Provider Services
Claims address: PO Box 16700, Phoenix, AZ 85011 - Provider ID required
AmeriChoice of New York Medicaid 009 86048 NY 212-509-5999 Provider Service
Claims address: PO Box 7720, Phoenix, Arizona 85011
AmeriChoice of New York Medicare 009 86002 NY 888-336-4845 Provider Relations
Payer Name EMC Type
Payer ID States Phone Contact
Claims address: PO Box 16500, Phoenix, Arizona 85011
AmeriChoice of Pennsylvania Care Plus Medicare 009 86003 PA 800-345-3627 Provider Service
Payer ID for claims with DOS on or before 8/1/2005 - See notes for addresses.
AmeriChoice of Pennsylvania Medicaid & KidChoic 009 86049 PA 800-345-3627 Customer Service
Old claims add: PO Box 16000 Phoenix, AZ new add: PO Box 659778, San Antonio TX
Amerigroup Corporation (Dallas/Ft Worth) 109 27514 TX 800-454-3730 Customer Service
Claims address: PO Box 61117, Virginia Beach, VA - Unique Provider ID required.
Amerigroup Florida 109 27519 FL 800-454-3730 Provider Inquiry Line
Claims address: PO Box 61010, Virginia Beach, VA - Unique Provider ID required
Amerigroup Illinois 940 27518 IL 800-454-3730 Provider Line
Claims address: PO Box 62469, Virginia Beach, VA - Unique Provider ID required.
Amerigroup Maryland 109 27517 MD 800-454 3730 Customer Service
Claims: PO Box 61749, Virginia Beach, VA - Requires State Medicaid Provider ID
Amerigroup New Jersey 109 27516 NJ 800-590-5745 Customer Service
Requires Provider's Medicaid Number or American Comm. unique ID
Amerigroup/Americaid / Fort Worth, TX / 940 26375 TX 800-454-3730 Provider Services
Claim address: PO Box 61117, Virginia Beach, VA - Provider ID required.
Amerigroup/Americaid / Houston 940 26374 TX 800-454-3730 Provider Services
Claim address: PO Box 62947, Virginia Beach, VA 23466-2947
Amerihealth Administrators, Inc. 763 54763 ALL 800-841-5328 Provider Relations
Located in Horsham, Pennsylvania Unique Provider ID required
Amerihealth Delaware - Non-HMO 688 93688 DE 800-595-3627 Customer Service
Located in Wilmington, Delware - Claims processed in Philadelphia, PA
AmeriHealth HMO New Jersey and Delaware 504 95044 DE, NJ 800-888-8211 Customer Service
Claims add: PO Box 41574, Philadelphia, PA Unique Provider ID number required
Amerihealth Mercy Health Plan 009 22248 PA 800-521-6007 Provider Service
Medicaid Managed Care
Amerihealth New Jersey - Non-HMO 606 60061 NJ 800-595-3627 Customer Service
Located in Iselin, New Jersey - claims processed in Philadelphia, PA
Ameritas Bankers Assurance 372 72630 ALL
Ameritas Life Insurance Corp. 372 47009 ALL
AMVI 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
Amway Corporation 009 38255 ALL 616-787-4908 Angie Berg
Payer Name EMC Type
Payer ID States Phone Contact
Located in Ada, MI
Anchor Benefits Consulting, Inc. 940 53085 FL 800-845-7629 Customer Service
Located in Maitland, Florida
Ancillary Care Management / testing 485 95485 ALL
testing
Anthem BCBS (IN, OH & KY) 372 84105 ALL 800-828-3677 Indiana Customer Service
Administered by HMS in Colorado Springs, Colorado
Anthem Health & Life Ins. Co. of New Jersey 057 80705 ALL 800-537-2033 Customer Service
APA Partners 372 16140 ALL 800-833-3650 Karen Matheson
Located in Latham, New York
APA Partners 009 16140 ALL 800-833-3650 Karen Matheson
Corporate office: 13 British Ave. Blvd, Latham, NY
APS Healthcare, Inc. 009 54160 ALL 301-563-5718 EDI Provider Rep.
See notes reagarding corporate office locations.
APWU 109 44444 ALL 301-622-5706 Mr. Tom Backer
American Postal Workers Union Health Plan
Aramark 866 WC731 ALL, EXCEPT FOR OH & WV
WORK COMP
Araz 009 16120 MN 952-896-9154 Andrea Failla
Located in Bloomington, MN
Arcadian Management Services, Inc. 009 77045 ALL 510-832-0311 Provider Services
Located in Oakland, California
Argonaut 866 WC271 CA, CT, DC, DE, FL, MD, NJ, NY, PA, VA
WORK COMP
Arizona Foundation for Medical Care 009 AZFMC AZ 800-624-4277 Provider Relations
Claims address: PO Box 2909, Phoeniz, Arizona 85062
Arizona Physicians IPA 009 M3432 AZ 800-445-1638 Provider Services
Claims address: PO Box 659421, San Antonio, Texas 78265
Arkansas Best Corporation 009 75278 AR 501-785-6178 Benefits Department
Located in Fort Smith, Arkansas
Arnett Health Plan 009 95440 IN 765-448-7483 EDI Coordinator
Located in Lafayette, Indiana - Unique Provider ID number required
Associates for Healthcare (AHC) 009 36326 MN, WI 414-784-9007 David Dobias
Assurant Healthcare 009 39065 ALL 800-533-7654 Customer Service
Claims address: PO Box 42033, Hazelwood, Missouri
Payer Name EMC Type
Payer ID States Phone Contact
Assured Benefit Administrators 940 74240 TX 800-247-7114 Customer Service
Located in El Paso, Texas
Athens Health Plan 009 95691 GA 800-293-6260 Provider Services
Located in Athens, Georgia
Atlantis Health Plan 009 13853 NY 212-747-0877 Provider Services
Located in New York, New York
Atlas Administrators 940 ATLAD ALL 800-232-9659 Customer Service
Located in Austin, Texs
AultCare 009 MNAUL OH 800-344-8858 Provider Services
Located in Canton, Ohio - unique Provider ID required
Automated Group Administration, Inc 940 37280 ALL 260-489-6447 Customer Service
Located in Fort Wayne, Indiana
Automotive Machinist Local 289 372 91136 ALL
Group # F32
Automotive Machinists Local 289 372 91136 ALL 206-441-7574
Group # F32
Automotive Machinists Local 289 H&W Trust 009 91136 AK, WA 206-441-7574 Customer Service
Group # F32
Avalon Medical Group 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
Avera Health Plans 009 46045 SD 605-322-4500 Margaret Solma
Located in Sioux City, South Dakota
AVMA GHLIT 109 95266 ALL 800-621-6360 Customer Service
Claims address: P. O. Box 909720, Chicago, Illinois 60690-9720
AvMed, Incorporated 109 59274 FL 800-452-8633 Network Support Services
Located in Miami, Florida - Unique Provider ID required
BAAI 235 00235 IA 800-407-0267 Provider Services
now known as Wellmark Administrators, Inc.
Barrien Health Plan 009 38338 MI 888-327-0671 Customer Service
Located in Flint, Michigan
Bass Administrators, Inc. 940 37248 LA 337-234-1790 Processing Supervisor
Located in Lafayette, Louisiana
Beacon Health Stratagies - TESTING 963 96311 CT, MA, NH, NJ, NY, PA, RI, VT 781-994-7500 Provider Relations
Located in Woburn, MA
Beech Street Corporation 009 95377 ALL 800-432-1776 Customer Service
Only address: PO Box 853925. Richardson, TX 75085 - SEE NOTES for requirements
BeneCare Dental Plans 372 23210 ALL 215-440-1018 Lee Serota
Payer Name EMC Type
Payer ID States Phone Contact
Located in Philadelphia, Pennsylvania
Benefit Administrators 372 62121 ALL 440-720-0700 ext 205 Rebecca Karlinsky
Only claims with address: PO Box 10585, Knoxville, Tennessee 37939
Benefit Consultants, Inc 600 10006 ALL 800-434-4620 Claims Department
Located in Ballwin, MO - Set-up is required for this payer contact Gateway EDI.
Benefit Coordinators Corporation 372 23145 ALL 440-720-0700 EXT222 Kathy Myers
Only claims with address: 111 Ryan Court, Suite 300, Pittsburg, PA 15205
Benefit Coordinators Corporation (Pittsburgh, PA) 126 25145 ALL 800-685-6100 Customer Service
Only claims with address: 111 Ryan Court, Suite 300, Pittsburgh, PA 15205
Benefit Management Administrators (BMA) 940 BMATP ALL 800-934-6302 Customer Service
Located in San Antonio, Texas
Benefit Management Inc., Joplin, MO 109 43178 MO 888-294-1515 Customer Service
Located in Joplin, MO See notes regarding addresses.
Benefit Management Systems, Inc. 940 37212 ALL 601-991-0060 Customer Service
Located in Ridgeland, Mississippi
Benefit Management Systems, Inc. 009 37212 ALL 601-991-0060 Customer Service
Located in Ridgeland, Mississippi
Benefit Plan Administrator of St. Louis, MO 009 13310 ALL 319-351-2667
x5610 Sue Hansen
Benefit Plan Administrators (BPA) 372 88027 ALL 800-423-1841 Customer Service
Located in Reno, Nevada
Benefit Plan Administrators Co.(Eau Claire, WI) 126 39081 ALL 715-832-9717 Customer Service
Only claims with the address: PO Box 1128, Eau Claire, WI 54702-1128
Benefit Plan Administrators, Inc. 940 37118 ALL 630-428-5397 Gary Trebolo
Located in Roanoke, Virginia
Benefit Plan Administrators/BPA 940 37286 ND 800-554-3951 Customer Service
Located in Fargo, North Dakota
Benefit Plan Management 109 37222 ALL 877-642-7500 Customer Service
Located in Rockland, Massachusetts
Benefit Planners 372 74223 ALL 210-558-2106 Lee deLuna
Located in Boerne, Texas
Benefit Planners, Inc. 940 74223 ALL 800-292-5386 Tammy Bennack
ONLY claims for P. O. Box 690450, San Antonio TX
Benefit Services, Inc. (Akron, Ohio) 109 34178 ALL 440-720-0700 ext 222 Kathy Myers
Payer Name EMC Type
Payer ID States Phone Contact
Located in Akron, Ohio
Benefit Systems & Services, Inc. (BSSI) 009 36342 ALL 630-789-2082 Lynn Demme
Benefit Systems and Services, Inc. (BSSI) 372 36342 ALL 630-789-2082 ext
211 Lynn Demme
Located in Westmont, Illinois
BenefitSource, Inc. 940 38257 IL, IN, MI, OH, WI See notes
Offices located in Monroe, Grand Rapids and Kalamazoo, Michigan
Benesight 009 87265 ALL 719-595-2768 Customer Service
Headquarters located in Lake Mary, Florida claims - PO Box 3060, Pueblo, CO
Benesys Inc. 940 37248 LA 337-234-1790 Processing Supervisor
Located in Lafayette, Louisiana
Benesys-LHP claims Unit 940 37248 LA 337-234-1790 Processing Supervisor
Located in Lafayette, Louisiana
Benesys/Benesys, Inc. 940 37248 LA 337-234-1790 Processing Supervisor
Located in Lafayette, Louisiana
Benicorp Insurance Company 940 BENCP AR, GA, KS, IN, MO, NE.NV, OH, TX 800-837-1205 Customer Service
Located in Indianapolis, Indiana
Best Life & Health Insurance Company 109 95604 ALL 800-433-0088 Customer Service
Located in Irvine, California
Better Health Plans, Inc. 109 62183 PA, TN 800-600-9007 Provider Relations
Located in Monroeville, Pennsylvania - Enrollment required
Big Lots Associates Plan 800 CX025 OH 877-304-0761 Customer Service
Located in Dublin, Ohio
BJC/ASO/HMO 23 340 00340 IL, MO 800-755-5242 Customer Service
Unique Provider ID required. Claims mailing address: PO Box 7112, London, KY
Blue Bell Benefits Trust 940 ECIBB TX
Located in Brenham, Texas
Blue Care Family Plan (BC/BS of CT) 372 00700 CT
Blue Choice (UB92) 112 90017 IL, MO 800-932-4480 Provider Services
Blue Choice of Missouri 017 00017 IL, MO 800-470-9630 Provider Services
Located in St. Louis, Missouri Unique Provider ID number required
Blue Cross and Blue Shield Michigan/Blue Care Net 779 77910 MI 800-662-6667 Customer Service
Enrollment required
Blue Cross and Blue Shield of 580 00580 AL 800-292-8868 Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
Alabama
Enrollment Required - Contact Gateway EDI
Blue Cross and Blue Shield of Alaska/Premera 822 00822 AK 800-435-2715 Customer Service
Enrollment required Contact Gateway EDI.
Blue Cross and Blue Shield of Arizona 500 00500 AZ 800-232-2345 Customer Service
Requires Enrollment contact Gateway EDI
Blue Cross and Blue Shield of Arkansas 181 00181 AR 501-378-3291 Customer Service
Requires Enrollment contact Gateway EDI
Blue Cross and Blue Shield of Colorado 072 00072 CO 800-332-3842 Provider Services
Payer requires enrollment forms - Contact Gateway EDI
Blue Cross and Blue Shield of Colorado Dental 372 84099 ALL
Blue Cross and Blue Shield of Connecticut 103 00103 CT 203-239-8293
ext8293 EDI Help Desk
Enrollment required contact Gateway EDI.
Blue Cross and Blue Shield of Connecticut Dental 372 65358 CT
Blue Cross and Blue Shield of DC/Carefirst 209 SB580 DE, MD, VA 800-334-3427 Customer Service
Enrollment required. Claims address: P.O. Box 2410, Easton, MD 21601
Blue Cross and Blue Shield of Delaware 570 00570 DE 302-421-8428 Customer Service
No enrollment required
Blue Cross and Blue Shield of Delaware Dental 372 53287 DE 302-421-8428 Andy Rumford
Located in Wilmington, DE
Blue Cross and Blue Shield of Florida 592 59201 FL (866) 454-9007 General Information
Provider Number required - Must be a Par Provider
Blue Cross and Blue Shield of Georgia 512 00512 GA 888-883-2720 EDI Services
Requires Enrollment contact Gateway EDI.
Blue Cross and Blue Shield of Hawaii/TESTING 995 99500 HI 800-377-4672 EDI Support
TESTING
Blue Cross and Blue Shield of Illinois 002 00002 IL 312-856-1946 Provider Service
Participating Providers require Unique Provider ID# and EDI Enrollment Form
Payer Name EMC Type
Payer ID States Phone Contact
Blue Cross and Blue Shield of Indiana 715 00715 IN 800-470-9630 Customer Service
Enrollment Required Contact Gatwway EDI
Blue Cross and Blue Shield of Iowa 234 00234 IA 800-526-8995 Customer Service
Participating Providers require Unique Provider ID# and EDI Enrollment Form
Blue Cross and Blue Shield of Kansas 031 00031 KS, MO 800-432-0272 Provider Relations
Participating Providers require Unique Provider ID# and Enrollement Form
Blue Cross and Blue Shield of Kansas City 041 00041 KS, MO 800-892-6048 Provider Relations
Participating Providers require Unique Provider ID# and Enrollment Form
Blue Cross and Blue Shield of Kentucky 660 00660 KY 800-470-9630 Customer Service
Anthem - - Contact Gateway EDI for enrollment
Blue Cross and Blue Shield of Louisiana 237 23738 LA 225-291-4334 EDI Help Desk
Enrollment required contact Gateway EDI, Inc.
Blue Cross and Blue Shield of Louisiana - Dental 372 23739 LA 225-295-8427 Kristi Hymel
Provider Enrollment Required before submitting claims
Blue Cross and Blue Shield of Maine/Anthem 680 20180 ME 207-822-8385 Customer Service
BA0.16 has to be tax id with provider's 3 digit location code i.e 001
Blue Cross and Blue Shield of Maryland /Carefirst 209 SB690 MD 800-842-5975 Provider Services
Enrollment required contact Gateway EDI
Blue Cross and Blue Shield of Massachusetts 642 64222 MA 800-266-2206 Help Desk
Enrollment Required-contact Gateway EDI
Blue Cross and Blue Shield of MI - Medicare Plus 778 00778 MI
TESTING ONLY
Blue Cross and Blue Shield of Michigan 777 77710 MI 248-486-2292 EDI Help Desk
Enrollment required contact Gateway EDI
Blue Cross and Blue Shield of Michigan Federal 791 77911 MI
BCBS MI Federal Claims Only Payer ID
Blue Cross and Blue Shield of Minnesota 956 00956 MN 800-711-9871 opt
2 Help Desk
Several Submitter numbers--check carefully --no global approval-providers test
Blue Cross and Blue Shield of Mississippi 730 00730 MS 601-664-4478 Sharon Boteler
Payer Name EMC Type
Payer ID States Phone Contact
Enrollment Required contact Gateway EDI
Blue Cross and Blue Shield of Missouri 012 00012 MO 800-470-9630 Provider Services
Participating and Non-Participating Providers - (Requires Unique Provider I
Blue Cross and Blue Shield of Missouri UB92 112 90012 IL, MO 800-932-4480 Provider Services
Blue Cross and Blue Shield of Montana 309 MTBLS MT 800-447-7828 Customer Service
Enrollment required contact Gateway EDI.
Blue Cross and Blue Shield of Nebraska 260 00260 NE (402) 398-3827 Dana Peterson
Enrollment required contact Gateway EDI Inc.
Blue Cross and Blue Shield of Nevada/Anthem 265 00265 NV 800-992-6907 Provider Services
Enrollment required.
Blue Cross and Blue Shield of New Hampshire 107 10770 NH 603-695-7000 Provider Services
Enrollment required contact Gateway EDI, Inc.
Blue Cross and Blue Shield of New Jersey 372 22099 NJ 888-334-9242 EDI Help Desk
Enrollment Required contact Gateway EDI
Blue Cross and Blue Shield of New Jersey (Horizon) 666 22099 NJ 800-969-3666 Gateway EDI
Enrollment Required call Gateway EDI - Includes all Products of Horizon BCBSNJ
Blue Cross and Blue Shield of New Mexico/THIN 290 00290 NM 800-835-8699 Customer Service
Enrollment required contact Gateway EDI.
Blue Cross and Blue Shield of New York Central 808 00808 NY 800-920-8889 Provider Services
Enrollment required contact Gateway EDI. Claims: PO Box 4792, Syracuse, NY 13221
Blue Cross and Blue Shield of New York Empire 804 00804 NY 800-342-3494 Provider Relations
Enrollment required contact Gateway EDI, Inc.
Blue Cross and Blue Shield of New York Northeaster 080 00800 NY 800-945-0556 Provider Call Center
Northeastern - Located in Albany, New York-Claims:PO Box 80, Buffalo, NY 14240
Blue Cross and Blue Shield of New York Rochester 807 00807 NY 800-462-0116 Provider Services
TESTING
Blue Cross and Blue Shield of New York Utica-Water 809 00809 NY 800-311-3536 Provider Service
Enrollment required contact Gateway EDI.
Payer Name EMC Type
Payer ID States Phone Contact
Blue Cross and Blue Shield of New York Western 301 00301 NY 800-950-0051 Provider Servcices
Enrollment required contact Gateway EDI
Blue Cross and Blue Shield of North Carolina 536 05536 NC 800-214-4844 Provider Relations
Enrollment required
Blue Cross and Blue Shield of North Dakota 250 00250 ND 800-368-2312 Provider Services
Enrollment and Provider Testing is required for this payer.
Blue Cross and Blue Shield of Ohio (Anthem) 834 00834 OH 800-470-9630 Customer Service
Enrollment Required contact GatewayEDI
Blue Cross and Blue Shield of Oklahoma 046 00046 OK 800-722-3730
x2156 EMC Support
Participating Providers require Unique Provider ID# and Enrollment Form
Blue Cross and Blue Shield of Oregon / Regence 850 00850 OR 503-225-5221 Eric
Provider enrollment required--contact Gateway EDI
Blue Cross and Blue Shield of Pennsylvania-Highmar 860 86500 PA 800-992-0246 Customer Service
Enrollment required contact Gateway EDI
Blue Cross and Blue Shield of Rhode Island 870 00870 RI
Enrollment required contact Gateway EDI.
Blue Cross and Blue Shield of South Carolina 028 57028 SC 800-868-2505 Customer Service
Enrollment required contract Gateway EDI.
Blue Cross and Blue Shield of South Dakota 848 88848 NE, SD 800-700-9137 Provider Services
TESTING
Blue Cross and Blue Shield of Tennessee 890 00890 TN 800-468-9736 Customer Service
Enrollment required contact Gateway EDI for enrollment forms.
Blue Cross and Blue Shield of Tennessee UB92 390 00390 TN 423-755-5717 Customer Support
Enrollment required contact Gateway EDI.
Blue Cross and Blue Shield of Texas 021 00021 TX 972-766-5480 Customer Service
Participating Providers require Unique Provider ID# and Enrollment Form
Blue Cross and Blue Shield of Texas 372 CB900 TX 800-969-3666 Gateway EDI
Requires Enrollment contact Gateway EDI
Blue Cross and Blue Shield of Utah 152 00152 UT 800-624-6519 Provider Service
Enrollment required contact Gateway EDI.
Blue Cross and Blue Shield of 915 00915 VT
Payer Name EMC Type
Payer ID States Phone Contact
Vermont
testing
Blue Cross and Blue Shield of Vermont 309 SB915 VT 800-924-3494 Customer Service
Enrollment Required contact Gateway EDI for enrollment forms
Blue Cross and Blue Shield of Virginia/Anthem 923 00923 VA 800-991-7259 Provider Services
Participating Providers only
Blue Cross and Blue Shield of West Virgina 943 00943 WV 800-543-7822 Provider Services
Enrollment is required - Contact Gateway EDI
Blue Cross and Blue Shield of Wisconsin 095 09500 WI 262-523-4782 Provider Services
Enrollment required contact Gateway EDI.
Blue Cross and Blue Shield Preferred Health SC 403 40300 SC
South Caroline BCBS Preferred Health Systems - HMO Blue-CONTACT GATEWAY TO TEST
Blue Cross and Blue Shield South Carolina FEP 402 40200 SC 800-868-2505 Customer Service
South Carolina BCBS Federal Employee Program Only - Enrollment required
Blue Cross and Blue Shield Wyoming/Noridian- 460 00460 WY 866-849-7246 Customer Service
Enrollment and Provider Testing is required for this payer.
Blue Cross Blue Shield State Employees-SC Health 000 40000 SC 800-868-2505 Customer Service
South Carolina Health Plan - Requires enrollment.
Blue Cross of California 471 47198 CA 800-227-3983 EDI Representative
Contact Gateway EDI for set-up.
Blue Cross of California 372 47198 CA 818-610-6277 Cecil Nyein-Claim Payment Info
Blue Cross of Idaho 054 00054 ID 888-224-3341 #3 Ken Russell
Enrollment required contact Gateway EDI.
Blue Cross of Washington & Alaska-Dental 372 47570 AL, WA
Blue Cross of Washington /Premera 830 00830 WA 800-435-2715 Customer Service
Enrollment required--contact Gateway EDI
Blue Cross of Washington and Alaska-Dental 372 84097 AL, WA
(MCDN claims only)
Blue Cross/Blue Shield of Nevada Dental 372 84101 ALL
Payer Name EMC Type
Payer ID States Phone Contact
Blue Cross/Blue Shield of New Mexico Dental 372 84100 ALL
Blue Shield of California 930 94036 CA 800-258-3091 Provider Service
Group Number Required
Blue Shield of Idaho/Regence 052 00052 ID 800-713-1693 EDI Support
No enrollment required. Unique Provider ID is required.
Blue Shield of Washington / Regence 829 00829 WA 800-373-1477
Contact Gateway EDI to set up to send claims electronically.
BlueCare - Blue Cross and Blue Shield of TN 892 00892 TN 423-755-5717 Customer Service
TennCare MCO product. - Enrollment required
Bluegrass Family Health 109 61124 KY 800-787-2680 Customer Service
Located in Lexington, Kentucky
BlueHorizons Medicare HMO of Missouri 017 00017 IL, MO 800-470-9630 Provider Services
Formerly BlueChoice Senior
Boilermakers National Health & Welfare Fund 372 36609 ALL
Located in Kansas City, Kansas
Boilermakers National Health & Welfare Fund 109 36609 ALL 913-371-2640 Customer Service
Located in Kansas City, Kansas
Boon-Chapman Administrators Inc. 940 74238 ALL 512-454-2681 ext 140 Brenda Haynes
Located in Austin, TX
Boston Medical Center Healthnet Plan, Inc. 109 13337 MA 617-414-6175 Sam Evans
Located in Boston, Massachusetts - Unique Provider ID required
Boyd Brothers Transportation Inc./BoydCare 940 37273 ALL 800-700-2693 Customer Service
Located in Clayton, Alabama
Bridgestone Claims Service 009 37285 ALL 800-237-8447 Customer Service
Located in Akron, Ohio
Brokerage Concepts 940 51037 ALL 630-718-8128 Pete Foskaris
Located in King of Prussia, Pennsylvania
Brown and Brown Benefits 940 59069 AZ, CA, FL, GA, IN, NJ, NM, NV, OH, PA, TX 630-428-5397 Gary Trebolo
Located In Daytona Beach, Florida
Brown and Toland Medical Group 109 94316 CA 415-553-6512 Kirsten Varnau
Payer Name EMC Type
Payer ID States Phone Contact
Located in San Francisco, CA
Bryan Independent School District 940 BRISD TX 979-209-1000 Customer Service
Located in Bryan, Texas
Buckeye Community Health Plan 324 32004 OH 800-225-2573 Customer Service
Enrollment required contact Gateway EDI - Provider ID required
Butler Benefit Services, Inc. (BBSI) 940 42150 ALL 866-927-2200 ext 226 Customer Service
Located in Davenport, Iowa
C&O Employees' Hospital Association 009 23708 IN, KY, OH, VA, WV 800-679-9135 Customer Service
Located in Clifton Forge, Virginia
CAC/Mailhandlers 109 62413 ALL 800-707-5586 Customer Service
Claims address effective 8/17/05-PO Box 8402, London, KY-see notes for old add.
Cambridge, ISG 009 59334 ALL 800-566-5663 ext 114 Todd Breeden
Located in Exton, Pennsylvania
Cannon Cochran Management Services, Inc. 372 37105 ALL 800-333-3841 Provider Services
Located in Danville, Illinois
Cannon Cochran Management Services, Inc. 126 37105 ALL 800-333-3841 Provider Services
Located in Danville, Illinois
Cap Management Systems 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
Cape Health Plan 009 38245 MI 888-354-2273 opt 4 Customer Service
Located in Detroit, Michigan Rednering Provider Network ID required.
Capital Blue Cross and Capital Advantage Ins. Co. 304 23045 PA 800-874-8433 Profession Provider
Automation
Enrollment required contact Gateway EDI.
Capital District Physicians Health Plan/TESTING 065 00065 NY
Testing - Please contact Gateway EDI for testing information
Capitol Administators 009 68011 ALL 800-331-5301 Customer Service
Located in Rancho Cordova, California
Care Oregon 940 93975 OR 888-393-2450 Customer Service
Claims address: PO Box 40328, Portland, Oregon
Care Management Resources 340 00340 MO, IL 800-775-3540 Customer Service
Unique Provider ID Required - Claims address PO Box 7121, Lexington, KY
Carelink Advantra 666 25139 WV 304-231-5015 Provider Relations
Located in Charleston, West Virginia Claims address: PO Box 7101, London, KY
Carelink Health Plan Commercial 666 25139 WV 304-231-5015 Provider Relations
Payer Name EMC Type
Payer ID States Phone Contact
Located in Charleston, West Virginia Claims address: PO Box 7373, London, KY
Carelink Medicaid 666 25140 PA, WV 304-231-5015 Provider Relations
Claims address: PO Box 7773, London, KY
Carenet 666 25142 VA 800-627-4872 Customer Service
Claims address: P.O. Box 7702 London, KY 40742
Caresource 109 31114 OH 800-488-0134 Customer Service
Enrollment and Unique Provider ID required. Par Providers only can submit elec.
Caresource of Indiana 009 37311 IN 866-930-0017 Provider Services
Claims address: PO Box 10310, Dayton, Ohio 45402
Cariten Healthcare - Commercial Claims Only 009 62073 TN 800-284-0042 Customer Service
Claims mailing address: PO Box 22987, Knoxville, TN. Group number is required
Cariten Senior Health 009 62072 TN 865-470-7563 Provider Services
Claims mailing address: PO Box 22985, Knoxville, TN. Group number is required.
Carolina Benefit Administrators, Inc. 009 37245 SC 864-573-6937 Customer Service
Located in Spartanburg, SC
Carolina Care Plan, Inc. 009 57105 SC 800-358-4471 Customer Service
formerly, Physicians Health Plan, Inc. Located in Columbia, South Carolina
Carpenters H & W Fund -- HCFA 125 25125 IL, MO 800-755-5242 Provider Relations
Claims mailing address changed 7/2005 - PO Box 42031, Hazelwood, MO 63042
Cascade East Health Plans 109 93040 OR 866-577-8941 Customer Service
Located in Hermiston, Oregon
Caterpillar 726 87726 ALL 800-447-6434 Customer Service
Caterpillar, Inc 372 37060 ALL 309-494-2363 Provider Relations
CBA - Cooperative Benefit Administrators 009 52132 ALL 402-483-9200 EDI Claim Service
CBCA Administrators 009 55438 FL, MN, TX 888-314-3348 Customer Service
Claims address: Po Box 9000, London, Kentucky 40702
CBSA 372 41124 ALL
CBSA (Corporate Benefit Services of America) 800 41124 ALL 800-765-4224 Customer Service
Claims with City & State Hopkins, MN & P. O. Box 27267, Minneapolis, MN 5542
CCEA Welfare Benefit Trust 372 88020 ALL 702-794-0272 Customer Support
Located in Las Vegas, Nevada
CCEA Welfare Benefit Trust 009 88019 NV 702-794-0272 Customer Service
Located in Las Vegas, Nevada
Payer Name EMC Type
Payer ID States Phone Contact
Celtic Insurance 009 CELTC ALL 800-477-7870 Customer Service
Claims address: PO Box 06410, Chicago, Illinois 60606
Cemara Administrators, Inc. 109 37250 ALL 847-234-8870 ext 600 Customer Service
Located in Tulsa, Oklahoma
Cement Mason & Plasterers Health & Welfare Trust 372 91136 ALL
Group # F16
Cement Masons & Plasterers H&W Trust 009 91136 AK, WA 206-441-7574 Customer Service
Group # F16
Centinela IPA 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
Centra 009 75243 ALL
Formerly Centra Benefits of Texas (MS, TX, WA)
Central & Southwest Services 372 75177 ALL
Central Benefits Life 009 31118 ALL 614-464-8409 Jeff Mills
Corp. Off. located in Westerville, Ohio Payer request Fed ID as Billing Provider
Central Reserve Life 009 34097 ALL 800-321-3997 Customer Service
Central States Joint Board Health & Welfare Trust 940 37214 IL 312-738-0822 Customer Service
Located in Chicago, Illinois
Central States Southeast & Southwest Areas 009 36215 ALL 800-323-5000 Customer Support
Only claims with the address in the state of Illinois
CHA Health 009 23171 KY 800-457-5683 Lori Bruelheide
Located in Lexington, Kentucky, claims sent to Plano, Texas
Champva - HAC 009 84146 ALL 800-733-8387 Customer Service
Claims address: PO Box 65024, Denver, Colorado 80206-9029
Chartered Health Plans 800 95748 DC 202-398-8683 Customer Service
Located in Washington, DC
Chautauqua County Healthcare Plan - Mayville, NY 126 16600 ALL 440-720-0700 ext
222 Kathy Myers
Located in Mayville, New York
Cheapeake Life Insurance Company 109 59223 ALL 800-733-8880 Customer Service
Insured ID number is 9 digits, first two postions are alpha, the next 7 numeric.
CHEC - A subsidiary of Sprint 940 CHECS TX
Chehallis - Previously King County 372 93200 ALL 800-373-1477 NDEX
Payer Name EMC Type
Payer ID States Phone Contact
Medical
Lewis County Blue Shield - Requires Unique Provider ID
CHIP-Choiceone (UTMB) 940 UHSCH TX 877-238-8543 Customer Service
Claims address: PO Box 15548, Austin, Texas 78761
CHIP-Seton Health Plan 940 SHPCH TX 512-324-3125 Provider Relations
Claims address: Po Box 15507, Austin, Texas 78761
Choice One/UTMB CHIP 109 76049 TX 877-238-8543 Customer Service
Located in Austin, Texas
Choice Plus (TRW) 372 68241 ALL 800-544-4778 Customer Support
Christian Brothers Services 372 61271 ALL 515-247-8051 Carla Houselog
Christian Brothers Services 109 61271 ALL 515-247-8051 Carla Houselog
Corporate office Des Moines, Iowa
Christus Spohn Network 940 SPOHN TX 361-881-3167 Provider Relations
Located in Corpus Christi, Texas
CIGNA 308 62308 ALL Number on Card Refer to Regional Service
Requires rendering Provider Address, City, State and Zip Code
CIGNA (Connecticut General) 372 62308 ALL Number on Card Refer to Regional Service
Requires rendering Provider Address, City, State and Zip Code.
Cigna Behaviroral Health 009 MCCBV ALL 800-926-2273 Customer Service
Located in Eden Prairie, Minnesota
CIGNA Flex Care (New Mexico ONLY) 372 62310 ALL Number on Card Refer to Regional
Service
Payer no longer accepts electronic claims
CIGNA Health Plan - HMO 308 62308 ALL Number on Card Refer to Regional Service
Requires rendering Provider Address, City, State and Zip Code
City of Jacksonville 866 WC811 FL
WORK COMP
Claim Management Service, Inc. 373 39141 ALL 800-472-7130 Customer Service
Located in Green Bay, Wisconsin
ClaimsWare, Inc. 009 57080 ALL 864-234-8200 Customer Service
no longer have a connection to send electronic.
Clarendon Kids Chip Program 940 EPOTX TX 800.-971-0480 Customer Service
Located Austin, Texas
Clarity Vision Medical 863 00863 PA
Medical claims only, does not accept vision codes.
Payer Name EMC Type
Payer ID States Phone Contact
CMR 340 00340 IL, MO 800-775-3540 Customer Service
Unique Provider ID number required. Contact Gateway EDI for set-up.
CNA Insurance 940 71063 ALL
New name is Healthscope Benefits
Colonial Healthcare 009 37123 MD, NY, PA, VA 301-306-3021 Mary Anne Beckette
Located in Lanham, Maryland
Colorado Access HMO 009 COACC CO 720-744-5100 Customer Service
Located in Denver, Colorado
Columbia United Providers 009 91162 WA 360-449-8873 Lori Martin
Located in Vancouver, Washington
Combined Benefits, Inc. 940 37271 ALL 630-428-5126 Ray Zroback
Located in Midland Park, New Jersey
Commerce Benefits Group 126 34181 ALL 440-720-0700ext 222 Kathy Myers
Headquaters in Cleveland, Ohio
Commonwealth Administrators, LLC 940 37237 KY 859-226-1559 Erica Mayers
Located in Lexington, Kentucly
Community Care Behavioral Health Organization 009 25179 ALL 412-454-2129 Anthony Bradford
Located In Pittsburgh, Pennsylvania
Community Care Managed Healthcare Plans of OK 009 73143 OK 918-594-5295
ext4040 Customer Service
Located in Tulsa, Oklahoma
Community Care Network (CCN) 009 33005 ALL 858-654-2053 Tracy Morin
Located in San Diego, CA - Group Number Required
Community Care Organization 009 39126 WI 414-902-2371 Amber Heckendorf
Located in Milwaukee, Wisconsin
Community Care Plus 330 00330 IL, MO 800-294-3557 Customer Service
Unique Provider ID number required - Contact Gateway EDI for set-up.
Community Choice Michigan 009 38325 MI 800-488-0134 Customer Service
Located in Dayton, Ohio & Okemos, Michigan
Community First Health Plans 940 COMMF TX 210- 227- 2347 Customer Service
Located in San Antonio, Texas
Community Health Choice 940 48145 TX 888-760-2600 Provider Relations
Located in Houston, Texas - Provider TPI/Medicaid Number is required
Community Health Electronic Clearinghouse (CHEC) 372 75261 ALL 817-633-9224 Scott Davis
Community Health Plan 009 90010 MO 816-271-7776 Lisa Wilcoxson
Located in St. Joseph, Missouri Unique Provider ID number required
Payer Name EMC Type
Payer ID States Phone Contact
Community Health Plan of Washington 940 CHPWA WA 800-440-1561 Provider Relations
Located in Seattle, Washington
Community Premier Plus for Neighborhood Health Pro 109 32481 NY 631-360-3102 Jeanine Yetimoglu
Located in New York, New York
Comp - Ohio 372 34177 ALL 440-720-0700 ext 205 Rebecca Karlinsky
Only claims with address: 33 Fitch Boulvard, Austintown, Ohio 44515
Companion Health Care - South Carolina 922 92200 SC
Enrollment required contact Gateway EDI.
Compensation Programs of Ohio, Inc. 126 34177 OH 440-720-0700 Customer Service
Located in Austintown, Ohio
Compmed 009 73145 OK 800-884-4776 Claims Customer Service
Located in Tulsa, OK
Comprehensive Benefit Administrator, Inc. 126 03036 ALL 800-525-8788 Provider Maintenance
Dept.
Located in South Burlington, Vermont
Comprehensive Care Management 800 CCMC1 NY 877-226-8500 Customer Service
Located in Bronx, New York
Confederation Life Insurance Company 057 80705 ALL 800-537-2033 Customer Service
Now known as Great West Life Assurance
Connecticare, Inc. 306 06105 CT 800-282-3407 Provider Service
Located in Farmington, Connecticut - Unique Provider ID Number Required
Connecticut General (CIGNA) 372 62308 ALL 800-726-3388 Customer Service
Requires Rendering Provider Address, City, State and Zip Code
Connecticut General (CIGNA) 308 62308 ALL Refer to Ins. Card Refer to Regional Service
Requires Rendering Provider Address, City, State and Zip Code
Consociate Group 126 37135 IL 800-798-2422 Customer Service
Located in Decatur, Illinois
Consolidated Group Dental 372 61305 ALL
Consumer Health Solutions 009 37295 ALL 877-573-9541 Customer Service
Located in Spartanburg, South Carolina
Continental General Insurance Company 940 71404 ALL 800-545-8905 Customer Service
Located in Omaha, Nebraska
Payer Name EMC Type
Payer ID States Phone Contact
Cook Children's Health Plan 940 CCHP1 TX 800-964-2247 Provider Relations
Claims address: PO Box 300267, Houston, Texas 77230
Cooperative Benefit Administrators - CBA 009 52132 ALL 402-483-9200 EDI Claim Support
Located in Lincoln, Nebraska
Cooperative Benefit Administrators - CBA 372 52132 ALL 402-483-9200 EDI Claim Support
Core Management Resources Group, Inc. 109 58231 GA 866-716-5463 IS Manager
Located in Macon, Georgia
Coresource AZ and MN 940 41045 ALL 612-372-5466 EDI Support Line
Formerly Northwestern Mutual and Reliastar.
CoreSource of North Carolina & Indiana 666 35180 ALL 800-832-3332 Customer Service
Located in Charlotte, North Carolina
Coresource of Ohio 009 35183 ALL 800-282-3920 Customer Service
Claims address: PO Box 279, Sheldon, IA 51201-0279
Coresource PA, MD and IL 666 35182 ALL 717-295-9201 ext343 Mark Westwood
Located in Lancaster, Pennsylvania
Coresource, Little Rock 666 75136 ALL 501-221-9905 Customer Service
Claims address: PO Box 8215, Little Rock, AR 72221
Corporate Benefit Services of America 372 41124 ALL
Corporate Benefit Services of America 800 41124 ALL 800-765-4224 Customer Service
Claims with City & State Hopkins, MN & P. O. Box 27267, Minneapolis, MN 5542
Corporate Benefit Solutions 666 75136 ALL 501-221-9905 Customer Service
New Name: Coresource, Little Rock Claims address: PO Box 8215, Little Rock, AR
Corporate Benefits Services, Inc. 009 56116 ALL 810-277-9476 Provider Relations
Only claims with the address: P. O. Box 12953, Charlotte, NC 28220
Corporate Systems Administration 009 37246 ALL 423-282-3420 Customer Service
Located in Johnson City, Tennesee
Correctional Medical Services, Inc. 940 43160 ALL 314-919-9135 Customer Service
Located in St. Louis, MO
Costco 866 WC751 ALL, EXCEPT FOR AR, IA, KY, LA, ME, MS, ND, NE, OH, RI, SD, WV, WY
WORK COMP
Country Life Insurance Company 009 62553 ALL
Located in Bloomington, Illinois
Payer Name EMC Type
Payer ID States Phone Contact
Covenant Administrators, Inc. 372 58102 ALL 800-374-6101 Customer Service
Located in Atlanta, Georgia
Covenant Administrators, Inc. 126 58102 ALL 800-374-6101 Customer Service
Headquarters in Atlanta, Georgia
Covenant Health 009 62155 ALL
Unique Provider ID required
Covenant Management Systems 940 CMSEB TX 512.420.2769 Customer Service
Located in Austin, TX
Coventry Health Care of Delaware, Inc. 666 25130 DE, NJ, MD, PA 800-833-7423 Customer Service
Claims address - PO Box 7713, London, KY .
Coventry Health Care of Georgia, Inc. 666 25127 GA 800-470-2004 Customer Service
Claims address - PO Box 7711, London, KY
Coventry Health Care of Iowa, Inc. 666 25132 ALL 800-470-6352 Provider Relations
Claims mailing address: PO Box 7709, London, KY 40742
Coventry Health Care of Kansas, Inc. - Kansas City 666 25133 ALL 800-969-3343 Provider Relations
Claims address - PO Box 7109, London, KY
Coventry Health Care of Kansas, Inc. - Wichita 666 25134 ALL 800-664-9251 Provider Relations
Claims address - PO Box 7124, London, KY 40742
Coventry Health Care of Louisiana 666 25135 ALL 800-664-9521 Provider Relations
Claims address - PO Box 7717, London, KY
Coventry Health Care of Nebraska, Inc. 666 25136 ALL 800-471-0240 Provider Relations
Claims address - PO Box 7705, London, KY
Coventry Health Care of the Carolinas, Inc. 666 25129 NC 800-470-4523 Customer Service
Located in Pittsburg, PA
Cox Freeman UB's 119 00119 AR, MO 417-269-2963 Provider Services
Contact Gateway EDI to submit claims electronically. Unique Provider ID number.
Cox Health Plan 019 00019 AR, MO 417-269-2963 Provider Services
Contact Gateway EDI to submit claims electronically. Unique Provider ID number.
Creative Medical Systems 009 64068 ALL
Culinary Workers Health Fund 109 59140 NV 800-237-7767 Customer Service
Located in Las Vegas, Nevada
Custom Benefit Administrators 126 39170 WI 608-784-8442 Customer Service
Located in La Crosse, Wisconsin
CustomCare 372 68241 ALL 800-544-4778 Customer Support
Payer Name EMC Type
Payer ID States Phone Contact
Southwestern Bell-Exec
Dakotacare 109 DAK01 SD 800-325-5598 Customer Service
Located in Sioux Falls, South Dakota Enrollment Required.
Dart Management Corporation/ Dart Container Corp. 940 DARTC ALL 800-248-0457 Vicky Hanson
Call Vicky Hanson @ 800-248-0457 ext 2311 prior to submission of claims
Definity Health Plan 009 64159 NY 866-478-2273` Provider Services
Corporate office: Minneapolis, MN., Claims address: PO Box 9525, Amherst, NY
Delaware Physicians Care, Inc. 009 27009 DE 800-287-9860 Provider Service
Claims address: P.O. Box 61145 Phoenix, AZ 85082-1145
Delta Dental (Northeast) 372 02027 ALL 800-537-1715 Customer Service
See Notes for Specific edits
Delta Dental Insurance Company 372 94276 ALL 800-521-2651 Provider Relations
AK, AL, FL, GA, LA, MS, MT, NV.TX, UT - Located in Alpharetta, Georgia
Delta Dental of Arizona 372 86027 ALL 800-352-6132 Customer Service
See Notes for Specific Edits
Delta Dental of California - CA00 Claim Office 372 77777 ALL 888-335-8227 Customer Service
See Notes for Specific Edits
Delta Dental of Colorado 372 84056 ALL
Delta Dental of Delaware 372 51022 ALL 800-932-0783 Customer Service
See Notes for Specific Edits
Delta Dental of Idaho 372 82029 ALL
Delta Dental of Illinois 372 05030 ALL
Delta Dental of Maryland (Pennsylvania) 372 23166 ALL
Delta Dental of Massachusetts 372 04614 ALL
Provider Requires Enrollment and Certification
Delta Dental of Missouri 372 43090 ALL
Delta Dental of Missouri in South Carolina 372 43091 ALL
Delta Dental of New Jersey 372 22189 ALL
Provider Requires Enrollment and Certification
Delta Dental of New Mexico 372 85022 ALL 800-999-0963 Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
See Notes for Specific Edits
Delta Dental of New York 372 11198 ALL 800-932-0783 Customer Service
See Notes for Specific Edits
Delta Dental of North Carolina 372 56101 ALL 800-662-8856 Customer Service
See Notes for Specific Edits
Delta Dental of Pennsylvania (Include Maryland) 372 23166 ALL 800-932-0783 Customer Service
See Notes for Specifuc Edits
Delta Dental of Rhode Island 372 05029 ALL 800-843-3582 Customer Service
See Notes for Specific Edits
Delta Dental of South Dakota 372 54097 ALL
Delta Dental of Washington D.C. 372 52147 ALL 800-554-1907 Customer Service
See Notes for Specific Edits
Delta Dental of West Virginia 372 31096 ALL 800-932-0783 Customer Service
See Notes for Specific Edits
Delta Dental of Wisconsin 372 39069 ALL
Delta Health Systems, CA 109 DHS01 CA 800-422-6099 Customer Service
Located in Stockton, California Enrollment Required
Dental Aetna Health Plans 372 60054 ALL 203-636-4504 Diane Fernandez
Dental Benefit Management, Inc. 372 23210 ALL 215-440-1018 Lee Serota
Located in Philadelphia, Pennsylvania, an affiliate of BeneCare Dental Plans
Dental Benefit Providers 372 52133 ALL 301-718-7495 Wes Wright
Located in Bethesda, Maryland
Dental Self Funded Plans, Inc. 372 34131 ALL 800-722-7374 ext7115 Tim Smith
Located in Cleveland, Ohio
Dentaquest 372 04356 800-879-0288 Provider Relations
Located in Boston, Massachusetts
Denti-Cal 372 94146 ALL 916-386-1620 Provider Enrollment
Provider Requires Enrollment
Diamond Plan Coventry Health Plan 666 25131 DE;MD 866-533-5154 Customer Service
Claims address: PO Box 7136, London, KY 40742
Directors Guide of America 109 23706 ALL 323-866-2200 Shea Savash
Located in Los Angeles, California
Diversified Adminstration 009 06102 ALL 203-295-9583 x217 Bob Coen
Payer Name EMC Type
Payer ID States Phone Contact
DMERC - Region A - Healthnow 811 00811 ME, NH, NY, VT, PA, DE, NJ, CT, RI, MA 800-842-2052 Beneficiary Call Center
Enrollment required contact Gateway EDI.
DMERC - Region B - Administar Federal 635 00635 MN, WI, IL, IN, MI, OH, WV, VA, DC, MD 877-273-4334 Beneficiary Call Center
Enrollment form required. Contact Gateway EDI for enrollment forms
DMERC - Region C - Palmetto GBA 885 00885 CO, NM, TX, OK, AR, LA, MS, KY, TN, AL, FL, GA, SC, NC, PR, VI 800-583-2236 Beneficiary Call Center
Enrollment Required contact Gateway EDI
DMERC - Region D - Cigna 655 05655AK, AR, AZ, CA, HI, ID, IA, KS, MO, UT, MO, MT, NE, ND, NV, OR, SD, UT, WA, WY
866-224-3094 Beneficiary Call Center
Enrollment form required. Contact Gateway EDI for enrollment forms
Dollar General 866 WC781AL, AR, DE, FL, GA, IL, IN, IA, KS, KY, LA, MO, MS, NC, OH, OK, PA, SC;TN;VA
WORK COMP
Driscoll Children's Health Plan - CHIP 940 DCHCH TX 877-451-5598 Customer Service
Located in Corpus Christi, Texas
E-V Benefits Management, Inc. 126 34159 ALL 800-321-4085 Cusomer Service
Claims address: PO Box 94928 or PO Box 89476, Cleveland, OH 44101.
Early Intevention Central 940 TH084 IL Do thru email
Located in Springfield, Illinois
EHI 372 73288 ALL 800-558-4444 X 7448
Bonnie or Jody - MIS Dept.
EHI 611 61101 ALL 800-558-4444 X 7448
Bonnie or Jody - MIS Dept.
Green Bay and Madison Wisconsin only
Elder Health Inc., Pennsylvania 009 52192 PA 800-556-3507 Customer Service
Located in Philadelphia, Pennsylvania
ElderPlan Inc. 109 31625 NY 718-921-7979 Customer Service
Located in Brooklyn, New York - Unique Provider ID required
Ellis Consultants, Inc 940 ECISF TX info@ ellisconsultants.com
Located in Bellaire, Texas
Emerald Health Network 126 34167 ALL 216-479-2030 X 2119 Lisa Glermann
Located in Cleveland, Ohio
EMPHESYS 372 73288 ALL 800-558-4444 X 7448
Bonnie ir Jody - MIS Dept.
Payer Name EMC Type
Payer ID States Phone Contact
EMPHESYS 611 61101 ALL 800-558-4444 X 7448
Bonnie or Jody - MIS Dept.
Green Bay and Madison Wisconsin only
Empire Plan is Metropolitan 726 87726 ALL Members card Customer Service
Employee Benefit Concepts, Inc. 126 38241 MI 440-720-0700 ext 222
EDI Contact - Kathy Myers
Located in Farmington Hills, Michigan
Employee Benefit Consultants, Inc. 126 37257 ALL 800-342-7407 Customer Service
Located in Milwaukee, WI - SEE NOTES for claims addresses.
Employee Benefit Management Corporation 800 CX025 ALL 877-304-0761 Customer Service
Located in Dublin, Ohio
Employee Benefit Management Services, Inc (EBMS 009 81039 ALL 800-777-3575 Customer Service
Located in Billings, Montana and Salt Lake City, Utah
Employee Benefit Management Services, Inc. 372 81039 MT 406-245-3575 ext
256 Don Johnson
Located in Billings, Montana and Salt Lake City, Utah and Portland, Oregon
Employee Benefit Plan Administration, Inc. 126 03036 ALL 800-525-8788 Provider Maintenance
Dept.
Located in Hampton, New Hampshire
Employee Benefit Services 940 37216 ALL 630-718-8230 Mandy Rak
Address: 534 Rivercrossing Drive, Fort Mill, South Carolina 29715
Employee Benefit Services of Louisiana, Inc. (EBS) 940 41198 LA 800-256-2657 Customer Service
Located in Shreveport, Louisiana
Employee Benefit Services, Inc of San Antonio 940 EBSSA ALL 210-738-1414 Customer Service
Located in San Antonio, Texas - Payer needs contacted to send claims
Employee Benefits Corp (EBC) 009 37215 ALL 800-645-9972 Customer Service
Located in Peoria, Illinois
Employee Plans, LLC 372 35112 ALL 219-436-1616 *2 Customer Service
Located in Fort Wayne, Indiana
Employee Plans, LLC 009 35112 ALL 219-436-1616 option Customer Service
Located in Fort Wayne, Indiana
Employee Security, Inc. 372 54098 ALL
Employer Mutual, Inc. 009 59298 ALL 800-697-2235 Customer Service
Located in Jacksonville, Florida
Employers Direct Health 940 75232 CA, NC, TX 800-550-8009 Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
Home Office - Dallas, Texas
Employers Health 372 73288 ALL 800-558-4444 X 7448
Bonnie or Jody - MIS Dept.
(Green Bay and Madison Wisconsin only)
Employers Health Coalition (EHC) 009 MIDSC AR 479-648-3432 Customer Service
Corporate offices are located in Onalaska, Wisonsin
Employers Health Insurance 372 73288 ALL 800-558-4444 X 7448
Bonnie or Jody - MIS Dept.
Green Bay and Madison Wisconsin only
Employers Health Insurance 611 61101 ALL 800-558-4444 X 7448
Bonnie or Jody - MIS Dept.
Green Bay and Madison Wisconsin only
Encompass 940 37110 ALL
Located in Des Moines, Iowa
Encore Health Network 009 35206 IL, IN, KY, MI, OH 888-446-5844 Customer Service
Only claims with PO Box 490, Hillview, KY and PO Box 5464, Ft. Wayne, IN
ENH Medical Group IPA 940 36364 IL 888-364-6400 Customer Service
Located in Evanston, Illinois
Enstar Natural Gas 372 91136 ALL
Group # P61
Enstar Natural Gas (Group # P61) 009 91136 AK, WA 206-441-7574 Customer Service
Group E P61
EPIC Life Insurance / WPS 158 00158 IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, WI 608-223-5857 Pat
Enrollment Required Contact Gateway EDI, Inc.
EPOCH 940 28777 ALL 800-255-6065 Customer Service
Claims for the Kansas and St. Louis addresses
EQUICOR 372 62308 ALL Number on card Refer to Regional Services
Requires rendering Provider Address, City, State and Zip Code
Equicor (Equitable) 308 62308 ALL
Also, Equitable Life Assurance Co., which is owned by Cigna
Equitable 372 62308 ALL Number on Card Refer to Regional Service
Requires rendering Provider Address, City, State and Zip Code
Equitable (CIGNA) 308 62308 ALL Number on Card Refer to Regional Service
Requires rendering Provider Address, City, State and Zip Code
Equitable Plan Services 126 73126 ALL 800-749-2631 Customer Service
Only claims with address: PO Box 720460, Oklahoma City, OK 73172
Erie 866 WC301 PA
Payer Name EMC Type
Payer ID States Phone Contact
WORK COMP
Erin Group Administrators 009 23250 ALL 800-433-9746 Provider Services
Located in Lancaster, PA
ERISA Administrative Services 940 74234 ALL 800-933-7472 Customer Service
Located in Austin, Texas
Essence Health 082 57082 MO 314-851-3600 Claims
Located in St. Louis, MO - Unique Provider ID required
Essex Dental Benefits 372 43168 ALL 800-501-3471 Customer Service
Claims addresses: PO Box 16993 and PO Box 8510. St. Louis, Missouri
Ethix Northwest 372 91135 ALL 800-654-3250 X617 Debora Allen
Everett-Previously known as King County Medical 372 93200 ALL 800-373-1477 NDEX
Snohomish County Physicians Corp. - Requires Unique Provider ID
Evergreen Health Plan 009 58233 ALL 888-294-9451 Customer Service
Located in Columbus, Georgia
Exceptional Care Medical 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
Exclusicare 009 71412 ALL 800-456-9292 Customer Service
ExclusiCare 372 71412 ALL 800-456-9292 Customer Service
FACS Group/Federated HR Services/Federated Benefit 940 37300 AZ, , FL, OH 800-337-2363 Customer Service/Tanya
Lewis
Located in Mason, Ohio
Fallon Community Health 209 SX072 MA 800-939-5433 Customer Service
Enrollment Required contact Gateway EDI
Family Choice Medical 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
Family Health Partners MC+ Missouri 173 43173 MO 800-347-9363 Provider Relations
Located in Kansas City, Missouri - Unique Provider ID number required
Family Health Plan 940 96865 OH 419-251-0474 Provider Relations
Located in Toledo, Ohio
Fara Benefit Services, Inc. 940 37289 ALL 800-224-3272 Customer Service
Located in Metairie, Louisiana
Farm Family 940 14140 CT, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VT, WV. 806-473-2406 Desri Petrucci
Located in Albany, New York
FCE Benefit Administrators, Inc. 940 33033 CA, TX 800-899-9355 ext Syria Castillo
Payer Name EMC Type
Payer ID States Phone Contact
246
Claims offices located in San Antonio, TX
Federated Mutual Health Insurance Company 009 41041 ALL See Members Card
Home Office is located in Owatonna, Minnesota
Fidelis Care New York 009 11315 NY 888-343-3547 Provider Call Center
Located in Rego Park, New York
Fireman's Fund 866 WC321 CT, DC, DE, IL, MD, NC, NJ, NY, PA, SC, TN, VA
WORK COMP
First Administrators, Inc. 109 FAMR1 ALL 800-622-3339 Customer Service
Located in Des Moines, IA, Rapid City &Sioux Falls, SD-see notes for Provider ID
First Carolina Care 009 56196 NC, SC 910-215-5268 Craig Humphrey
Located in Pinehurst, South Carolina
First Choice of Midwest 009 75138 CO, IA, ID, MN, MT, ND, NE, SD, UT, WY 888-246-9949 Dept. of Electronic
Claims
Located in Sioux Falls, South Dakota
First Great-West Life & Annuity Insurance Company 057 80705 ALL 800-537-2033 Customer Service
First Guard Kansas Plan 960 90060 KS 888-828-5698 Customer Care
Claims add: PO Box 3020, Farmington, MO Payer requires Provider ID be present.
First Guard Missouri MC+ Plan 961 90061 MO 888-828-5698 Customer Care
Claims add: PO Box 3010, Farmington, MO - Requires a Unique Provider ID number
First Health 372 87043 ALL 801-977-4916 Sharon Miller
First Health (ALTA Health Stratagies) 109 87043 ALL 800-813-0397 Customer Service
Claims address: P O Box 24220, Tucson, AZ 85734
First Priority Health 009 23241 PA 800-451-4477 Customer Service
Located in Wilkes-Barre, Pennsylvania
First Reliance Standard (N. Y. Business) 372 13317 ALL
FirstCare 940 TH003 TX 800-365-1051ext6456 Customer Service
Unique Provider ID number required - Enrollment required contact Gateway EDI.
Fiserv Health/Tennessee 009 62061 ALL 615-360-2843 Rene' Ernst
Formerly Willis Administrative Services Corporation
FlexCare 372 68241 ALL 800-544-4778 Customer Support
Payer Name EMC Type
Payer ID States Phone Contact
Florida 1st 009 59276 FL 813-293-0785 Pam Ortin
Located Winter Haven, Florida
Florida Health Choice (FL) - Wisconsin Only 109 AMS01 FL
Only claims with the address of Wisconsin can be submitted electronically.
Florida Health Choice/Select (FL) - Wisconsin Only 109 AMS01 FL
Only claims with the address of Wisconsin can be submitted electronically.
Florida Health Network - Wisconsin Only 109 AMS01 FL
Only claims with the address of Wisconsin can be submitted electronically.
Florida Hospital Healthcare Systems 009 59321 FL 800-741-4810 opt. 4 Provider Relations
Located in Orlando, Florida - Rendering FHHS Provider ID or UPIN # required.
Florida Hospital Waterman Employee Benefit Plan 666 48116 FL 913-685-4740 Peter Rupp
Located in Eustis, Florida
Florida Power & Light 372 68241 ALL 800-544-4778 Customer Support
FMH Benefit Services 666 48117 ALL 800-990-9058 Customer Service
Located in Overland Park, Kansas
Food Lion/Dalehaize 866 WC771 DC, DE, GA, KY, MD, NC, PA, SC, TN, VA, WV
WORK COMP
Fortis Benefits 009 70408 ALL 414-299-6334 Elizabeth Kegel
Benefit Centers Located in TX, MO, KC, MN, GA & P. O. Box 3195, Milwaukee, WI
Fortis Benefits Insurance Company 372 70408 ALL 414-299-6334 Dale Luedtke
Fortis Self Funded Administrative Services 800 41124 ALL 800-765-4224 Provider Services
Claims with City & State Hopkins, MN & P. O. Box 27267, Minneapolis, MN 5542
Fortis Self Funded Administrative Services 372 41124 ALL
Fortis/Time 009 39065 ALL 414-299-6317 Dwayne Riekena
Claims address: PO Box 624 and 501 West Michigan, Milwaukee, WI
Fox Valley Medicine - Site 199 940 FVMCH IL 630-482-9758 Provider Services
Located in Batavia, Illinois
Fox-Everett - Litton Ingalls Shipbuilding 009 64067 AL, LA, MS 601-718-5291 Missy Senn
Located in Jackson, MS - Only claims for Litton Ingalls Shipbuilding employees
Fox-Everett, Inc. 009 64069 ALL 601-364-5291 Missy Senn
Payer Name EMC Type
Payer ID States Phone Contact
Located in Jackson & Gulfport Mississippi
Frankenmuth 866 WC711 MI
WORK-COMP
Freedom Life Insurance Company 800 62324 TX 800-725-1407 Customer Service
Located in Fort Worth, Texas
Freeman IPA 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
G. E. Group Life Assurance Company 009 67814 ALL 800-451-2513 Customer Service
formerly Phoenix American Life (PAL), Phoenix Home Life and Phoenix Mutual
G. E. Group Life Assurance Company 009 67814 ALL 800-451-2513 Customer Service
Gallagher Bassett Services, Inc. 866 WC661 ALL
WORK-COMP
Gallagher Benefit Administrators 940 37283 ALL 800-345-0109 Customer Service
Claims offices in: Lisle, IL; San Antonio, TX; Jackson, MS & San Francisco, CA
Gateway Health Plan 009 25169 PA 800-392-1145 Provider Services
Claims : P.O. Box 11-718, Albany, NY 12211-0718 - Provider ID required
GE Group Administrators 009 75238 ALL 800-397-6241 Customer Service
Located in Arlington, Texas
GE Group Administrators (Agawam, MA) 009 06143 ALL 413-789-
7000ext.275 Joan Keefe
Located in Agawam, Massachusetts
Geisinger Health Plan 009 75273 PA 570-271-7135 Provider Network
Located in Danville, Pennsylvania - Enrollment Required
General American 057 80705 ALL 314-525-5226 Provider Relations
General American Life Insurance Company 372 63665 ALL 314-252-5226 Provider Relations
Genesis Healthcare (EMG) 109 IP087 CA
Enrollment required contact Gateway EDI
GEO 866 WC791 CA, CO, LA, MI, MS, NC, NM, NY, OK, PA, VA
WORK COMP
GHI - New York (Group Health Inc.) 666 13551 NY 212-615-4362 Providers Service
Claims address: PO Box 2832 & 2833, New York, New York 10116-2832
GHI - New York(Group Health Inc.) 372 13551 ALL
GHI HMO Select 666 25531 NY 845-340-2338 EMC Department
Payer Name EMC Type
Payer ID States Phone Contact
Claims address: PO Box 4141, Kingston, NY 12402
GHP 340 00340 IL, MO
Unique Provider# required - Contact Gateway EDI Customer Service Set-up
GIC Indemnity Plan 314 80314 MA 978-474-5139 Terry Haneffant
Claims mailing address: GIC Indemnity Plan, PO Box 9016, Andover, MA 01810-0916
Gilsbar, Inc. 372 07205 ALL 888-215-9841 Customer Service
Located in Covington, Louisiana
Gilsbar, Inc. 009 07205 ALL 888-215-9841 Provider Services
Located in Covington, LA
Glassworkers Health & Welfare Fund 372 91136 ALL
Group # F29
Glassworkers Health & Welfare Fund 009 91136 AK, WA 206-441-7574 Customer Service
Group # F29
Golden Rule Insurance Company 009 37602 ALL 317-297-4187 Client Services
See notes for claims addresses
Golden Triangle Physician Associates 940 GTPA1 TX 713-843-6780 Provider Services
Select Care of Texas - See Notes - Unique Provider ID required
Government Employees Hospital Assn. (GEHA) 109 44054 ALL 800-821-6136 Customer Services
Located in Independence, Missouri
Government Employees Hospital Association 372 44054 ALL 800-821-6136 Customer Service
Located in Independence, Missouri
Great Lakes Health Plan 009 95467 MI 248-331-4348 Barbara VanRaaphorst
Located Southfield, Michigan
Great West National Accounts 057 80705 ALL 888-836-4877 Customer Service
Claims mailing address: 1000 Great-West Drive, Kennett, MO
Great-West Life & Annuity Ins.Co. 372 80705 ALL
Great-West Life Assurance Co. of America 057 80705 ALL 800-537-2033 Customer Service
Greater L.A. Health 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
Greater San Gabriel 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
Group Administrators, LTD 372 36338 ALL 847-519-1880 ext 125 Ron Lawlor
Located in Schaumburg, IL
Group Administrators, LTD 009 36338 ALL 847-519-1880 ext Ron Lawlor
Payer Name EMC Type
Payer ID States Phone Contact
225
Located in Schaumburg, IL
Group and Pension Administrators, Inc. 009 48143 ALL 800-827-7223 Customer Service
Corporate office, Richardson, Texas
Group Benefit Administrators 126 72153 ALL 440-720-0700 ext205 Rebecca Karlinsky
Only claims with address: 260 West Main St., Suite 215, Hendersonville, TN 37075
Group Health Cooperative (WA) 940 91051 WA 800-919-4325 Provider Services
Claims with zip code of 98xxx should be sent to this payer.
Group Health Cooperative - East 940 91121 ID, WA 206-901-6347 Provider Services
Claims with zip code of 99xxx should be sent to this payer.
Group Health Cooperative - Madison, WI 009 39167 WI 608-251-4156
X4454 Customer Service
Located in Madison, Wisconsin
Group Health Insurance - DE 611 61101 ALL
Group Health Plan 340 00340 IL, MO 800-755-5242 Customer Service
Unique Provider# Required Claims address - PO Box 7374, London, KY
Group Insurance Service Center, Inc. 940 37276 ALL 800-242-4472 ext
136 Barb Tharp
Located in Pembroke, Massachusetts
Guardian Life Insurance Co. of America 372 64246 ALL 414-749-6303 Vance Kramer
Guardian Life Insurance Company 666 64246 ALL 414-749-6303 Vance Kramer
Home office located in New York, New York
Gundersen Lutheran Health Plan, Inc. 940 39180 WI 608-775-8026 Shari Oelke
Before submitting electronic all providers must contact Shari Oelke.
Gundersen Lutheran Health Plan, Inc. 009 39180 WI 608-775-8026 Shari Oelke
Before submitting electronic all providers must contact Shari Oelke.
H.E.R.E.I.U. Welfare Pension Plan Funds 940 37114 ALL 630-428-5397 Gary Trebolo
Located in Aurora, Illinois
Harmony Health Plan of Illinois 109 36406 IL 312-516-4900 Customer Service
Claims address: PO Box 06559, Chicago, IL 60606-0559
Harmony Health Plan of Indiana 009 36405 IN 800-504-2766 Provider Services
Indiana Hoosier Healthwise
Harrington Benefit Services 109 95266 ALL
Payer Name EMC Type
Payer ID States Phone Contact
Harrington Benefits, Inc. (Oklahoma) 109 59142 ALL 614-470-7383 &7427
Gayle Hyslop & Lisa Phillips
Located in Oklahoma City, Oklahoma
Hartford 866 WC121 ALL
WORK COMP
Harvard Pilgrim Health Plan 427 04271 ME, MA, NH, NY, VT 888-888-4742 Customer Service
Enrollment required contact Gateway EDI, Unique Provider ID required.
HCH Administration 940 37111 ALL 630-718-8128 Pete Foskaris
Located in Peoria, IL
HCHA-Albq, NM Self Funded 940 37329 NM 309-282-1203 Paul Wann
Located in Peoria, Illinois
HDM Benefit Solutions 940 HDMCO ALL 800-667-4824 Customer Service
Located in Omaha, Nebraska
Health Administration Service, Inc. 940 34185 ALL
Located in Richardson, Texas
Health Alliance Medical Plans, Inc. 070 77950 IL, IN 217-278-8566 Provider Service
Located in Urbana, IL - Rendering Provider Network ID Req. - Enrollment Req.
Health Alliance Plan of Michigan 109 38224 MI, OH 248-443-8516 EDI Specialist
Unique Provider ID # required
Health America of Ohio 666 25126 OH, PA, WV 800-470-4272 Provider Relations
Claims address - PO Box 8103, London, Kentucky
Health America of Pennsylvania - EPA 666 25126 OH, PA, WV 800-470-4272 Customer Service
Claims address - PO Box 7089, London, Kentucky
Health America of Pennsylvania - WPA 666 25126 OH, PA, WV 800-470-4272 Customer Service
Claims address - PO Box 7088, London, Kentucky - Unique Provider ID number req
Health Americaof Pennsylvania Advantra 666 25126 OH, PA, WV 800-470-4272 Provider Services
Claims address - PO Box 7087, London, Kentucky
Health Care Savings 009 56142 NC 800-833-2464ext2006 Provider Services
Only Claims with address: 4530 Park Road, Suite 110, Charlotte, NC
Health Choice, Inc. 940 22345 NJ 973-940-0120 Anthony Delbagno
Located in Newton, New Jersey -
Health Claims Service (Boise, ID) 126 82018 ALL 440-720-0700 x 205 Rebecca Karlinsky
Claims address: P. O. Box 1067, Boise, ID 83701
Health Comp 109 HCOMP ALL 800-442-7247 Customer Service
Main office located in Fresno, California
Health Design Plus 126 34158 ALL 440-720-0700 ext Kathy Myers
Payer Name EMC Type
Payer ID States Phone Contact
222
Located in Findlay, Ohio
Health First (Tyler, Texas) 940 75234 ALL 972-980-0900 ext 218 Kip Altman
Located in Tyler, Texas
Health First Health Plans 800 95019 FL 800-716-7737 Customer Service
Claims address: PO Box 565001 Rockledge, Florida 32956-5001
Health Future, LLC 372 30946 ALL 541-618-7253 Kyle Wichelmann
Located in Medford, Oregon
Health Management Administrators - HMA 940 HMA01 ALL 800-869-7093 Customer Service
Located in Bellevue, Washington
Health Management Associates 009 86066 ALL 239-598-3104 Customer Service
Located in Naples, Florida Unique Provider ID number required
Health Net California - Commercial Claims 109 95567 ALL 818-676-7864 Misty Cheluis
Claims address: P.O. Box 14702 Lexington, KY 40512
Health Net California - Seniority Plus Claims 109 95567 ALL 818-676-7864 Misty Chelius
Claims address: P.O. Box 14703 Lexington, KY 40512
Health Net of Arizona 940 38309 AZ 866-334-4638 EDI Department
Claims address: P.O. Box 14225 Lexington, KY- Rendering Provider ID required
Health Net of the Northeast, Inc. 109 06108 CT, NJ, NY, PA 203-385-5658 Provider Services
Payer requires Unique Provider ID - claims address: PO Box 14700, Lexington, KY
Health Net Oregon 109 95567 ALL
Claims address: PO Box 14130, Lexington, KY 40512
Health Net Plus (TN) - Wisconsin Only 109 AMS01 TN
Only claims with the address of Wisconsin can be submitted electronically.
Health Net SmartChoice 109 13402 NY 877-870-7065 Provider Service
Located in New York, New York
Health Network America 009 20199 ALL 732-676-2637 Ken Kline
Located in Eatontown, New Jersey
Health New England 800 04286 CT, MA 413-787-4000ext 5000 Network Development
Located in Springfield, Massachusetts Rendering Network ID required.
Health Partners (Tennessee) 009 62157 TN 800-825-8929 Bill Jones
Only the TPA Product
Health Partners (Tennessee) Dental 372 62157 TN 800-825-8929 Bill Jones
Located in Jackson, Tennessee
Health Partners of Minnesota 070 M3411 MN 952-883-6000 Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
Enrollment required.
Health Partners of Philadelphia 009 80142 PA 215-991-4350 Provider Services
Located in Philadelphia, PA - Rendering Provider Network ID required
Health Plan Management, Inc. 109 37221 IL 847-234-8870 ext 600 Customer Service
Located in Lake Bluff, Illinois
Health Plan of Upper Ohio Valley 162 00162 OH, WV 740-695-7906 Provider Services
Located in Saint Clairsville, OH - Contact Gateway EDI before sending
Health Plan Service Harrington (Columbus, OH) 109 95266 ALL
Columbus, OH
Health Plan Services (Oklahoma) 372 59142 ALL 614-470-7383 or 7427
Gayle Hyslop or Lisa Phillips
Located in Oklahoma City, OK
Health Plan Services (Oklahoma) 109 59142 ALL 614-470-7383 & 7427
Gayle Hyslop & Lisa Phillips
Located in Oklahoma City, OK
Health Plan Services (Oklahoma) 372 59142 ALL 614-470-7383 Gayle Hyslop
Located in Oklahoma City, OK
Health Plan Services (Tampa Only) 109 59140 ALL 800-282-4690 x4244 Diane Lutz
Health Plans, Inc. 109 44273 ALL
Health Plus of Louisiana 800 95009 LA 318-212-4765 Customer Service
Located in Shreveport, Louisiana
Health Plus, PHSP, Inc. 009 11324 NY 718-491-8355 Edward Yuabov
Located in Brooklyn, New York
Health Risk Management 009 41170 ALL 616-383-2300 Mary Beth Walsh
Corporate Headquarters. Minneapolis, Minnesota
Health Risk Management (HRM) 372 41170 ALL 616-383-2300 Mary Beth Walsh
Health Service Management 109 HSM01 IL, IN, IA, KY, MN, WI 651-287-4726 John Bould
Located in Woodberry, Minnesota
Health Services Preferred (HSP) by Emerald Health 126 34167 ALL
Health Value Mgmt. --DE (Humana) 611 61101 ALL
Healthcare Preferred 666 25147 MO 800-843-1787 Customer Service
See Notes
Payer Name EMC Type
Payer ID States Phone Contact
Healthcare Preferred (IA) - Wisconsin Only/TESTING 109 AMS01 IA
Only claims with the address of Wisconsin can be submitted electronically.
Healthcare Solutions Group 009 73147 ALL 806-473-2427 Customer Service
Located in Muskogee, Oklahoma
Healthcare USA - Medicaid MC+ Carrier 550 00550 MO 314-444-7249 Jodie
Unique Provider ID Required Claims address - PO Box 7629, London, KY
Healthcare, Inc. HMO/POS, PPO, MRN EPO 666 25127 GA 800-395-2545 Customer Service
Claims mailing address: PO Box 7128, London, KY 40742
Healthchoice - State of Oklahoma 109 59142 OK 405-499-4920 Customer Service
Located in Oklahoma City, Oklahoma
HealthChoice of Memphis 009 62168 AR, MS, TN
Healthease 009 59608 ALL 800-960-2530ext 1447 Tamara L. Allen
Located in Tampa, Florida / Requires a 5-9 character Rendering Provider ID numbe
Healthfirst Inc.-New York 940 80141 NY 212-801-6078 Manny Vito
Located in New York, NY - Rendering Provider ID Number Required
HealthGuard of Lancaster 009 23226 PA 800-581-4600 Provider Services
Located in Lancaster, Pennsylvania
HealthHelp Networks, Inc. (HHNI) 009 59087 ALL 281-447-7000 Customer Service
Located in Houston, Texas
Healthlink HMO 013 00013 AR, IL, MO 800-624-2356 Customer Service
Unique Provider ID# Required (Contact Gateway EDI Customer Service for Set-up)
Healthlink PPO 014 00014 AR, IA, IL, IN, KY, MO, WV 800-624-2356 Customer Service
Unique Provider ID# Required (Contact Gateway EDI Customer Service for Set-up)
Healthnow New York, Inc. 502 55204 NY
Enrollment required contact Gateway EDI, Inc.
Healthplex 372 11271 ALL
Healthscope Benefits, Inc. 372 71063 ALL 501-376-9015 X310 Linda Shumate
Healthscope Benefits, Inc. 940 71063 ALL 501-376-9015 x310 Linda Shumate
Claims address: PO Box 8002 and 3823, Little Rock, AR
HealthSmart Preferred Care, Inc. 940 75250 ALL 210-684-2983 ext 18 Sandy Davis
Located in Lubbock, Texas
Payer Name EMC Type
Payer ID States Phone Contact
Healthsource Provident Administrators 372 68195 ALL 423-755-1416 Annie Rowland
Healthsource Provident Insurance 372 68195 ALL 423-755-1416 Annie Rowland
Healthspring HMO & Healthspring Medicare + Choice 109 25193 TN 615-291-7035 Provider Relations
Located in Nashville, Tennessee. Not for PPO claims. Enrollment required.
HealthSpring of Alabama 009 63092 AL 800-743-7141 Provider Call Center
Enrollment and Rendering Provider ID number required.
Healthstar, Inc. 009 36332 ALL 708-673-3113 x2255 Courtney Turlington
Located in Chicago, Illinois
Helix Family Choice 109 00243 DC, MD 410- 574-3000 Provider Services
Located in Columbia, Maryland
Heritage Consultants 009 59230 FL 863-967-4139 Customer Service
Located in Auburndale, Florida
Heritage National Health Plan of TN, Inc. (HMO) 666 95378 TN 800-527-4390 Customer Service
TennCare MCO Plan - Certification required
Heritage New York Medical Group 009 11328 NY 516-746-2200 X 222 Leo Irarangal
Located in Garden City, New York
Heritage Physician Network 940 HPN11 TX 713-843-6780 Provider Services
Select Care of Texas - See notes - Unique Provider ID required
HFN, Inc. 109 36335 ALL 630-954-1232 Dave Parsons
Located in Oak Brook, Illinois
Hillcrest Benefit Administrators 940 59347 FL 800-743-9264 Customer Service
Located in Mt Dora, Florida
Hills Physicians Medical Group 109 10046 CA 925-362-6259 Tina Loftus
Unique Provider ID Number Required.
HIP - Health Insurance Plan of Greater New York 666 55247 NY 800-447-8275 Provider Relations
Individual Provider Enrollment required
HMO Blue - Blue Cross and Blue Shield of TN 890 00891 TN 423-755-5717 Customer Service
Health Maintenance Organization
HMO Blue of Texas / Blue Cross & Blue Shield of TX 021 00021 TX 412-766-5480 Customer Service
Same requirement for Blue Cross/Blue Shield of Texas, Plan route code is ZGA
HMO Blue Texas 021 00021 TX 800-637-0171 Customer Service
formerly NYLCARE - Effective 8/16/01 claims sent to BCBS TX
Payer Name EMC Type
Payer ID States Phone Contact
HMO Colorado 072 00073 CO 800-544-3879 Provider Services
Payer requires enrollment forms - Contact Gateway EDI
HMPK, Inc. 611 61101 ALL 800-367-7587 Customer Support
Hollywood Presbyterian 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA I
HomeTown Health Network 126 34150 OH 800-426-9013 Customer Service
Located in Cleveland, Ohio
Horizon Mercy Health Plan of New Jersey 009 22326 NJ 877-234-4273 Provider Services
Payer Requires Rendering Provider ID# -
Hotel Employees & Restaurant Employees Health 009 91136 AK, WA 206-441-7574 Customer Service
Group # F19
HPlan, Inc. 611 61101 ALL 800-367-7587 Customer Support
HPS Paradigm, Inc. 126 58227 ALL SEE NOTES SEE NOTES
SEE NOTES FOR ADDRESSES AND PHONE NUMBERS
HRM Claim Management 372 41170 ALL
Humana (Encounters) 611 61102 ALL
ENCOUNTERS ONLY
Humana - Employers Health 611 61101 ALL 800-558-4444 X 7448 Bonnie or Jody
Green Bay and Madison Wisconsin only
Humana Care Plan 611 61101 ALL 800-367-7587 Customer Support
Humana Employers Health of Georgia, Inc. 611 61101 ALL Members ID Card Customer Service
Claims mailing address: PO Box 14610, Lexington, KY 40512-4610
Humana Group Health Plan 611 61101 ALL 800-367-7587 Customer Support
Formerly GHA of Washington DC
Humana Health Chicago Inc. 611 61101 ALL 800-367-7587 Customer Support
Humana Health Chicago Ins. Co. 611 61101 ALL 800-367-7587 Customer Support
Humana Health Plan 611 61101 ALL 800-448-6262 Customer Support
Humana Insurance Agency 611 61101 ALL 800-367-7587 Customer Support
Payer Name EMC Type
Payer ID States Phone Contact
Humana Insurance Company 611 61101 ALL 800-367-7587 Customer Support
Humana Medical Plan-CA 611 61101 ALL 800-367-7587 Customer Support
Humana Medical Plan-KY 611 61101 ALL 800-367-7587 Customer Support
Humana Wisconsin Health Org. 611 61101 ALL 800-367-7587 Customer Support
formerly CareNetwork/Wisconsin Hlth. Org.
HUMANA/Employers Health 611 61101 ALL 800-558-4444 X 7448
Bonnie or Jody - MIS Dept.
Hunt Insurance Group/HRH TPA Services 109 37260 ALL 850-385-3636
ext.227 Cindy Clawson
Located in Tallahassee, Florida
Huntington Park Medical Group 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
Huntington Park Mission 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
I. E. Shaffer 372 22175 NJ, NY, PA 800-792-3666 Customer Service
Claims address: P. O. Box 1028, West Trenton, New Jersey,
I. E. Shaffer 126 22175 ALL 800-792-3666 Customer Service
Claims address: 830 Bear Tavern Road, West Trenton, NJ 08268-1020
IBA Self Funded Group 009 38234 MI 800-722-3644 Customer Service
Located in Kalamazoo, Michigan
IBC Personal Choice /Highmark 862 00862 PA 800-992-0246 Customer Service
Claims address: PO Box 890016, Camp Hill, PA 17089-0016
IBI 372 41124 ALL
IBI (Iowa Benefits, Inc.) 800 41124 ALL 800-765-4224 Customer Service
Claims with City & State Hopkins, MN & P. O. Box 27267, Minneapolis, MN 5542
IDPA (Illinois Department of Public Aid) 015 00015 IL 217-782-0538 Provider Relations
Payer requires agreement for participation - contact Gateway EDI for forms
Illinois Department of Public Aid (IDPA) 015 00015 IL 217-782-0538 Provider Relations
Payer requires agreement for participation - contact Gateway EDI for forms
Illinois Health Solutions 009 86069 IL 563-359-9034 Provider Relations
Located in Bettendorf, Iowa Unique Provider ID number required.
IMCARE 109 41600 MN 800-657-3613 Customer Service - EVS
Located in Grand Rapids, Minnesota
Payer Name EMC Type
Payer ID States Phone Contact
Indecs Corporation 109 40585 NJ 201-460-3214 June Simone
Located in Lyndhurst, New Jersey
Indiana Health Network 940 35204 IL, IN, KE, MI, OH 888-446-6670 Customer Service
Located in Indianapolis, Indiana
Indiana Prohealth Network 373 35161 ALL 317-588-7565 ProHealth Customer Service
Located in Indianapolis, IN
Inercultural Physicians Network (IPN) 021 00021 TX 972-766-7203 Helen Jarrett
Claims are sent to Blue Cross & Blue Shield of Texas
InforMed, LLC/Self Funding Administrators 126 52196 ALL 410-349-9750 Carla Denhardt
Located in Annapolis, Maryland
Insurance Administrators of America, Inc. 940 37279 ALL 888-599-1515 Customer Service
Located in Cherry Hill, New Jersey
Insurance Claims Service, Inc. 126 63082 ALL 440-720-0700 ext 222 Kathy Myers
Located in Birmingham, Alabama
Insurance Design Administrators 372 13315 ALL 201-337-0007 ext 207 Wayne Shoupe
Located in Oakland, New Jersey
Insurance Design Administrators 009 13315 ALL 201-337-0555 Customer Service
Located In Oakland, NJ
Insurance Management Services 372 88006 ALL 440-720-0700 ext 215 Tiffany Brown
Located in Elko, Nevada
Insurance Management Services 372 88006 ALL 440-720-0700ext215 Tiffany Brown
Located in Elko, Nevada
Insurance Management Services 126 88006 ALL 440-720-0700 x215 Tiffany Brown - EDI
Only claims with address: PO Box 71, Elko, NV 89803
Insurance Management Services of Texas 940 IMSMS TX 806-373-5944 EDI operations
Claims address: PO Box 15688, Amarillo, Texas
Insurers Administrative Corporation 940 IAC01 ALL 800-843-3106 Customer Service
Located in Phoenix, Arizona
Integra Administrative Group 126 51020 ALL 440-720-0700 ext 215 Tiffany Brown
Only claims with the address: 110 South Shipley Street, Seaford, DE 19973
Integra Administrative Group 372 51020 ALL 440-720-0700 ext 215 Tiffany Brown
Payer Name EMC Type
Payer ID States Phone Contact
Only claims with address: 110 S. Shipley Street, Seaford, Delaware 19973
Integra Group 009 31127 OH 513-459-1010 x 1177 Tom Brackmann
Located in Cincinnati, Ohio
Integrity Benefit Network, Inc. 126 58200 ALL 440-720-0700 ext 215 Tiffany Brown
Located in Marietta, Georgia
InterCare Health Plans, Inc. 009 37227 CO 303-770-5710 Customer Service
ENTERED TWICE
Interface EAP (IEAP) 940 60280 ALL 713-781-3364 Customer Service
Located in Houston, Texas
Intergroup 109 23287 NJ, PA, WV 800-537-9389 Customer Service
Located in Malven, PA - Group Number is required
International Union of Operating Engineers, Loc 009 37241 MA 781-861-1600 Customer Service
No longer accepts electronic
International Union of Operators Engineers - NY 940 37269 NY 630-428-5126 Ray Zroback
Local 15, 15A, 15C & 15D. A.F.L.-C.I.O. Located in New York, New York
Interplan Health Group-Accountable Health Plan 009 AHP01 ALL 800-613-1124 Customer Service
Only claims with PO Box 90613, Arlington, TX 76006 - See note for more info.
Iowa Benefits 372 41124 ALL
Iowa Benefits, Inc. 800 41124 ALL 800-765-4224 Customer Serice
Claims with City & State Hopkins, MN & P. O. Box 27267, Minneapolis, MN 5542
Iowa Health Solutions 009 86068 IA 800-928-8004 Provider Relations
Located in Bettendorf. Iowas Unique Provider ID number required.
J P Farley 126 34136 ALL 800-634-0173 Customer Service
Claims address: PO Box 458022, Cleveland, Ohio
J. F. Molloy & Associates, Inc. 109 61271 ALL 515-247-8051 Carla Houselog
Corporate office Des Moines, Iowa
J. F. Molloy and Associates 372 61271 ALL 515-247-8051 Carla Houselog
Jardine Group Services 372 14168 ALL
JI Specialties 940 TH033 TX
Enrollment required contact Gateway EDI, Inc.
John Alden Life Insurance Company 666 41099 ALL 800-328-4316 Customer Support
John Deere Health 372 95378 ALL 309-765-0539 Joan Bennett
Payer Name EMC Type
Payer ID States Phone Contact
John Deere Healthcare/Heritage 666 95378 ALL 800-527-4390 Customer Service
Certification required
John Hancock Health Security Plan 372 65099 ALL 617-572-7222 Claim Payment Check
Now UNICARE Special Accounts
John Hancock Health Security Plan 314 80314 ALL 877-334-4286 Customer Support
Now UNICARE Special Accounts
John Hancock Mutual Life Ins Co 314 80314 ALL 877-334-4286 Customer Support
Now UNICARE Special Accounts
John Hancock Mutual Life Insurance Co. 372 65099 ALL 617-572-7222 Claim Payment Check
Now UNICARE Special Accounts
John Hancock Preferred Health Plan 372 65099 ALL 617-572-7222 Claim Payment Check
Now UNICARE Special Accounts
John Hancock Preferred Health Plan 314 80314 ALL 877-334-4286 Customer Support
Now UNICARE Special Accounts
John Muir 109 JMH01 CA 925-952-2888 Customer Service
Enrollment required contact Gateway EDI.
John P. Pearl & Assoc., LTD 009 37215 ALL 800-447-4982 Customer Service
Located in Peoria Heights, IL
JSL Administrators 940 37272 ALL 888-295-4864 Georgia Customer Service
Located in Newnan, Georgia & Fayetteville, North Carolina - See notes
Kaiser Foundation Health Plan Mid-Atlantic Sta 009 52095 DC, MD, VA 800-777-7902 Customer Service
Located In Rockville, Maryland
Kaiser Foundation Health Plan (Northern CA) 940 94135 CA 866-285-0362 Cheryl Robinson
Located in Oakland, California - Payer requires a Unique ID number
Kaiser Foundation Health Plan of Southern CA 009 94134 CA 866-285-0361 Tina Cheung
Located in Los Angeles CA - Provider ID Number Required
Kaiser NW Region 109 KS007 OR, WA 503-813-3354 Deborah Hillan
Claims address: 500 NE Multnomah Street, Suite 100 Portland, OR 97232
Kaiser of Georgia 009 21313 GA 404-261-2825 Claims Services
Providers will need to be set-up.
Kanawha Insurance Company 009 57038 ALL 800-635-4242 Provider Services
Located Lancaster, SC
Kelsey Seybold 940 KELSE TX 410-363-3816 Technical contact
Located in Houston, Texas
Kempton Company 372 73100 ALL 405-521-1711 Dwight Berry
Payer Name EMC Type
Payer ID States Phone Contact
Kempton Company 009 73100 ALL 405-521-1711 Dwight Berry
Kempton Group Administrators 372 73100 ALL 405-521-1711 Dwight Berry
Kentucky Health Select 372 63076 ALL 888-895-0460 Provider Services
Located in Lexington, KY - Provider ID - Must contain provider's Medicaid Number
Kentucky Kare 611 61101 ALL 800-367-7587 Customer Support
Key Benefit Administrators, Inc. 940 37217 ALL 317-284-7100 Customer Service
Only claims with PO Box 55210, Indianapolis, IN 46205
Keystone Health Plan Central 239 23239 PA 800-874-8433 Provider Services
Claims add: P.O. Box 779521, Harrisburg, PA -Unique Provider ID req
Keystone Health Plan East 950 95056 DE, NJ, PA 800-227-3119 Provider Services
Claim add: PO Box 898815, CampHill, PA&PO Box 41574, Philadelphia, PA SEE NOTES
Keystone Mercy 009 23284 PA 877-234-4271 Provider Services
Claims add: PO Box 7115, London, KY - Enrollment & Provider ID required.
Kindred Health Care 611 61101 ALL 800-448-6262 Customer Service
Located in Lexington, Kentucky
King Count Medical-Grays Harbor Medical Bureau 372 93207 ALL 800-373-1477 Customer Service -
NDEX
Now known as Aberdeen and Raymond - Requires Unique Provider ID
King County Medical Blue Shield 372 93200 ALL 800-373-1477 Customer Service
Now known as Regance Washington Health - Requires Unique Provider ID
King County Medical Blue Shield-FEP 372 93200 ALL 800-373-1477 Customer Service
Now known as Regance Washington Health-FEP - Requires Unique Provider ID
King County Medical Thurston County Blue Shield 372 93211 ALL
King County Medical-Cowlitz Blue Shield - Now 372 93220 ALL 800-373-1477 Customer Service
Now known as Longview - Requires Unique Provider ID
King County Medical-Lewis County Blue Shield 372 93210 ALL 800-373-1477 Customer Service
Now known as Chehallis - Requires Unique Provider ID
King County Medical-Snohomish County Physicians 372 93219 ALL 800-373-1477 Customer Service
Now known as Everett - Requires Unique Provider ID
King County Medical-Yakima County Blue Shield 372 93214 ALL 800-373-1477 Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
Now known as Yakama - Requires Unique Provider ID
Klais & Company 940 34145 ALL 330-867-8443 x 214 Craig Sonntag
Located in Akron, Ohio
KPS Health Plan 940 KPS01 ID, MT, WA 800-552-7114 ext6502 Provider Services
Corporate office located in Bremerton, Washington
Lakeside Health Services 109 95416 ALL
Located in Glendale, California
Landmark Healthcare, Inc. 009 LNDMK ALL 800-638-4557 Customer Service
Located in Sacramento, California
Lebanon Mutual Insurance Company 866 WC451 PA
WORK COMP
Leggett and PLatt 009 75279 ALL 877-311-2150 Customer Service
Located in Carthage, Missouri
Liberty Mutual - MedRisk 866 WC461 CA, CT, DC, DE, FL, GA, IL, IN, MD, MO, NJ, NY, PA, SC, TN, VA
WORK COMP - Specific CPT Codes only - Codes are specific to PT.
Liberty Union Life Assurance Company 940 37281 ALL 800-482-0945 Customer Service
Located in Madison Heights, Michigan
Life Insurance Company of Boston & New York 372 78140 ALL
Life Investors Company of America 940 LIIC2 ALL 319-398-8511 Customer Service
Located in Cedar Rapids, Iowa
Lifewise Oregon 093 93093 OR 800-435-2715 EDI Department
Located in Bend, Oregon
Lincoln National 611 61101 ALL 800-558-4444 X7448
Bonnie or Jody - MIS Dept.
EMPHESYS, Green Bay and Madison, WI only
Lincoln National (WI) 372 73288 ALL 800-558-4444 X7448
Bonnie or Jody - MIS Dept.
Lincoln National-Phoenix AZ 611 61101 ALL 800-367-7587 Customer Support
Humana
Local 135 Health Benefits (Indianapolis, IN) 940 35107 IN 440-720-0700 ext
222 Kathy Myers
Located in Indianapolis, Indiana
London Health Administrators 009 37226 RI 401-435-4700 Customer Service
Located in East Providence, Rhode Island
Longs Drugs 866 WC801 CA, CO, GA, HI, IL, NM, OR, UT
Payer Name EMC Type
Payer ID States Phone Contact
WORK COMP
Louisiana Medicaid - KidMed 706 00706 LA
Lovelace Health Plan 372 62310 ALL
Payer no longer accepts electronic claims
Lovelace Salud 940 90328
Lovelace Sandia Health Plans 940 90329
Lovelace Senior Options (LSO) 372 62310 ALL
Payer no longer accepts electronic claims effective 4/30/04
Lovelace Senior Plan (LSP) 372 62310 ALL
Payer no longer accepts electronic claims effective 4/30/04
Lowe's 866 WC741 ALL
WORK COMP
Lumenos 009 54195 ALL 877-582-1849 EDI Coordinator
Located in Alexandria, VA - send claims to Po Box 69309, Harrisburg, PA 17106
Machigonne Benefit Administrators 372 10317 ALL 207-822-5893 Jane Dorr
Located in Portland, Maine
Machinist District 9 Welfare/Mental Health Only 940 37292 MO 314-739-6442 Customer Service
Located in Bridgeton, Missouri - Mental Health claims only - SEE NOTES
MagnaCare 940 11303 ALL 516-282-8350 Naren Lulla
Located in Garden City, New York
Mail Handlers Benefit Plan 109 62413 ALL 800-707-5586 Customer Service
Claims address effective 8/17/05-PO Box 8402, London, KY-see notes for old add.
Mailhandlers Benefit Plan/CAC 372 62413 ALL 800-410-7778 Customer Service
Claims address - P.O. Box 24503 Tucson, AZ 85734
MAMSI Life and Health Insurance Co. (MLH) 009 52148 DE, DC, MD, NC, PA, VA, WV 800-257-6458 Provider Service
Rendering Provider ID required.
Managed Care Services 009 35162 ALL 219-373-9100 Customer Service
Located in Fort Wayne, Indiana
Managed Dental Care Network (MDCN) 372 84097 ALL
Managed Health Networks (MHN) 009 22771 ALL 888-898-6252 Practitioner Inquiry Line
Claims address:MHN/HMC P.O. Box 14621, Lexington, Kentucky 40512-4621
Managed Health Services Indiana/Maxicare 186 39186 IN 800-414-9475 Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
Located in Indiana - Enrollment Required - aka - Risk Base Claims
Managed Health Services Wisconsin 109 39187 WI 800-222-9831 Customer Service
Claims add: PO Box 3001, Farmington, MO - Enrollment-Provider ID required
Managed Physical Network (MPN) 940 41159 ALL 800-236-9921 Provider Services
Located in Kingston, New York
Manulife, W. J. Sutton Co. 372 98010 ALL 416-366-2223ext 318 Brenda Best
Claims address; 33 Yonge St., Suite 420, Toronto, Ontario, Canada M5E1S9
Marriott 372 68241 ALL 800-544-4778 Customer Support
Marriott International, Inc. 866 WC221 ALL
WORK COMP
Maryland Physicians Care 009 00247 MD 800-953-8854 Provider Services
Located in Baltimore, Maryland Unique Provider ID number required.
Mashantucket Pequot Tribal Nation 109 37121 CT 630-718-8230 Mandy Rak
Located in Mashantucket., CT
Mass Mutual 314 80314 ALL 877-334-4286 Customer Support
Mass Mutual 372 80314 ALL 413-744-7528 Support Team
Now UNICARE Major Accounts
Mass Mutual 314 80314 ALL 413-744-7528 Support Team
Now UNICARE Major Accounts
Mayo Management Services, Inc. 009 41154 MN 800-304-1928 Customer Service
Located in Rochester, Minnesota
Mcare 109 38264 MI 800-688-3290 Customer Service
Claims address: Po Box 130799, Ann Arbor, MI - Unique Rendering Prov ID req.
McLaren Health Plan 009 38338 MI 888-327-0671 Provider Services
Located in Flint, Michigan
MDNY Healthcare 009 11338 NY 800-707-MDNY *3 Customer Service
Located in Long Island, New York
Med-Pay 130 00130 MO, IL 800-777-9087 Provider Services
Group Number must match Med-Pay table
Medcost Benefit Services (MSB) 372 56205 ALL 336-774-4419 Denise Porterfield
MedCost, Inc. 009 56162 GA, NC, SC, TN.VA 800-433-9178 x4189 EDI Coordinator
Located in Winston-Salem, North Carolina
MedFocus 009 95321 ALL 800-398-8999 Customer Service
Located in Santa Monica, California
Payer Name EMC Type
Payer ID States Phone Contact
Medica 940 94265 MN
Medica requires a unique Provider ID.
Medicaid Missouri - Dental 003 00003 MO 573-751-2896 Customer Service
Enrollment Required contact Gateway EDI
Medicaid of Alabama/EDS Federal Corp. 582 00582 AL 334-215-4152 Customer Service
Contact Gateway EDI to send claims electronically.
Medicaid of Alaska/AK DHSS 821 00821 AK
Medicaid of Arizona/Need to Test 501 00501 AZ 602-417-4892 Customer Service
SEE NOTES REGARDING HEALTH PLANS THAT CAN NOT BE SENT ELECTRONIC.
Medicaid of Arkansas / EDS Federal Corp. 185 00185 AR 501-374-6608 Provider Service
Payer requires Enrollment - Contact Gateway EDI
Medicaid of California--Claim type 5 148 00148 CA 916-636-1100 Customer Service
Medical Claims Form 05 only
Medicaid of Colorado / ACS 016 77016 CO
Enrollment required contact Gateway EDI. Inc.
Medicaid of Connecticut 104 00104 CT 860- 424-5166 Provider Services
Enrollment required contact Gateway EDI.
Medicaid of Delaware / TESTING 571 00571 DE 302-454-7154 Provider Relations
testing
Medicaid of Dist of Columbia 033 00033 DC 866-752-9233 Provider Enrollment
Enrollment required contact Gateway EDI.
Medicaid of Florida / ACS 027 77027 FL (850) 386-7755
Enrollment Required - Contact Gateway EDI
Medicaid of Georgia /ACS 084 00084 GA 1.800.987.6715 Provider Services
Payer requires Enrollment Form - Contact Gateway EDI
Medicaid of Hawaii 996 99600 HI 888.333.5641 EDI Support
Enrollment required contact Gateway EDI, Inc.
Medicaid of Idaho 053 00053 ID 800-685-3757 EDI Support
Enrollment required contact Gateway EDI
Medicaid of Illinois / BCBS of Illinois 015 00015 IL 217-782-0538 Provider Relations
Payer requires agreement for participation - contact Gateway EDI for forms
Medicaid of Indiana / EDS 711 00711 IN (317) 488-5160 opt 3 EDS Solutions
Enrollment required
Medicaid of Iowa / Noridian 233 00233 IA
Enrollment Required contact Gateway EDI.
Medicaid of Kansas/EDS 034 00034 KS, MO 800-933-6593 Provider Relations
Payer Name EMC Type
Payer ID States Phone Contact
Payer requires Enrollment - Contact Gateway EDI
Medicaid of Kentucky/Dept. Medicaid Services 661 00661 KY 800-205-4696 Provider Services
Enrollment required contact Gateway EDI
Medicaid of Louisiana - Physician Claims 703 00703 LA 800-473-2783 Customer Service
Enrollment Required - Contact Gateway EDI
Medicaid of Louisiana Ambulance Claims 704 00704 LA 800-473-2783 Customer Service
Requires testing
Medicaid of Louisiana Rehab 705 00705 LA
Requires Testing
Medicaid of Maine/Health & Human Services 681 00681 ME (207) 287-4050 Valerie Howard
Enrollment required contact Gateway EDI for enrollment forms.
Medicaid of Maryland/State of MD Dept. Health 911 00911 MD 410-767-6860 Customer Service
Enrollment required contact Gateway EDI
Medicaid of Mass - Form 9 Medical Services. 643 00644 MA (617) 576-4030 Jim Turnbull
Enrollment Required Form 9 Medical Services
Medicaid of Mass- Form 5 Physician Claims 643 00643 MA 617-576-4436 Laurie Berry
Enrollment required - Form 5 Physician Claims
Medicaid of Michigan 171 17111 MI 800-803-7174 Customer Service
Enrollment required contact Gateway EDI.
Medicaid of Minnesota/DHS 955 00955 MN 800-366-5411 Customer Service
Enrollment required contact Gateway EDI
Medicaid of Mississippi / ACS 514 00514 MS 800-884-3222 Provider Services
Requires Enrollment contact Gateway EDI
Medicaid of Missouri / Verizon 003 00003 MO 573-751-2896 Customer Service
Enrollment Required contact Gateway EDI.
Medicaid of Missouri UB92 Claims 430 00430 MO
Enrollment Required - Contact Gateway EDI
Medicaid of Nebraska/ Health & Human Services 261 00261 NE 866-498-4357 EDI Help Desk
Enrollment Required contact Gateway ED
Medicaid of Nevada / First Health 266 00266 NV 877-638-3472 EDI
Enrollment required contact Gateway EDI.
Medicaid of New Hampshire 108 SKNH0 NH 603-271-4329 Customer Service
Enrollment Required contact Gateway EDI, Inc.
Medicaid of New Jersey 806 00806 NJ 800-776-6334 Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
Enrollment required contact Gateway EDI, Inc.
Medicaid of New Mexico 309 SKNM0 NM 505- 246-0710 Customer Service
Enrollment Required Contact Gateway EDI
Medicaid of New York / Computer Science Corp 309 SKNY0 NY 518-447-9830 Provider Services
Enrollment Required - Contact Gateway EDI
Medicaid of North Carolina/EDS Federal Corp 750 00750 NC 919-851-8888 Customer Support
Enrollment Required contact Gateway EDI
Medicaid of Ohio 164 00164 OH
Enrollment required contact Gateway EDI
Medicaid of Oklahoma 049 00049 OK 405-522-7300 Provider Services
Contact Gateway EDI to send claims
Medicaid of Oregon/OMAP 845 00845 OR 503-220-3924 Electronic Media
Enrollment required conact Gateway EDI.
Medicaid of Pennsylvania / EDS 861 00861 PA 717-975-6789 Carolyn Graves
Enrollment Required contact Gateway EDI
Medicaid of Rhode Island 871 00871 RI 401-784-3810 Customer Service
Enrollment required contact Gateway EDI, Inc.
Medicaid of South Carolina/SC Dept Health 029 00029 SC 803-898-2500 Provider Services
Enrollment required contact Gateway EDI.
Medicaid of South Dakota 999 80999 SD
TESTING
Medicaid of Texas 372 CKTX1 TX 800-969-3666 Gateway EDI
Requires enrollment contact Gateway EDI
Medicaid of Texas / TMHP 024 00024 TX 888-863-3638 Helpdesk
Enrollment required contact Gateway EDI.
Medicaid of Utah 309 SKUT0 UT 800-662-9651 Provider Enrollment
Enrollment required contact Gateway EDI.
Medicaid of Vermont 914 00914 VT
Enrollment required contact Gateway EDI.
Medicaid of Virginia/First Hlth Serv Corp 913 00913 VA 800-924-6741 EDI
Enrollment form can be faxed
Medicaid of Washington/ ACS 838 00838 WA 800-562-6188 Customer Service
Medicaid of West Virginia / Unisys 770 77026 WV 304-345-0101 Provider Services
Enrollment required contact Gateway EDI
Medicaid of Wisconsin / EDS 941 00941 WI
Payer Name EMC Type
Payer ID States Phone Contact
Enrollment required contact Gateway EDI.
Medicaid of Wyoming 462 00462 WY 800-672-4959 EDI Support
Enrollment required contact Gateway EDI
Medical Benefits Companies - MCO 009 74323 IL, IN, OH 800-686-8425 Customer Service
Located in Newark, OH
Medical Benefits Mutual 372 74323 ALL 740-522-7383 Wayne Millard
Located in Newark, Ohio
Medical Claims Service, Inc. 009 04258 CT, MA, ME, NH, RI, VT 304-273-5384 Brian Johnson
Located in Ravenwood, West Virginia
Medical Development International 940 52181 ALL 800-841-6288 Customer Service
Headquartered in Ponte Verda Beach, Florida
Medical Mutual of Ohio 666 29076 ALL 800-362-1279 Provider Inquiry
Located in Cleveland, Ohio - Providers require a Unique Provider ID -
Medical Plan of Kansas City-MO 611 61101 ALL 800-367-7587 Customer Service
Medicare of Alabama/Cahaba 581 00581 AL 800-292-8855 Customer Service
Enrollment Required - Contact Gateway EDI
Medicare of Alaska/Noridian 831 00831 AK 701-277-6781 Provider Services
Payer requires Enrollment Forms - Contact Gateway EDI
Medicare of Arizona / BCBS of ND/Noridian 832 00832 AZ 877-908-8431 Provider Relations
Payer requires Enrollment Forms - Contact Gateway EDI
Medicare of Arkansas / BCBS of Arkansas 180 00180 AR 866-345-0274 Customer Service
Payer requires Enrollment Forms - Contact Gateway EDI
Medicare of California / Northern - NHIC 147 00147 CA 877-591-7024 Provider Customer
Service
Enrollment Required - Contact Gateway EDI
Medicare of California /Southern/ NHIC 146 31146 CA 866-502-9054 opt
1 Customer Support
Enrollment required contact Gateway EDI for enrollment forms.
Medicare of Colorado / Noridian 071 00071 CO 877-908-8431 Option2 Provider Call Center
Enrollment Required
Medicare of Connecticut/FCSO 102 10230 CT 203-639-3160 Customer Service
Enrollment required contact Gateway EDI
Medicare of Delaware/Trailblazer 902 00902 DE (866) 749-4302 opt 1 Customer Service
Claims address: P. O. Box 650094, Dallas, TX - Enrollment required.
Medicare of Dist of Columbia Area/Trailblazers 903 00903 MD, DE, VA, DC (866) 749-4302
opt 1 Customer Support
Payer Name EMC Type
Payer ID States Phone Contact
Claims address: P.O. Box 650092, Dallas, TX - Enrollment required.
Medicare of Florida / First Coast Service Options 591 59100 FL (866) 454-9007 EDI
Enrollment required - Contact Gateway EDI
Medicare of Georgia / Cahaba GBA, Division BCBS AL 511 00511 GA 877-567-7271
press 0 Provider Services
Enrollment required
Medicare of Hawaii /Noridian 075 00075 HI 877-908-8431 Customer Service
Payer requires Enrollment Forms - Contact Gateway EDI
Medicare of Idaho - Cigna 051 05130 ID 866-520-4023 EDI Support
Enrollment required contact Gateway EDI.
Medicare of Illinois / WPS 007 00007 IL 877-908-9499 Provider IVR
Payer requires Enrollment Forms - Contact Gateway EDI
Medicare of Indiana / Adminastar Federal, INC 710 00710 IN 877-273-4334 EDI Support
AdminaStar - Requires Enrollment contact Gateway EDI
Medicare of Iowa /Noridian 230 00230 IA 877-908-8431 Option1 Provider Relations
Payer requires Enrollment Forms - Contact Gateway EDI Customer Service
Medicare of Kansas / BCBS of Kansas 030 00030 KS, MO 866-839-2442 Provider Relations
Payer requires Enrollment Forms - Contact Gateway EDI
Medicare of Kansas City / Admin Svc of Kansas 040 00040 MO 800-892-6048 Help Desk
Payer requires Enrollment Forms - Contact Gateway EDI
Medicare of Kentucky / Administar Federal, Inc. 906 90660 KY 877-273-4334 Provider Relations
Payer required enrollment - Contact Gateway EDI
Medicare of Louisiana / Arkansas BCBS 701 00528 LA 877-567-7204 Provider Services
Enrollment Required call Gateway EDI for enrollment forms
Medicare of Maine / NHIC 311 31142 ME 781-749-7745 Lori
Payer requires enrollment - Contact Gateway EDI for Forms
Medicare of Maryland/ Trailblazer - 901 00901 MD (866) 749-4302 opt 1 Customer Service
Claims address: PO Box 660595, Dallas, TX - Enrollment required.
Medicare of Massachusetts / NHIC 143 31143 MA 781-741-3213 Customer Service
Enrollment required contact Gateway EDI for enrollment forms.
Medicare of Michigan / Wisconsin Physician Service 953 00953 MI 877-567-7201 Provider IVR
Enrollment required contact Gateway EDI
Medicare of Minnesota /WPS 954 00954 MN 877-908-8470 Provider Services
Payer Name EMC Type
Payer ID States Phone Contact
Enrollment required contact Gateway EDI, Inc.
Medicare of Mississippi / Cahaba GBA 513 00513 MS 866-419-9454 Provider Services
Enrollment required
Medicare of Missouri / BCBS of Arkansas 523 00523 MO 866-539-5599 Provider Relations
Payer requires enrollment forms and testing contact Gateway EDI
Medicare of Nebraska/ Admin Svc of KS 150 00150 NE 866-839-2438 Provider Relations Rep
Enrollment Required Contact Gateway EDI
Medicare of Nevada/ BCBS ND/Noridian 061 00061 NV 701-277-6784 Provider Services
Enrollment required - Contact Gateway EDI
Medicare of New Hampshire/NHIC 144 31144 NH 866-539-5595 Provider Servies
Enrollment required.
Medicare of New Jersey / Empire Medicare 805 00805 NJ 866-488-0546 #1 Help Desk
Enrollment required-
Medicare of New Mexico/AR BCBS 521 00521 NM 877-567-9230 Provider Services
Enrollment required contact Gateway EDI.
Medicare of New York (Upstate) 801 00801 NY 877-567-7173 Provider Relations
Enrollment required contact Gateway EDI.
Medicare of New York - BCBS/Empire 803 00803 NY 877-869-6504 Provider Services
Enrollment required contact Gateway EDI.
Medicare of New York GHI 802 00802 NY 877-868-7965 Customer Service
Enrollment required contact Gateway EDI
Medicare of North Carolina / Cigna 535 05535 NC 866-238-9651 Customer Service
Enrollment required - Contact Gateway EDI
Medicare of North Dakota/Noridian 251 00251 ND 800-933-0614 Provider Call Center
Medicare of Ohio / Palmetto 163 16360 OH 877-567-9232 Provider Service
Enrollment required.
Medicare of Oklahoma / Arkansas BCBS 045 00045 OK Gateway EDI Customer
Service
Enrollment required - Contact Gateway EDI
Medicare of Oregon / BCBS ND/Noridian 835 00835 OR 866-843-7243 EDI Customer Serv
Enrollment and Provider Testing required.
Medicare of Pennsylvania / HGSA 865 00865 PA 800-537-8862 Provider Relations
Enrollment Required
Medicare of Rhode Island /AR BCBS 524 00524 RI 1-866-582-3247 Provider Services
Payer Name EMC Type
Payer ID States Phone Contact
Enrollment required contact Gatewayn EDI, Inc.
Medicare of South Carolina /Palmetto 880 00880 SC 866-238-9654 Customer Servive
Enrollment required contact Gateway EDI.
Medicare of South Dakota/Noridian 849 88849 NE, SD 877-908-8431 option2 Provider Services
Enrollment required contact Gateway EDI
Medicare of Tennessee / Cigna 160 00160 TN 866-502-9056 Provider Service
Enrollment Required
Medicare of Texas / Trailblazer 020 00020 TX 877-392-9865 Customer Service
Payer requires Enrollment Forms - Contact Gateway EDI
Medicare of Utah 151 00151 UT 866-539-5600 Provider Line
Enrollment required contact Gateway EDI
Medicare of Vermont/NHIC 145 31145 VT 866-539-5595 Provider Services
Enrollment required contract Gateway EDI Inc.
Medicare of Virginia/ Trailblazer 904 00904 VA (866) 749-4302 opt 1 Provider enrollment
Claims address: P. O. Box 650208, Dallas, TX - Enrollment Required.
Medicare of Washington-Noridian 836 00836 WA
Enrollment required--Call Gateway EDI
Medicare of West Virginia / Palmetto 944 00944 WV 877-567-9232 Provider Call Center
Provider number is all numeric
Medicare of Wisconsin / Wisconsin Physician Serv 951 00951 WI 877-567-7261
Enrollment Required - Contact Gateway EDI
Medicare of Wyoming/Noridian 461 00461 WY 866-849-7246 Customer Service
Enrollment required contact Gateway EDI.
Medicina Familiar Medical Group 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
MediGold 800 95655 OH 800-826-9346 Provider Relations
Located in Westerville, Ohio
Mediversal 940 37304 ALL 800-318-1963 Customer Service
Located in Las Vegas, Nevada
MedPlus of Tennessee 009 25175 PA 800-600-9007 Provider Relations
Located in Monroeville, Pennsylvania Unique Provider ID required
MedSolutions 009 62160 ALL 615-468-0600 Customer Service
Service Center is located in Franklin, Tennessee
MedSolutions 610 00610 IL, MO 800-467-6424 Claim Status
Call Gateway EDI before sending
Mega Life & Health Insurance - Student Insurance 666 74227 ALL 800-767-0700 Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
Claims: PO Box 890025, 809067, 809079, 809066, 809036, 809081, Dallas, TX
Mega Life and Health Insurance - Insurance Cent 009 59221 ALL See Notes Customer Service
Claims address: P. O Box 982009, North Richlands Hills, Texas 76182
Mega Life and Health Insurance Company - Dental 372 59226 ALL 817-255-3338 Teresa Howeth
Located in North Richland, Texas
Mercy Care Plan 940 86052 AZ 602-263-3000 Customer Service
Located in Phoenix, Arizona Rendering Network Provider ID number required.
Mercy Health Plan 360 00360 MO, IL, TX 314-214-8158 Provider Relations
Provider # required, patient info must match MHP eligibility file
Mercy Health Plan Medicare UB92's 365 00365 MO, IL, TX
Mercy Health Plan Premier Plus 360 00360 MO, IL, TX 314-214-8158 Provider Relations
MHP Medicare Product - Requires Unique Provider ID-Call Gateway EDI for set-up
Mercy Health Plan UB92's 365 00365 MO, IL, TX
Mercy Physicians Medical Group - San Diego 109 IP079 CA 909-371-8440 Customer Service
Located in San Diego, California
Meridian Health Care Management 009 77042 ALL 800-939-1100 X 271 David Cherryhomes
Located in Woodland Hill, California
Met Life Health Care Network - PPO 726 87726 ALL Members card Customer Service
MetLife 726 87726 ALL See Number on Card Customer Service
Metlife Vision claims city and state, Utica, New York must be submitted on paper
MetLife (Formerly Travelers) 372 87726 ALL 864-234-6164 Claim Status Check
Metlife Dental 372 65978 ALL 800-942-0854 Customer Service
Reinstated 6/1/02
Metrahealth 726 87726 ALL
MetraHealth Elect 726 87726 ALL Members card Customer Service
MetraHealth Healthcare Network HMO & PPO 726 87726 ALL Members card Customer Service
MetraHealth or Metropolitan Life Ins. Co. 726 87726 ALL Members card Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
MetraHealth or Travelers 726 87726 ALL Members card Customer Service
Metropolitan Health Plan 009 10850 MN 612-347-6180 David Sell
Located in Minneapolis, MN
Metropolitan Life Insurance Co. 726 87726 ALL Members card Customer Service
MetroWest Health Plan Preferred 940 MWP01 TX 817-665-5100 Customer Service
Located in Fort Worth, Texas
Michael Reese HMO Plan-IL 611 61101 ALL 800-367-7587 Customer Support
Humana
Michael Reese HMO Plan-IN 611 61101 ALL 800-367-7587 Customer Support
Humana
Mid America Health leased PPO Network 666 25147 ALL 800-632-4174 Provider Relations
SEE NOTES
Mid Atlantic Psychiatric Services, Inc. (MAPSI) 109 52149 ALL 800-342-6141 Customer Service
Provider ID number required
Mid-America Associates, Inc. 940 37281 ALL 800-482-0945 Customer Service
Located in Madision Heights, Michigan
Mid-Atlantic Health Plan 009 63079 ALL 800-999-3371 Provider EDI help Line
New Castle, Delaware
Mid-West National Life Insurance Company of TN 009 59224 ALL 800-733-8880 Customer Service
Claims mailing address: P. O. Box 982017, North Richland Hills, TX 73182-8017
Mid-west National Insurance Company 666 74227 ALL 800-767-0700 Customer Service
Claims address: PO Box 890025, 809067, 809079, 809066, 809036, 809081, Dallas TX
Midlands Benefits Administrators 009 47081 IA, NE 402-390-8364 Bob Hood
Formerly, Healthcare Partners of MidAmerica (HPMA)
Midlands Health Partners (Midlands Choice) 099 47080 ALL 402-390-8391 Customer Service
Located in Omaha, Nebraska - Provider ID nmber required.
Midwest Health Plans, Inc. 940 MHP77 MI 888-654-2200 Provider Services
Claims address: 5050 Schaefer Road, Dearborn, MI
Midwest Security Insurance Company 009 MIDSC IA, IL, IN, OH, MI, WI 800-542-6642 Customer Service
Corporate offices are located in Onalaska, Wisconsin
Mississippi Public Entity Employee Benefit Trust 940 37233 MS 601-605-8170 Sarah Holmes
Payer Name EMC Type
Payer ID States Phone Contact
Located in Jackson, Mississippi
Mississippi Select Health Care (Gulfport, MS) 126 64088 MS 440-720-0700 ext
215 Tiffany Brown
Located in Gulfport, Mississippi
Missoula County Medical Benefits Plan 940 37275 MT 406-523-4876 Risk and Benefit Office
Located in Missoula, Montana
Missouri Care 530 00530 MO 800-322-6027 Provider Services
Provider Number Required - Testing required on the first transmission of claims
Missouri Medicaid Rural Health 430 00430 MO
Contact Gateway EDI for Enrollment
MMS, LLC 009 62178 TN 615-377-0170 Customer Service
TPO - Payer is a repricer, they do not pay the claims -
Molina Health Care - California Providers 009 38333 CA 866-665-4622 HIPAA Provider Hotline
Only CA Providers, Located in Long Beach, CA - Rendering Provider # required.
Molina Health Care - Washington Providers 009 38336 WA 866-665-4622 HIPAA Provider Hotline
Only WA Providers, Located in Long Beach, CA. Rendering Provider ID required.
Molina Health Care Indiana 042 57324 IN 800-642-4509 Provider Services
Claims address: PO Box 22717 Long Beach, CA
Molina Healthcare of Michigan 009 38334 MI
Provider ID required
Molina Healthcare of New Mexico 940 CIMSA NM 888-825-9266 Provider Services
Located in Albuquerque, New Mexico
Montgomery Insurance (Liberty RAM) 866 WC691 CA, CT, DC, DE, FL, GA, IL, IN, MD,
MO, NJ, NY, PA, SC, TN, VA
WORK COMP
Monumental Life Insurance Company 940 MMLI3 ALL 410-685-2900 Customer Service
Home office located in Baltimore, Maryland
Motorola Inc. 009 36111 ALL 480-441-7449 Shari Homyock
Located in Scottsdale, Arizona
Motorola, Inc. 372 36111 ALL 480-441-7008 Matilda Jaeger
Located in Scottsdale, Arizona
Mountain States Administrative Services 372 86040 ALL 440-720-0700 ext
215 Tiffany Brown
Only claims with address: PO Box 32709, Tucson, Arizona 85751
Mountain States Administrative Services 126 86040 AZ 800-866-4731 Customer Service
Only claims with address: PO Box 32709, Tucson, AZ 85751
MPlan 009 95444 IN 800-816-7526 Provider Services
Payer Name EMC Type
Payer ID States Phone Contact
Located in Indianapolis, Indiana Unique Provider ID required
Mutual Assurance Administrators 940 37256 ALL 405-848-1975 Client Services
Located in Oklahoma City, Oklahoma
Mutual Group, The (US) 009 70491 ALL 800-752-2557 Customer Support
Mutual of Omaha Insurance Co. 009 71412 ALL 402-342-7600 x3580 Group Support Services
Located in Omaha, Nebraska - See notes regarding edits
Mutual of Omaha Insurance Co. 372 71412 ALL 402-342-7600 x3580 Group Support Services
Mutual of Omaha Rural Health 410 00410 ALL 866-580-5981
Contact Gateway EDI for Enrollment
Mutually Preferred 372 71412 ALL 402-342-7600 x7703 Pat Shannon
Mutually Preferred 009 71412 ALL 402-342-7600 x7703 Pat Shannon
MVP Health Plan of NY 109 14165 NY 800-684-9286 Customer Service
For your MVP Provider Number, call 800-684-9286
N. W. International Assoc. of Machinist & 372 91136 ALL
Aerospace Engineers Benefits Trust Dental Program (Group F39)
N. W. Textile Processors 372 91136 ALL
Group # F14
N.W. Ironworkers Health & Security Trust Fund 372 91136 ALL
Group # F15
N.W. Ironworkers Health & Security Trust Fund 009 91136 AK, WA 206-441-7574 Customer Service
Group # F19
N.W. Roofers & Employers Health & Security 372 91136 ALL
Group # F26
N.W. Roofers & Employers Health & Security Trust 009 91136 AK, WA 206-441-7574 Customer Service
Group # F26
N.W. Textile Processors (Group # F14) 009 91136 AK, WA 206-441-7574 Customer Service
206-441-7574
NALC 009 53011 ALL 703-729-4677 Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
National Association of Letter Carriers
NALC 009 53011 ALL 703-729-4677 Customer Service
National Association of Letter Carriers
NAMM of Illinois 009 36398 ALL 708-432-4025 Caroline Endless
Located in Hillside, Illinois
National Assoc Preferred Provider (TX) - Wisconsin 109 AMS01 TX
Only claims with the address of Wisconsin can be submitted electronically.
National Assoc. of Letter Carriers/NALC 372 53011 ALL 703-729-4677 Customer Service
National Benefit Administrators - New Jersey 009 56175 NJ 440-720-0700 ext
215 Tiffany Brown
Located in Parsippany, New Jersey
National Benefit Administrators - North Carolin 009 56176 NC 440-720-0700 ext
222 Kathy Meyers
Located in Charlotte, North Carolina
National Capital PPO (NCPPO) 014 00014 DC, DE, MD, NJ, PA, VA, WV 800-624-2356 Customer Service
Located in Springfield, Virginia Unique Provider ID number required
National Claim Administration, Inc. 109 37126 ALL 800-635-9671 Customer Service
Located in Garden City, New York
National Rural Electric Coop-NRECA 009 52132 ALL 402-483-9200 EDI Claim Support
Located in Lincoln, NE 68506
National Rural Letter Carrier Assoc. 009 71412 ALL 402-978-5883 Customer Service
Policy # GMG1846
National Rural Letter Carrier Assoc. 372 71412 ALL 402-978-5883 Customer Service
National Telephone Coop Association 940 PV150 ALL 703-351-2000 Customer Service
Located in Arlington, Virginia
Nationwide Insurance 009 31417 ALL 614-249-4555 Fred Richards
Located in Columbus, Ohio
NCAS- Fairfax 009 75190 VA 703-934-6297 Tammy Thacker
located in Fairfax, Virginia
NCAS-Charlotte 009 75191 ALL 704-364-3865 Customer Service
Located in Charlotte, North Carolina
NCAS-Owing Mills 009 52118 MD 703-934-6215 Audria Tatken
Located in Owings Mills, Maryland
Neighborhood Health Partnership of Florida 009 96107 FL 305-715-4334 Provider Relations
Claims address: PO Box 025680, Miami, Florida 33102-5680
Payer Name EMC Type
Payer ID States Phone Contact
Neighborhood Health Providers - NY Medicaid HMO 009 11325 NY 631-360-3102 Provider Services
NY Medicaid HMO Plan - Unique Provider ID required
Nesika Health Group 940 37255 OR 541-677-5508 Customer Service
Located in Roseburg, Oregon
Netcare Life and Health Insurance 126 66055 ALL 440-720-0700 x205 Rebecca Karlinsky
Claims address: 424 W O'Brien Dr., Julale Center, Suite 107, Hagatna, Guam 96910
Network Health 009 04332 MA 617-806-8121 Diana Shaheen
Located in Cambridge, MA
Network Health Plan 009 39144 WI 800-826-0940 Customer Service
Located in Menasha, WI - Unique Provider ID required
Nevada Health Solutions 009 86067 NV 702-304-5500 Provider Relations
Located in Las Vegas, Nevada Unique Provider ID numnber required
NevadaCare 009 86067 NV 702-304-5500 Provider Relations
Located in Las Vegas, Nevada Unique Provider ID number required
NevadaCare Kids 009 86067 NV 702-304-5500 Provider Relations
Located in Las Vegas, Nevada Unique Provider ID number required
New England Dental Administrators 372 43351 ALL 603-223-1305 Eleanor Vien
Located in Concord, NH
New Era Life 009 75281 ALL 214-561-6424 Michael Newman
Located in Dallas, Texas
New Market Dimensions 940 65056 ALL 270-796-3579 Susan Hampton
Located in Bowling Green, Kentucky
New World Claims Services 372 38332 ALL 800-624-0698 Customer Service
Only claims with address: 2624 North 5th Street, Niles, MI 43120
New World Claims Services 126 38332 ALL 800-624-0698 Customer Service
Per IPN Payer no longer accepts claims electronically.
New York Network Management, LLC 009 11334 NY 718-748-7316 Gary Singh
Located in Brooklyn, New York Group Plan or Policy Number must be supplied.
New York Presbyterian Community Health Plan 109 48186 NY 631-342-0063 Customer Service
Located in Islandia, NY
NGS American 009 38225 ALL 810-445-6841 Customer Service
Located in St. Clair Shore, MI
NHC Health Benefit Plan 009 62124 ALL 615-278-1230 Customer Serviice
Claims address: PO Box 7036, Murpheesboro, Tennessee
Nippon Life Insurance Co. 109 81264 ALL 800-937-6542 Customer Service
Located in New York, New York
Payer Name EMC Type
Payer ID States Phone Contact
Nippon Life Insurance Company 372 81264 ALL
Noble Community 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA I
North American Administrators 126 65085 TN 440-720-0700 ext205 Rebecca Carlinsky
Claims address: PO Box 1984 or PO Box 25207, Nashville, TN 37202
North American Administrators, Inc. 070 64157 ALL 800-828-6922 Member Services
Located in Amherst, New York - Payer request Federal ID as Billing Provider
North American Benefits Network 126 34159 ALL 800-321-4085 Customer Service
Located in Cleveland, Ohio
North American Benefits Network 372 34159 ALL 800-321-4085 Customer Service
Only claims with address: P. O. Box 94928, Cleveland, Ohio 44101-4928
North American Medical Management - NAMM - CA 109 E3510 CA 510-450-1500 Reed Smoller
Corporate office located in Ontario, California
North American Preferred 070 64157 ALL 800-828-6922 Member Services
Located in Amherst, New York - Payer request Federal ID as Billing Provider
North AmeriCare 070 64157 ALL 800-828-6922 Member Services
Located in Amherst, New York - Payer request Federal ID as Billing Provider
North Texas Healthcare Network 109 35212 ALL 800-444-3995 Customer Service
Located in Irving, Texas
Northeast Delta Dental (ME, NH, VT) 372 02027 ALL
Northern California Sheet Metal Workers Health Pla 126 38238 CA
Sheet Metal Workers Local 104
Northwest Dental Services 372 93525 OR 541-677-7624 Kent Achterfoff
Located in Roseburg, Oregon
Northwest Suburban IPA (Illinois) 940 36346 IL
Located in Rockford, Illinois
Northwestern National Life (Now ReliaStar) 372 41045 ALL 612-372-5466 EDI Support Line
Nova Healthcare Administrators, Inc. 126 16644 NY 800-999-5703 Provider Services
Located in Grand Island, New York
NovaSys Health Network 940 71080 ALL 888-894-3557 Customer Service
Located in Little Rock, Arkansas Group number is required.
Nyhart 940 37299 IN
Corporate office Indianapolis, Indiana
Payer Name EMC Type
Payer ID States Phone Contact
NYLCare ETHIX Northwest 372 91135 ALL
NYLCare Health Plans Northwest 372 91166 ALL 800-654-3250 X617 Debora Allen
Ochsner Health Plan 009 72127 LA 800-451-6581 Provider Call Center
Located in Metarie, Louisiana - Rendering Provider Network ID required
ODS Health Plan 940 13350 OR 877-605-3229 Customer Service
Located in Portland, Oregon
Ohio Health Choice, PPO 126 34189 IN, KY, MI, OH, PA, WV 440-720-0700 ext 222 Kathy Myers
Only claims with the address PO Box 93538, Cleveland, OH 44101-5538
OmniCare Health Plan, Inc. a Coventry Health Plan 666 25150 MI 866-314-3784 Provider Inquiry Line
Claims address for claims after 10/1/04 PO Box 7150, London, Kentucky 40742
One Beacon (formerly CGU) 866 WC291 CT, NJ, NY
WORK COMP
One Health Plan of Alaska, Inc. 372 80705 ALL
One Health Plan of Arizona, Inc. 372 80705 ALL
One Health Plan of Florida, Inc. 372 80705 ALL
One Health Plan of all States 057 80705 ALL 800-537-2033 Customer Service
One Health Plan of California, Inc. 372 95379 ALL
One Health Plan of Colorado, Inc. 372 95412 ALL
One Health Plan of Georgia, Inc. 372 96559 ALL
One Health Plan of Illinois, Inc. 372 95388 ALL
One Health Plan of Indiana, Inc. 372 80705 ALL
One Health Plan of Kansas/Missouri, Inc 372 80705 ALL Claim office on Members
card
One Health Plan of Maine, Inc 372 80705 ALL
Payer Name EMC Type
Payer ID States Phone Contact
One Health Plan of Massachusetts, Inc. 372 80705 ALL
One Health Plan of Michigan, Inc 372 80705 ALL Claim office on Members card
One Health Plan of Minnesota, Inc 372 80705 ALL Claim office on Members card
One Health Plan of Nevada, Inc. 372 80705 ALL
One Health Plan of New Hampshire, Inc. 372 80705 ALL
One Health Plan of New Jersey, Inc. 372 80705 ALL
One Health Plan of New York, Inc 372 80705 ALL Claim office on Members card
One Health Plan of North Carolina, Inc. 372 80705 ALL
One Health Plan of Ohio, Inc. 372 80705 ALL
One Health Plan of Oregon, Inc. 372 80705 ALL
One Health Plan of Pennsylvania, Inc. 372 80705 ALL
One Health Plan of South Carolina, Inc. 372 80705 ALL
One Health Plan of Tennessee, Inc. 372 80705 ALL
One Health Plan of Texas, Inc. 372 51459 ALL
One Health Plan of the District of Columbia, Inc 372 80705 ALL Claim office on Members
card
One Health Plan of Virginia, Inc. 372 80705 ALL
One Health Plan of Washington, Inc. 372 80705 ALL
Payer Name EMC Type
Payer ID States Phone Contact
One Health Plan of Wisconsin, Inc. 372 80705 ALL
One Health Plan of Wyoming, Inc. 372 80705 ALL
One Health Plan, Inc. (Vermont) 372 80705 ALL
Operating Engineers Locals 302 & 612 009 91136 AK, WA 206-441-7574 Customer Service
Group # F12)
Operating Engineers Locals 302 & 612 372 91136 ALL
Group # F12
OptiCare 009 56190 ALL 203-465-1457 Dick Markowich
Located in Rocky Mount, North Carolina - Unique Provider ID Required
Optimum Choice of the Carolinas 070 52152 NC 800-257-6458 Provider Representative
Rendering Provider ID number is required
Optimum Choice, Inc. (OCI) 009 52148 DE, DC, MD, VA, WV 800-257-6458 Provider Services
Rendering Provider Network ID required
Orthonet Corporation 009 13381 ALL 914-681-8800 ext 155 Angel Ayala
Located in White Plains, New York
OSF Care Advantage 009 OSFMC IL
Located in Peoria, Illinois
OSF Health Plans 009 OSFIL IL 800-673-4699 Provider Services
Located in Peoria, Illinois.
Oxford Health Plans 307 06111 CT, DE, NJ, NY, PA 800-666-1353 Provider Service
Par-Providers require Unique Provider # - Non-Par Does not require Unique Prov.#
Oxford Health Plans 372 84104 ALL
Pacific Mutual Life Insurance Company 109 67466 ALL 714-760-4420 Deanna Mooring
Located in Phoenix, Arizona
PacifiCare Behavioral Health 009 33053 AZ, CA, CO, NM, NV, OK, OR, TX, WA 800-716-1166 Customer Service
Located in Laguna Hills, California
Pacificare Health Systems Oklahoma 009 95959 OK 800-825-9355 Commercial HMO
Unique Provider ID required
Pacificare Health Systems Oregon and Washington 009 95959 OR, WA 503-603-7104 Carolyn Anderson -
Oregon
Located in Hillsboro, Oregon
Payer Name EMC Type
Payer ID States Phone Contact
Pacificare Health Systems Texas 009 95959 TX 800-825-9355 Commercial HMO
Unique Provider ID required
Pacificare of Arizona 009 95964 AZ 800-344-3782 x4313 Tisha Mendoza
Provider Testing required contact Gateway EDI-see notes for testing procedures.
Pacificare of Colorado-HMO, POS & Secure Horizons 009 95962 CO (303) 714-2731 Colette Ward
Claims address: P.O. Box 6699, Englewood, CO 80155
Pacificare PPO - ALL STATES 009 95999 CO 719-522-6928 Lela Rae Nemmers
Claims address: PO Box 6099, Cypress, CA 90630
Pacificare/Secure Horizons California 009 95959 CA 800-624-8822 Customer Service
PacificSource Health Plans 372 93029 ALL (541)686-1242 X251 Ralph Haynes
PacificSource Health Plans 940 93029 ALL
Located in Eugene, Oregon
Palmetto GBA - RR Medicare Part B 320 00320 ALL 866-899-5227 Provider Relations
Payer requires Enrollment Form - Call Gateway EDI for Forms
Paramount Health Care 988 41988 MI, OH 800-462-3589 Customer Service
Offices in Maumee, Ohio and Dundee, Michigan.
Partners in Practice (TX) - Wisconsin Only 109 AMS01 TX
Only claims with the address of Wisconsin can be submitted electronically.
Partners National Health Plans of North Carolina 070 56152 NC, SC, VA 800-942-5695 Customer Service
Unique Provider ID number required.
Partnership Health Plan of California 109 PHP02 CA 707-863-4130 Claims Department
Located in Fairfield, California
Pasadena Primary Care Physicians 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
Passport Health Plan 009 61129 KY 877-234-4275 Provider Services
Payer requires Unique Provider ID -
Pathmark 866 WC821 DE, NJ, NY, PA
WORK COMP
Paul Revere / Provident 372 47009 ALL
Peerless Insurance Company 866 WC491 CA, CT, DC, DE, FL, GA, IL, IN, MD, MO, NJ, NY, PA, SC, TN, VA
WORK COMP
Payer Name EMC Type
Payer ID States Phone Contact
Pennsylvania Magellan Plan / TESTING 735 77035 PA
TESTING
PersonalCare 666 25146 IL 800-431-1211 Customer Service
Claims address: PO Box 7141, London, KY 40742-7141
PHA Insurance Services 126 95183 ALL 440-720-0700 x205 Rebecca Karlinsky
Claims address: P. O. Box 620123, Orlando, FL 32862
Phoenix American 372 67814 ALL 800-451-2513 Customer Service
Phoenix Group Services (Texas) 009 75238 ALL 817-465-4463ext.236 Rhonda Howery
located in Arlington, TX
Phoenix Home Life 372 67814 ALL 800-451-2513 Customer Service
Phoenix Home Life Mutual Ins. Co. 009 67814 ALL 800-451-2513 Customer Service
formerly Phoenix American Life (PAL), Phoenix Home Life and Phoenix Mutual
PHP Kansas City 036 00036 KS, MO 800-544-3014 Customer Service
Claims address: PO Box 25938 or 26650, Shawnee Mission, Kansas
PHP of Mid Michigan 726 87726 MI 517-327-2454 Customer Service
PHP Tenncare 009 62155 TN 800-705-5248 Provider Services
Claims mailing address: PO Box 22949, Knoxville, Tennessee Unique Provider ID .
Phycisians Health Plan of South Michigan 726 87726 MI 800-394-7569 Customer Service
Located in Jackson, Michigan
Physician Care Network (PCN) 940 36345 IL 800-747-2264 Customer Service
Only claims with City & State: Rockford, Illinois
Physicians Health Services 109 06108 CT, NJ, NY, PA 203-402-4283 Provider Services
Payer named changed to Healthnet of Northeast - See this Payer to set up.
Physicians Care Network 009 57098 SC 803-771-9474 ext 478 Wanda McCall
Located in Columbia, SC
Physicians Corporation of America 009 65018 ALL
(Florida Plan ONLY)
Physicians Health Association of Illinois (PHAI) 940 37136 IL 888-642-2948 Customer Service
Located in Rockford, Illinois
Physicians Health Plan of Northern Indiana 099 12399 IN 800-982-6257 x
549 Lori Sowle
Located in Fort Wayne, Indiana SEE NOTES - Unique Provider ID required
Payer Name EMC Type
Payer ID States Phone Contact
Physicians Healthcare Plans 009 65031 FL 800-807-7470 Provider Services
Located in Tampa, Florida
Physicians Mutual Insurance Company 666 47027 ALL 888-932-7642 Customer Service
Located in Omaha, Nebraska
Physicians Plus Insurance Corporation 009 39156 WI 800-545-5015 Provider Service
Claims address: P.O. Box 2078 Madison, WI 53701-2078
Piedmont Administrators, Inc. 940 56151 ALL 336-544-2222 Provider Services
Located in Greensboro, NC
Pinnacle claims Management, Inc. 109 24735 ALL 949-863-1000 x 309 Connie Rich
Locate in Newport Beach, CA
Pipeline Industry Benefit Fund 009 73074 OK 918-280-4800 Customer Service
Located in Tulsa, Oklahoma
Pittman & Associates 666 37224 ALL 630-718-8230 Mandy Rak
Located in Memphis, Tennessee
Plaines (IA) - Wisconsin Only 109 AMS01 IA
Only claims with the address of Wisconsin can be submitted electronically.
Plaines Advisor ( WI) - Wisconsin Only 109 AMS01 WI
Only claims with the address of Wisconsin can be submitted electronically.
Plaines Advisor (FL) - Wisconsin Only 109 AMS01 FL
Only claims with the address of Wisconsin can be submitted electronically.
Planned Administrators, Inc. /BCBS SC Plan 086 00866 SC
Enrollment required contact Gateway EDI, Inc.
Plumbers and Pipefitters - Local 33 (DesMoines, IA 333 00333 IA
Claims address: 2501 Bell Avenue, Des Moines, Iowa 50321-Set-up req contact us.
PM Group (PMG) 109 67466 ALL 714-760-4420 Deanna Mooring
Located in Phoenix Arizona
POMCO 009 16111 ALL Refer to Members ID Card
Located in Syracuse, NY
Port Angeles - Previously known as King County 372 93200 ALL 800-373-1477 Customer Service -
NDEX
Medical - Clallam County Physician Service - Requires Unique Provider ID
PPO Oklahoma 009 73159 OK 405-843-9551 Customer Service Help Desk
Located in Oklahoma City, Oklahoma Group Number is required on claim.
Payer Name EMC Type
Payer ID States Phone Contact
PPOM, Located in Southfield, MI 109 38335 MI, OH, IN, KY, WI 800-831-1166 Customer Service
PPOM physician sign-up form must be completed prior to first claim submission
PPOplus, LLC 109 72148 ALL 888-965-1180 Customer Service
Claims mailing address: P. O. Box 90802, Lubbock, Texas 79408-8802
Prairie Medical Group 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
Prairie States Enterprises, Inc. 009 36373 ALL 920-208-5991 Mike D'Alton
Located in Chicago, Illinois & Sheboygan, Wisconsin
Preferred Blue South Carolina 481 48100 SC
SC BCBS Preferred Blue plan -
Preferred Care New York 810 00810 NY
TESTING ONLY
Preferred Care Partners 009 65088 FL 305-670-8430 David Padron
Located in Miami, Florida
Preferred CommunityChoice PPO 009 73145 OK 800-884-4776 Claims Customer Service
Located in Tulsa, OK
Preferred Dental Organization 372 68241 ALL 800-544-4778 Customer Support
Preferred Health Network 109 35173 MD 800-422-1996ext 883 Lorraine Rutkowski
Located in Linthicam, Maryland - Provider Number Required
Preferred Health Plan, Inc. 009 61106 IN, KY 502-339-7500 Norm Shelman
Located in Louisville, KY
Preferred Health Systems Insurance Company (PHS 009 60110 KS, MO 877-609-2467 Provider Relations
Located in Wichita, Kansas Unique Provider ID# required
Preferred Healthcare System, Inc. 009 04320 PA 800-238-9900 Customer Service
Located in Altoona, Pennsylvania
Preferred Network Access 126 36401 IA, IL, IN, WI 630-493-0905 Customer Service
Claims address: PO Box 2248, Darien, Illinois 60561
Preferred One 070 41147 ALL (800) 451-9597 Customer Service
Located in Minneapolis, MN - Requires Provider ID
Preferred one (CT)/First Choice 009 14162 CT 800-960-2530ext 1447 Tamara Allen
Requires a 5-9 character Rendering Provider ID number
Premera Health Plus 828 00828 WA (800) 435-2715 Help Desk
Claims address: P. O. Box 2113, Seattle, WA 98111-2113. Not a Blue Shield.
Premier Health Plan/Mercy Health Plan 360 00360 MO, IL, TX 314-214-8158 Provider Relations
Located in Springfield, Missouri UPIN number required for Provider ID number.
Payer Name EMC Type
Payer ID States Phone Contact
Presbyterian Health Plan 940 TH061 NM 866-869-7737 Provider Care Unit
Claims address: PO Box 27489, Albuquerque, New Mexico-Provider ID req.
Presbyterian Salud 940 TH060 NM 866-869-7738 Provider Care Unit
Claims address: PO Box 92085, Albuquerque, New Mexico. Provider ID
Prevea Health Insurance Plan 800 39185 ALL 847-887-8033 Deana Tilson
Located in Evanston, Illinois
Primary Delivery Systems 611 61101 ALL 800-558-4444 X 7448 Bonnie or Jody
Green Bay and Madison Wisconsin only
Primary Health Plan 940 PRIME ID, OR 800-688-5008 Customer Service
Located in Bend, Oregon
Primary PhysicianCare, Inc. 009 56144 ALL 704-523-2758 Robert Vinson
Located in Charlotte, NC
Prime Benefit Systems, Inc.--MO 611 61101 ALL 800-367-7587 Customer Support
Prime Benefits Systems, Inc. - MO 611 61101 ALL
Prime Health Kansas City Inc.--MO 611 61101 ALL 800-367-7587 Customer Support
Prime Health Kansas City, Inc. - MO 611 61101 ALL
Prime Health Mgmt. Services--MO 611 61101 ALL 800-367-7587 Customer Support
Prime Health of Kansas, Inc.--MO 611 61101 KS 800-367-7587 Customer Support
Prime West Health Plan 009 61604 MN 866-431-0802 Provider Relations
Claims address: 822 South 3rd Street, Suite 150, Minneapolis, MN 55415
Principal Financial Group 109 61271 ALL 515-247-5368 Claim Status Inquiry
Corporate office Des Moines, Iowa
Principal Financial Group 109 61271 ALL 515-247-5368 Claim Status Inquiry
Corporate office Des Moines, IA
Principal Health Care of Georgia, Inc. 666 25127 GA 800-470-2004 Customer Service
Located in Atlanta, GA
Principal Mutual Life Insurance Co. 372 61271 ALL 515-247-5368 Claim Status Inquiry
NOT Principal Healthcare
Principal Mutual Life Insurance Co. 109 61271 ALL 515-247-5368 Claim Status Inquiry
Corporate office Des Moines, Iowa
Priority Health 009 38217 MI 616-975-8284 Wendell Broome
Prior to submitting call to obtain the Pay to code, Refer to notes for Plan names
Payer Name EMC Type
Payer ID States Phone Contact
Prism Network, Inc. 940 37268 CT, MA, NJ, NY, PA, VT 888-266-9041 Customer Service
Located in Lancaster, New York
Pro Health Compcare 940 31132 ALL 614-470-7383 Gayle Hyslop
BWC Claim Number required as Member ID, contact Gayle Hyslop @ 614-470-7383
Professional Benefit Admins., Inc. (Oakbrook, IL) 126 36331 ALL 440-720-0700ext.
222 Kathy Myers
Claims address: P.O. Box 4687, Oakbrook, IL 60522-4687.
Professional Claim Administrators (Proclaim) 109 41163 ALL 952-546-0310 Sue Lebert
Located oin Minnetonka, Minnesota
Professional Claims Management 009 37242 ALL 800-325-8424 Customer Service
Located in Canton, Ohio
Protective Life 009 70408 ALL 800-800-1212 Customer Service
Located in Kansas City, Missouri
Protective Life 372 70408 ALL 205-909-5861 Jackie Irvin
Claims address: P. O. Box 830626, Birmingham, Alabama 35283
Providence Health Plan 109 PHP01 OR 800-878-4445 Customer Service
Enrollment required contact Gateway EDI
Providence Preferred of Washington 009 91131 ALL
(Sisters of Providence Health Plans)
Providence Preferred of Washington 009 91131 OR, WA 800-878-4445 Customer Service
(Sisters of Providence Health Plans)
Provident Life & Acc. Ins Co. of Am. 372 68195 ALL 615-755-1416 Annie Rowland
Provident Life & Casualty Ins. Company 372 68195 ALL 615-755-1416 Annie Rowland
Provident Life and Accident Ins. Co. 372 68195 ALL 615-755-1416 Annie Rowland
Provident Preferred Network 372 68195 ALL 615-755-1416 Annie Rowland
Provider Networks of America (PRONET) 940 51032 ALL
Prucare HMO 372 68245 ALL
Capitated Claims Only (zero charges) - Do not enter number in Payer List
Prudential (Managed HealthCare, Indemnity, POS, 654 60054 ALL 800-544-4778 Customer Service
Tradl. Plus, In & Out of Nwk, Select, Plus Select, Psych. Mgmt., Resource Mgmt.
Prudential Dental Organization (PDO) 372 68241 ALL 800-544-4778 Claim Support
Payer Name EMC Type
Payer ID States Phone Contact
Prudential HealthCare 654 60054 ALL 800-544-4778 Customer Service
HMO, POS, PPO, SeniorCare, Comm. Plan-HMO Regional, Affiliates, Assoc., Metro Nwk
PSU Plan A 666 25126 PA 302-283-6570 Renee Crumlish
Rendering Provider must be Unique Provider ID number or UPIN number
PSU State HealthPass 666 25126 PA 302-283-6570 Renee Crumlish
Rendering Provider must be Unique Provider ID number or UPIN number
Puget Sound Benefits Trust 372 91136 ALL
Group # F25
Puget Sound Benefits Trust 009 91136 AK, WA 206-441-7574 Customer Service
Group # F25
Puget Sound Electrical Workers Trust 009 91136 AK, WA 206-441-7574 Customer Service
Group # F33
Puget Sound Electrical Workers Trust 372 91136 ALL
Group # F33
Qual Choice of Arkansas 009 35174 AR 501-228-7111 ext5059 Vicky McSwain
Requires a Unique Provider ID#
Qual Choice of Virginia 666 25128 VA 800-627-4872 Provider Services
New name is Southern Health Services
Qual Med - Wisconsin 126 39197 WI
Claims address: 555 S. 108th St., West Allis, WI
Qualcare, Inc. 009 23342 NJ, NY 800-992-6613 Provider Relations
Located in Piscataway, NJ No enrollment if participating provider
Qualmed - New Mexico 940 QUANM NM 505-889-8800 Customer Service
Located in Albuquerque, New Mexico
Quincy Health Care Management, Inc. 666 37129 IA, IL, MO 217-222-9157 ex
5151 Susan Dean
Located in Quincy, Illinois
R. E. Harrington, Inc 109 95266 ALL
R. E. Harrington, Inc. 372 95266 ALL
Railroad Medicare (Augusta, GA) 320 00320 ALL
Payer requires Enrollment Form - Call Gateway EDI for Forms
RBMS, LLC 940 91176 ALL 800-770-3740 Customer Service
Located in Anchorage, Alaska
Regence Washington Health - FEP 372 93200 ALL 800-373-1477 Customer Service - NDEX
Payer Name EMC Type
Payer ID States Phone Contact
Previously known as King County Medical Blue Shield-FEP-Requires Unique Prov.ID#
Regence Washington Health - Previously known as 372 93200 ALL 800-373-1477 Customer Service -
NDEX
King County Medical Blue Shield - Requires Unique Provider ID
Regional Care, Inc. 940 47076 ALL 308-635-2260 Scott Reisig
Located in Scottsbluff, Nebraska
Reliance Standard 372 36088 ALL
Reliastar 372 41045 ALL 612-372-5466 EDI Support
Reynolds and Reynolds 940 37270 ALL 800-736-3539 Customer Service
Located in Dayton, Ohio
River Quest Network, Inc. 666 37129 IA, IL, MO 800-637-7100 Customer Service
Located in Quincy, Illinois
Riverbend Rural Health 425 00425 ALL 877-296-6189 Customer Service
Contact Gateway EDI for Enrollment
Rocky Mountain HMO 009 RMHMO CO 800-854-4558 Provider Service
Located in Grand Junction, Colorado Enrollment required contact Gateway EDI
Rocky Mountain Life Dental 372 84102 ALL
Rooney Life Inc. 009 37602 ALL 317-297-4187 Client Services
Royal & Sun Alliance 866 WC171 CA, CT, DC, DE, GA, IL, IN, MD, MO, NC, NY, PA, SC, TN, TX, VA, WA
WORK COMP
Rural Carrier Benefit Plan 009 71412 ALL 800-638-8432 Customer Service
Located uin Charlotte, North Carolina
Rush Prudential Health Plans (HMO Only) 009 36389 ALL
S & S HealthCare Stratagies 009 31441 ALL # on member card Customer Service
Located in Cincinnati, Ohio
Safeguard Vision 373 SFG99 CA, FL, TX 800-635-4238 Provider Services
Located in Laguna Hills, California
Sagamore Health Network (IN) 940 35164 ALL 317-580-8043 Michelle Marshall
Located in Carmel, IN
Saint Barnabas System Health Plan 009 22240 NJ 732-562-2834 Allison Hofmann
Located in Pisataway, New Jersey
Santa Barbara Cottage Hospital 940 37288 CA 805-569-8220 Christine Gutierrez
Located in Santa Barbara, California
Payer Name EMC Type
Payer ID States Phone Contact
Sante Health System and Affiliates 009 77038 NY 559-228-5410 Customer Service
Located in New York, New York
Scott & White Health Plan 940 88030 TX 800-321-7947 Customer Service
Located in Temple, Texas
Seabury & Smith 009 13310 ALL 319-351-2667 x5610 Sue Hansen
Benefit Plan Admin. of St. Louis, MO & Office of the Admin., Wash., D.C.
Secure Health Plan of Georgia, LLC 009 28530 GA 800-648-7563 Opt 1 Customer Service
UPIN # or 6 digit alpha numeric # required.
Secure Horizons - Tufts Health Plan for Seniors 109 04298 MA 800-423-8080 Customer Service
Tuft's Health Plan must be notified before submitting claims
Security Health Plan 009 39045 WI 800-548-1224 Provider Services
Located in Marshfield, WI
Sedgwick Claims Management Services, Inc. (TPA) 866 WC511 CA, CT, DC, DE, FL, GA, IL, MD, NC,
NJ, PA, SC, TN, TX, VA, WI
WORK COMP
Select Benefit Administrators (Des Moines, Iowa) 126 42137 IA 800-397-0427 Customer Service
Corporate Headquarters, West Des Moines, Iowa
Select Benefits Administrators of America 126 37282 ALL 800-497-3699 Customer Service
Only claims with address: PO Box 440, Ashland, WI 54806
Select Health of South Carolina 009 23285 SC 888-394-3100 Customer Service
Rendering Provider ID number required. Claims address: PO Box 7120 London, KY
SelectCare 109 10014 MN, SD, WI 800-858-9060 Provider Service
Claims mailing address: PO Box 830489, Birmingham, AL 35283-0489
SelectCare (Coca Cola) 372 68241 ALL 800-544-4778 Customer Service
Self Insured Benefit Administrators 126 59111 ALL 800-683-7422 Customer Service
Only claims with address: 18167 US Highway 19 North, Suite 300, Clearwater, FL
Self Insured Plans LLC 109 36404 ALL 941-403-7884 Customer Service
Located in Naples, Florida
Self-Funded Plans (IL, PA, OH) 126 34131 ALL 216-566-1455 x116 Debbie Phillips
SensiCare--direct 340 00340 IL, MO
Requires Unique Provider ID# - Call Gateway EDI Customer Service for set-up
Sentara Health Plan 009 54154 VA 800-736-8272 Customer Service
Entered Twice
Payer Name EMC Type
Payer ID States Phone Contact
Sentinel Management Services 109 23249 PA 717-299-2341 Robert Hettrick
Located in Lancaster, Pennsylvania
Seoul Medical Group 109 IP080 CA 818-461-5554 Fed Villaluna
IPA located in Encino, CA
Seton Health Plan - Exclusive Provider Network 940 EPNSH TX 512-324-3125 Provider Relations
22 locations in Central Texas
Seton Healthcare Network - Employee Health Plan 940 SHEBP TX 512-421-5667 Customer Service
Claims address: Po Box 15445, Austin, Texas 78781
Shasta Administrative Services 940 75280 ALL 214-561-6424 Michael Newman
Jeld-Wen Claims only. PO Box 1747, Redmond, OR 97756
Sierra Health Services 009 76342 NV 702-242-7290 Leslie Hare
Located in Las Vegas, Nevada
Signature Health Alliance (SHA) 009 62159 TN 800-264-3060 Provider Service
Only claims currently mailed to PO Box 22419, Nashville, Tennessee
Sinclair Health Plan 940 84076 ALL 630-789-2082 Julie Weissmann
Located in South Temple, Utah
Sinclair Health Plan -Dental 372 84076 ALL 630-789-2082 Julie Weissmann
Located in South Temple, Utah
SISCO (Self Insured Services Company) 540 00540 ALL 319-583-7344
An Iowa Corporation
Sloans Lake Managed Care 009 84096 CO 800-850-2249 Customer Service
Located in Denver, Colorado
Smith Administrators 940 02057 ALL 806-473-2406 Desri Petrucci
Located in Forth Worth, Texas
Sooner Health Network - Wisconsin Only 109 AMS01 ALL
Only claims with the address of Wisconsin can be submitted electronically.
Southern Health Services, Inc. 666 25128 VA 800-627-4872 Provider Service
Located in Richmond, VA - claims sent to PO Box 7704, London, KY
Southwest Service Life 940 37266 ALL 800-966-7491 Customer Service
Located in Fort Worth, Texas
Southwestern Bell 372 68241 ALL 800-544-4778 Customer Service
Southwestern Bell Exec. - Custom Care 372 68241 ALL 800-544-4778 Customer Service
Southwestern Bell Exec. - Southwestern Bell 372 68241 ALL 800-544-4778 Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
Special Agents Mutual Benefit Association 109 37259 ALL 800-638-1440 Customer Service
Located In Rockville, Maryland
Special Risk International (SRI) 109 52190 ALL 410-321-3568 Suzanne Connolly
Located in Lutherville, Maryland
Spectera 773 00773 ALL 800-638-3120 Provider Services
Located in Baltimore, Maryland - Unique Provider ID required.
St. John's Claims Administration 940 37264 MO 630-428-5126 Ray Zroback
Located in Springfield, Missouri - claims address: PO Box 14230, Springfield, MO
St. Paul Company (MetraComp) 866 WC521 CA, CT, DC, DE, FL, GA, MD, NC, NJ, NY, PA.SC.TN, VA
WORK COMP
St. Paul Travelers 866 WC161 ALL, Except for TX
WORK COMP
St. Therese Physician Associates 940 37116 ALL 630-428-5397 Gary Trebolo
Located in Hinsdale, Illinois
Standard Insurance (OR) 372 93024 ALL
State Employee Group Benefits 009 72087 LA 615-885-3700 Provider Service
Employees of the State of Louisiana
State Farm Group Medical & Individual Health 009 31053 ALL 800-538-4643 Customer Service
Only Group and Individual Health Claims.
Staywell Health/Wellcare Choice 009 14163 FL, GA 800-960-2530 ext1447 Tamara Allen
Requires a 5-9 character Rendering Provider ID number
Sterling Option One 940 91151 ALL 888-858-8551 Claims Status
Medicare+Choice Plan - SEE NOTES REGARDING LAB CHARGES.
Stirling and Stirling 940 06089 ALL 800-447-6689 Customer Service
Located in Milford, Connecticut
Stoner and Associates 372 31121 ALL 440-720-0700 ext 215 Tiffany Brown
Only claims with address: 205 West 4th St., Suite 225, Cincinnati, Ohio 45202
Stoner and Associates 126 31121 OH 440-720-0700 x215 Tiffany Brown - EDI
Only claims with address: 205 West Fourth St, Suite 225, Cincinnati, OH 45202
Stowe Associates 126 58128 ALL 440-720-0700 ext205 Rebecca Karlinsky
Claims address: 2872 Woodcock Blvd., Suite 200, Atlanta, GA 30341
SummaCare HMO 009 95202 OH 800-996-8401 Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
Located in Akron, OH - Rendering Network Provider ID required.
Summit 866 WC721 AL, AR, FL, GA, KY, LA, MS, SD, TX
WORK COMP
Superior Administrators, Inc. 126 23218 ALL 888-429-9090 Customer Service
Located in Santa Anna, California
Superior Dental Care 372 31117 ALL 800-762-3159 Customer Service
Superior Health Plan Texas 666 39188 TX See List Customer Service
Provider ID and Enrollment required
Tarrant Health Services 940 37228 TX 817-740-8513 Diane Myrick
Located in Fort Worth, Texas
TBG Administrative Services 940 39157 ALL 800-826-0012 Customer Service
Located in Wausau, Wisconsin
Teamcare 009 36215 ALL 800-323-5000 Customer Support
Only claims with the address in the state of Illinois
Teamsters Local Union #301 009 36612 IL 630-789-2082 ext 203 Marian Jacob
Located in Waukegan, Illinois
TennCare Select 892 00892 TN 423-755-5717 Customer Service
TennCare MCO - Enrollment required
Tenncare Select UB 391 00391 TN 423-755-5717 Customer Support
Enrollment Required contact Gateway EDI.
Tennessee Benefit Administators 940 37293 TN 800-373-0374 Customer Service
Located in Memphis, Tennessee
Texas Childrens Individual & CHIP 940 76048 ALL 832-824-2600 Vicki Sublett
Claims address: PO Box 300125, Houston, Texas 77230
Texas Childrens Star Medicaid 940 TXCSM TX 800-990-8247 Provider Relations
Claims address: PO Box 300286, Houston, Texas 77230 - See notes
Texas Municipal League Group 940 74214 ALL 800-348-7879 Customer Service
Located in Austin, Texas
Texas True Choice 940 TH055 TX 800-683-4856 Customer Service
Headquarters in Plano, Texas
The New England 372 66893 ALL
Third Party Administrators/American Benefit Admin. 109 37225 ALL 630-416-1111 Customer Service
Located in Naperville, Illinois - SEE NOTES to verify if you should electronic.
Third Party Claims Management 372 95266 ALL 800-237-9293 Customer Service
Third Party Claims Management 109 95266 ALL 800-237-9293 Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
Located in Dayton, Ohio
Thomas Cooper - BCBS SC 315 00315 SC
TESTING
Time Insurance Company, A Fortis Company 372 39065 ALL 414-299-6317 Dwayne Riekena
Time Insurance, A Fortis Company 009 39065 ALL 414-299-6317 Dwayne Riekena
TLC Family Care Health Plan 800 36193 CO 901-725-7100 Customer Service
Located in Memphis, Tennessee Rendering Provider ID required
TMG Life Insurance Co. 009 70491 ALL 800-752-2557 Customer Service
TML Intergovernmental Employee Benefits 940 74214 ALL 800-348-7879 Customer Service
Located in Austin, Texas / Formerly Texas Municipal League
Tongass Timber Trust 940 92620 AK 806-473-2406 Desri Petrucci
Located in Ketchikan, Alaska
Total Care Management 726 87726 ALL
TOTAL CARE/Syracuse PHSP 800 TCARE NY 800-223-7242 Customer Service
Claims address: 819 South Salina St, PO Box 11507, Syracuse, NY 13218-1507
Total Claims Solutions 373 TCS99 ALL
Located in Green Bay, Wisconsin
Tower Life Insurance Company 940 69493 ALL 210-554-4400 Customer Service
TransAmerica Life Insurance Company 940 59222 ALL 800-527-2845 Customer Service
Insured's ID number will be a 10 digit numerical number.
TransChoice-Key Benefit Administators 940 37284 ALL 866-867-6883 Customer Service
Located in Fort Mill, South Carolina
Transwestern Insurance Admin, Inc. 940 TRAN1 AZ, CA 800-221-8942 Customer Service
Located in Fresno, California
Travelers 726 87726 ALL Members card Customer Service
Travelers 372 87726 ALL 864-234-6164 Claim Status Check
Travelers Health Network 726 87726 ALL Members card Customer Service
HMO & Care Option
Travelers Plan Adminstrators 726 87726 ALL Members card Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
Travelers/CGT - PPO 726 87726 ALL Members card Customer Service
Triad Healthcare, Inc. (Plainville, CT) 940 39181 ALL 800-550-0540 Provider Services
Located in Plainville, Connecticut
Tricare North Region 385 57106 IL, IN, KY, MI, MO, NC, OH, VA, WI, WV 877-334-2524 Customer Service
Tricare South Region 385 61125 AL, AR, FL, GA, LA, MS, OK, SC, TN, TX
800-325-5920 opt. 2 PGBA EDI Help Desk
Enrollment required please contact Gateway EDI.
Tricare West Region 111 00111AZ, CA, CO, IA, ID, KS, MN, MO, MT, NE, ND, NM, NV, OR, SD, TX, UT, WA, WY
(608) 221-5056 Marcia Green
Enrollment required contact Gateway EDI. see notes regarding provider number
Trispan Rural Health 420 00420 LA, MO, MS 601-664-4995 Customer Service
Contact Gateway EDI for Enrollment
True Choice USA 940 TCUSA TX 800-251-9665 Customer Service
Claims address: PO Box 251369, Plano, TX 75025
True Choice USA - Christus Health Plans 940 TCUCH TX 800-251-9665 Customer Service
Claims address: PO Box 250089, Plano, TX 75025
Trusteed Plans Service Corporation 126 91078 WA 440-720-0700 x222 Kathy Myers - EDI
Only claims for the following address: PO Box 1894, Tacoma, WA 98401-1894.
Trusteed Plans Service Corportion 372 91078 ALL 440-720-0700 ext 222 Kathy Myers
Only claims with address: PO Box 1894, Tacoma, Washington 98401-1894
Trustmark 009 61425 ALL 847-615-1500 Customer Service
Corporate Office located in Lake Forest, Illinois
Tufts Health Plan 109 04298 MA 800-423-8080 Customer Service (PPO Product)
Tuft's Health Plan must be notified before submitting claims
UGS 450 00450 MI, VA, WV (414) 226-5000
Provider Number Required Gateway contacts UGS to determine where to send claims
UGS 453 00453 ALL
Gateway contacts UGS to determine where to submit claims.
UHC Medicare Complete 726 87726 IL, MO
UICI - Administrators 009 75240 ALL
UICI Administrator - State of Nevada Only 940 74223 NV 972-443-2612 Wes Bell
Payer Name EMC Type
Payer ID States Phone Contact
Formerly submitted under Payer ID 75245
UMWA Health & Retirement Funds 009 52180 ALL 818-558-3630 Provider Services
Payer does not accept DME claims electronic.
Unicare 314 80314 ALL
Contact number on Member ID card,
Unicare Individual - Small Group 314 80314 ALL
See notes regarding locator codes
Unicare Life and Health 314 80314 ALL 877-334-4286 Customer Support
UniCARE Life & Health 314 80314 ALL Number on Card Customer Service
Now UNICARE Major Accounts - Group Number determines Payor ID
UniCARE Life & Health 372 80314 ALL
Now UniCARE Major Accounts
UniCare Major Accounts 372 80314 ALL Number on Card Customer Service
Formerly UNICARE Life & Health - Group number determines Payor ID
UniCare Major Accounts 314 80314 ALL Number on Card Customer Service
Formerly UNICARE Life & Health - Group number determines Payor ID
Unicare Major Accounts 314 80314 ALL 877-334-4286 Customer Suppoer
UniCare Special Accounts (Previously John Hancock 314 80314 ALL 877-334-4286 Customer Support
Health Security Plan, Mutual Life Ins. Co, & Preferred Health Plan
Uniform Medicare Plan/Harringon Benefits 009 75243 OR, WA 800-464-0967 Provider Services
Claims address: PO Box 34850, Seattle, Washington 98124
Uniformed Services Family Health Plan-St. Vince 009 13407 NY 800-241-4848 Customer Service
Only St. Vincent Catholic Medical Centers of New York-located in Staten Island.
Union Labor Life Insurance Company 126 13142 ALL 877-800-2956 Customer Service
Only claims with address: P.O. Box 61593, King of Prussia, PA 19406
Union Pacific Railroad Employees Health System 009 87042 ALL 800-547-0421 Customer Service
Only claims with the address 795 North, 400 West, Salt Lake City, Utah 81043
United Behavioral Health 726 87726 ALL
Entered Twice
United Behavioral Health 726 87726 ALL See notes
Various Mailing addresses - See notes
United Concordia (TRICARE FMDP) 372 CX002 ALL 800-969-3666 Gateway EDI
Requires enrollment contact Gateway EDI
United Concordia Dental Plus 372 CX013 ALL 800-969-3666 Gateway EDI
Payer Name EMC Type
Payer ID States Phone Contact
Requires enrollment contact Gateway EDI
United Concordia-Fee for Service 372 CX007 ALL 800-969-3666 Gateway EDI
Requires enrollment contact Gateway EDI
United Food and Commercial Workers Local 655 012 00012 MO 800-470-9630 Provider Services
Must have Prefix 655 before Social Security Number
United Health Services 009 62170 ALL
United Healthcare - MetraHealth/Metropolitan 726 87726 ALL Members card Customer Service
United HealthCare MetraHealth 726 87726 ALL Members card Customer Service
Formerly Travelers, Metlife, and Metroplitan Life
United Healthcare of Alabama 726 87726 ALL 800-945-0137 Customer Service
United HealthCare of all states 726 87726 ALL
See notes for claims addresses
United HealthCare of Florida 726 87726 FL
Requires Unique Provider ID - Provider # Prefix - RAM
United Healthcare of Tennessee 726 87726 TN 800-688-9195 Customer Service
United Healthcare of Wisconsin, Inc. 726 87726 WI
Located in Milwaukee, WI
United Healthcare Plan of Florida 726 87726 FL 305-441-1140 x2050 Ana Falcon
United Healthcare Plans of Florida (old CAC/Ramsay/Coral Gables Plan ONLY
United Medical Resources 009 31107 ALL
United of Omaha 009 71412 ALL 402-342-7600 x4825 Provider Relations
United of Omaha 372 71412 ALL 800-456-9292 Customer Service
United Physicians of Northern Colorado 009 84132 CO 970-224-4600 Elaine McAvoy
Located in Fort Collins, CO
United States Life Insurance Company 372 13545 ALL 732-922-7116 Jacquie Lee
Located in Neptune, New Jersey
Universal Care of California 109 33001 CA 800-635-6668 ext5330 Grace
Payer Name EMC Type
Payer ID States Phone Contact
Located in Signal Hill, California - Unique Provider ID number required
Universal Health Care, Inc. (Florida) 940 UNIV1 FL 866-690-4UHC Provider Services
Based in St. Petersburg, Florida
University Health Plan New Jersey 329 22329 NJ 800-780-2438 Provider Services
Enrollment required contact Gateway EDI - Provider ID required
University of Pittsburgh Medical Center (UPMC) 232 23281 PA 888-876-2756 Customer Service
Located in Pittsburgh, PA - only the commercial and UPMC for Life (Medicare).
University of Washington Students & Graduate Appts 009 91136 WA 206-441-7574 Customer Service
Group # P67
Upper Peninsula Health Plan 940 38337 MI 800-835-2556 Customer Service
Located in Marquette, Michigan - Provider ID Number required
US Benefits 009 93092 ALL 806-473-2406 Desi Petrucci
Located in Portland, Oregon
US Family Health Plan 940 USFHP LA, TX 713-683-2018 Provider Services
Texas and Louisiana Providers Only. Enrollment Required.
USAA (United States Automobile Association) 009 74095 ALL 210-456-2906 Carolyn Sullivan
United States Automobile Assoc.
USAA (United States Automobile Association) 009 74095 ALL 210-456-2906 Carolyn Sullivan
United States Automobile Assoc.
VA Fee Basis Program 009 12115 ALL
Value Options - TESTING 813 00813 ALL
TESTING
Vantage Health Plan, Inc, 109 72128 LA 318-361-0900 Annette Napier
Located in Monroe, Louisiana
Varian Health Care Plan 372 68241 ALL
VHP Community Care 009 23173 TN 800-457-5683 Lori Bruelheide
Located in Nashville, TN
Virgina Premier Health Plan 042 VPN01 VA 800-727-7536 Provider Services
Located in Richmond, Virginia - see notes for specific claims addresses
Vision Care Incorporated 940 37297 FL 800-393-2873 Customer Service
Corporate office: Roswell, Georgia
Vision Insurance Plan of America 099 BVVP1 ALL 800-883-5747 Customer Service
Located in Milwaukee, Wisconsin
Vista Health Plan 109 55248 FL 800-833-2169 ext2206 Jim Gallagher
Payer Name EMC Type
Payer ID States Phone Contact
Located in Tallahassee. Florida-claims address-PO Box 45-9011, Sunrise FL, 33345
Vytra Healthcare 666 22264 ALL 613-694-4000 Nick Barbati
Claims address: P.O. Box 9091 Melville, NY 11747
W. C. Beeler & Company 009 62111 ALL 615-533-8785 Bob Martin
Located in Hendersonville, Tennessee
Walla Walla Valley Medical Service Corp. 372 93200 ALL 800-373-1477 Customer Service -
NDEX
Previously known as King County Medical-Walla Walla Valley-Req. Unique Prov. ID
Washington Dental Service 372 91062 ALL
Washington Employers Trust 940 37294 ALL 888-533-6822 Customer Service
Located in Seattle, Washington
Washington State Council of County & City 372 91136 ALL
Employees Dental Trust (Group # F36)
Watkins Associated Industries, Inc. 126 58082 GA 440-720-0700 ext 215 Tiffany Brown
Located in Atlanta, Georgia
Wausau 866 WC601 CA, CT, DC, DE, FL, GA, IL, MD, NC, NJ, NY, PA, SC, TN, VA, WI
WORK COMP
Wausau Benefits 372 39026 ALL 715-841-7399 Tammy Grosskurth
Located in Wausau, Wisconsin
Wausau Insurance Companies 109 39026 ALL 715-847-7942 Jennifer Ress
Located in Wausau, Wisconsin
WEA Insurance Group 372 39151 ALL 608-276-0632 Lola Bieri
WEA Insurance Group 009 39151 ALL 608-276-0632 Lola Bieri
WebTPA 940 75261 TX 866-393-2872 Customer Service
Located in Grand Prarie, Texas
Weis Markets 866 WC611 PA
WORK COMP
Wellmark Administrators, Inc. 235 00235 IA 800-407-0267 Provider Services
previously known as BAAI
WellMed 940 WELM2 TX 210-617-4099 Wellmed Claims Department
Located in San Antonio, Texas
WellPath of Carolina, Inc 666 25129 NC, SC 800-708-9355 Provider Services
Rendering Provider Network ID Required. Claims address - PO Box 7715, London, KY
Wellpoint Dental 372 47198 ALL
Payer Name EMC Type
Payer ID States Phone Contact
West Coast Stationary Engineers Health & Security 009 91136 AK, WA 206-441-7574 Customer Service
Group # F13
Western and Southern Financial Group 126 31048 ALL 440-720-0700 ext
205 Rebecca Karlinsky
Only claims with address: PO Box 5735, Cincinnati, Ohio 45201-5735
Western Growers Assurance Trust 109 24735 ALL 949-863-1000 x309 Connie Rich
Western Growers Insurance Company 109 24735 ALL 949-863-1000
x309 Connie Rich
Western Growes/Pinnacle Claims 109 24735 ALL 949-863-1000 X309 Connie Rich
Western Mutual Insurance/WMI-TPA 940 37247 UT 801-263-8000 Customer Service
Located in Murray, Utah
Weyco Inc. 009 38232 ALL
Claims address: PO Box 30132, Lansing, MI 48909
William J Sutton & Co. LTD 126 98010 ALL 440-720-0700 x205 Rebecca Karlinsky
Claims address: 33 Yonge St, Suite 420, Toronto, Ontario, Canada M5E1S9
Willis Administrative Services Corporation 009 62061 ALL 615-360-2843 Rene' Ernst
Located in Nashville, Tennessee
Willse (Carefirst Administrators-Maryland) 009 52118 MD 703-934-6215 Audria Tatken
Located in Owing Mills, Maryland
WinHealth Partners 009 WNHLT WY 800-868-7670 Customer Service
Located in Cheyenne, Wyoming
Winn-Dixie 866 WC761 AL, FL, GA, IN, KY, LA, MS, NC, OH, OK, SC, TN, TX, VA
WORK COMP
Wisconsin Auto and Truck Dealers 126 39200 WI 608-251-5577 Customer Service
Claims address: P. O. Box 5345, Madision, WI 53705
Wisconsin Employers Group 611 61101 ALL 800-558-4444 X 7448
Bonnie or Jody - MIS Dept.
Green Bay and Madison Wisconsin only
Wisconsin Physician Services Commerical 159 00159 IA, IL, MN, WI 800-221-6925 Provider Relations
Enrollment Required - Only Par Providers
World Insurance Company 940 75276 ALL 800-786-7557 Customer Service
Payer Name EMC Type
Payer ID States Phone Contact
Located in Omaha, Nebraska
Writers' Guild Industry Health Plan 009 23710 CA 800-227-7863 Participant Services
Located in Burbank, California
Xantus Health Plan - Tennessee - Dental 372 62154 ALL 615-463-1696 Trenece Eady
Located in Nashville, Tennessee
Zenith 866 WC601 CT, DC, DE, MD, NJ, NY, PA
WORK COMP
Zurich 866 WC641 CA, CT, DE, DE, FL, GA, IL, IN, MD, MO, NC, NJ, NY, PA, SC, TN, VAWI
WORK COMP