Revised 04/06/2010 **** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Payer List subject to change without notice Page 1 of 22 All States Payer List UB04 *****Requires Pre-Enrollment Pre.Enr. Payer ID Name Claims Type State 13162 1199 National Benefit Fund (Provider should submit claims with assigned Plan Provider ID, as 2 digit suffix is no longer require d. Call Renaud Dufresne at (646) 473-6960 for a list of Network ID's.) Comm 59069 21st Century Health and Benefits Comm 59069 21st Century Health and Benefits Comm 51028 21st Century Insurance and Financial Services (For Minnesota only) Comm MN 20413 3P Admin Comm 93044 A & I Benefit Plan Administrators Comm 37283 AAG - American Administrative Group (Formerly Gallagher Benefit Admin) Comm 75185 AAG - American Administrative Group (Formerly Icon Benefit Admin) Comm 75240 AAG Benefit Plan Administrators, Inc Comm 87726 AARP - Payer ID valid only for claims with a billing submission address of PO Box 30968 Salt Lake City, UT 84130 Comm 87726 AARP - Payer ID valid only for claims with a billing submission address of PO Box 31361 Salt Lake City, UT 84161 Comm 87726 AARP - Payer ID valid only for claims with a billing submission address of PO Box 31362 Salt Lake City, UT 84161 Comm 64071 Acclaim Comm 21356 Acclaim Repricing Comm 72467 ACS Benefit Services Inc. Comm 36112 ACS Rewards Administration Center Comm 91173 Adaptis Comm 38265 Administration Systems Research Health Benefits Comm 38265 Administrative Systems Research Corporation Comm 59141 Administrative Systems, Inc. Comm AMM01 Advanced Medical Management Comm & HMO CA AMM02 Advanced Medical Management MSI Comm & HMO CA 68056 Advantage by Bridgeway Health Solutions Comm 68056 Advantage by Buckeye Community Health Plan Comm 68056 Advantage by Managed Health Services Comm 68056 Advantage by Superior HealthPlan Comm 35209 Advantage Health Solutions Comm ADVTK Advantek Benefit Administrators Comm 25133 Advantra - Health Assurance - Health America, Inc. Comm 25133 Advantra Freedom Comm 95340 Adventist Health System West - Roseville, California Comm 36320 Advocate Health Centers Comm IL 65093 Advocate Health Partners Comm IL 33898 Aegis Security Insurance Company Comm PA 60054 Aetna Comm 57604 Aetna Affordable Health Choices (SM)- SRC Comm 23225 Aetna Better Health Comm 60054 Aetna Better Health - Connecticut Medicaid Comm 23225 Aetna Better Health - Connecticut Medicaid Comm 38692 Aetna TX Medicaid Comm ADOCS Affiliated Doctor’s of Orange County (ADOC) Comm 13333 Affinity Health Comm ***** 13334 Affinity Health Plan Comm 95426 Affordable Benefit Administrators, Inc. Comm 13346 AFTRA Health Fund Comm NY 37280 AGA Comm 64158 Agency Services Inc (Now known as Meritain Health) Comm 91136 Alaska Children's Services, Inc. Group #P68 Comm 91136 Alaska Laborers Construction Industry Trust Group # F23 Comm 91136 Alaska Pipe Trades Local Group # F24 Comm 91136 Alaska UFCW Health & Welfare Trust Group # F45 Comm 13550 ALICARE Comm 37602 All Savers Insurance Company Comm 81040 Allegiance Benefit Plan Management, Inc. Comm 13079 Alliance Healthcare - Stones River Regional IPA Comm HCP01 Alliance IPA Comm CA 23172 Alliance Partners Comm OH 52148 Alliance PPO, LLC Comm 58234 Alliant Health Plans of Georgia Comm GA ALL STATES
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 1 of 22
All States Payer ListUB04
*****Requires Pre-EnrollmentPre.Enr. Payer ID Name Claims Type State
131621199 National Benefit Fund (Provider should submit claims with assigned Plan Provider ID, as 2 digit suffix is no longer required. Call Renaud Dufresne at (646) 473-6960 for a list of Network ID's.)
Comm
59069 21st Century Health and Benefits Comm 59069 21st Century Health and Benefits Comm51028 21st Century Insurance and Financial Services (For Minnesota only) Comm MN20413 3P Admin Comm93044 A & I Benefit Plan Administrators Comm37283 AAG - American Administrative Group (Formerly Gallagher Benefit Admin) Comm75185 AAG - American Administrative Group (Formerly Icon Benefit Admin) Comm75240 AAG Benefit Plan Administrators, Inc Comm
87726 AARP - Payer ID valid only for claims with a billing submission address of PO Box 30968 Salt Lake City, UT 84130 Comm
87726 AARP - Payer ID valid only for claims with a billing submission address of PO Box 31361 Salt Lake City, UT 84161 Comm
87726 AARP - Payer ID valid only for claims with a billing submission address of PO Box 31362 Salt Lake City, UT 84161 Comm
64071 Acclaim Comm21356 Acclaim Repricing Comm72467 ACS Benefit Services Inc. Comm36112 ACS Rewards Administration Center Comm91173 Adaptis Comm38265 Administration Systems Research Health Benefits Comm38265 Administrative Systems Research Corporation Comm59141 Administrative Systems, Inc. Comm
AMM01 Advanced Medical Management Comm & HMO CAAMM02 Advanced Medical Management MSI Comm & HMO CA68056 Advantage by Bridgeway Health Solutions Comm 68056 Advantage by Buckeye Community Health Plan Comm 68056 Advantage by Managed Health Services Comm 68056 Advantage by Superior HealthPlan Comm 35209 Advantage Health Solutions Comm
ADVTK Advantek Benefit Administrators Comm25133 Advantra - Health Assurance - Health America, Inc. Comm25133 Advantra Freedom Comm95340 Adventist Health System West - Roseville, California Comm36320 Advocate Health Centers Comm IL65093 Advocate Health Partners Comm IL33898 Aegis Security Insurance Company Comm PA60054 Aetna Comm57604 Aetna Affordable Health Choices (SM)- SRC Comm23225 Aetna Better Health Comm60054 Aetna Better Health - Connecticut Medicaid Comm23225 Aetna Better Health - Connecticut Medicaid Comm38692 Aetna TX Medicaid Comm
ADOCS Affiliated Doctor’s of Orange County (ADOC) Comm13333 Affinity Health Comm
***** 13334 Affinity Health Plan Comm95426 Affordable Benefit Administrators, Inc. Comm13346 AFTRA Health Fund Comm NY37280 AGA Comm64158 Agency Services Inc (Now known as Meritain Health) Comm91136 Alaska Children's Services, Inc. Group #P68 Comm91136 Alaska Laborers Construction Industry Trust Group # F23 Comm91136 Alaska Pipe Trades Local Group # F24 Comm91136 Alaska UFCW Health & Welfare Trust Group # F45 Comm13550 ALICARE Comm37602 All Savers Insurance Company Comm81040 Allegiance Benefit Plan Management, Inc. Comm13079 Alliance Healthcare - Stones River Regional IPA CommHCP01 Alliance IPA Comm CA23172 Alliance Partners Comm OH52148 Alliance PPO, LLC Comm58234 Alliant Health Plans of Georgia Comm GA
ALL STATES
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 2 of 22
Pre.Enr. Payer ID Name Claims Type State94177 Allied Administrators - San Francisco, California Comm37308 Allied Benefit Systems, Inc. Comm25133 Altius Health Plan Comm25133 Altius Health Plan- Coventry Comm UT13550 Amalgamated Life Comm CO13343 Amalgamated Life IPA Alicare Comm75137 Ameriben Solutions Comm27517 Americaid Community Care - Maryland Comm MD27516 Americaid Community Care - New Jersey Comm NJ75240 American Administrative Group Comm37283 American Administrative Group -AAG (Formerly Gallagher Benefit Admin) Comm42112 American Administrators - West Des Moines, Iowa Comm63103 American Behavioral Comm34187 American Benefits Management - North Canton, Ohio Comm OH41161 American Chiropractic Network (ACN) Comm41160 American Chiropractic Network IPA of New York (ACNIPA) Comm60305 American Community Mutual Insurance CommAMF11 American Family Insurance Comm62030 American General Life & Accident Comm01066 American Healthcare Alliance Comm36369 American Imaging Management, Inc. Comm81949 American Insurance Company of Texas Comm TX87726 American International Group, Inc. (AIG) (Plan of United Healthcare) Comm72099 American LIFECARE Comm81400 American Medical Security Comm74048 American National Insurance Company (ANICO) Comm44444 American Postal Workers Union Comm48055 American Progressive Life and Health Insurance Company Comm 42011 American Republic Insurance Company (ARIC) Comm17965 American Sentinel Insurance Company Comm PA37322 American Worker Health Plan Comm86001 AMERICAS CHOICE Comm95378 AmeriChoice - Tenncare Comm TN87726 AmeriChoice of Connecticut Comm CT
86001 AmeriChoice of New Jersey Personal Care Plus (Medicare) (All claims require AmeriChoice provider id - call 888-362-3368 to obtain.) Comm NJ
86047 AmeriChoice of New Jersey, Inc. - Medicaid NJ Comm NJ
86002 AmeriChoice of New York Personal Care Plus (Medicare) (All claims require AmeriChoice provider id - call 888-362-3368 to obtain.) Comm NY
86048 AmeriChoice of New York, Inc. - Medicaid NY Comm NY
86003 AmeriChoice of Pennsylvania Personal Care Plus (Medicare) (All claims require AmeriChoice provider id - call 888-345-3627 to obtain.) Comm PA
95378 AmeriChoice of Tennessee Comm TN27519 Amerigroup - Florida Comm FL27514 Amerigroup - Georgia Comm GA27518 Amerigroup - Illinois Comm IL27516 AmeriGroup – New Jersey Comm NJ27518 Amerigroup - Ohio Comm OH27514 Amerigroup Community Care Comm27514 Amerigroup Community Care of New Mexico Comm NM27515 Amerigroup Corporation - Houston, Texas Comm TX27514 Amerigroup Corporation - Ft Worth, Texas Comm TX
***** 22248 Amerihealth Mercy Health Plan Comm53085 Anchor Benefit Consulting, Inc. Comm86062 Ancillary Benefit Systems - Arizona Foundation for Medical Care Comm AZ
SYMED Angeles IPA (SynerMed) Comm & HMO CA34192 Antares Management Solutions Comm16140 APA Partners, Inc. Comm34196 Apex Benefit Services Comm54160 APS Healthcare, Inc. Comm54100 APS Paper Claim Comm16120 ARAZ Comm77045 Arcadian Management Services, Inc. Comm CA36356 Argus Health Systems Comm75278 Arkansas Best Corporation Comm
***** 95440 Arnett Health Plans Comm36326 Associates for Health Care, Inc. (AHC) Comm39065 Assurant Health Comm
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 3 of 22
Pre.Enr. Payer ID Name Claims Type State37313 Assurant Health Self-Funded - Ft. Mill, South Carolina Comm SC37323 Assurant Mini - Med Key Family Comm88035 AssureCare, Inc. Comm74240 Assured Benefits Administrators Comm95691 Athens Area Health Plan Select Comm22304 Atlanticare also known as Horizon HealthCare Admin (HHA) Comm13853 Atlantis Health Plan Comm38259 Automated Benefit Services Comm37280 Automated Group Administration, Inc. Comm46045 Avera Health Plans Comm59274 AvMed, Inc. Comm FL03432 AZ Physicians IPA Comm
BKRFM Bakersfield Family Medical Center (Regal) Comm CA37248 Bass Administrators, Inc. Comm49153 BCI Administrators, Inc. Comm95377 Beech Street Comm63100 Behavioral Health Systems CommSYMED Bellflower Hospital (Synermed) Comm & HMO33192 Bencorp National Corporation Comm36149 Benefit Administrative Systems Comm25145 Benefit Coordinators Corporation (Pittsburgh, PA) Comm PA20018 Benefit Management Group, Inc. (BMGI) Comm37212 Benefit Management Systems, Inc Comm39081 Benefit Plan Administrators Company - Eau Claire, Wisconsin Comm WI37118 Benefit Plan Administrators, Inc. - Roanoke, Virginia Comm VA37222 Benefit Plan Management, Inc. Comm74223 Benefit Planners Comm38257 Benefit Source, Inc. Comm36342 Benefit Systems & Services, Inc. (BSSI) Comm87265 Benesight (formerly The TPA) Comm37248 Benesys Inc. Comm95604 Best Life & Health Insurance Company Comm32006 Better Health Plans of South Carolina Comm SC62183 Better Health Plans, Inc. CommSB590 Blue Cross Blue Shield DC National Region - CareFirst Comm DC00590 Blue Cross Blue Shield of Florida Comm FLSB690 Blue Cross Blue Shield of Maryland Region - CareFirst Comm MD00720 Blue Cross Blue Shield of Minnesota Comm
12000 Blue Cross Blue Shield of NCA Region - includes coverage for DC & Northern Virginia - CareFirst Comm DC
22099 Blue Cross Blue Shield of New Jersey (Horizon) Comm NJ00840 Blue Cross Blue Shield of Oklahoma Comm OKBC001 Blue Cross of CA - Anthem Comm CABS001 Blue Shield of CA Comm CA61124 Bluegrass Family Health Comm KY
***** 13337 BMC HealthNet Plan Comm36609 Boilermakers National Health & Welfare Fund Comm74238 Boon – Chapman Administrators, Inc. Comm
BOONG Boon Group, The Comm***** 13337 Boston Medical Center Health Plan, Inc. Comm MA
37286 BPA/Benefit Plan Administrators (North Dakota) Comm ND13310 BPS Inc. Comm52192 Bravo Health (PA, MD, DE, TX and DC) Comm37285 Bridgestone Claims Services Comm68054 Bridgeway Arizona Comm35182 Brodart Comm51037 Brokerage Concepts Comm94316 Brown & Toland Comm CA94316 Brown & Toland Comm CA
***** 32004 Buckeye Community Health Comm42150 Butler Benefit Comm33192 Cadent Administrators Comm33192 Cadent Underwriters Comm
***** 10301 Cahaba GBA (Medicare Part A Rural)– (formerly known as Riverbend) Gov't All States***** CALOP CalOptima Comm & HMO CA
71057 Cannon Cochran Management Services - Metairie, Louisana (PO Box 6794, Metairie, LA 70009) Comm LA
37105 Cannon Cochran Management Services, Inc. Comm
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 4 of 22
Pre.Enr. Payer ID Name Claims Type StateCAPMN Cap Management Comm CA38245 Cape Health Plan Comm23045 Capital Blue Cross - CAIC Comm87726 Capital Community Health Plan Comm68011 Capitol Administrators Comm57116 Care 1st Health Plan of Arizona Comm
38269 Care Choices/Preferred Choices (Enrollment required; please contact Noreen at (248) 489-5281) Comm MI
77082 Care Improvement Plus Comm
38269 Carechoices Michigan - Mercy Healthplans (Enrollment required; please contact Noreen at (248) 489-5281.) Comm
14182 CareCore National Comm14184 CareCore National - Healthnet Comm14185 CareCore National LLC - Health Net New Jersey Comm14179 CareCore National LLC (Aetna Radiology) Comm14180 CareCore National LLC (Oxford Radiology) Comm12000 CareFirst BCBS NCA Region - includes coverage for DC and Northern Virginia Comm12011 CareFirst BCBS of Maryland Comm25133 Carelink Health Plan Comm25133 Carenet Comm93975 CareOregon, Inc. Comm OR65031 CarePlus Health Plans Comm
MRCHP Caresource Health Plan of Oregon Comm OR***** 37311 CareSource of Indiana Comm IN
31114 CareSource of Ohio Comm OH10010 Careworks Comm62073 Cariten Healthcare Comm62072 Cariten Senior Health Comm56215 Carolina Behavioral Health Alliance Comm NC57105 Carolina Care Plan Inc. Comm56195 Carolina Summit Healthcare, Inc. Comm25125 Carpenter's Health & Welfare Trust Fund of St. Louis Comm55438 CBCA Administrators Comm41170 CBCA Administrators (HRM) Comm25133 CCN Managed Care Inc. Comm87065 CDO Technologies Comm95167 Cedars Sinai Medical Network- Encounters Comm95166 Cedars Sinai Medical Network- payable claims Comm91136 Cement Masons & Plasterers Health & Welfare Trust Group# F16 Comm
68050 Cenpatico Behavioral Health - Georgia (Prior to submitting claims, please call Provider Relations Dept at 800-947-0633) Comm GA
68048 Cenpatico Behavorial Health - Arizona (Prior to submitting claims, please call Provider Relations Dept at 800-947-0633) Comm AZ
68052 Cenpatico Behavorial Health - Indiana (Prior to submitting claims, please call Provider Relations Dept at 877-647-4848) Comm IN
68047 Cenpatico Behavorial Health - Kansas (Prior to submitting claims, please contact Provider Relations Dept at 866-896-7293) Comm KS
68056 Centene Advantage Plans Comm 13357 CenterCare Comm31118 Central Benefits Life Comm31118 Central Benefits Mutual Comm31118 Central Benefits National Comm02041 Central Mass. Health Care (CMHC) Comm34097 Central Reserve Life CommCIPA1 Central SeniorCare Comm36215 Central States Health & Welfare Funds CommIP079 Central Valley Medical Group Comm CA48120 Century Health Solutions Comm23171 CHA Health Comm
WPSTC Champus - TriWest Govn't84146 CHAMPVA - HAC Comm95748 Chartered Health Plan Comm DC16600 Chautauqua County Healthcare Plan - Mayville, New York Comm NY25151 CHCcares of South Carolina Comm SC59223 Chesapeake Life Insurance Company Comm34154 Chesterfield Technologies CommAMM03 Child Health and Disabillity Prevention Treatment (Advanced Medical Management) Comm & HMO CA80141 Childhealth Plus by Healthfirst (CHP) Comm
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 5 of 22
Pre.Enr. Payer ID Name Claims Type State84146 Children of Women Vietnam Veterans - VA HAC Comm94302 Chinese Community Health Plan Comm38692 CHIP Comm33065 CHOC - Children's Hospital of Orange County Health Alliance Comm
UHSCH Choice One/UTMB CHIP Health Plan (Please contact payer before sending claims-1-877-238-8543) Comm
61271 Christian Brothers Services Comm62308 CIGNA - PPO Comm62308 CIGNA Health Plan Comm62308 CIGNA Health Plan - HMO Comm86033 CIGNA Healthcare for Seniors - Arizona Medicare Comm62308 CIGNA PPA Comm75600 City of Odessa Comm57080 Claimsware, Inc. DBA ManageMed Comm33192 Clarendon's Healthy Kids Comm02041 CMHC Comm
AMM03 CMS - Custody Medical Services (c/o Advanced Medical Management) CommAMM01 CMS (Custody Medical Services) (Advanced Medical Management) Comm & HMO CA37310 Coast Hotels & Casino, Inc. / DBA Coast Benefits Comm
COAST Coastal TPA Comm38335 Cofinity Comm37123 Colonial Healthcare Comm91162 Columbia United Providers Comm
***** 34181 Commerce Benefits Group Comm37237 Commonwealth Administrators, LLC. Comm14315 Commonwealth Care Alliance Comm25179 Community Care Behavioral Health Organization Comm23282 Community Care BHO Comm73143 Community Care Managed Health Care Plans of OK Comm OK39126 Community Care Organization Comm61948 Community Choice Health Plan of Westchester Comm38325 Community Choice of Michigan Comm MI26231 Community Claims Administration Comm
SYMED Community Family Care (SynerMed) Comm & HMO CACOMMF Community First Comm35193 Community Health Alliance Comm48145 Community Health Choice Comm75261 Community Health Electronic Claims/CHEC/webTPA Comm62149 Community Health Network of Connecticut Comm CT
90010 Community Health Plan (located in St. Joseph, MO. Service Area includes NW Missiouri, NE Kansas, SW Iowa, SE Nebraska) Comm
12T30 Community Health Plan of Washington CommCMGWV Community Medical Group of the West Valley Comm
32481 Community Premier Plus for Neighborhood Health Providers Comm34177 Comp - Ohio (Austintown, OH) Comm OH37297 CompBenefits Corporation Comm59314 Comprehensive Behavorial Care Comm03036 Comprehensive Benefits Administrator, Inc. Comm78375 Connecticare Medicare Comm CT06105 Connecticare, Inc. Comm37307 Connecticut Carpenters Health Fund Comm CT62308 Connecticut General Comm37135 Consociate Group Comm75284 Consolidated Associates Railroad Comm87843 Consolidated Health Plans Comm71404 Continental General Insurance Company Comm55544 Conversion Plan - APWU Comm
CCHP1 Cook Childrens Health Plan Comm35149 Cook Group Heath Plan Comm52132 Cooperative Benefit Administrators (CBA) Comm35199 Cooperative Managed Care Services Comm58204 Coordinated Medical Specialists Comm41045 CoreSource AZ MN Comm75136 CoreSource Little Rock Comm AR35182 CoreSource MD PA IL Comm35180 CoreSource NC IN Comm35183 CoreSource OH Comm OH35202 Cornerstone Benefit Adminstrators Comm
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 6 of 22
Pre.Enr. Payer ID Name Claims Type State
41124 Corp. Benefit Services/CBSA/Fortis Self Funded Admin (Now known as Meritain. Payer ID valid only for claims with a billing submission address of P.O. Box 27267, Minneapolis, MN 55427-0267) Comm
56116 Corporate Benefits Service, Inc. (NC) Comm NC37246 Corporate Systems Administration Comm43160 Correctional Medical Services, Inc. Comm62553 Country Life Insurance Company CommMCS03 County of Kern POS CA58102 Covenant Administrators, Inc. (Atlanta, GA) Comm25133 Coventry Advantra (Texas, New Mexico, Arizona) Comm25133 Coventry Health & Life – Oklahoma Comm OK25133 Coventry Health Care National Network (f.k.a. First Health Direct) Comm25133 Coventry Health Care of Delaware, Inc. Comm DE25133 Coventry Health Care of Georgia, Inc. Comm GA25133 Coventry Health Care of Nebraska, Inc. Comm NE25133 Coventry Healthcare of Iowa Comm IA25133 Coventry Healthcare of Kansas, Inc. - Wichita Comm KS25133 Coventry Healthcare of Louisiana Comm LA25133 Coventry Healthcare of Missouri Comm MO64068 Creative Medical Systems Comm37320 Creative Plan Administrators Comm37266 Croy-Hall Management, Inc. Comm
AMM03 Custody Medical Services - CMS (c/o Advanced Medical Management) Comm39170 Custom Benefit Administrators Comm82056 Custom Design Benefits Comm57080 CWIBENEFITS, INC. Comm
***** 95740 DC Chartered Health Plan, Inc. (Alliance) Comm95748 DC Chartered Health Plan, Inc. (Medicaid & Alliance) Comm95740 DC HealthCare Alliance Comm DC87726 Definity Health Comm27009 Delaware Physicians Care Comm94235 Delta Health Systems Comm84134 Denver Health - Indigent Comm84133 Denver Health and Hospital Authority Comm CO84135 Denver Health Medical Plan Comm CO84131 Denver Health Medical Plan, In. - Medicare Choice Comm36436 Destiny Health Comm56240 Detroit Medical Center Comm MI25133 Diamond Plan Comm23706 Director's Guild of America - Producer Health Plans Comm06102 Diversified Administration Corporation Comm74284 Driscoll Children's Health Plan Comm35186 Dunn & Associates Benefits Administrators, Inc Comm
SYMED East LA Doctors Hospital CommEMG11 Eastland Medical Group CommEBC01 EBC (Buffalo Rock) Birmingham Comm AL34166 EBS of Ohio (PO Box 2568, Mansfield, OH 44906) Comm OH73288 EHI (Employers Health Insurance) CommEPT03 El Paso First - CHIP Comm52192 Elder Health HMO of Pennsylvania Comm PA52192 Elder Health Maryland HMO Inc. Comm MD
***** 31625 ElderPlan, Inc. Comm37253 Elmco Comm31074 EMBC (Employee Benefit Management Corp) Comm OH34167 Emerald Health Network, Inc. (All PPO Business) CommAMM03 Emergency Medical Service Fund (EMSF) (Advanced Medical Management) Comm & HMO CA73288 EMI-KP Ambulance Claims Comm73288 Emphesys Comm38241 Employee Benefit Concepts Comm37215 Employee Benefit Corporation CommCX025 Employee Benefit Management Corp Comm OH31074 Employee Benefit Management Corp. (EBMC) aka Big Lots Assoc Benefit Plan Comm03036 Employee Benefit Plan Administration (E.B.P.A.) Comm VT37216 Employee Benefit Services - Ft. Mill, South Carolina Comm41198 Employee Benefit Services - Louisana Comm75184 Employee Claim ADJ Comm
SYMED Employee Health Systems Comm & HMO CA35112 Employee Plans, LLC Comm
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 7 of 22
Pre.Enr. Payer ID Name Claims Type State74212 Employer Plan Services Comm75232 Employers Direct Health Comm75236 Employer's Direct Health - Employee Plan Comm75235 Employer's Direct Health - Fully Insured Comm75233 Employer's Direct Health - Self Comm73288 Employers Health Insurance Comm59298 Employers Mutual, Inc. (Jacksonville, Florida) Comm59331 Employers Mutual, Inc. (Stuart, Florida) Comm FL
AMM01 EMSF (Emergency Medical Service Fund) (Advanced Medical Management) Comm & HMO CA35206 Encircle PPO Comm35206 Encore Health Network Comm36364 ENH Medical Group IPA Comm91136 Enstar Natural Gas, Group # P61 Comm62308 Equicor Comm62308 Equicor - PPO Comm73126 Equitable Plan Services - Oklahoma City, OK Comm OK23250 Erin Group Administrators Comm74234 ERISA Comm34108 ES Beveridge & Associates Comm20818 Essence Healthcare Comm34159 E-V Benefits Management, Inc (Columbus, OH) - Now known as Meritain Health Comm OH87726 Evercare Comm07501 Evercare Star Plus Comm58233 Evergreen Health Plan Comm59313 Evolutions Healthcare Systems - New Port Richey, FL Comm71412 Exclusicare Comm91136 F40 Alaska Carpenters Trust Comm37300 FACS Group Comm22254 Fallon Community Health Comm43173 Family Health Partners - MC + Missouri Comm MO31472 Family Health Partners Healthcare of Kansas Comm36396 Family Medical Network Comm37289 FARA Benefit Services, Inc. Comm14140 Farm Family Life Comm33033 FCE Benefit Administrators Comm00932 Federal Employees Plan WA (Regence Blue Shield) Comm WA37300 Federated Benefits Comm37300 Federated HR Services Comm41041 Federated Mutual Health Insurance Company Comm MN11315 Fidelis Care New York Comm NY56196 First Carolina Care Comm NC91131 First Choice Health Network Comm
***** 14162 First Choice HealthPlans of Connecticut Comm75138 First Choice of Midwest (PPO) Comm25133 First Health (CCN Managed Care and PPO for OK) Comm25133 First Health (CCN Managed Care and PPO for OK) Comm25133 First Health (See..Coventry Health Care National Network - Effective 1/1/07) Comm59276 First Service Administrators also known as Florida 1st Comm94999 FirstCare Comm
***** 90061 FirstGuard Missouri Comm MO62061 Fiserv Health - Kansas & Tennessee Comm39026 Fiserv Health - Wausau Benefits - Benesight Comm11244 Fitzharris & Company, Inc. Comm59321 Florida Hospital Healthcare Systems Comm FL48116 Florida Hospital Waterman Comm FL59698 Florida League of Cities Comm48117 FMH Benefit Services, Inc. Comm37305 Ford Meter Box Company Inc., The Comm25133 Foreign Service Benefit Plan Comm 87066 Formax, Inc. Comm39065 Fortis (Formerly Time Insurance) Comm64069 Fox-Everett Comm41212 Freedom Health Plan Comm62324 Freedom Life Insurance Company Comm TX
FMCHP Fresenius Medical Care Comm59069 Fringe Benefit Management Comm59069 Fringe Benefit Management Comm59204 Fringe Benefits Coordinators Comm
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 8 of 22
Pre.Enr. Payer ID Name Claims Type State34171 FrontPath Health Coalition Comm30005 Galveston County Indigent Health Care Comm60550 Gateway Health Plan - Medicare Assured Comm25169 Gateway Health Plan Medicaid PA Comm76028 Gateway Health Plan of Ohio Comm91741 Gateway Health Plan of Ohio - Medicare Assured Comm37283 GBA Comm67815 GEGLAC - G.E. Group Life Comm
75273Geisinger Health Plans (provider enrollment is required. Please call HIP Provider Relations to obtain the enrollment form at (800) 447-8386 or e-mail at [email protected])
Comm
MCS01 GEMCare (Golden Empire Managed Care System) Comm & HMO CAMCS03 GemCare Health Plan, Kern County EPO Comm46050 Generations Healthcare Comm46051 Generations- Hillcrest Comm67815 Genworth Life and Health Insurance Company (GLHIC) (Formerly GEGLAC) Comm23212 Gettysburg Health Preferred Comm 22937 GHI - Medicare Private Fee for Service Comm13551 GHI - New York (Group Health, Inc.) Comm25531 GHI HMO Comm25133 GHP Group Health Plan Comm58204 GI Innovative Management Comm80314 GIC Indemnity Plan Comm07205 Gilsbar Comm
AMM02 Glendale Physicians Alliance (GPA Medi-Cal and GPA Healthy Families claims only) (GPA Senior and GPA Commercial claims should be sent through REGAL) Comm
07689 Global Care Inc. Comm75246 GM Southwest Comm TX47083 GMS, Inc. Comm37602 Golden Rule Insurance Company CommMBA01 Golden State Medical Group Comm68041 Golden State Physicians Medical Group CommAMM01 Good Samaritan Medical Practice Association (GSMPA) Comm CA44054 Government Employees Hospital Association (GEHA) Comm37234 Grant Physicians Practice Association Comm95467 Great Lakes Health Plan Comm80705 Great West Health Care CommHCP01 Greater Valley Comm CA78521 Greentree Administrators Comm TX36338 Group Administrators Ltd. Comm48143 Group and Pension Administrators Comm72153 Group Benefit Administrators (Hendersonville, TN) Comm TN
***** 91121 Group Health Cooperative - East Comm95192 Group Health Cooperative of Eau Claire Comm WI39167 Group Health Cooperative of South Central Wisconsin Comm WI39168 Group Health Cooperative of South Central Wisconsin Comm WI91051 Group Health Cooperative, Healthy Options Comm91051 Group Health Cooperative, Medicare Plus Choice Comm91051 Group Health Cooperative, Washington State Comm38194 Group Health Managers Comm91051 Group Health Northwest Comm91051 Group Health Options, Alliant Comm91051 Group Health Options, Washington State Comm37276 Group Insurance Service Center Comm
***** 68046 Group Practice Affiliates Comm64246 Guardian Life (The Guardian) Comm39180 Gunderson Lutheran Health Plan Comm WI37114 H.E.R.E.I.U Welfare Pension Funds Comm38224 HAP/AHL/Curanet Comm MI
***** 36405 Harmony Health Plan of Illinois Comm IL***** 36405 Harmony Health Plan of Indiana Comm IN
HCP01 Harrimon Jones Comm CA95266 Harrington Benefit Services, Inc. Comm95266 Harrington Benefit Services, Inc. - Centra Comm
59152 Harrington Benefits Services-Oklahoma, State of Oklahoma-Healthchoice, City of Oklahoma City, Department of Rehabiltative Services, Department of Corrections, Mayes County Ja Comm OK
48330 Hawaii Management Alliance Association (HMAA) Comm HI37111 HCH Administration (Illinois) Comm
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 9 of 22
Pre.Enr. Payer ID Name Claims Type State37215 HCH Administration, Inc. Comm37329 HCHA Albq-Self Funded Comm82018 HCS - Health Claims Service (Boise, ID) Comm ID20257 HDPC - Alliance Physicians (High Desert Primary Care Alliance) Comm CA90023 HDPC - Premier Care (High Desert Primary Care Premier) Comm CA23173 Health 1,2,3, Inc. Comm
***** 77950 Health Alliance Medical Plan Comm38224 Health Alliance Plan of Michigan Comm MI25133 Health America Inc. - Health Assurance - Advantra Comm42102 Health Care Network of Wisconsin (HCN) Comm WIHCP01 Health Care Partners Comm56142 Health Care Savings Comm62111 Health Cost Solutions Comm34158 Health Design Plus (Hudson, Ohio) Comm OH20356 Health Exchange, The (Center Corporation) Comm16120 Health EZ Comm95019 Health First Health Plans Comm FL30946 Health Future LLC Comm55247 Health Insurance Plan of Greater NY (HIP) Comm NY62295 Health Market Care Assured Comm95567 Health Net (Claims Only) Comm95568 Health Net California (Institutional Encounters Only) Comm CA
***** 38309 Health Net of Arizona - Payer requires unique provider ID; please call the Provider Call Unit at 800-289-2818 Comm AZ
95567 Health Net of California & Oregon - Claims Comm CA
***** 06108 Health Net of the Northeast - Payer requires unique provider ID; please call the Provider Call Unit at 800-438-7886 Comm
20199 Health Network America Comm36368 Health Options of Illinois Comm IL
***** HPAMN Health Partners of Minnesota Comm MN62157 Health Partners of Tennessee Comm TN
80142Health Partners, PA (All claims submitted require a valid Health Partners, PA, provider ID in the Rendering Provider Network ID field)
Comm PA
52563 Health Plan of Michigan Comm MI34150 Health Plan, The (Massillon, Ohio & St. Clairsville, Ohio only) Comm44273 Health Plans, Inc. Comm11324 Health Plus PHSP (Brooklyn, NY) Comm NY55438 Health Risk Management Comm20896 Health Services Consulting Group Comm37290 Health Services for Children with Special Needs Comm34167 Health Services Preferred (HSP) by Emerald Health Comm27008 Health Systems International - ECOH Comm35206 Healthcare Group, The Comm11328 Healthcare Partners IPA - New York Comm
***** HCP01 HealthCare Partners, IPA Comm CA73147 Healthcare Solutions Group Comm25143 Healthcare USA Comm36335 Healthcare's Finest Network (HFN) Comm62179 HealthChoice of Arizona Comm85729 Healthcomp Inc. Comm80141 Healthfirst 65 Plus Comm80141 Healthfirst Family Health Plus (FHP) Comm80141 Healthfirst Inc - New York (Commercial) Comm80141 Healthfirst PHSP Comm75234 Healthfirst TPA (Tyler, TX) Comm
96475 Healthlink HMO (Please call Provider Relations Dept at (800) 624-2356 for unique provider number. ) Comm
90001 Healthlink PPO (Please call Provider Relations Dept at (800) 624-2356 for unique provider number. ) Comm
59140 HealthPlan Services (Tampa Only) Comm95009 HealthPlus of Louisiana Comm LA71063 HealthSCOPE Benefits, Inc Comm75250 HealthSmart Preferred Care Comm02041 Healthsource CMHC Comm68195 Healthsource Provident (CIGNA) Comm71075 Healthsource, AR (Med) (CIGNA) Comm58210 Healthsource, GA (CIGNA) Comm GA
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 10 of 22
Pre.Enr. Payer ID Name Claims Type State61127 Healthsource, KY (CIGNA) Comm KY02041 Healthsource, MA (CIGNA) Comm
01041 Healthsource, ME (Payer requires unique provider ID;please contact (800) 909-2227, ext.5760) Comm
75255 Healthsource, N. TX (CIGNA) Comm56147 Healthsource, NC (CIGNA) Comm02038 Healthsource, NH (CIGNA) Comm31141 Healthsource, OH (CIGNA) Comm OH06119 Healthsource, SC (CIGNA) Comm62129 Healthsource, TN (CIGNA) Comm63092 HealthSpring HMO/HealthSpring Medicare+Choice Comm36332 HealthStar, Inc. Comm58213 Healthways WholeHealth Networks Comm22148 Heavy & General Labors Fund of New Jersey Comm59230 Heritage Consultants Comm33069 High Desert Primary Care - Hesperia, California Comm35145 Highmark - Key Family Comm35145 Highmark - Key Family Comm59347 Hillcrest Benefit Administrators CommHPFFS Hispanic Physicians IPA Fee For Service - Encounters Only - Payer ID Required Comm
***** 86066 HMA Hawaii CommSYMED Hollywood Presbyterian (Synermed) Comm & HMO CACAPMN Hollywood Presbyterian Medical Group- (now known as Prudent Medical Group) Comm CA22099 Horizon BCBS of New Jersey Comm22304 Horizon HealthCare Admin (HHA) Comm22099 Horizon Healthcare of New York Comm22326 Horizon NJ Health Comm NJ37274 Hospital Benefits Comm91136 Hotel Employees & Restaurant Employees Health Trust, Group # F19 Comm58227 HPS Paradigm Comm13335 Hudson Health Plan (Please contact payer before sending claims- 914-631-1611) Comm61101 Humana Emphesys Comm61101 Humana Employers Health Insurance Comm61102 Humana Encounters Comm61101 Humana Gold Choice Comm61101 Humana Insurance Company Choice Care Network Comm61125 Humana Military - Tricare South Comm72127 Humana Ochsner 1 Comm61101 Humana Ochsner 1 Comm
OCH01 Humana Ochsner 2 Comm61101 Humana Ochsner 2 Comm65018 Humana Puerto Rico Comm61101 Humana, Inc. Comm
HDNFC Humboldt-Del Norte Foundation IPA Comm37260 Hunt Insurance Group Comm22175 I. E. Shaffer - West Trenton, NJ Comm37279 IAA (Insurance Administrator of America, Inc.) Comm12X26 IBC Personal Choice Comm
BS001 IBEW Local 6 - San Francisco Electrical Workers *They will all have a prefix code of "XEL" as their member ID on the BSC card. Comm
37296 ICM - Interstate Choice Management Comm75274 IHG Direct Comm41600 IMCARE Comm40585 INDECS Corporation Comm35204 Indiana Health Network Comm IN35161 Indiana ProHealth Network Comm35107 Indiana Teamsters Health Benefits Fund (Indianapolis, IN) Comm IN31053 Individual Health Insurance Companies Comm52196 Informed, LLC Comm52212 Injured Workers Insurance Fund Comm37279 Insurance Administrator of America, Inc. (IAA) Comm13315 Insurance Design Administrators Comm88006 Insurance Management Services (Elko, NV) Comm NV86304 Insurers Administrative Corp. Comm51020 Integra Administrative Group (Seaford, DE) Comm DE
***** 31127 Integra Group Comm31129 Integra Group-CHA CommINET1 Integranet Comm
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 11 of 22
Pre.Enr. Payer ID Name Claims Type State74314 Integrant - SelectCare of Texas Comm34167 Integrated Care Network (ICN) by Emerald Health Comm
68053 Integrated Mental Health Service (Prior to submitting claims, please call Provider Relations Dept at 1-800-716-5650 to verify your provider info is on file in the claim system) Comm
58200 Integrity Benefit Group, Inc. Comm37227 InterCare Health Plans Comm60280 Interface EAP (IEAP) Comm23287 Intergroup Services Corporation Comm36609 International Brotherhood of Boilermakers Comm37269 International Union of Operating Engineers ~ Local 15, 15A, 15C & 15D Comm37296 Interstate Choice Management Comm84137 Interwest Health (Acceptius Gateway Payer) Comm20435 Intgritas Benefit Group Comm41124 Iowa Benefits Comm37272 J. Smith Lanier & Co. Administrators Comm61271 J.F. Molloy & Associates Comm05014 Jackson Memorial Health Plan - Florida Comm41099 John Alden Life Insurance Co. Comm
JMH01 John Muir Health Network (If you have never submitted claims to John Muir before, please fax your W-9 with contact name and # to Patty Kan 925-941-2026) Comm
***** 52189 Johns Hopkins Healthcare Comm43178 Joplin Claims Comm34136 JP Farley Corporation Comm37272 JSL Administrators Comm94320 Kaiser CSI - California Select for Individuals (formerly known as Kaiser PPO) Comm91617 Kaiser Foundation Health Plan of Colorado Comm
KSRCS Kaiser Foundation Health Plan of Colorado ( Colorado Springs only) Comm COCOKSR Kaiser Foundation Health Plan of Colorado ( except Colorado Springs) Comm CO21313 Kaiser Foundation Health Plan of Georgia Comm GAKS005 Kaiser Foundation Health Plan of Ohio Comm OHKS001 Kaiser Foundation Health Plan of Southern CA Region Comm52095 Kaiser Foundation Health Plan of the Mid-Atlantic States (MD, VA and DC) CommNW002 Kaiser Foundation Health Plan of the Northwest Comm57038 Kanawha Healthcare Solutions Comm57038 Kanawha Insurance Company Comm
KMG11 Katy Medical Claims Comm73100 Kempton Company Comm73100 Kempton Group Administrators CommMCS03 Kern County EPO, (GemCare Health Plan) Comm77039 Kern Health Systems Comm CA37217 Key Benefit Administrators - Indianapolis, Indiana CommIP082 Key Medical Group Comm CA37321 Key Select Comm23284 Keystone Mercy Health Plan Comm PA34145 Klais & Company Comm
KAMG1 Korean American Medical Group CommKPS01 KPS Health Plans Comm WALACAR LA Care Comm & HMO CA72068 LA Carpenters Reg Council Health Benefit Trust Fund Comm LA72602 LA Carpenters Reg Council Welfare Fund Comm LA72603 LA Laborers Health & Welfare Fund Comm WV
LMG11 Lakeside Medical Group Comm36333 Lawndale Christian Health Center Comm52193 LBA Health Plans Comm65055 Leon Medical Center Health Plan Comm37248 LHP Claims Unit Comm37281 Liberty Union Comm87071 Liberty Health Advantage Comm37281 Liberty Union Comm37281 Life Assurance Associates Comm37281 Life Assurance Company Comm41136 Life Trac Comm
***** 91049 LifeWise (of Washington), A Premera Healthplan Comm WA***** 91155 LifeWise of Arizona, A Premera Healthplan Comm AZ***** 93093 LifeWise of Oregon, A Premera Healthplan Comm OR
73288 Lincoln National (EMPHESYS) Comm35107 Local 135 Health Benefits (Indianapolis, IN) Comm IN
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 12 of 22
Pre.Enr. Payer ID Name Claims Type State37267 Loma Linda University Adventist Health Sciences Center Comm37267 Loma Linda University Adventist Health Sciences Center Employee Health Plan Comm37267 Loma Linda University Behavorial Medicine Center Employee Health Plan Comm37267 Loma Linda University Employee Health Plan Comm33036 Loma Linda University Healthcare - ManagedCare Claims Comm37267 Loma Linda University Healthcare Employee Health Plan Comm
***** 23223 Loomis Company, The - TPA Wyomissing, PA (IHS Gateway Payer) CommSYMED Los Angeles Metro Medical Center Comm CASX159 Lovelace Salud (Medicaid claims only)90328 Lovelace Sandia Health Plan Comm37292 Machinist District 9 Welfare Comm36334 MacNeal Health Providers-CHS CommHCP01 Magan Medical Clinic Comm CA01260 Magellan Behavioral Health Services Comm12X27 Magellan Health Services for UB Comm11303 Magnacare Comm25133 Mailhandlers Benefit Plan (CAC) Comm22195 Maksin Management Corporation Comm52149 MAMSI Comm52148 MAMSI Life & Health Insurance Company (MLH) CommMCS03 Managed Care GemCare Health Plan Comm CA35162 Managed Care Services CommMCS02 Managed Care Systems (Delano Regional Med. Grp.) Comm CAMCS01 Managed Care Systems (GEMCARE) Comm CA22771 Managed Health Network (MHN) Comm
39186 Managed Health Services Indiana (Medicaid HMO) (Prior to submitting claims, please call Provider Relations Dept at 800-944-9661 to verify your provider info is on file.) Comm IN
***** 39187 Managed Health Services Wisconsin Comm WI41159 Managed Physical Network Comm41555 Manatee Service Center - Bradenton, Florida Comm98010 Manulife W.J. Sutton Company Comm13310 Marsh Advantage Comm22347 Maryland Health Insurance Plan Comm MD00247 Maryland Physicians Care Comm MD37121 Mashantucket Pequot Tribal Nation Comm
MMPHB Masters Mates and Pilots Program Comm41154 Mayo Management Services, Inc. (MMSI) Comm
87065 MBA Benefit Administrators (Payer ID valid for claims with a submission address of PO Box 651109, Salt Lake City, UT 84115) Comm UT
87065 MBA of Wyoming (Payer ID valid for claims with a submission address of PO Box 98, Worland, WY 82401) Comm WY
56205 MBS - Formerly MedCost Benefit Services Comm25160 MCA Admin (Formerly DGA) Comm PA38264 Mcare Comm38338 McLaren Health Plan Comm52148 MD - Individual Practice Association, Inc. (M.D. IPA) Comm20475 Mdwise Hoosier Alliance Comm58202 MedAdmin Solutions Comm58204 MedAdmin Solutions Comm74323 MedBen - Newark, Ohio Comm OH59231 MedCom Comm56162 MedCost, Inc. Comm95321 Medfocus Comm94265 Medica Comm68041 Medical Benefit Administration, Inc Comm37298 Medical Benefit Administrators of Maryland CommMBA01 Medical Benefits Administrators Comm74323 Medical Benefits Administrators, Inc. (Newark, OH) Comm OH74323 Medical Benefits Companies (Newark, OH) Comm OH74323 Medical Benefits Mutual Life Insurance Co. Comm04258 Medical Claims Service, Inc. Comm75229 Medical Control, Inc. Comm52181 Medical Development International Comm29076 Medical Mutual of Ohio Comm OH62177 Medical Reimbursements of America Comm62117 Medical Reimbursements of America Comm58203 Medical Resource Network (MRN) Comm
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 13 of 22
Pre.Enr. Payer ID Name Claims Type StateAMM02 Medical Services For Indigents (MSI) (Advanced Medical Management) Comm & HMO CA
***** MC051 MediCal type 04 Govn't CA38224 Medical Value Plan (MVP) - Ohio Comm OH
***** 01001 Medicare CA Gov CA***** 10301 Medicare Tennessee Gov't TN
95655 Medigold Comm OH13123 Medigold PPO Comm OH62160 MedSolutions, Inc Comm GA59221 Mega Life & Health Insurance Company - Insurance Center Comm59227 Mega Life & Health Insurance Company, The - OKC Comm59225 Mega Life & Health Insurance Company, The - Starbridge Star HRG Comm01047 MEMIC CommMCA11 Memorial Clinical Associates / SelectCare of Texas (MCA) CommMHHNP Memorial Hermann Health Net-Providers CommHCP01 Memorial Medical Group Comm CA13310 Mercer Administrators Comm86052 Mercy Care Plan (AHCCCS) Comm AZ
MER11 Mercy Health Plan CommIP079 Mercy Physicians Medical Group (MPMG) (NAMM Southern CA) Comm AZ
38232 Meritain Health (Formerly know was Weyco) – Payer ID valid for claims with billing submission address of 2370 Science Parkway Okemos, Michigan 48864 Comm
41124Meritain Health (Formerly known as Corp. Benefit Services/CBSA/Fortis Self Funded Admin and Performax, Inc. Payer ID valid only for claims with a billing submission address of P.O. Box 27267, Minneapolis, MN 55427-0267)
Comm
34159 Meritain Health (Formerly known as E-V Benefits Management, Inc, Columbus, OH) Comm
34159Meritain Health (Formerly known as NABN, Columbus, OH.) Payer ID valid only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476.
Comm
34159Meritain Health (Formerly known as North American Benefits Network, Cleveland, OH). Payer ID valid only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476
Comm
64157 Meritain Health (formerly North American Administrators, Inc.) Comm64158 Meritain Health/Agency Services (formerly Agency Servicess, Inc.) Comm64157 Meritain Health/North American Administrators Comm85035 Mesa Mental Health Comm NM23550 Methodist First Choice Comm13265 Metro Plus Health Plan Comm10850 Metropolitan Health Plan Comm MN10850 Metropolitan Health Plan Comm MN37127 Michael Reese Physicians Group Comm52148 Mid Atlantic Psychiatric Services, Inc. (MAPSI) CommMRIPA Mid Rogue Oregon Health Plan Comm OR37281 Mid-America Associates Inc. Comm37281 Mid-America Associates, Inc. Comm
SYMED Mid-County Physicians Medical Group (San Diego) (Synermed) Comm & HMO
47080 Midlands Choice, Inc. Comm
62168 MidSouth Administrative Group CommMHP77 Midwest Health Partners CommMPH77 Midwest Health Plans, Inc. Comm59224 Mid-West National Life Insurance Company of Tennessee Comm79480 MidWest Security Admin Comm79480 Midwest Security Administration Comm05018 MIPS Comm
SYMED Mission Community Hospital of Huntington Park Comm CA37233 Mississippi Public Entity Employee Benefit Trust (MPEEBT) Comm MS64088 Mississippi Select Health Care Comm MS37275 Missoula County Medical Benefits Plan Comm43179 Missouri Care/MC Comm37265 MLink Comm51062 Molina Healthcare - Florida Comm00076 Molina Healthcare - Indiana Comm38334 Molina Healthcare - Michigan Comm MI20676 Molina Healthcare - Nevada CommNM505 Molina Healthcare - New Mexico Comm20149 Molina Healthcare - Ohio Comm OH38336 Molina Healthcare - Washington Comm WA50749 Mondial Assistance Comm VA
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 14 of 22
Pre.Enr. Payer ID Name Claims Type State***** 13174 Montefiore Contract Management Organization Comm
MMLI3 Monumental Life Insurance Co (Hurst, TX) Comm TXMMLIC Monumental Life Insurance Co (Little Rock, AR) Comm ARMMLI2 Monumental Life Insurance Co. (Louisville, KY) Comm KY35092 Morris Associates CommIP083 Mosaic Medical Group Comm CA36111 Motorola Comm84095 Mountain Medical Affiliates Comm86040 Mountain States Administrative Services (Tucson, AZ) Comm37233 MPE Services Inc. Comm MS35177 MPLAN (Medicaid) Comm95444 MPLAN, Inc. - HealthCare Group Comm
AMM02 MSI (Medical Services For Indigents) (Advanced Medical Management) Comm & HMO CA95655 Mt Carmel Comm OH
SYMED Multicultural Primary Care Medical Group (San Diego) (Synermed) Comm & HMO39634 Multiplan Inc for American Family Comm34080 Multiplan Wisconsin Preferred Provider Network Comm37256 Mutual Assurance Comm OK59140 Mutual Group (The) (US) Comm71412 Mutual of Omaha Comm71412 Mutually Preferred Comm
***** 38224 MVP - Ohio Comm14165 MVP Health Plan of NY (For your MVP Provider number, call 800-684-9286) Comm NY91136 N.W. Ironworkers Health & Security Trust Fund Comm91136 N.W. Roofers & Employers Health & Security Trust Fund Comm91136 N.W. Textile Processors Comm
34159NABN (Columbus, OH) Now known as Meritain Health. Payer ID valid only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476
Comm OH
53011 National Association of Letter Carriers (NALC) Comm56175 National Benefit Administrators - New Jersey Comm NJ56176 National Benefit Administrators - North Carolina Comm
90001 National Capital Preferred Provider Organization (NCPPO) (To obtain your provider ID number, please call the NCPPO Customer Service Department at (800) 272-5911. ) Comm
90956 National Financial Insurance Co Comm TX98205 National Foundation Life Insurance Co Comm TX75275 National Health Insurance Company CommNIA11 National Imaging Assoc Inc Comm59087 National Radiology Network, The Comm59087 National Radiology Network, The (formerly Health Help Network) Comm52132 National Rural Electric Cooperative Assoc. Comm71412 National Rural Letter Carrier Assoc. Comm52104 National Telecommunications Cooperative Association (NTCA - Staff) Comm52103 National Telecommunications Cooperative Association (NTCA) Comm31417 Nationwide Health Plans Comm75191 NCAS - Charlotte, North Carolina Comm NC75190 NCAS - Fairfax, Virginia Comm CA
***** 04293 Neighborhood Health Plan - Boston, Massachusettes Comm MA96107 Neighborhood Health Plan - Florida Comm FL05047 Neighborhood Health Plan - Rhode Island Comm
11325 Neighborhood Health Providers & Suffolk Health Plan (NHP - SHP) (Please call 631-360-3102 for your unique NHP/SHP provider number) Comm
37255 Nesika Health Group Comm66055 Netcare Life & Health Insurance - Hagatna, Guam Comm
04332 Network Health (please contact Provider Relations at 617-806-8104 or [email protected] for an EDI setup form) Comm
77076 Network Health Insurance Corporation - Medicare Comm39111 Network Health Plan - Wisconsin Comm WI58204 Network TPA, LLC Comm76031 New Era Employee Welfare Benefit Comm75281 New Era Life Insurance Company Comm65056 New Market Dimensions Comm48186 New York Presbyterian Community Health Plan Comm NY24819 New York Presbyterian System Select Health Comm NY38225 NGS American Comm81264 Nippon Life Insurance Company of America Comm22603 NJ Carpenters Health Fund Comm65085 North America Administrators (NAA) - Nashville, Tennessee Comm TN
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 15 of 22
Pre.Enr. Payer ID Name Claims Type State
34159North American Benefits Network (Cleveland, OH). Now known as Meritain Health. Payer ID valid only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476
Comm OH
IP079 North American Medical Management - Southern California Comm CA64157 North American Preferred (Now known as Meritain Health) Comm37314 North Broward Hospital District Comm FL35212 North Texas Healthcare Network Comm64157 North American Administrators (Now known as Meritain Health) Comm38238 Northern California Sheet Metal Workers Health Care Plan Comm36347 Northern Illinois Health Plan Comm IL88027 Northern Nevada Trust Fund Comm
NWDC1 Northwest Diagnostic Clinic (NWDC) Comm36346 Northwest Suburban IPA (Illinois) Comm IL16644 Nova Healthcare Administrators, Inc. (Grand Island, NY) Comm71080 Novasys Health Network Comm37299 Nyhart Comm
72127 Ochsner Health Plan (Payor requires unique provider ID for each practitioner/provider; please contact Jill Brant at (504) 219-6682 or [email protected]) Comm
13350 ODS Health Plan Comm72087 Office of Group Benefits - Louisiana Comm LA14163 Ohana Health Plan Comm HI34189 Ohio Health Choice PPO Comm OH95435 Ohio Health Group Comm25133 Omnicare - A Coventry Health Plan Comm22321 One Call Medical Comm80705 One Health Plan of Georgia, Inc. Comm80705 One Health Plan of Illinois, Inc. Comm91136 Operating Engineers Locals 302 & 612 Health & Security Fund, Group # F12 Comm52148 Optimum Choice of the Carolina’s, Inc. (OCCI) Comm52148 Optimum Choice, Inc. (OCI) Comm20133 Optimum Healthcare Comm13383 Orthonet - Aetna Comm25681 Orthonet - Healthnet Comm13382 Orthonet - Uniformed Services Family Health Comm13381 Orthonet Corporation - CIGNA Comm62171 OSF Health Plans Comm IL06111 Oxford Health Plans Comm87068 P5 Health Plan Solutions of Utah Comm
SYMED Pacific Alliance Medical Center Comm CASYMED Pacific Alliance Medical Group and Hospital (Synermed) Comm & HMO93029 Pacific Source Health Plans Comm OR33053 Pacificare Behavioral Health Comm95959 Pacificare of California - Claims Comm95962 PacifiCare of Colorado - Claims Comm CO95959 Pacificare of Oregon -Secure Horizon/HMO claims only Comm OR95959 Pacificare of Washington Comm WA95999 Pacificare PPO - All States Comm
***** 95964 PacificCare of Arizona - Claims Comm AZ95959 PacificCare of Oklahoma - Claims Comm95959 PacificCare of Texas - Claims Comm TX37287 PAI (Planned Administrators, Inc.) Comm58174 Paragon Benefits, Inc. Comm58204 Parity Healthcare Comm66917 Parkland Community Health Plan Comm76569 Passport Advantage (DOS 1-1-10 and forward only) Comm
***** 61129 Passport Health Plan Comm10525 Patient Advocates, LLC Comm
***** 68049 Peach State Health Plan Comm20472 Pediatric Associates Comm37086 Pekin Insurance Comm IL
***** 72126 Peoples Health Network Comm13522 Perfect Health Insurance Company, The Comm
41124Performax, Inc. (Now known as Meritain. Payer ID valid only for claims with a billing submission address of P.O. Box 27267, Minneapolis, MN 55427-0267)
Comm MN
25133 PersonalCare Comm13306 PHCS Savility Payers Comm
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 16 of 22
Pre.Enr. Payer ID Name Claims Type State03440 Phoenix Health Plan Comm58204 Physician Associates - Louisiana Comm58204 Physician Care Network CommPA513 Physicians Associates of San Gabriel Valley - DOS 1-1-09 Comm38265 Physicians Care Comm36345 Physicians Care Network - Rockford, Illinois only Comm IL37136 Physicians Health Association - Illinois Comm IL
PHCS1 Physicians Health Choice - claims Comm20398 Physicians Health Collaborative Comm37330 Physicians Health Plan - Mid Michigan Comm MI37330 Physicians Health Plan - South Michigan Comm MI62155 Physicians Health Plan - TennCare Comm
***** 12399 Physicians Health Plan of Northern Indiana Comm IN47027 Physicians Mutual Insurance Company Comm39156 Physicians Plus Insurance Corporation Comm24735 Pinnacle Claims Management, Inc. CommPPM01 Pinnacle Physician Management Organization Comm84109 Pinnacol Assurance Comm37224 Pittman and Associates Comm64160 Pivotal Plan Comm37287 Planned Administrators, Inc. Comm72045 Plumbers & Steamfitters Health & Welfare Fund Comm LA58204 Podi Care Managed Care Comm32680 Poly America Medical & Dental Benefits Plan Comm16111 POMCO Comm72148 PPO Plus LLC Comm38335 PPOM LLC Comm04334 Practicare Inc Comm36373 Prairie States Enterprises Comm53476 Preferred Benefit Administrators Comm61665 Preferred Benefits Administrator Comm59291 Preferred Care FL Comm56178 Preferred Care NC Comm65090 Preferred Care Partners (Encounters) Comm65088 Preferred Care Partners (Miami, Florida) Comm FL73145 Preferred Community Choice Comm61106 Preferred Health Plan, Inc. - Louisville, Kentucky Comm KY31478 Preferred Health Professionals Comm60110 Preferred Health Systems Insurance Company (PHSIC) Comm36401 Preferred Network Access, Inc. Comm60110 Preferred Plus of Kansas Comm41147 PreferredOne Comm MN
***** BC099 Premera Blue Cross - Washington Comm WA***** BC099 Premera Blue Cross Blue Shield - Alaska Comm AK
43166 Premier Benefits Inc. Comm43166 Premier Health Plans Comm90440 Premier Health Systems Comm
PREHP Presbyterian Health Plan Comm NMPRESA Presbyterian Salud (NM) Comm NM45056 Prestige Health Choice Comm39185 Prevea Health Plan CommIP079 Primary Care Associates Medical Group (PCAMG) ( for DOS 1-1-09 and beyond) Comm82048 Primary Health Network CommPRIME Primary Health Plan Comm56144 Primary Physician Care Comm56190 Prime Vision Health CommIP079 PrimeCare Medical Network - Chino Comm & HMO CAIP079 PrimeCare Medical Network - Citrus Valley Comm & HMO CAIP079 PrimeCare Medical Network - Corona Comm & HMO CAIP079 PrimeCare Medical Network - Hemet Comm & HMO CAIP079 PrimeCare Medical Network - Inland Valley Comm & HMO CAIP079 PrimeCare Medical Network - Moreno Comm & HMO CAIP079 PrimeCare Medical Network - Redlands Comm & HMO CAIP079 PrimeCare Medical Network - Riverside Comm & HMO CAIP079 Primecare Medical Network - San Bernardino Comm & HMO CAIP079 PrimeCare Medical Network - Sun City Comm & HMO CAIP079 PrimeCare Medical Network - Temecula Comm & HMO CA11678 PrimeWest Health Systems Comm
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 17 of 22
Pre.Enr. Payer ID Name Claims Type State61271 Principal Financial Group Comm61271 Principal Life Insurance Comm38217 Priority Health Comm37303 Prism - First Health Comm37268 Prism Network, Inc. Comm37315 Prism-Univera Comm38329 Procare Health Plan - Detroit, Michigan Comm MI59296 Professional Benefit Administrators (Winter Park, FL) Comm FL36331 Professional Benefit Administrators, Inc. (Oak Brook, IL ONLY) Comm IL41163 Professional Claim Administrators Comm37242 Professional Claims Management - Canton, Ohio Comm59041 Professional Insurance Company (PIC) (Formerly GE Voluntary Benefits PIC) Comm34134 Professional Risk Management Comm37309 Protective Life Insurance Comm
CAPMN Prudent Medical Group (formerly known as Hollywood Presbyterian Medical Group) Comm CA09822 PSN - Florida Medicaid (JMH) Comm
AMM03 Public Health Medical Services (Advanced Medical Management) Comm & HMO CA91136 Puget Sound Benefits Trust Comm
91136 Puget Sound Electrical Workers Trust Comm
42172 Puget Sound Health Partners Comm
48055 Pyramid Life Insurance Company Comm51052 Pyschcare, LLC Comm39197 Quad Med - Pewaukee, Wisconsin Comm WI35174 Qual Choice of Arkansas Comm AR23342 QualCare, Inc. (New Providers must enroll with QualCare at (800) 992-6613, option 5.) Comm73067 Quick Trip Corporation Comm OK37129 Quincy Health Care Management Comm57117 QVI Risk Solutions Inc Comm91176 RBMS, LLC Comm
SYMED Redlands IPA (Synermed) Comm & HMO CA00851 Regence Blue Cross Blue Shield of Oregon Comm OR00910 Regence Blue Cross Blue Shield of Utah Comm UT00611 Regence Blue Shield - Idaho Comm ID00932 Regence Blue Shield WA only Comm WA00932 Regence Care WA only Comm WA38221 Regency Employee Benefits Comm47076 Regional Care, Inc. Comm73066 Reserve National Insurance Comm37278 Resource Administrators Comm
36396 Resurrection Health Care Preferred/AKA Family Medical Network *Please call (773) 572-8311 or ( 773) 572-8309 prior to your first submission of claims. Comm
16117 RMSCO, Inc. Comm84065 Rocky Mountain Health Plan Comm37602 Rooney Life Inc. Comm36215 Rosemont of Des Plaines, IL Comm36339 Rush Health Association Comm36389 Rush Prudential Health Plans - HMO Only Comm
AMM03 Ryan White Network (Advanced Medical Management) Comm & HMO CA31441 S & S Healthcare Strategies Comm35164 Sagamore Health Network Comm IN62308 SAMBA Comm
MSO77 San Diego County Coverage Initiative (CI) Comm CA
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 18 of 22
Pre.Enr. Payer ID Name Claims Type StateMSO11 San Diego County Medical Services (CMS) Comm CAMSO22 San Diego County Physician Emergency Services (PES) Comm CAMSO33 San Diego County Ryan White Care Act Comm CA
BS001 San Francisco Electrical Workers – IBEW Local 6 *They will all have a prefix code of "XEL" as their member ID on the BSC card. Comm
68035 San Joaquin Health Administrators Comm77038 Sante Health Systems and Affiliates Comm
SCAN1 SCAN Health Plan Comm CA16146 SCHC Total Care Inc Comm88030 Scott & White Health Care Plan Comm60054 Scripps Medical Plan Comm13310 Seabury & Smith Comm28530 Secure Health Plans of Georgia, LLC Comm95959 Secure Horizon California- Pacificare Comm CA
***** 95964 Secure Horizons Arizona - Claims Comm95962 Secure Horizons Colorado - Claims Comm CO95959 Secure Horizons Oklahoma - Claims Comm95959 Secure Horizons Oregon - Claims Comm95959 Secure Horizons Texas - Claims Comm95959 Secure Horizons Washington - Claims Comm39045 Security Health Plan Comm64088 Select Administrative Services (SAS) Comm MS42137 Select Benefit Administrators - Des Moines, Iowa Comm IA37282 Select Benefit Administrators of America Comm
37282 Select Benefits Administrators of America (submission address of P.O. Box 440, Ashland, Wisconsin 54806.) Comm
SCOK1 Select Care of Oklahoma - Tribute Comm OK23285 Select Health of South Carolina Comm SCSSC11 Select Senior Clinic Comm00014 SelectCare Comm59111 Self Insured Benefit Administrators (Clearwater, FL) Comm36404 Self Insured Plans (Naples, FL) Comm FL34131 Self-Funded Plans, Inc. Comm83035 Senior Whole Health Comm23249 Sentinel Management Services Comm39033 Sentry Insurance a Mutual Company Comm39033 Sentry Life of New York Comm
***** 76056 Seton CHIP Comm75280 Shasta Administrative Services Comm76342 Sierra Health Services Comm CA, NVMBA01 Sierra Nevada Medical Associates Comm62159 Signature Health Alliance Comm84076 Sinclair Health Plan Comm84096 Sloans Lake Preferred Health Networks Comm02057 Smith Administrators Comm91131 Sound Health (now known as First Choic Health Network) Comm ID25133 SouthCare - Healthcare Preferred Comm
STGEB SoutheastTexas GovEmp Bene Pool Comm37318 Southern Benefit Services Comm
SYMED Southern CA Children's Network (SynerMed) Comm & HMO56131 Southern Group Administrators Comm25133 Southern Health Services, Inc. Comm35227 SouthPoint Hotel & Casino Comm37266 Southwest Service Life Comm TX37259 Special Agents Mutual Benefit Association Comm52190 Special Risk International (SRI) Comm23253 Spectrum Admin, Inc. TPA Comm84146 Spina Bifida - VA HAC CommSLCH1 St Lawrance Co Healthcare Plan Comm NY35199 St. Anthony Memorial Healthcare Centers - MDWISE Comm22240 St. Barnabas System Health Plan Comm35199 St. Catherine Hospital PHO - MDWISE Comm35199 St. Francis Health Network Comm37264 St. John's Claim Administration CommSTJOE St. Joseph Hertiage HealthCare Comm CASTJOE St. Jude Hertiage HealthCare Comm CA
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 19 of 22
Pre.Enr. Payer ID Name Claims Type State35199 St. Margaret Mercy Healthcare Centers - MDWISE Comm88029 St. Mary's Health Plan Comm NV37116 St. Therese Physician Associates Comm IL59225 Star Hrg Ins. Comm61425 Starmark Comm31053 State Farm Insurance Companies Comm57254 State of Texas Dental Plan Comm75087 States General Life Insurance Comm
***** 14163 Staywell Health Plan Comm91151 Sterling Option One Comm WA6089 Stirling Benefits (Stirling & Stirling) Comm CT31121 Stoner & Associates - Cincinnati, Ohio Comm OH74227 Student Resources Comm95202 Summacare Health Plan Comm37301 Summit America Insurance Services, Inc. Comm12X52 Sun Health Corporation Comm68057 Sunshine State Health Plan Comm23218 Superior Administrators - Santa Ana, CA Comm CA
39188 Superior Health Plan Texas (Prior to submitting claims, please call Provider Relations Dept at 1-800-218-7453) Comm TX
35199 Surburban Health Organization CommSYMED SynerMed Comm & HMO CA88067 Tall Tree Administrators Comm37228 Tarrant Health Services Comm39157 TBG Administrative Services Comm36215 Teamcare Comm36612 Teamsters Local Union #301 Comm
SYMED Temple Hospital Comm CA76048 Texas Children's Health Plan Comm TX75228 Texas Childrens Health Plan (Medicaid) Comm TXTX1ST Texas First Healh Plans Comm TX63092 Texas HealthSpring CommTTCEC Texas True Choice Comm TXTHIPA THIPA Comm & HMO CA39065 Time Insurance Company Comm74214 TML Intergovernmental Employee Benefits Pool Comm TX20081 Todays Health Wisconsin Comm48055 Today's Option (American Progressive and Pyramid Life) Comm92620 Tongass Timber Trust Comm61425 Tooling and Manufacturing Assocation CommTHIPA Torrance Hospital IPA (THIPA) Comm & HMO CA31182 Total Community Care Comm38201 Total Health Care Comm38202 Total Health Choice - Florida Comm FL38201 Total Healthcare, Inc. Comm97910 Touchpoint Health Plan HMO Comm13402 Touchstone Health - Health Net SmartChoice Comm23856 Touchstone Health PSO Comm69493 Tower Life Insurance Company Comm37230 TR Paul, Inc. CommTFLIC TransAmerica Financial Life Insurance Co (Hurst, TX) Comm TXTLIN2 TransAmerica Life Insurance Co (Hurst, TX) Comm TXTLINS TransAmerica Life Insurance Co (Little Rock, AR) Comm ARTLIN3 TransAmerica Life Insurance Co (Louisville, KY) Comm KY59222 TransAmerica Life Insurance Company CommTOLIC TransAmerica Occidental Life Insurance Co (Kansas City, MO) Comm MO37284 TransChoice - Key Benefit Administrators Comm36397 Trellis Health Partners Comm57106 Tricare North Region Claims Comm38269 Trinity Health (Enrollment required; please contact Noreen at (248) 489-5281) Comm MI34185 TriSurant (formerly Health Administration Services - HAS) CommTCUSA True Choice USA CommTCUCH True Choice USA - Christus Comm91078 Trusteed Plans Service Corporation Comm61425 Trustmark Insurance Comm
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 20 of 22
Pre.Enr. Payer ID Name Claims Type State
***** Tufts Health Plan (Submitter must call the payer before submitting claims to to obtain payer id: 888-880-8699 ext 4042) Comm
63092 TX Healthspring Comm TXRPF02 TX Premier Plan - Medicaid-THIN Comm TX52629 UCare of Minnesota Comm33056 UCMN - United Behavioral Health (Health Plan - HMO) Comm74223 UICI - Administrators - State of Nevada Comm NV37292 UMMH Comm31107 UMR - Cincinnati Comm39026 UMR - Wausau - UHIS Comm52180 UMWA Health & Retirement Funds Comm80314 Unicare Comm62170 Unified Health Services (Workman's Comp Only) CommHCP01 Unified IPA Comm CA75243 Uniform Medical Plan (Harrington Benefit Services) Comm13142 Union Labor Life Insurance Comm87042 Union Pacific Railroad Employees Health Systems Comm70408 Union Security Insurance Company Comm25175 Unison Health Plan - (formerly known as Three Rivers) Comm62183 Unison Health Plan - Better Health Plans, Inc Comm86049 United Americhoice of Pennsylvania Comm87726 United Behavioral Health (UBH) Comm87726 United HealthCare Comm
87726 United HealthCare (formerly MetraHealth Care Plans, Met Life, Metropolitan Life Ins Co, MetraHealth Elect, MetraHealth Healthcare Network HMO) (no vision claims) Comm
87726 United HealthCare (formerly MetraHealth Healthcare Network PPO, New York State Employees (Empire), Travelers Ins Co, Travelers Plan Administrators) (no vision claims) Comm
87726 United HealthCare (formerly The Travelers, Travelers Health Network) Comm87726 United HealthCare of Alabama Comm AL87726 United HealthCare of Arizona Comm AZ87726 United HealthCare of Arkansas Comm AR87726 United HealthCare of California - Northern California Comm CA87726 United HealthCare of California - Southern California Comm CA87726 United HealthCare of Colorado Comm CO87726 United HealthCare of Florida Comm FL87726 United HealthCare of Georgia Comm GA87726 United HealthCare of Illinois Comm IL87726 United HealthCare of Kentucky Comm KY87726 United HealthCare of Louisiana Comm LA87726 United HealthCare of Mississippi Comm MS87726 United HealthCare of New England Comm87726 United HealthCare of New Jersey Comm NJ87726 United HealthCare of New York Comm NY87726 United HealthCare of North Carolina Comm NC87726 United HealthCare of Ohio Comm OH87726 United HealthCare of Tennesee Comm TN87726 United HealthCare of Texas - Dallas Comm TX87726 United HealthCare of Texas - Houston Comm TX87726 United HealthCare of the Mid-Atlantic Comm87726 United HealthCare of the Midlands - HMO (Choice Select) Comm87726 United HealthCare of the Midlands - PPO (Choice Plus, Select Plus, Self Funded) Comm87726 United HealthCare of the Midwest - Choice, Choice Plus, Select, Select Plus Comm87726 United HealthCare of the Midwest - Medicare Complete Comm87726 United HealthCare of Upstate New York Comm NY87726 United HealthCare of Utah Comm UT87726 United HealthCare of Virginia Comm VA87726 United HealthCare of Wisconsin Comm WI87726 United HealthCare Plans of Puerto Rico Comm84132 United Medical Alliance (UMA) Comm CO71412 United of Omaha Comm41194 United Resources Network - (URN) Comm74095 United States Automobile Association (USAA) Comm33001 Universal Care - California Comm CA50528 Universal Health Care, Inc. Comm09830 University Family Care Comm
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 21 of 22
Pre.Enr. Payer ID Name Claims Type State09908 University Family Care - Maricopa Health Plan Comm
***** 22329 University Health Plan of New Jersey Comm NJ25133 University of Missouri Comm23281 UPMC Health Plan Comm38337 Upper Peninsula Health Plan Comm93092 US Benefits Comm
USFHP US Family Health Plan (USFHP) Comm13407 USFHP - St. Vincent Catholic Medical Centers of New York Comm12115 VA Fee Basis Programs Comm
VAFSC VA Financial Services Center Comm TX23253 Valley Preferred - PPO Comm23173 Vanderbilt Health Plan Comm
SYMED Vanguard Health Systems (SynerMed) Comm & HMO72128 Vantage Health Plan, Inc. Comm86062 VentureNet Healthcare Comm
VHMG1 Verdugo Hills Medical Group Comm23173 VHP Community Care Comm24818 Vida Care CommVFP11 Village Family Practice Comm
***** 54176 Virginia Premier Health Plan Comm12K83 Virginia Premier Health Plan (Medicaid) Comm37297 Vison Care Incorporated Comm
***** 55248 Vista Health Plan Comm FL59266 Volusia Health Network Comm22264 Vytra Health Plans Comm NY37294 Washington Employers Trust Comm38356 Washtenaw Community Health Organization Comm73155 Waterstone Benefit Administrators Comm58082 Watkins Associated Industries Comm75261 Web TPA/Community Health Electronic claims/CHEC Comm TX36337 Weiss Health Providers Comm87815 Well Fargo 3rd Party Administrators (formerly known as Acordia National) Comm59354 Wellcare Health Plans (Encounters) Comm
***** 14163 Wellcare HMO, Inc. Comm***** 14164 Wellcare of Conneticut Comm CT***** 59608 Wellcare of Florida Comm
14163 Wellcare of Georgia (Wellcare Provider ID is required. To obtain your provider ID, please call (866) 231-1821 option 2 then 4) Comm GA
***** 14163 Wellcare of Louisiana Comm***** 14164 Wellcare of New York Comm NY
14163 WellCare of Ohio Comm OH14163 WellCare of Texas Comm TX77072 Wellcare Private Fee for Service Plans Comm25133 WellPath Comm87815 Wells Fargo 3rd Party Administrators, Inc. (Formerly Accordia) Comm
WCMG1 West Covina Medical Group Comm24735 Western Growers Assurance Trust Comm24735 Western Growers Insurance Company Comm37306 Western Health, Inc. Comm37247 Western Mutual Insurance Comm31048 Western Southern Financial Group - Cincinnati, Ohio Comm OH
38232 Weyco, Inc. (Now know as Meritain Health) – Payer ID valid for claims with billing submission address of 2370 Science Parkway Okemos, Michigan 48864 Comm
93050 William C. Earhart Comm41095 Wilson-McShane Comm11696 Windsor Home Network Comm62153 Windsor Medicare Extra Comm39200 Wisconsin Auto and Truck Dealers Comm12X29 Wisconsin Physicians Service Comm20333 Worksite Benefit Services, LLC Comm75276 World Insurance Company Comm34080 WPPN Comm34080 WPPN - HPO (HealthEOS) Comm
***** 12X29 WPS Tricare Comm23710 Writer's Guild Industry Health Plan Comm09829 Yavapai County Comm
Revised 04/06/2010
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submissionwww.officeally.com 866.575.4120
Payer List subject to change without notice Page 22 of 22
Pre.Enr. Payer ID Name Claims Type State75285 Young Life Comm
Related Documents
