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Revised 05/12/2010 **** 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 31 All States Payer List Professional Claims (HCFA 1500) ALL STATES *****Requires Pre-Enrollment Pre.Enr. Payer ID Name Claims Type State 13162 1199 Local Benefit Fund (Provider should submit claims with assigned Plan Provider ID, as 2 digit suffix is no longer required. Call Renaud Dufr esne at (646) 473-6960 for a list of Network ID's.) Comm 59069 21st Century Health and Benefits Comm 51028 21st Century Insurance and Financial Services (For Minnesota only) Comm MN 20413 3P Admin Comm 74234 8th District Elec Comm UT 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 IP079 ABMA Medical Corporation Comm CA 03443 ABRAZO Advantage Health Plan Comm AHS01 Access Administrators Comm COACC Access Behavioral Care Comm CO 64071 Acclaim Comm 21356 Acclaim Repricing Comm AHP01 Accountable Health Plan - Wisconsin & Iowa Comm ***** AHIPA Accountable IPA (California) Comm HPSVC ACEC Comm NV 72467 ACS Benefit Services, Inc. Comm 36112 ACS Rewards Administration Center Comm AHC01 ActivHealthCare Comm 22384 Administration Concepts, Inc. Comm 38265 Administration Systems Research Corp Comm 59141 Administrative Services, Inc. Comm 37278 AdminOne Comm TMG01 Advanced Medical Associates (Testing of each provider is required by payer and done automatically by Office Ally once you start submitting claims for this payer.) Comm AMM01 Advanced Medical Management Comm & HMO CA AMM02 Advanced Medical Management MSI Comm & HMO CA 74234 Advanstaff, Inc. Comm 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 NMM01 Advantage Medical Group Comm ADVTK Advantek Benefit Administrators Comm 25133 Advantra - Health Assurance - Health America, Inc. Comm 25133 Advantra - Kansas City Medicare - Coventry 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 23225 Aetna Better Health - Connecticut Medicaid Comm 60054 Aetna Student Health Comm 38692 Aetna TX Medicaid Comm TX ADOCS Affiliated Doctor's of Orange County (ADOC) Comm & HMO CA APG01 Affiliated Physicians Group (APG) Comm IL ***** 13334 Affinity Health Plan – Please contact before sending claims [email protected] or 718-794-7592 Comm 46594 Affinity Medical - Claim Status reports available at https://affinity-portals.ikaenterprise.com/Default.aspx Comm CA 13333 Affinity Medicare Advantage – for Medicare claims with DOS after 1-1-10 Comm 95426 Affordable Benefit Administrators, Inc. Comm 34444 AFL - CIO Food & Beverage Dealer’s Trust Fund Comm OH 13346 AFTRA Health Fund Comm NY 37280 AGA Comm 64158 Agency Services Inc. (Now known as Meritain Health) Comm MAP01 AIA- American Insurance Administrators (PO Box 2501 Bassett, CA and City of Industry addresses only) Comm CA CAPMN AKM Medical Group (Cap Managements Systems) Comm CA 06311 Alabama Medical Surgical Associates Comm 91136 Alaska Children's Services, Inc. Group #P68 Comm 92600 Alaska Electrical Health & Welfare Fund Comm AK 91136 Alaska Laborers Construction Industry Trust Group # F23 Comm
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Page 1: All States Payer List - Office Ally All... · Payer List subject to change without notice Page 1 of 31 All States Payer List Professional Claims ... should submit claims with assigned

Revised 05/12/2010

**** 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 31

All States Payer ListProfessional Claims (HCFA 1500)

ALL STATES *****Requires Pre-EnrollmentPre.Enr. Payer ID Name Claims Type State

131621199 Local 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 51028 21st Century Insurance and Financial Services (For Minnesota only) Comm MN20413 3P Admin Comm74234 8th District Elec Comm UT93044 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

IP079 ABMA Medical Corporation Comm CA03443 ABRAZO Advantage Health Plan CommAHS01 Access Administrators CommCOACC Access Behavioral Care Comm CO64071 Acclaim Comm21356 Acclaim Repricing CommAHP01 Accountable Health Plan - Wisconsin & Iowa Comm

***** AHIPA Accountable IPA (California) CommHPSVC ACEC Comm NV72467 ACS Benefit Services, Inc. Comm36112 ACS Rewards Administration Center Comm

AHC01 ActivHealthCare Comm22384 Administration Concepts, Inc. Comm38265 Administration Systems Research Corp Comm59141 Administrative Services, Inc. Comm37278 AdminOne Comm

TMG01 Advanced Medical Associates (Testing of each provider is required by payer and done automatically by Office Ally once you start submitting claims for this payer.) Comm

AMM01 Advanced Medical Management Comm & HMO CAAMM02 Advanced Medical Management MSI Comm & HMO CA74234 Advanstaff, Inc. Comm68056 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

NMM01 Advantage Medical Group CommADVTK Advantek Benefit Administrators Comm25133 Advantra - Health Assurance - Health America, Inc. Comm25133 Advantra - Kansas City Medicare - Coventry 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 Comm23225 Aetna Better Health - Connecticut Medicaid Comm60054 Aetna Student Health Comm38692 Aetna TX Medicaid Comm TX

ADOCS Affiliated Doctor's of Orange County (ADOC) Comm & HMO CAAPG01 Affiliated Physicians Group (APG) Comm IL

***** 13334 Affinity Health Plan – Please contact before sending claims [email protected] or 718-794-7592 Comm46594 Affinity Medical - Claim Status reports available at https://affinity-portals.ikaenterprise.com/Default.aspx Comm CA13333 Affinity Medicare Advantage – for Medicare claims with DOS after 1-1-10 Comm95426 Affordable Benefit Administrators, Inc. Comm34444 AFL - CIO Food & Beverage Dealer’s Trust Fund Comm OH13346 AFTRA Health Fund Comm NY37280 AGA Comm64158 Agency Services Inc. (Now known as Meritain Health) CommMAP01 AIA- American Insurance Administrators (PO Box 2501 Bassett, CA and City of Industry addresses only) Comm CACAPMN AKM Medical Group (Cap Managements Systems) Comm CA06311 Alabama Medical Surgical Associates Comm91136 Alaska Children's Services, Inc. Group #P68 Comm92600 Alaska Electrical Health & Welfare Fund Comm AK91136 Alaska Laborers Construction Industry Trust Group # F23 Comm

Page 2: All States Payer List - Office Ally All... · Payer List subject to change without notice Page 1 of 31 All States Payer List Professional Claims ... should submit claims with assigned

Revised 05/12/2010

**** 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 31

Pre.Enr. Payer ID Name Claims Type State91136 Alaska Pipe Trades Local 375 Group # F24 Comm91136 Alaska UFCW Health & Welfare Trust Group # F45 Comm13550 ALICARE Comm58213 Alignis Comm37602 All Savers Insurance Company Comm81040 Allegiance Benefit Plan Management, Inc.13079 Alliance Healthcare - Stones River Regional IPA CommHCP01 Alliance IPA Comm & HMO CA23172 Alliance Partners Comm OH20257 Alliance Physicians (High Desert Primary Care Alliance) Hesperia, CA Comm CA52149 Alliance PPO Comm88461 Alliance, The (A Wisconsin provider network) (Call Dave Sell at 608-210-6656 to pre-enroll) Comm91131 Alliant Health Plan (FCHN) Comm WA58234 Alliant Health Plans of Georgia Comm GA94177 Allied Administrators - San Francisco, California Comm CA37308 Allied Benefit Systems, Inc. CommNMM01 Allied Physicians Medical Group CommSYMED Alpha Care Medical Group Comm & HMO CA80705 ALTA Health & Life Insurance CommIP079 Alta Senior Care Comm CA25133 Altius Health Plan Comm25133 Altius Health Plan- Coventry Comm UTAMAIA Ama Insurance Agency, Inc. Comm13550 Amalgamated Life Comm CO13343 Amalgamated Life IPA Alicare Comm

COMPU Amalgamated Transit Union Division 1001 Health & Welfare Fund Comm75137 Ameriben Solutions, Inc. Comm20029 America’s Choice 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 Comm

HPSVC American Benefit Plan Administrators - HealthPlan Services, Inc. Comm & HMO34187 American Benefits Management - North Canton, Ohio Comm OH37128 American Commercial Barge Lines Comm60305 American Community Mutual Insurance CommACN01 American Complimentary Care Network CommCAPMN American Family Health Providers - Cap Managements Systems Comm CAAMF11 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) Comm72099 American Life Care Comm81400 American Medical Security Comm74048 American National Insurance Company (ANICO) CommAPSFL American Pioneer - South Florida Comm FLAPBPN American Pioneer Brevard PHY Net Comm62308 American Postal Workers Union (Claims with DOS prior to 1/1/10 should use Payer ID 44444) Comm14190 American PPO Comm48055 American Progressive Life and Health Insurance Company Comm 42011 American Republic Insurance Company (ARIC) Comm17965 American Sentinel Insurance Company Comm PA

ASHP1 American Specialty Health Plan Comm37322 American Worker Health Plan Comm41161 American Chiropractic Network (ACN) Comm41160 American Chiropractic Network IPA of New York (ACNIPA) Comm NY20029 Americas Health Choice Comm95378 AmeriChoice - Tenncare Comm TN87726 AmeriChoice of Connecticut Comm CT87726 AmeriChoice of Florida Comm FL87726 AmeriChoice of Illinois Comm IL87726 AmeriChoice of Maryland Comm MD87726 AmeriChoice of New England Comm NE86047 AmeriChoice of New Jersey Medicaid Comm NJ

86001 AmeriChoice of New Jersey Personal Care Plus (Medicare) (All claims require AmeriChoice provider id - call 888-362-3368 to obtain.) Comm NJ

86048 AmeriChoice of New York Medicaid and Child Health Plus Comm NY

86002 AmeriChoice of New York Personal Care Plus (Medicare) (All claims require AmeriChoice provider id - call 888-362-3368 to obtain.) Comm NY

86049 AmeriChoice of Pennsylvania Medicaid Comm PA

86003 AmeriChoice of Pennsylvania Personal Care Plus (Medicare) (All claims require AmeriChoice provider id - call 888-345-3627 to obtain.) Comm PA

87726 AmeriChoice of Rhode Island Comm RI

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Revised 05/12/2010

**** 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 31

Pre.Enr. Payer ID Name Claims Type State95378 AmeriChoice of Tennessee Comm TN

ASRM1 AmeriCorp Comm28804 Amerigroup Community Care of New Mexico Comm NM28804 Amerigroup Community Care Comm28804 Amerigroup Corporation - Fort Worth, Texas Comm TX28805 Amerigroup Corporation - Houston, Texas Comm TX28809 Amerigroup Florida Healthy Kid Comm FL28804 Amerigroup Georgia Comm GA28808 Amerigroup Illinois Comm IL28808 Amerigroup Ohio Comm OH

***** 54763 AmeriHealth Administrator *Must also be a Highmark provider* Comm***** 93688 Amerihealth Delaware Non-HMO (Highmark) *Must also be a Highmark provider* Comm DE***** 95044 Amerihealth Delware - New Jersey HMO (Highmark) *Must also be a Highmark provider* Comm DE/NJ

22248 Amerihealth Mercy Health Plan Comm***** 60061 Amerihealth New Jersey Non-HMO (Highmark) *Must also be a Highmark provider* Comm NJ

PPM01 Ameri-West Health Associates Comm AMILR AMIL - ARIA - Via Mediview Comm TXPROSP AMVI - Prospect Health Network (Prospect Medical Group) Comm & HMO CACAPMN AMVI (Cap Managements Systems) Comm CA53085 Anchor Benefit Consulting Inc. Comm86062 Ancillary Benefit Systems - Arizona Foundation for Medical Care Comm AZ

HSM01 Angel Medical Group DBA Superior Choice Medical Group CommSYMED Angeles IPA Comm & HMO CA34192 Antares Management Solutions Comm

HDMDG Antelope Valley Medical Associates Comm & HMO CA80705 Anthem Health & Life Insurance Company of New Jersey Comm & HMO NJ16140 APA Partners, Inc. Comm

PROSP APAC (Pinnacle Health Resources) (Prospect Medical Group) Comm & HMO CA34196 Apex Benefit Services CommAPP01 AppleCare Medical Management Comm & HMO CA54160 APS Healthcare Inc. Comm44444 APWU - Affordable Network Comm16120 ARAZ Comm AZAMS11 Arcadian Community Care Comm LAAMS11 Arcadian Health Plan Comm OKAMS11 Arcadian Management Services Comm CAAMS11 Arcadian of Washington (Arcadian Mgmt Serv) Comm WA36356 Argus Health Systems Comm86062 Arizona Foundation for Medical Care Comm & HMO AZ03432 Arizona Physicians IPA (APIPA) Comm74234 Arizona pipe Trades Health & Welfare Trust Fund Local Unions #469 & 741 Pipe Trades Health Plan Comm AZ75278 Arkansas Best Corporation CommAMS11 Arkansas Community Care Comm AR95440 Arnett Health Plans Comm

NMM01 Arroyo Vista Family Health Center CommHSM01 Asian Community Medical Group, Inc. CommASRM1 ASRM Corp CommASRM1 ASRM Corp. Comm NJFAABC ASSOCIATED BENEFITS CORPORATION CommHSM01 Associated Physicians Medical Group, Inc. CommATPA1 Associated Third Party Admin Comm36326 Associates for Health Care, Inc. (AHC) Comm39065 Assurant Health Comm37313 Assurant Health Self-Funded - Ft. Mill, South Carolina Comm SC37323 Assurant MiniMed-Key Family Comm88035 AssureCare, Inc. Comm74240 Assured Benefits Administrators Comm00932 Asuris Northwest Health (via Regence BSWA) Comm WA95691 Athens Area Health Plan Select Comm22304 Atlanticare AKA Horizon HealthCare Admin (HHA) Comm13853 Atlantis Health Plan Comm NY38259 Automated Benefit Services Comm37280 Automated Group Administration Inc. Comm

CAPMN Avalon IPA (Cap Managements Systems) Comm CACAPMN Avalon Medical Group (Cap Managements Systems) Comm CAAH001 Avante Health Comm46045 Avera Health Plans CommAV001 AVMED Healthplan Comm FLBKRFM Bakersfield Family Medical Center (Regal) Comm & HMO CASX145 Banner Health Company Comm37248 Bass Administrators, Inc. Comm49153 BCI Administrators, Inc. Comm

43324Beacon Health Strategies - Please use the following Plan IDs for block 11 on the 1500 form. Neighborhood Health Plan of MA=001; Hudson Health Plan=004;Fallon Community Plan=005; Neighborhood Health Plan of RI=006; Affinity Health Plan=009; DC Chartered Health Plan=013

Comm

95377 Beech Street Comm63100 Behavioral Health Systems Comm

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Revised 05/12/2010

**** 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 31

Pre.Enr. Payer ID Name Claims Type StateMPMOA Bella Vista Medical Group IPA Comm CASYMED Bellflower Medical Center (Synermed) Comm & HMO33192 Bencomp National Corporation 36149 Benefit Administrative Systems Comm25145 Benefit Coordinators Corporation - Pittsburgh, Pennsylvania Comm PABMATP Benefit Management Admin (BMA) Comm20018 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 Comm34178 Benefit Services Comm OHBSI01 Benefit Solutions, Inc. Comm FL38257 Benefit Source, Inc. Comm36342 Benefit Systems & Services, Inc. (BSSI) Comm74223 Benefits Planners, Inc. Comm87265 Benesight (formerly The TPA) Comm37248 Benesys, Inc. Comm

BNMK1 BenMark - Mississippi Comm MS95604 Best Life & Health Insurance Company Comm32006 Better Health Plans of South Carolina Comm SC62183 Better Health Plans, Inc. Comm00922 Blue Choice of South Carolina Comm SCBC001 Blue Cross (Cal-Optima - Medi-Cal) Comm CA

***** 00806 Blue Cross Blue Shield NY Excellus Utica Watertown Region Comm NY***** 00520 Blue Cross Blue Shield Arkansas - (Health Advantage, Blue Advantage, FEP, ITS and First Source) Comm***** 00510 Blue Cross Blue Shield of Alabama Comm AL***** BC099 Blue Cross Blue Shield of Alaska (Premera ) Comm AK

53589 Blue Cross Blue Shield of Arizona Comm AZ00050 Blue Cross Blue Shield of Colorado - Anthem Comm CO00060 Blue Cross Blue Shield of Connecticut Comm CTSB580 Blue Cross Blue Shield of DC (Carefirst) Comm DC

***** 00570 Blue Cross Blue Shield of Delaware Comm DE00590 Blue Cross Blue Shield of Florida Comm FL00601 Blue Cross Blue Shield of Georgia - Anthem Comm GA

***** HMSA1 Blue Cross Blue Shield of Hawaii Comm HI00621 Blue Cross Blue Shield of Illinois Comm IL

00630 Blue Cross Blue Shield of Indiana - 12 provider number required. Please contact BCBS customer service at 800-205-5870 option 9 if unknown. - Anthem Comm IN

***** BCSIA Blue Cross Blue Shield of Iowa Comm IA***** 47163 Blue Cross Blue Shield of Kansas Comm KS***** 47171 Blue Cross Blue Shield of Kansas City Comm MO

00660 Blue Cross Blue Shield of Kentucky - 12 provider number required. Please contact BCBS customer service at 800-205-5870 option 9 if unknown. - Anthem Comm KY

***** 53120 Blue Cross Blue Shield of Louisiana Comm LA00680 Blue Cross Blue Shield of Maine - Anthem Comm MESB690 Blue Cross Blue Shield of Maryland (CareFirst ) Comm MDBS059 Blue Cross Blue Shield of Massachusetts Comm MA

***** 00710 Blue Cross Blue Shield of Michigan Comm MI00720 Blue Cross Blue Shield of Minnesota Comm MN

***** 00230 Blue Cross Blue Shield of Mississippi Comm MS00241 Blue Cross Blue Shield of Missouri - Anthem Comm MO

***** BCSMT Blue Cross Blue Shield of Montana Comm MTSB580 Blue Cross Blue Shield of NCA Region – DC (Care First ) Comm DC

***** 23241Blue Cross Blue Shield of NE Pennsylvania - - All new providers must enroll with First Priority Health/Blue Cross of Northeastern PA prior to submitting electronic claims. Enrollment form available at: http://www.bcnepa.com/EDI/registrationForm.aspx

Comm PA

77780 Blue Cross Blue Shield of Nebraska00265 Blue Cross Blue Shield of Nevada - Anthem Comm NV00770 Blue Cross Blue Shield of New Hampshire - Anthem Comm NH00790 Blue Cross Blue Shield of New Mexico Comm NM22099 Blue Cross Blue Shield of New York & New Jersey Horizon Comm NY, NJ

***** SB810 Blue Cross Blue Shield of North Carolina (State Health Plan) Comm NC***** 00800 Blue Cross Blue Shield of North East New York (HealthNow) (not the same as Empire BCBS) Comm NY***** 00801 Blue Cross Blue Shield of North West New York (HealthNow) (not the same as Empire BCBS) Comm NY***** 00806 Blue Cross Blue Shield of NY – Excellus – Utica Region Comm NY***** 00805 Blue Cross Blue Shield of NY – Excellus Central Region Govn't NY***** 00804 Blue Cross Blue Shield of NY – Excellus Rochester Comm NY

00834 Blue Cross Blue Shield of Ohio - 12 provider number required. Please contact BCBS customer service at 800-205-5870 option 9 if unknown. - Anthem Comm OH

00840 Blue Cross Blue Shield of Oklahoma Comm OK00851 Blue Cross Blue Shield of Oregon (Regence) Comm OR

***** 54771 Blue Cross Blue Shield of Pennsylvania (Highmark) Comm PA***** 00870 Blue Cross Blue Shield of Rhode Island Comm RI

BCSSC Blue Cross Blue Shield of South Carolina Comm***** 88848 Blue Cross Blue Shield of South Dakota Comm SD

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Revised 05/12/2010

**** 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 31

Pre.Enr. Payer ID Name Claims Type State***** 00890 Blue Cross Blue Shield of Tennessee Comm TN

84980 Blue Cross Blue Shield of Texas Comm TX00910 Blue Cross Blue Shield of Utah (Regence) Comm UT

***** BCSVT Blue Cross Blue Shield of Vermont00923 Blue Cross Blue Shield of Virginia - Anthem Comm VA00950 Blue Cross Blue Shield of Wisconsin - Anthem Comm WIBC001 Blue Cross of California Anthem Comm CA23045 Blue Cross of Pennsylvania (Capital / CAIC) Comm PA

***** BC099 Blue Cross of Washington State (Premera) Comm WABS001 Blue Shield - California / Blue Shield (FEP) Comm CA00611 Blue Shield of Idaho (Regence) Comm ID

***** 00820 Blue Shield of North Dakota Comm ND00932 Blue Shield of Washington State (Regence) Comm WA

***** 00960 Blue Shield of Wyoming Comm WY61124 Bluegrass Family Health Comm KY13337 BMC HealthNet Plan Comm36609 Boilermakers National Health & Welfare Fund CommBOLL1 Bollinger, Inc. Comm74238 Boon Chapman Administrators, Inc. Comm13337 Boston Medical Center Health Plan, Inc. Comm MA38324 Botsford Health Plan - Farmington Hills, Michigan Comm MI37286 BPA Benefit Plan Administrators - North Dakota Comm ND13310 BPS, Inc. Comm52192 Bravo Health (PA, MD, DE, TX and DC) Comm38365 Bridge Benefits Comm68054 Bridgeway Arizona CommBHP01 Bright Health Physicians Comm35182 Brodart Comm51037 Brokerage Concepts Comm94316 Brown & Toland Medical Group Comm CABTSS1 Brown & Toland Sutter Select Comm CA84980 Bryan Independent School District Comm32004 Buckeye Community Health Plan Comm42150 Butler Benefit Comm23708 C & O Employees Hospital Association Comm33192 Cadent Aministrators Comm33192 Cadent Underwriters Comm

REGAL Caduceus Medical Group (Regal) Comm & HMO CAHDNFC California Care (Humboldt Del Norte) Comm CAHSM01 California Pacific Physicians medical Group, Inc. CommIP055 Cal-Net Physicians IPA Comm

CALOP Cal-Optima Direct Comm & HMO CACAMAA Cameron & Associates Comm71057 Cannon Cochran Management Services - Metairie, Louisiana (PO Box 6794, Metairie, LA 70009) Comm LA37105 Cannon Cochran Management Services, Inc. Comm

CAPMN Cap Management Systems Comm CA38245 Cape Health Plan Comm23045 Capital Blue Cross - CAIC Comm PASX065 Capital District Physicians Health Plan -CDPHP Comm95112 Capital Health Plan Comm65067 Capital International Management Services Comm68011 Capitol Administrators Comm

GCVCP Cardiovascular Care Providers Comm57116 Care 1st Health Plan of Arizona Comm AZ

HPSM1 Care Advantage77082 Care Improvement Plus Comm00344 Care Management Resources Comm

***** 11345CareCentrix – Enrollment required prior to claims submission. Please contact Rebecca Sweetman by email [email protected] Comm

38269 Carechoices Michigan - Mercy Healthplans (Enrollment required; please contact Noreen at (248) 489-5281) Comm MI

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 - HealthNet New Jersey Comm14179 CareCore National, LLC (Aetna Radiology Claims) Comm14180 CareCore National, LLC (Oxford Radiology Claims) CommSB580 CareFirst Blue Cross Blue Shield - DC, National Capital Area Comm DCSB690 CareFirst Blue Cross Blue Shield - Maryland Region Comm MD16147 CareGuide Comm25133 Carelink Health Plan Comm

CLUHS Carelink University Health System CommCARMO CareMore IPA Comm & HMO CACARMO CareMore Value Plus (CVP) Comm 25133 Carenet Comm

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Revised 05/12/2010

**** 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 31

Pre.Enr. Payer ID Name Claims Type State39280 CareOne Health Plan Comm FL93975 CareOregon Inc. Comm OR22248 CarePartners Comm MO95093 Careplus (Encounters) Comm

95092 Careplus Health Plan Comm

MRCHP Caresource Health Plan of Oregon Comm OR37311 CareSource of Indiana Comm IN31114 CareSource of Ohio Comm OH35167 Carewise Comm10010 Careworks Comm62073 Cariten Healthcare Comm62072 Cariten Senior Health Comm56215 Carolina Behavioral Health Alliance Comm NC57105 Carolina Care Plan, Inc. Comm56195 Carolina Summit Healthcare, Inc. Comm

COMPU Carpenters' and Millwrights' Health Benefit Trust Fund Comm & HMO CO91131 Carpenters Health & Welfare (FCHN) Comm WA25125 Carpenter's Health and Welfare Trust Fund of St. Louis Comm MO91131 Carpenters Trust (FCHN) WA Only Comm WA

COMPU Carpet, Linoleum and Resilient Tile Layers Health and Welfare Fund Comm & HMO CO37060 Caterpillar, Inc. CommSX183 Catholic Healthcare West Comm41170 CBCA Administrators (HRM) Comm25133 CCN Managed Care, Inc. (Now Part of First Health Network) Comm

87065 CDO Technologies Comm

SX065 CDPHP - Capital District Physicians Health Plan Comm88022 CDS Group Health CommHPIPA Cedars Towers Surgical Medical Group – encounters only – payer id required Comm95167 Cedars-Sinai Medical Group - Non - Payable Claims (Capitated) HMO CA95166 Cedars-Sinai Medical Group - Payable Claims Comm CA

CELTC Celtic Comm37250 Cemara Administrators Comm91136 Cement Masons & Plasterers Health & Welfare Trust Group #F16 Comm

68048Cenpatico Behavioral Health - Arizona (Prior to submitting claims, please call Provider Relations Dept at 866-495-6748) Comm AZ

68050Cenpatico Behavioral Health - Georgia (Prior to submitting claims, please call Provider Relations Dept at 800-947-0633) Comm GA

68052 Cenpatico Behavioral Health - Indiana (Prior to submitting claims, please call Provider Relations Dept at 877-647-4848) Comm IN

68047Cenpatico Behavioral Health - Kansas (Prior to submitting claims, please contact Provider Relations Dept at 866-896-7293) Comm KS

68056 Centene Advantage Plans Comm USC02 Center Care (For Safety Claims) CommUNC01 Center Care (For Unicare Claims) CommMER04 Center Care PPO (Meritain) CommSCP01 Center for Health Care Comm CA13357 Centercare CommAMS11 Centinela Valley IPA Comm CA75243 Centra Comm75196 Centra Benefits - Houston, Texas Comm TX31118 Central Benefits Life Comm31118 Central Benefits Mutual Comm31118 Central Benefits National Comm

***** CCA01 Central California Alliance for Health Comm

*****CCA01 Central California Alliance for Health (before submitting claims go to http://www.ccah-alliance.org/claims_ecs.html to

pre-enroll. The Alliance will contact you (800-700-3874 ext 5510) with approval.) Comm

02041 Central Mass. Health Care (CMHC) Comm34097 Central Reserve Life CommCIPA1 Central SeniorCare Comm36215 Central States Health & Welfare Funds Comm37214 Central States Joint Board Health & Welfare Trust Fund Comm IL

***** SC027 Central Valley Medical Group (pre-enrollment under Sutter Connect) Comm CA48120 Century Health Solutions Comm23171 CHA Health Comm

***** CH002CHAMPUS / TRICARE NORTH (Health Net Federal) : Connecticut, Delaware, Illinois, Indiana, Kentucky, Massachusetts, Maryland, Maine, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, Wash D.C., West Virginia and Wisconsin.

Govn't

***** CH002CHAMPUS / TRICARE SOUTH (Humana Military) : Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee and Texas. Govn't

***** WPSTC

CHAMPUS / TRIWEST (WPS): Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa(Except for the Rock Island

Arsenal Area), Kansas, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon South

Dakota, The Extreme Western Portion of Texas, Utah, Washington and Wyoming.

Govn't

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Payer List subject to change without notice Page 7 of 31

Pre.Enr. Payer ID Name Claims Type State84146 ChampVA Govn't95748 Chartered Health Plan Comm DC16600 Chautauqua County Healthcare Plan - Mayville, New York Comm NY25151 CHC Cares of South Carolina Comm SCCHECS CHEC - A Subsidiary of Sprint Comm59223 Chesapeake Life Insurance Company Comm34154 Chesterfield Technologies Comm

AMM03 Child Health and Disabillity Prevention Treatment (Advanced Medical Management) Comm & HMO CA86048 Child Health Plus and Americhoice of New York Medicaid Comm94321 Children First Medical Group Comm84146 Children of Women Vietnam Veterans - VA HAC Comm

CPMG1 Children’s Physicians Medical Group CommCSSD2 Children's Specialists of San Diego II Comm94302 Chinese Community Health Plan Comm38692 CHIP CommCHIPA CHIPA - College Health IPA Comm ACN01 ChiroCare CommLNDMK Chiropractic Care of Minnesota Comm MNACN01 Chiropractic Care of Wisconsin Comm WISCH01 CHOC Health Alliance (Schaller Anderson) Comm & HMO CAUHSCH Choice One UTMB CHIP Health Plan (Please contact payer before sending claims-1-877-238-8543) Comm61271 Christian Brothers Services Comm

SPOHN Christus Spohn Health Plan Comm62308 CIGNA Comm62308 CIGNA - PPO CommCIGBH CIGNA Behavioral Health Comm62310 CIGNA Flex Care (New Mexico Only) Comm NM86033 CIGNA For Seniors Comm86033 CIGNA for Seniors - Arizona Medicare Comm & HMO CA, MN62308 CIGNA Health Plan Comm62308 CIGNA Premier Plus Comm10207 Citrus Health Plan CommIP055 Citrus Valley Physician's Group Comm & HMO CACOA01 City of Amarillo Group Health Plan Comm74234 City of Austin Comm TX75600 City of Odessa Comm

TKFMC City of Visalia Comm & HMO CA25133 Claims Administration Corp. Comm57080 Claimsware, Inc. DBA ManageMed Comm33192 Clarendons Healthy Kids CommHPSVC Clark County NV77201 Clark County Comm

CRGMN Clinical Resource Group Comm MNAMM03 CMS - Custody Medical Services (c/o Advanced Medical Management) Comm71063 CNA Health Partners Comm71063 CNA Health Partners (Formerly Coresource, AR) Comm AR37310 Coast Hotels & Casino Inc. DBA Coast Benefits Comm

CCPN1 Coastal Communities Physician Network (CCPN) Comm & HMO CA77052 Coastal TPA Comm38335 Cofinity Comm37123 Colonial Health Care Inc. Comm

COACC Colorado Access Comm COCOKSR Colorado Kaiser Permanente (Colorado plans only **EXCEPT COLORADO SPRINGS**) Comm & HMO COCOMPU Colorado Laboreres Health & Welfare Fund Comm & HMO COAMS11 Columbia Community Care Comm WA25351 Columbia Cornell Care Comm91162 Columbia United Providers Comm62308 CoMed - CIGNA Comm34181 Commerce Benefits Group Comm37237 Commonwealth Administrators, LLC Comm14315 Commonwealth Care Alliance Comm23171 Commonwealth Health Alliance (CHA) 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 and CFC San Fernando Valley Comm & HMO CACOMMF Community First Comm35193 Community Health Alliance Comm

CHCN1 Community Health Center Network - CHCN Comm48145 Community Health Choice Comm75261 Community Health Electronic Claims - CHEC - WEB TPA Comm62149 Community Health Network of Connecticut Comm CT

90010 Community Health Plan (located in St. Joseph, MO. Service Area includes NW Missouri, NE Kansas, SW Iowa, SE Nebraska) Comm

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Pre.Enr. Payer ID Name Claims Type StateCHPWA Community Health Plan of Washington CommCMGWV Community Medical Group of the West Valley Comm & HMO CA

32481 Community Premier Plus for Neighborhood Health Providers Comm34177 Comp - Austintown, Ohio Comm OH37297 CompBenefits Corporation CommCHP01 Complementary Healthcare Plan Comm59314 Comprehensive Behavioral Care Comm03036 Comprehensive Benefits Administrator, Inc. Comm VT

CCMC1 Comprehensive Care Management Comm NY74234 CompuSys - Erisa Group Comm TX

COMPU CompuSys (Incorporated) of Colorado Comm & HMO CO74234 CompuSys Inc - Arizona Comm AZ74234 CompuSys Inc - New Mexico Comm NM74234 CompuSys Inc - Utah Comm UT80705 Confederation Administration Services & Life Insurance Comm78375 Connecticare Medicare Comm CT06105 Connecticare, Inc. Comm37307 Connecticut Carpenters Health Fund Comm CT62308 Connecticut General Comm63208 Connecticut PRI Comm37135 Consociate Group Comm75284 Consolidated Associates Railroad Comm87843 Consolidated Health Plans Comm37295 Consumer Health Solutions Comm71404 Continental General Insurance Company Comm55544 Conversion Plan - APWU Comm

CCHP1 Cook Childrens Health Plan CommCCHP9 Cook Childrens Star Plan Comm TX35149 Cook Group Heath Plan Comm52132 Cooperative Benefit Administrators (CBA) Comm35199 Cooperative Managed Care Services Comm58204 Coordinated Medical Specialists Comm58231 Core Management Resources Comm35182 CoreSource - Arizona Comm AZ35182 CoreSource - Illinois Comm IL35182 CoreSource - Indiana Comm IN35182 CoreSource - Iowa Comm IA75136 CoreSource - Little Rock, Arkansas Comm AR35182 CoreSource - Maryland Comm MD35180 CoreSource - North Carolina Comm NC35183 CoreSource - Ohio Comm OH35182 CoreSource - Pennsylvania Comm PA35202 Cornerstone Benefit Adminstrators Comm

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. - North Carolina Comm NC37246 Corporate Systems Administration Comm43160 Correctional Medical Services Inc. Comm62553 Country Life Insurance Company CommMCS03 County of Kern POS CA41045 CourSource Minnesota Comm MN58102 Covenant Administrators Inc. - Atlanta, Georgia Comm

CMSEB Covenant Mgnt Sys Employ Ben Comm25133 Coventry - Kansas City Medicare (Advantra) Comm KS25133 Coventry Advantra - Texas, New Mexico, Arizona Comm25133 Coventry Health & Life - Oklahoma Comm25133 Coventry Health Care National Network Comm25133 Coventry Health Care of Delaware Comm DE25133 Coventry Health Care of Georgia Comm GA25133 Coventry Health Care of Nebraska Comm NE25133 Coventry Healthcare of Iowa Comm IA25133 Coventry Healthcare of Louisiana Comm LA25133 Coventry Healthcare of Missouri Comm MO25133 Coventry Healthcare of Wichita, Kansas Comm KS64068 Creative Medical Systems Comm37320 Creative Plan Administrators Comm80705 Crown Life - Great West Comm37266 Croy - Hall Management, Inc. Comm

HPSVC Culinary Workers Union NVAMM03 Custody Medical Services - CMS (c/o Advanced Medical Management) Comm39170 Custom Benefit Administrators Comm82056 Custom Design Benefits Inc. Comm57080 CWIBENEFITS, INC. Comm06172 Dart Container Corporation CommAMS11 Daughters of Charity Robert F. Kennedy Med Ctr (DCRFK) (Arcadian Mgmt Serv) Comm CAAMS11 Daughters of Charity St Francis Med Ctr (Arcadian Mgmt Serv) Comm CA

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Pre.Enr. Payer ID Name Claims Type StateAMS11 Daughters of Charity St. Vincent Med Ctr (Arcadian Mgmt Serv) Comm CA95748 DC Chartered Health Plan, Inc. (Medicaid & Alliance) Comm95748 DC Chartered Health Plan, Inc. (Medicaid & Alliance) Comm DC95740 DC HealthCare Alliance Comm DC39113 Dean Health Plan Comm WI87726 Definity Health Comm63081 Delaware Health Plan Consortium Comm27009 Delaware Physicians Care CommDHS01 Delta Health Systems Comm CA84134 Denver Health - Indigent Comm CO84133 Denver Health and Hospital Authority Comm CO84135 Denver Health Medical Plan Comm CO84131 Denver Health Medical Plan - Medicare Choice Comm

***** MC006 Department of Social and Health Services - DSHS (Medicaid of WA) Govn't WADNS22 Dermatology Network Solutions, LLC BCBS (Payer requires 11 digit member ID Number) CommDNS77 Dermatology Network Solutions, LLC Humana (Payer requires 11 digit member ID Number) CommDNS44 Dermatology Network Solutions, LLC Vista (Payer requires 11 digit member ID Number) CommAMS11 Desert Canyon Community Care Comm AZDESRT Desert Medical Group (Regal) Comm & HMO CA36436 Destiny Health Comm56240 Detroit Medical Center Comm MI25133 Diamond Plan Comm34639 DiaTri, LLC Comm23706 Director's Guild of America - Producer Health Plans Comm25160 Diversified Group Administrators Comm PA25160 Diversified Group Brokerage (Marlb, CT) Comm CT06102 Diversified Group Brokerage/Healthplan Services Comm

***** 16003 DMERC Region A Medicare Govn't***** 17003 DMERC Region B Medicare Govn't***** 00885 DMERC Region C Medicare Govn't***** 05655 DMERC Region D Medicare Govn't

AMS11 Downey Regional Medical Center (Arcadian Mgmt Serv) Comm CAAPP01 Downey Select IPA (NOW KNOWN AS Applecare Medical Managment) Comm & HMO CA74284 Driscoll Childrens Health Plan Comm37600 DSCC DIV Special Care Children Comm

***** MC006 DSHS - Department of Social and Health Services (Medicaid of WA) Govn't WA35186 Dunn and Associates Benefits Administrators Comm75232 E3 Health, Inc. Comm36434 Early Intervention Central Billing Comm

DHS01 East Bay Drainage Drivers Security Fund CommSYMED East LA Doctors Hospital CommEMG11 Eastland Medical Group IPA Comm & HMO CA62308 Eaton Benefits, Ohio Comm OH22262 EBA & M Employee Beneifts Administration and Management Corp Comm CAEBC01 EBC (Buffalo Rock) Birmingham Comm AL34166 EBS of Ohio (PO Box 2568, Mansfield, OH 44906) CommEPF03 El Paso First - CHIP CommEPF08 El Paso First Group Health Comm

MPMOA El Proyecto del Barrio Comm CA52192 Elder Health HMO of Pennsylvania Comm PA52192 Elder Health Maryland HMO Comm MD

31625 ElderPlan, Inc. Elderplan Provider ID is necessary on all claim submissions. If you do not know your provider Id, contact (718) 921-7979. Comm

NAELM ElmCare LLC Comm37253 Elmco Comm31074 EMBC (Employee Benefit Management Corp) Comm OH34167 Emerald Health Network (All PPO Business) CommAMM03 Emergency Medical Service Fund (EMSF) (Advanced Medical Management) Comm & HMO CAAMM03 Emergency Medical Service Fund (EMSF) (Advanced Medical Management) Comm & HMO CA59299 EMI-KP Ambulance Claims Comm73288 Emphesys Comm

***** 13202 Empire Medicare New York Govn't NYEMP01 Empire Physicians Medical Group Comm87726 Empire Plan- United Healthcare Comm38241 Employee Benefit Concepts Comm37215 Employee Benefit Corporation CommCX025 Employee Benefit Management Corp Comm OH81039 Employee Benefit Management Services Comm03036 Employee Benefit Plan Administration (E.B.P.A.) Comm VT37216 Employee Benefit Services - Ft. Mill, South Carolina Comm41198 Employee Benefit Services - Louisiana CommEBSSA Employee Benefit Services (EBS of San Antonio) Comm TX37257 Employee Benefits Consultants Comm22262 Employee Beneifts Administration & Management Corp (EBA&M) Comm CA75184 Employee Claim ADJ Comm

SYMED Employee Health Systems Comm & HMO CA35112 Employee Plans, LLC Comm

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Pre.Enr. Payer ID Name Claims Type State74212 Employer Plan Services CommMIDSC Employers Coalition on Health (ECOH) Comm75232 Employers Direct Health Comm75236 Employer's Direct Health - Employee Plan Comm75235 Employer's Direct Health - Fully insured Comm75233 Employer's Direct Health - Self CommMIDSC Employers Health Cooperative (EHC) Comm73288 Employers Health Insurance Comm37249 Employers Life Insurance Corporation Comm59297 Employers Mutual Inc. Comm59298 Employers Mutual, Inc. - Jacksonville, Florida Comm FL59331 Employers Mutual, Inc. - Stuart, Florida Comm FL35206 Encircle PPO Comm35206 Encore Health Network Comm36364 ENH Medical Group IPA Comm91136 Enstar Natural Gas, Group # P61 Comm

EPNSH EPN (Seton Health Plan) Comm28777 EPOCH Group, The Comm62308 Equicor Comm62308 Equicor - Equitable Comm62308 Equicor - PPO Comm75196 Equifax Healthcare Admin Service (EHAS) Comm73126 Equitable Plan Services - Oklahoma City, Oklahoma Comm OK23250 Erin Group Administrators Comm74234 Erisa Administrative Services Comm34108 ES Beveridge & Associates Comm20818 Essence Healthcare Comm34159 E-V Benefits Management, Inc. - Columbus, Ohio - Now known as Meritain Health Comm OH87726 Evercare Comm07501 Evercare Star Plus Comm58233 Evergreen Health Plan Comm59313 Evolutions Healthcare Systems - New Port Richey, Florida CommEXC01 Excel MSO Comm & HMO CACAPMN Exceptional Care Medical (Cap Managements Systems) Comm & HMO CA71412 Exclusicare Comm37289 F.A. Richard & Associates Inc. Comm91136 F40 Alaska Carpenters Trust Comm95432 Facey Medical Foundation Comm37300 FACS Group CommSX072 Fallon Community Health CommFCM01 Family Care Medicaid Mental Health Comm OR

FCD01 Family Care Medicaid Comm OR FCR01 Family Care Medicare Comm ORAMS11 Family Care Specialists (Arcadian Mgmt Serv) Comm CACAPMN Family Choice Medical Comm CACAPMN Family Health Alliance (Cap Managements Systems) Comm CA43173 Family Health Partners - MC + Missouri Comm MO31472 Family Health Partners Healthcare of Kansas Comm37289 FARA Benefit Services, Inc. Comm14140 Farm Family Life Comm59069 FBMC Comm33033 FCE Benefit Administrators Comm00402 Federal Employee Plan of SC Comm SC37300 Federated Benefits Comm37300 Federated HR Services Comm41041 Federated Mutual Health Insurance Company Comm MN

COFHP FHP of Colorado HMO Claims only Trading Partner Number Required HMO CO11315 Fidelis Care New York Comm NY77054 Fidelis Secure Care Comm

FAMR1 First Administrators Comm56196 First Carolina Care Comm NC56196 First Carolina Care Comm14162 First Choice - Connecticut Comm91131 First Choice Health Network Comm75138 First Choice of Midwest PPO Comm80705 First Great West Life & Annuity Ins. Co. Comm25133 First Health Network (CCN Managed Care and PPO for OK) Comm25133 First Health Network (Coventry) Comm

06108First Option Health Plan PHS HealthNet of the NE (Please call the EDI Team at 866-334-4638 to verify Provider ID)

Comm

***** 23241 First Priority - All new providers must enroll with First Priority Health/Blue Cross of Northeastern PA prior to submitting electronic claims. Enrollment form available at: http://www.bcnepa.com/EDI/registrationForm.aspx Comm PA

87726 First Seniority Freedom/Harvard Pilgrim Comm59276 First Service Administrators also known as Florida 1st Comm63080 First State Health Plan Comm94999 Firstcare Comm

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Pre.Enr. Payer ID Name Claims Type State94998 Firstcare – Medicaid Comm90061 FirstGuard Missouri Comm MO62061 Fiserv Health - Kansas & Tennessee Comm39026 Fiserv Health - Wausau Benefits - Benesight Comm95266 Fiserv Health Harrington Comm11244 Fitzharris & Company, Inc. Comm60054 Flexcare Comm59276 Florida 1st - Winterhaven, Florida Comm FL68058 Florida Cenpatico Behavioral Health Comm59321 Florida Hospital Healthcare Systems Comm FL48116 Florida Hospital Waterman Comm FL48116 Florida Hospital Waterman Employee Benefit Plan Comm FL59698 Florida League of Cities Comm65063 Florida NetPass Comm60054 Florida Power & Light (Prudential) Comm FLAPJAX Floridian Care - Jacksonville Comm FL48117 FMH Benefit Services, Inc. Comm37305 Ford Meter Box Company, Inc., The Comm25133 Foreign Service Benefit Plan Comm 87066 Formax, Inc. Comm

TKFMC Foundation for Medical Care of Tulare & Kings County Comm & HMO CA64069 Fox Everett - Ingalls Ship Building Comm

FVMCH Fox Valley Medicine Site 199 CommFVMC1 Fox Valley Medicine Site 451 Comm64069 Fox-Everett, Inc. Comm41212 Freedom Health Plan Comm62324 Freedom Life Insurance Company Comm TX

FMCHP Fresenius Med Care HTH Plan CommDHS01 Fresno Unified Comm & HMO CATKFMC Friant Water Users Comm & HMO CA59069 Fringe Benefit Management Comm 59204 Fringe Benefits Coordinators Comm34171 FrontPath Health Coalition Comm37283 Gallagher Benefit Administrators, Inc (now AAG-American Administrative Group) Comm30005 Galveston County Indigent Health Care Comm60550 Gateway Health Plan - Medicare Assured Comm25169 Gateway Health Plan Medicaid Pennsylvania Comm91741 Gateway Health Plan of Ohio - Medicare Assured Comm76028 Gateway Health Plan of Ohio Comm

PROSP Gateway IPA (Pinnacle Health Resources) (Prospect Medical Group) Comm & HMO CA59041 GE Voluntary Benefits - PIC (GE Voluntary Benefits Professional Insurance Company) Comm06143 GEGA - Group Administrators, South Carolina Comm SC67815 GEGLAC - G.E. Group Life Assurance Company Comm44054 GEHA Comm44054 GEHA Ins. No. 372 Comm

75273 Geisinger Health Plans (Prior enrollment required. Please contact Geisinger Health Plan at 888-281-5338, option 3, to obtain an enrollment form; or download a PDF enrollment form at www.thehealthplan.com) Comm

MCS01 GEMCare (Golden Empire Managed Care System) Comm & HMO CAMCS03 GemCare Health Plan, Kern County EPO Comm63665 Gencare Health (St. Louis) Comm MO63665 Genelco (St. Louis Only) Comm MO

HDNFC General Hospital (Humboldt Del Norte) Comm CA46050 Generations Healthcare Comm46051 Generations- Hillcrest Comm

PROSP Genesis Healthcare (EMG) (Prospect Medical Group) Comm CA11345 Gentiva Health Service Comm61271 Georgia Power Med. Benefits Pln (Health Care Services) Comm GA23212 Gettysburg Health Preferred Comm 22937 GHI - Medicare Private FFS Comm13551 GHI - New York (Group Health, Inc.) Comm25531 GHI HMO Comm25141 GHP (Group Health Plan) Comm MO25133 GHP Group Health Plan Comm58204 GI Innovative Management Comm07205 Gilsbar Comm88053 Gilsbar 360 Comm

COMPU Glassworkers and Glaziers Health and Welfare Fund Trust Comm & HMO COREGAL Glendale Physicians Alliance Comm07689 Global Care Inc. Comm

MPMOA Global Care Medical Group IPA Comm CA75246 GM Southwest Comm TX47083 GMS, Inc. Comm37602 Golden Rule Insurance Company CommMBA01 Golden State Medical Group Comm & HMO CAGTPA1 Golden Triangle Physican All CommAMM01 Good Samaritan Medical Practice Association (GSMPA) Comm CA

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Pre.Enr. Payer ID Name Claims Type State44054 Government Employees Hospital Association Comm37234 Grant Physicians Practice Association Comm95467 Great Lakes Health Plan Comm80705 Great West Health Care Comm

CAPMN Greater L.A. Health (Cap Managements Systems) Comm CANMM01 Greater Orange Medical Group CommNMM01 Greater San Gabriel Medical Group CommCAPMN Greater San Gabriel Valley Physicians (Cap Managements Systems) Comm & HMO CAHCP01 Greater Valley Comm & HMO CA80705 Great-West Life & Annuity Insurance Company Comm78521 Greentree Administrators Comm TX36338 Group Administrators Ltd. Comm48143 Group and Pension Administrators Comm72153 Group Benefit Administrators (Hendersonville, TN) Comm TN72087 Group Benefits - Louisiana Comm LA91121 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 Medicare Plus Choice Comm91051 Group Health Cooperative Healthy Options 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 Comm25133 Group Health Plan (GHP) Comm37276 Group Insurance Service Center Comm68046 Group Practice Affiliates Comm64246 Guardian Life (The Guardian) CommRENBL GULF QUEST IPA HMO BLUE CommRENGQ Gulf Quest Renassaince Comm39180 Gunderson Lutheran Health Plan Comm WI91131 H.E.R.E Health Trust Comm WA37114 H.E.R.E.I.U Welfare Pension Funds Comm36406 Harmony Health Plan of Illinois Comm IL36405 Harmony Health Plan of Indiana Comm INHCP01 Harrimon Jones Comm & HMO CA95266 Harrington Benefit Services - Centra Comm95266 Harrington Benefit Services, Inc. Comm95266 Harrington Benefit Services, Inc. (Oklahoma) Comm OK95959 Harris Methodist Health Plan Comm04271 Harvard Pilgrim Health Care Comm48330 Hawaii Management Alliance Association (HMAA) Comm37111 HCH Administration - Illinois Comm IL37215 HCH Administration, Inc. Comm37329 HCHA Albq-Self Funded Comm82018 HCS - Health Claims Service - Boise, Idaho Comm ID20257 HDPC - Alliance Physicians (High Desert Primary Care Alliance) Comm CA33069 HDPC - High Desert Primary Care Comm CA90023 HDPC - Premier Care (High Desert Primary Care Premier) Comm CA34654 Health & Welfare fund of the Plumbers & Pipefitters Local Union#396 Comm OH77950 Health Alliance Medical Plan Comm38224 Health Alliance Plan of Michigan Comm MI25133 Health America Inc. - Health Assurance - Advantra Comm60054 Health Care Alliance (Sears) Comm

HCDPB Health Care District Palm Beach CommMPMOA Health Care LA, IPA Comm CA42102 Health Care Network of Wisconsin (HCN) Comm WIHCP01 Health Care Partners Comm34193 Health Care Payer's Coalition (HCPC) Comm OH56142 Health Care Savings Comm61271 Health Care Services, Georgia Power Comm GA62180 Health Choice Generations Comm34158 Health Design Plus - Hudson, Ohio Comm OH75196 Health Economics Corporation Comm20356 Health Exchange (Cerner Corp) Comm16120 Health EZ Comm95019 Health First Health Plans Comm FL30946 Health Future LLC Comm59087 Health Help Network, Inc. (HHNI) Comm55247 Health Insurance Plan of Greater NY (HIP) Comm NY62295 Health Market Care Assured Comm20199 Health Network America Comm65062 Health Network One Comm

***** 55204 Health Now New York Comm NYNAHOI Health Options of Illinois Comm IL

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Pre.Enr. Payer ID Name Claims Type State***** HPAMN Health Partners of Minnesota Comm MN

62157 Health Partners of Tennessee Comm TN

80142 Health Partners, PA (All claims submitted require a valid Health Partners, PA, provider ID in the Rendering Provider Network ID field) Comm PA

20270 Health Payment Systems, Inc. Comm37221 Health Plan Management Comm52563 Health Plan of Michigan Comm MI76342 Health Plan of Nevada Comm & HMO CA, NVHPSJ1 Health Plan of San Joaquin Comm CAHPSM1 Health Plan of San Mateo Comm & HMO CA94254 Health Plan of the Redwoods (Mediprime) Comm CA

HPSVC Health Plan Services - Oklahoma Comm44273 Health Plans, Inc. Comm95435 Health Pledge HMO 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 Comm37290 Health Servs for Children w-Special Needs Comm27008 Health Systems International - ECOH Comm61101 Health Value Management - DE (Humana) Comm DE35206 Healthcare Group, The CommHCP01 HealthCare Partners in CA Comm & HMO11328 Healthcare Partners IPA - New York Comm NY56731 Healthcare Resources NW Comm73147 Healthcare Solutions Group Comm25143 Healthcare USA Comm36335 Healthcare's Finest Network (HFN) Comm62179 HealthChoice of Arizona Comm AZ95376 HealthChoice of Connecticut Comm CT85729 HealthComp Comm CANAHOI Healthe Options of Illinois Comm

HCPHM HealthFirst (HMO) Comm TX80141 Healthfirst Health Plan of New Jersey Comm80141 Healthfirst Inc -New York Comm NY75234 Healthfirst Tyler, TX Comm TX23226 HealthGuard of Lancaster Comm59087 HealthHelp Network, Inc. (HHNI) Comm FL61101 Healthhelp Networks, Inc. (HNNI) Comm96475 Healthlink HMO (Please call Provider Relations Dept at (800) 624-2356 for unique provider number. ) Comm90001 Healthlink PPO (Please call Provider Relations Dept at (800) 624-2356 for unique provider number. ) Comm95567 HealthNet of California, Oregon & Washington Comm

***** CH002 HealthNet Federal Services (TRICARE for North Region) Govn't38309 HealthNet of Arizona Comm AZ06108 HealthNet of the Northeast CommSX185 HealthNet Pearl Comm

80142 HealthPartners, PA (All claims submitted require a valid Health Partners, PA, provider ID in the Rendering Provider Network ID field) Comm PA

59140 HealthPlan Services (Tampa only) Comm FLHPSVC HealthPlan Services, Inc. (American Benefit) Comm & HMO59256 Healthplan Southeast HPSE Comm FL95009 HealthPlus of Louisiana Comm LA68195 Healthpoint Corp Comm71063 HealthSCOPE Benefits, Inc. CommM3IL1 HealthSelect BCBS of Florida Comm FL75250 HealthSmart Preferred Care Comm13335 HealthSource - Hudson Health Plan (Please contact payer before sending claims- 914-631-1611) Comm02041 Healthsource CMHC Comm02041 Healthsource Massachusetts, Inc. (CIGNA) Comm68195 Healthsource Provident Comm71075 Healthsource, AR (Med) (CIGNA) Comm58210 Healthsource, GA (CIGNA) Comm GA61127 Healthsource, KY (CIGNA) Comm KY01041 Healthsource, ME (Payer requires unique provider ID; please contact (800) 909-2227, ext.5760) Comm75255 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 Network Comm

HLTHQ Healthy Equation Comm

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Pre.Enr. Payer ID Name Claims Type State95827 Healthy Palm Beaches, Inc. Comm FL22148 Heavy & General Labors Fund of NJ Comm NJ59230 Heritage Consultants CommREGAL Heritage Provider Network Comm & HMO CAHDMDG High Desert Medical Group - Lancaster, California Comm & HMO CA33069 High Desert Primary Care - Hesperia, California Comm CA91161 Highline Medical Service Organization - PSHP Comm91164 Highline Medical Service Organization – Molina Comm35145 Highmark - Key Family CommHIL01 Hill Physicians Medical Group Comm CA59347 Hillcrest Benefit Administrators Comm36385 Hinsdale Physicians Healthcare CommHPIPA Hispanic Physician IPA Comm CA61101 HMPK, INC. (Humana) Comm

SYMED Hollywood Presbyterian Medical Group CommCAPMN Hollywood Presbyterian Medical Group- (now known as Prudent Medical Group) Comm CANAHLX Holy Cross Health Partners CommVAICE Homeland Security (ATTN: Deportation) Comm CA88023 Hometown Health Plan Nevada Comm NV22099 Horizon Blue Cross Blue Shield of New York & New Jersey Comm NY, NJ22326 Horizon NJ Health Comm37274 Hospital Benefits Comm91136 Hotel Employees & Restaurant Employees Health Trust, Group # F19 Comm61101 HPLAN, INC. (Humana) Comm94254 HPR Comm58227 HPS Paradigm Comm41170 HRM Claim Management Comm41150 HSM - Health Services Management Comm MN13335 Hudson Health Plan (Please contact payer before sending claims- 914-631-1611) CommHBI01 Human Behavior Institute Comm61101 Humana Care Plan Comm61101 Humana Gold Choice Comm61101 Humana Gold Plus Comm61101 Humana Health Comm61101 Humana Health Chicago Insurance Company Comm61101 Humana Health Chicago, Inc. Comm61101 Humana Health Plan Comm61101 Humana Health Plan - HMO Comm95348 Humana Health Plans of Ohio OH61101 Humana Insurance Agency Comm61101 Humana Insurance Co. Comm61101 Humana Medical Plan - California Comm CA61101 Humana Medical Plan - Kentucky Comm KY

***** CH002 Humana Military Healthcare Services (TRICARE for South Region) Govn't61101 Humana Ochsner 1 Comm61101 Humana Ochsner 2 CommZ0005 Humana Ohio 2 Comm OH65018 Humana Puerto Rico Comm61160 Humana Veterans Healthcare Services Comm61101 Humana Wisconsin Health Organization (Formerly Carenetwork - Wisconsin Health Organization) Comm WI

HDNFC Humboldt - Del Norte Foundation IPA Comm CA37260 Hunt Insurance Group Comm

CAPMN Huntington Park Mission Medical Group (Cap Managements Systems) Comm CA13335 Husdon Health Plan (Please contact payer before sending claims- 914-631-1611) CommSX172 I U Medical Group Primary Care Comm22175 I. E. Shaffer - West Trenton, New Jersey Comm NJ38234 IBA Self Funded Group 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

74234 IBEW Local 640 & AZ Chapter NECA Health & Welfare Trust Comm74234 IBEW Western Utilities or Local 57 Comm60054 IBM Medical Plans Comm11695 iCARE (Independent Care Health Plan) Comm WI37296 ICM Comm75185 ICON Benefit Administrators Comm75274 IHG Direct CommIHORG IHO (Inland Health Organization) Comm36600 Illinois Central Hospital Association - Tinley Park, Illinois Comm IL91131 ILWU Local 21 (FCHN) Comm WA41600 IMCARE CommSCP01 Imperial County Physicians Med Group (SCPMCS) Comm40585 INDECS Corporation Comm54763 Independence Administrators Comm

***** 54704 Independence Blue Cross (Highmark) *Must also be a Highmark provider* Comm PAIMG01 Independence Medical Group - Kern County Comm CAIMG02 Independence Medical Group - Tulare County Comm CA35204 Indiana Health Network Comm IN

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Pre.Enr. Payer ID Name Claims Type State35161 Indiana ProHealth Network Comm35107 Indiana Teamsters Health Benefits Fund - Indianapolis, Indiana Comm IN31053 Individual Health Insurance Companies Comm

COMPU Industrial Machine Specialties Comm & HMO CO52196 Informed CommNAING Ingalls Provider Group Comm91131 Inland Empire Electrical Trust (FCHN) Comm & HMO WAIEHP1 Inland Empire Health Plan Comm CAIHORG Inland Health Organization (IHO) Comm04320 Innovative Healthware Solutions Comm93112 Inpronet, Portland, OR Comm ORVAICE INS Health Services Comm DC60054 Institutes of Quality Comm37279 Insurance Administrator of America, Inc. (IAA) Comm63082 Insurance Claims Services - Birmingham, Alabama Comm AL13315 Insurance Design Administrators CommIMSMS Insurance Management Services Comm TX88006 Insurance Management Services - Elko, Nevada Comm NVIAC01 Insurers Administrative Corp. Comm51020 Integra Administrative Group - Seaford, Deleware Comm DE31127 Integra Group Comm31129 Integra Group-CHA CommINET1 Integranet Comm37124 Integrated Benefit Services - Illinois Comm IL34167 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. Comm92649 Inter-Americas Insurance Comm37227 InterCare Health Plans Comm60280 Interface EAP (IEAP) Comm23287 Intergroup Services Corporation Comm74234 Intermountain Ironworkers Trust Fund Comm36609 International Brotherhood of Boilermakers CommIMGIN International Medica Group Inc Comm37269 International Union of Operating Engineers ~ Local 15, 15A, 15C & 15D 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 Comm FLJAI01 Jai Medical Systems Comm MDJISSP Ji Specjality Services, Inc. Comm41099 John Alden Life Insurance Co. Comm95378 John Deere Health Care CommJMH01 John Muir Physician Network Comm68013 John Muir Trauma Physicians37215 John P. Pearl & Associates, Ltd. Comm52189 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 & HMO CO

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 GA94135 Kaiser Foundation Health Plan of Northern CA Region Comm CAKS005 Kaiser Foundation Health Plan of Ohio Comm OHKS001 Kaiser Foundation Health Plan of Southern California Comm CA52095 Kaiser Foundation Health Plan of the Mid-Atlantic States (MD, VA and DC) CommNW002 Kaiser Foundation Health Plan of the Northwest CommKS006 Kaiser HDHP (High Deductable Health Plan) Comm57038 Kanawha Healthcare Solutions Comm57038 Kanawha Insurance Company Comm44030 Kansas City Life Insurance Company Comm25133 Kansas City Medicare - Coventry (Advantra) CommHSM01 Karing Physicians Medical Group, Inc. CommKMG11 Katy Medical Claims CommTKFMC Kaweah Delta Comm & HMO CAKEE01 Keenan & Associates Comm CAKELSE Kelsey Seybold Comm73100 Kempton Group Administrators Comm63077 Kentucky Health Select Comm KY61101 Kentucky Kare (Humana) Comm37124 Kepple & Co. (Formerly Integrated Benefit Svcs.) Comm IL

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Pre.Enr. Payer ID Name Claims Type StateMCS03 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 Comm23239 Keystone Health Plan Central Comm

***** 95056 Keystone Health Plan East (KHP) (Highmark) *Must also be a Highmark provider* Comm23284 Keystone Mercy Health Plan Comm PA86049 KidsChoice Medicaid and AmeriChoice of Pennsylvania Comm PA86049 KidsChoice via Information Network Corp. Comm PA34145 Klais & Company Comm

KAMG1 Korean American Medical Group Comm & HMO CAKPS01 KPS - Kitsap Physicians Services Comm WAKPS01 KPS Health Plan 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 WVLVCV1 La Vida Central Valley CommLVIPA La Vida IPA Comm CA71037 Lafayette Consolidated Government Comm LA

LCHC1 Lakeside Comprehensive Healthcare CommLMG11 Lakeside Medical Group Comm CALNDMK Landmark CommBPA01 Laundry Workers 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

LFGRD Lifeguard 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

61101 Lincoln National - Phoenix, AZ (Humana) Comm AZ73288 Lincoln National (EMPHESYS) CommLOBH1 Linden Oaks Behavioral Health Comm75283 Linn County CommLIPA1 Lipa-Agate Resources Hcfa Comm35107 Local 135 Health Benefits (Indianapolis, IN) Comm IN37267 Loma Linda University Adventist Health Sciences Center Employee Health Plan Comm37267 Loma Linda University Adventist Health Sciences Centers Comm37267 Loma Linda University Behavioral Medicine Center Employee Health Plan Comm37267 Loma Linda University Employee Health Plan Comm37267 Loma Linda University Health Care Employee Health Plan Comm33036 Loma Linda University Healthcare - ManagedCare Claims Comm37226 London Health Administrators Comm23223 Loomis Company, The - TPA Wyomissing, PA (IHS Gateway Payer) CommPPM01 Los Angeles Medical Center (LAMC) Comm SYMED Los Angeles Metro Medical Center Comm CASX159 Lovelace Medicaid NMSX159 Lovelace Salud (New Mexico Medicaid) NM90328 Lovelace Sandia Health Plan52148 M.D. Individual Practice Assoc. (M.D.IPA) Comm

CAPMN Mabuhay Medical Group (Cap Managements Systems) Comm & HMO CA37292 Machinist District 9 Welfare Comm36334 MacNeal Health Providers - CHS CommHCP01 Magan Medical Clinic Comm & HMO CA01260 Magellan Behavioral Health Services Comm11303 Magnacare Comm25133 Mailhandlers Benefit Plan (CAC) Comm22195 Maksin Management Corporation 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 NETW Comm

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Pre.Enr. Payer ID Name Claims Type State41159 Managed Physical Network Comm41555 Manatee Service Center - Bradenton, FL Comm75258 Mapco, Inc. Comm09908 Maricopa Health Plan – University Family Care CommIP097 Marin IPA Comm CA13310 MARSH ADVANTAGE Comm

MPHC1 Martins Point Health Care Comm22347 Maryland Health Insurance Plan Comm MD00247 Maryland Physicians Care Comm MD37121 Mashantucket Pequot Tribal Nation Comm80314 Mass Mutual Comm

MMPHB Masters Mates and Pilots Plan 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 Benefit Administrators, Inc. (Salt Lake City, UT) Comm UT87065 MBA of Wyoming (Payer ID valid for claims with a submission address of PO Box 98, Worland, WY 82401) Comm WY87065 MBA of Wyoming (Worland, WY) Comm WY56205 MBS - Formerly MedCost Benefit Services Comm25160 MCA Admin (Formerly DGA) Comm PA

CSMED Mcare of Colorado Springs Comm & HMO CO59331 McCreary Corporation CommMHM02 McKinley Medical Group (Magnolia Healthcare Mgmt) Comm38338 McLaren Health Plan Comm

MDAPN MD Anderson Physician Network CommMDC01 MD Care Health Plan Comm52148 MD - Individual Practice Association, Inc. (M.D. IPA) Comm20475 Mdwise Hoosier Alliance Comm58204 MedAdmin Solutions - Capitated claims- FL only Comm58202 MedAdmin Solutions - self funded plans Comm74323 MedBen (Newark, OH) Comm OH59231 MedCom Comm60054 Medconnection (Marriot) Comm

MDCOR MedCore Comm56162 MedCost, Inc. Comm38353 MedDirect Comm95321 Medfocus Comm94265 Medica Comm MN78857 Medica Health Care Plan, Inc Comm 78857 Medica Health Care Plan, INC. Comm

***** MCDAK Medicaid - Alaska Govn't AKMCDAZ Medicaid - Arizona Govn't

***** 77016 Medicaid - Colorado Govn't CO***** MCCOB Medicaid - Colorado Behavioral Health Comm CO***** 77027 Medicaid - Florida Govn't FL***** 77034 Medicaid - Georgia Govn't GA***** MCDID Medicaid - Idaho Govn't ID***** MCDIL Medicaid - Illinois Govn't IL

MCDIN Medicaid - Indiana Govn't IN***** 18049 Medicaid - Iowa Govn't IA

MCDKS Medicaid - Kansas Govn't KS***** MCDKY Medicaid - Kentucky Govn't KY***** MCDLA Medicaid - Louisiana Govn't LA***** 77062 Medicaid - Maryland MHS (PMHS) Comm MD

MCDMA Medicaid - Massachusetts Govn't MA***** MCMAB Medicaid - Massachusetts Behavioral Health Comm MA***** MCDMN Medicaid - Minnesota Govn't MN***** 77032 Medicaid - Mississippi Govn't MS

MCDMO Medicaid - Missouri Govn't MO

*****MC008 Medicaid - Nevada Govn't NV

***** MCDNH Medicaid - New Hampshire Govn't NH***** MCDNJ Medicaid - New Jersey Govn't NJ

NMMAD Medicaid - New Mexico Govn't NMNCXIX Medicaid - North Carolina Govn't NC

MCDND Medicaid - North Dakota Govt NDMCDOH Medicaid - Ohio Govn't OHMCDOK Medicaid - Oklahoma Govn't OK

***** ORDHS Medicaid - Oregon Govn't ORMCDPA Medicaid - Pennsylvania Govn't PA

***** SCXIX Medicaid - South Carolina Govn't SCTMHP1 Medicaid - Texas Govn't TXEPF02 Medicaid - Texas-Premier Plan

***** MCDVT Medicaid - Vermont Govn't VTMCDVA Medicaid - Virginia Govn't VA

***** MC006 Medicaid - Washington - DSHS - Department of Social and Health Services Govn't WAMCDWI Medicaid - Wisconsin Govn't WI

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Pre.Enr. Payer ID Name Claims Type State37298 Medical Benefit Administrators of Maryland Comm MD

MBA01 Medical Benefits Administrators Comm & HMO CA74323 Medical Benefits Administrators, Inc. (Newark, OH) Comm OH74323 Medical Benefits Companies (Newark, OH) Comm OH74323 Medical Benefits Mutual Comm04258 Medical Claims Services Inc. Comm75229 Medical Control Inc. Comm52181 Medical Development International CommBC004 Medical Mutual of Ohio Comm OH

CSMED Medical Network of Colorado Springs Comm & HMO CO61101 Medical Plan of Kansas City - MO (Humana) Comm MO

AMM02 Medical Services For Indigents (MSI) (Advanced Medical Management) Comm & HMO CAIP186 Medical Services Initiative Comm

***** MC051 MediCal Type 05 Govn't CA38224 Medical Value Plan-MVP-OH Comm OH

***** MR010 Medicare - Alaska Govn't AK***** MR008 Medicare - Arizona Govn't AZ***** MR086 Medicare - Arkansas Govn't AR***** MR001 Medicare - California (Northern California) Govn't CA***** MR002 Medicare - California (Southern California) Govn't CA***** MR004 Medicare - Colorado Govn't CO***** 13102 Medicare - Connectiuct Govn't CT***** 00902 Medicare - Deleware (Highmark) Govn't DE***** 00885 Medicare - DMERC Region C Govn't***** 05655 Medicare - DMERC Region D Govn't***** MR025 Medicare - Florida Govn't FL***** 10202 Medicare - Georgia Govn't GA***** MR057 Medicare - Hawaii Govn't HI***** MR003 Medicare - Idaho Govn't ID***** 00952 Medicare - Illinois Govn't IL***** MR089 Medicare - Indiana Govn't IN***** 05102 Medicare - Iowa Govn't IA***** 05202 Medicare - Kansas Govn't KS***** MR088 Medicare - Kentucky Govn't KY***** 00528 Medicare - Louisana Govn't LA***** 14102 Medicare - Maine Govn't ME***** 00901 Medicare - Maryland (Highmark) Govn't MD***** 14202 Medicare - Massachusetts Govn't MA***** 00953 Medicare - Michigan Govn't MI***** 00954 Medicare - Minnesota Govn't MN***** 05302 Medicare - Missouri (East and West) Govn't MO***** 03202 Medicare - Montana Govn't MT***** 00655 Medicare - Nebraska Govn't NE***** MR007 Medicare - Nevada Govn't NV***** 14302 Medicare - New Hampshire Govn't NH***** 12402 Medicare - New Jersey Govn't NJ***** 04202 Medicare - New Mexico Govn't NM***** 13202 Medicare - New York - Downstate - Empire Govn't NY***** 13292 Medicare - New York - Queens Govn't NY***** 13282 Medicare - New York - Upstate - Part B Govn't NY***** MR020 Medicare - North Carolina Govn't NC***** MR083 Medicare - North Dakota Govn't ND***** 00883 Medicare - Ohio Govn't OH***** 04302 Medicare - Oklahoma (Trailblazer) Govn't OK***** MR011 Medicare - Oregon Govn't OR***** 12502 Medicare - Pennsylvania Govn't PA***** MR018 Medicare - Railroad Govn't MULTI***** 14402 Medicare - Rhode Island Govn't RI***** 00880 Medicare - South Carolina Govn't SC***** MR084 Medicare - South Dakota Govn't SD***** MR034 Medicare - Tennessee Govn't TN***** MR085 Medicare - Texas (Trailblazer) Govn't TX***** MR046 Medicare - Utah Govn't UT***** 14502 Medicare - Vermont Govn't VT***** 00904 Medicare - Virginia Govn't VA***** MR006 Medicare - Washington Govn't WA***** 00903 Medicare - Washington, DC (Highmark) Govn't DC***** 00884 Medicare - West Virginia Govn't WV***** 00951 Medicare - Wisconsin Govn't MI***** MR074 Medicare - Wyoming Govn't WY

CAPMN Medicina Familiar Medical Group (Cap Managements Systems) Comm CA95655 Medigold Comm OH13123 Medigold PPO Comm OH94254 MediPrime Comm

MPMOA Medpoint Management Comm CA62160 MedSolutions, Inc. Comm GA82160 Medspan, Inc. Comm

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Pre.Enr. Payer ID Name Claims Type State

59221 Mega Life & Health Insurance Company - Insurance Center P.O. Box 982009, North Richland Hills, TX 76182 Comm

59227 Mega Life & Health Insurance Company - OKC P.O. Box 548801, Oklahoma City, OK 73154 Comm OK

01047 MEMIC CommMCA11 Memorial Clinical Associates / SelectCare of Texas (MCA) CommMHHNP Memorial Herman Health Net Comm

***** 59065 Memorial Integrated Healthcare (Please email Tracy Harswick at [email protected] before submitting claims.) Comm

HCP01 Memorial Medical Group Comm & HMO CA***** 59065 Memorial PSN/CMS (Please email Tracy Harswick at [email protected] before submitting claims.) Comm

74289 Mental Health Network (MHNet) Comm86052 Mercy Care Plan (AHCCCS) Comm AZ

MER11 Mercy Health Plan CommIP079 Mercy Physicians Medical Group (MPMG) (NAMM Southern CA) Comm

38232 Meritain Health (Formerly know was Weyco) – Payer ID valid for claims with billing submission address of 2370 Science Parkway Okemos, Michigan 48864 Comm

41124 Meritain 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

34159 Meritain 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

34159 Meritain 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 known as North American Administrators, Inc.) Comm64158 Meritain Health/Agency Services (Formaly known as Agency Services Inc.) Comm64157 Meritain Health (Formerly know as North American Administrators, Inc.) Comm64157 Meritain Health/North American Administrators Comm64157 Meritain Health/North American Administrators Comm85035 Mesa Mental Health Comm NM65113 Metcare Health Plans Comm23550 Methodist First Choice Comm95420 MethodistCare Comm87726 Metrahealth Network (HMO & Care Option:A United HealthCare Co.) Comm87726 Metrahealth Plan Administrators (A United HealthCare Co.) Comm87726 Metrahealth/Metrahealth Railroad (A United HealthCare Co.) Comm82135 Metro Alliance Comm13265 Metro Plus Health Plan CommMHP01 Metropolitan Health Plan Comm MN61101 Michael Reese HMO Plan - IL Comm IL61101 Michael Reese HMO Plan - IN Comm IN37127 Michael Reese Physicians Group Comm63079 Mid Atlantic Health Plan Comm52148 Mid Atlantic Psychiatric Services, Inc. (MAPSI) Comm52149 Mid Atlantic Psychiatric Services, Inc. (MAPSI) CommMRIPA Mid Rogue Oregon Health Plan Comm OR37281 Mid-America Associates Inc. Comm37281 Mid-America Associates, Inc. Comm63079 Mid-Atlantic Health Plan Comm

CAPMN MidCities IPA (Cap Managements Systems) Comm & HMO CAAMS11 Midcoast Care Inc. (Arcadian) Comm & HMO CASYMED Mid-County Physicians Medical Group (San Diego) Comm & HMO47080 Midlands Choice, Inc. Comm62168 Midsouth Administrative Group Comm61146 Midwest Group Benefits CommMHP77 Midwest Health Plans, Inc. Comm59224 Mid-West National Life Insurance Company of Tennessee CommMIDSC Midwest Preferred Comm79480 Midwest Security Administration CommMSI01 Midwester Preferred Comm

MPHS1 Mills Peninsula Health Services Comm CA

MPMG1 Mills Peninsula Medical Group Comm CA***** MCDMN Minnesota Health Care Program ( see Medicaid MN) Comm

05018 MIPS CommSTJOE Mission (St. Joseph Heritage Healthcare) Comm & HMO CASYMED Mission Community Hospital of Huntington Park Comm CAMPMOA Mission Community IPA Medical Group Comm CA37233 Mississippi Public Entity Employee Benefit Trust (MPEEBT) Comm MS37233 Mississippi Public Entity Employee Benefit Trust Comm MS64088 Mississippi Select Health Care Comm MS64088 Mississippi Select Health Care (Gulfport, MS) Comm MS37275 Missoula County Medical Benefits Plan Comm43179 Missouri Care (MC) Comm

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Pre.Enr. Payer ID Name Claims Type State37265 MLink Comm62178 MMS, LLC. CommIP095 Monarch Healthcare IPA Comm CA50749 Mondial Assistance Comm VA13174 Montefiore CMO CommMMLI2 Monumental Life Ins MMLI2 - Kentucky Comm KYMMLI3 Monumental Life Ins MMLI3 - Texas Comm TXMMLIC Monumental Life Ins MMLI3 - Texas Comm AKMMLI3 Monumental Life Insurance Co (Hurst, TX) Comm TXMMLIC Monumental Life Insurance Co (Little Rock, AR) Comm AR35092 Morris Associates CommIP083 Mosaic IPA Medical Group Comm CAMPI01 Motion Picture Industry Health Plan Comm CA36111 Motorola Comm84095 Mountain Medical Affiliates Comm86040 Mountain States Administrative Services Tucson, Arizona Comm

MTNST Mountain States Administrators (CO only) Comm37233 MPE Services Inc. Comm MS95444 MPLAN, Inc. - HealthCare Group CommIP079 MPMG (Mercy Physicians Medical Group) (NAMM Southern CA) 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, California Comm & HMO CA39634 Multiplan Inc for American Family Comm34080 Multiplan Wisconsin Preferred Network Comm37256 Mutual Assurance Comm OK59140 Mutual Group (The) (US) Comm71412 Mutual of Omaha Comm71412 Mutually Preferred Comm14165 MVP Health Plan of NY (For your MVP Provider number, call 800-684-9286) Comm NY91136 N.W. Ironworkers Health & Security Trust Fund, Group # F15 Comm91136 N.W. Roofers & Employers Health & Security Trust Fund, Group# F26 Comm91136 N.W. Textile Processors Group # F14 Comm

34159 NABN (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

NOD01 Nacel Open Door – (Minnesota providers only) CommNHCA1 Naperville Health Care Comm53011 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 TXNHAIN National Health Administrators, Inc. Comm 75275 National Health Insurance Company Comm37231 National Healthcare Exchange CommNIA11 National Imaging Association Comm59087 National Radiology Network, The 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 Insurance Comm75191 NCAS - Charlotte, North Carolina Comm NC75190 NCAS - Fairfax, Virginia Comm CA04293 Neighborhood Health Plan - Boston, Massachusettes Comm MA96107 Neighborhood Health Plan - Florida (Only valid for PO Box 025680, Miami, Florida 33102-5680 address) Comm FL05047 Neighborhood Health Plan - Rhode Island Comm RI

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 Comm39144 Network Health Plan - Wisconsin Comm WI

NMM01 Network Medical Management Comm58204 Network TPA, LLC CommNCH06 New Century Health - Bascom Palmer Eye Care Network Comm FLNCH05 New Century Health - California Eye Care Comm CANCH04 New Century Health - CarePlus Cardiology Comm FLNCH01 New Century Health - CarePlus Dermatology Comm FLNCH03 New Century Health - CarePlus Urology Comm FLNCH11 New Century Health – Humana Cardiology Comm CANCH02 New Century Health - Humana Dermatology Comm FL

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Pre.Enr. Payer ID Name Claims Type StateNCH10 New Century Health - Humana Oncology Comm FLNCH09 New Century Health – Vista Cardiology - Summit CommNCH07 New Century Infusion Solutions - CarePlus Oncology Comm FLNCH08 New Century Infusion Solutions - Vista Oncology Comm66893 New England, The Comm76031 New Era Employee Welfare Benefit Comm75281 New Era Life Insurance Company CommHSM01 New Life Medical Group, Inc. dba Healthy New Life Medical Corp. Comm65056 New Market Dimensions Comm74234 New Mexico District Council of Carpenters Comm NM74234 New Mexico Painters & Allied Trades Local #823 Comm UT74234 New Mexico West Texas Multi-Craft Comm37312 New Source Benefits, LLC Comm84141 New West Health Plan CommNYL11 New York Life Long Term Care Comm48186 New York Presbyterian Community Health Plan Comm NY24819 New York Presbyterian System Select Health Comm NY38225 NGS American Comm62124 NHC Health Benefit Plan Comm96107 NHP "Neighborborhood Health Partnership" Comm11325 NHP/SHP (Neighborhood Health Providers and Suffolk Health Plan) Comm81264 Nippon Life Insurance Company of America Comm22603 NJ Carpenters Health Fund Comm NJPDT01 Noble AMA Select IPA Comm & HMO CACAPMN Noble Community Medical Associates LA (Cap Managements Systems) Comm & HMO CAHSM01 Noble Mid OC Orange County (Health Smart) Comm & HMO CA65085 North America Administrators (NAA) - Nashville, Tennessee Comm TN

34159North American Benefits Network - Cleveland, Ohio. 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

64157 North American Health Plan (Now known as Meritain Health) Comm64157 North American Health Plan (Now known as Meritain Health) Comm36398 North American Medical Management - Illinois Comm ILE3510 North American Medical Management - Northern California Comm CAIP079 North American Medical Management - Southern California Comm CA64157 North American Preferred (Now known as Meritain Health) Comm37314 North Broward Hospital District Comm FLSCP01 North County Health Services Comm CANSA01 North Star Advantage Comm MN35212 North Texas Healthcare Network Comm TX91131 North West Administrators (FCHN) Comm WA

PROSP North West Orange County Medical Group Comm & HMO CA91131 North West Sheet Metal Workers (FCHN) Comm WA64157 North American Administrators (Now known as Meritain Health) CommAMS11 Northeast Community Care Comm ME,NY38238 Northern California Sheet Metal Workers Health Care Plan Comm CA36347 Northern Illinois Health Plan Comm IL88027 Northern Nevada Trust Fund Comm

NMG01 Northridge Medical Group Comm CANANWC Northwest Community Health Partners CommNWDC1 Northwest Diagnostic Clinic (NWDC) CommNHN11 Northwest Physicians Network Comm WA36346 Northwest Suburban IPA (Illinois) Comm IL16644 Nova Healthcare Administrators, Inc. (Grand Island, New York) Comm06226 Novanet Comm71080 Novasys Health Network Comm

PROSP Nuestra Familia Medical Group (Prospect Medical Group) Comm & HMO CA41045 NW National Life (Reliastar) Comm37299 Nyhart Comm

NAOAK Oak West Primary Physician Assoc Comm95358 Oaktree Health Plan CommDESRT Oasis IPA Comm & HMO CA72112 Oath For Louisiana, Inc., The (formerly, Southeast Medical Alliance) 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 LA13310 Office of the Administrator (Seabury and Smith) Comm DC14163 Ohana Health Plan Comm HI34189 Ohio Health Choice, PPO Comm OH95435 Ohio Health Group Comm OHAMS11 Ojai Dual Risk (Arcadian Mgmt Serv) Comm CAAMS11 Ojai Valley Community Med. Group (Arcadian Mgmt Serv) Comm CA22521 OK State Employees & Educators (EDS) Comm

HDNFC Omni Healthcare - Humboldt Del Norte, California Comm CAMDCOR Omni IPA - Medcore HP Comm

25133 Omnicare - A Coventry Health Plan Comm

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Pre.Enr. Payer ID Name Claims Type StateOMN02 Omnicare Medical Group (OMNI) Comm CA22321 One Call Medical Comm80705 One Health Plan Comm CA80705 One Health Plan Comm CO80705 One Health Plan (Except CA, CO, GA, IL, or TX) Comm80705 One Health Plan of Georgia, Inc. Comm80705 One Health Plan of Illinois, Inc. Comm80705 One Healthplan Comm52149 OneNet PPO, LLC Comm

BPA01 OPEIU Locals 30& 537 Comm74234 Operating Engineers Local #53 Comm UT

BPA01 Operating Engineers Local 501 Comm91136 Operating Engineers Locals 302 & 612 Health & Security Fund, Group # F12 Comm52152 Optimum Choice of the Carolina’s (OCCI) Comm52148 Optimum Choice, Inc. (OCI) Comm20133 Optimum Healthcare Comm37125 Option Services Group Comm91131 Options Health Plan Comm WA87726 OptumHealth Behavioral Solutions Comm41160 OptumHealth Care Solutions (ACN of NY) Comm41161 OptumHealth Care Solutions (ACN) Comm

HSM01 Orange County Advantage Medical Group CommOCFMC Orange County Foundation for Medical Care Comm25133 ORNDA Health D296Corp (First Health)+D312 Comm13383 Orthonet - Aetna Comm13382 Orthonet - Uniformed Services Family Health Plan Comm13381 Orthonet Corporation - CIGNA Comm25681 Orthonet-HealthNet Comm62171 OSF Health Plans Comm36365 Our Lady of the Resurrection Physician Association Comm06111 Oxford Health Plans Comm91131 P.S.E.W. Trust Comm87068 P5 Health Plan Solutions of Utah Comm UT

SYMED Pacific Alliance Medical Center Comm CASYMED Pacific Alliance Medical Group Comm & HMO CAHSM01 Pacific Healthcare IPA Medical Associates, Inc. CommPCFCI Pacific IPA Comm CA93029 Pacific Source Health Plans Comm OR95999 PacifiCare - PPO claims only Comm95959 PacifiCare - Secure Horizon - HMO claims only Comm CA33053 PacifiCare Behavioral Health Comm95964 PacifiCare of Arizona - For payable PacifiCare - Secure Horizons HMO claims only. Not for PPO claims Comm AZ

COFHP PacifiCare of Colorado Comm CO95962 PACIFICARE of Colorado Comm95959 PacifiCare of Oregon -Secure Horizon/HMO claims only Comm OR95959 PacifiCare of TX (OK & TX)-Secure Horizon/HMO claims only Comm TX95959 PacifiCare of Washington-Secure Horizon/HMO claims only Comm WAAMS11 Palomar Pomerado Health (Arcadian Mgmt Serv) Comm CA58174 Paragon Benefits, Inc. Comm58204 Parity Healthcare Comm66917 Parkland Community Health Plan Comm

***** Partners National Health Plans of North Carolina (Contracted providers only. Please call Partners National Health Plan of NC provider services department at (888) 296-9790; option 2 for electronic claims set-up and payer id.) Comm NC

CAPMN Pasadena Primary Care Physicians (Cap Managements Systems) Comm CA76569 Passport Advantage (DOS 1-1-10 and forward only) Comm61129 Passport Health Plan Comm10525 Patient Advocates, LLC Comm65018 PCA Health Plan of Florida Comm FL95885 PCA Health Plans of Texas (Humana) Comm TX61101 PCA Star (Humana) Comm68049 Peach State Health Plan Comm20472 Pediatric Associates Comm

HDMDG Pegasus Medical Group Comm & HMO CA37086 Pekin Insurance Comm IL72126 Peoples Health Network Comm13522 Perfect Health Insurance Company Comm

41124 Performax, 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

34173 Personal Physician Care Comm25133 PersonalCare Comm60054 PG&E (Pacific Gas & Electric) Comm95183 PHA Insurance Services - Orlando, Florida Comm FL13306 PHCS Savility Payers Comm75238 Phoenix Group Services - Texas Comm TX03440 Phoenix Health Plan Comm

PHYCR Phycor Comm CO

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Payer List subject to change without notice Page 23 of 31

Pre.Enr. Payer ID Name Claims Type StatePA513 Physician Associates of Greater San Gabriel Valley Comm CA58204 Physician Associates of Louisiana Comm58204 Physician Care Network Comm

PHPMC Physician Health Partners Comm CO15749 Physicians Alliance - SRR IPA CommHSM01 Physicians Alliance Network Comm38265 Physicians Care Comm57098 Physicians Care Network (North Carolina) Comm NC36345 Physicians Care Network-Rockford-IL only Comm ILPDT01 Physician's Data Trust Comm & HMO CA75297 Physicians Direct Comm37136 Physicians Health Association - Illinois Comm

PHCEN Physicians Health Choice - Encounters CommPHCS1 Physicians Health Choice- HCFA Claims Comm20398 Physicians Health Collaborative Comm

MHM03 Physicians Health Network (PHN) Comm CA12399 Physicians Health Plan - Northern Indiana Comm09173 Physicians Health Plan - South Carolina Comm SC37330 Physicians Health Plan - South Michigan Comm MI62155 Physicians Health Plan - TennCare Comm65031 Physicians Healthcare Plans Comm

CPMG1 Physicians Management Group CommEXC01 Physicians Medical Group of San Jose Comm CA47027 Physicians Mutual Insurance Company Comm39156 Physicians Plus Insurance Corporation Comm10775 Physicians United Plan Comm56151 Piedmont Administrators Comm06607 Piedmont Behavioral Health Comm

PGLTC Pinal / Gila Long Term Care Comm AZ24735 Pinnacle Claims Management, Inc. Comm

PROSP Pinnacle Health Resources (Prospect Medical Group) Comm & HMO CAPPM01 Pinnacle Physician Management Organization Comm84109 Pinnacol Assurance Comm CO

COMPU Pipe Industry Health & Welfare Comm & HMO CO37224 Pittman and Associates Comm64160 Pivotal Plan Comm37287 Planned Administrators, Inc. Comm37287 Planned Administrators, Inc. (PAI) Comm72045 Plumbers & Steamfitters Health & Welfare Fund Comm LA

HPSVC Plumbers and Pipefitters NV58204 Podi Care Managed Care Comm

POD1S Podiatry First59324 Podiatry Network Florida Comm59069 Poe & Brown Comm32680 Poly America Medical & Dental Benefits Plan Comm16111 POMCO CommIP057 Pomona Valley Medical Group (PVMG) ProMed Comm25133 PPO Oklahoma Comm72148 PPO Plus LLC Comm38335 PPOM Comm04334 Practicare Inc CommLVIPA Prairie Medical Group (La Vida) Comm CA36373 Prairie States Enterprises CommEPF10 Prefered Administrator Comm53476 Preferred Benefit Administrators Comm61665 Preferred Benefits Administrator Comm00481 Preferred Blue of South Carolina Comm SC59291 Preferred Care - Florida Comm56178 Preferred Care - North Carolina Comm65088 Preferred Care Partners - Miami, Florida Comm FL73145 Preferred Community Choice Comm73145 Preferred Community Choice - PCCSelect - CompMed Comm61106 Preferred Health Plan, Inc. - Louisville, Kentucky Comm KY31478 Preferred Health Professionals Comm60110 Preferred Health Systems Insurance Company (PHSIC) Comm04320 Preferred Healthcare System - PPO CommPFIPA Preferred IPA Comm CA36401 Preferred Network Access, Inc. Comm14162 Preferred One (CT), a Division of First Choice Comm60110 Preferred Plus of Kansas Comm KS41147 PreferredOne Comm MN

***** BC099 Premera Blue Cross - Washington Comm WA***** BC099 Premera Blue Cross Blue Shield - Alaska Comm AK***** 91155 Premera LifeWise of Arizona Comm AZ***** 93093 Premera LifeWise of Oregon Comm OR

43166 Premier Benefits, Inc. Comm61101 Premier Benefits, Inc. Comm

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Pre.Enr. Payer ID Name Claims Type State90023 Premier Care (High Desert Primary Care Premier) Hesperia, CA Comm CAAMS11 Premier Care of Northern California (Arcadian Mgmt Serv) Comm CAPREYE Premier Eye Care Comm & HMO43166 Premier Health Plans Comm90440 Premier Health Systems Comm

CAPMN Premier Physicians Network & Valley Division (PPN) (Cap Managements Systems) Comm CA05003 Presbyterian Health Plan Comm

PRESA Presbyterian Salud Comm45056 Prestige Health Choice Comm39185 Prevea Health Plan CommIP096 Prima Health IPA Comm NC

CAPMN Primary Care & Pediatrics IPA (PCPIPA) CommPCAMG Primary Care Associates Medical Group (PCAMG) ( for DOS 1-1-09 and beyond) Comm73288 Primary Delivery System Comm82048 Primary Health Network CommPRIME Primary Health Plan Comm56144 Primary Physician Care CommPPM01 Primary Provider Management Comm & HMO CA61101 Prime Benefits Systems Inc. - Missouri (Humana) Comm MO63088 Prime Health Comm61101 Prime Health Kansas City Inc. - Missouri (Humana) Comm MO61101 Prime Health Management Services - Missouri (Humana) Comm MO61101 Prime Health of Kansas City - Missouri (Humana) Comm MO56190 Prime Vision Health Comm11678 Prime West Health Systems Comm MNIP079 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 CA04320 PrimeSource Health Network CommPRI01 Princeton Premier IPA Comm61271 Principal Life Insurance (Principal Financial Group) Comm61271 Principal Mutual Life Insurance Company (Principal Mutual Life Assurance) Comm38217 Priority Health Comm37303 Prism - First Health Comm37315 Prism - Univera Comm37268 Prism Network, Inc. Comm31132 Pro Health Comp Care Comm

PROSP ProCare (Prospect) Comm & HMO CA38329 Procare Health Plan - Detroit, Michigan Comm MI59296 Professional Benefit Administrators - Winter Park, Florida Comm FL36331 Professional Benefit Administrators, Inc. - Oak Brook, Illinois ONLY Comm IL34176 Professional Benefits Administrators - Cuyahoga Falls, Ohio Comm OH41163 Professional Claim Administrators Comm37242 Professional Claims Management - Canton, Ohio Comm34134 Professional Risk Management CommPADC1 Project Access of Durham County CommIP057 ProMed Health Care Administrators Comm61101 Promina Comm

PROSP Prospect Medical Group Comm & HMO CAPROSP Prospect Sherman Oaks Medical Group (Prospect Medical Group) Comm & HMO CA37309 Protective Life Insurance CommPHP01 Providence Health Plan CommPHP00 Providence PPO Comm62308 Provident Healthsource (Cigna) Comm62308 Provident Life & Accident Comm62308 Provident Life & Casualty Comm62308 Provident Preferred Network Comm51032 Provider Network of America (Pro-Net) CommPF101 Providers First PPO CommHM015 PruCare HMO (Encounters Only) Comm & HMOCAPMN Prudent Medical Group (formerly known as Hollywood Presbyterian Medical Group) Comm CA09822 PSN - Florida Medicaid (JMH) Comm FL

AMM03 Public Health Medical Services (Advanced Medical Management) Comm & HMO CA91136 Puget Sound Benefits Trust, Group# F25 Comm91136 Puget Sound Electrical Workers Trust, Group# F33 Comm42172 Puget Sound Health Partners Comm48055 Pyramid Life Insurance Company Comm51052 Pyschcare, LLC Comm37330 Pysicians Health Plan - Mid Michigan Comm MI

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Pre.Enr. Payer ID Name Claims Type State39197 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.) Comm61101 Qualicare CommQHP01 Quality Health Plans Comm

73067Quick Trip Corporation

Comm OK

37129 Quincy Health Care Management. Comm57117 QVI Risk Solutions, Inc. CommTKFMC R & N Market Comm & HMO CA95266 R.E. Harrington, Inc. Comm

***** MR018 Railroad Medicare Govn't91176 RBMS, LLC Comm

SYMED Redlands IPA (San Bernardino) Comm & HMO CAREGAL Regal Comm & HMO CA00910 Regence Blue Cross Blue Shield of Utah Comm UT00611 Regence Blue Shield - Idaho Comm ID00932 Regence Blue Shield - Washington State Comm WA00851 Regence BlueCross BlueShield - Oregon Comm OR38221 Regency Employee Benefits CommHSM01 Regent Medical Group, Inc. (Regent Family Practice of Glendale) Comm47076 Regional Care, Inc. CommREH55 Rehab Network, LLC Humana (Payer requires 11 digit member ID Number) Comm & HMOASRM1 Reliance Standard Comm NJ41045 Reliastar Employee Ben. (Northwestern Nat Life) Comm

RENGQ Renaissance Gulf Quest CommRENRB RENASSAINCE RIVEROAKS BLUE CommRENRO RENASSAINCE-RIVER OAKS Comm73066 Reserve National Insurance Comm37278 ResourceOne Administrators Comm

36396Resurrection Health Care Preferred/AKA Family Medical Network *Please call (773) 572-8311 or ( 773) 572-8309 prior to your first submission of claims. Comm

RPPG1 Resurrection Physicians Group Comm37270 Reynolds & Reynolds Comm

MPMOA Riverside Family Health Medical Group Comm CA16117 RMSCO, Inc. Comm75196 Rockwell International Comm

***** RMHMO Rocky Mountain Health Plan - Grand Junction Comm37602 Rooney Life Inc. Comm36215 Rosemont of Des Plaines, Illinois Comm36339 Rush Health Association Comm60054 Rush Prudential Comm36389 Rush Prudential Health Plans - HMO Only Comm63070 RWDSU Benefit Fund Comm

AMM03 Ryan White Network - Advanced Medical Management Comm & HMO CA31441 S & S Healthcare Strategies Comm35164 Sagamore Health Network Comm INHSM01 Saigon Medical Group, Inc. Comm62308 SAMBA Comm74234 same as above - Metal Trades Health Plan Comm

MSO77 San Diego County Coverage Initiative (CI) Comm CAMSO11 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 CASCP01 San Diego Physicians Med Group (SCPMCS) Comm

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

HSM01 San Judas Medical Group IPA CommAMS11 San Luis Obispo Select IPA (Arcadian Mgmt Serv) Comm CA60054 Sandia Triple Option Plan (Sandia Top) Comm91184 Sanford Health Plan CommAMS11 Santa Barbara Select IPA (Arcadian Mgmt Serv) Comm CA10378 Santa Clara County IPA (SCCIPA) Comm

SANTE SANTE Comm CAAMS11 SBSI Appeals (Arcadian Mgmt Serv) Comm CASCAN1 SCAN Health Plan Comm & HMO CASCAN2 SCAN Health Plan Comm AZSCH01 Schaller Anderson - CHOC Health Alliance Comm & HMO CA16146 SCHC Total Care Inc. (Acceptius Gateway payer) Comm88030 Scott & White Health Care Plan Comm60054 Scripps Medical Plan Comm13310 Seabury & Smith Comm91131 Seattle Area Plumbing Comm WASVIPA Seaview IPA Comm & HMO CA28530 Secure Health Plans of Georgia Comm95959 Secure Horizon CA - Pacificare Comm CA

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Pre.Enr. Payer ID Name Claims Type State87726 Secure Horizon Direct Comm

COFHP Secure Horizons of CO * Comm & HMO CO42142 SecureCare of Iowa Comm IA42142 Securecare of Iowa-Infotrust Comm39045 Security Health Plan CommSCHP1 SeeChange Health Plan Comm64088 Select Administrative Services (SAS) Comm MS42137 Select Benefit Administrators - Des Moines, Iowa Comm IA93031 Select Benefits Administrators - Portland, Oregon) Comm OR

37282 Select Benefits Administrators of America (submission address of P.O. Box 440, Ashland, Wisconsin 54806.) Comm

SCOK1 Select Care of Oklahoma - Tribute Comm23285 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 Comm60054 SeniorCare Comm23249 Sentinel Management Services Comm39033 Sentry Insurance a Mutual Company Comm39033 Sentry Life Insurance Company Comm39033 Sentry Life of New York Comm

CAPMN Seoul Medical Group (Cap Managements Systems) Comm CATKFMC Sequoia Beverage Comm & HMO CA38610 SET SEG Comm76056 Seton CHIP Comm

SHEBP Seton Employee Plan CommSHPCH Seton Health PlanSHMAP Seton Map Program (Mediview) Comm87726 Share Health Plan - ILL/PPO Comm IL87726 Share Health Plan - ILX/HMO Comm IL

***** SCMG1 Sharp Community Medical Group Comm CA***** SHP01 Sharp Health Plan Comm CA

75280 Shasta Administrative Services Comm38238 Sheet Metal Workers Local 104 Health Care Plan (San Ramon, CA) Comm CA

PROSP Sierra Family Network (Prospect Medical Group) Comm & HMO CA76342 Sierra Health Services Comm & HMO CA, NV76343 Sierra Health Services (encounters) Comm

HDMDG Sierra Medical Group Comm & HMO CAMBA01 Sierra Nevada Medical Associates Comm & HMO CA62159 Signature Health Alliance Comm

NASCR Silver Cross Managed Care Org Comm84076 Sinclair Health Plan Comm84096 Sloans Lake Managed Care Comm02057 Smith Administrators CommAMS11 Sonoma County Primary Care (Arcadian Mgmt Serv) Comm CA91131 Sound Health Comm ID91131 Sound Health Comm MT91131 Sound Health (Sisters of Providence) Comm ID91131 Sound Health (Sisters of Providence) Comm MT91131 Sound Health (Sisters of Providence) Comm91131 Sound Health Wellness Trust Comm WA23266 South Central Preferred Comm PA25133 SouthCare - Healthcare Preferred CommAMS11 Southeast Community Care Comm GA,SC,NC72112 Southeast Medical Allience (The Oath For Louisiana, Inc.) Comm37318 Southern Benefit Services Comm

SYMED Southern California Children's Healthcare Network Comm & HMO CABPA01 Southern California Lumber CommSCP01 Southern California Physicians Managed Care Services Comm56131 Southern Group Administrators Comm25133 Southern Health Services, Inc. CommHSM01 Southland Advantage Medical Group, Inc. CommHSM01 Southland San Gabriel Valley Medical Group, Inc. Comm35227 SouthPoint Hotel & Casino Comm

SWSTA Southwest Administrators CommM3IL2 Southwest BCBS of Florida CommSPA98 Southwest Physicians Associates Comm TX37266 Southwest Service Life Comm TX37259 Special Agents Mutual Benefit Association Comm52190 Special Risk International (SRI) Comm23253 Spectrum Admin, Inc. TPA Comm

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Pre.Enr. Payer ID Name Claims Type State84146 Spina Bifida - VA HAC CommSPOHN Spohn Health CommAMS11 Spokane Community Care Comm WA95286 SSM Exclusive Choice CommSLCH1 St Lawrance Co Healthcare Plan Comm NY22240 St. Barnabas System Health Plan CommAPP01 St. Francis IPA (NOW KNOWN AS Applecare Medical Management) Comm & HMO CA37264 St. John's Claim Administration CommSTJOE St. Joseph Heritage Healthcare Comm & HMO CASTJOE St. Joseph IPA (St. Joseph Heritage Healthcare) Comm & HMO CASTJOE St. Jude (St. Joseph Heritage Healthcare) Comm & HMO CA88029 St. Mary's Health Plan Comm NVHSM01 St. Peter Medical Group, Inc. Comm37116 St. Therese Physician Associates Comm ILSTM01 ST. THOMAS MED NTWK GULFQUEST CommPDT01 St. Vincent IPA Comm & HMO CA59225 Star HRG Comm31053 State Farm Insurance Company Comm

***** SB810 State Health Plan of North Carolina Comm NC00400 State Health Plan of SC Comm SC75087 States General Life Insurance Comm14163 Staywell Health Plan Comm91151 Sterling Option One Comm WA6089 Stirling Benefits (Stirling & Stirling) Comm CT

31121 Stoner & Associates - Cincinnati, Ohio Comm OH58128 Stowe Associates Comm74227 Student Resources Comm95202 Summacare Health Plan (HMO) Comm37301 Summit America Insurance Services, Inc. CommSX186 Sun Health Corporation Comm68057 Sunshine State Health Plan Comm23218 Superior Administrators - Santa Ana, CA Comm CASHP11 Superior Health Centene Corp Comm

39188 Superior Health Plan Texas (Prior to submitting claims, please call Provider Relations Dept at 1-800-218-7453) Comm TX

***** SC006 Sutter Connect - Alta Bates Medical Group, Alta Bates Network (ABMG/ABN) (Claims/Encounters) Comm CA***** SC016 Sutter Connect - Solano Regional Medical Foundation, (SRMF) (Claims/Encounters) Comm CA***** SC018 Sutter Connect - Sutter Delta Medical Group Comm CA***** SC003 Sutter Connect - Sutter Gould Medical Foundation (Claims/Encounters) Comm CA

***** SC004 Sutter Connect - Sutter Independent Physicians, Sutter Medical Group, Sutter West Medical Group (SIP/SMF/SWMG) (Claims/Encounters) Comm CA

***** SC008 Sutter Connect - Sutter Medical Group of the Redwoods, Santa Rosa Network (SMGR/SRN) (Claims/Encounters) Comm CA

***** SC025 Sutter Connect - Sutter Select Comm CA***** SC020 Sutter East Bay Medical Foundation Comm CA***** SC028 Sutter Senior Care Comm CA

NASWD Swedish Covenant Managed Care CommSYMED SynerMed Comm & HMO CA

TMG01 Talbert Medical Group (Testing of each provider is required by payer and done automatically by Office Ally once you start submitting claims for this payer. ) Comm & HMO CA

88067 Tall Tree Administrators Comm37228 Tarrant Health Services Comm TX

TKFMC TASEBA Comm & HMO CACOMPU Tattered Cover, Inc. Comm & HMO CO39157 TBG Administrative Services Comm

BPA01 TCU-LA MTA Comm88019 Teachers Health Trust CommADSL1 Team Choice - Alpha Care Gold Comm36215 Teamcare Comm36612 Teamsters Local Union #301 Comm91131 Teamsters Welfare Trust Comm WA74234 Tech-Steel, Inc Comm

SYMED Temple Hospital Comm CA

***** 00390TennCare Select/ BlueCare – Pre Enrollment Forms are the same as those for BCBS TN. Typically if enrolled with BCBS TN the provider will not need to enroll for TennCare Select/BlueCare. Contact the payer directly to confirm if pre-enrollment is required.

Comm TN

37293 Tennessee Benefit Administrators, LLC CommKLSY1 Texan Plusslctcare TX Kelsey CommAMS11 Texarkana Community Care Comm AR,TXTTASB Texas Association of School Boards Comm TX76048 Texas Children's Health Plan Comm TX75228 Texas Childrens Health Plan (Medicaid) Comm TXAMS11 Texas Community Care Comm TXTX1ST Texas First Health Plans Comm TX

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Pre.Enr. Payer ID Name Claims Type StateTOPA1 Texas First Health Plans (TIOPA) Comm TX63092 Texas HealthSpring Comm74214 Texas Municipal League (TML) Comm TXTTCEC Texas True Choice CommBOONG The Boon Group CommCRI01 The Chesterfield Companies Comm75600 The City of Odessa Comm37305 The Ford Meter Box Company, Inc. Comm34150 The Health Plan (Massillon, Ohio and St. Clairsville, Ohio only) Comm35206 The Healthcare Group Comm58200 The Integrity Benefit Group, Inc. Comm72112 The Oath For Louisiana, Inc. (formerly, Southeast Medical Alliance) Comm04320 The Preferred Healthcare System - PPO Comm38200 The Wellness Plan Comm

THERA Theraphysics (All but Colorado) Comm & HMOCOTHE Theraphysics (Colorado Only) Comm & HMO COTHIPA THIPA Comm & HMO CA06131 Third Party Claims Management Comm00315 Thomas Cooper Comm39065 Time Insurance (A Fortis Company) Comm & HMOPH017 Time Insurance Company Comm74214 TML Intergovernmental Employee Benefits Pool Comm TX20081 Todays Health48055 Todays 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. Comm87726 Touchpoint Comm & HMO13402 Touchstone Health - Health Net SmartChoice Comm23856 Touchstone Health PSO Comm69493 Tower Life Insurance Company CommTKFMC Town & Country Comm & HMO CA60054 TPA Health Plan 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 KYTLINS TransAmerica Life Insurance Co. Comm59222 TransAmerica Life Insurance CompanyTOLIC TransAmerica Occidental Life Insurance Co (Kansas City, MO) Comm MO37284 TransChoice - Key Benefit Administrators Comm37284 TransChoice-Key Benefit Administrators Comm74234 Transwestern General Agency Comm87726 Travelers - CGT - PPO Comm87726 Travelers Health Network - HMO (Metrahealth) Comm CA

TCHD1 Travis County Hospital District MAP Comm36397 Trellis Health Partners Comm

***** TDDIR TriCare for Life Govn't

***** CH002 TRICARE NORTH (Health Net Federal) formerly known as CHAMPUS: Connecticut, Delaware, Illinois, Indiana, Kentucky, Massachusetts, Maryland, Maine, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, Wash D.C., West Virginia and Wisconsin.

Govn't

***** CH002TRICARE SOUTH (Humana Military) formerly known as CHAMPUS: Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee and Texas. Govn't

PDT01 TriCities IPA Comm & HMO CA38269 Trinity Health (Enrollment required; please contact Noreen at (248) 489-5281) Comm34185 TriSurant (formerly Health Administration Services-HAS) Comm

***** WPSTC

TRIWEST (WPS) formerly known as CHAMPUS: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa(Except for

the Rock Island Arsenal Area), Kansas, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North

Dakota, Oregon South Dakota, The Extreme Western Portion of Texas, Utah, Washington and Wyoming.

Govn't

TCUSA True Choice USA CommTCUCH True Choice USA - CRSTS Healthplan Comm91131 Trusted Plans Service Corp. (TPSC) (FCHN) Comm WA91131 Trustee Plans (FCHN) Comm WA91131 Trusteed Insurance (FCHN) Comm WA91078 Trusteed Plans Service Corporation Comm61425 Trustmark Insurance Comm04298 Tufts Health Plan Comm

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Pre.Enr. Payer ID Name Claims Type State63092 TX Healthspring Comm TX

***** SX192 UAHC Health Plan of Tennessee Comm TN87726 UBH Employer Division Comm87726 UBH Rios Comm60054 UC Care (University of California) Comm CA52629 UCare of Minnesota Comm74223 UICI - Administrators - Nevada (through Benefit Planners, Inc.) Comm NV75240 UICI Administrators Comm37292 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 & HMO CA75243 Uniform Medical Plan (Harrington Benefit Services) Comm13407 Uniformed Services Family Health Plan (USFHP) St. Vincent Catholic Medical Centers of New York Comm91131 UNIGARD (FCHN) Comm WA13142 Union Labor Life Insurance CommSCP01 Union Pacific IPA (SCPMCS) Comm87042 Union Pacific Railroad Employees Health System Comm

70408 Union Security Insurance Company Comm25175 Unison Health Plan - (formerly known as Three Rivers) Comm62183 Unison Health Plan - Better Health Plans, Inc. Comm

UAGBT United Agriculture Benefit Trust Comm & HMO CA87726 United Behavioral Health (RIOS) Comm87726 United Behavioral Health (UBH) Comm59069 United Benefits (formerly Brown & Brown Benefits) Comm

CAPMN United Care Medical Network (formerly United St. Joseph Mission [Cap Management]) Comm & HMO CA91131 United Employee Benefit Trust (FCHN) Comm WA

SCUFW United Food & Commercial Workers Unions and Food Employers Benefit Fund (Southern California, Cypress) Comm

87726 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 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 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 Comm95378 United HealthCare of the River Valley (John Deere) Comm87726 United HealthCare of Upstate New York Comm NY87726 United HealthCare of Utah Comm UT87726 United HealthCare of Virginia Comm VA87726 United HealthCare Plans of Puerto Rico Comm84132 United Medical Alliance (UMA) Comm & HMO CO71412 United of Omaha Comm84132 United Physicians of Northern Colorado (UPNC) Comm41194 United Resources Network Comm74095 United States Automobile Association (USAA) Comm

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Pre.Enr. Payer ID Name Claims Type State

66705Unity Health Insurance -Before submitting claims, please go to http://www.unityhealth.com/Providers/EDI/index.htm and complete EDI Sign Up Form and NPI Appendix A documents. Or call Joe Boerboom at 608-643-1531 to request these forms.

Comm

UC001 Universal Care - California Comm CAUC002 Universal Care Encounters Comm50528 Universal Health Care, Inc. Comm38298 Universal Standard Healthcare Comm09830 University Family Care Comm09908 University Family Care - Maricopa Health Plan Comm

***** UHA01 University Health Alliance Comm22329 University Health Plan of New Jersey Comm NJ25133 University of Missouri CommIP056 Upland Medical Group Comm23281 UPMC Health Plan Comm37324 Upper Peninsula Health Group (TPA) Comm38337 Upper Peninsula Health Plan Comm93092 US Benefits Comm

USFHP US Family Health Plan Comm60054 US Healthcare Comm50383 US Imaging Network Comm NY74234 Utah Carpenters Comm UT74234 Utah Laborers Comm UT74234 Utah Pipe Trades Comm UT12115 VA Fee Basis Programs CommVAFSC VA Financial Services Center Comm TXVCIPA Valley Care IPA Comm & HMO CA

***** VHP01 Valley Health Plan (Commercial) please email [email protected] with Provider name/Practice name, tax id, NPI and line of business (Commercial or Medi-Cal). Comm

***** VHP02 Valley Health Plan (Medi-Cal) please email [email protected] with Provider name/Practice name, tax id, NPI and line of business (Commercial or Medi-Cal). Comm

77004 Valley Physician's IPA Comm CA***** VALOP Value Options - (For commercial claims only) Comm

23173 Vanderbilt Health Plan (Formerly Health1-2-3) CommSYMED Vanguard Health Systems (SynerMed) Comm & HMO72128 Vantage Health Plan, Inc. (located in Louisiana) Comm LAPPM01 Vantage Medical Group (located in California) Comm & HMO CA60054 Varian Health Care Plan Comm73288 VENCOR Comm86062 VentureNet Healthcare Comm

VHMG1 Verdugo Hills Medical Group Comm23173 VHP Community Care Comm

VVMG1 Victor Valley IPA Comm & HMO CA24818 Vida Care CommVFP11 Village Family Practice Comm91131 Virginia Mason Group Health Comm

***** 54176 Virginia Premier Health Plan Comm37297 Vison Care Incorporated Comm86079 Vista Del Sol Health Care Comm55248 Vista Health Plan Comm FL63114 Viva Health Plan Comm59266 Volusia Health Network Comm22264 Vytra Health Plans Comm NY62111 W.C. Beeler & Company Comm TN91131 WA Teamster Comm WA37294 Washington Employers Trust Comm91131 Washington State Health Insurance Pool (WSHIP) Comm38356 Washtenaw Community Health Organization Comm73155 Waterstone Benefit Administrators Comm58082 Watkins Associated Industries Comm

MPMOA Watts Healthcare Corp. Comm CA75261 Web TPA Comm TX36337 Weiss Health Providers Comm59354 Wellcare Health Plans (Encounters) Comm14163 Wellcare HMO, Inc. Comm14164 Wellcare of Conneticut Comm CT59608 Wellcare of Florida Comm FL

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 LA14164 Wellcare of New York Comm NY14163 WellCare of Ohio Comm OH14163 Wellcare of Texas Comm TX77072 Wellcare Private Fee for Service Plans Comm

WELM2 Wellmed Medical (Claims) Comm

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Pre.Enr. Payer ID Name Claims Type StateWELMD Wellmed Medical Management Comm38200 Wellness Plan, The Comm25133 WellPath Comm87815 Wells Fargo 3rd Party Administrators (formerly known as Acordia National) Comm22925 WELS Benefit Plan Office Comm

WCMG1 West Covina Medical Group Comm & HMO CA75196 West Virginia State Employees (PEIA) Comm WV24735 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 OH74234 Western Utilities or Local 57 Comm

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 Comm98010 William J. Sutton & Company - Toronto, Canada Comm

WCMAP Williams & County Map Comm62061 Willis Administrative Services (now known as Fiserv Health- Kansas) Comm41095 Wilson-McShane Comm11696 Windsor Home Network Comm62153 Windsor Medicare Extra Comm

WNHLT WinHealth Comm & HMO39200 Wisconsin Auto and Truck Dealers CommSX022 Wisconsin Physicians Service Insurance Corporation Comm20333 Worksite Benefit Services, LLC Comm75276 World Insurance Company Comm91131 WPAS (FCHN) Comm WA34080 WPPN- HPO (HealthEOS) Comm

***** WPSTC WPS (TRIWEST for West Region) Govn'tWPS01 WPS Commercial Govn't23710 Writer's Guild Industry Health Plan Comm91131 WSHIP - Washington State Health Insurance Pool Comm91131 WVMC (FCNH) Comm WA

***** 09829 Yavapai County CommSTJOE Yorba Park (St. Joseph Heritage HealthCare) Comm & HMO CA75285 Young Life Comm91131 Zenith (WA only) (FCHN) Comm WA