CLAIMS & REMITS PAYER LIST 02/08/2018 2ndary … & REMITS PAYER LIST 02/08/2018 Payer Code Accepts 2ndary Claims ENR Remits ENR Payer Code Accepts 2ndary Claims ENR Remits ENR 1199

CLAIMS & REMITS PAYER LIST

02/08/2018 Payer Code

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1199 National Benefit Fund 13162 N N Y 13162 N N Y

1st Medical Network - Atlanta GA 29076 Y N na 29076 Y N na

1st MN--Atlanta GA 29076 Y N na 29076 Y N na

21st Century Health and Benefits 59069 N N na 59069 N N na

3P ADMIN 20413 Y N na 20413 Y N na

A & I Benefit Plan Administrators 93044 N N na 93044 N N na

A.G.I.A. Inc. 95241 N N na 95241 N N na

AAG Benefit Plan Administrators Inc. 75240 Y N na 75240 Y N na

AAG-American Administravie Group ( Formerly Icon Benefit Admin) 75185 Y N na 75185 Y N na

AARP Medicare Supplement Plans 36273 Y N Y 36273 Y N Y

AARP MedicareComplete through UnitedHealthcare/AARP MedicareComplete 87726 Y N Y 87726 Y N Y

Abrazo Advantage Health Plan 03443 Y N na 03443 Y N na

Absolute Total Care 68069 Y N Y 68069 Y N Y

Access Medical Group 95424 Y N na

Access Medicare 19305 N N Y 19305 N N Y

Acclaim 64071 Y N Y 64071 Y N Y

Accountable Healthcare IPA (AHCIPA) AHIPA Y N na AHIPA Y N na

ACMG 37118 N N na 37118 N N na

ACS Benefit Services Inc. 72467 N N Y 72467 N N Y

Activa Benefit Services LLC 38254 N N na 38254 N N na

Adaptis (remits only) 91173 na Y 91173 na Y

Administration Systems Research Corporation 38265 N N na 38265 N N na

Administrative Concepts Inc. 22384 N N Y 22384 N N Y

Administrative Services Inc. 59141 N N na 59141 N N na

ADVANCED DATA SOLUTIONS 58202 N N na 58202 N N na

Advanced Health Systems 12B17 Y Y Y SB730 Y Y Y

Advantage by Bridgeway Health Solutions 68069 Y N Y 68069 Y N Y

Advantage by Buckeye Community Health Plan 68069 Y N Y 68069 Y N Y

Advantage by Managed Health Services 68069 Y N Y 68069 Y N Y

Advantage by Peach State 68069 Y N Y 68069 Y N Y

Advantage by Sunshine State 68069 Y N Y 68069 Y N Y

Advantage by Superior HealthPlan 68069 Y N Y 68069 Y N Y

Advantage Care IPA ACIPA Y N na ACIPA Y N na

Advantage Health Solutions 35209 N N na 35209 N N na

Advantek Benefit Administrators 83077 N N na 83077 N N na

ADVANTICA BENEFITS 59374 Y N Y 59374 Y N Y

Advanzeon Solutions 59314 N N na 59314 N N na

Adventist Health System West - Roseville CA 95340 N N Y 95340 N N Y

Advicare (for claims with DOS prior to 9/1/16) 45423 N N na 45423 N N na

Advocate Medical Group - AMG (Legacy AHC) 36320 N N Y 36320 N N Y

Advocate Physician Partners 65093 N N Y 65093 N N Y

Aetna 60054 Y N Y 60054 Y N Y

INSTITUTIONAL PROFESSIONAL

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Aetna Affordable Health Choices (SM) - SRC 57604 Y N na 57604 Y N na

Aetna Better Health - PA Medicaid 23228 Y N na 23228 Y N na

Aetna Better Health of Illinois 26337 Y N Y 26337 Y N Y

Aetna Better Health of Kentucky 128KY Y N y 128KY Y N y

Aetna Better Health of Louisiana 128LA Y N y 128LA Y N y

Aetna Better Health of Michigan 128MI Y N Y 128MI Y N Y

Aetna Better Health of Missouri 128MO Y N Y 128MO Y N Y

Aetna Better Health of Nebraska (for claims with DOS prior to 1/1/17) 42130 Y N Y 42130 Y N Y

Aetna Better Health of New Jersey 46320 Y N Y 46320 Y N Y

Aetna Better Health of NY 34734 N N Y 34734 N N Y

Aetna Better Health of Ohio 50023 Y N Y 50023 Y N Y

Aetna Better Health of Pennsylvania 23228 Y N Y 23228 Y N Y

Aetna Better Health of Virginia 128VA Y N Y 128VA Y N Y

Aetna Better Health of West Virginia 128WV Y N Y 128WV Y N Y

Aetna Better Health Premier Plan (JVHL) M5JVH Y Y Y M5JVH Y Y Y

Aetna Medicare 60054 Y N Y 60054 Y N Y

Aetna TX Medicaid & CHIP 38692 N N Y 38692 N N Y

Aetna U.S.Healthcare (JVHL) J1JVH Y Y Y J1JVH Y Y Y

Aetna-American Continental Insurance Company (remits only) 62118 na na Y 62118 na na Y

Affiliated Doctor's of Orange County ADOCS N N na ADOCS N N na

Affilliated Physicians Group APG01 N N na APG01 N N na

Affinity Essentials 23334 Y N Y 23334 Y N Y

Affinity Health Plan 13334 N Y Y 13334 N Y Y

AFFINITY MEDICAL GROUP 46594 N N na 46594 Y N na

Affinity Medicare Advantage 13333 N N N 13333 N N N

Affordable Benefit Administrators Inc. 95426 N N na 95426 N N na

AFTRA Health Fund (claims with DOS on or after 1/1/2015) 62308 N N na 62308 N N na

AGA 37280 N N na 37280 N N na

Agate Resources Inc. (LIPA) 20048 N N na

Agency Services Inc 64158 N N na 64158 N N na

AHPO (Cleveland OH) 31138 N N na 31138 N N na

Alabama Medicaid 12K01 Y N Y SKAL0 Y N Y

Alamitos IPA AIPAZ Y N na AIPAZ Y N na

Alaska Carpenters Trust 91136 N N na

Alaska Children's Services Inc. 91136 N N Y 91136 N N Y

Alaska Electrical Trust Funds 60054 Y N Y 60054 Y N Y

Alaska Laborers Construction Industry Trust 91136 N N na 91136 N N na

Alaska Medicaid 77200 Y Y Y

Alaska Medicare SMAK0 Y Y Y

Alaska Pipe Trades Local 375 91136 N N na 91136 N N na

Alaska United Food & Commercial Workers Health & Welfare Trust 91136 N N na 91136 N N na

Alexian Brothers Community Services of TN 44423 N N na 44423 N N na

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ALICARE 13550 N N Y 13550 N N Y

Alignment Healthcare AHCA1 N N na AHCA1 N N na

All Savers/UHC 81400 Y N Y 81400 Y N y

Allcare PEBB 26158 N N na 26158 N N na

Allegian Advantage 82238 N N na 82238 N N na

Allegian Choice 55649 N N na 55649 N N na

Allegian Health Plan 82420 N N na 82420 N N na

Allegiance Benefit Plan Management Inc. 81040 N N na 81040 N N na

Alliance Behavioral Health 23071 Y Y Y 23071 Y Y Y

Alliance IPA HCP01 N N na

Alliant Health Plans of Georgia 58234 N N na 58234 N N na

Allianz Global Assistance 50749 N N na 50749 N N na

Allied Benefit Systems 37308 N N Y 37308 N N Y

Alpha Care Medical Group MPM32 N N na MPM32 N N na

Alta Bates Medical Group A0701 N N na A0701 N N na

ALTA Health Strategies 25133 Y N Y 25133 Y N Y

Altius Health Plans 25133 Y N Y 25133 Y N Y

Alvarado IPA SYMED N N na SYMED N N na

AMA Insurance Agency AMAIA N N Y TH071 N N Y

Amalgamated Life 13550 N N Y 13550 N N Y

Amalgamated Life - PA / Alicare 13343 N N na 13343 N N na

Ambay Health Network AMBHN N N na AMBHN N N na

Ambetter of Illinois 68069 Y N Y 68069 Y N Y

AMCO 62176 N N na 62176 N N na

AmeraPlan 38219 N N Y 38219 N N Y

AmeriBen Solutions Inc. 75137 N N Y 75137 N N Y

Americaid Community Care (New Jersey) 27516 Y N na 27516 Y N na

American Administrative Group 75240 Y N na 75240 Y N na

American Behavioral 63103 N N na 63103 N N na

American Benefit Plan Administrators 95170 N N na 95170 N N na

American Community Mutual Insurance 60305 N N Y 60305 N N Y

American Family Insurance 12T31 N N na TH095 N N na

American Family Medicare Sup and PPO Policies Administered by Am Rep 56071 N N Y 56071 N N Y

American Fidelity Assurance Company 60801 N N na 60801 N N na

American General 62030 N N Y 62030 N N Y

American Healthcare Alliance 01066 N N Y 01066 N N Y

American Heritage 77083 N N na

American Income Life Insurance Company (remits only) 60577 na na Y 60577 na na Y

American Insurance Administrators (AIA) (remits only) 26119 na na Y 26119 na na Y

American National Ins. Co. (ANICO) 74048 N N Y 74048 N N Y

American Postal Workers Union Health Plan 44444 N N Y 44444 N N Y

American Progressive Life and Health Insurance Company 48055 N N Y 48055 N N Y

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American Republic Insurance 42011 N N Y 42011 N N Y

American Sentinel Co. 17965 Y N na

American Specialty Health Plans 43146 N N na

American Trust Administrators Inc. 56195 N N na 56195 N N na

American Worker Health Plan 37322 Y N na 37322 Y N na

Americas 1st Choice Health Plans of South Carolina Inc. 20553 N N na 20553 N N na

Americas 1st Choice of South Carolina, Inc 55349 N N na 55349 N N na

America's Choice Health Plans 20029 N N Y 20029 N N Y

America's PPO 16120 N N na 16120 N N na

America's TPA 41178 N N na 41178 N N na

AmeriChoice by UnitedHealthcare-New York (remits only) NYU01 na Y NYU01 na Y

Americhoice Maryland and Washington (remits only) 04567 na Y 04567 na Y

Amerigroup Community Care 27514 Y N Y 27514 Y N Y

Amerigroup Corporation 27514 Y N Y 27514 Y N Y

Amerigroup Florida 27519 Y N Y 27519 Y N Y

Amerigroup Illinois 27518 Y N na 27518 Y N na

Amerigroup Ohio 27518 Y N na 27518 Y N na

AmeriHealth Administrators 54763 Y N Y 54763 Y N Y

AmeriHealth Administrators (BCBS) (remits only) SX055 na Y SX055 na Y

AmeriHealth Caritas Iowa 77075 Y N Y 77075 Y N Y

AmeriHealth Caritas Pennsylvania 22248 Y N Y 22248 Y N Y

Amerihealth Caritas VIP Care 77062 Y N Y 77062 Y N Y

AmeriHealth Caritus VIP Care Plus (Michigan) 77013 N N na 77013 N N na

AmeriHealth Delaware (Non-HMO) 93688 Y Y Y 93688 Y Y Y

Amerihealth District of Columbia 77002 N N Y 77002 N N Y

Amerihealth HMO NJ/DE 95044 Y Y Y 95044 Y Y Y

AmeriHealth HMO of NJ and Delaware (remits only) SX055 na Y SX055 na Y

AmeriHealth New Jersey (Non-HMO) 60061 Y Y Y 60061 Y Y Y

AmeriHealth NorthEast 77001 Y N Y 77001 Y N Y

Ameri-West Health Associates PPM01 Y N na PPM01 Y N na

AmFirst Insurance Company (payer only accepts Secondary claims) 64090 Y N Y 64090 Y N Y

Amida Care 24818 N N na 24818 N N na

Amida Care Medicare 79966 N N na 79966 N N na

Anchor Benefit Consulting Inc. 53085 Y N na 53085 Y N na

Ancillary Benefit Services (ABS) 86062 Y N na 86062 Y N na

Ancillary Care Services (remits only) A2004 na Y A2004 na Y

Angeles IPA HSM01 N N na HSM01 N N na

Antares Management Solutions 34192 Y N Y 34192 Y N Y

Anthem Blue Cross Blue Shield of Connecticut 12B04 Y N Y SB560 Y N Y

Anthem Blue Cross Blue Shield of Georgia 12015 Y N Y SB600 Y N Y

Anthem Blue Cross Blue Shield of Indiana 12B09 Y N Y SB630 Y N Y

Anthem Blue Cross Blue Shield of Kentucky 12B11 Y N Y SB660 Y N Y

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Anthem Blue Cross Blue Shield of Maine 12B13 Y N Y SB680 Y N Y

Anthem Blue Cross Blue Shield of Missouri 12B65 Y N Y SB741 Y N Y

Anthem Blue Cross Blue Shield of Nevada 12B20 Y N Y SB765 Y N Y

Anthem Blue Cross Blue Shield of New Hampshire 12B21 Y N Y SB770 Y N Y

Anthem Blue Cross Blue Shield of Ohio 12B24 Y N Y SB338 Y N Y

Anthem Blue Cross Blue Shield of Virginia 12002 Y N Y SB923 Y N Y

Anthem Blue Cross Blue Shield of Wisconsin 12B29 Y N Y SB950 Y N Y

Anthem Blue Cross of California 47198 Y N Y 47198 Y N Y

Anthem Blue Cross of Colorado 12B03 Y N Y SB550 Y N Y

Apex Benefit Services 34196 Y N na 34196 Y N na

Araz Group 16120 N N na 16120 N N na

ARC Administrators CXARC N N na CXARC N N na

Arcadian Management Services Inc 77045 N N na 77045 N N na

Arch Health Partners ARCH1 N N Y ARCH1 N N Y

Argus Dental Plans, Inc. ARGUS N N na ARGUS N N na

ARISE 39185 N N Y 39185 N N Y

Arizona Foundation for Medical Care (AFMC) 86062 Y N na 86062 Y N na

Arizona Medicare SMAZ0 Y Y Y

Arizona Priority Care Plus 27154 N N N 27154 N N N

Arkansas Best Corporation - Choice Benefits 62308 N N Y 62308 N N Y

Arkansas Medicaid 12023 Y N Y SKAR0 Y N Y

Arkansas Medicare 12022 Y Y Y SMAR0 Y Y Y

ARM, Ltd. 63240 N N Y 63240 N N Y

Arta Health Network WMM01 Y N na

ASAGEHA 06603 N N na 06603 N N na

Aspen Medical Associates 16180 Y N na 16180 Y N na

Aspire Health Plan 46156 Y N Y 46156 Y N Y

ASR 38265 N N na 38265 N N na

ASR Corporation 38265 N N na 38265 N N na

ASR Health Benefits 38265 N N na 38265 N N na

ASRM Corporation ASRM1 N N Y ASRM1 N N Y

Associates for Health Care Inc. (AHC) 36326 N N na 36326 N N na

Assurant Health Self Funded 75068 Y N na 75068 Y N na

Assured Benefits Administrators 74240 Y N Y 74240 Y N Y

Asuris NW Health 93221 Y N Y 93221 Y N Y

Atlantic Medical Insurance 22285 N N na 22285 N N na

Atrio Health Plans ATRIO N N Y ATRIO N N Y

AultCare 341488123 Y Y na 341488123 Y Y na

AultCare 341488123 Y Y Y 341488123 Y Y Y

Aultra Administrative Group 37242 N N na 37242 N N na

Aultra Administrative Group 37242 N N Y 37242 N N Y

Automated Benefit Services 38259 Y N Y 38259 Y N Y

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Automated Group Administration Inc. 37280 N N N 37280 N N N

Auxiant (remits only) 26202 na N

Avalon Administrative Services AVA01 N Y Y

Avalon IPA CAPMN N N na CAPMN N N na

Avera Health Plans 46045 N N Y 46045 N N Y

AveraAdvantage 48055 N N Y 48055 N N Y

Avesis Third Party Administrators 87098 Y N na

AvMed Inc. 59274 Y N Y 59274 Y N Y

AXA Assistance_USA 65101 N N na 65101 N N na

Azeros Health Plans Inc. 16644 N N Y 16644 N N Y

Bakersfield Family Medical Group 77005 N N na 77005 N N na

Banker's Life 99999-0178 N N Y

Banker's Life & Casualty (remits only) 36066 na Y 36066 na Y

Banner Health 12X42 Y N Y 12X42 Y N Y

Banner Health AZ SX145 Y N Y

Banner Health Co - ROCKY MOUNTAIN HMO GREELEY SX145 Y N Y

Banner Health Co. - ANTERO GREELEY SX145 Y N Y

Banner Health Co. - ANTERO HIGH PLAINS SX145 Y N Y

Banner Health Co. - ANTERO MOUNTAIN SHADOWS SX145 Y N Y

Banner Health Co. - CHOICE PLUS SX145 Y N Y

Banner Health Co. - HMO GREELEY SX145 Y N Y

Banner Health Co. - HMO HIGH PLAINS SX145 Y N Y

Banner Health Co. - HMO MOUNTAIN SHADOWS SX145 Y N Y

Banner Health Co. - PACIFICARE GREELEY SX145 Y N Y

Banner Health Co. - PACIFICARE HIGH PLAINS SX145 Y N Y

Banner Health Co. - PACIFICARE MOUNTAIN SHADOWS SX145 Y N Y

Banner Health Co. - ROCKY MOUNTAIN HMO HIGH PLAINS SX145 Y N Y

Banner Health Co. - SECURE HORIZONS GREELEY SX145 Y N Y

Banner Health Co. - SECURE HORIZONS HIGH PLAINS SX145 Y N Y

Banner Health Co. - SECURE HORIZONS MOUNTAIN SHADOWS SX145 Y N Y

Baptist Health Plan Advantage BHPMA N N na BHPMA Y N na

Basic Plus 41204 Y N na 41204 Y N na

Baycare Life Management 59279 N N na 59279 N N na

BCBS of AZ Advantage 77078 Y N Y 77078 Y N Y

BCBSM Medicare Plus Blue PPO (JVHL) KCJVH Y Y Y KCJVH Y Y Y

BEACON HEALTH STRATEGIES 43324 Y N Y 43324 Y N Y

Beaumont Employee Health Plan (JVHL) JEJVH Y Y Y JEJVH Y Y Y

Behavioral Health Systems 63100 N N na 63100 N N na

Benefit & Risk Management Services 99320 N N na 99320 N N na

Benefit Administrative Systems 36149 N N Y 36149 N N Y

Benefit Coordinators Corporation (Pittsburgh PA) 25145 N N na 25145 N N na

Benefit Management Admin (BMA) BMATP N N Y

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Benefit Management Group-NV 36459 Y N na 36459 Y N na

Benefit Management Inc. of KS 48611 N N Y 48611 N N Y

Benefit Management LLC/VBA 88092 Y N na 88092 Y N na

BENEFIT MANAGEMENT SERVICES 56139 N N Y 56139 N N Y

Benefit Management Systems Inc 37212 N N na 37212 N N na

Benefit Plan Administrators 88052 N N na 88052 N N na

Benefit Plan Administrators Co. (Eau Claire WI) 39081 N N Y 39081 N N Y

Benefit Plan Administrators Inc 37118 N N na 37118 N N na

Benefit Systems & Services Inc. 36342 N N Y 36342 N N Y

Ben-e-lect (remits only) EDHP1 na na Y EDHP1 na na Y

Benesight 87265 Y N na 87265 Y N na

Benesys 37248 N N na 37248 N N na

Benesys Inc. 37248 N N na 37248 N N na

Berkshire Intergroup 10956 Y N na 10956 Y N na

Berkshire Lehigh Partners 95606 Y N na 95606 Y N na

Better Health Plan of Florida 20488 N N na 20488 N N na

Better Health Plans Inc. 62183 Y N na 62183 Y N na

Better Health Plans of South Carolina 32006 N N na 32006 N N na

Blue Benefit Administrators of MA 03036 N N Y 03036 N N Y

Blue Care Network (BCN Commercial Labs) (JVHL) JJJVH Y Y Y JJJVH Y Y Y

Blue Care Network (BCN Reimbursable Labs) (JVHL) JQJVH Y Y Y JQJVH Y Y Y

Blue Care Network (JVHL Network) (JVHL) J9JVH Y Y Y J9JVH Y Y Y

Blue Care Network Advantage of Michigan 00210 Y Y Y 00710 Y Y Y

Blue Care Network of Michigan 00210 Y Y Y 00710 Y Y Y

Blue Cross Blue Shield of Alabama 12B54 Y Y Y SB510 Y N Y

Blue Cross Blue Shield of Arizona 53589 Y N Y 53589 Y N Y

Blue Cross Blue Shield of Arkansas 12021 Y Y Y SB520 Y Y Y

Blue Cross Blue Shield of Delaware 12B76 Y Y Y SB570 Y Y Y

Blue Cross Blue Shield of District of Columbia (Carefirst) 12000 Y N Y SB580 Y Y Y

Blue Cross Blue Shield of Illinois 12B08 Y N Y SB621 Y N Y

Blue Cross Blue Shield of Kansas 47163 Y Y Y 47163 Y Y Y

Blue Cross Blue Shield of Kansas City 47171 Y Y Y 47171 Y Y Y

Blue Cross Blue Shield of Louisiana 53120 Y Y Y 53120 Y Y Y

Blue Cross Blue Shield of Maryland (Carefirst) 12011 Y N Y SB690 Y N Y

Blue Cross Blue Shield of Massachusetts 12B14 Y Y Y SB700 Y Y Y

Blue Cross Blue Shield of Michigan 00210 Y Y Y 00710 Y Y Y

Blue Cross Blue Shield of Minnesota 00720 Y N Y 00720 Y N Y

Blue Cross Blue Shield of Mississippi 12B17 Y Y Y SB730 Y Y Y

Blue Cross Blue Shield of Montana (remits only) 00751 na na Y 00751 na na Y

Blue Cross Blue Shield of Nebraska 00760 Y N Y 00760 Y N Y

Blue Cross Blue Shield of New Mexico 00790 Y N Y 00790 Y N Y

Blue Cross Blue Shield of North Carolina 12B23 Y N Y SB810 Y N Y

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Blue Cross Blue Shield of Oklahoma 00840 Y N Y 00840 Y N Y

Blue Cross Blue Shield of Rhode Island 12B74 Y Y Y SB870 Y Y Y

Blue Cross Blue Shield of South Carolina 12B55 Y N Y SB880 Y N Y

Blue Cross Blue Shield of Tennessee 00390 Y Y Y 00390 Y Y Y

Blue Cross Blue Shield of Texas 84980 Y N Y 84980 Y N Y

Blue Cross Blue Shield of Texas - Medicaid STAR Kids 66001 Y N Y 66001 Y N Y

Blue Cross Blue Shield of Texas - Medicaid STAR/CHIP 66001 Y N Y 66001 Y N Y

Blue Cross Blue Shield of Vermont BCSVT Y N Y BCSVT Y N Y

Blue Cross Blue Shield of Wyoming 12B30 Y Y Y SB960 Y Y Y

Blue Cross Community Health Plans MCDIL Y N Y MCDIL Y N Y

Blue Cross Complete (JVHL) KPJVH Y Y Y KPJVH Y Y Y

Blue Cross Medicare Advantage (IL, MT, NM, OK, TX) 66006 N N Y 66006 N N Y

Blue Shield of California BSCAI Y N Y BS001 Y N Y

BlueChoice HealthPlan 00922 Y N Y 00922 Y N Y

BlueChoice HealthPlan Medicaid of South Carolina 00403 Y N Y 00403 Y N Y

Bluegrass Family Health 61124 N N Y 61124 N N Y

Boilermakers National Health & Welfare Fund 36609 N N na 36609 N N na

Bollinger, INC. - BOLLINGER BOLL1 N N na BOLL1 N N na

BookMD Inc 47405 Y N na 47405 Y N na

Boon-Chapman Benefit Administrators Inc. 74238 N N Y 74238 N N Y

Boston Health Net 13337 Y Y Y 13337 Y Y Y

Brand New Day (FFS) UC001 N N na UC001 N N na

Bravo Health 52192 Y N Y 52192 Y N Y

Bravo Health Star Plus 52192 Y N Y 52192 Y N Y

BridgeSpan BRIDG Y N Y BRIDG Y N Y

Bridgeway Arizona 68069 Y N Y 68069 Y N Y

BritCay 22286 N N na 22286 N N na

Brodart 35182 Y N na 35182 Y N na

Brokerage Concepts 51037 Y N na 51037 Y N na

Brookshire IPA BIPAZ Y N na BIPAZ Y N na

Broward Health 37314 N N na 37314 N N na

Brown & Toland Medical Group 94316 N N Y 94316 N N Y

Brown and Toland Health Services BTHS1 N N na BTHS1 N N na

Brown and Toland Sutter Select BTSS1 N N na

Buckeye Community Health 68069 Y N Y 68069 Y N Y

Butler Benefit 42150 Y N na 42150 Y N na

C&O Employees Hospital Association 23708 N N na

C. L. Frates & Co - OSMA Health 73071 N N na 73071 N N na

Cal Care IPA PPM01 Y N na PPM01 Y N na

Cal Care IPA PPM02 Y N na PPM02 Y N na

California Health and Wellness 68047 Y Y na 68047 Y Y na

California IPA CAIPA N N na CAIPA N N na

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California Medicaid (Medi-Cal) CAMC1 N Y Y SKCA0 Y Y Y

California Medicare 12M64 Y Y Y

California Medicare - Northern Region SMCA1 Y Y Y

California Medicare - Southern Region SMCA2 Y Y Y

California Pacific Medical Center 94056 Y N na 94056 Y N na

CalOptima Direct CALOP Y N Y CALOP Y N Y

Cannon Cochran Management Services Inc. Metairie LA 71057 N N na 71057 N N na

CAP Management Systems 95399 Y N na 95399 Y N na

Capital Blue Cross/CAIC 23045 Y N Y 23045 Y N Y

Capital District Health Plan 12X03 N N Y SX065 N N Y

Capital Health Plan 95112 N N na 95112 N N na

Capitol Administrators 68011 N N Y 68011 N N Y

Caprock Health Plans CAPHP N N Y CAPHP N N Y

Cardinal Innovations (Formerly Piedmont Behavioral Health) 06607 Y N na 06607 Y N na

Cardon Outreach 99999-0911 N Y na

Care 1st Health Plan of Arizona 57116 N N na 57116 N N na

CARE 1ST HEALTH PLAN OF CA 57115 N N na 57115 N N na

Care Access Health Plan (CAHP) 65062 na Y 65062 N N Y

Care Access PSN 65063 N N na

Care Improvement Plus (For DOS on or after 1/1/16.) 87726 Y N Y 87726 Y N Y

Care Improvement Plus (For DOS prior to 1/1/16.) 77082 N N Y 77082 N N Y

Care To Care 41222 N N na 41222 N N na

Care Wisconsin Health Plan (Trizetto) 27004 N N Y 27004 N N Y

CareCentrix 11345 N Y Y 11345 N Y Y

CareCore National 14182 N N na

CareCore National LLC (Aetna Radiology Claims) 14179 N N na 14179 N N na

CareCore National LLC (Oxford Radiology Claims) 14180 N N na

CareCore/WCNY RAD 14188 N N na

CareFirst Administrators/NCAS (Charlotte, NC) 75191 N N Y 75191 N N Y

CareFirst Administrators/NCAS (Fairfax, VA) 75190 N N Y 75190 N N Y

CareFirst BlueCross BlueShield MD Region 12011 N N Y SB690 Y N Y

CareFirst BlueCross BlueShield NCA Region 12000 N N Y SB580 Y N Y

CareFlorida 65088 N N na 65088 N N na

Carelink Medicaid 25133 Y N Y 25133 Y N Y

Caremore (remits only) CM001 na N CM001 na N

Caremore Health Plan CARMO Y N na CARMO Y N na

Carenet (remits only) 25133 na Y 25133 na Y

CareOregon Inc. 93975 N N na 93975 N N na

CarePlus Health Plans Inc. 95092 Y N Y 65031 Y N Y

Carepoint Health Plans 77023 N N Y 77023 N N Y

CareSource 26160 N N na 26160 N N na

CareSource Indiana INCS1 N N na INCS1 N N na

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CareSource KY KYCS1 Y N Y KYCS1 Y N Y

CareSource OH 31114 Y N Y 31114 Y N Y

Careworks 10010 N N na 10010 N N na

Cariten Senior Health 62072 Y N na 62072 Y N na

Carolina Benefit Administrators 00498 N N na 00498 N N na

Carolina Care Plan 29076 Y N na 29076 Y N na

Carpenters Health and Welfare Fund of Philadelphia CX101 N N na

Carpenters Health and Welfare Trust Fund of St. Louis (remits only) 12174 na Y 12174 na Y

CBA Blue 03036 N N na 03036 N N na

CBHNP - HealthChoices 65391 N N N 65391 N N N

CDS Group Health 88022 N N na 88022 N N na

Cedars Sinai Medical Center 33010 Y N na

Cedars-Sinai Medical Network Services 95166 N N na 95166 N N na

Celtic Insurance 68063 Y N Y 68063 Y N Y

CeltiCare 68069 Y N Y 68069 Y N Y

Cement Masons & Plasterers Health & Welfare Trust 91136 N N na 91136 N N na

Cencal Health 99111 Y N Y

Cenpatico - Arizona 68068 Y N Y 68068 Y N Y

Cenpatico - Florida 68068 Y N Y 68068 Y N Y

Cenpatico - Georgia 68068 Y N Y 68068 Y N Y

Cenpatico - Illinois 68068 Y N Y 68068 Y N Y

Cenpatico - Indiana 68068 Y N Y 68068 Y N Y

Cenpatico - Kansas 68068 Y N Y 68068 Y N Y

Cenpatico - Kentucky 68068 Y N Y 68068 Y N Y

Cenpatico - Massachuetts 68068 Y N Y 68068 Y N Y

Cenpatico - Mississippi 68068 Y N Y 68068 Y N Y

Cenpatico - Missouri 68068 Y N Y 68068 Y N Y

Cenpatico - Ohio 68068 Y N Y 68068 Y N Y

Cenpatico - South Carolina 68068 Y N Y 68068 Y N Y

Cenpatico - Texas 68068 Y N Y 68068 Y N Y

Cenpatico - Wisconsin 68068 Y N Y 68068 Y N Y

Centene Advantage Plans 68068 Y N Y 68068 Y N Y

Center for Elders Independence 94312 Y N na 94312 Y N na

CenterLight Healthcare 13360 Y N Y 13360 Y N Y

CentraCare 66698 N N na 66698 N N na

Central & Southwest Services 75177 Y N na

Central California Alliance for Health (CCAH) CCA01 Y Y Y CCA01 Y Y Y

Central DuPage Physician Group 36314 N N na 36314 N N na

Central Health Medicare Plan CHCPI Y N na CHCPI Y N na

Central Health MSO CHCPI Y N na CHCPI Y N na

Central Mass Heath Care 02041 Y N na

Central Reserve Life Ins Co-Medicare Supplement 13193 Y N Y 13193 Y N Y

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Central SeniorCare 62218 N N na 62218 N N na

Central States Health & Welfare Funds 36215 N N na 36215 N N na

Central Susquehanna Healthcare Providers (CSHP) 55731 Y N na 55731 Y N na

Central Valley Medical Group 77035 Y N na 77035 N N na

Centurion 42140 N N na 42140 N N na

Century Health Solutions 48120 Y N na 48120 Y N na

Century PHO INC 36393 Y N na 36393 Y N na

Cerner HealthPlan Services 20356 N N na 20356 N N na

CHAMPVA - HAC 84146 Y N Y 84146 Y N Y

CHAMPVA HAC MEDICARE CROSSOVER (remits only) 80214 na Y 80214 na Y

Change Healthcare Accident Claims Solution 88446 N N na 88446 N N na

Chautauqua County Healthcare Plan (Mayville NY) 16600 N N na 16600 N N na

CHCS Services, Inc (remits only) 75895 na Y 75895 na Y

Chesterfield Resources Inc. 34154 N N na 34154 N N na

Childhealth Plus by Healthfirst (CHP) 80141 Y N na

Children First Medical Group 94321 N N na

Children of Women Vietnam Veterans-VA HAC 84146 Y N Y 84146 Y N Y

Children’s Hospital Orange County (CHOC) Health Alliance CHOC1 N N Y CHOC1 N N Y

Children's Community Health Plan - Wisconsin 39113 N N Y 39113 N N Y

Childrens Medical Center Health Plan CMCHP N N Y CMCHP N N Y

Children's Medical Security Plan of Massachusetts 80314 Y N Y 80314 Y N Y

Children's Medical Services - Broward NORTH 37314 N N na 37314 N N na

Chinese Community Health Plan 94302 N N na 94302 N N na

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

Choice Medical Group CMG01 Y N na

CHP DIRECT SUPERMED 90441 N N na 90441 N N na

Christian Brothers Services 38308 N N na 38308 N N na

Christian Care Ministries 59355 N N na 59355 N N na

Christie Student Health Plans 75544 N N na 75544 N N na

Christus Health Medicare Advantage 10629 N N Y 10629 N N Y

Christus Health New Mexico HIX 21062 N N Y 21062 N N Y

Christus Health TX HIX 52106 N N na 52106 N N na

Christus Texas Medicaid 45210 Y N na 45210 Y N na

CIGNA 62308 Y N Y 62308 Y N Y

CIGNA – (Health Partners) (JVHL) KQJVH Y Y Y KQJVH Y Y Y

CIGNA - PPA 62308 Y N Y 62308 Y N Y

CIGNA - PPO 62308 Y N Y 62308 Y N Y

CIGNA (Non-HAP & CIGNA-HAP (JVHL) KDJVH Y Y Y KDJVH Y Y Y

CIGNA Behavioral Health MCCBV N N Y SX071 Y N Y

CIGNA Health Plan - HMO 62308 Y N Y 62308 Y N Y

Cigna HealthSpring 52192 N N Y 52192 N N Y

CIGNA Medicare Advantage 86033 N N na 86033 N N na

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Cincinnati Financial Corporation 46871 Y N na 46871 Y N na

Citrus Health Plan 10207 Y N na 10207 Y N na

Claims Development Corporation 43056 N N na

ClaimsBridge HPN 11752 Y N na 11752 Y N na

Claimshop- Employers Coalition on Health - MULTIPLAN PHCS/ECOH 27008 N N na 27008 N N na

ClaimsWare Inc. dba ManageMed 57080 Y N Y 57080 Y N Y

Clearchoice Health Plan / COIHS 77201 Y N Y

CMCS Advantage Health Solutions Medicare 35219 N N na 35219 N N na

CMHC 02041 Y N na

CNIC Health Solutions Inc. 37227 N N N 37227 N N N

Coachella Valley Physicians IP079 N N Y IP079 N N Y

Coastal Administrative Services 77052 N N Y 77052 N N Y

Coastal Care 43141 N Y Y 43141 N Y Y

Coastal Care Services Inc 47394 N N na

Coastal Communities Physician Network 51579 N N na 51579 N N na

Cofinity 38335 N N Y 38335 N N Y

College Health IPA CHIPA N N na

Colonial Life (remits only) 37077 na Y 37077 na Y

Colonial Medical 22284 N N na 22284 N N na

Colorado Access 84129 Y N Y 84129 Y N Y

Colorado Health OP 49718 N N na 49718 N N na

Colorado Medicaid 77016 Y Y Y 77016 Y Y Y

Colorado Medicare 12M03 Y Y Y SMCO0 Y Y Y

Commerce Benefits Group 34181 N N na 34181 N N na

Commercial Travelers/PHX 88091 N N na 88091 N N na

Common Ground Healthcare Cooperative 77170 N N Y 77170 N N Y

Commonwealth Care Alliance 14315 N N na 14315 N N na

Community Care Alliance of Illinois - CCAI 85468 N N Y 85468 N N Y

Community Care Associates (Healthchoice) (JVHL) JWJVH Y Y Y JWJVH Y Y Y

Community Care BHO 23282 N N na 23282 N N na

Community Care Inc. - Family Care (Wisconsin) 60995 Y N Y 60995 Y N Y

Community Care Inc. (Wisconsin) 39126 Y N Y 39126 Y N Y

Community Care IPA CCI01 N N na CCI01 N N na

Community Care Managed Health Care Plans of Oklahoma 73143 Y N Y 73143 Y N Y

Community First Health Plan, Inc. COMMF N N Y COMMF N N Y

Community Health Alliance 35193 Y N Y 35193 Y N Y

Community Health Alliance TN 27905 N N Y 27905 N N Y

Community Health Choice 48145 N N Y 48145 N N Y

Community Health Electronic Claims/CHEC/webTPA 75261 N N Y 75261 N N Y

Community Health Group CHGRI Y N Y

Community Health Plan of Washington CHPWA Y N Y CHPWA Y N Y

Community Health Plan, Inc. 60495 Y N na 60495 Y N na

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

CommunityConnect HealthPlan 95192 Y N na 95192 Y N na

Comp - Ohio (Austintown OH) 34177 N N na 34177 N N na

Compcare (Wisconsin BadgerCare only) 95192 Y N na 95192 Y N na

Compsych 37363 Y N Y 37363 Y N Y

Conifer Value-Based Care 55649 N N na 55649 N N na

Connecticare - Medicare 78375 N N Y 78375 N N Y

ConnectiCare Inc 06105 Y N Y 06105 Y N Y

Connecticut Carpenters Health Fund 37307 N N na 37307 N N na

Connecticut General (CIGNA) 62308 Y N na 62308 Y N na

Connecticut Medicaid 12K04 Y N Y SKCT0 Y N Y

Connecticut Medicare 12M04 Y Y Y SMCT0 Y Y Y

Conseco Services LLC (remits only) 11285 na Y 11285 na Y

Consociate Group 37135 Y N Y 37135 Y N Y

Consolidated Associates Railroad 75284 N N na 75284 N N na

Consolidated Health Plans 87843 N N Y 87843 N N Y

Constellation Health L0260 N N na

Consumer’s Mutual Insurance (JVHL) KWJVH Y Y Y KWJVH Y Y Y

Consumers Choice Health SC 45321 Y N Y 45321 Y N Y

Consumers Life Insurance Company 29076 Y N na 29076 Y N na

Continental General Ins Co-Medicare Supplement 13193 Y N Y 13193 Y N Y

Continuum (formerly Marrick WRx) 46478 N N na 46478 N N na

Contractors Laborers Teamsters & Engineers (Local 14B) 47046 Y N na 47046 Y N na

Conversion Plan-APWU 55544 N N na 55544 N N na

Cook Children STAR Plan THCP9 N N na THCP9 N N na

Cook Children's Health 12T58 N N na TH104 N N na

Cook Group Health Plan 35149 N N na 35149 N N na

Cooperative Benefit Administrators (CBA) 52132 Y N Y 52132 Y N Y

COOPERATIVE MANAGED CARE SERVICES 35199 N N Y 35199 N N Y

Coordinated Benefit Plan 14829 Y N Y 14829 Y N Y

Coordinated Medical Specialists 58204 N N na 58204 N N na

Core Administrative Services 58231 N N na 58231 N N na

CoreSource AZ MN 35182 Y N Y 35182 Y N Y

CoreSource Little Rock 75136 N N Y 75136 N N Y

CoreSource MD PA IL 35182 Y N Y 35182 Y N Y

CoreSource NC IN 35182 Y N Y 35182 Y N Y

CoreSource OH 35183 Y N Y 35183 Y N Y

CoreSource-Internal 35187 N N Y 35187 N N Y

Corizon Health Inc. CORIZ N N na CORIZ N N na

Corizon Inc. 43160 N N na 43160 N N na

Cornerstone Benefit Adminstrators 35202 Y N na 35202 Y N na

Cornerstone Preferred Resources CB268 N N na CB268 N N na

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Corporate Benefits Service 56116 N N na 56116 N N na

Corporate Plan Management, Inc. 64270 Y N na 64270 Y N na

CorrectCare CCIH N N na CCIH N N na

Country Life Insurance Company 62553 N N na 62553 N N na

County of Riverside EC999 N N na EC999 N N na

County Services Medical Program CMSP1 N N na CMSP1 N N na

CountyCare 06541 N N Y 06541 N N Y

CountyCare (Cenpatico TPA) 42138 N N na 42138 N N na

CountyCare (Centene TPA) 42139 N N na 42139 N N na

Covenant Administrators Inc. (Atlanta GA) 58102 N N Y 58102 N N Y

Coventry Advantra Texas 25133 Y N na 25133 Y N na

Coventry Health & Life (Oklahoma) 25133 Y N Y 25133 Y N Y

Coventry Health Care National Network 25133 Y N Y 25133 Y N Y

Coventry Health Care of Delaware Inc 25133 Y Y Y 25133 Y Y Y

Coventry Health Care of Florida 128FL Y N Y 128FL Y N Y

Coventry Health Care of Georgia Inc. 25133 Y N Y 25133 Y N Y

Coventry Health Care of Illinois 25133 Y N Y 25133 Y N Y

Coventry Health Care of Iowa Inc 25133 Y N Y 25133 Y N Y

Coventry Health Care of Kansas Inc 25133 Y N Y 25133 Y N Y

Coventry Health Care of Louisiana Inc 25133 Y N Y 25133 Y N Y

Coventry Health Care of Missouri 25133 Y N Y 25133 Y N Y

Coventry Health Care of Nebraska Inc 25133 Y N Y 25133 Y N Y

Coventry Health Care of Nevada 25133 Y N Y 25133 Y N Y

Coventry Health Care of the Carolinas 25133 Y N Y 25133 Y N Y

Coventry Summitt Health Plan Inc. 25133 Y N na 25133 Y N na

CoventryCares - Aetna Better Health of Michigan (JVHL) J8JVH Y Y Y J8JVH Y Y Y

CoventryCares of Kentucky 25133 Y N Y 25133 Y N Y

CoventryCares of Michigan 128MI Y N Y 128MI Y N Y

CoventryCares of Pennsylvania 23228 Y N Y 23228 Y N Y

Cox Health Plan 00119 N N Y 00019 N N Y

Creative Medical Systems 64068 N N na 64068 N N na

Creative Plan Administrators 37320 N N na 37320 N N na

Crescent Health Solutions 56213 N N na 56213 Y N na

Crown City Medical Group MPM35 Y N na MPM35 Y N na

Croy-Hall Mgmt. Inc. 37266 N N na 37266 N N na

Crystal Run Health Plans 46120 Y N na 46120 Y N na

CTI ADMINISTRATORS INC. 42141 Y N Y 42141 Y N Y

Current Health Solutions 77153 N N na 77153 N N na

Custom Design Benefits 82056 N N Y 82056 N N Y

CWIBENEFITS INC. 57080 Y N Y 57080 Y N Y

Dakotacare DAK01 Y N na DAK01 Y N Y

Dart Member Care CB987 N N na CB987 N N na

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Davis Vision 00157 N Y na

Dean Health Plan 39113 N N Y 39113 N N Y

DELANO IPA 77124 N N Y 77124 N N Y

Delaware Medicaid 12K87 Y N Y SKDE0 Y N Y

Delaware Medicare 12M76 Y Y Y SMDE0 Y Y Y

Dell Children's Health Plan 74272 Y N na 74272 Y N na

Delta Dental Northeast (ME, NH, VT) (remits only) 02027 na Y 02027 na Y

Delta Dental of Wisconsin (remits only) 39069 na Y 39069 na Y

Delta Health Systems DHS01 Y N Y DHS01 Y N Y

DentaQuest Vision 63740 Y N na

DentaQuest-Government Plans-Wisconsin (remits only) CX014 na Y CX014 na Y

Denver Health - Indigent 84134 N N na

Denver Health and Hospital Authority 84133 N N na 84133 N N na

Denver Health Medical Plan 84135 N N na 84135 N N na

Denver Health Medical Plan Inc. - Medicare Choice 84131 N N na 84131 N N na

Deseret Mutual 12X35 N Y Y UH105 N Y Y

Desert Medical Group DESRT N N na

Desert Oasis Healthcare 44006 N N na

Detroit Medical Center 56240 N N na 56240 N N na

Diamond Plan (Maryland Medicaid) 25133 Y N na 25133 Y N na

Direct Care Administrators DCA62 Y N na

District of Columbia Medicaid 12001 Y Y na SKDC0 Y Y Y

District of Columbia Medicare 12M63 Y Y na SMDC0 Y Y Y

Diversified Administration Corporation 06102 N N na 06102 N N na

DMC Care (JVHL) JSJVH Y Y Y JSJVH Y Y Y

Downey Select IPA (Applecare Medical Managment) APP01 N N na

Dreyer Health DREYR Y N na

DRISCOLL CHILDREN'S HEALTH PLAN 74284 N N Y 74284 N N Y

Dunn and Associates Benefits Administrators Inc. 35186 Y N na 35186 Y N na

E.S. BEVERIDGE & ASSOCIATES 34108 N N na 34108 N N na

Early Intervention Central TH084 N N na

East Carolina Behavioral Health 56089 N N Y 56089 N N Y

East Pointe Behavioral Health 08044 Y N Y 08044 Y N Y

Eastland Medical Group 66122 N N na 66122 N N na

Easy Choice Health Plan of California 20532 Y N na 20532 Y N na

Easy Choice Health Plan of New York 24770 N N na 24770 N N na

EBMC 31074 Y N na 31074 Y N na

EBMS (Employee Benefit Management Services Inc.) 12X44 N N y 81039 Y N y

Educators Mutual (EMIA) SX110 N N Y

EGID (Employees Group Insurance Division) 22521 N N Y 22521 N N Y

EHI (Employers Health Insurance) 73288 N N na

EHS Medical Group - Fresno SYMED N N na SYMED N N na

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El Paso First - CHIP 12T27 N N na TH090 N N na

ElderPlan Inc. 31625 N N Y 31625 N N Y

Elderwood Health 03964 N N na 03964 N N na

Elmco 37253 N N Y 37253 N N Y

Emerald Health Network Inc. (All PPO Business) 34167 N N na 34167 N N na

Emergency Medical Services Fund - Orange County CA 95600 N N na

EMI-KP Ambulance Claims 59299 N N na

EMPHESYS 73288 N N na

Empire Blue Cross and Blue Shield of New York 00303 Y N Y 00803 Y N Y

Empire Medicare Services 12M76 Y Y na

Empire Omnipro (BC NY City) 12B36 Y N na

Empire Omnipro (BC NY State) 12B35 Y N na

Empire Physician's Medical Group EMP01 N N na

Employee Benefit Concepts (Farmington Hills MI) 38241 N N na 38241 N N na

Employee Benefit Consultants Inc. (aka EBSO) 37257 N N Y 37257 Y N Y

Employee Benefit Logistics 92135 Y N na 92135 Y N na

Employee Benefit Management Corp (EBMC) 31074 Y N na 31074 Y N na

Employee Benefit Services 37216 Y N Y 37216 Y N Y

Employee Benefit Services of San Antonio TH109 N N na

Employee Benefit Systems 42149 N N na 42149 N N na

Employee Benefits Administration And Managment Company 22262 N N Y

Employee Benefits Plan Administration Inc. (E.B.P.A.) 03036 N N Y 03036 N N Y

Employee Health Systems SYMED N N na SYMED N N na

Employee Plans LLC 35112 N N na 35112 N N na

Employee Security, Inc. 54098 Y N na

Employers Direct Health 75232 N N na 75232 N N na

Employer's Direct Health - Employee Plan 75236 N N na 75236 N N na

Employer's Direct Health - FI 75235 N N na 75235 N N na

Employer's Direct Health - SF 75233 N N na 75233 N N na

Employers Health 73288 N N na

Employers Health Insurance 73288 N N na

Employers Mutual Inc (Jacksonville Florida) 59298 N N na 59298 N N na

Employers Mutual Inc. (Stuart Florida) 59331 N N na 59331 N N na

Encircle PPO 35206 N N na 35206 N N na

Encore Health Network 35206 N N na 35206 N N na

Enstar Natural Gas 91136 N N na 91136 N N na

Entrust, Inc. 36878 Y N na 36878 Y N na

Envolve Benefit Options (formerly OptiCare Managed Vision) 56190 N N na

EQUICOR 62308 Y N na 62308 Y N na

EQUICOR - PPO 62308 Y N na 62308 Y N na

Equitable (remits only) 81779 na Y 81779 na Y

ERISA TH110 Y N na

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ESSENCE HEALTHCARE 20818 N N Y 20818 N N Y

Everence 35605 Y N Y 35605 Y N Y

Evergreen Health Cooperative 93240 Y N N 93240 Y N N

eviCore 62160 N N Y 62160 N N Y

Evolutions Healthcare Systems (New Port Richey FL) 59313 N N Y 59313 N N Y

Exceedent LLC 22344 Y N na 22344 Y N na

Excel MSO EXC01 N N na

Excellus - BCBS Utica Watertown 12B38 Y Y Y SB806 Y N Y

Excellus - Blue Cross Blue Shield Central NY 12B37 Y Y Y SB805 Y N Y

Excellus - Blue Cross Blue Shield Rochester Area 12B40 Y Y Y SB804 Y N Y

ExclusiCare 71412 N N Y 71412 N N Y

Extended Care MLTC 46166 Y N na 46166 Y N na

Eye Management, Inc. (EMI) 65062 N N Y

EyeMed 31165 N Y na

F40 Alaska Carpenters Trust 91136 N N na

FABOH (CHP/RPU) 39112 Y N na 39112 Y N na

Facey Medical Foundation 95432 N N na

FACS Group 37300 N N na 37300 N N na

Fallon Community Health Plan 22254 Y N Y 22254 Y N Y

Family Care CCO 93121 N N Y 93121 N N Y

Family Care Specialists FCS01 Y N na FCS01 Y N na

Family Choice Medical Group CAPMN N N na CAPMN N N na

Family Health Network - FHN 85468 N N Y 85468 N N Y

FARA TP044 Y N na

Farm Bureau Health Plans (remits only) 62045 na Y 62045 na Y

Farm Family Life 14140 Y N na 14140 Y N na

FCE Benefit Administrators 33033 N N na 33033 N N na

Federal Employee Plan of South Carolina (BCBS SC) 00402 N N Y 00402 N N Y

Federal Employees Health Benefit Plan (MHBP) (remits only) 25133 na Y 25133 na Y

Federated Benefits 37300 N N na 37300 N N na

Federated HR Services 37300 N N na 37300 N N na

Federated Mutual Insurance 41041 N N Y 41041 N N Y

Fidelis Care New York 11315 N N Y 11315 N N Y

First Agency 88055 N N na 88055 N N na

First Carolina Care 56196 N N Y 56196 N N Y

First Choice Health Administrators 91131 Y N na 91131 Y N na

First Choice Health Network 91131 Y N na 91131 Y N na

First Choice of Midwest 75138 Y N na 75138 Y N na

First Choice VIP Care Plus 77009 N N Y 77009 N N Y

First Health Network 73159 Y N na 73159 Y N na

First Medical Network (FMN) - Atlanta GA 29076 Y N na 29076 Y N na

First Source/Arkansas Blue Cross 12047 Y Y na

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First United American Life Insurance Company (remits only) 74101 na na Y 74101 na na Y

FirstCare 94999 N N Y 94999 N N Y

Florida Blue 00590 Y N Y 00590 Y N Y

Florida Health Care Plan 59322 N N na 59322 N N na

Florida Hospital Waterman 48116 N N na 48116 N N na

Florida Medicaid 77027 Y Y Y 77027 Y Y Y

Florida Medicare 09101 N Y Y 09102 Y Y Y

FMH Benefit Services Inc. 48117 N N Y 48117 N N Y

Foreign Service Benefit Plan 25133 Y N Y 25133 Y N Y

FOUNDATION BENEFIT ADMINISTRATORS/CONTRACTOR EMPLOYEE BENEFITS ADMIN BOONG N N Y BOONG N N Y

Foundation for Medical Care of Tulare & Kings County TKFMC N N na

Fox Valley Medicine Site 199 FVMCH N N na FVMCH N N na

Fox-Everett Inc. 64069 N N Y 64069 N N Y

Freedom Blue Medicare Advantage (for Claims with DOS prior to 2015) 12B44 Y Y na SB942 Y Y na

Freedom Health Plan 41212 N N na 41212 N N na

Freedom Life Insurance 62324 N N na 62324 N N na

Fresenius Health Partners 43197 Y N na 43197 Y N na

Fresenius Medical Care 23130 N N na 23130 N N na

Fresno PACE 99660 N N na 99660 N N na

Friant Water Users TKFMC N N na

Fringe Benefit Group 45289 N N na 45289 N N na

Fringe Benefit Management 59069 N N na 59069 N N na

Fringe Benefits Coordinators 59204 Y N na 59204 Y N na

FrontPath Health Coalition 34171 N N na 34171 N N na

Galveston County Indigent Health Care 30005 N N na 30005 N N na

Gardena Memorial Medical Center SYMED N N na SYMED N N na

Gateway SX078 Y N na

Gateway Health Plan - Medicare Assured 60550 N N Y 60550 N N Y

Gateway Health Plan Medicaid PA 25169 N N Y 25169 N N Y

Gateway Health Plan OH - Medicare Assured 91741 N N Y 91741 N N Y

Gateway IPA (Pinnacle Health Resources) (Prospect Medical Group) PROSP N N na

Gateway to Better Health Plan - MO Medicaid U317M Y Y Y 4317M Y Y Y

GBS Group Benefit Services Incorporated 80241 N na 80241 N na

Geisinger Health Plan 75273 Y N Y 75273 Y N Y

GEMCare (Golden Empire Managed Care System) MCS01 N N Y

Gemcare Health Plan 20376 N N na 20376 N N na

Gemcare IPA 27133 Y N na 27133 Y N na

Generations Healthcare 46050 N N na 46050 N N na

Generations-Hillcrest 46051 N N na 46051 N N na

Genesis Healthcare PROSP N N na PROSP N N na

Georgia Medicaid 12K05 Y Y na SKGA0 Y Y na

Georgia Medicare 12M05 Y Y Y SMGA0 Y Y Y

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GHI - New York (Group Health Inc.) 13551 N N Y 13551 N N Y

GHI HMO 25531 Y N Y 25531 Y N Y

GHP (Group Health Plan) - MULTIPLAN PHCS/GROUP HEALTH 25141 N N na

Gilsbar Inc. 07205 N N Y 07205 N N Y

Glendale Physician's Alliance AMM02 N N na

Global Care Inc. 07689 Y N Y 07689 Y N Y

Global Excel Management GEM01 Y N na GEM01 Y N na

Global Health GHOKC Y N na GHOKC Y N na

Global Healthcare Alliance 12X59 N N na

Globe Life and Accident Insurance Company (remits only) 91472 na na Y 91472 na na Y

GMS Inc. 47083 Y N Y 47083 Y N Y

Gold Coast Health Plan (remits only) 77160 na na Y 77160 na na Y

Golden State Medical Group MBA01 N N na MBA01 N N na

Golden Triangle Physician Alliance/SelectCare of Texas (GTPA) 72189 N N na 72189 N N na

Good Samaritan Medical Practice Association IP086 N N na IP086 N N na

GOOD SHEPHERD HOSPICE INC 76923 Y N na 76923 Y N na

Government Employees Health Association (45235) 45235 N N na

Government Employees Health Association (Multiplan) 45235 N N na

Government Employees Health Association (PHCS) 45275 N N na 45275 N N na

Government Employees Hospital Association (GEHA) 44054 N N Y 44054 N N Y

Grand Valley Health Plan 95453 N N na

Great American Life Ins. Co-Medicare Supplement 13193 Y N Y 13193 Y N Y

Great Lakes PACE 39640 N N na 39640 N N na

Greater Covina Medical Group GCMG1 N N na

Greater Newport Physicians GNPMG Y N Y GNPMG Y N Y

Greater Orange County Medical Group NMM01 N N na

Greater San Gabriel Med Grp NMM01 N N na

Greater Valley HCP01 N N na

Great-West Healthcare 80705 N N Y 80705 N N Y

Great-West Healthcare (formerly American General) 63665 N N na 63665 N N na

Group Administrators Ltd. 36338 N N na 36338 N N na

Group and Pension Administrators 48143 N N Y 48143 N N Y

Group Benefit Services Inc. CB951 N N na CB951 N N na

Group Benefits - Louisiana 72087 N N na

Group Health Co-op 12X16 Y Y na

Group Health Cooperative of Eau Claire 95192 Y N Y 95192 Y N Y

Group Health Cooperative of South Central Wisconsin 39167 N N Y 39167 N N Y

Group Insurance Service Center Inc. 37276 N N na 37276 N N na

Guardian Life Insurance Company of America 64246 N N Y 64246 N N Y

Gulf Stream-General Dynamics CB624 Y N na CB624 Y N na

Gundersen Lutheran Health Plan 39180 N N Y 39180 N N Y

H.E.R.E.I.U Welfare Pension Funds 37114 N N na 37114 N N na

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HAA Preferred Partners 65101 N N na 65101 N N na

Hamaspik Choice 47738 N N na 47738 N N na

HAP Midwest Health Plan MHP77 Y N na MHP77 Y N na

HAP Midwest Health Plan (JVHL) JBJVH Y Y Y JBJVH Y Y Y

Harbor Advantage (Abrazo Health Care) 58305 N N na 58305 N N na

Harbor Choice 55649 N N na 55649 N N na

Harbor Health Plan (JVHL) M1JVH Y Y Y M1JVH Y Y Y

Harken Health 43313 Y N N 43313 Y N N

Harmony Health Plan of Illinois 36406 N N Y 36406 Y N Y

Harmony Health Plan of Indiana 36405 N N Y 36405 Y N Y

Harpeth IPA - Amerivantage 75126 Y N na

Harrimon Jones HCP01 N N na

Harrington Health Non-EPO 59143 N N na 59143 N N na

Harrington Health-Kansas (formerly known as Fiserv Health-Kansas) 62061 N N na 62061 N N na

Harris Methodist Health Plan 75201 N N na

Harvard Community Health Plan 04245 Y N na 04245 Y N na

Harvard Pilgrim Health Care 04271 Y N Y 04271 Y N Y

Hawaii Blue Cross 12B62 Y Y na

Hawaii Medicaid 12K62 Y N na SKHI0 Y Y na

Hawaii Medical Assurance Association (HMAA/HWMG) 48330 N N Y 48330 N N Y

Hawaii Medical Service Association (HMSA) SB971 Y Y na

Hawaii Medicare SMHI0 Y Y Y

HCC Life Insurance UCCMI N N na HCCMI N N na

HCH Administration 37111 N N na 37111 N N na

HCH Administration (formerly John P Pearl and Associates) 37215 N N Y 37215 N N Y

HCS - Health Claims Service (Boise ID) 82018 N N na 82018 N N na

Health Adv/US Able/First Pyramid Life/Arkansas Blue Cross 12049 Y Y na

Health Alliance Medical Plans of Illinois 77950 Y N Y 77950 Y N Y

Health Alliance Plan (Capitated Contracts) (JVHL) JGJVH Y Y Y JGJVH Y Y Y

Health Alliance Plan (Fee for Service Contracts) (JVHL) JHJVH Y Y Y JHJVH Y Y Y

Health Alliance Plan (HAP) 38224 N N Y 38224 N N Y

Health America Inc./Health Assurance/Advantra 25133 Y N Y 25133 Y N Y

Health Care Network of Wisconsin (HCN) 42102 N N na 42102 N N na

Health Care Savings 56142 N N na

Health Choice Arizona 62179 N N Y 62179 N N Y

Health Choice Generations 62180 N N Y 62180 N N Y

Health Choice Insurance Co 46221 Y N na 46221 Y N na

Health Choice Integrated Care 22100 Y N na 22100 Y N na

Health Choice Utah 45399 N N na 45399 N N na

Health Cost Solutions 62111 N N Y 62111 N N Y

Health Design Plus (Hudson OH) 34158 N N na 34158 N N na

Health Economics Corp 39026 N N Y 39026 N N Y

Page 20 of 52



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Health First Health Plan Inc. (remits only) A5234 na Y A5234 na Y

Health First TPA 95019 N N na 95019 N N na

Health Management Administrators (HMA) TH049 N N na

Health Net - VA Patient Centered Community Care Program 68021 N N N 68021 N N N

Health Net of Arizona 38309 Y N Y 38309 Y N Y

Health Net of California and Oregon - Claims 95567 Y N Y 95567 Y N Y

Health Network One 65062 na Y 65062 N N Y

Health New England 04286 N N Y 04286 N N Y

Health Options Inc (FL - BCBS HMO) 12B26 Y N na SX030 Y N na

Health Partners - Jackson TN 62157 N N na 62157 N N na

Health Partners PA 80142 N N Y 80142 N N Y

Health Payment Systems Inc. 20270 N N Y 20270 N N Y

Health Plan of Michigan 83253 N N Y 83253 N N Y

Health Plan of Nevada 76342 Y N Y 76342 Y N Y

Health Plan of San Joaquin 68035 Y N Y 68035 Y N Y

Health Plan of San Mateo HPSM1 N N Y HPSM1 N N Y

Health Plans Inc. 44273 N N Y 44273 N N Y

Health Plus (JVHL) KEJVH Y Y Y KEJVH Y Y Y

Health Plus Physicians Organization 63363 N N na 63363 N N na

Health Risk Management 41170 N N na 41170 N N na

Health Services for Children with Special Needs 37290 N N Y 37290 N N Y

Health Services Management 41150 N Y na

Health Services Preferred (HSP) by Emerald Health 34167 N N na 34167 N N na

Healthamerica (remits only) 25133 na Y 25133 na Y

Healthcare District of Palm Beach County 95828 N Y na 95828 N Y na

Healthcare Management Administrators (HMA) HMA01 Y N Y HMA01 Y N Y

Healthcare Partners HCP01 N N Y HCP01 N N Y

HealthCare Partners IPA 11328 Y N na 11328 Y N na

Healthcare Resources NW 56731 N N na 56731 N N na

Healthcare Solutions Group 73147 Y N na 73147 Y N na

Healthcare USA (remits only) 25133 na Y 25133 na Y

HealthChoice Oklahoma 71064 N N Y 71064 N N Y

Healthcomp Inc. 85729 N N Y 85729 N N Y

Healthease/Wellcare of FL 59608 N N na 59608 N N na

HealthEdge Administrators (Bakersfield CA) 95213 N N na 95213 N N na

HealthEZ 41178 N N na 41178 N N na

Healthfirst 65 Plus 80141 Y N na

Healthfirst Family Health Plus (FHP) 80141 Y N na

Healthfirst Health Plan of New Jersey 80141 Y N Y 80141 Y N Y

Healthfirst Inc. (New York) 80141 Y N Y 80141 Y N Y

Healthfirst PHSP 80141 Y N na

Healthfirst Tyler TX 75234 Y N na 75234 Y N na

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Healthgram Inc. 56144 N N Y 56144 N N Y

HealthGroup Limited 23274 Y N na 23274 Y N na

HealthGuard of Lancaster 23226 Y N na 23226 Y N na

Healthlink HMO 96475 N N Y 96475 N N Y

Healthlink PPO 90001 Y N na 90001 Y N na

HealthNow - BCBS Northeastern NY 12B68 Y Y na SB800 Y Y na

HealthNow - Blue Cross Blue Shield of Western NY 12B39 Y Y na SB801 Y Y na

Healthnow Division 55204 Y Y Y

HealthPartners MN 12X51 Y Y Y SX009 Y Y Y

HealthPlan Services 59140 N N Y 59140 Y N Y

HealthPlus of Michigan 38216 N N Y 38216 N N Y

Healthscope Benefits - EHC Repricing 52429 N N na 52429 N N na

HealthSCOPE Benefits Inc. 71063 Y N Y 71063 N N Y

HealthSelect IPA (IL) SB621 Y N na

Healthsmart Accel 75237 Y N na 75237 Y N na

HealthSmart Benefit Solutions 37272 N N Y 37272 N N Y

HealthSmart Benefit Solutions 37283 Y N Y 37283 Y N Y

HealthSmart Benefit Solutions fka Wells Fargo TPA.Inc. 87815 Y N Y 87815 Y N Y

HealthSmart -Noble Mid Orange HSM01 N N na HSM01 N N na

HealthSmart Preferred Care Inc. 75250 Y N na 75250 Y N na

Healthsource AR (Med) (CIGNA) 71075 Y N na 71075 Y N na

Healthsource CMHC 02041 Y N na 02041 Y N na

Healthsource GA (CIGNA) 58210 Y N na 58210 Y N na

Healthsource KY 61127 Y N na 61127 Y N na

Healthsource Massachusetts Inc. 02041 Y N na 02041 Y N na

Healthsource ME 01041 N N na 01041 N Y na

Healthsource N. TX (CIGNA) 75255 Y N na 75255 Y N na

Healthsource NC (CIGNA) 56147 Y N na 56147 Y N na

Healthsource NH 02038 Y N na

Healthsource OH 31141 Y N na 31141 Y N na

Healthsource Provident 68195 Y N na 68195 Y N na

Healthsource SC 06119 Y N na 06119 Y N na

Healthsource TN (CIGNA) 62129 Y N na 62129 Y N na

HealthSpring HMO/HealthSpring Medicare+Choice 63092 N N Y 63092 N N Y

Healthsun Health Plans HESUN N N na

Healthways WholeHealth Networks 58213 N N na

Healthy Texas 68064 Y N na 68064 Y N na

Healthy York Network 22251 Y N na 22251 Y N na

Heartland Nation (remits only) UHIN3 na Y UHIN3 na Y

Hennepin Health (formerly Metropolitan Health Plan) 10850 Y N Y 10850 Y N Y

Heritage Consultants 59230 N N na

Heritage Provider Network DESRT N N na

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Heritage Victor Valley Medical Group 30862 N N na 30862 N N na

Heritage Victor Valley Medical Group (Regal) VVMG1 N N na

HFN Inc. 36335 N N Y 36335 N N Y

High Desert Medical Group 95393 N N na 95393 N N na

Highmark BCBS Delaware Health Options 47181 N N na 47181 N N na

Highmark Blue Cross & Blue Shield of Pennsylvania 54771 Y Y Y

Highmark Blue Cross & Blue Shield of Pennsylvania Central 54771C Y Y Y

Highmark Blue Cross & Blue Shield of Pennsylvania Western 54771W Y Y YHighmark Senior Solutions PA (aka Freedom Blue Medicare Advantage)

(for Claims with DOS after to 2014) 95462 Y Y Y 95462 Y Y YHighmark Senior Solutions WV (aka Freedom Blue Medicare Advantage)

(for Claims with DOS after to 2014) 95461 Y Y Y 95461 Y Y Y

Hill Physicians Medical Group 00046 N N na 00046 N N na

HIP - Health Insurance Plan of Greater New York 55247 N N Y 55247 N N Y

Hispanic Physicians IPA HPFFS N N na

Hispanic Physicians IPA (Encounters Only) HPIPA N N na

HMA - Health Management Admin 12T11 Y N na

HMA Hawaii 86066 N N Y 86066 N N Y

HMC HealthWorks aka Health Management Co 75318 N N na 75318 N N na

HMSO-Highline Medical Service Organization 91164 Y N na 91164 Y N na

HN1 Therapy Network (HN1TN) 65062 na Y 65062 N N Y

Home Health & Hospice J10 Cahaba 12M53 Y Y Y

Home Health & Hospice J14 NHIC 12HHA Y Y na

Home Health & Hospice J15 Cigna 12M97 Y Y Y

Home Health & Hospice J6 NGS RHHWI N Y Y

Home Health & Hospice JC Palmetto 12M80 Y Y Y

Home Health & Hospice JK NGS JKHHH Y Y Y

Homelink 30750 Y N na 30750 Y N na

Hometown Health Plan Nevada 88023 Y N Y 88023 Y N Y

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) 22099 Y Y Y 22099 Y Y Y

Horizon Healthcare of NY 22099 Y Y na 22099 Y Y na

Horizon NJ Health 22326 Y N Y 22326 Y N Y

Hotel Employees & Restaurant Employees Health Trust 91136 N N na 91136 N N na

HP Administrative Services, LLC 22521 N N Y 22521 N N Y

HS1 Medical Management 65062 na Y 65062 N N Y

HSBS Memphis 37224 N N Y 37224 N N Y

HSBS Oklahoma City 37256 N N Y 37256 N N Y

HSBS World Trade Center Health Program 31172 Y N Y 31172 Y N Y

HSHS Medical Group IPA 37137 N N na 37137 N N na

Humana (JVHL) KVJVH Y Y Y KVJVH Y Y Y

Humana Choice Care Network (Batch) 611X1 Y N Y 611X1 Y N Y

Humana Choice Care Network (Real-Time) 61101 Y N Y 61101 Y N Y

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Humana Dermatology - New Century Health NCH02 N N na

Humana Emphesys (Batch) 611X1 Y N Y 611X1 Y N Y

Humana Emphesys (Real-Time) 61101 Y N Y 61101 Y N Y

Humana Employers Health Insurance (Batch) 611X1 Y N Y 611X1 Y N Y

Humana Employers Health Insurance (Real-Time) 61101 Y N Y 61101 Y N Y

Humana Inc. (Batch) 611X1 Y N Y 611X1 Y N Y

Humana Inc. (Real-Time) 61101 Y N Y 61101 Y N Y

Humana Long Term Care 61115 N N na 61115 N N na

Humana Military - Tricare South 61125 Y N Y 61125 Y N Y

Humana Veterans Healthcare Services 61120 N N na 61120 N N na

Humboldt-Del Norte Foundation for Medical Care 94154 N N na

Huron PACE 54750 N N na 54750 N N na

Hylton Payroll (Benefit Plan Administrators) 19753 N N na 19753 N N na

I. E. Shaffer (West Trenton NJ) 22175 N N na 22175 N N na

IAA 37279 N N Y 37279 N N Y

IBC Personal Choice 12X26 Y Y Y SX083 Y Y Y

IBEW Local 640 & Arizona Chapter NECA Health & Welfare Trust 74234 N N na

IBG Administrators, LLC 81810 N N na 81810 N N na

IBM Business Transformation Outsourcing Insurance Services Corporate 19028 N N na 19028 N N na

iCare Health Solutions 26054 Y N na

iCircle of New York 33884 Y N na 33884 Y N na

Idaho Medicaid 12K07 N N Y SKID0 Y N Y

Idaho Medicare 12M07 Y Y na SMID0 Y Y na

IEC Group - AmeriBen 97661 N N na 97661 N N na

IHG Direct 75274 N N na 75274 N N na

IlliniCare 68069 Y N Y 68069 Y N Y

Illinois Health Plan DMG01 N N na DMG01 N N na

Illinois Medicaid SKIL0 Y N Y SKIL0 Y N Y

Illinois Medicare 12M08 Y Y Y SMIL0 Y Y Y

Imagine Health 43123 N N na 43123 N N na

I'Mcare 41600 N N Y 41600 N N Y

Imperial County Physicians Med Group (SCPMCS) SCP01 N N na SCP01 N N na

IMS Management Services TH099 N N na

IMS Management Svcs - Texas 12T64 N N na

IMX Easy 86070 N N na 86070 N N na

INDECS Corporation 40585 N N na 40585 N N na

Independence Administrators TA720 N N na

Independence American Insurance Company CB231 N N na CB231 N N na

Independence Care Systems FIDA-MMP 64284 N N na 64284 N N na

Independence Medical Group MHM01 N N na

Independent Health 12X01 Y Y Y SX073 N Y Y

Independent Health Care Plan 11695 Y Y Y 11695 Y Y Y

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Independent Living Systems, LLC 45048 Y N Y 45048 Y N Y

Independent Physicians at Mercy INDPM N N na INDPM N N na

Indian Health Services 12X75 Y N na SX171 Y N na

Indiana Department of Health - Children's Health - Claims 35600 Y Y na 35600 Y Y Y

Indiana Medicaid 12K09 Y N Y SKIN0 Y N Y

Indiana Medicare 12M09 Y Y Y SMIN0 Y Y Y

Indiana ProHealth Network 35161 Y N N 35161 Y N N

Indiana Teamsters Health Benefits Fund (Indianapolis IN) 35107 N N na 35107 N N na

Indiana University Health Plan (Commercial) 26212 N N na 26212 N N na

Indiana University Health Plan (Medicare) 95444 N N Y 95444 N N Y

Individual Health Insurance Companies 31053 N N na 31053 N N na

INETICO INC. 43471 Y N na 43471 Y N na

Informed LLC 52196 N N na 52196 N N na

Informed UHC 50946 N N na 50946 N N na

Ingalls Provider Group (DOS beginning 5/1/15) 85578 N N Y 85578 N N Y

Ingham Health Plan Corporation 38343 N N na 38343 N N na

Inland Empire Health Plan IEHP1 N N Y IEHP1 N N Y

Inland Valley - (Redlands IPA) SYMED N N na SYMED N N na

InnovAge (remits only) 31182 na Y 31182 na Y

Innovation Health 40025 N N na 40025 N N na

Insurance Administrators of America Inc. 37279 N N na 37279 N N na

Insurance Design Administrators 13315 N N Y 13315 N N Y

Insurance Management Administrators 72091 N N N

Insurance Management Services (Amarillo TX) IMSMS N N Y IMSMS N N Y

Insurance Services of Lubbock TH012 Y N na

Insurance Systems 11889 Y N na 11889 Y N na

InsuranceTPA.com 39182 N N na 39182 N N na

Insurers Administrative Corp. 86304 N N na 86304 N N na

Integra Administrative Group (Seaford DE) 51020 N N Y 51020 N N Y

Integra Group 31127 N Y na 31127 N N na

INTEGRA GROUP/HOME 31128 N N na

Integra Group-CHA 31129 N N na

Integra Managed Long Term Care 45302 Y N na 45302 Y N na

Integrated Care Network (ICN) by Emerald Health 34167 N N na 34167 N N na

Integrated Medical Solutions LLC 20050 N N na 20050 N N na

Inter County Health Plan 54763 Y N Y

Interactive Medical Systems 56132 N N na 56132 N N na

Inter-County Health Plan SX079 Y Y na

Interface EAP (IEAP) 60280 Y N na 60280 Y N na

Intergroup Services Corporation 23287 N N na 23287 N N na

Intermountain Healthcare (now known as SelectHealth) SX107 N N na

International Benefit Administrator 11329 Y N na 11329 Y N na

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International Brotherhood of Boilermakers 36609 N N na 36609 N N na

International Brotherhood of Boilermakers Employee Health Care Plan(IBBEHC) 48603 N N na 48603 Y N na

International Medical Group IMGIN N N na IMGIN N N na

INTotal Health (claims with DOS on or after 7/01/2016) 35115 Y N Y 35115 Y N Y

Iowa Medicaid 12K10 Y Y Y SKIA0 Y Y Y

Iowa Medicare SMIA0 Y Y Y SMIA0 Y Y Y

IU Health Transplant Evaluation Program 47262 Y N na 47262 Y N na

Jencare Medical JCARE N N na JCARE N N na

JI Specialties TH033 N N na

JLS Family Enterprises JLSFE N N na JLSFE N N na

JOHN MORRELL COMPANY CO. - AHPBA 38310 N N na 38310 N N na

John Muir Mt. Diablo Health System 68036 N N N 68036 N N N

John Muir Physician Network 68036 N N na

Johns Hopkins Healthcare (EHP/PP) 52189 N Y Y 52189 N Y Y

Johns Hopkins Healthcare (USFHP) 52123 N N Y 52123 N N Y

Joplin Claims / Benefit Management Inc 43178 Y N na 43178 Y N na

JP Farley Corporation 34136 N N na 34136 N N na

JP Specialties 12T47 Y N na

JPS Preferred Care MWP01 N N na

Kaiser Foundation Health Plan of Colorado 91617 N N Y 91617 N N Y

Kaiser Foundation Health Plan of Hawaii 94123 N N na 94123 N N na

Kaiser Foundation Health Plan of Northern CA Region 94135 N N Y 94135 N N Y

Kaiser Foundation Health Plan of Southern CA Region 94134 N N Y 94134 N N Y

Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. 52095 N N Y 52095 N N Y

Kaiser Foundation Health Plan of Washington (formerly Group Health of WA) 91051 Y N Y 91051 Y N Y

Kaiser Foundation of the Northwest NW002 N N Y NW002 N N Y

Kaiser Permanente of Georgia 21313 N N Y 21313 N N Y

Kaiser Self Funded 94320 N N na 94320 N N na

Kane County BCBS KCIPA N N na KCIPA N N na

Kane County Harmony Medicaid IPAK1 N N na IPAK1 N N na

Kansas City Life Insurance Company 44030 Y N na

Kansas Medicaid MDKSI Y N Y MDKSP Y N Y

Kansas Medicare 57324 Y Y Y SMKS0 Y Y Y

Katy Medical Claims 81812 N N na 81812 N N na

Kaweah Delta TKFMC N N na

Keenan Associates (CA) 95279 N N na 95279 N N na

Kelseycare KELSE N N na KELSE N N na

Kemper Benefits 61453 Y N na

Kempton Company 73100 N N Y 73100 N N Y

Kempton Group Administrators 73100 N N Y 73100 N N Y

Kentucky Health Administrators Inc. 27215 Y N na 27215 Y N na

Kentucky Health Cooperative 77894 Y N Y 77894 Y N Y

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Kentucky Medicaid 12K11 Y Y Y SKKY0 Y Y Y

Kentucky Medicare 12M11 Y Y Y SMKY0 Y Y Y

Kentucky Passport (DOS after 9/30/17) 61325 Y N na 61325 Y N na

Kentucky Spirit Health Plan 68069 Y N Y 68069 Y N Y

Kern County CDCR 28021 N N na 28021 N N na

Kern Health Systems 77039 N N na 77039 N N na

Key Benefit Administrators (Indianapolis IN) 37217 Y N Y 37217 Y N Y

Key Gap 35317 Y N na 35317 Y N na

Key Health Medical Solutions Inc. 95460 N N na

Key Medical Group IP082 N N na

Key Select 37321 Y N na 37321 Y N na

Key Solution 37323 Y N Y 37323 Y N Y

Keystone First 23284 Y N Y 23284 Y N Y

Keystone Health Plan East 12X25 Y Y Y SX055 Y Y Y

Keystone Health Plan West SX056 Y Y na

Klais & Company 34145 Y N na 34145 Y N na

Klais & Company (Repricing for HealthSpan Network Only) 3414A N N na 3414A N N na

KPS-Kitsap Physician Services KPS01 N N na KPS01 N N na

KS - Sunflower State Health 68069 Y N Y 68069 Y N Y

LA Care Health Plan LACAR N N Y LACAR N N Y

LACare 27357 Y N Y 27357 Y N Y

Lake County Physicians Association 37116 N N na 37116 N N na

Lakeside Community Healthcare LMG01 N N na LMG01 N N na

Lakeside Comprehensive Healthcare 66127 N N na 66127 N N na

Lakeside Health Services LMG11 N N na

Lakeside Medical Group 66125 N N na 66125 N N na

Lakewood Health Plan LIPAZ Y N na LIPAZ Y N na

Landmark Healthcare Inc LNDMK Y N Y

LaSalle Medical Associates NMM02 N N na NMM02 N N na

Lawndale Christian Health Center LAWND N N na LAWND N N na

Lawndale Christian Health Center (For DOS prior to 2017) 36333 N N na 36333 N N na

LBA Health Plans 52193 N N na 52193 N N na

Leon Medical Center Health Plan 37316 N N na 37316 N N na

LHP Claims Unit 37248 N N na 37248 N N na

LHS Medcost Solutions LLC 90753 N N na 90753 N N na

Liberty Health Advantage 87071 N N na 87071 N N na

Liberty National Life Insurance Company (remits only) 65331 na na Y 65331 na na Y

Liberty Union 37281 N N na 37281 N N na

Life Assurance Company 37281 N N na 37281 N N na

Life Gift Cards 33LGC Y N na 33LGC Y N na

Life Investors Insurance 12T67 N N na TH120 Y N na

Life Investors Insurance of America - Long Term Care 12T39 N N na

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Life Investors of America - Long Term Care TH093 N N na

LIFE Pittsburgh 25181 N N na 25181 N N na

LIFE St. Joseph of the Pines 59847 N N na 59847 N N na

Life Trac 41136 N N na 41136 N N na

LifeCircles PACE 71498 N N na 71498 N N na

Lifemap RLH01 N N Y RLH01 N N Y

LifePath Hospice Inc 76870 Y N na 76870 Y N na

Lifestyle Health Plans 2700U Y N na 27005 Y N na

Lifetime Benefit Solutions EBSRM N N Y EBSRM N N Y

LifeWise Healthplan of Oregon 93093 Y N Y 93093 Y N Y

LifeWise Healthplan of Washington (Premera) 91049 Y N Y 91049 Y N Y

Lincoln Financial Group (Dental ERA Only) CX061 na na Y CX061 na na Y

Lincoln National (EMPHESYS Green Bay and Madison WI only) 73288 N N na

LIPA/Agate Resources TH106 N N na

Little Company of Mary (For claims with a DOS on or after 1/1/17) LCM1 N N na LCM1 N N na

Little Company of Mary (For claims with a DOS prior to 1/1/17) LCM01 N N na LCM01 N N na

Local 135 Health Benefits Fund (Indianapolis IN) 35107 N N na 35107 N N na

Lockard & Williams CB752 N N na CB752 N N na

Loma Linda 99255 Y N na

Loma Linda University Adventist Health Sciences Center Employee Health Plan 37267 N N na 37267 N N na

Loma Linda University Adventist Health Sciences Centers 37267 N N na 37267 N N na

Loma Linda University Behavioral Medicine Center Employee Health Plan 37267 N N na 37267 N N na

Loma Linda University Employee Health Plan 37267 N N na 37267 N N na

Loma Linda University Health Care Employee Health Plan 37267 N N na 37267 N N na

Loma Linda University Healthcare 33036 N N na 33036 N N na

Loma Linda University Medical Center Employee Health Plan 37267 N N na 37267 N N na

Loma Linda University Medical Center Residents Health Plan 37267 N N na 37267 N N na

Loma Linda University Student Health Plan 37267 N N na 37267 N N na

Los Angeles Medical Center (LAMC) PPM01 Y N na PPM01 Y N na

Louisiana Health Cooperative 88075 N N na 88075 N N na

Louisiana Healthcare Connections 68069 Y N Y 68069 Y N Y

Louisiana Medicaid MCDLA Y Y na MCDLA Y Y na

Louisiana Medicaid - Ambulance claims SKLA2 Y Y Y

Louisiana Medicaid - DME Claims SKLA1 Y Y na

Louisiana Medicaid - KidMed Claims SKLA3 Y Y na

Louisiana Medicaid - Rehab SKLA4 N N na

Louisiana Medicaid-Home Health 12K94 N N na

Louisiana Medicare 12M12 Y Y Y SMLA0 Y Y Y

Lovelace Sandia Health Plan (as of 9/27/14) 90328 Y N na 90328 Y N na

Loyal American Life Ins Co-Medicare Supplement 13193 Y N Y 13193 Y N Y

MacNeal Health Providers- CHS 36334 N N na 36334 N N Y

Magan Medical Clinic HCP01 N N na

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Magellan Complete Care of Virginia MCCVA Y N Y MCCVA Y N Y

Magellan Health Services 12X27 Y N Y 01260 Y N Y

Magnacare 11303 N N na 11303 N N na

Magnolia 68069 Y N Y 68069 Y N Y

Mail Handlers Benefit Plan 25133 Y N Y 25133 Y N Y

Maine Community Health Options 45341 Y N Y 45341 Y N Y

Maine Medicaid 12K13 Y Y Y SKME0 Y Y Y

Maine Medicare 12M13 Y Y Y SMME0 Y Y Y

MajestaCare Virginia 26372 N N na 26372 N N na

Maksin Management Corporation 22195 Y N na 22195 Y N na

Managed Care Services LLC 35162 N N na 35162 N N na

Managed Care Systems (Delano Regional Medical Group) MCS02 N N Y

Managed Care Systems (Gemcare) MCS01 N N na MCS01 N N na

MANAGED HEALTH CARE ASSOCIATES 36312 N N na 36312 N N na

Managed Health Network 22771 N N Y 22771 N N Y

Managed Health Services Indiana (Medicaid HMO) 68069 Y N Y 68069 Y N Y

Managed Health Services Wisconsin 68069 Y N Y 68069 Y N Y

Manulife W. J. Sutton Company 98010 N N na 98010 N N na

Mapfre (Canada Life) L0160 N N na L0160 N N na

March Vision Care Inc. 52461 N N na

Marion Polk Community Health Plan 33711 Y N na

Marquette Life Insurance Company 48055 N N Y 48055 N N Y

Marrick Medical Finance LLC. 20805 Y N na 20805 Y N na

MARTINS POINT HEALTH CARE 53275 N N na 53275 N N na

Maryland Medicaid MCDMD Y Y Y MCDMD Y Y Y

Maryland Medicare 12010 Y Y Y SMMD0 Y Y Y

Maryland Physicians Care 22348 N N Y 22348 N N Y

Maryland Public Mental Health SX069 N Y na

Mashantucket Pequot Tribal Nation 37121 N N na 37121 N N na

Massachusetts Medicaid 12K14 Y Y Y SKMA0 Y Y Y

Massachusetts Medicaid - Health Safety Net HSNMI Y Y Y HSNMP Y Y Y

Massachusetts Medicare 12M14 Y Y Y SMMA0 Y Y Y

Massachusetts Mutual 80314 Y N Y 80314 Y N Y

Masters Mates and Pilots Plan MMPHB N N na MMPHB N N na

Masters Mates and Pilots Program 12T52 N N na TH111 Y N na

Max Specialty Benefits 27320 N N na

Maxor Administrative Services 92805 N N na 92805 N N na

Mayo Clinic FL/GA 88090 N N Y 88090 N N Y

MBA Benefit Administrators Inc (Salt Lake UT) 83028 N N na 83028 N N na

MBA OF WYOMING INC 87065 N N na 87065 N N na

MCA ADMINISTRATORS 25160 N N Y 25160 N N Y

Mcare Advantage Plan 12M85 Y N na

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McKinley Medical Group MHM02 N N na

McLaren Health Plan 38338 Y N Y 38338 Y N Y

McLaren Health Plan (JVHL) K7JVH Y Y Y K7JVH Y Y Y

MD Anderson Physician Network MDAPN N N na MDAPN N N na

MDI Holdings (Formerly Medical Partners of America) 80026 N N na 80026 N N na

Mdwise Exchange Market Place 45627 N N Y 45627 N N Y

Mdwise Healthy Indiana Plan 31354 Y N Y 31354 Y N Y

Mdwise Hoosier Care Connect (for DOS prior to March 31, 2017) 91313 N N Y 91313 N N Y

Mdwise Hoosier Healthwise 35191 Y N Y 35191 Y N Y

MDwise Inc. (For claims with DOS prior to 1/1/2017) 12K81 N N Y SX172 N N Y

MDWise Select Health Network 35199 N N Y 35199 N N Y

MDX Hawaii MDXHI Y N na MDXHI Y N na

MED PAY 88058 Y N na 88058 Y N na

MED3000 CMS SAFETY NET EM284 N N na EM284 N N na

MED3000 CMS TITLE 19 REFORM EM843 N N na EM843 N N na

MED3000 CMS TITLE 21 EM205 N N na EM205 N N na

MedAdmin Solutions 58202 N N na 58202 N N na

MedBen (Newark OH) 74323 Y N Y 74323 Y N Y

MedCom 59231 Y N na 59231 Y N na

MedCost Benefit Services 56205 Y N Y 56205 Y N Y

MedCost Inc. 56162 Y N Y 56162 Y N Y

Medfocus 95321 N N na

Medica 94265 Y N Y 94265 Y N Y

MEDICA HEALTH CARE PLAN INC. 78857 Y N na 78857 Y N na

Medica2 12422 Y N Y 12422 Y N Y

Medicaid Hawaii Waivers 77059 Y Y na

Medi-Cal (Vision) SKCA1 N Y na

MEDICAL ASSOCIATES HEALTH PLAN MAHC1 N N N MAHC1 N N N

Medical Benefits Administration MBA01 N N na

Medical Benefits Administrators Inc. (Newark OH) 74323 Y N Y 74323 Y N Y

Medical Benefits Companies (Newark OH) 74323 Y N Y 74323 Y N Y

Medical Benefits Mutual (Newark OH) 74323 Y N Y 74323 Y N Y

Medical Benefits Mutual Life Insurance Co. 74323 Y N Y 74323 Y N Y

Medical Card System ( MCS ) L0170 N N na L0170 N N na

MEDICAL DEVELOPMENT INTERNATIONAL 52181 N N na 52181 N N na

Medical Mutual of Ohio 29076 Y N Y 29076 Y N Y

Medical Reimbursements of America 62177 N N na 62177 Y N na

Medical Services for Indigents AMM02 N N na

Medical Services Initiative 12057 Y N na 12057 Y N na

Medical Value Plan - Ohio (MVP) 38224 N N na 38224 N N na

Medicare Blue Private SX262 N N na

Medicare DME (All Jurisdictions) SDMEB Y Y Y

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Medicare Part A Legacy - JH 04911 Y Y Y

Medicare Part A Legay (CA, HI, NV) 12M65 Y Y na

Medicare Plus Blue Michigan 00210 Y Y Y 00710 Y Y Y

Medicare PPO (BCBS SC) 00C63 N N Y 00C63 N N Y

Medicare y Mucho Mas ( MMM ) L0210 N N na L0210 N N na

Medico Insurance Company 23160 N N Y 23160 N N Y

Mediture 20039 N N na 20039 N N na

Mediview Inc. STAR1 N N na STAR1 N N na

MedPartners - Mary Black Health Network 412MP N N Y 412MP N N Y

MedPartners Administrative Services 35205 Y N na 35205 N N Y

MedSolutions Inc 62160 N N Y 62160 N N Y

MedStar Family Choice 39190 N N na 39190 N N na

Medstar Select/Medstar Medicare Choice 251MS Y N na 251MS Y N na

MEGA Life & Health (United Ins. Div.) 97055 N N na

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

Memorial Herman Health Network Providers 37330 Y N Y 37330 Y N Y

Memorial Medical Group HCP01 N N na

MemorialCare Medical Foundation MMFMC Y N Y MMFMC Y N Y

MemorialCare Medical Foundation UCI MMFUC Y N Y MMFUC Y N Y

Menifee Valley Community Medical Group HCMG1 Y N na HCMG1 Y N na

Mercy Benefit Administration 37264 N N N 37264 N N N

Mercy Care Plan (AHCCCS) 86052 N N Y 86052 N N Y

Mercy Health Plans 43166 N N na 43166 N N na

Mercy LIFE of Alabama 63002 N N na 63002 N N na

Mercy Maricopa Integrated Care 33628 Y N na 33628 Y N na

Mercy Physicians Medical Group (MPMG) (NAMM Southern CA) IP079 N N Y IP079 N N Y

Mercy Provider Network 43185 N N na 43185 N N na

MercyCare 39114 N N na 39114 N N na

Meridian Health Plan 13189 N N Y 13189 N N Y

Meridian Health Plan of Michigan (JVHL) J2JVH Y Y Y J2JVH Y Y Y

Meritain Health 64157 N N Y 64157 N N Y

Meritain Health / Agency Services 64158 N N na 64158 N N na

Meritain Health Minneapolis 41124 Y N Y 41124 Y N Y

Methodist Associate Health Plan Pilot N N na

MetroPlus Health Plan 13265 N N Y 13265 N N Y

Metrowest HealthPlan TH068 N N na

Metrowest Star Medicaid TH069 N N na

MFC & HealthPlus Peoria 23550 N N na 23550 N N na

MHNET 74289 Y N Y 74289 Y N Y

MHP Systems 64068 N N na 64068 N N na

Michigan Medicaid 12K37 Y Y Y SKMI0 Y Y Y

Michigan Medicare SMMI0 Y Y Y SMMI0 Y Y Y

Page 31 of 52



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Michigan UFCW (remits only) 27401 na Y 27401 na Y

Mid American Benefits 22823 Y N na 22823 Y N na

Mid Rogue Oregon Health Plan 26161 N N na 26161 N N na

Mid-America Associates Inc. 37281 N N na 37281 N N na

MidCoast IPA 77012 N N na 77012 N N na

Mid-County Physicians Medical Group SCP01 N N na SCP01 N N na

Midlands Choice Inc. 47080 Y N na 47080 Y N na

Midwest Health Partners 76079 N N na 76079 N N na

Midwest Physicians Administrative Systems 66727 N N Y 66727 N N Y

Mills Peninsula Medical Group MPMG1 N N na

MINNESOTA DEPARTMENT OF HEALTH MNDH1 N N na MNDH1 N N na

Minnesota Medicaid 12K16 Y Y Y SKMN0 Y Y Y

Minnesota Medicare 12M16 Y Y na SMMN0 Y Y na

MinuteMan Health 01776 N N na 01776 N N na

Mission (St. Joseph Heritage Healthcare) STJOE N N na

Mississippi Health Partners 64068 N N na 64068 N N na

Mississippi Medicaid 12K17 Y Y Y SKMS0 Y Y Y

Mississippi Medicare 12M17 Y Y Y SMMS0 Y Y Y

Mississippi Physicians Care Network 64084 N N na 64084 N N na

Mississippi Public Entity Employee Benefit Trust 37233 N N na 37233 N N na

Mississippi Select Health Care 64088 N N Y 64088 N N Y

Missoula County Medical Benefits Plan 37275 N N Y 37275 N N na

Missouri Medicaid 12K15 Y N Y SKMO0 Y N Y

Missouri Medicare 12M15 Y N na SMMO0 Y N Y

Missouri Medicare Select MMS01 N N na MMS01 N N na

MMSI 41154 Y N Y 41154 Y N Y

MO - Missouri Home State Health Care 68069 Y N Y 68069 Y N Y

Moda Health 13350 Y N Y 13350 Y N Y

Molina Healthcare 12X09 N N na

Molina Healthcare of California 38333 Y N Y 38333 Y N Y

Molina Healthcare of Florida 51062 Y N Y 51062 Y N Y

Molina Healthcare of Illinois 20934 Y N Y 20934 Y N Y

Molina Healthcare of Michigan 38334 Y N Y 38334 Y N Y

Molina Healthcare of Michigan (JVHL) JIJVH Y Y Y JIJVH Y Y Y

Molina Healthcare of New Mexico - Salud 09824 N N Y 09824 Y N Y

Molina Healthcare of New Mexico -SCI 04423 Y N Y 04423 Y N Y

Molina Healthcare of Ohio 20149 Y N Y 20149 Y N Y

Molina Healthcare of Puerto Rico 81794 Y N Y 81794 Y N Y

Molina Healthcare of South Carolina 46299 Y N Y 46299 Y N Y

Molina Healthcare of Texas 20554 Y N Y 20554 Y N Y

Molina Healthcare of Utah (aka American Family Care) SX109 Y N na

Molina Healthcare of Virginia 26176 Y N na 26176 Y N na

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Molina Healthcare of Washington 38336 Y N Y 38336 Y N Y

Molina Healthcare of Wisconsin ABRI1 Y N Y ABRI1 Y N Y

Monarch IPA IP095 Y N na

Monitor Life Insurance Company (Secondary claims only) 16098 Y Y Y 16098 Y Y Y

Montana Medicaid 12K77 Y N na SKMT0 Y N na

Montana Medicare 12M77 Y Y Y SMMT0 Y Y Y

Montefiore Contract Management Organization 13174 Y N Y 13174 Y N Y

Montifiore HMO 46161 Y N N 46161 Y N N

Monumental Life Insurance Company MMLIC N N na MMLIC N N na

Monumental Life Insurance Company (AR) TLINS Y N na TLINS Y N na

Monumental Life Insurance Company (IA) TRCLF Y N na TRCLF Y N na

Monumental Life Insurance Company (IA, MD, PA) TRP1E Y N na TRP1E Y N na

Monumental Life Insurance Company (TX) TRLTC Y N na TRLTC Y N na

MORRIS ASSOCIATES 35092 N N na 35092 N N Y

Mosaic IPA Medical Group IP083 N N na

Motion Pictures Industry 99282 N N na 99282 N N na

Mountain State Blue Cross and Blue Shield SB941 Y Y na

Mountain State Blue Cross of West Virginia 12B28 Y Y na

MPE Services Inc. 37233 N N na 37233 N N na

MPEEBT 37233 N N na 37233 N N na

MSA Care Guard 20572 Y N na 20572 Y N na

MSC (Medical Service Company) Group, Inc. 80019 N Y na 80019 N Y na

MSH Reimbursement 05887-NOCD Y N na 05887-NOCD Y N na

Mt. Carmel Health Plan 95655 Y N Y 95655 Y N Y

Multiplan Wisconsin Preferred Provider Network 34080 N N na 34080 N N na

Municipal Health Benefit Fund 81883 N N na 81883 N N na

Mutual of Omaha Insurance Company 71412 N N Y 71412 N N Y

Mutually Preferred 71412 N N Y 71412 N N Y

MVP Health Plan (Mohawk Valley) 14165 Y N Y 14165 Y N Y

MVP Health Rochester 12X04 Y N na

My Family Medical Group 33020 N N na 33020 N N na

MyDecision HealthSmart 18840 Y N na 18840 Y N na

N.W. Ironworkers Health & Security Trust Fund 91136 N N na 91136 N N na

N.W. Roofers & Employers Health & Security Trust Fund 91136 N N na 91136 N N na

N.W. Textile Processors 91136 N N na 91136 N N na

NAA (North America Administrators L.P.) (Nashville TN) 65085 N N Y 65085 N N Y

NALC/Affordable 53011 Y N na 53011 Y N na

NAMCI/Global Care L0110 Y N na L0110 Y N na

NAMM-IL (Senior Care Partners) (remits only) NANPR na Y NANPR na Y

NAPHCARE INC. 58182 Y N Y 58182 Y N Y

National Association of Letter Carriers/NALCHBP 53011 Y N Y 53011 Y N Y

National Capital Preferred Provider Organization (NCPPO) 90001 Y N na 90001 Y N na

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National Elevator Industry Benefit Plan (Remits Only) CX045 na na Y CX045 na na Y

National General ASHC1 Y N na ASHC1 Y N na

National Imaging Assoc Inc / Magellan Health Services 12X27 Y N na

National Imaging Associates SX190 na Y SX190 N N Y

National Rural Electric Coop (NRECA) 52132 Y N na

National Telecommunications Cooperative Association 52120 N N Y 52120 N N Y

National Telecommunications Cooperative Association (NTCA - Staff) 52104 N N na 52104 N N na

National Telecommunications Cooperative Association (NTCA) 52103 N N na 52103 N N na

Native Care Health 19191 Y N na 19191 Y N na

NCDPS Correctional Claims 38520 Y N na 38520 Y N na

Nebraska Medicaid 12K19 Y Y Y SKNE0 Y Y Y

Nebraska Medicare 12M19 Y Y na SMNE0 Y Y Y

Nebraska Total Care 68069 Y N Y 68069 Y N Y

Neighborhood Health Partnership (NHP) 96107 Y N na 96107 Y N na

Neighborhood Health Plan (Boston MA) 04293 N N Y 04293 N N Y

Neighborhood Health Plan Rhode Island 05047 Y N Y 05047 Y N Y

Neighborhood Health Plan Rhode Island - Exchange, Unity, Integrity 96240 N N na 96240 N N na

Netcare Life and Health Insurance (Hagatna Guam) 66055 N N na 66055 N N na

Network Health Insurance Corp-Medicare 77076 N N Y 77076 N N Y

Network Health Plan of Wisconsin Inc. 39144 N N Y 39144 N N Y

Network Medical Management NMM01 N N na NMM01 N N na

Network Solutions IPA NSIPA Y N na

Network TPA LLC 58204 N N na 58204 N N na

Nevada Medicaid 12K20 Y Y na SKNV0 Y Y na

Nevada Medicare SMNV0 Y Y na

NEW AVENUES INC. 95998 Y N na 95998 Y N na

New Century Health - IEHP Oncology NCH11 N N na

New Century Health - Vista Cardiology NCH09 N N na

New Directions Behavioral Health (NDBH) NDX99 Y N na NDX99 Y N na

New England Dental Administrators (remits only) 43351 na Y 43351 na Y

New Era Life 98798 N N na 98798 N N na

New Hampshire Medicaid 12K90 Y Y Y SKNH0 Y Y Y

New Hampshire Medicare 12M21 Y Y na SMNH0 Y Y na

New Jersey Medicaid MDNJI Y Y Y MDNJP Y Y Y

New Jersey Medicaid (for providers enrolled prior to 12/15/15) 12006 Y Y Y SKNJ0 Y Y Y

New Jersey Medicaid-Charity Care CKNJ2 Y Y Y

New Jersey Medicare 12005 Y Y Y SMNJ0 Y Y Y

New Mexico Health Connections 45129 Y N Y 45129 Y N Y

New Mexico Medicaid 12K22 Y Y na SKNM0 N Y Y

New Mexico Medicare 12M22 Y Y Y SMNM0 Y Y Y

New West Health Plan 84141 N N na

New West Health Services SX164 N N na

Page 34 of 52



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New York Life 12T69 N N na TH122 Y N na

New York Medicaid 12K35 Y Y Y SKNY0 Y Y Y

New York Medicare 12M35 Y Y na

New York Medicare Downstate SMNY0 Y Y na

New York Medicare Queens SMNY2 Y Y na

New York Medicare Upstate SMNY1 Y Y Y

New York Network Management 11334 N N na

Next Level Health Partners 69821 N N Y 69821 N N Y

NGS American Inc 38225 N N Y 38225 N N Y

NHBCAUX 88050 N N na 88050 N N na

NHI BILLING SERVICES INC 14043 Y Y na

Nippon Life Insurance Company of America 81264 N N Y 81264 N N Y

NJ Carpenters Health Fund 22603 Y N na 22603 Y N na

Noble AMA Select IPA PDT01 N N na

North American Medical Management - Southern California IP079 N N Y IP079 N N Y

North Broward Hospital District 37314 N N na 37314 N N na

North Carolina Medicaid 12K23 Y Y Y SKNC0 Y Y Y

North Carolina Medicare 12M23 Y Y Y SMNC0 Y Y Y

North County Health Services SCP01 N N na SCP01 N N na

North Dakota Blue Cross (Noridian) 12B78 Y Y na

North Dakota Medicaid 12K78 Y N na SKND0 Y N na

North Dakota Medicare 12M82 Y Y na SMND0 Y Y na

North Texas Healthcare Network 35212 Y N na 35212 Y N na

North West Orange County Medical Group PROSP N N na

Northern Illinois Health Plan 36347 N N na 36347 N N na

Northern Nevada Trust Fund 88027 N N na 88027 N N na

Northridge Medical Group NMG01 N N na

Northshore LIJ Insurance Company 46227 Y N Y 46227 Y N y

NorthShore Physician Associates 48026 Y N N 48026 Y N N

NorthShore University Health System Medical Group 36364 N N na 36364 N N na

Northstar Advantage 60058 N N na 60058 N N na

Northwest Administrators Inc (remits only) 91068 na Y 91068 na Y

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

Northwest Physicians Network NPN11 Y N na NPN11 Y N na

Northwest Suburban IPA (Illinois) 36346 N N na 36346 N N na

Novanet OSCAR N N na 06226 N N na

Novasys Health Network 71080 N N na 71080 N N na

Nuestra Familia Medical Group (Prospect Medical Group) PROSP N N na

Nyhart 37299 N N na 37299 N N na

NYLCare Ethix Northwest 91135 N N na

NYS DOH UCP 14142 Y N Y 14142 Y N Y

Oak Street Health OAKST N N na OAKST N N na

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Oak West Physician Association 36400 N N Y 36400 N N Y

Oasis IPA DESRT N N na

Occular Benefits L0140 N N na L0140 N N na

Ohio Health Choice PPO 34189 N N na 34189 N N na

Ohio Medicaid SKOH0 Y N Y SKOH0 Y N Y

Ohio Medicare 12M24 Y Y Y SMOH0 Y Y Y

Ohio PPO Connect 74431 Y N Y 74431 Y N Y

OK State Employees & Educators (EDS) 22521 N N Y 22521 N N Y

Oklahoma DRS DOC 71065 N N Y 71065 N N Y

Oklahoma Medicaid 12K25 Y N Y SKOK0 Y N Y

Oklahoma Medicare 12M37 Y Y Y SMOK0 Y Y Y

Olympus Managed Health Care 65074 Y N na 65074 Y N na

OMNI Care Health Care 25150 Y N na 25150 Y N na

OMNI/Medicore HP 68037 N N na 68037 N N na

One Call Medical 22321 N N na 22321 N N na

Operating Engineers Locals 302 & 612 Health & Security Fund 91136 N N N 91136 N N N

Optima Health Plan 54154 Y N Y 54154 Y N Y

Optima Insurance Company 54154 Y N Y 54154 Y N Y

Optimum Choice of the Carolinas Inc. (OCCI) 52152 Y N na

Optimum Healthcare Inc. 20133 N N na 20133 N N na

Optum Medical Network / AZ, UT (formerly Lifeprint Arizona) LIFE1 Y N Y LIFE1 Y N Y

OptumHealth 87726 Y N na

OptumHealth Behavioral Solutions (formerly Pacificare Behavioral Health) 33053 N N na 33053 N N na

OptumHealth Behavioral Solutions (formerly United Behavioral Health) 87726 Y N na 87726 Y N na

OptumHealth Care Solutions (formerly United Resource Networks) 41194 Y N Y 41194 Y N Y

OptumHealth Physical Health - includes Oxford (formerly ACN & ACNIPA) 41160 N N na

OptumHealth Vision 00773 Y N na

Orange County Health Care Agency 65021 Y N na 65021 Y N na

Oregon Medicaid 12K41 Y Y Y SKOR0 Y Y Y

Oregon Medicare 12M41 Y Y na SMOR0 Y Y Y

Orthonet - Uniformed Services Family Health Plan 13382 N N na

Orthonet- Aetna 13383 Y N Y 13383 Y N Y

Oscar Health OSCAR Y N na OSCAR Y N na

OSF Healthcare Central OSFC9 N N na OSFC9 N N na

OSF Healthcare East OSFE9 N N na OSFE9 N N na

OSMA Health - C. L. Frates 73071 N N na 73071 N N na

OSU Center for Health Sciences 76619 Y N na

Outpatient Services/ZeroOutofPocket 04430 N N na 04430 N N na

Oxford Life Insurance Company (remits only) 76112 na Y 76112 na Y

PACE Central Iowa 72436 N N na 72436 N N na

PACE CNY 70454 N N na 70454 N N na

PACE Nebraska 35416 N N na 35416 N N na

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PACE Southeast Michigan 86711 N N na 86711 N N na

PACE Southwest Iowa 53534 N N na 53534 N N na

Pace Suburban Bus Service (via IDPA) PACE1 N N na

Pacific Alliance Medical Center SYMED N N na SYMED N N na

Pacific Alliance Medical Group SYMED N N na SYMED N N na

Pacific IPA PCFCI N N na

PacificSource Community Solutions 20416 N N na 20416 N N na

PacificSource Health Plans 93029 Y N Y 93029 Y N Y

PacificSource Medicare 20377 Y N na 20377 Y N na

Palo Alto Medical Foundation 94115 Y N na 94115 Y N na

Pan American Life Insurance Group 04218 N N na 04218 N N na

Paramount Healthcare Services SX158 N N Y SX158 N N Y

Parkland Community Health Plan 66917 N N Y 66917 N N Y

PARTNERS BEHAVIORAL HEALTH MANAGEMENT 52613 Y Y Y 52613 Y Y Y

Partners In Health PARTH N N na PARTH N N na

Partnership Health of California-CAPHP SX140 N Y Y

Partnership Health Plan Of CA 12M81 Y Y na

Passport Advantage 97652 Y N na 97652 Y N na

Passport Advantage (AmeriHealth) (remits only) SX055 na Y SX055 na Y

Passport Health Plan (DOS prior to 10/01/17) 61129 Y N Y 61129 Y N Y

Patient Advocates LLC 10525 N N na 10525 N N na

PATIENTPAY 26335 Y N Y

Payer Fusion 27048 N N na 27048 N N na

Peach State Health Plan 68069 Y N Y 68069 Y N Y

Peak Pace Solutions U7034 N N na 27034 N N na

PEF Clinic PEF01 N N na PEF01 N N na

Pegasus Medical Group PROSP N N na

PEHP - Utah Public Employee Health Plan SX106 Y Y Y SX106 Y Y Y

Pekin Insurance 37086 N N Y 37086 N N Y

Penn Behavioral Health 53226 Y Y na 53226 Y Y na

Pennsylvania Health Care Plan (remits only) VALHLTH na Y VALHLTH na Y

Pennsylvania Medicaid 12008 Y N Y SKPA0 Y N Y

Pennsylvania Medicare 12M60 Y Y Y SMPA0 Y Y Y

Pennsylvania Pace 20172 N N na 20172 N N na

Peoples Health Network 72126 N N Y 72126 N N Y

Permier Health Plans 43166 N N na

Personal Insurance Administrators Inc. (Agoura Hills CA) 95397 N N Y 95397 N N Y

PHCS Claims (formerly American LIFECARE) 72099 Y N na 72099 Y N na

PHCS Savility Payers 13306 N N Y 13306 N N Y

Phoenix Choice 55649 N N na 55649 N N na

Phoenix Health Plan 03440 Y N na 03440 Y N na

Phoenix Mutual Life 67814 N N na 67814 N N na

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Physician Associates of Louisiana 58204 N N na 58204 N N na

Physician Associates of the Greater San Gabriel Valley PA513 N N na PA513 N N na

Physician Care Network LLC 58204 N N na 58204 N N na

Physician Health Partners / Correction Health Partners PHPMC Y N na PHPMC Y N na

Physician Partners IPA PPRT1 N N na PPRT1 N N na

PHYSICIAN'S ACCOUNTABLE CARE ORG 28943 N N na 28943 N N na

Physicians Care (ASR Corporation) 38265 N N na 38265 N N na

Physicians Care Health Plans (ASR Corporation) 38265 N N na 38265 N N na

Physicians Care Network (ASR Corporation) 38265 N N na 38265 N N na

Physicians Care Network (Rockford IL only) 36345 N N na 36345 N N na

Physician's Data Trust PDT01 N N na

Physicians Health Association of Illinois 37136 N N na 37136 N N na

Physicians Health Collaborative 20398 N N na 20398 N N na

Physicians Health Network MHM03 N N na

Physicians Health Plan 37330 Y N Y 37330 Y N Y

Physicians Health Plan of Northern Indiana, Inc 12399 N N Y 12399 Y N Y

Physicians Healthways IPA NMM01 N N na NMM01 N N na

Physicians Medical Group of San Jose EXC01 N N na

Physicians Medical Group of Santa Cruz County PMGSC N N na

Physicians Mutual Insurance Company 47027 N N Y 47027 N N Y

Physicians of Southwest Washington 91171 N N na 91171 N N na

Physicians Plus Insurance Corporation 39156 N N Y 39156 N N Y

Physicians United Plan 10775-NOCD N Y na 10775-NOCD N Y na

PhysMetrics 48008 N N na

PIH Health (formerly Bright Health) BHP01 N N Y BHP01 N N Y

PIH Health (remits only) PIH01 na Y PIH01 na Y

Pinnacle Claims Management Inc. 24735 N N na 24735 N N na

Pinnacle Health Resources (Prospect Medical Group) PROSP N N na

Pinnacle Physician Management ORG 45985 N N na 45985 N N na

Pinnacol Assurance 84109 N N Y 84109 N N Y

Pioneer Medical Group PIONR N N na

Pioneer Provider Network PPNZZ Y N Y PPNZZ Y N Y

Pittsburgh Care Partnership Inc. 23283 N N Y 23283 N N Y

Plan de Salud Hospital Menonita L0190 N N na L0190 N N na

Planned Administrators, Inc. (PAI) 37287 Y Y N 37287 Y Y N

Plumbers and Pipefitters - Local 33 (DesMoines, IA) 00333 N N na

Podi Care Managed Care 58204 N N na 58204 N N na

PODIATRY NETWORK FL 59324 N N na 59324 N N na

Point Comfort Underwriters PCU01 N N na PCU01 N N na

POMCO 16111 Y N Y 16111 Y N Y

Pomona Valley Medical Group IP057 N N na

Positive Healthcare Florida (FL MCO PHC/PHP) 95411 Y N na 95411 Y N na

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PPOM LLC 38335 N N Y 38335 N N Y

PPOONE UHNDC Y N na

PPOPlus LLC 72148 Y N na 72148 Y N na

Prairie States Enterprises Inc. 36373 N N Y 36373 N N Y

Preferred Benefit Administrators (Longwood FL) 53476 Y N na 53476 Y N na

Preferred Blue (SC) 00481 N N Y 00481 N N Y

Preferred Care Partners Florida 65088 Y N Y 65088 Y N Y

Preferred Community Choice/PCCSelect/CompMed 73145 Y N na 73145 Y N na

Preferred Health Partners 14966 N N na 14966 N N na

Preferred Health Plan (Louisville KY) 61106 N N na 61106 N N na

Preferred Health Plan of the Carolinas CB404 N N Y CB404 N N Y

Preferred Health Professionals 31478 N N na 31478 N N na

Preferred Health Systems A Coventry Health Care Plan 60110 N N Y 61665 N N na

Preferred Health Systems Insurance Company 60110 N N na

Preferred IPA PFIPA N N na

Preferred IPA PFIPA N N na PFIPA N N na

Preferred Medical Plan 59345 N N na 59345 N N na

Preferred Network Access Inc. 36401 N N na 36401 N N na

Preferred Plus of Kansas 60110 N N na

PreferredOne (MN) 41147 Y N Y 41147 Y N Y

Premera BCBS of Alaska 00430 Y N Y 00430 Y N Y

Premera BCBS of Washington 00430 Y N Y 00430 Y N Y

Premier Benefits Inc. 43166 N N na 43166 N N na

Premier Care IPA PCI01 N N na

Premier Eye Care 65054 Y N na

Premier Health Plan 251PR Y N Y 251PR Y N Y

Premier Health Plans 43166 N N na

Premier Health Systems Inc. 29076 Y N na 29076 Y N na

Premier HealthCare Exchange 88056 N N Y 88056 N N Y

Premier HealthCare Exchange, Inc. (PHX) 88051 N N na 88051 N N na

Presbyterian (NM) 05003 Y N na 05003 Y N na

Presbyterian Health Plan PREHP N N Y PREHP N N Y

Prestige Health Choice 77003 Y N Y 77003 Y N Y

Prevea 360 Health Plan 39113 N N Y 39113 N N Y

Primary Care Associates Medical Group (PCAMG) IP079 N N Y IP079 N N Y

Primary Care of Joliet PCJOL N N na PCJOL N N na

Primary Care Practices Of Sacramento - EHS SYMED N N na SYMED N N na

Primary Care Services MSO44 N N na

Primary Health Network 82048 N N na 82048 N N na

Primary PhysicianCare Inc. 56144 N N Y 56144 N N Y

Primary Provider Management PPM01 Y N na PPM01 Y N na

Prime West Health Plan 61604 Y N Y 61604 Y N Y

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PrimeCare Medical Network IP079 N N Y IP079 N N Y

Principal Financial Group (Dental/Vision claims only) 61271 N N Y

Priority Health 38217 Y N Y 38217 Y N Y

Priority Health (JVHL) JZJVH Y Y Y JZJVH Y Y Y

Prism Network Inc. 37268 N N na

Prism-Univera 37315 N N na 37315 N N na

Pro Care Health Plan Inc. (Detroit MI) 38329 N N na 38329 N N na

ProCare (Prospect) PROSP N N na

ProCare Health Plan Medicaid 70259 N N na 70259 N N na

Professional Benefit Administrators Inc. (Oak Brook IL) 36331 N N Y 36331 N N Y

ProMed HealthCare Administrators IP057 N N na

Prominence Health Plan of Nevada 93082 N N na 93082 N N na

Prominence Health Plan of Texas 80095 N N na 80095 N N na

Prospect Health Network PROSP N N na

Prospect Medical Group PROSP N N na

Prospect Medical Group (formerly Genesis Healthcare) PROSP Y N Y PROSP Y N Y

Prospect Sherman Oaks Medical Group (Prospect Medical Group) PROSP N N na

Protective Life Insurance Company 37309 N N na 37309 N N na

Providence of Oregon Health Plan SX133 N N Y SX133 N N Y

Providence PPO SX187 Y N na SX187 N N na

Provident American Life & Health Ins Co-Medicare Supplement 13193 Y N Y 13193 Y N Y

ProviDRs Care Network 48100 Y N na 48100 Y N na

Prudential 68241 N N na

Pruitt Health Premier PH001 N N na PH001 N N na

PSKW Physician Reimbursement Program PSKW0 Y N N

Puerto Rico Medicare SMPR0 Y Y na

Puget Sound Benefits Trust 91136 N N N 91136 N N N

Puget Sound Electrical Workers Trust 91136 N N N 91136 N N N

Pyramid Life Insurance Company 48055 N N Y 48055 N N Y

Qual Choice of Arkansas 35174 Y N Y 35174 Y N Y

QualCare Inc. 23342 N N Y 23342 N Y Y

QualCare, Inc. (dba QANI Administrators) A Cigna Company 22312 N N na 23342 N Y na

Quality Care Partners 89461 Y N na 22312 Y N na

Quartz ASO 46571 Y N na 46571 Y N na

QuikTrip 73067 N N na 73067 N N Y

QVI Risk Solutions Inc. 57117 N N na

R&N Market TKFMC N N na

Railroad Medicare (PGBA) SRRGA Y Y Y

Ravenswood Physician Associates, Inc. RPAWC N N Y RPAWC N N Y

Reading Hospital Employer Group 44219 Y N na 44219 Y N na

Regal Medical Group 95449 N N na REGAL N N na

Regence Blue Cross Blue Shield of Oregon 00851 Y N Y 00851 Y N Y

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Regence Blue Cross Blue Shield of Utah 00910 Y N Y 00910 Y N Y

Regence Blue Shield Idaho 00611 Y N Y 00611 Y N Y

Regence Blue Shield of Washington 00932 Y N Y 00932 Y N Y

Regence Group Administrators RGA01 N N Y RGA01 N N Y

Regency Employee Benefits 38221 N N na 38221 N N na

Regional Care Inc. 47076 N N na 47076 N N na

Renaissance Physicians Organization 76066 N N na 76066 N N na

Reserve National Insurance 73066 Y N Y 73066 Y N Y

Resolve Health Plan Administrators LLC RHA01 N N na RHA01 N N na

ResourceOne Administrators 37278 N N Y 37278 N N Y

Resurrection Healthcare Preferred 36396 N N na 36396 N N na

Resurrection Physician Provider Group RPPG1 N N na RPPG1 N N na

Retiree Health Trust 26316 N N na

Rhode Island Medicaid 12K74 Y Y Y SKRI0 Y Y Y

Rhode Island Medicare 12M74 Y Y Y SMRI0 Y Y Y

Right Care from Scott & White 74205 Y N N 74205 Y N N

RightChoice Benefit Administrators 37331 N N na 37331 N N na

RIVER CITY MEDICAL GROUP RCMG1 N N na RCMG1 N N na

RiverLink Health 42172 N N Y 42172 N N Y

Riverside Health Inc. 45281 N N Y 45281 N N Y

Riverside Medical Clinic RMC01 N N na

RMSCO INC. 16117 Y N na 16117 Y N na

Rocky Mountain Health Plan - Grand Junction 84065 N Y Y SX141 N Y Y

Rosemont of Des Plaines IL 36215 N N na

Royal Health Care 73780 Y N na 73780 Y N na

Rural Carrier Benefit Plan 25133 Y N na 25133 Y N na

Rural Health Clinic - Cahaba GBA 12M53 Y Y Y

Rush Prudential Health Plans (HMO Only) 36389 N N na 36389 N N na

Ryan White Network AMM03 N N na

S & S Healthcare Strategies 31441 N N Y 31441 N N Y

Sagamore Health Network 35164 N N na 35164 N N na

Sage Technologies 37105 N N na 37105 N N na

Saint Joseph PACE of IN (Mediture, LLC) 47312 N N na 47312 N N na

SAINT MARY'S HEALTH PLAN 88029 N N na 88029 N N na

Samaritan Health Plans CP001 N N Y CP001 N N Y

San Diego County Coverage Initiative (CI) MSO77 N N na MSO77 Y N na

San Diego County Medical Services (CMS) MSO11 N N na MSO11 N N na

San Diego County Physician Emergency Services MSO22 N N na

San Diego County Ryan White Care Act MSO33 N N na MSO33 N N na

San Diego County Sheriff MSO55 N N na

San Diego PACE 96400 N N na 96400 N N na

San Diego Physicians Med Group (SCPMCS) SCP01 N N na SCP01 N N na

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San Francisco Health Plan SFHP1 N N Y SFHP1 N N Y

San Joaquin Health Administrators 68035 Y N Y

San Judas Medical Group IPA HSM01 N N na HSM01 N N na

San Louis Obispo Select 33072 N N na 33072 N N na

Sandhills Center SHC303 Y Y Y SHC303 Y Y Y

Sanford Health Plan 91184 Y N Y 91184 Y N Y

SANTA CLARA FAMILY HEALTH PLAN 24077 N N na 24077 N N na

Sante Community Physicians Medical Group Corp SNTMC N N na SNTMC N N na

Sante Health System and Affiliates 77038 N N Y 77038 N N Y

Satellite Health Plan, Inc. 45552 N N na 45552 N N na

SCAN ENCOUNTERS 99157 Y N na 99157 Y N na

SCAN Health Plan 72261 N N Y 72261 N N Y

SCAN Health Plan - California SCAN1 Y N na SCAN1 Y N na

Scan Health Plan Arizona 73172 N N na 73172 N N na

SCHC Total Care - ClaimsNet 16146 N N na 16146 N N na

Scott & White Health Plan 12T05 Y N Y TH002 N N Y

Scripps Health Plan Services SHPS1 N N N SHPS1 N N N

Seaside Health Plan 46187 Y N na 46187 Y N na

Seaview IPA SVIPA N N na

Secure Health Plans of Georgia LLC 28530 N N Y 28530 N N Y

Security Health Plan 39045 Y Y Y 39045 Y Y Y

Select Administrative Services (SAS) 64088 N N Y 64088 N N Y

Select Advantage SA704 N N Y SA704 N N Y

Select Benefit Administrators Inc. 93031 Y N na 93031 Y N na

Select Benefit Administrators of America 37282 N N na 37282 N N na

Select Health of South Carolina 23285 Y N Y 23285 Y N Y

Select Senior Clinic 20415 N N na 20415 N N na

SelectCare 00014 Y N na 00014 Y N na

SelectCare of Texas (HPN) Heritage Physicians Network 76045 N N Y 76045 N N Y

SelectCare of Texas (Kelsey-Seybold) 61225 N N Y 61225 N N Y

SelectHealth 12X37 N N na SX107 N N na

Self Insured Plans (Naples FL) 36404 N N na 36404 N N na

Self Insured Services Company (SISCO) 00540 N N Y 00540 N N Y

Self-Funded Plans Inc. 34131 N N na 34131 N N na

Selman Tricare Supp TRSEL Y N na TRSEL Y N na

Sendero STAR and CHIP SCS17 N N Y SCS17 N N Y

Senior Health Partners (SHP) 80141 Y N Y 80141 Y N Y

SENIOR WHOLE HEALTH 83035 N N Y 83035 N N Y

Sentara Family Care 54154 Y N Y 54154 Y N Y

Sentara Health Management 54154 Y N Y 54154 Y N Y

Sentinel Management Services 23249 N N na 23249 N N na

Sentinel Security Life Insurance Co (remits only) 87020 na Y 87020 na Y

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Sentry Insurance a Mutual Company 39033 N N na 39033 N N na

Sentry Life Insurance Company 39033 N N na 39033 N N na

Sentry Life of New York 39033 N N na 39033 N N na

Seoul Medical Group SMG01 Y N na SMG01 Y N na

Sequoia Beverage TKFMC N N na

Seton CHIP 76056 N N na 76056 N N na

Seton Health Plan - Exclusive 12T55 Y N na TH079 N N na

Seton MAP Program 12T57 Y N na TH081 N N na

Seven Corners 25404 N N na 25404 N N na

Sharp Community Medical Group SCMG1 N N Y SCMG1 N N Y

Sharp Rees-Sealy Medical Group SRS83 N N Y SRS83 N N Y

Shasta Administrative Services 75280 Y N Y 75280 Y N Y

Sheet Metal Workers Local 104 Health Care Plan (San Ramon CA) 38238 N N na 38238 N N na

Sherman Choice - BLUE CROSS SHERMAN CHOICE SC359 N N na SC359 N N na

Sierra Family Network (Prospect Medical Group) PROSP N N na

Sierra Health and Life 76342 Y N Y 76342 Y N Y

Sierra Medical Group 30891 N N na 30891 N N na

Sierra Nevada Medical Association MBA01 N N na

Signature Advantage SA002 N N na SA002 N N na

Significa Benefits Services Inc. 23250 N N na 23250 N N na

Silver Cross Health Connection 65093 N N na 65093 N N Y

Silverback TPA 37228 N N na 37228 N N na

Simply Healthcare 27094 N N Y 27094 N N Y

Sinclair Health Plan 84076 N N na 84076 N N na

Sloans Lake Preferred Health Networks 84096 N N na 84096 N N na

Smith Administrators 02057 Y N na 02057 Y N na

Smokey Mountain Center (aka Vaya Health) 13010 N Y Y 13010 N Y Y

Solstice Benefits 76578 N N na

Sound Health (now known as First Choice Health Network) 91131 Y N na 91131 Y N na

Soundpath Health 42172 N N Y 42172 N N Y

South Carolina Medicaid 12K55 Y Y Y SKSC0 Y N Y

South Carolina Medicare 12M55 Y Y Y SMSC0 Y Y Y

South Dakota Medicaid 12K36 Y Y na SKSD0 Y Y na

South Dakota Medicare 12M83 Y Y na SMSD0 Y Y na

South FL Community Care Network - NBHD 37314 N N na 37314 N N na

South Florida Musculoskeletal Care 06294 N N na 06294 N N na

South Indiana Health Operations - HMO 77153 Y N Y 77153 Y N Y

South Point Hotel & Casino 35227 N N na 35227 N N na

SouthCare/Healthcare Preferred 25147 Y N na 25147 Y N na

Southeast Community Care (Arcadian) 77045 N N na 77045 N N na

Southeast Texas Govt Employees Benefit Pool TH116 Y N na

Southern Cal Physicians Managed Care Services SCP01 N N na

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Southern California Physicians Managed Care Services SCP01 N N na

Southern Illinois Health Care Association UIHCA Y N na SIHCA Y N na

Southland BCBS SIPA1 N N na SIPA1 N N na

Southwest Physicians Group SWPG1 Y N na SWPG1 Y N na

Southwest Service Life 37266 N N na 37266 N N na

Special Agents Mutual Benefits Association (SAMBA) (remits only) 37259 na Y 37259 na Y

Spectera 00773 Y N na

Spectrum Administrators Inc. - TPA Allentown PA (IHS Gateway Payer) 23253 Y N na 23253 Y N na

Spencer Stuart (ARM, LTD) 38416 Y N na 38416 Y N na

Spina Bifida - VA HAC 84146 Y N Y 84146 Y N Y

Spohn Health 12T63 N N na TH100 N N na

St Francis IPA APP01 N N na

St Joseph IPA STJOE N N na

St Jude Yorba Linda STJOE N N na

St. Anthony Memorial Healthcare Centers - MDWISE 35199 N N Y 35199 N N Y

St. Barnabas System Health Plan 22240 N N na 22240 N N na

St. Catherine Hospital PHO - MDWISE 35199 N N Y 35199 N N Y

St. Francis Health Network 35199 N N Y 35199 N N Y

St. James PHO 11158 Y N na 11158 Y N na

St. Joseph Heritage Healthcare STJOE N N na STJOE N N na

St. Jude (St. Joseph Heritage Healthcare) STJOE N N na

St. Margaret Mercy Healthcare Centers - MDWISE 35199 N N Y 35199 N N Y

St. Mary's IPA SMIPA Y N na SMIPA Y N na

St. Vincent IPA PDT01 N N na

Standard Life and Accident (Secondary claims only) 73099 Y N N 73099 Y N N

Starmark 61425 N N Y 61425 N N Y

State Employee Plan (SC) 00400 N N Y 00400 N N Y

State Farm (Casualty & Property Claims) 31059 Y N Y 31059 Y N Y

State Farm Insurance Companies 31053 N N Y 31053 N N Y

State of Texas Dental Plan 57254 N N Y 57254 N N Y

State Trust Group 42162 N N na 42162 N N na

Sterling Option 1 91151 N N na 91151 N N na

Stirling & Stirling 06089 N N na

Stonebridge Life Insurance Company (IA, PA) TRP1E Y N na TRP1E Y N na

Stonebridge Life Insurance Company (TX) TRP1P Y N na TRP1P Y N na

Stoner and Associates (Cincinnati OH) 31121 N N na 31121 N N na

Stones River IPA - Amerivantage 57492 Y N na

Stones River Regional IPA/BCBST 15750 N N na

Stones River Regional IPA/BHFG 15754 N N na

Stones River Regional IPA/Humana 57549 Y N na

Stones River Regional IPA/Windsor 15752 N N na

Student Assurance Services (remits only) SAS01 na na Y SAS01 na na Y

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Suburban Health Organization 35199 N N Y 35199 N N Y

SummaCare Health Plan 95202 Y N Y 95202 Y N Y

Summit Administration Services Inc. 86083 N N Y 86083 N N Y

Summit America Insurance Services Inc. 37301 N N Y 37301 N N Y

Sunshine State Health Plan 68069 Y N Y 68069 Y N Y

Superior Administrators Inc (Santa Ana CA) 23218 N N na 23218 N N na

Superior Health Plan Texas 68069 Y N Y 68069 Y N Y

Superior Vision Services 13305 N N Y

Sutter Connect (SIP/SMG/SWMG) SC004 Y N na

Sutter Connect Medical Foundation 99308 Y N na

Sutter Delta Medical Group 77318 N N na

Sutter East Bay Medical Foundation 94269 Y N na 94269 N N na

Sutter East Bay Regional Hospital 96176 Y N na 96176 Y N na

Sutter East Bay Regional Hospital- Affinity 94119 Y N na 94119 Y N na

Sutter Gould Medical Foundation 77302 Y N na 77302 N N na

Sutter Medical Group of the Redwoods 77304 Y N na 77304 Y N na

Sutter Senior Care 56621 Y N na 56621 Y N na

Swedish Covenant Hospital 36411 N N na 36411 N N na

SynerMed SYMED N N na SYMED N N na

Talbert Medical Group TALMG N N na

Tall Tree Administrators 88067 N N na 88067 N N na

TASEBA TKFMC N N na

Taylor Benefits UAYLR N N Y TAYLR N N Y

TCC Benefits Administrator TCC13 Y N na TCC13 Y N na

Teachers Health Trust 88019 N N na

Team Choice PNS 75133 N N na 75133 N N na

Teamcare 36215 N N na 36215 N N na

Teamsters Local Union #301 36612 N N na

Tennessee Medicaid 12K46 N Y Y SKTN2 N Y Y

Tennessee Medicare 12M53 Y Y Y SMTN0 Y Y Y

Tethys Health Ventures 20212 N N na 20212 N N na

TEXAS CHILDRENS HEALTH TXCSM N N na

Texas Children's Health Plan 76048 N N N 76048 N N N

Texas Childrens Health Plan (Medicaid) 75228 N N Y 75228 N N Y

Texas Christus 45210 N N na 45210 N N na

Texas First Health Plans (TIOPA) 76046 N N na 76046 N N na

Texas Health Insurance Risk Pool SB900 Y N na

Texas HealthSpring 33104 N N na 33104 N N na

Texas Medicaid 12K64 Y N Y SKTX0 Y N Y

Texas Medicare 12M31 Y Y Y SMTX0 Y Y Y

Texas Municipal League Group (remits only) 74214 na Y 74214 na Y

Texas Mutual Insurance Company WK002 N N na WK002 N N na

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Texas Premier Plan TH089 N N na

TexasFirst Health Plan (NTX) 13185 N N Y 13185 N N Y

The Alliance 88461 Y N na 88461 Y N na

The Care Network/The Savannah Business Group 68423 Y N na 68423 Y N na

The City of Odessa 75600 N N na 75600 N N na

The Health Exchange (Cerner Corporation) 20356 N N na 20356 N N na

The Health Plan/Hometown Health 34150 N N Y 34150 N N Y

The Healthcare Group 35206 N N na 35206 N N na

The Integrity Benefit Group Inc. 58200 N N na 58200 N N na

The Loomis Company - TPA Wyomissing PA (IHS Gateway Payer) 23223 Y N na 23223 Y N na

The MEGA Life & Health Insurance Company-OKC 59227 N N na

The National Radiology Network 59087 N N na 59087 N N na

The New England 66893 N N na

The Physicians Assurance Corp (TPAC) /Employee Benefit Management Corp (EBM 31074 Y N na 31074 Y N na

Third Party Administrators 37225 N N na

Thomas H. Cooper & Company SX160 Y N na

Three Rivers Preferred MP340 Y N na

Thrivent Financial THRIV N N Y THRIV N N Y

TKSoftware (remits only) SX142 na Y SX142 na Y

TLC Benefit Solutions (Global Care) TLC79 N N Y TLC79 N N Y

Today's Options (American Progressive and Pyramid Life) 48055 N N Y 48055 N N Y

Today's Options powered by CCRX 48055 N N Y 48055 N N Y

Together with Children's Community Health Plan of Wisconsin 251CC N N Y 251CC N N Y

Tongass Timber Trust 92620 Y N na 92620 Y N na

Tooling & Manufacturing Association 61425 N N Y 61425 N N Y

Torrance Hospital IPA THIPA N N na THIPA N N na

Total Broker Benefits 36342 N N Y 36342 N N Y

Total Claims Administration 37314 N N na 37314 N N na

Total Community Care 31182 N N na 31182 N N na

Total Healthcare Inc. 38201 N N na 38201 N N na

Total Plan Services 41202 N N Y 41202 N N Y

Touchstone Health PSO 23856 N N na 23856 N N Y

Town & Country TKFMC N N na

TPAC/Employee Benefit Management Corp 31074 Y N na 31074 Y N na

TR Paul Inc. 37230 N N na 37230 N N na

Transact RX PARTD N N N

TransAmerica Financial Life Insurance Company (AR) TLINS Y N na TLINS Y N na

TransAmerica Financial Life Insurance Company (TX) TRP1P Y N na TRP1P Y N na

TransAmerica Life Insurance Company (AR) TLINS Y N na TLINS Y N na

TransAmerica Life Insurance Company (IA, MD, PA) TRP1E Y N Y TRP1E Y N Y

TransAmerica Life Insurance Company (TX) TRP1P Y N na TRP1P Y N na

TransAmerica Premier Life Insurance Company (AR) TLINS Y N na TLINS Y N na

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TransAmerica Premier Life Insurance Company (IA) TRCLF Y N na TRCLF Y N na

TransAmerica Premier Life Insurance Company (IA, MD, PA) TRP1E Y N na TRP1E Y N na

TransAmerica Premier Life Insurance Company (TX) TRP1P Y N na TRP1P Y N na

TransChoice-Key Benefit Administrators 37284 Y N na 37284 Y N na

Trellis Health Partners 36397 N N na 36397 N N na

Tribute /SelectCare of Oklahoma 73117 N N Y 73117 N N Y

Tribute Health Plan 31118 Y N na 31118 Y N Y

Tricare East TREST Y Y Y TREST Y N Y

Tricare for Life 12X43 Y Y Y SX176 Y Y Y

Tricare for Overseas 12X46 N Y Y SX163 N Y Y

Tricare North Region 57106 Y Y Y 57106 Y Y Y

Tricare West 99726 Y N Y 99726 Y N Y

TriCities IPA PDT01 N N na

Trigon Blue Cross and Blue Shield (Virginia) SB924 Y N na

TRIHEALTH PHYSICIAN SOLUTIONS 31144 N Y Y 31144 N Y Y

TRIHEALTH PHYSICIAN SOLUTIONS - CONCERN 31143 N N na 31143 N N na

Trillium Community Health Plan 68069 Y N Y 68069 Y Y Y

Trilogy Network 62777 Y N na 62777 Y N na

TRIPLEFIN LLC 64300 N N na 64300 N N na

Triple-S Inc. 12B48 N Y na SB980 N Y na

TRISTAR Benefit Administrators 42137 N N Y 42137 N N Y

TriWest VAPC3 Region 3 55912 N Y Y 55912 N Y Y

TriWest VAPC3 Region 5A 55915 N Y Y 55915 N Y Y

TriWest VAPC3 Region 5B 55916 N Y Y 55916 N Y Y

TriWest VAPC3 Region 6 55917 N Y Y 55917 N Y Y

True Blue / Blue Cross of Idaho 12B84 Y Y na

TRUSTED HEALTH PLAN L0230 Y N Y L0230 Y N Y

Trusteed Plans Service Corporation 91078 N N Y 91078 N N Y

Trustmark Insurance Company 61425 N N Y 61425 N N Y

Tuality Health Alliance 93112 Y N na 93112 Y N na

Tufts Health Plan 04298 Y Y Y 04298 Y Y Y

Tufts Health Public Plans (aka Network Health) 04298 N Y Y 04298 N Y Y

TX Premier Plan - Medicaid 12T29 N N na

Ucare Minnesota 12X50 N Y na SX178 N N na

UC-Davis Health 94603 Y N na 94603 Y N na

Ullico Inc. ULLIC N N na ULLIC N N na

Ultimate Health Plan 77022 N N na 77022 N N na

Ultra Benefits Inc. 41206 Y N Y 41206 Y N Y

UMC HEALTH PLAN 75130 Y N na 75130 Y N na

UMR (formerly Lexington / CommonWealth Administrative Group) 39026 Y N Y 39026 Y N Y

UMR (formerly UMR Onalaska) 79480 Y N na 79480 Y N na

UMR (formerly UMR San Antonio Benefit Planners) 39026 Y N Y 39026 Y N Y

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UMR (formerly UMR Wausau Fiserv Benesight) 39026 Y N Y 39026 Y N Y

UMR Westerville (formerly Harrington Benefit Services - Columbus) 39026 Y N Y 39026 Y N Y

UMWA Health & Retirement Funds 52180 Y N Y 52180 Y N Y

Unicare Life & Health 80314 Y N Y 80314 Y N Y

Unified Group Services 35198 N N Y 35198 N N Y

Unified Health Services 62170 N N Y 62170 N N Y

Unified IPA HCP01 N N na

Unified Physicians Network 34638 Y N Y 34638 Y N Y

Uniform Medical Plan 39026 N N Y 39026 N N Y

Union Labor Life Insurance Company (IA) TRP1E Y N na TRP1E Y N na

Union Pacific IPA (SCPMCS) SCP01 N N na SCP01 N N na

UNION PACIFIC RAILROAD EMPLOYES Health Systems 87042 Y N Y 87042 Y N Y

Unison Health Plan/Better Health Plans 62183 Y N na 62183 Y N na

United Administrative Services, Inc. (remits only) 94174 na Y 94174 na Y

United Agriculture Benefit Trust UABT1 Y N na

United American Insurance Company (remits only) 92916 na na Y 92916 na na Y

United Americhoice of Nebraska (remits only) UFNEP na Y UFNEP na Y

United AmeriChoice of Wisconsin (remits only) WID01 na Y WID01 na Y

United Care Medical Group ADCUC Y N na ADCUC Y N na

UNITED FOOD & COMM. WORKERS MIDWEST UNIONS 36659 N N na

United Healthcare (Golden Rule) (JVHL) KRJVH Y Y Y KRJVH Y Y Y

United Healthcare (non-Golden Rule) (JVHL) J5JVH Y Y Y J5JVH Y Y Y

United Healthcare Community Plan (Great Lakes Health Plan) (JVHL) JRJVH Y Y Y JRJVH Y Y Y

United Medical Alliance 84132 N N na 84132 N N na

United of Omaha 71412 N N Y 71412 N N Y

United Teacher Assoc Ins Co-Medicare Supplement 13193 Y N Y 13193 Y N Y

UnitedHealthcare 87726 Y N Y 87726 Y N Y

UnitedHealthcare (Definity Health Plan) 87726 Y N na 87726 Y N na

UnitedHealthcare (Empire Plan) 87726 Y N na

UnitedHealthcare (MAHP MD IPA Optimum Choice MAMSI) 87726 N N na 87726 N N na

UnitedHealthcare (Oxford Health Plans) 06111 Y N Y 06111 Y N Y

UnitedHealthcare / MAHP - MD IPA Optimum Choice MLH (formerly MAMSI) 87726 Y N na 87726 Y N na

UnitedHealthcare / UHIS - UnitedHealth Integrated Services 39026 Y N Y 39026 Y N Y

UnitedHealthcare / UnitedHealthcare Plan of the River Valley 87726 Y N Y 87726 Y N Y

UnitedHealthcare / UnitedHealthcare StudentResources 74227 Y N Y 74227 Y N Y

UnitedHealthcare / UnitedHealthcare West (formerly PacifiCare) 87726 Y N na 87726 Y N na

UnitedHealthCare Community Plan (KS / KanCare) 96385 Y N Y 96385 Y N Y

UnitedHealthcare Community Plan / DE, FL, HI, LA, MA, MD, NC, NM, OH, OK, PA, VA, WA 87726 Y N Y 87726 Y N Y

UnitedHealthcare Community Plan / AZ (formerly AZ Physicians IPA APIPA) 03432 Y N Y 03432 Y N Y

UnitedHealthcare Community Plan / FLHI LA MD MS CAN OH RI WAWI 87726 Y N na 87726 Y N na

UnitedHealthcare Community Plan / IA, hawk-I (formerly AmeriChoice of Iowa) 87726 Y N Y 87726 Y N Y

UnitedHealthcare Community Plan / MI (formerly Great Lakes Health Plan) 95467 Y N Y 95467 Y N Y

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UnitedHealthcare Community Plan / MO 86050 Y N Y 86050 Y N Y

UnitedHealthcare Community Plan / MS CHIP (formerly AmeriChoice MS-CHIP) 87726 Y N Y 87726 Y N Y

UnitedHealthcare Community Plan / NE 87726 Y N Y 87726 Y N Y

UnitedHealthcare Community Plan / NJ (formerly Americhoice NJ Medicaid) 86047 Y N Y 86047 Y N YUnitedHealthcare Community Plan / NY

(formerly AmeriChoice by UnitedHealthcare, AmeriChoice NY Medicaid & Child Health Plus,

AmeriChoice NY Personal Care Plus) 87726 Y N Y 86048 N N Y

UnitedHealthcare Community Plan / PA 87726 Y N Y 87726 Y N Y

UnitedHealthcare Community Plan / TN (formerly AmeriChoice TN: TennCare) 95378 Y N Y 95378 Y N Y

UnitedHealthcare Community Plan / TX 87726 Y N Y 87726 Y N Y

UnitedHealthcare Community Plan / UnitedHealthcare Dual Complete 87726 na 87726 Y N na

UnitedHealthcare Community Plan / UnitedHealthcare Long Term Care 87726 Y N na 87726 Y N na

UnitedHealthcare Community Plan / WI 87726 Y N Y 87726 Y N Y

UnitedHealthcare Medicare Solutions / UnitedHealthcare Chronic Complete 87726 Y N na 87726 Y N na

UnitedHealthcare Medicare Solutions / UnitedHealthcare Group Medicare Advan 87726 Y N na 87726 Y N na

UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareComplete 87726 Y N na 87726 Y N na

UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareDirect 87726 Y N na 87726 Y N na

UnitedHealthcare Medicare Solutions / UnitedHealthcare Nursing Home Plan 87726 Y N na 87726 Y N na

UnitedHealthcare Vision 00773 Y N na

UnitedHealthcare West (formerly PacifiCare of Arizona) 87726 Y N Y 87726 Y N Y

UnitedHealthcare West (formerly PacifiCare of CA - Claims) 87726 Y N Y 87726 Y N Y

UnitedHealthcare West (formerly PacifiCare of Colorado) 87726 Y N Y 87726 Y N Y

UnitedHealthcare West (formerly PacifiCare PPO - All States) 87726 Y N na 87726 Y N na

UnitedHealthOne (formerly American Medical Security) 81400 Y N Y 81400 Y N Y

UnitedHealthOne (formerly Golden Rule) 37602 Y N Y 37602 Y N Y

UnitedHeathcare Community Plan (formerly Unison Health Plan) 87726 Y N na 87726 Y N na

Unity Health Insurance 66705 N N Y 66705 N N Y

Univera - Health Care Plan/ChoiceCare Buffalo SX087 N Y na

Univera - Pre Paid Health Plan of NY SX086 N Y na

Univera - Univera Health Southern Tier SX088 N Y na

Univera Healthcare CNY 12X17 N Y na

Univera Healthcare SSA ENY 12X20 N Y na

Univera Healthcare SSA WNY PPO Traditional 12X19 N Y na

Univera Healthcare WNY 12X18 N Y na

Univera SSA ENY SX090 N Y na

Univera SSA WNY SX091 N Y na

Universal Benefits (IA, MD) TRP1E Y N na TRP1E Y N na

Universal Care - California 33001 N N na 33001 N N na

Universal Fidelity Administrators Company 93220 Y N Y 93220 Y N Y

University Family Care 09830 Y N Y 09830 Y N Y

University Family Care - Maricopa Health Plan 09908 Y N Y 09908 Y N Y

University Health Alliance 99026 Y Y na

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ENR Payer Code

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ENR


University Health Care Advantage 46407 N N na 46407 N N na

University Healthcare Marketplace 45437 Y N na 45437 Y N na

University of Illinois UIC67 N N na UIC67 N N na

University of Illinois at Chicago Div of Specialized Care for Children 37601 N N na 37601 N N na

University of Maryland Health Advantage 45282 Y N na 45282 Y N na

University of Missouri 25133 Y N na 25133 Y N na

University of Utah Health Plans SX155 na Y SX155 N N Y

Upland Medical Group IP056 N N na

UPMC Health Plan 23281 Y N Y 23281 Y N Y

UPMC Vision Advantage 25184 N N Y 25184 N N Y

Upper Peninsula Health Group (TPA) 37324 N N na 37324 N N na

Upper Peninsula Health Plan (Medicaid) 38337 N N Y 38337 N N Y

US Benefits 93092 Y N na 93092 Y N na

US Department of Labor 12X31 Y N na

US Department of Labor 77044 Y Y Y

US Department of Labor - Black Lung 77104 Y Y Y

US Department of Labor - Energy 77103 Y Y Y

US Family Health Plan 90551 N N na 90551 N N na

US Imaging (remits only) 50383 na Y 50383 na Y

USAA (United Services Automobile Association) 74095 N N na 74095 N N na

USFHP - St. Vincent Catholic Medical Centers of New York 13407 N N N 13407 N N N

UT- Altius (UHIN) 25133 Y N na 25133 Y N na

Utah Medicaid 12K42 Y Y na SKUT0 Y Y na

Utah Medicare 12M84 Y Y na SMUT0 Y Y Y

UW Graduate Appointee Plan 91136 N N N 91136 N N N

VA Fee Basis Programs 12115 Y N Y 12115 Y N Y

Valir Pace 64009 N N na 64009 N N na

Valley Baptist Health Plan 12T06 Y N na TH022 N N na

Valley Care IPA VCIPA N N na

Valley Health Plan (Commercial) VHP01 Y Y Y VHP01 Y Y Y

Valley Health Plan (Medi-Cal) VHP02 Y Y Y VHP02 Y Y Y

Valley Mental Health 94293 N N na

Valley Preferred - PPO Allentown PA (IHS Gateway Payer) 23253 Y N na

VALUE OPTIONS (TX NORTHSTAR) 99297 N N na

Value Options PA 12K1A N N na

ValueOptions Maryland Mental Hygiene Ad 22322 Y Y na

ValueOptions/MBHP (MA Behavioral Health Partnership) VALOP Y Y Y VALOP Y Y Y

Vantage Health Plan Inc. 72128 N N Y 72128 N N Y

Vantage Medical Group PPM01 Y N na PPM01 Y N na

VentureNet Healthcare 86062 Y N na 86062 Y N na

Verdugo Hills Medical Group 66126 N N na 66126 N N na

Verity National Group 75256 Y N na 75256 Y N na

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Vermont Medicaid 12K26 Y Y Y SKVT0 Y Y Y

Vermont Medicare 12M26 Y Y na SMVT0 Y Y na

VGM Homelink 50701 N N na

Via Christi HOPE 48123 N N na 48123 N N na

Vibra Health Plan (remits only) 15976 na na Y 15976 na na Y

Victor Valley IPA VVIPA N N na

Village Family Practice 73743 N N na 73743 N N na

VillageCareMAX 26545 N N na 26545 N N na

Virgin Islands Medicare 12M52 N Y na SMVI0 Y Y na

Virginia Coordinated Care-VCC 84806 N N na

Virginia Health Network, Inc. 54138 Y N na

Virginia Mason Group Health 91131 Y N na 91131 Y N na

Virginia Medicaid 12003 Y N Y SKVA0 Y N Y

Virginia Medicare 12004 Y Y na SMVA0 Y Y Y

Virginia Premier CompleteCare VPCCI Y Y na VPCCP Y Y na

Virginia Premier Elite Plus VPEP1 Y Y Y VPEP1 Y Y Y

Virginia Premier Health Plan 12K83 Y Y na 54176 Y Y Y

Vision Service Plan (VSP) 94163 N N na

Vista Health Plan 55248 N N na 55248 N N na

Vista Oncology - New Century Infusion Solutions NCH08 N N na

Viva Health Plan 63114 N N Y 63114 N N Y

VNA Homecare Options 31626 Y N na 31626 Y N na

VNS CHOICE Medicare 77073 N N Y 77073 N N Y

VOLUSIA HEALTH NETWORK 59266 N N Y 59266 N N Y

Vytra Healthcare 22264 Y N na 22264 Y N na

WA - Washington Coordinated Care 68069 Y N Y 68069 Y N Y

Wabash Memorial Hospital Association 85256 N N Y 85256 N N Y

Washington Medicaid 12K27 Y N Y SKWA0 Y N Y

Washington Medicare 12M45 Y Y Y SMWA0 Y Y Y

WASHINGTON State Dept of LABOR & INDUSTRY SX063 N N Y SX063 N Y Y

Waterstone Benefit Administrators (Oklahoma Providers) 73155 N N na 73155 N N na

Waterstone Benefit Administrators (Outside Oklahoma) 23051 N N na 23051 N N na

Watts Health Care MPM09 Y N na MPM09 Y N na

WEA Insurance Group 39151 N N Y 39151 N N Y

webTPA/Community Health Electronic Claims/CHEC 75261 N N Y 75261 N N Y

Weiss Health Providers 36337 N N na 36337 N N na

Wellcare Health Plan, Inc. (Encounters Only) 59354 Y N na 59354 Y N na

Wellcare Health Plan, Inc. (Fee for Service) 14163 Y N Y 14163 Y N Y

WellChoice of NJ SB803 Y N na

Wellmark BCBS - Medicare COB 12B92 Y N na SB645 Y N na

Wellmark Blue Cross and Blue Shield of Iowa 12B10 Y Y Y SB640 Y Y Y

Wellmed WELM2 Y N na WELM2 Y N na

Wellmed (remits only) TH023 na N TH023 na N

WellSystems LLC 35245 N N na 35245 N N na

Wenatchee Valley Medical Center 91064 N N na 91064 N N na

Page 51 of 52



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ENR


West Covina Medical Group 66124 N N na 66124 N N na

West Suburban Health Providers 80942 Y N na 80942 Y N na

West Virginia Family Health Plan 45276 N N Y 45276 N N Y

West Virginia Medicaid 12K28 Y N Y SKWV0 Y N Y

West Virginia Medicare 12M28 Y Y na SMWV0 Y Y na

Western Grower's Assurance Trust 24375 Y N na 24375 Y N na

Western Grower's Insurance Company 24735 N N na 24735 N N na

Western Health Advantage 68039 N N na 68039 N N na

Western Mutual Insurance 37247 N N na 37247 N N na

Western Oregon Advanced Health UOCSO N Y na DOCSO N Y na

Western Reserve Life Insurance Company (TX) TRLTC Y N na TRLTC Y N na

Western Southern Financial Group (Cincinnati OH) 31048 N N na 31048 N N na

WestLake Financial Group Inc. 90560 N N na 90560 N N na

William C. Earhart 93050 Y N Y 93050 Y N Y

William J Sutton & Co. Ltd (Toronto) 98010 N N na 98010 N N na

Wilson-McShane 41095 N N na 41095 N N na

Windsor Medicare Extra (as of 5/1/14) 14163 Y N Y 14163 Y N Y

Wisconsin Chronic Disease Program (WCDP) SKWID Y N Y SKWID Y N Y

Wisconsin Department of Corrections 74101 N N na 74101 N N na

Wisconsin Medicaid SKWI0 Y N Y SKWI0 Y N Y

Wisconsin Medicare 12M29 Y Y Y SMWI0 Y Y Y

Wisconsin Well Woman Program (WWWP) SKWIW Y N Y SKWIW Y N Y

Women's Integrated Network Inc. (WIN Fertility) 13413 N N na

Workers Comp of West Virginia SX067 N Y na

Workers Comp/Arkansas Blue Cross 12048 Y Y na

Worksite Benefit Services LLC 20333 N N na 20333 N N na

World Insurance Company (remits only) 75276 na Y 75276 na Y

WPP-ElderCare Wisconsin 77080 N N na 77080 N N na

WPPN 34080 N N na

WPS Commercial 12X29 Y Y Y SX022 Y Y Y

WPS Medicare Part A - Legacy - J12 (DC DE MD NJ PA) 12M99 Y Y Y

WPS Medicare Part A National - Legacy Claims - J5 52280 Y Y Y

Wyoming Medicaid 12K30 Y Y na SKWY0 Y Y na

Wyoming Medicare 12M30 Y Y Y SMWY0 Y Y Y

Yale University Heath Plan 60646 Y N na 60646 Y N na

YourCare Health Plan (remits only) 15003 na na Y 15003 na na Y

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CLAIMS & REMITS PAYER LIST 02/08/2018 2ndary … & REMITS PAYER LIST 02/08/2018 Payer Code Accepts 2ndary Claims ENR Remits ENR Payer Code Accepts 2ndary Claims ENR Remits ENR 1199

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