Top Banner
Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO BOX 2500 DETROIT MI BCBSM 00029010 359274 89 AS (999) 999-9999 PO BOX 2500,600 LAFAYETTE DETROIT MI BCBSM 00029015 359274 87 RX (999) 999-9999 PO BOX 2500, 600 LAFAYETTE DETROIT MI BCBS MEDCO 00029020 359274 87 RX (999) 999-9999 PO BOX 2500,600 LAFAYETTE DETROIT MI BCBSM/BCN PHARMACY 00029021 359274 87 RX (999) 999-9999 PO BOX 2500/600 LAFAYETTE DETROIT MI MEDCO BCBS 00038005 359274 89 X3 (800) 482-3600 600 LAFAYETTE DETROIT MI BC BS FEDERAL EMPLOYEE PROGRAM 00038010 359274 89 XR (800) 482-3600 600 LAFAYETTE DETROIT MI BC BS FEDERAL EMPLOYEE PROGRAM 00047005 359196 89 AS (877) 874-2273 PO BOX 7021 CAMDEN SC TRICARE/CHAMPUS 00056005 352530 88 DO (616) 254-3000 PO BOX 353 GRAND RAPIDS MI AETNA US HEALTHCARE 00056010 352530 01 AS (800) 635-2095 PO BOX 2295 FORT WAYNE IN AETNA US HEALTHCARE 00056015 352530 01 AS (800) 433-1594 PO BOX 871 FORT WAYNE IN AETNA US HEALTHCARE 00056020 352530 01 AS (999) 999-9999 7400 WEST CAMPUS ROAD NEW ALBANY OH AETNA US HEALTHCARE 00056025 352530 01 AS (614) 933-6000 7400 WEST CAMPUS ROAD NEW ALBANY OH AETNA US HEALTHCARE 00056030 352530 89 AS (800) 643-4301 PO BOX 150437 HARTFORD CT AETNA US HEALTHCARE 00056035 352530 01 AS (800) 442-1566 PO 2265 BLUE BELL PA AETNA US HEALTHCARE 00056040 352530 01 AS (414) 266-9700 PO BOX 26279 MILWAUKEE WI AETNA US HEALTHCARE 00056045 352530 01 AS (800) 858-5630 3541 WINCHESTER ROAD ALLENTOWN PA AETNA US HEALTHCARE 00056050 352530 01 AS (999) 999-9999 1300 HIGGINS RD SUITE 119 PARK RIDGE IL AETNA US HEALTHCARE 00056055 352530 01 AS (877) 362-0869 PO BOX 981107 EL PASO TX AETNA US HEALTHCARE 00056060 352530 89 AS (800) 972-8614 PO BOX 26279 MILWAUKEE WI AETNA US HEALTHCARE 00056065 352530 01 AS (817) 417-2000 PO BOX 91511 ARLINGTON TX AETNA US HEALTHCARE 00056070 352530 01 AS (800) 434-1927 PO BOX 5569 AKRON OH AETNA US HEALTHCARE 00056075 352530 01 AS (952) 594-6250 PO BOX 2907 LOOP STATION MINNEAPOLIS MN AETNA US HEALTHCARE 00056080 352530 89 AS (877) 371-2009 PO BOX 150409 HARTFORD CT AETNA US HEALTHCARE 00056085 352530 01 AS (907) 561-0011 4300 B STEET SUITE 205 ANCHORAGE AK AETNA US HEALTHCARE 00056090 352530 01 AS (800) 237-3197 PO BOX 12340 FRESNO CA AETNA US HEALTHCARE 00056095 352530 01 AS (877) 272-6375 PO BOX 150409 HARTFORD CT AETNA US HEALTHCARE 00056100 352530 01 AS (800) 770-6803 PO BOX 26107 GREENSBORO NC AETNA US HEALTHCARE 00056105 352530 89 AS (800) 451-2967 7676 HAZARD CENTER DRIVE SAN DIEGO CA AETNA US HEALTHCARE
173

Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

Sep 13, 2018

Download

Documents

builiem
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

Payer ID Tech ID OI Code

Coverage

Type Payer Phone Street City State Payer Name

00029005 359274 05 AS (999) 999-9999

600 LAFAYETTE,PO

BOX 2500 DETROIT MI BCBSM

00029010 359274 89 AS (999) 999-9999

PO BOX 2500,600

LAFAYETTE DETROIT MI BCBSM

00029015 359274 87 RX (999) 999-9999

PO BOX 2500, 600

LAFAYETTE DETROIT MI BCBS MEDCO

00029020 359274 87 RX (999) 999-9999

PO BOX 2500,600

LAFAYETTE DETROIT MI BCBSM/BCN PHARMACY

00029021 359274 87 RX (999) 999-9999

PO BOX 2500/600

LAFAYETTE DETROIT MI MEDCO BCBS

00038005 359274 89 X3 (800) 482-3600 600 LAFAYETTE DETROIT MI BC BS FEDERAL EMPLOYEE PROGRAM

00038010 359274 89 XR (800) 482-3600 600 LAFAYETTE DETROIT MI BC BS FEDERAL EMPLOYEE PROGRAM

00047005 359196 89 AS (877) 874-2273 PO BOX 7021 CAMDEN SC TRICARE/CHAMPUS

00056005 352530 88 DO (616) 254-3000 PO BOX 353 GRAND RAPIDS MI AETNA US HEALTHCARE

00056010 352530 01 AS (800) 635-2095 PO BOX 2295 FORT WAYNE IN AETNA US HEALTHCARE

00056015 352530 01 AS (800) 433-1594 PO BOX 871 FORT WAYNE IN AETNA US HEALTHCARE

00056020 352530 01 AS (999) 999-9999

7400 WEST CAMPUS

ROAD NEW ALBANY OH AETNA US HEALTHCARE

00056025 352530 01 AS (614) 933-6000

7400 WEST CAMPUS

ROAD NEW ALBANY OH AETNA US HEALTHCARE

00056030 352530 89 AS (800) 643-4301 PO BOX 150437 HARTFORD CT AETNA US HEALTHCARE

00056035 352530 01 AS (800) 442-1566 PO 2265 BLUE BELL PA AETNA US HEALTHCARE

00056040 352530 01 AS (414) 266-9700 PO BOX 26279 MILWAUKEE WI AETNA US HEALTHCARE

00056045 352530 01 AS (800) 858-5630

3541 WINCHESTER

ROAD ALLENTOWN PA AETNA US HEALTHCARE

00056050 352530 01 AS (999) 999-9999

1300 HIGGINS RD

SUITE 119 PARK RIDGE IL AETNA US HEALTHCARE

00056055 352530 01 AS (877) 362-0869 PO BOX 981107 EL PASO TX AETNA US HEALTHCARE

00056060 352530 89 AS (800) 972-8614 PO BOX 26279 MILWAUKEE WI AETNA US HEALTHCARE

00056065 352530 01 AS (817) 417-2000 PO BOX 91511 ARLINGTON TX AETNA US HEALTHCARE

00056070 352530 01 AS (800) 434-1927 PO BOX 5569 AKRON OH AETNA US HEALTHCARE

00056075 352530 01 AS (952) 594-6250

PO BOX 2907 LOOP

STATION MINNEAPOLIS MN AETNA US HEALTHCARE

00056080 352530 89 AS (877) 371-2009 PO BOX 150409 HARTFORD CT AETNA US HEALTHCARE

00056085 352530 01 AS (907) 561-0011

4300 B STEET SUITE

205 ANCHORAGE AK AETNA US HEALTHCARE

00056090 352530 01 AS (800) 237-3197 PO BOX 12340 FRESNO CA AETNA US HEALTHCARE

00056095 352530 01 AS (877) 272-6375 PO BOX 150409 HARTFORD CT AETNA US HEALTHCARE

00056100 352530 01 AS (800) 770-6803 PO BOX 26107 GREENSBORO NC AETNA US HEALTHCARE

00056105 352530 89 AS (800) 451-2967

7676 HAZARD CENTER

DRIVE SAN DIEGO CA AETNA US HEALTHCARE

Page 2: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

00056110 352530 01 AS (714) 888-2060 PO BOX 50031 SAN BERNADINO CA AETNA US HEALTHCARE

00056115 352530 89 AS (888) 632-3862 PO BOX 981107 EL PASO TX AETNA US HEALTHCARE

00056120 352530 89 AS (800) 237-0575 PO BOX 14079 LEXINGTON KY AETNA US HEALTHCARE

00056125 352530 89 AS (800) 942-5208 PO BOX 26190 GREENSBORO NC AETNA US HEALTHCARE

00056130 352530 89 AS (800) 531-9878 PO BOX 2523 FORT WAYNE IN AETNA US HEALTHCARE

00056135 352530 89 AS (800) 635-2095 PO BOX 2295 FORT WAYNE IN AETNA US HEALTHCARE

00056140 352530 89 AS (800) 654-7248 PO BOX 2559 FORT WAYNE IN AETNA US HEALTHCARE

00056145 352530 89 AS (800) 362-9497 PO BOX 5569 AKRON OH AETNA US HEALTHCARE

00056150 352530 89 AS (800) 345-4061 PO BOX 3926 ALLENTOWN PA AETNA US HEALTHCARE

00056155 352530 89 AS (614) 933-6000

7400 W CAMPUS

ROAD NEW ALBANY OH AETNA US HEALTHCARE

00056160 352530 89 AS (800) 454-2239 PO BOX 182756 COLUMBUS OH AETNA US HEALTHCARE

00056165 352530 89 AS (800) 362-9996 PO BOX 1858 BISMARK ND AETNA US HEALTHCARE

00056170 352530 89 AS (800) 227-2641 PO BOX 91555 ARLINGTON TX AETNA US HEALTHCARE

00056175 352530 89 AS (800) 531-5506 PO BOX 52121 MINNEAPOLIS MN AETNA US HEALTHCARE

00056180 352530 89 AS (800) 424-1909 PO BOX 1125 BLUE BELL PA AETNA US HEALTHCARE HMO

00056185 352530 89 AS (800) 557-9726 PO BOX 2520 TYLER TX AETNA US HEALTHCARE

00056190 352530 88 DO (800) 558-0860 PO BOX 14094 LEXINGTON KY AETNA US HEALTHCARE

00056195 352530 89 AS (800) 337-7224 PO BOX 91028 SEATTLE WA AETNA US HEALTHCARE

00056200 352530 89 AS (888) 257-0403 PO BOX 54467 LOS ANGELES CA AETNA US HEALTHCARE

00056210 352530 88 DO (800) 220-5479 PO BOX 44259 JACKSONVILLE FL AETNA US HEALTHCARE DMO

00056215 352530 88 DO (800) 843-3661 PO BOX 15250 ALBANY NY AETNA US HEALTHCARE DMO

00065005 352530 34 AS (999) 999-9999 26555 EVERGREEN RD SOUTHFIELD MI TRAVELERS INSURANCE COMPANY

00065010 352530 34 AS (800) 334-2400

1701 PINECROFT RD

ST300 GREENSBORO NC UNITED HEALTHCARE INS CO

00065015 352530 34 X3 (706) 855-1386 PO BOX 10066 AUGUSTA GA UNITED HEALTHCARE INS CO

00065020 352530 34 AS (800) 582-1005 PO BOX 9806 NEW HAVEN CT UNITED HEALTHCARE INS CO

00065025 352530 34 AS (860) 702-6984 ONE TOWER SQUARE HARTFORD CT UNITED HEALTHCARE INS CO

00065030 352530 34 AS (999) 999-9999 1375 EAST 9TH ST CLEVELAND OH UNITED HEALTHCARE INS CO

00065035 352530 34 AS (516) 296-2000 PO BOX 7005 EAST MEADOW NY UNITED HEALTHCARE INS CO

00065040 352530 34 AS (877) 842-3210 PO BOX 740800 ATLANTA GA UNITED HEALTHCARE INS CO

00065045 352530 34 AS (800) 357-1359 ONE PRAIRIE CT MATTESON IL UNITED HEALTHCARE INS CO

00065050 352530 34 AS (804) 254-4000 PO BOX C32056 RICHMOND VA UNITED HEALTHCARE INS CO

00065055 352530 34 AS (999) 999-9999 PO BOX 323 GRAND RAPIDS MI UNITED HEALTHCARE INS CO

00065060 352530 34 AS (800) 809-0453 PO BOX 30304 SALT LAKE CITY UT UNITED HEALTHCARE INS CO

00065065 352530 34 AS (800) 874-5693 PO BOX 3098 NAPERVILLE IL BENESIGHT

00065070 352530 34 AS (999) 999-9999 PO BOX 16676 COLUMBUS OH UNITED HEALTHCARE INS CO

00065075 352530 34 AS (800) 547-7433 PO BOX 700 VOORHEES TWNSHP NJ UNITED HEALTHCARE INS CO

00065080 351113 38 AS (800) 258-6534

2205 W WABASH AVE

#211 SPRINGFIELD IL RAILROAD MAINT & IND H & W

00065085 352530 34 AS (518) 437-0038 PO BOX 22010 ALBANY NY UNITED HEALTHCARE INS CO

Page 3: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

00065090 352530 34 AS (516) 296-2000 90 MERRICK AVE LONG ISLAND NY TRAVELERS PLAN ADMINISTRATION

00065095 352530 34 AS (999) 999-9999 PO BOX 6533 ENGLEWOOD CO UNITED HEALTHCARE INS CO

00065100 352530 34 AS (615) 373-3207

5214 MARYLAND

SUITE 207 BRENTWOOD TN UNITED HEALTHCARE INS CO

00065101 352530 34 AS (215) 371-3711 850 PARK RD NORTH WYOMISSING PA UNITED HEALTHCARE INS CO

00065102 352530 34 AS (404) 393-7500

WEST GATE CTR STE

BLDG B AUGUSTA GA UNITED HEALTHCARE INS CO

00065103 352530 34 AS (615) 747-5200

3401 WEST END AVE

STE690 NASHVILLE TN UNITED HEALTHCARE INS CO

00065104 352530 34 AS (800) 338-0327 PO BOX 380 PUEBLO CO BENESIGHT

00065105 352530 34 AS (999) 999-9999 PO BOX 17076 BALTIMORE MD UNITED HEALTHCARE INS CO

00065106 352530 34 AS (314) 425-8500 PO BOX 66878 ST LOUIS MO UNITED HEALTHCARE INS CO

00065107 352530 34 AS (800) 842-8000 PO BOX 473505 CHARLOTTE NC UNITED HEALTHCARE INS CO

00065108 352530 34 AS (800) 945-0150 415 N MCKINLEY LITTLE ROCK AR UNITED HEALTHCARE INS CO

00065109 352530 34 AS (602) 861-8600

7878 N 16TH ST, STE

140 PHOENIX AZ UNITED HEALTHCARE INS CO

00065110 352530 34 AS (800) 732-1086 PO BOX 2258 BREA CA UNITED HEALTHCARE INS CO

00065111 352530 34 AS (813) 281-6200 PO BOX 30015 TAMPA FL UNITED HEALTHCARE INS CO

00065112 352530 34 AS (617) 777-2800 208 ROSEWOOD DANVERS MA UNITED HEALTHCARE INS CO

00065113 352530 34 AS (800) 848-8406 PO BOX 740801 ATLANTA GA UNITED HEALTHCARE INS CO

00065114 352530 34 AS (999) 999-9999 250 JOHNSON RD MORRIS PLAINS NJ UNITED HEALTHCARE INS CO

00065115 352530 34 AS (801) 486-3161 7090 S UNION PARK MIDVALE UT UNITED HEALTHCARE INS CO

00065116 352530 34 AS (800) 426-9930 1200 6TH SEATTLE WA UNITED HEALTHCARE INS CO

00065117 352530 34 AS (999) 999-9999 PO BOX 29130 OVERLAND PARK KS UNITED HEALTHCARE INS CO

00065118 358569 38 AS (800) 441-3978 PO BOX 10319 DES MOINES IA CONSECO SENIOR HEALTH INS CO

00065119 352530 34 AS (999) 999-9999 PO BOX 441280 INDIANAPOLIS IN TRAVELERS IMASERV INC

00065120 352530 34 AS (800) 447-7020 PO BOX 901069 FORT WORTH TX UNITED HEALTHCARE INS CO

00065123 352530 34 AS (888) 334-6974 PO BOX 350 PUEBLO CO BENESIGHT

00065125 352530 34 AS (801) 942-6200 PO BOX 71409 SALT LAKE CITY UT UNITED HEALTHCARE INS CO

00065130 352530 34 AS (800) 872-8323 PO BOX 7046 ROCKFORD IL BENESIGHT

00065135 352530 89 AS (800) 648-4480 PO BOX 7046 ROCKFORD IL BENESIGHT

00065140 352530 89 AS (800) 842-8000 PO BOX 473505 CHARLOTTE NC UNITED HEALTHCARE INS CO

00065145 352530 89 AS (800) 842-6562 PO BOX 26721 GREENSBORO NC UNITED HEALTHCARE INS CO

00065150 352530 89 AS (800) 842-1126 PO BOX 30555 SALT LAKE CITY UT UNITED HEALTHCARE INS CO

00065155 352530 89 AS (630) 637-4400 PO BOX 3098 NAPERVILLE IL BENESIGHT

00065160 352530 89 AS (877) 842-3210 PO BOX 740800 ATLANTA GA UNITED HEALTHCARE INS CO

00065165 352530 89 AS (800) 528-8778 PO BOX 30298 TAMPA FL UNITED HEALTHCARE INS CO

00065170 352530 34 AS (407) 660-0202

600 COLONIAL

CENTER PKWY LAKE MARY FL BENESIGHT

00065175 352530 89 AS (800) 842-9905 PO BOX 30985 SALT LAKE CITY UT UNITED HEALTHCARE INS CO

00065180 352530 89 AS (877) 832-7734 PO BOX 30551 SALT LAKE CITY UT UNITED HEALTHCARE INS CO

Page 4: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

00065185 352530 89 AS (800) 732-1086 PO BOX 2258 BREA CA UNITED HEALTHCARE INS CO

00074005 351113 33 AS (313) 964-2400 2700 TRUMBULL DETROIT MI MI CONF OF TEAMSTERS WELFARE

00074010 351113 89 XR (313) 964-2400 2700 TRUMBULL DETROIT MI MI CONFERENCE OF TEAMSTERS

00074020 351113 86 VO (313) 964-2400 2700 TRUMBULL DETROIT MI MI CONF OF TEAMSTERS WELFARE/DELTA VISION

00074025 351113 88 DO (313) 964-2400 PO BOX 331237 DETROIT MI MI CONF OF TEAMSTERS WELFARE

00083005 358569 31 AS (999) 999-9999 PO BOX 1143 MINNEAPOLIS MN PRUDENTIAL INSURANCE COMPANY

00083010 358569 31 AS (999) 999-9999 PO BOX 44059 JACKSONVILLE FL PRUDENTIAL INSURANCE COMPANY

00083015 358569 31 AS (999) 999-9999 PO BOX 85080 SAN DIEGO CA PRUDENTIAL INSURANCE COMPANY

00083020 358569 31 AS (999) 999-9999 PO BOX 538 MATTESON IL PRUDENTIAL INSURANCE COMPANY

00083025 358569 31 AS (999) 999-9999 PO BOX 1065 LINWOOD NJ PRUDENTIAL INSURANCE COMPANY

00083030 358569 31 AS (999) 999-9999 PO BOX 40985 INDIANAPOLIS IN PRUDENTIAL INSURANCE COMPANY

00083035 358569 31 AS (999) 999-9999 PO BOX 207006 STOCKTON CA PRUDENTIAL INSURANCE COMPANY

00083040 358569 31 AS (999) 999-9999 PO BOX 7001 PARKERSBURG WV PRUDENTIAL INSURANCE COMPANY

00083045 358569 31 AS (999) 999-9999 PO BOX 500 MT ARLINGTON NJ PRUDENTIAL INSURANCE COMPANY

00083050 358569 31 AS (999) 999-9999 PO BOX 388 FORT WASHINGTON PA PRUDENTIAL INSURANCE COMPANY

00083055 358569 31 AS (999) 999-9999 PO BOX 450 ISELIN NJ PRUDENTIAL INSURANCE COMPANY

00083060 358569 31 AS (999) 999-9999 PO BOX 3018 MILLVILLE NJ PRUDENTIAL INSURANCE COMPANY

00083065 358569 31 AS (999) 999-9999 1875 CENTURY BLVD ATLANTA GA PRUDENTIAL INSURANCE COMPANY

00083070 358569 31 AS (999) 999-9999 PO BOX 5012 MIDDLETOWN NY PRUDENTIAL INSURANCE COMPANY

00083075 358569 31 AS (999) 999-9999 PO BOX 566 MATTESON IL PRUDENTIAL INSURANCE COMPANY

00083080 358569 88 DO (999) 999-9999 PO BOX 15077 ALBANY NY PRUDENTIAL INSURANCE COMPANY

00083085 358569 31 AS (999) 999-9999 PO BOX 499 PITTSBURGH PA PRUDENTIAL INSURANCE COMPANY

00083090 358569 31 AS (999) 999-9999 PO BOX C 11940 SANTA ANA CA PRUDENTIAL INSURANCE COMPANY

00083095 358569 31 AS (999) 999-9999 PO BOX 539 MATTESON IL PRUDENTIAL INSURANCE COMPANY

00083100 358569 31 AS (800) 828-0153 PO BOX 477917 BROADVIEW HEIGHTS OH PRUDENTIAL INSURANCE COMPANY

00083105 358569 31 AS (999) 999-9999 PO BOX 795031 SAN ANTONIO TX PRUDENTIAL INSURANCE COMPANY

00083110 358569 31 AS (999) 999-9999 PO BOX 411340 ST LOUIS MO PRUDENTIAL INSURANCE COMPANY

00083115 358569 88 DO (999) 999-9999 PO BOX 725089 ATLANTA GA PRUDENTIAL DMO

00083120 358569 31 AS (999) 999-9999 PO BOX 902 HORSHAM PA PRUDENTIAL INSURANCE COMPANY

00083125 358569 31 AS (999) 999-9999 PO BOX 6020 MILLVILLE NJ PRUDENTIAL INSURANCE COMPANY

00083130 358569 31 AS (999) 999-9999 PO BOX 10100 HIGHPOINT NC PRUDENTIAL INSURANCE COMPANY

00083135 358569 31 AS (999) 999-9999 PO BOX 5060 MILLVILLE NJ PRUDENTIAL INSURANCE COMPANY

00083140 358569 89 AS (999) 999-9999

5900 N ANDREWS

AVENUE FT LAUDERDALE FL PRUDENTIAL HEALTH CARE SYSTEM

00083145 352530 89 AS (312) 787-4778 PO BOX 804477 CHICAGO IL RUSH PRUDENTIAL PARTNERS

00083150 358569 89 AS (800) 732-0416 PO BOX 54289 LOS ANGELES CA PRUDENTIAL HEALTHCARE HMO

00083155 358569 89 AS (800) 828-0153 PO BOX 477917 BROADVIEW HEIGHTS OH PRUDENTIAL INS CO OF AMERICA

00083160 358569 89 AS (800) 345-8310 PO BOX 4804 HOUSTON TX PRUDENTIAL HEALTHCARE POS

00092005 351113 30 AS (800) 542-4261 PO BOX 8830 BRISTOL TN CIGNA HEALTHCARE

00092010 351113 30 AS (800) 843-8942 PO BOX 5200 SCRANTON PA CIGNA HEALTHCARE

00092015 351113 89 AS (800) 325-1402 PO BOX 8914 BRISTOL TN CIGNA HEALTHCARE

Page 5: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

00092020 351113 30 AS (800) 344-6323

25 MERCHANT BOX

405013 CINCINNATI OH CIGNA HEALTHCARE

00092025 351113 30 AS (800) 845-3815 PO BOX 34427 MEMPHIS TN CIGNA HEALTHCARE

00092030 351113 30 AS (800) 841-2290 PO BOX 219788 HOUSTON TX CIGNA HEALTHCARE

00092035 351113 30 AS (999) 999-9999 STATION B BOX 6185 GREENVILLE SC CIGNA HEALTHCARE

00092040 351113 89 AS (800) 531-3121 PO BOX 2041 CONCORD NH HEALTHSOURCE NH

00092045 351113 89 AS (800) 843-8942 PO BOX 5200 SCRANTON PA CIGNA HEALTHCARE

00092050 351113 89 AS (800) 244-6224 PO BOX 5200 SCRANTON PA CIGNA HEALTHCARE

00109005 351113 67 AS (999) 999-9999 241 E SAGINAW 601 EAST LANSING MI CARPENTERS H & W

00118005 358569 67 XR (999) 999-9999

500 STEPHENSON

HWY TROY MI DETROIT & VICINITY CONST H&W

00127005 352530 67 AS (800) 572-8553 30700 TELEGRAPH BIRMINGHAM MI REINFORCED IRONWORKERS FUND

00136005 351113 88 DO (517) 321-7502

6525 CENTURION

DRIVE LANSING MI MI LABORERS H & W FUND

00145005 358569 67 AS (800) 572-8975

37450 SCHOOLCRAFT

ROAD LIVONIA MI OPERATING ENGINEERS H&W FUND

00154005 351113 19 X5 (517) 332-2581 PO BOX 2560 EAST LANSING MI MI EDUC SPEC SERV ASSOC

00154010 351113 89 X5 (517) 332-2581 PO BOX 2560 EAST LANSING MI MI EDUC SPEC SERV ASSOC

00163005 352530 34 AS (800) 752-6638 P O BOX 2007 AURORA IL UNITED HEALTHCARE INS CO

00163010 352530 34 AS (999) 999-9999 PO BOX 7750 SAN FRANCISCO CA UNITED HEALTHCARE INS CO

00163015 352530 88 DO (800) 858-8903 177 S COMMONS DR AURORA IL METROPOLITAN LIFE INS

00163020 352530 88 DO (800) 275-4638 PO BOX 14093 LEXINGTON KY METROPOLITAN LIFE INS

00163025 352530 34 AS (800) 426-2657 PO BOX 2925 ENGLEWOOD CO UNITED HEALTHCARE INS CO

00163030 358569 86 VO (888) 581-3648 PO BOX 8504 MASON OH COLE MANAGED VISION

00163035 352530 34 AS (800) 453-8440 PO BOX 9033 CLEARWATER FL UNITED HEALTHCARE INS CO

00163040 352530 89 AS (800) 426-5372 PO BOX 2074 AURORA IL UNITED HEALTHCARE INS CO

00163045 352530 34 AS (800) 638-7392 PO BOX 71928 CHARLESTON SC UNITED HEALTHCARE INS CO

00163050 352530 88 DO (800) 275-4638 PO BOX 8740 DAYTON OH METLIFE

00172005 351113 07 AS (800) 223-9601 PO BOX 5200 SCRANTON PA CT GENERAL LIFE

00172010 351113 07 AS (800) 821-4727 PO BOX 3310 SUITE D ALBURQUERQUE NM CT GENERAL LIFE

00172015 351113 07 AS (800) 999-3527 PO BOX 24005 FRESNO CA CT GENERAL LIFE

00172020 351113 07 AS (800) 722-7535 PO BOX 5200 SCRANTON PA CT GENERAL LIFE

00172025 351113 07 AS (999) 999-9999 2 VANTAGE WAY NASHVILLE TN CT GENERAL LIFE

00172030 351113 07 AS (800) 468-0671 PO BOX 34335 CHARLOTTE NC CT GENERAL LIFE

00172035 351113 89 AS (800) 722-7535 PO BOX 5200 SCRANTON PA CIGNA HEALTHCARE

00172040 351113 89 AS (515) 223-9600 PO BOX 5200 SCRANTON PA CT GENERAL LIFE

00172045 351113 89 AS (515) 223-9600 PO BOX 10370 DES MOINES IA CT GENERAL LIFE

00172050 351113 88 DO (800) 367-1037 PO BOX 189060 PLANTATION FL CIGNA DENTAL HEALTH

Page 6: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

00172055 351113 89 AS (800) 654-9631 PO BOX 5200 SCRANTON PA CT GENERAL LIFE

00172060 351113 88 DO (888) 722-5505 PO BOX 2125 GLENDALE CA CIGNA DENTAL HMO

00181005 351113 07 AS (800) 523-4626 PO BOX 5046 SOUTHFIELD MI CT GENERAL LIFE

00181010 351113 89 AS (800) 526-7431 PO BOX 29000 ATLANTA GA CT GENERAL LIFE

00181015 351113 89 AS (800) 525-5803 PO BOX 2546 SHERMAN TX CT GENERAL LIFE

00181020 351113 89 AS (800) 243-8552 PO BOX 4010 FARMINGTON CT CT GENERAL LIFE

00181025 351113 07 PS (800) 523-4626 PO BOX 5132 SOUTHFIELD MI CT GENERAL LIFE

00181030 351113 88 DO (800) 367-1037 PO BOX 183 SOUTHFIELD MI CT GENERAL LIFE

00181035 351113 88 DO (800) 367-1037 PO BOX 9013 SHERMAN TX CT GENERAL LIFE

00181040 351113 07 AS (800) 645-7300 PO BOX 5200 SCRANTON PA CT GENERAL LIFE

00181045 351113 07 AS (800) 421-6764 PO BOX 8014 PLAINVILLE CT CT GENERAL LIFE

00181050 351113 07 AS (800) 828-7622 PO BOX 3077 BOURBONNAIS IL CT GENERAL LIFE

00181055 351113 07 AS (800) 525-5803 PO BOX 5200 SCRANTON PA CT GENERAL LIFE

00181060 351113 07 AS (800) 654-9320 PO BOX 16782 COLUMBUS OH CT GENERAL LIFE

00181065 351113 88 DO (888) 722-5505 PO BOX 5072 VISALIA CA CIGNA DENTAL PPO

00181070 351113 07 AS (800) 338-7691 PO BOX 2300 PITTSBURGH PA CT GENERAL LIFE

00181075 351113 07 AS (800) 441-7150 PO BOX 15408 WILMINGTON DE CT GENERAL LIFE

00181080 351113 07 AS (800) 526-7431 PO BOX 29000 ATLANTA GA CT GENERAL LIFE

00181085 351113 89 AS (800) 645-7300 PO BOX 978 BRISTOL TN CT GENERAL LIFE

00181090 351113 07 AS (800) 762-3726 PO BOX 4007 VISALIA CA CT GENERAL LIFE

00181095 351113 07 AS (800) 822-2994 PO BOX 85455 SAN DIEGO CA CT GENERAL LIFE

00181100 351113 89 AS (800) 828-7622 PO BOX 5200 SCRANTON PA CT GENERAL LIFE

00181105 351113 89 AS (800) 722-7535 PO BOX 5200 SCRANTON PA CT GENERAL LIFE

00181110 351113 83 NH (800) 523-4626 PO BOX 2305 SOUTHFIELD MI CT GENERAL LIFE

00181115 351113 89 AS (800) 982-8958 PO BOX 8014 PLAINVILLE CT CT GENERAL LIFE

00181120 351113 89 AS (800) 542-4271 PO BOX 2048 GASTONIA NC CT GENERAL LIFE

00181125 351113 89 AS (800) 817-2545 PO BOX 5019 VISALIA CA CT GENERAL LIFE

00181130 351113 89 AS (800) 516-2898 PO BOX 800 UNIONVILLE CT CT GENERAL LIFE

00181135 351113 89 AS (800) 441-7150 PO BOX 15408 WILMINGTON DE CT GENERAL LIFE

00181140 351113 89 AS (800) 523-4626 PO BOX 5046 SOUTHFIELD MI CT GENERAL LIFE

00181145 351113 89 AS (800) 817-2545 PO BOX 5019 VISALIA CA CIGNA HEALTHCARE

00190005 352530 16 AS (999) 999-9999 PO BOX 7677 SCHAUMBURG IL UNICARE/JOHN HANCOCK

00190010 352530 16 AS (999) 999-9999 PO BOX 4040 KALAMAZOO MI UNICARE/JOHN HANCOCK

00190015 358569 83 NH (800) 377-7311 PO BOX 852 BOSTON MA JOHN HANCOCK

00190020 352530 16 AS (800) 843-8184 PO BOX 4570 DEARBORN MI UNICARE/JOHN HANCOCK

00190025 352530 16 AS (999) 999-9999 CALLER #4005 SCHAUMBURG IL UNICARE/JOHN HANCOCK

00190030 352530 16 AS (800) 453-5739 PO BOX 4045 SCHAUMBURG IL UNICARE/JOHN HANCOCK

00190035 352530 16 AS (999) 999-9999 1585 PAOLI PIKE WEST CHESTER PA UNICARE/JOHN HANCOCK

00190040 352530 88 DO (877) 864-2273 PO BOX 4458 CHICAGO IL UNICARE/JOHN HANCOCK

00190045 352530 16 AS (800) 304-7258 PO BOX 4061 SCHAUMBURG IL UNICARE/JOHN HANCOCK

00190050 352530 16 AS (999) 999-9999 PO BOX 566499 ATLANTA GA UNICARE/JOHN HANCOCK

00190055 352530 16 AS (800) 689-2690 PO BOX 833835 RICHARDSON TX UNICARE/JOHN HANCOCK

00190060 352530 16 AS (800) 635-0734 PO BOX 4458 CHICAGO IL UNICARE/JOHN HANCOCK

Page 7: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

00190065 352530 16 AS (999) 999-9999 PO BOX 120 BALLWIN MO UNICARE/JOHN HANCOCK

00190070 352530 16 AS (999) 999-9999 PO BOX 4056 SCHAUMBURG IL UNICARE/JOHN HANCOCK

00190075 352530 16 AS (800) 535-0093 PO BOX 4570 DEARBORN MI UNICARE/JOHN HANCOCK

00190080 352530 16 AS (800) 453-5739 PO BOX 7677 SCHAUMBURG IL UNICARE/JOHN HANCOCK

00190085 352530 89 AS (800) 736-9369 PO BOX 4076 SCHAUMBURG IL UNICARE/JOHN HANCOCK

00190090 352530 16 AS (800) 491-6677 PO BOX 4055 SCHAUMBURG IL UNICARE/JOHN HANCOCK

00190095 352530 16 AS (800) 736-9369 PO BOX 4069 SCHAUMBURG IL UNICARE/JOHN HANCOCK

00190100 352530 89 AS (800) 408-0025 PO BOX 4069 SCHAUMBURG IL UNICARE

00190105 352530 89 AS (800) 736-9369 PO BOX 833813 RICHARDSON TX UNICARE

00190110 352530 16 AS (877) 864-2273 PO BOX 4458 CHICAGO IL UNICARE

00207005 413395 03 AS (800) 991-2642

39201 SEVEN MILE

ROAD LIVONIA MI AMERICAN COMMUNITY MUTUAL

00207010 413395 89 AS (800) 991-2642

39201 SEVEN MILE

ROAD LIVONIA MI AMERICAN COMMUNITY MUTUAL

00207015 413395 03 AS (800) 991-2642 39201 SEVEN MILE RD LIVONIA MI AMERICAN COMMUNITY MUTUAL

00216005 351113 74 AS (517) 482-0871

415 WEST

KALAMAZOO ST LANSING MI SET SEG INC

00216010 351113 88 DO (517) 482-0871

415 W KALAMAZOO

STREET LANSING MI SET SEG INC

00225005 358569 64 XR (800) 322-8190

876 HORACE BROWN

DR MADISON HEIGHTS MI MI UNITED FOOD & COMMERCIAL

00225010 358569 89 AS (800) 322-8190

876 HORACE BROWN

DRIVE MADISON HEIGHTS MI MI UNITED FOOD & COMMERCIAL WORKERS

00234005 352530 38 AS (999) 999-9999 BOX 2101 LOS ANGELES CA TRANSAMERICA OCCIDENTAL INS

00243005 352530 12 AS (800) 253-0856

6277 SEA HARBOR

DRIVE ORLANDO FL HBJ HARVEST LIFE INS CO

00252005 358569 38 AS (999) 999-9999 150 N WACKER DR CHICAGO IL PENN MUTUAL LIFE INS CO

00252010 351113 38 NH (800) 222-3469 PO BOX 7066 ALLENTOWN PA PTNA LIFE INSURANCE COMPANY

00252010 351113 38 R6 (800) 222-3469 PO BOX 7066 ALLENTOWN PA PTNA LIFE INSURANCE COMPANY

00261005 413395 41 XR (800) 222-2798 PO BOX 1358 GLEN BURNIE MD AMERICAN POSTAL WORKERS UNION HEALTH PLAN

00270005 358569 38 AS (800) 426-7234 PO BOX 8888 STEVENS POINT WI SENTRY INSURANCE COMPANY

00299005 413395 38 AS (800) 635-6585 P O BOX 8006 DUBLIN OH NATIONWIDE INSURANCE COMPANY

00305005 413395 10 AS (800) 826-9781 PO BOX 8013 WAUSAU WI UNITED MEDICAL RESOURCES

00305010 413395 10 AS (800) 826-9781 PO BOX 8092 WAUSAU WI UNITED MEDICAL RESOURCES

00305015 413395 89 AS (800) 826-9781 PO BOX 8092 WAUSAU WI UNITED MEDICAL RESOURCES

00314005 352530 38 X5 (219) 455-2000 PO BOX 2249 FORT WAYNE IN LINCOLN NATIONAL

00314010 352530 38 AS (219) 427-4832 PO BOX 5001 FT SCOTT KS LINCOLN NATIONAL

00332005 358569 38 AS (999) 999-9999

2600 NORTH CENTRAL

AVENUE PHOENIX AZ WA NATIONAL INSURANCE

00332010 358569 38 AS (800) 947-0319 PO BOX 3071 EVANSTON IL WA NATIONAL INSURANCE

00332015 358569 38 AS (800) 275-1896 PO BOX 3091 EVANSTON IL WA NATIONAL INSURANCE

00332020 358569 38 AS (999) 999-9999 PO BOX 91174 CHICAGO IL WA NATIONAL INSURANCE

Page 8: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

00332025 358569 38 AS (999) 999-9999 PO BOX 17719 ERVINE CA WA NATIONAL INSURANCE

00341005 351113 08 AS (312) 822-5627 PO BOX 305032 NASHVILLE TN CONTINENTAL ASSURANCE CO OF WI

00341010 351113 08 AS (800) 327-2430 PO BOX 13925 ORLANDO FL CONTINENTAL ASSURANCE CO FL

00341015 413395 08 XV (800) 262-4473 333 S WABASH AVE CHICAGO IL CNA OF IL

00341020 413395 08 AS (800) 999-0972 PO BOX 305283 NASHVILLE TN CNA OF TN

00341025 358569 38 AS (999) 999-9999

5434 W. ST CHARLES

RD. BERKELEY IL NIPS CO

00341030 413395 89 AS (800) 999-0972 PO BOX 305059 NASHVILLE TN CNA MANAGED CARE

00341035 413395 83 NH (800) 262-1037 PO BOX 305005 NASHVILLE TN CNA OF TN

00350005 358569 38 AS (800) 243-5860 3949 SPARKS DR SE GRAND RAPIDS MI HARTFORD

00350010 358569 38 AS (999) 999-9999 3033 W JEFFERSON JOLIET IL HARTFORD

00379005 413395 13 AS (800) 663-8081

1000 GREAT WEST

DRIVE KENNETT MO GREAT WEST HEALTHCARE

00379010 413395 89 AS (800) 685-2010

900 SECOND AVENUE

SOUTH MINNEAPOLIS MN GREAT WEST LIFE & ANNUITY INSURANCE CO

00379015 413395 89 AS (800) 663-8081

1000 GREAT WEST

DRIVE KENNETT MO GREAT WEST HEALTHCARE

00379020 413395 89 AS (800) 685-1050 PO BOX 1120 SAN JOSE CA GREAT WEST LIFE & ANNUITY INSURANCE CO

00379025 413395 13 AS (800) 685-2040 1377 DUBLIN ROAD COLUMBUS OH GREAT WEST LIFE & ANNUITY INSURANCE CO

00379030 413395 13 XR (800) 685-3120

10000 N CENTRAL

EXPRSWY DALLAS TX GREAT WEST LIFE & ANNUITY INSURANCE CO

00379035 413395 13 XR (800) 685-2020

116 INVERNESS E -

SUITE 210 DENVER CO GREAT WEST LIFE & ANNUITY INSURANCE CO

00379040 413395 89 AS (800) 685-2020 PO BOX 950 DENVER CO GREAT WEST LIFE & ANNUITY INSURANCE CO

00379045 413395 13 AS (800) 685-3040 PO BOX 11111 FORT SCOTT KS GREAT WEST LIFE & ANNUITY INSURANCE CO

00379050 413395 13 XR (800) 685-2010

900 SECOND AVENUE

S MINNEAPOLIS MN GREAT WEST LIFE & ANNUITY INSURANCE CO

00379055 413395 13 X3 (800) 678-5764

25145 COUNTRY CLUB

BLVD NORTH OLMSTED OH GREAT WEST LIFE & ANNUITY INSURANCE CO

00379060 413395 13 XR (800) 685-2020 PO BOX 429 PORTLAND OR GREAT WEST LIFE & ANNUITY INSURANCE CO

00379065 413395 13 XR (800) 685-1040 455 MARKET STREET SAN FRANCISCO CA GREAT WEST LIFE & ANNUITY INSURANCE CO

00379070 413395 13 XR (800) 423-3002 PO BOX 10188 GLENDALE CA GREAT WEST LIFE & ANNUITY INSURANCE CO

00379075 413395 13 AS (800) 685-4040

10401 N MERIDIAN

STREET INDIANAPOLIS IN GREAT WEST LIFE & ANNUITY INSURANCE CO

00379080 413395 13 XR (800) 685-1050 PO BOX 1120 SAN JOSE CA GREAT WEST LIFE & ANNUITY INSURANCE CO

00379085 413395 13 XR (800) 685-1010 PO BOX 97313 BELLEVUE WA GREAT WEST LIFE & ANNUITY INSURANCE CO

00379090 413395 13 AS (800) 314-9010 3875 FABER PLACE DR CHARLESTON SC GREAT WEST LIFE & ANNUITY INSURANCE CO

00379095 413395 13 AS (800) 663-8081 PO BOX 38088 TUCSON AZ GREAT WEST LIFE & ANNUITY INSURANCE CO

00379100 413395 89 AS (800) 685-2040 1377 DUBLIN ROAD COLUMBUS OH GREAT WEST LIFE & ANNUITY INSURANCE CO

00379105 413395 13 AS (800) 663-8081

1000 GREAT WEST

DRIVE KENNETT MO THE NEW ENGLAND FINANCIAL

Page 9: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

00379110 413395 13 AS (999) 999-9999

7700 BONHOMME

AVENUE CLAYTON MO GREAT WEST CARE

00379115 413395 13 XR (800) 685-3030 PO BOX 88620 ATLANTA GA GREAT WEST LIFE & ANNUITY INSURANCE CO

00379120 413395 13 AS (800) 333-5251 PO BOX 31251 TAMPA FL GREAT WEST LIFE & ANNUITY INSURANCE CO

00379125 413395 89 AS (800) 678-5764 PO BOX 8020 NORTH OLMSTED OH GREAT WEST LIFE & ANNUITY INSURANCE CO

00379130 413395 13 AS (800) 417-3802 PO BOX 920 FREDERICK MD GREAT WEST LIFE & ANNUITY INSURANCE CO

00379135 413395 89 AS (999) 999-9999

10401 N MERIDIAN

STREET INDIANAPOLIS IN GREAT WEST LIFE & ANNUITY INSURANCE CO

00379140 413395 89 AS (800) 458-3104 PO BOX 31251 TAMPA FL GREAT WEST LIFE & ANNUITY INSURANCE CO

00379145 413395 89 AS (800) 685-3040 PO BOX 11111 FORT SCOTT KS GREAT WEST LIFE & ANNUITY INSURANCE CO

00379150 413395 89 AS (800) 685-0073 PO BOX 27732 HOUSTON TX GREAT WEST LIFE & ANNUITY INSURANCE CO

00388005 352530 38 AS (999) 999-9999 0 VALLEY FORGE PA NATIONAL LIBERTY LIFE

00388010 351113 38 AS (800) 872-8387

MEMBS CAPITA

HOLDG FAMLY VALLEY FORGE PA AMERICAN VETERANS GROUP

00397005 413395 38 X5 (800) 487-6669 ONE MONY PLAZA SYRACUSE NY MUTUAL LIFE INSUR CO OF NY

00403005 351113 02 AS (800) 227-7789 PO BOX 740819 ATLANTA GA AARP

00412005 351113 29 X5 (800) 228-9100 PO BOX 2018 OMAHA NE PHYSICIANS MUTUAL

00412010 358569 38 AS (999) 999-9999 2600 DODGE OMAHA NE PHYSICIANS LIFE INSURANCE

00421005 358569 22 AS (800) 775-6000

MUTUAL OF OMAHA

PLAZA OMAHA NE MUTUAL OF OMAHA

00421010 358569 22 AS (800) 775-6000 PO BOX 668329 CHARLOTTE NC MUTUAL OF OMAHA

00421015 358569 22 AS (800) 462-2877 PO BOX 9 WOODWARD OK MUTUAL OF OMAHA

00421020 358569 84 IO (800) 775-1000

MUTUAL OF OMAHA

PLAZA OMAHA NE MUTUAL OF OMAHA

00421105 358569 83 NH (800) 775-1000

MUTUAL OF OMAHA

PLAZA OMAHA NE MUTUAL OF OMAHA

00424905 352530 86 VO (888) 723-7492 PO BOX 981107 EL PASP TX AETNA US HEALTHCARE

00430005 358569 04 AS (800) 621-3724 PO BOX 66927 CHICAGO IL BANKERS LIFE & CASUALTY

00459005 358569 12 X5 (999) 999-9999 PO BOX 14568 CINCINNATI OH INTER OCEAN

00468005 413395 38 X5 (800) 888-2452 P O BOX 1500 NASHVILLE TN AMER GEN LIFE & ACCIDENT IN CO

00477005 351113 38 AS (999) 999-9999 PO BOX 0 GRAND RAPIDS MI INDEPENDENT LIBERTY LIFE

00486005 351113 38 AS (800) 777-8467 ONE E WACKER DRIVE CHICAGO IL UNITED INSURANCE CO OF AMERICA

00486010 552530 38 AS (999) 999-9999 PO BOX 29149 SHAWNEE MISSION KS UNITED INSURANCE CO OF AMERICA

00495005 351113 38 AS (999) 999-9999 0 WAKEFIELD MA AM LIFE INS CO

00510005 358569 38 AS (999) 999-9999

51 LOUISIANA AVE

NW WASHINGTON DC ACACIA MUT LIFE INS

00539005 352530 38 X4 (800) 345-6352 PO BOX 3074 SOUTHEASTERN PA ACADEMY LIFE INSURANCE

00548005 352530 01 AS (800) 525-4225

11100 WAYZATA BLVD

SUITE 400 MINNETONKA MN AETNA US HEALTHCARE

00557005 352530 01 AS (999) 999-9999 PO BOX 15202 ALBANY NY AETNA US HEALTHCARE

00566005 352530 89 AS (888) 632-3862 PO BOX 981107 EL PASO TX AETNA US HEALTHCARE

00566010 352530 01 AS (800) 558-0860 PO BOX 981107 EL PASO TX AETNA US HEALTHCARE

Page 10: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

00566015 352530 01 AS (999) 999-9999 PO BOX 150431 HARTFORD CT AETNA US HEALTHCARE

00566020 352530 01 AS (999) 999-9999 PO BOX 11000 ORANGE CA AETNA US HEALTHCARE

00566025 352530 01 AS (817) 417-2000 4300 CENTREWAY ARLINGTON TX AETNA US HEALTHCARE

00566030 352530 89 AS (877) 272-6375 PO BOX 1214 TEWKSBURY MA AETNA US HEALTHCARE

00566035 352530 89 AS (877) 764-5727 PO BOX 24002 FRESNO CA AETNA US HEALTHCARE

00566040 352530 01 AS (210) 515-2000 PO BOX 795080 SAN ANTONIO TX AETNA US HEALTHCARE

00566045 352530 89 AS (800) 334-9778 PO BOX 578808 OKLAHOMA CITY OK AETNA US HEALTHCARE

00566050 352530 01 AS (999) 999-9999 PO BOX 182082 COLUMBUS OH AETNA US HEALTHCARE

00566055 352530 01 AS (800) 255-4492 PO BOX 2520 TYLER TX AETNA US HEALTHCARE

00566060 352530 01 AS (336) 801-7000 PO BOX 26190 GREENSBORO NC AETNA US HEALTHCARE

00566065 352530 87 RX (800) 238-6279 PO BOX 14024 LEXINGTON KY AETNA US HEALTHCARE RX MANAGEMENT

00566070 352530 01 AS (800) 553-9870 PO BOX 12244 OKLAHOMA CITY OK AETNA US HEALTHCARE

00566075 352530 89 AS (800) 354-5835 PO BOX 24024 FRESNO CA AETNA US HEALTHCARE

00566080 352530 01 AS (800) 962-6842 PO BOX 16423 PITTSBURGH PA AETNA US HEALTHCARE

00566085 352530 01 AS (800) 451-2967

7676 HAZARD CENTER

DRIVE SAN DIEGO CA AETNA US HEALTHCARE

00566090 352530 89 AS (800) 525-3148 PO BOX 12340 FRESNO CA AETNA US HEALTHCARE

00566095 352530 01 AS (502) 426-7130 PO BOX 5516 AKRON OH AETNA US HEALTHCARE

00575005 352530 01 AS (860) 952-5527 PO BOX 150417 HARTFORD CT AETNA US HEALTHCARE

00584005 352530 89 AS (877) 580-5018 PO BOX 44128 JACKSONVILLE FL AETNA US HEALTHCARE

00584010 352530 01 AS (813) 775-0000 PO BOX 31450 TAMPA FL AETNA US HEALTHCARE

00584015 352530 89 AS (813) 775-0000 PO BOX 31450 TAMPA FL AETNA US HEALTHCARE

00619005 413395 38 AS (414) 734-5721

4321 N BALLARD

ROAD APPLETON WI AID ASSN FOR LUTHERANS

00628005 352530 38 AS (999) 999-9999 3861 S RESEARCH PK ANN ARBOR MI AIRWAY UNDERWRITERS

00646005 352530 38 AS (800) 521-4397

33045 HAMILTON

BLVD FARMINGTON HILL MI ALEXANDER HAMILTON LIFE

00655005 352530 38 AS (419) 238-1010 800 S WASHINGTON VAN WERT OH ALL AMERICA INS CO

00691005 358569 38 AS (999) 999-9999

51 JOHN F KENNEDY

PK SHORT HILLS NJ ALLIANCE ASSOC CO LTD

00708005 358569 38 AS (999) 999-9999 6966 BROADWAY CLEVELAND OH ALLIANCE POLES AMER

00717005 358569 38 AS (999) 999-9999 303 LEADER BLDG CLEVELAND OH ALLIANCE TRANS SAXON

00726005 358569 38 AS (999) 999-9999

222 S RIVERSIDE

PLAZA CHICAGO IL ALLIED BENEFIT SYSTEMS

00726010 358569 89 AS (312) 906-8080 208 LASALLE STREET CHICAGO IL ALLIED BENEFIT SYSTEMS

00762005 413395 38 AS (312) 693-1020

4646 ROANOKE

PARKWAY KANSAS CITY MO AMALGAMATED LABOR LIFE INS CO

00771005 413395 67 AS (212) 473-5700 770 BROADWAY NEW YORK NY AMALGAMATED LIFE INS CO

00806005 358569 38 AS (999) 999-9999 PO BOX 1 GRAND RAPIDS MI AMERICAN ANNUITY LIFE

Page 11: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

00815005 358569 38 AS (999) 999-9999 777 SAN MARIN DRIVE NOVATO CA AMERICAN AUTO INS CO MO

00824005 358569 04 AS (999) 999-9999 600 BRICKELL AVE MIAMI FL AMERICAN BANKERS INS CO FL

00833005 358569 04 AS (999) 999-9999 PO BOX 4980 MIAMI FL AMERICAN BNKRS LIFE CO FL

00842005 351113 38 AS (999) 999-9999 310 S MICHIGAN CHICAGO IL AMERICAN CAS CO READING PA

00851005 413395 38 AS (999) 999-9999 100 CROSSWAYS PK W WOODBURY NY AMERICAN CONSUMER INS CO

00860005 351113 38 AS (999) 999-9999 COURT & MAIN STS CINCINNATI OH AMERICAN CONT INS CO

00889005 351113 38 AS (999) 999-9999 300 ST PAUL PLACE BALTIMORE MD AMERICAN CREDIT IND CO NY

00898005 352530 38 AS (999) 999-9999 30 E CENTRAL PKWY CINCINNATI OH AMERICAN DRUGGIST INS

00904005 351113 38 AS (999) 999-9999 PO BOX 2387 MORRISTOWN NJ AMERICAN EAGLE LIFE INS

00913005 352530 38 AS (999) 999-9999 542 N MERIDIAN ST INDIANAPOLIS IN AMERICAN ECONOMY INS CO

00922005 351113 38 AS (999) 999-9999 215 WASHINGTON ST WATERTOWN NY AMERICAN EMPIRE INS CO

00931005 351113 38 AS (999) 999-9999 ONE BEACON ST BOSTON MA AMERICAN EMPLOYERS INS

00940005 351113 38 AS (800) 992-3522 1932 WYNNTON RD COLUMBUS GA AMERICAN FAMILY LIFE ASSURANCE

00969005 351113 84 IO (706) 323-3431

1932 WYNNTON

ROAD COLUMBUS GA AFLAC - WORLDWIDE HEADQUARTERS

00969010 351113 88 DO (706) 323-3431

1932 WYNNTON

ROAD COLUMBUS GA AFLAC

00969015 351113 02 IO (800) 227-7789 PO BOX 740819 ATLANTA GA AARP

00978005 358569 38 AS (999) 999-9999

6000 AMERICAN

PARKWAY MADISON WI AMERICAN FAMILY MUT INS CO

00987005 351113 38 AS (999) 999-9999 2624 W GRAND BLVD DETROIT MI AMERICAN FELLOWSHIP MUT INS

00996005 358569 38 AS (999) 999-9999 100 CROSSWAYS PK W WOODBURY NY AMERICAN FIDELITY FIRE INS

01008005 358569 38 AS (999) 999-9999 PO BOX 4847 PENSACOLA FL AMERICAN FIDELITY LIFE

01017005 352530 38 AS (999) 999-9999 150 WILLIAM ST NEW YORK NY AMERICAN & FOREIGN INSURANCE

01026005 358569 38 AS (999) 999-9999 111 S FOURTH AVE ELY MN AMERICAN FRATERNAL UNION

01035005 413395 38 R6 (615) 749-1666 P.O. BOX 1500 NASHVILLE TN AMERICAN GENERAL LIFE & ACCID

01044005 413395 38 AS (999) 999-9999 PO BOX 1526 HOUSTON TX AMERICAN GEN LIFE INS DEL

01044010 413395 38 AS (734) 285-4040 PO BOX 449 WYANDOTTE MI AMERICAN GENERAL

01053005 413395 38 AS (315) 471-1121

300 SOUTH STATE

STREET SYRACUSE NY AMERICAN GENERAL LIFE INS NY

01062005 358569 38 AS (999) 999-9999 111 W JACKSON BLVD CHICAGO IL AMERICAN GUAR & LIAB INS

01071005 358569 38 AS (612) 920-1400 3033 EXCELSIOR BLVD MINNEAPOLIS MN AMERICAN HARDWARE MUTUAL INSUR

01080005 413395 38 AS (800) 760-4948 PO BOX 422279 SAN FRANCISCO CA ZENITH ADMINISTRATORS

Page 12: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

01106005 351113 89 AS (904) 992-1776

1776 AMERICAN

HERITAGE JACKSONVILLE FL AMERICAN HERITAGE LIFE INS

01115005 358569 38 AS (999) 999-9999 102 MAIDEN LANE NEW YORK NY AMERICAN HOME ASSURANCE CO

01124005 358569 38 AS (254) 761-6400 PO BOX 2608 WACO TX AMERICAN INCOME LIFE INS

01124010 351113 84 IO (254) 761-6400 PO BOX 2608 WACO TX AMERICAN INCOME LIFE

01133005 358569 38 AS (999) 999-9999 3333 CALIFORNIA ST SAN FRANCISCO CA AMERICAN INSURANCE CO NJ

01142005 351113 38 AS (999) 999-9999 102 MAIDEN LANE NEW YORK NY AMERICAN INTERNATIONAL INS

01151005 351113 38 AS (302) 428-3800 102 MAIDEN LANE NEW YORK NY AMERICAN INT LIFE ASSUR NY

01160005 351113 38 AS (999) 999-9999 810 SEVENTH AVE NEW YORK NY AMERICAN LIFE INS CO NY

01189005 358569 38 AS (999) 999-9999 9428 S HARDING EVERGREEN PARK IL AMERICAN LITHUANIAN WO ALL

01198005 351113 38 AS (999) 999-9999 200 SOUTH 4TH ST GENEVA IL AMERICAN LIVE STOCK INS

01204005 413395 38 AS (999) 999-9999 PO BOX 27387 RALEIGH NC AMERICAN MORTGAGE INS CO

01222005 413395 38 AS (999) 999-9999 PO BOX 756 MILWAUKEE WI AMERICAN MUN BOND ASSUR

01231005 413395 38 AS (999) 999-9999 0 WAKEFIELD MA AMERICAN MUT CO BOSTON

01240005 351113 38 AS (999) 999-9999

2625 BUTTERFIELD

RD. OAK BROOK IL AMERICAN MUTUAL LIABILITY INS

01269005 351113 38 AS (515) 280-1331 LIBERTY BLDG DES MOINES IA AMERICAN MUTUAL LIFE INS CO

01287005 351113 38 AS (999) 999-9999 PO BOX 30172 LOS ANGELES CA AMERICAN NATIONAL FIRE INS NY

01296005 358569 38 AS (800) 899-6805 PO BOX 1520 GALVESTON TX AMERICAN NATIONAL INSURANCE CO

01296010 358569 89 AS (800) 899-6805 PO BOX 1520 GALVESTON TX AMERICAN NATIONAL INSURANCE CO

01302005 351113 38 AS (999) 999-9999 0 WAKEFIELD MA AMERICAN POLICYHOLDERS INS

01311005 351113 38 AS (999) 999-9999 0 LONG GROVE IL AMERICAN PROTECTION INS

01320005 358569 38 AS (999) 999-9999 99 JOHN ST NEW YORK NY AMERICAN RE INSURANCE CO

01349005 358569 38 AS (999) 999-9999 PO BOX 10 DES MOINES IA AMERICAN REPUBLIC ASSUR CO

01358005 358569 38 AS (800) 247-2190 PO BOX 10 DES MOINES IA AMERICAN REPUBLIC INS CO

01367005 358569 38 AS (999) 999-9999 AMERICAN ROAD DEARBORN MI AMERICAN ROAD INS CO

01385005 351113 38 AS (999) 999-9999

351-53 NORTH

CHICAGO JOLIET IL AMERICAN SLOVENIAN CATH UN

01394005 358569 38 AS (999) 999-9999

3099 E WASHINGTON

AVE MADISON WI AMERICAN STAND INS CO WI

01400005 358569 38 AS (999) 999-9999 542 NORTH MERIDIAN INDIANAPOLIS IN AMERICAN STATES INSURANCE CO

01429005 358569 38 X5 (317) 262-6262 542 NORTH MERIDIAN INDIANAPOLIS IN AMERICAN STATES INS CO

01438005 358569 38 AS (999) 999-9999

150 SOUTHEAST

THIRD MIAMI FL AMERICAN TITLE INS CO

01447005 352530 38 AS (999) 999-9999 500 N MERIDIAN ST INDIANAPOLIS IN AMERICAN UNION INS CO NY

01456005 351113 38 AS (800) 553-3522 PO BOX 368 INDIANAPOLIS IN AMERICAN UNITED LIFE INS

01465005 351113 38 AS (999) 999-9999 144 WAYLAND AVE PROVIDENCE RI AMERICAN UNIVERSAL INS CO

01474005 351113 38 AS (999) 999-9999 440 LINCOLN ST WORCESTER MA AMERICAN VAR ANN LIFE ASSUR

01483005 358569 89 AS (602) 955-5401 PO BOX 10458 PHOENIX AZ ANCHOR HEALTH HMO

Page 13: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

01492005 358569 38 AS (999) 999-9999 3590 N MERIDIAN ST INDIANAPOLIS IN AQUILA LIFE INS CO

01518005 358569 38 AS (999) 999-9999 250 MIDDLEFIELD RD MENLO PARK CA ARGONAUT MIDWEST INS

01527005 352530 38 AS (999) 999-9999 225 WYMAN STREET WALTHAM MA ARK BOSTON MANUF MUT

01536005 351113 38 AS (999) 999-9999 28 W ADAMS AVE DETROIT MI ASSOCIATED GENERAL INSURANCE

01554005 352530 88 DO (800) 237-4463 PO BOX 25326 OVERLAND PARK KS UNIFIED LIFE

01563005 351113 38 AS (999) 999-9999

3333 MERIDIAN

STREET INDIANAPOLIS IN ASSOCIATES LIFE INS

01572005 352530 38 X3 (800) 529-4344 PO BOX 2708 JOPLIN MO SELECT BROKERAGE SERVICE

01572010 352530 38 AS (800) 752-2557 PO BOX 2976 MILWAUKEE WI SELECT BROKERAGE SERVICE

01581005 358569 38 AS (999) 999-9999 104-07 102ND ST OZONE PARK NY ASSOCIATED LITHUANIAN WKS

01590005 413395 38 AS (999) 999-9999 PO BOX 1185 BALTIMORE MD ASSUR CO AMERICA NY

01607005 358569 38 AS (404) 659-2100

100 AUBURN AVENUE

NE ATLANTA GA ATLANTA LIFE INS CO

01616005 358569 38 AS (999) 999-9999 PO BOX 1771 DALLAS TX ATLANTIC INSURANCE

01625005 358569 38 AS (999) 999-9999

ATLANTIC BLD 45

WALL NEW YORK NY ATLANTIC MUTUAL INS

01634005 358569 38 AS (999) 999-9999 PO BOX 1919 TULSA OK ATLAS LIFE INSURANCE

01661005 358569 38 R6 (517) 323-1200 PO BOX 30660 LANSING MI AUTO OWNERS LIFE INSURANCE

01699005 358569 38 AS (800) 874-9124 411 AVIATION WAY FREDERICK MD AVEMCO INSURANCE CO

01714005 358569 38 AS (999) 999-9999

5434 WEST CAPITOL

DR MILWAUKEE WI BADGER STATE MUT CAS

01723005 358569 38 AS (999) 999-9999

620 NEWPORT

CENTER NEWPORT BEACH CA BALBOA INSURANCE CO

01732005 413395 45 AS (800) 874-0993

1245 CORPORATE

BOULEVARD AURORA IL PRINCIPAL FINANCIAL GROUP

01732010 358569 04 AS (999) 999-9999 4620 W 77TH ST EDINA MN BANKERS LIFE COMPANY

01732015 358569 04 AS (999) 999-9999 603 W SEVENTH ST CADILLAC MI BANKERS LIFE INSURANCE

01732020 413395 45 AS (800) 323-4646 3435 STELZER ROAD COLUMBUS OH PRINCIPAL FINANCIAL GROUP

01732025 413395 45 AS (800) 533-5044

9428 BAYMEADOWS

RD JACKSONVILLE FL PRINCIPAL FINANCIAL GROUP

01732030 413395 45 AS (999) 999-9999

10210 NORTH 25TH

AVENUE PHOENIX AZ PRINCIPAL FINANCIAL GROUP

01732035 413395 45 AS (800) 223-8030

4050 RIVER RIDGE DR

NE CEDAR RAPIDS IA PRINCIPAL FINANCIAL GROUP

01732040 413395 45 AS (800) 523-5938

2505 W SHAW

AVENUE FRESNO CA PRINCIPAL FINANCIAL GROUP

01732045 413395 45 AS (999) 999-9999 PO DRAWER 31298 TAMPA FL PRINCIPAL FINANCIAL GROUP

01732050 413395 45 AS (800) 422-5002 PO BOX 2593 SPRINGFIELD MO PRINCIPAL FINANCIAL GROUP

01732055 413395 45 AS (800) 247-4695 1755 TELSTAR DR COLORADO SPRING CO PRINCIPAL FINANCIAL GROUP

Page 14: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

01732060 413395 45 AS (800) 331-0745 36 THROPE AVENUE WALLINGFORD CT PRINCIPAL FINANCIAL GROUP

01732065 413395 45 AS (800) 894-9576 4021 SOUTH 700 EAST SALT LAKE CITY UT PRINCIPAL FINANCIAL GROUP

01732070 413395 45 AS (999) 999-9999

14000 QUAIL SPRINGS

PKWY OKLAHOMA CITY OK PRINCIPAL FINANCIAL GROUP

01732075 413395 45 AS (800) 443-9456 PO BOX 3006 AMES IA PRINCIPAL FINANCIAL GROUP

01732080 413395 89 AS (800) 247-4695 PO BOX 39710 COLORADO SPRINGS CO PRINCIPAL LIFE INSURANCE

01732085 413395 45 AS (800) 284-8695

ONE INTERNATIONAL

PLAZA PHILADELPHIA PA PRINCIPAL FINANCIAL GROUP

01732090 413395 45 AS (999) 999-9999 851 SW SIXTH AVENUE PORTLAND OR PRINCIPAL FINANCIAL GROUP

01732095 413395 45 AS (800) 247-4695 PO BOX 795014 SAN ANTONIO TX PRINCIPAL FINANCIAL GROUP

01732100 413395 89 AS (800) 422-5002 PO BOX 2593 SPRINGFIELD MO PRINCIPAL FINANCIAL GROUP

01741005 358569 88 DO (800) 659-2223 PO BOX 82520 LINCOLN NE AMERITAS LIFE INSURANCE CORP

01750005 358569 04 AS (312) 777-7000

4810 NORTH

KENNETH CHICAGO IL BANKERS MULTIPLE LINE

01751005 358569 04 AS (999) 999-9999 PO BOX 655433 DALLAS TX BANKERS MULTIPLE LINE

01779005 358569 04 AS (999) 999-9999 500 WEST SOUTH ST FREEPORT IL BANKERS MUTUAL LIFE

01788005 358569 04 AS (999) 999-9999 1599 LITTLETON ROAD PARSIPPANY NJ BANKERS NATIONAL LIFE INS

01797005 358569 04 AS (999) 999-9999 475 PARK AVENUE S NEW YORK NY BANKERS SEC LIFE INS

01803005 358569 04 AS (999) 999-9999

PO BOX 659 262 E

MOR BURLINGTON NC BANKERS SHIPPERS NY

01812005 352530 38 AS (999) 999-9999 8555 MAIN STREET BUFFALO NY BAPTIST LIFE ASSOC

01821005 352530 38 AS (999) 999-9999 NORTH MAIN STREET ANDOVER MA BAY STATE INSURANCE

01830005 413395 38 AS (999) 999-9999

227 EAST MAIN

STREET CRAWFORDSVILLE IN BEN HUR LIFE ASSOC

01859005 351113 38 AS (999) 999-9999 36 SOUTH STATE ST SALT LAKE CITY UT BENEFICIAL LIFE INS

01868005 351113 84 NH (212) 684-6565 TWO PARK AVE NEW YORK NY BENEFICIAL NAT LIFE

01877005 351113 38 AS (800) 421-3259 5700 WILSHIRE BLVD LOS ANGELES CA BENEFICIAL STAN LIFE

01886005 413395 44 AS (800) 537-8275 PO BOX 2942 CLINTON IA TRUSTMARK

01886010 413395 44 AS (800) 537-8275 PO BOX 2942 CLINTON IA TRUSTMARK

01886015 413395 44 AS (800) 366-6663 PO BOX 7900 LAKE FOREST IL TRUSTMARK

01886020 413395 89 AS (800) 537-8275 PO BOX 2942 CLINTON IA TRUSTMARK

01886025 413395 89 AS (800) 877-9077 400 FIELD DRIVE LAKE FOREST IL TRUSTMARK

01886030 358113 38 AS (800) 252-4698 PO BOX 9137 FORT WORTH TX ERN ADMINISTRATORS

Page 15: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

01886035 358113 89 AS (800) 252-4698 6000 WESTERN PLACE FORT WORTH TX ERN ADMINISTRATORS

01886040 413395 89 AS (800) 537-8275 PO BOX 2942 CLINTON IA TRUSTMARK

01901005 351113 38 AS (999) 999-9999 102 MAIDEN LANE NEW YORK NY BIRMINGHAM FIRE PA

01939005 351113 38 AS (999) 999-9999 320 18TH STREET ROCK ISLAND IL BITUM FIRE MARINE

01948005 358569 38 AS (999) 999-9999 50 WEST 57TH STREET NEW YORK NY BNAI ZION

01957005 358569 38 AS (999) 999-9999 120 ROYALL STREET CANTON MA BOSTON MUTUAL LIFE

01966005 358569 38 AS (999) 999-9999 80 MAIDEN LANE NEW YORK NY BOSTON OLD COLONY MA

01975005 352530 38 AS (999) 999-9999 150 WILLIAM STREET NEW YORK NY BR FORGN MARINE LTD

01993005 351113 38 AS (999) 999-9999 PO BOX 2088 COLUMBUS OH CONTINENTAL LOSS ADJUSTING

02005005 358569 38 AS (999) 999-9999

1650 W BIG BEAVER

RD TROY MI BURTON ABSTRCT TITLE

02014005 413395 38 AS (816) 753-8000 PO BOX 419458 KANSAS CITY MO BUSINESS MEN'S ASSURANCE CO

02023005 358569 38 AS (999) 999-9999 34820 HARPER MT CLEMENS MI CMI CAST PARTSATION

02032005 358569 38 AS (999) 999-9999 PO BOX 2017 MADISON WI CMI CREDIT INS INC

02041005 358569 38 AS (999) 999-9999

CPA BLDG 2411 14

AVE DETROIT MI CPA INS COMPANY

02050005 352530 38 AS (313) 341-7100 16633 LIVERNOIS DETROIT MI CADILLAC MUTUAL INS

02079005 358569 38 AS (999) 999-9999 20155 GODDARD TAYLOR MI CA LIFE INS

02088005 358569 38 AS (999) 999-9999 PO BOX 187 SACRAMENTO CA CA WESTERN

02097005 358569 38 AS (999) 999-9999 300 ST PAUL PLACE BALTIMORE MD CALVERT FIRE INS CO

02103005 413395 38 AS (999) 999-9999 342 NORTH MAIN ST ANDOVER MA CAMBRIDGE MUTUAL

02112005 358569 38 AS (999) 999-9999 414 WALNUT STREET PHILADELPHIA PA CAMDEN FIRE INS ASS

02121005 352530 38 AS (313) 341-7100 16633 LIVERNOIS DETROIT MI CADILLAC MUTUAL INS

02130010 413395 38 AS (800) 238-9455 PO BOX 1475 PEORIA IL CNA INSURANCE COMPANIES

02159005 358569 89 XD (888) 354-2273

26711

NORTHWESTERN HWY SOUTHFIELD MI CAPE HMO

02168005 358569 38 AS (888) 650-6566 PO BOX 346 ALPHARETTA GA CAPITOL ADMINISTRATORS

02177005 358569 38 AS (303) 691-6045 PO BOX 24247 DENVER CO CAPITOL LIFE INS CO

02195005 358569 38 AS (999) 999-9999 KEOSAUQUA AT 3RD DES MOINES IA CARRIERS INS CO

02239005 413395 38 AS (414) 961-0500 PO BOX 11563 MILWAUKEE WI CATHOLIC FAMILY LIFE

02248005 352530 38 AS (999) 999-9999 709 BRIGHTON RD PITTSBURGH PA WM PENN ASSOCIATION

02257005 352530 38 AS (999) 999-9999 709 BRIGHTON RD PITTSBURGH PA WM PENN ASSOCIATION

02266005 352530 38 AS (412) 231-2979 709 BRIGHTON RD PITTSBURGH PA WILLIAM PENN ASSOCIATION

02275005 413395 38 AS (999) 999-9999 195 EAST BROAD ST COLUMBUS OH CATHOLIC LADIES

Page 16: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

02284005 413395 38 AS (999) 999-9999 107 NORTH CENTRAL NEW PRAGUE MN CATHOLIC WORKMAN

02293005 352530 38 AS (999) 999-9999 300 ST PAUL PLACE BALTIMORE MD CAVALIER INS CORP

02319005 351113 38 AS (999) 999-9999 INSURANCE SQUARE CELINA OH CELINA MUTUAL LIFE INS

02328005 351113 38 AS (999) 999-9999 INSURANCE SQUARE CELINA OH CELINA MUTUAL INS

02337005 352530 38 AS (999) 999-9999 45 WALL STREET NEW YORK NY CENTENNIAL INS CO

02346005 358569 62 X3 (800) 558-4444 PO BOX 14610 LEXINGTON KY HUMANA EMPLOYERS HEALTH INSURANCE

02364005 351113 38 AS (999) 999-9999 PO BOX 1319 MORRISTOWN NJ CENTRAL NAT INS CO

02382005 358569 47 AS (402) 399-3553 PO BOX 34350 OMAHA NE CENTRAL STATES HEALTH & LIFE

02391005 413395 38 AS (999) 999-9999 55 ELM ST HARTFORD CT CENTURY IDEM CO

02408005 413395 38 AS (999) 999-9999 315 17 S COCHRAN CHARLOTTE MI CENTURY MUTUAL INS

02417005 352530 38 AS (999) 999-9999 8301 MARYLAND AVE ST LOUIS MO CHARTER NATIONAL

02426005 351113 89 AS (999) 999-9999 PO BOX 538508 GRAND PRAIRE TX CHEC

02435005 413395 38 AS (999) 999-9999 PO BOX 297 BALTIMORE MD CHESAPEAKE LIFE INS

02444005 358569 38 AS (999) 999-9999

4455 DR MARTIN

LUTHE CHICAGO IL CHICAGO METROPOLITAN

02453005 351113 38 AS (999) 999-9999

111 W WASHINGTON

ST CHICAGO IL CHICAGO TITLE INS CO

02462005 351113 38 AS (999) 999-9999 PO BOX 858 CONCORD NH CHRISTIAN MUTUAL INS

02471005 358569 38 AS (999) 999-9999

16250 NORTHLAND

DR SOUTHFIELD MI CHRYSLER INS CO

02480005 358569 38 AS (999) 999-9999

16250 NORTHLAND

DR SOUTHFIELD MI CHRYSLER LIFE INS CO

02506005 352530 38 AS (999) 999-9999 800 SECOND AVE NEW YORK NY CHURCH INS CO

02515005 352530 38 AS (999) 999-9999 1004 E FIRST ST MERRILL WI CHURCH INS CO

02524005 358569 38 AS (513) 870-2000 PO BOX 145496 CINCINNATI OH CINCINNATI LIFE INSURANCE CO

02533010 358569 38 AS (999) 999-9999 544 W 5TH ST CLARE MI CITIZENS INS CO OF AMERICA

02533015 358569 38 AS (999) 999-9999 611 W COURT ST FLINT MI CITIZENS INS CO OF AMERICA

02542005 352530 38 AS (999) 999-9999 59 MAIDEN LANE NEW YORK NY CITY INSURANCE CO

02551005 413395 38 AS (999) 999-9999 HAMM BLDG ST PAUL MN COASTAL CASUALTY CO

02560005 358569 38 AS (999) 999-9999 PO BOX 68181 INDIANAPOLIS IN COLLEGE LIFE OF AMER

02589005 358569 38 AS (713) 954-3164 PO BOX 4271 HOUSTON TX POOL COMPANY INSURANCE

02598005 351113 38 AS (800) 325-4368 PO BOX 100195 COLUMBIA SC COLONIAL LIFE

02604005 358569 38 AS (800) 523-4000 19TH & MARKET ST PHILADELPHIA PA COLONIAL PENN

02613005 358569 38 AS (800) 523-4000 399 MARKET STREET PHILADELPHIA PA CONSECO DIRECT LIFE INSURANCE CO

02613010 358569 38 AS (800) 947-0319 PO BOX 2034 CARMEL IN CONSECO MEDICAL INSURANCE CO

02613015 358569 38 AS (800) 798-2422 PO BOX 1068 DECATUR IL CONSOCIATE GROUP

02613020 358569 38 AS (800) 541-2254 PO BOX 2024 CARMEL IN CONSECO HEALTH INSURANCE

02622005 358569 38 AS (999) 999-9999 19TH & MARKET ST. PHILADELPHIA PA COLONIAL PENN

Page 17: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

02631005 351113 38 AS (614) 221-5875 303 EAST BROAD ST COLUMBUS OH COLUMBUS MUTUAL LIFE

02640005 358569 84 IO (800) 225-4500 5050 BROADWAY CHICAGO IL COMBINED INSURANCE COMPANY

02669005 351113 38 AS (999) 999-9999 102 MAIDEN LANE NEW YORK NY COMMERCE & INDUSTRY

02678005 358569 38 AS (999) 999-9999 80 MAIDEN LANE NEW YORK NY COMMERCIAL INS CO OF NEWARK

02687005 358569 38 AS (999) 999-9999 606 MARINE PLAZA MILWAUKEE WI COMMERCIAL LOAN INS

02696005 358569 38 AS (999) 999-9999 2 EAST GILMAN ST MADISON WI COMMERCIAL MORTGAGE INS

02702005 358569 38 AS (800) 422-6200 70 GENESEE UTICA NY COMMERCIAL TRAVELERS MUT INS

02720005 358569 38 AS (999) 999-9999 ONE BEACON ST BOSTON MA COMMERCIAL UNION LIFE INS CO

02749005 358569 38 AS (999) 999-9999 1510 WALNUT ST PHILADELPHIA PA COMMONWLTH LAND TITLE

02758005 351113 38 AS (999) 999-9999 PO BOX 30400 LANSING MI COMMUNITY SERVICE INS CO

02767005 352530 38 AS (999) 999-9999 275 GLEN COVE RD CARLE PLACE NY COMPASS INSURANCE CO

02776005 352530 38 AS (800) 441-1195 PO BOX 29419-03 N CHARLESTON SC CONFED ADMINISTRATIVE SERVICES

02785005 351113 07 AS (999) 999-9999 PO BOX 420 HARTFORD CT CT INDEMNITY COMPANY

02794005 351113 07 AS (999) 999-9999 140 GARDEN ST HARTFORD CT CT MUTUAL LIFE INS CO

02829005 358569 38 AS (999) 999-9999 115 N PENNSYLVANIA INDIANAPOLIS IN CONSOLIDATED INS CO

02838005 358569 38 AS (999) 999-9999 345 ADAMS ST BROOKLYN NY CONSOLIDATED MUTUAL INS CO

02847005 358569 38 AS (999) 999-9999 115 N PENNSYLVANIA INDIANAPOLIS IN CONSOLIDATED NATIONAL LIFE INS

02856005 352530 38 AS (999) 999-9999 130 JOHN ST NEW YORK NY CONSTELLATION REINS

02865005 413395 38 AS (312) 825-0900 5353 N ELSTON AVE CHICAGO IL CONSTITUTION LIFE INS CO

02874005 358569 38 AS (999) 999-9999 PO BOX 368 MEMPHIS TN CONSUMERS NATIONAL

02883005 351113 38 AS (999) 999-9999 PO BOX 17570 WILMINGTON DE CONTINENTAL AMERICAN LIFE INS

02892005 351113 83 NH (800) 528-4582 PO BOX 946760 MAITLAND FL CONTINENTAL CASUALTY

02892010 413395 08 AS (800) 308-5948 PO BOX 55270 PHOENIX AZ CNA

02892015 413395 08 AS (800) 410-7778 PO BOX 44242 JACKSONVILLE FL CNA

02909005 351113 38 AS (212) 440-3000 80 MAIDEN LANE NEW YORK NY CONTINENTAL INS

02918005 351113 38 AS (999) 999-9999 2 EAST GILMAN MADISON WI CONTINENTAL MORTGAGE INS INC

02936005 352530 38 AS (213) 742-2345 1150 SO OLIVE ST LOS ANGELES CA COUNTRYWIDE INS CO

02945005 352530 38 AS (999) 999-9999 BOX 1169 HARTFORD CT COVENANT LIFE INS CO

02954005 358569 38 AS (513) 328-2200 120 S LIMESTONE ST SPRINGFIELD OH CREDIT LIFE INS CO

02963005 351113 38 AS (999) 999-9999 1705 L STREET NW WASHINGTON DC CRITERION INS CO

02972005 413395 38 AS (999) 999-9999 125 W FIFTH AVE GARY IN CROATIAN CATHOLIC UN

02981005 413395 38 AS (999) 999-9999 KINGSTON & DELANEY PITTSBURGH PA CROATION FRATERNAL

02990005 358569 38 AS (999) 999-9999 PO BOX 4020 BUFFALO NY CROWN LIFE INS CO

03002005 413395 38 AS (608) 238-5851 PO BOX 1084 MADISON WI CUMIS INS SOCIETY

03011005 352530 38 AS (800) 548-9390 PO BOX 391 MADISON WI CUNA MUTUAL INS SOC

03020005 352530 38 AS (999) 999-9999 5349 DOLLOFF RD CLEVELAND OH CZECH CATHOLIC UNION

03049005 352530 38 AS (999) 999-9999 2138 SO 61ST CT CICERO IL CZECH SOC OF AMERICA

03058005 352530 38 AS (999) 999-9999 PO BOX 5220 MADISON WI DAIRYLAND INS CO

Page 18: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

03067005 351113 38 AS (602) 240-2404 PO BOX 31748 OMAHA NE DANISH BRO IN AMER

03076005 351113 38 AS (999) 999-9999 325 CEDAR ST ST PAUL MN DEGREE HONOR PROTECTION

03085005 358569 88 DO (800) 424-5549 PO BOX 30416 LANSING MI DELTA DENTAL PLAN OF MI

03085010 358569 88 DO (800) 424-5549 PO BOX 9085 FARMINGTON HILLS MI DELTA DENTAL PLAN OF MI

03085015 358569 88 DO (999) 999-9999 PO BOX 43000 PHOENIX AZ DELTA DENTAL PLAN OF AZ

03085020 358569 88 DO (800) 521-2651 PO BOX 1809 ALPHARETTA GA DELTA DENTAL PLAN OF GA

03085025 358569 88 DO (800) 662-8856 333 SIX FORKS ROAD RALEIGH NC DELTA DENTAL PLAN OF NC

03085030 358569 88 DO (800) 610-0201 PO BOX 173803 DENVER CO DELTA DENTAL PLAN OF CO

03085035 358569 88 DO (800) 452-1987 PO BOX 5402 LISLE IL DELTA DENTAL PLAN OF IL

03085040 358569 88 DO (800) 872-0500 PO BOX 9695 BOSTON MA DELTA DENTAL PLAN OF MA

03085045 358569 88 DO (800) 932-0783 ONE DELTA DRIVE MECHANICSBURG PA DELTA DENTAL PLAN OF PA & W VIRGNIA

03085050 358569 88 DO (999) 999-9999

700 BISHOP ST SUITE

700 HONOLULU HI DELTA DENTAL PLAN OF HI

03085055 358569 88 DO (800) 448-3815 PO BOX 59238 MINNEAPOLIS MN DELTA DENTAL PLAN OF MN

03085060 358569 88 DO (800) 843-3582 PO BOX 1517 PROVIDENCE RI DELTA DENTAL OF RI

03085065 358569 88 DO (800) 999-0963

2500 LOUISIANA

BOULEVARD ALBURQUERQUE NM DELTA DENTAL OF NM

03085070 358569 88 DO (800) 238-3107 PO BOX 75983 SEATTLE WA DELTA USA/WA DENTAL

03100005 352530 38 AS (999) 999-9999 PO BOX 500 PLYMOUTH MI DETROIT MUTUAL INS

03129005 358569 38 AS (999) 999-9999 730 KEITH BLDG CLEVELAND OH DOMINION LIFE ASSURANCE

03138005 352530 38 AS (999) 999-9999 PO BOX 61 DURHAM NC PEOPLES SECURITY LIFE INSURANC

03156005 358569 38 AS (999) 999-9999 4400 N HIGH ST COLUMBUS OH EDUCATOR & EXEC INSURERS INC

03165005 358569 38 AS (999) 999-9999

800 BROOKSEDGE

BLVD WESTERVILLE OH EDUCATOR & EXEC LIFE INS CO

03174005 358569 38 AS (717) 397-2751 PO BOX 83888 LANCASTER PA EDUCATORS MUTUAL LIFE

03183005 352530 38 AS (508) 921-2080 715 LYNNWAY LYNN MA ELECTRIC INS CO

03192005 352530 38 AS (999) 999-9999 715 LYNNWAY LYNN MA ELECTRIC MUTUAL LIABILITY INS

03218005 358113 38 AS (999) 999-9999 221 WEST WAYNE ST SOUTH BEND IN EMMCO INSURANCE CO

03236005 358569 38 AS (999) 999-9999 1457 GRAND AVE ST PAUL MN EMPLOYEES MUTUAL BEN ASSOC

03254005 351113 38 AS (617) 725-6000 ONE BEACON ST BOSTON MA EMPLOYERS FIRE INS

03272005 358569 38 AS (999) 999-9999 PO BOX 712 DES MOINES IA EMPLOYERS MUTUAL CASUALTY CO

03281005 352530 38 AS (999) 999-9999 2000 WESTWOOD DR WAUSAU WI EMPLOYERS MUTUAL FIRE INS

03290005 358569 38 X2 (715) 847-7111 PO BOX 8013 WAUSAU WI EMPLOYERS INSUR OF WAUSAU MUT

03307005 352530 38 AS (999) 999-9999 PO BOX 2088 KANSAS CITY KS EMPLOYERS REINS CORP

03316005 358569 38 AS (999) 999-9999 4201 N 27TH ST MILWAUKEE WI EMPLOYEES MUTUAL BEN ASSOC

03325005 351113 07 AS (999) 999-9999 604 LOCUST ST DES MOINES IA EQUITABLE LIFE INS CO OF IA

03334005 351113 07 AS (999) 999-9999 PO BOX 900 MCLEAN VA EQUITABLE LIFE

03343005 351113 38 AS (999) 999-9999 PO BOX 448 NEENAH WI EQUITABLE RESERVE AS

03352005 352530 38 AS (999) 999-9999 221 WEST WAYNE ST SOUTH BEND IN EXCEL INSURANCE CO

Page 19: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

03361005 352530 38 AS (999) 999-9999 PO BOX 778 BETTENDORF IA EXCEL MTGE INS CORP

03370005 358569 38 AS (999) 999-9999 540 MADISON AVE NEW YORK NY EXECUTIVE LIFE INS CO OF NY

03399005 359196 38 AS (999) 999-9999 PO BOX 943 SYRACUSE NY EXCELSIOR INS CO NY

03405005 358569 38 AS (999) 999-9999 PARK PLACE SEATTLE WA FAMILY LIFE INS CO

03414005 351113 38 AS (616) 947-4460 PO BOX 30400 LANSING MI FARM BUREAU INS GROUP

03423005 351113 38 AS (517) 323-7000 7373 WEST SAGINAW LANSING MI FARM BUREAU MUTUAL INS MI

03441005 351113 38 AS (999) 999-9999 PO BOX 509 CALUMET MI FARMERS & MERCHANTS MUTUAL

03450005 352530 38 AS (999) 999-9999 36 DIVISION ST COLDWATER MI FARM MTL FIRE BR CO

03479005 352530 38 AS (999) 999-9999 201 EAST STATE ST ST JOHNS MI FARM MTL FIRE CLINTN

03488005 352530 38 AS (999) 999-9999 683 N PORT CRESCENT BAD AXE MI FARM MTL FIRE HURON

03497005 352530 38 AS (999) 999-9999 RFD #1 HOUGHTON MI FARM MTL FIRE OSKAR

03503005 351113 38 AS (999) 999-9999 2323 GRAND AVE DES MOINES IA FARMERS MUTUAL HAIL INS

03512005 351113 38 AS (999) 999-9999 141 W STATE ST TRAVERSE CITY MI FARMERS MUTUAL INS

03521005 351113 38 AS (206) 232-8400 150 S LINCOLN WAY AURORA IL FARMERS NEW WORLD IN

03530005 351113 38 AS (999) 999-9999 960 JAMES BOX 1056 SYRACUSE NY FARMERS TRADERS INS

03559005 358569 38 AS (999) 999-9999 51 JFK PARKWAY SHORT HILLS NJ FEDERAL INS CO NJ

03568005 359196 38 AS (999) 999-9999 ASSURANCE CO LONG GROVE IL FEDERAL KEMPER LIFE

03577005 358569 38 AS (999) 999-9999 3750 W DEERFIELD RD RIVER WOODS IL FEDERAL LIFE INS CO MUTUAL

03586005 358569 27 AS (877) 612-4477 PO BOX 50487 INDIANAPOLIS IN FEDERATED INSURANCE

03595005 358569 27 AS (800) 428-4143 PO BOX 328 OWATONNA MN FEDERATED MUTUAL INSURANCE CO

03595010 358569 89 AS (877) 612-4477 PO BOX 50487 INDIANAPOLIS IN FEDERATED MUTUAL INSURANCE CO

03595015 358569 89 AS (800) 428-4143 PO BOX 328 OWATONNA MN FEDERATED MUTUAL INSURANCE CO

03601005 352530 38 AS (999) 999-9999 2335 SOUTH 13TH ST MILWAUKEE WI FEDERATION LIFE INS

03610005 352530 04 AS (999) 999-9999 PO BOX 2368 RICHMOND VA FIDELITY BANKERS INS

03648005 352530 38 AS (999) 999-9999

CHARLES &

LEXINGTON BALTIMORE MD FIDELITY & DEPOSIT

03657005 352530 38 AS (999) 999-9999 CALVERT & REDWOOD BALTIMORE MD FIDELITY & GUAR UNDERWRITERS

03675005 352530 38 AS (999) 999-9999 3700 WILSHIRE BLVD LOS ANGELES CA FIDELITY INTERSTATE

03684005 352530 38 AS (999) 999-9999 110 TENTH AVENUE LONG GROVE IL FIDELITY LIFE ASSOC

03693005 352530 38 AS (999) 999-9999 PO BOX 7318 PHILADELPHIA PA FIDELITY MUTUAL LIFE

03719005 352530 38 AS (999) 999-9999 PO BOX 2580 DALLAS TX FIDELITY UNION LIFE

03728005 352530 38 AS (999) 999-9999 5858 WILSHIRE BLVD LOS ANGELES CA FINANCIAL INDEMNITY

03737005 351113 38 AS (999) 999-9999 100 QUINCY STREET HANCOCK MI FINNISH MUT FIRE INS

Page 20: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

03755005 351113 38 AS (999) 999-9999

3401 SAGINAW STE

211 LANSING MI FIRE INS EXCHANGE

03764005 413395 89 AS (800) 558-4444

1100 EMPLOYERS

BLVD GREEN BAY WI EMPLOYERS HEALTH INSURANCE

03773005 413395 62 AS (800) 558-4444 PO BOX 14610 LEXINGTON KY HUMANA EMPLOYERS HEALTH

03773010 358569 89 AS (800) 558-4444 PO BOX 14610 LEXINGTON KY HUMANA

03791005 352530 38 AS (999) 999-9999 24950 CHAGRIN BLVD CLEVELAND OH FIRST CATH SLOVIC LADIES ASSOC

03808005 352530 38 AS (999) 999-9999 3289 EAST 55TH ST CLEVELAND OH FIRST CATH SLOVIC UNION

03817005 358569 38 AS (999) 999-9999 700 MAIN ST LYNCHBURG VA FIRST COLONY LIFE INS CO

03826005 358569 38 AS (999) 999-9999 MUNSEY BUILDING BALTIMORE MD FIRST FEDERATED LIFE INS CO

03835005 352530 38 AS (999) 999-9999 PO BOX 468 WAYNE PA FIRST INVESTMENT ANNUITY OF AM

03844005 352530 38 AS (999) 999-9999 120 WALL STREET NEW YORK NY FIRST INVESTORS LIFE

03853005 352530 38 AS (999) 999-9999 PO BOX 3503 GREENSBORO NC FIRST MORTGAGE INS

03862005 358569 38 AS (999) 999-9999

4347 BROOKLYN AVE

NE SEATTLE WA FIRST NTL INS CO AME

03871005 358569 38 AS (999) 999-9999 475 479 BROADWAY GARY IN FIRST UNITED LIFE

03880005 352530 38 AS (999) 999-9999 500 ST LOUIS ST EDWARDSVILLE IL FLORISTS INSURANCE SERVICE INC

03906005 352530 38 AS (999) 999-9999 500 ST LOUIS STREET EDWARDSVILLE IL FLORISTS MUT INS CO

03915005 358871 38 AS (999) 999-9999 3700 WILSHIRE BLVD LOS ANGELES CA FORD LIFE INS CO

03915010 358871 38 AS (999) 999-9999 3700 WILSHIRE BLVD LOS ANGELES CA FORD LIFE INS CO

03924005 351113 38 X2 (999) 999-9999

5800 FOREMOST DR

SE GRAND RAPIDS MI FOREMOST GUARANTY CO

03933005 351113 38 AS (999) 999-9999 PO BOX 2186 GRAND RAPIDS MI FOREMOST INSURANCE COMPANY

03942005 413395 38 AS (616) 940-2099 PO BOX 888407 GRAND RAPIDS MI ASSURITY LIFE INSURANCE COMPANY

03951005 352530 38 AS (999) 999-9999 305 W MADISON CHICAGO IL FORESTERS CATH ORDER

03960005 352530 38 AS (999) 999-9999 789 DON MILLS RD DON MILLS ON FORESTERS IND ORDER

03989005 352530 38 AS (999) 999-9999 59 EAST VAN BUREN CHICAGO IL FORESTERS NAT CATH

03998005 358113 38 AS (999) 999-9999 ONE MUTUAL AVENUE FRANKENMUTH MI FRANKENMUTH MUTUAL

04019005 358113 38 AS (999) 999-9999 #1 FRANKLIN SQUARE SPRINGFIELD IL FRANKLIN LIFE INS CO

04019920 351113 89 NO (800) 687-0500 PO BOX 53010 LUBBOCK TX HEALTHSMART

04037005 413395 38 AS (999) 999-9999 5100 GAMBLE DR ST LOUIS PARK MN GAMBLE ALDEN LIFE INS CO

04042835 358113 38 AS (800) 605-2282 PO BOX 863 INDIANAPOLIS IN MULTI NATIONAL UNDERWRITERS

04046005 358569 89 AS (609) 588-3526 PO BOX 4808 TRENON NJ GARDEN STATE LIFE IN

04055005 351113 38 AS (999) 999-9999 4TH & WALNUT STS PHILADELPHIA PA GENERAL ACCIDENT FIRE & LIFE

Page 21: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

04064005 413395 13 AS (800) 854-7309

1000 GREAT WEST

DRIVE KENNETT MO GREAT WEST LIFE & ANNUITY INSURANCE CO

04064010 413395 38 AS (999) 999-9999 PO BOX 310 ELKHART IN GENERAL AMERICAN

04064015 413395 88 DO (800) 445-7119

1000 GREAT WEST

DRIVE KENNET MO GREAT WEST LIFE & ANNUITY INSURANCE CO

04064020 413395 38 AS (800) 854-7309 PO BOX 5445 ROCKFORD IL GENERAL AMERICAN

04064025 413395 38 AS (999) 999-9999

11700 WORTHINGTON

DRIVE TAYLOR MI GENERAL AMERICAN

04064030 413395 38 AS (800) 541-3234 719 TEACO RD KENNETT MO GENERAL AMERICAN

04064035 413395 89 AS (800) 854-7309

1000 GREAT WEST

DRIVE KENNETT MO GREAT WEST LIFE & ANNUITY INSURANCE CO

04073005 352530 38 AS (999) 999-9999 121 E WILSON ST MADISON WI GENERAL CASUALTY CO OF WI

04082005 351113 38 AS (999) 999-9999 275 GLEN COVE RD CARLE PLACE NY GENERAL FIRE & CASUALTY CO

04091005 358569 38 AS (999) 999-9999

4347 BROOKLYN AVE

NE SEATTLE WA GENERAL INS CO OF AMERICA

04108005 351113 38 AS (999) 999-9999

310 W WISCONSIN

AVE MILWAUKEE WI GENERAL LIFE INS CORP OF WI

04117005 352530 38 AS (999) 999-9999

TWO GREENWICH

PLAZA GREENWICH CT GENERAL REASSURANCE CORP

04126005 352530 38 AS (999) 999-9999 600 STEAMBOAT RD GREENWICH CT GENERAL REINSURANCE CORP

04135005 352530 38 AS (999) 999-9999 400 PARK AVE NEW YORK NY GENERAL REINSURANCE CORP

04144005 351113 38 AS (999) 999-9999 PO BOX 1302 DES MOINES IA GENERAL UNITED LIFE INS

04153005 352530 38 AS (999) 999-9999 PO 7325 ATLANTA GA GA INTL LIFE INS CO

04162005 358569 38 AS (999) 999-9999 445 STATE ST FREMONT MI GERBER LIFE INS CO

04171005 413395 38 AS (999) 999-9999 7784 AUSTIN ROAD SALINE MI GERMAN FARM MUT FIRE

04180005 413395 38 AS (999) 999-9999

GERMANTOWN MKT

SQUAR PHILADELPHIA PA GERMANTOWN INS CO

04206005 352530 38 AS (999) 999-9999

1600 N WOODWARD

AVE BIRMINGHAM MI GLEANER LIFE INS SOC

04215005 351113 38 AS (999) 999-9999 80 MAIDEN LANE NEW YORK NY GLEN FALLS INS CO

04224005 358569 38 AS (999) 999-9999 150 WILLIAM STREET NEW YORK NY GLOBE INDEMNITY CO

04233005 358569 38 AS (405) 270-1410 GLOBE LIFE CENTER OKLAHOMA CITY OK GLOBE LIFE AND ACCIDENT

04242005 358569 38 AS (999) 999-9999 GLOBE LIFE CENTER OKLAHOMA CITY OK GLOBE LIFE INS CO

04251005 358569 38 AS (213) 731-1131 PO BOX 2332 LOS ANGELES CA GOLDEN STATE MUTUAL LIFE INS

04289005 358569 41 AS (999) 999-9999 1705 L STREET NW WASHINGTON DC GOVERNMENT EMPLOYEES INS CO

04298005 358569 38 AS (999) 999-9999 1705 L STREET NW WASHINGTON DC GOVERNMENT EMPLOYEES LIFE INS

04304005 358569 38 AS (999) 999-9999 1752 N MERIDAN ST INDIANAPOLIS IN GRAIN DEALERS MUT CO

04313005 351113 38 AS (999) 999-9999 PO BOX 960 MANCHESTER NH GRANITE STATE INS CO

04331005 358569 38 AS (999) 999-9999 PO BOX 30019 LOS ANGELES CA GREAT AMERICAN LIFE INS NJ

Page 22: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

04340005 358569 38 AS (999) 999-9999 P.O. BOX 388 DALLAS TX GREAT AMERICAN RESERVE INS

04378005 351113 38 AS (999) 999-9999 1309 MAIN ST DALLAS TX GREAT COMMONWEALTH LIFE INS CO

04396005 352530 38 AS (999) 999-9999 4254 CLAIRTON BLVD PITTSBURGH PA GREATER BENEFICIAL UNION

04402005 351113 38 AS (999) 999-9999 770 BROADWAY NEW YORK NY GREATER NY MUTUAL INS CO

04411005 352530 38 AS (999) 999-9999 520 EAST 8TH AVENUE MUNHALL PA GREEK CATH UNION USA

04420005 358569 38 AS (999) 999-9999 150 BAGLEY AVENUE DETROIT MI GROUP INS CO OF MI

04449005 358569 38 AS (999) 999-9999 440 LINCOLN ST WORCESTER MA GUARANTEE MUTUAL CO OF AM

04458005 358569 38 AS (800) 842-3729 8721 INDIAN HILLS OMAHA NE GUARANTEE MUTUAL LIFE CO

04467005 358569 38 R6 (847) 699-0600 1275 MILWAUKEE AVE GLEN VIEW IL GUARANTEE TRUST LIFE

04476005 358569 38 AS (999) 999-9999 100 W 10TH ST WILMINGTON DE GUARDIAN LIFE & ANNUITY CO INC

04485005 358569 79 AS (800) 873-4542 PO BOX 8007 APPLETON WI GUARDIAN

04494005 358569 38 AS (999) 999-9999 PO BOX 1054 DALLAS TX GULF ATLANTIC LIFE

04500005 358569 38 AS (999) 999-9999 PO BOX 1771 DALLAS TX GULF INS CO MO

04529005 352530 38 AS (999) 999-9999 1520 MADISON ROAD CINCINNATI OH HAMILTON MUT INS CO

04538005 351113 38 AS (999) 999-9999 3925 N MERIDAN INDIANAPOLIS IN HAMILTON NATL LIFE

04556005 413395 38 AS (999) 999-9999 4201 WILSHIRE BLVD LOS ANGLELES CA HARBOR INSURANCE CO

04556010 413395 38 AS (877) 775-7300 PO BOX 2775 ELKHART IN HARBOR BENEFIT SERVICES

04565005 351113 38 AS (999) 999-9999 401 N EXECUTIVE DR BROOKFIELD WI ASSOCIATION LIFE INS

04574005 358569 38 AS (800) 243-5860 PO BOX 2910 HARTFORD CT HARTFORD

04592005 358569 38 AS (999) 999-9999 HARTFORD PLAZA HARTFORD CT HARTFORD ACC & INDEM

04618005 358569 38 AS (999) 999-9999 HARTFORD PLAZA HARTFORD CT HARTFORD FIRE INS CO

04627005 358569 38 AS (800) 444-3441 PO BOX 5002 BOLINGBROOK IL HARTFORD

04636005 358569 38 AS (201) 291-2852

PARK 80 W PLAZA 2

SUITE200 SADDLE BROOK NJ HARTFORD LIFE INSURANCE

04636010 358569 38 AS (999) 999-9999 PO BOX 9366 GARDEN CITY NY HARTFORD LIFE INS-RETIRED TEAM

04645005 358569 38 AS (999) 999-9999 56 PROSPECT STREET HARTFORD CT HARTFORD STEAM BOIL

04654005 358569 38 AS (999) 999-9999 HARTFORD PLAZA HARTFORD CT HARTFORD VARIABLE ANNUITY LIFE

04663005 358569 38 AS (999) 999-9999

404 EAST WOODLAND

AV HASTINGS MI HASTINGS MUTUAL INS

04672005 351113 38 AS (999) 999-9999 1017 WALNUT STREET DES MOINES IA HAWKEYE-SECURITY INS

04681005 351113 38 AS (999) 999-9999 676 N ST CLAIR ST CHICAGO IL HEALTH SERVICE INC

04681010 352530 38 AS (877) 624-1326 PO BOX 619055 DALLAS TX HEALTHSCOPE

04690005 352530 38 AS (999) 999-9999

CULLEN CTR BLANK

BLG HOUSTON TX HIGHLANDS INSURANCE

Page 23: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

04707005 413395 38 AS (999) 999-9999 ONE FAIRLANE DRIVE JOLIET IL HOLY FAMILY SOCIETY

04716005 352530 38 AS (603) 669-2761 PO BOX 5160 MANCHESTER NH HOME INDEMNITY CO NH

04734005 351113 38 X5 (800) 221-3231 P O BOX 1370 PISCATAWAY NJ ANTHEM HEALTH HOME LIFE INS CO

04734010 351113 38 AS (419) 342-8233 P O BOX 956353 DULUTH GA ANTHEM LIFE INSURANCE CORP

04734015 351113 05 AS (800) 231-5114 PO BOX 88260 ATLANTA GA ANTHEM HEALTH & LIFE

04734020 351113 89 AS (800) 728-3705 PO BOX 6881 PISCATAWAY NJ ANTHEM HEALTH HOME LIFE INS CO

04752005 351113 38 AS (999) 999-9999 PO BOX 660 LANSING MI HOME OWNERS MUTUAL

04761005 358569 38 AS (217) 789-2500 HORACE MANN PLAZA SPRINGFIELD IL HORACE MANN INS CO

04770005 358569 38 AS (999) 999-9999

1 HORACE MANN

PLAZA SPRINGFIELD IL HORACE MANN LIFE INS

04799005 352530 38 AS (999) 999-9999

3216 NEW MEXICO N

W WASHINGTON DC HUNGARIAN REFORM FED

04805005 358569 38 AS (800) 282-2536 IDS TOWER MINNEAPOLIS MN IDS LIFE INSURANCE

04814005 352530 38 AS (999) 999-9999 1600 ARCH STREET PHILADELPHIA PA INA REINSURANCE CO

04823005 351113 38 AS (800) 541-6757 505 HWY, 169 NORTH MINNEAPOLIS MN ITT HARTFORD LIFE & ANNUITY

04832005 413395 38 AS (999) 999-9999

261 MADISON

AVENUE NEW YORK NY IDEAL MUTUAL INS CO

04841005 352530 38 AS (309) 674-8255 300 SW ADAMS ST PEORIA IL IL MUTUAL LIFE

04879005 413395 87 RX (800) 233-3872 33381 WALKER RD AVON LAKE OH IMMEDIATE PHARMACEUTICAL SERVICE

04888005 352530 38 AS (999) 999-9999 111 JOHN STREET NEW YORK NY INDEMNITY MARINE ASR

04903005 352530 38 AS (317) 266-2217

115 NORTH

PENNSYLVAN INDIANAPOLIS IN IN INSURANCE CO

04912005 358569 38 AS (999) 999-9999 429 N PENNSYLVANIA INDIANAPOLIS IN IN LUMBERMENS

04921005 351113 38 AS (800) 628-4664 2960 N MERIDIAN ST INDIANAPOLIS IN INTERNATIONAL MANAGEMENT GROUP

04930005 358569 38 AS (999) 999-9999 PO BOX 3660 SAN FRANCISCO CA INDUSTRIAL INDEMNITY

04959005 358569 38 AS (999) 999-9999

3815 MONTROSE

BLVD HOUSTON TX STATESMAN NATIONAL LIFE INS CO

04968005 351113 38 AS (999) 999-9999 PO BOX 2085 HUNTINGTON WV INLAND MUTUAL INS CO

04977005 351113 38 AS (313) 353-4022 1600 ARCH ST PHILADELPHIA PA INSURANCE CO OF N AMERICA

04977010 351113 38 AS (999) 999-9999

406 W 34TH ST ROOM

316 KANSAS CITY MO INSURANCE CO OF N AMERICA

04986005 351113 38 AS (302) 594-2733 102 MAIDEN LANE NEW YORK NY INSURANCE CO OF PA

04986015 352530 38 AS (800) 225-1345 PO BOX 690 OAKLAND NJ INSURANCE DESIGN ADMINISTRATORS

04995005 351113 38 AS (999) 999-9999 420 NORTH SPRUCE ST WINSTON-SALEM NC INTEGON LIFE INS COR

05007005 413395 38 AS (999) 999-9999 197 CEDAR LANE TEANECK NJ INTEGRITY INSURANCE

05016005 413395 38 AS (502) 426-1843 PO BOX 32350 LOUISVILLE KY INTEGRITY NATIONAL LIFE

05025005 358569 38 X2 (515) 243-3210 PO BOX 9120 DES MOINES IA BENEFIT ADMINISTRATORS OF AMER

Page 24: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

05034005 352530 38 AS (999) 999-9999 24 COMMERCE ST NEWARK NJ INTERNATIONAL FIDELITY INS CO

05043005 358569 38 AS (616) 957-1751 PO BOX 2387 MORRISTOWN NJ INTERNATIONAL INS CO CHICAGO

05052005 358569 38 AS (999) 999-9999 6930 CARROLL AVE TAKOMA PARK MD INTERNATIONAL INS CO MD

05061005 358569 38 AS (999) 999-9999 120 DELAWARE AVE BUFFALO NY INTERNATIONAL LIFE INS

05070005 352530 38 AS (999) 999-9999 9611 SUNSET HWY SE MERCER ISLAND WA INVESTORS GUARANTY CA

05099005 352530 38 AS (999) 999-9999 PO BOX 8310 BOSTON MA INVESTORS MORTGAGE INS OF IL

05105005 351113 38 AS (999) 999-9999 208 EAST STATE ST MASON CITY IA IA KEMPER INS CO

05114005 351113 38 AS (999) 999-9999

518 SECOND AVENUE

SE CEDAR RAPIDS IA IA NATL MUT INS

05114010 351113 67 XR (999) 999-9999

5806 MEREDITH

DRIVE DES MOINES IA IA LABORERS DISTRICT COUNCIL

05123005 351113 38 AS (999) 999-9999 PO BOX 1474 DES MOINES IA IA ST TRAVELER ASSOC

05132005 352530 38 AS (999) 999-9999 327 HECLA STREET LAURIUM MI ITALIAN MUTUAL FIRE

05141005 351113 38 AS (800) 692-5246

2700 WEST PLANO

PARKWAY PLANO TX JC PENNEY INS CO

05150005 351113 84 IO (800) 692-5246

2700 WEST PLANO

PARKWAY PLANO TX STONEBRIDGE LIFE INS CO

05179005 352530 38 AS (517) 394-3400 1514 CLINTON ROAD JACKSON MI JACKSON NATL LIF INS

05188005 351113 38 AS (999) 999-9999 ONE PARK AVENUE NEW YORK NY JEFFERSON INS CO-NY

05197005 352530 38 AS (999) 999-9999

ONE VIRGINIA

AVENUE INDIANAPOLIS IN JEFFERSON NATL LIFE

05212005 351113 38 AS (800) 350-7584

1300 RIVER DR STE

200 MOLINE IL UNITED HEALTHCARE SERVICES OF THE RIVER VALLE

05212010 351113 89 AS (800) 350-7584

1300 RIVER DR STE

200 MOLINE IL UNITED HEALTHCARE SERVICES OF THE RIVER VALLE

05221005 351113 38 AS (999) 999-9999 291 GLEN ST GLEN FALLS NY KS CITY FIRE & MARINE INS

05230005 358569 38 AS (800) 874-5254 PO BOX 219325 KANSAS CITY MO KANSAS CITY LIFE INS

05259005 351113 38 AS (999) 999-9999 ROUTE 22 LONG GROVE IL KEMPER SECURITY INS

05268005 351113 38 AS (999) 999-9999 ONE KEMPER DRIVE LONG GROVE IL KEMPER REINSURANCE CO

05286005 413395 38 AS (999) 999-9999 99 HIGH STREET BOSTON MA KEYSTONE PROVIDEN RI

05286010 413395 89 AS (800) 227-3114 PO BOX 8339 PHILADELPHIA PA KEYSTONE HEALTH PLAN EAST

05295005 352530 38 AS (999) 999-9999 PO DRAWER 1670 NEW HAVEN CT KNIGHTS OF COLUMBUS

05301005 351113 38 AS (999) 999-9999 575 SIXTH AVENUE NEW YORK NY LABOR ZIONIST ALLIAN

05310005 352530 38 AS (999) 999-9999 69 PUBLIC SQUARE WILKES BARRE PA LADIES PA SLOV CATHO

05339005 352530 38 AS (317) 477-7411

1905 TEAL RD PO BOX

7007 LAFAYETTE IN LAFAYETTE LIFE INS CO

05348005 351113 38 AS (804) 281-6700 PO BOX 27567 RICHMOND VA LAWYERS TITLE INS CP

05357005 352530 38 AS (999) 999-9999 PO BOX 820 ANDERSON IN LAYMEN LIFE INS CO

05366005 352530 38 AS (999) 999-9999 PO BOX 5250 DETROIT MI LEAGUE GENERAL INS CO

Page 25: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

05375005 352530 38 AS (999) 999-9999

POST OFFICE BOX

5010 DETROIT MI LEAGUE LIFE INS CO

05384005 358569 38 AS (999) 999-9999 PO BOX 1500 SMITHTOWN NY LIBERTY MUTUAL

05393005 351113 38 AS (999) 999-9999

100 LINCOLNWAY

WEST MISHAWAKE IN LIBERTY LIFE INSURANCE CO

05419005 352530 38 AS (999) 999-9999

7840 MONTGOMERY

ROAD CINCINNATI OH LIBERTY MORTGAGE INS

05428005 358569 38 AS (800) 344-0197 175 BERKELEY STREET BOSTON MA LIBERTY MUTUAL INSURANCE GROUP

05437005 358569 38 AS (999) 999-9999

100 LINCOLNWAY

WEST MISHAWAKA IN LIBERTY MUTUAL

05446005 358569 38 AS (517) 595-6101 PO BOX 426 ALPENA MI PRESQUE ISLE CORPORATION

05446010 413395 89 AS (888) 711-1444 PO BOX 11625 GREEN BAY WI ARISE HEALTH PLAN

05455005 351113 38 AS (999) 999-9999 100 CALIFORNIA ST SAN FRANCISCO CA LIFE INS CO OF CA

05464005 351113 38 AS (999) 999-9999 102 MAIDEN LANE NEW YORK NY LIFE INS CO OF NH

05473005 351113 38 AS (999) 999-9999 PO BOX 147 PHILADELPHIA PA LIFE INS CO OF NORTH AMERICA

05482005 351113 38 AS (999) 999-9999 P O BOX 806093 CHICAGO IL LIFE OF VA

05491005 413395 38 AS (999) 999-9999 PO BOX 1173 LOUISVILLE KY LINCOLN INCOME LIFE

05508005 358569 38 AS (999) 999-9999 5700 CROOKS RD TROY MI LINCOLN MUTUAL CASUALTY

05517005 351113 38 AS (999) 999-9999 307W 30TH ST NEW YORK NY LITHUANIAN ALLI AMER

05526005 351113 38 AS (999) 999-9999 PO BOX 32 WILKES BARRE PA LITHUANIAN ROMAN CATHOLIC

05535005 351113 38 AS (999) 999-9999 150 WILLIAM ST NEW YORK NY LIVERPOOL LON GL INS

05544005 351113 38 AS (999) 999-9999 28W ADAMS AVE DETROIT MI LOCOMO ENG COND MUTL

05553005 352530 38 AS (999) 999-9999 80 MAIDEN LANE NEW YORK NY LONDON GUAR & ACC CO OF NY

05562005 352530 38 AS (999) 999-9999 150 WILLIAM ST NEW YORK NY LONDON & LANCASHIRE INS

05580005 351113 38 AS (999) 999-9999 225 BARONNE ST NEW ORLEANS LA LA & SOUTHERN LIFE INS

05606005 351113 38 AS (999) 999-9999 PO BOX 1865 LOUISVILLE KY LOUISVILLE TITLE INS

05615005 352530 38 AS (800) 633-6752 PO BOX 6408 MOBILE AL LOYAL AMERICAN INSURANCE

05624005 352530 38 AS (999) 999-9999 305W SIXTH ST ERIE PA LOYAL CHRIST BEN ASS

05633005 352530 38 AS (999) 999-9999

1 NEWTON EXECUTIVE

PARK NEWTON LOW FLS MA LOYAL PROTECTIVE LIFE INS CO

05642005 358569 38 AS (999) 999-9999 5651 LONG GROVE IL LUMBERMENS MUT CAS

05660005 358569 38 AS (800) 327-0515 5115 OAK ST KANSAS CITY MO LUMBERMENS UNDERWRITING ALL

05689005 358569 38 AS (612) 340-5865 625 4TH AVE SOUTH MINNEAPOLIS MN LUTHERAN BROTHERHOOD

05689010 358569 38 AS (999) 999-9999 PO BOX 59093 MINNEAPOLIS MN BOARD OF PENSIONS

05698005 358569 38 AS (999) 999-9999 728 PENOBSCOT BLDG DETROIT MI LUTHERAN LIFE ASSOC OF AMERICA

05704005 358569 38 AS (999) 999-9999 201 11 FIRST ST SE WAVERLY IA LUTHERAN MUTUAL LIFE INS CO

05704010 358569 89 AS (888) 312-9744 PO BOX 2592 FT. WAYNE IN LUTHERAN PREFERRED

05713005 351113 38 AS (999) 999-9999

1817 WEST

BROADWAY COLUMBIA MO MFA MUTUAL INS CO

Page 26: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

05722005 358569 38 AS (999) 999-9999 501 FIFTH AVE NEW YORK NY MGIC INDEMNITY CORP

05740005 358569 38 AS (999) 999-9999 PO BOX 2099 LOUISVILLE KY MAMMOTH LIFE ACC INS

05769005 351113 38 AS (999) 999-9999 260 LONG RIDGE RD STANFORD CT MANHATN FIRE MAR INS

05778005 351113 38 AS (999) 999-9999 111 WEST 57TH ST NEW YORK NY MANHATN LIFE INS CO

05787005 413395 38 AS (999) 999-9999 200 BLOOR ST E TORONTO ON MANUFACTURERS LIFE INS CO

05796005 352530 38 AS (999) 999-9999 0 NEW LOTHROP MI MAPLE GRV MUT FI INS

05802005 358569 38 AS (999) 999-9999 150 WILLIAM ST NEW YORK NY MARINE INS CO LIMITD

05820005 413395 38 AS (999) 999-9999 130 E RANDOLPH ST CHICAGO IL MD LIFE INSURANCE BAL

05849005 358569 38 AS (999) 999-9999 PO BOX 122 NEW YORK NY MA BAY INS CO

05867005 358569 38 AS (303) 779-1111

7730 E BELLEVIEW

AVE ENGLEWOOD CO MA GENERAL LIFE

05876005 358569 38 AS (213) 828-9547

3120 BRECKINRIDGE

BLVD. DULUTH GA MA INDEMNITY & LIFE

05885005 352530 16 AS (877) 864-2273 PO BOX 4458 CHICAGO IL UNICARE

05885010 352530 16 AS (800) 333-1114 PO BOX 201868 ARLINGTONN TX UNICARE

05885015 352530 16 AS (999) 999-9999 PO BOX 5005 BOILINGBROOK IL UNICARE

05885020 352530 16 AS (999) 999-9999 PO BOX 5025 BOLINGBROOK IL UNICARE

05885025 352530 16 AS (999) 999-9999 PO BOX 51660 INDIAN ORCHARD MA UNICARE

05885030 352530 16 AS (800) 288-8630 P.O. Box 4458 Chicago IL UNICARE

05885035 352530 16 AS (800) 284-3427 PO BOX 60073 CITY OF INDUSTR CA UNICARE

05885040 352530 16 AS (877) 864-2273 PO BOX 4458 CHICAGO IL UNICARE

05885045 352530 89 AS (800) 922-7308 PO BOX 10317 VAN NUYS CA UNICARE PPO

05885050 352530 89 AS (800) 288-8630 PO BOX 4458 CHICAGO IL UNICARE

05885055 352530 87 RX (877) 864-2273 PO BOX 4458 CHICAGO IL UNICARE

05886005 352530 16 AS (800) 333-2993 PO BOX 100008 DECATUR GA UNICARE

05894005 351113 38 AS (999) 999-9999

2 LIBERTY SQ. 4TH

FLOOR BOSTON MA MA PLATE GLASS INS

05900005 352530 38 AS (999) 999-9999

520 S LAFAYETTE PARK

PL LOS ANGELES CA IL INTERSTATE INS AGENCY

05929005 413395 38 AS (999) 999-9999 5814 REED RD FORT WAYNE IN MEDICAL PROTECT CO

05938005 352530 38 AS (999) 999-9999 300 S CAPITOL LANSING MI MERCANTILE & GENERAL REIN CO

05947005 358569 38 AS (716) 849-3907 250 MAIN ST BUFFALO NY MERCHANTS MUT INS CO

05956005 352530 38 AS (999) 999-9999

4321 OKEMOS RD-

BOX 2520 OKEMOS MI MERIDIAN MUTUAL INSURANCE CO

05965005 352530 38 AS (999) 999-9999 2955 N MERIDIAN ST INDIANAPOLIS IN MERIDIAN MUT INS CO

05983005 413395 38 AS (999) 999-9999 4027 E NINE MILE RD WARREN MI METRO MUTUAL INS CO

05992005 351113 34 AS (999) 999-9999 1000 ASYLUM AVE HARTFORD CT METROPOLITAN FIRE ASSUR CO

06004005 352530 38 AS (999) 999-9999 PO BOX 86 DETROIT MI MI BASIC PROPERTY INS

Page 27: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

06013005 351113 38 AS (999) 999-9999 20840 SOUTHFIELD RD SOUTHFIELD MI MI EDUCATIONAL EMPLOYEES MUT

06022005 351113 38 AS (800) 848-0630 P O BOX 2399 COLUMBUS OH MI LIFE INSURANCE CO

06031005 413395 38 AS (999) 999-9999 PO BOX 30060 LANSING MI MI MILLERS MUTUAL INSURA

06040005 352530 38 AS (999) 999-9999 121 W FRONT ST TRAVERSE CITY MI MI MUTUAL AUTO INS CO

06069005 352530 38 AS (999) 999-9999 28 W ADAMS AVE DETROIT MI MI MUTUAL LIABILITY CO

06087005 358569 38 AS (999) 999-9999 PO BOX 2106 SAGINAW MI MID AMER LF ASSURANC

06096005 413395 38 AS (999) 999-9999

3401 SAGINAW STE

211 LANSING MI MID CENTURY INS CO

06102005 358569 38 AS (999) 999-9999 310 S MICHIGAN AVE CHICAGO IL MID STATES INS CO

06111005 358569 38 AS (999) 999-9999 1301 CENTRAL ST EVANSTON IL MID STATES LIFE INS CO OF AMER

06120005 352530 38 AS (999) 999-9999 160 WATER ST NEW YORK NY MIDLAND INS CO

06149005 352530 38 AS (999) 999-9999 250 E BROAD ST COLUMBUS OH MIDLAND MUTUAL LIFE INS

06158005 352530 38 AS (999) 999-9999 ONE MIDLAND PLAZA SIOUX FALLS SD MIDLAND NAT LIFE INS

06167005 358569 38 AS (999) 999-9999 1111 ASHWORTH RD WEST DES MOINES IA MIDWEST MUT INS CO

06176005 413395 38 AS (999) 999-9999 7551 US HIGHWAY 24 W FORT WAYNE IN MIDWESTERN UN LF INS

06185005 358569 38 AS (999) 999-9999 805 N FRONT ST HARRISBURG PA MILLERS MUTUAL INS

06194005 358569 38 AS (999) 999-9999 320 EASTON ST ALTON IL MILLERS MUTUAL INS ASSOC OF IL

06200005 358569 38 AS (999) 999-9999 29 N WACKER DR CHICAGO IL MILLERS NAT INS CO

06229005 358569 38 AS (999) 999-9999 3100 W LAKE ST MINNEAPOLIS MN MINISTERS LIFE AND CASUALTY

06247005 358569 38 AS (999) 999-9999 345 CEDAR ST ST PAUL MN MN MUT LF INS

06256005 352530 38 AS (999) 999-9999 2601 WILSHIRE BLVD LOS ANGELES CA MISSION INS CO

06265005 358569 38 AS (999) 999-9999 1701 1ST AVE ROCK ISLAND IL MODERN WOODMEN AMER

06274005 358569 38 AS (419) 485-8371

910 EAST MAIN

STREET MONTPELIER OH MOHAWK TOOLS INC

06283005 351113 38 AS (999) 999-9999 19 RECTOR ST NEW YORK NY MONARCH INS OF OH

06292005 351113 38 AS (913) 649-0370 ONE MONARCH PLACE SPRINGFIELD MA MONARCH LIFE INS CO

06309005 358569 38 AS (999) 999-9999 PO BOX 5003 NORTH SUBURBAN IL MONTGOMERY WARD

06318005 413395 38 AS (800) 854-0186 P O BOX 97 SCRANTON PA MONUMENTAL GENERAL INS CO

06327005 351113 38 AS (999) 999-9999 600 MARINE PLAZA MILWAUKEE WI MORTGAGE GUAR INS

06390005 413395 38 AS (999) 999-9999 RM 359 PA CEN STA PHILADELPHIA PA MUTUAL BEN ASSOC OF PA

06407005 413395 69 AS (800) 454-5105 PO BOX 624 MILWAUKEE WI ASSURANT HEALTH

06407010 413395 69 AS (800) 444-6254 PO BOX 624 MILWAUKEE WI ASSURANT HEALTH

06407015 413395 89 AS (800) 552-0694 PO BOX 624 MILWAUKEE WI ASSURANT HEALTH

06407020 358569 69 AS (800) 847-8284 PO BOX 27267 MINNEAPOLIS MN CORPORATE BENEFIT SERVICES OF AMERICA

06407025 359196 87 RX (999) 999-9999 PO BOX 4999 INTERNA'L FALLS MN FORTIS BENEFITS/DPS

06407030 413395 69 AS (800) 325-8385 PO BOX 624 MILWAUKEE WI ASSURANT HEALTH

Page 28: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

06407035 413395 69 AS (800) 442-7742 PO BOX 624 MILWAUKEE WI ASSURANT HEALTH

06407040 358569 89 AS (800) 847-8284 PO BOX 27267 MINNEAPOLIS MN MERITAIN HEALTH (FORMERLY CBSA)

06416005 351113 38 AS (999) 999-9999 225 WYMAN ST WALTHAM MA MUTUAL BOILER & MACH INS CO

06425005 358569 38 AS (616) 458-8323 PO BOX 8591 GRAND RAPIDS MI MUTUAL FUNDING CORP

06434005 413395 54 R6 (800) 228-6080

1515 SOUTH 75TH

STREET OMAHA NE MUTUAL PROTECTIVE MEDICO LIFE

06443005 352530 38 AS (999) 999-9999

3000 E COLISEUM

BLVD FORT WAYNE IN MUTUAL SECURITY LIFE

06461005 351113 38 AS (800) 328-0482 PO BOX 64035 ST PAUL MN MUTUAL SERVICE LIFE INS CO

06470005 358569 38 AS (999) 999-9999 77 S WACKER DR CHICAGO IL MUTUAL TRUST LIFE INS CO

06499005 358569 38 AS (800) 527-2845 9151 GRAPEVINE HWY N RICHLAND HILL TX PFL AND LIFE

06505005 358569 38 AS (999) 999-9999 7100 W CENTER RD OMAHA NE NATIONAL AMERICAN INS CO

06514005 413395 38 AS (999) 999-9999 360 W JACKSON BLVD CHICAGO IL BEN FRANKLIN LIFE WI

06532005 358569 38 AS (999) 999-9999 ALLSTATE PLAZA NORTHBROOK IL NATIONAL EMBLEM INS

06541005 358569 38 AS (999) 999-9999 1002 WALNUT ST KANSAS CITY MO NATIONAL FIDELITY LIFE

06550005 358569 38 AS (999) 999-9999 4401 HAMPTON AVE ST LOUIS MO NATIONAL FIRE & INDEMNITY EXCH

06579005 358569 38 AS (999) 999-9999 310 S MICHIGAN CHICAGO IL NATIONAL FIRE INS OF HARTFORD

06588005 351113 38 AS (999) 999-9999 6701 W NORTH AVE OAK PARK IL NATIONAL FRAT SOCIETY OF DEAF

06597005 358569 38 AS (999) 999-9999 PO BOX 25096 LANSING MI NATIONAL GRANGE MUTUAL INS CO

06603005 358569 89 AS (800) 822-3287 110 GIBRALTAR ROAD HORSHAM PA AON SELECT

06612005 351113 38 AS (303) 779-1111

7730 E BELLEVIEW

AVE ENGLEWOOD CO NATIONAL HERITAGE LIFE INS CO

06621005 413395 38 AS (800) 523-7900 CLAIMS DEPARTMENT VALLEY FORGE PA MONUMENTAL LIFE INSURANCE COMPANY

06659005 351113 38 AS (999) 999-9999 LIBERTY PARK FRAZER PA NATIONAL INDEPENDENCE INS CO

06668005 358569 38 AS (999) 999-9999 PO BOX 10155 ST LOUIS MO NATIONAL INS UNDERWRITERS

06677005 358569 38 AS (999) 999-9999 300 S CAPITOL LANSING MI NATIONAL LIFE INS CO OF CANADA

06686005 358569 38 AS (999) 999-9999 NATIONAL LIFE DR MONTPELIER VT NATIONAL LIFE INS CO

06695005 351113 38 AS (614) 486-7713 PO BOX 2335 COLUMBUS OH NATIONAL MASONIC PROV ASSOC

06701005 351113 38 AS (999) 999-9999

119-121 MONONA

AVE MADISON WI NATIONAL MUTUAL BENEFIT

06748005 352530 38 AS (999) 999-9999 PO BOX 2900 LITTLE ROCK AR NATIONAL OLD LINE INS CO

06757005 352530 38 AS (999) 999-9999 123 WILLIAM ST NEW YORK NY NATIONAL REINSURANCE CORP

06766005 352530 38 AS (800) 332-3787

30775 BARRINGTON

AVENUE MADISON HEIGHTS MI FIRST SECURITY LIFE & HEALTH

06775005 351113 38 AS (999) 999-9999 516 COURT PLACE PITTSBURGH PA NATIONAL SLOVAK SOCIETY OF USA

Page 29: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

06784005 351113 38 AS (999) 999-9999 175 W JACKSON BLVD CHICAGO IL NATIONAL SURETY CORPORATION

06793005 352530 38 AS (800) 232-5818 P O BOX 9197 DES MOINES IA NATIONAL TRAVELERS LIFE

06819005 351113 89 AS (866) 960-0772 PO BOX 2066 JACKSONVILLE FL NATIONAL UNION FIRE INS CO

06828005 413395 38 X5 (800) 826-9781 P O BOX 16786 COLUMBUS OH NATIONWIDE LIFE INSUR CO

06837005 413395 38 AS (999) 999-9999 246 N HIGH STREET COLUMBUS OH NATIONWIDE MUT FIRE

06846005 351113 38 AS (999) 999-9999 62 MAPLE AVENUE KEENE NH NETHERLANDS INS CO

06855005 413395 38 AS (800) 678-5764 PO BOX 11111 FORT SCOTT KS NEW ENGLAND, THE

06855010 413395 38 AS (800) 663-8081 PO BOX 11111 FORT SCOTT KS NEW ENGLAND EMP BEN GROUP

06855015 413395 89 AS (800) 678-5764 PO BOX 11111 FORT SCOTT KS NEW ENGLAND THE

06856005 413395 38 XR (800) 241-3267

115 PERIMETER-

STE465 W ATLANTA GA NEW ENGLAND INSURANCE

06857005 413395 38 XR (800) 374-2749

900 SECOND AVE,S-

STE650 MINNEAPOLIS MN NEW ENGLAND, THE

06864005 413395 38 AS (999) 999-9999 60 BATTERYMARCH ST BOSTON MA NEW ENGLAND REINSURANCE CORP

06873005 351113 38 AS (999) 999-9999 1750 ELM ST MANCHESTER NH NH INDEMNITY

06882005 358569 38 AS (800) 562-8215 BOX 960 MANCHESTER NH NH INS CO

06891005 358569 71 AS (999) 999-9999 EAST STREET EDMESTON NY NY CENTRAL MUT FIRE INS

06908005 358569 38 AS (212) 576-7000 PO BOX 4000 FREEHOLD NJ NY LIFE

06908010 358569 38 AS (800) 876-4314

180 SHEREE BLVD STE

1400 EXTON PA NY LIFE

06908015 358569 89 AS (800) 486-3040 4500 FULLER DRIVE IRVING TX NY LIFE

06908020 358569 89 AS (800) 635-3121 PO BOX 509 GREENBELT MD NYLCARE HEALTH PLANS

06917005 351113 71 AS (999) 999-9999 HARTFORD PLAZA HARTFORD CT NY UNDERWRITERS INS

06926005 351113 38 AS (999) 999-9999 150 WILLIAM STREET NEW YORK NY NEWARK INS CO OF NJ

06935005 352530 38 AS (999) 999-9999 80 MAIDEN LANE NEW YORK NY NIAGRA FIRE INS CO

06944005 358569 38 AS (999) 999-9999 1338 MILITARY ST PORT HURON MI NORTH AMERICAN BENEFIT ASSOC

06953005 358569 38 AS (312) 648-7646 PO BOX 466 CHICAGO IL NORTH AMERICAN CO FOR LIFE &

06962005 413395 38 AS (999) 999-9999

105 ADELAIDE ST

WEST TORONTO M5HIRI ON NORTH AMERICAN LIFE ASSUR CO

06971005 413395 38 AS (800) 328-5600 1750 HENNEPIN AVE MINNEAPOLIS MN NORTH AMERICAN LIFE & CASUALTY

06980005 413395 38 AS (999) 999-9999 35 E WACKER DR CHICAGO IL NORTH AMERICAN LIFE INS CO OF

07001005 351113 38 AS (999) 999-9999 245 PARK AVE NEW YORK NY NORTH AMERICAN REINS CORP

07010005 358569 38 AS (312) 782-5350 703 LAKE STREET CHICAGO IL NORTH AMERICAN UNION LIFE

07039005 351113 38 AS (999) 999-9999 MUTUAL PLAZA DURHAM NC NC MUTUAL LIFE INS

07048005 352530 38 AS (999) 999-9999 275 E 4TH STREET ST PAUL MN NORTH CENTRAL LIFE

07057005 351113 38 AS (999) 999-9999 PO BOX 2387 MORRISTOWN NJ NORTH RIVER INS NJ

07066005 352530 38 AS (999) 999-9999 90 WILLIAM ST NEW YORK NY NORTH STAR REINSURANCE CORP

07075005 351113 38 AS (999) 999-9999 919 THIRD AVE 34TH F NEW YORK NY NORTHEASTERN LIFE NY

Page 30: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

07084005 413395 38 AS (999) 999-9999 ONE BEACON ST BOSTON MA NORTHERN ASSURANCE CO OF AM

07093005 358569 38 AS (999) 999-9999 PO BOX 91 BALTIMORE MD NORTHERN INSURANCE CO OF NY

07119005 352530 38 AS (999) 999-9999 380 WELLINGTON ST LONDON ON NORTHERN LIFE ASSURANCE CANADA

07128005 352530 38 AS (999) 999-9999 PO BOX 12530 SEATTLE WA NORTHERN LIFE INS CO

07137005 352530 38 AS (999) 999-9999 112 CLEVELAND ISHPEMING MI NORTHERN MUTUAL FIRE INS CO

07146005 352530 38 AS (999) 999-9999 BOX 580 BISMARCK ND NORTHERN NATIONAL LIFE

07155005 352530 38 AS (999) 999-9999 HAMM BUILDING ST PAUL MN NORTHLAND INSUR CO

07164005 358569 38 AS (514) 271-1444 720 E WISCONSIN AVE MILWAUKEE WI NORTHWEST MUTUAL LIFE

07173005 358569 38 AS (999) 999-9999 811 N WASHINGTON LANSING MI NORTHWEST NATIONAL CASUALTY

07182005 358569 38 AS (999) 999-9999 811 N WASHINGTON LANSING MI NORTHWESTERN NATIONAL INS CO

07191005 413395 38 AS (800) 274-6965 146 INDUSTRIAL PARK JACKSON MN CORESOURCE

07191010 413395 38 AS (800) 444-6965 PO BOX 1195 MINNEAPOLIS MN CORESOURCE

07191015 413395 38 AS (520) 290-4600 7830 E BROADWAY TUCSON AZ CORESOURCE

07191020 413395 89 AS (800) 888-7202 7830 E BROADWAY TUCSON AZ CORESOURCE

07217005 358569 38 AS (999) 999-9999

876 HORACE BROWN

DRIVE MADISON HEIGHTS MI OCCIDENTAL LIFE

07217010 358569 38 AS (999) 999-9999

876 HORACE BROWN

DRIVE MADISON HEIGHTS MI OCCIDENTAL LIFE

07226005 352530 38 AS (999) 999-9999 ROUTE 1 BLISSFIELD MI OGDEN RIGA MUT FIRE

07235005 358569 38 AS (999) 999-9999 136 N THIRD STREET HAMILTON OH OH CASUALTY INS CO

07244005 352530 38 AS (999) 999-9999 1 WESTFIELD CTR OH OH FARMERS INS CO

07253005 358569 38 AS (999) 999-9999 136 N THIRD STREET HAMILTON OH OH LIFE INSUR CO

07262005 352530 38 AS (999) 999-9999 BOX 237 CINCINNATI OH OH NATIONAL LIFE

07271005 352530 38 AS (999) 999-9999 136 N THIRD STREET HAMILTON OH OH SECURITY INS CO

07280005 358569 38 AS (614) 764-4018 PO BOX 910 COLUMBUS OH OH STATE LIFE INSURANCE CO

07306005 351113 38 X5 (800) 733-6242 3520 BROADWAY KANSAS CITY MO OLD AMERICAN INSUR CO

07315005 358569 38 AS (999) 999-9999 811 CHICAGO AVE EVANSTON IL OLD EQUITY LIFE INS

07324005 352530 38 AS (999) 999-9999 707 N ELEVENTH ST MILWAUKEE WI OLD LINE LIFE INS AM

07333005 352530 38 AS (999) 999-9999

231 W LOCKWOOD

AVE WEBSTER GROVES MO OLD RELIABLE FIRE

07342005 352530 38 AS (999) 999-9999 PO BOX 789 GREENSBURG PA OLD REPUBLIC INS CO

07351005 352530 38 AS (999) 999-9999

307 N MICHIGAN 7TH

F CHICAGO IL OLD REPUBLIC LIFE

07360005 351113 38 AS (999) 999-9999 PO BOX 1299 KANSAS CITY MO OLD SECURITY LIFE

07389005 352530 38 AS (999) 999-9999 BOX 2138 LOS ANGELES CA OLYMPIC INSURANCE CO

Page 31: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

07398005 352530 38 AS (999) 999-9999 3113 DODGE ST OMAHA NE OMAHA INDEMNITY CO

07404005 352530 38 AS (999) 999-9999 1600 ARCH ST PHILADELPHIA PA PACIFIC EMPLOYER INS

07413005 358569 38 AS (999) 999-9999 PO BOX 24022 LOS ANGELES CA PACIFIC FIDELITY LIF

07422005 352530 38 AS (999) 999-9999 51 J F KENNEDY PKY SHORT HILLS NJ PACIFIC INDEMNITY CO

07431005 358569 38 AS (999) 999-9999 80 MAIDEN LANE NEW YORK NY PACIFIC INS CO CA

07469005 413395 89 X5 (877) 569-3075 601 POYDRAS STREET NEW ORLEANS LA PAN AMERICAN LIFE INSUR CO

07478005 413395 38 AS (999) 999-9999 18 CHESTNUT STREET WORCESTER MA PAUL REVERE LIFE INSURANCE CO

07478010 413395 38 AS (999) 999-9999

26777 CENTRAL PARK

BLVD SOUTHFIELD MI PAUL REVERE

07487005 413395 38 AS (999) 999-9999 18 CHESTNUT ST WORCESTER MA PAUL REVERE VARIABLE ANN INS

07496005 358569 38 AS (999) 999-9999 62 MAPLE AVE KEENE NH PEERLESS INSUR CO

07502005 351113 38 AS (999) 999-9999 PO BOX 2667 JACKSONVILLE FL PENINSULAR LIFE INS

07511005 352530 38 AS (999) 999-9999 7777 BONHOMME ST LOUIS MO PA SECURITY LIFE

07520005 352530 38 AS (999) 999-9999 414 WALNUT STREET PHILADELPHIA PA PA GEN INS

07549005 352530 38 AS (999) 999-9999 3130 WILSHIRE BLVD SANTA MONICA CA PA LIFE INS CO

07558005 352530 38 AS (999) 999-9999 PO BOX 2361 HARRISBURG PA PA NATIONAL MUTUAL

07567005 352530 38 AS (999) 999-9999 173 N MAIN ST WILKES-BARRE PA PA SLOVAK CATH UNION

07576005 352530 38 AS (999) 999-9999

6277 SEA HARBOR

DRIVE ORLANDO FL PEOPLES HOME LIFE

07585005 352530 38 AS (999) 999-9999

601 NEW HAMPSHIRE

NW WASHINGTON DC PEOPLES LIFE INS CO

07594005 352530 38 AS (999) 999-9999 O538 WEST MAIN ST IONIA MI PEOPLES MUTUAL INS C

07600005 352530 38 AS (999) 999-9999 6150 W FOND DU LAC MILWAUKEE WI PERSONAL INDEM MUT

07629005 352530 38 AS (999) 999-9999

7711 BONHOMME

AVE ST LOUIS MO PERSONAL LIFE INS CO

07638005 352530 38 AS (999) 999-9999 PO BOX 2180 HOUSTON TX PETROLEUM CASUALTY

07647005 352530 38 AS (800) 713-4680 PO BOX 2465 HOUSTON TX PHILADELPHIA AMERICAN LIFE

07656005 352530 38 AS (999) 999-9999 PO BOX 824 VALLEY FORGE PA PHILADELPHIA MANUF MUT INS CO

07665005 352530 38 AS (999) 999-9999 PO BOX 4583 PHILADELPHIA PA PHILADELPHIA UNITED LIFE INS

07674005 352530 38 AS (999) 999-9999 80 MAIDEN LANE NEW YORK NY PHOENIX ASSUR OF NY

07683005 352530 38 AS (999) 999-9999 ONE TOWER SQUARE HARTFORD CT PHOENIX INS CO

07692005 358569 38 AS (800) 451-2513 PO BOX 8027 BOSTON MA PHOENIX HOME LIFE

07692010 351113 38 AS (888) 344-7220 PO BOX 100252 COLUMBIA SC GE FINANCIAL SERVICES

07709005 413395 38 AS (999) 999-9999 433 SOUTH SPRING ST LOS ANGELES CA PIONEER NATL TITLE

07718005 413395 38 AS (999) 999-9999 2776 FLUSHING RD FLINT MI PIONEER STATE MUTUAL

Page 32: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

07727005 352530 38 AS (999) 999-9999 3550 N WASHINGTON INDIANAPOLIS IN POLICE & FIREMEN INS

07736005 352530 38 AS (414) 645-4076

1202 W OKLAHOMA

AVE MILWAUKEE WI POLISH ASSOC OF AMER

07745005 352530 38 AS (999) 999-9999 97-99 SOUTH 18TH ST PITTSBURGH PA POLISH FALCONS

07754005 352530 38 AS (999) 999-9999 155 NOBLE STREET BROOKLYN NY POLISH NAT ALL BROOK

07763005 352530 38 AS (999) 999-9999

1514-1520 W

DIVISION CHICAGO IL POLISH NAT ALL US NA

07772005 352530 38 AS (999) 999-9999 984 MILWAUKEE AVE CHICAGO IL POLISH ROMAN CATHOLIC INS

07781005 352530 38 AS (999) 999-9999 761 FILLMORE AVE BUFFALO NY POLISH UNION OF AMER

07790005 352530 38 AS (999) 999-9999 53-59 N MAIN STREET WILKES BARRE PA POLISH UNION US INS

07807005 352530 38 AS (999) 999-9999

1309-15 N ASHLAND

AV CHICAGO IL POLISH WOMENS ALL IN

07807010 358569 89 AS (866) 834-4765 PO BOX 186 SYRACUSE NY POMCO, A MARKEL BUSINESS PARTNER

07807010 358569 89 X2 (866) 834-4765 PO BOX 186 SYRACUSE NY POMCO, A MARKEL BUSINESS PARTNER

07816005 352530 38 AS (999) 999-9999 414 WALNUT PHILADELPHIA PA POTOMAC INS CO

07825005 413395 38 AS (999) 999-9999 0 NEW BERLIN WY PREFERRED MUTUAL INS

07834005 413395 38 AS (800) 247-4176 1111 ASHWORTH RD WEST DES MOINES IA GUIDE ONE LIFE INS CO

07843005 413395 38 AS (999) 999-9999 1111 ASHWORTH RD WEST DES MOINES IA PREFERRED RISK MUTUAL INS CO

07852005 352530 38 AS (999) 999-9999 545 SANSOME STREET SAN FRANCISCO CA PREMIER INS CO

07852010 352530 88 DO (999) 999-9999 PO BOX 47126 PLYMOUTH MN PREMIER DENTAL GROUP

07861005 358569 38 AS (999) 999-9999 1809 WALNUT STREET PHILADELPHIA PA PRESBYTERIAN FUND IN

07870005 358569 38 AS (999) 999-9999 3600 EUCLID AVENUE CLEVELAND OH PROGRESSIVE CASUALTY

07899005 358569 38 AS (800) 323-3529 406 E WILSON WORTHINGTON OH AMERICAN CHAMBERS LIFE

07905005 352530 38 AS (999) 999-9999 30 EAST STATE STREET SHARON PA PROTECTED HOME MUT

07914005 352530 38 AS (999) 999-9999

300 S NORTHWEST

HWY PARK RIDGE IL PROTECTION MUTUAL IN

07923005 352530 38 AS (800) 231-6024 3100 N MERIDIAN ST INDIANAPOLIS IN PROTECTIVE INS CO

07923010 352530 88 DO (800) 443-0225 PO BOX 801694 DALLAS TX PROTECTIVE DENTAL CARE HMO

07932005 352530 38 AS (999) 999-9999 105 S 17TH ST OMAHA NE PROTECTIVE NAT OF OM

07941005 352530 38 AS (999) 999-9999

20 WASHINGTON

PLACE PROVIDENCE RI PROVIDENCE WA INS CO

Page 33: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

07950005 351113 38 AS (999) 999-9999

620 NEWPORT

CENTER NEWPORT BEACH CA PROVIDENT ALLIANCE INS CO

07979005 351113 30 AS (999) 999-9999

316 NORTH 5TH

STREET BISMARCK ND PROVIDENT LIFE & ACCIDENT

07979010 351113 30 AS (999) 999-9999 PO BOX 2206 ELKHART IN PROVIDENT LIFE & ACCIDENT

07988005 351113 38 AS (999) 999-9999 PO BOX 8207 PHILADELPHIA PA PROVIDENT MUTUAL LIFE INS

07997005 358569 38 AS (999) 999-9999 55 PUBLIC SQUARE CLEVELAND OH PRUDENT AMER LIFE

08027005 352530 38 AS (999) 999-9999 PO BOX 519 PROVIDENCE RI PURITAN LIFE INS CO

08036005 358569 38 AS (913) 722-1110 PO BOX 12922 PENSACOLOA FL PYRAMID LIFE INS CO

08045005 352530 38 AS (999) 999-9999 9025 N LINDBERG DR PEORIA IL RLI INSURANCE CO

08054005 352530 38 AS (999) 999-9999 PO BOX 2807 HOUSTON TX RANGER INSURANCE CO

08063005 352530 38 AS (999) 999-9999 92ND AND STATE LINE KANSAS CITY MO RECIPROCAL EXCHANGE

08072005 352530 38 AS (999) 999-9999 99 JOHN STREET NEW YORK NY REINSURANCE CO OF NY

08081005 358569 38 AS (999) 999-9999 PO BOX 4528 COLUMBUS OH RELIABLE INSURANCE

08090005 358569 38 AS (314) 968-4900

231 W LOCKWOOD

AVE WEBSTER GROVES MO RELIABLE LIFE INS CO

08107005 351113 38 AS (999) 999-9999 THREE PARKWAY PHILADELPHIA PA RELIANCE

08107010 351113 38 AS (800) 451-7929 PO BOX 2996 PARKERSBURG WV RELIANCE INSURANCE COMPANY

08116005 351113 38 AS (215) 864-4000 4 PENN CENTER PLAZA PHILADELPHIA PA RELIANCE INSURANCE CO

08125005 352530 38 AS (999) 999-9999 BOX 1438 COLUMBUS OH REPUBLIC FRANKLIN

08134005 352530 38 AS (999) 999-9999 PO BOX 1438 COLUMBUS OH REPUBLIC FRANKLIN LIFE

08143005 352530 38 AS (999) 999-9999 2727 TURTLE CREEK DALLAS TX REPUBLIC INSURANCE

08152005 413395 38 AS (800) 888-2567 PO BOX 660238 DALLAS TX AMERICAN GENERAL GROUP LIFE

08161005 352530 38 AS (999) 999-9999 2727 TURTE CREEK DALLAS TX REPUBLIC VANGUARD INSURANCE

08170005 352530 38 AS (999) 999-9999 65 E SOUTH WATER ST CHICAGO IL RESERVE INSURANCE CO

08199005 351113 38 AS (999) 999-9999 403 S AKARD STREET DALLAS TX NATIONAL FINANCIAL INS CO

08205005 352530 38 AS (999) 999-9999 163 ASYLUM STREET HARTFORD CT RESOLUTE INS CO RI

08214005 352530 38 AS (999) 999-9999 163 ASYLUM STREET HARTFORD CT RESOLUTE LIFE INS CO

08223005 358569 38 AS (999) 999-9999 6800 FRANCE AVE SO MINNEAPOLIS MN RETAIL LUMBERMENS IN

08232005 358569 38 AS (999) 999-9999 PO BOX 3098 MILWAUKEE WI RETAIL LUMBERMENS

08241005 352530 38 AS (999) 999-9999 70 WEST MICHIGAN BATTLE CREEK MI RIVERSIDE INS OF AMR

08250005 352530 38 AS (999) 999-9999 231 W LOCKWOOD ST LOUIS MO ROCKFORD LIFE INS CO

08279005 352530 38 AS (999) 999-9999 BOX 392 BOSTON MA ROYAL ARCANUM SUP CO

08288005 352530 38 AS (999) 999-9999 111 JOHN STREET NEW YORK NY ROYAL EXCHANGE ASSUR

Page 34: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

08297005 352530 38 AS (999) 999-9999 150 WILLIAM STREET NEW YORK NY ROYAL GLOBE INS CO

08303005 352530 38 AS (999) 999-9999 150 WILLIAM STREET NEW YORK NY ROYAL GLOBE LIFE INS

08312005 352530 38 AS (999) 999-9999 150 WILLIAM STREET NEW YORK NY ROYAL INDEMNITY CO

08330005 352530 38 AS (999) 999-9999 230 16TH STREET ROCK ISLAND IL ROYAL NEIGHBORS AMER

08359005 352530 38 AS (999) 999-9999 917 NORTH WOOD ST CHICAGO IL RUSSIAN IND MUTUAL

08368005 352530 38 X3 (206) 545-5000 4854 154H PLACE NE REDMOND WA SAFECO INSURANCE CO OF AMERICA

08386005 359253 38 AS (999) 999-9999 150 WILLIAM STREET NEW YORK NY SAFEGUARD INS

08401005 351113 38 AS (999) 999-9999 385 WASHINGTON ST PAUL MN ST PAUL GUARDIAN INS

08410005 351113 38 AS (999) 999-9999 PO BOX 43536 ST PAUL MN ST PAUL LIFE INSURANCE CO

08439005 351113 38 AS (999) 999-9999 385 WASHINGTON ST ST PAUL MN ST PAUL MERCURY INS

08448005 352530 38 AS (999) 999-9999

1650 W BIG BEAVER

RD TROY MI ST PAUL TITLE INS CO

08457005 352530 38 AS (999) 999-9999 228 SOUTH MAIN ST CARSONVILLE MI SANILAC MUTUAL INS

08466005 351113 38 AS (999) 999-9999 1417 JOHNSON ROAD GOWEN MI SCANDINAVIAN MUTUAL

08475005 352530 38 AS (999) 999-9999

51 JOHN KENNEDY

PKWY SHORT HILLS NJ SEA INS CO LTD

08484005 352530 38 AS (999) 999-9999 80 MAIDEN LANE NEW YORK NY SEABOARD FIRE MARINE

08493005 352530 38 AS (999) 999-9999 7045 N WESTERN AVE CHICAGO IL SEABOARD OF AMR FL

08519005 352530 38 AS (999) 999-9999 90 WILLIAM ST NEW YORK NY SEABOARD SURETY CO

08528005 352530 38 AS (999) 999-9999 24 E MAIN SEBEWAING MI SEBEWAING MUT FIRE

08537005 352530 38 AS (999) 999-9999 700 HARRISON ST TOPEKA KS SECURITY BENEFIT LIFE

08546005 352530 38 AS (999) 999-9999 SECURITY DR AVON CT SECURITY CT LIFE

08555005 352530 38 AS (999) 999-9999 PO BOX 420 HARTFORD CT SECURITY INS HARTFOR

08582005 352530 38 AS (999) 999-9999

500 GRAND

CONCOURSE BRONX NY SECURITY MUTUAL

08591005 352530 38 AS (999) 999-9999 PO BOX 1625 BINGHAMTON NY SECURITY MUTUAL

08617005 358569 38 AS (999) 999-9999 1421 STRONGS AVE STEVENS POINT WI SENTRY LIFE INS CO

08626005 352530 38 AS (999) 999-9999 3414 FIFTH AVE PITTSBURGH PA SERB NATL FEDERATION

08635005 352530 38 AS (999) 999-9999

NATIONAL LIFE

CENTER NASHVILLE TN SERVICE CASUALTY NY

08644005 352530 38 AS (999) 999-9999 650 MADISON AVE NEW YORK NY SERVICE FIRE INS NY

08653005 352530 38 AS (999) 999-9999 19 MANSFIELD AVE SHELBY OH SHELBY MUTUAL INS CO

08662005 352530 88 DO (800) 848-5433 PO BOX 12847 27102010 VA SHENANDOAH LIFE INS CO

Page 35: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

08662010 358569 38 AS (888) 330-8408 2145 FORD PARKWAY ST PAUL MN SHEFFIELD OLSON & MCQUEEN INC

08671005 358569 89 AS (800) 752-5863 PO BOX 91110 SIOUX FALLS SD SANFORD HEALTH PLAN

08680005 351113 38 AS (999) 999-9999 205 MADISON ST PASSAIC NJ SLOVAK CATHOLIC SOKO

08706005 351113 38 AS (999) 999-9999 276 PROSPECT ST EAST ORANGE NJ SLOVAK GYM UNION

08715005 351113 38 AS (800) 423-6011

2657-9 S LAWNDALE

AV CHICAGO IL SLOVENE NATL BEN SOC

08724005 352530 38 X5 (800) 945-8851 1455 W LAKE ST MINNEAPOLIS MN SONS OF NORWAY

08742005 358569 38 AS (999) 999-9999 3000 W BEECHER RD ADRIAN MI SOUTHEASTERN MUT INS

08751005 352530 38 AS (999) 999-9999 PO BOX 128 MARSHALL MI SOUTHERN MI MUTUAL INS

08760005 352530 38 AS (999) 999-9999 PO BOX 2220 DALLAS TX SOUTHLAND LIFE INS

08789005 358569 38 AS (999) 999-9999 1250 STATE ST SPRINGFIELD MA SPRINGFIELD LIFE INS CO

08798005 352530 38 AS (999) 999-9999 EXECUTIVE PLAZA PARK RIDGE IL STANDARD OF AMERICA

08804005 352530 38 AS (999) 999-9999

151 FARMINGTON

AVE HARTFORD CT STANDARD FIRE INS CO

08813005 351113 38 AS (999) 999-9999 300 E FALL CREEK BVD INDIANAPOLIS IN STANDARD LIFE OF IN

08822005 358569 38 AS (999) 999-9999 150 WILLIAM ST NEW YORK NY STANDARD MARINE INS

08831005 352530 38 AS (999) 999-9999 518 E BROAD ST COLUMBUS OH STATE AUTO MUT INS

08840005 352530 38 AS (999) 999-9999 28 N MINNESOTA ST NEW ULM MN STATE BOND & MORTGAG

08869005 351113 38 AS (999) 999-9999 410 EAST DR MARSHALL MI STATE FARM FIRE & CA

08878005 351113 38 AS (999) 999-9999 410 EAST DR MARSHALL MI STATE FARM GEN INS

08887005 351113 38 IO (999) 999-9999 P.O. BOX 339403 GREELEY CO STATE FARM LIFE INS

08902005 352530 38 X5 (800) 428-2316 PO BOX 406 INDIANAPOLIS IN STATE LIFE INS CO

08911005 352530 38 AS (999) 999-9999 518 W NEPESSING ST LAPEER MI STATE MUT CYCLONE

08920005 352530 38 AS (877) 872-5500

33 NORTH GARDEN

AVENUE CLEARWATER FL STATE MUTUAL INSURANCE CO

08949005 351113 38 AS (999) 999-9999 PO BOX 2029 HOUSTON TX STEWART TITLE GUARAN

08958005 352530 38 AS (999) 999-9999

2308 FOURTH AVE

NORT BIRMINGHAM AL STONEWALL INS CO

08967005 352530 38 AS (999) 999-9999 1105 HAMILTON ST ALLENTOWN PA STUYVESANT INS CO NY

08976005 352530 38 AS (999) 999-9999 1105 HAMILTON ST ALLENTOWN PA STUYVESANT LIFE INS

08985005 351113 38 AS (999) 999-9999 PO BOX 394 DES MOINES IA SUMMIT FIDEL & SURET

08994005 351113 38 AS (999) 999-9999

1900 TWO SHELL

PLAZA HOUSTON TX SUMMIT INS CO NY

09006005 352530 38 AS (999) 999-9999 111 JOHN ST NEW YORK NY SUN INSURANCE

09015005 352530 38 AS (999) 999-9999

JOHN F KENNEDY

PKWY SHORT HILLS NJ SUN INSURANCE

09024005 352530 38 AS (999) 999-9999 300 S CAPITOL AVE LANSING MI SUN LIFE ASSURANCE

Page 36: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

09033005 352530 38 AS (203) 222-4105

PO BOX 3050 RINCON

ANNEX SAN FRANCISCO CA STAUFFER CHEMICAL CO

09042005 352530 38 AS (999) 999-9999 SUN LIFE BLDG CHAR C BALTIMORE MD SUN INSURANCE

09042010 358569 38 AS (800) 759-3098 PO BOX 93098 ALBURQUERQUE NM SUN HEALTH CARE GROUP

09051005 352530 38 AS (999) 999-9999

3501 S DR MART

LUTHR CHICAGO IL SUPREME LIFE INS CO

09060005 352530 38 X5 (801) 355-3000 PO BOX 2520 SALT LAKE CITY UT SURETY LIFE INS CO

09089005 352530 38 AS (999) 999-9999 ROUTE NO 2 LE ROY MI SWED FARM MUTUAL FIR

09098005 352530 38 AS (800) 223-1919 237 PARK AVE NEW YORK NY SWISS AMERICA

09104005 352530 38 AS (999) 999-9999 202 W HILL BOX 986 CHAMPAIGN IL T JEFFERSON LIFE INS

09113005 413395 24 X5 (800) 867-8986 PO BOX 30010 AUSTIN TX UNITED TEACHER ASSOCIATES

09122005 352530 38 AS (800) 328-4441

400 SECOND AVE

SOUTH MINNEAPOLIS MN TITLE INS CO MN

09131005 352530 38 AS (999) 999-9999 1100 W WELLS ST MILWAUKEE WI TOWER INSURANCE CO

09140005 352530 38 AS (800) 969-7256 310 ST MARY'S ST SAN ANTONIO TX TOWER LIFE INSURANCE CO

09169005 352530 38 AS (999) 999-9999 PO BOX 54256 LOS ANGELES CA TRANSAMERICA INS CO

09178005 352530 38 AS (999) 999-9999

BOX 60033 TERMINAL

A LOS ANGELES CA TRANSAMERICA LIFE INS & ANNUIT

09187005 352530 38 AS (999) 999-9999 600 MONTGOMERY ST SAN FRANCISCO CA TRANSAMERICA TITLE INS

09202005 352530 38 AS (999) 999-9999 5454 WISCONSIN AVE CHEVY-CHASE MD TRANSGENERAL LIFE INS

09220005 352530 38 AS (999) 999-9999 3670 WILSHIRE BLVD LOS ANGELES CA TRANSPORT INDEMNITY

09249005 358569 38 AS (999) 999-9999

4100 HARRY HINES

BLD DALLAS TX TRANSPORT INS CO

09258005 352530 38 AS (999) 999-9999 714 MAIN ST FORT WORTH TX TRANSPORT LIFE INS

09267005 352530 38 AS (999) 999-9999 310 S MICHIGAN AVE CHICAGO IL TRANSPORTATION INS

09276005 352530 34 AS (999) 999-9999 1137 S JUPITER RD GARLAND TX TRAVELERS INSURANCE COMPANY

09285005 352530 34 AS (518) 454-4895 PO BOX 1917 ALBANY NY TRAVELERS INSURANCE COMPANY

09294005 352530 34 AS (999) 999-9999 500 GRANT SUITE 502 PITTSBURGH PA TRAVELERS INSURANCE COMPANY

09300005 352530 34 AS (999) 999-9999 3316 FARNAM OMAHA NE TRAVELERS INSURANCE COMPANY

09300010 358569 38 AS (999) 999-9999 6600 E 15 MILE STERLING HTS MI AUTOMOTIVE PLASTIC TECHNOLOGIS

09329005 352530 34 AS (800) 648-4480 PO BOX 7045 ROCKFORD IL TRAVELERS PLAN ADMINISTRATORS

09338005 352530 34 AS (999) 999-9999 3755 LINDELL BLVD ST LOUIS MO TRAVELERS PROTECTIVE ASSOC OF

09356005 352530 38 AS (999) 999-9999

3401 SAGINAW STE

211 LANSING MI TRUCK INS EXCHANGE

09365005 351113 38 AS (999) 999-9999 PO BOX 1517 BATTLE CREEK MI TWENTIETH CENTURY GUARDIAN LIF

09374005 358569 38 AS (999) 999-9999 HARTFORD PLAZA HARTFORD CT TWIN CTY FIRE MN

Page 37: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

09392005 352530 38 R6 (800) 292-8556 4119 BROADWAY SAN ANTONIO TX USAA LIFE INS CO

09409005 352530 38 AS (999) 999-9999 1300 N MEACHAM RD SCHAUMBURG IL US LIFE CREDIT LIFE INS CO

09418005 352530 38 AS (999) 999-9999 125 MAIDEN LANE NEW YORK NY US LIFE TITLE INS CO OF NY

09427005 351113 38 AS (999) 999-9999 61 83 GRAND ST JERSEY CITY NJ UKRAINIAN NATL ASSN

09436005 351113 38 AS (999) 999-9999 440 WYOMING AVE SCRANTON PA UKRAINIAN WORK ASSN

09445005 358569 38 AS (999) 999-9999 55 WALL STREET NEW YORK NY UNDERWRITERS INSURANCE COMPANY

09463005 359196 38 AS (999) 999-9999 1215 FOURTH AVE SEATTLE WA UNIGARD MTL INS CO

09472005 352530 38 AS (999) 999-9999

OLYMPIC NATL LIFE

BG SEATTLE WA UNIGARD OLYMPIC LIFE

09481005 352530 04 AS (888) 781-9555 PO BOX 13667 PENSACOLA FL UNION BANKERS INS CO

09481010 352530 38 AS (800) 789-6364 PO BOX 9110 CLEARWATER FL UNION BANKERS INSURANCE CO

09490005 352530 38 AS (999) 999-9999 PO BOX 179 CINCINNATI OH UNION CENTRAL LIFE

09507005 352530 38 X5 (800) 523-6599 PO BOX 10841 CLEARWATER FL UNION FIDELITY LIFE

09516005 352530 38 AS (202) 682-0900

111 MASSACHUSETTS

AVE,NW WASHINGTON DC UNION LABOR LIFE INS CO

09516010 352530 38 AS (800) 368-5724 SERVICE CENTER VALLEY FORGE PA UNION LABOR LIFE INSURANCE CO

09525005 352530 38 AS (999) 999-9999 2121 W 117TH STREET CLEVELAND OH UNION LEAG ROUM SOC

09534005 352530 38 NH (800) 693-4988

2211 CONGRESS

STREET PORTLAND ME UNUM GROUP BENEFITS

09552005 352530 38 AS (999) 999-9999 2211 CONGRESS ST PORTLAND MA UNION MUTUAL STOCK

09561005 358569 48 AS (972) 529-5085 PO BOX 26400 OKLAHOMA CITY OK UNITED AMERICAN INSURANCE CO

09561010 358569 48 AS (972) 529-5085 PO BOX 8080 MCKINNEY TX UNITED AMERICAN INSURANCE CO

09570005 358569 38 AS (800) 316-5607 PO BOX 2548 FORT WORTH TX WORLD SERVICE LIFE INS

09599005 552530 38 AS (999) 999-9999 DODGE AT 33RD ST OMAHA NE UNITED BENEFIT LIFE

09599010 352530 38 AS (517) 787-7400 110 1ST ST JACKSON MI HALL & KENNEDY INC INS

09599015 552530 38 X3 (888) 456-8164 PO BOX 30214 TAMPA FL UNITED BENEFIT LIFE INSUR CO

09599020 552530 89 AS (888) 456-8164 PO BOX TAMPA FL UNITED BENEFIT LIFE INSURANCE

09605005 413395 38 R6 (800) 848-0123 632 N PARK STREET COLUMBUS OH UNITED COMMERC TRAVELERS AMER

09614005 552530 38 AS (999) 999-9999 7373 N SICERO LINCOLN WOOD IL UNITED EQUITABLE INS

09623005 552530 38 AS (817) 390-1053 PO BOX 1778 FORT WORTH TX UNITED FIDELITY LIFE

09632005 359196 38 AS (999) 999-9999 1 EAST WACKER DRIVE CHICAGO IL UNITED FIRE INS NY

09641005 552530 38 AS (999) 999-9999

1000 NORTH

MADISON GREENWOOD IN UNITED HOME LIFE INS

09650005 552530 38 AS (999) 999-9999 PO BOX 1441 KANSAS CITY MO UNITED INVESTORS LIF

09679005 552530 38 AS (999) 999-9999 1 GRANITE PLACE CONCORD NH UNITED LIFE & ACCIDENT INS CO

09688005 552530 38 AS (999) 999-9999 223 E MAIN STREET LIGONIER PA UNITED LUTHERAN SOC

09703005 352530 38 AS (999) 999-9999 PO BOX 2163 S STA KOKOMO IN UNITED PRESIDENTIAL LIFE INS

09712005 351113 38 AS (999) 999-9999 333 BLVD OF ALLIES PITTSBURGH PA UNITED RUSSIAN ORTHODOX

Page 38: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

09721005 351113 38 AS (215) 723-3044 PO BOX 99 SOUDERTON PA UNITED SECURITY ASSURANCE

09721010 351113 38 AS (800) 875-4422

10275 W HIGGINS

ROAD ROSEMONT IL UNITED SECURITY LIFE INSURANCE

09721015 351113 38 AS (800) 880-5044 PO BOX 149151 AUSTIN TX CITIZENS INS CO OF AMERICA

09730005 352530 38 AS (210) 498-2211

9800 FREDRICKSBURG

RD SAN ANTONIO TX UNITED SERVICES AUTO ASSOC

09759005 352530 38 AS (999) 999-9999

1701 PENNSYLVANIA

NW WASHINGTON DC UNITED SERVICES LIFE INS CO

09768005 352530 38 AS (999) 999-9999 613 SINCLAIR ST MC KEESPORT PA UNITED SOC OF USA

09777005 352530 38 AS (999) 999-9999

CALVERT & REDWOOD

ST BALTIMORE MD US FIDELITY & GUARAN

09786005 413395 38 AS (999) 999-9999 PO BOX 2387 MORRISTOWN NJ UNITED STATES FIRE INSURANCE

09795005 352530 38 AS (999) 999-9999

1030 CONTINENTAL

DR KING OF PRUSSIA PA US LIABILITY INS CO

09801005 413395 38 X5 (800) 346-7692 P O BOX 1581 NEPTUNE NJ UNITED STATES LIFE INSURANCE

09801010 413395 38 AS (800) 542-2767 PO BOX 15205 READING PA UNITED STATES LIFE INSURANCE

09810005 351113 38 AS (999) 999-9999 6907 W CERMAK RD BERWYN IL UNITY OF CZECH LADIES & MEN

09839005 351113 38 AS (999) 999-9999 731 N JACKSON ST MILWAUKEE WI UNIVERSAL REINSURANCE CORP NJ

09848005 358569 38 AS (999) 999-9999 5115 OAK ST KANSAS CITY MO UNIVERSAL UNDERWRITERS INS CO

09857005 358569 38 AS (999) 999-9999 5115 OAK ST KANSAS CITY MO UNIVERSAL UNDERWRITERS LIFE

09866005 352530 38 AS (999) 999-9999 PO BOX 68181 INDIANAPOLIS IN UNIVERSITY LIFE INS CO OF AMER

09875005 352530 38 AS (999) 999-9999 PO BOX C ROCK MI UP MUTUAL INS CO

09919005 352530 38 AS (999) 999-9999 310 S MICHIGAN AVE CHICAGO IL VALLEY FORGE INS CO

09928005 352530 38 AS (999) 999-9999 CNA PLAZA CHICAGO IL VALLEY FORGE LIFE INS CO

09946005 352530 38 AS (999) 999-9999 PO BOX 3206 HOUSTON TX VARIABLE ANNU LF INS

09964005 358569 38 AS (999) 999-9999 200 E ONTARIO ST CHICAGO IL VIKINGS INDEP ORDER

09982005 352530 38 AS (999) 999-9999 THE AMERICAN RD DEARBORN MI VISTA INS CO

09991005 352530 38 AS (999) 999-9999 PO BOX 7246 ST LOUIS MO VOLKSWAGEN INS CO

10007005 352530 38 AS (999) 999-9999

VOLUNTEER ST LF

BLDG CHATTANOOGA TN VOLUNTEER STATE LIFE

10016005 352530 38 AS (999) 999-9999 4210 PETERSON AVE CHICAGO IL WARNERS RECIPROCAL

10043005 352530 38 AS (999) 999-9999 PO BOX 2387 MORRISTOWN NJ WESTCHESTER FIRE INS

10052005 352530 38 AS (999) 999-9999 14 E FIRST ST FORT SCOTT KS WESTERN CAS & SUR CO

10061005 352530 38 AS (999) 999-9999 14 E FIRST ST FORT SCOTT KS WESTERN FIRE INS CO

10070005 352530 38 AS (999) 999-9999 1900 FIRST AVE NE CEDAR RAPIDS IA WESTERN FRAT LIFE

10099005 352530 38 AS (999) 999-9999 P.O. BOX 64271 ST PAUL MN WESTERN LIFE INS CO

10105005 352530 38 AS (999) 999-9999 PO BOX 5068 CLEARWATER FL WESTERN RESERVE LIFE OF OH

10114005 358569 38 AS (800) 333-1455 PO BOX 5735 CINCINNATI OH WESTERN & SOUTHERN FINANCIAL GROUP

Page 39: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

10123005 352530 38 AS (999) 999-9999 908 WEST AVE NORTH SIOUX FALLS SD WESTERN SURETY CO

10132005 358569 38 AS (999) 999-9999 0 WESTFIELD CTR OH WESTFIELD LIFE INS

10141005 359196 38 AS (999) 999-9999 0 WESTFIELD CTR OH WESTFIELD NATL INS

10150005 352530 38 AS (999) 999-9999 300 S CAPITOL AVE LANSING MI WESTMOUNT LIFE INS

10179005 352530 38 AS (999) 999-9999 429 FORBES AVE PITTSBURGH PA WILLIAM PENN ASSOCIATION

10188005 352530 38 AS (999) 999-9999 420 W NORTH ST JUNEAU WI WI FARMERS MUTUAL

10197005 352530 38 AS (999) 999-9999 BOX 5099 MADISON WI WI LIFE INSURANCE

10203005 352530 38 AS (414) 235-0800 PO BOX 740 OSHKOSH WI WI NATIONAL LIFE INS CO

10212005 352530 38 AS (999) 999-9999 70 W MICHIGAN AVE BATTLE CREEK MI WOLVERINE INS CO

10230005 352530 38 AS (999) 999-9999 1526 PLAINFIELD NE GRAND RAPIDS MI WOODLAND MUTUAL INS

10259005 351113 38 AS (800) 869-0355 PO BOX 82288 LINCOLN NE WOODMEN ACCIDENT & LIFE

10259010 352530 38 AS (616) 798-2106

4250 GRAND HAVEN

ROAD MUSKEGON MI WOODMEN ACCIDENT & LIFE

10277005 352530 38 AS (999) 999-9999 440 LINCOLN ST WORCESTER MA WORCESTER MUTUAL INS

10286005 413395 38 AS (516) 938-6060 99 N BROADWAY HICKSVILLE NY WORKMENS BENEFIT FUND OF USA

10295005 413395 38 X3 (800) 922-2558 45 EAST 33RD STREET NEW YORK NY WORKMENS CIRCLE

10301005 351113 38 AS (999) 999-9999 MERCHANDISE MART CHICAGO IL WORLD BOOK LIFE INS

10310005 413395 38 AS (800) 786-7557 PO BOX 3160 OMAHA NE WORLD INS CO

10339005 352530 38 AS (999) 999-9999 2995 E GRAND BLVD DETROIT MI WRIGHT MUTUAL INS CO

10348005 352530 38 AS (999) 999-9999 111 W JACKSON BLVD CHICAGO IL ZURICH AMERICAN LIFE

10366005 352530 38 AS (999) 999-9999 111 W JACKSON BLVD CHICAGO IL ZURICH LIFE INS CO

10375005 352530 01 AS (800) 972-7894

4300 WEST CYPRESS

AVE TAMPA L FL AETNA US HEALTHCARE

10384005 351113 38 AS (999) 999-9999 1257 E SIENNA HTS DR ADRIAN MI ADRIAN DOM SISTERS

10393005 352530 67 AS (202) 737-8700 80 F STREET, NW WASHINGTON DC AFGE HEALTH & WELFARE

10419005 352530 38 AS (315) 449-7103 P O BOX 4710 SYRACUSE NY AGWAY INSURANCE GROUP TRUST

10428005 413395 67 AS (999) 999-9999

333 S ASHLAND

BOULEVARD CHICAGO IL AMALGAMATED LIFE/HEALTH INS CO

10437005 413395 67 AS (313) 961-8110 1550 HOWARD ST DETROIT MI AMALGAMATED COTTON GARMENTS

10455005 351113 67 X5 (313) 961-8110 1550 HOWARD DETROIT MI ACTWU INS FUND - SECONDARY

10464005 358569 38 AS (999) 999-9999 101 SOUTHFIELD RD BIRMINGHAM MI AMUSEMENT UNDERWRITE

10473005 413395 67 AS (999) 999-9999

8550 BRYN MAWR

AVE CHICAGO IL AMALGAMATED INS AGENCY SER

Page 40: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

10482005 413395 38 AS (999) 999-9999 PO BOX 23 BREWSTER NY AMERICAN PROGRESSIVE HEALTH

10491005 358569 38 AS (501) 785-6375 1000 SOUTH 21ST ST FORT SMITH AR AR BEST CORP

10508005 351113 38 AS (999) 999-9999 1400 RENAISSANCE DR PARK RIDGE IL ASSOCIATED GROUP UNDERWRITERS

10517005 358569 38 AS (301) 468-3731

10401 CONNECTICUT

AVE KENSINGTON MD BAKERY & CONFEC FUND

10526005 352530 67 AS (999) 999-9999 3901 N MERIDIAN INDIANAPOLIS IN BARBERS H & W PLAN

10535005 352530 67 AS (999) 999-9999

25 JEFFERSON PLACE

SE GRAND RAPIDS MI BUILDERS EXCH OF GRAND RAPIDS

10535010 358569 38 AS (248) 827-1050 PO BOX 5131 SOUTHFIELD MI CAM ADMINISTRATIVE SERVICES

10535015 358569 89 AS (248) 827-1050 PO BOX 5131 SOUTHFIELD MI CAM ADMINISTRATIVE SERVICES

10544005 413395 67 AS (913) 342-6555

754 MINNESOTA

AVENUE KANSAS CITY KS BOILERMAKERS NATIONAL H&W FUND

10544010 413395 89 AS (913) 342-6555

754 MINNESOTA

AVENUE KANSAS CITY KS BOILERMAKERS NATIONAL H & W FUND

10553005 352530 38 AS (999) 999-9999 PO BOX 161014 MEMPHIS TN CAVALIER INS

10562005 358569 38 AS (314) 854-4025 8400 MARYLAND AVE ST LOUIS MO BROWN GROUP INS

10571005 413395 38 AS (999) 999-9999 1492 FIRST NATL BLDG DETROIT MI BUTTERFIELD THEATERS

10580005 358569 47 AS (800) 323-5000 PO BOX 5103 DES PLAINES IL CENTRAL STATES SE SW TEAMSTERS

10580010 358569 89 AS (800) 323-2190 PO BOX 5116 DES PLAINES IL CENTRAL STATES SE SW TEAMSTERS

10606005 351113 38 AS (800) 621-3724 PO BOX 66933 CHICAGO IL CERT LIFE INS CO

10615005 352530 38 AS (999) 999-9999 PO BOX 1030 SCOTTSDALE AZ BSC INSURANCE CO

10624005 358569 38 AS (999) 999-9999 525 BLAKETON AVE MUSKEGON MI BRUNSWICK CORP INS

10633005 351113 38 AS (999) 999-9999 PO BOX 4500 PORTLAND ME CLAIMS SERVICE INTNL

10642005 352530 38 AS (999) 999-9999 333 W FORT DETROIT MI CHUBB PACIFIC INDEMN

10651005 351113 38 AS (999) 999-9999 S TRYON ST CHARLOTTE NC CHARLOTTE LIBERTY MUTUAL INS

10660005 358569 38 AS (999) 999-9999 1000 N JEFFERSON ST LOUIS MO COMMERCIAL STATE LIF

10689005 358569 38 AS (314) 878-4334 1861 CRAIG RD ST LOUIS MO COMMONWEALTH LIFE

10698005 358569 88 DO (800) 451-8000 PO BOX 9191 FRAMINGHAM MA CONSOLIDATED GROUP INC

10698010 358569 38 AS (500) 241-1121 PO BOX 2817 GAINESVILLE GA CONSOLIDATED GROUP CLAIMS

10704005 358569 89 NO (314) 965-9000 PO BOX 229013 ST LOUIS MO CONCORDIA HEALTH PLAN

10713005 358569 38 AS (999) 999-9999 111 W 10TH ST KANSAS CITY MO ALLIED GROUP INS TRUST

10722005 358569 38 AS (999) 999-9999

21700

NORTHWESTERN SOUTHFIELD MI CREATIVE INDUSTRIES

10731005 351113 38 AS (999) 999-9999 PO BOX 141700 GRAND RAPIDS MI CRAWFORD & COMPANY

10731010 358569 38 AS (999) 999-9999

25755 SOUTHFIELD

ROAD SOUTHFIELD MI EXECUTIVE AND EMPLOYER PLAN

10740005 413395 38 AS (999) 999-9999 209 S LASALLE CHICAGO IL DAUGHTERS AMER REVOL

10769005 352530 38 AS (999) 999-9999 PO BOX 2673 DETROIT MI DETROIT FREE PRESS INSURANCE

Page 41: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

10778005 413395 38 AS (999) 999-9999

26400 LAHSER RD

#315 SOUTHFIELD MI FIRST BENEFITS

10787005 351113 38 AS (313) 645-6446

STE 4601 BINGHAM

CENTER BIRMINGHAM MI DETROIT TILE TERRAZZO INS

10796005 352530 38 AS (999) 999-9999 500 S UNION ST MISHAWAKA IN DODGE MEDICAL PLAN

10802005 358569 38 AS (999) 999-9999 4000 3 MILE RD NW GRAND RAPIDS MI EBERHARD FOODS INC

10811005 352530 38 AS (999) 999-9999 2921 FULLER N E GRAND RAPIDS MI ESIS INSURANCE

10820005 358569 38 AS (999) 999-9999 1351 E JEFFERSON DETROIT MI EXCHANGE GRP UNDERWR

10849005 358569 38 AS (999) 999-9999 2100 M ST WASHINGTON DC FAMILY HLTH GRP INS

10867005 358569 38 AS (216) 379-7000

1200 FIRESTONE

PKWY AKRON OH FIRESTONE H&W INS

10876005 352530 38 AS (517) 321-7502

6525 CENTURION

DRIVE LANSING MI FLINT BLDG TRADES

10885005 358569 38 AS (999) 999-9999 BOX 131 KANSAS CITY MO FORREST & JONES & CO

10894005 358569 38 AS (999) 999-9999 PO BOX 1490 FLINT MI FUEL GAS CO INC

10900005 413395 38 AS (999) 999-9999 5100 GAMBLE DR ST LOUIS PARK MN GAMBLE ALDEN INS CO

10929005 358569 38 X4 (231) 928-2000 204 W MAIN STREET FREMONT MI GERBER LIFE INSURANCE

10938005 352530 38 AS (999) 999-9999 P O BOX 5004 ROCHESTER MI GM UNDERWRITERS

10947005 358569 38 AS (800) 334-9395 PO BOX 52040 PHOENIX AZ GOODYEAR MEDICAL BENEFITS DEPT

10956005 351113 38 AS (999) 999-9999

2700 PATTERSON AVE

SE GRAND RAPIDS MI GRAND RAPIDS PACKAGING

10965005 351113 38 AS (999) 999-9999 1151 SHELDON AVE SE GRAND RAPIDS MI GRAND RAPIDS TRANSIT

10974005 351113 38 AS (999) 999-9999 807 MCKAY TOWER GRAND RAPIDS MI GROUP ACTUARIES INC

10983005 358569 89 X5 (800) 322-8336

4200 FASHION

SQUARE BLVD SAGINAW MI BLUE CARE NETWORK OF E MI

10992005 358569 70 AS (269) 343-2611 PO BOX 19040 KALAMAZOO MI GROUP MARKETING SERVICE

10992010 358569 89 AS (616) 940-2099 PO BOX 19040 KALAMAZOO MI GROUP MARKETING SERVICES

11004005 351113 38 AS (800) 323-8764 530 RIVER OAKS WEST CALUMET CITY IL GUARANTEE RESERVE LIFE INS CO

11013005 358569 38 AS (248) 213-1099 18700 W TEN MILE RD SOUTHFIELD MI HERRUD HLTH INS PLAN

11022005 351113 38 AS (999) 999-9999 PO BOX 37502 OAK PARK MI NATIONAL LABOR UNION HLTH & WE

11031005 358569 38 AS (999) 999-9999 PO BOX 61 DURHAM NC HOME SECURITY INS CO

11040005 413395 38 AS (999) 999-9999 P.O. BOX 1018C HOLLAND MI HOSPITAL BENEFITS ASSOC INS

11040010 413395 38 AS (800) 878-7766 PO BOX 16248 ALTEMONTE SPRINGS FL HOSPITAL BENEFITS INC

11069005 351113 38 AS (312) 355-0958 P O BOX 588 NAPERVILLE IL HOTEL RESTAURANT EMPLOYEES UN

11078005 413395 38 AS (999) 999-9999 15 SOUTH WACKER DR CHICAGO IL ILGWU HEALTH FUND

11087005 351113 68 AS (800) 851-0404 PO BOX 51100 KALAMAZOO MI IBA HEALTH AND LIFE ASSURANCE

11087010 351113 89 AS (800) 233-2101 PO BOX 51719 KALAMAZOO MI IBA SELF FUNDED GROUP

Page 42: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

11087015 351113 89 NO (888) 883-2748 106 FARMERS ALLEY KALAMAZOO MI IBA PPO NETWORK

11087020 351113 88 DO (269) 341-7200 PO BOX 51100 KALAMAZOO MI IBA HEALTH & LIFE ASSURANCE

11087025 351113 89 AS (800) 851-0404 PO BOX 51100 KALAMAZOO MI IBA FULLY INSURED

11096005 358569 38 AS (999) 999-9999

130 N WESTNEDGE

AVE KALAMAZOO MI INTERSTATE INS PLAN

11102005 358569 38 AS (847) 520-1900 3750 DEERFIELD RD RIVERWOOD IL INTERSTATE LIFE

11111005 351113 67 AS (800) 572-8553 P.O. BOX 8006 NOVI MI IRONWORKERS LOCAL 25

11111111 359196 90 XM (999) 999-9999 N/A N/ MI MEDICARE-ELIGIBLE FOR,NOT ENROLLED

11120005 351113 67 AS (616) 962-8511 510 E COLUMBIA BATTLE CREEK MI IRONWORKERS LOCAL 340

11149005 351113 38 AS (999) 999-9999 0 THORP WI ITT LIFE INS CORP

11158005 351113 38 AS (999) 999-9999 ROUTE 22 LONG GROVE IL KEMPER INSURANCE

11167005 351113 38 AS (999) 999-9999 18720 MACK AVE. GROSSE PTE FARM MI L & PCWIF INSURANCE FUND

11176005 351113 38 AS (215) 635-4137 PO BOX 8857 ELKINS PARK PA LATVIAN RELIEF FUND

11185005 351113 38 AS (800) 821-7715 4534 WORNALL ROAD KANSAS CITY MO LEWER AGENCY INC

11194005 351113 38 AS (999) 999-9999

6841 N ROCHESTER

RD ROCHESTER MI LEAR SIEGLER INC

11194010 351113 38 AS (999) 999-9999 404 E HAYES HAZEL PARK MI LEAR SIEGLER INC

11194015 352530 38 AS (999) 999-9999 4141 EASTERN AVE SE GRAND RAPIDS MI SMITH INDUSTRIES

11194020 351113 38 AS (999) 999-9999 17600 BROADWAY CLEVELAND OH LEAR SIEGLER INC

11200005 358569 38 AS (800) 344-0197 301 S 20TH ST BIRMINGHAM AL LIBERTY NATL LIFE IN

11229005 352530 38 AS (999) 999-9999 117 WATER ALLEGAN MI L PERRIGO INS PLAN

11238005 358569 67 AS (800) 323-7268 2000 SPRINGER DR. LOMBARD IL LINE CONSTRUCTION BENEFIT FUND

11238010 358569 89 AS (800) 323-7268 2000 SPRING DRIVE LOMBARD IL LINECO

11247005 352530 38 AS (999) 999-9999 20820 RUTLAND SOUTHFIELD MI MACDONALDS EAST MI

11256005 352530 88 DO (800) 456-9194 PO BOX 830626 BIRMINGHAM AL VOLUNTARY BENEFITS INTERNATION

11265005 358569 89 AS (800) 348-6515 PO BOX 35 DANIA FL AMERICAN MARITIME OFFICERS

11274005 352530 38 AS (999) 999-9999 4800 N KENNETH AVE CHICAGO IL MARQUETTE NATL INS

11283005 358569 38 AS (999) 999-9999 120 S RIVERSIDE PLAZ CHICAGO IL MARTIN BOYER CO

11283010 358569 38 AS (800) 378-9933 PO BOX 7131 INDIANAPOLIS IN MARYLAND INSURANCE GROUP

11292005 352530 38 AS (999) 999-9999 21001 VAN BORN RD TAYLOR MI MASCO EMP BENEFIT PLAN

11309005 358569 38 AS (999) 999-9999 704 N CLARK ST ALBION MI MCGRAW EDISON CO

11318005 351113 72 AS (999) 999-9999 800 MCKAY TOWER GRAND RAPIDS MI MI ASSOC PLMBG & HTG

11327005 352530 38 AS (999) 999-9999 BOX 860 EAST LANSING MI MI AUTO DEALERS ASSOC

11336005 352530 38 AS (999) 999-9999 800 MCKAY TOWER GRAND RAPIDS MI MI AUTO WHOLESALE ASSOC

11345005 358569 38 AS (999) 999-9999 118 W ST JOSEPH LANSING MI MI CLAIM SERVICE

Page 43: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

11354005 413395 38 AS (999) 999-9999 206 FEDERAL SQUARE GRAND RAPIDS MI MI CONTRS & SUPPLIERS

11363005 352530 67 X2 (517) 323-9250 6011 W ST JOSEPH LANSING MI MI ELEC WRKRS H & W FUND

11372005 358569 38 AS (999) 999-9999

2420 SCIENCE

PARKWAY OKEMOS MI MI STATE FLORISTS ASSOC

11381005 358569 38 AS (517) 349-9565 PO BOX 27158 LANSING MI MI FUNERAL DIRECTORS

11390005 351113 67 XV (810) 645-1093 30700 TELEGRAPH RD BINGHAM FARMS MI MI GLASS & GLAZING INS

11407005 358569 38 AS (616) 459-0133

25 JEFFERSON

AVENUE GRAND RAPIDS MI MI GRAIN DEALERS

11416005 413395 67 AS (999) 999-9999 800 MCKAY TOWER GRAND RAPIDS MI MI NURSERYMEN ASSOC

11425005 358569 38 AS (248) 645-6420 6525 CENTURION DR LANSING MI MI STATE PAINTERS INSURANCE

11434005 351113 67 AS (999) 999-9999

4414 S PENNSYLVANIA

AVE. LANSING MI MI RETAIL HARDWARE ASSOC

11443005 358569 67 AS (517) 655-8010 221 N PINE ST LANSING MI MI RETAILERS GROUP INS

11449010 358113 83 NH (206) 285-1422

226 SECOND AVENUE

WEST SEATTLE WA GREAT REPUBLIC LIFE INSURANCE

11461005 351113 89 AS (248) 583-7123 PO BOX 71507 MADISON HEIGHTS MI LIBERTY UNION-MID AMERICA ASSOC

11470005 358569 38 AS (248) 645-6310 PO BOX 3039 BIRMINGHAM MI MID CONTINENTAL CLAIMS

11499005 358569 26 AS (952) 829-3500 PO BOX 9498 MINNEAPOLIS MN CBCA ADMINISTRATORS INC

11499010 351113 38 AS (800) 543-0161 PO BOX 44290 DETROIT MI DMC CARE

11499015 358569 26 AS (800) 372-2702 PO BOX 9498 MINNEAPOLIS MN HRM CLAIM MANAGEMENT

11505005 413395 67 AS (248) 641-4960 PO BOX 1157 TROY MI DETROIT MILLMENS LOC 1045 H&W

11514005 358569 67 DV (517) 321-7502

6525 CENTURION

DRIVE LANSING MI MILLWRIGHTS LOCAL1102 H&W FUND

11523005 352530 38 AS (800) 487-0771 PO BOX 104360 JEFFERSON CITY MO MO STATE MED CARE PLAN

11532005 358569 38 AS (999) 999-9999 PO BOX 5003 NORTH SUBURBAN IL MONTGOMERY WARD

11541005 358569 41 XR (703) 729-4677 20547 WAVERLY CT ASHBURN VA NALC HEALTH BENEFIT PLAN

11541010 358871 87 RX (800) 933-6252 PO BOX 686005 SAN ANTONIO TX CAREMARK/NALC

11550005 358569 38 AS (999) 999-9999 76 N BROADWAY IRVINGTON NY NATIONAL COUNCIL SR CITIZENS

11579005 352530 38 AS (999) 999-9999 PO BOX 1280 NASHVILLE TN NATIONAL EMPLOYEES TRUST

11588005 358569 38 AS (800) 652-7300 360 W 31ST ST. NEW YORK NY NATIONAL MARITIME UNION

11597005 358569 31 AS (999) 999-9999 PO BOX 13997 PHILADELPHIA PA PRUDENTIAL INSURANCE COMPANY

11603005 358569 38 AS (999) 999-9999 128 STATE ST HAMMOND IN NATIONAL PROTECTIVE LIFE

11612005 413395 38 AS (999) 999-9999 800 MCKAY TOWER GRAND RAPIDS MI N OTTAWA HLTH BENEFIT

11621005 351113 67 AS (999) 999-9999 6 E FOURTH ST CINCINNATI OH OH GRAPHIC ARTS

11630005 358569 38 AS (999) 999-9999 8550 W BRYN MAWR CHICAGO IL OH HIGHWAY DRIVERS WELFARE

11659005 352530 71 AS (999) 999-9999 1276 W 3RD ST CLEVELAND OH NY MUTUAL RELIEF ASSOC

11668005 358569 38 AS (519) 433-4561 POSTAL STATION A MISSISSAUGA ON ONTARIO HEALTH INSURANCE PLAN

11677005 352530 38 AS (999) 999-9999 2400 WEST BAY DR LARGO FL ORANGE STATE LIFE INS

Page 44: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

11686005 358569 38 AS (602) 263-6666 2721 N CENTRAL AVE PHOENIX AZ OXFORD LIFE

11686010 358569 89 AS (800) 444-6222 PO BOX 7082 BRIDGEPORT CT OXFORD HEALTH PLANS

11695005 413395 89 AS (248) 358-3340

26877

NORTHWESTERN HWY

STE 100 SOUTHFIELD MI PAINTERS UNION INSURANCE

11701005 358569 38 AS (999) 999-9999 55 PUBLIC SQUARE CLEVELAND OH PENN CENT MUT ASSOC

11710005 413395 38 AS (336) 691-3000 P O BOX 26011 GREENSBORO NC JEFFERSON PILOT LIFE INSURANCE

11739005 358569 72 AS (999) 999-9999 PO BOX 3040 TERRE HAUTE IN PIPE TRADES H&W FUND

11748005 358569 41 AS (703) 683-5585 1019 N ROYAL ST ALEXANDRIA VA POSTMASTERS BENEFIT PLAN

11757005 359196 67 AS (810) 645-6550 30700 TELEGRAPH RD BIRMINGHAM MI PLASTER TENDER INS & PENSION

11766005 358569 72 AS (999) 999-9999 161 E MICHIGAN AVE KALAMAZOO MI PLUMBERS & PIPEFITTERS H & W

11766010 358569 72 AS (999) 999-9999

308 MICHIGAN

BUILDING KALAMAZOO MI PLUMBERS & PIPEFITTERS H&W

11775005 358569 89 XR (734) 665-8022

2320 WASHTENAW

AVENUE ANN ARBOR MI PLUMBERS & STEAMFITTERS

11784005 358569 62 AS (800) 258-3311 P O BOX 14601 LEXINGTON KY HUMANA INSURANCE CLAIM CENTER

11784010 358569 89 AS (800) 457-4708 PO BOX 19080-F JACKSONVILLE FL HUMANA HEALTH INSURANCE CO OF FL

11793005 351113 38 AS (216) 831-7870

23900 COMMERCE

PARK RD CLEVELAND OH RAILROAD EMPLOYEES MUTUAL

11819005 352530 88 DO (999) 999-9999

1410 DET BANK &

TRUS DETROIT MI RR EMP DENTAL PLAN

11828005 358569 41 AS (999) 999-9999

51 MONROE ST PO

BOX 6222 ROCKVILLE MD RURAL CARRIERS

11837005 358569 72 AS (999) 999-9999

3101 ALLIED DR SUITE

B JACKSON MI PLUMBERS & PIPEFITTERS

11846005 351113 72 AS (800) 582-6181

32300

NORTHWESTERN-#125 FARMINGTON MI UA LOC 85 PLUMB & PIPE H&W FND

11855005 352530 38 AS (999) 999-9999 860 N DEARBORN CHICAGO IL SALVATION ARMY FUND

11864005 352530 38 AS (999) 999-9999 1111 FULTON MALL FRESNO CA SAN JOAQUIN ADMINIST

11864010 352530 38 AS (999) 999-9999 PO BOX 51368 KALAMAZOO MI SANFORD INSURANCE GROUP

11873005 352530 38 AS (999) 999-9999 6473 56TH AVE HUDSONVILLE MI S BLENDON BENFT ASSN

11882005 352530 67 AS (800) 252-4674 5201 AUTHWAY CAMP SPRINGS MD SEAFARERS WELFARE PLAN

11891005 352530 38 AS (999) 999-9999 PO BOX 1666 ARLINGTON HGTS IL SEARS ALLSTATE MEDICAL INS

11891010 352530 38 AS (999) 999-9999 PO BOX 1666 ARLINGTON HGTS IL SEARS ALLSTATE MEDICAL INS

11908005 358569 38 AS (312) 692-7020 PO BOX 389 DUBUQUE IA SELF INSURED SERVICES CO

11917005 358569 67 AS (999) 999-9999 PO BOX 3039 BINGHAM FARMS MI SHEET METAL WKRS LOCAL 80

11917010 358569 67 AS (888) 646-6565 PO BOX 189 TROY MI SHEET METAL WKRS LOCAL 292

11926005 358569 67 XR (800) 831-4914 P O BOX 1449 GOOLETTSVILLE TN SHEET METAL WKRS LOCAL 360

11935005 358569 67 AS (800) 922-7285 3765 ARTHUR ST GARY IN SHEET METAL WORKERS

Page 45: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

11944005 352530 38 AS (999) 999-9999 313 UNDERHILL RD SYOSETT NY SINGER EMPL BENEFITS

11953005 358569 38 AS (999) 999-9999 1120 36TH SE ST GRAND RAPIDS MI STEELCASE INC

11962005 358569 33 AS (999) 999-9999

3525 W PETERSON

#T24 CHICAGO IL TEAMSTERS N IL H&W

11971005 352530 38 AS (999) 999-9999 7445 MAYER RD FAIRHAVEN MI TEXTILE TRIM BENEFIT

11980005 358569 67 AS (800) 432-2924 PO BOX 697 TOLEDO OH UNION CONSTRUCTION WORKERS HEALTH PLAN

11980010 358569 89 AS (800) 432-2924 PO BOX 697 TOLEDO OH UNION CONSTRUCTION WORKERS HEALTH PLAN

12001005 413395 67 AS (999) 999-9999 5050 BENNETT RD TOLEDO OH TOLEDO PLUMBERS AND PIPEFITTER

12010005 358569 76 AS (800) 766-9780 PO BOX 1687 GRAND RAPIDS MI CBCA ADMINISTRATORS INC

12010010 358569 89 AS (800) 766-9780 PO BOX 1687 GRAND RAPIDS MI CBCA ADMINISTRATORS INC

12039005 358569 89 X4 (800) 826-2862

3011 W Grand Blvd

Suite 1600 DETROIT MI TOTAL HEALTH CARE

12048005 352530 38 AS (999) 999-9999

3260 HOSP FINANCE

BLDG ANN ARBOR MI U M MAJOR MEDICAL EXPENSE INS

12057005 358569 38 AS (800) 323-3529 PO BOX 3048 NAPERVILLE IL AMERICAN CHAMBERS LIFE

12066005 552530 41 AS (999) 999-9999 1310 APPLE AVE SILVERSPRING MD UNITED FED OF POSTAL CLERKS

12075005 552530 38 AS (999) 999-9999 PO BOX 8334 KANSAS CITY MO UNITED EMPLOYERS INS

12084005 358569 53 AS (615) 889-8860 1910 AIR LANE DRIVE NASHVILLE TN UNITED FURNITURE WORKERS

12084010 358569 89 AS (800) 800-8860 PO BOX 100037 NASHVILLE TN UNITED FURNITURE WORKERS

12093005 351113 38 XR (888) 865-5290 PO BOX 389 EPHRAIM UT UNITED MINE WORKERS

12119005 352530 01 AS (313) 464-2753 241 E SAGINAW EAST LANSING MI UNITED PARCEL SERVICE BEN PLAN

12128005 552530 38 AS (999) 999-9999 26401 HARPER 3 ST CLAIR SHORES MI UNITED INSURANCE TRUST

12137005 352530 38 AS (800) 228-7778

MUTUAL OF OMAHA

PLAZA OMAHA NE UNITED OF OMAHA

12146005 358569 67 AS (517) 321-7502 6525 CENTURION LANSING MI UP PLUMBERS & PIPEFITTERS

12155005 352530 67 AS (999) 999-9999 25 N 4TH ST PHILADELPHIA PA UPHOLSTERERS FUND

12164005 413395 38 AS (217) 443-2812 PO BOX 4007 DANVILLE IL MEDI CLAIM

12164010 413395 87 RX (800) 207-2568 PO BOX 545 DEERFIELD IL WALGREENS HEALTH INITIATIVE

12173005 352530 38 AS (616) 957-7265 4300 36TH SE GRAND RAPIDS MI WESTINGHOUSE INS PLA

12182005 352530 38 AS (414) 336-1100 PO BOX 1100 DEPERE WI WI EMPLOYERS GROUP

12191005 352530 38 AS (999) 999-9999

1503 CEDAR CREST

BLVD ALLENTOWN PA WILSON HOSPITAL MEDICAL PLAN

12191010 352530 89 AS (612) 854-0795

2850 METRO DRIVE

SUITE 404 BLOOMINGTON MN WILSON MCSHANE CORPORATION

12208005 351113 05 AS (800) 345-4344 PO BOX 37010 LOUISVILLE KY ANTHEM ACORDIA BC BS OF IN

12208010 351113 38 AS (999) 999-9999

4310 OLD

MCDONOUGH ROAD CONLEY GA ACORDIA

12208015 351113 38 AS (800) 228-2891 PO BOX 68416 INDIANAPOLIS IN ACORDIA

12217005 351113 05 AS (800) 382-2000 PO BOX 64338 ST PAUL MN BC BS OF MN

12217010 351113 89 AS (800) 262-0820 PO BOX 64338 ST PAUL MN BC BS OF MN

Page 46: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

12226005 413395 38 AS (800) 333-5711

4079 EXECUTIVE

PARKWAY WESTERVILLE OH CENTRAL BENEFITS MUTUAL INS CO

12235005 351113 05 AS (999) 999-9999 2400 MARKET STREET YOUNGSTOWN OH BC BS OF OH EASTERN

12244005 351113 05 AS (999) 999-9999 PO BOX 1046 LIMA OH BC BS OF OH LIMA

12253005 351113 89 AS (999) 999-9999

2060 EAST NINTH

STREET CLEVELAND OH MEDICAL MUTUAL OF OH

12253010 351113 38 AS (800) 362-4700 PO BOX 6018 CLEVELAND OH MEDICAL MUTUAL OF OH

12262005 351113 89 XR (419) 473-7100 PO BOX 5968 CLEVELAND OH MEDICAL MUTUAL OF OH

12271005 351113 38 AS (888) 613-6097

1351 WM HOWARD

TAFT RD CINCINNATI OH ANTHEM BC BS

12280005 351113 89 X3 (330) 492-2151

4150 BELDEN

VILLAGE,NW CANTON OH ANTHEM BC BS-CANTON REGION

12306005 351113 89 AS (800) 621-7336 PO BOX A-3694 CHICAGO IL HMO ILLINOIS

12306010 351113 05 AS (999) 999-9999 300 EAST RANDOLPH CHICAGO IL BC BS OF IL MEMBERS 1ST

12315005 351113 87 RX (800) 962-7378 PO BOX 9082 OXNARD CA WELLPOINT PHARMACY MANAGEMENT

12324005 351113 38 AS (999) 999-9999 2060 E NINTH ST CLEVELAND OH MEDICAL MUTUAL OF CLEVELAND

12333005 351113 05 AS (800) 368-5810 PO BOX 37180 LOUISVILLE KY ANTHEM COMMUNITY MUTUAL BC BS

12333010 351113 89 AS (800) 368-5810 PO BOX 37180 LOUISVILLE KY ANTHEM COMMUNITY MUTUAL BCBS

12342005 351113 05 AS (999) 999-9999 401 W MICHIGAN ST MILWAUKEE WI BC BS OF WI

12342010 351113 89 AS (800) 848-3308 PO BOX 34210 LOUISVILLE KY BC BS OF WI

12351005 358871 38 AS (800) 221-5313 PO BOX 8190 MADISON WI WI PHYSICIANS SERVICE

12351010 358871 89 AS (800) 221-5313 PO BOX 8190 MADISON WI WI PHYSICIANS SERVICE

12360005 351113 89 AS (517) 321-7502

6525 CENTURION

DRIVE LANSING MI LABORERS METRO DETROIT H & W

12389005 352530 38 AS (999) 999-9999 PO BOX 2069 FAYETTEVILLE NC MID SOUTH INSURANCE CO

12398005 358871 25 AS (800) 657-8205

712 ELEVENTH

AVENUE LAWRENCEVILLE IL GOLDEN RULE INSURANCE

12404013 358569 38 AS (999) 999-9999 24 N.E. CAPITAL AVE. BATTLE CREEK MI CALHOUN COUNTY FOC

12404025 358569 38 AS (999) 999-9999 1101 BEACH STREET FLINT MI GENESEE COUNTY FOC

12404039 352530 38 AS (999) 999-9999

ROOM G-6 COUNTY

BUILDING KALAMAZOO MI KALAMAZOO COUNTY FOC

12404050 351113 38 AS (999) 999-9999

MACOMB COUNTY

COURT BLDG MT CLEMENS MI MACOMB COUNTY FOC

12404063 358569 38 AS (999) 999-9999

1200 N. TELEGRAPH

RD. PONTIAC MI OAKLAND COUNTY FOC

12404082 352530 38 AS (999) 999-9999

3900 CADILLAC

TOWER DETROIT MI WAYNE COUNTY FOC

12413005 358569 38 AS (999) 999-9999 1551 E LINCOLN MADISON HEIGHTS MI ALLIED ACCESSORIES & AUTO PART

Page 47: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

12422005 358569 38 AS (999) 999-9999 1011 N HOLLYWOOD MEMPHIS TN AMERICAN ART CLAY INDUSTRIAL

12431005 352530 38 AS (999) 999-9999 0000 000000 0000 LONG GROVE IL AMERICAN MANUF MUTUAL INS

12440005 413395 38 AS (999) 999-9999 351 ROCHESTER KALAMAZOO MI ARVCO INS

12469005 351113 38 AS (999) 999-9999 201 HURON GRAYLING MI BENEFICIAL EMPLOYEES SEC TRST

12478005 351113 38 AS (999) 999-9999

300 W WASHINGTON

ROOM802 CHICAGO IL BINDERY WOMENS UNION INS FUND

12487005 351113 38 AS (999) 999-9999 12715B STATE HWY 55 MINNEAPOLIS MN CARLSON CO

12502005 351113 38 AS (999) 999-9999 203 PARK BLDG CLEVELAND OH COLONIAL INSURANCE COMPANY

12511005 358569 38 AS (999) 999-9999 104 S MAIN ST FOND DU LAC WI COMBINED INS OF WI

12520005 351113 38 AS (999) 999-9999 PO BOX 15608 LAKEWOOD CO CONTINENTAL EMP BENEFIT ASSOC

12549005 358569 38 AS (999) 999-9999

66 GRAND AVE BOX

751 ENGLEWOOD NJ DISTILLARY & WINE & ALLIED WKS

12558005 358569 38 AS (999) 999-9999

4597 SADDLEBAG

LAKE RD. WOODLAND MI EMPLOYEE BENEFITS

12567005 351113 07 AS (999) 999-9999

55 PUBLIC SQUARE

#2000 CLEVELAND OH EQUITABLE INSURANCE COMPANY

12576005 351113 07 AS (999) 999-9999 P.O. BOX 445 LAFAYETTE CA EQUITABLE LIFE

12585005 358113 38 AS (999) 999-9999 5071 WEST H AVENUE KALAMAZOO MI FIRST AGENCY

12594005 352530 38 AS (999) 999-9999

350 CLYDE MORRIS

BLVD DAYTONA BEACH FL FL HEALTH CARE PLAN

12600005 352530 38 AS (999) 999-9999

21350 WEST 7 MILE

RD DETROIT MI GRAND GROUP EMPLOYEE BENEFIT

12629005 352530 38 AS (999) 999-9999 PO BOX 206 FLINT MI GREAT LAKES MUTUAL LIFE INS CO

12638005 413395 38 AS (999) 999-9999

UNION COMMERCE

BLDG CLEVELAND OH HEALTH INSURANCE TRUST

12647005 413395 38 AS (999) 999-9999 PO BOX 10086 SAVANNAH GA ITPE NMU WELFARE PLAN

12656005 358569 38 AS (800) 464-4000 PO BOX 12923 OAKLAND CA KAISER PERMANENTE MED CARE PRO

12656010 358569 38 AS (999) 999-9999 1950 FRANKLIN OAKLAND CA KAISER FOUNDATION HEALTH PLAN

12656015 358569 38 AS (999) 999-9999 2005 FRANKLIN ST DENVER CO KAISER FOUNDATION HEALTH PLAN

12656020 358569 38 AS (999) 999-9999 11203 FAIRHILL RD CLEVELAND OH KAISER FOUNDATION HEALTH PLAN

12656025 358569 38 AS (999) 999-9999 PO BOX 6611 ROCKVILLE MD KAISER PERMANENTE

12665005 352530 38 AS (616) 473-8300 PO BOX 262 BERRIEN SPRINGS MI HOME HLTH EDUCATION SERVICE

12674005 352530 38 X5 (800) 888-2452 PO BOX 1500 NASHVILLE TN LIFE & CASUALTY INSURANCE

12683005 351113 38 AS (800) 320-8040 PO BOX 21628 TULSA OK MAPCO INC

12692005 413395 38 AS (999) 999-9999

143 SOUND BEACH

AVE OLD GREENWICH CT MARKET MANAGEMENT INCORP

12709005 413395 38 AS (800) 348-7468

1110 NORTH MAIN

STREET GOSHEN IN MENNONITE MUTUAL AID

12718005 358569 38 AS (999) 999-9999 PO BOX 486 NEWBERRY MI MI ASSOC OF TIMBERMAN

Page 48: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

12718010 358569 38 AS (999) 999-9999 PO BOX 5007 SOUTHFIELD MI MI ASSOC OF TIMBERMAN

12727005 352530 38 AS (999) 999-9999 28 W ADAMS DETROIT MI MI MUTUAL INSURANCE CO

12745005 358569 67 AS (800) 323-3060 6150 JOLIET RD COUNTRYSIDE IL MIDWEST OPER ENG WELFARE FUND

12754005 351113 38 AS (999) 999-9999 2147 UNIVERSITY AVE ST PAUL MN NATIONAL FAMILY INS CO

12763005 352530 38 X3 (800) 868-6788 1830 Craig Park Ct. ST LOUIS MO NATIONAL STATE INS CO

12772005 358569 38 AS (999) 999-9999 PO BOX 5123 SOUTHFIELD MI PENN GENERAL SERVICES

12772010 358569 38 AS (999) 999-9999 PO BOX 39843 EDINA MN PENN GENERAL SERVICES

12772015 358569 38 AS (800) 242-4472 PO BOX 9120 MARSHFIELD MA GROUP INSURANCE SERVICE CENTER

12781005 352530 38 AS (999) 999-9999 EXECUTIVE OFFICES CAMP HILL PA PA PUBLIC EMPLOYEE

12790005 352530 38 AS (999) 999-9999

1143 LANEY WALKER

BLVD AUGUSTA GA PILGRIM HEALTH AND LIFE

12807005 413395 89 AS (800) 950-0084 PO BOX 2034 CARMEL IN PIONEER LIFE INSURANCE CO OF IL

12807010 413395 38 AS (815) 965-8955 PO BOX 619076 DALLAS TX PIONEER LIFE INSURANCE

12807015 413395 59 XR (800) 759-7007 PO BOX 2034 CARMEL IN PIONEER LIFE INSURANCE CO OF IL

12807020 413395 38 AS (413) 539-9900 PO BOX 9040 W. SPRINGFIELD MA PIONEER MANAGEMENT SYSTEMS INC

12816005 352530 38 AS (999) 999-9999

20740 CASS PO BOX

216 MT CLEMENS MI ROSES

12825005 352530 38 AS (999) 999-9999 200 HORTON ST STRYKER OH SAUDER DESIGNARE INC

12834005 352530 38 AS (999) 999-9999 17100 W CAPITOL BROOKFIELD WI SEMMANN INSURANCE CO

12843005 351113 83 NH (405) 232-5281 PO BOX 1800 GALVESTON TX STANDARD LIFE/ACCIDENT INS CO

12843010 351113 89 AS (888) 350-1488 PO BOX 1800 Galveston TX STANDARD LIFE & ACCIDENT INSURANCE CO

12852005 351113 57 AS (866) 855-1212

1440 GRANVILLE

ROAD NEWARK OH STATE FARM INSURANCE

12852010 351113 89 AS (866) 855-1212

1440 GRANVILLE

ROAD NEWARK OH STATE FARM INSURANCE

12861005 352530 38 AS (999) 999-9999 99 UNIVERSITY PLACE NEW YORK NY TWUA HEALTH PLAN

12870005 351113 38 AS (999) 999-9999

ALGONQUIN&MT

PROSPECT RD DES PLAINES IL UNIVERSAL OIL PRODUCTS

12899005 352530 38 AS (999) 999-9999

912 HOUSTON ST

SUITE 500 FORT WORTH TX VICO COUNTY MUTUAL INS CO

12905005 352530 38 AS (999) 999-9999

BOX3745 PARKVIEW

AT RIDG GREEN BAY WI WI EMPLOYERS GROUP

12914005 358569 38 AS (999) 999-9999 DRAWER 6000 HAMPTON NH ZEBA INS

12923005 352530 38 AS (999) 999-9999 PO BOX 4097 ERIE PA EMPIRE STATE MUTUAL LIFE INS

12932005 413395 38 AS (999) 999-9999 22351 S WILMINGTON CARSON CA BERGEN BRUNSWIG CO

12941005 352530 38 AS (999) 999-9999 3303 W SAGINAW LANSING MI MI FARMERS GROUP

12950005 351113 05 AS (800) 676-2583

450 RIVERCHASE

PKWY EAST BIRMINGHAM AL BC BS OF AL

12950010 351113 89 AS (800) 676-2583

450 RIVERCHASE

PARKWAY EAST BIRMINGHAM AL BC BS OF AL

Page 49: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

12979005 351113 05 AS (800) 232-2345 PO BOX 13466 PHOENIX AZ BC BS OF AZ

12988005 351113 05 AS (800) 238-8379 PO BOX 2181 LITTLE ROCK AR BC BS OF AR

12988010 351113 89 AS (800) 238-8379 PO BOX 2181 LITTLE ROCK AR BC BS OF AR

12997005 351113 05 AS (800) 888-8288 PO BOX 9043 OXNARD CA BC BS OF CA

12997010 351113 89 AS (800) 888-8288 PO BOX 9043 OXNARD CA BC BS OF CA

12997015 351113 89 AS (800) 331-2001 PO BOX 272560 CHICO CA BS OF CA

12997020 351113 38 X5 (800) 934-2961 PO BOX 3190 RANCHO CORDOVA CA BC BS OF CA

13009005 351113 89 AS (800) 873-5553 2155 OXNARD ST WOODLAND HI CA ANTHEM BC CALIFORNIA

13018005 351113 05 AS (800) 345-7372 700 BROADWAY DENVER CO BC BS OF CO

13027005 351113 05 AS (203) 239-4911 PO BOX 533 NORTH HAVEN CT ANTHEM BC BS OF CT

13027010 351113 38 AS (800) 257-9873 PO BOX 32550 LOUISVILLE KY ANTHEM BENEFIT ADMINISTRATORS

13027015 351113 89 AS (800) 223-9693 370 BASSETT RD NORTH HAVEN CT ANTHEM BC BS OF CT

13036005 351113 05 AS (302) 421-3000 PO BOX 1991 WILMINGTON DE BC BS OF DE

13045005 351113 05 AS (800) 843-4280 PO BOX 812 OWINGS MILLS MD CARE FIRST BC BS

13045010 351113 89 AS (800) 843-4280 PO BOX 812 OWINGS MILLS MD CARE FIRST BC BS

13054005 351113 05 AS (800) 727-2227 PO BOX 1798 JACKSONVILLE FL BC BS OF FL INC

13054010 352530 89 PS (800) 782-2052 P O BOX 45297 JACKSONVILLE FL FL PSYCHIATRIC MANAGEMENT

13054015 351113 89 AS (800) 727-2227 PO BOX 45034 JACKSONVILLE FL BC BS OF FL

13063005 351113 05 AS (800) 362-2218 636 GRAND AVE DES MOINES IA BC BS OF IA

13063010 351113 89 AS (800) 526-5710 PO BOX 7020 SIOUX CITY IA BC BS OF IA

13072005 351113 05 AS (785) 291-7000 PO BOX 239 TOPEKA KS BC BS OF KS

13072010 351113 89 AS (785) 291-7000 1133 SW TOPEKA TOPEKA KS BC BS OF KS

13081005 351113 05 AS (800) 880-2583 PO BOX 37180 LOUISVILLE KY ANTHEM BC BS OF KY

13081010 351113 89 AS (800) 676-2583 PO BOX 37010 LOUISVILLE KY ANTHEM BC BS OF IN ITS INDY

13081025 351113 89 AS (800) 826-7987 PO BOX 37180 LOUISVILLE KY ANTHEM BC BS OF KY

13090005 351113 05 XR (800) 362-2218 PO BOX 98029 BATON ROUGE LA BC BS OF LA

13107005 351113 05 XR (207) 822-7000 2 GANNETT DRIVE SOUTH PORTLAND ME BC BS OF ME

13116005 351113 05 AS (800) 882-2060 PO BOX 986020 BOSTON MA BC BS OF MA

13116010 351113 89 AS (800) 882-2060 PO BOX 986020 BOSTON MA BC BS OF MA

13125005 351113 05 AS (800) 892-6048 PO BOX 419169 KANSAS CITY MO BC BS OF KANSAS CITY

13125010 351113 05 XR (800) 490-6145 PO BOX 14882 ST LOUIS MO ANTHEM BCBS OF MO

13125015 351113 89 AS (800) 490-6145 PO BOX 14882 ST LOUIS MO ANTHEM BCBS OF MO

13134005 351113 89 AS (800) 447-7828 PO BOX 5004 GREAT FALLS MT BC BS OF MT

13143005 351113 05 AS (800) 284-4640 PO BOX 3248 OMAHA NE BC BS OF NE

13143010 351113 89 AS (800) 284-4640 PO BOX 3248 OMAHA NE BC BS OF NE

13152005 351113 05 XR (800) 225-2666 3000 GOFFS FALLS RD MANCHESTER NH BC BS OF NH

13161005 351113 05 AS (800) 221-1396 PO BOX 1609 NEWARK NJ BC BS OF NJ

13161010 351113 88 DO (201) 446-4000 PO BOX 1938 NEWARK NJ BC BS OF NJ

13170005 351113 05 AS (800) 920-8889 PO BOX 4809 SYRACUSE NY EXCELLUS BCBSNY

13170010 351113 89 AS (800) 920-8889 PO BOX 4809 SYRACUSE NY EXCELLUS BCBSNY

13199005 351113 05 XR (800) 734-4069 PO BOX 4809 SYRACUSE NY EXCELLUS BCBSCNY

13199010 351113 89 AS (800) 734-4069 PO BOX 4809 SYRACUSE NY EXCELLUS BCBSCNY

Page 50: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

13205005 351113 05 AS (518) 367-4737 PO BOX 11800 ALBANY NY EMPIRE BC BS OF NY

13214005 351113 05 AS (800) 888-0757 1901 MAIN ST BUFFALO NY BC BS OF WESTERN NY

13214010 351113 89 AS (800) 444-2012 1901 MAIN STREET BUFFALO NY BC BS OF WESTERN NY

13223005 358569 38 AS (212) 501-4444 PO BOX 15030 ALBANY NY GHI ALBANY MSP UNIT

13232005 351113 05 AS (800) 222-5028 PO BOX 35 DURHAM NC BC BS OF NC

13232010 351113 05 XR (800) 422-4658 PO BOX 35 DURHAM NC BC BS OF NC

13241005 351113 05 AS (918) 560-3500 PO BOX 3283 TULSA OK BC BS OF OK

13241010 351113 89 AS (800) 672-2378 PO BOX 3283 TULSA OK BC BS OF OK

13250005 351113 05 AS (800) 722-5086 PO BOX 30805 SALT LAKE CITY UT REGENCE BCBS OF OR

13250010 351113 89 AS (800) 722-5086 PO BOX 30805 SALT LAKE CITY UT REGENCE BCBS OF OR

13279005 351113 05 XR (800) 626-8144

1901 MARKET 19TH

FL PHILADELPHIA PA INDEPENDENCE BC-OTHER PARTY LIABILITY

13279010 351113 89 AS (800) 275-2583 1901 MARKET,15TH FL PHILADELPHIA PA INDEPENDENCE BC

13288005 351113 05 X5 (800) 958-5558 1221 W HAMILTON ST ALLENTOWN PA CAPITAL BC & PA BS

13297005 351113 05 AS (800) 829-8599

19 NORTH MAIN

STREET WILKES-BARRE PA BC OF NORTHEASTERN PA

13303005 351113 05 AS (800) 235-4999 PO BOX 1210 PITTSBURGH PA HIGHMARK BC BS

13303010 351113 05 AS (800) 218-1441 DEPARTMENT 778974 HARRISBURG PA BC BS OF PA

13303015 351113 89 AS (800) 245-6642 PO BOX 1210 PITTSBURGH PA HIGHMARK BCBS

13303020 351113 89 AS (800) 218-1441 DEPARTMENT 778974 HARRISBURG PA BC BS OF PA

13303025 351113 38 AS (800) 279-2624 PO BOX 535078 PITTSBURGH PA HM BENEFITS ADMINISTRATORS

13304005 351113 05 AS (802) 229-4777 PO BOX 186 MONTPELIER VT BC BS OF VT

13312005 351113 89 AS (866) 688-2242 2500 ELMERTON AVE HARRISBURG PA CAPITAL BC

13321005 351113 05 AS (803) 788-0222 I-20 AT ALPINE ROAD COLUMBIA SC BC BS OF SC

13321010 351113 89 AS (803) 788-0222 I-20 AT ALPINE ROAD COLUMBIA SC BC BS OF SC

13330005 351113 05 AS (423) 755-5600 801 PINE ST CHATTANOOGA TN BC BS OF TN

13330010 351113 89 AS (800) 565-9140 PO BOX 180150 CHATTANOOGA TN BC BS OF TN

13359005 351113 05 AS (800) 451-0287 PO BOX 660044 DALLAS TX BC BS OF TX

13359010 351113 89 AS (800) 451-0287 PO BOX 660044 DALLAS TX BC BS OF TX

13368005 351113 05 AS (800) 533-1116 PO BOX 27401 RICHMOND VA ANTHEM BC BS

13377005 351113 05 AS (800) 213-5470 PO BOX 327 SEATTLE WA BC OF WA & AK

13377010 351113 89 AS (800) 627-1030 PO BOX 7408 BOISE ID BC OF IDAHO PPO

13377015 351113 05 AS (800) 627-1188 PO BOX 7408 BOISE ID BC OF IDAHO

13386005 351113 05 AS (800) 654-5028 PO BOX 1353 CHARLESTON WV BC BS OF WV

13395005 351113 05 AS (307) 634-1393 PO BOX 2266 CHEYENNE WY BC BS OF WY

13401005 351113 05 AS (999) 999-9999 FOXCROFT SQUARE JENKINTON PA BC BS JENKINTOWN PA

Page 51: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

13410005 358569 38 AS (616) 527-1000 1 GENERAL STREET AKRON OH GENERAL TIRE & RUBBER CO

13410010 358569 38 AS (616) 527-1000 119 S DEXTER IONIA MI GENERAL TIRE & RUBBER CO

13439005 358569 89 AS (800) 521-1555 PO BOX 7676 ST CLAIR SHORES MI NGS AMERICAN INC

13439010 358569 28 AS (800) 521-1555 PO BOX 7676 ST CLAIR SHORES MI NGS AMERICAN INC

13448005 413395 05 AS (999) 999-9999 150 FERRAND DR DON MILLS ON ONTARIO BC

13457005 351113 05 XR (800) 545-6199 PO BOX 811 OWINGS MILLS MD BC BS OF MD

13457010 351113 05 AS (800) 524-4555 PO BOX 1694 CUMBERLAND MD BC BS OF MD

13457015 351113 89 AS (877) 269-1990 PO BOX 1726 CUMBERLAND MD BC BS OF MD

13466005 351113 05 AS (800) 362-3152 PO BOX 1043 JACKSON MS BC BS OF MS

13475005 413395 89 AS (419) 666-4450 PO BOX 60408 ROSSFORD OH TOLEDO ELECTRICAL WELFARE FUND

13475010 413395 89 AS (419) 255-5314

714 WASHINGTON

STREET TOLEDO OH TOLEDO FIRE FIGHTERS HEALTH

13484005 352530 38 AS (999) 999-9999

3600 N WEST 82ND

AVENUE MIAMI FL RYDER FAMILY PROTECTION PLAN

13493005 351113 05 AS (999) 999-9999 600 LAFAYETTE EAST DETROIT MI BC BS NATIONAL ACCOUNTS

13493010 351113 05 AS (800) 424-7474 600 LAFAYETT EAST DETROIT MI BC NATIONAL ACCOUNTS

13519005 358569 38 AS (999) 999-9999

241 E SAGINAW SUITE

601 EAST LANSING MI UP PLMBRS & PIFTRS LOCAL 414

13528005 351113 38 AS (304) 525-0331 PO BOX 2648 HUNTINGTON WV AMERICAN BENEFIT CORP

13528010 358113 38 AS (800) 736-7872

1733 PARK STREET

SUITE 300 NAPERVILLE IL AMERICAN BENEFIT ADMINISTRATIVE SERVICES

13537005 352530 38 AS (313) 353-3523 20155 GODDARD TAYLOR MI LAUNDRY DRY CL & DYE HOUSE WKR

13546005 413395 38 AS (216) 521-8488

16010 DETROIT

AVENUE LAKEWOOD OH CATHOLIC KNIGHTS OF OH THE

13555005 358569 38 AS (999) 999-9999 BOX 300 TULSA OK CITY SERVICE COMPANY

13564005 352530 38 AS (999) 999-9999 6866 FLORIDA BLVD BATON ROUGE LA PLANNED SEC TRUST GROUP INS

13573005 351113 38 AS (999) 999-9999 PO BOX 8287 RICHMOND VA INTERNATIONAL GROUP TRUST

13582005 352530 38 AS (999) 999-9999 8100 MOUNTAIN RD ALBUQUERQUE NM GALBRAITH AND GREEN INC

13591005 351113 38 AS (612) 513-8880

12755 STATE

HIGHWAY 55 MINNEAPOLIS MN CCEBT

13608005 413395 38 AS (313) 361-2244 2441 W GRAND BLVD DETROIT MI INTERNATIONAL ASSOC MACHINISTS

13617005 352530 38 AS (999) 999-9999

14600 DETROIT

AVENUE CLEVELAND OH UNION INSURANCE ASSOCIATION

13626005 352530 38 AS (999) 999-9999 UPTON DRIVE ST JOSEPH MI WHIRLPOOL CORP ST JOSEPH DIV

13635005 352530 88 DO (800) 638-2603

8000 CORPORATE

DRIVE LANDOVER MD NATIONAL AUTO SPRINKLER SYSTEM

13644005 413395 67 AS (999) 999-9999 2604 FOURTH STREET DETROIT MI HEALTH & WELFARE SEIU LOC 79

Page 52: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

13653005 352530 38 AS (999) 999-9999

500 S MAIN ST DEPT

0018 AKRON OH BF GOODRICH INSURANCE

13662005 358569 38 AS (999) 999-9999

7404 WOODWARD

AVE DETROIT MI CO-OP OPTICAL

13662010 358569 86 VO (313) 366-3290 2424 E 8 MILE ROAD DETROIT MI CO-OP OPTICAL

13671005 352530 86 VO (800) 225-5877 PO BOX 2487 COLUMBUS OH VISION SERVICE PLAN

13671010 352530 86 VO (800) 877-7195 PO BOX 997105 SACRAMENTO CA VISION SERVICE PLAN

13680005 358569 67 AS (999) 999-9999 30700 TELEGRAPH RD BIRMINGHAM MI MEAT CUTTERS LOCAL 26

13706005 358113 89 XR (248) 828-6000 PO BOX 99490 TROY MI DETROIT VICINITY TROWEL TRADES

13715005 358569 67 AS (517) 321-7502

6525 CENTURION

DRIVE LANSING MI METROPOLITAN DETROIT LABORERS

13724005 358569 67 AS (248) 822-4150 PO BOX 4540 TROY MI MI REGIONAL COUNCIL OF CARPENTERS

13733005 358569 89 AS (800) 801-1766 2850 W GRAND BLVD DETROIT MI HEALTH ALLIANCE PLAN

13733010 358569 89 NO (888) 269-7003

2850 W GRAND

BOULEVARD DETROIT MI HEALTH ALLIANCE PLAN PPO NETWORK

13742005 351113 89 AS (800) 676-2583 PO BOX 890016 CAMP HILL PA BC BS OF PA

13751005 351113 05 AS (800) 223-1704 4510 13TH AVE SW FARGO ND BC BS OF ND

13760005 358569 41 AS (816) 257-5500 PO BOX 4665 INDEPENDENCE MO GOVERNMENT EMPLOYEES HOSP ASSO

13760010 358569 89 AS (816) 257-5500 PO BOX 4665 INDEPENDENCE MO GOVERNMENT EMPLOYEES HOSP ASSOC

13789005 358569 41 AS (800) 410-7778 PO BOX 8402 LONDON KY MAIL HANDLERS BENEFIT PLAN

13789010 358569 89 AS (800) 410-7778 PO BOX 8402 LONDON KY MAIL HANDLERS BENEFIT PLAN

13798005 351113 67 AS (800) 772-0459 PO BOX 1349 TROY MI MI COUNCIL OF ABATEMENT WORKERS

13798010 351113 38 AS (800) 772-0459 PO BOX 3039 BIRMINGHAM MI MI COUNCIL OF ABATEMENT WKRS

13804005 358569 38 AS (800) 363-2434 PO BOX 171841 MEMPHIS TN CONSOLIDATED FREIGHTWAYS

13813005 352530 38 AS (999) 999-9999

BIRMINGHAM CENTER

#4601 BIRMINGHAM MI MULTI PURPOSE INC BENEFIT FUND

13822005 413395 67 AS (999) 999-9999

21350 WEST 7 MILE

RD DETROIT MI AFL CIO WARREN PATTERM MAKERS

13831005 358569 38 AS (999) 999-9999 PO BOX 2511 HOUSTON TX TN LIFE INSURANCE COMP

13840005 358871 38 AS (517) 496-4000 PO BOX 0995 MIDLAND MI DOW CORNING GROUP INSURANCE

13869005 358871 38 AS (999) 999-9999 PO BOX 2349 MIDLAND MI DOW CHEMICAL

13878005 352530 38 AS (999) 999-9999 PO BOX 29019 PHOENIX AZ ARMOUR FOOD SERVICE

13887005 358569 01 AS (313) 241-7776 1151 W ELM AVE MONROE MI JEFFERSON SMURFIT CORPORATION

13896005 359196 38 AS (999) 999-9999

3200 WILSHIRE BLVD

STOWE LOS ANGELES CA WHITTAKER CORP MED CARE PLAN

13902005 352530 38 AS (999) 999-9999 PO BOX 60035 NEW ORLEANS LA J RAY MCDERMOTT

13911005 358569 88 DO (999) 999-9999

211 EAST CHICAGO

AVENUE CHICAGO IL IL DENTAL SERVICE

13920005 358569 38 AS (999) 999-9999 1651 EAST 4TH ST 218 SANTA ANNA CA UNIVERSAL WELFARE ADMIN CO INC

Page 53: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

13949005 358569 38 AS (999) 999-9999 425 NORTH MAIN ST CLAWSON MI CITY OF CLAWSON

13958005 351113 67 AS (999) 999-9999 PO BOX 3039 BINGHAM FARMS MI PATTERN & MODEL MAKERS-WARREN

13967005 358871 87 RX (800) 303-0187 PO BOX 52197 PHOENIX AZ CAREMARK/ADVANCE PCS

13967010 358871 87 RX (800) 624-5060 PO BOX 686002 SAN ANTONIO TX PCS HEALTH SYSTEMS

13976005 352530 38 AS (999) 999-9999 501 5TH AVENUE NEW YORK NY TRANSWORLD LIFE INSURANCE

13985005 358871 88 DO (999) 999-9999 1485 WEAVER STREET SCARSDALE NY AMERICAN MEDICAL DENTAL PLAN

13994005 358569 67 AS (313) 588-2090 30800 MONTPELIER MADISON HEIGHTS MI MEAT CUTTERS LOC.539/H&W FUND

14006005 413395 38 AS (999) 999-9999 5 RUTGER PARK UTICA NY NY TEAMSTERS COUNCIL H & W

14015005 358113 67 AS (999) 999-9999

2075 W BIG BEAVER

RD TROY MI RESILIENT FRINGE BENEFIT FUNDS

14024005 352530 38 AS (999) 999-9999 729 FREMONT BOYNE CITY MI COURTER INC GROUP BENEFITS

14033005 352530 67 AS (999) 999-9999

1111 WOODWARD

SUITE 100 ROYAL OAK MI GRAPHIC ARTS INTL UNION H&W FD

14042005 358569 86 VO (999) 999-9999

7711 CARONDELET ST

#807 ST LOUIS MO EMPLOYEE & COV DEP VISION SER

14051005 358616 55 AS (616) 942-2100 PO BOX 6488 GRAND RAPIDS MI EMPLOYEE BENEFIT ADMIN INC

14060005 352530 38 AS (999) 999-9999 10877 WATSON ROAD ST LOUIS MO NRFEA INSURANCE SERVICE INC

14060010 352530 89 NO (800) 557-1656 PO BOX 7078 MIDDLETOWN NY NATIONAL PREFERRED PROVIDER NETWORK

14089005 351113 38 AS (999) 999-9999 250 EAST TOWN ST COLUMBUS OH COLUMBUS AGENCY SER CORP

14098005 358569 89 AS (999) 999-9999 117 W PATERSON ST KALAMAZOO MI FAMILY HEALTH CARE PLAN

14104005 351113 38 AS (999) 999-9999 CROCKER PLAZA SAN FRANCISCO CA FOREMOST MCKESSON INC

14113005 358569 67 AS (248) 645-6411 PO BOX 3039 BIRMINGHAM MI ROOFERS INS FUND

14122005 413395 89 NO (999) 999-9999

CLAIMS DO NOT GET

MAILED LANSING MI FIRST HEALTH - BATCH CLAIMS

14131005 358569 38 AS (999) 999-9999 700 FISHER BLDG. DETROIT MI ALEXANDER & ALEXANDER

14140005 413395 67 AS (999) 999-9999 22655 CHRYSLER DR HAZEL PARK MI PAINTERS DISTRICT COUNCIL

14169005 358569 38 AS (999) 999-9999 550 12TH STREET WASHINGTON DC GOVERNMENT WIDE SERVICES

14178005 358569 89 X4 (866) 314-3784 1333 GRATIOT DETROIT MI OMNICARE INC

14178010 358569 38 AS (800) 477-6664

1155 BREWERY PARK

BOULEVARD DETROIT MI OMNICARE PLUS

14187005 351113 38 AS (999) 999-9999 3939 CIVIC CTR PLAZA SCOTTSDALE AZ HEALTH MAINTENANCE ASSOC

14196005 351113 38 AS (999) 999-9999 27590 PLYMOUTH RD LIVONIA MI AUTO SERVICE COUNCILS OF MI

14202005 351113 05 AS (800) 241-7475 PO BOX 9907 COLUMBUS GA BC BS OF GA

14202010 351113 89 AS (800) 441-2273 PO BOX 9907 COLUMBUS GA BC BS OF GA

14211005 358569 67 AS (812) 238-2551 PO BOX 1587 TERRE HAUTE IN IN ST COUNCIL LABORS & HOD CAR

14220005 352530 38 AS (999) 999-9999 PO BOX 191 ST CLAIRE MI PLASTIC EMPLOYEES BENEFIT FUND

Page 54: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

14249005 352530 38 AS (999) 999-9999 309 VINE ST SUITE 310 CINCINNATI OH LARRY FLYNT PUBLICATIONS

14258005 358569 38 AS (999) 999-9999 3303 E CORK KALAMAZOO MI FABRI KAL CORP

14267005 351113 38 AS (999) 999-9999 126 OTTAWA NW GRAND RAPIDS MI MI PLUMBERS & MECH CONTS

14276005 413395 38 AS (999) 999-9999 PO BOX 30200 AMARILLO TX ASARCO INC HEALTH PLAN

14285005 351113 38 AS (999) 999-9999

KENNEDY INTNATL

AIRPORT JAMAICA NY COMPREHENSIVE MED & DENT PLAN

14294005 358569 89 X5 (517) 322-4000 PO BOX 68707 GRAND RAPIDS MI BLUE CARE NETWORK OF MID MI

14300005 352530 38 AS (999) 999-9999 1125 W SIXTH ST LOS ANGELES CA ROSS LOOS FAMILY HEALTH PLAN

14329005 352530 38 AS (999) 999-9999 12TH STREET WASHINGTON DC FEDERAL EMP GOVT WIDE INDEM PL

14338005 358569 38 AS (904) 390-7700 PO BOX 2568 JACKSONVILLE FL GULF LIFE INS CO

14347005 413395 67 AS (614) 888-5881

7420 WORTHINGTON

GALENA WORTHINGTON OH OH LABORERS FRINGE BENEFITS

14356005 358569 38 AS (319) 398-8511

4333 EDGEWOOD

ROAD NE CEDAR RAPIDS IA LIFE INVESTORS

14365005 352530 38 AS (999) 999-9999 2455 E SUNRISE SUNRISE FL FOUNDATION LIFE INS CO

14374005 352530 67 AS (989) 684-2273 PO BOX 1132 BAY CITY MI MI STATE CNCL OF LATHERS

14383005 358569 38 AS (999) 999-9999 1400 RENAISSANCE DR PARK RIDGE IL HEALTH CLAIMS ADMINISTRATION

14392005 352530 89 X4 (313) 875-4200

7700 2ND AVE, ADMIN

BLDG/5THFL DETROIT MI WELLNESS PLAN

14409005 358569 38 AS (999) 999-9999 2211 PARSONS AVE COLUMBUS OH BUCKEYE INTNATL HEALTH PLAN

14418005 358569 38 AS (999) 999-9999 3579 GRATIOT AVE DETROIT MI FAYGO BEVERAGES INC

14427005 358569 89 AS (313) 424-8904

15565 NORTHLAND

DR SOUTHFIELD MI MAXICARES INDEPENDENCE HEALTH

14436005 352530 38 AS (999) 999-9999 1258 W 14 MILE RD CLAWSON MI SCHREIBER MANUFACTURING

14445005 358569 89 X4 (800) 822-3122 PO BOX 396 TROY MI SELECT CARE HMO & POS

14445010 352530 89 AS (999) 999-9999 PO BOX 11670 SALT LAKE CITY UT SELECTMED

14454005 358113 38 AS (999) 999-9999 PO BOX 10365 DES MOINES IA EDISON BROS STORES INC

14463005 351113 38 AS (800) 447-5002 PO BOX 4088 SILVER SPRING MD ADVENTIST RISK MGT INC.

14463010 351113 38 AS (909) 353-6800 PO BOX 8007 RIVERSIDE CA ADVENTIST RISK MANAGEMENT INC

14481005 351113 38 AS (999) 999-9999 PO BOX 2699 DALLAS TX SOUTHWESTERN LIFE INS CO

14490005 351113 38 AS (999) 999-9999 233 BROADWAY NEW YORK NY KINNEY SHOE CORP

14507005 352530 64 AS (999) 999-9999 1930 DIVISION DETROIT MI GLENDALE FOODS INC

14516005 351113 67 AS (810) 581-4053

24225 W NINE MILE

RD SOUTHFIELD MI PLASTERERS LOC 67 INS

14525005 358569 38 AS (313) 645-6418

BINGHAM CTR 30700

TELEGR BIRMINGHAM MI SIGN PICTORIAL & DISPLAY

14534005 351113 38 AS (616) 381-1242 PO BOX 2678 KALAMAZOO MI AERO MOTIVE MANUF CO

14543005 352530 38 AS (999) 999-9999 PO BOX 8867 BOISE ID NORTHWEST FED OF INDEP BUSINES

14552005 351113 38 AS (405) 251-3162 PO BOX 1431 DUNCAN OK LIFE INS CO OF THE SOUTHWEST

Page 55: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

14552010 358569 38 AS (800) 661-6385 PO BOX 12288 COLUMBUS GA PARAGON BENEFITS

14561005 351113 38 AS (999) 999-9999 2525 W 190TH ST TORRANCE CA GARRETT HEALTH CARE PLAN

14570005 351113 38 AS (999) 999-9999 1609 BIDDLE WYANDOTTE MI BASF WYANDOTTE CORP

14599005 352530 38 AS (999) 999-9999

800 MARQUETTE

AVENUE MINNEAPOLIS MN AMERICAN LUTHERAN CHURCH

14605005 352530 38 AS (404) 888-2263 PO BOX 647 ATLANTA GA ROLLINS INC

14614005 352530 38 AS (999) 999-9999 PO BOX 975 TOLEDO OH PUREX CORP

14623005 352530 38 AS (999) 999-9999 655 BIR TIMBER RD ELGIN IL SAFETY KLEEN CORP

14632005 352530 38 AS (303) 423-2400 PO BOX 987 WHEATRIDGE CO JAMES EMPLOYEES BENEFITS

14641005 358569 38 AS (402) 633-6382 2223 DODGE ST OMAHA NE NORTHERN NATURAL GAS CO

14650005 352530 38 AS (999) 999-9999

22534 GROESBECK

BOX 272 WARREN MI HOFLEY MFG CO

14679005 359274 88 DO (999) 999-9999 600 LAFAYETTE DETROIT MI BCBSM

14679010 359274 86 VO (999) 999-9999 600 LAFAYETTE DETROIT MI BCBSM

14688005 352530 38 AS (999) 999-9999 PO 8476 DALLAS TX LEGAL SECURITY LIFE INS CO

14697005 359196 89 AS (800) 733-8387 600 LAFAYETTE EAST DETROIT MI TRICARE/CHAMPVA

14703005 413395 67 AS (999) 999-9999 785 MARKET ST #510 SAN FRANCISCO CA AMALGAMATED SILVR & MTL WRKRS

14712005 352530 38 AS (999) 999-9999 2711 CEDAR SPRINGS DALLAS TX NATIONAL MOTOR CLUB OF AMERICA

14721005 358569 38 AS (404) 658-9000

4900 GEORGIA

PACIFIC CTR ATLANTA GA FUQUA INDUSTRIES INC

14730005 413395 89 AS (972) 605-7550

5400 LEGACY DRIVE,

H3-1C-05 PLANO TX ELECTRONIC DATA SYSTEMS CORP

14759005 351113 38 XR (800) 447-6434 LD 1400 E PEORIA IL CATERPILLAR TRACTOR CO

14768005 352530 38 AS (616) 536-2261 301 SPRING ST EAST JORDAN MI EAST JORDAN IRON WORKS

14777005 352530 38 AS (999) 999-9999 1333 FULTON ST GRAND HAVEN MI GARDNER DENVER CO

14786005 352530 38 AS (999) 999-9999

1314 N. STOUGHTON

RD. MADISON WI WI HEALTH FUND

14795005 351113 38 AS (999) 999-9999 1400 RENAISSANCE PARK RIDGE IL FEDERAL GROUP TRUST

14801005 352530 38 AS (999) 999-9999 18615 SHERWOOD DETROIT MI PESCHKE

14810005 352530 89 AS (800) 798-6075 PO BOX 14110 LEXINGTON KY AETNA US HEALTHCARE

14810010 352530 88 DO (800) 253-1090

151 FARMINGTON

AVENUE, WP14 HARTFORD CT AETNA US HEALTHCARE

14810015 352530 01 AS (800) 798-6075 PO BOX 14110 LEXINGTON KY AETNA US HEALTHCARE

14839005 358871 38 AS (313) 564-5190

BOX 237 GPO-INS

DEPT DETROIT MI GENERAL ELECTRIC CO

14848005 413395 38 AS (404) 885-8000 PO BOX 4081 ATLANTA GA EQUIFAX INC

14857005 351113 89 AS (800) 432-0750 PO BOX 27630 ALBUQUERQUE NM BC BS OF NM

14866005 351113 38 AS (517) 374-4979

2727 S PENNSYLVANIA

AVE LANSING MI LANSING GENERAL HOSPITAL

Page 56: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

14875005 413395 38 AS (999) 999-9999 PO BOX 912 WYOMING MI HA MED INS PLAN

14884005 352530 38 AS (999) 999-9999 6440 WIGHT DETROIT MI PURVIS & FORSTER INC

14893005 358569 67 AS (612) 645-4540 700 TRANSFER RD ST PAUL MN TWIN CITY PIPE TRADES WLFR FND

14919005 552530 67 AS (999) 999-9999 25 N FOURTH ST PHILADELPHIA PA UNITED INTERNATL UPHOLSTERERS

14928005 352530 38 AS (999) 999-9999 1417 S BELCHER RD CLEARWATER FL PRE PAID HEALTH CARE INC

14937005 352530 38 AS (999) 999-9999 307 FIRST ST NORTH VIRGINIA MN GROUP HEALTH ASSOC OF NE MN

14946005 352530 38 AS (999) 999-9999 PO BOX 502 GALLIPOLIS OH ROBBINS & MYERS INC

14955005 358569 38 AS (999) 999-9999 22811 MACK AVE ST CLAIR SHORES MI HASCO INDUSTRIES INC

14964005 358569 38 AS (999) 999-9999 PO BOX 6985 ATLANTA GA BROWN TRANSPORT CORP

14973005 358569 88 DO (800) 553-9536 PO BOX 245 MINNEAPOLIS MN DELTA DENTAL PLAN OF NE

14982005 351113 05 AS (800) 228-8263 PO BOX 30270 SALT LAKE CITY UT BC BS OF UT

14991005 351113 38 AS (999) 999-9999

BRIDGE ST &

SCHUYLKILL SPRING CITY PA JONES MOTOR COMPANY

15003005 358569 89 AS (800) 245-6102 850 RIDGE AVENUE PITTSBURGH PA HIGHAM WHITRIDGE INC

15012005 352530 38 AS (999) 999-9999 2480 W 70TH AVE DENVER CO SUNDSTRAND CORP

15021005 351113 34 AS (999) 999-9999 2200 170TH ST LANSING IL RAILROAD RETIREMENT BD MEDICAR

15030005 358569 89 AS (999) 999-9999 4747 NORTH 22ND ST PHOENIX AZ AZ BC HEALTH MAINTENANCE

15059005 351113 67 AS (999) 999-9999 1570 ELIZABETH ST GREEN BAY WI GREEN BAY ELECTRICAL WORKERS

15068005 351113 38 AS (999) 999-9999 799 LADD RD WALLED LAKE MI MARCHAND ENTERPRISES

15077005 358569 38 AS (616) 459-4541 464 FULLER NE GRAND RAPIDS MI PAULSTRA CRC CORP

15086005 352530 38 AS (999) 999-9999 3120 RIVERSIDE MARINETTE WI SCOTT PAPER CO

15086010 352530 89 AS (800) 321-7947 2401 S 31ST STREET TEMPLE TX SCOTT & WHITE

15095005 352530 38 AS (999) 999-9999 PO BOX 15822 PHILADELPHIA PA WASHINGTON SQUARE LIFE

15101005 358113 38 AS (800) 323-1726 PO BOX 93670 LUBBOCK TX AMERICAN ADMINISTRATIVE GROUP

15101010 358113 89 AS (800) 323-1726 PO BOX 93670 LUBBOCK TX HEALTHSMART BENEFIT SOLUTIONS

15101015 352530 38 AS (800) 221-4582 PO BOX 34297 SAN ANTONIO TX GALLAGHER BENEFIT ADMINISTRATORS INC

15110005 358569 38 AS (999) 999-9999 3401 E SAGINAW LANSING MI MI RETAIL LUMBER DEALERS

15139005 352530 38 AS (999) 999-9999 795 NORTH 400 WEST SALT LAKE CITY UT UNION PACIFIC RAILROAD

15148005 413395 38 AS (313) 237-8896 2000 SECOND AVE DETROIT MI DETROIT EDISON CO

15157005 352530 38 AS (314) 982-2474 835 SOUTH 8TH ST. ST LOUIS MO PURINA BENEFIT ASSOC

15166005 351113 39 AS (800) 924-6735 PO BOX 11708 TUCSON AZ FIRST HEALTH

15175005 358569 38 AS (999) 999-9999 6659 PEARL RD PARMA HEIGHTS OH EXECUTIVE EMPLOYEE BENEFIT

15184005 413395 38 AS (999) 999-9999 PO BOX 56189 ATLANTA GA COASTAL STATES LIFE INS CO

15193005 351113 38 AS (999) 999-9999 PO BOX 3652 WASHINGTON DC NATIONAL ASSOC RETIRED FED EMP

15219005 351113 38 AS (999) 999-9999 ATT PERSONNEL DEPT BENTON HARBOR MI HEATH COMPANY

15228005 352530 38 AS (999) 999-9999 4526 S PASEO KANSAS CITY MO INDEPENDENT TOOL DEALERS INS

15237005 351113 38 AS (999) 999-9999 PO BOX 99 ALTAMONTE SPRGS FL DECO PLANT CO

15246005 358569 38 AS (999) 999-9999 PO BOX 2367 FORT COLLINS CO HOSPITAL SERVICE INC

15255005 413395 38 AS (999) 999-9999 2000 BEVERLY SW GRAND RAPIDS MI BELL FIBRE PRODUCTS

Page 57: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

15264005 358871 38 AS (999) 999-9999 6305 W M-115 MESICK MI FOUR STAR CORPORATION

15273005 358569 67 AS (999) 999-9999 10800 PURITAN DETROIT MI INTERNATIONAL UNION OF

15282005 358569 38 AS (999) 999-9999 2023 ROSELAWN AVE ROYAL OAK MI BOSLEY PLAN ADMINISTRATION INC

15291005 413395 38 AS (999) 999-9999 3270 WILSON MARLETTE MI MARLETTE HOMES INC

15308005 352530 38 AS (999) 999-9999 300 S FLOWER ORANGE CA FOUNDATION FOR MEDICAL CARE OF

15317005 352530 38 AS (512) 338-6100 3305 NORTHLAND DR AUSTIN TX CENTRAL TX HEALTH PLAN

15326005 351113 38 AS (999) 999-9999

323 WEST MICHIGAN

AVE MARSHALL MI CITY OF MARSHALL

15335005 351113 38 AS (999) 999-9999 240 E 12TH STREET TRAVERSE CITY MI CONE DRIVE/RETIREES

15344005 358569 89 AS (313) 532-2022 24270 W 7 MILE DETROIT MI INTL UNION OF OPERATING ENGINEERS LOCAL 547

15353005 358569 38 AS (800) 356-8172 PO BOX 27008 SALT LAKE CITY UT FIRST CONTINENTAL LIFE & ACC

15362005 351113 38 AS (999) 999-9999 690 E NORTH AVE CAROL STREAM IL BLOMQUIST BATTE & CAMPBELL

15371005 351113 89 AS (800) 369-3718 PO BOX 610609 PORT HURON MI REGENCY MEDICAL ADMIN INC

15371010 351113 38 AS (800) 369-3718 PO BOX 610609 PORT HURON MI REGENCY EMPLOYEE BENEFITS

15380005 351113 38 AS (999) 999-9999

3 CONTINENTAL

TOWERS ROLLING MEADOWS IL HEALTH INSURANCE ADMIN

15406005 352530 38 AS (999) 999-9999 1261 LINCOLN AVE SAN JOSE CA TRANSWESTERN

15415005 358569 38 AS (616) 341-7333 PO BOX 51100 KALAMAZOO MI CUSTOM BENEFIT PLAN - TPA

15424005 352530 38 AS (999) 999-9999 RR #1 WILSON MI ROBINSONS FURNITURE MFG INC

15433005 358569 86 VO (999) 999-9999 PO BOX 29030 PHOENIX AZ ACT

15442005 351113 38 AS (999) 999-9999 55 E SANBORN CROSWELL MI AUNT JANE FOODS

15451005 358569 59 AS (999) 999-9999

2219 CHAPIN ST BOX

69 JACKSON MI GOODYEAR TIRE & RUBBER CO

15460005 351113 07 AS (801) 521-2500 PO BOX 2460 SALT LAKE CITY UT EQUITABLE LIFE

15489005 358569 04 AS (999) 999-9999

21031 VENTURA BLVD

#725 WOODLAND CA BANKERS LIFE INSURANCE

15498005 352530 38 AS (999) 999-9999 108 E MICHIGAN KALAMAZOO MI FIRST AMERICAN BANK CORP

15504005 358569 38 AS (999) 999-9999 PO BOX 8334 KANSAS CITY MO NATIONAL INS TRUST

15513005 358569 38 AS (513) 868-6660

KNIGHTSBRIDGE

DRIVE HAMILTON OH CHAMPION INTERNATIONAL CORP

15522005 351113 38 AS (999) 999-9999

29TH FLOOR 105 W

ADAMS CHICAGO IL AMERICAN VETERANS MUTUAL

15531005 352530 34 AS (888) 334-6974 PO BOX 121212 MARIETTA GA BENESIGHT

15540005 351113 05 AS (800) 558-1584 PO BOX 2025 MILWAUKEE WI BC BS UNITED OF WI

15540010 351113 89 AS (414) 224-6100 PO BOX 2141 MILWAUKEE WI BC BS UNITED OF WI

15569005 358569 38 AS (999) 999-9999 HWY 46 BATESVILLE IN HILLENBRAND INDUS HEALTH CARE

15569010 358569 38 AS (800) 245-6102 850 RIDGE AVENUE PITTSBURGH PA HIGNAM-WHITRIDGE INC

15578005 358569 55 AS (414) 365-4625

9275 N 49TH ST STE

300 MILWAUKEE WI EMPLOYEE BENEFITS CLAIMS OF WI

15587005 352530 38 AS (212) 490-9000 PO BOX 3779 NEW YORK NY TEACHERS INS ANNUITY ASSOC

15596005 352530 67 AS (999) 999-9999 15151 FENKELL DETROIT MI SHOPMENS LOCAL 508

Page 58: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

15602005 352530 38 AS (800) 874-5677

6902 PEARL RD STE

500 CLEVELAND OH VARIABLE PROTECTION ADMIN

15611005 358569 38 AS (999) 999-9999 30400 TELEGRAPH BIRMINGHAM MI I TEL HEALTH PLAN TRUST

15620005 351113 38 AS (999) 999-9999 1 PARK AVE ELSIE MI ITT HANCOCK INDUSTRIES

15649005 358569 67 AS (800) 552-6550 PO BOX 5769 LAFAYETTE IN IN STATE COUNC OF ROOFERS

15658005 352530 38 AS (999) 999-9999 7991 COLUMBUS PIKE DELAWARE OH PROPRIETORS LIFE ASSUR CO

15667005 351113 38 AS (999) 999-9999 PO BOX 757 ESCANABA MI MEAD HEALTH BENEFITS

15676005 413395 38 AS (800) 321-3997 17800 ROYALTON RD. STRONGSVILLE OH CENTRAL RESERVE LIFE OF NORTH

15676010 413395 89 AS (800) 321-3997

17800 ROYALTON

ROAD STRONGSVILLE OH CENTRAL RESERVE LIFE OF NORTH

15685005 352530 38 AS (999) 999-9999 35 N FOURTH ST COLUMBUS OH SHOE CORPORATIONS OF AMERICA

15694005 413395 38 X5 (800) 344-1412 PO BOX 88 AKRON OH CALIBER SYSTEMS

15700005 351113 38 AS (999) 999-9999 PO BOX 8000A CHICAGO IL JOSEPH T RYERSON & SON INC

15729005 352530 38 AS (999) 999-9999 555 E HURON AVE VASSAR MI SUPER FOOD SERVICES INC

15738005 358569 38 AS (800) 777-3622

10 SOUTH MAIN

STREET SALT LAKE CITY UT DESERT HEALTHCARE

15747005 351113 38 AS (999) 999-9999 PO BOX 907 MINNEAPOLIS MN BIO DYNAMICS INC

15756005 413395 38 AS (312) 807-2000 110 N WACKER DR CHICAGO IL MORTON NORWICH PENSION TRUST

15765005 358569 72 AS (999) 999-9999 2523 CLIO ROAD FLINT MI FLINT PLUMBING & PIPEFITTING

15774005 413395 63 AS (810) 792-2423 P.O. BOX 5710 LIVONIA MI PRESIDIUM INC

15783005 358569 38 AS (999) 999-9999 PO BOX 2265 GRAND RAPIDS MI EXECUTIVE SYSTEMS INC

15792005 358569 38 AS (608) 256-6600

3321 W BELTLINE

HWY MADISON WI RELIABLE LIFE & CASUALTY CO

15809005 352530 88 DO (800) 247-6875 PO BOX 82520 LINCOLN NE SUN LIFE OF CANADA - SC3250

15818005 351113 38 AS (999) 999-9999 PO BOX 8 OLNEY IL CEDCO DRILLING CO

15827005 358569 67 AS (999) 999-9999

241 E SAGINAW SUITE

601 EAST LANSING MI MI CARPENTERS COUNCIL

15836005 351113 64 AS (999) 999-9999 125 AVENUE C BATTLE CREEK MI INTERBAKE FOODS

15845005 352530 38 AS (999) 999-9999 PO BOX 3300 ASHLAND KY SAVE MART DIVISION

15854005 351113 30 AS (708) 798-7664 1055 W 57TH RD HOMEWOOD IL PROVIDENT LIFE & ACCIDENT

15863005 351113 38 AS (999) 999-9999 PO BOX B P IRVINE CA BENEFICIAL EMPLOYEES SECURITY

15872002 352530 38 AS (999) 999-9999 PO BOX 7338 MADISON WI WEA INSURANCE TRUST

15881005 413395 38 AS (999) 999-9999 1501 BUCHANAN SW GRAND RAPIDS MI MI WHEEL CORP

15890005 358569 38 AS (999) 999-9999 INTERNATIONAL DR MONROE MI MONROE AUTO EQUIPMENT

15907005 358569 67 AS (800) 922-7285 PO BOX 3039 BIRMINGHAM MI SHEET METAL WKRS LOCAL 408

15916005 352530 87 RX (800) 525-4225

11100 WAYZATA BLVD

SUITE 400 MINNETONKA MN AETNA PHARMACY/AETRX

15925005 358569 38 AS (999) 999-9999

325 N HANOVER

STREET HASTINGS MI HASTINGS MANUFACTURING CO

Page 59: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

15934005 358569 38 AS (999) 999-9999

75 LEONARD WOOD

DR BATTLE CREEK MI CEREAL CITY WIRE PRODUCTS

15943005 358569 38 AS (999) 999-9999 280 S EDISON BATTLE CREEK MI CONSOLIDATED PACKAGING CORP

15943010 358569 38 AS (888) 244-5687 PO BOX 9071 DUBLIN OH CONSOLIDATED STORES ASSOCIATE BENEFIT PLAN

15952005 352530 38 AS (999) 999-9999 10205 F DRIVE NORTH BATTLE CREEK MI ROCKWELL INTERNATIONAL

15961005 352530 38 AS (999) 999-9999 2160 W RIVER RD BATTLE CREEK MI SPRINGFIELD FOUNDRY

15970005 351113 38 AS (999) 999-9999 125 AVENUE C BATTLE CREEK MI INTERBAKE FOODS

15999005 352530 38 AS (999) 999-9999 PO BOX 7270 SHAWNEE MISSION KS YELLOW FREIGHT SYSTEMS INC

16000005 359196 38 AS (800) 862-8887 PO BOX 748 FORT WORTH TX GENERAL DYNAMICS DIVISION OF

16029005 351113 38 AS (999) 999-9999 4201 ST ANTOINE DETROIT MI HEALTH CARE INSTITUTE

16038005 352530 38 AS (999) 999-9999 BOX 1045 SKOKIE IL SEARLE

16047005 358569 38 AS (999) 999-9999 30660 W 12 MILE RD FARMINGTON HILL MI PAUL F LIVINGSTON CORP

16056005 358569 89 X5 (419) 241-6501 PO BOX 4708 TOLEDO OH FAMILY HEALTH PLAN OF OH

16056010 358569 89 AS (800) 690-1550

3510 PARK PLACE

WEST MISHAWAKA IN FAMILY HEALTH PLAN OF IN

16056015 358569 89 AS (414) 302-2300 PO BOX 1470 BROOKFIELD WI FAMILY HEALTH PLAN OF WI

16065005 413395 38 AS (800) 654-6208 PO BOX 197479 LOUISVILLE KY CENTRA BENEFIT SERVICES

16065010 358569 88 DO (999) 999-9999 PO BOX 869041 PLANO TX ACENTRA BENEFIT SERVICES

16065015 413395 38 X5 (888) 556-3831 PO BOX 8000 DUNCAN OK CENTRA HEALTHCARE ADM SERVICES

16074005 358569 89 AS (419) 243-8800 435 S HAWLEY TOLEDO OH TEAMSTERS H & W OF OH

16083005 351113 67 AS (800) 392-1703 PO BOX 26166 HOUSTON TX CARPENTERS WELFARE OF TX

16092005 358569 67 AS (999) 999-9999 PO BOX 4801 TOLEDO OH TOLEDO HEALTH & WELFARE

16109005 352530 38 AS (999) 999-9999 1150 S OLIVE ST LOS ANGELES CA TRANSAMERICA FINANCIAL CORP

16118005 358569 89 AS (312) 738-0822 1950 W ERIE ST CHICAGO IL CENTRAL STATES JOINT BOARD

16127005 352530 38 AS (800) 323-3359 333 W PIERCE RD ITASCA IL FIRST ALLMERICA FINANCIAL LIFE

16127010 352530 38 AS (800) 423-6011 PO BOX 107 HOWELL MI FIRST ALLMERICA FINANCIAL LIFE

16127015 352530 89 AS (800) 757-2078 PO BOX 107 HOWELL MI FIRST ALLMERICA FINANCIAL LIFE

16127020 352530 38 AS (314) 241-6888 200 N BROADWAY ST LOUIS MO FIRST ALLMERICA FINANCIAL LIFE

16127025 352530 38 AS (800) 431-5197 PO BOX 1667 ROCKVILLE MD FIRST ALLMERICA FINANCIAL LIFE

16136005 358569 38 AS (313) 624-3020 799 LADD RD WALLED LAKE MI GAY TOYS INC

16145005 358569 38 AS (999) 999-9999 PO BOX 1623 CLARKSBURG WV MONONGAHELA VALLEY HOSP SERV

16154005 352530 38 AS (999) 999-9999 PO BOX 878 CHULA VISTA CA ROHR HEALTH CARE PLAN

16163005 352530 38 AS (999) 999-9999 57 US HIGHWAY 1 NEW BRUNSWICK NJ RUTGERS COMMUNITY HEALTH PLAN

16172005 358569 67 AS (317) 998-8100 PO BOX 548 UPLAND IN APAC HEALTH & WELFARE TRUST

16181005 352530 38 AS (999) 999-9999

21405 TROLLEY

INDUSTRIAL DETROIT MI HIGHLAND APPLIANCE EMP BNFTS

16190005 358871 38 AS (999) 999-9999 PO BOX 160 BANGOR MI DUWEL EMPLOYEE BENEFIT PLAN

16207005 352530 38 AS (999) 999-9999 RADIO CITY STATION NEW YORK NY MARKETING ORGANIZATION

16216005 358569 38 AS (612) 349-1472 PO BOX 9478 MINNEAPOLIS MN SHOPKO HEALTH PLAN

16225005 352530 38 AS (702) 252-7001 PO BOX 1121 ALHAMBRA CA SOUTHWEST ADMINISTRATORS INC

Page 60: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

16234005 352530 38 AS (999) 999-9999 14700 RIVERSIDE DETROIT MI UNITED STATES PUBLIC HEALTH

16243005 359196 38 AS (999) 999-9999 PO BOX 7 KALKASKA MI WAYNE WIRE CLOTH PRODUCTS INC

16252005 358569 86 VO (999) 999-9999 PO BOX 29030 PHOENIX AZ ADVANCED COMPUTER TECHNIQUES

16261005 358569 38 AS (999) 999-9999 PO BOX 3600 WINTER PARK FL AMERICAN SUN LIFE INS CO

16270005 352530 38 AS (999) 999-9999 PO BOX 1511 TAMPA FL FOUNDERS LIFE ASSUR CO OF FL

16299005 352530 38 AS (999) 999-9999 PO BOX 79326 HOUSTON TX GA LIFE & HEALTH INS CO

16305005 352530 38 AS (999) 999-9999 PO BOX 1991 CHARLESTON WV WV PUBLIC EMPLOYEES'INSUR

16314005 351113 38 AS (714) 251-5000

16420 VALLEY VIEW

AVE LA MIRADA CA DENNYS INC

16323005 351113 38 AS (999) 999-9999

26401 HARPER AVE

SUITE 3 ST CLAIR SHORES MI CHAMBER SERVICES OF MI

16332005 351113 38 AS (999) 999-9999 PO BOX 2002 AURORA IL AMOCO OIL

16350005 352530 38 AS (999) 999-9999 PO BOX 1472 MIDLAND MI FISHER COMPANIES GROUP INS

16379005 351113 38 AS (999) 999-9999 13100 WAYZATA BLVD MINNETONKA MN HEALTH CARE ADMINISTRATORS

16388005 351113 38 AS (999) 999-9999

25461 HARPER AVE

SUITE 3 ST CLAIR SHORES MI CHAMBER SERVICES OF MI

16397005 352530 38 AS (999) 999-9999 748 N CEDAR ST LANSING MI MAPA GROUP TRUST

16403005 358569 38 AS (999) 999-9999 PO BOX 4785 SYRACUSE NY CIS CORP

16412005 352530 38 AS (999) 999-9999 PO BOX 647 ATLANTA GA ROLLINS GROUP MEDICAL EXPENSES

16421005 351113 38 AS (999) 999-9999 4334 SECOR RD TOLEDO OH HEALTH PLUS INSURANCE

16421010 358569 38 AS (800) 727-1444 PO BOX 15660 EVANSVILLE IN HEALTH RESOURCES INC

16430005 352530 38 AS (999) 999-9999 1450 S ISABELLA RD MT PLEASANT MI COOK COMMUNICATIONS CO

16459005 358569 38 AS (800) 342-4841

590 CASCADE

PARKWAY SE GRAND RAPIDS MI CROSBY & HENRY INS CO

16468005 358569 38 AS (999) 999-9999

1601 W PEACHTREE ST

NE ATLANTA GA COX BROADCASTING CORP

16477005 358569 38 AS (999) 999-9999 PO BOX 81 VERSAILLES OH CARL SUBLER TRUCKING INC

16485010 413395 89 NO (800) 799-6172 PO BOX 6189 SAGINAW MI HCAP

16486005 358569 42 AS (800) 269-7196

2905 LUNCERNE DR SE

STE 110 GRAND RAPIDS MI ALTICOR

16486010 358569 89 AS (402) 334-7288 2607 S 159TH PLAZA OMAHA NE ALTPROS

16495005 351113 38 AS (999) 999-9999 PO BOX 2527 KALAMAZOO MI SUMNEY AGENCY INC

16501005 358569 38 AS (999) 999-9999 901 BROADWAY NW GRAND RAPIDS MI AMERICAN SEATING

16510005 413395 36 AS (800) 221-4254

3001 WEST BIG

BEAVER ROAD TROY MI AMERA PLAN INC

16510010 413395 89 AS (800) 221-4254

3001 WEST BIG

BEAVER ROAD TROY MI AMERA PLAN INC

16515000 358569 38 AS (800) 323-1726 PO BOX 93670 LUBBOCK TX AMERICAN ADMINISTRATORS GROUP

16539005 352530 38 AS (517) 772-5955 1315 MISSION RD MT PLEASANT MI JAMES BIGARD DRILLING CO

Page 61: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

16548005 358113 38 AS (800) 231-0801 PO BOX 219040 DALLAS TX GREAT SOUTHERN LIFE INS CO

16557005 358569 38 AS (800) 456-3920

3815 MONTROSE

BLVD HOUSTON TX STATESMAN NATIONAL LIFE INS CO

16566005 352530 38 X5 (800) 221-2554 33 WEST 34TH STREET NEW YORK NY NATIONAL BENEFIT LIFE INS CO

16575005 352530 64 AS (999) 999-9999

2601 FORTUNE CL E

#300A INDIANAPOLIS IN INDIANA AREA UNTD FOOD & COMM

16575010 358569 89 AS (800) 382-1799 PO BOX 42669 INDIANAPOLIS IN IN AREA UNITED FOOD & COMMERCIAL WORKERS

16584005 351113 38 AS (999) 999-9999

2314 KOHLER

MEMORIAL DR. SHEBOYAN WI HC PRANGE CO MUTUAL AID SOC

16593005 358569 38 AS (713) 759-5008 PO BOX 2521 HOUSTON TX TX EASTERN INSURANCE

16593010 358569 38 AS (281) 652-8932 PO BOX 266696 HOUSTON TX TX UNIVERSITY HEALTH PLAN

16619005 413395 38 AS (318) 388-9666 PO BOX 4065 MONROE LA CENTURY TELEPHONE ENTERPR INC

16628005 358569 41 AS (999) 999-9999 BOX 23653 WASHINGTON DC NATIONAL LEAGUE OF POSTMASTERS

16637005 358569 38 AS (616) 530-7000 PO BOX 1787 GRAND RAPIDS MI GORDON FOOD SERVICE

16646005 351113 38 AS (999) 999-9999 777 THIRD ST DESMOINES IA NATIONAL RIFLE ASSOCIATION

16655005 358569 38 AS (800) 441-1195

8 PENN CENTER 15TH

FL. PHILADELPHIA PA BEVERLY ENTERPRISES INS CO

16664005 351113 38 AS (999) 999-9999 PO BOX 548 MARCELLUS MI CRAFTMAN INC

16673005 351113 38 AS (999) 999-9999 SUITE 385 KANSAS CITY KS NATIONAL TRANSIT MAKERS UN INS

16682005 358569 38 X5 (405) 233-4000 PO DRAWER 3248 ENID OK AMERICAN STANDARD LIFE & ACC

16691005 358569 38 AS (212) 870-3036

475 RIVERSIDE DR RM

1700 NEW YORK NY AMERICAN BAPTIST CHURCHES

16708005 358569 38 AS (999) 999-9999 PO BOX 220045 DALLAS TX CAMPBELL TAGGART BENEFIT TRUST

16717005 351113 38 AS (999) 999-9999 PO BOX 65 ZEELAND MI CHRISTIAN LABORERS ASSOC

16726005 351113 38 AS (999) 999-9999 PO BOX 879 ANDERSON IN INDEPENDENT BENEFITS PLAN

16735005 352530 67 AS (303) 428-5141

7000 N BROADWAY,

BLDG 3 DENVER CO CO LABORERS H&W FUND

16744005 352530 38 AS (999) 999-9999 13001 STEPHENS DR WARREN MI WALCO ENTERPRISES INC

16753005 352530 89 AS (800) 332-9161 PO BOX 1700 FLINT MI HEALTHPLUS OF MI

16762005 351113 38 AS (616) 531-7970 PO BOX 350 GRAND RAPIDS MI LEON PLASTICS DIV OF US INDUS

16771005 352530 38 AS (800) 968-6616 4660 S HAGADORN RD EAST LANSING MI CC SYSTEMS

16771010 352530 38 AS (999) 999-9999 PO BOX 64668 ST PAUL MN CC SYSTEMS

16780005 352530 38 AS (999) 999-9999 PLAZA 51510 CHICAGO IL NHC COMPANY

16806005 352530 38 AS (999) 999-9999

140 S SAGINAW SUITE

100 PONTIAC MI MI MASTER HEALTH PLAN

16815005 351113 05 AS (800) 648-3190

818 KEEAUMOKU

STREET HONOLULU HI HMSA BC BS OF HI

16815010 351113 89 AS (800) 730-8445 PO BOX 860 HONOLULU HI HMSA BC BS OF HI

16824005 351113 38 X5 (800) 877-7756 PO BOX 3013 LONGHORN PA LIFE INSUR OF GA ASSOC DRS

Page 62: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

16833005 351113 38 AS (999) 999-9999 409A WATERS BLDG GRAND RAPIDS MI GROUP UNDERWRITERS

16842005 352530 38 AS (999) 999-9999 550 12TH ST SW WASHINGTON DC GROUP HOSPITALIZATION INC

16851005 352530 38 AS (999) 999-9999 2200 LAKE AVE FT WAYNE IN RICHTER ROBB INC

16860005 413395 38 AS (999) 999-9999

501 BOYLSTON

STREET BOSTON MA NEW ENGLAND HEALTH PLANS INS

16889005 352530 38 AS (999) 999-9999

175 W JACKSON BLVD

901 CHICAGO IL AFFILIATED PLAN SERVICES INC

16898005 352530 38 AS (800) 866-3466 PO BOX 6200 COSTA MESA CA INSURNATIONAL INS ADMIN

16904005 358569 38 AS (999) 999-9999 PO BOX 35090 LOUISVILLE KY BROWN & WILLIAMSON HLTH CR PLN

16904010 352530 38 AS (800) 323-4890

220 S RIDGEWOOD

AVE DAYTONA BEACH FL UNITED BENEFITS INC

16913005 413395 67 AS (212) 473-5700 PO BOX 1435 NEW YORK NY AMALGAMATED LIFE INS CO

16922005 413395 38 AS (999) 999-9999 PO BOX 2589 KALAMAZOO MI BUCK TOOL COMPANY

16931005 351113 38 AS (999) 999-9999

5732 CURLEW PO BOX

12759 NORFOLK VA STEWART SANDWICHES INC

16940005 352530 38 AS (999) 999-9999 PO BOX 18384 TAMPA FL CENTENNIAL LIFE & CASUALTY

16969005 352530 38 X2 (517) 835-7542 PO BOX 1346 MIDLAND MI MI INSURANCE ASSOCIATES

16978005 352530 38 AS (312) 372-3424 35 E WACKER DR CHICAGO IL MEANS SERVICE HEALTH PLAN

16987005 351113 38 AS (800) 482-9356 30500 VANDYKE WARREN MI MIDWEST EMPLOYERS CLAIM

16996005 352530 38 AS (616) 392-7163 725 E 40TH ST HOLLAND MI S2 YACHTS INC

17008005 352530 38 AS (999) 999-9999 TRAVEL BLDG FLORAL PARK NY NATIONAL TRAVEL CLUB

17017005 413395 38 AS (248) 641-4951 700 TOWER DRIVE TROY MI INTERNATIONAL ASSOC OF MACH

17026005 351113 38 AS (999) 999-9999 G4300 W PIERSON FLINT MI HURAND ENTERPRISES

17035005 352530 38 AS (616) 927-2263 PO BOX 1026 BENTON HARBOR MI QUALITY PACKAGING PRODUCTS INC

17044005 358569 38 AS (999) 999-9999 PO BOX 59093 MINNEAPOLIS MN BOARD OF PENSIONS ELCA

17053005 352530 38 AS (517) 543-2010 530 WEST LOVETT CHARLOTTE MI HOOVER UNIVERSAL INC

17062005 358569 38 AS (999) 999-9999 PO BOX 7 ERWIN NC BURLINGTON INDUSTRIES

17071005 358569 38 AS (503) 295-0107 PO BOX 4050 PORTLAND OR FIRST FAR WEST INS CO

17080005 413395 38 AS (999) 999-9999 PO BOX 12099 HAMTRAMACK MI METROPOLITAN CLUB HOSPTLZATION

17106005 351113 38 AS (999) 999-9999

21350 W SEVEN MILE

RD DETROIT MI TILE TERRAZZO MARBLE & PRECAST

17115005 351113 38 AS (999) 999-9999 PO BOX 55221 INDIANAPOLIS IN EDWARD MORRIS INS CO

17133005 358569 38 AS (999) 999-9999 6400 SHAFFER CT ROSEMONT IL BROKERS MARKETING SERVICE

17142005 352530 38 AS (999) 999-9999 PO BOX 3440 FARMINGTON HILL MI HERTZ CLAIM MANAGEMENT (HCM)

17143000 351113 89 NO (800) 295-5444 PO BOX 3428 OAK BROOK IL HFN

17151005 358569 38 AS (999) 999-9999 10 PELHAM PARKWAY PELHAM MANOR NY ITC SPICE & SEASONING

17160005 413395 38 AS (800) 245-6102 850 RIDGE AVE PITTSBURG PA BABB INC

17189005 352530 38 X3 (800) 833-0030

1145 BROADWAY,

FIFTH FLR TACOMA WA WEYERHAEUSER GROUP

17198005 413395 67 AS (918) 627-7000

4845 S 83RD EAST

AVENUE TULSA OK PIPELINE INDUSTRS BENEFIT FUND

Page 63: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

17204005 358569 38 AS (999) 999-9999 333 PLYMOUTH RD PLYMOUTH MI MUTUAL OF DETROIT INS CO

17213005 358569 38 AS (219) 295-3240 PO BOX 1167 ELKHART IN NIBCO MEDICAL BENEFITS

17222005 358616 38 AS (999) 999-9999 838 W LONG LAKE RD BLOOMFIELD HILL MI GREAT LAKES BENEFIT ADMIN INC

17231005 358569 38 AS (317) 423-1577 635 S EARL AVE LAFAYETTE IN IN ST COUNCIL OF ROOFERS

17240005 358569 38 AS (999) 999-9999 PO BOX 1918 SARASOTA FL CHARLES SHEDMAN GROUP

17269005 413395 87 RX (800) 922-1557 PO BOX 14711 LEXINGTON KY MEDCO HEALTH

17269010 413395 87 RX (999) 999-9999 PO BOX 650522 DALLAS TX MERCK MEDCO

17278005 358569 38 AS (999) 999-9999

1625 K ST NW SUITE

301 WASHINGTON DC NAFO NATIONAL BENEFIT PLAN

17287005 351113 38 AS (317) 875-8500

8500 GEORGETOWN

RD INDIANAPOLIS IN COLONIAL OIL RI MARKETING

17296005 352530 38 AS (313) 296-2974 17903 MASONIC FRASIER MI GRAND TRAVERSE VILLAGE

17302005 351113 89 AS (800) 831-4818 1601 W MADISON ST SIOUX FALLS SD BC BS OF SD

17320005 352530 38 AS (999) 999-9999 12675 HAGGERTY RD BELLEVILLE MI HORST MANUF CO

17349005 358569 38 AS (999) 999-9999 2223 DODGE OMAHA NE INTER NORTH

17358005 352530 89 X3 (800) 321-3856 11590 N MERIDIAN ST. CARMEL IN TIC INTERNATIONAL CORP HEALTH

17358010 352530 38 AS (800) 482-0948

6525 CENTURION

DRIVE LANSING MI TIC

17367005 352530 38 AS (999) 999-9999 330 UPTON AVE BATTLE CREEK MI SWANSON COOKIE COMPANY

17376005 352530 67 AS (999) 999-9999 205 HOTEL DULUTH DULUTH MN DULUTH BUILDING TRADES

17385005 358569 38 AS (800) 628-9000 PO BOX 9004 SPRINGFIELD MA AVON REPRESENTATIVE INS FUND

17394005 358569 38 AS (999) 999-9999 23333 COMMERCE DR FARMINGTON HILL MI ACO INCORPORATED

17400005 351113 38 AS (999) 999-9999 1400 N WOODWARD BIRMINGHAM MI CUNNINGHAM LIMP

17429005 358569 38 AS (517) 685-2455 3059 BEECHWOOD RD ROSE CITY MI GAY PLASTICS

17438005 352530 38 AS (999) 999-9999 BOX 387 MADISON TN GARRETTSTREET & ASSOCIATES

17447005 351113 38 AS (999) 999-9999 3742 LAMAR AVE MEMPHIS TN HOLIDAY INNS INC

17456005 358569 38 AS (999) 999-9999

120 S RIVERSIDE

PLAZA CHICAGO IL INTERSTATE UNITED CORPORATION

17465005 351113 07 AS (999) 999-9999 444 N MICHIGAN AVE CHICAGO IL EQUITABLE LIFE

17474005 352530 38 AS (404) 656-2000

244 WASHINGTON ST

SW ATLANTA GA STATE OF GA

17483005 358569 38 AS (999) 999-9999 1600 N LARCH ST LANSING MI MOTOR WHEEL CORP DEPT 100

17492005 358569 38 AS (810) 678-2295 4057 S OAK METAMORA MI METAMORA PRODUCTS SELF INS

17509005 358569 38 AS (999) 999-9999 2441 W GRAND BLVD DETROIT MI MOTOR CITY H & W FUND

Page 64: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

17518005 352530 38 AS (999) 999-9999 129 WABASH AVE MONTPELIER OH WINZELER STAMPING CO

17527005 358569 38 AS (513) 226-5738 PO BOX 1004 DAYTON OH DAYCO CORP

17536005 351113 02 AS (800) 227-7789 PO BOX 13998 PHILADELPHIA PA AARP PRUDENTIAL INSURANCE CO

17545005 358569 38 AS (999) 999-9999 PO BOX 21218 COLUMBIA SC ADCO EMPLOYEES WELFARE &

17554005 351113 38 AS (999) 999-9999 PO BOX 23532 TAMPA FL ASSOCIATED CHAMBERS TRUST

17563005 413395 23 AS (800) 328-4316 PO BOX 981652 El Paso TX JOHN ALDEN

17563010 413395 23 AS (999) 999-9999 PO BOX 025586 MIAMI FL JOHN ALDEN

17572005 358569 38 AS (999) 999-9999 PO BOX 18384 TAMPA FL MA GROUP TRUST

17581005 351113 38 AS (614) 228-5565 141 E TOWN ST COLUMBUS OH MCELROY MINISTER CO

17581010 351113 38 AS (318) 747-8008 PO BOX 527 MARSHALL MI MCELROY METAL MILL INC

17590005 358569 38 AS (800) 621-0393 PO BOX 5008 CAROL STREAM IL MONTGOMERY WARD INSURANCE

17607005 352530 38 AS (999) 999-9999

BU RET INS & OCCUP

HLTH WASHINGTON DC FEDERAL EMP HLTH BEN PROGRAM

17616005 351113 38 AS (999) 999-9999 209 S LASALLE ST CHICAGO IL ASSOCIATED GROUP INS TRUST

17625005 358569 38 AS (999) 999-9999 1303 LINCOLN RD ALLEGAN MI CRESCENT MACHINE & NIPPLE

17634005 352530 67 AS (999) 999-9999

8550 W BRYNMAUR

AVE CHICAGO IL GENERAL STATES HLTH & WELFARE

17643005 352530 38 AS (999) 999-9999 PO BOX 1208 MT CLEMENS MI PECK ASSOCIATES

17652005 352530 01 AS (999) 999-9999 PO BOX 2909 MINNEAPOLIS MN SPERRY BENEFITS

17661005 413395 38 AS (999) 999-9999 DYER ST NORTH BERWICK ME HUSSEY MANUFACTURING INC

17670005 352530 38 AS (999) 999-9999 PO BOX 82288 LINCOLN NE JOINT EMPLOYERS TRUST

17699005 352530 38 AS (999) 999-9999 301 INDUSTRIAL AVE. COLDWATER MI UNITED TECHNOLOGIES

17705005 358569 38 AS (312) 692-7020 PO BOX 338 EAST ST LOUIS IL ESMARK HEALTH BENEFIT

17714005 351113 38 AS (517) 487-8480 PO BOX 15069 LANSING MI MI OIL & GAS ASSOCIATION

17723005 351113 38 AS (913) 451-4900 PO BOX 87 SHAWNEE MISSION KS AMERICAN TRUST ADMINISTRATORS

17723010 351113 89 AS (913) 451-4900 PO BOX 87 SHAWNEE MISSION KS AMERICAN TRUST ADMINISTRATORS

17732005 358569 89 AS (800) 333-3841 PO BOX 1738 ATLANTA GA WATKINS ASSOCIATED INDUSTRIES

17741005 413395 38 AS (800) 325-7140 PO BOX 9007 ST LOUIS MO AMERICAN CONSULTING ENGINEERS

17750005 358569 38 AS (904) 358-5534 ONE INDEPENDENT DR JACKSONVILLE FL INDEPENDENT LIFE

17750010 358569 38 AS (999) 999-9999 PO BOX 3161 ROCKFORD IL INDEPENDENT LIFE & HEALTH

17779005 352530 67 AS (999) 999-9999 713A BIGLEY AVE CHARLESTON WV WV LABOR TRUST FUND

17788005 358569 67 AS (217) 786-2850

6450 6TH ST

FRONTAGE RD SPRINGFIELD IL AUTOMOTIVE WHOLESALERS OF IL

17797005 359196 27 AS (999) 999-9999 PO BOX 50087 INDIANAPOLIS IN FEDERATED INS CO

17803005 351113 38 AS (999) 999-9999 PO BOX 97 DADE CITY FL LYKES-PASCO GROUP INS

17812005 351113 38 AS (999) 999-9999 PO BOX 10946 TAMPA FL PLAN SERVICES

17821005 352530 88 DO (800) 866-5020 PO BOX 830626 BIRMINGHAM AL PROTECTIVE LIFE INSURANCE

17830005 358569 38 AS (999) 999-9999 2001 E MOUND RD DECATUR IL FEDERAL KEMPER INS CO

17859005 352530 34 AS (999) 999-9999

1000 TRAVELERS

TOWER SOUTHFIELD MI TRAVELERS INSURANCE COMPANY

17868005 352530 38 AS (999) 999-9999 PO BOX 4002 EAU CLAIRE WI WI STATE CARPENTERS

Page 65: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

17877005 413395 67 AS (999) 999-9999

9970 OLD AIRPORT

HWY MONTCOVA OH AMALGAMATED HEALTH/WELFARE FND

17886005 352530 38 AS (999) 999-9999

11TH ST &

WINCHESTER AVE ASHLAND KY DIRECT MARKETING CO

17895005 358569 38 AS (999) 999-9999 RT 5 BOX 524 BLOOMSBERG PA COLUMBIA ACCIDENT

17901005 358569 20 AS (517) 349-7800 PO BOX 1386 EAST LANSING MI GROUP BENEFIT SERVICES INC

17910005 352530 38 AS (800) 237-5033 4288 W DUBLIN DUBLIN OH WENDYS INTERNATIONAL

17939005 351113 05 AS (999) 999-9999 PO BOX 1106 LEWISTON ID REGENCE BS OF ID

17948005 352530 38 AS (999) 999-9999 20 WHIPPANY RD MORRISTOWN NJ KEUFFEL & ESSER CO

17957005 358569 38 AS (999) 999-9999 2113 ENTERPRISE DR MT PLEASANT MI TD PROVINS DRILLING CO

17966005 358569 38 AS (999) 999-9999 P.O. BOX 9012 MENOMINEE FALLS WI MIDWESTERN BUS INS TRUST

17975005 352530 38 AS (800) 237-4753 PO BOX 30144 TAMPA FL DUN & BRADSTREET INS TRUST

17984005 358569 38 AS (616) 940-1156

4875 CASCADE ROAD

SE GRAND RAPIDS MI BENEFIT ACTUARIES INC

17993005 351113 38 AS (616) 381-7995 2200 OLDS AVE LANSING MI INDUSTRIAL WELDING EMP BENEFIT

17993010 358569 89 AS (847) 887-8000 PO BOX 7955 LAKE FOREST IL INFO TRUST

18005005 352530 38 AS (999) 999-9999 2121 CLEVELAND AVE MARINETTE WI KARGARD INDUSTRIES

18014005 351113 38 AS (717) 396-2563 PO BOX 3001 LANCASTER PA ARMSTRONG WORLD INDUSTRIES INC

18014010 351113 89 AS (888) 448-7440 PO BOX 6108 LAFAYETTE IN ARNETT HEALTH PLANS

18023005 358569 89 X5 (248) 354-7450 25925 TELEGRAPH RD SOUTHFIELD MI BLUE CARE NETWORK OF SE MI

18032005 352530 38 AS (616) 345-2141 508 HARRISON ST. KALAMAZOO MI KTS INDUSTRIES HLTH BEN PLAN

18041005 358569 33 AS (999) 999-9999 WALL ST LAS VEGAS NV TEAMSTERS SECURITY FUND

18050005 351113 38 AS (616) 842-5308 US-31 AT M-45 GRAND HAVEN MI CARBORUNDUM EMP MED PLAN/TRUST

18079005 358569 38 AS (999) 999-9999 24703 RYAN RD WARREN MI COLE CARBIDE INDUSTRIES

18079010 358569 86 VO (800) 334-7591 PO BOX 8504 MASON OH COLE VISION

18088005 351113 38 AS (999) 999-9999 721 N WAVERLY LANSING MI AGENTS ASSISTANCE CORP OF MI

18089005 358569 38 AS (999) 999-9999 PO BOX 30053 LANSING MI MEDICAL SERVICES ADMINISTRATIO

18097005 351113 05 AS (800) 632-2022 PO BOX 1106 LEWISTON ID REGENCE BS OF ID

18103005 352530 38 AS (309) 557-2940 PO BOX 2000 BLOOMINGTON IL COUNTRY LIFE INS CO

18112005 358569 38 AS (999) 999-9999

200 TRUST BLDG 40

PEARL GRAND RAPIDS MI HEALTH CARE & RETIREMENT CORP

18121005 351113 38 AS (999) 999-9999

1141 CENTENNIAL

WAY LANSING MI INDEPENDENT INSURANCE AGENTS

18130005 358569 38 XR (800) 492-2385 720 BLAIR MILL HORSHAM PA INTER-COUNTY HOSP PLAN INC

18159005 558569 38 AS (999) 999-9999 PO BOX 66100 CHICAGO IL UNITED AIRLINES

18168005 413395 76 AS (800) 832-3709 34820 HARPER AVE MT CLEMENS MI CAMBRIDGE

18177005 351113 38 AS (999) 999-9999 90 S MAIN ROCHESTER NH KENDALL INSURANCE CO

18186005 413395 38 AS (305) 772-7702

600 CORPORATE

DRIVE FT LAUDERDALE FL MEDICAL INS ADMINISTRATORS INC

Page 66: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

18195005 352530 38 AS (403) 310-0000

10025 JASPER

AVENUE EDMONTON ALBERT ON ALBERTA HEALTH CARE INS PLAN

18201005 358569 67 AS (614) 488-0708 PO BOX 12009 COLUMBUS OH OH OPERATING ENG H&W PLAN

18210005 351113 38 AS (800) 222-0809 2935 E. 96TH STREET INDIANAPOLIS IN MIDWEST ADMINISTRATORS

18239005 351113 38 AS (999) 999-9999 100 2ND AVE. SOUTH ST. PETERSBURG FL FL MUNICIPAL HLTH TRUST

18248005 358569 38 AS (800) 258-5542 PO BOX 66978 CHICAGO IL LAMAR LIFE INS CO

18257005 352530 38 AS (999) 999-9999 400 W SAMPLE ST SOUTH BEND IN SOUTH BEND LATHE INC

18266005 352530 38 AS (219) 495-9866 BOX 657 FREMONT IN WESTERN RUBBER CO

18275005 351113 05 AS (999) 999-9999 550 SHERBROOKE ST W MONTREAL ON QUEBEC BC

18284005 358569 38 AS (999) 999-9999 PO BOX 8700 JACKSONVILLE FL GEORGE WASHINGTON LIFE INS CO

18293005 351113 38 AS (999) 999-9999 PO BOX 60035 NEW ORLEANS LA MCDERMOTT HEALTH CARE PLAN

18319005 413395 38 AS (999) 999-9999 123 WILLIAMS ST NEW YORK NY LORD & TAYLOR GAB

18328005 351113 38 AS (313) 585-7900

30775 BARRINGTON

AVENUE MADISON HEIGHTS MI MID AMERICA ASSOCIATES

18337005 351113 05 AS (212) 476-7500 PO BOX 11800 ALBANY NY EMPIRE BC BS

18346005 351113 38 AS (316) 846-2286 PO BOX 336 MONTEZUMA KS CHRISTIAN HOSPITALIZATION AID

18355005 352530 38 AS (999) 999-9999 PO BOX 19569 HOUSTON TX INSURANCE MANAGEMENT

18364005 351113 89 AS (206) 464-3744 1800 NINTH AVENUE SEATTLE WA REGENCE BS

18373005 352530 38 AS (999) 999-9999 2550 S TELEGRAPH RD BLOOMFIELD HILL MI RADCLIFFE ADMINISTRATORS INC

18382005 351113 38 AS (999) 999-9999 650 S FRONT ST COLUMBUS OH GRANGE LIFE INS CO

18391005 413395 76 AS (765) 778-8511 BOX 879 ANDERSON IN CORESOURCE

18408005 358569 38 AS (901) 345-7620

3385 AIRWAYS

BOULEVARD MEMPHIS TN ALLEN & OHARA INC

18417005 351113 38 AS (999) 999-9999 1 CARBIDEX RD SOUTHGATE MI CARBIDEX CORP

18426005 351113 38 AS (313) 547-3150 PO BOX 228 MADISON HEIGHTS MI KASPER MACHINE CO

18444005 358569 38 AS (999) 999-9999

CARE CLAIMS PO BOX

8082 FRESNO CA CA PACIFIC LIFE INS CO

18453005 413395 89 AS (800) 675-1233 PO BOX 1847 GRAND RAPIDS MI SECUREONE BENEFIT ADMIN INC

18462005 351113 38 AS (999) 999-9999 PO BOX 43271 ST PAUL MN ST PAUL EMPLOYERS GRP INS

18471005 358569 38 AS (999) 999-9999 1 WOODWARD AVE DETROIT MI MARSH MCLENNAN GRP ASSOCIATES

18480005 352530 38 AS (999) 999-9999 PO BOX 907 MINNEAPOLIS MN MOREFAR EMPLOYERS TRUST

18506005 358569 38 AS (999) 999-9999 700 E OGDEN AVE WESTMONT IL BENEFIT PAYMENTS INC

18515005 358569 38 AS (312) 372-0973

20 NORTH WACKER

DRIVE CHICAGO IL GROUP ADMINISTRATION AGENCY

18524005 358569 38 AS (999) 999-9999 12 WENGER RD ENGLEWOOD OH STOP N GO

18533005 358569 67 AS (999) 999-9999 228 N LASALLE ST CHICAGO IL ELECTRICAL INSURANCE TRUSTEES

18542005 358569 38 AS (999) 999-9999 PO BOX 431800 SOUTH MIAMI FL FL LIFE

Page 67: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

18551005 358569 38 AS (813) 967-1101 502 E BRIDGERS AVE AUBURNDALE FL COMMERCIAL CARRIER CORP

18560005 358569 68 AS (999) 999-9999 25 VAN ZANT ST EAST NORWALK CT SELF FUNDING ADMIN INC

18589005 358113 66 AS (616) 957-1751 PO BOX 6392 GRAND RAPIDS MI ASR

18589010 358113 89 AS (800) 968-2449 PO BOX 6392 GRAND RAPIDS MI ASR

18598005 358569 04 AS (999) 999-9999 PO BOX 2650 WACO TX AMERICAN BANKERS INS CO

18604005 351113 89 AS (800) 533-1116 PO BOX 27401 RICHMOND VA ANTHEM BC BS

18613005 413395 89 AS (517) 676-3803 PO BOX 318 MASON MI DART CONTAINER CORP

18622005 352530 38 AS (999) 999-9999

1211 N WESTSHORE

BLVD TAMPA FL FIRST SOUTHEAST RISK

18631005 358113 89 AS (616) 949-2410 829 FOREST HILL AVE. GRAND RAPIDS MI GRAND VALLEY HEALTH

18640005 358569 38 AS (999) 999-9999 1225 E COOLSPRING MICHIGAN CITY IN MAXICARE INTERGROUP

18678005 358569 38 AS (800) 451-0929 3540 WILSHIRE BLVD LOS ANGELES CA US ADMINISTRATORS

18687005 551113 64 AS (800) 482-5642

1501 N UNIVERSITY

#314 LITTLE ROCK AR UNITED FOOD & COMMERCIAL WKRS

18696005 358569 89 XR (800) 968-2583

611 CASCADE W

PARKWAY SE GRAND RAPIDS MI BLUE CARE NETWORK OF W MI

18702005 358569 38 AS (999) 999-9999

158 STONE ST PO BOX

570 WATERTOWN NY HOSPITAL SERVICE OF JEFFERSON

18711005 352530 38 AS (999) 999-9999 BOX 418 BREMERTON WA SCOTT WEITZEL SERVICES

18720005 352530 38 AS (999) 999-9999 88 FIRST ST SUITE 303 SAN FRANCISCO CA BAY AREA AUTO GRP WELFARE FUND

18749005 351113 75 NO (800) 472-7130 PO BOX 10888 GREEN BAY WI CLAIM MANAGEMENT SERVICES INC

18749010 351113 89 AS (800) 472-7130 PO BOX 10888 GREEN BAY WI ANTHEM OF WISCONSIN (CMSI)

18758005 351113 38 AS (999) 999-9999 PO BOX 6245 SOUTH BEND IN ADMINISTRATIVE SERVICES OF IN

18767005 352530 38 AS (203) 222-4105

PO BOX 3050 RINCON

ANNEX SAN FRANCISCO CA STAUFFER CHEMICAL CO

18776005 351113 89 AS (800) 527-4613

131 N ELMOLINO AVE

#330 PASADENA CA CA IRONWORKERS

18785005 358569 38 AS (999) 999-9999 PO BOX 30078 TAMPA FL PROMEDIX HEALTH INSURANCE

18794005 413395 38 AS (999) 999-9999 290 WILSON AVE GRANDVILLE MI ALLOY TEK

18800005 351113 38 AS (999) 999-9999

10100 BRECKSVILLE

RD BRECKSVILLE OH ANVIL INDUSTRIES INC

18829005 358569 38 AS (999) 999-9999 PO BOX 928 FINDLAY OH BENEFIT PLANS RISK MGT INC

18838005 351113 67 AS (312) 771-7900 1515 S HARLEM AVE FOREST PARK IL LABORERS HEALTH & WELFARE

18847005 352530 38 AS (999) 999-9999 227 W SOUTHERN AVE COVINGTON KY LIBERTY CHERRY & FRUIT CO

18856005 351113 38 AS (999) 999-9999 PO BOX 558 BAY CITY MI PARTS JOBBERS EE BENEFITS

18865005 351113 38 AS (999) 999-9999 611 SAGINAW ST BAY CITY MI CAR QUEST

Page 68: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

18874005 358569 89 AS (999) 999-9999

4200 FASHION

SQUARE BLVD SAGINAW MI BLUE CARE NETWORK OF E MI

18883005 351113 05 AS (901) 544-2111 PO BOX 98 MEMPHIS TN BC BS OF MEMPHIS

18892005 358569 38 AS (231) 755-2270 P.O. BOX 209 MUSKEGON MI KNOLL GROUP

18909005 351113 38 AS (999) 999-9999 29800 BAINBRIDGE SOLON OH STOUFFERS HEALTH BENEFIT PLAN

18918005 351113 38 AS (999) 999-9999

30680 MONTPELIER

DR MADISON HEIGHTS MI NATIONAL ACTUARIES

18927005 358569 38 AS (999) 999-9999 PO BOX 1338 MURFREESBORO TN NATIONAL SAVINGS LIFE INS CO

18936005 358569 38 AS (999) 999-9999 1825 SCOTT ST DETROIT MI EASTERN MARKET BEEF PROC CORP

18945005 351113 38 AS (999) 999-9999

30500 VAN DYKE STE

502 WARREN MI PLAN SERVICE CENTER MECS

18954005 358569 38 AS (999) 999-9999

PORTER & BEVERLY

STS SW GRAND RAPIDS MI REYNOLDS METALS COMPANY

18963005 352530 38 AS (999) 999-9999

458 W SOUTH ST BOX

151 KALAMAZOO MI SMALL BUSINESS GROUP INS

18972005 352530 38 AS (999) 999-9999 BYPASS RD ASHLAND CITY TN STATE INDUSTRIES

18972010 352530 38 AS (999) 999-9999 PO BOX 844 HENDERSON NV STATE INDUSTRIES

18981005 413395 38 AS (999) 999-9999 PO BOX 30082 TAMPA FL ADMINISTRATIVE PLAN SERVICES

18990005 352530 38 AS (999) 999-9999

18872 MACARTHUR

BLVD IRVINE CA ASSOCIATION ADMINISTRATORS &

19002005 351113 38 AS (312) 572-7000 800 JORIE BLVD OAK BROOK IL CBI INDUSTRIES INC

19011005 358569 38 AS (999) 999-9999 PO BOX 7676 ST CLAIR SHORES MI MHA SERVICE CORP

19020005 352530 38 AS (999) 999-9999 PO BOX 825 DAYTON OH PRICE BROTHERS INS

19049005 352530 38 AS (999) 999-9999 PO BOX 88511 INDIANAPOLIS IN RANSBURG CORPORATION

19058005 358569 38 AS (999) 999-9999 23333 COMMERCE DR FARMINGTON HILL MI ACO INC

19067005 351113 38 AS (999) 999-9999 755 W BIG BEAVER TROY MI AMERISK CORP

19067010 358569 87 RX (800) 681-6912 PO BOX 67138 CUYAHOGA FALLS OH AMERISCRIPT

19076005 358569 38 AS (999) 999-9999 PO BOX 14000 LEXINGTON KY ASHLAND OIL EMPLOYEE BENEFITS

19085005 351113 38 AS (999) 999-9999 FOY STATION LOS ANGELES CA BILES & COOK ADMINISTRATORS

19094005 351113 67 AS (999) 999-9999 PO BOX 695 KENDALL FL CARPENTERS H & W FUND OF S FL

19100005 413395 38 AS (999) 999-9999 PO BOX 1973 ORLANDO FL CENTRAL FL CLAIMS SERVICE

19129005 413395 38 AS (999) 999-9999 PO BOX 7580 ATLANTA GA KENNESAW LIFE & ACCIDENT

19138005 358569 38 AS (999) 999-9999 PO BOX 849 BLOOMFIELD HILL MI PARAMED INC

19147005 351113 38 AS (906) 353-6611 OFFICES & PLANT BARAGA MI PETTIBONE MI CORP

19156005 413395 38 AS (999) 999-9999 PO BOX 2141 MILWAUKEE WI PREFERRED SERVICE CENTER

19165005 352530 38 AS (999) 999-9999 161 E MICHIGAN AVE KALAMAZOO MI PROFESSIONAL SALES

19174005 352530 38 AS (800) 832-8333 PO BOX 1440 FRANINGTON MA SERVICE INDUSTRY CONSOLIDATED

19183005 352530 38 AS (517) 263-7811 1357 DIVISION ST ADRIAN MI UARCO

19192005 552530 38 AS (999) 999-9999 850 3RD AVE NEW YORK NY UNITED LABOR LIFE INS

19209005 358569 84 IO (800) 843-7705 500 VIRGINIA DRIVE FORT WASHINGTON PA WA NATIONAL INSURANCE

Page 69: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

19218005 358569 89 AS (312) 991-9700 865 WILMETTE PALATINE IL ANCHOR HEALTH HMO

19227005 352530 38 AS (800) 237-1900 PO BOX 619999 DALLAS/FT WORTH TX NATIONAL HEALTH INSURANCE CO

19227010 352530 89 AS (800) 237-1900 PO BOX 619999 DALLAS TX NATIONAL HEALTH INSURANCE CO

19236005 352530 38 AS (999) 999-9999 PO BOX 644-A DETROIT MI AMERICAN LIFE AND CASUALTY

19245005 358569 89 AS (800) 355-8040 PO BOX 2365 FARMINGTON HILL MI EMPLOYEE BENEFIT CONCEPTS INC

19254005 358569 38 AS (999) 999-9999 PO BOX 2590 EAST LANSING MI MI CATHOLIC CONFERENCE

19263005 358569 67 AS (602) 234-0524

4725 N. 19TH

AVENUE, SUITE 1 PHOENIX AZ IBEW LOCAL 640

19263010 358569 67 AS (800) 221-7025 PO BOX 66745 MOBILE AL IBEW LOCAL UNION 903 HEALTH &

19263015 358569 67 AS (800) 387-0449

85 BAGBY DRIVE

SUITE 216 BIRMINGHAM AL IBEW LOCAL UNION 508 EASTERN DIVISION

19272005 351113 38 AS (999) 999-9999 475 RIVERSIDE DRIVE NEW YORK NY REFORMED CHURCH OF AMERICA

19281005 358113 89 AS (800) 832-9186

1400 EAST MICHIGAN

AVENUE LANSING MI PHP MID MICHIGAN

19281010 358113 89 R6 (999) 999-9999

PO BOX 169055-

ROUTE 2701 DULUTH MN PHP NETWORK

19281015 358113 89 X2 (800) 225-7951 SUITE 400 COLUMBUS OH UHC OF OH

19290005 358569 38 AS (800) 237-4753 PO BOX 30082 TAMPA FL CELTIC LIFE INS CO

19290010 358569 38 AS (800) 477-7870 PO BOX 33839 INDIANAPOLIS IN CELTIC INSURANCE CO

19307005 358569 38 AS (314) 241-8665 314 N BROADWAY ST LOUIS MO DBL SERVICES INC

19316005 358569 38 AS (999) 999-9999 550 NORTH HOBBIE KANKAKEE IL MORTELL COMPANY

19325005 351113 89 AS (999) 999-9999 PO BOX 13085 TUCSON AZ PIMACARE INC

19334005 358569 38 AS (999) 999-9999 9101 WESLEYAN RD INDIANAPOLIS IN SOCIETY NATIONAL LIFE INS CO

19343005 358569 33 AS (312) 254-2500 4217 S HALSTED ST CHICAGO IL TEAMSTERS LOCAL 710

19352005 358569 38 AS (616) 426-4884 PO BOX 245 SAWYER MI VENTURES COUNTY MEDICAL

19361005 352530 38 AS (999) 999-9999

901 W WALNUT HILL

LANE IRVING TX ZALE EMPLOYEE BENEFITS ASSOC

19370005 352530 38 AS (999) 999-9999 25 N 4TH ST PHILADELPHIA PA UPHOLSTERERS INTER LOCAL 655

19399005 352530 38 AS (999) 999-9999 PO BOX 231036 PLEASANT HILL CA NATIONAL HEALTHCARE ADMIN INC

19405005 351113 05 AS (401) 272-8500

444 WESTMINSTER

MALL PROVIDENCE RI BC BS OF RI

19405010 351113 89 AS (800) 327-6712

444 WESTMINSTER

MALL PROVIDENCE RI BC BS OF RI

19414005 351113 38 AS (999) 999-9999 350 S SANFORD PONTIAC MI ARCHITECTURAL MFG

19423005 358569 72 AS (999) 999-9999 LOCAL 130 UA CHICAGO IL PLUMBERS WELFARE FUND

19432005 358569 38 AS (847) 981-8202 1965 PRATT BLVD ELKGROVEVILLAGE IL TANG INDUSTRIES INC

19441005 413395 38 AS (800) 522-0088 PO BOX 9103 VAN NUYS CA HEALTH NET

19450005 358569 55 AS (616) 942-2100 2040 RAYBROOK GRAND RAPIDS MI EBP HEALTHPLANS

19479005 351113 07 AS (602) 241-0433 777 E. MISSOURI AVE. PHOENIX AZ EQUITABLE LIFE

Page 70: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

19488005 352530 64 AS (999) 999-9999 4704 HARLAN STE 375 DENVER CO ROCKY MTN UFCW UNIONS & EMPLRS

19497005 358569 89 XR (800) 775-2583

611 CASCADE W

PARKWAY SE GRAND RAPIDS MI BLUE CARE NETWORK OF SW MI

19503005 358569 67 AS (999) 999-9999 1555 EASTERN SE GRAND RAPIDS MI INTERNATIONAL UNION ELECT WKS

19512005 358569 38 AS (999) 999-9999 PO BOX 7676 ST CLAIR SHORES MI MI HOSP ASSN SERV CORP

19521005 352530 38 AS (999) 999-9999 PO BOX 18752 FORT WORTH TX NORTH AMERICAN RISK MGMT

19530005 352530 38 AS (800) 343-8136

WALNUT & PACIFIC

STREET STAMFORD CT PITNEY BOWES

19559005 352530 38 AS (999) 999-9999 713 SOUTH JAMES LUDINGTON MI BRILL MFG CO

19559050 352530 38 AS (999) 999-9999 PO BOX 9050 VICTORIA BC V8W9E2 ON BRITISH COLUMBIA MINISTRY OF HEALTH

19568005 358569 20 AS (999) 999-9999 PO BOX 1386 EAST LANSING MI GROUP BENEFIT SERVICES

19577005 552530 67 AS (999) 999-9999 675 4TH AVE BROOKLYN NY UNITED INDUSTRIAL WRKS OF N AM

19586005 352530 38 AS (999) 999-9999 40550 BRENTWOOD STERLING HGHTS MI STERLING PLASTICS

19595005 352530 38 AS (999) 999-9999 306 CENTER ST LITTLE ROCK AR UNION LIFE INSURANCE

19601005 351113 38 AS (508) 632-8244 SIMPLEX PLAZA GARDNER MA COMPLETE CARE CONTROL

19610005 352530 01 AS (517) 423-8411 S EVANS TECUMSEH MI TECUMSEH PRODUCTS CO

19639005 352530 38 AS (313) 967-1640 4199 MARCY WARREN MI ELIAS BROTHERS RESTAURANTS INC

19648005 351113 38 AS (999) 999-9999 3130 WILSHIRE BLVD SANTA MONICA CA PENNCORP FINANCIAL INC

19657005 358569 38 AS (810) 353-9787

24370

NORTHWESTERN SOUTHFIELD MI SELF INSURED RISK SERVICES

19666005 358569 38 AS (999) 999-9999 PO BOX 16609 IRVINE CA BEECH STREET HEALTH CARE SERVS

19666010 358569 89 NO (800) 432-1776 PO BOX 17719 IRVINE CA BEECH STREET PPO NETWORK

19666015 358569 89 AS (800) 749-1858 PO BOX 83900 MIAMI FL BEECH STREET PPO

19666020 358569 89 AS (800) 937-2277 PO BOX 1662 MINNEAPOLIS MN BEECH STREET PPO

19675005 413395 38 AS (999) 999-9999 26400 LASHER RD. SOUTHFIELD MI FIRST BENEFITS

19684005 351113 38 AS (616) 392-6233 PO BOX 1018 HOLLAND MI HOME BUILDERS ASSOCIATION

19693005 358569 38 AS (999) 999-9999 PO BOX 110845 NASHVILLE TN MARKETING THROUGH PRODUCTION

19719005 413395 38 AS (800) 542-6642 2700 MIDWEST DRIVE ONALSKA WI UMR

19728005 358569 38 AS (999) 999-9999 231 W LAFAYETTE DETROIT MI ACTION

19737005 352530 38 AS (999) 999-9999

3700 E MICHIGAN

BLVD MICHIGAN CITY IN SULLIAR

19746005 352530 38 AS (999) 999-9999 13100 WAYZATA BLVD MINNETONKA MN DCA HEALTHCARE MGT GROUP

19755005 352530 38 AS (800) 654-9106 PO BOX 18448 OKLAHOMA CITY OK RESERVE NATIONAL INSURANCE CO

19764005 352530 67 AS (999) 999-9999 PO BOX 14070 NORFOLK VA UNION PLAN BRICKLAYERS

19773005 358569 89 AS (866) 822-7037 PO BOX 1156 TROY MI SHEET METAL WKRS LOCAL 7 ZONE1 BENEFIT FUNDS

19782005 351113 38 AS (999) 999-9999

301 EAST ARMOR

BLVD KANSAS CITY MO LMA GROUP BENEFIT

Page 71: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

19791005 358569 38 AS (999) 999-9999

120 PERE MARQUETTE

ST BIG RAPIDS MI MI KNIFE COMPANY

19808005 358569 38 AS (800) 323-0131 PO BOX 94099 SCHAUMBURG IL COTTER & COMPANY

19817005 413395 38 AS (999) 999-9999 PO BOX 8888 STEVENS POINT WI CENTURY HEALTH CARE

19826005 358569 38 AS (616) 361-2681 701 ANN STREET NW GRAND RAPIDS MI EVANS TEMPCON

19835005 352530 86 VO (800) 225-3095 PO BOX 464 MT CLEMENS MI STERLING VISION SHOPS INC

19844005 413395 38 AS (800) 328-0927

10405 6TH AVE

NORTH PLYMOUTH MN BENE PRO INC

19853005 413395 38 AS (999) 999-9999 PO BOX 50011 SAN JOSE CA AMDAHL HEALTH CARE TRUST

19862005 351113 38 AS (999) 999-9999 1819 W OSBORN RD PHOENIX AZ DAN R WAGNON ASSOC

19871005 358569 38 AS (999) 999-9999 3411 WOODHEAD DR NORTHBROOK IL DANIEL WOODHEAD INC

19880005 358113 38 AS (800) 221-6036 PO BOX 16691 COLUMBUS OH EATON CORP BENEFITS

19906005 358569 38 AS (999) 999-9999 2206 SW 3RD ST ANKENY IA HEALTH LIFE AMERICAN INS

19915005 352530 38 R6 (800) 523-6599

UNION FIDELITY

OFFICE PK TREVOSE PA UNION FIDELITY LIFE INSUR CO

19915010 352530 38 AS (800) 621-0393 PO BOX 5008 CAROL STREAM IL UNION FIDELITY LIFE INSURANCE CO

19924005 358569 38 AS (203) 563-1910

8120 LINGLESTOWN

RD HARRISBURG PA INTERNATIONAL HARNESS RACING

19933005 413395 38 AS (616) 396-6531 PO BOX 917 HOLLAND MI KARR MFRS EMPLOYEE BEN PLAN

19942005 351113 38 AS (248) 559-2579 PO BOX 547 LATHRUP VILLAGE MI NATIONAL FOOT CARE PROGRAM

19951005 413395 38 AS (999) 999-9999 STC C700 DENVER CO PREFERRED BENEFITS SERV INC

19960005 358569 38 AS (800) 548-2040

1600 S BRENTWOOD

BLVD ST LOUIS MO GENELCO

19989005 358569 88 DO (999) 999-9999 23403 FORD RD DEARBORN MI METROPOLITAN IND DENTAL ASSOC

19998005 352530 38 AS (999) 999-9999 PO BOX 11476 FT WORTH TX NATIONAL BENEFIT LIFE

20003005 351113 38 AS (999) 999-9999

2900 TEXAS

COMMERCE TWR HOUSTON TX REED STENHOUSE ASSOC INC

20012005 351113 38 AS (313) 645-6310 30700 TELEGRAPH RD BIRMINGHAM MI SCHOOL DIST CITY OF PONTIAC

20021005 352530 38 AS (800) 732-1121

2815 SECOND AVE.,

SUITE 300 SEATTLE WA WELFARE & PENSION ADM SERV INC

20030005 352530 38 AS (414) 433-5546 700 N ADAMS ST GREEN BAY WI WI PUBLIC SERV CORP

20059005 352530 38 AS (999) 999-9999 16928 148TH AVE SPRING LAKE MI ROLL FORM DESIGN INC

20068005 358569 38 AS (999) 999-9999 PO BOX 2475 FORT WORTH TX COLOR TILE INC

20077005 358569 38 AS (999) 999-9999 PO BOX 8687 FORT WORTH TX GIC REGIONAL CLAIMS OFFICE

20086005 352530 38 X3 (800) 925-6000 PO BOX 149138 AUSTIN TX INTERCONTINENTAL LIFE INS CO

20095005 358569 38 AS (999) 999-9999 2060 E NINTH ST CLEVELAND OH MEDICAL LIFE

20101005 351113 38 AS (999) 999-9999

4101 WASHINGTON

AVE NEWPORT NEWS VA NEWPORT NEWS SHIPBUILDING &

20110005 358113 38 AS (999) 999-9999 2045 MARTINDALE INDIANAPOLIS IN ERTEL MANUFACTURING

Page 72: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

20139005 351113 38 AS (999) 999-9999 INSURANCE OFFICE PIONEER OH KUSTOM FIT OF OH INC

20148005 358569 67 AS (313) 270-1284

30800 MONTPELIER

DR MADISON HEIGHTS MI MEAT CUTTERS LOCAL 539

20157005 352530 38 AS (999) 999-9999 141 S ADAMS MARIAN IN US CARE CORPORATION

20166005 352530 38 AS (999) 999-9999 440 LINCOLN ST WORCESTER MA SMA LIFE ASSURANCE COMPANY

20175005 352530 38 AS (800) 388-5190 PO BOX 3968 BOCA RATON FL CLAIMS ADMINISTRATION SERV INC

20184005 352530 38 AS (999) 999-9999 PO BOX 1748 GRAND RAPIDS MI ROSPATCH CORPORATION

20193005 358569 38 AS (999) 999-9999 201 S DELANEY RD OWOSSO MI MOTOR PRODUCTS

20219005 413395 38 AS (248) 213-1074

800 STEVENS PORT

DRIVE DAKOTA DUNES SD IBP INC

20228005 352530 38 AS (999) 999-9999 363 NORTH GRATIOT MT CLEMENS MI TOWER BUS INC

20237005 358569 43 AS (800) 748-0003 PO BOX 30126 LANSING MI MERITAIN HEALTH (WEYCO)

20237010 358569 89 AS (800) 748-0003 PO BOX 30126 LANSING MI MERITAIN HEALTH (WEYCO)

20246005 352530 38 AS (999) 999-9999 PO BOX 1130 MODESTO CA GALLO GLASS UNION HEALTH PLAN

20255005 358569 89 XR (616) 941-7823

611 CASCADE W

PARKWAY SE GRAND RAPIDS MI BLUE CARE NETWORK OF N MI

20264005 352530 38 AS (999) 999-9999

800 EAST BRIDGE

STREET PLAINWELL MI UNITED TECHNOLOGIES

20273005 358569 88 DO (999) 999-9999 PO BOX 54709 OKLAHOMA CITY OK DELTA DENTAL PLAN OF OK

20282005 351113 38 AS (999) 999-9999 147 E 6TH STREET HOLLAND MI BEATRICE CHEESE INC

20291005 351113 38 AS (517) 799-7300 PO BOX 2309 SAGINAW MI MI SUGAR COMPANY

20317005 358569 38 AS (314) 421-1525

100 NORTH

JEFFERSON ST LOUIS MO DANIEL AND HENRY

20326005 352530 38 X5 (800) 253-0856 PO BOX 10821 CLEARWATER FL HARVEST LIFE INSURANCE

20335005 352530 38 AS (800) 547-1402 3755 SE 8TH PORTLAND OR PHA LIFE INSURANCE CO

20344005 358569 38 AS (999) 999-9999

STAR

COMMONWEALTH RD ALBION MI STAR COMMONWEALTH SCHOOL

20344010 358569 89 AS (800) 308-5948 PO BOX 55270 PHOENIX AZ CIGNA

20353005 358569 38 AS (999) 999-9999 PO BOX 33056 DETROIT MI CONSTRUCTION ASSOC OF MI

20362005 358569 88 DO (800) 253-0966 PO BOX 4022 KALAMAZOO MI HRM CLAIM MANAGEMENT INC.

20371005 352530 64 AS (999) 999-9999

190 N WIGENT

DRAWER 9000 WALNUT CREEK CA N CA FOOD EMP RETAIL CLKS UNIO

20380005 352530 38 AS (999) 999-9999 1515 S HARLEM AVE FOREST PARK IL WELFARE & PENSION GROUP

20406005 413395 89 AS (800) 331-1199

5200 77 CENTER DR

STE 400 CHARLOTTE NC CORESOURCE

20415005 351113 67 AS (800) 331-4277 PO BOX 398 DAYTON OH IRONWORKERS WELFARE TRUST

20424005 358569 38 AS (999) 999-9999 PO BOX 35008 CANTON OH AMERICAN HEALTHCARE MANAGEMENT

20433005 358569 38 AS (800) 257-1900 P O BOX 9202 FARMINGTON HILL MI AMERISURE CO MEDICAL CLAIMS

20442005 351113 38 AS (999) 999-9999 1275 PECK ST MUSKEGON MI CLOETINGH SEAWAY AGENCY

Page 73: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

20451005 352530 38 AS (999) 999-9999 3090 TEAGARDEN ST SAN LEANDRO CA DAIRY INDUSTRY TRUST

20460005 351113 38 AS (999) 999-9999

1415 N LOOP WEST

STE180 HOUSTON TX PEACE OFFICERS MEDICAL TRUST

20489005 352530 38 AS (999) 999-9999 1925 STONE COURT MISHAWAKA IN STONE CONTAINER CORP-PERSONNEL

20498005 413395 89 AS (999) 999-9999

1375 E 9TH ST STE

1400 CLEVELAND OH HEALTH AMERICA

20504005 352530 38 AS (999) 999-9999 4789 RINGS RD DUBLIN OH KOBACKER ASSOCIATES BEN PLAN

20513005 351113 38 AS (999) 999-9999 PO BOX 35417 DETROIT MI NATIONAL LABOR UNION

20522005 352530 38 AS (612) 338-6309 PILLSBURY CENTER MINNEAPOLIS MN PILLSBURY COMPANY

20531005 413395 38 AS (999) 999-9999 4027 E NINE MILE RD WARREN MI PIONEER INSURANCE

20540005 352530 38 AS (999) 999-9999 PO BOX 2932 FORT WORTH TX TRADERS & GENERAL INS CO

20569005 352530 38 AS (999) 999-9999 PO BOX 178 MADISONVILLE KY INDEPENDENT HAULERS ASSOC GRP

20578005 352530 38 AS (999) 999-9999 EXECUTIVE OFFICE TREVOSE PA NATIONAL SENIOR CITIZENS GROUP

20587005 358569 72 AS (312) 633-0597 45 N OGDEN AVENUE CHICAGO IL PIPEFITTERS LOCAL UNION WELFARE FUND

20596005 358569 38 AS (999) 999-9999 PO BOX 660211 DALLAS TX AAFES CATALOG SALES

20602005 351113 38 AS (999) 999-9999

105 W ADAMS ST

29TH F1 CHICAGO IL AVMA GROUP INSURANCE TRUST

20611005 413395 38 AS (734) 242-4443 PO BOX 240 MONROE MI BENEFIT SOURCE

20611010 413395 89 AS (734) 242-4443 PO BOX 240 MONROE MI BENEFIT SOURCE

20620005 358569 38 AS (999) 999-9999 PO BOX 7650 NEWPORT BEACH CA BEST LIFE ASSURANCE CO OF CA

20649005 352530 38 AS (999) 999-9999 72 W 7TH ST LOS ANGELES CA COSMOPOLITAN LIFE INSURANCE CO

20658005 413395 38 XR (999) 999-9999

1901 N STEPHENSON

AVENUE IRON MOUNTAIN MI CUMMINS GREAT LAKES EMP BENEF

20667005 358569 38 AS (999) 999-9999 PO BOX 40198 JACKSONVILLE FL FL MEDICAL INS TRUST

20676005 351113 38 AS (999) 999-9999 40 MORRIS AVE BRYN MAWR PA HERCULES COMP HEALTH CARE PLAN

20685005 358569 38 AS (612) 887-5584

9600 ALDRICH AVE

SOUTH MINNEAPOLIS MN TELEX COMMUNICATIONS INC

20694005 352530 38 AS (999) 999-9999 101 S WATERMAN ST DETROIT MI STAN SAX CORP

20700005 352530 38 AS (616) 456-8557 136 E FULTON GRAND RAPIDS MI WEST MI TOURIST ASSOC

20729005 351113 38 AS (906) 863-2671 5520 13TH STREET MENOMINEE MI HOSE COUPLINGS MANUF CO

20738005 351113 38 AS (999) 999-9999

186 LAWRENCE

AVENUE STEVENSVILLE MI PLASTRONIC PACKAGING CORP

20747005 352530 38 AS (999) 999-9999 1245 HURSTVIEW HURST TX CHRISTIAN ORGANIZATIONS MED SO

20756005 352530 38 AS (999) 999-9999 PO BOX 9126 VAN NUYS CA RCA PLAN FOR HEALTH

20765005 358569 38 AS (800) 662-1113 BOX 25523 OKLAHOMA CITY OK AMERICAN FIDELITY ASSURANCE

20774005 351113 38 AS (999) 999-9999 HEALTH CARE PLAN MASON MI DART MANAGEMENT CORPORATION

20783005 351113 38 AS (616) 393-3000 1400 M-40 HOLLAND MI HAWORTH INSURANCE

20792005 358569 38 AS (408) 943-9400 BOX 5506 SAN JOSE CA LIFEGUARD

Page 74: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

20809005 351113 38 AS (714) 939-7060

2107 NORTH

BROADWAY SANTA ANA CA PACIFIC COAST ADMINISTRATORS

20818005 352530 38 AS (999) 999-9999 409A WATERS BLDG GRAND RAPIDS MI PAUL GOEBEL INSURANCE

20827005 352530 38 AS (800) 333-9202

100 N 6TH STREET STE

800 WACO TX PHILADELPHIA AMERICAN LIFE

20836005 413395 17 AS (800) 848-4623 130 W 2ND ST DAYTON OH UNITED MEDICAL RESOURCES

20845005 351113 38 AS (999) 999-9999 PO BOX 1386 EAST LANSING MI SCHOOL ADMINISTRATIVE SERVICES

20854005 358113 87 RX (616) 957-1751 PO BOX 6392 GRAND RAPIDS MI ASR CLAIMS-PHARMACY

20863005 351113 38 AS (414) 289-9190

330 E KILBOURN

AVENUE MILWAUKEE WI ADJUSTCO

20872005 352530 38 AS (999) 999-9999 444 N COURTLAND ST MUNDELEIN IL CONDECOR INC

20881005 358569 38 AS (999) 999-9999 9501 WEST DEVON ROSEMONT IL EMPLOYEE BENEFITS CLAIMS INC

20890005 352530 38 AS (999) 999-9999

WESTMINSTER AT

PARKER ELIZABETH NJ INTERCONTINENTAL LIFE INSURANC

20907005 358569 38 AS (999) 999-9999 5421 MANTHEI RD PETOSKEY MI MANTHEI HEALTH

20916005 358569 38 AS (800) 421-3973 PO BOX 29005 PHOENIX AZ MOTOROLA INC

20925005 358569 38 AS (703) 825-9600 6620 TAYLOR RD CLINTON OH BROTHERHOOD NEWSLETTER

20934005 358569 38 AS (800) 642-4089 PO BOX 2835 OMAHA NE CORPORATE DIVERSIFIED SERVICES

20943005 351113 38 AS (999) 999-9999

994 OLD EAGLE

SCHOOL RD WAYNE PA LEADERS ADMINISTRATORS

20952005 352530 38 AS (999) 999-9999 311 W WASHINGTON INDIANAPOLIS IN LIFE OF IN INSURANCE CO

20961005 413395 67 AS (800) 892-1893 PO BOX 230 NILES OH OH CONFERENCE OF PLASTERERS & CEMENT MASONS

20970005 358113 89 X4 (800) 394-7569 1 JACKSON SQUARE JACKSON MI PHP OF SOUTH MICHIGAN

20999005 358113 89 X4 (800) 548-6574 4316 RICE LAKE ROAD DULUTH MN PHP OF SOUTHWEST MICHIGAN

21000005 358113 89 X4 (517) 364-8460 PO BOX 30377 LANSING MI PHP MUSKEGON

21029005 352530 38 AS (313) 353-5800

BOX 5007 24700 NW

HWY SOUTHFIELD MI REP HOGG ROBINSON PENN GEN SER

21038005 352530 88 DO (800) 275-4638 PO BOX 14093 LEXINGTON KY METLIFE

21047005 351113 67 AS (313) 663-2178 3135 S STATE STREET ANN ARBOR MI ELECTRICAL WORKERS H & W FUND

21056005 358569 38 AS (616) 621-3135 ROUTE 2 HARTFORD MI HILLTOP ORCHARDS

21065005 352530 38 AS (214) 458-1099

8300 DUNWOODY

PLACE ATLANTA GA LIBERTY LOAN CORP WELFARE BENE

21074005 352530 38 X3 (215) 443-0404

110 GIBRALTAR RD-

STE116 HORSHAM PA NATIONAL BENEFIT CORP

21083005 358569 38 AS (999) 999-9999

7010 METROPLEX

DRIVE ROMULUS MI SENTRY DRUG STORES

21092005 358569 38 AS (404) 266-5500 PO BOX 105652 ATLANTA GA BANKERS FIDELITY LIFE INS CO

Page 75: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

21109005 358569 38 AS (999) 999-9999

54693 COUNTY RD 17

SOUTH ELKHART IN BANKS LUMBER COMPANY INC

21118005 358569 38 AS (999) 999-9999 57540 STATE ROAD ELKHART IN BOCK INDUSTRIES INC

21127005 352530 38 AS (999) 999-9999 PO BOX 113 MINNEAPOLIS MN GMI CORPORATE HEALTH CLAIMS

21136005 413395 38 AS (305) 866-7771 PO BOX 41-4043 MIAMI FL INSURANCE & RISK MANAGEMENT

21145005 352530 38 AS (999) 999-9999 PO BOX 5766 LITTLE ROCK AR OWENS & ASSOCIATES

21154005 413395 89 AS (810) 873-2725 2850 W GRAND BLVD DETROIT MI PREFERRED HEALTH PLAN

21154010 413395 89 AS (999) 999-9999 PO BOX 60308 6MF LOS ANGELES CA PREFERRED HEALTH NETWORK

21163005 351113 87 RX (800) 992-7763 PO BOX 85042 RICHMOND VA FIRST HEALTH RX

21163010 351113 39 AS (999) 999-9999

2614 SOUTH 1935

WEST SALT LAKE CITY UT FIRST HEALTH

21163015 351113 39 AS (800) 942-6511 2222 EWING RD MON TWP PA FIRST HEALTH

21163020 351113 39 AS (800) 242-8276 PO BOX 30995 SALT LAKE CITY UT FIRST HEALTH

21163025 351113 39 AS (800) 891-6506 PO BOX 23806 TUSCON AZ FIRST HEALTH

21163030 351113 39 AS (800) 891-6506 PO BOX 11708 TUCSON AZ FIRST HEALTH

21163035 351113 39 AS (800) 924-6712 PO BOX 11708 TUCSON AZ FIRST HEALTH

21163040 351113 89 AS (800) 891-6506 PO BOX 23806 TUCSON AZ FIRST HEALTH

21163045 351113 39 AS (800) 331-5961 PO BOX 2067 MILWAUKEE WI FIRST HEALTH

21163050 351113 39 AS (800) 877-8930 PO BOX 100223 MILWAUKEE WI FIRST HEALTH

21163055 351113 39 AS (800) 558-9056 PO BOX 26199 MILWAUKEE WI FIRST HEALTH

21163060 351113 39 AS (800) 368-2469 PO BOX 682 MILWAUKEE WI FIRST HEALTH

21163065 351113 39 AS (999) 999-9999 PO BOX 17377 SALT LAKE CITY UT FIRST HEALTH

21163070 351113 39 AS (800) 477-3140 PO BOX 945030 MAITLAND FL FIRST HEALTH

21163075 351113 39 AS (800) 554-4954 PO BOX 450450 ATLANTA GA FIRST HEALTH

21163080 351113 39 AS (208) 321-3000 PO BOX 535935 PITTSBURG PA FIRST HEALTH

21163085 351113 39 AS (800) 877-8930

2514 S 102ND ST STE

250 WEST ALLIS WI FIRST HEALTH

21163090 351113 39 AS (800) 572-2089

6975 UN PARK CTR

STE 600 MIDVALE UT FIRST HEALTH

21163095 351113 39 AS (800) 477-3071 PO BOX 11708 TUCSON AZ FIRST HEALTH

21163100 351113 39 AS (800) 421-9064 PO BOX 54170 LOS ANGELES CA FIRST HEALTH

21163105 351113 39 AS (800) 572-2089 PO BOX 30110 SALT LAKE CITY UT FIRST HEALTH

21163110 351113 39 AS (800) 429-6514 PO BOX 26247 SALT LAKE CITY UT FIRST HEALTH

21163115 351113 39 AS (800) 627-6396 PO BOX 11490 TUSCON AZ FIRST HEALTH

21163120 351113 89 AS (800) 486-9451 PO BOX 672768 HOUSTON TX FIRST HEALTH

21163125 351113 39 AS (800) 237-6302 PO BOX 40 MINNEAPOLIS MN FIRST HEALTH

21163130 351113 39 AS (800) 884-3415 PO BOX C-85042 RICHMOND VA FIRST HEALTH

21163135 351113 89 AS (800) 280-6658 PO BOX 23070 TUCSON AZ FIRST HEALTH

21163140 351113 39 AS (999) 999-9999 PO BOX 30120 SALT LAKE CITY UT FIRST HEALTH

21163145 351113 39 AS (800) 382-6411 PO BOX 30080 SALT LAKE CITY UT FIRST HEALTH

21163150 351113 39 AS (801) 973-7300 2610 DECKER LANE SALT LAKE CITY UT FIRST HEALTH

Page 76: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

21163155 358569 89 NO (916) 374-4600

750 RIVERPOINT

DRIVE WEST SACRAMENTO CA FIRST HEALTH NETWORK

21163160 351113 39 AS (800) 237-6302 PO BOX 11925 COROAPOLIS PA FIRST HEALTH

21163165 351113 39 AS (800) 449-9892 PO BOX 535935 PITTSBURGH PA FIRST HEALTH

21163170 351113 89 AS (800) 292-1289 PO BOX 11708 TUCSON AZ FIRST HEALTH

21163175 351113 39 AS (999) 999-9999 23829 TUSCON AZ FIRST HEALTH

21163180 351113 89 AS (800) 833-5914 PO BOX 23550 TUCSON AZ FIRST HEALTH

21163185 351113 39 AS (800) 551-7792 100 S CHARLES BALTIMORE MD FIRST HEALTH

21163190 351113 39 AS (800) 487-0771 PO BOX 104360 JEFFERSON CITY MO FIRST HEALTH

21163195 351113 89 AS (800) 449-9892 PO BOX 24040 TUCSON AZ FIRST HEALTH

21163200 358569 39 AS (999) 999-9999 PO BOX 8400 LONDON KY FIRST HEALTH/COVENTRY HEALTH CARE

21163205 351113 39 AS (800) 909-6790 2000 HOGBACK ROAD ANN ARBOR MI FIRST HEALTH

21163210 351113 39 AS (800) 774-0679 PO BOX 26487 SALT LAKE CITY UT FIRST HEALTH

21163215 358569 39 AS (999) 999-9999 PO BOX 44365 MADISON WI FIRST HEALTH ALLIANCE

21163220 351113 39 AS (800) 477-3071 PO BOX C-85042 RICHMOND VA FIRST HEALTH

21163225 351113 39 AS (800) 280-6658 PO BOX 23070 TUCSON AZ FIRST HEALTH

21172005 352530 38 AS (999) 999-9999

11301 OLD

GEORGETOWN NORTH BETHESDA MD SPECIAL AGENTS MUTUAL BENEFIT

21181005 358569 04 AS (312) 283-1100

222 MERCHANDISE

MART PLZ CHICAGO IL BANKERS LIFE & CASUALTY

21181010 358569 84 IO (312) 396-6000

222 MERCHANDISE

MART PLAZA CHICAGO IL BANKERS LIFE AND CASUALTY CO

21190005 358569 38 AS (999) 999-9999 208 S LASALLE ST CHICAGO IL BUCKINGHAM LIFE INSURANCE

21207005 358569 38 AS (999) 999-9999 5400 SCATTERFIELD ANDERSON IN EMPLOYEE MEDICAL BENEFIT PLAN

21216005 351113 38 AS (999) 999-9999

8 PROGRESS

PARKWAY ST LOUIS MO GROUP INSURANCE PROCESSOR

21225005 358569 38 AS (999) 999-9999 19224 CO ROAD 8 BRISTOL IN PARKWOOD CORP EMPLOYEE BENEFIT

21234005 352530 38 AS (999) 999-9999

2040 W WISCONSIN

AVE MILWAUKEE WI SAMARITAN HEALTH PLAN

21243005 358569 55 AS (999) 999-9999 PO BOX 6218 DENVER CO EMPLOYEE BENEFIT ADMIN AMERICA

21252005 352530 38 AS (999) 999-9999 PO BOX 1038 HURST TX INVESTORS LIFE

21261005 351113 67 AS (999) 999-9999 4231 SIGMA ROAD DALLAS TX NORTH CENTRAL TX LABORERS

21270005 352530 38 AS (999) 999-9999 PO BOX 6036 PINE BLUFF AR UNIVERSAL LIFE

21299005 351113 38 AS (999) 999-9999 1377 DUBLIN ROAD COLUMBUS OH DOMINO S PIZZA INC

21305005 358569 38 PH (999) 999-9999 8300 96TH AVENUE ZEELAND MI BIL MAR FOODS INC

21305010 358569 38 AS (877) 565-8046 PO BOX 9074 DUBLIN OH BIG LOTS

21314005 358569 38 AS (216) 934-1033 PO BOX 900 ELYRIA OH THE COMMERCE GROUP

21314010 351113 89 AS (800) 223-9941 PO BOX 900 ELYRIA OH COMMERCE BENEFITS GROUP INC

21323005 358569 89 AS (800) 992-0678 101 EAST MAIN LOUISVILLE KY HUMANA HEALTH CARE PLAN INC

21323010 358569 89 AS (800) 992-0678 101 EAST MAIN LOUISVILLE KY HUMANA HEALTH CARE PLAN INC

21332005 358569 89 AS (800) 826-9400 540 NORTH LASALLE CHICAGO IL HMO AMERICA MI LTD

Page 77: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

21341005 358569 38 AS (999) 999-9999 PO BOX 3262 CHARLESTON WV CHARLESTON AREA MEDICAL CENTER

21350005 351113 38 AS (815) 720-2400 PO BOX 1300 ROCKFORD IL CONTINENTAL LIFE & ACCIDENT CO

21379005 351113 38 AS (999) 999-9999 PO BOX 727 MEMPHIS TN FEDERAL EXPRESS CORPORATION

21388005 358569 38 AS (999) 999-9999 P O BOX 1210 GRANTS PASS OR GREATER OR. HEALTH SERVICES

21397005 413395 38 AS (317) 875-0142 9101 WESTLEYAN RD INDIANAPOLIS IN HEALTH TECH DYNAMICS

21403005 351113 38 AS (999) 999-9999 B O BOX 588 NAPERVILLE IL HERIV WELFARE FUND

21412005 352530 38 AS (999) 999-9999 759 MARKET STREET AKRON OH INSURED PLANS INC

21421005 351113 38 AS (999) 999-9999 825 EAST 99TH STREET CHICAGO IL JAYS FOODS INC

21430005 358569 89 AS (800) 688-3290

2301

COMMONWEALTH

BLVD ANN ARBOR MI MCARE

21459005 358569 89 AS (800) 283-0505

105 E JEFFERSON

BLVD STE 512 SOUTH BEND IN HEALTHCARE RESOURCES GROUP

21459010 358569 38 AS (800) 283-0505

105 E JEFFERSON

BLVD STE 512 SOUTH BEND IN HEALTHCARE RESOURCES GROUP

21468005 358569 67 AS (999) 999-9999

8401 CORPORATE

DRIVE LANDOVER MD NATIONAL ASBESTOS WORKER MED

21477005 358569 38 AS (813) 626-6111 P O BOX 30324 TAMPA FL NATIONAL INSURANCE SERVICE INC

21486005 358569 88 DO (616) 698-2029

4511 BROADEMOOR

SE GRAND RAPIDS MI PATTERSON DENTAL CO

21495005 352530 38 AS (999) 999-9999 11903 U S 31 BEAR LAKE MI SAWYER FRUIT & VEGETABLE COOP

21501005 358569 89 AS (563) 583-7344 PO BOX 389 DUBUQUE IA SISCO INC

21510005 352530 38 AS (999) 999-9999 25631 LITTLE MACK ST CLAIR SHORE MI TECHNICAL INDUSTRIES INC

21539005 413395 38 R6 (615) 749-1555 P O BOX 307 LANGHORNE PA AMERICAN GENERAL LIFE & ACCID

21548005 413395 38 AS (800) 837-3711 PO BOX 145804 CINCINNATI OH UNITED MED RESOURCES-DEPT EPHT

21557005 358569 38 AS (999) 999-9999 4650 MOORE OKEMOS MI MI HARNESS HORSEMAN'S AS

21566005 351113 38 AS (999) 999-9999 PO BOX 8833 EMERYVILLE CA PACIFIC ADMINISTRATIVE SERVICE

21575005 351113 38 AS (999) 999-9999 111 SW COLUMBIA PORTLAND OR PACIFIC HERITAGE ASSURANCE CO

21584005 358569 67 AS (999) 999-9999 30700 TELEGRAPH RD BIRMINGHAM MI PACKINGHOUSE WKR & MEAT CUTTER

21593005 358569 31 AS (999) 999-9999 PO BOX 540 MATTESON IL PRUDENTIAL INSURANCE COMPANY

21619005 352530 38 AS (999) 999-9999 PO BOX 177 LITCHFIELD MI SIMPSON MANUFACTURING DIVISION

21628005 413395 38 AS (248) 213-1099 1487 FARNSWORTH DETROIT MI THORNAPPLE VALLEY

21637005 351113 38 AS (999) 999-9999 11 GREENWAY PLAZA HOUSTON TX ADVANCED EMPLOYER CLAIM SERV

21646005 351113 38 AS (999) 999-9999 118 ST CLAIR AVE,N.E. CLEVELAND OH AMERICAN INTERNAT'L COMPANIES

21646010 351113 38 AS (800) 468-7077 PO BOX 25050 WILMINGTON DE AMERICAN INTERNATIONAL COMPANY

21655005 351113 38 AS (999) 999-9999 PO BOX 299 HUNTINGTON WV APPALACHIAN LIFE INSURANCE

Page 78: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

21664005 351113 05 AS (999) 999-9999 GPO BOX G 3628 SAN JUAN PR BS OF PR

21673005 413395 38 AS (999) 999-9999 PO BOX 2026 SCRANTON PA CATHOLIC AGENCY

21682005 358569 38 AS (614) 793-8000 PO BOX 16580 COLUMBUS OH FRANK GATES SERVICE CO

21691005 413395 38 AS (999) 999-9999 PO BOX 1705 FORT WAYNE IN INSURANCE & RISK MANAGEMENT

21708005 358569 38 AS (999) 999-9999

7500 GRAND DIVISION

AVE CLEVELAND OH METAL SOURCE SELF-FUND

21717005 358569 88 DO (313) 582-0150 5050 SCHAFER RD DEARBORN MI MIDWESTERN DENTAL CENTER

21726005 352530 38 AS (999) 999-9999 51 LOCUST AVENUE WEW CANAAN CT STIRLING AND WEISS INC

21735005 358569 38 AS (999) 999-9999 3711 RUPP DRIVE FORT WAYNE IN ADVANCED ADMINISTRATIVE SERVIC

21735010 358569 38 AS (888) 419-1094 PO BOX 30570 PHOENIX AZ ADVANCED BENEFIT SOLUTIONS

21744005 358569 38 AS (999) 999-9999 PO BOX 1776 TOLEDO OH BENEFIT CLAIMS ADMINISTRATORS

21753005 413395 17 X3 (800) 222-2733 P.O. BOX 1391 DAYTON OH UNITED MEDICAL RESOURCES

21762005 358569 38 AS (999) 999-9999 PO BOX 87 GALION OH CHRISTIAN EDUCATORS INS TRUST

21771005 351113 38 AS (219) 825-8425

423 NORTH MAIN

STREET MIDDLEBURY IN COACHMAN INDUSTRIES INC

21780005 352530 38 AS (999) 999-9999 18720 MACK AVE GROSSE POINT MI WM B FITZGERALD CO

21806005 351113 38 AS (503) 221-2045

111 SW COLUMBIA

STREET PORTLAND OR ETHIX PACIFIC

21806010 351113 89 NO (210) 690-9690 9901 1H 10 WEST SAN ANTONIO TX ETHIX SOUTHWEST

21815005 413395 38 AS (999) 999-9999 30 BOWMAN ST MANSFIELD OH FIRST BENEFITS INC

21824005 351113 38 AS (617) 837-6171 PO BOX 518 MARSHFIELD MA GROUP INS SERVICE CENTER INC

21833005 358569 38 AS (703) 255-9800

243 CHURCH STREET

WEST VIENNA VA INTERNATL UNDERWRITER BROKERS

21842005 358569 38 AS (999) 999-9999 MI STATE UNIVERSITY EAST LANSING MI MSU MAJOR MEDICAL

21851005 358569 67 AS (734) 241-6180 309 DETROIT AVENUE MONROE MI MONROE PLUMBERS & PIPEFITTERS

21860005 358569 89 AS (313) 489-6300 PO BOX 9082 FARMINGTON HILL MI MCAULEY HEALTH PLAN

21889005 358569 38 AS (800) 455-1938 PO BOX 10906 EVANSVILLE IN MERITAIN

21898005 358569 68 AS (999) 999-9999 1432 HAMILTON AVE CLEVELAND OH SELF FUNDED PLANS INC

21904005 358569 38 AS (999) 999-9999 25 NORTH ST SALEM MA SOMERS KITCHEN & ESSLER INS

21913005 352530 38 AS (999) 999-9999 BOX 2000 FAIRVIEW MI WE CARE HEALTH PLAN

21922005 358569 67 AS (999) 999-9999 5125 NORTH 16TH ST PHOENIX AZ AZ STATE CARPENTERS TRUST

21931005 358569 38 X2 (999) 999-9999 PO BOX 667 SCHOOLCRAFT MI ARCO INDUSTRIES CORP

21969005 358569 38 AS (999) 999-9999

9400 S DADELAND

BLVD MIAMI FL AV MED HEALTH PLAN

21978005 413395 89 AS (330) 666-0337 PO BOX 4241 AKRON OH BENEFIT SERVICES

21987005 358569 67 AS (999) 999-9999 2785 N SPEER BLVD DENVER CO BRICKMASONS HLTH & WELF TRUST

21996005 351113 38 AS (800) 807-0100 100 DELASALLE DRIVE ROMEOVILLE IL CHRISTIAN BROTHERS EMPLOYEE TR

21997005 352530 38 AS (815) 625-8595 PO BOX 674 STERLING IL CHRISTIAN CARE MEDI SHARE

Page 79: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

22008005 358569 38 AS (999) 999-9999 20 N WACKER DRIVE CHICAGO IL CM VERBIEST & ASSOC INC

22017005 358569 38 AS (999) 999-9999 29 SUPERIOR ST HILLSDALE MI CONTOUR PLASTICS COMPANY

22026005 358569 38 AS (999) 999-9999 247 HANNA BLDG CLEVELAND OH CORPORATE BENEFITS ADMIN & CON

22035005 358569 38 AS (999) 999-9999 500 FIRST STREET NW WASHINGTON DC DEPT OF HUMAN SERVICES

22044005 351113 38 AS (999) 999-9999 5801 CLAY AVE SW GRAND RAPIDS MI GILL & WILLIAMS TOOLING INC

22053005 413395 89 AS (999) 999-9999 67 W MICHIGAN MALL BATTLE CREEK MI HMO WEST

22062005 351113 38 AS (999) 999-9999

3550 INDEPENDENCE

DR BIRMINGHAM AL KEY ROYAL AUTOMOTIVE CO

22071005 351113 38 AS (804) 369-5641 PO BOX 2147 HICKORY NC LANE HEALTH CARE PLAN

22080005 351113 38 AS (999) 999-9999 PO BOX 119 NAUGATUCK WV MARROWBONE DEVELOPMENT CO

22106005 413395 38 AS (800) 624-8605 PO BOX 3262 CHARLESTON WV WELLS FARGO

22106010 413395 89 AS (888) 440-7342 PO BOX 3262 CHARLESTON WV WELLS FARGO

22115005 352530 38 AS (800) 624-0698 2624 N 5TH STREET NILES MI NEW WORLD CLAIMS SERVICES

22124005 358569 38 AS (415) 387-2110 PO BOX 42576 SAN FRANCISCO CA NEW SYSTEMS INC

22133005 358569 72 AS (512) 423-5210 PO BOX 2647 HARLINGEN TX PLUMBER & PIPEFITTER LOCAL 823

22142005 352530 38 AS (419) 446-2711 502 MIDDLE ST ARCHBOLD OH SAUDER WOODWORKING COMPANY

22160005 358569 38 AS (800) 848-2664 2461 MCGAW ROAD COLUMBUS OH SILENT WATCHMEN BENEF PLAN

22189005 358569 33 AS (999) 999-9999 3315 EASTERN AVE SE GRAND RAPIDS MI TEAMSTERS LOCAL UNION 406

22198005 358569 38 AS (999) 999-9999 1701 E BROADWAY ST TOLEDO OH TOTAL BUSINESS SYSTEM

22204005 413395 67 AS (616) 772-9153 PO BOX 65 ZEELAND MI UNITED CONSTRUCTION WKR INS

22213005 351113 38 AS (999) 999-9999 300 E MAIN ST OWOSSO MI UNIVERSAL ELECTRIC CO

22222005 358569 38 AS (999) 999-9999 50 5TH STREET SIOUX CITY IA BUD LEWIS & ASSOC

22222222 359196 91 ND (999) 999-9999 N/A N/A MI MEDICARE-ELIGIBLE,NOT ENROLLED IN MEDICARE D

22231005 351113 38 AS (999) 999-9999 PO BOX 22777 TEMPE AZ JAMES BENEFIT

22240005 352530 38 AS (312) 921-1230 PO BOX 59350 SCHAUMBURG IL SYNCOR ADMIN SERVICES INC

22269005 552530 67 AS (999) 999-9999

22521 GRAND RIVER

AVE DETROIT MI UNITED BRTHHOOD CARPENTERS & J

22278005 351113 38 AS (999) 999-9999 G-3200 BECHER FLINT MI ACTRON STEEL CORPORATION

22287005 413395 38 AS (999) 999-9999 PO BOX 5002 LAKE FOREST CA AMERICAN CONSUMERS ASSOCIATION

22296005 413395 38 AS (999) 999-9999 80 LEXINGTON AVE NEW YORK NY ASSOC HOSP SERVICE OF NY

22302005 358569 38 AS (800) 999-6282

ONE CENTRAL PARK

PLAZA OMAHA NE CONAGRA INC

22311005 352530 38 AS (999) 999-9999 2627 LINWOOD AVE SHREVEPORT LA COURTESY CHEVROLET INC

22320005 351113 38 AS (999) 999-9999 PO BOX 3850 NEW YORK NY EMPIRE BC BS OF NY

22349005 358569 38 AS (630) 653-5300 PO BOX 969 WHEATON IL THE EVANGELICAL ALLIANCE MISSION

22367005 358569 38 AS (999) 999-9999 PO BOX 899 CLEARWATER FL GULF AMERICAN HEALTH

Page 80: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

22376005 352530 38 AS (999) 999-9999

8300 DUNWOODY

PLACE ATLANTA GA LLC WELFARE BENEFIT PLAN

22385005 351113 38 AS (999) 999-9999 905 16TH ST, NW WASHINGTON DC LABORER'S INTERNAT'L UNION

22394005 413395 33 AS (312) 577-8828 2160 FOSTER AVENUE WHEELING IL IN CONFERENCE OF TEAMSTER

22400005 358569 38 AS (503) 220-6134

400 SW 6TH ST 4TH

FLOOR PORTLAND OR OR LIFE & HEALTH

22429005 358569 38 AS (216) 929-2992 PO BOX 5560 AKRON OH OSTROV CORP

22438005 351113 38 AS (999) 999-9999 153 COMMERCIAL ST PAW PAW MI PRODUCTION RUBBER PRODUCTS

22456005 358569 38 AS (999) 999-9999 PO BOX 32344 KANSAS CITY MO VFW HOSP BENEFIT PLAN

22465005 352530 38 AS (999) 999-9999 XX XXX XXX XXXX MI ANNUITY COMPANIES

22474005 351113 38 AS (999) 999-9999 110 KNAPP DRIVE BATTLE CREEK MI BILL KNAPPS

22483005 351113 38 AS (999) 999-9999 PO BOX 3040 NORTHBROOK IL DART & KRAFT INC

22492005 358569 38 AS (999) 999-9999 26205 FIVE MILE RD REDFORD MI GOVERNMENTAL HEALTH MANAGERS

22518005 358569 89 AS (999) 999-9999 27777 FRANKLIN RD SOUTHFIELD MI HMO AMERICA MI LTD

22527005 351113 38 AS (999) 999-9999 PO BOX 1399 ROCK ISLAND IL JAYDON INC

22536005 352530 38 X2 (314) 621-0040 PO BOX 9007 ST LOUIS MO KIRKE VAN ORSDEL

22536010 351113 38 AS (800) 626-9074 PO BOX 10439 DES MOINES IA MARSH AFFINITY GROUP SERVICES

22545005 358569 61 AS (999) 999-9999 848 W CHICAGO RD QUINCY MI CROTTY CORPORATION

22554005 352530 34 AS (999) 999-9999

9797 SPRINGBORO

PIKE DAYTON OH UNITED HEALTHCARE INS CO

22563005 413395 38 AS (999) 999-9999 PO BOX 1386 EAST LANSING MI MI MEDICAL NETWORK

22572005 413395 38 AS (800) 229-6164

501 BOYLSTON

STREET BOSTON MA NEW ENGLAND GEN LIFE INSUR

22581005 358569 38 AS (407) 547-2400

1000 EAST FIRST

STREET SANFORD FL NEW TRIBES MISSION

22590005 358569 01 AS (517) 456-4144 PO BOX 620 CLINTON MI PEERLESS GEAR

22590010 352530 38 AS (901) 757-3600 PO BOX 760 PARAGOULD AR PEERLESS CORPORATION

22607005 358569 89 AS (800) 822-3122 PO BOX 7036 TROY MI SELECT CARE PPO

22607010 358569 89 NO (800) 822-3122 2401 BIG BEAVER TROY MI SELECT CARE NETWORK

22616005 358569 38 AS (999) 999-9999 30700 TELEGRAPH RD BIRMINGHAM MI TAS HEALTH BENEFIT PLAN

22625005 358569 20 XR (801) 972-1177 PO BOX 30749 SALT LAKE CITY UT GROUP BENEFIT ADMINISTRATORS

22625010 358569 38 AS (800) 872-8409 527 S ROSE STREET KALAMAZOO MI GROUP BENEFIT ADMINISTRATORS

22634005 358569 38 AS (999) 999-9999 PO BOX 9130 VAN NUYS CA US ADMINISTRATORS INC

22643005 351113 38 AS (999) 999-9999 PO BOX 928 FINDLEY OH MATHER CO BENEFIT PLAN

22652005 351113 38 AS (800) 321-0935 PO BOX 1884 AKRON OH CHESTERFIELD RESOURCES INC

22661005 351113 67 AS (517) 321-7502

6525 CENTURION

DRIVE LANSING MI ASBESTOS WORKERS LOCAL 47

Page 81: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

22670005 413395 38 AS (999) 999-9999

341 PONCE DELEON

AVE NE ATLANTA GA BD OF ANNUITIES & RELIEF INS

22699005 352530 38 AS (999) 999-9999 603 W SEVENTH ST CADILLAC MI CADILLAC RUBBER INC

22705005 358569 38 AS (314) 878-4334 1861 CRAIG ROAD ST LOUIS MO COMMONWEALTH LIFE

22714005 358569 38 AS (906) 864-3100 1821 13TH ST MENOMINEE MI EMERSON ELECTRIC CO

22723005 351113 84 HO (800) 543-7497 PO BOX 10367 DES MOINES IA CIGNA HEALTHCARE

22732005 413395 38 AS (999) 999-9999 PO BOX 156 AUBURN NY EXECUPLAN OF CENTRAL NY INC

22741005 352530 38 AS (999) 999-9999 PO BOX 66100 CHICAGO IL EXOIN

22750005 358569 38 AS (999) 999-9999 811 N WASHINGTON LANSING MI NORTHWESTERN NATIONAL INS CO

22779005 358569 38 AS (999) 999-9999

2650 THOUSAND

OAKES BLVD MEMPHIS TN PARTNERS NATIONAL HEALTH PLANS

22788005 358113 89 AS (612) 992-3200 5601 SMETANA DRIVE MINNETONKA MN PHP OF MN

22797005 413395 38 AS (999) 999-9999 PO BOX 9302 MADISON WI PREFERRED ADMINISTRATIVE SERV

22803005 352530 38 AS (999) 999-9999 41211 VICENTI COURT NOVI MI SPEARHEAD AUTOMATED SYSTEMS

22812005 358569 38 AS (601) 982-7304 PO BOX 16707 JACKSON MS MHA DIVERSIFIED

22821005 358569 38 AS (999) 999-9999 PO BOX 1384 MANSFIELD OH INTERNATIONAL BROTHERHOOD ELEC

22830005 358569 38 AS (612) 375-9055

1221 NICOLLET MALL

#221 MINNEAPOLIS MN CLAIMS INCORPORATED

22859005 351113 38 AS (999) 999-9999 PO BOX 2274 LOS ANGELES CA BAKER INTERNATIONAL

22868005 358569 38 AS (419) 473-7373 PO BOX 385 TOLEDO OH MED CHOICE

22868010 351113 89 NO (800) 824-7406 PO BOX 25307 WINSTON SALEM NC MEDCOST

22877005 351113 38 AS (615) 377-1300 PO BOX 1188 BRENTWOOD TN CONTINENTAL LIFE INSURANCE CO

22886005 351113 01 AS (616) 651-0211 309 N PROSPECT ST STURGIS MI KIRSCH COMPANY

22895005 351113 38 AS (999) 999-9999

E31 CENTRAL AVE STE

L-1 SPOKANE WA MT RETAIL STORE EMPLOYEES

22901005 352530 38 AS (999) 999-9999 PO BOX 1245 SOUTHFIELD MI IHP FINANCIAL INC

22910005 351113 38 AS (999) 999-9999 PO BOX 100 WALLED LAKE MI AMERICAN PLASTIC TOYS INC

22939005 358569 38 AS (616) 471-7771 NORTH U S 31 BERRIEN SPRINGS MI ANDREWS UNIVERSITY

22939010 358569 38 AS (999) 999-9999

2701 TROY CENTER

DRIVE TROY MI ANGEL HEALTH CARE INC

22948005 358569 38 AS (312) 246-4900 PO BOX 305148 NASHVILLE TN NY LIFE

22957005 358569 67 AS (999) 999-9999 5125 N SIXTEENTH ST PHOENIX AZ AZ STATE CARPENTERS H & W

22966005 352530 34 AS (800) 357-1293 330 E KILBOURN AVE MILWAUKEE WI UNITED HEALTHCARE INS CO

22975005 358569 89 NO (800) 942-0954 PO BOX 232Y LANE GRAND RAPIDS MI PRIORITY HEALTH PPO NETWORK

22984005 358569 38 AS (616) 774-0455 G6046 CORUNNA RD FLINT MI EAST MI CONF OF FREE METHODIST

22993005 351113 38 X3 (800) 432-2686

3751 MAGUIRE BLVD-

STE100 ORLANDO FL PROFESS ADMINISTRATORS INC

Page 82: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

23005005 358569 38 AS (999) 999-9999 PO BOX 1950 ALTAMONTE SPRIN FL FL HOTEL/MOTEL HLTH BNFT

23014005 352530 38 AS (888) 284-4464

13100 WAYZATA

BOULEVARD MINNETONKA MN DCA HEALTHCARE MANAGEMENT GROU

23023005 358569 38 AS (313) 987-4000 1925 LAPEER AVENUE PORT HURON MI MUELLER BRASS COMPANY

23032005 358569 38 AS (218) 728-1010 2002 LONDON RD DULUTH MN MN TIMBER PRODUCERS ASSOCIATIO

23050005 413395 38 AS (999) 999-9999

1300 EAST EMPIRE

AVENUE BENTON HARBOR MI AVION COACH

23079005 352530 38 AS (999) 999-9999

10000 MIDLANTIC DR

#403W MT LAUREL NJ CONFED ADMINISTRATIVE SERVICES

23088005 352530 38 AS (999) 999-9999 700 TERRACE ST MUSKEGON MI TELEDYNE CONTINENTAL MOTORS

23097005 358569 38 X3 (999) 999-9999 PO BOX 189 COLUMBUS OH RESOURCE PARTNERS

23103005 358569 38 AS (605) 336-2457 PO BOX 769 SIOUX FALLS SD EMPLOYEE SERVICES INC

23112005 352530 38 AS (800) 272-8451 PO BOX 44036 BATON ROUGE LA STATE OF LA EMPLOYEES BEN GRP

23121005 352530 38 AS (999) 999-9999

825 NORTH CASS

AVENUE WESTMONT IL AFFILIATED PLAN SERVICE OF IL

23130005 351113 67 AS (313) 629-5801 PO BOX 530 FENTON MI CARPENTER ENTERPRISES LTD

23159005 358569 87 RX (602) 391-4357 PO BOX 52175 PHOENIX AZ MEDI MET PCS

23168005 351113 38 AS (999) 999-9999 700 SOUTH COUNCIL MUNCIE IN N G GILBERT CORPORATION

23177005 352530 38 AS (800) 839-1959 PO BOX 268849 OKLAHOMA CITY OK CHUBB LIFE AMERICA

23186005 413395 71 AS (513) 619-3000 PO BOX 145804 CINCINNATI OH UNITED MEDICAL RESOURCES INC

23186010 413395 89 AS (513) 619-3000 PO BOX 145804 CINCINNATI OH UNITED MEDICAL RESOURCES INC

23195005 351113 89 AS (800) 645-7300 PO BOX 5200 SCRANTON PA CT GENERAL LIFE

23201005 352530 38 AS (999) 999-9999 1110 WOODMERE TRAVERSE CITY MI UNITED TECHNOLOGIES

23210005 351113 07 AS (800) 245-1066

4 GATEWAY CENTER

STE 625 PITTSBURGH PA CT GENERAL LIFE

23239005 351113 30 PS (800) 926-2273 PO BOX 46270 EDEN PRARIE MN CIGNA BEHAVORIAL HEALTH CARE

23248005 358569 38 AS (800) 826-0940 411 LINCOLN STREET NEENAH WI NETWORK HEALTH PLAN

23257005 358569 38 AS (888) 285-6402 PO BOX 80884 INDIANAPOLIS IN NYHART COMPANY INC

23266005 358569 38 X2 (999) 999-9999 PO BOX 667 SCHOOLCRAFT MI ARCO INDUSTRIES CORP

23266010 358569 38 AS (800) 407-5406 PO BOX 8311 FORT WAYNE IN ASO NORTH AMERICA

23275005 352530 89 AS (313) 535-7100 26205 FIVE MILE RD REDFORD MI GROUP HEALTH MANAGERS INC

23284005 358569 38 AS (800) 323-1683

450 E REMINGTON

RDPRESSW SCHAUMBURG IL GROUP ADMINISTRATORS INC

23284010 358569 89 AS (800) 323-1683 450 REMINGTON RD SCHAUMBURG IL GROUP ADMINISTRATORS LTD

23293005 352530 38 AS (999) 999-9999 3800 CLASSEN RD OKLAHOMA CITY OK SECURITY GENERAL

23319005 358569 38 AS (404) 951-6000 1755 THE EXCHANGE ATLANTA GA MOHASCO CARPET DIVISION

Page 83: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

23328005 358569 89 AS (999) 999-9999

7775 BAYMEADOWS

WAY JACKSONVILLE FL HMO OF FL

23328010 358569 89 AS (999) 999-9999 2170 STATE RD 434W LONGWOOD FL HMO OF FL

23328015 358569 89 AS (999) 999-9999

4350 WEST CYPRESS

STREET TAMPA FL HMO OF FL

23337005 352530 38 AS (999) 999-9999 PO BOX 7850 TOLEDO OH SENTLE TRUCKING HEALTH PLAN

23346005 352530 38 AS (999) 999-9999 PO BOX 40964 INDIANAPOLIS IN LIFE OF IN INSURANCE CO

23355005 351113 38 AS (999) 999-9999 PO BOX 140500 DALLAS TX STATES GENERAL LIFE INSURANCE

23364005 358569 89 AS (800) 942-4765

PO BOX 232, 1231 E

BELTLINE NE GRAND RAPIDS MI PRIORITY HEALTH

23364010 358569 88 DO (800) 446-5674

PO BOX 232, 1231 E

BELTLINE NE GRAND RAPIDS MI PRIORITY HEALTH - SELF FUNDED

23364015 358569 89 AS (800) 956-1954 PO BOX 232 GRAND RAPIDS MI PRIORITY HEALTH - SELF FUNDED

23364020 358569 86 VO (800) 956-1954

PO BOX 232 1231 E

BELTLINE NE GRAND RAPIDS MI PRIORITY HEALTH

23373005 358569 38 AS (999) 999-9999 3811 GILBERT AVENUE SHREVEPORT LA FRINGE BENEFIT PLANS INC

23382005 358569 86 VO (888) 478-3722 PO BOX 1662 WAUKESHA WI PROVANTAGE VISION PLAN

23391005 351113 38 AS (999) 999-9999 3015 EAST CENTRAL WICHITA KS INSURANCE SERVICES INC

23408005 413395 49 XR (517) 784-0535

100 S JACKSON

STREET JACKSON MI JFP BENEFIT MANAGEMENT

23408010 413395 89 XR (517) 784-0535

100 S JACKSON

STREET JACKSON MI JFP BENEFIT MANAGEMENT

23417005 351113 38 AS (999) 999-9999

2700 OAK INDUSTRIAL

DRNE GRAND RAPIDS MI KNAPP & VOGT MANUFACTURING CO

23426005 358569 89 AS (231) 935-0500 PO BOX 1280 TRAVERSE CITY MI PRIORITY HEALTH HMO

23435005 413395 89 NO (800) 992-6837 PO BOX 9082 FARMINGTON HILL MI PREFERRED CHOICES PPO NETWORK

23444005 358569 38 AS (616) 249-9797 5300 STUART SE KENTWOOD MI BRICKLAYERS & ALLIED CRAFTSMEN

23453005 352530 38 AS (999) 999-9999 2200 LINDEN ZANESVILLE OH UNITED TECHNOLOGIES

23462005 358569 38 AS (999) 999-9999

5 PENN CENTER 21ST

FLOOR PHILADELPHIA PA COMMERCIAL LIFE INSURANCE

23471005 351113 38 AS (999) 999-9999

740 EAST LANCASTER

PIKE EXTON PA COMPREHENSIVE BENEFITS SERV CO

23480005 358569 38 AS (914) 791-5100 217 BROADWAY MONTICELLO NY MEDICAL BENEFIT ADMINISTRATORS

23506005 413395 38 AS (999) 999-9999

30555 SOUTHFIELD

ROAD SOUTHFIELD MI FITNESS MANAGEMENT CORPORATION

23515005 358569 38 AS (999) 999-9999 1963 BELL AVENUE DES MOINES IA FARMLAND MUTUAL INSURANCE CO

23524005 358569 87 RX (800) 824-0898 PO BOX 390873 BLOOMINGTON MN EXPRESS SCRIPTS/MEDICOST RX

23533005 351113 07 AS (800) 292-9902 PO BOX 64143 ST PAUL MN CT GENERAL LIFE

23542005 351113 38 AS (999) 999-9999 PO BOX 2068 CLIFTON NJ AMERICAN CYANAMID COMPANY

Page 84: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

23551005 358569 38 AS (800) 678-4005

1718 INDIAN WOOD

CIR STE E MAUMEE OH ASO NORTH AMERICAN GREAT LAKES

23560005 413395 38 R6 (717) 342-3294 PO BOX 249 OLYPHANT PA CATHOLIC GOLDEN AGE

23589005 358569 38 AS (999) 999-9999 PO BOX 390 MISHAWAKA IN EMPLOYEE BENEFICIARY ASSN TR

23598005 351113 38 AS (999) 999-9999 13530 INWOOD ROAD DALLAS TX NATIONAL FAMILY CARE LIFE INS

23604005 351113 38 AS (999) 999-9999 PO BOX 1755 MINNEAPOLIS MN CCEBT

23613005 358569 38 AS (999) 999-9999 PO BOX 181 DANVILLE IN PLAN ADMINISTRATORS

23622005 358569 38 AS (616) 467-9575 26400 LAHSER RD SOUTHFIELD MI FAIRVIEW MEDICAL CARE FACILITY

23631005 358569 38 AS (999) 999-9999

50000 WEST PONTIAC

TRAIL WIXOM MI KOREX COMPANY

23640005 358569 38 AS (414) 797-7383

11270 W PARK PL

#950 MILWAUKEE WI BENEFIT PLAN ADMINISTRATION WI

23669005 413395 38 AS (999) 999-9999 PO BOX 943 TOLEDO OH AMC

23678005 351113 38 AS (999) 999-9999

7413 WESTSHIRE

DRIVE LANSING MI HEALTH CARE ASSOC OF MI

23687005 358569 38 AS (999) 999-9999 PO BOX 1460 LITTLE ROCK AR AR DIVERSIFIED SERVICES

23696005 413395 38 AS (313) 827-3976

27777 FRANKLIN

ROAD SOUTHFIELD MI AMERICAN MOTORS INSURANCE PLAN

23702005 351113 38 AS (999) 999-9999 161 EAST MICHIGAN KALAMAZOO MI NORTHBROOK GROUP INSURANCE

23711005 358569 38 AS (999) 999-9999 475 RIVERSIDE DR NEW YORK NY MINISTERS & MISSIONARIES BENEF

23720005 358569 38 AS (999) 999-9999 ONE STANTON STREET MARINETTE WI ANSUL FIRE PROTECTION

23749005 358569 38 AS (800) 323-0131 203 JANDUS RD CARY IL MEMBER INSURANCE

23758005 358569 38 AS (717) 969-4020

76 NORTH

BROADWAY IRVINGTON NY NCSC INSURANCE PLAN

23767005 413395 38 R6 (800) 878-7766 P O BOX 2720 FARMINGTON HILL MI PREFERRED PROVIDERS OF MI

23776005 352530 38 AS (999) 999-9999 MERCHANDISE PLAZA CHICAGO IL QUAKER OATS COMPANY

23785005 351113 38 AS (419) 423-3823

215 STANFORD

PARKWAY FINDLAY OH ADMINISTRATIVE SERVICE CONSULT

23785010 351113 38 AS (440) 526-2730

3301 E ROYALTON

ROAD CLEVELAND OH ADMINISTRATIVE SERVICES CONSULTANTS

23794005 352530 38 AS (999) 999-9999

35 E CHESTNUT

STREET COLUMBUS OH COUNTRYMARK INC

23800005 358569 38 AS (999) 999-9999 PO BOX 3048 NAPERVILLE IL AMERICAN CHAMBER LIFE INS CO

23829005 358569 38 AS (708) 299-0010 53 W. SEEGERS ROAD ARLINGTON HGTS. IL ALLIED SERVICES DIVISION

23838005 358569 38 AS (999) 999-9999 111 E CHISHOLM ALPENA MI INSURANCE CENTER CORP - ALPENA

23847005 413395 38 AS (999) 999-9999

2270 LAKE AVE SUITE

130 FT WAYNE IN AUTOMATED GROUP ADMINISTRATION

23856005 358113 89 AS (999) 999-9999 PO BOX 30337 LANSING MI PHP

Page 85: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

23865005 358113 89 AS (800) 982-6257 PO BOX 2359 FORT WAYNE IN PHP MANAGEMENT SYSTEMS

23874005 351113 89 AS (800) 282-1016 P O BOX 425 WORTHINGTON OH HEALTH MAINTENANCE PLAN

23883005 352530 34 AS (999) 999-9999 PO BOX 52100 PHOENIX AZ TRAVELERS PLAN ADMINISTRATORS

23892005 352530 38 AS (999) 999-9999 2949 NORTH MAYFAIR MILWAUKEE WI WI EVANGELICAL LUTHERAN

23909005 351113 38 AS (999) 999-9999 531 NORTH CLIPPERT LANSING MI ASSOC BLDRS & CONTRACT

23918005 358569 38 AS (999) 999-9999 9650 TELEGRAPH RD TAYLOR MI INTERNATIONAL UNION UNITED TEC

23927005 358569 88 DO (999) 999-9999 143 BOSTWICK NE GRAND RAPIDS MI DENTAL REIMBURSEMENT PROGRAM

23927010 352530 88 DO (800) 999-9789

65 E WADSWORTH

PARK ROAD DRAPER UT DENTAL SELECT

23936005 358569 38 AS (999) 999-9999 STATE OF ILLINOIS SPRINGFIELD IL DENTA PLAN

23945005 351113 38 AS (517) 787-8121

300 SOUTH EAST

AVENUE JACKSON MI AEROQUIP HEALTH CARE PLAN

23954005 351113 39 AS (999) 999-9999 350 GLENBOROUGH HOUSTON TX ALTA ADMINISTRATORS

23963005 351113 38 AS (800) 323-8092

800 ROOSEVELT

SUITE 200 GLEN ELLYN IL AMERICAN SELFCARE CORPORATION

23972005 351113 38 AS (999) 999-9999

200 RENAISSANCE

CENTER DETROIT MI CLUB MAJOR MEDICAL

23981005 352530 38 AS (999) 999-9999

250 SOUTH WACKER

DRIVE CHICAGO IL CONFED ADMINISTRATIVE SERVICES

23990005 358569 38 AS (877) 304-0761 4789 RINGS ROAD DUBLIN OH EMPLOYEE BENEFIT MANAGEMENT CORP

24002005 351113 89 AS (800) 283-2556 PO BOX 15121 WORCESTER MA FALLON COMMUNITY HEALTH PLAN

24011005 352530 38 AS (999) 999-9999 PO BOX 1518 WINTER HAVEN FL HEALTH BENEFIT SERVICES INC

24020005 351113 38 AS (515) 232-8585 PO BOX 1966 AMES IA HEALTH INSURANCE ADM OF IA

24049005 351113 38 AS (999) 999-9999

4337 SOUTH OHIO

STREET MICHIGAN CITY IN GENERAL TEAMSTERS CHAUFFEURS

24058005 352530 38 AS (999) 999-9999

8300 DUNWOODY

PLACE ATLANTA GA LLC WELFARE BENEFIT PLAN

24067005 352530 38 AS (999) 999-9999 PO BOX 943 TOLEDO OH LOF GLASS

24076005 358569 38 AS (800) 255-6065 PO BOX 12170 OVERLAND PARK KS LAHOOD AND ASSOCIATES

24085005 352530 38 AS (999) 999-9999 PO BOX 551 BURBANK CA LOCKHEED-CA COMPANY

24094005 351113 89 AS (800) 321-0935 PO BOX 1884 AKRON OH CHESTERFIELD RESOURCES INC

24100005 352530 38 AS (517) 345-8219

631 NORTH FIRST

STREET WEST BRANCH MI TAYLOR DOOR

24129005 358569 38 AS (999) 999-9999

406 WEST 34TH

STREET KANSAS CITY MO VFW CLAIMS

24138005 352530 38 AS (999) 999-9999 5900 ROCHE DRIVE COLUMBUS OH US PATRIOT LIFE INSURANCE

24147005 352530 38 AS (800) 848-7589 PO BOX 2692 COLUMBUS OH WENMED SERVICE CENTER

24156005 358569 38 AS (201) 818-5000

ONE MACK CENTRE

DRIVE PARAMUS NJ WESTERN UNION TELEGRAPH COMPAN

Page 86: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

24165005 358569 38 AS (312) 693-5410

2720 S RIVER RD

STE232 DES PLAINES IL BMS ADMINISTRATIVE SERVICES

24174005 358569 38 AS (999) 999-9999

119 NORTH GRAND

TRAVERSE FLINT MI BENEFITS ADMINISTRATION

24183005 358569 38 AS (800) 832-8333 PO BOX 2062 NASHUA NH CONSOLIDATED GROUP INC

24192005 358569 38 AS (888) 322-2524 PO BOX 419 MARLBOROUGH CT DIVERSIFIED GROUP ADMINISTRATION

24209005 358569 38 AS (999) 999-9999 PO BOX 30086 TAMPA FL IDS PLAN SERVICES

24218005 352530 38 AS (999) 999-9999

20 WASHINGTON

AVENUE SO MINNEAPOLIS MN MRFY CORP GROUP HEALTH BENEFIT

24227005 413395 38 AS (800) 825-3540 PO BOX 42096 OKLAHOMA CITY OK MUTUAL ASSURANCE AGENCY INC

24236005 413395 38 X3 (800) 228-4912 PO BOX 42820 HOUSTON TX EQUAFAX HEALTH CORP

24245005 358569 67 X2 (517) 754-0611 PO BOX 1471 SAGINAW MI ROOFERS LOCAL #244

24245010 358569 67 AS (999) 999-9999

2075 W BIG BEAVER

RD TROY MI ROOFERS LOCAL 70 HEALTH

24245015 358569 67 AS (800) 905-0904 2800 CLINTON ST. WEST SENECA NY ROOFERS LOCAL 74 HEALTH & WELFARE FUND

24254005 358569 38 AS (999) 999-9999

12282 WOODBINE

AVE DETROIT MI STAHL MFG CO GRP HEALTH PLAN

24263005 358569 38 AS (216) 749-8257 PO BOX 6946 CLEVELAND OH AMERITRUST BENEFITS MANAGEMENT

24272005 358569 38 AS (800) 654-5321 505 WATERS BLDG GRAND RAPIDS MI ATLAS EMPLOYEE HEALTH BENEFIT

24272010 358569 89 AS (800) 966-0073 PO BOX 801234 DALLAS TX ATLAS ADMINISTRATORS INC

24281005 351113 38 AS (606) 344-4995 P O BOX 298 SOUTHFIELD MI FARM CARE GROUP INSURANCE

24290005 358569 38 AS (999) 999-9999

1010 WEST 2610

SOUTH SALT LAKE CITY UT JB'S INSURANCE TRUST

24307005 358569 38 AS (517) 866-2381 P O BOX 1000 WINN MI MORBARK INDUSTRIES INC

24316005 358569 64 AS (999) 999-9999

3218 EAST HIGHWAY

67 MESQUITE TX SOUTH CENTRAL UNITED FOOD

24316010 358569 89 AS (800) 842-1768 PO BOX 2347 YORK PA SOUTH CENTRAL PREFERRED

24325005 352530 38 AS (217) 429-5246

1900 EAST LAKE

SHORE DR DECATUR IL WABASH MEMORIAL HOSPITAL ASSOC

24334005 352530 38 AS (999) 999-9999

4151 NAPERVILLE

ROAD LISLE IL WATER QUALITY ASSOCIATION

24343005 352530 38 AS (999) 999-9999

10400 WEST NORTH

AVENUE MILWAUKEE WI MANAGEMENT EMPLOYEE GROUP ADM

24352005 351113 38 AS (614) 488-1666 707 CANTON RD NW CARROLLTON OH CARROLLTON GRAPHICS

24361005 351113 67 AS (999) 999-9999 1168 SUTTER STREET SAN FRANCISCO CA LABORERS HEALTH & WELFARE

24370005 358569 38 AS (800) 487-8322

2949 NORTH MAYFAIR

ROAD MILWAUKEE WI WELS VEBA GROUP HEALTH PLAN

24399005 352530 38 AS (999) 999-9999

400 W MARKET

STREET LOUISVILLE KY HILLHAVEN CORPORATION

24405005 413395 38 AS (999) 999-9999

650 EAST

SWEDESFORD WAYNE PA HEALTH CORPORATION OF AMERICA

Page 87: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

24405050 351113 38 AS (877) 286-3559 PO BOX 2584 HUDSON OH HEALTH DESIGN PLUS

24414005 352530 38 AS (619) 225-8401 4045 HANCOCK ST SAN DIEGO CA COMPUTER SCIENCES CORPORATION

24423005 352530 38 AS (999) 999-9999 1000 LOUISIANA HOUSTON TX WELLTECH INC

24432005 351113 38 AS (999) 999-9999 PO BOX 29045 PHOENIX AZ MODERN INCOME LIFE

24432010 351113 88 DO (800) 876-2270 PO BOX 4000 SOUTHFIELD MI MODERN BENEFITS CORPORATION

24432020 351113 38 AS (800) 876-2270 PO BOX 4000 SOUTHFIELD MI MODERN BENEFITS CORP

24441005 351113 67 AS (999) 999-9999 30700 TELEGRAPH BIRMINGHAM MI PATTERN & MODEL MAKERS ASSOC

24450005 351113 38 AS (999) 999-9999 PO BOX 538 LEWISTON ID AGRICULTURE INSURANCE ADMIN

24479005 358569 38 AS (999) 999-9999 PO BOX 11107 LEWISTON ID AMERICAN INSTITUTE OF MANAGEME

24488005 351113 38 AS (415) 768-1234 PO BOX 193965 SAN FRANCISCO CA BECHTEL POWER CORPORATION

24497005 358569 38 AS (999) 999-9999 65528 STATE ROAD 19 WAKARUSA IN HOLIDAY RAMBLER CORPORATION

24503005 351113 38 AS (999) 999-9999 201 E MAIN ST BARRINGTON IL CARE AMERICA

24512005 413395 38 AS (260) 489-6447 PO BOX 15568 FORT WAYNE IN AUTOMATED GROUP ADMINISTRATION

24521005 413395 55 AS (800) 558-4444 PO BOX 14610 LEXINGTON KY EMPLOYERS HEALTH INSURANCE

24530005 352530 38 AS (999) 999-9999 PO BOX 330 CANONSBURG PA SIMPLIFIED EMPLOYEE CLAIMS INC

24568005 352530 38 AS (405) 251-2055 PO BOX 6000 DUNCAN OK HALLIBURTON EMPLOYEES TRUST

24577005 352530 38 AS (800) 345-1335

208 OLD LANCASTER

ROAD DEVON PA FIDELITY SECURITY LIFE INS

24586005 413395 38 AS (999) 999-9999 1111 E EIGHT MILE RD FERNDALE MI BONNIE BAKERS INC

24595005 413395 38 AS (999) 999-9999

26900 W ELEVEN MILE

RD SOUTHFIELD MI PREFERRED PROVIDER OPTION

24601005 358569 38 AS (402) 398-0881 1515 SOUTH 75TH ST OMAHA NE MEDICO GROUP

24610005 351113 89 NO (800) 683-6830 PO BOX 94808 CLEVELAND OH EMERALD HEALTH NETWORK INC

24639005 352530 38 AS (999) 999-9999 970 PARCHMENT SE GRAND RAPIDS MI COST CONTAINMENT SERVICES

24648005 358569 38 AS (999) 999-9999 777 THIRD STREET DES MOINES IA AIA INSURANCE ADMINISTRATORS

24657005 358569 38 AS (999) 999-9999 PO BOX 943 TOLEDO OH QUALCARE

24666005 351113 38 AS (999) 999-9999 1275 PECK ST MUSKEGON MI CSA ADMINISTRATORS

24675005 358569 38 AS (999) 999-9999 P O BOX 1403 FINDLAY OH HUDSON GROUP ADMINISTRATOR INC

24684005 352530 38 AS (999) 999-9999 1 BALA CYNWYD BALA CYNWYD PA PLANNED EMPLOYEE PROGRAMS

24693005 351113 38 AS (999) 999-9999 PO BOX 32064 SAN ANTONIO TX LAQUINTA MOTOR INNS INC

24719005 358569 38 AS (412) 937-7500 730 HOLIDAY DRIVE PITTSBURGH PA PEN WEL INC

24728005 351113 38 AS (800) 621-6360 PO BOX 909720 CHICAGO IL AVMA GROUP HEALTH & LIFE INSURANCE TRUST

24737005 413395 38 AS (800) 225-9369 8220 IRVING RD STERLING HTS MI AUTOMATED BENEFIT SERVICES

24737010 413395 89 AS (800) 225-9369 8220 IRVING RD STERLING HTS MI AUTOMATED BENEFIT SERVICES

24737015 413395 89 AS (800) 225-9369 8220 IRVING RD STERLING HTS MI AUTOMATED BENEFIT SERVICES

24746005 358569 38 AS (999) 999-9999

7333 N. OAK PARK

AVENUE NILES IL BROTHERHOOD RAILWAY AIRLINE &

24755005 351113 38 AS (999) 999-9999 PO BOX 1907 GREENVILLE SC DAVIS ELECTRICAL CONSTRUCTORS

24764005 358569 55 AS (999) 999-9999 PO BOX 438 GRAND BLANC MI EMPLOYEE BENEFITS INC

Page 88: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

24764010 358569 89 AS (810) 695-0005 PO BOX 347 GRAND BLANC MI EMPLOYEE BENEFITS

24773005 358569 38 AS (601) 981-6000 PO BOX 188 JACKSON MS FOX EVERETT INC

24782005 358569 38 AS (999) 999-9999

1422 W PEACHTREE ST

NE ATLANTA GA GA MEDICAL PLAN

24782105 358569 38 AS (912) 966-3805 PO BOX 2406 SAVANNAH GA GA PORTS AUTHORITY

24791005 358569 89 X2 (419) 245-5142 405 MADISON TOLEDO OH MEDICAL VALUE PLAN

24808005 351113 38 AS (800) 301-9128

7400 COLLEGE BLVD.,

SUITE 100 OVERLAND PARK KS NASCC CLAIMS

24817005 358569 72 AS (999) 999-9999

501 SHATTO PLACE

5TH FL LOS ANGELES CA RETIREMENT FUND TRUST PLUMBING

24826005 352530 38 AS (999) 999-9999 600 GRANT STREET PITTSBURGH PA US STEEL & CARNEGIE PENSION

24835005 413395 38 AS (800) 888-2567 P.O. BOX 959 SACRAMENTO CA AMERICAN GENERAL GROUP LIFE IN

24841005 352530 38 AS (999) 999-9999 PO BOX 800 AUSTIN MN GEORGE A HORMEL & COMPANY

24844005 413395 38 AS (999) 999-9999 1301 GULF LIFE DRIVE JACKSONVILLE FL AMERICAN GENERAL FL GROUP INS

24853005 413395 38 AS (800) 888-2567 P.O. BOX 660238 DALLAS TX AMERICAN GENERAL GROUP LIFE IN

24862005 413395 38 AS (999) 999-9999 P.O. BOX 1931 HOUSTON TX AMERICAN GENERAL LIFE INS CO

24871005 358569 38 AS (800) 552-6550 PO BOX 5769 LAFAYETTE IN BENEFIT ADMINISTRATORS

24880005 413395 38 AS (999) 999-9999 P.O. BOX 020816 MIAMI FL AVIALL MEDICAL PLAN

24906005 351113 05 AS (712) 277-3081 PO BOX 1677 SIOUX CITY IA BC BS OF W IA & SD

24915005 352530 38 AS (999) 999-9999

12000 SOUTH DOTY

AVENUE CHICAGO IL BULKAMATIC TRANSPORT COMPANY

24924005 358569 89 AS (800) 541-0985

PO BOX 232 1231 E

BELTLINE NE GRAND RAPIDS MI PRIORITY HEALTH (CARE CHOICES)

24933005 358569 38 AS (303) 277-2535 DEPT NH-220 GOLDEN CO COORS INSURANCE

24942005 358569 38 AS (999) 999-9999 414 EAST 40TH HOLLAND MI DONNELLY CORP HEALTH BENEFIT

24951005 358871 38 AS (999) 999-9999 P.O. BOX 460 KALKASKA MI EAGLE PICHER

24960005 358569 38 AS (999) 999-9999

100 S CHARLES ST

17TH FL BALTIMORE MD GROUP ADMINISTRATION SERVICES

24989005 351113 38 AS (999) 999-9999

PO BOX 70 402 N.

MAIN MIDDLEBURY IN HUMAN RESOURCES MANAGER

24998005 352530 67 AS (201) 893-0333 1460 BROAD STREET BLOOMFIELD NJ IUE AFL CIO HEALTH FUND

25019005 358569 38 AS (615) 256-3561 PO BOX 1984 NASHVILLE TN JW CARELL ADMINISTRATORS

25028005 413395 38 AS (800) 331-1096 1867 W MARKET ST AKRON OH KLAIS AND COMPANY INC

25028010 413395 89 AS (800) 331-1096

1867 W MARKET

STREET AKRON OH KLAIS AND COMPANY INC

25037005 358569 15 AS (800) 237-9624

105 E JEFFERSON

BLVD STE 512 SOUTH BEND IN PYRAMID BENEFIT SERVICES

25046005 352530 89 AS (800) 641-1906

450 REGENCY

PARKWAY OMAHA NE UNITED HEALTHCARE OF THE

25046010 352530 89 AS (402) 572-3500

302 SOUTH 36TH

STREET OMAHA NE SHARE HEALTH PLAN OF NE

Page 89: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

25055005 352530 38 AS (999) 999-9999 2025 NORTH WABASH KOKOMO IN SYNDICATE SALES EMPLOYEE MED

25064005 352530 89 AS (999) 999-9999 219 WEST FIFTH PUEBLO CO UPPER AR VALLEY HMO

25073005 358569 38 XR (800) 677-6965 PO BOX 1195 MINNEAPOLIS MN NORTHWEST NATIONAL LIFE

25082005 351113 30 AS (800) 817-2545 PO BOX 5019 VISALIA CA CIGNA HEALTHCARE

25091005 352530 89 AS (800) 552-7114 PO BOX 339 BREMERTON WA KITSAP PHYSICIANS SERVICE

25108005 358569 38 AS (999) 999-9999 PO BOX 74218 CHICAGO IL MA INS CONSULTANTS & ADMIN

25117005 358569 38 AS (999) 999-9999 6640 PARKDALE PLACE INDIANAPOLIS IN METROHEALTH

25117010 352530 89 AS (999) 999-9999 PO BOX 945520 MAITLAND FL METRAHEALTH CARE PLAN OF TX

25126005 358569 38 AS (810) 763-1214 207 FLETCHER STREET ANN ARBOR MI UNIVERSITY HEALTH SERVICE

25135005 352530 38 AS (999) 999-9999 P.O. BOX 538 ALLENTOWN PA AIR PRODUCTS & CHEMICALS

25144005 352530 67 AS (999) 999-9999

3540-D N. 12TH

STREET BROOKFIELD WI AIW AFL CIO REG 9 H & W

25153005 352530 38 AS (999) 999-9999 P.O. BOX 5137 MERTON IL SELF ASSURANCE COMPANY

25162005 358569 88 DO (313) 353-7644 2000 TOWN CENTER SOUTHFIELD MI MIDA DENTAL PLANS

25180005 351113 38 AS (999) 999-9999 919 SHERIDAN ST NW WASHINGTON DC PLAN SERVICE CENTER

25215005 358569 67 AS (800) 231-4622

601 NORTH FAIRFAX

STREET ALEXANDREA VA SHEET METAL WKRS VA

25224005 351113 38 AS (999) 999-9999 P.O. BOX 17258 WINSTON-SALEM NC NORTHBROOK LIFE INSURANCE

25233005 352530 38 AS (999) 999-9999 1030 HIGGINS ROAD PARK RIDGE IL SIBS

25242005 358569 38 AS (999) 999-9999 PO BOX 6157 SAGINAW MI GAB BUSINESS SERVICES

25251005 358569 38 AS (999) 999-9999 69 RAWLS ROAD DES PLAINES IL AH ROBBINS INSURANCE COMPANY

25260005 358569 38 AS (999) 999-9999 P.O. BOX 7000 INDIANAPOLIS IN FIRSTMARK STANDARD LIFE INS CO

25289005 358569 38 AS (800) 552-0455 P.O. BOX 6946 CLEVELAND OH ABM

25304005 352530 38 AS (999) 999-9999 400 WABASH AVENUE AKRON OH AKRON GENERAL PERSONNEL DEPT

25313005 351113 38 AS (800) 344-8858 2600 SIXTH STREET CANTON OH AULTCARE

25322005 351113 38 AS (999) 999-9999 2600 SIXTH STREET CANTON OH AULTMAN HOSPITAL

25331005 351113 38 AS (999) 999-9999

11 SOUTH FORGE

STREET AKRON OH BABCOX PUBLICATIONS INC

25340005 358569 38 AS (999) 999-9999 24500 CHAGRIN BLVD. BEACHWOOD OH BENEFIT DEVELOPMENT CORP.

25369005 352530 38 AS (999) 999-9999 PO BOX 9159 AKRON OH CLAIMS ADMINISTRATION

25369010 352530 87 RX (999) 999-9999 PO BOX 4050 SCOTTSDALE AZ CLAIMS ADMINISTRATION

25378005 413395 38 AS (999) 999-9999

1041 MOGADORE

ROAD KENT OH COLONIAL MACHINE COMPANY

25387005 358569 38 AS (999) 999-9999 247 HANNA BUILDING CLEVELAND OH CORPORATE BENEFITS SYSTEMS

Page 90: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

25396005 352530 38 AS (999) 999-9999 29201 AURORA ROAD SOLON OH DEMAG CORPORATION

25402005 413395 38 AS (999) 999-9999

1031 SUPERVISOR

AVENUE CLEVELAND OH DIOCESE OF CLEVELAND HLTH BEN

25411005 351113 38 AS (800) 553-5240 PO BOX 18215 COLUMBUS OH E & E BENEFIT PLANS INC

25420005 351113 38 AS (999) 999-9999 P.O. BOX 6946 CLEVELAND OH EMERALD LIFE CO OF AMERICA

25449005 413395 38 AS (216) 348-8010

1120 CHESTER

AVENUE CLEVELAND OH EMPLOYER SPONSORED PLANS

25458005 352530 38 AS (999) 999-9999 55 PUBLIC AVENUE CLEVELAND OH FIRST UNION

25467005 351113 38 AS (999) 999-9999 1226 HURON ROAD CLEVELAND OH GCHA

25476005 352530 38 AS (999) 999-9999 210 BROADWAY, EAST CUYAHOGA FALLS OH GROUP PLANS INC

25485005 352530 38 AS (999) 999-9999 100 PUBLIC SQUARE CLEVELAND OH HIGBEE COMPANY

25494005 358569 38 AS (800) 521-2991

1370 W SIXTH ST

#202 CLEVELAND OH PROGRESSIVE ADMINISTRATORS

25500005 352530 38 AS (999) 999-9999 P.O. BOX 670 KENT OH SCHNELLER INC

25529005 351113 39 AS (999) 999-9999 PO BOX HOUSTON MO ALTA ADMINISTRATORS

25538005 351113 38 AS (999) 999-9999

4495 CORANWOOD

PARKWAY WARRENSVILLE OH EXCELLO SPECIALTY COMPANY

25547005 351113 67 AS (999) 999-9999

1564 EAST 23RD

STREET CLEVELAND OH IRONWORKERS LOCAL 17

25547010 351113 89 AS (800) 272-4248

2100 N MAYFAIR RD

SUITE 100 MILWAUKEE WI IRON WORKERS LOCAL 8 WELFARE FUND

25565005 359196 33 AS (999) 999-9999

2191 EAST 19TH

STREET CLEVELAND OH TEAMSTERS LOCAL 436

25574005 358569 67 AS (999) 999-9999 PO BOX 2047 KALAMAZOO MI TEAMSTERS UNION LOCAL 7

25583005 413395 38 AS (800) 968-6327

3809 LAKE

EASTBROOK BLVD. GRAND RAPIDS MI MI EMPLOYEES BENEFIT SER

25592005 351113 38 AS (313) 852-5700 275 REX BLVD AUBURN HILLS MI CARS & CONCEPTS

25609005 352530 38 AS (810) 641-0900 P.O. BOX 6500 TROY MI FINANCIAL GUARDIAN

25618005 358569 38 AS (877) 311-2150

#1 LEGGETT RD PO

BOX 757 CARTHAGE MO LEGGETT & PLATT INC

25627005 352530 34 AS (800) 241-9964

2400 LAKE PARK DR

S.E. SMYRNA GA UNITED HEALTHCARE INS CO

25636005 358569 67 AS (800) 666-9277 PO BOX 5119 LAFAYETTE IN SHEET METAL WKRS MID STATES

25645005 358569 38 AS (817) 390-1606 714 MAIN ST FT WORTH TX AMERICAN HLTH CARE ADVISORY AS

25654005 352530 38 AS (999) 999-9999 4626 SW 9TH STREET DES MOINES IA ASSOCIATION GROUP AGENCY

25663005 358569 38 AS (602) 250-3580 PO BOX 53970 PHOENIX AZ AZ PUBLIC SERVICE

25672005 352530 38 AS (999) 999-9999 PO BOX 55210 INDIANAPOLIS IN HEALTHWIN HOSPITAL EMP BENEFIT

25681005 358569 38 AS (999) 999-9999

2221 UNIVERSITY AVE

SE MINNEAPOLIS MN PRECARE

Page 91: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

25690005 351113 30 AS (999) 999-9999 PO BOX 1130 BLOOMFIELD NJ PROVIDENT LIFE & ACCIDENT

25707005 352530 38 AS (800) 777-4013 PO BOX 7830 BURBANK CA SCREEN ACTORS GUILD

25716005 352530 38 AS (999) 999-9999 100 ERIEVIEW PLAZA CLEVELAND OH TRANSAMERICA OCCIDENTAL LIFE

25725005 352530 38 AS (999) 999-9999 BOX 64271 ST PAUL MN WESTERN LIFE INSURANCE CO

25734005 358569 38 AS (999) 999-9999 28436 HIGHLAND RD ROMULUS MI TAYSTEE BAKING COMPANY

25743005 352530 38 AS (800) 351-8204

2801 N TAMIAMI

TRAIL SARASOTA FL BROKERAGE HOUSE INS AGENCY

25752005 358569 38 AS (800) 842-3216 PO BOX 80447 INDIANAPOLIS IN BENEFIT SYSTEMS

25752010 358569 89 AS (317) 573-2004 PO BOX 80447 INDIANAPOLIS IN BENEFIT SYSTEMS

25761005 358569 38 AS (999) 999-9999 PO BOX 337 BRISTOL IN ZIMMER HOMES OF IN INC

25770005 351113 38 AS (999) 999-9999

24225 W 9 MILE SUITE

100 SOUTHFIELD MI CITY OF STURGIS EMPLOYEES

25799005 358569 88 DO (800) 236-3713 PO BOX 828 STEVENS POINT WI DELTA DENTAL PLAN OF WI

25814005 358569 38 AS (800) 552-7575

600 MECHANICS

TOWER WORCHESTER MA EGIS CLAIM CENTER

25832005 358569 38 AS (999) 999-9999 P.O. BOX 5430 GREENVILLE SC GENERAL ADMINISTRATORS INC

25841005 352530 38 AS (999) 999-9999 P.O. BOX 800 AUSTIN MN GEORGE A HORMEL & COMPANY

25850005 351113 38 AS (313) 589-1250 PO BOX 71643 MADISON HEIGHTS MI GROUP INS FUND TRUSTEE (GIFT)

25879005 352530 38 AS (800) 634-2712 5363 44TH STREET S.E. GRAND RAPIDS MI HHS

25888005 358569 38 AS (312) 246-4900

5600 SOUTH WOLF

ROAD WESTERN SPRINGS IL INSURANCE BENEFIT ADMINISTRAT

25897005 352530 89 AS (800) 962-1345 PO BOX 1299 PITTSBURGH PA UNITED HEALTHCARE INS CO

25903005 352530 38 AS (999) 999-9999

2105 SOUTH EUCLID

AVE BAY CITY MI RWC INC HEALTH BENEFIT PLAN

25912005 352530 38 AS (800) 678-8161 PO BOX 5508 NEWTOWN CT TR PAUL INC

25921005 358569 38 AS (999) 999-9999 BOX 488 MANSFIELD MA AUGUT INC

25930005 358569 38 AS (800) 433-1170 PO BOX 7187 DUBLIN OH ACCELERATION LIFE

25959005 358871 38 AS (999) 999-9999 570 EAST 16TH STREET HOLLAND MI GENERAL ELECTRIC

25968005 358569 38 AS (999) 999-9999 P.O. BOX 68501 INDIANAPOLIS IN HERFF JONES INC L

25977005 358569 38 AS (999) 999-9999

137 NORTH OAK PARK

AVENU OAK PARK IL INDUSTRIAL CASUALTY INS

25986005 358569 38 AS (999) 999-9999 P.O. BOX 248 NEWTOWN PA JOHNSON ADMINISTRATORS

25995005 358569 38 AS (999) 999-9999

215 PARK AVENUE

SOUTH NEW YORK NY MASON TENDERS DISTRICT COUNCIL

26007005 358569 67 AS (999) 999-9999 PO BOX 27095 LANSING MI MI LUMBER & BUILDING MAT

26016005 358569 38 AS (999) 999-9999 PO BOX 9012 MENOMONEE FALLS WI MIDWESTERN BUSINESS INS TRUST

26025005 413395 38 AS (608) 256-6600 PO BOX 44160 MADISON WI NORTH AMERICAN INSURANCE CO

26034005 352530 38 AS (999) 999-9999 100 EAST 90TH DRIVE MERRILLVILLE IN PHYSICIANS CHOICE OF NW IN

Page 92: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

26034010 352530 89 NO (616) 957-1751

3033 ORCHARD VISTA

DRIVE SE GRAND RAPIDS MI PHYSICIANS CARE NETWORK

26043005 352530 38 AS (904) 487-1678 530 CARLTON BLDG. TALLAHASSEE FL STATE OF FL

26052005 352530 38 AS (214) 392-2930 PO BOX 802516 DALLAS TX TUCKER & CLARK INC

26061005 358569 38 AS (999) 999-9999

5400 NORTH HIGH

STREET COLUMBUS OH ACCELERATION OF OH

26070005 352530 68 AS (999) 999-9999 875 RIVERVIEW BENTON HARBOR MI ALL PHASE ELECTRIC

26099005 358569 38 AS (999) 999-9999 BOX 2522 FORT WORTH TX AMERICAN COLLEGE OF SURGEONS

26105005 352530 38 AS (999) 999-9999 P.O. BOX 4271 HOUSTON TX ENSERCH EMPLOYEE BENEFIT TRUST

26114005 351113 38 AS (606) 344-4995 PO BOX 17750 FORT MITCHELL KY FARM CARE CLAIM DEPARTMENT

26123005 352530 38 AS (999) 999-9999 130 S ALVARADO LOS ANGELES CA LOS ANGELES HOTEL RESTAURANT

26132005 358569 67 AS (517) 394-5225 5815 EXECUTIVE DR LANSING MI MI LUMBER & BUILDING MATERIALS

26141005 352530 38 AS (999) 999-9999

1976 CHOCOLATE

DRIVE COOKEVILLE TN RUSSELL STOVER CANDIES

26150005 358569 38 AS (999) 999-9999 P.O. BOX 809 TRAVERSE CITY MI HANNA & LAY CO

26169005 351113 38 AS (999) 999-9999 BOX 3583 SPRINGFIELD IL IL AUTO TRADE ASSOCIATIO

26179005 358569 38 AS (999) 999-9999 3500 DEPAUW BLVD. INDIANAPOLIS MN ADVANCED COMPUTING ADMINISTRA

26188005 351113 38 AS (999) 999-9999 2960 LUCERNE DR., SE GRAND RAPIDS MI AMERICAN EXECUTIVE

26197005 352530 38 AS (999) 999-9999 18511 171ST SPRING LAKE MI MERIDIAN EMPLOYEE HEALTH PLAN

26203005 351113 30 AS (999) 999-9999 230 W MONROE CHICAGO IL PROVIDENT LIFE & ACCIDENT

26212005 352530 34 AS (999) 999-9999 5455 CORPORATE DR TROY MI TRAVELERS PLAN ADMINISTRATORS

26221005 352530 64 AS (614) 237-7618 4150 E MAIN ST COLUMBUS OH UFCW UNIONS & EMPLOYERS

26221010 352530 64 AS (800) 456-0539 PO BOX 3440 FARMINGTON HILL MI UFCW LOCAL 539 & EMPLOYERS

26230005 352530 01 AS (999) 999-9999 29855 SCHOOLCRAFT LIVONIA MI UPS BENEFIT PLAN INS DEPT

26259005 351113 64 AS (305) 638-5000 621 TRAIL DRIVE NAPOLEON OH UNITED FOOD & COMMERCIAL WKRS

26259010 351113 89 AS (800) 241-3473

1800 PHOENIX BLVD

STE310 ATLANTA GA UNITED FOOD & COMMERCIAL WKRS

26268005 358569 38 AS (999) 999-9999 23212 MILL CREEK DR LAGUNA HILLS CA ADMINISTRAX INC

26277005 358569 89 AS (999) 999-9999 131 E COLUMBIA BATTLE CREEK MI BLUE CARE NETWORK BATTLE CREEK

26286005 358569 38 AS (999) 999-9999 4336 COOLIDGE RD ROYAL OAK MI HAWTHORNE METAL PRODUCTS

26295005 358569 04 AS (214) 980-1151 5720 L B J FREEWAY DALLAS TX BANKERS COMMERCIAL LIFE

26301005 358569 38 AS (999) 999-9999 207 FLETCHER STREET ANN ARBOR MI UNIVERSITY HEALTH SERVICE

26310005 351113 38 AS (999) 999-9999 PO BOX 979 VALLEY FORGE PA AG ADMINISTRATORS

26339005 358569 38 X3 (800) 348-2616 ST.MARY'S BOX 5000 NOTRE DAME IN HOLY CROSS EMPLOYEE HEALTH

Page 93: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

26348005 358569 38 AS (800) 342-4841 PO BOX 2039 GLEN ALLEN VA MARKEL RHULEN

26366005 351113 38 AS (800) 842-3210 PO BOX 791428 DALLAS TX ALPHA DATA SYSTEMS

26375005 358569 38 AS (205) 832-1850 7 CLAYTON STREET MONTGOMERY AL FIRST NATIONAL LIFE INS CO

26384005 358569 38 AS (517) 345-3850 4747 SOUTH M-76 WEST BRANCH MI FRANKLIN FORGE INSURANCE

26393005 352530 38 AS (999) 999-9999 P.O. BOX 21166 TAMPA FL PATRIOT HEALTH SERVICES

26393010 352530 38 AS (800) 290-8559 PO BOX 8236 PORTLAND MA PATIENT ADVOCATES

26419005 358569 38 AS (612) 588-2731

4000 OLSON

MEMORIAL HWY MINNEAPOLIS MN PAUL BURKE & ASSOCIATES INC

26428005 351113 57 X5 (866) 855-1212 PO BOX 3080 NEWARK OH STATE FARM INSURANCE

26428010 351113 89 X5 (866) 855-1212 PO BOX 2978 CLINTON IA STATE FARM INSURANCE

26428015 351113 38 AS (866) 855-1212 PO BOX 3080 NEWARK OH STATE FARM INSURANCE

26437005 352530 38 AS (999) 999-9999

157 S KALAMAZOO

MALL KALAMAZOO MI VAIL RUBBER WORKS INC

26446005 352530 38 AS (800) 831-4555 PO BOX 542 CORNING NY CORNING INCORPORATED HEALTH

26455005 358569 26 AS (800) 632-5764 PO BOX 1194 MINNEAPOLIS MN HRM

26455010 358569 26 AS (999) 999-9999 PO BOX 2061 LITTLE ROCK AR CBCA ADMINISTRATORS INC

26455015 358569 89 AS (952) 829-3500 PO BOX 9498 MINNEAPOLIS MN CBCA ADMINISTRATORS INC

26455020 358569 89 AS (800) 632-5764 PO BOX 4089 KALAMAZOO MI HRM CAREPASS USA

26464005 352530 34 AS (800) 345-8563

6160 SUMMIT DR STE

360 BROOKLYN CENTER MN UNITED HEALTHCARE INS CO

26464010 358113 89 X4 (866) 854-0013 4316 RICE LAKE ROAD DULUTH MN UHC/PHP SELF-FUNDED

26473005 351113 38 AS (616) 798-7240

4250 GRAND HAVEN

RD MUSKEGON MI ADMINISTRATION & CREATIVE SERV

26482005 358569 38 AS (313) 270-1149 PO BOX 33446 DETROIT MI BORMANS INC

26491005 358569 38 AS (999) 999-9999 RT 5 BOX 524 BLOOMSBERG PA COLUMBIA ACCIDENT

26508005 358113 38 AS (999) 999-9999 PO BOX 33158 DETROIT MI EATON CORP BENEFITS

26517005 351113 38 AS (517) 871-4550

4705 INDUSTRIAL

DRIVE MILLINGTON MI KAUMAGRAPH FLINT CORPORATION

26526005 351113 38 AS (800) 228-6472 PO BOX 9 4601 CLEVELAND OH MUTUAL HEALTH SERVICE COMPANY

26535005 352530 38 AS (800) 231-2918 PO BOX 659752 SAN ANTONIO TX UHC OF OHIO

26544005 352530 38 AS (999) 999-9999 PO BOX 6123 SALT LAKE CITY UT SMITH ADMINISTRATION

26553005 358569 38 AS (999) 999-9999 PO BOX 83301 LANCASTER PA SAI NEW ENGLAND

26562005 351113 64 AS (414) 476-2523 2001 N MAYFAIR RD MILWAUKEE WI UNITED FOOD & COMMERCIAL WRKS

26571005 352530 38 AS (999) 999-9999 5700 W SHAFFER RD. COLEMAN MI VERCON INC

26580005 358569 88 DO (614) 890-1117 PO BOX 29979 COLUMBUS OH DELTA DENTAL PLAN OF OH

26606005 358569 38 AS (800) 292-5386 PO BOX 690450 SAN ANTONIO TX BENEFIT PLANNERS

26615005 358569 38 AS (800) 635-4252 210 S WHITE ST LANCASTER SC KANAWHA HEALTHCARE SOLUTIONS INC

26624005 358569 38 AS (999) 999-9999

300 INTERSTATE N

PARKWAY ATLANTA GA FRINGE BENEFIT REVIEW

26633005 352530 38 AS (920) 457-4441 KOHLER AVE. KOHLER WI KOHLER CO INSURANCE

Page 94: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

26642005 413395 01 AS (999) 999-9999

1502 MAGNAVOX

WAY S 110 FORT WAYNE IN LAFARGE CORPORATION

26651005 358569 89 AS (313) 424-8900

3131 EXECUTIVE

PKWY 101 TOLEDO OH MAXICARE HEALTH AMERICA

26660005 358569 38 AS (800) 873-3039 PO BOX 3108 RANCHO CORDOVA CA MERVYN'S HEALTH PLAN TRUST

26689005 358569 38 AS (999) 999-9999

1717 DIXIE HWY. STE

700 FORT WRIGHT KY PACIFIC MUTUAL BENEFITS

26698005 352530 38 AS (999) 999-9999 P.O. BOX 489 ABERDEEN SD SUPER 8 MOTEL EMP BEN PLAN

26704005 352530 34 AS (800) 323-8520

1900 E GOLF RD STE

1105 SCHAUMBURG IL UNITED HEALTHCARE INS CO

26704010 352530 89 AS (888) 323-8520

1900 E GOLF RD SUITE

1105 SCHAUMBURG IL UNITED HEALTHCARE INS CO

26713005 358569 38 AS (407) 363-6600 PO BOX 10130 LAKE BUENA VIST FL DISNEY WORLD WIDE SERVICES INC

26722005 358569 38 AS (999) 999-9999 P.O. BOX 2469 HOUSTON TX WESTERN ATLAS INTER COBRA

26731005 352530 38 AS (999) 999-9999 PO BOX 1448 DALTON GA WORLD CARPETS INC

26740005 352530 38 AS (314) 434-6114 PO BOX 27380 ST LOUIS MO UNITED HEALTHCARE INS CO

26741010 352530 89 AS (999) 999-9999

15000 GRATIOT

AVENUE DETROIT MI SARATOGA MANAGEMENT INC

26769005 358569 72 AS (800) 925-2272 400 HIGHWAY 169 MINNEAPOLIS MN MERITAIN HEALTH (CBSA)

26769010 358569 89 AS (800) 925-2272 PO BOX 27267 MINNEAPOLIS MN CORPORATE BENEFIT SERVICES OF AMERICA

26778005 351113 38 AS (999) 999-9999 980 S ISABELLA ROAD MT PLEASANT MI DELFIELD COMPANY

26787005 358569 38 AS (509) 536-4700 PO BOX 3048 SPOKANE WA MEDICAL SERVICE CORPORATION

26796005 352530 38 AS (999) 999-9999 3310 LIVE OAK STREET DALLAS TX SOUTHWEST HEALTH PLAN

26802005 358569 67 AS (999) 999-9999 PO BOX 3080 LANCASTER PA SPARKOMATIC HEALTH & WELFARE

26802010 352530 89 NO (517) 364-8150

2900 HANNAH

BOULEVARD LANSING MI SPARROW PHYSICIANS HEALTH NETWORK

26811005 358569 38 AS (999) 999-9999 615 EAST 40TH STREET HOLLAND MI TEMPLE EASTEX INC

26820005 351113 38 AS (999) 999-9999

25145 COUNTRY CLUB

BLVD NORTH OLMSTED OH CLEVELAND BENEFIT PAYMENTS

26849005 358569 38 AS (999) 999-9999 PO BOX 7325 METAIRIE LA FUNDING BENEFITS ADMIN SERV

26858005 358569 38 AS (999) 999-9999 PO BOX 292209 DAYTON OH GRAND BENEFITS

26858010 358569 38 AS (616) 235-4487 PO BOX 230139 GRAND RAPIDS MI GRAND BENEFITS

26867005 352530 38 AS (999) 999-9999 PO BOX 368 GRAND ISLAND NY HEALTHCARE ADMINISTRATIVE SERV

26876005 358569 01 AS (219) 275-2711 0 BROOK IN JEFFERSON SMURFIT CORPORATION

26885005 358569 38 AS (999) 999-9999 1221 NICOLLET MALL MINNEAPOLIS MN MCINERNEY INC HEALTH CARE

26894005 358569 38 AS (999) 999-9999 PO BOX 660239 DALLAS TX NY LIFE

26900005 352530 38 AS (708) 719-4848 2607 W. 22ND OAKBROOK IL UNION LABOR LIFE INSURANCE CO

26929005 352530 38 AS (800) 423-9791 PO BOX 1196 BALTIMORE MD WILLSE & ASSOCIATES INC

Page 95: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

26938005 413395 89 AS (612) 379-1971

3001 UNIVERSITY AVE

SE MINNEAPOLIS MN MINNESOTA TEAMSTERS HEALTH AND WELFARE FUND

26938010 358569 67 AS (312) 829-6506

300 S ASHLAND

AVENUE CHICAGO IL BEVERAGE INDUSTRY LOCAL 733

26947005 413395 38 AS (800) 237-3459 PO BOX 61 BOISE ID BOISE CASCADE CORPORATION

26947010 413395 38 AS (973) 467-0444 PO BOX 727 SHORT HILLS NJ BOLLINGER INSURANCE INC

26956005 358113 38 AS (313) 238-8200 PO BOX 1500 SPRINGFIELD OH EMRO PROPANE

26956010 358113 38 AS (614) 785-1310 PO BOX 6200 SPRINGFIELD OH EMRO MARKETING BENEFITS DEPT

26965005 352530 38 AS (607) 257-0100 11 ASCOT PLACE ITHACA NY HINCHCLIFF INTERNATIONAL INC

26974005 358569 67 AS (248) 822-4156

24225 W NINE MILE

RD SOUTHFIELD MI IBEW LOCAL 17

26983005 351113 67 AS (999) 999-9999 254 LEO DAYTON OH IRONWORKERS COUNCIL OF S OH

26992005 351113 38 AS (999) 999-9999 PO BOX 2256 WICHITA KS KOCH INDUSTRIES

27004005 351113 38 AS (906) 542-7101

324 WOOSTER ROAD

NORTH BARBERTON OH LA PACIFIC CORP

27013005 358569 38 XR (800) 572-0778 PO BOX 3048 SPOKANE WA MEDICAL SERVICE CORP OF E WA

27022005 352530 46 AS (800) 527-2845 9151 GRAPEVINE HWY N RICHLAND HILL TX NATIONAL ASSOC FOR SELF EMP

27031005 352530 38 AS (999) 999-9999 PO BOX 420188 ATLANTA GA PIEDMONT ASSOCIATES

27040005 413395 45 X5 (800) 447-4701 PO BOX 10826 CLEARWATER FL PRINCIPAL LIFE INSURANCE CO

27069005 358871 38 AS (999) 999-9999 PO BOX 2720 FARMINGTON HILL MI AMERICAN MEDICAL SECURITY

27078005 352530 38 X5 (800) 873-3039 P O BOX 50011 SAN JOSE CA DELEWARE AMERICAN LIFE

27087005 413395 38 AS (517) 845-3061 1103 W PEARL CHESANING MI HEHR INTERNATIONAL

27096005 358569 38 AS (999) 999-9999

BB&T BLDG. SUITE

300 ASHEVILLE NC NATIONAL TELEPHONE COOPERATIVE

27102005 413395 11 AS (800) 423-1028 PO BOX 240 MONROE MI BENEFIT SOURCE

27102010 413395 89 AS (800) 423-1028 PO BOX 240 MONROE MI BENEFIT SOURCE

27103005 358569 38 AS (999) 999-9999 PO BOX 3048 SPOKANE WA MEDICAL SERVICE CORP

27111005 358569 38 AS (999) 999-9999 PO BOX 1089 GREER SC SPARTAN EXPRESS

27111010 351113 89 AS (734) 289-5428

3300 WOLVERINE

DRIVE MONROE MI SPARTAN STEEL

27120005 352530 38 AS (999) 999-9999 850 LADD ROAD WALLED LAKE MI TEXTRON

27149005 358569 31 AS (999) 999-9999 PO BOX 537 MATTESON IL PRUDENTIAL INSURANCE COMPANY

27158005 351113 38 AS (616) 392-3181 171 24TH ST HOLLAND MI BAKER FURNITURE

27167005 358569 01 AS (315) 477-7000

WOLF & SEVENTH

NORTH STS SYRACUSE NY COOPER INDUSTRIES INC

27176005 358569 38 AS (602) 230-0680 PO BOX 34799 PHOENIX AZ PACIFIC MUTUAL GROUP

27176010 358569 21 AS (999) 999-9999

8144 WALNUT HILL

LANE DALLAS TX EMPLOYEE BENEFITS OF AMERICA

27185005 358569 38 AS (999) 999-9999 1220 US HIGHWAY #1 NORTH PALM BEAC FL EUROPEAN INTERNATIONAL SERV

27194005 358569 38 AS (999) 999-9999 950 E PACES FERRY RD ATLANTA GA HEALTH FIRST

Page 96: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

27200005 358569 38 AS (999) 999-9999

1034 SOUTH

BRENTWOOD ST LOUIS MO HEALTH MANAGEMENT SYSTEM

27200010 352530 89 AS (800) 448-3585 PO BOX 2069 COTTONWOOD AZ HEALTH MANAGEMENT & ASSOCIATES

27229005 358569 67 AS (999) 999-9999 PO BOX 34203 SEATTLE WA NORTHWEST IRONWORKERS HEALTH

27238005 358569 33 AS (999) 999-9999

4920 HILLS & DELLS

NW CANTON OH OH CONFERENCE OF TEAMSTERS

27247005 413395 38 AS (315) 448-9011 PO BOX 6309 SYACUSE NY RMSCO INC

27256005 352530 38 X5 (708) 778-1900 211 E ILLINOIS ST WHEATON IL STUDENT PLANS

27265005 352530 34 AS (999) 999-9999

9085 E MINERAL

CIRCLE EAGLEWOOD CO TRAVELERS PLAN ADMINISTRATORS

27274005 358569 55 AS (999) 999-9999 STE BLDG 4 CORAOPOLIS PA EBP HEALTH PLANS

27274010 351113 89 AS (800) 368-4453 PO BOX 87 STEVENS POINT WI COMPCARE NORTHWEST

27283005 351113 38 AS (800) 545-8905 PO BOX 26580 AUSTIN TX CONTINENTAL GENERAL INS CO

27292005 352530 38 AS (999) 999-9999 650 WEST 20 ST HIALEAH FL COULTER ELECTRONICS

27309005 358871 38 AS (999) 999-9999 6917 COLLINS AVE. MIAMI BEACH FL DWG CORPORATION

27318005 358569 38 AS (999) 999-9999 2025 E BELTLINE GRANDS RAPIDS MI GAINEY INSURANCE SERVICES

27327005 413395 38 AS (999) 999-9999 PO BOX 26011 GREENSBORO NC JEFFERSON PILOT

27327010 413395 38 AS (999) 999-9999

3450 WILSHIRE

BOULEVARD LOS ANGELES CA JEFFERSON-PILOT CLAIMS DIVISIO

27327015 413395 88 DO (800) 842-3729 P O BOX 51487 ONTARIO CA JEFFERSON PILOT

27327020 413395 38 AS (800) 423-2765 PO BOX 2615, DEPT BE OMAHA NE JEFFERSON PILOT

27336005 358569 38 AS (713) 529-0045 2727 ALLEN PARKWAY HOUSTON TX LIFE OF AMERICA

27345005 358569 38 AS (999) 999-9999 302 STATE ST ZANESVILLE OH MATTINGLY FOODS INC

27354005 358569 38 AS (206) 236-2500 PO BOX 9004 MERCER ISLAND WA NETWORK MANAGEMENT INC

27363005 413395 38 AS (999) 999-9999 201 E ARMOUR BLVD KANSAS CITY MO PREFERRED PRESCRIPTION

27372005 352530 38 AS (999) 999-9999 PO BOX 800 ALVARADO TX TX CONF 7-DAY ADVENTISTS

27381005 352530 38 AS (800) 236-7734

7000 W GOOD HOPE

RD MILWAUKEE WI WRLA INSURANCE TRUST

27390005 358569 38 AS (616) 956-0002 6000 CLAY AVE SW GRAND RAPIDS MI GAINEY INSURANCE SERVICES

27407005 351113 38 AS (999) 999-9999 PO BOX 336 MONTEZUMA KS CHRISTIAN HOSPITALIZATION AID

27407010 351113 89 AS (800) 700-2651 PO BOX 35690 COLORADO SPRINGS CO CHRISTIAN MISSIONARY ALLIANCE

27416005 351113 38 AS (616) 726-4002 1806 BEIDLER MUSKEGON MI DILESCO CORP

27425005 351113 67 AS (999) 999-9999 1445 N LOOP WEST HOUSTON TX ELECTRICAL MEDICAL TRUST

27434005 358569 38 AS (313) 750-1655 2140 ELLSWORTH RD ANN ARBOR MI HI STAT MI MFG CO EMPL

27443005 351113 38 AS (999) 999-9999 PO BOX 418051 BRECKSVILLE OH INTERGY INC

27452005 352530 38 AS (999) 999-9999 PO BOX 156 COLFAX NC LCP GROUP HEALTH CARE

27461005 358569 38 AS (999) 999-9999 PO BOX 80269 LINCOLN NE LINCOLN EMPLOYEE HEALTHCARE

27470005 358569 38 AS (414) 771-5600 PO BOX 601 MILWAUKEE WI WI HEALTH FUND

27489005 352530 38 AS (999) 999-9999 PO BOX 55728 BIRMINGHAM AL RWDSU HEALTH & BENEFIT

Page 97: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

27498005 352530 38 AS (616) 651-9351

1111 N CENTERVILLE

RD STURGIS MI RAM PRODUCTS

27507005 352530 38 AS (999) 999-9999 619 COLLEGE NE GRAND RAPIDS MI REAMES CO MEDICAL REIMBURSEMEN

27516005 413395 89 AS (800) 397-3373 4633 LIUNA LANE DEFOREST WI WI LABORERS HEALTH

27525005 351113 05 AS (800) 535-8000 PO BOX 272530 CHICO CA BS OF CA

27534005 352530 38 AS (999) 999-9999 PO BOX 358 SANDUSKY OH LYNN HOLDREN EMPLOYEE BEN

27543005 358569 38 AS (999) 999-9999 PO BOX 2645 WACO TX AMERICAN INSURANCE CO OF TX

27552005 352530 38 AS (999) 999-9999

13601 PRESTON RD AT

LBJ DALLAS TX ASSOCIATIONS COMBINED TRUST

27561005 358569 38 AS (800) 837-4557 PO BOX 20945 COLUMBUS OH BOA EMPLOYEE BENEFIT

27579005 358569 38 AS (800) 733-1773 PO BOX 945005 MAITLAND FL CONSUMERS UNITED INSURANCE CO.

27588005 351113 38 AS (999) 999-9999

130 RYAN COURT

#201 SAN RAMON CA DESIGNED BEN OF CA

27606005 351113 38 AS (616) 273-8451 612 4TH STREET THREE RIVERS MI FONDA GROUP

27615005 358569 38 AS (999) 999-9999 PO BOX 55210 INDIANAPOLIS IN GATEWAY INC EMP MED BEN PLAN

27624005 351113 38 AS (999) 999-9999 2001 REXFORD RD CHARLOTTE NC GOLD BOND BUILDING PRODUCTS

27633005 358569 88 DO (586) 573-8118 29377 HOOVER RD WARREN MI GOLDEN DENTAL

27642005 351113 67 AS (301) 377-6010 6229 N CHARLES BALTIMORE MD IRONWORKERS FRINGE BEN LOC 16

27651005 358569 01 AS (999) 999-9999 201 N EDWARDS ST CASSOPOLIS MI JEFFERSON SMURFIT CORPORATION

27669005 352530 38 AS (999) 999-9999 PO BOX 55210 INDIANAPOLIS IN KRUZMAN EMPLOYEE BENEFICIARY

27678005 352530 89 AS (999) 999-9999 333 NORTH ALABAMA INDIANAPOLIS IN KEY HEALTH PLAN

27687005 358569 36 AS (999) 999-9999 1284 N TELEGRAPH MONROE MI LAZY BOY CHAIR CO

27696005 358569 89 AS (800) 325-7386 PO BOX 1289 MINNEAPOLIS MN MED CENTERS

27705005 351113 38 AS (999) 999-9999 100 ANILINE AVE. HOLLAND MI MURRAY INDUSTRIES INC

27714005 351113 67 AS (215) 923-5700 25 N 4TH ST PHILADELPHIA PA UIU HEALTH & WELFARE

27723005 358569 38 AS (999) 999-9999 PO BOX 5555 MADISON WI RURAL SECURITY LIFE INSURANCE

27732005 413395 38 AS (314) 878-1800 11975 WESTLINE DR ST LOUIS MO WORLDWIDE INSURANCE GROUP

27741005 358569 38 AS (612) 333-7651 PO BOX 59093 MINNEAPOLIS MN EVANGELICAL LUTHERN CHUR IN AM

27759005 413395 38 AS (516) 822-8700 35 BROADWAY CS 546 HICKSVILLE NY AMERICAN MEDICAL & LIFE

27768005 413395 38 AS (999) 999-9999 1221 NICOLLET MALL MINNEAPOLIS MN BENEFIT CORP

27768010 413395 38 AS (800) 685-6100

111 RYAN COURT

SUITE 300 PITTSBURGH PA BENEFIT COORDINATORS CORPORATION

27777005 352530 38 AS (999) 999-9999 PO BOX 1442 MINNEAPOLIS MN COUNTRY SEAT STORES

27786005 351113 38 AS (999) 999-9999 PO BOX 4051 SCHAUMBURG IL HARTMARX MEDICAL

27795005 352530 38 AS (999) 999-9999 333 NORTH ALABAMA INDIANAPOLIS IN KEY HEALTH PLAN

27795010 358113 38 AS (888) 882-5882

216 N GREEN BAY

ROAD THIENSVILLE WI KEY LINK GROUP

Page 98: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

27804005 358569 38 AS (999) 999-9999

1715 N WESTSHORE

BLVD. TAMPA FL HEALTH OPTION

27804010 358569 38 AS (999) 999-9999 417 1/2 COURT ST JOSEPH MI HEALTH OPTIONS

27813005 351113 38 AS (999) 999-9999 PO BOX 441280 INDIANAPOLIS IN IMASERV INC

27822005 352530 38 AS (616) 755-3741 2860 MCCRACKEN MUSKEGON MI KAYDON CORPORATION

27831005 413395 38 AS (999) 999-9999 539 SOUTH MAIN ST. FINDLAY OH MARATHON OIL CO

27849005 358569 38 AS (999) 999-9999 PO BOX 200 SOUTHFIELD MI MIDWEST CORP

27858005 352530 38 AS (999) 999-9999 810 S WAVERLY LANSING MI VALUE CITY

27867005 413395 89 AS (800) 779-7577

4633 LIUNA WAY STE

201 DEFOREST WI WI SHEET METAL WORKERS FUND

27876005 351113 38 AS (999) 999-9999 PO BOX 928 FINDLAY OH ADMINISTRATIVE SERVICE CONSULT

27885005 358569 38 AS (999) 999-9999 BOX 8787 BENTON HARBOR MI AUTO SPECIALTIES MANUFACTURING

27894005 351113 38 AS (999) 999-9999

11301 OLD

GEORGETOWN NORTH BETHESDA MD BACE HEALTH PLAN

27903005 351113 38 AS (800) 331-1096 1867 W MARKET ST AKRON OH BEKAERT CORP

27912005 358569 38 AS (999) 999-9999 0 VALLEY FORGE PA CREDIT UNION MEMBERS INS SERV

27921005 358569 38 AS (999) 999-9999 3702 RUFFIN RD SAN DIEGO CA GREATER SAN DIEGO HEALTH

27939005 351113 38 AS (999) 999-9999 15 DAN RD CANTON MA HILLS GROUP HEALTH PLAN

27948005 413395 76 AS (800) 848-3012

18401 MAPLE CREEK

DR STE 300 TINLEY PARK IL CORESOURCE

27957005 358569 38 X4 (517) 849-9911 1040 N 2ND ROCKFORD IL ATWOOD GROUP BENEFITS

27966005 358569 67 AS (414) 475-6411 633 S HAWLEY ROAD MILWAUKEE WI MILWAUKEE PAINTERS LOCAL 781

27984005 413395 38 AS (810) 967-1640 14650 W 8 MILE RD. OAK PARK MI PREFERRED PROGRAM ORGANIZATION

27993005 352530 38 AS (800) 336-8331 PO BOX 2610 DAVENPORT IA STOKELD HEALTH SERVICE

28002005 359196 38 AS (999) 999-9999 CALL BOX 1501 BRYN MAWR PA WCI EMPLOYEE BENEFIT

28011005 358569 38 AS (800) 873-2022

310 E 96TH ST SUITE

200 INDIANAPOLIS IN WARREN STEINBORN ASSOCIATES

28039005 358569 38 AS (800) 947-0319 PO BOX 1250 ROCKFORD IL WA NATIONAL INSURANCE

28048005 358569 31 AS (999) 999-9999 PO BOX 565 MATTESON IL PRUDENTIAL INSURANCE COMPANY

28057005 413395 89 AS (999) 999-9999 1100 W 22ND OAK BROOK IL ACCESS HMO

28065005 358569 38 AS (615) 859-0131

907 TWO WILW

PARKWAY GOODLETTSVILLE TN TN VALLEY OPERATING ENGINEERS HEALTH FUND

28066005 352530 67 AS (999) 999-9999 7045 N WESTERN CHICAGO IL CHICAGO PAINTERS & DECORATORS

28066010 352530 67 AS (773) 774-4500

6547 N AVONDALE -

SUITE 202 CHICAGO IL CHICAGO PLASTERING HEALTH & WELFARE TRUST

28075005 352530 38 AS (213) 598-6681 911 STUDEBAKER LONG BEACH CA DUAL PLUS INSURANCE ADMIN

28084005 351113 38 AS (999) 999-9999 PO BOX 6767 RICHMOND VA FOREIGN MISSION BOARD

28093005 413395 38 X3 (800) 228-4912 1302 N HIGHWAY 81 DUNCAN OK UNITED MEDICAL RESOURCES

28102005 413395 76 AS (800) 282-3920 PO BOX 279 SHELDON IA CORESOURCE

Page 99: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

28102010 413395 89 AS (800) 282-3920 PO BOX 279 SHELDON IA CORESOURCE

28111005 351113 38 AS (999) 999-9999 PO BOX 160126 IRVING TX LGS INSURANCE COMPANY

28129005 358569 38 AS (810) 851-0700 SUITE 300 FARMINGTON HILL MI MED VIEW

28138005 358569 38 AS (999) 999-9999 PO BOX 729 MESICK MI MESICK METAL

28147005 358569 38 AS (999) 999-9999 3033 CLEVELAND SANTA ROSE CA NORTHERN CA FOUNDATION

28156005 351113 38 AS (999) 999-9999

25 E WASHINGTON

#715 CHICAGO IL PRINTCO INC

28165005 352530 38 AS (999) 999-9999 855 RIDGE LAKE BLVD MEMPHIS TN TERMINIX INTERNATIONAL

28176005 352530 38 AS (999) 999-9999 904 INDUSTRIAL RD MARSHALL MI WALKER MANUFACTURING

28187005 358569 89 X5 (800) 541-0985 PO BOX 9082 FARMINGTON HILL MI CARE CHOICES GRAND RAPIDS

28196005 358569 89 X5 (800) 852-9780 PO BOX 9082 FARMINGTON HILL MI CARE CHOICES LANSING

28214005 359274 89 AS (800) 255-1690

611 CASCADE W

PARKWAY SE GRAND RAPIDS MI BCN

28214005 359274 89 PH (800) 255-1690

611 CASCADE W

PARKWAY SE GRAND RAPIDS MI BCN

28214005 359274 89 X5 (800) 255-1690

611 CASCADE W

PARKWAY SE GRAND RAPIDS MI BCN

28214010 359274 88 DO (800) 255-1690

611 CASCADE W

PARKWAY SE GRAND RAPIDS MI BCN

28214015 359274 86 VO (800) 255-1690

611 CASCADE W

PARKWAY SE GRAND RAPIDS MI BCN

28223005 358569 89 XR (999) 999-9999

333 LOUIS GLICK HWY

W JACKSON MI BLUE CARE NETWORK HC JACKSON

28232005 352530 38 AS (999) 999-9999 PO BOX 2976 MILWAUKEE WI CAPP CARE

28241005 351113 67 AS (800) 232-2527 PO BOX 3010 CONCORD CA CARPENTERS H & W TRUST FUND CA

28250005 351113 38 AS (216) 247-4315 35 RIVER ST CHAGRIN FALLS OH CHANDLER & ASSOCIATES

28269005 352530 89 AS (312) 424-4460 500 N DEARBORN CHICAGO IL UNITED HEALTHCARE OF IL

28269010 352530 89 AS (800) 526-2414 PO BOX 981502 EL PASO TX UNITED HEALTHCARE INS CO

28269015 352530 34 AS (800) 526-2414 PO BOX 659744 SAN ANTONIO TX UNITED HEALTHCARE INS CO

28269105 352530 89 AS (800) 239-3215 PO BOX 659737 SAN ANTONIO TX UNITED HEALTHCARE OF TN

28278005 413395 63 AS (810) 792-2423 PO BOX 3440 FARMINGTON HILL MI PRESIDIUM INC

28287005 352530 38 AS (999) 999-9999 PO BOX GG BOISE ID CONSULTANTS BROKERS & ACTUARIE

28296005 351113 38 AS (999) 999-9999 1100 OAKMAN BLVD. DETROIT MI CONTINENTAL BAKING COMPANY

28305005 358569 38 AS (999) 999-9999 1507 S OLIVE SOUTH BEND IN DIVERSIFIED SYS. TECHNOLOGIES

28314005 352530 38 AS (800) 950-6789 PO BOX 50440 INDIANAPOLIS IN EDWARD B MORRIS ASSOC INC

28314010 352530 89 AS (800) 950-6789 PO BOX 50440 INDIANAPOLIS IN MORRIS ASSOCIATES

28323005 358569 89 AS (800) 873-7780 PO BOX 1347 TROY MI IBEW LOCAL 17

28324005 358569 67 AS (517) 321-7502

6525 CENTURION

DRIVE LANSING MI IBEW 117

Page 100: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

28332005 351113 38 AS (999) 999-9999

1 WOODLAWN GREEN

STE 300 CHARLOTTE NC IMASCO USA INC

28341005 351113 38 AS (215) 635-4137 PO BOX 8857 ELKINS PARK PA LATVIAN RELIEF FUND

28350005 358569 38 AS (999) 999-9999 BOX 1111 N WILKESBORO NC LOWES COMPANIES INC

28383005 358569 86 VO (800) 875-6322 PO BOX 17190 INDIANAPOLIS IN MUTUAL EYE CLAIM AUDITS INC

28394005 351113 39 XR (800) 242-8276 PO BOX 30995 SALT LAKE CITY UT FIRST HEALTH

28405005 352530 38 AS (800) 320-8040

ONE WILLIAM CT BOX

2400 TULSA OK WILLIAMS COMPANIES INC

28416005 352530 38 AS (999) 999-9999 5340 S QUEBEC ENGLEWOOD CO SIC SIPCO

28427005 358569 55 AS (800) 443-1897

2777 N STEMMONS

FWY DALLAS TX EMPLOYEE BENEFIT PLANS INC

28438005 358569 89 AS (800) 877-1122 PO BOX 3018 MISSOULA MT ALLEGIANCE BENEFIT PLAN MANAGEMENT

28449005 358569 38 AS (313) 484-0460 124 PEARL YPSILANTI MI BOB TURNER AND ASSOCIATES

28450005 358569 67 XR (860) 643-6401

1155 SILASDEANE

HWY WEATHERSFIELD CT CT PIPE TRADES H FUND/LOC 777

28461005 352530 38 AS (800) 843-3106 PO BOX 39119 PHOENIX AZ INSURERS ADMINISTRATIVE CORP

28472005 352530 38 AS (717) 231-4870 1820 LINGLESTOWN HARRISBURG PA NCAS PA

28483005 413395 38 AS (999) 999-9999 PO BOX 11111 FORT SCOTT KS NEW ENGLAND MUTUAL

28494005 352530 38 AS (999) 999-9999 5601 E SLAUSON LOS ANGELES CA RB SHANNON INC

28505005 351113 38 AS (999) 999-9999 750 E 40TH HOLLAND MI TNT HOLLAND MOTOR EXP

28516005 352530 38 AS (999) 999-9999 33469 14 MILE FARMINGTON HILL MI TREITCO INC

28527005 352530 38 AS (812) 425-8716 PO BOX 16 EVANSVILLE IN VANTAGE EMPLOYEE MEDICAL BENEF

28527010 352530 89 AS (888) 621-9552

4602 TIMBER

COMMONS DRIVE SANDUSKY OH VANTAGE HEALTH PLAN

28538005 351113 38 AS (813) 885-4781 7030 ANDERSON TAMPA FL AERODYNE INVESTMENT & CASTINGS

28549005 358569 38 AS (999) 999-9999 PO BOX 730282 DALLAS TX AMERICAN AIRLINES

28550005 358871 14 AS (800) 232-5432 PO BOX 19032 GREEN BAY WI AMERICAN MEDICAL SECURITY TX EXT 11510

28550010 358871 89 AS (800) 232-5432 PO BOX 19032 GREEN BAY WI AMERICAN MEDICAL SECURITY

28561005 358569 38 AS (999) 999-9999 ONE CITY BLVD WEST ORANGE CA AUGUST FUND INC

28572005 352530 38 AS (614) 457-8760

2245 NORTH BANK

DRIVE COLUMBUS OH BERWANGER OVERMYER ASSOCIATES

28583005 358569 38 AS (818) 782-5400 6727 ODESSA AVE VAN NUYS CA CPP PINKERTON GROUP

28594005 351113 38 AS (708) 742-5100 1451 DUNDEE ELGIN IL CHURCH OF THE BRETHREN MED PLA

28605005 351113 38 AS (999) 999-9999 PO BOX 2000 HAMPTON NH COMP AIRE

28605010 351113 88 DO (800) 342-5209 PO BOX 769569 ROSWELL GA COMPDENT

28616005 358569 38 AS (800) 235-0123 PO BOX 1858 BISMARK ND CORPORATE HEALTH ADMINISTRATOR

28627005 351113 38 AS (999) 999-9999 100 W FRANKLIN RICHMOND VA HL DUKE & COMPANY

28638005 352530 38 AS (800) 253-1272

18501 MAPLE CREEK

DRIVE TINLEY PARK IL IL CENTRAL HOSPITAL ASSO

28649005 358569 89 AS (999) 999-9999

1010 N. FINANCE CTR

DR TUCSON AZ INTERGROUP OF AZ

Page 101: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

28650005 358569 38 AS (918) 560-3200

1400 S BOSTON- 7TH

FLR TULSA OK MEMBER SERVICE LIFE INSUR CO

28661005 358569 38 AS (999) 999-9999 734 15TH STREET NW WASHINGTON DC PLAN ADMINISTRATOR MAIT

28672005 358569 38 AS (999) 999-9999 PO BOX 6093 ROCKVILLE MD POSTAL SUPERVISORS HEALTH

28683005 352530 38 AS (999) 999-9999

9040 BURROUGH-

DOVER PENNSAUKEN NJ RMP

28705005 352530 38 AS (999) 999-9999 PO BOX 671207 HOUSTON TX SKYCHEFS MEDICAL REVIEW

28716005 358569 38 AS (615) 546-2529 912 GAY KNOXVILLE TN TN FIRST HEALTH PLAN

28727005 358569 38 AS (517) 849-9971 121 WATER ST JONESVILLE MI KLEIN TOOLS JONESVILLE PLANT

28738005 358569 87 RX (920) 436-6160 PO BOX 1662 WAUKESHA WI PROVANTAGE

28749005 413395 17 AS (800) 446-8182 PO BOX 720 PUEBLO CO UNITED MEDICAL RESOURCES

28749010 413395 89 AS (800) 222-2733 PO BOX 1391 DAYTON OH UNITED MEDICAL RESOURCES

28749015 413395 17 AS (999) 999-9999 PO BOX 765 PUEBLO CO HARRINGTON BENEFIT SERVICES

28749020 413395 17 AS (800) 946-4147 PO BOX 268902 OKLAHOMA CITY OK UNITED MEDICAL RESOURCES

28749025 413395 17 AS (800) 462-0189 PO BOX 730 PUEBLO CO UNITED MEDICAL RESOURCES

28749030 413395 89 AS (800) 462-0189 PO BOX 730 PUEBLO CO UMR

28749035 413395 88 DO (800) 446-8182 PO BOX 720 PUEBLO CO UNITED MEDICAL RESOURCES

28749040 413395 89 AS (800) 446-8182 PO BOX 720 PUEBLO CO UNITED MEDICAL RESOURCES

28750005 352530 67 AS (216) 867-5253 2858 W. MARKET AKRON OH ASSOCIATION PLAN ADMINISTRATOR

28761005 358569 38 AS (616) 956-0966

3040 CHARLEVOIX DR

SE GRAND RAPIDS MI CASCADE DIE CASTING GROUP

28772005 352530 38 AS (419) 485-3193 PO BOX 152 MONTPELIER OH CHASE BRASS & COPPER

28783005 351113 38 AS (999) 999-9999 PO BOX 1258 MINNEAPOLIS MN DODSON GROUP

28794005 351113 38 X3 (800) 236-8809 PO BOX 8924 MADISON WI EPIC LIFE INSURANCE

28805005 358569 38 AS (999) 999-9999 4027 E 9 MILE WARREN MI GOLD CROSS ASSOCIATED OF MI

28816005 351113 89 AS (999) 999-9999 233 N MICHIGAN CHICAGO IL HMO IL

28827005 358569 38 AS (800) 446-8182 PO BOX 30367 TAMPA FL HEALTHPLAN SERVICES

28838005 358569 38 AS (999) 999-9999 PO BOX 9615 DEERFIELD BCH FL HEALTH CLAIM SERVICES INC

28849005 352530 89 AS (800) 843-3106 PO BOX 39119 PHOENIX AZ INSURERS ADMINISTRATIVE CORP

28850005 352530 38 AS (999) 999-9999 9350 WALSH MONTAGUE MI INTERNATIONAL MASTER PRODUCTS

28861005 358113 38 AS (800) 871-2335 PO BOX 55210 INDIANAPOLIS IN KEY BENEFIT ADMINISTRATORS

28861010 358113 89 AS (317) 848-0529 PO BOX 55210 INDIANAPOLIS IN KEY BENEFIT ADMINISTRATORS

28872005 413395 38 AS (402) 479-8300 PO BOX 18497 OKLAHOMA CITY OK LIFESHARES SERVICES COMPANY

28893005 351113 38 AS (999) 999-9999 PO BOX 766 MUSKEGON MI LORIN INDUSTRIES

28904005 352530 38 AS (999) 999-9999 PO BOX 107 INDIANAPOLIS IN MAYFLOWER GROUP

28915005 351113 38 AS (999) 999-9999 PO BOX 111719 NASHVILLE TN MCALISTER MARKETING

28926005 358569 38 AS (999) 999-9999 475 RIVERSIDE NEW YORK NY MINISTERS & MISSIONAIRIES BEN

28937005 358569 67 AS (612) 835-7035 7645 METRO BLVD MINNEAPOLIS MN MN LABORERS H & W FUND

28959005 351113 87 RX (800) 467-2006

711 RICHDALE

AVENUE EAST HANOVER NJ NATIONAL PRESCRIPTION ADMIN

28960005 358569 38 AS (999) 999-9999 5507 S CEDAR LANSING MI NEW DAWN DISTRIBUTING

28971005 351113 38 AS (999) 999-9999 PO BOX 9478 MINNEAPOLIS MN NORTH CENTRAL GROUP OPERATIONS

Page 102: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

28982005 351113 38 AS (999) 999-9999 916 MYRTLE STURGIS MI STURGIS HOSPITAL

28993005 358569 38 AS (999) 999-9999 PO BOX 7152 DUBLIN OH SUPERIOR METAL PRODUCTS

29004005 352530 38 AS (999) 999-9999 8300 DUNWOODY ATLANTA GA SYBRA INC

29015005 352530 34 AS (999) 999-9999

5455 CORPORATE

DRIVE TROY MI TRAVELERS PLAN ADMIN OF MI

29026005 352530 38 AS (999) 999-9999 566 N STATE BRIARCLIFF NY TREE PRESERVATION CO

29037005 352530 38 AS (999) 999-9999

180 NORTH MICHIGAN

AVE CHICAGO IL WESTERN GENERAL SERVICES

29048005 352530 38 AS (999) 999-9999 PO BOX 22166 PORTLAND OR WESTERN GROCERS EMPLOYEES BEN

29059005 413395 38 AS (999) 999-9999 529 GREENWOOD SE E GRAND RAPIDS MI ADMINISTRATIVE RESEARCH SERV.

29060005 352530 67 AS (999) 999-9999 154 36TH SE GRAND RAPIDS MI BC & T LOCAL 70

29071005 358569 38 AS (606) 344-4995 PO BOX 17750 FORT MITCHELL KY BENEFIT ADMINISTRATORS KY

29082005 352530 38 AS (219) 271-4600 PO BOX 416 SOUTH BEND IN BURGER SERVICES INC

29093005 351113 88 DO (800) 321-8077 27000 WEST 11 MILE SOUTHFIELD MI DENTAL CARE NETWORK

29104005 413395 76 AS (800) 327-5462

6100 FAIRVIEW STE

1000 CHARLOTTE NC CORESOURCE

29104010 358569 67 XR (810) 855-3860

32300

NORTHWESTERN HWY FARMINGTON HILL MI FRINGE BENEFIT

29104015 413395 89 AS (800) 327-5462

6100 FAIRVIEW RD

SUITE 1000 CHARLOTTE NC CORESOURCE

29115005 352530 67 AS (999) 999-9999 162 E MICHIGAN KALAMAZOO MI GILMORE GROUP HEALTH & WELFARE

29126005 351113 38 AS (999) 999-9999 BOX 18197 COLUMBUS OH GOLD SHARE

29137005 352530 38 AS (999) 999-9999 1233 N CHURCH ROCKY MOUNT NC HARDEES FOOD SYSTEMS GROUP INS

29148005 413395 38 AS (999) 999-9999 PO BOX 30769 JAMICA NY MADISON BENEFITS

29159005 358569 38 AS (813) 753-7811

1651 WHITFIELD

AVENUE SARASOTA FL MINISTAR INC WELLCRAFT MARINE

29160005 352530 38 AS (999) 999-9999 2150 GRAND AVE DES MOINES IA SURE CARE

29171005 358569 89 AS (800) 462-3589 PO BOX 497 TOLEDO OH PARAMOUNT HEALTH CARE

29171010 358569 89 AS (888) 241-5604 106 PARK PLACE DUNDEE MI PARAMOUNT HEALTH CARE OF MI

29182005 358569 38 AS (999) 999-9999 9140 ARROWPOINT CHARLOTTE NC TUCKER ADMINISTRATOR

29193005 352530 38 AS (999) 999-9999 3231 E 6TH TOPEKA KS VOLUME SHOE CORP

29204005 352530 38 AS (999) 999-9999 PO BOX 848 BLOOMINGTON IN WETTERAU INCORPORATED

29205005 358569 89 X5 (800) 541-0985 PO BOX 9082 FARMINGTON HILL MI CARE CHOICES MUSKEGON

29215005 358569 38 AS (601) 489-3815

PO BOX A-STAFFORD

DR PONTOTOC MS ACTION INDUSTRIES INC

29215010 358569 89 AS (800) 533-9899 2905 LUCERNE DR GRAND RAPIDS MI ACTIVA BENEFIT

29226005 358569 38 AS (999) 999-9999 PO BOX 17237 MEMPHIS TX AGENCY SERVICE INC

29237005 358569 38 AS (614) 488-1666 1397 DUBLIN RD COLUMBUS OH CORPORATE CLAIM SERVICE

29248005 358569 38 AS (800) 522-0041 PO BOX 1999 DETROIT MI FEDERAL MOGUL CORPORATION

29259005 351113 38 AS (219) 436-1616 4910 LIMA RD FT WAYNE IN FORT WAYNE FOUNDRY

Page 103: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

29260005 413395 38 AS (999) 999-9999 2 FENWAY PLAZA BOSTON MA HARVARD COMMUNITY HLTH PLAN

29271005 413395 38 AS (309) 681-0707 4815 N PROSPECT RD PEORIA IL JOHN P PEARL & ASSOCIATES LTD

29303005 352530 38 AS (800) 321-5325 20005 LAKE ROAD ROCKY RIVER OH LESCO INC

29314005 413395 38 AS (999) 999-9999 PO BOX 81209 LINCOLN NE LIFESHARES SERVICES COMPANY

29325005 351113 38 AS (999) 999-9999 PO BOX 1690 TAMPA FL LYKES BROTHERS INC GROUP HLTH

29336005 358569 38 AS (800) 347-9355 PO BOX 9110 NEWTON MA MED TAC CLAIM CENTER

29347005 352530 38 AS (201) 791-6000 502 VALLEY ROAD WAYNE NJ MEDIPLAN

29358005 413395 38 X4 (800) 236-2515 2700 MIDWEST DRIVE ONALASKA WI UMR

29369005 358569 38 AS (999) 999-9999 PO BOX 330 CANONSBURG PA NOBEL GROUP BENEFITS

29370005 351113 38 AS (800) 356-9822 PO BOX 218 ALBANY OR PHILLIPS ADMINISTRATION

29381005 352530 38 AS (999) 999-9999 PO BOX 788 WARRENDALE PA RETAIL VENTURES INC

29381010 358569 89 AS (800) 426-5980 PO BOX 2265 SEATTLE WA RETAIL CLERKS WELFARE TRUST

29392005 352530 89 AS (999) 999-9999 300 W 80TH PLACE MERRILLVILLE IN RUSH ANCHOR HMO

29403005 352530 38 AS (800) 522-1246 400 FIELD DRIVE LAKE FOREST IL STARMARK INSURANCE

29403010 358569 38 AS (800) 522-1246 PO BOX 2942 CLINTON IA STARMARK

29414005 413395 38 AS (999) 999-9999 2637 N ADAMS RD ROCHESTER HILLS MI TRANS INDUSTRIES INC

29425005 352530 32 X2 (800) 421-1362

922 W WALNUT SUITE

A ROGERS AR WAL-MART CLAIMS ADMINISTRATION

29425010 352530 89 X2 (800) 421-1362

922 W WALNUT SUITE

A ROGERS AR WAL-MART CLAIMS ADMINISTRATION

29436005 358569 38 AS (714) 540-0781 BOX 395 JANESVILLE WI AMI

29447005 351113 05 AS (999) 999-9999 PO BOX 833888 RICHARDSON TX BC BS OF TX

29458005 358569 89 AS (999) 999-9999 34605 12 MILE FARMINGTON HILL MI CARE CHOICES HEALTH PLAN

29469005 351113 38 AS (999) 999-9999 90 MADISON AVE DENVER CO CO AUTO DEALERS ASSOC

29469010 351113 89 NO (877) 366-3415 5501 LBJ FREEWAY DALLAS TX CCN

29469015 351113 38 AS (800) 247-7724 Bldg 3, Suite 500 AUSTIN TX BOON ADMINISTRATIVE SERVICES

29470005 352530 38 AS (248) 386-6302 PO BOX 5013 SOUTHFIELD MI ESIS

29481005 358569 55 AS (708) 696-3660

435 FORD ROAD STE

500 MINNEAPOLIS MN EMPLOYEE BENEFITS PLAN INC

29492005 352530 38 AS (999) 999-9999 PO BOX 6000 HAMPTON NH FLEX PLUS

29503005 358569 38 AS (800) 822-1274 PO BOX 2000 LANCASTER SC KANAWHA INSURANCE COMPANY

29503010 358569 38 AS (800) 476-5150 PO BOX 5150 GREENVILLE SC KANAWHA BENEFIT SOLUTIONS INC

29514005 352530 34 AS (800) 541-8332 PO BOX 468 WARWICK RI UNITED HEALTHCARE INS CO

29525005 351113 67 AS (999) 999-9999 PO BOX 627 CADILLAC MI MI ASSOC OF BROADCASTERS

29536005 358569 38 AS (999) 999-9999 123 S PHILLIPS DECATUR MI NEWELL AGENCY

29547005 358569 38 AS (800) 523-3669 PO BOX 202069 ARLINGTON TX PROAMERICA

29547010 358569 89 AS (800) 874-5254 PO BOX 201888 ARLINGTON TX PROAMERICA MANAGED CARE

29547015 358569 89 NO (800) 546-1900 PO BOX 90603 ARLINGTON TX PROAMERICA NETWORK

29558005 352530 38 AS (999) 999-9999 4700 KNOWLES RD NORTH ADAMS MI QUINCY IND GROUP HEALTH

29569005 352530 56 AS (803) 736-6463 PO BOX 23759 COLUMBIA SC STRATEGIC RESOURCE COMPANY

29569010 352530 89 AS (800) 869-0808 PO BOX 23759 COLUMBIA SC STRATEGIC RESOURCE COMPANY

Page 104: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

29570005 352530 38 AS (999) 999-9999 PO BOX 55010 FRESNO CA WESTERN STATES ADMINISTRATORS

29581005 352530 38 AS (999) 999-9999 PO BOX 10223 WEST ALLIS WI WI CENTRAL

29592005 352530 38 AS (999) 999-9999 PO BOX 288 ST JOSEPH MI WOLVERINE METAL STAMPING INC

29603005 352530 38 AS (313) 942-0458 PO BOX 279 ROMULUS MI WOODBRIDGE GROUP COMPANIES

29614005 352530 38 AS (999) 999-9999 BOX 36128 DALLAX TX COST CURE

29625005 352530 38 X2 (312) 347-7428 313 S MICHIGAN CHICAGO IL ENCYCLOPEDIA BRITANICA INC

29647005 413395 38 AS (815) 633-5800 PO BOX 2638 ROCKFORD IL CLARENDON

29647010 358569 38 AS (800) 237-7767 PO BOX 30367 TAMPA FL HEALTHPLAN SERVICES

29658005 351113 67 AS (800) 759-6944 2111 W LINCOLN HWY MERRILLVILLE IN IRONWORKERS LOCAL 395 TRUST

29669005 358569 38 AS (999) 999-9999

815 COLORADO BLVD

2ND FL LOS ANGELES CA KAISER REGIONAL CLAIMS DEPT

29670005 358569 38 AS (801) 268-3334 PO BOX 651109 SALT LAKE CITY UT MBA

29681005 351113 38 AS (800) 331-0841 PO BOX 0541 QUINCY MA MEDICAL CLAIMS SERVICE

29681010 351113 89 AS (800) 331-0841 1 WALL STREET RAVENSWOOD WV MEDICAL CLAIMS SERVICE

29692005 352530 38 AS (248) 304-2855 PO BOX 4000 SOUTHFIELD MI NCAS MIDWEST

29692010 352530 38 AS (800) 338-7971 PO BOX 91010 SEATTLE WA NORTH STAR ADMINISTRATORS

29703005 358569 38 AS (800) 321-4085 PO BOX 94928 CLEVELAND OH MERITAIN HEALTH

29703010 358569 89 AS (800) 321-4085 PO BOX 94928 CLEVELAND OH MERITAIN HEALTH

29714005 351113 38 AS (800) 356-9822 BOX 218 ALBANY OR PHILLIPS ADMINISTRATIVE SERVS

29725005 352530 38 AS (999) 999-9999 3245 HILL TOLEDO OH RKO GENERAL INC

29736005 358569 38 AS (999) 999-9999 6210 CAMPBELL DALLAX TX UNDERWRITERS LIFE

29747005 352530 38 AS (999) 999-9999 PO BOX 277 RIVER RD WHITE PIGEON MI WHITE PIGEON

29758005 358569 38 AS (999) 999-9999

25 JEFFERSON PLACE,

SE GRAND RAPIDS MI AUTO DEALERS OF MI

29769010 351113 87 RX (800) 962-7378 PO BOX 145433 CINCINNATI OH WELLPOINT NEXT RX/EXPRESS SCRIPTS

29770005 358569 38 AS (708) 799-7400

17475 JOVANNA DR

#1B HOMEWOOD IL BENEFIT ADMINISTRATIVE SYSTEMS

29770010 358569 89 AS (708) 799-7400

17475 JOVANNA DR

#1B HOMEWOOD IL BENEFIT ADMINISTRATIVE SYSTEMS

29781005 351113 38 AS (999) 999-9999 8191 MOORSBRIDGE PORTAGE MI BILCORE

29792005 351113 38 AS (999) 999-9999 PO BOX 2037 SOUTHFIELD MI FARMERS INSURANCE

29803005 352530 38 AS (999) 999-9999 10550 RICHMOND HOUSTON TX GRANT NORPAC INC

29814005 358569 38 AS (999) 999-9999 PO BOX 16707 JACKSON MS INSURANCE SYSTEMS INC

29825005 358569 38 AS (999) 999-9999 PO BOX 9034 ST LOUIS MO LITTLE CAESAR GROUP CLAIM

29836005 352530 89 AS (888) 234-8850 PO BOX 806467 CHICAGO IL UNICARE PPO CLAIMS

29847005 351113 38 AS (999) 999-9999 PO BOX 7227 SHAWNEE MISSION KS MEDICAL DISBURSEMENTS INC

29858005 352530 86 VO (313) 553-7303

37635 ENTERPRISE

COURT FARMINGTON HILL MI METROVISION MEDICAL PLAN

29869005 352530 38 AS (999) 999-9999 9300 METCALF OVERLAND KS NATIONAL BENEFIT UNDERWRITERS

29870005 352530 38 AS (713) 522-1781 PO BOX 27328 HOUSTON TX SOLTEX POLYMER CORP

Page 105: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

29881005 352530 38 AS (616) 651-7841 307 SPRUCE STURGIS MI THURSTON WOODS VILLAGE INC

29892005 358569 38 AS (616) 685-6886 PO BOX 247 PLAINWELL MI MURCO INC

29903005 351113 38 AS (999) 999-9999 PO BOX 10319 DES MOINES IA AMERICAN TRAVELERS

29914005 351113 38 AS (999) 999-9999 815 FRONT ST BELDING MI CHARLOTTE COMPANY

29915005 351113 38 AS (999) 999-9999 3350 E PARIS SE GRAND RAPIDS MI CHRISTIAN SCHOOLS INTERNATION

29926005 358569 88 DO (888) 335-8227 PO BOX 997330 SAN FRANCISCO CA DELTA DENTAL PLAN OF CA

29937005 358569 38 AS (800) 523-5789 PO BOX 928 FINLEY OH EMPLOYEE BENEFIT CONSULTANTS

29948005 352530 38 AS (616) 861-2165 1330 INDUSTRIAL DR. SHELBY MI ICT INC

29959005 351113 38 AS (800) 262-3875 PO BOX 707 AMES IA IA BENEFITS

29960005 358569 38 AS (312) 243-1265 900 W JACKSON BLVD CHICAGO IL LEAHY & ASSOCIATES INC

29971005 351113 38 X3 (800) 634-3506 PO BOX 1430 DANVILLE IL MANAGEMENT SERVICES INC

29982005 351113 38 X2 (800) 824-3577 500 N AKARD DALLAS TX MODERN AMERICAN LIFE INSUR CO

29993005 352530 38 AS (800) 752-2677 PO BOX 1791 WILMINGTON DE ROLLINS LEASING CORP

29994005 352530 38 AS (999) 999-9999 PO BOX 196 STILLWATER MN SECURITY LIFE INSURANCE

29994010 352530 38 AS (800) 688-0010 PO BOX 5348 BELLINGHAM WA SECURITY LIFE INSURANCE CO OF AMERICA

29995005 358569 68 AS (216) 566-1455 1432 HAMILTON AVE CLEVELAND OH SELF FUNDED PLANS INC

29995010 358569 68 AS (800) 334-7374

1797 W STATE ST

SUITE B GENEVA IL SELF FUNDED PLANS INC

29996005 358569 38 AS (517) 349-8980 PO BOX 804 OKEMOS MI TRI TEC EMPLOYEE BENEFITS INC

29997005 352530 01 AS (999) 999-9999

GREENWICH OFFICE

PARK 5 GREENWICH CT UNITED PARCEL SERVICE

29998005 358569 38 AS (800) 880-1370 PO BOX 19085 GREENVILLE SC LIFESECURE INS CO

29999005 351113 01 AS (219) 825-9591 PO BOX 827 MIDDLEBURY IN KIRSCH PRODUCTS

30000005 352530 34 AS (999) 999-9999 PO BOX 19077 AUSTIN TX METROPOLITAN LIFE INS

30001005 358569 38 AS (999) 999-9999 4027 E 9 MILE WARREN MI MI PIONEER HOSPITAL INS

30002005 351113 38 AS (612) 631-1075

1801 W COUNTY

ROAD B ROSEVILLE MN MID AMERICA MUTUAL LIFE INS

30003005 358569 38 X3 (800) 822-3287 110 GIBRALTAR RD. HORSHAM PA AON SELECT

30004005 351113 38 AS (800) 624-8822 PO BOX 6006 CYPRESS CA PACIFICARE OF CA

30004010 351113 38 AS (800) 825-9355

7666 E 61ST STREET,

SUITE 500 TULSA OK PACIFICARE OF OK

30004015 351113 38 AS (999) 999-9999

5 CENTERPOINTE

DRIVE LAKE OSWEGO OR PACIFICARE OF OR

30004020 351113 89 AS (800) 624-8822 PO BOX 6006 CYPRESS CA PACIFICARE OF CA

30005005 351113 38 AS (999) 999-9999

10450 HOLMES ST

#200 KANSAS CITY MO PRIME HEALTH

30006005 352530 38 AS (999) 999-9999

8585 STEMMONS

FREEWAY DALLAS TX REPUBLIC BANKERS LIFE INS CO

30007005 351113 38 AS (999) 999-9999 4242 44TH ST SE KENTWOOD MI DAVIS INC

30007010 351113 86 VO (800) 999-5431 PO BOX 1525 LATHAM NY DAVIS VISION

Page 106: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30008005 359196 38 AS (999) 999-9999 301 W 3RD STERLING IL FRANTZ MANUFACTURING DIVISION

30009005 352530 38 AS (999) 999-9999

4301 CONNECTICUT,

NW WASHINGTON DC GROUP HEALTH ASSOC

30010005 351113 38 AS (999) 999-9999 636 E 40TH ST HOLLAND MI GUARDSMAN EMPLOYEE BENEFIT

30011005 351113 38 AS (312) 738-3920

1645 W JACKSON

BLVD CHICAGO IL CHICAGO TRUCK DRIVER UNION

30012005 352530 38 AS (999) 999-9999

345 PARK AVENUE,

SOUTH NEW YORK NY HERBERT L JAMISON & CO

30013005 413395 87 RX (216) 328-5555 PO BOX 94785 CLEVELAND OH MERCK-MEDCO

30014005 351113 38 AS (999) 999-9999 1142 44TH KENTWOOD MI KENTWOOD HEALTH CENTER

30015005 352530 34 AS (999) 999-9999

2701 UNIVERSITY DR

#415 AUBURN HILLS MI METROPOLITAN LIFE INS

30016005 352530 34 AS (999) 999-9999 2740 S ONEIDA ST GREENBAY WI METROPOLITAN LIFE INS

30017005 351113 38 AS (999) 999-9999 PO BOX 901 BAY CITY MI MUTUAL SAVINGS & LOAN ASSOC

30018005 352530 38 AS (999) 999-9999

FEDERAL BLDG 607

MARQUET MINNEAPOLIS MN PRE CARE

30019005 352530 38 AS (800) 279-4000 45 W BELTLINE MADISON WI WEA INSURANCE GROUP

30020005 413395 67 AS (800) 759-6944 2111 W LINCOLN HWY MERRILLVILLE IN STEWART C MILLER & CO INC

30021005 413395 38 AS (999) 999-9999 PO BOX 200675 AUSTIN TX AMERICAN GROUP LIFE

30022005 352530 38 AS (999) 999-9999 PO BOX 3080 LANCASTER PA EHD ADMINISTRATORS

30023005 351113 89 AS (216) 687-6615 PO BOX 6018 CLEVELAND OH HMO HEALTH OH

30024005 352530 38 AS (999) 999-9999 3010 KNIGHT ST SHREVEPORT LA INSURANCE MANAGEMENT ADM

30025005 352530 34 AS (800) 638-0116 PO BOX 14105 ORANGE CA METROPOLITAN LIFE INS CO

30026005 352530 34 AS (800) 357-1356 PO BOX 30430 TAMPA FL UNITED HEALTHCARE INS CO

30027005 352530 89 AS (800) 638-0153 PO BOX 3041 UTICA NY UNITED HEALTHCARE INS CO

30028005 352530 34 AS (999) 999-9999 3090 W MARKET FAIRLAWN OH METROPOLITAN LIFE INS

30029005 351113 05 AS (999) 999-9999 811 GRAND CENTRAL VIENNA WV MOUNTAIN STATE BC BS

30030005 352530 38 AS (999) 999-9999 P O BOX 5004 ROCHESTER MI GM UNDERWRTERS AGENCY INC

30031005 351113 38 AS (999) 999-9999

11935 RILEY ST STE

200 SHAWNEE MISSION KS POSITIVE CARE SERVICES INC

30032005 413395 89 AS (800) 553-8933

9490 PRIORITY WAY

WEST DRIVE INDIANAPOLIS IN ADVANTAGE HEALTHPLAN HMO

30033005 352530 38 AS (999) 999-9999 PO BOX 581060 TULSA OK TULSA TURKEY PRODUCTS

30034005 352530 01 AS (302) 674-7600 PO BOX 7012 DOVER DE AETNA US HEALTHCARE

30034010 352530 89 AS (800) 833-4826 PO BOX 7012 DOVER DE AETNA US HEALTHCARE

30035005 352530 01 AS (503) 221-5535 PO BOX 112 PORTLAND OR AETNA US HEALTHCARE

30036005 351113 39 AS (999) 999-9999 PO BOX MINN MN ALTA ADMINISTRATORS

30037005 358569 87 RX (999) 999-9999

2811 LORD

BALTIMORE DR. BALTIMORE MD ASSOCIATED PRESCRIPTION SERV

30038005 351113 05 AS (212) 476-1000 11 W 42ND NEW YORK NY EMPIRE BC BS OF NY

30038010 351113 89 AS (800) 675-1277 PO BOX 5012 MIDDLETOWN NY EMPIRE BC BS OF NY

Page 107: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30039005 358569 55 AS (800) 552-0455 4789 RINGS DUBLIN OH EMPLOYEE BENEFIT MANAGEMENT

30039010 358569 89 AS (800) 552-0455 4789 RINGS RD DUBLIN OH EMPLOYEE BENEFIT MANAGEMENT CORP

30040005 351113 38 AS (800) 845-0747

1975 SPAULDING

AVENUE,SE GRAND RAPIDS MI ETHIX GREAT LAKES

30040010 358569 89 AS (800) 442-7247 PO BOX 45018 FRESNO CA HEALTHCOMP ADMINISTRATORS

30041005 358569 38 AS (999) 999-9999 7 CLAYTON ST MONTGOMERY AL FIRST NATIONAL INSURANCE

30042005 358569 38 AS (999) 999-9999

1855 STEPHENSON

HWY TROY MI HL BLACHFORD INC

30043005 352530 16 AS (999) 999-9999 PO BOX 4046 SCHAUMBURG IL UNICARE/JOHN HANCOCK

30044005 358569 38 AS (999) 999-9999 95 MIDLAND SAGINAW MI MANUFACTURERS INDUSTRIAL BENEF

30045005 352530 34 AS (302) 292-8026 PO BOX 6017 NEWARK DE UNITED HEALTHCARE INS CO

30045010 352530 89 AS (800) 301-5545 PO BOX 6017 NEWARK DE UNITED HEALTHCARE INS CO

30046005 352530 34 AS (516) 348-7200 2929 EXPRESS HAUPPAUGE NY UNITED HEALTHCARE INS CO

30047005 352530 34 AS (800) 942-4640 PO BOX 1600 KINGSTON NY UNITED HEALTHCARE INS CO

30047010 352530 89 AS (800) 942-4640 PO BOX 1600 KINGSTON NY UNITED HEALTHCARE INS CO

30048005 352530 34 AS (212) 578-2211 ONE MADISON AVE NEW YORK NY UNITED HEALTHCARE INS CO

30049005 352530 34 AS (999) 999-9999

1701 DIRECTORS

BLVD. 800 AUSTIN TX UNITED HEALTHCARE INS CO

30050005 358569 67 AS (262) 970-5790 PO BOX 670 PEWAUKEE WI MILWAUKEE CARPENTERS DISTRICT

30051005 358569 38 AS (312) 704-5000 PO BOX 811100 CHICAGO IL PRINTING INDUSTRY OF IL

30052005 358569 31 AS (999) 999-9999 PO BOX 4305 HOUSTON TX PRUDENTIAL INSURANCE COMPANY

30052010 358569 31 AS (999) 999-9999 PO BOX 15055 ALBANY NY PRUDENTIAL INSURANCE COMPANY

30053005 413395 89 NO (800) 320-0015 PO BOX 6051 INDIANAPOLIS IN SAGAMORE

30054005 558569 38 AS (999) 999-9999 PO BOX 655433 DALLAS TX UNITED BANKERS INSURANCE

30055005 351113 38 AS (999) 999-9999 PO BOX 6450 NORCROSS GA WAFFLE HOUSE EMP BENEFIT PLAN

30056005 351113 38 AS (999) 999-9999 601 TALLMADGE KENT OH CARTER COMPANIES

30057005 351113 47 AS (999) 999-9999 333 S ASHLAND CHICAGO IL CHICAGO & CENTRAL STATES JOINT

30058005 358569 55 AS (999) 999-9999 PO BOX 24007 FRESNO CA EBP INSURANCE SERVICES

30059005 358569 38 AS (999) 999-9999 PO BOX 55210 INDIANAPOLIS IN EAST MI FREE METHODIST

30060005 358569 38 AS (999) 999-9999 14848 SW 21ST TOPEKA KS GROUP INSURANCE ADMINISTRATORS

30061005 351113 38 AS (999) 999-9999 PO BOX 27087 SALT LAKE CITY UT HEALTH ONE MEDICAL

30062005 351113 38 AS (999) 999-9999 PO BOX 172115 MEMPHIS TN INCENTIVE MEDICAL PLAN

30063005 413395 38 AS (800) 882-0220 PO BOX 9060 PHOENIX AZ LEGIONNAIRE INSURANCE TRUST

30064005 352530 38 AS (317) 674-9771 PO BOX 1750 MARION IN MCCLURE OIL CO

30065005 413395 38 AS (999) 999-9999 PO BOX 37511 OAK PARK MI MI ASSOC OF SFS RETAIL

30066005 351113 38 AS (999) 999-9999 PO BOX 69 MIDDLEVILLE MI MIDDLEVILLE OPERATION

30067005 413395 38 AS (999) 999-9999 50 LASALLE CHICAGO IL NORTHERN TRUST CO

30068005 413395 38 AS (304) 340-0253 PO BOX 3262 CHARLESTON WV OM SCOTT AND SONS

30069005 352530 89 AS (479) 636-0198 PO BOX 1627 ROGERS AR SB HOWARD & COMPANY

30070005 358569 38 X2 (708) 299-3040 2250 E DEVON DES PLAINS IL STRATEGIC HEALTH CARE MANAGEME

30071005 352530 38 AS (800) 236-7734 PO BOX 840 GERMANTOWN WI WRLA EMPLOYEE BENEFIT

30072005 413395 38 AS (206) 282-4100

201 QUEEN ANNE

AVENUE SEATTLE WA ZENITH ADMINISTRATORS

Page 108: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30072010 413395 38 X3 (877) 355-2116 PO BOX 11137 CHICAGO IL ZENITH ADMINISTRATORS

30073005 351113 38 AS (513) 872-7505 310 TERRACE CINCINNATI OH ACTURIAL AND EMPLOYEE BENEFITS

30074005 352530 38 AS (999) 999-9999 7 SKYLINE DR HAWTHORNE NY CIBA GEIGY CORP

30075005 413395 38 AS (800) 777-3377 PO BOX 16526 COLUMBUS OH CENTRAL BENEFITS NATIONAL LIFE

30076005 351113 38 AS (999) 999-9999 PO BOX 1365 COLUMBIA SC COLONIAL LIFE & ACCIDENT

30077005 358569 38 AS (662) 563-7664 PO BOX 1133 BATESVILLE MS CROWN CORK & SEAL INSURANCE

30078005 351113 05 AS (800) 238-6597 PO BOX 5012 MIDDLETOWN NY EMPIRE BC BS OF NY

30079005 413395 06 AS (800) 367-3762 PO BOX 4138 AKRON OH BENEFIT SERVICES INC

30080005 351113 38 AS (999) 999-9999 1501 WOHLERT ANGOLA IN HANDY & HARMON AUTO GROUP

30081005 352530 38 AS (999) 999-9999 PO BOX 39119 PHOENIX AZ INSURERS ADMINISTRATIVE CORP

30082005 352530 38 AS (999) 999-9999 PO BOX 51005 SHREVEPORT IL JOHN CHANCE AND ASSOCIATES

30083005 358569 61 AS (999) 999-9999

17870 CASTLETON,

STE 300 CITY OF INDUSTR CA MA MUTUAL SONY CORP

30084005 352530 89 AS (616) 935-0500 109 E FRONT TRAVERSE CITY MI NORTH MED HMO

30085005 352530 38 AS (800) 443-2595

14665 MIDWAY RD

STE 110 DALLAS TX PRODUCERS EXCHANGE BEN SERV IN

30086005 358569 38 AS (999) 999-9999

111111 SUNSET HILL

RD RESTON VA POSTAL EMPLOYEES HEALTH BEN

30087005 352530 38 XR (999) 999-9999 609 MYRTLE, NW GRAND RAPIDS MI ROCKFORD

30088005 358569 38 AS (999) 999-9999

222 W COLINAS BLVD

#756 IRVING TX SOUTHERN BENEFIT CONSULTANTS

30089005 358569 38 AS (651) 439-7098 DRAWER 196 STILLWATER MN STUDENT ASSURANCE SERVICES

30090005 352530 38 AS (999) 999-9999 PO BOX 327 VALLEY AL WEST POINT PEPPERELL

30091005 358113 38 AS (248) 813-9800 PO BOX 1218 TROY MI BAC LOCAL 32 INSURANCE FUND

30092005 358871 38 AS (317) 849-3282 6330 E. 75TH STE. 106 INDIANAPOLIS IN DONLEY HORAN & ASSOC

30094005 358113 38 AS (800) 767-0700 PO BOX 982009 NORTH RICHLAND HILLS TX MEGA LIFE & HEALTH INSURANCE

30094010 358113 38 AS (800) 608-1234 PO BOX 982009 NORTH RICHLAND HILLS TX MEGA LIFE & HEALTH INSURANCE

30095005 358569 38 AS (999) 999-9999 PO BOX 548 UPLAND IN MELLING FORGING

30095010 358113 89 AS (800) 505-5450 PO BOX 982009 NORTH RICHLAND HILLS TX MEGA LIFE & HEALTH

30096005 351113 38 XV (402) 330-4075 399 N 117TH STREET OMAHA NE MID AMERICA BENEFITS INC

30097005 413395 38 AS (999) 999-9999 3120 BRECKENRIDGE DULUTH GA MILLICO INSURANCE

30098005 358569 38 AS (999) 999-9999 5575 N RIVERVIEW KALAMAZOO MI NAARCO WELLS ALUMINUM

30099005 358569 38 AS (800) 828-6922 PO BOX 853921 RICHARDSON TX MERITAIN HEALTH

30100005 352530 38 AS (616) 694-2231 431 HELEN AVE OTSEGO MI ROCK TENN COMPANY

30101005 552530 38 AS (999) 999-9999 PO BOX 1260 FORT WORTH TX UNITED INTERNATIONAL LIFE

30102005 352530 38 AS (999) 999-9999 PO BOX 151 DECATUR IL VIGORTONE

30103005 352530 89 AS (999) 999-9999 3033 S KETTERING DAYTON OH WHP HEALTH MAINTENANCE PLAN

30104005 352530 38 AS (517) 676-5445

PO BOX 10 WEST

NORTH ST MASON MI WYETH AYERST LABORATORIES

30105005 358569 04 AS (586) 826-4300 PO BOX 37504 OAK PARK MI ABS BANKERS CLAIM SERVICE

Page 109: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30106005 351113 38 AS (999) 999-9999 PO BOX 8787 BENTON HARBOR MI AUSCO INC

30107005 351113 07 AS (800) 243-8552 PO BOX 4010 FARMINGTON CT CT GENERAL LIFE

30108005 358569 38 AS (616) 940-1745 PO BOX 878 GRAND RAPIDS MI D & W MANAGEMENT

30109005 351113 38 AS (999) 999-9999 2960 LUCERNE SE GRAND RAPIDS MI GREAT LAKES AMERICAN LIFE

30200005 413395 86 VO (800) 445-2363 PO BOX 1570 EAST LANSING MI HEALTH APPLICATIONS NETWORK

30201005 358569 89 AS (800) 833-8464 4530 PARK RD STE 110 CHARLOTTE NC HEALTH CARE SAVINGS

30202005 352530 38 AS (999) 999-9999 263 MART, SW GRAND RAPIDS MI INDEPENDENT CO-OP MILK PRODUCE

30203005 358569 38 AS (301) 762-8205 4 TAFT COURT ROCKVILLE MD MDIPA HEALTH PLAN

30204005 351113 38 AS (847) 297-3640 PO BOX 859 PARK RIDGE IL MCCONACHIE FINANCIAL SERVICES

30205005 352530 34 AS (800) 323-8520 PO BOX 5090 ROLLING MEADOWS IL UNITED HEALTHCARE INS CO

30206005 358569 38 AS (999) 999-9999 PO BOX 770 MIDDLEBURG VA NATIONAL OFFICE PRODUCTS

30207005 358569 38 AS (217) 233-4677 PO BOX 7600 SOUTH BEND IN PARTNERS HEALTH PLAN

30208005 358569 38 AS (800) 722-2783

1825 JEFFERSON

PLACE NW WASHINGTON DC PENTECO INC

30209005 351113 87 RX (999) 999-9999 PO BOX 71 WEST POINT GA PHARMACY ADVANTAGE SYSTEM

30300005 352530 38 AS (616) 744-2491 PO BOX 5200 N MUSKEGON MI QUALITY STORES INC

30301005 351113 55 AS (800) 752-2677 PO BOX 8788 WILMINGTON DE EMPLOYEE BENEFITS TRUST

30302005 352530 38 AS (999) 999-9999 PO BOX 1510 DALLAS TX SOUTHLAND CORP

30303005 352530 38 AS (706) 855-1764 3665 WHEELER AUGUSTA GA TFE MEDICAL SYSTEMS

30304005 358569 38 AS (999) 999-9999 PO BOX 338 BRADENTON FL TROPICANA HEALTH CARE

30305005 352530 01 AS (336) 801-7000 PO BOX 26053 GREENSBORO NC AETNA US HEALTHCARE

30306005 351113 38 X3 (800) 733-8880 PO BOX 982017 N RICHLAND HILLS TX AMERICAN SERVICE LIFE INS

30307005 351113 07 AS (214) 907-6500

12225 GREENVILLE

AVENUE DALLAS TX CT GENERAL LIFE

30308005 358569 38 AS (999) 999-9999 PO BOX 337 HILLSBORO TX DEF INVESTMENTS INC

30309005 351113 38 AS (999) 999-9999

950 WARRENVILLE

ROAD LISLE IL HEALTH CHICAGO

30400005 352530 38 AS (216) 441-4900 2910 HARVARD CLEVELAND OH MCGEAN ROHCO INC

30401005 352530 38 AS (999) 999-9999 PO BOX 470397 FORT WORTH TX NATIONAL ASSOC OF PRIVATE ENT

30402005 352530 38 AS (999) 999-9999 5801 E KILGORE KALAMAZOO MI HYCORR MACHINE CORPORATION

30403005 358569 38 AS (999) 999-9999 PO BOX 720677 ATLANTA GA PENN GENERAL SERVICES CORP INC

30404005 352530 38 AS (614) 454-8938 PO BOX 2667 ZANESVILLE OH BASIC BENEFITS INC

30405005 358569 89 AS (800) 677-7057 PO BOX 50431 INDIANAPOLIS IN BENEFIT DESIGN & ADMINISTRATOR

30406005 413395 76 AS (800) 331-1199

5200 77 CENTER DR

STE 400 CHARLOTTE NC CORESOURCE

30407005 358569 67 X2 (734) 663-2178 3135 S STATE STREET ANN ARBOR MI IBEW LOCAL 252 FRINGE FUNDS

30408005 413395 89 AS (800) 331-3287 PO BOX 68947 INDIANAPOLIS IN J F MOLLOY & ASSOCIATES

30408010 413395 38 AS (800) 331-3287 PO BOX 68947 INDIANAPOLIS IN J F MOLLOY & ASSOCIATES

30409005 352530 38 AS (999) 999-9999 PO BOX 32210 KANSAS CITY MO LADIES AUXILIARY TO VFW INSURA

30500005 352530 89 AS (205) 991-6000 P O BOX 830570 BIRMINGHAM AL PHYSICIANS CORPS/AMER HEALTH

Page 110: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30501005 352530 38 AS (999) 999-9999 21032 DEVONSHIRE CHATSWORTH CA TOMFORD INSURANCE ADMINISTRATO

30502005 352530 38 AS (999) 999-9999

6700 ALLENTOWN

BLVD HARRISBURG PA WEST BRANCH ADMINISTRATORS

30503005 352530 38 AS (999) 999-9999 300 NORTH AVE BATTLE CREEK MI BATTLE CREEK HEALTH SYSTEM

30504005 351113 38 X2 (800) 480-5034 720 BLAIR MILL RD HORSHAM PA BLAIR MILL ADMINISTRATION

30504010 413395 38 AS (800) 480-5036 720 BLAIRMILL ROAD HORSHAM PA AMERIHEALTH ADMINISTRATORS

30505005 352530 38 AS (214) 937-4420 2001 BATES DR. WARAHACHIE TX CHRISTIAN FIDELITY

30505010 351113 38 AS (999) 999-9999

205 SOUTH BC

AVENUE LYNDEN WA CHRISTIAN HEALTHCARE NETWORK

30506005 351113 89 AS (800) 543-0161 PO BOX 44290 DETROIT MI DMC CARE

30507005 351113 89 AS (800) 759-9199

1877 W DONNER

PLACE AURORA IL HMO IL DREYER

30508005 358569 38 AS (914) 738-4446 PO BOX 372 OWENSBORO KY IPS BENEFITS

30509005 352530 38 AS (999) 999-9999

7445 NEW

TECHNOLOGY WAY FREDERICK MD LINCOLN NATIONAL

30510005 358569 38 AS (800) 257-6250 PO BOX CN85000 PENN SAUKEN NJ MAKSIN MANAGEMENT CORP

30511005 358569 89 AS (317) 844-5775

9480 PRIORITY WAY

WEST INDIANAPOLIS IN MAXICARE IN INC

30512005 352530 87 RX (313) 674-7743 PO BOX 436021 PONTIAC MI PERRY DRUG STORES INC

30513005 352530 38 AS (999) 999-9999 233 EAST FULTON GRAND RAPIDS MI WESTERN MI UNDERWRITERS

30514005 351113 89 AS (800) 331-0424 3401 N PERRYVILLE RD ROCKFORD IL ROCKFORD HEALTH PLANS

30515005 351113 87 RX (216) 723-6263 PO BOX 1327 MEDINA OH COMPLETE PHARMACY NETWORK

30516005 358569 38 DO (800) 752-1547 12016 DERRING LIVONIA MI HEALTH CARE EXCHANGE DENTAL

30517005 358569 38 AS (999) 999-9999 PO BOX 16250 CHICAGO IL HUMANA MICHAEL REESE HEALTH

30519005 351113 38 AS (808) 433-2778 1301 PUNCHBOWL HONOLULU HI QUEENS HEALTH CARE PLAN

30520005 352530 38 AS (800) 323-3993 PO BOX C32029 RICHMOND VA REYNOLDS HEALTH CARE

30521005 352530 38 AS (999) 999-9999 PO BOX 2667 RIVERSIDE CA RIVERSIDE COUNTY FOUNDATION

30522005 352530 38 AS (999) 999-9999 600 4TH SIOUX CITY IA TERRA INTERNATIONAL

30523005 552530 38 AS (999) 999-9999 PO BOX Z SOUTH LYON MI UNITED INSURANCE GROUP INC

30525005 358569 38 AS (999) 999-9999 2858 W MARKET AKRON OH ASSOCIATED PLAN ADMINISTRATORS

30526005 351113 67 AS (517) 351-3400 3101 ALLIED DR JACKSON MI CARPENTERS LOCAL UNION 704

30527005 352530 87 RX (800) 837-9600

695 GEORGE

WASHINGTON HWY LINCOLN RI PHARMACARE GROUP SALES DIVISION

30528005 351113 38 AS (999) 999-9999 PO DRAWER 67 AUBURDALE FL COMCARR

30529005 358569 38 AS (999) 999-9999 PO BOX 31107 TAMPA FL COORDINATED BENEFIT PLANS

30530005 358569 88 DO (800) 223-3104 240 VENTURE CIRCLE NASHVILLE TN DELTA DENTAL PLAN OF TN

30531005 351113 38 AS (800) 477-4277 PO BOX 1250 INDIANAPOLIS IN FARM BUREAU INSURANCE

30532005 358569 38 X5 (616) 531-0400 6475 28TH ST SE GRAND RAPIDS MI GRM INDUSTRIES

Page 111: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30533005 351113 38 AS (999) 999-9999 1101 2ND SE CEDAR RAPIDS IA GREAT PLAINS GAS

30534005 358569 89 AS (999) 999-9999 PO BOX 385 TOLEDO OH HMO TOLEDO OH

30535005 351113 38 AS (999) 999-9999 6031 JOY RD. DETROIT MI METRO 25

30536005 358569 38 AS (999) 999-9999 1 MERRICK AVE WESTBURY NY OLSTEN CORPORATION

30537005 358569 68 AS (800) 233-2101 PO BOX 51719 KALAMAZOO MI IBA SELF FUNDED GROUP

30537010 358569 68 AS (999) 999-9999 PO BOX 6596 ANNAPOLIS IN SELF FUNDING ADMINISTRATORS IN

30538005 352530 38 AS (999) 999-9999 2024 HICKORY HOMEWOOD IL IL CENTRAL HOSPITAL ASSO

30539005 352530 38 AS (999) 999-9999

5900 PRINCESS

GARDEN LANHAM MD UPG HEALTH PLAN

30540005 352530 38 AS (999) 999-9999 FIVE CROWN CENTER KANSAS CITY MO WOODSMALL BENEFIT SERVICE

30541005 358569 38 AS (702) 646-4406 PO BOX 61320 LAS VEGAS NV ASSOCIATED THIRD PARTY ADMINISTRATION

30542005 413395 38 AS (800) 426-7453 PO BOX 3559 ENGLEWOOD CO CNIC HEALTH SOLUTIONS

30542010 358569 87 RX (800) 364-6440 2448 EAST 81ST TULSA OK INTERCHANGE PMP

30543005 351113 38 AS (999) 999-9999 955 BROOKS HOLLAND MI HICKORY SPRINGS MFG

30544005 358569 38 AS (999) 999-9999 1350 S HICKORY MELBOURNE FL HOMES REGIONAL HEALTHCARE

30545005 352530 38 AS (999) 999-9999 11260 CHESTER CINCINNATI OH LINCOLN NATIONAL

30546005 352530 38 AS (999) 999-9999 PO BOX 2381 FORT WAYNE IN LINCOLN NATIONAL

30547005 358871 87 RX (800) 303-0187 PO BOX 52188 Phoenix AZ CAREMARK

30547010 352530 87 RX (708) 689-6625

1450 WAUKEGAN RD-

4TH FLR MCGAW PARK IL BAXTER HLTHCARE CORP BLDG N

30547100 358569 89 AS (800) 284-0042 PO BOX 22987 KNOXVILLE TN CARITEN HEALTHCARE

30548005 352530 38 AS (999) 999-9999 PO BOX 1199 TROY MI LINCOLN NATIONAL

30549005 413395 38 AS (800) 854-0186 PO BOX 97 SCRANTON PA MONUMENTAL LIFE INSURANCE CO/ TRANSAMERICA

30550005 351113 87 RX (800) 837-7279 PO BOX 370 MAWMEE OH PHARMACY CARD INC

30550010 358569 87 RX (800) 777-0074

9343 TECH CENTER

DRIVE SACRAMENTO CA PHARMACEUTICAL CARE NETWORK

30552005 352530 38 AS (999) 999-9999 3600 CENTENNIAL MIDLAND MI QUALITY AIR OF MIDLAND

30553005 352530 38 AS (999) 999-9999 4830 KNIGHTSBRIDGE COLUMBUS OH US HEALTH PLAN

30554005 351113 67 AS (213) 386-8590 PO BOX 17973 LOS ANGELES CA CARPENTERS H & W OF S CA

30555005 358569 38 AS (999) 999-9999 PO BOX 2568 BIRMINGHAM AL SOUTHERN BENEFITS

30556005 352530 38 AS (999) 999-9999 1122 S BRIDGE BELDING MI COUNTRY ROADS

30557005 358569 38 AS (999) 999-9999 8322 ONE CALAIS AVE BATON ROUGE LA AMERICAN LIFE PENSION HLTH

30558005 352530 38 AS (999) 999-9999 PO BOX 4809 ATLANTA GA GROUP HEALTH CARE PLAN

30559005 413395 38 AS (999) 999-9999 PO BOX 7217 DEERFIELD IL GUARANTY ASSOC CLAIM OFFICE

30560005 413395 38 AS (999) 999-9999 222 N LASALLE ST. CHICAGO IL MATERIAL SERVICE CORPORATION

30561005 413395 89 AS (301) 984-1440 PO BOX 5909 SCRANTON PA SAMBA MUTUAL BENEFIT ASSOCIATION INC

30562005 352530 38 AS (999) 999-9999 PO BOX 27328 HOUSTON TX SOLVAY POLYMERS

30563005 558569 38 AS (313) 873-2852 8255 2ND AVENUE DETROIT MI UNITED AMERICAN HEALTHCARE COR

30564005 358569 86 VO (999) 999-9999 PO BOX 1822 LAPORTE IN VISION CARE ADMINISTRATORS

30565005 351113 38 AS (999) 999-9999 PO BOX 945005 MAITLAND FL ADJUSTCO

Page 112: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30566005 351113 38 AS (999) 999-9999 PO BOX 55210 INDIANAPOLIS IN BATSON PRINTING BENEFIT

30567005 358569 38 AS (316) 264-5311 PO BOX 10130 LAKE BUENA VIST FL DISNEY WORLD WIDE SERVICES INC

30568005 351113 67 AS (999) 999-9999

1449 ENERGY PARK

DR. ST PAUL MN ELECTRICAL WORKERS LOC 364

30569005 413395 38 AS (309) 673-7330 PO BOX 1986 PEORIA IL HCH ADMINISTRATION

30569010 358569 89 NO (800) 845-6142 PO BOX 6269 FORT SMITH AR HCI TOUCH POINT NETWORK

30570005 413395 89 NO (800) 688-3290 PO BOX 134005 ANN ARBOR MI M PREFERRED PPO

30571005 352530 89 AS (218) 727-2001 PO BOX 2704 DULUTH MN UNITED HEALTH CARE MANAGEMENT

30571010 352530 89 X2 (800) 521-2112 PO BOX 169050 DULUTH MN UHC MANAGEMENT COMPANY INC

30572005 352530 38 AS (999) 999-9999 PO BOX 9753 BELLINGHAM WA WHATCOM MEDICAL

30573005 351113 38 AS (999) 999-9999 PO BOX 619022 DALLAS TX ASSOCIATES EMPLOYER SERVICES

30574005 358569 38 HO (800) 541-1225 PO BOX 94953 CLEVELAND OH CAPITOL AMERICAN LIFE

30575005 351113 38 AS (999) 999-9999 PO BOX 3770 CAPITOL HTS MD COLONIAL BENEFIT ADM

30576005 351113 87 RX (800) 788-7871

PO BOX 6037 LC07-

190 CLAIMS CYPRESS CA PRESCRIPTION SOLUTIONS

30576010 352530 87 RX (999) 999-9999

155 HIDDEN RAVINES

DRIVE POWELL OH PRESCRIPTION PLUS

30577005 352530 38 AS (612) 454-0603

2600 EAGAN WOODS

DR. EAGAN MN JJJ GROUP

30577105 351113 88 DO (800) 280-0147 PO BOX 2233 SCHENECTADY NY JLT SERVICES

30578005 352530 38 AS (999) 999-9999 PO BOX 35803 COLORADO SPRING CO LINCOLN NATIONAL

30579005 352530 38 AS (999) 999-9999 PO BOX 2013 MILWAUKEE WI UNITED WI INSURANCE

30580005 351113 67 NO (517) 321-7502

6525 CENTURION

DRIVE LANSING MI MICHIANA AREA ELECTRICAL WORKERS

30581005 358569 38 AS (999) 999-9999 830 OLD MAGNOLIA CORONA CA CIRCLE CITY MEDICAL GROUP

30582005 358569 38 AS (800) 235-3341 PO BOX 4773 SYRACUSE NY ONONDAGA COUNTY HEALTH PLAN

30583005 358569 55 AS (999) 999-9999 100 W CLARENDON PHOENIX AZ EMPLOYEE BENEFIT AMERICA

30584005 413395 38 AS (999) 999-9999 5000 N US-131 REED CITY MI MATRON CORPORATION

30586005 352530 38 AS (800) 944-6692

25145 COUNTRY CLUB

BLVD. NORTH OLMSTEAD OH NEW ENGLAND CLEVELAND TNE

30586010 413395 89 AS (800) 944-6692 PO BOX 8020 N OLMSTEAD OH NEW ENGLAND HEALTH BENEFITS

30587005 358569 38 AS (999) 999-9999 PO BOX 31497 HARTFORD CT PROGRAMMED BENEFITS

30588005 358569 87 RX (888) 459-3015 PO BOX 8046 WAUSAU WI WAUSAU PHARMACY BENEFITS

30589005 358569 38 AS (615) 373-3537

214 CENTERVIEW DR-

#250 BRENTWOOD TN ADMINITRON INC

30590005 351113 07 AS (999) 999-9999 JFK AIRPORT STATION JAMAICA NY CT GENERAL LIFE

30591005 351113 88 DO (312) 427-0255 PO BOX 4677 CHICAGO IL COMPDENT

30592005 358569 87 RX (877) 363-1303 PO BOX 66518 ST LOUIS MO EXPRESS SCRIPTS - TRICARE ONLY

30592010 358569 87 RX (888) 202-4560 PO BOX 64022 PHOENIX AZ EXPRESS SCRIPTS

30592015 358569 87 RX (919) 573-3498 PO BOX 270 PITTSURGH PA EXPRESS PHARMACY SERVICES

30592020 358569 87 RX (800) 451-6245 PO BOX 390873 BLOOMINGTON MN EXPRESS SCRIPTS

Page 113: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30593005 358569 38 AS (313) 965-1400 1001 WOODWARD DETROIT MI FIRST FEDERAL OF MI

30594005 413395 38 AS (999) 999-9999 PO BOX 16707 JACKSON MS MHEBT

30595005 413395 17 AS (800) 801-5409 PO BOX 710 PUEBLO CO UNITED MEDICAL RESOURCES

30596005 358569 38 AS (999) 999-9999 PO BOX 6249 LINCOLN NE NATIONAL RURAL ELECTRIC COOP

30597005 352530 38 AS (999) 999-9999 20155 GODDARD TAYLOR MI RAYMOND TAYLOR AGENCY

30598005 358569 38 AS (999) 999-9999 540 LAKE COOK DEERFIELD IL ACIC CLAIM ADMINISTRATOR

30599005 358569 64 AS (800) 382-1799 PO BOX 42669 INDIANAPOLIS IN IN AREA UNITED FOOD AND

30600005 351113 38 AS (999) 999-9999 PO BOX 97058 REDMOND WA HEALTHCARE MANAGEMENT ADMIN

30601005 358569 38 AS (248) 645-6310 PO BOX 480199 NEW HAVEN MI JMS ADMINISTRATORS

30601010 358569 89 AS (248) 645-6310 30700 TELEGRAPH RD FRANKLIN MI JMS ADMINISTRATORS

30602005 351113 38 AS (800) 852-5195 PO BOX 40384 PORTLAND OR ODS

30602010 351113 89 AS (800) 852-5195 PO BOX 40384 PORTLAND OR ODS

30603005 352530 38 AS (404) 564-7955 3120 BRECKINRIDGE DULUTH GA PRIMERICA LIFE INSURANCE CO

30603010 352530 38 AS (999) 999-9999 PO BOX 66953 CHICAGO IL PRIMERICA LIFE INSURANCE CO

30604005 358569 38 AS (800) 331-7620 PO BOX 1049 YOUNGSTOWN OH PROFESSIONAL RISK MANAGEMENT

30605005 358569 38 AS (999) 999-9999 PO BOX 50182 NASHVILLE TN ADMINITRON INC

30606005 351113 88 DO (800) 443-5089 PO BOX 30567 SALT LAKE CITY UT DENTAL BENEFIT PROVIDERS

30606010 351113 88 DO (800) 645-9851 PO BOX 256 MINNEAPOLIS MN DENTAL CLAIMS ADMINISTRATIVE SERVICES INC

30607005 358569 38 AS (412) 746-8700 PO BOX 330 CANONSBURG PA DIVERSIFIED GROUP ADMIN INC

30608005 358569 87 RX (800) 824-0898 PO BOX 390873 BLOOMINGTON MN EXPRESS SCRIPTS/DIVERSIFIED

30609005 351113 38 AS (999) 999-9999 PO BOX 11836 SAN FRANCISCO CA HEALTH SERVICE SYSTEM

30700005 352530 38 AS (999) 999-9999 PO BOX 1228 PASCAGOULA MS MILLETTE ADMINISTRATION

30701005 358569 38 AS (999) 999-9999 828 SHERIDAN ESCANABA MI RAMPART EMERGENCY MED SERVICES

30702005 413395 87 RX (999) 999-9999 313 TENT TOLEDO OH SMG MEDNET

30703005 413395 88 DO (999) 999-9999 1101 S CHESTNUT OWOSSO MI KIRKWOOD IND TOLEDO COMMUTATOR

30704005 358569 38 AS (999) 999-9999 PO BOX 5006 MONTICELLO NY MARKEL SERVICE INC

30705005 358569 88 DO (800) 772-4313 PO BOX 379 CLAWSON MI MICHIGAN DENTAL PLAN

30706005 358569 88 DO (999) 999-9999 PO BOX 183 SOUTHFIELD MI NORTH CENTRAL REG DENTAL

30707005 352530 38 AS (999) 999-9999 PO BOX 4759 SILVER SPRING MD RISK MANAGEMENT SERVICES

30708005 358569 38 AS (999) 999-9999 PO BOX 833828 RICHARDSON TX TARGET BENEFIT SERVICES

30709005 358569 38 AS (314) 822-7890

13515 BARRETT PKWY

DR BALLWIN MO BENEFIT CONSULTANTS INC

30709005 358569 38 X3 (314) 822-7890

13515 BARRETT PKWY

DR BALLWIN MO BENEFIT CONSULTANTS INC

30710005 358569 38 AS (614) 222-5463 PO DRAWER V VAN BUREN AZ BURGETT & LIFE

30711005 351113 38 AS (800) 764-7602 PO BOX 7152 DUBLIN OH CCI ADMINISTRATORS

30712005 358569 38 AS (215) 442-7000 PO BOX C5009 WARMINSTER PA BENEFIT CONCEPT

30712010 358569 89 AS (215) 442-7000 PO BOX C5009 WARMINSTER PA BENEFIT CONCEPT

30713005 358569 72 X5 (999) 999-9999 P O BOX 13307 LEXINGTON KY PLUMBERS & PIPEFITTERS H & W

30713010 358569 67 AS (800) 552-6550

2111 W LINCOLN

HIGHWAY MERRILLVILLE IN PLUMBERS & PIPEFITTERS LOCAL 172

Page 114: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30713015 358569 67 AS (800) 759-6944

2111 W LINCOLN

HIGHWAY MERRILLVILLE IN WEST MI PLUMBERS FITTERS & SERVICE TRADES

30714005 352530 38 AS (419) 897-1400

1720 INDIAN WOOD

CIRCLE, STE C MAUMEE OH STATELINE TPA INC

30716005 352530 38 AS (999) 999-9999 PO BOX 370 CHELSEA MI BOOKCRAFTERS

30717005 351113 39 AS (800) 441-3115 435 FORD ROAD MINNEAPOLIS MN FIRST HEALTH

30717010 358569 55 AS (800) 441-3115 435 FORD ROAD MINNEAPOLIS MN EBP HEALTH PLANS

30717015 358569 55 AS (999) 999-9999

2514 SOUTH 102ND

STREET WEST ALLIS WI EBP HEALTHPLANS

30718005 351113 39 AS (800) 325-3408 3109 W 41ST ST SIOUX FALLS SD FIRST HEALTH

30719005 351113 89 AS (800) 255-1139 PO BOX 5105 ENGLEWOOD CO PACIFICARE

30720005 358569 38 AS (866) 996-5200

2320 BRIGHTON-

HENRIETTA TOWNLI ROCHESTER NY BENEFIT RESOURCES INC

30721005 358569 67 AS (999) 999-9999 2929 S JEFFERSON ST LOUIS MO OPERATING ENGINEERS LOCAL 2

30721010 358569 67 XR (800) 238-4863

7370 CHEF MENTUR

HWY NEW ORLEANS LA OPERATING ENGINEERS

30721015 358569 89 AS (626) 356-1004 PO BOX 7067 PASADENA CA OPERATING ENGINEERS

30721020 358569 67 AS (800) 242-7018 PO BOX 160 PEWAUKEE WI OPERATING ENGINEERS LOCAL 139

30723005 351113 38 AS (999) 999-9999 PO BOX 453 GOSHEN IN AG TRUCKING

30724005 358569 38 AS (999) 999-9999

4410 NEW HAVEN

AVENUE FORT WAYNE IN INTERSTATE COLD STORAGE

30725005 358569 38 AS (999) 999-9999 1359 E 86TH PL MERRILLVILLE IN LABOR RESOURCES INC

30726005 352530 87 RX (999) 999-9999 PO BOX 740800 ATLANTA GA UNITED HEALTHCARE INS CO-PHARMACY

30727005 352530 38 AS (999) 999-9999 PO BOX 340 NEW BUFFALO MI PLASTIC MASTERS INC

30728005 352530 38 AS (999) 999-9999

6767 WEST OUTER

DRIVE DETROIT MI SINAIPLUS EMPLOYEE HEALTH

30729005 352530 89 AS (999) 999-9999 29777 TELEGRAPH RD SOUTHFIELD MI HEALTHPLUS OF MI

30730005 358569 89 AS (313) 496-0748 2401 20TH STEET DETROIT MI LIFE CHOICES QUALITY HEALTH

30731005 352530 89 AS (999) 999-9999 ONE EAST FIRST ST FLINT MI WELLNESS PLAN

30732005 352530 38 AS (800) 332-9161 PO BOX 1700 FLINT MI HEALTHPLUS OF MI

30733005 352530 89 AS (999) 999-9999 1060 WEST NORTON MUSKEGON MI WELLNESS PLAN

30734005 358569 89 AS (800) 677-6965 PO BOX 1195 MINNEAPOLIS MN CORESTAR

30735005 351113 38 AS (219) 485-0273 5972 STELLHORN FORT WAYNE IN CALEND GROUP

30736005 351113 05 AS (800) 238-6597 PO BOX 4445 ATLANTA GA BC BS OF GA

30737005 352530 38 AS (999) 999-9999 PO BOX 38058 TUSCON AZ CONFED ADMINISTRATIVE SERVICES

30738005 351113 38 AS (602) 244-8200 410 N 4TH PHOENIX AZ PACIFIC CARE

30739005 352530 38 AS (999) 999-9999 P.O. BOX 3368 OMAHA NV MUTUAL PLAN ADMINISTRATORS

30740005 358569 38 AS (309) 346-1161 2505 COURT PEKIN IL PEKIN LIFE

30741005 352530 38 AS (999) 999-9999 PO BOX 12847 ST PETERSBURG FL WITTNER INC CO

Page 115: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30742005 358569 38 AS (614) 848-6985 DRAWER 12477 COLUMBUS OH BENEFIT PLANS INC

30743005 352530 38 AS (999) 999-9999

11200 W PLAN CT STE

160 MILWAUKEE WI MEDICAL COLLEGE OF WI

30743010 352530 89 NO (800) 860-6381 PO BOX 549005 DALLAS TX MEDICAL CONTROL NETWORK

30744005 352530 34 AS (800) 553-7360 PO BOX 6101 AUBURN NY UNITED HEALTHCARE INS CO

30745005 358569 38 AS (999) 999-9999 20935 SWENSON DR. WAUKESHA WI PARTNERS MUTUAL INSURANCE

30746005 358569 38 AS (999) 999-9999 PO BOX 5007 SOUTHFIELD MI PENN GENERAL SERVICES

30747005 352530 38 AS (800) 235-7160

300 W DOUGLAS STE

800 WICHITA KS WILLIS CORROON CORP OF KS

30748005 413395 89 AS (602) 789-1170 5810 W BEVERLY LN GLENDALE AZ ADMINISTRATIVE ENTERPRISES INC

30749005 351113 05 AS (800) 730-8445 PO BOX 1220 CHICAGO IL BC BS OF IL

30750005 351113 89 AS (800) 423-2055 PO BOX 805107 CHICAGO IL BC BS OF IL

30751005 358871 87 RX (866) 485-0268 PO BOX 52136 PHOENIX AZ CAREMARK

30752005 358569 38 AS (517) 732-6264 PO BOX 580 GAYLORD MI GLEN'S MARKET

30753005 358569 76 AS (800) 354-4225 PO BOX 365 PARSIPPANY NJ CBCA ADMINISTRATORS INC

30754005 351113 38 AS (999) 999-9999

1901 E ELLSWORTH

RD YPSILANTI MI JAC PRODUCTS

30755005 351113 38 AS (999) 999-9999 703 LEONARD ST NW GRAND RAPIDS MI KENT PROVISION CLAIMS

30757005 413395 38 AS (800) 356-7126 40 JOHN GLENN DRIVE BUFFALO NY NORTH AMERICAN ADMINISTRATORS

30757010 413395 38 AS (615) 256-3561 PO BOX 1984 NASHVILLE TN NORTH AMERICA ADMINISTRATORS

30757015 413395 89 AS (615) 256-3561 PO BOX 1984 NASHVILLE TN NORTH AMERICA ADMINISTRATORS

30758005 352530 87 RX (999) 999-9999

111 CHERRY HILL

ROAD BALTIMORE MD PRESCRIPTION DRUGS INC

30759005 352530 38 AS (219) 237-0560 PO BOX 70 MIDDLEBURY IN SYNDICATE SYSTEMS

30760005 358569 67 AS (999) 999-9999 PO BOX 6298 TOLEDO OH TOLEDO HEALTH PLAN

30761005 358569 31 AS (999) 999-9999 PO BOX 567 MATTESON IL PRUDENTIAL INSURANCE COMPANY

30762005 358569 38 AS (999) 999-9999 4301 CANAL SW GRANDVILLE MI AFL CIO PUBLIC EMPLOYEE TRUST

30762010 413395 38 AS (800) 252-1303 PO BOX 1449 NEW YORK NY AFL CIO TRUST FUND

30763005 413395 87 RX (269) 226-7089 1521 GULL ROAD KALAMAZOO MI BORGESS HUMAN RESOURCES

30764005 358569 88 DO (800) 462-5410 PO BOX 15965 NORTH LITTLE ROCK AR DELTA DENTAL PLAN OF AR

30765005 358569 38 AS (999) 999-9999 PO BOX 19040 KALAMAZOO MI GROUP MARKETING SERVICE

30766005 358569 87 RX (616) 459-0133

25 JEFFERSON PLACE

SE GRAND RAPIDS MI PHARMACY NETWORK

30766010 358569 87 RX (800) 331-7108

4020 WAKE FOREST

ROAD RALIEGH NC CATALYST RX

30767005 358569 31 AS (999) 999-9999 PO BOX 9315 VAN NUYS CA PRU CARE OF CA

30768005 358569 38 AS (999) 999-9999 PO BOX 9888 SAVANNAH GA EMPLOYEE BENEFIT SERVICES

30769005 352530 89 AS (888) 853-6415 PO BOX 568 NORTH HAVEN CT BENESIGHT

Page 116: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30770005 352530 89 X2 (310) 671-3465

3405 W IMPERIAL

HWY INGLEWOOD CA UNITED HEALTH PLAN

30771005 358569 31 AS (999) 999-9999 PO BOX 4042 ISELIN NJ PRU CARE OF NJ

30772005 352530 67 AS (999) 999-9999 705 LIME CITY ROAD ROSSFORD OH UNITY PLUS H & W LOCAL 1076

30773005 413395 38 AS (800) 814-6084 PO BOX 171823 MEMPHIS TN UNITED MEDICAL RESOURCES

30773010 413395 38 AS (800) 414-6084 PO BOX 268820 OKLAHOMA CITY OK THIRD PARTY CLAIMS MANAGEMENT

30774005 351113 38 AS (313) 429-2218 8800 DIX AVENUE DETROIT MI EDWARD C LEVY COMPANY

30775005 358569 38 AS (412) 255-6906 PO BOX 1168 PITTSBURGH PA GAGE COMPANY

30776005 351113 38 AS (407) 295-8610

5526 PLYMOUTH

SORRENTO APOPKA FL DEALERS ASSOCIATION PLAN

30776010 413395 89 AS (800) 279-1301 PO BOX 56099 MADISON WI DEAN HEALTH PLAN

30777005 352530 38 AS (999) 999-9999

511 FARBER LAKES

DRIVE BUFFALO NY INDEPENDENT HEALTH

30778005 351113 88 DO (999) 999-9999

2570 TECHNICAL

DRIVE MIAMISBURG OH KY KARE DENTAL PLAN

30779005 351113 38 AS (999) 999-9999 PO BOX 37450 LOUISVILLE KY KY KARE PLANS

30780005 358569 38 AS (999) 999-9999

30775 BERRINGTON

AVENUE MADISON HEIGHTS MI MI EMPLOYERS TRUST

30781005 358569 38 AS (999) 999-9999

7651 HASKELL

AVENUE VAN NUYS CA NATIONAL STAFF NETWORK

30782005 413395 89 R6 (248) 357-7766 P O BOX 2720 FARMINGTON HILL MI PPOM

30783005 358569 38 AS (800) 365-9036 10795 WATSON ROAD ST LOUIS MO PENSION ASSOCIATES INC

30784005 351113 38 AS (800) 732-3412

2959 LUCERNE SE

SUITE 205 GRAND RAPIDS MI PROFESSIONAL BENEFITS SERVICES

30785005 358569 67 AS (800) 762-1215 PO BOX 55287 INDIANAPOLIS IN SHEET METAL WKRS LOCAL 20

30786005 352530 34 AS (999) 999-9999 1235 NE 47TH PORTLAND OR TRAVELERS PREFERRED

30787005 552530 38 X5 (800) 888-3306 P O BOX 4325 BATON ROUGE LA UNITED INSURANCE CO OF AMERICA

30788005 352530 38 AS (999) 999-9999 PO BOX 1250 ROCKFORD IL WESTERN FIDELITY INSURANCE CO

30789005 351113 38 AS (800) 226-5171 3203 LAWTON ROAD ORLANDO FL ADMINISTRATIVE SERVICES INC

30789010 351113 38 AS (305) 595-4040 PO BOX 839000 MIAMI FL ADMINISTRATIVE SERVICES INC

30790005 352530 67 AS (999) 999-9999 2700 EASTMAN ROAD MIDLAND MI THREE RIVERS CONSTRUCTION

30791005 351113 05 AS (206) 597-6500 1501 MARKET STREET TACOMA WA REGENCE BS

30791015 358616 89 AS (800) 533-1116 PO BOX 27401 RICHMOND VA TRIGON BC BS

30791025 358569 05 AS (800) 533-1116 PO BOX 14046 ROANOKE VA TRIGON BC BS

30792005 413395 38 AS (800) 365-9036 10795 WATSON RD ST LOUIS MO EPOCH GROUP

30792010 413395 38 AS (800) 255-6065 PO BOX 12170 OVERLAND PARK KS EPOCH GROUP

30792015 413395 89 AS (800) 255-6065 PO BOX 12170 OVERLAND PARK KS EPOCH GROUP

Page 117: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30793005 358569 38 AS (800) 244-2824 110 FREE STREET PORTLAND ME ME HEALTH PLAN INC

30794005 358569 89 X5 (800) 533-1116 PO BOX 27401 RICHMOND VA TRIGON BC BS

30794015 358569 88 DO (800) 453-3622

555 MIDDLECREEK

PARKWAY MS425 COLORADO SPINGS CO TRIGON BC BS

30795005 358569 38 AS (419) 866-7000

1001 HOLLAND PARK

BLVD HOLLAND OH BUNTING BEARINGS CORPORATION

30796005 352530 89 X4 (800) 851-0404

PO BOX 659747 RTE

2702 SAN ANTONIO TX UNITED HEALTHCARE/IBA

30796010 352530 89 NO (800) 842-3585 PO BOX 1459 MINNEAPOLIS MN UNITED HEALTHCARE PPO NETWORK

30797005 352530 38 AS (800) 443-2595

14665 MIDWAY RD

STE 110 DALLAS TX PRODUCERS EXCHANGE BEN SERV IN

30798005 413395 45 AS (999) 999-9999

4601 WESTOWN

PKWY #100 WEST DES MOINES IA PRINCIPAL FINANCIAL GROUP

30799005 358569 04 AS (708) 571-6210 9000 W 67TH STREET MERRIAM KS BANKERS UNITED LIFE ASSURANCE

30800005 358569 38 AS (999) 999-9999 PO BOX 13896 PHILADELPHIA PA BOARD OF PENSIONS PRESBYTERIAN

30801005 358569 38 AS (999) 999-9999 PO BOX 809092 DALLAS TX MOTEL 6 MEDICAL CLAIM SERVICE

30802005 358569 31 AS (999) 999-9999 PO BOX 378710 DENVER CO PRU CARE OF CO

30802010 358569 31 AS (999) 999-9999 PO BOX 45088 JACKSONVILLE FL PRU CARE OF CINCINNATI

30803005 358569 38 AS (999) 999-9999 35 WEST BROADWAY SALT LAKE CITY UT FHP OF UT

30803010 351113 38 AS (800) 333-4347 PO BOX 25187 SANTA ANA CA FHP

30804005 351113 38 AS (999) 999-9999 7 WEST 34TH STREET NEW YORK NY HIP OF GREATER NY

30805005 413395 63 AS (999) 999-9999 PO BOX 24110 OKLAHOMA CITY OK PRESIDIUM INC

30806005 413395 87 RX (717) 761-5266 20 ERFORD ROAD LEMOYNE PA MEDI-CLAIM INC

30806010 352530 38 AS (706) 279-1463 PO BOX 2088 DALTON GA MEDPLAN SELECT

30807005 358569 87 RX (800) 521-4548 2045 MIDWAY DRIVE TWINSBURG OH PRIME XTRA

30808005 352530 89 AS (999) 999-9999 PO BOX 1378 TROY MI SELECT HEALTH PLAN

30809005 352530 38 AS (800) 848-9978 PO BOX 1985 BATTLE CREEK MI TRANSAMERICA INSURNCE GROUP

30810005 351113 38 AS (999) 999-9999 PO BOX 796 DEERFIELD IL ACLIC

30812005 351113 38 AS (504) 849-1400

3616 S I-10 SERVICE

ROAD METAIRIE LA GULF SOUTH ADMINISTRATORS

30813005 358569 38 X5 (800) 626-3880

4133 WHITNEY

AVENUE NEW HAVEN CT ASSOCIATED PLAN ADMINISTRATORS

30814005 358569 88 DO (999) 999-9999 NORTH DRIVE #191 INDIANAPOLIS IN DELTA DENTAL PLAN OF IN

30815005 351113 38 AS (616) 663-8525 PO DRAWER C EDWARDSBURG MI DUO FORM OF MI INC

30816005 413395 89 AS (800) 964-7444

1101 CHESTNUT HILLS

PKWY FORT WAYNE IN EMPLOYEE PLANS

30817005 358569 38 AS (616) 777-2537 950 W NORTON MUSKEGON MI FLEET ENGINEERS

30818005 352530 38 AS (999) 999-9999

6554 LAKESHORE

ROAD LEXINGTON MI HANSON INDUSTRIES MEDICAL PLAN

Page 118: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30819005 351113 38 AS (918) 687-1261 PO BOX 1309 MUSKOGEE OK HEALTH CARE ADMINISTRATORS

30820005 351113 38 AS (999) 999-9999 PO BOX 9800 FRESNO CA MILK & ICE CREAM EMP WEL PLAN

30821005 358569 38 AS (309) 674-0888 PO BOX 689 PEORIA IL MUTUAL MEDICAL PLANS

30822005 352530 38 AS (999) 999-9999 5000 NORTH US131 REED CITY MI NARTRON CORPORATION

30823005 413395 67 AS (800) 362-9354

WARREN RD SUITE

240 NILES OH OH CARPENTERS H & W FUND

30824005 413395 89 NO (800) 831-1166 PO BOX 2720 FARMINGTON HILL MI COFINITY (PPOM)

30825005 358569 38 AS (999) 999-9999

1500 PRC DRIVE #239-

E MCLEAN VA PRC CORPORATED

30826005 413395 38 AS (877) 569-3075 PO BOX 60219 NEW ORLEANS LA PAN AMERICAN

30827005 352530 89 AS (800) 967-5439 PO BOX 7600 SOUTH BEND IN PARTNERS HEALTH PLAN

30827010 358569 89 AS (520) 696-1425 333 E WETMORE RD TUCSON AZ HEALTH PARTNERS HEALTH PLANS

30827015 358569 89 AS (800) 942-5695 PO BOX 24907 WINSTON SALEM NC PARTNERS NATIONAL HEALTH PLANS OF NC

30828005 358569 87 RX (999) 999-9999

815 NORTH

WASHINGTON AVE LANSING MI PHARMACY NETWORK

30829005 413395 45 AS (888) 476-8663

10895 CODY SUITE

200 OVERLAND PARK KS PRINCIPAL FINANCIAL GROUP

30830005 358569 88 DO (800) 843-3661 PO BOX 156 MINNEAPOLIS MN PRUDENTIAL DMO

30831005 358569 31 AS (999) 999-9999 PO BOX 44097 JACKSONVILLE FL PRU CARE OF ATLANTA

30832005 352530 38 AS (999) 999-9999 PO BOX 3640 DAYTON OH ST ELIZABETH INSURANCE CO

30833005 352530 38 AS (630) 637-4400 1733 PARK STREET NAPERVILLE IL THIRD PARTY ADMINISTRATORS

30833010 352530 89 XR (630) 637-4400 1733 PARK STREET NAPERVILLE IL THIRD PARTY ADMINISTRATORS

30833015 352530 38 AS (800) 466-7550

2900 CHAMBLEE

TUCKER ROAD ATLANTA GA TPA OF GA

30834005 352530 64 AS (317) 247-7381

2601 FORTUNE CIRCLE

E 103 A INDIANAPOLIS IN UFCW IN AREA

30835005 352530 38 AS (800) 338-4485 PO BOX 66210 ST PETERSBURG FL ALL RISK ADMINISTRATORS INC

30836005 358569 38 AS (312) 649-0444 PO BOX 11137 CHICAGO IL CHICAGO GRAPHIC ARTS

30837005 358569 38 AS (216) 526-5300 10100 BRECKVILLE RD BRECKSVILLE OH ASHMAN INTRA CORP

30838005 358569 38 AS (999) 999-9999 1111 S W GAGE BLVD TOPEKA KS CORPORATE PLAN MANAGEMENT

30839005 358569 55 AS (803) 577-8051 14 N ADGERS WHARF CHARLESTON SC EMPLOYEE BENEFIT SERVICES

30839010 358569 55 AS (800) 325-7477

229 E MICHIGAN

AVENUE STE 235 KALAMAZOO MI EMPLOYEE BENEFIT STRATEGIES

30839015 358569 89 AS (800) 325-7477

229 E MICHIGAN STE

235 KALAMAZOO MI EMPLOYEE BENEFIT STRATEGIES

30841005 358569 79 AS (800) 685-4542 PO BOX 26200 LEHIGH VALLEY PA GUARDIAN

30841010 358569 89 AS (800) 685-4542 PO BOX 8024 APPLETON WI GUARDIAN

30842005 358569 79 AS (800) 545-8604 PO BOX 9128 NORWELL MA GUARDIAN

30843005 358569 88 DO (800) 541-7846 PO B0X 2459 SPOKANE WA GUARDIAN DENTAL GUARD PREFERRED

Page 119: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30844005 358569 79 AS (999) 999-9999 PO BOX 2457 SPOKANE WA GUARDIAN

30845005 413395 38 AS (800) 392-1770 171 WEST WING ARLINGTON HGTS IL ALTERNATIVE RISK MANAGEMENT

30846005 352530 38 AS (999) 999-9999 PO BOX 1386 EAST LANSING MI HEALTH BENEFIT

30847005 413395 38 AS (999) 999-9999 200 S 1ST STREET CHESANING MI HEHR GLASS

30848005 413395 38 AS (999) 999-9999 4301 CANAL SW GRANDVILLE MI MEBS INC

30849005 358569 33 AS (999) 999-9999

2160 S FOSTER

AVENUE WHEELING IL MID STATES TEAMSTERS H & W

30850005 358569 38 AS (718) 392-2242 3232 48TH AVENUE LONG ISLAND CIT NY METAL TRADES BRANCH LOCAL 638

30851005 352530 87 RX (800) 247-4526 PO BOX 5824 SPARTANBURG SC PREMIER PHARMACY PLAN

30852005 352530 38 AS (815) 282-0622

1400 SOUTH

INDUSTRIAL DR MISHAWAKA IN THERMOPLASTICS INC

30853005 352530 38 X5 (407) 287-7650

700 CENTRAL

PARKWAY STUART FL MCCREARY CORP

30854005 352530 38 AS (999) 999-9999 ROUTE 2704 DULUTH MN VHC MANAGEMENT CO INC

30855005 351113 38 AS (812) 372-9955 PO BOX 2549 COLUMBUS IN WOODS & GROOMS

30855010 351113 89 AS (812) 372-9955 PO BOX 2549 COLUMBUS IN WOODS & GROOMS

30856005 352530 38 AS (999) 999-9999

5001 N SECOND

STREET ROCKFORD IL WOODWARD GOVERNOR CO HEALTH

30857005 358569 38 AS (999) 999-9999 PO BOX T GRAND RAPIDS MI AMERICAN COMMERCIAL LIABILITY

30858005 358569 38 AS (999) 999-9999 207 E FULTON GRAND RAPIDS MI AMISURE

30859005 358569 38 AS (704) 845-5608 PO BOX 1178 MATTHEWS NC BENEFIT MANAGEMENT SERVICES

30859010 352530 38 AS (800) 245-3529 PO BOX 3859 PORTLAND ME BENEFIT MANAGEMENT OF ME

30859015 352530 38 AS (616) 891-1984 PO BOX 17 CALEDONIA MI BENEFIT MANAGEMENT ADMINISTRATION INC

30859020 358569 89 AS (800) 228-1803 PO BOX 1178 MATTHEWS NC BENEFIT MANAGEMENT SERVICES

30860005 352530 38 AS (612) 896-3200 PO BOX 9312 MINNEAPOLIS MN BEST BUY GROUP BENEFIT PLAN

30861005 352530 38 AS (999) 999-9999 PO BOX 30078 TAMPA FL CENTENNIAL LIFE

30862005 358569 38 AS (601) 982-8210 PO BOX 22587 JACKSON MS DIXIE NATIONAL LIFE

30863005 352530 38 AS (812) 378-9960 PO BOX 2369 COLUMBUS IN DUNN & ASSOCIATES

30864005 351113 39 AS (800) 780-6768 PO BOX 392 EXTON PA FIRST HEALTH

30865005 358569 38 AS (800) 845-7046 PO BOX 55237 PHOENIX AZ ELDORADO CLAIMS SERVICE INC

30866005 358569 38 AS (281) 368-7878 PO BOX 441588 HOUSTON TX ENTRUST INC

30868005 352530 38 AS (206) 287-2000 PO BOX 34750 SEATTLE WA GROUP HEALTH COOPERATIVE

30868010 352530 89 AS (608) 831-1766 PO BOX 44971 MADISON WI GROUP HEALTH COOPERATIVE HMO

30869005 358569 38 AS (999) 999-9999 PO BOX 8210 CLEARWATER FL JEC HEALTH CLAIMS

30870005 352530 38 AS (999) 999-9999 PO BOX 29300 ATLANTA GA KIMBERLY CLARK CORPORATION

30871005 358569 38 AS (999) 999-9999 2255 FORT STREET LINCOLN PARK MI MASTER CARE PLAN

30872005 352530 38 AS (800) 475-5025 PO BOX 540 COLORADO SPRING CO MEDICAL NETWORK OF

30873005 413395 38 AS (999) 999-9999 PO BOX 31 DAVENPORT IA OSCAR MAYER FOODS CORPORATION

30874005 358569 89 AS (999) 999-9999

PO BOX 169064 RT

2781 DULUTH MN PHYSICIANS PLUS HMO

30874010 352530 89 NO (800) 394-7569 PO BOX 4055 JACKSON MI PHYSICIANS CHOICE NETWORK

30875005 413395 45 AS (999) 999-9999

18000 PACIFIC HWY

SOUTH SEATTLE WA PRINCIPAL FINANCIAL GROUP

Page 120: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30876005 358569 31 AS (999) 999-9999 PO BOX 2688 JACKSONVILLE FL PRUDENTIAL INSURANCE COMPANY

30877005 352530 38 AS (800) 526-8409 100 S BROADWAY SALEM OH QUAKER HEALTH SERVICES

30878005 352530 67 AS (999) 999-9999

32300

NORTHWESTERN HWY FARMINGTON HILL MI REINFORCED IRONWORKERS LOCAL

30879005 351113 38 AS (800) 426-8803 PO BOX 8069 COLUMBUS GA SOUTHERN ADMINISTRATIVE

30880005 413395 38 AS (860) 652-4400

115 GLASTONBURY

BLVD. GLASTONBURY, CT TRIAD LLC

30881005 552530 38 AS (800) 223-2440 PO BOX 8130 TACOMA WA UNITED EMPLOYEES BENEFIT TRUST

30882005 351113 38 AS (800) 370-5790 PO BOX 1460 LITTLE ROCK AR BLUE ADVANTAGE ADMINISTRATORS

30883005 352530 67 AS (715) 835-3174 PO BOX 4002 EAU CLAIRE WI WI CARPENTERS HEALTH

30884005 352530 38 AS (330) 966-5500 PO BOX 35008 CANTON OH AMERICAN BENEFITS MANAGEMENT

30884010 352530 89 AS (800) 456-4002

8310 PORT JACKSON

AVE NW NORTH CANTON OH AMERICAN BENEFITS MANAGEMENT

30885005 413395 38 AS (999) 999-9999 PO BOX 4138 AKRON OH BENEFIT SERVICES INC

30886005 358569 38 AS (800) 296-5555 550 12TH ST SW #12 WASHINGTON DC CAPITAL CARE

30887005 352530 38 AS (803) 735-1251 PO BOX 100102 COLUMBIA SC COMPANION LIFE

30888005 358569 38 AS (800) 732-9375 PO DRAWER 349 TROY AL CONSOLIDATED NATIONAL LIFE

30889005 358569 67 AS (414) 449-1155

6310 W APPLETON

AVENUE MILWAUKEE WI CONSTRUCTION WORKERS HEALTH

30890005 358569 38 AS (999) 999-9999 PO BOX 9084 FARMINGTON HILL MI FAMILY HEALTHCARE PLAN

30891005 352530 38 AS (216) 673-5821 PO BOX 807 KENT OH GOUGLER INDUSTRIES INC

30892005 413395 38 AS (999) 999-9999 PO BOX 80817 INDIANAPOLIS IN GREAT WESTERN HEALTH PLAN

30894005 351113 38 X3 (901) 725-6435 PO BOX 41779 MEMPHIS TN INSUREX BENEFITS ADMIN INC

30895005 358569 88 DO (999) 999-9999 PO BOX 1251 BUFORD GA PRUDENTIAL INSURANCE COMPANY

30896005 358569 31 AS (999) 999-9999 PO BOX 100 MONROEVILLE PA PRUDENTIAL INSURANCE COMPANY

30897005 358569 87 RX (800) 248-1062 PO BOX 758 WEST BEND WI RESTAT DRUG PROGRAM

30898005 352530 89 XD (800) 462-0224 333 WYMAN STREET WALTHAM MA TUFT ASSOCIATED HEALTH PLAN

30899005 352530 38 AS (717) 249-1866 PO BOX 40 CARLISLE PA MASLAND PLUS

30899010 352530 38 AS (999) 999-9999

1855 STEPEHENSON

HIGHWAY TROY MI MASLAND INDUSTRIES

30900005 358569 67 AS (312) 787-9455 12 EAST ERIE STREET CHICAGO IL CHICAGO CARPENTERS H & W

30901005 352530 38 AS (999) 999-9999 600 LUCY GARRETT ROXBORO NC FLEETWOOD ENTERPRISES

30902005 358113 38 AS (317) 861-1424 PO BOX 279 BEECH GROVE IN GOOD SAMARITAN PROGRAM

30902010 358569 87 RX (800) 324-6331 PO BOX 686002 SAN ANTONIO TX ADVANCE PCS

30903005 358569 38 AS (999) 999-9999

325 N HANOVER

STREET HASTINGS MI HASTINGS MANUFACTURING CO

30904005 351113 38 AS (999) 999-9999 PO BOX 5059 LAFAYETTE IN HEALTH CARE ADMINISTRATORS

Page 121: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30905005 351113 38 AS (800) 284-4885

150 W MARKET ST

STE 830 INDIANAPOLIS IN ISTA INSURANCE TRUST

30906005 352530 38 AS (800) 247-1466

511 FARBER LAKES

DRIVE BUFFALO NY INDEPENDENT HEALTH

30907005 413395 38 AS (999) 999-9999

5211 LINBAR DR STE

513 NASHVILLE TN JEFFERSON PILOT

30908005 413395 45 AS (999) 999-9999

1001 GALLERIA

PARKWAY ATLANTA GA PRINCIPAL FINANCIAL GROUP

30909005 358569 38 AS (800) 236-1272

2901 W BELTLINE STE

100 MADISON WI BENEFIT PLAN ADMINISTRATORS

30910005 113395 88 DO (800) 526-2414

PO BOX 169063 RT

2708 DULUTH MN UNITED HEALTH & LIFE DENTAL PL

30911005 359253 38 AS (999) 999-9999 PO BOX 8947 GRAND RAPIDS MI WEST MI CUSTOMER SERVICE

30912005 358569 87 RX (800) 324-6331

909 EAST COLLINS

BLVD RICHARDSON TX ADVANCE DRUG

30913005 358569 87 RX (517) 787-1370 3529 SCHEELE DRIVE JACKSON MI ALLIED CHUCKER

30914005 352530 38 AS (800) 741-0185

14801 QUORUM

DR.,#500 DALLAS TX NEXCALIBER

30915005 352530 86 VO (800) 828-9341

4201 N 24TH ST, STE

300 PHOENIX AZ AVESIS VISION SERVICES

30916005 351113 38 AS (540) 629-6469 PO BOX 626 BASSETT VA BASSETT FURNITURE INDUSTRIES

30917005 358569 47 AS (800) 323-5000 PO BOX 5116 DES PLAINES IL CENTRAL STATES

30918005 358569 47 AS (999) 999-9999 PO BOX 5100 CHICAGO IL CENTRAL STEEL & WIRE COMPANY

30919005 358569 38 PS (800) 934-7245 PO BOX 1002 MERRIFIELD VA VALUE OPTIONS

30920005 358569 38 AS (708) 689-4900

NUMBER ONE

TANTALUM PLAC N CHICAGO IL FANSTEEL INC

30921005 358569 38 AS (800) 245-0533 PO BOX 909991 MILWAUKEE WI MEDICAL BENEFITS ADMIN

30922005 358569 38 AS (905) 521-7100 BOX 2280,STATION A HAMILTON ON ONTARIO MINISTRY OF HEALTH

30923005 351113 30 AS (999) 999-9999 P O BOX 2094 CONCORD NH CIGNA HEALTHCARE

30925005 351113 38 AS (999) 999-9999 PO BOX 5010 FT SCOTT KS ITT HARTFORD

30925010 351113 38 AS (999) 999-9999 9300 TECH CENTER DR SACRAMENTO CA ITT HARTFORD

30926005 358569 38 AS (999) 999-9999 1001LAKESIDE AVE CLEVELAND OH KAISER

30926010 358569 89 AS (800) 464-4000 PO BOX 7004 DOWNEY CA KAISER PERMANENTE

30927005 351113 38 AS (815) 282-0622 PO BOX 2850 ROCKFORD IL MID AMERICA PLAN ADMINISTRATOR

30928005 358569 38 AS (219) 253-6621 PO BOX 655 MONON IN MONON CORPORATION

30929005 352530 89 AS (800) 252-4611 PO BOX 477 NEWTOWN SQUARE PA NATIONAL ELEVATOR INDUSTRY

30930005 351113 38 AS (800) 368-2469 PO BOX 11959 TUCSON AZ NATIONAL STANDARD

30931005 352530 89 AS (800) 888-6227 PO BOX 10153 FAIRFAX VA NCAS

30932005 351113 38 R6 (800) 237-7820 505 MERRITT- SEVEN NORWALK CT OLIN CORPORATION

Page 122: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30933005 413395 89 AS (800) 491-4425 PO BOX 240 MONROE MI BENEFIT SOURCE

30933010 413395 89 AS (616) 226-8028

1535 GULL RD - SUITE

340 KALAMAZOO MI BORGESS MANAGED CARE

30933015 413395 89 NO (800) 491-4425 PO BOX 19400 KALAMAZOO MI PREFERRED PARTNERS NETWORK

30933020 413395 38 AS (800) 491-4425 PO BOX 240 MONROE MI BENEFIT SOURCE

30934005 358569 87 RX (999) 999-9999 49 S YORK ROAD HATBORO PA PRESCRIPTION DELIVERY SYSTEMS

30935005 413395 45 AS (800) 533-5044 PO BOX 39710 COLORADO SPRINGS CO PRINCIPAL FINANCIAL GROUP

30935010 413395 45 AS (888) 447-3696 PO BOX 39710 COLORADO SPRINGS CO PRINCIPAL FINANCIAL GROUP

30936005 352530 38 AS (999) 999-9999 PO BOX 2608 DAYTON OH REYNOLDS & REYNOLDS

30937005 413395 38 AS (800) 322-3506 PO BOX 8495 CHICAGO IL RMSCO MANAGEMENT SERVICES INC

30938005 352530 38 AS (800) 547-9515 PO BOX 209 PORTLAND OR STANDARD INSURANCE COMPANY

30939005 413395 38 AS (512) 451-2224 PO BOX 26580 AUSTIN TX UNITED TEACHER ASSOC INSURANCE

30940005 358569 38 AS (999) 999-9999 PO BOX 025351 MIAMI FL AMERICAN HEALTH RESOURCES ASSO

30941005 352530 38 AS (800) 888-9603 PO BOX 5096 PORTLAND OR ASSOCIATED AMINISTRATORS INC

30943005 358569 88 DO (800) 626-1456 2401 S E TONES DRIVE ANKENY IA DELTA DENTAL PLAN OF IA

30944005 358569 88 DO (999) 999-9999 23 OLD DEPOT ROAD NEW CUMBERLAND PA DELTA USA

30944010 358569 88 DO (800) 524-0149 PO BOX 9085 FARMINGTON HILL MI DELTA USA

30944015 358569 88 DO (800) 237-6060 4818 STARKEY RD SW ROANOKE VA DELTA DENTAL PLAN OF VA

30944020 358569 88 DO (800) 398-7203 PO BOX 5402 LISLE IL DELTA USA

30944025 358569 88 DO (800) 448-3815 PO BOX 59238 MINNEAPOLIS MN DELTA USA

30945005 358569 55 AS (999) 999-9999 6864 LOOP ROAD CENTERVILLE OH EBP HEALTH PLANS

30946005 358569 38 AS (999) 999-9999 731 JAMES STREET SYRACUSE NY FOUNIER GROUP

30947005 358569 89 AS (800) 852-9556 3400 LAKESIDE DRIVE MIRAMAR FL HUMANA HEALTH CARE PLANS

30948005 358569 38 X5 (214) 340-8995 9304 FORSEST LANE DALLAS TX JEFFERSON LIFE INSURANCE CO

30949005 352530 38 AS (810) 293-8240 34800 BENNETT FRASER MI MP PUMPS

30950005 358569 38 AS (999) 999-9999 PO BOX 10909 SPRINGFIELD MO MED PAY INC

30950010 358569 89 AS (800) 777-9087 PO BOX 10909 SPRINGFIELD MO MED PAY INC

30951005 358569 38 AS (219) 436-7879 PO BOX 80247 FORT WAYNE IN MIDWEST HEALTH SYSTEMS INC

30952005 358569 38 AS (999) 999-9999 PO BOX 8500 CORAOPOLIS PA MIDWEST BENEFIT CORP

30953005 413395 72 AS (800) 759-6944

2111 WEST LINCOLN

HWY MERRILLVILLE IN MUSKEGON PLUMBERS & PIPEFITTER

30954005 358569 38 AS (800) 615-7020 PO BOX 23 SHEBOYGAN WI PRAIRIE STATES

30955005 358569 89 AS (414) 443-4130 PO BOX 26649 MILWAUKEE WI PRIMECARE HEALTH PLAN INC

30956005 358569 38 AS (800) 562-5453 10560 WAYZATA BLVD MINNETONKA MN PROFESSIONAL CLAIM ADMINISTRAT

30957005 358569 38 AS (800) 824-3882 PO BOX 9387 MINNEAPOLIS MN HEALTH RISK MANAGEMENT

30958005 352530 89 AS (213) 385-6161 501 SHATTO PLACE LOS ANGELES CA SOUTH CA PIPE TRADERS

30958010 358569 64 AS (805) 327-4481 PO BOX 1808 BAKERSFIELD CA SOUTHERN CA UFCW

Page 123: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30959005 352530 38 AS (313) 477-1450

23985 INDUSTRIAL

PARK DR FARMINGTON HILL MI WHITE CASTLE SYSTEMS INC

30960005 358569 89 X2 (800) 289-0260 111 WEST PLEASANT MILWAUKEE WI WI HEALTH ORGANIZATION

30961005 358569 38 AS (999) 999-9999 PO BOX 2000 WINSTON-SALEM NC ACS CONSULTING SERVICES INC

30962005 358569 87 RX (800) 824-0898 PO BOX 390873 BLOOMINGTON MN EXPRESS SCRIPTS/VALUE RX

30962010 358569 87 RX (800) 347-8777 PO BOX 41366 PLYMOUTH MN EXPRESS SCRIPTS/ RX CHOICE VALUE RX

30963005 351113 38 AS (999) 999-9999 PO BOX 4925 LANCASTER PA ADMINISTRATOR & CONSULT. LTD

30964005 358569 38 AS (999) 999-9999 PO BOX 978 FT VALLEY GA ALLEN MEDICAL CLAIMS ADMINISTR

30965005 352530 38 AS (216) 293-5900 PO BOX 459 ANDOVER OH BUFFALO MOLDED PLASTICS INC

30966005 351113 38 AS (209) 478-6540 1617 ST MARKS PLAZA STOCKTON CA BECKWITH HIGHTOWER INS SER INC

30967005 358569 38 AS (773) 736-0505

4801 W PETERSON

AVENUE CHICAGO IL BENE-FLEX INC

30968005 358569 38 AS (999) 999-9999 PO BOX 4509 ROCKFORD IL BENEFITS ADMINISTRATION SERVIC

30969005 359274 89 AS (800) 645-2583

PO BOX 2500,600

LAFAYETTE DETROIT MI BLUE CHOICE NETWORK

30970005 358569 38 AS (800) 657-0805 3065 N 124TH STREET BROOKFIELD WI BROWER GROUP SERVICES INC

30971005 351113 38 AS (999) 999-9999 75 VALENCIA AVENUE CORAL GABLES FL CAC RAMSAY HEALTH PLANS INC

30972005 351113 89 AS (716) 884-2800 PO BOX 159 BUFFALO NY COMMUNITY BLUE HMO OF W NY

30973005 358569 38 AS (800) 833-8464 139 S TRYON STREET CHARLOTTE NC CORPORATE BENEFITS SERVICE INC

30974005 358569 38 AS (800) 444-2393 PO BOX 13307 LEXINGTON KY EAGLES ADMINISTRATORS LIMITED

30975005 358569 55 AS (999) 999-9999

2300 MAIN ST SUITE

1090 KANSAS CITY MO EMPLOYEE BENEFIT PLANS INC

30976005 351113 38 AS (999) 999-9999 PO BOX 1391 DAYTON OH HEALTH BUILDER

30977005 352530 89 AS (800) 224-8535 PO BOX 930 FREDERICK MD UNITED HEALTHCARE/MAMSI LIFE & HEALTH

30978005 358569 38 AS (800) 733-8880 PO BOX 809095 DALLAS TX MID WEST NATL LIFE INS CO TN

30979005 352530 38 AS (800) 523-4702 PO BOX 477 NEWTOWN SQUARE PA NATIONAL ELEVATOR INDUSTRY

30980005 352530 38 AS (999) 999-9999 PO BOX 23325 OAKLAND CA N CA BUTCHER'S UNION & EMP HLT

30981005 351113 67 AS (304) 525-0331 PO BOX 2967 HUNTINGTON WV OUTSIDE ELECTRICAL WELF FUND

30982005 352530 38 AS (602) 230-0052 P O BOX 34799 PHOENIX AZ PM GROUP BENEFITS

30983005 358569 38 AS (800) 776-6070 PO BOX 1550 HUNTINGTON BEAC CA PACIFIC HEALTH ADMINISTRATORS

30984005 352530 38 AS (616) 963-5585

131 GRAND TRUNK

AVENUE BATTLE CREEK MI KENDALL ELECTRIC

30985005 358569 38 AS (800) 866-7879 PO BOX 2703 CHICAGO IL PREFERRED WORKS INC

30985010 413395 38 AS (800) 675-1233 PO BOX 1847 GRAND RAPIDS MI PREFERRED UNITED PLANS/SECURE ONE

30986005 358569 38 AS (999) 999-9999 1100 OAKMAN BLVD DETROIT MI RALSTON PURINA COMPANY

30987005 358569 38 AS (918) 586-7950

TWO WEST SECOND

STREET TULSA OK SEABURY & SMITH

Page 124: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

30987010 358569 38 AS (800) 245-6728 PO BOX 14426 DES MOINES IA SEABURY & SMITH

30988005 352530 38 XR (800) 432-6636

4775 INDIAN

SCHOOL,NE105 ALBUQUERQUE NM NM UFCW UNION H&W TRUS

30989005 358569 87 RX (248) 637-5300

2401 W BIG BEAVER

ROAD TROY MI SELECT CARE PHARMACY

30990005 358569 38 AS (888) 310-2533 PO BOX 02459 DETROIT MI ALLIANCE

30990010 358569 38 AS (972) 960-8497 PO BOX 809095 DALLAS TX ALLIANCE

30991005 352530 38 AS (999) 999-9999 980 JOLLY ROAD BLUE BELL PA US HEALTHCARE

30992005 352530 38 AS (999) 999-9999 PO BOX 1871 APPLETON WI UNITED PREFERRED

30993005 351113 88 DO (810) 263-1717

17010 CLINTON RIVER

RD MT CLEMENS MI AMERICA'S BEST DENTAL PLAN

30994005 358569 38 AS (818) 973-3700 PO BOX 7891 BURBANK CA ARATEX SERVICES INC

30995005 352530 38 AS (999) 999-9999 PO BOX 1006 DALTON GA DURKAND

30996005 358569 89 AS (999) 999-9999 333 14TH STREET TOLEDO OH FAMILY HEALTH PLAN

30997005 358569 89 X2 (800) 635-3121 7601 ORA GLEN DRIVE GREENBELT MD NYLCARE HEALTH PLANS

30998005 352530 38 AS (999) 999-9999 PO BOX 2150 MONTGOMERY AL KINDER CARE GROUP INSURANCE

30999005 358569 38 AS (203) 572-1946 PO BOX 49 LEDYARD CT MASHANTUCKET PEQUOT TRIBE

33333333 358871 91 AA (999) 999-9999 NA NA MI MEDICARE-ENROLLED IN PART A

33992231 a AS (999) 999-9999 TEST LANSING MI TEST

40000005 358569 38 AS (999) 999-9999 PO BOX 9514 MANCHESTER NH MATTHEW THORNTON HEALTH PLAN

40001005 358569 38 AS (800) 221-9039 777 MAIN STREET FORT WORTH TX NATIONAL FOUNDATION LIFE INS

40002005 352530 38 AS (999) 999-9999

1901 N STATE HWY

360 GRAND PRAIRIE TX NATIONAL HEALTH CARE

40003005 358569 38 AS (800) 546-4620

20300 CIVIC CENTER

DRIVE SOUTHFIELD MI NORTH AMERICAN DENTAL

40004005 358569 89 AS (800) 999-5703 PO BOX 9010 BUFFALO NY NOVA HEALTHCARE ADMINISTRATORS

40005005 352530 38 AS (999) 999-9999 PO BOX 151 DECATUR IL PM AG PRODUCTS

40006005 358569 67 AS (800) 525-1817 PO BOX 2640 PASADENA CA PRINTING SPECIALTIES & PAPER

40007005 358569 38 AS (999) 999-9999 2030 S NATIONAL SPRINGFIELD MO PREMIER BENEFITS

40008005 352530 89 AS (800) 472-2363 PO BOX 8000 MARSHFIELD WI SECURITY HEALTH PLAN

40008005 352530 89 XR (800) 472-2363 PO BOX 8000 MARSHFIELD WI SECURITY HEALTH PLAN

40009005 358569 88 DO (800) 762-3159

6683 CENTERVILLE

BUS PKY DAYTON OH SUPERIOR DENTAL CARE

40009010 358569 86 VO (800) 507-3800 PO BOX 967 RANCHO CORDOVA CA SUPERIOR VISION SERVICES INC

40010005 352530 34 AS (999) 999-9999 PO BOX 182281 COLUMBUS OH UNITED HEALTHCARE INS CO

40011005 352530 38 AS (800) 879-9288

601 THIRTEENTH

STREET NW WASHINGTON DC WYATT CO

40012005 351113 36 AS (999) 999-9999 PO BOX 567 GREENWOOD IN ACORDIA CORPORATE BENEFITS

40013005 358569 38 AS (999) 999-9999 1716 N STREET NW WASHINGTON DC AMERICAN FOREIGN SERVICE

40014005 358569 38 AS (999) 999-9999 PO BOX 35 DANIA FL AMERICAN MARITIME OFFICERS

40015005 351113 38 AS (999) 999-9999 345 S HIGH STREET MUNCIE IN BALL CORPORATION

Page 125: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40016005 358569 38 AS (800) 344-5822

450 WEST 76TH

STREET DAVENPORT IA BENEFIT ADMINISTRATORS OF AMER

40017005 358569 38 AS (999) 999-9999 PO BOX 2720 FARMINGTON HILL MI BOSCH CHOICE

40018005 351113 67 AS (999) 999-9999 PO BOX 11509 CHATTANOOGA TN CARPENTERS FRINGE BENEFITS

40019005 351113 38 AS (317) 872-2100 PO BOX 68550 INDIANAPOLIS IN CECORR INC

40020005 352530 38 AS (616) 246-0700

2850 KALAMAZOO

AVE SE GRAND RAPIDS MI CHRISTIAN REFORMED

40021005 358569 38 AS (999) 999-9999 PO BOX 23759 COLUMBIA SC CREW BENEFITS PLAN

40022005 413395 38 AS (810) 984-9563 PO BOX 5003 PORT HURON MI EB EDDY PAPER INC

40022010 413395 38 AS (419) 525-3961 PO BOX 636 MANSFIELD OH EB BEVERAGES

40023005 358569 55 AS (412) 922-0780

26600 EMERY IND

PKWY CLEVELAND OH EMPLOYEE BENEFIT CLAIMS INC

40023010 358569 38 AS (999) 999-9999 820 PARISH STREET PITTSBURGH PA EMPLOYEE BENEFIT CLAIMS INC

40024005 351113 89 AS (520) 748-8900

698 E WETMORE

ROAD TUCSON AZ FHP INC

40025005 358569 38 AS (219) 237-0560

1525 SOUTH TENTH

STREET GOSHEN IN GOSHEN RUBBER PRODUCTS

40026005 358569 38 AS (616) 343-2611 BOX 19040 KALAMAZOO MI GREAT LAKES EMPLOYERS ASSOCIAT

40027005 358569 38 AS (999) 999-9999

3210 WATLING

STREET EAST CHICAGO IN INLAND STEEL FLAT PRODUCTS CO

40028005 358569 38 AS (414) 336-3134 PO BOX 3007 DE PERE WI MCMONAGLE LUMBAR INC

40029005 413395 89 AS (800) 458-5512 PO BOX 30990 SALT LAKE CITY UT MEDICA

40030005 358569 38 AS (999) 999-9999 4428 SECOR ROAD TOLEDO OH NORTHWEST PHYSICIANS

40031005 413395 38 R6 (313) 677-6790 2000 HOGBACK ROAD ANN ARBOR MI PREFERRED HEALTH PARTNERS

40032005 352530 89 AS (800) 913-9982 PO BOX 619055 DALLAS TX HEALTHSCOPE BENEFITS

40032010 358569 89 AS (800) 793-9403 PO BOX 17571 BALTIMORE MD PRIMARY SELECT

40033005 352530 87 RX (800) 759-3203 PO BOX 240034 MILWAUKEE WI SERVE YOU CUSTOM RX MGMT

40034005 352530 38 X3 (800) 722-0292 2073 E SAHARA STE B LAS VEGAS NV SILVER STATE MEDICAL

40035005 352530 88 DO (414) 357-2040

9052 N DEERBROOK

TRAIL MILWAUKEE WI SMILEAGE DENTAL CARE

40036005 358569 38 AS (999) 999-9999

515 EAST MUSSER

STREET CARSON CITY NV STATE INDUSTRIAL INSURANC

40037005 358569 89 AS (800) 323-5000 PO BOX 5116 DES PLAINES IL TEAMCARE

40038005 352530 38 AS (800) 368-3653 PO BOX 11910 ALEXANDRIA VA TEAM MED CARE

40039005 358569 38 AS (999) 999-9999 PO BOX 3205 MT CLEMENS MI HEALTH CARD

40040005 358569 38 AS (999) 999-9999 13467 QUINCY STREET HOLLAND MI TRENDWAY CORPORATION

40041005 351113 64 AS (714) 220-2297 P O BOX 6010 CYPRESS CA UNITED FOOD & COMMERCIAL TRUST

40042005 358569 38 AS (999) 999-9999 2215 FULLER ROAD ANN ARBOR MI VETERANS MEDICAL

40043005 352530 38 AS (608) 251-5577 PO BOX 5345 MADISON WI WI AUTO & TRUCK DEALERS ASSOC

40044005 352530 38 XR (501) 378-2164 PO BOX 1520 IOWA CITY IA ARKANSAS FIRST SOURCE

Page 126: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40045005 358569 89 AS (415) 952-2005

1111 BAYHILL DR STE

300 SAN BRAVO CA AETNA HEALTH PLANS OF NORTHERN

40046005 351113 38 AS (999) 999-9999 PO BOX 100 WALLED LAKE MI AMERICAN PLASTIC TOYS INC

40047005 413395 38 AS (800) 533-4585 409 E COOK ROAD FORT WAYNE IN PRINCIPAL HEALTH CARE OF IN

40047010 413395 38 AS (999) 999-9999 PO BOX 410976 KANSAS CITY MO PRINCIPAL HEALTH CARE

40047015 413395 38 AS (800) 833-7423 2751 CENTERVILLE RD WILMINGTON DE PRINCIPAL HEALTH CARE

40047020 413395 89 AS (800) 358-6205 PO BOX 44029 JACKSONVILLE FL PRINCIPAL HEALTH CARE OF FL

40047025 413395 89 AS (800) 325-7498 PO BOX 5057 VILLA PARK IL PRINCIPAL HEALTH CARE OF IL

40048005 358569 38 AS (999) 999-9999 50 GLEN STREET GLEN COVE NY BENEFIT PLAN ADMINISTRATORS

40048010 358569 38 AS (800) 277-8973

101 S JEFFERSON

STREET ROANOKE VA BENEFIT PLAN ADMINISTRATORS

40048015 358569 38 AS (800) 554-3951 PO BOX 2339 FARGO ND BENEFIT PLAN ADMINISTRATORS

40049005 358113 38 AS (999) 999-9999

15725 TWELVE MILE

ROAD ROSEVILLE MI FRAZA EQUIPMENT INC

40050005 351113 89 AS (866) 926-8409 PO BOX 368 PARIS KY REVSTONE HEALTH SERVICES

40050005 351113 89 X5 (866) 926-8409 PO BOX 368 PARIS KY REVSTONE HEALTH SERVICES

40050010 358569 38 AS (419) 891-1212 PO BOX 1500 MAUMEE OH AMERICAN HEALTH GROUP

40050015 413395 38 AS (800) 827-7223 PO BOX 749075 DALLAS TX GROUP AND PENSION ADMINISTRATORS

40050020 358569 89 AS (419) 891-1212

1789 INDIAN WOOD

CIRCLE MAUMEE OH AMERICAN HEALTH GROUP

40051005 413395 38 AS (800) 344-5076 PO BOX 6607 CHARLESTON WV HEC

40052005 352530 87 RX (800) 729-3784 PO BOX 994 DES MOINES IA SYSTEMED

40053005 351113 38 AS (866) 481-8450 PO BOX 1210 SANDUSKY OH NORTH SHORE ADMINISTRATORS

40054005 358569 38 AS (616) 887-1479 PO BOX 202 SPARTA MI NORTHWEST AMBULANCE SERVICE

40055005 413395 89 AS (866) 798-0803 PO BOX 6702 COLUMBIA SC PLANNED ADMINISTRATORS INC

40056005 358569 89 AS (999) 999-9999

100 LEBARRON

STREET WAUKEGON IL PLUMBERS LOCAL UNION 93 H & W

40056010 358569 67 AS (800) 792-3666 PO BOX 1028 TRENTON NJ PLUMBERS & PIPEFITTERS LOCAL #9

40057005 358569 89 AS (703) 903-7100

7700 A LEESBURG

PIKE FALLS CHURCH VA AETNA HEALTH PLANS OF THE

40058005 352530 38 AS (999) 999-9999 PO BOX 248 NEWTOWN PA SNL ADMINISTRATORS

40059005 351113 38 AS (800) 955-7376

1188 FRANKLIN ST

#102 SAN FRANCISCO CA ANTHEM HEALTH ACORDIA BENEFITS

40060005 358569 38 AS (800) 323-1726 PO BOX 93670 LUBBOCK TX AMERICAN ADMINISTRATORS

40061005 358569 38 AS (815) 967-4704

5701 W DICKMAN

ROAD BATTLE CREEK MI ATWOOD AUTOMOTIVE INC

40062005 358569 38 AS (999) 999-9999 PO BOX 1017 INDIANAPOLIS IN BOEHRINGER MANNHEIM

40063005 351113 38 AS (999) 999-9999 PO BOX 3355 PITTSBURGH PA HIGHMARK LIFE & CASUALTY

40064005 413395 64 X2 (800) 241-3473 1800 PHOENIX BLVD ATLANTA GA CUB UFCW THE

40064010 413395 89 AS (702) 733-9938

1901 LAS VEGAS

BOULEVARD LAS VEGAS NV CULINARY WORKERS HEALTH FUND

Page 127: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40065005 358569 38 AS (914) 694-2122 209 HARRISON AVE HARRISON NY EXCESS HEALTH

40066005 358569 38 AS (800) 222-2184 8228 MAYFIELD ROAD CHESTERFIELD OH FRANK HELLER ASSOCIATES

40067005 358569 38 AS (800) 441-4518 PO BOX 1747 REDMOND OR JELD WEN HEALTH BENEFIT PLAN

40068005 358569 38 AS (999) 999-9999 PO BOX 248 BRATTLEBORO VT LIBERTY PREFERRED CARE

40069005 551113 64 AS (312) 829-0850

1649 W ADAMS

STREET CHICAGO IL UNITED FOOD & COMMERCIAL WKRS

40070005 413395 89 XR (800) 533-4585 PO BOX 39710 COLORADO SPRINGS CO PRINCIPAL HEALTH CARE OF IN

40071005 358569 38 AS (217) 421-2236 2200 EAST ELDORADO DECATUR IL AE STALEY MANUFACTURING CO

40072005 351113 38 AS (999) 999-9999 PO 2226 WILMINGTON DE AMERICAN LIFE INSURANCE

40073005 352530 87 RX (800) 792-7487 1300 WASHINGTON KANSAS CITY MO ARGUS HEALTH SYSTEMS

40074005 352530 38 AS (999) 999-9999

1355 OAKMAN

BOULEVARD DETROIT MI FOCUS HOPE

40075005 352530 38 AS (800) 824-1895 PO BOX 255700 SACRAMENTO CA FOUNDATION HEALTH

40076005 358569 38 AS (616) 796-2400

1919 INDUSTRIAL

DRIVE BIG RAPIDS MI GLOBE BUSINESS FURNITURE

40077005 352530 38 AS (317) 844-6201 PO BOX 1950 CARMEL IN IN CONF OF SEVENTH DAY ADVENT

40078005 352530 38 AS (999) 999-9999 131 GRAND TRUNK BATTLE CREEK MI KENDALL ELECTRIC INC

40079005 352530 38 PS (999) 999-9999 11095 VIKING DR EDEN PRAIRIE MN MCC BEHAVIORAL CARE

40080005 358569 38 AS (999) 999-9999

2600 HORIZON DRIVE

SE GRAND RAPIDS MI MANUFACTURERS INDUSTRIAL

40081005 358569 38 AS (800) 423-3151 PO BOX 1129 NEWARK OH MEDICAL BENEFITS MUTUAL

40081500 358569 89 AS (704) 525-1473 PO BOX 12995 CHARLOTTE NC MEDICAL CLAIMS MANAGEMENT CORPORATION

40082005 358569 38 AS (888) 792-7828 PO BOX 7834 GREENSBORO NC PENN WESTERN BENEFITS INC

40083005 358569 38 AS (800) 521-4548 PO BOX 1088 TWINSBURG OH PRIME XTRA

40084005 351113 87 RX (800) 622-5579 P O BOX 3598 SCRANTON PA ARGUS (RX PRIME/CIGNA RX SERVICES)

40084010 413395 87 RX (800) 622-5579 PO BOX 780 HARTFORD CT RX PRIME

40084015 358569 87 RX (800) 854-4469 PO BOX 390873 BLOOMINGTON MN EXPRESS SCRIPTS

40084020 351113 87 RX (800) 770-8014

221 N CHARLES

LINDBERGH DR SALT LAKE CITY UT RX AMERICA

40084025 358569 87 RX (888) 479-2000 PO BOX 4517 ENGLEWOOD CO WELLDYNE RX WEST

40085005 352530 38 AS (517) 791-9800 PO BOX 610609 SAGINAW MI SAGINAW CHARTER TOWNSHIP

40086005 352530 87 RX (999) 999-9999 448 EAST 6400 SOUTH SALT LAKE CITY UT SCRIPT CARD

40086010 352530 87 RX (800) 880-9988 6380 FOLSOM DR BEAUMONT TX SCRIPT CARE

40086015 351113 87 RX (877) 794-3576 15400 E. JEFFERSON GROSSE POINTE PARK MI SCRIPTGUIDE

40087005 352530 89 AS (800) 269-2698 PO BOX 909714 CHICAGO IL SHARE HEALTH PLAN OF IL

40088005 352530 38 AS (800) 831-7783

1979 MARCUS

AVENUE LAKE SUCCESS NY W J JONES ADMINISTRATIVE SERVICES INC

Page 128: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40088010 352530 89 AS (800) 831-7783

1979 MARCUS

AVENUE LAKE SUCCESS NY W J JONES ADMINISTRATIVE SERVICES INC

40089005 351113 05 AS (808) 948-6110

818 KEEAUMOKU

STREET HONOLULU HI BC BS OF HI

40090005 351113 67 AS (702) 646-4406 PO BOX 61320 LAS VEGAS NV CARPENTERS HEALTH & WELFARE

40091005 358569 38 AS (417) 623-5229 PO BOX 2547 JOPLIN MO CONTRACT FREIGHTERS INC

40092005 358569 88 DO (810) 743-2356 500 PERRY RD GRAND BLANC MI DENTAL GROUP OF AMERICA

40093005 351113 38 AS (713) 224-9483

440 LOUISIANA

STREET HOUSTON TX DONOVAN BENEFIT SYSTEMS INC

40094005 413395 17 AS (800) 848-2664 PO BOX 6133 WESTERVILLE OH UNITED MEDICAL RESOURCES

40095005 358569 38 AS (999) 999-9999 4839 DUBOIS DETROIT MI HOTELS STATLER CO INC

40096005 358569 33 AS (800) 859-6862 1233 SHELBY STREET INDIANAPOLIS IN LOCAL 135 WELFARE FUND

40096010 358569 67 AS (800) 425-1272 11270 W PARK PLACE MILWAUKEE WI LOCAL UNIONS 19 & 127 H & W

40096015 358569 89 AS (516) 832-9200

1587 STEWART

AVENUE WESTBURY NY LOCAL UNION INSURANCE #1102

40097005 358569 88 DO (800) 346-0310

200 N MARTINGALE

RD SCHAUMBURG IL SIGNATURE DENTAL PLAN

40098005 358569 89 AS (518) 798-3555

TWO BROAD STREET

PLAZA GLEN FALLS NY NORTHCARE COMMUNITY HEALTH

40099005 352530 87 RX (999) 999-9999 PO BOX 9007 OVERLAND PARK KS PHARMA LINK PHARMACY PROGRAM

40099010 358871 87 RX (800) 777-1023 PO BOX 52188 PHOENIX AZ CAREMARK (PHARMACARE)

40100005 352530 38 AS (800) 562-8560 PO BOX 1461 ST LOUIS MO REGIT

40100010 352530 38 AS (999) 999-9999 PO BOX 3796 SCOTTSDALE AZ REGIT

40101005 352530 38 AS (800) 888-2264 PO BOX 51629 NEW ORLEANS LA SIERRA HEALTH & LIFE

40102005 413395 89 AS (800) 666-4449 PO BOX 5548 FORT WAYNE IN SIGNATURE CARE INC

40103005 352530 38 AS (615) 929-1193 PO BOX 1296 JOHNSON CITY TN SNAP ON TOOLS

40103010 352530 38 AS (414) 656-5411 2801 80TH STREET KENOSHA WI SNAP ON TOOLS

40104005 358569 38 AS (800) 826-0012 PO BOX 1724 WAUSAU WI TBG

40105005 358569 38 AS (712) 258-1525 PO BOX 3440 SIOUX CITY IA THREE RIVERS BENEFIT CORP

40106005 413395 38 X3 (800) 270-4329 PO BOX 30153 TAMPA FL UNITED PLANS INC

40107005 358569 38 AS (515) 628-7273 PO BOX 200 PELLA IA VERMEER

40108005 352530 38 AS (805) 566-9191 1155 EUGENIA PLACE CARPINTERIA CA ASSOCIATION GROUP INSURANCE

40109005 351113 38 AS (999) 999-9999 PO BOX 8788 WILMINGTON DE EMPLOYEE BENEFITS TRUST

40110005 351113 38 AS (800) 552-7879 PO BOX 4884 HOUSTON TX NEW ERA LIFE INSURANCE COMPANY

40111005 352530 38 AS (999) 999-9999 2045 EAST M-78 EAST LANSING MI OVERHEAD DOOR CO OF LANSING

40112005 352530 34 AS (800) 542-3590 PO BOX 9476 MINNEAPOLIS MN TRAVELERS EXPRESS COMPANY INC

40113005 351113 87 RX (708) 455-8300

3030 CULLERTON

DRIVE FRANKLIN PARK IL AMERICAN DRUG

40114005 351113 89 AS (708) 503-5000 SUITE 1450 CHICAGO IL AMERICAN HMO/AMERICAN HEALTHCARE PLAN

40115005 358569 38 AS (800) 424-9883 PO BOX 5108 DES MOINES IA AMERICAN SOCIETY OF CIVIL ENGINEERS

Page 129: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40116005 413395 38 AS (800) 558-8909

P O BOX 506 STATION

F TORONTO ON MANULIFE FINANCIAL INSURANCE

40117005 351113 89 AS (800) 909-6790 P O BOX 9084 FARMINGTON HILLS MI COMMUNITY HEALTH PARTNERS

40117010 351113 89 NO (574) 647-1820 PO BOX 1293 SOUTH BEND IN COMMUNITY HEALTH ALLIANCE NETWORK

40117015 351113 89 AS (800) 378-5234 PO BOX 14039 MILWAUKEE WI COMMUNITY HEALTH PLAN OF WI

40118005 351113 38 AS (999) 999-9999 DEPARTMENT 778983 HARRISBURG PA COMP 1 CENTER

40119005 413395 76 AS (614) 890-0070 PO BOX 2920 CLINTON IA CORESOURCE

40119010 413395 76 AS (999) 999-9999 4940 CAMPBELL BLVD BALTIMORE MD CORESOURCE

40119015 413395 76 AS (717) 295-9201 PO BOX 83301 LANCASTER PA CORESOURCE

40119020 413395 76 AS (800) 582-7140 419 E MAIN SUITE 2 MIDDLETON NY CORESOURCE

40119025 413395 89 AS (800) 511-0468 PO BOX 83301 LANCASTER PA CORESOURCE

40119030 413395 89 AS (800) 624-7130

4940 CAMPBELL BLVD

SUITE 200 BALTIMORE MD CORESOURCE

40119035 413395 89 AS (800) 545-1769

5200 77 CENTER DR

STE 400 CHARLOTTE NC CORESOURCE

40119040 413395 76 AS (800) 223-3943 PO BOX 2920 CLINTON IA CORESOURCE

40120005 351113 87 RX (999) 999-9999 PO BOX 27488 OMAHA NE CURAFLEX PRESCRIPTION SERVICES

40121005 358569 38 AS (999) 999-9999 PO BOX 45530 SALT LAKE CITY UT DMBA

40122005 358569 88 DO (800) 870-9988 PO BOX 79001 DETROIT MI DELTA CARE HMO PLAN OF MI

40123005 358569 88 DO (800) 494-4138 PO BOX 222 PARSIPPANY NJ DELTA DENTAL PLAN OF NJ

40124005 358569 88 DO (800) 392-1167 PO BOX 8690 ST LOUIS MO DELTA DENTAL PLAN OF MO

40125005 358569 38 AS (317) 276-2000

LILLY CORPORATE

CENTER INDIANAPOLIS IN ELI LILLY & COMPANY EMPLOYEE

40126005 358569 38 AS (402) 342-7600 PO BOX 31488 OMAHA NE EXCLUSIVE HEALTHCARE OF CO

40127005 358569 38 AS (419) 692-6145 PO BOX 369 DELPHOS OH I & K DISTRIBUTORS INC

40128005 358569 38 AS (999) 999-9999 PO BOX 9424 MADISON WI MEDICAL BENEFIT ADMINISTRATORS

40129005 358569 38 AS (800) 247-2192 PO BOX 9126 DES MOINES IA MEDIPLUS THE HARTFORD

40130005 358569 38 AS (999) 999-9999 PO BOX 7677 ST CLAIR SHORES MI MONGOOSE ADMINISTRATORS

40131005 358569 89 AS (800) 238-1344

ONE PRESCOTT

SOUTH MEMPHIS TN PITTMAN & ASSOCIATES

40132005 358569 87 RX (999) 999-9999 SUITE 200 MAUMEE OH PRESCRIPTION CARD INC

40133005 358569 38 AS (999) 999-9999 P O BOX 639 LAKEWOOD OH PROGRESSIVE ADMIN CONSULTANTS

40134005 352530 38 AS (704) 587-1483 PO BOX 7900 CHARLOTTE NC SIM USA

40135005 358569 38 AS (712) 258-1525 518 8TH ST SUITE E SIOUX CITY IA THREE RIVERS BENEFIT CORPORATI

40136005 352530 89 AS (800) 521-2612 PO BOX 659750 SAN ANTONIO TX UNITED HEALTH CARE OF GA

40136010 358569 89 AS (800) 236-6440 PO BOX 507 APPLETON WI TOUCHPOINT HEALTH PLAN

40136015 352530 89 AS (800) 711-3566 P.O. BOX 659735 SAN ANTONIO TX UNITED HEALTHCARE OF FL

40137005 352530 38 AS (800) 237-1900 PO BOX 200908 ARLINGTON TX UNITED SERVICE ASSOCIATION

40137010 352530 38 AS (999) 999-9999 PO BOX 619999 DALLAS TX UNITED SERVICE ASSOCIATION

Page 130: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40137015 352530 38 AS (999) 999-9999

1901 N STATE HWY

#360 GRAND PRAIRIE TX UNITED SERVICE ASSOCIATION

40138005 358569 38 AS (866) 900-8322 PO BOX 91588 ARLINGTON TX VEBA

40139005 358569 38 AS (312) 906-8080 208 LASALLE STREET CHICAGO IL ALLIED BENEFIT SYSTEMS

40139010 351113 38 AS (888) 926-8436 PO BOX 15244 NEWARK NJ ANTHEM HEALTH & LIFE

40140005 351113 38 AS (800) 245-0886 PO BOX 59345 MINNEAPOLIS MN ARCH MINERAL CORPORATION

40141005 413395 38 AS (800) 237-8447 PO BOX 247 SHELDON IA BRIDGESTONE AMERICAS HOLDING, INC

40142005 358569 67 AS (706) 278-6666 PO BOX 4539 DALTON GA COMBINED ADMINISTRATIVE SERV

40143005 413395 38 AS (800) 759-0101 PO BOX 1326 FORT WORTH TX FSL ADMINISTRATIVE SERVICES

40144005 358569 38 AS (800) 633-1860

1030 15TH STREET

NW WASHINGTON DC GLOBAL BENEFITS INC

40144010 413395 89 AS (954) 430-6767 PO BOX 823067 SOUTH FLORIDA FL GLOBAL EXCHANGE

40145005 358569 20 AS (800) 354-4008 540 GLEN AVE MOORESTOWN NJ GROUP BENEFIT

40146005 358569 38 AS (262) 567-9695 100 S MAIN SUITE 400 OCONOMOWOK WI HEP ADMINISTRATORS INC

40147005 358569 89 AS (847) 234-8870

101 N WAUKEGAN

ROAD LAKE BLUFF IL CEMARA

40148005 358569 38 AS (517) 321-3130

1118 CENTENNIAL

WAY LANSING MI MAXCO INC

40149005 358569 38 AS (800) 937-6542 PO BOX 39710 COLORADO SPRINGS CO NIPPON LIFE INSURANCE

40149010 358569 89 AS (800) 937-6542 PO BOX 39710 COLORADO SPRINGS CO NIPPON LIFE INSURANCE

40150005 358569 38 XR (800) 777-1502 PO BOX 7709 BEND OR PACIFIC HEALTH & LIFE

40151005 352530 87 RX (999) 999-9999 PO BOX 80715 LOS ANGELES CA PRESCRIPTION HEALTH SERVICE

40152005 351113 38 AS (999) 999-9999 PO BOX 6963 LINCOLN NE RE MEMBER GROUP HOSPITAL CLAIM

40153005 352530 38 AS (317) 778-8511 PO BOX 991 MUNCIE IN TOWNSEND TREE SERVICE CO INC

40154005 413395 38 AS (800) 847-8217 P O BOX 43999 CLEVELAND OH ADMINISTAR SOLUTIONS

40155005 358569 38 AS (999) 999-9999 PO BOX 1321 BRADENTON FL EIF

40156005 358569 62 XD (800) 638-2639 8119 DATAPOINT SAN ANTONIO TX HUMANA HEALTH CARE PLAN INC

40156010 358569 89 AS (800) 333-6400

2231 E CAMELBACK

ROAD PHOENIX AZ HUMANA UNITED HEALTH CARE

40156015 358569 89 AS (800) 638-2639 PO BOX 14603 LEXINGTON KY HUMANA HEALTH CARE PLAN INC

40157005 352530 38 AS (999) 999-9999 PO BOX 802346 CHICAGO IL TDI MANAGED CARE INC

40157010 352530 87 RX (800) 785-5301 PO BOX 2680 PITTSBURGH PA PHARMACARE

40157015 352530 88 DO (317) 356-6543 PO BOX 19884 INDIANAPOLIS IN ECIT DENTAL PLANS

40158005 413395 38 AS (800) 842-9815 200 N LASALLE STREET CHICAGO IL AMA INSURANCE AGENCY INC

40159005 358569 89 AS (999) 999-9999

640 TEMPLE SUITE

200 DETROIT MI BEST CHOICE ALLIANCE

40160005 351113 38 AS (216) 848-1511

127 HAZELWOOD

AVENUE BARBERTON OH CHRISTIAN BROTHERHOOD

40161005 358569 38 AS (800) 356-7126 PO BOX 1046 ELKHART IN CREATION WINDOWS OF IN

40162005 358569 87 RX (630) 420-3900 55 SHUMAN BLVD NAPERVILLE IL DRUG CARD INCORPORATED

Page 131: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40163005 352530 38 AS (800) 438-7886

2300 MAIN ST SUITE

700 KANSAS CITY MO HEALTHNET

40164005 351113 38 AS (800) 554-8744 411 N. BAYLEN ST. PENSACOLA FL IDEALIFE INSURANCE

40165005 358569 67 AS (818) 769-0007 PO BOX 1118 STUDIO CITY CA MOTION PICTURE H & W

40166005 413395 38 AS (856) 428-7722

132 KINGS HIGHWAY

EAST HADDONFIELD NJ RAPP & COMPANY

40167005 352530 84 IO (202) 638-4318

100 INDIANA AVE NW

#510 WASHINGTON DC US LETTER CARRIERS MUTUAL

40168005 352530 38 AS (616) 772-4697 1992 96TH AVENUE ZEELAND MI WALTERS GARDENS INC

40169005 351113 89 AS (800) 955-3035 PO BOX 23705 LOUISVILLE KY ALTERNATIVE HEALTH

40170000 358569 86 VO (999) 999-9999 285 W 74TH PLACE HIALEAH FL ARANON CORPORATION

40170005 358569 04 AS (999) 999-9999 926 BUHL BUILDING DETROIT MI BANKERS LIFE INSURANCE

40171005 352530 38 AS (812) 482-3212

4201-A MANNHEIM

ROAD JASPER IN BR ASSOCIATES EMPLOYEE

40172005 358569 38 AS (800) 989-2505 PO BOX 18245 COLUMBUS OH BUCKEYE EMPLOYEE BENEFIT SERVS

40173005 358569 38 AS (800) 809-6119 PO BOX 1608 ROCKVILLE MD CONTINUED HEALTH CARE

40174005 413395 87 RX (888) 837-4518 2045 MIDWAY DRIVE TWINSBURG OH EB RX INC

40174010 358569 38 AS (800) 242-1510 PO BOX 1929 FORT MILL SC EB SERVICES INC

40174015 358569 89 AS (800) 256-2657

5960 W PARKER RD

STE 278 #161 PLANO TX EMPLOYEE BENEFIT SERVICES OF LA

40175005 358569 38 AS (810) 463-3840 1558 MALOW MT CLEMONS MI FINDLAY INDUSTRIES EMPLOYEE

40176005 351113 38 X5 (202) 833-4910 1716 N STREET NW WASHINGTON DC FOREIGN SERVICE BENEFIT PLAN

40177005 351113 38 AS (999) 999-9999

PKWY #4108 - PO BOX

2568 BIRMINGHAM AL FOUNTAINHEAD ADMINISTRATORS

40178005 358569 38 AS (999) 999-9999 PO BOX 419397 KANSAS CITY MO GALLAGHER WOODSMALL

40179005 358569 38 AS (919) 846-8400 PO BOX 19108 RALEIGH NC INTERACTIVE MEDICAL SYSTEMS

40180005 358569 38 AS (800) 542-9172 PO BOX 34750 SEATTLE WA OPTIONS HEALTH CARE

40181005 358569 38 X2 (800) 289-1122 PO BOX 1410 JACKSONVILLE FL PROFESSIONAL INSURANCE CORPORA

40181010 358569 38 PS (800) 854-1133

240 CORPORATE

BOULEVARD NORFOLK VA OPTIONS MENTAL HEALTH

40182005 352530 38 AS (999) 999-9999 1415 MOYLIN ROAD PANAMA CITY BEA FL RADIO OFFICERS UNION

40183005 352530 38 AS (508) 855-5326 440 LINCOLN STREET WORCESTER MA FIRST ALLMERICA FINANCIAL LIFE

40184005 358569 38 AS (612) 546-7041

5270 W 84TH ST STE

520 MINNEAPOLIS MN SUBURBAN HEALTH CARE BENEFITS

40184010 358569 38 AS (999) 999-9999

240 CORPORATE

BOULEVARD NORFOLK VA OPTIONS MENTAL HEALTH

40185005 352530 67 AS (312) 243-1265

53 W JACKSON SUITE

630 CHICAGO IL TUCKPOINTERS WELFARE LOCAL 52

40186005 358569 38 X2 (305) 557-9004 285 W 74TH PLACE HIALEAH FL ARANON CORPORATION

Page 132: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40187005 351113 38 AS (609) 931-0200 540 GLEN AVENUE MOORESTOWN NJ AMERICAN SHOWER & BATH CORP

40188005 358569 38 AS (317) 290-1205 PO BOX 68917 INDIANAPOLIS IN BENICORP INSURANCE CO OF IN

40189005 351113 67 AS (999) 999-9999 27 WAREHOUSE ROAD ALBANY NY CARPENTERS BENEFIT PLAN

40190005 351113 38 AS (999) 999-9999 FIFTH STREET MARQUETTE MI CAR QUEST

40191005 352530 38 AS (419) 936-2800 PO BOX 2790 TOLEDO OH CITY OF TOLEDO EMPLOYER

40191010 358569 87 RX (248) 948-9900

26711

NORTHWESTERN HWY

STE 400 SOUTHFIELD MI EMPLOYEE HEALTH INS MANAGEMENT (EHIM)

40191015 358569 88 DO (866) 302-4542 PO BOX 2459 SPOKANE WA FIRST COMMONWEALTH

40191020 352530 38 AS (800) 449-9137 117 CENTER PARK DR KNOXVILLE TN FUTUREPOINT INC

40191025 358569 38 AS (419) 252-5500 ONE SEAGATE TOLEDO OH HEALTH CARE & RETIREMENT CORP

40191030 358569 38 AS (888) 310-2533 PO BOX 02399 DETROIT MI HEALTH CHOICE(HAP)

40191035 358569 89 AS (888) 310-2533 PO BOX 02399 DETROIT MI HEALTH CHOICE (HAP)

40191040 358569 38 AS (800) 801-1766 PO BOX 02459 DETROIT MI ALLIANCE HEALTH & LIFE INSURANCE

40191045 358569 89 AS (800) 801-1766 PO BOX 02459 DETROIT MI ALLIANCE HEALTH & LIFE INSURANCE

40192005 351113 38 AS (802) 864-8321 PO BOX 2365 S BURLINGTON VT COMPREHENSIVE BENEFITS ADMIN

40192010 351113 89 AS (800) 365-2735 PO BOX 64668 ST PAUL MN COMPREHENSIVE CARE SERVICES

40192015 358569 38 AS (888) 999-4957 PO BOX 9219 OAK BROOK IL DESTINY HEALTH

40192020 358569 89 AS (888) 448-3299 PO BOX 130799 ANN ARBOR MI PARTNERSHIP HEALTH

40193005 358569 38 AS (800) 204-2300 PO BOX 2156 BISMARK ND CORPORATE HEALTH INSURANCE CO

40194005 352530 38 AS (216) 337-1155 PO BOX 1189 SALEM OH EWI INC

40195005 358569 38 AS (999) 999-9999 PO BOX 3125 PORTLAND OR PROVIDENCE GOOD HEALTH PLAN OF OR

40196005 358569 20 AS (800) 354-4008 1000 PLAZA DRIVE SCHAUMBURG IL GROUP BENEFITS UNLIMITED

40196010 358569 89 AS (800) 354-4008 999 PLAZA DRIVE SCHAUMBURG IL GROUP BENEFITS UNLIMITED

40197005 352530 87 RX (800) 788-2949

10660 SCRIPPS RANCH

BLVD SAN DIEGO CA WAYNE COUNTY HEALTHCHOICE

40198005 351113 89 AS (702) 242-7418 PO BOX 15645 LAS VEGAS NV HEALTH PLAN OF NV

40199005 358569 38 AS (800) 624-2356 PO BOX 419104 ST LOUIS MO HEALTHLINK

40199010 351113 89 AS (800) 658-9777

2002 W LOOP 289,

SUITE 105 LUBBOCK TX ICON/TED PARKER & ASSOC

40199050 351113 89 AS (800) 822-0350

280 GRANITE RUN

DRIVE LANCASTER PA HEALTHGUARD

40200005 358569 38 AS (999) 999-9999 500 GRISWOLD DETROIT MI MICHCON

40201005 351113 38 AS (999) 999-9999 691 N SQUIRREL ROAD AUBURN HILLS MI MI EDUCATION EMP MUT INS

40202005 413395 89 AS (800) 663-8081 PO BOX 11111 FORT SCOTT KS GREAT WEST LIFE & ANNUITY PHCS

40203005 358569 38 AS (800) 222-7150 1957 BEVERLY SW WYOMING MI PACKAGING CORP OF AMERICA

40204005 358569 38 AS (999) 999-9999

3120 BRECKINRIDGE

BLVD DULUTH GA PRIMENICAN LIFE INSURANCE CO

40205005 358569 38 AS (999) 999-9999 PO BOX 101387 FORT WORTH TX PRO NET

Page 133: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40205010 352530 87 RX (999) 999-9999 PO BOX 2228 OMAHA NE PRO PAR SERVICES INC

40205015 358569 89 AS (800) 551-7334 PO BOX 9648 FORT WAYNE IN PRO-CLAIM PLUS INC

40206005 351113 38 AS (800) 435-5694 PO BOX 4687 OAKBROOK IL PROFESSIONAL BENEFIT ADMINISTRATORS

40206010 351113 89 AS (800) 435-5694 PO BOX 4687 OAKBROOK IL PROFESSIONAL BENEFIT ADMINISTRATORS

40206015 351113 89 AS (800) 732-3412 2959 LUCERNE SE GRAND RAPIDS MI PROFESSIONAL BENEFIT SERVICES

40207005 358569 38 AS (202) 863-0025

PO BOX 6803 FT DAVIS

STA WASHINGTON DC PUBLIC SERVICE EMP HEALTH

40207010 352530 38 AS (800) 765-7347 560 EAST 200 SOUTH SALT LAKE CITY UT PEHP

40208005 358569 38 AS (800) 248-1062

INDUSTRIAL

BOULEVARD FORT WORTH TX TECNOL INC

40209005 358569 38 AS (502) 244-1343 PO BOX 23507 LOUISVILLE KY UNDERWRITERS SAFETY & CLAIMS

40210005 352530 38 AS (941) 936-6242 5245 BIG PINE WAY FORT MYERS FL GMP EMPLOYERS RETIREES TRUST

40211005 358569 38 AS (217) 546-5290 PO BOX 3041 SPRINGFIELD IL PROFESSIONAL SERV INDUSTRIES

40212005 413395 38 AS (419) 475-7107 4428 SECOR ROAD TOLEDO OH ACCESS HEALTH CARE

40213005 352530 38 AS (800) 621-5081

230 W MONROE

STREET CHICAGO IL ALBERT H WOHLERS & CO

40214005 351113 87 RX (800) 213-5640 33 NORTH ROAD WAKEFIELD RI SCRIPT SOLUTIONS

40215005 352530 38 AS (999) 999-9999 PO BOX 468 MOLINE IL BARTLETT AGENCY INC

40216005 358569 89 NO (262) 784-0223 PO BOX 0978 BROOKFIELD WI HCN PPO NETWORK

40217005 358569 38 AS (800) 424-1120 P.O. BOX 10340R DESMOINES IA FLEET RESERVE ASSOCIATION

40218005 352530 87 RX (800) 872-7471 PO BOX 859 SANDY UT HCPP CLAIMS

40219005 352530 38 R6 (800) 645-4585 PO BOX 38 GREENACRES WA HEALTH CARE INCORPORATED

40220005 413395 86 VO (888) 322-0919 18984 LIVERNOIS DETROIT MI HERITAGE VISION PLANS

40220010 358569 38 AS (999) 999-9999 PO BOX 24825 FORT LAUDERDALE FL HERITAGE INSURANCE

40221005 352530 38 AS (999) 999-9999 PO BOX 54996E ROAD SANTA CLARA CA HITACHI DATA SYSTEMS

40222005 351113 38 AS (601) 963-2308 PO DRAWER K NETTLETON MS LUCKY STAR INDUSTRIES

40223005 358569 38 AS (423) 238-7111 PO BOX 2078 COLLEGEDALE TN MCKEE FOODS

40223010 358569 89 AS (888) 327-0671 PO BOX 1511 FLINT MI MCLAREN HEALTH ADVANTAGE

40223100 358569 38 AS (800) 785-5535 PO BOX 1670 DANVILLE IL INTERSTATE ADMINISTRATIVE SERVICES

40224005 351113 38 AS (999) 999-9999 PO BOX 14247 LANSING MI MI MANUFACTURERS ASSOC

40225005 351113 87 RX (800) 423-1973 PO BOX 64812 ST PAUL MN PRIME THERAPEUTICS

40225010 351113 87 RX (999) 999-9999 PO BOX 64338 ST PAUL MN GOLDNET

40226005 358569 38 AS (999) 999-9999

340 WEST

WASHINGTON AVE MADISON WI PHYSICIANS PLUS INS CORP

40227005 358569 38 AS (216) 493-7278 PO BOX 35276 CANTON OH PROFESSIONAL CLAIMS MANAGEMENT

40228005 352530 38 AS (800) 862-4638

3033 CLEVELAND

AVENUE SANTA ROSA CA SONOMA COUNTY MEDICAL FOUNDATI

40229005 352530 38 AS (999) 999-9999 467 SELDEN DETROIT MI TOTAL ARMORED CAR SERVICE

40230005 413395 38 AS (800) 654-9768 PO BOX 619099 DALLAS TX AAG BENEFIT PLAN ADMINISTRATORS INC

40231005 558569 72 AS (999) 999-9999 PO BOX 3039 BIRMINGHAM MI UNITED ASSOC JOURN PLUMB/STEAM

40232005 351113 38 XR (800) 926-1094 PO BOX 19 MEMPHIS TN BENEFIX

Page 134: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40233005 358569 38 AS (800) 798-1109 PO BOX 100896 NASHVILLE TN CRYSTAL CARRIERS INC

40234005 358569 20 AS (999) 999-9999 PO BOX 44036 BATON ROUGE LA GROUP BENEFIT PROGRAM

40235005 352530 38 AS (616) 323-6197 PO BOX 5097 SOUTHFIELD MI NETWORK CHOICE

40236005 352530 38 AS (999) 999-9999

2317 WINNEBAGO

STREET MADISON WI RAYOVAC CORPORATION

40237005 358569 68 AS (999) 999-9999 PO BOX 6596 ANNAPOLIS MD SELF FUNDING ADMINISTRATION

40238005 358569 38 AS (937) 443-1074 PO BOX 1167 DAYTON OH STANDARD REGISTER

40239005 358569 38 AS (304) 562-1913 PO BOX 950 HURRICANE WV BENEFIT ASSISTANCE CORPORATION

40239010 358569 38 AS (800) 657-0805 PO BOX 470 BROOKFIELD WI BENEFIT ASSOCIATES

40240005 352530 38 AS (999) 999-9999 PO BOX 901024 FORT WORTH TX COST MANAGEMENT TECHNOLOGY

40241005 358569 89 AS (800) 451-6929 PO BOX 1236 DAYTON OH DAYMED HMP INC

40242005 358569 87 RX (999) 999-9999

9400 S W BARBER

STREET WILSONVILLE OR FIRST CLASS PHARMACY

40243005 351113 38 AS (999) 999-9999 PO BOX 1326 FORT WORTH TX INTERNATIONAL BENEFIT SERVICES

40244005 351113 38 AS (999) 999-9999

4001 MCEWEN SUITE

200 DALLAS TX MAGNA LIFE

40244010 358569 38 PS (866) 503-3158 PO BOX 2278 MARYLAND HEIGHTS MO MAGELLAN

40245005 351113 88 DO (800) 232-0616 PO BOX141700 GRAND RAPIDS MI AMERICAN EXECUTIVE ASSOCIATION

40245010 351113 38 AS (800) 303-5770 PO BOX 658 BELOIT WI FIRST CHOICE BENEFITS MANAGEME

40245015 351113 89 NO (800) 231-6935 PO BOX 2289 SEATTLE WA FIRST CHOICE HEALTH NETWORK

40246005 358569 67 AS (708) 482-0110

133 S ASHLAND

AVENUE CHICAGO IL AUTOMOBILE MECHANICS LOCAL 701

40247005 358569 38 AS (334) 793-2284 PO BOX 10585 KNOXVILLE TN BENEFIT ADMINISTRATORS

40248005 351113 87 RX (407) 852-4903

7101 T P C DRIVE,

SUITE 150 ORLANDO FL CURA SCRIPTS

40249005 358569 87 RX (800) 341-2234

305 MADDISON AVE

STE 1166B NEW YORK NY GENERAL PRESCRIPTION PROGRAMS INC

40250005 351113 38 AS (813) 222-4017 PO BOX 3257 TAMPA FL INSURANCE ADMINISTRATION CTR

40250010 358569 38 AS (856) 778-9199

521 FELLOWSHIP

ROAD MOUNT LAUREL NJ INSURANCE ADMINISTRATOR OF AMERICA

40251005 352530 38 AS (800) 635-7418 110 GILBRALTER ROAD HORSHAM PA PA TREATY LIFE INSURANCE CO

40252005 358569 38 AS (800) 407-3776

10701 W RESEARCH

DRIVE MILWAUKEE WI PRIMECARE HEALTH PLAN INC

40253005 358569 38 AS (501) 666-2200 PO BOX 8072 LITTLE ROCK AR PROVIDENTIAL LIFE INSURANCE CO

40254005 352530 38 AS (800) 925-2272 PO BOX 27267 MINNEAPOLIS MN ROBEY BARBER INSURANCE

40255005 351113 38 XR (999) 999-9999

W224 N3322

DUPLAINVILLE PEWAUKEE WI QUAD GRAPHICS

40255010 351113 87 RX (414) 566-6005

W224 N3322

DUPLAINVILLE PEWAUKEE WI QUAD MED PHARMACY

40256005 352530 67 AS (402) 341-8771

10801 PACIFIC STREET

STE #100 OMAHA NE STEAMFITTERS LOCAL UNION 464

40257005 351113 87 RX (866) 841-8951 PO BOX 4496 WOODLAND HILLS CA WELLPOINT PHARMACY MANAGEMENT

Page 135: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40257010 358569 38 AS (800) 526-5710 636 GRAND AVENUE DES MOINES IA WELLMARK

40257015 351113 89 AS (800) 831-4818 636 GRAND AVENUE DES MOINES IA WELLMARK BCBS

40257020 352530 87 RX (800) 222-7390 PO BOX 27908 MILWAUKEE WI WELLPOINT PHARMACY SERVICE

40258005 413395 38 AS (308) 389-2600 PO BOX 4093 GRAND ISLE NE PRINCIPAL LIFE INSURANCE

40259005 351113 87 RX (800) 788-2949 10680 TREENA STREET SAN DIEGO CA MEDIMPACT

40260005 351113 38 AS (800) 872-8896 PO BOX 100877 FORT WORTH TX AMERICAN ASSOCIATION FOR

40261005 358569 38 AS (517) 898-1119

7135 SYLVANIA AVE.

BLDG 2C SYLVANIA OH BENEFIT PLAN ALTERNATIVES INC

40262005 351113 38 AS (614) 222-5463 PO BOX 1838 COLUMBUS OH CBC COMPANIES

40263005 358569 89 AS (800) 432-5925 PO BOX 380 PUEBLO CO CHOICE ONE

40263010 351113 38 AS (513) 942-1085 PO BOX 19013 GREEN BAY WI CHOICECARE CORP

40264005 358569 87 RX (612) 509-2500 PO BOX 30 GREENSBURG PA COLUMBIA PHARMACY SOLUTIONS

40264010 358569 87 RX (999) 999-9999 437 LAFAYETTE MEDINA OH COLUMBIA PHARMACY SERVICE

40265005 358569 88 DO (999) 999-9999

4061 POWDER MILL

ROAD CALVERTON MD CONSUMER DENTAL CARE

40266005 358569 88 DO (999) 999-9999

45 E MILWAUKEE

AVENUE DETROIT MI DENCAP DENTAL PLANS

40267005 413395 38 AS (800) 837-4097 PO BOX 4310 AKRON OH FIRST BENEFITS OF THE MIDWEST

40268005 358569 38 AS (999) 999-9999 PO BOX 150500 NASHVILLE TN INTRACORPBUYERS HEALTHCARE

40268010 358569 38 AS (999) 999-9999 PO BOX 17719 IRVINE CA INTRACORP PREFERRED CARE

40269005 358569 67 AS (612) 920-5905

6600 FRANCE AVE

SOUTH EDINA MN MINNEAPOLIS MEAT CUTTERS &

40270005 358569 89 AS (800) 327-8870

MUTUAL OF OMAHA

PLAZA OMAHA NE MUTUALLY PREFERRED PPO

40271005 358569 38 AS (999) 999-9999 PO BOX 30004 DURHAM NC PERSONAL CARE PLAN

40271010 352530 38 AS (800) 468-4343 PO BOX 5004 THOUSAND OAKS CA PERSONAL INSURANCE ADMINISTRATORS

40272005 358569 89 AS (800) 365-0009

6100 UPTOWN BLVD

NE ALBUQUERQUE NM QUAL MED

40272010 413395 89 AS (800) 816-0911

100 KIMEL FOREST

DRIVE WINSTON-SALEM NC QUAL CHOICE OF NC

40273005 358569 38 AS (999) 999-9999 PO BOX 10 DALTON GA SHAW MEDICAL CLAIMS CENTER

40274005 358569 38 AS (714) 259-5800 PO BOX 8050 RIVERSIDE CA SOUTHEASTERN CA CONFERENCE

40275005 358569 87 RX (999) 999-9999 9501 E SHEA BLVD #2 SCOTTSDALE AZ MANAGED PRESCRIPTION SERVICE

40275010 351113 38 X5 (800) 992-8088 PO BOX 17264 GREENVILLE SC MANAGEMED TPA

40276005 358569 38 AS (999) 999-9999

10497 TOWN &

COUNTRY WAY HOUSTON TX BMG ADMIN

40277005 352530 38 AS (812) 331-1025 PO BOX 489 BLOOMINGTON IN COOK GROUP HEALTH PLAN

Page 136: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40278005 358569 38 AS (999) 999-9999

2120 INDIANAPOLIS

BLVD SCHEREVILLE IN HEALTH CARE 2000

40279005 413395 89 AS (800) 922-4966 820 PARISH STREET PITTSBURGH PA MANAGED CARE OF AMERICA

40279010 358569 88 DO (999) 999-9999

3 PENN PLAZA EAST PP-

03Q NEWARK NJ MANAGED DENTAL CHOICE

40280005 358569 38 AS (999) 999-9999 PO BOX 1008 DELAWARE OH MANAGING UNDERWRITERS INC

40281005 352530 89 X5 (800) 848-4747

ONE FAR MILL

CROSSING SHELTONL CT PHYSICIANS HEALTH SERVICES

40282005 352530 38 AS (616) 621-2411 12 S CENTER STREET HARTFORD MI TOUCH OF HOPE

40283005 352530 38 AS (999) 999-9999 PO BOX 419052 ST LOUIS MO CORRECTIONAL MEDICAL SERVICES

40284005 358569 87 RX (717) 730-8371 PO BOX 546 CAMP HILL PA EAGLE MANAGED CARE

40285005 358871 38 RX (999) 999-9999 PO BOX 1058 DETROIT MI FORD CMP SERVICES

40286005 358569 38 AS (877) 333-6424 P.O. BOX 458022 WESTLAKE OH JP FARLEY CORPORATION

40286010 358569 89 AS (877) 333-6424 PO BOX 458022 WESTLAKE OH JP FARLEY CORPORATION

40287005 413395 38 AS (999) 999-9999 PO BOX 559005O AUSTIN TX NYLACOR

40288005 351113 88 DO (800) 866-8499 PO BOX 69421 HARRISBURG PA UNITED CONCORDIA COMPANIES INC

40288010 351113 88 DO (800) 332-0366 PO BOX 69422 HARRISBURG PA UNITED CONCORDIA COMPANIES

40289005 352530 38 AS (678) 339-0211 PO BOX 2490 ALPHARETTA GA ADMINISTRATIVE SOLUTIONS INC

40290005 413395 38 AS (999) 999-9999 PO BOX 9368 GARDEN CITY NY BERKELY ASSOCIATION SERVICES

40291005 352530 38 AS (999) 999-9999 PO BOX 2720 FARMINGTON HILL MI CONSULTEC

40292005 358113 89 X4 (800) 548-6574 4316 RICE LAKE ROAD DULUTH MN PHP PLUS INC

40293005 358569 87 RX (999) 999-9999

2307 W CONE

BOULEVARD GREENSBORO NC RESOURCE RX

40294005 358569 87 RX (800) 699-7857

8536 CROW DRIVE

SUITE 105 MACEDONIA OH FFI RX MANAGED CARE INC

40295005 358569 88 DO (800) 729-1227 PO BOX 2209 SCHENECTADY NY JARDINE GROUP SERVICES

40296005 358569 89 NO (800) 622-5398 PO BOX 11328 SOUTH BEND IN PNI PPO NETWORK

40297005 358569 87 RX (630) 577-3100

2441 WARRENSVILLE

STE 610 LISLE IL INFORMEDRX

40297010 352530 87 RX (800) 822-4542 PO BOX 3010 ANDOVER MA PHARMACY ACCESS

40298005 358569 38 R6 (800) 642-0483 PO BOX 11967 WINSTON SALEM NC SAVERS LIFE INSURANCE COMPANY

40299005 358569 38 AS (800) 328-5600

1750 HENNEPIN AVE

SOUTH MINNEAPOLIS MN ALLIANZ LIFE INS CO OF N AMER

40300005 351113 38 AS (800) 328-0927

13700 WATER TOWER

CIRCLE PLYMOUTH MN ASSURECARE

40300010 351113 38 AS (517) 827-1524 PO BOX 1570 EAST LANSING MI ASSURECARE

40300015 351113 89 AS (517) 827-1524 PO BOX 1386 EAST LANSING MI ASSURECARE

40301005 358569 89 NO (800) 543-7158 PO BOX 3188 CINCINNATI OH CHOICE CARE

40301010 352530 89 AS (716) 857-4440 PO BOX 23000 ROCHESTER NY UNIVERA HEALTHCARE

Page 137: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40302005 352530 87 RX (715) 251-8217 1101 MILL STREET NIAGRA WI COPPS PHARMACY CARD

40303005 351113 89 XR (800) 258-8000 PO BOX 8020 LANSING MI COMMUNITY BLUE PPO

40304005 352530 89 NO (800) 266-5896 PO BOX 1489 STOW OH DCA PHS AND AFFILIATES

40305005 351113 38 AS (999) 999-9999

340 QUADRANGLE

DRIVE BOLINGBROOK IL ASSURECARE OF IL

40306005 413395 38 AS (999) 999-9999

21 FIRST ST SW STE

401 ROCHESTER MN MAYO MANAGEMENT SERVICES INC

40307005 352530 67 AS (999) 999-9999 4316 CARLISLE NE ALBUQUERQUE NM NM PIPE TRADES H & W TRUST

40308005 358569 38 AS (800) 220-2600 PO BOX 60608 KING OF PRUSSIA PA BENEFIT CONCEPTS INC

40308010 352530 89 AS (888) 413-0938 PO BOX 395 PUEBLO CO BENESIGHT

40308015 352530 34 AS (888) 413-0938 PO BOX 320 PUEBLO CO BENESIGHT

40309005 358569 38 AS (800) 777-0595 5151 PFEIFFER ROAD CINCINNATI OH GATES HEALTH CARE MANAGEMENT

40310005 358569 87 RX (216) 442-6022 PO BOX 43069 CLEVELAND OH S RX PHARMACY SPECIALISTS

40311005 413395 89 AS (800) 859-8452 PO BOX 45708 BOSTON MA CHICKERING

40312005 358569 38 AS (901) 528-4351 PO BOX 430 MEMPHIS TN MEMPHIS LIGHT GAS & WATER

40313005 351113 38 DV (999) 999-9999 PO BOX 956353 DULUTH GA MI BAPTIST BENEFIT PLAN

40314005 352530 89 AS (800) 472-5411 PO BOX 3128 EAU CLAIRE WI VALLEY HEALTH PLAN

40315005 413395 88 DO (800) 236-1100

30400 TELEGRAP RD

STE 327 BINGHAM FARMS MI AMERICAN DENTAL NETWORK

40315010 413395 88 DO (810) 229-0303

8609 W GRAND RIVER

AVENUE BRIGHTON MI AMERICAN DENTAL GROUP OF MI

40316005 358569 38 XR (501) 646-4711 PO BOX 2400 FORT SMITH AR BALDOR MOTORS & DRIVES

40317005 358569 38 AS (800) 445-7227 PO BOX 998 COVINGTON LA GILSBAR INC

40318005 358569 87 RX (999) 999-9999

215 NE HILLCREST

DRIVE GRANTS PASS OR PSG PCM

40319005 358569 89 NO (262) 879-0100 PO BOX 981 BROOKFIELD WI AHC PPO NETWORK

40319010 352530 38 AS (888) 926-8436 PO BOX 15244 NEWARK NJ A H & L

40319015 413395 89 AS (800) 990-9058 PO BOX 25946 OVERLAND PARK KS FMH BENEFIT SERVICES INC

40320005 358569 38 AS (888) 420-9490 PO BOX 8244 SOUTH BEND IN CASI INC

40320010 358569 89 AS (888) 420-9490 PO BOX 8244 SOUTH BEND IN CASI INC

40321005 358569 87 RX (800) 345-3189 PO BOX 921229 NORCROSS GA BENESCRIPT SERVICES INC

40322005 358569 87 RX (800) 594-4734 PO BOX 180141 CHATTANOOGA TN HEALTH SOURCE RX

40322010 358569 38 AS (205) 968-1300

2 PERIMETER PARK

SOUTH BIRMINGHAM AL HEALTH STRATEGIES INC

40323005 358569 38 AS (800) 733-8880 PO BOX 982017 NORTE RICHLAND HILLS TX MID-WEST NATIONAL INS CO OF TN

40324005 358569 38 AS (800) 251-5013 PO BOX 23980 OAKLAND CA PENSIONED OPERATING ENGINEERS

40325005 413395 69 AS (800) 444-6254 PO BOX 624 MILWAUKEE WI ASSURANT HEALTH

40325010 413395 89 AS (800) 553-7654 PO BOX 624 MILWAUKEE WI ASSURANT HEALTH

40326005 358569 38 AS (999) 999-9999 PO BOX 163930 AUSTIN TX USA HEALTH NETWORK

40327005 413395 38 AS (888) 327-2234 PO BOX 1256 BALTIMORE MD EDSA

40328005 358569 38 AS (800) 693-5350 PO BOX 200579 AUSTIN TX AMIL INTERNATIONAL

40329005 358569 38 AS (770) 920-2088 PO BOX 1526 DOUGLASVILLE GA PARAGON BENEFITS

Page 138: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40330005 352530 38 AS (765) 608-6680 PO BOX 10 PENDLETON IN UNIFIED GROUP SERVICE

40330010 352530 89 AS (765) 608-6680 PO BOX 10 PENDLETON IN UNIFIED GROUP SERVICE

40331005 358569 38 AS (800) 749-9963 PO BOX 100043 DULUTH GA GROUP RESOURCES INC

40332005 358569 38 AS (800) 732-1486 PO BOX 89310 SIOUX FALLS SD DAKOTA TRUCK UNDERWRITERS

40333005 358569 38 AS (800) 606-5479 PO BOX 389 ETHENY UT THE FUNDS

40334005 352530 89 NO (800) 552-0455 PO BOX 10636 SCOTTSDALE AZ THE AFFORDABLE MEDICAL NETWORK

40335005 358569 38 AS (800) 328-3323 PO BOX 96 MINNEAPOLIS MN INSURANCE ADMINISTRATIVE SERVICES

40335010 352530 89 AS (999) 999-9999

6101 BLUE LAGOON

DR MIAMI FL PCA HEALTH PLAN OF FL INC

40336005 358569 89 AS (800) 332-3539 PO BOX 901024 FORT WORTH TX PROAMERICA MANAGED CARE

40337005 358569 67 AS (800) 943-4248

5 GATEWAY CTR,

SUITE 620 PITTSBURGH PA GRAPHIC COMMUNICATIONS NATIONA

40338005 358569 89 AS (248) 813-9800 700 TOWER DRIVE TROY MI BENESYS

40338010 358569 67 AS (800) 772-0459 PO BOX 1349 TROY MI ABATEMENT WORKERS NATIONAL

40339005 358569 38 AS (800) 673-5222 PO BOX 1229 PEORIA IL OSF HEALTH PLANS

40340005 358569 38 AS (800) 548-7689 PO BOX 610 JEFFERSONVILLE IN AMERICAN COMMERCIAL LINE INC

40341005 358569 89 AS (800) 633-8598 PO BOX 90100 ARLINGTON TX HARRIS METHODIST HEALTH PLAN

40342005 351113 38 AS (999) 999-9999 PO BOX 419325 KANSAS CITY MO ADMINISTRATIVE SERVICES ONLY

40343005 352530 38 AS (605) 334-7240 PO BOX 898 SIOUX FALLS SD HAGAN BENEFITS ADMINISTRATORS

40344005 358569 38 AS (800) 845-7629 PO BOX 945260 MAITLAND FL ANCHOR BENEFIT CONSULTING INC

40345005 413395 38 AS (586) 826-4400 PO BOX 1378 TROY MI US HEALTH & LIFE INSURANCE CO

40345010 351113 38 AS (800) 546-1900 PO BOX 840 HARRISON AR AMERICAN FREIGHTWAYS INC

40346005 358569 38 AS (412) 366-9621 820 PARISH ST PITTSBURG PA CONSOLIDATED BENEFITS INC

40347005 358569 38 AS (800) 947-0319 PO BOX 1250 ROCKFORD IL CT NATIONAL LIFE

40347010 358569 38 AS (800) 345-1174 PO BOX 3071 EVANSTON IL CT NATIONAL LIFE

40347015 358569 89 AS (800) 947-0319 PO BOX 1250 ROCKFORD IL CT NATIONAL LIFE

40348005 358569 89 NO (800) 666-4449 PO BOX 5548 FORT WAYNE IN MANAGED CARE SERVICES

40349005 352530 38 AS (800) 252-9653 PO BOX 9201 AUSTIN TX BOON CHAPMAN BENEFIT ADMINISTR

40350005 358569 89 AS (800) 284-4512 100 PARKER DRIVE OTSEGO MI PARKER HANNIFIN CORPORATION

40351005 413395 87 RX (800) 324-2200 5445 LA SIERRA DRIVE DALLAS TX INTEQ

40352005 358569 38 AS (888) 725-7600 PO BOX 1180 LAS VEGAS NV MIRAGE RESORTS EMPLOYEE HEALTH

40353005 358569 88 DO (888) 256-9068 PO BOX 13009 NORFOLK VA NATIONAL DENTAL PLANS

40354005 358569 38 AS (513) 598-2929

4373 HARRISON

AVENUE CINCINNATI OH CUSTOM DESIGN BENEFIT PLAN

40355005 413395 89 AS (800) 996-8815 PO BOX 3620 AKRON OH SUMMA CARE

40356005 351113 38 AS (414) 328-5330 PO BOX 340414 MILWAUKEE WI THE OLIGEAR COMPANY

40356010 358569 89 AS (800) 538-5038 PO BOX 11670 SALT LAKE CITY UT IHC CARE PLUS

40356015 352530 67 AS (800) 973-1010

2156 WEST 2200

SOUTH SALT LAKE CITY UT UT LABORERS TRUST FUNDS

40356020 358569 83 NH (800) 456-7766 PO BOX 8021 SAN RAFAEL CA GE LIFE & ANNUITY ASSURANCE CO

40356025 352530 38 AS (614) 488-4842

1200 CHAMBERS RD

STE 206 COLUMBUS OH INTEGRATED BENEFIT SYSTEMS INC

Page 139: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40356030 351113 88 DO (616) 258-9886

410 E DRESDEN

STREET KALKASKA MI HAGUE EQUIPMENT COMPANY

40356035 358871 88 DO (800) 653-4427 PO BOX 1028 HOUSTON TX BROKERS NATIONAL LIFE ASSURANC

40356040 351113 88 DO (800) 222-2733 PO BOX 1391 DAYTON OH DENTEMAX PPO

40356045 358569 38 R6 (877) 825-9337 PO BOX 10821 CLEARWATER FL GE LIFE & ANNUITY ASSURANCE CO

40356050 413395 88 DO (800) 451-2513 PO BOX 1477 GREENFIELD MA GE FINANCIAL ASSURANCE

40357005 358569 89 AS (800) 351-1505 PO BOX 36439 PHOENIX AZ HEALTH PARTNERS HEALTH PLANS

40358005 352530 86 VO (800) 565-3827

1200 N ARLINGTON

HEIGHTS ITASCA IL PROTECTIVE VISION PLAN

40359005 358569 38 AS (800) 866-4142 PO BOX 101 JACKSON MS ROBINSON JULIENNE & BAILEY INC

40360005 413395 87 RX (800) 519-8374 PO BOX 820277 FORT WORTH TX UNITED PROVIDER SERVICES

40361005 352530 38 HO (717) 730-9777 PO BOX 8 CAMP HILL PA WILSON GREGORY AGENCY INC

40362005 351113 38 PS (800) 999-9426 PO BOX 2158 MARYLAND HEIGHT MO MERIT BEHAVIORAL CARE

40363005 351113 89 AS (800) 866-4731 PO BOX 32709 TUCSON AZ MOUNTAIN STATES ADMINISTRATIVE

40364005 352530 89 AS (800) 903-5253

17117 W NINE MILE

ROAD SOUTHFIELD MI GREAT LAKES HEALTH PLAN

40365005 413395 89 AS (800) 235-7111

10800 FINANCIAL

CENTRE PKWY LITTLE ROCK AR QUALCHOICE OF AR

40366005 352530 38 AS (888) 223-0294 PO BOX 321127 DETROIT MI ULTICARE INC

40367005 351113 38 AS (214) 696-9091 PO BOX 679005 DALLAS TX PROVIDENT AMERICAN LIFE

40368005 358569 38 AS (559) 499-2450 PO BOX 45018 FRESNO CA HEALTHCOMP ADMINISTRATORS

40369005 413395 89 NO (800) 451-9597

6105 GOLDEN HILLS

DR GOLDEN VALLEY MN PREFERRED ONE PPO NETWORK

40369010 413395 38 AS (800) 997-1750 PO BOX 59212 MINNEAPOLIS MN PREFERRED ONE ADMINISTRATIVE SERVICES

40370005 351113 89 AS (800) 447-6588

2180 NORTH LOOP

WEST HOUSTON TX EMPLOYER PLAN SERVICES INC

40371005 351113 89 AS (800) 697-6985 PO BOX 8012 WAUSAU WI NCHPP

40371010 351113 38 AS (888) 400-0091 111 MARKET PLACE BALTIMORE MD JOHN HOPKINS EMPLOYER HEALTH PLANS

40371015 358569 89 AS (999) 999-9999

1005 W ORANGEBURG

AVENUE MODESTO CA NATIONAL HEALTH PLAN

40371020 358569 89 NO (888) 492-6811 PO BOX 37705 OAK PARK MI ST JOHNS SMART PLAN

40372005 358569 38 MS (800) 447-9599 7277 BERNICE CENTERLINE MI NORTHWOOD INC

40373005 358569 89 AS (999) 999-9999 PO BOX 66930 CHICAGO IL HEALTHSTAR PPO INC

40374005 358569 38 AS (800) 837-7400

8310 CLINTON PARK

DRIVE FORT WAYNE IN BENICOMP INCORPORATED

40375005 358569 38 AS (800) 510-3949 PO BOX 1909 DANBURY CT USI ADMINSTRATORS

40375010 358569 87 RX (800) 383-8737 675 FOXON ROAD EAST HAVEN CT USI RX

40375015 358569 38 AS (866) 311-8864 PO BOX 776 MELLVILLE NY USI ADMINISTRATORS

40376005 358569 38 AS (800) 219-7670

200 LAFAYETTE

STREET MIDDLEVILLE MI BRADFORD WHITE CORPORATION

40377005 352530 89 AS (937) 866-7933

2570 TECHNICAL

DRIVE MIAMISBURG OH ACMG INC

Page 140: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40378005 352530 38 MS (800) 831-0999 PO BOX 82060 ROCHESTER MI AMERICAN BENEFIT PLANS

40379005 358569 89 AS (888) 411-3888 PO BOX 201115 ARLINGTON TX CAPELLA GROUP

40380005 413395 87 RX (800) 396-2219

224 NORTH PARK

AVUNUE FREMONT NE SAV-RX

40381005 358569 38 AS (800) 522-7279

150 S 43RD STEET

SUITE 1 HARRISBURG PA PA EMPLOYEES BENEFIT TRUST FUND

40382005 352530 38 AS (502) 394-2100

10140 LINN STATION

ROAD LOUISVILLE KY RES CARE

40383005 352530 89 AS (800) 449-3339

3401 WEST END

AVENUE NASHVILLE TN XANTUS

40384005 351113 87 RX (800) 752-2211

10901 W 120TH

AVENUE BROOMFIELD CO TOTAL SCRIPTS

40385005 358569 38 AS (800) 454-8814 PO BOX 860 WOODRUFF WI SUPERIOR HEALTH SERVICES

40386005 351113 64 AS (414) 476-2523

2001 N MAYFAIR

ROAD MILWAUKEE WI WI UFCW UNIONS & EMPLOYERS HEALTH PLAN

40387005 358569 38 AS (999) 999-9999 PO BOX 81520 ROCHESTER MI AON-SELECT INC

40387010 358569 38 AS (888) 722-1668 PO BOX 2409 FLORENCE SC AON SELECT INC

40388005 352530 88 DO (313) 897-7155 3531 JUNCTION DETROIT MI DENTAL HEALTH GROUP

40388010 358569 88 DO (800) 323-6840 PO BOX 5005 OAKBROOK TERRACE IL DENTAL NETWORK OF AMERICA

40389005 351113 89 AS (800) 807-5244 1925 BRETON SE #204 GRAND RAPIDS MI COMMUNITY CARE PLAN

40389010 351113 89 NO (800) 807-5244 1925 BRETON SE #204 GRAND RAPIDS MI COMMUNITY CARE PLAN NETWORK

40390005 358569 38 AS (800) 782-0392 PO BOX 7011 WYOMISSING PA LOOMIS COMPANY

40391005 358569 38 AS (800) 922-1245 PO BOX 2348 COLUMBUS OH AMERICAN INSURANCE ADMINISTRATORS

40391010 358569 89 AS (800) 317-7594

1300 CONNECTICUT

AVE #300 WASHINGTON DC NATIONAL IAM BENEFIT TRUST FUND

40391015 358569 87 RX (678) 248-3100

3090 PREMIER

PARKWAY DULUTH GA PROCARE NOVA SCRIPTS

40391020 358569 89 AS (219) 436-0500 PO BOX 40132 FORT WAYNE IN SPI

40392005 352530 38 AS (800) 680-8728 PO BOX 105738 ATLANTA GA COVENANT ADMINISTRATORS INC

40393005 358569 89 AS (800) 251-7722

30 BATTERSON PARK

ROAD FARMINGTON CT CONNECTICARE

40393010 351113 38 X2 (877) 391-7101 PO BOX 4158 ROCKFORD IL BENCHMARK HEALTH

40393015 358569 38 AS (888) 306-5299

1600 S BRENTWOOD

BLVD ST LOUIS MO WESTPORT BENEFITS

40393020 358569 89 NO (888) 646-2429 4009 ORCHARD DRIVE MIDLAND MI CONNECTCARE ALLIANCE

40394005 351113 89 AS (800) 497-3699 PO BOX 440 ASHLAND WI SELECT BENEFIT ADMINISTRATORS

40395005 358871 89 AS (800) 201-0450 PO BOX 159 WARREN MI CHEROKEE INSURANCE CO

40396005 352530 38 AS (800) 442-4037 PO BOX 1207 SEATTLE WA VIRGINIA MASON GROUP HEALTH ALLIANCE

40397005 358569 89 AS (800) 359-7475

509 S LENOLA RD

BLDG 2 MOORESTOWN NJ AMERICAN SPECIAL RISKS

Page 141: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40397010 358569 89 AS (800) 234-0225 PO BOX 2010 WESTERVILLE OH POLARIS BENEFIT ADMINISTRATORS

40398005 413395 89 AS (574) 296-9990 PO BOX 1007 ELKHART IN CORNERSTONE BENEFITS ADMINISTRATORS INC

40398010 413395 38 AS (219) 296-9990 PO BOX 1007 ELKHART IN CORNERSTONE BENEFITS ADMINISTRATORS INC

40399005 358569 89 NO (800) 279-9776 PO BOX 6090 DEPERE WI HEALTH EOS/WPPN MULTIPLAN

40399105 358569 89 NO (800) 677-1098 115 FIFTH AVENUE NEW YORK NY MULTIPLAN

40399200 358569 89 NO (616) 459-9600

24 WESTON STREET

SW GRAND RAPIDS MI REAL HEALTH/MULTIPLAN

40400005 358569 89 AS (888) 306-5299 PO BOX 66743 ST LOUIS MO PHCS

40400010 358569 89 NO (800) 950-7040 1100 WINTER STREET WALTHAM MA PHCS NETWORK

40401005 351113 89 AS (877) 342-5258 PO BOX 91059 SEATTLE WA PREMERA BC OF WA & AK

40401010 351113 38 AS (800) 757-7204 PO BOX 250878 WEST BLOOMFIELD MI BCI ADMINISTRATORS

40401015 351113 86 VO (602) 414-1200 PO BOX 8504 MASON OH EYECARE PLAN OF AMERICA

40401020 351113 86 VO (888) 581-3648 PO BOX 8504 MASON OH EYEMED VISION CARE

40402005 352530 89 AS (919) 846-2525 PO BOX 97547 RALEIGH NC FIA ADMINISTRATORS INC

40402010 352530 89 NO (800) 881-4474 PO BOX 5001 NEW PORT RICHEY FL EVOLUTIONS HEALTHCARE SYSTEMS NETWORK

40402015 358569 87 RX (800) 645-3332 PO BOX 1170 PORT WASHINGTON NY NATIONAL MEDICAL HEALTH CARD SYSTEMS

40402020 358569 86 VO (800) 638-3120

6220 OLD DOBBIN LN

STE 200 COLUMBIA MD SPECTERA INC

40402025 351113 38 AS (888) 687-6277 PO BOX 2207 SCHENECTADY NY MVP HEALTH PLAN

40402050 358569 38 AS (800) 737-0878 6 EXECUTIVE DRIVE FAIRVIEW HTS IL BENEFIT ADMINISTRATIVE SYSTEMS

40403005 352530 38 AS (999) 999-9999

550 E BOUGHTON

ROAD BOLLINGBROOK IL UNIVERSITY OF CHICAGO HEALTH PLAN

40404005 358569 38 AS (800) 221-9039 110 W 7TH STREET FORT WORTH TX FREEDOM LIFE

40405005 413395 89 AS (800) 663-8081

1000 GREATWEST

DRIVE KENNETT MO ONE HEALTH PLAN BENEFIT

40406005 358871 38 AS (800) 933-7472 12325 HYMEADOW AUSTIN TX ERISA

40406010 352530 38 AS (512) 719-6500 PO BOX 149140 AUSTIN TX TML INTERGOVERNMENTAL EMPLOYEE BENEFITS POOL

40406015 352530 38 AS (704) 669-2941 PO BOX 15174 ASHEVILLE NC INGLES MARKETS INCORPORATED

40406020 413395 38 AS (800) 239-9088 PO BOX 29916 COLUMBUS OH E-V BENEFITS MANAGEMENT INC

40406025 358569 38 AS (999) 999-9999 PO BOX 5260 COLUMBIA MD TN BEHAVIORAL HEALTH INC

40406030 413395 89 AS (999) 999-9999 PO BOX 22358 NASHVILLE TN ACCESS MEDPLUS

40407005 352530 38 AS (616) 241-5675

50 COTTAGE GROVE

SW GRAND RAPIDS MI PRIDGEON & CLAY HEALTH TRUST

40407010 358569 38 AS (999) 999-9999

1600 W BROADWAY -

SUITE 260 TEMPE AZ HEALTH CHOICE AZ

40408005 352530 38 AS (999) 999-9999

701 PLYMOUTH

AVENUE DELAND FL FL HEALTH ALLIANCE

40409005 358569 38 AS (800) 265-5615 PO BOX 1699 WINDSOR ON EXTENDED HEALTH SERVICES

40410005 358569 38 AS (800) 826-0419 PO BOX 581630 TULSA OK CONSOLIDATED BENEFIT RESOURCE

40411005 413395 89 NO (888) 446-5844 PO BOX 50487 INDIANAPOLIS IN ENCORE

Page 142: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40411105 352530 89 NO (800) 444-4036

2575 GRAND CANAL

BLVD STE 200 STOCKTON CA INTERPLAN

40411205 352530 38 AS (800) 776-1545 PO BOX 5079 WESTLAKE VILLAGE CA E B A & M CORPORATION

40411305 358569 38 AS (800) 847-8217 PO BOX 3430 CARMEL IN AMERICORPS VISTA

40411405 351113 38 AS (800) 223-9941 PO BOX 900 ELYRIA OH COMMERCE BENEFIT GROUP

40411505 351113 89 AS (866) 246-9309 PO BOX 535045 PITTSBURGH PA BS OF PA

40411745 351113 38 AS (800) 633-4226 PO BOX 60432 KING OF PRUSSIA PA AMERICAS CHOICE HEALTHPLANS

40411805 358569 38 AS (800) 447-0220

3481 CENTRAL

PARKWAY SUITE 100 CINCINNATI OH AEBS

40411845 351113 38 AS (800) 633-4226 PO BOX 922043 HOUSTON TX AMERICAS CHOICE HEALTHPLANS

40411855 413395 87 RX (999) 999-9999 PO BOX 85402 RICHMOND VA FIRST HEALTH - BATCH CLAIMS

40411865 358569 38 AS (877) 463-1380 PO BOX 742168 DALLAS TX THIRD PARTY ADVANTAGE ADM INC

40412005 413395 89 AS (800) 542-6642 2700 MIDWEST DRIVE ONALSKA WI UMR

40412015 358569 89 NO (419) 868-5220

5555 AIRPORT

HIGHWAY TOLEDO OH DIRECT CARE AMERICA

40412025 352530 89 NO (419) 868-5220

5555 AIRPORT

HIGHWAY TOLEDO OH COOPERATIVE HEALTH NETWORK

40412085 351113 84 X5 (800) 323-2707 PO BOX 71507 MADISON HEIGHTS MI LIBERTY UNION LIFE ASSURANCE COMPANY

40412105 358569 89 AS (800) 249-4300 PO BOX 64338 ST PAUL MN ATRIUM HEALTH PLAN

40412205 352530 38 AS (502) 722-9746 PO BOX 346 SIMSONVILLE KY PROVIDER BENEFIT PLANS INC

40412305 351113 38 AS (800) 295-5444 PO BOX 3428 OAKBROOK IL HFN EPO

40412805 358569 88 DO (800) 558-4444 PO BOX 14610 LEXINGTON KY HUMANA

40412815 352530 38 AS (800) 962-6294 PO BOX 220 STANFORD NY CATSKILL AREA SCHOOL EMPLOYEE BENEFIT PLAN

40412825 352530 86 VO (800) 792-2737 1700 S PARK KALAMAZOO MI VISION ADVANTAGE

40412905 352530 89 AS (800) 850-0281 2211 GREEN WAY LOUISVILLE KY INTEGRATED BENEFIT ADMINISTRATORS

40413005 358569 38 AS (800) 551-4049 PO BOX 9554 SALT LAKE CITY UT P5 ELECTRONIC HEALTH SERVICES

40413105 351113 38 AS (800) 866-4731 PO BOX 32709 TUCSON AZ MOUNTAIN STATES ADMINISTRATIVE

40413115 351113 38 AS (800) 628-4664 PO BOX 88500 INDIANAPOLIS IN INTERNATIONAL MEDICAL GROUP IMG

40413125 351113 89 AS (800) 244-6224 PO BOX 28087 RALEIGH NC CIGNA

40413135 358569 89 AS (866) 562-4004

11270 W PARK PLACE

STE 950 MILWAUKEE WI BENEFIT PLAN ADMIN OF WI

40413145 358569 38 AS (800) 550-2427 8105 GEORGIA ST MERRILLVILLE IN AMERICAN HEALTH CARE PARTNERSHIP

40413155 352530 38 AS (800) 335-0477

9200 KEYSTONE

CROSSING INDIANAPOLIS IN SPECIALITY RISK INTERNATIONAL

40413165 358569 88 DO (414) 365-4625 9275 N 49TH STREET MILWAUKEE WI EMPLOYEE BENEFIT CONSULTANTS

40413175 352530 38 AS (800) 770-3740 PO BOX 241569 ANCHORAGE AK RBMS LLC

40413185 413395 89 AS (888) 803-1780 PO BOX 12467 PENSACOLA FL NATIONWIDE HEALTH PLANS/CHCS

40413205 413395 17 AS (877) 233-1800 PO BOX 450 PUEBLO CO UNITED MEDICAL RESOURCES

40413215 413395 89 NO (800) 380-6216 PO BOX 9498 MINNEAPOLIS MN PRINCIPAL HEALTHCARE NETWORK

Page 143: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40413225 358569 89 AS (800) 729-8545 PO BOX 33699 PHOENIX AZ PACIFIC LIFE AND ANNUITY BENEFITS OFFICE

40413235 358569 89 AS (800) 477-7870 PO BOX 33839 INDIANAPOLIS IN CELTIC INSURANCE CO

40413245 351113 38 AS (800) 421-3959 3611 CHESTER AVE CLEVELAND OH CARPENTERS HOSPITALIZATION PLAN

40413255 351113 38 AS (800) 546-1900 PO BOX 5007 HARRISON AR FEDEX FREIGHT EAST INC

40413265 358569 38 AS (800) 317-2324 808 VARSITY DR TUPELO MS ACCLAIM MEDICAL SERVICES

40413275 413395 38 AS (866) 333-4648 PO BOX 9525 AMHERST NY DEFINITY HEALTH

40413285 351113 89 AS (800) 920-8889 PO BOX 4782 SYRACUSE NY BCBS OF CENTRAL NEW YORK

40413295 358569 38 AS (800) 257-4692 PO BOX 7709 LONDON KY COVENTRY

40413305 351113 30 AS (800) 351-9198 PO BOX 5200 SCRANTON PA CIGNA

40413315 352530 38 HO (800) 440-8610 PO BOX 475 NORTHBROOK IL SEARS LIFE INSURANCE CO

40413325 351113 89 NO (888) 258-6477 PO BOX 7597 CHARLESTON WV 4-MOST HEALTH NETWORK

40413335 358569 38 AS (412) 922-0780 820 PARISH STREET PITTSBURGH PA MCA ADMINISTRATORS

40413345 351113 38 AS (800) 542-4271 PO BOX 5200 SCRANTON PA CIGNA HEALTHCARE

40413355 351113 84 IO (800) 228-9100 PO BOX 2018 OMAHA NE PHYSICIANS MUTUAL

40413365 351113 88 DO (866) 268-9615 PO BOX 1328 ROSEBURG OR ADVANTAGE DENTAL PLAN INC

40413375 358569 89 AS (800) 372-6149 PO BOX 9 WOODWARD OK MUTUAL OF OMAHA PPO

40413385 358569 38 AS (847) 981-0491 53 W SEEGERS RD ARLINGTON HEIGHTS IL ALLIED SERVICES DIVISION BENEFIT FUND

40413395 413395 89 NO (800) 605-8259 PO BOX 5809 TROY MI MIDLANDS CHOICE

40413405 358569 38 AS (877) 469-3073 PO BOX 46518 MADISON WI OXFORD LIFE INSURANCE

40413415 351113 38 AS (317) 329-8222

5835 WEST 74TH

STREET INDIANAPOLIS IN MEDICAL SAVINGS INSURANCE COMPANY

40413425 352530 38 AS (503) 233-3888 PO BOX 13190 PORTLAND OR US BENEFITS

40413435 358569 38 AS (601) 856-9029 PO BOX 2058 MADISON MS BENEFIT MANAGEMENT SYSTEM

40413445 352530 89 NO (800) 660-6212 PO BOX 8071 LITTLE ROCK AR HEALTHSCOPE BENEFITS

40413455 413395 89 AS (800) 991-2642 39201 SEVEN MILE RD LIVONIA MI AMERICAN COMMUNITY MUTUAL

40413465 352530 38 AS (888) 977-9299 PO BOX 7068 EUGENE OR PACIFIC SOURCE HEALTH PLANS

40413475 358569 38 AS (800) 308-5948 PO BOX 55270 PHOENIX AZ STAR HRG

40413485 413395 38 AS (800) 225-9369 8220 IRVING RD STERLING HTS MI AUTOMATED BENEFIT SERVICES

40413495 352530 89 AS (800) 975-0975 PO BOX 7704 LONDON KY SOUTHERN HEALTH SERVICES INC

40413505 413395 17 AS (800) 801-5409 PO BOX 725 PUEBLO CO UNITED MEDICAL RESOURCES

40413515 351113 38 AS (800) 251-0669 PO BOX 5200 SCRANTON PA CIGNA HEALTHCARE

40413525 358569 38 AS (800) 762-1215 PO BOX 42489 INDIANAPOLIS IN SHEET METAL WORKERS LOCAL 20

40413535 352530 38 X4 (954) 384-1000 PO BOX 269000 WESTON FL BENEFIT MANAGEMENT COMPANY

40413545 352530 38 AS (800) 483-6983 PO BOX 38151 ATLANTA GA STATE HEALTH BENEFIT PLAN

40413555 358569 88 DO (800) 541-7846 PO BOX 2459 SPOKANE WA DENTAL GUARD PREFERRED NETWORK

40413565 351113 89 NO (800) 397-3373 PO BOX 981 BROOKFIELD WI ASSOCIATES FOR HEALTH CARE INC

40413575 351113 88 DO (800) 836-4098

2236 MARSHALL AVE

STE 100 ST. PAUL MN MIDWEST DENTAL BENEFITS

40413585 351113 87 RX (800) 546-5677 PO BOX 407 BOYSTOWN NE NATIONAL PHARMACEUTICAL SERVICES

40413595 358569 38 AS (248) 641-4949 PO BOX 149 TROY MI ROOFERS LOCAL 149

40413605 413395 88 DO (800) 366-6663 PO BOX 2980 CLINTON IA TRUSTMARK

40413615 351113 89 NO (800) 486-4220 PO BOX 200248 ARLINGTON TX FORMOST/BCE EMERGIS

Page 144: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40413625 358569 88 DO (800) 955-2030 PO BOX 242810 LOUISVILLE KY DELTA DENTAL PLAN OF KENTUCKY

40413635 358569 89 X4 (703) 729-4677 20547 WAVERLY CT ASHBURN VA NALC HEALTH BENEFIT PLAN

40413645 351113 89 AS (410) 850-8607

5700 HAMMONDS

FERRY ROAD LINTHICUM HEIGHTS MD MASTERS,MATES & PILOTS HEALTH & BENEFIT PLAN

40413655 352530 88 DO (877) 816-3596 PO BOX 659747 SAN ANTONIO TX UNITED HEALTHCARE DENTAL

40413665 351113 38 AS (877) 236-0844 PO BOX 7020 APPLETON WI CYPRESS BENEFIT ADMINISTRATORS

40413675 358569 83 NH (800) 621-3724 PO BOX 66994 CHICAGO IL BANKERS LIFE AND CASUALTY CO

40413685 352530 89 AS (800) 528-6220 PO BOX 218180 HOUSTON TX SOUTHERN PLAN ADMINISTRATORS

40413695 352530 87 RX (877) 363-6337 PO BOX 7021 CAMDEN SC SENIOR RX PROGRAM

40413705 352530 89 AS (877) 396-4835 PO BOX 310 PUEBLO CO BENESIGHT

40413715 358569 89 IO (800) 322-7451 102 E MAIN ST URBANA IL HEALTH ALLIANCE PLAN OF ILLINOIS

40413725 352530 01 AS (800) 235-0123 PO BOX 1858 BISMARK ND AETNA US HEALTHCARE

40413735 413395 89 AS (800) 621-3330 PO BOX 30805 SALT LAKE CITY UT REGENTS HEALTH & LIFE

40413745 351113 89 AS (800) 676-2583 PO BOX 890173 CAMP HILL PA HIGHMARK BLUE SHIELD

40413755 413395 38 AS (800) 255-8109 PO BOX 305154 NASHVILLE TN UNITED MEDICAL RESOURCES

40413765 351113 89 AS (800) 355-2583 PO BOX 1219 NEWARK NJ HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY

40413775 358569 38 AS (800) 526-3919 PO BOX 1439 HENDERSONVILLE TN HEALTH COST SOLUTIONS

40413785 358569 89 AS (605) 334-7240 PO BOX 5091 SIOUX FALLS SD FIRST ADMINISTRATORS

40413795 359196 38 AS (877) 874-2273 PO BOX 7052 CAMDEN SC TRICARE FOR LIFE

40413805 358569 89 AS (888) 881-9295 PO BOX 12307 FRESNO CA DELTA HEALTH SYSTEMS

40413815 358569 89 AS (800) 826-0940 PO BOX 568 MENASHA WI NETWORK HEALTH PLAN

40413825 358569 38 XR (888) 916-2273 PO BOX 14407 CINCINNATI OH S&S HEALTHCARE STRATEGY

40413835 358569 87 RX (888) 869-4600

9525 HILLWOOD

DRIVE LAS VEGAS NV CATALYST RX

40413845 351113 38 AS (800) 362-5894

5045 N 12TH ST STE

100 PHOENIX AZ DAN R WAGNON & ASSOC

40413855 358569 38 AS (877) 697-2299 PO BOX 40846 JACKSONVILLE FL EMPLOYERS MUTUAL INC

40413865 352530 89 NO (800) 952-5277 PO BOX 695001 ORLANDO FL SOUTH CARE HMO

40413875 351113 38 AS (800) 252-2091 PO BOX 42018 PHOENIX AZ CIGNA HEALTHCARE

40413885 358569 38 AS (800) 999-2224

1001 HEATHROW

PARK LN #5001 LAKE MARY FL AMERICAN PIONEER LIFE INS CO

40413895 352530 38 AS (800) 733-8387 PO BOX 65024 DENVER CO VA HEALTH ADMINISTRATION CENTER

40413905 351113 89 AS (800) 600-4149

636 GRAND AVE

STATION 39 DES MOINES IA BCBS OF IA

40413915 413395 89 NO (419) 891-5206

12875 ECKEL

JUNCTION RD STE B PERRYSBURG OH FRONT PATH

40413925 351113 89 XR (888) 767-9640 PO BOX 10399 EUGENE OR EMERALD HEALTH ALLIANCE

40413935 351113 89 AS (800) 505-2858 PO BOX 6910 CANTON OH AULTCARE PPA PLAN

40413945 413395 89 AS (800) 298-4964 PO BOX 740 PUEBLO CO UNITED MEDICAL RESOURCES

40413955 413395 87 RX (888) 380-6182 PO BOX 545 DEERFIELD IL WALGREENS HEALTH INITIATIVES

40413965 351113 38 AS (866) 219-5625 PO BOX 18197 COLUMBUS OH ONE NATION BENEFITS

40413975 351113 38 AS (800) 832-6538 PO BOX 5817 WALLINGFORD CT NEW ENGLAND ELECTRICAL WORKERS BENEFITS FUND

Page 145: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40413985 413395 38 AS (800) 252-5742 PO BOX 7089 LONDON KY HEALTH AMERICA/HEALTH ASSURANCE

40413995 358569 89 AS (800) 633-7867 PO BOX 1998 SPRINGFIELD MA CONSOLIDATED HEALTH PLANS

40423105 351113 38 AS (703) 683-1664 PO BOX 9554 SALT LAKE CITY UT PBP HEALTH PLAN

40423115 358569 38 AS (800) 541-2363 PO BOX 34952 OMAHA NE CENTRAL STATES HEALTH & LIFE CO OF OMAHA

40423125 413395 88 DO (800) 866-5020 PO BOX 2940 CLINTON IA ASSURANT HEALTH

40423135 352530 83 NH (800) 638-9641 PO BOX 937 WESTPORT CT METLIFE

40423145 351113 87 RX (800) 771-4648 6310 LAMAR STE 230 OVERLAND PARK KS MEDTRAK SERVICES

40423155 413395 38 AS (800) 631-2828 PO BOX 6367 WYOMISSING PA ALTERNATIVE BENEFIT SYSTEMS

40423165 358569 89 AS (716) 664-4391 202 W FOURTH ST JAMESTOWN NY SOUTHERN TIER BLDG TRADES BENEFIT PLAN

40423175 413395 38 AS (800) 878-8802

8802 N MERIDIAN ST

STE 100 INDIANAPOLIS IN M PLAN

40423185 413395 89 NO (800) 200-0747

1420 CENTER POINT

BLVD KNOXVILLE TN PREFERRED HEALTH PARTNERSHIP NETWORK

40423195 358113 38 AS (800) 749-2631 PO BOX 720460 OKLAHOMA CITY OK EQUITABLE PLAN SERVICES

40423205 413395 89 AS (800) 462-0189 PO BOX 730 PUEBLO CO UNITED MEDICAL RESOURCES

40423215 413395 38 AS (614) 797-5200 PO BOX 619053 DALLAS TX CENTRAL BENEFTIS

40423225 352530 89 AS (800) 272-8451 PO BOX 44036 BATON ROUGE LA OFFICE OF GROUP BENEFITS

40423235 358569 38 AS (800) 873-2022

310 EAST 96TH ST STE

200 INDIANAPOLIS IN WSA TPA SERVICES INC

40423245 413395 88 DO (404) 842-0316

3350 PEACHTREE RD

NE STE 1040 ATLANTA GA GROUP INSURANCE ADMINISTRATION

40423255 413395 76 AS (888) 604-9397 PO BOX 8215 LITTLE ROCK AR CORESOURCE

40423265 358569 38 AS (800) 634-3506 PO BOX 1430 DANVILLE IL CANNON COCHRAN MANAGEMENT SERVICES INC

40423275 413395 87 RX (800) 273-9166 20427 N 27TH AVE PHOENIX AZ AVIA PARTNERS

40423285 358569 89 AS (972) 424-6269 PO BOX 860037 PLANO TX TEXAS PIPE TRADES

40423295 352530 38 AS (800) 252-8039 PO BOX 6109 ABILENE TX HEALTH SELECT OF TEXAS

40423305 352530 38 AS (800) 567-5899

USCW 9970 OLD

AIRPORT HWY MONCLOVA OH NATIONAL EMPLOYEE BENEFITS

40423315 358569 89 AS (248) 948-9900

24700 W TWELVE

MILE RD STE 101 SOUTHFIELD MI EMPLOYEE HEALTH INSURANCE MANAGEMENT

40423325 351113 38 AS (800) 847-4836 4321 N BALLARD RD APPLETON WI THRIVENT FINANCIAL FOR LUTHERANS

40423335 352530 89 NO (800) 266-5896 PO BOX 2090C STOW OH SUPERIEN HEALTH NETWORK

40423345 352530 89 AS (800) 338-7971 PO BOX 91010 SEATTLE WA NORTH STAR ADMINISTRATORS

40423355 352530 38 AS (630) 238-1900 234 SPRING LAKE DR ITASCA IL METLIFE

40423365 351113 38 AS (877) 775-5430 PO BOX 599 PENNSKAN NJ MASKIN MANAGEMENT CORP

40423375 358569 67 AS (603) 749-5140 PO BOX 271 DOVER NH IBEW LOCAL 490

40423385 352530 89 AS (888) 271-5870 PO BOX 45180 SALT LAKE CITY UT UNIVERSITY OF UTAH HEALTH

40423395 358569 89 NO (800) 613-1124 600 SIX FLAGS DR ARLINGTON TX ACCOUNTABLE HEALTH PLANS OF AMERICA INC

40423405 352530 89 AS (866) 737-0506 PO BOX 379018 LAS VEGAS NV HEALTH MANAGEMENT & ASSOCIATES

40423415 358569 38 AS (800) 321-0347 PO BOX 1245 DES PLAINES IL ALLIANCE HEALTH BENEFIT PLAN

Page 146: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40423425 358569 38 AS (607) 272-2707

118 PROSPECT ST STE

102 ITHACA NY IEES

40423435 352530 38 AS (810) 257-3515 PO BOX 8023 NOVI MI FINANCIAL DESIGNS

40423445 358569 67 AS (602) 650-8161 PO BOX 16200 PHOENIX AZ OPERATING ENGINEERS LOCAL 428

40423455 352530 89 NO (800) 451-4308 PO BOX 730 PUEBLO CO OSHCARE NETWORK

40423465 352530 38 AS (800) 228-0048 6525 CENTURION DR LANSING MI TIC INTERNATIONAL

40423475 358569 38 AS (972) 424-6269 PO BOX 860037 PLANO TX TEXAS PIPE TRADES

40423485 358113 38 AS (317) 894-2000 PO BOX 90 NEW PALESTINE IN GOOD SAMARITAN

40423495 351113 38 AS (800) 686-8425 PO BOX 1099 NEWARK OH MEDBEN

40423505 352530 86 VO (800) 883-5747 PO BOX 44077 MILWAUKEE WI VISION INSURANCE PLAN OF AMERICA

40423515 358569 38 AS (800) 600-4441 PO BOX 61659 VIRGINIA BEACH VA AMERIGROUP

40423525 351113 89 AS (800) 342-0719

1511 N WEST SHORE

BLVD STE 820 TAMPA FL ALLNATION INSURANCE CO

40423535 413395 38 AS (800) 840-7443

777 S HARBOUR

ISLAND BL#350 TAMPA FL PHYSICIANS HEALTHCARE PLANS

40423545 352530 89 AS (800) 660-6212 PO BOX 619055 DALLAS TX HEALTHSCOPE BENEFITS

40423555 351113 38 AS (888) 553-8009 PO BOX 11265 ALEXANDRIA VA LUMENOS

40423565 351113 38 AS (419) 662-1388

7570 CABLE BLVD STE

B NORTHWOOD OH NORTHWESTERN OHIO PLUMBERS & PIPEFITTERS NO50

40423575 351113 89 AS (323) 866-2200 PO BOX 48127 LOS ANGELS CA DGA PRODUCER HEALTH PLANS

40423585 351113 89 AS (800) 321-3497 PO BOX 944 OWINGS MILLS MD BC BS OF MD

40423595 351113 38 AS (800) 447-6588

2180 NORTH LOOP

WEST HOUSTON TX EMPLOYER PLAN SERVICES INC

40423605 358569 38 AS (800) 662-5851

852 EAST

ARROWHEAD LANE MURRAY UT EDUCATORS MUTUAL INSURANCE ASSOC OF UTAH

40423615 352530 38 AS (800) 203-7225 2000 SUMMER ST NE MINNEAPOLIS MN U CARE MINNESOTA

40423625 413395 38 AS (888) 801-1907 PO BOX 232 MORTON IL MORTON BUILDINGS INC

40423635 358569 38 AS (800) 615-7020 PO BOX 23 SHEBOYGAN WI PRAIRIE STATES ENTERPRISES INC

40423645 352530 89 AS (877) 864-2273 PO BOX 4458 CHICAGO IL UNICARE

40423655 358569 38 AS (800) 544-5531 PO BOX 638 BELLINGHAM WA COMBINED PRIORITY ONE

40423665 358569 89 AS (801) 572-0720 PO BOX 4000 DRAPER UT EMPLOYEE BENEFIT MANAGEMENT SERVICES

40423675 352530 38 AS (904) 596-4500 PO BOX 10269 JACKSONVILLE FL MEDCOM SERVICES

40423685 413395 89 AS (800) 225-9674 PO BOX 37504 OAK PARK MI US HEALTH AND LIFE

40423695 352530 34 AS (859) 296-6000 PO BOX 14079 LEXINGTON KY UNITED HEALTHCARE

40423705 352530 89 NO (800) 891-4422 PO BOX 810 PEWAUKEE WI PLAINES HEALTH NETWORK INC

40423715 351113 88 DO (800) 741-2798 PO BOX 162390 ATLANTA GA MONARCH BENEFIT GROUP

40423725 413395 38 AS (800) 235-7160 PO BOX 520 PUEBLO KS UNITED MEDICAL RESOURCES

40423735 352530 38 AS (800) 537-8275 PO BOX 2942 CLINTON IA TRUSTMARK INSURANCE CO

40423745 358569 38 AS (800) 342-1407 PO BOX 884 APPLETON WI EMPLOYEE BENEFIT CLAIMS OF WI

40423755 413395 38 AS (417) 882-8100 4675 S HOLLAND SPRINGFIELD MO WORLDWIDE INSURANCE & CLAIMS SVC

Page 147: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40423765 413395 38 AS (800) 505-4160 PO BOX 809067 DALLAS TX CHESAPEAKE LIFE INS CO

40423775 351113 89 AS (800) 222-5028 PO BOX 35 DURHAM NC BC BS OF NC

40423785 358569 88 DO (800) 300-9409 PO BOX 30888 PHOENIX AZ STAR HRG

40423795 352530 34 AS (402) 445-5000

2717 NORTH 118TH

CIRCLE OMAHA NE UNITED HEALTHCARE

40423805 352530 89 AS (469) 417-1700 PO BOX 99906 GRAPEVINE TX WEB TPA

40423815 352530 38 AS (888) 352-5246 PO BOX 6580 THOMASVILLE GA TAYLOR BENEFIT RESOURCE

40423825 351113 89 AS (800) 232-2345 PO BOX 13466 PHOENIX AZ BC BS OF AZ

40423835 351113 38 AS (800) 949-5845

ONE WEST THIRD ST

STE 900 TULSA OK MARSH ADVANTAGE AMERICA

40423845 351113 89 AS (800) 244-6224 PO BOX 7000 ROCKAWAY NJ CIGNA

40423855 358569 89 AS (800) 292-5386 PO BOX 690450 SAN ANTONIO TX BENEFIT PLANNERS

40423865 351113 88 DO (877) 277-7280 601 SW 2ND AVE PORTLAND OR ODS

40423875 351113 89 AS (866) 738-3924 PO BOX 52890 BELLEVUE WA REGENCY GROUP ADMINISTRATORS

40423885 413395 38 AS (888) 255-7772 PO BOX 0637 CAROL STREAM IL ALLSTATE BENEFITS CENTER

40423895 352530 34 AS (314) 592-7000 PO BOX 2560 MARYLAND HTS MO UNITED HEALTHCARE

40423905 352530 89 NO (800) 543-3195 PO BOX 3120 ELKHART IN ELKHART MEDICAL ORGANIZATION

40423915 352530 88 DO (800) 842-3729 PO BOX 2640 OMAHA NE LINCOLN FINANCIAL

40423925 358569 88 DO (616) 954-3300 PO BOX 1687 GRAND RAPIDS MI CBCA ADMINISTRATORS INC

40423935 413395 38 AS (800) 776-2452

9201 WATSON RD STE

350 ST LOUIS MO CENTURY PLANNERS

40423945 413395 89 AS (800) 362-9354

6281 YOUNGSTOWN

WARREN RD NILES OH OHIO CARPENTERS H&W FUND

40423955 351113 88 DO (800) 367-6401 PO BOX 23059 BELLEVILLE IL BC BS IL DENTAL PROGRAM

40423965 352530 89 NO (800) 634-9585 PO BOX 970 AMHERST NY SELECT MEDICAL MANAGEMENT

40423978 358569 38 AS (757) 461-8091 5303 VA BEACH BLCD NORFOLK VA PLUMBERS & PIPEFITTERS LOCAL 450

40423985 351113 89 AS (800) 543-7822 PO BOX 7026 WHEELING WV MOUNTAIN STATE BC BS

40423995 351113 38 AS (800) 775-3540 PO BOX 7139 LONDON KY CARPENTERS HEALTH & WELFARE TRUST FUND

40424015 352530 38 AS (800) 438-7886 PO BOX 14700 LEXINGTON KY HEALTHNET

40424025 413395 38 AS (800) 331-3287 PO BOX 68947 INDIANAPOLIS IN J F MOLLOY & ASSOCIATES

40424035 351113 89 AS (302) 421-3276 PO BOX 8830 WILMINGTON DE BC BS OF DE

40424045 351113 38 AS (800) 283-4927 PO BOX 21109 ROANOKE VA HEALTH & WELFARE BENEFIT SYSTEMS

40424055 351113 38 AS (888) 352-5246 829 FAIRWAYS CT STOCKBRIDGE GA MONARCH BENEFITS

40424065 413395 38 AS (800) 331-3287 PO BOX 68947 INDIANAPOLIS IN JF MOLLOY & ASSOCIATES

40424075 413395 84 IO (504) 566-3956 PO BOX 60219 NEW ORLEANS LA PAN AMERICAN

40424085 358569 89 AS (888) 654-3300 5050 SCHAEFER DEARBORN MI MIDWEST HEALTH AKM

40424095 358569 38 AS (800) 638-8432 PO BOX 668329 CHARLOTTE NC RURAL CARRIER BENEFIT PLAN

40424115 352530 84 IO (800) 955-4304 PO BOX 12686 BIRMINGHAM AL PROTECTIVE LIFE INS CO

40424125 351113 89 AS (800) 429-9886 PO BOX 80 BUFFALO NY BC BS OF NORTH EASTERN NY

40424135 413395 89 AS (800) 827-9842 PO BOX 10 BEEBE PLAIN VT GLOBAL EXCEL MANAGEMENT

40424145 351113 38 AS (800) 638-0589 PO BOX 4759 SILVER SPRING MD ADVENTIST RISK MANAGEMENT INC

Page 148: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40424155 351113 30 AS (800) 722-7535 PO BOX 182352 COLUMBUS OH CIGNA HEALTHCARE

40424165 413395 89 AS (800) 480-5035 720 BLAIRMILL RD HORSHAM PA AMERIHEALTH ADMINISTRATORS

40424175 358569 38 AS (866) 247-1443 PO BOX 4000 DRAPER UT EMPLOYEE BENEFIT MANAGEMENT SERVICES

40424185 358569 38 AS (866) 718-6034 PO BOX 1557 MINNEAPOLIS MN CBCA ADMINISTRATORS INC

40424195 351113 38 AS (800) 645-4116 PO BOX 399127 Cambridge MA AMERICAN PROGRESSIVE LIFE & HLTH INS CO OF NY

40424215 352530 38 AS (866) 616-8288 2401 20TH ST DETROIT MI JVP ENTERPRISES/PLATINUM HEALTH

40424225 358569 38 AS (866) 470-6150 1477 BARCLAY BLVD BUFFALO GROVE IL WESTLAKE FINANCIAL

40424235 352530 89 AS (419) 446-4100 PO BOX 156 ARCHBALD OH SAUDERS WOODWORKING

40424245 413395 89 AS (888) 293-9229

997 OLD EAGLE

SCHOOL RD STE215 WAYNE PA ADMINISTRATIVE CONCEPTS

40424255 351113 89 NO (888) 446-6670 PO BOX 20570 INDIANAPOLIS IN INDIANA HEALTH NETWORK

40424265 358569 38 AS (608) 784-2443 PO BOX 1385 LACROSSE WI CUSTOM BENEFIT ADMINISTRATORS

40424275 351113 38 AS (800) 348-7468 PO BOX 483 GOSHEN IN MMA INSURANCE CO

40424285 351113 89 NO (800) 799-6172 PO BOX 30319 LANSING MI CURANET

40424295 358569 89 AS (888) 472-4352 PO BOX 2947 COVINGTON LA GILSBAR INC

40424315 413395 89 AS (231) 728-5180 PO BOX 0238 MUSKEGON MI ACCESS HEALTH

40424325 351113 89 AS (800) 443-2980 PO BOX 1787 COLUMBUS IN SIHO INS SERVICES

40424335 351113 89 AS (800) 988-2262

52160 NATIONAL RD

EAST ST CLAIRSVILLE OH HEALTH PLAN OF UPPER OHIO VALLEY

40424345 358569 89 AS (800) 526-3919 PO BOX 1409 HENDERSONVILLE TN HEALTH COST SOLUTIONS

40424355 358569 89 NO (574) 535-2940 200 HIGH PARK AVE GOSHEN IN GOSHEN PREFFERED NETWORK

40424365 358569 67 AS (952) 854-0795

2850 METRO DR STE

404 BLOOMINGTON MN OPERATING ENGINEERS 49

40424375 413395 89 AS (800) 556-0711 2950 INDUSTRIAL RD LAS VEGAS NV PERCS

40424385 413395 38 AS (800) 883-2177 PO BOX 1172 MINNEAPOLIS MN HEALTHPARTNERS CLAIMS

40424395 351113 89 AS (800) 932-3906 PO BOX 11158 TUSCON AZ FIRST HEALTH

40424415 351113 38 AS (877) 775-5430 CN85000 PENNSAUKEN NJ MASKIN MANAGEMENT CORP

40424425 352530 89 AS (800) 231-7729 PO BOX 30258 TAMPA FL AETNA GLOBAL BENEFITS

40424435 352530 38 AS (800) 767-0700 PO BOX 809025 DALLAS TX STUDENT INSURANCE

40424445 358113 38 AS (888) 772-2299 PO BOX 399127 CAMBRIDGE MA PENNSYLVANIA LIFE

40424455 351113 89 AS (800) 884-0194 PO BOX 11068 TUCSON AZ FIRST HEALTH

40424465 413395 38 AS (800) 553-2801 PO BOX 7128 PHOENIX AZ ZENITH ADMINISTRATORS

40424475 352530 38 AS (800) 428-8194

1720 INDIANWOOD

CIR STE C MAUMEE OH BRIDGE BENEFITS

40424485 351113 89 NO (877) 575-4209 PO BOX 247002 OMAHA NE FIRST HEALT/CRL

40424495 352530 38 AS (800) 258-0103 PO BOX 263 PARSIPPANY NJ NATIONAL BENEFIT ADMINISTRATORS

40424515 413395 89 AS (888) 333-4742 PO BOX 699183 QUINCY MA HARVARD PILGRIM

40424525 351113 89 AS (800) 822-4470 PO BOX 190 TROY OH SUMMIT INSURANCE CO

40424535 351113 89 AS (800) 892-6048 PO BOX 419169 KANSAS CITY MO BC BS OF KANSAS CITY

Page 149: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40424545 351113 88 DO (888) 236-1100 PO BOX 610 SOUTHFIELD MI ADN DENTAL NETWORK

40424555 351113 89 AS (877) 543-3935

1701 BARRETT LAKES

BLVD STE290 KENNESAW GA LIFEWELL HEALTH PLANS

40424565 351113 89 AS (800) 368-2469 PO BOX 11959 TUSCON AZ FIRST HEALTH

40424575 351113 89 AS (800) 621-0678 PO BOX 23600 TUSCON AZ FIRST HEALTH

40424585 358569 89 AS (800) 288-1474 PO BOX 54150 PHOENIX AZ CONNECTICUT GENERAL-STAR HRG

40424595 358569 38 AS (800) 478-1246 2600 DENALI STE 200 ANCHORAGE AK IBEW 547

40424605 413395 88 DO (800) 533-5044 PO BOX 39710 COLORADO SPRINGS CO PRINCIPAL FINANCIAL GROUP

40424615 351113 89 AS (800) 601-8769 PO BOX 11745 TUSCON AZ FIRST HEALTH

40424625 413395 38 AS (800) 835-5509 PO BOX 730 PUEBLO CO UNITED MEDICAL RESOURCES

40424635 413395 38 AS (614) 863-8780 PO BOX 107 REYNOLDSBURG OH BUSINESS ADMINISTRATION CONSULT

40424645 413395 89 AS (800) 533-5044 PO BOX 39710 COLORADO SPRINGS CO PRINCIPAL FINANCIAL GROUP

40424655 352530 89 NO (888) 315-6045 PO BOX 2388 STOW OH THE CHANDLER GROUP

40424665 358569 38 AS (800) 624-2414 PO BOX 2832 NEW YORK NY GHI

40424675 352530 86 VO (888) 478-3722 NORTH 17 W 24222 WAUKESHA WI NATIONAL VISION ADMINISTRATION

40424685 352530 38 AS (304) 737-0768

600 CHARLES ST

COLONY CTR WELLSBURG WV WV PIPE TRADES HEALTH & WELFARE FUND

40424695 413395 38 R6 (888) 202-4340 PO BOX 12466 PENSACOLA FL SECURE HORIZONS

40424705 351113 89 AS (800) 851-2369 PO BOX 22410 TUCSON AZ FIRST HEALTH

40424715 352530 88 DO (800) 942-0854 PO BOX 981282 EL PASO TX METLIFE

40424725 351113 38 AS (719) 381-1950 PO BOX 520 COLORADO SPRINGS CO YOUNG LIFE BENEFIT PLAN

40424735 351113 89 AS (888) 344-7220 PO BOX 100252 COLUMBIA SC GE FINANCIAL SERVICES

40424745 352530 38 AS (800) 538-5512

930 CANTERBURY

PLACE ESCONDIDO CA THE PLAN HANDLERS

40424755 413395 88 DO (800) 624-7130 4940 CAMPBELL BLVD BALTIMORE MD CORESOURCE

40424765 358569 87 RX (800) 558-4444 PO BOX 14610 LEXINGTON KY HUMANA RX

40424775 352530 89 AS (217) 429-5246 PO BOX 1340 DECATUR IL WABASH MEMORIAL HOSP ASSOC

40424785 352530 88 DO (800) 430-5161 PO BOX 30567 SALT LAKE CITY UT UNITED HEALTHCARE DENTAL

40424795 351113 38 AS (800) 443-2980 PO BOX 1787 COLUMBUS IN SIHO INS SERVICES

40424805 351113 89 AS (800) 207-7692 PO BOX 24040 TUCSON AZ FIRST HEALTH

40424815 413395 87 RX (248) 948-9900

26711

NORTHWESTERN HWY

STE 400 SOUTHFIELD MI EHIM

40424825 358569 38 AS (888) 259-7022 PO BOX 27267 MINNEAPOLIS MN CORPORATE BENEFIT SERVICES

40424835 358569 88 DO (800) 828-6922 PO BOX 9501 AMHERST NY MERITAIN HEALTH

40424845 413395 38 AS (800) 722-8477 PO BOX 382048 BIRMINGHAM AL PREFERRED HEALTH ALLIANCE CORP

40424855 413395 38 AS (800) 810-9892 902 CLINT MORE RD BOCA RATON FL UNITED GROUP PROGRAMS

40424865 413395 38 AS (800) 922-3420 PO BOX 39 MINNEAPOLIS MN HEALTH WORLDWIDE

40424875 351113 38 AS (608) 276-9111

2730 DARY DRIVE

SUITE 101 MADISON WI WI ELECTRICAL EMPLOYEES HEALTH PLAN

Page 150: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40424885 351113 05 AS (800) 438-5270 5250 S VIRGINIA ST RENO NV BC BS OF NV

40424895 352530 38 AS (877) 800-2956 PO BOX 61593 KING OF PRU PA ULLICARE

40424905 352530 86 VO (888) 723-7492 PO BOX 981107 EL PASO TX AETNA US HEALTHCARE

40424915 358569 87 RX (800) 341-2234 685 BLOOMFIELD AVE VERONA NJ GENERAL PRESCRIPTION

40424925 351113 89 AS (800) 443-2583 PO BOX 30272 SALT LAKE CITY UT REGENCE BC BS OF UTAH

40424935 351113 38 AS (888) 363-4537 PO BOX 442048 HOUSTON TX MEIJER FIRST CARE MEDICAL

40424945 358569 38 AS (864) 582-7990 PO BOX 3492 SPARTANBURG SC CONSUMER HEALTH

40424955 358871 88 DO (800) 232-5432 PO BOX 19032 GREEN BAY WI AMERICAN MEDICAL SECURITY

40424965 351113 86 VO (517) 482-0871 415 E KALAMAZOO ST LANSING MI SET SEG INC

40424975 351113 84 IO (800) 497-3699 PO BOX 440 ASHLAND WI SELECT BENEFIT ADMINISTRATORS

40424985 413395 89 AS (800) 441-4518 PO BOX 1747 REDMOND OR SHASTA ADMINISTRATIVE SERVICE

40424995 358569 38 AS (406) 869-5555 PO BOX 21367 BILLINGS MT EMPLOYEE BENEFIT MANAGEMENT

40425005 351113 38 AS (800) 257-9873 PO BOX 32550 LOUISVILLE KY ANTHEM BENEFIT ADMINISTRATORS

40425015 358569 88 DO (888) 711-7876 PO BOX 30126 LANSING MI MERITAIN HEALTH (WEYCO)

40425025 358569 38 AS (888) 711-7876 PO BOX 31026 LANSING MI MERITAIN HEALTH (WEYCO)

40425035 413395 38 AS (888) 645-6410 PO BOX 6702 COLUMBIA SC PLANNED ADMINISTRATORS INC

40425045 352530 89 NO (800) 835-2556

228 W WASHINGTON

ST MARQUETTE MI UPPER PENINSULA HEALTH PLAN

40425055 351113 89 AS (800) 362-4700 PO BOX 6018 CLEVELAND OH MEDICAL MUTUAL OF OH

40425065 358569 38 AS (866) 906-0200 11465 W CERMAK RD WEST IL LABOR HEALTH AND WELFARE

40425075 352530 38 AS (260) 492-9979 PO BOX 15952 FORT WAYNE IN Q3 BUSINESS TECHNOLOGY

40425085 352530 88 DO (913) 362-1112 PO BOX 25326 OVERLAND PARK KS UNIFIED LIFE

40425095 358569 38 AS (800) 446-5439 PO BOX 11088 CHARLOTTE NC PRIMARY PHYSICIANCARE INC

40425105 358569 38 AS (800) 831-0785

1323 S MINNESOTA

AVE SIOUX FALLS SD DAKOTACARE

40425115 358569 38 AS (417) 269-2900

1443 N ROBBERSON

AVE STE 700 SPRINGFIELD MO COX HEALTH PLAN

40425125 352530 38 AS (800) 426-9786 PO BOX 1894 TACOMA WA TRUSTEED PLANS

40425135 358569 89 AS (800) 969-6447 PO BOX 16110 SALT LAKE CITY UT MEDICAL GROUP INSURANCE SPECIALISTS

40425145 352530 89 AS (262) 544-4811 PO BOX 1611 WAUKESHA WI GENERAC POWER SYSTEMS INC

40425155 352530 89 AS (800) 348-2922 PO BOX 7373 LONDON KY CARELINK

40425165 413395 38 AS (800) 842-3216 PO BOX 853921 RICHARDSON TX BSI NORTHERN AMERICAN

40425175 351113 88 DO (800) 817-2545 PO BOX 188037 CHATTANOOGA TN CIGNA

40425185 358113 38 PS (800) 865-3200

512 TOWNSHIP LINE

RD BLUE BELL PA BEHAVIORAL HEALTH CARE SERVICES

40425195 413395 76 AS (800) 480-6658 PO BOX 2920 CLINTON IA CORESOURCE INC

40425205 358569 86 VO (800) 507-3800 PO BOX 967 RANCHO CORDOVA CA SUPERIOR VISION SERVICES

40425215 351113 89 AS (800) 362-3152 PO BOX 1043 JACKSON MS BC BS OF MS

Page 151: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40425225 358569 38 AS (800) 510-3949

10 CHATHAM CENTER

SOUTH SAVANNAH GA CBCA ADMINISTRATORS

40425235 351113 88 DO (866) 316-4140 PO BOX 5004 SCHENECTADY NY CONTINENTAL GENERAL CENTRAL RESERVE LIFE

40425245 351113 89 AS (800) 328-8749 PO BOX 24504 TUCSON AZ FIRST HEALTH

40425255 358569 88 DO (800) 533-9899 2905 LUCERNE DR GRAND RAPIDS MI ACTIVA

40425265 358569 88 DO (800) 627-6396 PO BOX 8400 LONDON KY FIRST HEALTH-COVENTRY HEALTH CARE

40425275 351113 89 AS (800) 221-1396 PO BOX 1609 NEWARK NJ BC BS OF NJ

40425285 358569 89 AS (888) 650-6566 PO BOX 346 ALPHARETTA GA CAPITOL ADMINISTRATORS

40425295 413395 88 DO (800) 542-6642 2700 MIDWEST DR ONALSKA WI UMR

40425305 358569 88 DO (800) 206-0827 PO BOX 9900 SIOUX CITY IA FIRST ADMINISTRATORS

40425315 413395 89 NO (574) 283-5959 2710 EXECUTIVE DR GREEN BAY WI PREVEA HEALTH NETWORK

40425325 351113 88 DO (877) 286-3559 PO BOX 5085 FINDLAY OH HEALTH DESIGN PLUS

40425335 413395 89 AS (800) 962-3158 PO BOX 20490 INDIANAPOLIS IN INDIANA LABORERS PENSION FUND

40425345 413395 38 AS (866) 340-2046 PO BOX 50427 INDIANAPOLIS IN VERUS HEALTH

40425355 351113 38 AS (708) 562-0200 11465 W SURMACK WESTCHESTER IL LABORERS HEALTH & WELFARE

40425365 358569 89 AS (866) 818-3106

2605 W 22ND ST STE

25 OAKBROOK IL CONCERT HEALTH PLAN

40425375 358569 88 DO (248) 855-8040 PO BOX 2365 FARMINGTON HILLS MI EMPLOYEE BENEFITS CONCEPTS INC

40425385 351113 88 DO (800) 757-7204 PO BOX 250878 WEST BLOOMFIELD MI BCI ADMINISTRATORS

40425395 358569 33 AS (510) 796-4678 PO BOX 5820 FREEMONT CA TEAMSTERS BENEFIT TRUST

40425405 352530 88 DO (800) 221-3480 PO BOX 1581 NEPTUNE NJ AIG DENTAL

40425415 351113 38 AS (800) 669-9030 PO BOX 925309 HOUSTON TX MANHATTAN LIFE INS CO

40425425 358569 88 DO (800) 634-0173 PO BOX 458022 WESTLAKE OH JP FARLEY

40425435 351113 89 AS (800) 332-3842 PO BOX 17849 DENVER CO ANTHEM BCBS OF COLORADO

40425445 352530 88 DO (803) 735-1251 PO BOX 100102 COLUMBIA SC COMPANION LIFE

40425455 413395 86 VO (800) 541-2039 PO BOX 890500 CAMP HILL PA CLARITY VISION

40425465 358569 38 AS (803) 750-7400

201 EXECUTIVE

CENTER DR COLUMBIA SC CAROLINA CARE PLAN

40425475 413395 86 VO (800) 801-5409 PO BOX 710 PUEBLO CO UNITED MEDICAL RESOURCES

40425485 351113 86 VO (888) 367-3393 PO BOX 1525 LATHAM NY DAVIS VISION

40425495 413395 89 AS (800) 832-8212 PO BOX 437017 LOUISVILLE KY PREFERRED HEALTH PLANS

40425505 352530 38 AS (800) 451-2513 PO BOX 677 GREENFIELD MA SUN LIFE & HEALTH INSURANCE CO

40425515 413395 38 X5 (212) 539-5111 PO BOX 1449 NEW YORK NY ALICARE

40425525 351113 89 AS (800) 244-6224

2223 WASHINGTON ST

STE 200 NEWTON MA CIGNA HEALTHCARE

40425535 351113 89 AS (800) 888-0757 1901 MAIN ST BUFFALO NY BC BS OF WESTERN NY

40425545 358569 38 AS (800) 476-2295 PO BOX 3257 SPARTANBURG SC CAROLINA BENEFITS ADMINISTRATORS

40425555 352530 88 DO (800) 708-5652 DEPT CH 10579 PALATINE IL METLIFE

40425565 352530 38 AS (800) 842-1109 450 COLUMBUS BLVD HARTFORD CT UNITED HEALTHCARE

40425575 358569 38 PS (800) 934-7245 PO BOX 1002 MERRIFIELD VA VALUE OPTIONS

40425585 352530 88 DO (800) 342-5209 PO BOX 14093 LEXINGTON KY COMPBENEFITS

Page 152: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40425605 352530 38 AS (404) 257-0072

4170 ASHFORD

DUNWOODY RD NE ATLANTA GA THE GUARDIAN

40425615 351113 89 AS (888) 690-2020 PO BOX 25160 SCOTTSDALE AZ SUMMIT MANAGEMENT SERVICES

40425625 352530 88 DO (602) 241-0914 3625 N 16TH ST #206 PHOENIX AZ SECURE CARE DENTAL

40425645 352530 38 AS (800) 294-3557 PO BOX 25230 LITTLE ROCK AR NOUASYS HEALTH

40425655 352530 86 VO (800) 432-4966 300 WEYMAN PLAZA PITTSBURGH PA VISION BENEFITS OF AMERICA

40425665 358569 38 AS (404) 365-0966

3495 PIEDMONT RD

NE ATLANTA GA KAISER PERMANENTE

40425675 352530 86 VO (800) 225-3095 140 MACOMB MT CLEMENS MI SVS VISION

40425685 351113 38 AS (800) 873-5553 2155 OXNARD ST WOODLAND HI CA ANTHEM BC CALIFORNIA

40425695 352530 38 AS (800) 786-7930 PO BOX 7186 BOISE ID AMERIBEN SOLUTIONS

40425705 351113 88 DO (800) 937-6432 PO BOX 69421 HARRISBURG PA UNITED CONCORDIA

40425715 358569 89 AS (800) 611-1811 PO BOX 190849 ATLANTA GA KAISER

40425725 351113 38 AS (612) 671-3131

227 AMERICAN

EXPRESS FIN. CTR MINNEAPOLIS MN IDSN

40425735 413395 38 AS (800) 631-1656

100 NORTH ACADEMY

AVE DANVILLE PA GEISINGER HEALTH PLAN

40425745 358569 88 DO (800) 336-8264 PO BOX 151240 IRVING TX DELTA DENTAL OF TX

40425755 351113 88 DO (800) 587-6857 PO BOX 1348 MINNEAPOLIS MN DCARE DENTAL

40425765 352530 88 DO (800) 926-0925 1432 D JONES BLVD LAS VEGAS NV NEVADA PACIFIC DENTAL

40425785 352530 88 DO (800) 367-1037 300 NW 82ND ST PLANTATION FL D CARE DENTAL

40425795 352530 88 DO (800) 879-0288

4061 POWDER MILL

RD STE 325 CALVERTON MD DENTAQUEST

40425805 413395 38 AS (800) 497-3699 PO BOX 440 ASHLAND WI SELECT BENEFIT ADMINISTRATORS

40425815 352530 89 AS (800) 527-3322 2000 W MARSHALL DR GRAND PRAIRIE TX POLY AMERICA

40425825 413395 89 AS (888) 362-4585 PO BOX 62735 PHOENIX AZ ARIZONA FOUNDATION

40425835 352530 89 NO (888) 914-7726

225 PICTORIA DRIVE

STE 320 CINCINNATI OH HEALTH SPAN

40425845 351113 89 AS (702) 697-8593 PO BOX 97979 LAS VEGAS NV IMPERIAL PALACE HOTEL AND CASINO

40425855 352530 89 AS (213) 484-8480 PO BOX 57924 LOS ANGELES CA LA HOTEL/RESTAURANT EMPLOYER UNION WELFARE

40425865 351113 89 AS (775) 352-6900 1625 E PRATER WAY SPARKS NV CDS GROUP HEALTH

40425875 351113 88 DO (513) 598-2929 PO BOX 58339 CINCINNATI OH DENTAL CARE PLUS/CUSTOM DESIGN BENEFITS

40425885 352530 38 AS (800) 700-2693 PO BOX 70 CLAYTON AL BOYD CARE

40425895 358569 89 AS (866) 646-8919 PO BOX 2631 MONROE MI PLUMBERS LOCAL 98

40425905 352530 89 AS (800) 899-9355 PO BOX 3039 BIRMINGHAM MI FC BENEFITS

40425915 358569 88 DO (702) 869-6200 7312 W CHEYENNE LAS VEGAS NV DIVERSIFIED DENTAL SERVICES

40425925 358569 89 AS (800) 524-0227 200 FREEWAY DRIVE E EAST ORANGE NJ EASTERN BENEFITS SYSTEM INC

Page 153: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40425935 351113 38 AS (866) 616-8288

33035 SCHOOLCRAFT

RD LIVONIA MI PLATINUM HEALTH

40425945 352530 38 AS (800) 525-8788 PO BOX 15440 PORTLAND ME MED NET

40425955 413395 86 VO (800) 451-2513 PO BOX 1477 GREENFIELD MA GE FINANCIAL ASSURANCE

40425965 358569 86 VO (800) 865-3676 PO BOX 30349 TAMPA FL HUMANA COMP BENEFITS

40425975 351113 88 DO (800) 441-7150 PO BOX 188037 CHATTANOOGA TN CIGNA DENTAL

40425985 358569 89 AS (888) 599-1515 PO BOX 5082 MT LAUREL NJ INSURANCE ADMINISTRATORS OF AMERICA

40425995 351113 89 AS (800) 362-2218 PO BOX 98029 BATON ROUGE LA BC BS OF LA

40426005 351113 86 VO (800) 672-7723 PO BOX 2187 CLIFTON NJ NVA-NATIONAL VISION ADMINISTRATORS

40426015 358569 87 RX (800) 331-7108 PO BOX 1069 ROCKVILLE MD CATALYST RX

40426025 358569 38 AS (800) 275-4614 PO BOX 530603 BIRMINGHAM AL EMPLOYEE BENEFIT CONSULTANTS

40426035 413395 87 RX (800) 479-0031

PO BOX 419019 DEPT

248 KANSAS CITY MO BENRX

40426045 352530 88 DO (800) 848-5433 PO BOX 70602 CHARLOTTE NC SHANDOAH

40426055 358569 86 VO (248) 822-4150

2075 W BIG BEAVER

STE 700 TROY MI MRCC EMPLOYEE BENEFITS PLAN

40426065 358569 88 DO (248) 822-4150

2075 W BIG BEAVER

STE 700 TROY MI MRCC EMPLOYEE BENEFITS PLAN

40426075 413395 88 DO (800) 247-4695 PO BOX 47126 PLYMOUTH IA PRINCIPAL FINANCIAL

40426085 413395 87 RX (866) 957-6437 1014 VINE STREET CINCINNATI OH KROGER PRESCRIPTION PLANS

40426095 358569 88 DO (800) 533-0472 PO BOX 328 OWATONNA MN FEDERATED MUTUAL INS CO

40426105 358569 87 RX (248) 822-4150

2075 W BIG BEAVER

STE 700 TROY MI MRCC EMPLOYEE BENEFITS PLAN

40426115 358569 89 AS (248) 822-4141 PO BOX 1408 TROY MI SHEET METAL WRKRS LOCAL 80

40426125 358569 89 AS (800) 777-3575 PO BOX 21367 BILLINGS MT EBMS

40426135 352530 86 VO (800) 877-6372 PO BOX 93033 LONG BEACH CA MES VISION

40426145 352530 88 DO (888) 715-0760 PO BOX 659010 SACRAMENTO CA PREMIER ACCESS DENTAL

40426155 352530 38 AS (800) 497-4856

1776 AMERICAN

HERITAGE DR JACKSONVILLE FL BENEFITS IN A CARD

40426165 351113 38 AS (734) 994-9099

950 VICTORS WAY STE

10 ANN ARBOR MI KAPNICK INSURANCE GROUP

40426175 413395 86 VO (800) 804-4384 PO BOX 8504 TWINSBURG OH VISION ONE EYE CARE PROGRAM

40426185 358569 38 AS (888) 813-7099 3501 FRONTAGE RD TAMPA FL ACEC

40426195 358569 88 DO (800) 964-7811

2100 POLICE DA LEON

STE 950 CORAL GABLES FL ATLANTIC DENTAL

40426205 413395 89 AS (866) 333-4648

1600 UTICA AVE S STE

900 ST LOUISE PARK MN DEFINITY HEALTH

40426215 352530 88 DO (877) 203-9921 PO BOX 100135 COLUMBIA SC FLORIDA COMBINED LIFE

40426225 358569 38 PS (800) 432-7461 PO BOX 1290 LATHAM NY VALUE OPTIONS

40426235 358569 86 VO (800) 474-5744 PO BOX 2218 SYRACUSE NY IBEW LOCAL 43 & ELECTRICAL CONTRACTORS TRUST

40426245 413395 38 AS (800) 843-1371 PO BOX 4934 GRAND ISLAND NE PRINCIPAL FINANCIAL GROUP

Page 154: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40426255 351113 88 DO (800) 752-1547

28588

NORTHWESTERN HWY SOUTHFIELD MI DENTEMAX

40426265 352530 89 AS (877) 596-3199 PO BOX 30444 NEW ORLEANS LA TOTAL BENEFIT SERVICES

40426275 352530 89 AS (405) 440-8888

4013 NW

EXPRESSWAY STE 575 OKLAHOMA CITY OK WATERSTONE BENEFITS

40426285 413395 38 AS (308) 385-7004 711 HIGH ST DES MOINES IA PRINCIPAL FINANCIAL GROUP

40426295 351113 88 DO (888) 745-3274 PO BOX 72749 NWNAN GA JSL ADMINISTRATORS

40426305 352530 88 DO (800) 828-9230

6300 OLSON

MEMORIAL HWY GOLDEN VALLEY MN UNIMERICA

40426315 413395 89 AS (800) 546-1166 PO BOX 14702 LEXINGTON KY HEALTH NET

40426325 352530 38 AS (888) 368-7910

6300 BRIDGE POINT

PARKWAY AUSTIN TX FOUNDATION ONE BENEFITS ADMINISTRATORS

40426335 352530 89 AS (734) 728-8432 36040 MI AVE WAYNE MI SHOPMENS LOCAL 508 HEALTH & WELFARE FUND

40426345 358569 88 DO (800) 452-4250 PO BOX 3111 MILWAUKEE WI HEARTLAND DENTAL PLAN

40426355 352530 38 AS (800) 842-6563

601 BOOK CREEK

BLVD OLDSMAR FL UNITED HEALTHCARE

40426365 413395 38 AS (800) 475-2232 PO BOX 75008 CEDAR RAPIDS IA AUXIANT

40426385 358569 89 AS (800) 229-8822 PO BOX 5028 TROY MI OPTIMA HEALTH

40426395 352530 38 AS (800) 827-2464 PO BOX 16423 MESA AZ BANNER HEALTH AND DENTAL PLAN

40426405 358569 88 DO (316) 264-4511 PO BOX 49198 WICHITA KS DELTA DENTAL PLAN OF KS

40426415 413395 38 AS (800) 733-7879 PO BOX 807009 KANSAS CITY MO ASSURANT EMPLOYEE BENEFITS

40426425 352530 88 DO (800) 627-0004 PO BOX 9201 OXNARD CA DENTAL SERVICES

40426435 351113 89 NO (888) 354-5470 PO BOX 30319 LANSING MI CURANET

40426445 351113 38 PS (888) 202-5525 PO BOX 2327 SPRINGFIELD IL MINNESOTA LIFE

40426455 358569 88 DO (888) 223-9575

12695 W NATIONAL

AVE NEW BERLIN WI DENTABLUE DENTACARE OF WI

40426465 351113 89 AS (866) 249-0930 PO BOX 11431 TORRANCE CA KEENAN & ASSOC

40426475 351113 89 AS (800) 282-1414 PO BOX 69510 HARRISBURG PA HEALTH MARKET

40426485 352530 38 AS (800) 284-0042 DEPT 888113 KNOXVILLE TN CARITEN

40426495 352530 89 AS (800) 937-7039

1776 AMERICAN

HERITAGE LIFE DR JACKSONVILLE FL ALL STATE

40426505 413395 88 DO (800) 279-6772 PO BOX 90991 MILWAUKEE WI AUXIANT

40426515 352530 88 DO (610) 325-9100 PO BOX 475 NEWTON PA NATIONAL ELEVATOR INDUSTRY BENEFIT PLANS

40426525 352530 86 VO (610) 325-9100 PO BOX 476 NEWTON PA NATIONAL ELEVATOR INDUSTRY BENEFIT PLANS

40426535 352530 89 AS (800) 453-7536 808 VARSITY DR TUPELO MN HEALTH LINK

40426545 413395 88 DO (800) 456-9194 PO BOX 624 MILAUKEE WI ASSURANT EMPLOYEE BENEFITS

40426555 352530 38 AS (248) 539-8000

28104 ORCHARD LAKE

RD STE 140 FARMINGTON HILLS MI DRS SERVICES

40426565 358569 38 AS (800) 777-4782 PO BOX 2977 GAINSVILLE GA BENEFIT SUPPORT INC

40426575 351113 89 AS (803) 817-7000 1800 OVERVIEW DR ROCKHILL SC CHICAGO PNEUMATIC TOOL CO HEALTHCARE PLAN

Page 155: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40426585 358113 89 AS (800) 670-1202 PO BOX 421169 HOUSTON TX NATIONAL WAY HEALTHCARE

40426595 358569 89 AS (818) 769-0007 PO BOX 1999 STUDIO CITY CA MOTION PICTURE IND PENSION & HEALTH PLANS

40426605 351113 88 DO (800) 633-1262 PO BOX 769649 ROSWELL GA COMP BENEFITS

40426615 352530 87 RX (877) 559-2955 PO BOX 8082 WAUSAU WI INNOVIANT

40426625 352530 38 X5 (800) 694-9888 PO BOX 260808 PLANO TX US NOW

40426635 351113 89 AS (440) 349-2210 5910 HARPER RD CLEVELAND OH ENTERPRISE GROUP PLANNING

40426645 413395 89 AS (800) 443-2995 501 WEST MICHIGAN MILWAUKEE WI ASSURANT EMPLOYEE BENEFITS

40426655 358569 89 AS (800) 825-7531 PO BOX 419233 KANSAS CITY MO ALLIED NATIONAL

40426665 351113 88 DO (800) 245-6642 PO BOX 1210 PITTSBURGH PA HIGHMARK BCBS

40426675 351113 89 AS (800) 586-5386 PO BOX 1434 SCHENECTADY NY MVP SELECT CARE

40426685 358569 89 AS (800) 356-2219 PO BOX 27489 ALBUQUERQUE NM PRESBYTERIAN

40426695 358569 88 DO (800) 388-3490 PO BOX 2870 BOISE ID DELTA DENTAL PLAN OF ID

40426705 358569 88 DO (800) 832-5700 PO BOX 2022 CONCORD NH NORTHEAST DELTA DENTAL

40426715 358569 88 DO (800) 843-3582 PO BOX 1517 PROVIDENCE RI DELTA DENTAL PLAN OF RI

40426725 413395 38 AS (800) 761-1778

100 CAMPUS VIEW

BLVD STE 200 COLUMBUS OH GREAT WEST HEALTHCARE

40426735 351113 87 RX (888) 437-1508

PO BOX 12625 M/S

S2P SALEM OR REGENCE RX

40426745 352530 86 VO (800) 624-7900 PO BOX 14106 SCOTTSDALE AZ EYE BENEFITS

40426755 351113 38 AS (866) 375-0775

509 LENOLA RD BLDG

2 MOORESTOWN NJ RELIANT STANDARD LIFE

40426765 358569 89 AS (800) 700-6756 PO BOX 421729 INDIANAPOLIS IN INDIANA CARPENTERS WELFARE & PENSION

40426775 352530 88 DO (800) 554-1907 PO BOX 75688 SEATTLE WA WASHINGTON DENTAL SERVICE

40426785 358569 88 DO (800) 627-3961 PO BOX 1157 PIERRE SD DELTA DENTAL PLAN OF SD

40426795 413395 86 VO (248) 649-0514

2855 COOLIDGE HWY

STE 202 TROY MI PREFERRED VISION SERVICES INC

40426805 352530 88 DO (586) 751-9000 27275 MOUND RD WARREN MI JAMES BURG TRUCKING CO

40426815 358113 86 VO (676) 957-1751 PO BOX 6392 GRAND RAPIDS MI ASR-VISION

40426825 358113 88 DO (616) 957-1751 PO BOX 6392 GRAND RAPIDS MI ASR-DENTAL

40426835 351113 88 DO (800) 547-9515 PO BOX 82622 LINCOLN NE STANDARD LIFE & ACCIDENT

40426845 352530 38 AS (562) 424-6200 PO BOX 438 PARK RIDGE IL UNIVERSAL CARE INC

40426855 351113 87 RX (800) 800-7364

940 WINDHAM CRT

STE 1 BOARDMAN OH PHARMACY DATA MANAGMENT

40426865 352530 88 DO (800) 842-6926 1 FINANCIAL BLDG. BOSTON MA METLIFE

40426875 351113 38 AS (800) 441-2668 PO BOX 15050 WILMINGTON DE CIGNA INTERNATIONAL

40426885 413395 88 DO (586) 954-3540 310 EUCLID MT CLEMENS MI FITZGERALD COMPANY

40426895 413395 86 VO (586) 954-3540 310 EUCLID MT CLEMENS MI FITZGERALD COMPANY

40426905 352530 89 AS (702) 252-7001 PO BOX 26509 LAS VEGAS NV SOUTHWEST ADMINISTRATORS

40426915 351113 38 AS (800) 365-2735 PO BOX 64668 ST PAUL MN COMPREHENSIVE CARE SERVICES

40426925 413395 38 AS (800) 376-0110 PO BOX 10888 GREENBAY WI TOTAL CLAIMS SOLUTION (TCS)

40426935 351113 89 AS (800) 937-6824 PO BOX 8400 LONDON KY COVENTRY HEALTH CARE-FIRST HEALTH

40426945 413395 89 AS (800) 881-9466 PO BOX 20000 NASHVILLE TN HEALTHSPRING

Page 156: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40426955 358569 86 VO (571) 548-7941

1451 OLD PINCKNEY

RD HOWELL MI ROOFERS LOCAL 70 INS FUND

40426965 351113 88 DO (877) 778-4104 PO BOX 30567 SALT LAKE CITY UT MWG DENTAL

40426975 351113 38 AS (800) 795-1023 PO BOX 24042 WINSTON SALEM NC MEDCOST BENEFIT SERVICES

40426985 413395 87 RX (888) 868-5854 PO BOX 391180 CLEVELAND OH MEMBER HEALTH

40426995 351113 89 AS (802) 229-4777 PO BOX 186 MONTPELIER VT BC BS OF VT

40427005 413395 89 AS (800) 948-9450 PO BOX 398220 MINNEAPOLIS MN HEALTHEZ/AMERICAS TPA

40427015 352530 38 R6 (877) 815-8877 PO BOX 10850 CLEARWATER FL ROYAL NEIGHBORS OF AMERICA

40427025 351113 89 AS (800) 932-3004 PO BOX 6090 CYPRESS CA PACIFICARE OF OR

40427035 358569 38 AS (866) 839-4301 PO BOX 853921 RICHADSON TX MERITAIN HEALTH (PERFORMAX)

40427045 351113 89 AS (800) 858-4468 PO BOX 981801 EL PASO TX LBA HEALTH PLANS

40427055 358113 38 AS (800) 562-4023 PO BOX 4542 IOWA CITY IA MERCER ADMINISTRATION

40427065 413395 88 DO (941) 924-0109 PO BOX 1000 GRAHAM NC ARROWHEAD INDUSTRIAL SERVICES

40427075 358569 89 NO (800) 825-8929 PO BOX 3490 JACKSON TN HEALTH PARTNERS

40427085 358569 89 AS (877) 642-7500 PO BOX 5199 WESTBOROUGH MA HEALTH PLANS INC

40427095 352530 88 DO (800) 234-9009 PO BOX 9385 MINNEAPOLIS MN SECURIAN DENTAL

40427105 413395 89 AS (800) 788-6445 120 E KENSINGER DR CRANBURY TW PA HEALTH ASSURANCE

40427115 358569 89 AS (216) 623-8765 PO BOX 5316 CLEVELAND OH KAISER PERMANENTE

40427125 413395 87 RX (877) 800-3086

10455 MILL RUN

CIRCLE OWINGS MILLS MD CARE FIRST PHARMACY MANAGEMENT

40427135 352530 86 VO (800) 886-2320 3130 BROADWAY KANSAS CITY MO FIDELITY SECURITY LIFE INS CO

40427145 352530 88 DO (520) 696-4343 PO BOX 36600 TUCSON AZ EMPLOYERS DENTAL SERVICES

40427155 351113 87 RX (800) 263-2178

300 TECHNE CENTER

DR STEB MILFORD OH PBM PLUS

40427165 358569 38 AS (800) 688-3290

2301

COMMONWEALTH

BLVD ANN ARBOR MI MCARE

40427175 413395 87 RX (888) 879-7336

400 CHISHOLM PLACE

STE 301 PLANO TX RXEDO

40427185 358569 88 DO (800) 521-1555 PO BOX 7676 ST CLAIR SHORES MI NGS

40427195 358569 86 VO (800) 521-1555 PO BOX 7676 ST CLAIR SHORES MI NGS

40427205 351113 38 AS (800) 259-8388

1625 W. CAUSEWAY

APPROACH MANDEVILLE LA FARA HEALTHCARE MGT

40427215 352530 38 AS (888) 817-4636

1600 E PIONEER

PARKWAY #410 ARLINGTON TX TRIUNE RESOURCES

40427225 351113 87 RX (212) 476-1000 85 CRYSTAL RUN RD MIDDLETOWN NY EMPIRE

40427235 351113 86 VO (800) 757-7204 PO BOX 250878 WEST BLOOMFIELD MI BCI ADMINISTRATORS

40427245 358569 88 DO (800) 290-0523 PO BOX 2568 FRISCO TX CARRINGTON DENTAL

40427255 351113 87 RX (877) 839-8119

8300 E MAPLEWOOD

AVE GREENWOOD VILLAGE CO HEALTHTRANS

Page 157: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40427265 352530 89 AS (800) 585-0940 PO BOX 50427 INDIANAPOLIS IN WABASH AMERICAN BENEFITS GROUP

40427275 351113 89 AS (800) 749-2631 PO BOX 720460 OKLAHOMA CITY OK EQUITABLE PLAN SERVICES INC

40427285 351113 89 AS (800) 441-2668 PO BOX 15050 WILMINGTON DE CIGNA INTERNATIONAL

40427295 352530 86 VO (517) 332-2581 PO BOX 2560 EAST LANSING MI MI EDUC SPEC SERV ASSOC

40427305 351113 88 DO (517) 332-2581 PO BOX 2560 EAST LANSING MI MI EDUC SPEC SERV ASSOC

40427315 358569 86 VO (800) 748-0003 PO BOX 30126 LANSING MI MERITAIN HEALTH (WEYCO)

40427325 358569 88 DO (800) 748-0003 PO BOX 30126 LANSING MI MERITAIN HEALTH (WEYCO)

40427335 413395 86 VO (800) 968-6327

3809 LAKE

EASTBROOK BLVD GRAND RAPIDS MI MI EMPLOYEES BENEFIT SER

40427345 413395 88 DO (800) 968-6327

3809 LAKE

EASTBROOK BLVD GRAND RAPIDS MI MI EMPLOYEES BENEFIT SER

40427355 358113 87 RX (800) 282-3232

2441 WARRENVILLE

RD STE 610 LISLE IL SXC HEALTH SOLUTIONS INC

40427365 358569 89 AS (313) 925-4607 PO BOX 3130 DETROIT MI PROCARE HEALTH PLAN

40427375 413395 87 RX (800) 361-4542

2181 E AURORA RD

STE 201 TWINSBURG OH ENVISION RX OPTIONS

40427385 413395 89 NO (866) 257-0445 50 COMMERCE DR WYOMISSING PA BERKSHIRE HEALTH PARTNERS

40427395 352530 89 AS (816) 531-0334 406 W 34TH ST KANSAS CITY MO MO-KAN SHEET METAL WRKRS & WELFARE FUND

40427405 358569 38 PS (800) 472-4992

2600 N MAYFAIR RD

STE 490 MILWAUKEE WI MANAGED HEALTH NETWORK (MNA)

40427415 351113 89 AS (800) 527-7706 2 GANNETT DR SOUTH PORTLAND ME ANTHEM BLUE CHOICE

40427425 413395 88 DO (800) 991-2642 39201 SEVEN MILE RD LIVONIA MI AMERICAN COMMUNITY DENTAL

40427435 413395 38 AS (888) 997-7716 PO BOX 3079 LEXINGTON KY UNITED MEDICAL RESOURCES

40427445 352530 89 AS (800) 592-6834 PO BOX 91134 SEATTLE WA LIFEWISE HEALTH PLAN OF AZ

40427455 351113 88 DO (800) 686-8425 PO BOX 1099 NEWARK OH MEDBEN

40427465 413395 87 RX (800) 652-9550

300 SOUTH GRAND

BLVD ST LOUIS MO LDI PHARMACY BENEFIT MANAGEMENT

40427475 358113 89 AS (269) 381-6630 5071 W H AVE KALAMAZOO MI FIRST AGENCY

40427485 358113 88 DO (888) 729-5433

7800 OFFICE PARK

BLVD BATON ROUGE LA STARMOUNT INSURANCE

40427495 413395 87 RX (800) 687-0707 320 S POLK STE 200 AMARILLO TX MAXOR

40427505 413395 38 AS (602) 240-2404 5045 N 12TH ST, STE A PHOENIX AZ TRIDENT PLAN ADMINISTRATORS

40427515 413395 88 DO (602) 240-2404 5045 N 12TH ST, STE A PHOENIX AZ TRIDENT PLAN ADMINISTRATORS

40427525 358569 89 AS (800) 256-8606 PO BOX 925 JACKSON MS AMERICAN PUBLIC LIFE

40427535 358569 88 DO (888) 330-5408 PO BOX 16608 ST PAUL MN SHEFFIELD OLSON & MCQUEEN INC

40427545 352530 38 AS (800) 793-3773 PO BOX 1511 LATHAM NY REAGIT

40427555 352530 89 XR (800) 858-9060 PO BOX 830489 BIRMINGHAM AL SELECTCARE

40427565 358569 86 VO (248) 641-4907 PO BOX 1349 TROY MI ABATEMENT WORKERS NATIONAL

40427575 352530 89 NO (269) 927-5207 1234 NAPIER AVE ST JOSEPH MI LAKELAND CARE

Page 158: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40427585 351113 89 AS (800) 765-4239 2120 HUBBARD AVE DECATER IL NECA IBEW

40427595 358569 89 AS (602) 263-6666 2721 N CENTRAL AVE PHOENIX AZ OXFORD LIFE

40427605 413395 38 AS (800) 245-8813

100 COURT AVE STE

306 DES MOINES IA CTI ADMINISTRATORS

40427615 413395 89 AS (702) 734-8601 PO BOX 26449 LAS VEGAS NV ZENITH ADMIN

40427625 413395 38 AS (877) 875-7700 PO BOX 14409 SPRINGFIELD MO ST JOHNS CLAIM ADMINISTRATION

40427635 358569 89 AS (989) 776-8290

800 S WASHINGTON

AVE SAGINAW MI ASCENSION HEALTH

40427645 358569 88 DO (800) 323-1683 450 REMINGTON RD SCHAUMBERG IL GROUP ADMINISTRATORS LTD

40427655 352530 89 AS (800) 279-4000 PO BOX 7338 MADISON WI WEA INSURANCE GROUP

40427665 352530 88 DO (586) 598-0007

50790 RICHARD W

BLVD CHESTERFIELD MI PROFILE MANUFACTURING INC

40427675 358569 86 VO (800) 615-7020 PO BOX 23 SHEBOYGAN WI PRAIRIE STATES ENTERPRISES INC

40427685 358569 88 DO (800) 615-7020 PO BOX 23 SHEBOYGAN WI PRAIRIE STATES ENTERPRISES INC

40427695 352530 87 RX (888) 879-9432 PO BOX 961025 FORT WORTH TX PRECISION RX

40427705 351113 89 AS (301) 731-1050

4601 PRESIDENTS DR

STE 300 LANHAM MD ELECTRICAL WELFARE TRUST FUND

40427715 351113 88 DO (800) 451-2513 PO BOX 677 GREENFIELD MA GENWORTH DENTAL

40427725 352530 83 NH (800) 224-4582

51 MADISON AVE RM

1808 NEW YORK NY NEW YORK LIFE

40427735 413395 88 DO (800) 675-1233 PO BOX 1847 GRAND RAPIDS MI SECUREONE

40427745 413395 86 VO (800) 675-1233 PO BOX 1847 GRAND RAPIDS MI SECUREONE

40427755 358569 87 RX (800) 383-8737 675 FOXON RD EAST HAVEN CT CBCA RX

40427765 351113 87 RX (800) 552-0053 PO BOX 22999 ROCHESTER NY FLRX

40427775 352530 89 AS (941) 742-5700 PO BOX 851258 RICHARDSON TX MANATEE SERVICE CENTER

40427785 352530 87 RX (616) 583-5201

8650 BYRON CENTER

AVE SW BYRON CENTER MI BUIST ELECTRIC INC

40427795 552530 38 PS (800) 720-4158 PO BOX 30755 SALT LAKE CITY UT UNITED BEHAVIORAL HEALTH

40427805 352530 38 AS (800) 311-1573 PO BOX 24327 JACKSON MS MPE EMPLOYEE BENEFIT SERVICES INC

40427815 352530 38 AS (800) 426-3070 PO BOX 619055 DALLAS TX HEALTHSCOPE BENEFITS

40427825 413395 38 AS (866) 668-6299 PO BOX 61070 NEW ORLEANS LA PAN AMERCIAN LIFE

40427835 358569 38 AS (770) 455-3802

3835 PRESIDENTIAL

PKWY STE 123 ATLANTA GA ATLANTA PLUMBERS & STEAMFITTERS LOCAL 72

40427845 352530 87 RX (770) 455-3820

3835 PRESIDENTIAL

PKWY STE 123 ATLANTA GA R THROUGH NMHC

40427855 352530 89 AS (800) 777-3603 PO BOX 22185 PORTLAND OR WESTERN BENEFITS

40427865 352530 89 AS (800) 447-5116 300 S PARK RD HOLLYWOOD FL VISTA HEALTH PLAN

40427875 352530 89 AS (800) 809-5916 PO BOX 158 SMITHFIELD VA SMITHFIELD FOOD HEALTH CARE BENEFITS

40427885 413395 38 AS (888) 444-1995 PO BOX 2256 GRAPEVINE TX CENTURY HEALTH CARE

40427895 351113 89 AS (888) 294-9451 PO BOX 380276 BIRMINGHAM AL EVERGREEN

Page 159: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40427905 352530 89 NO (913) 895-2800

9801 RENNER BLVD

STE 100 LENEXA KS SISTERS OF CHARITY LEAVONWORTH HEALTH SYSTEM

40427915 358569 86 VO (800) 291-9138 PO BOX 9059 FARMINGTON MI DELTA VISION

40427925 352530 89 AS (386) 615-4022 PO BOX 9910 DAYTONA BEACH FL FLORIDA HEALTH CARE

40427935 352530 38 AS (888) 901-4636 PO BOX 34585 SEATTLE WA GROUP HEALTH OPTIONS

40427945 351113 89 AS (888) 687-6277 PO BOX 2207 SCHENECTADY NY MVP HEALTH PLAN

40427955 352530 89 AS (800) 482-6736 PO BOX 690903 CHARLOTTE NC NATIONAL BENEFITS ADMINISTRATORS

40427965 351113 89 AS (800) 337-6288 PO BOX 2857 FAYETTEVILLE NC JSL ADMINISTRATORS

40427975 358569 89 AS (913) 529-7222 PO BOX 26103 OVERLAND PARK KS AMERICAN STERLING

40427985 358569 88 DO (800) 735-3379 PO BOX 29 CHEYENNE WY DELTA DENTAL PLAN OF WYOMING

40427995 358569 87 RX (630) 737-5368 3200 HIGHLAND AVE DOWNERS GROVE IL FIRST RX

40428005 351113 38 AS (877) 825-9337 PO BOX 10824 CLEARWATER FL GENWORTH LIFE & ANNUITY

40428015 413395 38 AS (866) 579-8811 PO BOX 659787 SAN ANTONIO TX SECURE HORIZONS

40428025 413395 89 AS (702) 734-8601 PO BOX 27287 LAS VEGAS NV ZENITH ADMINISTRATORS TEAMSTERS LOCAL 14

40428035 358569 89 AS (239) 403-7884

1016 COLLIER CTR

WAY NAPLES FL SELF INSURED PLANS

40428045 352530 89 AS (888) 876-2756 PO BOX 2999 PITTSBURGH PA UNIVERSITY OF PITTSBURGH MEDICAL CTR (UPMC)

40428055 352530 89 AS (217) 228-6550 PO BOX 3156 QUINCY IL SHIPPERS RENTAL CO EMPLOYEE BENEFIT PLAN

40428065 352530 89 AS (702) 251-8000

1701 W CHARLESTON

STE 300 LAS VEGAS NV HARMONY HEALTHCARE

40428075 352530 86 VO (800) 476-0677 PO BOX 1250 TUSCALOOSA AL SOUTHLAND NATIONAL

40428085 413395 76 AS (800) 444-6965 PO BOX 279 SHELDON IA CORESOURCE

40428095 352530 86 VO (877) 694-7347 PO BOX 44148 JACKSONVILLE FL HR DIRECT

40428105 413395 38 AS (800) 292-2288 PO BOX 619099 DALLAS TX UMWA HEALTH & RETIREMENT FUNDS

40428115 358569 38 NH (888) 320-8741 PO BOX 40007 LYNCHBURG VA IDS LIFE INSURANCE CO (GENWORTH)

40428125 352530 89 AS (888) 350-2002 PO BOX 968 HORSHAM PA HTH WORLDWIDE INSURANCE

40428135 351113 89 AS (800) 830-1918

14528 S OUTER 40

#300 CHESTERFIELD MO MERCY HEALTH PLANS

40428145 413395 38 AS (800) 933-3920 PO BOX 22920 ROCHESTER NY PREFERRED HEALTH

40428155 351113 38 AS (877) 293-8499 PO BOX 247007 OMAHA NE CONTINENTAL GENERAL INS

40428165 352530 89 AS (501) 374-3484 PO BOX 188 NORTH LITTLE ROCK AR MUNICIPAL HEALTH BENEFIT FUND

40428175 352530 89 AS (800) 493-4240 PO BOX 853925 RICHARDSON TX HOMELAND HEALTH CARE PPO

40428185 358569 89 AS (877) 777-6076 PO BOX 853921 RICHARDSON TX MERITAIN HEALTH (PERFORMAX)

40428195 352530 89 AS (800) 223-5508 PO BOX 24708 OMAHA NE GMS (GROUP MANAGEMENT SERVICES)

40428205 352530 89 AS (773) 385-9300 7026 W NORTH AVE CHICAGO IL SEIU LOCAL 4 HEALTH & WELFARE FUND

40428215 351113 89 AS (314) 644-4800 PO BOX 42031 HAZELWOOD MO CARPENTERS HEALTH & WELFARE FUND/CARE MANAGEM

40428225 352530 89 AS (866) 867-6883 PO BOX 8063 LITTLE ROCK AR TRANSAMERICA

40428235 351113 87 RX (800) 603-7796

10400 W INNOVATION

DR MILWAUKEE WI TRICAST

Page 160: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40428245 351113 38 AS (800) 865-3200

1500 WATERSRIDGE

DR LEWISVILLE TX HORIZON BEHAVIORAL SERVICES

40428255 413395 89 AS (800) 325-5261 600 PARKLAND BLVD CLEVELAND OH QUALCHOICE

40428265 352530 89 AS (800) 884-4901 12940 N HWY 183 AUSTIN TX FIRST CARE

40428275 358569 89 AS (800) 635-4252 210 S WHITE ST LANCASTER SC KANAWHA HEALTHCARE SOLUTIONS

40428285 358569 88 DO (517) 321-7502

2565 CENTURION

BLVD LANSING MI SHEET METAL WORKERS LOCAL 7 ZONE 2

40428295 358113 89 AS (800) 949-5845

701 MARKET ST STE

1100 ST LOUIS MO MERCER ADMINISTRATION

40428305 413395 89 NO (800) 556-1144 PO BOX 15253 PORTLAND MA MEDNET

40428315 352530 38 AS (866) 858-7223 PO BOX 763 WESTBORO MA ULTRA BENEFITS INC

40428325 351113 87 RX (877) 850-0185 PO BOX 145433 CINCINNATI OH WELLPOINT (WMS RX DRUG PLAN)

40428335 413395 38 X5 (800) 692-7338 PO BOX 61140 HARRISBURG PA AMERICAN SENTINEL/AEGIS

40428345 352530 89 AS (800) 447-9834 PO BOX 82505 LAS VEGAS NV NEVADA CARE

40428355 352530 89 AS (888) 396-5899

8875 LIBERTY RIDGE

DR JACKSONVILLE FL NATIONAL EMPLOYEE BENEFITS ADMINISTRATORS

40428365 358569 89 AS (716) 319-5399 PO BOX 853921 RICHARDSON TX MERITAIN HEALTH

40428375 352530 88 DO (269) 321-1017

301 S KALAMAZOO ST

BOX 158 VICKSBURG MI VICKSBURG COMMUNITY SCHOOLS

40428385 358569 89 AS (800) 925-8459 2166 SOUTH 12TH ST ALLENTOWN PA SPECTRUM ADMINISTRATORS

40428395 358569 88 DO (800) 492-8923 PO BOX 868 LATHAM NY BOSTON MUTUAL

40428405 358569 89 AS (800) 290-1368 2015 16TH ST GREAT BEND KS BENEFIT MANUFACTURING INC

40428415 413395 89 AS (866) 333-4648 PO BOX 740810 ATLANTA GA DEFINITY HEALTH

40428425 358569 83 NH (800) 441-3978 PO BOX 2002 CARMEL IN CONSECO SENIOR HEALTH INS CO

40428435 358569 88 DO (231) 832-7234 4507 170TH AVE HERSEY MI EAGLE VILLAGE INC

40428445 413395 89 AS (415) 438-5500 185 BERRY ST STE 300 SAN FRANCISCO CA CATHOLIC HEALTHCARE WEST (CHW)

40428455 352530 89 AS (800) 858-8569 PO BOX 828 PARK RIDGE IL INSURERS ADMINISTRATIVE CORP

40428465 352530 38 DV (916) 858-2950 PO BOX 2650 RANCHO CORDOVA CA BRMS BENEFIT & RISK MANAGEMENT SERVICES

40428475 352530 86 VO (800) 783-8909

777 108TH AVE NE STE

200 BELLEVUE WA GALLAGHER BENEFIT ADMINISTRATORS

40428485 352530 38 AS (800) 638-2610 PO BOX 2168 ROCKVILLE MD ASSOCIATION & SOCIETY INS

40428495 413395 87 RX (866) 251-3317

1600 W BROADWAY

RD #300 TEMPE AZ RX PHARMACY SOLUTIONS

40428505 358569 89 AS (800) 548-6662 461 STATE HWY 33 MANALAPAN NJ OPERATING ENGINEERS LOCAL 25

40428515 351113 89 AS (877) 624-6224 825 EASTGATE BLVD GARDEN CITY NY MAGNACARE

40428525 352530 87 RX (800) 277-1657 30 HUNTER LANE CAMP HILL PA RITE AID HEALTH SOLUTIONS

40428535 413395 38 AS (866) 831-5925

630 BRIDGEPOINT

PKWY BLDG 3 AUSTIN TX FBA (FOUNDATION BENEFIT ADMINISTRATORS)

Page 161: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40428545 352530 89 AS (419) 267-2801 22-900 ST RT 34 ARCHEBOLD OH NO BUCKEYE EDUCATIONAL COUNCIL

40428555 358569 89 AS (800) 545-5015 PO BOX 269017 PLANO TX PHYSICIANS PLUS

40428565 352530 86 VO (800) 368-4790 PO BOX 7548 ROCKY MOUNTAIN NC OPTICARE

40428575 413395 89 AS (866) 440-1450 PO BOX 251369 PLANO TX UMR

40428585 351113 89 AS (513) 872-8100

1351 WM HOWARD

TAFT RD CINCINNATI OH ANTHEM BC BS

40428595 413395 89 AS (800) 433-0088 PO BOX 19721 IRVINE CA BEST LIFE AND HEALTH INS CO

40428605 358569 88 DO (800) 843-7752 PO BOX 436149 LOUISVILLE KY CITIZENS SECURITY LIFE INS

40428615 413395 89 AS (800) 636-0661 PO BOX 5037 CHERRYHILL NJ 21ST CENTURY

40428625 413395 38 AS (800) 789-6364 PO BOX 399127 CAMBRIDGE MA CONSTITUTION LIFE

40428635 358569 38 AS (717) 391-5717 PO BOX 83149 LANCASTER PA EASTERN LIFE & HEALTH INS CO

40428645 351113 89 AS (800) 808-7363

4101 INDIAN SCHOOL

NE STE110 S ALBUQUERQUE NM LOVELACE HEALTH PLAN

40428655 352530 87 RX (888) 678-7012

PO BOX 419019 DEPT

0382 KANSAS MO FUTURE SCRIPTS

40428665 413395 89 AS (866) 867-6883 PO BOX 1279 FORT MILLS SC TRANSCHOICE

40428675 352530 38 AS (602) 275-8744

2258 NORTH 44TH ST

STE 260 PHOENIX AZ BASHAS BENEFIT TRUST

40428685 352530 38 PS (800) 222-8335 PO BOX 60968 PHOENIX AZ CONTACT BEHAVIORAL HEALTH

40428695 351113 38 AS (406) 248-6224 PO BOX 1301 BILLINGS MT ASSOCIATED EMPLOYERS

40428705 352530 38 AS (800) 742-9944 PO BOX 71120 BOSSIER CITY LA IMA INSURANCE MANAGEMENT

40428715 352530 89 AS (800) 334-8159 200 S MARSHALL ST WINSTON SALEM NC SOUTHERN GROUP ADMINISTRATORS

40428725 352530 38 AS (800) 456-4002 8310 PORT JACKSON N CANTON OH AMERICAN BENEFITS MANAGEMENT

40428735 352530 38 AS (800) 634-2700 33 EASTLAND ST SPRINGFIELD MA UFCW LOCAL 1459

40428745 352530 89 AS (800) 787-2680 PO BOX 22738 LEXINGTON KY BLUE GRASS FAMILY HEALTH

40428755 352530 38 PS (866) 376-2901

1300 SUMMIT AVE

STE 811 FT WORTH TX CORP HEALTH

40428765 352530 89 AS (402) 445-6115 10675 BEDFORD AVE OMAHA NE THE BENEFIT GROUP

40428775 413395 89 AS (877) 233-1800 PO BOX 8013 WAUSAU WI UNITED MEDICAL RESOURCES

40428785 352530 89 AS (800) 392-1770 171 W WING ST #210 ARLINGTON HTS IL ARM

40428795 352530 89 AS (800) 451-7929 PO BOX 477911 BROADVIEW OH ANTARES

40428805 352530 38 AS (888) 344-5587 PO BOX 30271 SALT LAKE CITY UT ASURIS NORTHWEST HEALTH

40428815 352530 38 X5 (800) 237-4463 PO BOX 25326 OVERLAND PARK KS UNIFIED LIFE

40428825 352530 89 AS (425) 462-1000 PO BOX 85008 BELLEVUE WA HMA (HEALTHCARE MANAGEMENT ADMINISTRATORS)

40428835 358113 38 AS (800) 605-2282 PO BOX 863 INDIANAPOLIS IN MULTI NATIONAL UNDERWRITERS

40428845 351113 89 AS (888) 553-8009 PO BOX 11265 ALEXANDRIA VA LUMENOS

40428855 352530 89 AS (800) 617-1114 PO BOX 23000 ROCHESTER NY UNIVERA HEALTH PLANS

40428865 351113 38 AS (866) 926-8409 PO BOX 368 PARIS KY REVSTONE HEALTH SERVICES

40428875 352530 89 AS (800) 676-2583 2949 N MAYFAIR MILWAUKEE WI THE WELLS PLAN

Page 162: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40428885 351113 88 DO (414) 647-6329

3305 W FOREST

HOME AVE MILWAUKEE WI AURORA DENTAL

40428895 413395 38 AS (800) 298-4964 PO BOX 740 PUEBLO CO UNITED MEDICAL RESOURCES

40428905 413395 89 AS (866) 881-0111 PO BOX 360 PUEBLO CO UNITED MEDICAL RESOURCES

40428915 413395 38 AS (866) 881-0111 PO BOX 360 PUEBLO CO UNITED MEDICAL RESOURCES

40428925 413395 89 AS (800) 801-5409 PO BOX 725 PUEBLO CO UNITED MEDICAL RESOURCES

40428935 413395 89 AS (877) 233-1800 PO BOX 450 PUEBLO CO UNITED MEDICAL RESOURCES

40428945 358113 89 AS (260) 492-7451 PO BOX 5182 FORT WAYNE IN CORE BENEFITS INC

40428955 351113 38 AS (414) 647-6329

3305 W FOREST

HOME AVE MILWAUKEE WI AURORA DIRECT NETWORK

40428965 413395 38 AS (800) 723-0202 PO BOX 880 FREEPORT IL NORTHERN ILLINOIS HEALTH PLAN

40428975 352530 89 AS (800) 538-5038 PO BOX 30192 SALT LAKE CITY UT SELECT HEALTH PLAN

40428985 352530 38 AS (800) 346-4643 PO BOX 10600 GRAND JUNCTION CO ROCKY MOUNTAIN HEALTH PLANS

40428995 413395 89 AS (800) 553-7654 PO BOX 981602 EL PASO TX ASSURANT HEALTH - UNION SECURITY INS CO

40429005 351113 87 RX (888) 274-2031 PO BOX 721098 BERKLEY MI 4D PHARMACY MANAGEMENT

40429015 413395 89 AS (800) 786-7557 PO BOX 3160 OMAHA NE WORLD INS CO

40429025 413395 38 AS (866) 440-1450 PO BOX 251369 PLANO TX UMR

40429035 351113 89 AS (800) 422-2026 PO BOX 1729 STOW OH ASSURECARE OF OHIO

40429045 358569 89 AS (800) 470-2004

1100 CRCLE75 PRKWY

STE 1400 ATLANTA GA COVENTRY GA

40429055 358569 89 AS (605) 322-4700 3900 W AVERA DR SIOUX FALLS SD AVERA HEALTH PLAN

40429065 352530 89 X3 (800) 880-9960 PO BOX 2369 COLUMBUS IN DUNN & ASSOCIATES

40429075 352530 89 AS (800) 616-5709 PO BOX 725549 ATLANTA GA FAMILY SECURITY COUNCIL

40429085 413395 38 AS (800) 833-0010

1000 BURR RIDGE

PRKWY BURR RIDGE IL OKLAHOMA CARPENTERS HEALTH AND WELFARE FUND

40429095 358569 38 AS (800) 397-2122 PO BOX 853921 RICHARDSON TX MERITAIN HEALTH

40429105 351113 89 AS (800) 795-1023 PO BOX 25987 WINSTON-SALEM NC MEDCOST BENEFIT SERVICES

40429115 413395 86 VO (800) 247-4695 PO BOX 47126 PLYMOUTH IA PRINCIPAL FINANCIAL

40429125 358569 86 VO (800) 322-8190

876 HORACE BROWN

DR MADISON HEIGHTS MI MI UNITED FOOD & COMMERCIAL WORKERS

40429135 358569 88 DO (800) 322-8190

876 HORACE BROWN

DR MADISON HEIGHTS MI MI UNITED FOOD & COMMERCIAL WORKERS

40429145 352530 38 NH (800) 366-5463 PO BOX 4243 WOODLAND HILLS CA SCOR LIFE INS CO

40429155 358569 87 RX (800) 659-4112 PO BOX 12119 SCOTTSDALE AZ PARTNERS RX MANAGEMENT

40429165 352530 89 AS (800) 567-5899

9970 OLD AIRPORT

HWY MONCLAVA OH UFCW LOCAL 911 & EMPLOYERS HEALTH & WELFARE

40429175 413395 83 NH (800) 775-1541 PO BOX 64912 ST. PAUL MN CNA/CONTINENTAL CASUALTY

40429185 351113 89 AS (800) 851-0404

PO BOX 659747 RTE

2702 SAN ANTONIO TX IBA HEALTH & LIFE ASSURANCE CO/UHC

40429195 413395 89 AS (800) 328-4316 PO BOX 981652 EL PASO TX JOHN ALDEN

40429205 358569 38 AS (800) 364-9505 5310 N 99TH ST STE 1 OMAHA NE MID AMERICAN BENEFITS INC

Page 163: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40429215 413395 86 VO (800) 221-4254

22500

METROPOLITAN PKWY CLINTON TWP MI AMERA PLAN

40429225 413395 88 DO (800) 221-4254

22500

METROPOLITAN PKWY CLINTON TWP MI AMERA PLAN

40429235 358569 38 AS (866) 646-8919 PO BOX 2631 MONROE MI PLUMBERS LOCAL 98

40429245 352530 89 AS (800) 732-1121 PO BOX 34203 SEATTLE WA WELFARE & PENSION ADM SERV INC

40429255 413395 89 AS (800) 426-7453 PO BOX 3559 ENGLEWOOD CO CNIC HEALTH SOLUTIONS

40429265 358569 87 RX (866) 333-2757

PO BOX 999 FIVE

INNOVATION CRT APPLETON WI NAVITUS HEALTH SOLUTIONS

40429275 352530 89 AS (888) 563-2250

1331 GARDEN HWY

STE 100 SACRAMENTO CA WESTERN HEALTH ADVANTAGE HMO

40429285 351113 86 VO (866) 565-1540 PO BOX 8056 TWINSBURG OH CIGNA VISION CARE

40429295 358569 87 RX (800) 925-2272

400 HIGHWAY 169 STE

800 MINNEAPOLIS MN CORPORATE BENEFIT SERVICES OF AMERICA (CBSA)

40429305 351113 89 AS (877) 691-5856 PO BOX 14115 LEXINGTON KY CARE FIRST BLUE CROSS BLUE SHIELD

40429315 352530 89 AS (888) 870-8103 PO BOX 25310 LITTLE ROCK AR NOVASYS HEALTH

40429325 351113 38 AS (866) 759-4414 PO BOX 7154 LONDON KY ADVANTRA FREEDOM

40429335 351113 88 DO (800) 497-7044 PO BOX 82510 LINCOLN NE RELIANCE STANDARD LIFE INS POLICY

40429345 358569 38 MS (800) 936-9314 PO BOX 3078 CENTERLINE MI NORTHWOOD NPN

40429355 413395 89 AS (888) 524-2777 PO BOX 916188 LONGWOOD FL PREFERRED BENEFIT ADMINISTRATORS

40429365 351113 89 AS (800) 432-5859 PO BOX 96238 LAS VEGAS NV TEACHERS HEALTH TRUST

40429375 358569 38 AS (800) 548-1771 PO BOX 1618 SAN RAMON CA SHEET METAL WORKERS LOCAL 104

40429385 358569 86 VO (888) 729-5433 PO BOX 80139 BATON ROUGE LA ALWAYSCARE BENEFITS

40429395 358569 88 DO (888) 729-5433 PO BOX 80139 BATON ROUGE LA ALWAYSCARE BENEFITS

40429405 352530 38 AS (201) 867-1333 PO BOX 8037 UNION CITY NJ T.E.N.J. WELFARE FUND INC

40429415 351113 89 AS (800) 686-8425 PO BOX 1099 NEWARK OH MEDBEN

40429425 358569 86 VO (800) 659-2223 PO BOX 82520 LINCOLN NE AMERITAS LIFE INSURANCE CORP

40429435 351113 89 AS (800) 811-0391 PO BOX 3355 PITTSBURGH PA HIGHMARK BLUE CROSS BLUE SHIELD

40429445 351113 38 AS (614) 764-4516 PO BOX 1083 DUBLIN OH AVALON INSURANCE

40429455 351113 89 AS (787) 774-6060 PO BOX 363628 SAN JUAN PR TRIPLE S INC (BC BS OF PUERTO RICO)

40429465 351113 87 RX (787) 286-6032 PO BOX 4908 CAGUAS PR MC 21

40429475 358569 89 AS (800) 681-0056 PO BOX 24146 SEATTLE WA FIRST HEALTH LIFE AND HEALTH

40429485 352530 89 AS (800) 501-3439 PO BOX 9066 BUFFALO NY INDEPENDENT HEALTH

40429495 352530 88 DO (800) 880-1800 PO BOX 30920 LAGUNA HILLS CA SAFEGUARD DENTAL

40429505 352530 86 VO (800) 880-1800 PO BOX 30920 LAGUNA HILLS CA SAFEGUARD VISION

40429515 352530 88 DO (888) 683-3682

100 CORPORATE PARK

STE 342 AMHERST NY DENTAL PAY PLUS

40429525 351113 89 AS (888) 642-5040 PO BOX 742567 HOUSTON TX MEMORIAL HERMAN HEALTH NETWORK

40429535 351113 38 AS (800) 355-2583 PO BOX 247 DEPT V NEWARK NJ HORIZON BCBS OF NEW JERSEY

40429545 352530 89 AS (877) 842-3210 PO BOX 659747 SAN ANTONIO TX UNITED HEALTHCARE

40429555 413395 88 DO (800) 342-3279 PO BX 9201 AUSTIN TX 32 DENTAL

Page 164: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40429565 413395 89 AS (800) 223-3943 PO BOX 2920 CLINTON IA CORESOURCE

40429575 351113 38 AS (800) 888-6472 7605 WESTFIELD DR FORT WAYNE IN AGA/AUTOMATED GROUP ADMINISTRATORS INC

40429585 358569 88 DO (800) 257-4692 PO BOX 7709 LONDON KY COVENTRY

40429595 358569 88 DO (800) 433-0088 PO BOX 19721 IRVINE CA BEST LIFE DENTAL PLANS

40429605 413395 38 PS (800) 646-5608 PO BOX 14621 LEXINGTON KY MHN

40429615 351113 89 AS (800) 868-2528 PO BOX 6170 COLUMBIA SC BLUE CHOICE HEALTH PLAN

40429625 413395 89 AS (866) 838-9374 PO BOX 7129 LONDON KY HEALTH ASSURANCE

40429635 413395 89 AS (866) 838-9374 PO BOX 7089 LONDON KY HEALTH AMERICA

40429645 358569 38 AS (800) 582-1823

250

COMMONWEALTH DR

STE 110 GREENVILLE SC STARBRIDGE

40429655 358569 89 AS (866) 365-2413

5001 PLAINFIELD AVE

STE A GRAND RAPIDS MI CORPORATE BENEFIT STRATEGIES

40429665 352530 89 AS (800) 462-0224 PO BOX 9163 WATERTOWN MA TUFTS HEALTH PLAN

40429675 352530 38 PS (800) 230-4876

1111 W 10TH ST RM

221 INDIANAPOLIS IN INDIANA UNIVERSITY PSYCIATRIC

40429685 352530 89 AS (800) 359-2002 PO BOX 939035 SAN DIEGO CA SHARP HEALTH PLAN

40429695 352530 89 AS (800) 286-4160 PO BOX 19002 PROVO UT EVEREST HEALTH PLAN ADMINISTRATORS

40429705 352530 89 AS (775) 826-7200 PO BOX 11337 RENO NV NORTH NEVADA TRUST

40429715 352530 88 DO (800) 969-5419 PO BOX 35519 CANTON OH KENAN ADVANTAGE GROUP

40429725 413395 38 PS (800) 752-7242 PO BOX 1246 ROCKVILLE MD APS HEALTHCARE

40429735 352530 87 RX (800) 522-7487 PO BOX 419019 KANSAS CITY MO ARGUS HEALTH SYSTEMS

40429745 358569 88 DO (866) 433-6391 PO BOX 10949 ROCKVILLE MD DENEX DENTAL

40429755 358569 89 AS (800) 811-4793 PO BOX 3708 CORPUS CHRISTI TX ALLIANT HEALTH PLANS

40429765 352530 38 AS (866) 508-1696 PO BOX 9077 CLEARWATER FL DIRECT ASSIGNMENTS

40429775 352530 89 AS (888) 298-6828 PO BOX 6708 GREENVILLE SC HEWITT COLEMAN & ASSOC

40429785 351113 88 DO (888) 468-2183

333 LEARLE

OVINGTON STE 300 UNION DALE NY HEALTHPLEX

40429795 351113 86 VO (248) 641-4957 PO BOX 966 TROY MI MICHIGAN GLASS AND GLAZING 357

40429805 352530 89 AS (800) 433-3077

1510 MEADOW

WOOD LANE RENO NV SAINT MARY'S HEALTH FIRST

40429815 352530 38 PS (800) 221-5487 10200 SUNSET DR MIAMI FL PSYCHARE

40429825 352530 89 AS (877) 632-1801 PO BOX 90802 LUBBOCK TX GROUP HEALTH ALLIANCE

40429835 358569 89 AS (800) 282-2460 PO BOX 1730 AUBURNDALE FL HERITAGE CONSULTANTS

40429845 358569 89 AS (800) 755-3901 PO BOX 7374 LONDON KY GROUP HEALTH PLAN

40429855 358569 89 AS (800) 716-7737 PO BOX 565001 ROCKLEDGE FL HEALTH FIRST

40429865 352530 89 AS (800) 762-6004 PO BOX 34850 SEATTLE WA UNIFORM MEDICAL PLAN

40429875 351113 89 AS (419) 251-1477 PO BOX 6018 CLEVELAND OH MERCY HEALTH PARTNERS

40429885 352530 38 AS (800) 231-4015 PO BOX 165750 KANSAS CITY MO CERNER

40429895 352530 89 AS (918) 615-7777 PO BOX 733 BUCKEYSTOWN MD QUICKTRIP

40429905 351113 88 DO (313) 928-0877

105010 ALLEN RD STE

204 ALLEN PARK MI DETROIT BAKERS H&W LOCAL 326

Page 165: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40429915 358569 89 AS (775) 982-3044 PO BOX 1217 PARK RIDGE IL HOMETOWN HEALTH

40429925 352530 88 DO (800) 359-7408 PO BOX 20593 INDIANAPOLIS IN GROUP LINK

40429935 358569 88 DO (800) 765-4224 PO BOX 27267 MINNEAPOLIS MN MERITAIN HEALTH (CBSA)

40429945 352530 88 DO (800) 234-9090 PO BOX 72 TAYLOR MI GROUP INSURANCE CONSULTANTS

40429955 351113 86 VO (866) 425-2323

3290 PINE ORCHARD

LN STE D ELLICOTT CITY MD ADVANTICA EYECARE

40429965 413395 89 AS (888) 444-1995 PO BOX 2256 GRAPEVINE TX CENTURY HEALTHCARE

40429975 352530 87 RX (800) 650-1817 PO BOX 360 BELTON TX EMPLOYER HEALTH OPTIONS

40429985 351113 38 PS (877) 677-2247

6000 W CREEK RD STE

20 INDEPENDENCE OH MERRY MOUNT BEHAVIORAL HEALTH

40429995 358569 89 AS (800) 732-1121 PO BOX 34684 SEATTLE WA OPERATING ENGINEERS 302, 612

40439005 352530 89 AS (801) 266-3256 4885 S 900 E STE 202 SALT LAKE CITY UT JENSEN ADMINISTRATIVE SERVICES (JAS)

40439015 352530 89 AS (800) 407-3772

6040 N BAILEY AVE

STE 200 AMHERST NY AIG WORLDWIDE ASSISTANCE

40439025 351113 89 NO (800) 362-4700 PO BOX 6018 CLEVELAND OH MEDICAL MUTUAL OF OH NETWORK

40439035 413395 89 AS (800) 357-7553 PO BOX 1400 OXFORD MS MAS BENEFITS

40439045 358569 89 AS (800) 807-0820 PO BOX 80 STOCKTON CA DELTA HEALTH SYSTEMS

40439055 413395 89 AS (800) 749-1422 PO BOX 1309 MUSKOGEE OK HEALTH CARE SOLUTIONS

40439065 352530 89 AS (800) 992-8088 PO BOX 6125 GREENVILLE SC CWI BENEFITS

40439075 352530 88 DO (800) 360-1909

6950 NE CAMPUS

WAY HILLSBORO OR WILLAMETTE DENTAL

40439085 352530 89 AS (800) 223-4590 54 CORPORATE PARK IRVINE CA UABT (UNITED AGRICULTURAL BENEFIT TRUST)

40439095 358569 89 AS (888) 582-3370 PO BOX 6012 RIDGELAND MS FOX EVERETT

40439105 352530 88 DO (419) 244-0135

701 ADAMS ST STE

850 TOLEDO OH HEALTH CARE PAYERS COALITION

40439115 413395 89 AS (800) 937-7039 PO BOX 853916 RICHARDSON TX ALLSTATE WORKPLACE DIVISION

40439125 352530 88 DO (847) 451-9100 11355 FRANKLIN AVE FRANKLIN PARK IL ARLINGTON METALS

40439135 552530 89 AS (970) 224-4600

2021 BATTLECREEK DR

STE A FORT COLLINS CO UNITED MEDICAL ALLIANCE

40439145 358569 89 AS (808) 532-4000

700 BISHOP ST STE

300 HONOLULU HI UNIVERSITY HEALTH ALLIANCE

40439155 358569 87 RX (212) 924-7220 216 W 14TH ST NEW YORK NY TEAMSTERS LOCAL 237

40439165 352530 87 RX (800) 413-7721 2425 W SHAW AVE FRESNO CA US SCRIPTS

40439175 413395 89 AS (888) 540-0094 PO BOX 247 ONALASKA WI 3 P ADMINISTRATORS

40439185 352530 89 AS (718) 370-5380 PO BOX 140724 STATEN ISLAND NY PERFECT HEALTH

40439195 352530 89 AS (512) 719-6500 PO BOX 149190 AUSTIN TX TEXAS MUNICIPAL LEAGUE (TML)

40439205 352530 89 AS (888) 333-8828 PO BOX 425 NEWTON UPPER FALLS MA HMA DIRECT (HEALTH ADMINISTRATORS)

40439215 352530 89 AS (800) 822-3906 PO BOX 110 PARK RIDGE IL STANDARD SECURITY LIFE

40439225 352530 88 DO (602) 266-1995 PO BOX 44035 PHOENIX AZ TOTAL DENTAL ADMINISTRATORS

Page 166: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40439235 358569 89 AS (800) 423-1841

760 PASQUINELLI DR

STE 320 WESTMONT IL BENEFIT SYSTEMS AND SERVICES

40439245 358569 88 DO (212) 924-7220 216 W 14TH ST NEW YORK NY TEAMSTERS LOCAL 237

40439255 358569 38 PS (800) 926-8862 PO BOX 19947 CINCINNATI OH ALLIANCE BEHAVIORAL CARE

40439265 413395 89 AS (800) 327-5926 PO BOX 13817 SAVANNAH GA ITPE HEALTH AND WELFARE FUND

40439275 352530 38 AS (877) 406-3699 PO BOX 1046 BOULDER MT BOULDER ADMINISTRATION SERVICES

40439285 358569 89 AS (513) 585-6699 PO BOX 69319 HARRISBURG PA ALLIANCE PARTNERS

40439295 352530 88 DO (847) 451-9100 11355 FRANKLIN AVE FRANKLIN PARK IL ARLINGTON METALS

40439305 358569 38 PS (800) 475-7900 PO BOX 571137 WINSTON-SALEM NC CAROLINA BEHAVIORAL HEALTH ALLIANCE

40439315 351113 86 VO (888) 254-4290

2359 PERIMETER

POINTE PRKWY CHARLOTTE NC COMMUNITY EYECARE

40439325 351113 89 AS (206) 441-6514 PO BOX 1929 SEATTLE WA CARPENTERS TRUST OF WESTERN WASHINGTON

40439335 352530 89 AS (800) 290-3657 PO BOX 548 KALISPELL MT NEW WEST HEALTH PLAN

40439345 351113 89 AS (800) 808-7363 PO BOX 760 PUEBLO CO LOVELACE HEALTH PLAN

40439355 352530 86 VO (480) 961-1702 220 N MCKEMY AVE CHANDLER AZ SIGHTCARE

40439365 352530 89 AS (252) 523-1210 PO BOX 400 KINSTON NC HILLCO LTD

40439375 352530 89 AS (800) 362-3310 PO BOX 610 SAUK CITY WI UNITY HEALTH INSURANCE

40439385 413395 89 AS (314) 739-6442

12365 ST CHARLES

ROCK RD BRIDGETON MO DISTRICT 9 INTL ASSOC OF MACHINISTS & AERO

40439395 358113 86 VO (630) 734-0074 415 E PLAZA DR WESTMONT IL BAC LOCAL 74

40439405 358569 89 AS (972) 980-1123 PO BOX 819015 DALLAS TX IBEW NECA SW HEALTH

40439415 358569 89 AS (850) 383-3311 PO BOX 15349 TALLAHASSEE FL CAPITAL HEALTH PLAN

40439425 351113 89 AS (317) 923-4577

1828 N MERIDIAN ST

STE 103 INDIANAPOLIS IN ELECTRICAL WRKRS BEN TRUST FUND IBEW LOCAL 41

40439435 352530 89 AS (866) 272-2507 PO BOX 15445 AUSTIN TX SETON HEALTH PLAN

40439445 413395 89 AS (800) 950-3224 PO BOX 22920 ROCHESTER NY PREFERRED CARE

40439455 352530 89 AS (800) 732-1121 PO BOX 34970 SEATTLE WA PUGET SOUND ELECTRICAL WORKER

40439465 413395 89 AS (877) 429-7473 PO BOX 21240 DENVER CO ARIZONA PIPE TRADES H&W TRUST FUND

40439475 351113 89 AS (866) 524-2285 PO BOX 6199 INDIANAPOLIS IN ANTHEM BCBS IN

40439485 352530 89 AS (800) 591-8326 9848 E BURNSIDE ST PORTLAND OR MASONRY INDUSTRY TRUST ADMINISTRATORS

40439495 358569 89 AS (248) 352-7530

26777 CENTRAL PARK

STE 200 SOUTHFIELD MI ARCADIA RESOURCES

40439505 358569 89 AS (888) 729-5433 PO BOX 80139 BATON ROUGE LA ALWAYSCARE

40439515 352530 38 PS (312) 595-4000 PO BOX 8379 CHICAGO IL COMPSYCH

40439525 352530 89 AS (972) 919-4800

16001 LBJ FREEWAY

STE 800 FARMERS BRANCH TX TACO BUENO HEALTH PLAN

40439535 358569 89 AS (800) 297-6110 PO BOX 1649 GRAND RAPIDS MI MERS PREMIER HEALTH

40439545 351113 87 RX (800) 724-5033 PO BOX 22998 ROCHESTER NY FINGER LAKES RX (FLRX)

40439555 358569 88 DO (314) 543-4900 PO BOX 8510 ST LOUIS MO ESSEX

40439565 352530 38 PS (877) 263-8827 PO BOX 880639 SAN DIEGO CA US BEHAVIORAL HEALTH

40439575 358569 38 AS (315) 671-7074 PO BOX 4863 SYRACUSE NY EBS SOLUTIONS

Page 167: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40439585 351113 89 AS (800) 331-4277 PO BOX 398 DAYTON OH IRONWORKERS LOCAL 292

40439595 351113 89 AS (888) 657-9677 PO BOX 60007 LOS ANGELES CA ANTHEM BC BS OF CA

40439605 351113 89 AS (800) 777-4890 PO BOX 3248 TULSA OK COMMUNITY CARE

40439615 352530 89 AS (719) 365-5025 PO BOX 828 COLORADO SPRINGS CO MEDICAL NETWORK

40439625 352530 89 AS (800) 294-7780 PO BOX 55926 BIRMINGHAM AL VIVA HEALTH

40439635 358569 38 PS (800) 677-4544

550 MONTGOMERY

HWY STE 300 BIRMINGHAM AL AMERICAN BEHAVIORAL HEALTH

40439645 352530 89 AS (800) 458-3053

2323 EASTLAKE AVE

EAST SEATTLE WA NORTHWEST ADMINISTRATORS

40439655 358569 38 PS (800) 779-3825

17100 PIONEER BLVD

STE 420 CERRITOS CA COLLEGE HEALTH IPA

40439665 351113 38 AS (866) 225-8880 PO BOX 20765 INDIANAPOLIS IN AMERICAN WORKER PLAN (AWP)

40439675 359196 89 AS (702) 452-1520 PO BOX 29150 LAS VEGAS NV PLUMBERS AND PIPEFITTERS 525

40439685 352530 89 AS (419) 244-0135 PO BOX 5810 TROY MI HEALTH CARE PAYERS COALITION

40439695 351113 86 VO (800) 367-5897

555 MIDDLE CREEK

PKWY COLORADO SPRINGS CO ANTHEM VISION

40439705 351113 89 AS (800) 778-7996 PO BOX 22999 ROCHESTER NY EXCELLUS BCBS

40439715 352530 89 AS (800) 831-4914 PO BOX 1449 GOODLETTSVILLE TN NEW ORLEANS ELECTRICAL HEALTH FUND

40439725 358569 38 DV (216) 778-6302 707 BROOKPARK RD CLEVELAND OH LOCAL 400 WELFARE FUND

40439735 352530 89 AS (319) 272-7322 635 GRAND BLVD DES MOINES IA WHEATON FRANCISCAN PLAN

40439745 358569 89 AS (800) 426-7234 PO BOX 8025 STEVENS POINT WI SENTRY INSURANCE

40439755 358569 38 DV (800) 732-1121 PO BOX 34687 SEATTLE WA OPERATING ENGINEERS LOCAL 701

40439765 351113 89 AS (636) 728-7700 PO BOX 989 CHESTERFIELD MO JW TERRILL

40439775 358569 89 AS (800) 226-3155 3035 LAKELAND HILLS LAKELAND FL FIRST SERVICE ADMINISTRATORS

40439785 352530 89 AS (808) 523-0199 1440 KAPIOLANI BLVD HONOLULU HI SOUTHWEST SERVICES ADMINISTRATORS

40439795 352530 89 AS (800) 354-0222 PO BOX 025680 MIAMI FL NEIGHBORHOOD HEALTH

40439805 352530 89 AS (800) 769-6019 PO BOX 308 ASHLAND WI EAGLE ADMINISTRATORS

40439815 413395 88 DO (800) 624-8605 PO BOX 3262 CHARLESTON WV WELLS FARGO

40439825 352530 89 AS (800) 718-1293 PO BOX 869035 PLANO TX UNITED HEALTH INTERNATIONAL

40439835 352530 89 AS (888) 774-0848

6470 EAST JOHNS

CROSSING DULUTH GA NATIONAL BETTER LIVING ASSOCIATION (NBLA)

40439845 352530 88 DO (800) 451-2513 PO BOX 1477 GREENFIELD MA SUNLIFE FINANCIAL

40439855 358569 88 DO (888) 518-5338 PO BOX 1920 BOWIE MD DOMINION DENTAL

40439865 413395 89 AS (954) 276-3131 PO BOX 849029 PENBROKE PINES FL MEMORIAL MANAGED CARE

40439875 351113 38 PS (800) 865-3200 PO BOX 292580 LEWISVILLE TX HORIZON HEALTH

40439885 352530 89 AS (800) 426-9013 PO BOX 4816 MASSILLON OH THE HEALTH PLAN

40439895 358569 89 AS (800) 205-7002

1220 SW MORRISON

STE 300 PORTLAND OR A&I BENEFIT PLAN ADMINISTRATORS

40439905 358569 89 AS (800) 775-3540 PO BOX 7121 LONDON KY GROUP HEALTH PLAN

40439915 358569 89 NO (800) 258-0974 PO BOX 2600 FT WAYNE IN THREE RIVERS NETWORK

Page 168: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40439925 358569 86 VO (800) 877-7195 PO BOX 2459 SPOKANE WA GUARDIAN VISION

40439935 352530 89 AS (800) 833-3650 PO BOX 66601 ALBANY NY ASSOCIATION PLAN ADMINISTRATORS

40439945 413395 89 AS (614) 863-8780 PO BOX 107 REYNOLDSBURG OH BUSINESS ADMINISTRATORS CONSULTANTS

40439955 351113 89 AS (888) 356-7899 PO BOX 1010 HORSHAM PA INDEPENDENCE ADMINISTRATORS

40439965 358569 89 AS (800) 291-9586 PO BOX 87269 FAYETTEVILLE NC CM ADMINISTRATORS

40439975 352530 89 AS (800) 252-4674 PO BOX 380 PINEY POINT MD SEAFARERS HEALTH AND BENEFITS PLAN

40439985 358569 38 AS (800) 825-2117 PO BOX 7306 BEAUMONT TX GREENTREE ADMINISTRATORS SPINDLETOP MHMR

40439995 352530 38 PS (800) 395-1616 PO BOX 30018 LAGUNA NIGUEL CA INTEGRATED BEHAVIORAL HEALTH

40440005 358569 89 AS (800) 362-1279 PO BOX 94875 CLEVELAND OH CONSUMER LIFE

40440015 358569 89 AS (423) 282-3420 PO BOX 4985 JOHNSON CITY TN CORPORATE SYSTEMS ADMINISTRATION

40440025 358569 38 AS (860) 396-6409 PO BOX 3620 MASHANTUCKET CT MASHANTUCKET PEQUOT PLAN

40440035 352530 89 AS (800) 749-2714 PO BOX 853935 RICHARDSON TX TRISURANT

40440045 352530 89 AS (765) 447-8803 PO BOX 5769 LAFAYETTE IN STEWART C MILLER & CO

40440055 352530 89 AS (877) 453-4201 PO BOX 71570 SALT LAKE CITY UT TALL TREE ADMINISTRATORS

40440065 351113 89 AS (800) 482-8416 PO BOX 8069 LITTLE ROCK AR HEALTH ADVANTAGE

40440075 351113 89 AS (800) 447-5002 PO BOX 1926 GRAPEVINE TX ADVENTIST RISK MANAGEMENT

40440085 352530 89 AS (800) 628-6562 PO BOX 30101 SALT LAKE CITY UT COMPUSYS

40440095 352530 88 DO (231) 755-1686 2925 LINCOLN ST MUSKEGON MI NUGENT SAND CO

40440105 358569 87 RX (866) 903-6885 PO BOX 1339 MINNEAPOLIS MN CBCA RX

40440115 413395 89 AS (800) 322-1516 PO BOX 1986 PEORIA IL HCH ADMINISTRATION

40440125 358871 89 AS (800) 657-8205 712 11TH ST LAWRENCEVILLE IL GOLDEN RULE

40440135 351113 89 AS (800) 632-2022 PO BOX 31603 SALT LAKE CITY UT REGENCE BLUE SHIELD OF IDAHO

40440145 352530 38 AS (212) 815-1234 125 BARCLAY ST NEW YORK NY DC 37 HEALTH & SECURITY PLAN BENEFITS

40440155 358569 87 RX (800) 942-4765

PO BOX 232 1231 E

BELTLINE NE GRAND RAPIDS MI ARGUS (PRIORITY HEALTH RX)

40440165 352530 89 NO (866) 521-0156 PO BOX 140050 KANSAS CITY MO THE CARE NETWORK

40440175 358569 88 DO (765) 643-5112

13515 BARRETT PKWY

DR STE 265 BALLWIN MO INTERNATIONAL UNION OPERATING ENGINEERS 112

40440185 413395 38 AS (217) 243-8521 PO BOX 1267 JACKSONVILLE IL CENTRAL LABORERS PENSION WELFARE & ANNUITY

40440195 358569 89 AS (765) 643-5112 PO BOX 30555 SALT LAKE CITY UT INTERNATIONAL UNION OPERATING ENGINEERS 112

40440205 351113 89 X5 (800) 228-9100 PO BOX 2018 OMAHA NE PHYSICIANS MUTUAL

40440215 351113 89 AS (877) 293-8499 PO BOX 247007 OMAHA NE CONTINENTAL GENERAL INS

40440225 351113 38 AS (800) 429-9886 PO BOX 80 BUFFALO NY BC BS OF NORTH EASTERN NY

40440235 351113 38 X5 (888) 586-8810 PO BOX 10843 CLEARWATER FL LINCOLN HERITAGE LIFE INS CO

40440245 413395 89 AS (316) 609-2700 PO BOX 29288 WICHITA KS PREFERRED HEALTH SYSTEMS

40440255 358569 87 RX (800) 872-8276

2217 PLAZA DR STE

100 ROCKLIN CA AMERICAN HEALTH CARE

40440265 413395 89 AS (918) 280-4800 PO BOX 470950 TULSA OK PIPELINE INDUSTRY BENEFIT FUND

40440275 413395 88 DO (918) 280-4800 PO BOX 470950 TULSA OK PIPELINE INDUSTRY BENEFIT FUND

40440285 352530 89 AS (866) 511-4757 PO BOX 6743 LUBBOCK TX INTERPLAN HEALTH GROUP

40440295 352530 89 AS (800) 878-4445 PO BOX 3125 PORTLAND OR PROVIDENCE HEALTH PLANS

40440305 352530 89 AS (800) 794-5678 PO BOX 9000 WALNUT CREEK CA UFCW EMPLOYERS BENEFIT PLANS

40440315 351113 89 AS (888) 244-2228 PO BOX 605 BRENHAM TX BLUE BELL BENEFITS TRUST

Page 169: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40440325 352530 89 AS (808) 941-4622 PO BOX 32580 HONOLULU HI HAWAII MEDICAL ASSURANCE ASSOC

40440335 351113 38 NH (800) 456-7766 PO BOX 40007 LYNCHBURG VA GENWORTH FINANCIAL

40440345 352530 89 AS (800) 231-1407 PO BOX 2002 MONTEREY PARK CA SYNERMED

40440355 351113 38 HO (866) 262-5635 PO BOX 890179 CAMP HILL PA BC OF NORTHEAST PENNSYLVANIA

40440365 352530 89 AS (800) 521-1711 PO BOX 54889 OKLAHOMA CITY OK THE KEMPTON GROUP INC

40440375 352530 89 X5 (800) 778-1695 PO BOX 419104 ST LOUIS MO THE RIGHT CHOICE BENEFIT ADMINISTRATORS

40440385 352530 89 X2 (818) 243-0222

1000 NORTH CENTRAL

AVE STE 400 GLENDALE CA PACIFIC FEDERAL BENEFIT ADMINISTRATORS

40440395 413395 89 AS (800) 560-7744 PO BOX 30541 SALT LAKE CITY UT UMR

40440405 351113 89 AS (877) 832-1823 4001 41ST ST NW ROCHESTER MN MMSI

40440415 352530 89 AS (800) 451-2513 PO BOX 8027 BOSTON MA PHOENIX MUTUAL LIFE

40440425 358569 89 AS (808) 951-4621 PO BOX 13505 HONOLULU HI SUMMERLIN LIFE AND HEALTH

40440435 359196 89 AS (217) 228-2644 PO BOX 3765 QUINCY IL SISBRO INC

40440445 352530 89 AS (502) 839-8166 1996 BYPASS S LAWRENCEBURG KY KENTUCKY LABORERS DISTRICT COUNCIL H&W FUND

40440455 358569 38 AS (888) 532-3467 PO BOX 950 FOREST HILL MD MBA OF MARYLAND

40440465 352530 89 AS (800) 990-7262 PO BOX 15165 SANTA ANA CA PHYSICIANS CARE OF CA

40440475 358569 38 AS (800) 872-6732 320 PARK AVE NEW YORK NY MUTUAL OF AMERICA

40440485 351113 86 VO (800) 365-4999 600 NORTHERN BLVD GREAT NECK NY FIRST REHABILITATION LIFE INS CO OF AMERICA

40440495 352530 89 AS (888) 294-1515 PO BOX 3001 JOPLIN MO BENEFIT MANAGEMENT INC

40440505 358569 89 AS (800) 947-4338 PO BOX 10067 MANHATTAN BEACH CA SHEETMETAL WRKRS HLTH PLAN OF S. CA,AZ & NV

40440515 351113 86 VO (866) 818-8805 PO BOX 789773 WICHITA KS SURENCY VISION

40440525 352530 88 DO (800) 476-3010 PO BOX 1250 TUSCALOOSA AL SOUTHLAND NATIONAL

40440535 351113 89 X5 (800) 847-1148

1844 N NOB HILL RD

STE 623 PLANTATION FL CINERGY HEALTH

40440545 351113 89 AS (218) 724-3083 PO BOX 64267 ST PAUL MN FIRST PLAN OF MINNESOTA

40440555 352530 88 DO (800) 376-3462 PO BOX 40017 BATON ROUGE LA DINA DENTAL

40440565 351113 89 AS (212) 898-9160

45 BROADWAY 5TH

FLOOR NEW YORK NY NYSA-ILA WELFARE FUND

40440575 352530 89 AS (972) 943-9559 PO BOX 250089 PLANO TX CENTRAL TEXAS HEALTH & BENEFIT PLAN

40440585 358569 89 AS (800) 603-2299 PO BOX 98044 BATON ROUGE LA BENEFIT MANAGEMENT SERVICES

40440595 358113 89 AS (888) 741-2673 PO BOX 90 MACON GA CORE ADMINISTRATIVE SERVICES

40440605 351113 89 AS (866) 823-3790 PO BOX 1460 LITTLE ROCK AR BLUE ADVANTAGE ADMINISTRATORS

40440615 358569 88 DO (714) 508-3600

2860 MICHELLE DR

STE 200 IRVINE CA PACIFIC DENTAL SERVICES

40440625 351113 89 AS (800) 897-1923 1836 SOUTH AVE LACROSSE WI GUNDERSON LUTHERAN HEALTH PLAN

40440635 358569 89 AS (800) 577-1713

3835 PRESIDENTIAL

PKWY STE 123 ATLANTA GA SHEET METAL WORKERS WELFARE FUND LOCAL NO 85

40440645 351113 89 AS (866) 642-7045 PO BOX 1348 TROY MI INSULATORS LOCAL 45 FRINGE BENEFIT FUNDS

40440645 351113 89 DO (866) 642-7045 PO BOX 1348 TROY MI INSULATORS LOCAL 45 FRINGE BENEFIT FUNDS

40440655 351113 89 AS (801) 606-2425 PO BOX 30124 SALT LAKE CITY UT IRONWORKERS INTERMOUNTAIN HEALTH & WELFARE

40440665 352530 89 AS (800) 442-1101 PO BOX 1640 COLUMBIA SC WELLNET

Page 170: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

40440675 351113 89 AS (602) 275-8744

2255 N 44TH ST STE

250 PHOENIX AZ PROFESSIONAL BENEFIT SERVICES INC

40440685 352530 87 RX (602) 678-1191

7227 N 16TH ST STE

160 PHOENIX AZ UNITED DRUGS

40440695 352530 89 AS (877) 480-7442 PO BOX 315 PICKNEY MI EMPLOYEE BENEFIT LOGISTICS

40440705 358569 89 AS (800) 477-2287 PO BOX 130217 TYLER TX HEALTH FIRST

40440715 413395 89 AS (303) 428-5586 PO BOX 21240 DENVER CO COLORADO CONTRACTORS TRUST

40440725 358569 89 AS (410) 677-6606 PO BOX 6752 ANNAPOLIS MD INFORMED LLC

40440735 351113 89 XR (847) 742-0900

2400 BIG TIMBER RD

#206 B ELGIN IL FOX VALLEY LABORERS

40440745 358569 89 XR (206) 441-7574

2815 SECOND AVE STE

300 SEATTLE WA NORTHWEST ROOFERS & EMPLOYERS H&W TRUST FUND

40440755 351113 89 AS (877) 480-7442 PO BOX 5434 SPOKANE WA LABORERS AGC TRUST OF MONTANA

40441805 351113 38 AS (800) 447-0220

3481 CENTRAL

PKWY.,SUITE 100 CINCINNATI OH ACTURIAL & EMPLOYEE BENEFIT SERVICES

41413125 351113 89 AS (800) 832-3211 PO BOX 28087 RALEIGH NC CIGNA

44112405 413395 38 AS (248) 948-9900

26711

NORTHWESTERN HWY

STE 400 SOUTHFIELD MI EHIM

44444444 358871 91 BB (999) 999-9999 NA NA MI MEDICARE-ENROLLED IN PART B

55555555 358871 96 CC (999) 999-9999 NA NA MI MEDICARE-ENROLLED IN MEDICARE ADVANTAGE PLAN

60000000 352530 89 AS (954) 767-5500 PO Box 21128 Fort Lauderdale FL TOTAL CLAIMS ADMINISTRATION

60000001 351113 89 AS (800) 342-4718 4510 13th Ave Fargo ND BC BS OF NORTH DAKOTA

60000002 413395 89 AS (800) 235-7160 PO Box 30544 Salt Lake City UT HARRINGTON HEALTH

60000003 358569 89 AS (907) 276-1246

2600 Denali Street

Suite 200 Anchorage AK ALASKA ELECTRICAL HEALTH AND WELFARE PLAN

60000004 413395 89 AS (877) 517-6370 PO Box 99004 Anchorage AK WELLS FARGO INSURANCE SERVICES

60000005 351113 38 AS (800) 433-3036 PO Box 427 Columbia SC CONTINENTAL AMERICAN INSURANCE COMPANY

60000006 358113 89 AS (212) 499-4800

261 Madison Ave. 8th

Floor New York NY AFTRA HEALTH AND RETIREMENT

60000007 352530 88 DO (888) 203-7770 PO Box 3217 Eau Claire WI GROUP HEALTH COOPERATIVE

60000008 358569 89 AS (228) 762-2500 PO Box 1688 Pascagoula MS LOCKARD AND WILLIAMS

60000010 358569 88 DO (800) 342-5209 PO Box 8236 Chicago IL HUMANA COMP BENEFITS

60000011 358569 87 RX (800) 826-2862

3011 W GRAND BLVD

STE 1600 DETROIT MI TOTAL HEALTHCARE

60000012 358569 89 AS (800) 733-8880 PO Box 982017 Norte Richland Hills TX MID-WEST NATIONAL INS CO OF TN

60000013 358569 86 VO (800) 843-7752 PO Box 436149 Louisville KY CITIZENS SECURITY LIFE INS

60000014 358113 88 DO (419) 255-4320 PO BOX 1265 HOLLAND MI ROYAL BENEFITS AND ADMINISTRATION

60000015 352530 83 NH (888) 320-8741 PO Box 40007 Lynchburg VA RIVERSOURCE LONG TERM CARE

60000016 351113 87 RX (877) 469-7879 4590 LOCKHILL SELMA SAN ANTONIO TX PTRX

60000017 352530 89 AS (586) 693-1207 8220 Irving Rd. Sterling Heights MI NATIONAL EMPLOYEE HEALTH PLAN

Page 171: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

60000018 351113 88 DO (800) 255-5681 1640 Hempstead TPKE East meadow NY DDS

60000019 352530 89 X5 (517) 364-5858

1200 E. MICHIGAN

AVE. STE 235 LANSING MI SPARROW PHYSICIANS HEALTH

60000022 358113 89 XR (800) 851-6268

40 Calhoun St. Ste.

450 Charleston SC TCC OF SOUTH CAROLINA

60000023 413395 88 DO (800) 527-8702 PO Box 30567 Salt Lake City UT STONEBRIDGE LIFE INSURANCE CO

60000024 351113 89 AS (205) 871-3229 PO Box 660787 Birmingham AL ALTERNATIVE INSURANCE RESOURCES

60000025 58569 83 NH (877) 451-5824 P.O. Box 64913 St. Paul MN SENIOR HEALTH INSURANCE OF PA

60000026 352530 83 NH (800) 868-6788 1830 CRAIG PARK CT ST LOUIS MO NATIONAL STATES INS CO

60000027 351113 89 X2 (800) 521-0265 101 SE THIRD ST EVANSVILLE IN WELLBORN HEALTH PLANS

60000028 413395 88 DO (800) 290-1445

1450 W Long lake Rd.

Ste 300 Troy MI THE STANDARD

60000029 413395 89 XD (248) 524-0454

667 E BIG BEAVER

SUITE 101 TROY MI COPS HEALTH TRUST

60000030 52530 83 NH (215) 723-3044 673 East Cherry Lane Souderton PA UNITED SECURITY ASSURANCE

60000031 358113 89 AS (877) 842-3625 PO BOX 3000 NEW YORK NY EMBLEM HEALTH

60000032 351113 89 XD (866) 950-2368 PO Box 3726 Seattle WA CHARTIS ACCIDENT AND HEALTH

60000033 358113 89 AS (952) 883-5000 PO BOX 1309 MINNEAPOLIS MN HEALTH PARTNERS

60000034 352530 89 AS (800) 786-7930 PO BOX 7186 BOISE ID AMERIBEN

60000035 351113 89 AS (202) 833-4910 1716 N STREET NW WASHINGTON DC FOREIGN SERVICE BENEFIT PLAN

60000038 413395 89 AS (718) 591-2000 15811 Jewell Ave Flushing NY PENSION HOSPITALIZATION AND BENEFIT PLAN

60000041 358569 89 AS (800) 377-4161

10421 S JORDAN

GATEWAY STE 400 S JORDAN UT ALTIUS

60000041 358569 89 XV (800) 377-4161

10421 S JORDAN

GATEWAY STE 400 S JORDAN UT ALTIUS

60000045 358871 87 RX (800) 552-8159 PO BOX 832407 RICHARDSON TX CAREMARK CVS

60000046 358871 89 XR (260) 431-2050 PO BOX 2362 FT WAYNE IN SOUTHWEST ALLEN COUNTY SCHOOLS EMPLEE PLANS

60000049 358871 89 AS (866) 429-3242

18000 West Sarah

Lane Suite 3 Brookfield WI TRILOGY HEALTH INSURANCE INC

60000052 358871 89 AS (800) 247-2190 PO BOX 9371 DES MOINES IA AMERICAN REPUBLIC INS CO

60000054 358871 38 X5 (888) 888-2519 PO BOX 16708 JACKSON MS MORGAN WHITE ADMINISTRATORS INC

60000055 358871 89 AS (563) 327-2200 PO BOX 3310 DAVENPORT IA BUTLER BENEFIT SERVICE

60000056 358871 89 AS (800) 246-4622 PO BOX 98 WORLAND WY MOUNTAIN BENEFITS ASSOCIATES

60000057 358871 89 X5 (800) 687-5944 PO BOX 15688 AMARILLO TX INSURANCE MANAGEMENT SERVICES

60000058 358871 89 X5 (800) 543-6044

3545 NW 58TH ST STE

110 OKLAHOMA CITY OK HEALTHCHOICE

60000059 358871 87 RX (800) 677-4323

10050 CROSSTOWN

CIRCLE STE 300 EDEN PRAIRIE MN BIOSCRIP

60000060 358871 89 AS (866) 342-6555 754 MINNESOTA AVE KANSAS CITY KS BOILERMAKERS

Page 172: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

60000061 358871 89 AS (877) 233-1800 PO BOX 2838 CLINTON IA UMR

60000062 358871 89 AS (800) 883-2177 PO BOX 1309 MINNEAPOLIS MN HEALTHPARTNERS

60000063 358871 89 AS (866) 447-9717 55 WATER STREET NEW YORK NY HIP HEALTH PLAN NY

60000064 358871 89 AS (866) 390-3872

1605 ASSOCIATES DR

STE 101 DUBUQUE IA PREFERRED HEALTH CHOICES

60000065 358871 86 VO (800) 638-3120 PO BOX 30978 SALT LAKE CITY UT OPTUMHEALTH VISION

60000066 358871 89 AS (877) 531-1159 PO BOX 6430 ABBAPOLIS MD COMPASS ROSE HP

60000067 358871 38 IO (800) 822-3906 PO BOX 21156 EAGON MN STANDARD SECURITY LIFE C/O IHC

60000068 358871 89 AS (800) 521-0265 101 SE THIRD ST EVANSVILLE IN WELBORN HEALTH PLAN

60000069 358871 88 DO (800) 721-7987 PO BOX 23060 BELLEVILLE IL DEARBORN NATIONAL

60000070 358871 38 AS (800) 457-4726 800 MAIN ST DUBUQUE IA SISCO INC

60000071 358871 89 AS (800) 759-7422

13700 WATER TOWER

CIRCLE STE D PLYMOUTH MN ASSURECARE

60000072 358871 89 AS (800) 859-6862 PO BOX 47130 OAK PARK MI INDIANA TEAMSTERS HEALTH BENEFITS

60000073 358871 89 AS (913) 685-6300 PO BOX 25938 SHAWNEE MISSION KS PREFERRED HEALTH PROFESSIONALS

60000074 358871 86 VO (913) 236-5490 6405 METCALF AVE OVERLAND PARK KS CONSTRUCTION INDUSTRY LABORERS WELFARE FUND

60000075 358871 89 AS (877) 311-2150 PO BOX 757 CARTHAGE MO LEGGETT & PLATT INC

60000076 358871 89 AS (800) 272-4248 PO BOX 30783 SALT LAKE CITY UT UNITED HEALTHCARE INTEGRATED SERVICES

60000077 358871 38 AS (800) 517-4791 PO BOX 420 SPRINGFIELD MA NATIONWIDE

60000078 358871 89 AS (888) 800-2230 PO BOX 30827 SALT LAKE CITY UT SINCLAIR HEALTH SERVICES

60000079 358871 88 DO (800) 227-7620 PO BOX 21518 EAGAN MN IHC HEALTH SOLUTIONS

60000080 358616 38 AS (888) 888-8888 400 S Pine Lansing MI MICHILD POLICY

60000081 358616 38 AS (888) 888-8888 400 S Pine Lansing MI MICHILD POLICY

60000082 358871 38 X2 (800) 942-4765

PO BOX 232 1231 E

BELTLINE NE GRAND RAPIDS MI PRIORITY HEALTH

60000083 358871 89 AS (866) 288-8052 PO BOX 1818 TACOMA WA BENEFITMD

60000084 358871 89 AS (800) 426-9786 PO BOX 2950 TACOMA WA TRUSTEED PLANS SERVICE CORP

60000085 358871 89 AS (800) 628-4664 PO BOX 88500 INDIANAPOLIS IN INTERNATIONAL MEDICAL GROUP IMG

60000086 358871 87 RX (800) 830-2310

4246 RIVERBOAT RD

STE 175 SALT LAKE CITY UT SCRIP WORLD

60000087 358871 38 AS (231) 728-5180

1200 RANSOM ST STE

102 MUSKEGON MI ACCESS HEALTH

60000088 358871 88 DO (800) 471-4920

700 PARKER SQUARE

STE 150 FLOWER MOUND TX DELTA DENTAL OF TX

60000089 358871 89 AS (509) 534-0600 PO BOX 5433 SPOKANE WA REHN & ASSOCIATES INC

60000090 358871 89 AS (800) 615-7020 PO BOX 23 SHEBOYGAN WI PRAIRIE STATES

60000091 358871 83 NH (877) 450-5824 PO BOX 64913 ST PAUL MN SENIOR HEALTH INS CO OF PENNSYLVANIA

60000092 358871 89 AS (800) 982-7838 PO BOX 790 RIPLEY WV BENEFIT ASSISTANCE CORP

60000095 358871 89 AS (216) 566-1455 1432 HAMILTON AVE CLEVELAND OH SELF FUNDED PLAN INC

60000096 358871 89 AS (866) 382-2527 PO BOX 105187 ATLANTA GA BC BS OF GA

60000097 358871 89 AS (800) 223-1704 4510 13TH AVE SW FARGO ND BC BS OF ND

Page 173: Coverage Payer ID Tech ID OI Code Type Payer …€¦ · Payer ID Tech ID OI Code Coverage Type Payer Phone Street City State Payer Name 00029005 359274 05 AS (999) 999-9999 600 LAFAYETTE,PO

60000098 358871 38 AS (888) 241-5604 106 PARK PLACE DUNDEE MI PARAMOUNT

60000099 358871 88 DO (866) 867-6883 PO BOX 8063 LITTLE ROCK AR TRANSAMERICA

60000100 358871 89 AS (800) 749-9963 PO BOX 100043 DULUTH GA GROUP RESOURCES

60000101 358871 89 AS (800) 767-0700 PO BOX 809025 DALLAS TX UNITED HEALTH CARE STUDENT RESOURCES

60000102 358871 38 AS (866) 763-6695 PO BOX 898845 CAMPHILL PA HIGHMARK BLUE SHIELD

60000103 358871 88 DO (800) 828-9341

4201 N 24TH ST STE

300 PHOENIX AZ AVESIS DENTAL SERVICES

60000104 358871 83 NH (800) 504-0469 PO BOX 5555 ALBANY NY RIVERSOURCE LIFE INS CO

60000105 358871 86 VO (800) 225-9674 PO BOX 37504 OAK PARK MI US HEALTH AND LIFE

60000106 358871 89 AS (800) 442-2376 PO BOX 2266 CHEYENNE WY BC BS OF WY

60000107 358871 88 DO (888) 703-6999 PO BOX 26110 SANTA ANA CA LIBERTY DENTAL PLAN

60000108 358871 87 RX (800) 717-6614

144 METRO CENTER

BLVD WARWICK RI AMWINS RX

60000109 358871 87 RX (800) 801-1766 PO BOX 02459 DETROIT MI ALLIANCE RX

60000110 358871 86 VO (888) 356-7899 PO BOX 1010 HORSHAM PA INDEPENDENCE ADMINISTRATORS

60000111 358871 88 DO (888) 772-4256

4510 13TH AVE

SOUTH FARGO ND DENTAL SERVICE CORP

60000112 358871 89 AS (800) 748-8696 PO BOX 21515 EAGAN MN BENEFIT ADMINISTRATION SERVICES

60000113 358871 89 AS (800) 631-1656

100 NORTH ACADEMY

AVE DANVILLE PA GEISINGER HEALTH PLAN

60000114 358871 87 RX (800) 788-7871 PO BOX 29044 HOT SPRINGS AR OPTUMRX/PRESCRIPTION SOLUTIONS

60000115 358871 83 NH (877) 451-5824 PO BOX 64913 ST. PAUL MN SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVAN

60894005 351113 38 AS (999) 999-9999 PO BOX 41779 MEMPHIS TN INSUREX BENEFITS ADMIN INC

66666666 359196 91 DD (999) 999-9999 N/A N/A MI MEDICARE-ENROLLED IN MEDICARE PART D

77777777 359196 50 XX (999) 999-9999 N/A N/A MI MEDICARE-ALIENS NOT ENROLLED FOR MEDICARE

99999999 359196 89 NO (999) 999-9999 TEST STREET TEST CITY WI CARRIER IDENTIFIED BY PHARMACY