eClaims Medical Payer List January 2011 - Find Answers · 2016-02-28 · eClaims Medical Payer List January 2011 Payer ID State Model Enroll Additional Information A.G.I.A. Inc. 95241

eClaims Medical Payer List

January 2011

Payer ID State Model Enroll Additional Information Americas 1st Choice Health Plans of North Carolina Inc.26078 COMMERCIAL N Americas 1st Choice Health Plans of North Carolina Inc.26078 COMMERCIAL N Americas 1st Choice Health Plans of South Carolina Inc.20553 COMMERCIAL N Americas 1st Choice Health Plans of South Carolina Inc.20553 COMMERCIAL N Arroyo Vista Family Health Center NMM01 COMMERCIAL N Arroyo Vista Family Health Center NMM01 COMMERCIAL N Lakeside Medical Group 66125 COMMERCIAL N Lakeside Medical Group 66125 COMMERCIAL N Optimum Healthcare Inc. 20133 COMMERCIAL N Optimum Healthcare Inc. 20133 COMMERCIAL N Primary Care Associates Medical Group IP079 COMMERCIAL N Primary Care Associates Medical Group IP079 COMMERCIAL N Texas First Health Plans (TIOPA) 76046 COMMERCIAL N Texas First Health Plans (TIOPA) 76046 COMMERCIAL N

1-888-OHIOCOMP (Ohio BWC) 31147 COMMERCIAL N

For Ohio Worker's Comp Claims

ONLY.

1-888-OHIOCOMP (Ohio BWC) 31147 COMMERCIAL N


ONLY.1199 National Benefit Fund 13162 COMMERCIAL N1199 National Benefit Fund 13162 COMMERCIAL N

1st MN--Atlanta GA 29076 COMMERCIAL N

1st Medical Network is part of the

Medical Mutual Family of

Companies. Former payer ID

58203.

1st MN--Atlanta GA 29076 COMMERCIAL N




58203.

1st Medical Network - Atlanta GA 29076 COMMERCIAL N




58203.

1st Medical Network - Atlanta GA 29076 COMMERCIAL N




58203.21st Century Health and Benefits 59069 COMMERCIAL N21st Century Health and Benefits 59069 COMMERCIAL N21st Century Insurance and Financial Services 51028 COMMERCIAL N For Minnesota Only21st Century Insurance and Financial Services 51028 COMMERCIAL N For Minnesota Only

3-Hab (Ohio BWC) 31147 COMMERCIAL N


ONLY.

3-Hab (Ohio BWC) 31147 COMMERCIAL N


ONLY.3P ADMIN 20413 COMMERCIAL N3P ADMIN 20413 COMMERCIAL NA & I Benefit Plan Administrators 93044 COMMERCIAL NA & I Benefit Plan Administrators 93044 COMMERCIAL N

A.G.I.A. Inc. 95241 COMMERCIAL N

Claims are printed and mailed to

the payer.

For an updated payer list please visit our website https://pattersonsupport.custhelp.com

Page 1


January 2011

Payer ID State Model Enroll Additional Information

A.G.I.A. Inc. 95241 COMMERCIAL N


the payer.AAG Benefit Plan Administrators Inc. 75240 COMMERCIAL NAAG Benefit Plan Administrators Inc. 75240 COMMERCIAL NAAG-American Administravie Group ( Formerly Icon Benefit Admin)75185 COMMERCIAL NAAG-American Administravie Group ( Formerly Icon Benefit Admin)75185 COMMERCIAL N

ABMA (Alta Bates Medical Assocs) Medical Corp (Hnet Sr. and Secure Horizon)E3510 COMMERCIAL P

Only claims from providers in

Northern California. Please

contact the EDI Dept for North

American Medical Management

(NAMM) - Northern California

Lead/Supervisor at 1-800-956-

8000 prior to initial submission of

claims.

ABMA (Alta Bates Medical Assocs) Medical Corp (Hnet Sr. and Secure Horizon)E3510 COMMERCIAL P








claims.ACMG 87066 COMMERCIAL NACMG 87066 COMMERCIAL N

ACS Benefit Services Inc. 72467 COMMERCIAL N

DO NOT send ACS/Health Net or

ACS Inc. Medicaid claims to this

payer ID. This payer ID is for ACS

Benefit Services. Inc. ONLY.

ACS Benefit Services Inc. 72467 COMMERCIAL N

DO NOT send ACS/Health Net or

ACS Inc. Medicaid claims to this

payer ID. This payer ID is for ACS

Benefit Services. Inc. ONLY.ACS Rewards Administration Center 36112 COMMERCIAL NACS Rewards Administration Center 36112 COMMERCIAL NADOC (Affiliated Doctor's of Orange County) ADOCS COMMERCIAL NADOC (Affiliated Doctor's of Orange County) ADOCS COMMERCIAL NADVANCED DATA SOLUTIONS 58202 COMMERCIAL NADVANCED DATA SOLUTIONS 58202 COMMERCIAL NADVANTICA BENEFITS 59374 COMMERCIAL NADVANTICA BENEFITS 59374 COMMERCIAL NAEQUITAS CAPITAL MANAGEMENT Call COMMERCIAL NAEQUITAS CAPITAL MANAGEMENT Call COMMERCIAL NAFFINITY MEDICAL GROUP 46594 COMMERCIAL NAFFINITY MEDICAL GROUP 46594 COMMERCIAL NAFTRA Health Fund 13346 COMMERCIAL NAFTRA Health Fund 13346 COMMERCIAL NAGA 37280 COMMERCIAL N


Page 2


January 2011

Payer ID State Model Enroll Additional InformationAGA 37280 COMMERCIAL NAHPO (Cleveland OH) 31138 COMMERCIAL NAHPO (Cleveland OH) 31138 COMMERCIAL NALICARE 13550 COMMERCIAL NALICARE 13550 COMMERCIAL N

ALPS CompCare (Ohio BWC) 31147 COMMERCIAL N


ONLY.

ALPS CompCare (Ohio BWC) 31147 COMMERCIAL N


ONLY.AMA Insurance Agency TH071 COMMERCIAL NAMA Insurance Agency TH071 COMMERCIAL NAMCO 62176 COMMERCIAL NAMCO 62176 COMMERCIAL NAMERIGROUP Community Care of New Mexico 27514 COMMERCIAL NAMERIGROUP Community Care of New Mexico 27514 COMMERCIAL NAMERIGROUP Georgia 27514 COMMERCIAL NAMERIGROUP Georgia 27514 COMMERCIAL NAMVI/Prospect Health Network (Prospect Medical Group)PROSP COMMERCIAL NAMVI/Prospect Health Network (Prospect Medical Group)PROSP COMMERCIAL NAPAC (Pinnacle Health Resources) (Prospect Medical Group)PROSP COMMERCIAL NAPAC (Pinnacle Health Resources) (Prospect Medical Group)PROSP COMMERCIAL NAPS Healthcare Inc. 54160 COMMERCIAL NAPS Healthcare Inc. 54160 COMMERCIAL N

APS Paper Claim 54100 COMMERCIAL N

Claims will be printed and mailed

to APS Paper Claim 54100.

APS Paper Claim 54100 COMMERCIAL N

Claims will be printed and mailed

to APS Paper Claim 54100.ARAZ Group 16120 COMMERCIAL NARAZ Group 16120 COMMERCIAL N

ASC of Oho Call COMMERCIAL N

To obtain the payer ID please call

(440) 262-1160.

ASC of Oho Call COMMERCIAL N


(440) 262-1160.ASR 38265 COMMERCIAL NASR 38265 COMMERCIAL NASR Corporation 38265 COMMERCIAL NASR Corporation 38265 COMMERCIAL NASR Health Benefits 38265 COMMERCIAL NASR Health Benefits 38265 COMMERCIAL N

ASW \ Lifewise 37294 COMMERCIAL N

Payer moved to live with vision

and dental claims on 6/22. Now

they are allowing all other

medical claim submitter to send.

ASW \ Lifewise 37294 COMMERCIAL N

Payer moved to live with vision

and dental claims on 6/22. Now

they are allowing all other

medical claim submitter to send.


Page 3


January 2011


ATA-FL 65064 COMMERCIAL N

ONLY Physical Occupational and

Speech Therapy Claims for the

following FLORIDA Health Plans

should be submitted to this payer

ID: Aetna Health Plan CarePlus

JMH Health Plan Sunshine State

Health Plan WellCare Health Plan

ATA-FL 65064 COMMERCIAL N

ONLY Physical Occupational and

Speech Therapy Claims for the

following FLORIDA Health Plans

should be submitted to this payer

ID: Aetna Health Plan CarePlus

JMH Health Plan Sunshine State

Health Plan WellCare Health PlanAXA Assistance_USA 65101 COMMERCIAL NAXA Assistance_USA 65101 COMMERCIAL NAbrazo Advantage Health Plan 3443 COMMERCIAL NAbrazo Advantage Health Plan 3443 COMMERCIAL N

Absolute Total Care 68055 COMMERCIAL N

Prior to submitting claims please

call Provider Relations Dept at 1-

866-433-6041 to verify your

provider info is on file in the claim

system. This will prevent

rejections and allow payments to

be made in a timely manner.

Absolute Total Care 68055 COMMERCIAL N







be made in a timely manner.Access Administrators TH067 COMMERCIAL NAccess Administrators TH067 COMMERCIAL NAccess IPA CM001 COMMERCIAL NAccess IPA CM001 COMMERCIAL NAccess IPA REGAL COMMERCIAL NAccess IPA REGAL COMMERCIAL NAcclaim 64071 COMMERCIAL NAcclaim 64071 COMMERCIAL NAcclaim Repricing 21356 COMMERCIAL NAcclaim Repricing 21356 COMMERCIAL NActiva Benefit Services 88056 COMMERCIAL NActiva Benefit Services 88056 COMMERCIAL NAdministration Systems Research Corporation 38265 COMMERCIAL NAdministration Systems Research Corporation 38265 COMMERCIAL NAdministrative Concepts Inc. 22384 COMMERCIAL N


Page 4


January 2011

Payer ID State Model Enroll Additional InformationAdministrative Concepts Inc. 22384 COMMERCIAL NAdministrative Services Inc. 59141 COMMERCIAL NAdministrative Services Inc. 59141 COMMERCIAL NAdvanced Medical Management AMM01 COMMERCIAL NAdvanced Medical Management AMM01 COMMERCIAL NAdvantage Health Solutions 35209 COMMERCIAL NAdvantage Health Solutions 35209 COMMERCIAL NAdvantage Med Grp NMM01 COMMERCIAL NAdvantage Med Grp NMM01 COMMERCIAL NAdvantage Preferred Plus 77070 COMMERCIAL NAdvantage Preferred Plus 77070 COMMERCIAL NAdvantage by Bridgeway Health Solutions 68056 COMMERCIAL NAdvantage by Bridgeway Health Solutions 68056 COMMERCIAL NAdvantage by Buckeye Community Health Plan 68056 COMMERCIAL NAdvantage by Buckeye Community Health Plan 68056 COMMERCIAL NAdvantage by Managed Health Services 68056 COMMERCIAL NAdvantage by Managed Health Services 68056 COMMERCIAL NAdvantage by Superior HealthPlan 68056 COMMERCIAL NAdvantage by Superior HealthPlan 68056 COMMERCIAL NAdvantek Benefit Administrators 83077 COMMERCIAL NAdvantek Benefit Administrators 83077 COMMERCIAL N

Advantra Freedom 25133 COMMERCIAL N

Formerly payer ID 25152. Now

part of Coventry Consolidated

payer ID.

Advantra Freedom 25133 COMMERCIAL N



payer ID.

Advantra Savings 25133 COMMERCIAL N



payer ID.

Advantra Savings 25133 COMMERCIAL N



payer ID.Adventist Health System West - Roseville CA 95340 COMMERCIAL NAdventist Health System West - Roseville CA 95340 COMMERCIAL N

AdvoCare Incorporated (Ohio BWC) 31147 COMMERCIAL N


ONLY.

AdvoCare Incorporated (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Advocate Health Centers 36320 COMMERCIAL N

Please contact Advocate

Physician Partners Debbie Motz

at (847)635-4182 for questions or

more information for both payer

IDs.

Advocate Health Centers 36320 COMMERCIAL N





IDs.


Page 5


January 2011


Advocate Physician Partners 65093 COMMERCIAL N





IDs.

Advocate Physician Partners 65093 COMMERCIAL N





IDs.Aetna 60054 COMMERCIAL NAetna 60054 COMMERCIAL NAetna Affordable Health Choices (SM) - SRC 57604 COMMERCIAL NAetna Affordable Health Choices (SM) - SRC 57604 COMMERCIAL NAffiliated Doctors of Orange County (ADOC) ADOCS COMMERCIAL NAffiliated Doctors of Orange County (ADOC) ADOCS COMMERCIAL NAffiliated Physicians Group APG01 COMMERCIAL NAffiliated Physicians Group APG01 COMMERCIAL N

Affinity Health Plan 13334 COMMERCIAL P

Please contact Affinity's EDI

Coordinator before submitting

claims electronically at

[email protected] or call

(718)794-7592.

Affinity Health Plan 13334 COMMERCIAL P

Please contact Affinity's EDI

Coordinator before submitting

claims electronically at

[email protected] or call

(718)794-7592.

Affinity Medicare Advantage 13333 COMMERCIAL N

When submitting to this payer ID

please ensure the following: The

claim is for a Medicare Advantage

Member the date of service is

equal to or greater than 1/1/10

and the subscriber ID you submit

is 9 characters in length.

Affinity Medicare Advantage 13333 COMMERCIAL N

When submitting to this payer ID

please ensure the following: The

claim is for a Medicare Advantage

Member the date of service is

equal to or greater than 1/1/10

and the subscriber ID you submit

is 9 characters in length.

Affordable Benefit Administrators Inc. 95426 COMMERCIAL N

Claims with the following address

should only be sent to this payer

id. ABA P.O. Box 10787 Burbank

CA 91510-0787


Page 6


January 2011


Affordable Benefit Administrators Inc. 95426 COMMERCIAL N

Claims with the following address

should only be sent to this payer

id. ABA P.O. Box 10787 Burbank

CA 91510-0787

Agate Resources Inc. (LIPA) 20048 COMMERCIAL N

Please contact Risa Rhodes at

(514) 762-2165 for the Agate

Resources Inc. (LIPA) Payer ID

Agate Resources Inc. (LIPA) 20048 COMMERCIAL N

Please contact Risa Rhodes at

(514) 762-2165 for the Agate

Resources Inc. (LIPA) Payer ID

Agency Services Inc 64158 COMMERCIAL N Now known as Meritain Health

Agency Services Inc 64158 COMMERCIAL N Now known as Meritain Health

Alaska Children's Services Inc. 91136 COMMERCIAL N

Please enter Group Number (P68)

when submitting claims.

Alaska Children's Services Inc. 91136 COMMERCIAL N


when submitting claims.Alaska Electrical Health & Welfare Fund 92600 COMMERCIAL NAlaska Electrical Health & Welfare Fund 92600 COMMERCIAL N

Alaska Laborers Construction Industry Trust 91136 COMMERCIAL N

Please enter Group Number (F23)


Alaska Laborers Construction Industry Trust 91136 COMMERCIAL N



Alaska Pipe Trades Local 375 91136 COMMERCIAL N



Alaska Pipe Trades Local 375 91136 COMMERCIAL N



Alaska United Food & Commercial Workers Health & Welfare Trust91136 COMMERCIAL N



Alaska United Food & Commercial Workers Health & Welfare Trust91136 COMMERCIAL N


when submitting claims.Allegiance Benefit Plan Management Inc. 81040 COMMERCIAL NAllegiance Benefit Plan Management Inc. 81040 COMMERCIAL N

Alliance Healthcare/Florida for Stones River Regional IPA13079 COMMERCIAL N

This Payer ID should be used for

Stones River Regional IPA -

Alliance Healthcare Florida claims

only.

Alliance Healthcare/Florida for Stones River Regional IPA13079 COMMERCIAL N


Stones River Regional IPA -

Alliance Healthcare Florida claims

only.

Alliance The (A Wisconsin provider network) Call COMMERCIAL N

ID cards should show mailing

address of PO Box 44365 Madison

WI 53744. Call Dave Sell at 608-

210-6656 to obtain Payer ID.


Page 7


January 2011


Alliance The (A Wisconsin provider network) Call COMMERCIAL N

ID cards should show mailing

address of PO Box 44365 Madison

WI 53744. Call Dave Sell at 608-

210-6656 to obtain Payer ID.Alliant Health Plans of Georgia 58234 COMMERCIAL NAlliant Health Plans of Georgia 58234 COMMERCIAL NAllied Administrators (San Francisco CA) 94177 COMMERCIAL NAllied Administrators (San Francisco CA) 94177 COMMERCIAL NAllied Benefit Systems 37308 COMMERCIAL NAllied Benefit Systems 37308 COMMERCIAL NAllied Health Systems Chiropractic SX156 COMMERCIAL NAllied Health Systems Chiropractic SX156 COMMERCIAL NAllied Physicians NMM01 COMMERCIAL NAllied Physicians NMM01 COMMERCIAL NAlpha Data TH085 COMMERCIAL NAlpha Data TH085 COMMERCIAL N

Alta Bates Medical Group A0701 COMMERCIAL N

Payer ID is only for dates of

service after 7/1/2010.

Alta Bates Medical Group A0701 COMMERCIAL N

Payer ID is only for dates of

service after 7/1/2010.

Alta Bates Medical Group Call COMMERCIAL P

Network ID required on all claims.

Call Sutter Connect EDI

Department at (800) 611-5191 to

obtain Network ID prior to first

submission.

Alta Bates Medical Group Call COMMERCIAL P





submission.

Alta Senior Care (Hnet Sr and Secure Horizons only) E3510 COMMERCIAL P








claims.

Alta Senior Care (Hnet Sr and Secure Horizons only) E3510 COMMERCIAL P








claims.


Page 8


January 2011


Altius (Utah) 25133 COMMERCIAL N

Formerly Payer ID SX113. Now

part of the Consolidated payer ID.

Altius (Utah) 25133 COMMERCIAL N

Formerly Payer ID SX113. Now

part of the Consolidated payer ID.Amalgamated Life 13550 COMMERCIAL NAmalgamated Life 13550 COMMERCIAL NAmalgamated Life - PA / Alicare 13343 COMMERCIAL NAmalgamated Life - PA / Alicare 13343 COMMERCIAL N

AmeraPlan 38219 COMMERCIAL N


the payer.

AmeraPlan 38219 COMMERCIAL N


the payer.AmeriBen Solutions Inc. 75137 COMMERCIAL NAmeriBen Solutions Inc. 75137 COMMERCIAL N

AmeriChoice of New Jersey Personal Care Plus (Medicare)86001 COMMERCIAL N

All claims submitted require your

AmeriChoice assigned Provider ID

Number. Please contact

AmeriChoice at (888) 362-3368

for your Provider ID Number.

AmeriChoice of New Jersey Personal Care Plus (Medicare)86001 COMMERCIAL N





for your Provider ID Number.AmeriChoice of New Jersey Inc. (Medicaid NJ) 86047 COMMERCIAL NAmeriChoice of New Jersey Inc. (Medicaid NJ) 86047 COMMERCIAL N

AmeriChoice of New York Personal Care Plus (Medicare)86002 COMMERCIAL N






AmeriChoice of New York Personal Care Plus (Medicare)86002 COMMERCIAL N





for your Provider ID Number.AmeriChoice of New York Inc. (Medicaid NY) 86048 COMMERCIAL NAmeriChoice of New York Inc. (Medicaid NY) 86048 COMMERCIAL N

AmeriChoice of Pennsylvania Personal Care Plus (Medicare)86003 COMMERCIAL N







Page 9


January 2011


AmeriChoice of Pennsylvania Personal Care Plus (Medicare)86003 COMMERCIAL N





for your Provider ID Number.AmeriChoice of Pennsylvania Inc. (Medicaid PA) 86049 COMMERCIAL NAmeriChoice of Pennsylvania Inc. (Medicaid PA) 86049 COMMERCIAL NAmeriHealth Administrators 54763 COMMERCIAL NAmeriHealth Administrators 54763 COMMERCIAL NAmeriHealth HMO New Jersey and Delaware 23037 COMMERCIAL NAmeriHealth HMO New Jersey and Delaware 23037 COMMERCIAL N

AmeriHealth Mercy Health Plan 22248 COMMERCIAL N

Medicaid managed care. For EDI

support please e-mail

[email protected].

AmeriHealth Mercy Health Plan 22248 COMMERCIAL N



[email protected]'s PPO 16120 COMMERCIAL NAmerica's PPO 16120 COMMERCIAL NAmerica's TPA 41178 COMMERCIAL NAmerica's TPA 41178 COMMERCIAL NAmericaid Community Care (Maryland) 27517 COMMERCIAL NAmericaid Community Care (Maryland) 27517 COMMERCIAL NAmericaid Community Care (New Jersey) 27516 COMMERCIAL NAmericaid Community Care (New Jersey) 27516 COMMERCIAL NAmerican Administrative Group 75240 COMMERCIAL NAmerican Administrative Group 75240 COMMERCIAL N

American Administrators (West Des Moines Iowa) 42112 COMMERCIAL N

Please check the Insured ID card

to verify the Payer ID before

submitting claims. If you have

questions please contact Provider

Relations at 800-456-4584.

American Administrators (West Des Moines Iowa) 42112 COMMERCIAL N






American Administrators dba Select Benefit Administrators (W.DesMoines IA)42137 COMMERCIAL N







Page 10


January 2011


American Administrators dba Select Benefit Administrators (W.DesMoines IA)42137 COMMERCIAL N





Relations at 800-456-4584.American Behavioral 63103 COMMERCIAL NAmerican Behavioral 63103 COMMERCIAL NAmerican Behavioral FEP/ITS 63106 COMMERCIAL NAmerican Behavioral FEP/ITS 63106 COMMERCIAL NAmerican Behavioral-LifeSynch 63101 COMMERCIAL NAmerican Behavioral-LifeSynch 63101 COMMERCIAL NAmerican Benefit Plan Administrators 95170 COMMERCIAL NAmerican Benefit Plan Administrators 95170 COMMERCIAL N

American Benefits Management (North Canton OH) 34187 COMMERCIAL N

Payer ID valid only for claims with

a billing submission address of

P.O. Box 35008 N. Canton OH

44735

American Benefits Management (North Canton OH) 34187 COMMERCIAL N



P.O. Box 35008 N. Canton OH

44735American Chiropractic Network (ACN) 41161 COMMERCIAL NAmerican Chiropractic Network (ACN) 41161 COMMERCIAL NAmerican Chiropractic Network IPA of NY (ACNIPA) 41160 COMMERCIAL NAmerican Chiropractic Network IPA of NY (ACNIPA) 41160 COMMERCIAL NAmerican Community Mutual Insurance 60305 COMMERCIAL NAmerican Community Mutual Insurance 60305 COMMERCIAL NAmerican Family Insurance TH095 COMMERCIAL NAmerican Family Insurance TH095 COMMERCIAL NAmerican Family PPO Policies Administered by Am Rep56071 COMMERCIAL NAmerican Family PPO Policies Administered by Am Rep56071 COMMERCIAL NAmerican General 62030 COMMERCIAL NAmerican General 62030 COMMERCIAL NAmerican Healthcare Alliance 1066 COMMERCIAL NAmerican Healthcare Alliance 1066 COMMERCIAL N

American Imaging Management Inc. 36369 COMMERCIAL N

Assigned Group Policy Plan ID is

required. To obtain please call

American Imaging Management

Inc. at (800) 252-2021.

American Imaging Management Inc. 36369 COMMERCIAL N

Assigned Group Policy Plan ID is

required. To obtain please call

American Imaging Management

Inc. at (800) 252-2021.American International Group Inc. (AIG) 87726 COMMERCIAL N Plan of UnitedHealthcareAmerican International Group Inc. (AIG) 87726 COMMERCIAL N Plan of UnitedHealthcare


Page 11


January 2011


American LIFECARE 72099 COMMERCIAL N

Please enter the Group Number

from ID card when submitting

claims. Payer ID valid only for

claims with a billing submission

address of 1100 Poydras Street

Suite 2600 New Orleans LA

70163-2602.

American LIFECARE 72099 COMMERCIAL N

Please enter the Group Number

from ID card when submitting

claims. Payer ID valid only for

claims with a billing submission

address of 1100 Poydras Street

Suite 2600 New Orleans LA

70163-2602.American Medical Security Inc. 81400 COMMERCIAL NAmerican Medical Security Inc. 81400 COMMERCIAL NAmerican Medical and Life Insurance 23212 COMMERCIAL NAmerican Medical and Life Insurance 23212 COMMERCIAL NAmerican National Ins. Co. (ANICO) 74048 COMMERCIAL NAmerican National Ins. Co. (ANICO) 74048 COMMERCIAL N

American Postal Workers Union Health Plan 44444 COMMERCIAL N

Claims for the state of Maine

ONLY must be sent on paper to

MedNet P. O. Box 15440 Portland

ME 04112.

American Postal Workers Union Health Plan 44444 COMMERCIAL N

Claims for the state of Maine

ONLY must be sent on paper to

MedNet P. O. Box 15440 Portland

ME 04112.American Progressive Life and Health Insurance Company48055 COMMERCIAL NAmerican Progressive Life and Health Insurance Company48055 COMMERCIAL NAmerican Republic Insurance 42011 COMMERCIAL NAmerican Republic Insurance 42011 COMMERCIAL NAmerican Whole Health Networks TH117 COMMERCIAL NAmerican Whole Health Networks TH117 COMMERCIAL NAmerican Worker Health Plan 37322 COMMERCIAL NAmerican Worker Health Plan 37322 COMMERCIAL NAmerigroup Community Care 27514 COMMERCIAL NAmerigroup Community Care 27514 COMMERCIAL N

Amerigroup Corporation (Ft Worth) 27514 COMMERCIAL N

Formally Americaid Community

Care (Dallas/Ft. Worth).

Amerigroup Corporation (Ft Worth) 27514 COMMERCIAL N

Formally Americaid Community

Care (Dallas/Ft. Worth).

Amerigroup Corporation (Houston) 27515 COMMERCIAL N

Formerly Americaid Community

Care (Houston).

Amerigroup Corporation (Houston) 27515 COMMERCIAL N

Formerly Americaid Community

Care (Houston).Amerigroup Florida 27519 COMMERCIAL N


Page 12


January 2011

Payer ID State Model Enroll Additional InformationAmerigroup Florida 27519 COMMERCIAL NAmerigroup Illinois 27518 COMMERCIAL NAmerigroup Illinois 27518 COMMERCIAL NAmerigroup Ohio 27518 COMMERCIAL NAmerigroup Ohio 27518 COMMERCIAL N

Amida Care 24818 COMMERCIAL N Formerly known as VidaCare

Amida Care 24818 COMMERCIAL N Formerly known as VidaCareAnchor Benefit Consulting Inc. 53085 COMMERCIAL NAnchor Benefit Consulting Inc. 53085 COMMERCIAL NAncillary Benefit Services (ABS) 86062 COMMERCIAL NAncillary Benefit Services (ABS) 86062 COMMERCIAL NAncillary Care Management/ACM 3172 COMMERCIAL NAncillary Care Management/ACM 3172 COMMERCIAL NAngeles IPA (SynerMed) SYMED COMMERCIAL NAngeles IPA (SynerMed) SYMED COMMERCIAL NAntares Management Solutions 34192 COMMERCIAL NAntares Management Solutions 34192 COMMERCIAL N

Apex Benefit Services 34196 COMMERCIAL N

Apex is also a Medicaid payer and

will accept claims with either a

Medicaid or Commercial

classification

Apex Benefit Services 34196 COMMERCIAL N

Apex is also a Medicaid payer and

will accept claims with either a

Medicaid or Commercial

classificationAppleCare Medical Management APP01 COMMERCIAL NAppleCare Medical Management APP01 COMMERCIAL NArcadian Management Services Inc 77045 COMMERCIAL NArcadian Management Services Inc 77045 COMMERCIAL NArizona Foundation for Medical Care (AFMC) 86062 COMMERCIAL NArizona Foundation for Medical Care (AFMC) 86062 COMMERCIAL NArizona Physicians IPA 3432 COMMERCIAL NArizona Physicians IPA 3432 COMMERCIAL NArkansas Best Corporation - Choice Benefits 75278 COMMERCIAL NArkansas Best Corporation - Choice Benefits 75278 COMMERCIAL NArkansas Municipal League 71603 COMMERCIAL NArkansas Municipal League 71603 COMMERCIAL N

Arnett Health Plans 95440 COMMERCIAL N

Payer requires unique Provider ID

for billing rendering or referring

provider fields. Contact Arnett

Health Plan's EDI Coordinator at 1-

888-448-7440 for additional

information prior to first claims

submission.


Page 13


January 2011


Arnett Health Plans 95440 COMMERCIAL N

Payer requires unique Provider ID

for billing rendering or referring

provider fields. Contact Arnett

Health Plan's EDI Coordinator at 1-

888-448-7440 for additional

information prior to first claims

submission.Associates for Health Care Inc. (AHC) 36326 COMMERCIAL NAssociates for Health Care Inc. (AHC) 36326 COMMERCIAL N

Association Benefit Plan 25133 COMMERCIAL N

Formerly payer ID 62413 Now


payer ID. Including Combined

Government Health Plan &

Contract Health Insurance Plan.

Association Benefit Plan 25133 COMMERCIAL N



payer ID. Including Combined

Government Health Plan &

Contract Health Insurance Plan.Assurant Health 39065 COMMERCIAL NAssurant Health 39065 COMMERCIAL N

Assurant Health Self-Funded (Ft. Mill SC) 37313 COMMERCIAL N

MUST VERIFY ALL CLAIMS

SHOULD GO TO PAYER IN FT. MILL

SC

Assurant Health Self-Funded (Ft. Mill SC) 37313 COMMERCIAL N



SCAssurant MiniMed-Key Family 37323 COMMERCIAL NAssurant MiniMed-Key Family 37323 COMMERCIAL NAssureCare Inc. 88035 COMMERCIAL NAssureCare Inc. 88035 COMMERCIAL NAssured Benefits Administrators 74240 COMMERCIAL NAssured Benefits Administrators 74240 COMMERCIAL N

Asuris Northwest/MedAdvantage SX179 COMMERCIAL N

Payer must receive

REF*1B*Provider ID in Billing and

Rendering even when NPI is

submitted.

Asuris Northwest/MedAdvantage SX179 COMMERCIAL N

Payer must receive

REF*1B*Provider ID in Billing and

Rendering even when NPI is

submitted.Athens Area Health Plan Select 95691 COMMERCIAL NAthens Area Health Plan Select 95691 COMMERCIAL NAtlantic Medical Insurance 22285 COMMERCIAL NAtlantic Medical Insurance 22285 COMMERCIAL NAtlanticare [also known as Horizon HealthCare Admin (HHA)]22304 COMMERCIAL NAtlanticare [also known as Horizon HealthCare Admin (HHA)]22304 COMMERCIAL NAtlantis Health Plan 13853 COMMERCIAL N


Page 14


January 2011

Payer ID State Model Enroll Additional InformationAtlantis Health Plan 13853 COMMERCIAL N

Atlas Administrators TH004 COMMERCIAL N

Currently only accepts UCO

Providers. The group number

must be 8 characters in length.

Only one of the characters can be

a dash. If the group number is

entered then the group name

must also be entered.

Atlas Administrators TH004 COMMERCIAL N

Currently only accepts UCO

Providers. The group number

must be 8 characters in length.

Only one of the characters can be

a dash. If the group number is

entered then the group name

must also be entered.

AultComp Managed Care Organization (Ohio BWC) 31147 COMMERCIAL N


ONLY.

AultComp Managed Care Organization (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Aultra Administrative Group 37242 COMMERCIAL N



P.O. Box 35276 Canton OH 44735-

5276

Aultra Administrative Group 37242 COMMERCIAL N



P.O. Box 35276 Canton OH 44735-

5276Automated Benefit Services 38259 COMMERCIAL NAutomated Benefit Services 38259 COMMERCIAL N

Automated Group Administration Inc. 37280 COMMERCIAL N

Please send these EDI claims to

the Payer ID of the PPO shown on

the Member's ID Card. If you

have any questions please call

260-489-6447 (703).

Automated Group Administration Inc. 37280 COMMERCIAL N

Please send these EDI claims to

the Payer ID of the PPO shown on

the Member's ID Card. If you

have any questions please call

260-489-6447 (703).

AvMed Inc. 59274 COMMERCIAL N

The Insured ID and Patient ID fro

this payer must be the 11-digit

Member ID.

AvMed Inc. 59274 COMMERCIAL N

The Insured ID and Patient ID fro

this payer must be the 11-digit

Member ID.

AvatarComp (Ohio BWC) 31147 COMMERCIAL N


ONLY.

AvatarComp (Ohio BWC) 31147 COMMERCIAL N


ONLY.


Page 15


January 2011

Payer ID State Model Enroll Additional InformationAvera Health Plans 46045 COMMERCIAL NAvera Health Plans 46045 COMMERCIAL NAveraAdvantage 48055 COMMERCIAL NAveraAdvantage 48055 COMMERCIAL NAverde Health 26355 COMMERCIAL NAverde Health 26355 COMMERCIAL N

Avesis Third Party Administrators 87098 COMMERCIAL N

These payer is live for VISION

CLAIMS ONLY.

Avesis Third Party Administrators 87098 COMMERCIAL N

These payer is live for VISION

CLAIMS ONLY.BCI Administrators Inc. 49153 COMMERCIAL NBCI Administrators Inc. 49153 COMMERCIAL N

BEACON HEALTH STRATEGIES 43324 COMMERCIAL N

Beacon requires submission of

the member's Plan ID. Please

follow the link to our payer fact

sheet for ID's and further

instructions.

BEACON HEALTH STRATEGIES 43324 COMMERCIAL N

Beacon requires submission of

the member's Plan ID. Please

follow the link to our payer fact

sheet for ID's and further

instructions.

BENEFIT MANAGEMENT SERVICES Call COMMERCIAL N

Please contact Chris Burak at

(704) 321-3156 for payer id

information.

BENEFIT MANAGEMENT SERVICES Call COMMERCIAL N

Please contact Chris Burak at

(704) 321-3156 for payer id

information.BHSG of Tennessee SX002 COMMERCIAL NBHSG of Tennessee SX002 COMMERCIAL N

BMC HealthNet Plan 13337 COMMERCIAL N

Submissions to BMCHP must

include the correct 12 digit

BMCHP Provider ID # including all

leading zeros.

BMC HealthNet Plan 13337 COMMERCIAL N




leading zeros.BMGI - Benefit Management Group Inc. 20018 COMMERCIAL NBMGI - Benefit Management Group Inc. 20018 COMMERCIAL NBPA/Benefit Plan Administrators (North Dakota) 37286 COMMERCIAL NBPA/Benefit Plan Administrators (North Dakota) 37286 COMMERCIAL NBPS Inc. 13310 COMMERCIAL NBPS Inc. 13310 COMMERCIAL N

BSI Call COMMERCIAL N


(440) 262-1160.

BSI Call COMMERCIAL N


(440) 262-1160.Bakersfield Family Medical Center BKRFM COMMERCIAL N


Page 16


January 2011

Payer ID State Model Enroll Additional InformationBakersfield Family Medical Center BKRFM COMMERCIAL NBanner Health AZ SX145 COMMERCIAL NBanner Health AZ SX145 COMMERCIAL NBanner Health Co - ROCKY MOUNTAIN HMO GREELEYSX145 COMMERCIAL NBanner Health Co - ROCKY MOUNTAIN HMO GREELEYSX145 COMMERCIAL NBanner Health Co. - ANTERO GREELEY SX145 COMMERCIAL NBanner Health Co. - ANTERO GREELEY SX145 COMMERCIAL NBanner Health Co. - ANTERO HIGH PLAINS SX145 COMMERCIAL NBanner Health Co. - ANTERO HIGH PLAINS SX145 COMMERCIAL NBanner Health Co. - ANTERO MOUNTAIN SHADOWS SX145 COMMERCIAL NBanner Health Co. - ANTERO MOUNTAIN SHADOWS SX145 COMMERCIAL NBanner Health Co. - CHOICE PLUS SX145 COMMERCIAL NBanner Health Co. - CHOICE PLUS SX145 COMMERCIAL NBanner Health Co. - HMO GREELEY SX145 COMMERCIAL NBanner Health Co. - HMO GREELEY SX145 COMMERCIAL NBanner Health Co. - HMO HIGH PLAINS SX145 COMMERCIAL NBanner Health Co. - HMO HIGH PLAINS SX145 COMMERCIAL NBanner Health Co. - HMO MOUNTAIN SHADOWS SX145 COMMERCIAL NBanner Health Co. - HMO MOUNTAIN SHADOWS SX145 COMMERCIAL NBanner Health Co. - PACIFICARE GREELEY SX145 COMMERCIAL NBanner Health Co. - PACIFICARE GREELEY SX145 COMMERCIAL NBanner Health Co. - PACIFICARE HIGH PLAINS SX145 COMMERCIAL NBanner Health Co. - PACIFICARE HIGH PLAINS SX145 COMMERCIAL NBanner Health Co. - PACIFICARE MOUNTAIN SHADOWSSX145 COMMERCIAL NBanner Health Co. - PACIFICARE MOUNTAIN SHADOWSSX145 COMMERCIAL NBanner Health Co. - ROCKY MOUNTAIN HMO HIGH PLAINSSX145 COMMERCIAL NBanner Health Co. - ROCKY MOUNTAIN HMO HIGH PLAINSSX145 COMMERCIAL NBanner Health Co. - SECURE HORIZONS GREELEY SX145 COMMERCIAL NBanner Health Co. - SECURE HORIZONS GREELEY SX145 COMMERCIAL NBanner Health Co. - SECURE HORIZONS HIGH PLAINS SX145 COMMERCIAL NBanner Health Co. - SECURE HORIZONS HIGH PLAINS SX145 COMMERCIAL NBanner Health Co. - SECURE HORIZONS MOUNTAIN SHADOWSSX145 COMMERCIAL NBanner Health Co. - SECURE HORIZONS MOUNTAIN SHADOWSSX145 COMMERCIAL NBanner Medisun 77078 COMMERCIAL NBanner Medisun 77078 COMMERCIAL NBascom Palmer Eye Care Network - New Century HealthNCH06 COMMERCIAL NBascom Palmer Eye Care Network - New Century HealthNCH06 COMMERCIAL NBass Administrators Inc. 37248 COMMERCIAL NBass Administrators Inc. 37248 COMMERCIAL NBeech Street 95377 COMMERCIAL NBeech Street 95377 COMMERCIAL NBehavioral Health Systems 63100 COMMERCIAL NBehavioral Health Systems 63100 COMMERCIAL NBellflower Hospital (Synermed) SYMED COMMERCIAL NBellflower Hospital (Synermed) SYMED COMMERCIAL NBencomp National Corporation 33192 COMMERCIAL NBencomp National Corporation 33192 COMMERCIAL NBenefit Admin Services 88055 COMMERCIAL NBenefit Admin Services 88055 COMMERCIAL NBenefit Administrative Systems 36149 COMMERCIAL NBenefit Administrative Systems 36149 COMMERCIAL N


Page 17


January 2011


Benefit Coordinators Corporation (Pittsburgh PA) 25145 COMMERCIAL N



111 Ryan Court Suite 300

Pittsburgh PA 15205.

Benefit Coordinators Corporation (Pittsburgh PA) 25145 COMMERCIAL N



111 Ryan Court Suite 300

Pittsburgh PA 15205.Benefit Management Services Inc. 999 COMMERCIAL NBenefit Management Services Inc. 999 COMMERCIAL NBenefit Management Systems Inc 37212 COMMERCIAL NBenefit Management Systems Inc 37212 COMMERCIAL N

Benefit Management Inc. of KS 48611 COMMERCIAL N

This payer will only accept

medical and hospital claims for

these groups listed:

BMI187BMI219BMI234BMI236B

MI214.BMI241BMI617

BMI245.BMI246

Benefit Management Inc. of KS 48611 COMMERCIAL N

This payer will only accept

medical and hospital claims for

these groups listed:

BMI187BMI219BMI234BMI236B

MI214.BMI241BMI617

BMI245.BMI246Benefit Plan Administrators 88052 COMMERCIAL NBenefit Plan Administrators 88052 COMMERCIAL N

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



P.O. Box 1128 Eau Claire WI

54702-1128.

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



P.O. Box 1128 Eau Claire WI

54702-1128.

Benefit Plan Administrators Inc. (Roanoke VA) 37118 COMMERCIAL N

Please call Mary Bender at (540)

345-2721 to verify if you should

be sending to the Benefit Plan

Administrators Inc. in Roanoke

VA.

Benefit Plan Administrators Inc. (Roanoke VA) 37118 COMMERCIAL N

Please call Mary Bender at (540)

345-2721 to verify if you should

be sending to the Benefit Plan

Administrators Inc. in Roanoke

VA.Benefit Planners Inc. 74223 COMMERCIAL NBenefit Planners Inc. 74223 COMMERCIAL N


Page 18


January 2011

Payer ID State Model Enroll Additional InformationBenefit Systems & Services Inc. (BSSI) 36342 COMMERCIAL NBenefit Systems & Services Inc. (BSSI) 36342 COMMERCIAL NBenesight 87265 COMMERCIAL N (Formerly known as The TPA)Benesight 87265 COMMERCIAL N (Formerly known as The TPA)Benesys 37248 COMMERCIAL NBenesys 37248 COMMERCIAL NBenesys Inc. 37248 COMMERCIAL NBenesys Inc. 37248 COMMERCIAL N

Berkshire Health Partners - PPO Wyomissing PA (IHS Gateway Payer)Call COMMERCIAL N

Before submitting please contact

Lori Calpino at (610) 372-8044

ext. 3019

Berkshire Health Partners - PPO Wyomissing PA (IHS Gateway Payer)Call COMMERCIAL N


Lori Calpino at (610) 372-8044

ext. 3019Berkshire Lehigh Partners Call COMMERCIAL NBerkshire Lehigh Partners Call COMMERCIAL NBest Life & Health Insurance Co. 95604 COMMERCIAL NBest Life & Health Insurance Co. 95604 COMMERCIAL NBetter Health Plans of South Carolina 32006 COMMERCIAL NBetter Health Plans of South Carolina 32006 COMMERCIAL N

Better Health Plans Inc. 62183 COMMERCIAL N

Now known as Unison Health

Plan

Better Health Plans Inc. 62183 COMMERCIAL N


PlanBlue Benefit Administrators of MA 3036 COMMERCIAL NBlue Benefit Administrators of MA 3036 COMMERCIAL N

Blue Grass Family Health/SRRIPA ONLY 15754 COMMERCIAL N


Stones River Regional IPA - Blue

Grass Family Health claims

Blue Grass Family Health/SRRIPA ONLY 15754 COMMERCIAL N


Stones River Regional IPA - Blue

Grass Family Health claimsBluegrass Family Health 61124 COMMERCIAL NBluegrass Family Health 61124 COMMERCIAL NBoilermakers National Health & Welfare Fund 36609 COMMERCIAL NBoilermakers National Health & Welfare Fund 36609 COMMERCIAL NBoon-Chapman Benefit Administrators Inc. 74238 COMMERCIAL NBoon-Chapman Benefit Administrators Inc. 74238 COMMERCIAL N

Boston Medical Center Health Plan Inc. 13337 COMMERCIAL N




leading zeros.

Boston Medical Center Health Plan Inc. 13337 COMMERCIAL N




leading zeros.Boulder Administration Services 20381 COMMERCIAL NBoulder Administration Services 20381 COMMERCIAL N


Page 19


January 2011


Bravo Health 52192 COMMERCIAL N

Formerly known as Elder Health

Inc. serving members in

Pennsylvania Maryland Delaware

Texas and Washington DC. Not to

be confused with ElderPlan in NY.



















Bridgestone/Firestone See Comments COMMERCIAL N

?call CSU for the payor ID.? The

CSU telephone number is 330 379

4500.

Bridgestone/Firestone See Comments COMMERCIAL N

?call CSU for the payor ID.? The

CSU telephone number is 330 379

4500.

Bridgeway Arizona 68054 COMMERCIAL N


call Provider Relations Dept. at 1-


provider info is on file in the

Health Plans claim system. This

will prevent rejections and allow

payments to be made in a timely

manner.

Bridgeway Arizona 68054 COMMERCIAL N


call Provider Relations Dept. at 1-


provider info is on file in the

Health Plans claim system. This

will prevent rejections and allow

payments to be made in a timely

manner.BritCay 22286 COMMERCIAL NBritCay 22286 COMMERCIAL NBrockerage Concepts Inc. 51037 COMMERCIAL NBrockerage Concepts Inc. 51037 COMMERCIAL N


Page 20


January 2011

Payer ID State Model Enroll Additional InformationBrodart 35182 COMMERCIAL NBrodart 35182 COMMERCIAL N

Brokerage Service Inc Call COMMERCIAL N


(440) 262-1160.

Brokerage Service Inc Call COMMERCIAL N


(440) 262-1160.Broward Health 37314 COMMERCIAL NBroward Health 37314 COMMERCIAL NBrown & Toland Medical Group 94316 COMMERCIAL NBrown & Toland Medical Group 94316 COMMERCIAL NBrown and Toland Medical Group BTSS1 COMMERCIAL NBrown and Toland Medical Group BTSS1 COMMERCIAL N

Buckeye Community Health 32004 COMMERCIAL N








Buckeye Community Health 32004 COMMERCIAL N







be made in a timely manner.Butler Benefit 42150 COMMERCIAL NButler Benefit 42150 COMMERCIAL NC&O Employees Hospital Association 23708 COMMERCIAL NC&O Employees Hospital Association 23708 COMMERCIAL NC. L. Frates & Co - OSMA Health 73071 COMMERCIAL NC. L. Frates & Co - OSMA Health 73071 COMMERCIAL NCAP Management Systems 95399 COMMERCIAL NCAP Management Systems 95399 COMMERCIAL NCAPSTONE HEALTH PLAN INC 86044 COMMERCIAL NCAPSTONE HEALTH PLAN INC 86044 COMMERCIAL N

CBA Blue 3036 COMMERCIAL N

Formerly known as

Comprehensive Benefits

Administrator Inc.

CBA Blue 3036 COMMERCIAL N

Formerly known as

Comprehensive Benefits

Administrator Inc.CBCA Administrators 55438 COMMERCIAL NCBCA Administrators 55438 COMMERCIAL NCDO Technologies 87065 COMMERCIAL NCDO Technologies 87065 COMMERCIAL NCDPHP SX065 COMMERCIAL N Par for BillingCDPHP SX065 COMMERCIAL N Par for BillingCDS Group Health 88022 COMMERCIAL NCDS Group Health 88022 COMMERCIAL N


Page 21


January 2011

Payer ID State Model Enroll Additional InformationCHA Health 23171 COMMERCIAL NCHA Health 23171 COMMERCIAL N

CHAMPVA - HAC 84146 COMMERCIAL N

CHAMPVA - HAC is not associated

with and does not process claims

for TRICARE (formerly CHAMPUS).

CHAMPVA - HAC 84146 COMMERCIAL N

CHAMPVA - HAC is not associated

with and does not process claims

for TRICARE (formerly CHAMPUS).CHCcares of South Carolina 25151 COMMERCIAL NCHCcares of South Carolina 25151 COMMERCIAL NCHOC - Children's Hospital Of Orange County Health Alliance33065 COMMERCIAL NCHOC - Children's Hospital Of Orange County Health Alliance33065 COMMERCIAL NCHP DIRECT SUPERMED 90441 COMMERCIAL NCHP DIRECT SUPERMED 90441 COMMERCIAL N

CHP/RPU (FABOH) Call COMMERCIAL N

Payer ID rendering provider and

location number required to

submit claims. Please call Dave

Sell at (608) 210-6656 to obtain.

CHP/RPU (FABOH) Call COMMERCIAL N




Sell at (608) 210-6656 to obtain.CIGNA 62308 COMMERCIAL NCIGNA 62308 COMMERCIAL NCIGNA - PPA 62308 COMMERCIAL NCIGNA - PPA 62308 COMMERCIAL NCIGNA - PPO 62308 COMMERCIAL NCIGNA - PPO 62308 COMMERCIAL NCIGNA Behavioral Health SX071 COMMERCIAL NCIGNA Behavioral Health SX071 COMMERCIAL NCIGNA Health Plan - HMO 62308 COMMERCIAL NCIGNA Health Plan - HMO 62308 COMMERCIAL NCIGNA Medicare Advantage 86033 COMMERCIAL NCIGNA Medicare Advantage 86033 COMMERCIAL NCM Administrators Inc 56211 COMMERCIAL NCM Administrators Inc 56211 COMMERCIAL N

COOPERATIVE MANAGED CARE SERVICES 35199 COMMERCIAL N

To obtain the payer ID for this

payer please contact CMCS

Customer Service at (800) 352-

7502

COOPERATIVE MANAGED CARE SERVICES 35199 COMMERCIAL N




7502

CRA Managed Care (Ohio BWC) 31147 COMMERCIAL N


ONLY.


Page 22


January 2011


CRA Managed Care (Ohio BWC) 31147 COMMERCIAL N


ONLY.CWIBENEFITS INC. 57080 COMMERCIAL NCWIBENEFITS INC. 57080 COMMERCIAL NCadent Administrators 33192 COMMERCIAL NCadent Administrators 33192 COMMERCIAL NCadent Underwriters 33192 COMMERCIAL NCadent Underwriters 33192 COMMERCIAL NCal-Optima Direct CALOP COMMERCIAL NCal-Optima Direct CALOP COMMERCIAL NCalifornia Eye Care - New Century Health NCH05 COMMERCIAL NCalifornia Eye Care - New Century Health NCH05 COMMERCIAL NCannon Cochran Management Services Inc. Metairie LA71057 COMMERCIAL NCannon Cochran Management Services Inc. Metairie LA71057 COMMERCIAL NCapital Community Health Plan 87726 COMMERCIAL NCapital Community Health Plan 87726 COMMERCIAL NCapital District Physician's Health Plan SX065 COMMERCIAL N Par for BillingCapital District Physician's Health Plan SX065 COMMERCIAL N Par for Billing

Capital Health Plan 95112 COMMERCIAL N

Payer will accept either rendering

provider UPIN or NPI on claims.

Before submitting NPI please call

Capital Health Plan at 850-523-

7361 to register your NPI

numbers with them.

Capital Health Plan 95112 COMMERCIAL N

Payer will accept either rendering

provider UPIN or NPI on claims.

Before submitting NPI please call

Capital Health Plan at 850-523-

7361 to register your NPI

numbers with them.Capitol Administrators 68011 COMMERCIAL NCapitol Administrators 68011 COMMERCIAL NCare 1st Health Plan of Arizona 57116 COMMERCIAL NCare 1st Health Plan of Arizona 57116 COMMERCIAL NCare Improvement Plus 77082 COMMERCIAL NCare Improvement Plus 77082 COMMERCIAL NCare To Care 41222 COMMERCIAL NCare To Care 41222 COMMERCIAL NCare Wisconsin Health Plan (Trizetto) 27004 COMMERCIAL NCare Wisconsin Health Plan (Trizetto) 27004 COMMERCIAL N

CareCentrix 11345 COMMERCIAL P

Enrollment required prior to

claim submission. Please contact

Rebecca Sweetman by email

Rebecca.Sweetman@CareCentrix.

com


Page 23


January 2011


CareCentrix 11345 COMMERCIAL P

Enrollment required prior to

claim submission. Please contact

Rebecca Sweetman by email

Rebecca.Sweetman@CareCentrix.

comCareCore National 14182 COMMERCIAL NCareCore National 14182 COMMERCIAL NCareCore National - Healthnet 14184 COMMERCIAL NCareCore National - Healthnet 14184 COMMERCIAL NCareCore National LLC (Aetna Radiology Claims) 14179 COMMERCIAL NCareCore National LLC (Aetna Radiology Claims) 14179 COMMERCIAL NCareCore National LLC (Oxford Radiology Claims) 14180 COMMERCIAL NCareCore National LLC (Oxford Radiology Claims) 14180 COMMERCIAL NCareCore National LLC - Health Net New Jersey 14185 COMMERCIAL NCareCore National LLC - Health Net New Jersey 14185 COMMERCIAL N

CareCore National LLC - WellCare New York POS 11 Rad Claims14188 COMMERCIAL N

WellCare New York POS 11

Radiology Claims Only. Claims for

members in the following

counties should be submitted to

WellCare: Monroe Erie Wayne

and Onondaga.

CareCore National LLC - WellCare New York POS 11 Rad Claims14188 COMMERCIAL N

WellCare New York POS 11

Radiology Claims Only. Claims for

members in the following

counties should be submitted to

WellCare: Monroe Erie Wayne

and Onondaga.CareCore National LLC - WellCare New York POS 11 Rad Claims74289 COMMERCIAL NCareCore National LLC - WellCare New York POS 11 Rad Claims74289 COMMERCIAL NCareFirst Administrators/NCAS 75191 COMMERCIAL NCareFirst Administrators/NCAS 75191 COMMERCIAL NCareOregon Inc. 93975 COMMERCIAL NCareOregon Inc. 93975 COMMERCIAL NCarePlus Cardiology - New Century Health NCH04 COMMERCIAL NCarePlus Cardiology - New Century Health NCH04 COMMERCIAL NCarePlus Dermatology - New Century Health NCH01 COMMERCIAL NCarePlus Dermatology - New Century Health NCH01 COMMERCIAL N

CarePlus Health Plans Inc. 65031 COMMERCIAL N

(Formerly Physicians Healthcare

Plans Inc)

CarePlus Health Plans Inc. 65031 COMMERCIAL N

(Formerly Physicians Healthcare

Plans Inc)CarePlus Oncology - New Century Infusion Solutions NCH07 COMMERCIAL NCarePlus Oncology - New Century Infusion Solutions NCH07 COMMERCIAL NCarePlus Urology - New Century Health NCH03 COMMERCIAL NCarePlus Urology - New Century Health NCH03 COMMERCIAL NCareSource OH 31114 COMMERCIAL NCareSource OH 31114 COMMERCIAL N

CareWorks (Ohio BWC) 31147 COMMERCIAL N


ONLY.


Page 24


January 2011


CareWorks (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Carelink Health Plan 25133 COMMERCIAL N



payer ID. Carelink Commercial &

Advantra claims only. For

Carelink Medicaid send claims to

payer ID 25140

Carelink Health Plan 25133 COMMERCIAL N



payer ID. Carelink Commercial &

Advantra claims only. For

Carelink Medicaid send claims to

payer ID 25140

Carelink Medicaid 25133 COMMERCIAL N

Formerly Payer ID 25140. Now


payer ID.




payer ID.


The go forward payer ID for this

plan is 25133. Please see new

entry under that ID on the payer

list.





list.





list.





list.Caremore CM001 COMMERCIAL NCaremore CM001 COMMERCIAL N

Carenet 25133 COMMERCIAL N



payer ID.




payer ID.





list.


Page 25


January 2011






list.





list.





list.

Careworks 10010 COMMERCIAL N

Payer is receiving NSF 3.0. eMCDS

file is sent to OKC and then

translated to NSF3.0. Files are

then pushed to Careworks'

Production Server.

Careworks 10010 COMMERCIAL N

Payer is receiving NSF 3.0. eMCDS

file is sent to OKC and then

translated to NSF3.0. Files are

then pushed to Careworks'

Production Server.Carilion Clinic Medicare Health Plan 77015 COMMERCIAL NCarilion Clinic Medicare Health Plan 77015 COMMERCIAL N

Carolina Care Plan 29076 COMMERCIAL N

Carolina Care Plan is part of the



57105.

Carolina Care Plan 29076 COMMERCIAL N

Carolina Care Plan is part of the



57105.

Carolina Crescent Health Plan Inc. SX191 COMMERCIAL N

Enrollment forms are available on

our website

Carolina Crescent Health Plan Inc. SX191 COMMERCIAL N

Enrollment forms are available on

our websiteCarolina Summit Healthcare Inc. 56195 COMMERCIAL NCarolina Summit Healthcare Inc. 56195 COMMERCIAL NCarpenter's Health and Welfare Trust Fund of St. Louis25125 COMMERCIAL N Utilizes the CMR Network.Carpenter's Health and Welfare Trust Fund of St. Louis25125 COMMERCIAL N Utilizes the CMR Network.Cedars-Sinai Medical Network Services 95166 COMMERCIAL NCedars-Sinai Medical Network Services 95166 COMMERCIAL NCeltiCare 68060 COMMERCIAL NCeltiCare 68060 COMMERCIAL N

Cement Masons & Plasterers Health & Welfare Trust 91136 COMMERCIAL N



Cement Masons & Plasterers Health & Welfare Trust 91136 COMMERCIAL N




Page 26


January 2011


Cenpatico - Arizona 68048 COMMERCIAL N








Cenpatico - Arizona 68048 COMMERCIAL N







be made in a timely manner.Cenpatico - FL 68058 COMMERCIAL NCenpatico - FL 68058 COMMERCIAL N

Cenpatico - Georgia 68050 COMMERCIAL N








Cenpatico - Georgia 68050 COMMERCIAL N








Cenpatico - Indiana 68052 COMMERCIAL N








Cenpatico - Indiana 68052 COMMERCIAL N









Page 27


January 2011


Cenpatico - Kansas 68047 COMMERCIAL P








Cenpatico - Kansas 68047 COMMERCIAL P







be made in a timely manner.Cenpatico - OHIO 68051 COMMERCIAL NCenpatico - OHIO 68051 COMMERCIAL NCenpatico Massachuetts 68061 COMMERCIAL NCenpatico Massachuetts 68061 COMMERCIAL NCenpatico South Carolina 68059 COMMERCIAL NCenpatico South Carolina 68059 COMMERCIAL NCentene Advantage Plans 68056 COMMERCIAL NCentene Advantage Plans 68056 COMMERCIAL NCentral Benefits Life 31118 COMMERCIAL NCentral Benefits Life 31118 COMMERCIAL NCentral Benefits Mutual 31118 COMMERCIAL NCentral Benefits Mutual 31118 COMMERCIAL NCentral Benefits National 31118 COMMERCIAL NCentral Benefits National 31118 COMMERCIAL NCentral Reserve Life 34097 COMMERCIAL N Non Medicare SupplementCentral Reserve Life 34097 COMMERCIAL N Non Medicare SupplementCentral SeniorCare 62218 COMMERCIAL NCentral SeniorCare 62218 COMMERCIAL NCentral States Health & Welfare Funds 36215 COMMERCIAL NCentral States Health & Welfare Funds 36215 COMMERCIAL NCentral Valley Medical Group 77035 COMMERCIAL NCentral Valley Medical Group 77035 COMMERCIAL N

Central Valley Medical Group E3510 COMMERCIAL P








claims.


Page 28


January 2011


Central Valley Medical Group E3510 COMMERCIAL P








claims.

Centre for Health Care Call COMMERCIAL N

To obtain Payer ID and enroll with

payer California providers should

contact Tristin Rausche 858-824-

7100 [email protected]

Centre for Health Care Call COMMERCIAL N




7100 [email protected] Health Solutions 48120 COMMERCIAL NCentury Health Solutions 48120 COMMERCIAL NChautauqua County Healthcare Plan (Mayville NY) 16600 COMMERCIAL NChautauqua County Healthcare Plan (Mayville NY) 16600 COMMERCIAL N

Chesapeake Life Insurance Company - Insurance Center59223 COMMERCIAL N

Payer ID valid only if the address

on the Health ID Card matches

the following: P.O. Box 982017

North Richland Hills TX 76182.

Chesapeake Life Insurance Company - Insurance Center59223 COMMERCIAL N




North Richland Hills TX 76182.Chesterfield Resources Inc. 34154 COMMERCIAL NChesterfield Resources Inc. 34154 COMMERCIAL NChild Health and Disability Prevention Treatment AMM03 COMMERCIAL NChild Health and Disability Prevention Treatment AMM03 COMMERCIAL N

Children First Medical Group 94321 COMMERCIAL N

For questions regarding claim

status providers will need to

contact payer: CFMG Provider

Customer Service 510-428-3154.

Children First Medical Group 94321 COMMERCIAL N

For questions regarding claim

status providers will need to

contact payer: CFMG Provider

Customer Service 510-428-3154.Children of Women Vietnam Veterans-VA HAC 84146 COMMERCIAL NChildren of Women Vietnam Veterans-VA HAC 84146 COMMERCIAL NChildren's Medical Services - Broward NORTH 37314 COMMERCIAL NChildren's Medical Services - Broward NORTH 37314 COMMERCIAL N


Page 29


January 2011

Payer ID State Model Enroll Additional InformationChildrens Physician Medical Group CPMG1 COMMERCIAL NChildrens Physician Medical Group CPMG1 COMMERCIAL NChildrens Specialist of San Diego CSSD2 COMMERCIAL NChildrens Specialist of San Diego CSSD2 COMMERCIAL NChinese Community Health Plan 94302 COMMERCIAL NChinese Community Health Plan 94302 COMMERCIAL NChoice One/UTMB CHIP Health Plan 76049 COMMERCIAL NChoice One/UTMB CHIP Health Plan 76049 COMMERCIAL NChristian Brothers Services 61271 COMMERCIAL NChristian Brothers Services 61271 COMMERCIAL NCincinnati Financial Corporation 46871 COMMERCIAL NCincinnati Financial Corporation 46871 COMMERCIAL NCitrus Health TH130 COMMERCIAL NCitrus Health TH130 COMMERCIAL NCitrus Valley Physicians Medical Group CVPG1 COMMERCIAL NCitrus Valley Physicians Medical Group CVPG1 COMMERCIAL NCity of Amarillo TH107 COMMERCIAL NCity of Amarillo TH107 COMMERCIAL NCity of Visalia TKFMC COMMERCIAL NCity of Visalia TKFMC COMMERCIAL NClaims Management Services 39141 COMMERCIAL NClaims Management Services 39141 COMMERCIAL NClaimsWare Inc. dba ManageMed 57080 COMMERCIAL NClaimsWare Inc. dba ManageMed 57080 COMMERCIAL NClaimshop- Employers Coalition on Health 27008 COMMERCIAL NClaimshop- Employers Coalition on Health 27008 COMMERCIAL NClarendon's Healthy Kids 33192 COMMERCIAL NClarendon's Healthy Kids 33192 COMMERCIAL NClarian Health Plans Inc. 95444 COMMERCIAL NClarian Health Plans Inc. 95444 COMMERCIAL NClearchoice Health Plan / COIHS 77201 COMMERCIAL NClearchoice Health Plan / COIHS 77201 COMMERCIAL NClubMD 37272 COMMERCIAL NClubMD 37272 COMMERCIAL NCoastal Administrative Services 77052 COMMERCIAL NCoastal Administrative Services 77052 COMMERCIAL NCofinity 38335 COMMERCIAL NCofinity 38335 COMMERCIAL NColonial Healthcare 37123 COMMERCIAL NColonial Healthcare 37123 COMMERCIAL NColonial Medical 22284 COMMERCIAL NColonial Medical 22284 COMMERCIAL NColorado Access 84129 COMMERCIAL NColorado Access 84129 COMMERCIAL NColumbia United Providers 91162 COMMERCIAL NColumbia United Providers 91162 COMMERCIAL NCommerce Benefits Group 34181 COMMERCIAL NCommerce Benefits Group 34181 COMMERCIAL NCommonwealth Care Alliance 14315 COMMERCIAL NCommonwealth Care Alliance 14315 COMMERCIAL NCommunity Care BHO 23282 COMMERCIAL NCommunity Care BHO 23282 COMMERCIAL N


Page 30


January 2011

Payer ID State Model Enroll Additional InformationCommunity Care Managed Health Care Plans of Oklahoma73143 COMMERCIAL NCommunity Care Managed Health Care Plans of Oklahoma73143 COMMERCIAL NCommunity Care Organization 39126 COMMERCIAL NCommunity Care Organization 39126 COMMERCIAL NCommunity Choice of Michigan 38325 COMMERCIAL NCommunity Choice of Michigan 38325 COMMERCIAL NCommunity Claims Administration 26231 COMMERCIAL NCommunity Claims Administration 26231 COMMERCIAL NCommunity Family Care (SynerMed) SYMED COMMERCIAL NCommunity Family Care (SynerMed) SYMED COMMERCIAL NCommunity First TH005 COMMERCIAL NCommunity First TH005 COMMERCIAL NCommunity Health Alliance 35193 COMMERCIAL NCommunity Health Alliance 35193 COMMERCIAL NCommunity Health Choice 48145 COMMERCIAL NCommunity Health Choice 48145 COMMERCIAL NCommunity Health Electronic Claims/CHEC/webTPA 75261 COMMERCIAL NCommunity Health Electronic Claims/CHEC/webTPA 75261 COMMERCIAL NCommunity Health Network of CT 62149 COMMERCIAL NCommunity Health Network of CT 62149 COMMERCIAL N

Community Health Plan 90010 COMMERCIAL N

Located in St. Joseph MO. Service

area includes NW Missouri NE

Kansas SW Iowa and SE Nebraska.

Community Health Plan 90010 COMMERCIAL N

Located in St. Joseph MO. Service

area includes NW Missouri NE

Kansas SW Iowa and SE Nebraska.Community Health Plan Washington SB613 COMMERCIAL NCommunity Health Plan Washington SB613 COMMERCIAL NCommunity Medical Group of the West Valley Inc. 66121 COMMERCIAL NCommunity Medical Group of the West Valley Inc. 66121 COMMERCIAL NComp - Ohio (Austintown OH) 34177 COMMERCIAL NComp - Ohio (Austintown OH) 34177 COMMERCIAL N

Comp One (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Comp One (Ohio BWC) 31147 COMMERCIAL N


ONLY.CompBenefits Corporation 37297 COMMERCIAL NCompBenefits Corporation 37297 COMMERCIAL N

CompManagement Health Systems Inc. (Ohio BWC) 31147 COMMERCIAL N


ONLY.

CompManagement Health Systems Inc. (Ohio BWC) 31147 COMMERCIAL N


ONLY.

CompManagement/Integrated Comp (Ohio BWC) 31147 COMMERCIAL N


ONLY.

CompManagement/Integrated Comp (Ohio BWC) 31147 COMMERCIAL N


ONLY.Complimentary Health Plan Call COMMERCIAL NComplimentary Health Plan Call COMMERCIAL NComprehensive Behavioral Care 59314 COMMERCIAL NComprehensive Behavioral Care 59314 COMMERCIAL N


Page 31


January 2011


Comprehensive Medical Care (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Comprehensive Medical Care (Ohio BWC) 31147 COMMERCIAL N


ONLY.ConnectiCare Inc 6105 COMMERCIAL NConnectiCare Inc 6105 COMMERCIAL NConnecticare - Medicare 78375 COMMERCIAL NConnecticare - Medicare 78375 COMMERCIAL NConnecticut Carpenters Health Fund 37307 COMMERCIAL NConnecticut Carpenters Health Fund 37307 COMMERCIAL NConnecticut General (CIGNA) 62308 COMMERCIAL NConnecticut General (CIGNA) 62308 COMMERCIAL NConsociate Group 37135 COMMERCIAL NConsociate Group 37135 COMMERCIAL NConsolidated Associates Railroad 75284 COMMERCIAL NConsolidated Associates Railroad 75284 COMMERCIAL NConsolidated Health Plans 87843 COMMERCIAL NConsolidated Health Plans 87843 COMMERCIAL N

Consumers Life Insurance Company 29076 COMMERCIAL N

Consumers Life insurance

Company is part of the Medical

Mutual Family of Companies.

Consumers Life Insurance Company 29076 COMMERCIAL N

Consumers Life insurance

Company is part of the Medical

Mutual Family of Companies.Continental General Insurance Company 71404 COMMERCIAL N Non Medicare SupplementContinental General Insurance Company 71404 COMMERCIAL N Non Medicare SupplementContinental Key Family 35315 COMMERCIAL NContinental Key Family 35315 COMMERCIAL NContractors Laborers Teamsters & Engineers 47046 COMMERCIAL NContractors Laborers Teamsters & Engineers 47046 COMMERCIAL N

Conversion Plan-APWU 55544 COMMERCIAL N


the payer.; For conversion plan

members only. If filing a claim for

a federal plan member please use

payer ID 44444.

Conversion Plan-APWU 55544 COMMERCIAL N


the payer.; For conversion plan

members only. If filing a claim for

a federal plan member please use

payer ID 44444.Cook Children's Health Group TH104 COMMERCIAL NCook Children's Health Group TH104 COMMERCIAL NCook Group Health Plan 35149 COMMERCIAL NCook Group Health Plan 35149 COMMERCIAL NCooperative Benefit Administrators (CBA) 52132 COMMERCIAL NCooperative Benefit Administrators (CBA) 52132 COMMERCIAL NCoordinated Medical Specialists 58204 COMMERCIAL N


Page 32


January 2011

Payer ID State Model Enroll Additional InformationCoordinated Medical Specialists 58204 COMMERCIAL NCore Administrative Services 58231 COMMERCIAL NCore Administrative Services 58231 COMMERCIAL N

CoreSource AZ MN 35182 COMMERCIAL N For assistance 800-689-0106

CoreSource AZ MN 35182 COMMERCIAL N For assistance 800-689-0106

CoreSource Little Rock 75136 COMMERCIAL N

Only for claims where the "submit

claims to address" on the medical

ID card is a CoreSource address in

Little Rock Arkansas. For

assistance call 800-689-0106.

CoreSource Little Rock 75136 COMMERCIAL N




Little Rock Arkansas. For

assistance call 800-689-0106.CoreSource MD PA IL 35182 COMMERCIAL N For assistance 800-689-0106CoreSource MD PA IL 35182 COMMERCIAL N For assistance 800-689-0106CoreSource NC IN 35182 COMMERCIAL N For assistance 800-689-0106CoreSource NC IN 35182 COMMERCIAL N For assistance 800-689-0106

CoreSource OH 35183 COMMERCIAL N




the state of Ohio. For assistance

call 800-689-0106.

CoreSource OH 35183 COMMERCIAL N




the state of Ohio. For assistance

call 800-689-0106.CoreSource-Internal 35187 COMMERCIAL NCoreSource-Internal 35187 COMMERCIAL NCornerstone Benefit Adminstrators 35202 COMMERCIAL NCornerstone Benefit Adminstrators 35202 COMMERCIAL N

Corporate Benefits Service Inc. (NC) 56116 COMMERCIAL N


a claims submission address of

P.O. Box 12953 Charlotte NC

28220.

Corporate Benefits Service Inc. (NC) 56116 COMMERCIAL N


a claims submission address of

P.O. Box 12953 Charlotte NC

28220.Corporate Systems Administration 37246 COMMERCIAL NCorporate Systems Administration 37246 COMMERCIAL NCorrectional Medical Services 43160 COMMERCIAL NCorrectional Medical Services 43160 COMMERCIAL N


Page 33


January 2011


Corvel Corporation (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Corvel Corporation (Ohio BWC) 31147 COMMERCIAL N


ONLY.Country Life Insurance Company 62553 COMMERCIAL NCountry Life Insurance Company 62553 COMMERCIAL NCovenant Administrators Inc. (Atlanta GA) 58102 COMMERCIAL NCovenant Administrators Inc. (Atlanta GA) 58102 COMMERCIAL NCovenant Management Systems TH108 COMMERCIAL NCovenant Management Systems TH108 COMMERCIAL NCoventry Advantra Texas 25133 COMMERCIAL NCoventry Advantra Texas 25133 COMMERCIAL N

Coventry Health & Life (Oklahoma) 25133 COMMERCIAL N

Now part of Coventry

Consolidated payer IDCoventry Health & Life (Oklahoma) 25133 COMMERCIAL NCoventry Health & Life (Oklahoma) 25133 COMMERCIAL N

Coventry Health & Life (Oklahoma) 25133 COMMERCIAL N


Consolidated payer ID

Coventry Health Care 25133 COMMERCIAL N

Coventry's consolidated payer ID.

Claims for all of these legacy

payer IDs may now be submitted

to this payer ID. 25126 25127

25128 25129 25130 25132 25135

25136 25139 25141 25146 25149

25152 62413 87043.

Coventry Health Care 25133 COMMERCIAL N

Coventry's consolidated payer ID.

Claims for all of these legacy

payer IDs may now be submitted

to this payer ID. 25126 25127

25128 25129 25130 25132 25135

25136 25139 25141 25146 25149

25152 62413 87043.

Coventry Health Care National Network 25133 COMMERCIAL N


part of Coventry consolidated

payer ID.




payer ID.



part of Coventry consolidated

payer ID.




payer ID.

Coventry Health Care Nevada 25133 COMMERCIAL N




Page 34


January 2011


Coventry Health Care Nevada 25133 COMMERCIAL N



Coventry Health Care of Florida Inc. 25133 COMMERCIAL N

Formerly Vista Health Plan Inc.


Consolidated Payer ID.

Coventry Health Care of Florida Inc. 25133 COMMERCIAL N

Formerly Vista Health Plan Inc.



Coventry Health Care of Georgia Inc. 25133 COMMERCIAL N



payer ID.

Coventry Health Care of Georgia Inc. 25133 COMMERCIAL N



payer ID.

Coventry Health Care of Iowa Inc. 25133 COMMERCIAL N



payer ID.

Coventry Health Care of Iowa Inc. 25133 COMMERCIAL N



payer ID.

Coventry Health Care of Kansas Inc. 25133 COMMERCIAL N



Coventry Health Care of Kansas Inc. 25133 COMMERCIAL N


Consolidated payer IDCoventry Health Care of Kansas Inc. 25133 COMMERCIAL NCoventry Health Care of Kansas Inc. 25133 COMMERCIAL N

Coventry Health Care of Louisiana Inc. 25133 COMMERCIAL N



payer ID.

Coventry Health Care of Louisiana Inc. 25133 COMMERCIAL N



payer ID.

Coventry Health Care of Nebraska Inc. 25133 COMMERCIAL N



payer ID.

Coventry Health Care of Nebraska Inc. 25133 COMMERCIAL N



payer ID.

Coventry Health Plan of Florida 25133 COMMERCIAL N

Formerly Vista Health Plan of

South Florida Inc. Now part of

Coventry Consolidated Payer ID.

Coventry Health Plan of Florida 25133 COMMERCIAL N

Formerly Vista Health Plan of

South Florida Inc. Now part of

Coventry Consolidated Payer ID.Coventry Health and Life Insurance Company administered by PersonalCare25133 COMMERCIAL NCoventry Health and Life Insurance Company administered by PersonalCare25133 COMMERCIAL N


Page 35


January 2011


Coventry Health and Life Insureance (Tennessee) 25133 COMMERCIAL N



payer ID.

Coventry Health and Life Insureance (Tennessee) 25133 COMMERCIAL N



payer ID.

Coventry Missouri 25133 COMMERCIAL N



payer ID.

Coventry Missouri 25133 COMMERCIAL N



payer ID.Coventry Nebraska 25133 COMMERCIAL NCoventry Nebraska 25133 COMMERCIAL N

Coventry Summitt Health Plan Inc. 25133 COMMERCIAL N

Formerly Summitt Health Plan

Inc. Now part of Coventry


Coventry Summitt Health Plan Inc. 25133 COMMERCIAL N

Formerly Summitt Health Plan

Inc. Now part of Coventry


Coventry of Health Care Delaware Inc. 25133 COMMERCIAL N



payer ID.

Coventry of Health Care Delaware Inc. 25133 COMMERCIAL N



payer ID.

CoventryCares 25133 COMMERCIAL N



CoventryCares 25133 COMMERCIAL N



Crawford & Company (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Crawford & Company (Ohio BWC) 31147 COMMERCIAL N


ONLY.Creative Medical Systems 64068 COMMERCIAL NCreative Medical Systems 64068 COMMERCIAL NCreative Plan Administrators 37320 COMMERCIAL NCreative Plan Administrators 37320 COMMERCIAL N

Croy-Hall Mgmt. Inc. 37266 COMMERCIAL N

Please enter the unique policy

number or ID card when

submitting claims. Payer ID valid

only for claims with a billing

submission address of PO Box

982005 Ft. Worth TX 76182.


Page 36


January 2011


Croy-Hall Mgmt. Inc. 37266 COMMERCIAL N






982005 Ft. Worth TX 76182.Custom Benefit Administrators 39170 COMMERCIAL NCustom Design Benefits Inc. 82056 COMMERCIAL NCustom Design Benefits Inc. 82056 COMMERCIAL N

D.H. EVANS & ASSOC. Call COMMERCIAL N

Call Jessica Picarde @ 410-349-

3222 for Payer id.

D.H. EVANS & ASSOC. Call COMMERCIAL N

Call Jessica Picarde @ 410-349-

3222 for Payer id.

DC Chartered Health Plan Inc. (Medicaid & Alliance) 95748 COMMERCIAL N

PLEASE CONTACT Ronald Gray at

202-408-2229 TO JOIN

CHARTERED HEALTH PLANS EDI

NETWORK

DC Chartered Health Plan Inc. (Medicaid & Alliance) 95748 COMMERCIAL N

PLEASE CONTACT Ronald Gray at

202-408-2229 TO JOIN

CHARTERED HEALTH PLANS EDI

NETWORKDELANO IPA 77124 COMMERCIAL NDELANO IPA 77124 COMMERCIAL NDRISCOLL CHILDREN'S HEALTH PLAN 74284 COMMERCIAL NDRISCOLL CHILDREN'S HEALTH PLAN 74284 COMMERCIAL NDart Container Corporation DARTC COMMERCIAL NDart Container Corporation DARTC COMMERCIAL NDart Container Corporation TH073 COMMERCIAL NDart Container Corporation TH073 COMMERCIAL NDart Management Corporation 6172 COMMERCIAL NDart Management Corporation 6172 COMMERCIAL NDean Health Plan 39113 COMMERCIAL NDean Health Plan 39113 COMMERCIAL NDefinity Health 64159 COMMERCIAL NDefinity Health 64159 COMMERCIAL NDelaware Physicians Care Inc. 27009 COMMERCIAL NDelaware Physicians Care Inc. 27009 COMMERCIAL NDelta Health Systems 94235 COMMERCIAL NDelta Health Systems 94235 COMMERCIAL NDenver Health - Indigent 84134 COMMERCIAL NDenver Health - Indigent 84134 COMMERCIAL NDenver Health Medical Plan 84135 COMMERCIAL NDenver Health Medical Plan 84135 COMMERCIAL NDenver Health Medical Plan Inc. - Medicare Choice 84131 COMMERCIAL NDenver Health Medical Plan Inc. - Medicare Choice 84131 COMMERCIAL NDenver Health and Hospital Authority 84133 COMMERCIAL NDenver Health and Hospital Authority 84133 COMMERCIAL NDeseret Mutual SX105 COMMERCIAL RDeseret Mutual SX105 COMMERCIAL RDesert Medical Group DESRT COMMERCIAL N


Page 37


January 2011

Payer ID State Model Enroll Additional InformationDesert Medical Group DESRT COMMERCIAL NDestiny Health 36436 COMMERCIAL NDestiny Health 36436 COMMERCIAL NDetroit Medical Center 56240 COMMERCIAL NDetroit Medical Center 56240 COMMERCIAL NDiaTri LLC 36439 COMMERCIAL NDiaTri LLC 36439 COMMERCIAL N

Diamond Plan 25131 COMMERCIAL N




list.





list.





list.





list.

Diamond Plan (Maryland Medicaid) 25133 COMMERCIAL N



payer ID.

Diamond Plan (Maryland Medicaid) 25133 COMMERCIAL N



payer ID.Directors Guild of America - Producer Health Plan 23706 COMMERCIAL NDirectors Guild of America - Producer Health Plan 23706 COMMERCIAL N

Diversified Administration Corporation 6102 COMMERCIAL N

Please verify the Payer ID on the

Member ID card in addition to

the Payer City and State before

submitting claims to Diversified

Admin (Payer ID 06102)

Diversified Administration Corporation 6102 COMMERCIAL N

Please verify the Payer ID on the

Member ID card in addition to

the Payer City and State before

submitting claims to Diversified

Admin (Payer ID 06102)Downey Select IPA (Applecare Medical Managment) APP01 COMMERCIAL NDowney Select IPA (Applecare Medical Managment) APP01 COMMERCIAL N

Dr. Rivera Call COMMERCIAL N






Page 38


January 2011


Dr. Rivera Call COMMERCIAL N




7100 [email protected] and Associates Benefits Administrators Inc. 35186 COMMERCIAL NDunn and Associates Benefits Administrators Inc. 35186 COMMERCIAL N

E-V Benefits Management Inc (Columbus OH) 34159 COMMERCIAL N Now known as Meritain Health.

E-V Benefits Management Inc (Columbus OH) 34159 COMMERCIAL N Now known as Meritain Health.

EBC Mid-America Call COMMERCIAL N


(440) 262-1160.

EBC Mid-America Call COMMERCIAL N


(440) 262-1160.

EBC Inc. Call COMMERCIAL N


(440) 262-1160.

EBC Inc. Call COMMERCIAL N


(440) 262-1160.EBMC 31074 COMMERCIAL NEBMC 31074 COMMERCIAL NEBMS SX182 COMMERCIAL NEBMS SX182 COMMERCIAL N

EBS OF OHIO 34166 COMMERCIAL N

Payer ID valid for claims with a


2568 Mansfield OH 44906.

EBS OF OHIO 34166 COMMERCIAL N



2568 Mansfield OH 44906.EMI-KP Ambulance Claims 59299 COMMERCIAL NEMI-KP Ambulance Claims 59299 COMMERCIAL NEQUICOR 62308 COMMERCIAL NEQUICOR 62308 COMMERCIAL NEQUICOR - PPO 62308 COMMERCIAL NEQUICOR - PPO 62308 COMMERCIAL NERISA TH110 COMMERCIAL NERISA TH110 COMMERCIAL NES Beveridge and Associates 34108 COMMERCIAL NES Beveridge and Associates 34108 COMMERCIAL NESSENCE HEALTHCARE 20818 COMMERCIAL NESSENCE HEALTHCARE 20818 COMMERCIAL NEarly Intervention Central TH084 COMMERCIAL NEarly Intervention Central TH084 COMMERCIAL N

East Bay Medical Network Call COMMERCIAL P





submission.


Page 39


January 2011


East Bay Medical Network Call COMMERCIAL P





submission.Eastland Medical Group 66122 COMMERCIAL NEastland Medical Group 66122 COMMERCIAL NEducators Mutual (EMIA) SX110 COMMERCIAL NEducators Mutual (EMIA) SX110 COMMERCIAL NEl Paso First - Chip TH090 COMMERCIAL NEl Paso First - Chip TH090 COMMERCIAL N

ElderPlan Inc. 31625 COMMERCIAL N

Elderplan no longer requires

enrollment & individual provider

testing; However Elderplan

Provider ID is necessary on all

claim submissions. If you do not

know your provider Id contact

(718) 921-7979.

ElderPlan Inc. 31625 COMMERCIAL N

Elderplan no longer requires

enrollment & individual provider

testing; However Elderplan

Provider ID is necessary on all

claim submissions. If you do not

know your provider Id contact

(718) 921-7979.Elmcare LLC 36399 COMMERCIAL NElmcare LLC 36399 COMMERCIAL NElmco 37253 COMMERCIAL NElmco 37253 COMMERCIAL NEmerald Health Network Inc. (All PPO Business) 34167 COMMERCIAL NEmerald Health Network Inc. (All PPO Business) 34167 COMMERCIAL NEmergency Medical Services Fund (EMSF) AMM03 COMMERCIAL NEmergency Medical Services Fund (EMSF) AMM03 COMMERCIAL NEmpire Physician's Medical Group EMP01 COMMERCIAL NEmpire Physician's Medical Group EMP01 COMMERCIAL NEmployee Benefit Administration & Management CorporationPilot COMMERCIAL NEmployee Benefit Administration & Management CorporationPilot COMMERCIAL N

Employee Benefit Claims - Mid-America Call COMMERCIAL N


(440) 262-1160.

Employee Benefit Claims - Mid-America Call COMMERCIAL N


(440) 262-1160.

Employee Benefit Claims of WI Call COMMERCIAL N


(440) 262-1160.

Employee Benefit Claims of WI Call COMMERCIAL N


(440) 262-1160.

Employee Benefit Claims of Wisconsin Call COMMERCIAL N


(440) 262-1160.


Page 40


January 2011


Employee Benefit Claims of Wisconsin Call COMMERCIAL N


(440) 262-1160.Employee Benefit Concepts (Farmington Hills MI) 38241 COMMERCIAL NEmployee Benefit Concepts (Farmington Hills MI) 38241 COMMERCIAL N

Employee Benefit Consultants Inc. Call COMMERCIAL N


(440) 262-1160.

Employee Benefit Consultants Inc. Call COMMERCIAL N


(440) 262-1160.Employee Benefit Corporation 37215 COMMERCIAL NEmployee Benefit Corporation 37215 COMMERCIAL NEmployee Benefit Management Corp (EBMC) 31074 COMMERCIAL NEmployee Benefit Management Corp (EBMC) 31074 COMMERCIAL N

Employee Benefit Services (Ft. Mill SC) 37216 COMMERCIAL N



SC

Employee Benefit Services (Ft. Mill SC) 37216 COMMERCIAL N



SCEmployee Benefit Services of Louisiana Inc (EBS) 41198 COMMERCIAL NEmployee Benefit Services of Louisiana Inc (EBS) 41198 COMMERCIAL NEmployee Benefit Services of San Antonio TH109 COMMERCIAL NEmployee Benefit Services of San Antonio TH109 COMMERCIAL NEmployee Benefit Systems 42149 COMMERCIAL NEmployee Benefit Systems 42149 COMMERCIAL NEmployee Benefits Administration and Management Corp.22262 COMMERCIAL NEmployee Benefits Administration and Management Corp.22262 COMMERCIAL NEmployee Benefits Plan Administration Inc. (E.B.P.A.) 3036 COMMERCIAL NEmployee Benefits Plan Administration Inc. (E.B.P.A.) 3036 COMMERCIAL NEmployee Health System SYMED COMMERCIAL NEmployee Health System SYMED COMMERCIAL NEmployee Plans LLC 35112 COMMERCIAL NEmployee Plans LLC 35112 COMMERCIAL NEmployer Plan Services 74212 COMMERCIAL NEmployer Plan Services 74212 COMMERCIAL NEmployer's Direct Health - Employee Plan 75236 COMMERCIAL NEmployer's Direct Health - Employee Plan 75236 COMMERCIAL NEmployer's Direct Health - FI 75235 COMMERCIAL NEmployer's Direct Health - FI 75235 COMMERCIAL NEmployer's Direct Health - SF 75233 COMMERCIAL NEmployer's Direct Health - SF 75233 COMMERCIAL NEmployers Direct Health 75232 COMMERCIAL NEmployers Direct Health 75232 COMMERCIAL NEmployers Mutual Inc (Jacksonville Florida) 59298 COMMERCIAL NEmployers Mutual Inc (Jacksonville Florida) 59298 COMMERCIAL N

Employers Mutual Inc. (Stuart Florida) 59331 COMMERCIAL N

For plan and claim requirements

please contact the Employers

Mutual Inc. (Stuart FL) Customer

Service Department at (772) 287-

7650 ext. 4052.


Page 41


January 2011


Employers Mutual Inc. (Stuart Florida) 59331 COMMERCIAL N

For plan and claim requirements

please contact the Employers

Mutual Inc. (Stuart FL) Customer

Service Department at (772) 287-

7650 ext. 4052.Encircle PPO 35206 COMMERCIAL NEncircle PPO 35206 COMMERCIAL NEncore Health Network 35206 COMMERCIAL NEncore Health Network 35206 COMMERCIAL N

Enstar Natural Gas 91136 COMMERCIAL N



Enstar Natural Gas 91136 COMMERCIAL N


when submitting claims.Entrust 36878 COMMERCIAL NEntrust 36878 COMMERCIAL N

Equitable Plan Services (Oklahoma City OK) 73126 COMMERCIAL N



P.O. Box 720460 Oklahoma City

OK 73172.

Equitable Plan Services (Oklahoma City OK) 73126 COMMERCIAL N



P.O. Box 720460 Oklahoma City

OK 73172.Evercare 87726 COMMERCIAL NEvercare 87726 COMMERCIAL NEvergreen Health Plan 58233 COMMERCIAL NEvergreen Health Plan 58233 COMMERCIAL N

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



5001 New Port Richey FL 34656.

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



5001 New Port Richey FL 34656.Excel MSO EXC01 COMMERCIAL NExcel MSO EXC01 COMMERCIAL NExclusiCare 71412 COMMERCIAL NExclusiCare 71412 COMMERCIAL NF40 Alaska Carpenters Trust 91136 COMMERCIAL NF40 Alaska Carpenters Trust 91136 COMMERCIAL N

FABOH (CHP/RPU) Call COMMERCIAL N




Sell at (608) 210-6656 to obtain.


Page 42


January 2011


FABOH (CHP/RPU) Call COMMERCIAL N




Sell at (608) 210-6656 to obtain.FACS Group 37300 COMMERCIAL NFACS Group 37300 COMMERCIAL NFAMILY CARE 60995 COMMERCIAL NFAMILY CARE 60995 COMMERCIAL NFCE Benefit Administrators 33033 COMMERCIAL NFCE Benefit Administrators 33033 COMMERCIAL NFIRST ADMINISTRATORS INC FAMR1 COMMERCIAL NFIRST ADMINISTRATORS INC FAMR1 COMMERCIAL N

FMH Benefit Services Inc. 48117 COMMERCIAL N

For assistance send email to

[email protected]

FMH Benefit Services Inc. 48117 COMMERCIAL N


[email protected] BENEFIT ADMINISTRATORS/CONTRACTOR EMPLOYEE BENEFITS ADMINBOONG COMMERCIAL NFOUNDATION BENEFIT ADMINISTRATORS/CONTRACTOR EMPLOYEE BENEFITS ADMINBOONG COMMERCIAL NFacey Medical Foundation 95432 COMMERCIAL NFacey Medical Foundation 95432 COMMERCIAL NFallon Community Health Plan 22254 COMMERCIAL NFallon Community Health Plan 22254 COMMERCIAL NFamily Health Partners - Healthwave of Kansas 31472 COMMERCIAL NFamily Health Partners - Healthwave of Kansas 31472 COMMERCIAL NFamily Health Partners/MC+ Missouri 43173 COMMERCIAL NFamily Health Partners/MC+ Missouri 43173 COMMERCIAL NFamily Health Plan TH045 COMMERCIAL NFamily Health Plan TH045 COMMERCIAL N

Family Health Plan (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Family Health Plan (Ohio BWC) 31147 COMMERCIAL N


ONLY.Farm Family Life 14140 COMMERCIAL NFarm Family Life 14140 COMMERCIAL NFederated Benefits 37300 COMMERCIAL NFederated Benefits 37300 COMMERCIAL NFederated HR Services 37300 COMMERCIAL NFederated HR Services 37300 COMMERCIAL NFederated Mutual Insurance 41041 COMMERCIAL NFederated Mutual Insurance 41041 COMMERCIAL NFidelis Care New York 11315 COMMERCIAL NFidelis Care New York 11315 COMMERCIAL NFidelis Secure Care 77054 COMMERCIAL NFidelis Secure Care 77054 COMMERCIAL NFirst Carolina Care 56196 COMMERCIAL NFirst Carolina Care 56196 COMMERCIAL NFirst Choice Health Administrators 91131 COMMERCIAL NFirst Choice Health Administrators 91131 COMMERCIAL NFirst Choice Health Network 91131 COMMERCIAL NFirst Choice Health Network 91131 COMMERCIAL NFirst Choice HealthPlans of Connecticut 14162 COMMERCIAL N


Page 43


January 2011

Payer ID State Model Enroll Additional InformationFirst Choice HealthPlans of Connecticut 14162 COMMERCIAL NFirst Choice of Midwest (PPO) 75138 COMMERCIAL NFirst Choice of Midwest (PPO) 75138 COMMERCIAL NFirst Health Network (f.k.a. CCN Managed Care Inc. & PPO Oklahoma)73159 COMMERCIAL NFirst Health Network (f.k.a. CCN Managed Care Inc. & PPO Oklahoma)73159 COMMERCIAL NFirst Health Network (f.k.a. CCN Managed Care Inc. & PPO Oklahoma)73159 COMMERCIAL NFirst Health Network (f.k.a. CCN Managed Care Inc. & PPO Oklahoma)73159 COMMERCIAL N

First Medical Network (FMN) - Atlanta GA 29076 COMMERCIAL N




58203.

First Medical Network (FMN) - Atlanta GA 29076 COMMERCIAL N




58203.First Service Administrators Inc 59276 COMMERCIAL N Also known as Florida 1stFirst Service Administrators Inc 59276 COMMERCIAL N Also known as Florida 1stFirst Sevice Admin - Limited Medical 20807 COMMERCIAL NFirst Sevice Admin - Limited Medical 20807 COMMERCIAL NFirstCare TH003 COMMERCIAL NFirstCare TH003 COMMERCIAL NFitzharris & Company Inc. 11244 COMMERCIAL NFitzharris & Company Inc. 11244 COMMERCIAL NFlorida Health Care Plan 59322 COMMERCIAL NFlorida Health Care Plan 59322 COMMERCIAL N

Florida Hospital Healthcare Systems 59321 COMMERCIAL N

If Bill Prov NPI not present Render

Prov NPI required -or- If Render

Prov NPI is not present either

Render Prov Network ID (REF*N5)

or Commercial Num (REF*G2) is

required. FHHS member ID must

be 11 digits.

Florida Hospital Healthcare Systems 59321 COMMERCIAL N

If Bill Prov NPI not present Render

Prov NPI required -or- If Render

Prov NPI is not present either

Render Prov Network ID (REF*N5)

or Commercial Num (REF*G2) is

required. FHHS member ID must

be 11 digits.

Florida Hospital Waterman 48116 COMMERCIAL N


[email protected]

Florida Hospital Waterman 48116 COMMERCIAL N


[email protected] League of Cities Inc. 59698 COMMERCIAL NFlorida League of Cities Inc. 59698 COMMERCIAL N

Foreign Service Benefit Plan 25133 COMMERCIAL N



payer ID. Including AFSPA Staff

Plan


Page 44


January 2011


Foreign Service Benefit Plan 25133 COMMERCIAL N




PlanFoundation for Medical Care of Tulare & Kings CountyTKFMC COMMERCIAL NFoundation for Medical Care of Tulare & Kings CountyTKFMC COMMERCIAL NFox-Everett Inc. 64069 COMMERCIAL NFox-Everett Inc. 64069 COMMERCIAL NFreedom First 31313 COMMERCIAL NFreedom First 31313 COMMERCIAL NFreedom Health Plan 41212 COMMERCIAL NFreedom Health Plan 41212 COMMERCIAL NFresenius Medical Care 23130 COMMERCIAL NFresenius Medical Care 23130 COMMERCIAL NFriant Water Users TKFMC COMMERCIAL NFriant Water Users TKFMC COMMERCIAL NFringe Benefit Management 59069 COMMERCIAL NFringe Benefit Management 59069 COMMERCIAL NFringe Benefits Coordinators 59204 COMMERCIAL NFringe Benefits Coordinators 59204 COMMERCIAL NFrontPath Health Coalition 34171 COMMERCIAL NFrontPath Health Coalition 34171 COMMERCIAL N

GATES MCDONALD HEALTH PLUS INC 31147 COMMERCIAL N


ONLY.

GATES MCDONALD HEALTH PLUS INC 31147 COMMERCIAL N


ONLY.GBA 37283 COMMERCIAL NGBA 37283 COMMERCIAL NGEMCare (Golden Empire Managed Care System) MCS01 COMMERCIAL NGEMCare (Golden Empire Managed Care System) MCS01 COMMERCIAL N

GENEX Care of Ohio (Ohio BWC) 31147 COMMERCIAL N


ONLY.

GENEX Care of Ohio (Ohio BWC) 31147 COMMERCIAL N


ONLY.GHI - Medicare Private Fee for Service 22937 COMMERCIAL NGHI - Medicare Private Fee for Service 22937 COMMERCIAL NGHI - New York (Group Health Inc.) 13551 COMMERCIAL NGHI - New York (Group Health Inc.) 13551 COMMERCIAL NGHI HMO 25531 COMMERCIAL NGHI HMO 25531 COMMERCIAL N

GHP (Group Health Plan) 25133 COMMERCIAL N



payer ID.

GHP (Group Health Plan) 25133 COMMERCIAL N



payer ID.GIC Indemnity Plan 80314 COMMERCIAL NGIC Indemnity Plan 80314 COMMERCIAL NGMS Inc. 47083 COMMERCIAL NGMS Inc. 47083 COMMERCIAL NGalveston County Indigent Health Care 30005 COMMERCIAL NGalveston County Indigent Health Care 30005 COMMERCIAL N


Page 45


January 2011


Gates McDonald Health Plus Inc. (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Gates McDonald Health Plus Inc. (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Gateway Health Plan - Medicare Assured 60550 COMMERCIAL N

Gateway Health Plan - Medicare

Assured; 60550 (Yellow Card).

Please check the ID card to verify

the Payer ID before submitting

claims. If you have questions

please contact Gateway Provider

Servicing Department at 1-800-

685-5205.

Gateway Health Plan - Medicare Assured 60550 COMMERCIAL N

Gateway Health Plan - Medicare

Assured; 60550 (Yellow Card).





Servicing Department at 1-800-

685-5205.

Gateway Health Plan Medicaid PA 25169 COMMERCIAL N

Caution: Gateway Health Plan has

several different Payer ID

numbers please look for the

Payer ID on the ID card before

submitting. PA Medicaid

25169(Green Card). If you have

questions contact Gateway

Provider Servicing Department at

1-800-685-5205.

Gateway Health Plan Medicaid PA 25169 COMMERCIAL N

Caution: Gateway Health Plan has

several different Payer ID

numbers please look for the

Payer ID on the ID card before

submitting. PA Medicaid

25169(Green Card). If you have

questions contact Gateway

Provider Servicing Department at

1-800-685-5205.

Gateway Health Plan OH- Medicare Assured 91741 COMMERCIAL N





Servicing @ 1-800-685-5205


Page 46


January 2011


Gateway Health Plan OH- Medicare Assured 91741 COMMERCIAL N





Servicing @ 1-800-685-5205Gateway IPA (Pinnacle Health Resources) (Prospect Medical Group)PROSP COMMERCIAL NGateway IPA (Pinnacle Health Resources) (Prospect Medical Group)PROSP COMMERCIAL N

Geisinger Health Plan 75273 COMMERCIAL P

Prior enrollment required. Please

contact Geisinger Health Plan at 1-

888-281-5338 option 3 to obtain

an enrollment form; or download

a PDF enrollment form at

www.thehealthplan.com.

Geisinger Health Plan 75273 COMMERCIAL P

Prior enrollment required. Please

contact Geisinger Health Plan at 1-

888-281-5338 option 3 to obtain

an enrollment form; or download

a PDF enrollment form at

www.thehealthplan.com.Gemcare Health Plan 20376 COMMERCIAL NGemcare Health Plan 20376 COMMERCIAL NGemcare Health Plan MCS03 COMMERCIAL NGemcare Health Plan MCS03 COMMERCIAL NGemcare IPA 27133 COMMERCIAL NGemcare IPA 27133 COMMERCIAL NGenerations Healthcare 46050 COMMERCIAL NGenerations Healthcare 46050 COMMERCIAL NGenerations-Hillcrest 46051 COMMERCIAL NGenerations-Hillcrest 46051 COMMERCIAL NGenesis Healthcare PROSP COMMERCIAL NGenesis Healthcare PROSP COMMERCIAL NGilsbar 88053 COMMERCIAL NGilsbar 88053 COMMERCIAL NGilsbar Inc. 7205 COMMERCIAL NGilsbar Inc. 7205 COMMERCIAL NGlendale Physician's Alliance AMM02 COMMERCIAL NGlendale Physician's Alliance AMM02 COMMERCIAL NGlobal Care Inc. 7689 COMMERCIAL NGlobal Care Inc. 7689 COMMERCIAL NGolden Rule Insurance Company 37602 COMMERCIAL NGolden Rule Insurance Company 37602 COMMERCIAL NGolden State Medical Group MBA01 COMMERCIAL NGolden State Medical Group MBA01 COMMERCIAL NGolden Triangle Physician Alliance/SelectCare of Texas (GTPA)72189 COMMERCIAL NGolden Triangle Physician Alliance/SelectCare of Texas (GTPA)72189 COMMERCIAL NGood Samaritan Medical Practice Association AMM01 COMMERCIAL NGood Samaritan Medical Practice Association AMM01 COMMERCIAL NGovernment Employees Hospital Association (GEHA) 44054 COMMERCIAL N


Page 47


January 2011

Payer ID State Model Enroll Additional InformationGovernment Employees Hospital Association (GEHA) 44054 COMMERCIAL NGreat Lakes Health Plan 95467 COMMERCIAL NGreat Lakes Health Plan 95467 COMMERCIAL NGreat-West Healthcare 80705 COMMERCIAL NGreat-West Healthcare 80705 COMMERCIAL NGreat-West Healthcare (formerly American General) 63665 COMMERCIAL NGreat-West Healthcare (formerly American General) 63665 COMMERCIAL NGreater Orange County Medical Group NMM01 COMMERCIAL NGreater Orange County Medical Group NMM01 COMMERCIAL NGreater San Gabriel Med Grp NMM01 COMMERCIAL NGreater San Gabriel Med Grp NMM01 COMMERCIAL NGroup Administrators Ltd. 36338 COMMERCIAL NGroup Administrators Ltd. 36338 COMMERCIAL N

Group Health Cooperative - WA State 91051 COMMERCIAL N

All GHC products; GHC Group

Individual Medicare + Choice and

Healthy Options can be submitted

electronically

Group Health Cooperative - WA State 91051 COMMERCIAL N

All GHC products; GHC Group

Individual Medicare + Choice and

Healthy Options can be submitted

electronicallyGroup Health Cooperative of Eau Claire 95192 COMMERCIAL NGroup Health Cooperative of Eau Claire 95192 COMMERCIAL NGroup Health Cooperative of South Central Wisconsin39167 COMMERCIAL NGroup Health Cooperative of South Central Wisconsin39167 COMMERCIAL NGroup Health Cooperative of South Central Wisconsin39168 COMMERCIAL NGroup Health Cooperative of South Central Wisconsin39168 COMMERCIAL NGroup Health Inc. 22937 COMMERCIAL NGroup Health Inc. 22937 COMMERCIAL NGroup Health Managers 38194 COMMERCIAL NGroup Health Managers 38194 COMMERCIAL N

Group Health Options - WA State 91051 COMMERCIAL N

All GHO products; Options and

Alliant can be submitted

electronically

Group Health Options - WA State 91051 COMMERCIAL N

All GHO products; Options and

Alliant can be submitted

electronicallyGroup Insurance Service Center Inc. 37276 COMMERCIAL NGroup Insurance Service Center Inc. 37276 COMMERCIAL NGroup Practice Affiliates 68046 COMMERCIAL NGroup Practice Affiliates 68046 COMMERCIAL NGroup and Pension Administrators 48143 COMMERCIAL NGroup and Pension Administrators 48143 COMMERCIAL NGuardian Healthcare INC. (SC) 77010 COMMERCIAL NGuardian Healthcare INC. (SC) 77010 COMMERCIAL NGuardian Life Insurance Company of America 64246 COMMERCIAL NGuardian Life Insurance Company of America 64246 COMMERCIAL NH.E.R.E.I.U Welfare Pension Funds 37114 COMMERCIAL NH.E.R.E.I.U Welfare Pension Funds 37114 COMMERCIAL NHAA Preferred Partners 65101 COMMERCIAL NHAA Preferred Partners 65101 COMMERCIAL N


Page 48


January 2011

Payer ID State Model Enroll Additional InformationHAP/AHL/Curanet 38224 COMMERCIAL NHAP/AHL/Curanet 38224 COMMERCIAL NHCH Administration (Illinois) 37111 COMMERCIAL NHCH Administration (Illinois) 37111 COMMERCIAL N

HCH Administration Inc. 37215 COMMERCIAL N Formerly John P. Pearl Associates

HCH Administration Inc. 37215 COMMERCIAL N Formerly John P. Pearl AssociatesHCHA Albq-Self Funded 37329 COMMERCIAL NHCHA Albq-Self Funded 37329 COMMERCIAL NHCS - Health Claims Service (Boise ID) 82018 COMMERCIAL NHCS - Health Claims Service (Boise ID) 82018 COMMERCIAL NHDM Benefit Solutions TH070 COMMERCIAL NHDM Benefit Solutions TH070 COMMERCIAL NHDPC - Premier Healthcare 90023 COMMERCIAL NHDPC - Premier Healthcare 90023 COMMERCIAL NHDPC/Alliance Physicians 20257 COMMERCIAL NHDPC/Alliance Physicians 20257 COMMERCIAL NHEALTHY PALM BEACHES Call COMMERCIAL NHEALTHY PALM BEACHES Call COMMERCIAL NHFN Inc. 36335 COMMERCIAL NHFN Inc. 36335 COMMERCIAL NHIP - Health Insurance Plan of Greater New York 55247 COMMERCIAL NHIP - Health Insurance Plan of Greater New York 55247 COMMERCIAL NHMA Administrators LLC 39044 COMMERCIAL NHMA Administrators LLC 39044 COMMERCIAL NHMA Hawaii 86066 COMMERCIAL NHMA Hawaii 86066 COMMERCIAL NHPS Paradigm Inc. 58227 COMMERCIAL NHPS Paradigm Inc. 58227 COMMERCIAL NHarmony Health Plan of Illinois 36406 COMMERCIAL NHarmony Health Plan of Illinois 36406 COMMERCIAL NHarmony Health Plan of Indiana 36405 COMMERCIAL NHarmony Health Plan of Indiana 36405 COMMERCIAL N

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

(Formerly Willis Administrative

Services Corporation)

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

(Formerly Willis Administrative

Services Corporation)Harvard Pilgrim Health Care 4271 COMMERCIAL NHarvard Pilgrim Health Care 4271 COMMERCIAL NHawaii Medical Assurance Association (HMAA) 99208 COMMERCIAL NHawaii Medical Assurance Association (HMAA) 99208 COMMERCIAL NHealth Alliance Medical Plans 77950 COMMERCIAL NHealth Alliance Medical Plans 77950 COMMERCIAL N

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



payer ID.

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



payer ID.


Page 49


January 2011

Payer ID State Model Enroll Additional InformationHealth Care Network of Wisconsin (HCN) 42102 COMMERCIAL NHealth Care Network of Wisconsin (HCN) 42102 COMMERCIAL NHealth Choice Arizona 62179 COMMERCIAL NHealth Choice Arizona 62179 COMMERCIAL NHealth Choice Generations 62180 COMMERCIAL NHealth Choice Generations 62180 COMMERCIAL NHealth Cost Solutions 62111 COMMERCIAL NHealth Cost Solutions 62111 COMMERCIAL NHealth Design Plus (Hudson OH) 34158 COMMERCIAL NHealth Design Plus (Hudson OH) 34158 COMMERCIAL NHealth Future LLC. 30946 COMMERCIAL NHealth Future LLC. 30946 COMMERCIAL NHealth Management Administrators (HMA) TH049 COMMERCIAL NHealth Management Administrators (HMA) TH049 COMMERCIAL N

Health Management Solutions (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Health Management Solutions (Ohio BWC) 31147 COMMERCIAL N


ONLY.Health Market Care Assured 62295 COMMERCIAL NHealth Market Care Assured 62295 COMMERCIAL NHealth Net Pearl SX185 COMMERCIAL NHealth Net Pearl SX185 COMMERCIAL NHealth Net of Arizona 38309 COMMERCIAL N Payer requires NPIHealth Net of Arizona 38309 COMMERCIAL N Payer requires NPIHealth Net of California and Oregon - Claims 95567 COMMERCIAL NHealth Net of California and Oregon - Claims 95567 COMMERCIAL NHealth Net of the Northeast Inc. 6108 COMMERCIAL N Payer requires NPI.Health Net of the Northeast Inc. 6108 COMMERCIAL N Payer requires NPI.Health Network America 20199 COMMERCIAL NHealth Network America 20199 COMMERCIAL NHealth Network One 65062 COMMERCIAL NHealth Network One 65062 COMMERCIAL N

Health New England Call COMMERCIAL N

To obtain payer id please contact

Joanne Shaw 413-233-3444

[email protected] or Joanne

Walton-Bicknell 413-233-3456

[email protected]

Health New England Call COMMERCIAL N

To obtain payer id please contact

Joanne Shaw 413-233-3444

[email protected] or Joanne

Walton-Bicknell 413-233-3456

[email protected] Options of Florida SX030 COMMERCIAL NHealth Options of Florida SX030 COMMERCIAL NHealth Options of Illinois 36368 COMMERCIAL NHealth Options of Illinois 36368 COMMERCIAL NHealth Partners - Jackson TN 62157 COMMERCIAL NHealth Partners - Jackson TN 62157 COMMERCIAL NHealth Partners PA 80142 COMMERCIAL N


Page 50


January 2011

Payer ID State Model Enroll Additional InformationHealth Partners PA 80142 COMMERCIAL NHealth Payment Systems Inc. 20270 COMMERCIAL NHealth Payment Systems Inc. 20270 COMMERCIAL NHealth Plan of Michigan 83253 COMMERCIAL NHealth Plan of Michigan 83253 COMMERCIAL NHealth Plan of San Joaquin 68035 COMMERCIAL NHealth Plan of San Joaquin 68035 COMMERCIAL N

Health Plan of San Mateo Call COMMERCIAL N

CONTACT PAYER FOR

REGISTRATION AND PAYER ID.

Endry Lo: 650-616-2017 or Ken

Cottrell: 650-616-2021

Health Plan of San Mateo Call COMMERCIAL N

CONTACT PAYER FOR

REGISTRATION AND PAYER ID.

Endry Lo: 650-616-2017 or Ken

Cottrell: 650-616-2021Health Plans Inc. 44273 COMMERCIAL NHealth Plans Inc. 44273 COMMERCIAL N

Health Plus PHSP (Brooklyn NY) 11324 COMMERCIAL P

Providers must contact Health

Plus at 718-491-8355 prior to

submitting claims.

Health Plus PHSP (Brooklyn NY) 11324 COMMERCIAL P

Providers must contact Health

Plus at 718-491-8355 prior to

submitting claims.Health Right 52201 COMMERCIAL NHealth Right 52201 COMMERCIAL NHealth Services Consulting Group Inc. 20896 COMMERCIAL NHealth Services Consulting Group Inc. 20896 COMMERCIAL NHealth Services Management 41150 COMMERCIAL RHealth Services Management 41150 COMMERCIAL RHealth Services Preferred (HSP) by Emerald Health 34167 COMMERCIAL NHealth Services Preferred (HSP) by Emerald Health 34167 COMMERCIAL NHealth Services for Children with Special Needs 37290 COMMERCIAL NHealth Services for Children with Special Needs 37290 COMMERCIAL NHealth Strategies SX044 COMMERCIAL NHealth Strategies SX044 COMMERCIAL N

HealthCare Partners IPA 11328 COMMERCIAL N

Formerly Heritage New York

Medical Group.

HealthCare Partners IPA 11328 COMMERCIAL N

Formerly Heritage New York

Medical Group.HealthEZ 41178 COMMERCIAL NHealthEZ 41178 COMMERCIAL NHealthFirst TPA (Houston TX) 34185 COMMERCIAL NHealthFirst TPA (Houston TX) 34185 COMMERCIAL NHealthGroup Limited 23274 COMMERCIAL NHealthGroup Limited 23274 COMMERCIAL N


Page 51


January 2011


HealthPartners MN SX009 COMMERCIAL R

Payer must be requested via the

Provider Setup Form and Payer

Reqistration completed prior to

electronic claims submission.

Provider Forms can be found:

www.emdeon.com/enrollment

HealthPartners MN SX009 COMMERCIAL R

Payer must be requested via the

Provider Setup Form and Payer

Reqistration completed prior to

electronic claims submission.

Provider Forms can be found:

www.emdeon.com/enrollmentHealthPlan Services 59140 COMMERCIAL NHealthPlan Services 59140 COMMERCIAL N

HealthPlus of Michigan 38216 COMMERCIAL R

HealthPlus requires a Trading

Partner Agreement. Providers

should contact the EDI

department at (810-230-2084)

upon billing via Emdeon to

request a TPA form.

HealthPlus of Michigan 38216 COMMERCIAL R

HealthPlus requires a Trading

Partner Agreement. Providers

should contact the EDI

department at (810-230-2084)

upon billing via Emdeon to

request a TPA form.HealthSCOPE Benefits Inc. 71063 COMMERCIAL NHealthSCOPE Benefits Inc. 71063 COMMERCIAL NHealthSmart -Noble Mid Orange HSM01 COMMERCIAL NHealthSmart -Noble Mid Orange HSM01 COMMERCIAL NHealthSmart Preferred Care Inc. 75250 COMMERCIAL NHealthSmart Preferred Care Inc. 75250 COMMERCIAL N

HealthSpring HMO/HealthSpring Medicare+Choice 63092 COMMERCIAL N

It is no longer necessary to notify

HealthSpring before submitting

claims electronically.

HealthSpring encourages

electronic submission of all

claims. Be sure to submit only

the HealthSpring

subscriber/member ID number

found on the HealthSpring ID card


Page 52


January 2011


HealthSpring HMO/HealthSpring Medicare+Choice 63092 COMMERCIAL N

It is no longer necessary to notify

HealthSpring before submitting

claims electronically.

HealthSpring encourages

electronic submission of all

claims. Be sure to submit only

the HealthSpring

subscriber/member ID number

found on the HealthSpring ID cardHealthStar Inc. 36332 COMMERCIAL NHealthStar Inc. 36332 COMMERCIAL NHealthcare Partners HCP01 COMMERCIAL NHealthcare Partners HCP01 COMMERCIAL NHealthcare Resources NW 56731 COMMERCIAL NHealthcare Resources NW 56731 COMMERCIAL NHealthcare Solutions Group 73147 COMMERCIAL NHealthcare Solutions Group 73147 COMMERCIAL N

Healthcare Transaction Processing Inc (HTP) 31147 COMMERCIAL N


ONLY.

Healthcare Transaction Processing Inc (HTP) 31147 COMMERCIAL N


ONLY.

Healthcare USA 25133 COMMERCIAL N



payer ID.

Healthcare USA 25133 COMMERCIAL N



payer ID.Healthcare USA 25143 COMMERCIAL NHealthcare USA 25143 COMMERCIAL NHealthcare USA 25143 COMMERCIAL NHealthcare USA 25143 COMMERCIAL NHealthcomp Inc. 85729 COMMERCIAL NHealthcomp Inc. 85729 COMMERCIAL NHealthfirst Health Plan of New Jersey 80141 COMMERCIAL NHealthfirst Health Plan of New Jersey 80141 COMMERCIAL NHealthfirst TPA (Tyler TX) 75234 COMMERCIAL NHealthfirst TPA (Tyler TX) 75234 COMMERCIAL NHealthfirst of Austin 75289 COMMERCIAL NHealthfirst of Austin 75289 COMMERCIAL NHealthfirst Inc. (New York) 80141 COMMERCIAL NHealthfirst Inc. (New York) 80141 COMMERCIAL N

Healthlink HMO 96475 COMMERCIAL N

Please call Provider Relations

Dept at (800) 624-2356 for

unique provider number.

Healthlink HMO 96475 COMMERCIAL N

Please call Provider Relations

Dept at (800) 624-2356 for

unique provider number.

Healthlink PPO 90001 COMMERCIAL N

Customer Service phone number:

(800 624-2356)


Page 53


January 2011


Healthlink PPO 90001 COMMERCIAL N


(800 624-2356)

Healthnow Division 55204 COMMERCIAL R

Provider id = 12 digits with G2

qualifier

Healthnow Division 55204 COMMERCIAL R

Provider id = 12 digits with G2

qualifierHealthscope Benefits - EHC Repricing 52429 COMMERCIAL NHealthscope Benefits - EHC Repricing 52429 COMMERCIAL NHealthsmart Accel 75237 COMMERCIAL NHealthsmart Accel 75237 COMMERCIAL NHealthsource CMHC 2041 COMMERCIAL NHealthsource CMHC 2041 COMMERCIAL NHealthsource Massachusetts Inc. 2041 COMMERCIAL NHealthsource Massachusetts Inc. 2041 COMMERCIAL N

Healthsource Provident 68195 COMMERCIAL N

Claims are edited under CIGNA's

payer specific edits Payer ID

62308.

Healthsource Provident 68195 COMMERCIAL N



62308.

Healthsource AR (Med) (CIGNA) 71075 COMMERCIAL N



62308.

Healthsource AR (Med) (CIGNA) 71075 COMMERCIAL N



62308.

Healthsource GA (CIGNA) 58210 COMMERCIAL N



62308.

Healthsource GA (CIGNA) 58210 COMMERCIAL N



62308.Healthsource KY 61127 COMMERCIAL NHealthsource KY 61127 COMMERCIAL NHealthsource ME 1041 COMMERCIAL PHealthsource ME 1041 COMMERCIAL P

Healthsource N. TX (CIGNA) 75255 COMMERCIAL N



62308.

Healthsource N. TX (CIGNA) 75255 COMMERCIAL N



62308.

Healthsource NC (CIGNA) 56147 COMMERCIAL N



62308.

Healthsource NC (CIGNA) 56147 COMMERCIAL N



62308.Healthsource NH 2038 COMMERCIAL NHealthsource NH 2038 COMMERCIAL NHealthsource OH 31141 COMMERCIAL NHealthsource OH 31141 COMMERCIAL N


Page 54


January 2011


Healthsource SC 6119 COMMERCIAL N

Healthsource Network Providers

Only

Healthsource SC 6119 COMMERCIAL N

Healthsource Network Providers

Only

Healthsource TN (CIGNA) 62129 COMMERCIAL N



62308.

Healthsource TN (CIGNA) 62129 COMMERCIAL N



62308.Healthways WholeHealth Networks 58213 COMMERCIAL NHealthways WholeHealth Networks 58213 COMMERCIAL N

Heritage Consultants 59230 COMMERCIAL N

For faster payment please be sure

to use only the 9-digit subscriber

ID on all claims.

Heritage Consultants 59230 COMMERCIAL N

For faster payment please be sure

to use only the 9-digit subscriber

ID on all claims.Heritage Physician Network TH011 COMMERCIAL NHeritage Physician Network TH011 COMMERCIAL NHeritage Provider Network DESRT COMMERCIAL NHeritage Provider Network DESRT COMMERCIAL NHeritage Provider Network REGAL COMMERCIAL NHeritage Provider Network REGAL COMMERCIAL NHewittt Coleman 88051 COMMERCIAL NHewittt Coleman 88051 COMMERCIAL NHigh Desert Primary Care 33069 COMMERCIAL NHigh Desert Primary Care 33069 COMMERCIAL NHighmark- Key Family 35145 COMMERCIAL NHighmark- Key Family 35145 COMMERCIAL NHill Physicians Medical Group 46 COMMERCIAL NHill Physicians Medical Group 46 COMMERCIAL NHinsdale Physician Healthcare 36385 COMMERCIAL NHinsdale Physician Healthcare 36385 COMMERCIAL NHispanic Physicians IPA HPIPA COMMERCIAL NHispanic Physicians IPA HPIPA COMMERCIAL NHollywood Presbyterian (Synermed) SYMED COMMERCIAL NHollywood Presbyterian (Synermed) SYMED COMMERCIAL NHoly Cross Health Partners 36412 COMMERCIAL NHoly Cross Health Partners 36412 COMMERCIAL NHometown Health Plan Nevada 88023 COMMERCIAL NHometown Health Plan Nevada 88023 COMMERCIAL NHometown Health Providers 88537 COMMERCIAL NHometown Health Providers 88537 COMMERCIAL NHorizon HealthCare Admin (HHA) 22304 COMMERCIAL NHorizon HealthCare Admin (HHA) 22304 COMMERCIAL N

Horizon NJ Health 22326 COMMERCIAL N



[email protected] ;

Formerly Horizon Mercy Health

Plan


Page 55


January 2011


Horizon NJ Health 22326 COMMERCIAL N



[email protected] ;

Formerly Horizon Mercy Health

PlanHospital Benefits Inc. 37274 COMMERCIAL NHospital Benefits Inc. 37274 COMMERCIAL N

Hotel Employees & Restaurant Employees Health Trust91136 COMMERCIAL N



Hotel Employees & Restaurant Employees Health Trust91136 COMMERCIAL N


when submitting claims.Hudson Health Plan 13335 COMMERCIAL RHudson Health Plan 13335 COMMERCIAL RHumana Dermatology - New Century Health NCH02 COMMERCIAL NHumana Dermatology - New Century Health NCH02 COMMERCIAL NHumana Emphesys 61101 COMMERCIAL NHumana Emphesys 61101 COMMERCIAL NHumana Employers Health Insurance 61101 COMMERCIAL NHumana Employers Health Insurance 61101 COMMERCIAL NHumana Inc. 61101 COMMERCIAL NHumana Inc. 61101 COMMERCIAL N

Humana Insurance Company Choice Care Network 61101 COMMERCIAL N

Does not include Humana

ChoiceCare of Cincinnati -

(Humana Health Plans of Ohio)

Humana Insurance Company Choice Care Network 61101 COMMERCIAL N

Does not include Humana

ChoiceCare of Cincinnati -

(Humana Health Plans of Ohio)Humana Veterans Healthcare Services 61160 COMMERCIAL NHumana Veterans Healthcare Services 61160 COMMERCIAL NHumboldt-Del Norte Foundation for Medical Care 94154 COMMERCIAL NHumboldt-Del Norte Foundation for Medical Care 94154 COMMERCIAL NI'Mcare 41600 COMMERCIAL NI'Mcare 41600 COMMERCIAL NI. E. Shaffer (West Trenton NJ) 22175 COMMERCIAL NI. E. Shaffer (West Trenton NJ) 22175 COMMERCIAL NIAA 37279 COMMERCIAL NIAA 37279 COMMERCIAL N

IHG Direct 75274 COMMERCIAL N

Valid for claims with the following

mailing address: P.O. Box 2388

Stow OH 44224

IHG Direct 75274 COMMERCIAL N

Valid for claims with the following

mailing address: P.O. Box 2388

Stow OH 44224

IHS Networks - 1 Call COMMERCIAL N

Call Jessica Picarde at Provider

relations (410) 349-3222 to

acquire payer id information.


Page 56


January 2011


IHS Networks - 1 Call COMMERCIAL N

Call Jessica Picarde at Provider

relations (410) 349-3222 to

acquire payer id information.IMS Management Services TH099 COMMERCIAL NIMS Management Services TH099 COMMERCIAL NIMX Easy 86070 COMMERCIAL NIMX Easy 86070 COMMERCIAL NINDECS Corporation 40585 COMMERCIAL NINDECS Corporation 40585 COMMERCIAL NINETICO INC. 43471 COMMERCIAL NINTERNATIONAL FUNDING LTD 39182 COMMERCIAL NINTERNATIONAL FUNDING LTD 39182 COMMERCIAL N

INTGRITAS BENEFIT GROUP 20435 COMMERCIAL N


Payer.IU Medical Group Primary Care SX172 COMMERCIAL NIU Medical Group Primary Care SX172 COMMERCIAL NIllinois Health Solutions 86069 COMMERCIAL NIllinois Health Solutions 86069 COMMERCIAL N

Imperial County Physicians Medical Group Call COMMERCIAL N





Imperial County Physicians Medical Group Call COMMERCIAL N




7100 [email protected] Medical Group MHM01 COMMERCIAL NIndependence Medical Group MHM01 COMMERCIAL NIndependence Medical Group - Tulare 26274 COMMERCIAL NIndependence Medical Group - Tulare 26274 COMMERCIAL NIndependent Health SX073 COMMERCIAL PIndependent Health SX073 COMMERCIAL P

Indian Health Services SX171 COMMERCIAL N

Enrollment is required. Providers

should contact BCBSNM

Customer Service Department at

1-800-225-0241

Indian Health Services SX171 COMMERCIAL N

Enrollment is required. Providers

should contact BCBSNM


1-800-225-0241Indiana Department of Health - Children's Health - Claims35600 COMMERCIAL RIndiana Department of Health - Children's Health - Claims35600 COMMERCIAL RIndiana ProHealth Network 35161 COMMERCIAL NIndiana ProHealth Network 35161 COMMERCIAL N

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

Formerly known as Local 135

Health Benefits Fund

(Indianapolis IN)


Page 57


January 2011


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

Formerly known as Local 135

Health Benefits Fund

(Indianapolis IN)

Individual Health Insurance Companies 31053 COMMERCIAL N

Payer ID 31053 is for State Farm -

Health line of business.

Individual Health Insurance Companies 31053 COMMERCIAL N


Health line of business.Informed LLC 52196 COMMERCIAL NInformed LLC 52196 COMMERCIAL NIngalls Provider Group 36348 COMMERCIAL NIngalls Provider Group 36348 COMMERCIAL N

Injured Workers Insurance Fund 52212 COMMERCIAL N

Injured Workers Insurance Fund

requires first time submitters to

contact Grace Sobrio at (410) 494-

2045 prior to submitting claims.

Injured Workers Insurance Fund 52212 COMMERCIAL N

Injured Workers Insurance Fund

requires first time submitters to

contact Grace Sobrio at (410) 494-

2045 prior to submitting claims.Inland Empire Health Plan IEHP1 COMMERCIAL NInland Empire Health Plan IEHP1 COMMERCIAL NInnovante Benefit Administrators 31172 COMMERCIAL NInnovante Benefit Administrators 31172 COMMERCIAL N

Innovative Healthware Services Call COMMERCIAL N


Jessica Picarde at (410) 349-3222

to obtain Payer ID

Innovative Healthware Services Inc. Call COMMERCIAL N

Before submitting contact Jessica

Picarde at (410) 349-3222

Innovative Healthware Services Inc. Call COMMERCIAL N


Picarde at (410) 349-3222Insurance Administrators of America Inc. 37279 COMMERCIAL NInsurance Administrators of America Inc. 37279 COMMERCIAL NInsurance Design Administrators 13315 COMMERCIAL NInsurance Design Administrators 13315 COMMERCIAL N

Insurance Management Services (Amarillo TX) 15688 COMMERCIAL N

This Payer ID is only valid for

claims with submission address of

P.O. Box 15688; Amarillo TX

79105

Insurance Management Services (Amarillo TX) 15688 COMMERCIAL N

This Payer ID is only valid for

claims with submission address of

P.O. Box 15688; Amarillo TX

79105Insurance Services of Lubbock TH012 COMMERCIAL NInsurance Services of Lubbock TH012 COMMERCIAL NInsurdata/Insurnational SX011 COMMERCIAL N


Page 58


January 2011

Payer ID State Model Enroll Additional InformationInsurdata/Insurnational SX011 COMMERCIAL N

Insurers Administrative Corp. 86304 COMMERCIAL N

Please visit website prior to

submitting claims:

edihelp.iacusa.com

Insurers Administrative Corp. 86304 COMMERCIAL N

Please visit website prior to

submitting claims:

edihelp.iacusa.com

Integra Administrative Group (Seaford DE) 51020 COMMERCIAL N



110 S. Shipley Street Seaford DE

19973.

Integra Administrative Group (Seaford DE) 51020 COMMERCIAL N



110 S. Shipley Street Seaford DE

19973.Integra Group 31127 COMMERCIAL NIntegra Group 31127 COMMERCIAL NIntegra Group-CHA 31129 COMMERCIAL NIntegra Group-CHA 31129 COMMERCIAL NIntegrated Care Network (ICN) by Emerald Health 34167 COMMERCIAL NIntegrated Care Network (ICN) by Emerald Health 34167 COMMERCIAL N

Integrated Mental Health Services 68053 COMMERCIAL N








Integrated Mental Health Services 68053 COMMERCIAL N







be made in a timely manner.InterCare Health Plans Inc. 37227 COMMERCIAL NInterCare Health Plans Inc. 37227 COMMERCIAL NInterWest Health (Acceptius Gateway payer) 84137 COMMERCIAL NInterWest Health (Acceptius Gateway payer) 84137 COMMERCIAL NInterface EAP (IEAP) 60280 COMMERCIAL NInterface EAP (IEAP) 60280 COMMERCIAL NIntergroup Services Corporation 23287 COMMERCIAL NIntergroup Services Corporation 23287 COMMERCIAL NInternational Brotherhood of Boilermakers 36609 COMMERCIAL NInternational Brotherhood of Boilermakers 36609 COMMERCIAL NInternational Brotherhood of Boilermakers Employee Health Care Plan(IBBEHC)48603 COMMERCIAL NInternational Brotherhood of Boilermakers Employee Health Care Plan(IBBEHC)48603 COMMERCIAL NInternational Educational Exchange Services Inc. (IEES)16158 COMMERCIAL NInternational Educational Exchange Services Inc. (IEES)16158 COMMERCIAL N


Page 59


January 2011

Payer ID State Model Enroll Additional InformationInternational Medical Group TH105 COMMERCIAL NInternational Medical Group TH105 COMMERCIAL NIowa Health Solutions 86068 COMMERCIAL NIowa Health Solutions 86068 COMMERCIAL NJ. F. Molloy and Associates Inc. 61271 COMMERCIAL NJ. F. Molloy and Associates Inc. 61271 COMMERCIAL NJ. Smith Lanier & Co. Administrators 37272 COMMERCIAL NJ. Smith Lanier & Co. Administrators 37272 COMMERCIAL NJI Specialties TH033 COMMERCIAL NJI Specialties TH033 COMMERCIAL NJMH - SFCCN PHT (PSN CMSN) 9822 COMMERCIAL NJMH - SFCCN PHT (PSN CMSN) 9822 COMMERCIAL NJMH HEALTH PLAN COMMERCIAL HMO 5014 COMMERCIAL NJMH HEALTH PLAN COMMERCIAL HMO 5014 COMMERCIAL NJOHN MORRELL COMPANY CO. - AHPBA 38310 COMMERCIAL NJOHN MORRELL COMPANY CO. - AHPBA 38310 COMMERCIAL N

JOHN MUIR TRAUMA PHYSICIANS Call COMMERCIAL N

Please contact John Muir Trauma

Physicians at 925-947-5288 for

Payer id information.

JOHN MUIR TRAUMA PHYSICIANS Call COMMERCIAL N

Please contact John Muir Trauma

Physicians at 925-947-5288 for

Payer id information.JP Farley Corporation 34136 COMMERCIAL NJP Farley Corporation 34136 COMMERCIAL NJSL Administrators 37272 COMMERCIAL NJSL Administrators 37272 COMMERCIAL NJohn Alden Life Insurance Co. 41099 COMMERCIAL NJohn Alden Life Insurance Co. 41099 COMMERCIAL N

John Muir Mt. Diablo Health System 68036 COMMERCIAL N

Providers who have never

submitted claims to John Muir

are required to register Tax ID

prior to initial claims submission.

Please fax W-9 along with contact

name and number to the

attention of Patty Kan at (925)

941-2026. Allow 2 days for

processing bef

John Muir Mt. Diablo Health System 68036 COMMERCIAL N









processing bef


Page 60


January 2011


John Muir Physician Network 68036 COMMERCIAL N









processing bef

John Muir Physician Network 68036 COMMERCIAL N









processing bef

Johns Hopkins Healthcare (EHP/PP) 52189 COMMERCIAL P

New submitters should send in

their Billing NPI and

Rending/Servicing NPI.

Johns Hopkins Healthcare (EHP/PP) 52189 COMMERCIAL P




Johns Hopkins Healthcare (USFHP) 52123 COMMERCIAL N




Johns Hopkins Healthcare (USFHP) 52123 COMMERCIAL N




Jopari Careworks J1410 COMMERCIAL N

The above Payer Name(s) may

represent multiple Accounts

(employers). For a complete list

please refer directly to Emdeon's

published Payer List at:

www.emdeon.com/PayerLists/pa

yerlists.php Search the Payer List

using the above Payer ID(s) to

identify the


Page 61


January 2011


Jopari Careworks J1410 COMMERCIAL N









identify theJoplin Claims 43178 COMMERCIAL NJoplin Claims 43178 COMMERCIAL NKEY GAP 35317 COMMERCIAL NKEY GAP 35317 COMMERCIAL NKPS-Kitsap Physician Services KPS01 COMMERCIAL NKPS-Kitsap Physician Services KPS01 COMMERCIAL NKaiser CSI-California Select for Individuals (formerly known as Kaiser PPO)94320 COMMERCIAL NKaiser CSI-California Select for Individuals (formerly known as Kaiser PPO)94320 COMMERCIAL NKaiser Foundation Health Plan of Colorado 91617 COMMERCIAL NKaiser Foundation Health Plan of Colorado 91617 COMMERCIAL N

Kaiser Foundation Health Plan of Northern CA Region94135 COMMERCIAL N

Please call (510) 987-4639 for

approval prior to submitting

Northern California referral

claims.

Kaiser Foundation Health Plan of Northern CA Region94135 COMMERCIAL N

Please call (510) 987-4639 for

approval prior to submitting

Northern California referral

claims.

Kaiser Foundation Health Plan of Ohio 34092 COMMERCIAL N

Kaiser Ohio will be receiving

Extend Content. E-tactic Billing

Service participating in Pilot.

Kaiser Foundation Health Plan of Ohio 34092 COMMERCIAL N

Kaiser Ohio will be receiving

Extend Content. E-tactic Billing

Service participating in Pilot.

Kaiser Foundation Health Plan of Southern CA Region94134 COMMERCIAL N

For more information please call

(866) 285-0361

Kaiser Foundation Health Plan of Southern CA Region94134 COMMERCIAL N

For more information please call

(866) 285-0361

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

For more information please

contact Kenya Neal at Kaiser at

(301) 625-2264.

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

For more information please

contact Kenya Neal at Kaiser at

(301) 625-2264.

Kaiser Foundation of the Northwest 93079 COMMERCIAL N

This payer id can only be used to

submit claims for Oregon and

Washington Kaiser Permanente

members.


Page 62


January 2011


Kaiser Foundation of the Northwest 93079 COMMERCIAL N

This payer id can only be used to

submit claims for Oregon and

Washington Kaiser Permanente

members.Kaiser Permanente of Georgia 21313 COMMERCIAL NKaiser Permanente of Georgia 21313 COMMERCIAL NKanawha HealthCare Solutions Inc. 57038 COMMERCIAL NKanawha HealthCare Solutions Inc. 57038 COMMERCIAL NKanawha Insurance Co. 57038 COMMERCIAL NKanawha Insurance Co. 57038 COMMERCIAL NKaty Medical Claims 81812 COMMERCIAL NKaty Medical Claims 81812 COMMERCIAL NKaweah Delta TKFMC COMMERCIAL NKaweah Delta TKFMC COMMERCIAL NKempton Company 73100 COMMERCIAL NKempton Company 73100 COMMERCIAL NKempton Group Administrators 73100 COMMERCIAL NKempton Group Administrators 73100 COMMERCIAL NKern County CDCR 28021 COMMERCIAL NKern County CDCR 28021 COMMERCIAL NKern Health Systems 77039 COMMERCIAL NKern Health Systems 77039 COMMERCIAL N

Key Benefit Administrators (Indianapolis IN) 37217 COMMERCIAL N

MUST VERIFY AL CLAIMS SHOULD

GO TO PAYER IN INDIANAPOLIS IN

Key Benefit Administrators (Indianapolis IN) 37217 COMMERCIAL N

MUST VERIFY AL CLAIMS SHOULD

GO TO PAYER IN INDIANAPOLIS INKey Health Pilot COMMERCIAL NKey Health Pilot COMMERCIAL NKey Medical Group IP082 COMMERCIAL NKey Medical Group IP082 COMMERCIAL NKey Select 37321 COMMERCIAL NKey Select 37321 COMMERCIAL N

Keystone Mercy Health Plan 23284 COMMERCIAL N



[email protected].

Keystone Mercy Health Plan 23284 COMMERCIAL N



[email protected] & Company 34145 COMMERCIAL NKlais & Company 34145 COMMERCIAL N

Klais & Company (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Klais & Company (Ohio BWC) 31147 COMMERCIAL N


ONLY.Korean American Medical Group 66123 COMMERCIAL NLA Care Health Plan LACAR COMMERCIAL NLA Care Health Plan LACAR COMMERCIAL NLBA Health Plans 52193 COMMERCIAL NLBA Health Plans 52193 COMMERCIAL NLHP Claims Unit 37248 COMMERCIAL N


Page 63


January 2011

Payer ID State Model Enroll Additional InformationLHP Claims Unit 37248 COMMERCIAL NLIPA/Agate Resources TH106 COMMERCIAL NLIPA/Agate Resources TH106 COMMERCIAL NLake County Physicians Association 37116 COMMERCIAL NLake County Physicians Association 37116 COMMERCIAL NLakeside Comprehensive Healthcare 66127 COMMERCIAL NLakeside Comprehensive Healthcare 66127 COMMERCIAL NLakeside Health Services LMG11 COMMERCIAL NLakeside Health Services LMG11 COMMERCIAL N

Lancaster General Health Group - Preferred Health Care (IHS Payer)Call COMMERCIAL N

Contact Sherry Wolgemuth Vice

President of Claims Operations

for Preferred Health Care at (717)

560-9290 ext. 124 for approval

and the Payer ID.

Lancaster General Health Group - Preferred Health Care (IHS Payer)Call COMMERCIAL N





and the Payer ID.Landmark Healthcare Inc LNDMK COMMERCIAL NLandmark Healthcare Inc LNDMK COMMERCIAL NLawndale Christian Health Center 36333 COMMERCIAL NLawndale Christian Health Center 36333 COMMERCIAL NLeon Medical Center Health Plan 37316 COMMERCIAL NLeon Medical Center Health Plan 37316 COMMERCIAL NLiberty Health Advantage 87071 COMMERCIAL NLiberty Health Advantage 87071 COMMERCIAL NLiberty Union 37281 COMMERCIAL NLiberty Union 37281 COMMERCIAL NLife Assurance Company 37281 COMMERCIAL NLife Assurance Company 37281 COMMERCIAL NLife Investors Insurance TH120 COMMERCIAL NLife Investors Insurance TH120 COMMERCIAL NLife Investors of America - Long Term Care TH093 COMMERCIAL NLife Investors of America - Long Term Care TH093 COMMERCIAL NLife Trac 41136 COMMERCIAL NLife Trac 41136 COMMERCIAL N

LifeWise Healthplan of Oregon 93093 COMMERCIAL R

Payer EDI agreement must be

processed thru Emdeon's

Enrollment Dpt. Do not send EDI

Agreement to Payer. Applies to all

providers (including those adding

site id's) enrolling for Electronic

submission thru WebMD.

Questions: (800) 845-6592


Page 64


January 2011


LifeWise Healthplan of Oregon 93093 COMMERCIAL R


processed thru Emdeon's



providers (including those adding

site id's) enrolling for Electronic


Questions: (800) 845-6592

Lifewise Health Plan of Arizona 91155 COMMERCIAL R


processed thru Emdeons



providers (incl. those adding site

ids) enrolling for Electronic


Questions: (800) 845-6592

Lifewise Health Plan of Arizona 91155 COMMERCIAL R


processed thru Emdeons



providers (incl. those adding site

ids) enrolling for Electronic


Questions: (800) 845-6592Local 135 Health Benefits Fund (Indianapolis IN) 35107 COMMERCIAL NLocal 135 Health Benefits Fund (Indianapolis IN) 35107 COMMERCIAL NLoma Linda University Adventist Health Sciences Center Employee Health Plan37267 COMMERCIAL NLoma Linda University Adventist Health Sciences Center Employee Health Plan37267 COMMERCIAL NLoma Linda University Adventist Health Sciences Centers37267 COMMERCIAL NLoma Linda University Adventist Health Sciences Centers37267 COMMERCIAL NLoma Linda University Behavioral Medicine Center Employee Health Plan37267 COMMERCIAL NLoma Linda University Behavioral Medicine Center Employee Health Plan37267 COMMERCIAL NLoma Linda University Employee Health Plan 37267 COMMERCIAL NLoma Linda University Employee Health Plan 37267 COMMERCIAL NLoma Linda University Health Care Employee Health Plan37267 COMMERCIAL NLoma Linda University Health Care Employee Health Plan37267 COMMERCIAL N

Loma Linda University Healthcare - ManagedCare Claims33036 COMMERCIAL N


the payer.

Loma Linda University Healthcare - ManagedCare Claims33036 COMMERCIAL N


the payer.Loma Linda University Medical Center Employee Health Plan37267 COMMERCIAL NLoma Linda University Medical Center Employee Health Plan37267 COMMERCIAL NLoma Linda University Medical Center Residents Health Plan37267 COMMERCIAL NLoma Linda University Medical Center Residents Health Plan37267 COMMERCIAL NLoma Linda University Student Health Plan 37267 COMMERCIAL NLoma Linda University Student Health Plan 37267 COMMERCIAL NLovelace Salud SX159 COMMERCIAL NLovelace Salud SX159 COMMERCIAL NLovelace Sandia Health Plan 90328 COMMERCIAL N


Page 65


January 2011

Payer ID State Model Enroll Additional InformationLovelace Sandia Health Plan 90328 COMMERCIAL NMAMSI Life and Health Insurance Co. (MLH) 52148 COMMERCIAL NMAMSI Life and Health Insurance Co. (MLH) 52148 COMMERCIAL NMBA Benefit Administrators Inc. 83028 COMMERCIAL NMBA Benefit Administrators Inc. 83028 COMMERCIAL N

MBA Benefit Administrators Inc. (Salt Lake City UT) 87065 COMMERCIAL N



651109 Salt Lake City UT 84115

MBA Benefit Administrators Inc. (Salt Lake City UT) 87065 COMMERCIAL N



651109 Salt Lake City UT 84115

MBA of Wyoming (Worland WY) 87065 COMMERCIAL N


submission address of PO Box 98

Worland WY 82401

MBA of Wyoming (Worland WY) 87065 COMMERCIAL N


submission address of PO Box 98

Worland WY 82401MBS 56205 COMMERCIAL N Formerly Payer ID 56151MBS 56205 COMMERCIAL N Formerly Payer ID 56151MCA ADMINISTRATORS 25160 COMMERCIAL NMCA ADMINISTRATORS 25160 COMMERCIAL NMCOA 88054 COMMERCIAL NMCOA 88054 COMMERCIAL NMD - Individual Practice Association Inc. (M.D. IPA) 52148 COMMERCIAL NMD - Individual Practice Association Inc. (M.D. IPA) 52148 COMMERCIAL NMDWise Hoosier Alliance 20475 COMMERCIAL NMDWise Hoosier Alliance 20475 COMMERCIAL NMEDICA HEALTH CARE PLAN INC. 78857 COMMERCIAL NMEDICA HEALTH CARE PLAN INC. 78857 COMMERCIAL NMEDICAL DEVELOPMENT INTERNATIONAL 52181 COMMERCIAL NMEDICAL DEVELOPMENT INTERNATIONAL 52181 COMMERCIAL NMEMIC 1047 COMMERCIAL NMEMIC 1047 COMMERCIAL N

MEMORIAL INTEGRATED HEALTHCARE Call COMMERCIAL N

PLEASE EMAIL TRACY HARSWICK

AT [email protected] FOR

PAYER ID INFORMATION

MEMORIAL INTEGRATED HEALTHCARE Call COMMERCIAL N

PLEASE EMAIL TRACY HARSWICK

AT [email protected] FOR

PAYER ID INFORMATIONMFC & HealthPlus Peoria 23550 COMMERCIAL NMFC & HealthPlus Peoria 23550 COMMERCIAL NMHP Systems 64068 COMMERCIAL NMHP Systems 64068 COMMERCIAL NMIPS 5018 COMMERCIAL NMIPS 5018 COMMERCIAL NMMA 35316 COMMERCIAL NMMA 35316 COMMERCIAL N

MMAC (Managed Medical Assurance Co. Ltd.) (Ohio BWC)31147 COMMERCIAL N


ONLY.


Page 66


January 2011


MMAC (Managed Medical Assurance Co. Ltd.) (Ohio BWC)31147 COMMERCIAL N


ONLY.

MMSI 41154 COMMERCIAL N Mayo Management Services Inc.

MMSI 41154 COMMERCIAL N Mayo Management Services Inc.MORRIS ASSOCIATES 35092 COMMERCIAL NMORRIS ASSOCIATES 35092 COMMERCIAL NMPA-Custom Provider Network 80900 COMMERCIAL NMPA-Custom Provider Network 80900 COMMERCIAL NMPE Services Inc. 37233 COMMERCIAL NMPE Services Inc. 37233 COMMERCIAL NMPEEBT 37233 COMMERCIAL NMPEEBT 37233 COMMERCIAL NMVP Health Plan of NY 14165 COMMERCIAL NMVP Health Plan of NY 14165 COMMERCIAL N

MVP Health Rochester SX089 COMMERCIAL N

Formerly known as Preferred

Care NY

MVP Health Rochester SX089 COMMERCIAL N

Formerly known as Preferred

Care NYMacNeal Health Providers- CHS 36334 COMMERCIAL NMacNeal Health Providers- CHS 36334 COMMERCIAL NMagellan Health Services 1260 COMMERCIAL NMagellan Health Services 1260 COMMERCIAL NMagnacare 11303 COMMERCIAL NMagnacare 11303 COMMERCIAL N

Mail Handlers Benefit Plan 25133 COMMERCIAL N




Plan. a.k.a. Mailhandlers CAC.

Mail Handlers Benefit Plan 25133 COMMERCIAL N




Plan. a.k.a. Mailhandlers CAC.Maksin Management Corporation 22195 COMMERCIAL NMaksin Management Corporation 22195 COMMERCIAL NManaged Care Services LLC 35162 COMMERCIAL NManaged Care Services LLC 35162 COMMERCIAL NManaged Care Systems (Delano Regional Medical Group)MCS02 COMMERCIAL NManaged Care Systems (Delano Regional Medical Group)MCS02 COMMERCIAL NManaged Care Systems (Gemcare) MCS01 COMMERCIAL NManaged Care Systems (Gemcare) MCS01 COMMERCIAL NManaged Health Network 22771 COMMERCIAL NManaged Health Network 22771 COMMERCIAL N

Managed Health Services Indiana (Medicaid HMO) 39186 COMMERCIAL P


call Provider Relations Dept at

877.647.4848 to verify your






Page 67


January 2011


Managed Health Services Indiana (Medicaid HMO) 39186 COMMERCIAL P


call Provider Relations Dept at

877.647.4848 to verify your





Managed Health Services Wisconsin 39187 COMMERCIAL P








Managed Health Services Wisconsin 39187 COMMERCIAL P







be made in a timely manner.Managed Physical Network 41159 COMMERCIAL NManaged Physical Network 41159 COMMERCIAL NManatee Service Center (Bradenton FL) 41555 COMMERCIAL NManatee Service Center (Bradenton FL) 41555 COMMERCIAL NManulife W. J. Sutton Company 98010 COMMERCIAL NManulife W. J. Sutton Company 98010 COMMERCIAL NMarquette Life Insurance Company 48055 COMMERCIAL NMarquette Life Insurance Company 48055 COMMERCIAL NMarsh Advantage 13310 COMMERCIAL NMarsh Advantage 13310 COMMERCIAL NMaryland Medicaid SKMD0 COMMERCIAL AMaryland Medicaid SKMD0 COMMERCIAL A

Maryland Physicians Care 22348 COMMERCIAL N

Rendering provider id must

contain 1D qualifier. Payer

accepts zero dollar service line

charges. Payer Registration not

required. Autoenroll payer.

Maryland Physicians Care 22348 COMMERCIAL N

Rendering provider id must

contain 1D qualifier. Payer

accepts zero dollar service line

charges. Payer Registration not

required. Autoenroll payer.Mashantucket Pequot Tribal Nation 37121 COMMERCIAL NMashantucket Pequot Tribal Nation 37121 COMMERCIAL NMaster Mates & Pilots Program TH111 COMMERCIAL NMaster Mates & Pilots Program TH111 COMMERCIAL N


Page 68


January 2011

Payer ID State Model Enroll Additional InformationMcKinley Medical Group MHM02 COMMERCIAL NMcKinley Medical Group MHM02 COMMERCIAL NMdwis-HIP MDWIS COMMERCIAL NMdwis-HIP MDWIS COMMERCIAL NMedAdmin Solutions 58202 COMMERCIAL NMedAdmin Solutions 58202 COMMERCIAL NMedAdmin Solutions 58204 COMMERCIAL NMedAdmin Solutions 58204 COMMERCIAL NMedBen (Newark OH) 74323 COMMERCIAL NMedBen (Newark OH) 74323 COMMERCIAL NMedCom 59231 COMMERCIAL NMedCom 59231 COMMERCIAL N

MedCost Inc. 56162 COMMERCIAL N

For questions on claim

submission please contact

Customer Service 800-824-7406

MedCost Inc. 56162 COMMERCIAL N

For questions on claim

submission please contact

Customer Service 800-824-7406MedDirect 38353 COMMERCIAL NMedDirect 38353 COMMERCIAL NMedPartners 35205 COMMERCIAL NMedPartners Administrative Services 35205 COMMERCIAL NMedSolutions Inc 62160 COMMERCIAL NMedSolutions Inc 62160 COMMERCIAL NMedfocus 95321 COMMERCIAL NMedfocus 95321 COMMERCIAL NMedica 94265 COMMERCIAL NMedica 94265 COMMERCIAL NMedicaid Hawaii Waivers 77059 COMMERCIAL RMedicaid Hawaii Waivers 77059 COMMERCIAL R

Medical Administrators Inc. (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Medical Administrators Inc. (Ohio BWC) 31147 COMMERCIAL N


ONLY.Medical Benefit Administrators Inc/dba MBA of MD Inc37298 COMMERCIAL NMedical Benefit Administrators Inc/dba MBA of MD Inc37298 COMMERCIAL NMedical Benefits Administration MBA01 COMMERCIAL NMedical Benefits Administration MBA01 COMMERCIAL NMedical Benefits Administrators Inc. (Newark OH) 74323 COMMERCIAL NMedical Benefits Administrators Inc. (Newark OH) 74323 COMMERCIAL NMedical Benefits Companies (Newark OH) 74323 COMMERCIAL NMedical Benefits Companies (Newark OH) 74323 COMMERCIAL NMedical Benefits Mutual (Newark OH) 74323 COMMERCIAL NMedical Benefits Mutual (Newark OH) 74323 COMMERCIAL NMedical Benefits Mutual Life Insrance Co. 74323 COMMERCIAL NMedical Benefits Mutual Life Insrance Co. 74323 COMMERCIAL NMedical Claims Service Inc. 4258 COMMERCIAL NMedical Claims Service Inc. 4258 COMMERCIAL NMedical Mutual of Ohio 29076 COMMERCIAL NMedical Mutual of Ohio 29076 COMMERCIAL N


Page 69


January 2011

Payer ID State Model Enroll Additional InformationMedical Network of Colorado Springs 84600 COMMERCIAL NMedical Network of Colorado Springs 84600 COMMERCIAL NMedical Partners of America 80026 COMMERCIAL NMedical Partners of America 80026 COMMERCIAL NMedical Reimbursements of America 62177 COMMERCIAL NMedical Reimbursements of America 62177 COMMERCIAL NMedical Services Initiative 12057 COMMERCIAL NMedical Services Initiative 12057 COMMERCIAL NMedical Value Plan - Ohio (MVP) 38224 COMMERCIAL NMedical Value Plan - Ohio (MVP) 38224 COMMERCIAL N

Mega Life & Health Insurance Company - Insurance Center59221 COMMERCIAL N





Mega Life & Health Insurance Company - Insurance Center59221 COMMERCIAL N




North Richland Hills TX 76182.Memorial Clinical Associates/ SelectCare of Texas (MCA)62181 COMMERCIAL NMemorial Clinical Associates/ SelectCare of Texas (MCA)62181 COMMERCIAL NMemorial Herman Health Network Providers TH092 COMMERCIAL NMemorial Herman Health Network Providers TH092 COMMERCIAL N

Memorial PSN/CMS Call COMMERCIAL N

Please contact Memorial

Enrollment department at 954-

276-3176 for payer ID

information.

Memorial PSN/CMS Call COMMERCIAL N

Please contact Memorial

Enrollment department at 954-

276-3176 for payer ID

information.Mennonite Mutual Aid Association and Affiliates (MMA)35605 COMMERCIAL NMennonite Mutual Aid Association and Affiliates (MMA)35605 COMMERCIAL NMercer Administrators 13310 COMMERCIAL NMercer Administrators 13310 COMMERCIAL NMercy Care Plan (AHCCCS) 86052 COMMERCIAL NMercy Care Plan (AHCCCS) 86052 COMMERCIAL NMercy Health Plans 43166 COMMERCIAL NMercy Health Plans 43166 COMMERCIAL N

MercyCare Call COMMERCIAL N

Please call 608-758-7739 for

payer id.

MercyCare Call COMMERCIAL N

Please call 608-758-7739 for

payer id.Meridian Health Plan 13189 COMMERCIAL NMeridian Health Plan 13189 COMMERCIAL N

Meritain Health / Agency Services 64158 COMMERCIAL N

Formerly know as Agency Services

Inc.

Meritain Health / Agency Services 64158 COMMERCIAL N

Formerly know as Agency Services

Inc.Meritain Health Minneapolis 41124 COMMERCIAL NMeritain Health Minneapolis 41124 COMMERCIAL N


Page 70


January 2011


Meritain Health/North American Administrators 64157 COMMERCIAL N

Formerly know as North

American Administrators Inc.

Meritain Health/North American Administrators 64157 COMMERCIAL N

Formerly know as North

American Administrators Inc.Mesa Mental Health 85035 COMMERCIAL NMesa Mental Health 85035 COMMERCIAL NMethodist Associate Health Plan Pilot COMMERCIAL NMethodist Associate Health Plan Pilot COMMERCIAL N

MetroPlus Health Plan 13265 COMMERCIAL N

Registration and submission of

the Billing Provider's NPI is

required. If you have not

registered please contact MHP


9626. Claims will reject if the NPI

is not registered and/or

submitted on claims sent

electronically.

MetroPlus Health Plan 13265 COMMERCIAL N

Registration and submission of

the Billing Provider's NPI is

required. If you have not

registered please contact MHP


9626. Claims will reject if the NPI

is not registered and/or

submitted on claims sent

electronically.Metropolitan Health Plan 10850 COMMERCIAL NMetropolitan Health Plan 10850 COMMERCIAL NMetrowest HealthPlan TH068 COMMERCIAL NMetrowest HealthPlan TH068 COMMERCIAL NMetrowest Star Medicaid TH069 COMMERCIAL NMetrowest Star Medicaid TH069 COMMERCIAL NMichael Reese Physicians Group 37127 COMMERCIAL NMichael Reese Physicians Group 37127 COMMERCIAL NMid Atlantic Psychiatric Services Inc. (MAPSI) 52149 COMMERCIAL NMid Atlantic Psychiatric Services Inc. (MAPSI) 52149 COMMERCIAL NMid-America Associates Inc. 37281 COMMERCIAL NMid-America Associates Inc. 37281 COMMERCIAL NMid-County Physicians Medical Group (San Diego) (Synermed)SYMED COMMERCIAL NMid-County Physicians Medical Group (San Diego) (Synermed)SYMED COMMERCIAL N

Mid-West National Life Insurance Co. of Tennessee - Insurance Center59224 COMMERCIAL N





Mid-West National Life Insurance Co. of Tennessee - Insurance Center59224 COMMERCIAL N






Page 71


January 2011


Mid-West National Life Insurance Co. of Tennessee - Student Insurance74227 COMMERCIAL N

Payer ID only valid if the P.O. Box


one of the following P.O. Boxes:

P.O. Box 890025 809067 809079

809066 809036 809081 Dallas Tx

75380-9025.

Mid-West National Life Insurance Co. of Tennessee - Student Insurance74227 COMMERCIAL N




P.O. Box 890025 809067 809079

809066 809036 809081 Dallas Tx

75380-9025.MidCoast IPA 77012 COMMERCIAL NMidCoast IPA 77012 COMMERCIAL NMidlands Choice Inc. 47080 COMMERCIAL NMidlands Choice Inc. 47080 COMMERCIAL NMidwest Health Partners 76079 COMMERCIAL NMidwest Health Partners 76079 COMMERCIAL N

Midwest Health Plans Inc. TH074 COMMERCIAL P

Accepts NPI only. Require the

billing NPI to be the group NPI if

using a Business Tax id. Service

provider NPI required in servicing

provider loop. No longer require

6 digit provider identifier.

Provider must complete

enrollment form on payers

website.

Midwest Health Plans Inc. TH074 COMMERCIAL P

Accepts NPI only. Require the

billing NPI to be the group NPI if

using a Business Tax id. Service

provider NPI required in servicing

provider loop. No longer require

6 digit provider identifier.

Provider must complete

enrollment form on payers

website.Mills Peninsula Health Services MPHS1 COMMERCIAL NMills Peninsula Health Services MPHS1 COMMERCIAL NMills Peninsula Medical Group MPMG1 COMMERCIAL NMills Peninsula Medical Group MPMG1 COMMERCIAL NMission (St. Joseph Heritage Healthcare) STJOE COMMERCIAL NMission (St. Joseph Heritage Healthcare) STJOE COMMERCIAL NMississippi Health Partners 64068 COMMERCIAL NMississippi Health Partners 64068 COMMERCIAL NMississippi Medicaid SKMS0 COMMERCIAL AMississippi Medicaid SKMS0 COMMERCIAL AMississippi Physicians Care Network 64084 COMMERCIAL NMississippi Physicians Care Network 64084 COMMERCIAL NMississippi Public Entity Employee Benefit Trust 37233 COMMERCIAL N


Page 72


January 2011

Payer ID State Model Enroll Additional InformationMississippi Public Entity Employee Benefit Trust 37233 COMMERCIAL N

Mississippi Select Health Care 64088 COMMERCIAL N

Also doing business as Select

Administrative Services (SAS).

Mississippi Select Health Care 64088 COMMERCIAL N

Also doing business as Select

Administrative Services (SAS).Missoula County Medical Benefits Plan 37275 COMMERCIAL NMissoula County Medical Benefits Plan 37275 COMMERCIAL NMissouri Care/MC 43179 COMMERCIAL NMissouri Care/MC 43179 COMMERCIAL NMolina Healthcare Utah (aka: American Family Care) SX109 COMMERCIAL NMolina Healthcare Utah (aka: American Family Care) SX109 COMMERCIAL NMolina Healthcare of CALIFORNIA 38333 COMMERCIAL NMolina Healthcare of CALIFORNIA 38333 COMMERCIAL NMolina Healthcare of Florida 51062 COMMERCIAL NMolina Healthcare of Florida 51062 COMMERCIAL NMolina Healthcare of MICHIGAN 38334 COMMERCIAL NMolina Healthcare of MICHIGAN 38334 COMMERCIAL N

Molina Healthcare of Missouri 71079 COMMERCIAL N

Please note the payer name

changed effective 4/1/10. For

questions please contact Molina

Healthcare of Missouri. Please

refer to the Member ID cards for

payer contact information.

Molina Healthcare of Missouri 71079 COMMERCIAL N

Please note the payer name

changed effective 4/1/10. For

questions please contact Molina

Healthcare of Missouri. Please

refer to the Member ID cards for

payer contact information.Molina Healthcare of Nevada 20676 COMMERCIAL NMolina Healthcare of Nevada 20676 COMMERCIAL NMolina Healthcare of New Mexico - Salud 9824 COMMERCIAL NMolina Healthcare of New Mexico - Salud 9824 COMMERCIAL NMolina Healthcare of New Mexico -SCI 4423 COMMERCIAL NMolina Healthcare of New Mexico -SCI 4423 COMMERCIAL NMolina Healthcare of Ohio 20149 COMMERCIAL NMolina Healthcare of Ohio 20149 COMMERCIAL NMolina Healthcare of Texas 20554 COMMERCIAL NMolina Healthcare of Texas 20554 COMMERCIAL NMolina Healthcare of WASHINGTON 38336 COMMERCIAL NMolina Healthcare of WASHINGTON 38336 COMMERCIAL NMolina Healthcare of Washington ASO 91128 COMMERCIAL NMolina Healthcare of Washington ASO 91128 COMMERCIAL NMonarch IPA IP095 COMMERCIAL NMonarch IPA IP095 COMMERCIAL NMontefiore Contract Management Organization 13174 COMMERCIAL PMontefiore Contract Management Organization 13174 COMMERCIAL PMonumental Life Insurance Company TH094 COMMERCIAL NMonumental Life Insurance Company TH094 COMMERCIAL NMonumental Life Insurance Company TH121 COMMERCIAL N


Page 73


January 2011

Payer ID State Model Enroll Additional InformationMonumental Life Insurance Company TH121 COMMERCIAL NMosaic IPA Medical Group IP083 COMMERCIAL NMosaic IPA Medical Group IP083 COMMERCIAL NMotion Pictures Industry 99282 COMMERCIAL NMotion Pictures Industry 99282 COMMERCIAL NMountain States Administrative Services (Tucson AZ) 86040 COMMERCIAL NMountain States Administrative Services (Tucson AZ) 86040 COMMERCIAL NMulticultural Primary Care Medical Group (San Diego) (Synermed)SYMED COMMERCIAL NMulticultural Primary Care Medical Group (San Diego) (Synermed)SYMED COMMERCIAL NMultiplan Wisconsin Preferred Provider Network 34080 COMMERCIAL NMultiplan Wisconsin Preferred Provider Network 34080 COMMERCIAL NMunicipal Health Benefit Fund 81883 COMMERCIAL NMunicipal Health Benefit Fund 81883 COMMERCIAL NMutual Assurance Administrators 37256 COMMERCIAL NMutual Assurance Administrators 37256 COMMERCIAL NMutual Group (The) (US) 59140 COMMERCIAL NMutual Group (The) (US) 59140 COMMERCIAL NMutual of Omaha Insurance Company 71412 COMMERCIAL NMutual of Omaha Insurance Company 71412 COMMERCIAL NMutually Preferred 71412 COMMERCIAL NMutually Preferred 71412 COMMERCIAL N

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



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



N.W. Roofers & Employers Health & Security Trust Fund91136 COMMERCIAL N



N.W. Roofers & Employers Health & Security Trust Fund91136 COMMERCIAL N



N.W. Textile Processors 91136 COMMERCIAL N



N.W. Textile Processors 91136 COMMERCIAL N


when submitting claims.NAA (North America Administrators L.P.) (Nashville TN)65085 COMMERCIAL NNAA (North America Administrators L.P.) (Nashville TN)65085 COMMERCIAL N

NABN (Cleveland OH) 34159 COMMERCIAL N

Now known as Meritain Health.


billing submission address of P.O.

Box 94928 Cleveland OH 44101-

4928 or P.O. Box 89476 Cleveland

OH 44101-5476.

NABN (Cleveland OH) 34159 COMMERCIAL N






OH 44101-5476.NALC/Affordable 53011 COMMERCIAL NNALC/Affordable 53011 COMMERCIAL N


Page 74


January 2011

Payer ID State Model Enroll Additional InformationNCAS - Fairfax VA 75190 COMMERCIAL NNCAS - Fairfax VA 75190 COMMERCIAL NNGS American Inc 38225 COMMERCIAL NNGS American Inc 38225 COMMERCIAL NNHBC 01 88049 COMMERCIAL NNHBC 01 88049 COMMERCIAL NNHBCAUX 88050 COMMERCIAL NNHBCAUX 88050 COMMERCIAL NNHP/SHP (Neighborhood Health Providers and Suffolk Health Plan)11325 COMMERCIAL PNHP/SHP (Neighborhood Health Providers and Suffolk Health Plan)11325 COMMERCIAL PNJ Carpenters Health Fund 22603 COMMERCIAL NNJ Carpenters Health Fund 22603 COMMERCIAL NNMCI Pilot COMMERCIAL NNMCI Pilot COMMERCIAL NNORTHWEST COMMUNITY HEALTH PARTNERS 36234 COMMERCIAL NNORTHWEST COMMUNITY HEALTH PARTNERS 36234 COMMERCIAL NNaperville Healthcare TH088 COMMERCIAL NNaperville Healthcare TH088 COMMERCIAL NNational Association of Letter Carriers 53011 COMMERCIAL NNational Association of Letter Carriers 53011 COMMERCIAL NNational Association of Letter Carriers/NALC 53011 COMMERCIAL NNational Association of Letter Carriers/NALC 53011 COMMERCIAL NNational Benefit Administrators - New Jersey 56175 COMMERCIAL NNational Benefit Administrators - New Jersey 56175 COMMERCIAL NNational Benefit Administrators - North Carolina 56176 COMMERCIAL NNational Benefit Administrators - North Carolina 56176 COMMERCIAL N

National Capital Preferred Provider Organization (NCPPO)90001 COMMERCIAL N


(800 272-5911)

National Capital Preferred Provider Organization (NCPPO)90001 COMMERCIAL N


(800 272-5911)National Imaging Associates SX190 COMMERCIAL NNational Imaging Associates SX190 COMMERCIAL NNational Rural Electric Coop (NRECA) 52132 COMMERCIAL NNational Rural Electric Coop (NRECA) 52132 COMMERCIAL NNational Telecommunications Cooperative Association (NTCA - Staff)52104 COMMERCIAL NNational Telecommunications Cooperative Association (NTCA - Staff)52104 COMMERCIAL NNational Telecommunications Cooperative Association (NTCA)52103 COMMERCIAL NNational Telecommunications Cooperative Association (NTCA)52103 COMMERCIAL NNationwide Health Plans 31417 COMMERCIAL NNationwide Health Plans 31417 COMMERCIAL N

Neighborhood Health Partnership of Florida 96107 COMMERCIAL N

Payer ID is valid for claims

submission address PO Box

025680 Miami FL 33102-5680.

Any questions should be directed

to (305)715-4334.

Neighborhood Health Partnership of Florida 96107 COMMERCIAL N

Payer ID is valid for claims

submission address PO Box

025680 Miami FL 33102-5680.

Any questions should be directed

to (305)715-4334.


Page 75


January 2011

Payer ID State Model Enroll Additional InformationNeighborhood Health Plan (Boston MA) 4293 COMMERCIAL NNeighborhood Health Plan (Boston MA) 4293 COMMERCIAL N

Neighborhood Health Plan of Rhode Island (NHPRI) 5047 COMMERCIAL N

Please call NHPRI at 1-401-459-

6020 to obtain or confirm your

provider and vendor number

prior to your initial claims

submission.

Neighborhood Health Plan of Rhode Island (NHPRI) 5047 COMMERCIAL N

Please call NHPRI at 1-401-459-

6020 to obtain or confirm your

provider and vendor number

prior to your initial claims

submission.Nesika Health Group 37255 COMMERCIAL NNesika Health Group 37255 COMMERCIAL NNetcare Life and Health Insurance (Hagatna Guam) 66055 COMMERCIAL NNetcare Life and Health Insurance (Hagatna Guam) 66055 COMMERCIAL N

Network Health 4332 COMMERCIAL P

Before initiating submissions

please go to www.network-

health.org and go to the

Providers Tab then forms then

Claims Forms then EDI setup

forms or email edi@network-

health.org for an EDI setup form

or call Gary Evans @ 781-393-

7487 or Bob Williams

2111,,04332,Network

Health,,COMMERCIAL,M,B,N,P,0,

Claims,1,,Y,,,http://transact.emde

on.com/factsheets/edi_fact_shee

t_04332.php,Before initiating

submissions please go to

www.network-health.org and go

to the Providers Tab then forms

then Claims Forms then EDI setup

forms or email edi@network-

health.org for an EDI setup form

or call Gary Evans @ 781-393-

7487 or Bob Williams Network Health Insurance Corp-Medicare 77076 COMMERCIAL NNetwork Health Insurance Corp-Medicare 77076 COMMERCIAL N


Page 76


January 2011


Network Health Plan of Wisconsin Inc. 39144 COMMERCIAL N

Use for Network Health Plan

HMO and POS claims only. Payer

Id valid only if the send claims to

address on the back of the

member's card is PO Box 568

Menasha WI 54952. DO NOT USE

this payer id for Network

Platinum Plus Network Premier

Plus or Managed

Network Health Plan of Wisconsin Inc. 39144 COMMERCIAL N

Payer id is valid only if the claim

submission address on the back

of the member's card is PO Box

568 Menasha WI 54952.Network Medical Management NMM01 COMMERCIAL NNetwork Medical Management NMM01 COMMERCIAL NNetwork TPA LLC 58204 COMMERCIAL NNetwork TPA LLC 58204 COMMERCIAL NNevadaCare 86067 COMMERCIAL NNevadaCare 86067 COMMERCIAL NNew Century Health - IEHP Oncology NCH11 COMMERCIAL NNew Century Health - IEHP Oncology NCH11 COMMERCIAL NNew Century Health - Vista Cardiology NCH09 COMMERCIAL NNew Century Health - Vista Cardiology NCH09 COMMERCIAL NNew Era Employee Welfare Benefit Plan Trust 76031 COMMERCIAL NNew Era Employee Welfare Benefit Plan Trust 76031 COMMERCIAL NNew Era Life Insurance Company 75281 COMMERCIAL NNew Era Life Insurance Company 75281 COMMERCIAL NNew Market Dimensions 65056 COMMERCIAL NNew Market Dimensions 65056 COMMERCIAL NNew West Health Services SX164 COMMERCIAL NNew West Health Services SX164 COMMERCIAL NNew York Life TH122 COMMERCIAL NNew York Life TH122 COMMERCIAL NNew York Network Management 11334 COMMERCIAL NNew York Network Management 11334 COMMERCIAL NNew York Presbyterian System Select Health 24819 COMMERCIAL NNew York Presbyterian System Select Health 24819 COMMERCIAL NNippon Life Insurance Company of America 81264 COMMERCIAL NNippon Life Insurance Company of America 81264 COMMERCIAL NNoble AMA Select IPA PDT01 COMMERCIAL NNoble AMA Select IPA PDT01 COMMERCIAL N

North American Administrators Inc. 64157 COMMERCIAL N Now known as Meritain Health

North American Administrators Inc. 64157 COMMERCIAL N Now known as Meritain Health


Page 77


January 2011


North American Benefits Network (Cleveland OH) 34159 COMMERCIAL N






OH 44101-5476.

North American Benefits Network (Cleveland OH) 34159 COMMERCIAL N






OH 44101-5476.

North American Health Plan 64157 COMMERCIAL N Now known as Meritain Health

North American Health Plan 64157 COMMERCIAL N Now known as Meritain Health

North American Medical Management (NAMM) - Northern CaliforniaE3510 COMMERCIAL P

Please contact the EDI Dept for

North American Medical

Management (NAMM) - Northern

California Lead/Supervisor at 1-

800-956-8000 prior to initial

submission of claims.

North American Medical Management (NAMM) - Northern CaliforniaE3510 COMMERCIAL P

Please contact the EDI Dept for

North American Medical

Management (NAMM) - Northern

California Lead/Supervisor at 1-

800-956-8000 prior to initial

submission of claims.North American Medical Management (NAMM) - Southern CaliforniaE3510 COMMERCIAL PNorth American Medical Management (NAMM) - Southern CaliforniaE3510 COMMERCIAL P

North American Preferred 64157 COMMERCIAL N Now known as Meritain Health

North American Preferred 64157 COMMERCIAL N Now known as Meritain HealthNorth Broward Hospital District 37314 COMMERCIAL NNorth Broward Hospital District 37314 COMMERCIAL N

North County Health Services Call COMMERCIAL N





North County Health Services Call COMMERCIAL N




7100 [email protected] Suburban Associated Physicians 36392 COMMERCIAL NNorth Suburban Associated Physicians 36392 COMMERCIAL N


Page 78


January 2011

Payer ID State Model Enroll Additional InformationNorth Texas Healthcare Network 35212 COMMERCIAL NNorth Texas Healthcare Network 35212 COMMERCIAL NNorth West Orange County Medical Group PROSP COMMERCIAL NNorth West Orange County Medical Group PROSP COMMERCIAL NNorthShore University Health System Medical Group 36364 COMMERCIAL NNorthShore University Health System Medical Group 36364 COMMERCIAL NNorthStar Advantage NSA01 COMMERCIAL NNorthStar Advantage NSA01 COMMERCIAL N

Northern California Sheet Metal Workers Health Care Plan38238 COMMERCIAL N



1138 San Ramon CA 94583.

Northern California Sheet Metal Workers Health Care Plan38238 COMMERCIAL N



1138 San Ramon CA 94583.Northern Illinois Health Plan 36347 COMMERCIAL NNorthern Illinois Health Plan 36347 COMMERCIAL N

Northern Nevada Trust Fund 88027 COMMERCIAL N

Please call (775) 826-7200 to

verfiy if you should be sending

claims to Northern Nevada Trust

Fund.

Northern Nevada Trust Fund 88027 COMMERCIAL N

Please call (775) 826-7200 to

verfiy if you should be sending

claims to Northern Nevada Trust

Fund.Northridge Medical Group NMG01 COMMERCIAL NNorthridge Medical Group NMG01 COMMERCIAL NNorthstar Advantage 60058 COMMERCIAL NNorthstar Advantage 60058 COMMERCIAL NNorthwest Diagnostic Clinic/SelectCare of Texas (NWDC)62119 COMMERCIAL NNorthwest Diagnostic Clinic/SelectCare of Texas (NWDC)62119 COMMERCIAL NNorthwest Suburban IPA (Illinois) 36346 COMMERCIAL NNorthwest Suburban IPA (Illinois) 36346 COMMERCIAL NNova Casualty Company 16114 COMMERCIAL NNova Casualty Company 16114 COMMERCIAL NNovanet 6226 COMMERCIAL NNovanet 6226 COMMERCIAL NNovasys Health Network 71080 COMMERCIAL NNovasys Health Network 71080 COMMERCIAL NNuestra Familia Medical Group (Prospect Medical Group)PROSP COMMERCIAL NNuestra Familia Medical Group (Prospect Medical Group)PROSP COMMERCIAL NNyhart 37299 COMMERCIAL NNyhart 37299 COMMERCIAL NOAK WEST PRIMARY PHYSICIAN ASSOCIATION 36402 COMMERCIAL NOAK WEST PRIMARY PHYSICIAN ASSOCIATION 36402 COMMERCIAL NODS Health Plan 13350 COMMERCIAL NODS Health Plan 13350 COMMERCIAL NOK State Employees & Educators (EDS) 22521 COMMERCIAL NOK State Employees & Educators (EDS) 22521 COMMERCIAL NOMNI/Medicore HP 68037 COMMERCIAL NOMNI/Medicore HP 68037 COMMERCIAL N


Page 79


January 2011

Payer ID State Model Enroll Additional InformationOSF Health Plans 62171 COMMERCIAL NOSF Health Plans 62171 COMMERCIAL NOSMA Health - C. L. Frates 73071 COMMERCIAL NOSMA Health - C. L. Frates 73071 COMMERCIAL N

OSNA Cigna Commercial SX193 COMMERCIAL N

Claims submitted with a DOS on

or after May 1 2010 will be

rejected while claims with a DOS

prior to May 1 2010 will

continued to be accepted and

processed.

OSNA Cigna Commercial SX193 COMMERCIAL N






processed.

OSNA Cigna Medicare SX194 COMMERCIAL N






processed.

OSNA Cigna Medicare SX194 COMMERCIAL N






processed.

OSNA United Health Care SX195 COMMERCIAL N






processed.

OSNA United Health Care SX195 COMMERCIAL N






processed.Oasis IPA DESRT COMMERCIAL NOasis IPA DESRT COMMERCIAL N

Occupational Health Mgmt Inc. (HealthManage) (Ohio BWC)31147 COMMERCIAL N


ONLY.

Occupational Health Mgmt Inc. (HealthManage) (Ohio BWC)31147 COMMERCIAL N


ONLY.


Page 80


January 2011


Office of Group Benefits- Louisiana 72087 COMMERCIAL N

Office of Group Benefits is located

in the state of Louisiana. This

payer is currently not sending

997's. Syntax errors will be

worked on with payer tech.

Office of Group Benefits- Louisiana 72087 COMMERCIAL N

Office of Group Benefits is located

in the state of Louisiana. This

payer is currently not sending

997's. Syntax errors will be

worked on with payer tech.Ohana Health Plan 14163 COMMERCIAL NOhana Health Plan 14163 COMMERCIAL N

Ohio BWC 31147 COMMERCIAL N


ONLY.

Ohio BWC 31147 COMMERCIAL N


ONLY.

Ohio Comp Choice Inc. (HMS) (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Ohio Comp Choice Inc. (HMS) (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Ohio Employee Health Partnership (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Ohio Employee Health Partnership (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Ohio Health Choice PPO 34189 COMMERCIAL N


a billing submission address of PO

Box 3619 Akron OH 44309-3619

or PO Box 93538

Ohio Health Choice PPO 34189 COMMERCIAL N


a billing submission address of PO

Box 3619 Akron OH 44309-3619

or PO Box 93538Ohio Health Group 95435 COMMERCIAL NOhio Health Group 95435 COMMERCIAL N

Omnicare 25133 COMMERCIAL N



payer ID.

Omnicare 25133 COMMERCIAL N



payer ID.Omnicare Medical Group (OMNI) OMN02 COMMERCIAL NOmnicare Medical Group (OMNI) OMN02 COMMERCIAL N

Omnicare A Coventry Health Plan 25150 COMMERCIAL N




list.


Page 81


January 2011






list.





list.





list.One Call Medical 22321 COMMERCIAL NOne Call Medical 22321 COMMERCIAL N

OneNet PPO LLC. 52149 COMMERCIAL N

Name effective from 9/1/2006.

Previous name Alliance PPO LLC.

OneNet PPO LLC. 52149 COMMERCIAL N

Name effective from 9/1/2006.

Previous name Alliance PPO LLC.

Operating Engineers Locals 302 & 612 Health & Security Fund91136 COMMERCIAL N



Operating Engineers Locals 302 & 612 Health & Security Fund91136 COMMERCIAL N


when submitting claims.OptiCare Managed Vision 56190 COMMERCIAL NOptiCare Managed Vision 56190 COMMERCIAL N

Optima Health Plan 54154 COMMERCIAL N

Note: Rendering Provider

Network ID (E6-14) field is reqd.

Field must be 5-7 chars positions

1-5 must be numeric only and

positions 6&7 (if applicable) must

be alpha only. Please contact

Ydsia Slagle-Provider Relations at

(757) 552-7477.

Optima Health Plan 54154 COMMERCIAL N








(757) 552-7477.


Page 82


January 2011


Optima Insurance Company 54154 COMMERCIAL N








(757) 552-7477.

Optima Insurance Company 54154 COMMERCIAL N








(757) 552-7477.Optimum Choice of the Carolinas Inc. (OCCI) 52152 COMMERCIAL NOptimum Choice of the Carolinas Inc. (OCCI) 52152 COMMERCIAL NOptimum Choice Inc. (OCI) 52148 COMMERCIAL NOptimum Choice Inc. (OCI) 52148 COMMERCIAL NOptumHealth - CMC 41194 COMMERCIAL NOptumHealth - CMC 41194 COMMERCIAL N

Orthonet - Uniformed Services Family Health Plan 13382 COMMERCIAL N


the payer. For Payable USFHP (NY

& NJ) outpatient therapy claims

only. Contact Theresa Malgioglio

at (914) 681-8800.

Orthonet - Uniformed Services Family Health Plan 13382 COMMERCIAL N


the payer. For Payable USFHP (NY

& NJ) outpatient therapy claims

only. Contact Theresa Malgioglio

at (914) 681-8800.Orthonet Corporation - CIGNA 13381 COMMERCIAL NOrthonet Corporation - CIGNA 13381 COMMERCIAL NOrthonet- Aetna 13383 COMMERCIAL NOrthonet- Aetna 13383 COMMERCIAL NOrthonet-HealthNet 25681 COMMERCIAL NOrthonet-HealthNet 25681 COMMERCIAL NOxford Health Plans 6111 COMMERCIAL NOxford Health Plans 6111 COMMERCIAL NP5 Health Plan Solutions of Utah 87068 COMMERCIAL NP5 Health Plan Solutions of Utah 87068 COMMERCIAL NPAI 37287 COMMERCIAL NPAI 37287 COMMERCIAL N

PEHP - Utah Public Employee Health Plan Call COMMERCIAL P

Call EDI at 801-366-7544 or email

[email protected] to obtain

the payer id.


Page 83


January 2011


PEHP - Utah Public Employee Health Plan Call COMMERCIAL P

Call EDI at 801-366-7544 or email

[email protected] to obtain

the payer id.PHCS Savility Payers 13306 COMMERCIAL NPHCS Savility Payers 13306 COMMERCIAL N

PHP - Physicians Health Plan of Northern Indiana (Fort Wayne IN)12399 COMMERCIAL N

Contracted Providers: All claims

require NPI. Contact (260) 432-

6690 x549 with questions.

Corrected/adjustment claims -

submit via paper. Anesthesia

claims - submit with ASA/AA

modifiers and billed with minutes

PHP - Physicians Health Plan of Northern Indiana (Fort Wayne IN)12399 COMMERCIAL N

Contracted Providers: All claims

require NPI. Contact (260) 432-

6690 x549 with questions.

Corrected/adjustment claims -

submit via paper. Anesthesia

claims - submit with ASA/AA

modifiers and billed with minutesPHP of South Michigan 87726 COMMERCIAL NPHP of South Michigan 87726 COMMERCIAL NPHP of Southwest Michigan 87726 COMMERCIAL NPHP of Southwest Michigan 87726 COMMERCIAL NPHP of West Michigan 87726 COMMERCIAL NPHP of West Michigan 87726 COMMERCIAL NPIMA Health 9861 COMMERCIAL RPIMA Health 9861 COMMERCIAL RPODIATRY NETWORK FL 59324 COMMERCIAL NPODIATRY NETWORK FL 59324 COMMERCIAL NPOMCO 16111 COMMERCIAL NPOMCO 16111 COMMERCIAL NPPOM LLC 38335 COMMERCIAL NPPOM LLC 38335 COMMERCIAL NPPOPlus LLC 72148 COMMERCIAL NPPOPlus LLC 72148 COMMERCIAL NPSYCHCARE LLC 51052 COMMERCIAL NPSYCHCARE LLC 51052 COMMERCIAL NPUGET SOUND HEALTH PARTNERS INC. 42172 COMMERCIAL NPUGET SOUND HEALTH PARTNERS INC. 42172 COMMERCIAL NPacifiCare Behavioral Health 33053 COMMERCIAL NPacifiCare Behavioral Health 33053 COMMERCIAL N

PacifiCare PPO - All States 95999 COMMERCIAL N

For payable PPO claims only. NOT

for Pacificare/Secure Horizons

HMO claims. For further

questions you may inquire via

email at

[email protected].


Page 84


January 2011


PacifiCare PPO - All States 95999 COMMERCIAL N

For payable PPO claims only. NOT

for Pacificare/Secure Horizons

HMO claims. For further


email at

[email protected].

PacifiCare of Arizona - Claims 95964 COMMERCIAL N

For payable PacifiCare/Secure

Horizons HMO and POS claims

only. Not for PPO claims. For

further questions you may inquire

via email at

[email protected]

PacifiCare of Arizona - Claims 95964 COMMERCIAL N





via email at

[email protected]

PacifiCare of California - Claims 95959 COMMERCIAL N

For Payable Pacificare/Secure

Horizon HMO claims only. NOT

for PPO claims. For further


email at [email protected].

PacifiCare of California - Claims 95959 COMMERCIAL N






PacifiCare of Colorado - Claims 95962 COMMERCIAL N





via email at

[email protected]

PacifiCare of Colorado - Claims 95962 COMMERCIAL N





via email at

[email protected]

PacifiCare of Oklahoma - Claims 95959 COMMERCIAL N







Page 85


January 2011


PacifiCare of Oklahoma - Claims 95959 COMMERCIAL N






PacifiCare of Oregon - Claims 95959 COMMERCIAL N






PacifiCare of Oregon - Claims 95959 COMMERCIAL N






PacifiCare of Texas - Claims 95959 COMMERCIAL N






PacifiCare of Texas - Claims 95959 COMMERCIAL N






PacifiCare of Washington - Claims 95959 COMMERCIAL N






PacifiCare of Washington - Claims 95959 COMMERCIAL N





email at [email protected] Alliance Medical Group and Hospital (Synermed)SYMED COMMERCIAL NPacific Alliance Medical Group and Hospital (Synermed)SYMED COMMERCIAL NPacific IPA PCFCI COMMERCIAL NPacific IPA PCFCI COMMERCIAL N

PacificSource Health Plans 93029 COMMERCIAL N

Payer does not accept COB claims

electronically

PacificSource Health Plans 93029 COMMERCIAL N

Payer does not accept COB claims

electronicallyParagon Benefits Inc. 58174 COMMERCIAL N


Page 86


January 2011

Payer ID State Model Enroll Additional InformationParagon Benefits Inc. 58174 COMMERCIAL NParamount SX158 COMMERCIAL NParamount SX158 COMMERCIAL N

Paramount Preferred Network (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Paramount Preferred Network (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Park Terrace/Encompass Medical Group Call COMMERCIAL N


payer please contact Tristin

Rausche 858-824-7100

[email protected]

Park Terrace/Encompass Medical Group Call COMMERCIAL N


payer please contact Tristin

Rausche 858-824-7100

[email protected] Community Health Plan 66917 COMMERCIAL NParkland Community Health Plan 66917 COMMERCIAL N

Passport Advantage 76569 COMMERCIAL N

Only claims with a DOS and/or

Admit Date on or after 1/1/2010

shall be submitted to this new

Payer ID.

Passport Advantage 76569 COMMERCIAL N

Only claims with a DOS and/or

Admit Date on or after 1/1/2010

shall be submitted to this new

Payer ID.

Passport Health Plan 61129 COMMERCIAL N



[email protected].

Passport Health Plan 61129 COMMERCIAL N



[email protected] Advocates LLC 10525 COMMERCIAL NPatient Advocates LLC 10525 COMMERCIAL N

Peach State Health Plan 68049 COMMERCIAL P








Peach State Health Plan 68049 COMMERCIAL P







be made in a timely manner.Pegasus Medical Group PROSP COMMERCIAL NPegasus Medical Group PROSP COMMERCIAL N


Page 87


January 2011


Pennsylvania's Preferred Health Network Call COMMERCIAL N

Call Jessica Picarde Manager of

PPHN Claims Operations(410) 349-

3222

Pennsylvania's Preferred Health Network Call COMMERCIAL N

Call Jessica Picarde Manager of

PPHN Claims Operations(410) 349-

3222Peoples Health Network 72126 COMMERCIAL NPeoples Health Network 72126 COMMERCIAL N

PerformCare-Select Health MH/SA 25176 COMMERCIAL N

For Behavioral Health EDI support

please e-mail [email protected]

PerformCare-Select Health MH/SA 25176 COMMERCIAL N

For Behavioral Health EDI support

please e-mail [email protected] Insurance Administrators Inc. (Agoura Hills CA)95397 COMMERCIAL NPersonal Insurance Administrators Inc. (Agoura Hills CA)95397 COMMERCIAL N

PersonalCare 25133 COMMERCIAL N



payer ID.

PersonalCare 25133 COMMERCIAL N



payer ID.Phoenix Health Plan 3440 COMMERCIAL NPhoenix Health Plan 3440 COMMERCIAL NPhyicians Health Plan (PHP) Mid-Michigan 37330 COMMERCIAL NPhyicians Health Plan (PHP) Mid-Michigan 37330 COMMERCIAL NPhysician Associates of Louisiana 58204 COMMERCIAL NPhysician Associates of Louisiana 58204 COMMERCIAL N

Physician Associates of the Greater San Gabriel Valley Call COMMERCIAL N

Please call David McGee 626-817-

8354 or Art Tarin 626-817-8318

to obtain the Payer Id

Physician Associates of the Greater San Gabriel Valley Call COMMERCIAL N

Please call David McGee 626-817-

8354 or Art Tarin 626-817-8318

to obtain the Payer IdPhysician Associates of the Greater San Gabriel ValleyPA513 COMMERCIAL NPhysician Associates of the Greater San Gabriel ValleyPA513 COMMERCIAL NPhysician Care Network LLC 58204 COMMERCIAL NPhysician Care Network LLC 58204 COMMERCIAL NPhysician's Data Trust PDT01 COMMERCIAL NPhysician's Data Trust PDT01 COMMERCIAL NPhysicians Alliance/Stones River Regional IPA 15749 COMMERCIAL NPhysicians Alliance/Stones River Regional IPA 15749 COMMERCIAL N

Physicians Care (ASR Corporation) 38265 COMMERCIAL N

Note: This is Physicians Care

Network located in Michigan

Physicians Care (ASR Corporation) 38265 COMMERCIAL N



Physicians Care Health Plans (ASR Corporation) 38265 COMMERCIAL N



Physicians Care Health Plans (ASR Corporation) 38265 COMMERCIAL N




Page 88


January 2011


Physicians Care Network (ASR Corporation) 38265 COMMERCIAL N



Physicians Care Network (ASR Corporation) 38265 COMMERCIAL N


Network located in MichiganPhysicians Care Network (Rockford IL only) 36345 COMMERCIAL NPhysicians Care Network (Rockford IL only) 36345 COMMERCIAL NPhysicians Health Association of Illinois 37136 COMMERCIAL NPhysicians Health Association of Illinois 37136 COMMERCIAL NPhysicians Health Choice - Encounters TH114 COMMERCIAL NPhysicians Health Choice - Encounters TH114 COMMERCIAL NPhysicians Health Claims - Claims TH113 COMMERCIAL NPhysicians Health Claims - Claims TH113 COMMERCIAL NPhysicians Health Collaborative 20398 COMMERCIAL NPhysicians Health Collaborative 20398 COMMERCIAL NPhysicians Health Network MHM03 COMMERCIAL NPhysicians Health Network MHM03 COMMERCIAL NPhysicians Health Plan (PHP) - SC 9173 COMMERCIAL NPhysicians Health Plan (PHP) - SC 9173 COMMERCIAL NPhysicians Health Plan PHP South Michigan 37330 COMMERCIAL NPhysicians Health Plan PHP South Michigan 37330 COMMERCIAL NPhysicians Medical Group of San Jose EXC01 COMMERCIAL NPhysicians Medical Group of San Jose EXC01 COMMERCIAL N

Physicians Mutual Insurance Company 47027 COMMERCIAL N

Please send all PPO and dental

claims to the address on the back

of the insured's ID Card

Physicians Mutual Insurance Company 47027 COMMERCIAL N

Please send all PPO and dental

claims to the address on the back

of the insured's ID CardPhysicians Plus Insurance Corporation 39156 COMMERCIAL NPhysicians Plus Insurance Corporation 39156 COMMERCIAL NPhysicians United Plan TH131 COMMERCIAL NPhysicians United Plan TH131 COMMERCIAL NPiedmont Behavioral Health 6607 COMMERCIAL NPiedmont Behavioral Health 6607 COMMERCIAL NPinnacle Claims Management Inc. 24735 COMMERCIAL NPinnacle Claims Management Inc. 24735 COMMERCIAL NPinnacle Health Resources (Prospect Medical Group) PROSP COMMERCIAL NPinnacle Health Resources (Prospect Medical Group) PROSP COMMERCIAL NPinnacle Physician Management ORG 45985 COMMERCIAL NPinnacle Physician Management ORG 45985 COMMERCIAL NPinnacol Assurance 84109 COMMERCIAL NPinnacol Assurance 84109 COMMERCIAL NPioneer Medical Group PIONR COMMERCIAL NPioneer Medical Group PIONR COMMERCIAL NPittman & Associates 37224 COMMERCIAL NPittman & Associates 37224 COMMERCIAL NPivotal Plan 64160 COMMERCIAL NPivotal Plan 64160 COMMERCIAL N


Page 89


January 2011


Planned Administrators Inc. 37287 COMMERCIAL N

Providers submitting claims as a

Preferred Blue provider should

not submit claims using payer ID

37287

Planned Administrators Inc. 37287 COMMERCIAL N

Providers submitting claims as a

Preferred Blue provider should

not submit claims using payer ID

37287Podi Care Managed Care 58204 COMMERCIAL NPodi Care Managed Care 58204 COMMERCIAL NPoly America Medical & Dental Benefits Plan 32680 COMMERCIAL NPoly America Medical & Dental Benefits Plan 32680 COMMERCIAL NPomona Valley Medical Group IP057 COMMERCIAL NPomona Valley Medical Group IP057 COMMERCIAL NPracticare Inc 4334 COMMERCIAL NPracticare Inc 4334 COMMERCIAL NPrairie States Enterprises Inc. 36373 COMMERCIAL NPrairie States Enterprises Inc. 36373 COMMERCIAL NPreferred Benefits Administrator 61665 COMMERCIAL N E6-14 Required on MedicalPreferred Benefits Administrator 61665 COMMERCIAL N E6-14 Required on Medical

Preferred Care Partners Florida 65088 COMMERCIAL N

We process claims for Florida

members only. Please check the

member address on the ID card

before submitting claims to

Preferred Care Partners.

Preferred Care Partners Florida 65088 COMMERCIAL N

We process claims for Florida

members only. Please check the

member address on the ID card

before submitting claims to

Preferred Care Partners.Preferred Community Choice/PCCSelect/CompMed 73145 COMMERCIAL NPreferred Community Choice/PCCSelect/CompMed 73145 COMMERCIAL N

Preferred Health Care - PPO Lancaster PA (IHS Gateway Payer)Call COMMERCIAL N





and the Payer ID.

Preferred Health Care - PPO Lancaster PA (IHS Gateway Payer)Call COMMERCIAL N





and the Payer ID.Preferred Health Plan (Louisville KY) 61106 COMMERCIAL NPreferred Health Plan (Louisville KY) 61106 COMMERCIAL NPreferred Health Professionals 31478 COMMERCIAL NPreferred Health Professionals 31478 COMMERCIAL NPreferred Health Systems Insurance Company 60110 COMMERCIAL NPreferred Health Systems Insurance Company 60110 COMMERCIAL NPreferred IPA PFIPA COMMERCIAL NPreferred IPA PFIPA COMMERCIAL N


Page 90


January 2011

Payer ID State Model Enroll Additional InformationPreferred Network Access Inc. 36401 COMMERCIAL NPreferred Network Access Inc. 36401 COMMERCIAL NPreferred Plus of Kansas 60110 COMMERCIAL NPreferred Plus of Kansas 60110 COMMERCIAL NPreferredOne (MN) 41147 COMMERCIAL NPreferredOne (MN) 41147 COMMERCIAL NPremier Benefits Inc. 43166 COMMERCIAL NPremier Benefits Inc. 43166 COMMERCIAL N

Premier Comp of Hometown Health Network (Ohio BWC)31147 COMMERCIAL N


ONLY.

Premier Comp of Hometown Health Network (Ohio BWC)31147 COMMERCIAL N


ONLY.Premier Health Plans 43166 COMMERCIAL NPremier Health Plans 43166 COMMERCIAL N

Premier Health Systems Inc 90440 COMMERCIAL N

Premier Health Systems Inc. is

part of the Medical Mutual Family

of Companies. For claims with

DOS prior to 4/1/09 use payer ID

90440. Claims with DOS 4/1/09

and after use their new payer ID

29076.

Premier Health Systems Inc 90440 COMMERCIAL N



of Companies. For claims with

DOS prior to 4/1/09 use payer ID

90440. Claims with DOS 4/1/09

and after use their new payer ID

29076.

Premier Health Systems Inc. 29076 COMMERCIAL N



of Companies. Former payer ID

90040. Use Payer ID 20976 for

claims with DOS 4/1/09 and after.

For claims with DOS prior to

4/1/09 use former payer ID

90440.

Premier Health Systems Inc. 29076 COMMERCIAL N



of Companies. Former payer ID

90040. Use Payer ID 20976 for

claims with DOS 4/1/09 and after.

For claims with DOS prior to

4/1/09 use former payer ID

90440.

Premier Managed Care Inc. (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Premier Managed Care Inc. (Ohio BWC) 31147 COMMERCIAL N


ONLY.


Page 91


January 2011

Payer ID State Model Enroll Additional InformationPresbyterian (NM) 5003 COMMERCIAL NPresbyterian (NM) 5003 COMMERCIAL NPrestige Health Choice 45056 COMMERCIAL NPrestige Health Choice 45056 COMMERCIAL NPrevea Health Plan 39185 COMMERCIAL NPrevea Health Plan 39185 COMMERCIAL NPrima Health IPA IP096 COMMERCIAL NPrima Health IPA IP096 COMMERCIAL NPrimary Health Network 82048 COMMERCIAL NPrimary Health Network 82048 COMMERCIAL NPrimary PhysicianCare Inc. 56144 COMMERCIAL NPrimary PhysicianCare Inc. 56144 COMMERCIAL NPrime West Health Plan 61604 COMMERCIAL NPrime West Health Plan 61604 COMMERCIAL N

PrimeSource Health Network (PSHN) - PPO Harrisburg PA (IHS Gateway Payer)Call COMMERCIAL N


Picarde at (410) 349-3222

PrimeSource Health Network (PSHN) - PPO Harrisburg PA (IHS Gateway Payer)Call COMMERCIAL N


Picarde at (410) 349-3222Principal Financial Group 61271 COMMERCIAL NPrincipal Financial Group 61271 COMMERCIAL NPriority Health 38217 COMMERCIAL NPriority Health 38217 COMMERCIAL NPrism Network Inc. 37268 COMMERCIAL NPrism Network Inc. 37268 COMMERCIAL NPrism Network Inc. 37296 COMMERCIAL NPrism Network Inc. 37296 COMMERCIAL NPrism-First Health 37303 COMMERCIAL NPrism-First Health 37303 COMMERCIAL NPrism-Univera 37315 COMMERCIAL NPrism-Univera 37315 COMMERCIAL N

Pro Care Health Plan Inc. (Detroit MI) 38329 COMMERCIAL N

Payer ID valid for claims with the

following submission addresses:

PO Box 3160 Detroit MI 48203

AND PO Box 3590 Detroit MI

48203.

Pro Care Health Plan Inc. (Detroit MI) 38329 COMMERCIAL N

Payer ID valid for claims with the

following submission addresses:

PO Box 3160 Detroit MI 48203

AND PO Box 3590 Detroit MI

48203.ProCare (Prospect) PROSP COMMERCIAL NProCare (Prospect) PROSP COMMERCIAL NProCare Health Plan Medicaid 70259 COMMERCIAL NProCare Health Plan Medicaid 70259 COMMERCIAL NProMed HealthCare Administrators IP057 COMMERCIAL NProMed HealthCare Administrators IP057 COMMERCIAL NProfessional Benefit Administrators (Winter Park FL) 59296 COMMERCIAL NProfessional Benefit Administrators (Winter Park FL) 59296 COMMERCIAL N


Page 92


January 2011


Professional Benefit Administrators Inc. (Oak Brook IL)36331 COMMERCIAL N

Payer ID is valid only for claims

with billing submission name city

and state of Professional Benefit

Administrators Inc. Oak Brook IL.

Professional Benefit Administrators Inc. (Oak Brook IL)36331 COMMERCIAL N

Payer ID is valid only for claims

with billing submission name city

and state of Professional Benefit

Administrators Inc. Oak Brook IL.Professional Risk Management 34134 COMMERCIAL NProfessional Risk Management 34134 COMMERCIAL NProspect Health Network PROSP COMMERCIAL NProspect Health Network PROSP COMMERCIAL NProspect Medical Group PROSP COMMERCIAL NProspect Medical Group PROSP COMMERCIAL NProspect Sherman Oaks Medical Group (Prospect Medical Group)PROSP COMMERCIAL NProspect Sherman Oaks Medical Group (Prospect Medical Group)PROSP COMMERCIAL NProtective Life Insurance Company 37309 COMMERCIAL NProtective Life Insurance Company 37309 COMMERCIAL N

Protegrity Services (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Protegrity Services (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Providence PPO SX187 COMMERCIAL N

For Claims Status please contact

Susan Naanes @ 503-574-7441 or

Debra Wallenstein at 503-574-

7450 .

Providence PPO SX187 COMMERCIAL N




7450 .

Providence of Oregon Health Plan SX133 COMMERCIAL N




7450.

Providence of Oregon Health Plan SX133 COMMERCIAL N




7450.

Puget Sound Benefits Trust 91136 COMMERCIAL N



Puget Sound Benefits Trust 91136 COMMERCIAL N



Puget Sound Electrical Workers Trust 91136 COMMERCIAL N



Puget Sound Electrical Workers Trust 91136 COMMERCIAL N




Page 93


January 2011

Payer ID State Model Enroll Additional InformationPyramid Life Insurance Company 48055 COMMERCIAL NPyramid Life Insurance Company 48055 COMMERCIAL NQVI Risk Solutions Inc. 57117 COMMERCIAL NQVI Risk Solutions Inc. 57117 COMMERCIAL NQuad Med LLC (Pewaukee WI) 39197 COMMERCIAL NQuad Med LLC (Pewaukee WI) 39197 COMMERCIAL NQual Choice of Arkansas 35174 COMMERCIAL NQual Choice of Arkansas 35174 COMMERCIAL N

QualCare Inc. 23342 COMMERCIAL P

New Providers must enroll with

QualCare at (800) 992-6613

option 5.

QualCare Inc. 23342 COMMERCIAL P

New Providers must enroll with

QualCare at (800) 992-6613

option 5.

QuikTrip 73067 COMMERCIAL N

E-print address: QuikTrip P.O. Box

733 Buckeystown MD 21717

QuikTrip 73067 COMMERCIAL N

E-print address: QuikTrip P.O. Box

733 Buckeystown MD 21717R&N Market TKFMC COMMERCIAL NR&N Market TKFMC COMMERCIAL N

RADCON INC. Call COMMERCIAL N

Please contact Kathy King @ (856)

608-1350 for Payer Id

information.

RADCON INC. Call COMMERCIAL N

Please contact Kathy King @ (856)

608-1350 for Payer Id

information.RBMS LLC 91176 COMMERCIAL NRBMS LLC 91176 COMMERCIAL NRIVERSIDE SAN BERNARDINO COUNTY INDIAN HEALTH INC.Call COMMERCIAL NRIVERSIDE SAN BERNARDINO COUNTY INDIAN HEALTH INC.Call COMMERCIAL NRMSCO INC. 16117 COMMERCIAL NRMSCO INC. 16117 COMMERCIAL NRWDSU BENEFIT FUND 63070 COMMERCIAL NRWDSU BENEFIT FUND 63070 COMMERCIAL NRedlands IPA (Synermed) SYMED COMMERCIAL NRedlands IPA (Synermed) SYMED COMMERCIAL NRegal Medical Group REGAL COMMERCIAL NRegal Medical Group REGAL COMMERCIAL NRegency Employee Benefits 38221 COMMERCIAL NRegency Employee Benefits 38221 COMMERCIAL NRegional Care Inc. 47076 COMMERCIAL NRegional Care Inc. 47076 COMMERCIAL NRenaissance Physicians Organization 76066 COMMERCIAL NRenaissance Physicians Organization 76066 COMMERCIAL N

Reserve National Insurance 73066 COMMERCIAL N

For claims rejections please

contact Reserve National


7931


Page 94


January 2011


Reserve National Insurance 73066 COMMERCIAL N


contact Reserve National


7931ResourceOne Administrators 37278 COMMERCIAL NResourceOne Administrators 37278 COMMERCIAL N

Resurrection Health Care Preferred/FKA Family Medical Network36396 COMMERCIAL N

Please call (773) 572-8311 or(

773) 572-8309 prior to your first

submission of claims

Resurrection Health Care Preferred/FKA Family Medical Network36396 COMMERCIAL N

Please call (773) 572-8311 or(

773) 572-8309 prior to your first

submission of claimsRetiree Health Trust 26316 COMMERCIAL NRetiree Health Trust 26316 COMMERCIAL NRightChoice Benefit Administrators 37331 COMMERCIAL NRightChoice Benefit Administrators 37331 COMMERCIAL NRocky Mountain Health Plan - Grand Junction SX141 COMMERCIAL RRocky Mountain Health Plan - Grand Junction SX141 COMMERCIAL RRooney Life Inc. 37602 COMMERCIAL NRooney Life Inc. 37602 COMMERCIAL N

Rural Carrier Benefit Plan 25133 COMMERCIAL N



payer ID. Including NRLCA Staff

Plan.

Rural Carrier Benefit Plan 25133 COMMERCIAL N



payer ID. Including NRLCA Staff

Plan.Rush Health Association 36339 COMMERCIAL NRush Health Association 36339 COMMERCIAL NRush Prudential Health Plans (HMO Only) 36389 COMMERCIAL NRush Prudential Health Plans (HMO Only) 36389 COMMERCIAL NRyan White Network AMM03 COMMERCIAL NRyan White Network AMM03 COMMERCIAL NS & S Healthcare Strategies 31441 COMMERCIAL NS & S Healthcare Strategies 31441 COMMERCIAL NSAINT MARY'S HEALTH PLAN 88029 COMMERCIAL NSAINT MARY'S HEALTH PLAN 88029 COMMERCIAL NSANTA CLARA FAMILY HEALTH PLAN 24077 COMMERCIAL NSANTA CLARA FAMILY HEALTH PLAN 24077 COMMERCIAL NSCAN ENCOUNTERS 99157 COMMERCIAL N Diversified Data Design (DDD)SCAN ENCOUNTERS 99157 COMMERCIAL N Diversified Data Design (DDD)SCAN Health Plan 72261 COMMERCIAL NSCAN Health Plan 72261 COMMERCIAL NSCAN Long Term Care 20460 COMMERCIAL NSCAN Long Term Care 20460 COMMERCIAL NSCHC Total Care Inc. (Acceptius Gateway payer) 16146 COMMERCIAL NSCHC Total Care Inc. (Acceptius Gateway payer) 16146 COMMERCIAL NSENIOR WHOLE HEALTH 83035 COMMERCIAL NSENIOR WHOLE HEALTH 83035 COMMERCIAL NSagamore Health Network 35164 COMMERCIAL N


Page 95


January 2011

Payer ID State Model Enroll Additional InformationSagamore Health Network 35164 COMMERCIAL NSage Technologies 37105 COMMERCIAL NSage Technologies 37105 COMMERCIAL NSage Technologies - PBS 37137 COMMERCIAL NSage Technologies - PBS 37137 COMMERCIAL NSan Diego County Coverage Initiative (CI) MSO77 COMMERCIAL NSan Diego County Coverage Initiative (CI) MSO77 COMMERCIAL NSan Diego County Medical Services (CMS) MSO11 COMMERCIAL NSan Diego County Medical Services (CMS) MSO11 COMMERCIAL NSan Diego County Ryan White Care Act MSO33 COMMERCIAL NSan Diego County Ryan White Care Act MSO33 COMMERCIAL N

San Diego Physicians Call COMMERCIAL N





San Diego Physicians Call COMMERCIAL N





San Diego Physicians Medical Group Central Region Call COMMERCIAL N





San Diego Physicians Medical Group Central Region Call COMMERCIAL N




7100 [email protected] Joaquin Health Administrators 68035 COMMERCIAL NSan Joaquin Health Administrators 68035 COMMERCIAL NSan Judas Medical Group IPA HSM01 COMMERCIAL NSan Judas Medical Group IPA HSM01 COMMERCIAL NSan Louis Obispo Select 33072 COMMERCIAL NSan Louis Obispo Select 33072 COMMERCIAL NSanford Health Plan 91184 COMMERCIAL NSanford Health Plan 91184 COMMERCIAL NSante Health System 77024 COMMERCIAL NSante Health System 77024 COMMERCIAL NSante Health System and Affiliates 77038 COMMERCIAL NSante Health System and Affiliates 77038 COMMERCIAL NScan Health Plan Arizona 73172 COMMERCIAL NScan Health Plan Arizona 73172 COMMERCIAL NScott & White TH002 COMMERCIAL NScott & White TH002 COMMERCIAL NSeabury & Smith 13310 COMMERCIAL NSeabury & Smith 13310 COMMERCIAL NSeaview IPA SVIPA COMMERCIAL NSeaview IPA SVIPA COMMERCIAL NSecure Health Plans of Georgia LLC 28530 COMMERCIAL N


Page 96


January 2011

Payer ID State Model Enroll Additional InformationSecure Health Plans of Georgia LLC 28530 COMMERCIAL N

Secure Horizons Arizona - Claims 95964 COMMERCIAL N





via email at

[email protected]

Secure Horizons Arizona - Claims 95964 COMMERCIAL N





via email at

[email protected]

Secure Horizons California - Claims 95959 COMMERCIAL N






Secure Horizons California - Claims 95959 COMMERCIAL N






Secure Horizons Colorado - Claims 95962 COMMERCIAL N





via email at

[email protected]

Secure Horizons Colorado - Claims 95962 COMMERCIAL N





via email at

[email protected]

Secure Horizons Washington - Claims 95959 COMMERCIAL N







Page 97


January 2011


Secure Horizons Washington - Claims 95959 COMMERCIAL N






Secure Horizons of Oklahoma - Claims 95959 COMMERCIAL N






Secure Horizons of Oklahoma - Claims 95959 COMMERCIAL N






Secure Horizons of Oregon - Claims 95959 COMMERCIAL N






Secure Horizons of Oregon - Claims 95959 COMMERCIAL N






Secure Horizons of Texas - Claims 95959 COMMERCIAL N






Secure Horizons of Texas - Claims 95959 COMMERCIAL N





email at [email protected] Health Plan 39045 COMMERCIAL NSecurity Health Plan 39045 COMMERCIAL N

Select Administrative Services (SAS) 64088 COMMERCIAL N

Also known as Mississippi Select

Health Care.

Select Administrative Services (SAS) 64088 COMMERCIAL N

Also known as Mississippi Select

Health Care.


Page 98


January 2011


Select Benefit Administrators of America 37282 COMMERCIAL N



P.O. Box 440 Ashland WI 54806.

Select Benefit Administrators of America 37282 COMMERCIAL N



P.O. Box 440 Ashland WI 54806.Select Benefit Administrators Inc. 93031 COMMERCIAL NSelect Benefit Administrators Inc. 93031 COMMERCIAL N

Select Health of South Carolina 23285 COMMERCIAL N

For EDI support please e-mail

[email protected].

Select Health of South Carolina 23285 COMMERCIAL N

For EDI support please e-mail

[email protected] Senior Clinic 20415 COMMERCIAL NSelect Senior Clinic 20415 COMMERCIAL NSelectCare 14 COMMERCIAL NSelectCare 14 COMMERCIAL NSelectCare of Texas (HPN) Heritage Physicians Network76045 COMMERCIAL NSelectCare of Texas (HPN) Heritage Physicians Network76045 COMMERCIAL NSelectCare of Texas (Kelsey-Seybold) 61225 COMMERCIAL NSelectCare of Texas (Kelsey-Seybold) 61225 COMMERCIAL N

SelectHealth SX107 COMMERCIAL N

SelectHealth was formerly

Intermountain Healthcare (IHC)

SelectHealth SX107 COMMERCIAL N

SelectHealth was formerly

Intermountain Healthcare (IHC)

Self Insured Benefit Administrators (Clearwater FL) 59111 COMMERCIAL N


a submission address of 18167 US

Highway 19 North Suite 300

Clearwater FL 33764.

Self Insured Benefit Administrators (Clearwater FL) 59111 COMMERCIAL N


a submission address of 18167 US

Highway 19 North Suite 300

Clearwater FL 33764.

Self Insured Plans (Naples FL) 36404 COMMERCIAL N


a submission address of 1016

Collier Center Way Suite 200

Naples FL 34110. Please call


7884 to verify claims submission

to Self Insured Plans - Payer ID

36404 (Naples FL).


Page 99


January 2011


Self Insured Plans (Naples FL) 36404 COMMERCIAL N


a submission address of 1016

Collier Center Way Suite 200

Naples FL 34110. Please call


7884 to verify claims submission

to Self Insured Plans - Payer ID

36404 (Naples FL).Self-Funded Plans Inc. 34131 COMMERCIAL NSelf-Funded Plans Inc. 34131 COMMERCIAL NSenior Care Partners 36390 COMMERCIAL NSenior Care Partners 36390 COMMERCIAL N

Sentara Family Care 54154 COMMERCIAL N








(757) 552-7477.

Sentara Family Care 54154 COMMERCIAL N








(757) 552-7477.

Sentara Health Management 54154 COMMERCIAL N








(757) 552-7477.

Sentara Health Management 54154 COMMERCIAL N








(757) 552-7477.Sentinel Management Services 23249 COMMERCIAL NSentinel Management Services 23249 COMMERCIAL N


Page 100


January 2011


Sentry Insurance a Mutual Company 39033 COMMERCIAL N

Claims must have the Sentry Life

Insurance Co. Group and

Subscriber Numbers. To verify

you are using the correct number

you may contact Sentry's


1-800-426-7234

Sentry Insurance a Mutual Company 39033 COMMERCIAL N







1-800-426-7234

Sentry Life Insurance Company 39033 COMMERCIAL N







1-800-426-7234

Sentry Life Insurance Company 39033 COMMERCIAL N







1-800-426-7234

Sentry Life of New York 39033 COMMERCIAL N







1-800-426-7234

Sentry Life of New York 39033 COMMERCIAL N







1-800-426-7234Sequoia Beverage TKFMC COMMERCIAL NSequoia Beverage TKFMC COMMERCIAL NSeton CHIP 76056 COMMERCIAL NSeton CHIP 76056 COMMERCIAL NSeton Employee Plan TH080 COMMERCIAL NSeton Employee Plan TH080 COMMERCIAL NSeton Health Plan - Exclusive TH079 COMMERCIAL NSeton Health Plan - Exclusive TH079 COMMERCIAL N


Page 101


January 2011

Payer ID State Model Enroll Additional InformationSeton MAP Program TH081 COMMERCIAL NSeton MAP Program TH081 COMMERCIAL NSeven Corners 25404 COMMERCIAL NSeven Corners 25404 COMMERCIAL NShasta Administrative Services 75280 COMMERCIAL N Jeld-Wen Claims OnlyShasta Administrative Services 75280 COMMERCIAL N Jeld-Wen Claims Only

Sheakley UNICOMP (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Sheakley UNICOMP (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Sheet Metal Workers Local 104 Health Care Plan (San Ramon CA)38238 COMMERCIAL N




Sheet Metal Workers Local 104 Health Care Plan (San Ramon CA)38238 COMMERCIAL N




Sheffield Olson & McQueen Inc Call COMMERCIAL N

Please contact Cate Ahlquist at

Sheffield Olson & McQueen Inc.

prior to submitting claims

electronically. Phone number is

651-695-2602

Sheffield Olson & McQueen Inc Call COMMERCIAL N

Please contact Cate Ahlquist at

Sheffield Olson & McQueen Inc.

prior to submitting claims

electronically. Phone number is

651-695-2602Sierra Family Network (Prospect Medical Group) PROSP COMMERCIAL NSierra Family Network (Prospect Medical Group) PROSP COMMERCIAL NSierra Health Services 76342 COMMERCIAL NSierra Health Services 76342 COMMERCIAL NSierra Nevada Medical Association MBA01 COMMERCIAL NSierra Nevada Medical Association MBA01 COMMERCIAL N

Signature Health Alliance 62159 COMMERCIAL N

Valid only for HCFA-1500 claims

currently mailed to Signature

Health Alliance P.O. Box 22419

Nashville TN 37202-2419.

Signature Health Alliance 62159 COMMERCIAL N

Valid only for HCFA-1500 claims

currently mailed to Signature

Health Alliance P.O. Box 22419

Nashville TN 37202-2419.Significa Benefits Services Inc. 23250 COMMERCIAL NSignifica Benefits Services Inc. 23250 COMMERCIAL NSilver Cross Managed Care Organization 36387 COMMERCIAL NSilver Cross Managed Care Organization 36387 COMMERCIAL NSinclair Health Plan 84076 COMMERCIAL NSinclair Health Plan 84076 COMMERCIAL NSloans Lake Preferred Health Networks 84096 COMMERCIAL N


Page 102


January 2011

Payer ID State Model Enroll Additional InformationSloans Lake Preferred Health Networks 84096 COMMERCIAL NSmith Administrators 2057 COMMERCIAL NSmith Administrators 2057 COMMERCIAL N

Solano Regional Medical Group Call COMMERCIAL P

Sutter Connect requires the

providers to complete an

application & get approval from

us prior to sending claims to a

clearinghouse. Contact Sutter

Connect EDI Dept @ (800)611-

5191 for payer ID.

Solano Regional Medical Group Call COMMERCIAL P







5191 for payer ID.

Solidarity Managed Care Organization (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Solidarity Managed Care Organization (Ohio BWC) 31147 COMMERCIAL N


ONLY.Sound Health (now known as First Choice Health Network)91131 COMMERCIAL NSound Health (now known as First Choice Health Network)91131 COMMERCIAL N

South Central Preferred - PPO York PA (IHS Gateway Payer)Call COMMERCIAL N

Call Jane Grove at Provider

Relations for South Central

Preferred (717) 851-6715

South Central Preferred - PPO York PA (IHS Gateway Payer)Call COMMERCIAL N

Call Jane Grove at Provider

Relations for South Central

Preferred (717) 851-6715

South Dakota Medicaid SKSD0 COMMERCIAL R

Secondary claims note: Only

accepts Medicare Crossover

claims

South Dakota Medicaid SKSD0 COMMERCIAL R

Secondary claims note: Only

accepts Medicare Crossover

claimsSouth FL Community Care Network - NBHD 37314 COMMERCIAL NSouth FL Community Care Network - NBHD 37314 COMMERCIAL NSouth Haven Community Hospital Call COMMERCIAL NSouth Haven Community Hospital Call COMMERCIAL NSouth Indiana Health Operations - HMO SX142 COMMERCIAL NSouth Indiana Health Operations - HMO SX142 COMMERCIAL NSouth Indiana Health Options - Prime Care Choice SX143 COMMERCIAL NSouth Indiana Health Options - Prime Care Choice SX143 COMMERCIAL NSouth Indiana Health Options - TPA SX144 COMMERCIAL NSouth Indiana Health Options - TPA SX144 COMMERCIAL NSouth Point Hotel & Casino 35227 COMMERCIAL NSouth Point Hotel & Casino 35227 COMMERCIAL NSouthCare/Healthcare Preferred 25147 COMMERCIAL NSouthCare/Healthcare Preferred 25147 COMMERCIAL NSouthCare/Healthcare Preferred 25147 COMMERCIAL N


Page 103


January 2011

Payer ID State Model Enroll Additional InformationSouthCare/Healthcare Preferred 25147 COMMERCIAL NSoutheast Texas Govt Employees Benefit Pool TH116 COMMERCIAL NSoutheast Texas Govt Employees Benefit Pool TH116 COMMERCIAL N

Southern Benefit Services 37318 COMMERCIAL N

Southern Benefit Services will no

longer process claims from the

following Provider Groups:

Brockman Enterprises and SPS

International.

Southern Benefit Services 37318 COMMERCIAL N

Southern Benefit Services will no

longer process claims from the

following Provider Groups:

Brockman Enterprises and SPS

International.Southern CA Children's Network (SynerMed) SYMED COMMERCIAL NSouthern CA Children's Network (SynerMed) SYMED COMMERCIAL NSouthern Cal Physicians Managed Care Services SCP01 COMMERCIAL NSouthern Cal Physicians Managed Care Services SCP01 COMMERCIAL N

Southern Health Service Inc. 25133 COMMERCIAL N



payer ID.

Southern Health Service Inc. 25133 COMMERCIAL N



payer ID.Southwest Administrators California SWSTA COMMERCIAL NSouthwest Administrators California SWSTA COMMERCIAL NSouthwest Administrators Nevada SWSTA COMMERCIAL NSouthwest Administrators Nevada SWSTA COMMERCIAL N

Southwest Service Life 37266 COMMERCIAL N






982005 Ft. Worth TX 76182.

Southwest Service Life 37266 COMMERCIAL N






982005 Ft. Worth TX 76182.Special Risk International 52190 COMMERCIAL NSpecial Risk International 52190 COMMERCIAL NSpectrum Administrators Inc. - TPA Allentown PA (IHS Gateway Payer)23253 COMMERCIAL NSpectrum Administrators Inc. - TPA Allentown PA (IHS Gateway Payer)23253 COMMERCIAL NSpina Bifida - VA HAC 84146 COMMERCIAL NSpina Bifida - VA HAC 84146 COMMERCIAL NSpohn Health TH100 COMMERCIAL NSpohn Health TH100 COMMERCIAL NSt Francis IPA APP01 COMMERCIAL NSt Francis IPA APP01 COMMERCIAL N


Page 104


January 2011

Payer ID State Model Enroll Additional InformationSt Joseph IPA STJOE COMMERCIAL NSt Joseph IPA STJOE COMMERCIAL NSt Jude Yorba Linda STJOE COMMERCIAL NSt Jude Yorba Linda STJOE COMMERCIAL N

St. Anthony Memorial Healthcare Centers - MDWISE 35199 COMMERCIAL N




7502

St. Anthony Memorial Healthcare Centers - MDWISE 35199 COMMERCIAL N




7502St. Barnabas System Health Plan 22240 COMMERCIAL NSt. Barnabas System Health Plan 22240 COMMERCIAL N

St. Catherine Hospital PHO - MDWISE 35199 COMMERCIAL N




7502

St. Catherine Hospital PHO - MDWISE 35199 COMMERCIAL N




7502

St. Francis Health Network 35199 COMMERCIAL N




7502

St. Francis Health Network 35199 COMMERCIAL N




7502St. John's Claims Administration 37264 COMMERCIAL NSt. John's Claims Administration 37264 COMMERCIAL NSt. Joseph Heritage Healthcare STJOE COMMERCIAL NSt. Joseph Heritage Healthcare STJOE COMMERCIAL NSt. Jude (St. Joseph Heritage Healthcare) STJOE COMMERCIAL NSt. Jude (St. Joseph Heritage Healthcare) STJOE COMMERCIAL N

St. Margaret Mercy Healthcare Centers - MDWISE 35199 COMMERCIAL N




7502

St. Margaret Mercy Healthcare Centers - MDWISE 35199 COMMERCIAL N




7502St. Vincent IPA PDT01 COMMERCIAL NSt. Vincent IPA PDT01 COMMERCIAL N


Page 105


January 2011


Star HRG 59225 COMMERCIAL N




P.O. Box 55270 30870 30888

54150 30069 55400 Phoenix AZ

85270-5270.

Star HRG 59225 COMMERCIAL N




P.O. Box 55270 30870 30888

54150 30069 55400 Phoenix AZ

85270-5270.Starmark 61425 COMMERCIAL NStarmark 61425 COMMERCIAL NStarmark 61425 COMMERCIAL NStarmark 61425 COMMERCIAL NState Auto Insurance Companies 46450 COMMERCIAL NState Auto Insurance Companies 46450 COMMERCIAL N

State Farm (Casualty & Property Claims) 31059 COMMERCIAL N

State Farm - Property & Casualty

line of business is Payer ID 31059.

State Farm (Casualty & Property Claims) 31059 COMMERCIAL N

State Farm - Property & Casualty

line of business is Payer ID 31059.

State Farm Insurance Companies 31053 COMMERCIAL N


Health line of business.

State Farm Insurance Companies 31053 COMMERCIAL N


Health line of business.State of Texas Dental Plan 57254 COMMERCIAL NState of Texas Dental Plan 57254 COMMERCIAL NStates General Life Insurance 75087 COMMERCIAL NStates General Life Insurance 75087 COMMERCIAL NStaywell Health Plan 14163 COMMERCIAL NStaywell Health Plan 14163 COMMERCIAL N

Sterling Option 1 91151 COMMERCIAL N

To register for ERA (sent directly

from Sterling to the provider)

please go to

https://providernet.adminisource

.com/. If you have any questions

support is available by phone at

877-389-1160.

Sterling Option 1 91151 COMMERCIAL N

To register for ERA (sent directly

from Sterling to the provider)

please go to

https://providernet.adminisource

.com/. If you have any questions

support is available by phone at

877-389-1160.Stoner and Associates (Cincinnati OH) 31121 COMMERCIAL N


Page 106


January 2011

Payer ID State Model Enroll Additional InformationStoner and Associates (Cincinnati OH) 31121 COMMERCIAL NStones River Regional IPA- Windsor 15752 COMMERCIAL NStones River Regional IPA- Windsor 15752 COMMERCIAL N

Student Insurance - Mid-West National Life Insurance Co. of Tenessee74227 COMMERCIAL N




P.O. Box 890025 809067 809079

809066 809036 809081 Dallas Tx

75380-9025.

Student Insurance - Mid-West National Life Insurance Co. of Tenessee74227 COMMERCIAL N




P.O. Box 890025 809067 809079

809066 809036 809081 Dallas Tx

75380-9025.

Student Insurance - The MEGA Life & Health Insurance Company74227 COMMERCIAL N




P.O. Box 890025 809067 809079

809066 809036 809081 Dallas Tx

75380-9025.

Student Insurance - The MEGA Life & Health Insurance Company74227 COMMERCIAL N




P.O. Box 890025 809067 809079

809066 809036 809081 Dallas Tx

75380-9025.

Suburban Health Organization 35199 COMMERCIAL N




7502

Suburban Health Organization 35199 COMMERCIAL N




7502SummaCare Health Plan 95202 COMMERCIAL NSummaCare Health Plan 95202 COMMERCIAL NSummerlin Life & Health Insurance 86071 COMMERCIAL NSummerlin Life & Health Insurance 86071 COMMERCIAL N

Summit America Insurance Services Inc. 37301 COMMERCIAL N

Student Accident and Sickness

College Sports and NASCC claims

only

Summit America Insurance Services Inc. 37301 COMMERCIAL N

Student Accident and Sickness

College Sports and NASCC claims

only

SummitCorp (Ohio BWC) 31147 COMMERCIAL N


ONLY.


Page 107


January 2011


SummitCorp (Ohio BWC) 31147 COMMERCIAL N


ONLY.Sunshine State Health Plan 68057 COMMERCIAL NSunshine State Health Plan 68057 COMMERCIAL N

Superior Administrators Inc (Santa Ana CA) 23218 COMMERCIAL N


submission address of P.O. Box

27730 Santa Ana CA 92799-7730

Superior Administrators Inc (Santa Ana CA) 23218 COMMERCIAL N


submission address of P.O. Box

27730 Santa Ana CA 92799-7730

Superior Health Plan Texas 39188 COMMERCIAL P








Superior Health Plan Texas 39188 COMMERCIAL P








Sutter Delta Medical Group Call COMMERCIAL P







5191 for payer ID.

Sutter Delta Medical Group Call COMMERCIAL P







5191 for payer ID.Sutter East Bay Medical Foundation Call COMMERCIAL NSutter East Bay Medical Foundation Call COMMERCIAL N


Page 108


January 2011


Sutter Gould Medical Foundation Call COMMERCIAL P







5191 for payer ID.

Sutter Gould Medical Foundation Call COMMERCIAL P







5191 for payer ID.

Sutter Independent Physicians Call COMMERCIAL P







5191 for payer ID

Sutter Independent Physicians Call COMMERCIAL P







5191 for payer ID

Sutter Medical Foundation Call COMMERCIAL P







5191 for payer ID.

Sutter Medical Foundation Call COMMERCIAL P







5191 for payer ID.


Page 109


January 2011


Sutter Medical Group of the Redwoods Call COMMERCIAL P







5191 for payer ID.

Sutter Medical Group of the Redwoods Call COMMERCIAL P







5191 for payer ID.Swedish Covenant Hospital 36411 COMMERCIAL NSwedish Covenant Hospital 36411 COMMERCIAL NSynermed SYMED COMMERCIAL NSynermed SYMED COMMERCIAL NTASEBA TKFMC COMMERCIAL NTASEBA TKFMC COMMERCIAL NTBT 94304 COMMERCIAL NTBT 94304 COMMERCIAL NTEXAS CHILDRENS HEALTH TXCSM COMMERCIAL NTEXAS CHILDRENS HEALTH TXCSM COMMERCIAL N

TN IPA 15750 COMMERCIAL N


Stones River Regional IPA - BC/BS

Tennessee claims.

TN IPA 15750 COMMERCIAL N


Stones River Regional IPA - BC/BS

Tennessee claims.TOUCHSTONE HEALTH/HEALTH NET SMART CHOICE 13402 COMMERCIAL NTOUCHSTONE HEALTH/HEALTH NET SMART CHOICE 13402 COMMERCIAL NTPAC/Employee Benefit Management Corp 31074 COMMERCIAL NTPAC/Employee Benefit Management Corp 31074 COMMERCIAL NTR Paul Inc. 37230 COMMERCIAL NTR Paul Inc. 37230 COMMERCIAL N

TRIHEALTH PHYSICIAN SOLUTIONS 31144 COMMERCIAL R

Payer registration is required

prior to claims submission. Forms

are located at

www.emdeon.com/enrollment.

TRIHEALTH PHYSICIAN SOLUTIONS 31144 COMMERCIAL R

Payer registration is required

prior to claims submission. Forms

are located at

www.emdeon.com/enrollment.TRIHEALTH PHYSICIAN SOLUTIONS - CONCERN 31143 COMMERCIAL NTRIHEALTH PHYSICIAN SOLUTIONS - CONCERN 31143 COMMERCIAL NTRLHN/AS 98514 COMMERCIAL NTRLHN/AS 98514 COMMERCIAL NTRLHN/EB 62777 COMMERCIAL N


Page 110


January 2011

Payer ID State Model Enroll Additional InformationTRLHN/EB 62777 COMMERCIAL NTalbert Medical Group TALMG COMMERCIAL NTalbert Medical Group TALMG COMMERCIAL NTall Tree Administrators 88067 COMMERCIAL NTall Tree Administrators 88067 COMMERCIAL NTarrant Health Services 37228 COMMERCIAL NTarrant Health Services 37228 COMMERCIAL NTeachers Health Trust 88019 COMMERCIAL NTeachers Health Trust 88019 COMMERCIAL NTeam Choice Gold 75139 COMMERCIAL NTeam Choice Gold 75139 COMMERCIAL NTeam Choice PNS 75133 COMMERCIAL NTeam Choice PNS 75133 COMMERCIAL NTeam Choice UMC 75134 COMMERCIAL NTeam Choice UMC 75134 COMMERCIAL NTeamcare 36215 COMMERCIAL NTeamcare 36215 COMMERCIAL NTeamsters Benefit Trust 94304 COMMERCIAL NTeamsters Benefit Trust 94304 COMMERCIAL NTethys Health Ventures 20212 COMMERCIAL NTethys Health Ventures 20212 COMMERCIAL NTexas Children's Health Plan 76048 COMMERCIAL NTexas Children's Health Plan 76048 COMMERCIAL N

Texas Children's Star Call COMMERCIAL N

Provider ID required for all THIN

payers.

Texas Children's Star Call COMMERCIAL N

Provider ID required for all THIN

payers.Texas Childrens Health Plan (Medicaid) 75228 COMMERCIAL NTexas Childrens Health Plan (Medicaid) 75228 COMMERCIAL NTexas HealthSpring 33104 COMMERCIAL NTexas HealthSpring 33104 COMMERCIAL NTexas Premier Plan TH089 COMMERCIAL NTexas Premier Plan TH089 COMMERCIAL NTexas True Choice TH055 COMMERCIAL NTexas True Choice TH055 COMMERCIAL NTexasFirst Health Plan (NTX) 13185 COMMERCIAL NTexasFirst Health Plan (NTX) 13185 COMMERCIAL N

The Chesapeake Life Insurance Company - Student Insurance74227 COMMERCIAL N




P.O. Box 890025 809067 809079

809066 809036 809081 Dallas Tx

75380-9025.

The Chesapeake Life Insurance Company - Student Insurance74227 COMMERCIAL N




P.O. Box 890025 809067 809079

809066 809036 809081 Dallas Tx

75380-9025.The City of Odessa 75600 COMMERCIAL N


Page 111


January 2011

Payer ID State Model Enroll Additional InformationThe City of Odessa 75600 COMMERCIAL NThe Ford Meter Box Company Inc. 37305 COMMERCIAL NThe Ford Meter Box Company Inc. 37305 COMMERCIAL NThe Health Exchange (Cerner Corporation) 20356 COMMERCIAL NThe Health Exchange (Cerner Corporation) 20356 COMMERCIAL N

The Health Plan (Massillon Ohio and St. Clairsville Ohio only)34150 COMMERCIAL N

Services ordered by outside

provider require referring

provider on a HCFA and attending

physician on a UB. Pease provide

physician name and UPIN if

available.

The Health Plan (Massillon Ohio and St. Clairsville Ohio only)34150 COMMERCIAL N

Services ordered by outside

provider require referring

provider on a HCFA and attending

physician on a UB. Pease provide

physician name and UPIN if

available.

The Health Plan (Ohio BWC) 31147 COMMERCIAL N


ONLY.

The Health Plan (Ohio BWC) 31147 COMMERCIAL N


ONLY.The Healthcare Group 35206 COMMERCIAL NThe Healthcare Group 35206 COMMERCIAL NThe Integrity Benefit Group Inc. 58200 COMMERCIAL NThe Integrity Benefit Group Inc. 58200 COMMERCIAL NThe Loomis Company - TPA Wyomissing PA (IHS Gateway Payer)23223 COMMERCIAL NThe Loomis Company - TPA Wyomissing PA (IHS Gateway Payer)23223 COMMERCIAL N

The MEGA Life & Health Insurance Company - Insurance Center59221 COMMERCIAL N

Payer ID valid only if the P.O. Box

on the Health ID card matches

the following P.O. Box: P.O. Box

982009 North Richland Hills TX

76182

The MEGA Life & Health Insurance Company - Insurance Center59221 COMMERCIAL N

Payer ID valid only if the P.O. Box

on the Health ID card matches

the following P.O. Box: P.O. Box

982009 North Richland Hills TX

76182

The MEGA Life & Health Insurance Company - Starbridge StarHRG59225 COMMERCIAL N




P.O. Box 55270 30870 30888

54150 30069 55400 Phoenix AZ

85270-5270.


Page 112


January 2011


The MEGA Life & Health Insurance Company - Starbridge StarHRG59225 COMMERCIAL N




P.O. Box 55270 30870 30888

54150 30069 55400 Phoenix AZ

85270-5270.

The MEGA Life & Health Insurance Company - Student Insurance74227 COMMERCIAL N




P.O. Box 890025 809067 809079

809066 809036 809081 Dallas Tx

75380-9025.

The MEGA Life & Health Insurance Company - Student Insurance74227 COMMERCIAL N




P.O. Box 890025 809067 809079

809066 809036 809081 Dallas Tx

75380-9025.

The MEGA Life & Health Insurance Company-OKC 59227 COMMERCIAL N

If the P.O. Box on the health ID

card matches the following P.O.

Box: P.O. Box 548801 Oklahoma

City OK 73154

The MEGA Life & Health Insurance Company-OKC 59227 COMMERCIAL N

If the P.O. Box on the health ID

card matches the following P.O.

Box: P.O. Box 548801 Oklahoma

City OK 73154

The National Radiology Network 59087 COMMERCIAL N

Electronic Payer ID for Claims

printed and mailed to payer

The National Radiology Network 59087 COMMERCIAL N

Electronic Payer ID for Claims

printed and mailed to payerThe Perfect Health Insurance Co. 13522 COMMERCIAL NThe Perfect Health Insurance Co. 13522 COMMERCIAL NThe Physicians Assurance Corp (TPAC) /Employee Benefit Management Corp (EBM31074 COMMERCIAL NThe Physicians Assurance Corp (TPAC) /Employee Benefit Management Corp (EBM31074 COMMERCIAL N

The Preferred Healthcare System (TPHS) - PPO Altoona PA (IHS GatewayPayer)Call COMMERCIAL N


Picarde at (410) 349-3222

The Preferred Healthcare System (TPHS) - PPO Altoona PA (IHS GatewayPayer)Call COMMERCIAL N


Picarde at (410) 349-3222

Therapy Review Systems 75305 COMMERCIAL N

This payer id is valid for

contracted Therapy Review

Systems Georgia providers only.

Therapy Review Systems 75305 COMMERCIAL N

This payer id is valid for

contracted Therapy Review

Systems Georgia providers only.Thomas H. Cooper SX160 COMMERCIAL N


Page 113


January 2011

Payer ID State Model Enroll Additional InformationThomas H. Cooper SX160 COMMERCIAL N

Three Rivers Health Plans Inc 25175 COMMERCIAL N


Plan

Three Rivers Health Plans Inc 25175 COMMERCIAL N


PlanTime Insurance Company 39065 COMMERCIAL NTime Insurance Company 39065 COMMERCIAL NToday's Health Wisconsin 20081 COMMERCIAL NToday's Health Wisconsin 20081 COMMERCIAL NToday's Options (American Progressive and Pyramid Life)48055 COMMERCIAL NToday's Options (American Progressive and Pyramid Life)48055 COMMERCIAL NToday's Options powered by CCRX 48055 COMMERCIAL NToday's Options powered by CCRX 48055 COMMERCIAL NTongass Timber Trust 92620 COMMERCIAL NTongass Timber Trust 92620 COMMERCIAL NTooling & Manufacturing Association 61425 COMMERCIAL NTooling & Manufacturing Association 61425 COMMERCIAL NTorrance Hospital IPA THIPA COMMERCIAL NTorrance Hospital IPA THIPA COMMERCIAL NTotal Claims Administration 37314 COMMERCIAL NTotal Claims Administration 37314 COMMERCIAL NTotal Community Care 31182 COMMERCIAL NTotal Community Care 31182 COMMERCIAL N

Total Health Management - PBM (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Total Health Management - PBM (Ohio BWC) 31147 COMMERCIAL N


ONLY.Total Healthcare Inc. 38201 COMMERCIAL NTotal Healthcare Inc. 38201 COMMERCIAL NTouchpoint Health Plan HMO 97910 COMMERCIAL NTouchpoint Health Plan HMO 97910 COMMERCIAL NTouchstone Health PSO 23856 COMMERCIAL NTouchstone Health PSO 23856 COMMERCIAL NTower Life Insurance Co. 69493 COMMERCIAL NTower Life Insurance Co. 69493 COMMERCIAL NTown & Country TKFMC COMMERCIAL NTown & Country TKFMC COMMERCIAL NTransAmerica Assurance Company (TLIN3) TH127 COMMERCIAL NTransAmerica Assurance Company (TLIN3) TH127 COMMERCIAL NTransAmerica Assurance Company (TLINS) TH126 COMMERCIAL NTransAmerica Assurance Company (TLINS) TH126 COMMERCIAL NTransAmerica Assurance Company (TSAA2) TH124 COMMERCIAL NTransAmerica Assurance Company (TSAA2) TH124 COMMERCIAL NTransAmerica Assurance Company (TSAAC) TH125 COMMERCIAL NTransAmerica Assurance Company (TSAAC) TH125 COMMERCIAL N

TransAmerica Life Insurance Company 59222 COMMERCIAL N






Page 114


January 2011


TransAmerica Life Insurance Company 59222 COMMERCIAL N




North Richland Hills TX 76182.TransAmerica Occidental Life Insurance (TOLIC) TH128 COMMERCIAL NTransAmerica Occidental Life Insurance (TOLIC) TH128 COMMERCIAL NTransChoice-Key Benefit Administrators 37284 COMMERCIAL NTransChoice-Key Benefit Administrators 37284 COMMERCIAL NTrellis Health Partners 36397 COMMERCIAL NTrellis Health Partners 36397 COMMERCIAL NTriCities IPA PDT01 COMMERCIAL NTriCities IPA PDT01 COMMERCIAL NTribute /SelectCare of Oklahoma 73117 COMMERCIAL NTribute /SelectCare of Oklahoma 73117 COMMERCIAL NTrue Choice USA 54210 COMMERCIAL NTrue Choice USA 54210 COMMERCIAL NTrue Choice USA TH083 COMMERCIAL NTrue Choice USA TH083 COMMERCIAL NTrusteed Plans Service Corporation 91078 COMMERCIAL NTrusteed Plans Service Corporation 91078 COMMERCIAL NTrustmark Insurance Company 61425 COMMERCIAL NTrustmark Insurance Company 61425 COMMERCIAL N

Tufts Health Plan Call COMMERCIAL P

Please contact the Tufts Health

Plan EDI Operations Department

at 888-880-8699 ext. 4042. for

payer id.

Tufts Health Plan Call COMMERCIAL P

Please contact the Tufts Health

Plan EDI Operations Department

at 888-880-8699 ext. 4042. for

payer id.UBH - United Behavioral Health (Health Plan - HMO) 87726 COMMERCIAL NUBH - United Behavioral Health (Health Plan - HMO) 87726 COMMERCIAL NUBH - United Behavioral Health (former MetraHealth - UNET)87726 COMMERCIAL NUBH - United Behavioral Health (former MetraHealth - UNET)87726 COMMERCIAL NUCARE of Minnesota SX178 COMMERCIAL NUCARE of Minnesota SX178 COMMERCIAL N

UHP of New Jersey 22329 COMMERCIAL N









Page 115


January 2011


UHP of New Jersey 22329 COMMERCIAL N








UICI - Administrators - State of Nevada 74223 COMMERCIAL N

Accepting claims only for the

State of Nevada.

UICI - Administrators - State of Nevada 74223 COMMERCIAL N

Accepting claims only for the

State of Nevada.UMC HEALTH PLAN 75130 COMMERCIAL NUMC HEALTH PLAN 75130 COMMERCIAL N

UMR - Cincinnati (formerly known as United Medical Resources)31107 COMMERCIAL N

This Payer ID is valid for all claims

addresses on UMR Member ID

cards with a listed Payer ID of

31107.

UMR - Cincinnati (formerly known as United Medical Resources)31107 COMMERCIAL N

This Payer ID is valid for all claims

addresses on UMR Member ID

cards with a listed Payer ID of

31107.UMR - Harrington (formerly known as Harrington Benefit Services-Columbus)95266 COMMERCIAL N Harrington; RE HarringtonUMR - Harrington (formerly known as Harrington Benefit Services-Columbus)95266 COMMERCIAL N Harrington; RE HarringtonUMR - Lexington (formerly known as CommonWealth Administrative Group)37237 COMMERCIAL NUMR - Lexington (formerly known as CommonWealth Administrative Group)37237 COMMERCIAL NUMR - Onalaska (formerly known as Midwest Security of WI)79480 COMMERCIAL NUMR - Onalaska (formerly known as Midwest Security of WI)79480 COMMERCIAL NUMR - Wausau/UHIS (formerly Fiserv Health - Wausau Benefits/Benesight)39026 COMMERCIAL NUMR - Wausau/UHIS (formerly Fiserv Health - Wausau Benefits/Benesight)39026 COMMERCIAL N

UMR -Harrington (formerly known as Harrington Benefit Services-Westerville)75196 COMMERCIAL N Centra; Centra Benefit Services

UMR -Harrington (formerly known as Harrington Benefit Services-Westerville)75196 COMMERCIAL N Centra; Centra Benefit ServicesUMWA Health & Retirement Funds 52180 COMMERCIAL NUMWA Health & Retirement Funds 52180 COMMERCIAL NUNICARE 80314 COMMERCIAL NUNICARE 80314 COMMERCIAL NUNION PACIFIC RAILROAD EMPLOYES Health Systems87042 COMMERCIAL NUNION PACIFIC RAILROAD EMPLOYES Health Systems87042 COMMERCIAL NUNITED FOOD & COMM. WORKERS MIDWEST UNIONS36659 COMMERCIAL NUNITED FOOD & COMM. WORKERS MIDWEST UNIONS36659 COMMERCIAL N

UNIVERSITY OF MIAMI BEHAVIORAL HEALTH Call COMMERCIAL N

All submitters call for detailed

information and payer id prior to

sending claims. Contact UMBH

Provider Relations (305) 243-7270


Page 116


January 2011


UNIVERSITY OF MIAMI BEHAVIORAL HEALTH Call COMMERCIAL N

All submitters call for detailed

information and payer id prior to

sending claims. Contact UMBH

Provider Relations (305) 243-7270UPMC Health Plan 23281 COMMERCIAL NUPMC Health Plan 23281 COMMERCIAL NUS Benefits 93092 COMMERCIAL NUS Benefits 93092 COMMERCIAL NUS Family Health Plan (USFHP) TH103 COMMERCIAL NUS Family Health Plan (USFHP) TH103 COMMERCIAL N

USAA (United Services Automobile Association) 74095 COMMERCIAL N

Property and Casualty Division

Only

USAA (United Services Automobile Association) 74095 COMMERCIAL N

Property and Casualty Division

OnlyUSC Health Services TH021 COMMERCIAL NUSC Health Services TH021 COMMERCIAL N

USFHP - St. Vincent Catholic Medical Centers of New York13407 COMMERCIAL N

Serving parts of New York NYC all

of New Jersey Southeastern

Pennsylvania and Western

Connecticut. For member

eligibility call 1-800-241-4848

USFHP - St. Vincent Catholic Medical Centers of New York13407 COMMERCIAL N

Serving parts of New York NYC all

of New Jersey Southeastern

Pennsylvania and Western

Connecticut. For member

eligibility call 1-800-241-4848

UT- Altius (UHIN) 25133 COMMERCIAL N

Formerly Payer ID 12X38. Now


UT- Altius (UHIN) 25133 COMMERCIAL N

Formerly Payer ID 12X38. Now

part of the Consolidated payer ID.Unified Group Services 35198 COMMERCIAL NUnified Group Services 35198 COMMERCIAL N

Unified Health Services 62170 COMMERCIAL N

Worker's Compensation Claims

Only.

Unified Health Services 62170 COMMERCIAL N

Worker's Compensation Claims

Only.

Uniform Medical Plan/Harrington Benefit Services 75243 COMMERCIAL N

Harrington; Uniform Medical

Plan; Centra

Uniform Medical Plan/Harrington Benefit Services 75243 COMMERCIAL N

Harrington; Uniform Medical

Plan; Centra

Union Pacific IPA Call COMMERCIAL N






Page 117


January 2011


Union Pacific IPA Call COMMERCIAL N




7100 [email protected] Security Insurance Company 70408 COMMERCIAL NUnion Security Insurance Company 70408 COMMERCIAL NUnison Health Plan/Better Health Plans 62183 COMMERCIAL NUnison Health Plan/Better Health Plans 62183 COMMERCIAL NUnison Health Plan/Three Rivers 25175 COMMERCIAL NUnison Health Plan/Three Rivers 25175 COMMERCIAL NUnited Agriculture Benefit Trust UAGBT COMMERCIAL NUnited Agriculture Benefit Trust UAGBT COMMERCIAL NUnited Healthcare Ovations Insurance Solutions (AARP)36273 COMMERCIAL NUnited Healthcare Ovations Insurance Solutions (AARP)36273 COMMERCIAL N

United Healthcare of River Valley 95378 COMMERCIAL P

Prior to initial submission

provider must first contact John

Deere at (309) 765-1593 - toll free

(866) 509-1593 - to verify NPI

registration is complete

United Healthcare of River Valley 95378 COMMERCIAL P

Prior to initial submission

provider must first contact John

Deere at (309) 765-1593 - toll free

(866) 509-1593 - to verify NPI

registration is completeUnited Medical Alliance 84132 COMMERCIAL NUnited Medical Alliance 84132 COMMERCIAL N

United Security Life & Health Ins Co 36362 COMMERCIAL N

Please do not submit claims on or

after 1/1/2011 using payer ID

36362. Claims will need to be

submitted on paper to United

Security Life and Health PO Box

24655 Seattle WA 98124-0655.

For questions call 1-800-875-

4422.United Security Life & Health Ins Co 36362 COMMERCIAL NUnited of Omaha 71412 COMMERCIAL NUnited of Omaha 71412 COMMERCIAL NUnitedHealthcare 87726 COMMERCIAL N

UnitedHealthcare 87726 COMMERCIAL N

[former MetraHealth Healthcare

Network PPO New York State

Employees (Empire) Travelers Ins

Co Travelers Plan Administrators]


[former The Travelers Travelers

Health Network (HMO & Care

Option Travelers/CGT - PPO

MetraHealth - UNET]


Page 118


January 2011



[former MetraHealth Healthcare

Network PPO New York State

Employees (Empire) Travelers Ins

Co Travelers Plan Administrators]


[former The Travelers Travelers

Health Network (HMO & Care

Option Travelers/CGT - PPO

MetraHealth - UNET]UnitedHealthcare 87726 COMMERCIAL NUnitedHealthcare Plans of Puerto Rico 87726 COMMERCIAL NUnitedHealthcare Plans of Puerto Rico 87726 COMMERCIAL NUnitedHealthcare of Alabama 87726 COMMERCIAL NUnitedHealthcare of Alabama 87726 COMMERCIAL NUnitedHealthcare of Arizona Inc. 87726 COMMERCIAL NUnitedHealthcare of Arizona Inc. 87726 COMMERCIAL NUnitedHealthcare of Arkansas 87726 COMMERCIAL NUnitedHealthcare of Arkansas 87726 COMMERCIAL NUnitedHealthcare of California - Northern California 87726 COMMERCIAL NUnitedHealthcare of California - Northern California 87726 COMMERCIAL NUnitedHealthcare of California - Southern California 87726 COMMERCIAL NUnitedHealthcare of California - Southern California 87726 COMMERCIAL NUnitedHealthcare of Colorado Inc. 87726 COMMERCIAL NUnitedHealthcare of Colorado Inc. 87726 COMMERCIAL NUnitedHealthcare of Florida 87726 COMMERCIAL NUnitedHealthcare of Florida 87726 COMMERCIAL NUnitedHealthcare of Georgia 87726 COMMERCIAL NUnitedHealthcare of Georgia 87726 COMMERCIAL NUnitedHealthcare of Illinois 87726 COMMERCIAL NUnitedHealthcare of Illinois 87726 COMMERCIAL NUnitedHealthcare of Kentucky Ltd. 87726 COMMERCIAL NUnitedHealthcare of Kentucky Ltd. 87726 COMMERCIAL NUnitedHealthcare of Louisiana 87726 COMMERCIAL NUnitedHealthcare of Louisiana 87726 COMMERCIAL NUnitedHealthcare of Mississippi 87726 COMMERCIAL NUnitedHealthcare of Mississippi 87726 COMMERCIAL NUnitedHealthcare of New England 87726 COMMERCIAL NUnitedHealthcare of New England 87726 COMMERCIAL NUnitedHealthcare of New York (includes New York and New Jersey)87726 COMMERCIAL NUnitedHealthcare of New York (includes New York and New Jersey)87726 COMMERCIAL NUnitedHealthcare of North Carolina Inc. 87726 COMMERCIAL NUnitedHealthcare of North Carolina Inc. 87726 COMMERCIAL NUnitedHealthcare of Ohio 87726 COMMERCIAL NUnitedHealthcare of Ohio 87726 COMMERCIAL NUnitedHealthcare of Tennessee 87726 COMMERCIAL NUnitedHealthcare of Tennessee 87726 COMMERCIAL NUnitedHealthcare of Texas - Dallas 87726 COMMERCIAL NUnitedHealthcare of Texas - Dallas 87726 COMMERCIAL NUnitedHealthcare of Texas - Houston 87726 COMMERCIAL NUnitedHealthcare of Texas - Houston 87726 COMMERCIAL NUnitedHealthcare of Upstate New York 87726 COMMERCIAL NUnitedHealthcare of Upstate New York 87726 COMMERCIAL N


Page 119


January 2011

Payer ID State Model Enroll Additional InformationUnitedHealthcare of Utah 87726 COMMERCIAL NUnitedHealthcare of Utah 87726 COMMERCIAL NUnitedHealthcare of Virginia 87726 COMMERCIAL NUnitedHealthcare of Virginia 87726 COMMERCIAL NUnitedHealthcare of Wisconsin Inc. 87726 COMMERCIAL NUnitedHealthcare of Wisconsin Inc. 87726 COMMERCIAL NUnitedHealthcare of the Mid-Atlantic 87726 COMMERCIAL NUnitedHealthcare of the Mid-Atlantic 87726 COMMERCIAL NUnitedHealthcare of the Midlands - HMO (Choice Select)87726 COMMERCIAL NUnitedHealthcare of the Midlands - HMO (Choice Select)87726 COMMERCIAL NUnitedHealthcare of the Midlands - PPO(Choice PlusSelect PlusSelf Funded)87726 COMMERCIAL NUnitedHealthcare of the Midlands - PPO(Choice PlusSelect PlusSelf Funded)87726 COMMERCIAL NUnitedHealthcare of the Midwest - Choice Choice Plus Select Select Plus87726 COMMERCIAL NUnitedHealthcare of the Midwest - Choice Choice Plus Select Select Plus87726 COMMERCIAL NUnitedHealthcare of the Midwest - Medicare Complete87726 COMMERCIAL NUnitedHealthcare of the Midwest - Medicare Complete87726 COMMERCIAL N

Unity Health Insurance 66705 COMMERCIAL N

Before submitting claims please

go to

http://www.unityhealth.com/Pro

viders/AdminResources/EDI/inde

x.htm and complete EDI Sign Up

Form and NPI Appendix A

documents.

Unity Health Insurance 66705 COMMERCIAL N

Before submitting claims please

go to

http://www.unityhealth.com/Pro

viders/AdminResources/EDI/inde

x.htm and complete EDI Sign Up

Form and NPI Appendix A

documents.Univera - Health Care Plan/ChoiceCare Buffalo SX087 COMMERCIAL RUnivera - Health Care Plan/ChoiceCare Buffalo SX087 COMMERCIAL RUnivera - Pre Paid Health Plan of NY SX086 COMMERCIAL RUnivera - Pre Paid Health Plan of NY SX086 COMMERCIAL RUnivera - Univera Health Southern Tier SX088 COMMERCIAL RUnivera - Univera Health Southern Tier SX088 COMMERCIAL RUnivera SSA ENY SX090 COMMERCIAL RUnivera SSA ENY SX090 COMMERCIAL RUnivera SSA WNY SX091 COMMERCIAL RUnivera SSA WNY SX091 COMMERCIAL RUniversal Care - California 33001 COMMERCIAL NUniversal Care - California 33001 COMMERCIAL N

Universal Health Care Inc 50528 COMMERCIAL N

The payer ID's of the TH057 and

12t36 will no longer be active

please use the new payer ID of

the 50528 for all EDI submissions

to Emdeon.


Page 120


January 2011


Universal Health Care Inc 50528 COMMERCIAL N

The payer ID's of the TH057 and

12t36 will no longer be active

please use the new payer ID of

the 50528 for all EDI submissions

to Emdeon.

University Comp Care (Ohio BWC) 31147 COMMERCIAL N


ONLY.

University Comp Care (Ohio BWC) 31147 COMMERCIAL N


ONLY.University Family Care 9830 COMMERCIAL NUniversity Family Care 9830 COMMERCIAL NUniversity Family Care - Healthcare Group 7503 COMMERCIAL NUniversity Family Care - Healthcare Group 7503 COMMERCIAL NUniversity Family Care - Maricopa Health Plan 9908 COMMERCIAL NUniversity Family Care - Maricopa Health Plan 9908 COMMERCIAL N

University Health Alliance 99026 COMMERCIAL R

Payer Registration is required. EDI

Enrollment form is available at

www.emdeon.com

University Health Alliance 99026 COMMERCIAL R

Payer Registration is required. EDI

Enrollment form is available at

www.emdeon.comUniversity of Illinois at Chicago Div of Specialized Care for Children37601 COMMERCIAL NUniversity of Illinois at Chicago Div of Specialized Care for Children37601 COMMERCIAL N

University of Missouri 25133 COMMERCIAL N



payer ID.

University of Missouri 25133 COMMERCIAL N



payer ID.University of Utah Health Plans SX155 COMMERCIAL NUniversity of Utah Health Plans SX155 COMMERCIAL NUpland Medical Group IP056 COMMERCIAL NUpland Medical Group IP056 COMMERCIAL NUpper Peninsula Health Group (TPA) 37324 COMMERCIAL NUpper Peninsula Health Group (TPA) 37324 COMMERCIAL NUpper Peninsula Health Plan (Medicaid) 38337 COMMERCIAL NUpper Peninsula Health Plan (Medicaid) 38337 COMMERCIAL NVA Fee Basis Programs 12115 COMMERCIAL NVA Fee Basis Programs 12115 COMMERCIAL NVHAMA-WATERSTONE BENEFITS Call COMMERCIAL NVHAMA-WATERSTONE BENEFITS Call COMMERCIAL N

VNS CHOICE Medicare 77073 COMMERCIAL N

Formerly listed as Visiting Nurses

Service

VNS CHOICE Medicare 77073 COMMERCIAL N

Formerly listed as Visiting Nurses

ServiceVOLUSIA HEALTH NETWORK 59266 COMMERCIAL NVOLUSIA HEALTH NETWORK 59266 COMMERCIAL NValley Baptist Health Plan TH022 COMMERCIAL NValley Baptist Health Plan TH022 COMMERCIAL NValley Care IPA VCIPA COMMERCIAL N


Page 121


January 2011

Payer ID State Model Enroll Additional InformationValley Care IPA VCIPA COMMERCIAL NValley Mental Health 94293 COMMERCIAL NValley Mental Health 94293 COMMERCIAL NValley Preferred - PPO Allentown PA (IHS Gateway Payer)23253 COMMERCIAL NValley Preferred - PPO Allentown PA (IHS Gateway Payer)23253 COMMERCIAL N

Value Options - Commercial SX173 COMMERCIAL R

Enrollment is required and forms

can be located on


Value Options - Commercial SX173 COMMERCIAL R


can be located on

www.emdeon.com/enrollmentVantage Health Plan Inc. 72128 COMMERCIAL NVantage Health Plan Inc. 72128 COMMERCIAL N

Vantage Health Plan Inc. (Ohio BWC) 31147 COMMERCIAL N


ONLY.

Vantage Health Plan Inc. (Ohio BWC) 31147 COMMERCIAL N


ONLY.Vantage Medical Group PPM01 COMMERCIAL NVantage Medical Group PPM01 COMMERCIAL NVentureNet Healthcare 86062 COMMERCIAL NVentureNet Healthcare 86062 COMMERCIAL NVerdugo Hills Medical Group 66126 COMMERCIAL NVerdugo Hills Medical Group 66126 COMMERCIAL NVerity National Group 75256 COMMERCIAL NVerity National Group 75256 COMMERCIAL NVictor Valley IPA VVIPA COMMERCIAL NVictor Valley IPA VVIPA COMMERCIAL NVictor Valley IPA VVMG1 COMMERCIAL NVictor Valley IPA VVMG1 COMMERCIAL NVillage Family Practice 73743 COMMERCIAL NVillage Family Practice 73743 COMMERCIAL NVirginia Medicaid CVAK1 COMMERCIAL NVirginia Medicaid CVAK1 COMMERCIAL N

Virginia Premier Health Plan 54176 COMMERCIAL R

Virginia Premier enrollment forms

located on


Virginia Premier Health Plan 54176 COMMERCIAL R

Virginia Premier enrollment forms

located on

www.emdeon.com/enrollmentVison Care Incorporated 37297 COMMERCIAL NVison Care Incorporated 37297 COMMERCIAL N

Vista Health Plan 25133 COMMERCIAL N



payer ID. Plan name is now

Coventry Health Care of Florida

Inc.

Vista Health Plan 25133 COMMERCIAL N



payer ID. Plan name is now

Coventry Health Care of Florida

Inc.


Page 122


January 2011

Payer ID State Model Enroll Additional InformationVista Oncology - New Century Infusion Solutions NCH08 COMMERCIAL NVista Oncology - New Century Infusion Solutions NCH08 COMMERCIAL N

Viva Health Plan 63114 COMMERCIAL N

VIVA Health requires a complete

member ID number including

suffix on all claim submissions. Pls

use the following site to verify

member information:

https://estepp.cschcg.com/TRI_pr

ovider/doEntry.jsp

Viva Health Plan 63114 COMMERCIAL N

VIVA Health requires a complete

member ID number including

suffix on all claim submissions. Pls

use the following site to verify

member information:

https://estepp.cschcg.com/TRI_pr

ovider/doEntry.jspVytra Healthcare 22264 COMMERCIAL NVytra Healthcare 22264 COMMERCIAL NWEA Insurance Group 39151 COMMERCIAL NWEA Insurance Group 39151 COMMERCIAL NWPP-ElderCare Wisconsin 77080 COMMERCIAL NWPP-ElderCare Wisconsin 77080 COMMERCIAL NWPS - Tricare for Life SX176 COMMERCIAL PWPS - Tricare for Life SX176 COMMERCIAL P

WPS Commercial SX022 COMMERCIAL R

Subscriber id = 9 digits Provider id

qualifier = G2

WPS Commercial SX022 COMMERCIAL R

Subscriber id = 9 digits Provider id

qualifier = G2WRHN BEECHSTREET COMMERCIAL NWRHN BEECHSTREET COMMERCIAL NWabash Memorial Hospital Association 85256 COMMERCIAL NWabash Memorial Hospital Association 85256 COMMERCIAL NWashington Labor & Industry SX063 COMMERCIAL RWashington Labor & Industry SX063 COMMERCIAL RWaterstone Benefit Administrators 73155 COMMERCIAL NWaterstone Benefit Administrators 73155 COMMERCIAL NWeiss Health Providers 36337 COMMERCIAL NWeiss Health Providers 36337 COMMERCIAL NWellCare of Ohio Inc 14163 COMMERCIAL NWellCare of Ohio Inc 14163 COMMERCIAL NWellMed TH023 COMMERCIAL NWellMed TH023 COMMERCIAL N

WellPath 25133 COMMERCIAL N



payer ID.

WellPath 25133 COMMERCIAL N



payer ID.Wellcare HMO Inc. 14163 COMMERCIAL NWellcare HMO Inc. 14163 COMMERCIAL N


Page 123


January 2011

Payer ID State Model Enroll Additional InformationWellcare Private Fee for Service Plans 77072 COMMERCIAL NWellcare Private Fee for Service Plans 77072 COMMERCIAL NWellcare of CT 14164 COMMERCIAL NWellcare of CT 14164 COMMERCIAL NWellcare of Florida 59608 COMMERCIAL NWellcare of Florida 59608 COMMERCIAL NWellcare of Georgia 14163 COMMERCIAL NWellcare of Georgia 14163 COMMERCIAL NWellcare of Louisiana 14163 COMMERCIAL NWellcare of Louisiana 14163 COMMERCIAL NWellcare of New York 14163 COMMERCIAL NWellcare of New York 14163 COMMERCIAL NWells Fargo Third Party Administrators Inc. 87815 COMMERCIAL NWells Fargo Third Party Administrators Inc. 87815 COMMERCIAL NWells Fargo Third Party Administrators Inc. (Formerly JSL Administrators)37272 COMMERCIAL N Newnan GA & Fayetteville NCWells Fargo Third Party Administrators Inc. (Formerly JSL Administrators)37272 COMMERCIAL N Newnan GA & Fayetteville NCWenatchee Valley Medical Center 91064 COMMERCIAL NWenatchee Valley Medical Center 91064 COMMERCIAL NWest Covina Medical Group 66124 COMMERCIAL NWest Covina Medical Group 66124 COMMERCIAL NWestLake Financial Group Inc. 90560 COMMERCIAL NWestLake Financial Group Inc. 90560 COMMERCIAL NWestern Grower's Assurance Trust 24735 COMMERCIAL NWestern Grower's Assurance Trust 24735 COMMERCIAL NWestern Grower's Insurance Company 24735 COMMERCIAL NWestern Grower's Insurance Company 24735 COMMERCIAL NWestern Health Advantage 68039 COMMERCIAL NWestern Health Advantage 68039 COMMERCIAL NWestern Health Inc 37306 COMMERCIAL NWestern Health Inc 37306 COMMERCIAL NWestern Mutual Insurance 37247 COMMERCIAL NWestern Mutual Insurance 37247 COMMERCIAL NWestern Southern Financial Group (Cincinnati OH) 31048 COMMERCIAL NWestern Southern Financial Group (Cincinnati OH) 31048 COMMERCIAL NWestlake Financial Group TH101 COMMERCIAL NWestlake Financial Group TH101 COMMERCIAL NWeyco Inc. 38232 COMMERCIAL NWeyco Inc. 38232 COMMERCIAL NWilliam C. Earhart 93050 COMMERCIAL NWilliam C. Earhart 93050 COMMERCIAL NWilson-McShane 41095 COMMERCIAL NWilson-McShane 41095 COMMERCIAL NWindsor Medicare Extra 62153 COMMERCIAL NWindsor Medicare Extra 62153 COMMERCIAL NWisconsin Auto and Truck Dealers 39200 COMMERCIAL NWisconsin Auto and Truck Dealers 39200 COMMERCIAL NWisconsin Department of Corrections 74101 COMMERCIAL RWisconsin Department of Corrections 74101 COMMERCIAL RWisconsin Physicians Service - Third Party Pricing SX162 COMMERCIAL NWisconsin Physicians Service - Third Party Pricing SX162 COMMERCIAL NWomen's Integrated Network Inc. (WIN Fertility) 13413 COMMERCIAL N WIN HealthcareWomen's Integrated Network Inc. (WIN Fertility) 13413 COMMERCIAL N WIN Healthcare


Page 124


January 2011

Payer ID State Model Enroll Additional InformationWorkers Comp of West Virginia SX067 COMMERCIAL AWorkers Comp of West Virginia SX067 COMMERCIAL AWorksite Benefit Services LLC 20333 COMMERCIAL NWorksite Benefit Services LLC 20333 COMMERCIAL NWorld Insurance Company 75276 COMMERCIAL NWorld Insurance Company 75276 COMMERCIAL NWriters' Guild - Industry Health Plan 23710 COMMERCIAL NWriters' Guild - Industry Health Plan 23710 COMMERCIAL NWyoming Medicaid SKWY0 COMMERCIAL RWyoming Medicaid SKWY0 COMMERCIAL RYale University Heath Plan 60646 COMMERCIAL NYale University Heath Plan 60646 COMMERCIAL NYavapai County 9829 COMMERCIAL NYavapai County 9829 COMMERCIAL NYorba Park STJOE COMMERCIAL NYorba Park STJOE COMMERCIAL NYorba Park (St. Joseph Heritage HealthCare) STJOE COMMERCIAL NYorba Park (St. Joseph Heritage HealthCare) STJOE COMMERCIAL NYoung Life 75285 COMMERCIAL NwebTPA/Community Health Electronic Claims/CHEC 75261 COMMERCIAL NwebTPA/Community Health Electronic Claims/CHEC 75261 COMMERCIAL NAmeriHealth - Delaware (Non-HMO Claims) SX074 DE BLUE CROSS/BLUE SHIELD NAmeriHealth - Delaware (Non-HMO Claims) SX074 DE BLUE CROSS/BLUE SHIELD NAmeriHealth - New Jersey (Non-HMO Claims) SX075 NJ BLUE CROSS/BLUE SHIELD NAmeriHealth - New Jersey (Non-HMO Claims) SX075 NJ BLUE CROSS/BLUE SHIELD N

Anthem Blue Cross 47198 CA BLUE CROSS/BLUE SHIELD N

California License number

required.

Anthem Blue Cross 47198 CA BLUE CROSS/BLUE SHIELD N

California License number

required.Anthem Blue Cross Blue Shield of Connecticut SB560 CT BLUE CROSS/BLUE SHIELD NAnthem Blue Cross Blue Shield of Connecticut SB560 CT BLUE CROSS/BLUE SHIELD N

Anthem Blue Cross and Blue Shield (Virginia) SB923 VA BLUE CROSS/BLUE SHIELD N

Always bill with type 1 npi

however there are some

exceptions. Please refer back to

credentialing with Anthem.

Please call Provider enrollment

for credentialing @ 800-533-

1120.

Anthem Blue Cross and Blue Shield (Virginia) SB923 VA BLUE CROSS/BLUE SHIELD N

Always bill with type 1 npi

however there are some

exceptions. Please refer back to

credentialing with Anthem.

Please call Provider enrollment

for credentialing @ 800-533-

1120.

Anthem Blue Cross and Blue Shield - Indiana SB630 IN BLUE CROSS/BLUE SHIELD N

This is for secondary Claim

volume

Anthem Blue Cross and Blue Shield - Indiana SB630 IN BLUE CROSS/BLUE SHIELD N


volume


Page 125


January 2011


Anthem Blue Cross and Blue Shield - Kentucky SB660 KY BLUE CROSS/BLUE SHIELD N


volume

Anthem Blue Cross and Blue Shield - Kentucky SB660 KY BLUE CROSS/BLUE SHIELD N


volumeAnthem Blue Cross and Blue Shield of Ohio SB338 OH BLUE CROSS/BLUE SHIELD NAnthem Blue Cross and Blue Shield of Ohio SB338 OH BLUE CROSS/BLUE SHIELD NArkansas Blue Cross and Blue Shield SB520 AR BLUE CROSS/BLUE SHIELD RArkansas Blue Cross and Blue Shield SB520 AR BLUE CROSS/BLUE SHIELD R

BCBS SC - Instil Health PFFS SX161 SC BLUE CROSS/BLUE SHIELD N

Non par payer that requires 1B

qualifier with provider id.

Requires 2010 AA REF 01 = 1B

BCBS SC - Instil Health PFFS SX161 SC BLUE CROSS/BLUE SHIELD N

Non par payer that requires 1B

qualifier with provider id.

Requires 2010 AA REF 01 = 1B

BCBSPA - BlueCard Par Point of Service (POS) SX168 BLUE CROSS/BLUE SHIELD R

No special enrollment required

on Synaptek but must have the

BCBSPA step in production in

provider's enrollment for claims

to go electronically. This payer id

is to be used for member id alpha

prefixes of:AMS ATS NJP NRG or

YHF.

BCBSPA - BlueCard Par Point of Service (POS) SX168 BLUE CROSS/BLUE SHIELD R

No special enrollment required

on Synaptek but must have the

BCBSPA step in production in

provider's enrollment for claims

to go electronically. This payer id

is to be used for member id alpha

prefixes of:AMS ATS NJP NRG or

YHF.BLUE CARE NETWORK (BLUE CROSS BLUE SHIELD OF MICHIGAN)SB711 MI BLUE CROSS/BLUE SHIELD RBLUE CARE NETWORK (BLUE CROSS BLUE SHIELD OF MICHIGAN)SB711 MI BLUE CROSS/BLUE SHIELD RBlue CHiP of Rhode Island SB871 RI BLUE CROSS/BLUE SHIELD ABlue CHiP of Rhode Island SB871 RI BLUE CROSS/BLUE SHIELD ABlue Care Family/Anthem Medicaid SB562 CT BLUE CROSS/BLUE SHIELD NBlue Care Family/Anthem Medicaid SB562 CT BLUE CROSS/BLUE SHIELD NBlue Choice Network SB900 TX BLUE CROSS/BLUE SHIELD NBlue Choice Network SB900 TX BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield - Montana SB751 MT BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield - Montana SB751 MT BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield Mississippi State and Teacher EmployeesSB731 MS BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield Mississippi State and Teacher EmployeesSB731 MS BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield NC BlueMedicare HMO/PPO Call NC BLUE CROSS/BLUE SHIELD P

This is Blue Cross Blue Shield NC

Medicare Advantage Plan. Please

call BCBSNC BlueMedicare

HMO/PPO Provider Services

Department at (888)296-9790

option 2 for electronic claims set

up.


Page 126


January 2011


Blue Cross Blue Shield NC BlueMedicare HMO/PPO Call NC BLUE CROSS/BLUE SHIELD P

This is Blue Cross Blue Shield NC

Medicare Advantage Plan. Please

call BCBSNC BlueMedicare

HMO/PPO Provider Services

Department at (888)296-9790

option 2 for electronic claims set

up.Blue Cross Blue Shield Wyoming SB960 WY BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield Wyoming SB960 WY BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Alabama SB510 AL BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Alabama SB510 AL BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Arizona SB530 AZ BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Arizona SB530 AZ BLUE CROSS/BLUE SHIELD N

Blue Cross Blue Shield of Colorado SB550 CO BLUE CROSS/BLUE SHIELD N

Secondary claims accepted

electronically only when

Medicare is primary.

Blue Cross Blue Shield of Colorado SB550 CO BLUE CROSS/BLUE SHIELD N

Secondary claims accepted

electronically only when

Medicare is primary.Blue Cross Blue Shield of Connecticut SB563 CT BLUE CROSS/BLUE SHIELD N (FEP Product)Blue Cross Blue Shield of Connecticut SB563 CT BLUE CROSS/BLUE SHIELD N (FEP Product)Blue Cross Blue Shield of Delaware SB570 DE BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Delaware SB570 DE BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Florida SB590 FL BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Florida SB590 FL BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Georgia (Atlanta) SB600 GA BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Georgia (Atlanta) SB600 GA BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Illinois SB621 IL BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Illinois SB621 IL BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Kansas SB650 KS BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Kansas SB650 KS BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Kansas City SB740 MO BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Kansas City SB740 MO BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Kansas HMO FEP SB651 KS BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Kansas HMO FEP SB651 KS BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Kansas HMO Regular SB652 KS BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Kansas HMO Regular SB652 KS BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Kansas HMO Senior Plan SB653 KS BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Kansas HMO Senior Plan SB653 KS BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield of Louisiana 23738 LA BLUE CROSS/BLUE SHIELD P

For enrollment information call

(225) 295-2427.

Blue Cross Blue Shield of Louisiana 23738 LA BLUE CROSS/BLUE SHIELD P

For enrollment information call

(225) 295-2427.Blue Cross Blue Shield of Maine SB680 ME BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Maine SB680 ME BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Massachusetts SB700 MA BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Massachusetts SB700 MA BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Michigan SB710 MI BLUE CROSS/BLUE SHIELD ABlue Cross Blue Shield of Michigan SB710 MI BLUE CROSS/BLUE SHIELD ABlue Cross Blue Shield of Minnesota SB720 MN BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Minnesota SB720 MN BLUE CROSS/BLUE SHIELD N


Page 127


January 2011

Payer ID State Model Enroll Additional InformationBlue Cross Blue Shield of Mississippi SB730 MS BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Mississippi SB730 MS BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield of Missouri SB741 MO BLUE CROSS/BLUE SHIELD N

NPI only is required when

submitting claims to BCBSMO.

Emdeon requires a provider set

up form to be completed before

initial claims submission.

Blue Cross Blue Shield of Missouri SB741 MO BLUE CROSS/BLUE SHIELD N






Blue Cross Blue Shield of Missouri (Blue Choice) SB742 MO BLUE CROSS/BLUE SHIELD N






Blue Cross Blue Shield of Missouri (Blue Choice) SB742 MO BLUE CROSS/BLUE SHIELD N





initial claims submission.Blue Cross Blue Shield of Nebraska SB760 NE BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Nebraska SB760 NE BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Nevada SB765 NV BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Nevada SB765 NV BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of New Hampshire SB770 NH BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of New Hampshire SB770 NH BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of New Mexico SB790 NM BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of New Mexico SB790 NM BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of North Carolina SB810 NC BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of North Carolina SB810 NC BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of North Dakota SB820 ND BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of North Dakota SB820 ND BLUE CROSS/BLUE SHIELD RBlue Cross Blue Shield of Oklahoma SB840 OK BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Oklahoma SB840 OK BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Rhode Island SB870 RI BLUE CROSS/BLUE SHIELD ABlue Cross Blue Shield of Rhode Island SB870 RI BLUE CROSS/BLUE SHIELD ABlue Cross Blue Shield of South Carolina - Companion HealthcareSX085 SC BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of South Carolina - Companion HealthcareSX085 SC BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of South Carolina - Companion TechnologiesSB880 SC BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of South Carolina - Companion TechnologiesSB880 SC BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of South Carolina - Consolidated Benefits Inc.SX108 SC BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of South Carolina - Consolidated Benefits Inc.SX108 SC BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of South Carolina - Federal Employee Program (FEP)SX084 SC BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of South Carolina - Federal Employee Program (FEP)SX084 SC BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of South Carolina - Planned Administrators Inc.SX104 SC BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of South Carolina - Planned Administrators Inc.SX104 SC BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of South Carolina - State Health PlanSX103 SC BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of South Carolina - State Health PlanSX103 SC BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of South Dakota (Sioux Falls) SB889 SD BLUE CROSS/BLUE SHIELD R


Page 128


January 2011

Payer ID State Model Enroll Additional InformationBlue Cross Blue Shield of South Dakota (Sioux Falls) SB889 SD BLUE CROSS/BLUE SHIELD R

Blue Cross Blue Shield of Tennessee (Chattanooga HMO Plans)SB891 TN BLUE CROSS/BLUE SHIELD R

Multiple plans. Please call (423)

755-5717 for plan code

information. Single Enrollment

with BCBSTN enables electronic

claim submission for all BCBSTN

payer ID's listed (enrollment is

not 'plan specific').

Blue Cross Blue Shield of Tennessee (Chattanooga HMO Plans)SB891 TN BLUE CROSS/BLUE SHIELD R

Multiple plans. Please call (423)

755-5717 for plan code

information. Single Enrollment

with BCBSTN enables electronic

claim submission for all BCBSTN

payer ID's listed (enrollment is

not 'plan specific').

Blue Cross Blue Shield of Tennessee (Chattanooga) SB890 TN BLUE CROSS/BLUE SHIELD R

Single Enrollment with BCBSTN

enables electronic claim

submission for all BCBSTN payer

ID's listed (enrollment is not 'plan

specific').

Blue Cross Blue Shield of Tennessee (Chattanooga) SB890 TN BLUE CROSS/BLUE SHIELD R





specific').

Blue Cross Blue Shield of Tennessee (Memphis) SB892 TN BLUE CROSS/BLUE SHIELD R





specific').

Blue Cross Blue Shield of Tennessee (Memphis) SB892 TN BLUE CROSS/BLUE SHIELD R





specific').Blue Cross Blue Shield of Texas SB900 TX BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Texas SB900 TX BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Vermont SB915 VT BLUE CROSS/BLUE SHIELD NBlue Cross Blue Shield of Vermont SB915 VT BLUE CROSS/BLUE SHIELD NBlue Cross and Blue Shield United of Wisconsin/Comp CareSB950 WI BLUE CROSS/BLUE SHIELD NBlue Cross and Blue Shield United of Wisconsin/Comp CareSB950 WI BLUE CROSS/BLUE SHIELD NBlue Cross of Idaho Health Services Inc SB612 ID BLUE CROSS/BLUE SHIELD RBlue Cross of Idaho Health Services Inc SB612 ID BLUE CROSS/BLUE SHIELD R


Page 129


January 2011


Blue Shield of California 94036 CA BLUE CROSS/BLUE SHIELD P

Group number is required.;

Please contact Blue Shield of CA

EDI Customer Service at (800) 480-

1221 to verify correct provider

information prior to sending

claims.

Blue Shield of California 94036 CA BLUE CROSS/BLUE SHIELD P

Group number is required.;

Please contact Blue Shield of CA

EDI Customer Service at (800) 480-

1221 to verify correct provider

information prior to sending

claims.Capital Blue Cross - Facility 24705 PA BLUE CROSS/BLUE SHIELD PCapital Blue Cross - Facility 24705 PA BLUE CROSS/BLUE SHIELD PCapital Blue Cross/CAIC 23045 PA BLUE CROSS/BLUE SHIELD NCapital Blue Cross/CAIC 23045 PA BLUE CROSS/BLUE SHIELD NCareFirst BlueCross BlueShield MD Region SB690 MD BLUE CROSS/BLUE SHIELD NCareFirst BlueCross BlueShield MD Region SB690 MD BLUE CROSS/BLUE SHIELD N

CareFirst BlueCross BlueShield NCA Region SB580 DC BLUE CROSS/BLUE SHIELD N

Includes coverage for DC and

Northern Virginia.

CareFirst BlueCross BlueShield NCA Region SB580 DC BLUE CROSS/BLUE SHIELD N


Northern Virginia.Empire Blue Cross and Blue Shield of New York SB803 NY BLUE CROSS/BLUE SHIELD NEmpire Blue Cross and Blue Shield of New York SB803 NY BLUE CROSS/BLUE SHIELD NExcellus - BCBS Utica Watertown SB806 NY BLUE CROSS/BLUE SHIELD RExcellus - BCBS Utica Watertown SB806 NY BLUE CROSS/BLUE SHIELD RExcellus - Blue Cross Blue Shield of Central New York SB805 NY BLUE CROSS/BLUE SHIELD RExcellus - Blue Cross Blue Shield of Central New York SB805 NY BLUE CROSS/BLUE SHIELD RExcellus - Blue Cross/Blue Shield Rochester Area SB804 NY BLUE CROSS/BLUE SHIELD RExcellus - Blue Cross/Blue Shield Rochester Area SB804 NY BLUE CROSS/BLUE SHIELD R

First Priority 23241 PA BLUE CROSS/BLUE SHIELD P

Beginning 1/8/2007 all new

providers must enroll with First

Priority Health/Blue Cross of

Northeastern PA prior to

submitting electronic claims.

Enrollment form available at:

http://www.bcnepa.com/EDI/regi

strationForm.aspx

First Priority 23241 PA BLUE CROSS/BLUE SHIELD P

Beginning 1/8/2007 all new

providers must enroll with First

Priority Health/Blue Cross of

Northeastern PA prior to

submitting electronic claims.

Enrollment form available at:

http://www.bcnepa.com/EDI/regi

strationForm.aspxFreedom Blue Medicare Advantage Claims SB942 BLUE CROSS/BLUE SHIELD NFreedom Blue Medicare Advantage Claims SB942 BLUE CROSS/BLUE SHIELD NGateway SX078 PA BLUE CROSS/BLUE SHIELD R


Page 130


January 2011

Payer ID State Model Enroll Additional InformationGateway SX078 PA BLUE CROSS/BLUE SHIELD R

Hawaii Medical Service Association (HMSA) SB971 HI BLUE CROSS/BLUE SHIELD R

Payer requires provider level

testing.

Hawaii Medical Service Association (HMSA) SB971 HI BLUE CROSS/BLUE SHIELD R

Payer requires provider level

testing.HealthNow - BCBS Northeastern NY SB800 NY BLUE CROSS/BLUE SHIELD RHealthNow - BCBS Northeastern NY SB800 NY BLUE CROSS/BLUE SHIELD RHealthNow - Blue Cross Blue Shield of Western NY SB801 NY BLUE CROSS/BLUE SHIELD RHealthNow - Blue Cross Blue Shield of Western NY SB801 NY BLUE CROSS/BLUE SHIELD RHighmark Blue Cross & Blue Shield of Pennsylvania SB865 PA BLUE CROSS/BLUE SHIELD RHighmark Blue Cross & Blue Shield of Pennsylvania SB865 PA BLUE CROSS/BLUE SHIELD RHorizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ)22099 NY BLUE CROSS/BLUE SHIELD PHorizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ)22099 NY BLUE CROSS/BLUE SHIELD PHorizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ)22099 NJ BLUE CROSS/BLUE SHIELD PHorizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ)22099 NJ BLUE CROSS/BLUE SHIELD P

Horizon Healthcare of NY 22099 NJ BLUE CROSS/BLUE SHIELD P

Participating Payer - see last page

for definition.

Horizon Healthcare of NY 22099 NJ BLUE CROSS/BLUE SHIELD P


for definition.

Horizon Healthcare of NY 22099 NY BLUE CROSS/BLUE SHIELD P


for definition.

Horizon Healthcare of NY 22099 NY BLUE CROSS/BLUE SHIELD P


for definition.IBC Personal Choice SX083 PA BLUE CROSS/BLUE SHIELD NIBC Personal Choice SX083 PA BLUE CROSS/BLUE SHIELD NIndependence Administrators TA720 BLUE CROSS/BLUE SHIELD NIndependence Administrators TA720 BLUE CROSS/BLUE SHIELD NInter-County Health Plan SX079 PA BLUE CROSS/BLUE SHIELD NInter-County Health Plan SX079 PA BLUE CROSS/BLUE SHIELD NKeystone Health Plan East SX055 PA BLUE CROSS/BLUE SHIELD NKeystone Health Plan East SX055 PA BLUE CROSS/BLUE SHIELD NKeystone Health Plan West SX056 PA BLUE CROSS/BLUE SHIELD RKeystone Health Plan West SX056 PA BLUE CROSS/BLUE SHIELD RMedicare Blue SX263 BLUE CROSS/BLUE SHIELD NMedicare Blue SX263 BLUE CROSS/BLUE SHIELD NMedicare Blue Private SX262 BLUE CROSS/BLUE SHIELD NMedicare Blue Private SX262 BLUE CROSS/BLUE SHIELD N

Mountain State Blue Cross and Blue Shield SB941 WV BLUE CROSS/BLUE SHIELD R

Testing Required: 25 Claims. Test

claims should be representative

of production claims.

Mountain State Blue Cross and Blue Shield SB941 WV BLUE CROSS/BLUE SHIELD R

Testing Required: 25 Claims. Test

claims should be representative

of production claims.Regence Blue Cross Blue Shield of Oregon SB850 OR BLUE CROSS/BLUE SHIELD NRegence Blue Cross Blue Shield of Oregon SB850 OR BLUE CROSS/BLUE SHIELD NRegence Blue Cross Blue Shield of Utah SB910 UT BLUE CROSS/BLUE SHIELD RRegence Blue Cross Blue Shield of Utah SB910 UT BLUE CROSS/BLUE SHIELD RRegence Blue Shield of Idaho SB611 ID BLUE CROSS/BLUE SHIELD NRegence Blue Shield of Idaho SB611 ID BLUE CROSS/BLUE SHIELD NRegence Blue Shield of Washington SB931 WA BLUE CROSS/BLUE SHIELD N


Page 131


January 2011

Payer ID State Model Enroll Additional InformationRegence Blue Shield of Washington SB931 WA BLUE CROSS/BLUE SHIELD NSelect Advantage SA704 BLUE CROSS/BLUE SHIELD NSelect Advantage SA704 BLUE CROSS/BLUE SHIELD NTexas Health Insurance Risk Pool SB900 TX BLUE CROSS/BLUE SHIELD NTexas Health Insurance Risk Pool SB900 TX BLUE CROSS/BLUE SHIELD NTrigon Blue Cross and Blue Shield (Virginia) SB924 VA BLUE CROSS/BLUE SHIELD NTrigon Blue Cross and Blue Shield (Virginia) SB924 VA BLUE CROSS/BLUE SHIELD N

Triple-S Inc. SB980 BLUE CROSS/BLUE SHIELD P

Payer requires enrollment via

forms or by calling 1-787-479-

4067.

Triple-S Inc. SB980 BLUE CROSS/BLUE SHIELD P

Payer requires enrollment via

forms or by calling 1-787-479-

4067.

WA - Premera Blue Cross SB930 WA BLUE CROSS/BLUE SHIELD R

Payer Enrollment form is listed

under the Alaska BCBS

http://www.emdeon.com/enroll

ment/MED/SB930CLMP_2.pdf

WA - Premera Blue Cross SB930 AK BLUE CROSS/BLUE SHIELD R





WA - Premera Blue Cross SB930 AK BLUE CROSS/BLUE SHIELD R





WA - Premera Blue Cross SB930 WA BLUE CROSS/BLUE SHIELD R




ment/MED/SB930CLMP_2.pdfWellChoice of NJ SB803 NY BLUE CROSS/BLUE SHIELD NWellChoice of NJ SB803 NY BLUE CROSS/BLUE SHIELD N

Wellmark BCBS - Medicare COB SB645 BLUE CROSS/BLUE SHIELD N

Use payer id when Medicare has

processed as Primary

Wellmark BCBS - Medicare COB SB645 BLUE CROSS/BLUE SHIELD N

Use payer id when Medicare has

processed as PrimaryWellmark Blue Cross and Blue Shield of Iowa (IASD) SB640 IA BLUE CROSS/BLUE SHIELD RWellmark Blue Cross and Blue Shield of Iowa (IASD) SB640 IA BLUE CROSS/BLUE SHIELD RAetna Better Health - PA Medicaid 23228 MEDICAID NAetna Better Health - PA Medicaid 23228 MEDICAID NAetna Better Health Connecticut Medicaid 23225 MEDICAID NAetna Better Health Connecticut Medicaid 23225 MEDICAID NAetna TX Medicaid & CHIP 38692 MEDICAID NAetna TX Medicaid & CHIP 38692 MEDICAID NAlabama Medicaid SKAL0 AL MEDICAID NAlabama Medicaid SKAL0 AL MEDICAID NAlaska Medicaid SKAK0 AK MEDICAID RAlaska Medicaid SKAK0 AK MEDICAID RArizona Medicaid SKAZ0 AZ MEDICAID NArizona Medicaid SKAZ0 AZ MEDICAID NArkansas Medicaid SKAR0 AR MEDICAID NArkansas Medicaid SKAR0 AR MEDICAID N


Page 132


January 2011

Payer ID State Model Enroll Additional InformationAzeros Health Plans Inc. 16644 NY MEDICAID NAzeros Health Plans Inc. 16644 NY MEDICAID N

Better Health Plan of Florida 20488 MEDICAID N

Please note for claims rejections

please contact Better Health of

Florida at 1-800-514-4561 and

select the provider services

option.

Better Health Plan of Florida 20488 MEDICAID N

Please note for claims rejections

please contact Better Health of

Florida at 1-800-514-4561 and

select the provider services

option.Blue Choice Medicaid Managed Care 403 MEDICAID NBlue Choice Medicaid Managed Care 403 MEDICAID N

California Medicaid SKCA0 CA MEDICAID R

Additional Enrollment

Requirement for Providers in LA

County. Please call (916) 636-

1000 and ask for LA County Unit.

California Medicaid SKCA0 CA MEDICAID R

Additional Enrollment

Requirement for Providers in LA

County. Please call (916) 636-

1000 and ask for LA County Unit.

Central California Alliance for Health SX169 CA MEDICAID N

Alliance EDI Support Unit - 831-

430-5510

Central California Alliance for Health SX169 CA MEDICAID N

Alliance EDI Support Unit - 831-

430-5510Colorado Medicaid SKCO0 CO MEDICAID RColorado Medicaid SKCO0 CO MEDICAID RConnecticut Medicaid SKCT0 CT MEDICAID RConnecticut Medicaid SKCT0 CT MEDICAID RDC Medicaid SKDC0 DC MEDICAID ADC Medicaid SKDC0 MD MEDICAID ADC Medicaid SKDC0 DC MEDICAID ADC Medicaid SKDC0 MD MEDICAID ADelaware Medicaid SKDE0 DE MEDICAID RDelaware Medicaid SKDE0 DE MEDICAID RFlorida Medicaid SKFL0 FL MEDICAID RFlorida Medicaid SKFL0 FL MEDICAID RFlorida NetPass 65063 MEDICAID NFlorida NetPass 65063 MEDICAID NGeorgia Medicaid SKGA0 GA MEDICAID RGeorgia Medicaid SKGA0 GA MEDICAID RHawaii Medicaid SKHI0 HI MEDICAID RHawaii Medicaid SKHI0 HI MEDICAID RIdaho Medicaid SKID0 ID MEDICAID PIdaho Medicaid SKID0 ID MEDICAID PIllinois Medicaid SKIL0 IL MEDICAID NIllinois Medicaid SKIL0 IL MEDICAID NIndiana Medicaid SKIN0 IN MEDICAID NIndiana Medicaid SKIN0 IN MEDICAID N


Page 133


January 2011

Payer ID State Model Enroll Additional InformationIntegral Quality Care 23229 MEDICAID NIntegral Quality Care 23229 MEDICAID NIowa Medicaid SKIA0 IA MEDICAID RIowa Medicaid SKIA0 IA MEDICAID RJMH Health Plan Medicaid HMO 16001 MEDICAID NJMH Health Plan Medicaid HMO 16001 MEDICAID NKansas Medicaid SKKS0 KS MEDICAID NKansas Medicaid SKKS0 KS MEDICAID N

Kentucky Medicaid SKKY0 KY MEDICAID P

Unysis is fiscal agent until

11/30/05. After 12/1/05 fiscl

agent will be EDS.

Kentucky Medicaid SKKY0 KY MEDICAID P

Unysis is fiscal agent until

11/30/05. After 12/1/05 fiscl

agent will be EDS.Louisiana Medicaid SKLA0 LA MEDICAID ALouisiana Medicaid SKLA0 LA MEDICAID A

Louisiana Medicaid - Ambulance claims SKLA2 LA MEDICAID R

Payer Enrollment required utilize

form for SKLA0 to complete

enrollment for SKLA2 and SKLA3

Louisiana Medicaid - Ambulance claims SKLA2 LA MEDICAID R




Louisiana Medicaid - DME Claims SKLA1 MEDICAID R



enrollment for SKLA1

Louisiana Medicaid - DME Claims SKLA1 MEDICAID R



enrollment for SKLA1

Louisiana Medicaid - KidMed Claims SKLA3 LA MEDICAID R




Louisiana Medicaid - KidMed Claims SKLA3 LA MEDICAID R




MPlan (Medicaid) 35177 IN MEDICAID N

Edits to mirror current edits

submitted for 1st payer id 95444.

MPlan (Medicaid) 35177 IN MEDICAID N

Edits to mirror current edits

submitted for 1st payer id 95444.

Maine Medicaid SKME0 ME MEDICAID N

MaineCare asks all providers to re-

enroll in MIHMS. Enrollment

forms can be found

at:https://mainecare.maine.gov/

Default.aspx


Page 134


January 2011


Maine Medicaid SKME0 ME MEDICAID N

MaineCare asks all providers to re-

enroll in MIHMS. Enrollment

forms can be found

at:https://mainecare.maine.gov/

Default.aspxMaryland Public Mental Health SX069 MD MEDICAID AMaryland Public Mental Health SX069 MD MEDICAID A

Massachusetts Medicaid SKMA0 MA MEDICAID A

Providers must email

([email protected]) or

fax (617-988-8971) a letter stating

they would like to submit claims

to payer via Emdeon/WebMD.

They must include their provider

ID and Emdeon's Trading Partner

# of 9900756

Massachusetts Medicaid SKMA0 MA MEDICAID A

Providers must email

([email protected]) or

fax (617-988-8971) a letter stating

they would like to submit claims

to payer via Emdeon/WebMD.

They must include their provider

ID and Emdeon's Trading Partner

# of 9900756MedStar Family Choice 39190 MEDICAID RMedStar Family Choice 39190 MEDICAID RMedi-Cal (Vision) SKCA1 CA MEDICAID NMedi-Cal (Vision) SKCA1 CA MEDICAID N

Medicaid New York (eMedNY Test System) SKNYT MEDICAID N

NY Medicaid offers a provider test

enviroment as a platform to

enable providers to test claims

using the same validation and

adjudication methods as the NY

Medicaid production enviroment.

Medicaid New York (eMedNY Test System) SKNYT MEDICAID N

NY Medicaid offers a provider test

enviroment as a platform to

enable providers to test claims

using the same validation and

adjudication methods as the NY

Medicaid production enviroment.Michigan Medicaid SKMI0 MI MEDICAID AMichigan Medicaid SKMI0 MI MEDICAID AMinnesota Medicaid SKMN0 MN MEDICAID AMinnesota Medicaid SKMN0 MN MEDICAID AMissouri Medicaid SKMO0 MO MEDICAID NMissouri Medicaid SKMO0 MO MEDICAID NMontana Medicaid SKMT0 MT MEDICAID NMontana Medicaid SKMT0 MT MEDICAID N


Page 135


January 2011

Payer ID State Model Enroll Additional InformationNYS DOH UCP 14142 MEDICAID NNYS DOH UCP 14142 MEDICAID NNebraska Medicaid SKNE0 NE MEDICAID RNebraska Medicaid SKNE0 NE MEDICAID RNevada Medicaid: First Health Services SKNV0 NV MEDICAID ANevada Medicaid: First Health Services SKNV0 NV MEDICAID ANew Hampshire Medicaid SKNH0 NH MEDICAID RNew Hampshire Medicaid SKNH0 NH MEDICAID RNew Jersey Medicaid SKNJ0 NJ MEDICAID RNew Jersey Medicaid SKNJ0 NJ MEDICAID RNew Mexico Medicaid SKNM0 NM MEDICAID NNew Mexico Medicaid SKNM0 NM MEDICAID NNew York Medicaid SKNY0 NY MEDICAID RNew York Medicaid SKNY0 NY MEDICAID RNorth Carolina Medicaid SKNC0 NC MEDICAID PNorth Carolina Medicaid SKNC0 NC MEDICAID PNorth Dakota Medicaid (Medical) SKND0 ND MEDICAID NNorth Dakota Medicaid (Medical) SKND0 ND MEDICAID NOhio Medicaid SKOH0 OH MEDICAID NOhio Medicaid SKOH0 OH MEDICAID NOklahoma Medicaid SKOK0 OK MEDICAID NOklahoma Medicaid SKOK0 OK MEDICAID NOregon Medicaid SKOR0 OR MEDICAID ROregon Medicaid SKOR0 OR MEDICAID R

Partnership Health of California-CAPHP SX140 CA MEDICAID R

NEW PROVIDERS ONLY: Payer

requires EDI enrollment and

testing. Please see the following

link for more information:

www.emdeon.com/enrollment/M

ED/SX140CLMP.pdf

Partnership Health of California-CAPHP SX140 CA MEDICAID R

NEW PROVIDERS ONLY: Payer

requires EDI enrollment and

testing. Please see the following

link for more information:

www.emdeon.com/enrollment/M

ED/SX140CLMP.pdfPennsylvania Medicaid SKPA0 PA MEDICAID NPennsylvania Medicaid SKPA0 PA MEDICAID NRhode Island Medicaid SKRI0 RI MEDICAID RRhode Island Medicaid SKRI0 RI MEDICAID RSouth Carolina Medicaid SKSC0 SC MEDICAID ASouth Carolina Medicaid SKSC0 SC MEDICAID ATennessee Medicaid SKTN2 TN MEDICAID RTennessee Medicaid SKTN2 TN MEDICAID RTexas Medicaid SKTX0 TX MEDICAID NTexas Medicaid SKTX0 TX MEDICAID NUtah Medicaid SKUT0 UT MEDICAID RUtah Medicaid SKUT0 UT MEDICAID RValue Options New Mexico SX177 MEDICAID NValue Options New Mexico SX177 MEDICAID N


Page 136


January 2011


ValueOptions/MBHP (MA Behavioral Health Partnership)43307 MEDICAID R


contact e-

[email protected]

om or 888-247-9311 (8am-6pm M-

F)

ValueOptions/MBHP (MA Behavioral Health Partnership)43307 MEDICAID R


contact e-

[email protected]

om or 888-247-9311 (8am-6pm M-

F)Vermont Medicaid SKVT0 VT MEDICAID AVermont Medicaid SKVT0 VT MEDICAID AVirginia Medicaid SKVA0 VA MEDICAID RVirginia Medicaid SKVA0 VA MEDICAID RWashington Medicaid SKWA0 WA MEDICAID RWashington Medicaid SKWA0 WA MEDICAID RWest Virginia Medicaid SKWV0 WV MEDICAID NWest Virginia Medicaid SKWV0 WV MEDICAID N

Wisconsin Medicaid SKWI0 WI MEDICAID N

Any questions about provider

enrollment should be directed to

the Medicaid WI's provider

helpdesk: 800-947-9627

Wisconsin Medicaid SKWI0 WI MEDICAID N

Any questions about provider

enrollment should be directed to

the Medicaid WI's provider

helpdesk: 800-947-9627ZEPHERELLA 26335 MEDICAID N Pilot Payer currently testingZEPHERELLA 26335 MEDICAID N Pilot Payer currently testingAK Medicare Part B (J2) SMAK0 AK MEDICARE RAK Medicare Part B (J2) SMAK0 AK MEDICARE RAL Medicare Part B (J10 - Cahaba) SMAL0 AL MEDICARE RAL Medicare Part B (J10 - Cahaba) SMAL0 AL MEDICARE RAR Medicare Part B (J7) SMAR0 AR MEDICARE RAR Medicare Part B (J7) SMAR0 AR MEDICARE RAZ Medicare Part B (J3 - Noridian) SMAZ0 AZ MEDICARE RAZ Medicare Part B (J3 - Noridian) SMAZ0 AZ MEDICARE RCA Medicare Part B North (J1 - PGBA) SMCA1 CA MEDICARE RCA Medicare Part B North (J1 - PGBA) SMCA1 CA MEDICARE R

CA Medicare Part B South (J1 - PGBA) SMCA2 CA MEDICARE R

Includes coverage for Southern

CA. Please indicate Southern CA

on the WebMD Envoy Set Up

Form.

CA Medicare Part B South (J1 - PGBA) SMCA2 CA MEDICARE R

Includes coverage for Southern

CA. Please indicate Southern CA

on the WebMD Envoy Set Up

Form.CO Medicare Part B (J4 - Trailblazer) SMCO0 CO MEDICARE RCO Medicare Part B (J4 - Trailblazer) SMCO0 CO MEDICARE RCT Medicare Part B (J13 - NGS) SMCT0 CT MEDICARE RCT Medicare Part B (J13 - NGS) SMCT0 CT MEDICARE R


Page 137


January 2011


DC Medicare Part B (J12 - Highmark) SMDC0 DC MEDICARE A


Northern Virginia.

DC Medicare Part B (J12 - Highmark) SMDC0 DC MEDICARE A


Northern Virginia.DE Medicare Part B (J12 - Highmark) SMDE0 DE MEDICARE ADE Medicare Part B (J12 - Highmark) SMDE0 DE MEDICARE ADME Region D (DMERC D) SDMED US MEDICARE ADME Region D (DMERC D) SDMED US MEDICARE AEducators Mututal Medicare Advantage SX111 MEDICARE NEducators Mututal Medicare Advantage SX111 MEDICARE NFL Medicare Part B (J9 First Coast) SMFL0 FL MEDICARE RFL Medicare Part B (J9 First Coast) SMFL0 FL MEDICARE RFamilyCare Inc 93087 MEDICARE NFamilyCare Inc 93087 MEDICARE NGA Medicare Part B (J10 - Cahaba) SMGA0 GA MEDICARE RGA Medicare Part B (J10 - Cahaba) SMGA0 GA MEDICARE RHI Medicare Part B (J1 - PGBA) SMHI0 HI MEDICARE RHI Medicare Part B (J1 - PGBA) SMHI0 HI MEDICARE RHMSO-Highline Medical Service Organization 91164 MEDICARE NHMSO-Highline Medical Service Organization 91164 MEDICARE NHighline Medical Service Organization - PSHP 91161 MEDICARE NHighline Medical Service Organization - PSHP 91161 MEDICARE NIA Medicare Part B (J5 - WPS) SMIA0 IA MEDICARE RIA Medicare Part B (J5 - WPS) SMIA0 IA MEDICARE RID Medicare Part B (J2) SMID0 ID MEDICARE RID Medicare Part B (J2) SMID0 ID MEDICARE RIL Medicare Part B (J6) SMIL0 IL MEDICARE AIL Medicare Part B (J6) SMIL0 IL MEDICARE AIN Medicare Part B (J8) SMIN0 IN MEDICARE AIN Medicare Part B (J8) SMIN0 IN MEDICARE AJMH Medicare Advantage 59171 MEDICARE NJMH Medicare Advantage 59171 MEDICARE NKS Medicare Part B (J5 - WPS) SMKS0 KS MEDICARE RKS Medicare Part B (J5 - WPS) SMKS0 KS MEDICARE RKY Medicare Part B (J15) SMKY0 KY MEDICARE RKY Medicare Part B (J15) SMKY0 KY MEDICARE RLA Medicare Part B (J7) SMLA0 LA MEDICARE RLA Medicare Part B (J7) SMLA0 LA MEDICARE RMA Medicare Part B (J14 - NHIC) SMMA0 MA MEDICARE RMA Medicare Part B (J14 - NHIC) SMMA0 MA MEDICARE RMD Medicare Part B (J12 - Highmark) SMMD0 MD MEDICARE AMD Medicare Part B (J12 - Highmark) SMMD0 MD MEDICARE AME Medicare Part B (J14 - NHIC) SMME0 ME MEDICARE RME Medicare Part B (J14 - NHIC) SMME0 ME MEDICARE RMI Medicare Part B (J8) SMMI0 MI MEDICARE RMI Medicare Part B (J8) SMMI0 MI MEDICARE RMN Medicare Part B (J6) SMMN0 MN MEDICARE RMN Medicare Part B (J6) SMMN0 MN MEDICARE RMO Medicare Part B East (J5 - WPS) SMMO0 MO MEDICARE RMO Medicare Part B East (J5 - WPS) SMMO0 MO MEDICARE RMO Medicare Part B West (J5 - WPS) SMKC0 KS MEDICARE R


Page 138


January 2011


MO Medicare Part B West (J5 - WPS) SMKC0 KS MEDICARE R

New Provider Enrollments please

complete payer enrollment forms

for SMMO0.MO Medicare Part B West (J5 - WPS) SMKC0 MO MEDICARE R

MO Medicare Part B West (J5 - WPS) SMKC0 MO MEDICARE R

New Provider Enrollments please

complete payer enrollment forms

for SMMO0.MS Medicare Part B (J7) SMMS0 MS MEDICARE RMS Medicare Part B (J7) SMMS0 MS MEDICARE RMT Medicare Part B (J3 - Noridian) SMMT0 MT MEDICARE RMT Medicare Part B (J3 - Noridian) SMMT0 MT MEDICARE RMedicare DME (JA - CEDI/NHIC) SDMEA US MEDICARE AMedicare DME (JA - CEDI/NHIC) SDMEA US MEDICARE AMedicare DME (JB - CEDI/NGS) SDMEB US MEDICARE AMedicare DME (JB - CEDI/NGS) SDMEB US MEDICARE AMedicare DME (JC - CEDI/CGS) SDMEC US MEDICARE AMedicare DME (JC - CEDI/CGS) SDMEC US MEDICARE A

Medicare Plus Blue SX170 MI MEDICARE R

Provider enrolls at

https://editest.bcbsm.com/tpaLo

gon.html OR by calling 248-486-

2292 opt 1. Emdeon PSF required.

Medicare Plus Blue SX170 MI MEDICARE R

Provider enrolls at

https://editest.bcbsm.com/tpaLo

gon.html OR by calling 248-486-

2292 opt 1. Emdeon PSF required.NC Medicare Part B (J11) SMNC0 NC MEDICARE RNC Medicare Part B (J11) SMNC0 NC MEDICARE RND Medicare Part B (J3 - Noridian) SMND0 ND MEDICARE RND Medicare Part B (J3 - Noridian) SMND0 ND MEDICARE RNE Medicare Part B (J5 - WPS) SMNE0 NE MEDICARE RNE Medicare Part B (J5 - WPS) SMNE0 NE MEDICARE RNH Medicare Part B (J14 - NHIC) SMNH0 NH MEDICARE RNH Medicare Part B (J14 - NHIC) SMNH0 NH MEDICARE RNJ Medicare Part B (J12 - Highmark) SMNJ0 NJ MEDICARE RNJ Medicare Part B (J12 - Highmark) SMNJ0 NJ MEDICARE RNM Medicare Part B (J4 - Trailblazer) SMNM0 NM MEDICARE RNM Medicare Part B (J4 - Trailblazer) SMNM0 NM MEDICARE RNV Medicare Part B (J1 - PGBA) SMNV0 NV MEDICARE RNV Medicare Part B (J1 - PGBA) SMNV0 NV MEDICARE RNY Medicare Part B Downstate (J13 - NGS) SMNY0 NY MEDICARE ANY Medicare Part B Downstate (J13 - NGS) SMNY0 NY MEDICARE ANY Medicare Part B Queens (J13 - NGS) SMNY2 NY MEDICARE ANY Medicare Part B Queens (J13 - NGS) SMNY2 NY MEDICARE ANY Medicare Part B Upstate (J13 - NGS) SMNY1 NY MEDICARE ANY Medicare Part B Upstate (J13 - NGS) SMNY1 NY MEDICARE AOH Medicare Part B (J15) SMOH0 WV MEDICARE ROH Medicare Part B (J15) SMOH0 OH MEDICARE ROH Medicare Part B (J15) SMOH0 WV MEDICARE ROH Medicare Part B (J15) SMOH0 OH MEDICARE ROK Medicare Part B (J4 - Trailblazer) SMOK0 OK MEDICARE R


Page 139


January 2011

Payer ID State Model Enroll Additional InformationOK Medicare Part B (J4 - Trailblazer) SMOK0 OK MEDICARE ROR Medicare Part B (J2 - Noridian) SMOR0 OR MEDICARE ROR Medicare Part B (J2 - Noridian) SMOR0 OR MEDICARE RPA Medicare Part B (J12 - Highmark) SMPA0 PA MEDICARE RPA Medicare Part B (J12 - Highmark) SMPA0 PA MEDICARE R

PR Medicare Part B (J9 - First Coast) SMPR0 MEDICARE R

Payer approval required prior to

submitting claims.

PR Medicare Part B (J9 - First Coast) SMPR0 MEDICARE R


submitting claims.RI Medicare Part B (J14 - NHIC) SMRI0 RI MEDICARE RRI Medicare Part B (J14 - NHIC) SMRI0 RI MEDICARE RRailroad Medicare (PGBA) SRRGA US MEDICARE R RailRoad MedicareRailroad Medicare (PGBA) SRRGA US MEDICARE R RailRoad MedicareSC Medicare Part B (J11) SMSC0 SC MEDICARE RSC Medicare Part B (J11) SMSC0 SC MEDICARE RSD Medicare Part B (J3 - Noridian) SMSD0 SD MEDICARE RSD Medicare Part B (J3 - Noridian) SMSD0 SD MEDICARE RTN Medicare Part B (J10 - Cahaba) SMTN0 TN MEDICARE RTN Medicare Part B (J10 - Cahaba) SMTN0 TN MEDICARE RTX Medicare Part B and Indian Health Services (J4 - Trailblazer)SMTX0 TX MEDICARE ATX Medicare Part B and Indian Health Services (J4 - Trailblazer)SMTX0 TX MEDICARE AUT Medicare Part B (J3 - Noridian) SMUT0 UT MEDICARE RUT Medicare Part B (J3 - Noridian) SMUT0 UT MEDICARE R

VA Medicare Part B (J11) SMVA0 VA MEDICARE R

Includes coverage for All Regions

(except Northern Virginia).

VA Medicare Part B (J11) SMVA0 VA MEDICARE R

Includes coverage for All Regions

(except Northern Virginia).

VI Medicare Part B (J9 - First Coast) SMVI0 MEDICARE R


submitting claims.

VI Medicare Part B (J9 - First Coast) SMVI0 MEDICARE R


submitting claims.VT Medicare Part B (J14 - NHIC) SMVT0 VT MEDICARE RVT Medicare Part B (J14 - NHIC) SMVT0 VT MEDICARE RVirginia Premier Gold SX198 MEDICARE NVirginia Premier Gold SX198 MEDICARE NWA Medicare Part B (J2 - Noridian) SMWA0 WA MEDICARE RWA Medicare Part B (J2 - Noridian) SMWA0 WA MEDICARE RWI Medicare Part B (J6) SMWI0 WI MEDICARE RWI Medicare Part B (J6) SMWI0 WI MEDICARE R

WV Medicare Part B (J11) SMWV0 MEDICARE R


and can be located at

www.emdeon.com

WV Medicare Part B (J11) SMWV0 MEDICARE R


and can be located at

www.emdeon.comWY Medicare Part B (J3 - Noridian) SMWY0 WY MEDICARE RWY Medicare Part B (J3 - Noridian) SMWY0 WY MEDICARE R


Page 140


January 2011


Humana Military - Tricare South 61125 US CHAMPUS N

Participating Payer for Tricare

South including AL AR FL GA LA

MS OK SC TN and East TX.

Humana Military - Tricare South 61125 US CHAMPUS N

Participating Payer for Tricare

South including AL AR FL GA LA

MS OK SC TN and East TX.

Tricare North Region 57106 US CHAMPUS N

TRICARE North Region includes -

CT DE IL IN KY MA MD ME MI NC

NH NJ NY OH PA RI VA VT WI WV

and some zip codes in IA/MO/TN -

contact Tricare North at (877) 874-

2273 for details.

Tricare North Region 57106 US CHAMPUS N

TRICARE North Region includes -

CT DE IL IN KY MA MD ME MI NC

NH NJ NY OH PA RI VA VT WI WV

and some zip codes in IA/MO/TN -

contact Tricare North at (877) 874-

2273 for details.WPS Tricare TriWest SCWI0 US CHAMPUS N West RegionWPS Tricare TriWest SCWI0 US CHAMPUS N West Region

Auto Club Association (ACG) 11983 AUTOMOBILE MEDICAL N

Payer id is for Automobile

Medical MN claims Only. You

and/or your vendor must be

contracted for this transaction

service (Emdeon Office customers

excluded). Please visit

www.transact.emdeon.com for

info.

Auto Club Association (ACG) 11983 AUTOMOBILE MEDICAL N








info.

Uvalde CISD J1204 WORKERS COMPENSATION N

Payer id is for Workers Comp TX

MN claims Only. You and/or your

vendor must be contracted for

this transaction service (Emdeon

Office customers excluded).

Please visit


info.


Page 141


January 2011


Uvalde CISD J1204 WORKERS COMPENSATION N






Please visit


info.

''Nova Pro Risk Solutions (San Diego) J1056 WORKERS COMPENSATION N






Please visit


info.

''Nova Pro Risk Solutions (San Diego) J1056 WORKERS COMPENSATION N






Please visit


info.

'Hortica Florist Mutual Insurance 13978 WORKERS COMPENSATION N






Please visit


info.

'Hortica Florist Mutual Insurance 13978 WORKERS COMPENSATION N






Please visit


info.


Page 142


January 2011


AAA Chicago 11983 AUTOMOBILE MEDICAL N

This payer id is for Automobile

Medical claims Only. You and/or

your vendor must be contracted

for the Automobile Medical

transaction service (Emdeon


Please visit Emdeon's transact

Website for contacts and

additional informati

AAA Chicago 11983 AUTOMOBILE MEDICAL N










AAA Chicago Motor Club 11983 AUTOMOBILE MEDICAL N










AAA Chicago Motor Club 11983 AUTOMOBILE MEDICAL N










AAA Michigan 11983 AUTOMOBILE MEDICAL N











Page 143


January 2011


AAA Michigan 11983 AUTOMOBILE MEDICAL N










AAA Minnesota/Iowa 11983 AUTOMOBILE MEDICAL N










AAA Minnesota/Iowa 11983 AUTOMOBILE MEDICAL N










AAA Nebraska 11983 AUTOMOBILE MEDICAL N










AAA Nebraska 11983 AUTOMOBILE MEDICAL N











Page 144


January 2011


AAA North Dakota 11983 AUTOMOBILE MEDICAL N




for this transaction service

(Emdeon Office customers



info.

AAA North Dakota 11983 AUTOMOBILE MEDICAL N








info.

AAA Wisconsin 11983 AUTOMOBILE MEDICAL N








info.

AAA Wisconsin 11983 AUTOMOBILE MEDICAL N








info.

ACIA 11983 AUTOMOBILE MEDICAL N








info.


Page 145


January 2011


ACIA 11983 AUTOMOBILE MEDICAL N








info.

Abilene ISD Run-Off J1204 WORKERS COMPENSATION N

This payer id is for Workers

Compensation claims in the State

of Texas Only. You and/or your


the Workers Compensation



Please visit

http://transact.emdeon.com/ for

conta

Abilene ISD Run-Off J1204 WORKERS COMPENSATION N








Please visit


conta

Abilene ISD Self-Insured J1121 WORKERS COMPENSATION N


claims Only. You and/or your




Please visit


info.

Abilene ISD Self-Insured J1121 WORKERS COMPENSATION N






Please visit


info.


Page 146


January 2011


Abilene Independent School District J1204 WORKERS COMPENSATION N








Please visit


conta

Abilene Independent School District J1204 WORKERS COMPENSATION N








Please visit


conta

Accuride Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Accuride Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Alamo Heights I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac


Page 147


January 2011


Alamo Heights I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac

Aledo I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Aledo I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Allianz Global Risk US Insurance Company TP117 WORKERS COMPENSATION N






Please visit


info.

Allianz Global Risk US Insurance Company TP117 WORKERS COMPENSATION N






Please visit


info.


Page 148


January 2011


Alvey Systems (AON Risk) TP117 WORKERS COMPENSATION N






Please visit


info.

Alvey Systems (AON Risk) TP117 WORKERS COMPENSATION N






Please visit


info.

American Coin Merchandising Inc TP117 WORKERS COMPENSATION N






Please visit


info.

American Coin Merchandising Inc TP117 WORKERS COMPENSATION N






Please visit


info.

American Cyanamid TP117 WORKERS COMPENSATION N






Please visit


info.


Page 149


January 2011


American Cyanamid TP117 WORKERS COMPENSATION N






Please visit


info.

American Hardware Mutual Insurance J1203 WORKERS COMPENSATION N






Please visit


info.

American Hardware Mutual Insurance J1203 WORKERS COMPENSATION N






Please visit


info.

American National Property and Casualty Company (ANPAC)See Comments AUTOMOBILE MEDICAL N

Please call 1-800-333-2860 if you

would like to submit claims to

ANPAC.

American National Property and Casualty Company (ANPAC)See Comments AUTOMOBILE MEDICAL N

Please call 1-800-333-2860 if you

would like to submit claims to

ANPAC.

American Specialty Companies TP117 WORKERS COMPENSATION N






Please visit


info.

American Specialty Companies TP117 WORKERS COMPENSATION N






Please visit


info.


Page 150


January 2011


American Specialty Ins. / MIB TP117 WORKERS COMPENSATION N






Please visit


info.

American Specialty Ins. / MIB TP117 WORKERS COMPENSATION N






Please visit


info.

Ameriprise Auto & Home Ins. C1004 AUTOMOBILE MEDICAL N








info.

Ameriprise Auto & Home Ins. C1004 AUTOMOBILE MEDICAL N








info.

Amica 12287 AUTOMOBILE MEDICAL N








info.


Page 151


January 2011


Amica 12287 AUTOMOBILE MEDICAL N








info.

Atlantic Mutual Insurance 19895 WORKERS COMPENSATION N






Please visit


info.

Atlantic Mutual Insurance 19895 WORKERS COMPENSATION N






Please visit


info.

Auto Club Group 11983 AUTOMOBILE MEDICAL N








info.

Auto Club Group 11983 AUTOMOBILE MEDICAL N








info.


Page 152


January 2011


Auto Club Group Insurance Company 11983 AUTOMOBILE MEDICAL N








info.

Auto Club Group Insurance Company 11983 AUTOMOBILE MEDICAL N








info.

Auto Club Property-Casualty Insurance Company 11983 AUTOMOBILE MEDICAL N








info.

Auto Club Property-Casualty Insurance Company 11983 AUTOMOBILE MEDICAL N








info.

Ayers Trucking J1056 WORKERS COMPENSATION N






Please visit


info.


Page 153


January 2011


Ayers Trucking J1056 WORKERS COMPENSATION N






Please visit


info.

Beall's Inc / Midwest Employers TP117 WORKERS COMPENSATION N






Please visit


info.

Beall's Inc / Midwest Employers TP117 WORKERS COMPENSATION N






Please visit


info.

Bellville I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac

Bellville I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac


Page 154


January 2011


Benavides I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac

Benavides I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac

Berkley Specialty Underwriters 25224 WORKERS COMPENSATION N






Please visit


info.

Berkley Specialty Underwriters 25224 WORKERS COMPENSATION N






Please visit


info.

Berwind Corporation TP117 WORKERS COMPENSATION N






Please visit


info.


Page 155


January 2011


Berwind Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Big Spring I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac

Big Spring I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac

Birdville Independendent School District J1204 WORKERS COMPENSATION N








Please visit


conta


Page 156


January 2011


Birdville Independendent School District J1204 WORKERS COMPENSATION N








Please visit


conta

Brackett I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Brackett I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Brady I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac


Page 157


January 2011


Brady I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac

Breckenridge ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Breckenridge ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Brooks County I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac


Page 158


January 2011


Brooks County I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac

Brownfield I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Brownfield I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Brownfield ISD J1123 WORKERS COMPENSATION N






Please visit


info.

Brownfield ISD J1123 WORKERS COMPENSATION N






Please visit


info.


Page 159


January 2011


Brownyard Group Inc. (Arch Insurance) TP117 WORKERS COMPENSATION N






Please visit


info.

Brownyard Group Inc. (Arch Insurance) TP117 WORKERS COMPENSATION N






Please visit


info.

Brunswick Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Brunswick Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Burleson County Alternative School J1204 WORKERS COMPENSATION N








Please visit


contac


Page 160


January 2011


Burleson County Alternative School J1204 WORKERS COMPENSATION N








Please visit


contac

Burleson-Milam Special Svcs Co-Op J1204 WORKERS COMPENSATION N








Please visit


contac

Burleson-Milam Special Svcs Co-Op J1204 WORKERS COMPENSATION N








Please visit


contac

Burlington Coat Factory Wareho TP117 WORKERS COMPENSATION N






Please visit


info.

Burlington Coat Factory Wareho TP117 WORKERS COMPENSATION N






Please visit


info.


Page 161


January 2011


CCMSI J1010 WORKERS COMPENSATION N






Please visit


info.

CCMSI J1010 WORKERS COMPENSATION N






Please visit


info.

CNA Insurance 20443 WORKERS COMPENSATION N

Payer id is for Workers Comp





Please visit


info.

CNA Insurance 20443 WORKERS COMPENSATION N






Please visit


info.

CVS Pharmacy TP117 WORKERS COMPENSATION N






Please visit


info.

CVS Pharmacy TP117 WORKERS COMPENSATION N






Please visit


info.For an updated payer list please visit our website https://pattersonsupport.custhelp.com

Page 162


January 2011


Caldwell I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac

Caldwell I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac

Canyon I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac

Canyon I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac


Page 163


January 2011


Carrizo Springs CISD J1204 WORKERS COMPENSATION N








Please visit


contac

Carrizo Springs CISD J1204 WORKERS COMPENSATION N








Please visit


contac

Cendant Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Cendant Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Centennial Insurance Company 19895 WORKERS COMPENSATION N






Please visit


info.


Page 164


January 2011


Centennial Insurance Company 19895 WORKERS COMPENSATION N






Please visit


info.

Center Point ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Center Point ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Central Hockey League TP117 WORKERS COMPENSATION N






Please visit


info.

Central Hockey League TP117 WORKERS COMPENSATION N






Please visit


info.


Page 165


January 2011


Charming Shoppes Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Charming Shoppes Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

City Of Arlington J1056 WORKERS COMPENSATION N






Please visit


info.

City Of Arlington J1056 WORKERS COMPENSATION N






Please visit


info.

City Of El Paso J1056 WORKERS COMPENSATION N






Please visit


info.


Page 166


January 2011


City Of El Paso J1056 WORKERS COMPENSATION N






Please visit


info.

City of Plano 13978 WORKERS COMPENSATION N






Please visit


info.

City of Plano 13978 WORKERS COMPENSATION N






Please visit


info.

Clarksville ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Clarksville ISD J1204 WORKERS COMPENSATION N








Please visit


contac


Page 167


January 2011


Classic Residence By Hyatt TP117 WORKERS COMPENSATION N






Please visit


info.

Classic Residence By Hyatt TP117 WORKERS COMPENSATION N






Please visit


info.

Coca-Cola Enterprises Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Coca-Cola Enterprises Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Columbia Sussex Corporation TP117 WORKERS COMPENSATION N






Please visit


info.


Page 168


January 2011


Columbia Sussex Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

CompTech 13978 WORKERS COMPENSATION N






Please visit


info.

CompTech 13978 WORKERS COMPENSATION N






Please visit


info.

Compass Group Usa Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Compass Group Usa Inc. TP117 WORKERS COMPENSATION N






Please visit


info.


Page 169


January 2011


Contech Construction Products TP117 WORKERS COMPENSATION N






Please visit


info.

Contech Construction Products TP117 WORKERS COMPENSATION N






Please visit


info.

Continental Airlines TP117 WORKERS COMPENSATION N






Please visit


info.

Continental Airlines TP117 WORKERS COMPENSATION N






Please visit


info.

Convergys Corporation TP117 WORKERS COMPENSATION N






Please visit


info.


Page 170


January 2011


Convergys Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Correctional Management Service TP117 WORKERS COMPENSATION N






Please visit


info.

Correctional Management Service TP117 WORKERS COMPENSATION N






Please visit


info.

Corrections Corp of America TP117 WORKERS COMPENSATION N






Please visit


info.

Corrections Corp of America TP117 WORKERS COMPENSATION N






Please visit


info.


Page 171


January 2011


Cotulla ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Cotulla ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Coworx Staffing LLC TP117 WORKERS COMPENSATION N






Please visit


info.

Coworx Staffing LLC TP117 WORKERS COMPENSATION N






Please visit


info.

Crum & Forster Indemnity Company 31348 WORKERS COMPENSATION N






Please visit


info.


Page 172


January 2011


Crum & Forster Indemnity Company 31348 WORKERS COMPENSATION N






Please visit


info.

Crystal City ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Crystal City ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Dalhart ISD J1204 WORKERS COMPENSATION N








Please visit


conta


Page 173


January 2011


Dalhart ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Danaher Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Danaher Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

De Bartolos Inc TP117 WORKERS COMPENSATION N






Please visit


info.

De Bartolos Inc TP117 WORKERS COMPENSATION N






Please visit


info.


Page 174


January 2011


De Soto ISD J1204 WORKERS COMPENSATION N








Please visit


contac

De Soto ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Del Valle ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Del Valle ISD J1204 WORKERS COMPENSATION N








Please visit


conta


Page 175


January 2011


Denver City I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Denver City I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Denver City ISD J1124 WORKERS COMPENSATION N






Please visit


info.

Denver City ISD J1124 WORKERS COMPENSATION N






Please visit


info.

Dilley ISD J1204 WORKERS COMPENSATION N








Please visit


contac


Page 176


January 2011


Dilley ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Directory Distributing Assoc. TP117 WORKERS COMPENSATION N






Please visit


info.

Directory Distributing Assoc. TP117 WORKERS COMPENSATION N






Please visit


info.

Discover Re (Burger King) TP117 WORKERS COMPENSATION N






Please visit


info.

Discover Re (Burger King) TP117 WORKERS COMPENSATION N






Please visit


info.


Page 177


January 2011


Dumas I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Dumas I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Dunn-Edwards Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Dunn-Edwards Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Dustrol 21407 WORKERS COMPENSATION N






Please visit


info.


Page 178


January 2011


Dustrol 21407 WORKERS COMPENSATION N






Please visit


info.

Dynamex Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Dynamex Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

EMC Insurance Companies 21407 WORKERS COMPENSATION N






Please visit


info.

EMC Insurance Companies 21407 WORKERS COMPENSATION N






Please visit


info.


Page 179


January 2011


ERMC J1056 WORKERS COMPENSATION N






Please visit


info.

ERMC J1056 WORKERS COMPENSATION N






Please visit


info.

ESIS TP043 WORKERS COMPENSATION N






Please visit


info.

ESIS TP043 WORKERS COMPENSATION N






Please visit


info.

ESIS (First American Insurance Co) TP117 WORKERS COMPENSATION N






Please visit


info.


Page 180


January 2011


ESIS (First American Insurance Co) TP117 WORKERS COMPENSATION N






Please visit


info.

Eagle Mt-Saginaw ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Eagle Mt-Saginaw ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Edinburg CISD J1204 WORKERS COMPENSATION N








Please visit


conta


Page 181


January 2011


Edinburg CISD J1204 WORKERS COMPENSATION N








Please visit


conta

Edwards Claim Administration J1204 WORKERS COMPENSATION N








Please visit


conta

Edwards Claim Administration J1204 WORKERS COMPENSATION N








Please visit


conta

El Paso Community College (Tx Jur) J1056 WORKERS COMPENSATION N






Please visit


info.

El Paso Community College (Tx Jur) J1056 WORKERS COMPENSATION N






Please visit


info.


Page 182


January 2011


El Paso Water Util Tx Jur J1056 WORKERS COMPENSATION N






Please visit


info.

El Paso Water Util Tx Jur J1056 WORKERS COMPENSATION N






Please visit


info.

Electric Insurance (EIC) 21261 WORKERS COMPENSATION N






Please visit


info.

Electric Insurance (EIC) 21261 WORKERS COMPENSATION N






Please visit


info.

Employers Insurance Group J1232 WORKERS COMPENSATION N









identify the


Page 183


January 2011


Employers Insurance Group J1232 WORKERS COMPENSATION N









identify the

Employers Mutual Casualty 21407 WORKERS COMPENSATION N






Please visit


info.

Employers Mutual Casualty 21407 WORKERS COMPENSATION N






Please visit


info.

Envirosource TP117 WORKERS COMPENSATION N






Please visit


info.

Envirosource TP117 WORKERS COMPENSATION N






Please visit


info.


Page 184


January 2011


Esurance Inc. 30210 AUTOMOBILE MEDICAL N








info.

Esurance Inc. 30210 AUTOMOBILE MEDICAL N








info.

Evolution Insurance Company TP117 WORKERS COMPENSATION N






Please visit


info.

Evolution Insurance Company TP117 WORKERS COMPENSATION N






Please visit


info.

F.A. Richard & Associates (FARA) TP044 WORKERS COMPENSATION N






Please visit


info.


Page 185


January 2011


F.A. Richard & Associates (FARA) TP044 WORKERS COMPENSATION N






Please visit


info.

FARMERS INSURANCE C1025 WORKERS COMPENSATION N

Payer id is for Workers Comp MN





Please visit


info.

FARMERS INSURANCE C1025 WORKERS COMPENSATION N






Please visit


info.

FKI Industries Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

FKI Industries Inc. TP117 WORKERS COMPENSATION N






Please visit


info.


Page 186


January 2011


Factory 2 U J1056 WORKERS COMPENSATION N






Please visit


info.

Factory 2 U J1056 WORKERS COMPENSATION N






Please visit


info.

Federated Rural Electric (TX) 13978 WORKERS COMPENSATION N






Please visit


info.

Federated Rural Electric (TX) 13978 WORKERS COMPENSATION N






Please visit


info.

Federated Services Insurance Company 13935 WORKERS COMPENSATION N






Please visit


info.


Page 187


January 2011


Federated Services Insurance Company 13935 WORKERS COMPENSATION N






Please visit


info.

Fireman's Fund Insurance Company 21873 WORKERS COMPENSATION N






Please visit


info.

Fireman's Fund Insurance Company 21873 WORKERS COMPENSATION N






Please visit


info.

Fireman's Fund Insurance Company C1019 AUTOMOBILE MEDICAL N








info.

Fireman's Fund Insurance Company C1019 AUTOMOBILE MEDICAL N








info.


Page 188


January 2011


Firstcomp J1011 WORKERS COMPENSATION N






Please visit


info.

Firstcomp J1011 WORKERS COMPENSATION N






Please visit


info.

Floresville ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Floresville ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Forney ISD J1204 WORKERS COMPENSATION N








Please visit


contac


Page 189


January 2011


Forney ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Frank Gates Service Company TP056 WORKERS COMPENSATION N






Please visit


info.

Frank Gates Service Company TP056 WORKERS COMPENSATION N






Please visit


info.

Frenship I.S.D. J1204 WORKERS COMPENSATION N








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conta

Frenship I.S.D. J1204 WORKERS COMPENSATION N








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conta


Page 190


January 2011


Frenship ISD J1125 WORKERS COMPENSATION N






Please visit


info.

Frenship ISD J1125 WORKERS COMPENSATION N






Please visit


info.

Frio County J1204 WORKERS COMPENSATION N








Please visit


conta

Frio County J1204 WORKERS COMPENSATION N








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conta

Ft Sam Houston ISD J1204 WORKERS COMPENSATION N








Please visit


contac


Page 191


January 2011


Ft Sam Houston ISD J1204 WORKERS COMPENSATION N








Please visit


contac

GAB Robbins Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

GAB Robbins Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Gainesville ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Gainesville ISD J1204 WORKERS COMPENSATION N








Please visit


contac


Page 192


January 2011


Gallagher Bassett TP057 WORKERS COMPENSATION N






Please visit


info.

Gallagher Bassett TP057 WORKERS COMPENSATION N






Please visit


info.

Garner I.S.D. J1204 WORKERS COMPENSATION N








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conta

Garner I.S.D. J1204 WORKERS COMPENSATION N








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conta

Gates Corp Dba Gates Rubber Co TP117 WORKERS COMPENSATION N






Please visit


info.


Page 193


January 2011


Gates Corp Dba Gates Rubber Co TP117 WORKERS COMPENSATION N






Please visit


info.

Georgetown ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Georgetown ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Godley ISD J1204 WORKERS COMPENSATION N








Please visit


conta


Page 194


January 2011


Godley ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Golden Corral Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Golden Corral Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Graford ISD J1204 WORKERS COMPENSATION N








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conta

Graford ISD J1204 WORKERS COMPENSATION N








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conta


Page 195


January 2011


Grange 10322 AUTOMOBILE MEDICAL N








info.

Grange 10322 AUTOMOBILE MEDICAL N








info.

Graphic Arts Mutual 25984 WORKERS COMPENSATION N






Please visit


info.

Graphic Arts Mutual 25984 WORKERS COMPENSATION N






Please visit


info.

Great American Alliance Ins Co. 26832 WORKERS COMPENSATION N






Please visit


info.


Page 196


January 2011


Great American Alliance Ins Co. 26832 WORKERS COMPENSATION N






Please visit


info.

Great American Assurance Company 26344 WORKERS COMPENSATION N






Please visit


info.

Great American Assurance Company 26344 WORKERS COMPENSATION N






Please visit


info.

Great American Ins. Co. of N.Y. 22136 WORKERS COMPENSATION N






Please visit


info.

Great American Ins. Co. of N.Y. 22136 WORKERS COMPENSATION N






Please visit


info.


Page 197


January 2011


Great American Ins. Company 16691 WORKERS COMPENSATION N






Please visit


info.

Great American Ins. Company 16691 WORKERS COMPENSATION N






Please visit


info.

Great Divide Insurance 25224 WORKERS COMPENSATION N






Please visit


info.

Great Divide Insurance 25224 WORKERS COMPENSATION N






Please visit


info.

Gruver I.S.D. J1204 WORKERS COMPENSATION N








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conta


Page 198


January 2011


Gruver I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Gse Lining Technology Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Gse Lining Technology Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Health Partners Managed Care 44547 WORKERS COMPENSATION N






Please visit


info.

Health Partners Managed Care 44547 WORKERS COMPENSATION N






Please visit


info.


Page 199


January 2011


Heritage Group TP117 WORKERS COMPENSATION N






Please visit


info.

Heritage Group TP117 WORKERS COMPENSATION N






Please visit


info.

Hidalgo ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Hidalgo ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Holly Farms Corp. TP117 WORKERS COMPENSATION N






Please visit


info.


Page 200


January 2011


Holly Farms Corp. TP117 WORKERS COMPENSATION N






Please visit


info.

Household Merch Nni TP117 WORKERS COMPENSATION N






Please visit


info.

Household Merch Nni TP117 WORKERS COMPENSATION N






Please visit


info.

Housing Authority El Paso (TX) J1056 WORKERS COMPENSATION N






Please visit


info.

Housing Authority El Paso (TX) J1056 WORKERS COMPENSATION N






Please visit


info.


Page 201


January 2011


Houston Hunters Patrol Inc J1056 WORKERS COMPENSATION N






Please visit


info.

Houston Hunters Patrol Inc J1056 WORKERS COMPENSATION N






Please visit


info.

Howard County J1204 WORKERS COMPENSATION N








Please visit


conta

Howard County J1204 WORKERS COMPENSATION N








Please visit


conta

Hudspeth County J1204 WORKERS COMPENSATION N








Please visit


conta


Page 202


January 2011


Hudspeth County J1204 WORKERS COMPENSATION N








Please visit


conta

Huffman ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Huffman ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Hughes Tool Company TP117 WORKERS COMPENSATION N






Please visit


info.

Hughes Tool Company TP117 WORKERS COMPENSATION N






Please visit


info.


Page 203


January 2011


IDS PROPERTY CASUALTY INSURANCE COMPANY 12504 WORKERS COMPENSATION N






Please visit


info.

IDS PROPERTY CASUALTY INSURANCE COMPANY 12504 WORKERS COMPENSATION N






Please visit


info.

Insilco Corp TP117 WORKERS COMPENSATION N






Please visit


info.

Insilco Corp TP117 WORKERS COMPENSATION N






Please visit


info.

Integrity Mutual Insurance Company 10322 AUTOMOBILE MEDICAL N








info.


Page 204


January 2011


Integrity Mutual Insurance Company 10322 AUTOMOBILE MEDICAL N








info.

Irex Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Irex Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Ironworking Contract I.P. TP117 WORKERS COMPENSATION N






Please visit


info.

Ironworking Contract I.P. TP117 WORKERS COMPENSATION N






Please visit


info.


Page 205


January 2011


J B Hunt Transport Inc. J1056 WORKERS COMPENSATION N






Please visit


info.

J B Hunt Transport Inc. J1056 WORKERS COMPENSATION N






Please visit


info.

JI Specialty Services J1006 WORKERS COMPENSATION N






Please visit


info.

JI Specialty Services J1006 WORKERS COMPENSATION N






Please visit


info.

Jones Truck LinesInc. TP117 WORKERS COMPENSATION N






Please visit


info.


Page 206


January 2011


Jones Truck LinesInc. TP117 WORKERS COMPENSATION N






Please visit


info.

Junction ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Junction ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Juvenile Jail Facility Managem TP117 WORKERS COMPENSATION N






Please visit


info.

Juvenile Jail Facility Managem TP117 WORKERS COMPENSATION N






Please visit


info.


Page 207


January 2011


KCI Holdings USA TP117 WORKERS COMPENSATION N






Please visit


info.

KCI Holdings USA TP117 WORKERS COMPENSATION N






Please visit


info.

Karnes City ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Karnes City ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Ken Davis Industries Inc. TP117 WORKERS COMPENSATION N






Please visit


info.


Page 208


January 2011


Ken Davis Industries Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Kennedale ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Kennedale ISD J1204 WORKERS COMPENSATION N








Please visit


conta

La Vernia ISD J1204 WORKERS COMPENSATION N








Please visit


contac


Page 209


January 2011


La Vernia ISD J1204 WORKERS COMPENSATION N








Please visit


contac

La Villa ISD J1204 WORKERS COMPENSATION N








Please visit


contac

La Villa ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Lackland ISD J1204 WORKERS COMPENSATION N








Please visit


contac


Page 210


January 2011


Lackland ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Lago Vista I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Lago Vista I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Landstar Bco Wc Program TP117 WORKERS COMPENSATION N






Please visit


info.

Landstar Bco Wc Program TP117 WORKERS COMPENSATION N






Please visit


info.


Page 211


January 2011


Levelland I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Levelland I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Levelland ISD J1126 WORKERS COMPENSATION N






Please visit


info.

Levelland ISD J1126 WORKERS COMPENSATION N






Please visit


info.

Lewisville ISD Self-Insured J1122 WORKERS COMPENSATION N






Please visit


info.


Page 212


January 2011


Lewisville ISD Self-Insured J1122 WORKERS COMPENSATION N






Please visit


info.

Lewisville Independent School District J1204 WORKERS COMPENSATION N








Please visit


conta

Lewisville Independent School District J1204 WORKERS COMPENSATION N








Please visit


conta

Liberty-Eylau ISD J1204 WORKERS COMPENSATION N








Please visit


conta


Page 213


January 2011


Liberty-Eylau ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Lsg Sky Chefs International TP117 WORKERS COMPENSATION N






Please visit


info.

Lsg Sky Chefs International TP117 WORKERS COMPENSATION N






Please visit


info.

MCMC LLC J1007 WORKERS COMPENSATION N






Please visit


info.

MCMC LLC J1007 WORKERS COMPENSATION N






Please visit


info.


Page 214


January 2011


Major League Baseball 8 TP117 WORKERS COMPENSATION N






Please visit


info.

Major League Baseball 8 TP117 WORKERS COMPENSATION N






Please visit


info.

Marble Falls I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Marble Falls I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Marlin ISD J1204 WORKERS COMPENSATION N








Please visit


contac


Page 215


January 2011


Marlin ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Matrix Absence Management TP075 WORKERS COMPENSATION N






Please visit


info.

Matrix Absence Management TP075 WORKERS COMPENSATION N






Please visit


info.

Maxim Crane Works TP117 WORKERS COMPENSATION N






Please visit


info.

Maxim Crane Works TP117 WORKERS COMPENSATION N






Please visit


info.


Page 216


January 2011


Mc Donald'S-Mcopco TP117 WORKERS COMPENSATION N






Please visit


info.

Mc Donald'S-Mcopco TP117 WORKERS COMPENSATION N






Please visit


info.

Member Select Insurance Company 11983 AUTOMOBILE MEDICAL N








info.

Member Select Insurance Company 11983 AUTOMOBILE MEDICAL N








info.

Mendota Insurance Company 33650 AUTOMOBILE MEDICAL N








info.


Page 217


January 2011


Mendota Insurance Company 33650 AUTOMOBILE MEDICAL N








info.

Mercedes ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Mercedes ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Metropolitan Property and Casualty Insurance CompanyC1011 AUTOMOBILE MEDICAL N






Please visit


info.

Metropolitan Property and Casualty Insurance CompanyC1011 AUTOMOBILE MEDICAL N






Please visit


info.


Page 218


January 2011


Metropolitan Transit Athority J1238 WORKERS COMPENSATION N









identify the

Metropolitan Transit Athority J1238 WORKERS COMPENSATION N









identify the

Mexia I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Mexia I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta


Page 219


January 2011


Midland County J1204 WORKERS COMPENSATION N








Please visit


conta

Midland County J1204 WORKERS COMPENSATION N








Please visit


conta

Midwest Drywall 21407 WORKERS COMPENSATION N






Please visit


info.

Midwest Drywall 21407 WORKERS COMPENSATION N






Please visit


info.

Midwest Insurance 10895 WORKERS COMPENSATION N






Please visit


info.


Page 220


January 2011


Midwest Insurance 10895 WORKERS COMPENSATION N






Please visit


info.

Millsap I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Millsap I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Mission CISD J1204 WORKERS COMPENSATION N








Please visit


conta


Page 221


January 2011


Mission CISD J1204 WORKERS COMPENSATION N








Please visit


conta

Mission Consolidated Independent School District J1204 WORKERS COMPENSATION N








Please visit


conta

Mission Consolidated Independent School District J1204 WORKERS COMPENSATION N








Please visit


conta

Mitchell Energy & Devel TP117 WORKERS COMPENSATION N






Please visit


info.

Mitchell Energy & Devel TP117 WORKERS COMPENSATION N






Please visit


info.


Page 222


January 2011


Montgomery County Texas J1056 WORKERS COMPENSATION N






Please visit


info.

Montgomery County Texas J1056 WORKERS COMPENSATION N






Please visit


info.

Moody ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Moody ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Morris Material Handling TP117 WORKERS COMPENSATION N






Please visit


info.


Page 223


January 2011


Morris Material Handling TP117 WORKERS COMPENSATION N






Please visit


info.

Morrison Health Care Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Morrison Health Care Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Morton ISD J1127 WORKERS COMPENSATION N






Please visit


info.

Morton ISD J1127 WORKERS COMPENSATION N






Please visit


info.


Page 224


January 2011


Motorist Mutual Insurance J1203 WORKERS COMPENSATION N






Please visit


info.

Motorist Mutual Insurance J1203 WORKERS COMPENSATION N






Please visit


info.

Muleshoe I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Muleshoe I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Muleshoe ISD J1128 WORKERS COMPENSATION N






Please visit


info.


Page 225


January 2011


Muleshoe ISD J1128 WORKERS COMPENSATION N






Please visit


info.

Munford Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Munford Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Nacogdoches ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Nacogdoches ISD J1204 WORKERS COMPENSATION N








Please visit


conta


Page 226


January 2011


Nap Tools 21407 WORKERS COMPENSATION N






Please visit


info.

Nap Tools 21407 WORKERS COMPENSATION N






Please visit


info.

Natalia ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Natalia ISD J1204 WORKERS COMPENSATION N








Please visit


conta

National Interstate (TX) 13978 WORKERS COMPENSATION N






Please visit


info.


Page 227


January 2011


National Interstate (TX) 13978 WORKERS COMPENSATION N






Please visit


info.

National Loss Prevention Inc J1056 WORKERS COMPENSATION N






Please visit


info.

National Loss Prevention Inc J1056 WORKERS COMPENSATION N






Please visit


info.

New Caney ISD J1204 WORKERS COMPENSATION N








Please visit


conta

New Caney ISD J1204 WORKERS COMPENSATION N








Please visit


conta


Page 228


January 2011


New Caney ISD Self-Insured J1204 WORKERS COMPENSATION N








Please visit


conta

New Caney ISD Self-Insured J1204 WORKERS COMPENSATION N








Please visit


conta

New York State Insurance Fund (NYSIF) 45052 WORKERS COMPENSATION N

Payer id is for Workers Comp NY





Please visit


info.

New York State Insurance Fund (NYSIF) 45052 WORKERS COMPENSATION N

Payer id is for Workers Comp NY





Please visit


info.

Norwood TP117 WORKERS COMPENSATION N






Please visit


info.


Page 229


January 2011


Norwood TP117 WORKERS COMPENSATION N






Please visit


info.

Nova Pro Risk Solutions J1056 WORKERS COMPENSATION N






Please visit


info.

Nova Pro Risk Solutions J1056 WORKERS COMPENSATION N






Please visit


info.

Old Republic Insurance Co TP117 WORKERS COMPENSATION N






Please visit


info.

Old Republic Insurance Co TP117 WORKERS COMPENSATION N






Please visit


info.


Page 230


January 2011


One Beacon Insurance 20621 WORKERS COMPENSATION N






Please visit


info.

One Beacon Insurance 20621 WORKERS COMPENSATION N






Please visit


info.

Orica Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Orica Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Papa John's International Inc TP117 WORKERS COMPENSATION N






Please visit


info.


Page 231


January 2011


Papa John's International Inc TP117 WORKERS COMPENSATION N






Please visit


info.

Paradigm J1001 WORKERS COMPENSATION N






Please visit


info.

Paradigm J1001 WORKERS COMPENSATION N






Please visit


info.

Pearsall ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Pearsall ISD J1204 WORKERS COMPENSATION N








Please visit


contac


Page 232


January 2011


Peg Discover Re TP117 WORKERS COMPENSATION N






Please visit


info.

Peg Discover Re TP117 WORKERS COMPENSATION N






Please visit


info.

Peg Discover Re( Food Merchant) TP117 WORKERS COMPENSATION N






Please visit


info.

Peg Discover Re( Food Merchant) TP117 WORKERS COMPENSATION N






Please visit


info.

Pegi-Family Dining TP117 WORKERS COMPENSATION N






Please visit


info.


Page 233


January 2011


Pegi-Family Dining TP117 WORKERS COMPENSATION N






Please visit


info.

Perryton I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Perryton I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Phh Fleetamerica TP117 WORKERS COMPENSATION N






Please visit


info.

Phh Fleetamerica TP117 WORKERS COMPENSATION N






Please visit


info.


Page 234


January 2011


Plains I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Plains I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Plemons-Stinnett-Phillips CISD J1204 WORKERS COMPENSATION N








Please visit


conta

Plemons-Stinnett-Phillips CISD J1204 WORKERS COMPENSATION N








Please visit


conta


Page 235


January 2011


Poolville ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Poolville ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Poth ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Poth ISD J1204 WORKERS COMPENSATION N








Please visit


contac


Page 236


January 2011


Potter County J1204 WORKERS COMPENSATION N








Please visit


conta

Potter County J1204 WORKERS COMPENSATION N








Please visit


conta

Preferred Employers TP117 WORKERS COMPENSATION N






Please visit


info.

Preferred Employers TP117 WORKERS COMPENSATION N






Please visit


info.

Preferred Employers Group TP117 WORKERS COMPENSATION N






Please visit


info.


Page 237


January 2011


Preferred Employers Group TP117 WORKERS COMPENSATION N






Please visit


info.

Providence Property and Casualty 28711 WORKERS COMPENSATION N






Please visit


info.

Providence Property and Casualty 28711 WORKERS COMPENSATION N






Please visit


info.

RIver Road ISD J1204 WORKERS COMPENSATION N








Please visit


contac

RIver Road ISD J1204 WORKERS COMPENSATION N








Please visit


contac


Page 238


January 2011


RSC Insurance Services Ltd. TP117 WORKERS COMPENSATION N






Please visit


info.

RSC Insurance Services Ltd. TP117 WORKERS COMPENSATION N






Please visit


info.

RTW (Return to Work) J1202 WORKERS COMPENSATION N






Please visit


info.

RTW (Return to Work) J1202 WORKERS COMPENSATION N






Please visit


info.

Rampart Insurance Company TP117 WORKERS COMPENSATION N






Please visit


info.


Page 239


January 2011


Rampart Insurance Company TP117 WORKERS COMPENSATION N






Please visit


info.

Randall County J1204 WORKERS COMPENSATION N








Please visit


conta

Randall County J1204 WORKERS COMPENSATION N








Please visit


conta

Recovery & Claim Services AKA Mayo Clinic 41193 WORKERS COMPENSATION N






Please visit


info.

Recovery & Claim Services AKA Mayo Clinic 41193 WORKERS COMPENSATION N






Please visit


info.


Page 240


January 2011


Red Oak Independent School District J1056 WORKERS COMPENSATION N






Please visit


info.

Red Oak Independent School District J1056 WORKERS COMPENSATION N






Please visit


info.

Republic Franklin Insurance 12475 WORKERS COMPENSATION N






Please visit


info.

Republic Franklin Insurance 12475 WORKERS COMPENSATION N






Please visit


info.

Republic Indemnity J1008 WORKERS COMPENSATION N






Please visit


info.


Page 241


January 2011


Republic Indemnity J1008 WORKERS COMPENSATION N






Please visit


info.

Residential Services Group TP117 WORKERS COMPENSATION N






Please visit


info.

Residential Services Group TP117 WORKERS COMPENSATION N






Please visit


info.

Restaurant Reinsurance Limited TP117 WORKERS COMPENSATION N






Please visit


info.

Restaurant Reinsurance Limited TP117 WORKERS COMPENSATION N






Please visit


info.


Page 242


January 2011


Rhone-PoulencInc. TP117 WORKERS COMPENSATION N






Please visit


info.

Rhone-PoulencInc. TP117 WORKERS COMPENSATION N






Please visit


info.

Rieth-Riley Construction Company TP117 WORKERS COMPENSATION N






Please visit


info.

Rieth-Riley Construction Company TP117 WORKERS COMPENSATION N






Please visit


info.

Risk Transfer Technologies Inc. TP117 WORKERS COMPENSATION N






Please visit


info.


Page 243


January 2011


Risk Transfer Technologies Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Roth Staffing Companies J1056 WORKERS COMPENSATION N






Please visit


info.

Roth Staffing Companies J1056 WORKERS COMPENSATION N






Please visit


info.

Ryder Services Inc. J1009 WORKERS COMPENSATION N






Please visit


info.

Ryder Services Inc. J1009 WORKERS COMPENSATION N






Please visit


info.


Page 244


January 2011


SRS Hilton Worldwide Inc J1237 WORKERS COMPENSATION N









identify the

SRS Hilton Worldwide Inc J1237 WORKERS COMPENSATION N









identify the

SUA Insurance Company 40134 WORKERS COMPENSATION N






Please visit


info.

SUA Insurance Company 40134 WORKERS COMPENSATION N






Please visit


info.

SafeCo Insurance 24740 WORKERS COMPENSATION N






Please visit


info.


Page 245


January 2011


SafeCo Insurance 24740 WORKERS COMPENSATION N






Please visit


info.

Safety-Kleen Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Safety-Kleen Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

San Angelo ISD J1204 WORKERS COMPENSATION N








Please visit


contac

San Angelo ISD J1204 WORKERS COMPENSATION N








Please visit


contac


Page 246


January 2011


Schlumberger Technology TP117 WORKERS COMPENSATION N






Please visit


info.

Schlumberger Technology TP117 WORKERS COMPENSATION N






Please visit


info.

Scotts Miracle-Gro Company TP117 WORKERS COMPENSATION N






Please visit


info.

Scotts Miracle-Gro Company TP117 WORKERS COMPENSATION N






Please visit


info.

Selective 39926 WORKERS COMPENSATION N






Please visit


info.


Page 247


January 2011


Selective 39926 WORKERS COMPENSATION N






Please visit


info.

Seminole I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Seminole I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Silsbee ISD J1204 WORKERS COMPENSATION N








Please visit


contac


Page 248


January 2011


Silsbee ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Slaton I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Slaton I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Snap-On Incorporated TP117 WORKERS COMPENSATION N






Please visit


info.

Snap-On Incorporated TP117 WORKERS COMPENSATION N






Please visit


info.


Page 249


January 2011


Solvay America Inc TP117 WORKERS COMPENSATION N






Please visit


info.

Solvay America Inc TP117 WORKERS COMPENSATION N






Please visit


info.

Somerset ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Somerset ISD J1204 WORKERS COMPENSATION N








Please visit


contac

South Plains School WC Program J1204 WORKERS COMPENSATION N








Please visit


conta


Page 250


January 2011


South Plains School WC Program J1204 WORKERS COMPENSATION N








Please visit


conta

Southland ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Southland ISD J1204 WORKERS COMPENSATION N








Please visit


conta

Southside ISD J1204 WORKERS COMPENSATION N








Please visit


contac


Page 251


January 2011


Southside ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Southwest Airlines J1233 WORKERS COMPENSATION N









identify the

Southwest Airlines J1233 WORKERS COMPENSATION N









identify the

Spearman I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta


Page 252


January 2011


Spearman I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Springtown I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Springtown I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Stant Corporation TP117 WORKERS COMPENSATION N






Please visit


info.

Stant Corporation TP117 WORKERS COMPENSATION N






Please visit


info.


Page 253


January 2011


Stockdale ISD J1204 WORKERS COMPENSATION N






Please visit


info.

Stockdale ISD J1204 WORKERS COMPENSATION N






Please visit


info.

Stratford I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Stratford I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Summit Health Ltd TP117 WORKERS COMPENSATION N






Please visit


info.


Page 254


January 2011


Summit Health Ltd TP117 WORKERS COMPENSATION N






Please visit


info.

Sunray I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Sunray I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Swift Transportation TP117 WORKERS COMPENSATION N






Please visit


info.

Swift Transportation TP117 WORKERS COMPENSATION N






Please visit


info.


Page 255


January 2011


Synder ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Synder ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Tarrant Appraisal District J1204 WORKERS COMPENSATION N








Please visit


conta

Tarrant Appraisal District J1204 WORKERS COMPENSATION N








Please visit


conta


Page 256


January 2011


Texas A&M TAMU A0235 WORKERS COMPENSATION N






Please visit


info.

Texas A&M TAMU A0235 WORKERS COMPENSATION N






Please visit


info.

Texas Association of School Boards A0234 WORKERS COMPENSATION N






Please visit


info.

Texas Association of School Boards A0234 WORKERS COMPENSATION N






Please visit


info.

Texas Municipal League IRP A0245 WORKERS COMPENSATION N






Please visit


info.

Texas Municipal League IRP A0245 WORKERS COMPENSATION N






Please visit


info.


Page 257


January 2011


Texas Mutual Insurance Company 22945 WORKERS COMPENSATION N






Please visit


info.

Texas Mutual Insurance Company 22945 WORKERS COMPENSATION N






Please visit


info.

Texas Small Business Pool TP117 WORKERS COMPENSATION N






Please visit


info.

Texas Small Business Pool TP117 WORKERS COMPENSATION N






Please visit


info.

The Auto Club Group 11983 AUTOMOBILE MEDICAL N








info.


Page 258


January 2011


The Auto Club Group 11983 AUTOMOBILE MEDICAL N








info.

The Beacon Mutual Ins Co J1234 WORKERS COMPENSATION N









identify the

The Beacon Mutual Ins Co J1234 WORKERS COMPENSATION N









identify the

The Scotts Company TP117 WORKERS COMPENSATION N






Please visit


info.

The Scotts Company TP117 WORKERS COMPENSATION N






Please visit


info.


Page 259


January 2011


The Zenith 13269 WORKERS COMPENSATION N






Please visit


info.

The Zenith 13269 WORKERS COMPENSATION N






Please visit


info.

Total Petroleum Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Total Petroleum Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Triple A 11983 AUTOMOBILE MEDICAL N








info.


Page 260


January 2011


Triple A 11983 AUTOMOBILE MEDICAL N








info.

US Foodservice Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

US Foodservice Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

US National Resources (Aigrm) TP117 WORKERS COMPENSATION N






Please visit


info.

US National Resources (Aigrm) TP117 WORKERS COMPENSATION N






Please visit


info.


Page 261


January 2011


UTICA (C1027) C1027 AUTOMOBILE MEDICAL N









identify the

UTICA (C1027) C1027 AUTOMOBILE MEDICAL N









identify the

Underwriters Safety and Claims TP108 WORKERS COMPENSATION N






Please visit


info.

Underwriters Safety and Claims TP108 WORKERS COMPENSATION N






Please visit


info.

Union Insurance Company of Providence 21407 WORKERS COMPENSATION N






Please visit


info.


Page 262


January 2011


Union Insurance Company of Providence 21407 WORKERS COMPENSATION N






Please visit


info.

United Dominion Realty Trust TP117 WORKERS COMPENSATION N






Please visit


info.

United Dominion Realty Trust TP117 WORKERS COMPENSATION N






Please visit


info.

United States Cold Storage TP117 WORKERS COMPENSATION N






Please visit


info.

United States Cold Storage TP117 WORKERS COMPENSATION N






Please visit


info.


Page 263


January 2011


Unitrin Direct Property & Casualty Company 16063 AUTOMOBILE MEDICAL N








info.

Unitrin Direct Property & Casualty Company 16063 AUTOMOBILE MEDICAL N








info.

Utica Mutual Insurance Company 25976 WORKERS COMPENSATION N






Please visit


info.

Utica Mutual Insurance Company 25976 WORKERS COMPENSATION N






Please visit


info.

Utica National Insurance Co of Texas 43478 WORKERS COMPENSATION N






Please visit


info.


Page 264


January 2011


Utica National Insurance Co of Texas 43478 WORKERS COMPENSATION N






Please visit


info.

Vanliners Insurance Company 21172 WORKERS COMPENSATION N






Please visit


info.

Vanliners Insurance Company 21172 WORKERS COMPENSATION N






Please visit


info.

Vicorp Restaurants Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Vicorp Restaurants Inc. TP117 WORKERS COMPENSATION N






Please visit


info.


Page 265


January 2011


WC Solutions J1204 WORKERS COMPENSATION N








Please visit


conta

WC Solutions J1204 WORKERS COMPENSATION N








Please visit


conta

Wal-Mart J1004 WORKERS COMPENSATION N






Please visit


info.

Wal-Mart J1004 WORKERS COMPENSATION N






Please visit


info.

Weatherford I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac


Page 266


January 2011


Weatherford I.S.D. J1204 WORKERS COMPENSATION N








Please visit


contac

Weimer ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Weimer ISD J1204 WORKERS COMPENSATION N








Please visit


contac

White Deer I.S.D J1204 WORKERS COMPENSATION N








Please visit


contac


Page 267


January 2011


White Deer I.S.D J1204 WORKERS COMPENSATION N








Please visit


contac

Whiteface C.I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Whiteface C.I.S.D. J1204 WORKERS COMPENSATION N








Please visit


conta

Wyman-Gordon Companies TP117 WORKERS COMPENSATION N






Please visit


info.

Wyman-Gordon Companies TP117 WORKERS COMPENSATION N






Please visit


info.


Page 268


January 2011


Xl Environmental Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Xl Environmental Inc. TP117 WORKERS COMPENSATION N






Please visit


info.

Yorkstown ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Yorkstown ISD J1204 WORKERS COMPENSATION N








Please visit


contac

Znat Insurance (Zenith National Insurance) 30120 WORKERS COMPENSATION N






Please visit


info.


Page 269


January 2011


Znat Insurance (Zenith National Insurance) 30120 WORKERS COMPENSATION N






Please visit


info.

Zurich Farmers J1015 WORKERS COMPENSATION N






Please visit


info.

Zurich Farmers J1015 WORKERS COMPENSATION N






Please visit


info.

Zurich Insurance NA 16535 WORKERS COMPENSATION N






Please visit


info.

Zurich Insurance NA 16535 WORKERS COMPENSATION N






Please visit


info.


Page 270

eClaims Medical Payer List January 2011 - Find Answers · 2016-02-28 · eClaims Medical Payer List January 2011 Payer ID State Model Enroll Additional Information A.G.I.A. Inc. 95241

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