OptumInsight Medical Payer List (08/16/2018) - … · OptumInsight Medical Payer List (08/16/2018) 1 of 41 ... Activa Benefits Services, LLC (Formerly Amway Corporation) 38254 NOCD;

OptumInsight Medical Payer List (08/20/2018)

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For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivityor contact OptumInsight Customer Service and Support at 1-866-367-9778

Payer Name Payer IDClaim Office

NumberState Reports Entered As Secondary** Enrollment

CodeSet

(See Legend)

Payer Type

(UCS) Masonry Industry Trust 60230 NOCD ALL Y UCS MASONRY IND T N FALSE BOTH G1199 SEIU National Benefit Fund 13162 NOCD ALL Y 1199 NATIONAL BEN Y FALSE BOTH G21st Century Insurance and Financial Services 51028 NOCD MN Y 21ST CENTURY INS Y FALSE BOTH G360 Alliance PPO Gilsbar 07205 NOCD ALL Y 360 ALLIANCE PPOG N FALSE BOTH G3P ADMIN 20413 NOCD ALL Y 3P ADMIN Y FALSE BOTH G8th Distric Electrical 74234 NOCD UT N 8TH DIST ELECTRIC N FALSE BOTH GA & I Benefit Plan Administrators 93044 NOCD ALL N A AND I BENEFIT P Y FALSE BOTH GAARP Hospital Indemnity Plans insured by UnitedHealthcare Insurance Company 36273 NOCD ALL Y AARP MEDICARE SUP Y FALSE BOTH # CAARP Medicare Supplement Plans insured by UnitedHealthcare Insurance Company 36273 NOCD ALL Y AARP MEDICARE SUP Y FALSE BOTH # CAARP MedicareComplete insured through UnitedHealthcare (AARP MedicareComplete Mosaic) 87726 NOCD ALL Y OXFORD MEDICARE N Y FALSE BOTH # C

AARP MedicareComplete insured through UnitedHealthcare (formerly AARP MedicareComplete from SecureHorizons) 87726 NOCD ALL Y AARP MEDICARECOMP Y FALSE BOTH # C

AARP MedicareComplete insured through UnitedHealthcare / Oxford Medicare Network, former payer id 06111 87726 NOCD ALL Y UHC OXFORD Y FALSE BOTH # CABMG A0701 NOCD CA Y ABMG N FALSE BOTH GAbrazo Advantage Health Plan 03443 NOCD ALL Y ABRAZO ADV HEALTH Y FALSE BOTH GAbri Healthplan ABRI1 NOCD ALL N ABRI HEALTHPLAN Y FALSE BOTH GAccess Administrators AHS01 NOCD ALL N ACCESS ADMINISTRA N FALSE BOTH GAccess Behavioral Care COACC NOCD CO S ACCESS BEHAVIORAL Y FALSE BOTH PAccess Medical Group AMG01 NOCD All Y ALLIED MED GROUP N FALSE BOTH GAccess Medical Group 95424 NOCD ALL Y ACCESS MEDICAL GR N FALSE BOTH GACCLAIM 64071 NOCD All N ACCLAIM Y FALSE BOTH GAcclaim IPA MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE BOTH GAcclaim IPA (MHCAC) MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE BOTH GAccountable HC IPA (Customer Service (562) 435-3333 for claims with DOS prior to 5/1/15) AHIPA NOCD ALL Y ACCOUNTABLE HC IP N FALSE BOTH GAcordia National (Now known as Wells Fargo TPA) 87815 MCSI ALL Y ACORDIA NATIONAL Y FALSE BOTH GACS Benefit Services, inc. 72467 NOCD ALL Y ACS BENEFIT SERVI Y FALSE BOTH GACS Benefits Payer Compass PA331 NOCD ALL Y ACS BENE PAYER CO N FALSE BOTH G

Activa Benefits Services, LLC (Formerly Amway Corporation) 38254 NOCD ALL Y ACTIVA BENE SVCS N FALSE BOTH GActivHealthcare AHC01 NOCD ALL Y ACTIVHEALTHCARE N FALSE BOTH GAdministrative Services, Inc. 59141 NOCD ALL Y ADMIN SVCS INC Y FALSE BOTH GAdminone 37278 NOCD ALL N ADMINONE N FALSE BOTH GAdminstrative Concepts, Inc. 22384 NOCD ALL N ADMIN CONCEPTS IN Y FALSE BOTH GAdvanced Data Solutions 58202 NOCD ALL Y ADVANCED DATA SOL Y FALSE BOTH GAdvanstaff, Inc. 74234 NOCD ALL N ADVANSTAFF INC N FALSE BOTH GAdvantage Care IPA ACIPA NOCD CA N ADVANTAGE CARE IP Y FALSE BOTH GAdvantage Health Network IPA NMM01 NOCD ALL Y ADVANTAGE HLTH IP Y FALSE BOTH GAdvantage Health Solutions, Inc. 35209 NOCD ALL N ADVANTAGE HEALTH N FALSE BOTH GAdvantage Preferred Plus (Old payerID of 77070 will be valid for a limited time.) 35219 NOCD ALL Y ADVANTAGE PREFERR N FALSE BOTH NAdvantek Benefit Administrators 83077 NOCD ALL N ADVANTEK BENEFIT N FALSE BOTH GAdvantica Benefits 59374 NOCD ALL A ADVANTICA BENEFIT Y FALSE BOTH GAdvanzeon Solutions 59314 NOCD ALL Y ADVANZEON SOLUTIO N FALSE BOTH GAdventist Health System 95340 NOCD ALL Y ADVENTIST HLTH SY Y FALSE BOTH GAdvocate Health Centers (AHC) 36320 NOCD ALL Y ADVOCATE HEALTH N FALSE BOTH GAdvocate Health Partners (PHO) 65093 NOCD ALL Y ADVOCATE HLTH PAR N FALSE BOTH GAegis Administrative Services CB637 NOCD ALL Y AEGIS ADMIN SVCS N FALSE BOTH GAetna Affordable Health Choices (SM) - SRC 57604 NOCD ALL Y AETNA AFFORDABLE Y FALSE BOTH CAetna Better Health - PA Medicaid 23228 NOCD PA Y AETNA BH PA MEDIC Y FALSE BOTH GAetna Better Health Medicaid IL 26337 NOCD IL N AETNA BH MCAID IL Y FALSE BOTH GAetna Better Health Nevada 128NV NOCD NV N AETNA NV N BOTH GAetna Better Health NY 34734 NOCD ALL N AETNA BET HLTH NY N FALSE BOTH GAetna Better Health of Kentucky 128KY NOCD KY Y AETNA BET HLTH KY Y FALSE BOTH GAetna Better Health of Louisiana 128LA NOCD LA Y AETNA BH LOUISIAN Y FALSE BOTH GAetna Better Health of Maryland 128MD NOCD MD Y AETNA MD N FALSE BOTH GAetna Better Health of Michigan 128MI NOCD MI Y AETNA BH MICHIGAN Y FALSE BOTH GAetna Better Health of Missouri 128MO NOCD MO Y AETNA BH MISSOURI Y FALSE BOTH GAetna Better Health of New Jersey 46320 NOCD NJ Y AETNA BH NEW JERS Y FALSE BOTH GAetna Better Health of Ohio 50023 NOCD ALL Y AETNA BTTR HLTH O Y FALSE BOTH GAetna Better Health of Virginia 128VA NOCD VA Y AETNA BH VA N FALSE BOTH GAetna Better Health of West Virginia 128WV NOCD WV Y AETNA BTR HLTH WV Y FALSE BOTH GAetna Health Plan - PPO 60054 NOCD All Y AETNA HEALTH PLAN Y FALSE BOTH CAetna Life & Casualty Company 60054 NOCD All Y AETNA Y FALSE BOTH C

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer


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CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerAetna Life & Casualty Company 60054 NOCD All Y AETNA LIFE Y FALSE BOTH CAetna Life & Casualty Company 60054 NOCD All Y AETNA LIFE INSUR Y FALSE BOTH CAetna Life & Casualty Company 60054 NOCD All Y AETNA LIFE INSURA Y FALSE BOTH CAetna TX Medicaid & CHIP 38692 NOCD TX Y AETNA TX MEDICAID Y FALSE BOTH CAffiliated Doctors of Orange County ADOCS NOCD CA Y AFFIL DOCS OF OC Y FALSE BOTH GAffiliated Physicians IPA POP06 NOCD ALL Y AFF PHYSICIANS IP N FALSE BOTH GAffinity Essentials 23334 NOCD ALL Y AFFINITY ESSENTIA Y FALSE BOTH GAffinity Health Plans (Contact Affinity EDI Coordinator before submitting claims electronically at [email protected] or call 718-794-7592.) 13334 NOCD ALL Y AFFINITY HEALTH O Y FALSE BOTH GAffinity Health Plans (TMG Health) (Effective for Medicare claims with DOS on or after 01/01/2010) 13333 NOCD ALL Y AFFINITY HEALTH N Y FALSE BOTH GAFFINITY MEDICAL GROUP 46594 NOCD ALL N AFFINITY MED GROU N FALSE BOTH GAffordable Benefit Administrators, Inc. (Claims with the following address should only be sent to this payerID: ABA, PO BOX 10787, Burbank, CA 91510-0787) 95426 NOCD ALL N AFFORDABLE BENE A N FALSE BOTH GAgewell New York AWNY6 NOCD ALL Y AGEWELL NEW YORK N FALSE BOTH GAGIA Inc (Claims are printed and mailed to the payer.) 95241 NOCD ALL N AGIA INC Y FALSE BOTH GAgua Caliente AGUA1 NOCD ALL Y AGUA CALIENTE N FALSE BOTH GAHPO (Cleveland, OH) 31138 NOCD OH Y AHPO CLEVELAND OH Y FALSE BOTH GAIG Chartis 19402 NOCD ALL Y AIG CHARTIS N FALSE BOTH GAIG Educational Markets (Formerly Maksin Management Corporation) 22195 NOCD ALL Y AIG EDUC MARKETS Y FALSE BOTH GAKM Medical Group IP080 NOCD CA N AKM MEDICAL GROUP Y FALSE BOTH G

Alameda Alliance for Health (Provider must contact payer to be approved. Contact at Alameda is Anet Quiambao at 510-747-6153 or [email protected]) 95327 NOCD ALL Y ALAMEDA ALLIANCE N FALSE BOTH TAlamitos IPA (Customer Service 562-602-1563) AIPAZ NOCD CA N ALAMITOS IPA Y FALSE BOTH GAlaska Childrens Services, Inc 91136 NOCD AK Y ALASKA CHILD SVCS Y FALSE BOTH GAlaska Laborers Construction Industry Trust 91136 NOCD AK Y AK LABORERS TRUST N FALSE BOTH GAlaska Pipe Trades Local 375 91136 NOCD AK Y AK PIPE LOCAL 375 N FALSE BOTH GAlaska United Food & Commercial Workers Health & Welfare Trust 91136 NOCD AK Y AK UNITED FOOD TR N FALSE BOTH GAlbuquerque Public Schools 85600 NOCD ALL A ALBUQUERQUE PS N FALSE BOTH GAlexian Brothers Community Services of Tennessee 44423 NOCD ALL Y ALEXIAN BROTHERS N FALSE BOTH GAliCare 13550 NOCD All Y ALICARE Y FALSE BOTH GAlignment Healthcare CCHPC NOCD ALL Y ALIGNMENT HCARE N FALSE BOTH GAll Savers Insurance / UnitedHealthcare 81400 NOCD ALL Y UNITEDHEALTHONE Y FALSE BOTH # CAllCare (Must contact AllCare, 800-564-6901 for setup and payerID.) CALL CALL ALL N CONTACT SUPPORT N FALSE BOTH GAllCare PEBB 26158 NOCD ALL Y ALLCARE PEBB N FALSE BOTH GAllegian Choice 55649 NOCD ALL Y ALLEGIAN CHOICE N FALSE BOTH GAllegiance Benefit Plan Management, Inc. 81040 NOCD ALL Y ALLEGIANCE BENEFI Y FALSE BOTH GAlliance Coal Health Plan 93658 NOCD ALL N ALLIANCE COAL N FALSE BOTH GAlliance Physicians High Desestt 22417 NOCD A;LL Y ALL PHYS HIGH DES Y FALSE BOTH GAlliant Health Plans of Georgia 58234 NOCD GA Y ALLIANT GEORGIA N FALSE BOTH GAllied Benefit Systems 37308 NOCD ALL Y ALLIED BENEFIT Y FALSE BOTH GAllied Physicians of California IPA NMM01 NOCD ALL Y ALLIED PHYS OF CA Y FALSE BOTH GAlohaCare ALOHA NOCD HI N ALOHACARE N TRUE BOTH NAlpha Care Medical Group ACMG1 NOCD CA N ALPHA CARE MEDICA N FALSE BOTH GAlphaCare ALPHA NOCD ALL N ALPHACARE N FALSE BOTH GAlphacare Medical Group MPM32 NOCD ALL N ALPHACARE MEDICAL Y FALSE BOTH GAlta Bates Medical Group A0701 NOCD CA Y ABMG N FALSE BOTH GAlternative Opportunities 16089 NOCD ALL Y ALTERNATIVE OPPOR N FALSE BOTH GAmalgamated Life - PA/Alicare 13343 NOCD ALL Y AMALGAMATED LIFE Y FALSE BOTH GAmalgamated Transit Union Division 1001 Health & Welfare Fund COMPU NOCD CO N AMALG TRANSIT UNI N FALSE BOTH GAmeraPlan 38219 NOCD ALL Y AMERAPLAN Y FALSE BOTH GAmeriben - IEC Group 97661 NOCD ALL Y AMERIBEN IEC GROU N FALSE BOTH GAmeriben Solutions 75137 NOCD ALL Y AMERIBEN SOLUTION N FALSE BOTH PAmericaid Community Care (Houston) 27515 NOCD TX Y AMERICAID HOUSTON Y FALSE BOTH TAmericaid Community Care (Maryland) 27517 NOCD MD Y AMERICAID MD Y FALSE BOTH GAmericaid Community Care (New Jersey) 27516 NOCD NJ Y AMERICAID NJ Y FALSE BOTH GAmerican Administrative Group - AAG (Formerly known as UICI Administrators 75240 NOCD ALL Y AAG N FALSE BOTH G

American Administrative Group (formerly Gallagher Benefit) 37283 NOCD ALL A AMERICAN ADMINIST N FALSE BOTH GAmerican Behavior 63103 NOCD ALL N AMERICAN BEHAVIOR Y FALSE BOTH GAmerican Benefits Plan Administrators (Las Vegas, NV) 59140 NOCD NV A AM BENEFITS PLAN Y FALSE BOTH G


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CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerAmerican Family (administered by American Republic) 56071 NOCD ALL N AM FAMILY INSURAN N FALSE BOTH GAmerican Family Health Providers IP080 NOCD CA N AM FAMILY HLTH PR Y FALSE BOTH GAmerican Family Insurance TH095 NOCD ALL Y AMERICAN FAMILY I N FALSE BOTH GAmerican Fidelity Assurance Company 60801 NOCD ALL Y AMERICAN FIDELITY N FALSE BOTH GAmerican General 62030 NOCD ALL N AMERICAN GENERAL Y FALSE BOTH GAmerican Health Medicare 66065 NOCD PR Y AM HEALTH MCARE N FALSE BOTH NAmerican Healthcare Alliance 01066 NOCD ALL N AM HEALTHCARE ALL Y FALSE BOTH GAmerican Insurance Company of TX 81949 NOCD ALL N AMER INS OF TEXAS N FALSE BOTH GAmerican LIFECARE (Group Number required. Valid only for claims with a billing address of 1100 Poydras ST. #2600, New Orleans, LA 70163) 72099 NOCD ALL Y AMERICAN LIFECARE Y FALSE BOTH GAmerican National Insurance Co 74048 NOCD ALL Y AMER NAT INSURANC N FALSE BOTH GAmerican Postal Workers Union Health Plan 44444 NOCD All Y AMERICAN POSTAL W Y FALSE BOTH GAmerican Postal Workers Union Health Plan 44444 NOCD All Y APWU Y FALSE BOTH GAmerican Republic Insurance Company 42011 NOCD ALL N ARIC N FALSE BOTH GAmerican Specialty Health ASH01 NOCD ALL Y AM SPECIALTY HLTH N FALSE BOTH GAmerican Therapy Administrators ATA Wisconsin ATHAL NOCD ALL Y ATA WISCONSIN N FALSE BOTH GAmerican Worker Health Plan 37322 NOCD ALL N AMERICAN WORKER H Y FALSE BOTH GAmericas 1st Choice Health Plans of South Carolina 20553 NOCD ALL R AMERICAS FIRST CH Y FALSE BOTH GAmericas 1st Choice of South Carolina, Inc. 55349 NOCD ALL Y AM FIRST CHOICE S N FALSE BOTH GAmerica's Choice NMA 20029 NOCD ALL Y AMERICAS CHOICE N Y FALSE BOTH GAmerica's Health Choice 21810 NOCD ALL Y AMERICAS HEALTH C N FALSE BOTH GAmerica's PPO (Formerly known as ARAZ.) 16120 NOCD ALL Y AMERICAS PPO ARAZ Y FALSE BOTH GAmerica's PPO / America's TPA 41178 NOCD ALL Y AMERICAS PPO Y FALSE BOTH GAmeriChoice NJ, Medicaid, NJ Family Care (UnitedHealthcare Community Plan) 86047 NOCD NJ Y UHC COMMUNITY NJ Y FALSE BOTH # CAmerigroup - Illlinois 28804 NOCD ALL Y AMERIGROUP N FALSE BOTH GAmerigroup - Maryland and District of Columbia 28807 NOCD MD,DC N AMERIGROUP MD N FALSE BOTH TAmerigroup - New Jersey 28806 NOCD NJ N AMERIGROUP NJ N FALSE BOTH GAmerigroup of Iowa 26375 NOCD ALL Y AMERIGROUP IOWA N FALSE BOTH GAmerigroup / Americaid - Houston 28805 NOCD TX Y AMERIGROUP HOUSTO N FALSE BOTH TAMERIGROUP Georgia 27514 NOCD GA Y AMERIGROUP GA Y FALSE BOTH GAmerigroup Houston (Claims and Encounters) 26374 NOCD TX Y AMERIGROUP HOUST N FALSE BOTH GAmerigroup Illinois (Claims and Encounters 27518 NOCD IL Y AMERIGROUP ILLINO N FALSE BOTH GAmerigroup Multiple States (Claims and Encounters) 26378 NOCD ALL Y AMERIGROUP MULTI N FALSE BOTH GAmerigroup of Florida 28809 NOCD FL Y AMERIGROUP OF FL N FALSE BOTH TAmerigroup Ohio (Claims and Encounters 27518 NOCD OH Y AMERIGROUP OHIO N FALSE BOTH GAMERIGROUP Tennessee 27514 NOCD TN Y AMERIGROUP TN Y FALSE BOTH GAmeriHealth - New Jersey (Non-HMO Claims) SX075 NOCD ALL Y AMERIHEALTH NJ Y TRUE BOTH NAmeriHealth Administrators 54763 NOCD ALL Y AMERIHEALTH ADMIN N FALSE BOTH GAmerihealth Caritas Iowa ( For EDI Support, email [email protected] or call 844-341-7644.) 77075 NOCD IA Y AMERIH CARITAS IA Y FALSE BOTH G

AmeriHealth Caritas Louisiana (Formerly known as LA Care) 27357 NOCD LA Y LA CARE N FALSE BOTH GAmeriHealth Caritas VIP Care 77062 NOCD ALL N AMERIHLTH CARITAS N FALSE BOTH GAmeriHealth Caritus VIP Care Plus (Michigan) 77013 NOCD MI Y AH CARITUS VIP CA N FALSE BOTH GAmerihealth Delaware 77799 NOCD ALL N AMERIHEALTH DE N FALSE BOTH G

Amerihealth District of Columbia (For EDI Support, please email [email protected] or call 1-888-656-2383) 77002 NOCD ALL Y AMERIHEALTH DC N FALSE BOTH GAmeriHealth HMO New Jersey and Delaware 23037 NOCD NJ,DE Y AMERIHEALTH HMO Y TRUE BOTH GAmerihealth HMO NJ and Delaware 95044 NOCD NJ DE Y AHLTH HMO NJ & DE Y TRUE BOTH NAmeriHealth Mercy Health Plan 22248 NOCD All Y AMERIHEALTH MERCY Y FALSE BOTH GAmeriHealth NorthEast 77001 NOCD ALL Y AMERIHEALTH NE Y FALSE BOTH GAmerikids-Dallas/Ft. Worth 26374 NOCD TX Y AMERIKIDS DALLAS N FALSE BOTH GAmerivantage 26375 NOCD ALL Y AMERIGROUP IOWA N FALSE BOTH GAmfirst Insurance Company 64090 NOCD ALL Y AMFIRST INS CO N FALSE BOTH G

AM-First Insurance Morgan White (Payer accepts secondary claims only, and Medicare cannot be primary payer.) 01757 NOCD ALL Y AM FIRST INS MORG Y FALSE BOTH GAmida Care (Formerly Vida Care.) 24818 NOCD ALL N AMIDA CARE Y FALSE BOTH GAmida Care Medicare 79966 NOCD ALL Y AMIDA CARE MEDICA N FALSE BOTH GAMVI IP080 NOCD CA N AMVI Y FALSE BOTH GAmway Corporation 38254 NOCD All Y AMWAY N FALSE BOTH GAnaheim Memorial IPA (MHCAN) MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE BOTH GAnchor Benefit Consulting 53085 NOCD ALL A ANCHOR BENEFIT CO N FALSE BOTH GAncillary Benefits/Arizona Foundation for Medical Care AZFMC NOCD ALL Y ANCILLARY BENEFIT Y FALSE BOTH PAnerican Founders Life Ins Co (NFL Plans only) 98205 NOCD ALL N AMERICAN FOUNDERS N FALSE BOTH GAngeles IPA (SynerMed) 75299 NOCD ALL Y ANGELES IPA SYNER N FALSE BOTH GAntares Management Solutions 34192 NOCD ALL Y ANTARES MGMT SOLN Y FALSE BOTH G


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CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerAnthem BCBS Indiana 00630 NOCD IN Y ANTHEM BCBS IN Y FALSE BOTH GAnthem BCBS Virginia 00423 NOCD VA Y ANTHEM BCBS VA Y FALSE BOTH GAnthem Blue Cross of California BC001 NOCD CA Y CA BLUE CROSS Y FALSE BOTH GAnthem Medicaid (WI) (Formerly BadgerCare) WIBLS NOCD WI N ANTHEM WI MEDICAI Y FALSE BOTH NAnthem of Colorado COBLS BCBS CO Y CO ANTHEM Y FALSE BOTH NAnthem of Nevada NVBLS NOCD NV N NV ANTHEM Y FALSE BOTH NApex Benefit Services (Claims must contain the rendering provider ID or the claim will reject.) 34196 NOCD ALL N APEX BENE SERVICE Y FALSE BOTH GAPEX Healthcare 51909 NOCD ALL Y APEX HEALTHCARE N FALSE BOTH GARAZ (Now known as America's PPO.) 16120 NOCD ALL Y ARAZ Y FALSE BOTH GArbor Health 52312 NOCD ALL N ARBOR HEALTH Y FALSE BOTH GArcadian Management Services, Inc (Group number should be entered if available. ) 61101 NOCD All Y ARCADIAN MGMT SVS Y FALSE BOTH GArise Health Plan (Formerly Prevea Health) 39185 NOCD ALL Y ARISE HEALTH PLAN N FALSE BOTH TArizona Foundation for Medical Care AZFMC NOCD AZ Y AZ FOUNDATION MED Y FALSE BOTH PArizona Medicaid (AHCCCS) AZMCD NOCD AZ Y AZ MEDICAID Y FALSE BOTH NArizona Physicians IPA (APIPA) (UnitedHealthcare Community Plan) 03432 NOCD AZ Y UHC AZIPA Y FALSE BOTH # CArizona Pipe Trades Health and Welfare Trust Fund Local Union Nos. 469 & 741 Metal Trades Health Plan 74234 NOCD AZ N AZ METAL TRADES N FALSE BOTH GArizona Pipe Trades Health and Welfare Trust Fund Local Union Nos. 469 & 741 Pipe Trades Health Plan 74234 NOCD AZ N AZ PIPE TRADES N FALSE BOTH GArizona Priority Care Plus 27154 NOCD ALL N AZ PRIORITY CARE N FALSE BOTH GArkansas Best Corporation (previous payer ID 75278, new payer ID is effective for claims submitted December 15, 2017 and after). 62308 NOCD ALL Y ARKANSAS BEST COR Y FALSE BOTH CArkansas Managed Care Organization (AMCO) 62176 NOCD AR Y AR MCO Y FALSE BOTH GArnett Health Plan - former payer id 95440 87726 NOCD ALL Y ARNETT HEALTH PLA Y FALSE BOTH # CArroyo Viata Family Health Center NMM01 NOCD ALL Y ARROYO VISTA FAM Y FALSE BOTH GArta Health Network WMM01 NOCD CA N ARTA HLTH NETWORK Y FALSE BOTH GASAGEHA 06603 NOCD ALL Y ASAGEHA N FALSE BOTH GAsian American Medical Group AAMG1 NOCD CA N ASIAN AMERICAN MG N FALSE BOTH GAspen Insurance 16180 NOCD ALL N ASPEN INSURANCE Y FALSE BOTH GAspire Health Plan 46156 NOCD ALL N ASPIRE HEALTH PLA Y FALSE BOTH GASR Corporation 38265 NOCD ALL Y ASR CORPORATION Y FALSE BOTH GASRM Corporation ASRM1 NOCD ALL Y ASRM CORP N FALSE BOTH GAssoc De Meastros 94027 NOCD PR N ASSOC DE MEASTROS N FALSE BOTH NAssociates for Healthcare 36326 NOCD ALL Y ASSOC HEALTHCARE Y FALSE BOTH CAssurant Employee Benefits (Formerly Fortis Insurance) 39065 NOCD All N FORTIS N FALSE BOTH GAssurant Health Self Funded (MUST VERIFY ALL CLAIMS SHOULD GO TO ALLIED BENEFIT for Assurant Health Self Funded groups with Plan effective dates after 5/1/2013) 75068 NOCD ALL N ASSURANT HLTH SLF Y FALSE BOTH GAssured Benefits Administrators 74240 NOCD ALL Y ASSURED BENEFITS Y FALSE BOTH G

Asuris Northwest/MedAdvantage (REF*1B*Provider ID in Billing and Rendering required even when NPI is submitted.) SX179 NOCD ALL Y ASURIS NW MEDADVA Y FALSE BOTH GAsuris NW Health 93221 NOCD ALL Y ASURIS NW HEALTH Y FALSE BOTH GAtlantic Medical 22285 NOCD ALL N ATLANTIC MEDICAL N FALSE BOTH GAtlantis Eye Care AEC01 NOCD ALL Y ATLANTIS EYE CARE Y FALSE BOTH GAtlas Life Ins Co (NFIC Plan only) 90956 NOCD ALL N ATLAS LIFE INS CO N FALSE BOTH GAtrio Health Plan (Formerly known as Marion Polk Health Plan Advantage) MPCHA NOCD ALL Y MARION POLK HP AD N TRUE BOTH GAultcare MNAUL NOCD OH N AULTCARE Y TRUE BOTH NAutomated Benefit Services (ABS) 38259 NOCD ALL Y AUTOMATED BEN SVC N FALSE BOTH GAutomated Group Administration, Inc. 37280 NOCD ALL N AUTOMATED GROUP A Y FALSE BOTH GAutomotive Machinists Local 289 Health & Welfare Trust - Grp#F32 91136 NOCD ALL Y AUTO GRP F32 N FALSE BOTH G

Avalon Healthcare Solutions (Must contact the payer directly at Provider Services @ 855-895-1676 prior to sending claims.) AVA01 NOCD ALL Y AVALON HC SOLUTIO N FALSE BOTH GAvalon IPA IP080 NOCD CA N AVALON IPA Y FALSE BOTH GAvante Health (Customer Service 559-261-9060) AH001 NOCD ALL N AVANTE HEALTH Y FALSE BOTH GAvectus Healthcare Solutions (Call 855-AVECTUS) MP001 NOCD ALL N MEDPAY FIRST ONE FALSE BOTH GAvera Health Plans 46045 NOCD ALL Y AVERA HEALTH PLAN Y FALSE BOTH GAvesis Third Part Administrators 87098 NOCD ALL Y AVESIS TPA Y FALSE BOTH GAVMED 59274 NOCD FL Y AVMED Y FALSE BOTH PAVMED-Parity Healthcare (OB/GYN only) 58204 NOCD FL Y AVMED PARITY Y FALSE BOTH GAxminister Medical Group AXM01 NOCD ALL N AXMINISTER MED GR Y FALSE BOTH GAZ Integrated Physicians NCHON NOCD ALL N AZ INTEGRATED PHY N FALSE BOTH GBakersfield Family Medical Center BKRFM NOCD ALL N BAKERSFIELD FAMIL Y FALSE BOTH G


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CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerBakery & Confectionery Union and Industry International Health BCTF1 NOCD ALL N BAKERY UNION N FALSE BOTH GBanner Health 12X42 NOCD ALL Y BANNER HEALTH Y FALSE BOTH GBanner Health & Aetna Health Insurance Company 67895 NOCD ALL Y AETNA BANNER HLTH Y FALSE BOTH GBanner Medisun 77078 NOCD ALL N BANNER MEDISUN Y FALSE BOTH GBanner University Family Care (University of Arizona Health Plans) 66901 NOCD ALL A BANNER UNIV OF AZ Y FALSE BOTH GBaptist Health Plan (Formerly Bluegrass Family Health) 61124 NOCD ALL Y BLUEGRASS FAM HLT N FALSE BOTH GBaptist Health South Florida 65026 NOCD ALL N BAPTIST HLTH S FL N FALSE BOTH GBaycare Life Management 59279 NOCD ALL N BAYCARE LIFE MGMT N FALSE BOTH GBCBS Of Michigan (Dental Claims Only) BBMDQ NOCD MI N BCBS MI DENTAL N FALSE BOTH G

BCBS of Texas Medicaid (Plan effective December 1, 2015) 66001 NOCD TX Y BCBS TEXAS MEDICA N FALSE BOTH GBCBS Western NY Medicaid WNYMD NOCD NY Y BCBS W NY MEDICAI Y TRUE BOTH NBeacon Health Options (Formerly Value Options) VALOP NOCD ALL N BEACON HLTH OPTIO N TRUE BOTH GBeacon Health Strategies (Providers need to call Provider Relations Dept at 781-994-7576 to register before sending claims.) 43324 NOCD ALL Y BEACON HLTH STRAT N FALSE BOTH GBehavioral Health Systems 63100 NOCD ALL N BEHAVIORAL HS N FALSE BOTH GBehavioral Healthcare, Inc. BHI00 NOCD CO Y BEHAVIORAL HC INC Y FALSE BOTH PBella Vista Med Grp IPA MPM10 NOCD CA N BELLA VISTA MED G N FALSE BOTH NBenefit & Risk Management Services (Commercial Medicare under Med3000) 99320 NOCD ALL N BENE RISK MGMT SV N FALSE BOTH GBenefit Administration Services 41205 NOCD ALL Y BENEFIT ADMIN SVC Y FALSE BOTH GBenefit Administrative Systems 36149 NOCD ALL Y BENE ADMIN SYSTEM Y FALSE BOTH GBenefit Concepts 51037 NOCD ALL Y BENEFIT CONCEPTS N FALSE BOTH GBenefit Coordinators Corporation 25145 NOCD ALL N BENEFIT COOR CORP N FALSE BOTH GBenefit Management LLC/VBA 88092 NOCD ALL Y BENE MGMT LLC VBA Y FALSE BOTH GBenefit Management Services 56139 NOCD ALL N BENE MGMT SVCS Y FALSE BOTH GBenefit Management Systems, Inc of Mississippi 37212 NOCD MS Y BMS OF MS Y FALSE BOTH GBenefit Management, Inc. of KS (Only accepts claims for these groups BMI187,BMI219,BMI234,BMI236,BMI214,BMI241,BMI617 BMI246,BMI246.) 48611 NOCD ALL N BENEFIT MGMT KS N FALSE BOTH GBenefit Plan Administrators Co. (Payer ID valid only for claims with a billing submission address of PO Box 1128, Eau Claire, WI 54702-1128) 39081 NOCD WI Y BENEFIT PLAN WI N FALSE BOTH GBenefit Systems and Services, Inc. 36342 NOCD All Y BENEFIT SYSTEMS Y FALSE BOTH GBenefit Trust Life Insurance Company 61425 NOCD All Y BENEFIT TRUST LIF N FALSE BOTH GBenesight (formerly The TPA) 87265 NOCD ALL Y BENESIGHT N FALSE BOTH G

BeneSys, Inc. (Now known as Sheet Metal Workers Local 104) 38238 NOCD ALL N BENESYS INC MI N FALSE BOTH GBenmark BNMK1 NOCD ALL N BENMARK N FALSE BOTH GBerkshire Health Partners 23243 NOCD ALL N BERKSHIRE HLTH PA Y FALSE BOTH GBerkshire Intergroup 10956 NOCD ALL Y BERKSHIRE INTERGR N FALSE BOTH GBest Life & Health Insurance Co. 95604 NOCD ALL N BEST LIFE AND HEA Y FALSE BOTH G

Better Health Plan of Florida (For claims rejections, contact payer at 800-514-4561 and select provider services option.) 20488 NOCD ALL N BETER HP OF FL Y FALSE BOTH GBeverly Alianza IPA POP05 NOCD ALL Y BEVERLY ALIANZA I N FALSE BOTH GBHP-Unity 44219 NOCD ALL R BHP UNITY Y FALSE BOTH GBHSF International 67668 NOCD ALL Y BHSF INTERNATIONA N FALSE BOTH GBig Lots Associates Benefit Plans CX025 NOCD ALL N BIG LOTS ASSOC BE N FALSE BOTH GBlock Vision of Texas BVTX1 NOCD TX Y BLOCK VISION TX Y FALSE BOTH GBlock Vision, Inc. BV001 NOCD ALL Y BLOCK VISION INC Y FALSE BOTH GBlue Advantage of Arkansas ARBLS NOCD AR Y AR BLUE ADVANTAGE Y TRUE BOTH NBlue Care PPO VABLS BCBS VA Y BLUECARE PPO Y FALSE BOTH NBlue Chip of Rhode Island RICHP NOCD RI Y RI BLUE CHIP Y FALSE BOTH NBlue Choice Medicaid 00403 NOCD SC Y BLUE CHOICE MCAID Y FALSE BOTH NBlue Choice of Rochester NY N6BLS NOCD NY N ROCHESTER BLUE CH Y FALSE BOTH NBlue Choice of South Carolina 00922 NOCD SC N BLUE CHOICE OF SC N FALSE BOTH GBlue Cross Blue Shield Michigan Medicare MIMCR NOCD MI Y BCBS MI MEDICARE Y TRUE BOTH NBlue Cross Blue Shield of Arizona 53589 NOCD AZ Y AZ BLUE SHIELD Y FALSE BOTH NBlue Cross Blue Shield of Florida FLBLS BCBS FL Y FL BLUE SHIELD Y FALSE BOTH NBlue Cross Blue Shield Of Western New York N1BLS NOCD ALL N BCBS OF WEST NY Y FALSE BOTH G

Blue Cross Community Solutions (Effective 12-14-14. Payer was previously known as IL BCBS ICP with a payerID of 00621) MCDIL NOCD ALL Y ILLINOIS BCBS ICP N FALSE BOTH GBlue Cross Complete 32002 NOCD ALL Y BLUE CROSS COMPLE Y FALSE BOTH GBlue Cross Complete of Michigan, LLC MIBCN NOCD MI Y BC COMPLETE OF MI N FALSE BOTH # G


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CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerBlue Cross Medicare Advantage (For DOS after 01-01-2017 and for MemberID starting with YDL, YDJ, XOD, XOJ, ZGD,ZGI, ID,YIJ, YUX and UYB only) 66006 NOCD MT,IL,TX,OK N BC MCARE ADV MIT N FALSE BOTH NBlue Cross MI Blue Care Complete MIBCN NOCD MI N MI BLUE CARE Y TRUE BOTH # NBlue Cross of California BC001 NOCD CA Y CA BLUE CROSS Y FALSE BOTH GBlue Cross of Idaho IDBLC BCBS ID Y ID BLUE CROSS Y TRUE BOTH NBlue Grass Family Health (SRRIPA) 15754 NOCD ALL N BLUE GRASS FAMILY Y FALSE BOTH GBlue Lake Rancheria IP061 NOCD CA N BLUE LAKE RANCHER Y FALSE BOTH GBlue Medicare of North Carolina (Contracted providers only. Call 888-296-9790) CALL NOCD NC Y CALL SUPPORT Y FALSE BOTH NBlue Shield of Alabama ALBLS NOCD AL Y AL BLUE SHIELD Y FALSE BOTH NBlue Shield of Alaska AKBLS NOCD AK N AK BLUE SHIELD Y FALSE BOTH NBlue Shield of Arizona AZBLS NOCD AZ Y AZ BLUESHIELD Y FALSE BOTH NBlue Shield of Arkansas ARBLS NOCD AR Y AR BLUE SHIELD Y TRUE BOTH NBlue Shield of California BS001 NOCD CA Y CA BLUE SHIELD Y FALSE BOTH GBlue Shield of Central NY HMO/PPO N2BLS NOCD NY Y CE NY BLUE SHIELD Y FALSE BOTH NBlue Shield of Colorado COBLS BCBS CO Y CO BLUE SHIELD Y FALSE BOTH NBlue Shield of Connecticut CTBLS NOCD CT Y CT BLUE SHIELD Y FALSE BOTH NBlue Shield of Delaware DEBLS BCBS DE Y DE BLUE SHIELD Y TRUE BOTH NBlue Shield of Georgia (State Health of GA) GABLS BCBS GA Y GA BLUE SHIELD Y FALSE BOTH NBlue Shield of Hawaii HIBLS NOCD HI N HI BLUE SHIELD Y TRUE BOTH NBlue Shield of Idaho (Per Provider Testing) IDBLS BCBS ID Y ID BLUE SHIELD Y FALSE BOTH NBlue Shield of Illinois ILBLS BCBS IL Y IL BLUESHIELD Y FALSE BOTH NBlue Shield of Indiana INBLS NOCD IN Y IN BLUE SHIELD Y FALSE BOTH NBlue Shield of Iowa IABLS BCBS IA N IA BLUE SHIELD Y TRUE BOTH NBlue Shield of Iowa (For Secondary claims only where Medicare is primary) (Provider must be enrolled with IABLS prior to sending to this payer. ) IABLM NOCD IA N IA BLUE SHIELD CO Y TRUE BOTH NBlue Shield of Kansas KSBLS BCBS KS Y KS BLUE SHIELD N FALSE BOTH NBlue Shield of Kansas City KCBLS NOCD KS,MS Y KC BLUE SHIELD N FALSE BOTH NBlue Shield of Kentucky KYBLS NOCD KY Y KY BLUE SHIELD Y FALSE BOTH NBlue Shield of Louisiana LABLS NOCD LA N LA BLUE SHIELD Y TRUE BOTH NBlue Shield of Maine MEBLS NOCD ME Y ME BLUE SHIELD Y FALSE BOTH NBlue Shield of Maryland MDBLS BCBS MD Y MD BLUE SHIELD Y FALSE BOTH NBlue Shield of Massachusetts MABLS NOCD MA Y MA BLUE SHIELD Y FALSE BOTH NBlue Shield of Michigan MIBLS NOCD MI Y MI BLUE SHIELD Y TRUE BOTH # NBlue Shield of Minnesota MNBLS NOCD MN N MN BLUE SHIELD Y FALSE BOTH NBlue Shield of Mississippi MSBLS NOCD MS Y MS BLUE SHIELD Y TRUE BOTH NBlue Shield of Missouri MOBLS NOCD MO Y MO BLUE SHIELD Y FALSE BOTH NBlue Shield of Montana MTBLS BCBS MT Y MT BLUE SHIELD Y FALSE BOTH NBlue Shield of National Capital Area NCABS NOCD DC VA MD Y NCA N TRUE BOTH NBlue Shield of Nebraska NEBLS BCBS NE Y NE BLUE SHIELD Y FALSE BOTH NBlue Shield of Nevada NVBLS NOCD NV Y NV BLUE SHIELD Y FALSE BOTH NBlue Shield of New Hampshire NHBLS NOCD NH Y NH BLUE SHIELD Y FALSE BOTH NBlue Shield of New Jersey 22099 NOCD NJ Y NJ BLUESHIELD Y TRUE BOTH NBlue Shield of New Mexico NMBLS NOCD NM Y NM BLUE SHIELD Y FALSE BOTH NBlue Shield of New York (Empire) NYBLS NOCD NY N NY BLUE SHIELD Y FALSE BOTH NBlue Shield of North Carolina NCBLS NOCD NC Y NC BLUE SHIELD Y FALSE BOTH NBlue Shield of North Dakota NDBLS BCBS ND N ND BLUE SHIELD Y FALSE BOTH NBlue Shield of Northeast NY N5BLS NOCD NY Y NE NY BLUE SHIELD Y TRUE BOTH NBlue Shield of Ohio OHBLS NOCD OH Y OH BLUE SHIELD Y FALSE BOTH NBlue Shield of Oklahoma OKBLS BCBS OK Y OK BLUE SHIELD Y FALSE BOTH NBlue Shield of Oregon ORBLS NOCD OR Y OR BLUE SHIELD Y FALSE BOTH NBlue Shield of Pennsylvania PABLS NOCD PA Y PA BLUE SHIELD Y TRUE BOTH NBlue Shield of Rhode Island RIBLS NOCD RI Y RI BLUE SHIELD Y FALSE BOTH NBlue Shield of Rochester NY N7BLS NOCD NY N ROCHESTER BLUE SH Y FALSE BOTH NBlue Shield of South Carolina SCBLS NOCD SC Y SC BLUE SHIELD Y FALSE BOTH NBlue Shield of South Dakota SDBLS BCBS SD N SD BLUE SHIELD N TRUE BOTH NBlue Shield of Tennessee TNBLS BCBS TN Y TN BLUE SHIELD Y TRUE BOTH NBlue Shield of Texas TXBLS NOCD TX Y TX BLUE SHIELD Y FALSE BOTH GBlue Shield of Utah UTBLS NOCD UT Y UT BLUE SHIELD Y FALSE BOTH NBlue Shield of Utica NY N4BLS NOCD NY Y UTICA BLUE SHIELD Y FALSE BOTH NBlue Shield of Vermont VTBLS NOCD VT N VT BLUE SHIELD N FALSE BOTH NBlue Shield of Virginia VABLS BCBS VA Y VA BLUE SHIELD Y FALSE BOTH NBlue Shield of West Virginia WVBLS NOCD WV Y WV BLUE SHIELD Y TRUE BOTH NBlue Shield of Western New York N1BLS NOCD NY Y NY BLUE SHIELD WE Y TRUE BOTH NBlue Shield of Wisconsin WIBLS NOCD WI N WI BLUE SHIELD Y FALSE BOTH NBlue Shield of Wyoming WYBLS BCBS WY Y WY BLUE SHIELD Y TRUE BOTH NBluebonnet Administrators 37121 NOCD LA N BLUEBONNET ADMINI Y FALSE BOTH GBoilermakers national Health & Welfare Fund 36609 NOCD ALL Y BOILERMAKERS NATL Y FALSE BOTH G


7 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerBollinger, INC. BOLL1 NOCD ALL N BOLLINGER INC Y FALSE BOTH NBoncura Health (Dupage Medical Group) DMG01 NOCD ALL N BONCURA HEALTH N FALSE BOTH GBoon-Chapman Benefit Administrators, Inc. 74238 NOCD ALL Y BOON CHAPMAN BENE N FALSE BOTH GBoston Medical Center Healthnet 13337 NOCD MA N BOSTON MED CENTER Y FALSE BOTH GBPS Inc 48964 NOCD ALL Y BPS INC Y FALSE BOTH GBravo Health (Now CIGNA HealthSprings.) 52192 NOCD ALL Y BRAVO HEALTH Y FALSE BOTH GBridgeSpan BRIDG NOCD ALL N BRIDGESPAN N FALSE BOTH GBridgeway Arizona 68069 NOCD AZ Y BRIDGEWAY ARIZONA Y FALSE BOTH GBright Health Advantage Plan BRT01 NOCD ALL N BRIGHT HEALTH N FALSE BOTH GBright Health Physicians BHP01 NOCD CA Y BRIGHT HEALTH PHY N FALSE BOTH GBright Health Plan CB186 NOCD ALL Y BRIGHT HEALTH PLA N FALSE BOTH GBrighton Health Plan Solutions (formerly MAGNACARE) 11303 NOCD ALL N MAGNACARE Y FALSE BOTH GBritCay 22286 NOCD ALL Y BRITCAY N FALSE BOTH GBrockerage Concepts, Inc (Benefit Concepts) 51037 NOCD ALL Y BROCKERAGE CONCEP N FALSE BOTH GBrown & Brown Benefits 59069 NOCD All Y BROWN AND BROWN N FALSE BOTH GBrown & Toland Medical Group 94316 NOCD ALL Y BROWN TOLAND Y FALSE BOTH GBrown & Toland Sutter BTSS1 NOCD ALL N BROWN TOLAND SUTT N FALSE BOTH GBrown & Toland SutterSelect BTSS1 NOCD ALL Y BROWN TOLAND SUT Y FALSE BOTH GBuckeye Community Health 68069 NOCD IA Y BUCKEYE COMM HLTH Y FALSE BOTH GButler Benefits 42150 NOCD ALL Y BUTLER BENEFITS N FALSE BOTH GC & O Employees Hospital Association 23708 NOCD ALL Y C AND 0 EMP HOSP Y FALSE BOTH GC3 Health (fka Access Health Inc.) A1680 NOCD MI N ACCESS HEALTH PLA Y FALSE BOTH GCalifornia Anthem Blue Cross BC001 NOCD CA Y CA BLUE CROSS Y FALSE BOTH GCalifornia Blue Cross BC001 NOCD CA Y CA BLUE CROSS Y FALSE BOTH GCalifornia Health and Wellness 68069 NOCD CA Y CA HEALTH WELLNES Y FALSE BOTH GCalifornia IPA AMM14 NOCD CA N CALIFORNIA IPA N FALSE BOTH GCalifornia Pacific Medical Center 94056 NOCD ALL Y CA PACIFIC MED CE Y FALSE BOTH GCalifornia Water Services CWS99 NOCD CA Y CA WATER SERVICES N FALSE BOTH GCal-Optima Direct CALOP NOCD ALL Y CALOPTIMA DIRECT Y FALSE BOTH GCannon Cochran Management Services, Inc. LA (Claims for Payer address of Metairie, LA only.) 71057 NOCD LA N CANNON COCHRAN LA N FALSE BOTH GCAP Management 95399 NOCD ALL N CAP MANAGEMENT Y FALSE BOTH GCap Management Systems IP080 NOCD CA N CAP MGMT SYSTEMS Y FALSE BOTH GCapital Advantage Insurance Company (CAIC) PROFESSIONAL (BCBS ProviderID and Performing ProviderID required. Call 800-874-8433) 23045 NOCD PA Y CAPITAL ADV INS Y FALSE BOTH NCapital Blue Cross PROFESSIONAL (BCBS ProviderID and Performing ProviderID required. Call 800-874-8433) 23045 NOCD PA Y CAPITAL BLUE CROS Y TRUE BOTH NCapital District PHP SX065 NOCD ALL A CAPITAL DIST PHP Y FALSE BOTH GCapital Health Plan 95112 NOCD All Y CAPITAL HEALTH PL Y FALSE BOTH CCapital International Management Services 65067 NOCD ALL Y CAP INTL MGMT SVC Y FALSE BOTH GCapitol Administrators 68011 NOCD ALL Y CAPITOL ADMINISTR Y FALSE BOTH GCapRock HealthPlans CAPHP NOCD ALL N CAPROCK HEALTH PL Y FALSE BOTH G

Cardinal Innovations. (Formerly Piedmont Behavioral Health) 06607 NOCD ALL Y CARDINAL INNOVATI Y FALSE BOTH GCardiovascular Care Providers GCVCP NOCD ALL N CARDIOVASCULAR CA N FALSE BOTH GCare 1st Health Plan of Arizona 57116 NOCD AZ Y AZ CARE FIRST HP Y FALSE BOTH GCare 1st Health Plan of CA 57115 NOCD CA N CARE 1ST HP OF CA N FALSE BOTH GCare Access PSN 65063 NOCD ALL N CARE ACCESS PSN N FALSE BOTH NCare Around the Clock 57721 NOCD ALL Y CARE AROUND CLOCK Y FALSE BOTH GCare Choices HMO HM037 NOCD ALL N CARE CHOICES HMO Y FALSE BOTH TCare Core National 14182 NOCD ALL Y CARE CORE NATIONA Y FALSE BOTH GCare N' Care 37228 NOCD ALL N CARE N CARE N FALSE BOTH GCare Plus 65031 NOCD ALL A CARE PLUS N FALSE BOTH GCare to Care 41222 NOCD ALL N CARE TO CARE N FALSE BOTH GCare Wisconsin Health Plan (Trizetto) 27004 NOCD ALL N CARE WI HEALTH PL Y FALSE BOTH GCareCentrix 11345 NOCD ALL Y CARECENTRIX Y TRUE BOTH GCarecore National Wellcare 14188 NOCD ALL N CARECORE NAT WELL N FALSE BOTH GCareCore National, LLC (Aetna Radiology Claims) 14179 NOCD ALL N CARECORE NATIONAL N FALSE BOTH GCareCore National, LLC (Radiology charges for Oxford) 14180 NOCD NY, NJ Y CARECORE OXFORD Y FALSE BOTH GCareFirst BCBS - DC, National Capital Area SB580 NOCD MD,DC Y CAREFIRST NCA N TRUE BOTH NCarelink Medicaid 25140 NOCD ALL Y CARELINK MEDICAID Y FALSE BOTH GCaremore CM001 NOCD ALL Y CAREMORE N FALSE BOTH GCaremore IPA CARMO NOCD ALL N CAREMORE IPA N FALSE BOTH GCareMore Value Plus (CVP) CARMO NOCD ALL N CAREMORE IPA N FALSE BOTH GCarenet of Virginia (Prepare to use consolidated Coventry payerID of 25133.) 25142 NOCD VA Y CARENET VIRGINIA Y FALSE BOTH GCareOregon, Inc. 93975 NOCD OR Y CAREOREGON INC N FALSE BOTH GCarePlus Cardiology - New Century Health NCH04 NOCD ALL N CAREPLUS CARDIO Y FALSE BOTH NCarePlus Health Plan (Call payer for PayerID) CALL CALL ALL N CALL PAYER N FALSE BOTH N


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CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerCaresource Health Plan of Oregon MRCHP NOCD ALL N CARESOURCEHPOR N FALSE BOTH GCaresource IN INCS1 NOCD IN Y CARESOURCE IN Y FALSE BOTH GCareSource KY KYCS1 NOCD KY N CARESOURCE KY Y FALSE BOTH GCareSource of Georgia GACS1 NOCD ALL N CARESOURCE OF GA N FALSE BOTH GCareSource OH 31114 NOCD OH R CARESOURCE OH Y FALSE BOTH GCaresource West Virginia WVCS1 NOCD ALL Y CARESOURCE WV N FALSE BOTH GCareworks of Ohio 10010 NOCD OH N CAREWORKS OF OHIO N FALSE BOTH GCarolina Behavioral Health Alliance 56215 NOCD NC N CAROLINA BEHAV HL N FALSE BOTH GCarolina Care Plan (Part of the Medical Mutual Family of companies. Former payerID was 57105.) 29076 NOCD SC Y CAROLINA CARE PLA Y FALSE BOTH GCarolina Crescent 68069 NOCD ALL Y CAROLINA CRESCENT Y FALSE BOTH GCarolina Summit Healthcare, Inc 56195 NOCD ALL Y CAROLINA SUMMIT Y FALSE BOTH GCarpenters' and Millwrights' Health Benefit Trust Fund COMPU NOCD CO N CARPENTERS HBTF N FALSE BOTH GCarpenters Health and Welfare Fund of Philadelphia CX101 NOCD ALL N CARPENTERS HW FUN N FALSE BOTH GCarpet, Linoleum and Resilient Tile Layers Health and Welfare Fund COMPU NOCD CO N CARPET TILE HWF N FALSE BOTH GCBA Blue 03036 NOCD ALL Y CBA BLUE N FALSE BOTH G

CBA, Inc. (Cooperative Benefits Administrators, Inc.) (For Dates of Service after 01-01-2014, submit claims to 39026.) 52132 NOCD All Y CBA Y FALSE BOTH GCBHA Carolina Behavioral Health Alliance 56215 NOCD ALL Y CBHA Y FALSE BOTH GCBNHP Health Choices 65391 NOCD ALL Y CBHNP HEALTH CHOI N FALSE BOTH GCBSA (Corporation Benefit Services of America) 41124 MCSI ALL Y CBSA N FALSE BOTH GCCMC - Comprehensive Care Management Corp CCMC1 NOCD NY Y CCMC N FALSE BOTH GCCS (aka Comprehensive Care Systems) MNBLS NOCD MN Y CCS COMPREHENSIVE Y FALSE BOTH NCDO Technologies 63028 NOCD WY,UT Y MBA OF WYOMING N FALSE BOTH GCDS Group Health 88022 NOCD ALL Y CDS GROUP HEALTH Y FALSE BOTH GCedar Valley Community Health Plan SISCO NOCD ALL N SISCO N FALSE BOTH GCedars-Sinai Medical Network Services Claims 95166 NOCD ALL Y CEDARS SINAI CLAI Y FALSE BOTH GCedars-Sinai Medical Network Services Encounters 95167 NOCD ALL Y CEDARS SINAI ENCO Y FALSE BOTH GCeltic Insurance CELTC NOCD ALL N CELTIC INS Y FALSE BOTH GCeltiCare 68069 NOCD ALL Y CELTICARE Y FALSE BOTH G

Cement Masons & Plasterers Health & Welfare Trust - Grp#F16 91136 NOCD ALL Y CEMENT GRP F16 N FALSE BOTH GCenCal Health 95386 NOCD CA N CENCAL HEALTH Y FALSE BOTH GCenpatico - Georgia 68069 NOCD GA Y CENPATICO GA Y FALSE BOTH GCenpatico - Kansas (Prior to submitting claims please call Provider Relations Dept at 866-896-7293 to verify your provider info is on file in the claim system.) 68068 NOCD ALL Y CENPATICO KANSAS Y FALSE BOTH GCenpatico (For multiple states) 68068 NOCD ALL Y CENPATICO Y FALSE BOTH GCenpatico Behavioral Health - Wisconsin (Call 800-225-2573 ext 25525 prior to submitting claims.) 68068 NOCD ALL Y CENPATICO BHAV WI Y FALSE BOTH GCenpatico Behavioral Health AZ (Prior to submission, contact 866-495-6748 to verify provider ID.) 68068 NOCD AZ Y CENPATICO BH AZ Y FALSE BOTH GCenpatico Florida Behavioral Health 68068 NOCD FL Y CENPATICO FL BHV Y FALSE BOTH GCenpatico Indiana 68068 NOCD ALL Y CENPATICO INDIANA Y FALSE BOTH GCenpatico Massachusetts 68068 NOCD MA Y CENPATICO MASSACH Y FALSE BOTH GCenpatico Ohio 68068 NOCD OH Y CENPATICO OHIO Y FALSE BOTH GCentene Advantage Plans (claims for former payer ID 95567 with DOS on or after 1/1/18) 68069 NOCD ALL Y CENTENE ADVANTAGE Y FALSE BOTH GCenter for Elders Independence 94312 NOCD ALL N CENTER ELDERS IND Y FALSE BOTH GCenter IPA POP01 NOCD ALL Y CENTER IPA N FALSE BOTH GCenterCare 13357 NOCD ALL Y CENTERCARE Y FALSE BOTH GCenterLight Healthcare 13360 NOCD ALL N CENTERLIGHT HC Y FALSE BOTH GCentinela IPA IP080 NOCD CA N CENTINELA IPA Y FALSE BOTH GCentraCare 66698 NOCD ALL Y CENTRACARE N FALSE BOTH G

Central Benefit National (Now known as Tribute Health Plan.) 31118 NOCD ALL Y CENTRAL BENEFITS Y FALSE BOTH GCentral California Alliance for Health (Alliance EDI Support Unit 831-430-5510) SX169 NOCD CA N CEN CAL ALLIANCE N FALSE BOTH N

Central California Electricial Workers Health and Welfare Trust NWADM NOCD CA N CCEW HLTH WELFARE Y FALSE BOTH GCentral California Women's Health WH001 NOCD CA Y CENT CA WOMENS HE N FALSE BOTH GCentral Health Medicare CHCPI NOCD ALL N CENTRAL HLTH MEDI Y FALSE BOTH GCentral Ohio Primary Care Senior Care Advantage AGL02 NOCD ALL Y CENTRAL OHIO Y FALSE BOTH GCentral Reserve Life 13193 NOCD ALL Y CENTRAL RESERVE L Y FALSE BOTH GCentral Reserve Life Ins.Co. (Formertly Loyal American Life (Medicare Supplement) ) 13193 NOCD ALL Y LOYAL AMERICAN L Y FALSE BOTH GCentral States Southeast and Southwest Areas Health and Welfare and Pensions Funds 36215 NOCD All Y CENTRAL STATES SO Y FALSE BOTH G


9 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerCenturion of Tennessee 42140 NOCD ALL N CENTURION TENNESS N FALSE BOTH GCentury PHO 36393 NOCD ALL N CENTURY PHO N FALSE BOTH GCHA - Commonwealth Health Alliance 23171 NOCD ALL Y CHA Y FALSE BOTH G

CHAMPVA-HAC (CHAMPVA-HAC is not associated with and does not process claims for TRICARE (formerly CHAMPUS.) 84146 NOCD ALL N CHAMPVA HAC Y FALSE BOTH GChautauqua County Health Plan (Mayville,NY) 16600 NOCD NY Y CHAUTAUQUA HEALTH N FALSE BOTH GChildren First Medical Group (For questions regarding claim status, providers will need to contact payer: CFMG Provider Customer Service 510-428-3154) 94321 NOCD ALL N CHILDREN FIRST MG N FALSE BOTH GChildren's Community Health Plan 39113 NOCD ALL N CHILDRENS COMM HP Y FALSE BOTH GChildren's Community Health Plan Wisconsin 251CC NOCD ALL Y CHILD COMM HP WI N FALSE BOTH GChildrens Medical Center Health Plan CMCHP NOCD ALL N CHILD MED CENT HP N FALSE BOTH GChildren's Specialists of San Diego CSSD2 NOCD CA Y CHILD SPEC OF SD N FALSE BOTH GChinese Community Health Plan (Unique Provider ID must be on claim.) 94302 NOCD ALL Y CHINESE COMM HP Y FALSE BOTH GCHIPA - College Health IPA CHIPA NOCD ALL N COLLEGE HLTH IPA N FALSE BOTH GChirometrics Inc. 33070 NOCD ALL Y CHIROMETRICS INC Y FALSE BOTH GChiropractic Association of South Dakota CASD1 NOCD SD R CHIRO ASSOC SD Y FALSE BOTH GChiropractic Care of Minnesota, Inc. (For Dates of service before 1-01-08, continue to use payerID of ACN01.) LNDMK NOCD MN Y CHIRO CARE MN Y FALSE BOTH PChiropractic Health Plans (Enrollment required, please contact Provider Relations 801-352-7270) (NOTE that this payer accepts Chiropractic claims only.) U1439 NOCD UT N CHIROPRACTIC HP U Y TRUE BOTH N

CHOC - Childrens Hospital of Orange County Health Alliance 33065 NOCD CA Y CHOC HEALTH ALLIA Y FALSE BOTH GChoice Physicians Net First Choice CPNFC NOCD ALL Y CHOICE PHY NET FI Y FALSE BOTH GChoiceOne IPA POP03 NOCD ALL Y CHOICEONE IPA N FALSE BOTH G

CHP/RPU (FABOH) (Facility physical address required on claim.) 39112 NOCD ALL Y CHP RPU FABOH Y FALSE BOTH CChristian Brothers Services 38308 NOCD ALL N CHRISTIAN BROTHER N FALSE BOTH G

Christian Care Ministries (Medishare) (Providers should check the member ID card and use the Household ID value as the member ID when submitting claims electron 59355 NOCD ALL N CHRISTIAN CARE MI N FALSE BOTH GChristie Student Helath Plan 75544 NOCD ALL Y CHRISTIE STUDENT N FALSE BOTH GChristus Health Medicare Advantage 10629 NOCD ALL N CHRISTUS HLTH MC N FALSE BOTH GChristus Health New Mexico,HIX 21062 NOCD NM N CHRISTUS HLTH NM N FALSE BOTH GChristus Health Plan HIX 52106 NOCD ALL Y CHRISTUS HLTH HIX N FALSE BOTH GChristus Health Plan Medicaid 45210 NOCD ALL Y CHRISTUS HLTH MED N FALSE BOTH GChristus Spohn Health Network SPOHN NOCD ALL Y CHRISTUS SPOHN HE N FALSE BOTH GCIGNA - PPO 62308 NOCD All Y CIGNA PPO Y FALSE BOTH # CCIGNA - PPO 62308 NOCD All Y CIGNA-PPO Y FALSE BOTH # C

CIGNA Behavioral Health (We will also accept PID SX071 for these claims: use of either ID accomplishes the same routing.) MCCBV NOCD All Y CIGNA BEHAVIORAL Y FALSE BOTH CCIGNA Health Plan - HMO 62308 NOCD All Y CIGNA HEALTH HMO Y FALSE BOTH # CCIGNA Healthcare for Seniors - Arizona Medicare 86033 NOCD AZ N CIGNA AZ SR HLTH Y FALSE BOTH GCIGNA HealthSprings 52192 NOCD ALL Y BRAVO HEALTH Y FALSE BOTH GCIGNA Premier Plus 62308 NOCD ALL Y CIGNA PREMIER PLU Y FALSE BOTH # CCimarron Salud (Receiver type 'D' - Claims are printed and mailed to the Payer.) PRINT NOCD NM N CIMARRON SALUD N FALSE BOTH NCinncinnati Financial Corporation 46871 NOCD ALL Y CINNCINNATI FINAN Y FALSE BOTH GCitrus Health Care 10207 NOCD ALL Y CITRUS HEALTH CAR Y FALSE BOTH CCitrus Valley Physician's Group IP055 NOCD CA N CITRUS VALLEY PHY N FALSE BOTH GCity of Amarillo Group Health COA01 NOCD ALL Y AMARILLO GRP HLTH N FALSE BOTH GCity of Austin 74234 NOCD TX N CITY OF AUSTIN N FALSE BOTH GCL Frates CLFR2 NOCD ALL Y CL FRATES N FALSE BOTH G

Clackamas County Mental Health (Administered by PH Tech) CCMMH NOCD OR N CLACKAMAS CTY MH Y FALSE BOTH GClaims Development Corporation (Effective 2-2-15, Dermatology Networks Solutions claims will process under this payerID. 43056 NOCD ALL Y CLAIMS DEV CORP N FALSE BOTH GClaimsBridge HPN 11752 NOCD ALL N CLAIMSBRIDGE HPN Y FALSE BOTH GClaimsWare, Inc. DBA ManageMed 57080 NOCD ALL Y CLAIMSWARE INC Y FALSE BOTH GClarian Health Plans 95444 NOCD ALL N CLARIAN HEALTH PL N FALSE BOTH GClient First 41201 NOCD ALL Y CLIENT FIRST N FALSE BOTH GClifton Health Systems D/B/A Actin Care Groups 24585 NOCD ALL Y ACTIN CARE GROUPO N FALSE BOTH GClinical Resource Group CRGMN NOCD ALL N CLINICAL RESOURCE N FALSE BOTH GClover (Formerly Carepoint Health Plan) 77023 NOCD ALL Y CAREPOINT HEALTH N FALSE BOTH G


10 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerCoastal Administrative Services 77052 NOCD ALL Y COASTAL ADMIN SVC Y FALSE BOTH GCoastal Care 43141 NOCD ALL N COASTAL CARE N FALSE BOTH NCoastal Communities Physician Network (CCPN) CCPN1 NOCD CA N CCPN N FALSE BOTH GCoastal Healthcare Management LIPAZ NOCD ALL N COASTAL HLTHCARE N TRUE BOTH NCofinity (formerly Sloans Lake) SLOAN SLON CO Y SLOANS Y FALSE BOTH CCofinity (formerly Sloans Lake) 38335 SLON CO R COFINITY Y FALSE BOTH CColonial Medical 22284 NOCD ALL N COLONIAL MEDICAL Y FALSE BOTH GColorado Access HMO COACC COAC CO S CO ACCESS HMO Y FALSE BOTH PColorado Choice Health Plans H0657 NOCD CO N CO CHOICE HEALTH N FALSE BOTH NColorado Health Insurance Cooperative 49718 NOCD CO N CO HLTH INS COOP Y FALSE BOTH GColorado Laborers Health and Welfare Fund COMPU NOCD CO N CO LABORERS HWF N FALSE BOTH GColumbine Health Plan CHP02 NOCD ALL N COLUMBINE HEALTH Y FALSE BOTH GCommerce Benefits Group 34181 NOCD ALL Y COMMERCE BENEFITS N FALSE BOTH GCommercial Travelers/PHX 88091 NOCD ALL Y COMMERCIAL TRAVEL N FALSE BOTH GCommon Ground Healthcare Cooperative 77170 NOCD ALL N COMMON GROUND HC N FALSE BOTH GCommonWealth Administrative Group 37237 NOCD ALL Y COMMONWEALTH ADMI Y FALSE BOTH # CCommonwealth Care Alliance 14315 NOCD ALL N COMMWEALTH CARE A Y FALSE BOTH GCommunity Care Associates 17902 NOCD MI N COMMUNITY CARE AS N FALSE BOTH GCommunity Care Behavioral Health Org. (For Dates of Service prior to October 1, 2007) 25179 NOCD All Y COMM CARE BEHAVIO Y FALSE BOTH GCommunity Care BHO (For Dates of Service after October 1, 2007) 23282 NOCD ALL Y COMMUNITY CARE BH Y FALSE BOTH GCommunity Care Inc. (WI) 39126 NOCD ALL A COMMUNITY CARE WI Y FALSE BOTH G

Community Care Managed Health Care Plans of Oklahoma 73143 NOCD OK Y COMMUNITY CARE OK N FALSE BOTH GCommunity Connect Medicaid 95192 NOCD ALL N COMM CONNECT MCAI N FALSE BOTH GCommunity Eye Care CECVP NOCD ALL Y COMMUNITY EYE CAR N FALSE BOTH GCommunity First Health Plan, Inc. COMMF NOCD ALL Y COMMUNITY FIRST H N FALSE BOTH GCommunity Health 60495 NOCD ALL N COMMUNITY HEALTH N FALSE BOTH GCommunity Health Alliance 35193 NOCD ALL Y COM HLTH ALLIANCE N FALSE BOTH GCommunity Health Allliance TN 27905 NOCD ALL N COMMUNITY HLTH TN N FALSE BOTH GCommunity Health Center Network CHCN1 NOCD NC N COMM HLTH CENTER N FALSE BOTH GCommunity Health Choice (Please include TPI Number (Texas Medicaid Number) in Field FA0-23) 48145 NOCD ALL Y COMM HEALTH CHOIC N FALSE BOTH GCommunity Health Electronic Claims/CHEC/webTPA 75261 NOCD ALL N CHEC TPA CLAIMS N FALSE BOTH GCommunity Health Group 66170 NOCD ALL Y COMMUNITY HLTH GR Y FALSE BOTH GCommunity Health Plan of Washington CHPWA NOCD ALL Y COMM HLTH OF WA N FALSE BOTH GCommunity Health Solutions (Claims now route to Medicaid of Louisiana) LAMCD NOCD LA Y COMMUNITY HLTH SO N TRUE BOTH NCommunity IPA AMM12 NOCD ALL Y COMMUNITY IPA N FALSE BOTH GCommunity Medical Group of the West Valley CMGWV NOCD CA N COMM MED GRP W VA Y FALSE BOTH GCOMP - Ohio (Austintown, OH) 34177 NOCD OH N COMPENSATION PROG N FALSE BOTH GCompFirst, LLC 23296 NOCD ALL Y COMPFIRST Y FALSE BOTH GComplementary HealthCare Plans 93101 NOCD OR WA Y COMPLEMENTARY HCP Y FALSE BOTH GCompManagement Health 15243 NOCD ALL Y COMPMANAGEMENT HE Y FALSE BOTH GComprehensive Benefits Administrator, Inc. (Now known as CBA Blue.) 03036 NOCD ALL Y COMPREHENSIVE BEN N FALSE BOTH GComprehensive Care Services (BCBSMN) 00720 NOCD ALL N COMP CARE SERVICE Y FALSE BOTH GComprehensive Medical/Vision Program AZ M0166 NOCD AZ Y COMP MED/VIS AZ N FALSE BOTH NComPsych 37363 NOCD ALL N COMPSYCH N FALSE BOTH GCompuSys Incorporated (New Mexico) 74234 NOCD NM N COMPUSYS INC NM N FALSE BOTH GCompuSys Incorporated of Arizona 74234 NOCD AZ N COMPUSYS INC AZ N FALSE BOTH GCompuSys Incorporated of Colorado COMPU NOCD CO N COMPUSYS INC CO N FALSE BOTH GCompuSys Incorporated of Utah 74234 NOCD UT N COMPUSYS INC UT N FALSE BOTH GCompusys of Colorado COMPU COLO CO N COMPUSYS OF COLO N FALSE BOTH GCompuSys/Erisa Group, Incorporated (AZ) 74234 NOCD AZ N CS ERISA GROUP AZ N FALSE BOTH GCompuSys/Erisa Group, Incorporated (NM) 74234 NOCD NM N CS ERISA GROUP NM N FALSE BOTH GCompuSys/Erisa Group, Incorporated (TX) 74234 NOCD TX N CS ERISA GROUP TX N FALSE BOTH GConcordia Care Inc. 33632 NOCD ALL N CONCORDIA CARE IN N FALSE BOTH GConnecticare - Medicare 78375 NOCD ALL Y CONNECTICARE MCAR Y FALSE BOTH GConnecticare, Inc. 06105 NOCD ALL Y CONNECTICARE Y FALSE BOTH GConnecticare, Inc. 06105 NOCD ALL Y CONNECTICARE INC Y FALSE BOTH GConnecticut Carpenters Health Fund 37307 NOCD CT Y CT CARPENTERS HLT N FALSE BOTH GConnective RX (PSKW) PSKW0 NOCD ALL Y CONNECTIVE RX N FALSE BOTH GConsociate Group 37135 NOCD ALL Y CONSOCIATE GROUP Y FALSE BOTH GConsolidated Associates Railroad 75284 NOCD ALL Y CONS ASSOC RAILRO Y FALSE BOTH GConsolidated Group 59140 NOCD All Y CONSOLIDATED GROU N FALSE BOTH GConsolidated Health Plans 87843 NOCD ALL N CONSOLIDATED HPS Y FALSE BOTH GConstitution State / Travelers 19046 NOCD ALL N CONSTITUTION STAT N FALSE BOTH GConsumers Choice Health SC 45321 NOCD ALL A CONSUMERS CHCE SC Y FALSE BOTH G


11 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerCook Children's Health Plan CCHP1 NOCD ALL N COOK CHILDRENS HP N FALSE BOTH GCook Children's Star Plan CCHP9 NOCD ALL Y COOK CHILDRENS ST Y FALSE BOTH GCook Group Health Plan 35149 NOCD ALL Y COOK GRP HLTH PLA Y FALSE BOTH GCooperative Benefit Administrators, Inc. 52132 NOCD All Y COOPERATIVE BENEF N FALSE BOTH GCoordinated Benefit Plan 14829 NOCD ALL N COORDINATED BENE Y FALSE BOTH GCoordinated Medical Specialists (CMS) 58204 NOCD ALL Y COORD MED SPECIAL N FALSE BOTH GCore Administrative Services 58231 NOCD ALL N CORE ADMIN SERVIC Y FALSE BOTH GCore Value (Part of Gettysburg Health.) 23274 NOCD ALL Y CORE VALUE GETTYS N FALSE BOTH GCoreSource 35187 NOCD ALL Y CORESOURCE Y FALSE BOTH GCoreSource Little Rock (For claims where the 'submit claims to address' on the medical ID card is an address in Little Rock. For assistance, call 800-689-0106) 75136 NOCD AR A CORESOURCE LR Y FALSE BOTH GCoreSource of Illinois 35182 NOCD IL Y IL CORESOURCE Y FALSE BOTH GCoreSource of IOWA 35182 NOCD IA Y IA CORESOURCE Y FALSE BOTH GCoreSource of Maryland 35182 NOCD MD Y MD CORESOURCE Y FALSE BOTH GCoreSource of North Carolina (Start using new PayerID of 35182. Old payerID will start rejecting soon.) 35180 NOCD NC Y NC CORESOURCE Y FALSE BOTH GCoresource of OH 35183 NOCD OH N CORESOURCE OF OH Y FALSE BOTH GCoreSource of Pennsylvania 35182 NOCD PA Y PA CORESOURCE Y FALSE BOTH GCoreStar AZ MN (Start using new PayerID of 35182. Old payerID will start rejecting soon.) 41045 NOCD AZ, MN Y CORESTAR N FALSE BOTH GCorizon Health Inc.(Claims with address of Brentwood,TN should be submitted to this Payer ID.) CORIZ NOCD ALL Y CORIZON HEALTH IN N FALSE BOTH G

Corizon, Inc. (fka Correctional Medical Services) Claims with address of St. Louis, MO should be submitted to this Payer ID. 43160 NOCD ALL N CORRECTIONAL MEDI N FALSE BOTH GCornerstone Benefit Administrators 35202 NOCD ALL Y CORNERSTONE BENEF N FALSE BOTH GCornerstone Preferred Resources CB268 NOCD ALL N CORNERSTONE PREF Y FALSE BOTH GCorporate Plan Management Inc. 64270 NOCD ALL Y CORP PLAN MANAGEM Y FALSE BOTH GCorrectCare Integrated Health CCIHC NOCD CA N CORRECTCARE N FALSE BOTH GCorrectCare Integrated Health LADOC NOCD CA Y CORRECTCARE LA N FALSE BOTH GCorrection Health Partners PHPMC NOCD ALL N CORR HLTH PARTNER Y FALSE BOTH # GCounty Care (Behavioral Health claims with a DOS prior to 4/1/16) 42138 NOCD ALL Y COUNTY CARE N FALSE BOTH GCounty Care (Behavioral Health and regular claims with a DOS after 4/1/16) 06541 NOCD ALL Y COUNTY CARE N FALSE BOTH GCounty Care (formerly Centene IPA ) Claims with a DOS prior to 4/1/16) 42139 NOCD ALL Y CENTENE IPA N FALSE BOTH GCOVA (Commonwealth of VA) VABLS BCBS VA Y COVA Y FALSE BOTH NCovenant Administrators, Inc. 58102 NOCD ALL N COVENANT ADMINIST N FALSE BOTH GCovenant Management Systems Employee Benefit plan CMSEB NOCD ALL N COVENANT MGMT SYS N FALSE BOTH GCoventry Health Care (Coventry old Legacy Payer ID's are still accepted.) 25133 NOCD ALL Y COVENTRY HEALTH Y FALSE BOTH GCoventry Health Care of Florida 128FL NOCD FL Y COVENTRY HC FL Y FALSE BOTH GCox Health Plan (Requires Provider ID in Box 33a. Contact Cox Health Plan for ID.) 00019 NOCD AR,MO N COX HEALTH PLAN N FALSE BOTH GCreative Medical Systems 64068 NOCD ALL Y CREATIVE MED SYS Y FALSE BOTH GCreative Plan Administrators 37320 NOCD ALL N CREATIVE PLAN ADM N FALSE BOTH GCrescent PPO Health Solutions. CALL NOCD ALL N Call S&S Y FALSE BOTH GCrystal Run Health Plans 46120 NOCD ALL Y CRYSTAL RUN HP Y FALSE BOTH GCSI Network Services 34186 NOCD ALL N CSI NETWORK SVCS N FALSE BOTH GCTI Administrators Inc 42141 NOCD ALL N CTI ADMINISTRATOR Y FALSE BOTH GCulinary Health & Welfare Fund (Las Vegas, NV) 59140 NOCD NV A CULINARY HFUND NV Y FALSE BOTH GCustom Design Benefits, Inc. 82056 NOCD ALL Y CUSTOM DESIGN BE N FALSE BOTH GD. H. Evans and Associates (Call Jessica Picarde @ 410-349-3222 before sending this payerID.) 25172 NOCD ALL N DH EVANS AND ASSO Y FALSE BOTH GDakotaCare DAK01 NOCD SD Y DAKOTACARE Y FALSE BOTH GDart Member Care CB987 NOCD ALL N DART MEMBER CARE Y FALSE BOTH GDavis Vision 00157 NOCD ALL N DAVIS VISION N TRUE BOTH NDCHS Medical Foundation DCHSF NOCD ALL Y DCHS MED FOUNDATI N FALSE BOTH GDean Health Plan DEAN1 NOCD WI N DEANCARE Y FALSE BOTH NDell Children's Health Plan 74272 NOCD ALL Y DELL CHILDRENS HP N FALSE BOTH GDelta Health Systems DHS01 NOCD ALL N DELTA HEALTH SYST Y FALSE BOTH GDentemax AMS01 NOCD MI N DENTEMAX Y FALSE BOTH GDentemax/DPI (MI) AMS01 NOCD MI N DENTEMAX DPI MI Y FALSE BOTH GDenver Health - Indigent 84134 NOCD CO Y DENVER HLTH INDIG Y FALSE BOTH GDenver Health and Hospital Authority 84133 NOCD CO N DENVER HEALTH HOS Y FALSE BOTH GDenver Health Medical Plan 84135 NOCD CO N DENVER HEALTH MED Y FALSE BOTH GDenver Health Medical Plan, Inc. - Medicare Choice 84131 NOCD CO Y DENVER HLTH MCARE Y FALSE BOTH GDepartment of Labor J1438 NOCD ALL Y DEPT OF LABOR N FALSE BOTH N


12 of 41




CodeSet

(See Legend)

Payer Type


Dermatology Network Solutions BCBS for the Health Options HMO (Payer requires 11 digit member ID Number) 58204 NOCD All Y DBC Y FALSE BOTH GDermatology Network Solutions, LLC BCBS (Payer requires 11 digit member ID Number) 58204 NOCD All Y DERM NETWORK BCBS Y FALSE BOTH GDermatology Network Solutions, LLC Humana (Payer requires 11 digit member ID Number) 58204 NOCD All Y DERM NET HUMANA Y FALSE BOTH GDermatology Network Solutions, LLC Vista (Payer requires 11 digit member ID Number) 58204 NOCD All Y DERM NETWORK VIST Y FALSE BOTH GDeseret Mutual SX105 NOCD UT N DESERET MUTUAL Y TRUE BOTH NDesert Family Practice Association PPM01 NOCD ALL A DESERT FAM PRACTI Y FALSE BOTH GDesert Medical Group DESRT NOCD CA N DESERT MED GROUP N FALSE BOTH GDesert Valley Medical Group DVMC1 NOCD CA Y DESERT VALLEY MG N FALSE BOTH GDetroit Medical Center 56240 NOCD ALL N DETROIT MED CENTE Y FALSE BOTH GDGA - Diversified Group Administrators 25160 NOCD ALL N DGA N FALSE BOTH GDignity Global MPM27 NOCD ALL N DIGNITY GLOBAL Y FALSE BOTH GDignity HCLA MPM28 NOCD ALL N DIGNITY HCLA Y FALSE BOTH GDignity Health - Sacramento Hospital claim shop for Mercy Medical Group, Woodland Clinic Medical Group and Hill Physicians Medical group (hospital risk) HOSH1 NOCD ALL R DIGNTY HLTH HOSH1 N FALSE BOTH P

Dignity Health Medical Foundation for Mercy Medical Group or Woodland Clinic Medical Group (professional risk) PROH1 NOCD ALL Y DIGNTY HLTH PROH1 N FALSE BOTH PDignity Health Medical Foundation for Sequoia Physicians Network (professional risk) PROH2 NOCD ALL Y DIGNTY HLTH PROF2 N FALSE BOTH PDirect Care Administrators DCA62 NOCD ALL N DIRECT CARE ADMIN N FALSE BOTH NDirectors Guild of America BC001 NOCD CA Y DIRECTORS GUILD A Y FALSE BOTH GDiversified Group Brokerage 06102 NOCD All Y DIVERSIFIED GROUP Y FALSE BOTH GDMERC Region A (Testing is required for claims requiring CMNs.) DMERA NOCD REG A N DMERC REGION A Y TRUE BOTH NDMERC Region B (Testing is required for claims requiring CMNs.) DMERB NOCD REG B N DMERC REGION B Y TRUE BOTH NDMERC Region C (Testing is required for claims requiring CMNs.) DMERC NOCD REG CA N DMERC REGION C Y TRUE BOTH NDMERC Region D (Testing is required for claims requiring CMNs.) DMERD NOCD REG D N DMERC REGION D Y TRUE BOTH NDowney Select IPA (Applecare Medical Mgmt) APP01 NOCD ALL Y DOWNEY SELECT IPA N FALSE BOTH GDreyer Medical DREYR NOCD ALL Y DREYER MEDICAL Y FALSE BOTH GDriscoll Childrens Health Plan 74284 NOCD ALL N DRISCOLL CHILDREN Y FALSE BOTH GDriscoll Childrens Health Plan (CHIP) 74284 NOCD TX Y DRISCOLL CHILD HP N FALSE BOTH GDunn and Associates Benefits Administrators, Inc. 35186 NOCD ALL N DUNN ASSOC BENE Y FALSE BOTH GE.S. Beveridge and Associates 34108 NOCD ALL A ES BEVERIDGE AND N FALSE BOTH GE3 Health, Inc (Formerly First Integrated Health) 75232 NOCD ALL Y E3 HEALTH N FALSE BOTH GEarly Intervention Central Billing 36434 NOCD IL Y EARLY INTERVENTIO N FALSE BOTH GEast Bay Medical Network IP130 NOCD ALL Y EAST BAY MED NETW Y FALSE BOTH GEAST CAROLINA BEHAVIORAL HEALTH 56089 NOCD ALL A E CAROLINA BH N FALSE BOTH GEastern Main Healthcare Systems (EMHS) 16565 NOCD ALL N EMHS Y FALSE BOTH GEastland Medical Group EMG11 NOCD ALL N EASTLAND MED GRP N FALSE BOTH GEastpointe 08044 NOCD ALL N EASTPOINTE Y TRUE BOTH NEasy Choice Health Plan of NY 24770 NOCD ALL Y EASY CHOICE HP NY N FALSE BOTH G

EBC Inc. (To obtain the payerID, please call (440) 262-1160) CALL NOCD ALL Y CALL ENS FOR NAME Y FALSE BOTH GEberle Vivian EV001 NOCD ALL Y EBERLE VIVIAN N FALSE BOTH GEBMC CX025 NOCD ALL N EBMC N FALSE BOTH GEBMS (Employee Benefit Management Services, Inc) 81039 NOCD ALL Y EBMS PROFESSIONAL N FALSE BOTH GEDS Healthchoice (formerly payer ID 22521 - For dates of service on or after 01/01/2018 ) 71064 NOCD ALL Y EDS HEALTHCHOICE Y FALSE BOTH GEducators Mutual (EMIA) (Enrollment required, contact EMIA to enroll 800-362-0533, Opt. 2) SX110 NOCD UT N EDUCATORS MUTUAL Y TRUE BOTH NEHI (Employers Health Insurance) 73288 NOCD ALL Y EHI Y FALSE BOTH GEl Paso First - CHIP EPF03 NOCD ALL N ELPASO FIRST CHIP N FALSE BOTH GEl Proyecto Del Barrio IPA MPM04 NOCD CA N EL PROYECTO DEL B N FALSE BOTH NElder Service Plan of the North Shore. 04326 NOCD ALL Y ELDER SVC N SHORE N FALSE BOTH GElderPlan, Inc. (Elderplan Provider ID necessary on all claims. Contact (718)921-7979 for Provider ID.) 31625 NOCD ALL N ELDERPLAN INC Y FALSE BOTH GEllis Consultants, INC. ECISF NOCD ALL N ELLIS CONSULTANTS N FALSE BOTH NElmcare NAELM NOCD ALL Y ELMCARE Y FALSE BOTH GElmcare L.L.C. NAELM NOCE IL Y ELMCARE LLC Y FALSE BOTH GElmco 37253 NOCD NY Y ELMCO Y FALSE BOTH GEmerald Health Network 34167 NOCD All Y EMERALD HEALTH Y FALSE BOTH G


13 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerEmerald Health Network, Inc. (All HMO Business) 34167 NOCD ALL Y EMERALD HLTH HMO Y FALSE BOTH GEMI (Eye Management Inc) 65062 NOCD ALL T EYE MANAGEMENT IN Y FALSE BOTH GEmpire Physician's Medical Group EMP01 NOCD ALL Y EMPIRE PHYS MG Y FALSE BOTH GEmpire Plan (UnitedHealthcare) 87726 NOCD ALL Y EMPIRE PLAN Y FALSE BOTH # C

Employee Benefit Administration & Management (EBA&M) 95288 NOCD CA Y EMP BENE ADMIN MA N FALSE BOTH GEmployee Benefit Concepts 38241 NOCD ALL N EMP BENE CONCEPTS N FALSE BOTH GEmployee Benefit Consultants (To obtain the payer ID, please call (440) 262-1160.) CALL CALL ALL A CALL SUPPORT N FALSE BOTH GEmployee Benefit Consultants, Inc. (Call (440) 262-1160 for PayerID.) CALL CALL ALL Y CALL ENS SUPPORT Y FALSE BOTH GEmployee Benefit Management Corp. 31074 NOCD OH N EMP BENEFIT MGMT Y FALSE BOTH GEmployee Benefit Svcs (EBS) of San Antonio EBSSA NOCD TX Y EMP BENE SVCS SAN Y FALSE BOTH TEmployee Benefit System 42149 NOCD ALL Y EMPLOYEE BENE SYS N FALSE BOTH GEmployee Benefit Systems 37216 NOCD ALL Y EMPLOYEE BENEFIT N FALSE BOTH GEmployee Benefits Plan Administration, Inc. (EBPA) (Now known as CBA Blue.) 03036 NOCD ALL Y EBPA N FALSE BOTH GEmployee Logistics 92135 NOCD ALL N EMPLOYEE LOGIST N FALSE BOTH GEmployee Plans, LLC 35112 NOCD ALL Y EMPLOYEE PLAN Y FALSE BOTH GEmployees Mutual (EMC) 21415 NOCD ALL N EMPLOYEES MUTUAL N FALSE BOTH GEmployer Plan Services, Inc. 74212 NOCD ALL y EMP PLAN SERVICES N FALSE BOTH GEmployers Coalition On Health (ECOH) 27008 NOCD All Y EHOC EMPLOYERS N FALSE BOTH GEmployers Direct Health - Employee Plan 75236 NOCD ALL Y EMPLOYERS DIRECT Y FALSE BOTH GEmployers Direct Health - FI 75235 NOCD ALL N EMPLOYERS DIR FI Y FALSE BOTH GEmployers Direct Health - SF 75233 NOCD ALL N EMPLOYERS DIR SF Y FALSE BOTH GEmployers Health Cooperative (EHC) 27008 NOCD All Y EHC EMPLOYERS HEA N FALSE BOTH GEmployers Mutual, Inc. (Florida Providers only) 59298 NOCD FL Y EMPLOYERS MUTUAL Y FALSE BOTH GEncore Health Network (Note: Group Policy Number in HCFA Box 11 is required.) 35206 NOCD All N ENCORE HEALTH NET N FALSE BOTH GENH Medical Group IPA 36364 NOCD ALL Y ENH MED GROUP IPA N FALSE BOTH GEnstar Natural Gas - Grp# P61 91136 NOCD ALL Y ENSTAR GAS GRPP61 N FALSE BOTH GEntrust 36878 NOCD ALL Y ENTRUST N FALSE BOTH GEon Health 73780 NOCD ALL N EON HEALTH N FALSE BOTH GEPN - Seton Health Plan Exclusive (Provider ID required) EPNSH NOCD ALL N EPN SETON HEALTH N FALSE BOTH GEQUICOR 62308 NOCD All Y EQUICOR Y FALSE BOTH # CEQUICOR - PPO 62308 NOCD All Y EQUICOR-PPO Y FALSE BOTH # CErin Group Administrators (Now known as Significa Benefit Services, Inc.) 23250 NOCD ALL Y ERIN GROUP ADMIN Y FALSE BOTH GErisa Administrative Services Incorporated 74234 NOCD AZ N ERISA ADMIN SVCS N FALSE BOTH GErisa Administrative Services, Inc. 74234 NOCD All N ERISA ADMIN N FALSE BOTH GEssence Healthcare 57082 NOCD MO N ESSENCE HEALTHCAR N FALSE BOTH GEverence 35605 NOCD ALL N EVERENCE Y FALSE BOTH GEvergreen Health Cooperative (Please check the member ID Card for the correct Payer ID.) 93240 NOCD ALL Y EVERGREEN HLTH CO N FALSE BOTH GEvolutions Healthcare 59313 NOCD ALL Y EVOLUTIONS HEALTH Y FALSE BOTH GExceedent LLC 22344 NOCD ALL Y EXCEEDENT LLC Y FALSE BOTH GExceptional Care Medical IP080 NOCD CA N EXCEP CARE MEDICA Y FALSE BOTH GExclusive Care (ALL providers must contact Exclusive Care prior to submitting claims electronically. Please contact Martha Cuevas at 951-955-8853) EC999 NOCD ALL Y EXCLUSIVE CARE N FALSE BOTH GEye Specialists (Provider ID number required in Box33a or Box24J) BVES1 NOCD CO N EYE SPECIALISTS Y FALSE BOTH GEyeMed 31165 NOCD ALL Y EYEMED N TRUE BOTH NEyeQuest 63740 NOCD ALL Y EYEQUEST Y FALSE BOTH GFacey Medical Foundation 95432 NOCD ALL Y FACEY MED FOUNDAT Y FALSE BOTH GFACS Group 37300 NOCD ALL N FACS GROUP N FALSE BOTH GFalling Colors FCC20 NOCD ALL N FALLING COLORS Y BOTH GFallon (Transplant claims) FT254 NOCD ALL Y FALLON TRANSPLANT N FALSE BOTH TFallon Community Health 22254 NOCD ALL Y FALLON COMM HLTH Y FALSE BOTH GFamily Care - Milwaukee WI 60995 NOCD WI N FAMILY CARE WI Y FALSE BOTH GFamily Care CCO (Admin by PH Tech. Use for claims with DOS of 08/01/2012 and later.) PHD01 NOCD ALL Y FAMILY CARE CCO Y FALSE BOTH PFamily Care Medicaid (Admin by PH Tech) PHD01 NOCD ALL Y FAMCAR MC PHT Y FALSE BOTH PFamily Care Medicaid Mental Health FCM01 NOCD OR N FAM CARE MCAID ME Y FALSE BOTH PFamily Care Medicare (Admin by PH Tech) PHR01 NOCD ALL Y FAMCAR MC PHT Y FALSE BOTH PFamily Choice Medical IP080 NOCD CA N FAMILY CHOICE MED Y FALSE BOTH GFamily Health Alliance IP080 NOCD CA N FAM HLTH ALLIANCE Y FALSE BOTH GFamily Health Network 85468 NOCD ALL Y FAMILY HEALTH NET N FALSE BOTH GFamily Medical Network 36396 NOCD ALL Y FAMILY MEDICAL NE Y FALSE BOTH GFarm Family 14140 NOCD ALL Y FARM FAMILY N FALSE BOTH G


14 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerFCE Benefit Administrators 33033 NOCD ALL Y FCE BENE ADMINIST N FALSE BOTH GFederal Employee Program (Connecticut) C2BLS NOCD CT Y CT FED EMPLOYEE Y FALSE BOTH NFederated Mutual Insurance 41041 NOCD ALL Y FEDERATED MUTUAL Y FALSE BOTH GFidelis Care New York 11315 NOCD ALL N FIDELIS CARE NY Y FALSE BOTH G

Fire Department Cityof New York World Trade Center Health FDNYP NOCD NY Y FD NEW YORK WTC H N FALSE BOTH GFirst Agency 88055 NOCD ALL N FIRST AGENCY N FALSE BOTH GFirst Carolina Care 56196 NOCD ALL Y FIRST CAROLINA CA Y FALSE BOTH GFirst Choice Health Network 91131 NOCD WA,OR,ID,A Y FIRST CHOICE HEAL Y FALSE BOTH GFirst Choice Medical Group FCMG1 NOCD ALL N FIRST CHOICE MED Y FALSE BOTH GFirst Choice of Midwest (PPO) 75138 NOCD ALL Y FIRST CHOICE MIDW N FALSE BOTH GFirst Choice VIP Care Plus SC (First Choice VIP Care Plus is a Medicare Medicaid Plan (MMP), part of the AmeriHealth Caritas Family of Companies) 77009 NOCD ALL Y 1ST CHOICE VIP SC N FALSE BOTH GFirst Health Network 73159 NOCD ALL Y FIRST HEALTH NETW Y FALSE BOTH GFirst Seniority Freedom 87726 NOCD ALL Y FIRST SENIORITY F Y FALSE BOTH # CFirst Service Administrators 59276 NOCD FL Y FIRST SERVICE ADM N FALSE BOTH GFirst Solution FS802 NOCD ALL N FIRST SOLUTION N FALSE BOTH GFirstCare 94999 NOCD ALL N FIRSTCARE Y FALSE BOTH GFirstCare Star Medicaid 94998 NOCD ALL N FIRSTCARE MEDICAI Y FALSE BOTH GFitzharris & Company 11244 NOCD ALL N FITZHARRIS AND CO N FALSE BOTH GFL MCO PHC/PHP 95411 NOCD ALL Y FL MCO PHC PHP Y FALSE BOTH GFlorida 1st - Winterhaven, Florida 59276 NOCD FL Y FLORIDA 1ST N FALSE BOTH GFlorida Health Plan 59322 NOCD FL N FLORIDA HEALTH PL Y FALSE BOTH GFlorida Hospital VBR VB001 NOCD FL Y FL HOSPITAL VBR N FALSE BOTH GFlorida Hospital Waterman 48116 NOCD ALL Y FL HOSP WATERMAN Y FALSE BOTH GFMH Benefit Services 48117 NOCD ALL Y FMH BENEFIT Y FALSE BOTH GForest County Potawatomi Ins Dept 25059 NOCD ALL Y FOREST CO POTAWA N FALSE BOTH GFormax, Inc. 87066 NOCD ALL Y FORMAX INC N FALSE BOTH TFortis Self Funded Administrative Services 41124 MCSI ALL Y FORTIS SELF FUND N FALSE BOTH GFoundation Health of CA FH001 NOCD CA N FOUNDATION HLT CA Y FALSE BOTH GFoundation Health of Florida-Encounters FHFLE FLHL FL Y FL FOUNDATION ENC Y FALSE BOTH GFox Valley Medicine Site 199 FVMCH NOCD ALL Y FOX VALLEY ST 199 N FALSE BOTH GFox Valley Medicine Site 451 FVMC1 NOCD ALL N FOX VALLY MED 451 N FALSE BOTH GFox-Everett, Inc. 64069 NOCD ALL Y FOX EVERETT Y FALSE BOTH GFreedom Health Plan 41212 NOCD ALL T FREEDOM HEALTH PL N FALSE BOTH GFreedom Life Insurance Company 62324 NOCD ALL N FREEDOM LIFE INSU N FALSE BOTH GFreeman IPA IP080 NOCD CA N FREEMAN IPA Y FALSE BOTH GFresenius Medical Care TH118 NOCD TX Y FRESENIUS MEDICAL Y FALSE BOTH TFresenius Total Health 43197 NOCD ALL Y FRESENIUS TOTAL H Y FALSE BOTH GFresno PACE 99660 NOCD ALL Y FRESNO PACE N FALSE BOTH GFringe Benefit Coordinators 59204 NOCD ALL Y FRINGE BENE COORD N FALSE BOTH GFrontPath Health Coalition 34171 NOCD ALL Y FRONTPATH HEALTH Y FALSE BOTH GGateway Health Plan 25169 NOCD All N GATEWAY HEALTH PL N FALSE BOTH GGateway Health Plan of Ohio, Inc. 76028 NOCD OH Y GATEWAY HP OF OHI Y FALSE BOTH GGateway to Better Health 4317M NOCD ALL N GATEWAY TO BETTER Y TRUE BOTH GGBS Global Benefit CB951 NOCD ALL Y GBS GLOBAL BENEFI N FALSE BOTH GGBS Group Benefit Services 80241 NOCD ALL N GBS N BOTH GGEHA Group Health Nevada Medicaid GEHA9 NOCD NV N GEHA GH NV MEDICA N FALSE BOTH GGeisinger Health Plan 75273 NOCD PA Y GEISINGER HEALTH Y FALSE BOTH TGEMCare (Golden Empire Managed Care System) MCS01 NOCD ALL Y GEMCARE Y FALSE BOTH GGemcare Health Plan MCS03 NOCD ALL Y GEMCARE HLTH PLAN N FALSE BOTH GGenerations Health 46050 NOCD ALL N GENERATIONS HEALT Y FALSE BOTH GGenesis Health Care IP105 NOCD ALL N GENESIS HEALTHCAR N FALSE BOTH N

Georgia State Health Benefit Plan (Processed by GA BC/BS) GABLS BCBS GA Y GA ST HEALTH BENE Y FALSE BOTH NGettysburg Health (Including Core Value.) 23274 NOCD ALL Y GETTYSBURG HEALTH N FALSE BOTH GGHI HMO Select 25531 NOCD All Y GHI HMO SELECT Y FALSE BOTH GGHI Medicare Part B of New York GHMCR NOCD NY N GHI MEDICARE NY Y TRUE BOTH NGHP (Group Health Plan) 25141 NOCD ALL A GROUP HEALTH PLAN N FALSE BOTH GGI Innovative Management 58204 NOCD ALL Y GI INNOVATIVE MAN N FALSE BOTH GGilsbar, Inc 07205 NOCD ALL Y GILSBAR INC N FALSE BOTH G

Glassworkers and Glaziers Health and Welfare Fund Trust COMPU NOCD CO N GLASSWORKERS HBTF N FALSE BOTH GGlassworkers Health & Welfare Fund - Grp# F29 91136 NOCD ALL Y GLASSWORKERS F29 N FALSE BOTH GGlobal Care Inc 07689 NOCD ALL Y GLOBAL CARE INC N FALSE BOTH GGlobal Care Med Grp IPA MPM05 NOCD ALL N GLOBAL CARE MED G N FALSE BOTH NGlobal Excel Management GEM01 NOCD ALL N GLOBAL EXCEL MGMT Y FALSE BOTH GGlobal Health GHOKC NOCD ALL Y GLOBAL HEALTH Y FALSE BOTH GGMS, Inc. 47083 NOCD ALL A GMS INC N FALSE BOTH G


15 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerGold Coast 77160 NOCD ALL N GOLD COAST N FALSE BOTH GGolden Rule (UnitedHealthOne) 37602 NOCD All N GOLDEN RULE INS Y FALSE BOTH # CGolden Shore Medical Group (GSMG) NMM03 NOCD ALL N GSMG Y FALSE BOTH GGolden Triangle Physician Alliance GTPA1 NOCD ALL N GOLDEN TRIANGLE N FALSE BOTH TGood Samaritan Medical Practice Association (GSMPA) IP086 NOCD CA N GSMPA Y FALSE BOTH GGood Shepherd Hospice 76923 NOCD ALL Y GOOD SHEPHERD HOS Y FALSE BOTH GGovernment Employees Health Association,Inc. (GEHA) 44054 NOCD ALL Y GOVERNMENT EMPLOY Y FALSE BOTH # CGovernment Employees Health Association,Inc. (GEHA) 57254 NOCD ALL Y GEHA Y FALSE BOTH C

Great Lakes Health Plan (UnitedHealthcare Community Plan) 95467 NOCD ALL Y GREAT LAKES HEALT Y FALSE BOTH # CGreat Lakes PACE 39640 NOCD ALL Y GREAT LAKES PACE N FALSE BOTH GGreater Covina Medical Group GCMG1 NOCD CA N GREATER COVINA ME N FALSE BOTH GGreater L. A. Health IP080 NOCD CA N GREATER LA HEALTH Y FALSE BOTH GGreater Newport IPA GNPMG NOCD ALL Y GREATER NEWPORT I N FALSE BOTH GGreater Orange IPA NMM01 NOCD ALL Y GREATER ORANGE MG Y FALSE BOTH GGreater Oregon Behavioral Health GOBHI NOCD ALL Y GREATER OR BEHAV Y FALSE BOTH GGreater San Gabriel IP080 NOCD CA N GREATER SAN GABRI Y FALSE BOTH GGreater San Gabriel Valley Physicians IPA NMM01 NOCD ALL Y GR SAN GABRIEL VA Y FALSE BOTH GGreater Tricities IPA (Noble AMA Select) PDT01 NOCD ALL N GREATER TRICITIES N FALSE BOTH GGroup Administrators Ltd. 36338 NOCD ALL Y GROUP ADMINISTRAT Y FALSE BOTH GGroup Administrators Self-Funded Alternative GASA1 NOCD ALL Y GROUP ADMIN SFA N FALSE BOTH GGroup and Pension Administrators 48143 NOCD ALL Y GROUP PENSION ADM Y FALSE BOTH GGroup Health Cooperative of Eau Claire 95192 NOCD ALL N GH COOP EAU CLAIR N FALSE BOTH G

Group Health Cooperative of South Central Wisconsin Claims 39167 NOCD WI Y GHC SC WI CLAIMS Y FALSE BOTH GGroup Health Cooperative of South Central Wisconsin Encounters 39168 NOCD WI Y GHC SC WI ENCOUNT Y FALSE BOTH GGroup Health Incorporated (GHI) (New York) 13551 NOCD NY Y GHI NYC Y FALSE BOTH GGroup Health Insurance - DE 61101 NOCD DE R GROUP HEALTH DE Y FALSE BOTH GGroup Health Northwest (Old PayerID of 91121 is being retired. Now use payerID of 91051) 91051 NOCD ID,WA Y GROUP HEALTH NW N FALSE BOTH GGroup Health Options (Formerly KPS Health Plans) 91051 NOCD ALL N KPS HEALTH PLANS N FALSE BOTH GGroup Insurance Service Center, INC 37276 NOCD ALL N GROUP INS SVC CEN N FALSE BOTH GGroup Resources PHCS 28680 NOCD ALL Y GROUP RESOURCES P N FALSE BOTH GGuardian Life Insurance Company of America 64246 NOCD All Y GUARDIAN LIFE N FALSE BOTH GGulf South Risk Services 60652 NOCD ALL N GULF SO RISK SVCS Y FALSE BOTH GGulf Stream General Dynamics CB624 NOCD ALL N GULF STREAM GD N FALSE BOTH GGundersen Lutheran Health Plan 39180 NOCD ALL Y GUNDERSEN LUTH HP N FALSE BOTH GH.E.R.E.I.U. Welfare Pension Funds 37114 NOCD ALL N HEREIU WELFARE N FALSE BOTH GHAA Preferred Partners 65101 NOCD ALL N HAA PREFERRED PAR Y FALSE BOTH GHalcyon Behavioral Health HALCY NOCD ALL Y HALCYON BEHAVIORA Y FALSE BOTH GHamaspik Choice Inc. 47738 NOCD ALL Y HAMASPIK CHOICE N FALSE BOTH GHammerman & Gainer 97258 NOCD ALL Y HAMMERMAN GAINER N FALSE BOTH GHarbor Advantage 58305 NOCD ALL N HARBOR ADVANTAGE N FALSE BOTH GHarken Health 43313 NOCD ALL R HARKEN HEALTH Y FALSE BOTH # CHarmony Health Plan of Illinois (Wellcare Provider ID required, call (800) 960-2530 opt. 2 then 5) 36406 NOCD IL Y HARMONY HP OF IL Y FALSE BOTH GHarmony Health Plan of Indiana (Only claims for Indiana Hoosier Healthwise members can be sent to this payer electronically.) 36405 NOCD IN Y INDIANA HARMONY H Y FALSE BOTH GHarrington Health - Kansas ((Formerly known as Fiserv Health-Kansas) 62061 NOCD ALL Y HARRINGTON KS N FALSE BOTH GHarrington Health BPO 59143 NOCD ALL Y HARRINGTON HLTH B N FALSE BOTH GHarris Methodist Health Plan 87726 NOCD All Y HARRIS METHODIST Y FALSE BOTH # CHarvard Community Health Plan 04245 NOCD ALL Y HARVARD COMM HP N FALSE BOTH GHarvard Pilgrim 04271 NOCD ALL Y HARVARD PILGRIM Y FALSE BOTH NHarvard Pilgrim Passport Connect 87726 NOCD ALL Y HARVARD PILGRIM P Y FALSE BOTH # CHawaii Medical Assurance Association (HMAA) 48330 NOCD HI N HAWAII HMAA N FALSE BOTH GHawaii Western Management (HWMG) 99208 NOCD ALL Y HI WESTERN MGMT N FALSE BOTH GHawki (Provider ID Required) 86068 NOCD ALL Y HAWKI Y FALSE BOTH NHCC Life Insurance HCCMI NOCD ALL Y HCC LIFE INSURANC N FALSE BOTH GHCH Administration 37111 NOCD ALL Y HCH ADMINISTRATIO N FALSE BOTH GHCP Nevada 20501 NOCD ALL N HCP NEVADA Y FALSE BOTH GHCSC Insurance Services Company 84980 NOCD ALL Y HCSC INSURANCE SE Y FALSE BOTH GHDM Benefit Solutions HDMCO NOCD ALL N HDM BENE SOLUTION N FALSE BOTH GHDPC - Premier Healthcare 90023 NOCD ALL Y PREMIER HC HDPC Y FALSE BOTH GHealth Advantage of Arkansas ARBLS NOCD AR Y AR HEALTH ADVANTA Y TRUE BOTH NHealth Alliance Medical Plans of Illinois 77950 NOCD IL Y HLTH ALLIANCE PLA Y FALSE BOTH GHealth Alliance Plan of Michigan 38224 NOCD All Y HEALTH ALLIANCE P Y FALSE BOTH GHealth Care District of Palm Beach HCDPB NOCD ALL N HCD PALM BEACH N FALSE BOTH G


16 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerHealth Care Network of Wisconsin (HCN) 42102 NOCD ALL Y WI HEALTHCARE NET Y FALSE BOTH CHealth Care Partners - AZ (For Dates of Service of 5-01-13 and later.) HCP02 NOCD AZ N HLTHCARE PART AZ Y FALSE BOTH GHealth Choice Generations 62180 NOCD ALL Y HEALTH CHOICE GEN Y FALSE BOTH GHealth Choice Insurance 46221 NOCD ALL Y HEALTH CHOICE INS Y FALSE BOTH GHealth Choice Integrated Care (The Payer Id 22100 is valid only for DOS 10/01/2015 and after. Do not Submit claims with DOS prior to 10/1/2015) 22100 NOCD ALL Y HLTH CHOICE INTEG Y FALSE BOTH GHealth Choice of AZ 62179 NOCD AZ Y HEALTH CHOICE AZ Y FALSE BOTH GHealth Choice Utah 45399 NOCD UT Y HEALTH CHOICE UTA Y FALSE BOTH GHealth Claims Service 82018 NOCD ALL N HEALTH CLAIMS SVC N FALSE BOTH GHealth Cost Solutions 62111 NOCD ALL N HEALTH COST SOLUT Y FALSE BOTH GHealth Design Plus 34158 NOCD ALL N HEALTH DESIGN PLU N FALSE BOTH GHealth EZ 16120 NOCD All Y HEALTH EZ N FALSE BOTH GHealth First Health Plans 95019 NOCD ALL N HEALTH FIRST HLTH N FALSE BOTH GHealth First-Tyler, TX 75234 NOCD ALL Y HEALTH FIRST TX N FALSE BOTH GHealth Help Networks, Inc. 59087 NOCD All Y HEALTHHELP Y FALSE BOTH GHealth Information Plan (HIP) 43313 NOCD ALL R HARKEN HEALTH Y FALSE BOTH # C

Health Management Associates (HMA, servicing Southeastern and Southwestern Regions) (Provider ID Required) 86066 NOCD ALL Y HEALTH MGMT ASSOC Y FALSE BOTH NHealth Net (California Encounters Only.) 95567 NOCD CA Y CA HLTHNET ENC Y FALSE BOTH GHealth Net of Arizona AZHNT NOCD AZ Y HEALTHNET OF AZ N FALSE BOTH THealth Net of California (for claims with DOS prior to 12/31/17. For claims with DOS on or after 1/1/18, please use payer ID 68069 ) 95567 NOCD CA Y HEALTH NET Y FALSE BOTH GHealth Net Oregon 22340 NOCD OR Y HEALTH NET OREGON Y FALSE BOTH GHealth Network One 65062 NOCD ALL T HEALTH NETWORK ON Y FALSE BOTH GHealth New England 04286 NOCD ALL N HEALTH NEW ENGLAN N FALSE BOTH GHealth Options of Florida (Blue Shield HMO) FLHLT BCBS FL N FL HEALTH OPTIONS N FALSE BOTH NHealth Options of Florida (Blue Shield HMO) ENCOUNTERS ONLY!! FLENC BCBS FL N FL ENCOUNTERS HEA N TRUE BOTH NHealth Options of Illinois NAHOI NOCD IL Y HEALTH OPTIONS IL Y FALSE BOTH GHealth Partners - Jackson,TN 62157 NOCD TN Y HLTH PARTNERS TN Y FALSE BOTH GHealth Partners, PA 80142 NOCD PA Y HLTH PARTNERS PA Y FALSE BOTH GHealth Payment Systems 20270 NOCD ALL Y HEALTH PAYMENT SY Y FALSE BOTH G

Health Plan of Michigan (Now known as Meridian Health Plan) 83253 NOCD ALL Y HEALTH PLAN OF MI Y FALSE BOTH GHealth Plan of Nevada (Encounter claims) 76343 NOCD NV R HP OF NV ENCOUNTE Y FALSE BOTH CHealth Plan of Nevada (Encounter) 76342 NOCD NV R HP OF NV FFS Y FALSE BOTH # CHealth Plan of San Joaquin 68035 NOCD ALL N HLTH PLAN SAN JOA Y FALSE BOTH GHealth Plan of San Mateo HPSM1 NOCD CA Y HEALTH PLAN OF SA Y FALSE BOTH GHealth Plan Services, Tampa Office 59140 NOCD All N HEALTH PLAN TAMPA Y FALSE BOTH GHealth Plans Inc. 44273 NOCD ALL Y HEALTH PLANS INC Y FALSE BOTH GHealth Plus Physicians Organization 63363 NOCD ALL Y HEALTH PLUS PHY O N FALSE BOTH G

Health Select IPA (Enrollment required. Contact 866-703-1444.) M3IL1 NOCD ALL Y HEALTH SELECT IPA N FALSE BOTH GHealth Services for Children with Special Needs (HSCSN) 37290 NOCD ALL N HSCSN Y FALSE BOTH GHealth Services Management, Inc. (NOTE: ANSI submitters can also submit to plans AHP, CMS, ONP, PCI, PHP and VHP with proper value in SBR04.) HSM01 NOCD ALL Y HEALTH SVCS MGMT Y FALSE BOTH GHealth Services Management, Inc. for AHS HSM01 NOCD ALL Y HSM AHS Y FALSE BOTH GHealth Services Management, Inc. for BPA HSM01 NOCD ALL Y HSM BPA Y FALSE BOTH GHealth Services Management, Inc. for ECOH HSM01 NOCD ALL Y HSM ECOH Y FALSE BOTH GHealth Services Management, Inc. for EHC HSM01 NOCD ALL Y HSM EHC Y FALSE BOTH GHealth Services Management, Inc. for ENCR HSM01 NOCD ALL Y HSM ENCR Y FALSE BOTH GHealth Services Management, Inc. for FCM HSM01 NOCD ALL Y HSM FCM Y FALSE BOTH GHealth Services Management, Inc. for HF HSM01 NOCD ALL Y HSM HF Y FALSE BOTH GHealth Services Management, Inc. for HT HSM01 NOCD ALL Y HSM HT Y FALSE BOTH GHealth Services Management, Inc. for MMSI HSM01 NOCD ALL Y HSM MMSI Y FALSE BOTH GHealth Services Management, Inc. for MSHO HSM01 NOCD ALL Y HSM MSHO Y FALSE BOTH GHealth Services Management, Inc. for PNET HSM01 NOCD ALL Y HSM PNET Y FALSE BOTH GHealth Services Management, Inc. for PONE HSM01 NOCD ALL Y HSM PONE Y FALSE BOTH GHealth Services Management, Inc. for SC HSM01 NOCD ALL Y HSM SC Y FALSE BOTH GHealth Services Management, Inc. for WEA HSM01 NOCD ALL Y HSM WEA Y FALSE BOTH GHealth Services Mgmt/Magellen Health 41150 NOCD ALL Y HLTH SVCS MAGELLE N FALSE BOTH GHealth Span of Ohio (Payer has ceased operations using payerID 31434. claims should now be sent to Medical Mutual of Ohio, PayerID 29076_ 29076 NOCD OH Y HEALTH SPAN OH N FALSE BOTH GHealth Systems Inc 11889 NOCD ALL N HEALTH SYSTEMS Y FALSE BOTH G


17 of 41




CodeSet

(See Legend)

Payer Type


Healthteam Advantage 88250 NOCD ALL N HEALTHTEAM N FALSE BOTH GHealth Texas Medical Group HTHTX NOCD ALL N HEALTH TX MED GRP Y FALSE BOTH GHealth West / CHP (Enrollment required, please contact Provider Relations 801-352-7270) (NOTE that this payer accepts Chiropractic claims only.) U1439 NOCD UT N CHIROPRACTIC HP U Y TRUE BOTH NHealthcare Highways HCH01 NOCD ALL Y HEALTHCARE HWY Y FALSE BOTH GHealthcare LA, IPA MPM06 NOCD CA N HEALTHCARE LA IPA N FALSE BOTH NHealthcare Management Administrators, Inc. (also known as HMA, servicing Western Region) HMA01 NOCD WESTERN N HLTHCARE MGMT ADM N FALSE BOTH GHealthcare Partners HCP01 NOCD CA Y HEALTHCARE PARTNE Y FALSE BOTH NHealthCare Partners, IPA (Formerly Heritage New York Medical Group) 11328 NOCD All Y HCARE PARTNERS IP Y FALSE BOTH GHealthcare Resources NW 56731 NOCD ALL Y HLTHCARE RES NW Y FALSE BOTH GHealthCare Solutions Group 73147 NOCD ALL A HEALTHCARE SOL GR N FALSE BOTH GHealthcare USA 25133 NOCD ALL Y HEALTHCARE USA Y FALSE BOTH GHealthChoice Dept of Corrections & Rehab 71065 NOCD ALL Y HEALTH CHOICE UTA Y FALSE BOTH GHealthcomp 85729 NOCD ALL Y HEALTHCOMP N FALSE BOTH GHealthease 59608 NOCD FL Y HEALTHEASE N FALSE BOTH G

HealthEdge Administrators (PayerID valid for claims with a submission address of PO Box 11210, Bakersfield, CA 93389) 95213 NOCD ALL Y HEALTHEDGE ADMINS N FALSE BOTH GHealthEZ 41178 NOCD ALL Y HEALTHEZ Y FALSE BOTH GHealthfirst of Austin TPA 75289 NOCD ALL Y HEALTHFIRST AUSTI N FALSE BOTH GHealthfirst, Inc. (NY) 80141 NOCD NY Y HEALTHFIRST NY Y FALSE BOTH GHealthGram 56144 NOCD ALL Y PRIMARY PHYSICIAN N FALSE BOTH GHealthkeeper HMO VABLS BCBS VA Y HEALTHKEEPER HMO Y FALSE BOTH NHEALTHLINK HMO 96475 NOCD All Y HEALTHLINK HMO N FALSE BOTH GHEALTHLINK PPO 90001 NOCD All Y HEALTHLINK PPO Y FALSE BOTH GHealthnet of AZ 38309 NOCD AZ Y HEALTHNET OF AZ N FALSE BOTH GHealthnow BCBS New York Western SB801 NOCD NY N HEALTHNOW BCBS Y TRUE BOTH NHealthPartners of Minnesota 55764 NOCD ALL Y MN HEALTH PARTNER Y FALSE BOTH THealthplus Amerigroup 27514 NOCD ALL Y HEALTHPLUS AMERIG Y FALSE BOTH GHealthPlus of Louisiana (Old PayerID of 95009 is no longer valid) 07205 NOCD LA Y HEALTHPLUS OF LA N FALSE BOTH GHealthpoint Corporation 68195 NOCD All Y HEALTHPOINT CORP Y FALSE BOTH GHealthSCOPE Benefits, INC 71063 NOCD All Y HEALTHSCOPE BENEF N FALSE BOTH GHealthsmart Accel 75237 NOCD ALL Y HEALTHSMART ACCEL Y FALSE BOTH GHealthsmart Mgmt Services Org Inc A0067 NOCD ALL N HEALTHSMART MGMT N FALSE BOTH GHealthSmart Preferred Care 75250 NOCD ALL A HEALTHSMART PREF N FALSE BOTH GHealthsource \ Hudson Health Plan (Provider enrollment is required by the payer. Must call (914) 372-2291 to obtain payerID) CALL CALL ALL Y CALL ENS SUPPORT N FALSE BOTH T

Healthsource Arkansas - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID 71074 NOCD AR Y HEALTHSOURCE ARK Y FALSE BOTH T

Healthsource Kentucky - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID 61127 NOCD KY Y HEALTHSOURCE KY Y FALSE BOTH GHealthsource Maine - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID 01041 NOCD ME Y HEALTHSOURCE ME Y FALSE BOTH GHealthsource New Hampshire - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID 02038 NOCD NH Y HEALTHSOURCE NH Y FALSE BOTH GHealthsource North Carolina - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID 56147 NOCD NC Y HEALTHSOURCE NC Y FALSE BOTH T

Healthsource North Texas - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID 75255 NOCD TX Y HEALTHSOURCE NTEX Y FALSE BOTH THealthsource Provident Ins. Co. 68195 NOCD All Y HEALTHSOURCE PROV Y FALSE BOTH GHealthsource, AR (Med) (CIGNA) 71075 NOCD AR Y HEALTHSOURCE AR M Y FALSE BOTH GHealthsource, GA (CIGNA) 58210 NOCD GA Y HEALTHSOURCE GA Y FALSE BOTH GHealthsource, Mass 02041 NOCD MA Y HEALTHSOURCE MASS Y FALSE BOTH GHealthsource, OH 31141 NOCD OH Y HEALTHSOURCE OH Y FALSE BOTH GHealthsource, TN (CIGNA) 62129 NOCD TN Y HEALTHSOURCE TN Y FALSE BOTH GHealthSpan Integrated Care (Only accepting claims with DOS up to 1-31-2017) RH007 NOCD ALL Y HEALTHSPAN N FALSE BOTH GHealthspan, aka Kaiser of Ohio NG007 NOCD OH Y KAISER HP OF OHIO Y FALSE BOTH THealthSpring HT001 NOCD ALL N HEALTHSPRING Y FALSE BOTH G


18 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerHealthSpring HMO/HealthSpring Medicare+Choice 63092 NOCD ALL N HEALTHSPRING HMO Y FALSE BOTH GHealthSun HESUN NOCD ALL N HEALTHSUN N FALSE BOTH GHealthways WholeHealth Networks 58213 NOCD ALL N HEALTHWAYS WH NET N FALSE BOTH GHealthy CT 77180 NOCD CT N HEALTHY CT N FALSE BOTH GHealthy Texas 68064 NOCD TX Y HEALTHY TEXAS Y FALSE BOTH GHealthy York Network (Call Jane Grove at Provider Relations for Healthy York Network (717) 851-6715) 22251 NOCD ALL N HEALTHY YORK NETW Y FALSE BOTH GHelix Family Choice 00243 NOCD MD Y HELIS FAMILY CHOI Y FALSE BOTH GHemet Community Medical Group (Providers need to contact 951-791-1111 prior to submitting claims) HCMG1 NOCD ALL N HEMET COMM MED GR Y FALSE BOTH NHennepin Health / Northstar Advantage 60058 NOCD ALL Y HENNEPIN HEALTH N FALSE BOTH GHeritage Consultants (Must use 9-digit subscriber ID on all claims) 59230 NOCD ALL Y HERITAGE CONSULTA Y FALSE BOTH GHeritage IPA HER01 NOCD ALL N HERITAGE IPA N FALSE BOTH GHFN, Inc. 36335 NOCD ALL N HFNIN Y FALSE BOTH GHigh Desert Medical Group (Lancaster, California) HDMDG NOCD CA N HIGH DESERT MED G N FALSE BOTH GHigh Desert Primary Care STJOE NOCD ALL N HIGH DESERT PRIM Y FALSE BOTH GHighline Medical Services MOLINA 91164 NOCD ALL Y HIGHLINE MOLINA N FALSE BOTH GHighmark BCBSD Health Options. 47181 NOCD ALL Y HIGHMARK BCBSDHOP Y FALSE BOTH GHighmark Senior Health Company (PA Blue Shield Medicare Plan) 15460 NOCD PA Y HIGHMARK SHC PA Y TRUE BOTH NHighmark Senior Solutions Company (WV Blue Shield Medicare Plan) 15459 NOCD WV Y HIGHMARK SSC WV Y TRUE BOTH NHill Physicians Blue Shield PPO HLPBS NOCD ALL Y HILL PHYS BLS PPO Y FALSE BOTH GHill Physicians Health Net PPO HLPHN NOCD ALL N HILL PHYS N FALSE BOTH GHill Physicians Medical Group HIL01 NOCD ALL Y HILL PHYSICIANS N FALSE BOTH GHill Physicians United Healthcare PPO HLPUH NOCD ALL Y HILL PHYS PPO Y FALSE BOTH GHIP-Health Insurance Plan of Greater NY 55247 MCSI NY Y HIP HEALTH INS NY Y FALSE BOTH GHispanic Physicians IPA HPFFS NOCD ALL N HISPANIC PHYS IPA N FALSE BOTH GHMA (servicing HI, AZ and NV) (Provider ID is required and is 1-6 numeric characters in length. ) 86066 NOCD LISTED Y HMA N FALSE BOTH NHMC Healthworks aka Health Management Co. 75318 NOCD ALL N HMC HEALTHWORKS N FALSE BOTH GHMO Louisiana Blue Advantage 84555 NOCD LA N HMO LA BLUE ADVAN N FALSE BOTH GHockenberg's Equipment (UCS) 59573 NOCD ALL Y HOCKENBERS EQUIP N FALSE BOTJ GHollywood Presbyterian IP080 NOCD CA N HOLLYWOOD PRESBYT Y FALSE BOTH GHoly Cross Health Partners NAHLX NOCD IL Y HOLY CROSS HLTH P Y FALSE BOTH GHome State Health Plan 68069 NOCD LA Y HOME STATE HP Y FALSE BOTH GHomeland Security (ATTN: Deportation) VAICE NOCD ALL N HOMELAND SECURITY N FALSE BOTH GHomelink 50701 NOCD ALL Y HOMELINK N FALSE BOTH GHomelink 30750 NOCD ALL N HOMELINK Y BOTH GHomelink Healthpartners 55744 NOCD ALL N HOMELINK PARTNERS Y BOTH GHometown Health Plan Nevada 88023 NOCD NV Y HOMETOWN HP OF NV Y FALSE BOTH GHometown Health Plan of Ohio (Now known as The Health Plan) 30757 NOCD OH A HOMETOWN HP OF OH N FALSE BOTH GHopkins Health Advantage 66003 NOCD ALL Y HOPKINS HLTH ADVA N FALSE BOTH GHorace Mann Life Insurance HMLIC NOCD ALL Y HORACE MANN LIFE N FALSE BOTH GHorizon Blue Cross Blue Shield of New Jersey 22099 NOCD NJ R HORIZON BCBS NJ Y TRUE BOTH NHotel Employees & Restaurant Employees Health Trust - Grp#F19 91136 NOCD All Y HOTEL EMP GRPF19 N FALSE BOTH G

HP Administrative Services LLC (For dates of service on or after 01/01/2018 use payer ID 71064. This payer ID should only be used for dates of service prior to 01/01/2018.) 22521 NOCD ALL Y HP ADMIN N FALSE BOTH GHPMS (Send claims to payerID listed on patient's insurance card.) CARD NOCD MI Y CALL INGENIX S&S N FALSE BOTH GHSBS Memphis (Formerly Pittman and Associates) 37224 NOCD ALL Y PITTMAN AND ASSOC Y FALSE BOTH GHSBS Oklahoma Cityi (Formerly Mutual Assurance Administrators) 37256 NOCD ALL N MUTUAL ASSURANCE N FALSE BOTH GHSHS Medical Group IPA 37137 NOCD ALL Y HSHS MED GROUP IP Y FALSE BOTH GHuman Behavioral Institute HBI01 NOCD ALL N HUMAN BEHAVIORAL N FALSE BOTH GHumana Puerto Rico L0200 NOCD PR N HUMANA PR N FALSE BOTH GHUMANA, Claims only 61101 NOCD ALL R HUMANA CLAIMS Y FALSE BOTH GHUMANA, Encounters Only 61102 NOCD All R HUMANA ENCOUNTERS N FALSE BOTH GHuntington Park Medical Group IP080 NOCD CA N HUNTINGTON PK MED Y FALSE BOTH GHuntington Park Mission IP080 NOCD CA N HUNTINGTON PK MIS Y FALSE BOTH GHylton Payroll (Benefit Plan Administrators) 19753 NOCD ALL Y HYLTON PAYROLL BP N FALSE BOTH GI. E. Shaffer 22175 NOCD ALL N IE SHAFFER N FALSE BOTH GIBA Self Funded Group 38234 NOCD ALL N IBA SELFFUNDED GP Y FALSE BOTH G

IBEW Local 640 & Arizona Chapter NECA Health & Welfare Trust 74234 NOCD AZ N IBEW 640 AZ NECA N FALSE BOTH G


19 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerIBEW Western Utilities or Local 57 74234 NOCD UT N IBEW WESTERN UTIL N FALSE BOTH GIBG Administrators, LLC 81810 NOCD ALL N IBG ADMINISTRATOR N FALSE BOTH GIBI 41124 NOCD All Y IBI N FALSE BOTH GiCARE (Independent Care Health Plan) 11695 NOCD WI T ICARE Y FALSE BOTH GICARE Health Options TPA 26054 NOCD ALL N ICARE HEALTH OPTI Y FALSE BOTH GiCircle of New Yok 33884 NOCD ALL Y ICIRCLE NEW YORK Y FALSE BOTH GICON Benefit Administrators 75185 NOCD ALL Y ICON BENEFIT ADMI N FALSE BOTH GIdaho True Blue TRUEB BCBS ID Y TRUE BLUE N TRUE BOTH NIllinicare Behavioral Health 68068 NOCD ALL Y ILLINICARE BH Y FALSE BOTH GIllinicare Group Health 68069 NOCD ALL Y ILLINICARE GRP Y FALSE BOTH GIllinois Health Plan (IHP) DMG01 NOCD ALL N IL HEALTH PLAN N FALSE BOTH GIllinois Health Solutions ( ProviderID Required) 86069 NOCD IL Y IL HEALTH SOLUTIO Y FALSE BOTH NIMA of Louisiana Inc. 72091 NOCD ALL N INS MGMT ADMINIST N FALSE BOTH GImagine Health 43123 NOCD ALL Y IMAGINE HEALTH N FALSE BOTH GIMCARE 41600 NOCD ALL N IMCARE Y FALSE BOTH GINDECS Corporation 40585 NOCD ALL Y INDECS CORPORATIO Y FALSE BOTH GIndependence Administrators TA720 NOCD ALL Y INDEPENDENCE ADMI Y TRUE BOTH NIndependence Medical Group MHM01 NOCD ALL Y INDEPENDENCE MEDI Y FALSE BOTH GIndependence Medical Group of Kern County IMG01 NOCD CA Y INDEPEND MG KERN N FALSE BOTH GIndependence Medical Group Tulare County IMG02 NOCD ALL N INDEP MED GP TULA Y FALSE BOTH GIndependent BLC of PA (Also known as Personal Choice PPO of Pennsylvania.) 54704 NOCD PA N PA PERSONAL CHOIC Y TRUE BOTH NIndependent Health SX073 NOCD ALL N INDEP HEALTH NJ N TRUE BOTH GIndependent Living Systems 45048 NOCD ALL Y INDEP LIVING SYS Y FALSE BOTH GIndian Health Services 00290 NOCD ALL N INDIAN HEALTH SER N FALSE BOTH GIndiana Department of Health Children's Health 35600 NOCD IN N IN DEPT HLTH CHIL Y TRUE BOTH NIndiana ProHealth Network 35161 NOCD IN Y INDIANA PROHEALTH N FALSE BOTH GIndiana Teamsters Health Benefits Fund (Formerly known as Local 135 Health Benefits Fund) 35107 NOCD IN N INDIANA TEAMSTERS N FALSE BOTH GIndiana University IUHPL NOCD ALL N IN UNIVERSITY SE N FALSE BOTH GIndustrial Machine Specialties COMPU NOCD CO N IND MACHINE SPECS N FALSE BOTH GINETICO, Inc. 43471 NOCD ALL N INETICO INC Y FALSE BOTH GInformed UHC Compass Rose 50946 NOCD ALL Y INFORMED UHC ROSE N FALSE BOTH GInforMed, LLC 52196 NOCD ALL N INFORMED LLC N FALSE BOTH GIngalls Provider Group 85578 NOCD ALL Y INGALLS PROV GROU N FALSE BOTH GIngham Health Plan Corp. 38343 NOCD ALL Y INGHAM HP CORP N FALSE BOTH GInland Empire Health Plan IEHP1 NOCD ALL A INLAND EMPIRE HP N FALSE BOTH GInland Faculty Medical Group (Call Chirs Gonzales at (323) 257-7637 *277 to ensure you are approved to submit electronically. Payer ID required ) MVMM1 NOCD ALL N INLAND FAC MED GR N TRUE BOTH NInnovante Benefit Admin/ (HSBS WTC) (Effective 3-1-17) 31172 NOCD ALL N INNOVANTE BENEFIT N FALSE BOTH GInnovation Health 40025 NOCD ALL N INNOVATION HEALTH N FALSE BOTH GInnovative Physician Associates 80087 NOCD ALL A INNOVATIVE PHYSIC N FALSE BOTH GInnovista Health INDPM NOCD ALL Y INNOVISTA HEALTH Y FALSE BOTH GINS Health Services VAICE NOCD ALL N INS HEALTH SERVIC N FALSE BOTH GInsurance Administrator of America 37279 NOCD ALL N INS ADMIN OF AMER N FALSE BOTH GInsurance Design Administrators 13315 NOCD ALL A INS DESIGN ADMINI Y FALSE BOTH GImmigration Services VAICE NOCD ALL N INSURANCE HLTH SE N BOTH GInsurance Management Administrators 72091 NOCD ALL N INS MGMT ADMINIST N FALSE BOTH GInsurance Management Services of Texas IMSMS NOCD TX Y INS MGMT SVCS TX N FALSE BOTH GInsurance Management Services, (Amarillo TX)(This payerID is only valid for claims submission address of PO Box 15688 Amarillo, TX 79105) 15688 NOCD ALL N INSURMGMTSVCS TX N FALSE BOTH GInsurance Service of Lubbock ISL11 NOCD All Y INS SERVICE LUBBO N FALSE BOTH GInsurer's Administration Corporation IAC01 NOCD ALL N INSURERS ADM CORP N FALSE BOTH GInsurers Administrative Corp. (Please visit website prior to submitting claims: edihelp.iacusa.com) 86304 NOCD ALL Y INSURERS ADMIN CO N FALSE BOTH GINTEGRA Administrative Group, Inc. 51020 NOCD ALL N INTEGRA ADMIN GRO N FALSE BOTH GIntegra Group - CHA 31129 NOCD ALL N INTEGRA GRP CHA Y FALSE BOTH GIntegra Group (Also known as Rehab Provider Network, but not the same as Colorado payer of same name.) 31127 NOCD ALL A INTEGRA GROUP RPN Y FALSE BOTH GIntegra Managed Long Term Care 45302 NOCD ALL N INTEGRA MGD LONG Y FALSE BOTH GIntegrated Medical Solutions 20050 NOCD ALL Y INTEGRATED MED SO N FALSE BOTH GIntegrated Mental Health Services 68068 NOCD ALL Y INTEGRATED MENTAL Y FALSE BOTH GIntegrity Administrators (Champion Chevrolet) 99795 NOCD ALL N INTEGRITY ADMIN N FALSE BOTH GInteractive Medical Systems 56132 NOCD ALL Y INTERACTIVE MED S N FALSE BOTH GIntercommunity Health Net INCHN NOCD ALL N INTERCOMM HLTH NE Y FALSE BOTH GInterface EAP 60280 NOCD ALL Y INTERFACE EAP N FALSE BOTH GIntergroup Services Corporation 23287 NOCD ALL N INTERGROUP SVCS Y FALSE BOTH G


20 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerIntermountain Health Care (Contact payer at 801-442-5442 before sending claims to verify provider numbers.) SX107 NOCD UT Y INTERMOUNTAIN HEA Y TRUE BOTH NIntermountain Ironworkers Trust Fund 74234 NOCD AZ,ID,UT N INTRMTN IRONWORKS N FALSE BOTH GInternational Benefit Administration 11329 NOCD ALL Y INTL BENE ADMINIS Y FALSE BOTH GInternational Brotherhood of Boilermakers Employee Health Care Plan (IBBEHC) 48603 NOCD ALL Y IBBEHC Y FALSE BOTH GInternational Funding Inc. 39182 NOCD ALL Y INTL FUNDING INC Y FALSE BOTH GInternational Medical Group, INC IMGIN NOCD ALL N INT MEDICAL GROUP N FALSE BOTH GInternational Union Operating Engineers 37269 NOCD ALL N INT UNION OP ENGI N FALSE BOTH GInterWest Health PPO (Montana) 84137 NOCD MT Y INTERWEST HPPO MT Y FALSE BOTH GINTotal Health 35115 NOCD ALL Y INTOTAL HEALTH N FALSE BOTH GIowa Benefits, Inc. 41124 NOCD IA Y IOWA BENEFITS N FALSE BOTH GIowa Health Solutions (Provider ID Required) 86068 NOCD IA Y IOWA HEALTH SOLUT Y FALSE BOTH NIU Health Transplant Evaluation Program 47262 NOCD ALL Y IU HLTH TRANS Y FALSE BOTH GIU Medical Group Primary Care SX172 NOCD ALL Y IU MEDICAL GROUP Y FALSE BOTH GJackson Care Connect JCC01 NOCD ALL Y JACKSON CARE CONN Y FALSE BOTH GJAI Medical Systems JAI01 NOCD ALL N JAI MEDICAL SYSTE N FALSE BOTH GJohn Hopkins Healthcare (EHP/PP) (Submit Billing NPI and Rendering/Servicing NPI) 52189 NOCD ALL N JOHN HOPKINS HC Y FALSE BOTH GJohn Morrell Company - AHPBA 38310 NOCD ALL Y J MORRELL CO AHPB Y FALSE BOTH GJohn Muir Health Network JMH01 NOCD CA N JOHN MUIR HLTH NE Y FALSE BOTH GJohn Muir Mt. Diablo Health System 68036 NOCD ALL Y JOHN MUIR MT DBLO Y FALSE BOTH GJohn Muir Trauma Physicians (Please call 925-947-5288 for Payer ID information.) CALL CALL ALL Y CALL ENS S&S Y FALSE BOTH GJohns Hopkins (USFHP) (New submitter should send in their Billing NPI & Rendering servicing NPI) 52123 NOCD ALL Y JOHNS HOPKINS N FALSE BOTH GJoplin Claims 43178 NOCD ALL Y JOPLIN CLAIMS Y FALSE BOTH GJP Farley Corporation 34136 NOCD ALL Y JP FARLEY CORP N FALSE BOTH GJPS Preferred Care MWP01 NOCD ALL N JPS PREFERRED CAR N FALSE BOTH NJSL Administrators AKA Wells Fargo Third Party Administrators aka Healthsmart Benefits Solutions 37272 NOCD ALL N JSL ADMINISTRATOR Y FALSE BOTH GKaiser Foundation Health Plan of Colorado COKSR NOCD CO R CO KAISER PERMANE N FALSE BOTH CKaiser Foundation Health Plan of Georgia NG010 NOCD GA Y KAISER FOUND GA Y FALSE BOTH CKaiser Foundation Health Plan of Northern CA Region 94135 NOCD CA Y KAISER NORTH CA N FALSE BOTH GKaiser Foundation Health Plan of Northern California KS003 NOCD CA N N CA KAISER PERMA N FALSE BOTH GKaiser Foundation Health Plan of Southern CA Region 94134 NOCD CA Y KAISER FOUND S CA Y FALSE BOTH TKaiser Foundation Health Plan of Southern California KS001 NOCD CA N SCA KAISER PERMAN Y FALSE BOTH GKaiser Foundation Health Plan of the Mid-Atlantic NG008 NOCD ALL Y KAISER MID ATLANT Y FALSE BOTH GKaiser Foundation Health Plan of the NW NG009 NOCD OR,WA Y KAISER NW REGION Y FALSE BOTH CKaiser Foundation Health Plan of Washington (Formerly Group Health Cooperative of WA) 91051 NOCD WA Y GROUP HEALTH COOP Y FALSE BOTH GKaiser Foundation Health Plan PPO 94320 NOCD ALL Y KAISER PPO Y FALSE BOTH GKaiser Foundation of the Northwest 93079 NOCD ALL Y KAISER FOUND NW N FALSE BOTH GKaiser Permanente Hawaii RH011 NOCD HI Y KAISER PERM HAWAI N FALSE BOTH GKalos Health 40137 NOCD ALL Y KALOS HEALTH N FALSE BOTH GKeenan & Associates KEE01 NOCD CA N KEENAN AND ASSOCI Y FALSE BOTH GKelsey Seybold KELSE NOCD ALL N KELSEY SEYBOLD N FALSE BOTH GKemper Benefits 61453 NOCD ALL N KEMPER BENEFITS Y FALSE BOTH GKempton Group 73100 NOCD ALL N KEMPTON GROUP N FALSE BOTH GKent County Health Plan KENT1 NOCD MI N KENT COUNTY HP Y FALSE BOTH GKentucky Health Administrators, Inc. 27215 NOCD ALL N KY HEALTH ADMIN Y FALSE BOTH GKentucky Spirit Health Plan 68069 NOCD KY Y KENTUCKY SPIRIT H Y FALSE BOTH GKern County CDCR 28021 NOCD ALL A KERN COUNTY CDCR N FALSE BOTH GKern Health Care Network (Valid for dates of service prior to 01-01-2016.) 22149 NOCD ALL Y KERN HC NETWORK N FALSE BOTH GKern Health Systems 77039 NOCD ALL N KERN HEALTH SYSTE Y FALSE BOTH GKern Legacy Health Plan 89890 NOCD ALL Y KERN LEGACY HP Y FALSE BOTH GKey Benefit Administrators 37217 NOCD ALL Y KEY BENEFIT ADMIN N FALSE BOTH GKey Health Medical Solutions 95460 NOCD ALL Y KEY HEALTH MED SO N FALSE BOTH GKey Medical Group (Providers please contact Brandi Guinn @ 559-735-3892 x233 for authorization.) IP082 NOCD CA N KEY MEDICAL GROUP Y FALSE BOTH NKey Select 37321 NOCD ALL Y KEY SELECT Y FALSE BOTH GKey Solution 37323 NOCD ALL Y KEY SOLUTION Y FALSE BOTH GKeycare PPO VABLS BCBS VA Y KEYCARE PPO Y FALSE BOTH NKeystone Mercy Health Plan 23284 NOCD All Y KEYSTONE MERCY Y FALSE BOTH GKeystone VIP Choice (formerly payer ID 84223) 77741 NOCD ALL N KEYSTONE VIP CHOI Y FALSE BOTH GKlais and Company 31147 NOCD ALL Y KLAIS AND COMPANY N FALSE BOTH GKlais and Company 34145 NOCD ALL Y KLAIS AND COMPANY N FALSE BOTH GKlais and Company Repriced HealthSpan 3414A NOCD ALL T KLAIS CO REPRICED N FALSE BOTH GKova Healthcare Incorporated KOVA1 NOCD ALL Y KOVA HEALTH Y FALSE BOTH G


21 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerKPIC - Kaiser Permanente (Valid in the states of CA,CO, DC, GA, HI, MD, OH and OR) KPIC1 NOCD LISTED N KPIC KAISER PERM N FALSE BOTH GLA Care Health Plan LACAR NOCD ALL Y LA CARE HEALTH PL Y FALSE BOTH GLa Salle Medical Associates IPA NMM01 NOCD ALL Y LA SALLE MED ASSO Y FALSE BOTH GLACH HealthNet by MedPoint MPM19 NOCD ALL Y LACH HEALTHNET Y FALSE BOTH GLake Region Community Health Plan SISCO NOCD ALL N SISCO N FALSE BOTH GLakeside Medical Group 66125 NOCD ALL A LAKESIDE MEDICAL N FALSE BOTH GLakeside Medical Group Inc. LMG11 NOCD ALL N LAKESIDE MEDICAL N FALSE BOTH GLancaster General Health Group - Preferred Health Care (Contact Sherry Wolgemuth at (717) 560-9290 ext. 124 for approval and the Payer ID.) CALL CALL ALL N CALL SUPPORT Y FALSE BOTH TLandmark Healthcare Inc. LNDMK NOCD ALL Y LANDMARK Y FALSE BOTH PLas Vegas Fire Fighters Local No 1285 Security Fund NWADM NOCD CA N LV FIRE LOC 1285 Y FALSE BOTH GLaSalle Medical Associates NMM02 NOCD CA N LASALLE MED ASSOC N FALSE BOTH GLawndale Christian Health Center 36333 NOCD ALL Y LAWNDALE CHRISTIA Y FALSE BOTH GLBA HealthPlans 52193 NOCD ALL N LBA HEALTHPLANS N FALSE BOTH GLeisure World Managed Care LWMC1 NOCD ALL Y LEISURE WORLD MGD N FALSE BOTH GLeon Medical Center Health Plan 37316 NOCD ALL Y LEON MEDCENTER HP Y FALSE BOTH GLiberty Health Advantage 11328 NOCD ALL Y LIBERTY HLTH ADVA Y FALSE BOTH GLife & Health Ins Co of America (NFL Plan only) 98205 NOCD ALL N LIFE HLTH INS CO N FALSE BOTH GLife Beaver County 25924 NOCD ALL Y LIFE BEAVER COUNT N FALSE BOTH GLife Investors Ins Co of America (Specialized claims only. Call 866-745-3545 with claim routing questions.) LIICA NOCD ALL N LIFE INVESTORS AM N FALSE BOTH GLife St. Joseph of the Pines 59847 NOCD ALL Y LIFE ST JOSEPH PI N FALSE BOTH GLife Trac 41136 NOCD ALL N LIFE TRAC Y FALSE BOTH GLifeCircles PACE 71498 NOCD ALL Y LIFECIRCLES PACE N FALSE BOTH GLifePath Hospice Inc. 76870 NOCD ALL N LIFEPATH HOSPICE Y FALSE BOTH GLifetime Benefits Solutions EBSRM NOCD ALL N LIFETIME BENEFITS N FALSE BOTH GLifewise A Premier Health Plan 93093 NOCD OR Y LIFEWISE Y FALSE BOTH NLifewise Health Plan of Oregon A Premier Health Plan 93093 NOCD OR Y OR LIFEWISE HP Y FALSE BOTH N

Lifewise Health Plan of Washington A Premier Health Plan 91049 NOCD WA Y WA LIFEWISE HP Y FALSE BOTH NLinn County 75283 NOCD ALL Y LINN COUNTY Y FALSE BOTH NLipa/Agate Resources LIPA1 NOCD ALL N LIPA AGATE RESOUR N FALSE BOTH GLittle Company of Mary Health 4725P NOCD ALL Y LITTLE CO OF MARY N FALSE BOTH GLocal 137 Operating Engineers Welfare Fund 84041 NOCD ALL N LOC 137 OPER ENGI Y FALSE BOTH GLocal Choice VABLS BCBS VA Y LOCAL CHOICE Y FALSE BOTH NLockard & Williams CB752 NOCD ALL Y LOCKARD AND WILLI N FALSE BOTH GLoma Linda University Adventist 37267 NOCD ALL N LOMA LINDA UN ADV N FALSE BOTH GLoma Linda University Health Care 33036 NOCD ALL Y LOMA LINDA UNIV H N FALSE BOTH GLone Star TPA 45289 NOCD ALL Y LONE STAR TPA Y FALSE BOTH GLong Beach Memorial IPA (MHCLB) MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE BOTH GLouisiana Healthcare Connections 68069 NOCD LA Y LA HLTHCARE CONNE Y FALSE BOTH GLovelace Sandia Health Plan (Acquired by Blue Shield of New Mexico) NMBLS NOCD NM Y LOVELACE SANDIA Y FALSE BOTH NLutheran Preferred 39198 NOCD ALL Y LUTHERAN PREFERRE N FALSE BOTH NMabuhay Medical Group CAPMN NOCD ALL N MABUHAY MED GRP N FALSE BOTH GMacNeal Health Providers - CHS (Contact 708-783-7100 prior to first submission.) 36334 NOCD ALL N MACNEAL HEALTH PR N FALSE BOTH G

Magellan Behavioral Health (All Non-AETNA Subscribers - Provider ID Required) (Payer Address required on all claims.) 01260 NOCD ALL N MAGELLAN BEHAVIOR Y FALSE BOTH G

Magellan Behavioral Health (For Dates of Service 1/1/2006 and After - Provider ID Required - AETNA Subscribers only.) 60054 NOCD ALL Y MAGELLAN BHAVIOR N FALSE BOTH CMagellan Complete Care FL 01260 NOCD ALL N MAGELLAN COMPLETE N FALSE BOTH GMagellan Complete Care Of VA MCCVA NOCD VA N VA MAGELLAN N FALSE BOTH GMagnolia Mississippi 68069 NOCD ALL Y MAGNOLIA MS Y FALSE BOTH G

MAHP (MD IPA, Optimum Choice and MLH) UnitedHealthcare 87726 NOCD MD Y MAMP Y FALSE BOTH # CMaine Community Health Options 45341 NOCD ALL N ME COMMUNITY H OP Y FALSE BOTH GMaksin Management Corporation (Now known as AIG Educational Markets) 22195 NOCD ALL Y MAKSIN MGMT CORP Y FALSE BOTH G

Managed Care Administrators / CHP (Enrollment required, please contact Provider Relations 801-352-7270) (NOTE that this payer accepts Chiropractic claims only. U1439 NOCD UT N CHIROPRACTIC HP U Y TRUE BOTH NManaged Care Services, LLC 35162 NOCD ALL Y MANAGED CARE SERV Y FALSE BOTH GManaged Care Systems (Delango Regional Medical) MCS02 NOCD ALL N DELANGO REGIONAL Y FALSE BOTH G


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CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerManaged Care Systems CDCR (Customer Service: (800) 494-4662) MCS04 NOCD CA N MGD CARE SYS CDCR Y FALSE BOTH GManaged Health Care Admin EPS MHCA1 NOCD ALL Y MGD HLTH CARE EPS N TRUE BOTH GManaged Health Care Administration EPS MHCA1 NOCD ALL Y MNGD HC ADMIN EPS Y FALSE BOTH GManaged Health Care Associates 36312 NOCD ALL Y MANAGED HEALTH N FALSE BOTH GManaged Health Networks (MHN) 22771 NOCD ALL N MANAGED HEALTH NE Y FALSE BOTH GManaged Health Services Indiana 68069 NOCD IN Y IN MGD HEALTH SVC Y FALSE BOTH GManaged Health Services of Wisconsin (Please contact the payer @ 800-225-2573, ext 25525 to get setup to submit electronic claims.) 68069 NOCD WI Y MANAGEDHLTHSVCSWI Y FALSE BOTH GMapfre Life Commercial 46012 NOCD ALL Y MAPFRE LIFE COMME N FALSE BOTH GMarch Vision Health Plan 5246M NOCD ALL N MARCH VISION HP N FALSE BOTH GMarin IPA IP097 NOCD CA N MARIN IPA Y FALSE BOTH GMarrick Medical Finance, LLC 20805 NOCD ALL N MARRICK MED FINAN Y FALSE BOTH GMarrick WRx 46478 NOCD ALL N MARRICK WRX N FALSE BOTH G

Martin's Point Health Care USFHP/Generations Advantage MPHC2 NOCD ALL Y MARTINS PT HC N FALSE BOTH GMaryland Physicians Care 22348 NOCD ALL N MD PHYSICIANS CAR Y FALSE BOTH G

Maryland PMHS ValueOptions (Use for ALL Dates of Service) 77063 NOCD MD N MARYLAND PMHS VO Y TRUE BOTH NMashantucket Pequot Tribal Nation 37121 NOCD ALL Y MASHANTUCKET PEQU N FALSE BOTH GMass Health (MA Medicaid) MAMCD NOCD MA Y MASS HEALTH Y TRUE BOTH NMassachusetts Mutual also known as Mass Mutual 80314 NOCD All Y MASSACHUSETTS MUT Y FALSE BOTH PMasters, Mates and Pilots Plan MMPHB NOCD ALL N MASTERS MATES PIL N FALSE BOTH GMax Specialty Benefits 27320 NOCD ALL N MAX SPECIALTY BEN N FALSE BOTH GMaxCare (Universal Fidelity Administrators Company) 93220 NOCD ALL Y MAXCARE N FALSE BOTH GMaxor 92805 NOCD ALL Y MAXOR N FALSE BOTH GMayo Clinic FL/GA 88090 NOCD ALL Y MAYO CLINIC FL GA N FALSE BOTH GMayo Management Services, Inc. 41154 NOCD ALL N MAYO MANAGEMENT Y FALSE BOTH GMBA Benefit Administrators 83028 NOCD ALL Y MBA BENEFIT ADMIN N FALSE BOTH GMBA of Wyoming 87065 NOCD WY,UT Y CDO TECHNOLOGIES N FALSE BOTH GMcare of Michigan (Payer no longer accepting electronic claims. Claim will be printed and mailed to payer.) 38264 NOCD MI Y MCARE Y FALSE BOTH G

MCC Behavioral Care (We will also accept PID SX071 for these claims: use of either ID accomplishes the same routing.) MCCBV NOCD All Y MCC BEHAVIORAL Y TRUE BOTH CMcCreary Corporation 59331 NOCD FL Y MCCREARY CORP Y FALSE BOTH GMcGregor Pace 31149 NOCD ALL Y MCGREGOR PACE N FALSE BOTH GMcLaren Health Advantage 3833A NOCD ALL Y MCLAREN HLTH ADVA Y FALSE BOTH CMcLaren Health Plan 38338 NOCD ALL Y MCLAREN Y FALSE BOTH CMcLaren Medicaid 3833C NOCD ALL Y MCLAREN MEDICAID Y FALSE BOTH CMcLaren Medicare Supplement 3833S NOCD ALL Y MCLAREN MEDICARE Y FALSE BOTH CMcLarenAdvantage SNP 3833R NOCD ALL Y MCLAREN ADV SNP Y FALSE BOTH CMCS 6197P NOCD PR Y MCS N FALSE BOTH NMCS Life 66039 NOCD ALL Y MCS LIFE N FALSE BOTH GMD CARE HEALTH PLAN MDC01 NOCD ALL N MD CARE HP N FALSE BOTH GMD Rogue Oregon Health Plan MRIPA NOCD ALL N MD ROGUE OR HP N FALSE BOTH GMD-Individual Practice Association, Inc. (M.D. IPA) (Previously Payer ID 52148) 87726 NOCD All Y MD INDIVIDUAL PRA Y FALSE BOTH # CMDwise Exchange Market (For DOS on or after 1-01-2017) 45627 NOCD ALL Y MDWISE EXCHANGE M N FALSE BOTH G

MDwise Health Indiana Plan (For DOS on or after 1-01-2017) 31354 NOCD ALL Y MDWISE HEALTHY IN N FALSE BOTH G

MDwise Hoosier Care Connect (For DOS on or after 1-01-2017) 91313 NOCD ALL Y MDWISE HOOSIER CA N FALSE BOTH G

MDwise Hoosier Healthwise (For DOS on or after 1-01-2017) 35191 NOCD ALL Y MDWISE HOOSIER HE N FALSE BOTH GMDWise Select Health Network 35199 NOCD ALL N MDWISE SELECT HN N FALSE BOTH GMDX Hawaii MDXHI NOCD HI Y MDX HAWAII Y FALSE BOTH P

Med Pay (For claims repriced by Premier Health Care Exchange) 88058 NOCD ALL A MED PAY Y FALSE BOTH GMed3000 CMS Early Steps EM350 NOCD ALL N MED3000 CMS EARLY N FALSE BOTH GMed3000 CMS Safety Net EM284 NOCD ALL N MED3000 CMS SAFET N FALSE BOTH GMed3000 CMS Title 19 Reform EM843 NOCD ALL N MED3000 CMS T19 R N FALSE BOTH GMed3000 CMS Title 21 EM205 NOCD ALL N MED3000 CMS TTL21 N FALSE BOTH GMed3000 HealthSpring EM216 NOCD ALL N MED3000 HLTHSPRIN N FALSE BOTH GMed3000 Pedicare Title 19 (Now send claims to EM843) EM843 NOCD ALL N MED3000 PEDCARE19 N FALSE BOTH GMed3000 Pedicare Title 21 (Now send claims to EM205) EM205 NOCD ALL N MED3000 PEDCARE21 N FALSE BOTH GMedAdmin Sol Inc 58204 NOCD ALL Y MEDADMIN SOL INC N FALSE BOTH GMedCom 59231 NOCD ALL N MEDCOM N FALSE BOTH GMedCost 56162 NOCD All N MEDCOST Y FALSE BOTH G


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CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerMedCost / Liberty Health Share 90753 NOCD ALL Y LIBERTY HEALTH SH N FALSE BOTH TMedCost Benefit Services 56205 NOCD ALL Y MEDCOST BENEFIT Y FALSE BOTH GMedfocus 95321 NOCD ALL N MEDFOCUS Y FALSE BOTH GMEDICA 94265 NOCD ALL Y MEDICA Y FALSE BOTH # CMedica HealthCare Plans / FL 78857 NOCD FL Y MEDICA HCARE PLAN Y FALSE BOTH CMedica2 12422 NOCD ALL Y MEDICA2 Y FALSE BOTH GMedicaid of Delaware DEMCD NOCD DE N DE MEDICAID Y TRUE BOTH TMedicaid - TX Premier Plan (Please contact Provider Relations at (915)-532-3778 x1507 to enroll.) EPF02 NOCD TX Y TX PREMIER MEDICA N TRUE BOTH GMedicaid of Alabama ALMCD NOCD AL Y AL MEDICAID Y FALSE BOTH NMedicaid of Alaska AKMCD NOCD AK N AK MEDICAID Y TRUE BOTH NMedicaid of Arizona (AHCCCS) AZMCD NOCD AZ Y AZ MEDICAID Y FALSE BOTH NMedicaid of Arkansas ARMCD NOCD AR Y AR MEDICAID Y FALSE BOTH NMedicaid of Colorado COMCD BCBS CO Y CO MEDICAID Y TRUE BOTH NMedicaid of Connecticut CTMCD NOCD CT Y CT MEDICAID Y TRUE BOTH NMedicaid of Florida FLMCD UNIS FL N FL MEDICAID Y TRUE BOTH NMedicaid of GA GAMCD NOCD GA N GA MEDICAID Y FALSE BOTH NMedicaid of Idaho IDMCD NOCD ID R ID MEDICAID Y FALSE BOTH NMedicaid of Illinois ILMCD NOCD IL Y IL MEDICAID Y FALSE BOTH NMedicaid of Indiana INMCD NOCD IN N IN MEDICAID Y FALSE BOTH NMedicaid of Iowa IAMCD CONS IA N IA MEDICAID Y TRUE BOTH NMedicaid of Kansas KSMCD BCBS KS N KS MEDICAID Y FALSE BOTH NMedicaid of Kentucky KYMCD NOCD KY Y KY MEDICAID Y TRUE BOTH NMedicaid of Louisiana (Includes KidMed claims.) LAMCD NOCD LA Y LA MEDICAID Y TRUE BOTH NMedicaid of Maine MEMCD NOCD ME N ME MEDICAID N TRUE BOTH NMedicaid of Maryland MDMCD NOCD MD N MD MEDICAID Y TRUE BOTH NMedicaid of Massachusetts MAMCD NOCD MA Y MA MEDICAID Y TRUE BOTH NMedicaid of Michigan MIMCD NOCD MI Y MI MEDICAID Y TRUE BOTH NMedicaid of Minnesota MNMCD NOCD MN N MN MEDICAID Y TRUE BOTH NMedicaid of Mississippi MSMCD NOCD MS Y MS MEDICAID N TRUE BOTH NMedicaid of Missouri MOMCD NOCD MO Y MO MEDICAID Y FALSE BOTH NMedicaid of Montana MTMCD CONS MT N MT MEDICAID Y FALSE BOTH NMedicaid of Nebraska NEMCD NOCD NE Y NE MEDICAID N TRUE BOTH NMedicaid of Nevada NVMCD NOCD NV N NV MEDICAID Y TRUE BOTH NMedicaid of New Hampshire NHMCD NOCD NH N NH MEDICAID N TRUE BOTH NMedicaid of New Jersey NJMCD NOCD NJ Y NJ MEDICAID Y TRUE BOTH NMedicaid of New Mexico NMMCD NOCD NM Y NM MEDICAID N FALSE BOTH NMedicaid of New York NYMCD NOCD NY Y NY MEDICAID Y TRUE BOTH NMedicaid of North Carolina NCMCD NOCD NC N NC MEDICAID Y TRUE BOTH NMedicaid of North Dakota NDMCD NOCD ND N ND MEDICAID Y TRUE BOTH NMedicaid of Ohio OHMCD NOCD OH Y OH MEDICAID Y FALSE BOTH NMedicaid of Oklahoma OKMCD NOCD OK N OK MEDICAID Y FALSE BOTH NMedicaid of Oregon ORMCD NOCD OR N OR MEDICAID N TRUE BOTH NMedicaid of Pennsylvania PAMCD NOCD PA Y PA MEDICAID Y FALSE BOTH NMedicaid of Rhode Island RIMCD NOCD RI N RI MEDICAID Y TRUE BOTH NMedicaid of South Carolina SCMCD NOCD SC Y SC MEDICAID Y TRUE BOTH NMedicaid of South Dakota SDMCD NOCD SD N SD MEDICAID Y TRUE BOTH NMedicaid of Tennessee (TennCare) TNMCD NOCD TN Y TN MEDICAID Y TRUE BOTH NMedicaid of Texas TXMCD NOCD TX Y TX MEDICAID Y FALSE BOTH GMedicaid of Utah UTMCD NOCD UT Y UT MEDICAID Y TRUE BOTH NMedicaid of Vermont VTMCD NOCD VT N VT MEDICAID Y TRUE BOTH NMedicaid of Virginia VAMCD NOCD VA N VA MEDICAID Y FALSE BOTH NMedicaid of Washington DC DCMCD NOCD DC Y DC MEDICAID Y TRUE BOTH NMedicaid of Washington State WAMCD NOCD WA Y WA MEDICAID Y TRUE BOTH NMedicaid of West Virginia WVMCD NOCD WV Y WV MEDICAID Y FALSE BOTH NMedicaid of Wisconsin WIMCD EDS WI N WI MEDICAID Y FALSE BOTH NMedicaid of Wyoming WYMCD NOCD WY N WY MEDICAID Y TRUE BOTH NMedical Associates Health Plan MAHP1 NOCD ALL Y MED ASSOC HLTH PL N FALSE BOTH GMedical Benefit Administration, Inc. 68041 NOCD ALL Y MEDICAL BENEFIT A Y FALSE BOTH GMedical Benefits Mutual 74323 NOCD ALL Y MEDICAL BENEFITS Y FALSE BOTH GMedi-Cal by MedPoint MPM18 NOCD ALL N MEDPOINT MEDICAL N FALSE BOTH GMedical Mutual of Ohio (Payer requires a 12 digit rendering provider ID#, which needs to be obtained from payer by calling 800-321-7223) 29076 NOCD OH Y MEDICAL MUTUAL OH Y FALSE BOTH GMediCal of California MDCAL NOCD CA N CA MEDICAL Y TRUE BOTH NMedical Orange Coast Memorial IPA MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE BOTH GMedical Reimbursements of America 62177 NOCD ALL Y MED REIMBURSE AME Y FALSE BOTH GMedical Resource Network (MRN, INC) 58203 NOCD ALL Y MEDICAL RESOURCE Y FALSE BOTH GMedical Services Initiative 12057 NOCD ALL Y MEDICAL SVCS INIT Y FALSE BOTH GMedical Value Plan - Ohio (MVP) 38224 NOCD OH Y MEDICAL VALUE PLA Y FALSE BOTH G


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CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerMedicare Blue Advantage of South Carolina SCBLS NOCD SC Y SC BLUE SHIELD Y FALSE BOTH NMedicare DME MAC Jurisdiction C 18003 NOCD ALL Y MEDICARE DME MAC N TRUE BOTH NMedicare of Missouri (Includes both Eastern and Western Missouri.) KCMCR NOCD KS,MS Y KC MEDICARE Y TRUE BOTH NMedicare Part B GHI GHMCR NOCD NY N GHI MEDICARE NY Y TRUE BOTH NMedicare Part B of Alabama ALMCR NOCD AL Y AL MEDICARE Y TRUE BOTH NMedicare Part B of Alaska AKMCR NOCD AK N AK MEDICARE Y TRUE BOTH NMedicare Part B of American Samoa HIMCR NOCD AM Samoa Y HI MEDICARE Y TRUE BOTH NMedicare Part B of Arizona AZMCR NOCD AZ Y AZ MEDICARE Y TRUE BOTH NMedicare Part B of Arkansas ARMCR NOCD AR Y AR MEDICARE Y TRUE BOTH NMedicare Part B of Colorado COMCR BCBS CO Y CO MEDICARE Y TRUE BOTH NMedicare Part B of Connecticut CTMCR NOCD CT Y CT MEDICARE Y TRUE BOTH NMedicare Part B of DC 00903 NOCD DC R DC MEDICARE Y TRUE BOTH NMedicare Part B of Delaware 00902 NOCD DE R DE MEDICARE Y TRUE BOTH NMedicare Part B of Florida FLMCR BCBS FL Y FL MEDICARE Y TRUE BOTH NMedicare Part B of Georgia GAMCR AETN GA Y GA MEDICARE Y TRUE BOTH NMedicare Part B of Guam HIMCR NOCD Guam Y HI MEDICARE Y TRUE BOTH NMedicare Part B of Hawaii HIMCR BCBS HI Y HI MEDICARE Y TRUE BOTH NMedicare Part B of Idaho IDMCR NOCD ID Y ID MEDICARE Y TRUE BOTH NMedicare Part B of Illinois ILMCR BCBS IL Y IL MEDICARE Y TRUE BOTH NMedicare Part B of Indiana INMCR NOCD IN N IN MEDICARE Y TRUE BOTH NMedicare Part B of Iowa IAMCR BCBS IA Y IA MEDICARE Y TRUE BOTH NMedicare Part B of Kansas KSMCR BCBS KS Y KS MEDICARE Y TRUE BOTH NMedicare Part B of Kentucky KYMCR NOCD KY Y KY MEDICARE Y TRUE BOTH NMedicare Part B of Louisiana LAMCR BCBS LA Y LA MEDICARE Y TRUE BOTH NMedicare Part B of Maine MEMCR NOCD ME Y ME MEDICARE Y TRUE BOTH NMedicare Part B of Maryland 00901 NOCD MD R MD MEDICARE Y TRUE BOTH NMedicare Part B of Massachusetts MAMCR NOCD MA Y MA MEDICARE Y TRUE BOTH NMedicare Part B of Michigan MIMCR NOCD MI Y MI MEDICARE Y TRUE BOTH NMedicare Part B of Minnesota MNMCR NOCD MN Y MN MEDICARE Y TRUE BOTH NMedicare Part B of Mississippi MSMCR NOCD MS Y MS MEDICARE Y TRUE BOTH NMedicare Part B of Missouri (Eastern) (Specialty testing required) MOMCR NOCD MO N MO MEDICARE EAST Y TRUE BOTH NMedicare Part B of Montana MTMCR NOCD MT Y MT MEDICARE Y TRUE BOTH NMedicare Part B of Nebraska NEMCR BCBS NE Y NE MEDICARE Y TRUE BOTH NMedicare Part B of Nevada NVMCR NOCD NV N NV MEDICARE Y TRUE BOTH NMedicare Part B of New Hampshire NHMCR NOCD NH Y NH MEDICARE Y TRUE BOTH NMedicare Part B of New Mexico NMMCR NOCD NM Y NM MEDICARE Y TRUE BOTH NMedicare Part B of New York (Empire) NYMCR NOCD NY Y NY MEDICARE Y TRUE BOTH NMedicare Part B of NJ (Specialty testing required) NJMCR NOCD NJ Y NJ MEDICARE Y TRUE BOTH NMedicare Part B of North Carolina NCMCR NOCD NC Y NC MEDICARE Y TRUE BOTH NMedicare Part B of North Dakota NDMCR NOCD ND N ND MEDICARE Y TRUE BOTH NMedicare Part B of Northern California CNMCR NOCD CA Y CA MEDICARE NORTH Y TRUE BOTH NMedicare Part B of Northern Mariana Islands HIMCR NOCD CNMI Y HI MEDICARE Y TRUE BOTH NMedicare Part B of Northern Virginia (inc. Prince George, Montgomery, Fairfax and Arlington Counties and City of Alexandria) 00903 NOCD VA N VA NORTH MEDICARE Y TRUE BOTH NMedicare Part B of Ohio OHMCR NOCD OH Y OH MEDICARE Y TRUE BOTH NMedicare Part B of Oklahoma OKMCR NOCD OK Y OK MEDICARE Y TRUE BOTH NMedicare Part B of Oregon ORMCR NOCD OR Y OR MEDICARE Y TRUE BOTH NMedicare Part B of Pennsylvania PAMCR NOCD PA Y PA MEDICARE Y TRUE BOTH NMedicare Part B of Rhode Island RIMCR NOCD RI Y RI MEDICARE Y TRUE BOTH NMedicare Part B of South Carolina SCMCR NOCD SC Y SC MEDICARE Y TRUE BOTH NMedicare Part B of South Dakota SDMCR NOCD SD N SD MEDICARE Y TRUE BOTH NMedicare Part B of Southern California CSMCR NOCD CA Y CA MEDICARE SOUTH Y TRUE BOTH NMedicare Part B of Tennessee TNMCR NOCD TN Y TN MEDICARE Y TRUE BOTH NMedicare Part B of Texas TXMCR NOCD TX Y TX MEDICARE Y TRUE BOTH NMedicare Part B of Upstate NY N1MCR NOCD NY Y UPSTATE NY MEDICA Y TRUE BOTH NMedicare Part B of Utah UTMCR NOCD UT Y UT MEDICARE Y TRUE BOTH NMedicare Part B of Vermont VTMCR NOCD VT Y VT MEDICARE Y TRUE BOTH NMedicare Part B of Virginia VAMCR NOCD VA Y VA MEDICARE Y TRUE BOTH NMedicare Part B of Washington WAMCR NOCD WA N WA MEDICARE Y TRUE BOTH NMedicare Part B of West Virginia WVMCR NOCD WV Y WV MEDICARE B Y TRUE BOTH NMedicare Part B of Western Missouri MWMCR NOCD MS Y W MO MEDICARE Y TRUE BOTH NMedicare Part B of Wisconsin WIMCR WPS WI Y WI MEDICARE Y TRUE BOTH NMedicare Part B of Wyoming WYMCR BCBS WY Y WY MEDICARE Y TRUE BOTH NMedicare Railroad (MetraHealth Medicare) RRWMC TRAV All N RRW MEDICARE Y TRUE BOTH NMedicare Supplemental VABLS BCBS VA Y VA MEDICARE SUPPL Y FALSE BOTH NMedico Insurance Company 23160 NOCD ALL N MEDICO INS COMPAN N FALSE BOTH GMEDIGOLD 95655 NOCD ALL N MEDIGOLD N FALSE BOTH G


25 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerMediture 20039 NOCD ALL Y MEDITURE N FALSE BOTH GMediture IPA AMM11 NOCD ALL Y MEDITURE IPA N FALSE BOTH GMediview Vista 360 Health V360H NOCD ALL N MEDIVIEW VISTA N FALSE BOTH GMedova Healthcare 27005 NOCD ALL N MEDOVA HEALTHCARE N FALSE BOTH GMedPartners (PHCS Repricing) (PO Box 10240 Fort Wayne, In 46857) 441MP NOCD ALL Y MEDPARTNERS PHCS N FALSE BOTH GMedPartners Admin Services 412MP NOCD ALL N MEDPARTNERS ADMIN N FALSE BOTH GMed-Pay 00130 NOCD MO, IL Y MEDPAY N FALSE BOTH GMedSolutions, Inc. 62160 NOCD ALL Y MEDSOLUTIONS Y FALSE BOTH GMedStar Family Choice 39190 NOCD ALL N MEDSTAR FAM CHOIC N FALSE BOTH GMedstar Physician Partners 00243 NOCD MD Y MEDSTAR PHYS PART Y FALSE BOTH GMedstar Select 251MS NOCD ALL N MEDSTAR SEL N FALSE BOTH GMemorial Clinical Associates MCA11 NOCD ALL N MEM CLINICAL ASSO N FALSE BOTH TMemorial Healthcare IPA MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE BOTH GMemorial Hermann Health Network MHHNP NOCD ALL N MEM HERMANN HLTH N FALSE BOTH GMemorial Integrated Healthcare 59064 NOCD All N MEMORIAL INTEGRA Y FALSE BOTH GMemorialCare Medical Foundation MMFMC NOCD ALL N MEMORIALCARE MED N FALSE BOTH GMendicina Familiar Medical Group IP080 NOCD CA N MEDICINA FAMILIAR Y FALSE BOTH GMennonite Mutual (Now known as Everence) 35605 NOCD ALL N MENNONITE MUTUAL Y FALSE BOTH GMental Health Network (Only claims for PO Box 209010 Austin TX 78720) 74289 NOCD ALL Y MENTAL HEALTH NET Y FALSE BOTH GMercy Health Plan (AHCCCS) 86052 NOCD AZ Y MERCY HP AHCCCS Y FALSE BOTH GMercy Health Plan of AZ 86052 NOCD AZ Y MERCY HP AZ Y FALSE BOTH GMercy Health Plan of New Jersey (Provider ID Required in Box33a - Contact (800) 682-9091 to obtain ID) 22326 NOCD All Y MERCY HLTH PL NJ Y FALSE BOTH GMercy LIFE of Alabama 63002 NOCD ALL Y MERCY LIFE OF AL N FALSE BOTH GMercy Maricopa Integrated Care 33628 NOCD ALL Y MERCY MARICOPA IC N FALSE BOTH GMercy Provider Network 43185 NOCD ALL Y MERCY PROV NETWOR N FALSE BOTH GMercyCare of WI. (Call 608-758-7739 for PayerID.) CALL NOCD ALL N Call INGENIX supp N FALSE BOTH CMeridian Health Plan 13189 NOCD ALL Y MERIDIAN HEALTH P Y FALSE BOTH GMeritain Health (North American Health Plan.) 64157 NOCD ALL Y MERITAIN HLTH NAH N FALSE BOTH GMeritain Health / Agency Services 64158 NOCD ALL Y MERITAIN HEALTH Y FALSE BOTH NMeritain Health Minneapolis 41124 NOCD ALL Y MERITAIN MN N FALSE BOTH GMetro Plus Health Plan 13265 NOCD ALL A METRO PLUS HEALTH Y FALSE BOTH GMetropolitan Health Plan 10850 NOCD ALL Y METRO HEALTH PLAN Y FALSE BOTH GMiami Behavioral Health 92579 NOCD ALL Y MIAMI BEHAVIORAL N FALSE BOTH GMichigan Blue Care HMO (BCN of Michigan) MIBCN NOCD MI N MI BLUE CARE Y TRUE BOTH # NMichigan Medicare PlusBlue MIMPB NOCD MI Y MI MEDICARE PLUSB Y TRUE BOTH # NMicron Tech 96598 NOCD ALL Y MICRON TECH Y FALSE BOTH GMid-America Associates 37281 NOCD ALL N MIDAMERICA ASSOC N FALSE BOTH GMid-American Benefits 22823 NOCD ALL N MID AMER BENEFITS Y FALSE BOTH GMidland Management/MFC 23550 NOCD ALL Y MIDLAND MGMT MFC Y FALSE BOTH GMidland National Life Ins Co (NFIC Plan only) 90956 NOCD ALL N MIDLAND NAT LIFE N FALSE BOTH GMidlands Choice 47080 NOCD NE,IA Y MIDLANDS CHOICE Y FALSE BOTH TMidlands Health Partners 47080 NOCD ALL Y MIDLANDS HEALTH Y FALSE BOTH TMid-West Behavioral Health Network MVBCN NOCD ALL Y MW BEHAV HLTH NET N FALSE BOTH GMidwest Group Benefits 61146 NOCD ALL Y MIDWEST GROUP BEN N FALSE BOTH GMidwest Health Partners 76079 NOCD ALL N MIDWEST HLTH PART N FALSE BOTH GMidwest Health Plans, INC. MHP77 NOCD ALL N MIDWEST HLTH PLAN Y FALSE BOTH GMidwest Physician Administrative Services TH088 NOCD ALL Y MW PHYS ADMIN SVC N FALSE BOTH GMinuteman Health 01776 NOCD MA N MINUTEMAN HEALTH N FALSE BOTH NMission Community IPA Med Grp MPM07 NOCD CA N MISSION COMM IPA N FALSE BOTH NMission HospitalAffiliates STJOE NOCD CA Y MISSION HOSPITAL Y FALSE BOTH GMississippi Health Partners 64068 NOCD ALL Y MS HEALTH PARTNER Y FALSE BOTH GMississippi Physicians Care Network 64084 NOCD ALL Y MS PHYS CARE NETW Y FALSE BOTH G

Mississippi Select Healthcare (Mississippi Select Health Care) 64088 NOCD All Y MS SELECT HEALTHC N FALSE BOTH GMissoula County Medical Benefits 37275 NOCD MT N MISSOULA COUNTY M N FALSE BOTH GML Healthcare 26097 NOCD ALL N ML HEALTHCARE N FALSE BOTH GMMM - Medicare y mucho Mas 88600 NOCD PR N MEDICARE Y MUCHO N FALSE BOTH NMolina Healcare of New Mexico - SCI 04423 NOCD ALL Y MOLINA HC NM SCI Y FALSE BOTH GMolina Health Care of South Carolina 46299 NOCD ALL N MOLINA HC SC Y FALSE BOTH GMolina Healthcare of CA - Encounters only. 33373 NOCD CA Y MOLINA HC CA ENC N FALSE BOTH GMolina Healthcare of California (Rendering provider must use Medi-Cal ID number or State License Number. Billing provider should use Federal TaxID only.) 38333 NOCD CA Y MOLINA HC OF CALI Y FALSE BOTH GMolina Healthcare of Florida 51062 NOCD ALL Y MOLINA HC OF FLOR Y FALSE BOTH GMolina Healthcare of Illinois 20934 NOCD ALL Y MOLINA HC OF IL Y FALSE BOTH GMolina Healthcare of Michigan 38334 NOCD MI Y MOLINA HC OF MICH Y FALSE BOTH GMolina Healthcare of New Mexico NM505 NOCD NM Y MOLINA HC OF NEW Y FALSE BOTH G


26 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerMolina Healthcare of New Mexico Salud 09824 NOCD NM N MOLINA HC NM SALU Y FALSE BOTH GMolina Healthcare of Ohio 20149 NOCD OH Y MOLINA HC OF OHIO Y FALSE BOTH GMolina Healthcare of Texas 20554 NOCD TX Y MOLINA HC OF TEX Y FALSE BOTH GMolina Healthcare of Washington (Rendering providers use DSHS Medicaid ID or State Licence Number.) 38336 NOCD WA Y MOLINA HC OF WASH Y FALSE BOTH GMolina Healthcare of Washington ENCOUNTERS ONLY 43174 NOCD ALL N MOLINA HC WA ENC N FALSE BOTH GMolina Healthcare Utah SX109 NOCD UT Y MOLINA HCARE UT Y FALSE BOTH NMonarch Healthcare IPA (Rendering provider ID# required on all claims.) IP095 NOCD ALL N MONARCH HEALTH IP N FALSE BOTH NMonitor Life (Payer accepts secondary claims only, and Medicare cannot be primary payer.) 01759 NOCD ALL Y MONITOR LIFE Y FALSE BOTH GMontefiore Contract Management Organization (Provider ID required, call 914-377-4400 for ID prior to first claims submissions.) 13174 NOCD ALL A MONTEFIORE CONTRA Y FALSE BOTH GMontefiore HMO 46161 NOCD ALL N MONTEFIORE HMO Y FALSE BOTH GMonterey Bay IPA MBIPA NOCD ALL Y MONTEREY BAY IPA N FALSE BOTH GMonumental Life Ins Co. MMLIC NOCD ALL N MONUMENTAL LIFE N FALSE BOTH NMorris Associates aka HealthScope Benefits 35092 NOCD ALL Y MORRIS ASSOCIATES Y FALSE BOTH GMosaic IPA Medical Group (Providers please contact Brandi Guinn @ 559-735-3892 x233 for authorization.) IP083 NOCD CA N MOSAIC IPA MEDICA Y FALSE BOTH NMotion Picture Industry Health Plan (These claims now processed by Anthem BC of CA) MPI01 NOCD CA Y MOTIONPIXINDUS N FALSE BOTH GMountain States Administrators (COLORADO ONLY) MTNST NOCD CO N MOUNTAIN STATES Y FALSE BOTH GMPE Employee Benefit Services 37233 NOCD ALL N EMP EMPLOYEE BENE N FALSE BOTH GMPLAN Inc. Healthcare Group 95444 NOCD ALL A MPLAN INC HEALTH Y FALSE BOTH GMPM Prospect MPM16 NOCD ALL N MPM PROSPECT Y FALSE BOTH GMRIPA Allcare CCO (Medicaid Payer) 26161 NOCD ALL Y MRIPA ALLCARE CCO N FALSE BOTH GMS BCBS State Employees SB731 NOCD MS Y MS BCBS SE N FALSE BOTH NMt. Carmel 95655 NOCD ALL N MOUNT CARMEL N FALSE BOTH GMultiplan Wisconsin Preferred Provider Network 34080 NOCD ALL Y WI MULTIPLAN PPN Y FALSE BOTH CMultnomah County MLTOT NOCD ALL Y MULTNOMAH COUNTY N FALSE BOTH GMunicipal Health Benefits Fund 81883 NOCD ALL N MUNI HEALTH BENEF N FALSE BOTH GMuskegon Care A1681 NOCD MI N MUSKEGON CARE Y FALSE BOTH GMutual Benefit 39065 NOCD All Y MUTUAL BENEFIT N FALSE BOTH GMutual Benefit Life 39065 NOCD All Y MUTUAL BENEFIT LI N FALSE BOTH G

Mutual Health Services (fka Antares Management Solutions) 34192 NOCD ALL Y ANTERES MGMT SOLN Y FALSE BOTH GMutual of Omaha Insurance Company 71412 NOCD All N MUTUAL OF OMAHA Y FALSE BOTH # PMutual of Omaha Insurance Company 71412 NOCD All N MUTUAL OF OMAHA I N FALSE BOTH # PMutually Preferred 71412 NOCD All N MUTUALLY PREFERRE N FALSE BOTH # PMVP Health Plan of NY 14165 NOCD NY Y MVP HEALTH NY Y FALSE BOTH GMy Family Medical Group 33020 NCOD ALL Y MY FAMILY MEDICAL N FALSE BOTH GMyNexus, Inc. 32043 NOCD ALL Y MYNEXUS INC N FALSE BOTH GN.W. Ironworkers Health & Security Trust Fund - Grp#F15 91136 NOCD ALL Y NW IRONWRKRS F15 N FALSE BOTH GN.W. Roofers & Employers Health & Security Trust Fund - Grp#F14 91136 NOCD ALL Y NW ROOFERS F26 N FALSE BOTH GN.W. Textile Processors - Grp#F14 91136 NOCD ALL Y NW TEXTILE F14 N FALSE BOTH GNAA (North America Administrators) 65085 NOCD ALL N NAA N FALSE BOTH GNAMCI/Global Care L0110 NOCD ALL Y NAMCI GLOBAL CARE Y FALSE BOTH GNaphcare Inc 58182 NOCD ALL A NAPHCARE INC Y FALSE BOTH GNational Accident & Health General Agency Inc. 67788 NOCD ALL Y NAT ACC HEALTH GE Y FALSE BOTH GNational Allied Workers Union Local 831 CB148 NOCD ALL Y NAT ALLIED LCL831 N FALSE BOTH GNational Association of Letter Carriers 53011 NOCD All N NALC Y FALSE BOTH TNational Association of Letter Carriers 53011 NOCD All N NATIONAL ASSOCIAT Y FALSE BOTH TNational Capital Area NCABS NOCD DC VA MD N NCA N TRUE BOTH N

National Capital Preferred Provider Organization (NCPPO) (To obtain your provider ID number, please call the NCPPO Customer Service Department at (800) 272-5911 90001 NOCD ALL N NAT CAPITAL PPO Y FALSE BOTH GNational Financial Insurance Company 90956 NOCD ALL N NAT FINANCIAL INS N FALSE BOTH GNational Foundation Life Insurance Company 98205 NOCD ALL N NAT FOUNDATION LI N FALSE BOTH GNational Health Benefit 88057 NOCD ALL Y NATL HEALTH BENEF Y FALSE BOTH GNational Health Benefits Corporation - NHBC02 88050 NOCD ALL Y NHBC02 Y FALSE BOTH GNational Rural Electric 52132 NOCD All Y NAT RURAL ELECT N FALSE BOTH GNational Teachers Association (NTA) NTA11 NOCD ALL A NTA N FALSE BOTH G

National Telecommunications Cooperative Association (NTCA) 52103 NOCD ALL Y NAT TELECOMM COOP Y FALSE BOTH GNational Telecommunications Cooperative Association (NTCS Staff) 52104 NOCD ALL Y NTCS STAFF Y FALSE BOTH GNational Vision NVADM NOCD ALL N NATIONAL VISION N TRUE BOTH N


27 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerNative Care Health 19191 NOCD ALL N NATIVE CARE HEALT Y FALSE BOTH GNCAS - Charlotte, VA 75191 NOCD VA Y NCAS CHARLOTTE Y FALSE BOTH GNCAS - Fairfax, VA 75190 NOCD VA Y NCAS FAIRFAX Y FALSE BOTH GNebraskaTotal Care 68069 NOCD ALL Y NEBRASKA TOTAL CA N FALSE BOTH GNeighborhood Health Partnership (NHP) 96107 NOCD ALL Y NEIGH HLTH PARTNE N FALSE BOTH # CNeighborhood Health Partnership (NHP) If member id begins with JD, use original PID, else use 87726. Checkk eligibility online to validate member card.) 95123 NOCD ALL Y NEIGHBORHOOD HEAL N FALSE BOTH # C

Neighborhood Health Plan of Rhode Island (Contact NHPRI 401-459-6030 to verify provider and vendor number.) 05047 NOCD RI N RI NEIGHBORHOOD H Y FALSE BOTH GNeighborhood Health Plan RI- Exchange, Unity, Integrity (Patient ID cards will have 11 digit Ids that start with 135) 96240 NOCD RI Y NEIGHBORHOOD HP R N FALSE BOTH NNeighborhood Plan (Boston, MA) 04293 NOCD ALL Y NGHBRHOOD PLAN MA Y FALSE BOTH G

Nesika Health Group (Old payerID of 37255 is no longer valid.) 75280 NOCD ALL Y NESIKA HEALTH GRP N FALSE BOTH GNetcare Life and Health Insurance 66055 NOCD ALL N NETCARE LIFE HLTH N FALSE BOTH GNetwork Health (Before initiating submissions, please call Provider Relations at (617)806-8104 or www.network-health.org for an EDI startup plan.) CALL CALL ALL Y CALL ENS SUPPORT N FALSE BOTH GNetwork Health Insurance Corp - Medicare 77076 NOCD ALL T NETWORK HLTH INSU Y FALSE BOTH GNetwork Health Plan of Wisconsin, Inc.(Prior to initial claims submission, please contact Network Health Plan EDI specialist at 920-720-1506.) 39144 NOCD ALL N WI NETWORK HEALTH Y FALSE BOTH G

Network Health 04332 NOCD ALL N NETWORK HLTH N TRUE BOTH NNetwork Health PPO AMS01 NOCD ALL N NETWORK HEALTH PP Y FALSE BOTH GNetwork Solutions IPA NSIPA NOCD ALL Y NETWORK SOLN IPA Y FALSE BOTH GNevada Health Solutions (Provider ID Required) 86067 NOCD NV Y NV HEALTH SOLUTIO Y FALSE BOTH NNevadaCare (Provider ID Required) 86067 NOCD NV R NEVADACARE Y FALSE BOTH NNevadaCare Kids (Provider ID Required) 86067 NOCD NV R NEVADACARE KIDS Y FALSE BOTH NNew Avenues, Inc. 95998 NOCD ALL N NEW AVENUES INC Y FALSE BOTH GNew Century Health NCHCA NOCD ALL Y NEW CENT HEALTH N FALSE BOTH GNew Century Health - Vista Cardiology NCH09 NOCD ALL N NEW CENTURY HEALT Y FALSE BOTH GNew Century Health Arizona Integrated Physicians NCHOR NOCD ALL N NEW CENTURY AZIP N FALSE BOTH GNew Century Health Urology NCH03 NOCD ALL N NEW CENT HLTH URO N FALSE BOTH GNew England, The 66893 NOCD All Y NEW ENGLAND N FALSE BOTH PNew England, The 66893 NOCD All Y THE NEW ENGLAND N FALSE BOTH PNew Hampshire Healthy Family 68069 NOCD NH Y NH HEALTHY FAMILY Y FALSE BOTH GNew Mexico Blue Cross Community Centennial (MemberIDs start with "YIP") MC721 NOCD NM Y NM BC COMMUNITY C Y FALSE BOTH GNew Mexico District Council of Carpenters 74234 NOCD NM N NM DIST CARPENTER N FALSE BOTH GNew Mexico Health Connections 45129 NOCD ALL N NM HEALTH CONNECT Y FALSE BOTH GNew Mexico Painters and Allied Trades Local No 823 74234 NOCD UT N NM PAINTERS #823 N FALSE BOTH GNew Mexico Public Schools Insurance Authority 85036 NOCD ALL Y NM PUB SCHOOLS iN N FALSE BOTH GNew Mexico-West Texas Multi-Craft (lso known as New Mexico Laborers) 74234 NOCD UT N NM MULTI-CRAFT N FALSE BOTH GNew West Health Plan 84141 NOCD MT Y NEW WEST HEALTH P Y FALSE BOTH GNew York Hotel Trade Council 7707C NOCD ALL N NY HOTEL TRADE Y TRUE BOTH NNew York Life - Long Term Care NYL11 NOCD ALL N NYL LONG TERM CAR N FALSE BOTH NNew York Medical Imaging-MVP 14179 NOCD NY Y NEW YORK MVP Y FALSE BOTH G

New York Network Management (Healthplus Amerigroup claims with Dates of service after March 1st, 2015 should be sent directly to the payer with payerID 27514) 11334 NOCD ALL Y NY NETWORK MGMNT Y FALSE BOTH GNexcaliber ADSL1 NOCD ALL Y NEXCALIBER N FALSE BOTH NNext Level Health Partners 69821 NOCD ALL Y NEXT LEVEL HEALTH N FALSE BOTH GNGS CoreSource 38225 NOCD ALL Y NGS AMERICAN Y FALSE BOTH GNippon Life Insurance Company 81264 NOCD All Y NIPPON LIFE INSUR N FALSE BOTH GNJ Carpenters Health Fund 22603 NOCD NJ N NJ CARPENTERS HF Y FALSE BOTH GNoble Community IP080 NOCD CA N NOBLE COMMUNITY Y FALSE BOTH GNorth American Administrators, Inc. 64157 NOCD ALL Y NORTH AM ADMIN N FALSE BOTH GNorth American Benefits Network (NABN) 34159 NOCD ALL N NORTH AMERICAN BE N FALSE BOTH GNorth American Medical Management (Provider number must be in box 33a) IP079 NOCD All Y NORTH AMERICAN ME Y FALSE BOTH GNorth Broward Hospital District 37314 NOCD FL Y NO BROWARD HOSPIT Y FALSE BOTH GNorth Shore - LIJ (Healthfirst) 17516 NOCD ALL N NORTH SHORE LIJ Y FALSE BOTH GNorth Shore - LIJ CareConnect Insurance Company 46227 NOCD ALL N NORTH SHORE CARE Y FALSE BOTH G


28 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerNorth Suburban Associated Physicians (Formerly payer ID 36392. As of 9-01-2017, please submit claims under payer ID 48026) 48026 NOCD ALL N N SUB ASSOC PHYSI Y FALSE BOTH GNorth Texas Healthcare Network 35212 NOCD All Y NORTH TEXAS HEALT Y FALSE BOTH GNorth West Life PH018 NOCD All Y NORTH WEST Y FALSE BOTH GNortheast Georgia Health Services 58169 NOCD ALL Y NE GA HLTH SVCS N FALSE BOTH GNortheast Iowa Community Health Plan SISCO NOCD ALL N SISCO N FALSE BOTH GNortheastGeorgia Health Services 58169 NOCD ALL Y NE GA HLTH SVCS N FALSE BOTH GNorthern California Advantage Medical Group NCA01 NOCD CA Y NOCAL ADV MED GRP N FALSE BOTH GNorthern Illinois Health Plan 36347 NOCD IL Y NO ILLINOIS HLTH Y FALSE BOTH GNorthern Nevada Trust Funds (Call 775-826-7200 prior to submitting claims.) 88027 NOCD NV A NO NV TRUST FUNDS Y FALSE BOTH GNorthridge Medical Group NMG01 NOCD ALL N NORTHRIDGE MED GP Y FALSE BOTH GNorthShore Physicians Associates 48026 NOCD ALL N NO SHORE PHY ASSO Y FALSE BOTH GNorthwest Physicians Network NPN11 NOCD ALL Y NW PHYSICIANS NET N FALSE BOTH GNorthwest Suburban IPA (IL) 36346 NOCD IL Y NW SUBURBAN IPA N FALSE BOTH GNorthwestern National Life PH018 NOCD All Y NORTHWESTERN NATI Y FALSE BOTH GNorthwood Healthcare NWOOD NOCD All Y NORTHWOOD N FALSE BOTH GNova Healthcare Administrators, Inc. (Grand Island, NY) 16644 NOCD ALL Y NOVA HLTHCARE ADM N FALSE BOTH GNovaNet (Please contact payer directly for payer ID (770)729-1997 ext. 220.) CALL NOCD ALL Y CALL SUPPORT Y FALSE BOTH GNOVASYS Health Network 68069 NOCD ALL Y NOVASYS HLTH NETW N FALSE BOTH GNW Diagnostic Clinic/SelectCare of Texas (NWDC) 62119 NOCD ALL Y NWDC SELECTCARE T N FALSE BOTH GNY Central FEP (Federal Employee Program) Blue Shield N2FEP NOCD NY Y NY CENTRAL BS FEP Y TRUE BOTH GNyhart 37299 NOCD ALL N NYHART N FALSE BOTH GNYS DOH UCP 14142 NOCD NY N NYS DOH UCP Y FALSE BOTH NOak West Physician Association 36400 NOCD ALL Y OAK WEST PHYSICIA N FALSE BOTH GOak West Primary Physician Association NAOAK NOCD ALL Y OAK WEST PRIMARY Y FALSE BOTH GOak West Primary Physician Association NAOAK NOCD IL Y OAK WEST PPA Y FALSE BOTH GOccular Benefits L0140 NOCD ALL N OCCULAR BENEFITS N FALSE BOTH GODS Health Plan 13350 NOCD ALL A ODS HEALTH PLAN Y FALSE BOTH GOhio Health Choice PPO 34189 NOCD OH Y OHIO HLTH CHOICE N FALSE BOTH GOhio PPO Connect 74431 NOCD ALL N OHIO PPO CONNECT Y FALSE BOTH GOLOLRMC Uninsured Patient Services Program OLRMC NOCD LA N OLOLRMC UNINSUR N FALSE BOTH GOlympus Management Health Care 65074 NOCD ALL Y OLYMPUS MGD HC N FALSE BOTH GOMNI Administrators / CHP (Enrollment required, please contact Provider Relations 801-352-7270) (NOTE that this payer accepts Chiropractic claims only.) U1439 NOCD UT N CHIROPRACTIC HP U Y TRUE BOTH N

OmniCare (For claims with Dates of Service after 10/01/04) 25150 NOCD ALL N OMNICARE Y FALSE BOTH GOmnicare IPA OMN02 NOCD ALL Y OMNICARE IPA N FALSE BOTH GOncology Network of Orange County. ONOCI NOCD ALL N ONCOLOGY NW OC N FALSE BOTH GOne Call Medical 22321 NOCD ALL N ONE CALL MEDICAL Y FALSE BOTH GOne Health Plan of California 95379 NOCD CA Y ONE HEALTH CA N FALSE BOTH POne Health Plan of Colorado 95412 NOCD CO Y ONE HEALTH COLO N FALSE BOTH POne Health Plan of Illinois 95388 NOCD IL Y ONE HEALTH IL N FALSE BOTH POPEIU Locals 30 & 537 BPA01 NOCD ALL N OPEIU LOC 30 537 Y FALSE BOTH GOperating Engineers Local No 53 74234 NOCD UT N OPER ENG LOCAL 53 N FALSE BOTH GOperating Engineers Locals 302 & 612 Health & Security Fund - Grp#F12 91136 NOCD ALL Y OPERATING ENGINEE N FALSE BOTH GOpticare Eye Health Network 56190 MCSI ALL Y OPTICARE EYE HEAL Y FALSE BOTH GOpticare of Utah OPCAU NOCD ALL Y OPTICARE OF UTAH Y FALSE BOTH GOptima Insurance Company 54154 NOCD ALL Y OPTIMA INS COMPAN Y FALSE BOTH GOptimum Healthcare, Inc. 20133 NOCD ALL N OPTIMUM HEALTHCAR Y FALSE BOTH GOptum Care Network of Connecticut E3287 NOCD ALL Y OPTUM CARE NETWORK N FALSE BOTH COptumCare / AZ, UT (formerly Lifeprint Network) LIFE1 NOCD ALL R LIFEPRINT N FALSE BOTH # COptumHealth (OptumHealth Behavior Solutions) formerly United Behavioral Health and Pacificare Behavioral Health), former payerID 33053 87726 NOCD ALL Y OPTUMHEALTH BEHAV Y FALSE BOTH # C

OptumHealth (OptumHealth Behavioral Solutions of NM) 87726 NOCD ALL Y OPTUMHEALTH BEHAV Y FALSE BOTH # COptumHealth Complex Medical Conditions (CMC) (formerly OptumHealth Care Solutions and United Resource Networks) (Former payerID 52190) 41194 NOCD ALL Y UNITED RESOURCES Y FALSE BOTH # COptumHealth Physical Health - includes Oxford (former payer id 41159, 41160) 41161 NOCD ALL N OPTUMHEALTH Y FALSE BOTH # COptumHealth Salt Lake County U6885 NOCD ALL Y OPTUMHEALTH SLC N TRUE BOTH GOrange Coast Memorial IPA MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE BOTH G

Oregon Health Mgmt OHMS aka Primary Health of Josephine OHMSP NOCD ALL N OR HEALTH MGMR N FALSE BOTH G


29 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerOregon's Health CO-OP 45332 NOCD OR N OR HEALTH COOP N FALSE BOTH GOrthonet - AETNA 13383 NOCD ALL Y ORTHONET AETNA Y FALSE BOTH GOscar Health OSCAR NOCD ALL Y OSCAR HEALTH Y FALSE BOTH GOSF Health Plans 61101 NOCD IL Y OSF HEALTH PLANS N FALSE BOTH GOSG-Michael Reese 37127 NOCD IL N OSG MICHAEL REESE N FALSE BOTH GOxford Health Plans 06111 NOCD All Y OXFORD HEALTH PLA N FALSE BOTH # COxford Medicare Network (AARP MedicareComplete insured through UnitedHealthcare ) 87726 NOCD ALL Y OXFORD MEDICARE N Y FALSE BOTH # COxford Mosaic Network / AARP Medicare Complete insured through UnitedHealthcare 87726 NOCD ALL Y OXFORD MOSAID NET Y FALSE BOTH # CP5 Health 87068 NOCD ALL N P5 HEALTH Y FALSE BOTH GPA Preferred Health (Call PPHN Claims Operations at 410-349-3222) CALL CALL ALL N CALL ENS SUPPORT Y FALSE BOTH TPace Central Iowa 72436 NOCD ALL Y PACE CENTRAL IOWA N FALSE BOTH GPACE CNY 70454 NOCD ALL Y PACE CNY N FALSE BOTH GPace Nebraska 35416 NOCD ALL N PACE NEBRASKA N FALSE BOTH GPace of Southwest Michigan Inc. 45114 NOCD ALL Y PACE SW MICHIGAN N FALSE BOTH GPace Southeast Michigan 86711 NOCD ALL Y PACE SE MICHIGAN N FALSE BOTH GPace Southwest Iowa 53534 NOCD ALL Y PACE SOUTHWEST IA N FALSE BOTH GPacific Southwest Administrators (PSWA) 75309 NOCD ALL N PSWA Y FALSE BOTH GPacifiCare Life and Health Insurance Company (UnitedHealthOne) 81400 NOCD ALL T UNITEDHEALTHONE Y FALSE BOTH # CPacificSource Administrators 93031 NOCD ALL N SELECT BENE ADMIN n FALSE BOTH GPacificSource Commercial 93029 NOCD ALL N PACIFICSOURCE COM N FALSE BOTH GPacificsource Medicare 20377 NOCD ALL N PACIFICSOURCE MCA Y FALSE BOTH GPacificsource OHP COIHS NOCD ALL N PACIFICSOURCE OHP Y FALSE BOTH GPALIC 81240 NOCD PR N PALIC N FALSE BOTH NPalladian Muscular Skeletal Health (Formerly Prism Health Networks) 37268 NOCD ALL A PALLADIAN MUSCULA N FALSE BOTH GPalo Alto Medical Foundation IP132 NOCD ALL Y PALO ALTO MED FOU N FALSE BOTH GPan American Life Insurance 04218 NOCD ALL N PAN AMERICAN LIFE N FALSE BOTH GPaper Claims (ENS will print and mail the claims submitted with the payerID of PRINT) PRINT NOCD ALL N PAPER CLAIMS N FALSE BOTH NParamount Health SX158 NOCD ALL N PARAMOUNT HEALTH N FALSE BOTH NParity Healthcare, Inc. 58204 NOCD ALL N PARITY HEALTHCARE N FALSE BOTH GParkland Community Health Plan 66917 NOCD ALL N PARKLAND COMM HP Y FALSE BOTH GPartners Behavioral Health 13141 NOCD ALL N PARTNERS BEHAV HL Y TRUE BOTH NPartners Health Plan 14966 NOCD ALL Y PARTNERS HLTH PLA N FALSE BOTH G

Partnership Health Plan (Client must contact OptumInsight Enrollments Department for enrollment forms.) PHP02 NOCD CA N PARTNERSHIP HP CA N TRUE BOTH NPasadena Primary Care Physicians IP080 NOCD CA N PASADENA PRIMARY Y FALSE BOTH GPassport Advantage (Effective 7-1-18 new PID 66008, former payer ID 97652) 66008 NOCD ALL Y PASSPORT ADVANTAG Y FALSE BOTH GPassport Health Plan 61325 NOCD ALL N PASSPORT HEALTH Y FALSE BOTH GPatient Access PAN01 NOCD ALL Y PATIENT ACCESS Y FALSE BOTH GPatient Advocates, LLC 10525 NOCD ALL Y PATIENT ADVOCATES Y FALSE BOTH GPATIENTPAY 26335 NOCD ALL Y PATIENTPAY Y FALSE BOTH GPayer Fusion 27048 NOCD ALL A PAYER FUSION Y FALSE BOTH GPeach State Health Plan (Behavioral Health) 68069 NOCD GA Y PEACH STATE HP BH Y FALSE BOTH GPeach State Health Plan (Medicaid) (Call 800-225-2573 ext 25525 prior to submitting claims.) 68069 NOCD GA Y PEACH STATE HP MD Y FALSE BOTH GPeak Pace Solutions 27034 NOCD ALL N PEAK PACE SOLUTIO N FALSE BOTH G

PEHP - Utah Public Employee Health Plan (Enrollment required, please contact Provider Relations 800-765-7347) SX106 NOCD UT N PEHP UTAH PUBLIC N TRUE BOTH NPediatric Associates of Broward 20472 NOCD ALL Y PEDIATRIC ASSOCIA Y FALSE BOTH GPeninsula Healthcare VABLS BCBS VA Y PENINSULA HEALTHC Y FALSE BOTH NPenn Behavioral Health 53226 NOCD ALL A PENN BEHAV HEALTH Y TRUE BOTH GPennsylvania Keystone Health Plan East (claims only) PCBLS NOCD PA Y KEYSTONE HLTH CLA Y TRUE BOTH N

Pennsylvania Keystone Health Plan East (encounters only) PEBLS NOCD PA Y KEYSTONE HLTH ENC Y TRUE BOTH NPennsylvania Life Insurance 23130 NOCD PA Y PA LIFE INSURANCE Y FALSE BOTH GPennsylvania Pace 20172 NOCD ALL Y PENNSYLVANIA PACE N FALSE BOTH GPeoples Health Network (Tenet) (Network ID must be on claim. Contact [email protected]) 72126 NOCD ALL N PEOPLES HLTH NETW Y FALSE BOTH GPersonal Choice PPO of Pennsylvania (Also know as Independent BLC) 54704 NOCD PA N PA PERSONAL CHOIC Y TRUE BOTH NPersonal Insurance Administrators 95397 NOCD ALL N PERSONAL INS ADMI N FALSE BOTH GPHCS Savility (ONLY for Savility card members.) 13306 NOCD ALL N PHCS SAVILITY Y FALSE BOTH G


30 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerPhifer Wire Insurance (Per request from Payer, claims are printed and mailed.) PHIF4 NOCD ALL N PHIFER WIRE INSUR N FALSE BOTH NPhoenix Choice 55649 NOCD ALL Y PHOENIX CHOICE N FALSE BOTH GPhoenix Health Plan 03440 NOCD AZ Y PHOENIX HEALTH PL Y FALSE BOTH G

PHX Teamsters UT/MT/ID (For Dates of Service after 05/01/16) CX100 NOCD ALL N PHX TEAMSTERS UT N FALSE BOTH GPhysician Associates of Greater San Gabriel Valley PA513 NOCD CA Y PA G SAN GABRIEL Y FALSE BOTH GPhysician Associates of Louisiana (PAL) 58204 NOCD LA Y PHYS ASSOC OF LA N FALSE BOTH G

Physician Health Cooperative/SRRIPA ( This Payer ID should be used for Stones River Regional IPA Humana Claims) 57549 NOCD ALL Y PHYS HLTH COOP SR Y FALSE BOTH GPhysician Partners IPA PPRT1 NOCD ALL N PHYS PARTNERS IPA N FALSE BOTH NPhysicians Care Network 38265 NOCD ALL Y PHYS CARE NETWORK Y FALSE BOTH GPhysicians Care Network (Rockford, IL Only) PayerID valid only for claims with billing submission name, city and state of Physicians Care Network, Rockford, IL. 36345 NOCD IL Y PCN ROCKFORD IL N FALSE BOTH GPhysicians Care Network/The Polyclinic PCN12 NOCD ALL N PCN THE POLYCLINI N FALSE BOTH GPhysicians Choice Medical Group of Santa Maria MCI01 NOCD ALL N PHY CHOICE SANTA N FALSE BOTH GPhysicians Choice Medical Grp of San Luis Obispo (formerly San Luis Obispo Select IPA) SLOS1 NOCD ALL N PHY CH SANTA MARI N FALSE BOTH GPhysicians Corporation of America (Florida Plan Only) 65018 NOCD FL Y PHYS CORP FL Y FALSE BOTH GPhysicians Health Association of Illinois 37136 NOCD IL Y PHY HLTH ASSOC IL N FALSE BOTH G

Physicians Health Choice - Claims (Administered by Wellmed) PHCS1 NOCD ALL N PHY HLTH CHCE CLA N FALSE BOTH CPhysicians Health Collaborative 20398 NOCD ALL Y PHYSICIANS HLTH C Y FALSE BOTH GPhysicians Health Network MHCM2 NOCD ALL N PHYS HLTH NETWORK N FALSE BOTH G

Physicians Health Plan (For behavioral Health claims processing, see documents sent to your office from the payer.) 37330 NOCD ALL N PHYSICIAN HLTH PL Y FALSE BOTH PPhysicians Health Plan (PHP-SC) 09173 NOCD ALL Y PHYSICIANS HP SC Y FALSE BOTH GPhysicians Health Plan of Northern Indiana 12399 NOCD IN A PHYS HLTHPLN N IN Y FALSE BOTH GPhysicians Healthways IPA PHIPA NOCD CA N PHYS HEALTHWAYS I Y FALSE BOTH GPhysicians Medical Group of Santa Cruz County PMGSC NOCD CA Y PHYS MG SANTACRUZ N FALSE BOTH GPhysicians Mutual Insurance Company 47027 NOCD ALL N PHYSICIANS MUTUAL Y FALSE BOTH GPhysicians of Southwest Washington 91171 NOCD ALL R PHYSICIANS SW WA N FALSE BOTH GPhysicians Plus Insurance Corp. 39156 NOCD ALL Y PHYSICIANS PLUS Y FALSE BOTH CPIA 95397 NOCD ALL N PERSONAL INS ADMI N FALSE BOTH GPiedmont WellStar Health Plan 251PD NOCD ALL Y PIEDMONT WELLSTAR N FALSE BOTH GPIH Health (Formerly Bright Health Plan) BHP01 NOCD ALL Y PIH HEALTH N FALSE BOTH GPinnacol Assurance CCIA1 CCIA CO Y PINNACOL ASSURANC Y FALSE BOTH PPioneer Provider Network PPNZZ NOCD CA Y PIONEER PROVIDER Y FALSE BOTH GPipe Industry Health & Welfare Fund of Colorado COMPU NOCD CO N PIPE INDUSTRY CO N FALSE BOTH GPittsburgh Care Partnership 23283 NOCD ALL Y PITTSBURGH CARE P N FALSE BOTH GPlanned Administrators, Inc. (PAI) 37287 NOCD ALL N PAI Y FALSE BOTH GPMG of San Jose PMGSJ NOCD CA N PMG OF SAN JOSE N FALSE BOTH GPodiatry Network FL 59324 NOCD FL N PODIATRY NETWK FL N FALSE BOTH GPoint Comfort Underwriters PCU01 NOCD ALL Y PTCOMFORT UNDERWR N FALSE BOTH GPoint Comfort Underwriters (Payer not accepting electronic claims until February 1st, 2017) PCU02 NOCD ALL Y PT COMFORT UNDERW N FALSE BOTH GPOMCO 16111 NOCD ALL Y POMCO Y FALSE BOTH GPomona Valley Medical Group (PVMG) ProMed IP057 NOCD CA N POMONA VALLEY MG N FALSE BOTH GPopulytics (formerly Spectrum Administrators) 23253 NOCD ALL N SPECTRUM ADMIISTR Y FALSE BOTH GPPO Oklahoma (WinterBrook HealthCare Management) 73159 NOCD OK Y PPO OKLAHOMA Y FALSE BOTH GPPO Plus, LLC 72148 NOCD ALL Y PPO PLUS LLC Y FALSE BOTH GPrairie States Enterprises, Inc. 36373 NOCD ALL N PRAIRE STATES ENT Y FALSE BOTH GPreferred Administrator (Contact Provider Relations @ (915)532-2778, x1068) EPF10 NOCD TX Y TX PREFERRED ADMI N FALSE BOTH GPreferred Benefit Administrators 53476 NOCD ALL Y PREFERRED BEN ADM N FALSE BOTH G

Preferred Care Partners (Encounters from delegated entities only. To get payerID, call Jeff Nehms at 305-670-8440.) CALL CALL FL N CALL ICS SUPPORT N FALSE BOTH GPreferred Care Partners / FL 65088 NOCD FL N PREF CARE PARTNER Y FALSE BOTH CPreferred Community Choice 73145 NOCD ALL Y PREF COMM CHOICE Y FALSE BOTH GPreferred Health Care - PPO Lancaster, PA (IHS Gateway Payer) - Contact Sherry Wolgemuth at (717)560-9290 ext. 124 for approval and the Payer ID. CALL CALL PA Y CALL ENS SUPPORT Y FALSE BOTH TPreferred Health Plan (Louisville, KY) 61106 NOCD KY Y PREFERRED HLTH KY Y FALSE BOTH GPreferred Health Professionals 31478 NOCD ALL Y PREF HEALTH PROF Y FALSE BOTH GPreferred Health Professionals Kansas City 00036 NOCD KS,MO N PREF HLTH PROF KC N FALSE BOTH GPreferred Health Systems Insurance Co (PPO) 61665 NOCD ALL Y PREF HLTH SYS PPO Y FALSE BOTH G


31 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerPreferred Health Systems, Inc. 60110 NOCD ALL Y PREF HLTH SYSTEMS Y FALSE BOTH GPreferred IPA PFIPA NOCD ALL N PREFERRED IPA Y FALSE BOTH GPreferred Medicare L0250 NOCD ALL N PREFERRED MEDICAR N FALSE BOTH NPreferred Network Access 36401 NOCD ALL N PREFERRED NET ACC N FALSE BOTH GPreferred One 41147 NOCD ALL Y PREFERRED ONE Y FALSE BOTH GPremier Eye Care 65054 NOCD ALL Y PREMIER EYE CARE Y FALSE BOTH GPremier Health Plan 251PR NOCD ALL Y PREMIER HEALTH PL Y FALSE BOTH GPremier Healthcare Exchange 88051 NOCD ALL N PREMIER HCX N FALSE BOTH GPremier HealthCare Exchange (Cypress) 88056 NOCD ALL N PREMIER HCARE EXC N FALSE BOTH GPresbyterian Health Plan (Commercial) (Provider ID is required. Contact (888) 923-5757, #6 then #2 to obtain ID. New Mexico Providers only.) PREHP NOCD NM Y PRESBYTERIAN HP N FALSE BOTH GPresbyterian Salud (Please add provider number in 2010AA REF02 or 2310B REF02 Number is 11 digits or less. Contact 888-923-5757, #6,#2 to obtain ID.) PRESA NOCD NM N PRESBYTERIAN SALU N FALSE BOTH GPresbyterian(NM) 05003 NOCD NM Y PRESBYTERIAN NM Y FALSE BOTH GPrestige Health Choice (Payer is effective 5/1/2014 Managed Medicaid Plan. For EDI Support, please email [email protected] or call 800-617-5727) 77003 NOCD ALL Y PRESTIGE HLTH CHO Y FALSE BOTH GPrevea Health Insurance Plan 39185 NOCD ALL A PREVEA HEALTH INS N FALSE BOTH GPrimary Care Assoc of California (Customer Service Phone Number 877-602-1563) PCACZ NOCD CA Y PRIMARY CARE CALI N FALSE BOTH GPrimary Care of Joliet PCJOL NOCD ALL Y PRIMARY CARE OF J Y FALSE BOTH GPrimary Choice (Aetna HP-NY/NJ) 60054 NOCD NY, NJ Y PRIMARY CHOICE Y FALSE BOTH CPrimary Delivery Systems 73288 NOCD ALL Y PRIMARY DELIVERY Y FALSE BOTH GPrimary Health Network 82048 NOCD ALL Y PRIMARY HLTH NETW Y FALSE BOTH GPrimary PhysicianCare, Inc.(Now known as HealthGram) 56144 NOCD ALL Y PRIMARY PHYSICIAN N FALSE BOTH GPrime Community Care Central Valley MVCV1 NOCD ALL Y PRIME COMMCARE CV N FALSE BOTH GPrime West Health Plan 61604 NOCD MN N PRIME WEST HEALT Y FALSE BOTH GPrimeCare Health Plan IP079 NOCD CA Y PRIMECARE HLTH PL N FALSE BOTH GPrimeSource Health Network 04320 NOCD ALL Y PRIMESOURCE HLTNT Y FALSE BOTH GPrincipal Financial Group (Vision Claims only.) 61271 NOCD ALL Y PRINCIPAL FINANCI N FALSE BOTH GPriority Health (Please contact Priority Health EDI Dept at 616-464-8686 or email [email protected]) 38217 NOCD ALL Y PRIORITY HEALTH Y FALSE BOTH TPriority Healthcare VABLS BCBS VA Y PRIORITY HEALTHCA Y FALSE BOTH NPrism Health Networks (Now known as Palladian Muscular Skeletal Health ) 37268 NOCD ALL A PRISM HEALTH NETW N FALSE BOTH GPrism Univera 37315 NOCD ALL N PRISM UNIVERA N FALSE BOTH GProCare Health Plan Medicaid 70259 NOCD ALL Y PROCARE HP MEDICA Y FALSE BOTH GProductive Processing Inc. 13396 NOCD ALL Y PRODUCTIVE PROCES N FALSE BOTH GProfessional Benefit Administrators, Inc. (Oak Brook, IL) 36331 NOCD IL A PROF BENE ADM IL N FALSE BOTH GProfessional Claims Management 37242 NOCD ALL Y PROF CLAIMS MGMT Y FALSE BOTH GProfessional Claims Manangement 56001 NOCD ALL T PROF CLAIMS MGMT N FALSE BOTH TProminence Health Plan Encounters 88082 NOCD ALL Y PROMINENCE HP N FALSE BOTH GProminence Health Plan of Nevada 93082 NOCD ALL N PROMINENCE HP NV N FALSE BOTH GProminence Health Plan of Texas 80095 NOCD ALL N PROMINENCE HP TX N FALSE BOTH GProspect Medical Group PROSP NOCD CA Y PROSPECT MED GROU Y FALSE BOTH GProtective Life Insurance Company 37309 NOCD ALL Y PROTECTIVE LIFE I Y FALSE BOTH GProvidence Choice Option PHP01 NOCD ALL Y PROVIDENCE CHOICE Y FALSE BOTH GProvidence Good Health Plan PHP01 NOCD ALL Y PROVIDENCE GOOD H Y FALSE BOTH GProvidence Health Plan SX133 NOCD ALL Y PROVIDENCE HEALTH N FALSE BOTH GProvidence Health PPO SX187 NOCD ALL Y PROVIDENCE H PPO N FALSE BOTH GProvidence Preferred (PPO) (ProviderID and Enrollment required.) PHP00 NOCD ALL Y PROVIDENCE PREFER Y FALSE BOTH GProvident Life & Accident Insurance Company 68195 NOCD All Y PROVIDENT INS CO Y FALSE BOTH G

Provident Life & Accident Insurance Company of America 68195 NOCD All Y PROVIDENT LIFE Y FALSE BOTH GProvident Life & Casualty Insurance Company 68195 NOCD All Y PROVIDENT CASUALT Y FALSE BOTH GProviDRs Care Network 48100 NOCD ALL N PROVIDERS CARE NE N FALSE BOTH GPruCare HMO (Encounters Only) HM015 NOCD All Y PRUCARE HMO N FALSE BOTH PPrudent Medical Group MPM25 NOCD ALL Y PRUDENT MED GROUP Y FALSE BOTH GPrudential Encounters HM015 NOCD All Y PRU ENCOUNTERS N FALSE BOTH PPruitt Health Premier PH001 NOCD ALL Y PRUITT HLTH PREMI N FALSE BOTH GPuget Sound Benefits Trust - Grp#F25 91136 NOCD WA Y PUGET GRP F25 N FALSE BOTH GPuget Sound Electrical Workers Trust - Grp#33 91136 NOCD WA Y PUGET GRP 33 N FALSE BOTH GQuad Cities Community Health Plan SISCO NOCD ALL N SISCO N FALSE BOTH GQuad City Community Healthcare (QCCH) 40437 NOCD ALL Y QUAD CITY COMMUN N FALSE BOTH GQual Choice of Arkansas 35174 NOCD AR Y QUAL CHOICE AR Y FALSE BOTH GQualcare 23342 NOCD ALL Y QUALCARE Y FALSE BOTH GQualCare Alliance Networks Inc. (Qani) 22312 NOCD ALL A QUALCARE ALLIANCE Y FALSE BOTH G


32 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerQuality Care Partners 89461 NOCD ALL R QUALITY CARE PART Y FALSE BOTH GQuantumCare (We Care Health Plan) QCTPA NOCD ALL N QUANTUMCARE N FALSE BOTH GQuestcare Medical (USC) 84562 NOCD ALL Y QUESTCARE MEDICAL N FALSE BOTH GQuicktrip Corporation 73067 NOCD ALL N QUICKTRIP CORPORA Y FALSE BOTH GQVI Risk Solutions, Inc. 57117 NOCD ALL N QVI RISK SOLUTION Y FALSE BOTH GRadcon, Inc. (Please contact Kathy King @ 856-608-1350 for Payer ID information.) CALL NOCD ALL N CALL ENS SUPPORT Y FALSE BOTH GRady Children's Health Network RCHN1 NOCD ALL Y RADY CHILDRENS HE N FALSE BOTH GRBMS, LLC 91176 NOCD ALL Y RBMS LLC Y FALSE BOTH GRedlands IPA (Synermed) SYMED NOCD ALL N REDLANDS IPA Y FALSE BOTH GRegal Medical Group REGAL NOCD ALL Y REGAL MEDICAL GRO Y FALSE BOTH GRegence Blue Shield of Washington 00932 NOCD WA Y REGENCE BCBS Y FALSE BOTH NRegence Group Administrators RGA01 NOCD ALL Y REGENCE GRP ADMIN N FALSE BOTH GRegional Care, Inc. 47076 NOCD ALL Y REGIONAL CARE INC N FALSE BOTH GRehn and Associates REHNA NOCD ALL Y REHN AND ASSOCIAT N FALSE BOTH GRELIASTAR (Formerly NWNL) PH018 NOCD All Y RELIASTAR Y FALSE BOTH GRenaissance Physicians Organization 76066 NOCD ALL Y RENAISSANCE PHYS Y FALSE BOTH G

Reserve National Insurance (For Claims rejections, please contact Reserve national Customer Service at (405)848-7931.) 73066 NOCD ALL N RESERVE NAT INSUR Y FALSE BOTH GResolve Health Plan Administrators (Authorization number required: begins with the number 5 and is 13 characters in length.) 20481 NOCD ALL Y RESOLVE HP ADMINI Y FALSE BOTH GResurrection Physician Provider Group RPPG1 NOCD ALL N RESURRECTION PHY N FALSE BOTH GRevclaims (Provides TPL benefits services for Providers. Providers must be contracted with RevClaims to submit claims. For more info, call 601-345-8500.) RVC01 NOCD ALL N REVCLAIMS N FALSE BOTH GRight Care from Scott & White 74205 NOCD ALL N RIGHT CARE SCOTT N FALSE BOTH GRightChoice Benefits Administrators 37331 NOCD ALL N RIGHTCHOICE BENEF Y FALSE BOTH GRIVER CITY MEDICAL GROUP RCMG1 NOCD CA N RIVER CITY MG Y FALSE BOTH GRiverside Health, Inc 45281 NOCD ALL N RIVERSIDE HEALTH N FALSE BOTH GRMSCO, Inc. 16117 NOCD ALL Y RMSCO INC Y FALSE BOTH GRocky Mountain Health Plan Grand Junction SX141 NOCD CO Y ROCKY MTN HP GJ N FALSE BOTH NRocky Mountain HMO RMHMO NOCD CO Y ROCKY MOUNTAIN HM Y FALSE BOTH PRooney Life Ins. 37602 NOCD All N ROONEY LIFE INS Y FALSE BOTH # CRoyal Health Care (Extended Care MTC) 46166 NOCD ALL N ROYAL HEALTH CARE Y FALSE BOTH GRush Prudential Health Plans (HMO Only) 36389 NOCD ALL Y RUSH PRDENTL HMO Y FALSE BOTH GS & S Healthcare Strategies 31441 NOCD ALL A S AND S HEALTHCAR Y FALSE BOTH GSagamore Health Network, Inc. 35164 NOCD All Y SAGAMORE HEALTH N N FALSE BOTH PSage MNDH1 NOCD ALL Y SAGE Y FALSE BOTH GSage Plus MNDH1 NOCD ALL Y SAGE PLUS Y FALSE BOTH GSage Technologies (Formerly CCMSI) (Claims for payer address of Rockford, IL ONLY.) 37105 NOCD ALL Y SAGE TECHNOLOGIES N FALSE BOTH GSaint Anthony PHO STA01 NOCD ALL N ST ANTHONY PHO N FALSE BOTH GSaint Marys Health Plan 88029 NOCD ALL Y ST MARYS HEALTH P Y FALSE BOTH GSamaritan Advantage SAMAD NOCD ALL N SAMARITAN ADVANTA Y FALSE BOTH GSamaritan Choice Plan SAMCP NOCD ALL N SAMARITAN CHOICE N FALSE BOTH GSamaritan Employer Group Plan SAM00 NOCD ALL N SAMARITAN EMP GRP N FALSE BOTH GSan Bernardino Medical Group SBMED NOCD ALL N SAN BERNARDINO ME N BOTH GSan Diego County Medical Services (CMS) MSO11 NOCD CA N SD COUNTY MED SVC Y FALSE BOTH GSan Diego County Physician Emergency Services MSO22 NOCD CA N SD COUNTY PHY EME Y FALSE BOTH GSan Diego County Ryan White Primary Care Program MSO33 NOCD CA N SD COUNTY RYAN WH Y FALSE BOTH GSan Diego County Sheriffs Department MSO55 NOCD CA N SD COUNTY SHERIFF Y FALSE BOTH GSan Diego PACE 96400 NOCD ALL Y SAN DIEGO PACE N FALSE BOTH GSan Luis Obispo Select IPA 33072 NOCD ALL N SAN LUIS OBISPO S N FALSE BOTH GSandhills Center SHC30 NOCD ALL N SANDHILLS CENTER Y TRUE BOTH GSanford Health Plan MNSHP NOCD ALL Y SANFORD HEALTH PL Y FALSE BOTH GSanta Clara County IPA SCACO NOCD ALL N SANTA CLARA CO IP N FALSE BOTH GSanta Clara Family Health Plans 24077 NOCD CA N SANTA CLARA FAM H N FALSE BOTH GSanta Clara IPA HMO 10378 NOCD ALL Y SANTA CLARA IPA H N FALSE BOTH GSante Community Physicians Medical Group Corp. SNTMC NOCD ALL Y SANTE COMM PHYS M N FALSE BOTH GSante Health Systems 77038 NOCD ALL N SANTE HEALTH SYST N FALSE BOTH PSatellite Health Plan, Inc (Satellite Health Plan is a MA ESRD C-SNP effective 1/1/14. First Time submitters, please fax a W9 to 650-625-6083) 45552 NOCD MA N SATELLITE HLTH PL N FALSE BOTH GSC BCBS Companion Health SC922 NOCD SC Y SC COMPANION HEAL Y FALSE BOTH NSC BCBS Planned Administrators SC886 NOCD SC Y SC PLANNED ADMINI Y FALSE BOTH NSC BCBS State Employee Health Plan SC400 NOCD SC Y SC ST EMP HEALTH Y FALSE BOTH NSC FEP Blue Cross SC402 NOCD SC Y SC FEP BLUE CROSS Y FALSE BOTH NScan CA SCAN1 NOCD CA N SCAN CA N FALSE BOTH G


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CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerSCAN Encounters (Diversified Data Design (DDD)) 99157 NOCD ALL N SCAN ENCOUNTERS Y FALSE BOTH NSCAN Health Plan 72261 NOCD ALL Y SCAN HEALTH PLAN Y FALSE BOTH GScan Health Plan Arizona 73172 NOCD AZ Y SCAN HLTH PLAN AZ Y FALSE BOTH GSCAN Long Term Care 20460 NOCD ALL N SCAN LONG TERM CA N FALSE BOTH GSchaller Anderson CHOC Health Alliance SCH01 NOCD ALL N SCHALLER ANDERSON Y FALSE BOTH GSCHC Total Care 16146 NOCD ALL Y SCHC TOTAL CARE Y FALSE BOTH GScott & White Health Care 88030 NOCD TX N SCOTT WHITE HEALT N FALSE BOTH NScripps Health Plan MSO SHPM1 NOCD ALL Y SCRIPPS HP MSO Y FALSE BOTH GScripps Health Plan Services SHPS1 NOCD ALL N SCRIPPS HP SERVIC Y FALSE BOTH GSeaside Health Plan (Starting with DOS 9/1/2013) 46187 NOCD CA Y SEASIDE HEALTH PL N FALSE BOTH GSeaview IPA SVIPA NOCD ALL N SEAVIEW IPA N FALSE BOTH GSecure Health of Georgia 28530 NOCD GA Y SECURE HEALTH GA Y FALSE BOTH GSecurity Administrative Systems 35202 NOCD ALL Y SECURITY ADMIN SY N FALSE BOTH GSecurity Health Plan 39045 NOCD ALL Y SECURITY HEALTH N FALSE BOTH CSedgwick TP097 NOCD ALL Y SEDGWICK N FALSE BOTH GSeeChange HealthPlan SCHP1 NOCD ALL Y SEECHANGE HEALTH N FALSE BOTH G

Select Benefit Administrators (PayerID valid for claims submission address of PO Box 8339, Des Moines, IA 50301) 42137 NOCD IA A SELECT BENEFIT AD N FALSE BOTH GSelect Benefit Administrators of America 37282 NOCD ALL N SELECT BEN ADM AM N FALSE BOTH GSelect Choice 60054 NOCD All Y SELECT CHOICE Y FALSE BOTH CSelect Health of South Carolina 23285 NOCD SC N SELECT HEALTH SC Y FALSE BOTH GSelectCare 00014 NOCD MO,IL A SELECTCARE Y FALSE BOTH GSelectCare of OK - Tribute SCOK1 NOCD OK A SELECTCARE TRIBUT N FALSE BOTH TSelectCare of Texas (HPN) Heritage Physicians Network 76045 NOCD TX Y SELECTCARE TX HPN Y FALSE BOTH GSelectCare of TX (Beaumont) (Provider ID Required - Contact (713) 843-6780 to obtain ID.) GTPA1 NOCD TX A SELECTCARE BEAUMO N FALSE BOTH TSelectCare of TX (Houston) (Provider ID Required - Contact (713) 843-6780 to obtain ID.) HPN11 NOCD TX A SELECTCARE HOUSTO N FALSE BOTH TSelectCare of TX (Kelsey-Seybold) (Provider ID Required - Contact (713) 843-6780 to obtain ID.) KLSY1 NOCD TX A SELECTCARE KELSEY N FALSE BOTH TSelectHealth (Formerly IHC) (Contact payer at 801-442-5442 before sending claims to verify provider numbers.) UH107 NOCD UT Y SELECTHEALTH Y TRUE BOTH NSelf Insured Benefit Administrators 59111 NOCD FL Y SELF INS BENE ADM N FALSE BOTH GSelf Insured Plans, LLC 36404 NOCD ALL Y SELF INSURED PLAN Y FALSE BOTH GSelf-Funded Plans (IL, PA, OH) 34131 NOCD IL,PA,OH Y SELF FUNDED Y FALSE BOTH GSelman Tricare Supplement Plans TRSEL NOCD ALL Y SELMAN TRICARE SU Y FALSE BOTH GSendero IdealCare 11440 NOCD ALL Y SENDERO IDEALCARE N FALSE BOTH GSendero Star/Chip SCS17 NOCD ALL N SENDERO HEALTH Y FALSE BOTH GSenior Choice (Aetna HP-NY/NJ) 60054 NOCD All Y SENIOR CHOICE Y FALSE BOTH CSenior Smart Choice 95444 NOCD ALL N SENOIR SMART CHOI N FALSE BOTH GSenior Whole Health 83035 NOCD ALL N SENIOR WHOLE HEAL Y FALSE BOTH GSentara Family Plan 54154 NOCD ALL Y SENTARA FAMILY PL Y FALSE BOTH GSentara Health Management 54154 NOCD ALL Y SENTARA HEALTH MA Y FALSE BOTH GSentara Mental Health Professional 5415M NOCD ALL N SENTARA MENTAL HE N FALSE BOTH TSentinel Management Services 23249 NOCD ALL N SENTINEL MGMT SVC Y FALSE BOTH GSeoul Medical Group IP080 NOCD CA N SEOUL MEDICAL GRO Y FALSE BOTH GSeoul Medical Group AMM07 NOCD ALL N SEOUL MEDICAL GRP N FALSE BOTH GSequoia Health IPA ALG01 NOCD ALL Y SEQUOIA HEALTH IPA Y FALSE BOTH GSeton CHIP (Provider ID required.) SHPCH NOCD ALL N SETON CHIP N FALSE BOTH GSeton Employee Plan SHEBP NOCD ALL N SETON EMPLOYEE PL N FALSE BOTH GSeton Star STAR1 NOCD ALL N SETON STAR N FALSE BOTH GSeven Corners 25404 NOCD ALL N SEVEN CORNERS N FALSE BOTH GSharp Community Medical Group SCMG1 NOCD CA N SHARP COMM MED GR Y TRUE BOTH GSharp Health Plan SHP01 NOCD CA Y SHARP HEALTH PLAN N TRUE BOTH NSharp Rees-Stealy Med Group SRS83 NOCD CA Y SHARP REESSTEALY N TRUE BOTH NShasta Administrative Services 75280 NOCD ALL Y SHASTA ADMIN SVCS N FALSE BOTH GSheakley Unicomp 10002 NOCD ALL Y SHEAKLEY UNICOMP N FALSE BOTH GSheet Metal Workers Local 104 (PayerID valid for submission add of PO Box 1138, San Ramon, CA 94583.) 38238 NOCD CA N SHEET METAL 104 N FALSE BOTH GSieba, LTD. 03699 NOCD ALL Y SIEBA LTD N FALSE BOTH GSierra Health and Life 76342 NOCD CA,NV R SIERRA HEALTH SVC Y FALSE BOTH # CSierra Health and Life (Encounters) 76342 NOCD CA,NV R SIERRA HEALTH SVC Y FALSE BOTH # CSierra Health and Life (FFS Claims) (SecureHorizons by UnitedHealthcare) 76342 NOCD ALL R SECUREHORIZONSFFS Y FALSE BOTH # CSierra Health Services Encounters 76343 NOCD CA,NV R SIERRA HEALTH ENC Y FALSE BOTH # CSierra Medical Group (Customer Service 661-480-2047) SMG01 NOCD CA N SIERRA MED GRP N FALSE BOTH GSignifica Benefit Services, Inc. 23250 NOCD ALL Y SIGNIFICA BENEFIT Y FALSE BOTH GSIHO 77153 NOCD ALL N SIHO N FALSE BOTH GSilver Cross Managed Care Organization NASCR NOCD IL Y SILVER CROSS MCO Y FALSE BOTH G


34 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerSilver Star Pace 97691 NOCD ALL Y SILVER STAR PACE N FALSE BOTH GSilverback TPA 37228 NOCD ALL N SILVERBACK TPA N FALSE BOTH GSilverSummit Health Plan 68069 NOCD ALL N SILVERSUMMIT N BOTH GSimply HealthCare Plans 27094 NOCD ALL N SIMPLY HEALTHCARE N FALSE BOTH GSinclair Health Plan 84076 NOCD ALL N SINCLAIR HLTH PLN Y FALSE BOTH GSISCO SISCO NOCD ALL N SISCO N FALSE BOTH GSmith Administrators SMITH NOCD ALL A SMITH ADMINISTRAT N FALSE BOTH GSmoky Mountain Center 13010 NOCD ALL Y SMOKY MTN CENTER Y TRUE BOTH GSolidarity Healthshare 77721 NOCD ALL N SOLIDARITY N FALSE BOTH GSound Health 91131 NOCD All Y SOUND HEALTH N FALSE BOTH GSoundpath Health (Formerly known as Puget Sound Health Partners, Inc.) 42172 NOCD ALL Y PUGET SOUND HP N FALSE BOTH GSouth Atlantic Medical Group SAMG1 NOCD CA Y SO ATLANTIC MED G Y FALSE BOTH GSouth Carolina Solutions 42406 NOCD SC N SOUTH CAROLINA SO Y TRUE BOTH NSouth Central Preferred - PPO York, PA (IHS Gateway Payer) ( Contact Jane Grove for South Central Preferred (717) 851-6715.) CALL CALL ALL Y CALL ENS SUPPORT Y FALSE BOTH GSouth Dakota Chiropractic (Sanford Health Plan) CASD2 NOCD SC R SANFORD HP SD CHI Y FALSE BOTH GSouth Florida Common Services 59065 NOCD FL Y SO FL COMMON SVCS N FALSE BOTH GSouth Florida Musculoskeletal Care 06294 NOCD ALL Y SO FL MUSCULO CAR N FALSE BOTH GSouth Indiana Health Options - HMO SX142 NOCD IN Y SO INDIANA HEALTH Y FALSE BOTH GSouthcare / Healthcare Preferred 25147 NOCD ALL N SOUTHCARE HEALTHC Y FALSE BOTH GSoutheast Iowa Health Plan (Provider ID Required) 86068 NOCD IA Y SE IOWA HLTH PLAN Y FALSE BOTH NSouthern Benefit Services 37318 NOCD ALL N SOUTHERN BENE SVC N FALSE BOTH GSouthern Cal Physicians Managed Care Services SCP01 NOCD CA N SO CAL PHYSICIANS N FALSE BOTH GSouthern California Bakery Drivers Security Fund NWADM NOCD CA N SOCAL BAKERY DRIV Y FALSE BOTH GSouthern California Health Care System aka(CHS Alta Pod by Medpoint and SCHS Alto Pod by MedPoint MPM20 NOCD CA Y SOCAL HLTH CARE S Y FALSE BOTH GSouthern Illinois Healthcare SIHCA NOCD ALL Y SO ILLINOIS HEALT Y FALSE BOTH GSouthland IPA SIPA1 NOCD ALL Y SOUTHLAND IPA N FALSE BOTH GSouthwest Physicians Group SWPG1 NOCD ALL Y SW PHYSICIAN GRP Y FALSE BOTH GSouthwest Service Administrators CX100 NOCD ALL N SW SERVICE ADMINI N FALSE BOTH GSouthwest Service Life 37266 NOCD ALL N SW SERVICE LIFE N FALSE BOTH GSpectera 00773 NOCD ALL Y SPECTERA N FALSE BOTH CSpencer Stuart ARM Ltd. 38416 NOCD ALL Y SPENCER STUART AR N FALSE BOTH GSt James PHO (Call payer for payer ID) CALL NOCD ALL N CALL PAYER Y FALSE BOTH GSt Joseph Health IP062 NOCD CA N ST JOSEPH HLTH CA Y FALSE BOTH GSt Mary's IPA SMIPA NOCD CA N ST MARYS IPA N TRUE BOTH GSt. Barnabas System Health Plan 22240 NOCD ALL N ST BARNABAS HEALT Y FALSE BOTH GSt. Joe High Desert JOEHD NOCD CA N ST JOE HIGH DESER N FALSE BOTH GSt. John's Claims Administration 37264 NOCD ALL N ST JOHNS CLMS ADM N FALSE BOTH GSt. Joseph Heritage Healthcare IP106 NOCD CA Y ST JOSEPH HERITAG N FALSE BOTH NSt. Joseph HUMBOLT County IP059 NOCD CA A ST JOE HUMBOLT CO Y FALSE BOTH GSt. Therese Physician Association 37116 NOCD ALL Y ST THERESE PHYSIC N FALSE BOTH GSt.. Mary's Health Plan Encounters 88082 NOCD ALL Y PROMINENCE HP N FALSE BOTH GStandard Life & Accident (Payer accepts secondary claims only, and Medicare cannot be primary payer.) 01758 NOCD ALL Y STANDARD LIFE AND Y FALSE BOTH GStandard Life & Accident Insurance Co.(Payer only accepts Secondary claims and then only if Primary payer is not Medicare.) 73099 NOCD ALL Y STANDARD LIFE ACC Y FALSE BOTH GStarmark 61425 NOCD All Y STARMARK N FALSE BOTH GState Employees Group Benefits LABLS NOCD LA Y LA STATE EMP GRP Y FALSE BOTH NState Farm (Property & Casualty ) 31059 NOCD ALL N STATE FARM C AND Y FALSE BOTH GState Farm Homeowners Group Medical Plans (Note that payer requires Insured's ID of 11 or 12 digits and exact structure. Otherwise claims will reject.) 31053 NOCD ALL N STATE FARM GROUP Y FALSE BOTH GState Farm Workers Compensation Plans (Note that payer requires Insured's ID of 11 or 12 digits and exact structure. Otherwise claims will reject.) 31053 NOCD ALL N STATE FARM GROUP Y FALSE BOTH GState Merit GA GABLS NOCD GA Y STATE MERIT GA Y FALSE BOTH NSterling Medicare Advantage (Claims containing Dates of service after 4-30-2014, claims should be sent to Wellcare, PayerID 14163) 67829 NOCD ALL Y STERLING MCARE AD N FALSE BOTH GStoner & Associates 31121 NOCD ALL N STONER AND ASSOCI N FALSE BOTH GStones River IPA Amerivantage 57492 NOCD ALL Y STONES RVR IPA AM Y FALSE BOTH GStones River Regional IPA - The Physicians ACO 28943 NOCD TN N STONES RVR IPA TN Y FALSE BOTH NStones River Regional IPA - Windsor 15752 NOCD ALL Y STONES RVR IPA WI Y FALSE BOTH GStones River Regional IPA/BCBST 15750 NOCD ALL N STONES RIVER REG N FALSE BOTH GStudent Resources (UnitedHealthcare) 74227 NOCD ALL Y STUDENT RESOURCES N FALSE BOTH # CSummaCare Health Plan 95202 NOCD ALL Y SUMMACARE HEALTH Y FALSE BOTH G


35 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerSummit Administration Services, Inc. 86083 NOCD ALL Y SUMMIT ADMIN SVCS N FALSE BOTH G

Summit America Insurance Services, Inc. (Student Accident and Sickness, College Sports and NASCC claims only.) 37301 NOCD ALL Y SUMMIT AMERICA IN Y FALSE BOTH GSunAmerica Life Ins Co (NFIC Plan only) 90956 NOCD ALL N SUNAMERICA LIFE N FALSE BOTH GSunflower State Healthcare Plan 68069 NOCD IA Y SUNFLOWER STATE H Y FALSE BOTH GSunshine Health Plan 68069 NOCD ALL Y SUNSHINE HEALTH P Y FALSE BOTH GSuperior Administrators, Inc. 23218 NOCD ALL N SUPERIOR ADMINIST N FALSE BOTH GSuperior Health Plan 68069 NOCD TX Y SUPERIOR HEALTH P Y FALSE BOTH GSuperior Vision Services 13305 NOCD ALL N SUPERIOR VISION S N FALSE BOTH NSutter Connect - Central Valley Med Group (Claims) 77035 NOCD CA Y SUTTER CNTRL CLAI Y FALSE BOTH GSutter Connect - Delta - Claims IP100 NOCD CA Y SUTTER DELTA Y FALSE BOTH GSutter Connect - SIP, SMG, SWMG - Encounters only HM059 NOCD CA Y SUTTER CONNECT EN Y FALSE BOTH GSutter Connect - Solano Regional Medical Group - Claims IP099 NOCD CA Y SUTTER SRMG Y FALSE BOTH G

Sutter Connect - Sutter Gould Medical Foundation - Claims IP091 NOCD CA Y SUTTER SGMF Y FALSE BOTH GSutter Connect East Bay Med Foundation IP130 NOCD CA Y SUTTER CONNECT EA Y FALSE BOTH GSutter Connect East Bay Medical HM065 NOCD CA Y SUTTER EB MEDICA N FALSE BOTH GSutter Connect Sutter Medical Group (SMG,SWMG,SIP) (Please contact Sutter to get set up to send claims, 800-611-5191) Per Provider Testing Required IP092 NOCD CA Y SUTTER MED GROUP Y FALSE BOTH GSutter Connect-Palo Alto Medical Foundation SC050 NOCD CA Y SUTTER PALO ALTO Y FALSE BOTH GSutter East Bay Regional Hosp-Affinity Claims SC052 NOCD CA Y SUTTER EB REG HOS N FALSE BOTH G

Sutter Medical Group of the Redwoods (SMGR) (Please contact Sutter to get setup to send Encounters, 800-611-5191) HM057 NOCD CA Y SMG REDWOODS Y FALSE BOTH GSutter Senior Care SC028 NOCD ALL Y SUTTER SENIOR CAR Y FALSE BOTH GSW Service Administrators 53589 NOCD AZ Y SW SERVICE ADMINI Y FALSE BOTH NSwedish Covenant Hospital 36411 NOCD ALL A SWEDISH COVENANT N FALSE BOTH GSwift Glass Corporation 07040 NOCD ALL Y SWIFT GLASS CORP N FALSE BOTH GTakeCare Insurance Company 98022 NOCD ALL Y TAKECARE INS CO N FALSE BOTH GTalbert Medical Group TALMG NOCD ALL Y TALBERT MED GROUP Y FALSE BOTH GTall Trees Administrators 88067 NOCD ALL Y TALL TREES ADMINI Y FALSE BOTH GTattered Cover, Inc. COMPU NOCD CO N TATTERED COVER IN N FALSE BOTH GTaylor Benefits TAYLR NOCD ALL N TAYLOR BENEFITS N FALSE BOTH GTeachers Health Trust 88019 NOCD ALL Y CCEA WELFARE BENE Y FALSE BOTH GTeamcare 36215 NOCD All Y TEAMCARE N FALSE BOTH GTeamsters Local 631 Security Fund for Southern Nevada NWADM NOCD CA N TEAMSTERS LOC 631 Y FALSE BOTH GTeamsters Miscellaneous Security Trust Fund NWADM NOCD CA N TEAMSTERS MISC SE Y FALSE BOTH GTech-Steel, Inc. 74234 NOCD ALL N TECH-STEEL INC N FALSE BOTH GTelamon 22483 NOCD ALL Y TELAMON N FALSE BOTH GTennCare (Medicaid of Tennessee) TNMCD NOCD TN Y TENNCARE Y TRUE BOTH NTethys Health Ventures 20212 NOCD ALL N TETHYS HLTH VENTU Y FALSE BOTH GTexas Agricultural Cooperative Trust TXABA NOCD ALL Y TX AGRI COOP TRUS N FALSE BOTH GTexas Children's Health Plan 76048 NOCD TX Y TX CHILDREN HLTH N FALSE BOTH GTexas Children's Health Plan (Medicaid) (After 10-08-16, submit claims with payerID TXCSM) TXCSM NOCD TX Y TX CHILD HLTH MCD Y FALSE BOTH GTexas Childrens Star Medicaid (Enrollment verification calls should be directed to 800-990-TCHP (8247)) TXCSM NOCD TX Y TX CHILD STAR MED N FALSE BOTH GTexas First Health Plans TX1ST NOCD TX Y TEXAS 1ST HEALTH Y FALSE BOTH TTexas HealthSpring THS01 NOCD TX Y TEXAS HEALTHSPRIN N FALSE BOTH GTexas Plus HPN11 NOCD TX Y TEXAS PLUS N FALSE BOTH GTexasFirst Health Plan 13185 NOCD ALL Y TEXASFIRST HP N FALSE BOTH GThe Alliance of Wisconsin (Only for ID Cards showing PO Box 44365 Madison WI 53744 as mailing address) 88461 NOCD ALL Y ALLIANCE WI ONLY Y FALSE BOTH CThe Benefit Group TBGNE NOCD ALL Y THE BENEFIT GROUP N FALSE BOTH GThe Boon Group BOONG NOCD ALL Y THE BOON GROUP N FALSE BOTH GThe Care Network 68423 NOCD ALL Y THE CARE NETWORK Y FALSE BOTH GThe Chesterfield Companies 34154 NOCD ALL N THE CHESTERFIELD N FALSE BOTH GThe City of Amarillo COA01 NOCD TX Y CITY OF AMARILLO N FALSE BOTH GThe City of Odessa 75600 NOCD ALL N THE CITY OF ODESS Y FALSE BOTH GThe Health Exchange (Cerner Corporation) 20356 NOCD ALL Y THE HEALTH EXCHAN Y FALSE BOTH GThe Health Plan (Formerly known as Hometown Health Plan of Ohio.) 30757 NOCD OH A HOMETOWN HP OF OH N FALSE BOTH GThe Health Plan (Upper Ohio Valley) 34150 NOCD ALL Y THE HEALTH PLAN Y FALSE BOTH GThe Healthcare Group (THCG) 35206 NOCD ALL N THE HLTHCARE GRP N FALSE BOTH GThe Integrity Benefit Network, Inc. 58200 NOCD ALL N INTEGRITY BEN NET N FALSE BOTH G

The Loomis Company (Call Provider Relations at 610-374-4040 ext. 2438 for procedures prior to submitting electronically.) 23223 NOCD ALL Y LOOMIS COMPANY Y FALSE BOTH G


36 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerThe MEGA Life and Health Insurance Company-OKC (Valid if PO BOX 548801 Oklahoma City OK 73154.) 59227 NOCD ALL N THE MEGA LIFE AND Y FALSE BOTH GThe Oath - Health Partners of Alabama (Now known as HealthSpring HMO/HealthSpring Medicare+Choice) 63092 NOCD ALL N THE OATH OF AL Y FALSE BOTH G

Thomas Cooper (Provider must be enrolled with SC Blue Shield.) SC315 NOCD SC Y THOMAS COOPER Y FALSE BOTH NThree Rivers Preferred MP340 NOCD ALL N THREE RIVERS PREF Y FALSE BOTH NTLC Advantage in Sioux Falls TLC01 NOCD SD R TLC ADV IN SIOUX Y FALSE BOTH GTLC Benefit Solutions TLC79 NOCD ALL Y TLC BENE SOLUTION N FALSE BOTH GToday's Health WITH1 NOCD ALL Y TODAYS HEALTH Y FALSE BOTH TTodays Option (American Progressive and Pyramid Life) 48055 NOCD ALL N TODAYS OPTION APP N FALSE BOTH GTongass Timber Trust 92620 NOCD AK N TONGASS TIMBER TR N FALSE BOTH GTooling & Manufacturing Assoc. 61425 NOCD All Y TOOLING AND MAN N FALSE BOTH GTorrance Hospital IPA THIPA NOCD ALL Y TORRANCE HOSP IPA N FALSE BOTH GTotal Care of NY (As of 4-1-18, claims must be submitted with payer ID 16146) TCARE NOCD NY N NY TOTAL CARE N FALSE BOTH GTotal Care of NY (Former payer ID TCARE) 16146 NOCD NY N NY TOTAL CARE N FALSE BOTH GTotal Carolina Care 68069 NOCD ALL Y TOTAL CAROLINA CA Y FALSE BOTH GTotal Community Care 31182 NOCD ALL Y TOTAL COMMUNITY C Y FALSE BOTH GTotal Healthcare, Inc. 38201 NOCD MI Y TOTAL HEALTHCARE Y FALSE BOTH CTouchpoint Solutions CRM TPS01 NOCD ALL Y TOUCHPOINT SOL CR Y FALSE BOTH GTouchstone Health PSO 23856 NOCD ALL Y TOUCHSTONE HLTH P Y FALSE BOTH GTouchstone Health/Health Net Smart 13402 NOCD ALL Y TOUCHSTONE HEALTH N FALSE BOTH TTR Paul Inc. 37230 NOCD ALL N TR PAUL INC N FALSE BOTH GTransamerica Life Ins/Monumental Life/Stonebridge Life TRP1E NOCD ALL N TRANSAMERICA LIFE Y FALSE BOTH GTranschoice - Key Benefit Admin 37284 NOCD ALL N TRNSCHOICE KEY BE N FALSE BOTH GTranswestern General Agency 74234 NOCD ALL N TRANSWESTERN GEN N FALSE BOTH GTranswestern Insurance Administrators, Inc. TRAN1 NOCD ALL N TRANSWE INS ADMIN N FALSE BOTH GTravis County MAP - Mediview TCMAP NOCD ALL Y TRAVIS COUNTY MAP N FALSE BOTH GTriad Healthcare Inc 39181 NOCD ALL N TRIAD HEALTHCARE N FALSE BOTH G

Tribute Health Plan (Formerly Central Benefits National.) 31118 NOCD ALL Y TRIBUTE HEALTH PL Y FALSE BOTH GTricare East (effective 01-01-2018) TREST NOCD ALL Y TREST N TRUE BOTH NTricare for Life (All Regions 1-12) TDDIR NOCD ALL Y TRICARE FOR LIFE Y TRUE BOTH TTricare Overseas FOREN NOCD ALL Y TRICARE OVERSEAS Y FALSE BOTH G

TRICARE West (UnitedHealthcare Military & Veterans) to use for claims w/DOS on/after 4/1/13) (formerly TriWest) 99726 NOCD MANY Y TRICARE Y TRUE BOTH TTRICARE West / UnitedHealthcare Military & Veterans (formerly TriWest) 99726 NOCD MANY Y TRICARE Y TRUE BOTH TTriHealth Physician Solutions 31144 NOCD ALL N TRIHEALTH PHY SOL N FALSE BOTH GTrilogy Health Network 62777 NOCD ALL Y TRLHN EB N FALSE BOTH GTriple S 97300 NOCD PR N TRIPLE S N FALSE BOTH GTriplefin LLC 64300 NOCD ALL Y TRIPLEFIN LLC Y FALSE BOTH GTrusted Health Plan L0230 NOCD ALL N TRUSTED HLTH PLAN Y FALSE BOTH GTrusteed Plans Service Corporation 91078 NOCD ALL N TRUSTEED PLANS SV N FALSE BOTH GTrustmark (Includes Starmark & TMA) 61425 NOCD All Y TRUSTMARK N FALSE BOTH GTuality Health THA01 NOCD ALL Y TUALITY HEALTH N FALSE BOTH GTuality Health Select THASC NOCD ALL Y TUALILTY HLTH SEL N FALSE BOTH GTufts Associated Health 04298 NOCD ALL Y TUFTS ASSOC HLTH Y FALSE BOTH TUC Davis Health Systems UCDMG NOCD ALL N UC DAVIS HLTH SYS Y FALSE BOTH GUcare of Minnesota 52629 NOCD MN N UCAREOFMN Y FALSE BOTH GUC-Davis Health 94603 NOCD CA Y UC DAVIS HEALTH Y FALSE BOTH GUCHealth Plan Administrators (As of 8/1/14 CSMED, UMA & Phycor combined) 84132 NOCD CO N UNITED MED ALLIAN N FALSE BOTH GUCLA Medical Group USMBP NOCD ALL N UCLA MEDICAL GROU Y FALSE BOTH GUCS (Electrical Workers Insurance Fund Local 5800) 93235 NOCD ALL Y UCS ELEC WORK 580 N FALSE BOTH GUFCW Local 400-5205 (Submitters to UFCW must register with CA Blue Shield at www.blueshieldca.com/provider. If registration NOT completed, claims will reject.) BS001 NOCD CA Y UFCW LOC 400 5205 Y FALSE BOTH GUICI Administrators - State of Nevada 75245 NOCD NV Y NEVADA UICI N FALSE BOTH GUltimate Health Plan 77022 NOCD ALL Y ULTIMATE HP N FALSE BOTH GUltra Benfits Inc. 41206 NOCD ALL N ULTRA BENEFITS IN Y FALSE BOTH GUMC Health Plan 75130 NOCD ALL Y UMC HEALTH PLAN Y FALSE BOTH GUMR (formerly UMR Wausau) former payer ids 31107, 33108, 74223, 75196, 75243) 39026 NOCD All Y UMR WAUSAU Y FALSE BOTH # CUMWA Health & Retirement Funds 52180 NOCD All Y UMWA HEALTH N FALSE BOTH GUnicare Life & Health Insurance Company 80314 NOCD All Y UNICARE LIFE HEAL Y FALSE BOTH PUnified Group Services 35198 NOCD OH Y UNIFIED GRP SERVI Y FALSE BOTH GUnified Health Services 62170 NOCD ALL Y UNIFIED HLTH SERV Y FALSE BOTH G


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CodeSet

(See Legend)

Payer Type


Unified Physicians Network (For Claims rejections, please contact Unified Physicians claim department at 847-763-1700) 34638 NOCD ALL N UNIFIED PHY NETWO Y FALSE BOTH GUniformed Service Family Health Plan 13407 NOCD ALL Y UNIFORMED SVC FHP Y FALSE BOTH GUnion Pacific Railroad Employees Health Systems 87042 NOCD ALL Y UP RAIL EMP HLTH Y FALSE BOTH GUnited Agriculture Benefit Trust UABT1 NOCD ALL N UNITED AG BENEFIT Y FALSE BOTH GUnited Benefits, Inc (a Brown & Brown Company) 59069 NOCD All Y BROWN AND BROWN N FALSE BOTH GUnited Care Medical Group ADCUC NOCD ALL N UNITED CARE MED G N FALSE BOTH GUnited Claim Solutions A0047 NOCD ALL N UNITED CLAIM SOLU N FALSE BOTH GUnited Food & Commercial Workers UFCW Local 1529 21850 NOCD ALL Y UFCW LOCAL 1529 N FALSE BOTH GUnited Food and Commmercial Workers Midwest Unions 36659 NOCD ALL Y UNITED FOOD COMM N FALSE BOTH GUnited of Omaha 71412 NOCD All N UNITED OF OMAHA N FALSE BOTH # PUnitedHealthcare 87726 NOCD All R UNITED HEALTHCARE Y FALSE BOTH # C

UnitedHealthcare (Definity Health Plan) former payer ID 64159 87726 NOCD ALL Y UHC DEFINITY HEAL Y FALSE BOTH # CUnitedHealthcare (Empire Plan) 87726 NOCD ALL Y UHC EMPIRE PLAN Y FALSE BOTH # CUnitedHealthcare / All Savers Alternate Funding 81400 NOCD ALL Y UHC ALL SAVERS Y FALSE BOTH # CUnitedHealthcare / All Savers Insurance 81400 NOCD ALL Y UNITEDHEALTHONE Y FALSE BOTH # CUnitedHealthcare / Oxford 06111 NOCD All Y OXFORD HEALTH PLA N FALSE BOTH # CUnitedHealthcare / Spectera Eyecare Networks 00773 NOCD ALL Y OPTUMHEALTH VISIO N FALSE BOTH CUnitedHealthcare / StudentResources 74227 NOCD TN Y STUDENT INSURANCE Y FALSE BOTH # C

UnitedHealthcare / UHIS-UnitedHealthcare Integrated Services 39026 NOCD ALL Y UHIS UHC SERVICES Y FALSE BOTH # CUnitedHealthcare / UnitedHealthcare of the Mid-Atlantic, MD IPA, Optimum Choice and MAMSI Life and Health (formerly MAMSI) (Former payer ID 52148) 87726 NOCD ALL Y UHC MAHP Y FALSE BOTH # C

UnitedHealthcare / UnitedHealthcare Plan of the River Valley (formerly John Deere Healthcare) former payer id 95378 87726 NOCD ALL Y UHC RIVER VALLEY Y FALSE BOTH # C

UnitedHealthcare Community Plan / Arizona Long Term Care 87726 NOCD AZ Y UHC AZ LONG TERM N FALSE BOTH # CUnitedHealthcare Community Plan / Arizona Long Term Care - BH & SNP 03432 NOCD AZ Y UHC AZIPA Y FALSE BOTH # CUnitedHealthcare Community Plan / AZ (formerly Arizona Physicians IPA and APIPA) 03432 NOCD AZ Y AZ PHYSICIANS IPA Y FALSE BOTH # CUnitedHealthcare Community Plan / AZ (formerly Arizona Physicians IPA and APIPA) 03432 NOCD AZ Y UHC AZIPA Y FALSE BOTH # CUnitedHealthcare Community Plan / CA, DE, FL, HI, IA, LA, MA, MD, MS, NC, NE, NM, NY, OH, OK, PA, RI, TX, VA, WA, WI (formerly AmeriChoice or Unison)NC and OK effective 1/1/2018; former payer id 25175, 86002, 86003, 86048, 86049, 95378 87726 NOCD ALL Y UNITED HEALTHCARE Y FALSE BOTH # CUnitedHealthcare Community Plan / Children's Rehabilitative Services (CRS) former payer id 87726 03432 NOCD AZ Y UHC AZIPA Y FALSE BOTH # CUnitedHealthcare Community Plan / KS - KanCare 96385 NOCD ALL Y KANCARE Y FALSE BOTH # CUnitedHealthcare Community Plan / MI (formerly Great Lakes Health Plan) 95467 NOCD ALL Y GREAT LAKES HEALT Y FALSE BOTH # CUnitedHealthcare Community Plan / NJ (formerly AmeriChoice NJ Medicaid, NJ Family Care, NJ Personal Care Plus) former payer id 86001 86047 NOCD NJ Y AMERICHOICE NJ Y FALSE BOTH # CUnitedHealthcare Community Plan / TN (formerly AmeriChoice TN: TennCare, Secure Plus Complete) 95378 NOCD ALL Y UHC COMMUNITY PLA Y FALSE BOTH # CUnitedHealthcare Community Plan / UnitedHealthcare Dual Complete (formerly Evercare) 87726 NOCD ALL Y UHC DUAL COMPLETE Y FALSE BOTH # CUnitedHealthcare Community Plan / UnitedHealthcare Long Term Care (formerly Evercare) 87726 NOCD ALL Y UHC LONG TERM CAR Y FALSE BOTH # CUnitedHealthcare Community Plan Missouri 86050 NOCD ALL Y UHC COMM PLAN MO Y FALSE BOTH # CUnitedHealthcare Dual Complete - Oxford Medicare Network (UnitedHealthcare Community) 87726 NOCD ALL Y OXFORD MEDICARE N Y FALSE BOTH # CUnitedHealthcare Medicare Solutions (UnitedHealthcare Group Medicare Advantage) 87726 NOCD ALL Y UHC GROUP MCARE A Y FALSE BOTH # CUnitedHealthcare Medicare Solutions / Care Improvement Plus (CIP), XLHealth former payer id 77082 87726 NOCD ALL N CARE IMPROVEMENT Y FALSE BOTH # CUnitedHealthcare Medicare Solutions / UnitedHealthcare Chronic Complete (formerly Evercare) 87726 NOCD ALL Y UHC MEDICARE SOLU Y FALSE BOTH # C

UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareComplete (formerly SecureHorizons) 87726 NOCD ALL Y UHC MEDICARECOMPL Y FALSE BOTH # C


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CodeSet

(See Legend)

Payer Type


UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareDirect (formerly SecureHorizons) 87726 NOCD ALL Y UHC MEDICARE COMP Y FALSE BOTH # C

UnitedHealthcare Medicare Solutions / UnitedHealthcare Nursing Home Plan (formerly Evercare) 87726 NOCD ALL Y UHC MEDICARE SOLU Y FALSE BOTH # CUnitedHealthcare Military & Veterans / TRICARE West 99726 NOCD MANY Y TRICARE Y TRUE BOTH TUnitedHealthcare Vision 00773 NOCD ALL Y OPTUMHEALTH VISIO N FALSE BOTH C

UnitedHealthcare West / Encounters (formerly PacifiCare) 95958 NOCD ALL N UHC WEST ENCOUNTE Y FALSE BOTH # CUnitedHealthcare West / UnitedHealthcare of CA, OK, OR, TX, WA and PacifiCare of AZ, CO, NV 87726 NOCD ALL Y UHC WEST Y FALSE BOTH # CUnitedHealthOne / UnitedHealthcare Life Insurance Company - Golden Rule 37602 NOCD All N GOLDEN RULE INS Y FALSE BOTH # CUnitedHealthOne / UnitedHealthcare Life Insurance Company (formerly American Medical Security) 81400 NOCD ALL Y UNITEDHEALTHONE Y FALSE BOTH # CUnity Health Insurance 66705 NOCD ALL Y UNITY HLTH INSUR Y FALSE BOTH CUnivera Community Health 15003 NOCD ALL Y UNIVERA COMM HLTH N FALSE BOTH GUnivera Health Care Plan/ChoiceCare Buffalo SX087 NOCD ALL Y UNIVERA CC BUFFA N TRUE BOTH NUnivera Healthcare - CNY HC001 NOCD NY Y UNIVERA HC CNY Y FALSE BOTH NUnivera Healthcare (SSA) SX091 NOCD ALL Y UNIVERA HCARE SSA Y TRUE BOTH NUnivera Traditional PPO UNINW NOCD ALL A UNIVERA TRAD PPO N FALSE BOTH NUniversal Care - California (ProviderID required.) 33001 NOCD CA Y UNIVERSAL CARE CA Y FALSE BOTH GUniversity Family Care 09830 NOCD ALL Y UNIVERSITY FAM CA Y FALSE BOTH GUniversity Family Care - Healthcare Group 07503 NOCD ALL Y UNIV FAMILY CARE Y FALSE BOTH GUniversity Family Care - Maricopa Health Plan 09908 NOCD AZ Y MARICOPA HP UFC Y FALSE BOTH GUniversity Family Care - Maricopa Health Plan 09908 NOCD ALL Y UNIV FAMCARE MARI Y FALSE BOTH GUniversity Health Alliance 99026 NOCD ALL Y UNIVERSITY HLTH A Y TRUE BOTH NUniversity Health Care Advantage 46407 NOCD ALL N UNIV HC ADVANTAGE N FALSE BOTH GUniversity Healthcare Marketplace 45437 NOCD ALL A UNIVERSITY HC MAR Y FALSE BOTH GUniversity of Illinois UIC67 NOCD ALL Y UNIVERSITY ILLINO Y FALSE BOTH GUniversity of Maryland Health Advantage 45282 NOCD ALL Y UNIV MD HLTH ADVA Y FALSE BOTH GUniversity of Utah Health Plans SX155 NOCD UT N UT UNIV HLTH PLAN Y TRUE BOTH NUniversity of Washington Students & Graduate Appts. - Grp#P67 91136 NOCD WA Y UNIVERSITY GRP67 N FALSE BOTH GUpland Medical Group (Customer Service Phone number, (909) 291-4400) IP056 NOCD CA Y UPLAND MEDICAL GR Y FALSE BOTH GUPMC Health Plan 23281 NOCD ALL Y UPMC HEALTH PLAN Y FALSE BOTH GUpper Peninsula Health Group TPA 37324 NOCD ALL Y UP PENINSULA TPA N FALSE BOTH GUpper Peninsula Health Plan 38337 NOCD ALL A UP HEALTH PLAN Y FALSE BOTH GUS Benefits 93092 NOCD ALL Y US BENEFITS N FALSE BOTH GUS Family Health Plan (USFHP) USFHP NOCD ALL N USFHP Y FALSE BOTH GUS Virgin Islands Medicaid SKVI0 NOCD VI Y US VI MEDICAID N FALSE BOTH NUSAA 74095 NOCD All Y USAA Y FALSE BOTH GUtah Carpenters 74234 NOCD UT N UTAH CARPENTERS N FALSE BOTH GUtah Laborers 74234 NOCD UT N UTAH LABORERS N FALSE BOTH GUtah Pipe Trades 74234 NOCD UT N UTAH PIPE TRADES N FALSE BOTH GUtica NY FEP (Federal Employee Program) Blue Shield N4FEP NOCD NY Y UTICA NY FEP Y TRUE BOTH GVA Fee Basis Programs 12115 NOCD ALL N VA FEE BASIS PROG Y FALSE BOTH GVA Patient Centered Community Care Program (VAPCCC) Region 3 VAP33 NOCD ALL Y VAPCCC REG 3 Y TRUE BOTH NVA Patient Centered Community Care Program Regions 1,2 and 4 (Please include the VA authorization number when submitting claims.) 68021 NOCD ALL Y VAPCCC REG124 Y FALSE BOTH GVA Patient Centered Community Care Region 6 VAPC6 NOCD AK Y VA PCCC REGION 6 N TRUE BOTH NVA Patient-Centered Community Care Program (VAPCCC) Region 5A VAPC3 NOCD ALL Y VAPCCC5A Y TRUE BOTH NVA State Employer Funds VABLS BCBS VA Y VA STATE EMP FUND Y FALSE BOTH NValir Pace (Formerly Via Christi Hope) 48123 NOCD ALL Y VIA CHRISTI HOPE N FALSE BOTH GValley Baptist Health 82420 NOCD ALL N VALLEY BAPTIST HE N FALSE BOTH GValley Care IPA (Customer Service 805-604-3332) VCIPA NOCD CA N VALLEY CARE IPA Y FALSE BOTH GValley Health Administrators VHA11 NOCD ALL Y VALLEY HLTH ADMIN N FALSE BOTH GValley Health Plan VHP01 NOCD ALL N VALLEY HEALTH Y FALSE BOTH GValley Mental Health 94293 NOCD ALL Y VALLEY MENTAL HEA N FALSE BOTH GValue Options Colorado Medicaid 00815 NOCD CO N VALUE OP CO MCAID Y TRUE BOTH NValue Options Commercial Claims 00813 NOCD ALL N VALUE OPT COMMERC N TRUE BOTH NValue Options Maryland 00823 NOCD ALL Y VALUE OPTIONS MD N TRUE BOTH NValue Options Pennsylvania Medicaid 00817 NOCD PA N VALUE OPT PAMCD N TRUE BOTH NValue Options Texas Northstar 00818 NOCD TX N VAL OPT TX NORTHS N TRUE BOTH N


39 of 41




CodeSet

(See Legend)

Payer Type


ValueOptions/MBHP (For claim rejections please contact [email protected] or 888-247-9311) 43307 NOCD MA Y VALUEOPTIONS MBHP Y TRUE BOTH NVantage Health Plan, Inc. 72128 NOCD ALL N VANTAGE HEALT PLA Y FALSE BOTH GVantage Medical Group PPM01 NOCD ALL A VANTAGE MED GROUP N FALSE BOTH GVAPCCC Region 5B 55916 NOCD ALL Y VAPCCC REG 5B N TRUE BOTH NVENCOR 73288 NOCD ALL Y VENCOR Y FALSE BOTH GVentura County Healthcare Plan VCHCP NOCD CA Y VENTURA CO HCP N FALSE BOTH GVerity VMMH1 NOCD ALL Y VERITY Y FALSE BOTH GVerity Medical Foundation (DCHS Medical Foundation) VMF01 NOCD ALL Y VERITY MEDICAL FO N FALSE BOTH GVerity National Group 75256 NOCD ALL Y VERITY NATL GROUP Y FALSE BOTH GVerity Plus VMMH2 NOCD ALL Y VERITY PLUS Y FALSE BOTH GVestaCare / RH Admin VESTA NOCD ALL N VESTACARE Y FALSE BOTH GVida Care (Now known as Amida Care.) 24818 NOCD ALL N VIDA CARE Y FALSE BOTH GVillageCareMAX 26545 NOCD ALL N VILLAGECAREMAX N FALSE BOTH GVirginia Coordinated Care 84806 NOCD ALL Y VA COORDINATED CA N FALSE BOTH GVirginia Health Network,Inc (To get the payerID, call payer at (804)320-3837) CALL CALL ALL N CALL S&S SUPPORT N FALSE BOTH GVirginia Premier Complete Care VPCCP NOCD ALL N VA PREMIER COMPL N TRUE BOTH NVirginia Premier Elite Plus VPEP1 NOCD VA Y VA ELITE PLUS Y TRUE BOTH NVirginia Premier Health Plan 54176 NOCD VA Y VA PREMIER HP Y TRUE BOTH GVista Oncology New Century Infusion Solutions NCH08 NOCD ALL A VISTA ONCOLOGY NE N FALSE BOTH GViva Health Plan 63114 NOCD ALL Y VIVA HEALTH PLAN N FALSE BOTH GVNA Homecare Options 31626 NOCD ALL N VNA HOMECARE OPTI Y FALSE BOTH GVNS Choice Medicare (Formerly Visiting Nurse Service) 77073 NOCD ALL N VNS CHOICE MEDICA Y FALSE BOTH GVolusia Health Network 59266 NOCD ALL N VOLUSIA HLTH NETW Y FALSE BOTH GVYTRA Healthcare (Provider ID number required. Please call 1-631-420-4100, opt 4, opt 4 for payer set-up and payer assigned provider ID number.) 22264 NOCD All Y VYTRA HEALTHCARE Y FALSE BOTH GWA Blue Cross Regence (UMP) 00932 NOCD WA Y REGENCE BCBS UMP Y FALSE BOTH NWabash Memorial Hospital Association 85256 NOCD ALL Y WABASH MEM HOSPIT Y FALSE BOTH GWashington County Health and Human Services WCHHS NOCD ALL Y WASH COUNTY HHS N FALSE BOTH GWashington State Labor and Industry WALAI NOCD WA N WA LABOR AND INDU Y TRUE BOTH NWashington State Premera Blue Cross WABLC NOCD WA Y WA PREMERA BC Y FALSE BOTH NWaterstone Benefit Administrators 73155 NOCD OK Y WATERSTONE BEN AD Y FALSE BOTH GWatts Healthcare Corp IPA MPM09 NOCD CA N WATTS HC CORP IPA N FALSE BOTH NWEA Insurance Group 39151 NOCD ALL Y WEA INSURANCE GRO Y FALSE BOTH GWeiss Health Providers 36337 NOCD ALL N WEISS HLTH PROVID N FALSE BOTH GWellcare Health Plan, Inc. (Encounters only) 59354 NOCD ALL Y WELLCARE HP ENCOU Y FALSE BOTH GWellcare HMO, Inc. 14163 NOCD ALL Y WELLCARE HMO Y FALSE BOTH GWellcare of CT 14164 NOCD CT Y WELLCARE CT Y FALSE BOTH GWellcare of NY 14164 NOCD NY Y WELLCARE OF NY Y FALSE BOTH GWellMed (Claims) WELM2 NOCD ALL A WELLMED Y FALSE BOTH CWellMed (Encounters) WELMD NOCD ALL A WELLMED ENC Y FALSE BOTH C

Wells Fargo TPA now known as Healthsmart Benefit Solutions 87815 NOCD ALL Y WELLS FARGO TPA Y FALSE BOTH GWellSpan Plus 23266 NOCD ALL N WELLSPAN PLUS N FALSE BOTH GWellSystems, LLC 35245 NOCD ALL N WELLSYSTEMS LLC N FALSE BOTH GWenatchee Valley Medical Center 91064 NOCD ALL N WENATCHEE VLY MED Y FALSE BOTH GWest Coast Stationary Engineers Health & Security Trust Fund - Grp#F13 91136 NOCD ALL Y WEST COAST GRPF13 N FALSE BOTH GWest Suburban Health Providers 80942 NOCD ALL N W SUBURBAN HLTH P Y FALSE BOTH GWest Virginia Family Health Plan 45276 NOCD WV Y WV FAMILY HEALTH Y FALSE BOTH GWestern 39065 NOCD All Y WESTERN N FALSE BOTH GWestern Care 39065 NOCD All Y WESTERN CARE N FALSE BOTH GWestern Grower's Assurance Trust 24735 NOCD ALL Y WEST GROWERS TRUS Y FALSE BOTH GWestern Grower's Insurance Company 24735 NOCD ALL Y WEST GROWERS INS Y FALSE BOTH GWestern Life Ins. Benefit Plan (FORTIS) 39065 NOCD All Y WESTERN LIFE INS N FALSE BOTH GWestern Mutual Insurance 37247 NOCD ALL Y WESTERN MUTUAL IN N FALSE BOTH GWestern Oregon Advanced Health DOCSO NOCD ALL Y WEST OR ADV HLTH N FALSE BOTH GWestern Oregon Advanced Health WOAHM NOCD OR Y WEST OR ADV HLTH Y FALSE BOTH GWestern Southern Financial Group 31048 NOCD ALL N W S FINANCIAL GRO N FALSE BOTH GWestLake Financial Group, Inc. 90560 NOCD ALL Y WESTLAKE FIN GROU Y FALSE BOTH GWeyco Inc. 38232 NOCD ALL Y WEYCO Y FALSE BOTH GWillamette Valley Community Health CCO (Formerly known as Marion Polk Health Plan) MPCHP NOCD ALL Y MARION POLK HP N FALSE BOTH GWilliam C. Earhart Co, Inc. 93050 NOCD GA Y WILLIAM C EARHART Y FALSE BOTH GWilliam J Sutton & Co. Ltd. 98010 NOCD ALL N WILLIAM J SUTTON N FALSE BOTH GWillow Health WHLTH NOCD ALL Y WILLOW HEALTH Y FALSE BOTH GWIN Healthcare (Woman's Integrated Network, Inc.) 13413 NOCD ALL Y WIN HEALTHCARE Y FALSE BOTH G


40 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerWoodman Accident and Life Co (AICT Plans only) 81949 NOCD ALL N WOODMAN ACCIDENT N FALSE BOTH GWorksite Benefit Services 20333 NOCD ALL N WORKSITE BENE SVC Y FALSE BOTH GWPP Eldercare Wisconsin 77080 NOCD ALL N WPP ELDERCARE WIS Y FALSE BOTH GWPPA-ProviDRs Care Network WP481 NOCD ALL Y WPPA PROVIDRS CAR N FALSE BOTH GWPS Commercial OOWPS NOCD WI N WPS COMMERCIAL N TRUE BOTH GWyoming School Boards Association Insurance Trust WYSCH NOCD WY N WY SCHOOL BOARD A Y FALSE BOTH GYale University Health Plan 60646 NOCD ALL N YALE UNIVERSITY H Y FALSE BOTH GYam Hill CCO-PHTech YAMHL NOCD ALL Y YAM HILL CCO PHT Y FALSE BOTH GYerington Paiute Tribe 51350 NOCD ALL Y YERINGTON PAIUTE N FALSE BOTH GZebra Health HC 88858 NOCD ALL Y ZEBRA HEALTH Y FALSE BOTH GZoomCare ZOOM1 NOCD ALL Y ZOOMCARE N FALSE BOTH GZurich Insurance 16535 NOCD ALL N ZURICH INSURANCE N FALSE BOTH G


41 of 41




CodeSet

(See Legend)

Payer Type

Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payerLegend for Report Types ALYNSR TGeneral Payer Information

PCTGNFootnotes

**BOTH

BOTH #

Payer will accept ICD-10 code sets for Dates of Service > 10-01-15 and ICD-9 codes for Dates of Service < 10-01-15Payer has requested that we reject claims using ICD-10 codes for Dates of service < 10-01-15 and claims using ICD-9 codes for Dates of Service > 10-01-15

Secondary claim submission is supported by X12 submitters only

SUMMARY - REPORTS ONLY REJECTION - REPORTS TO BE DETERMINED

LATER DATE - ENS HOPES TO PROVIDE REPORTS FROM THE INSURANCE COMPANY IN THE FUTURE YES - REPORTS ARE PROVIDED NO- REPORTS ARE NOT PROVIDED

ACKNOWLEDGEMENTS ONLYMeaning

NonPar Payers, Direct and NonDirect Connections

PAR Payers, Direct ConnectionsContracted Restricted, Direct ConnectionsTransitional, Direct and NonDirect ConnectionsGateway, NonDirect Connections

OptumInsight Medical Payer List (08/16/2018) - … · OptumInsight Medical Payer List (08/16/2018) 1 of 41 ... Activa Benefits Services, LLC (Formerly Amway Corporation) 38254 NOCD;

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