OptumInsight Medical Payer List (09/16/2020) · Access Behavioral Care COACC NOCD CO S ACCESS BEHAVIORAL Y FALSE G ... LLC (Formerly Amway Corporation) 38254 NOCD ALL Y ACTIVA BENE

OptumInsight Medical Payer List (01/25/2021)

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Payer Name Payer IDClaim Office

NumberState Reports Entered As Secondary** Enrollment Payer

Type

(UCS) Masonry Industry Trust 60230 NOCD ALL Y UCS MASONRY IND T N FALSE G1199 SEIU National Benefit Fund 13162 NOCD ALL Y 1199 NATIONAL BEN Y FALSE G21st Century Insurance and Financial Services 51028 NOCD MN Y 21ST CENTURY INS Y FALSE G2020 Eyecare 2020E NOCD ALL N 2020 EYECARE N FALSE G360 Alliance PPO Gilsbar 07205 NOCD ALL Y 360 ALLIANCE PPOG N FALSE G3P ADMIN 20413 NOCD ALL Y 3P ADMIN Y FALSE G8th Distric Electrical 74234 NOCD UT N 8TH DIST ELECTRIC N FALSE GA & I Benefit Plan Administrators 93044 NOCD ALL N A AND I BENEFIT P Y FALSE GAARP Hospital Indemnity Plans insured by UnitedHealthcare Insurance Company 36273 NOCD ALL Y AARP MEDICARE SUP Y FALSE CAARP Medicare Supplement Plans insured by UnitedHealthcare Insurance Company 36273 NOCD ALL Y AARP MEDICARE SUP Y FALSE CAARP MedicareComplete insured through UnitedHealthcare / Oxford Mosaic Network / Oxford Medicare Network 87726 NOCD ALL Y OXFORD MEDICARE N Y FALSE CAARP MedicareComplete insured through UnitedHealthcare (formerly AARP MedicareComplete from SecureHorizons) 87726 NOCD ALL Y AARP MEDICARECOMP Y FALSE CABMG A0701 NOCD CA Y ABMG N FALSE GAbrazo Advantage Health Plan 03443 NOCD ALL Y ABRAZO ADV HEALTH Y FALSE GAbri Healthplan ABRI1 NOCD ALL N ABRI HEALTHPLAN Y FALSE GAccess Administrators AHS01 NOCD ALL N ACCESS ADMINISTRA N FALSE GAccess Behavioral Care COACC NOCD CO S ACCESS BEHAVIORAL Y FALSE GAccess Medical Group AMG01 NOCD All Y ALLIED MED GROUP N FALSE GAccess Medical Group 95424 NOCD ALL Y ACCESS MEDICAL GR N FALSE GACCLAIM 64071 NOCD All N ACCLAIM Y FALSE GAcclaim IPA MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE GAcclaim IPA (MHCAC) MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE 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 GHealthsmart Benefit Solutions (Wells Fargo TPA, formerly Acordia National) 87815 MCSI ALL Y ACORDIA NATIONAL Y FALSE GACS Benefit Services, inc. 72467 NOCD ALL Y ACS BENEFIT SERVI Y FALSE GACS Benefits Payer Compass PA331 NOCD ALL Y ACS BENE PAYER CO N FALSE GActiva Benefits Services, LLC (Formerly Amway Corporation) 38254 NOCD ALL Y ACTIVA BENE SVCS N FALSE GActivHealthcare AHC01 NOCD ALL Y ACTIVHEALTHCARE N FALSE GAdministrative Services, Inc. 59141 NOCD ALL Y ADMIN SVCS INC Y FALSE GAdminone 37278 NOCD ALL N ADMINONE N FALSE GAdminstrative Concepts, Inc. 22384 NOCD ALL N ADMIN CONCEPTS IN Y FALSE GAdvance Benefit Mgmt Systems USA Incorp 66457 NOCD ALL N ADV BENE MGMT USA Y FALSE GAdvanced Data Solutions 58202 NOCD ALL Y ADVANCED DATA SOL Y FALSE GAdvanstaff, Inc. 74234 NOCD ALL N ADVANSTAFF INC N FALSE GAdvantage Care IPA ACIPA NOCD CA N ADVANTAGE CARE IP Y FALSE GAdvantage Health Network IPA NMM01 NOCD ALL Y ADVANTAGE HLTH IP Y FALSE GAdvantage Health Solutions, Inc. 35209 NOCD ALL N ADVANTAGE HEALTH N FALSE GAdvantage Preferred Plus (Old payerID of 77070 will be valid for a limited time.) 35219 NOCD ALL Y ADVANTAGE PREFERR N FALSE NAdvantek Benefit Administrators 83077 NOCD ALL N ADVANTEK BENEFIT N FALSE GAdvantica Benefits 59374 NOCD ALL A ADVANTICA BENEFIT Y FALSE GAdvanzeon Solutions 59314 NOCD ALL Y ADVANZEON SOLUTIO N FALSE GAdventist Health System 95340 NOCD ALL Y ADVENTIST HLTH SY Y FALSE GAdvocate Health Centers (AHC) 36320 NOCD ALL Y ADVOCATE HEALTH N FALSE GAdvocate Health Partners (PHO) 65093 NOCD ALL Y ADVOCATE HLTH PAR N FALSE GAegis Administrative Services CB637 NOCD ALL Y AEGIS ADMIN SVCS N FALSE GAetna Affordable Health Choices (SM) SRC 57604 NOCD ALL Y AETNA AFFORDABLE Y FALSE GAetna Better Health - PA Medicaid 23228 NOCD PA Y AETNA BH PA MEDIC Y FALSE GAetna Better Health Medicaid IL 26337 NOCD IL N AETNA BH MCAID IL Y FALSE GAetna Better Health Nevada 128NV NOCD NV N AETNA NV N FALSE GAetna Better Health NY 34734 NOCD ALL N AETNA BET HLTH NY N FALSE GAetna Better Health Kansas 128KS NOCD KS N AETNA BET HLTH KS N FALSE GAetna Better Health of Illinois Inc

68024 NOCD IL YAETNA BETTER HEALTH OF ILLINOIS INC Y FALSE G

Aetna Better Health of Kentucky 128KY NOCD KY Y AETNA BET HLTH KY Y FALSE GAetna Better Health of Louisiana 128LA NOCD LA Y AETNA BH LOUISIAN Y FALSE GAetna Better Health of Maryland 128MD NOCD MD Y AETNA MD N FALSE GAetna Better Health of Michigan 128MI NOCD MI Y AETNA BH MICHIGAN Y FALSE GAetna Better Health of New Jersey 46320 NOCD NJ Y AETNA BH NEW JERS Y FALSE GAetna Better Health of Ohio 50023 NOCD ALL Y AETNA BTTR HLTH O Y FALSE GAetna Better Health of Virginia 128VA NOCD VA Y AETNA BH VA Y FALSE GAetna Better Health of West Virginia 128WV NOCD WV Y AETNA BTR HLTH WV Y FALSE GAetna Health Plan - PPO 60054 NOCD All Y AETNA HEALTH PLAN Y FALSE GAetna Life & Casualty Company 60054 NOCD All Y AETNA Y FALSE G

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


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Type

Aetna Life & Casualty Company 60054 NOCD All Y AETNA LIFE Y FALSE GAetna Life & Casualty Company 60054 NOCD All Y AETNA LIFE INSUR Y FALSE GAetna Life & Casualty Company 60054 NOCD All Y AETNA LIFE INSURA Y FALSE GAffiliated Doctors of Orange County ADOCS NOCD CA Y AFFIL DOCS OF OC Y FALSE GAffiliated Physicians IPA POP06 NOCD ALL Y AFF PHYSICIANS IP N FALSE GAffinity Essentials 23334 NOCD ALL Y AFFINITY ESSENTIA Y FALSE 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 GAFFINITY MEDICAL GROUP 46594 NOCD ALL N AFFINITY MED GROU N FALSE 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 GAgewell New York AWNY6 NOCD ALL Y AGEWELL NEW YORK N FALSE GAgua Caliente AGUA1 NOCD ALL Y AGUA CALIENTE N FALSE GAHPO (Cleveland, OH) 31138 NOCD OH Y AHPO CLEVELAND OH Y FALSE GAIG Chartis 19402 NOCD ALL Y AIG CHARTIS N FALSE GAIG Educational Markets (Formerly Maksin Management Corporation) 22195 NOCD ALL Y AIG EDUC MARKETS Y FALSE GAKM Medical Group IP080 NOCD CA N AKM MEDICAL GROUP Y FALSE GAlameda 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 TRUE TAlamitos IPA (Customer Service 562-602-1563) AIPAZ NOCD CA N ALAMITOS IPA Y FALSE GAlaska Childrens Services, Inc 91136 NOCD AK Y ALASKA CHILD SVCS Y FALSE GAlaska Laborers Construction Industry Trust 91136 NOCD AK Y AK LABORERS TRUST N FALSE GAlaska Pipe Trades Local 375 91136 NOCD AK Y AK PIPE LOCAL 375 N FALSE G

Alaska United Food & Commercial Workers Health & Welfare Trust 91136 NOCD AK Y AK UNITED FOOD TR N FALSE GAlbuquerque Public Schools 85600 NOCD ALL A ALBUQUERQUE PS N FALSE GAlexian Brothers Community Services of Tennessee 44423 NOCD ALL Y ALEXIAN BROTHERS N FALSE GAliCare 13550 NOCD ALL Y ALICARE Y FALSE GAlignment Healthcare CCHPC NOCD ALL Y ALIGNMENT HCARE N FALSE GAll Savers Insurance / UnitedHealthcare 81400 NOCD ALL N UNITEDHEALTHONE Y FALSE C

AllCare (Must contact AllCare, 800-564-6901 for setup and payerID.) CALL CALL ALL N CONTACT SUPPORT N FALSE GAllCare PEBB 26158 NOCD ALL Y ALLCARE PEBB N FALSE GAlivi Health ALIVI NOCD ALL N ALIVI HEALTH N FALSE GAliera Health Care ALH01 NOCD ALL N ALIERA HEALTH N FALSE GAllegian Choice 55649 NOCD ALL Y ALLEGIAN CHOICE N FALSE GAllegiance Benefit Plan Management, Inc. 81040 NOCD ALL Y ALLEGIANCE BENEFI Y FALSE GAlliance Coal Health Plan 93658 NOCD ALL N ALLIANCE COAL N FALSE GAlliance Physicians High Desestt 22417 NOCD A;LL Y ALL PHYS HIGH DES Y FALSE GAlliant Health Plans of Georgia 58234 NOCD GA Y ALLIANT GEORGIA N FALSE GAllied Benefit Systems 37308 NOCD ALL Y ALLIED BENEFIT Y FALSE GAllied Physicians of California IPA NMM01 NOCD ALL Y ALLIED PHYS OF CA Y FALSE GAlohaCare ALOHA NOCD HI N ALOHACARE N TRUE NAlpha Care Medical Group ACMG1 NOCD CA N ALPHA CARE MEDICA N FALSE GAlphaCare ALPHA NOCD ALL N ALPHACARE N FALSE GAlphacare Medical Group MPM32 NOCD ALL N ALPHACARE MEDICAL Y FALSE GAlta Bates Medical Group A0701 NOCD CA Y ABMG N FALSE GAltaMed ALTAM NOCD ALL N ALTAMED Y FALSE GAlternative Opportunities 16089 NOCD ALL Y ALTERNATIVE OPPOR N FALSE GAmalgamated Life - PA/Alicare 13343 NOCD ALL Y AMALGAMATED LIFE Y FALSE G

Amalgamated Transit Union Division 1001 Health & Welfare Fund COMPU NOCD CO N AMALG TRANSIT UNI N FALSE GAmbetter of Arkansas 68069 NOCD ALL Y AMBETTER Y FALSE GAmeraPlan 38219 NOCD ALL Y AMERAPLAN Y FALSE GAmeriben - IEC Group 97661 NOCD ALL Y AMERIBEN IEC GROU N FALSE GAmeriben Solutions 75137 NOCD ALL Y AMERIBEN SOLUTION N FALSE GAmericaid Community Care (Houston) 27515 NOCD TX Y AMERICAID HOUSTON Y FALSE TAmerican Administrative Group - AAG (Formerly known as UICI Administrators 75240 NOCD ALL Y AAG N FALSE GAmerican Administrative Group (formerly Gallagher Benefit) 37283 NOCD ALL A AMERICAN ADMINIST N FALSE GAmerican Behavioral 63103 NOCD ALL N AMERICAN BEHAVIOR Y FALSE GAmerican Benefits Plan Administrators (Las Vegas, NV) 59140 NOCD NV A AM BENEFITS PLAN Y FALSE GAmerican Family (administered by American Republic) 56071 NOCD ALL N AM FAMILY INSURAN N FALSE GAmerican Family Health Providers IP080 NOCD CA N AM FAMILY HLTH PR Y FALSE GAmerican Family Insurance TH095 NOCD ALL Y AMERICAN FAMILY I N FALSE GAmerican Fidelity Assurance Company 60801 NOCD ALL Y AMERICAN FIDELITY N FALSE G



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Type

American General 62030 NOCD ALL N AMERICAN GENERAL Y FALSE GAmerican Healthcare Alliance 01066 NOCD ALL N AM HEALTHCARE ALL Y FALSE GAmerican Insurance Company of TX 81949 NOCD ALL N AMER INS OF TEXAS N FALSE 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 GAmerican National Insurance Co 74048 NOCD ALL Y AMER NAT INSURANC N FALSE GAmerican Postal Workers Union Health Plan 44444 NOCD All Y AMERICAN POSTAL W Y FALSE GAmerican Postal Workers Union Health Plan 44444 NOCD All Y APWU Y FALSE GAmerican Republic Insurance Company 42011 NOCD ALL N ARIC N FALSE GAmerican Specialty Health ASH01 NOCD ALL Y AM SPECIALTY HLTH N FALSE GAmerican Therapy Administrators ATA Wisconsin ATHAL NOCD ALL Y ATA WISCONSIN N FALSE GAmerican Worker Health Plan 37322 NOCD ALL N AMERICAN WORKER H Y FALSE GAmericas 1st Choice Health Plans of South Carolina 20553 NOCD ALL R AMERICAS FIRST CH Y FALSE GAmericas 1st Choice of South Carolina, Inc. 55349 NOCD ALL Y AM FIRST CHOICE S N FALSE GAmerica's Choice NMA 20029 NOCD ALL Y AMERICAS CHOICE N Y FALSE GAmerica's Health Choice 21810 NOCD ALL Y AMERICAS HEALTH C N FALSE GAmerica's PPO (Formerly known as ARAZ.) 16120 NOCD ALL Y AMERICAS PPO ARAZ Y FALSE GAmerica's PPO / America's TPA 41178 NOCD ALL Y AMERICAS PPO Y FALSE GAmeriChoice NJ, Medicaid, NJ Family Care (UnitedHealthcare Community Plan) 86047 NOCD NJ Y UHC COMMUNITY NJ Y FALSE CAmerigroup - Illlinois 28804 NOCD ALL Y AMERIGROUP N FALSE GAmerigroup - Maryland and District of Columbia 28807 NOCD MD,DC N AMERIGROUP MD N FALSE TAmerigroup - New Jersey 28806 NOCD NJ N AMERIGROUP NJ N FALSE GAmerigroup of Iowa 26375 NOCD ALL Y AMERIGROUP IOWA N FALSE GAmerigroup / Americaid - Houston 28805 NOCD TX Y AMERIGROUP HOUSTO N FALSE TAmerigroup Houston (Claims and Encounters) 26374 NOCD TX Y AMERIGROUP HOUST N FALSE GAmerigroup Illinois (Claims and Encounters 27518 NOCD IL Y AMERIGROUP ILLINO N FALSE GAmerigroup Multiple States (Claims and Encounters) 26378 NOCD ALL Y AMERIGROUP MULTI N FALSE GAmerigroup of Florida 28809 NOCD FL Y AMERIGROUP OF FL N FALSE TAmerigroup Ohio (Claims and Encounters 27518 NOCD OH Y AMERIGROUP OHIO N FALSE GAmeriHealth - New Jersey (Non-HMO Claims) SX075 NOCD ALL Y AMERIHEALTH NJ Y TRUE NAmeriHealth Administrators 54763 NOCD ALL Y AMERIHEALTH ADMIN N FALSE GAmeriHealth Caritas Louisiana (Formerly known as LA Care) 27357 NOCD LA Y LA CARE N FALSE GAmeriHealth Caritas Healthplan New Hampshire 87716 NOCD NH Y NH CARITAS N FALSE GAmeriHealth Caritas VIP Care 77062 NOCD ALL N AMERIHLTH CARITAS Y FALSE GAmeriHealth Caritus VIP Care Plus (Michigan) 77013 NOCD MI Y AH CARITUS VIP CA N FALSE GAmerihealth Delaware 77799 NOCD ALL N AMERIHEALTH DE N FALSE GAmerihealth District of Columbia (For EDI Support, please email [email protected] or call 1-888-656-2383) 77002 NOCD ALL Y AMERIHEALTH DC N FALSE GAmeriHealth HMO New Jersey and Delaware 23037 NOCD NJ,DE Y AMERIHEALTH HMO Y TRUE GAmerihealth HMO NJ and Delaware 95044 NOCD NJ DE Y AHLTH HMO NJ & DE Y TRUE N

AmeriHealth Mercy Health Plan (Name has changed to AmeriHealth Caritas Pennsylvania. Claims containing Dates of Service on or after Jan. 1, 2021 will need to be sent under this payer ID). 22248 NOCD All Y AMERIHEALTH MERCY Y FALSE GAmeriHealth NorthEast (Dates of Service on or before Dec. 31, 2020, may continue to use the following until Dec. 31, 2021. For dates of service 01/01/21 or after use payer ID 22248} 77001 NOCD ALL Y AMERIHEALTH NE Y FALSE GAmerikids-Dallas/Ft. Worth 26374 NOCD TX Y AMERIKIDS DALLAS N FALSE GAmerivantage 26375 NOCD ALL Y AMERIGROUP IOWA N FALSE GAmfirst Insurance Company 64090 NOCD ALL Y AMFIRST INS CO Y FALSE GAM-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 GAmida Care (Formerly Vida Care.) 24818 NOCD ALL N AMIDA CARE Y FALSE GAmida Care Medicare 79966 NOCD ALL Y AMIDA CARE MEDICA N FALSE GAMVI IP080 NOCD CA N AMVI Y FALSE GAmway Corporation 38254 NOCD All Y AMWAY N FALSE GAnaheim Memorial IPA (MHCAN) MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE GAnchor Benefit Consulting 53085 NOCD ALL A ANCHOR BENEFIT CO N FALSE GAncillary Benefits/Arizona Foundation for Medical Care AZFMC NOCD ALL Y ANCILLARY BENEFIT Y FALSE PAnerican Founders Life Ins Co (NFL Plans only) 98205 NOCD ALL N AMERICAN FOUNDERS N FALSE GAngeles IPA (SynerMed) 75299 NOCD ALL Y ANGELES IPA SYNER N FALSE GAntares Management Solutions 34192 NOCD ALL Y ANTARES MGMT SOLN Y FALSE GAnthem BCBS Indiana 00630 NOCD IN Y ANTHEM BCBS IN Y FALSE GAnthem BCBS Virginia 00423 NOCD VA Y ANTHEM BCBS VA Y FALSE GAnthem Blue Cross of California BC001 NOCD CA Y CA BLUE CROSS Y FALSE GAnthem Medicaid (WI) (Formerly BadgerCare) WIBLS NOCD WI N ANTHEM WI MEDICAI Y FALSE NAnthem of Colorado COBLS BCBS CO Y CO ANTHEM Y FALSE NAnthem of Nevada NVBLS NOCD NV N NV ANTHEM Y FALSE N



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Type

Apex Benefit Services (Claims must contain the rendering provider ID or the claim will reject.) 34196 NOCD ALL N APEX BENE SERVICE Y FALSE G

APEX Healthcare (Now knows as Access Community Health Network) ACCOM NOCD ALL Y APEX HEALTHCARE N FALSE GApostrophe 81312 NOCD ALL N APOSTROPHE N FALSE GARAZ (Now known as America's PPO.) 16120 NOCD ALL Y ARAZ Y FALSE GArbor Health 52312 NOCD ALL N ARBOR HEALTH Y FALSE GArcadian Management Services, Inc (Group number should be entered if available. ) 61101 NOCD All Y ARCADIAN MGMT SVS Y FALSE GArgus Dental and Vision ARGUS NOCD ALL N ARGUS N FALSE GArise Health Plan (Formerly Prevea Health) 39185 NOCD ALL Y ARISE HEALTH PLAN N FALSE TArizona Foundation for Medical Care AZFMC NOCD AZ Y AZ FOUNDATION MED Y FALSE PArizona Medicaid (AHCCCS) AZMCD NOCD AZ Y AZ MEDICAID Y FALSE NArizona 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 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 GArizona Priority Care Plus 27154 NOCD ALL N AZ PRIORITY CARE N FALSE G

Arkansas 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 GArkansas Managed Care Organization (AMCO) 62176 NOCD AR Y AR MCO Y FALSE GArkansas Total Care 68069 NOCD AR Y AK TOTAL CARE Y FALSE GArnett Health Plan - former payer id 95440 87726 NOCD ALL Y ARNETT HEALTH PLA Y FALSE CArroyo Viata Family Health Center NMM01 NOCD ALL Y ARROYO VISTA FAM Y FALSE GArta Health Network OCN01 NOCD CA N ARTA HLTH NETWORK Y FALSE GASAGEHA 06603 NOCD ALL Y ASAGEHA N FALSE GAsian American Medical Group AAMG1 NOCD CA N ASIAN AMERICAN MG N FALSE GAspen Insurance 16180 NOCD ALL N ASPEN INSURANCE Y FALSE GAspire Health Plan 46156 NOCD ALL N ASPIRE HEALTH PLA Y FALSE GASR Corporation 38265 NOCD ALL Y ASR CORPORATION Y FALSE GASRM Corporation ASRM1 NOCD ALL Y ASRM CORP N FALSE GAssociates for Healthcare 36326 NOCD ALL Y ASSOC HEALTHCARE Y FALSE 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 GAssured Benefits Administrators 74240 NOCD ALL Y ASSURED BENEFITS Y FALSE GAsuris 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 GAsuris NW Health 93221 NOCD ALL Y ASURIS NW HEALTH Y FALSE GAtlantic Medical 22285 NOCD ALL N ATLANTIC MEDICAL N FALSE GAtlantis Eye Care AEC01 NOCD ALL Y ATLANTIS EYE CARE Y FALSE GAtlas Life Ins Co (NFIC Plan only) 90956 NOCD ALL N ATLAS LIFE INS CO N FALSE GAtrio Health Plan (Formerly known as Marion Polk Health Plan Advantage) MPCHA NOCD ALL Y MARION POLK HP AD N FALSE GAultcare MNAUL NOCD OH N AULTCARE Y TRUE NAutomated Benefit Services (ABS) 38259 NOCD ALL Y AUTOMATED BEN SVC N FALSE GAutomated Group Administration, Inc. 37280 NOCD ALL N AUTOMATED GROUP A Y FALSE G

Automotive Machinists Local 289 Health & Welfare Trust - Grp#F32 91136 NOCD ALL Y AUTO GRP F32 N FALSE GAvalon 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 GAvalon Healthcare Solutions North Carolina AVA02 NOCD NC N AVALON HEALTHCARE N TRUE NAvalon IPA IP080 NOCD CA N AVALON IPA Y FALSE GAvante Health (Customer Service 559-261-9060) AH001 NOCD ALL N AVANTE HEALTH Y FALSE GAvectus Healthcare Solutions (Call 855-AVECTUS) MP001 NOCD ALL N MEDPAY FIRST ONE FALSE GAvera Health Plans 46045 NOCD ALL Y AVERA HEALTH PLAN Y FALSE GAvesis Third Part Administrators 87098 NOCD ALL Y AVESIS TPA Y FALSE GAVMED 59274 NOCD FL Y AVMED Y FALSE NAVMED-Parity Healthcare (OB/GYN only) 58204 NOCD FL Y AVMED PARITY Y FALSE GAxminister Medical Group AXM01 NOCD ALL N AXMINISTER MED GR Y FALSE GAZ Integrated Physicians NCHON NOCD ALL N AZ INTEGRATED PHY N FALSE GBakersfield Family Medical Center BKRFM NOCD ALL N BAKERSFIELD FAMIL Y FALSE G

Bakery & Confectionery Union and Industry International Health BCTF1 NOCD ALL N BAKERY UNION N FALSE GBanner Health 12X42 NOCD ALL Y BANNER HEALTH Y FALSE GBanner Health & Aetna Health Insurance Company 67895 NOCD ALL Y AETNA BANNER HLTH Y FALSE GBanner Medisun 77078 NOCD ALL N BANNER MEDISUN Y FALSE G

Banner University Family Care (University of Arizona Health Plans) 66901 NOCD ALL A BANNER UNIV OF AZ Y FALSE G



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Type

Baptist Health South Florida 65026 NOCD ALL N BAPTIST HLTH S FL N FALSE GBaycare Life Management 59279 NOCD ALL N BAYCARE LIFE MGMT N FALSE GBaycare Select Health Plans Incorp 81079 NOCD ALL Y BAYCARE SELECT Y FALSE GBCBS Of Vermont SB915 NOCD VA N BCBS VA N FALSE NBCBS Of Michigan (Dental Claims Only) BBMDQ NOCD MI N BCBS MI DENTAL N FALSE GBCBS of Texas Medicaid (Plan effective December 1, 2015) 66001 NOCD TX Y BCBS TEXAS MEDICA N FALSE GBCBS Western NY Medicaid WNYMD NOCD NY Y BCBS W NY MEDICAI Y FALSE NBeacon Health Options BHOVO NOCD ALL N BEACON HLTH OPTIO N TRUE GBeacon of Life 65432 NOCD ALL Y BEACON LIFE N FALSE GBehavioral Health Systems 63100 NOCD ALL N BEHAVIORAL HS N FALSE GBella Vista Med Grp IPA MPM10 NOCD CA N BELLA VISTA MED G N FALSE NBenefit & Risk Management Services (Commercial Medicare under Med3000) 99320 NOCD ALL N BENE RISK MGMT SV N FALSE GBenefit Administration Services 41205 NOCD ALL Y BENEFIT ADMIN SVC Y FALSE GBenefit Administrative Systems 36149 NOCD ALL Y BENE ADMIN SYSTEM Y FALSE GBenefit Concepts 51037 NOCD ALL Y BENEFIT CONCEPTS N FALSE GBenefit Coordinators Corporation 25145 NOCD ALL N BENEFIT COOR CORP N FALSE GBenefit Management LLC/VBA 88092 NOCD ALL Y BENE MGMT LLC VBA Y FALSE GBenefit Management Services 56139 NOCD ALL N BENE MGMT SVCS Y FALSE GBenefit Management Systems, Inc of Mississippi 37212 NOCD MS Y BMS OF MS Y FALSE G

Benefit 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 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 GBenefit Systems and Services, Inc. 36342 NOCD All Y BENEFIT SYSTEMS Y FALSE GBenefit Trust Life Insurance Company 61425 NOCD All Y BENEFIT TRUST LIF N FALSE GBenesight (formerly The TPA) 87265 NOCD ALL Y BENESIGHT N FALSE GBeneSys, Inc. (Now known as Sheet Metal Workers Local 104) 38238 NOCD ALL N BENESYS INC MI N FALSE GBenmark BNMK1 NOCD ALL N BENMARK N FALSE GBerkshire Health Partners 23243 NOCD ALL N BERKSHIRE HLTH PA Y FALSE GBerkshire Intergroup 10956 NOCD ALL Y BERKSHIRE INTERGR N FALSE GBest Life & Health Insurance Co. 95604 NOCD ALL N BEST LIFE AND HEA Y FALSE GBetter 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 GBeverly Alianza IPA POP05 NOCD ALL Y BEVERLY ALIANZA I N FALSE GBHP-Unity 44219 NOCD ALL R BHP UNITY Y FALSE GBHSF International 67668 NOCD ALL Y BHSF INTERNATIONA N FALSE GBig Lots Associates Benefit Plans CX025 NOCD ALL N BIG LOTS ASSOC BE N FALSE GBIND (UHC Choice Plus Multiplan) 25463 NOCD ALL N BIND N FALSE GBlock Vision of Texas BVTX1 NOCD TX Y BLOCK VISION TX Y FALSE GBlock Vision, Inc. BV001 NOCD ALL Y BLOCK VISION INC Y FALSE GBlue Advantage of Arkansas ARBLS NOCD AR Y AR BLUE ADVANTAGE Y TRUE NBlue Care PPO VABLS BCBS VA Y BLUECARE PPO Y FALSE NBlue Chip of Rhode Island RICHP NOCD RI Y RI BLUE CHIP Y FALSE NBlue Choice Medicaid 00403 NOCD SC Y BLUE CHOICE MCAID Y FALSE NBlue Choice of Rochester NY N6BLS NOCD NY Y ROCHESTER BLUE CH Y FALSE NBlue Choice of South Carolina 00922 NOCD SC N BLUE CHOICE OF SC N FALSE GBlue Cross Blue Shield Michigan Medicare MIMCR NOCD MI Y BCBS MI MEDICARE Y TRUE NBlue Cross Blue Shield of Florida FLBLS BCBS FL Y FL BLUE SHIELD Y FALSE NBlue Cross Blue Shield Of Western New York N1BLS NOCD ALL N BCBS OF WEST NY Y FALSE GBlue 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 GBlue Cross Complete 32002 NOCD ALL Y BLUE CROSS COMPLE Y FALSE GBlue Cross IA COB SB645 NOCD MT,IL,TX,OK N BLUE CROSS IA N FALSE GBlue 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 NBlue Cross MI Blue Care Complete MIBCN NOCD MI N MI BLUE CARE Y TRUE NBlue Cross of California BC001 NOCD CA Y CA BLUE CROSS Y FALSE GBlue Cross of Idaho IDBLC BCBS ID Y ID BLUE CROSS Y TRUE NBlue Grass Family Health (SRRIPA) 15754 NOCD ALL N BLUE GRASS FAMILY Y FALSE GBlue Lake Rancheria IP061 NOCD CA N BLUE LAKE RANCHER Y FALSE GBlue Medicare of North Carolina (Contracted providers only. Call 888-296-9790) CALL NOCD NC Y CALL SUPPORT Y FALSE NBlue Shield of Alabama ALBLS NOCD AL Y AL BLUE SHIELD Y FALSE NBlue Shield of Alaska AKBLS NOCD AK N AK BLUE SHIELD Y FALSE NBlue Shield of Arizona AZBLS NOCD AZ Y AZ BLUESHIELD Y FALSE N



6 of 41



Type

Blue Shield of Arkansas ARBLS NOCD AR Y AR BLUE SHIELD Y TRUE NBlue Shield of California BS001 NOCD CA Y CA BLUE SHIELD Y FALSE GBlue Shield of Central NY HMO/PPO N2BLS NOCD NY Y CE NY BLUE SHIELD Y FALSE NBlue Shield of Colorado COBLS BCBS CO Y CO BLUE SHIELD Y FALSE NBlue Shield of Connecticut CTBLS NOCD CT Y CT BLUE SHIELD Y FALSE NBlue Shield of Delaware DEBLS BCBS DE Y DE BLUE SHIELD Y TRUE NBlue Shield of Georgia (State Health of GA) GABLS BCBS GA Y GA BLUE SHIELD Y FALSE NBlue Shield of Hawaii HIBLS NOCD HI N HI BLUE SHIELD Y TRUE NBlue Shield of Idaho (Per Provider Testing) IDBLS BCBS ID Y ID BLUE SHIELD Y FALSE NBlue Shield of Illinois ILBLS BCBS IL Y IL BLUESHIELD Y FALSE NBlue Shield of Indiana INBLS NOCD IN Y IN BLUE SHIELD Y FALSE NBlue Shield of Iowa IABLS BCBS IA N IA BLUE SHIELD Y TRUE 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 NBlue Shield of Kansas KSBLS BCBS KS Y KS BLUE SHIELD N FALSE NBlue Shield of Kansas City KCBLS NOCD KS,MS Y KC BLUE SHIELD N FALSE NBlue Shield of Kentucky KYBLS NOCD KY Y KY BLUE SHIELD Y FALSE NBlue Shield of Louisiana LABLS NOCD LA N LA BLUE SHIELD Y TRUE NBlue Shield of Maine MEBLS NOCD ME Y ME BLUE SHIELD Y FALSE NBlue Shield of Maryland MDBLS BCBS MD Y MD BLUE SHIELD Y FALSE NBlue Shield of Massachusetts MABLS NOCD MA Y MA BLUE SHIELD Y FALSE NBlue Shield of Michigan MIBLS NOCD MI Y MI BLUE SHIELD Y TRUE NBlue Shield of Minnesota MNBLS NOCD MN N MN BLUE SHIELD Y FALSE NBlue Shield of Mississippi MSBLS NOCD MS Y MS BLUE SHIELD Y TRUE NBlue Shield of Missouri MOBLS NOCD MO Y MO BLUE SHIELD Y FALSE NBlue Shield of Montana MTBLS BCBS MT Y MT BLUE SHIELD Y FALSE NBlue Shield of National Capital Area NCABS NOCD DC VA MD Y NCA N FALSE NBlue Shield of Nebraska NEBLS BCBS NE Y NE BLUE SHIELD Y FALSE NBlue Shield of Nevada NVBLS NOCD NV Y NV BLUE SHIELD Y FALSE NBlue Shield of New Hampshire NHBLS NOCD NH Y NH BLUE SHIELD Y FALSE NBlue Shield of New Jersey 22099 NOCD NJ Y NJ BLUESHIELD Y TRUE NBlue Shield of New Mexico NMBLS NOCD NM Y NM BLUE SHIELD Y FALSE NBlue Shield of New York (Empire) NYBLS NOCD NY N NY BLUE SHIELD Y FALSE NBlue Shield of North Carolina NCBLS NOCD NC Y NC BLUE SHIELD Y FALSE NBlue Shield of North Dakota NDBLS BCBS ND N ND BLUE SHIELD Y FALSE NBlue Shield of Northeast NY N5BLS NOCD NY Y NE NY BLUE SHIELD Y FALSE NBlue Shield of Ohio OHBLS NOCD OH Y OH BLUE SHIELD Y FALSE NBlue Shield of Oklahoma OKBLS BCBS OK Y OK BLUE SHIELD Y FALSE NBlue Shield of Oregon ORBLS NOCD OR Y OR BLUE SHIELD Y FALSE NBlue Shield of Pennsylvania PABLS NOCD PA Y PA BLUE SHIELD Y TRUE NBlue Shield of Rhode Island RIBLS NOCD RI Y RI BLUE SHIELD Y FALSE NBlue Shield of Rochester NY N7BLS NOCD NY Y ROCHESTER BLUE SH Y FALSE NBlue Shield of South Carolina SCBLS NOCD SC Y SC BLUE SHIELD Y FALSE NBlue Shield of South Dakota SDBLS BCBS SD N SD BLUE SHIELD N TRUE NBlue Shield of Tennessee TNBLS BCBS TN Y TN BLUE SHIELD Y TRUE NBlue Shield of Texas TXBLS NOCD TX Y TX BLUE SHIELD Y FALSE GBlue Shield of Utah UTBLS NOCD UT Y UT BLUE SHIELD Y FALSE NBlue Shield of Utica NY N4BLS NOCD NY Y UTICA BLUE SHIELD Y FALSE NBlue Shield of Vermont VTBLS NOCD VT N VT BLUE SHIELD N FALSE NBlue Shield of Virginia VABLS BCBS VA Y VA BLUE SHIELD Y FALSE NBlue Shield of West Virginia WVBLS NOCD WV Y WV BLUE SHIELD Y TRUE NBlue Shield of Western New York N1BLS NOCD NY Y NY BLUE SHIELD WE Y TRUE NBlue Shield of Wisconsin WIBLS NOCD WI N WI BLUE SHIELD Y FALSE NBlue Shield of Wyoming WYBLS BCBS WY Y WY BLUE SHIELD Y FALSE NBluebonnet Administrators 37121 NOCD LA N BLUEBONNET ADMINI Y FALSE GBoilermakers national Health & Welfare Fund 36609 NOCD ALL Y BOILERMAKERS NATL Y FALSE GBollinger, INC. BOLL1 NOCD ALL N BOLLINGER INC Y FALSE NBoncura Health (Dupage Medical Group) DMG01 NOCD ALL N BONCURA HEALTH N FALSE GBoon-Chapman Benefit Administrators, Inc. 74238 NOCD ALL Y BOON CHAPMAN BENE N FALSE GBoston Medical Center Healthnet 13337 NOCD MA N BOSTON MED CENTER Y FALSE GBPS Inc 48964 NOCD ALL Y BPS INC Y FALSE GBrand New Day (Encounters) UC002 NOCD ALL N BRAND NEW ENC N FALSE GBrand New Day (FFS) UC001 NOCD ALL N BRAND NEW FFS N FALSE GBravo Health (Now CIGNA HealthSprings.) 52192 NOCD ALL Y BRAVO HEALTH Y FALSE GBridgeSpan BRIDG NOCD ALL N BRIDGESPAN N FALSE GBridgeway Arizona 68069 NOCD AZ Y BRIDGEWAY ARIZONA Y FALSE GBright Health Advantage Plan BRT01 NOCD ALL N BRIGHT HEALTH N FALSE GBright Health Physicians BHP01 NOCD CA Y BRIGHT HEALTH PHY N FALSE GBright Health Plan CB186 NOCD ALL Y BRIGHT HEALTH PLA N FALSE G



7 of 41



Type

Brighton Health Plan Solutions (formerly MAGNACARE) 11303 NOCD ALL N MAGNACARE Y FALSE GBritCay 22286 NOCD ALL Y BRITCAY N FALSE GBrockerage Concepts, Inc (Benefit Concepts) 51037 NOCD ALL Y BROCKERAGE CONCEP N FALSE GBrown & Toland Medical Group 94316 NOCD ALL Y BROWN TOLAND Y FALSE GBrown & Toland Sutter BTSS1 NOCD ALL N BROWN TOLAND SUTT N FALSE GBrown & Toland SutterSelect BTSS1 NOCD ALL Y BROWN TOLAND SUT Y FALSE GBuckeye Community Health 68069 NOCD IA Y BUCKEYE COMM HLTH Y FALSE GButler Benefits 42150 NOCD ALL Y BUTLER BENEFITS N FALSE GC & O Employees Hospital Association 23708 NOCD ALL Y C AND 0 EMP HOSP Y FALSE GC3 Health (fka Access Health Inc.) A1680 NOCD MI N ACCESS HEALTH PLA Y FALSE GCalifornia Anthem Blue Cross BC001 NOCD CA Y CA BLUE CROSS Y FALSE GCalifornia Blue Cross BC001 NOCD CA Y CA BLUE CROSS Y FALSE GCalifornia Health and Wellness 68069 NOCD CA Y CA HEALTH WELLNES Y FALSE GCalifornia IPA AMM14 NOCD CA N CALIFORNIA IPA N FALSE GCalifornia Pacific Medical Center 94056 NOCD ALL Y CA PACIFIC MED CE Y FALSE GCalifornia Water Services CWS99 NOCD CA Y CA WATER SERVICES N FALSE GCal-Optima Direct CALOP NOCD ALL Y CALOPTIMA DIRECT Y FALSE GCannon Cochran Management Services, Inc. LA (Claims for Payer address of Metairie, LA only.) 71057 NOCD LA N CANNON COCHRAN LA N FALSE GCAP Management 95399 NOCD ALL N CAP MANAGEMENT Y FALSE GCap Management Systems IP080 NOCD CA N CAP MGMT SYSTEMS Y FALSE G

Capital Advantage Insurance Company (CAIC) PROFESSIONAL (BCBS ProviderID and Performing ProviderID required. Call 800-874-8433) 23045 NOCD PA Y CAPITAL ADV INS Y FALSE NCapital Blue Cross PROFESSIONAL (BCBS ProviderID and Performing ProviderID required. Call 800-874-8433) 23045 NOCD PA Y CAPITAL BLUE CROS Y FALSE NCapital District PHP SX065 NOCD ALL A CAPITAL DIST PHP Y FALSE GCapital Health Plan 95112 NOCD All Y CAPITAL HEALTH PL Y FALSE CCapital International Management Services 65067 NOCD ALL Y CAP INTL MGMT SVC Y FALSE GCapitol Administrators (Lucent Health) 68011 NOCD ALL Y CAPITOL ADMINISTR Y FALSE GCapRock HealthPlans CAPHP NOCD ALL N CAPROCK HEALTH PL Y FALSE GCardinal Innovations. (Formerly Piedmont Behavioral Health) 06607 NOCD ALL Y CARDINAL INNOVATI Y FALSE GCardiovascular Care Providers GCVCP NOCD ALL N CARDIOVASCULAR CA N FALSE GCare 1st Health Plan of Arizona 57116 NOCD AZ Y AZ CARE FIRST HP Y FALSE GCare 1st Health Plan of CA 57115 NOCD CA N CARE 1ST HP OF CA N FALSE GCare Access PSN 65063 NOCD ALL N CARE ACCESS PSN N FALSE NCare Around the Clock 57721 NOCD ALL Y CARE AROUND CLOCK Y FALSE GCare Choices HMO HM037 NOCD ALL N CARE CHOICES HMO Y FALSE TCare Core National 14182 NOCD ALL Y CARE CORE NATIONA Y FALSE GCare N' Care 66010 NOCD ALL N CARE N CARE N FALSE GCare Plus 65031 NOCD ALL A CARE PLUS N FALSE GCare to Care 41222 NOCD ALL N CARE TO CARE N FALSE GCare Wisconsin Health Plan (Trizetto) 27004 NOCD ALL N CARE WI HEALTH PL Y FALSE GCareCentrix 11345 NOCD ALL Y CARECENTRIX Y TRUE GCarecore National Wellcare 14188 NOCD ALL N CARECORE NAT WELL N FALSE GCareCore National, LLC (Aetna Radiology Claims) 14179 NOCD ALL N CARECORE NATIONAL N FALSE GCareCore National, LLC (Radiology charges for Oxford) 14180 NOCD NY, NJ Y CARECORE OXFORD Y FALSE GCareFirst BCBS - DC, National Capital Area SB580 NOCD MD,DC Y CAREFIRST NCA N FALSE NCarelink Medicaid 25140 NOCD ALL Y CARELINK MEDICAID Y FALSE GCaremore CM001 NOCD ALL Y CAREMORE N FALSE GCaremore IPA CARMO NOCD ALL N CAREMORE IPA N FALSE GCareMore Value Plus (CVP) CARMO NOCD ALL N CAREMORE IPA N FALSE GCarenet of Virginia (Prepare to use consolidated Coventry payerID of 25133.) 25142 NOCD VA Y CARENET VIRGINIA Y FALSE GCareOregon, Inc. 93975 NOCD OR Y CAREOREGON INC N FALSE GCarePlus Cardiology - New Century Health NCH04 NOCD ALL N CAREPLUS CARDIO Y FALSE NCarePlus Health Plan (Call payer for PayerID) CALL CALL ALL N CALL PAYER N FALSE NCaresource Health Plan of Oregon MRCHP NOCD ALL N CARESOURCEHPOR N FALSE GCaresource IN INCS1 NOCD IN Y CARESOURCE IN Y FALSE GCareSource KY KYCS1 NOCD KY N CARESOURCE KY Y FALSE GCareSource of Georgia GACS1 NOCD ALL N CARESOURCE OF GA N FALSE GCareSource OH 31114 NOCD OH R CARESOURCE OH Y FALSE GCaresource West Virginia WVCS1 NOCD ALL Y CARESOURCE WV N FALSE GCareworks of Ohio 10010 NOCD OH N CAREWORKS OF OHIO N FALSE GCarolina Behavioral Health Alliance 56215 NOCD NC N CAROLINA BEHAV HL N FALSE GCarolina Care Plan (Part of the Medical Mutual Family of companies. Former payerID was 57105.) 29076 NOCD SC Y CAROLINA CARE PLA Y FALSE GCarolina Crescent 68069 NOCD ALL Y CAROLINA CRESCENT Y FALSE GCarolina Summit Healthcare, Inc 56195 NOCD ALL Y CAROLINA SUMMIT Y FALSE GCarpenters' and Millwrights' Health Benefit Trust Fund COMPU NOCD CO N CARPENTERS HBTF N FALSE G



8 of 41



Type

Carpenters Health and Welfare Fund of Philadelphia CX101 NOCD ALL N CARPENTERS HW FUN N FALSE G

Carpet, Linoleum and Resilient Tile Layers Health and Welfare Fund COMPU NOCD CO N CARPET TILE HWF N FALSE GCBA Blue 03036 NOCD ALL Y CBA BLUE N FALSE GCBHA Carolina Behavioral Health Alliance 56215 NOCD ALL Y CBHA Y FALSE GCBNHP Health Choices 65391 NOCD ALL Y CBHNP HEALTH CHOI N FALSE GCBSA (Corporation Benefit Services of America) 41124 MCSI ALL Y CBSA N FALSE GCCMC - Comprehensive Care Management Corp CCMC1 NOCD NY Y CCMC N FALSE GCCS (aka Comprehensive Care Systems) MNBLS NOCD MN Y CCS COMPREHENSIVE Y FALSE NCDO Technologies 63028 NOCD WY,UT Y MBA OF WYOMING N FALSE GCedar Valley Community Health Plan SISCO NOCD ALL N SISCO N FALSE GCedars-Sinai Medical Network Services Claims 95166 NOCD ALL Y CEDARS SINAI CLAI Y FALSE GCedars-Sinai Medical Network Services Encounters 95167 NOCD ALL Y CEDARS SINAI ENCO Y FALSE GCeltic Insurance CELTC NOCD ALL N CELTIC INS Y FALSE GCeltiCare 68069 NOCD ALL Y CELTICARE Y FALSE G

Cement Masons & Plasterers Health & Welfare Trust - Grp#F16 91136 NOCD ALL Y CEMENT GRP F16 N FALSE GCenCal Health 95386 NOCD CA N CENCAL HEALTH Y FALSE GCenpatico - Georgia 68069 NOCD GA Y CENPATICO GA Y FALSE 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 GCenpatico (For multiple states) 68068 NOCD ALL Y CENPATICO Y FALSE GCenpatico Behavioral Health - Wisconsin (Call 800-225-2573 ext 25525 prior to submitting claims.) 68068 NOCD ALL Y CENPATICO BHAV WI Y FALSE GCenpatico Behavioral Health AZ (Prior to submission, contact 866-495-6748 to verify provider ID.) 68068 NOCD AZ Y CENPATICO BH AZ Y FALSE GCenpatico Florida Behavioral Health 68068 NOCD FL Y CENPATICO FL BHV Y FALSE GCenpatico Indiana 68068 NOCD ALL Y CENPATICO INDIANA Y FALSE GCenpatico Massachusetts 68068 NOCD MA Y CENPATICO MASSACH Y FALSE GCenpatico Ohio 68068 NOCD OH Y CENPATICO OHIO Y FALSE 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 GCenter for Elders Independence 94312 NOCD ALL N CENTER ELDERS IND Y FALSE GCenter for Healthy Living CPHL1 NOCD ALL N CTR HLTH LIVING Y FALSE GCenter IPA POP01 NOCD ALL Y CENTER IPA N FALSE GCenterCare 13357 NOCD ALL Y CENTERCARE Y FALSE GCenterLight Healthcare 13360 NOCD ALL N CENTERLIGHT HC Y FALSE GCentinela IPA IP080 NOCD ALL N CENTINELA IPA Y FALSE GCentivo 45564 NOCD CA N CENTIVO N FALSE GCentraCare 66698 NOCD ALL Y CENTRACARE N FALSE GCentral Benefit National (Now known as Tribute Health Plan.) 61184 NOCD ALL Y CENTRAL BENEFITS Y FALSE GCentral California Alliance for Health (Alliance EDI Support Unit 831-430-5510) SX169 NOCD CA N CEN CAL ALLIANCE Y FALSE N

Central California Electricial Workers Health and Welfare Trust NWADM NOCD CA N CCEW HLTH WELFARE Y FALSE GCentral California Women's Health WH001 NOCD CA Y CENT CA WOMENS HE N FALSE GCentral Health Medicare CHCPI NOCD ALL N CENTRAL HLTH MEDI Y FALSE GCentral Ohio Primary Care Senior Care Advantage AGL02 NOCD ALL Y CENTRAL OHIO Y FALSE GCentral Reserve Life 13193 NOCD ALL Y CENTRAL RESERVE L Y FALSE GCentral Reserve Life Ins.Co. (Formertly Loyal American Life (Medicare Supplement) ) 13193 NOCD ALL Y LOYAL AMERICAN L Y FALSE GCentral States Southeast and Southwest Areas Health and Welfare and Pensions Funds 36215 NOCD All Y CENTRAL STATES SO Y FALSE GCenturion of Tennessee 42140 NOCD ALL N CENTURION TENNESS N FALSE GCentury PHO 36393 NOCD ALL N CENTURY PHO N FALSE GCHA - Commonwealth Health Alliance 23171 NOCD ALL Y CHA Y FALSE GCHAMPVA-HAC (CHAMPVA-HAC is not associated with and does not process claims for TRICARE (formerly CHAMPUS.) 84146 NOCD ALL N CHAMPVA HAC Y FALSE GChautauqua County Health Plan (Mayville,NY) 16600 NOCD NY Y CHAUTAUQUA HEALTH N FALSE 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 GChildren's Community Health Plan Wisconsin 251CC NOCD ALL Y CHILD COMM HP WI N FALSE GChildrens Medical Center Health Plan CMCHP NOCD ALL N CHILD MED CENT HP N FALSE GChildren's Specialists of San Diego CSSD2 NOCD CA Y CHILD SPEC OF SD N FALSE GChinese Community Health Plan (Unique Provider ID must be on claim.) 94302 NOCD ALL Y CHINESE COMM HP Y FALSE GCHIPA - College Health IPA CHIPA NOCD ALL N COLLEGE HLTH IPA N FALSE GChirometrics Inc. 33070 NOCD ALL Y CHIROMETRICS INC Y FALSE G



9 of 41



Type

Chiropractic Association of South Dakota CASD1 NOCD SD R CHIRO ASSOC SD Y FALSE 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 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 NCHOC - Childrens Hospital of Orange County Health Alliance 33065 NOCD CA Y CHOC HEALTH ALLIA Y FALSE GChoice Physicians Net First Choice CPNFC NOCD ALL Y CHOICE PHY NET FI Y FALSE GChoiceOne IPA POP03 NOCD ALL Y CHOICEONE IPA N FALSE G

CHP/RPU (FABOH) (Facility physical address required on claim.) 39112 NOCD ALL Y CHP RPU FABOH Y FALSE CChristian Brothers Services 38308 NOCD ALL N CHRISTIAN BROTHER N FALSE GChristian 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 GChristie Student Helath Plan 75544 NOCD ALL Y CHRISTIE STUDENT N FALSE GChristus Health Medicare Advantage 10629 NOCD ALL N CHRISTUS HLTH MC N FALSE GChristus Health New Mexico,HIX 21062 NOCD NM N CHRISTUS HLTH NM N FALSE GChristus Health Plan HIX 52106 NOCD ALL Y CHRISTUS HLTH HIX N FALSE GChristus Health Plan Medicaid 45210 NOCD ALL Y CHRISTUS HLTH MED N FALSE GChristus Spohn Health Network SPOHN NOCD ALL Y CHRISTUS SPOHN HE N FALSE GCIGNA - PPO 62308 NOCD All Y CIGNA PPO Y FALSE GCIGNA - PPO 62308 NOCD All Y CIGNA-PPO Y FALSE G

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 GCIGNA Health Plan - HMO 62308 NOCD All Y CIGNA HEALTH HMO Y FALSE GCIGNA Healthcare for Seniors - Arizona Medicare 86033 NOCD AZ N CIGNA AZ SR HLTH Y FALSE GCIGNA HealthSprings 52192 NOCD ALL Y BRAVO HEALTH Y FALSE GCIGNA Premier Plus 62308 NOCD ALL Y CIGNA PREMIER PLU Y FALSE GCimarron Salud (Receiver type 'D' - Claims are printed and mailed to the Payer.) PRINT NOCD NM N CIMARRON SALUD N FALSE NCinncinnati Financial Corporation 37283 NOCD ALL Y CINNCINNATI FINAN Y FALSE GCitrus Health Care 10207 NOCD ALL Y CITRUS HEALTH CAR Y FALSE CCitrus Valley Physician's Group IP055 NOCD CA N CITRUS VALLEY PHY N FALSE GCity of Amarillo Group Health COA01 NOCD ALL Y AMARILLO GRP HLTH N FALSE GCity of Austin 74234 NOCD TX N CITY OF AUSTIN N FALSE GCL Frates CLFR2 NOCD ALL Y CL FRATES N FALSE GClackamas County Mental Health (Administered by PH Tech) CCMMH NOCD OR N CLACKAMAS CTY MH Y FALSE G

Claims Development Corporation (Effective 2-2-15, Dermatology Networks Solutions claims will process under this payerID. 43056 NOCD ALL Y CLAIMS DEV CORP N FALSE GClaimsBridge HPN 11752 NOCD ALL N CLAIMSBRIDGE HPN Y FALSE GClaimsWare, Inc. DBA ManageMed 57080 NOCD ALL Y CLAIMSWARE INC Y FALSE GClarian Health Plans 95444 NOCD ALL N CLARIAN HEALTH PL N FALSE GClear Health Alliance CLEAR NOCD ALL N CLEAR HEALTH N FALSE GClient First 41201 NOCD ALL Y CLIENT FIRST N FALSE GClifton Health Systems D/B/A Actin Care Groups 24585 NOCD ALL Y ACTIN CARE GROUPO N FALSE GClinical Resource Group CRGMN NOCD ALL N CLINICAL RESOURCE N FALSE G

Clover (Formerly Carepoint Health Plan, previous payer ID 77023) 13285 NOCD ALL Y CAREPOINT HEALTH N FALSE GCoastal Administrative Services 77052 NOCD ALL Y COASTAL ADMIN SVC Y FALSE GCoastal Care 43141 NOCD ALL N COASTAL CARE N FALSE NCoastal Communities Physician Network (CCPN) CCPN1 NOCD CA N CCPN N FALSE GColonial Medical 22284 NOCD ALL N COLONIAL MEDICAL Y FALSE GColorado Access HMO COACC COAC CO S CO ACCESS HMO Y FALSE GColorado Choice Health Plans H0657 NOCD CO N CO CHOICE HEALTH N FALSE NColorado Community Health Alliance COCHA NOCD CO Y CO COMM HLTH ALLI Y FALSE NColorado Health Insurance Cooperative 49718 NOCD CO N CO HLTH INS COOP Y FALSE GColorado Laborers Health and Welfare Fund COMPU NOCD CO N CO LABORERS HWF N FALSE GColumbine Health Plan CHP02 NOCD ALL N COLUMBINE HEALTH Y FALSE GCommerce Benefits Group 34181 NOCD ALL Y COMMERCE BENEFITS N FALSE GCommercial Travelers/PHX 88091 NOCD ALL Y COMMERCIAL TRAVEL N FALSE GCommon Ground Healthcare Cooperative 77170 NOCD ALL N COMMON GROUND HC N FALSE GCommonwealth Care Alliance 14315 NOCD ALL N COMMWEALTH CARE A Y FALSE GCommunity Care Associates 17902 NOCD MI N COMMUNITY CARE AS N FALSE GCommunity Care Behavioral Health Org. (For Dates of Service prior to October 1, 2007) 25179 NOCD All Y COMM CARE BEHAVIO Y FALSE G

Community Care BHO (For Dates of Service after October 1, 2007) 23282 NOCD ALL Y COMMUNITY CARE BH Y FALSE G



10 of 41



Type

Community Care Inc. (WI) 39126 NOCD ALL A COMMUNITY CARE WI Y FALSE GCommunity Care Managed Health Care Plans of Oklahoma 73143 NOCD OK Y COMMUNITY CARE OK N FALSE GCommunity Care Plan(Palm Beach Health District) PBHD1 NOCD ALL N CCP PALM BEACH N FALSE GCommunity Connect Medicaid 95192 NOCD ALL N COMM CONNECT MCAI N FALSE GCommunity Eye Care CECVP NOCD ALL Y COMMUNITY EYE CAR N FALSE GCommunity Family Care NMM05 NOCD ALL N COMMUNITY FAMILY CARE N FALSE GCommunity First Health Plan, Inc. COMMF NOCD ALL Y COMMUNITY FIRST H N FALSE GCommunity Health 60495 NOCD ALL N COMMUNITY HEALTH N FALSE GCommunity Health Alliance 35193 NOCD ALL Y COM HLTH ALLIANCE N FALSE GCommunity Health Allliance TN 27905 NOCD ALL N COMMUNITY HLTH TN N FALSE GCommunity Health Center Network CHCN1 NOCD NC N COMM HLTH CENTER N FALSE GCommunity Health Choice (Please include TPI Number (Texas Medicaid Number) in Field FA0-23) 48145 NOCD ALL Y COMM HEALTH CHOIC N FALSE GCommunity Health Electronic Claims/CHEC/webTPA 75261 NOCD ALL N CHEC TPA CLAIMS N FALSE GCommunity Health Group 66170 NOCD ALL Y COMMUNITY HLTH GR Y FALSE GCommunity Care Plan- Florida Healthy Kids FHKC1 NOCD FL N COMM CARE KIDS FL N FALSE GCommunity Health Plan of Washington CHPWA NOCD ALL Y COMM HLTH OF WA N FALSE GCommunity Health Solutions (Claims now route to Medicaid of Louisiana) LAMCD NOCD LA Y COMMUNITY HLTH SO N TRUE NCommunity IPA AMM12 NOCD ALL Y COMMUNITY IPA N FALSE GCommunity Medical Group of the West Valley CMGWV NOCD CA N COMM MED GRP W VA Y FALSE GCOMP - Ohio (Austintown, OH) 34177 NOCD OH N COMPENSATION PROG N FALSE GCompFirst, LLC 23296 NOCD ALL Y COMPFIRST Y FALSE GComplementary HealthCare Plans 93101 NOCD OR WA Y COMPLEMENTARY HCP Y FALSE GCompManagement Health 15243 NOCD ALL Y COMPMANAGEMENT HE Y FALSE GComprehensive Benefits Administrator, Inc. (Now known as CBA Blue.) 03036 NOCD ALL Y COMPREHENSIVE BEN N FALSE GComprehensive Care Services (BCBSMN) 00720 NOCD ALL N COMP CARE SERVICE Y FALSE GComprehensive Care Services (BCBSMN For DOS on and after 01-01-2019) 00562 NOCD ALL N COMP CARE SERV Y FALSE GComprehensive Medical/Vision Program AZ M0166 NOCD AZ Y COMP MED/VIS AZ N FALSE NComPsych 37363 NOCD ALL N COMPSYCH N FALSE GCompuSys Incorporated (New Mexico) 74234 NOCD NM N COMPUSYS INC NM N FALSE GCompuSys Incorporated of Arizona 74234 NOCD AZ N COMPUSYS INC AZ N FALSE GCompuSys Incorporated of Colorado COMPU NOCD CO N COMPUSYS INC CO N FALSE GCompuSys Incorporated of Utah 74234 NOCD UT N COMPUSYS INC UT N FALSE GCompusys of Colorado COMPU COLO CO N COMPUSYS OF COLO N FALSE GCompuSys/Erisa Group, Incorporated (AZ) 74234 NOCD AZ N CS ERISA GROUP AZ N FALSE GCompuSys/Erisa Group, Incorporated (NM) 74234 NOCD NM N CS ERISA GROUP NM N FALSE GCompuSys/Erisa Group, Incorporated (TX) 74234 NOCD TX N CS ERISA GROUP TX N FALSE GConcordia Care Inc. 33632 NOCD ALL N CONCORDIA CARE IN N FALSE GCornerstone Preferred Resources CB268 NOCD ALL N CORNERSTONE N FALSE GConnecticare - Medicare 78375 NOCD ALL Y CONNECTICARE MCAR Y FALSE GConnecticare, Inc. 06105 NOCD ALL Y CONNECTICARE Y FALSE GConnecticare, Inc. 06105 NOCD ALL Y CONNECTICARE INC Y FALSE GConnecticut Carpenters Health Fund 37307 NOCD CT Y CT CARPENTERS HLT N FALSE GConnective RX (PSKW) PSKW0 NOCD ALL Y CONNECTIVE RX N FALSE GConsociate Group 37135 NOCD ALL Y CONSOCIATE GROUP Y FALSE GConsolidated Associates Railroad 75284 NOCD ALL Y CONS ASSOC RAILRO Y FALSE GConsolidated Group 59140 NOCD All Y CONSOLIDATED GROU N FALSE GConsolidated Health Plans 87843 NOCD ALL N CONSOLIDATED HPS Y FALSE GContessa Health CH102 NOCD ALL N CONTESSA HEALTH N FALSE GContessa Health Security Health Plan CH101 NOCD ALL N CONTESSA SEC HLT N FALSE GConstitution State / Travelers 19046 NOCD ALL N CONSTITUTION STAT N FALSE GConsumers Choice Health SC 45321 NOCD ALL A CONSUMERS CHCE SC Y FALSE GCook Children's Health Plan CCHP1 NOCD ALL N COOK CHILDRENS HP N FALSE GCook Children's Star Plan CCHP9 NOCD ALL Y COOK CHILDRENS ST Y FALSE GCook Group Health Plan 35149 NOCD ALL Y COOK GRP HLTH PLA Y FALSE GCooperative Benefit Administrators, Inc. 52132 NOCD All Y COOPERATIVE BENEF N FALSE GCoordinated Benefit Plan 14829 NOCD ALL N COORDINATED BENE Y FALSE GCoordinated Medical Specialists (CMS) 58204 NOCD ALL Y COORD MED SPECIAL N FALSE GCore Administrative Services 58231 NOCD ALL N CORE ADMIN SERVIC Y FALSE GCore Value (Part of Gettysburg Health.) 23274 NOCD ALL Y CORE VALUE GETTYS N FALSE GCoreSource 35187 NOCD ALL Y CORESOURCE Y FALSE 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 GCoreSource of Illinois 35182 NOCD IL Y IL CORESOURCE Y FALSE GCoreSource of IOWA 35182 NOCD IA Y IA CORESOURCE Y FALSE GCoreSource of Maryland 35182 NOCD MD Y MD CORESOURCE Y FALSE G



11 of 41



Type

CoreSource of North Carolina (Start using new PayerID of 35182. Old payerID will start rejecting soon.) 35180 NOCD NC Y NC CORESOURCE Y FALSE GCoresource of OH 35183 NOCD OH N CORESOURCE OF OH Y FALSE GCoreSource of Pennsylvania 35182 NOCD PA Y PA CORESOURCE Y FALSE GCoreStar AZ MN (Start using new PayerID of 35182. Old payerID will start rejecting soon.) 41045 NOCD AZ, MN Y CORESTAR N FALSE 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 GCorizon, 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 GCornerstone Benefit Administrators 35202 NOCD ALL Y CORNERSTONE BENEF N FALSE GCornerstone Preferred Resources CB268 NOCD ALL N CORNERSTONE PREF Y FALSE GCorporate Benefits Service, Inc. 56116 NOCD ALL N CORP BENE N FALSE GCorporate Plan Management Inc. 64270 NOCD ALL Y CORP PLAN MANAGEM Y FALSE GCorrectCare Integrated Health CCIHC NOCD CA N CORRECTCARE N FALSE GCorrectCare Integrated Health LADOC NOCD CA Y CORRECTCARE LA N FALSE GCorrection Health Partners PHPMC NOCD ALL N CORR HLTH PARTNER Y FALSE G

County Care (Behavioral Health claims with a DOS prior to 4/1/16) 42138 NOCD ALL Y COUNTY CARE N FALSE GCounty Care (Behavioral Health and regular claims with a DOS after 4/1/16) 06541 NOCD ALL Y COUNTY CARE N FALSE GCounty Care (formerly Centene IPA ) Claims with a DOS prior to 4/1/16) 42139 NOCD ALL Y CENTENE IPA N FALSE GCOVA (Commonwealth of VA) VABLS BCBS VA Y COVA Y FALSE NCovenant Administrators, Inc. 58102 NOCD ALL N COVENANT ADMINIST N FALSE GCovenant Management Systems Employee Benefit plan CMSEB NOCD ALL N COVENANT MGMT SYS N FALSE GCoventry Health Care (Coventry old Legacy Payer ID's are still accepted.) 25133 NOCD ALL Y COVENTRY HEALTH Y FALSE GCoventry Health Care of Florida 128FL NOCD FL Y COVENTRY HC FL Y FALSE GCOVID19 HRSA Uninsured Testing and Treatment Fund 95964 NOCD ALL N COVID19 HRSA N FALSE 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 GCreative Medical Systems 64068 NOCD ALL Y CREATIVE MED SYS Y FALSE GCreative Plan Administrators 37320 NOCD ALL N CREATIVE PLAN ADM N FALSE GCrescent PPO Health Solutions. CALL NOCD ALL N Call S&S Y FALSE GCrystal Run Health Plans 46430 NOCD ALL Y CRYSTAL HEALTH Y FALSE GCSI Network Services 34186 NOCD ALL N CSI NETWORK SVCS N FALSE GCTI Administrators Inc 42141 NOCD ALL N CTI ADMINISTRATOR Y FALSE GCulinary Health & Welfare Fund (Las Vegas, NV) 59140 NOCD NV A CULINARY HFUND NV Y FALSE GCustom Design Benefits, Inc. 82056 NOCD ALL Y CUSTOM DESIGN BE N FALSE 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 GDakotaCare DAK01 NOCD SD Y DAKOTACARE Y FALSE GDart Member Care CB987 NOCD ALL N DART MEMBER CARE Y FALSE GDavis Vision 00157 NOCD ALL N DAVIS VISION N TRUE NDCHS Medical Foundation DCHSF NOCD ALL Y DCHS MED FOUNDATI N FALSE GDean Health Plan DEAN1 NOCD ALL Y DEANCARE N FALSE GDell Children's Health Plan 74272 NOCD ALL Y DELL CHILDRENS HP N FALSE GDelta Health Systems DHS01 NOCD ALL N DELTA HEALTH SYST Y FALSE GDentemax AMS01 NOCD MI N DENTEMAX Y FALSE GDentemax/DPI (MI) AMS01 NOCD MI N DENTEMAX DPI MI Y FALSE GDenver Health - Indigent 84134 NOCD CO Y DENVER HLTH INDIG Y FALSE GDenver Health and Hospital Authority 84133 NOCD CO N DENVER HEALTH HOS Y FALSE GDenver Health Medical Plan 84135 NOCD CO N DENVER HEALTH MED Y FALSE GDenver Health Medical Plan, Inc. - Medicare Choice 84131 NOCD CO Y DENVER HLTH MCARE Y FALSE GDepartment of Labor J1438 NOCD ALL Y DEPT OF LABOR N FALSE NDermatology Network Solutions BCBS for the Health Options HMO (Payer requires 11 digit member ID Number) 58204 NOCD All Y DBC Y FALSE GDermatology Network Solutions, LLC BCBS (Payer requires 11 digit member ID Number) 58204 NOCD All Y DERM NETWORK BCBS Y FALSE GDermatology Network Solutions, LLC Humana (Payer requires 11 digit member ID Number) 58204 NOCD All Y DERM NET HUMANA Y FALSE GDermatology Network Solutions, LLC Vista (Payer requires 11 digit member ID Number) 58204 NOCD All Y DERM NETWORK VIST Y FALSE GDeseret Mutual SX105 NOCD UT N DESERET MUTUAL Y TRUE NDesert Family Practice Association PPM01 NOCD ALL A DESERT FAM PRACTI Y FALSE GDesert Medical Group DESRT NOCD CA N DESERT MED GROUP N FALSE GDesert Valley Medical Group DVMC1 NOCD CA Y DESERT VALLEY MG N FALSE GDevoted Health DEVOT NOCD ALL A DEVOTE Y FALSE GDGA - Diversified Group Administrators 25160 NOCD ALL N DGA N FALSE G



12 of 41



Type

Dignity Global MPM27 NOCD ALL N DIGNITY GLOBAL Y FALSE GDignity HCLA MPM28 NOCD ALL N DIGNITY HCLA Y FALSE 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 PDignity Health Medical Foundation for Mercy Medical Group or Woodland Clinic Medical Group (professional risk) PROH1 NOCD ALL R DIGNTY HLTH PROH1 N FALSE PDignity Health Medical Foundation for Sequoia Physicians Network (professional risk) Date of Service must be before Nov 1 2018 for this Payer ID PROH2 NOCD ALL R DIGNTY HLTH PROF2 N FALSE PDirect Care Administrators DCA62 NOCD ALL N DIRECT CARE ADMIN N FALSE NDirectors Guild of America BC001 NOCD CA Y DIRECTORS GUILD A Y FALSE GDiversified Group Brokerage 06102 NOCD All Y DIVERSIFIED GROUP Y FALSE G

DMERC Region A (Testing is required for claims requiring CMNs.) DMERA NOCD REG A Y DMERC REGION A Y TRUE N

DMERC Region B (Testing is required for claims requiring CMNs.) DMERB NOCD REG B Y DMERC REGION B Y TRUE N

DMERC Region C (Testing is required for claims requiring CMNs.) DMERC NOCD REG CA Y DMERC REGION C Y TRUE N

DMERC Region D (Testing is required for claims requiring CMNs.) DMERD NOCD REG D Y DMERC REGION D Y TRUE NDoctors Healthcare Plan DRHCP NOCD ALL A DOCTORS HEALTH Y FALSE GDowney Select IPA (Applecare Medical Mgmt) APP01 NOCD ALL Y DOWNEY SELECT IPA N FALSE GDriscoll Childrens Health Plan 74284 NOCD ALL N DRISCOLL CHILDREN Y FALSE GDriscoll Childrens Health Plan (CHIP) 74284 NOCD TX Y DRISCOLL CHILD HP N FALSE GDunn and Associates Benefits Administrators, Inc. 35186 NOCD ALL N DUNN ASSOC BENE Y FALSE GE.S. Beveridge and Associates 34108 NOCD ALL A ES BEVERIDGE AND N FALSE GE3 Health, Inc (Formerly First Integrated Health) 75232 NOCD ALL Y E3 HEALTH N FALSE GEarly Intervention Central Billing 36434 NOCD IL Y EARLY INTERVENTIO N FALSE GEast Bay Medical Network IP130 NOCD ALL Y EAST BAY MED NETW Y FALSE GEast Boston Neighborhood Pace 25849 NOCD ALL N E BOSTON PACE N FALSE GEAST CAROLINA BEHAVIORAL HEALTH 56089 NOCD ALL A E CAROLINA BH N FALSE GEastern Main Healthcare Systems (EMHS) 16565 NOCD ALL N EMHS Y FALSE GEastland Medical Group EMG11 NOCD ALL N EASTLAND MED GRP N FALSE G

Easy Choice HP of NY 14163 NOCD ALL YEASY CHOICE

Y FALSE GEBC Inc. (To obtain the payerID, please call (440) 262-1160) CALL NOCD ALL Y CALL ENS FOR NAME Y FALSE GEberle Vivian EV001 NOCD ALL Y EBERLE VIVIAN N FALSE GEBMC CX025 NOCD ALL N EBMC N FALSE GEBMS (Employee Benefit Management Services, Inc) 81039 NOCD ALL Y EBMS PROFESSIONAL N FALSE GEDS Healthchoice (formerly payer ID 22521 - For dates of service on or after 01/01/2018 ) 71064 NOCD ALL Y EDS HEALTHCHOICE Y FALSE GEducators Mutual (EMIA) (Enrollment required, contact EMIA to enroll 800-362-0533, Opt. 2) SX110 NOCD UT N EDUCATORS MUTUAL Y FALSE NEach Care Network- Effective 08/01/2020 88846 NOCD ALL N EACH CARE NETWORK N FALSE GEl Paso First - CHIP EPF03 NOCD ALL N ELPASO FIRST CHIP N FALSE GEL Paso First Health Plan HCO Healthcare Options EPF37 NOCD ALL N EL PASO HLTH Y FALSE GEl Proyecto Del Barrio IPA MPM04 NOCD CA N EL PROYECTO DEL B N FALSE NElder Service Plan of the North Shore. 04326 NOCD ALL Y ELDER SVC N SHORE N FALSE GElderPlan, Inc. (Elderplan Provider ID necessary on all claims. Contact (718)921-7979 for Provider ID.) 31625 NOCD ALL N ELDERPLAN INC Y FALSE GEllis Consultants, INC. ECISF NOCD ALL N ELLIS CONSULTANTS N FALSE NElmcare NAELM NOCD ALL Y ELMCARE Y FALSE GElmcare L.L.C. NAELM NOCE IL Y ELMCARE LLC Y FALSE GElmco 37253 NOCD NY Y ELMCO Y FALSE GEmerald Health Network 34167 NOCD All Y EMERALD HEALTH Y FALSE GEmerald Health Network, Inc. (All HMO Business) 34167 NOCD ALL Y EMERALD HLTH HMO Y FALSE GEMI (Eye Management Inc) 65062 NOCD ALL T EYE MANAGEMENT IN Y FALSE GEmpire Physician's Medical Group EMP01 NOCD ALL Y EMPIRE PHYS MG Y FALSE GEmpire Plan (UnitedHealthcare) 87726 NOCD ALL Y EMPIRE PLAN Y FALSE CEmployee Benefit Administration & Management (EBA&M) 95288 NOCD CA Y EMP BENE ADMIN MA N FALSE GEmployee Benefit Concepts 38241 NOCD ALL N EMP BENE CONCEPTS N FALSE GEmployee Benefit Consultants (To obtain the payer ID, please call (440) 262-1160.) CALL CALL ALL A CALL SUPPORT N FALSE G

Employee Benefit Consultants, Inc. (Call (440) 262-1160 for PayerID.) CALL CALL ALL Y CALL ENS SUPPORT Y FALSE GEmployee Benefit Management Corp. 31074 NOCD OH N EMP BENEFIT MGMT Y FALSE GEmployee Benefit System 42149 NOCD ALL Y EMPLOYEE BENE SYS N FALSE GEmployee Benefit Systems 37216 NOCD ALL Y EMPLOYEE BENEFIT N FALSE G



13 of 41



Type

Employee Benefits Plan Administration, Inc. (EBPA) (Now known as CBA Blue.) 03036 NOCD ALL Y EBPA N FALSE GEmployee Logistics 92135 NOCD ALL N EMPLOYEE LOGIST N FALSE GEmployee Plans, LLC 35112 NOCD ALL Y EMPLOYEE PLAN Y FALSE GEmployees Mutual (EMC) 21415 NOCD ALL N EMPLOYEES MUTUAL N FALSE GEmployer Plan Services, Inc. 74212 NOCD ALL y EMP PLAN SERVICES N FALSE GEmployers Coalition On Health (ECOH) 27008 NOCD All Y EHOC EMPLOYERS N FALSE GEmployers Direct Health - Employee Plan 75236 NOCD ALL Y EMPLOYERS DIRECT Y FALSE GEmployers Direct Health - FI 75235 NOCD ALL N EMPLOYERS DIR FI Y FALSE GEmployers Direct Health - SF 75233 NOCD ALL N EMPLOYERS DIR SF Y FALSE GEmployers Health Cooperative (EHC) 27008 NOCD ALL Y EHC EMPLOYERS HEA N FALSE GEmployers Mutual, Inc. (Florida Providers only) 59298 NOCD FL Y EMPOWER Y FALSE GEmpower Arkansas 12956 NOCD FL Y EMPLOYERS MUTUAL Y FALSE GEncore Health Network (Note: Group Policy Number in HCFA Box 11 is required.) 35206 NOCD ALL N ENCORE HEALTH NET N FALSE GEnstar Natural Gas - Grp# P61 91136 NOCD ALL Y ENSTAR GAS GRPP61 N FALSE GEntrust 36878 NOCD ALL Y ENTRUST N FALSE GEon Health 73780 NOCD ALL N EON HEALTH N FALSE GEPN - Seton Health Plan Exclusive (Provider ID required) EPNSH NOCD ALL N EPN SETON HEALTH N FALSE GEQUICOR 62308 NOCD All Y EQUICOR Y FALSE GEQUICOR - PPO 62308 NOCD All Y EQUICOR-PPO Y FALSE GErin Group Administrators (Now known as Significa Benefit Services, Inc.) 23250 NOCD ALL Y ERIN GROUP ADMIN Y FALSE GErisa Administrative Services Incorporated 74234 NOCD AZ N ERISA ADMIN SVCS N FALSE GErisa Administrative Services, Inc. 74234 NOCD All N ERISA ADMIN N FALSE GEssence Healthcare 57082 NOCD MO N ESSENCE HEALTHCAR N FALSE GEssential Health Partner EHPSC NOCD ALL N ESSENTIAL HLTH Y FALSE GEverence 35605 NOCD ALL N EVERENCE Y FALSE GEvergreen Health Cooperative (Please check the member ID Card for the correct Payer ID.) 93240 NOCD ALL Y EVERGREEN HLTH CO N FALSE GEvolutions Healthcare 59313 NOCD ALL Y EVOLUTIONS HEALTH Y FALSE GExceedent LLC 22344 NOCD ALL Y EXCEEDENT LLC Y FALSE GExceptional Care Medical IP080 NOCD CA N EXCEP CARE MEDICA Y FALSE 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 G

Eye Specialists (Provider ID number required in Box33a or Box24J) BVES1 NOCD CO N EYE SPECIALISTS Y FALSE GEyeMed 31165 NOCD ALL Y EYEMED N TRUE NEyeQuest 63740 NOCD ALL Y EYEQUEST Y FALSE GFacey Medical Foundation 95432 NOCD ALL Y FACEY MED FOUNDAT Y FALSE GFACS Group 37300 NOCD ALL N FACS GROUP N FALSE GFalling Colors FCC20 NOCD ALL N FALLING COLORS Y GFallon (Transplant claims) FT254 NOCD ALL Y FALLON TRANSPLANT N FALSE TFallon Community Health 22254 NOCD ALL Y FALLON COMM HLTH Y FALSE GFamily Care - Milwaukee WI 60995 NOCD WI N FAMILY CARE WI Y FALSE GFamily Choice Medical IP080 NOCD CA N FAMILY CHOICE MED Y FALSE GFamily Health Alliance IP080 NOCD CA N FAM HLTH ALLIANCE Y FALSE GFamily Health Network 85468 NOCD ALL Y FAMILY HEALTH NET N FALSE GFamily Medical Network 36396 NOCD ALL Y FAMILY MEDICAL NE Y FALSE GFarm Family 14140 NOCD ALL Y FARM FAMILY N FALSE GFCE Benefit Administrators 33033 NOCD ALL Y FCE BENE ADMINIST N FALSE GFederal Employee Program (Connecticut) C2BLS NOCD CT Y CT FED EMPLOYEE Y FALSE NFidelis Care New York 11315 NOCD ALL N FIDELIS CARE NY Y FALSE GFire Department Cityof New York World Trade Center Health FDNYP NOCD NY Y FD NEW YORK WTC H N FALSE GFirst Agency 88055 NOCD ALL N FIRST AGENCY N FALSE GFirst Carolina Care 56196 NOCD ALL Y FIRST CAROLINA CA Y FALSE GFirst Choice Health Network 91131 NOCD WA,OR,ID,A Y FIRST CHOICE HEAL Y FALSE GFirst Choice Medical Group FCMG1 NOCD ALL N FIRST CHOICE MED Y FALSE GFirst Choice of Midwest (PPO) 75138 NOCD ALL Y FIRST CHOICE MIDW N FALSE 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 GFirst Health 96708 NOCD ALL Y FIRST HEALTH NETW N FALSE GFirst Health Network 73159 NOCD ALL A FIRSTHEALTH Y FALSE GFirst Seniority Freedom 87726 NOCD ALL Y FIRST SENIORITY F Y FALSE CFirst Service Administrators 59276 NOCD FL Y FIRST SERVICE ADM N FALSE GFirst Solution FS802 NOCD ALL N FIRST SOLUTION N FALSE GFirstCare 94999 NOCD ALL N FIRSTCARE Y FALSE GFirstCare Star Medicaid 94998 NOCD ALL N FIRSTCARE MEDICAI Y FALSE G



14 of 41



Type

Fitzharris & Company 11244 NOCD ALL N FITZHARRIS AND CO N FALSE GFL MCO PHC/PHP 95411 NOCD ALL Y FL MCO PHC PHP Y FALSE GFlorida 1st - Winterhaven, Florida 59276 NOCD FL Y FLORIDA 1ST N FALSE GFlorida Community Care FLCCR NOCD FL N FL COMM CARE N FALSE GFlorida Health Plan 59322 NOCD FL N FLORIDA HEALTH PL Y FALSE GFlorida Hospital VBR VB001 NOCD FL Y FL HOSPITAL VBR N FALSE GFlorida Hospital Waterman 48116 NOCD ALL Y FL HOSP WATERMAN Y FALSE GFlorida Pace Centers

FLPAC NOCD ALL N FLORIDA PACE N FALSE GFlume Health INC FH205 NOCD ALL N FLUME HEALTH N FALSE GFMH Benefit Services 48117 NOCD ALL Y FMH BENEFIT Y FALSE GForest County Potawatomi Ins Dept 25059 NOCD ALL Y FOREST CO POTAWA N FALSE GFortis Self Funded Administrative Services 41124 MCSI ALL Y FORTIS SELF FUND N FALSE GFoundation Health of CA FH001 NOCD CA N FOUNDATION HLT CA Y FALSE GFoundation Health of Florida-Encounters FHFLE FLHL FL Y FL FOUNDATION ENC Y FALSE GFox Valley Medicine Site 199 FVMCH NOCD ALL Y FOX VALLEY ST 199 N FALSE GFox Valley Medicine Site 451 FVMC1 NOCD ALL N FOX VALLY MED 451 N FALSE GFox-Everett, Inc. 64069 NOCD ALL Y FOX EVERETT Y FALSE GFreedom Health Plan 41212 NOCD ALL T FREEDOM HEALTH PL N FALSE GFreedom Life Insurance Company 62324 NOCD ALL N FREEDOM LIFE INSU N FALSE GFreeman IPA IP080 NOCD CA N FREEMAN IPA Y FALSE GFresenius Medical Care TH118 NOCD TX Y FRESENIUS MEDICAL Y FALSE TFresno PACE 99660 NOCD ALL Y FRESNO PACE N FALSE G

Fringe Benefit Coordinators 59204 NOCD ALL Y FRINGE BENE COORD N FALSE G

FrontPath Health Coalition 34171 NOCD ALL Y FRONTPATH HEALTH Y FALSE G

Gateway Health Plan - Medicaid PA 25169 NOCD All N GATEWAY HEALTH N FALSE GGateway Health Plan - Medicare Assured Ohio 91741 NOCD ALL Y GATEWAYHP N FALSE GGateway Health Plan ((Yellow Card). Check the ID card to verify the Payer ID before submitting) 60550 NOCD ALL Y GATEWAY HLTH PLAN Y FALSE GGateway Health Plan 25169 NOCD All N GATEWAY HEALTH PL N FALSE GGateway Health Plan of Ohio, Inc. 76028 NOCD OH Y GATEWAY HP OF OHI Y FALSE GGateway to Better Health 4317M NOCD ALL N GATEWAY TO BETTER Y FALSE GGBS Global Benefit CB951 NOCD ALL Y GBS GLOBAL BENEFI N FALSE GGBS Group Benefit Services 80241 NOCD ALL N GBS N GGEHA Group Health Nevada Medicaid GEHA9 NOCD NV N GEHA GH NV MEDICA N FALSE GGeisinger Health Plan 75273 NOCD PA Y GEISINGER HEALTH Y FALSE TGEMCare (Golden Empire Managed Care System) MCS01 NOCD ALL Y GEMCARE Y FALSE GGemcare Health Plan MCS03 NOCD ALL Y GEMCARE HLTH PLAN N FALSE GGemcare IPA (former payer ID PMGSC) 27133 NOCD ALL Y GEMCARE IPA N FALSE GGenerations Health 46050 NOCD ALL N GENERATIONS HEALT Y FALSE GGenesis Health Care IP105 NOCD ALL N GENESIS HEALTHCAR N FALSE NGeorgia Health Advantage A2327 NOCD GA Y GA HEALTH N FALSE GGeorgia State Health Benefit Plan (Processed by GA BC/BS) GABLS BCBS GA Y GA ST HEALTH BENE Y FALSE NGettysburg Health (Including Core Value.) 23274 NOCD ALL Y GETTYSBURG HEALTH N FALSE GGHI HMO Select 25531 NOCD All Y GHI HMO SELECT Y FALSE GGHI Medicare Part B of New York GHMCR NOCD NY N GHI MEDICARE NY Y TRUE NGHP (Group Health Plan) 25141 NOCD ALL A GROUP HEALTH PLAN N FALSE GGI Innovative Management 58204 NOCD ALL Y GI INNOVATIVE MAN N FALSE GGilsbar, Inc 07205 NOCD ALL Y GILSBAR INC N FALSE GGlassworkers and Glaziers Health and Welfare Fund Trust COMPU NOCD CO N GLASSWORKERS HBTF N FALSE GGlassworkers Health & Welfare Fund - Grp# F29 91136 NOCD ALL Y GLASSWORKERS F29 N FALSE GGlobal Care Inc 07689 NOCD ALL Y GLOBAL CARE INC N FALSE GGlobal Care Med Grp IPA MPM05 NOCD ALL N GLOBAL CARE MED G N FALSE NGlobal Excel Management GEM01 NOCD ALL N GLOBAL EXCEL MGMT Y FALSE GGlobal Health GHOKC NOCD ALL Y GLOBAL HEALTH Y FALSE GGlobal One Ventures GLOBA NOCD ALL N GLOBAL ONE N FALSE GGMS, Inc. 47083 NOCD ALL A GMS INC N FALSE GGold Coast 77160 NOCD ALL N GOLD COAST N FALSE GGolden Shore Medical Group (GSMG) NMM03 NOCD ALL N GSMG Y FALSE GGood Samaritan Medical Practice Association (GSMPA) IP086 NOCD CA N GSMPA Y FALSE GGood Shepherd Hospice 76923 NOCD ALL Y GOOD SHEPHERD HOS Y FALSE GGovernment Employees Health Association,Inc. (GEHA) 44054 NOCD ALL Y GOVERNMENT EMPLOY Y FALSE CGovernment Employees Health Association,Inc. (GEHA) 57254 NOCD ALL Y GEHA Y FALSE CGreat Lakes Health Plan (UnitedHealthcare Community Plan) 95467 NOCD ALL Y GREAT LAKES HEALT Y FALSE CGreat Lakes PACE 39640 NOCD ALL Y GREAT LAKES PACE N FALSE GGreater Covina Medical Group GCMG1 NOCD CA N GREATER COVINA ME N FALSE GGreater L. A. Health IP080 NOCD CA N GREATER LA HEALTH Y FALSE G



15 of 41



Type

Greater Newport IPA GNPMG NOCD ALL Y GREATER NEWPORT I N FALSE GGreater Newport Physicians Medical Group 33010 NOCD ALL Y GREATER NEWPORT N FALSE GGreater Orange IPA NMM01 NOCD ALL Y GREATER ORANGE MG Y FALSE GGreater Oregon Behavioral Health GOBHI NOCD ALL Y GREATER OR BEHAV Y FALSE GGreater San Gabriel IP080 NOCD CA N GREATER SAN GABRI Y FALSE GGreater San Gabriel Valley Physicians IPA NMM01 NOCD ALL Y GR SAN GABRIEL VA Y FALSE GGreater Tricities IPA (Noble AMA Select) PDT01 NOCD ALL N GREATER TRICITIES N FALSE GGroup Administrators Ltd. 36338 NOCD ALL Y GROUP ADMINISTRAT Y FALSE GGroup Administrators Self-Funded Alternative GASA1 NOCD ALL Y GROUP ADMIN SFA N FALSE GGroup and Pension Administrators 48143 NOCD ALL Y GROUP PENSION ADM Y FALSE GGroup Health Cooperative of Eau Claire 95192 NOCD ALL N GH COOP EAU CLAIR N FALSE GGroup Health Cooperative of South Central Wisconsin Claims 39167 NOCD WI Y GHC SC WI CLAIMS Y FALSE G

Group Health Cooperative of South Central Wisconsin Encounters 39168 NOCD WI Y GHC SC WI ENCOUNT Y FALSE GGroup Health Incorporated (GHI) (New York) 13551 NOCD NY Y GHI NYC Y FALSE GGroup Health Insurance - DE 61101 NOCD DE R GROUP HEALTH DE Y FALSE 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 GGroup Health Options (Formerly KPS Health Plans) 91051 NOCD ALL N KPS HEALTH PLANS N FALSE GGroup Insurance Service Center, INC 37276 NOCD ALL N GROUP INS SVC CEN N FALSE GGroup Resources PHCS 28680 NOCD ALL Y GROUP RESOURCES P N FALSE GGuardian Life Insurance Company of America 64246 NOCD All Y GUARDIAN LIFE N FALSE GGulf South Risk Services 60652 NOCD ALL N GULF SO RISK SVCS Y FALSE GGulf Stream General Dynamics CB624 NOCD ALL N GULF STREAM GD N FALSE GGundersen Lutheran Health Plan 39180 NOCD ALL Y GUNDERSEN LUTH HP N FALSE GH.E.R.E.I.U. Welfare Pension Funds 37114 NOCD ALL N HEREIU WELFARE N FALSE GHAA Preferred Partners 65101 NOCD ALL N HAA PREFERRED PAR Y FALSE GHalcyon Behavioral Health HALCY NOCD ALL Y HALCYON BEHAVIORA Y FALSE GHamaspik Choice Inc. 47738 NOCD ALL Y HAMASPIK CHOICE N FALSE GHammerman & Gainer 97258 NOCD ALL Y HAMMERMAN GAINER N FALSE GHarmony 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 G

Harmony 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 GHarrington Health - Kansas ((Formerly known as Fiserv Health-Kansas) 62061 NOCD ALL Y HARRINGTON KS N FALSE GHarrington Health BPO 59143 NOCD ALL Y HARRINGTON HLTH B N FALSE GHarris Methodist Health Plan 87726 NOCD All Y HARRIS METHODIST Y FALSE CHarvard Community Health Plan 04245 NOCD ALL Y HARVARD COMM HP N FALSE GHarvard Pilgrim 04271 NOCD ALL Y HARVARD PILGRIM Y FALSE GHarvard Pilgrim Passport Connect 87726 NOCD ALL Y HARVARD PILGRIM P Y FALSE CHawaii Medical Assurance Association (HMAA) 48330 NOCD HI N HAWAII HMAA N FALSE GHawaii Western Management (HWMG) 99208 NOCD ALL Y HI WESTERN MGMT N FALSE GHawki (Provider ID Required) 86068 NOCD ALL Y HAWKI Y FALSE NHCC Life Insurance HCCMI NOCD ALL Y HCC LIFE INSURANC N FALSE GHCH Administration 37111 NOCD ALL Y HCH ADMINISTRATIO N FALSE GHCP Nevada 20501 NOCD ALL N HCP NEVADA Y FALSE GHCSC Insurance Services Company 84980 NOCD ALL Y HCSC INSURANCE SE Y FALSE GHDM Benefit Solutions HDMCO NOCD ALL N HDM BENE SOLUTION N FALSE GHDPC - Premier Healthcare 90023 NOCD ALL Y PREMIER HC HDPC Y FALSE GHealth Advantage of Arkansas ARBLS NOCD AR Y AR HEALTH ADVANTA Y TRUE NHealth Alliance Medical Plans of Illinois 77950 NOCD IL Y HLTH ALLIANCE PLA Y FALSE GHealth Alliance Plan of Michigan (Use payer ID 38224 for claims with a date of service 01-01-20 and greater. For dates of service 12-31-19 and prior please use payer ID 70259) 38224 NOCD All Y HEALTH ALLIANCE P N FALSE GHealth Care District of Palm Beach HCDPB NOCD ALL N HCD PALM BEACH Y FALSE GHealth Care Network of Wisconsin (HCN) 42102 NOCD ALL Y WI HEALTHCARE NET Y FALSE CHealth Choice Generations 62180 NOCD ALL Y HEALTH CHOICE GEN Y FALSE GHealth Choice Insurance 46221 NOCD ALL Y HEALTH CHOICE INS Y FALSE 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 GHealth Choice of AZ 62179 NOCD AZ Y HEALTH CHOICE AZ Y FALSE GHealth Choice Utah 45399 NOCD UT Y HEALTH CHOICE UTA Y FALSE GHealth Claims Service 82018 NOCD ALL N HEALTH CLAIMS SVC N FALSE GHealth Cost Solutions 62111 NOCD ALL N HEALTH COST SOLUT Y FALSE GHealth Design Plus 34158 NOCD ALL N HEALTH DESIGN PLU N FALSE GHealth EZ 16120 NOCD All Y HEALTH EZ N FALSE GHealth First Health Plans 95019 NOCD ALL N HEALTH FIRST HLTH N FALSE G



16 of 41



Type

Health First-Tyler, TX 75234 NOCD ALL Y HEALTH FIRST TX N FALSE GHealth Help Networks, Inc. 59087 NOCD All Y HEALTHHELP Y FALSE GHealth Management Associates (HMA, servicing Southeastern and Southwestern Regions) (Provider ID Required) 86066 NOCD ALL Y HEALTH MGMT ASSOC Y FALSE NHealth Net (California Encounters Only.) 95567 NOCD CA Y CA HLTHNET ENC Y FALSE GHealth Net of Arizona AZHNT NOCD AZ Y HEALTHNET OF AZ N FALSE T

Health 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 GHealth Net Oregon 22340 NOCD OR Y HEALTH NET OREGON Y FALSE GHealth Network One 65062 NOCD ALL T HEALTH NETWORK ON Y FALSE GHealth New England 04286 NOCD ALL N HEALTH NEW ENGLAN N FALSE GHealth Options of Florida (Blue Shield HMO) FLHLT BCBS FL N FL HEALTH OPTIONS N FALSE N

Health Options of Florida (Blue Shield HMO) ENCOUNTERS ONLY FLENC BCBS FL N FL ENCOUNTERS HEA N FALSE NHealth Partners 07003 NOCD ALL Y HLTH PART N TRUE NHealth Partners - Jackson,TN 62157 NOCD TN Y HLTH PARTNERS TN Y FALSE GHealth Partners, PA 80142 NOCD PA Y HLTH PARTNERS PA Y FALSE GHealth Payment Systems 20270 NOCD ALL Y HEALTH PAYMENT SY Y FALSE G

Health Plan of Michigan (Now known as Meridian Health Plan) 52563 NOCD ALL Y HEALTH PLAN OF MI Y FALSE GHealth Plan of San Joaquin 68035 NOCD ALL N HLTH PLAN SAN JOA Y FALSE GHealth Plan of San Mateo HPSM1 NOCD CA Y HEALTH PLAN OF SA Y FALSE GHealth Plan Services, Tampa Office 59140 NOCD All N HEALTH PLAN TAMPA Y FALSE GHealth Plans Inc. 44273 NOCD ALL Y HEALTH PLANS INC Y FALSE GHealth Plus Physicians Organization 63363 NOCD ALL Y HEALTH PLUS PHY O N FALSE GHealthscope 40026 NOCD ALL Y HEALTHSCOPE Y FALSE C

Health Select IPA (Enrollment required. Contact 866-703-1444.) M3IL1 NOCD ALL Y HEALTH SELECT IPA N FALSE GHealth Services for Children with Special Needs (HSCSN) 37290 NOCD ALL N HSCSN Y FALSE 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 GHealth Services Management, Inc. for AHS HSM01 NOCD ALL Y HSM AHS Y FALSE GHealth Services Management, Inc. for BPA HSM01 NOCD ALL Y HSM BPA Y FALSE GHealth Services Management, Inc. for ECOH HSM01 NOCD ALL Y HSM ECOH Y FALSE GHealth Services Management, Inc. for EHC HSM01 NOCD ALL Y HSM EHC Y FALSE GHealth Services Management, Inc. for ENCR HSM01 NOCD ALL Y HSM ENCR Y FALSE GHealth Services Management, Inc. for FCM HSM01 NOCD ALL Y HSM FCM Y FALSE GHealth Services Management, Inc. for HF HSM01 NOCD ALL Y HSM HF Y FALSE GHealth Services Management, Inc. for HT HSM01 NOCD ALL Y HSM HT Y FALSE GHealth Services Management, Inc. for MMSI HSM01 NOCD ALL Y HSM MMSI Y FALSE GHealth Services Management, Inc. for MSHO HSM01 NOCD ALL Y HSM MSHO Y FALSE GHealth Services Management, Inc. for PNET HSM01 NOCD ALL Y HSM PNET Y FALSE GHealth Services Management, Inc. for PONE HSM01 NOCD ALL Y HSM PONE Y FALSE GHealth Services Management, Inc. for SC HSM01 NOCD ALL Y HSM SC Y FALSE GHealth Services Management, Inc. for WEA HSM01 NOCD ALL Y HSM WEA Y FALSE GHealth Services Mgmt/Magellen Health 41150 NOCD ALL Y HLTH SVCS MAGELLE N FALSE 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 GHealth Systems Inc 11889 NOCD ALL N HEALTH SYSTEMS Y FALSE GHealth Tradition Health Plan HLTHT NOCD ALL Y HEALTH TRADITION Y FALSE G

Healthteam Advantage 88250 NOCD ALL N HEALTHTEAM N FALSE G

Healthteam Advantage HMO Diabetes and Heart Plan 88350 NOCD ALL N HEALTHTEAM HMO N FALSE GHealth Texas Medical Group HTHTX NOCD ALL N HEALTH TX MED GRP Y FALSE 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 NHealthcare Highways HCH01 NOCD ALL Y HEALTHCARE HWY Y FALSE GHealthcare LA, IPA MPM06 NOCD CA N HEALTHCARE LA IPA N FALSE NHealthcare Management Administrators, Inc. (also known as HMA, servicing Western Region) HMA01 NOCD WESTERN N HLTHCARE MGMT ADM N FALSE GHealthcare Partners OCN01 NOCD CA Y HEALTHCARE PARTNE Y FALSE GHealthCare Partners, IPA (Formerly Heritage New York Medical Group) 11328 NOCD All Y HCARE PARTNERS IP Y FALSE GHealthcare Resources NW 56731 NOCD ALL Y HLTHCARE RES NW Y FALSE GHealthCare Solutions Group 73147 NOCD ALL A HEALTHCARE SOL GR N FALSE G



17 of 41



Type

Healthcare USA 25133 NOCD ALL Y HEALTHCARE USA Y FALSE GHealthChoice Dept of Corrections & Rehab 71065 NOCD ALL Y HEALTH CHOICE UTA Y FALSE GHealthcomp 85729 NOCD ALL Y HEALTHCOMP N FALSE GHealthEdge Administrators (PayerID valid for claims with a submission address of PO Box 11210, Bakersfield, CA 93389) 95213 NOCD ALL Y HEALTHEDGE ADMINS N FALSE GHealthEZ 41178 NOCD ALL Y HEALTHEZ Y FALSE GHealthfirst of Austin TPA 75289 NOCD ALL Y HEALTHFIRST AUSTI N FALSE GHealthfirst, Inc. (NY) 80141 NOCD NY Y HEALTHFIRST NY Y FALSE GHealthGram 56144 NOCD ALL Y PRIMARY PHYSICIAN N FALSE GHealthkeeper HMO VABLS BCBS VA Y HEALTHKEEPER HMO Y FALSE NHEALTHLINK HMO 96475 NOCD All Y HEALTHLINK HMO N FALSE GHEALTHLINK PPO 90001 NOCD All Y HEALTHLINK PPO Y FALSE GHealthnet of AZ 38309 NOCD AZ Y HEALTHNET OF AZ N FALSE GHealthnet Community Solutions 68069 NOCD ALL Y HEALTHNET COMM N FALSE GHealthnow BCBS New York Western SB801 NOCD NY N HEALTHNOW BCBS Y FALSE NHealthPartners of Minnesota 55764 NOCD ALL Y MN HEALTH PARTNER Y FALSE T

HealthPlus of Louisiana (Old PayerID of 95009 is no longer valid) 07205 NOCD LA Y HEALTHPLUS OF LA N FALSE GHealthpoint Corporation 68195 NOCD All Y HEALTHPOINT CORP Y FALSE GHealthSCOPE Benefits, INC 71063 NOCD All Y HEALTHSCOPE BENEF N FALSE GHealthsmart Accel 75237 NOCD ALL Y HEALTHSMART ACCEL Y FALSE GHealthsmart Mgmt Services Org Inc A0067 NOCD ALL N HEALTHSMART MGMT N FALSE GHealthSmart Preferred Care 75250 NOCD ALL A HEALTHSMART PREF N FALSE G

Healthsource \ 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 THealthsource Arkansas - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID 71074 NOCD AR Y HEALTHSOURCE ARK Y FALSE THealthsource Kentucky - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID 61127 NOCD KY Y HEALTHSOURCE KY Y FALSE GHealthsource Maine - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID 01041 NOCD ME Y HEALTHSOURCE ME Y FALSE G

Healthsource New Hampshire - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID 02038 NOCD NH Y HEALTHSOURCE NH Y FALSE GHealthsource Provident Ins. Co. 68195 NOCD All Y HEALTHSOURCE PROV Y FALSE GHealthsource, AR (Med) (CIGNA) 71075 NOCD AR Y HEALTHSOURCE AR M Y FALSE GHealthsource, GA (CIGNA) 58210 NOCD GA Y HEALTHSOURCE GA Y FALSE GHealthsource, Mass 02041 NOCD MA Y HEALTHSOURCE MASS Y FALSE GHealthsource, OH 31141 NOCD OH Y HEALTHSOURCE OH Y FALSE GHealthsource, TN (CIGNA) 62129 NOCD TN Y HEALTHSOURCE TN Y FALSE GHealthSpan Integrated Care (Only accepting claims with DOS up to 1-31-2017) RH007 NOCD ALL Y HEALTHSPAN N FALSE GHealthspan, aka Kaiser of Ohio NG007 NOCD OH Y KAISER HP OF OHIO Y FALSE THealthSpring HT001 NOCD ALL N HEALTHSPRING Y FALSE GHealthSpring HMO/HealthSpring Medicare+Choice 63092 NOCD ALL N HEALTHSPRING HMO Y FALSE GHealthSun HESUN NOCD ALL N HEALTHSUN N FALSE GHealthTeam Advantage 88250 NOCD ALL Y HEALTHTEAM ADV N FALSE GHealthways WholeHealth Networks 58213 NOCD ALL N HEALTHWAYS WH NET N FALSE GHealthy CT 77180 NOCD CT N HEALTHY CT N FALSE GHealthy Blue (NE) 00544 NOCD NE N HEALTHY BLUE NE N FALSE GHealthy Blue (MO) 00541 NOCD MO N HEALTHY BLUE MO N FALSE GHealthy Texas 68064 NOCD TX Y HEALTHY TEXAS Y FALSE 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 GHelix Family Choice 00243 NOCD MD Y HELIS FAMILY CHOI Y FALSE 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 NHennepin Health / Northstar Advantage 60058 NOCD ALL Y HENNEPIN HEALTH N FALSE G

Heritage Consultants (Must use 9-digit subscriber ID on all claims) 59230 NOCD ALL Y HERITAGE CONSULTA Y FALSE GHeritage IPA HER01 NOCD ALL N HERITAGE IPA N FALSE GHFN, Inc. 36335 NOCD ALL N HFNIN Y FALSE GHigh Desert Medical Group (Lancaster, California) HDMDG NOCD CA N HIGH DESERT MED G N FALSE GHigh Desert Primary Care STJOE NOCD ALL N HIGH DESERT PRIM Y FALSE GHighline Medical Services MOLINA 91164 NOCD ALL Y HIGHLINE MOLINA N FALSE GHighmark BCBSD Health Options. 47181 NOCD ALL Y HIGHMARK BCBSDHOP Y FALSE G

Highmark Senior Health Company (PA Blue Shield Medicare Plan) 15460 NOCD PA Y HIGHMARK SHC PA Y TRUE NHealthcare Highways Health Plan HCHHP NOCD ALL N HEALTHCARE HWY Y FALSE N



18 of 41



Type

Highmark Senior Solutions Company (WV Blue Shield Medicare Plan) 15459 NOCD WV Y HIGHMARK SSC WV Y TRUE NHill Physicians Blue Cross PPO HLPBC NOCD ALL N HILL PHYS BC Y FALSE GHill Physicians Blue Shield PPO HLPBS NOCD ALL Y HILL PHYS BLS PPO Y FALSE GHill Physician Cigna PPO HLPCG NOCD ALL N HILL PHYS CIG N FALSE GHill Physicians Health Net PPO HLPHN NOCD ALL N HILL PHYS N FALSE GHill Physicians Medical Group 00046 NOCD ALL Y HILL PHYSICIANS N FALSE GHill Physicians United Healthcare PPO HLPUH NOCD ALL Y HILL PHYS PPO Y FALSE GHIP-Health Insurance Plan of Greater NY 55247 MCSI NY Y HIP HEALTH INS NY Y FALSE GHispanic Physicians IPA HPFFS NOCD ALL N HISPANIC PHYS IPA N FALSE 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 NHMC Healthworks aka Health Management Co. 75318 NOCD ALL N HMC HEALTHWORKS N FALSE GHMO Louisiana Blue Advantage 84555 NOCD LA N HMO LA BLUE ADVAN N FALSE GHockenberg's Equipment (UCS) 59573 NOCD ALL Y HOCKENBERS EQUIP N FALSE GHollywood Presbyterian IP080 NOCD CA N HOLLYWOOD PRESBYT Y FALSE GHoly Cross Health Partners NAHLX NOCD IL Y HOLY CROSS HLTH P Y FALSE GHome State Health Plan 68069 NOCD LA Y HOME STATE HP Y FALSE GHomeland Security (ATTN: Deportation) VAICE NOCD ALL N HOMELAND SECURITY N FALSE GHomelink 50701 NOCD ALL Y HOMELINK N FALSE GHomelink 30750 NOCD ALL N HOMELINK Y GHomelink Healthpartners 55744 NOCD ALL N HOMELINK PARTNERS Y GHometown Health Plan Nevada 88023 NOCD NV Y HOMETOWN HP OF NV Y FALSE G

Hometown Health Plan of Ohio (Now known as The Health Plan) 30757 NOCD OH A HOMETOWN HP OF OH N FALSE GHopkins Health Advantage 66003 NOCD ALL Y HOPKINS HLTH ADVA N FALSE GHorace Mann Life Insurance HMLIC NOCD ALL Y HORACE MANN LIFE N FALSE GHorizon Blue Cross Blue Shield of New Jersey 22099 NOCD NJ R HORIZON BCBS NJ Y TRUE N

Hotel Employees & Restaurant Employees Health Trust - Grp#F19 91136 NOCD All Y HOTEL EMP GRPF19 N FALSE GHP 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 G

HPMS (Send claims to payerID listed on patient's insurance card.) CARD NOCD MI Y CALL INGENIX S&S N FALSE GHSA Health Plan U7632 NOCD ALL N HSA HEALTH PLAN Y FALSE GHSBS Memphis (Formerly Pittman and Associates) 37224 NOCD ALL Y PITTMAN AND ASSOC Y FALSE G

HSBS Oklahoma Cityi (Formerly Mutual Assurance Administrators) 37256 NOCD ALL N MUTUAL ASSURANCE N FALSE GHSHS Medical Group IPA 37137 NOCD ALL Y HSHS MED GROUP IP Y FALSE GHuman Behavioral Institute HBI01 NOCD ALL N HUMAN BEHAVIORAL N FALSE GHumana Puerto Rico L0200 NOCD PR N HUMANA PR N FALSE GHUMANA, Claims only 61101 NOCD ALL R HUMANA CLAIMS Y FALSE GHUMANA, Encounters Only 61102 NOCD All R HUMANA ENCOUNTERS N FALSE GHuntington Park Medical Group IP080 NOCD CA N HUNTINGTON PK MED Y FALSE GHuntington Park Mission IP080 NOCD CA N HUNTINGTON PK MIS Y FALSE GHylton Payroll (Benefit Plan Administrators) 19753 NOCD ALL Y HYLTON PAYROLL BP N FALSE GI. E. Shaffer 22175 NOCD ALL N IE SHAFFER N FALSE GIBA Self Funded Group 38234 NOCD ALL N IBA SELFFUNDED GP Y FALSE G

IBEW Local 640 & Arizona Chapter NECA Health & Welfare Trust 74234 NOCD AZ N IBEW 640 AZ NECA N FALSE GIBEW Western Utilities or Local 57 74234 NOCD UT N IBEW WESTERN UTIL N FALSE GIBG Administrators, LLC 81810 NOCD ALL N IBG ADMINISTRATOR N FALSE GIBI 41124 NOCD All Y IBI N FALSE GiCARE (Independent Care Health Plan) 11695 NOCD WI T ICARE Y FALSE GICARE Health Options TPA 26054 NOCD ALL N ICARE HEALTH OPTI Y FALSE GiCircle of New Yok 33884 NOCD ALL Y ICIRCLE NEW YORK Y FALSE GICON Benefit Administrators 75185 NOCD ALL Y ICON BENEFIT ADMI N FALSE GIdaho True Blue TRUEB BCBS ID Y TRUE BLUE N TRUE NIllinicare Behavioral Health 68068 NOCD ALL Y ILLINICARE BH Y FALSE GIllinicare Group Health 68069 NOCD ALL Y ILLINICARE GRP Y FALSE GIllinois Health Plan (IHP) DMG01 NOCD ALL N IL HEALTH PLAN N FALSE GIMA of Louisiana Inc. 72091 NOCD ALL N INS MGMT ADMINIST N FALSE GIMCARE 41600 NOCD ALL N IMCARE Y FALSE GImperial Health Holdings Medical Group IHHMG NOCD ALL N IMPERIAL HLTH Y FALSE GINDECS Corporation 40585 NOCD ALL Y INDECS CORPORATIO Y FALSE GIndependence Administrators TA720 NOCD ALL Y INDEPENDENCE ADMI Y TRUE NIndependence Medical Group MHM01 NOCD ALL Y INDEPENDENCE MEDI Y FALSE GIndependence Medical Group of Kern County IMG01 NOCD CA Y INDEPEND MG KERN N FALSE GIndependence Medical Group Tulare County IMG02 NOCD ALL N INDEP MED GP TULA Y FALSE G



19 of 41



Type

Independent BLC of PA (Also known as Personal Choice PPO of Pennsylvania.) 54704 NOCD PA N PA PERSONAL CHOIC Y TRUE NIndependent Health SX073 NOCD ALL N INDEP HEALTH NJ N TRUE GIndependent Living Systems 45048 NOCD ALL Y INDEP LIVING SYS Y FALSE GIndian Health Services 00290 NOCD ALL N INDIAN HEALTH SER N FALSE GIndiana Department of Health Children's Health 35600 NOCD IN N IN DEPT HLTH CHIL Y TRUE NIndiana ProHealth Network 35161 NOCD IN Y INDIANA PROHEALTH N FALSE GIndiana University IUHPL NOCD ALL N IN UNIVERSITY SE N FALSE GIndustrial Machine Specialties COMPU NOCD CO N IND MACHINE SPECS N FALSE GIntegranet INET1 NOCD ALL N INTEGRANET N FALSE GINETICO, Inc. 43471 NOCD ALL N INETICO INC Y FALSE GInforMed, LLC 52196 NOCD ALL N INFORMED LLC N FALSE GIngalls Provider Group 85578 NOCD ALL Y INGALLS PROV GROU N FALSE G

Ingalls Provider Group (New PID for DOS 1-1-19 and after only) 66727 NOCD ALL Y INGALLS N FALSE GIngham Health Plan Corp. 38343 NOCD ALL Y INGHAM HP CORP N FALSE GInland Empire Health Plan IEHP1 NOCD ALL A INLAND EMPIRE HP N FALSE 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 FALSE NInnovante Benefit Admin/ (HSBS WTC) (Effective 3-1-17) 31172 NOCD ALL N INNOVANTE BENEFIT N FALSE GInnovation Health 40025 NOCD ALL N INNOVATION HEALTH N FALSE GInnovative Physician Associates 80087 NOCD ALL A INNOVATIVE PHYSIC N FALSE GInnovista Health INDPM NOCD ALL Y INNOVISTA HEALTH Y FALSE GINS Health Services VAICE NOCD ALL N INS HEALTH SERVIC N FALSE GInsurance Administrator of America 37279 NOCD ALL N INS ADMIN OF AMER N FALSE GInsurance Design Administrators 13315 NOCD ALL A INS DESIGN ADMINI Y FALSE GImmigration Services VAICE NOCD ALL N INSURANCE HLTH SE N GInsurance Management Administrators 72091 NOCD ALL N INS MGMT ADMINIST N FALSE GInsurance Management Services of Texas IMSMS NOCD TX Y INS MGMT SVCS TX N FALSE 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 GInsurance Service of Lubbock ISL11 NOCD All Y INS SERVICE LUBBO N FALSE GInsurer's Administration Corporation IAC01 NOCD ALL N INSURERS ADM CORP N FALSE GInsurers Administrative Corp. (Please visit website prior to submitting claims: edihelp.iacusa.com) 86304 NOCD ALL Y INSURERS ADMIN CO N FALSE GINTEGRA Administrative Group, Inc. 51020 NOCD ALL N INTEGRA ADMIN GRO N FALSE GIntegra Group - CHA 31129 NOCD ALL N INTEGRA GRP CHA Y FALSE 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 GIntegra Managed Long Term Care 45302 NOCD ALL N INTEGRA MGD LONG Y FALSE GIntegrated Medical Solutions 20050 NOCD ALL Y INTEGRATED MED SO N FALSE GIntegrated Mental Health Services 68068 NOCD ALL Y INTEGRATED MENTAL Y FALSE GIntegrity Administrators (Champion Chevrolet) 99795 NOCD ALL N INTEGRITY ADMIN N FALSE GInteractive Medical Systems 56132 NOCD ALL Y INTERACTIVE MED S N FALSE GIntercommunity Health Net INCHN NOCD ALL N INTERCOMM HLTH NE Y FALSE GInterface EAP 60280 NOCD ALL Y INTERFACE EAP N FALSE GIntergroup Services Corporation 23287 NOCD ALL N INTERGROUP SVCS Y FALSE GIntermountain Health Care (Contact payer at 801-442-5442 before sending claims to verify provider numbers.) SX107 NOCD UT Y INTERMOUNTAIN HEA Y FALSE NIntermountain Ironworkers Trust Fund 74234 NOCD AZ,ID,UT N INTRMTN IRONWORKS N FALSE GInternational Benefit Administration 11329 NOCD ALL Y INTL BENE ADMINIS Y FALSE GInternational Brotherhood of Boilermakers Employee Health Care Plan (IBBEHC) 48603 NOCD ALL Y IBBEHC Y FALSE GInternational Funding Inc. 39182 NOCD ALL Y INTL FUNDING INC Y FALSE GInternational Medical Group, INC IMGIN NOCD ALL N INT MEDICAL GROUP N FALSE GInternational Union Operating Engineers 37269 NOCD ALL N INT UNION OP ENGI N FALSE GInterWest Health PPO (Montana) 84137 NOCD MT Y INTERWEST HPPO MT Y FALSE GINTotal Health 35115 NOCD ALL Y INTOTAL HEALTH N FALSE GIowa Benefits, Inc. 41124 NOCD IA Y IOWA BENEFITS N FALSE GIowa Health Solutions (Provider ID Required) 86068 NOCD IA Y IOWA HEALTH SOLUT Y FALSE NIowa Total Care 68069 NOCD IA Y IA TOTAL CARE Y FALSE GIU Health Transplant Evaluation Program 47262 NOCD ALL Y IU HLTH TRANS Y FALSE GIU Medical Group Primary Care SX172 NOCD ALL Y IU MEDICAL GROUP Y FALSE GJAI Medical Systems JAI01 NOCD ALL N JAI MEDICAL SYSTE N FALSE GJohn Hopkins Healthcare (EHP/PP) (Submit Billing NPI and Rendering/Servicing NPI) 52189 NOCD ALL N JOHN HOPKINS HC Y FALSE GJohn Morrell Company - AHPBA 38310 NOCD ALL Y J MORRELL CO AHPB Y FALSE GJohn Muir Health Network JMH01 NOCD CA N JOHN MUIR HLTH NE Y FALSE G



20 of 41



Type

John Muir Mt. Diablo Health System 68036 NOCD ALL Y JOHN MUIR MT DBLO Y FALSE GJohn Muir Trauma Physicians (Please call 925-947-5288 for Payer ID information.) CALL CALL ALL Y CALL ENS S&S Y FALSE GJohns Hopkins (USFHP) (New submitter should send in their Billing NPI & Rendering servicing NPI) 52123 NOCD ALL Y JOHNS HOPKINS N FALSE GJoplin Claims 43178 NOCD ALL Y JOPLIN CLAIMS Y FALSE GJP Farley Corporation 34136 NOCD ALL Y JP FARLEY CORP N FALSE GJPS Preferred Care MWP01 NOCD ALL N JPS PREFERRED CAR N FALSE NJSL Administrators AKA Wells Fargo Third Party Administrators aka Healthsmart Benefits Solutions 37272 NOCD ALL N JSL ADMINISTRATOR Y FALSE GJVHL Aetna U.S. Healthcare J1JVL NOCD ALL Y J1JVL N TRUE GJVHL Aetna Better Health Premier Plan M5JVL NOCD ALL Y M5JVL N TRUE GJVHL AmeriHealth Caritas VIP Care Plus MDJVL NOCD ALL Y MDJVL N TRUE GJVHL Blue Care Network* (JVHL Network) J9JVL NOCD ALL Y J9JVL N TRUE GJVHL Blue Care Network* (BCN Commercial Labs) JJJVL NOCD ALL Y JJJVL N TRUE GJVHL Blue Care Network* (BCN Reimbursable Labs) JQJVL NOCD ALL Y JQJVL N TRUE G

JVHL Blue Care Network* (Critical Access / Small Volume Labs) MJJVL NOCD ALL Y MJJVL N TRUE GJVHL Blue Cross Complete KPJVL NOCD ALL Y KPJVL N TRUE GJVHL BCBSM Medicare Plus Blue PPO KCJVL NOCD ALL Y KCJVL N TRUE GJVHL CIGNA (Non-HAP and CIGNA-HAP members) KDJVL NOCD ALL Y KDJVL N TRUE GJVHL CIGNA – (Health Partners members only) KQJVL NOCD ALL Y KQJVL N TRUE GJVHL Community Care Associates (Healthchoice) JWJVL NOCD ALL Y JWJVL N TRUE GJVHL CoventryCares - Aetna Better Health of MI J8JVL NOCD ALL Y J8JVL N TRUE GJVHL Genesee County Health Plan MBJVL NOCD ALL Y MBJVL N TRUE GJVHL Health Alliance Plan (Capitated Contracts) JGJVL NOCD ALL Y JGJVL N TRUE GJVHL Health Alliance Plan (Fee for Service Contracts) JHJVL NOCD ALL Y JHJVL N TRUE GJVHL HAP Empowered (Midwest) Health Plan JBJVL NOCD ALL Y JBJVL N TRUE GJVHL Humana KVJVL NOCD ALL Y KVJVL N TRUE GJVHL McLaren Health Plan K7JVL NOCD ALL Y K7JVL N TRUE GJVHL Meridian Health Plan of MI (Health Plan of Michigan) J2JVL NOCD ALL Y J2JVL N TRUE GJVHL Molina Healthcare of Michigan JIJVL NOCD ALL Y JIJVL N TRUE GJVHL Priority Health JZJVL NOCD ALL Y JZJVL N TRUE GJVHL Reliance HMO MKJVL NOCD ALL Y MKJVL N TRUE GJVHL United Healthcare (non-Golden Rule Members) J5JVL NOCD ALL Y J5JVL N TRUE GJVHL United Healthcare (Golden Rule Members) KRJVL NOCD ALL Y KRJVL N TRUE G

JVHL United Healthcare Community Plan (Great Lakes Health Plan) JRJVL NOCD ALL Y JRJVL N TRUE GJVHL WellCare MMJVL NOCD ALL Y MMJVL N TRUE GKaiser Foundation Health Plan of Colorado COKSR NOCD CO R CO KAISER PERMANE N FALSE CKaiser Foundation Health Plan of Georgia NG010 NOCD GA Y KAISER FOUND GA Y FALSE CKaiser Foundation Health Plan of Northern CA Region 94135 NOCD CA Y KAISER NORTH CA N FALSE GKaiser Foundation Health Plan of Northern California KS003 NOCD CA N N CA KAISER PERMA N FALSE GKaiser Foundation Health Plan of Southern California KS001 NOCD CA N SCA KAISER PERMAN Y FALSE GKaiser Foundation Health Plan of the Mid-Atlantic NG008 NOCD ALL Y KAISER MID ATLANT Y FALSE GKaiser Foundation Health Plan of the NW NG009 NOCD OR,WA Y KAISER NW REGION Y FALSE CKaiser Foundation Health Plan of Washington (Formerly Group Health Cooperative of WA) 91051 NOCD WA Y GROUP HEALTH COOP Y FALSE GKaiser Foundation Health Plan PPO 94320 NOCD ALL Y KAISER PPO Y FALSE GKaiser Permanente Hawaii RH011 NOCD HI Y KAISER PERM HAWAI N FALSE GKalos Gold Health Plan 61185 NOCD ALL Y KALOS GOLD Y FALSE GKalos Health 40137 NOCD ALL Y KALOS HEALTH N FALSE GKeenan & Associates KEE01 NOCD CA N KEENAN AND ASSOCI Y FALSE GKelsey Seybold KELSE NOCD ALL N KELSEY SEYBOLD N FALSE GKemper Benefits 61453 NOCD ALL N KEMPER BENEFITS Y FALSE GKempton Group 73100 NOCD ALL N KEMPTON GROUP N FALSE GKent County Health Plan KENT1 NOCD MI N KENT COUNTY HP Y FALSE GKentucky Health Administrators, Inc. 27215 NOCD ALL N KY HEALTH ADMIN Y FALSE GKentucky Spirit Health Plan 68069 NOCD KY Y KENTUCKY SPIRIT H Y FALSE GKern County CDCR 28021 NOCD ALL A KERN COUNTY CDCR N FALSE GKern Health Care Network (Valid for dates of service prior to 01-01-2016.) 22149 NOCD ALL Y KERN HC NETWORK N FALSE GKern Health Systems 77039 NOCD ALL N KERN HEALTH SYSTE Y FALSE GKern Legacy Health Plan 89890 NOCD ALL Y KERN LEGACY HP Y FALSE GKey Benefit Administrators 37217 NOCD ALL Y KEY BENEFIT ADMIN N FALSE GKey Health Medical Solutions 95460 NOCD ALL Y KEY HEALTH MED SO N FALSE GKey Medical Group (Providers please contact Brandi Guinn @ 559-735-3892 x233 for authorization.) IP082 NOCD CA N KEY MEDICAL GROUP Y FALSE NKey Select 37321 NOCD ALL Y KEY SELECT Y FALSE GKey Solution 37323 NOCD ALL Y KEY SOLUTION Y FALSE G



21 of 41



Type

Keycare PPO VABLS BCBS VA Y KEYCARE PPO Y FALSE NKeystone Mercy Health Plan 23284 NOCD All Y KEYSTONE MERCY Y FALSE GKeystone First Community Health Choices 42344 NOCD ALL Y KEYSTONE FIRST Y FALSE GKeystone VIP Choice (formerly payer ID 84223) 77741 NOCD ALL N KEYSTONE VIP CHOI Y FALSE GKlais and Company 31147 NOCD ALL Y KLAIS AND COMPANY N FALSE GKlais and Company 34145 NOCD ALL Y KLAIS AND COMPANY N FALSE GKlais and Company Repriced HealthSpan 3414A NOCD ALL T KLAIS CO REPRICED N FALSE GKova Healthcare Incorporated KOVA1 NOCD ALL Y KOVA HEALTH Y FALSE GLA Care Health Plan LACAR NOCD ALL Y LA CARE HEALTH PL Y FALSE GLa Salle Medical Associates IPA NMM01 NOCD ALL Y LA SALLE MED ASSO Y FALSE GLACH HealthNet by MedPoint MPM19 NOCD ALL Y LACH HEALTHNET Y FALSE GLake Region Community Health Plan SISCO NOCD ALL N SISCO N FALSE GLakeside Medical Group 66125 NOCD ALL A LAKESIDE MEDICAL N FALSE GLakeside Medical Group Inc. LMG11 NOCD ALL N LAKESIDE MEDICAL N FALSE 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 TLandmark Healthcare Inc. LNDMK NOCD ALL Y LANDMARK Y FALSE PLas Vegas Fire Fighters Local No 1285 Security Fund NWADM NOCD CA N LV FIRE LOC 1285 Y FALSE GLaSalle Medical Associates NMM02 NOCD CA N LASALLE MED ASSOC N FALSE GLasso Healthcare MSA 10550 NOCD ALL N LASSO N FALSE GLBA HealthPlans 52193 NOCD ALL N LBA HEALTHPLANS N FALSE GLeisure World Managed Care LWMC1 NOCD ALL Y LEISURE WORLD MGD N FALSE GLeon Medical Center Health Plan 37316 NOCD ALL Y LEON MEDCENTER HP Y FALSE GLiberty Health Advantage 11328 NOCD ALL Y LIBERTY HLTH ADVA Y FALSE GLife & Health Ins Co of America (NFL Plan only) 98205 NOCD ALL N LIFE HLTH INS CO N FALSE GLife Beaver County 25924 NOCD ALL Y LIFE BEAVER COUNT N FALSE 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 GLife St. Joseph of the Pines 59847 NOCD ALL Y LIFE ST JOSEPH PI N FALSE GLife St Mary (Trinity Health Pace) 76184 NOCD ALL N LIFE ST MARY N FALSE GLife Trac 41136 NOCD ALL N LIFE TRAC Y FALSE GLifeCircles PACE 71498 NOCD ALL Y LIFECIRCLES PACE N FALSE GLifePath Hospice Inc. 76870 NOCD ALL N LIFEPATH HOSPICE Y FALSE GLifetime Benefits Solutions EBSRM NOCD ALL N LIFETIME BENEFITS N FALSE GLifewise A Premier Health Plan 93093 NOCD OR Y LIFEWISE Y FALSE NLifewise Health Plan of Oregon A Premier Health Plan 93093 NOCD OR Y OR LIFEWISE HP Y FALSE NLifewise Health Plan of Washington A Premier Health Plan 91049 NOCD WA Y WA LIFEWISE HP Y FALSE NLipa/Agate Resources LIPA1 NOCD ALL N LIPA AGATE RESOUR N FALSE GLittle Company of Mary Health 4725P NOCD ALL Y LITTLE CO OF MARY N FALSE GLocal 137 Operating Engineers Welfare Fund 84041 NOCD ALL N LOC 137 OPER ENGI Y FALSE GLocal Choice VABLS BCBS VA Y LOCAL CHOICE Y FALSE NLockard & Williams CB752 NOCD ALL Y LOCKARD AND WILLI N FALSE GLoma Linda University Adventist 37267 NOCD ALL N LOMA LINDA UN ADV N FALSE GLoma Linda University Health Care 33036 NOCD ALL Y LOMA LINDA UNIV H N FALSE GLone Star TPA 45289 NOCD ALL Y LONE STAR TPA Y FALSE GLong Beach Memorial IPA (MHCLB) MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE GLongevity Illinois LIL01 NOCD ALL N LONGEVITY Y FALSE GLongevity NJ LNJ01 NOCD ALL N LONG NJ Y FALSE GLouisiana Healthcare Connections 68069 NOCD LA Y LA HLTHCARE CONNE Y FALSE G

Lovelace Sandia Health Plan (Acquired by Blue Shield of New Mexico) NMBLS NOCD NM Y LOVELACE SANDIA Y FALSE NLutheran Preferred 39198 NOCD ALL Y LUTHERAN PREFERRE N FALSE NMabuhay Medical Group CAPMN NOCD ALL N MABUHAY MED GRP N FALSE GMacNeal Health Providers - CHS (Contact 708-783-7100 prior to first submission.) 36334 NOCD ALL N MACNEAL HEALTH PR N FALSE GMagellan Behavioral Health (All Non-AETNA Subscribers - Provider ID Required) (Payer Address required on all claims.) 01260 NOCD ALL N MAGELLAN BEHAVIOR Y FALSE GMagellan 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 GMagellan Complete Care FL 01260 NOCD ALL N MAGELLAN COMPLETE N FALSE GMagellan Complete Care Of VA MCCVA NOCD VA N VA MAGELLAN N FALSE GMagnolia Mississippi 68069 NOCD ALL Y MAGNOLIA MS Y FALSE GMAHP (MD IPA, Optimum Choice and MLH) UnitedHealthcare 87726 NOCD MD Y MAMP Y FALSE CMaine Community Health Options 45341 NOCD ALL N ME COMMUNITY H OP Y FALSE GMaksin Management Corporation (Now known as AIG Educational Markets) 22195 NOCD ALL Y MAKSIN MGMT CORP Y FALSE GManaged 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 N



22 of 41



Type

Managed Care Services, LLC 35162 NOCD ALL Y MANAGED CARE SERV Y FALSE GManaged Care Systems (Delango Regional Medical) MCS02 NOCD ALL N DELANGO REGIONAL Y FALSE G

Managed Care Systems CDCR (Customer Service: (800) 494-4662) MCS04 NOCD CA N MGD CARE SYS CDCR Y FALSE GManaged Health Care Admin EPS MHCA1 NOCD ALL Y MGD HLTH CARE EPS N TRUE GManaged Health Care Administration EPS MHCA1 NOCD ALL Y MNGD HC ADMIN EPS Y FALSE GManaged Health Care Associates 36312 NOCD ALL Y MANAGED HEALTH N FALSE GManaged Health Networks (MHN) 22771 NOCD ALL N MANAGED HEALTH NE Y FALSE GManaged Health Services Indiana 68069 NOCD IN Y IN MGD HEALTH SVC Y FALSE G

Managed 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 GMapfre Life Commercial 46012 NOCD ALL Y MAPFRE LIFE COMME N FALSE GMarch Vision Health Plan 52461 NOCD ALL N MARCH VISION HP N FALSE CMarin IPA IP097 NOCD CA N MARIN IPA Y FALSE GMarrick Medical Finance, LLC 20805 NOCD ALL N MARRICK MED FINAN Y FALSE GMarrick WRx 46478 NOCD ALL N MARRICK WRX N FALSE GMarin Headlands Medical Group 77304 NOCD ALL Y MARIN HEADLANDS Y TRUE NMartins Point Health Care MPHC2 NOCD ALL Y MARTINS POINT N FALSE GMartin's Point Health Care USFHP/Generations Advantage MPHC2 NOCD ALL Y MARTINS PT HC N FALSE GMaryland Physicians Care 22348 NOCD ALL N MD PHYSICIANS CAR Y FALSE GMaryland Physicians Care (MPC) 76498 NOCD ALL N Maryland Phys Y FALSE GMaryland PMHS ValueOptions (Use for ALL Dates of Service) 77063 NOCD MD N MARYLAND PMHS VO Y TRUE NMashantucket Pequot Tribal Nation 37121 NOCD ALL Y MASHANTUCKET PEQU N FALSE GMassachusetts Behavioral Health (BHO) BHOMA NOCD MA Y MASS BEHAV Y TRUE NMassachusetts Mutual also known as Mass Mutual 80314 NOCD ALL Y MASSACHUSETTS MUT Y FALSE GMass Health (MA Medicaid) MAMCD NOCD MA Y MASS HEALTH Y TRUE NMasters, Mates and Pilots Plan MMPHB NOCD ALL N MASTERS MATES PIL N FALSE GMax Specialty Benefits 27320 NOCD ALL N MAX SPECIALTY BEN N FALSE GMaxCare (Universal Fidelity Administrators Company) 93220 NOCD ALL Y MAXCARE N FALSE GMaxor 92805 NOCD ALL Y MAXOR N FALSE GMayo Clinic FL/GA 88090 NOCD ALL Y MAYO CLINIC FL GA N FALSE GMBA Benefit Administrators 83028 NOCD ALL Y MBA BENEFIT ADMIN N FALSE GMBA of Wyoming 87065 NOCD WY,UT Y CDO TECHNOLOGIES N FALSE GMcare of Michigan (Payer no longer accepting electronic claims. Claim will be printed and mailed to payer.) 38264 NOCD MI Y MCARE Y FALSE GMCC 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 CMcCreary Corporation 59331 NOCD FL Y MCCREARY CORP Y FALSE GMcGregor Pace 31149 NOCD ALL Y MCGREGOR PACE N FALSE GMcLaren Health Advantage 3833A NOCD ALL Y MCLAREN HLTH ADVA Y FALSE CMcLaren Health Plan 38338 NOCD ALL Y MCLAREN Y FALSE CMcLaren Medicaid 3833C NOCD ALL Y MCLAREN MEDICAID Y FALSE CMcLaren State of Michigan 3833M NOCD ALL Y MCLAREN MI Y FALSE CMcLaren Medicare Supplement 3833S NOCD ALL Y MCLAREN MEDICARE Y FALSE CMcLarenAdvantage SNP 3833R NOCD ALL Y MCLAREN ADV SNP Y FALSE CMCS 6197P NOCD PR Y MCS N FALSE NMCS Life 66039 NOCD ALL Y MCS LIFE N FALSE GMD CARE HEALTH PLAN MDC01 NOCD ALL N MD CARE HP N FALSE GMD Rogue Oregon Health Plan MRIPA NOCD ALL N MD ROGUE OR HP N FALSE GMD-Individual Practice Association, Inc. (M.D. IPA) (Previously Payer ID 52148) 87726 NOCD All Y MD INDIVIDUAL PRA Y FALSE CMDwise Health Indiana Plan 3135M NOCD ALL Y MDWISE HEALTHY IN Y FALSE CMDwise Hoosier Care Connect (For DOS on or after 1-01-2017) 91313 NOCD ALL Y MDWISE HOOSIER CA N FALSE GMDwise Hoosier Healthwise 3519M NOCD ALL Y MDWISE HOOSIER HE N FALSE CMDWise Select Health Network 35199 NOCD ALL N MDWISE SELECT HN N FALSE GMDX Hawaii MDXHI NOCD HI Y MDX HAWAII Y FALSE G

Med Pay (For claims repriced by Premier Health Care Exchange) 88058 NOCD ALL A MED PAY Y FALSE GMed3000 CMS Early Steps EM350 NOCD ALL N MED3000 CMS EARLY N FALSE GMed3000 CMS Safety Net EM284 NOCD ALL N MED3000 CMS SAFET N FALSE GMed3000 CMS Title 19 Reform (New PID Effective For DOS After 1/31/19) 14163 NOCD ALL N MED3000 CMS T19 R N FALSE GMedAdmin Sol Inc 58204 NOCD ALL Y MEDADMIN SOL INC N FALSE GMedCom 59231 NOCD ALL N MEDCOM N FALSE GMedCost 56162 NOCD All N MEDCOST Y FALSE GMedCost / Liberty Health Share 90753 NOCD ALL Y LIBERTY HEALTH SH N FALSE TMedCost Benefit Services 56205 NOCD ALL Y MEDCOST BENEFIT Y FALSE GMedfocus 95321 NOCD ALL N MEDFOCUS Y FALSE GMEDICA 94265 NOCD ALL Y MEDICA Y FALSE C



23 of 41



Type

Medica HealthCare Plans / FL 78857 NOCD FL Y MEDICA HCARE PLAN Y FALSE CMedica Health Plan Solutions 71890 NOCD ALL Y MEDICA HLTH N FALSE GMedica2 12422 NOCD ALL Y MEDICA2 Y FALSE GMedicaid of Delaware DEMCD NOCD DE N DE MEDICAID Y FALSE TMedicaid - TX Premier Plan (Please contact Provider Relations at (915)-532-3778 x1507 to enroll.) EPF02 NOCD TX Y TX PREMIER MEDICA N TRUE GMedicaid of Alabama ALMCD NOCD AL Y AL MEDICAID Y FALSE NMedicaid of Alaska AKMCD NOCD AK N AK MEDICAID Y TRUE NMedicaid of Arizona (AHCCCS) AZMCD NOCD AZ Y AZ MEDICAID Y FALSE NMedicaid of Arkansas ARMCD NOCD AR Y AR MEDICAID Y FALSE NMedicaid of Colorado COMCD BCBS CO Y CO MEDICAID Y TRUE NMedicaid of Connecticut CTMCD NOCD CT Y CT MEDICAID Y FALSE NMedicaid of Florida FLMCD UNIS FL N FL MEDICAID Y TRUE NMedicaid of GA GAMCD NOCD GA N GA MEDICAID Y FALSE NMedicaid of Idaho IDMCD NOCD ID R ID MEDICAID Y FALSE NMedicaid of Illinois ILMCD NOCD IL Y IL MEDICAID Y FALSE NMedicaid of Indiana INMCD NOCD IN N IN MEDICAID Y FALSE NMedicaid of Iowa IAMCD CONS IA N IA MEDICAID Y TRUE NMedicaid of Kansas KSMCD BCBS KS N KS MEDICAID Y FALSE NMedicaid of Kentucky KYMCD NOCD KY Y KY MEDICAID Y TRUE NMedicaid of Louisiana (Includes KidMed claims.) LAMCD NOCD LA Y LA MEDICAID Y TRUE NMedicaid of Maine MEMCD NOCD ME N ME MEDICAID N FALSE NMedicaid of Maryland MDMCD NOCD MD N MD MEDICAID Y TRUE NMedicaid of Massachusetts MAMCD NOCD MA Y MA MEDICAID Y TRUE NMedicaid of Michigan BCCCP SKMI1 NOCD MI Y MEDICAID MICHIGAN BCCCP Y FALSE GMedicaid of Michigan MIMCD NOCD MI Y MI MEDICAID Y TRUE NMedicaid of Minnesota MNMCD NOCD MN N MN MEDICAID Y TRUE NMedicaid of Mississippi MSMCD NOCD MS Y MS MEDICAID N TRUE NMedicaid of Missouri MOMCD NOCD MO Y MO MEDICAID Y FALSE NMedicaid of Montana MTMCD CONS MT N MT MEDICAID Y FALSE NMedicaid of Nebraska NEMCD NOCD NE Y NE MEDICAID N TRUE NMedicaid of Nevada NVMCD NOCD NV N NV MEDICAID Y TRUE NMedicaid of New Hampshire NHMCD NOCD NH N NH MEDICAID Y FALSE NMedicaid of New Jersey NJMCD NOCD NJ Y NJ MEDICAID Y TRUE NMedicaid of New Mexico NMMCD NOCD NM Y NM MEDICAID N TRUE NMedicaid of New York NYMCD NOCD NY Y NY MEDICAID Y TRUE NMedicaid of North Carolina NCMCD NOCD NC N NC MEDICAID Y TRUE NMedicaid of North Dakota NDMCD NOCD ND N ND MEDICAID Y FALSE NMedicaid of Ohio OHMCD NOCD OH Y OH MEDICAID Y FALSE NMedicaid of Oklahoma OKMCD NOCD OK N OK MEDICAID Y FALSE NMedicaid of Oregon ORMCD NOCD OR N OR MEDICAID N TRUE NMedicaid of Pennsylvania PAMCD NOCD PA Y PA MEDICAID Y FALSE NMedicaid of Rhode Island RIMCD NOCD RI N RI MEDICAID Y TRUE NMedicaid of South Carolina SCMCD NOCD SC Y SC MEDICAID Y TRUE NMedicaid of South Dakota SDMCD NOCD SD N SD MEDICAID Y TRUE NMedicaid of Tennessee (TennCare) TNMCD NOCD TN Y TN MEDICAID N TRUE NMedicaid of Texas TXMCD NOCD TX Y TX MEDICAID Y FALSE GMedicaid of Utah UTMCD NOCD UT Y UT MEDICAID Y TRUE NMedicaid of Vermont VTMCD NOCD VT N VT MEDICAID Y TRUE NMedicaid of Virginia VAMCD NOCD VA N VA MEDICAID Y FALSE NMedicaid of Washington DC DCMCD NOCD DC Y DC MEDICAID Y TRUE NMedicaid of Washington State WAMCD NOCD WA Y WA MEDICAID Y TRUE NMedicaid of West Virginia WVMCD NOCD WV Y WV MEDICAID Y FALSE NMedicaid of Wisconsin WIMCD EDS WI N WI MEDICAID Y FALSE NMedicaid of Wyoming WYMCD NOCD WY N WY MEDICAID Y TRUE NMedical Associates Health Plan MAHP1 NOCD ALL Y MED ASSOC HLTH PL N FALSE GMedical Benefit Administration, Inc. 68041 NOCD ALL Y MEDICAL BENEFIT A Y FALSE GMedical Benefits Mutual 74323 NOCD ALL Y MEDICAL BENEFITS Y FALSE NMedi-Cal by MedPoint MPM18 NOCD ALL N MEDPOINT MEDICAL N FALSE G

Medical 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 GMediCal of California MDCAL NOCD CA N CA MEDICAL Y TRUE NMedical Orange Coast Memorial IPA MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE GMedical Reimbursements of America 62177 NOCD ALL Y MED REIMBURSE AME Y FALSE GMedical Resource Network (MRN, INC) 58203 NOCD ALL Y MEDICAL RESOURCE Y FALSE GMedical Services Initiative 12057 NOCD ALL Y MEDICAL SVCS INIT Y FALSE GMedical Value Plan - Ohio (MVP) 38224 NOCD OH Y MEDICAL VALUE PLA N FALSE GMedicare Advantage PHP Michigan 83276 NOCD MI Y MEDICARE ADV MI N FALSE GMedicare & Much More Florida Incorporated MMMFL NOCD FL Y MEDICARE MORE N FALSE G



24 of 41



Type

Medicare Blue Advantage of South Carolina SCBLS NOCD SC Y SC BLUE SHIELD Y FALSE NMedicare DME MAC Jurisdiction C 18003 NOCD ALL Y MEDICARE DME MAC N TRUE NMedicare of Missouri (For pre-existing providers only) (Includes both Eastern and Western Missouri.) KCMCR NOCD KS,MO Y KC MEDICARE Y N/A NMedicare Part B GHI GHMCR NOCD NY N GHI MEDICARE NY Y TRUE NMedicare Part B of Alabama ALMCR NOCD AL Y AL MEDICARE Y TRUE NMedicare Part B of Alaska AKMCR NOCD AK N AK MEDICARE Y TRUE NMedicare Part B of American Samoa HIMCR NOCD AM Samoa Y HI MEDICARE Y TRUE NMedicare Part B of Arizona AZMCR NOCD AZ Y AZ MEDICARE Y TRUE NMedicare Part B of Arkansas ARMCR NOCD AR Y AR MEDICARE Y TRUE NMedicare Part B of Colorado COMCR BCBS CO Y CO MEDICARE Y TRUE NMedicare Part B of Connecticut CTMCR NOCD CT Y CT MEDICARE Y TRUE NMedicare Part B of DC 00903 NOCD DC R DC MEDICARE Y TRUE NMedicare Part B of Delaware 00902 NOCD DE R DE MEDICARE Y TRUE NMedicare Part B of Florida FLMCR BCBS FL Y FL MEDICARE Y TRUE NMedicare Part B of Georgia GAMCR AETN GA Y GA MEDICARE Y TRUE NMedicare Part B of Guam HIMCR NOCD Guam Y HI MEDICARE Y TRUE NMedicare Part B of Hawaii HIMCR BCBS HI Y HI MEDICARE Y TRUE NMedicare Part B of Idaho IDMCR NOCD ID Y ID MEDICARE Y TRUE NMedicare Part B of Illinois ILMCR BCBS IL Y IL MEDICARE Y TRUE NMedicare Part B of Indiana INMCR NOCD IN N IN MEDICARE Y TRUE NMedicare Part B of Iowa IAMCR BCBS IA Y IA MEDICARE Y TRUE NMedicare Part B of Kansas KSMCR BCBS KS Y KS MEDICARE Y TRUE NMedicare Part B of Kentucky KYMCR NOCD KY Y KY MEDICARE Y TRUE NMedicare Part B of Louisiana LAMCR BCBS LA Y LA MEDICARE Y TRUE NMedicare Part B of Maine MEMCR NOCD ME Y ME MEDICARE Y TRUE NMedicare Part B of Maryland 00901 NOCD MD R MD MEDICARE Y TRUE NMedicare Part B of Massachusetts MAMCR NOCD MA Y MA MEDICARE Y TRUE NMedicare Part B of Michigan MIMCR NOCD MI Y MI MEDICARE Y TRUE NMedicare Part B of Minnesota MNMCR NOCD MN Y MN MEDICARE Y TRUE NMedicare Part B of Mississippi MSMCR NOCD MS Y MS MEDICARE Y TRUE N

Medicare Part B of Missouri (Eastern) (Specialty testing required) MOMCR NOCD MO N MO MEDICARE EAST Y TRUE NMedicare Part B of Montana MTMCR NOCD MT Y MT MEDICARE Y TRUE NMedicare Part B of Nebraska NEMCR BCBS NE Y NE MEDICARE Y TRUE NMedicare Part B of Nevada NVMCR NOCD NV N NV MEDICARE Y TRUE NMedicare Part B of New Hampshire NHMCR NOCD NH Y NH MEDICARE Y TRUE NMedicare Part B of New Mexico NMMCR NOCD NM Y NM MEDICARE Y TRUE NMedicare Part B of New York (Empire) NYMCR NOCD NY Y NY MEDICARE Y TRUE NMedicare Part B of NJ (Specialty testing required) NJMCR NOCD NJ Y NJ MEDICARE Y TRUE NMedicare Part B of North Carolina NCMCR NOCD NC Y NC MEDICARE Y TRUE NMedicare Part B of North Dakota NDMCR NOCD ND N ND MEDICARE Y TRUE NMedicare Part B of Northern California CNMCR NOCD CA Y CA MEDICARE NORTH Y TRUE NMedicare Part B of Northern Mariana Islands HIMCR NOCD CNMI Y HI MEDICARE Y TRUE N

Medicare 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 NMedicare Part B of Ohio OHMCR NOCD OH Y OH MEDICARE Y TRUE NMedicare Part B of Oklahoma OKMCR NOCD OK Y OK MEDICARE Y TRUE NMedicare Part B of Oregon ORMCR NOCD OR Y OR MEDICARE Y TRUE NMedicare Part B of Pennsylvania PAMCR NOCD PA Y PA MEDICARE Y TRUE NMedicare Part B of Rhode Island RIMCR NOCD RI Y RI MEDICARE Y TRUE NMedicare Part B of South Carolina SCMCR NOCD SC Y SC MEDICARE Y TRUE NMedicare Part B of South Dakota SDMCR NOCD SD N SD MEDICARE Y TRUE NMedicare Part B of Southern California CSMCR NOCD CA Y CA MEDICARE SOUTH Y TRUE NMedicare Part B of Tennessee TNMCR NOCD TN Y TN MEDICARE Y TRUE NMedicare Part B of Texas TXMCR NOCD TX Y TX MEDICARE Y TRUE NMedicare Part B of Upstate NY N1MCR NOCD NY Y UPSTATE NY MEDICA Y TRUE NMedicare Part B of Utah UTMCR NOCD UT Y UT MEDICARE Y TRUE NMedicare Part B of Vermont VTMCR NOCD VT Y VT MEDICARE Y TRUE NMedicare Part B of Virginia VAMCR NOCD VA Y VA MEDICARE Y TRUE NMedicare Part B of Washington WAMCR NOCD WA N WA MEDICARE Y TRUE NMedicare Part B of West Virginia WVMCR NOCD WV Y WV MEDICARE B Y TRUE N

Medicare Part B of Western Missouri (For pre-existing providers only) MWMCR NOCD MO Y W MO MEDICARE Y N/A NMedicare Part B of Wisconsin WIMCR WPS WI Y WI MEDICARE Y TRUE NMedicare Part B of Wyoming WYMCR BCBS WY Y WY MEDICARE Y TRUE NMedicare Railroad (MetraHealth Medicare) RRWMC TRAV All N RRW MEDICARE Y TRUE NMedicare Supplemental VABLS BCBS VA Y VA MEDICARE SUPPL Y FALSE NMedico Insurance Company 23160 NOCD ALL N MEDICO INS COMPAN N FALSE G



25 of 41



Type

MEDIGOLD 95655 NOCD ALL N MEDIGOLD N FALSE GMediture IPA AMM11 NOCD ALL Y MEDITURE IPA N FALSE GMedova Healthcare 27005 NOCD ALL N MEDOVA HEALTHCARE N FALSE G

MedPartners (PHCS Repricing) (PO Box 10240 Fort Wayne, In 46857) 441MP NOCD ALL Y MEDPARTNERS PHCS N FALSE GMedPartners Admin Services 412MP NOCD ALL N MEDPARTNERS ADMIN N FALSE GMed-Pay 00130 NOCD MO, IL Y MEDPAY N FALSE GMedSolutions, Inc. 62160 NOCD ALL Y MEDSOLUTIONS Y FALSE GMedStar Family Choice 39190 NOCD ALL N MEDSTAR FAM CHOIC N FALSE GMedstar Physician Partners 00243 NOCD MD Y MEDSTAR PHYS PART Y FALSE GMedstar Select 251MS NOCD ALL N MEDSTAR SEL N FALSE GMemorial Clinical Associates MCA11 NOCD ALL N MEM CLINICAL ASSO N FALSE TMemorial Healthcare IPA MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE GMemorial Hermann Health Network MHHNP NOCD ALL N MEM HERMANN HLTH N FALSE GMemorial Integrated Healthcare 59064 NOCD All N MEMORIAL INTEGRA Y FALSE GMemorialCare Medical Foundation MMFMC NOCD ALL N MEMORIALCARE MED N FALSE GMendicina Familiar Medical Group IP080 NOCD CA N MEDICINA FAMILIAR Y FALSE GMennonite Mutual (Now known as Everence) 35605 NOCD ALL N MENNONITE MUTUAL Y FALSE GMental Health Consultants Inc 37050 NOCD ALL N MENTAL HLTH CONS N FALSE GMental Health Network (Only claims for PO Box 209010 Austin TX 78720) 74289 NOCD ALL Y MENTAL HEALTH NET Y FALSE GMercy Care 39114 NOCD WI N MERCYCARE WI N FALSE CMercy Health Plan (AHCCCS) 86052 NOCD AZ Y MERCY HP AHCCCS Y FALSE GMercy Health Plan of AZ 86052 NOCD AZ Y MERCY HP AZ Y FALSE 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 GMercy LIFE of Alabama 63002 NOCD ALL Y MERCY LIFE OF AL N FALSE GMercy Maricopa Integrated Care 33628 NOCD ALL Y MERCY MARICOPA IC N FALSE GMercy Provider Network 43185 NOCD ALL Y MERCY PROV NETWOR N FALSE GMercyCare of WI. (Call 608-758-7739 for PayerID.) CALL NOCD ALL N Call INGENIX supp N FALSE CMeridianHealth Illinois 13189 NOCD ALL Y MERIDIAN HEALTH P Y FALSE GMeridian Health Plan Illinois Complete (Meridian Health Plan Illinois Medicaid effective until 12/31/20) 13189 NOCD ALL Y MERIDIAN HEALTH P Y FALSE GMeridianComplete (Ambetter from Michigan, Meridian Complete, Michigan Complete) Payer ID effective 01-01-2021 MHPMI NOCD MI A MERIDIAN MI N FALSE GMeridianHealth Michigan 52563 NOCD MI A MERIDIAN N FALSE GMeridian Health Plan Michigan (Meridian Health Plan Michigan Complete and Meridian Health Plan Michigan Medicaid) effective until 12/31/20 52563 NOCD MI A MERIDIAN N FALSE GMeridianTotal (Meridian Complete, Illinois Complete, YouthCare and Ambetter Payer ID effective 01-01-2021) MHPIL NOCD ALL Y MERITAIN HLTH NAH N FALSE GMeritain Health (North American Health Plan.) 64157 NOCD ALL Y MERITAIN HLTH NAH N FALSE GMeritain Health / Agency Services 64158 NOCD ALL Y MERITAIN HEALTH Y FALSE NMeritain Health Minneapolis 41124 NOCD ALL Y MERITAIN MN N FALSE GMetro Plus Health Plan 13265 NOCD ALL A METRO PLUS HEALTH Y FALSE GMetropolitan Health Plan 10850 NOCD ALL Y METRO HEALTH PLAN Y FALSE GMiami Behavioral Health 92579 NOCD ALL Y MIAMI BEHAVIORAL N FALSE GMiami Children’s Health Plan 82832 NOCD ALL Y MIAMI CHILDREN Y FALSE GMichigan Blue Care HMO (BCN of Michigan) MIBCN NOCD MI N MI BLUE CARE Y TRUE NMichigan Complete Health 68069 NOCD MI Y MI COMP HLTH N FALSE GMichigan Medicare PlusBlue MIMPB NOCD MI Y MI MEDICARE PLUSB Y TRUE NMicron Tech 96598 NOCD ALL Y MICRON TECH Y FALSE GMid-America Associates 37281 NOCD ALL N MIDAMERICA ASSOC N FALSE GMid-American Benefits 22823 NOCD ALL N MID AMER BENEFITS Y FALSE GMidland Management/MFC 23550 NOCD ALL Y MIDLAND MGMT MFC Y FALSE GMidland National Life Ins Co (NFIC Plan only) 90956 NOCD ALL N MIDLAND NAT LIFE N FALSE GMidlands Choice 47080 NOCD NE,IA Y MIDLANDS CHOICE Y FALSE TMidlands Health Partners 47080 NOCD ALL Y MIDLANDS HEALTH Y FALSE TMid-West Behavioral Health Network MVBCN NOCD ALL Y MW BEHAV HLTH NET N FALSE GMidwest Group Benefits 61146 NOCD ALL Y MIDWEST GROUP BEN N FALSE GMidwest Health Partners 76079 NOCD ALL N MIDWEST HLTH PART N FALSE GMidwest Physician Administrative Services TH088 NOCD ALL Y MW PHYS ADMIN SVC N FALSE GMinuteman Health 01776 NOCD MA N MINUTEMAN HEALTH N FALSE NMission Community IPA Med Grp MPM07 NOCD CA N MISSION COMM IPA N FALSE NMission HospitalAffiliates STJOE NOCD CA Y MISSION HOSPITAL Y FALSE GMississippi Health Partners 64068 NOCD ALL Y MS HEALTH PARTNER Y FALSE GMississippi Physicians Care Network 64084 NOCD ALL Y MS PHYS CARE NETW Y FALSE GMississippi Select Healthcare (Mississippi Select Health Care) 64088 NOCD All Y MS SELECT HEALTHC N FALSE GMissoula County Medical Benefits 37275 NOCD MT N MISSOULA COUNTY M N FALSE GML Healthcare 26097 NOCD ALL N ML HEALTHCARE N FALSE G



26 of 41



Type

Moda Health (ODS Health Plan) 13350 NOCD ALL N MODA HEALTH N FALSE NMMM - Medicare y mucho Mas 88600 NOCD PR N MEDICARE Y MUCHO N FALSE NMolina Healcare of New Mexico - SCI 04423 NOCD ALL Y MOLINA HC NM SCI Y FALSE GMolina Health Care of South Carolina 46299 NOCD ALL N MOLINA HC SC Y FALSE GMolina Healthcare of CA - Encounters only. 33373 NOCD CA Y MOLINA HC CA ENC N FALSE 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 GMolina Healthcare of Florida 51062 NOCD ALL Y MOLINA HC OF FLOR Y FALSE GMolina Healthcare of Illinois 20934 NOCD ALL Y MOLINA HC OF IL Y FALSE GMolina Healthcare of Michigan 38334 NOCD MI Y MOLINA HC OF MICH Y FALSE GMolina Healthcare Mississippi 77010 NOCD MS Y MOLINA MS Y FALSE GMolina Healthcare of New Mexico NM505 NOCD NM Y MOLINA HC OF NEW Y FALSE GMolina Healthcare of New Mexico Salud 09824 NOCD NM N MOLINA HC NM SALU Y FALSE GMolina Healthcare of Ohio 20149 NOCD OH Y MOLINA HC OF OHIO Y FALSE GMolina Healthcare of Texas 20554 NOCD TX Y MOLINA HC OF TEX Y FALSE GMolina Healthcare of Washington (Rendering providers use DSHS Medicaid ID or State Licence Number.) 38336 NOCD WA Y MOLINA HC OF WASH Y FALSE GMolina Healthcare of Washington ENCOUNTERS ONLY 43174 NOCD ALL N MOLINA HC WA ENC N FALSE GMolina Healthcare Utah SX109 NOCD UT Y MOLINA HCARE UT Y FALSE NMonarch Healthcare IPA (Rendering provider ID# required on all claims.) IP095 NOCD ALL N MONARCH HEALTH IP N FALSE NMonitor Life (Payer accepts secondary claims only, and Medicare cannot be primary payer.) 01759 NOCD ALL Y MONITOR LIFE Y FALSE G

Montefiore 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 GMontefiore HMO 46161 NOCD ALL N MONTEFIORE HMO Y FALSE GMonumental Life Ins Co. MMLIC NOCD ALL N MONUMENTAL LIFE N FALSE NMorris Associates aka HealthScope Benefits 35092 NOCD ALL Y MORRIS ASSOCIATES Y FALSE GMosaic IPA Medical Group (Providers please contact Brandi Guinn @ 559-735-3892 x233 for authorization.) IP083 NOCD CA N MOSAIC IPA MEDICA Y FALSE NMotion Picture Industry Health Plan (These claims now processed by Anthem BC of CA) MPI01 NOCD CA Y MOTIONPIXINDUS N FALSE GMountain States Administrators (COLORADO ONLY) MTNST NOCD CO N MOUNTAIN STATES Y FALSE GMPE Employee Benefit Services 37233 NOCD ALL N EMP EMPLOYEE BENE N FALSE GMPLAN Inc. Healthcare Group 95444 NOCD ALL A MPLAN INC HEALTH Y FALSE GMPM Prospect MPM16 NOCD ALL N MPM PROSPECT Y FALSE GMRIPA Allcare CCO (Medicaid Payer) 26161 NOCD ALL Y MRIPA ALLCARE CCO N FALSE GMS BCBS State Employees SB731 NOCD MS Y MS BCBS SE N FALSE NMt. Carmel 95655 NOCD ALL N MOUNT CARMEL N FALSE GMultiplan Wisconsin Preferred Provider Network 34080 NOCD ALL Y WI MULTIPLAN PPN Y FALSE CMultnomah County MLTOT NOCD ALL Y MULTNOMAH COUNTY N FALSE GMunicipal Health Benefits Fund 81883 NOCD ALL N MUNI HEALTH BENEF N FALSE GMuskegon Care A1681 NOCD MI N MUSKEGON CARE Y FALSE GMutual Health Services (fka Antares Management Solutions) 34192 NOCD ALL Y ANTERES MGMT SOLN Y FALSE GMutual of Omaha Insurance Company 71412 NOCD ALL N MUTUAL OF OMAHA N FALSE G

Mutual of Omaha Medicare Advantage 82275 NOCD ALL NMUTUAL OF OMAHA MEDICARE ADVANTAGE N FALSE N

MVP Health Plan of NY 14165 NOCD NY Y MVP HEALTH NY Y FALSE GMy Family Medical Group 33020 NCOD ALL Y MY FAMILY MEDICAL N FALSE GMyNexus, Inc. 32043 NOCD ALL Y MYNEXUS INC N FALSE GN.W. Ironworkers Health & Security Trust Fund - Grp#F15 91136 NOCD ALL Y NW IRONWRKRS F15 N FALSE G

N.W. Roofers & Employers Health & Security Trust Fund - Grp#F14 91136 NOCD ALL Y NW ROOFERS F26 N FALSE GN.W. Textile Processors - Grp#F14 91136 NOCD ALL Y NW TEXTILE F14 N FALSE GNAA (North America Administrators) 65085 NOCD ALL N NAA N FALSE GNAMCI/Global Care L0110 NOCD ALL Y NAMCI GLOBAL CARE Y FALSE GNaphcare Inc 58182 NOCD ALL A NAPHCARE INC Y FALSE GNational Accident & Health General Agency Inc. 67788 NOCD ALL Y NAT ACC HEALTH GE Y FALSE GNational Allied Workers Union Local 831 CB148 NOCD ALL Y NAT ALLIED LCL831 N FALSE GNational Capital Area NCABS NOCD DC VA MD N NCA N TRUE NNational 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 GNew Era Life Insurance Company 98798 NOCD ALL N NEW ERA LIFE N FALSE GNational Financial Insurance Company 90956 NOCD ALL N NAT FINANCIAL INS N FALSE GNational Foundation Life Insurance Company 98205 NOCD ALL N NAT FOUNDATION LI N FALSE GNational Health Benefit 88057 NOCD ALL Y NATL HEALTH BENEF Y FALSE GNational Health Benefits Corporation - NHBC02 88050 NOCD ALL Y NHBC02 Y FALSE G



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Type

National Rural Electric 52132 NOCD All Y NAT RURAL ELECT N FALSE GNational Teachers Association (NTA) NTA11 NOCD ALL A NTA N FALSE G

National Telecommunications Cooperative Association (NTCA) 52103 NOCD ALL Y NAT TELECOMM COOP Y FALSE G

National Telecommunications Cooperative Association (NTCS Staff) 52104 NOCD ALL Y NTCS STAFF Y FALSE GNational Vision NVADM NOCD ALL N NATIONAL VISION N FALSE NNative Care Health 19191 NOCD ALL N NATIVE CARE HEALT Y FALSE GNCAS - Charlotte, VA 75191 NOCD VA Y NCAS CHARLOTTE Y FALSE GNCAS - Fairfax, VA 75190 NOCD VA Y NCAS FAIRFAX Y FALSE GNebraskaTotal Care 68069 NOCD ALL Y NEBRASKA TOTAL CA N FALSE GNeighborhood Health Partnership (NHP) 96107 NOCD ALL Y NEIGH HLTH PARTNE N FALSE 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 CNeighborhood 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 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 NAllWays Health Plan (prev. Neighborhood Plan, Boston, MA) 04293 NOCD ALL Y NGHBRHOOD PLAN MA Y FALSE GNesika Health Group (Old payerID of 37255 is no longer valid.) 75280 NOCD ALL Y NESIKA HEALTH GRP N FALSE GNetcare Life and Health Insurance 66055 NOCD ALL N NETCARE LIFE HLTH N FALSE 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 GNetwork Health Insurance Corp - Medicare 77076 NOCD ALL T NETWORK HLTH INSU Y FALSE 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 N

Network Health 04332 NOCD ALL N NETWORK HLTH N TRUE NNetwork Health PPO AMS01 NOCD ALL N NETWORK HEALTH PP Y FALSE GNetwork Solutions IPA NSIPA NOCD ALL Y NETWORK SOLN IPA Y FALSE GNew Avenues, Inc. 95998 NOCD ALL N NEW AVENUES INC Y FALSE GNew Century Health NCHCA NOCD ALL Y NEW CENT HEALTH N FALSE GNew Century Health - Vista Cardiology NCH09 NOCD ALL N NEW CENTURY HEALT Y FALSE GNew Century Health Arizona Integrated Physicians NCHOR NOCD ALL N NEW CENTURY AZIP N FALSE GNew Century Health Urology NCH03 NOCD ALL N NEW CENT HLTH URO N FALSE GNew Hampshire Healthy Family 68069 NOCD NH Y NH HEALTHY FAMILY Y FALSE GNew Mexico Blue Cross Community Centennial (MemberIDs start with "YIP") MC721 NOCD NM Y NM BC COMMUNITY C Y FALSE GNew Mexico District Council of Carpenters 74234 NOCD NM N NM DIST CARPENTER N FALSE GNew Mexico Health Connections 45129 NOCD ALL N NM HEALTH CONNECT Y FALSE GNew Mexico Painters and Allied Trades Local No 823 74234 NOCD UT N NM PAINTERS #823 N FALSE GNew Mexico Public Schools Insurance Authority 85036 NOCD ALL Y NM PUB SCHOOLS iN N FALSE GNew Mexico-West Texas Multi-Craft (lso known as New Mexico Laborers) 74234 NOCD UT N NM MULTI-CRAFT N FALSE GNew York Hotel Trade Council 7707C NOCD ALL N NY HOTEL TRADE Y TRUE NNew York Life - Long Term Care NYL11 NOCD ALL N NYL LONG TERM CAR N FALSE NNew York Medical Imaging-MVP 14179 NOCD NY Y NEW YORK MVP Y FALSE GNew York Network Management 11334 NOCD ALL Y NY NETWORK MGMNT Y FALSE GNexcaliber ADSL1 NOCD ALL Y NEXCALIBER N FALSE NNext Level Health Partners (FKA 69821) 81085 NOCD ALL Y NEXT LEVEL HEALTH N FALSE GNGS CoreSource 38225 NOCD ALL Y NGS AMERICAN Y FALSE GNippon Life Insurance Company 81264 NOCD ALL Y NIPPON LIFE INSUR N FALSE GNivano Physicians IPA MBA01 NOCD ALL N NIVANO IPA Y FALSE GNJ Carpenters Health Fund 22603 NOCD NJ N NJ CARPENTERS HF Y FALSE GNoble Community IP080 NOCD CA N NOBLE COMMUNITY Y FALSE GNorth American Administrators, Inc. 64157 NOCD ALL Y NORTH AM ADMIN N FALSE GNorth American Benefits Network (NABN) 34159 NOCD ALL N NORTH AMERICAN BE N FALSE GNorth American Medical Management Northern California E3510 NOCD CA Y NAMM N FALSE GNorth American Medical Management (Provider number must be in box 33a) IP079 NOCD ALL Y NORTH AMERICAN ME Y FALSE GNorth Broward Hospital District 37314 NOCD FL Y NO BROWARD HOSPIT Y FALSE GNorth Shore - LIJ (Healthfirst) 17516 NOCD ALL N NORTH SHORE LIJ Y FALSE G

North 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 GNorth Texas Healthcare Network (Effective 01-01-2019) 75250 NOCD All Y NORTH TEXAS HEALT Y FALSE GNorth West Life PH018 NOCD All Y NORTH WEST Y FALSE G



28 of 41



Type

Northeast Iowa Community Health Plan SISCO NOCD ALL N SISCO N FALSE GNorthern California Advantage Medical Group NCA01 NOCD CA Y NOCAL ADV MED GRP N FALSE GNorthern Illinois Health Plan 36347 NOCD IL Y NO ILLINOIS HLTH Y FALSE GNorthern Nevada Trust Funds (Call 775-826-7200 prior to submitting claims.) 88027 NOCD NV A NO NV TRUST FUNDS Y FALSE GNorthridge Medical Group OCN01 NOCD ALL N NORTHRIDGE MED GP Y FALSE GNorthShore Physicians Associates 48026 NOCD ALL N NO SHORE PHY ASSO Y FALSE GNorthwest Physicians Network (For claims with a DOS of 01/21/2021 and greater use payer ID LIFE1) NPN11 NOCD ALL Y NW PHYSICIANS NET N FALSE GNorthwest Suburban IPA (IL) 36346 NOCD IL Y NW SUBURBAN IPA N FALSE GNorthwestern National Life PH018 NOCD All Y NORTHWESTERN NATI Y FALSE GNorthwood Healthcare NWOOD NOCD All Y NORTHWOOD N FALSE GNova Healthcare Administrators, Inc. (Grand Island, NY) 16644 NOCD ALL Y NOVA HLTHCARE ADM N FALSE GNovaNet (Please contact payer directly for payer ID (770)729-1997 ext. 220.) CALL NOCD ALL Y CALL SUPPORT Y FALSE GNOVASYS Health Network 68069 NOCD ALL Y NOVASYS HLTH NETW N FALSE GNW Diagnostic Clinic/SelectCare of Texas (NWDC) 62119 NOCD ALL Y NWDC SELECTCARE T N FALSE GNX Health Network 44412 NOCD ALL N NX HEALTH N FALSE GNY Central FEP (Federal Employee Program) Blue Shield N2FEP NOCD NY Y NY CENTRAL BS FEP Y FALSE GNyhart 37299 NOCD ALL N NYHART N FALSE GNYS DOH UCP 14142 NOCD NY N NYS DOH UCP Y FALSE NOak West Physician Association 36400 NOCD ALL Y OAK WEST PHYSICIA N FALSE GOccular Benefits L0140 NOCD ALL N OCCULAR BENEFITS N FALSE GODS Health Plan 13350 NOCD ALL A ODS HEALTH PLAN Y FALSE GOhio Health Choice PPO 34189 NOCD OH Y OHIO HLTH CHOICE N FALSE GOhio PPO Connect 74431 NOCD ALL N OHIO PPO CONNECT Y FALSE GOLOLRMC Uninsured Patient Services Program OLRMC NOCD LA N OLOLRMC UNINSUR N FALSE GOlympus Management Health Care 65074 NOCD ALL Y OLYMPUS MGD HC N FALSE 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 NOMMS South Carolina CALL NOCD SC Y CALL SUPPORT N FALSE GOmniCare (For claims with Dates of Service after 10/01/04) 25150 NOCD ALL N OMNICARE Y FALSE GOmnicare IPA OMN02 NOCD ALL Y OMNICARE IPA N FALSE GOncology Network of Orange County. ONOCI NOCD ALL N ONCOLOGY NW OC N FALSE GOne Call Medical 22321 NOCD ALL N ONE CALL MEDICAL Y FALSE GOne Health Plan of California 95379 NOCD CA Y ONE HEALTH CA N FALSE COne Health Plan of Colorado 95412 NOCD CO Y ONE HEALTH COLO N FALSE COne Health Plan of Illinois 95388 NOCD IL Y ONE HEALTH IL N FALSE COPEIU Locals 30 & 537 BPA01 NOCD ALL N OPEIU LOC 30 537 Y FALSE GOperating Engineers Local No 53 74234 NOCD UT N OPER ENG LOCAL 53 N FALSE GOperating Engineers Locals 302 & 612 Health & Security Fund - Grp#F12 91136 NOCD ALL Y OPERATING ENGINEE N FALSE GOpticare Eye Health Network 56190 MCSI ALL Y OPTICARE EYE HEAL Y FALSE GOpticare Eye Health Network (Envolve Benefit Option) 56190 MCSI ALL Y OPTICARE Y FALSE GOpticare of Utah OPCAU NOCD ALL Y OPTICARE OF UTAH Y FALSE GOptima Insurance Company 54154 NOCD ALL Y OPTIMA INS COMPAN Y FALSE GOptimum Healthcare, Inc. 20133 NOCD ALL N OPTIMUM HEALTHCAR Y FALSE GOptum Care Network of Connecticut E3287 NOCD ALL Y OPTUM CARE NETWORK N FALSE COptum Maryland Behavioral Health OMDBH NOCD MD N OMD BEHAV HLTH Y FALSE COptumCare / AZ, UT (formerly Lifeprint Network) LIFE1 NOCD ALL R LIFEPRINT N FALSE COptumHealth (OptumHealth Behavior Solutions) formerly United Behavioral Health and Pacificare Behavioral Health), former payerID 33053 87726 NOCD ALL Y OPTUMHEALTH BEHAV Y FALSE COptumHealth (OptumHealth Behavioral Solutions of NM) 87726 NOCD ALL Y OPTUMHEALTH BEHAV Y FALSE COptumHealth Complex Medical Conditions (CMC) (formerly OptumHealth Care Solutions and United Resource Networks) (Former payerID 52190) 41194 NOCD ALL Y UNITED RESOURCES Y FALSE COptumHealth Physical Health - includes Oxford (former payer id 41159, 41160) 41161 NOCD ALL N OPTUMHEALTH Y FALSE COptumHealth Salt Lake County U6885 NOCD ALL Y OPTUMHEALTH SLC N TRUE GOrange Coast Memorial IPA MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE GOregon Health Mgmt OHMS aka Primary Health of Josephine OHMSP NOCD ALL N OR HEALTH MGMR N FALSE GOregon's Health CO-OP 45332 NOCD OR N OR HEALTH COOP N FALSE GOrthonet - AETNA 13383 NOCD ALL Y ORTHONET AETNA Y FALSE GOscar Health OSCAR NOCD ALL Y OSCAR HEALTH Y FALSE GOSF Health Plans 61101 NOCD IL Y OSF HEALTH PLANS N FALSE GOSG-Michael Reese 37127 NOCD IL N OSG MICHAEL REESE N FALSE GOxford Health Plans 06111 NOCD All Y OXFORD HEALTH PLA N FALSE CP3 Health Partners -Arizona 58375 NOCD ALL N HLTH AZ PARTNERS Y FALSE G



29 of 41



Type

P5 Health 87068 NOCD ALL N P5 HEALTH Y FALSE G

PA Preferred Health (Call PPHN Claims Operations at 410-349-3222) CALL CALL ALL N CALL ENS SUPPORT Y FALSE TPace Central Iowa 72436 NOCD ALL Y PACE CENTRAL IOWA N FALSE GPACE CNY 70454 NOCD ALL Y PACE CNY N FALSE GPace Nebraska 35416 NOCD ALL N PACE NEBRASKA N FALSE GPace of Southwest Michigan Inc. 45114 NOCD ALL Y PACE SW MICHIGAN N FALSE GPace Southeast Michigan 86711 NOCD ALL Y PACE SE MICHIGAN N FALSE GPace Southwest Iowa 53534 NOCD ALL Y PACE SOUTHWEST IA N FALSE GPacific Southwest Administrators (PSWA) 75309 NOCD ALL N PSWA Y FALSE GPacificSource Administrators 93031 NOCD ALL N SELECT BENE ADMIN n FALSE GPacificSource Commercial 93029 NOCD ALL N PACIFICSOURCE COM N FALSE GPacificsource Medicare 20377 NOCD ALL N PACIFICSOURCE MCA Y FALSE GPacificsource OHP COIHS NOCD ALL N PACIFICSOURCE OHP Y FALSE G

Palladian Muscular Skeletal Health (Formerly Prism Health Networks) 37268 NOCD ALL A PALLADIAN MUSCULA N FALSE GPalo Alto Medical Foundation IP132 NOCD ALL Y PALO ALTO MED FOU N FALSE GPan American Life Insurance 04218 NOCD ALL N PAN AMERICAN LIFE N FALSE GPaper Claims (ENS will print and mail the claims submitted with the payerID of PRINT) PRINT NOCD ALL N PAPER CLAIMS N FALSE NParamount Health SX158 NOCD ALL N PARAMOUNT HEALTH N FALSE NParity Healthcare, Inc. 58204 NOCD ALL N PARITY HEALTHCARE N FALSE GParkland Community Health Plan 66917 NOCD ALL N PARKLAND COMM HP Y FALSE GPartners Behavioral Health 13141 NOCD ALL N PARTNERS BEHAV HL Y TRUE NPartners Health Plan 14966 NOCD ALL Y PARTNERS HLTH PLA N FALSE GPartnership Health Plan (Client must contact OptumInsight Enrollments Department for enrollment forms.) PHP02 NOCD CA N PARTNERSHIP HP CA N TRUE NPasadena Primary Care Physicians IP080 NOCD CA N PASADENA PRIMARY Y FALSE GPassport Advantage (Effective 7-1-18 new PID 66008, former payer ID 97652) 66008 NOCD ALL Y PASSPORT ADVANTAG Y FALSE GPassport Health Plan 61325 NOCD ALL N PASSPORT HEALTH Y FALSE GPatient Access PAN01 NOCD ALL Y PATIENT ACCESS Y FALSE GPatient Advocates, LLC 10525 NOCD ALL Y PATIENT ADVOCATES Y FALSE GPATIENTPAY 26335 NOCD ALL Y PATIENTPAY Y FALSE GPayer Fusion 27048 NOCD ALL A PAYER FUSION Y FALSE GPeach State Health Plan (Behavioral Health) 68069 NOCD GA Y PEACH STATE HP BH Y FALSE 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 GPeak Pace Solutions 27034 NOCD ALL N PEAK PACE SOLUTIO N FALSE GPEHP - Utah Public Employee Health Plan (Enrollment required, please contact Provider Relations 800-765-7347) SX106 NOCD UT N PEHP UTAH PUBLIC N TRUE NPediatric Associates of Broward 20472 NOCD ALL Y PEDIATRIC ASSOCIA Y FALSE GPeninsula Healthcare VABLS BCBS VA Y PENINSULA HEALTHC Y FALSE NPenn Behavioral Health 53226 NOCD ALL A PENN BEHAV HEALTH Y TRUE GPennsylvania Keystone Health Plan East (claims only) PCBLS NOCD PA Y KEYSTONE HLTH CLA Y TRUE NPennsylvania Keystone Health Plan East (encounters only) PEBLS NOCD PA Y KEYSTONE HLTH ENC Y TRUE NPennsylvania Life Insurance 23130 NOCD PA Y PA LIFE INSURANCE Y FALSE GPennsylvania Pace 20172 NOCD ALL Y PENNSYLVANIA PACE N FALSE GPeoples Health Network (Tenet) (Network ID must be on claim. Contact [email protected]) 72126 NOCD ALL N PEOPLES HLTH NETW Y FALSE G

Personal Choice PPO of Pennsylvania (Also know as Independent BLC) 54704 NOCD PA N PA PERSONAL CHOIC Y TRUE NPersonal Insurance Administrators 95397 NOCD ALL N PERSONAL INS ADMI N FALSE GPHCS Maxor Administrative Services A0047 NOCD ALL N UNITED CLAIM SOLU N FALSE GPHCS Savility (ONLY for Savility card members.) 13306 NOCD ALL N PHCS SAVILITY Y FALSE GPhifer Wire Insurance (Per request from Payer, claims are printed and mailed.) PHIF4 NOCD ALL N PHIFER WIRE INSUR N FALSE NPhoenix Choice 55649 NOCD ALL Y PHOENIX CHOICE N FALSE GPhoenix Health Plan 03440 NOCD AZ Y PHOENIX HEALTH PL Y FALSE GPHX Teamsters UT/MT/ID (For Dates of Service after 05/01/16) CX100 NOCD ALL N PHX TEAMSTERS UT N FALSE GPhysician Associates of Greater San Gabriel Valley OCN01 NOCD CA Y PA G SAN GABRIEL Y FALSE GPhysician Associates of Louisiana (PAL) 58204 NOCD LA Y PHYS ASSOC OF LA N FALSE GPhysician 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 GPhysician Partners IPA PPRT1 NOCD ALL N PHYS PARTNERS IPA N FALSE NPhysicians Care Network 38265 NOCD ALL Y PHYS CARE NETWORK Y FALSE 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 GPhysicians Care Network/The Polyclinic PCN12 NOCD ALL N PCN THE POLYCLINI N FALSE G



30 of 41



Type

Physicians Choice Medical Group of Santa Maria MCI01 NOCD ALL N PHY CHOICE SANTA N FALSE GPhysicians Choice Medical Grp of San Luis Obispo (formerly San Luis Obispo Select IPA) SLOS1 NOCD ALL N PHY CH SANTA MARI N FALSE GPhysicians Corporation of America (Florida Plan Only) 65018 NOCD FL Y PHYS CORP FL Y FALSE GPhysicians Health Association of Illinois 37136 NOCD IL Y PHY HLTH ASSOC IL N FALSE GPhysicians Health Choice - Claims (Administered by Wellmed) PHCS1 NOCD ALL N PHY HLTH CHCE CLA N FALSE CPhysicians Health Collaborative 20398 NOCD ALL Y PHYSICIANS HLTH C Y FALSE GPhysicians Health Network MHCM2 NOCD ALL N PHYS HLTH NETWORK N FALSE 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 GPhysicians Health Plan (PHP-SC) 09173 NOCD ALL Y PHYSICIANS HP SC Y FALSE GPhysicians Health Plan of Northern Indiana 12399 NOCD IN A PHYS HLTHPLN N IN Y FALSE GPhysicians Healthways IPA PHIPA NOCD CA N PHYS HEALTHWAYS I Y FALSE GPhysicians Mutual Insurance Company 47027 NOCD ALL N PHYSICIANS MUTUAL Y FALSE NPhysicians of Southwest Washington 91171 NOCD ALL R PHYSICIANS SW WA N FALSE GPhysicians Plus Insurance Corp. 39156 NOCD ALL Y PHYSICIANS PLUS Y FALSE CPIA 95397 NOCD ALL N PERSONAL INS ADMI N FALSE GPIH Health (Formerly Bright Health Plan) BHP01 NOCD ALL Y PIH HEALTH N FALSE GPinnacol Assurance CCIA1 CCIA CO Y PINNACOL ASSURANC Y FALSE PPioneer Provider Network PPNZZ NOCD CA Y PIONEER PROVIDER Y FALSE GPipe Industry Health & Welfare Fund of Colorado COMPU NOCD CO N PIPE INDUSTRY CO N FALSE GPittsburgh Care Partnership 23283 NOCD ALL Y PITTSBURGH CARE P N FALSE GPlanned Administrators, Inc. (PAI) 37287 NOCD ALL N PAI Y FALSE GPMG of San Jose PMGSJ NOCD CA N PMG OF SAN JOSE N FALSE GPodiatry Network FL 59324 NOCD FL N PODIATRY NETWK FL N FALSE GPoint Comfort Underwriters PCU01 NOCD ALL Y PTCOMFORT UNDERWR N FALSE GPoint Comfort Underwriters (Payer not accepting electronic claims until February 1st, 2017) PCU02 NOCD ALL Y PT COMFORT UNDERW N FALSE GPomona Valley Medical Group (PVMG) ProMed IP057 NOCD CA N POMONA VALLEY MG N FALSE GPopulytics (formerly Spectrum Administrators) 23253 NOCD ALL N SPECTRUM ADMIISTR Y FALSE GPPO Oklahoma (WinterBrook HealthCare Management) 73159 NOCD OK Y PPO OKLAHOMA Y FALSE GPPO Plus, LLC 72148 NOCD ALL Y PPO PLUS LLC Y FALSE GPrairie States Enterprises, Inc. 36373 NOCD ALL N PRAIRE STATES ENT Y FALSE GPreferred Administrator (Contact Provider Relations @ (915)532-2778, x1068) EPF10 NOCD TX Y TX PREFERRED ADMI N FALSE GPreferred Benefit Administrators 53476 NOCD ALL Y PREFERRED BEN ADM N FALSE GPreferred 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 GPreferred Care Partners / FL 65088 NOCD FL N PREF CARE PARTNER Y FALSE CPreferred Community Choice 73145 NOCD ALL Y PREF COMM CHOICE Y FALSE 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 TPreferred Health Plan (Louisville, KY previous payer ID 61106 ) 87815 NOCD KY Y PREFERRED HLTH KY Y FALSE GPreferred Health Professionals 31478 NOCD ALL Y PREF HEALTH PROF Y FALSE GPreferred Health Professionals Kansas City 00036 NOCD KS,MO N PREF HLTH PROF KC N FALSE GPreferred Health Systems Insurance Co (PPO) 61665 NOCD ALL Y PREF HLTH SYS PPO Y FALSE GPreferred Health Systems, Inc. 60110 NOCD ALL Y PREF HLTH SYSTEMS Y FALSE GPreferred IPA PFIPA NOCD ALL N PREFERRED IPA Y FALSE GPreferred Medicare L0250 NOCD ALL N PREFERRED MEDICAR N FALSE NPreferred Network Access 36401 NOCD ALL N PREFERRED NET ACC N FALSE GPreferred One 41147 NOCD ALL Y PREFERRED ONE Y FALSE GPremier Eye Care 65054 NOCD ALL Y PREMIER EYE CARE Y FALSE NPremier Healthcare Exchange 88051 NOCD ALL N PREMIER HCX N FALSE GPremier HealthCare Exchange (Cypress) 88056 NOCD ALL N PREMIER HCARE EXC N FALSE 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 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 GPresbyterian(NM) 05003 NOCD NM Y PRESBYTERIAN NM Y FALSE GPresence ERC 46311 NOCD ALL N PRESENCE ERC Y FALSE 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 GPrevea Health Insurance Plan 39185 NOCD ALL A PREVEA HEALTH INS N FALSE GPrimary Care Assoc of California (Customer Service Phone Number 877-602-1563) PCACZ NOCD CA Y PRIMARY CARE CALI N FALSE G



31 of 41



Type

Primary Care of Joliet PCJOL NOCD ALL Y PRIMARY CARE OF J Y FALSE GPrimary Choice (Aetna HP-NY/NJ) 60054 NOCD NY, NJ Y PRIMARY CHOICE Y FALSE GPrimary Delivery Systems 73288 NOCD ALL Y PRIMARY DELIVERY Y FALSE GPrimary Health Network 82048 NOCD ALL Y PRIMARY HLTH NETW Y FALSE GPrimary PhysicianCare, Inc.(Now known as HealthGram) 56144 NOCD ALL Y PRIMARY PHYSICIAN N FALSE GPrime Community Care Central Valley MVCV1 NOCD ALL Y PRIME COMMCARE CV N FALSE GPrime West Health Plan 61604 NOCD MN N PRIME WEST HEALT Y FALSE GPrimeCare Health Plan IP079 NOCD CA Y PRIMECARE HLTH PL N FALSE GPrimeSource Health Network 04320 NOCD ALL Y PRIMESOURCE HLTNT Y FALSE GPrincipal Financial Group (Vision Claims only.) 61271 NOCD ALL Y PRINCIPAL FINANCI N FALSE GPriority Health (Please contact Priority Health EDI Dept at 616-464-8686 or email [email protected]) 38217 NOCD ALL Y PRIORITY HEALTH Y FALSE TPriority Healthcare VABLS BCBS VA Y PRIORITY HEALTHCA Y FALSE NPrism Health Networks (Now known as Palladian Muscular Skeletal Health ) 37268 NOCD ALL A PRISM HEALTH NETW N FALSE GPrism Univera 37315 NOCD ALL N PRISM UNIVERA N FALSE GProCare Health Plan Medicaid (Use payer ID 70259 for dates of service 12-31-19 and prior.Use payer ID 38224 for claims with a date of service 01-01-20 and greater.) 70259 NOCD ALL Y PROCARE HP MEDICA N FALSE GProCare Texas PTX01 NOCD ALL N PROCARE TEXAS N FALSE GProductive Processing Inc. 13396 NOCD ALL Y PRODUCTIVE PROCES N FALSE GProfessional Benefit Administrators, Inc. (Oak Brook, IL) 36331 NOCD IL A PROF BENE ADM IL N FALSE GProfessional Claims Management 37242 NOCD ALL Y PROF CLAIMS MGMT Y FALSE GProfessional Claims Manangement 56001 NOCD ALL T PROF CLAIMS MGMT N FALSE TPROGYNY PROGY NOCD ALL N PROGYNY N FALSE GProminence Health Plan Encounters 88082 NOCD ALL Y PROMINENCE HP N FALSE GProminence Health Plan of Nevada 93082 NOCD ALL N PROMINENCE HP NV N FALSE GProminence Health Plan of Texas 80095 NOCD ALL N PROMINENCE HP TX N FALSE GProspect Medical Group PROSP NOCD CA Y PROSPECT MED GROU Y FALSE GProtective Life Insurance Company 37309 NOCD ALL Y PROTECTIVE LIFE I Y FALSE GProvidence Choice Option PHP01 NOCD ALL Y PROVIDENCE CHOICE Y FALSE GProvidence Good Health Plan PHP01 NOCD ALL Y PROVIDENCE GOOD H Y FALSE GProvidence Health Plan SX133 NOCD ALL Y PROVIDENCE HEALTH N FALSE GProvidence Health PPO SX187 NOCD ALL Y PROVIDENCE H PPO N FALSE GProvidence Insurance & Administrative Services PAS01 NOCD ALL N PROVIDENCE ADMIN N FALSE G

Providence Preferred (PPO) (ProviderID and Enrollment required.) PHP00 NOCD ALL Y PROVIDENCE PREFER Y FALSE GProvident Life & Accident Insurance Company 68195 NOCD ALL Y PROVIDENT INS CO Y FALSE GProvident Life & Accident Insurance Company of America 68195 NOCD ALL Y PROVIDENT LIFE Y FALSE GProvident Life & Casualty Insurance Company 68195 NOCD ALL Y PROVIDENT CASUALT Y FALSE G

Provider Partners Health Plan Illinois 31401 NOCD IL N IL PROVIDER HLTH N FALSE GProviDRs Care Network 48100 NOCD ALL N PROVIDERS CARE NE N FALSE GPruCare HMO (Encounters Only) HM015 NOCD All Y PRUCARE HMO N FALSE GPrudent Medical Group MPM25 NOCD ALL Y PRUDENT MED GROUP Y FALSE GPrudential Encounters HM015 NOCD ALL Y PRU ENCOUNTERS N FALSE GPruitt Health Premier PH001 NOCD ALL Y PRUITT HLTH PREMI N FALSE GPuget Sound Benefits Trust - Grp#F25 91136 NOCD WA Y PUGET GRP F25 N FALSE GPuget Sound Electrical Workers Trust - Grp#33 91136 NOCD WA Y PUGET GRP 33 N FALSE GQuad Cities Community Health Plan SISCO NOCD ALL N SISCO N FALSE GQuad City Community Healthcare (QCCH) 40437 NOCD ALL Y QUAD CITY COMMUN N FALSE GQual Choice of Arkansas (formerly payer ID 35174) 58379 NOCD AR Y QUAL CHOICE AR Y FALSE GQualCare Alliance Networks Inc. (Qani) 22312 NOCD ALL A QUALCARE ALLIANCE Y FALSE GQuality Care Partners 89461 NOCD ALL R QUALITY CARE PART Y FALSE GQuantumCare (We Care Health Plan) QCTPA NOCD ALL N QUANTUMCARE N FALSE GQuartz Administrative Services Organization (ASO) 46571 NOCD ALL Y QUARTZ ADMIN Y FALSE GQuestcare Medical (USC) 84562 NOCD ALL Y QUESTCARE MEDICAL N FALSE GQuicktrip Corporation 73067 NOCD ALL N QUICKTRIP CORPORA Y FALSE GQVI Risk Solutions, Inc. 57117 NOCD ALL N QVI RISK SOLUTION Y FALSE GRadcon, Inc. (Please contact Kathy King @ 856-608-1350 for Payer ID information.) CALL NOCD ALL N CALL ENS SUPPORT Y FALSE GRady Children's Health Network RCHN1 NOCD ALL Y RADY CHILDRENS HE N FALSE GRBMS, LLC 91176 NOCD ALL Y RBMS LLC Y FALSE GRedlands IPA (Synermed) SYMED NOCD ALL N REDLANDS IPA Y FALSE GRegal Medical Group REGAL NOCD ALL Y REGAL MEDICAL GRO Y FALSE GRegence BCBS Oregon 00851 NOCD OR Y REGENCE BCBS OR N FALSE NRegence Blue Shield of Washington 00932 NOCD WA Y REGENCE BCBS Y FALSE NRegence Group Administrators RGA01 NOCD ALL Y REGENCE GRP ADMIN N FALSE GRegional Care, Inc. 47076 NOCD ALL Y REGIONAL CARE INC N FALSE GRehn and Associates REHNA NOCD ALL Y REHN AND ASSOCIAT N FALSE G



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Type

RELIASTAR (Formerly NWNL) PH018 NOCD All Y RELIASTAR Y FALSE GRenaissance Physicians Organization 76066 NOCD ALL Y RENAISSANCE PHYS Y FALSE GReserve National Insurance (For Claims rejections, please contact Reserve national Customer Service at (405)848-7931.) 73066 NOCD ALL N RESERVE NAT INSUR Y FALSE G

Resolve 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 GResourceOne Administrators 58200 NOCD ALL Y RESOURCEONE N FALSE GResurrection Physician Provider Group RPPG1 NOCD ALL N RESURRECTION PHY N FALSE 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 GRight Care from Scott & White 74205 NOCD ALL N RIGHT CARE SCOTT N FALSE GRightChoice Benefits Administrators 37331 NOCD ALL N RIGHTCHOICE BENEF Y FALSE GRIVER CITY MEDICAL GROUP RCMG1 NOCD CA N RIVER CITY MG Y FALSE GRiverside Health, Inc 45281 NOCD ALL N RIVERSIDE HEALTH N FALSE GRMSCO, Inc. 16117 NOCD ALL Y RMSCO INC Y FALSE GRocky Mountain Health Plan Grand Junction SX141 NOCD CO Y ROCKY MTN HP GJ N FALSE NRocky Mountain HMO RMHMO NOCD CO Y ROCKY MOUNTAIN HM Y FALSE PRooney Life Ins. 37602 NOCD All N ROONEY LIFE INS Y FALSE CRoyal Health Care (Extended Care MTC) 46166 NOCD ALL N ROYAL HEALTH CARE Y FALSE GRush Prudential Health Plans (HMO Only) 36389 NOCD ALL Y RUSH PRDENTL HMO Y FALSE GS & S Healthcare Strategies 31441 NOCD ALL A S AND S HEALTHCAR Y FALSE GSagamore Health Network, Inc. 35164 NOCD All Y SAGAMORE HEALTH N N FALSE GSage MNDH1 NOCD ALL Y SAGE Y FALSE GSage Plus MNDH1 NOCD ALL Y SAGE PLUS Y FALSE GSage Technologies (Formerly CCMSI) (Claims for payer address of Rockford, IL ONLY.) 37105 NOCD ALL Y SAGE TECHNOLOGIES N FALSE GSaint Anthony PHO STA01 NOCD ALL N ST ANTHONY PHO N FALSE GSaint Marys Health Plan 88029 NOCD ALL Y ST MARYS HEALTH P Y FALSE GSamaritan Advantage SAMAD NOCD ALL N SAMARITAN ADVANTA Y FALSE GSamaritan Choice Plan SAMCP NOCD ALL N SAMARITAN CHOICE N FALSE GSamaritan Employer Group Plan SAM00 NOCD ALL N SAMARITAN EMP GRP N FALSE GSana Benefits 50114 NOCD ALL N SANA BENEFITS N FALSE GSan Bernardino Medical Group SBMED NOCD ALL N SAN BERNARDINO ME N FALSE GSan Diego County Medical Services (CMS) MSO11 NOCD CA N SD COUNTY MED SVC Y FALSE CSan Diego County Physician Emergency Services MSO22 NOCD CA N SD COUNTY PHY EME Y FALSE CSan Diego County Ryan White Primary Care Program MSO33 NOCD CA N SD COUNTY RYAN WH Y FALSE CSan Diego County Sheriffs Department MSO55 NOCD CA N SD COUNTY SHERIFF Y FALSE CSan Diego PACE 96400 NOCD ALL Y SAN DIEGO PACE N FALSE GSan Luis Obispo Select IPA 33072 NOCD ALL N SAN LUIS OBISPO S N FALSE GSandhills Center SHC30 NOCD ALL N SANDHILLS CENTER Y TRUE GSanford Health Plan MNSHP NOCD ALL Y SANFORD HEALTH PL Y FALSE GSanta Clara County IPA SCACO NOCD ALL N SANTA CLARA CO IP N FALSE GSanta Clara Family Health Plans 24077 NOCD CA N SANTA CLARA FAM H N FALSE GSanta Clara IPA HMO 10378 NOCD ALL Y SANTA CLARA IPA H N FALSE GSante Community Physicians Medical Group Corp. SNTMC NOCD ALL Y SANTE COMM PHYS M N FALSE GSante Health Systems 77038 NOCD ALL N SANTE HEALTH SYST N FALSE 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 GSaudi Health Mission SHM01 NOCD ALL N SAUDI HLTH Y FALSE GSC BCBS Companion Health SC922 NOCD SC Y SC COMPANION HEAL Y FALSE NSC BCBS Planned Administrators SC886 NOCD SC Y SC PLANNED ADMINI Y FALSE NSC BCBS State Employee Health Plan SC400 NOCD SC Y SC ST EMP HEALTH Y FALSE NSC FEP Blue Cross SC402 NOCD SC Y SC FEP BLUE CROSS Y FALSE NScan CA SCAN1 NOCD CA N SCAN CA N FALSE GSCAN Encounters (Diversified Data Design (DDD)) 99157 NOCD ALL N SCAN ENCOUNTERS Y FALSE NSCAN Health Plan 72261 NOCD ALL Y SCAN HEALTH PLAN Y FALSE GScan Health Plan Arizona 73172 NOCD AZ Y SCAN HLTH PLAN AZ Y FALSE GSCAN Long Term Care 20460 NOCD ALL N SCAN LONG TERM CA N FALSE GSCHC Total Care 16146 NOCD ALL Y SCHC TOTAL CARE Y FALSE GScott & White Health Care 88030 NOCD TX N SCOTT WHITE HEALT N FALSE NScripps Health Plan MSO SHPM1 NOCD ALL Y SCRIPPS HP MSO Y FALSE GScripps Health Plan Services SHPS1 NOCD ALL N SCRIPPS HP SERVIC Y FALSE GSeaside Health Plan (Starting with DOS 9/1/2013) 46187 NOCD CA Y SEASIDE HEALTH PL N FALSE GSeaview IPA SVIPA NOCD ALL N SEAVIEW IPA N FALSE GSecure Health of Georgia 28530 NOCD GA Y SECURE HEALTH GA Y FALSE GSecurity Administrative Systems 35202 NOCD ALL Y SECURITY ADMIN SY N FALSE GSecurity Health Plan 39045 NOCD ALL Y SECURITY HEALTH N FALSE C



33 of 41



Type

Sedgwick TP097 NOCD ALL Y SEDGWICK N FALSE GSeeChange HealthPlan SCHP1 NOCD ALL Y SEECHANGE HEALTH N FALSE GSelect 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 GSelect Benefit Administrators of America 37282 NOCD ALL N SELECT BEN ADM AM N FALSE GSelect Choice 60054 NOCD All Y SELECT CHOICE Y FALSE GSelect Health of South Carolina 23285 NOCD SC N SELECT HEALTH SC Y FALSE GSelectCare of OK - Tribute SCOK1 NOCD OK A SELECTCARE TRIBUT N FALSE TSelectCare of Texas (HPN) Heritage Physicians Network 76045 NOCD TX Y SELECTCARE TX HPN Y FALSE GSelectCare of TX (Houston) (Provider ID Required - Contact (713) 843-6780 to obtain ID.) HPN11 NOCD TX A SELECTCARE HOUSTO N FALSE TSelectHealth (Formerly IHC) (Contact payer at 801-442-5442 before sending claims to verify provider numbers.) UH107 NOCD UT Y SELECTHEALTH Y FALSE NSelf Insured Benefit Administrators 59111 NOCD FL Y SELF INS BENE ADM N FALSE GSelf Insured Plans, LLC 36404 NOCD ALL Y SELF INSURED PLAN Y FALSE GSelf-Funded Plans (IL, PA, OH) 34131 NOCD IL,PA,OH Y SELF FUNDED Y FALSE GSelman Tricare Supplement Plans TRSEL NOCD ALL Y SELMAN TRICARE SU Y FALSE GSendero Health SCS17 NOCD ALL N SENDERO HLTH N FALSE GSendero IdealCare MV440 NOCD ALL Y SENDERO IDEALCARE N FALSE GSenior Choice (Aetna HP-NY/NJ) 60054 NOCD All Y SENIOR CHOICE Y FALSE GSenior Smart Choice 95444 NOCD ALL N SENOIR SMART CHOI N FALSE GSenior Whole Health 83035 NOCD ALL N SENIOR WHOLE HEAL Y FALSE NSentara Family Plan 54154 NOCD ALL Y SENTARA FAMILY PL Y FALSE GSentara Health Management 54154 NOCD ALL Y SENTARA HEALTH MA Y FALSE GSentara Mental Health Professional 5415M NOCD ALL N SENTARA MENTAL HE N FALSE TSentinel Management Services 23249 NOCD ALL N SENTINEL MGMT SVC Y FALSE GSentinel Security Life Insurance 87020 NOCD ALL N SENTINEL N FALSE GSeoul Medical Group IP080 NOCD CA N SEOUL MEDICAL GRO Y FALSE GSeoul Medical Group AMM07 NOCD ALL N SEOUL MEDICAL GRP N FALSE GSequoia Health IPA ALG01 NOCD ALL Y SEQUOIA HEALTH IPA Y FALSE GSeton CHIP (Provider ID required.) SHPCH NOCD ALL N SETON CHIP N FALSE GSeton Employee Plan SHEBP NOCD ALL N SETON EMPLOYEE PL N FALSE GSeton Star STAR1 NOCD ALL N SETON STAR N FALSE GSeven Corners 25404 NOCD ALL N SEVEN CORNERS N FALSE GSGIC 11789 NOCD ALL N SGIC N FALSE GSharp Community Medical Group SCMG1 NOCD CA N SHARP COMM MED GR Y FALSE GSharp Health Plan SHP01 NOCD CA Y SHARP HEALTH PLAN N FALSE NSharp Rees-Stealy Med Group SRS83 NOCD CA Y SHARP REESSTEALY N FALSE NShasta Administrative Services 75280 NOCD ALL Y SHASTA ADMIN SVCS N FALSE GSheakley Unicomp 10002 NOCD ALL Y SHEAKLEY UNICOMP N FALSE 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 GSieba, LTD. 03699 NOCD ALL Y SIEBA LTD N FALSE GSierra Health and Life (Health Plan of Nevada) 76342 NOCD CA,NV R SIERRA HEALTH SVC Y FALSE CSierra Health Services Encounters (Health Plan of Nevada) 76343 NOCD CA,NV R SIERRA HEALTH ENC Y FALSE CSierra Medical Group (Customer Service 661-480-2047) SMG01 NOCD CA N SIERRA MED GRP N FALSE GSignifica Benefit Services, Inc. 23250 NOCD ALL Y SIGNIFICA BENEFIT Y FALSE GSIHO 77153 NOCD ALL N SIHO N FALSE GSilver Cross Managed Care Organization NASCR NOCD IL Y SILVER CROSS MCO Y FALSE GSilver Star Pace 97691 NOCD ALL Y SILVER STAR PACE N FALSE GSilverback TPA (previous payer ID 37728) For all dates of service prior to Jan. 1, 2019, claims should be submitted to UnitedHealthcare, payer ID 87726 87726 NOCD ALL N SILVERBACK TPA N FALSE CSilverback TPA (previous payer ID 37728) For all dates of services on and after Jan. 1, 2019, claims should be submitted WellMed, payer ID WELM2 WELM2 NOCD ALL N SILVERBACK TPA N FALSE GSilverSummit Health Plan 68069 NOCD ALL N SILVERSUMMIT N GSimply HealthCare Plans (new payer ID SMPLY as of 12-1-2018) SMPLY NOCD ALL N SIMPLY HEALTHCARE N FALSE GSinclair Health Plan 84076 NOCD ALL N SINCLAIR HLTH PLN Y FALSE GSISCO SISCO NOCD ALL N SISCO N FALSE GSISCO 44827 NOCD ALL N SISCO1 N FALSE GSmith Administrators SMITH NOCD ALL A SMITH ADMINISTRAT N FALSE GSmoky Mountain Center 13010 NOCD ALL Y SMOKY MTN CENTER Y TRUE GSolidarity Healthshare 77721 NOCD ALL N SOLIDARITY N FALSE GSolis Health Plans SOLIS NOCD ALL A SOLIS Y FALSE GSound Health 91131 NOCD All Y SOUND HEALTH N FALSE GSoundpath Health (Formerly known as Puget Sound Health Partners, Inc.) 42172 NOCD ALL Y PUGET SOUND HP N FALSE GSouth Atlantic Medical Group SAMG1 NOCD CA Y SO ATLANTIC MED G Y FALSE G



34 of 41



Type

South 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 G

South County Health Alliance (previously under Payer ID 41154) 81600 NOCD ALL N SOUTH CNTY HLTH Y FALSE GSouth Dakota Chiropractic (Sanford Health Plan) CASD2 NOCD SC R SANFORD HP SD CHI Y FALSE GSouth Florida Common Services 59065 NOCD FL Y SO FL COMMON SVCS N FALSE GSouth Florida Musculoskeletal Care 06294 NOCD ALL Y SO FL MUSCULO CAR N FALSE GSouth Indiana Health Options - HMO SX142 NOCD IN Y SO INDIANA HEALTH Y FALSE GSouthcare / Healthcare Preferred 25147 NOCD ALL N SOUTHCARE HEALTHC Y FALSE GSoutheast Iowa Health Plan (Provider ID Required) 86068 NOCD IA Y SE IOWA HLTH PLAN Y FALSE NSouthern Cal Physicians Managed Care Services SCP01 NOCD CA N SO CAL PHYSICIANS N FALSE GSouthern California Bakery Drivers Security Fund NWADM NOCD CA N SOCAL BAKERY DRIV Y FALSE 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 GSouthland IPA SIPA1 NOCD ALL Y SOUTHLAND IPA N FALSE GSouthwest Physicians Group SWPG1 NOCD ALL Y SW PHYSICIAN GRP Y FALSE GSouthwest Service Administrators CX100 NOCD ALL N SW SERVICE ADMINI N FALSE GSouthwest Service Life 37266 NOCD ALL N SW SERVICE LIFE N FALSE GSpectera 00773 NOCD ALL Y SPECTERA N FALSE CSpencer Stuart ARM Ltd. 38416 NOCD ALL Y SPENCER STUART AR N FALSE GSt James PHO (Call payer for payer ID) CALL NOCD ALL N CALL PAYER Y FALSE GSt Joseph Health IP062 NOCD CA N ST JOSEPH HLTH CA Y FALSE GSt Mary's IPA SMIPA NOCD CA N ST MARYS IPA N FALSE GSt. Joe High Desert JOEHD NOCD CA N ST JOE HIGH DESER N FALSE GSt. John's Claims Administration 37264 NOCD ALL N ST JOHNS CLMS ADM N FALSE GSt. Joseph Heritage Healthcare IP106 NOCD CA Y ST JOSEPH HERITAG N FALSE NSt. Joseph HUMBOLT County IP059 NOCD CA A ST JOE HUMBOLT CO Y FALSE GSt. Therese Physician Association 37116 NOCD ALL Y ST THERESE PHYSIC N FALSE GSt.. Mary's Health Plan Encounters 88082 NOCD ALL Y PROMINENCE HP N FALSE GStandard Life & Accident (Payer accepts secondary claims only, and Medicare cannot be primary payer.) 01758 NOCD ALL Y STANDARD LIFE AND Y FALSE G

Standard 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 GStarmark 61425 NOCD All Y STARMARK N FALSE GState Employees Group Benefits LABLS NOCD LA Y LA STATE EMP GRP Y FALSE NState Farm (Property & Casualty ) 31059 NOCD ALL N STATE FARM C AND Y FALSE 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 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 GState Merit GA GABLS NOCD GA Y STATE MERIT GA Y FALSE N

Sterling 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 GStoner & Associates 31121 NOCD ALL N STONER AND ASSOCI N FALSE GStones River IPA Amerivantage 57492 NOCD ALL Y STONES RVR IPA AM Y FALSE GStones River Regional IPA - The Physicians ACO 28943 NOCD TN N STONES RVR IPA TN Y FALSE NStones River Regional IPA - Windsor 15752 NOCD ALL Y STONES RVR IPA WI Y FALSE GStones River Regional IPA/BCBST 15750 NOCD ALL N STONES RIVER REG N FALSE GSummaCare Health Plan 95202 NOCD ALL Y SUMMACARE HEALTH Y FALSE GSummit Administration Services, Inc. 86083 NOCD ALL Y SUMMIT ADMIN SVCS N FALSE GSummit America Insurance Services, Inc. (Student Accident and Sickness, College Sports and NASCC claims only.) 37301 NOCD ALL Y SUMMIT AMERICA IN Y FALSE GSummit Community Care PASSE NOCD ALL Y SUMMIT COMM CARE Y FALSE GSunAmerica Life Ins Co (NFIC Plan only) 90956 NOCD ALL N SUNAMERICA LIFE N FALSE GSunflower State Healthcare Plan 68069 NOCD IA Y SUNFLOWER STATE H Y FALSE GSunshine Health Plan 68069 NOCD ALL Y SUNSHINE HEALTH P Y FALSE GSunrise Advantage Plan Pennsylvania SPA01 NOCD ALL N SUNRISE ADV PA N FALSE GSuperior Health Plan 68069 NOCD TX Y SUPERIOR HEALTH P Y FALSE GSuperior Insurance Services 97802 NOCD ALL Y SUPERIOR SERV Y FALSE GSuperior Vision Services 13305 NOCD ALL N SUPERIOR VISION S N FALSE NSutter Connect - Central Valley Med Group (Claims) 77035 NOCD CA Y SUTTER CNTRL CLAI Y FALSE GSutter Connect - Delta - Claims IP100 NOCD CA Y SUTTER DELTA Y FALSE GSutter Connect - SIP, SMG, SWMG - Encounters only HM059 NOCD CA Y SUTTER CONNECT EN Y FALSE GSutter Connect - Solano Regional Medical Group - Claims IP099 NOCD CA Y SUTTER SRMG Y FALSE GSutter Connect - Sutter Gould Medical Foundation - Claims IP091 NOCD CA Y SUTTER SGMF Y FALSE G



35 of 41



Type

Sutter Connect East Bay Med Foundation 94269 NOCD CA Y SUTTER CONNECT EA Y FALSE GSutter Connect East Bay Medical HM065 NOCD CA Y SUTTER EB MEDICA N FALSE 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 GSutter Connect-Palo Alto Medical Foundation SC050 NOCD CA Y SUTTER PALO ALTO Y FALSE GSutter East Bay Regional Hosp-Affinity Claims SC052 NOCD CA Y SUTTER EB REG HOS N FALSE GSutter 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 GSutter Pacific Medical Foundation 77304 NOCD ALL Y SUTTER PACIFIC MEDICAL Y TRUE NSutter Senior Care SC028 NOCD ALL Y SUTTER SENIOR CAR Y FALSE GSutter West Bay Medical Group 77304 NOCD ALL Y SUTTER WEST Y TRUE NSwedish Covenant Hospital 36411 NOCD ALL A SWEDISH COVENANT N FALSE GSwift Glass Corporation 07040 NOCD ALL Y SWIFT GLASS CORP N FALSE GTakeCare Insurance Company 98022 NOCD ALL Y TAKECARE INS CO N FALSE GTalbert Medical Group TALMG NOCD ALL Y TALBERT MED GROUP Y FALSE GTall Trees Administrators 88067 NOCD ALL Y TALL TREES ADMINI Y FALSE GTattered Cover, Inc. COMPU NOCD CO N TATTERED COVER IN N FALSE GTaylor Benefits TAYLR NOCD ALL N TAYLOR BENEFITS N FALSE GTeachers Health Trust 88019 NOCD ALL Y CCEA WELFARE BENE Y FALSE GTeamcare 36215 NOCD All Y TEAMCARE N FALSE GTeamsters Local 631 Security Fund for Southern Nevada NWADM NOCD CA N TEAMSTERS LOC 631 Y FALSE GTeamsters Miscellaneous Security Trust Fund NWADM NOCD CA N TEAMSTERS MISC SE Y FALSE GTech-Steel, Inc. 74234 NOCD ALL N TECH-STEEL INC N FALSE GTelamon 22483 NOCD ALL Y TELAMON N FALSE GTennCare (Medicaid of Tennessee) TNMCD NOCD TN Y TENNCARE Y TRUE NTethys Health Ventures 20212 NOCD ALL N TETHYS HLTH VENTU Y FALSE GTexas Agricultural Cooperative Trust TXABA NOCD ALL Y TX AGRI COOP TRUS N FALSE GTexas Children's Health Plan 76048 NOCD TX Y TX CHILDREN HLTH N FALSE 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 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 GTexas First Health Plans TX1ST NOCD TX Y TEXAS 1ST HEALTH Y FALSE TTexas HealthSpring THS01 NOCD TX Y TEXAS HEALTHSPRIN N FALSE GTexas Independence Health Plan 31403 NOCD TX Y TEXAS INDE N FALSE GTexas Plus HPN11 NOCD TX Y TEXAS PLUS N FALSE GTexasFirst Health Plan 13185 NOCD ALL Y TEXASFIRST HP N FALSE 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 CThe Benefit Group TBGNE NOCD ALL Y THE BENEFIT GROUP N FALSE GThe Boon Group BOONG NOCD ALL Y THE BOON GROUP N FALSE GThe Care Network 68423 NOCD ALL Y THE CARE NETWORK Y FALSE GThe Chesterfield Companies 34154 NOCD ALL N THE CHESTERFIELD N FALSE GThe City of Amarillo COA01 NOCD TX Y CITY OF AMARILLO N FALSE GThe City of Odessa 75600 NOCD ALL N THE CITY OF ODESS Y FALSE GThe Health Exchange (Cerner Corporation) 20356 NOCD ALL Y THE HEALTH EXCHAN Y FALSE G

The Health Plan (Formerly known as Hometown Health Plan of Ohio.) 30757 NOCD OH A HOMETOWN HP OF OH N FALSE GThe Health Plan (Upper Ohio Valley) 34150 NOCD ALL Y THE HEALTH PLAN Y FALSE GThe Healthcare Group (THCG) 35206 NOCD ALL N THE HLTHCARE GRP N FALSE GThe Integrity Benefit Network, Inc. 58200 NOCD ALL N INTEGRITY BEN NET N FALSE GThe 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 GThe 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 GThe Oath - Health Partners of Alabama (Now known as HealthSpring HMO/HealthSpring Medicare+Choice) 63092 NOCD ALL N THE OATH OF AL Y FALSE G

Thomas Cooper (Provider must be enrolled with SC Blue Shield.) SC315 NOCD SC Y THOMAS COOPER Y FALSE NThree Rivers Preferred MP340 NOCD ALL N THREE RIVERS PREF Y FALSE NTLC Advantage in Sioux Falls TLC01 NOCD SD R TLC ADV IN SIOUX Y FALSE GTLC Benefit Solutions TLC79 NOCD ALL Y TLC BENE SOLUTION N FALSE GTodays Option (American Progressive and Pyramid Life) 14163 NOCD ALL N TODAYS OPTION APP N FALSE GTongass Timber Trust 92620 NOCD AK N TONGASS TIMBER TR N FALSE GTooling & Manufacturing Assoc. 61425 NOCD All Y TOOLING AND MAN N FALSE GTorrance Hospital IPA THIPA NOCD ALL Y TORRANCE HOSP IPA N FALSE 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 GTotal Care of NY (Former payer ID TCARE) 16146 NOCD NY N NY TOTAL CARE N FALSE G



36 of 41



Type

Total Carolina Care 68069 NOCD ALL Y TOTAL CAROLINA CA Y FALSE GTotal Community Care 31182 NOCD ALL Y TOTAL COMMUNITY C Y FALSE GTotal Healthcare, Inc. 38201 NOCD MI Y TOTAL HEALTHCARE Y FALSE CTotal Plan Concepts 80900 NOCD ALL Y TOTAL PLAN N FALSE GTouchpoint Solutions CRM TPS01 NOCD ALL Y TOUCHPOINT SOL CR Y FALSE GTouchstone Health PSO 23856 NOCD ALL Y TOUCHSTONE HLTH P Y FALSE GTouchstone Health/Health Net Smart 13402 NOCD ALL Y TOUCHSTONE HEALTH N FALSE TTR Paul Inc. 37230 NOCD ALL N TR PAUL INC N FALSE GTransamerica Life Ins/Monumental Life/Stonebridge Life TRP1E NOCD ALL N TRANSAMERICA LIFE Y FALSE GTranschoice - Key Benefit Admin 37284 NOCD ALL N TRNSCHOICE KEY BE N FALSE GTranswestern General Agency 74234 NOCD ALL N TRANSWESTERN GEN N FALSE GTranswestern Insurance Administrators, Inc. TRAN1 NOCD ALL N TRANSWE INS ADMIN N FALSE GTravis County MAP - Mediview TCMAP NOCD ALL Y TRAVIS COUNTY MAP N FALSE GTriad Healthcare Inc 39181 NOCD ALL N TRIAD HEALTHCARE N FALSE GTribute Health Plan (Formerly Central Benefits National.) 31118 NOCD ALL Y TRIBUTE HEALTH PL Y FALSE GTricare East (effective 01-01-2018) TREST NOCD ALL Y TREST N TRUE NTricare for Life (All Regions 1-12) TDDIR NOCD ALL Y TRICARE FOR LIFE Y TRUE TTricare Overseas FOREN NOCD ALL Y TRICARE OVERSEAS Y FALSE GTRICARE West / UnitedHealthcare Military & Veterans (formerly TriWest) 99726 NOCD MANY Y TRICARE Y TRUE TTriHealth Physician Solutions 31144 NOCD ALL N TRIHEALTH PHY SOL N FALSE GTrilogy Health Network 62777 NOCD ALL Y TRLHN EB N FALSE GTri-Valley Medical Group 20538 NOCD ALL N TRI VALLEY MED N FALSE GTrinity Health Pace TRNPC NOCD ALL N TRIN HLTH PACE N FALSE GTriple S 97300 NOCD PR N TRIPLE S N FALSE GTriplefin LLC 64300 NOCD ALL Y TRIPLEFIN LLC Y FALSE GTrusted Health Plan L0230 NOCD ALL N TRUSTED HLTH PLAN Y FALSE GTrusteed Plans Service Corporation 91078 NOCD ALL N TRUSTEED PLANS SV N FALSE GTrustmark (Includes Starmark & TMA) 61425 NOCD All Y TRUSTMARK N FALSE GTuality Health THA01 NOCD ALL Y TUALITY HEALTH N FALSE GTuality Health Select THASC NOCD ALL Y TUALILTY HLTH SEL N FALSE GTufts Associated Health 04298 NOCD ALL Y TUFTS ASSOC HLTH Y FALSE TUC Davis Health Systems UCDMG NOCD ALL N UC DAVIS HLTH SYS Y FALSE GUCare Individual & Family Plans 55413 NOCD MN N UCARE FAMILY Y FALSE G

Ucare of Minnesota (Use payer ID 52629 for DOS in 2018. Use new payer ID 55413 for UCare Individual & Family Plans with DOS in 2019) 52629 NOCD MN N UCAREOFMN Y FALSE GUC-Davis Health 94603 NOCD CA Y UC DAVIS HEALTH Y FALSE GUCHealth Plan Administrators (As of 8/1/14 CSMED, UMA & Phycor combined) 84132 NOCD CO N UNITED MED ALLIAN N FALSE GUCLA Medical Group USMBP NOCD ALL N UCLA MEDICAL GROU Y FALSE GUCS (Electrical Workers Insurance Fund Local 5800) 93235 NOCD ALL Y UCS ELEC WORK 580 N FALSE 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 GUICI Administrators - State of Nevada 75245 NOCD NV Y NEVADA UICI N FALSE GUHA Health Insurance UHA01 NOCD ALL N UHA HEALTH Y FALSE GUltimate Health Plan 77022 NOCD ALL Y ULTIMATE HP N FALSE GUltra Benfits Inc. 41206 NOCD ALL N ULTRA BENEFITS IN Y FALSE GUMASS Medical School Health and Criminal Justice Program UMHCJ NOCD ALL N UMASS N FALSE GUMC Health Plan 75130 NOCD ALL Y UMC HEALTH PLAN Y FALSE GUMWA Health & Retirement Funds 52180 NOCD All Y UMWA HEALTH N FALSE GUnicare Life & Health Insurance Company 80314 NOCD All Y UNICARE LIFE HEAL Y FALSE GUnified Group Services 35198 NOCD OH Y UNIFIED GRP SERVI Y FALSE GUnified Health Services 62170 NOCD ALL Y UNIFIED HLTH SERV Y FALSE GUnified Physicians Network (For Claims rejections, please contact Unified Physicians claim department at 847-763-1700) 34638 NOCD ALL N UNIFIED PHY NETWO Y FALSE GUniformed Service Family Health Plan 13407 NOCD ALL Y UNIFORMED SVC FHP Y FALSE GUnion Pacific Railroad Employees Health Systems 87042 NOCD ALL Y UP RAIL EMP HLTH Y FALSE GUnite Health Share Ministries (UHSM) 83173 NOCD ALL N Unite Health Share N FALSE GUnite Here 59144 NOCD ALL N UNITE HERE N TRUE NUnited Agriculture Benefit Trust UABT1 NOCD ALL N UNITED AG BENEFIT Y FALSE GUnited Care Medical Group ADCUC NOCD ALL N UNITED CARE MED G N FALSE GUnited Food & Commercial Workers UFCW Local 1529 21850 NOCD ALL Y UFCW LOCAL 1529 N FALSE GUnited Food and Commmercial Workers Midwest Unions 36659 NOCD ALL Y UNITED FOOD COMM N FALSE GUnitedHealthcare 87726 NOCD All R UNITED HEALTHCARE Y FALSE C

UnitedHealthcare (Definity Health Plan) former payer ID 64159 87726 NOCD ALL Y UHC DEFINITY HEAL Y FALSE CUnitedHealthcare (Empire Plan) 87726 NOCD ALL Y UHC EMPIRE PLAN Y FALSE CUnitedHealthcare / All Savers Alternate Funding 81400 NOCD ALL N UHC ALL SAVERS Y FALSE C



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Type

UnitedHealthcare / All Savers Insurance 81400 NOCD ALL N UNITEDHEALTHONE Y FALSE CUnitedHealthcare / Oxford 06111 NOCD All Y OXFORD HEALTH PLA N FALSE CUnitedHealthcare / Spectera Eyecare Networks 00773 NOCD ALL Y OPTUMHEALTH VISIO N FALSE CUnitedHealthcare / StudentResources 74227 NOCD TN Y STUDENT INSURANCE Y FALSE C

UnitedHealthcare / UHIS-UnitedHealthcare Integrated Services 39026 NOCD ALL Y UHIS UHC SERVICES Y FALSE 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 CUnitedHealthcare / UnitedHealthcare Plan of the River Valley (formerly John Deere Healthcare) former payer id 95378 87726 NOCD ALL Y UHC RIVER VALLEY Y FALSE CUnitedHealthcare Community Plan / Arizona Long Term Care - BH & SNP / Children's Rehabilitative Services (CRS) 03432 NOCD AZ Y UHC AZIPA Y FALSE CUnitedHealthcare Community Plan / AZ (formerly Arizona Physicians IPA and APIPA) 03432 NOCD AZ Y AZ PHYSICIANS IPA Y FALSE C

UnitedHealthcare Community Plan / CA, DC, DE, FL, GA, HI, IA, KY, LA, MA, MD, MS, NC, NE, NM, NY, OH, OK, PA, RI, TX, VA, WA, WI

87726 NOCD ALL Y UNITED HEALTHCARE Y FALSE CUnitedHealthcare Community Plan / KS - KanCare 96385 NOCD ALL Y KANCARE Y FALSE CUnitedHealthcare Community Plan / MI (formerly Great Lakes Health Plan) 95467 NOCD ALL Y GREAT LAKES HEALT Y FALSE 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 CUnitedHealthcare Community Plan / TN (formerly AmeriChoice TN: TennCare, Secure Plus Complete) 95378 NOCD ALL Y UHC COMMUNITY PLA Y FALSE CUnitedHealthcare Community Plan / UnitedHealthcare Dual Complete (formerly Evercare) 87726 NOCD ALL Y UHC DUAL COMPLETE Y FALSE CUnitedHealthcare Community Plan / UnitedHealthcare Long Term Care / UnitedHealthcare Chronic Complete / UnitedHealthcare Nursing Home Plan (formerly Evercare) 87726 NOCD ALL Y UHC LONG TERM CAR Y FALSE CUnitedHealthcare Community Plan Missouri 86050 NOCD ALL Y UHC COMM PLAN MO Y FALSE CUnitedHealthcare Dual Complete - Oxford Medicare Network (UnitedHealthcare Community) 87726 NOCD ALL Y OXFORD MEDICARE N Y FALSE CUnitedHealthcare Medicare Solutions (UnitedHealthcare Group Medicare Advantage) 87726 NOCD ALL Y UHC GROUP MCARE A Y FALSE CUnitedHealthcare Medicare Solutions / Care Improvement Plus (CIP), XLHealth former payer id 77082 87726 NOCD ALL N CARE IMPROVEMENT Y FALSE CUnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareComplete (formerly SecureHorizons) 87726 NOCD ALL Y UHC MEDICARECOMPL Y FALSE CUnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareDirect (formerly SecureHorizons) 87726 NOCD ALL Y UHC MEDICARE COMP Y FALSE CUnitedHealthcare Military & Veterans / TRICARE West 99726 NOCD MANY Y TRICARE Y TRUE TUnitedHealthcare Vision 00773 NOCD ALL Y OPTUMHEALTH VISIO N FALSE CUnitedHealthcare West / Encounters (formerly PacifiCare) 95958 NOCD ALL N UHC WEST ENCOUNTE Y FALSE CUnitedHealthcare West / UnitedHealthcare of CA, OK, OR, TX, WA and PacifiCare of AZ, CO, NV 87726 NOCD ALL Y UHC WEST Y FALSE CUnitedHealthOne / UnitedHealthcare Life Insurance Company - Golden Rule 37602 NOCD All N GOLDEN RULE INS Y FALSE CUnitedHealthOne / UnitedHealthcare Life Insurance Company (formerly American Medical Security) 81400 NOCD ALL N UNITEDHEALTHONE Y FALSE CUnity Health Insurance 66705 NOCD ALL Y UNITY HLTH INSUR Y FALSE CUnivera Community Health 15003 NOCD ALL Y UNIVERA COMM HLTH N FALSE GUnivera Health Care Plan/ChoiceCare Buffalo SX087 NOCD ALL Y UNIVERA CC BUFFA N TRUE NUnivera Healthcare - CNY HC001 NOCD NY Y UNIVERA HC CNY Y FALSE NUnivera Healthcare (SSA) SX091 NOCD ALL Y UNIVERA HCARE SSA Y TRUE NUnivera Traditional PPO UNINW NOCD ALL A UNIVERA TRAD PPO N FALSE NUniversal Care - California (ProviderID required.) 33001 NOCD CA Y UNIVERSAL CARE CA Y FALSE GUniversity Family Care 09830 NOCD ALL Y UNIVERSITY FAM CA Y TRUE GUniversity Family Care - Healthcare Group 07503 NOCD ALL Y UNIV FAMILY CARE Y FALSE GUniversity Family Care - Maricopa Health Plan 09908 NOCD AZ Y MARICOPA HP UFC Y FALSE GUniversity Health Alliance 99026 NOCD ALL Y UNIVERSITY HLTH A Y TRUE NUniversity Health Care Advantage 46407 NOCD ALL N UNIV HC ADVANTAGE N FALSE GUniversity Healthcare Marketplace 45437 NOCD ALL A UNIVERSITY HC MAR Y FALSE GUniversity of Illinois UIC67 NOCD ALL Y UNIVERSITY ILLINO Y FALSE GUniversity of Maryland Health Advantage 45282 NOCD ALL Y UNIV MD HLTH ADVA Y FALSE GUniversity of Utah Health Plans SX155 NOCD UT N UT UNIV HLTH PLAN Y FALSE N

University of Washington Students & Graduate Appts. - Grp#P67 91136 NOCD WA Y UNIVERSITY GRP67 N FALSE G



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Type

Upland Medical Group (Customer Service Phone number, (909) 291-4400) IP056 NOCD CA Y UPLAND MEDICAL GR Y FALSE GUPMC Health Plan 23281 NOCD ALL Y UPMC HEALTH PLAN Y FALSE GUpper Peninsula Health Group TPA 37324 NOCD ALL Y UP PENINSULA TPA N FALSE GUpper Peninsula Health Plan 38337 NOCD ALL A UP HEALTH PLAN Y FALSE NUS Benefits 93092 NOCD ALL Y US BENEFITS N FALSE GUS Family Health Plan (USFHP) USFHP NOCD ALL N USFHP Y FALSE GUS Virgin Islands Medicaid SKVI0 NOCD VI Y US VI MEDICAID N FALSE NUSAA 74095 NOCD ALL Y USAA Y FALSE GUS Network and Administrative Services USN01 NOCD ALL Y US NETWORK Y FALSE CUtah Carpenters 74234 NOCD UT N UTAH CARPENTERS N FALSE GUtah Laborers 74234 NOCD UT N UTAH LABORERS N FALSE GUtah Pipe Trades 74234 NOCD UT N UTAH PIPE TRADES N FALSE GUtica NY FEP (Federal Employee Program) Blue Shield N4FEP NOCD NY Y UTICA NY FEP Y FALSE G

VA Community Care Network Region 1 (Effective for 837P claims with DOS on or after 07/29/2019) VACCN NOCD

CT, DE, ME, MD, MA, NH, NJ, NY, NC, PA, RI, VT, VA, WV, DC Y VA COMM CARE Y FALSE G

VA Community Care Network for Dental Providers Region 1 (Effective for Dental claims with DOS on or after 06/26/2019) VACCN NOCD

CT, DE, ME, MD, MA, NH, NJ, NY, NC, PA, RI, VT, VA, WV, DC Y VACCN Region 1 Y FALSE G


IA, IL, IN, KS, KY, MI, MN, MO, ND, NE, OH, SD, WI Y VA COMM CARE Y FALSE G


IA, IL, IN, KS, KY, MI, MN, MO, ND, NE, OH, SD, WI Y VACCN Region 1 Y FALSE G


OK, AR, LA, TN, MS, AL, GA, SC, FL, PR, VI Y VA COMM CARE Y FALSE G


OK, AR, LA, TN, MS, AL, GA, SC, FL, PR, VI Y VACCN Region 1 Y FALSE G

VA Fee Basis Programs 12115 NOCD ALL N VA FEE BASIS PROG Y FALSE G

VA Patient Centered Community Care Program (VAPCCC) Region 3 VAP33 NOCD ALL Y VAPCCC REG 3 Y TRUE NVA Patient Centered Community Care Region 6 VAPC6 NOCD AK Y VA PCCC REGION 6 N TRUE N

VA Patient-Centered Community Care Program (VAPCCC) Region 5A VAPC3 NOCD ALL Y VAPCCC5A Y FALSE NVA State Employer Funds VABLS BCBS VA Y VA STATE EMP FUND Y FALSE NValir Pace (Formerly Via Christi Hope) 48123 NOCD ALL Y VIA CHRISTI HOPE N FALSE GValley Care IPA (Customer Service 805-604-3332) VCIPA NOCD CA N VALLEY CARE IPA Y FALSE GValley Health Administrators VHA11 NOCD ALL Y VALLEY HLTH ADMIN N FALSE GValley Health Plan VHP01 NOCD ALL N VALLEY HEALTH Y FALSE GValley Health Plan Medi-CAL VHP02 NOCD ALL N VALLEY HEALTH MED Y FALSE GValley Mental Health 94293 NOCD ALL Y VALLEY MENTAL HEA N FALSE GValue Options Colorado Medicaid 00815 NOCD CO N VALUE OP CO MCAID Y TRUE NValue Options Commercial Claims 00813 NOCD ALL N VALUE OPT COMMERC N TRUE NValue Options Maryland 00823 NOCD ALL Y VALUE OPTIONS MD N TRUE NValue Options Pennsylvania Medicaid 00817 NOCD PA N VALUE OPT PAMCD N TRUE NValue Options Texas Northstar 00818 NOCD TX N VAL OPT TX NORTHS N TRUE NValueOptions/MBHP (For claim rejections please contact [email protected] or 888-247-9311) 43307 NOCD MA Y VALUEOPTIONS MBHP Y TRUE N



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Type

Vantage Health Plan, Inc. 72128 NOCD ALL N VANTAGE HEALT PLA Y FALSE GVantage Medical Group Use Payer ID PPM01 for claims with DOS prior to 08.01.2020 PPM01 NOCD ALL A VANTAGE MED GROUP N FALSE GVantage Medical Group Use Payer ID PROSP for claims with DOS after 08.01.2020 PROSP NOCD ALL A VANTAGE MED GROUP N FALSE GVAPCCC Region 5B 55916 NOCD ALL Y VAPCCC REG 5B N TRUE NVaripro 72187 NOCD ALL Y VARIPRO N FALSE GVENCOR 73288 NOCD ALL Y VENCOR Y FALSE GVentura County Healthcare Plan VCHCP NOCD CA Y VENTURA CO HCP N FALSE GVerity VMMH1 NOCD ALL Y VERITY Y FALSE GVerity National Group 75256 NOCD ALL Y VERITY NATL GROUP Y FALSE GVerity Plus VMMH2 NOCD ALL Y VERITY PLUS Y FALSE GVestaCare / RH Admin VESTA NOCD ALL N VESTACARE Y FALSE GVida Care (Now known as Amida Care.) 24818 NOCD ALL N VIDA CARE Y FALSE GVillageCareMAX 26545 NOCD ALL N VILLAGECAREMAX N FALSE GVirginia Coordinated Care 84806 NOCD ALL Y VA COORDINATED CA N FALSE GVirginia Health Network,Inc (To get the payerID, call payer at (804)320-3837) CALL CALL ALL N CALL S&S SUPPORT N FALSE GVirginia Premier Preferred Gold 251VA NOCD VA N VA GOLD Y FALSE G

Virginia Premier Health Plans (Effective 02-01-2019, former payer IDs VPEP1, 54176, VPELT, VPCCP, VPHP1,VPCCI, MAPDI, 12K83, MAPDP) VAPRM NOCD VA Y VIRGINIA HEALTH Y FALSE GVista Oncology New Century Infusion Solutions NCH08 NOCD ALL A VISTA ONCOLOGY NE N FALSE GViva Health Plan 63114 NOCD ALL Y VIVA HEALTH PLAN N FALSE G

Vivida Health Plan (Use this ID for dates of service prior to 01/01/21) 45488 NOCD ALL N Vivida Health N FALSE GVivida Health Plan (Use this ID for dates of service on or after 01/01/21) A0102 NOCD ALL N Viv Health N FALSE GVNA Homecare Options 31626 NOCD ALL N VNA HOMECARE OPTI Y FALSE GVNS Choice Medicare (Formerly Visiting Nurse Service) 77073 NOCD ALL N VNS CHOICE MEDICA Y FALSE GVolusia Health Network 59266 NOCD ALL N VOLUSIA HLTH NETW Y FALSE 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 GWA Blue Cross Regence (UMP) 00932 NOCD WA Y REGENCE BCBS UMP Y FALSE NWabash Memorial Hospital Association 85256 NOCD ALL Y WABASH MEM HOSPIT Y FALSE GWashington County Health and Human Services WCHHS NOCD ALL Y WASH COUNTY HHS N FALSE GWashington State Labor and Industry WALAI NOCD WA N WA LABOR AND INDU Y TRUE NWashington State Premera Blue Cross WABLC NOCD WA Y WA PREMERA BC Y FALSE NWaterstone Benefit Administrators 73155 NOCD OK Y WATERSTONE BEN AD Y FALSE GWatts Healthcare Corp IPA MPM09 NOCD CA N WATTS HC CORP IPA N FALSE NWEA Insurance Group 39151 NOCD ALL Y WEA INSURANCE GRO Y FALSE GWeiss Health Providers 36337 NOCD ALL N WEISS HLTH PROVID N FALSE GWellcare Health Plan, Inc. (Encounters only) 59354 NOCD ALL Y WELLCARE HP ENCOU Y FALSE GWellcare HMO, Inc. 14163 NOCD ALL Y WELLCARE HMO Y FALSE GWellcare of CT 14164 NOCD CT Y WELLCARE CT Y FALSE GWellcare of NY 14164 NOCD NY Y WELLCARE OF NY Y FALSE GWellfirst Health 39113 NOCD ALL N WELLFIRST HEALTH Y FALSE CWellMed (Claims) WELM2 NOCD ALL N WELLMED Y FALSE CWellMed (Encounters) WELMD NOCD ALL N WELLMED ENC Y FALSE CWellSpan Plus 23266 NOCD ALL N WELLSPAN PLUS N FALSE GWellSystems, LLC 35245 NOCD ALL N WELLSYSTEMS LLC N FALSE GWenatchee Valley Medical Center 91064 NOCD ALL N WENATCHEE VLY MED Y FALSE GWest Coast Stationary Engineers Health & Security Trust Fund - Grp#F13 91136 NOCD ALL Y WEST COAST GRPF13 N FALSE G

West Suburban Health Providers 80942 NOCD ALL N W SUBURBAN HLTH P Y FALSE G only for claims for service dates prior to 7/1/2019. Providers should check member cards to ensure they send claims to the correct WV MCO plan for service dates 7/1/2019 and forward).

45276 NOCD WV Y WV FAMILY HEALTH Y FALSE GWest Virginia Senior Choice WVS01 NOCD All N WV SENIOR N FALSE NWestern Grower's Assurance Trust 24735 NOCD ALL Y WEST GROWERS TRUS Y FALSE GWestern Grower's Insurance Company 24735 NOCD ALL Y WEST GROWERS INS Y FALSE GWestern Mutual Insurance 37247 NOCD ALL Y WESTERN MUTUAL IN N FALSE GWestern Oregon Advanced Health DOCSO NOCD ALL Y WEST OR ADV HLTH N FALSE GWestern Sky Community Care 68069 NOCD ALL Y WESTERN SKY Y FALSE GWestern Oregon Advanced Health WOAHM NOCD OR Y WEST OR ADV HLTH Y FALSE GWestern Southern Financial Group 31048 NOCD ALL N W S FINANCIAL GRO N FALSE GWestLake Financial Group, Inc. 90560 NOCD ALL Y WESTLAKE FIN GROU Y FALSE G



40 of 41



Type

Weyco Inc. 38232 NOCD ALL Y WEYCO Y FALSE GWillamette Valley Community Health CCO (Formerly known as Marion Polk Health Plan) MPCHP NOCD ALL Y MARION POLK HP N FALSE GWilliam C. Earhart Co, Inc. 93050 NOCD GA Y WILLIAM C EARHART Y FALSE GWilliam J Sutton & Co. Ltd. 98010 NOCD ALL N WILLIAM J SUTTON N FALSE GWillow Health WHLTH NOCD ALL Y WILLOW HEALTH Y FALSE GWilson McShane 41095 NOCD ALL N W MCSHANE N FALSE GWIN Healthcare (Woman's Integrated Network, Inc.) 13413 NOCD ALL Y WIN HEALTHCARE Y FALSE GWisconsin Dept of Corrections VEST1 NOCD WI N WI DEPT OF CORR N FALSE CWoodman Accident and Life Co (AICT Plans only) 81949 NOCD ALL N WOODMAN ACCIDENT N FALSE GWorksite Benefit Services 20333 NOCD ALL N WORKSITE BENE SVC Y FALSE GWPP Eldercare Wisconsin 77080 NOCD ALL N WPP ELDERCARE WIS Y FALSE GWPPA-ProviDRs Care Network WP481 NOCD ALL Y WPPA PROVIDRS CAR N FALSE GWPS Commercial OOWPS NOCD WI N WPS COMMERCIAL N TRUE GWyoming School Boards Association Insurance Trust WYSCH NOCD WY N WY SCHOOL BOARD A Y FALSE GYale University Health Plan 60646 NOCD ALL N YALE UNIVERSITY H Y FALSE GYam Hill CCO-PHTech YAMHL NOCD ALL Y YAM HILL CCO PHT Y FALSE GYerington Paiute Tribe 51350 NOCD ALL Y YERINGTON PAIUTE N FALSE GZebra Health HC 88858 NOCD ALL Y ZEBRA HEALTH Y FALSE GZoomCare ZOOM1 NOCD ALL Y ZOOMCARE N FALSE GZurich Insurance 16535 NOCD ALL N ZURICH INSURANCE N FALSE G



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Type

Legend for Report Types ALYNSR TGeneral Payer Information

PCTGNFootnotes

** 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 (09/16/2020) · Access Behavioral Care COACC NOCD CO S ACCESS BEHAVIORAL Y FALSE G ... LLC (Formerly Amway Corporation) 38254 NOCD ALL Y ACTIVA BENE

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