| Americas 1st Choice Health Plans of South Carolina, Inc. |
20553 |
|
|
|
| Custom Benefit Administrators |
39170 |
|
|
|
| Sage Technologies |
37105 |
|
|
|
| 1199 National Benefit Fund |
13162 |
|
|
Please include Network ID when submitting claims. Call Renaud Dufresne at 646-473-6960 for a list of Network Ids. |
| 21st Century Insurance and Financial Services |
51028 |
|
|
Claims and ERA's for Minnesota ONLY. |
| A & I Benefit Plan Administrators |
93004 |
|
|
|
| AAG - American Administrative Group |
75185 |
|
|
|
| AARP |
36273 |
|
|
|
| ABC Health Plan of New York |
48185 |
|
|
|
| ACCLAIM |
64071 |
|
|
|
| Acclaim Repricing (Tupelo, MI) |
21356 |
|
|
Include group # when submitting claims |
| Accordia National |
87815 |
|
Y |
|
| ACS Benefit Services |
72467 |
|
|
|
| Activa Benefit Svcs |
38254 |
|
|
Formerly Amway Corp |
| Administrative Concepts Inc |
22384 |
|
|
|
| AdminOne |
37278 |
|
|
|
| Advantage by Bridgeway/Buckeye/Managed Health/Superior Healt |
68056 |
|
|
|
| Advantage Health Solutions |
35209 |
|
|
|
| Advantage Preferred Plus |
77070 |
|
|
|
| Advantek Benefit Administrators |
83077 |
|
|
|
| Advantra Freedom |
25133 |
|
Y |
|
| Advocate Health Centers ( IL ) |
36320 |
|
|
|
| Advocate Health Partners |
65093 |
|
|
Requires Payer Sub ID |
| Aetna Better Health Connecticut Medicaid |
23225 |
|
|
|
| Aetna Encounters |
60055 |
|
|
Please contact your Aetna Network Manager for submission requirements |
| Aetna Health Plans |
60054 |
|
Y |
|
| Aetna TX Medicaid & CHIP |
38692 |
|
|
|
| Affordable Benefit Admin |
95426 |
|
|
|
| AFTRA Health Fund |
13346 |
|
|
|
| AGA |
37280 |
|
|
|
| AHPO (Cleveland, OH) |
31138 |
|
|
|
| Alaska Children's Services Inc. Grp#P68 |
91136 |
|
|
Please include Group # |
| Alaska Electrical Health & Welfare Fund |
92600 |
|
|
|
| Alaska Laborers Construction Industry Trust Grp#F23 |
91136 |
|
|
Please include Group # |
| Alaska Pipe Trades Local 375 Grp#F24 |
91136 |
|
|
Please include Group # |
| Alaska United Food & Commercial Workers Health and Welfare T |
91136 |
|
|
Please include Group # |
| ALICARE (also known as Amalgamated Life) |
13550 |
|
|
|
| All Savers Insurance Co. |
37602 |
|
|
|
| Alliance PPO |
52148 |
|
|
Professional Services 800-342-6141 or 301-294-5083 |
| Alliant Health Plans of Georgia |
58234 |
|
|
|
| Allied Administrators (San Francisco, CA) |
94177 |
|
|
|
| Allied Benefit Systems |
37308 |
|
|
Now accepted for the following addresses: 208 LaSalle St, Suite 1300, Chicago IL 60604; PO Box 909786, Chicago IL 60690; PO Box 909799, Chicago IL 60690 |
| ALTIUS (UHIN) - Utah |
25133 |
|
|
|
| Amalgamated Life (aka ALICARE) |
13550 |
|
|
|
| Americaid Community Care (Maryland) |
27517 |
|
|
|
| Americaid Community Care (New Jersey) |
27516 |
|
|
Formerly Americaid Inc. |
| American Administrative Group |
75240 |
|
|
|
| American Benefit Plan Administrators |
95170 |
|
|
|
| American Benefits Management (North Canton, OH) |
34187 |
|
|
Payer ID valid only for claims with a billing submission address of P.O. Box 35008, N. Canton, OH 44735 |
| American Commercial Barge Lines |
87726 |
|
|
|
| American Commercial Barge Lines |
37128 |
|
|
|
| American Community Mutual Insurance |
60305 |
|
Y |
|
| American General (Nashville, TN) |
62030 |
|
Y |
|
| American Healthcare Alliance |
01066 |
|
|
|
| American Imaging Management Inc. |
36369 |
|
|
Assigned group Policy Plan ID is required. To obtain, Please call American Imaging Management at (800) 252-2021. |
| American International Group (Wilmington, DE ) |
87726 |
|
Y |
Plan of United Healthcare |
| American Lifecare (Louisiana) |
72099 |
|
|
Please enter the Group Number from ID card when submitting claims. Payer ID valid only for claims with a billing submission address of 1100 Poydras Street, Suite 2600, New Orleans, LA 70163-2602 |
| American Medical Security, Inc. |
81400 |
|
|
|
| American Postal Workers Union Health Pla |
44444 |
|
|
Claims for the state of Maine ONLY must be sent on paper to MedNet, P. O. Box
15440, Portland, ME 04112 |
| American Progressive/Pyramid/Today's Option |
48055 |
|
|
|
| American Republic Insurance Co, ( Des Moines, IA) |
42011 |
|
Y |
|
| American Worker Health Plus |
37322 |
|
|
|
| Americas TPA |
41178 |
|
|
|
| Americhoice (TN) |
87726 |
|
|
|
| Americhoice of New Jersey Medicaid |
86047 |
|
|
|
| Americhoice of New York Medicaid |
86048 |
|
|
|
| Americhoice of Pennsylvania Medicaid |
86049 |
|
Y |
|
| Americhoice-New Jersey Medicare |
86001 |
|
|
All claims submitted require your AmeriChoice assigned Provider ID Number.
Please contact AmeriChoice at (888) 362-3368 for your Provider ID Number.
|
| Americhoice-New York Medicare |
86002 |
|
|
|
| Americhoice-Pennesylvania Medicare |
86003 |
|
|
|
| Amerigroup (Nevada, Austin, New Mexico) |
26375 |
|
|
|
| Amerigroup (TN) |
27514 |
|
|
|
| Amerigroup Corp (Ft. Worth/Dallas) |
27514 |
|
|
Formally Americaid Community Care (Dallas/Ft. Worth).
|
| Amerigroup Corp (Houston) |
27515 |
|
|
Formally Americaid Community Care (Houston).
|
| Amerigroup Florida |
27519 |
|
|
|
| Amerigroup Georgia |
27514 |
|
Y |
|
| Amerigroup Illinois and Ohio |
27518 |
|
|
|
| AmeriHealth Administrators |
54763 |
|
|
|
| AmeriHealth Mercy Health Plan |
22248 |
|
|
Medicaid Managed Care |
| Amida Care |
24818 |
|
|
|
| Ancillary Benefit Systems/Arizona Foundation for Medical Car |
86062 |
|
|
|
| Antares Management Solution |
34192 |
|
Y |
|
| Anthem Indiana |
BS130 |
|
Y |
|
| Anthem Kentucky |
BS160 |
|
Y |
|
| Anthem Ohio |
BS332 |
|
Y |
|
| APA Partners |
16140 |
|
|
|
| Apex Benefit Services |
34196 |
|
|
|
| ARAZ |
16120 |
|
|
|
| Arizona Blue Cross and Blue Shield |
53589 |
|
Y |
|
| Arkansas Best |
75278 |
|
|
|
| Arkansas Medicaid |
ARMCD |
Y |
Y |
|
| Arnett Health Plans (Lafayette, IN) |
95440 |
|
|
Requires Unique Provider ID |
| ASR/Physicians Care |
38265 |
|
|
|
| Associates of Healthcare |
36326 |
|
|
|
| Association Benefit Plan |
25133 |
|
|
|
| Assurant Health |
39065 |
|
Y |
|
| Assurant Health Self-Funded |
37313 |
|
Y |
Must verify all claims should go to payer in Ft. Mill, SC.
|
| Athens Area Health Plan Select |
95691 |
|
|
|
| Atlantic Medical Insurance |
22285 |
|
|
|
| Atlanticare (Horizon Healthcare Admin/HHA) |
22304 |
|
|
|
| Aultra Administrative Group |
37242 |
|
|
Payer ID valid only for claims with a billing submission address of P.O. Box 35276 Canton,OH 44735-5276
|
| Automated Benefit Services |
38259 |
|
|
|
| Automated Group Administration |
37280 |
|
|
|
| Automotive Machinists Local 289 Health and Welfare Trust Grp |
91136 |
|
|
Include Group # when submitting |
| Avera Health Plans |
46045 |
|
|
|
| Azeros Health Plans, Inc |
16114 |
|
|
|
| Azeros Health Plans, Inc. |
16644 |
|
|
|
| Bass Administrators, Inc |
37248 |
|
|
|
| BCI Administrators, Inc (Farmington Hills, MI) |
49153 |
|
|
|
| Beech Street Corp (Irvine, CA) |
95377 |
|
|
Must contain payer name |
| Behavioral Health Systems |
63100 |
|
|
|
| Benefirst |
37125 |
|
|
|
| Benefit Coordinators Corporation (Pittsburg, PA) |
25145 |
|
|
Only valid for 111 Ryan Court, ste 300 Pittsburgh, PA 15205 |
| Benefit Management Services Inc |
00999 |
|
|
|
| Benefit Management Systems, Inc |
37212 |
|
|
|
| Benefit Plan Administrators (Roanoke, VA) |
37118 |
|
|
|
| Benefit Plan Administrators (WI) |
39081 |
|
|
Payer ID valid only for claims with a billing submission address of P.O. Box 1128, Eau Claire, WI 54702-1128.
|
| Benefit Systems & Services, Inc. (BSSI) |
36342 |
|
|
|
| Benefits Management Group Inc. |
20018 |
|
|
|
| Benesight |
87265 |
|
|
(Formarly known as the TPA)
|
| Benesys |
37248 |
|
|
|
| Best Life & Health Insurance Co. |
95604 |
|
|
|
| Better Health Plans of South California |
32006 |
|
|
|
| Blue Cross / Blue Shield of Illinois |
12B08 |
|
|
|
| Blue Cross of South Carolina |
12B55 |
|
|
|
| Blue Shield of California |
94036 |
|
Y |
For hospital, Pref. Prov. only. Please contact Blue Shield of CA EDI Customer Service at (800)
480-1221 to verify correct provider information prior to sending claims.
|
| Blue Shield of Kansas |
BS650 |
Y |
Y |
|
| Bluegrass Family Health |
61124 |
|
Y |
|
| BMC (Boston Medical Center) HealthNet Plan |
13337 |
|
|
Include all leading zeros in provider ID. |
| Boilermakers National Health & Welfare Fund |
36609 |
|
|
|
| Boon-Chapman Administrators |
74238 |
|
|
|
| Boulder Administration Services |
20381 |
|
|
|
| BPA/Benefit Plan Administrators (ND) |
37286 |
|
|
|
| BPS, Inc. |
13310 |
|
|
|
| Bravo Health |
52192 |
|
|
this payer was formerly known as Elder Health |
| Bridgeway Arizona |
68054 |
|
Y |
Prior to submitting claims, please call Provider Relations Dept at 1-866-475-3129 to verify your provider info is on file in the claim system
|
| BritCay |
22286 |
|
|
|
| Brockerage Concepts, Inc |
51037 |
|
|
|
| Brodart Company |
35182 |
|
|
|
| Broward Health |
37314 |
|
|
|
| Brown & Toland Medical Group |
94316 |
|
|
|
| Buckeye Community Health Plan |
32004 |
|
Y |
|
| California Blue Cross |
47198 |
Y |
Y |
|
| California Blue Shield |
94036 |
|
Y |
For hospital, Pref. Prov. only. Please contact Blue Shield of CA EDI Customer Service at (800)
480-1221 to verify correct provider information prior to sending claims.
|
| California Home Health and Hospice |
CAHHH |
|
Y |
|
| California Medicaid |
57016 |
|
|
|
| California Medicare - Southern |
CSMCR |
Y |
Y |
|
| California Medicare Jurisdiction J1A1 |
CAMCR |
|
Y |
|
| California Medicare Jurisdiction J1A2 |
CAMR2 |
|
|
|
| Cambridge ISG (Exton, PA ) |
59334 |
|
|
|
| Cannon Cochran Management Services, Inc. |
71057 |
|
|
|
| Cape Health Plan |
38245 |
|
|
|
| Capital Community Health Plans |
87726 |
|
|
|
| Capital District Physician's Health Plan |
SX065 |
|
Y |
|
| Capital Health Plan |
95112 |
|
|
|
| Capitol Administrators |
68011 |
|
|
|
| Capitol Blue Cross Blue Shield (PA) |
BSCAP |
Y |
|
|
| Capstone Health Plan Inc |
86044 |
|
|
|
| Care Improvement Plus |
77082 |
|
|
|
| Care Wisconsin Health Plan |
27004 |
|
|
|
| CareCore National LLC - Health Net New Jersey |
14185 |
|
|
|
| CareFirst Blue Cross Maryland |
12001 |
|
|
|
| Carelink Health Plan |
25133 |
|
|
|
| Carelink Medicaid |
25140 |
|
|
|
| Carenet of Virginia |
25142 |
|
Y |
|
| CareOregon, Inc |
93975 |
|
|
|
| CarePlus Health Plan |
95092 |
|
|
|
| Caresource |
31114 |
|
|
|
| Carilion Clinic Medicare Health Plan |
77015 |
|
|
|
| Cariten Healthcare ( Knoxville, TN ) |
62073 |
|
|
|
| Cariten Senior Health ( Knoxville, TN) |
62072 |
|
|
|
| Carolina Care Plan |
29076 |
|
|
|
| Carolina Summit Healthcare, Inc. |
56195 |
|
|
|
| Carpenter's Health and Welfare Trust of St. Louis (St. Louis |
25125 |
|
|
|
| CBCA Administrators |
55438 |
|
|
|
| CBSA |
41124 |
|
|
|
| Cedars-Sinai Medical Network |
95166 |
|
|
|
| CeltiCare |
68060 |
|
|
|
| Cement Masons & Plasterers Health & Welfare Trust Grp#F16 |
91136 |
|
|
Please enter group number F16 when submitting |
| Cenpatico Massachusettes |
68061 |
|
|
|
| Cenpatico-OH |
68051 |
|
|
|
| Centra/ Centra Benefit Services |
75196 |
|
|
|
| Central Benefits Life |
31118 |
|
|
|
| Central Benefits Mutual |
31118 |
|
|
|
| Central Benefits National |
31118 |
|
|
|
| Central Mass Health Care |
02041 |
|
|
|
| Central Reserve Life |
34097 |
|
Y |
|
| Central States Health & Welfare Funds |
36215 |
|
|
|
| CHA - Commonwealth Health Alliance |
23171 |
|
Y |
|
| CHAMPVA - HAC |
84146 |
|
Y |
CHAMPVA – HAC is not associated with and does not process claims for TRICARE (formerly CHAMPUS)
|
| Chautauqua County Health care Plan ( Maryville, NY) |
16600 |
|
|
|
| Chesapeake Life Insurance |
59223 |
|
Y |
Valid for mailing address of PO Box 982017 North Richland Hills, TX 76182 |
| Chesterfield Resources, Inc. |
34154 |
|
|
|
| Childhealth Plus by Healthfirst (CHP) |
80141 |
|
|
|
| Children of Women Vietnam Veterans - VA HAC |
84146 |
|
Y |
CHAMPVA – HAC is not associated with and does not process claims for TRICARE (formerly CHAMPUS)
|
| Choice One/UTMB CHIP Health Plan |
76049 |
|
|
Prior to submitting, call Provider Relations at (281) 652-8700 |
| ChoiceCare, Cincinnati, Ohio |
CHOIC |
|
|
|
| Christian Brothers Services |
61271 |
|
|
|
| Christus Spohn Health Network |
SPOHN |
|
|
|
| CIGNA |
62308 |
|
Y |
|
| CIGNA Health Plan-HMO |
62308 |
|
|
|
| CIGNA Healthcare for Seniors- Arizona Medicare |
86033 |
|
|
|
| Cigna Medicare Advantage |
86033 |
|
|
|
| CIGNA-PPO |
62308 |
|
|
|
| Cincinnati Financial Corp/Healthsmart |
46871 |
|
|
|
| City of Odessa (Odessa, TX) |
75600 |
|
|
|
| Claim Management Services, Inc. ( Green Bay, WI ) |
39141 |
|
Y |
|
| Clarendon's Healthy Kids / Cadent Underwriters / Bencomp Nat |
33192 |
|
|
|
| CMHC |
02041 |
|
|
|
| Coastal Administrative Services |
77052 |
|
|
|
| Colonial Healthcare (Lanham, MD) |
37123 |
|
|
|
| Colonial Medical |
22284 |
|
|
|
| Colorado BCBS |
BS050 |
|
Y |
|
| Colorado Medicaid |
COMCD |
|
Y |
|
| Colorado Medicare |
COMCR |
|
Y |
|
| Columbia Cornell Care |
25351 |
|
|
|
| Commerce Benefits Group |
34181 |
|
|
|
| Commonwealth Administrative Group ( Lexington, KY ) |
37237 |
|
|
|
| Community Care Behavioral Health Organization |
23282 |
|
|
|
| Community Care Managed HC Plans (Oklahoma) |
73143 |
|
|
|
| Community Care Organization (Milwaukee, WI) |
39126 |
|
|
|
| Community Care Plus |
71079 |
|
|
Please note the payer name changed
effective 4/1/10. For questions, please contact Molina Healthcare of Missouri.
Please refer to the Member ID cards for payer contact information |
| Community Choice of Michigan |
38325 |
|
|
|
| Community Health Choice ( Houston, TX ) |
48145 |
|
|
|
| Community Health Electronic Claims ( CHEC ) - Texas |
75261 |
|
Y |
|
| Community Health Network of Connecticut (Mediden, CT) |
62149 |
|
|
|
| Community Health Plan ( St. Joseph's, MO ) |
90010 |
|
Y |
Located in St. Joseph, MO. Service area
includes NW Missouri, NE Kansas, SW
Iowa, and SE Nebraska.
|
| Community Medical Group of West Valley Inc |
66121 |
|
|
|
| Community Premier Plus |
13374 |
|
|
|
| Community Premier Pus for Neigh. ( NY, NY ) |
32481 |
|
|
|
| Comp - Ohio |
34177 |
|
|
|
| Comprehensive Benefits Admin ( South Burlington, VT ) |
03036 |
|
|
|
| ConnectiCare, Inc |
06105 |
|
|
|
| Connecticare- Medicare |
78375 |
|
|
|
| Connecticut General (CIGNA) |
62308 |
|
|
|
| Consociate Group ( Decatur, IL ) |
37135 |
|
|
|
| Consolidated Associates Railroad |
75284 |
|
|
|
| Consolidated Health Plans |
87843 |
|
|
|
| Consumers Life Insurance Company |
29076 |
|
|
|
| Continental General Insurance Company |
71404 |
|
Y |
|
| Continental Key Family |
35315 |
|
|
|
| Contractors Laborers Teamsters & Engineers |
47046 |
|
|
|
| Cook Group Health |
35149 |
|
|
|
| Cooperative Benefit Administrators-CBA |
52132 |
|
Y |
P.O. Box 6249 Lincoln, NE 68506-0249 |
| Cooperative Managed Care Services |
35199 |
|
|
|
| Coordinated Medical Specialists |
58204 |
|
|
|
| Core Administrative Services |
58231 |
|
|
|
| CoreSource Little Rock |
75136 |
|
Y |
Only for claims where the "submit claims to address" on the medical ID
card is a CoreSource address in Little Rock, Arkansas. For assistance call
800-689-0106. |
| CoreSource MD PA IL |
35182 |
|
Y |
|
| Coresource NC IN |
35180 |
|
Y |
Only for claims where the "submit
claims to address" on the medical ID card is a CoreSource address in the
states of North Carolina or Indiana. For assistance call 800-689-0106. |
| CoreSource OH |
35183 |
|
Y |
Only for claims where the "submit claims to address" on the medical ID card is a CoreSource address in the state of Ohio. For assistance call
800-689-0106.
|
| Corporate Benefit Services of America ( CBSA ) (MN) |
41124 |
|
|
|
| Corporate Benefits Services ( Charlotte, NC ) |
56116 |
|
|
|
| Corporate Systems Administration ( Johnson City, TN ) |
37246 |
|
|
|
| Country Life Ins. Co. |
62553 |
|
|
|
| Covenant Administrators (Atlanta, GA) |
58102 |
|
|
|
| Coventry Health Care |
25133 |
|
|
|
| CoventryCares |
00510 |
|
|
|
| Creative Medical Systems |
64068 |
|
|
|
| Croy-Hall Mgmt, Inc |
37266 |
|
|
Please enter the unique policy number
or ID card when submitting claims.
Payer ID valid only for claims with a
billing submission address of PO Box
982005 Ft. Worth, TX 76182. |
| Custom Design Benefits |
82056 |
|
Y |
|
| Custom Design Benefits |
82056 |
|
|
|
| CWIBenefits Inc |
57080 |
|
|
Formerly ClaimsWare, Inc |
| Dart Management Corporation / Dart Container |
06172 |
|
|
|
| DC Blue Cross/Blue Shield |
12000 |
Y |
Y |
|
| Definity Health (Amherst, NY) |
64159 |
|
|
|
| Delaware Medicare |
12M76 |
|
|
|
| Delaware Physicians Care Inc/ DPCI |
27009 |
|
|
Rendering Provider ID Required |
| Denver Health and Hospital Authority |
84133 |
|
|
|
| Denver Health Medical Plan (Denver, CO) |
84135 |
|
|
|
| Denver Health-Indigent (Denver, CO) |
84134 |
|
|
|
| Deseret Mutual |
12X35 |
|
Y |
Please call Debbie Hansen at 800-777-3622 ext 5838 to be setup for electronic claims.
|
| Diamond Plan |
25131 |
|
Y |
|
| Directors Guild of America-Producer Health Plan |
23706 |
|
|
|
| Diversified Administration (Marlborough, CT) |
06102 |
|
|
Please verify the Payer ID on the
Member ID card in addition to the Payer
City and State before submitting claims
to Diversified Admin (Payer ID 06102)
|
| Driscoll Children’s Health Plan |
74284 |
|
|
|
| E-V Benefits Management (Columbus, OH) |
34159 |
|
|
|
| Eastland Medical Group |
66122 |
|
|
|
| EBMS (Employee Benefit Management Services, Inc.) |
81039 |
|
|
|
| El Paso First Health Network |
EPF03 |
|
|
Call ECP for forms |
| Elder Health ( Baltimore, MD ) |
52192 |
|
Y |
|
| Elderplan (Brooklyn, NY) |
31625 |
|
Y |
Elderplan no longer requires enrollment & individual provider testing; However,
Elderplan Provider ID is necessary on all
claim submissions. If you do not know
your provider Id, contact (718) 921-7979. |
| Elmcare, LLC |
36399 |
|
|
|
| Elmco |
37253 |
|
|
|
| Emerald Health Network (All PPO Business) |
34167 |
|
|
|
| Employee Benefit Concepts, Inc. ( Farmington Hills, MI ) |
38241 |
|
|
|
| Employee Benefit Management Corp (EBMC) |
31074 |
|
|
|
| Employee Benefit Services |
37216 |
|
|
|
| Employee Benefit Services ( Charlotte, NC ) |
37126 |
|
|
|
| Employee Benefit Services of Louisiana, Inc |
41198 |
|
|
|
| Employee Benefits Plan Administration, Inc (EBPA) |
03036 |
|
|
|
| EMPLOYEE CLAIM ADJUDICATION SVCS |
75184 |
|
|
|
| Employee Plans, LLC |
35112 |
|
|
|
| Employer's Direct Health |
75232 |
|
|
|
| Employer's Direct Health-Employee Plan |
75236 |
|
|
|
| Employer's Direct Health-FI |
75235 |
|
|
|
| Employer's Direct Health-SF |
75233 |
|
|
|
| Employers Mutual (Jacksonville, FL) |
59298 |
|
|
|
| Employers Mutual (Stuart, FL) |
59331 |
|
|
|
| Encircle PPO |
35206 |
|
|
|
| Encore Health Network ( Ft. Wayne, IN ) |
35206 |
|
|
|
| Encore Health Network ( Hillview, KY ) |
35206 |
|
|
|
| ENH Medical Group IPA |
36364 |
|
|
|
| Enstar Natural Gas - Grp. #P61 |
91136 |
|
|
Please include group number when submitting claims. |
| Entrust |
36878 |
|
|
|
| EQUICOR |
62308 |
|
|
|
| EQUICOR-PPO |
62308 |
|
|
|
| Equitable Plan Services (Oklahoma City, OK) |
73126 |
|
|
|
| Erin Group Administrators (Lancaster, PA) |
23250 |
|
|
|
| Essence Healthcare |
20818 |
|
|
|
| EVERCARE (All States) |
87726 |
|
|
|
| Evergreen Health Plan |
58233 |
|
|
|
| Evolutions Healthcare Systems |
59313 |
|
|
|
| ExclusiCare |
71412 |
|
|
|
| FACS/Federated HR Services/Federated Benefits (Mason, OH) |
37300 |
|
|
|
| Fallon Community Health |
22254 |
|
|
|
| Family Care |
60995 |
|
|
|
| Family Care Medicaid |
FCD01 |
|
|
|
| Family Care Medicaid Mental Health |
FCM01 |
|
|
|
| Family Care Medicare |
FCR01 |
|
|
|
| Family Health Partners ( Kansas City, MO ) |
43173 |
|
Y |
|
| Family Health Partners-Healthwave of Kansas |
31472 |
|
Y |
|
| FARA Benefit Services |
37289 |
|
|
|
| Farm Family Life |
14140 |
|
|
|
| FCE Benefit Administrators, Inc (Burlingame, CA) |
33033 |
|
|
|
| Federated Mutual Insurance |
41041 |
|
Y |
|
| Fidelis Care New York |
11315 |
|
|
|
| Fidelis Secure Care |
77054 |
|
|
|
| First (1st) Medical Network - Atlanta, GA |
29076 |
|
|
|
| First Administrators, Inc |
FAMR1 |
|
|
|
| First Carolina Care |
56196 |
|
|
|
| First Choice (CT) |
14162 |
|
|
Render Provider Network ID required. |
| First Choice Health Network |
91131 |
|
|
|
| First Choice of Midwest PPO |
75138 |
|
|
|
| First Health Network (f.k.a. CCN & PPO Oklahoma) |
73159 |
|
|
Requires Provider Group # |
| First State Health Plan |
63080 |
|
|
|
| Firstcare (Star) Medicaid |
94998 |
|
Y |
|
| FirstGuard Health Plan |
90060 |
|
|
Call Karen Joslin at 816-922-7225 to verify provider ID. |
| FirstGuard Missouri |
90061 |
|
|
Provider ID Required |
| Florida BCBS |
BS590 |
|
Y |
|
| Florida First |
59276 |
|
|
|
| Florida First Coast Service Options |
12M34 |
Y |
|
|
| Florida Hospital Healthcare Systems |
59321 |
|
|
|
| Florida Hospital Waterman |
48116 |
|
|
|
| Florida Medicare |
FLMCR |
Y |
Y |
|
| FMH Benefits Services |
48117 |
|
Y |
|
| Foreign Service Benefit Plan |
25133 |
|
|
|
| Formax, Inc |
87066 |
|
|
|
| Fortis Benefits, Inc. |
70408 |
|
Y |
|
| Fortis Ins. Co. |
39065 |
|
Y |
PHCS Network Claims only |
| Foundation Benefits Administration |
BOONG |
|
|
|
| Fox-Everett - Ingalls Ship Building |
64067 |
|
|
|
| Fox-Everett, Inc. |
64069 |
|
|
|
| Fringe Benefits Coordinators |
59204 |
|
|
|
| FrontPath Health |
34171 |
|
|
|
| G.E. Group Administrators South Carolina |
06143 |
|
|
Formerly Phoenix Group Services, Inc |
| G.E. Group Administrators Texas |
75238 |
|
|
Formerly Phoenix Group Services - Texas |
| Gallagher Benefit Administrators/GBA |
37283 |
|
|
Lisle, IL, San Antonio, TX, Jackson, MS, San Francisco, CA |
| Galveston County Indigent Health Care |
30005 |
|
|
|
| Gateway Health Plan |
25169 |
|
Y |
|
| Gateway Health Plan - Medicare Assured |
60550 |
|
Y |
|
| Geisinger Health Plan (Danville, PA) |
75273 |
|
Y |
|
| General American Life Insurance Co. |
63665 |
|
|
ALIASES: GENELCO, Sanus HMO--St.Louis, Sanus PPO--St. Louis |
| Georgia BC/BS |
BS601 |
|
Y |
Enrollment required for 835 only. |
| Georgia Medicaid |
GAMCD |
Y |
Y |
|
| Georgia Medicaid |
GAMCD |
Y |
Y |
|
| Georgia Medicare |
GAMCR |
Y |
Y |
|
| GH Basic Health Plan |
91051 |
|
|
Western WA call (206) 901-6347 |
| GH Individual and Family Plan |
91051 |
|
|
Western WA call (206) 901-6347 |
| GHC Medicare + Choice |
91051 |
|
|
Western WA call (206) 901-6347 |
| GHC-Commercial |
91051 |
|
|
Western WA call (206) 901-6347 |
| GHI HMO Select |
25531 |
|
|
|
| GHI--NY (Group Health, Inc.) |
13551 |
|
Y |
|
| GHP (Group Health Plan) |
25133 |
|
|
|
| GIC Indemnity Plan |
80314 |
|
|
|
| Gilsbar, Inc |
07205 |
|
Y |
|
| Glassworkers Health & Welfare Fund Grp#F29 |
91136 |
|
|
Group number required |
| Global Care Inc. |
07689 |
|
|
|
| Global Health |
GLOBL |
|
|
|
| Golden Rule Insurance Co. |
37602 |
|
|
Please include group number when submitting. |
| Goodyear Tire & Rubber Company |
34025 |
|
|
|
| Government Employees Hospital Assn. |
44054 |
|
Y |
|
| Grant Physicians Practice Assoc (Chicago, IL) |
37234 |
|
|
|
| Great Lakes Health Plan (Southfield, MI) |
95467 |
|
|
|
| Great-West Life Assurance Co. of America |
80705 |
|
Y |
|
| Group Administrators Ltd. |
36338 |
|
|
|
| Group and Pension Administrators ( Richardson, TX ) |
48143 |
|
|
|
| Group Health Cooperative ( Madison, WI ) |
39167 |
|
|
|
| Group Health Cooperative ( Madison, WI )- |
39168 |
|
|
|
| Group Health Cooperative-West/Group Health Options |
91051 |
|
|
Western Washington state. |
| Group Health Managers (Redford, MI) |
38194 |
|
|
9-digit numeric insured ID required |
| Group Insurance Service Center (Pembroke, MA) |
37276 |
|
|
|
| Guardian Life Ins. Co. of America |
64246 |
|
Y |
|
| Gundersen Lutheran Health Plan |
39180 |
|
|
Call Shari Oelke (608) 775-8026 before submit. |
| H.E.R.E.I U. Welfare Pension Funds |
37114 |
|
|
|
| HAA Preferred Partners |
65101 |
|
|
|
| Harmony Health Plan (Illinois) |
36406 |
|
|
|
| Harmony Health Plan (Indiana) |
36405 |
|
|
Indiana Hoosier Healthwise members only. |
| Harrington Benefit Services (Oklahoma) |
22521 |
|
|
|
| Harrington Benefit Services Centra |
75196 |
|
|
|
| Harrington Health-Kansas formerly known as Fiserv Health-KS |
62061 |
|
|
Formerly Willis Admin Services Corp
|
| Harvard Pilgrim Health Care |
04271 |
|
|
|
| HCH Administration (Illinois) |
37111 |
|
|
|
| HCHA Albq-Self Funded |
37329 |
|
|
|
| HCS-Health Claims Service (Boise, ID) |
82018 |
|
|
|
| HDM Benefit Solutions |
12T77 |
|
|
|
| Health 1,2,3, Inc. |
23173 |
|
|
|
| Health Alliance Exclusive Plus Aliance Partners |
23172 |
|
|
|
| Health Alliance Medical Plans |
77950 |
|
Y |
|
| Health Alliance Plan of Michigan |
38224 |
|
|
|
| Health America Inc |
25133 |
|
|
|
| Health Care Network of Wisconsin (HCN) |
42102 |
|
|
|
| Health Care Savings |
56142 |
|
|
|
| Health Choice Arizona |
62179 |
|
Y |
|
| Health Choice Generations |
62180 |
|
Y |
|
| Health Cost Solutions |
62111 |
|
|
|
| Health Design Plus ( Findlay, OH ) |
34158 |
|
|
|
| Health First--Tyler, TX |
75234 |
|
|
|
| Health Future LLC |
CALL |
|
Y |
|
| Health Future, LLC |
30946 |
|
|
|
| Health Market Care Assured |
62295 |
|
|
|
| Health Net of Arizona |
38309 |
|
|
Payer requires unique provider ID; please call the Provider Call Unit at 800-289-2818 |
| Health Net of California |
95568 |
|
|
(Institutional Encounters ONLY) |
| Health Net of California and Oregon |
95567 |
|
Y |
|
| Health Net of the Northeast, Inc |
06108 |
|
Y |
|
| Health Net Pearl |
12X48 |
|
|
|
| Health Network America (Eatontown, NJ) |
20199 |
|
|
|
| Health New England |
04286 |
|
|
|
| Health Options of Illinois |
36368 |
|
|
|
| Health Partners (Jackson, TN) |
62157 |
|
|
|
| Health Partners of MN |
07003 |
|
|
|
| Health Partners, AL aka HealthSpring |
63092 |
|
|
|
| Health Partners, PA |
80142 |
|
|
|
| Health Plan Management ( Lake Bluff, IL ) |
37221 |
|
|
|
| Health Plan of Michigan |
83253 |
|
|
|
| Health Plan of Upper Ohio Valley |
HPUOV |
|
Y |
|
| Health Plans, Inc. |
44273 |
|
|
|
| Health Plus PHSP, Inc (Brooklyn, NY) |
11324 |
|
Y |
|
| Health Risk Management |
55438 |
|
|
|
| Health Risk Management, Inc |
41170 |
|
|
|
| Health Services Consulting Group Inc. |
20896 |
|
|
|
| Health Services Preferred (HSP) by Emerald Health |
34167 |
|
|
|
| Health Systems International |
27008 |
|
|
|
| Healthcare Options |
EPF37 |
|
|
Call ECP for forms |
| Healthcare Partners, IPA |
11328 |
|
|
Formerly Heritage NY Medical Group |
| Healthcare Resources Group, HRG |
82468 |
|
|
|
| Healthcare Resources NW |
56731 |
|
|
|
| Healthcare Solutions Group |
73147 |
|
|
|
| HealthCare USA |
25143 |
|
Y |
|
| Healthease |
59608 |
|
|
|
| Healthfirst 65 Plus/Healthfirst Family Health Plus |
80141 |
|
Y |
|
| Healthfirst of Austin |
75289 |
|
|
|
| HealthGuard of Lancaster |
23226 |
|
|
|
| HealthHelp Network, Inc (HHNI) |
59087 |
|
|
|
| Healthlink HMO |
96475 |
|
|
|
| Healthlink PPO |
90001 |
|
|
|
| HealthPlan Services |
59140 |
|
|
|
| HealthSCOPE Benefits, Inc |
71063 |
|
Y |
|
| HealthSCOPE Benefits, Inc (Repricing AR) |
48153 |
|
|
|
| Healthsmart Accel |
75237 |
|
|
|
| Healthsmart Preferred (Lubbock, TX) |
75250 |
|
|
|
| Healthsource CMHC |
02041 |
|
|
|
| Healthsource Massachusetts Inc |
02041 |
|
|
|
| Healthsource Provident Adminstrators |
68195 |
|
|
|
| Healthsource, AR |
71074 |
|
|
Payor requires provider ID; call 800-831-6654 |
| Healthsource, AR (Medicare HMO) |
71075 |
|
|
|
| Healthsource, GA |
58210 |
|
|
|
| Healthsource, IN |
35167 |
|
|
|
| Healthsource, KY |
61127 |
|
|
|
| Healthsource, ME |
01041 |
|
|
Requires unique provider ID. Contact 800-909-2227 x 5760 |
| Healthsource, NC |
56147 |
|
|
|
| Healthsource, NH |
02038 |
|
|
|
| Healthsource, North Texas |
75255 |
|
|
|
| Healthsource, OH |
31141 |
|
|
|
| Healthsource, SC |
06119 |
|
|
|
| Healthsource, TN |
62129 |
|
|
|
| HealthStar, Inc |
36332 |
|
|
|
| Healthy Options (DSHS) |
91051 |
|
|
Western WA |
| HFN, Inc. |
36335 |
|
|
|
| HHIC Freedom Blue |
71768 |
Y |
Y |
|
| High Desert Primary Care (Victorville, CA) |
33069 |
|
|
|
| Hillcrest Benefit Administrators |
59347 |
|
|
|
| Hinsdale Physician Healthcare |
36385 |
|
|
|
| HIP - Health Insurance Plan of Greater New York |
55247 |
|
Y |
|
| HMA Administrators, LLC |
39044 |
|
|
|
| Holy Cross Health Partners |
36412 |
|
|
|
| Hometown Health Network ( Massillon, OH ) |
34150 |
|
|
|
| Hometown Health Providers |
88537 |
|
|
|
| Horizon Healthcare Admin (HHA) |
22304 |
|
|
|
| Horizon Mercy (NJ) |
22326 |
|
Y |
Medicaid Managed Care |
| Hotel Employees & Restaurant Employees Health Trust Grp# F19 |
91136 |
|
|
|
| HPS Paradigm, Inc |
58227 |
|
|
|
| HRM |
41170 |
|
|
|
| HRM Claim Management |
41170 |
|
|
|
| Hudson Health Plan |
13335 |
|
|
|
| Humana Care Plan |
61101 |
|
|
|
| Humana Group Health Plan |
61101 |
|
|
|
| Humana Health Chicago |
61101 |
|
|
|
| Humana Health Chicago Insurance Company |
61101 |
|
|
|
| Humana Health Plan |
61101 |
|
Y |
|
| Humana Insurance Agency |
61101 |
|
|
|
| Humana Insurance Company |
61101 |
|
|
|
| Humana Medical Plan--CA |
61101 |
|
|
|
| Humana Medical Plan--KY |
61101 |
|
|
|
| Hunt Insurance Group |
37260 |
|
|
|
| I.E. Shaffer (West Trenton, NJ) |
22175 |
|
|
|
| IAA |
37279 |
|
|
|
| IBA Self Funded Group ( Kalamazoo, MI ) |
38234 |
|
|
|
| IBC Personal Choice |
12X26 |
|
|
|
| IBI |
41124 |
|
|
|
| IHG Direct |
75274 |
Y |
|
|
| Illinois Medicare |
ILMCR |
Y |
Y |
|
| IMCare |
41600 |
|
|
|
| INDECS Corp (Lyndhurst, NJ) |
40585 |
|
|
|
| Independent Health |
12X01 |
|
Y |
|
| Indiana BlueCross/Blue Shield |
BS130 |
|
Y |
Enrollment required for Remittance Advice |
| Indiana Health Network |
35204 |
|
|
|
| Indiana Medicare |
INMCR |
Y |
Y |
|
| Indiana ProHealth Network |
35161 |
|
|
|
| Indiana Teamsters Health Benefits Fund (Indianapolis, IN) |
35107 |
|
|
Formerly Local 135 Health Benefits Fund |
| Individual Health Insurance Companies |
31053 |
|
|
|
| Informed LLC/Self Funding Admin |
52196 |
|
|
|
| Ingalls Provider Group |
36348 |
|
|
|
| Innovative Healthware Solutions |
23266 |
|
|
|
| INstill Health |
SX161 |
|
|
|
| Instill Health |
SX161 |
|
|
|
| Insurance Administrators of America, Inc |
37279 |
|
|
|
| Insurance Design Administrators |
13315 |
|
|
|
| Integra Administrative Group (Seaford, DE) |
51020 |
|
|
|
| Integra Group |
31127 |
|
|
Please contact Mark Warner at (513) 326-5600, ext 1013 prior to submitting claims. |
| Integra Group CHA |
31129 |
|
|
|
| Integrated Care Network (ICN) |
34167 |
|
|
|
| Intercare Health Plans, Inc. (Greenwood Village, CO ) |
37227 |
|
|
|
| Interface EAP (Houston, TX) |
60280 |
|
|
|
| Intergroup Services PPO |
23287 |
|
|
|
| International Brotherhood of Boilermakers |
36609 |
|
Y |
|
| International Funding, LTD |
39182 |
|
|
|
| International Medical Group |
IMGIN |
|
|
|
| International Union of Operating Engineers, Local 15, 15A, 1 |
37269 |
|
|
|
| Iowa Benefits -Meritain Health Minneapolis |
41124 |
|
|
|
| Iowa Blue Cross Blue Shield |
12B10 |
|
Y |
|
| Iowa Medicare |
IAMCR |
|
Y |
|
| J. F. Molloy and Associates, Inc. |
61271 |
|
|
|
| J. Smith Lanier & Co. Administrators |
37272 |
|
|
|
| John Alden Life Insurance Co. |
41099 |
|
Y |
|
| Joplin Claims |
43178 |
|
|
formerly BMI |
| JP Farley Corporation |
34136 |
|
|
|
| JSL Administrators |
37272 |
|
Y |
|
| Kaiser Foundation Health Plan ( Mid-Atlantic States ) |
52095 |
|
Y |
|
| Kaiser Foundation Health Plan of Colorado |
91617 |
|
|
|
| Kaiser Foundation Health Plan of Georgia |
21313 |
|
Y |
Tara Kremer 404-949-5043 |
| Kaiser Foundation Health Plan of MD |
52095 |
|
|
|
| Kaiser Foundation Health Plan of Northern CA Region |
94135 |
|
|
|
| Kaiser Foundation Health Plan of Ohio |
34092 |
|
|
remits only require enrollment |
| Kaiser Foundation Health Plan of Southern CA region |
94134 |
|
|
Certification required--call 518-783-1864 x40422 |
| Kaiser Foundation of the Northwest |
93079 |
|
Y |
This payer id only to be used to submit claims for Oregon and Washington Kaiser Permanente members.
|
| Kanawha Insurance Co. |
57038 |
|
Y |
|
| Kansas Blue cross Blue Shield |
BS650 |
Y |
Y |
|
| Kansas Blue cross Blue Shield |
BS650 |
Y |
Y |
|
| Kansas City Blue Cross Blue Shield |
BS740 |
Y |
Y |
|
| Kansas City Life Insurance (Kansas City, MO) |
N/A |
|
|
Cancelled |
| Kansas Medicare |
KSMCR |
Y |
Y |
|
| Kempton Company |
73100 |
|
|
|
| Kempton Group Administrators |
73100 |
|
|
|
| Kentucky Blue Shield (Anthem) |
BS160 |
|
Y |
Enrollement Required for Remittance Advice |
| Kentucky Medicare |
KYMCR |
Y |
Y |
|
| Kern Health Systems |
77039 |
|
|
|
| Key Benefit Administrators ( Indianapolis, IN ) |
37217 |
|
|
|
| Key Benefits Administrators-TransChoice (SC) |
37284 |
|
|
|
| Key Select |
37321 |
|
|
|
| Keystone Health Plan East/IBC |
12X25 |
Y |
|
|
| Keystone Mercy Health Plan |
23284 |
|
Y |
Provider enrollment required--call 877-234-4271 |
| Klais & Company |
34145 |
|
|
|
| Korean American Medical Group |
66123 |
|
|
|
| Lake County Physicians Association |
37116 |
|
|
|
| Lakeside Comprehensive Healthcare |
66127 |
|
|
|
| Lakeside Health Services |
95415 |
|
|
|
| Lakeside Medical Group |
66125 |
|
|
|
| LBA Health Plans |
52193 |
|
|
|
| Leggett and Platt ( Carthage, MO ) |
75279 |
|
|
|
| LHP Claims Unit |
37248 |
|
|
|
| Liberty Union/Life Assurance Company |
37281 |
|
|
|
| Life Trac (Golden Valley, MN) |
41136 |
|
|
Include group # when submitting claims |
| Local 135 Health Benefits (Indianapolis, IN) |
35107 |
|
|
|
| Loma Linda University |
37267 |
|
|
|
| Louisiana Medicare |
LAMCR |
Y |
Y |
|
| Lovelace Salud |
SX159 |
|
|
|
| Lovelace Sandia Health Plan (New Mexico) |
90328 |
|
|
|
| Magellan Health Services |
12X27 |
|
Y |
|
| MagnaCare |
11303 |
|
|
|
| Mail Handlers Benefit Plan |
25133 |
|
|
|
| Maine Blue Cross Blue Shield |
BS034 |
|
Y |
|
| Maine Medicare |
MEMCR |
Y |
Y |
|
| MAMSI Life and Health Insurance Co. (MLH) |
52148 |
|
|
|
| Managed Care Services ( Ft. Wayne, IN ) |
35162 |
|
|
|
| Managed Health Network |
22771 |
|
|
|
| Managed Health Services Indiana/Maxicare (Medicaid HMO) |
39186 |
|
|
Prior to submitting claims, please call
Provider Relations Dept at
1-866-296-8731 to verify your provider
info is on file in the claim system.
|
| Managed Health Services Wisconsin |
39187 |
|
Y |
|
| Managed Physical Network |
41159 |
|
|
|
| Manatee Service Center (Bradenton, FL) |
41555 |
|
|
|
| Maryland CareFirst BlueCross BlueShield MD Region |
12011 |
|
|
|
| Maryland CareFirst BlueCross BlueShield MD Region |
|
Y |
Y |
|
| Maryland Medicare |
MDMCR |
Y |
Y |
|
| Maryland Physicians Care |
22348 |
|
|
Requires Rendering Provider ID |
| Mashantucket Pequot Tribal Nation |
37121 |
|
|
|
| Masters, Mates and Pilots Plan |
MMPHB |
|
|
|
| Mayo Management Services Inc. (MMSI) |
41154 |
|
Y |
|
| MBA Benefit Administrators / CDO Technologies |
87065 |
|
|
|
| McLaren Health Plan (Flint, MI) |
38338 |
|
|
|
| MD--Individual Practice Association, Inc (M.D.IPA) |
52148 |
|
|
Requires new providers to enroll prior to submitting |
| Mdwis-HIP |
MDWIS |
|
|
|
| MDWise Hoosier Alliance |
20475 |
|
Y |
|
| MedAdmin Solutions |
58204 |
|
|
|
| MedAdmin Solutions |
58202 |
|
|
|
| MedBen (Newark, OH) |
74323 |
|
|
|
| MedCom |
59231 |
|
|
|
| MedCost Benefit Services (Winston-Salem, NC) |
56205 |
|
|
|
| MedCost, Inc. |
56162 |
|
|
|
| Medica |
94265 |
|
|
|
| Medical Benefits Administrators |
74323 |
|
|
Located in Newark, Ohio |
| Medical Benefits Mutual |
74323 |
|
Y |
Located in Newark, Ohio |
| Medical Claims Service Inc. |
04258 |
|
|
|
| Medical Development International |
52181 |
|
|
|
| Medical Mutual of Ohio |
29076 |
|
Y |
|
| Medical Reimbursements of America |
62177 |
|
|
|
| Medical Resource Network--Atlanta, GA |
58203 |
|
|
|
| Medical Value Plan--Ohio (MVP) |
38224 |
|
|
|
| MEDSOLUTIONS, INC (NASHVILLE, TENNESSEE) |
62160 |
|
|
|
| MEGA Life and Health Insurance (North Richland Hills, TX) |
59221 |
|
Y |
|
| MEGA Life and Health Insurance Company - OKC |
59227 |
|
|
P.O.Box 548801 Oklahoma City, OK 73154 |
| Memorial Clinical Associates |
MCA11 |
|
|
|
| Memorial Hermann Health Network |
MHHNP |
|
|
|
| Mennonite Mutual Aid Association and Affiliates |
35605 |
|
|
|
| Mercy Care Plan (Phoenix, AZ) |
86052 |
|
|
|
| Mercy Health Plans |
43166 |
|
|
|
| MercyCare |
39114 |
|
|
|
| Meridian Health Care Management |
77042 |
|
|
|
| Meridian Health Plan |
13189 |
|
|
|
| Meritain Health / Agency Services |
64158 |
|
|
|
| Meritain Health / North American Admin |
64157 |
|
|
|
| Mesa Mental Health |
85035 |
|
|
|
| Metcare Health Plans, Inc. |
65113 |
|
|
|
| MetroPlus Health Plan |
13265 |
|
|
|
| Metropolitan Health Plan |
10850 |
|
Y |
|
| MHNET |
74289 |
|
|
|
| Michael Reese Physicians Group ( Hindsdale, IL ) |
37127 |
|
|
|
| Michigan Blue Care |
77910 |
Y |
|
|
| Michigan Blue Cross Blue Shield |
BS710 |
Y |
Y |
|
| Michigan Medicaid |
MIMCD |
|
Y |
|
| Michigan Medicare |
MIMCR |
|
Y |
|
| Mid Atlantic Psychiatric Services, Inc. |
52148 |
|
|
|
| Mid Rogue Oregon Health |
MRIPA |
|
|
|
| Mid Rogue Oregon Health Plan. |
MRIPS |
|
|
|
| Mid-America Assoc/Liberty Union (Madison Hts, MI) |
37281 |
|
|
|
| Mid-Atlantic Health System |
63079 |
|
|
Previously payor ID 51035 |
| Mid-West National Life Ins ( Tennessee) |
59224 |
|
Y |
|
| Mid-West United Life (Student Division) |
74227 |
|
|
Payer ID only valid if the P.O. Box on
the Health ID Card matches one of the
following P.O. Boxes: P.O. Box 890025,
809067, 809079, 809066, 809036,
809081, Dallas, Tx 75380-9025
|
| Midlands Choice (Nebraska/Iowa) |
47080 |
|
|
|
| Midlands Health Partners (Nebraska/Iowa) |
47080 |
|
|
|
| Midwest Health Plans |
MHP77 |
|
|
|
| Midwest Health Plans, Inc. |
12T54 |
|
|
Accepts NPI only. Require the billing
NPI to be the group NPI if using a
Business Tax id. Service provider NPI
required in servicing provider loop. No
longer require 6 digit provider identifier.
Provider must complete enrollment form
on payers website. |
| Midwest Security |
79480 |
|
Y |
|
| Minnesota Blue Cross Blue Shield |
BS720 |
|
|
|
| Minnesota Medicaid |
DPWMN |
|
|
|
| Minnesota Medicare |
MNMCR |
|
Y |
|
| Mississippi Medicare |
MSMCR |
Y |
Y |
|
| Mississippi Public Entity Employee Benefit Trust |
37233 |
|
|
|
| Mississippi Select Healthcare |
64088 |
|
|
Also DBA Select Administrative Services (SAS) |
| Missoula County Medical Benefits Plan |
37275 |
|
|
|
| Missouri BCBS |
BS999 |
|
Y |
|
| Missouri Care/ MC (Columbia, MO) |
43179 |
|
|
Rendering Provider ID Required |
| Missouri Medicaid |
12K15 |
|
|
|
| Missouri Medicare |
MOMCR |
|
Y |
|
| MMA |
35316 |
|
|
|
| MMSI |
41154 |
|
Y |
|
| Molina Healthcare of California |
38333 |
|
|
|
| Molina Healthcare of Michigan |
38334 |
|
|
|
| Molina Healthcare of Missouri |
71079 |
|
|
|
| Molina Healthcare of New Mexico Salud |
09824 |
|
|
|
| Molina Healthcare of New Mexico SCI . |
04423 |
|
|
|
| Molina Healthcare of Ohio |
20149 |
|
|
|
| Molina Healthcare of Washington |
38336 |
|
|
|
| Montefiore CMO ( Yonkers, NY ) |
13174 |
|
|
|
| Motion Pictures Industry |
99282 |
|
|
|
| Motorola ( Scottsdale, AZ ) |
36111 |
|
|
|
| Mountain States Administrative Services (Tucson, AZ) |
86040 |
|
|
|
| MPA-Custom Provider Network |
80900 |
|
|
|
| MPE Services Inc/MPEEBT, Inc |
37233 |
|
|
|
| Mplan, Inc/HealthCare Group, LLC |
95444 |
|
|
|
| Multiplan Inc. for American Family |
39634 |
|
|
Payer ID 39634 only accepts claims for
the states of AZ, IL, IN and OH.
|
| Multiplan Wisconsin Preferred Provider Network |
34080 |
|
|
|
| Mutual Assurance Administrators |
37256 |
|
|
|
| Mutual Group, The (US) |
59140 |
|
|
|
| Mutual of Omaha |
MUMCR |
|
|
|
| Mutual of Omaha Insurance Co. |
71412 |
|
Y |
|
| Mutually Preferred |
71412 |
|
|
|
| MVP Health Plan of NY |
14165 |
|
|
|
| N.W. Ironworkers Health & Security Trust Fund Grp#F15 |
91136 |
|
|
|
| N.W. Roofers & Employers Health & Security Trust Fund Grp#F2 |
91136 |
|
|
Please include group# |
| N.W. Textile Processors Grp#F14 |
91136 |
|
|
Please include group# |
| NAA/North American Administrators (Nashville, TN) |
65085 |
|
|
|
| NABN (Cleveland, OH) |
34159 |
|
|
|
| NALC (National Association of Letter Carriers) |
53011 |
|
|
Please include group# |
| National Assoc. of Letter Carriers/NALC |
53011 |
|
|
|
| National Benefit |
56175 |
|
|
|
| National Benefit Administrators ( Charlotte, NC) |
56176 |
|
|
|
| National Capital Preferred Provider Organization |
90001 |
|
|
|
| National Claim Administration (Garden City, NY) |
37126 |
|
|
|
| National Rural Letter Carrier Assoc. |
71412 |
|
|
(Policy#GMG1846) |
| NATIONAL TEACHERS ASSOCIATION - NTA |
NTA11 |
|
|
|
| Nationwide Health Plans |
31417 |
|
Y |
|
| NCAS - Charlotte, NC |
75191 |
|
|
|
| NCAS - Fairfax, VA |
75190 |
|
|
|
| Nebraska Medicare |
NEMCR |
|
Y |
|
| Neighborhood Health Partnership of Florida |
96107 |
|
|
|
| Neighborhood Health Plan (Boston, MA) |
04293 |
|
|
|
| Nesika Health Group |
37255 |
|
|
|
| Netcare Life and Health Insurance (Hagatna, Guam) |
66055 |
|
|
|
| Network Health |
04332 |
|
|
Before initiating submissions, please
contact Provider Relations at (617)
806-8104 or edi@network-health.org
for an EDI setup form. |
| Network Health Insurance Corp-Medicare |
77076 |
|
|
|
| Network Health Plan Of Wisconsin |
39111 |
|
|
Payer Id valid only if the send claims to
address on the back of the member's
card is PO Box 568 Menasha, WI 54952.
DO NOT USE this payer id for Network
Platinum Plus, Network Premier Plus or
Managed |
| Network TPA, LLC |
58204 |
|
|
|
| New Era Life Insurance Co |
75281 |
|
|
|
| New Hampshire Blue Cross Blue Shield |
SB770 |
|
Y |
|
| New Jersey Horizon Blue Cross Blue Shield |
22099 |
|
Y |
|
| New Market Dimensions |
65056 |
|
|
|
| New York Computer Science Corp. |
12K35 |
|
|
|
| New York Presbyterian Community |
48186 |
|
|
|
| New York Presbyterian System Select Health |
24819 |
|
|
|
| NGS American |
38225 |
|
Y |
|
| NHP/SHP (Neighborhood Health Providers and Suffolk Health Pl |
11325 |
|
|
Unique Provider ID required |
| Nippon Life Insurance Co. |
81264 |
|
Y |
|
| NJ Carpenters Health Fund |
22603 |
|
|
|
| North American Administrators, Inc. |
64157 |
|
|
|
| North American Benefits Network (Cleveland, OH) |
34159 |
|
|
|
| North American Health Plan |
64157 |
|
|
|
| North Carolina Medicare |
NCMCR |
Y |
Y |
|
| North Texas Healthcare Network |
35212 |
|
|
|
| Northern Illinois Health Plan |
36347 |
|
|
|
| Northern Nevada Trust Fund |
88027 |
|
|
|
| Northwest Community Health Partners |
36234 |
|
|
|
| Northwest Suburban IPA (Illinois) |
36346 |
|
|
|
| Novasys Health Network ( Little Rock, AR ) |
71080 |
|
|
|
| Nyhart |
37299 |
|
|
|
| Oak West Primary Physician Association |
36402 |
|
|
|
| Ochsner Health Plan |
72127 |
|
|
|
| ODS Health Plan |
13350 |
|
|
|
| Office of Group Benefits-Louisianna |
72087 |
|
|
|
| Ohio Blue Shield: Anthem |
BS332 |
|
Y |
Enrollment required for Remittance Advice |
| Ohio Health Choice PPO |
34189 |
|
|
Payer ID valid only for claims with a billing submission address of PO Box 3619, Akron, OH 44309-3619 or PO Box 93538 |
| Ohio Medicaid |
OHMCD |
|
Y |
|
| Ohio Medicare |
OHMCR |
Y |
Y |
|
| Oklahoma Blue Cross |
12B59 |
Y |
Y |
|
| Oklahoma Blue Cross Blue Shield |
SB840 |
Y |
Y |
|
| Oklahoma Medicare |
OKMCR |
Y |
Y |
|
| OMNI/Medicore HP |
68037 |
|
|
|
| Omnicare Health Plan of Michigan ( Detroit) |
38252 |
|
|
|
| Omnicare, A Coventry Health Plan |
25150 |
|
Y |
|
| Operating Engineers Locals 302 &612 |
91136 |
|
|
Please enter group number F12 when submitting |
| Optima Health Insurance Co. (Virginia Beach, VA ) |
54154 |
|
|
|
| Optima Health Plan ( Virginia Beach, VA ) |
54154 |
|
|
|
| Optimum Choice of the Carolina's |
52148 |
|
|
|
| Optimum Choice, Inc (OCI) |
52148 |
|
|
|
| Optimum Healthcare, Inc. |
20133 |
|
|
|
| OptumHealth - CMC |
41194 |
|
|
|
| Oregon Medicaid |
12K41 |
|
Y |
|
| oregon medicare |
ORMCR |
Y |
Y |
|
| OrthoNet - Aetna |
13383 |
|
|
|
| Orthonet - Cigna (White Plains, NY) |
13381 |
|
|
|
| OSMA (Oklahoma State Medical Association) |
73071 |
|
|
|
| Oxford Health Plan |
06111 |
|
Y |
|
| P5 Health Plan Solutions of Utah |
87068 |
|
|
|
| Pacific Life & Annuity Company |
67466 |
|
|
|
| Pacificare Behavioral Health (Santa Ana, CA) |
33053 |
|
|
|
| PacifiCare of California |
95959 |
|
Y |
HMO claims only, Not PPO claims |
| PacifiCare of Colorado |
95962 |
|
|
|
| PacifiCare of Oklahoma |
95959 |
|
Y |
HMO claims only, Not PPO claims |
| PacifiCare of Oregon |
95959 |
|
Y |
HMO claims only, Not PPO claims |
| Pacificare PPO - All States |
95999 |
|
|
PPO Claims only, Not HMO claims. |
| PacificSource Health Plans |
93029 |
|
|
Call Margaret Murphy at 206-230-7475 |
| PAI |
37287 |
|
|
|
| Palmetto Home Health & Hospice for Ohio |
SCMCR |
Y |
|
|
| Paper Claims |
PAPER |
|
|
|
| Paragon Benefits |
58174 |
|
|
|
| Parkland Community Health |
66917 |
|
|
|
| Passport Advantage |
12x54 |
|
|
for DOS prior to 1/1/2010 |
| Passport Advantage |
76569 |
|
|
for DOS 1/1/2010 and after |
| Passport Health Plan |
61129 |
|
Y |
Medicaid Managed Care |
| Patient Advocates, LLC |
10525 |
|
|
|
| Peach State Health Plan |
68049 |
Y |
|
Enrollment required. Please call ECP |
| PEHP (Utah Public Employee Health Plan) |
12X36 |
|
|
|
| Pennsylvania Blue Cross Blue Shield Central |
BS362 |
Y |
Y |
|
| Pennsylvania Blue Cross Blue Shield Western |
BS36W |
Y |
Y |
|
| Pennsylvania Medicaid |
12008 |
|
|
|
| Pennsylvania Medicare |
PAMCR |
Y |
Y |
|
| Personal Insurance Administrators, Inc. (Agoura Hills, CA) |
95397 |
|
|
|
| PersonalCare |
25133 |
|
|
|
| PHA Admin Serv, Prime Health of Alabama |
63088 |
|
|
|
| PHCS (fortis benefits) |
70408 |
|
|
|
| PHCS (Private Healthcare Systems) |
13306 |
|
|
|
| PHP of Mid Michigan, Inc |
87726 |
|
|
|
| PHP of S. Michigan, Inc |
87726 |
|
|
|
| PHP of SW Michigan, Kalamazoo |
87726 |
|
|
|
| PHP of West Michigan, Inc. |
87726 |
|
|
|
| PHP Tenncare (Knoxville, TN) |
62155 |
|
|
|
| Physician Associates of Louisiana |
|
|
|
|
| Physician Associates of Louisiana |
58204 |
|
|
|
| Physician Care Network, LLC |
58204 |
|
|
|
| Physicians Alliance/Stones River Regional |
15749 |
|
|
|
| Physicians Care Network - Rockford, IL only |
36345 |
|
|
|
| Physicians Health Association of Illinois |
37136 |
|
|
|
| Physicians Health Plan (PHP) Mid Michigan |
37330 |
|
Y |
|
| Physicians Health Plan of No. Indiana |
12399 |
|
Y |
Corrected/Adjusted claims must be sent paper |
| Physicians Mutual Insurance Company (Omaha, NE) |
47027 |
|
Y |
Please send all PPO and dental claims to the address on the back of the insured's ID Card.
|
| Physicians Plus Insurance Corporation |
39156 |
|
|
|
| Physicians United Plan |
10775 |
|
|
|
| Piedmont Administrators |
56151 |
|
|
|
| Pinnacle Claims Management Inc. |
24735 |
|
|
|
| Pipeline Industry Benefit Fund ( Tulsa, OK ) |
73074 |
|
|
|
| Pittman & Associates |
37224 |
|
Y |
|
| Planned Administrators, Inc |
37287 |
|
|
|
| PM Group (PMG) |
67466 |
|
|
|
| Podi Care Managed Care |
58204 |
|
|
|
| Poly America Medical & Dental Benefits Plan |
32680 |
|
|
|
| POMCO |
16111 |
|
|
|
| PPO Plus |
72148 |
|
|
|
| PPOM |
38335 |
|
|
|
| Prairie States Enterprises, Inc (Chicago, IL/Sheboygan, WI) |
36373 |
|
|
|
| Preferred Administrators |
EPF10 |
|
|
Call ECP for forms |
| Preferred Benefit Administrators |
53476 |
|
|
|
| Preferred Benefits Administrator (Wichita, KS) |
61665 |
|
|
Rendering Provider ID Required |
| Preferred Care Inc. (Florida) |
59291 |
|
|
|
| Preferred Care Inc. (North Carolina) |
56178 |
|
|
|
| Preferred Care Partners (Miami, FL) |
65088 |
|
|
|
| Preferred Community Choice/PCCSELECT/CompMed (Tulsa, OK) |
73145 |
|
|
|
| Preferred Health Network (PHN) |
35173 |
|
|
|
| Preferred Health Plan (Louisville, KY) |
61106 |
|
|
|
| Preferred Health Professionals |
31478 |
|
|
|
| Preferred Health Systems Insurance Company |
60110 |
|
|
|
| Preferred Network Access (Darien, IL) |
36401 |
|
|
|
| Preferred One (CT) a Division of First Choice |
14162 |
|
|
|
| Preferred One (MN) |
41147 |
|
|
|
| Premier Benefits |
43166 |
|
|
|
| Premier Health Plans |
43166 |
|
|
|
| Premier Health Systems |
29076 |
|
|
|
| Presbyterian Health Plan |
PREHP |
|
|
|
| Prevea Health Insurance Plan |
39185 |
|
|
|
| Primary Physician Care, Inc. |
56144 |
|
|
|
| Prime Health |
63088 |
|
|
|
| Prime West Health Plan |
61604 |
|
Y |
|
| PrimeSource Health Network |
23266 |
|
|
|
| Principal Financial Group |
61271 |
|
Y |
|
| Principal Life Insurance Co. |
61271 |
|
|
|
| Principal Mutual Life Insurance Co. |
61271 |
|
|
|
| Prinicipal Health Care |
61271 |
|
|
|
| Priority Health |
38217 |
|
Y |
|
| Prism Network, Inc |
37268 |
|
|
|
| Prism-Univera |
37315 |
|
|
|
| Pro Care Health Plan Inc. (Detroit, MI) |
38329 |
|
|
Payer ID valid for claims with the
following submission addresses: PO Box
3160, Detroit MI 48203 AND PO Box
3590, Detroit MI 48203
|
| Professional Benefit Administrators (Oak Brook, IL) |
36331 |
|
|
Payer ID is valid only for claims with
billing submission name, city, and state
of Professional Benefit Administrators,
Inc., Oak Brook, IL.
|
| Professional Benefits Administrators |
59296 |
|
|
|
| Professional Insurance Company |
59041 |
|
|
|
| Professional Risk Management |
34134 |
|
|
|
| Prosepect Health Network |
PROSP |
|
|
|
| PSYCHCARE, LLC |
51052 |
|
|
|
| Puget Sound Benefits Trust |
91136 |
|
|
Please include Group# F25 |
| Puget Sound Electrical Workers Trust |
91136 |
|
|
Please include Group# F33 |
| Pyramid Life |
48055 |
|
|
|
| Quad Med (Pewaukee, WI) |
39197 |
|
|
|
| QualCare, Inc. |
23342 |
|
|
|
| QualChoice, Arkansas |
35174 |
|
|
|
| Quincy Health Care Management ( Quincy, IL ) |
37129 |
|
|
|
| Regency Employee Ben (Port Huron, MI) |
38221 |
|
|
9-digit numeric insured ID required |
| Regional Care, Inc |
47076 |
|
|
|
| Resurrection Health Care Preferred / FKA |
36396 |
|
|
Please call (773) 572-8311 or( 773) 572-8309 prior to first submission of claims
|
| River Quest Network |
37129 |
|
|
|
| RMSCO Inc. |
16117 |
|
|
|
| Rocky mountain Health Plan |
84065 |
|
|
|
| Rooney Life Inc. |
37602 |
|
|
|
| Rosemont of Des Plaines, IL |
36215 |
|
|
|
| Rural Carrier Benefit Plan |
25133 |
|
|
|
| RUSH Prudential - HMO Only |
36389 |
|
|
|
| S & S Healthcare Strategies |
31441 |
|
|
|
| Sagamore Health Network (IN) **Requires Group Policy Number |
35164 |
|
|
|
| Sanford Health Plan |
91184 |
|
Y |
|
| Sante Health System and Affiliates |
77038 |
|
|
|
| Scott & White |
88030 |
|
|
|
| Secure Health Plans of Georgia (Macon) |
28530 |
|
|
Requires Rendering Provider Number. |
| Security Health Plan |
39045 |
|
|
Benefit plan administrator of St. Louis, MO, Office of the Administrator, Wash. D.C. |
| Select Administrative Services (SAS) |
64088 |
|
|
|
| Select Benefit Administrators (Des Moines, IA) |
42137 |
|
|
|
| Select Benefit Administrators of America (Ashland, WI) |
37282 |
|
|
|
| Select Health |
12X37 |
|
|
|
| Select Health of South Carolina |
25176 |
|
|
|
| Select Health of South Carolina ( Charleston, SC ) |
23285 |
|
Y |
|
| SelectCare |
00014 |
|
|
|
| SelectCare of Texas (Kelsey-Seybold) |
61225 |
|
|
|
| Self Insured Benefit Admin (Clearwater, FL) |
59111 |
|
|
|
| Self Insured Plans, Naples FL |
36404 |
|
|
|
| Self-Funded Plans (IL, PA, OH) |
34131 |
|
|
|
| Senior Care Partners |
36390 |
|
|
|
| Senior Whole Health |
83035 |
|
|
|
| Sentara Family Care |
54154 |
|
|
Rendering Provider Network ID required |
| Sentara Health Management |
54154 |
|
|
|
| Sentara Health Management ( Virginia Beach, VA ) |
54154 |
|
|
|
| Sentinel Management Svcs |
23249 |
|
|
Include group # when submitting claims |
| Sentry Life Insurance Company |
39033 |
|
Y |
|
| Seton Employee Plan |
12T46 |
|
|
|
| Seven Corners |
25404 |
|
|
|
| Shasta Administrative Services |
75280 |
|
|
Jen-Weld Claims only |
| Sheet Metal Workers Local 104 Health Care Plan (San Ramon, C |
38238 |
|
|
|
| Sierra Health Services |
76343 |
|
|
|
| Sierra Health Services (Las Vegas, NV) |
76342 |
|
Y |
EFT is a requirement to receive ERA
transactions from Sierra Health Services
|
| Signature Health Alliance |
62159 |
|
|
|
| Significa Benefit Services, Inc |
23250 |
|
Y |
|
| Silver Cross Managed Care Organization |
36387 |
|
|
|
| Sinclair Health Plan |
84076 |
|
|
|
| Sloan's Lake Managed Care (N) |
84096 |
|
|
|
| Smith Administrators (Ft Worth, TX) |
02057 |
|
|
|
| Sound Health (Sisters of Providence) |
91131 |
|
|
Now known as First Choice Health Network |
| South Carolina Blue Cross Blue Shield |
BS481 |
Y |
Y |
|
| South Carolina Medicare |
SCMCR |
Y |
Y |
|
| South Central Preferred |
23266 |
|
|
|
| South Dakota Medicaid |
12K36 |
|
|
|
| SouthCare/Healthcare Preferred |
25147 |
|
|
|
| Southern Benefit Services LLC |
37318 |
|
|
|
| Southern Group Admin (Winston-Salem, NC) |
56131 |
|
|
9-digit numeric insured ID required |
| Southern Health Service |
25133 |
|
Y |
|
| Southwest Service Life |
37266 |
|
|
Please enter the unique policy number
or ID card when submitting claims.
Payer ID valid only for claims with a
billing submission address of PO Box
982005 Ft. Worth, TX 76182. |
| Special Risk International (Lutherville, MD) |
52190 |
|
|
|
| Spectrum Administrators |
23253 |
|
|
|
| Spina Bifida - VA HAC |
84146 |
|
|
CHAMPVA – HAC is not associated with and does not process claims for TRICARE (formerly CHAMPUS)
|
| SRC Services |
57604 |
|
|
|
| St. Anthony Memorial Healthcare Centers-MDWISE |
35199 |
|
|
|
| St. Barnabas System Health Plan |
22240 |
|
|
|
| St. Catherine Hospital PHO-MDWISE |
35199 |
|
|
|
| St. Catherine Hospital PHO-MDWISE |
35199 |
|
Y |
|
| St. Francis Health Network |
35199 |
|
|
|
| St. John's Claims Admin |
37264 |
|
|
|
| St. Margaret Mercy Healthcare Centers-MDWISE |
35199 |
|
|
|
| Star HRG |
59225 |
|
|
|
| Starmark |
61425 |
|
|
Formerly ICH Corp. |
| State Auto Insurance Companies |
46450 |
|
|
|
| State Auto INsurance Companies |
46450 |
|
|
|
| State Farm Group Medical & Individual Health Insurance Compa |
31053 |
|
Y |
Not for auto accident claims |
| State of Texas Dental Plan |
57254 |
|
|
|
| States General Life Insurance |
75087 |
|
|
|
| Staywell Health Plan |
14163 |
|
|
Rendering Provider Network ID required |
| Sterling Option One (Bellingham, WA) |
91151 |
|
|
|
| Stoner and Associates (Cincinnati, OH) |
31121 |
|
|
|
| Student Insurance Division |
74227 |
|
|
Payer ID only valid if the P.O. Box on
the Health ID Card matches one of the
following P.O. Boxes: P.O. Box 890025,
809067, 809079, 809066, 809036,
809081, Dallas, Tx 75380-9025
|
| Suburban Health Organization |
35199 |
|
|
|
| Suffolk Health Plan of New York |
88331 |
|
|
|
| SummaCare HMO |
95202 |
|
|
ALIASES: Bankers United Life, MEGA Life and Health Ins. Co., Midwest United Life |
| Summit America Insurance Services (Leawood, KS) |
37301 |
|
|
Student Accident and Sickness, College Sports and NASCC claims only
|
| Superior Administrators, Inc (Santa Ana, CA) |
23218 |
|
|
|
| Superior Health Plan |
SHP11 |
|
|
|
| Superior Health Plan |
SHP11 |
|
Y |
|
| Superior Health Plan of Texas |
39188 |
|
Y |
Prior to submitting claims, please call
Provider Relations Dept at
1-800-218-7453 to verify your provider
info is on file in the claim system. This
will prevent rejections and allow
payments to be made in a timely
manner.
|
| Swedish Covenant Hospital |
36411 |
|
|
|
| Tall Tree Administrators |
88067 |
|
|
|
| Tarrant Health Services |
37228 |
|
|
|
| TBG Administrative Services |
39157 |
|
|
|
| Team Choice - Alpha Care Gold |
ADSL1 |
|
|
|
| Team Choice Gold |
75139 |
|
|
|
| Team Choice UMC |
75134 |
|
|
|
| Teamcare |
36215 |
|
|
|
| Teamsters Local Union #301 ( Waukegan, IL ) |
36612 |
|
|
|
| Tehtys Health Ventures |
20212 |
|
|
|
| Tenncare Select |
BS390 |
|
|
Enrollment included with BCBS TN |
| Tennessee Blue Cross |
BS390 |
Y |
Y |
|
| Tennessee Medicare |
TNMCR |
Y |
Y |
|
| Texas Association of School Boards |
A0234 |
|
|
Payer id is for Workers Comp claims Only. You and/or your vendor must be contracted for this transaction service (Emdeon Office customers excluded).
Please visit www.transact.emdeon.com
for info.
|
| Texas Blue Cross Blue Shield |
BS400 |
|
Y |
|
| Texas Children's Health Plan (N) |
76048 |
|
|
|
| Texas First Health Plans - TIOPA |
76046 |
|
|
|
| Texas HealthSpring |
33104 |
|
|
|
| Texas Medicaid |
TXMCD |
|
Y |
|
| Texas Medicare |
TXMCR |
Y |
Y |
|
| Texas Premier Plan Medicaid |
EPF02 |
|
|
Call ECP for forms |
| Texas True Choice |
TTCEC |
|
|
|
| The Chesapeake Life Insurance Co-Student Insurance (Dallas, |
74227 |
|
|
Payer ID only valid if the P.O. Box on
the Health ID Card matches one of the
following P.O. Boxes: P.O. Box 890025,
809067, 809079, 809066, 809036,
809081, Dallas, Tx 75380-9025
|
| The Epoch Group |
28777 |
|
|
|
| The Ford Meter Box Company, Inc (Wabash, IN) |
37305 |
|
|
|
| The Health Plan |
HPUOV |
|
|
|
| The Healthcare Group |
35206 |
|
|
|
| The Integrity Benefit Group |
58200 |
|
|
|
| The Loomis Company |
23223 |
|
|
Please call 610-374-4040 x 2438 prior to submit |
| The MEGA life and Health Insurance Company - Insurance Cente |
59221 |
|
Y |
P.O.Box 982009 North Richland Hills, TX 76182 |
| The MEGA Life and Health Insurance Company - Student Insuran |
74227 |
|
|
Payer ID only valid if the P.O. Box on
the Health ID Card matches one of the
following P.O. Boxes: P.O. Box 890025,
809067, 809079, 809066, 809036,
809081, Dallas, Tx 75380-9025
|
| The Perfect Health Insurance Co. |
13522 |
|
|
|
| The Preferred Healthcare System - PPO |
23266 |
|
|
|
| The Union Labor Life Insurance Company |
13142 |
|
|
|
| Therapy Review Systems |
75305 |
|
|
|
| Time Insurance Company |
39065 |
|
Y |
|
| Tongass Timber Trust |
92620 |
|
|
|
| Tooling & Manufacturing Assoc. |
61425 |
|
|
|
| Total Community Care |
31182 |
|
|
|
| Total Healthcare, Inc |
38201 |
|
|
|
| Touchstone Health PSO (NY, NY) |
23856 |
|
|
|
| Touchstone Health/Health Net Smart Choice (NY, NY) |
13402 |
|
|
|
| Tower Life Insurance Co. |
69493 |
|
|
|
| TR Paul Inc |
37230 |
|
|
|
| Transamerica Life Insurance |
59222 |
|
Y |
Requires Unique Insured ID #. |
| TransChoice-Key Benefit Administrators (SC) |
37284 |
|
|
|
| TriCare Region 1 |
TRI01 |
Y |
Y |
covered states: ME, VT, NH, MA, RI, CT, NJ, DE, MD, DC, PA |
| TriCare Region 10 |
TRI10 |
Y |
Y |
covered states: NORTHERN CA
|
| TriCare Region 11 |
TRI11 |
Y |
Y |
covered states: WA, OR |
| TriCare Region 12 |
TRI12 |
Y |
Y |
covered states: AK, HI |
| Tricare Region 2 |
TRI02 |
Y |
Y |
covered states: VA, NC
|
| TriCare Region 3 |
TRI03 |
Y |
Y |
covered states: SC, GA, FL |
| TriCare Region 4 |
TRI04 |
Y |
Y |
covered states: TN, AL, MS |
| TriCare Region 5 |
TRI05 |
Y |
Y |
covered states: OH, WV, KY, IN, IL, WI, MI |
| TriCare region 6 |
TRI06 |
Y |
Y |
covered states: OK, AR, LA, TX(except SW lower corner) |
| TriCare Region 7 |
TRI07 |
Y |
Y |
covered state: MN, IA, MO, ND, SD, NE, KS, MT, WY, CO, TX(lower SW corner) |
| TriCare Region 8 |
TRI08 |
Y |
Y |
covered states: NM, AZ, UT, NV, ID |
| TriCare Region 9 |
TRI09 |
Y |
Y |
covered states: SOUTHERN CA |
| TRIHEALTH PHYSICIAN SOLUTIONS |
31144 |
|
|
|
| TriHealth Physicians Solutions-CONCERN |
31143 |
|
|
|
| Trisurant |
34185 |
|
|
|
| TRLHN/EB AKA Trilogy Health Network |
62777 |
|
|
|
| True Choice USA |
54210 |
|
|
|
| True Choice USA - Christus Healthplan |
TCUCH |
|
|
|
| Trusteed Plans Service Corp |
91078 |
|
|
|
| Trustmark |
61425 |
|
Y |
|
| Tufts Health Plan |
Call |
|
|
Submitter must call before sending 888-880-8699, ext 4042 |
| UBH United Behavioral Health |
87726 |
|
|
|
| UHC (Columbus) |
87726 |
|
|
Use 9-digit SSN/member ID. Use 7-digit provider number. |
| UHC (Dayton) |
87726 |
|
|
Use 9-digit SSN/member ID. Use 7-digit provider number. |
| UHC Iowa Choice & Senior Care |
87726 |
|
|
|
| UHC Utah, Inc. |
87726 |
|
|
|
| UICI Administrators |
75240 |
|
|
|
| UICI Administrators (State of Nevada) |
75223 |
|
|
Accepting claims only for the state of Nevada |
| UICI/Benefit Planners |
74223 |
|
|
|
| UMR - Harrington (formerly known as Harrington Benefit Servi |
95266 |
|
|
|
| UMR - Wausau/UHIS (formerly Fiserv Health - Wausau Benefits/ |
39026 |
|
Y |
|
| UMWA Health and Retirement Funds |
52180 |
|
|
|
| UniCARE Major Accounts |
80314 |
|
Y |
Effective 6-1-98, payor ID 65935 will no longer be valid. Please send to ID 80314. |
| Unified Health Svcs. |
62170 |
|
|
|
| Uniform Medical Plan (also known as Centra) |
75243 |
|
|
|
| Union Pacific Railroad Employees (Salt Lake City, UT) |
87042 |
|
|
|
| Unison / Better Health Plans ( Monroeville, PA) |
62183 |
|
Y |
|
| Unison / Three Rivers Health Plans ( Pittsburgh, PA ) |
25175 |
|
Y |
|
| United Benefits |
59069 |
|
|
|
| United Government Services |
UGMCR |
Y |
Y |
CAll ECP for ERA Information 800-676-7645 |
| United Healthcare |
87726 |
|
Y |
|
| United Healthcare of River Valley |
95378 |
|
Y |
Prior to initial submission, provider must first contact John Deere at (309) 765-1593, toll free (866) 509-1593 to receive provider id.
|
| United Healthcare--Metrahealth/Metropolitan |
87726 |
|
|
|
| United HealthCare--Travelers |
87726 |
|
|
|
| United Medical Aliance |
84132 |
|
|
|
| United Medical Resources |
31107 |
|
Y |
|
| United of Omaha |
71412 |
|
|
|
| Universal Care of California |
33001 |
|
|
|
| Universal Health Care |
50528 |
|
|
|
| University Health Plan of NJ |
22329 |
|
Y |
|
| University of Illinois at Chicago, Div of Specialized Care f |
37601 |
|
|
|
| University of Missouri |
25133 |
|
|
|
| University of Washington Students & Graduate Appts |
91136 |
|
|
Please enter Group # (P67) when submitting |
| UPMC Health Plan |
23281 |
|
Y |
|
| UPMC Health Plan ( Pittsburgh, PA ) |
23281 |
|
Y |
|
| Upper Peninsula Health Plan (Marquette, MI) |
38337 |
|
|
|
| US Benefits (Portland, OR) |
93092 |
|
|
|
| USAA (United States Automobile Assoc.) |
74095 |
|
|
|
| USFHP - St. Vincent Catholic Medical Centers of NY |
13407 |
|
|
Serving parts of New York, NYC, all of
New Jersey, Southeastern Pennsylvania,
and Western Connecticut. For member
eligibility, call 1-800-241-4848
|
| Utah Blue Cross / Blue Shield |
12B1E |
|
|
|
| Utah Blue Cross / Blue Shield |
12B42 |
Y |
|
|
| VA Fee Basis Programs |
12115 |
|
Y |
|
| Valley Preferred |
23253 |
|
|
|
| Vanderbilt Health Plan |
23173 |
|
|
|
| Vantage Health Plan, Inc. |
72128 |
|
|
|
| Verdugo Hills Medical Group |
66126 |
|
|
|
| Verity National Group |
75256 |
|
|
|
| VHP Community Care |
23173 |
|
|
|
| Virginia Anthem Blue Cross Blue Shield |
BS923 |
|
Y |
|
| Virginia First HEalth Services Corp. |
SKVA0 |
|
|
|
| Virginia Medicare |
VAMCR |
Y |
Y |
|
| Vista Health |
25133 |
|
|
|
| Vista/Foundation/Coventry ( Sunrise, FL) |
55248 |
|
|
Requires Rendering Provider Number. |
| Viva Health Plan |
63114 |
|
|
|
| Vytra Healthcare |
22264 |
|
|
|
| Washington Employers Trust |
37294 |
|
|
|
| Washington Medicare |
WAMCR |
Y |
Y |
|
| Waterstone Benefit Administrators |
73115 |
|
|
|
| WEA Trust |
39151 |
|
|
|
| webTPA/Community Health Electronic Claims/CHEC |
75261 |
|
Y |
|
| Wellcare Health Plan, Inc (Encounters) |
59354 |
|
|
|
| Wellcare HMO Inc |
14163 |
|
|
|
| Wellcare of CT |
14164 |
|
|
5-9 digit Rendering Provider Network ID required |
| Wellcare of Florida |
59608 |
|
|
|
| Wellcare of Georgia |
14163 |
|
|
|
| Wellcare of Louisiana |
14163 |
|
|
|
| Wellcare of New York |
14163 |
|
|
5-9 digit Rendering Provider Network ID required |
| WellCare of Ohio |
14163 |
|
|
|
| Wellcare Private Fee for Service Plans |
77072 |
|
|
|
| Wellmed Medical |
WELM2 |
|
|
|
| WellPath |
25133 |
|
|
|
| WELS Benefit Plan Office (Milwaukee, WI) |
22925 |
|
|
|
| Wenatchee Valley Medical Center |
91064 |
|
|
|
| West Coast Stationary Engineers Health & Security Trust Fund |
91136 |
|
|
Include group# F13 when submitting claims. |
| West Covina Medical Group |
66124 |
|
|
|
| West Virginia Medicaid |
WVMCD |
|
Y |
|
| West Virginia Medicare |
WVMCR |
|
Y |
|
| Western Grower's Assurance Trust |
24735 |
|
|
|
| Western Grower's Insurance Company |
24735 |
|
|
|
| Western Health, Inc. |
37306 |
|
|
|
| Western Mutual Insurance |
37247 |
|
|
|
| Western Southern Financial Group (Cincinnati, OH) |
31048 |
|
|
|
| Westlake Financial Group Inc. |
90560 |
|
|
|
| Weyco, Inc. |
38232 |
|
|
|
| William J. Sutton & Co. (Toronto, Canada) |
98010 |
|
|
|
| Windsor Medicare Extra |
62153 |
|
|
|
| Wisconsin Auto and Truck Dealers |
39200 |
|
|
|
| Wisconsin Blue Cross Blue Shield |
12B29 |
|
|
|
| Wisconsin Department of Corrections |
74101 |
|
|
|
| Wisconsin Medicaid |
12K29 |
|
|
|
| Wisconsin Medicare |
WIMCR |
Y |
Y |
|
| Wisconsin Medicare Part A & FQHC |
12M29 |
|
|
|
| Wisconsin Physicians Service Insurance Corporation |
SX022 |
Y |
|
|
| Wisconsin Physicians Service Insurance Corporation |
12X29 |
Y |
|
|
| World Insurance Company ( Omaha, NE ) |
75276 |
|
Y |
|
| WPPN |
34080 |
|
|
|
| Writers Guild Industry Health ( Burbank, CA ) |
23710 |
|
|
|
| Wyoming Medicaid |
WYMCD |
Y |
Y |
|
| Wyoming Medicare |
WYMCR |
|
Y |
|
| Young Life (Colorado Springs, CO) |
75285 |
|
|
|