270/271 Payer List - PHIcure | Clearinghouse · Benefit Management Services (Please contact Chris...
Transcript of 270/271 Payer List - PHIcure | Clearinghouse · Benefit Management Services (Please contact Chris...
PHICURE - CONFIDENTIAL - November 01, 2019
Payer ID Payer Name
13162 1199 SEIU National Benefit Fund
07205 360 Alliance PPO Gilsbar
74234 8th Distric Electrical
36273
AARP Medicare Supplement/Fixed Indemity by UnitedHealthcare
(UnitedHealthcare)
87726 AARP MedicareComplete (AARP MedicareComplete from SecureHorizons)
36273
AARP UnitedHealthcare Insurance Co. (Special Data Requirements located in
Vendor Download Tools or Provider Training Materials.)
ABRI1 Abri Healthplan
COACC Access Behavioral Care
87815 Acordia National (Now known as Wells Fargo TPA)
72467 ACS Benefit Services, inc.
59141 Administrative Services, Inc.
74234 Advanstaff, Inc.
10447 Advantra (TX, NM, AZ Only)
25152 Advantra Freedom
23228 Aetna Better Health - PA Medicaid
128LA Aetna Better Health LA
26337 Aetna Better Health Medicaid IL
128MO Aetna Better Health MO
46320 Aetna Better Health NJ
128KY Aetna Better Health of KY
128MD Aetna Better Health of MD
128MI Aetna Better Health of Michigan
42130 Aetna Better Health of Nebraska
50023 AETNA BETTER HEALTH OF OHIO
128VA Aetna Better Health of Virginia
128WV Aetna Better Health WV
60054 Aetna Health Plan - PPO
60054 Aetna Life & Casualty Company
38692 Aetna TX Medicaid & CHIP
23334 Affinity Essentials
13334
Affinity Health Plans (Contact Affinity EDI Coordinator before submitting claims
electronically at [email protected] or call 718-794-7592.)
13333
Affinity Health Plans (TMG Health) (Effective for Medicare claims with DOS on or
after 01/01/2010)
46503 Aflac
13346 Aftra Health Fund
AWNY6 AGE WELL NY
95241 AGIA Inc (Claims are printed and mailed to the payer.)
80705 AH & L
270/271 Payer List
95327
Alameda Alliance for Health (Provider must contact payer to be approved. Contact
at Alameda is Anet Quiambao at 510-747-6153 or
ALH01 Aliera Health Care
81400 All Savers Insurance (UnitedHealthOne)
37602 All Savers Insurance Co.
81040 Allegiance Benefit Plan Management, Inc.
58234 Alliant Health Plans of Georgia
37308 Allied Benefit Systems
04293 Allways Health Plan (Formerly NHP Boston)
ALOHA AlohaCare
80705 ALTA Health and Life Insurance Company
SX113 Altius Health Plans
75137 Ameriben Solutions
59140 American Benefits Plan Administrators (Las Vegas, NV)
TH095 American Family Insurance
AMF11 AMERICAN FAMILY INSURANCE COMPANY
62030 American General
50587 American Health
66065 AMERICAN HEALTH MEDICARE
87726 American International Group, Inc.
81400 American Medical Security
81400 American Medical Security (UnitedHealthOne)
74048 American National Insurance Co
44444 American Postal Workers Union Health Plan
42011 American Republic Insurance Company
41178 America's PPO / America's TPA
87726 AmeriChoice - CT, FL, MD, RI, TX, WI (UnitedHealthcare Community Plan)
87726 AmeriChoice by UnitedHealthcare (NYU) (UnitedHealthcare Community Plan)
87726 AmeriChoice MS - CHIP & CAN (UnitedHealthcare Community Plan)
86047 AmeriChoice NJ, Medicaid, NJ Family Care (UnitedHealthcare Community Plan)
87726 AmeriChoice of Florida
87726 AmeriChoice of Illinois
87726 AmeriChoice of Maryland
87726 AmeriChoice of Nebraska
87726 AmeriChoice of Nebraska (UnitedHealthcare Community Plan)
86047 AmeriChoice of NJ Medicaid & Family Care
87726 AmeriChoice of Rhode Island
95378 Americhoice of TN
25175 Americhoice Personal Care Plus PA (UnitedHealthcare Community Plan)
95378
AmeriChoice TN: TennCare, Secure Plus Complete (UnitedHealthcare Community
Plan)
28804 Amerigroup
28807 Amerigroup - Maryland, Virginia and District of Columbia
28806 Amerigroup - New Jersey
28805 Amerigroup / Americaid - Houston
27514 AMERIGROUP Georgia
28804 Amerigroup IL
26375 Amerigroup Iowa
26378 AMERIGROUP MULTIPLE STATES
28809 Amerigroup of Florida
27514 AMERIGROUP Tennessee
93688 AmeriHealth - DE (PPO)
60061 AmeriHealth - New Jersey (Non-HMO Claims)
54763 AmeriHealth Administrators
27357 Amerihealth Caritas
77075 Amerihealth Caritas Iowa
77013 Amerihealth Caritus VIP Michigan
77799 Amerihealth DE
77002 Amerihealth District of Columbia
23037 AMERIHEALTH HMO
22248 AmeriHealth Mercy Health Plan
77001 AmeriHealth NorthEast
22355
AmeriHealth VIP Care (Medicare Advantage Plan Part of the AmeriHealth Mercy
Family of Companies)
26375 Amerivantage
34192 Antares Management Solutions
80705 Anthem Health and Life Insurance Company of New Jersey
00050 Anthem of Colorado
52312 Arbor Health
03432 Arizona Physicians IPA
03432 Arizona Physicians IPA (APIPA) (UnitedHealthcare Arizona Physicians IPA)
74234
Arizona Pipe Trades Health and Welfare Trust Fund Local Union Nos. 469 & 741
Metal Trades Health Plan
74234
Arizona Pipe Trades Health and Welfare Trust Fund Local Union Nos. 469 & 741
Pipe Trades Health Plan
06603 ASAGEHA
94027 Asociacion de Maestros
39065 Assurant Employee Benefits (Formerly Fortis Insurance)
AHTIN Assurant Health - Time Insurance
AHUSY Assurant Health- Union Security Insurance
SX179
Asuris Northwest/MedAdvantage (REF*1B*Provider ID in Billing and Rendering
required even when NPI is submitted.)
MNAUL Aultcare
38259 Automated Benefit Services (ABS)
46045 Avera Health Plans
59274 AVMED
95964 AZ PACIFICARE CLA
BANK1 BANKERS FIDELITY LIFE INSURANCE CO (ERA ONLY)
74227 Bankers United Life (Student Division)
12X42 Banner Health
SX145
Banner Health Co. (All Banner Health Plans were consolidated to the payerID of
SX145.)
66901 Banner-University Family Care(University of Arizona Health Plans)
SB570 BCBS DELAWARE
SB700 BCBS MASSACHUSETTS
SB690 BCBS of Maryland
66001 BCBS TEXAS MEDICAID STAR CHIP
VALOP Beacon Health Options (Formerly Value Options)
43324
Beacon Health Strategies (Block 11 on the HCFA 1500 form must use Plan specific
IDs.)
56139 Benefit Managaement Svcs
56139
Benefit Management Services (Please contact Chris Burak at 704-321-3156 for
payerID information.)
61425 Benefit Trust Life Insurance Company
95604 Best Life & Health Insurance Co.
01508 BETTER HEALTH FLORIDA
00923 Blue Care PPO
00870 Blue Chip of Rhode Island
00403 Blue Choice Medicaid
00804 Blue Choice of Rochester NY
00922 Blue Choice of South Carolina
BCSAL Blue Cross Blue Shield Alabama
53589 Blue Cross Blue Shield of Arizona
MC721 BLUE CROSS COMMUNITY CENTENNIAL
MCDIL Blue Cross Community Options
66006 Blue Cross Medicare Advantage
47198 Blue Cross of California
00610 Blue Cross of Idaho
IDBLC BLUE CROSS OF IDAHO
00580 Blue Shield of Alabama
00822 Blue Shield of Alaska
00520 Blue Shield of Arkansas
BS001 Blue Shield of California
00805 Blue Shield of Central NY HMO/PPO
00060
Blue Shield of Connecticut (NOTE: The DOS in Reports is programmatically
calculated and is not actual claim's data. Some variances may exist.)
00590 Blue Shield of Florida
00601 Blue Shield of Georgia (State Health of GA)
HIBCS Blue Shield of Hawaii
00611 Blue Shield of Idaho-Regence
00621 Blue Shield of Illinois
00630 Blue Shield of Indiana
88848 Blue Shield of Iowa
47163 Blue Shield of Kansas
47171 Blue Shield of Kansas City
00660 Blue Shield of Kentucky
53120 Blue Shield of Louisiana
00680 Blue Shield of Maine
00200 Blue Shield of Massachusetts
00710 Blue Shield of Michigan
00720 Blue Shield of Minnesota
00230 Blue Shield of Mississippi
00241 Blue Shield of Missouri
BCSMT Blue Shield of Montana
77780 Blue Shield of Nebraska
00265 Blue Shield of Nevada
00770 Blue Shield of New Hampshire
NJBCS Blue Shield of New Jersey
00790 Blue Shield of New Mexico
00803 Blue Shield of New York (Empire)
05536 Blue Shield of North Carolina
00820 Blue Shield of North Dakota
00800 Blue Shield of Northeast NY
00834 Blue Shield of Ohio
00840 Blue Shield of Oklahoma
00851 Blue Shield of Oregon
54771 Blue Shield of Pennsylvania
00870 Blue Shield of Rhode Island
00804 Blue Shield of Rochester NY (Excellus)
SCBCS Blue Shield of South Carolina
88848 Blue Shield of South Dakota
00390 Blue Shield of Tennessee
84980 Blue Shield of Texas
TXBLS BLUE SHIELD OF TEXAS
84980 Blue Shield of TX HCSC Insurance Services Company
00910 Blue Shield of Utah
00806 Blue Shield of Utica NY
VTBLS Blue Shield of Vermont
00923 Blue Shield of Virginia
54828 Blue Shield of West Virginia
00801 Blue Shield of Western New York
00950 Blue Shield of Wisconsin
00960 Blue Shield of Wyoming
00246 BlueCross BlueShield of Western New York Medicaid
61124 Bluegrass Family Health
74238 Boon-Chapman Benefit Administrators, Inc.
13337 Boston Medical Center Healthnet
52192
Bravo Health (Formerly known as Elder Health Inc. Serving members in PA, MD, DE,
TX and Washington DC.)
BRIDG Bridgespan
68069 Bridgeway Arizona (Also 68054)
CB186 BRIGHT HEALTH PLAN
BTSS1 Brown & Toland Sutter
BTSS1 Brown & Toland SutterSelect
68069 Buckeye Community Health (Also 32004)
KS003 CA Kaiser Permanente (Northern California Only)
68069 California Health and Wellness
CALOP Cal-Optima Direct
23045
Capital Advantage Insurance Company (CAIC) PROFESSIONAL (BCBS ProviderID and
Performing ProviderID required. Call 800-874-8433)
23045
Capital Blue Cross PROFESSIONAL (BCBS ProviderID and Performing ProviderID
required. Call 800-874-8433)
SX065 Capital District PHP
95112 Capital Health Plan
68011 Capitol Administrators
CAPHP Caprock Health Plan
57116 Care 1st Health Plan of Arizona
57115 Care 1st Health Plan of CA
77082 Care Improvement Plus
SB580 CareFirst BCBS - DC, National Capital Area
SB691 CareFirst DELMARVA Health Plan
CM001 Caremore
95092 CAREPLUS
77023 Carepoint Health Plan
31114 CareSource
INCS1 CareSource IN
KYCS1 CareSource KY
GACS1 CARESOURCE OF GA
62073 Cariten Commercial
29076
Carolina Care Plan (Part of the Medical Mutual Family of companies. Former
payerID was 57105.)
68069 Carolina Crescent (Also 68055)
52132 CBA, Inc. (Cooperative Benefits Administrators, Inc.)
41124 CBSA (Corporation Benefit Services of America)
CCStpa CCSTPA COMPREHENSIVE CARE SERVICES
CELTC Celtic Insurance
68069 CeltiCare
68060 Celticare
95386 CenCal Health
68068 Cenpatico - Multiple States
68048
Cenpatico Behavioral Health AZ (Prior to submission, contact 866-495-6748 to
verify provider ID.)
68068 Cenpatico Kansas
68069 Centene Advantage Plans (Also 68056)
13360 Centerlight Healthcare Inc.
SX169 CENTRAL CALIFORNIA ALLIANCE FOR HEALTH
34097 Central Reserve Life
CIPA1 Central Senior Care
62218 CENTRAL SENIOR CARE
84146
CHAMPVA-HAC (CHAMPVA-HAC is not associated with and does not process claims
for TRICARE (formerly CHAMPUS.))
J1908 CHESAPEAKE INSURANCE
38308 Christian Brothers Services
75544 CHRISTIE STUDENT HEALTH PLANS
10629 Christus Health Medicare Advantage
21062 Christus Health New Mexico HIX
52106 CHRISTUS HEALTH PLAN TEXAS HIX
62308 CIGNA - PPO
62308 CIGNA Health Plan - HMO
62308 CIGNA Premier Plus
74234 City of Austin
95444 Clarian Health Plans
COACC Colorado Access HMO
COKSR Colorado Kaiser Permanente (Colorado plans only)
91162 Columbia United Providers
77170 Common Ground Healthcare Cooperative
73143 Community Care Managed Health Care Plans of Oklahoma
COMMF Community First
48145
Community Health Choice (Please include TPI Number (Texas Medicaid Number) in
Field FA0-23)
75261 Community Health Electronic Claims/CHEC/webTPA
66170 COMMUNITY HEALTH GROUP
SB613 Community Health Plan of Washington
00720 Comprehensive Care Services (BCBSMN)
74234 CompuSys Incorporated (New Mexico)
74234 CompuSys Incorporated of Arizona
74234 CompuSys Incorporated of Utah
74234 CompuSys/Erisa Group, Incorporated (AZ)
74234 CompuSys/Erisa Group, Incorporated (NM)
74234 CompuSys/Erisa Group, Incorporated (TX)
80705 Confederation Admin Services
80705 Confederation Life Insurance
78375 Connecticare - Medicare
06105 Connecticare, Inc.
75284 Consolidated Associates Railroad
59140 Consolidated Group
87843 Consolidated Health Plans
L0260 CONSTELLATION HEALTH
71404 Continental General Insurance Co.
CCHP1 Cook Children's Health Plan
HPAMN Cooportunity Health
35187 CoreSource
35182 CoreSource of Illinois
35182 CoreSource of Iowa
35182 CoreSource of Maryland
35180
CoreSource of North Carolina (Start using new PayerID of 35182. Old payerID will
start rejecting soon.)
35183 Coresource of OH
35182 CoreSource of Pennsylvania
56116
Corporate Benefits Service, Inc. (NC) (Only valid for payer address of PO Box 12953,
Charlotte, NC 28220)
62553 COUNTRY LIFE
42139 County Care
00923 COVA (Commonwealth of VA)
58102 Covenant Administrators, Inc.
25133 Coventry Health Care (Coventry old Legacy Payer ID's are still accepted.)
25132 COVENTRY HEALTH CARE IOWA
25135 COVENTRY HEALTH CARE LOUISIANA
25136 COVENTRY HEALTH CARE LOUISIANA
25127 COVENTRY HEALTHCARE GEORGIA
128FL Coventry Healthcare of FL
00019 Cox Health Plan (Requires Provider ID in Box 33a. Contact Cox Health Plan for ID.)
80705 Crown Life
46120 CRYSTAL RUN HEALTH PLANS
34186 CSI Network Services
59225 CT General Life Insurance (Formerly STAR HRG.)
59140 Culinary Health & Welfare Fund (Las Vegas, NV)
DAK01 DakotaCare
DEAN1 Dean Health Plan
64159 DEFINITY HEALTH
87726 Definity Health Plan (UnitedHealthcare)
87726 Definity Services
DCHPMCAID DELL CHILDRENS HEALTH PLAN
SX105 Deseret Mutual
UH105 Deseret Mutual
25160 DGA - Diversified Group Administrators
BC001 DIRECTORS GUILD OF AMERICA
SX105 DMBA AKA MISSIONARY MEDICAL
74284 Driscoll Childrens Health Plan
74284 Driscoll Childrens Health Plan (CHIP)
81039 EBMS (Employee Benefit Management Services, Inc)
58379 ECHO Health
SX110
Educators Mutual (EMIA) (Enrollment required, contact EMIA to enroll 800-362-
0533, Opt. 2)
52192 Elder Health Maryland HMO Inc. (Now known as Bravo Health.)
31625
ElderPlan, Inc. (Elderplan Provider ID necessary on all claims. Contact (718)921-
7979 for Provider ID.)
EMBLM EMBLEM
87726 Empire Plan (UnitedHealthcare)
SC446 Employee Benefit Services DBA Key Benefit Administrators
62308 EQUICOR
62308 EQUICOR - PPO
23250 Erin Group Administrators (Now known as Significa Benefit Services, Inc.)
74234 Erisa Administrative Services Incorporated
74234 Erisa Administrative Services, Inc.
57082 Essence Healthcare
87726 Evercare Special Needs (Evercare by UnitedHealthcare)
87726 Evercare Star Plus
35605 Everence
93240 EVERGREEN HEALTH COOPERATIVE
58233 EVERGREEN HLTH PL
22254 Fallon Community Health
93121 FAMILYCARE COORDINATED CARE ORGANIZATION
33033 FCE Benefit Administrators
41041 Federated Mutual Insurance
11315 Fidelis Care New York
56196 First Carolina Care
91131 First Choice Health Network
80705 First Great-West Life & Annuity
87043 FIRST HEALTH
73159 First Health Network
87726 First Seniority Freedom
94999 FirstCare
59322 Florida Health Plan
59321
Florida Hospital Healthcare Systems (In network providers must submit UP or FHHS
ProviderID. Out of network providers must contact FHHS at 407-701-4893.)
48117 FMH Benefit Services
39065 FORTIS (Formerly Time Insurance)
39065 Fortis (Western Life Ins. Benefit Plan)
39065 Fortis Benefits, Inc. (Woodbury) PHCS Network Claims
41124 Fortis Self Funded Administrative Services
39065 FORTIS Western
64069 Fox-Everett, Inc.
41212 Freedom Health Plan
43197 FRESENIUS HEALTH PARTNERS
59204 Fringe Benefit Coordinators
25169 Gateway Health Plan
25169 Gateway Health Plan Medicaid PA
75273 Geisinger Health Plan
61271 Georgia Power Medical Benefits Plan
00601 Georgia State Health Benefit Plan (Processed by GA BC/BS)
25141 GHP (Group Health Plan)
07205 Gilsbar, Inc
GHOKC Global Health
77160 Gold Coast
37602 Golden Rule Insurance
GTPA1 Golden Triangle Physician Alliance
44054 Government Employees Hospital Association,Inc. (GEHA)
80705 Great West (SF)
80705 Great West (WA)
80705 Great West Care
80705 Great West Denver
80705 Great West Life Assurance
80705 Great West Life Assurance Company of America
80705 Great-West Bellevue
48143 Group and Pension Administrators
13551 Group Health Incorporated (GHI) (New York)
61101 Group Health Insurance - DE
91121
Group Health Northwest (Call Payer at 888-767-4670 prior to submitting electronic
claims.)
64246 Guardian Life Insurance Company of America
80705 GWL
80705 GWL & A
43313 Harken Health
36406
Harmony Health Plan of Illinois (Wellcare Provider ID required, call (800) 960-2530
opt. 2 then 5)
36405
Harmony Health Plan of Indiana (Only claims for Indiana Hoosier Healthwise
members can be sent to this payer electronically.)
14163 Harmony-Wellcare HMO, Inc.
95959 Harris Methodist Health Plan
04271 Harvard Pilgrim Health Care
87726 Harvard Pilgrim Passport Connect
77950 Health Alliance Medical Plans of Illinois
38224 Health Alliance Plan of Michigan
46221 Health Choice Insurance
62179 Health Choice of AZ
62111 Health Cost Solutions
95019 Health First Health Plans
95567 Health Net (of California)
06108
Health Net of the North East, Inc. (Health Net six digit ID REQUIRED in B0X33a; call
866-334-4638)
04286 Health New England
80142 Health Partners, PA
76342 Health Plan of Nevada (FFS claims)
68035 Health Plan of San Joaquin
HPSM1 Health Plan of San Mateo
59140 Health Plan Services, Tampa Office
38216 Health Plus of Michigan
37290 Health Services for Children with Special Needs (HSCSN)
HLTHT Health Traditions
HCH01 HEALTHCARE HIGHWAYS
HMA01
Healthcare Management Administrators, Inc. (also known as HMA, servicing
Western Region)
73147 HealthCare Solutions Group
25133 Healthcare USA
71064 HEALTHCHOICE
HCA77 HealthComp
59608 Healthease
41178 HealthEZ
80141 Healthfirst, Inc. (NY)
56144 HealthGram
00923 Healthkeeper HMO
38309 Healthnet of AZ
55204 HealthNow NY
55764 HealthPartners of Minnesota
27514 Healthplus Amerigroup
68195 Healthpoint Corporation
71063 HealthSCOPE Benefits, INC
68195 Healthsource Provident Ins. Co.
HT001 HealthSpring HMO (No PPO claims accepted via this payerID.)
63092 HealthSpring HMO/HealthSpring Medicare+Choice
88250 HealthTeam Advantage
00661 Healthy Blue Louisiana
68064 Healthy Texas
00243 Helix Family Choice
55247 HIP-Health Insurance Plan of Greater NY
68069 Home State Health Plan
88023 Hometown Health Plan Nevada
CALL HORIZON BCBS NEW JERSEY
61115 HUMANA LONG TERM CARE
61125 Humana Military Tricare
61101 HUMANA, Claims only
74234 IBEW Local 640 & Arizona Chapter NECA Health & Welfare Trust
74234 IBEW Western Utilities or Local 57
41124 IBI
11695 iCARE (Independent Care Health Plan)
68066 Illini Care Health
68069 Illinicare Group Health (Also 68066)
TA720 Independence Administrators
54704 Independent BLC of PA (Also known as Personal Choice PPO of Pennsylvania.)
95308 Independent Health (Enrollment and Testing Required, contact (716) 635-3911)
35161 Indiana ProHealth Network
77153 Indiana University (Southeastern Indiana Health)
95444 INDIANA UNIVERSITY HEALTH PLAN
IEHP1 Inland Empire Health Plan
86304 Insurers Administrative Corp
51020 INTEGRA Administrative Group, Inc.
68068 Integrated Mental Health Services
INCHN Intercommunity Health Net
74234 Intermountain Ironworkers Trust Fund
41124 Iowa Benefits, Inc.
JAI01 JAI Medical Systems
61271 JF Molloy
87726 John Deere Healthcare, now know as UnitedHealthcare River Valley
52123
Johns Hopkins (USFHP) (New submitter should send in their Billing NPI & Rendering
servicing NPI)
34136 JP Farley Corporation
NG007 Kaiser Foundation Health Plan of Ohio
94134 Kaiser Foundation Health Plan of Southern CA Region
93079 KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
NG008 Kaiser Mid-Atlantic
21313 KAISER PERMANENTE GEORGIA
RH011 Kaiser Permanente Hawaii
KMG11 Katy Medical Group
61453 Kemper Benefits
73100 Kempton Group
68067 Kentucky Spirit Health
68069 Kentucky Spirit Health Plan (Also 68067)
37217 Key Benefit Administrators
00923 Keycare PPO
77741 Keystone First PA Community Health Choices
23284 Keystone Mercy Health Plan
84223 Keystone VIP Choice
27357 LA Care
LACAR LA Care Health Plan
90096 Land of Lincoln Health
RLH01 LIFEMAP
EBSRM Lifetime Benefit Solutions
EBSRM Lifetime Benefits Solutions
93093 Lifewise A Premier Health Plan
93093 Lifewise Health Plan of Oregon A Premier Health Plan
91049 Lifewise Health Plan of Washington A Premier Health Plan
00923 Local Choice
45289 Lone Star TPA
68069 Lousiana Healthcare Connections
13193 Loyal American
37292 Machinist District 9 Welfare
60054
Magellan Behavioral Health (For Dates of Service 1/1/2006 and After - Provider ID
Required - AETNA Subscribers only.)
MCCVA Magellan Complete Care of VA
01260 Magellan Health (All Non-AETNA Subscribers - Provider ID Required)
11303 MAGNACARE
68062 Magnolia
68069 Magnolia Mississippi (Also 68062)
87726 MAHP (MD IPA, Optumun Choice and MLH) UnitedHealthcare
62413 MailHandlers
45341 Maine Community Health Options
MCS04 Managed Care Systems
22771 Managed Health Networks (MHN)
68069 Managed Health Services Indiana (Also 39186)
68069
Managed Health Services of Wisconsin (Please contact the payer @ 800-225-2573,
ext 25525 to get setup to submit electronic claims.)
46012 Mapfre Life Commercial
52461 MARCH VISION CARE INCORPORATED
53275 MARTINS POINT HEALTH CARE
22348 Maryland Physicians Care
41154 Mayo Management Services, Inc.
87726 MD-Individual Practice Association, Inc. (M.D. IPA) (Previously Payer ID 52148)
88058 Med Pay
88058 Med Pay
90753 MedCost / Liberty Health Share
56205 MedCost Benefit Services
56162 MedCost, Inc.
94265 MEDICA
78857 Medica Health Care Plan, Inc.
71890 Medica Health Plan Solutions
12422 Medica2
DEMCD Medicaid of Delaware
ALMCD Medicaid of Alabama
AKMCD Medicaid of Alaska
AZMCD Medicaid of Arizona (AHCCCS)
ARMCD Medicaid of Arkansas
COMCD Medicaid of Colorado
CTMCD Medicaid of Connecticut
FLMCD Medicaid of Florida
GAMCD Medicaid of GA
HIMCD Medicaid of Hawaii
IDMCD Medicaid of Idaho
ILMCD Medicaid of Illinois
INMCD Medicaid of Indiana
IAMCD Medicaid of Iowa
KSMCD Medicaid of Kansas
KYMCD Medicaid of Kentucky
LAMCD Medicaid of Lousiana (Includes KidMed claims.)
MEMCD Medicaid of Maine
MDMCD Medicaid of Maryland
MAMCD Medicaid of Massachusetts
MIMCD Medicaid of Michigan
MNMCD Medicaid of Minnesota
MSMCD Medicaid of Mississippi
MOMCD Medicaid of Missouri
MTMCD Medicaid of Montana
NEMCD Medicaid of Nebraska
NVMCD Medicaid of Nevada
NHMCD Medicaid of New Hampshire
NJMCD Medicaid of New Jersey
NMMCD Medicaid of New Mexico
NYMCD Medicaid of New York
NCMCD Medicaid of North Carolina
NDMCD Medicaid of North Dakota
OHMCD Medicaid of Ohio
OKMCD Medicaid of Oklahoma
ORMCD Medicaid of Oregon
PAMCD Medicaid of Pennsylvania
RIMCD Medicaid of Rhode Island
SCMCD Medicaid of South Carolina
SDMCD Medicaid of South Dakota
TNMCD Medicaid of Tennessee (TennCare)
TXMCD Medicaid of Texas
UTMCD Medicaid of Utah
VTMCD Medicaid of Vermont
VAMCD Medicaid of Virginia
DCMCD Medicaid of Washington DC
WAMCD Medicaid of Washington State
WVMCD Medicaid of West Virginia
WIMCD Medicaid of Wisconsin
WYMCD Medicaid of Wyoming
MAHP1 Medical Associates Health Plan
MAHC1 Medical Associates Health Plan
PRMCS Medical Card System (MCS)
29076
Medical Mutual of Ohio (Payer requires a 12 digit rendering provider ID#, which
needs to be obtained from payer by calling 800-321-7223)
CAMCD MediCal of California
38224 Medical Value Plan - Ohio (MVP)
KMMCR Medicare of Missouri (Includes both Eastern and Western Missouri.)
ALMCR Medicare Part A/B of Alabama
AKMCR Medicare Part A/B of Alaska
AZMCR Medicare Part A/B of Arizona
ARMCR Medicare Part A/B of Arkansas
COMCR Medicare Part A/B of Colorado
CTMCR Medicare Part A/B of Connecticut
DEMCR Medicare Part A/B of Delaware
FLMCR Medicare Part A/B of Florida
GAMCR Medicare Part A/B of Georgia
HIMCR Medicare Part A/B of Hawaii
IDMCR Medicare Part A/B of Idaho
ILMCR Medicare Part A/B of Illinois
INMCR Medicare Part A/B of Indiana
IAMCR Medicare Part A/B of Iowa
KSMCR Medicare Part A/B of Kansas
KYMCR Medicare Part A/B of Kentucky
LAMCR Medicare Part A/B of Louisiana
MEMCR Medicare Part A/B of Maine
MDMCR Medicare Part A/B of Maryland
MAMCR Medicare Part A/B of Massachusetts
MIMCR Medicare Part A/B of Michigan
MNMCR Medicare Part A/B of Minnesota
MSMCR Medicare Part A/B of Mississippi
MOMCR Medicare Part A/B of Missouri (Eastern) (Specialty testing required)
MTMCR Medicare Part A/B of Montana
NEMCR Medicare Part A/B of Nebraska
NVMCR Medicare Part A/B of Nevada
NHMCR Medicare Part A/B of New Hampshire
NMMCR Medicare Part A/B of New Mexico
ENMCR Medicare Part A/B of New York (Empire)
NYMCR Medicare Part A/B of New York (Upstate)
NJMCR Medicare Part A/B of NJ (Specialty testing required)
NCMCR Medicare Part A/B of North Carolina
NDMCR Medicare Part A/B of North Dakota
CNMCR Medicare Part A/B of Northern California
VNMCR
Medicare Part A/B of Northern Virginia (inc. Prince George, Montgomery, Fairfax
and Arlington Counties and City of Alexandria)
OHMCR Medicare Part A/B of Ohio
OKMCR Medicare Part A/B of Oklahoma
ORMCR Medicare Part A/B of Oregon
PAMCR Medicare Part A/B of PA (Specialty testing required)
RIMCR Medicare Part A/B of Rhode Island
SCMCR Medicare Part A/B of South Carolina
SDMCR Medicare Part A/B of South Dakota
CSMCR Medicare Part A/B of Southern California
TNMCR Medicare Part A/B of Tennessee
TXMCR Medicare Part A/B of Texas
UTMCR Medicare Part A/B of Utah
VTMCR Medicare Part A/B of Vermont
VAMCR Medicare Part A/B of Virginia
WAMCR Medicare Part A/B of Washington
WVMCR Medicare Part A/B of West Virginia
MWMCR Medicare Part A/B of Western Missouri
WIMCR Medicare Part A/B of Wisconsin
WYMCR Medicare Part A/B of Wyoming
ASMCR Medicare Part B of American Samoa
QUMCR Medicare Part B of New York GHI
PRMCR Medicare Part B of Puerto Rico (In Test)
00923 Medicare Supplemental
23160 Medico Insurance Company
95655 MEDIGOLD
00130 MedPay
39190 MedStar Family Choice
00243 Medstar Physician Partners
74227 MEGA Life & Health Ins. Co. (Student Division)
59221
Mega Life & Health Insurance Company (SSN is not a valid Insured ID. Must be
similar to 01234567899 or AA1234567)
MCA11 Memorial Clinical Associates
62181 MEMORIAL CLINICAL ASSOCIATES SELECTCARE TEXAS
74289 Mental Health Network (Only claims for PO Box 209010 Austin TX 78720)
86052 Mercy Health Plan (AHCCCS)
86052 Mercy Health Plan of AZ
22326
Mercy Health Plan of New Jersey (Provider ID Required in Box33a - Contact (800)
682-9091 to obtain ID)
33628 Mercy Maricopa Integrated Care
13189 Meridian Health Plan
64157 Meritain Health (North American Health Plan.)
41124 Meritain Health Minneapolis
13265 Metro Plus Health Plan
10850 Metropolitan Health Plan
59224
Mid-West National Life Insurance Co. of Tennessee (ID valid only for following: PO
Box 982017, North Richland Hills, TX 76182)
74227 Mid-West United Life (Student Division)
STJOE Mission Hospital Affiliates
SX105 Missionary Medical
00530 MISSOURI CARE
88600 MMM (Medicare y mucho mas)
13350 MODA Health - Formerly ODS Health Plan
81793 Molina Health Reforma
38333
Molina Healthcare of California (Rendering provider must use Medi-Cal ID number
or State License Number. Billing provider should use Federal TaxID only.)
51062 Molina Healthcare of Florida
20934 Molina Healthcare of Illinois
38334 Molina Healthcare of Michigan
NM505 Molina Healthcare of New Mexico
20149 Molina Healthcare of Ohio
46299 Molina Healthcare of South Carolina
20554 Molina Healthcare of Texas
38336
Molina Healthcare of Washington (Rendering providers use DSHS Medicaid ID or
State Licence Number.)
SX109 Molina Healthcare Utah
13174
Montefiore Contract Management Organization (Provider ID required, call 914-377-
4400 for ID prior to first claims submissions.)
35092 Morris Associates aka HealthScope Benefits
95444 MPLAN Inc. Healthcare Group
SB731 MS BCBS State Employees
95655 Mt. Carmel
81883 Municipal Health Benefits Fund
39065 Mutual Benefit
39065 Mutual Benefit Life
34192 Mutual Health Services
71412 Mutual of Omaha Insurance Company
71412 Mutually Preferred
14165 MVP Health Plan of NY
58182 Naphcare Inc
53011 National Association of Letter Carriers
88050 National Health Benefits Corporation - NHBC02
52132 National Rural Electric
52103 National Telecommunications Cooperative Association (NTCA)
95123 Neighborhood Health Partnership (NHP)
96240 Neighborhood Health Plan of RI - Integrity
96240 Neighborhood Health RI Exchange, Unity, Integrity Plans
04332
Network Health (Before initiating submissions, please call Provider Relations at
(617)806-8104 or www.network-health.org for an EDI startup plan.)
77076 Network Health Insurance Corp - Medicare
04332 Network Health Massachusetts
39144
Network Health Plan of Wisconsin, Inc.(Prior to initial claims submission, please
contact Network Health Plan EDI specialist at 920-720-1506.)
75281 New ERA Life
68069 New Hampshire Healthy Family
74234 New Mexico District Council of Carpenters
45129 New Mexico Health Connections
74234 New Mexico Painters and Allied Trades Local No 823
74234 New Mexico-West Texas Multi-Craft (lso known as New Mexico Laborers)
81264 Nippon Life Insurance Company
64157 North American Administrators, Inc.
NWDC1 Northwest Diagnostic Clinic
71080 NOVASYS Health Network
62119 NW Diagnostic Clinic SelectCare of TX (NWDC)
25150 OmniCare (For claims with Dates of Service after 10/01/04)
80705 One Health Plan Inc.
80705 One Health Plan Michigan, Inc.
80705 One Health Plan New York, Inc.
80705 One Health Plan of Alaska
80705 One Health Plan of Arizona, Inc.
80705 One Health Plan of DC Inc,
80705 One Health Plan of Florida
80705 One Health Plan of Indiana, Inc.
80705 One Health Plan of Kansas and Missouri
80705 One Health Plan of Maine, Inc.
80705 One Health Plan of Massachusetts, Inc.
80705 One Health Plan of Minnesota, Inc.
80705 One Health Plan of Nevada, Inc.
80705 One Health Plan of New Jersey
80705 One Health Plan of North Carolina
80705 One Health Plan of Ohio
80705 One Health Plan of Pennsylvania
80705 One Health Plan of South Carolina
80705 One Health Plan of Tennessee
80705 One Health Plan of Texas
80705 One Health Plan of Virginia, Inc.
80705 One Health Plan of Washington
80705 One Health Plan of Wisconsin, Inc.
80705 One Health Plan of Wyoming
74234 Operating Engineers Local No 53
54154 Optima Insurance Company
87726 Optimum Choice, Inc. (OCI) (Previously Payer ID 52148)
87726 OptumHealth Behavior Solutions
87726 OptumHealth Behavioral Solutions of NM (OptumHealth)
87726 OptumHealth New Mexico
45332 Oregons Health CO-OP
OSCAR Oscar Health
06111 Oxford (UnitedHealthcare/Oxford)
06111 Oxford Health Plans
15460 PA Care Advantage Highmark Senior Health
81400 PacifiCare Individual Business Plan (UnitedHealthOne)
95958 PacifiCare of CA Encounters
95958 PacifiCare of OK Encounters
95958 PacifiCare of OR Encounters
95958 PacifiCare of TX Encounters
95958 PacifiCare of WA Encounters
95999 PacifiCare PPO
20416 PACIFICSOURCE COMMUNITY SOLUTIONS
93029 PacificSource Health Plans
20377 Pacificsource Medicare
81240 Palic / Pan-American Health
04218 Pan American Life Insurance
SX158 Paramount Health
66917 Parkland Community Health Plan
PHP02 PARTNERSHIP HEALTH PLAN (OPTUMINSIGHT FOR ENROLL FORMS)
61129 Passport Health Plan
61325 Passport Health Plan
68069 Peach State Health Plan (Behavioral Health)
68069
Peach State Health Plan (Medicaid) (Call 800-225-2573 ext 25525 prior to
submitting claims.) (Also 39187)
68049 Peach State HP
SX106
PEHP - Utah Public Employee Health Plan (Enrollment required, please contact
Provider Relations 800-765-7347)
37086 PEKIN INSURANCE
00923 Peninsula Healthcare
95056 Pennsylvania Keystone Health Plan East (claims only)
95056 Pennsylvania Keystone Health Plan East (encounters only)
PEBLS PENNSYLVANIA KEYSTONE HEALTH PLAN EAST (ENCOUNTERS ONLY)
72126
Peoples Health Network (Tenet) (Network ID must be on claim. Contact
54704 Personal Choice PPO of Pennsylvania (Also know as Independent BLC)
95397 Personal Insurance Administrators
13306 PHCS Savility (ONLY for Savility card members.)
03440 Phoenix Health Plan
37330 Physicians Health Plan (PHP) Mid-Michigan
12399 Physicians Health Plan of Northern Indiana
06108
Physicians Health Services (now Health Net of NE) (Health Net six digit ID
REQUIRED in B0X33a; call 866-334-4638)
47027 Physicians Mutual Insurance Company
39156 Physicians Plus Insurance Corp.
95397 PIA
24735 Pinnacle Claims Management
45985 PINNACLE PHYSICIAN MANAGEMENT ORGANIZATION
37224 Pittman and Associates
37287 Planned Administrators, Inc. (PAI)
73159 PPO Oklahoma (WinterBrook HealthCare Management)
36373 Prairie States Enterprises, Inc.
65088 Preferred Care Partners (Miami,Florida)
60110 Preferred Health Systems, Inc.
L0250 Preferred Medicare
41147 Preferred One
43166 PREMIER HEALTH PL
PREHP
Presbyterian Health Plan (Commercial) (Provider ID is required. Contact (888) 923-
5757, #6 then #2 to obtain ID. New Mexico Providers only.)
77003 PRESTIGE HEALTH CHOICE
39185 Prevea Health Insurance Plan / Arise Health Plan
60054 Primary Choice (Aetna HP-NY/NJ)
56144 Primary PhysicianCare, Inc.
61604 Prime West Health Plan
61271 Principal Financial Group
61271 Principal Mutual Life Insurance Company
38217
Priority Health (Please contact Priority Health EDI Dept at 616-464-8686 or email
00923 Priority Healthcare
36331 Professional Benefit Administrators, Inc. (Oak Brook, IL)
93082 Prominence Health Plan of Nevada
80095 Prominence Health Plan of Texas
PHP01 Providence Good Health Plan
PHP00 Providence Preferred (PPO) (ProviderID and Enrollment required.)
68195 Provident Life & Accident Insurance Company
68195 Provident Life & Accident Insurance Company of America
68195 Provident Life & Casualty Insurance Company
35174 Qual Choice of Arkansas
23342 Qualcare
73067 Quicktrip Corporation
RRMCR Railroad Medicare
00932 Regence Blue Shield of Washington
RGA01 REGENCE GROUP ADMINISTRATORS
73066
Reserve National Insurance (For Claims rejections, please contact Reserve national
Customer Service at (405)848-7931.)
74205 Right Care from Scott & White
42172 Riverlink Health
RMSCO RMSCO
RMHMO Rocky Mountain HMO
37602 Rooney Life Ins.
31441 S & S Healthcare Strategies
SFG99 SafeGuard
SFHP1 San Francisco Health Plan
91184 Sanford Health Plan
24077 Santa Clara Family Health Plans
SCAN1 Scan CA
SCH01 Schaller Anderson CHOC Health Alliance
88030 Scott & White Health Care
87726 SecureHorizons MedicareComplete (SecureHorizons by UnitedHealthcare)
87726 SecureHorizons MedicareDirect (SecureHorixons by UnitedHealthcare)
39045 Security Health Plan
60054 Select Choice
23285 Select Health of South Carolina (Provider ID required in Box33a.)
SSC11 SELECT SENIOR CLINIC
76045 SelectCare of Texas (HPN) Heritage Physicians Network
GTPA1
SelectCare of TX (Beaumont) (Provider ID Required - Contact (713) 843-6780 to
obtain ID.)
HPN11
SelectCare of TX (Houston) (Provider ID Required - Contact (713) 843-6780 to
obtain ID.)
KLSY1
SelectCare of TX (Kelsey-Seybold) (Provider ID Required - Contact (713) 843-6780
to obtain ID.)
72189 SELECTCARE TEXAS BEAUMONT & GOLDEN TRIANGLE
TRSEL SELMAN TRICARE SUPP
60054 Senior Choice (Aetna HP-NY/NJ)
95444 Senior Smart Choice
83035 Senior Whole Health
54154 Sentara Family Plan
54154 Sentara Health Management
23249 Sentinel Management Services
SHP01 SHARP HEALTH PLAN
76342 Sierra Health and Life (FFS Claims) (SecureHorizons by UnitedHealthcare)
76342 Sierra Health Services
23250 Significa Benefit Services, Inc.
27094 Simply HealthCare Plans
00540 SISCO
25125 SL CARPENTERS FUN
91131 Sound Health
42172 Soundpath Health (Formerly known as Puget Sound Health Partners, Inc.)
77153 Southeastern Indiana Health SIHO
23253 Spectrum Administrators
73099 Standard Life & Accident Insur Co
59225 STAR HRG (Now part of CT General Life Insurance.)
61425 Starmark
31059 State Farm (Casualty and Property)
00601 State Merit GA
SLIC1 STONEBRIDGE LIFE INS COMPANY (VALLEY FORGE PENNSYLVANIA)
74227 Student Insurance
74227 Student Insurance - Boston Mutual Life Insurance Company
74227 Student Insurance - Life Insurance Company of Boston and New York
74227 Student Insurance - MEGA Life & Health Insurance Company
74227 Student Insurance - Mid-West National Life Insurance Company of Tennessee
74227 Student Insurance - Reliance Insurance Company
74227 Student Insurance - Reliance National Insurance Company
74227 Student Insurance Division
74227 Student Resources International (UnitedHealthcare)
95202 SummaCare Health Plan
68069 Sunflower State Healthcare Plan
68057 Sunshine Health Plan
68057 Sunshine Health Plan
68069 Sunshine Health Plan (Also 68057)
68069 Superior Health Plan (Also 39188)
53589 SW Service Administrators
74234 Tech-Steel, Inc.
76048 Texas Children's Health Plan
TX1ST Texas First Health Plans
BOONG The Boon Group
87726 The Empire Plan
20356 The Health Exchange (Cerner Corporation)
34150 The Health Plan (Upper Ohio Valley)
23223
The Loomis Company (Call Provider Relations at 610-374-4040 ext. 2438 for
procedures prior to submitting electronically.)
63092
The Oath - Health Partners of Alabama (Now known as HealthSpring
HMO/HealthSpring Medicare+Choice)
25175 Three Rivers Provider Network (Now known as Unison Health Plan.)
THRIV THRIVENT FINANCIAL
39065 Time Insurance (A Fortis Company)
48055 Todays Option (American Progressive and Pyramid Life)
61425 Tooling & Manufacturing Assoc.
68055 Total Carolina Care
68069 Total Carolina Care (Also 68055)
87726 Touchpoint
23856 Touchstone Health PSO
13402 Touchstone Health/Health Net Smart
RX001 TRANSACTRX INFUSION AND SPECIALTY
TLINS
Transamerica Life Ins. Co.(Specialized claims only. Call 501-277-1284 for
information.)
TRP1E TRANSAMERICA LIFE INSURANCE COMPANY
59222
TransAmerica Life Insurance Company (Valid for PO Box 982009, North Richland
Hills, TX 76182)
MMLI3 TRANSAMERICA PREMIER LIFE INSURANCE COMPANY (MONUMENTAL)
74234 Transwestern General Agency
TREST TRICARE EAST
TDDIR Tricare for Life (All Regions 1-12)
57106 Tricare North
FOREN TRICARE OVERSEAS
57106 Tricare South
99726 Tricare West
A0011 TRILLIUM HEALTHCARE RESOURCES
97300 Triple S
61425 Trustmark (Includes Starmark & TMA)
04298 Tufts Associated Health
87726 UBH Employer Division
87726 UBH RIOS
19991 Ucare of Minnesota
55413 Ucare of Minnesota - DOS after 1.1.2019
BS001
UFCW Local 400-5205 (Submitters to UFCW must register with CA Blue Shield at
www.blueshieldca.com/provider. If registration NOT completed, claims will reject.)
39026 UHIS-UnitedHealthcare Integrated Services (UnitedHealthcare)
ULLIC ULLICO INCORPORATED (VALLEY FORGE PENNSYLVANIA)
77022 ULTIMATE HEALTH PLAN
31107 UMR Cincinnati
62061 UMR Kansas (Formerly Fiserv Health - Kansas)
39026 UMR Wausau/UHIS
52180 UMWA Health & Retirement Funds
80314 Unicare Life & Health
25175 Unison DC, DE, NJ, OH, PA, SC, TN (UnitedHealthcare Community Plan)
25175 Unison Health Plan (Formerly Three Rivers Provider Network.)
92916 United American Insurance Company
87726 United Behavioral Health
96385 United Healthcare Community Plan Kansas
31107
United Medical Resources, Inc. (Some of UMR's new member cards no longer print
the full SSN. When submitting electronically, the full SSN must be entered.)
71412 United of Omaha
UTAMS UNITED TEACHER ASSOCIATES
87726 UnitedHealthcare
87726
UnitedHealthcare / MAMSI Life and Health Insurance Co. (MLH) (Previously Payer
ID 52148)
87726 UnitedHealthcare Group Medicare Advantage
87726 UnitedHealthcare hawk-I (UnitedHealthcare Community Plan)
87726 UnitedHealthcare Plan of the River Valley (UnitedHealthcare Communit Plan)
87726 UnitedHealthcare River Valley (formerly known as John Deere Healthcare
87726 UnitedHealthcare West (formerly know as PacifiCare) (UnitedHealthcare)
95958
UnitedHealthcare West Encounters(Formerly know as PacifiCare)
(UnitedHealthcare)
15003 UNIVERA COMMUNITY HEALTH
HC001 Univera Healthcare - CNY
UNINW Univera Traditional PPO
UNBCI UNIVERSAL BENEFITS CORPORATION
33001 Universal Care - California (ProviderID required.)
07503 University Family Care - Healthcare Group
09908 University Family Care - Maricopa Health Plan
09908 University Family Care - Maricopa Health Plan
23281 UPMC Health Plan
74095 USAA
74234 Utah Carpenters
74234 Utah Laborers
74234 Utah Pipe Trades
12115 VA Fee Basis Programs
00923 VA State Employer Funds
VCIPA Valley Care IPA
VHA11 Valley Health Administrators
72128 Vantage Health Plan, Inc.
VFP11 VILLAGE FAMILY PRACTICE
63114 Viva Health Plan
77073 VNS Choice Medicare (Formerly Visiting Nurse Service)
22264
VYTRA 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.)
00934 Washington State Premera Blue Cross
39026 Wausau Insurance Companies (Now known as UMR Wausau/UHIS.)
39151 WEA Insurance Group
59354 Wellcare Health Plan, Inc. (Encounters only)
87815 Wells Fargo TPA
39065 Western
39065 Western Care
24735 Western Grower's Assurance Trust
24735 Western Grower's Insurance Company
68039 WESTERN HEALTH ADVANTAGE
39065 Western Life Ins. Benefit Plan (FORTIS)
31048 Western Southern Financial Group
90560 WestLake Financial Group, Inc.
62061 Willis Administrative Services Corporation (Now UMR Kansas)
41095 Wilson-McShane
27327 WinHealth Partners/Wyoming Health Solutions
74101 WISCONSIN DEPARTMENT OF CORRECTIONS
75276 World Insurance Company
OOWPS WPS Commercial
SX022 WPS HEALTH INSURANCE