All Payers Eligibility Guide PC - Emdeon Payers Eligibility Guide PC ... BCBS North Dakota ......

PC Products

Input Guide for Eligibility/Benefit

Transactions

Emdeon MAX®, Emdeon Assistant®, and Emdeon NetDirect®

Version 18.29

6.1.2018

All Payers Eligibility Guide PC

This publication is the proprietary property of Emdeon and is furnished solely for use pursuant to a license agreement giving the user

the right to use the Emdeon product(s) referenced in this document. All uses of this document are subject to the terms of such license

agreement. This document may not be used except as permitted by such license agreement or changed, copied, photocopied,

reproduced, translated, or reduced to any electronic medium or machine readable form without the prior consent of Emdeon.

Copyright is held by Emdeon Business Services, LLC.

Emdeon is not liable for any losses or damages that result from the use of this material, including loss of profit or indirect, special, or

consequential damages.

© 2018, Emdeon Business Services LLC, 3055 Lebanon Pike Suite 1000, Nashville, TN 37214.

All Rights Reserved. Printed in the USA.

All Payers Eligibility Guide PC Table of Contents

© 2018 Emdeon Business Services LLC. All rights reserved. Page i

Table of Contents

Overview --------------------------------------------------------------------------------------------------------------- 1

About This Guide -------------------------------------------------------------------------------------------------- 1 Customer Support ------------------------------------------------------------------------------------------------- 1

General Information --------------------------------------------------------------------------------------------------- 2

Requests ----------------------------------------------------------------------------------------------------------- 2 Determine the Transaction Type ----------------------------------------------------------------------------- 2 Determine the Search Types --------------------------------------------------------------------------------- 2 Enter the Search Data ---------------------------------------------------------------------------------------- 3

Responses --------------------------------------------------------------------------------------------------------- 5

Payer-Specific Information -------------------------------------------------------------------------------------------- 6

Payer Details ------------------------------------------------------------------------------------------------------ 6 1199 National Benefit Fund ------------------------------------------------------------------------------ 6 AARP ------------------------------------------------------------------------------------------------------ 6 Absolute Total Care (CTOTL) ---------------------------------------------------------------------------- 6 Administrative Services, Inc. ---------------------------------------------------------------------------- 6 Advantage by Bridgeway Health Solutions -------------------------------------------------------------- 6 Advantage by Buckeye Community Health Plan -------------------------------------------------------- 6 Advantage by Managed Health Services ---------------------------------------------------------------- 6 Advantage by Superior HealthPlan ---------------------------------------------------------------------- 6 Aetna ------------------------------------------------------------------------------------------------------ 7 Aetna Administrator − Medicare Supplemental --------------------------------------------------------- 7 Aetna Better Health of CA ------------------------------------------------------------------------------- 7 Aetna Better Health of FL -------------------------------------------------------------------------------- 7 Aetna Better Health of NJ -------------------------------------------------------------------------------- 7 Aetna Better Health of KY -------------------------------------------------------------------------------- 7 Aetna Better Health of LA -------------------------------------------------------------------------------- 7 Aetna Better Health of MD ------------------------------------------------------------------------------- 7 Aetna Better Health of MI -------------------------------------------------------------------------------- 7 Aetna Better Health of MO ------------------------------------------------------------------------------- 7 Aetna Better Health of NV ------------------------------------------------------------------------------- 8 Aetna Better Health of PA -------------------------------------------------------------------------------- 8 Aetna Better Health of VA ------------------------------------------------------------------------------- 8 Aetna Better Health of WV ------------------------------------------------------------------------------- 8 Aetna Long Term Care ----------------------------------------------------------------------------------- 8 Aetna Senior Supplemental Insurance ------------------------------------------------------------------ 8 Affinity Essentials ---------------------------------------------------------------------------------------- 8 Affinity Health Plan --------------------------------------------------------------------------------------- 8 Affinity Health Plan Medicare ---------------------------------------------------------------------------- 8 AGIA Inc -------------------------------------------------------------------------------------------------- 8 Aflac Dental Insurance ----------------------------------------------------------------------------------- 8 Aflac - Medicare Supplemental -------------------------------------------------------------------------- 9 Alabama Medicaid ---------------------------------------------------------------------------------------- 9 All Savers Life Insurance Company --------------------------------------------------------------------- 9 Alliant Health Plans --------------------------------------------------------------------------------------- 9 Allied Benefit Systems, Inc. ----------------------------------------------------------------------------- 9 Alternative Insurance Resources, Inc. ------------------------------------------------------------------ 9 AmeriBen ------------------------------------------------------------------------------------------------- 9 American Behavioral Benefit Managers ----------------------------------------------------------------- 9 American Community Mutual -------------------------------------------------------------------------- 10 American General Life and Accident ------------------------------------------------------------------- 10 American Health Medicare (Inmediata Health) ------------------------------------------------------- 10 American Income Life Insurance Company ----------------------------------------------------------- 10 American National Insurance Company --------------------------------------------------------------- 10


© 2018 Emdeon Business Services LLC. All rights reserved. Page ii

American National Life Insurance Company of Texas ------------------------------------------------ 10 American Network Insurance (REHAB) − Medicare Supplemental ---------------------------------- 11 American Postal Workers Union ----------------------------------------------------------------------- 11 American Retirement Life Insurance Company – Medicare Supplement ---------------------------- 11 Americhoice of New Jersey ---------------------------------------------------------------------------- 11 Amerigroup --------------------------------------------------------------------------------------------- 11 AmeriHealth Caritas Delaware ------------------------------------------------------------------------- 11 AmeriHealth Caritas Iowa ------------------------------------------------------------------------------ 11 AmeriHealth Caritas Louisiana ------------------------------------------------------------------------- 11 AmeriHealth Caritas Pennsylvania --------------------------------------------------------------------- 11 AmeriHealth Caritas VIP Care Plus -------------------------------------------------------------------- 12 AmeriHealth District of Columbia ---------------------------------------------------------------------- 12 AmeriHealth VIP Care ---------------------------------------------------------------------------------- 12 Ameritas Dental Group --------------------------------------------------------------------------------- 12 Anthem BlueCross of California ------------------------------------------------------------------------ 12 APS ------------------------------------------------------------------------------------------------------ 12 Archbold Medical Center ------------------------------------------------------------------------------- 12 Arise Health Plan --------------------------------------------------------------------------------------- 12 Arise Health Plan − Medicare Select Policy ----------------------------------------------------------- 12 Arizona Medicaid (AHCCCS) --------------------------------------------------------------------------- 13 Arizona Physicians IPA --------------------------------------------------------------------------------- 13 Arkansas Medicaid -------------------------------------------------------------------------------------- 13 Associacion de Maestros Puerto Rico ------------------------------------------------------------------ 13 AVMed -------------------------------------------------------------------------------------------------- 13 Banner Health Plans ------------------------------------------------------------------------------------ 13 Banner University Family Care ------------------------------------------------------------------------ 13 Baptist Health Plan Advantage ------------------------------------------------------------------------ 13 BC Complete of Michigan ------------------------------------------------------------------------------ 13 BC Idaho ------------------------------------------------------------------------------------------------ 14 BC Medicare Advantage -------------------------------------------------------------------------------- 14 BCBS Alabama (Benefits) ------------------------------------------------------------------------------ 14 BCBS Alabama (Eligibility) ----------------------------------------------------------------------------- 14 BCBS Arizona ------------------------------------------------------------------------------------------- 15 BCBS Arkansas ----------------------------------------------------------------------------------------- 15 BCBS Colorado ----------------------------------------------------------------------------------------- 15 BCBS Connecticut -------------------------------------------------------------------------------------- 15 BCBS Delaware (Highmark) --------------------------------------------------------------------------- 15 BCBS District of Columbia ----------------------------------------------------------------------------- 15 BCBS Florida -------------------------------------------------------------------------------------------- 16 BCBS Georgia ------------------------------------------------------------------------------------------- 16 BCBS Illinois -------------------------------------------------------------------------------------------- 16 BCBS Indiana ------------------------------------------------------------------------------------------- 16 BCBS Iowa ---------------------------------------------------------------------------------------------- 16 BCBS Kansas ------------------------------------------------------------------------------------------- 16 BCBS Kansas City -------------------------------------------------------------------------------------- 16 BCBS Kentucky ----------------------------------------------------------------------------------------- 17 BCBS LA Medicare Advantage ------------------------------------------------------------------------- 17 BCBS Louisiana ----------------------------------------------------------------------------------------- 17 BCBS Maine --------------------------------------------------------------------------------------------- 17 BCBS Maryland ----------------------------------------------------------------------------------------- 17 BCBS Massachusetts ----------------------------------------------------------------------------------- 17 BCBS Michigan ----------------------------------------------------------------------------------------- 18 BCBS Minnesota ---------------------------------------------------------------------------------------- 18 BCBS Mississippi ---------------------------------------------------------------------------------------- 19 BCBS Missouri ------------------------------------------------------------------------------------------ 19 BCBS Nebraska ----------------------------------------------------------------------------------------- 19 BCBS Nevada ------------------------------------------------------------------------------------------- 19 BCBS New Hampshire ---------------------------------------------------------------------------------- 19 BCBS New Jersey (Horizon) --------------------------------------------------------------------------- 19 BCBS New Mexico -------------------------------------------------------------------------------------- 19 BCBS New York Empire -------------------------------------------------------------------------------- 20 BCBS North Carolina ----------------------------------------------------------------------------------- 20


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BCBS North Dakota ------------------------------------------------------------------------------------ 20 BCBS Ohio ---------------------------------------------------------------------------------------------- 20 BCBS Oklahoma ---------------------------------------------------------------------------------------- 20 BCBS Oregon (Regence) ------------------------------------------------------------------------------- 20 BCBS Pennsylvania (Highmark) ----------------------------------------------------------------------- 21 BCBS Rhode Island ------------------------------------------------------------------------------------- 21 BCBS South Carolina ----------------------------------------------------------------------------------- 21 BCBS South Carolina ----------------------------------------------------------------------------------- 22 BCBS South Dakota ------------------------------------------------------------------------------------ 22 BCBS Tennessee --------------------------------------------------------------------------------------- 22 BCBS Texas --------------------------------------------------------------------------------------------- 23 BCBS Texas-Medicaid ---------------------------------------------------------------------------------- 23 BCBS Vermont ------------------------------------------------------------------------------------------ 23 BCBS Virginia ------------------------------------------------------------------------------------------- 23 BCBS Wisconsin ---------------------------------------------------------------------------------------- 23 BCBS Wyoming ----------------------------------------------------------------------------------------- 23 Behavioral Health Systems ---------------------------------------------------------------------------- 23 Benefit Management Inc. ------------------------------------------------------------------------------ 24 Better Health ------------------------------------------------------------------------------------------- 24 Better Health Plans of Tennessee --------------------------------------------------------------------- 24 BlueChoice HealthPlan of South Carolina Medicaid --------------------------------------------------- 24 BlueCross BlueShield of Western New York Medicaid/CHP ------------------------------------------- 24 Bluegrass Family Health ------------------------------------------------------------------------------- 24 Boon Group --------------------------------------------------------------------------------------------- 24 Bridgeway Health Solutions (Arizona)----------------------------------------------------------------- 24 BS California -------------------------------------------------------------------------------------------- 24 BS Washington (Regence) ----------------------------------------------------------------------------- 24 Buckeye Community Health --------------------------------------------------------------------------- 25 California Medicaid (Medi-Cal) ------------------------------------------------------------------------- 25 Capital BlueCross --------------------------------------------------------------------------------------- 25 Capital District Physician’s Health Plan ---------------------------------------------------------------- 25 Care1st Health Plan Arizona --------------------------------------------------------------------------- 25 Care Improvement Plus -------------------------------------------------------------------------------- 25 CareFirst Administrators ------------------------------------------------------------------------------- 26 CarePlus Health Plan ----------------------------------------------------------------------------------- 26 CarePoint Medicare Advantage ------------------------------------------------------------------------ 26 CareSource Health ------------------------------------------------------------------------------------- 26 Carpenters Health and Welfare Trust Fund of St Louis ----------------------------------------------- 26 CareSource --------------------------------------------------------------------------------------------- 26 CDS Group Health -------------------------------------------------------------------------------------- 26 Celtic Insurance ---------------------------------------------------------------------------------------- 26 CeltiCare ------------------------------------------------------------------------------------------------ 26 Cenpatico ----------------------------------------------------------------------------------------------- 27 Central Reserve Life Insurance Company ― Medicare Supplement --------------------------------- 27 Central States Funds ----------------------------------------------------------------------------------- 27 Chesterfield Resources Inc ----------------------------------------------------------------------------- 27 Christian Brothers Services ---------------------------------------------------------------------------- 27 Christie Student Health Plans -------------------------------------------------------------------------- 27 CHRISTUS Health Plan Medicaid ----------------------------------------------------------------------- 27 CHRISTUS Health Plan New Mexico Health Insurance Exchange ------------------------------------ 27 CHRISTUS Health Plan NM MA ------------------------------------------------------------------------- 28 Cigna ---------------------------------------------------------------------------------------------------- 28 CMFG Life Insurance ----------------------------------------------------------------------------------- 28 Colorado Access ---------------------------------------------------------------------------------------- 28 Colorado Medicaid -------------------------------------------------------------------------------------- 29 Community Care of Oklahoma ------------------------------------------------------------------------- 29 Community Health Plan of Washington --------------------------------------------------------------- 29 Concentrix Insurance Solutions ----------------------------------------------------------------------- 29 Connecticare Inc --------------------------------------------------------------------------------------- 29 Connecticut Medicaid ----------------------------------------------------------------------------------- 29 Consolidated Associates Railroad ---------------------------------------------------------------------- 29 Consumer Mutual of Michigan ------------------------------------------------------------------------- 29


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Continental General Insurance Company ― Medicare Supplement --------------------------------- 30 Cooperative Benefit Administrators ------------------------------------------------------------------- 30 CoreSource --------------------------------------------------------------------------------------------- 30 CountyCare --------------------------------------------------------------------------------------------- 30 Coventry ------------------------------------------------------------------------------------------------ 30 Coventry/Dentex Dental ------------------------------------------------------------------------------- 30 CREATE ------------------------------------------------------------------------------------------------- 30 Crystal Run Health Plan -------------------------------------------------------------------------------- 30 CSA Fraternal Life ― Medicare Supplement ---------------------------------------------------------- 31 Dean Health Plan --------------------------------------------------------------------------------------- 31 Delaware Medicaid ------------------------------------------------------------------------------------- 31 Dell Childrens Health Plan ----------------------------------------------------------------------------- 31 Dentaquest Government Payer WI -------------------------------------------------------------------- 31 District No. 9, I. A. of M. & A. W. Welfare Trust ------------------------------------------------------ 31 District of Columbia Medicaid -------------------------------------------------------------------------- 31 Diversified Administration Corp ----------------------------------------------------------------------- 31 Driscoll Health Plan ------------------------------------------------------------------------------------- 31 EBMS ---------------------------------------------------------------------------------------------------- 31 Elderplan ------------------------------------------------------------------------------------------------ 32 Emblem Health ----------------------------------------------------------------------------------------- 32 Epic Life Insuranace ------------------------------------------------------------------------------------ 32 Essence Healthcare------------------------------------------------------------------------------------- 32 Evergreen Health --------------------------------------------------------------------------------------- 32 Everence Financial ------------------------------------------------------------------------------------- 32 Excellus BlueCross BlueShield ------------------------------------------------------------------------- 32 Fallon Community Health Plan ------------------------------------------------------------------------- 32 Farm Bureau Health Plans ----------------------------------------------------------------------------- 32 Federated Insurance Company ------------------------------------------------------------------------ 32 Fidelis Care New York ---------------------------------------------------------------------------------- 33 First Carolina Care ------------------------------------------------------------------------------------- 33 First Choice VIP Care Plus ----------------------------------------------------------------------------- 33 First Community Health Plan -------------------------------------------------------------------------- 33 First United American Insurance Company ----------------------------------------------------------- 33 Florida Medicaid ---------------------------------------------------------------------------------------- 34 Florida Medicaid ---------------------------------------------------------------------------------------- 35 Food Employers & Bakery & Confectionery Workers Benefit Fund of Southern California --------- 35 Fresenius Health Partners------------------------------------------------------------------------------ 35 Georgia Medicaid --------------------------------------------------------------------------------------- 36 Globe Life and Accident Insurance Company --------------------------------------------------------- 36 G.M.P. Employers Retiree Trust ----------------------------------------------------------------------- 36 Golden Rule --------------------------------------------------------------------------------------------- 36 Government Employees Hospital Association (GEHA) ------------------------------------------------ 36 Great American Life Assurance Company ― Medicare Supplement --------------------------------- 36 Great American Life Insurance Company ― Medicare Supplement --------------------------------- 36 Great-West Healthcare --------------------------------------------------------------------------------- 37 Group and Pension Administrators Inc. --------------------------------------------------------------- 37 Group Dental Service ---------------------------------------------------------------------------------- 37 Harmony Health Plan (WellCare of Florida) ----------------------------------------------------------- 37 Harvard Pilgrim Health Care --------------------------------------------------------------------------- 37 Hawaii Medicaid ---------------------------------------------------------------------------------------- 37 Hawaii Medical Service Association -------------------------------------------------------------------- 38 Health Alliance of Illinois ------------------------------------------------------------------------------- 38 Health Alliance Plan ------------------------------------------------------------------------------------ 38 Health Choice of Arizona ------------------------------------------------------------------------------- 38 Health First Health Plan -------------------------------------------------------------------------------- 38 Health First Insurance --------------------------------------------------------------------------------- 38 Health Partners MN ------------------------------------------------------------------------------------- 38 Health Partners of Philadelphia ------------------------------------------------------------------------ 38 Health Services for Children with Special Needs ----------------------------------------------------- 38 Health Share of Oregon -------------------------------------------------------------------------------- 38 HEALTHe Exchange ------------------------------------------------------------------------------------ 39 HealthEase (WellCare of Florida) ---------------------------------------------------------------------- 39


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HealthEase Kids (WellCare of Florida) ----------------------------------------------------------------- 39 HealthEZ ------------------------------------------------------------------------------------------------ 39 Healthfirst of New Jersey ------------------------------------------------------------------------------ 39 Healthfirst of New York -------------------------------------------------------------------------------- 39 HealthNet National ------------------------------------------------------------------------------------- 39 HealthPlus of Michigan --------------------------------------------------------------------------------- 39 HealthSmart Benefit Solutions ------------------------------------------------------------------------- 39 HealthSmart Benefit Solutions − WV ----------------------------------------------------------------- 39 HealthSpring -------------------------------------------------------------------------------------------- 40 Healthy Blue Louisiana --------------------------------------------------------------------------------- 40 Highmark BCBSD Health Options ---------------------------------------------------------------------- 40 HMA (Hawaii Mainland Admin) ------------------------------------------------------------------------ 40 Horizon New Jersey Health ---------------------------------------------------------------------------- 40 HSBS Oklahoma City ----------------------------------------------------------------------------------- 40 Humana ------------------------------------------------------------------------------------------------- 40 IBEW Local 508 Health Plan --------------------------------------------------------------------------- 40 Idaho Medicaid ----------------------------------------------------------------------------------------- 40 IlliniCare Health Plan ----------------------------------------------------------------------------------- 40 Illinois Medicaid ---------------------------------------------------------------------------------------- 41 Illinois Medicaid ---------------------------------------------------------------------------------------- 42 Independence Blue Cross ------------------------------------------------------------------------------ 42 Indiana Medicaid --------------------------------------------------------------------------------------- 42 Inland Empire Health Plan ----------------------------------------------------------------------------- 42 Inter Valley Health Plan -------------------------------------------------------------------------------- 43 International Medical Card ----------------------------------------------------------------------------- 43 Iowa Medicaid ------------------------------------------------------------------------------------------ 43 Island Home Insurance -------------------------------------------------------------------------------- 43 Johns Hopkins HealthCare ----------------------------------------------------------------------------- 43 Johns Hopkins HealthCare LLC ------------------------------------------------------------------------ 43 Johns Hopkins US Family Health Plan ----------------------------------------------------------------- 43 Kaiser Foundation Health Plan of Colorado ----------------------------------------------------------- 43 Kaiser Foundation Health Plan of Hawaii -------------------------------------------------------------- 43 Kaiser Foundation Health Plan of Hawaii (DHMO/CHOICE) ------------------------------------------ 44 Kaiser Foundation Mid-Atlantic ------------------------------------------------------------------------ 44 Kaiser Foundation Health Plan of Northwest ---------------------------------------------------------- 44 Kaiser NW Dental --------------------------------------------------------------------------------------- 44 Kaiser Permanente Insurance Company KPIC -------------------------------------------------------- 44 Kaiser Permanente of Georgia ------------------------------------------------------------------------- 44 Kaiser Permanente of Northern California ------------------------------------------------------------ 44 Kaiser Permanente of Southern California ------------------------------------------------------------ 44 KanCare-UnitedHealthcare Community Plan Kansas ------------------------------------------------- 44 Kansas Medicaid ---------------------------------------------------------------------------------------- 44 Kempton Company ------------------------------------------------------------------------------------- 45 Kentucky Medicaid ------------------------------------------------------------------------------------- 45 Kentucky Spirit Health Plan ---------------------------------------------------------------------------- 45 Key Benefit Administrators ---------------------------------------------------------------------------- 45 Key Benefit Administrators (Indianapolis, IN) -------------------------------------------------------- 45 Keystone First ------------------------------------------------------------------------------------------ 45 Keystone VIP Choice ----------------------------------------------------------------------------------- 45 L.A. Care. ----------------------------------------------------------------------------------------------- 45 Leon Medical Centers Health Plan, Inc. --------------------------------------------------------------- 45 Liberty National Life Insurance Company ------------------------------------------------------------- 46 LifeCare Assurance Company -------------------------------------------------------------------------- 46 Lincoln Financial ---------------------------------------------------------------------------------------- 46 Louisiana Healthcare Connections --------------------------------------------------------------------- 46 Louisiana Medicaid ------------------------------------------------------------------------------------- 47 Loyal American Life ― Medicare Supplement --------------------------------------------------------- 47 Maine Community Health Options --------------------------------------------------------------------- 47 Magnolia Health Plan ----------------------------------------------------------------------------------- 47 MagnaCare ---------------------------------------------------------------------------------------------- 48 MaineCare (Maine Medicaid) --------------------------------------------------------------------------- 48 Managed Care of America------------------------------------------------------------------------------ 48


© 2018 Emdeon Business Services LLC. All rights reserved. Page vi

Managed Health Network (MHN) ---------------------------------------------------------------------- 48 Managed Health Services - Indiana ------------------------------------------------------------------- 48 MAPFRE Life Puerto Rico ------------------------------------------------------------------------------- 48 MAPFRE Medicare Excel -------------------------------------------------------------------------------- 48 Maricopa Care Advantage ------------------------------------------------------------------------------ 48 Maricopa Health Plan (Arizona) ------------------------------------------------------------------------ 48 Maryland Medicaid-------------------------------------------------------------------------------------- 48 Maryland Physicians Care ------------------------------------------------------------------------------ 49 Massachusetts Medicaid (MassHealth) ---------------------------------------------------------------- 49 MDWISE Exchange ------------------------------------------------------------------------------------- 49 MDWISE Medicaid Health Plans ------------------------------------------------------------------------ 49 Med-Pay, Inc. ------------------------------------------------------------------------------------------- 49 Medi-Share --------------------------------------------------------------------------------------------- 49 MedBen Newark OH ------------------------------------------------------------------------------------ 49 Medica -------------------------------------------------------------------------------------------------- 49 Medica Health Plans ------------------------------------------------------------------------------------ 49 Medica2 ------------------------------------------------------------------------------------------------- 49 Medical Associates Health Plan/Health Choices ------------------------------------------------------- 49 Medical Card System ----------------------------------------------------------------------------------- 50 Medical Mutual of Ohio (MMO) ------------------------------------------------------------------------- 50 Medicare Part A & B ------------------------------------------------------------------------------------ 51 Medicare Part A & B ------------------------------------------------------------------------------------ 52 Medicare y Mucho Mas --------------------------------------------------------------------------------- 52 Meridian Health Plan of Illinois ------------------------------------------------------------------------ 52 Meritain Health ----------------------------------------------------------------------------------------- 52 Meritus Health Partners -------------------------------------------------------------------------------- 53 MetLife -------------------------------------------------------------------------------------------------- 53 MetroPlus Health Plan ---------------------------------------------------------------------------------- 53 Michigan Medicaid -------------------------------------------------------------------------------------- 53 Michigan MIChild --------------------------------------------------------------------------------------- 53 Minnesota Medicaid ------------------------------------------------------------------------------------ 53 Mississippi Medicaid ------------------------------------------------------------------------------------ 53 Mississippi State Employees’ Health Plan (SEHP) ---------------------------------------------------- 54 Missouri Medicaid --------------------------------------------------------------------------------------- 54 MMSI ---------------------------------------------------------------------------------------------------- 55 Molina Healthcare -------------------------------------------------------------------------------------- 55 Molina Healthcare of New Mexico --------------------------------------------------------------------- 55 Molina Healthcare of Virginia -------------------------------------------------------------------------- 55 Montana Medicaid -------------------------------------------------------------------------------------- 55 Molina of Puerto Rico ----------------------------------------------------------------------------------- 55 Mountain State ----------------------------------------------------------------------------------------- 55 Municipal Health Benefit Fund ------------------------------------------------------------------------- 55 Mutual Health Services --------------------------------------------------------------------------------- 55 Mutual of Omaha --------------------------------------------------------------------------------------- 55 MVP Health Care (New York) -------------------------------------------------------------------------- 56 National Association of Letter Carriers (NALC) ------------------------------------------------------- 56 National Claims Admin Services ----------------------------------------------------------------------- 56 Nebraska Medicaid ------------------------------------------------------------------------------------- 56 Network Health Plan ----------------------------------------------------------------------------------- 56 Nevada Medicaid --------------------------------------------------------------------------------------- 56 New Era Life Insurance Company --------------------------------------------------------------------- 56 New Hampshire Medicaid ------------------------------------------------------------------------------ 56 New Jersey Medicaid ----------------------------------------------------------------------------------- 57 New Mexico Health Connections ----------------------------------------------------------------------- 57 New Mexico Medicaid ----------------------------------------------------------------------------------- 57 New York Medicaid ------------------------------------------------------------------------------------- 58 Nippon Life Benefits ------------------------------------------------------------------------------------ 59 NMPSIA ------------------------------------------------------------------------------------------------- 59 NMRHCA ------------------------------------------------------------------------------------------------ 59 North Carolina Medicaid -------------------------------------------------------------------------------- 59 North Dakota Medicaid --------------------------------------------------------------------------------- 59 Northwest Administrators, Inc. ------------------------------------------------------------------------ 59


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NovaSys Health----------------------------------------------------------------------------------------- 59 ‘Ohana Health Plan (WellCare of Hawaii) ------------------------------------------------------------- 59 Ohio Medicaid ------------------------------------------------------------------------------------------- 59 Oklahoma Employees Group Insurance Division ----------------------------------------------------- 60 Oklahoma Medicaid ------------------------------------------------------------------------------------ 60 Operating Engineers Local No. 428 Health and Welfare Trust Fund --------------------------------- 60 Optima Health ------------------------------------------------------------------------------------------ 60 Orange County Fire Authority ------------------------------------------------------------------------- 60 Oregon Medicaid ---------------------------------------------------------------------------------------- 60 Oregon’s Health CO-OP -------------------------------------------------------------------------------- 60 Oxford Health Plans ------------------------------------------------------------------------------------ 60 Oxford Life Insurance Company ----------------------------------------------------------------------- 60 PacificSource Administrators -------------------------------------------------------------------------- 61 PacificSource Health Plans ----------------------------------------------------------------------------- 61 PacificSource Community Solutions ------------------------------------------------------------------- 61 PacificSource Medicare --------------------------------------------------------------------------------- 61 Pan-American Life Insurance -------------------------------------------------------------------------- 61 Panamerican Life Puerto Rico (PALIC) ---------------------------------------------------------------- 61 Partnership Health Plan of California ------------------------------------------------------------------ 61 Passport Health Plan ----------------------------------------------------------------------------------- 61 Pekin Life Insurance ------------------------------------------------------------------------------------ 61 Penn Treaty Network America Insurance (REHAB) − Medicare Supplemental ---------------------- 62 Pennsylvania Medical Assistance ---------------------------------------------------------------------- 62 Peoples Health ------------------------------------------------------------------------------------------ 62 PerformCare -------------------------------------------------------------------------------------------- 62 Personal Insurance Administrators -------------------------------------------------------------------- 62 PHCS Savility Payers ----------------------------------------------------------------------------------- 62 Physicians Mutual -------------------------------------------------------------------------------------- 62 Piedmont Wellstar HealthPlans ------------------------------------------------------------------------ 62 Pittman and Associates -------------------------------------------------------------------------------- 62 Plan de Salud Hospital Menonita ---------------------------------------------------------------------- 62 Planned Administrators, Inc. -------------------------------------------------------------------------- 63 Plumbers and Pipefitters Local 525 Health & Welfare Trust ------------------------------------------ 63 Preferred Care Partners -------------------------------------------------------------------------------- 63 Preferred Health Systems ------------------------------------------------------------------------------ 63 PreferredOne ------------------------------------------------------------------------------------------- 63 Premera Blue Cross ------------------------------------------------------------------------------------ 63 Prestige Health Choice --------------------------------------------------------------------------------- 63 Primary PhysicianCare, Inc. --------------------------------------------------------------------------- 64 Principal Financial -------------------------------------------------------------------------------------- 64 Priority Health ------------------------------------------------------------------------------------------ 64 Prominence Health Plan -------------------------------------------------------------------------------- 64 Providence Health Plan --------------------------------------------------------------------------------- 64 Provident American Life & Health Insurance Company ― Medicare Supplement ------------------- 64 Puerto Rico Medicaid (ODSI) -------------------------------------------------------------------------- 64 Quartz ASO --------------------------------------------------------------------------------------------- 64 QuikTrip Corporation ----------------------------------------------------------------------------------- 64 RightCare from Scott and White Health Plan --------------------------------------------------------- 65 Rocky Mountain Health Plan (HMO) ------------------------------------------------------------------- 65 SAMBA Health Benefit Plan ---------------------------------------------------------------------------- 65 San Joaquin Health Plan ------------------------------------------------------------------------------- 65 Santa Clara Family Health Plan ------------------------------------------------------------------------ 65 Schaller Anderson Health Plans ----------------------------------------------------------------------- 65 Schaller Anderson Mercy Maricopa -------------------------------------------------------------------- 65 Select Health of South Carolina ----------------------------------------------------------------------- 65 Selman & Company ------------------------------------------------------------------------------------ 65 Senior Care Action Network (SCAN) Health Maintenance Organization (HMO) --------------------- 66 Senior Health Services Center – Universal American Family of Companies------------------------- 66 Senior Whole Health ----------------------------------------------------------------------------------- 66 Significa Benefit Services ------------------------------------------------------------------------------ 66 Silver Summit Health Plan ----------------------------------------------------------------------------- 66 Simply Healthcare Plans ------------------------------------------------------------------------------- 66


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South Carolina Medicaid ------------------------------------------------------------------------------- 66 South Dakota Medicaid--------------------------------------------------------------------------------- 66 SPJST ― Medicare Supplement ------------------------------------------------------------------------ 67 Standard Life and Accident Insurance Company ----------------------------------------------------- 67 Star HRG ------------------------------------------------------------------------------------------------ 67 StayWell (WellCare of Florida) ------------------------------------------------------------------------- 67 StayWell Kids (WellCare of Florida) ------------------------------------------------------------------- 67 Stonebridge Life Insurance Company ----------------------------------------------------------------- 67 Summit America Insurance Service ------------------------------------------------------------------- 67 Sunflower State Health Plan --------------------------------------------------------------------------- 67 Sunshine State Health Plan ---------------------------------------------------------------------------- 67 Tennessee Medicaid (TennCare) ----------------------------------------------------------------------- 68 TexanPlus (North Texas Area) ------------------------------------------------------------------------- 68 TexanPlus (Southeast Texas Area) -------------------------------------------------------------------- 68 Texas Childrens Health Plan --------------------------------------------------------------------------- 68 Texas Medicaid ----------------------------------------------------------------------------------------- 68 The Ullico Family of Companies ----------------------------------------------------------------------- 68 Three Rivers Health Plan ------------------------------------------------------------------------------- 68 Today’s Options ---------------------------------------------------------------------------------------- 69 TransactRX Infusion and Specialty -------------------------------------------------------------------- 69 Transamerica Financial Life Insurance Company ----------------------------------------------------- 69 Transamerica Life Insurance Company --------------------------------------------------------------- 69 Transamerica Premier Life Insurance Company ------------------------------------------------------ 69 TRICARE ------------------------------------------------------------------------------------------------ 69 TRICARE East Region ---------------------------------------------------------------------------------- 69 Tricare For Life ----------------------------------------------------------------------------------------- 69 Tricare Overseas --------------------------------------------------------------------------------------- 69 Triple-S Salud (BCBS of Puerto Rico) ----------------------------------------------------------------- 70 Trillium Community Health Plan ----------------------------------------------------------------------- 70 True Health New Mexico Inc --------------------------------------------------------------------------- 70 Trustmark ----------------------------------------------------------------------------------------------- 70 Tufts Health Plan --------------------------------------------------------------------------------------- 70 Ucare of Minnesota ------------------------------------------------------------------------------------- 70 Ultimate Health Plans ---------------------------------------------------------------------------------- 70 UMR Wausau ------------------------------------------------------------------------------------------- 70 UMWA Health and Retirement Funds ------------------------------------------------------------------ 70 UniCare ------------------------------------------------------------------------------------------------- 70 Union Pacific Railroad Employes Health Systems ----------------------------------------------------- 70 United American Insurance Company ----------------------------------------------------------------- 71 United Healthcare Dental ------------------------------------------------------------------------------ 71 United Healthcare Nevada Market --------------------------------------------------------------------- 71 UnitedHealthcare Shared Services -------------------------------------------------------------------- 71 UnitedHealthcare StudentResources ------------------------------------------------------------------ 71 UnitedHealthcare (UHC) ------------------------------------------------------------------------------- 71 UnitedHealthcare Community Plan − Tennessee ----------------------------------------------------- 71 United Healthcare Securehorizons − Medicare Supplemental --------------------------------------- 72 United Teacher Associates Insurance Company ― Medicare Supplement -------------------------- 72 Unity Health Insurance --------------------------------------------------------------------------------- 72 Universal Benefit Corp --------------------------------------------------------------------------------- 72 Universal Care of California ---------------------------------------------------------------------------- 72 University Care Advantage (Arizona) ----------------------------------------------------------------- 72 University Family Care (Arizona) ---------------------------------------------------------------------- 72 University of Arizona Health Plans − UHM ------------------------------------------------------------ 72 University Physicians Care Advantage ---------------------------------------------------------------- 73 UnitedHealthCare Life Insurance Company (UHCLIC) ------------------------------------------------ 73 UPMC Health Plan -------------------------------------------------------------------------------------- 73 USAA – Medicare Supplemental ----------------------------------------------------------------------- 73 USFHP – St. Vincent Catholic Medical Centers of New York ----------------------------------------- 73 Vantage Health Plan ------------------------------------------------------------------------------------ 73 Vermont Medicaid -------------------------------------------------------------------------------------- 73 Veterans Affairs Fee Basis Programs ------------------------------------------------------------------ 74 Veterans Affairs Health Administration Center ------------------------------------------------------- 74


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Virginia Medicaid --------------------------------------------------------------------------------------- 74 Viva Health Inc. ---------------------------------------------------------------------------------------- 74 VNS CHOICE Medicare --------------------------------------------------------------------------------- 74 Washington Medicaid ----------------------------------------------------------------------------------- 75 WEB-TPA, Inc. ------------------------------------------------------------------------------------------ 75 WellCare Health Plans ---------------------------------------------------------------------------------- 75 Wells Fargo Third Party Administrators --------------------------------------------------------------- 75 West Virginia Family Health Plan ---------------------------------------------------------------------- 75 West Virginia Medicaid --------------------------------------------------------------------------------- 75 Western Health Advantage ---------------------------------------------------------------------------- 75 Western Southern Financial Group -------------------------------------------------------------------- 75 Windsor Health Plan ------------------------------------------------------------------------------------ 76 Wisconsin Chronic Disease Program ------------------------------------------------------------------ 76 Wisconsin Medicaid ------------------------------------------------------------------------------------- 76 Wisconsin Well Woman Program ---------------------------------------------------------------------- 76 Wyoming Medicaid ------------------------------------------------------------------------------------- 76

Plan Network IDs ------------------------------------------------------------------------------------------------ 77 Ameritas Dental Group Plans ------------------------------------------------------------------------------ 77

Ameritas Life Insurance Company--------------------------------------------------------------------- 77 First Ameritas of New York ---------------------------------------------------------------------------- 77 First Reliance Standard Life Insurance Company ----------------------------------------------------- 77 Reliance Standard Life Insurance Company ---------------------------------------------------------- 77 Standard Insurance Company ------------------------------------------------------------------------- 77 Standard Insurance Company of New York ----------------------------------------------------------- 77

Cenpatico Plans --------------------------------------------------------------------------------------------- 77 Cenpatico Behavioral Health Arizona ------------------------------------------------------------------ 77 Cenpatico Behavioral Health Florida------------------------------------------------------------------- 77 Cenpatico Behavioral Health Illinois ------------------------------------------------------------------- 77 Cenpatico Behavioral Health Indiana ------------------------------------------------------------------ 77 Cenpatico Behavioral Health Kansas ------------------------------------------------------------------ 77 Cenpatico Behavioral Health Kentucky ---------------------------------------------------------------- 77 Cenpatico Behavioral Health Massachusetts ---------------------------------------------------------- 77 Cenpatico Behavioral Health Ohio --------------------------------------------------------------------- 77 Cenpatico Behavioral Health South Carolina ---------------------------------------------------------- 77 Cenpatico Behavioral Health Texas-------------------------------------------------------------------- 77 Cenpatico Behavioral Health Wisconsin --------------------------------------------------------------- 77 Cenpatico – Managed Health Services (Indiana) ----------------------------------------------------- 77 CMHIN -------------------------------------------------------------------------------------------------- 77 Cenpatico – Managed Health Services (Wisconsin) -------------------------------------------------- 77 CMHWI -------------------------------------------------------------------------------------------------- 77 Cenpatico – Superior Health Plan --------------------------------------------------------------------- 77 CHSPT --------------------------------------------------------------------------------------------------- 77

CoreSource Plans ------------------------------------------------------------------------------------------- 78 CoreSource – FMH-------------------------------------------------------------------------------------- 78 CoreSource – Little Rock ------------------------------------------------------------------------------- 78 CoreSource – Maryland, Pennsylvania, and Illinois -------------------------------------------------- 78 CoreSource – Ohio ------------------------------------------------------------------------------------- 78

Coventry Plans ---------------------------------------------------------------------------------------------- 78 Health America of PA ----------------------------------------------------------------------------------- 78 CHC Georgia -------------------------------------------------------------------------------------------- 78 CHC Virginia -------------------------------------------------------------------------------------------- 78 CHC Louisiana ------------------------------------------------------------------------------------------ 78 CHC West Virginia* ------------------------------------------------------------------------------------ 78 CHC of Carolinas --------------------------------------------------------------------------------------- 78 CHC Delaware ------------------------------------------------------------------------------------------ 78 CHC Iowa ----------------------------------------------------------------------------------------------- 78 CHC Kansas / CHC Oklahoma ------------------------------------------------------------------------- 78 CHC Nebraska ------------------------------------------------------------------------------------------ 78 CHC Illinois --------------------------------------------------------------------------------------------- 78 CoventryCares of West Virginia ----------------------------------------------------------------------- 78 CHC of MO, MS, AK , TN ------------------------------------------------------------------------------- 78 CHC Healthcare USA* ---------------------------------------------------------------------------------- 78


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CoventryCares of Virginia* ---------------------------------------------------------------------------- 78 CvtyNatnlAccts/UofMO/CvtyOne ----------------------------------------------------------------------- 78 Mail Handlers & FEHBP --------------------------------------------------------------------------------- 78 CHC Altius Health Plan/CHC Nevada ------------------------------------------------------------------ 78 CoventryCares of Michigan ---------------------------------------------------------------------------- 78 CHC Texas ---------------------------------------------------------------------------------------------- 78 Vista ----------------------------------------------------------------------------------------------------- 78 CoventryCares of Pennsylvania ------------------------------------------------------------------------ 78 CoventryCares of Nebraska* -------------------------------------------------------------------------- 78 CHC Florida --------------------------------------------------------------------------------------------- 78 MHNET Behavioral Health ------------------------------------------------------------------------------ 78 Aetna Better Health of Kentucky ---------------------------------------------------------------------- 78 *Medicaid Plans ---------------------------------------------------------------------------------------- 78

Glassman Plans --------------------------------------------------------------------------------------------- 79 AFTRA Health Fund ------------------------------------------------------------------------------------- 79 Best Life and Health ------------------------------------------------------------------------------------ 79

Molina Healthcare Plans ------------------------------------------------------------------------------------ 79 Molina CA (California) ---------------------------------------------------------------------------------- 79 Molina FL (Florida) ------------------------------------------------------------------------------------- 79 Molina ID (Idaho) -------------------------------------------------------------------------------------- 79 Molina MI (Michigan) ----------------------------------------------------------------------------------- 79 Molina NM (New Mexico) ------------------------------------------------------------------------------- 79 Molina OH (Ohio) --------------------------------------------------------------------------------------- 79 Molina TX (Texas) -------------------------------------------------------------------------------------- 79 Molina UT (Utah) --------------------------------------------------------------------------------------- 79 Molina WA (Washington) ------------------------------------------------------------------------------- 79 Molina WI (Wisconsin) --------------------------------------------------------------------------------- 79

Principal Financial Plans ------------------------------------------------------------------------------------ 79 Principal Financial Life Insurance Company of America ---------------------------------------------- 79 Nippon Life Insurance Company of America ---------------------------------------------------------- 79

Schaller Anderson Health Plans ---------------------------------------------------------------------------- 80 Schaller Anderson Aetna Better Health of New York ------------------------------------------------- 80 Schaller Anderson Aetna Better Health of Ohio ------------------------------------------------------- 80 Schaller Anderson Aetna Better Health – PA Medicaid ----------------------------------------------- 80 Schaller Anderson Aetna IL Medicaid ----------------------------------------------------------------- 80 Schaller Anderson Aetna TX Medicaid & CHIP -------------------------------------------------------- 80 Schaller Anderson Delaware Physicians Care, Inc. --------------------------------------------------- 80 Schaller Anderson MajestaCare VA -------------------------------------------------------------------- 80 Schaller Anderson Maryland Physicians Care --------------------------------------------------------- 80 Schaller Anderson Mercy Care ------------------------------------------------------------------------- 80 Schaller Anderson Missouri Care ---------------------------------------------------------------------- 80 Schaller Anderson Parkland Community Health Plan ------------------------------------------------- 80 Schaller Anderson TX Christus ------------------------------------------------------------------------- 80

Appendices ----------------------------------------------------------------------------------------------------------- 81

Appendix A: Reference Guides --------------------------------------------------------------------------------- 81 Appendix B: Service Types ------------------------------------------------------------------------------------- 81

Index ----------------------------------------------------------------------------------------------------------------- 88

All Payers Eligibility Guide PC Overview

© 2018 Emdeon Business Services LLC. All rights reserved. Page 1

Overview

About This Guide This guide provides:

• General instructions for entering an eligibility request.

• Payer-specific input requirements and special considerations. The section “Payer Details” beginning on page 6 lists each eligibility transaction by payer name, including any date of service

restrictions, special considerations, and a hyperlink to the appropriate response guide.

This guide has these appendices: “Appendix A: Reference Guides” on page 81, lists additional reference materials. “Appendix B:

Service Types” on page 81 lists Service Types and abbreviated descriptions used in the requests and responses.

For transactions other than eligibility (for example, claim status, referral inquiry, credit report, etc.), see the guides specific to those

transactions.

Customer Support

Emdeon Customer Support

800.333.0263

[email protected]

mailto:[email protected]

All Payers Eligibility Guide PC General Information


General Information

Requests

Determine the Transaction Type

If all members of a plan have a unique member ID, regardless of their relationship to other family members covered under the same

plan, you will have only one option as the eligibility transaction type: Eligibility. If plan dependents have the same member ID as the

plan subscriber, select Subscriber Eligibility if the claim is for the plan subscriber or Dependent Eligibility if the claim is for a plan

dependent.

Determine the Search Types

Before you can submit a query, you must make sure that you enter enough information to complete at least one type of search in the

database you select.

Most databases can be queried using any one of several different combinations of information. Emdeon provides input fields for all of

the possible search types by which you can search the selected database. Search types are database-specific; however, common search

types include:

• Plan member ID and date(s) of service.

• Plan member ID, date of birth, and date(s) of service.

• Plan member ID, name, and date(s) of service.

• Plan member ID, Social Security number, name, date of birth, and date(s) of service.

• Social Security number and date(s) of service.

• Social Security number, date of birth, and date(s) of service.

• Social Security number, name, and date(s) of service.

• Social Security number, name, date of birth, and date(s) of service.

• Name, date of birth, and date(s) of service. Most payers require that you enter the provider identification number of the inquiring provider. For more information, see “Provider

IDs” on page 4.

You must make sure that at least one query set is complete by verifying that there is data in every input box underscored by one single

color (for example, all boxes underscored by a black bar). If you want the Emdeon server to automatically initiate another search if the

first search does not find the patient's file, make sure that you enter enough data to perform more than one type of query. (For

example, make sure there is data in input boxes underscored by both black and red bars.)

The query may also contain optional fields (for example, middle initial, gender, or group number). In certain cases, these optional

fields may help the payer find the patient’s file.

If you enter data for more than one type of search:

If you enter data for more than one search type, you enable Emdeon’s SmartSearchTM feature. This feature causes the software to

resend the query, using each different search type, until the patient’s record is found. This process is referred to as a search cascade.

The SmartSearch cascade process works like this:

1. When the query is processed, the software sends the combination of data that is most likely to

locate the patient’s file.

2. If the database responds that the data file was not found, the software sends the combination

of data which is the next most likely to locate the file.

3. If again the file is not found, the process repeats until one of the following occurs:

• The record is found.



• All search combinations from the query have been sent.

• Certain types of errors occur.

• You cancel processing.

Enter the Search Data

Data Input Area

The data input area contains the information Emdeon will use to query the payer's database. You can manually enter or change

information, if necessary.

Color Bars

The color bars beneath input boxes identify the input data required to complete each type of search. All data elements with the same

color bar compose a search type or query set. For example, to complete entries for a subscriber ID search, you would need to make an

entry in each field that has a black color bar.

Note the following:

• The position of the color bar beneath an input field indicates the sequence in which the search

will be conducted in the event of a SmartSearchTM search cascade. The left-most position

indicates that the data element is used in the highest-priority search type. The next position

from the left is for the second-priority search type, and so on.

• The colors themselves also indicate the priority of the search type, in this sequence:

Black

Red

Yellow

Light green

Blue Optional input fields do not have a color bar. The Account# and Amount fields are always optional fields that are not sent to the

payer in the request. These fields may be used for your internal use only. The account number is the number you have assigned to the

account. The amount is the dollar amount applicable to the inquiry.

Text Color in Input Fields The initial entry you make in a field in a new query will be blue if it is valid or red if it is invalid (for example, letters in a numeric

field or the wrong length).

Black type indicates that you changed the original entry, but that the change is valid.

Help Line For information about a field in which the cursor is resting, consult the help line at the bottom of the window. See the following

example.



Special Considerations

The payer may have guidelines for the information that you enter. For example, the patient’s group

number may be an optional entry field, but the payer may recommend that you enter the group number

to narrow your search. To determine if there are any special considerations for the transaction, see the

“Payer Details” on page 6.

Provider IDs Most searches require that you enter the provider identification number of the inquiring provider. A payer may require that you enter

your National Provider Identifier (NPI) as the provider ID, your federal taxpayer ID, a payer-assigned ID, or a combination of any of

these identifiers. Rest your cursor in the field, and note the entry requirements listed on the help line at the bottom of the screen.

In order for you to use your NPI, the following conditions must exist:

• The payer must be ready to accept NPI. Consult our payer lists at

https://access.emdeon.com/PayerLists/ for this payer’s NPI-readiness status.

• The inquiring provider must have fulfilled all of the payer’s NPI registration requirements. You can set up a default provider ID number or a drop-down list of frequently used provider IDs. For more information, see your

product’s user guide.

Date Entries You can enter either a six-digit (mmddyy) or an eight-digit (mmddyyyy) date of service.

If you enter a two-digit year, the software will convert the century, as follows, when you move off the date of service field:

• If the figure you enter is equal to or less than 20, the century converts to a date in the 2000s.

For example, if you enter 03, the system converts the century to 2003.

• If the figure you enter is greater than 20, the century converts to a date in the 1900s. For

example, if you enter 50, the system converts the century to 1950. You must enter all eight digits for a date of birth.

https://access.emdeon.com/PayerLists/



Date of Service Restrictions The current date appears on the date(s) of service input prompt(s) for each payer. To send the current date in your request, press the

Tab key to go to the next input prompt.

However, if you want to enter another date, be aware that your payer may or may not have restrictions on the date(s) of service. For

example, many payers do not allow you to enter future dates of service. Some payers let you inquire about eligibility for a date of

service range, but may limit the span between the service dates. To determine your payer’s date of service requirements, see the

“Payer Details” on page 6.

Card Swipe Some payers allow you to run an eligibility transaction using the data provided on the member’s magnetic swipe card. You must have

a card reader set up on your computer in order to use the card swipe feature.

To run a transaction using the magnetic swipe card:

1. From a new record, choose the payer and query type of the card in question.

2. Swipe the card through the card reader attached to your computer.

Emdeon MAX reads the data from the card and inserts it into the appropriate input fields.

3. Enter any additional required information, for example, the provider ID.

4. Submit the transaction as usual. See the “Payer Details” on page 6 to see which payers support magnetic swipe card searches.

Dollar Amounts An input field for a dollar amount places a static decimal point two decimal places to the left of the right-most two digits. Therefore,

you must enter a cent value, even for whole dollar amounts.

Add New Button In some cases, a query will allow you to enter several occurrences of an input field or group of fields (such as up to 12 diagnosis codes

or up to 10 procedure codes and dates), but only one instance of the field is initially displayed. The presence of an Add New button

beside the field indicates that the additional input fields are hidden.

You can display additional occurrences of the field by clicking the Add New button.

Responses There are three types of eligibility responses available through your product:

• A response using version 4 of Emdeon’s standard response format.

• A response using version 5 of Emdeon’s standard response format.

• A response that uses a non-standard format. For information on the response used for each payer, see the “Payer Details” on page 6. Here, the Response Guide column provides a

hyperlink to the appropriate response guide.

The response guides are also available on your installation CD or on the Emdeon resource library at

www.emdeon.com/resourcelibrary/#84; choose User Manuals.

http://www.emdeon.com/resourcelibrary/#84

All Payers Eligibility Guide PC Payer-Specific Information


Payer-Specific Information

Payer Details

Payer Name / Version Date of Service Restrictions Special Considerations Response Guide

1199 National Benefit

Fund

Eligibility v1.0

Any date on file. If no date is

entered, the date of service will default to the current date.

This payer requires use of the National

Provider Identifier (NPI) the provider identifier.

PC-v5-Standard-Eligibility-

Response.pdf

AARP

Eligibility v1.3

Any past date on file; future dates up to the end of the current month.

This payer permits use of a provider ID or a tax ID as the provider identifier.

PC-v4-Standard-Eligibility-Response.pdf

Absolute Total Care (CTOTL)

Eligibility v1.1

If no date is entered, the date of service will default to the current date.

This payer permits use of a National Provider Identifier (NPI) or tax ID as the provider identifier.


Administrative Services, Inc.

Eligibility v1.0

If no date is entered, the date of service will default to the current

date.

This payer permits use of a provider ID or tax ID as the provider identifier.

If you do not enter a service type, service type 30 (Health Benefit Plan Coverage) will be sent with your request.


Advantage by Bridgeway Health Solutions

Eligibility v1.1

Any date on file. If no date is entered, the date of service will default to the current date.



Advantage by Buckeye Community Health Plan

Eligibility v1.0




Advantage by Managed Health Services

Eligibility v1.0




Advantage by Superior HealthPlan

Eligibility v1.1




http://www.emdeon.com/resourcepdfs/PC-v5-Standard-Eligibility-Response.pdf



















Aetna

Subscriber Eligibility v3.2 Dependent Eligibility v3.2


This payer permits use of the provider ID or the tax ID as the provider identifier.

Entry of the subscriber’s or dependent’s date

of birth is required for all subscriber ID searches, unless an eight-character HMO ID was entered as the subscriber ID.

If you do not enter a service type, service type 30 (Health Benefit Plan Coverage) will

be sent with your request. For dental inquiries, enter ADA codes in the Svc/Proc Code field rather than a service type.


Aetna Administrator − Medicare Supplemental



This payer permits use of a tax ID as the provider identifier.


Aetna Better Health of CA

Eligibility v1.0

Any date on file. If no date is entered, the date of service will

default to the current date.

This payer permits use of the National Provider Identifier (NPI) or tax ID as the

provider identifier.


Aetna Better Health of FL

Eligibility v1.1


This payer permits use of the National Provider Identifier (NPI) or tax ID as the provider identifier.


Aetna Better Health of NJ

Eligibility v1.0




Aetna Better Health of KY

Eligibility v1.0




Aetna Better Health of LA

Eligibility v1.0




Aetna Better Health of MD

Eligibility v1.0




Aetna Better Health of MI

Eligibility v1.0



This payer permits use of a National Provider Identifier (NPI) or tax ID as the provider

identifier.


Aetna Better Health of MO

Eligibility v1.0




identifier.

























Aetna Better Health of NV

Eligibility v1.0




Aetna Better Health of PA

Eligibility v1.0




identifier.


Aetna Better Health of VA

Eligibility v1.0


entered, the date of service will


This payer permits use of a National Provider

Identifier (NPI) or tax ID as the provider

identifier.


Response.pdf

Aetna Better Health of WV

Eligibility v1.0




identifier.


Aetna Long Term Care

Eligibility v1.4




Aetna Senior

Supplemental Insurance

Eligibility v1.1




Identifier (NPI) or tax ID as the provider identifier.


Response.pdf

Affinity Essentials



This payer permits use of a National Provider Identifier (NPI), provider ID, or tax ID as the provider identifier.


Affinity Health Plan

Eligibility v1.0


This payer permits use of a National Provider Identifier (NPI) as the provider identifier.


Affinity Health Plan

Medicare

Eligibility v1.0




Identifier (NPI), provider ID, or tax ID as the provider identifier.


Response.pdf

AGIA Inc

Subscriber Eligibility v1.0

Dependent Eligibility v1.0


This payer permits use of a National Provider Identifier (NPI), or tax ID as the provider identifier.


Aflac Dental Insurance




This payer permits use of a National Provider Identifier (NPI), provider ID, or tax ID as the



be sent with your request.



























Aflac - Medicare Supplemental






Alabama Medicaid

Eligibility v2.4

Up to 3 years in the past, future dates not allowed, date span of up to 90 days.

Entry of the patient’s middle initial is required if on file in the payer’s database.

This payer has card swipe capabilities.


All Savers Life Insurance Company





Alliant Health Plans






Allied Benefit Systems, Inc.



date.




Alternative Insurance Resources, Inc.



This payer permits use of a National Provider Identifier (NPI) or tax ID as the provider identifier. Entry if the tax ID is preferred,

but if the NPI is submitted instead, it will be used.


AmeriBen







If you do not enter a service type, service

type 30 (Health Benefit Plan Coverage) will be sent with your request.


American Behavioral Benefit Managers




This payer permits use of the National Provider ID as the provider identifier.





















American Community Mutual




This payer permits use of a provider ID or a tax ID as the provider identifier. This payer has no date of service restrictions, but if a date range is submitted and the member does not have eligibility for the entire range, the response will be Inactive. This payer does not return service types in the response. If a member is active for the

service type requested, the response will indicate that the member has active coverage for 30 (Health Benefit Plan Coverage). The response received is for the service type entered only. For example, if the service type in the request was 35, then the response would apply to dental coverage and

not to medical coverage.

All requests for vision service types will

return the message: “Contact the following Entity for Benefits Information.” Contact

information will follow the message.


American General Life and Accident

Eligibility v1.0




American Health Medicare (Inmediata Health)

Eligibility v1.0


Entry of the provider’s National Provider Identifier (NPI) is required.


American Income Life Insurance Company

Eligibility v1.0




American National Insurance Company






American National Life Insurance Company of

Texas



date.




















American Network Insurance (REHAB) − Medicare Supplemental





American Postal Workers Union








American Retirement Life Insurance Company –

Medicare Supplement

Eligibility v1.0








Americhoice of New

Jersey

Eligibility v2.0




This payer permits use of the National

Provider Identifier (NPI) or tax ID as the



Response.pdf

Amerigroup

Eligibility v2.0





AmeriHealth Caritas

Delaware

Eligibility v1.0

Up to 1,461 days in the past (four

years). Future dates of service are allowed.


Provider Identifier (NPI) or tax ID as the provider identifier.


Response.pdf

AmeriHealth Caritas Iowa

Eligibility v1.0

Up to 1,461 days in the past (four years). Future dates of service are allowed.



AmeriHealth Caritas Louisiana

Eligibility v1.0




AmeriHealth Caritas

Pennsylvania

Eligibility v1.3i

Any past date that is on file, future

dates not allowed.

None. PC-v4-Standard-Eligibility-

Response.pdf






















AmeriHealth Caritas VIP Care Plus

Eligibility v1.0


This payer permits use of the National Provider Identifier (NPI) or Service Provider ID as the provider identifier.


AmeriHealth District of Columbia

Eligibility v1.0


This payer permits use of the National Provider Identifier (NPI) or Service Provider ID as the provider identifier.


AmeriHealth VIP Care

Eligibility v1.0

Up to 1,461 days in the past (four

years). Future dates of service are allowed.


Provider Identifier (NPI) or Service Provider ID as the provider identifier.


Response.pdf

Ameritas Dental Group




This payer supports multiple plans; see “Ameritas Dental Group Plans” on page 77.



Anthem BlueCross of California



Future dates not allowed. This payer supports inquiries to out-of-state plans participating in Blue Exchange.


APS





Archbold Medical Center





Arise Health Plan






identifier.


Arise Health Plan − Medicare Select Policy


























Arizona Medicaid (AHCCCS)

Eligibility v5.0

• The Begin Date of Service must be less than or equal to the current date, and can be 24 months prior to the current date.

• The End Date of Service can be in the past and 30 days in the future from current date.

• Begin Date of Service to End Date of Service span cannot exceed 24 months.

This payer permits use of the National Provider Identifier (NPI), or provider ID as the provider identifier.


Arizona Physicians IPA

Eligibility v2.1

Up to six months in the past, up to 30 days in the future.

This payer permits use of the National Provider Identifier (NPI), provider ID, or tax ID as the provider identifier.


Arkansas Medicaid

Eligibility v3.4

Up to one year in the past, future dates not allowed, begin and end dates can span up to one year and may cross year-end.

Responses are specific both to the date of service and to the provider; for example, long-term care providers may receive different and/or additional data than

providers who are not long-term care

providers.


Associacion de Maestros Puerto Rico

Eligibility v1.0





AVMed

Eligibility v1.3

Up to one year in the past, future dates not allowed.

None. PC-v4-Standard-Eligibility-Response.pdf

Banner Health Plans






Provider Identifier (NPI), provider ID, or tax

ID as the provider identifier.


Response.pdf

Banner University Family Care

Eligibility v1.0




Baptist Health Plan Advantage





BC Complete of Michigan

Eligibility v1.3

Up to 1,461 days (4 years) in the past, future dates not allowed.

This payer permits use of a National Provider Identifier (NPI) or provider ID as the provider

identifier.























BC Idaho



This payer supports inquiries to out-of-state plans participating in Blue Exchange.

Blue Cross of Idaho strongly recommends

not sending service type 30 (Health Benefit Plan Coverage) with your request. It is recommended that you select a specific service type instead, for example, 1 (Medical Care), 35 (Dental Care), or AL (Vision

[Optometry]). When service type 30 is submitted, the payer returns copay and

deductible information for every service type supported.


BC Medicare Advantage

Eligibility v1.0


This payer permits use of a National Provider Identifier (NPI) or Tax ID as the provider identifier.


BCBS Alabama (Benefits)

Benefits v1.6


This transaction returns details about benefits for which the provider is contracted.

The benefit information that is returned in

the response is customized to the provider’s

area of specialization. For example, an orthopedic physician may receive information related to fractures, casts, and equipment. A general practitioner may receive detail on many benefits.

BCBS-Alabama-Benefits-PC.pdf

BCBS Alabama (Eligibility)





Dental providers must enter a procedure

code or a dental service type; hospitals and Shield providers must enter a service type.

The benefit information that is returned in the response is customized to the provider’s area of specialization. For example, an orthopedic physician may receive information

related to fractures, casts and equipment. A general practitioner may receive data on all of the patient’s benefits.






http://www.emdeon.com/resourcepdfs/BCBS-Alabama-Benefits-PC.pdf

http://www.emdeon.com/resourcepdfs/BCBS-Alabama-Benefits-PC.pdf






BCBS Arizona


Past date back to the plan enrollment date, up to 14 days in the future.


If you submit your Legacy provider ID and

not your National Provider Identifier (NPI), you must enter the provider’s tax ID. If you submit your NPI, the tax ID is optional.


BCBS Arkansas


Date of inquiry only. This payer supports inquiries to out-of-state plans participating in Blue Exchange.

Response information is for the date of

inquiry only.


BCBS Colorado


Up to 18 months in the past, future dates not allowed, date span of up

to 18 months.


Dependents may not be submitted as a subscriber, or vice versa.

Include the alpha characters in the member ID.

Open-ended eligibility/benefit periods are

returned with an end date 99991231.

Unlimited quantities are returned as 99999.


BCBS Connecticut


Up to 18 months in the past, future dates not allowed, date span of up to 18 months.



This payer requires entry of full first and last names where possible. For hyphenated names, the hyphen can be removed. Do not replace the hyphen with a space.

Open-ended eligibility/benefit periods are returned with an end date 99991231.

Unlimited quantities are returned as 99999.


BCBS Delaware (Highmark)



This payer permits use of the National Provider Identifier (NPI) as the provider identifier.


BCBS District of Columbia



This payer supports inquiries to out-of-state plans accessing the Blue Exchange network.


















BCBS Florida


Date of inquiry only. This payer supports inquiries to out-of-state plans accessing the Blue Exchange network.

The last and first names are recommended

for out-of-state plans.


BCBS Georgia




Entry of the inquiring provider’s Q-Care

License Number or National Provider Identifier (NPI) is required.


BCBS Illinois


Up to two years in the past, future dates not allowed.


This payer responds with eligibility/benefit information for the current date only. If the date of service submitted is prior to the most recent policy change, this payer responds

with the error message RH0629 - Date of Service Not Within Allowable Inquiry

Period.

For more detailed benefit responses, enter the provider type and facility type.


BCBS Indiana







BCBS Iowa






This payer permits use of the National Provider Identifier (NPI), provider ID, or tax



BCBS Kansas


Up to two years in the past, future dates up to the end of the current

month.



BCBS Kansas City


Up to two years in the past, future dates up to the end of the current month.




















BCBS Kentucky




Dependents may not be submitted as a

subscriber, or vice versa.


BCBS LA Medicare Advantage




This payer supports entry of the National

Provider ID or the Federal Tax ID.


BCBS Louisiana




The patient’s first name is optional. However, if a patient has siblings with the same birth date (twins, triplets, etc.), it is recommended that the child’s first name be entered. This will help to retrieve a response that shows

the amount of the deductible that has been met by this specific patient.

BCBS-Louisiana-Eligibility-PC.pdf

BCBS Maine





BCBS Maryland




This payer supports entry of the provider ID or the tax ID.


BCBS Massachusetts




This payer permits use of a National Provider Identifier (NPI) or provider ID as the provider identifier.






http://www.emdeon.com/resourcepdfs/BCBS-Louisiana-Eligibility-PC.pdf

http://www.emdeon.com/resourcepdfs/BCBS-Louisiana-Eligibility-PC.pdf










BCBS Michigan


Date of inquiry only. This payer supports inquiries to out-of-state plans accessing the Blue Exchange network.

Entry of the patient’s first and last names is

required for non-BCBS of Michigan members. Entry of the group number is required if there are multiple policies on file for the patient; otherwise, it is optional.

The Payer ID that you use is dependent upon

which of the two Emdeon Submitter IDs you registered with your BCBS of Michigan Provider ID with the payer. If you registered your BCBS MI Provider ID under Emdeon

Submitter ID C0DOQ (Professional), you may use the following Payer IDs:

Professional – 00710P

Vision – 00710V Hearing – 00710H FEP – 00710W

If you registered your BCBS MI Provider ID under Emdeon Submitter ID 521409791 (Institutional), you may use the following Payer IDs:

Institutional – 00210I Dental – 00710D

If you use the wrong Payer ID for your registration with BCBS of Michigan, error messages Invalid Provider Number Was Submitted On Request and RH0502 -

Invalid/Missing Provider ID are returned in the response. You will need to confirm with BCBS Michigan whether you are registered under Emdeon’s Submitter ID(s) as a Professional or as an Institutional Provider. BCBS Michigan Provider Enrollment can be reached at 800-822-2761 for

Professional Providers or at 800-777-2118 for Institutional Providers.


BCBS Minnesota


Up to one year in the past, future

dates not allowed.

This payer supports inquiries to out-of-state

plans accessing the Blue Exchange network.


Response.pdf








BCBS Mississippi


Up to one year in the past, future dates not allowed, date span of up to 31 days.

The subscriber ID is printed on the patient’s card with a three-character prefix. Do not enter the prefix in the Subscriber ID field.


BCBS Missouri




Dependents may not be submitted as a subscriber, or vice versa. Include the alpha

characters in the member ID.


BCBS Nebraska


Up to 24 months in the past, future dates not allowed, date span of up to 90 days.


Entry of the facility type is optional but highly recommended.


BCBS Nevada





Include the alpha characters in the member

ID. Open-ended eligibility/benefit periods are returned with an end date 99991231.


BCBS New Hampshire







BCBS New Jersey (Horizon)



Up to two years in the past to January 1, future dates not allowed.

For example, if the current year is

2011, you can inquire back to January 1, 2009.



Identifier (NPI) only as the provider

identifier.


BCBS New Mexico




This payer responds with eligibility/benefit information for the current date only. If the

date of service submitted is prior to the most recent policy change, this payer responds with the error message RH0629 - Date of Service Not Within Allowable Inquiry

Period.




















BCBS New York Empire


Up to two years in the past to January 1, future dates not allowed. For example, if the current year is 2010, you can inquire back to January 1, 2008.



BCBS North Carolina



Up to three years in the past. Date of inquiry will be used if a future date is submitted.


For subscriber or dependent searches, the

Subscriber ID must be submitted exactly as it appears on the patient’s membership ID card, including alpha prefixes and numeric suffixes. Numeric suffixes are used to uniquely identify dependents who share

some portion of the Subscriber ID.



BCBS North Dakota


Up to 30 days in the past. If the current date is the first through the

fifteenth of the month, the payer

allows inquiries up to the last day of the current month. If the current date is the sixteenth to the end of the month, the payer allows inquiries through to the last day of the next month.




BCBS Ohio






BCBS Oklahoma






BCBS Oregon (Regence)




















BCBS Pennsylvania (Highmark)



Up to two years in the past, up to six months in the future, although date of inquiry will be used for future dates.


The following service types entered in the

request produce eligibility/benefit response information under the service type 1 (Medical Care):

10, 23, 24, 25, 26, 27, 28, 32, 35, 36, 37, 38, 39, 41, 60, 85, 87, AA, BA, BJ, BK, BL,

BM, BN, BP, BQ, BR

See Appendix B: Service Types for descriptions and abbreviations.


BCBS Rhode Island



Up to one year in the past Date of inquiry will be used if a future date is submitted.


Entry of the gender is optional but highly recommended.


BCBS South Carolina


Dependent Eligibility v1.1 Subscriber Detailed Benefits

v1.1 Dependent Detailed Benefits v1.1

Up to three years in the past, up to one year in the future.


Eligibility:

The Eligibility inquiries return general responses indicating a status of Active or Inactive for Medical, Dental, Pharmacy, or

Vision coverage.

Detailed Benefits:

The Detailed Benefits inquiries return extensive benefit details based on a specific service type or procedure code. If detailed

benefits cannot be determined, the payer will

return a general eligibility response for Medical, Dental, Pharmacy, or Vision coverage. This does not necessarily indicate that the specific service is covered.

(Continued)











BCBS South Carolina


Subscriber Detailed Benefits v1.1 Dependent Detailed Benefits v1.1

(Continued)

Up to three years in the past, up to one year in the future.

This payer uses the Billing Provider ID to determine if the provider is part of the BCBS network. If network matching occurs, the response may display only the applicable in-network or out-of-network benefits. If the performing and billing providers are the same, then the provider should be submitted as both performing and billing for network

matching to occur. If network matching does not occur, benefits for both billing and performing providers are returned.

Entry of the Performing Provider Specialty (taxonomy code) is recommended to ensure network matching occurs and detailed benefits are returned.

If the performing provider is not on file at the payer, and the performing provider’s specialty is invalid or omitted, this payer

attempts to provide detailed benefits based

on the service type, procedure code, diagnosis code, and/or facility type.

The performing provider must be on file at the payer as the patient's primary care physician in order to receive PCP level benefits in managed care.

Misspelled names can prevent patient matching even if the date of birth is correct. Entry of the patient name is not required for

local inquiries, but may be required for Blue Exchange transactions.


BCBS South Dakota


Up to one year in the past, up to 30 days in the future.




BCBS Tennessee


Up to 30 days in the future. This payer supports inquiries to out-of-state plans accessing the Blue Exchange network.

First character of the subscriber ID is

alphabetic.











BCBS Texas




This payer responds with eligibility/benefit

information for the current date only. If the date of service submitted is prior to the most recent policy change, this payer responds with the error message RH0629 - Date of Service Not Within Allowable Inquiry

Period.



BCBS Texas-Medicaid





BCBS Vermont


Date of inquiry only. This payer permits use of a provider ID or a tax ID as the provider identifier.


BCBS Virginia





BCBS Wisconsin






BCBS Wyoming



Up to 30 days in the past. If the current date is the first through the

fifteenth of the month, the payer allows inquiries up to the last day of the current month. If the current date is the sixteenth to the end of the month, the payer allows

inquiries through to the last day of the next month.


This payer permits use of a provider ID or a

tax ID as the provider identifier.


Behavioral Health Systems
























Benefit Management Inc.





Better Health

Eligibility v1.0




Better Health Plans of

Tennessee

Eligibility v1.3


dates not allowed.

Emdeon MAX users with a modem connection

can have the system automatically query this payer following TennCare eligibility transaction when this payer is identified as

the patient’s MCO in the TennCare response. See the Auto MCO topic your Emdeon MAX User’s Guide or online help for details.


Response.pdf

BlueChoice HealthPlan of South Carolina Medicaid

Eligibility v1.1

Up to 18 months in the past, future dates not allowed.

Entry of the patient’s gender is optional but highly recommended.



BlueCross BlueShield of

Western New York Medicaid/CHP

Eligibility v1.0




Identifier (NPI) only as the provider identifier.


Response.pdf

Bluegrass Family Health

Eligibility v2.0


This payer permits use of a National Provider Identifier (NPI) only as the provider identifier.


Boon Group





Bridgeway Health Solutions (Arizona)

Eligibility v1.0




BS California






BS Washington (Regence)





























Buckeye Community Health

Eligibility v2.0




California Medicaid (Medi-Cal)

Eligibility v2.3



When a patient presents a Medi-Cal Benefits

Identification Card, you must verify the patient’s eligibility status before you submit a

claim. (Benefits Identification Cards are not a guarantee of Medi-Cal eligibility because they are a permanent form of identification and patients retain the card even if they are not eligible for Medi-Cal during the current month.)

When you submit an eligibility transaction, Emdeon accesses the Medi-Cal Eligibility Data System (MEDS) to determine patient

eligibility information. Once you have correctly verified patient eligibility and used the same provider number, subscriber ID, and date of service for the claim as used for the eligibility inquiry, the claim will not suspend or be denied for eligibility.



Capital BlueCross



Up to one year in the past, up to six months in the future.




Capital District Physician’s Health Plan

Eligibility v1.0

Date cannot be greater than current day and 1 year in the past.



Care1st Health Plan Arizona

Eligibility v1.0




identifier.


Care Improvement Plus

Eligibility v1.0



















CareFirst Administrators





CarePlus Health Plan

Eligibility v1.3




CarePoint Medicare

Advantage

Eligibility v1.0




Identifier (NPI)or tax ID as the provider identifier.


Response.pdf

CareSource Health

Eligibility v1.0


This payer permits use a National Provider Identifier (NPI) or tax ID as the provider identifier.


Carpenters Health and Welfare Trust Fund of St Louis






CareSource

Eligibility v3.2


None. CareSource-Eligibility-PC.pdf

CDS Group Health



This payer permits use of a National Provider Identifier (NPI), provider ID, or the tax ID as the provider identifier.



Celtic Insurance






CeltiCare

Eligibility v1.1














http://www.emdeon.com/resourcepdfs/CareSource-Eligibility-PC.pdf

http://www.emdeon.com/resourcepdfs/CareSource-Eligibility-PC.pdf










Cenpatico

Eligibility v1.1

Any date on file. You may enter a range of service dates, but the payer uses the current date of service in the request.

This payer supports multiple plans; see “Cenpatico Plans” on page 77.


Identifier (NPI), provider ID, or the tax ID as the provider identifier.


Central Reserve Life Insurance Company ―

Medicare Supplement

Eligibility v2.0







Central States Funds









Chesterfield Resources

Inc






Identifier (NPI), or tax ID as the provider

identifier.


Response.pdf

Christian Brothers Services






Christie Student Health Plans

Eligibility v1.0




CHRISTUS Health Plan Medicaid

Eligibility v1.0




CHRISTUS Health Plan New Mexico Health Insurance Exchange

























CHRISTUS Health Plan NM MA

Eligibility v1.0




Cigna


Up to 18 months in the past and 30 days in the future.




The service type entered must be appropriate for the line of business (medical,

dental, or behavioral) for which you are inquiring, per the following

Medical Line of Business Codes

1, 2, 3, 4, 6, 7, 8, 10, 12, 13, 17, 19, 20, 30, 33, 42, 45, 46, 47, 48, 49, 50, 51, 52, 53,

56, 61, 62, 64, 67, 68, 69, 70, 71, 72, 73,

74, 75, 76, 78, 79, 80, 81, 82, 83, 84, 88, 90, 91, 92, 93, 96, 97, 98, A0, A3, A9, AC, AD, AF, AG, AL, AM, AN, AO, AR, BD, BF, BG, BH, BK, BL, BN, BQ, BR

Dental Line of Business Code

35

Behavioral Line of Business Codes

5, 9, 22, 49, 59, 86, 99, A2, A4, A5, A6, A7,

A8, AA, AI, AJ, AK, BB, BC

See Appendix B: Service Types for code

descriptions and abbreviations.



CMFG Life Insurance





Colorado Access



This payer permits use of a National Provider Identifier (NPI) or a tax ID as the provider identifier.















Colorado Medicaid

Eligibility v2.4


This payer has card swipe capabilities. PC-v4-Standard-Eligibility-Response.pdf

Community Care of Oklahoma





Community Health Plan of

Washington








Response.pdf

Concentrix Insurance Solutions



This payer permits use of a National Provider Identifier (NPI), provider ID, Social Security number, or tax ID as the provider identifier.


Connecticare Inc





Connecticut Medicaid

Eligibility v1.4



Consolidated Associates Railroad







Consumer Mutual of Michigan

























Continental General Insurance Company ― Medicare Supplement

Eligibility v2.0





Cooperative Benefit Administrators









CoreSource



This payer supports multiple plans; see “CoreSource Plans” on page 77.

This payer permits use a National Provider Identifier (NPI), provider ID, or tax ID as the





CountyCare

Eligibility v1.0




Coventry

Eligibility v2.1

Up to 18 months in the past, up to three months in the future, date span of up to 21 months.

This payer supports multiple plans; see “Coventry Plans” on page 78.


Coventry/Dentex Dental







identifier.


Response.pdf

CREATE

Eligibility v1.0




Crystal Run Health Plan
























CSA Fraternal Life ― Medicare Supplement

Eligibility v1.1






DAKOTACARE Administrative ServicesEligibility v1.0




identifier.


Dean Health Plan

Eligibility v1.1

Up to seven days in the future. If no date is entered, the date of

service will default to the current date.



Delaware Medicaid

Eligibility v1.0

Payer accepts a date of service range. No future dates.



Dell Childrens Health Plan

Eligibility v1.0




Dentaquest Government Payer WI

Eligibility v1.0




District No. 9, I. A. of M. & A. W. Welfare Trust






Response.pdf

District of Columbia Medicaid

Eligibility v3.4



Diversified Administration Corp





Response.pdf

Driscoll Health Plan

Eligibility v1.0




EBMS






























Elderplan

Eligibility v1.0




Emblem Health

Eligibility v2.0



This payer permits use of the National Provider Identifier (NPI) as the provider

identifier.


Epic Life Insuranace







identifier.


Response.pdf

Essence Healthcare

Eligibility v2.0





Evergreen Health







Everence Financial






Excellus BlueCross BlueShield


Any date on file. Future dates not allowed.



Fallon Community Health Plan

Eligibility v2.0

Current date of service only. This payer permits use of the tax ID only.



Farm Bureau Health Plans






Federated Insurance Company





























Fidelis Care New York

Eligibility v1.0




First Carolina Care

Eligibility v1.0



This payer requires use of the National Provider Identifier (NPI) the provider

identifier.


First Choice VIP Care Plus

Eligibility v1.0

Date cannot be greater than current

day & 1461 days in the past (4

years).


Provider Identifier (NPI) or Service Provider



Response.pdf

First Community Health Plan

Eligibility v1.0






First United American Insurance Company

Eligibility v1.0

















Florida Medicaid

Eligibility v3.4


The dates of service you enter in the request determine the type of response you will receive.

If you inquire for a single date of service (beginning and end dates are the same), the Eligibility/Benefits segment will contain details about the patient’s eligibility on the date of service.

If you inquire for a date of service range, Florida Medicaid will return up to nine Eligibility/Benefit segments, one for each period of eligibility within the date of service

span. The Eligibility/Benefit segments will be summarized. For those users who are familiar with the Florida Medicaid proprietary transactions, this type of response will resemble the Span transaction.

In short, use date spans to identify periods of

eligibility, and a single date of service to retrieve detailed eligibility and benefit information for a specific date.


Response Details

Benefit and Utilization Limit Information

For single date of service inquiries, the following benefit utilization and limit information will be returned (if in the patient’s file):

(Continued)







Florida Medicaid

Eligibility v3.4

(Continued)


Inpatient days limit

Inpatient days used

Outpatient dollar limit

Outpatient dollars used

Last hearing aid date

Last glasses date

Child Health Check-Up (CHCUP) screen

date

Applicable Dollar Amount or Percentage

With a service type of Hospital—Outpatient, an insurance type of Medicaid, and a time period of Service Year, the dollar amount

shown is the approved amount.

With a service type of Hospital—Outpatient, an insurance type of Medicaid, and a time

period of Exceeded or Not Exceeded, the dollar amount shown is the amount used.

For spenddowns, the patient’s remaining share of cost will appear.

Benefit-Specific Eligibility Dates

In the case of the last CHCUP screen date,

the most recent screen date appears.

In the case of the last hearing aid date or

last glasses date, the date represents the most recent date of issue.


Food Employers & Bakery

& Confectionery Workers

Benefit Fund of Southern California






Provider Identifier (NPI) or tax ID as the



Response.pdf

Fresenius Health Partners

Eligibility v1.0













Georgia Medicaid

Eligibility v5.4


Entry of the provider ID is optional if you are using your payer-assigned ID; entry is required if you are using your NPI and have registered the number with Georgia Medicaid. This payer has card swipe capabilities.


Globe Life and Accident Insurance Company

Eligibility v1.0






G.M.P. Employers Retiree Trust

Eligibility v1.0




Golden Rule


Up to six months in the past, up to 30 days in the future.



Government Employees

Hospital Association (GEHA)





Provider Identifier (NPI), provider ID, or tax ID as the provider identifier.

Entry of the Member ID field can be either the patient’s GEHA member ID number or the patient’s Social Security number.


Response.pdf

Great American Life Assurance Company ― Medicare Supplement

Eligibility v1.0





Great American Life Insurance Company ― Medicare Supplement

Eligibility v2.0






















Great-West Healthcare

Eligibility v1.3

Up to 18 months in the past, future dates not allowed.


This payer recommends that you use one of

the following service type codes in your request:

1, 35, AL

See Appendix B: Service Types for code descriptions and abbreviations.


Group and Pension Administrators Inc.





Group Dental Service





Harmony Health Plan (WellCare of Florida)

Eligibility v1.0

Up to two years in the past. This payer permits use of a provider ID or a tax ID as the provider identifier.


Harvard Pilgrim Health Care

Eligibility v1.2


You can enter a partial first name. For example, a partial first name of Jo will match Joe, Joseph, or Josephine. However, an

exact first name of Joe will not match a first name of Joey or a combined first name and middle initial of Joe B.

The last name must match exactly, including any suffix, hyphen, or apostrophe. For

example, Smithers Jackson will not match Smithers-Jackson and James will not match James Sr.


Hawaii Medicaid

Eligibility v1.7

Future dates not allowed, date span of up to 30 days.

Hospital providers can search for dates of service further back than one year in the past.

Non-hospital providers must search for dates of service within the past

year.

Entry of the patient’s middle initial is required if on file in the payer’s database. If the patient’s first or last names have a special character such as an apostrophe, a

hyphen, or a space (for example, O’Hara, Smith-Jones, La Toya), try searching with and without the special characters or space.


Hawaii-Medicaid-Eligibility-PC.pdf











http://www.emdeon.com/resourcepdfs/Hawaii-Medicaid-Eligibility-PC.pdf

http://www.emdeon.com/resourcepdfs/Hawaii-Medicaid-Eligibility-PC.pdf




Hawaii Medical Service Association



Any date on file, up to 90 days in the future.

If no date is entered, the date of




Health Alliance of Illinois

Eligibility v1.0

Payer accepts a date of service range. No future dates.



Health Alliance Plan

Eligibility v1.3

In the past to 1996, future dates not allowed.


Health Choice of Arizona

Eligibility v2.2



This payer permits use of the National Provider Identifier (NPI) or the tax ID as the





Health First Health Plan






Provider Identifier (NPI) or the tax ID as the



Response.pdf

Health First Insurance



This payer permits use of the National Provider Identifier (NPI), provider ID, or the tax ID as the provider identifier.


Health Partners MN

Eligibility v1.0




Health Partners of

Philadelphia

Eligibility v1.3




Response.pdf

Health Services for Children with Special Needs

Eligibility v1.0






Health Share of Oregon

Eligibility v3.0




























HEALTHe Exchange





HealthEase (WellCare of Florida)

Eligibility v1.0



HealthEase Kids

(WellCare of Florida)

Eligibility v1.0

Up to two years in the past. This payer permits use of a provider ID or a



Response.pdf

HealthEZ





Healthfirst of New Jersey

Eligibility v2.2



Healthfirst of New York

Eligibility v2.2




Response.pdf

HealthNet National

Eligibility v1.2

Up to 12 months in the past, future dates up to the last day of the current month, date span of up to 12 months in the past to the last day of the current month.

You must enter the suffix for an ID search. If you do not enter the ID suffix, you will receive error message CL0003 – Insufficient Information to Complete a Search.

If you do not know the suffix, perform an ID/Social Security number/date of birth or an ID/name/date of birth search instead.


HealthPlus of Michigan

Eligibility v1.3

Up to one year in the past, up to 60 days in the future, date span of up to 60 days.


HealthSmart Benefit Solutions





HealthSmart Benefit Solutions − WV





identifier.

























HealthSpring

Eligibility v2.0




Healthy Blue Louisiana

Eligibility v1.0





Highmark BCBSD Health

Options

Eligibility v1.0





Identifier (NPI) as the provider identifier.


Response.pdf

HMA (Hawaii Mainland Admin)





Horizon New Jersey Health

Eligibility v1.3

Any date in the past on file, future dates not allowed.


HSBS Oklahoma City




This payer permits use of a National Provider Identifier (NPI) or the tax ID as the provider

identifier.


Humana

Eligibility v2.3

Up to two years in the past, future dates up to one year based on the member’s date of renewal restriction.


Information on as many as five family members can be returned in a single response.


IBEW Local 508 Health

Plan





Identifier (NPI) or the tax ID as the provider identifier.


Response.pdf

Idaho Medicaid

Eligibility v1.2

Up to one year in the past, future dates not allowed, date span of up to one year.

Patient eligibility is determined on a month-to-month basis. For example, a patient may be eligible during the months of April and June, but ineligible during May.



IlliniCare Health Plan

Eligibility v1.1




identifier.

























Illinois Medicaid

Eligibility v6.2

Any date on file, date span of up to 94 days.

This payer has combined the former eligibility and pending eligibility transactions into a single eligibility transaction. The service type code is used in the request to differentiate between eligibility and pending eligibility: enter 30 for an eligibility request and 32 for a pending eligibility request.



Once a recipient has been assigned a recipient ID, the recipient’s record will no

longer be in the pending eligibility database. If you search by recipient ID and service type of 32 (pending eligibility), the recipient’s record will not be found. You will receive the following error message: RH0247 – Patient Not Found. Search for the recipient’s

eligibility status using a service type of 30.

Pending Eligibility Responses

Application Still Pending

If a patient’s application for Medicaid is still pending, the Eligibility/Benefit portion of the response will appear as follows:

First Eligibility/Benefit Segment:

Eligibility type Inactv Coverage type Individual Service type Health Bene Plan Cvg

Second Eligibility/Benefit Segment:

Eligibility type Inactv – Pending Elig Update Coverage type Individual Service type Plan Waiting Period Date of the last update to the record

(Continued)







Illinois Medicaid

Eligibility v6.2

(Continued)

Any date on file, date span of up to 94 days.

Application No Longer Pending

If a patient’s application for Medicaid is no longer pending—for example, it has been

approved or denied—the Eligibility/Benefit portion of the response will appear as follows::

First Eligibility/Benefit Segment:

Eligibility type Inactv

Coverage type Individual Service type Health Bene Plan Cvg Second Eligibility/Benefit Segment:

Eligibility type Non-Cvd Coverage type Individual Service type Plan Waiting Period Date of the last update to the record

You must submit the transaction using service type 30 to determine whether the patient has become Medicaid-eligible.


Independence Blue Cross




The provider ID can be either the provider’s NPI or the provider’s federal tax ID with a leading zero (0).


Indiana Medicaid

Eligibility v3.5

Future dates not allowed. Date span of up to 31 days, within the same month and year.

Entry of the service type is optional. However, entry of a service type allows you to whether benefit limits have been exceeded. For example, a provider wishing to

confirm Durable Medical Purchase would

enter a service type code of 12. If the benefit limit has been exceeded, the response will include a Limitations Eligibility/Benefit type. If benefit limits have not been exceeded, this payer will return basic Health Benefit Plan Coverage information.



Inland Empire Health

Plan

Eligibility v2.2


dates not allowed.


Response.pdf












Inter Valley Health Plan

Eligibility v2.2


When searching by name/date of birth, you must enter the patient’s full last name. If the patient’s last name has more than 13 characters, you will not find a matching record in the database. You must use a different search type.


International Medical Card

Eligibility v1.0



This payer permits use a National Provider Identifier (NPI) as the provider identifier.


Iowa Medicaid

Eligibility v2.4

Up to three years in the past, future dates not allowed.


Island Home Insurance

Eligibility v1.0




Johns Hopkins HealthCare

Eligibility v1.2

Up to two years in the past, future dates not allowed. If no date is entered, the date of service will




Johns Hopkins HealthCare LLC

Eligibility v1.0




Johns Hopkins US Family Health Plan





Kaiser Foundation Health

Plan of Colorado

Eligibility v2.1




This payer permits use of the provider’s

National Provider Identifier (NPI), provider

ID, or tax ID as the provider identifier.




Response.pdf

Kaiser Foundation Health Plan of Hawaii

Eligibility v2.0

























Kaiser Foundation Health Plan of Hawaii (DHMO/CHOICE)






Kaiser Foundation Mid-Atlantic

Eligibility v2.1



This payer permits use a National Provider Identifier (NPI), provider ID, or tax ID as the



Kaiser Foundation Health Plan of Northwest

Eligibility v2.1




Kaiser NW Dental





identifier.


Kaiser Permanente Insurance Company KPIC





identifier.


Kaiser Permanente of Georgia

Eligibility v2.0




Kaiser Permanente of Northern California

Eligibility v2.1



This payer permits use of the provider’s National Provider Identifier (NPI), provider

ID, or tax ID as the provider identifier.


Kaiser Permanente of

Southern California

Eligibility v2.1



This payer permits use of the provider’s

National Provider Identifier (NPI), provider ID, or tax ID as the provider identifier.


Response.pdf

KanCare-UnitedHealthcare Community Plan Kansas

Eligibility v1.0

Up to 18 months in the past. End date of date range must be no greater than the end of the current month.

This payer permits use of the provider’s National Provider Identifier (NPI) as the provider identifier.


Kansas Medicaid

Eligibility v3.5


























Kempton Company



This payer permits use of the provider’s National Provider Identifier (NPI) or tax ID as the provider identifier.



Kentucky Medicaid

Eligibility v5.3



Kentucky Spirit Health Plan

Eligibility v1.0





Key Benefit Administrators







Key Benefit Administrators (Indianapolis, IN)





Keystone First

Eligibility v1.3

Future dates not allowed. None. PC-v4-Standard-Eligibility-

Response.pdf

Keystone VIP Choice

Eligibility v1.0

Date cannot be greater than current day & 1461 days in the past (4 years).

This payer permits use of a National Provider Identifier (NPI) or Service Provider ID as the provider identifier.


L.A. Care.





Leon Medical Centers Health Plan, Inc.

Eligibility v1.0




identifier.























Liberty National Life Insurance Company

Eligibility v1.0




LifeCare Assurance Company



This payer permits use of a Federal Tax ID as the provider identifier.


Lincoln Financial






Louisiana Healthcare Connections

Eligibility v1.0

















Louisiana Medicaid

Eligibility v2.4

Up to one year in the past, future dates up to and including the last day of the current month.

When performing searches that involve the patient’s name, you must enter the name exactly as it is spelled on the Louisiana plastic swipe card, so that it will match the state’s files. The first and last name entries must include any special characters such as hyphens, commas, apostrophes, and spaces (excluding asterisks).

Some patients may be currently covered by one of the following programs but have not

been issued a Louisiana plastic swipe card (hard card):

SOBRA presumptive eligible.

Illegal/ineligible aliens (emergency services).

Long term care (type-case 16-Certification of Long Term Care eligible applicants who

die before their certification can be

processed).

Since these patients do not have a hard card, you can verify their eligibility status by using other search methods, such as a name and date of birth search or a Social Security number and date of birth search.



Loyal American Life ― Medicare Supplement

Eligibility v2.0





Maine Community Health Options





Magnolia Health Plan

Eligibility v1.0



This payer permits use of the provider’s National Provider Identifier (NPI) or a tax ID

as the provider identifier.













MagnaCare





MaineCare (Maine Medicaid)

Eligibility v2.0




Managed Care of America



Past dates of service up to January

1, 2011. Future dates and date spans are not allowed.

Entry of the provider’s National Provider

Identifier (NPI) is required.


Response.pdf

Managed Health Network (MHN)





identifier.


Managed Health Services - Indiana






MAPFRE Life Puerto Rico

Eligibility v1.0





MAPFRE Medicare Excel

Eligibility v1.0






Maricopa Care Advantage

Eligibility v1.2




Maricopa Health Plan (Arizona)



This payer permits use of the provider’s National Provider Identifier (NPI) or a tax ID as the provider identifier.



Maryland Medicaid

Eligibility v2.2



























Maryland Physicians Care

Eligibility v1.0

A range of dates is acceptable, but Centene only looks up based on current date.



Massachusetts Medicaid (MassHealth)

Eligibility v1.4



This payer’s member ID can be found on the patient’s hard card and consists of the first

nine characters of the number to the right of the patient’s name.


MDWISE Exchange





MDWISE Medicaid Health Plans

Eligibility v1.0




Med-Pay, Inc.






Medi-Share





identifier.


MedBen Newark OH


Payer supports a single date of service only. Any date on file can be submitted.



Medica


Up to one year in the past. None. PC-v4-Standard-Eligibility-Response.pdf

Medica Health Plans

Eligibility v1.1




Medica2





Medical Associates Health Plan/Health Choices































Medical Card System

Eligibility v1.0




Medical Mutual of Ohio (MMO)


Up to two years in the past, up to one year in the future. If no date is


This payer permits use of a National Provider Identifier (NPI) or a tax ID as the provider

identifier.


type 30 (Health Benefit Plan Coverage) will










Medicare Part A & B

Eligibility v2.8

Up to 12 months in the past, future dates up to four months, based upon the date the transaction was received. If no dates are entered, the dates of service will default to the current date.


General Information

This transaction returns both Part A and Part B information. Part A and B providers can

access this transaction for eligibility.

Medicare Part A helps cover inpatient care in

hospitals, critical access hospitals, and skilled nursing facilities. It also covers hospice care and some home health care.

Medicare Part B helps cover these services when they are medically necessary: doctors’ services, outpatient hospital care, some of the services of physical and occupational therapists, and some home health care.

The Medicare HIPAA Eligibility Transaction System (HETS) will be loaded from the

common working files. HETS may be behind

the Medicare common working files by at least 24 hours. Claims to Medicare should be submitted using the HETS information returned with this transaction.

Railroad beneficiaries are accessible through this transaction.


Service Types

CMS supports all Service Type codes.

HCCPS Codes

HCPCS Codes are accepted. Supported

codes are listed in the user interface.

Current versus Historical Data

The response returns only the spell data that has occurred within 60 days prior to the date of service. To receive historical spell

information, you must enter a date of service within 60 days of the spell date, or the date of service span must cover the spell date.

Hospital Days Remaining

If the inquiry is for the current date of service (the date on which the transaction was submitted), the number of hospital days remaining will be valid as of the current day. If your inquiry is for a prior date of service,







Medicare Part A & B

Eligibility v2.8

(Continued)

Up to 12 months in the past, future dates up to four months, based upon the date the transaction was received. If no dates are entered, the dates of service will default to the current date.

Hospital Days Remaining

If the inquiry is for the current date of service (the date on which the transaction

was submitted), the number of hospital days remaining will be valid as of the current day. If your inquiry is for a prior date of service, or if the date span extends into the past, the number of hospital days remaining will be

valid as of the admission date shown in that segment.

HMO Enrollment

If the beneficiary has had HMO enrollment, the HMO information will appear in the response only if the beneficiary’s HMO enrollment period is active or if the

requested date span covers the HMO end date. For example, if a beneficiary was enrolled in an HMO from January 1, 2010

through December 31, 2012, the HMO information will appear on the response only if your beginning or ending dates of service

fall on or between January 1, 2010 and December 31, 2012.

Incarceration

If the patient is incarcerated during the date span submitted, then the person is ineligible.


Medicare y Mucho Mas

Eligibility v1.0





Meridian Health Plan of Illinois

Eligibility v1.0





Meritain Health





Provider Identifier (NPI) only as the provider identifier.


Response.pdf












Meritus Health Partners





MetLife








MetroPlus Health Plan



Entry of the provider’s National Provider Identifier (NPI) and tax ID is required.

MetLife highly recommends entry of the subscriber’s group number.


Michigan Medicaid

Eligibility v3.0

A single date of service or a date of service range of up to three months.

Up to one year in the past, future dates up to the end of the current

month.

Enter the requesting provider’s National Provider Identifier (NPI) or provider ID.



Michigan MIChild

Eligibility v2.5


month.

Enter the requesting provider’s National Provider Identifier (NPI), or for HIPAA-

exempt providers, their seven-digit Michigan provider ID.



Minnesota Medicaid

Eligibility v4.1


dates not allowed.




Response.pdf

Mississippi Medicaid

Eligibility v4.3






















Mississippi State Employees’ Health Plan (SEHP)

Eligibility v1.7



About License Numbers

Entry of the ordering provider’s MMIS provider ID or the License Number is optional. However, depending on the requesting provider’s classification with New

York Medicaid, it may be necessary for you to enter this information.

When using a License Number as a provider identifier for eMedNY Phase II, the New York State Department of Education (NYSDOH) additionally requires a three-digit Profession Code as a prefix. The codes are a subset of the two-digit Profession Codes assigned by NYSDOH and the Office of the Professions

when it issues professional licenses. A leading zero is added to the left to create the NYSDOH three-digit Profession Code, and, for

NYS licensed providers, two more zeros must follow between the Profession Code and the License Number.

An exception exists for services of a NYS licensed Privileged Nurse Practitioner or

Privileged Midwife. In these two cases, a value of 0F must be inserted between the Profession Code and License number instead of the two zeros. All out-of-state licenses must be formatted with the two-letter State,

District of Columbia, or US Territory Code as assigned by the United States Postal Service

in place of the 00 or 0F values.

When entering a license number in the

Ordering Prov ID field, omit the leading zero of the Profession Code. Emdeon will insert the leading zero before sending the request to New York Medicaid.

Mississippi-SEHP-Eligibility-PC.pdf

Missouri Medicaid

Eligibility v5.3


month, date span of up to 31 days.

The Case DCN is the dependent’s casehead ID number or Medicaid DCN number.



http://www.emdeon.com/resourcepdfs/Mississippi-SEHP-Eligibility-PC.pdf

http://www.emdeon.com/resourcepdfs/Mississippi-SEHP-Eligibility-PC.pdf






MMSI







Molina Healthcare

Eligibility v2.0



This payer supports multiple plans; see “Molina Healthcare Plans” on page 79.



Molina Healthcare of New Mexico

Eligibility v1.3




Molina Healthcare of Virginia

Eligibility v1.0




Montana Medicaid

Eligibility v2.3


dates not allowed. This payer has card swipe capabilities. PC-v4-Standard-Eligibility-

Response.pdf

Molina of Puerto Rico





Mountain State


Up to two years in the past, up to six months in the future.


Municipal Health Benefit Fund





identifier.


Mutual Health Services





Mutual of Omaha






























MVP Health Care (New York)

Eligibility v1.3



National Association of Letter Carriers (NALC)





National Claims Admin Services





Nebraska Medicaid

Eligibility v1.1


This payer permits use of a National Provider Identifier (NPI), or a service provider ID as the provider identifier.


Network Health Plan

Eligibility v1.1



This payer permits use of a National Provider Identifier (NPI), provider ID, or a tax ID as

the provider identifier.



Nevada Medicaid

Eligibility v2.2

Up to one year in the past, up to five days in the future, date span of up to one calendar month.


New Era Life Insurance Company





This payer includes the following plans under the same payer ID:

• New Era Life Insurance Company of the Midwest

• Philadelphia American Life Insurance Company


New Hampshire Medicaid

Eligibility v1.5

Up to one year in the past, future dates not allowed. Date span of up to one month.
























New Jersey Medicaid

Eligibility v5.3

Up to 24 months in the past, future dates up to the end of the current month, date span of up to three months.

Only hospital providers are allowed to use name/date of birth and Social Security number/name searches. An error is returned if a non-hospital provider attempts these search types.



New Mexico Health Connections




date.

This payer permits use of a National Provider Identifier (NPI) or Tax ID as the provider

identifier.


New Mexico Medicaid

Eligibility v4.2


month.

This payer permits use of a National Provider Identifier (NPI) or provider ID as the provider

identifier.












New York Medicaid

Eligibility v3.3




About License Numbers

Entry of the ordering provider’s MMIS provider ID or the License Number is optional. However, depending on the

requesting provider’s classification with New York Medicaid, it may be necessary for you to enter this information.

When using a License Number as a provider identifier for eMedNY Phase II, the New York State Department of Education (NYSDOH) additionally requires a three-digit Profession Code as a prefix. The codes are a subset of the two-digit Profession Codes assigned by

NYSDOH and the Office of the Professions

when it issues professional licenses. A leading zero is added to the left to create the NYSDOH three-digit Profession Code, and, for NYS licensed providers, two more zeros must follow between the Profession Code and the

License Number.

An exception exists for services of a NYS licensed Privileged Nurse Practitioner or

Privileged Midwife. In these two cases, a value of 0F must be inserted between the

Profession Code and License number instead of the two zeros. All out-of-state licenses must be formatted with the two-letter State, District of Columbia, or US Territory Code as

assigned by the United States Postal Service in place of the 00 or 0F values.

When entering a license number in the

Ordering Prov ID field, omit the leading zero of the Profession Code. Emdeon will insert the leading zero before sending the request to New York Medicaid.







Nippon Life Benefits






NMPSIA





identifier.


NMRHCA

Eligibility v1.0




North Carolina Medicaid

Eligibility v3.0




North Dakota Medicaid

Eligibility v4.4



Northwest Administrators, Inc.






NovaSys Health







‘Ohana Health Plan (WellCare of Hawaii)

Eligibility v1.0



Ohio Medicaid

Eligibility v3.0


























Oklahoma Employees Group Insurance Division






Oklahoma Medicaid

Eligibility v4.3

Up to 13 months in the past, future dates up to the end of the current month, date span must be within the

same month.


Operating Engineers Local No. 428 Health and

Welfare Trust Fund






identifier.


Optima Health

Eligibility v1.3






Orange County Fire Authority

Eligibility v1.0




Oregon Medicaid

Eligibility v2.6


You must enter the patient’s first and last names exactly as they are on file with this payer.


Oregon’s Health CO-OP






identifier.


Oxford Health Plans

Eligibility v1.5

Up to 18 months in the past, future dates up to the end of the current

month.

Emdeon sends the following service types to this payer regardless of the value entered in

the Service Types field: 30, 35, 47, 48, and 98. If you do not enter a service type, service type 30 (Health Benefit Plan Coverage) will be sent with your request.

See Appendix B: Service Types for code descriptions and abbreviations.


Oxford Life Insurance Company

Eligibility v1.0

























PacificSource Administrators






PacificSource Health Plans






PacificSource Community Solutions





PacificSource Medicare

Eligibility v1.0




Pan-American Life

Insurance







Response.pdf

Panamerican Life Puerto Rico (PALIC)

Eligibility v1.0




Partnership Health Plan of California

Eligibility v2.2


When searching by name/date of birth, you must enter the patient’s full last name. If the patient’s last name has more than 13 characters, you will not find a matching

record in the database. You must use a different search type instead.


Passport Health Plan

Eligibility v1.4



Pekin Life Insurance


























Penn Treaty Network America Insurance (REHAB) − Medicare Supplemental





Pennsylvania Medical Assistance

Eligibility v2.4

Up to ten years in the past, future dates not allowed.


Peoples Health

Eligibility 2.0




PerformCare

Eligibility v1.0

Date cannot be greater than current day & 1461 days in the past (4 years).

This payer permits use of a National Provider Identifier (NPI) or Service Provider ID as the provider identifier.


Personal Insurance Administrators





identifier.


PHCS Savility Payers





Physicians Mutual


Any date on file, future dates up to one month past the current contract date are allowed.



Piedmont Wellstar HealthPlans

Eligibility v1.0

Current date of service only. Entry of the provider’s National Provider Identifier (NPI) is required.


Pittman and Associates






Plan de Salud Hospital Menonita

Eligibility v1.0




























Planned Administrators, Inc.




Entry of the provider’s tax ID is required. PC-v5-Standard-Eligibility-Response.pdf

Plumbers and Pipefitters Local 525 Health & Welfare Trust





Response.pdf

Preferred Care Partners

Eligibility v1.0




Response.pdf

Preferred Health Systems





PreferredOne

Eligibility v2.3




Response.pdf

Premera Blue Cross





This payer includes the following plans under the same payer ID:

• Premera Blue Cross (PPO/PAR, Indemnity, Traditional)

• Premera Blue Cross Blue Shield of Alaska

(PPO/PAR, Indemnity, Traditional)

• Premera Dimensions – Foundation, Access, Global and Heritage

• LifeWise Health Plan of Washington

• LifeWise Health Plan of Oregon

• Federal Employee Program


Prestige Health Choice

Eligibility v1.0





















Primary PhysicianCare, Inc.







Principal Financial




This payer supports multiple plans; see “Principal Financial Plans” on page 79.




Priority Health

Eligibility v1.1

Up to one year in the past, up to one year in the future.




Prominence Health Plan






identifier.


Providence Health Plan





Provident American Life & Health Insurance Company ― Medicare Supplement

Eligibility v2.0







Puerto Rico Medicaid (ODSI)

Eligibility v3.2




Quartz ASO

Eligibility v1.0




QuikTrip Corporation





























RightCare from Scott and White Health Plan

Eligibility v1.0


This payer permits use of a National Provider Identifier (NPI) or a Tax ID as the provider identifier.


Rocky Mountain Health Plan (HMO)

Eligibility v2.0


This payer permits use of a provider Identifier (NPI) or a tax ID as the provider identifier.


SAMBA Health Benefit

Plan




This payer permits use of a provider

Identifier (NPI) or a tax ID as the provider identifier.


Response.pdf

San Joaquin Health Plan

Eligibility v2.3




Santa Clara Family Health Plan

Eligibility v1.0




Schaller Anderson Health Plans

Eligibility v1.2


This payer supports multiple plans; see “Schaller Anderson Health Plans” on page 80.







Schaller Anderson Mercy Maricopa

Eligibility v1.0


This payer permits use of a National Provider Identifier (NPI) or Tax ID as the provider identifier.


Select Health of South Carolina

Eligibility v1.2

Any past date that is on file, future dates not allowed.


Selman & Company






identifier.























Senior Care Action Network (SCAN) Health Maintenance Organization (HMO)

Eligibility v2.3




Senior Health Services Center – Universal

American Family of Companies






Senior Whole Health

Eligibility v1.1




Significa Benefit Services






Silver Summit Health Plan


If no date is entered, the date of service will default to the current date.0





Response.pdf

Simply Healthcare Plans

Eligibility v1.0




identifier.


South Carolina Medicaid

Eligibility v3.4


Entry of the patient’s middle initial for name/date of birth searches is required if on

file in the payer’s database. If you do not enter the patient’s middle initial and it is on file, you will receive the error message RH0547 – Subscriber/Insured Not Found. You will also receive this error message if you enter a middle initial, and the patient does not have one on file.



South Dakota Medicaid

Eligibility v1.3

Future dates not allowed. This payer has card swipe capabilities. PC-v4-Standard-Eligibility-Response.pdf




















SPJST ― Medicare Supplement

Eligibility v2.0





Standard Life and Accident Insurance

Company



date.





Star HRG



This payer permits use of the federal tax ID as the provider identifier.


StayWell (WellCare of Florida)

Eligibility v1.0



StayWell Kids (WellCare of Florida)

Eligibility v1.0



Stonebridge Life Insurance Company



date.


identifier.


Summit America Insurance Service



date.


identifier.


Sunflower State Health Plan

Eligibility v1.0





Sunshine State Health

Plan

Eligibility v1.2






Response.pdf






















Tennessee Medicaid (TennCare)

Eligibility v4.2

This payer allows providers to check eligibility for dates of service from 1994 to one calendar month in the future. Date span of up to 92 days.

The following information pertains to Emdeon MAX users who process transactions using a modem connection.

If the Auto MCO preference is selected and the TennCare response indicates the recipient has coverage by Better Health Plans of Tennessee, MAX will automatically query that payer to verify eligibility.

See your Emdeon MAX User’s Guide or online help for details on setting defaults.

Note: The Auto MCO feature will not work for users that process transactions via the Direct server connection.



TexanPlus (North Texas Area)

Eligibility v1.0



TexanPlus (Southeast Texas Area)

Eligibility v1.0




Texas Childrens Health Plan





Texas Medicaid

Eligibility v5.3

Up to three years in the past, up to one month in the future for CIDC

(Chronically Ill and Disabled Children program) patients only, date span of up to 90 days.


CIDC Medicaid numbers begin with 9.



To receive service-specific benefit limitations,

enter a service type code.


The Ullico Family of Companies






Three Rivers Health Plan

Eligibility v1.3




















Today’s Options

Eligibility v1.0



TransactRX Infusion and Specialty

Eligibility v1.0



Transamerica Financial Life Insurance Company





Transamerica Life Insurance Company





Transamerica Premier

Life Insurance Company


If no date is entered, the date of





Response.pdf

TRICARE



Entry of the patient’s gender is optional but highly recommended.


TRICARE East Region

Eligibility v1.0




Tricare For Life

Eligibility v1.0





Tricare Overseas

Eligibility v1.0



























Triple-S Salud (BCBS of Puerto Rico)




This payer permits use of a National Provider Identifier (NPI) as the requesting provider identifier.


Trillium Community Health Plan

Eligibility v1.0




True Health New Mexico Inc





Trustmark






Tufts Health Plan

Eligibility v1.6

Any past date on file, future dates up to 90 days.


Ucare of Minnesota

Eligibility v1.0




Ultimate Health Plans

Eligibility v1.0




UMR Wausau



This payer permits use of a National Provider Identifier (NPI) or tax ID as the requesting provider identifier.


UMWA Health and

Retirement Funds





Identifier (NPI) or tax ID as the requesting provider identifier.


Response.pdf

UniCare


Up to 18 months in the past, future dates not allowed, date span up to 18 months.


Union Pacific Railroad Employes Health Systems

Eligibility v2.0


This payer permits use of a National Provider Identifier (NPI) or tax ID as the requesting provider identifier.



























United American Insurance Company

Eligibility v1.0




United Healthcare Dental


If no date is present, default to current date.

Start date must be no greater than 18 months in the past.

End date must be no greater than the end of the current month.



United Healthcare Nevada Market

Eligibility v1.0

Inquiries can be submitted for up to 18 months in the past, and up to 1 month in the future.



UnitedHealthcare Shared Services



This payer permits use of a National Provider Identifier (NPI) or a tax ID as the provider identifier.





UnitedHealthcare StudentResources






UnitedHealthcare (UHC)



The group number is specific to the patient. If you enter a group number, it must match the group number on file for the patient. If it

does not match, you will receive the error

message RH547 – Subscriber/Insured Not Found.



UnitedHealthcare Community Plan − Tennessee

Eligibility v3.0

Up to six months in the past; up to 30 days in the future.




















United Healthcare Securehorizons − Medicare Supplemental





United Teacher Associates Insurance

Company ― Medicare

Supplement

Eligibility v2.0




identifier.




Unity Health Insurance

Eligibility v1.0




Universal Benefit Corp

Eligibility v1.0


date.


identifier.


Universal Care of California

Eligibility v2.2


When searching by name/date of birth, you must enter the patient’s full last name. If the

patient’s last name has more than 13 characters, you will not find a matching record in the database. You must use a different search type.


University Care Advantage (Arizona)







University Family Care (Arizona)






University of Arizona

Health Plans − UHM

Eligibility v1.0




Identifier (NPI) or tax ID as the requesting provider identifier.


Response.pdf




















University Physicians Care Advantage

Eligibility v1.1




UnitedHealthCare Life Insurance Company (UHCLIC)






UPMC Health Plan

Eligibility v1.0


This payer permits use of a provider Identifier (NPI) or a tax ID as the provider identifier.


USAA – Medicare Supplemental





USFHP – St. Vincent

Catholic Medical Centers of New York

Eligibility v1.0



This payer permits use of a provider

Identifier (NPI) only as the provider identifier.


Response.pdf

Vantage Health Plan







Vermont Medicaid

Eligibility v1.4

Any past date on file, future dates up to the end of the current month.

The recipient ID can be either the 8-digit Vermont Medicaid ID or the recipient’s Social

Security number.



















Veterans Affairs Fee Basis Programs

Eligibility v1.3


The Department of Veterans Affairs Fee Basis Programs are not health insurance plans. These programs are designed to assist veterans who cannot easily receive care at a VA medical center. Each individual veteran’s eligibility status and medical care needs are legally and medically reviewed for each episode of care. Each local Fee site

determines whether non-VA treatment can be approved. For these reasons, all Fee Basis Programs eligibility responses will return an Inactive status along with contact information for the local Fee office.



Veterans Affairs Health Administration Center

Eligibility v1.3


This transaction covers CHAMPVA, Spina Bifida, and Children of Women Vietnam Vets programs.


This payer is not affiliated with TRICARE/CHAMPUS.


Virginia Medicaid

Eligibility v2.4

Up to one year in the past, up to five days in the future, date span of up to one month.

If you enter both a procedure code and a service type code, the procedure code will be forwarded on to the payer.



Viva Health Inc.








Response.pdf

VNS CHOICE Medicare

Eligibility v1.1





















Washington Medicaid

Eligibility v6.4

Up to four years in the past, future dates not allowed.




WEB-TPA, Inc.






WellCare Health Plans

Eligibility v2.0


This payer permits use of a provider ID or tax ID as the provider identifier.



Wells Fargo Third Party Administrators

Eligibility v1.4


If a child is enrolled in CHIPS Plans 1 through 12, enter the child’s member ID. If the child is enrolled in CHIPS Plan 13, enter his/her

guardian’s member ID.

If a child has siblings with the same date of birth (e.g., twins), you must enter the child’s

first name.

Wells-Fargo-TPA-Eligibility-PC.pdf

Wells-Fargo-TPA-Coverage-

Summary-Sheets.pdf

West Virginia Family Health Plan

Eligibility v1.0





West Virginia Medicaid

Eligibility v3.3

Up to 12 months in the past, future dates up to the last day of the

current month, date span of up to one year in the past to the last day of the current month.

Once the provider has registered their NPI with this payer, the provider’s NPI must be

entered in the request.


Western Health Advantage





Western Southern Financial Group












http://www.emdeon.com/resourcepdfs/Wells-Fargo-TPA-Eligibility-PC.pdf

http://www.emdeon.com/resourcepdfs/Wells-Fargo-TPA-Eligibility-PC.pdf

http://www.emdeon.com/resourcepdfs/Wells-Fargo-TPA-Coverage-Summary-Sheets.pdf

http://www.emdeon.com/resourcepdfs/Wells-Fargo-TPA-Coverage-Summary-Sheets.pdf












Windsor Health Plan

Eligibility v1.0




Wisconsin Chronic Disease Program

Eligibility v1.2

Up to one year in the past, future dates not allowed, date span of up

to 365 days.


Wisconsin Medicaid

Eligibility v5.4


dates not allowed, date span of up to 365 days.

This payer has card swipe capabilities. PC-v4-Standard-Eligibility-

Response.pdf

Wisconsin Well Woman Program

Eligibility v1.2



Wyoming Medicaid

Eligibility v2.5


For searches involving the name, enter the first five characters of the patient’s last name and the first two characters of the first name.

Once the provider has registered their NPI

with this payer, the provider’s NPI must be entered in the request. This payer has card swipe capabilities.














Plan Network IDs

Ameritas Dental Group Plans

For details, see “Ameritas Dental Group” on page 12.

Plan Name Plan ID

Ameritas Life Insurance Company 00425

First Ameritas of New York 00426

First Reliance Standard Life Insurance

Company 00428

Reliance Standard Life Insurance Company 00427

Standard Insurance Company 00429

Standard Insurance Company of New York 00430

Cenpatico Plans

For details, see “Cenpatico” on page 27.

Plan Name Plan ID

Cenpatico Behavioral Health Arizona CBHAZ

Cenpatico Behavioral Health Florida CBHFL

Cenpatico Behavioral Health Illinois CBHIL

Cenpatico Behavioral Health Indiana CBHIN

Cenpatico Behavioral Health Kansas CBHKS

Cenpatico Behavioral Health Kentucky CBHKY

Cenpatico Behavioral Health Massachusetts CBHMA

Cenpatico Behavioral Health Ohio CBHOH

Cenpatico Behavioral Health South Carolina CBHSC

Cenpatico Behavioral Health Texas CBHTX

Cenpatico Behavioral Health Wisconsin CBRPR

Cenpatico – Managed Health Services (Indiana) CMHIN

Cenpatico – Managed Health Services (Wisconsin) CMHWI

Cenpatico – Superior Health Plan CHSPT



CoreSource Plans

For details, see “CoreSource” on page 30.

Plan Name Plan ID

CoreSource – FMH 00204

CoreSource – Little Rock 00205

CoreSource – Maryland, Pennsylvania, and Illinois

00236

CoreSource – Ohio 00239

Coventry Plans

For details, see “Coventry” on page 30.

Plan Name Plan ID

Health America of PA 00148

CHC Georgia 00154

CHC Virginia 00156

CHC Louisiana 00158

CHC West Virginia* 00160

CHC of Carolinas 00164

CHC Delaware 00166

CHC Iowa 00170

CHC Kansas / CHC Oklahoma 00172

CHC Nebraska 00176

CHC Illinois 00179

CoventryCares of West Virginia 00182

CHC of MO, MS, AK , TN 00184

CHC Healthcare USA* 00186

CoventryCares of Virginia* 00190

CvtyNatnlAccts/UofMO/CvtyOne 00250

Mail Handlers & FEHBP 00251

CHC Altius Health Plan/CHC Nevada 00364

CoventryCares of Michigan 00413

CHC Texas 00453

Vista 00508

CoventryCares of Pennsylvania 00510

CoventryCares of Nebraska* 00511

CHC Florida 00512

MHNET Behavioral Health 00514

Aetna Better Health of Kentucky 00515

*Medicaid Plans



Glassman Plans

For details, see “Glassman” on page Error! Bookmark not defined..

Plan Name Plan ID

AFTRA Health Fund 00258

Best Life and Health 00257

Molina Healthcare Plans

For details, see “Molina Healthcare” on page 55.

Plan Name Plan ID

Molina CA (California) 00222

Molina FL (Florida) 00506

Molina ID (Idaho) MLNID

Molina MI (Michigan) 00226

Molina NM (New Mexico) 00071

Molina OH (Ohio) 00445

Molina TX (Texas) 00451

Molina UT (Utah) 00227

Molina WA (Washington) 00228

Molina WI (Wisconsin) 00516

Principal Financial Plans

For details, see “Principal Financial” on page 64.

Plan Name Plan ID

Principal Financial Life Insurance Company of

America

00143

Nippon Life Insurance Company of America 00144



Schaller Anderson Health Plans

For details, see “Schaller Anderson Health Plans” on page 65.

Plan Name Plan ID

Schaller Anderson Aetna Better Health of New York ABHNY

Schaller Anderson Aetna Better Health of Ohio ABHOH

Schaller Anderson Aetna Better Health – PA Medicaid PENNS

Schaller Anderson Aetna IL Medicaid ILMSA

Schaller Anderson Aetna TX Medicaid & CHIP TMDSA

Schaller Anderson Delaware Physicians Care, Inc. DPCSA

Schaller Anderson MajestaCare VA MACVA

Schaller Anderson Maryland Physicians Care MPCSA

Schaller Anderson Mercy Care AEMED

Schaller Anderson Missouri Care MOSCA

Schaller Anderson Parkland Community Health Plan PRCHP

Schaller Anderson TX Christus TXCSA

All Payers Eligibility Guide PC Appendices


Appendices

Appendix A: Reference Guides

Guide Name Link to

Common Response Abbreviations Common-Response-Abbreviations.pdf

Country Codes Country-Codes.pdf

Emdeon MAX User’s Guide See your installation CD

Error Messages Dictionary Error Messages Dictionary.pdf

Insurance Types Insurance-Types.pdf

Payer Maintenance Schedule Payer_Maintenance_Windows.pdf

Appendix B: Service Types Payers’ eligibility requests often support entry of one or more service types.

Italicized rows represent service types which are available only for version 5 of the Emdeon standard request and response.

Code Full Description Service Types Input

Field Choice List

Service Types

Description in Response

1 Medical Care Medical Care Med Care

2 Surgical Surgical Surg

3 Consultation Consultation Consultation

4 Diagnostic X-Ray Dx X-Ray Dx X-Ray

5 Diagnostic Lab Dx Lab Dx Lab

6 Radiation Therapy Radiation Thrpy Radiation Thrpy

7 Anesthesia Anesthesia Anesth

8 Surgical Assistance Surgical Assistance Surg Asstnce

9 Other Medical Other Medical Other Medcl

10 Blood Charges Blood Charges Blood Charges

11 Used Durable Medical Equipment

Used DME Used DME

12 Durable Medical Equipment Purchase

DME Purchase DME Purchase

13 Ambulatory Service Center Facility

Amb Svc Ctr Facil Amb Svc Ctr Facility

14 Renal Supplies in the Home

Renal Supply-Home Renal Supplies in the Home

15 Alternate Method Dialysis

Alt Meth Dialysis Alternate Method Dial

16 Chronic Renal Disease (CRD) Equipment

CRD Equipment CRD Equipment

17 Pre-Admission Testing Pre-Admissn Testing Pre-Admin Testing

http://www.emdeon.com/resourcepdfs/Common-Response-Abbreviations.pdf

http://www.emdeon.com/resourcepdfs/Country-Codes.pdf

http://www.emdeon.com/resourcepdfs/Error%20Messages%20Dictionary.pdf

http://www.emdeon.com/resourcepdfs/Insurance-Types.pdf

http://www.emdeon.com/resourcepdfs/Payer_Maintenance_Windows.pdf




Field Choice List

Service Types


18 Durable Medical Equipment Rental

DME Rental DME Rent

19 Pneumonia Vaccine Pneumonia Vaccine Pneumonia Vaccine

20 Second Surgical Opinion

Second Surg Opinion Second Surg Opinion

21 Third Surgical Opinion Third Surg Opinion Third Surg Opinion

22 Social Work Social Work Social Work

23 Diagnostic Dental Dx Dntl Dx Dntl

24 Periodontics Periodontics Periodontics

25 Restorative Restorative Restorative

26 Endodontics Endodontics Endodontics

27 Maxillofacial Prosthetics

MFP MFP

28 Adjunctive Dental Services

Adjunc Dntl Svcs Adjunctive Dntl Svcs

30 Health Benefit Plan Coverage

Hlth Bene Plan Cvg Health Bene Plan Cvg

32 Plan Waiting Period Plan Waiting Period Plan Waiting Period

33 Chiropractic Chiropractic Chiropractic

34 Chiropractic Office Visits

Chiropractic Visits Chiropractic Office Visits

35 Dental Care Dntl Care Dntl Care

36 Dental Crowns Dntl Crowns Dntl Crowns

37 Dental Accident Dntl Accident Dntl Accident

38 Orthodontics Orthodontics Orthodontics

39 Prosthodontics Prosthodontics Prosthodontics

40 Oral Surgery Oral Surgery Oral Surg

41 Routine (Preventive) Dental

Routine Prev Dntl Routine (Preventive) Dntl

42 Home Health Care Home Health Care HHC

43 Home Health Prescriptions

Home Health Rxs HH Rxs

44 Home Health Visits Home Health Visits HH Visits

45 Hospice Hospice Hspc

46 Respite Care Respite Care Respite Care

47 Hospital Hospital Hosp

48 Hospital - Inpatient Hosp-IP Hosp - IP

49 Hospital - Room and Board

Hosp-Room Board Hosp - Room/Board

50 Hospital - Outpatient Hosp-OP Hosp - OP

51 Hospital - Emergency Accident

Hosp-Emerg Accident Hosp - Emergency Accident




Field Choice List

Service Types


52 Hospital - Emergency Medical

Hosp-Emerg Medical Hosp - Emergency Medical

53 Hospital - Ambulatory Surgical

Hosp-Amb Surgical Hosp - Ambulatory Surg

54 Long Term Care Long Term Care LTC

55 Major Medical Major Medical Major Medical

56 Medically Related Transportation

Med Related Trans Medical Related Transport

57 Air Transportation Air Transportation Air Transportation

58 Cabulance Cabulance Cabulance

59 Licensed Ambulance Licensed Ambulance Licensed Ambulance

60 General Benefits General Benefits General Benefits

61 In-vitro Fertilization IVF IVF

62 MRI/CAT Scan MRI/CAT Scan MRI/CAT Scan

63 Donor Procedures Donor Procedures Donor Procedures

64 Acupuncture Acupuncture Acupuncture

65 Newborn Care Newborn Care Newborn Care

66 Pathology Pathology Pa

67 Smoking Cessation Smoking Cessation Smoking Cessation

68 Well Baby Care Well Baby Care Well Baby Care

69 Maternity Maternity Maternity

70 Transplants Transplants Transplants

71 Audiology Exam Audiology Exam Audiology Exam

72 Inhalation Therapy Inhalation Therapy Inhalation Thrpy

73 Diagnostic Medical Dx Medical Dx Medical

74 Private Duty Nursing Private Duty Nurse Private Duty Nursing

75 Prosthetic Device Prosthetic Device Prosthetic Device

76 Dialysis Dialysis Dial

77 Otological Exam Otological Exam Otological Exam

78 Chemotherapy Chemotherapy CH

79 Allergy Testing Allergy Testing Allergy Testing

80 Immunizations Immunizations Immunizations

81 Routine Physical Routine Physical Routine Physical

82 Family Planning Family Planning FP

83 Infertility Infertility Infertility

84 Abortion Abortion Abortion

85 AIDS AIDS AIDS

86 Emergency Services Emergency Services Emergency Svcs

87 Cancer Cancer Cancer




Field Choice List

Service Types


88 Pharmacy Pharmacy Pharm

89 Free Standing Prescription Drug

Free Stand Rx Drug Free Standing Rx Drg

90 Mail Order Prescription Drug

Mail Order Rx Drug Mail Order Rx Drg

91 Brand Name Prescription Drug

Brand Name Rx Drug Brand Name Rx Drg

92 Generic Prescription Drug

Generic Rx Drug Generic Rx Drg

93 Podiatry Podiatry Podiatry

94 Podiatry - Office Visits Podiatry-Off Visits Podiatry - Office Visits

95 Podiatry - Nursing Home Visits

Podiatry-NH Visits Podiatry - Nursng Home Vsts

96 Professional (Physician)

Professional (PHY) Professional (PHY)

97 Anesthesiologist Anesthesiologist Anesthesiologist

98 Professional (Physician) Visit - Office

Prof PHY Vist-Offc Prof (PHY) Visit - Office

99 Professional (Physician) Visit - Inpatient

Prof PHY Vist-IP Prof (PHY) Visit - IP

A0 Professional (Physician) Visit - Outpatient

Prof PHY Vist-OP Prof (PHY) Visit - OP

A1 Professional (Physician) Visit - Nursing Home

Prof PHY Vist-NH Prof (PHY) Vst - Nursng Hme

A2 Professional (Physician) Visit - Skilled Nursing Facility

Prof PHY Vist-SNF Prof (PHY) Visit - SNF

A3 Professional (Physician) Visit -

Home

Prof PHY Vist-Home Prof (PHY) Visit - Home

A4 Psychiatric Psychiatric PC

A5 Psychiatric - Room and Board

Psych-Room Board PC - Room/Board

A6 Psychotherapy Psychotherapy Psychotherapy

A7 Psychiatric - Inpatient Psych-Inpatient PC - IP

A8 Psychiatric - Outpatient Psych-Outpatient PC - OP

A9 Rehabilitation Rehabilitation Rehab

AA Rehabilitation - Room and Board

Rehab-Room Board Rehab - Room/Board

AB Rehabilitation - Inpatient

Rehab-IP Rehab - IP




Field Choice List

Service Types


AC Rehabilitation - Outpatient

Rehab-OP Rehab - OP

AD Occupational Therapy Occupation Therapy OT

AE Physical Medicine Physical Medicine Physical Medicine

AF Speech Therapy Speech Therapy Spch Thrpy

AG Skilled Nursing Care Skilled Nurse Care Skilled Nursing Care

AH Skilled Nursing Care - Room and Board

SNC-Room Board Sklled Nrsng Cre - Rm & Brd

AI Substance Abuse Substance Abuse SA

AJ Alcoholism Alcoholism Alcoholism

AK Drug Addiction Drug Addiction Drg Addiction

AL Vision (Optometry) Vision (Optometry) Vision (Optometry)

AM Frames Frames Frames

AN Routine Exam Routine Exam Routine Exam

AO Lenses Lenses Lenses

AQ Nonmedically Necessary Physical

Nonmed Ncssry Phys Nonmedical Ncessry Physical

AR Experimental Drug

Therapy

Expermnt Drg Thrpy Experimental Drg Thrpy

B1 Burn Care Burn Care Burn care

B2 Brand Name Prescription Drug - Formulary

Brand Rx-Formly Brand Nm Rx-Formulary

B3 Brand Name Prescription Drug - Non-Formulary

Brand Rx-NoFormly Brand Nm Rx-NonFormulary

BA InDependent Medical Evaluation

Ind Medical Eval InDependent Medical Eval

BB Partial Hospitalization (Psychiatric)

Partial Hosp-Psych Prtl Hospitalization (PC)

BC Day Care (Psychiatric) Day Care-Psych Day Care (PC)

BD Cognitive Therapy Cognitive Therapy Cognitive Thrpy

BE Massage Therapy Massage Therapy Massage Thrpy

BF Pulmonary Rehabilitation

Pulmonary Rehab Pulmonary Rehab

BG Cardiac Rehabilitation Cardiac Rehab Cardiac Rehab

BH Pediatric Pediatric Peds

BI Nursery Nursery Nursery

BJ Skin Skin Skin

BK Orthopedic Orthopedic Orthopedic

BL Cardiac Cardiac Cardiac

BM Lymphatic Lymphatic Lymphatic




Field Choice List

Service Types


BN Gastrointestinal Gastrointestinal GI

BP Endocrine Endocrine Endocrine

BQ Neurology Neurology Neuro

BR Eye Eye Eye

BS Invasive Procedures Invasive Procedures Invasive Procs

BT Gynecological Gynecological Gynecological

BU Obstetrical Obstetrical Obstetrical

BV Obstetrical/

Gynecological Obstetrical/ Gynecological Obstetrical/ Gynecological

BW Mail Order Prescription Drug: Brand Name

Mail Order Rx-Brand Mail Order Rx-Brand Name

BX Mail Order Prescription Drug: Generic

Mail Order Rx-Gener Mail Order Rx-Generic

BY Physician Visit/Office: Sick

PHY Visit/Off-Sick PHY Visit/Office-Sick

BZ Physician Visit/Office: Well

PHY Visit/Off-Well PHY Visit/Office-Well

C1 Coronary Care Coronary Care Coronary Care

CA Private Duty Nursing - Inpatient

Private Nurse-IP Private Duty Nursing-IP

CB Private Duty Nursing - Home

Private Nurse-Home Private Duty Nursing-Home

CC Surgical Benefits - Professional (Physician)

Surgical Bene-PHY Surgical Benefits-PHY

CD Surgical Benefits - Facility

Surgical Bene-Facil Surgical Benefits-Facility

CE Mental Health Provider - Inpatient

Mental Hlth Prov-IP Mental Health Provider-IP

CF Mental Health Provider - Outpatient

Mental Hlth Prov-OP Mental Health Provider-OP

CG Mental Health Facility - Inpatient

Mental Hlth Fac-IP Mental Health Facility-IP

CH Mental Health Facility - Outpatient

Mental Hlth Fac-OP Mental Health Facility-OP

CI Substance Abuse Facility - Inpatient

SA Facility-IP SA Facility-IP

CJ Substance Abuse Facility - Outpatient

SA Facility-OP SA Facility-OP

CK Screening X-Ray Screening X-Ray Screening X-Ray

CL Screening Laboratory Screening Lab Screening Lab

CM Mammogram, high risk patient

Mammogram-high risk Mammogram-high risk patient




Field Choice List

Service Types


CN Mammogram, low risk patient

Mammogram-low risk Mammogram-low risk patient

CO Flu Vaccination Flu Vaccination Flu Vaccination

CP Eyewear and Eyewear Accessories

Eyewear/Accessories Eyewear/Accessories

CQ Case Management Case Management Case Management

DG Dermatology Dermatology Dermatology

DM Durable Medical Equipment

DME DME

DS Diabetic Supplies Diabetic Supplies Diabetic Supplies

GF Generic Prescription Drug - Formulary

Generic Rx-Formly Generic Rx-Formulary

GN Generic Prescription Drug - Non-Formulary

Generic Rx-NoFormly Generic Rx-NonFormulary

GY Allergy Allergy Allergy

IC Intensive Care IC IC

MH Mental Health Mental Health Mental Health

NI Neonatal Intensive Care

Neonatal IC Neonatal IC

ON Oncology Oncology Oncology

PT Physical Therapy PT PT

PU Pulmonary Pulmonary Pulmonary

RN Renal Renal Renal

RT Residential Psychiatric Treatment

Residential Psych Residential Psychiatric

TC Transitional Care Transitional Care Transitional Care

TN Transitional Nursery Care

Transition Nursery Transitional Nursery Care

UC Urgent Care Urgent Care Urgent Care

All Payers Eligibility Guide PC Index


Index

A

AARP, 6 About This Guide, 1 Absolute Total Care, 6 Add New Button, 5 Administrative Services, Inc., 6 Advantage by Bridgeway Health Solutions, 6 Advantage by Buckeye Community Health Plan, 6 Advantage by Managed Health Services, 6 Advantage by Superior HealthPlan, 6 Aetna, 7 Aetna Administrator − Medicare Supplemental, 7 Aetna Better Health - NJ, 7 Aetna Better Health of CA, 7 Aetna Better Health of FL, 7 Aetna Better Health of KY, 7 Aetna Better Health of LA, 7 Aetna Better Health of MD, 7 Aetna Better Health of MI, 7 Aetna Better Health of MO, 7 Aetna Better Health of NV, 8 Aetna Better Health of PA, 8 Aetna Better Health of VA, 8 Aetna Better Health of WV, 8 Aetna Long Term Care, 8 Affinity Essentials, 8 Affinity Health Plan, 8 Affinity Health Plan Medicare, 8 Aflac - Medicare Supplemental, 9 Aflac Dental Insurance, 8 AFTRA Health Fund, 79 AGIA Inc, 8 Alabama Medicaid, 9 All Savers Life Insurance Company, 9 Alliant Health Plans, 9 Allied Benefit Systems, Inc., 9 Alternative Insurance Resources, Inc, 9 AmeriBen, 9 American Behavioral Benefit Managers, 9 American Community Mutual, 10 American General Life and Accident), 10 American Health Medicare (Inmediata Health), 10

American Income Life Insurance Company, 10 American National Insurance Company, 10 American National Life Insurance Company of Texas, 10 American Network Insurance (REHAB) − Medicare

Supplemental, 11 American Postal Workers Union, 11 American Retirement Life Insurance Company – Medicare

Supplement, 11 Americhoice of New Jersey, 11 Amerigroup, 11 AmeriHealth Caritas Delaware, 11 AmeriHealth Caritas Iowa, 11 AmeriHealth Caritas Louisiana, 11 AmeriHealth Caritas Pennsylvania, 11 AmeriHealth Caritas VIP Care Plus, 12 AmeriHealth District of Columbia, 12 AmeriHealth VIP Care, 12 Ameritas Dental Group, 12 Ameritas Dental Group Plans, 77 Ameritas Life Insurance Company, 77 Anthem BlueCross of California, 12 Appendix A: Reference Guides, 81 Appendix B: Service Types, 81

APS, 12 Archbold Medical Center, 12 Arise Health Plan, 12 Arise Health Plan − Medicare Select Policy, 12 Arizona Medicaid (AHCCCS), 13 Arizona Physicians IPA, 13 Arkansas Medicaid, 13 Associacion de Maestros Puerto Rico, 13 AVMed, 13

B

Banner Health Plans, 13 Banner University Family Care, 13 Baptist Health Plan Advantage, 13 BC Complete of Michigan, 13 BC Idaho, 14 BC Medicare Advantage, 14 BCBS Alabama (Benefits), 14 BCBS Alabama (Eligibility), 14 BCBS Arizona, 15 BCBS Arkansas, 15 BCBS Colorado, 15 BCBS Connecticut, 15 BCBS Delaware (Highmark), 15 BCBS District of Columbia, 15 BCBS Florida, 16 BCBS Georgia, 16 BCBS Illinois, 16 BCBS Indiana, 16 BCBS Iowa, 16 BCBS Kansas, 16 BCBS Kansas City, 16 BCBS Kentucky, 17 BCBS LA Medicare Advantage, 17 BCBS Louisiana, 17 BCBS Maine, 17 BCBS Maryland, 17 BCBS Massachusetts, 17 BCBS Michigan, 18 BCBS Minnesota, 18 BCBS Mississippi, 19 BCBS Missouri, 19 BCBS Nebraska, 19

BCBS Nevada, 19 BCBS New Hampshire, 19 BCBS New Jersey (Horizon), 19 BCBS New Mexico, 19 BCBS New York Empire, 20 BCBS North Carolina, 20 BCBS North Dakota, 20 BCBS Ohio, 20 BCBS Oregon (Regence), 20 BCBS Pennsylvania (Highmark), 21 BCBS Rhode Island, 21 BCBS South Carolina, 21, 22 BCBS South Dakota, 22 BCBS Tennessee, 22 BCBS Texas, 23 BCBS Texas-Medicaid, 23 BCBS Vermont, 23 BCBS Virginia, 23 BCBS Wisconsin, 23 BCBS Wyoming, 23 Behavioral Health Systems, 23 Benefit Management Inc., 24



Best Life and Health, 79 Better Health, 24 Better Health Plans of Tennessee, 24 BlueChoice HealthPlan of South Carolina Medicaid, 24 BlueCross BlueShield of Western New York Medicaid/CHP, 24 Bluegrass Family Health, 24 Boon Group, 24 Bridgeway Health Solutions (Arizona), 24 BS California, 24 BS Washington (Regence), 24 Buckeye Community Health, 25

C

California Medicaid (Medi-Cal), 25 Capital BlueCross, 25 Capital District Physician’s Health Plan, 25 Card Swipe, 5 Care Improvement Plus, 25 Care1st Health Plan Arizona, 25 CareFirst Administrators, 26 CarePlus Health Plan, 26 CarePoint Medicare Advantage Health Plan, 26 CareSource, 26 CareSource Health, 26 Carpenters Health and Welfare Trust Fund of St Louis, 26 CDS Group Health, 26 Celtic Insurance, 26 CeltiCare, 26 Cenpatico, 27 Central Reserve Life Insurance Company ― Medicare

Supplement, 27 Central States Funds, 27 Chesterfield Resources Inc, 27 Christian Brothers Services, 27 Christie Student Health Plans, 27 CHRISTUS Health Plan Medicaid, 27 CHRISTUS Health Plan New Mexico Health Insurance

Exchange, 27 CHRISTUS Health Plan NM MA, 28 Cigna, 28 CMFG Life Insurance, 28 Color Bars, 3 Colorado Access, 28 Colorado Medicaid, 29 Community Care of Oklahoma, 29 Community Health Plan of Washington, 29 Concentrix Insurance Solutions, 29 Connecticare Inc, 29 Connecticut Medicaid, 29

Consolidated Associates Railroad, 29 Consumer Mutal of Michigan, 29 Continental General Insurance Company ― Medicare

Supplement, 30 Cooperative Benefit Administrators, 30 CoreSource, 30 CoreSource - FMH, 78 CoreSource - Little Rock, 78 CoreSource - Maryland, Pennsylvania, and Illinois, 78 CoreSource - Ohio, 78 CoreSource Plans, 78 CountyCare, 30 Coventry, 30 Coventry Plans, 78 Coventry/Dentex Dental, 30 CREATE, 30 Crystal Run Health Plan, 30 CSA Fraternal Life ― Medicare Supplement, 31 Customer Support, 1

D

DAKOTACARE Administrative Services, 31 Data Input Area, 3

Date Entries, 4 Date of Service Restrictions, 5 Dean Health Plan, 31, 38 Dell Childrens Health Plan, 31 Dentaquest Government Payer WI, 31 Determine the Search Types, 2 Determine the Transaction Type, 2 District No. 9, I. A. of M. & A. W. Welfare Trust, 31 District of Columbia Medicaid, 31 Diversified Administration Corp, 31 Dollar Amounts, 5 Driscoll Health Plan, 31

E

EBMS, 31 Elderplan, 32 Emblem Health, 32 Emdeon Customer Support, 1 Enter the Search Data, 3 Epic Life Insurance, 32 Essence Healthcare, 32 Everence Financial, 32 Evergreen Health, 32 Excellus BlueCross BlueShield, 32

F

Fallon Community Health Plan, 32 Farm Bureau Health Plans, 32 Federated Insurance Company, 32 Fidelis Care New York, 33 First Ameritas of New York, 77 First Choice VIP Care Plus, 33 First Community Health Plan, 33 First Reliance Standard Life Insurance Company, 77 First United American Insurance Company, 33 Florida Medicaid, 34, 35 Food Employers & Bakery & Confectionery Workers Benefit

Fund of Southern California, 35 Fresenius Health Partners, 35

G

G.M.P. Employers Retiree Trust, 36 Georgia Medicaid, 36 Glassman Plans, 79 Globe Life & Accident Insurance Company, 36 Golden Rule, 36 Government Employees Hospital Association (GEHA), 36 Great American Life Assurance Company ― Medicare

Supplement, 36 Great American Life Insurance Company ― Medicare

Supplement, 36 Great-West Healthcare, 37 Group and Pension Administrators, 37 Group Dental Service, 37

H

Harmony Health Plan (WellCare of Florida), 37 Harvard Pilgrim Health Care, 37 Hawaii Medicaid, 37 Hawaii Medical Service Association, 38 Health Alliance Plan, 38



Health Choice of Arizona, 6, 33, 38 Health First Health Plan, 38 Health First Insurance, 38 Health Partners MN, 38 Health Partners of Philadelphia, 38 Health Services for Children with Special Needs, 38 Health Sharer of Oregon, 38 HEALTHe Exchange, 39 HealthEase (WellCare of Florida), 39 HealthEase Kids (WellCare of Florida), 39 HealthEZ, 39 Healthfirst of New Jersey, 39 Healthfirst of New York, 39 HealthNet National, 39 HealthPlus of Michigan, 39 HealthSmart Benefit Solutions, 39 HealthSmart Benefit Solutions − WV, 39 HealthSpring, 40 Healthy Blue Louisiana, 40 Help Line, 3

Highmark BCBSD Health Options, 40 HMA (Hawaii Mainland Admin), 40 Horizon New Jersey Health, 40 HSBS Oklahoma City, 40 Humana, 40

I

IBEW Local 508 Health Plan, 40 Idaho Medicaid, 40 If you enter data for more than one type of search:, 2 IlliniCare Health Plan, 40 Illinois Medicaid, 41, 42 Independence Blue Cross, 42 Indiana Medicaid, 42 Inland Empire Health Plan, 42 Inter Valley Health Plan, 43 International Medical Card, 43 Iowa Medicaid, 43 Island Home Insurance, 43

J

Johns Hopkins HealthCare, 43 Johns Hopkins HealthCare LLC, 43 Johns Hopkins US Family Health Plan, 43

K

Kaiser Foundation Health Plan of Hawaii, 43 Kaiser Foundation Health Plan of Hawaii (DHMO/CHOICE, 44 Kaiser Foundation Health Plan of Northwest, 44 Kaiser Foundation Health Plans of Colorado, 43 Kaiser Foundation Mid-Atlantic, 44 Kaiser NW Dental, 44 Kaiser Permanente Insurance Company KPIC, 44 Kaiser Permanente of Georgia, 44 Kaiser Permanente of Northern California, 44 Kaiser Permanente of Southern California, 44 KanCare-UnitedHealthcare Community Plan Kansas, 44 Kansas Medicaid, 44 Kempton Company), 45 Kentucky Medicaid, 45 Kentucky Spirit Health Plan, 45 Key Benefit Administrators, 45

Key Benefit Administrators (Indianapolis, IN), 45 Keystone First, 45 Keystone VIP Choice, 45

L

L.A. Care, 45 Leon Medical Centers Health Plan, Inc., 45

Liberty National Life Insurance Company, 46 LifeCare Assurance Company, 46 Lincoln Financial, 46 Louisiana Healthcare Connections, 46 Louisiana Medicaid, 47 Loyal American Life ― Medicare Supplement, 47

M

MagnaCare, 48 Magnolia Health Plan, 47 Maine Community Health Options, 47 MaineCare (Maine Medicaid), 48 Managed Care of America, 48 Managed Health Network, 48 Managed Health Services - Indiana, 48 MAPFRE Life Puerto Rico, 48 MAPFRE Medicare Excel, 48 Maricopa Care Advantage, 48 Maricopa Health Plan (Arizona), 48 Maryland Medicaid, 48 Maryland Physicians Care, 49 Massachusetts Medicaid (MassHealth), 49 MDWISE Exchange, 49 MDWISE Medicaid Health Plans, 49 MedBen Newark OH, 49 Medica, 49 Medica Health Plans, 49 Medica2, 49 Medical Associates Health Plan/Health Choices, 49

Medical Card System), 50 Medical Mutual of Ohio (MMO), 50 Medicare Part A & B, 51, 52 Medicare y Mucho Mas, 52 Medi-Share, 49 Med-Pay, Inc., 49 Meridian Health Plan of Illinois, 52 Meritain Health, 52 Meritus Health Partners, 53 MetLife, 53 MetPlus Health Plan, 53 Michigan Medicaid, 53 Michigan MIChild, 53 Minnesota Medicaid, 53 Mississippi Medicaid, 53 Mississippi State Employees' Health Plan (SEHP), 54 Missouri Medicaid, 54 MMSI, 55 Molina CA (California), 79 Molina FL (Florida), 79 Molina Healthcare, 55 Molina Healthcare of New Mexico, 55 Molina Healthcare of Virginia, 55 Molina Healthcare Plans, 79 Molina ID (Idaho), 79 Molina MI (Michigan), 79 Molina NM (New Mexico), 79 Molina of Puerto Rico, 55 Molina OH (Ohio), 79 Molina TX (Texas), 79 Molina UT (Utah), 79 Molina WA (Washington), 79 Molina WI (Wisconsin), 79 Montana Medicaid, 55 Mountain State, 55



Municipal Health Benefit Fund, 55 Mutual Health Services, 55 Mutual of Omaha, 55 MVP Health Care (New York), 56

N

National Association of Letter Carriers (NALC), 56 National Claims Admin Services, 56 Nebraska Medicaid, 56 Network Health Plan, 56 Nevada Medicaid, 56 New Era Life Insurance Company, 56 New Hampshire Medicaid, 56 New Jersey Medicaid, 57 New Mexico Health Connections, 57 New Mexico Medicaid, 57 New York Medicaid, 58 Nippon Life Benefits, 59 Nippon Life Insurance Company of America, 79 NMPSIA, 59 NMRHCA, 59 North Carolina Medicaid, 59 North Dakota Medicaid, 59 Northwest Administrators, Inc., 59 NovaSys Health, 59

'

'Ohana Health Plan (WellCare of Hawaii), 59

O

Ohio Medicaid, 59 Oklahoma Employees Group Insurance Division, 60 Oklahoma Medicaid, 60 Operating Engineers Local No. 428 Health and Welfare Trust

Fund, 60 Optima Health, 60 Orange County Fire Authority, 60 Oregon Medicaid, 60 Oregon’s Health CO-OP, 60 Oxford Health Plans, 60 Oxford Life Insurance Company, 60

P

PacificSource Administrators, 61 PacificSource Community Solutions, 61

PacificSource Health Plans, 61 PacificSource Medicare, 61 Panamerican Life Puerto Rico (PALIC), 61 Partnership Health Plan of California, 61 Passport Health Plan, 61 Payer Details, 6 Pekin Life Insurance, 61 Penn Treaty Network America Insurance (REHAB) − Medicare

Supplemental, 62 Pennsylvania Medical Assistance, 62 Peoples Health, 62 PerformCare, 62 Personal Insurance Administrators, 62 PHCS Savility Payers, 62 Physicians Mutual, 62 Piedmont Wellstar HealthPlans, 62 Pittman and Associates, 62 Plan de Salud Hospital Menonita, 62 Plan Network IDs, 77 Planned Administrators, Inc., 63

Plumbers and Pipefitters Local 525 Health & Welfare Trust, 63 Preferred Care Partners, 63 Preferred Health Systems, 63 PreferredOne, 63 Premera Blue Cross, 63 Prestige Health Choice, 63 Primary PhysicianCare, Inc., 64 Principal Financial, 64 Principal Financial Life Insurance Company of America, 79 Principal Financial Plans, 79 Priority Health, 64 Prominence Health Plan, 64 Providence Health Plan, 64 Provident American Life & Health Insurance Company ―

Medicare Supplement, 64 Provider IDs, 4 Puerto Rico Medicaid (ODSI), 64

Q

Quartz ASO, 64 QuikTrip Corporation, 64

R

Reliance Standard Life Insurance Company, 77 Requests, 2 Responses, 5 RightCare from Scott and White Health Plan, 65 Rocky Mountain Health Plan (HMO), 65

S

SAMBA Health Benefit Plan, 65 San Joaquin Health Plan, 65 Santa Clara Family Health Plan, 65 Schaller Anderson Health Plans, 65, 80 Schaller Anderson Mercy Maricopa, 65 Select Health of South Carolina, 65 Selman & Company, 65 Senior Care Action Network (SCAN) Health Maintenance

Organization (HMO), 66 Senior Health Services Center – Universal American Family of

Companies, 66 Senior Whole Health, 66 Significa Benefit Services, 66 Silver Summit Health Plan, 66 Simply Healthcare Plans, 66 South Carolina Medicaid, 66 South Dakota Medicaid, 66 Special Considerations, 4 SPJST ― Medicare Supplement, 67 Standard Insurance Company, 77 Standard Insurance Company of New York, 77 Standard Life and Accident Insurance Company, 67 Star HRG, 67 StayWell (WellCare of Florida), 67 StayWell Kids (WellCare of Florida), 67 Stonebridge Life Insurance Company, 67 Summit America Insurance Service, 67 Sunflower State Health Plan, 67 Sunshine State Health Plan, 67

T

Tennessee Medicaid (TennCare), 68 TexanPlus (North Texas Area), 68 TexanPlus (Southeast Texas Area), 68 Texas Childrens Health Plan, 68



Texas Medicaid, 68 Text Color in Input Fields, 3 The Ullico Family of Companies, 68 Three Rivers Health Plan, 68 Today's Options, 69 TransactRX Infusion and Specialty, 69 Transamerica Financial Life Insurance Company, 69 Transamerica Life Insurance Company, 69 Transamerica Premier Life Insurance Company, 69 TRICARE, 69 TRICARE East Region, 69 Tricare For Life, 69 Tricare Overseas, 69 Trillium Community Health Plan, 70 Triple-S Salud (BCBS of Puerto Rico), 70 True Health New Mexico Inc), 70 Trustmark, 70 Tufts Health Plan, 70

U

Ucare of Minnesota, 70 Ultimate Health Plans, 70 UMR Wausau, 70 UMWA Health and Retirement Funds, 70 UniCare, 70 Union Pacific Railroad Employes Health Systems, 70 United American Insurance Company, 71 United Healthcare Dental, 71 United Healthcare Nevada Market, 71 United Healthcare Securehorizons − Medicare Supplemental,

72 United Teacher Associates Insurance Company ― Medicare

Supplement, 72 UnitedHealthcare (UHC), 71 UnitedHealthcare Community Plan − Tennessee, 71 UnitedHealthCare Life Insurance Company (UHCLIC), 73 UnitedHealthcare Shared Services, 71 UnitedHealthcare StudentResources, 71 Unity Health Insurance, 72 Universal Benefit Corp, 72 Universal Care of California, 72 University Care Advantage (Arizona), 72 University Family Care (Arizona), 72 University of Arizona Health Plans – UHM, 72 University Physicians Care Advantage, 73 UPMC Health Plan, 73 USAA − Medicare Supplemental, 73

V

Vantage Health Plan, 73 Vermont Medicaid, 73 Veterans Affairs Fee Basis Programs, 74 Veterans Affairs Health Administration Center, 74 Virginia Medicaid, 74 Viva Health Inc., 74 VNS CHOICE Medicare, 74

W

Washington Medicaid, 75 WEB-TPA, Inc., 75 WellCare Health Plans, 75 Wells Fargo Third Party Administrators, 75

West Virginia Family Heatlh Plan, 75 West Virginia Medicaid, 75 Western Health Advantage, 75 Western Southern Financial Group, 75

Windsor Health Plan, 76 Wisconsin Chronic Disease Program, 76 Wisconsin Medicaid, 76 Wisconsin Well Woman Program, 76 Wyoming Medicaid, 76

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All Payers Eligibility Guide PC - Emdeon Payers Eligibility Guide PC ... BCBS North Dakota ......

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