PHICURE - CONFIDENTIAL - November 01, 2019

Payer ID Payer Name

13162 1199 SEIU National Benefit Fund

07205 360 Alliance PPO Gilsbar

74234 8th Distric Electrical

36273

AARP Medicare Supplement/Fixed Indemity by UnitedHealthcare

(UnitedHealthcare)

87726 AARP MedicareComplete (AARP MedicareComplete from SecureHorizons)

36273

AARP UnitedHealthcare Insurance Co. (Special Data Requirements located in

Vendor Download Tools or Provider Training Materials.)

ABRI1 Abri Healthplan

COACC Access Behavioral Care

87815 Acordia National (Now known as Wells Fargo TPA)

72467 ACS Benefit Services, inc.

59141 Administrative Services, Inc.

74234 Advanstaff, Inc.

10447 Advantra (TX, NM, AZ Only)

25152 Advantra Freedom

23228 Aetna Better Health - PA Medicaid

128LA Aetna Better Health LA

26337 Aetna Better Health Medicaid IL

128MO Aetna Better Health MO

46320 Aetna Better Health NJ

128KY Aetna Better Health of KY

128MD Aetna Better Health of MD

128MI Aetna Better Health of Michigan

42130 Aetna Better Health of Nebraska

50023 AETNA BETTER HEALTH OF OHIO

128VA Aetna Better Health of Virginia

128WV Aetna Better Health WV

60054 Aetna Health Plan - PPO

60054 Aetna Life & Casualty Company

38692 Aetna TX Medicaid & CHIP

23334 Affinity Essentials

13334

Affinity Health Plans (Contact Affinity EDI Coordinator before submitting claims

electronically at EDI@Affinityplan.org or call 718-794-7592.)

13333

Affinity Health Plans (TMG Health) (Effective for Medicare claims with DOS on or

after 01/01/2010)

46503 Aflac

13346 Aftra Health Fund

AWNY6 AGE WELL NY

95241 AGIA Inc (Claims are printed and mailed to the payer.)

80705 AH & L

270/271 Payer List

95327

Alameda Alliance for Health (Provider must contact payer to be approved. Contact

at Alameda is Anet Quiambao at 510-747-6153 or

aquiambao@alamedaalliance.com)

ALH01 Aliera Health Care

81400 All Savers Insurance (UnitedHealthOne)

37602 All Savers Insurance Co.

81040 Allegiance Benefit Plan Management, Inc.

58234 Alliant Health Plans of Georgia

37308 Allied Benefit Systems

04293 Allways Health Plan (Formerly NHP Boston)

ALOHA AlohaCare

80705 ALTA Health and Life Insurance Company

SX113 Altius Health Plans

75137 Ameriben Solutions

59140 American Benefits Plan Administrators (Las Vegas, NV)

TH095 American Family Insurance

AMF11 AMERICAN FAMILY INSURANCE COMPANY

62030 American General

50587 American Health

66065 AMERICAN HEALTH MEDICARE

87726 American International Group, Inc.

81400 American Medical Security

81400 American Medical Security (UnitedHealthOne)

74048 American National Insurance Co

44444 American Postal Workers Union Health Plan

42011 American Republic Insurance Company

41178 America's PPO / America's TPA

87726 AmeriChoice - CT, FL, MD, RI, TX, WI (UnitedHealthcare Community Plan)

87726 AmeriChoice by UnitedHealthcare (NYU) (UnitedHealthcare Community Plan)

87726 AmeriChoice MS - CHIP & CAN (UnitedHealthcare Community Plan)

86047 AmeriChoice NJ, Medicaid, NJ Family Care (UnitedHealthcare Community Plan)

87726 AmeriChoice of Florida

87726 AmeriChoice of Illinois

87726 AmeriChoice of Maryland

87726 AmeriChoice of Nebraska

87726 AmeriChoice of Nebraska (UnitedHealthcare Community Plan)

86047 AmeriChoice of NJ Medicaid & Family Care

87726 AmeriChoice of Rhode Island

95378 Americhoice of TN

25175 Americhoice Personal Care Plus PA (UnitedHealthcare Community Plan)

95378

AmeriChoice TN: TennCare, Secure Plus Complete (UnitedHealthcare Community

Plan)

28804 Amerigroup

28807 Amerigroup - Maryland, Virginia and District of Columbia

28806 Amerigroup - New Jersey

28805 Amerigroup / Americaid - Houston

27514 AMERIGROUP Georgia

28804 Amerigroup IL

26375 Amerigroup Iowa

26378 AMERIGROUP MULTIPLE STATES

28809 Amerigroup of Florida

27514 AMERIGROUP Tennessee

93688 AmeriHealth - DE (PPO)

60061 AmeriHealth - New Jersey (Non-HMO Claims)

54763 AmeriHealth Administrators

27357 Amerihealth Caritas

77075 Amerihealth Caritas Iowa

77013 Amerihealth Caritus VIP Michigan

77799 Amerihealth DE

77002 Amerihealth District of Columbia

23037 AMERIHEALTH HMO

22248 AmeriHealth Mercy Health Plan

77001 AmeriHealth NorthEast

22355

AmeriHealth VIP Care (Medicare Advantage Plan Part of the AmeriHealth Mercy

Family of Companies)

26375 Amerivantage

34192 Antares Management Solutions

80705 Anthem Health and Life Insurance Company of New Jersey

00050 Anthem of Colorado

52312 Arbor Health

03432 Arizona Physicians IPA

03432 Arizona Physicians IPA (APIPA) (UnitedHealthcare Arizona Physicians IPA)

74234

Arizona Pipe Trades Health and Welfare Trust Fund Local Union Nos. 469 & 741

Metal Trades Health Plan

74234

Arizona Pipe Trades Health and Welfare Trust Fund Local Union Nos. 469 & 741

Pipe Trades Health Plan

06603 ASAGEHA

94027 Asociacion de Maestros

39065 Assurant Employee Benefits (Formerly Fortis Insurance)

AHTIN Assurant Health - Time Insurance

AHUSY Assurant Health- Union Security Insurance

SX179

Asuris Northwest/MedAdvantage (REF*1B*Provider ID in Billing and Rendering

required even when NPI is submitted.)

MNAUL Aultcare

38259 Automated Benefit Services (ABS)

46045 Avera Health Plans

59274 AVMED

95964 AZ PACIFICARE CLA

BANK1 BANKERS FIDELITY LIFE INSURANCE CO (ERA ONLY)

74227 Bankers United Life (Student Division)

12X42 Banner Health

SX145

Banner Health Co. (All Banner Health Plans were consolidated to the payerID of

SX145.)

66901 Banner-University Family Care(University of Arizona Health Plans)

SB570 BCBS DELAWARE

SB700 BCBS MASSACHUSETTS

SB690 BCBS of Maryland

66001 BCBS TEXAS MEDICAID STAR CHIP

VALOP Beacon Health Options (Formerly Value Options)

43324

Beacon Health Strategies (Block 11 on the HCFA 1500 form must use Plan specific

IDs.)

56139 Benefit Managaement Svcs

56139

Benefit Management Services (Please contact Chris Burak at 704-321-3156 for

payerID information.)

61425 Benefit Trust Life Insurance Company

95604 Best Life & Health Insurance Co.

01508 BETTER HEALTH FLORIDA

00923 Blue Care PPO

00870 Blue Chip of Rhode Island

00403 Blue Choice Medicaid

00804 Blue Choice of Rochester NY

00922 Blue Choice of South Carolina

BCSAL Blue Cross Blue Shield Alabama

53589 Blue Cross Blue Shield of Arizona

MC721 BLUE CROSS COMMUNITY CENTENNIAL

MCDIL Blue Cross Community Options

66006 Blue Cross Medicare Advantage

47198 Blue Cross of California

00610 Blue Cross of Idaho

IDBLC BLUE CROSS OF IDAHO

00580 Blue Shield of Alabama

00822 Blue Shield of Alaska

00520 Blue Shield of Arkansas

BS001 Blue Shield of California

00805 Blue Shield of Central NY HMO/PPO

00060

Blue Shield of Connecticut (NOTE: The DOS in Reports is programmatically

calculated and is not actual claim's data. Some variances may exist.)

00590 Blue Shield of Florida

00601 Blue Shield of Georgia (State Health of GA)

HIBCS Blue Shield of Hawaii

00611 Blue Shield of Idaho-Regence

00621 Blue Shield of Illinois

00630 Blue Shield of Indiana

88848 Blue Shield of Iowa

47163 Blue Shield of Kansas

47171 Blue Shield of Kansas City

00660 Blue Shield of Kentucky

53120 Blue Shield of Louisiana

00680 Blue Shield of Maine

00200 Blue Shield of Massachusetts

00710 Blue Shield of Michigan

00720 Blue Shield of Minnesota

00230 Blue Shield of Mississippi

00241 Blue Shield of Missouri

BCSMT Blue Shield of Montana

77780 Blue Shield of Nebraska

00265 Blue Shield of Nevada

00770 Blue Shield of New Hampshire

NJBCS Blue Shield of New Jersey

00790 Blue Shield of New Mexico

00803 Blue Shield of New York (Empire)

05536 Blue Shield of North Carolina

00820 Blue Shield of North Dakota

00800 Blue Shield of Northeast NY

00834 Blue Shield of Ohio

00840 Blue Shield of Oklahoma

00851 Blue Shield of Oregon

54771 Blue Shield of Pennsylvania

00870 Blue Shield of Rhode Island

00804 Blue Shield of Rochester NY (Excellus)

SCBCS Blue Shield of South Carolina

88848 Blue Shield of South Dakota

00390 Blue Shield of Tennessee

84980 Blue Shield of Texas

TXBLS BLUE SHIELD OF TEXAS

84980 Blue Shield of TX HCSC Insurance Services Company

00910 Blue Shield of Utah

00806 Blue Shield of Utica NY

VTBLS Blue Shield of Vermont

00923 Blue Shield of Virginia

54828 Blue Shield of West Virginia

00801 Blue Shield of Western New York

00950 Blue Shield of Wisconsin

00960 Blue Shield of Wyoming

00246 BlueCross BlueShield of Western New York Medicaid

61124 Bluegrass Family Health

74238 Boon-Chapman Benefit Administrators, Inc.

13337 Boston Medical Center Healthnet

52192

Bravo Health (Formerly known as Elder Health Inc. Serving members in PA, MD, DE,

TX and Washington DC.)

BRIDG Bridgespan

68069 Bridgeway Arizona (Also 68054)

CB186 BRIGHT HEALTH PLAN

BTSS1 Brown & Toland Sutter

BTSS1 Brown & Toland SutterSelect

68069 Buckeye Community Health (Also 32004)

KS003 CA Kaiser Permanente (Northern California Only)

68069 California Health and Wellness

CALOP Cal-Optima Direct

23045

Capital Advantage Insurance Company (CAIC) PROFESSIONAL (BCBS ProviderID and

Performing ProviderID required. Call 800-874-8433)

23045

Capital Blue Cross PROFESSIONAL (BCBS ProviderID and Performing ProviderID

required. Call 800-874-8433)

SX065 Capital District PHP

95112 Capital Health Plan

68011 Capitol Administrators

CAPHP Caprock Health Plan

57116 Care 1st Health Plan of Arizona

57115 Care 1st Health Plan of CA

77082 Care Improvement Plus

SB580 CareFirst BCBS - DC, National Capital Area

SB691 CareFirst DELMARVA Health Plan

CM001 Caremore

95092 CAREPLUS

77023 Carepoint Health Plan

31114 CareSource

INCS1 CareSource IN

KYCS1 CareSource KY

GACS1 CARESOURCE OF GA

62073 Cariten Commercial

29076

Carolina Care Plan (Part of the Medical Mutual Family of companies. Former

payerID was 57105.)

68069 Carolina Crescent (Also 68055)

52132 CBA, Inc. (Cooperative Benefits Administrators, Inc.)

41124 CBSA (Corporation Benefit Services of America)

CCStpa CCSTPA COMPREHENSIVE CARE SERVICES

CELTC Celtic Insurance

68069 CeltiCare

68060 Celticare

95386 CenCal Health

68068 Cenpatico - Multiple States

68048

Cenpatico Behavioral Health AZ (Prior to submission, contact 866-495-6748 to

verify provider ID.)

68068 Cenpatico Kansas

68069 Centene Advantage Plans (Also 68056)

13360 Centerlight Healthcare Inc.

SX169 CENTRAL CALIFORNIA ALLIANCE FOR HEALTH

34097 Central Reserve Life

CIPA1 Central Senior Care

62218 CENTRAL SENIOR CARE

84146

CHAMPVA-HAC (CHAMPVA-HAC is not associated with and does not process claims

for TRICARE (formerly CHAMPUS.))

J1908 CHESAPEAKE INSURANCE

38308 Christian Brothers Services

75544 CHRISTIE STUDENT HEALTH PLANS

10629 Christus Health Medicare Advantage

21062 Christus Health New Mexico HIX

52106 CHRISTUS HEALTH PLAN TEXAS HIX

62308 CIGNA - PPO

62308 CIGNA Health Plan - HMO

62308 CIGNA Premier Plus

74234 City of Austin

95444 Clarian Health Plans

COACC Colorado Access HMO

COKSR Colorado Kaiser Permanente (Colorado plans only)

91162 Columbia United Providers

77170 Common Ground Healthcare Cooperative

73143 Community Care Managed Health Care Plans of Oklahoma

COMMF Community First

48145

Community Health Choice (Please include TPI Number (Texas Medicaid Number) in

Field FA0-23)

75261 Community Health Electronic Claims/CHEC/webTPA

66170 COMMUNITY HEALTH GROUP

SB613 Community Health Plan of Washington

00720 Comprehensive Care Services (BCBSMN)

74234 CompuSys Incorporated (New Mexico)

74234 CompuSys Incorporated of Arizona

74234 CompuSys Incorporated of Utah

74234 CompuSys/Erisa Group, Incorporated (AZ)

74234 CompuSys/Erisa Group, Incorporated (NM)

74234 CompuSys/Erisa Group, Incorporated (TX)

80705 Confederation Admin Services

80705 Confederation Life Insurance

78375 Connecticare - Medicare

06105 Connecticare, Inc.

75284 Consolidated Associates Railroad

59140 Consolidated Group

87843 Consolidated Health Plans

L0260 CONSTELLATION HEALTH

71404 Continental General Insurance Co.

CCHP1 Cook Children's Health Plan

HPAMN Cooportunity Health

35187 CoreSource

35182 CoreSource of Illinois

35182 CoreSource of Iowa

35182 CoreSource of Maryland

35180

CoreSource of North Carolina (Start using new PayerID of 35182. Old payerID will

start rejecting soon.)

35183 Coresource of OH

35182 CoreSource of Pennsylvania

56116

Corporate Benefits Service, Inc. (NC) (Only valid for payer address of PO Box 12953,

Charlotte, NC 28220)

62553 COUNTRY LIFE

42139 County Care

00923 COVA (Commonwealth of VA)

58102 Covenant Administrators, Inc.

25133 Coventry Health Care (Coventry old Legacy Payer ID's are still accepted.)

25132 COVENTRY HEALTH CARE IOWA

25135 COVENTRY HEALTH CARE LOUISIANA

25136 COVENTRY HEALTH CARE LOUISIANA

25127 COVENTRY HEALTHCARE GEORGIA

128FL Coventry Healthcare of FL

00019 Cox Health Plan (Requires Provider ID in Box 33a. Contact Cox Health Plan for ID.)

80705 Crown Life

46120 CRYSTAL RUN HEALTH PLANS

34186 CSI Network Services

59225 CT General Life Insurance (Formerly STAR HRG.)

59140 Culinary Health & Welfare Fund (Las Vegas, NV)

DAK01 DakotaCare

DEAN1 Dean Health Plan

64159 DEFINITY HEALTH

87726 Definity Health Plan (UnitedHealthcare)

87726 Definity Services

DCHPMCAID DELL CHILDRENS HEALTH PLAN

SX105 Deseret Mutual

UH105 Deseret Mutual

25160 DGA - Diversified Group Administrators

BC001 DIRECTORS GUILD OF AMERICA

SX105 DMBA AKA MISSIONARY MEDICAL

74284 Driscoll Childrens Health Plan

74284 Driscoll Childrens Health Plan (CHIP)

81039 EBMS (Employee Benefit Management Services, Inc)

58379 ECHO Health

SX110

Educators Mutual (EMIA) (Enrollment required, contact EMIA to enroll 800-362-

0533, Opt. 2)

52192 Elder Health Maryland HMO Inc. (Now known as Bravo Health.)

31625

ElderPlan, Inc. (Elderplan Provider ID necessary on all claims. Contact (718)921-

7979 for Provider ID.)

EMBLM EMBLEM

87726 Empire Plan (UnitedHealthcare)

SC446 Employee Benefit Services DBA Key Benefit Administrators

62308 EQUICOR

62308 EQUICOR - PPO

23250 Erin Group Administrators (Now known as Significa Benefit Services, Inc.)

74234 Erisa Administrative Services Incorporated

74234 Erisa Administrative Services, Inc.

57082 Essence Healthcare

87726 Evercare Special Needs (Evercare by UnitedHealthcare)

87726 Evercare Star Plus

35605 Everence

93240 EVERGREEN HEALTH COOPERATIVE

58233 EVERGREEN HLTH PL

22254 Fallon Community Health

93121 FAMILYCARE COORDINATED CARE ORGANIZATION

33033 FCE Benefit Administrators

41041 Federated Mutual Insurance

11315 Fidelis Care New York

56196 First Carolina Care

91131 First Choice Health Network

80705 First Great-West Life & Annuity

87043 FIRST HEALTH

73159 First Health Network

87726 First Seniority Freedom

94999 FirstCare

59322 Florida Health Plan

59321

Florida Hospital Healthcare Systems (In network providers must submit UP or FHHS

ProviderID. Out of network providers must contact FHHS at 407-701-4893.)

48117 FMH Benefit Services

39065 FORTIS (Formerly Time Insurance)

39065 Fortis (Western Life Ins. Benefit Plan)

39065 Fortis Benefits, Inc. (Woodbury) PHCS Network Claims

41124 Fortis Self Funded Administrative Services

39065 FORTIS Western

64069 Fox-Everett, Inc.

41212 Freedom Health Plan

43197 FRESENIUS HEALTH PARTNERS

59204 Fringe Benefit Coordinators

25169 Gateway Health Plan

25169 Gateway Health Plan Medicaid PA

75273 Geisinger Health Plan

61271 Georgia Power Medical Benefits Plan

00601 Georgia State Health Benefit Plan (Processed by GA BC/BS)

25141 GHP (Group Health Plan)

07205 Gilsbar, Inc

GHOKC Global Health

77160 Gold Coast

37602 Golden Rule Insurance

GTPA1 Golden Triangle Physician Alliance

44054 Government Employees Hospital Association,Inc. (GEHA)

80705 Great West (SF)

80705 Great West (WA)

80705 Great West Care

80705 Great West Denver

80705 Great West Life Assurance

80705 Great West Life Assurance Company of America

80705 Great-West Bellevue

48143 Group and Pension Administrators

13551 Group Health Incorporated (GHI) (New York)

61101 Group Health Insurance - DE

91121

Group Health Northwest (Call Payer at 888-767-4670 prior to submitting electronic

claims.)

64246 Guardian Life Insurance Company of America

80705 GWL

80705 GWL & A

43313 Harken Health

36406

Harmony Health Plan of Illinois (Wellcare Provider ID required, call (800) 960-2530

opt. 2 then 5)

36405

Harmony Health Plan of Indiana (Only claims for Indiana Hoosier Healthwise

members can be sent to this payer electronically.)

14163 Harmony-Wellcare HMO, Inc.

95959 Harris Methodist Health Plan

04271 Harvard Pilgrim Health Care

87726 Harvard Pilgrim Passport Connect

77950 Health Alliance Medical Plans of Illinois

38224 Health Alliance Plan of Michigan

46221 Health Choice Insurance

62179 Health Choice of AZ

62111 Health Cost Solutions

95019 Health First Health Plans

95567 Health Net (of California)

06108

Health Net of the North East, Inc. (Health Net six digit ID REQUIRED in B0X33a; call

866-334-4638)

04286 Health New England

80142 Health Partners, PA

76342 Health Plan of Nevada (FFS claims)

68035 Health Plan of San Joaquin

HPSM1 Health Plan of San Mateo

59140 Health Plan Services, Tampa Office

38216 Health Plus of Michigan

37290 Health Services for Children with Special Needs (HSCSN)

HLTHT Health Traditions

HCH01 HEALTHCARE HIGHWAYS

HMA01

Healthcare Management Administrators, Inc. (also known as HMA, servicing

Western Region)

73147 HealthCare Solutions Group

25133 Healthcare USA

71064 HEALTHCHOICE

HCA77 HealthComp

59608 Healthease

41178 HealthEZ

80141 Healthfirst, Inc. (NY)

56144 HealthGram

00923 Healthkeeper HMO

38309 Healthnet of AZ

55204 HealthNow NY

55764 HealthPartners of Minnesota

27514 Healthplus Amerigroup

68195 Healthpoint Corporation

71063 HealthSCOPE Benefits, INC

68195 Healthsource Provident Ins. Co.

HT001 HealthSpring HMO (No PPO claims accepted via this payerID.)

63092 HealthSpring HMO/HealthSpring Medicare+Choice

88250 HealthTeam Advantage

00661 Healthy Blue Louisiana

68064 Healthy Texas

00243 Helix Family Choice

55247 HIP-Health Insurance Plan of Greater NY

68069 Home State Health Plan

88023 Hometown Health Plan Nevada

CALL HORIZON BCBS NEW JERSEY

61115 HUMANA LONG TERM CARE

61125 Humana Military Tricare

61101 HUMANA, Claims only

74234 IBEW Local 640 & Arizona Chapter NECA Health & Welfare Trust

74234 IBEW Western Utilities or Local 57

41124 IBI

11695 iCARE (Independent Care Health Plan)

68066 Illini Care Health

68069 Illinicare Group Health (Also 68066)

TA720 Independence Administrators

54704 Independent BLC of PA (Also known as Personal Choice PPO of Pennsylvania.)

95308 Independent Health (Enrollment and Testing Required, contact (716) 635-3911)

35161 Indiana ProHealth Network

77153 Indiana University (Southeastern Indiana Health)

95444 INDIANA UNIVERSITY HEALTH PLAN

IEHP1 Inland Empire Health Plan

86304 Insurers Administrative Corp

51020 INTEGRA Administrative Group, Inc.

68068 Integrated Mental Health Services

INCHN Intercommunity Health Net

74234 Intermountain Ironworkers Trust Fund

41124 Iowa Benefits, Inc.

JAI01 JAI Medical Systems

61271 JF Molloy

87726 John Deere Healthcare, now know as UnitedHealthcare River Valley

52123

Johns Hopkins (USFHP) (New submitter should send in their Billing NPI & Rendering

servicing NPI)

34136 JP Farley Corporation

NG007 Kaiser Foundation Health Plan of Ohio

94134 Kaiser Foundation Health Plan of Southern CA Region

93079 KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST

NG008 Kaiser Mid-Atlantic

21313 KAISER PERMANENTE GEORGIA

RH011 Kaiser Permanente Hawaii

KMG11 Katy Medical Group

61453 Kemper Benefits

73100 Kempton Group

68067 Kentucky Spirit Health

68069 Kentucky Spirit Health Plan (Also 68067)

37217 Key Benefit Administrators

00923 Keycare PPO

77741 Keystone First PA Community Health Choices

23284 Keystone Mercy Health Plan

84223 Keystone VIP Choice

27357 LA Care

LACAR LA Care Health Plan

90096 Land of Lincoln Health

RLH01 LIFEMAP

EBSRM Lifetime Benefit Solutions

EBSRM Lifetime Benefits Solutions

93093 Lifewise A Premier Health Plan

93093 Lifewise Health Plan of Oregon A Premier Health Plan

91049 Lifewise Health Plan of Washington A Premier Health Plan

00923 Local Choice

45289 Lone Star TPA

68069 Lousiana Healthcare Connections

13193 Loyal American

37292 Machinist District 9 Welfare

60054

Magellan Behavioral Health (For Dates of Service 1/1/2006 and After - Provider ID

Required - AETNA Subscribers only.)

MCCVA Magellan Complete Care of VA

01260 Magellan Health (All Non-AETNA Subscribers - Provider ID Required)

11303 MAGNACARE

68062 Magnolia

68069 Magnolia Mississippi (Also 68062)

87726 MAHP (MD IPA, Optumun Choice and MLH) UnitedHealthcare

62413 MailHandlers

45341 Maine Community Health Options

MCS04 Managed Care Systems

22771 Managed Health Networks (MHN)

68069 Managed Health Services Indiana (Also 39186)

68069

Managed Health Services of Wisconsin (Please contact the payer @ 800-225-2573,

ext 25525 to get setup to submit electronic claims.)

46012 Mapfre Life Commercial

52461 MARCH VISION CARE INCORPORATED

53275 MARTINS POINT HEALTH CARE

22348 Maryland Physicians Care

41154 Mayo Management Services, Inc.

87726 MD-Individual Practice Association, Inc. (M.D. IPA) (Previously Payer ID 52148)

88058 Med Pay

88058 Med Pay

90753 MedCost / Liberty Health Share

56205 MedCost Benefit Services

56162 MedCost, Inc.

94265 MEDICA

78857 Medica Health Care Plan, Inc.

71890 Medica Health Plan Solutions

12422 Medica2

DEMCD Medicaid of Delaware

ALMCD Medicaid of Alabama

AKMCD Medicaid of Alaska

AZMCD Medicaid of Arizona (AHCCCS)

ARMCD Medicaid of Arkansas

COMCD Medicaid of Colorado

CTMCD Medicaid of Connecticut

FLMCD Medicaid of Florida

GAMCD Medicaid of GA

HIMCD Medicaid of Hawaii

IDMCD Medicaid of Idaho

ILMCD Medicaid of Illinois

INMCD Medicaid of Indiana

IAMCD Medicaid of Iowa

KSMCD Medicaid of Kansas

KYMCD Medicaid of Kentucky

LAMCD Medicaid of Lousiana (Includes KidMed claims.)

MEMCD Medicaid of Maine

MDMCD Medicaid of Maryland

MAMCD Medicaid of Massachusetts

MIMCD Medicaid of Michigan

MNMCD Medicaid of Minnesota

MSMCD Medicaid of Mississippi

MOMCD Medicaid of Missouri

MTMCD Medicaid of Montana

NEMCD Medicaid of Nebraska

NVMCD Medicaid of Nevada

NHMCD Medicaid of New Hampshire

NJMCD Medicaid of New Jersey

NMMCD Medicaid of New Mexico

NYMCD Medicaid of New York

NCMCD Medicaid of North Carolina

NDMCD Medicaid of North Dakota

OHMCD Medicaid of Ohio

OKMCD Medicaid of Oklahoma

ORMCD Medicaid of Oregon

PAMCD Medicaid of Pennsylvania

RIMCD Medicaid of Rhode Island

SCMCD Medicaid of South Carolina

SDMCD Medicaid of South Dakota

TNMCD Medicaid of Tennessee (TennCare)

TXMCD Medicaid of Texas

UTMCD Medicaid of Utah

VTMCD Medicaid of Vermont

VAMCD Medicaid of Virginia

DCMCD Medicaid of Washington DC

WAMCD Medicaid of Washington State

WVMCD Medicaid of West Virginia

WIMCD Medicaid of Wisconsin

WYMCD Medicaid of Wyoming

MAHP1 Medical Associates Health Plan

MAHC1 Medical Associates Health Plan

PRMCS Medical Card System (MCS)

29076

Medical Mutual of Ohio (Payer requires a 12 digit rendering provider ID#, which

needs to be obtained from payer by calling 800-321-7223)

CAMCD MediCal of California

38224 Medical Value Plan - Ohio (MVP)

KMMCR Medicare of Missouri (Includes both Eastern and Western Missouri.)

ALMCR Medicare Part A/B of Alabama

AKMCR Medicare Part A/B of Alaska

AZMCR Medicare Part A/B of Arizona

ARMCR Medicare Part A/B of Arkansas

COMCR Medicare Part A/B of Colorado

CTMCR Medicare Part A/B of Connecticut

DEMCR Medicare Part A/B of Delaware

FLMCR Medicare Part A/B of Florida

GAMCR Medicare Part A/B of Georgia

HIMCR Medicare Part A/B of Hawaii

IDMCR Medicare Part A/B of Idaho

ILMCR Medicare Part A/B of Illinois

INMCR Medicare Part A/B of Indiana

IAMCR Medicare Part A/B of Iowa

KSMCR Medicare Part A/B of Kansas

KYMCR Medicare Part A/B of Kentucky

LAMCR Medicare Part A/B of Louisiana

MEMCR Medicare Part A/B of Maine

MDMCR Medicare Part A/B of Maryland

MAMCR Medicare Part A/B of Massachusetts

MIMCR Medicare Part A/B of Michigan

MNMCR Medicare Part A/B of Minnesota

MSMCR Medicare Part A/B of Mississippi

MOMCR Medicare Part A/B of Missouri (Eastern) (Specialty testing required)

MTMCR Medicare Part A/B of Montana

NEMCR Medicare Part A/B of Nebraska

NVMCR Medicare Part A/B of Nevada

NHMCR Medicare Part A/B of New Hampshire

NMMCR Medicare Part A/B of New Mexico

ENMCR Medicare Part A/B of New York (Empire)

NYMCR Medicare Part A/B of New York (Upstate)

NJMCR Medicare Part A/B of NJ (Specialty testing required)

NCMCR Medicare Part A/B of North Carolina

NDMCR Medicare Part A/B of North Dakota

CNMCR Medicare Part A/B of Northern California

VNMCR

Medicare Part A/B of Northern Virginia (inc. Prince George, Montgomery, Fairfax

and Arlington Counties and City of Alexandria)

OHMCR Medicare Part A/B of Ohio

OKMCR Medicare Part A/B of Oklahoma

ORMCR Medicare Part A/B of Oregon

PAMCR Medicare Part A/B of PA (Specialty testing required)

RIMCR Medicare Part A/B of Rhode Island

SCMCR Medicare Part A/B of South Carolina

SDMCR Medicare Part A/B of South Dakota

CSMCR Medicare Part A/B of Southern California

TNMCR Medicare Part A/B of Tennessee

TXMCR Medicare Part A/B of Texas

UTMCR Medicare Part A/B of Utah

VTMCR Medicare Part A/B of Vermont

VAMCR Medicare Part A/B of Virginia

WAMCR Medicare Part A/B of Washington

WVMCR Medicare Part A/B of West Virginia

MWMCR Medicare Part A/B of Western Missouri

WIMCR Medicare Part A/B of Wisconsin

WYMCR Medicare Part A/B of Wyoming

ASMCR Medicare Part B of American Samoa

QUMCR Medicare Part B of New York GHI

PRMCR Medicare Part B of Puerto Rico (In Test)

00923 Medicare Supplemental

23160 Medico Insurance Company

95655 MEDIGOLD

00130 MedPay

39190 MedStar Family Choice

00243 Medstar Physician Partners

74227 MEGA Life & Health Ins. Co. (Student Division)

59221

Mega Life & Health Insurance Company (SSN is not a valid Insured ID. Must be

similar to 01234567899 or AA1234567)

MCA11 Memorial Clinical Associates

62181 MEMORIAL CLINICAL ASSOCIATES SELECTCARE TEXAS

74289 Mental Health Network (Only claims for PO Box 209010 Austin TX 78720)

86052 Mercy Health Plan (AHCCCS)

86052 Mercy Health Plan of AZ

22326

Mercy Health Plan of New Jersey (Provider ID Required in Box33a - Contact (800)

682-9091 to obtain ID)

33628 Mercy Maricopa Integrated Care

13189 Meridian Health Plan

64157 Meritain Health (North American Health Plan.)

41124 Meritain Health Minneapolis

13265 Metro Plus Health Plan

10850 Metropolitan Health Plan

59224

Mid-West National Life Insurance Co. of Tennessee (ID valid only for following: PO

Box 982017, North Richland Hills, TX 76182)

74227 Mid-West United Life (Student Division)

STJOE Mission Hospital Affiliates

SX105 Missionary Medical

00530 MISSOURI CARE

88600 MMM (Medicare y mucho mas)

13350 MODA Health - Formerly ODS Health Plan

81793 Molina Health Reforma

38333

Molina Healthcare of California (Rendering provider must use Medi-Cal ID number

or State License Number. Billing provider should use Federal TaxID only.)

51062 Molina Healthcare of Florida

20934 Molina Healthcare of Illinois

38334 Molina Healthcare of Michigan

NM505 Molina Healthcare of New Mexico

20149 Molina Healthcare of Ohio

46299 Molina Healthcare of South Carolina

20554 Molina Healthcare of Texas

38336

Molina Healthcare of Washington (Rendering providers use DSHS Medicaid ID or

State Licence Number.)

SX109 Molina Healthcare Utah

13174

Montefiore Contract Management Organization (Provider ID required, call 914-377-

4400 for ID prior to first claims submissions.)

35092 Morris Associates aka HealthScope Benefits

95444 MPLAN Inc. Healthcare Group

SB731 MS BCBS State Employees

95655 Mt. Carmel

81883 Municipal Health Benefits Fund

39065 Mutual Benefit

39065 Mutual Benefit Life

34192 Mutual Health Services

71412 Mutual of Omaha Insurance Company

71412 Mutually Preferred

14165 MVP Health Plan of NY

58182 Naphcare Inc

53011 National Association of Letter Carriers

88050 National Health Benefits Corporation - NHBC02

52132 National Rural Electric

52103 National Telecommunications Cooperative Association (NTCA)

95123 Neighborhood Health Partnership (NHP)

96240 Neighborhood Health Plan of RI - Integrity

96240 Neighborhood Health RI Exchange, Unity, Integrity Plans

04332

Network Health (Before initiating submissions, please call Provider Relations at

(617)806-8104 or www.network-health.org for an EDI startup plan.)

77076 Network Health Insurance Corp - Medicare

04332 Network Health Massachusetts

39144

Network Health Plan of Wisconsin, Inc.(Prior to initial claims submission, please

contact Network Health Plan EDI specialist at 920-720-1506.)

75281 New ERA Life

68069 New Hampshire Healthy Family

74234 New Mexico District Council of Carpenters

45129 New Mexico Health Connections

74234 New Mexico Painters and Allied Trades Local No 823

74234 New Mexico-West Texas Multi-Craft (lso known as New Mexico Laborers)

81264 Nippon Life Insurance Company

64157 North American Administrators, Inc.

NWDC1 Northwest Diagnostic Clinic

71080 NOVASYS Health Network

62119 NW Diagnostic Clinic SelectCare of TX (NWDC)

25150 OmniCare (For claims with Dates of Service after 10/01/04)

80705 One Health Plan Inc.

80705 One Health Plan Michigan, Inc.

80705 One Health Plan New York, Inc.

80705 One Health Plan of Alaska

80705 One Health Plan of Arizona, Inc.

80705 One Health Plan of DC Inc,

80705 One Health Plan of Florida

80705 One Health Plan of Indiana, Inc.

80705 One Health Plan of Kansas and Missouri

80705 One Health Plan of Maine, Inc.

80705 One Health Plan of Massachusetts, Inc.

80705 One Health Plan of Minnesota, Inc.

80705 One Health Plan of Nevada, Inc.

80705 One Health Plan of New Jersey

80705 One Health Plan of North Carolina

80705 One Health Plan of Ohio

80705 One Health Plan of Pennsylvania

80705 One Health Plan of South Carolina

80705 One Health Plan of Tennessee

80705 One Health Plan of Texas

80705 One Health Plan of Virginia, Inc.

80705 One Health Plan of Washington

80705 One Health Plan of Wisconsin, Inc.

80705 One Health Plan of Wyoming

74234 Operating Engineers Local No 53

54154 Optima Insurance Company

87726 Optimum Choice, Inc. (OCI) (Previously Payer ID 52148)

87726 OptumHealth Behavior Solutions

87726 OptumHealth Behavioral Solutions of NM (OptumHealth)

87726 OptumHealth New Mexico

45332 Oregons Health CO-OP

OSCAR Oscar Health

06111 Oxford (UnitedHealthcare/Oxford)

06111 Oxford Health Plans

15460 PA Care Advantage Highmark Senior Health

81400 PacifiCare Individual Business Plan (UnitedHealthOne)

95958 PacifiCare of CA Encounters

95958 PacifiCare of OK Encounters

95958 PacifiCare of OR Encounters

95958 PacifiCare of TX Encounters

95958 PacifiCare of WA Encounters

95999 PacifiCare PPO

20416 PACIFICSOURCE COMMUNITY SOLUTIONS

93029 PacificSource Health Plans

20377 Pacificsource Medicare

81240 Palic / Pan-American Health

04218 Pan American Life Insurance

SX158 Paramount Health

66917 Parkland Community Health Plan

PHP02 PARTNERSHIP HEALTH PLAN (OPTUMINSIGHT FOR ENROLL FORMS)

61129 Passport Health Plan

61325 Passport Health Plan

68069 Peach State Health Plan (Behavioral Health)

68069

Peach State Health Plan (Medicaid) (Call 800-225-2573 ext 25525 prior to

submitting claims.) (Also 39187)

68049 Peach State HP

SX106

PEHP - Utah Public Employee Health Plan (Enrollment required, please contact

Provider Relations 800-765-7347)

37086 PEKIN INSURANCE

00923 Peninsula Healthcare

95056 Pennsylvania Keystone Health Plan East (claims only)

95056 Pennsylvania Keystone Health Plan East (encounters only)

PEBLS PENNSYLVANIA KEYSTONE HEALTH PLAN EAST (ENCOUNTERS ONLY)

72126

Peoples Health Network (Tenet) (Network ID must be on claim. Contact

phn.provider@tenethealth.com)

54704 Personal Choice PPO of Pennsylvania (Also know as Independent BLC)

95397 Personal Insurance Administrators

13306 PHCS Savility (ONLY for Savility card members.)

03440 Phoenix Health Plan

37330 Physicians Health Plan (PHP) Mid-Michigan

12399 Physicians Health Plan of Northern Indiana

06108

Physicians Health Services (now Health Net of NE) (Health Net six digit ID

REQUIRED in B0X33a; call 866-334-4638)

47027 Physicians Mutual Insurance Company

39156 Physicians Plus Insurance Corp.

95397 PIA

24735 Pinnacle Claims Management

45985 PINNACLE PHYSICIAN MANAGEMENT ORGANIZATION

37224 Pittman and Associates

37287 Planned Administrators, Inc. (PAI)

73159 PPO Oklahoma (WinterBrook HealthCare Management)

36373 Prairie States Enterprises, Inc.

65088 Preferred Care Partners (Miami,Florida)

60110 Preferred Health Systems, Inc.

L0250 Preferred Medicare

41147 Preferred One

43166 PREMIER HEALTH PL

PREHP

Presbyterian Health Plan (Commercial) (Provider ID is required. Contact (888) 923-

5757, #6 then #2 to obtain ID. New Mexico Providers only.)

77003 PRESTIGE HEALTH CHOICE

39185 Prevea Health Insurance Plan / Arise Health Plan

60054 Primary Choice (Aetna HP-NY/NJ)

56144 Primary PhysicianCare, Inc.

61604 Prime West Health Plan

61271 Principal Financial Group

61271 Principal Mutual Life Insurance Company

38217

Priority Health (Please contact Priority Health EDI Dept at 616-464-8686 or email

EDISETUP@Priority-Health.com)

00923 Priority Healthcare

36331 Professional Benefit Administrators, Inc. (Oak Brook, IL)

93082 Prominence Health Plan of Nevada

80095 Prominence Health Plan of Texas

PHP01 Providence Good Health Plan

PHP00 Providence Preferred (PPO) (ProviderID and Enrollment required.)

68195 Provident Life & Accident Insurance Company

68195 Provident Life & Accident Insurance Company of America

68195 Provident Life & Casualty Insurance Company

35174 Qual Choice of Arkansas

23342 Qualcare

73067 Quicktrip Corporation

RRMCR Railroad Medicare

00932 Regence Blue Shield of Washington

RGA01 REGENCE GROUP ADMINISTRATORS

73066

Reserve National Insurance (For Claims rejections, please contact Reserve national

Customer Service at (405)848-7931.)

74205 Right Care from Scott & White

42172 Riverlink Health

RMSCO RMSCO

RMHMO Rocky Mountain HMO

37602 Rooney Life Ins.

31441 S & S Healthcare Strategies

SFG99 SafeGuard

SFHP1 San Francisco Health Plan

91184 Sanford Health Plan

24077 Santa Clara Family Health Plans

SCAN1 Scan CA

SCH01 Schaller Anderson CHOC Health Alliance

88030 Scott & White Health Care

87726 SecureHorizons MedicareComplete (SecureHorizons by UnitedHealthcare)

87726 SecureHorizons MedicareDirect (SecureHorixons by UnitedHealthcare)

39045 Security Health Plan

60054 Select Choice

23285 Select Health of South Carolina (Provider ID required in Box33a.)

SSC11 SELECT SENIOR CLINIC

76045 SelectCare of Texas (HPN) Heritage Physicians Network

GTPA1

SelectCare of TX (Beaumont) (Provider ID Required - Contact (713) 843-6780 to

obtain ID.)

HPN11

SelectCare of TX (Houston) (Provider ID Required - Contact (713) 843-6780 to

obtain ID.)

KLSY1

SelectCare of TX (Kelsey-Seybold) (Provider ID Required - Contact (713) 843-6780

to obtain ID.)

72189 SELECTCARE TEXAS BEAUMONT & GOLDEN TRIANGLE

TRSEL SELMAN TRICARE SUPP

60054 Senior Choice (Aetna HP-NY/NJ)

95444 Senior Smart Choice

83035 Senior Whole Health

54154 Sentara Family Plan

54154 Sentara Health Management

23249 Sentinel Management Services

SHP01 SHARP HEALTH PLAN

76342 Sierra Health and Life (FFS Claims) (SecureHorizons by UnitedHealthcare)

76342 Sierra Health Services

23250 Significa Benefit Services, Inc.

27094 Simply HealthCare Plans

00540 SISCO

25125 SL CARPENTERS FUN

91131 Sound Health

42172 Soundpath Health (Formerly known as Puget Sound Health Partners, Inc.)

77153 Southeastern Indiana Health SIHO

23253 Spectrum Administrators

73099 Standard Life & Accident Insur Co

59225 STAR HRG (Now part of CT General Life Insurance.)

61425 Starmark

31059 State Farm (Casualty and Property)

00601 State Merit GA

SLIC1 STONEBRIDGE LIFE INS COMPANY (VALLEY FORGE PENNSYLVANIA)

74227 Student Insurance

74227 Student Insurance - Boston Mutual Life Insurance Company

74227 Student Insurance - Life Insurance Company of Boston and New York

74227 Student Insurance - MEGA Life & Health Insurance Company

74227 Student Insurance - Mid-West National Life Insurance Company of Tennessee

74227 Student Insurance - Reliance Insurance Company

74227 Student Insurance - Reliance National Insurance Company

74227 Student Insurance Division

74227 Student Resources International (UnitedHealthcare)

95202 SummaCare Health Plan

68069 Sunflower State Healthcare Plan

68057 Sunshine Health Plan

68057 Sunshine Health Plan

68069 Sunshine Health Plan (Also 68057)

68069 Superior Health Plan (Also 39188)

53589 SW Service Administrators

74234 Tech-Steel, Inc.

76048 Texas Children's Health Plan

TX1ST Texas First Health Plans

BOONG The Boon Group

87726 The Empire Plan

20356 The Health Exchange (Cerner Corporation)

34150 The Health Plan (Upper Ohio Valley)

23223

The Loomis Company (Call Provider Relations at 610-374-4040 ext. 2438 for

procedures prior to submitting electronically.)

63092

The Oath - Health Partners of Alabama (Now known as HealthSpring

HMO/HealthSpring Medicare+Choice)

25175 Three Rivers Provider Network (Now known as Unison Health Plan.)

THRIV THRIVENT FINANCIAL

39065 Time Insurance (A Fortis Company)

48055 Todays Option (American Progressive and Pyramid Life)

61425 Tooling & Manufacturing Assoc.

68055 Total Carolina Care

68069 Total Carolina Care (Also 68055)

87726 Touchpoint

23856 Touchstone Health PSO

13402 Touchstone Health/Health Net Smart

RX001 TRANSACTRX INFUSION AND SPECIALTY

TLINS

Transamerica Life Ins. Co.(Specialized claims only. Call 501-277-1284 for

information.)

TRP1E TRANSAMERICA LIFE INSURANCE COMPANY

59222

TransAmerica Life Insurance Company (Valid for PO Box 982009, North Richland

Hills, TX 76182)

MMLI3 TRANSAMERICA PREMIER LIFE INSURANCE COMPANY (MONUMENTAL)

74234 Transwestern General Agency

TREST TRICARE EAST

TDDIR Tricare for Life (All Regions 1-12)

57106 Tricare North

FOREN TRICARE OVERSEAS

57106 Tricare South

99726 Tricare West

A0011 TRILLIUM HEALTHCARE RESOURCES

97300 Triple S

61425 Trustmark (Includes Starmark & TMA)

04298 Tufts Associated Health

87726 UBH Employer Division

87726 UBH RIOS

19991 Ucare of Minnesota

55413 Ucare of Minnesota - DOS after 1.1.2019

BS001

UFCW Local 400-5205 (Submitters to UFCW must register with CA Blue Shield at

www.blueshieldca.com/provider. If registration NOT completed, claims will reject.)

39026 UHIS-UnitedHealthcare Integrated Services (UnitedHealthcare)

ULLIC ULLICO INCORPORATED (VALLEY FORGE PENNSYLVANIA)

77022 ULTIMATE HEALTH PLAN

31107 UMR Cincinnati

62061 UMR Kansas (Formerly Fiserv Health - Kansas)

39026 UMR Wausau/UHIS

52180 UMWA Health & Retirement Funds

80314 Unicare Life & Health

25175 Unison DC, DE, NJ, OH, PA, SC, TN (UnitedHealthcare Community Plan)

25175 Unison Health Plan (Formerly Three Rivers Provider Network.)

92916 United American Insurance Company

87726 United Behavioral Health

96385 United Healthcare Community Plan Kansas

31107

United Medical Resources, Inc. (Some of UMR's new member cards no longer print

the full SSN. When submitting electronically, the full SSN must be entered.)

71412 United of Omaha

UTAMS UNITED TEACHER ASSOCIATES

87726 UnitedHealthcare

87726

UnitedHealthcare / MAMSI Life and Health Insurance Co. (MLH) (Previously Payer

ID 52148)

87726 UnitedHealthcare Group Medicare Advantage

87726 UnitedHealthcare hawk-I (UnitedHealthcare Community Plan)

87726 UnitedHealthcare Plan of the River Valley (UnitedHealthcare Communit Plan)

87726 UnitedHealthcare River Valley (formerly known as John Deere Healthcare

87726 UnitedHealthcare West (formerly know as PacifiCare) (UnitedHealthcare)

95958

UnitedHealthcare West Encounters(Formerly know as PacifiCare)

(UnitedHealthcare)

15003 UNIVERA COMMUNITY HEALTH

HC001 Univera Healthcare - CNY

UNINW Univera Traditional PPO

UNBCI UNIVERSAL BENEFITS CORPORATION

33001 Universal Care - California (ProviderID required.)

07503 University Family Care - Healthcare Group

09908 University Family Care - Maricopa Health Plan

09908 University Family Care - Maricopa Health Plan

23281 UPMC Health Plan

74095 USAA

74234 Utah Carpenters

74234 Utah Laborers

74234 Utah Pipe Trades

12115 VA Fee Basis Programs

00923 VA State Employer Funds

VCIPA Valley Care IPA

VHA11 Valley Health Administrators

72128 Vantage Health Plan, Inc.

VFP11 VILLAGE FAMILY PRACTICE

63114 Viva Health Plan

77073 VNS Choice Medicare (Formerly Visiting Nurse Service)

22264

VYTRA Healthcare (Provider ID number required. Please call 1-631-420-4100, opt 4,

opt 4 for payer set-up and payer assigned provider ID number.)

00934 Washington State Premera Blue Cross

39026 Wausau Insurance Companies (Now known as UMR Wausau/UHIS.)

39151 WEA Insurance Group

59354 Wellcare Health Plan, Inc. (Encounters only)

87815 Wells Fargo TPA

39065 Western

39065 Western Care

24735 Western Grower's Assurance Trust

24735 Western Grower's Insurance Company

68039 WESTERN HEALTH ADVANTAGE

39065 Western Life Ins. Benefit Plan (FORTIS)

31048 Western Southern Financial Group

90560 WestLake Financial Group, Inc.

62061 Willis Administrative Services Corporation (Now UMR Kansas)

41095 Wilson-McShane

27327 WinHealth Partners/Wyoming Health Solutions

74101 WISCONSIN DEPARTMENT OF CORRECTIONS

75276 World Insurance Company

OOWPS WPS Commercial

SX022 WPS HEALTH INSURANCE