ASK 1

Administrative Services of Kansas

Updated March 2019

Administrative Services of Kansas (ASK) is Blue Cross and Blue Shield of Kansas DBA ASK.

Institutional (Hospital) and Professional (Medical) Payer Listing

Payer ID Order

ASK 2

Payer ID Hospital Medical47163 X X47171 X X00301 X X00801 X X00800 X X31478 X X31478 X X31478 X X55204 X X31478 X X31478 X X31478 X X

PAYER NAME

HealthNow New York, Inc Mo-Kan Sheet Metal Workers Welfare Fund PHP (Preferred Health Professionals) Preferred Health Professionals PPO (PHP PPO)

BlueShield of Northeastern New York Freedom Network Freedom Network Select

ASK accepts claims for the payers listed on this page at no charge to the trading partner. Participation in the EDI Midwest Commercial Claims Clearinghouse is not required for any transactions submitted for these payers.

Only these Additional Payers are Available (Free)

Health Partners of Kansas (HPK)

Blue Cross and Blue Shield of Kansas Blue Cross and Blue Shield of Kansas City BlueCross and BlueShield of Western New YorkBlueCross and BlueShield of Western New York

ASK 3

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

00014 SelectCare Claims X X00046 Hill Physicians Medical Group Claims X X00773 UnitedHealthcare / Spectera Eyecare Networks Claims X01041 Healthsource ME Claims X X01260 Magellan Health Services Claims X02038 Healthsource NH Claims X02041 Healthsource CMHC Claims X X02041 Healthsource Massachusetts Inc. Claims X X02057 Smith Administrators Claims X X

03432 UnitedHealthcare Community Plan / AZ (formerly AZ Physicians IPA APIPA) Claims

X X04218 Pan American Life Insurance Group Claims X X04293 Neighborhood Health Plan (Boston MA) Claims X X04430 ZeroOutofPocket Claims X X05003 Presbyterian Health Plan (NM) Claims X X05047 Neighborhood Health Plan of RI - Medicaid and UNITY Claims X X06102 Diversified Administration Corporation - CT Claims X X06105 ConnectiCare Inc Claims X X

06111 AARP MedicareComplete through UnitedHealthcare / Oxford Medicare Network Claims

X X

06111 AARP MedicareComplete through UnitedHealthcare / Oxford Mosaic Network Claims

X X06111 UnitedHealthcare / Oxford Claims X X06119 Healthsource SC Encounters X X06119 Healthsource SC Claims X X06603 ASAGEHA Claims X X07689 Global Care Inc. Claims X X09830 University Family Care Claims X X09908 University Family Care - Maricopa Health Plan Claims X X10629 Christus Health Medicare Advantage Claims X X10850 Metropolitan Health Plan Claims X X10910 HPMC - Preferred IPA (HPMC - PMG) Claims X X11315 Fidelis Care New York Claims X X11334 New York Network Management Claims X11345 CareCentrix Claims X X11346 CareCentrix Cigna Claims X11347 Carecentrix Florida Blue Claims X11348 CareConnect Insurance Company Inc Claims X11440 Sendero-IdealCare Claims X X12057 Medical Services Initiative Claims X X12115 VA Fee Basis Programs Claims X X12422 Medica2 Claims X X13027 Primaria VillageMD of Central Indiana Claims X13054 Steward Health Choice Utah Inc. Claims X13162 1199 National Benefit Fund Claims X X13174 Montefiore Contract Management Organization Claims X X13189 Meridian Health Plan of Illinois Inc Claims X X13193 Central Reserve Life Ins Co-Medicare Supplement Claims X X

ASK 4

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

13193 Continental General Ins Co-Medicare Supplement Claims X X13193 Great American Life Ins. Co-Medicare Supplement Claims X X13193 Loyal American Life Ins Co-Medicare Supplement Claims X X

13193 Provident American Life & Health Ins Co-Medicare Supplement Claims

X X13193 United Teacher Assoc Ins Co-Medicare Supplement Claims X X13265 MetroPlus Health Plan Claims X X13315 Insurance Design Administrators Claims X X13337 BMC HealthNet Plan Claims X X13337 Boston Medical Center Health Plan Inc. Claims X X13337 Well Sense Health Plan Claims X X13337 Boston Medical Center Health Plan Inc. Encounters X X13343 Amalgamated Life - PA / Alicare Claims X X13350 ODS Health Plan Claims X X13360 CenterLight Healthcare Claims X X13360 Productive Programming Inc. Claims X13382 Orthonet - Uniformed Services Family Health Plan Claims X13383 Orthonet Corporation - AETNA Claims X X

13407 USFHP - St. Vincent Catholic Medical Centers of New York ClaimsX X

13550 ALICARE Claims X X13550 Amalgamated Life Claims X X13551 Emblem Health (GHI - New York Group Health Inc.) Claims X X14140 Farm Family Life Claims X X14165 MVP Health Plan of NY Claims X X14179 CareCore National LLC (Aetna Radiology Claims) Claims X X14180 CareCore National LLC (Oxford Radiology Claims) Claims X14182 CareCore National Claims X14188 CareCore/WCNY RAD Claims X14966 HealthSmart (EDI #14966) Claims X14966 Partners Health Plan Claims X X15688 Insurance Management Services (Amarillo, TX) Claims X16098 Monitor Life Insurance Company Claims X X16117 Lifetime Benefit Solutions Claims X X16120 ARAZ Group Claims X X16120 America's PPO Claims X X16146 SCHC Total Care - ClaimsNet Claims X X16180 Aspen Claims X X16600 Chautauqua County Healthcare Plan (Mayville NY) Claims X X17516 North Shore - LIJ (Healthfirst) Claims X X17929 Hernando Pasco Hospice Claims X18840 MyDecision HealthSmart Claims X X19028 Concentrix Insurance Solutions Claims X X20048 Agate Resources Inc (LIPA) Claims X20048 Trillium Community Health Plan Claims X20356 Cerner Health Plan Services Claims X X20376 Gemcare Health Plan Claims X X20398 Physicians Health Collaborative Claims X X

ASK 5

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

20413 3P ADMIN Claims X X20818 Essence Healthcare Claims X X21062 Christus Health New Mexico HIX Claims X X21313 Kaiser Permanente of Georgia Claims X X21547 MedSettlements LLC Claims X X22100 Health Choice Integrated Care Claims X X22195 AIG Educational Markets Claims X X22240 St. Barnabas System Health Plan Claims X X22348 Maryland Physicians Care Claims X X22521 EGID (Employees Group Insurance Division) Claims X22521 HP Administrative Services LLC Claims X

22521 OSEEGIB (Oklahoma State and Education Employees Group Ins. Board) Claims

X22603 NJ Carpenters Health Fund Claims X X22771 Managed Health Network Claims X X22823 Mid-American Benefits Claims X X23051 Waterstone Benefit Administrators (Outside Oklahoma) Claims X X23218 Superior Administrators Inc (Santa Ana CA) Claims X X23249 Sentinel Management Services Claims X X23250 Significa Benefits Services Inc. Claims X X23281 UPMC Health Plan Claims X X23282 Community Care BHO Claims X X23283 Pittsburgh Care Partnership Inc. Claims X X23287 Intergroup Services Corporation Claims X X23550 MFC & HealthPlus Peoria Claims X X23708 C&O Employees Hospital Association Claims X X24077 SANTA CLARA FAMILY HEALTH PLAN Claims X X24245 Medical Eye Services Claims X X24735 Pinnacle Claims Management Inc. Claims X X24735 Western Grower's Assurance Trust Claims X X24735 Western Grower's Insurance Company Claims X X25133 Altius (Utah) Claims X X25133 Advantra Savings Claims X X25133 Coventry Advantra Texas Claims X X25133 Coventry Health Care of Georgia Inc. Claims X X25133 Coventry Health Care of Virginia Claims X X25133 Coventry Health Care of the Carolinas Claims X X25133 Coventry Health Care of Illinois Claims X X25133 Coventry Health & Life (Oklahoma) Claims X X25133 Coventry Health Care of Iowa Inc. Claims X X25133 Coventry Health Care Claims X X25133 Coventry Health Care of Kansas Inc. Claims X X25133 Coventry Health Care Carelink - West Virginia only Claims X X25133 Coventry Health Care of Louisiana Inc. Claims X X

25133 Coventry Health Care Carelink Medicaid - West Virginia only ClaimsX X

25133 Coventry Health Care of Missouri Claims X X25133 Coventry Health Care National Network Claims X X

ASK 6

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

25133 Coventry Health and Life Insureance (Tennessee) Claims X X25133 Coventry Health Care of Nebraska Inc. Claims X X25133 Coventry Missouri Claims X X25133 Coventry Health Care of Nevada Claims X X25133 Coventry Summitt Health Plan Inc. Claims X X25133 Coventry of Health Care Delaware Inc. Claims X X25133 University of Missouri Claims X X25133 Foreign Service Benefit Plan Claims X X25133 Coventry Health Care of Florida Claims X X25133 Health America Inc./Health Assurance/Advantra Claims X X25133 Coventry Health Care of Florida Inc. Claims X X25133 Mail Handlers Benefit Plan Claims X X25133 Rural Carrier Benefit Plan Claims X X25133 UT- Altius (UHIN) Claims X X25145 Benefit Coordinators Corporation (Pittsburgh PA) Claims X X25160 MCA Administrators Inc. Claims X X25169 Gateway Health Plan Medicaid PA Claims X X25184 UPMC Vision Advantage Claims X X25404 Seven Corners Claims X X25850 LifeCare Assurance Co Claims X X26158 AllCare PEBB Claims X X26227 MSH REIMBURS Claims X X26267 Vestica Healthcare - Value Based Solutions Claims X26316 Retiree Health Trust Claims X X27005 Lifestyle Health Plans Claims X27048 Payer Fusion Claims X X27133 Gemcare IPA Claims X X27133 Managed Care Systems Claims X X27154 Arizona Priority Care Plus Claims X X27344 Affiliated Doctors of Orange County Claims X X27514 Amerigroup Claims X X27514 Empire Blue Cross Blue Shield HealthPlus Claims X X28021 Kern County CDCR Claims X X28530 Secure Health Plans of Georgia LLC Claims X X29076 Consumers Life Insurance Company Claims X X29076 Medical Mutual of Ohio Claims X X29076 Premier Health Systems Inc. Claims X X30005 Galveston County Indigent Health Care Claims X X30862 Heritage Victor Valley Medical Group Claims X X30891 Sierra Medical Group Claims X X31053 Individual Health Insurance Companies Claims X X31053 State Farm Insurance Companies Claims X X31074 EBMC Claims X X31074 Employee Benefit Management Corp (EBMC) Claims X X31074 TPAC/Employee Benefit Management Corp Claims X X

31074 The Physicians Assurance Corp (TPAC) /Employee Benefit Management Corp (EBM Claims

X X31114 CareSource OH Claims X X

ASK 7

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

31118 Tribute Health Plan Claims X X31121 Stoner and Associates (Cincinnati OH) Claims X X31127 Integra Group Claims X X31128 INTEGRA GROUP/HOME Claims X31129 Integra Group-CHA Claims X31138 AHPO (Cleveland OH) Claims X X31141 Healthsource OH Claims X X31182 Innovage Claims X X31182 Total Community Care Claims X X31182 Total Long Term Care Claims X X31441 S & S Healthcare Strategies Claims X X31626 VNA Homecare Options Claims X X33001 Universal Care - California Claims X X33010 Greater Newport Physicians Medical Group Claims X X33020 My Family Medical Group Claims X X33036 Loma Linda University Health Care Managed Care Dept Claims X X33065 Rady Children's Hospital Claims X X33072 San Louis Obispo Select Claims X X33099 Scripps Health Plan Services Claims X X33104 Texas HealthSpring Claims X X33373 Molina Healthcare of California (Encounters Only) Encounters X X33628 Mercy Maricopa Integrated Care Claims X X34080 Multiplan Wisconsin Preferred Provider Network Claims X X34131 Self-Funded Plans Inc. Claims X X34136 JP Farley Corporation Claims X X34145 Klais & Company Claims X X

34150 The Health Plan (Massillon Ohio and St. Clairsville Ohio only) ClaimsX X

34158 Health Design Plus (Hudson OH) Claims X X34159 E-V Benefits Management Inc (Columbus OH) Claims X X34159 NABN (Cleveland OH) Claims X X34159 North American Benefits Network (Cleveland OH) Claims X X34167 Emerald Health Network Inc. (All PPO Business) Claims X X34167 Health Services Preferred (HSP) by Emerald Health Claims X X34167 Integrated Care Network (ICN) by Emerald Health Claims X X34171 FrontPath Health Coalition Claims X X34177 Comp - Ohio (Austintown OH) Claims X X34178 Benefit Services Inc. (Akron OH) Claims X34189 Ohio Health Choice PPO Claims X X34192 Mutual Health Services Claims X X34196 Apex Benefit Services Claims X X34638 Unified Physicians Network Claims X X34734 Aetna Better Health of NY Claims X X35092 Morris Associates Claims X X35107 Indiana Teamsters Health Benefits Fund (Indianapolis IN) Claims X X35107 Local 135 Health Benefits Fund (Indianapolis IN) Claims X X35112 Employee Plans LLC Claims X X35115 INTotal Health LLC Claims X X

ASK 8

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

35145 HealthSmart (EDI#34145) Claims X35161 Indiana ProHealth Network Claims X X35162 Managed Care Services LLC Claims X X35164 Sagamore Health Network Claims X X35174 QualChoice Claims X X35182 Brodart Claims X X35186 Dunn and Associates Benefits Administrators Inc. Claims X X35199 Cooperative Managed Care Services Claims X X35199 MDwise Franciscan St. Anthony-HHW Claims X X35199 MDwise Franciscan St. Margaret-HHW Claims X X35199 MDwise Select Health-HHW Claims X X35199 MDwise St. Catherine-HHW Claims X X35199 MDwise St. Vincent-HHW Claims X X35199 St. Anthony Memorial Healthcare Centers - MDWISE Claims X X35199 St. Catherine Hospital PHO - MDWISE Claims X X35199 St. Francis Health Network Claims X X35199 St. Margaret Mercy Healthcare Centers - MDWISE Claims X X35202 Security Administrative Services Claims X X35206 Encircle PPO Claims X X35206 Encore Health Network Claims X X35206 The Healthcare Group Claims X X35212 North Texas Healthcare Network Claims X X35245 Continental Benefits Claims X X35245 WellSystems LLC Claims X X36057 Guildnet Claims X36149 Benefit Administrative Systems Claims X X36215 Central States Health & Welfare Funds Claims X X36215 Teamcare Claims X X

36273 AARP Hospital Indemnity Plans insured by UnitedHealthcare Insurance Co Claims

X X

36273 AARP Medicare Supplement Plans insured by UnitedHealthcare Insurance Co Claims

X X36312 MANAGED HEALTH CARE ASSOCIATES Claims X X36320 Advocate Medical Group - AMG (Legacy AHC) Claims X X36326 Associates for Health Care Inc. (AHC) Claims X X36335 Arkansas Managed Care Organization Inc. (AMCO) Claims X X36335 HFN Inc. Claims X X36345 Physicians Care Network (Rockford IL only) Claims X X36346 Northwest Suburban IPA (Illinois) Claims X X36347 Northern Illinois Health Plan Claims X X36389 Rush Prudential Health Plans (HMO Only) Claims X X36397 Trellis Health Partners Claims X X36401 Preferred Network Access Inc. Claims X X36411 Swedish Covenant Hospital Claims X X36609 Boilermakers National Health & Welfare Fund Claims X X36609 International Brotherhood of Boilermakers Claims X X36659 United Food & Comm. Workers Midwest Unions Claims X37105 Sage Technologies Claims X X

ASK 9

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

37116 Lake County Physicians Association Claims X X37136 Physicians Health Association of Illinois Claims X X37137 HSHS Medical Group IPA Claims X X37226 London Health Administrators Claims X37230 TR Paul Inc. Claims X X37247 Western Mutual Insurance Claims X X37256 HSBS Oklahoma City Claims X37272 HealthSmart Benefit Solutions Claims X X37279 IAA Claims X X37279 Insurance Administrators of America Inc. Claims X X37282 Select Benefit Administrators of America Claims X X37283 HealthSmart Benefit Solutions Claims X X37287 PAI Claims X X37287 Planned Administrators Inc. Claims X X37308 Allied Benefit Systems Claims X X37330 Physicians Health Plan (PHP) Mid-Michigan Claims X37330 Physicians Health Plan (PHP) South Michigan Claims X37331 RightChoice Benefit Administrators Claims X X37363 Compsych Claims X X37602 UnitedHealthOne / Golden Rule Claims X X38201 Total Healthcare Inc. Claims X X38217 Priority Health Claims X X38219 AmeraPlan Claims X38224 HAP/AHL/Curanet Claims X X38224 Medical Value Plan - Ohio (MVP) Claims X X

38238 Northern California Sheet Metal Workers Health Care Plan (San Ramon CA) Claims

X X

38238 Sheet Metal Workers Local 104 Health Care Plan (San Ramon CA) Claims

X X38241 Employee Benefit Concepts (Farmington Hills MI) Claims X X38254 Insight Benefit Administrators Claims X X38265 ASR Claims X X38265 ASR Corporation Claims X X38265 ASR Health Benefits Claims X X38265 Administration Systems Research Corporation Claims X X38265 Physicians Care (ASR Corporation) Claims X X38265 Physicians Care Health Plans (ASR Corporation) Claims X X38265 Physicians Care Network (ASR Corporation) Claims X X38309 Health Net of Arizona Claims X X38310 JOHN MORRELL COMPANY CO. - AHPBA Claims X X38333 Molina Healthcare of California (Claims only) Claims X X38334 Molina Healthcare of Michigan (Claims Only) Claims X X38335 Cofinity Claims X X38335 PPOM LLC Claims X X38338 McLaren Health Plan Claims X X38828 HPMC - Alta Med Clinics (HPMC - AMC) Claims X X39026 UnitedHealthcare / UHIS-UnitedHealth Integrated Services Claims X X39033 Sentry Insurance a Mutual Company Claims X X

ASK 10

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

39033 Sentry Life Insurance Company Claims X X39033 Sentry Life of New York Claims X X39045 Security Health Plan Claims X X39081 Benefit Plan Administrators Co. (Eau Claire WI) Claims X X39113 Dean Health Plan Claims X X39114 MercyCare Claims X X39126 Community Care Inc. (Wisconsin) Claims X X39156 Physicians Plus Insurance Corporation Claims X X39185 ARISE Claims X X40025 Innovation Health Claims X X40137 Kalos Health Claims X X40270 First Managed Care Options Inc. Claims X40585 INDECS Corporation Claims X X41041 Federated Mutual Insurance Claims X X41124 Meritain Health Minneapolis Claims X X41136 Life Trac Claims X X41147 PreferredOne (MN) Claims X X41150 Health Services Management Claims X41154 Mayo Clinic Health Solutions Claims X X

41160 OptumHealth Physical Health - includes Oxford (formerly ACN & ACNIPA) Claims

X

41161 OptumHealth Physical Health - includes Oxford (formerly ACN & ACNIPA) Claims

X

41194 Optum ? Complex Medical Conditions (CMC) (formerly OptumHealth Care Solutio Claims

X X

41194 OptumHealth Care Solutions (formerly United Resource Networks) Claims

X X

41194 OptumHealth Care Solutions (formerly United Resource Networks) Encounters

X X41206 Ultra Benefits Inc. Claims X X41600 IMCare Claims X X42102 Health Care Network of Wisconsin (HCN) Claims X X42138 Cenpatico TPA Claims X X42139 Centene TPA Claims X X42140 Centurion Claims X X42150 Butler Benefit Claims X X43036 VillageMD of Western Kentucky Claims X43146 American Specialty Health Claims X43174 Molina Healthcare of Washington (Encounters Only) Claims X X43174 Molina Healthcare of Washington (Encounters Only) Encounters X X43178 Joplin Claims / Benefit Management Inc Claims X X43259 Valor Health Plan Claims X43313 Harken Health Insurance Claims X X43619 Teamsters Medicare Trust for Retired Employees Claims X X44006 Desert Oasis HealthCare Claims X44054 Government Employees Health Association (GEHA) Claims X X44273 Health Plans Inc. Claims X X44444 American Postal Workers Union Health Plan Claims X X

ASK 11

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

45048 Health Pointe NY Claims X45048 Independent Living Systems Claims X X

45235 Government Employees Health Association (GEHA PHCS) ClaimsX X

45275 Government Employees Health Association (GEHA-PHCS-45275) Claims

X X45302 Integra Managed Long Term Care Claims X X45437 University Healthcare Marketplace Claims X X45967 Beaver Medical Group Claims X46045 Avera Health Plans Claims X X46120 Crystal Run Health Plans Claims X X46156 Aspire Health Plan Claims X X46161 Montefiore HMO Claims X X46227 CareConnect Insurance Company Inc Claims X X46407 University Health Care Advantage Claims X X46478 Continuum Health Solutions LLC Claims X X46571 Quartz ASO Claims X X46594 AFFINITY MEDICAL GROUP Claims X X46871 Cincinnati Financial Corporation Claims X X47080 Midlands Choice Inc. Claims X X47083 GMS Inc. Claims X X47262 IU Health Transplant Evaluation Program Claims X X47394 Coastal Care Services Inc Claims X47405 BookMD Inc Claims X X47410 Avectus Healthcare Solutions Claims X X48008 PhysMetrics Claims X

48055 American Progressive Life and Health Insurance Company ClaimsX X

48055 AveraAdvantage Claims X X48055 Marquette Life Insurance Company Claims X X48055 Pyramid Life Insurance Company Claims X X48055 Today's Options (American Progressive and Pyramid Life) Claims X X48055 Today's Options powered by CCRX Claims X X48100 ProviDRs Care Network Claims X X48117 CoreSource KC Claims X X48143 Group and Pension Administrators Claims X X48145 Community Health Choice Claims X X48611 Benefit Management LLC Claims X50701 VGM Homelink Claims X51037 Brokerage Concepts Claims X X51579 Coastal Communities Physician Network Claims X X

52095 Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. ClaimsX X

52106 CHRISTUS Health Plan TX HIX Claims X X52120 National Telecommunications Cooperative Association Claims X X52123 Johns Hopkins Healthcare (USFHP) Claims X X52132 Cooperative Benefit Administrators (CBA) Claims X X52132 National Rural Electric Coop (NRECA) Claims X

ASK 12

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

52152 Optimum Choice of the Carolinas Inc. (OCCI) Claims X52180 UMWA Health & Retirement Funds Claims X X52189 Johns Hopkins Healthcare (EHP/PP) Claims X X

52190 OptumHealth Care Solutions (formerly United Resources Networks Claims

X X52192 Bravo Health Claims X X52192 Bravo Health Star Plus Claims X X52192 Cigna-Healthspring Claims X X52196 Conifer (formerly InforMed) Claims X X52429 Healthscope Benefits - EHC Repricing Claims X X52461 March Vision Care Inc. Claims X53011 NALC/Affordable Claims X X53011 National Association of Letter Carriers Claims X X53011 National Association of Letter Carriers/NALC Claims X X53012 National Association of Letter Carriers Claims X53085 Anchor Benefit Consulting Inc. Claims X X53275 Martin's Point Health Care Claims X X54176 Virginia Premier Health Plan Claims X54398 Allina Health Aetna Claims X54750 Huron PACE Claims X X55544 Conversion Plan-APWU Claims X X55912 TriWest Healthcare Alliance PC3/VCP Region 3 Claims X

55912 TriWest VA-Patient-Centered Community Care Program (VAPCCC) Region 3 Claims

X X55915 TriWest Healthcare Alliance PC3/VCP Region 5A

55915 TriWest VA-Patient-Centered Community Care Program (VAPCCC) Region 5A Claims

X X55916 TriWest Healthcare Alliance PC3/VCP Region 5B Claims X

55916 TriWest VA-Patient-Centered Community Care Program (VAPCCC) Region 5B Claims

X X55917 TriWest Healthcare Alliance PC3/VCP Region 6 Claims X

55917 TriWest VA-Patient-Centered Community Care Program (VAPCCC) Region 6 Claims

X X56139 BENEFIT MANAGEMENT SERVICES Claims X X56139 Maestro Health Plan Claims X56144 Healthgram Inc Claims X X56147 Healthsource NC (CIGNA) Claims X X56162 MedCost Inc. Claims X X

56190 Envolve Benefit Options (formerly OptiCare Managed Vision) ClaimsX

56195 American Trust Administrators Inc. Claims X X56196 First Carolina Care Claims X X57080 CWIBENEFITS INC. Claims X X57080 ClaimsWare Inc. dba ManageMed Claims X X

57115 Blue Shield of California Promise Health Plan (formerly - CARE 1ST HEALTH PLAN OF CA) Claims

X57116 Care 1st Health Plan of Arizona Claims X X57116 OneCare Claims X X

ASK 13

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

57117 QVI Risk Solutions Inc. Claims X57254 Government Employees Health AssociationInc. (GEHA) Claims X X57604 Aetna Affordable Health Choices (SM) - SRC Claims X X58202 ADVANCED DATA SOLUTIONS Claims X X58202 MedAdmin Solutions Claims X X58204 Coordinated Medical Specialists Claims X X58204 MedAdmin Solutions Claims X X58204 Network TPA LLC Claims X X58204 Physician Associates of Louisiana Claims X X58204 Physician Care Network LLC Claims X X58204 Podi Care Managed Care Claims X X58210 Healthsource GA (CIGNA) Claims X X58213 Healthways WholeHealth Networks Claims X59087 The National Radiology Network Claims X X59204 Fringe Benefits Coordinators Claims X X59230 Heritage Consultants Claims X59231 MedCom Claims X X59274 AvMed Inc. Claims X X59275 AVMED INC Encounters X X59314 Advanzeon Solutions Claims X X59324 PODIATRY NETWORK FL Claims X X59354 Wellcare Health Plan Inc. (Encounters) Claims X X59374 Advantica Benefits Claims X X60054 Aetna Claims X X60054 Aetna Encounters X X60055 Aetna Encounters Encounters X X60058 Hennepin Health Claims X60058 Northstar Advantage Claims X X60110 Preferred Health Systems A Coventry Health Care Plan Claims X60110 Preferred Health Systems Insurance Company Claims X60110 Preferred Plus of Kansas Claims X60280 Interface EAP (IEAP) Claims X X60495 Community Health Choice-Health Insurance Marketplace Claims X X60550 Gateway Health Plan - Medicare Assured Claims X X60624 Sutter Health Aetna Claims X60995 Community Care Inc. - Family Care (Wisconsin) Claims X X61067 Harmony Health Plan Claims X61101 Humana Emphesys Claims X X61101 Humana Employers Health Insurance Claims X X61101 Humana Inc. Claims X X61101 Humana Insurance Company Choice Care Network Claims X X61106 Preferred Health Plan (Louisville KY) Claims X X61115 Humana Long Term Care Claims X X61120 Humana Veterans Healthcare Services Claims X X61124 Baptist Health Plan Claims X X61127 Healthsource KY Claims X X61184 Arkansas Superior Select Claims X61185 Kalos Gold Health Plan Claims X

ASK 14

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

61271 J. F. Molloy and Associates Inc. Claims X61271 Principal Financial Group Claims X61425 Starmark Claims X X61425 Tooling & Manufacturing Association Claims X X61425 Trustmark Insurance Company Claims X X61604 PrimeWest Health Claims X X62030 American General Claims X X

62061 Harrington Health-Kansas (formerly known as Fiserv Health-Kansas) Claims

X X62129 Healthsource TN (CIGNA) Claims X X62157 Health Partners - Jackson TN Claims X X62170 Unified Health Services Claims X X62308 CIGNA Claims X X62308 CIGNA - PPA Claims X X62308 CIGNA - PPO Claims X X62308 CIGNA Health Plan - HMO Claims X X62308 Connecticut General (CIGNA) Claims X X62308 EQUICOR Claims X X62308 EQUICOR - PPO Claims X X62308 Seton Employee Plan Claims X X62480 Kemberton Healthcare Services Claims X62777 Trilogy Health Solutions Inc. (formerly - TRLHN/EB) Claims X62777 TRILOGY NETWORK Claims X X63092 HealthSpring HMO/HealthSpring Medicare+Choice Claims X X63665 Great-West Healthcare (formerly American General) Claims X X63740 DentaQuest Vision Claims X X63740 EyeQuest Claims X X64071 Acclaim Claims X X64084 Mississippi Physicians Care Network Claims X X64090 AmFirst Insurance Company Claims X X64157 Meritain Health Claims X X64158 Agency Services Inc Claims X X64158 Meritain Health / Agency Services Claims X X64270 Corporate Plan Management Inc Claims X X65021 Orange County Health Care Agency Claims X X65031 CarePlus Health Plans Inc. Claims X65085 NAA (North America Administrators L.P.) (Nashville TN) Claims X X65088 CareFlorida Claims X X65088 Preferred Care Partners Florida Claims X X65088 Preferred Care Partners Encounters X X65093 Advocate Physician Partners Claims X X65093 Silver Cross Health Connection Claims X X66121 Community Medical Group of the West Valley Inc. Claims X X66122 Eastland Medical Group Claims X X66124 West Covina Medical Group Claims X X66125 LakeSide Medical Group Claims X X66126 Verdugo Hills Medical Group Claims X X66127 Lakeside Comprehensive Healthcare Claims X X

ASK 15

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

66170 Community Health Group Claims X X66705 Quartz Health Solutions Inc. Claims X X66705 Unity Health Insurance Claims X X66917 Parkland Community Health Plan Claims X X67895 Banner Health and Aetna Health Insurance Company Claims X X

68021 Health Net - VA Patient Centered Community Care Program ClaimsX X

68035 Health Plan of San Joaquin Claims X X68035 San Joaquin Health Administrators Claims X X68036 John Muir Mt. Diablo Health System Claims X X68036 John Muir Physician Network Claims X68037 OMNI/Medicore HP Claims X X68047 California Health & Wellness Claims X X68068 Cenpatico - Arizona Claims X X68068 Cenpatico - FL Claims X68068 Cenpatico - Georgia Claims X X68068 Cenpatico - Indiana Claims X X68068 Cenpatico - OHIO Claims X X68068 Cenpatico - WI Claims X X68068 Cenpatico Behavioral Health Claims X X68068 Cenpatico Behavioral Health Texas Claims X X68068 Cenpatico Massachuetts Claims X X68068 Cenpatico New Hampshire Claims X X68068 Cenpatico South Carolina Claims X X68068 Centene Advantage Plans Claims X X68068 ILCBH Claims X X68068 KS - Cenpatico Kansas Claims X X68068 KY - Cenpatico Kentucky Claims X X68068 MO - Cenpatico Missouri Claims X X68068 MS - Cenpatico Mississippi Claims X X68069 Absolute Total Care Claims X X68069 Advantage by Bridgeway Health Solutions Claims X X68069 Advantage by Buckeye Community Health Plan Claims X X68069 Advantage by Managed Health Services Claims X X68069 Advantage by Peach State Claims X X68069 Advantage by Sunshine State Claims X X68069 Advantage by Superior HealthPlan Claims X X68069 Ambetter from Buckeye Community Health Plan Claims X X68069 Ambetter from CeltiCare Health Plan Claims X X68069 Ambetter from Magnolia Health Claims X X68069 Ambetter from Managed Health Services Claims X X68069 Ambetter from Peach State Health Plan Claims X X68069 Ambetter from Sunshine Health Claims X X68069 Ambetter from Superior Health Claims X X68069 Ambetter of Arkansas Claims X X68069 Bridgeway Arizona Claims X X68069 Buckeye Community Health Claims X X68069 CeltiCare Claims X X

ASK 16

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

68069 Granite State Health Plan Claims X X68069 IlliniCare Claims X X68069 KS - Sunflower State Health Claims X X68069 Kentucky Spirit Health Plan Claims X X68069 Louisiana Healthcare Connections Claims X X68069 MO - Missouri Home State Health Care Claims X X68069 Magnolia Claims X X68069 Managed Health Services Indiana (Medicaid HMO) Claims X X68069 Managed Health Services Wisconsin Claims X X68069 Michigan Fidelis Secure Care Claims X X68069 Nebraska Total Care Claims X X68069 Peach State Health Plan Claims X X68069 Silver Summit Health Plan Claims X X68069 Sunshine State Health Plan Claims X X68069 Superior Health Plan Texas Claims X X68069 Trillium Medicaid Claims X X68069 Trillium Medicare 2016 Claims X X68069 WA - Washington Coordinated Care Claims X X68195 Healthsource Provident Claims X X70259 Harbor Health Plan Claims X X71064 HealthChoice Oklahoma Claims X X71065 Oklahoma DRS DOC Claims X X71075 Healthsource AR (Med) (CIGNA) Claims X X71412 ExclusiCare Claims X X71412 Mutual of Omaha Insurance Company Claims X X71412 Mutually Preferred Claims X X71412 United of Omaha Claims X X71890 Medica Health Plan Solutions Claims X72099 PHCS/Cigna Claims X72099 PHCS Claims (formerly American LIFECARE) Claims X X72126 Peoples Health Network Claims X X72148 PPOPlus LLC Claims X X73067 QuikTrip Claims X X73071 C. L. Frates & Co - OSMA Health Claims X X73071 OSMA Health - C. L. Frates Claims X X73099 Standard Life and Accident Insurance Company Claims X X73126 Equitable Plan Services (Oklahoma City OK) Claims X X

73143 Community Care Managed Health Care Plans of Oklahoma ClaimsX X

73145 Preferred Community Choice/PCCSelect/CompMed Claims X X73147 Healthcare Solutions Group Claims X X73155 Waterstone Benefit Administrators (Oklahoma Providers) Claims X X73172 Scan Health Plan Arizona Claims X X73331 HPMC - San Judas IPA (HPMC - SJM) Claims X X74048 American National Ins. Co. (ANICO) Claims X X74095 USAA (United Services Automobile Association) Claims X X74101 Wisconsin Department of Corrections Claims X X74227 UnitedHealthcare StudentResources Claims X X

ASK 17

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

74240 Assured Benefits Administrators Claims X X74256 North Carolina Department of Public Safety (NC DPS) Claims X X74272 Dell Children's Health Plan Claims X X74289 MHNET Claims X X74323 MedBen (Newark OH) Claims X X74323 Medical Benefits Administrators Inc. (Newark OH) Claims X X74323 Medical Benefits Companies (Newark OH) Claims X X74323 Medical Benefits Mutual (Newark OH) Claims X X74323 Medical Benefits Mutual Life Insrance Co. Claims X X75136 CoreSource Little Rock Claims X X75137 AmeriBen Solutions Inc. Claims X X

75185 AAG-American Administravie Group ( Formerly Icon Benefit Admin) Claims

X X75232 Employers Direct Health Claims X X75233 Employer's Direct Health - SF Claims X X75235 Employer's Direct Health - FI Claims X X75236 Employer's Direct Health - Employee Plan Claims X X75237 Healthsmart Accel (EDI #75247) Claims X X75237 VillageMD of Northern Indiana Claims X75250 HealthSmart Preferred Care Inc. Claims X X75255 Healthsource N. TX (CIGNA) Claims X X75256 Verity National Group Claims X X75273 Geisinger Health Plan Claims X X75274 IHG Direct Claims X X75545 VillageMD of New Hampshire Claims X75600 The City of Odessa Claims X X75838 VillageMD of Chicago Claims X76045 SelectCare of Texas (HPN) Heritage Physicians Network Claims X X76048 Texas Children's Health Plan (Medicaid) - CHIP Claims X X76066 Renaissance Physicians Organization Claims X X76079 Midwest Health Partners Claims X X76342 Health Plan of Nevada Claims X X76342 Sierra Health and Life Claims X X76343 Health Plan of Nevada (Encounters) Encounters X76343 Sierra Health and Life (Encounters) Encounters X76578 Solstice Benefits Claims X76870 HealthSmart (EDI #76870) Claims X76870 LifePath Hospice Inc Claims X X76923 Good Sheperd Hospice Inc Claims X X76923 HealthSmart (EDI #76923) Claims X77005 Bakersfield Family Medical Group Claims X X77012 MidCoast IPA Claims X X77022 Ultimate Health Plan Claims X X77023 Clover Health Claims X X77035 Central Valley Medical Group Claims X X77038 Sante Health System and Affiliates Claims X X77039 Kern Health Systems Claims X X77045 Arcadian Management Services Inc Claims X X

ASK 18

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

77062 AmeriHealth Caritas PA Community HealthChoices Claims X X77062 AmeriHealth Caritas VIP Care Claims X X77073 VNS CHOICE Medicare Claims X X77080 WPP-ElderCare Wisconsin Claims X X77082 Care Improvement Plus (CIP) Claims X X77124 DELANO IPA Claims X X77153 CGS Health Claims X X77153 Cook Group Solutions Claims X X77153 DH Cook Associates Claims X X77153 Southeastern Indiana Health (SIHO) Claims X X77170 Common Ground Health Cooperative Claims X77201 Clearchoice Health Plan / COIHS Claims X

77302 Sutter Valley Medical Foundation dba Sutter Gould Medical Foundation Claims

X X77304 Sutter Medical Group of the Redwoods Claims X X77306 Solano Regional Medical Group Claims X77316 Solano Regional Medical Group Claims X77318 Sutter Delta Medical Group Claims X77741 Keystone First VIP Choice Claims X X77950 Health Alliance Medical Plans Claims X X78375 Connecticare - Medicare Claims X X79966 Amida Care Medicare Claims X X80141 Childhealth Plus by Healthfirst (CHP) Claims X80141 Healthfirst 65 Plus Claims X80141 Healthfirst Family Health Plus (FHP) Claims X80141 Healthfirst Health Plan of New Jersey Claims X X80141 Healthfirst Inc. (New York) Claims X X80141 Senior Health Partners (SHP) Claims X X80314 GIC Indemnity Plan Claims X X80314 UNICARE Claims X X80705 Great-West Healthcare Claims X X81079 BayCare Plus Medicare Advantage Claims X80950 Clover Health Claims X81312 Apostrophe Claims X X81400 UnitedHealthCare / All Savers Alternate Funding Claims X X

81400 UnitedHealthOne / PacifiCare Life and Health Insurance Company Claims

X X81794 Molina Healthcare of Puerto Rico (Claims Only) Claims X X82018 HCS - Health Claims Service (Boise ID) Claims X X82048 Primary Health Network Claims X X82420 Allegian Health Plan Claims X X82435 Dialysis TPA Claims X83028 MBA Benefit Administrators Inc (Salt Lake UT) Claims X X83035 Senior Whole Health Claims X X83077 Advantek Benefit Administrators Claims X X83253 Meridian Health Plan of Michigan Inc. Claims X X84096 Sloans Lake Preferred Health Networks Claims X X84109 Pinnacol Assurance Claims X X

ASK 19

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

84131 Denver Health Medical Plan Inc. - Medicare Choice Claims X X84132 United Medical Alliance Claims X X84133 Denver Health and Hospital Authority Claims X X84134 Denver Health and Hospital Authority - Indigent Care Claims X84135 Denver Health Medical Plan Claims X X84146 CHAMPVA - HAC Claims X X84146 Children of Women Vietnam Veterans-VA HAC Claims X X84146 Spina Bifida - VA HAC Claims X X84555 HMO Louisiana Inc Claims X X84806 Virginia Coordinated Care-VCC Claims X85256 Wabash Memorial Hospital Association Claims X X85461 Memorial Medical Center - AllCare Claims X85729 Healthcomp Inc. Claims X X86033 CIGNA Medicare Advantage Claims X X86047 UnitedHealthcare Community Plan / NJ Claims X X86052 Mercy Care Plan (AHCCCS) Claims X X86062 Ancillary Benefit Services (ABS) Claims X X86062 Arizona Foundation for Medical Care (AFMC) Claims X X86062 VentureNet Healthcare Claims X X86066 HMA Hawaii Claims X X86087 Merchants Benefit Administration Claims X X86304 Insurers Administrative Corp. Claims X X87042 Union Pacific Railroad Employees Health Systems Claims X X

87726 AARP MedicareComplete through UHC / Oxford Medicare Network Claims

X X

87726 AARP MedicareComplete through UHC / Oxford Mosaic Network - AARP MedicareCo Claims

X X

87726 AARP MedicareComplete through UnitedHealthcare/AARP MedicareComplete Claims

X X87726 Arnett Health Plan Claims X X87726 OptumHealth Claims X87726 OptumHealth / OptumHealth Behavioral Solutions of NM Claims X X

87726 OptumHealth Behavioral Solutions (formerly United Behavioral Health) Claims

X X87726 UnitedHealthcare Claims X87726 UnitedHealthcare / Definity Health Plan Claims X87726 UnitedHealthcare / Empire Plan Claims X

87726 UnitedHealthcare / MAHP - MD IPA Optimum Choice MLH (formerly MAMSI) Claims

X X87726 UnitedHealthcare / UnitedHealthcare Plan of River Valley Claims X X

87726 UnitedHealthcare / UnitedHealthcare West (UnitedHealthcare of CA OK OR) Claims

X X

87726 UnitedHealthcare Community Plan / IA hawk-i (formerly AmeriChoice of Iowa) Claims

X X

87726 UnitedHealthcare Community Plan / MS CHIP (formerly AmeriChoice MS - CHIP) Claims

X X87726 UnitedHealthcare Community Plan / NE Claims X X

ASK 20

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

87726 UnitedHealthcare Community Plan / NE (formerly Americhoice NEShareAdvantag Claims

X

87726 UnitedHealthcare Community Plan / NY (formerly AmeriChoice Personal Care) Claims

X

87726 UnitedHealthcare Community Plan / UnitedHealthcare Dual Complete Claims

X X

87726 UnitedHealthcare Community Plan / UnitedHealthcare Long Term Care Claims

X X87726 UnitedHealthcare Community Plan of Louisiana Claims X X

87726 UnitedHealthcare Community Plan/DEFLHILAMDMS CANNMOHPARITXWAWI Claims

X X

87726 UnitedHealthcare Community Plan/FLHILAMDMS CANNMOHRITXWI Claims

X X

87726 UnitedHealthcare Medicare Solutions / UnitedHealthcare Chronic Complete Claims

X X

87726 UnitedHealthcare Medicare Solutions / UnitedHealthcare Group Medicare Advan Claims

X X

87726 UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareComplete Claims

X X

87726 UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareDirect Claims

X X

87726 UnitedHealthcare Medicare Solutions / UnitedHealthcare Nursing Home Plan Claims

X X87815 HealthSmart Benefit Solutions fka Wells Fargo TPA.Inc. Claims X X88019 Teachers Health Trust Claims X88027 Northern Nevada Trust Fund Claims X X88050 NHBCAUX Claims X X88051 Premier Healthcare Exchange Inc. (PHX) Claims X X88052 Benefit Plan Administrators Claims X X88055 First Agency Claims X X88056 Premier HealthCare Exchange Claims X X88058 MED PAY Claims X X88067 Tall Tree Administrators Claims X X88092 Benefit Management LLC/VBA Claims X X88221 Texas Health Aetna Claims X X88461 The Alliance Claims X X88622 Quality Health Plans of New York Claims X X90001 Healthlink PPO Claims X X

90001 National Capital Preferred Provider Organization (NCPPO) ClaimsX X

90551 US Family Health Plan Claims X X91051 Kaiser Foundation Health Plan of Washington Claims X X91051 Kaiser Foundation Health Plan of Washington Options Inc Claims X X91064 Wenatchee Valley Medical Center Claims X X91078 Trusteed Plans Service Corporation Claims X X91131 First Choice Health Administrators Claims X X91131 First Choice Health Network Claims X X91131 Sound Health (now known as First Choice Health Network) Claims X X

ASK 21

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

91136 Alaska Carpenters Trust Claims X X91136 Alaska Children's Services Inc. Claims X X91136 Alaska Laborers Construction Industry Trust Claims X X91136 Alaska Pipe Trades Local 375 Claims X X

91136 Alaska United Food & Commercial Workers Health & Welfare Trust Claims

X X91136 Cement Masons & Plasterers Health & Welfare Trust Claims X X91136 Enstar Natural Gas Claims X X91136 Hotel Employees & Restaurant Employees Health Trust Claims X X91136 N.W. Ironworkers Health & Security Trust Fund Claims X X91136 N.W. Roofers & Employers Health & Security Trust Fund Claims X X91136 N.W. Textile Processors Claims X X

91136 Operating Engineers Locals 302 & 612 Health & Security Fund Claims

X X91136 Puget Sound Benefits Trust Claims X X91136 Puget Sound Electrical Workers Trust Claims X X91136 UW Graduate Appointee Plan Claims X X91151 Sterling Option 1 Claims X X91176 RBMS LLC Claims X X91184 Sanford Health Plan Claims X X91617 Kaiser Foundation Health Plan of Colorado Claims X X91741 Gateway Health Plan OH- Medicare Assured Claims X X92620 Tongass Timber Trust Claims X X93029 PacificSource Health Plans Claims X X93031 Select Benefit Administrators Inc. Claims X X93044 A & I Benefit Plan Administrators Claims X X93050 William C. Earhart Claims X X93079 Kaiser Foundation of the Northwest Claims X X93092 US Benefits Claims X X93093 LifeWise Healthplan of Oregon Claims X93112 Tuality Health Alliance Claims X X93170 VMD of SE TX (Houston) Claims X93221 Asuris Claims X X93975 CareOregon Inc. Claims X X94056 California Pacific Medical Center Claims X X94115 Palo Alto Medical Foundation Claims X X94119 Sutter East Bay Regional Hospital- Non Sutter Group Claims X X94123 Kaiser Permanente Health Plan of Hawaii Claims X X94134 Kaiser Foundation Health Plan of Southern CA Region Claims X X94135 Kaiser Foundation Health Plan of Northern CA Region Claims X X94154 Humboldt-Del Norte Foundation for Medical Care Claims X94265 Medica (UHC) Claims X X94269 Sutter East Bay Medical Foundation Claims X X94302 Chinese Community Health Plan Claims X X94312 Center for Elders Independence Claims X X94316 Brown & Toland Medical Group Claims X X94320 Kaiser Self Funded Claims X X94321 Children First Medical Group Claims X

ASK 22

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

94603 UC-Davis Health Claims X X95019 Matrix - Health First Health Plan Claims X95112 Capital Health Plan Claims X X95164 Cedars Sinai Medical Claims X X95166 Cedars-Sinai Medical Network Services Claims X X95167 Cedars-Sinai Medical Network Services Encounters X X95192 CommunityConnect HealthPlan Claims X X95192 Compcare (Wisconsin BadgerCare only) Claims X X95192 Group Health Cooperative of Eau Claire Claims X X95202 SummaCare Health Plan Claims X X95279 Keenan Associates (CA) Claims X X95321 Medfocus Claims X95378 UnitedHealthcare / UnitedHealthcare Plan of River Valley Claims X X

95378 UnitedHealthcare Community Plan / IA hawk-i (formerly AmeriChoice of Iowa) Claims

X X

95378 UnitedHealthcare Community Plan / MS CHIP (formerly AmeriChoice MS - CHIP) Claims

X X

95378 UnitedHealthcare Community Plan / TN (formerly AmeriChoice TN: TennCare Claims

X X95393 High Desert Medical Group Claims X X95399 CAP Management Systems Claims X X95411 FL MCO PHC/PHP Claims X X95424 Access Medical Group Claims X95432 Facey Medical Foundation Claims X95449 Regal Medical Group Claims X X95460 Key Health Medical Solutions Inc Claims X

95467 UnitedHealthcare Community Plan / MI (formerly Great Lakes Health Plan) Claims

X X95567 Health Net of California and Oregon Claims X X95568 Health Net - California (Institutional Encounters ONLY) Encounters X95570 Health Net - California (Professional Encounters ONLY) Encounters X95600 Emergency Medical Services Fund - Orange County CA Claims X95655 MediGold Claims X X95655 Mt. Carmel Health Claims X X

95958 UnitedHealthcare / UnitedHealthcare West Encounters (formerly PacifiCare) Encounters

X X

95959 UnitedHealthcare West / UnitedHealthcare of CA OK OR TX WA Claims

X X96107 Neighborhood Health Partnership (NHP) Claims X X96176 Sutter East Bay Regional Hospital Claims X X

96240 Neighborhood Health Plan of RI - Commercial Products and INTEGRITY Claims

X X96385 UnitedHealthcare Community Plan / KS (KanCare) Claims X X96475 Healthlink HMO Claims X X96708 First Health The Lewer Agency Claims X97661 IEC Group - AmeriBen Claims X X99026 University Health Alliance Claims X99227 Cooperative Managed Care Services Repricing Claims X X

ASK 23

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

99282 Motion Pictures Industry Claims X X99284 Greater Covina Medical Group Claims X X99308 Sutter Connect Medical Foundation Claims X99320 Benefit & Risk Management Services Claims X X99433 Contessa Health Claims X X128CA Aetna Better Health California Claims X X128FL Aetna Better Health of Florida Claims X X128KS Aetna Better Health of Kansas Claims X X128KY Aetna Better Health of Kentucky Claims X X128MD Aetna Better Health of Maryland Claims X X128MI Aetna Better Health of Michigan Claims X X128VA Aetna Better Health of Virginia Claims X X128WV Aetna Better Health of West Virginia Claims X X12C01 Tricare West Claims X12T30 Community Health Plan of Washington Claims X12X27 Magellan Health Services Claims X12X27 National Imaging Assoc Inc / Magellan Health Services Claims X12X29 WPS Health Insurance Claims X12X46 Tricare for Overseas Claims X12X51 CoOportunity Health Claims X12X51 HealthPartners MN Claims X12X59 Global Healthcare Alliance Claims X251CC Together with CCHP Claims X X251MS Medstar Select/Medstar Medicare Choice Claims X X251PR Premier Health Plan Claims X X2700U Medova Claims X33LGC Alvin Claims X33LGC Life Gift Cards Claims X X33LGC Mediphe Claims X XA0701 Alta Bates Medical Group Claims X X

AAMG1 Asian American Medical Group Claims X XAHCA1 Alignment Healthcare Claims X XAMBHN Ambay Health Network Claims X XASHC1 National General Claims X XAVA01 Avalon Administrative Services - BCBSSC Claims XAVA02 Avalon Administrative Services - BCBSNC Claims XAVA03 Avalon Administrative Services - Capital Blue Cross Claims XAWNY6 AgeWell New York Claims X XBSN01 Bravo Health Claims XBTSS1 Brown & Toland Sutter Select Claims XCB186 Bright Health Plan Claims X XCB212 Luther Care Claims X XCB231 Independence American Ins. Co Claims X XCB457 SelectCare Claims XCB457 WellSpan Employee Assistance Program Claims XCB637 Aegis Administrative Services Claims X XCB695 Resolve/Solarte Health Inc. Claims X XCCI01 Community Care IPA Claims X X

ASK 24

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

CCIH0 Correctcare Integrated Health (CA Prison Health Care Services) Claims

XCHERO Cherokee Nation Comprehensive Care Agency Claims XCMSP1 County Services Medical Program Claims X XCORIZ Corizon Health Inc. Claims X XCP001 Samaritan Employer Group Plans Claims X XCP001 Samaritan Health Plans Claims X XCREA8 Create Claims X XCXARC ARC Administrators Claims X XDCA62 Direct Care Administrators Claims XDOLMG Dolton Medical Group Claims X XDREYR Dreyer Health Claims XE3287 Optumcare Netowrk of Connecticut Claims XE3510 Central Valley Medical Group Claims X

E3510 North American Medical Management (NAMM) - Northern California Claims

X X

E3510 North American Medical Management (NAMM) - Southern California Claims

XE4618 Seaside Health Plan Encounters X X

EBSRM Lifetime Benefit Solutions Claims X XEC999 County of Riverside Claims X XEM205 MED3000 CMS Title 21 Claims X XEM216 MED3000 Claims X XEM284 MED3000 CMS SAFETY NET Claims X XEM843 CMS MMA Specialty Plan Claims X XFS802 Bridgeview Claims X

FVMCH Fox Valley Medicine Claims X XGACS1 CareSource Georgia Claims X XGEM01 Global Excel Management Claims X XGHOKC Global Health Claims X XGPND1 Great Plains Medicare Advantage of North Dakota Claims X XGPNE1 Great Plains Medicare Advantage of Nebraska Claims X XHESUN Healthsun Health Plans Claims XHLPBS Hill Physicians Blue Shield PPO Claims XHLPHN Hill Physicians Health Net PPO Claims XHPU22 Hill UHC PPO Claims XINCS1 Caresource Indiana Inc Claims X XINDPM Independent Physicians at Mercy Claims X XIP086 Good Samaritan Medical Practice Association Claims XIPA99 Illinois Physicians Alliance IPA Claims X X

JCARE Jencare Medical Claims X XJLSFE JLS Family Enterprises Claims X XKCIPA Kane County BCBS Claims X XKELSE Kelseycare Claims X XKYCS1 CareSource KY Claims X XL0110 NAMCI/Global Care Claims X XL0140 Ocular Benefits Claims X XL0260 Constellation Health Claims X

ASK 25

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

LACAR LA Care Health Plan Claims X XLAWND Lawndale Christian Health Center Claims X XLCM10 Little Company of Mary Claims X XLIB01 Liberty Advantage LLC Claims X X

LIFE1 Optum Medical Network / AZ UT (formerly Lifeprint Network) ClaimsX X

LNDMK Landmark Healthcare Inc Claims XMAHC1 Medical Associates Health Plan/Health Choices Claims X XMDXHI MDX Hawaii Claims X XMSO11 San Diego County Medical Services (CMS) Claims XMSO33 San Diego County Ryan White Care Act Claims XMSO77 San Diego County Coverage Initiative (CI) Claims XNMM02 LaSalle Medical Group Claims X XNPN11 Northwest Physicians Network Claims X XNSIPA Network Solutions IPA Claims X XOAKST Oak Street Health Claims X XOSCAR Oscar Health Claims X XOSFC9 OSF Healthcare Central Claims X XOSFE9 OSF Healthcare East Claims X XPARTD Transact RX Claims XPARTH Partners in Health Claims X XPCJOL Primary Care of Joliet Claims X XPEF01 PEF Clinic Claims X XPILOT Healthsource SC Encounters X

PMGSC Physicians Medical Group of Santa Cruz County Claims XPSKW0 PSKW Claims X XRCMG1 River City Medical Group Claims X XRMC01 Riverside Medical Clinic Claims XRPPG1 Resurrection Physician Provider Group Claims X XRX001 TransactRX Infusion and Specialty Claims XSCS17 IdealCare by Sendero Claims XSCS17 Sendero STAR and CHIP Claims X XSCWI0 Tricare West Claims XSDCOM Scion Dental Commercial Claims XSIL01 Sunrise Health Plan of Illinois Claims X XSIM01 Simpra Advantage Inc Claims X XSIPA1 Southland BCBS Claims X XSMG01 Seoul Medical Group Claims X XSNTMC Sante Community Physicians Medical Group Corp Claims X XSNY01 Sunrise Health Plan of New York Claims X XSODRC Skygen Medical: Ohio Department of Rehab/Corrections Claims XSPA01 Sunrise Health Plan of Pennsylvania Claims X XSVA01 Sunrise Health Plan of Virginia Claims X XSX009 CoOportunity Health Claims XSX009 HealthPartners MN Claims XSX022 WPS Health Insurance Claims XSX071 CIGNA Behavioral Health Claims XSX109 Molina Healthcare Utah (Claims Only) Claims X

ASK 26

EDI Midwest Payer ID

Payer Name Services Hospital (837I)

Medical (837P)

SX133 Providence of Oregon Health Plan Claims X XSX141 Rocky Mountain Health Plan - Grand Junction Claims XSX163 Tricare Overseas Claims XSX174 Health Plan of San Mateo Claims XSX187 Providence PPO Claims X XSX190 National Imaging Associates Claims XTH131 Physicians United Plan Claims X XTHCP9 Cook Children Star Plan Claims X XTLINS Monumental Life Insurance Company Claims X XTLINS Transamerica Financial Life Insurance Company Claims X XTLINS Transamerica Life Insurance Company Claims X XTLINS Transamerica Premier Life Insurance Company Claims X XTRCLF Monumental Life Insurance Company Claims X XTRCLF Transamerica Premier Life Insurance Company Claims X XTRLTC Monumental Life Insurance Company Claims X XTRLTC Stonebridge Life Insurance Company Claims X XTRLTC Transamerica Financial Life Insurance Company Claims X XTRLTC Transamerica Life Insurance Company Claims X XTRLTC Transamerica Premier Life Insurance Company Claims X XTRLTC Western Reserve Life Insurance Company Claims X XTRP1E Monumental Life Insurance Company Claims X XTRP1E Stonebridge Life Insurance Company Claims X XTRP1E Transamerica Financial Life Insurance Company Claims X XTRP1E Transamerica Life Insurance Company Claims X XTRP1E Transamerica Premier Life Insurance Company Claims X XTRP1E Union Labor Life Insurance Company - Admin By UBC Claims X X

TRP1E Universal Benefits - Admin For Chubb Life Insurance Company Of America Claims

X XTRP1E Universal Benefits - Admin For City Of Bridgeport CT Claims X X

TRP1E Universal Benefits - Admin For Hartford Life And Accident Insurance Co Claims

X X

TRP1E Universal Benefits - Admin For Hartford Life Insurance Company Claims

X XTRP1P Monumental Life Insurance Company Claims X XTRP1P Stonebridge Life Insurance Company Claims X XTRP1P Transamerica Financial Life Insurance Company Claims X XTRP1P Transamerica Life Insurance Company Claims X XTRP1P Transamerica Premier Life Insurance Company Claims X XTRSEL Selman Tricare Supp Claims X XUHNDC PPOONE Claims XUIC67 University of Illinois Claims X XV360H Vista360Health Claims XVLGMD Village MD Claims X XWELM2 WellMed Claims X XWVCS1 CareSource West Virginia Claims X X