WORKERS' COMPENSATION PAYER LIST

01/05/18Payer ID TX MN CA IL LA NY OR WI NC NM OK VA

All

States 1500 UB04 835

1st Auto & Casualty J1585 x x x x

21st Century Insurance 41556 x x x Rejects Only

22125 Roscoe Corp. 41556 x x x Rejects Only

AAA Northern California, Nevada & Utah Insurance Exchange 41556 x x x Rejects Only

ABC Const. Company 41556 x x x Rejects Only

Acadia Insurance Company * Paper Only

Accident Fund Insurance Co of America J1790 x x x x

Accuride Corporation J1024 x x x x x

Ace Property & Casualty Ins Co 41556 x x x Rejects Only

ACIG Insurance Company J1578 x x x x x

ACTS Retirement - Life Communities J2163 x x x x

Acuity, A Mutual Insurance Company J1240 x x x Rejects Only

AD-COMP J1667 x x x x

Adelanto Correctional Facility (CA) J1798 x x x x

Administaff J1241 x x x x x x x x x x

Administrative Claim Service, Inc J1005 x x x Rejects Only

Adminsure J2292 x x x Rejects Only

Admiral Linen & Uniform Service J2144 x x x Rejects Only

Advance America Cash Advance Centers J1843 x x x x

Advance Services, Inc. J1608 x x x x

Advanced Auto Parts - All states EXCEPT TX MN J2162 x x x x

Advanced Auto Parts - TX MN J2161 x x x x x

Adventist Health System (Bunch CareSolutions) J1973 ** x x x

Advocare MCO, Inc J1896 x x x x

Affiliated Foods, Inc. J1977 x x x

AG Facilities Operations, LLC 41556 x x x Rejects Only

Agri Beef Co. 41556 x x x Rejects Only

AIG-Chartis 19402 x x x Rejects Only

Alaska National Insurance J1577 x x x x

Alcoa Fasteners Systems J1244 x x Rejects Only

Alex Lee, Inc. J2166 x x x x

Allen Canning J1740 x x x x

Allergan W.C. Holding, INC. J2341 x x x Rejects Only

Alliant Energy J1619 x x x x x

Allianz J1452 x x x x

Allied Claims Administration, Inc. J1733 x x x x

Allied Construction (via EMC Risk Services) J1118 x x x x x x

Allied Insurance Companies J1550 x x x x x x x x

Allied Property and Casualty Ins Co J1550 x x x x x x x x

Allmerica Financial Benefits Insurance Company J1589 x x x x

Alta Healthcare 41556 x x x Rejects Only

Page 1 of 29

WORKERS' COMPENSATION PAYER LIST

01/05/18Payer ID TX MN CA IL LA NY OR WI NC NM OK VA

All

States 1500 UB04 835

Alternative Service Concepts (ASC) J2149 x x x Rejects Only

Aluminum Precision (Carl Warren) * Paper Only

Alvey Systems (AON Risk) J1025 x x x x

AMCO Ins Co J1550 x x x x x x x x

America First J1427 x x x Rejects Only

American Airlines - DOI after 9/1/2014 ONLY J2000 x x x x x x x x x x

American Apparel, LLC (DOI after 7/14/16) J2189 x x x x

American Claims Management (ACM) J1236 x x x Rejects Only

American Coin Merchandising, Inc J1026 x x x x

American Cyanamid J1027 x x x x

American Family Mutual Insurance Company J2134 x x x x

American Furniture Warehouse 41556 x x x Rejects Only

American Home Craft J1250 x x x Rejects Only

American Liberty Insurance Company 41556 x x x Rejects Only

American Mining Insurance Group, LLC J1524 x x x x

American Specialty Companies J1028 x x x x

American Specialty Ins. / MIB J1029 x x x x

Amerisure Insurance J1206 x x x Rejects Only

Amerisure Mutual Insurance J1205 x x x Rejects Only

AmGuard Insurance Company - Guard DBA J1453 x x x x

Amtrust North America J1868 x x x x x x

ANACO 41556 x x x Rejects Only

ANAIC Cibus 41556 x x x Rejects Only

Anchor Claims Management J1919 x x x Rejects Only

Anchor Glass Container Corporation J2136 x x x x

Anheuser Busch J1620 x x x x

Antelope Valley Community Hospital J2197 x x x x

Antelope Valley Ret. 41556 x x x Rejects Only

Antelope Valley Union High School District J2185 x x x x

Applied Materials J2160 x x x x

Applied Underwriters (Except AZ) J1775 x x x Rejects Only

Aramark J1502 x x x x

Archer Daniels Midland Company J1735 x x x x

Ardagh Group J2344 x x x Rejects Only

Areas USA, Inc. J1944 x x x x

Argent (Subsidiary of West Bend but this route is Argent only) J1420 x x x x

Argonaut Insurance Company(ARGO) 19801 x x x x

Arizona & 21st Corp. DBA Berkley East Conv. Hospital 41556 x x x Rejects Only

Arkansas Best J2142 x x x Rejects Only

Arrowpoint J1564 x x x x

Association Casualty Insurance Company J1254 x x x x

Page 2 of 29

WORKERS' COMPENSATION PAYER LIST

01/05/18Payer ID TX MN CA IL LA NY OR WI NC NM OK VA

All

States 1500 UB04 835

Association County Commissioners of Georgia (ACCG). J1869 x x x Rejects Only

Athens J1914 x x x Rejects Only

Athens - ABF Freight Systems, Inc J2096 x x x Rejects Only

Athens - Alemeda Health Systems J2097 x x x Rejects Only

Athens - American Apparel, Inc (DOI prior to 7/14/16) J2098 x x x Rejects Only

Athens - American Brass & Iron Foundry J2099 x x x Rejects Only

Athens - Angelus Block J2100 x x x Rejects Only

Athens - Bay Area Housing Authority Risk Management J2101 x x x Rejects Only

Athens - Central County Fire Department J2102 x x x Rejects Only

Athens - Children's Hospital Los Angeles J2103 x x x Rejects Only

Athens - City of Beverly Hills J2104 x x x Rejects Only

Athens - City of Mountain View J2105 x x x Rejects Only

Athens - City of San Jose J2106 x x x Rejects Only

Athens - City of Vernon J2107 x x x Rejects Only

Athens - County of Solano J2108 x x x Rejects Only

Athens - East Bay Municipal Utility District J2109 x x x Rejects Only

Athens - East Bay Regional Parks District J2110 x x x Rejects Only

Athens - Fairmont Hotel J2111 x x x Rejects Only

Athens - FASIS J2112 x x x Rejects Only

Athens - Golden Gate Bridge Highway & Transportation J2113 x x x Rejects Only

Athens - Goodwill Industries (San Francisco, San Mateo, Marin Counties) J2114 ** x x Rejects Only

Athens - H&S Venture J2335 x x x x

Athens - Household Industries Self Insured Group J2115 x x x Rejects Only

Athens - Kings Seafood Company J2116 x x x Rejects Only

Athens - KPC Healthcare J2117 x x x Rejects Only

Athens - Long Beach Public Transportation Company J2118 x x x Rejects Only

Athens - McKesson Corporation J2119 x x x Rejects Only

Athens - Orora North American J2120 x x x Rejects Only

Athens - Placentia-Yorba Linda Unified School District J2121 x x x Rejects Only

Athens - Presbyterian Intercommunity Hospital PIH J2122 x x x Rejects Only

Athens - San Francisco Unified School District J2124 x x x Rejects Only

Athens - Sony Corporation of America J2126 x x x Rejects Only

Athens - Sunsweet Growers, Inc. J2127 x x x Rejects Only

Athens - Temecula Valley Unified School District J2128 x x x Rejects Only

Athens - The Conco Companies - ARCH WC J2129 x x x Rejects Only

Athens - The Conco Companies - Zurich J2130 x x x Rejects Only

Athens - The Permanente Medical Group, Inc. J2131 x x x Rejects Only

Athens - Vintage Senior Living J2132 x x x Rejects Only

Atlantic PPO to Atlantic Imaging Group J2013 x x x Rejects Only

Atlantic PPO to Hartford Insurance J2035 x x x Rejects Only

Atlantic PPO to Merchants Mutual J2046 x x x Rejects Only

Page 3 of 29

WORKERS' COMPENSATION PAYER LIST

01/05/18Payer ID TX MN CA IL LA NY OR WI NC NM OK VA

All

States 1500 UB04 835

Atlantic PPO to New York City Law Department J2053 x x x Rejects Only

Atlantic PPO to NJ-PLIGA J2054 x x x Rejects Only

Atlantic PPO to NY City Transit J2055 x x x Rejects Only

Atlantic PPO to NYC Dept. of Sanitation J2056 x x x Rejects Only

Atlantic PPO to NYSIF J2057 x x x Rejects Only

Atlantic PPO TO QBE Insurance J2067 x x x Rejects Only

Atlantic PPO to Sedgwick WC Insurance J2071 x x x Rejects Only

Atlantic PPO to Sentry Insurance J2074 x x x Rejects Only

Atlantic PPO to Travelers J2079 x x x Rejects Only

Atlantic PPO to U.S. Department of Labor-PA J2081 x x x Rejects Only

Atlantic PPO to US DOL NJ claims J2083 x x x Rejects Only

Atlantic PPO to US DOL NY claims J2084 x x x Rejects Only

Aureon HR Solutions (via EMC Risk Services) J1118 x x x x

Austin Mutual Ins J1682 x x x x

Automobile Dealers Insurance Company Inc J1861 x x x Rejects Only

Auto-Owners \ Home-Owners Insurance Company J1580 x x x x

Auto-Owners \ Owners Insurance Company J1583 x x x x

Auto-Owners \ Property-Owners Insurance Co J1699 x x x x

Auto-Owners \ Southern-Owners Company J1688 x x x x

Auto-Owners Insurance Company J1556 x x x x

Auto-Owners Life Insurance Company J1596 x x x x

AVIR Inc. 41556 x x x Rejects Only

Avizent J1415 x x x Rejects Only

Ayers Trucking J1018 x x x x

Baker Tanks, Inc. 41556 x x x Rejects Only

Bank of America J1729 x x x x

Baptist Healthcare Systems, Inc (KY ONLY) J2164 x x x

Bardavon Health Innovations J2334 x x x Rejects Only

Barnes J1503 x x x x

Barrett Business Services Inc (BBSI) J1686 x x x x

BART - San Francisco Bay Area Rapid Transit J1770 x x x x

Basic Resources, Inc. 41556 x x x Rejects Only

Bass Pro Group, LLC J1958 x x x x

Bb&T Corporation (Branch Banking & Trust) J1995 x x x

Beacon Mutual J1234 x x x x

Beall's Inc / Midwest Employers J1030 x x x x

Bed Bath & Beyond J2167 x x x x

Beeville ISD 41556 x x x Rejects Only

Belk, Inc. J2168 x x x x

Benchmark Insurance J1257 x x x Rejects Only

Berkley Agribusiness Risk Specialists J2190 x x x x