workers' compensation payer list 11/03/15 all payer id tx ... · allmerica financial benefits...

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WORKERS' COMPENSATION PAYER LIST11/03/15

Payer ID TX MN CA IL LA NY OR WI NC NM OKAll

States 1500 UB04 8351st Auto & Casualty J1585 x x x x21st Century Insurance 41556 x x x Rejects Only22125 Roscoe Corp. 41556 x x x Rejects OnlyAAA Northern California, Nevada & Utah Insurance Exchange 41556 x x x Rejects OnlyABC Const. Company 41556 x x x Rejects OnlyAcadia Insurance Company J1477 x x x x x xAccident Fund Insurance Co of America J1790 x x x xAccuride Corporation J1024 x x x x xAce Property & Casualty Ins Co 41556 x x x Rejects OnlyACIG Insurance Company J1578 x x x x xAcuity, A Mutual Insurance Company J1240 x x Rejects OnlyAD-COMP J1667 x x x xAdelanto Correctional Facility (CA) J1798 x x x xAdelanto School District (CA) J1690 x x x xAdministaff J1241 x x x x x x x x xAdministrative Claim Service, Inc J1005 x x x Rejects OnlyADP Total Source Inc. J1242 x x Rejects OnlyAdvance America Cash Advance Centers J1843 x x x xAdvance Services, Inc. J1608 x x x xAdvocare MCO, Inc J1896 x x x xAG Facilities Operations, LLC 41556 x x x Rejects OnlyAgri Beef Co. 41556 x x x Rejects OnlyAIG-Chartis 19402 x x x Rejects OnlyAir Liquide USA LLC J1516 x x x xAlaska National Insurance J1577 x x x xAlcoa Fasteners Systems J1244 x x Rejects OnlyAllegheny Technologies J1245 x x Rejects OnlyAllen Canning J1740 x x x xAlliant Energy J1619 x x x x xAllianz J1452 x x x xAllied Claims Administration, Inc. J1733 x x x x

Allied Construction (via EMC Risk Services) J1118 x x x x x xAllied Insurance Companies J1550 x x x x x x x xAllied Property and Casualty Ins Co J1550 x x x x x x x xAllmerica Financial Benefits Insurance Company J1589 x x x x x x x x

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States 1500 UB04 835Alta Healthcare 41556 x x x Rejects OnlyAlvey Systems (AON Risk) J1025 x x x x xAMCO Ins Co J1550 x x x x x x x xAmerica First J1427 x x x Rejects OnlyAmerican Claims Management (ACM) J1236 x x x Rejects OnlyAmerican Coin Merchandising, Inc J1026 x x x x xAmerican Cyanamid J1027 x x x x xAmerican Furniture Warehouse 41556 x x x Rejects OnlyAmerican Home Craft J1250 x x x Rejects OnlyAmerican Interstate - TX only J1852 x x Rejects OnlyAmerican Liberty Insurance Company 41556 x x x Rejects OnlyAmerican Mining Insurance Group, LLC J1524 x x x xAmerican Specialty Companies J1028 x x x x xAmerican Specialty Ins. / MIB J1029 x x x x xAmerisafe J1447 x x x x x x x x x xAmerisafe Risk Services J1447 x x x x x x x x x xAmerisure Insurance J1206 x x x Rejects OnlyAmGuard Insurance Company - Guard DBA J1453 x x x xAmtrust Insurance Company of Kansas J1868 x x x x x xANACO 41556 x x x Rejects OnlyANAIC Cibus 41556 x x x Rejects OnlyAnchor Claims Management J1919 x x x Rejects OnlyAnheuser Busch J1620 x x x xAntelope Valley Ret. 41556 x x x Rejects OnlyApplied Underwriters J1775 x x x Rejects OnlyAramark J1502 x x x xArcher Daniels Midland Company J1735 x x x xAreas USA, Inc. J1944 x x x xArgent (Subsidiary of West Bend but this route is Argent only) J1420 x x x xArgonaut Insurance Company(ARGO) 19801 x x x xArizona & 21st Corp. DBA Berkley East Conv. Hospital 41556 x x x Rejects OnlyArrowpoint J1564 x x x xAssociation County Commissioners of Georgia (ACCG). J1869 x x x Rejects OnlyAthens J1914 x x x Rejects OnlyAustin Mutual Ins J1682 x x x x

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States 1500 UB04 835Automobile Dealers Insurance Company Inc J1861 x x x Rejects OnlyAuto-Owners \ Home-Owners Insurance Company J1580 x x x xAuto-Owners \ Owners Insurance Company J1583 x x x xAuto-Owners \ Property-Owners Insurance Co J1699 x x x xAuto-Owners \ Southern-Owners Company J1688 x x x xAuto-Owners Insurance Company J1556 x x x xAuto-Owners Life Insurance Company J1596 x x x xAVIR Inc. 41556 x x x Rejects OnlyAvizent J1415 x x x Rejects OnlyAyers Trucking J1018 x x x x x xBaker Tanks, Inc. 41556 x x x Rejects OnlyBank of America J1729 x x x xBarnes J1503 x x x xBarrett Business Services Inc (BBSI) J1686 x x x xBART - San Francisco Bay Area Rapid Transit J1770 x x x xBasic Resources, Inc. 41556 x x x Rejects OnlyBass Pro Group, LLC J1958 x x x xBeacon Mutual J1234 x x x xBeall's Inc / Midwest Employers J1030 x x x x xBear Valley Unified School District (CA) J1690 x x x xBeeville ISD 41556 x x x Rejects OnlyBenchmark Insurance J1257 x x x Rejects OnlyBerkley Agribusiness Risk Specialists J1477 x x x x x xBerkley National Insurance Company J1477 x x x x x xBerkley Net Underwriters, LLC J1523 x x x xBerkley Regional Insurance Company J1477 x x x x x xBerkley Risk Administrators Company, LLC J1526 x x x xBerkley Specialty Underwriters TP019 x x x xBerkley Valley Conv Hospital 41556 x x x Rejects OnlyBerkshire Hathaway Homestate Companies (BHHC) 20044 x x x x x x x xBernardo H. Co. Club 41556 x x x Rejects OnlyBerwind Corporation J1031 x x x x xBeverly Hills Carmel 41556 x x x Rejects OnlyBig 5 Corp J1738 x x x xBighorn Construction 41556 x x x Rejects Only

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States 1500 UB04 835Bituminous Fire and Marine J1691 x x x xBituminous Insurance Company J1579 x x x xBloomingdale's J1347 x x x xBMW Manufacturing Corp. J1258 x x Rejects OnlyBMW North America J1259 x x Rejects OnlyBobrick Washroom 41556 x x x Rejects OnlyBoeing Company J1964 x x x x x x x x x x

Boeing Company - WC ONLY J1964 x x x x x x x x x xBoise Cascade Company J1801 x x x xBoler Company J1870 x x x xBoulder Community Hospital 41556 x x x Rejects OnlyBremco Construction 41556 x x x Rejects OnlyBrickstreet J1761 x x x xBroadspire, a Crawford Company TP021 x x x xBrotherhood Mutual Insurance J1445 x x x x x x x x xBrownsville Independent School District 41556 x x x Rejects OnlyBrownyard Group Inc. (Arch Insurance) 11150 x x x x xBrunswick Corporation J1032 x x x x xBuffets Inc (Old Country Buffett, Ryan's, HomeTown Buffet, Fire Mountain, Country Buffett, Granny's Buffett) J1501 x x x xBuilders Group of MN J1391 x x x Rejects OnlyBunch and Associates J1435 x x x xBurlington Coat Factory Wareho J1033 x x x x xBurton Way Carmel 41556 x x x Rejects OnlyBycor Gen Contract 41556 x x x Rejects OnlyCadet Uniform Supply 41556 x x x Rejects OnlyCalifornia Fair Services Authority J1535 x x x xCalifornia Water Service Company 41556 x x x Rejects OnlyCallahan, McCune 41556 x x x Rejects OnlyCambridge Integrated Services J1819 x x x Rejects OnlyCampbell Union School District 41556 x x x Rejects OnlyCapistrano Unified School District (CA) J1637 x x x xCapitol Indemnity J1262 x x x Rejects OnlyCapitol Insurance Companies J1809 x x x xCAPS-SIG 41556 x x x Rejects Only

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States 1500 UB04 835CareWorks Consultants, Inc. (aka CareWorks USA and CCI) - OHIO ONLY J1866 NOTE x x xCarhartt J1931 x x x xCarl Warren - Carolina United National Labor J1932 x x x xCarl Warren - Universal Limousine & Trans J1932 x x x xCasitas Municipal Water District (CA) J1630 x x x xCatholic Diocese of San Diego 41556 x x x Rejects OnlyCatholic Mutual - Preferred Professional Insurance Company 41556 x x x Rejects OnlyCatholic Mutual - Virginia Surety Company, Inc. 41556 x x x Rejects OnlyCC-Development Group, Inc. J1900 x x x xCCMSI J1010 x x x Rejects OnlyCedars-Sinai Health System 41556 x x x Rejects OnlyCendant Corporation J1034 x x x x xCentennial Insurance Company 19895 x x x x xCentral Contra Costa Transit Authority J1605 x x x xCentral Hockey League J1035 x x x x xChaffey Joint Union H. S. District (CA) J1646 x x x xChandler's P. Verdes 41556 x x x Rejects OnlyChapman Convalescent 41556 x x x Rejects OnlyCharming Shoppes, Inc. J1036 x x x x xChesapeake Insurance J1908 x x x Rejects OnlyChesterfield Services, Inc. J1479 x x x x x x xChildren's Hospital Colorado 41556 x x x Rejects OnlyChildren's Hospital of Orange County - First Aid 41556 x x x Rejects OnlyChubb & Son (Work Comp Only) J1554 x x x xChubb Services J1561 x x x xChula Vista Elementary School District 41556 x x x Rejects OnlyChurch Mutual Insurance Company (WC ONLY) J1265 / J1725 x x x xCIGA J1532 x x x Rejects OnlyCincinnati Insurance J1562 x x x Rejects OnlyCitizens Insurance Company of America J1582 x x x x x x xCitrus Valley Health Partners J1613 x x x xCitrus World, Inc. J1945 x x x xCity and County of San Francisco (CCSF) J1885 x x x x

City of Ames (via EMC Risk Services) J1118 x x x x x xCity of Arlington A0033 x x x x x x

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States 1500 UB04 835City of Ashland 41556 x x x Rejects OnlyCity of Atlanta J1516 x x x xCity of Banning (CA) J1792 x x x xCity of Barstow (CA) J1793 x x x xCity of Beaverton 41556 x x x Rejects OnlyCity of Belmont (Self Insured) 41556 x x x Rejects OnlyCity of Blythe (CA) J1794 x x x xCity of Brea J1880 x x x Rejects OnlyCity of Campbell 41556 x x x Rejects OnlyCity of Carlsbad 41556 x x x Rejects OnlyCity of Carmel By The Sea 41556 x x x Rejects OnlyCity of Carson 41556 x x x Rejects OnlyCity of Charlotte J1928 x x x Rejects OnlyCity of Chula Vista 41556 x x x Rejects OnlyCity of Colton 41556 x x x Rejects OnlyCity of Coronado 41556 x x x Rejects OnlyCity of Dallas J1441 x x x Rejects OnlyCity of Del Mar 41556 x x x Rejects Only

City of Des Moines (via EMC Risk Services) J1118 x x x x x xCity of Desert Hot Springs (CA) J1799 x x x xCity of Edinburg, Texas 41556 x x x Rejects OnlyCity of El Paso A0046 x x x x x xCity of Encinitas 41556 x x x Rejects OnlyCity of Escondido 41556 x x x Rejects OnlyCity of Fort Worth (TX) J1680 x x x xCity of Fountain Valley (CA) J1632 x x x xCity of Gardena (CA) J1634 x x x xCity of Glendale (AZ) J1800 x x x xCity of Grand Junction 41556 x x x Rejects OnlyCity of Hillsboro 41556 x x x Rejects OnlyCity of Houston J1444 x x x Rejects OnlyCity of Imperial Beach 41556 x x x Rejects OnlyCity of Imperial Beach (Voucher) 41556 x x x Rejects OnlyCity of Irving 41556 x x x Rejects OnlyCity of Jacksonville J1504 x x x x

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States 1500 UB04 835City of La Mesa 11 (CA) J1711 x x x xCity of Laguna Hills (CA) J1653 x x x xCity of Lemon Grove 41556 x x x Rejects OnlyCity of Los Altos 41556 x x x Rejects OnlyCity of Los Angeles J1536 x x x Rejects OnlyCity of Merced 41556 x x x Rejects OnlyCity of Miami Beach (FL) J1946 x x x xCity of Minneapolis J1269 x x x xCity of Monrovia (CA) J1714 x x x xCity of Murieta (CA) J1797 x x x xCity of National City 41556 x x x Rejects OnlyCity of Oceanside 41556 x x x Rejects OnlyCity of Omaha (NE) J1721 x x x xCity of Ontario 41556 x x x Rejects OnlyCity of Orange J1881 x x x Rejects OnlyCity of Perris (CA) J1795 x x x xCity of Pompano Beach (FL) J1947 x x x xCity of Redding (CA) J1617 x x x xCity of Rialto, CA J1901 x x x xCity of Richardson 41556 x x x Rejects OnlyCity of Salinas J1849 x x x xCity of San Diego J1497 x x x xCity of San Jacinto (CA) J1796 x x x xCity of San Mateo (CA) J1727 x x x xCity of Santee 41556 x x x Rejects OnlyCity of Snyder (TX) J1598 x x x x xCity of Solana Beach 41556 x x x Rejects OnlyCity of South San Francisco 41556 x x x Rejects OnlyCity of St. Paul (MN) J1602 x x x xCity of Stanton (CA) J1636 x x x xCity of Stockton (CA) J1664 x x x xCity of Topeka (KS) J1607 x x x xCity of Upland (CA) J1645 x x x xCity of Vista 41556 x x x Rejects OnlyCity of Waco 41556 x x x Rejects Only

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States 1500 UB04 835

City of West Des Moines (via EMC Risk Services) J1118 x x x x x xCity of West Palm Beach (FL) J1948 x x x xCity of Yorba Linda (CA) J1708 x x x xCity of Yuma 41556 x x x Rejects OnlyCivil Constructors 41556 x x x Rejects OnlyClaims Administrative Services (CAS) J1271 x x x xClassic Residence By Hyatt J1037 x x x x xClougherty Packing, LLC J1739 x x x xCNA Insurance 20443 x x x xCo Grande Casino 41556 x x x Rejects OnlyCoach USA J1272 x x Rejects OnlyCoachella Valley Water District (CA) J1902 x x x xCoast Converters 41556 x x x Rejects OnlyCoca-Cola Enterprises Inc. J1038 x x x x xCollin County 41556 x x x Rejects OnlyColorado Casualty J1428 x x x Rejects OnlyColorado Contractors Program 41556 x x x Rejects OnlyColorado HealthCare Assoc. - Safety National Casualty Corp. 41556 x x x Rejects OnlyColorado Prime Corp. 41556 x x x Rejects OnlyColumbia Sussex Corporation J1039 x x x x xColumbine Health Systems 41556 x x x Rejects OnlyCommunity Development Commission (CA) J1655 x x x xComp West J1925 x x x Rejects OnlyCompanion Property and Casualty Insurance Company (dba Sussex Insurance Company) J1829 x x x xCompass Group Usa, Inc. J1040 x x x x xCompton Unified School District (CA) J1652 x x x xContech Construction Products J1041 x x x x xContinental Airlines J1042 x x x x xContinental Western Insurance Co (CWG) J1274 x x x x x x xContra Coastal County Schools Insurance Group (CCCSIG) J1715 x x x Rejects OnlyConvergys Corporation J1043 x x x x xCon-Way Inc. J1844 x x x xCook & Solis Const. 41556 x x x Rejects OnlyCorrectional Management Service J1044 x x x x x

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States 1500 UB04 835Corrections Corp of America J1045 x x x x xCorrections Corporation of America (CCA) J1942 x x x xCottingham & Butler Claim Services, Inc. J1683 x x x xCountry Casualty Insurance Company J1684 x x x x x x x xCountry Insurance \ Modern Service Casualty Insur Co J1712 x x x x x x x xCountry Insurance \ Mountain States Insurance J1572 x x x x x x x xCountry Insurance \ MSI Preferred Insurance Company J1591 x x x x x x x xCountry Mutual Insurance Company J1702 x x x x x x x xCountry Preferred Insurance Company J1705 x x x x x x x xCountry Villa Health Services - SNCC 41556 x x x Rejects OnlyCountry Villa Ox Hlth 41556 x x x Rejects OnlyCounty Of Alameda/AIG 41556 x x x Rejects OnlyCounty of Humboldt (CA) J1603 x x x xCounty of Imperial J1960 x x x Rejects OnlyCounty of Kern J1935 x x x xCounty of Los Angeles (1000) J1625 x x x xCounty of Los Angeles (2000) J1722 x x x Rejects OnlyCounty of Los Angeles (3000) J1967 x x x Rejects OnlyCounty of Los Angeles (4000/5000) J1723 x x x Rejects OnlyCounty Of Marin 41556 x x x Rejects OnlyCounty of San Diego J1513 x x x xCounty of Santa Barbara (CA) J1631 x x x xCounty of Santa Barbara-CSAC (CA) J1631 x x x xCounty of Santa Barbara-Non-CSAC (CA) J1631 x x x xCounty of Shasta (CA) J1616 x x x xCounty of Sonoma (CA) J1662 x x x xCounty of Tulare (CA) J1666 x x x xCourtyard Health C. 41556 x x x Rejects OnlyCoworx Staffing, LLC J1046 x x x x xCox Construction Co 41556 x x x Rejects OnlyCPS Security Solutions 41556 x x x Rejects OnlyCR&R J1516 x x x x

Crescent Crown Distributing J1965 x x x x

Crescent Crown Distributing J1965 x x x xCrestbrook Insurance Company J1550 x x x x x x x x

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States 1500 UB04 835Crum & Forster Indemnity Co 31348 x x x xCucamonga School District (CA) J1690 x x x xCVS/Caremark/Minute Clinic J1457 x x x xCypress Insurance Company (Member of BHHC) 20044 x x x x x x x xDahl's Foods (via EMC Risk Services) J1118 x x x x x xDaimlerChrysler Corporation 41556 x x x Rejects OnlyDakota Fire 21415 x x x xDallas County Community College District 41556 x x x Rejects OnlyDallas Independent School District J1494 x x x xDanaher Corporation J1051 x x x x xDarigold J1936 x x x xDavis Mech Systems 41556 x x x Rejects OnlyDaylight Transport 41556 x x x Rejects OnlyDe Bartolos, Inc J1058 x x x x xDel Taco, LLC J1681 x x x xDenver Public Schools 41556 x x x Rejects OnlyDepartment of Energy J1449 x x x xDepartment of Labor J1438 x x x xDepartment of Labor Black Lung J1448 x x x xDepartment of Water and Power of the City of Los Angeles (LADWP) J1514 x x x xDepositors Ins Co J1550 x x x x x x x xDesert Hospital District 41556 x x x Rejects OnlyDesert Princess 41556 x x x Rejects OnlyDiamond Farming Company 41556 x x x Rejects OnlyDirectory Distributing Assoc. J1059 x x x x xDiscount Tire J1611 x x x xDiscover Re (Burger King) J1060 x x x x xDiscovery Hy-Vee (via EMC Risk Services) J1118 x x x x x xDisneyland Resorts (Bunch) J1933 x x x xDouglas County 41556 x x x Rejects OnlyDunn-Edwards Corporation J1061 x x x x xDurango Coffee Co. 41556 x x x Rejects OnlyDustrol (via EMC Risk Services) J1118 x x x x xDynamex, Inc. J1062 x x x x xEagle Claims J1934 x x x x

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States 1500 UB04 835Eagle Pass ISD 41556 x x x Rejects OnlyEast San Gabriel Valley ROP (CA) J1690 x x x xEastGUARD Insurance Company - Guard DBA J1453 x x x xEastman Kodak Company J1903 x x x xEcho Pacific Develop 41556 x x x Rejects OnlyEDIC J1289 x x Rejects OnlyEdinburg Consolidated Independent School District 41556 x x x Rejects OnlyEdwards Claim Administration (SEE TAB) J1204 x x x xEl Paso Community College (TX Jur) A0106 x x x x x xEl Paso Water Util TX Jur J1017 x x x x x xEl Pollo Loco J1737 x x x xELC Electric Inc 41556 x x x Rejects OnlyElite Comp 41556 x x x Rejects OnlyEMC Property and Casualty - WC ONLY 21415 x x x xEmeritus Corporation J1679 x x x xEmployer Insurance Group (EIG) J1232 x x x x x x xEmployers Assurance Company J1232 x x x x x x xEMPLOYER'S CLAIM SERVICE, INC - City of Naperville J1559 x x x xEmployers Compensation Insurance Company J1232 x x x x x x xEmployers General Insurance Group J1696 x x x xEmployers Insurance (BUNCH) J1912 x x x Rejects OnlyEmployers Mutual Casualty - WC ONLY 21415 x x x xEmployers Preferred Insurance Company J1232 x x x x x x xEnvirosource J1063 x x x x xEnvision Radiology, LLC 41556 x x x Rejects OnlyEplica, Inc. 41556 x x x Rejects OnlyErgon, Inc. J1952 x x x xErickson-Hall Constr 41556 x x x Rejects OnlyERMC J1022 x x x x x xESIS TP043 x x x Rejects OnlyESIS - First American Insurance Co J1064 x x x x xESIS - Kelly Services J1451 x x x xESIS - Lockheed Martin Corporation J1454 x x x xEvolution Insurance Company J1065 x x x x xExxonMobil Corporation J1606 x x x x

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States 1500 UB04 835F&G Guaranty Ins Co/Main Street Program Colorado 41556 x x x Rejects OnlyFactory 2 U J1019 x x x x x xFairchild Fasteners J1624 x x x xFairfax County Government J1884 x x x xFairmont Specialty Insurance Company - TX J1697 x x x xFairview Health Services J1618 x x x xFamily Health & Housing 41556 x x x Rejects OnlyFAMSA, Inc. J1807 x x x xFarm Bureau Mutual Insurance Company (MN Only) J1853 x x x xFarmers \ Civic Property and Casualty Company J1687 x x x xFarmers \ Exact Property and Casualty Company J1703 x x x xFarmers \ Fire Insurance Exchange J1706 x x x xFarmers \ Mid-Century Insurance Company J1710 x x x xFarmers \ Neighborhood Spirit Property and Casualty Company J1701 x x x xFarmers \ Truck Insurance Exchange J1713 x x x xFarmers Insurance Exchange (WC ONLY) J1563 x x x xFarmland Mutual Ins Co J1551 x x x x x x x xFCCI J1830 x x x x x x xFederated Claims Service Corp. J1297 x x x xFederated Department Stores, Inc J1297 x x x xFederated Linen & Uniform 41556 x x x Rejects OnlyFederated Mutual Insurance Company 13935 x x x xFederated Rural Electric (Tx) 11118 x x x x x x x xFederated Services Insurance Company 28304 x x x xFFVA Mutual Insurance J1909 x x x Rejects OnlyFireman's Fund Insurance Company 21873 x x x xFiremen's Insurance Company J1274 x x x x x x xFirstcomp J1011 x x x Rejects OnlyFKI Industries, Inc. J1047 x x x x xFlorida Fruit and Vegetable Association J1910 x x x Rejects OnlyForge Industrial Staffing J1529 x x x xFranciscan Alliance J1883 x x x xFranco Construction 41556 x x x Rejects OnlyFrankenmuth Mutual J1440 x x x xFresno County Office of Education 41556 x x x Rejects Only

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States 1500 UB04 835Fresno County Self Insurance Group 41556 x x x Rejects OnlyFullerton Union High School District (CA) J1633 x x x xGAB Robbins, Inc. TP117 x x x x xGAB Robins (For Van Tuyl Companies ONLY) TP117 x x x x xGallagher Bassett TP057 x x x xGarden Grove Unified School District J1519 x x x xGarden Regional Hospital & Med Center, Inc. 41556 x x x Rejects OnlyGategourmet #836 J1302 x x x Rejects OnlyGates Corp DBA Gates Rubber Co J1066 x x x x xGates O'Doherty 41556 x x x Rejects OnlyGates O'Doherty G&G 41556 x x x Rejects OnlyGateway Trans., Inc. 41556 x x x Rejects OnlyGE Auto J1557 x x x xGeneral Parts International J1678 x x x xGenesis Construction 41556 x x x Rejects OnlyGenex Care for Ohio J1895 x x x xGEO J1461 x x x xGillette Childrens Specialty Healthcare J1927 x x x xGlendale Elementary School District #40 41556 x x x Rejects OnlyGolden Corral Corporation J1067 x x x x xGolden Eagle J1430 x x x Rejects OnlyGolden State Supply J1306 x x x Rejects OnlyGood Samaritan Hospital J1647 x x x xGoodrich J1462 x x x xGoodwill Industries J1621 x x x xGrand River Insurance (WC Only) J1566 x x x xGrange WC 14060 x x x xGraphic Arts Mutual 25984 x x x x x x xGreat American Alliance Ins Co. 26832 x x x x x x x xGreat American Assurance Co. 26344 x x x x x x x xGreat American Ins. Co. 16691 x x x x x x x xGreat American Ins. Co. of N.Y. 22136 x x x x x x x xGreat Divide Insurance 25224 x x x xGreen Diamond WA J1642 x x x xGreene Rad Maloney 41556 x x x Rejects Only

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States 1500 UB04 835Greer Constructon CO 41556 x x x Rejects OnlyGreif Brothers Corporation 41556 x x x Rejects OnlyGreve Clifford Wengel & Paras 41556 x x x Rejects OnlyGrimmway Enterprises, Inc. 41556 x x x Rejects OnlyGrinnell Reinsurance Company J1571 x x x x xGrinnell Select J1541 x x x x xGrundfos Manufacturing Corporation 41556 x x x Rejects OnlyGS Metals 41556 x x x Rejects OnlyGse Lining Technology, Inc. J1068 x x x x xGuard J1453 x x x xGuideOne Elite Insurance J1590 x x x xGuideOne Mutual Insurance J1574 x x x xH & R Block J1672 x x x xHamilton Mutual - WC 21415 x x x xHannaford J1463 x x x xHanover Insurance Company J1693 x x x x x x x xHanover Lloyd's Insurance Company J1588 x x x x x x xHarleysville Insurance Company J1595 x x x xHartford Dealership Advantage Program - WC 41556 x x x Rejects OnlyHastings College of the Law 41556 x x x Rejects OnlyHawkeye J1426 x x x Rejects OnlyHayhoe Construction 41556 x x x Rejects OnlyHCA-Hosptial Corporation of America J1450 x x x xHealthPartners 44547 x x x x xHealthsmart J1481 x x x xHeartland Employment Services, LLC 41556 x x x Rejects OnlyHeartland Express J1677 x x x xHelmsman Management Services 33600 x x x xHemet Unified School District (CA) J1654 x x x xHeritage Group J1069 x x x x xHighland Golf 41556 x x x Rejects OnlyHillshire Brands J1959 x x x xHilmar Cheese Company J1833 x x x xHMSHost J1612 x x x xHogan Motor Leasing 41556 x x x Rejects Only

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States 1500 UB04 835Hogan Personell 41556 x x x Rejects OnlyHolly Farms Corp. J1070 x x x x xHome Sweet Home 41556 x x x Rejects OnlyHortica Florist Mutual Insurance 13978 x x x x x x x x xHousehold Merch Nni J1071 x x x x xHousing Authority El Paso (TX) A0107 x x x x x xHouston Hunters Patrol, Inc J1020 x x x x x xHoward County Government (MD) J1888 x x x xHughes Tool Company J1072 x x x x xHutchinson Technology J1626 x x x x xHy-Vee (via EMC Risk Services) J1118 x x x x x xICW (Insurance Co of the West) 27847 x x x xIllinois Casualty J1575 x x x x xIllinois EMCASCO 21415 x x x xImperial Irrigation District 41556 x x x Rejects OnlyInconen Corporation 41556 x x x Rejects OnlyIndiana Insurance J1425 x x x Rejects OnlyIngles Markets J1907 x x x xInland Valley Hospice 41556 x x x Rejects OnlyInnovative Claim Solutions (ICS) - Rancho Cordova J1599 x x x xInnovative Claim Solutions (ICS) - San Ramon J1601 x x x xInsilco Corp J1073 x x x x xIntegrity Mutual Insurance Company (WC ONLY) 14303 x x x xIntercare J1542 x x x Rejects Only

Intercare Holdings Insurance Services, Inc. J1957 x x x x

Intercare Holdings Insurance Services, Inc. J1957 x x x xInterinsurance Exchange of the Automobile Club J1810 x x x xIPMG Claims Management Services (Insurance Program Managers Group) J1887 x x x xIrex Corporation J1074 x x x x xIronworking Contract I.P. J1075 x x x x xiSurity J1911 x x xJ B Hunt Transport Inc. A0138 x x x x x xJ.H. Mccormack Const 41556 x x x Rejects OnlyJD Mechanical 41556 x x x Rejects OnlyJefferson County Texas 41556 x x x Rejects Only

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States 1500 UB04 835JI Specialty Services J1006 x x x Rejects OnlyJohn Muir Health 41556 x x x Rejects OnlyJohnston Schools (via EMC Risk Services) J1118 x x x x x xJones Truck Lines,Inc. J1076 x x x x xJudson ISD 41556 x x x Rejects OnlyJuvenile Jail Facility Managem J1077 x x x x xKautz Vinyards 41556 x x x Rejects OnlyKCI Holdings USA J1078 x x x x xKeenan and Associates (See note for exclusions) J1498 x x x xKellogg Companies J1803 x x x xKen Davis Industries Inc. J1079 x x x x xKey Risk Management Services LLC J1521 x x x xKeystone (via EMC Risk Services) J1118 x x x x x xKing Pak Potato Company LLC 41556 x x x Rejects OnlyKing Ranch 41556 x x x Rejects OnlyKirkland's, Inc. J1614 x x x xKTA Construction (COSD2) 41556 x x x Rejects OnlyL. Arrowhead C. Club 41556 x x x Rejects OnlyLaclede Chain 41556 x x x Rejects OnlyLaclede Steel 41556 x x x Rejects OnlyLake Elsinore School District 41556 x x x Rejects OnlyLamar Consolidated ISD 41556 x x x Rejects OnlyLamesa ISD 41556 x x x Rejects OnlyLandmark Golf Co 41556 x x x Rejects OnlyLandmark Grad&Paving 41556 x x x Rejects OnlyLandry's J1889 x x x xLandstar Bco Wc Program J1080 x x x x xLane County 41556 x x x Rejects OnlyLarimer County - WC 41556 x x x Rejects OnlyLB Auto/Pacific Part 41556 x x x Rejects OnlyLB Auto/Pacific Supp 41556 x x x Rejects OnlyLeague of Minnesota Cities Insurance Trust J1527 x x x xLekos Electric 41556 x x x Rejects OnlyLevin Enterprises, Inc. 41556 x x x Rejects OnlyLFP Corporation J1650 x x x x

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States 1500 UB04 835Liberty Mutual 33600 x x x xLiberty Mutual Middle Markets 33600 x x x xLiberty Northwest 33600 x x x xLiberty Wausau 33600 x x x xLivingston ISD 41556 x x x Rejects OnlyLk Arrowhead Co Club 41556 x x x Rejects OnlyLodi Memorial Hospital 41556 x x x Rejects OnlyLong Beach Unified School District J1515 x x x xLongs Drugs J1464 x x x xLouisiana State University J1953 x x x xLouisiana Workers' Compensation Corporation (LWCC) J1547 x x x xLowe's J1465 x x x xLsg Sky Chefs International J1081 x x x x xLuba Casualty Insurance Company J1341 x x x x xLumbermen's Underwriting Alliance J1540 x x x x x x x xLumbermen's Underwriting Alliance J1899 x x x x xLynwood Unified School District (CA) J1669 x x x xLYNX J1949 x x x xMackinaw Administrators J1343 x x x xMacys (Daly City) J1345 x x x xMacys (Newport Beach) J1346 x x x xMacys Corporate Services Inc J1347 x x x xMadera Community Hospital 41556 x x x Rejects OnlyMajor League Baseball 8 J1082 x x x x xManufacturers Alliance Insurance Company 41556 x x x Rejects OnlyMarcotte & Hearne 41556 x x x Rejects OnlyMaricopa County Community College District 41556 x x x Rejects OnlyMariposa County 41556 x x x Rejects OnlyMassachusetts Bay Insurance Company J1689 x x x x x x x xMatagorda County 41556 x x x Rejects OnlyMatheson Trucking J1736 x x x xMatrix Absence Management TP075 x x x xMaxim Crane Works J1083 x x x x xMay Department Stores J1347 x x x xMayo Clinic/Recovery and Claims Services 41193 x x x x

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States 1500 UB04 835Mc Donald'S-Mcopco J1084 x x x x xMDSI Phys Group INC 41556 x x x Rejects OnlyMeadowbrook Insurance Group J1478 x x x Rejects OnlyMedical Ben Admin 41556 x x x Rejects Only

Meijer Stores J1930 x x x x

Meijer Stores J1930 x x x xMEMIC 11030 x x x xMemorial Health Services 41556 x x x Rejects OnlyMeridian Construction Program 41556 x x x Rejects OnlyMeritage Corporation 41556 x x x Rejects OnlyMesa County Colorado 41556 x x x Rejects OnlyMesa County Valley School District 51 41556 x x x Rejects OnlyMetropolitan Council J1355 x x x xMetropolitan Transit Authority J1238 x x x xMexicana Airlines 41556 x x x Rejects OnlyMichael Hogan Assoc 41556 x x x Rejects OnlyMidwest Drywall J1119 x x x x xMidwest Family Mutual Insurance Co (Work Comp Only) J1685 x x x x xMidwest Insurance 10895 x x x Rejects OnlyMillard Refrigerated J1482 x x x x x xMinnesota Counties Ins Trust (MCIT) J1351 x x x xMinnesota Department of Labor & Industry – Claims Services & Investigations Unit J1436 x x x xMission Aviation Fellowship 41556 x x x Rejects OnlyMission Lodge Sanitarium 41556 x x x Rejects OnlyMissoula Cart Co, In 41556 x x x Rejects OnlyMitchell Energy & Devel J1085 x x x x xMitsui Sumitomo Insurance Group - Toyota Claims Only J1692 x x x xMitsui Sumitomo Insurance USA Inc. - Toyota Claim Only J1694 x x x xMMIC J1622 x x x xModesto Irrigation District 41556 x x x Rejects OnlyMontgomery J1424 x x x Rejects OnlyMontgomery County Self-Insurance Program (MD) J1890 x x x xMontgomery County Texas A0179 x x x x x xMonument Administrators - Cornerstone Comp J1530 x x x x

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States 1500 UB04 835Monument Administrators - Elite Country Club J1530 x x x xMorongo Basin Transit Authority (CA) J1651 x x x xMorris Material Handling J1086 x x x x xMorrison Health Care, Inc. J1087 x x x x xMotion Picture & Television Fund 41556 x x x Rejects OnlyMTS J1641 x x x xMunford, Inc. J1088 x x x x xMusco (via EMC Risk Services) J1118 x x x x x xNap Tools J1120 x x x x xNational American Insurance Co (NAICO) J1695 x x x x x x x xNational Casualty Company J1551 x x x x x x x xNational Farmers Union Property and Casualty Company - QBE DBA J1484 x x x x x x xNational Interstate 32620 x x x x x x x x xNational Jewish Health 41556 x x x Rejects OnlyNational Liability and Fire Insurance Company (DOI before 7/1/2014) 20044 x x x x x x x xNational Liability and Fire Insurance Company (DOI on or after 7/1/2014) J1453 x x x xNational Loss Prevention, Inc J1021 x x x x x xNationwide Affinity Ins Co Of America (NAICOA) J1552 x x x x x x x xNationwide Agribusiness Companies J1551 x x x x x x x xNationwide Agribusiness Ins Co J1551 x x x x x x x xNationwide Ins Co Of America (NICOA) J1552 x x x x x x x xNationwide Insurance Companies J1552 x x x x x x x xNationwide Mutual Fire Co J1552 x x x x x x x xNationwide Mutual Insurance Company J1552 x x x x x x x xNationwide Property And Casualty Ins Co J1552 x x x x x x x xNavistar, Inc J1558 x x x xNBC Universal J1359 x x Rejects OnlyNCLM - North Carolina League of Municipalities J1772 x x x xNew Jersey Manufacturing 12122 x x x xNew Koosharem Corporation/Select Staffing (DOI after 7/31/2014) J1875 x x x xNonprofit Insurance Trust J1845 x x x xNordstrom, Inc. J1360 x x Rejects OnlyNorGUARD Insurance Company - Guard DBA J1453 x x x xNorth Bay Schools Insurance Authority (NBSIA) J1549 x x x xNorth Carolina Farm Bureau J1825 x x x x

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States 1500 UB04 835North Carolina Guarantee Insurance Association J1906 x x x xNorth Clackamas School District #12 41556 x x x Rejects OnlyNorth County Transit District 41556 x x x Rejects OnlyNorth East Independent School District (NEISD) J1872 x x x Rejects OnlyNorth River Insurance Company 31348 x x x x x x xNorthern Claims Management J1923 x x x Rejects OnlyNorthern Colorado School Districts Workers' Compensation Pool 41556 x x x Rejects OnlyNorthern Kentucky University J1943 x x x xNorthwest Insurance J1361 x x x Rejects OnlyNorwood J1089 x x x x xNova Dealership Advantage Program - WC 41556 x x x Rejects OnlyNova Elite Comp Program 41556 x x x Rejects OnlyNova Metals Advantage Plus Program - WC 41556 x x x Rejects OnlyNova Pro Risk Solutions J1056 x x x x x xNuevo Engineering 41556 x x x Rejects OnlyNYSIF 45052 x x Rejects OnlyOak River Insurance Company (Member of BHHC) 20044 x x x x x x x xOhio Casualty Group 24074 x x x xOld Republic Insurance Co 24147 x x x x xOne Beacon 20621 x x x x x x x xOrange County Fire Authority J1876 x x x x

Orchard Supply Company (Bunch CareSolutions) J1962 x x x x

Orchard Supply Company (Bunch CareSolutions) J1962 x x x xOregon State Accident Insurance Fund (SAIF) Corporation J1720 x x x xO'Reilly Auto Parts J1670 x x x xOrica, Inc. J1090 x x x x xOSI Group, LLC J1904 x x x xOutrigger Lodging 41556 x x x Rejects OnlyOverhill Farms, Inc. 41556 x x x Rejects OnlyPacific Coast Building Products J1808 x x x xPacific Compensation Insurance Company J1913 x x x Rejects OnlyPacific Dental Services J1806 x x x xPacific Gas & Electric -115 J1916 x x x Rejects OnlyPacific Hydrotech Co 41556 x x x Rejects OnlyPacific Lumber Company (Marathon) 41556 x x x Rejects Only

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States 1500 UB04 835Pacific Motor Company J1364 x x x Rejects OnlyPacific Specialty Insurance 41556 x x x Rejects OnlyPacific Sunwear J1805 x x x xPajaro Vly Comnty Health Trust 41556 x x x Rejects OnlyPaladin ISL J1827 x x x x xPaladin Managed Care Services, Inc. J1475 x x x xPalo Alto Medical Foundation 41556 x x x Rejects OnlyPapa John's International Inc J1091 x x x x xParadigm J1001 x x x xPark District Risk Management Association (PDRMA) J1365 x x x xPas Coffee Roasters 41556 x x x Rejects OnlyPatterson Bro Light. 41556 x x x Rejects OnlyPeerless J1423 x x x Rejects OnlyPeg Discover Re J1092 x x x x xPeg Discover Re( Foood Merchant) J1054 x x x x xPegasus Risk Management CA J1924 x x x Rejects OnlyPegi-Family Dining J1093 x x x x xPenn Millers Insurance Co J1573 x x x x xPennsylvania Manufacturers' Association Insurance Company 41556 x x x Rejects OnlyPennsylvania Manufacturers Indemnity Company 41556 x x x Rejects OnlyPennsylvania Manufacturing Associates J1439 x x x xPeople 2.0 J1466 x x x xPerformance Contracting Inc J1940 x x x xPerma J1623 x x x xPetaluma Valley Hospital 41556 x x x Rejects OnlyPflugerville ISD 41556 x x x Rejects OnlyPharmacist Mutual Insurance Co. J1570 x x x x xPhh Fleetamerica J1094 x x x x xPier 1 Inc. USA J1369 x x Rejects OnlyPima County 41556 x x x Rejects OnlyPlainview ISD 41556 x x x Rejects OnlyPlott Health Care 41556 x x x Rejects OnlyPoly-America 41556 x x x Rejects OnlyPonderosa Landscape 41556 x x x Rejects OnlyPort of Oakland (CA) J1627 x x x x

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States 1500 UB04 835Prairie Meadows (via EMC Risk Services) J1118 x x x x x xPreferred Employers J1095 x x x x xPreferred Employers Group J1096 x x x x xPreferred Employers Insurance Company (PEI) J1496 x x x xPrime Healthcare J1673 x x x xPrince George's County Government (MD) J1891 x x x xProfessional Claims Management J1821 x x Rejects OnlyProtective Insurance Co J1568 x x x xPrudential Overall Supply - AZ, CA 41556 x x x Rejects OnlyPublix Super Markets, Inc. J1897 x x xQBE - General Casualty - Eden Prairie J1485 x x x x x x xQBE - General Casualty - Farmers Union J1483 x x x x x x xQBE - General Casualty - Freeport J1486 x x x x x x xQBE - General Casualty - Indianapolis J1487 x x x x x x xQBE - General Casualty - Simsbury J1488 x x x x x x xQBE - General Casualty - Sun Prairie J1489 x x x x x x xQBE - General Casualty - West Des Moines J1490 x x x x x x xQBE - General Casualty Co of Wisconsin J1484 x x x x x x xQuality Care Conv 41556 x x x Rejects OnlyQuality Health M. G. 41556 x x x Rejects OnlyQueen of Angels - Hollywood 41556 x x x Rejects OnlyRaley's Family of Fine Stores J1522 x x x xRalph Lauren J1938 x x x xRAM Mutual Insurance Company J1894 x x x Rejects OnlyRampart Insurance Company 38512 x x x x xRamsey County (MN) J1663 x x x xRancho Santiago Community College District (CA) J1635 x x x xRCH Protective - SNCC 41556 x x x Rejects OnlyRecology J1675 x x x xRed Oak Independent School District A0205 x x x x x xRedwood Fire and Casualty Insurance Company (Member of BHHC) 20044 x x x x x x x xRegent Insurance Company - QBE DBA J1484 x x x x x x xRegis Brands J1467 x x x xRehab Center of Beverly Hills 41556 x x x Rejects OnlyRepublic Franklin Insurance 12475 x x x x x x x

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States 1500 UB04 835Republic Indemnity Company of America J1008 x x x Rejects OnlyRepublic Western Ins. Co J1597 x x x x xRescare, Inc. J1376 x x Rejects OnlyResidential Services Group J1097 x x x x xResolute Forest Products J1954 x x x xRestaurant Reinsurance Limited J1098 x x x x xRestoration Prof 41556 x x x Rejects OnlyReturn to Work J1202 x x x xRevMed J1848 x x x xRhone-Poulenc,Inc. J1099 x x x x xRick Concrete Const. 41556 x x x Rejects OnlyRieth-Riley Construction Compa J1100 x x x x xRisk Administration Services J1828 x x x Rejects OnlyRisk Enterprise Management (REM) (SEE TAB) SEE TAB x x x x x x xRisk Transfer Technologies, Inc. J1101 x x x x xRiverport Insurance (MN School Board Association) J1546 x x x xRiverport Insurance Company (Agricultural ONLY) J1477 x x x x x xRobstown ISD 41556 x x x Rejects OnlyRockford Mutual Insurance Company 27065 x x x x xRockwall ISD 41556 x x x Rejects OnlyRose Garden Guest Ho 41556 x x x Rejects OnlyRosewoood Equipment 41556 x x x Rejects OnlyRossi Concrete, Inc 41556 x x x Rejects OnlyRoth Staffing Companies J1516 x x x xRSC Insurance Services, Ltd. J1102 x x x x xRural Special District Insurance Program 41556 x x x Rejects OnlyRyder Services, Inc. J1009 x x x Rejects OnlySA Recycling, LLC J1728 x x x xSafeCo Insurance 24740 x x x xSafety-Kleen Corporation J1103 x x x x xSaint Louis County (MN) J1658 x x x xSalt Lake City Corporation J1730 x x x xSalt Lake City Corporation 41556 x x x Rejects OnlySam Kane Beef Processors, Inc. 41556 x x x Rejects OnlySan Bernardino City Unified School District J1741 x x x x

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States 1500 UB04 835San Bernardino County Superintendent of Schools (CA) J1690 x x x xSan Diego Community College District (CA) J1638 x x x xSan Diego Hospice and The Institute for Palliative Medicine 41556 x x x Rejects OnlySan Diego Metropolitan Transit System 41556 x x x Rejects OnlySan Diego Metropolitan Transit System (SCHIP Liability) 41556 x x x Rejects OnlySan Diego Transit Corp. 41556 x x x Rejects OnlySan Diego Trolley, Inc. 41556 x x x Rejects OnlySan Francisco Municipal Transportation Agency (SFMTA) J1886 x x x xSan Joaquin County 41556 x x x Rejects OnlySanta Clara Co Office Of Educ 41556 x x x Rejects OnlySanta Clara Valley Tansportation Authority J1518 x x x xSchlumberger Technology J1104 x x x x xSchneider Gain 41556 x x x Rejects OnlySchnuck Market, Inc J1560 x x x xSCIF AZ J1538 x x x Rejects OnlyScotts Miracle-Gro Company J1049 x x x x xSeabright (SBIC) J1499 x x x xSECURA Insurance A Mutual Company J1379 x x Rejects OnlySedgwick / Cargill, Inc. J1661 x x x xSedgwick CMS TP097 x x x x x x x xSeeno Construction (Chartis) 41556 x x x Rejects OnlySeeno Homes 41556 x x x Rejects OnlySela Health Care 41556 x x x Rejects OnlySelect Energy Services J1937 x x x xSelect Staffing (Koosharem, Real Time Staffing, Remedy, Select/Remedy & Westaff J1446 x x x xSelective 12572 x x x xSelf-Insured Schools of California (SISC) J1520 x x x xSelman Breitman 41556 x x x Rejects OnlySempra Energy/Employee Care Services J1915 x x x Rejects OnlySentry Insurance J1417 x x x x x x x xService Lloyds Insurance Co J1593 x x x xSFN Group (Spherion, Technisource, Tatum, The Mergis Group, SourceRight Solutions, & Today's Office Professionals J1456 x x x xSharyland Independent School District 41556 x x x Rejects OnlyShaws/StarMarket J1468 x x x x

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States 1500 UB04 835Sierra Nevada Memorial 41556 x x x Rejects OnlySilberberger Engn 41556 x x x Rejects OnlySISCO (RCM&D Self Insured Services Company, Cost Containment Services) J1898 x x x xSKB Corporation 41556 x x x Rejects OnlySmart and Final J1824 x x x Rejects OnlySnap-On Incorporated J1105 x x x x xSolvay America Inc J1106 x x x x xSonic Automotive Inc. J1381 x x Rejects OnlySonoma Valley Healthcare District 41556 x x x Rejects OnlySonoma Valley Hlth 41556 x x x Rejects OnlySouth Coast Area Transit (CA) J1731 x x x xSoutheast Leasing (legal name is Packard Claims Administration, Inc.) J1865 x x xSouthern California Edison J1817 x x x xSouthern California Risk Management J1690 x x x xSouthern Textile Recycling, Inc. (CA) J1648 x x x xSouthwest Airlines (SWA) J1233 x x x x x xSouthwest Gas Corporation 41556 x x x Rejects OnlySpecialty Coffee 41556 x x x Rejects OnlySpooner's Woodworks 41556 x x x Rejects OnlySpringfield Insurance Co. J1922 x x x Rejects OnlySprouts Farmers Market, Inc. J1850 x x x xSt Paul Insurance J1926 x x Rejects OnlySt. Rose Hospital 41556 x x x Rejects OnlyStandard Forwarding (via EMC Risk Services) J1118 x x x x x xStandard Fruit & Veg 41556 x x x Rejects OnlyStanley Steemer International Inc J1939 x x x xStanley Works, Inc. J1385 x x Rejects OnlyStant Corporation J1107 x x x x x

State Auto Mutual Insurance Company J1966 x x x x

State Auto Mutual Insurance Company J1966 x x x xState Compensation Insurance Fund (SCIF) 35076 x x x xState Farm J1548 x x x Rejects OnlyState Fund Mutual J1553 x x x xState of Minnesota - DOER J1555 x x x xState of North Carolina J1659 x x x x

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States 1500 UB04 835State Office of Risk Management J1418 x x x Rejects OnlyStimson Lumber Company - MT, OR, WA 41556 x x x Rejects OnlyStonington C. Club 41556 x x x Rejects OnlySummit Health Ltd J1108 x x x x xSummit Holdings J1437 x x x xSun Mar Healthcare J1610 x x x xSunrise Country Club 41556 x x x Rejects OnlySUNZ Insurance Company J1584 x x x xSuperior Access Ins Services 41556 x x x Rejects OnlySuperior Industries International, Inc. 41556 x x x Rejects OnlySuperior Ready Mix 41556 x x x Rejects OnlySupreme Court of California J1804 x x x x

Sussex Insurance Company (formerly Companion Property & Casualty Insurance) J1829 x x x xSutter Health J1512 x x x xSwift Transportation J1109 x x x x xT.H.E. Insurance J1791 x x x xTan Medical Group 41556 x x x Rejects OnlyTD Tile 41556 x x x Rejects OnlyTechnology Insurance Co J1855 x x x x xTexas A&M A0235 x x x xTexas Association of School Boards A0234 x x x xTexas Builders Insurance Co J1581 x x x xTexas Mutual Insurance 22945 x x x xTexas Mutual League (TML) (SEE TAB) - Employees of IEBP Only A0245 x x x xTexas Political Subdivisions JSIF J1921 x x x Rejects OnlyTexas Roadhouse, Inc. J1676 x x x xTexas Small Business Pool J1110 x x x x xThe Gap, Inc. J1671 x x x x x x x xThe Hartford J1422 x x x xThe Jones Financial Companies, LLP J1846 x x x xThe Main Street America Group / Austin Mutual J1834 x x x xThe Main Street America Group / Grain Dealers Mutual J1835 x x x xThe Main Street America Group / Great Lakes Casualty J1836 x x x xThe Main Street America Group / Main Street America Assurance J1837 x x x x

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States 1500 UB04 835The Main Street America Group / MSA Insurance Protection J1838 x x x xThe Main Street America Group / MSAIC Surplus/Non-Admitted J1839 x x x xThe Main Street America Group / NGM J1840 x x x xThe Main Street America Group / Old Dominion Insurance Company J1841 x x x xThe Main Street America Group / Spring Valley Mutual J1842 x x x xThe Men's Wearhouse, Inc J1615 x x x x

The Mentor Network (Bunch CareSolutions) J1963 x x x x x x x x x x x x x x

The Mentor Network (Bunch CareSolutions) J1963 x x x x x x x x x x x x x xThe Salvation Army J1472 x x x xThe Scotts Company J1111 x x x x xThe Zenith 13269 x x x xTherapy Direct Network J1831 x x x xThomas McGee J1746 x x x Rejects OnlyThomas Staffing Services, Inc/Venturi Staffing 41556 x x x Rejects OnlyTidewater Marine Western J1392 x x x Rejects OnlyTOPA Insurance Company J1537 x x x xTopanga Roscoe Corp. 41556 x x x Rejects OnlyTotal Petroleum, Inc. J1112 x x x x xTower Energy Group J1604 x x x xTown of Colma (CA) J1668 x x x xTractor Supply Company J1505 x x x xTravelers 19046 x x x xTri-City Healthcare District J1905 x x x xTri-City Healthcare District 41556 x x x Rejects OnlyTri-City Linen Suppl 41556 x x x Rejects OnlyTricity Uniform 41556 x x x Rejects OnlyTrillium Staffing Solutions J1674 x x x xTri-State Insurance Company J1477 x x x x x xTucson Unified School Dist WC 41556 x x x Rejects OnlyTyson Foods Inc. J1732 x x x x x xUnderwriters Safety and Claims TP108 x x x x xUnigard Insurance Company - QBE DBA J1484 x x x x x x xUnion Construction Workers' Comp Program J1629 x x x x xUnion Insurance Company J1274 x x x x x x xUnion Insurance Company of Providence 25844 x x x x

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States 1500 UB04 835United Convalescent 41556 x x x Rejects OnlyUnited Dominion Realty Trust J1048 x x x x xUnited Fire J1401 x x x xUnited Heartland J1859 x x x xUnited Self Insured Services - USIS J1851 x x x Reject onlyUnited States Cold Storage J1113 x x x x xUnited States Fire Insurance Company 31348 x x x x x x xUnited Wisconsin Insurance Company J1235 x x x Rejects OnlyUniversity of Colorado 41556 x x x Rejects OnlyUniversity of Kentucky Health Services J1941 x x x xUS Foodservice, Inc. J1114 x x x x xUS Mobile Wireless 41556 x x x Rejects OnlyUS National Resources (Aigrm) J1115 x x x x xUS Sugar Corporation J1950 x x x xUtica Mutual Insurance Co 25976 x x x xUtica National Insurance Co of Texas 43478 x x x xV&M Restoration 41556 x x x Rejects OnlyValenzuela Eng. Inc 41556 x x x Rejects OnlyValley Casework Inc 41556 x x x Rejects OnlyValley Harvesting & Packing, Inc. 41556 x x x Rejects OnlyValley Health Care Management Services, LLC 41556 x x x Rejects OnlyValley Health System 41556 x x x Rejects OnlyValley Memorial Hospital 41556 x x x Rejects OnlyValley Mills ISD J1873 x x x Rejects OnlyVanliners Insurance Company 21172 x x x xVenture Pac Develop 41556 x x x Rejects OnlyVermeer (via EMC Risk Services) J1118 x x x x x xVertical Concrete 41556 x x x Rejects OnlyVicorp Restaurants, Inc. J1116 x x x x xVictor Plastics (via EMC Risk Services) J1118 x x x x x xVictoria ISD 41556 x x x Rejects OnlyVirginia Surety Company, Inc. J1404 x x x Rejects OnlyVista Hills C Club 41556 x x x Rejects OnlyVons / Safeway J1750 x x x x x x x x xVought Aircraft Industries J1405 x x Rejects Only

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States 1500 UB04 835W Co Radiology Cntr 41556 x x x Rejects OnlyWal-Mart J1004 x x x Rejects OnlyWashington County 41556 x x x Rejects OnlyWashington Hospital 41556 x x x Rejects OnlyWatkins Manufacturing Corporation 41556 x x x Rejects OnlyWATTSHealth Foundation, Inc. (SNCC) 41556 x x x Rejects OnlyWawona Packing 41556 x x x Rejects Only

WE Energies J1406 x x x x x

WE Energies J1406 x x x x xWerner Enterprises J1856 x x x Rejects OnlyWesco Insurance Company J1857 x x x x x Rejects OnlyWeslaco Independent School District 41556 x x x Rejects OnlyWest Coast Hospitals, Inc. 41556 x x x Rejects OnlyWest Oso ISD 41556 x x x Rejects OnlyWest Texas Rural Counties Association Preferred Risk Pool - WC 41556 x x x Rejects OnlyWestamerica/Phil Long Dealerships 41556 x x x Rejects OnlyWestern National Assurance J1569 x x x xWestern National Insurance \ Pioneer Specialties J1586 x x x xWestern National Insurance Group J1495 x x x xWestfield Insurance J1858 x x x Rejects OnlyWestGUARD Insurance Company - Guard DBA J1453 x x x xWillamette View 41556 x x x Rejects OnlyWilliams & Sonoma J1473 x x x xWilmer-Hutchins ISD/Dallas ISD 41556 x x x Rejects OnlyWilson Mutual Insurance (All States EXCEPT WI/MN) J1893 x x x xWilson Mutual Insurance (MN/WI ONLY) J1407 x x x x xWoodland Park West 41556 x x x Rejects OnlyWorldcom Inc J1874 x x x Rejects OnlyWyman-Gordon Companies J1117 x x x x xXcel Energy J1628 x x x x xXchanging, Inc J1412 x x x Rejects Onlyxl Environmental, Inc. J1055 x x x x xYMCA 41556 x x x Rejects OnlyYork Claim Services J1421 x x x Rejects OnlyZachry Construction J1409 x x Rejects OnlyZ-Nat Insurance (Zenith National) 30120 x x x xZurich Farmers J1015 x x x x x x x x x xZurich Insurance N.A. 16535 x x x x x x x x x x

workers' compensation payer list 11/03/15 all payer id tx ... · allmerica financial benefits...

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