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eClaims Dental Payer List Information
Payer IDs are required to send your claims electronically. When you add a new insurance company in your system,
please use this payer list to find the Insurance Company’s Payer ID.
• Payer IDs can be entered by going to List|Insurance Companies|Edit the Insurance Company and enter the payer
ID number in the ‘Claim Payer Id field’
• If you are working with Blue Cross/Blue Shield or Medicaid you will also need to update the payment source
accordingly
Payer List Includes: Commercial Payers – Pages 1-15
Blue Cross Blue Shield Payers – Pages 15-17
Delta Dental Payers – Page 17-18
Medicaid Payers – Pages 18-19
Payer ID 06126: Use this eClaims payer id for those insurance companies that are not listed on
this eClaims Payer List
Group Number Column: Yes = the payer requires the group number
No = the group number is optional
Enroll Column: This column indicates whether or not the payer requires enrollment prior to
accepting your claims electronically
Yes = Payer requires enrollment please do the following for these payers:
1. Within EagleSoft go to Online|FAQ
2. Under the Search by Keyword field type 4400
3. Click on the eClaims Additional Enrollment Paperwork
No = No paperwork is required
Real Time Claims: Y = Payer participates in Real Time Claims
Know what insurance companies will pay on the rendered services within
seconds and know the patient portion while the patient is still at the office.
Real Time Pre Estimates: Y = Payer participates in Real Time Pre Estimates
Additional Information Column: This column includes important information specific to the insurance
companies.
Obtaining Current Payer List: Recommended every 2-3 months
1. Go to Online|FAQ or pattfaq.com
2. Under the Search by Keyword field type 2453
3. Click on eClaims Payer List and Payer List Changes
For additional questions, please contact the eServices Support Team by using Live Chat, Help|Live Help,
or calling 800-475-5036.
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
A & I Benefit Plan Administrators 93044 Yes No
A.D.N. Administrators, Inc. CXADN Yes No
AARP AARP1 Yes NoAARP Claims with a mailing address of PO Box
2059, Mechanicsburg, PA
Acceptius (Benefit Management Inc of
MO (BMI)43178 Yes No
Access Dental CX097 Yes No via Performance Health Technology
Acclaims 64071 Yes No
ACS Benefit Services Inc. 72468 Yes No f.k.a. ACS Consulting Services, Inc.
Activa Benefit Services, LLC/Dental 38255 Yes No (Formerly Amway Corporation/Dental)
Administrative Services, Inc. 59141 Yes No
Administrative Services Only, Inc. CX076 Yes No
Additional enrollment is not required by the payer,
however, providers wishing to submit Claims
electronically must be credentialed with the payer.
Please ensure you have successfully process one
paper Claims with the payer prior to submitting
your first electronic Claims.
Advantage by Superior CPPSA Yes Yes
Effective only for Dates of Service prior to 2-01-
13. Call DentaQuest at 800-896-2374 and MCNA
Dental at 855-776-6262 for Dates of Service 2-1-
13 and greater.
Advantage Dental Plan, Inc. 93524 No No
Advantek Benefit Administrators 83077 Yes No
Advantica Benefits 43168 Yes No Y Y
Aetna 60054 Yes No
Aetna Affordable Health Choices (SM) -
SRC57604 Yes No
Aetna Medicare EPO/PPO Dental 18014 Yes No
Affordable Benefits Admin. 95426 Yes No
AFLAC GA - GRP 58066 Yes NoGroup Plan coverage please refer to your ID card
for group coverage/number verification.
AFLAC NY 52080 Yes No
This plan also shares the same mailing address
as payer ID 58066 and the only difference
between the plans is that the insured ID for the
NY based plan begins with "PN" as "PNxxxxxx"
(followed by 6+ digits)
AFLAC NY - GRP 52080 Yes NoGroup Plan Coverage please refer to your ID card
for group coverage/number verification.
AGC International Union of Operating
Engineers Local 70191136 Yes No
Please enter group # F07 when submitting claims.
A Welfare and Pension Administration Services
payer
AK United Food and Commercial
Workers (AK UFCW)91136 Yes No
Please enter group # F45 when submitting claims.
A Welfare and Pension Administration Services
payer
Alask Carpenters 91136 Yes No
Please enter group # F40 when submitting claims.
A Welfare and Pension Administration Services
payer
Alaska Electrical Health & Welfare
Fund92600 Yes No
Alaska Hotel Employees, Restaurant &
Camp Employees (AK HERE)91136 Yes No
Please enter group # F41 when submitting claims.
A Welfare and Pension Administration Services
payer
Alaska Laborers Construction Industry
Health & Security Trust91136 Yes No
Please enter group # F23 when submitting claims.
A Welfare and Pension Administration Services
payer
Alaska Machinists Health and Welfare
Trust91136 Yes No
Please enter group # F21 when submitting claims.
A Welfare and Pension Administration Services
payer
Alaska Pipe Trades U A Local 375 91136 Yes No
Please enter group # F24 when submitting claims.
A Welfare and Pension Administration Services
payer
Alaska Public Employees Association
(APEA/JESS Health & WelfareTrust)91136 Yes No
Please enter group # F60 when submitting claims.
A Welfare and Pension Administration Services
payer
For an updated payer list please visit our website www.eaglesoft.net
Page 1
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
Alexian Brothers Community Services
of TN44423 Yes No
AllCare CCO Dental CXALC Yes No via Performance Health Technology
Allegeant 52193 Yes No f.k.a. LBA Health Plans
Allegiance Benefit Plan 81040 Yes No
Alliant Services 70106 Yes NoClaims mailing address of PO Box 12009,
Cheshire, CT
Allied Benefit Systems 37308 Yes No
Allied Metal Crafts Security Plan Trust
Fund91136 Yes No
Please enter group # F18 when submitting claims.
A Welfare and Pension Administration Services
payer
Allina Health Plan 54398 No
AlwaysCare Benefit STR01 No
Amalgamated Life - PA Alicare 13343 Yes No
Ameraplan 38219 Yes No
Ameriben Solutions 75137 Yes No
American Administrators dba Select
Benefit Administrators (West Des
Moines, IA)
42137 Yes No
Please check the Insured ID card to verify the
Payer ID before submitting claims. If you have
questions, please contact Provider Relations at
800-456-4584.
American Benefit Corporation CX084 Yes No
Only limited plans may be sent electronically.
Group name is required with one of the following
plan names: Sheet Metal, Berekely, Boone,
Carpenter, Cabell, Clarksbur, Doodridge,
Hancock, Harrison, Marion, Monongalia, Mingo,
Mineral, Morgan, Nicholas, Putnam, Taylor, Tyler,
Wetzel.
American Medical Security CX001 Yes No A United Healthcare Payer
American Postal Workers Union Health
Plan44444 Yes No
Americas TPA 41178 Yes No
Amerihealth Administrators 54763 Yes No
Ameritas Life Insurance Corp. 47009 Yes No
Ameritas Life insurance Corp. of New
York72630 Yes No
Amway Corporation 38255 Yes No (Formerly Amway Corporation/Dental)
Anchor Benefit 53085 Yes No
Antares Management Solutions 34192 No No
Apostrophe, Inc. 81312 Yes No
ARC Administrators CXARC Yes No
Argus Dental Plans, Inc. ARGUS Yes No
Arkansas Superior Direct 61184 Yes No
ASR Corporation 38265 Yes No
Association Benefit Plan 25133 Yes No
Formerly payer ID 62413. Now part of Coventry
Consolidate payer ID. Including Combined
Government Health Plan & Contract Health
Insurance Plan.
Assurant Employee Benefits 70408 Yes No PO Box 2877, Clinton, IA 52733
Assurant, Inc, 70408 Yes No PO Box 2877, Clinton, IA 52733
Asuris 93221 Yes No
Atlantic Dental Inc. (ADI) - Commercial CX085 Yes No
Automated Benefit Services 38259 Yes No
Automated Group Administration, Inc.
(AGA)37280 Yes No
Avesis 86098 Yes No
Banner Health Systems SX145 Yes No
Banner Plan Administration 77078 Yes No
BARINet CB369 Yes No
BCI Administrators, Inc. 49153 Yes No
Beam BEAM1 Yes No
Beam CXBMD Yes No
Beam Dental CXBMD Yes No
Beam Ins Admin BEAM1 Yes No
Beam Ins Admin CXBMD Yes No
Beam Ins. BEAM1 Yes No
Beam Ins. CXBMD Yes No
Beam Insurance BEAM1 Yes No
Beam Insurance CXBMD Yes No
Beam Insurance Ad BEAM1 Yes No
For an updated payer list please visit our website www.eaglesoft.net
Page 2
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
Beam Insurance Ad CXBMD Yes No
Beam Insurance Admin BEAM1 Yes No
Beam Insurance Admin CXBMD Yes No
Beam Insurance Administrator BEAM1 Yes No
Beam Insurance Administrator CXBMD Yes No
BEAM Insurance administrators BEAM1 Yes No
Beam Insurance Administrators BEAM1 Yes No
Bell Atlantic 68241 Yes No
BeneCare Dental Plans 23210 Yes No
Benefit Administrative Systems 36149 Yes No
Benefit Coordinators Corporation
(Pittsburgh, PA)25145 Yes No
Payer ID valid only for Claims with a submission
address of 111 Ryan Court, Suite 300, Pittsburgh,
PA 15205.
Benefit Inc. R7003 No No
Benefit Management Group NV 36459 Yes No
Benefit Management Services of MS 37212 Yes No
Benefit Management Services, Inc. 56139 Yes No
Benefit Management, Inc. of KS 48611 Yes No
Benefit Plan Administrators Co. (Eau
Claire, WI)39081 Yes No
Payer ID valid for Benefit Plan Administrators
(Eau Claire, WI submission address only) and
Custom Benefit Administrators
BIA CXBMD Yes No
BIA / Beam CXBMD Yes No
Blue BeneFit Administrators of MA 03036 Yes No a.k.a. CBA Blue
Blue Care Family Plan GWD01 No No Administered by Golden West (Well point)
Boilermakers National Health & Welfare
Fund36609 Yes No
Boon Administrative Services, Inc. BOONG Yes No
BridgeSpan Health (Regence Group) BRIDG Yes No
Brokers National CX032 Yes No
Broward Health 37314 Yes No
Butler Benefits 42150 Yes No
C. L. Frates CX075 Yes No
California State Government Programs CPPCA Yes No
Cannon Cochran Management
Services, Inc. Metairie, LA71057 Yes No
Payer ID for claims with a mailing address of PO
Box 6794, Metairie, LA 70009
Capitol Dental CX095 Yes No via Performance Health Technology
CareFirst, Inc. Maryland BCBS 00580 Yes No
Careington Benefit Solutions 60601 Yes No
CareOregon 93975 Yes No
Caresource GA GACS1 Yes No
Caresource IN INCS1 Yes No
Caresource KY KYCS1 Yes No
Caresource WV WVCS1 Yes No
Carolina Summit Healthcare 56195 Yes No
Carpenters Health and Welfare Fund of
PhiladelphiaCX101 Yes No
Cascade Health Alliance, Inc. CHA01 Yes No
Caterpillar Inc. 37060 Yes No A United Healthcare Payer
CBA Blue 03036 Yes No f.k.a. Comprehensive Benefits Administrators, Inc.
CCEA Teachers Health Trust 88019 Yes No
CDO Technologies 83028 Yes No
CDS Group Health 88022 Yes No
Cement Masons and Plasterers Health
& Welfare Trust91136 Yes No
Please enter group # F16 when submitting claims.
A Welfare and Pension Administration Services
payer
Central Reserve Life 34097 Yes NoOnly Non Medicare Supplement and Dental lines
of business administered under this payer ID.
Central States Health and Welfare
Fund36215 Yes No
Central Susquehanna Healthcare
Providers (CSHP)55731 Yes No An Innovative Healthware Services Payer.
For an updated payer list please visit our website www.eaglesoft.net
Page 3
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
CHAMPVA - HAC 84147 Yes No
CHAMPVA - HAC is not associated with and does
not process Claims for TRICARE (formerly
CHAMPUS)
Chesterfield Resources, Inc.
(Uniontown, OH)34154 Yes No a.k.a. Salvation Army
Chewsi First Circle Solution / DD RI RICHW Yes nO Y Y
Choice Plus (TRW) 68241 Yes No
Christian Brothers Services 38308 Yes No
CIGNA 62308 Yes No
Citizens Security Life CX071 Yes No
Civil Service Employees Association
(CSEA)CX054 Yes No
Provider ID number required. Max of 50 procedure
lines per Claims. ID number must be 5 characters
in length, numbers 6 in length & ending with a '1'
are accepted when '1' is removed. Numbers with
leading zeros will have leading zeros omitted. ID
numbers cannot contain an "-".
ClaimsBridge HPN 11752 Yes No
Community Health Alliance of TN 27905 Yes No
Community Health Electronic
Claims/CHEC/webTPA75261 Yes No
Companion Life / KHP 37322 Yes No
CompBenefits CX021 Yes No
Comprehensive Healthcare options CHCP1 No
CompuSys / Erisa Group, Inc. 74234 No
Comsumers Choice Health Plan - State
of SC45321 Yes No
Connecticut Carpenters Health Fund 37307 Yes No
Connecticut General (CIGNA) 62308 Yes No
Consolidated Group Dental 61305 Yes No
Continental Benefits 35245 Yes No
Core Management Resources Group 58231 Yes No
Core V 60601 Yes No
CoreSource AZ MN 41045 Yes No
Only for Claims where the "submit Claims to
address" on the medical ID card is a CoreSource
address in the states of Arizona or Minnesota. For
assistance call 800-698-0106.
CoreSource Detroit 38225 Yes No
CoreSource KC 48117 Yes No f.k.a. FMH Benefit Services, Inc.
CoreSource Little Rock 75136 Yes No
CoreSource MD PA IL 35182 Yes No
Only for Claims where the "submit Claims to
address" on the medical ID card is a CoreSource
address in the states of Maryland, Pennsylvania
or Illinois. For assistance call 800-689-0106.
CoreSource NC IN 35180 Yes No
Only for Claims where the "submit Claims to
address" on the medical ID card is a CoreSource
address in the states of North Carolina or Indiana.
For assistance call 800-689-0106.
CoreSource OH 35183 Yes No
CoreStar 41045 Yes No
Only for Claims where the "submit Claims to
address" on the medical ID card is a CoreSource
address in the states of Arizona or Minnesota. For
assistance call 800-698-0106.
Covenant Administrators, Inc. (Atlanta,
GA)58102 Yes No f.k.a. Benesys, Inc.
Coventry Dental CX049 Yes No
Coventry Health Care 25133 Yes No West Virginia Only
Coventry Health Care Carelink 25133 Yes No West Virginia Only
Coventry Health Care Carelink
Medicaid25133 Yes No West Virginia Only
Coventry Health Care National Network 25133 Yes NoFormerly payer ID 87043. Now part of Coventry
Consolidated payer ID.
Coventry Health Care of Georgia 25148 Yes No
For an updated payer list please visit our website www.eaglesoft.net
Page 4
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
Coventry Missouri 25133 Yes NoFormerly payer ID 87043. Now part of Coventry
Consolidated payer ID.
CoventryCares 86098 Yes NoKentucky Medicaid CoventryCares administered
by Avesis
Creative Plan Administrators 37320 No No
Crescent Dental - Meritain Health CX074 Yes No
Crescent Health Solution 56213 Yes No
CTI Administrators 42141 Yes No
CustomCare 68241 Yes No
Cypress Ancillary Benefits TLZ04 Yes No
Dart Management Corp. 06172 Yes No
DeCare Dental Health Insurance 07035 Yes No
Denex Dental CX049 Yes No
Dental Care Plus CX035 Yes No
Dental Health Services of America CX094 Yes No
Dental Network of MD CX034 Yes No
Dental Professionals of Wisconsin 39148 Yes No
f.k.a. Southeast Dental Associates. Effective 7-1-
14 payer name must be listed as DPOW-CCHP
OR DPOW-ANTHEM OR DPOW-ICA
Dental Select CX093 Yes No
Dentist Direct UTUDD No
Dentaquest Commercial Plans (Group
and Individual)04356 No No
Dentegra 88888 No
Deseret Mutual Benefit Administrators CX089 Yes Yes
DH Evans CX065 Yes No An Innovative Healthware Services Payer.
Diversified Administration Corporation CX040 Yes No
Downstream Casino 19191 Yes No
DQ/Emblem (Emblem Health Medicaid) EMBDQ No No
Dunn & Associates Benefits
Administrators, Inc.35186 Yes No
EBC, Inc. 37257 No No
Payer Id valid only for Claims with a billing
submission address of Employee Benefit
Consultants, located in Broadview Hts, OH,
Appleton, WI, Albuquerque, NM, Findlay, OH,
Louisville, KY and Milwaukee, WI
EBMC CX025 Yes No
EBMS (Employee Benefit Management
Services, Inc.)81039 Yes No
EBS - RMSCO EBSRM Yes No
EBS Benefit Solutions CX043 No No
EHI 73288 Yes No
Emblem Health (GHI - New York Group
Health Inc.)13551 Yes No
EMI Health CX079 Yes No
f.k.a. Educators Mutual Insurance Association.
Prior to accepting claims electronically EMIA
requires the provider to call 801-262-7476 or 800-
662-5850. Providers should advise EMIA that
they will be submitting their claims through
Change Healthcare Business Services, Inc. UHIN
submitter ID HT000214-001.
EMPHESYS 73288 Yes No
Employee Benefit Concepts
(Farmington Hills, MI)38241 Yes No
Employee Benefit Consultants 37257 No No
Payer Id valid only for Claims with a billing
submission address of Employee Benefit
Consultants, located in Broadview Hts, OH,
Appleton, WI, Albuquerque, NM, Findlay, OH,
Louisville, KY and Milwaukee, WI
Employee Benefit Management Corp
(EBMC)CX025 Yes No
Employee Benefits Plan Administration,
Inc. (E.B.P.A.)03036 Yes No a.k.a. CBA Blue
Employee Benefits Systems of IA 42149 Yes No
Employee Plans, LLC 35112 Yes No
For an updated payer list please visit our website www.eaglesoft.net
Page 5
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
Employer Plan Services, Inc. CX031 Yes No
Employers Direct Health 75232 Yes No
Employers Health 73288 Yes No
Employers Health Insurance 73288 Yes No
Employers Mutual, Inc. 59297 Yes No
Encara WDENC Yes No
Envolve Health 46278 Yes No f.k.a. Dental Health & Wellness
EPSI Dental II CX037 Yes No f.k.a. Capital Dental
EQUICOR 62308 Yes No
ES Beveridge and Associates 34108 Yes No An Innovative Healthware Services Payer.
E-V Benefits Management, Inc
(Columbus, OH)34159 Yes No
Everence 35605 Yes No
Evergreen Health Co-Op 93240 No
ExclusiCare 71412 Yes No
Fairbanks North Star Borough 91136 Yes No
Please enter group # F62 when submitting claims.
A Welfare and Pension Administration Services
payer
Fairbanks North Star Borough School
District Plan A (FNSBSD)91136 Yes No
Please enter group # F62 when submitting claims.
A Welfare and Pension Administration Services
payer
Fairbanks North Star Borough School
District Plan B (FNSBSD)91136 Yes No
Please enter group # F62 when submitting claims.
A Welfare and Pension Administration Services
payer
Fidelio Dental Insurance Company FDIC1 Yes No
fidelity / Key Select 37321 Yes No
First Continental Life & Accident
InsuranceCX090 Yes No
First Dental Health / BIA CXBMD Yes No
First Dental Health of CA CX086 Yes No
First Reliance Standard Life Ins. Co.
(NY Business)13317 Yes No
FL MCO PHC/PHP 95411 Yes No
Flex Compensation R7004 Yes No
FlexCare 68241 Yes No
Florida Combined Life CBFLU No
Florida Power & Light 68241 Yes No
Foreign Service Benefit Plan 25133 Yes No
Formerly payer ID 62413. Now part of Coventry
Consolidated payer ID. Including AFSPA Staff
Plan.
Formula Card Dental LX050 Yes No
Foundation Benefit Admin (FBA) - Boon
GroupBOONG Yes No
Fox Everett, Inc. 64069 Yes No
Fraternal Order of Police - Dental
Division (Philadelphia, PA)CX041 No No
Fringe Benefits Coordinators 59204 Yes No
GDS CX036 Yes
Gettysburg CX064 Yes No An Innovative Healthware Services Payer.
GIC Indemnity Plan 80314 Yes No
Gilsbar, Inc. 07205 Yes No
Golden West Dental GWD01 No No
Government Employees Health
Association44054 Yes No
Government Employees Hospital
Association (GEHA)57254 Yes No
Great-West Healthcare 63665 Yes No f.k.a. General American
Great-West Healthcare 80705 Yes No
Group Administrators Ltd. 36338 Yes No
Group and Pension Administrators 48143 Yes No
Group Benefit Administrators 72153
Group Health Coop (Individual &
Family, and Small Business Groups)89070 Yes No Administered by United Concordia
Group Insurance Service Center, Inc 37276 Yes No
Group Link of Indiana CX015 Yes No
Guaranty (DINA) CX090 Yes No
Guardian Life Insurance Company of
America64246 Yes No
For an updated payer list please visit our website www.eaglesoft.net
Page 6
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
Hamaspik Choice 47738 No
Harrington Health Colonial Dental 59143 No
Hawaii - Mainland Administrators 86066 No
Hawaii Medical Service Association
(HMSA)HMSA1 Yes No
Federal Employee claims cannot be sent
electronically
HCS - Health Claims Service (Boise,
ID)82018 Yes No
Healthchoice OK 71064 Yes No
Health Choice Arizona 62179 Yes No
Health Choice Insurance 46221 Yes No
Health Choice Integrated Care 22100 Yes No
Health Economics Group, Inc. CX039 No No
Health Partners - Jackson, TN 62157 Yes No
Health Plan Services 59140 Yes No
Health Plans Inc. CX055 Yes No
Health Resources Incorporated (HRI) CX019 Yes No
Healthcare Management
Administrators, Inc.HMA01 Yes No
The insured ID number is required. Maximum of
25 procedure lines per Claims. Secondary Claims
cannot be sent electronically. Claims remarks
exceeding 80 bytes in length cannot be sent
electronically.
Healthcomp, Inc. 85729 Yes No
HealthE Exchange Inc. 20356 Yes No
HealthEZ 41178 Yes No
Healthgram, Inc. 56144 Yes No
Healthgram, Inc. 56144 Yes No f.k.a. Primary Physician Care
HealthPartners MN CX009 Yes
MN HealthPartners MN CX010 Yes
Healthplex, Inc. 11271 Yes No
HealthSCOPE Benefits, Inc.(Formerly
CNA Health Partners of Arkansas)71063 Yes No
HealthSmart Benefit Solutions 37272 Yes Nof.k.a. Wells Fargo TPA, Inc., Newnan GA and
Fayetteville, NC
HealthSmart Benefit Solutions 37283 Yes No
HealthSmart Benefit Solutions 87815 Yes No f.k.a. Wells Fargo, TPA, Inc., Charleston, WV
HealthTrans 31172 Yes No a.k.a. Innovante Benefit Administrators
Healthy Michigan Dental HMD01 No No
Ho-Chunk Nation Department of Health 6251 No No
Hometown Health Plans Nevada 88023 Yes No
Hoosier Dental (in Indianapolis,
Indiana)CX015 Yes No
Hotel Employees Restaurant
Employees Health Trust (HERE)91136 Yes No
Please enter group # F19 when submitting claims.
A Welfare and Pension Administration Services
payer
HSBS Memphis 37224 Yes No f.k.a. Pittman & Associates
HSBS Oklahoma City 37256 Yes No f.k.a. Mutual Assurance Administrators
Humana 73288 Yes No
Humana, Inc. 61101 Yes No
I. E. Shaffer (West Trenton, NJ) 22175 Yes No
IBT - Local 145 Health Service & Ins
PlanCXIBT Yes No
Only for claims with date of service prior to 1-1-16.
Dates of service greater than 12-31-15 should be
sent using payer ID 60054.
iCircle Care of NY 33884 Yes No
IMCare 41600 Yes No f.k.a Itasca Medical Care
Indiana Teamsters Health Benefits
Fund (Indianapolis, IN)35107 Yes No
Formerly known as Local 135 Health Benefits
Fund (Indianapolis, IN)
Inetico 43471 Yes No An Innovative Healthware Services Payer.
Innovante Benefit Administrators 31172 Yes No a.k.a. HealthTrans
Innovation Health 40025 Yes No
Insurance Administrators of America 37279 Yes No
Insurance Design Administrators 13315 Yes No
Insurance Management Services 15688 Yes No
Insurance Systems Inc. 74385 Yes No
Insurers Administrative Corp. 86304 Yes NoPlease visit website prior to submitting Claims:
edihelp.iacusa.com
For an updated payer list please visit our website www.eaglesoft.net
Page 7
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
Integra Administrative Group (Seaford,
DE)51020 Yes No
Payer ID valid only for Claims with a billing
submission address of 110 S. Shipley Street,
Seaford, DE 19973.
International Brotherhood of
Boilermakers36609 Yes No
Jensen Administrative Services, Inc. CXJAS Yes No
John Morrell Company - AHBPA 38310 Yes No
Joint Benefit Trust CHSJT Yes NoAdministered by Health Services Benefit
Administrators, Inc. (HSBA)
JP Farley Corporation 34136 Yes No
Payer ID valid only for Claims with a billing
submission address of PO Box 458022, Westlake,
OH 44145
Kaiser CX073 Yes No
Kalos Gold Health Plan 61185 Yes No
Kalos Health 40137 Yes No
Kanawha Insurance Co. 57038 Yes No
Keenan Associates 95279 No No
Kemper Benefits 61453 Yes No
Kempton Company 73100 Yes No
Kempton Group Administrators 73100 Yes No
Kentucky Health Co-Op 77894 Yes No
Kentucky Spirit 65030 Yes NoKentucky Medicaid Kentucky Spirit administered
by MCNA
Key Solutions 37323 Yes No
Klais & Company 34145 Yes No
LA BCBS AdvantagePlus Network 53021 Yes No Administered by United Concordia
Land of Lincoln 90096 Yes No
Level LEVEL No
Life Gift Cards 33LGC Yes No
Life Insurance Company of Boston &
New York78140 Yes No
LifeMap Assurance Company RLH01 Yes No
Lifestyle Dental 27005 Yes No
Lifewise Health Plan of Oregon 93093 Yes No
Lincoln Financial Group CX061 Yes No f.k.a. Jefferson Pilot
Lincoln National (WI) 73288 Yes No
Line Construction Benefit Fund LCB01 Yes No
Local 135 Health Benefits Fund
(Indianapolis, IN)35107 Yes No
Local 17 Fund - International
Association of Heat and Frost
Insulators
IAHFI No
Locals 302 & 612 of the Internation
Union of Operating Engineers91136 Yes No
Please enter group # F12 when submitting claims.
A Welfare and Pension Administration Services
payer
Lockard & Williams CB752 Yes No
Mail Handlers Benefit Plan 25133 Yes No
Formerly payer ID 62413. Now part of Coventry
Consolidated payer ID. Including AFSPA Staff
Plan.
MAMSI CX033 No No
Managed Care Services, LLC 35162 No
Managed Dental Guard GI813 Yes NoOnly for the individual marketplace, not for
Group/SHOP business
MAPFRE PRFRE Yes No
Masonry Institute/Administrative D.C.
No. 1 Welfare FundCX098 Yes No
Mayo Clinic Health Solutions 41154 Yes No
MBA Benefit Administrators, Inc. (Salt
Lake City, UT)83028 Yes No
MBA of Wyoming (Worland, WY) 87065 Yes No
McGregor PACE 31149 Yes No
MCNA Dental 65030 Yes No
Med3000 CMS Safety Net EM284 Yes No
Med3000 CMS Title 19 Reform EM843 Yes No
MED3000 CMS Title 21 EM205 Yes No
For an updated payer list please visit our website www.eaglesoft.net
Page 8
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
MEDICA of Minnesota CX026 Yes No
Medical Associate Health Plan
(HEALTH CHOICES)MAHC1 Yes No
Medical Benefits Mutual Administrators
(MedBen)74323 Yes No
Medical Card System (MCS) PRMCS Yes No
Medical Mutual of Ohio 29076 Yes No
Medical Mutual of Ohio CB833 Yes No
Medico Insurance Company 23160 No
Only for Policy Numbers that begin with 000M1D
and claims mailed to PO Box 21660, Eagan, MN
55121
Mercy Care Plan 86052 Yes No
Mercy Maricopa Integrated Care 33628 Yes No
Meritain Health 38232 Yes No f.k.a. Weyco
Meritain Health Minneapolis 41124 Yes No f.k.a. CBSA
Methodist First Choice 23550 Yes No
MetLife 65978 Yes No
Michigan Regional Council of
Carpenters Employees Benefit Plan 38238 Yes No
Michigan UFCW 27401 Yes No
Mid-America Associates, Inc. 37281 Yes No
Mid-American Benefits 22823 Yes No An Innovative Healthware Services Payer.
Midwest Dental Benefits 41101 Yes No
Momentum Insurance Plan 31415 Yes No
Morris Associates 35092 Yes No
Motorola 36111 Yes No
Mountain States Administrative
Services (Tucson, AZ)86040 Yes No
MPEEBT/ MPE Services, Inc. 37233 Yes No
MSA CareGuard 20572 Yes No
MultiFlex Dental (Merchants Benefit) MBAAZ Yes No
Municipal Health Benefit Fund 81883 Yes No
Mutual of Omaha Commercial CX087 Yes No
Mutual of Omaha Insurance Company 71412 Yes No
Mutually Preferred 71412 Yes No
MyDecision 18840 No No
NAA (North America Administrators,
L.P.) (Nashville, TN)65085 Yes No
NABN (Cleveland, OH) 34159 Yes No
Payer ID valid only for Claims with billing
submission address of P.O. Box 94928,
Cleveland, OH 44101-4928 or P.O. Box 89476,
Cleveland, OH 44101-5476.
NAPHCARE, Inc. 58182 No No
National Elevator Industry Benefit Plan
(NEIB)CX045 Yes No
National Pacific of TX (NCFLEX) CX057 Yes No A United Healthcare Payer
National Rural Letter Carrier
Association71412 Yes No
National Telecommunications
Cooperative Association52120 Yes No
Nationwide Employee Benefits 314RV Yes No
Nationwide Health Plans 31417 Yes No
Native Care Health 19191 Yes No
NCAS - Charlotte 75191 Yes No
NCAS - Fairfax, VA 75190 Yes No
Netcare Life and Health Insurance
(NLH) 66055 Yes No
Nevad Dental Benefits NDB01 Yes No
Nevada Health Co-Op 90091 Yes No
New England Dental Administrators 43351 Yes No
Nippon Life Insurance Company of
America81264 Yes No
NNEBT (Northern New England Benefit
Trust)38238 Yes No
For an updated payer list please visit our website www.eaglesoft.net
Page 9
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
North American Benefits Network
((Cleveland, OH)34159 Yes No
Payer ID valid only for Claims with billing
submission address of P.O. Box 94928,
Cleveland, OH 44101-4928 or P.O. Box 89476,
Cleveland, OH 44101-5476.
North Broward Hospital District 37314 Yes No
Northern California Pipe Trades Trust
FundsCX099 Yes No
For Dates of Service beginning 1-1-15 please use
payer ID 77777.
Northern Illinois Health Plan 36347 Yes No
Northern Minnesota Dental LX062 Yes No
Northern Nevada Trust Fund 88027 Yes No
Please call (775) 826-7200 to verify if you should
be sending claims to Northern Nevada Trust
Fund.
NorthShore University Health System
Medical Group36364 Yes No
Northwest Dental Services 93525 No No
Northwest Ironworkers Health &
Security Fund91136 Yes No
Please enter group # F15 when submitting claims.
A Welfare and Pension Administration Services
payer
Northwest Roofers & Employers Health
& Security Trust Fund91136 Yes No
Please enter group # F26 when submitting claims.
A Welfare and Pension Administration Services
payer
Northwest Suburban IPA 36346 Yes No
Northwest Textile Processors and
Service Trades91136 Yes No
Please enter group # F14 when submitting claims.
A Welfare and Pension Administration Services
payer
Nova Healthcare Administrators, Inc.
(Grand Island, NY)16644 Yes No
NW International Association of
Machinists (NW IAM)91136 Yes No
Please enter group # F39 when submitting claims.
A Welfare and Pension Administration Services
payer
NW Plumbers & Pipefitters Health &
Welfare Trust91136 Yes No
Please enter group # F31 when submitting claims.
A Welfare and Pension Administration Services
payer
Nyhart 37299 Yes No
OH Dental / UHC Dental Government
ProgramsGP133 Yes No f.k.a. Optum Specialty Svcs / Americhoice of NJ
Ohio AFSCME Care Plan AFSOH No
OK DRS DOC 71065 Yes No
Ohio Dept of Corrections (Careworks) J1410 Yes No
OK State Employees & Educators
(EDS)22521 Yes No
Olympus Managed Health Care 65074 Yes No
PA Faculty Health & Welfare CX066 Yes No An Innovative Healthware Services Payer.
PACE Central Iowa 72436 Yes No
PACE Greater New Orlean (NORLIN) 21614 Yes No
PACE Nebraska 35416 Yes No
PACE Southwest Iowa 53534 Yes No
Pace of Southwest Michigan 45114 Yes No
PACE Southeast Michigan 86711 Yes No
Pacific Union CX056 Yes No A United Healthcare Payer
Pacificare Dental and Vision HMO CX060 Yes No A United Healthcare Payer
Pacificare Dental and Vision PPO CX053 Yes No A United Healthcare Payer
PacificSource Administrators 93031 Yes No a.k.a. Select Benefit Administrators
PacificSource Community CXPSC Yes No via Performance Health Technology
PacificSource Health Plans 93029 Yes No
Pan American Life Insurance Group 04218 Yes No
Partners Benefit Group PBGSM Yes No
Partners Health Plan 23213 No
Patient Advocates, LLC 10525 Yes No
PDO 68241 Yes No
PEHP (Public Employees Health
Program)CX080 Yes Yes
Prior to accepting claims electronically PEHP
requires the provider to call EDI Support at 801-
366-7544 or 800-753-7818. Providers should
advise PEHP that they will be submitting their
claims through Change Healthcare Business
Services, Inc UHIN submitter ID HT000158-001.
For an updated payer list please visit our website www.eaglesoft.net
Page 10
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
Pequot Pharmaceutical 37121 Yes No
Personal Insurance Administrators, Inc 95397 Yes No
Physician Health Partners, Loc PHPMA No
Physicians Health Plan of Northern
Indiana, Inc.12399 Yes No
Physicians Mutual CX068 Yes No
Pinnacle Claims Management, Inc. 24735 Yes No
Planned Administrators, Inc. 37287 Yes No
Prairie States Enterprises, Inc. 36373 Yes No
Preferred Dental Organization 68241 Yes No
Preferred Health Plan of the Carolinas CB404 Yes No
Preferred Health Professionals 31478 Yes No a.k.a. Freedom Network Dental
Preferred One 41147 Yes No
Premier Access Insurance Company CX078 Yes No
Premier Access UT Government CX110 Yes No f.k.a. UT CHIP & UT Medicaid
Premier Dental Plan of MN CX029 Yes No
Prime Health Choice 81502 Yes No
PrimeCare Administrators (PPO) PCA01 Yes No
PrimeWest Health LX049 Yes No
New providers, learn about submitting your first
claim. Please visit https://www.primewest.org/new-
facility-claims
Principal Financial Group 61271 Yes No Payer Only accepts VISION and DENTAL claims.
Priority Health 38217 Yes No
Professional Benefit Administrators,
Inc. (Oak Brook, IL)36331 Yes No
Payer ID is valid only for Claims with billing
submission name, city, and state of Professional
Benefit Administrators, Inc., Oak Brook, IL.
Prominence Health Plan 88029 Yes No
Prudential for Health 68241 Yes No
Prudential HealthCare & Life Ins. Co of
America68241 Yes No
Prudential HealthCare Health
Maintenance Organization68241 Yes No
Prudential HealthCare HMO for Small
Business68241 Yes No
Prudential Healthcare of America Inc. 68241 Yes No
Prudential HealthCare POS for Small
Business68241 Yes No
Prudential HealthCare PPO for Small
Business68241 Yes No
Puget Sound Electrical Workers
Healthcare Trust (PSEW)91136 Yes No
Please enter group # F33 when submitting claims.
A Welfare and Pension Administration Services
payer
Quality Care Partners 89461 Yes No An Innovative Healthware Services Payer.
Quality Plan Administrators Inc CX077 Yes No
Quapaw Casino 19191 Yes No
Quapaw Tribal Member Plan 19191 Yes No
Quapaw Tribe Employee Plan 19191 Yes No
Quartz ASO 46571 Yes No
RBMS, LLC 91176 Yes No
Regency Employee Benefits 38221 Yes No
Reliance Standard Life 36088 Yes No
Reliastar 80314 Yes No
ReliaStar (now known as CoreStar
formerly NW National Life)41045 Yes No
Only for Claims where the "submit Claims to
address" on the medical ID card is a CoreSource
address in the states of Arizona or Minnesota. For
assistance call 800-698-0106.
Renaissance Life and Health RLHA1 Yes No
Resolve / Solarte Health, Inc CB695 Yes No
Riverside San Bernardino County
Indian Health Inc.50664 Yes No
RMSCO, INC. 16117 Yes No
Rochester Public Schools 41625 Yes No
For an updated payer list please visit our website www.eaglesoft.net
Page 11
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
Rural Carrier Benefit Plan 25133 Yes No
Formerly payer ID 62413. Now part of Coventry
Consolidated payer ID. Including NRLCA Staff
Plan.
S&S Health Strategies 31441 Yes No
Safeguard HMO CX048 No No
SafeGuard PPO CX030 Yes No
Sage Technologies 37105 Yes No
f.k.a. Cannon Cochran Management Services,
Inc. Claims with a mailing address of PO Box
17009, Rockford, IL ONLY may be sent
electronically with this payer ID.
Salvation Army 34154 Yes No a.k.a. Chesterfield Resource, Inc.
SAMBA 37259 Yes No
Sana Benefits 50114 Yes No
Sanford Health Plan 91184 Yes No
Scion Dental Commercial SDCOM Yes No
Scion Gateway Health Plan 96938 Yes No
Secure Health Plan of GA 28530
SecureCare Dental 86057 Yes No
Securian 93742 No No
Security Life Insurance Co of America CX092 Yes No
Select Benefit Administrators 93031 Yes No a.k.a. PacificSource Administrators
Select Health CX107 Yes No
SelectCare (Coca Cola) 68241 Yes No
Sele-Dent CX109 Yes No
Self Insured Services Company
(SISCO)CX020 Yes No
Self-Funded Plans, Inc. 34131 Yes No
Self-Insured Dental Services (SIDS) CX076 Yes No
Additional enrollment is not required by the payer,
however, providers wishing to submit Claims
electronically must be credentialed with the payer.
Please ensure you have successfully process one
paper Claims with the payer prior to submitting
your first electronic Claims.
Self-Insured Plans, LLC 36404 Yes No
Senior Network Health - Utica 15682 Yes No
Sheffield, Olson and McQueen 41143 Yes No
Shelter Point Life 81434 Yes No
Sierra Health Services 76342 Yes No A United Healthcare Payer
Significa Benefits Services, Inc. CX046 Yes No f.k.a. Erin Group Admin.
Sinclair Health Plan 84076 Yes No
SingelCare 95456 Yes No
SKYGEN USA SKYGN Yes No
Solstice Benefits, Inc. 76578 Yes No
South Central Preferred - PPO York,
PA (I H S Gateway Payer)23266 Yes No An Innovative Healthware Services Payer.
South FL Community Care Network -
NBHD37314 Yes No
South Point Hotel & Casino 35227 Yes No
Southern Indiana Health Organization
(SIHO)77153 No
Southland Benefit Solutions 26374 Yes No
GROUP NUMBER as printed and displayed on
dental benefit member ID cards is REQUIRED to
be submitted on the claim. Claims will be
REJECTED if the GROUP NUMBER is not
provided. Also, predetermination claims cannot be
accepted at this time and will be REJECTED.
Southwest Service Administrators CX100 Yes No
Southwestern Bell 68241 Yes No
Southwestern Bell Exec 68241 Yes No
Southwestern Bell Exec. - Custom Care 68241 Yes No
Southwestern Bell Exec. -
Southwestern Bell68241 Yes No
Spectrum Admin. 23253 Yes No An Innovative Healthware Services Payer
Standard Ins. Co. (OR Business) 93024 Yes No
Standard Insurance Company (NY) 13411 Yes No
For an updated payer list please visit our website www.eaglesoft.net
Page 12
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
STAR +Plus Value Added CPPSP Yes Yes
Effective only for Dates of Service prior to 2-01-
13. Call DentaQuest at 800-896-2374 and MCNA
Dental at 855-776-6262 for Dates of Service 2-1-
13 and greater.
Star Health CX090 Yes NoUse this payer ID for Dates of Service prior to
June 1, 2010.
StarDent CX090 Yes No
State of Texas Dental Plan 73288 Yes No
Summit America Insurance Services 37301 Yes No
Sun Life and Health Insurance
Company67814 Yes No
f.k.a Genworth Life and Health Insurance
Company (GLHIC) (Formerly GEGLAC)
Superior Dental Care 31117 Yes No
SuperiorSTAR Pregnant Women CPPSW Yes Yes
Effective only for Dates of Service prior to 2-01-
13. Call DentaQuest at 800-896-2374 and MCNA
Dental at 855-776-6262 for Dates of Service 2-1-
13 and greater.
Supplemental Coverage ASHC1 Yes No PO Box 2829 Clinton IA 52733
Tall Tree Administrators 88067 Yes No
TDC 73288 Yes No
The Dental Companies 73288 Yes No
The Dental Concern 73288 Yes No
The health Plan of the Upper Ohio
Valley34150 Yes No
The Loomis Company - TPA
Wyomissing, PA (IHS Gateway Payer)23223 Yes No An Innovative Healthware Services Payer.
The Physicians Assurance Corp
(TPAC) /Employee Benefit
Management Corp (EBMC)
CX025 Yes No
Total Dental Administrators CX112 Yes No
Total Plan Concepts 80900 Yes No
Total Senior Care - OLEAN 12268 Yes No x
TPAC/Employee Benefit Management
CorpCX025 Yes No
TR Paul, Inc. 37230 Yes No
Travelers (now MetLife) 65978 Yes No
Travis County Map TCMAP No
TRICARE Dental Program 89070 No Administered by United Concordia effect 5-1-17
Tri-Counties Welfare Trust Fund CHSWT Yes NoAdministered by Health Services Benefit
Administrators, Inc. (HSBA)
Triple-S Salud CBPR1 Yes Yes
Completing this enrollment request will enroll the
provider(s) for
3 transactions – Electronic Claims (837D), Electric
Remittance
Advice (835) and Real Time Eligibility Inquiry and
Response
(270/271) with all 3 payers listed above. Please
ensure you
have an active ERA and Real Time account with
Change
Healthcare prior to submitting the enrollment
request form.
Please feel free to contact your software vendor or
Change
Healthcare to confirm account status.
TriState Benefit Solutions 31144 Yes No
TruAssure ILDTA Yes No
Trusteed Plans Service Corporation 91078 Yes No
Trustmark Insurance Company 61425 Yes No
UltraBenefits, Inc. 41206 No
UMR - Cincinnati 33108 Yes No f.k.a. United Medical Resources
UMR - Harrington 75196 Yes No f.k.a. Harrington Benefit Services (Westerville)
UMR - Harrington 95266 Yes No f.k.a. Harrington Benefit Services (Columbus)
UMR - Lexington 37237 Yes No f.k.a. Commonwealth Administrative Group
UMR - Onalaska 79480 Yes No f.k.a. Midwest Security of WI
For an updated payer list please visit our website www.eaglesoft.net
Page 13
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
UMR - San Antonio 74223 Yes Nof.k.a. Benefit Planners Inc., UICI Administrators -
State of Nevada
UMR - Wausau/UHIS 39026 Yes Nof.k.a. Fiserv Health - Wausau Benefits/Benesight,
Employers Insurance of Wisconsin
UMWA Health & Retirement Funds 52180 No
UNICARE 80314 Yes No
Unified Group Services 35198 Yes No
Uniform Medical Plan 75243 Yes Nof.k.a. Uniform Medical Plan / Harrington Benefit
Services
Union Security Insurance Company 70408 Yes No PO Box 2877, Clinton, IA 52733
United Concordia - Dental Plus CX013 Yes No Y Y
United Concordia - Fee for Service CX007 Yes No Y Y Administered by United Concordia
United Food & Comm Workers union &
Employers Midwest Health Benefit
Funds
36659 Yes No
United HealthCare Insurance Company
- Student Insurance74227 Yes No
A United Healthcare Payer. Payer ID only valid if
the P.O. Box on the Health ID Card matches one
of the following P.O. Boxes: P.O. Box 809024,
809025, 809026, 809027, 809035, 809036,
809066, 809067, 809079, or 809081 Dallas, Tax
75380-9025.
United of Omaha 71412 Yes No
United States Life Insurance Company 13545 Yes No f.k.a. American General
UnitedHealthcare Dental 52133 NoFormerly OptumHealth Dental, Dental Benefit
Providers/DBP and DBP of California
Unity Health Insurance Corp 66705 Yes NoOnly claims for Oral Surgery, TMJ or Accidents
can be sent electronically to this payer ID.
University of Missouri 25133 Yes NoFormerly payer ID 87043. Now part of Coventry
Consolidated payer ID.
UPMC Health Plan 23281 Yes No
Upper Peninsula Health Group (TPA) 37324 Yes No
US Benefits Inc. 93092 Yes No
US Life Ins. Co. 70106 Yes NoClaims mailing address of PO Box 12009,
Cheshire, CT
VA Fee Basis Programs 12116 Yes No
Valley Baptist Health Plan 89070 Yes Administered by United Concordia
Valor Health Plan 43259 Yes No
Vantage Health Plan 72128 Yes No
Varian Health Care Plan 68241 Yes No
Verity National Group 75256 Yes No
VieCare - LIFE Armstrong 25922 Yes No
VieCare - LIFE Butler 25293 Yes No
VieCare Life Beaver and Life Lawrence
Counties25924 Yes No
Viva Health Medicare Plus 63114 Yes No
Voluntary Benefits Plan 70106 Yes NoClaims mailing address of PO Box 12009,
Cheshire, CT
Volusia Health Network 59266 Yes No
Washington State Council of County &
City Employees (WSCCCE)91136 Yes No
Please enter group # F36 when submitting claims.
A Welfare and Pension Administration Services
payer
Waterstone Benefit Administrators
(Oklahoma Providers)73155 Yes No
Web TPA, Inc of TX 59332 Yes No
Wells Fargo TPA, Inc (Charleston, WV) 87815 Yes No f.k.a. Acordia National
Wells Fargo TPA, Inc. (Newnan, GA
and Fayetteville, NC)37272 Yes No f.k.a. JSL Administrators
Western Grower's Assurance Trust 24735 Yes No
Western Grower's Insurance Company 24735 Yes No
WestLake Financial Group, Inc.
(Buffalo Grove, IL)90560 Yes No
Wichita and Affiliated Tribes 19191 Yes No
For an updated payer list please visit our website www.eaglesoft.net
Page 14
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
Willamette Valley CXWVC Yes No via Performance Health Technology
William C. Earhart 93050 No No
WilsonMcShane R7002 No No
Worksite Benefit Services, LLC 20333 Yes No
Wyoming PACE 98543 No No
Zenith Administrators R7001 No No
ACS Benefit Services, Inc. 61474 Yes No ACS Branded Dental Product
Alameda Alliance CX083 No Admin by LIBERTY Dental Plan
Anthem Health Plans - HMOD & HMOG CX083 Yes No Admin by LIBERTY Dental Plan
Anthem Health Plans of Kentucky -
OSB High & LowCX083 Yes No Admin by LIBERTY Dental Plan
Anthem Health Plans of Kentucky -
PPOB & PPOD CX083 Yes No Admin by LIBERTY Dental Plan
Anthem Health Plans of Virginia - OSB
High & Low CX083 Yes No Admin by LIBERTY Dental Plan
Anthem Health Plans of Virginia -
PPOB & PPOD CX083 Yes No Admin by LIBERTY Dental Plan
Anthem HMO Colorado - HMO-B CX083 Yes No Admin by LIBERTY Dental Plan
Anthem Insurance - OSB High & Low CX083 Yes No Admin by LIBERTY Dental Plan
Anthem Insurance - PPOB & PPOD CX083 Yes No Admin by LIBERTY Dental Plan
Blue Cross Blue Shield Association -
FEP DentalBCAFD Yes No
Blue Cross Blue Shield of North
Carolina61474 Yes No Dental Blue Select Product
Blue Cross Blue Shield of North
Carolina61472 Yes No EHB Pediatric Dental Claims
Blue Cross Blue Shield of North
Carolina61472 Yes No Federal Employee Claims.
Blue Cross Blue Shield of North
Carolina61473 Yes No Dental Blue Product
Blue Cross Blue Shield of Wisconsin -
PPOD CX083 Yes No Admin by LIBERTY Dental Plan
Blue Cross Dental CBMNU Yes No Non FEP claims
Blue Cross of California - OSB High &
Low CX083 Yes No Admin by LIBERTY Dental Plan
Blue Cross of California - Plan SS10 &
SS20 CX083 Yes No Admin by LIBERTY Dental Plan
Blue Cross of California - PPOA CX083 Yes No Admin by LIBERTY Dental Plan
Cal Optimal -OneCare CX083 Yes No Admin by LIBERTY Dental Plan
Care 1st Health Plan Medicare
Advantage CX083 Yes No Admin by LIBERTY Dental Plan
Care 1st PHP LA & San Bernadino
County CX083 Yes No Admin by LIBERTY Dental Plan
Community Insurance - HMOA & PPOB CX083 Yes No Admin by LIBERTY Dental Plan
Community Insurance - PPOD & PPOF CX083 Yes No Admin by LIBERTY Dental Plan
Dearborn National 36123 No No
EasyChoice Health Plan CX083 Yes No Admin by LIBERTY Dental Plan
EmpireHealthChoice Assurance - OSB
Low & PPOB CX083 Yes No Admin by LIBERTY Dental Plan
EmpireHealthChoice HMO CX083 Yes No Admin by LIBERTY Dental Plan
Golden State Health Plan CX083 Yes No Admin by LIBERTY Dental Plan
Health Net 21 - LA & Sacramento CX083 Yes No Admin by LIBERTY Dental Plan
Health Net Healthy Families A, B & C CX083 Yes No Admin by LIBERTY Dental Plan
Health Net Los Angeles PHP CX083 Yes No Admin by LIBERTY Dental Plan
Health Net Sacramento GMC CX083 Yes No Admin by LIBERTY Dental Plan
Healthy Alliance Life Insurance - PPOB CX083 Yes No Admin by LIBERTY Dental Plan
Horizon Healthcare Dental Services 22099 Yes No
LA Care Health Plan CX083 Yes No Admin by LIBERTY Dental Plan
Liberty Dental Plan CX083 Yes No
MD Care Health Plan CX083 Yes No Admin by LIBERTY Dental Plan
MGM Resorts International CX083 Yes No Admin by LIBERTY Dental Plan
Molina HealthCare CX083 Yes No Admin by LIBERTY Dental Plan
NorthStar Administrators 47570 Yes No
For an updated payer list please visit our website www.eaglesoft.net
Page 15
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
Ohana Health Plan CX083 Yes No Admin by LIBERTY Dental Plan
Ozark Health Plan CX083 Yes No Admin by LIBERTY Dental Plan
Physicians United Plan-PUP CX083 Yes No Admin by LIBERTY Dental Plan
Premera Blue Cross 47570 Yes No
Rocky Mountain Hospital & Medical
Service - OSB High & High CX083 Yes No Admin by LIBERTY Dental Plan
Rocky Mountain Life Dental 84102 Yes No
Sands Bethworks Gaming CX083 Yes No Admin by LIBERTY Dental Plan
Santa Clara Family Health Plan CX083 Yes No Admin by LIBERTY Dental Plan
Venetian CX083 Yes No Admin by LIBERTY Dental Plan
Wellcare CX083 Yes No Admin by LIBERTY Dental Plan
WellPoint CX083 Yes No Admin by LIBERTY Dental Plan
Blue Cross of Alaska and Washington 47570 Yes No
AL Blue Cross of Alabama CBAL1 Yes No
AZ Arizona Blue Cross Blue Shield 53589 Yes No
Anthem Blue Cross 47198 Yes No f.k.a. Blue Cross of California; Wellpoint
CA CA Blue Shield 94036 No Non FEP Claims Only
CO Blue Cross of Colorado 84099 Yes No
CO Trigon Blue Cross Blue Shield -
Colorado Dental Office84103 Yes No
Claims Mailing Address: Trigon Dental Admin,
555 Middle Creek Parkway, MS 400, Colorado
Springs, CO 80921.
CTBlue Cross Blue Shield OH/KY
(Anthem)84105 Yes No
CT Blue Care Family Plan (BCBS of CT) 00700 Yes No
FL Florida Blue FEP CBFLF No Only FEP claims
GA Georgia BCBS CBGA1 Yes No
IA Blue Cross of Iowa "Wellmark" CBIA2 Yes Yes
IA Blue Cross of Iowa (FEP Claims Only) CBIA1 Yes Yes FEP Claims only
ID Blue Cross of Idaho CBID1 Yes Yes
ID Blue Shield of Idaho CBID2 Yes No
IL Blue Cross of Illinois CB621 Yes No
KYBlue Cross Blue Shield OH/KY
(Anthem)84105 Yes No
LA Blue Cross Blue Shield of Louisiana 23739 Yes NoPayer requires providers be tied to our submitter
ID of P0003784
MA Blue Cross of Massachusetts CBMA1 Yes No
MI Blue Cross Blue Shield of Michigan CBMI1 Yes No
MN Blue Cross Blue Shield of Minnesota CBMN1 NoUse for claims mailed to PO Box 64338, St. Paul,
MN 55164-0338
MOBlue Cross Blue Shield of Kansas City
MO47171 Yes No
EDI enrollment is no longer required by ASK
however the payer requires each provider register
with them.
MS Blue Cross of Mississippi CBMS1 Yes Yes
MT Blue Cross Blue Shield of Montana CBMT1 Yes No
NDBlue Cross of North Dakota (ND Dental
Services)CX004 Yes Yes Administered by United Concordia
NE Blue Cross of Nebraska CBNE1 No No
NM Blue Cross of New Mexico CBNM1 No No
NV Blue Cross of Nevada 84101 Yes NoNo FEP Claims. Please send FEP Claims on
paper or use Payer ID 06126.
NY BCBS of Rochester New York CBNYR No No
NY BCBS of Western NY CBNYW Yes No
NY BS of Northeastern NY CBNYE Yes No
EDI enrollment is no longer required by ASK
however the payer requires each provider register
with them.
NY Empire Blue Cross Blue Shield CBNY1 No No FEP claims may not be sent electronically.
NY Healthnow of Northeastern NY CBNYE Yes Yes
NY Healthnow of Western NY CBNYW Yes Yes
EDI enrollment is no longer required by ASK
however the payer requires each provider register
with them.
OHBlue Cross Blue Shield OH/KY
(Anthem)84105 Yes No
OK Blue Cross blue Shield of Oklahoma SB840 No
OR Regence OR BC/BS CB850 Yes No
PA Pennsylvania Blue Shield CB865 Yes No
For an updated payer list please visit our website www.eaglesoft.net
Page 16
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
PA Pennsylvania Blue Shield Dental Plus CBPA2 Yes No
RI South Carolina BCBS 38520 Yes No
SD Blue Cross Blue Shield of South Dakota
"Wellmark"CBSD1 Yes Yes
TN Blue Cross of Tennessee CBTN1 Yes Yes
TX Blue Cross of Texas CB900 Yes No
UT Regence UT BCBS CBUT1 Yes No
UT Regence UT BCBS FEP CBUTF Yes No
VA Trigon VA - BCBS (Dental) CB923 Yes No
WA Blue Cross of Alaska and Washington 47570 Yes No
WA Regence Blue Shield 93200 Yes No
WA Regence Blue Shield FEP 93200 Yes No
WA Regence Northwest Health 93200 Yes No
WI WI - BCBS (Dental) CB950 Yes No
WY Blue Cross Blue Shield Wyoming CBWY1 Yes Yes Administered by United Concordia
AL Delta Dental AL (DDIC) DDAL1 No No
Delta Dental Insurance Co. (DDIC) - All
Payers94276 No No
DeltaCare USA Claims DDCA2 Yes No f.k.a. PMI
Northeast Delta Dental (ME, NH, VT) 02027 Yes No
AR Delta Dental of Arkansas CDAR1 Yes No
AZ Delta Dental of Arizona 86027 Yes No Y Y
CA Delta Dental of California - CA00
Claims Office77777 Yes No
CA Delta Dental of California/Tricare
Retiree DentalCDCA1 Yes No
CO Delta Dental of Colorado 84056 Yes No
DC Delta Dental of Washington DC 52147 Yes No
DE Delta Dental of Delaware 51022 Yes No
FL Delta Dental of Florida (DDIC) DDFL1 No No
GA Delta Dental of Georgia (DDIC) DDGA1 No No
IA Delta Dental of Iowa CDIA1 Yes No Y Y
ID Delta Dental of Idaho 82029 Yes No
IL Delta Dental of Illinois Group Plans 05030 Yes No Y Y
IL Delta Dental of Illinois Individual Plan IDIND Yes No
IN Delta Dental of Indiana CDIN1 Yes No
KS Delta Dental of Kansas CDKS1 Yes No
KY Delta Dental of Kentucky CDKY1 Yes No
LA Delta Dental of Louisiana (DDIC) DDLA1 No No
MA Delta Dental Massachusetts 04614 No No
MDDelta Dental of Maryland and
Pennsylvania23166 Yes No
MI Delta Dental of Michigan CDMI0 Yes No
MN Delta Dental of Minnesota CDMN1 Yes No
MO Delta Dental of Missouri 43090 Yes No Y Y
MS Delta Dental of Mississippi (DDIC) DDMS1 No No
MT Delta Dental of Montana (DDIC) DDMT1 No No
NC Delta Dental of North Carolina 56101 Yes No
ND Delta Dental of North Dakota CDND1 Yes No
NE Delta Dental of Nebraska CDNE1 Yes No
NJ Delta Dental of New Jersey 22189 Yes No
NJ NJ Delta DHMO 22267 No
NM Delta Dental of New Mexico 85022 Yes No
NV Delta Dental of Nevada (DDIC) DDNV1 No No
NY Delta Dental of New York 11198 Yes No
OH Delta Dental of Ohio CDOH1 Yes No
OK Delta Dental of Oklahoma CDOK1 Yes No
OR Delta Dental of Oregon (Oregon Dental
Service)CDOR1 Yes No
PADelta Dental of Maryland and
Pennsylvania23166 Yes No
PR Delta Dental Puerto Rico 66043 Yes No
RI Altus 50503 Yes No
RI Delta Dental of Rhode Island 05029 Yes No
SC Delta Dental of South Carolina 43091 Yes No Y Y
SD Delta Dental of South Dakota 54097 Yes No
For an updated payer list please visit our website www.eaglesoft.net
Page 17
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
TN Delta Dental of Tennessee CDTN1 Yes No
TX Delta Dental of Texas (DDIC) DDTX1 No No
UT Delta Dental of Utah (DDIC) DDUT1 No No
VA Delta Dental of Virginia CDVA1 No No
WA Delta Dental of Washington 91062 Yes No Y f.k.a. Washington Dental Service
WI Delta Dental of Wisconsin 39069 Yes No Y Y
WV Delta Dental of West Virginia 31096 Yes No
A&D Charitable Foundation, Inc. (dba
GreatLakes PACE)39640 No
DentaQuest - Government Plans CX014 No
Eddy SeniorCare 08754 No
Elderwood Health 03964 No
Fresno PACE 99660 No
Life Circles PACE 71498 No
Next Level Health Partners, LLC 69821 No
PACE CNY 70454 No
San Diego PACE 96400 No
SCION Dental SCION No
U. S. Virgin Island Medicaid CUSVI No
Valir PACE 64009 No
Via Christi HOPE 48123 No
Medicaid of Alaska CKAK1 Yes
AL Medicaid of Alabama CKAL1 Yes
AR Arkansas Medicare Advantage ARCMS No
AR Medicaid of Arkansas CKAR1 No
AZ Arizona Medicaid CKAZ1 No
Please visit
http://www.azahcccs.gov/commercial/ProviderRegi
stration/registration.aspx for provider registration
information prior to submitting claims.
AZ Department of Economic Security DESAZ No
CA Dental Transformation Initiative (DTI) DTCA7 No
There is no enrollment for claims submission. To
become a participating provider an office must fill
out a form
(http://www.dhcs.ca.gov/provgovpart/denti-
cal/Documents/Safety%20Net%20Clinic%20Opt-
In%20Form(fin)Edits.docx) and email it to
CA Denti-Cal / Medicaid of California 94146 No
CA Medi-Cal / Medicaid of Californai 57016 Yes Claims sent in the instiutuional format 837I
CO Medicaid of Colorado CKCO1 No
CT Medicaid of Connecticut CKCT1 No
DC District of Columbia Medicaid CKDC1 Yes
DE Delaware Medicaid CKDE1 Yes
FL DentaQuest - Government Plans CX052 No
FL Florida Medicaid CKFL1 Yes
FL Medicaid of Florida CKFL1 Yes
GA Medicaid of Georgia CKGA1 No
IA Delta Dental of Iowa Medicaid Program CDIAM No Y Y
IA Medicaid of Iowa CKIA1 Yes
ID DentaQuest - Government Plans CKID1 No
IL DentaQuest - Government Plans CKIL1 No
IN Indiana Children's Special Healthcare CX070 No
IN Medicaid of Indiana CKIN1 No
KS Medicaid of Kansas CKKS1 No
KY DentaQuest - Government Plans CKKY3 No
KY Medicaid of Kentucky CKKY1 Yes
LA Medicaid of Louisiana 65030 No
MA Health Safety Net CKHSN Yes
MA Massachusetts Health Program CKMA1 NoPlease place MASS Health or MA Medicaid or
MASS Medicaid in the carrier name field.
MD DentaQuest - Government Plans CKMD1 No
ME Maine Medicaid for FQHC CKMEH Yes
ME Medicaid of Maine CKME1 Yes
MI BCBS MI Medicare Advantage BBMDQ No
MI Medicaid of Michigan CKMI1 No
MN Medicaid of Minnesota CKMN1 Yes
MO Medicaid of Missouri CKMO1 No
For an updated payer list please visit our website www.eaglesoft.net
Page 18
eClaims Dental Payer List
April 2020
State Payer ID Group # EnrollReal Time Claims
*
Real Time Pre
Estimates* Additional Info
MS Medicaid of Mississippi CKMS1 Yes
MT Medicaid of Montana CKMT1 No
NC Medicaid of North Carolina CKNC1 No
ND North Dakota Medicaid CKND1 No
Additional enrollment is not required by the payer,
however, providers wishing to submit Claims
electronically must submit their ND Medicaid
assigned provider ID(s) within the Claims.
Provider IDs are always 5 digits long and begin
with the number 4.
NE Medicaid of Nebraska CKNE1 Yes
NH Medicaid of New Hampshire CKNH1 No
NJ Medicaid of New Jersey CKNJ1 Yes
NM New Mexico Medicaid CKNM1 Yes
NV Medicaid of Nevada CKNV1 Yes
NY Medicaid of New York CKNY1 Yes
NY Medicaid of New York (Dental Clinics
Only)CKNY2 Yes
NY NYS DOH UCP 14142 YesDept of Health AIDS Drug Assistance Program
(ADAP) - UCP is Uninsured Care Program
OH CareSource CKOH2 No
OH Medicaid of Ohio CKOH1 No
OK Medicaid of Oklahoma CKOK1 No
OR Medicaid of Oregon CKOR1 Yes
PA Medicaid of Pennsylvania CKPA1 No
PR Triple-S Medicaid Advantage PRADV No
RI Medicaid of Rhode Island CKRI1 No
SC DentaQuest - Government Plans CKSC1 No
SD South Dakota Medicaid CKSD1 NoSouth Dakota's Meddicaid contractor is South
Dekota Delta
TN DentaQuest - Government Plans 62154 No
TX Cook Children's Dental CPPCC No
TX Medicaid of Texas CKTX1 No
UT Medicaid of Utah CKUT1 No
VA DentaQuest - Government Plans CKVA1 No
VT Medicaid of Vermont CKVT1 Yes
WA Medicaid of Washington CKWA1 Yes
WI Medicaid of Wisconsin CKWI1 No
WI Wisconsin Medicare Advantage WIMAN No
WV Aetna Better Health of WV 128WV No
WV Medicaid of West Virginia CKWV1 No
WY Delta Dental of Wyoming CDWY1 Yes No
WY Medicaid of Wyoming CKWY1 Yes
For an updated payer list please visit our website www.eaglesoft.net
Page 19