Prompt Solutions Payer · PDF filePrompt Solutions Payer List ** New Payers are in Bold 5 AUSTIN MUTUAL INSURANCE CCV--AUSMUIN-01 I5991 I5991 AULTRA ADMINISTRATIVE GROUP CNE-

Prompt Solutions Payer List

** New Payers are in Bold 1

Payor Name Internal Pay Number PSI 5 Digit NAIC Special Instructions1199 NATIONAL BENEFIT FUND CNE--NATBEFU-01 13162 13162 Provider should submit claims with assigned plan1ST MN CNE--FIRSTMN-01 29076 29076 Atlanta, GA NEW PAYER ID1st MEDICAL NETWORK CNE--FIRSTMN-01 29076 29076 Atlanta, GA NEW PAYER ID21st CENTURY HEALTH & BENEFITS CNE--CENHEBE-01 59069 5906921st Century Insurance and Financial Services CNE--CENTINS-01 51028 51028 Minnesota Only3P ADMIN CNE--3PADMIN-01 20413 20413A & I BENEFIT PLAN ADMINISTRATORS CNE--AIBEPLA-01 93044 93044A.G.I.A., INC. CNE--AGIAINC-01 95241 95241 Claims are printed and mailed to payorAAG BENEFIT PLAN ADMINISTRATORS CNE--AAGBEPL-01 75240 75240AAG AMERICAN ADMINIS GROUP CNE--AAGAMAD-01 37283 37283 Formerly Gallagher Benefit AdminAAG AMERICAN ADMINIS GROUP CNE--AAGAMAD-02 75185 75185 Formerly Icon Benefit AdminAARP MEDICARE COMPLETE BY SECURE HORIZONS CNE--UHCARE--01 87726 87726 NOT MCR SUPPLEMENT

ABMA MEDICAL CORP CNE--ABMAMEC-01 E3510 E3510Alta Bates Med Assoc (Hnet Sr & Secure Horizon Only Claims from California Providers

ABRAZO ADVANTAGE HEALTH PLAN CNE--ABRADHE-01 03443 03443ABRI CNW--ABRHPWI-01 ABRI1 ABRI1

ABSOLUTE TOTAL CARE CNE--ABSTOCA-01 68069 68069

Prior to submitting claims, please call Provider Relations Dept at 866-433-6041 to verify provider info is on file in the claim system ** 8/2013 new payer ID 68069 old 68055 - This payr switched over to a single payr system with CENTENE CORP

ACCLAIM CNE--ACCLAIM-01 64071 64071 ACCLAIM REPRICING CNE--ACCLARE-01 21356 21356 ACCORDIA NATIONAL CNE--ACCONAT-01 87815 87815 ACMG CNE--BENPLAD-01 37118 37118 Claims are processe by Benefit Plan Administrators

ACS BENEFIT SERVICES CNE--ACSBESE-01 72467 72467Do not send ACS/Health Net or ACS Medicaid claims to this payer ID

ACS CONSULTING SVS, INC CNE--ACSCOSE-01 72467 72467 ACS REWARDS ADMINISTRATION CTR CNE--ACSREAD-01 36112 36112ACTIVA BENEFIT SERVICES CNE--ACTBESE-02 88056 88056ADMINISTRATION SYSTEMS RESEARCH CORPORATIONCNE--ADMSYRE-01 38265 38265ADMINISTRATIVE CONCEPTS INC CNE--ADMICON-01 22384 22384ADMINISTRATIVE SERVICE CONSULTANTS CALL PROMPT FOR ASSISTANCE WITH THIS PAYORADMINISTRATIVE SERVICES INC CNE--ADMISER-01 59141 59141 ASRAdminOne CNE--ADMINON-01 37278 37278ADVANCED DATA SOLUTIONS CNE--ADVDASO-01 58202 58202ADVANCED MEDICAL MANAGEMENT CNE--ADVMEMA-01 AMM01 AMM01ADVANTAGE BY BRIDGEWAY HEALTH SOLUTIONS CNE--ADVANTA-01 68056 68056

MHS - MEDICARE ADVANTAGE MAILING ADDRESS: PO BOX 3060, FARMINGTON, MO

ADVANTAGE BY MANAGED HEALTH SERVICES CNE--ADVANTA-01 68056 68056ADVANTAGE BY SUPERIOR HEALTHPLAN CNE--ADVANTA-01 68056 68056ADVANTAGE HEALTH SOLUTIONS CNE--ADVHESO-01 35209 35209ADVANTAGE PREFERRED PLUS CNE--ADVPRPL-01 77070 77070ADVANTEK BENEFIT ADMINISTRATORS CNE--ADVBEAD-01 83077 83077ADVANTICA BENEFITS CNE--ADVABEN-01 59374 59374ADVANTRA FREEDOM CNE--ADVAFRE-02 25133 25133 OLD NAIC 25152 NEW NAIC 25133



ADVANTRA SAVINGS CNE--ADVASAV-01 25133 25133 OLD NAIC 25152 NEW NAIC 25133ADVENTIST HEALTH SYSTEM WEST CNE--ADVHESY-01 95340 95340 ROSEVILLE, CAADVOCATE HEALTH CENTERS CNE--ADVHECE-01 36320 36320 CLAIM OFFICE NO LONGER REQUIRED ADVOCATE PHYSICIAN PARTNERS CNE--ADVOCPP-01 65093 65093 CLAIM OFFICE NO LONGER REQUIRED AETNA H.P. - SELECT CHOICE CNE--AETSECH-01 60054 60054 (Former Prudential to 60054)AETNA H.P. - SR. CHOICE- NY/NJ CNE--AETSRNY-01 60054 60054AETNA H.P.-SEL. CHOICE-NY/NJ CNE--AETSENY-01 60054 60054AETNA HEALTH PLANS-ELECT CHOIC CNE--AETELCH-01 60054 60054AETNA HEALTH PLANS-MANAGED CHO CNE--AETMACH-01 60054 60054AETNA HEALTH PLN PTNRS PPO CNEP-AETHEPL-01 60054 60054AETNA LIFE AND CASUALTY CO CNE--AETLICA-01 60054 60054AETNA ILLINOIS MEDICAID CNE--AETILMD-01 26337 26337 ILLINOIS MEDICAID CLAIMS ONLYAETNA/US HEALTHCARE CNE--USHEACA-02 60054 60054AETNA AFFORDABLE HEALTH CHOICES CNE--AETAFHE-01 57604 57604 Affordable Health Choices (SM) - SRCAFFINITY HEALTH PLAN CNE--AFFHEPL-01 13334 13334 Call payor before sending

AFFINITY MEDICARE ADV CNE--AFFMEAD-01 13333 13333Medicare Advantage Member Subscriber ID must be length of 9 DOS greater than 1/1/10

AFFINITY MEDICAL GROUP CNE--AFFMEGR-01 46594 46594AFFORDABLE BENEFIT ADMINISTRATORS CNE--AFFBEAD-01 95426 95426 ABA, PO BOX 10787, BURBANK, CA, 91510-0787 OnlyAFTRA HEALTH FUND CNE--AFTHEFU-02 13346 13346

AGA CNE--AGAINSU-01 37280 37280

Automated Group Administration. Please send PPO claims to the Payer ID of the PPO shown on the Members ID Card Call 260-489-6447 for questions

AGATE RESOURCES INC (LIPA) CNE--AGATRES-01 20048 20048Contact Denise Watts at 541-762-2172 for assistance from Payor

AGENCY SERVICES CNE--AGENCSE-01 64158 64158 Now known as Meritain HealthAH & L CNE--ANTHELI-02 80705 80705 Great West HealthcareAHC CNE--ASCFOHE-01 36326 36326 HealthEOSAHPO (CLEVELAND, OH) CNE--AHPOCOH-01 31138 31138AKM MEDICAL GROUP CNE--CAPMANA-01 CAPMN CAPMNALASKA CARPENTERS TRUST CNE--ALACATR-01 91136 91136 Group Number (F40) req'dALASKA CHILDREN'S SERVICES,INC CNE--ALACHSE-01 91136 91136 Group Number (P68) req'd ALASKA ELECTRICAL H&W FUND CNE--ALAELHE-01 92600 92600ALASKA LABORERS CONSTRUCTION CNE--ALALACO-01 91136 91136 Group Number (F23) req'd ALASKA PIPE TRADES LOCAL 375 CNE--ALAPITR-01 91136 91136 Group Number (F24) req'dALASKA UNITED FOOD & COMM. CNE--ALAUNFO-01 91136 91136 Group Number (F45) req'dALICARE(AKA AMALGAMATED LIFE) CNE--ALICARE-01 13550 13550ALICARE - PA CNE--ALICARE-02 13343 13343 (AKA AMALGAMATED LIFE)ALIGNIS CNE--ALIGNIS-01 58213 58213ALLEGIANCE BENEFIT PLAN MGMT INC CNE--ALLBEPL-01 81040 81040ALLIANCE HEALTHCARE CNE--ALLSTRI-01 13079 13079 STONES RIVER REGIONAL IPA

ALLIANCE, THE PPO - WISCONSIN CNE--ALLIAWI-01 88461 88461The Alliance PPO in Wisconsin - Only WI Providers Only Mailing address: PO Box 44365, Madison, WI 53744

ALLIANCE PPO, INC. (Maryland) CNE--ALLPPIN-01 52149 52149 KNA OneNet PPO, LLCALLIANT HEALTH PLANS CNE--ALLHEPL-01 58234 58234 of GeorgiaALLIED ADMINISTRATORS CNE--ALLIEAD-01 94177 94177 San Francisco, CAALLIED BENEFIT SYSTEMS CNE--ALLBESY-01 37308 37308ALTA BATES MEDICAL GROUP CNE--ALTBAME-01 A0701 A0701 Payer ID for DOS AFTER 7/1/2010ALTA HEALTH & LIFE INSURANCE CNE--ALTHELI-01 80705 80705 Great West Healthcare



ALTA SENIOR CARE CNE--ALTSECA-01 E3510 E3510Hnet Sr and Secure horizons only - Providers in Northern California only.

ALTIUS (UTAH) CNE--ALTIUUT-01 25133 25133AMALGAMATED LIFE CNE--AMALLIF-01 13550 13550 AKA ALICAREAMALGAMATED LIFE - PA CNE--AMALIPA-01 13343 13343 AKA ALICAREAMCO CNE--AMCO----01 62176 62176 Arkansas Managed Care OrgAMERIBEN SOLUTIONS, INC CNE--AMERSOL-01 75137 75137AMERICAID COMMUNITY CARE - NJ CNE--AMECOCA-04 27516 27516 New JerseyAMERICAID COMMUNITY CARE- MD. CNE--AMECOCA-03 27517 27517 MarylandAMERICAN ADMINISTRATIVE GROUP CNE--AMEADGR-01 75240 75240AMERICAN ADMINISTRATORS CNE--AMERADM-01 42112 42112 West Des Moines, Iowa PAYOR id on all cardsAMERICAN ADMINISTRATORS DBA SELECT BENEFIT ADMINISTRATORS CNE--AMERADM-02 42137 42137 West Des Moines, Iowa PAYOR id on all cardsAMERICAN BEHAVIORAL CNE--AMERBEH-01 63103 63103AMERICAN BEHAVIORAL FEP/ITS CNE--AMERBEH-02 63106 63106AMERICAN BEHAVIORAL - LifeSynch CNE--AMERBEH-03 63101 63101AMERICAN BENEFIT PLAN ADMINISTRATORS CNE--AMEBEPL-01 95170 95170

AMERICAN BENEFITS MANAGEMENT CNE--AMEBEMA-01 34187 34187Billing Submission Address only: P.O. Box 35008 North Canton, Ohio 44735

AMERICAN CHIROPRACTIC NETWORK CNE--AMECHNE-01 41161 41161 Also Known As - ACNAMERICAN CHIROPRACTIC NWK NY CNE--AMECHNY-01 41160 41160 IPA of NY (ACNIPA)AMERICAN COMMUNITY MUTUAL INS CNE--AMECOMU-01 60305 60305AMERICAN FAMILY HEALTH PROVIDERS CNE--CAPMANA-01 CAPMN CAPMNAMERICAN FAMILY MED CNE--AMEFAME-01 56071 56071AMERICAN GENERAL CNE--AMERGEN-01 62030 62030AMERICAN HEALTHCARE ALLIANCE CNE--AMEHEAL-01 01066 01066

AMERICAN IMAGING MANAGEMENT CNE--AMEIMMA-01 36369 36369 Assigned Grp Policy Plan ID req'dAMERICAN INTERNATIONAL GROUP CNE--AMEINGR-02 87726 87726 old naic 13311 - send to UHC 87726 Dec 04 AIG

AMERICAN LIFECARE CNE--AMERLIF-01 72099 72099Group # req'd - Only 1100 Poydras Street, Suite 2600, New Orleans, LA 70163-2602

AMERICAN MEDICAL AND LIFE INS CNE--AMEMELI-01 23212 23212AMERICAN MEDICAL SECURITY, INC CNE--AMEMESE-01 81400 81400 AMSAMERICAN NATIONAL INS CO CNE--AMENAIN-01 74048 74048 (ANICO)AMERICAN POSTAL WKRS UN HTH CNE--AMEPOWO-01 44444 44444 Not including State of Maine APWU - CONVERSION PLAN CNE--APWUPLA-01 55544 55544AMERICAN PROGRESSIVE LIFE & HLTH CNE--AMEPRLI-01 48055 48055AMERICAN REPUBLIC INS CO CNE--AMEREIN-01 42011 42011 No Secondary/Teritiary claims accepted electronicallyAMERICAN WORKER HEALTH PLAN CNE--AMEWOHE-01 37322 37322AMERICAS 1ST CHOICE HEALTH PLANS OF NORTH CAROLINA CNE--AMECHNC-01 26078 26078AMERICAS 1ST CHOICE HEALTH PLANS OF SOUTH CAROLINA CNE--AMECHSC-01 20553 20553AMERICAS PPO CNE--AMERPPO-01 16120 16120AMERICAS TPA CNE--AMERTPA-01 41178 41178



AMERICHOICE OF NEW JERSEY MCR CNE--AMENJMR-01 86001 86001 Provider Network ID Req'dAMERICHOICE OF NEW YORK MCR CNE--AMENYMR-01 86002 86002 Provider Network ID Req'dAMERICHOICE OF NJ MEDICAID CNE--AMENJME-01 86047 86047 Provider Network ID Req'dAMERICHOICE OF NY MEDICAID CNE--AMENYME-01 86048 86048 Provider Network ID Req'dAMERICHOICE OF PERSONAL CARE PLUS CNE--AMEPAME-01 86003 86003 Provider Network ID Req'd MedicareAMERICHOICE OF PENNSYLVANIA CNE--AMECHPA-01 86049 86049 Provider Network ID Req'd MedicaidAMERIGROUP CORPORATION CNE--AMEGRCO-01 27514 27514 FORT WORTH FKA Americaid Community CareAMERIGROUP GEORGIA CNE--AMEGRGA-01 27514 27514AMERIGROUP CORPORATION CNE--AMEGRCO-02 27515 27515 Houston FKA Americaid Community CareAMERIGROUP COMMUNITY CARE OF NEW MEXICO CNE--AMECOCA-05 27514 27514AMERIGROUP FLORIDA CNE--AMERIFL-01 27519 27519AMERIGROUP ILLINOIS & OHIO CNE--AMERIIL-01 27518 27518AMERIHEALTH ADMINISTRATORS CNE--AMEHEAD-01 54763 54763AMERIHEALTH HMO (NJ & DE) CNE--AMENJDE-01 23037 23037AMERIHEALTH MERCY HEALTH PLAN CNE--AMEMEHE-01 22248 22248 Medicaid managed careAMIDA CARE CNE--AMIDCAR-01 24818 24818 Formerly Known as VidaCareANCHOR BENEFIT CONSULTING INC CNE--ANCBEC0-01 53085 53085ANCILLARY CARE MANAGEMENT CNE--ANCCAMA-01 03172 03172 ACMANTARES MANAGEMENT SOLUTIONS CNE--ANTMASO-01 34192 34192ANTHEM HEALTH & LIFE INS OF New Jersey CNE--ANTHELI-01 80705 80705 Great West HealthcareAPEX BENEFIT SERVICES CNE--APEBESE-01 34196 34196 Commercial & Medicaid Claims acceptedAPS HEALTHCARE INC CNE--APSHECA-01 54160 54160ARAZ BLOOMINGTON, MN CNE-----ARAZ-01 16120 16120 HEALTH EZARCADIAN MANAGEMENT SERVICES CNE--ARCMASE-01 77045 77045

ARISE HEALTH PLAN CNE--PREHEIN-01 39185 39185PO BOX 11625, GREEN BAY, WI Claims delivered to ClaimsNet from Emdeon

ARIZONA FOUNDATION FOR MEDICAL CARE CNE--AZFOUMC-01 86062 86062 AFMCARIZONA PHYSICIANS IPA CNE--ARIPHIP-01 03432 03432ARKANSAS BEST CORP CNE--ARKBEST-01 75278 75278 CHOICE BENEFITSARKANSAS MANGED CARE ORGANIZATION INC CNE--ARMANCA-01 62176 62176 AMCOASH - AMERICAN SPECIALTY HEALTH CASH-AETLINK-01 ASH01 ASH01 CALL PROMPT PRIOR TO SENDING CLAIMSASR / ASR CORP / ASR HEALTH BENEFITS CNE--ASRHEBE-01 38265 38265ASSOCIATES FOR HEALTHCARE CNE--ASCFOHE-01 36326 36326 AHCASSOCIATION BENEFIT PLAN CNE--ASSBEPL-01 25133 25133ASSOCIATION BENEFIT PLAN CNE--ASSUHEA-01 39065 39065ASSOCIATION BENEFIT PLAN CNE--ASSUASA-01 58730 58730 also known as Assurant HealthASSOCIATION BENEFIT PLAN CNE--ASSUHEA-02 37313 37313 Ft. Mill, SCASSOCIATION BENEFIT PLAN CNE--ASSUREC-01 88035 88035ASSOCIATION BENEFIT PLAN CNE--ASSBEAD-01 74240 74240

ATA-FL CNE--ATAFL---01 65064 65064

Only Physical, Occupational and Speech Therapy Claims for Florida Health Plans: Aetna, CarePlus, JMH, Sunshine State, WellCare

ATHENS AREA HEALTH PLAN SELECT CNE--ATHARHE-01 95691 95691ATLANTIC MEDICAL INSURANCE CNE--ATLMEIN-01 22285 22285ATLANTICARE ADMINISTRATORS CNE--ATLANAD-01 22304 22304 AkA Horizon Healthcare Admin - HHAATLANTIS HEALTH PLAN CNE--ATLHEPL-01 13853 13853 Provider Network ID Req'd



AUSTIN MUTUAL INSURANCE CCV--AUSMUIN-01 I5991 I5991

AULTRA ADMINISTRATIVE GROUP CNE--AULADGR-01 37242 37242Billing submission address: P.O. Box 35276 Canton, OH 44735-5276

AUTOMATED BENEFIT SERVICES CNE--AUTBESE-01 38259 38259 ABS - PO BOX 37506, OAK PARK, MI 48237

AUTOMATED GROUP ADMINISTRATION CNE--AUTGRAD-01 37280 37280Please send these EDI claims to the Payer ID of the PPO shown on the Members ID card.

AUTOMOTIVE MACHINISTS LOCAL289 CNE--AUTMALO-01 91136 91136 Group Number (F32) req'd AUXIANT CNE--NHBCAUX-01 88050 88050 NHBCAUXAVALON IPA CNE--CAPMANA-01 CAPMN CAPMNAVALON MEDICAL GROUP CNE--CAPMANA-01 CAPMN CAPMNAVERA HEALTH PLANS CNE--AVEHEPL-01 46045 46045AveraAdvantage CNE--AVERADV-01 48055 48055AVERDE HEALTH CNE--AVERHEA-01 26355 26355AvMed, Inc. CNE--AVMEDIN-01 59274 59274 Insured ID must be 11 digit Member IDAXA ASSISTANCE USA CNE--AXAASUS-01 65101 65101AZEROS HEALTH PLANS INC CNE--AZEHEPL-01 16114 16114

BANNER HEALTH CNE--BANNHEA-01 SX145 SX145

Enrollment is required. Arizona, Rocky Mountain HMO Greeley, Antero Greeley, Antero High Plains, Antero Mountain Shadows, Choice Plus, HMO Greeley, HMO High Plains, HMO Mountain Shadows, Pacificare Greeley, Pacificare High Plains, Pacificare Mountain Shadows, Rocky Mountain HMO High Plains, Secure Horizons Greeley, Secure Horizons High Plains & Secure Horizons Mountain Shadows

BANNER MEDISUN CNE--BANNMED-01 77078 77078BASS ADMINISTRATORS, INC CNE--BASADIN-01 37248 37248BC INDIGENT CNE--BCINDIG-01 74230 74230BCI ADMINISTRATORS CNE--BCIADIN-01 49153 49153

BEACON HEALTH STRATEGIES CNE--BEAHEST-01 43324 43324

Please use the following Plan IDs forblock 11 on the 1500 form.Neighborhood Health Plan of MA=001;Hudson Health Plan=004;FallonCommunity Plan=005; NeighborhoodHealth Plan of RI=006; Affinity HealthPlan=009; DC Chartered HealthPlan=013

BEECH STREET CORP CNE--BEESTCO-01 95377 95377Also Claims Repricing mailed to: Beech Street Corp PO Box 57015 Irvine, CA 92619

BEHAVIORAL HEALTH SYSTEMS CNE--BEHHESY-01 63100 63100BENCOMP NATIONAL CORP CNE--BENNACO-01 33192 33192BENEFIT ADMIN SERVICES CNE--BENADSE-01 88055 88055BENEFIT ADMINISTRATIVE SYSTEMS CNE--BENADSY-01 36149 36149

BENEFIT COORDINATORS CORP CNE--BENCOCO-01 25145 25145 Only: 111 Ryan Ct. # 300, Pitsburg, PA 15205

BENEFIT MANAGEMENT ADMINISTRATORS CNE--BENMAAD-01 74266 74266



BENEFIT MANAGEMENT INC OF KS CNE--BENMAKS-01 48611 48611Only Groups: BMI187, BMI219, BMI234, BMI236, BMI214, BMI241, BMI617, BMI245, BMI246

BENEFIT MANAGEMENT SYSTEMS CNE--BENMASY-01 37212 37212BENEFIT PLAN ADMINISTRATORS CNE--BENPLND-01 37286 37286 North Dakota - BPABENEFIT PLAN ADMINISTRATORS CNE--BENPLAD-03 88052 88052BENEFIT PLAN ADMINISTRATORS INC CNE--BENPLAD-01 37118 37118 Roanoke, VA

BENEFIT PLAN ADMINISTRATORS CO CNE--BENPLCO-01 39081 39081 Only: PO Box 1128, Eau Claire, WI 54702BENEFIT PLANNERS, INC. CNE--BENPLIN-01 74223 74223BENEFIT SOURCE INC CNE--BENESOU-01 38257 38257BENEFIT SYSTEMS & SVCS INC CNE--BESYSVC-01 36342 36342 BSSIBENESIGHT CNE--BENSIGT-01 87265 87265 (formerly known as The TPA)

BERKSHIRE HEALTH PARTNERS - PPOCALL PROMPT SOLUTIONS FOR SETUP Wyomissing, PA (IHS Gateway Payer)

BEST LIFE & HEALTH INS CO CNE--BESLIHE-01 95604 95604BETTER HEALTH PLANS OF S. CAROLIN CNE--BETHEPL-02 32006 32006 South CarolinaBETTER HEALTH PLANS, INC CNE--BETHEPL-01 62183 62183 KNA Unison Health PlanBLUE BENEFIT ADMINISTRATORS OF MA CNE--BLUBEAD-01 03036 03036BLUE SHIELD CALIFORNIA B----CALIFOR-01 BS001 BS001 OFFICE ALLY PIPELINE - NO ENROLLMENT REQ'DBLUE SHIELD CONNECTICUT B----CONNECT-01 CTBCS PAR AND NON PAR PROVIDERS ACCEPTED

BLUE SHIELD DC / Northern Virginia CNE--CAREFST-01 SB580 SB580

BLUE SHIELD ILLINOIS BIL--ILLINOI-01 ILBCSBLUE SHIELD ILLINOIS - SECONDARY CLAIMS ONLY B----BSPIL---01 BSPIL

SECONDARY CLAIMS ONLY - ADDITIONAL DATA REQUIRED, CALL PROMPT FOR ASSISTANCE

BLUE SHIELD INDIANA BAD--INDIANA-01 INBCS

BLUE SHIELD FLORIDA B----FLORIDA-01 FLBCS

BLUE SHIELD KANSAS B----KANSAS--01 KSBCS CALL PROMPT PRIOR TO SENDING CLAIMS

BLUE SHIELD KENTUCKY B----KENTUCK-01 KYBCS

BLUE SHIELD MARYLAND CNE--CAREFST-02 SB690 SB690

BLUE SHIELD MICHIGAN BMI--MICHIGA-01 MIBCS EDI ENROLLMENT REQ'D - PROVIDER NUMBER REQ'D

BLUE SHIELD MICHIGAN - MED PLUS BLUE M----MEDPLBL-01 MEDPL EDI ENROLLMENT REQ'D - PROVIDER NUMBER REQ'D

BLUE SHIELD MI - BLUE CARE NETWORK B----MIBCNHM-01 MIBCN EDI ENROLLMENT REQ'D - PROVIDER NUMBER REQ'D



BLUE SHIELD MI - SECONDARY PAYER B----BSPMI---01 MIBSPEDI ENROLLMENT REQ'D - PROVIDER NUMBER REQ'D **FEP CLAIMS MUST GO ON PAPER IF SECONDARY

BLUE SHIELD MINNESOTA B----MINNESO-01 MNBCSBLUE SHIELD MINNESOTA AS A SECONDARY PAYR B----BSPMN---01 BSPMN

BLUE SHIELD NEW JERSEY CNE--BLUSHNJ-01 22099 22099 EDI ENROLLMENT REQ'D - PROVIDER NUMBER REQ'D

BLUE SHIELD NEW YORK - EMPIRE B----NYEMPIR-01 00803

BLUE SHIELD OHIO B----OHIO----01 OHBCS

BLUE SHIELD OREGON - REGENCE B----OREGON--01 ORBCSCLEARINGHOUSE AVAILITY NO ENROLLMENT REQUIRED

BLUE SHIELD PA - HIGHMARK B----PAHIGHM-01 BPAHI CALL PROMPT TO ENROLL

BLUE SHIELD PA - PERSONAL CHOICE B----PAPERCH-01 54704 54704 CALL PROMPT TO ENROLL

BLUE SHIELD TX B----TEXAS---01 84980 84980

BLUE SHIELD WASHINGTON - REGENCE B----WASHING-01 WABCSCLEARINGHOUSE AVAILITY NO ENROLLMENT REQUIRED

BLUE SHIELD WASHINGTON - PREMERA B----WAPREME-01 WABC2 PREMERA.COM

BLUE SHIELD WISCONSIN BWI--WISCONS-01 WIBCSBLUEGRASS FAMILY HEALTH CNE--BLUFAHE-01 61124 61124BLUEGRASS FAMILY HEALTH/SRRIPA CNE--BLUFAHE-02 15754 15754 SRRIPABMC HEALTHNET PLAN CNE--BMCHEPL-01 13337 13337 12 DIGIT PROVIDER NUMBER REQUIREDBOILERMAKERS NATIONAL HEALTH CNE--BOINAHE-01 36609 36609 and Welfare FundBOON-CHAPMAN ADMINISTRATORS CNE--BOOCHAD-01 74238 74238BOSTON MEDICAL CENTER HEALTHNE CNE--BOSMECE-01 13337 13337 Provider Nwk ID Req'd - 12 DigitsBOULDER ADMINISTRATION SERVICES CNE--BOUADSE-01 20381 20381

BRAVO HEALTH CNE--BRAVHEA-01 52192 52192

FKA Elder Health, Inc. serving members in Pennsylvania, Maryland, Delaware, Texas and Washington D.C. - not to be confused with ElderPlan in NY

BRIDGEWAY ARIZONA CNE--BRIDGAZ-01 68054 68054 Provider Relations 866-475-3129BritCay CNE--BRITCAY-01 22286 22286BROKERAGE CONCEPTS CNE--BROKCON-01 51037 51037BRODART CO. CNE--BRODART-01 35182 35182 NEW NAICBROWARD HEALTH CNE--BROWHEA-01 37314 37314BROWN AND TOLAND MEDICAL GROUP CNE--BROTOME-01 94316 94316BUCKEYE COMMUNITY HEALTH CNE--BUCCOHE-01 32004 32004 Enrollment is required. Call 800-225-2573 ext.25525



BUTLER BENEFIT CNE--BUTLBEN-01 42150 42150C & O EMPLOYEES' HOSPITAL ASSO CNE--C&OEMHO-01 23708 23708C. L. FRATES & CO - OSMA HEALTH CNE--OSMAHEA-01 73071 73071CADENT ADMINISTRATORS CNE--CADEADM-01 33192 33192CADENT UNDERWRITERS CNE--CADEUND-01 33192 33192CANNON COCHRAN MANAGEMENT SVC CNE--CANCOMA-02 37105 37105CANNON COCHRAN MANAGEMENT SVC CNE--CANCOMA-03 71057 71057 Metairie, LACAP MANAGEMENT CNE--CAPMANA-01 CAPMN CAPMNCAP MANAGEMENT SYSTEMS CNE--CAPMASY-01 95399 95399CAPITAL COMMUNITY HLTH PLN CNE--CAPCOHE-01 87726 87726

CAPITAL HEALTH PLAN CNE--CAPHEPL-01 95112 95112Call Payor prior to sending - provider must register NPI - Rendering NPI or UPIN is req'd

CAPITOL ADMINISTRATORS CNE--CAPITAD-01 68011 68011CAPSTONE HEALTH PLAN INC CNE--CAPSTHE-01 86044 86044CARE 1st HEALTH PLAN OF ARIZONA CNE--CARE1ST-01 57116 57116CARE 1st HEALTH PLAN OF CA CNE--CARE1ST-02 57115 57115CARE IMPROVEMENT PLUS CNE--CARIMPL-01 77082 77082CARE TO CARE CNE--CARTOCA-01 41222 41222CARE WISCONSIN HEALTH PLAN CNE--CARWIHE-01 27004 27004 TRIZETTOCareCentrix CNE--CARECEN-01 11345 11345 Enrollment req'd prior to sending claimsCareCore National CNE--CARENAT-01 14182 14182

CareCore National - Healthnet CNE--CARNAHE-01 14184 14184Provider network and Rend prov'd id - facility and facility id also required

CareCore National LLC CNE--CARNAAE-01 14179 14179 Aetna Radiology ClaimsCareCore National LLC CNE--CARNAOX-01 14180 14180 Oxford Radiology ClaimsCareCore National LLC CNE--CARECOR-01 14185 14185 Health Net New JerseyCareCore/WCNY RAD CNE--CARECOR-02 14188 14188 WellCare New York, POS 11 Radiology Claims OnlyCareFirst Administrators / NCAS CNE--CARFIAD-01 75191 75191CARELINK MEDICAID CNE--CAREMED-02 25133 25133 Medicaid Claims OnlyCARENET CNE--CARENET-02 25133 25133 new naic 25133CareOregon INC CNE--CAREORE-01 93975 93975CarePlus Health Plans, Inc CNE--CARPLHE-01 65031 65031 Formerly Physicians Healthcare Plans IncCARESOURCE KY CNE--HUMCASO-01 KYCS1 KYCS1 HUMANA CARESOURCE KYCARESOURCE OH CNE--CARESOU-01 31114 31114 OhioCAREWORKS CNE--CAREWOR-01 10010 10010 NOT WORK COMP CLAIMSCARILION CLINIC MEDICARE HEALTH PL CNE--CARCLME-01 77015 77015CAROLINA CARE PLAN INC CNE--CARCAPL-02 29076 29076 OLD NAIC # 57105 NOW 29076CAROLINA CRESCENT HEALTH PLAN CNE--CARCRHE-01 SX191 SX191 Enrollment is required. See payors website.CAROLINA SUMMIT HEALTHCARE CNE--CARSUHE-01 56195 56195CARPENTER'S HEALTH & WELFARE TRUST FUND OF ST. LOUIS CNE--CARHEWE-01 25125 25125

Utilizes CMR Network - Claims printed and mailed to the payor

CBA BLUE CNE--CBABLUE-01 03036 03036CBCA ADMINISTRATORS CNE--CBCAADM-01 55438 55438CBSA CNE--CBSA---01 41124 41124 CORPORATE BENEFIT SERVICES OF AMERICACCSTPA - COMPREHENSIVE CARE SERVICES B----MINNESO-01 MNBCS 00720 CLAIMS GO TO BLUE SHIELD OF MINNESOTA

CDO TECHNOLOGIES CNE--CDOTECH-01 83028 83028 83028 NEW PAYER ID



CDS GROUP HEALTH CNE--CDSGRHE-01 88022 88022CEDARS-SINAI MEDICAL NETWORK SVS CNE--CEDSIME-02 95166 95166CELTIC INSURANCE CNE--CELTINS-01 68063 68063CeltiCare CNE--CELTICA-01 68060 68060

CEMENT MASONS & PLASTERERS H&W CNE--CEMMAPL-01 91136 91136 Group Number (F16) req'd on claim

CENPATICO BEHAVIORAL HEALTH CNE--CENBEHE-02 68048 68048Arizona Enrollment is required. Call 800-225-2573 ext.25525

CENPATICO BEHAVIORAL HEALTH CNE--CENBEHE-01 68047 68047KANSAS Enrollment is required. Call 800-225-2573 ext.25525

CENPATICO BEHAVIORAL HEALTH CNE--CENBETX-01 68053 68053 TEXAS Call payer prior to sending claims 800-716-5650

CENPATICO FLORIDA CNE--CENPAFL-01 68058 68058

CENPATICO GEORGIA CNE--CENPGEO-01 68050 68050 Enrollment is required. Call 800-225-2573 ext.25525

CENPATICO INDIANA CNE--CENPIND-01 68052 68052

Call Provider Relations Dept at Prior to submitting claims, please call Provider Relations Dept at 1-877-647-4848 to verify your provider info is on file in the claim system

CENPATICO KANSAS CNE--CENPAKS-01 68047 68047Call Provider Relations Dept at 1-866-896-7293 to verify your provider info is on file in the claim system

CENPATICO MASSACHUETTS CNE--CENPAMA-01 68061 68061

CENPATICO OHIO CNE--CENPAOH-01 68051 68051

CENPATICO SOUTH CAROLINA CNE--CENPASC-01 68059 68059

CENPATICO - WI CNE--CENPAWI-01 68046 68046

CENTENE ADVANTAGE PLANS CNE--CENADPL-01 68056 68056

CENTEGRA HEALTH SYSTEMS CNE--CENHESY-01 36474 364748/1/2014 AND AFTER Valence Health Purchased Centegra all claims on or after 8/1/2014 dos

CENTRAL BENEFITS LIFE CNE--CENBELI-01 31118 31118CENTRAL BENEFITS MUTUAL CNE--CENBEMU-01 31118 31118CENTRAL BENEFITS NATIONAL CNE--CENBENA-01 31118 31118

CENTRAL RESERVE LIFE CNE--CENRELI-01 34097 34097Payer Does not accept Secondary/Tertiary claims electronically

CENTRAL RESERVE LIFE MEDICARE SUPPLEMENT CNE--CENRESU-01 13193 13193CENTRAL SeniorCare CNE--CENTSEN-01 62218 62218



CENTRAL STATES H & W FUNDS CNE--CENSTHE-01 36215 36215Claims may go to your Local Blue for this payer - please call the provider help line for additional information

CENTRAL VALLEY MEDICAL GROUP CNE--CENVAME-01 E3510 E3510ONLY CLAIMS FROM NORTHERN CALIFORNIA PROVIDERS

CENTRAL VALLEY MEDICAL GROUP CNE--CENVAME-02 77035 77035CENTURY HEALTH SOLUTIONS CNE--CENHESO-01 48120 48120CERNER HEALTHPLAN SERVICES CNE--CERHESE-01 20356 20356CHA HEALTH CNE--CHAHEAL-01 23171 23171 Commonwealth Health AllianceCHAMPVA - HAC CNE--CHAMPVA-01 84146 84146 This payor does not process Tricare ClaimsCHAUTAUQUA COUNTY HEALTHCARE P CNE--CHACOHE-01 16600 16600 Mayville, NYCHC CARES OF SOUTH CAROLINA CNE--CHCSOCA-01 25151 25151CHESAPEAK LIFE INS CO CNE--CHELIIN-01 59223 59223 ONLY: PO Box 982017, North Richland Hills, TX 76182CHESTERFIELD RESOURCES INC CNE--CHESRES-01 34154 34154CHILDREN FIRST MEDICAL GROUP CNE--CHIFIMG-01 94321 94321CHILDREN OF WOMEN VIETNAM VETERANS - VA HAC CNE--CHIWOVI-01 84146 84146 Claims are printed and mailed to payorCHILDREN'S MEDICAL SERVICES CNE--CHIMESE-01 37314 37314 North Broward Hospital District (Florida)CHINESE COMMUNITY HEALTH PLAN CNE--CHICOHE-01 94302 94302 CCHP Provider ID req'd. Call payor prior to sendingCHIROCARE LANDMARK CPT--CCLNDMK-01 LNDMK LNDMKCHOC CHILDRENS HOSPITAL OF ORANGE COUNTY HEALTH ALLIANCE CNE--CHIHOOR-01 33065 33065CHOICE ONE UTMB CHIP HEALTH PLAN CNE--CHOIONE-01 76049 76049 CALL PAYOR PRIOR TO SENDINGCHP DIRECT SUPERMED CNE--CHPDISU-01 90441 90441

CHP/RPU (FABOH) CNE--CHPRPUF-01 39112 39112Commonwealth Health Plan Repricing Unit. All providers may file in or out of network

CHRISTIAN BROTHERS SERVICES CNE--CHRBRSE-02 38308 38308CHRISTIAN BROTHERS SERVICES CNE--CHRBRSE-01 61271 61271CHUBB & SONS CCV--CHUBBSO-01 20281 20281CHUBB SERVICES CCV--CHUBBSE-01 20346 20346CIGNA CNE--CIGNA---01 62308 62308 ALSO CIGNA PPA, Cigna Great WestCIGNA BEHAVIORAL HEALTH CNE--CIGBEHE-01 SX071 SX071 BEHAVIORAL HEALTH ONLYCIGNA HEALTH PLAN HMO CNEH-CIGHEPL-01 62308 62308CIGNA PPO CNEP-CIGNAPP-01 62308 62308CIGNA MEDICARE ADVANTAGE CNE--CIGHESE-01 86033 86033 CIGNA HEALTHCARE FOR SENIORSCITRUS VALLEY PHYSICIANS MEDICAL GROUPCNE--COMMASE-01 CMSI1 CMSI1

CLAIMSBRIDGE WEST CNE--CLAIWES-01 11752 11752CLAIMSHOP - EMPLOYERS COALITION ON HEALTH CNE--CLAIMSH-01 27008 27008

ClaimsWare, INC. CNE--CLAWAIN-01 57080 57080 DBA ManageMed

CLARENDON'S HEALTHY KIDS CNE--CLAHEKI-01 33192 33192

CLARIAN HEALTH PLANS CNE--CLAHEPL-01 95444 95444CLEARCHOICE HEALTH PLAN CNE--CLEHEPL-01 77201 77201 COIHSCLUBMD CNE--CLUBMD--01 37272 37272CM ADMINISTRATORS, INC CNE--CMADMIN-01 56211 56211



CMCS ADVANTAGE HEALTH SOLUTIONS MEDICARE ADVANTAGE C----CMCSMCA-01 35219 35219 Live pipeline with Availity 9/2014Coastal Administrative Services CNE--COAADSE-01 77052 77052COFINITY CNE--COFINIT-01 38335 38335COLONIAL HEALTHCARE CNE--COLOHEA-01 37123 37123COLONIAL MEDICAL CNE--COLOMED-01 22284 22284COLORADO ACCESS CNE--COLOACC-01 84129 84129COLUMBIA UNITED PROVIDERS CNE--COLUNPR-01 91162 91162COMBINED MANAGEMENT SERVICES CNE--COMMASE-01 CMSI1 CMSI1COMMERCE BENEFITS GROUP CNE--COMBEGR-01 34181 34181COMMONGROUND CAC--COMMGRO-01 77170 77170 ACS EDI GATEWAY COMMONWEALTH CARE ALLIANCE CNE--COMCAAL-01 14315 14315COMMUNITY CARE ALLIANCE C----CCAI----01 CCAI CCAI Live pipeline with Availity 9/2014COMMUNITY CARE BHO CNE--COMCBHO-01 23282 23282

COMMUNITY CARE INC CNE--COMMCAR-01 60995 60995FAMILY CARE WISCONSIN - Must be contracted with this payer to be paid

COMMUNITY CARE MANAGED CARE OK CNE--COMCAMA-01 73143 73143 Managed Health Care Plans of Oklahoma

COMMUNITY CARE ORGANIZATION CNE--COMCAOR-01 39126 39126PACE - Wisconsin - must be contracted with this payer to be paid

COMMUNITY CARE PLUS CNE--COMCAPL-01 71079 71079 KNA Molina Healthcare of MissouriCOMMUNITY CHOICE OF MICHIGAN CNE--COMCHMI-01 38325 38325COMMUNITY HEALTH ALLIANCE CNE--COMHEAL-01 35193 35193COMMUNITY HEALTH CHOICE CNE--COMHECH-01 48145 48145COMMUNITY HEALTH ELE. PLANS CNE--COMHEEL-01 75261 75261 CHEC

COMMUNITY HEALTH NETWORK CT CNE--COMHECT-01 62149 62149 Anesthesia claims must go paperCOMMUNITY MEDICAL GROUP OF THE WEST VALLEY, INC

CNE--COMMEGR-01 66121 66121CommunityConnect HealthPlan

SEND TO BLUE

SEND ALL DOS JULY 1,2014 AND AFTER TO YOUR LOCAL BLUE SHIELD ALL DOS PRIOR TO 7/1/2014 SEND TO PAYER # 95192

COMPMED CNE--COMPMED-01 73145 73145 AKA Preferred Community ChoiceCOMP - OHIO CNE--COMPOHI-01 34177 34177 Austintown, OHCompBenefits CORPORATION CNE--COMPCOR-01 37297 37297CompCare CNE--COMPCAR-01 95192 95192 Accepts Medicaid ClaimsCOMPREHENSIVE BEHAVIORAL CARE CNE--COMBECA-01 59314 59314COMPREHENSIVE BENEFITS ADMIN CNE--COMBEAD-01 03036 03036 KNA CBA BLUEConnectiCare, INC. CNE--CONNECT-01 06105 06105ConnectiCare - MEDICARE CNE--CONNMCR-01 78375 78375

CONNECTICUT CARPENTERS HEALTH FUND CNE--CONCAHE-01 37307 37307CONNECTICUT GENERAL LIFE INS CNE--CONGELI-01 62308 62308CONSOCIATE GROUP CNE--CONGROU-01 37135 37135CONSOLIDATED ASSOC RAILROAD CNE--CONASRR-01 75284 75284CONSOLIDATED HEALTH PLANS CNE--CONHEPL-01 87843 87843CONSUMER MUTUAL OF MICHIGAN CNE--CONMUMI-01 58112 58112CONSUMERS LIFE INSURANCE PLANS CNE--CONLIIN-01 29076 29076



CONTINENTAL GENERAL INS CO CNE--CONGEIN-01 71404 71404Payer Does not accept Secondary/Tertiary claims electronically

CONTINENTAL KEY FAMILY CNE--CONKEFA-01 35315 35315CONTRACTORS LABORERS TEAMSTERS & ENGINEERS CNE--CONLATE-01 47046 47046COOK GROUP HEALTH PLAN CNE--COOGRHE-01 35149 35149COOPERATIVE BENEFIT ADMIN CNE--COOBEAD-01 52132 52132 CBA

COOPERATIVE MANAGED CARE SERVICES CNE--COOMACA-01 35199 35199

EDI Enrollment Req'd Call Payor ST ANTHONY MEMORIAL, ST CATHERINE HOSPITAL, ST FRANCIS & ST MARGARET MERCY CMCS CUST SERV 800-352-7502

COORDINATED MEDICAL SPECIALISTS CNE--COOMESP-01 58204 58204CORE ADMINISTRATIVE SERVICES CNE--CORADSE-01 58231 58231CORE MANAGEMENT RESOURCES GRP CNE--CORMARE-01 58231 58231

CORESOURCE AZ MN CNE--CORAZMN-02 35182 35182NEW NAIC ONLY Arizona & Minnesota Addresses 800-689-0106

CORESOURCE LITTLE ROCK CNE--CORLITT-01 75136 75136 Little Rock, Arkansas only 800-689-0106

CORESOURCE OF NC IN CNE--COROFNC-01 35182 35182Claims mailing address in NorthCarolina or Indiana *New Payor 5 digit 800-689-0106

CORESOURCE PA MD IL CNE--CORPAMD-01 35182 35182Claims mailing address in Maryland, Penn or Illinois 800-689-0106

CORESOURCE, IOWA CNE--CORPAMD-01 35182 35182PO BOX 2920, CLINTON, IOWA MAILING ADDRESS ONLY 800-689-0106

CORESOURCE, IOWA CNE--COROFOH-01 35183 35183PO BOX 279, SHELDON, IOWA MAILING ADDRESS ONLY 800-689-0106

CORESOURCE OHIO CNE--COROFOH-01 35183 35183 Claims mailing address in Ohio only 800-689-0106CORESOURCE - INTERNAL CNE--CORSOUR-01 35187 35187CORIZON INC CNE--CORIZON-01 43160 43160CORNERSTONE BENEFIT ADMINISTRATO CNE--CORBEAD-01 35202 35202

CORPORATE BENEFIT SRV. OF AMER CNE--CORBESE-01 41124 41124 Only: PO Box 27267, Minneapolis, MN 55427

CORPORATE BENEFITS SVCS., INC CNE--CORBESE-02 56116 56116 Only: PO Box 12953, Charlotte, NC 28220 CORPORATE SYSTEMS ADMINI CNE--CORSYAD-01 37246 37246CORRECTIONAL MEDICAL SERVICES CNE--CORMESE-01 43160 43160

CorVel Corporation

SEE PAYORS: COUNTRY CASUALTY INS CO, STATE FUND MUTUAL INS, RTW, WESTERN NATIONAL ASSURANCE, WESTERN NATION MUTUAL

COUNTRY CASUALTY INS C/O CORVEL INS CCV--COCAINS-01 20982 20982COUNTRY LIFE INSURANCE CNE--COULIIN-01 62553 62553

COUNTY CARE - COOK COUNTY, IL CNE--COUNCAR-01 60827 60827

CountyCare accepts both claims and encounters. CountyCare Provider Help Desk: 312-864-8200 or toll free 855-444-1661. Available M-F 8am-8pm, and Sat 9am-2pm

COVENANT ADMINISTRATORS INC CNE--COVADGA-01 58102 58102 Atlanta, GA



COVENTRY ADVANTRA CNE--COVENTR-01 25133 25133Texas, New Mexico, Arizona Payor ID change from 25152 to 25133

COVENTRY HLTH AND LIFE INS CNE--COVHELI-01 25133 25133 Oklahoma COVENTRY HLTH AND LIFE INS CNE--COVENTR-01 25133 25133 TENNESSEE Payor ID change from 25141 to 25133COVENTRY HLTH CARE DE CNE--COVENTR-01 25133 25133 Delaware Payor ID change from 25130 to 25133COVENTRY HLTH CARE GA CNE--COVENTR-01 25133 25133 Georgia - Payor ID change from 25127 to 25133COVENTRY HLTH CARE IA CNE--COVENTR-01 25133 25133 Iowa - Payor ID change from 25132 to 25133COVENTRY HLTH CARE KS CNE--COVHEKS-01 25133 25133 KansasCOVENTRY HLTH CARE LA CNE--COVENTR-01 25133 25133 Lousiana Payor ID change from 25135 to 25133COVENTRY HLTH CARE NE CNE--COVENTR-01 25133 25133 Nebraska Payor ID change from 25136 to 25133COVENTRY HLTH CARE Nevada CNE--COVENTR-01 25133 25133 Nevada Payor ID change from 25149 to 25133COVENTRY HLTH CARE NATIONAL NETWORK CNE--COVENTR-01 25133 25133

FKA FIRST HEALTH DIRECT Payor ID change from 87043 to 25133

COVENTRY MISSOURI CNE--COVENTR-01 25133 25133 Payor ID change from 87043 to 25133CREATIVE MEDICAL SYSTEMS CNE--CREMESY-01 64068 64068CREATIVE PLAN ADMINISTRATORS CNE--CREPLAD-01 37320 37320

CROY-HALL MGMT INC CNE--CROHAMG-01 37266 37266

Billing Submission address only: PO Box 982005, Ft. Workth, TX 76182 - Unique Policy Number or ID Card Number Req'd

CTI ADMINISTRATORS INC CNE--CTIADMI-01 42141 42141CWIBENEFITS INC CNE--CWIBEIN-01 57080 57080CUSTOM DESIGN BENEFITS INC CNE--CUSDEBE-01 82056 82056D. H. EVANS & ASSOC CALL PROMPT FOR ASSISTANCEDART CONTAINER CORP CNE--DARTCON-01 TH073 TH073DART MANAGEMENT CORP CNE--DARTMAN-01 06172 06172DC CHARTERED HEALTH PLAN INC CNE--DCCHAHE-01 95748 95748 Medicaid & Alliance

DEANCARE HMO C--H-DEANCAR-01 DNCAH

EDI enrollment req'd INCLUDES: CHILDRENS COMMUNITY MEDICAID PO BOX 56099, MADISON, WI 53705

DEFINITY SERVICES CNE--DEFINSE-01 64159 64159 AKA Definity Health

DELANO IPA CNE--DELAIPA-01 77124 77124DELAWARE PHYSICIANS CARE INC CNE--DELPHCA-01 27009 27009DELTA HEALTH SYSTEMS CNE--DELHESY-01 94235 94235DENVER HEALTH MEDICAID CHOICE CNE--DENHEMC-01 84133 84133 AKA Denver Health & Hospital AuthorityDENVER HEALTH - INDIGENT CNE--DENHEIN-01 84134 84134DENVER HEALTH MEDICAL PLAN CNE--DENHEME-01 84135 84135

DENVER HEALTH MEDICAL PLAN - MEDICARE CHOICE CNE--DENHEME-02 84131 84131 MEDICARE CHOICEDETROIT MEDICAL CENTER CNE--DETMECE-01 56240 56240DIAMOND PLAN CNE--DIAMPLA-01 25131 25131 Maryland MedicaidDiaTri LLC CNE--DIATRIL-01 36439 36439DIRECT ASSIGNMENT BENEFIT PLANS CNE--DIRASBE-01 33192 33192DIRECTORS GUILD OF AMERICA CNE--DIRGUAM-01 23706 23706 Producer Health Plan



DIVERSIFIED GROUP BROKERAGE CNE--DIVGRBR-01 06102 06102AKA Diversified Administration Corp Payor ID should be on Members card - 06102

DME REGION B M----DMEREGB-01 DMERB

Call Prompt Prior to Sending; Provider Enrollment Req'd Durable Medical Equipment - Region B IL, IN, KY, MI, MN, OH, and WI

DREYER HEALTH CNE--DREYHEA-01 DREYR DREYRDRISCOLL CHILDRENS HEALTH PLAN CNE--DRICHHE-01 74284 74284DUNN AND ASSOCIATES BENEFITS ADMINISTRATORS INC CNE--DUNNBEN-01 35186 35186

E-V BENEFITS MANAGEMENT, INC CNE--EVBENMA-01 34159 34159Only: PO Box 94928 or PO Box 89476 Cleveland, OH 44101 KNA Meritain Health

EASTLAND MEDICAL GROUP CNE--EASMEGR-01 66122 66122EASTLAND MEDICAL GROUP CNE--COMMASE-01 CMSI1 CMSI1EBC CNE--EBCTPA1-01 37257 37257 www.ebctpa.com (440) 262-1160.EBMC CNE--EBMC----01 31074 31074ELDER HEALTH PLAN CNE--ELDHEIN-01 52192 52192 Pennsylvania & Maryland HMOElderPlan INC CNE--ELDPLIN-01 31625 31625 Provider ID req'dElmcare LLC CNE--ELMCALL-01 36399 36399ELMCO CNE--ELMCO---01 37253 37253EMERALD HEALTH NETWORK CNE--EMEHENE-01 34167 34167 All PPO BusinessEMI-KP AMBULANCE CLAIMS CNE--EMIAMCL-01 59299 59299EMPLOYEE BENEFIT CLAIMS OF WISCONSIN CNE--EBCTPA1-01 37257 37257 www.ebctpa.com (440) 262-1160.EMPLOYEE BENEFIT CONCEPTS, INC CNE--EMPBECO-01 38241 38241 Farmington Hills, MIEMPLOYEE BENEFIT CONSULTANTS CNE--EBCTPA1-01 37257 37257 www.ebctpa.com (440) 262-1160.EMPLOYEE BENEFIT CORPORATION CNE--EMPBECO-02 37215 37215EMPLOYEE BENEFIT MGMT CORP CNE--EMPBEMA-02 31074 31074 EBMC - www.ebmconline.comEMPLOYEE BENEFIT SERVICES CNE--EMPBESE-01 37216 37216 MAILING ADDRESS: FT. MILLS, SCEMPLOYEE BENEFIT SERVICES OF LOUISIANACNE--EMPBESE-02 41198 41198 EBS OF LOUISIANAEMPLOYEE BENEFIT SYSTEMS CNE--EMPBESY-01 42149 42149EMPLOYEE BENEFITS PLAN ADMINISTRATION, INC CNE--EMPBEPL-01 03036 03036 E.B.P.A.EMPLOYER PLAN SERVICES CNE--EMPPLSE-01 74212 74212EMPLOYERS DIRECT HEALTH CNE--EMPDIHE-01 75232 75232EMPLOYERS DIRECT HEALTH CNE--EMPDIHE-02 75236 75236 Employee PlanEMPLOYERS DIRECT HEALTH - FI CNE--EMPDIFI-01 75235 75235EMPLOYERS DIRECT HEALTH - SF CNE--EMPDISF-01 75233 75233EMPLOYERS HEALTH (EMPHESYS) CNE--EMPHEIN-01 61101 61101 12/1/02 claims go to HumanaEMPLOYERS INS OF WAUSAU CNE--EMPINWA-01 39026 39026EMPLOYERS MUTUAL INC/ FL ONLY CNE--EMPMUIN-01 59298 59298 Jacksonville, FloridaEMPLOYERS MUTUAL INC CNE--EMPMUIN-02 59331 59331 Stuart, Florida Call payor for filing requirementsENCIRCLE PPO CNE--ENCIRCL-01 35206 35206ENCORE HEALTH NETWORK CNE--ENCHENE-01 35206 35206ENH MEDICAL GROUP IPA EVANSTON CNE--ENHMEGR-01 36364 36364

ENSTAR NATURAL GAS CNE--ENSNAGA-01 91136 91136 Group Number (P61) req'd on claims

ENTRUST CNE--ENTRUST-01 36878 36878 Claims Printed and Mailed to PayerEQUICOR PPO CNEP-EQUICOR-01 62308 62308



EQUICOR/EQUITABLE CNE--EQUEQUI-01 62308 62308EQUITABLE(CIGNA) CNE--EQUITAB-01 62308 62308EQUITABLE PLAN SERVICES CNE--EQUPLSE-01 73126 73126 ONLY: PO Box 720460, Oklahoma City, OK 73172ERIN GROUP ADMINISTRATORS CNE--ERIGRAD-01 23250 23250ES BEVERIDGE AND ASSOCIATES CNE--ESBEVAS-01 34108 34108ESSENCE HEALTHCARE CNE--ESSEHEA-01 20818 20818 EVERENCE CNE--EVERENC-01 35605 35605

EVOLUTIONS HEALTHCARE SYSTEMS CNE--EVOHEFL-01 59313 59313Claims billing address only: PO Box 5001, Newport Richey, FL 34656

ExclusiCare CNE--EXCLUSI-01 71412 71412FABOH (CHP/RPU) CNE--FABOHWI-01 39112 39112 Rendering provider and location number req'dFACEY MEDICAL FOUNDATION CNE--FACMEFO-01 95432 95432FACS GROUP CNE--FACSGRP-01 37300 37300FALLON COMMUNITY HEALTH CNE--FALCOHE-01 22254 22254 SX072 OLD # - PLEASE USE 22254FAMILY CARE CNE--FAMICAR-01 60995 60995 WISCONSINFAMILY HEALTH ALLIANCE CNE--CAPMANA-01 CAPMN CAPMNFAMILY HEALTH PARTNERS CNE--FAMHEKS-01 31472 31472 HEALTHWAVE OF KANSASFAMILY HEALTH PARTNERS MC, MO CNE--FAMHEPA-01 43173 43173 MC + MISSOURIFAMILY MEDICAL NETWORK CNE--FAMMENE-01 36396 36396 Call payor prior to sendingFARM FAMILY LIFE CNE--FARFALI-01 14140 14140FCE BENEFIT ADMINISTRATORS CNE--FCEBEAD-01 33033 33033FEDERATED BENEFITS CNE--FEDEBEN-01 37300 37300 AKA FEDERATED HR SERVICESFEDERATED MUTUAL HLTH INS CO CNE--FEDMUHE-01 41041 41041FIDELIS CARE NEW YORK CNE--FIDCANY-01 11315 11315 Provider ID Req'd as secondary IDFIDELIS SECURE CARE CNE--FIDSECA-01 77054 77054FIRST CAROLINA CARE CNE--FIRCACA-01 56196 56196FIRST CHOICE HEALTH NETWORK CNE--FIRCHHE-01 91131 91131 AKA First Choice Health AdministratorsFIRST CHOICE OF MIDWEST - PPO CNE--FIRCHMI-01 75138 75138FIRST HEALTH NETWORK CNE--FIRHENE-01 73159 73159 FKA CCN MANAGED CARE INC & PPO OKLAHOMAFIRST MEDICAL NETWORK CNE--FIRMENE-01 29076 29076 FMN - Atlanta, GA Payor ID Change From 58203 to 29076FIRST PRIORITY CNE--FIRSPRI-01 23241 23241 Enrollment req'd prior to sending claimsFIRST SERVICE ADMINISTRATORS INC CNE--FIRSEAD-01 59276 59276 Also known as Florida 1stFISERV HEALTH - KANSAS/TENNESSEE CNE--FISERHE-01 62061 62061 Also for Trilogy Health payor # 62061 on cardFISERV HEALTH - WAUSAU BENEFITS/BENESIGHT CNE--FISHEWA-01 39026 39026FITZHARRIS & COMPANY CNE--FITZCOM-01 11244 11244FLORIDA 1st CNE--FLORFIR-01 59276 59276 AKA First Service AdministratorsFLORIDA HEALTH CARE PLAN CNE--FLORHCP-01 59322 59322

FLORIDA HOSPITAL HEALTHCARE SYS CNE--FLOHOHE-01 59321 59321Provider network ID req'd - out of network must call payor prior to sending

FLORIDA HOSP WATERMAN EMP BEN CNE--FLOHOWA-01 48116 48116FLORIDA LEAGUE OF CITIES INC CNE--FLOLECI-01 59698 59698FMH BENEFIT SERVICES, INC. CNE--FMHBESE-01 48117 48117FOREIGN SERVICE BENEFIT PLAN CNE--FORSEBE-01 25133 25133FORTIS BENEFITS INC CNE--FORBEIN-01 70408 70408 KNA Union Security Insurance CompanyFOUNDATION BENEFIT ADMINISTRATORS CNE--FOUBEAD-01 BOONG BOONG CONTRACTOR EMPLOYEE BENEFITS ADMINFOX-EVERETT, INC. CNE--FOXEVIN-01 64069 64069FREEDOM FIRST CNE--FREEFIR-01 31313 31313FREEDOM HEALTH PLAN CNE--FREHEPL-01 41212 41212



FRESENIUS MEDICAL CARE CNE--FREMECA-01 23130 23130FRINGE BENEFIT MANAGEMENT CNE--FRIBEMA-01 59069 59069FRINGE BENEFITS COORDINATORS CNE--FRIBECO-01 59204 59204FrontPath HEALTH COALITION CNE--FROHECO-01 34171 34171GALLAGHER BENEFITS ADMIN CNE--GALBEAD-01 37283 37283 GBA KNA American Administrative GroupGALVESTON COUNTY INDIGENT HEALTH CARE CNE--GALCOIN-01 30005 30005GATEWAY HEALTH PLAN - MEDICARE ASSURED CNE--GATHEPL-02 60550 60550

Medicare Assured - check ID card for payor # 60550 - (yellow card)

GATEWAY HEALTH PLAN CNE--GATHEPL-01 25169 25169Medicaid PA. Check ID card for payor # 25169 - (green card)

GBA CNE--GALBEAD-01 37283 37283 GBA KNA American Administrative GroupGEICO - ACCIDENT INSURANCE C----GEICOIN-01 GEICOGEISINGER HEALTH PLAN CNE--GEIHEPL-01 75273 75273 EDI ENROLLMENT REQ'D - Call payorGEMCARE HEALTH PLAN CNE--GEMHEPL-01 20376 20376GEMCARE IPA CNE--GEMCIPA-01 27133 27133GENERATIONS HEALTHCARE CNE--GENEHEA-01 46050 46050GENERATIONS HILLCREST CNE--GENEHIL-01 46051 46051Gettysburg Health CNE--GETTHEA-01 23212 23212 Cinergy Health Plan

GH BASIC HEALTH PLAN CNE--GHBASIC-01 91051 91051 Western Washington State. Payor setup req'd call payor 1st

GH INDIVIDUAL AND FAMILY PLAN CNE--GHINDFA-01 91051 91051 Western Washington State. Payor setup req'd call payor 1st

GHC COMMERCIAL CNE--CHCCOMM-01 91051 91051 Western Washington State. Payor setup req'd call payor 1st

GHC MEDICARE & CHOICE CNE--GHCMECH-01 91051 91051 Western Washington State. Payor setup req'd call payor 1stGHI - MEDICARE PRIVATE FEE FOR SERV CNE--GHIMCRP-01 22937 22937GHI - NEW YORK CNE--GHINY---01 13551 13551 Group Health Inc.GHI HMO SELECT CNE--GHIHMSE-01 25531 25531GI INNOVATIVE MANAGEMENT CNE--GIINMAN-01 58204 58204GIC INDEMNITY PLAN CNE--GICINPL-01 80314 80314GILSBAR, INC. CNE--GILSBAR-01 07205 07205

GLOBAL CARE INC CNE--GLOBCAR-01 07689 07689

Allied National mailing adderss: PO Box 247, Alpharetta, GA 30009 And all other Claims for Payer ID 07689

GMS, INC CNE--GMSINCO-01 47083 47083GLASSWORKERS HEALTH & WELFARE CNE--GLAHEWE-01 91136 91136 Group Number (F29) req'dGOLDEN RULE INSURANCE CO. CNE--GOLRUIN-01 37602 37602 NKA - UnitedHealthOneGOLDEN TRIANGLE PHYSICIAN ALLIANCE CNE--GOLTRPH-01 72189 72189 SELECTCARE OF TEXAS (GTPA)GOOD SHEPHERD HOSPICE INC CNE--GOOSHHO-01 76923 76923GOV'T EMPLOYEES HOSP ASSOC CNE--GOVEMHO-01 44054 44054 GEHAGREAT LAKES HEALTH PLAN CNE--GRELAHE-01 95467 95467GREAT-WEST HEALTHCARE CNE--FIRGRWE-01 80705 80705GREAT-WEST HEALTHCARE CNE--GREWEHE-02 63665 63665 Formerly General AmericanGREAT-WEST LIFE ASSURANCE CO. CNE--GREWELI-01 80705 80705 AKA Great-West HealthcareGROUP ADMINISTRATORS, LTD. CNE--GROADLT-01 36338 36338GROUP AND PENSION ADMIN CNE--GROPEAD-01 48143 48143



GROUP HEALTH COOP MADISON,WI CNE--GROHEWI-01 39167 39167 South Central WisconsinGROUP HEALTH COOPERATIVE CNE--GHEAUCL-01 95192 95192 Eau Claire, Wisconsin

GROUP HEALTH COOP. WEST CNE--GROHECO-01 91051 91051 Western Washington State. Payor setup req'd call payor 1stGROUP HEALTH COOPERATIVE CNE--GROHECO-03 39167 39167 South Central Wisconsin www.ghcscw.comGROUP HEALTH INC. (GHI) CNE--GROHEIN-02 13551 13551 New YorkGROUP HEALTH INC. (GHI) CNE--GHIMCRP-01 22937 22937 MEDICARE PRIVATE FEE FOR SERVGROUP HEALTH MANAGERS CNE--GROHEMA-01 38194 38194

GROUP HEALTH OPTIONS INC CNE--GROHEOP-01 91051 91051 Western Washington State. Call Payor prior to sendingGROUP INSURANCE SERVICE CENTER CNE--GROINSE-01 37276 37276GROUP PRACTICE AFFILIATES CNE--GROPRAF-01 68046 68046 Enrollment req'd prior to sending claimsGUARDIAN HEALTHCARE CNE--GUARHEA-01 77010 77010 SCGUARDIAN LIFE INS CO AMERICA CNE--GUALIIN-01 64246 64246H.E.R.E.I.U WELFARE FUND CNE--HEREIU--01 37114 37114HAA PREFERRED PARTNERS CNE--HAAPRPA-01 65101 65101HAP/AHL/CURANET CNE--HAPAHLC-01 38224 38224 Provider ID requiredHARRINGTON BENEFIT SERVICES CNE--HARBESE-01 95266 95266 Harrington; RE HarringtonHARRINGTON HEALTH-KANSAS- FNA FiServe Health-Kansas CNE--FISERHE-01 62061 62061 Formerly Willis Admin Services CorpHARRINGTON HEALTH NON EPO CNE--HARRHEA-01 59143 59143HAWAII MANAGEMENT ALLIANCE ASSO CNE--HAWMAAL-01 99208 99208 HMAAHCH ADMINISTRATION CNE--HCHADMI-01 37111 37111 ILLINOIS - CLAIMS PIPELINE TO RELAY HEALTH 2013HCH ADMINISTRATION CNE--HCHADMI-02 37215 37215 Formerly John P Pearl AssociatesHCHA ALBQ NM SELF FUNDED CNE--HCHALNM-01 37329 37329HCN CNE--HEACANE-01 42102 42102 Health Care Network of Wisconsin - Health EOSHCS - HEALTH CLAIMS SERVICE CNE--HEACLSE-01 82018 82018 BOISE, IDHDPC - PREMIER HEALTHCARE CNE--PREMHEA-01 90023 90023HDPC/ALLIANCE PHYSICIANS CNE--ALLIPHY-01 20257 20257HEALTH ADMINISTRATION SERVICE CNE--HEAADSE-01 34185 34185HEALTH ALLIANCE MEDICAL PLANS CNE--HEAALME-01 77950 77950 Pipeline change to Relay Health Nov 2011HEALTH AMERICA, INC CNE--HEALAME-01 25133 25133 AKA ADVANTRAHEALTH CARE NETWORK OF WISCONSIN CNE--HEACANE-01 42102 42102 HCN - Located in WisconsinHEALTH CHOICE GENERATIONS CNE--HEACHGE-01 62180 62180HEALTH COST SOLUTIONS CNE--HEACOSO-01 62111 62111HEALTH DESIGN PLUS CNE--HEADEPL-01 34158 34158 Hudson, OhioHEALTH EOS CNE--HEALEOS-01 34080 34080 also know as MultiplanHEALTH EZ CNE--HEALTEZ-01 16120 16120HEALTH FIRST TPA - -TYLER,TEXAS. CNE--HEAFITX-01 75234 75234HEALTH MARKET CARE ASSURED CNE--HEAMACA-01 62295 62295HEALTH NET ARIZONIA CNE--HEANEAZ-01 38309 38309 Unique Provider ID req'dHEALTH NET OF CA. CNE--HEANECA-01 95567 95567 Contact Payor prior to sendingHEALTH NET OF THE NORTHEAST CNE--HEANENE-01 06108 06108HEALTH NET OREGON CNE--HEANEOR-01 95567 95567 Contact Payor prior to sendingHEALTH NETWORK ONE CNE--HEANEON-01 65062 65062HEALTH OPTIONS OF ILLINOIS CNE--HEAOPIL-01 36368 36368HEALTH PARTNERS MINNESOTA CNE--HEAPAMN-01 SX009 SX009 ENROLL REQ'D CALL PROMPT FOR ASSIST.HEALTH PARTNERS (TN) CNE--HEAPATN-01 62157 62157 Jackson, Tennessee



HEALTH PARTNERS OF PHILADELPHI CNE--HEAPAPH-01 80142 80142 Provider Network ID req'dHEALTH PAYMENT SYSTEMS INC CNE--HEAPASY-01 20270 20270HEALTH PLAN MANAGEMENT SERVICES CNE--HEAPLMA-02 63719 63719 HPMSHEALTH PLAN OF MICHIGAN CNE--HEAPLMI-01 83253 83253HEALTH PLAN OF SAN JOAQUIN CNE--HEAPLSJ-01 68035 68035

HEALTH PLANS INC CNE--HEAPLIN-01 44273 44273 Claims are printed and mailed to payorHEALTH PLUS PHSP CNE--HEAPLPH-01 11324 11324 Brooklyn, NY Call payor prior to sending claimsHEALTH RIGHT CNE--HEALRIG-01 52201 52201HEALTH RISK MANAGEMENT CNE--HEARIMA-02 55438 55438HEALTH SERVICES CONSULTING GROUP INC CNE--HEASECO-01 20896 20896HEALTH SERVICES FOR CHILDREN WITH SPECIAL NEEDS CNE--HEASECH-01 37290 37290

HEALTH SERVICES MANAGEMENT CNE--HEASEMA-01 41150 41150EDI Enrollment Required. Call Prompt prior to sending claims. Chiropractic claims only HSM/WEA

HEALTH SERVICES PREFERRED CNE--HEASEPR-01 34167 34167 by Emerald HealthHEALTH SYSTEMS INTERNATIONAL CNE--ECOHHSI-01 27008 27008 ECOH - Employers Coalition on Health - ClaimshopHEALTH VALUE MANAGEMENT - DE CNE--HEAVAMA-01 61101 61101 HumanaHEALTHCARE PARTNERS, IPA CNE--HEAPAIP-01 11328 11328 Formerly Heritage New York Medical GroupHEALTHCARE RESOURCES NW CNE--HEACARE-01 56731 56731HEALTHCARE SOLUTIONS GROUP CNE--HEASOGR-01 73147 73147HEALTHCARE USA CNE--HEACAUS-01 25143 25143HEALTHCHOICE OF AZ CNE--HEACHAZ-01 62179 62179 ARIZONAHEALTHCOMP INC CNE--HEACOIN-01 85729 85729HealthEZ CNE--HEALTEZ-02 41178 41178HEALTHFIRST HEALTH PLAN - NJ CNE--HEAFINJ-01 80141 80141 NEW JERSEY - PROVIDER NUMBER REQ'DHEALTHFIRST TPA CNE--HEALFTX-02 34185 34185 Houston, TXHEALTHFIRST TPA - TYLER, TX CNE--HEALFTX-01 75234 75234HEALTHFIRST, INC NEW YORK CNE--HEAFINY-01 80141 80141 Provider Network ID Req'dHEALTHGROUP LIMITED CNE--HEALLIM-01 23274 23274HEALTHHELP NETWORKS, INC CNE--HEANETI-01 59087 59087 HHNI NKA The National Radiology NetworkHEALTHLINK HMO CNE--HEALHMO-01 96475 96475 Provider Network ID RequiredHEALTHLINK PPO CNE--HEALPPO-01 90001 90001 Will accept claims from Non Participating providersHEALTHPLAN SERVICES TAMPA ONLY CNE--HEAPLSE-01 59140 59140HealthPartners MN CNE--HEAPAMN-01 SX009 SX009 Enrollment is req'd prior to sending - call PromptHEALTHPLUS MICHIGAN C----HEAPLMI-01 HPLMI Enrollment is req'd prior to sending - call PromptHEALTHSCOPE BENEFITS CNE--HEASCBE-02 71063 71063

HEALTHSCOPE BENEFITS - EHC REPRICING CNE--HSREPRI-01 52429 52429HEALTHSMART ACCEL CNE--HEASMAC-01 75237 75237HEALTHSMART BENEFIT SOLUTIONS CNE--HEASMBE-01 37283 37283HEALTHSMART PREFERRED CARE CNE--HEASMPR-01 75250 75250 HealthSmart RepricingHEALTHSOURCE - SC CNE--HEASOSC-01 06119 06119 Network providers onlyHEALTHSOURCE CMHC CNE--HEACMNC-01 02041 02041HEALTHSOURCE MASSACHUSETTS CNE--HEAMAIN-01 02041 02041HEALTHSOURCE NORTH TEXAS CNE--HEANOTX-01 75255 75255HEALTHSOURCE OHIO CNE--HEAOHIO-01 31141 31141



HEALTHSOURCE PROV. ADMIN. CNE--HEASOPR-01 68195 68195HEALTHSOURCE PROV. INS. CO. CNE--HEASOPI-01 68195 68195HEALTHSOURCE, ARK. MEDICARE CNE--HEAARME-01 71075 71075HEALTHSOURCE, GEORGIA CNE--HEASOGA-01 58210 58210HEALTHSOURCE, KY, INC. CNE--HEAKEIN-01 61127 61127HEALTHSOURCE, MAINE CNE--HEASOMA-01 01041 01041 Provider Network ID RequiredHEALTHSOURCE, NC, INC. CNE--HEANOCA-01 56147 56147HEALTHSOURCE, NH CNE--HEASONH-01 02038 02038 Provider Network ID RequiredHEALTHSOURCE, TENNESSEE, INC. CNE--HEALTTN-01 62129 62129HEALTHSPAN NETWORK REPRICING CNE--HEANERE-01 HSPAN HSPANHealthSpring CNE--HEALSPR-01 33104 33104

HEALTHSPRING OF ALABAMA- HMO CNE--HEASPAL-01 63092 63092Also, Healthspring Medicare + Choice - send all claims electronically - no prior contact with payer req'd

HEALTHSTAR CNE--HEASTAR-01 36332 36332

HEALTHWAYS WHOLE HEALTH NETWORKS CNE--HEAWHHE-01 58213 58213

HEALTHY OPTIONS DSHS CNE--HEALOPT-01 91051 91051 Western Washington State. Call payor prior to sending

HEALTHY TEXAS CNE--HEALTEX-01 68064 68064

HealthyCT CNE--HEALTHY-01 77180 77180HERITAGE CONSULTANTS FL CNE--HEACOFL-01 59230 59230 9 digit subscriber number req'dHERITAGE NEW YORK MEDICAL GRP CNE--HERNYME-01 11328 11328 KNA HealthCare Partners, IPAHEWITT COLEMAN CNE--HEWICOL-01 88051 88051HFN, INC. OAK BROOK IL CNE--HFNINC--01 36335 36335HIGH DESERT PRIMARY CARE CNE--HIGDEPR-01 33069 33069HIGHMARK - KEY FAMILY CNE--HIGHMAR-02 35145 35145HILL PHYSICIANS MEDICAL GROUP CNE--HILPHME-01 00046 00046 HINSDALE PHYSICIAN HEALTHCARE CNE--HINSPHE-01 36385 36385HIP - HEALTH INS PLAN GR NY CNE--HIPGRNY-01 55247 55247 Provider enrollment req'dHMPK, INC. CNE--HMPKINC-01 61101 61101HOLY CROSS HEALTH PARTNERS CNE--HOLCRHP-01 36412 36412HOMETOWN HEALTH PLAN - NEVADA CNE--HOMHENV-01 88023 88023HOMETOWN HEALTH NETWORK - OH CNE--HOMHENE-01 34150 34150 Referring Provider RequiredHOMETOWN HEALTH PROVIDERS CNE--HOMHEPR-01 88537 88537HORIZON BC/BS OF NEW JERSEY CNE--HORBCBS-01 22099 22099HORIZON HEALTHCARE ADMIN CNE--HORHECA-01 22304 22304 HHA AKA Horizon Inner Circle Tier 1/RayantHORIZON MERCY CNE--HORIMER-01 22326 22326 Medicaid managed care AKA Horizon NJ HealthHOSPITAL BENEFITS INC CNE--HOSPBEN-01 37274 37274HOTEL EMPLOYEES & RESTAURANT EMPLOYEES HEALTH TRUST CNE--HOTREEM-01 91136 91136 Group Number (F19) req'dHPLAN, INC. CNE--HPLANIN-01 61101 61101

HSHS MEDICAL GROUP IPA CNE--HSHSIPA-01 37137 37137



HSM - WEA INSURANCE C----PRACINS-01 WEA01

Chiropractic Specialty only HSM, Woodbury, MN 55125 EDI ENROLLMENT REQ'D ALL PROVIDERS IN AND OUT OF NETWORK MAY FILE ELECTRONICALLY PLAN CODE REQUIRED IN PLAN NAME "WEA"

HSM - WEA PATIENT CHOICE INSIGHT C----PRACINS-01 WEA01

Chiropractic Specialty only ALL PROVIDERS IN AND OUT OF NETWORK MAY FILE ELECTRONICALLY PLAN CODE REQUIRED IN PLAN NAME "WEA"

HSM - ECOH Plan Code ECOH C----PRACINS-02 ECOH1

Chiropractic Specialty only HSM - 7805 Hudson Rd. #190, Woodbury, MN 55125 EDI ENROLLMENT REQ'D PLAN CODE REQUIRED IN PLAN NAME IN NETWORK PROVIDERS ONLY

HSM - PREFERRED ONE Plan Code PONE C----PRACINS-03 HSMP1

Chiropractic Specialty only HSM - 7805 Hudson Rd. #190, Woodbury, MN 55125 EDI ENROLLMENT REQ'D PLAN CODE REQUIRED IN PLAN NAME IN NETWORK PROVIDERS ONLY

HSM - SELECT CARE /ZENITH PLAN CODE SC C----PRACINS-04 HSMSC

Chiropractic Specialty only ALL PROVIDERS IN AND OUT OF NETWORK MAY FILE ELECTRONICALLY PLAN CODE REQUIRED IN PLAN NAME "SC"

HSM - Benefit Plan Admin Plan Code BPA C----PRACINS-05 HSMBP

Chiropractic Specialty only IN NETWORK PROVIDERS ONLY - OUT OF NETWORK MUST FILE ON PAPER TO: HSM - 7805 Hudson Rd. #190, Woodbury, MN 55125 EDI ENROLLMENT REQ'D PLAN CODE REQUIRED IN PLAN NAME

HSM - Mayo Management Services Plan Code MMSI C----PRACINS-06 MMSI1

Chiropractic Specialty only OUT OF NETWORK FILE ON PAPER ONLY - HSM - 7805 Hudson Rd. #190, Woodbury, MN 55125 EDI ENROLLMENT REQ'D PLAN CODE REQUIRED IN PLAN NAME

HSM - HEALTH TRADITION Plan Code HT C----PRACINS-07 HSMHT HSMHT

Chiropractic Specialty only - IN NETWORK PROVIDERS ONLY - OUT OF NETWORK PROVIDERS MUST FILE ON PAPER TO: HSM - 7805 Hudson Rd. #190, Woodbury, MN 55125 EDI ENROLLMENT REQ'D PLAN CODE REQUIRED IN PLAN NAME

HUDSON HEALTH PLAN CNE--HUDHEPL-01 13335 13335HUMANA CARE PLAN CNE--HUMCAPL-01 61101 61101 Also, Humana Employers HealthHUMANA CARESOURCE KY CNE--HUMCASO-01 KYCS1 KYCS1 MEDICAID KY REPLACEMENT POLICYHUMANA GROUP HEALTH PLAN CNE--HUMGRHE-01 61101 61101 Group and Rendering NPI data req'd by PayorHUMANA HEALTH CHICAGO INS CO CNE--HUMHECH-01 61101 61101 Group and Rendering NPI data req'd by PayorHUMANA HEALTH PLAN CNE--HUMHEPL-01 61101 61101 Group and Rendering NPI data req'd by Payor



HUMANA INSURANCE AGENCY CNE--HUMINAG-01 61101 61101 Group and Rendering NPI data req'd by PayorHUMANA INSURANCE COMPANY CNE--HUMINCO-01 61101 61101 Group and Rendering NPI data req'd by PayorHUMANA INS CO CHOICE CARE NETWORK CNE--HUMCHOI-01 61101 61101 DOES NOT INC HUMANA CHOICECARE OF CINCINNATIHUMANA MEDICAL PLAN-CA CNE--HUMMEPL-01 61101 61101 Group and Rendering NPI data req'd by PayorHUMANA MEDICAL PLAN-KY CNE--HUMMEPL-02 61101 61101 Group and Rendering NPI data req'd by PayorHUMANA MICHEAL REESE HMO IL CNEH-HUMREIL-01 61101 61101 Group and Rendering NPI data req'd by PayorHUMANA MICHEAL REESE HMO IN CNEH-HUMREIN-01 61101 61101 Group and Rendering NPI data req'd by PayorHUMANA VETERANS HEALTHCARE SERVICES CNE--HUMVETS-01 61160 61160HUMANA WISCONSIN HEALTH ORG CNE--HUMWIOR-01 61101 61101 Group and Rendering NPI data req'd by PayorHUMBOLDT-DEL NORTE FOUNDATION FOR MEDICAL CARE CNE--HUMDENO-01 94154 94154I.E. SHAFFER CNE--IESHAFF-01 22175 22175 WEST TRENTON, NJI'Mcare CNE---IMCARE-01 41600 41600IAA CNE--IAACLAI-01 37279 37279IBI CNE------IBI-01 41124 41124ICARE C----NETICAR-01 11695 11695 Independence Care Health PlaniCare Health Options TPA CNE--ICARTPA-01 26054 26054IHG DIRECT CNE--IHGDIRE-01 75274 75274 Claims Submission only: PO Box 2388, Stow, OH 44224ILCBH CNE--ILCBH---01 68065 68065IlliniCare CNE--ILLICAR-01 68066 68066INDECS CORPORATION CNE--INDECCO-01 40585 40585

INDEPENDENCE MEDICAL GROUP - TULARE CNE--INDMEGR-01 26274 26274INDIANA PROHEALTH NETWORK CNE--INDPRHE-01 35161 35161INDIANA TEAMSTERS HLTH BENEFITS CNE--INDTEHE-01 35107 35107 Formerly Local 135 Health Benefits Fund - Indianapolis, ININDIVIDUAL HEALTH INS. CO. CNE--INDHEIN-01 31053 31053INETICO INC CNE--INETICO-01 43471 43471INFORMED LLC/SELF FUNDING ADM CNE--INFSEFU-01 52196 52196INFORMED LLC CNE--INFOLLC-01 96490 96490INFORMED UHC CNE--INFOUHC-01 50946 50946INGALLS PROVIDER GROUP CNE--INGPRGR-01 36348 36348INJURED WORKERS INSURANCE FUND CNE--INJWOIN-01 52212 52212 First time Submitters - call payor prior to sending claimsINNOVANTE BENEFIT ADMINISTRATORS CNE--INNBEAD-01 31172 31172INNOVATIVE HEALTHWARE SERVICES CALL PROMPT TO ENROLLINSURANCE ADMINISTRATIVE SOLUTIONS CNE--INSADSO-01 04204 04204INSURANCE ADMINISTRATORS OF AMERICA, INC. CNE--INSADAM-01 37279 37279INSURANCE DESIGN ADMINISTRATOR CNE--INSDEAD-01 13315 13315

INSURANCE MANAGEMENT SERVICES CNE--INSMASE-01 15688 15688

This Payer ID is only valid for claims with submission address of P.O. Box 15688; Amarillo, TX 79105

INSURERS ADMINISTRATIVE CORP CNE--INSADCO-01 86304 86304INTEGRA ADMINISTRATIVE GROUP (Seaford, DE) CNE--INTADDE-01 51020 51020 Only: 110 S. Shipley St, Seaford, DE 19973INTEGRA GROUP CNE--INTEGRO-01 31127 31127INTEGRA GROUP - CHA CNE--INTEGRO-02 31129 31129INTEGRATED CARE NETWORK CNE--INTCANE-01 34167 34167 ICN by Emerald Health



INTEGRATED MENTAL HEALTH SERVICES CNE--INTMEHE-01 68053 68053 Call Payor Prior to Sending 1-800-716-5650INTEGRITY BENEFIT NETWORK, INC CNE--INTBENE-01 58200 58200 Marietta, GAINTERACTIVE MEDICAL SYSTEMS CNE--INTMESY-01 56132 56132INTERCARE HEALTH PLANS - CO CNE--INTHEPL-01 37227 37227INTERFACE EAP (IEAP) CNE--INTEEAP-01 60280 60280INTERGROUP SERVICES PPO CNE--INTGRSE-01 23287 23287INT'L BROTHERHOOD OF BOILERMAKERS CNE--INTBRBO-01 36609 36609INTERNATIONAL EDUCATIONAL EXCHANGE SERVICES INC CNE--INTEDEX-01 16158 16158 IEESINTERNATIONAL FUNDING LTD CNE--INTEFUN-01 39182 39182

INT'L UNION OPER ENG NEW YORK CNE--INTUNOP-03 64157 64157 Local 15, 15A, 15C & 15D - Located in New York, NY

INTERWEST HEALTH CNE--INTWEHE-01 84137 84137 Acceptius Gateway payerIOWA BENEFITS, INC. CNE--IOWBEIN-01 41124 41124IU MEDICAL GROUP PRIMARY CARE CNE--IUMEDGR-01 SX172 SX172J F MOLLOY & ASSOCIATES CNE--JFMOLAS-01 61271 61271

J. SMITH LANIER AND CO ADMINISTRATORS CNE--JSLADMI-01 37272 37272JACKSON MEMORIAL HEALTH PLAN CNE--JACMEHE-01 05014 05014 FLORIDA JMH Health Plan Commercial HMO

JMH - SFCCN PHT CNE--JMHSFCC-01 09822 09822 PSN CMSN

JOHN DEERE HEATH CARE-HERITAGE CNE--JOHDEHE-01 95378 95378NKA UnitedHealthcare of River Valley ** If Chiropractic claims, call the payer to secure claim filing information

JOHN MORRELL COMPANY CO CNE--JOHMOCO-01 38310 38310 AHPBA

JOHN MUIR MT. DIABLO HEALTH SYSTE CNE--JOHMUMT-01 68036 68036 Registration with payor is required prior to sending

JOHN MUIR PHYSICIAN NETWORK CNE--JOHMUPN-01 68036 68036 Registration with payor is required prior to sending

JOHN MUIR TRAUMA PHYSICIANS CALL PROMPT TO ENROLLJOHN P PEARL & ASSOC LTD CNE--JOHPEAS-01 37215 37215 Now Known as HCH Administration

JOHNS HOPKINS HEALTHCARE CNE--JOHHOHE-01 52189 52189NPI MUST BE SHARED WITH PAYOR PRIOR TO SENDING (EHP/PP)

JOHNS HOPKINS HEALTHCARE CNE--JOHHOHC-01 52123 52123NPI MUST BE SHARED WITH PAYOR PRIOR TO SENDING (USFHP)

JOPLIN CLAIMS CNE--JOPLIN--01 43178 43178JP FARLEY CORPORATION CNE--JPFARCO-01 34136 34136JSL ADMINISTRATORS CNE--JSLADMI-01 37272 37272KAISER CSI CNE--KAISCSI-01 94320 09432 California Select for Individuals FNA Kaiser PPOKAISER FOUNDATION HEALTH PLAN CNE--KAIFOHE-02 91617 91617 ColoradoKAISER FOUNDATION HEALTH PLAN CNE--KAIFOCA-01 94135 94135 Northern CA Region Call payor prior to sendingKAISER FOUNDATION HEALTH PLAN CNE--KAIFOOH-01 34092 34092 OHIOKAISER FOUNDATION MID-ATLANTIC CNE--KAIFOMI-01 52095 52095 Mid-Atlantic States

KAISER FOUNDATION OF THE NORTHWEST CNE--KAIFONW-01 93079 93079 Only for Oregon & Washington MembersKAISER FOUNDATION OF SO. CAL. CNE--KAIFOHE-01 94134 94134 Provider Network ID requiredKAISER PERMENANTE OF GEORGIA CNE--KAIOFGA-01 21313 21313



KANAWHA INSURANCE CO CNE--KANINCO-01 57038 57038KANE COUNTY IPA C----IPAKANE-01 IPAK1 IPAK1KANE COUNTY IPA C----IPAKANE-02 KCIPA KCIPAKATY MEDICAL CLAIMS CNE--KATYMED-01 81812 81812KEMPTON COMPANY, THE CNE--KEMPTCO-01 73100 73100KEMPTON GROUP ADMINISTRATORS CNE--KEMGRAD-01 73100 73100KENTUCKY HEALTH ADMINISTRATORS INC CNE--KENHEAD-01 27215 27215KENTUCKY HEALTH COOPERATIVE CNE--KENHECO-01 77894 77894KENTUCKY KARE CNE--KENKARE-01 61101 61101KENTUCKY SPIRIT HEALTH PLAN CNE--KENSPHE-01 68067 68067KERN COUNTY CDCR CNE--KERNCOU-01 28021 28021KERN HEALTH SYSTEMS CNE--KERHESY-01 77039 77039KEY BENEFIT ADMINISTRATORS INC CNE--KEYBEAD-01 37217 37217 Indianapolis, IN Billing submission address onlyKEY GAP CNE--KEYGAP--01 35317 35317KEY SELECT CNE--KEYSELE-01 37321 37321KEYSTONE MERCY HEALTH PLAN CNE--KEYMEHE-01 23284 23284 Medicaid managed careKINDRED HEALTH CARE CNE--KINHECA-01 61101 61101 (formerly known as VENCOR)KLAIS & COMPANY CNE--KLAANCO-01 34145 34145KOREAN AMERICAN MEDICAL GROUP CNE--KORAMME-01 KAMG1 KAMG1 NEW NAIC KAMG1 old 66123LAKE COUNTY PHYSICIANS ASSOC CNE--LAKCOPH-01 37116 37116

LAKESIDE COMPREHENSIVE HEALTH CARE CNE--LAKCOHE-01 66127 66127LAKESIDE MEDICAL GROUP CNE--LAKMEGR-01 66125 66125LANDMARK CHIROCARE CPT--CCLNDMK-01 LNDMK LNDMKLAWNDALE CHRISTIAN HEALTH CENTER CNE--LAWCHHE-01 36333 36333LBA HEALTH PLANS CNE--LBAHEPL-01 52193 52193LEON MEDICAL CENTER HEALTH PLAN CNE--LEOMECE-01 37316 37316LHP CLAIMS UNIT CNE--LHPCLUN-01 37248 37248LIBERTY HEALTH ADVANTAGE CNE--LIBHEAD-01 87071 87071

LIBERTY MUTUAL GROUP CAC--LIBEMUT-01 77138 77138EDI ENROLLMENT IS REQUIRED NO WORK COMP CLAIMS

LIBERTY UNION CNE--LIBEUNI-01 37281 37281LIFE ASSURANCE COMPANY CNE--LIFASCO-01 37281 37281LIFE TRAC CNE--LIFETRA-01 41136 41136

LIFEWISE, A PREMERA HEALTHPLAN CNE--LIFAPHE-01 93093 93093OREGON - ENROLLMENT REQUIRED - CALL PROMPT PRIOR TO SENDING CLAIMS

LIFEWISE OF WASHINGTON B----WAPREME-01 WABC2Send claims directly to Premera Blue - Alpha prefix is required on the insured ID

LOCAL 135 HEALTH BENEFITS CNE--LOC135H-01 35107 35107 Indianapolis, INLOMA LINDA UNIVERSITY HEALTH PLNS CNE--LOMLIUN-01 37267 37267LOMA LINDA UNIV MANAGED CARE CLM CNE--LOMLIMC-01 33036 33036 Claims are printed and mailed to payorLOVELACE SALUD CNE--LOVESAL-01 SX159 SX159LOVELACE SANDIA HEALTH PLAN CNE--LOVSAHP-01 90328 90328MABUHAY MEDICAL GRP CNE--CAPMANA-01 CAPMN CAPMNMacNeal Health Providers - CHs CNE--MACHEPR-01 36334 36334MAGELLAN HEALTH SERVICES CNE--MAGBEHE-01 01260 01260 MAGELLAN BEHAVIORAL HEALTHMAGNACARE CNE--MAGNACA-01 11303 11303MAGNOLIA CNE--MAGNOLI-01 68062 68062



MAILHANDLERS BENEFIT PLAN CNE--MAIBEPL-02 25133 25133 New NAIC 25133 old # 62413MAILHANDLERS/CAC CNE--MAILCAC-02 25133 25133 New NAIC 25133 old # 62413MAKSIN MANAGEMENT CORP CNE--MAKMACO-01 22195 22195MAMSI LIFE & HEALTH INS. CO. CNE--MAMLIHE-01 52148 52148MANAGED CARE SERVICES CNE--MANCASE-01 35162 35162MANAGED HEALTH NETWORK CNE--MANHENE-01 22771 22771

MANAGED HEALTH SERVICES WI CNE--ABSTOCA-01 68069 68069SINGLE PAYR SYSTEM SEE ABSOLUTE TOTAL CARE - CENTENE CORP

MANAGED HEALTH SVCS IN INDIANA CNE--ABSTOCA-01 68069 68069SINGLE PAYR SYSTEM SEE ABSOLUTE TOTAL CARE - CENTENE CORP

MANATEE SERVICE CENTER FL CNE--MANSECE-01 41555 41555 Only: PO Box 1098, Bradenton, FL 34206

MANULIFE W.J. SUTTON COMPANY CNE--MANWJSU-01 98010 98010MARQUETTE LIFE INSURANCE CO CNE--MARLIIN-01 48055 48055MARYLAND PHYSICIANS CARE CNE--MARPHCA-01 22348 22348 Rendering Provider ID requiredMASHANTUCKET PEQUOT TRIBAL NAT CNE--MASPETR-01 37121 37121MAYO MANAGEMENT SERVICES, INC. CNE--MAYMASE-01 41154 41154 MMSI

MBA OF WYOMING (WORLAND, WY) CNE--MBAWOWY-01 87065 87065Claims submission address: PO Box 98, Worland, WY 82401

MBS CNE--MBS-----01 56205 56205MCA ADMINISTRATORS CNE--MCAADMI-01 25160 25160MCLAREN CNW--MCLAREN-01 Call Prompt Solutions for Setup MD INDIVIDUAL PRACTICE ASSOC. CNE--MDINDPR-01 52148 52148 M.D. IPAMD OPTION HEALTH PLAN CNE--MDOPTHE-01 52148 52148MDI CUSTOM PROVIDER NETWORK CNE--MDICUPR-01 80900 80900 FORMERLY MPAMDI HOLDINGS CNE--MDIHOLD-01 80026 80026 FORMERLY MEDICAL PARTNERS OF AMERICAMDWIS-HIP CNE--MDWISHI-01 MDWIS MDWISMDWise Hoosier Alliance CNE--HOOSIER-01 20475 20475 Provider ID Required by Payor (Including Suffix)MDWISE SELECT HEALTH CMCS CRE--MDWSEHE-01 MDWSH Pipeline to Relay Health CPID: 6139MED PAY CNE--MEDPAY--01 88058 88058MEDADMIN SOLUTIONS CNE--MEDADSO-02 58204 58204MEDADMIN SOLUTIONS CNE--MEDADSO-01 58202 58202MEDBEN (NEWARK, OH) CNE--MEDBEOH-01 74323 74323MEDCOM CNE--MEDCOM--01 59231 59231MEDCOST BENEFIT SERVICES CNE--MEDBESE-01 56205 56205 Also Known as MBSMEDCOST,INC CNE--MEDCOST-01 56162 56162MedDirect CNE--MEDDIRE-01 38353 38353MEDFOCUS CNE--MEDFOCU-01 95321 95321MEDICA - MINNETONKA, MN CNE--MEDICA--01 94265 94265 Provider Network ID required 877-842-3210MEDICA - MINNETONKA, MN CNE--MEDICA2-02 12422 12422 for Group IFB business ALL OTHER USE 94265MEDICA HEALTH CARE PLAN INC CNE--MEDHECA-01 78857 78857

MEDICAID ILLINOIS DIL--ILLINOI-01 ILMCD



MEDICAID INDIANA D----INDIANA-01 INMCD

MEDICAID KENTUCKY D----KENTUCK-01 KYMCD Edi Enrollment Req'd - Provider Number Req'd

MEDICAID MICHIGAN D----MICHIGA-01 MIMCD Edi Enrollment Req'd - Provider Number Req'd

MEDICAID MINNESOTA D----MINNESO-01 MNMCDEDI ENROLLMENT REQ'D - CALL PROMPT FOR ASSISTANCE

MEDICAID NEBRASKA D----NEBRASK-01 NEMCDEDI ENROLLMENT REQ'D - CALL PROMPT FOR ASSISTANCE

MEDICAID OHIO D----OHIO----01 OHMCDEDI ENROLLMENT REQ'D - CALL PROMPT FOR ASSISTANCE

MEDICAID PENNSYLVANIA D----PENNSYL-01 PAMCD CALL PROMPT FOR ENROLLMENT

MEDICAID WISCONSIN D----WISCONS-01 WIMCD

Only Forward Health Claims - This is not CCHP - send directly to Childrens Community Health Plan - *** see Dean HMO

MEDICAID WISCONSIN HIRSP D----WIHIRSP-02 HIRSP Edi Enrollment Req'd - Provider Number Req'd

MEDICAL BENEFIT ADMINISTRATORS CNE--MEDBEAD-02 37298 37298 dba MBA of MD, Inc

MEDICAL BENEFITS MUTUAL CNE--MEDBEMU-01 74323 74323Newark, OH Also, Medical Benefits Administrators & Medical Benefits Companies

MEDICAL DEVELOPMENT INTERNATIONA CNE--MEDDEIN-01 52181 52181

MEDICAL MUTUAL OF OHIO CNE--MEDMUOH-01 29076 29076Provider Number Req'd - Out of State Providers use Tax ID in Legacy and NPI in NPI fields

Medical Network of Colorado Springs CNE--MEDNECS-01 84600 84600MEDICAL PLAN KC (MO) CNE--MEDPLKC-01 61101 61101MEDICAL REIMBURSEMENTS OF AMERICA CNE--MEDREAM-01 62177 62177MEDICAL SERVICES INITIATIVE CNE--MEDSEIN-01 12057 12057MEDICAL VALUE PLAN - OHIO CNE--MEDVAPL-01 38224 38224 Aka MVP - Ohio Call Payor for provider numberMEDICARE CONNECTICUT M----CONNECT-01 MCRCT Edi Enrollment Req'd - Provider Number Req'dMEDICARE FLORIDA M----FLORIDA-01 FLMCR Edi Enrollment Req'd - Provider Number Req'd

MEDICARE ILLINOIS MIL--ILLINOI-01 ILMCR Edi Enrollment Req'd - Provider Number Req'd

MEDICARE INDIANA MAD--INDIANA-01 INMCR Edi Enrollment Req'd - Provider Number Req'd

MEDICARE KANSAS M----KANSAS--01 KSMCR Edi Enrollment Req'd - Provider Number Req'd

MEDICARE KENTUCKY M----KENTUCK-01 KYMCR Edi Enrollment Req'd - Provider Number Req'd

MEDICARE MARYLAND M----MARYLAN-01 MCRMD Edi Enrollment Req'd - Provider Number Req'd



MEDICARE MICHIGAN MMI--MICHIGA-01 MIMCR Edi Enrollment Req'd - Provider Number Req'd

MEDICARE MINNESOTA M----MINNESO-01 MNMCR Edi Enrollment Req'd - Provider Number Req'd

MEDICARE MISSOURI M----MISSOUR-01 MOMCR Edi Enrollment Req'd - Provider Number Req'd

MEDICARE NEBRASKA M----NEBRASK-01 NEMCR Edi Enrollment Req'd - Provider Number Req'd

MEDICARE OHIO M----OHIO----01 OHMCR Edi Enrollment Req'd - Provider Number Req'd

MEDICARE PENNSYLVANIA M----PENNSYL-01 PAMCR EDI Enrollment Req'd

MEDICARE TEXAS M----TEXAS---01 TXMCR EDI Enrollment Req'd

MEDICARE WASHINGTON ASSIGNED BY PROMPT CALL PROMPT CALL PROMPT FOR ASSISTANCE

MEDICARE WISCONSIN M----WISCONS-01 WIMCR Edi Enrollment Req'd - Provider Number Req'd

MEDICARE SECONDARY CLAIMS ILLINOIS M----MSPIL---01 ILMSPADD'L INFORMATION REQUIRED - CALL PROMPT FOR DETAILED FILING INSTRUCTIONS

MEDICARE SECONDARY CLAIMS INDIANA M----MSPIN---01 INMSPADD'L INFORMATION REQUIRED - CALL PROMPT FOR DETAILED FILING INSTRUCTIONS

MEDICARE SECONDARY CLAIMS KENTUCKY M----MSPKY---01 KYMSP

ADD'L INFORMATION REQUIRED - CALL PROMPT FOR DETAILED FILING INSTRUCTIONS

MEDICARE SECONDARY CLAIMS MICHIGAN M----MSPMI---01 MIMSPADD'L INFORMATION REQUIRED - CALL PROMPT FOR DETAILED FILING INSTRUCTIONS

MEDICARE SECONDARY CLAIMS MINNESOTA M----MSPMN---01 MNMSP


MEDICARE SECONDARY CLAIMS OHIO M----MSPOH---01 OHMSPADD'L INFORMATION REQUIRED - CALL PROMPT FOR DETAILED FILING INSTRUCTIONS

MEDICARE SECONDARY CLAIMS WISCONSIN MSP--WISCONS-01 WIMSP


MEDICINA FAMILIAR MEDICAL GROUP CNE--CAPMANA-01 CAPMN CAPMNMedPartners CNE--MEDPART-01 35205 35205MEDSOLUTIONS INC OF GA CNE--MEDINGA-01 62160 62160MEGA LIFE & HEALTH CNE--MEGLIHE-01 59221 59221 Only: PO Box 982009, North Richland Hills, TX 76182MEMIC CNE--MEMIC---01 01047 01047MEMORIAL CLINICAL ASSOCIATES CNE--MEMCLAS-01 62181 62181 SELECTCARE OF TEXAS (MCA)MEMORIAL INTEGRATED HEALTHCARE CALL PROMPT FOR ASSISTANCEMENNONITE MUTUAL AID ASSOC AND AFFILIATES CNE--MENMUAI-01 35605 35605MERCY CARE PLAN CNE--MERCAPL-01 86052 86052 AHCCCSMERCY CARE PLUS CNE--MERCAPL-02 71079 71079



MERCY HEALTH PLANS CNE--MERHEPL-01 43166 43166MERCYCARE CNE--MERCCAR-01 39114 39114MERIDIAN HEALTH PLAN CNE--MERIDHP-01 13189 13189MERITAIN HEALTH / AGENCY SERVICES CNE--MERHEAG-01 64158 64158 Formerly known as Agency Services IncMERITAIN HEALTH MINNEAPOLIS CNE--MERHEMN-01 41124 41124 MINNESOTA

MERITAIN HEALTH/NORTH AMERICAN ADMINISTRATORS CNE--MERHENA-01 64157 64157 FKA North American AdministratorsMETHODIST FIRST CHOICE CNE--METFICH-01 23550 23550METRO PLUS HEALTH PLAN CNE--METPLHE-01 13265 13265METROPOLITAN HEALTH PLAN CNE--METHEPL-01 10850 10850METROPOLITAN LIFE INSURANCE CO CNE--METLIIN-01 87726 87726MFC & HealthPlus Peoria CNE--MFCPEOR-01 23550 23550 AKA Methodist First ChoiceMHNET CNE--MHNET---01 74289 74289MHP SYSTEMS CNE--MHPSYST-01 64068 64068 Mississippi Health PartnersMICHAEL REESE PHYSICIANS GROUP CNE--MICREPH-01 37127 37127MID-AMERICA ASSOCIATES, INC CNE--MIDAMAS-01 37281 37281MID-ATLANTIC PSYCHIATRIC CNE--MIDATPS-01 52149 52149MIDCITIES IPA CNE--CAPMANA-01 CAPMN CAPMNMIDCOAST IPA CNE--MIDCIPA-01 77012 77012MIDLANDS HEALTH PARTNERS CNE--MIDHEPA-01 47080 47080 AKA Midlands Choice, Inc.MIDWEST HEALTH PARTNERS CNE--MIDHEPA-02 76079 76079MIDWEST SECURITY CNE--MIDWSEC-01 79480 79480MID-WEST NATIONAL LIFE INS OKC CNE--MIDWEOK-01 59227 59227 Only: PO Box 548801, Oklahoma City, OK 73154MID-WEST NATIONAL LIFE INS TN CNE--MIDWETN-01 59224 59224 Only: PO Box 982017, North Richland Hills, Tx 76182MID-WEST NATIONAL LIFE INS - STUDENT INSURANCE CNE--MIDWEST-01 74227 74227

Only: PO Box 890025 or 809067 or 809079 or 809066 or 809036 or 809081, Dallas, TX 75380

MILLS PENINSULA HEALTH SERVICES CNE--MILPEHE-01 MPHS1 MPHS1MISSISSIPPI HEALTH PARTNERS CNE--MISHEPA-01 64068 64068MISSISSIPPI PHYSICIANS CNE--MISSPHY-01 64084 64084MISSISSIPPI PUBLIC ENTITY EMPL CNE--MISPUEN-01 37233 37233

MISSISSIPPI SELECT HEALTH CARE CNE--MISSEHE-02 64088 64088Also doing business as Select Administrative Services (SAS)

MISSOULA COUNTY MEDICAL BENEFITS CNE--MISCOME-01 37275 37275MISSOURI CARE/MC CNE--MISCARE-01 43179 43179MMA CNE--MMA-----01 35316 35316MMSI - SEE MAYO MANAGEMENT SERVICES INCMOLINA HEALTHCARE OF CALIFORNIA CNE--MOLHECA-01 38333 38333MOLINA HEALTHCARE OF FLORIDA CNE--MOLHCFL-01 51062 51062MOLINA HEALTHCARE OF MICHIGAN CNE--MOLHCMI-01 38334 38334MOLINA HEALTHCARE OF MISSOURI CNE--MOLHEMO-01 71079 71079 CHANGE EFFECTIVE 4/1/2010MOLINA HEALTHCARE OF NEVADA CNE--MOLHCNV-01 20676 20676MOLINA HEALTHCARE OF NEW MEXICO CNE--MOLHCNM-01 09824 09824 SALUDMOLINA HEALTHCARE OF NEW MEXICO CNE--MOLHENM-01 04423 04423 SCIMOLINA HEALTHCARE OF OHIO CNE--MOLHCOH-01 20149 20149MOLINA HEALTHCARE OF TEXAS CNE--MOLHCTX-01 20554 20554MOLINA HEALTHCARE OF WA CNE--MOLHEWA-01 38336 38336MOLINA HEALTHCARE OF WI CNE--MOLHEWI-01 ABRI1 ABRI1



MONARCH IPA CNE--MONAIPA-01 IP095 IP095MONDIAL ASSISTANCE CNE--MONDIAS-01 50749 50749MONTEFIORE CONTRACT MGMT ORG CNE--MONCOMA-01 13174 13174 Provider Network ID req'dMORRIS ASSOCIATES CNE--MORRISA-01 35092 35092MOTION PICTURES INDUSTRY CNE--MOTPIIN-01 99282 99282MOUNTAIN STATES ADMIN SVS INC CNE--MOUSTAD-01 86040 86040 Tucson, AZMPE EMPLOYEE BENEFIT SERVICES CNE--MPEEMBE-01 37233 37233MPE SERVICES INC CNE--MPEEBT--01 37233 37233MPEEBT CNE--MPEEBT--01 37233 37233MPLAN, INC. CNE--MPLANIN-01 95444 95444MULTIPLAN WISCONSIN PREFERRED PROVIDER NETWORK CNE--MULTIPL-01 34080 34080 AHC, HCN & WPPN Health EOSMUNICIPAL HEALTH BENEFIT FUND CNE--MUNHEBE-01 81883 81883MUTUAL ASSURANCE ADMIN CNE--MUTASAD-01 37256 37256

MUTUAL GROUP (THE) (US) CNE--MUTGRTH-01 59140 59140 (also claims for HealthPlan Services Tampa Only)MUTUAL OF OMAHA INSURANCE CO CNE--MUTOMIN-01 71412 71412MUTUALLY PREFERRED CNE--MUTPRPP-01 71412 71412MVP HEALTH PLAN OF NY CNE--MVPHEPL-01 14165 14165 Provider Network ID req'dMVP OHIO CNE--MEDVAPL-01 38224 38224 Medical Value Plan Ohio Call payor for provider numberNAA (NORTH AMERICA ADMIN, L.P.) CNE--NAANATN-01 65085 65085 Nashville, TNN.W. IRONWORKERS HEALTH & SEC. CNE--NWIROHE-01 91136 91136 Group Number (F15) req'dN.W. ROOFERS & EMPLOYERS HLTH CNE--NWROOEM-01 91136 91136 Group Number (F26) req'dN.W. TEXTILE PROCESSORS CNE--NWTEXPR-01 91136 91136 Group Number (F14) req'd

NABN CNE--NABN----01 34159 34159Only: PO Box 94928 or PO Box 89476 Cleveland, OH 44101 KNA Meritain Health

NALC/AFFORDABLE CNE--NALCAFF-01 53011 53011NAT'L ASSOC OF LETTER CARRIERS CNE--NATASLE-01 53011 53011NATIONAL BENEFIT ADMIN - NC CNE--NATBEAD-01 56176 56176NATIONAL BENEFIT ADMIN - NJ CNE--NATBENJ-01 56175 56175NATIONAL CAPITAL PPO ORGANIZATION CNE--NATCAPP-01 90001 90001 Provider Network ID req'd NCPPONATIONAL IMAGING ASSOCIATES CNE--NATIMAS-01 SX190 SX190NAT'L RURAL ELECTRIC CO-OP CNE--NATRUEL-01 52132 52132 NRECANAT'L. RURAL LETTER CARRIERS CNE--NATRULE-01 71412 71412 Policy Nubmer GMG1846NATIONAL TELECOMMUNICATIONS COOPERATIVE ASSOCIATION CNE--NATTECO-03 52120 52120NATIONAL TELECOMMUNICATIONS COOPERATIVE ASSOCIATION CNE--NATTECO-01 52104 52104 NTCA STAFFNATIONAL TELECOMMUNICATIONS COOPERATIVE ASSOCIATION CNE--NATTECO-02 52103 52103 NTCA NATIONWIDE GROUP CNE--NATGROU-01 31417 31417NATIONWIDE HEALTH PLANS CNE--NATHEPL-01 31417 31417NATIONWIDE INSURANCE CNE--NATINSU-01 31417 31417NATIONWIDE LIFE AND HEALTH CNE--NATLIHE-01 31417 31417NATIONWIDE MUTUAL INS. CO. CNE--NATMUIN-01 31417 31417NCAS - CHARLOTTE CNE--NCASCHA-01 75191 75191NCAS- FAIRFAX, VA CNE--NCASFAI-01 75190 75190NEIGHBORHOOD DOCTORS ORG CNE--NEIDOOR-01 51909 51909 CHICAGO, IL



NEIGHBORHOOD HEALTH PARTNERSHIP OF FLORIDA CNE--NEIHEFL-01 96107 96107

Claims Submission address of: PO Box 025680, Miami, FL 33102-5680 ONLY

NEIGHBORHOOD HEALTH PLAN MA CNE--NEIHEPL-01 04293 04293 Boston, MANEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND CNE--NEIHERI-01 05047 05047

NHPRI - Provider and vendor number req'd prior to sending claims. Please call payor.

NEIGHBORHOOD HEALTH PROVIDERS CNE--NEIHEPR-01 11325 11325 Unique NHP/SHP Provider Number req'dNESIKA HEALTH GROUP CNE--NESHEGR-01 37255 37255NETCARE LIFE AND HEALTH INS CNE--NETLIHE-01 66055 66055 Hagatna, Guam

NETWORK HEALTH CNE--NETWHEA-01 04332 04332 Call provider relations prior to sending claims 617-806-8104Network Health Insurance Corp-Medicare CNE--NETHEIN-01 77076 77076 NETWORK PLATINUM PLUS

NETWORK HEALTH PLAN OF WISCONSIN, INC CNE--NETHEPL-01 39144 39144

Payer id is valid only if the claim submission address on the back of the member's card is PO Box 568 Menasha, WI 54952.

NETWORK TPA LLC CNE--NETWTPA-01 58204 58204NEW CENTURY HEALTH CNE--NEWCEHE-01 NCH09 NCH09 VISTA CARDIOLOGYNEW ERA EMPLOYEE WELFARE BENEFIT PLAN TRUST CNE--NEWERAT-01 76031 76031NEW ERA LIFE INSURANCE CO CNE--NEWERLI-01 75281 75281NEW MARKET DIMENSIONS CNE--NEWMADI-01 65056 65056NEW YORK NETWORK MGMT, LLC CNE--NEWYONE-01 11334 11334 Claims are printed and mailed to payorNEW YORK PRESBYTERIAN SYSTEM SELECT HEALTH CNE--NYPRSEH-01 24819 24819NGS AMERICAN CNE--NGSAMER-01 38225 38225NHBCAUX CNE--NHBCAUX-01 88050 88050NIPPON LIFE INSURANCE CO CNE--NIPLIIN-01 81264 81264NJ CARPENTERS HEALTH FUND CNE--NJCARHF-01 22603 22603NOBLE COMMUNITY MEDICAL ASSOCIATES LA CNE--CAPMANA-01 CAPMN CAPMNNORTH AMERICAN ADMINISTRATORS CNE--NORAMAD-01 64157 64157 Now known as Meritain Health

NORTH AMERICAN BENEFITS NETWRK CNE--NORAMBE-01 34159 34159Only: PO Box 94928 or PO Box 89476 Cleveland, OH 44101 NKA Meritain Health

NORTH AMERICAN HEALTH PLAN CNE--NORAMHE-01 64157 64157 Now known as Meritain Health

NORTH AMERICAN MED MGMT- Northern CA CNE--NORAMCA-01 E3510 E3510Only Providers in Northern California. Call payor prior to sending

NORTH AMERICAN PREFERRED CNE--NORAMPR-01 64157 64157 Now known as Meritain HealthNORTH AMERICARE CNE--NORAMER-01 64157 64157 Now known as Meritain HealthNORTH BROWARD HOSPITAL DISTRICT CNE--NORBRHO-01 37314 37314NORTH SUBURBAN ASSOCIATED PHYSICIANS CNE--NORSUAS-01 36392 36392NORTH TEXAS HEALTHCARE NETWORK CNE--NORTXHE-01 35212 35212NORTHERN CALIFORNIA SHEET METAL WORKERS HEALTH CARE PLAN CNE--NORCASM-01 38238 38238

Only Claims Submission Address: PO Box 1138, San Ramon, CA 94583

NORTHERN ILLINOIS HEALTH PLAN CNE--NORILHE-01 36347 36347

NORTHERN NEVADA TRUST FUND CNE--NORNETR-01 88027 88027Call (775) 826-7200 to verify if you should be sending claims to this payor



NorthShore University Health System Medical Group CNE--NORUNHE-01 36364 36364Northstar Advantage CNE--NORSTAD-01 60058 60058NORTHWEST COMMUNITY HEALTH PARTNERS CNE--NORCOHE-01 36234 36234NORTHWEST DIAGNOSTIC CLINIC CNE--NORDICL-01 62119 62119 SELECTCARE OF TEXAS (NWDC)NORTHWEST SUBURBAN IPA IL CNE--NORSUIP-01 36346 36346 IllinoisNOVA CASUALTY COMPANY CNE--NOVCACO-01 16114 16114NOVA HEALTHCARE ADMIN CNE--NOVHEAD-01 16644 16644NOVANET CNE--NOVANET-01 06226 06226NOVASYS HEALTH NETWORK CNE--NOVHENE-01 71080 71080NYHART CNE--NYHART--01 37299 37299OAK WEST PRIMARY PHYSICIAN ASSOC CNE--OAKWEPR-01 36402 36402ODS HEALTH PLAN CNE--ODSHEPL-01 13350 13350OFFICE OF GROUP BENEFITS LA CNE--OFFGRBE-01 72087 72087 Located in LouisianaOHIO BUREAU OF WORKERS COMP C----HEATRPR-01 HEAT1 ProviderGroup/PIN req'd

OHIO HEALTH CHOICE PPO CNE--OHIHECH-01 34189 34189Only: PO Box 93538 Cleveland, OH 44101 or PO Box 3619 Akron, OH 44309

OHIO HEALTH GROUP CNE--OHIHEGR-01 95435 95435

OK State Employees & Educators (EDS) CNE--OKSTEDS-01 22521 22521

OMNI Medicore HP CNE--OMNMEHP-01 68037 68037

OMNICARE CNE--OMNICAR-01 25133 25133

OMNICARE, A COVENTRY HEALTH PLN CNE--OMNCOHE-01 25150 25150 For claims with date of service AFTER 10/1/2004

ONE CALL MEDICAL CNE--ONECAME-01 22321 22321

OneNet PPO, LLC CNE--ONENEPP-01 52149 52149Name effective from 9/1/2006. Previous name Alliance PPO LLC

OPERATING ENGINEERS LOCALS 302 CNE--OPERENG-01 91136 91136 Group Number (F12) req'd on claimsOptiCare Managed Vision CNE--OPTMAVI-01 56190 56190OPTIMUM CHOICE NC/SC CNE--OPTCHCA-01 52152 52152OPTIMUM CHOICE,INC. CNE--OPTICHO-01 52148 52148OPTIMUM HEALTHCARE INC CNE--OPTIHEA-01 20133 20133OptumHealth - CMC CNE--OPHECMC-01 41194 41194 (This is not American Chiropractic Network)ORTHONET CORPORATION CNE--ORTHCOR-01 13381 13381 CIGNAORTHONET - UNIFORMED SVS FAM HP CNE--ORTUSFH-01 13382 13382 USFHP (NY & NJ) outpatient therapy claims onlyORTHONET- AETNA CNE--ORTHAET-01 13383 13383 AETNAORTHONET - HEALTHNET CNE--ORTHOHN-01 25681 25681OSF HEALTH PLANS CNE--OSFHEPL-01 62171 62171OSMA HEALTH - C. L. FRATES & CO CNE--OSMAHEA-01 73071 73071

OXFORD HEALTH PLAN CNE--OXFHEPL-01 06111 06111Provider Network ID req'd Call payor 203-459-6570 to register

P5 HEALTH PLAN SOLUTIONS OF UTAH CNE--PHEPLUT-01 87068 87068PACIFICARE BEHAVIORAL HEALTH CNE--PACBEHE-01 33053 33053



PACIFICARE OF ARIZONA CNE--PACCAAZ-01 95964 95964PACIFICARE/SECURE HORIZONS HMO & POS CLAIMS ONLY --- NO PPO CLAIMS

PACIFICARE HEALTH SYS CALIFORNIA CNE--PACHESY-01 95959 95959 Only PacifiCare/Secure Horizon HMO & in-area POS claimsPACIFICARE HLTH SYS CA ENCOUNT CNE--PACHECA-01 95958 95958 Encounters only

PACIFICARE OF COLORADO CNE--PACCACO-01 95962 95962PACIFICARE/SECURE HORIZONS HMO & POS CLAIMS ONLY --- NO PPO CLAIMS

PACIFICARE HLTH SYS OKLAHOMA CNE--PACHEOK-02 95959 95959PACIFICARE HLTH SYS OK ENCOUNT CNE--PACHEOK-01 95958 95958 Encounters onlyPACIFICARE HLTH SYS OR ENCOUNT CNE--PACHEOR-01 95958 95958 Encounters only

PACIFICARE HLTH SYS OREGON CNE--PACHEOR-02 95959 95959 Only PacifiCare/Secure Horizon HMO & in-area POS claimsPACIFICARE HLTH SYS TEXAS CNE--PACHETX-02 95959 95959PACIFICARE HLTH SYS TX ENCOUNT CNE--PACHETX-01 95958 95958 Encounters onlyPACIFICARE HLTH SYS WA ENCOUNT CNE--PACHEWA-01 95958 95958 Encounters only

PACIFICARE HLTH SYS WASHINGTON CNE--PACHEWA-02 95959 95959 Only PacifiCare/Secure Horizon HMO & in-area POS claimsPACIFICARE HEALTH SYSTEMS PPO CNE--PACHEPP-01 95999 95999 PPO claims All StatesPACIFICSOURCE HEALTH PLANS CNE--PACSOHE-01 93029 93029 Payor does not accept COB claims electronicallyPAI CNE--PAICLAI-01 37287 37287PARAGON BENEFITS INC CNE--PARABEN-01 58174 58174PARITY HEALTHCARE LLC CNE--PARIHEA-01 58204 58204PARK TERRACE ENCOMPASS MEDICAL GROUP Call Prompt for assistancePARKLAND HEALTHFIRST CNE--PARHEFI-01 66917 66917 AKA Parkland Community Health PlanPARTNERS NAT'L HEALTH PLANS OF NORTH CAROLINA Contracted providers only Call Prompt for assistancePASADENA PRIMARY CARE PHYSICIANS CNE--CAPMANA-01 CAPMN CAPMNPASSPORT ADVANTAGE CNE--PASSADV-01 76569 76569PASSPORT HEALTH PLAN CNE--PASHEPL-01 61129 61129 Medicaid managed carePATIENT ADVOCATES, LLC CNE--PATIADV-01 10525 10525PCC SELECT CNE--PCCSELE-01 73145 73145

PEACH STATE HEALTH PLAN CNE--PEASTHE-01 68049 68049ENROLLMENT REQUIRED PRIOR TO SENDING, CALL PAYOR 800-225-2573 ext 25525

PENSYLVANIA PACE CNE--PENNPAC-01 20172 20172PENNSYLVANIAS PREFERRED HEALTH NETWORK Call Prompt for assistancePEOPLES HEALTH NETWORK CNE--PEOHENE-01 72126 72126 Network ID Required to send claimsPerformCare-Select Health CNE--PERSEHE-01 25176 25176 MH/SA

PERFORMAX, INC CNE--PERFORM-01 41124 41124Claims mailing address: PO Box 27267, Minneapolis, MN 55427-0267

PERSONAL INSURANCE ADMINISTRATORS INC CNE--PERINAD-01 95397 95397 Agoura Hills CA

PHCS CLAIMS CNE--PHCSWIS-01 72099 72099Group Number req'd. Claims mailing address only: PO Box 5007, DePere, WI 54115

PHCS SAVILITY PAYERS CNE--PHCSSAV-01 13306 13306PHOENIX HEALTH PLAN CNE--PHOHEPL-01 03440 03440 SX146 old NAIC - Please use new # 03440PHP - Physicians Health Plan Mid-Michigan CNE--PHPMIMI-01 37330 37330PHP - PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA CNE--PHYHPIN-01 12399 12399

Fort Wayne, IN All Claims Require NPI Effective March 2012 all claims to Relay Health

PHP - PHYSICIANS HEALTH PLAN - SC CNE--PHYHESC-02 09173 09173



PHP of SOUTH MICHIGAN CNE--PHPSOMI-01 87726 87726PHP of SOUTH MICHIGAN CNE--PHPSOMI-02 37330 37330PHP of Southwest Michigan CNE--PHPSWMI-01 87726 87726PHP of West Michigan CNE--PHPWEMI-01 87726 87726PHYSICIAN ASSOCIATES OF LA CNE--PHYASLA-01 58204 58204 LouisianaPHYSICIAN ASSOCIATES OF THE GREATER SAN GABRIEL VALLEY Call Prompt for assistancePHYSICIAN CARE NETWORK LLC CNE--PHYCANE-03 58204 58204PHYSICIANS ALLIANCE STONES RIVER REGIONAL IPA CNE--STONIPA-01 15749 15749

PHYSICIANS CARE NETWORK (ASR Corp) CNE--PHYCANE-01 38265 38265new naic - old # 57098 AKA PHYSICANS CARE & PHYSICIANS CARE HEALTH PLANS

PHYSICIANS CARE NETWORK-ROCKFO CNE--PHYCANE-02 36345 36345 Only Physicians Care Network, Rockford, ILPHYSICIANS HEALTH ASSOC IL CNE--PHYHEAS-01 37136 37136 ILLINOISPHYSICIANS HEALTH COLLABORATIVE CNE--PHYHECO-01 20398 20398PHYSICIANS HEALTH PLAN - SEE PHP

PHYSICIANS MUTUAL INS CO CNE--PHYMUIN-01 47027 47027PPO CLAIMS SHOULD BE SENT TO THE ADDRESS ON THE BACK OF THE INSUREDS ID CARD

PHYSICIANS PLUS INS CORP CNE--PHYPLIN-01 39156 39156 Provider group & pin req'dPIEDMONT BEHAVIORAL HEALTH CNE--PIEDBEH-01 06607 06607PINNACLE CLAIMS MANAGEMENT,INC CNE--PINCLMA-01 24735 24735PINNACLE PHYSICIAN MGMT ORG CNE--PINPHMA-01 45985 45985PINNACOL ASSURANCE CNE--PINNASS-01 84109 84109PITTMAN & ASSOCIATES CNE--PITASSO-01 37224 37224PIVOTAL PLAN CNE--PIVOPLA-01 64160 64160PLANNED ADMINISTRATORS INC CNE--PLANADM-01 37287 37287 No preferred blue claims to this payorPODI CARE MANAGED CARE CNE--PODCAMA-01 58204 58204PODIATRY NETWORK FLORIDA CNE--PODNEFL-01 59324 59324PODIATRY NETWORK SOLUTIONS CNE--PODNESO-01 58204 58204POMCO CNE----POMCO-01 16111 16111PPO OKLAHOMA CNE--PPOOKLA-01 73159 73159PPOM, LLC CNE-----PPOM-01 38335 38335PPOPLUS (FKA SMA PPO) CNE--PPOPLUS-01 72148 72148 Effective 1/1/2003 payor ID 72148PPOPLUS LLC CNE--PPOPLUS-02 72148 72148PRACTICARE CNE--PRACTIC-01 04334 04334PRAIRIE STATES ENTERPRISES INC CNE--PRASTEN-01 36373 36373PREFERRED BENEFITS ADMINISTRATORS CNE--PREBEAD-01 61665 61665PREFERRED CARE PARTNERS CNE--PRECAPA-01 65088 65088 Miami, Florida members onlyPREFERRED COMMUNITY CHOICE CNE--PRECOCH-01 73145 73145PREFERRED HEALTH CARE - PPO LANCASTER, PA (IHS GATEWAY PAYOR Call Prompt for assistancePREFERRED HEALTH PLN KY CNE--PREHEPL-02 61106 61106 Louisville, KYPREFERRED HEALTH PROFESSIONALS CNE--PREHEPR-01 31478 31478PREFERRED HEALTH SYSTEMS INS CNE--PREHESY-02 60110 60110PREFERRED NETWORK ACCESS INC CNE--PRENEAC-01 36401 36401PREFERRED ONE - MN CNE--PREFONE-01 41147 41147PREFERRED PLUS OF KANSAS (PPK) CNE--PREPLKS-01 60110 60110PREMIER BENEFITS, INC. CNE--PREBEIN-01 43166 43166PREMIER HEALTH PLANS CNE--PREHEPL-01 43166 43166PREMIER HEALTH SYSTEMS INC CNE--PREHESY-04 29076 29076 New Naic - 29076 old # 90441



PREMIER PHYSICIANS NETWORK CNE--CAPMANA-01 CAPMN CAPMN & Valley Division (PPN)PRESBYTERIAN (NM) CNE--PRESBNM-01 05003 05003PRESTIGE HEALTH CHOICE CNE--PREHECH-01 45056 45056PREVEA HEALTH INSURANCE PLAN CNE--PREHEIN-01 39185 39185 Arise Health Plan PRIMA HEALTH IPA CNE--PRIMIPA-01 IP096 IP096PRIMARY CARE & PEDIATRICS IPA CNE--CAPMANA-01 CAPMN CAPMN PCPIPAPRIMARY HEALTH NETWORK CNE--PRIHENE-02 82048 82048Primary PhysicianCare, INC. CNE--PRIPHCA-01 56144 56144PRIME VISION HEALTH CNE--PRIMEHE-01 56190 56190PRIME WEST HEALTH PLAN CNE--PRIWEHE-01 61604 61604PRINCIPAL FINANCIAL GROUP CNE--PRIFIGR-01 61271 61271PRINCIPAL HEALTH CARE CNE--PRIHECA-01 61271 61271PRINCIPAL LIFE INSURANCE CO CNE--PRILIIN-01 61271 61271PRINCIPAL MUTUAL LIFE INS CNE--PRIMULI-01 61271 61271PRIORITY HEALTH CNE--PRIOHEA-01 38217 38217PRISM NETWORK, INC. CNE--PRINEIN-01 37268 37268PRISM-FIRST HEALTH CNE--PRIFIHE-01 37303 37303PRISM-UNIVERA CNE--PRISUNI-01 37315 37315

PRO CARE HEALTH PLAN INC CNE--PROCAHE-01 38329 38329CLAIMS ADDRESS: PO Box 3160, Detroit, MI 48203 & PO Box 3590, Detroit, MI 48203

ProCare Health Plan Medicaid CNE--PROHEPL-01 70259 70259

PROFESSIONAL BENEFIT ADMIN CNE--PROBEAD-02 59296 59296Only: Professional Benefits Administrators Winter Park, Florida

PROFESSIONAL BENEFIT ADMIN CNE--PROBEAD-01 36331 36331Only: Professional Benefit Admninistrators, Inc. Oak Brook, IL

PROFESSIONAL CLAIMS MANAGEMENT CNE--PROCLMA-01 37242 37242Claims Mailing Address only: PO Box 35276, Canton, Ohio 44735-5276

PROFESSIONAL RISK MANAGEMENT CNE--PRORIMA-01 34134 34134PROTECTIVE LIFE INSURANCE COMPANY CNE--PROLIIN-01 37309 37309PROVIDENCE PPO CNE--PROVPPO-01 SX187 SX187PROVIDENCE OF OREGON HEALTH PLAN CNE--PROORHE-01 SX133 SX133PSN - FLORIDA MEDICAID (JMH) CNE--PSNFLME-01 09822 09822PSYCHCARE, LLC CNE--PSYCHCA-01 51052 51052PUGET SOUND BENEFITS TRUST CNE--PUGSOBE-01 91136 91136 Group Number (F25) req'd on claimsPUGET SOUND ELECTRICAL WORKERS CNE--PUGSOEL-01 91136 91136 Group Number (F33) req'd on claimsPUGET SOUND HEALTH PARTNERS INC CNE--PUGSOHE-01 42172 42172 KNA Southpath HealthPYRAMID LIFE INSURANCE CO CNE--PYRLIIN-01 48055 48055QUAD MED LLC (WEST ALLIS, WI) CNE--QUADMED-01 39197 39197

QUALCARE, INC. CNE--QUALCIN-01 23342 23342New providers must enroll - call payor (800) 992-6613, OPTION 5

QUALCHOICE OF ARKANSAS CNE--QUAOFAK-01 35174 35174QUALITY HEALTH PLANS INC CNE--QUALHEA-01 59375 59375QuickTrip CNE--QUICTRI-01 73067 73067QVI RISK SOLUTIONS INC CNE--QVIRISO-01 57117 57117RADCON INC CALL PROMPT FOR ASSISTANCERAILROAD MEDICARE M----TRARAME-01 TRVRR Edi Agrmt req'd - 9 digit prov # req'dRBMS, LLC CNE--RBMSLLC-01 91176 91176REGENCY EMPLOYEE BENEFITS CNE--REGEMBE-01 38221 38221REGIONAL CARE INC CNE--REGICAR-01 47076 47076



RENAISSANCE PHYSICIANS ORGANIZ CNE--RENPHOR-01 76066 76066RESERVE NATIONAL INSURANCE CNE--RESNAIN-01 73066 73066ResourceOne Administrators CNE--RESONAD-01 37278 37278RESURRECTION HEALTH CARE PREFERRED CNE--RESHECA-03 36396 36396

FKA FAMILY MEDICAL NETWORK CALL PAYOR PRIOR TO YOUR FIRST SUBMISSION

RETIREE HEALTH TRUST CNE--RETHETR-01 26316 26316RightChoice Benefit Administrators CNE--RIGBEAD-01 37331 37331RMSCO, INC CNE--RMSCOIN-01 16117 16117ROCKY MOUNTAIN HEALTH PLAN CNE--ROCMOHE-01 SX141 SX141 Grand JunctionROONEY LIFE INC. CNE--ROOLIIN-01 37602 37602RTW C/O CORVEL CORP CCV--RTWINCC-01 I7496 I7496RUSH PRUDENTIAL HMO CNE--RUSPRHM-01 36389 36389 HMO ONLYRWDSU BENEFIT FUND CNE--RWDSUBE-01 63070 63070S & S HEALTHCARE STRATEGIES CNE--S&SHEST-01 31441 31441SAGAMORE HEALTH NETWORK CNE--SAGHENE-01 35164 35164

SAGE TECHNOLOGIES CNE--SAGETEC-01 37105 37105f.k.a. Cannon Cochran Management Services, Inc. Mailing Address of PO Box 17009, Rockford, IL only

SAGE TECHNOLOGIES - PBS CNE--SAGETEC-02 37137 37137 SAINT MARYS HEALTH PLAN CNE--STMARHP-01 88029 88029 SAMARITAN HEALTH PLANS CNE--SAMHEPL-01 CP001 CP001

SAN DIEGO COUNTY COVERAGE INITIATIVE CNE--SANDICO-01 MSO77 MSO77 (CI)SAN DIEGO COUNTY MEDICAL SERVICES CNE--SANDICO-02 MSO11 MSO11 (CMS)SAN DIEGO COUNTY RYAN WHITE CARE ACT CNE--SANDICO-03 MSO33 MSO33SAN JOAQUIN HEALTH ADMIN CNE--SANJOHE-01 68035 68035 SAN LOUIS OBISPO SELECT CNE--SANLOOB-01 33072 33072SANFORD HEALTH PLAN CNE--SANHEPL-01 91184 91184SANFORD HEALTH PLAN CNE--SANFREP-01 TP984 TP984 REPRICED CLAIMSSANTA CLARA FAMILY HEALTH PLAN CNE--SANCLFA-01 24077 24077SANTE HEALTH SYSTEM & AFFILIATES CNE--SANHESY-01 77038 77038SCAN HEALTH PLAN CNE--SCANHEP-01 72261 72261SCAN HEALTH PLAN ARIZONA CNE--SCAHEAZ-01 73172 73172SCAN LONG TERM CARE CNE--SCALOTE-01 20460 20460SCHC TOTAL CARE INC CNE--SCHCTOT-01 16146 16146 Acceptius Gateway payerSECURE HEALTH PLANS OF GA CNE--SECHEGA-01 28530 28530 Georgia

SECURE HORIZONS ARIZONA CNE--SECHOAZ-01 95964 95964PACIFICARE/SECURE HORIZONS HMO & POS CLAIMS ONLY --- NO PPO CLAIMS

SECURE HORIZONS CALIFORNIA CNE--SECHOCA-01 95959 95959PACIFICARE/SECURE HORIZONS HMO & POS CLAIMS ONLY --- NO PPO CLAIMS

SECURE HORIZONS COLORADO CNE--SECHOCO-01 95962 95962PACIFICARE/SECURE HORIZONS HMO & POS CLAIMS ONLY --- NO PPO CLAIMS

SECURE HORIZONS LIFEPRINT CNE--SECHOLI-01 LIFE1 LIFE1 ARIZONA

SECURE HORIZONS OKLAHOMA CNE--SECHOOK-01 95959 95959PACIFICARE/SECURE HORIZONS HMO & POS CLAIMS ONLY --- NO PPO CLAIMS

SECURE HORIZONS OREGON CNE--SECHOOR-01 95959 95959PACIFICARE/SECURE HORIZONS HMO & POS CLAIMS ONLY --- NO PPO CLAIMS

SECURE HORIZONS TEXAS CNE--SECHOTX-01 95959 95959PACIFICARE/SECURE HORIZONS HMO & POS CLAIMS ONLY --- NO PPO CLAIMS



SECURE HORIZONS WASHINGTON CNE--SECHOWA-01 95959 95959PACIFICARE/SECURE HORIZONS HMO & POS CLAIMS ONLY --- NO PPO CLAIMS

SECURITY HEALTH PLAN CNE--SECHEPL-01 39045 39045SeeChange CNE--SEECHAN-01 77024 77024SELECT ADMINISTRATIVE SERVICES CNE--SELADSE-01 64088 64088 Also know as Mississippi Select Health CareSELECT BENEFIT ADMINISTRATORS CNE--SELBEAD-01 42137 42137 West Des Moines, IowaSELECT BENEFIT ADMINISTRATORS OF AMERICA CNE--SELBEAM-01 37282 37282

Only Claims with billing address: PO Box 440, Ashland, WI 54806

SELECT BENEFIT ADMINISTRATORS, INC CNE--SELBEAD-02 93031 93031SELECT HEALTH SOUTH CAROLINA CNE--SELHESC-01 23285 23285SELECT SENIOR CLINIC CNE--SELSECL-01 20415 20415SELECTCARE CNE--SELECTC-02 00014 00014SELECTCARE OF TEXAS CNE--SELCATX-02 76045 76045 HPN Heritage Physicians NetworkSelectCare of Texas CNE--SELCATX-01 61225 61225 Kelsey-Seybold

SELF INSURED BENEFIT ADMIN CNE--SELINFL-01 59111 59111Only claims addressed to: 18167 US Highway 19 North, Suite 300, Clearwater, FL 33764

SELF INSURED PLANS LLC FL CNE--SELINPL-01 36404 36404Only claims addressed to: 1016 Collier Center Way, Suite 200, Naples, FL 34110

SELF-FUNDED PLANS(IL,PA,OH) CNE--SELFUPL-01 34131 34131SENIOR CARE PARTNERS CNE--SENCAPA-01 36390 36390SENIOR HEALTH PARTNERS CNE--SENHEPA-01 80141 80141 SHPSENIOR WHOLE HEALTH CNE--SENWHHE-01 83035 83035SENTINEL MANAGEMENT SERVICES CNE--SENMASE-01 23249 23249SENTRY INSURANCE A MUTUAL CO CNE--SENINMU-01 39033 39033 Subscribers Group and Insured id req'dSENTRY LIFE INS CO CNE--SENLIIN-01 39033 39033 Subscribers Group and Insured id req'dSENTY LIFE OF NEW YORK CNE--SENLINY-01 39033 39033 Subscribers Group and Insured id req'dSEOUL MEDICAL GROUP CNE--CAPMANA-01 CAPMN CAPMNSETON CHIP VIA MEDIVIEW CNE--SETONCH-01 76056 76056SEVEN CORNERS CNE--SEVECOR-01 25404 25404SHASTA ADMINISTRATIVE SERVICES CNE--SHAADSE-01 75280 75280 Jeld-Wen Claims OnlySHEET METAL WORKERS LOCAL 104 HEALTH CARE PLAN CNE--SHEMEWO-01 38238 38238

Billing Address Only: PO Box 1618, San Ramon, CA 94583

SHERMAN CHOICE C----SHERCHO-01 SC369 SC369SIERRA HEALTH SERVICES CNE--SIEHESE-01 76342 76342SIERRA HEALTH SERVICES CNE--SIEHEEN-01 76343 76343 Encounters only

SIGNATURE HEALTH ALLIANCE TPO CNE--SIGHEAL-01 62159 62159Only: Signature Health Alliance, PO Box 22419, Nashville, TN 37202

SIGNIFICA BENEFITS SERVICES INC CNE--SIGBESE-01 23250 23250

SILVER CROSS MANAGED CARE ORGANIZATION CNE--SILVCRO-01 36387 36387SISCO C----SISCO---01 SISCO Dubuque, IowaSINCLAIR HEALTH PLAN CNE--SINHEPL-01 84076 84076SLOANS LAKE MANAGED CARE CNE--SLOLAMA-01 84096 84096



SMITH ADMINISTRATORS CNE--SMITADM-01 02057 02057SOLANO REGIONAL MEDICAL GROUP Call Prompt For Assistance

SONOMA COUNTY PRIMARY CARE IPA CNE--SONCOPR-01 E3510 E3510ONLY CLAIMS FROM NORTHERN CALIFORNIA PROVIDERS

SOUND HEALTH (SISTERS OF PROV) CNE--SOUNHEA-01 91131 91131 Now known as First Choice Health NetworkSOUNDPATH HEALTH CNE--SOUPAHE-01 42172 42172 FKA Pudget Sound Health Partners IncSOUTH CENTRAL PREFERRED - PPO YORK, PA (IHS GATEWAY PAYOR) Call Prompt For AssistanceSOUTH FL COMMUNITY CARE NETWORK CNE--SOFLCCN-01 37314 37314 NBHDSOUTH HAVEN COMMUNITY HOSPITAL Call Prompt For AssistanceSOUTH POINT HOTEL & CASINO CNE--SOUPOHO-01 35227 35227SouthCare/Healthcare Preferred CNE--SOUTHCA-02 25147 25147

SOUTHERN BENEFIT SERVICES CNE--SOUBESE-01 37318 37318No longer processed for the following Provider Groups: Brockman Enterprises and SPS International

SOUTHERN HEALTH SERVICES CNE--SOUTHEA-03 25133 25133 New Payr ID - Coventry

SOUTHWEST SERVICE LIFE CNE--SOUSELI-01 37266 37266Claims billing address only: PO Box 982005, Ft. Worth, TX 76182 - Unique Policy number req'd from ID card

SPECIAL RISK INTERNATIONAL CNE--SPERIIN-01 52190 52190SPECTRUM ADMINISTRATORS TPA CNE--SPECADM-01 23253 23253 Allentown, PA (HIS Gateway Payer)SPINA BIFIDA - VA HAC CNE--SPINABI-01 84146 84146

ST ANTHONY MEMORIAL HEALTHCARE CNE--STANTME-01 35199 35199CMCS Customer Service 800-352-7502 MDWISE EDI Enrollment Req'd- Call Payor

ST BARNABAS SYSTEM HLTH PLN CNE--STBARSY-01 22240 22240

ST CATHERINE HOSPITAL PHO CNE--STCATHO-01 35199 35199CMCS Customer Service 800-352-7502 MDWISE EDI Enrollment Req'd- Call Payor

ST FRANCIS HEALTH NETWORK CNE--STFRAHE-01 35199 35199CMCS Customer Service 800-352-7502 MDWISE EDI Enrollment Req'd- Call Payor

ST JOHNS CLAIMS ADMINISTRATION CNE--STJOCLA-01 37264 37264ST MARGARET MERCY HEALTHCARE CENTERS CNE--STMARME-01 35199 35199

CMCS Customer Service 800-352-7502 MDWISE EDI Enrollment Req'd- Call Payor

ST THERESE PHYSICIAN ASSOC CNE--STTPHAS-01 37116 37116

StarHRG - The Mega Life & Hlth Ins Co CNE--STARHRG-01 59225 59225Only the following P.O. Boxes: PO Box 55270, 30870, 30888, 54150, 30069, 55400, Phoenix, AZ 58270-5270

STARMARK CNE--STARMAR-01 61425 61425STATE AUTO INSURANCE COMPANIES CNE--STAAUIN-01 46450 46450

STATE FARM INSURANCE CO CNE--STAFAIN-01 31053 31053Medical Health Ins Policies Only - Do not send Auto Accident claims-send to the agent

STATE FUND MUTUAL INS C/O CORVEL CORP CCV--STAFUMI-01 11347 11347STATES GENERAL LIFE INSURANCE CNE--STAGELI-01 75087 75087

STAYWELL HLTH/WELLCARE CH CNE--STAHEWE-01 14163 14163SENDING TO RELAY HEALTH SEPT 2011 - 14163 payer ID

STERLING MEDICARE ADVANTAGE CNE--STEMEAD-01 67829 67829STERLING OPTION ONE CNE--STEOPON-01 91151 91151STONER AND ASSOCIATES CNE--STONEAS-01 31121 31121 CINCINNATI, OHIOSTONES RIVER REGIONAL IPA - WINDSOR CNE--STORIRE-01 15752 15752



STUDENT INS/MEGA LIFE & HEALTH CNE--STUMELI-01 74227 74227Only: PO Box 890025, 809067, 809079, 809066, 809036, 809081 Dallas, TX 75380

STUDENT INS-LIFE INS/BOSTON/NY CNE--STUINLI-01 74227 74227STUDENT INS-MIDWEST NATL/TENN CNE--STUINMI-01 74227 74227STUDENT INS-RELIANCE INS. CO. CNE--STUINRE-01 74227 74227STUDENT INS-RELIANCE NAT'L INS CNE--STUINRE-02 74227 74227STUDENT INSURANCE CNE--STUDINS-01 74227 74227STUDENT INSURANCE-BOSTON MUT. CNE--STUINBO-01 74227 74227

SUBURBAN HEALTH ORGANIZATION CNE--SUBHEOR-01 35199 35199CMCS Customer Service 800-352-7502 EDI Enrollment Req'd- Call Payor

SUFFOLK HEALTH PLAN OF NEW YORK CNE--SUFHEPL-01 88331 88331 Of New YorkSUMMACARE HEALTH PLAN CNE--SUMHEPL-01 95202 95202SUMMACARE HMO CNE--SUMMHMO-01 95202 95202

SUMMIT AMERICA INS SERVICES INC CNE--SUMAMIN-01 37301 37301Student Accident and Sickness, College Sports and NASCC claims only

SUNSHINE STATE HEALTH PLAN CNE--SUNSTHE-01 68057 68057SUPERIOR BENEFITS AKA Superior AdministratorsCNE--SUPBENE-01 23218 23218 Only: PO Box 27730, Santa Ana, CA 92799-7730

SUPERIOR HEALTH PLAN TEXAS CNE--SUPHEPL-01 39188 39188Enrollment req'd, call 800-225-2573 ext 25525 prior to sending claims

SUTTER DELTA MEDICAL GROUP CNE--SUTDEME-01 77318 77318SUTTER EAST BAY MEDICAL FOUNDATION CNE--SUTEABA-01 94269 94269SUTTER GOULD MEDICAL FOUNDATION Call Prompt For AssistanceSUTTER INDEPENDENT PHYSICIANS Call Prompt For AssistanceSUTTER MEDICAL FOUNDATION Call Prompt For AssistanceSUTTER MEDICAL GROUP OF THE REDWOODS Call Prompt For AssistanceSWEDISH COVENANT HOSPITAL CNE--SWECOHO-01 36411 36411TALL TREE ADMINISTRATORS CNE--TALLTRE-01 88067 88067TARRANT HEALTH SERVICES CNE--TARHESE-01 37228 37228TBT - TEAMSTERS BENEFIT TRUST CNE--TEABETR-01 94304 94304TEACHERS HEALTH TRUST CNE--TEAHETR-01 88019 88019TEAMCARE CNE--TEAMCAR-01 36215 36215TEAMSTERS BENEFIT TRUST CNE--TEABETR-01 94304 94304 TBTTETHYS HEALTH VENTURES CNE--TETHEVE-01 20212 20212TEXAS CHILDRENS HEALTH CNE--TEXCHHE-03 TXCSM TXCSMTEXAS CHILDREN'S HEALTH PLAN CNE--TEXCHHE-01 76048 76048TEXAS CHILDREN'S HEALTH PLN (MCD) CNE--TEXCHHE-02 75228 75228 Medicaid claims onlyTexasFirst Health Plan (NTX) CNE--TXFIRHE-01 13185 13185 TEXAN PLUS HMO MEDICARETexasFirst Health Plan (TIOPA) CNE--TXFIRHE-02 76046 76046 TEXAN PLUS HMO MEDICARETEXAS HealthSpring CNE--TXHEASP-01 33104 33104THE CHESAPEAKE LIFE INS CO CNE--CHELIIN-02 59223 59223 Only PO Box 982016, North Richland Hills, Tx 76182THE CHESAPEAKE LIFE INS CO - OKC CNE--CHLIOKC-01 59227 59227 Only: PO Box 548801, Oklahoma City, OK 73154THE CHESAPEAKE LIFE INS CO - STUDENT INSURANCE CNE--CHLISTU-01 74227 74227

Only: PO Box 890025, 809067, 809079, 809066, 809036, 809081, Dallas, TX 75380-9025

THE CITY OF ODESSA CNE--THECIOD-01 75600 75600THE DIAMOND PLAN CNE--THEDIPL-01 25133 25133 Old NAIC # 25131 New 25133THE FORD METER BOX CO, INC. CNE--THEFOME-01 37305 37305THE HEALTH EXCHANCE CNE--THEHEEX-01 20356 20356 (Cerner Corporation)

THE HEALTH PLAN CNE--THEHEPL-01 34150 34150Massillon, Ohio & St. Clairsville, Ohio - Services ordered by outside provider require referring provider on HCFA



THE HEALTHCARE GROUP CNE--THEHEGR-01 35206 35206THE INTEGRITY BENEFIT NETWORK CNE--THEINBE-01 58200 58200 Marietta, GA

THE LOOMIS COMPANY - TPA CNE--THELOCO-01 23223 23223 Call payor prior to sending claims 610-374-4040 EXT. 2438THE MEGA LIFE & HEALTH INS CO CNE--THEMELI-01 59221 59221 Only PO Box 982009, North Richland Hills, TX 76182THE MEGA LINFE & HEALTH INS - STARBRIDGE STARHRG SEE STARBRIDGE STARHRGTHE MEGA LIFE & HEALTH INS CO - OKC CNE--THEMELI-02 59227 59227 Only: PO Box 548801, Oklahoma City, OK 73154THE MEGA LIFE - STUDENT INS See Student InsuranceTHE MUTUAL GROUP (US) CNE--MUTGRUS-01 59140 59140

THE NATIONAL RADIOLOGY NETWORK CNE--THENARA-01 59087 59087FORMERLY HEALTH HELP NETWORK Claims are Printed and mailed to payer

THE PERFECT HEALTH INS CO CNE--THEPEHE-01 13522 13522THE PHYSICIANS ASSURANCE CORP CNE--THEPHAS-01 31074 31074 EMPLOYEE BENEFIT MANAGEMENT CORPTHERAPY REVIEW SYSTEMS CNE--THERESY-01 75305 75305 GEORGIA PROVIDERS ONLY

THOMAS H COOPER CNE--THOHCOO-01 SX160 SX160THREE RIVERS HLTH PLANS - PA CNE--THRRIHE-01 25175 25175 KNA Unison Health PlanTIME INSURANCE / FORTIS CNE--TIMINSC-01 39065 39065 Now Known As FortisTN IPA CNE--TNIPA---01 15750 15750 Stones River Regional IPA - BC/BS Tennessee claimsTODAYS HEALTH WISCONSIN CNE--TODHEWI-01 20081 20081 ABRI HEALTH PLAN INCTODAYS OPTIONS CNE--TODAOPT-01 48055 48055 American Progressive and Pyramid LifeTODAYS OPTIONS powered BY CCRX CNE--TODAOPT-01 48055 48055TONGASS TIMBER TRUST CNE--TONTITR-01 92620 92620TOOLING & MANUFACTURING ASSOC CNE--TOOMAAS-01 61425 61425TOTAL BROKER BENEFITS CNE--TOTBRBE-01 36342 36342 FKA Benefit Systems & Services IncTOTAL CAROLINA CARE CNE--TOTCACA-01 68055 68055TOTAL CLAIMS ADMINISTRATION CNE--TOTCLAD-01 37314 37314TOTAL COMMUNITY CARE CNE--TOTCOCA-01 31182 31182TOTAL HEALTHCARE INC CNE--TOTAHEA-01 38201 38201TOUCHPOINT HEALTH PLAN HMO CNE--TOUHEPL-01 97910 97910TOUCHSTONE HEALTH PSO CNE--TOUHEPS-01 23856 23856TOUCHSTONE HEALTH PARTNERSHIP CNE--TOUSTHE-01 13402 13402 On behalf of Health Net Smart ChoiceTOWER LIFE INSURANCE CO CNE--TOWLIIN-01 69493 69493TR PAUL INC CNE--TRPAUIN-01 37230 37230TPA, INC See Third Party AdministratorsTPAC THE PHYSICIANS ASSURANCE CORP CNE--THEPHAS-01 31074 31074 EMPLOYEE BENEFIT MANAGEMENT CORPTRANSAMERICA LIFE INS CO CNE--TRALIIN-01 59222 59222 Only: PO Box 982009, North Richland Hills, Tx 76182TRANSCHOICE - KEY BENEFIT ADMIN CNE--TRANSCH-01 37284 37284Transchoice or TransSmile CNE--TRANCHO-01 20807 20807 First Service Administrator's IncTransSmile CNE--TRANSMI-01 20807 20807 First Service Administrator's IncTRAVELERS CNE--TRAVLER-01 87726 87726TRAVELERS / CGT - PPO CNE--TRACGPP-01 87726 87726TRAVELERS HEALTH NETWORK HMO CNEH-TRAHENE-01 87726 87726TRAVELERS PLAN ADMINISTRATORS CNE--TRAPLAD-01 87726 87726TRAVELERS RAILROAD MEDICARE M----TRARAME-01 TRVRR Edi Agrmt req'd - 9 digit prov # req'dTRELLIS HEALTH PARTNERS CNE--TREHEPA-01 36397 36397TRIBUTE - SelectCare of Oklahoma CNE--TRIBUTE-01 73117 73117



TRICARE PALMETTO CNE--TRICAPA-01 57106 57106

PATIENT STATE NOT PROVIDER** FOR ALL MILITARY TRICARE** Tricare Northern Region Includes: CT, DE, IL, IN, KY, MA, MD, ME, MI, NC, NH, NJ, NY,OH, PA, RI, VA, VT, WI, WV AND SOME ZIP CODES IN IA/MO/TN. Provider Group & Pin Req'd - Call payor for details

TRICARE WEST CNE--TRIWEST-01 SCWI0 SCWI0

TRICARE WEST REGION INCLUDES: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excluding Rock Island Arsenal area), Kansas, Minnesota, Missouri (except the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (the southwestern corner, including El Paso), Utah, Washington and Wyoming.

TRIHEALTH PHYSICIAN SOLUTIONS - CONCERN CNE--TRIHEPH-02 31143 31143

TRIHEALTH PHYSICIAN SOLUTIONS CNE--TRIHEPH-01 31144 31144 Edi Enrollment req'd prior to sending claimsTriSurant CNE--TRISURA-01 34185 34185 FKA Health Administration Services - HAS

TRLHN/AS CNE--TRLHNAS-01 98514 98514

Trilogy Health - Assurant Mailing Address: Trilogy / HealthSmartP.O. Box 94436Lubbock, TX 79493

TRLHN/EB CNE--TRLHNEB-01 62777 62777

Trilogy Health - EBC & Cypress Mailing address: Trilogy Health InsurancePO Box 1171Milwaukee WI 53201

TRUE CHOICE USA CNE--TRCHUSA-01 54210 54210

TRUSTEED PLANS SERVICE CORP CNE--TRUPLSE-01 91078 91078TRUSTMARK CNE--TRUMARK-01 61425 61425TUFTS HEALTH PLAN CALL PROMPT FOR ASSISTANCEUBH-UNITED BEHAVIORAL HEALTH CNE--UNIBEHE-01 87726 87726 Former MetraHealth - UNETUBH-UNITED BEHAVIORAL HEALTH CNE--UNIBEHM-01 87726 87726UHC RAILROAD MEDICARE M----TRARAME-01 TRVRR Edi Agrmt req'd - 9 digit prov # req'dUICI-ADMINISTRATORS NV CNE--UICADNV-01 74223 74223 State of Nevada onlyUMC HEALTH PLAN CNE--UMCHEPL-01 75130 75130UMR - Legacy 31107 CNE--UNIMERE-01 31107 31107 PO BOX 145804, CINCINNATI, OH 45250UMR - Legacy FI SERVE/WAUSAU CNE--WAUSAUI-01 39026 39026 PO BOX 30541, SALT LAKE CITY, UT 84130UMR - Legacy MIDWEST SECURITY ADMIN CNE--MIDWSEC-01 79480 79480 PO BOX 266, ONALASKA, WI 54650UMR - FiServe - Harrington Benefits CNE--HARBESE-03 75196 75196 WESTERVILLEUMR - FiServe - Harrington Benefits CNE--HARBESE-01 95266 95266 PO BOX 30781, SALT LAKE CITY, UT 84130 UMR - COMMONWEALTH ADMIN LLC CNE--COMMOAD-01 37237 37237 LEXINGTONUMWA HEALTH & RETIREMENT FUNDS CNE--UMWHERE-01 52180 52180 Provider Network ID req'd



UNICARE INDIVIDUAL-SMALL GRP CNE--UNIINSM-01 80314 80314UNICARE LIFE & HEALTH CNE--UNILIHE-01 80314 80314UNICARE MAJOR ACCTS. CNE--UNIMAAC-01 80314 80314UNICARE MAJOR ACCTS. CNE--UNIMAAC-02 80314 80314UNICARE SPECIAL ACCOUNTS CNE--UNISPAC-01 80314 80314UNIFIED HEALTH SERVICES CNE--UNIHESE-01 62170 62170 Worker's Compensation Claims OnlyUNIFIED PHYSICIANS NETWORK CNE--UNIPHNE-01 34638 34638UNIFORM MEDICAL PLAN CNE--UNIMEPL-01 75243 75243 Harrington Benefit Services; CentraUNIFORMED SERVICES FAM HLTH PL CNE--UNISEFA-01 13407 13407UNION PACIFIC IPA CALL PROMPT FOR ASSISTANCEUNION PACIFIC RAILROAD EMP HLT CNE--UNIPARA-01 87042 87042UNION SECURITY INSURANCE CO CNE--UNISEIN-01 70408 70408UNISON HEALTH PLAN CNE--UNISONH-01 62183 62183 Better Health PlansUNISON HEALTH PLAN CNE--UNIHEPL-02 25175 25175 Three RiversUNITED CARE MEDICAL NETWORK CNE--CAPMANA-01 CAPMN CAPMN

UNITED FOOD & COMM WORKERS CNE--UNIFOCO-01 36659 36659MIDWEST UNIONS & EMPLOYERS HEALTH BENEFITS FUND

UNITED HEALTHCARE CNE--UHCARE--01 87726 87726UNITED HEALTHCARE INTEGRATED SERVICESCNE--WAUSAUI-01 39026 39026 UHIS

UNITED HEALTHCARE OF RIVER VALLEY CNE--UNIHERV-01 95378 95378

If Chiropractic claims, please call 800-747-1446 to check EDI payor number for your member. Prior to initial submission, provider must call John Deere at (309) 765-1593 to verify NPI registration is complete

UNITED HEALTHCARE OVATIONS INSURANCE SOLUTIONS (AARP) CNE--UHCAARP-01 36273 36273UNITED HEALTHCARE WISCONSIN CNE--UNIHEWI-01 87726 87726UNITED HEALTHCARE-METRAHEALTH CNE--UNITHEA-01 87726 87726UNITED HEALTHCARE-TRAVELERS CNE--UNIHETR-01 87726 87726UNITED MEDICAL ALLIANCE CNE--UNIMEAL-01 84132 84132UNITED MEDICAL RESOURCES CNE--UNIMERE-01 31107 31107 Legacy UMR - other options see UMR CincinnatiUNITED OF OMAHA CNE--UNIOMAH-01 71412 71412UNITED RESOURCES NETWORK CNE--UNIRENE-01 41194 41194UNITY HEALTH INSURANCE CNE--UNIHEIN-01 66705 66705 ENROLLMENT REQ'D - CALL 608-643-1531 UNIVERSAL CARE OF CALIFORNIA CNE--UNICACA-01 33001 33001UNIVERSAL HEALTH CARE INC CNE--UNIHECA-01 50528 50528UNIVERSITY FAMILY CARE CNE--UNIFACA-01 09830 09830 SX148 NO LONGER VALID US NEW # 09830UNIVERSITY FAMILY CARE CNE--UNIFACA-02 09908 09908 Maricopa Health PlanUNIVERSITY FAMILY CARE CNE--UNIFACA-03 07503 07503 Healthcare Group

UNIVERSITY HEALTH ALLIANCE CNE--UNIHEAL-01 99026 99026PAYOR REGISTRATION IS REQUIRED - CALL PROMPT FOR ASSISTANCE

UNIVERSITY OF ILLINOIS AT CHICAGO CNE--UNIILCH-01 37601 37601 DIV OF SPECIALIZED CARE FOR CHILDREN

UNIVERSITY OF MIAMI BEHAVIORAL HEALTH CNE--UNIMIBH-01 92579 92579UNIVERSITY OF WASHINGTON STUDE CNE--UNIWAST-01 91136 91136 Group Numer (P67) req'dUPMC HEALTH PLAN-COMMERCIAL CNE--UPMCHEA-01 23281 23281UPPER PENINSULA HEALTH GRP TPA CNE--UPPETPA-01 37324 37324 TPAUPPER PENINSULA HLTH PLN MI CNE--UPPPEHE-01 38337 38337 MedicaidUS BENEFITS CNE--USBENEF-01 93092 93092US DEPT OF LABOR CAC--USDEPLA-01 77044 77044 ACS GOV'T GATEWAY - EDI ENROLLMENT REQ'D



USAA (U.S. AUTOMOBILE ASSOC.) CNE--USAA----01 74095 74095 Property and Casualty Division OnlyUSFHP ST VINCENT MED CTR NY CNE--USFHPNY-01 13407 13407UTMB CHIP/MEDIVIEW, INC. CNE--UTMCHME-01 76049 76049UTMB HEALTHCARE SYSTEMS CNE--UTMHESY-01 76049 76049 Choice OneVA FEE BASIS PROGRAMS CNE--VAFEEBA-01 12115 12115VALLEY PREFERRED - PPO CNE--VALLPRE-01 23253 23253 Allentown, PA (HIS Gateway Payer)ValueOptions C----VALUOPT-01 VALOP NEW PAYR - CALL PROMPT FOR ASSISTANCEVANTAGE HEALTH PLAN, INC CNE--VANHEPL-01 72128 72128VentureNet Healthcare CNE--VENNEHE-01 86062 86062VERDUGO HILLS MEDICAL GROUP CNE--VERHIME-01 66126 66126VERITY NATIONAL GROUP CNE--VERNAGR-01 75256 75256VHAMA-WATERSTONE BENEFITS CALL PROMPT FOR ASSISTANCEVIDA CARE CNE--VIDACAR-01 24818 24818 KNA Amida CareVILLAGE FAMILY PRACTICE CNE--VILFAPR-01 73743 73743VIRGINIA PREMIER HEALTH PLAN CNE--VAPREHE-01 54176 54176 Enrollment req'd - call PromptVISION CARE INCORPORATED CNE--VISCAIN-01 37297 37297VIVA HEALTH PLAN CNE--VIVAHEA-01 63114 63114VNS CHOICE MEDICARE CNE--VNSCHME-01 77073 77073VOLUSIA HEALTH NETWORK CNE--VOLHENE-01 59266 59266

VYTRA HEALTHCARE CNE--VYTRAHE-01 22264 22264WABASH MEMORIAL HOSP ASSOC CNE--WABMEHO-01 85256 85256WATERSTONE BENEFIT ADMINISTRATORS CNE--WATBEAD-01 73155 73155WEA CHIROPRACTIC SPECIALTY CLAIMS - SEE HSM

WEA - NON CHIROPRACTIC CLAIMS CNW--WEANODC-01 39151 39151ONLY NON CHIROPRACTIC CLAIMS. FOR CHIROPRACTIC CLAIMS PLEASE SEE HSM-WEA

WEB TPA CNE--WEBTPA--01 75261 75261WEISS HEALTH PROVIDERS CNE--WEIHEPR-01 36337 36337

WELLCARE CNE--WELLHMO-01 14163 14163Relay Health New Clearinghouse 9/2011 Includes claims for Harmony Health IL & IN

WELLS FARGO THIRD PARTY ADMINISTRATORS INC CNE--WEFATPA-01 87815 87815 WELLS FARGO THIRD PARTY ADMINISTRATORS INC CNE--WEFATPA-02 37272 37272 FKA JSL AdministratorsWENATCHEE VALLEY MEDICAL CENTER CNE--WENVAME-01 91064 91064WEST COAST STATIONARY ENGINEER CNE--WESCOST-01 91136 91136 Group Number (F13) req'dWEST COVINA MEDICAL GROUP CNE--WESCOME-01 66124 66124WESTERN GROWERS/PINNACLE CLMS CNE--WESGRPI-01 24735 24735WESTERN HEALTH ADVANTAGE CNE--WESHEAD-01 68039 68039WESTERN HEALTH INC CNE--WESTHEA-01 37306 37306WESTERN MUTUAL INSURANCE CNE--WESMUIN-01 37247 37247WESTERN NATIONAL ASSURANCE C/O CORVEL CORP CCV--WESNAAS-01 13005 13005WESTERN NATIONAL MUTUAL C/O CORVEL CORP CCV--WESNAMU-01 15865 15865WESTERN SOUTHERN FINANCIAL GRP CNE--WESSOFI-01 31048 31048 CINCINNATI, OHIOWESTLAKE FINANCIAL GROUP CNE--WESFIGR-01 90560 90560 BUFFALO GROVE, ILLINOISWEYCO, INC. CNE--WEYCOIN-01 38232 38232



WILLIAM C EARHART CNE--WILCEAR-01 93050 93050WILSON-MCSHANE CNE--WILSMCS-01 41095 41095WINDSOR MEDICARE EXTRA CNE--WINMEEX-01 62153 62153WILLIAM J SUTTON & COMPANY CNE--WILJSUT-01 98010 98010 Toronto, CanadaWISCONSIN AUTO & TRUCK DEALERS CNE--WISAUTR-01 39200 39200WISCONSIN DEPARTMENT OF CORRECTIONS CNE--WISDECO-01 74101 74101WOMEN'S INTEGRATED NETWORK CNE--WOMINNE-01 13413 13413 WIN FERTILITYWORKSITE BENEFIT SERVICES LLC CNE--WORBESE-01 20333 20333

WORLD INSURANCE COMPANY CNE--WORINCO-01 75276 75276Payer Does not accept Secondary/Tertiary claims electronically

WPP- ElderCare WISCONSIN CNE--WPPELDW-01 77080 77080WPPN CNE--MULTIPL-01 34080 34080 Multiplan - Health EOS

WPS COMMERCIAL C----WISPHSE-01 WPSCOEdi Agrmt req'd - Prov id = tax id NEW MAILING ADDRESS EL PASO, TX

WRITERS' GUILD INDUSTRY HEALTH CNE--WRIGUIN-01 23710 23710YALE UNIVERSITY HEALTH PLAN CNE--YALUNHE-01 60646 60646YAVAPAI COUNTY CNE--YAVACOU-01 09829 09829

Documents

Prompt Solutions Payer · PDF filePrompt Solutions Payer List ** New Payers are in Bold 5 AUSTIN MUTUAL INSURANCE CCV--AUSMUIN-01 I5991 I5991 AULTRA ADMINISTRATIVE GROUP CNE-