Institutional Claim Payers List (01/28/2015)
Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. 1199 National Benefit Fund ## 13162 Y FALSE 5010A2 G 1ST MEDICAL NETWORK (MEDICAL 58203 Y FALSE 5010A2 G RESOURCES) ** 360 Alliance Gilsbar ## 07205 Y FALSE 5010A2 G 3P ADMIN ** 20413 Y FALSE 5010A2 G A.G.I.A, INC. 95241 Y Claims are printed and FALSE PRINT G mailed AAG - American Administrative Group 37283 Y Formerly Gallagher Benefit FALSE 5010A2 G ** Admin AARP - UnitedHealthcare Insurance 36273 Y Medicare Supplement and FALSE 5010A2 C Company Hospital Indemnity Plans that carry the AARP name, but are insured by UnitedHealthcare. Code Set ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 AARP Hospital Indemnity Plans insured by UnitedHealthcare Insurance Company ** AARP Medicare Supplement Plans insured by UnitedHealthcare Insurance Company ** AARP MedicareComplete insured through UnitedHealthcare (formerly AARP MedicareComplete from SecureHorizons) ** AARP MedicareComplete insured through UnitedHealthcare) / Lifeprint Network (Arizona) # # 36273 Y FALSE 5010A2 C ICD-9 36273 Y FALSE 5010A2 C ICD-9 87726 Y FALSE 5010A2 C ICD-9 LIFE1 R FALSE 5010A2 C ICD-9 AARP MedicareComplete insured through UnitedHealthcare / Oxford Medicare Network, former payer id 06111 # # Abrazo Advantage Health Plan ** Abri Healthplan ## Access Administrators Access Medicare (Cuatro LLC) ## Acclaim ** Acordia National AKA Healthsmart Benefit Solutions ** ADMINISTRATIVE CONCEP ## Administrative Services ## ADVANTAGE HEALTH SOLU ## Advantage Preferred Plans ## 06111 Y FALSE 5010A2 C ICD-9 03443 ABRI1 AHS01 19305 64071 87815 Y N Y N Y Y FALSE FALSE FALSE TRUE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G G T G G T ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 22384 59141 35209 35219 Y N Y Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G G N ICD-9 ICD-9 ICD-9 ICD-9 Advantek Benefit Administrators ## 83077 N FALSE 5010A2 G ICD-9 Advantica Benefits ** ADVENTIST HEALTH SYSTEM ## Advicare ## Advocate Health Centers Advocate Health Partners Aetna 60054 (Commercial only) Aetna Affordable Health Choices ** 59374 95340 45423 36320 65093 60054 57604 A Y N Y Y Y Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G G G G T C G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Aetna Better Health IL Medicaid ** 26337 N FALSE 5010A2 G ICD-9 Aetna Better Health NY ## 34734 N FALSE 5010A2 G ICD-9 Claims submitted with old payerID of 77070 may need to be resubmitted after May 23rd, 2014 Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Aetna Better Health of Nebraska ** 42130 Y FALSE 5010A2 G ICD-9 Aetna Better Health OH ** Aetna Better Health PA Medicaid ** Payer ID Reports 50023 23228 Y Y Additional Info Call payer for payerID Enrollment Submission Type FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 FALSE 5010A2 G ICD-9 Aetna American Continental Insurance ## AETNA TEXAS MEDICAID ## Affiliated Doctors of Orange County ** Call N 38692 ADOCS Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 Affiliated Physicians Group Affinity Essentials ** Affinity Health Plan ## M3CA1 23334 13334 Y Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 T G G ICD-9 ICD-9 ICD-9 Affinity Health Plans (TMG Health) ## 13333 Y FALSE 5010A2 G ICD-9 AHPO (Cleveland, OH) ## Alaska Children's Services, Inc. Group # P68 ## 31138 91136 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 ALASKA ELECTRICAL HEALTH ## 92600 Y FALSE 5010A2 G ICD-9 Alaska Laborers Construction Industry Trust - Group # F23 ## 91136 Y Group submitting FALSE 5010A2 G ICD-9 Alaska Pipe Trades Local 375 - Group # F24 ## 91136 Y Group submitting FALSE 5010A2 G ICD-9 Alaska United Food & Commercial Workers Health & Welfare Trust Group # F45 ## ALICARE All Savers Insurance / UnitedHealthcare ## AllCare PEBB ## Allegian Choice ## Allegiance Benefit Plan Management, Inc. ## Alliance PPO, LLC (Previously Payer ID 52148) Alliance, The (Only for ID Cards showing PO Box 44365 Madison WI 53744 as mailing address. Call 608210-6656 for Payer ID. ** 91136 Y Group submitting FALSE 5010A2 G ICD-9 13550 81400 Y Y FALSE FALSE 5010A2 5010A2 G C ICD-9 ICD-9 26158 55649 81040 Y Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 87726 Y FALSE 5010A2 C ICD-9 Call Y FALSE 5010A2 T ICD-9 Alliant Health Plans of Georgia ## 58234 Y FALSE 5010A2 G ICD-9 Allied Benefit Systems ## Allstate Workplace Division ## AMA Insurance Agency, Inc. Amalgamated Life ## Amalgamated Life - PA / Alicare ## 37308 77083 AMAIA 13550 13343 Y N Y Y N FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 G G G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 AmeraPlan AMERIBEN SOLUTIONS America 1st Choice Plans of North Carolina ## Americaid CC Tampa ** 38219 75137 26078 Y Y N FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 06161 Y FALSE 5010A2 T ICD-9 Contact [email protected] or (718)794-7592 prior to sending claims. Please include Group Number when submitting claims. Please include Number when claims. Please include Number when claims. Please include Number when claims. Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Americaid Community Care (Dallas/Ft. 27514 Y FALSE 5010A2 T Worth) ** Americaid Community Care (Houston) 27515 Y FALSE 5010A2 G ** Americaid Community Care (Maryland) 27517 Y FALSE 5010A2 G ** Americaid Community Care (New 27516 Y FALSE 5010A2 G Jersey) ** American Behavior ## 63103 N FALSE 5010A2 G American Benefit Plan Administrators 95170 Y FALSE 5010A2 G ## American Family Insurance ## 12T31 Y FALSE 5010A2 G American Family Insurance 56071 N FALSE 5010A2 G (Administered by American Republic) Code Set ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 American Fidelity Assurance Company ## AMERICAN GENERAL LIFE AND ACCIDENT ## American Healthcare Alliance ## 60801 Y FALSE 5010A2 T ICD-9 62030 Y FALSE 5010A2 G ICD-9 01066 Y FALSE 5010A2 G ICD-9 American Heritage ## American Lifecare 77083 72099 N Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 American NatIonal Insurance (ANICO) ## American Postal Workers Union Health Plan ## American Republic Insurance Company ## American Service Life Insurance Company AMERICAN WORKER HEALTH PLUS ** 74048 Y FALSE 5010A2 G ICD-9 44444 Y FALSE 5010A2 G ICD-9 42011 Y FALSE 5010A2 G ICD-9 97055 Y FALSE 5010A2 G ICD-9 37322 Y FALSE 5010A2 G ICD-9 Valid for billing address of 1100 Poydras Street, Suite 2600, New Orleans, LA 70163-2602 United Ins. Div. Americas 1st Choice Health Plans of South Carolina ## America's Health Choice America's PPO (Formerly ARAZ) ## 20553 N FALSE 5010A2 T ICD-9 21810 16120 Y N FALSE FALSE 5010A2 5010A2 T T ICD-9 ICD-9 America's PPO / America's TPA ## 41178 Y FALSE 5010A2 T ICD-9 AmeriChoice FL, HI, LA, MD, MS, CAN, OH, RI, TX, WA, WI (UnitedHealthcare Community Plan ) 87726 Y FALSE 5010A2 C ICD-9 AmeriChoice by UnitedHealthcare (NYU) (UnitedHealthcare Community Plan) ** AmeriChoice NJ Medicaid, NJ Family Care, NJ Personal Care Plus / UnitedHealthcare Community Plan (former payer id 86001) ** 87726 Y FALSE 5010A2 C ICD-9 86047 Y FALSE 5010A2 C ICD-9 AmeriChoice of NE (UnitedHealthcare Community Plan) ** Americhoice of PA Personal Care Plus (Medicare) ** 87726 Y FALSE 5010A2 C ICD-9 86003 Y FALSE 5010A2 C ICD-9 Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. AmeriChoice Personal Care Plus PA 25175 N FALSE 5010A2 C (UnitedHealthcare Community Plan) ** Code Set ICD-9 Amerihealth Administrators, Inc. ** 54763 Y FALSE 5010A2 T ICD-9 AmeriHealth Caritas Louisiana(Formerly known as LA Care)## AmeriHealth Connect ** 27357 Y FALSE 5010A2 G ICD-9 77051 Y Pennsylvania Healthy PA Private Coverage (for EDI support please email edi.amerihealthconnect@am erihealthcaritas.com or call 1-855-707-5823) FALSE 5010A2 G ICD-9 Amerihealth DC ## 77002 Y For EDI Support, please email [email protected] or call 1-888-656-2383 FALSE 5010A2 G ICD-9 Amerihealth NJ/DE - HMO ** AmeriHealth NorthEast ** Amerihealth VIP Care DC ## 23037 77001 77007 Y Y TRUE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 Amerihealth VIP Care LA ## 77006 N Payer is effective 1-1-14. Claims for Dates of Service before this date will reject. FALSE 5010A2 G ICD-9 AM-First Insurance Morgan White ** 01757 N FALSE 5010A2 G ICD-9 Amida Care Medicare ## Antares Management Services ** 79966 34192 Y Y Payer accepts secondary claims only, and Medicare cannot be the primary payer FALSE FALSE 5010A2 5010A2 G T ICD-9 ICD-9 Anthem Blue Cross of California 47198 Y FALSE 5010A2 N ICD-9 ANTHEM MEDICAID (WI) (formerly BadgerCare) ** APEX BENEFITS SERVICE ** APS Healthcare, Inc (American Psych Systems) ## APWU Health WIBLS y FALSE 5010A2 N ICD-9 34196 54160 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 55544 Y FALSE PRINT G ICD-9 ARAZ (Now known as America's PPO.) ## Arbor Health ** ARCADIAN MGMT SERVICE ## Arizona Foundation for Medical Care ** Arizona Physicians IPA (APIPA) / UnitedHealthcare Community Plan ## 16120 N FALSE 5010A2 T ICD-9 52312 77045 86062 Y Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 03432 Y FALSE 5010A2 C ICD-9 27154 N FALSE 5010A2 G ICD-9 Arizona Priority Care Plus ## ** Payer is effective 1-1-14. Claims for Dates of Service before this date will reject. Claims are printed and mailed to the payer. If filing a claim for a federal plan member, use payer ID 44444 Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Arkansas Best Corporation - Choice 75278 Y FALSE 5010A2 G Benefits ## Arnett Health Plans ** Former 87726 Y FALSE 5010A2 C PayerID 95440 ASC Benefit Services, Inc. ## 72467 Y Payer ID is for ACS Benefit FALSE 5010A2 G Services. Inc. ONLY Aspen ** ASR Physicians Care ## Associates for Health Care, Inc. (AHC) ** Assurant Health (Fortis Insurance Company) Assurant Health Re-Pricing via HealthSpan ASSURANT HLT SELF FUN ** Code Set ICD-9 ICD-9 ICD-9 16180 38265 36326 N Y Y FALSE FALSE TRUE 5010A2 5010A2 5010A2 G G C ICD-9 ICD-9 ICD-9 39065 Y FALSE 5010A2 G ICD-9 ASNTH N FALSE 5010A2 T ICD-9 37313 Y FALSE 5010A2 G ICD-9 Assurant Health Self Funded ** 75068 N FALSE 5010A2 G ICD-9 AssureCare, Inc. ## ASSURED BENEFITS ADMI ** Asuris NW Health Athens Area Health Plan Select 88035 74240 93221 95691 Y Y Y Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G G G ICD-9 ICD-9 ICD-9 ICD-9 Atlantic Medical Insurance ## Atlantis Health Plan ## Automated Group Administration ## 22285 13853 37280 N N Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 Automotive Machinists Local 289 Health & Welfare Trust -Group #F32 ## Avectus Healthcare Solutions ## Avera Health Plans Avmed, Inc. Banner Health ** Banner Medisun ** Beacon Health Strategies ## 91136 Y FALSE 5010A2 G ICD-9 MP001 46045 59274 12X42 77078 43324 N Y Y Y N Y FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 C G T G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Beech Street BeneFirst ## Benefit & Risk Management Services ## Benefit Administration Services ** 95377 37125 99320 Y Y A FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 41205 Y FALSE 5010A2 T ICD-9 BENEFIT ADMIN. SYSTEM ## 36149 Y FALSE 5010A2 G ICD-9 ## Claims should go to payer in FT. MILL, SC Only MUST VERIFY ALL CLAIMS SHOULD GO TO ALLIED BENEFIT for Assurant Health self funded groups with plan effective dates after 5/1/2013 Please send these EDI claims to the Payer ID of the PPO shown on the Members ID Card. If you have any questions, please call 260-489-6447 (703). Call 855-AVECTUS (Providers need to call Provider Relations Dept at 781-994-7576 to register before sending claims.) Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Benefit Coordinators ** 25145 Y Valid for billing address of FALSE 5010A2 N 111 Ryan Court, Suite 300, Pittsburgh, PA Code Set ICD-9 Benefit Management Admin (BMA) BMATP Y FALSE 5010A2 T ICD-9 Benefit Management Service, Inc of Louisiana ## Benefit Management Services for Charlotte, NC Benefit Management Systems, Inc. ## Benefit Plan Administrators ## 00999 N FALSE 5010A2 G ICD-9 56139 Y FALSE 5010A2 G ICD-9 37212 Y FALSE 5010A2 G ICD-9 39081 N FALSE 5010A2 G ICD-9 Benefit Plan Administrators, Inc. 37118 Y FALSE 5010A2 G ICD-9 Benefit Planners, Inc. ** Benefit Systems & Services, Inc. (BSSI) ## Benefit Management, Inc. of KS 74223 36342 Y Y FALSE FALSE 5010A2 5010A2 C G ICD-9 ICD-9 48611 N FALSE 5010A2 N ICD-9 Benesight (Formerly TPA) ** BERKSHIRE HEALTH PLAN 87265 23243 Y Y FALSE FALSE 5010A2 5010A2 G T ICD-9 ICD-9 BEST LIFE & HEALTH CO ## Better Health Plan of Florida ** 95604 20488 Y N FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 BHP Unity ** BIENVIVIR SENIOR HEALTH SERVICES ## Blue Care Network ** Blue Choice Medicaid ## Blue Cross Blue Shield of Wisconsin ** Blue Cross of Alabama ** Blue Cross of Alaska ** Blue Cross of Arizona Blue Cross of Arkansas ** Blue Cross of California ** Blue Cross of Colorado Blue Cross of Connecticut Blue Cross of Delaware ## Blue Cross of Florida Blue Cross of Georgia Blue Cross of Idaho ** Blue Cross of Illinois ** Blue Cross of Indiana ** Blue Cross of Iowa ** Blue Cross of Kansas ** 44219 12X40 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 12B58 00403 WIBLS N N Y TRUE FALSE FALSE 5010A2 5010A2 5010A2 N N N ICD-9 ICD-9 ICD-9 12B54 12B47 5547I 00520 47198 15491 3534I 12B76 3517I 3537I 12B07 12B08 12B09 12B10 KSBLS Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y TRUE TRUE TRUE TRUE FALSE FALSE TRUE TRUE TRUE FALSE TRUE TRUE TRUE TRUE TRUE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 N N N N N N N N N N N N N N N ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ## Payer ID valid only for claims with a billing submission address of P.O. Box 1128, Eau Claire, WI 54702-1128 ONLY accept claims for these groups:BMI187,BMI219,BMI 234,BMI236,BMI214.BMI24 1,BMI617, BMI245.BMI246 Prior to submitting, call (610) 372-8044 ext. 3019 For claims rejections, please contact Better Health of Florida at 1-800-514-4561 and select the provider services option. South Carolina Payer Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. of Kansas City ** KCBLS Y TRUE 5010A2 N of Kentucky 5534I Y TRUE 5010A2 N of Louisiana ## 12B12 Y TRUE 5010A2 N of Maine ** 12B13 Y TRUE 5010A2 N of Maryland 12011 Y TRUE 5010A2 G of Massachusetts ** 00200 Y TRUE 5010A2 N of Michigan ** 12B18 Y TRUE 5010A2 N of Minnesota 00220 Y FALSE 5010A2 N of Mississippi ** 12B17 Y TRUE 5010A2 N of Missouri ** 12B65 Y TRUE 5010A2 N of Missouri - Kansas City, 5569I Y TRUE 5010A2 N ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 of of of of of of of Payer Blue Cross Blue Cross Blue Cross Blue Cross Blue Cross Blue Cross Blue Cross Blue Cross Blue Cross Blue Cross Blue Cross Missouri Blue Cross Blue Cross Blue Cross Blue Cross Blue Cross Blue Cross Blue Cross ** Blue Cross ** Blue Cross ID Reports Additional Info Enrollment Submission Type Montana ** Nebraska Nevada New Hampshire New Jersey Horizon New Mexico ** New York City (Empire) 12B77 00260 00265 1512I 5526I 12B22 12B36 Y Y Y Y Y Y Y TRUE TRUE FALSE TRUE TRUE TRUE TRUE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 N G G N N N N ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 of New York Northeastern 12B68 Y TRUE 5010A2 N ICD-9 of New York of Central 12B37 Y TRUE 5010A2 N ICD-9 Blue Cross of New York of Rochester ** Blue Cross of New York of Utica, Watertown ** Blue Cross of New York State ** 12B40 Y TRUE 5010A2 N ICD-9 12B38 Y TRUE 5010A2 N ICD-9 12B35 Y FALSE 5010A2 N ICD-9 Blue Cross of New York Western ** 12B39 Y TRUE 5010A2 N ICD-9 Blue Cross of North Carolina ** Blue Cross of North Dakota ** Blue Cross of Ohio ** Blue Cross of Oklahoma ** Blue Cross of Oregon Regence ** Blue Cross of Pennsylvania Capital ** Blue Cross of Pennsylvania Western/Central Highmark ** Blue Cross of Rhode Island ** Blue Cross of South Carolina ** Blue Cross of South Dakota ** Blue Cross of Tennessee Blue Cross of Texas Blue Cross of Utah ** Blue Cross of Utah - FEP ** Blue Cross of Vermont ** Blue Cross of Washington (Premera) ** Blue Cross of West Virginia ** Blue Cross of Wisconsin ** Blue Cross of Wyoming ** Blue Medicare of NC ## 12B23 12B78 12B24 12B59 00851 12B60 Y Y Y Y N Y FALSE TRUE TRUE TRUE FALSE TRUE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 N N N N G N ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 12B81 Y TRUE 5010A2 N ICD-9 12B74 12B55 12B33 5513I 84980 12B42 12B1E 12B32 12B27 Y Y Y Y Y Y Y Y Y TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 N N N N G G G N N ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 12B28 12B29 12B30 CALL Y Y Y Y TRUE TRUE TRUE FALSE 5010A2 5010A2 5010A2 5010A2 N N N G ICD-9 ICD-9 ICD-9 ICD-9 Blue Shield of California Bluegrass Family Health ## BMC Health Net Plan Boilermakers National Health & Welfare Fund ## 94036 61124 13337 36609 Y Y Y Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G G G ICD-9 ICD-9 ICD-9 ICD-9 (Contracted providers only. Call 888-296-9790) Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Boon-Chapman Benefit Administrators, 74238 Y FALSE 5010A2 G Inc. ## Bravo Health 52192 Y Formerly known as Elder FALSE 5010A2 T Health Inc, serving members in PA, MA, DE, TX and WA DC. Not to be cofused with Elder Plan in NY. BrickStreet Insurance Company ## 12X53 N FALSE 5010A2 G BridgeSpan ## BRIDGEWAY NETWORK ** BritCay ## Brockerage Concepts, Inc. ** Brown & Brown Benefits ## Brown & Toland Medical Group BRIDG 68069 22286 51037 59069 94316 N Y N Y Y Y Buckeye Community Health ** 68069 Y Butler Benefits ## C3 Health (fka Access Health Inc.) 42150 A1680 N N CA Home Health & Hospice ** Home Health & Hospice J15 Cigna 12M98 12M97 N N California Anthem Blue Cross 47198 California Blue Cross ** Cal-Optima Direct ## CANNON COCHRAN MANAGEMENT SERVICES INC ## Code Set ICD-9 ICD-9 ICD-9 FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G T G G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 FALSE 5010A2 T ICD-9 FALSE FALSE 5010A2 5010A2 T C ICD-9 ICD-9 TRUE TRUE 5010A2 5010A2 G G ICD-9 ICD-9 Y FALSE 5010A2 N ICD-9 47198 CALOP 71057 Y Y Y TRUE FALSE FALSE 5010A2 5010A2 5010A2 N G G ICD-9 ICD-9 ICD-9 CANNON COCHRAN MGMT ## CAP Management Systems ** Capital Community Health Plan Capital District Physicians Health Plan 37105 95399 87726 12X03 Y N Y Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G C G ICD-9 ICD-9 ICD-9 ICD-9 Capital Health Plan Capitol Administrators ## Caprock Health Plan ** Cardinal Innovations (Formerly Piedmont Behavioral Health) ## Cardiovascular Care Providers ## 95112 68011 CAPHP 06607 Y Y N Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 C G T G ICD-9 ICD-9 ICD-9 ICD-9 GCVCP Y FALSE 5010A2 T ICD-9 12K89 57116 57115 77082 N Y N N FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 N G G C ICD-9 ICD-9 ICD-9 ICD-9 Care Care Care Care ## ## ** Access PSN ## First Health Plan of AZ ## First Health Plan of CA ## Improvement Plus/CIP/XLHealth Prior to submitting claims, please call Provider Relations Dept at 1-866296-8731 to verify your provider info is on the file in the claim system. This will prevent rejections and allow payements to be made in a timely manner. Valid for the following states: CO, WV, VA, UT, SD, PA,NE, ND, MT, MO, MD, KS, IA, DE, DC and WY Claims for Payer address of Metairie, LA ONLY Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Care Oregon ## 93975 N FALSE 5010A2 G Care to Care ## 41222 N FALSE 5010A2 G Care Wisconsin Health Plan (Trizetto) 27004 N FALSE 5010A2 T ## CareCentrix ## 11345 Y Enrollment required prior to FALSE 5010A2 G claim submission, please contact [email protected] CareCore Aetna Radiology CareCore National CareCore National - Healthnet 14179 14182 14184 Y Y Y CareCore National - Healthnet New Jersey CareCore Oxford Radiology Carefirst BCBS NCA ## 14185 Y 14180 12000 Y Y Carelink Medicaid ** (Prepare to use consolidated Coventry payerID of 25133) Carenet ** (Prepare to use consolidated Coventry payerID of 25133) Carepoint Health Plan ## CareSource KY ** CareSource OH ** Carilion Clinic Medicare Health Plan ## 25140 Code Set ICD-9 ICD-9 ICD-9 ICD-9 FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 FALSE 5010A2 G ICD-9 FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 Y FALSE 5010A2 G ICD-9 25142 Y FALSE 5010A2 G ICD-9 77023 KYCS1 31114 77015 Y Y Y N FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G G G ICD-9 ICD-9 ICD-9 ICD-9 Cariten Commercial Cariten Senior Health Carolina Behavioral Health Alliance ## 62073 62072 56215 Y Y N FALSE FALSE FALSE 5010A2 5010A2 5010A2 T T G ICD-9 ICD-9 ICD-9 Carolina Care Plan ** 29076 Y FALSE 5010A2 G ICD-9 Carolina Crescent Health Plan ** Carolina Summit Healthcare, Inc. ## 12K85 56195 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 Caterpillar Inc. ## CBHNP - Health Choices ## CBSA ## CDO Technologies ## CDS GROUP HEALTH ## Cedar Valley Community Health Plan ## Celtic Health Insurance ** CeltiCare ** Cement Masons & Plasterers Health & Welfare Trust -Group #F16 ## 37060 65391 41124 87065 88022 SISCO Y Y Y N Y N FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G G G G G P ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 68063 68069 91136 N Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G T G ICD-9 ICD-9 ICD-9 Cenpatico ** CENPATICO ARIZONA ** Cenpatico Behavior Health ** 68068 68068 68068 Y Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 T T T ICD-9 ICD-9 ICD-9 Additional Provider Info RENDERING PROVIDER NETWORK ID, REFERRING PROVIDER ID, FACILITY INFO and FACILITY ID required Includes coverage for DC and Northern Virginia Carolina Care Plan is part of Medical Mutual Family of Companies Please include Group Number when submitting claims. Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Cenpatico Florida Behavioral Health ** 68068 Y FALSE 5010A2 T ICD-9 CENPATICO GEORGIA ** CENPATICO INDIANA ** Cenpatico Kansas ** Cenpatico Massachusetts ** Cenpatico Ohio ** CENPATICO TEXAS ** Centegra Health System ## Centene Advantage Plans ** Center Care (For Safety & Claims) 68068 68068 68068 68068 68068 68068 36474 68069 USC02 Y Y Y Y Y Y N Y Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 T T T T T T G T T ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Center for Elders Independence ** 94312 Y FALSE 5010A2 G ICD-9 CenterCare CenterLight Healthcare ** CenterPoint Human Services ** Centra Healthplan ## 13357 13360 56122 75196 Y N Y Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G G C ICD-9 ICD-9 ICD-9 ICD-9 Centra Healthplan ** 75243 Y FALSE 5010A2 C ICD-9 Central Benefits Life aka HealthScope Benefits ** Central Benefits Mutual ** Central Benefits National ** Central California Alliance ** Call CCA EDI support at 831-430-5510 prior to submitting claims for first time 31118 Y FALSE 5010A2 T ICD-9 31118 31118 12K82 Y Y N FALSE FALSE FALSE 5010A2 5010A2 5010A2 T T G ICD-9 ICD-9 ICD-9 02041 34097 36215 Y Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 48120 36393 23171 Y N Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G T G ICD-9 ICD-9 ICD-9 84146 59223 Y Y FALSE FALSE 5010A2 5010A2 N G ICD-9 ICD-9 34154 39113 Y N FALSE TRUE 5010A2 5010A2 G N ICD-9 ICD-9 CHOC Childrens Hosp of Orange Cty Health Alliance ## CHP Direct Supermed ## CHP/RPU (FABOH) ** 33065 Yes FALSE 5010A2 G ICD-9 90441 39112 N Y FALSE FALSE 5010A2 5010A2 G C ICD-9 ICD-9 Christian Brothers Services CIGNA CIGNA - PPA CIGNA - PPO CIGNA Behavioral Health CIGNA Flex Care (New Mexico only) ** CIGNA Health Plan - HMO CIGNA Medicare Advantage CIGNA Senior Cincinnati Financial Corporation ** 38308 62308 62308 62308 MCCBV 62310 N Y Y Y Y Y FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G C C C C G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 62308 86033 86033 46871 Y Y Y Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 C G G G ICD-9 ICD-9 ICD-9 ICD-9 Payer Central Mass Heath Care ** Central Reserve Life ## Central States Health & Welfare Funds ## Century Health Solutions ** Century PHO ## CHA Commonwealth Health Alliance ## CHAMPVA - HAC ** Chesapeake Life Insurance Company ## Chesterfield Resources, Inc. ## Children's Community Health Plan ** ID Reports Additional Info (Formerly Health Economics Corp.) [Formerly Centra Benefits of Texas (MS, TX, WA)] (Facility physical address required on claim.) Enrollment Submission Type Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Citrus Health Plan 10207 Y FALSE 5010A2 C ClaimsBridge HPN ** 11752 N FALSE 5010A2 T Claimshop- Employers Coalition on 27008 N FALSE 5010A2 G Health ## Claimsware Inc. DBA ManageMed ## 57080 Y FALSE 5010A2 G Clarian Health Plans ## CMHC ** CNA Health Partners ## CNA Health Partners Repricing - AR ## CNIC Health Solutions. Cofinity Colonial Medical ## Columbia United Providers ** COMM CHOICE HLTH PLAN ## COMMERCE BENEFITS GRP ## Common Ground Healthcare Cooperative ## Commonwealth Admn, LLC ## Commonwealth Care Alliance ## Community Care Behavioral Health Organization ## Community Care BHO Community Care Managed Health Care Plans of Oklahoma ** Community Care of Oregon ** Community Care Organization ## Community Community Community Community First I Par Plus Health ## Health Alliance ** Health Alliance TN ## Community Health Choice Community Health Electronic Claims/CHEC/webTPA ## Community Health Plan of Washington ** Community Health Solutions ## Community Premier Plus ## COMP-Ohio (Austintown, Ohio) ## CompManagement Health ** Comprehensive Benefits Administrators, Inc ## Comprehensive Medical/Vision Program AZ ## ComPsych ## Concordia Care Inc ## CONNECTICARE ## ConnectiCare, Inc ## Connecticut Carpenters Health Fund ## Connecticut General (CIGNA) Consociate Group ** Consolidated Health Plans ## Consumer Mutual of Michigan ** Consumers Choice Health SC ** Continental General Insurance ## Code Set ICD-9 ICD-9 ICD-9 ICD-9 95444 02041 71063 48153 N Y Y Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G T G ICD-9 ICD-9 ICD-9 ICD-9 CHCNT 38335 22284 91162 61948 34181 77170 N Y N Y Y Y Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE 4010A1 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 P C G G G G N ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 37237 14315 Y Y FALSE FALSE 5010A2 5010A2 C G ICD-9 ICD-9 25179 Y FALSE 5010A2 G ICD-9 23282 73143 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 21455 39126 N Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 COMMF 60495 35193 27905 Y N Y N FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 T G G G ICD-9 ICD-9 ICD-9 ICD-9 48145 75261 Y N FALSE FALSE 5010A2 5010A2 T G ICD-9 ICD-9 CHPWA Y FALSE 5010A2 T ICD-9 ULA11 13374 34177 N Y A TRUE FALSE FALSE 5010A2 5010A2 5010A2 N G G ICD-9 ICD-9 ICD-9 15243 03036 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 M0166 Y FALSE 5010A2 N ICD-9 U7363 33632 78375 06105 37307 N Y Y Y N FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 G T G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 62308 37135 87843 58112 45321 71404 Y Y N N A Y FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 C T G G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Pilot (in testing) Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Conversion Plan - APWU 55544 y Claims are printed and FALSE PRINT G mailed to the payer.; For conversion plan members only. If filing a claim for a federal plan member, please use payer ID 44444 Code Set ICD-9 Cook Childrens Health Plan CHIP ** CCHP1 N FALSE 5010A2 T ICD-9 Cook Childrens Health Plan Star ** CCHP9 N FALSE 5010A2 T ICD-9 Cook Group Health Plan ## Cooperative Benefit Administrators CBA ** 35149 52132 Y Y FALSE FALSE 5010A2 5010A2 G C ICD-9 ICD-9 COOPERATIVE MANAGE CARE SERVICES, INC ## Coordinated Benefit Plan ** CORE MGMT RESORCE GRP ## CoreSource Little Rock ## CoreSource of PA, MD, IL ** CORESOURCE OH ** 35199 Y FALSE 5010A2 G ICD-9 14829 58231 75136 35182 35183 N Y Y Y Y FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 T G G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 CoreStar (PayerID Termed to 35182. Older payerID of 41045 will start rejecting.) ** Corizon Health, Inc ## 35182 Y FALSE 5010A2 G ICD-9 CORIZ R FALSE 5010A2 G ICD-9 35202 Y FALSE 5010A2 G ICD-9 41124 Y FALSE 5010A2 G ICD-9 56116 Y FALSE 5010A2 G ICD-9 43160 Y FALSE 5010A2 G ICD-9 75235 42138 58102 CMSEB Y Y Y Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G T G T ICD-9 ICD-9 ICD-9 ICD-9 25133 Y FALSE 5010A2 G ICD-9 Cornerstone Benefit Administrators ** Corporate Benefit Services of America ## CORPORATE BENEFITS SERVICES, INC. ## Correctional Medical Services ## CORSOLUTIONS ## CountyCare ** Covenant Administrators ## Covenant Management System Employee Benefit I Par Plus Coventry Health Care (Coventry old Legacy Payer ID's are still accepted) For Dates of service after Jan. 1, 2014 use PayerID 39026 Submit claims where address is in Ohio. For assistance 800-689-0106 Corizon, Inc claims with address of Brentwood, TN should be submitted to this Payer ID Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. CoverColorado CHCNT N FALSE 4010A1 P ICD-9 Payer ID Reports Additional Info Enrollment Submission Type Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Cox Health Plan ## 00119 N FALSE 5010A2 G ICD-9 Payer ID Reports Additional Info Enrollment Submission Type Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Creative Medical Systems ## 64068 Y FALSE 5010A2 G Creative Plan Administrators ## 37320 Y FALSE 5010A2 G Crescent Health Solutions ** 56213 N FALSE 5010A2 G CSI Network Services ## 34186 N FALSE 5010A2 T CTI Administrators Inc. ** 42141 N FALSE 5010A2 G Custom Design Benefits Inc. ## 82056 Y FALSE 5010A2 T D.H. EVANS & ASSOC. CALL N Call Jessica Picarde @ 410FALSE 5010A2 G 349-3222 for Payer ID ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Payer ID Reports Additional Info Enrollment Submission Type DakotaCare Dart Member Care ## Dean Health Plan ** Definity Health Plan (UnitedHealthcare) ** Definity Services Delaware Physicians Care, Inc. DELTA HEALTH SYSTEMS ** DENVER HEALTH MED PLN ## DENVER HEALTH MEDICAID CHOICE DAK01 CB987 39113 87726 Y N N Y FALSE FALSE TRUE FALSE 5010A2 5010A2 5010A2 5010A2 G G N C ICD-9 ICD-9 ICD-9 ICD-9 64159 27009 94235 84135 84133 Y Y N Y Y FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 C G T G T ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Deseret Mutual/DMBA ** DETROIT MEDICAL CTR ** DIVERSIFIED GROUP BKG ## 12X35 56240 06102 N N Y TRUE FALSE FALSE 5010A2 5010A2 5010A2 N G G ICD-9 ICD-9 ICD-9 Driscoll Childrens Health Plan ## E. S. Beveridge and Associates ## 74284 34108 Y N FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 East Carolina Behavioral Health ## 56089 N FALSE 5010A2 G ICD-9 Easy Choice Health Plan of NY ## EBC INC 24770 CALL Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 EBMS (Employee Benefit Management Services, Inc) ## Educators Mutual (EMIA) ** El Paso First - CHIP I Par Plus Elder Health HMO of Pennsylvania 12X44 Y FALSE 5010A2 G ICD-9 SX110 EPF03 52192 N Y Y TRUE FALSE FALSE 5010A2 5010A2 5010A2 N T T ICD-9 ICD-9 ICD-9 04326 Y FALSE 5010A2 G ICD-9 31625 Y FALSE 5010A2 G ICD-9 Elmcare L.L.C. ELMCO ## Emerald Health Network, Inc. (All PPO Business) ## Emerald HMO (HMO Claims only) ## NAELM 37253 34167 Y Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 34555 Y FALSE 5010A2 G ICD-9 Empire Plan (UnitedHealthcare) ** Employee Benefit Concepts MI ## 87726 Y FALSE 5010A2 C ICD-9 38241 Y FALSE 5010A2 G ICD-9 Employee Benefit Consultants ## CALL A FALSE 5010A2 G ICD-9 Employee Benefit Corporation ## 37215 Y FALSE 5010A2 G ICD-9 Elder Service Health Plan of the North Shore ## ELDERPLAN ## Verify the Payer ID, Member ID, Payer City, and State before submitting claims Please call (440) 262-1160 to obtain the payerID. Now known as Bravo Health Provider ID required on all claims (To obtain the payer ID, please call (440) 2621160.) Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Employee Benefit Management Corp. 31074 Y FALSE 5010A2 T (EBMC) ** Employee Benefit Services ** 37216 Y FALSE 5010A2 G Employee Benefit System ## 42149 Y FALSE 5010A2 G Employee Benefits Plan 03036 Y FALSE 5010A2 G Administration, Inc Employee Logistics ## 92135 N FALSE 5010A2 T Employee Plans, LLC ## 35112 Y FALSE 5010A2 G Employers Direct Health ## 75236 Y FALSE 5010A2 G EMPLOYER'S DIRECT SF ## 75233 Y FALSE 5010A2 G Employers Insurance of Wausau - aka 39026 Y FALSE 5010A2 C Wausau (Now known as UMR Wausau/UHIS) ** Employers Mutual, Inc (FL) ## 59298 Y FALSE 5010A2 G Encore Health Network 35206 N FALSE 5010A2 T Enstar Natural Gas - Group # P61 91136 Y Please include Group FALSE 5010A2 G ## Number when submitting claims. Entrust ## (These claims will be PRINT N FALSE PRINT N dropped to paper and mailed to payer as they no longer accept claims electronically. Also use of old payerID 36879 will cause claim to reject. ) Epic Life Ins. (Wisconsin Physician Services) ** 12X29 Y EPN (Seton Health Plan Exclusive PR I Par Plus) EQUICOR EQUICOR - PPO Equitable (CIGNA) Equitable Plan Services ## EPNSH Y 62308 62308 62308 73126 Y Y Y Y Erin Group Administrators ## ESSENCE HEALTHCARE ## Everence ** Evergreen Health ## EVOLUTIONS HEALTHCARE SYSTEMS, INC. ## 23250 20818 35605 45319 59313 Y Y N A Y ExclusiCare Fallon Community Health Plan Family Care ## Family Care CCO ** 71412 22254 60995 PHD01 Y Y Y Y Family Care Medicaid (Use for claims with DOS of 12/31/2012 and prior.) FCD01 Y Family Care Medicaid Mental Health FCM01 Family Care Medicare Family Care Medicare ## (Admin by PH Tech. Use for claims with DOS of 01/01/2013 and later.) FCR01 PHR01 Subscriber id = 9 digits, WPS Provider id qualifier G2 Code Set ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 FALSE 5010A2 G ICD-9 FALSE 5010A2 T ICD-9 FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 C C C G ICD-9 ICD-9 ICD-9 ICD-9 FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 G G G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G G P ICD-9 ICD-9 ICD-9 ICD-9 FALSE 5010A2 P ICD-9 Y FALSE 5010A2 P ICD-9 Y Y FALSE FALSE 5010A2 5010A2 P P ICD-9 ICD-9 Valid for billing address of P O Box 720460, Oklahoma City, OK 73172 Valid for PO Box 5001, New Port Richey, FL 34656. Admin by PH Tech Use for claims with DOS of 08/01/2012 and after Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Family Health Systems - WI/Group 39167 Y Now known as Group Health FALSE 5010A2 G Health Cooperative ## Cooperative of South Central Wisconsin. (Formerly Family Health Systems - WI/Group Health Cooperative) Family Health Systems - WI/Group Health Cooperative ## 39168 Y FCE BENEFIT ADMINISTRATORS ## 33033 Federally Qualified Healthcare Clinic Now known as Group Health Cooperative of South Central Wisconsin. (Formerly Family Health Systems - WI/Group Health Cooperative) Code Set ICD-9 FALSE 5010A2 G ICD-9 Y FALSE 5010A2 T ICD-9 FQHC1 Y TRUE 5010A2 N ICD-9 Federated Mutual Insurance ## Fidelis Care New York Fidelis Secure Care ## First Agency ## First Carolina Care ## First Choice ## First Choice Health Network First Choice VIP Care ## First Health Network ** First Integrated Health ## First Priority Health ## FirstCare FirstCare Star Medicaid FirstGuard Health Plan - Kansas 41041 11315 77054 88055 56196 75138 91131 37510 73159 75232 42331 94999 94998 90060 Y Y Y N Y Y Y N Y Y N N N Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE TRUE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G G G G G G G G G G G G G N ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 FirstGuard Missouri 90061 Y TRUE 5010A2 N ICD-9 FL MCO PHC/PHP ** Florida 1st ## Florida Healthcare ## Florida Healthcare Plus ## FLORIDA HOSP HC SYS 95411 59276 59322 12611 59321 Y Y N N Y FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 G G G G T ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Florida Hospital Waterman ## Florida League of Cities, Inc. ## Florida True Health ## FMH Benefit Services, Inc. Formax, Inc. ** Fortis Benefits ## Fortis Insurance Company (Assurant Health) ## Fox-Everett, Inc. ## 48116 59698 26492 48117 87066 70408 39065 Y Y N Y Y Y Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G G G T G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 64069 Y FALSE 5010A2 G ICD-9 Enrollment required. Call 800-225-2573 ext 25525 Enrollment required. Call 800-225-2573 ext 25525 If Bill Prov NPI not present, Attend Prov NPI required or- If Attend Prov NPI is not present, either Attend Prov Network ID (REF*N5) or Commercial Num (REF*G2) is required. FHHS member ID must be 11 digits. Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Freedom First ## 31313 N FALSE 5010A2 G Freedom Health Plan ## 41212 Y FALSE 5010A2 G Freedom Life ## 62324 N FALSE 5010A2 T Fresenius Family Care ## 23130 Y FALSE 5010A2 G Fresenius Medical Care Health Plan I FMCHP Y FALSE 5010A2 T Par Plus FrontPath Health Coalition 34171 Y FALSE 5010A2 G Gallagher ** 37283 Y FALSE 5010A2 G GALVESTON COUNTY INDIGENT 30005 Y FALSE 5010A2 G HEALTHCARE ## Gateway Health Plan - Medicare 60550 Y Please verify claims for FALSE 5010A2 G Assured Gateway Health Plan Medicare Assured; 60550 (Yellow Card). Gateway Health Plan Medicaid PA 25169 N FALSE 5010A2 T Gateway Health Plan of Ohio, Inc. ## 76028 Y Please verify claims for FALSE 5010A2 G Gateway Health Plan of Ohio Inc.; 76028 (White Card). Gateway to Better Health ## GE Group Administrators, South Carolina ## GEHA (Government Employees Health Association) ## GEHA (Members in NY and NJ (MultiPlan Network)) GEHA (Members in AR, CT, HI, IN, KY MA, ME, MI, NH, RI and VT (PHCS Network)) ## Geisinger Health Plan ## Generations Health ## GettingUsCovered GHI - New York (Group Health Inc.) ## GHI HMO Select ** Gilsbar ## Glassworkers Health & Welfare Fund Group # F29 ## 4317M 06143 N Y 44054 Y 45235 Code Set ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 TRUE FALSE 5010A2 5010A2 N G ICD-9 ICD-9 FALSE 5010A2 C ICD-9 Y FALSE 5010A2 G ICD-9 45275 Y FALSE 5010A2 G ICD-9 75273 46050 CHCNT 13551 Y N N Y FALSE FALSE FALSE FALSE 5010A2 5010A2 4010A1 5010A2 T G P G ICD-9 ICD-9 ICD-9 ICD-9 25531 07205 91136 Y Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 Global Care ** Global Excel Management ** Global Health ** GMS INC ** Golden Rule (UnitedHealthOne) ** 07689 GEM01 GHOKC 47083 37602 Y N Y Y Y FALSE FALSE TRUE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010 G G C G C ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Golden Triangle Physician Alliance GTPA1 Y FALSE 5010A2 T ICD-9 Good Shepherd Hospice ** Grand Valley Health Plan ** Great Lakes Health Plan (UnitedHealthcare Community Plan) ** Greater Orange Medical Group ** Great-West Life & Annuity Ins. Co. 76923 95453 95467 Y A Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G C ICD-9 ICD-9 ICD-9 NMM01 80705 Y Y FALSE FALSE 5010A2 5010A2 G C ICD-9 ICD-9 Group Administrators Ltd. ## Group and Pension Administrators ## 36338 48143 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 GROUP HEALTH COOPERATIVE ## 39167 Y FALSE 5010A2 G ICD-9 Formerly Phoenix Group Services Please include Group Number when submitting claims. Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Group Health Cooperative (Northwest) 91051 Y FALSE 5010A2 G ICD-9 Payer ID Group Health Cooperative of EauClaire ** Group Insurance Service Center, Inc. ## GROUP PRACTICE AFFILIATES ** Guardian Life Insurance Company of America ## Gundersen Lutheran Health Care H.E.R.E.I.U Welfare Pension Funds ## HAA Preferred Partners ## Harmony Health Plan of Illinios ## Reports Additional Info Enrollment Submission Type 95192 N FALSE 5010A2 T ICD-9 37276 Y FALSE 5010A2 G ICD-9 68068 64246 Y Y FALSE FALSE 5010A2 5010A2 T G ICD-9 ICD-9 39180 37114 Y Y FALSE FALSE 5010A2 5010A2 T G ICD-9 ICD-9 65101 36406 N N FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 Harmony Health Plan of Indiana ## 36405 N FALSE 5010A2 G ICD-9 Harrington ** Harrington Health - Kansas 75243 62061 Y N FALSE FALSE 5010A2 5010A2 C G ICD-9 ICD-9 59143 75201 75202 Y Y Y TRUE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 Harvard Community Health Plan ** 04245 Y FALSE 5010A2 G ICD-9 Harvard Pilgrim Healthcare ## Harvard Pilgrim Passport Connect ** 04271 87726 Y Y FALSE FALSE 5010A2 5010A2 N C ICD-9 ICD-9 Hawaii Medical Assurance Association (HMAA) ## HCH Administration 99208 Y FALSE 5010A2 T ICD-9 37215 Y FALSE 5010A2 G ICD-9 HCH Administration ## HCHA ALBQ-Self Funded ## HCP Nevada ** HDPC Alliance Physicians ** HDM Benefit Solutions I Par Plus ** 37111 37329 20501 20257 12T77 Y Y Y Y Y Formerly John P Pearl Associates FALSE FALSE TRUE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 G G C G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 HDPC Premier Healthcare ## STJOE N FALSE 5010A2 G ICD-9 Health Health Health Health Administrators ## Alliance Medical Plans ## Alliance Plan of Michigan Care District ## 34185 77950 38224 Call Y Y Y Y Customer Service (714) 9376143 Note the new PayerID FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 T G G G ICD-9 ICD-9 ICD-9 ICD-9 Health Care Network of Wisconsin (HCN) ** Health Care Partners AZ ## Health Care Savings HEALTH CHOICE ARIZONA ## 42102 Y FALSE 5010A2 C ICD-9 HCP02 56142 62179 N Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 Health Choice Generations ## Health Choice Insurance ** Health Choice Utah ## HEALTH COST SOLUTIONS ## Health Design ## 62180 46221 45399 62111 34158 Y A Y Y Y FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 G G G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Harrington Health BPO ## Harris Methodist Health Plan Harris Methodist Health Plan ## ## (Formerly known as Fiserv Health-Kansas) For HMO Medicaid Product Call Provider Services at 866-930-1002 for EDI Enrollment and PayerID Contact 480.333.4538 JPerlmutter@iasishealthcare .com prior to submission Institutional Claim Payers List (02/02/2015) Payer Health Health Health Health Health only.) Health Health ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. First 95019 Y FALSE 5010A2 T First - Tyler, TX ## 75234 Y FALSE 5010A2 T Management Admin ** 12T11 N FALSE 5010A2 G Net - California ## 95567 Y FALSE 5010A2 G Net - California (Encounters 95568 Y FALSE 5010A2 G ## New England 04286 Y FALSE 5010A2 G Options of Illinois I Par Plus NAHOI Y FALSE 5010A2 G Health Partners - Jackson, TN Code Set ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ## 62157 Y FALSE 5010A2 G ICD-9 Health Partners, PA ## Health Payments Systems, Inc. ## 80142 20270 Y N FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 Health Plan of Michigan (Now known as Meridian Health Plan) ** 83253 Y FALSE 5010A2 C ICD-9 Health Plan of Nevada (Encounter claims) ** Health Plan of Nevada (FFS claims) ** 76343 R FALSE 5010A2 C ICD-9 76342 R FALSE 5010A2 C ICD-9 Health Plan of San Joaquin ## Health Plan of San Mateo ** 68035 CALL Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 HEALTH PLAN SERVICES Health Plans, Inc. ## Health Plus of LA ## Health Services for Children with Special Needs ## Health Services Preferred (HSP) by Emerald Health ## Healthcare Options I Par Plus Healthcare Resources NW ## HEALTHCARE SOLUTIONS ** HEALTHCARE USA ** (Prepare to use consolidated Coventry payerID of 25133) HealthChoice of Memphis ## HEALTHCOMP INC HealthEZ ## Healthfirst of NY ** Healthfirst TPA - Austin ## HealthGuard of Lancaster ## HealthHelp Network, Inc. (HHNI) ## 59140 44273 95009 37290 Y Y Y Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 T G T G ICD-9 ICD-9 ICD-9 ICD-9 34167 Y FALSE 5010A2 G ICD-9 EPF37 56731 73147 25143 Y Y Y Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 T G T G ICD-9 ICD-9 ICD-9 ICD-9 62168 85729 41178 80141 75289 23226 59087 Y Y Y Y Y Y Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G G T G T G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Healthlink HMO ## HealthLink PPO ** Healthnet of Arizona, Inc. ## Healthnet of the Northeast ## HEALTHEOS ** Healthpartners of MN ** HealthScope Benefits ## Healthsmart Accel ** Healthsmart Benefit Solutions. ## 96475 90001 38309 06108 34080 55764 71063 75237 37272 Y Y Y Y Y Y Y Y Y FALSE FALSE FALSE FALSE TRUE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G T G G C T T T G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 HealthSmart Preferred Care ** Healthsource CMHC ** HEALTHSOURCE GA HEALTHSOURCE IN 75250 02041 62308 62308 Y Y Y Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G C C ICD-9 ICD-9 ICD-9 ICD-9 CONTACT PAYER FOR REGISTRATION AND PAYER ID. Endry Lo 650-616-2017 or Ken Cottrell 650-6162021 Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. HEALTHSOURCE KY 62308 Y FALSE 5010A2 C Healthsource Massachusetts, Inc **. 02041 Y FALSE 5010A2 G ICD-9 ICD-9 HEALTHSOURCE ME HEALTHSOURCE NH HEALTHSOURCE OH HEALTHSOURCE PROVI Healthsource Provident (CIGNA) ** 62308 62308 62308 62308 68195 Y Y Y Y Y HEALTHSOURCE SOUTH Healthsource, AR (Med) (CIGNA) ** 62308 71075 Y Y Healthsource, GA (CIGNA) ** 58210 Y Healthsource, Inc ** Healthsource, KY ** Healthsource, ME (CIGNA) ## HS001 61127 01041 N Y Y Healthsource, N. TX (CIGNA) ** 75255 Y Healthsource, NC (CIGNA) ** 56147 Y Healthsource, OH ** Healthsource, SC (claims) ** 31141 06119 Y Y Healthsource, SC (Encounters) Healthsource, TN (CIGNA) ** 06119 62129 Y Y Healthspan aka Kaiser of Ohio ** HealthSpan Network Repricing ## 34092 HSPAN Y N Healthspring HMO/Medicare + Choice ## Healthy Kids I Par Plus Healthy Palm Beaches ## 63092 Y M3FL3 CALL Y A Healthy Texas ** Heritage New York Medical Group 68064 11328 Y Y Heritate Physician Network I Par Plus HPN11 HFN Healthease I Par Plus HFN, Inc ** High Desert Primary Care ** Payer ID Reports Additional Info Enrollment Submission Type FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 C C C C G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 FALSE FALSE 5010A2 5010A2 C G ICD-9 ICD-9 FALSE 5010A2 G ICD-9 FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 FALSE 5010A2 G ICD-9 FALSE 5010A2 G ICD-9 FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 FALSE FALSE 5010A2 5010A2 T T ICD-9 ICD-9 FALSE 5010A2 G ICD-9 FALSE FALSE 5010A2 5010A2 T G ICD-9 ICD-9 FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 Y FALSE 5010A2 T ICD-9 M3FL5 36335 STJOE Y N Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G T G ICD-9 ICD-9 ICD-9 Highline Medical Services MOLINA ## 91164 Y FALSE 5010A2 G ICD-9 HIP - Health Insurance Plan of Greater New York ** 55247 Y TRUE 5010A2 G ICD-9 ## Claims are edited under CIGNA's payer specific edits, Payer ID 62308 Claims are edited under CIGNA's payer specific edits, Payer ID 62308 Claims are edited under CIGNA's payer specific edits, Payer ID 62308 Claims are edited under Cigna's Payer Specific Edits Payer ID 62318 Claims are edited under CIGNA's payer specific edits, Payer ID 62308 Claims are edited under CIGNA's payer specific edits, Payer ID 62308 Healthsource Network Providers Only. Claims are edited under Cigna's Payer Specific Edits - Payer ID 62318 Claims are edited under CIGNA's payer specific edits, Payer ID 62308 Call Provider Services at 866-930-1002 for EDI Enrollment and PayerID As of 10-23-2014, Payer ID of 33069 is no longer valid Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. HMA Hawaii ## 86066 Y FALSE 5010A2 N HMSA (Hawaii Medical Service 1518I N TRUE 5010A2 N Association) ## Holy Cross Health Partners NAHLX Y FALSE 5010A2 G Home State Health Plan ** 68069 Y FALSE 5010A2 T HOMETOWN HEALTH ## 88023 Y FALSE 5010A2 G Horizon Healthcare of New York 5526I Y TRUE 5010A2 N Horizon NJ Health ** 22326 Y FALSE 5010A2 G Hotel Employees & Restaurant 91136 Y Please include Group FALSE 5010A2 G Employees Health Trust -Group #F19 Number when submitting ## claims. HPMS (Send claims to payerID listed CARD Y FALSE 5010A2 G on patient's Insurance card.) ## Hudson Health Plan ## Humana Care Plan Humana Group Health Plan Humana Health Chicago Humana Health Chicago Insurance Company Humana Health Plan 13335 61101 61101 61101 61101 N Y Y Y Y 61101 Y Humana Insurance Agency Humana Insurance Company Humana Medical Plan - CA Humana Medical Plan - KY Humana Military - Tricare (Regions 3 & 4) ## Humana Veterans Healthcare Services ** Humana Wisconsin Health Organization I E SHAFFER ## IBA Health & Life Assurance Co. ## 61101 61101 61101 61101 61125 Y Y Y Y Y 61120 Code Set ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 TRUE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 G T T T T ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 FALSE 5010A2 T ICD-9 FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 T T T T G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Y TRUE 5010A2 G ICD-9 61101 Y FALSE 5010A2 T ICD-9 22175 38234 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 IBC Personal Choice ** IBI ## Idaho True Blue ** Illinicare Behavioral Health ** Illinicare Group Health ** Illinois BCBS ICP ## IMCARE ## INDECS CORPORATION ## Independent Living Systems ** Indian Health Services ## Indiana Department of Health Children's Health ** INDIANA PROHEALTH ## Indiana Teamsters Health Benefits Fund ## INETICO, INC. ** Informed UHC Compass Rose ## 12X26 41124 12B84 68068 68069 00621 41600 40585 45048 00290 35600 Y Y Y Y Y N Y Y Y N N TRUE FALSE TRUE FALSE FALSE FALSE FALSE FALSE FALSE FALSE TRUE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A1 5010A2 5010A2 5010A2 5010A2 5010A2 G G N T T G T G G G N ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 35161 35107 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 43471 50946 N N FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 Informed, LLC ## Ingalls Provider Group Inland Empire Health Plan. ## Innovante Benefit Administrators ** 52196 NAING IEHP1 31172 Y Y N N FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G G G ICD-9 ICD-9 ICD-9 ICD-9 [HCDS only call L. Stansbury at (502) 5807375) This PID good for DOS prior to 12/31/13. For DOS after 12/31/13 should be sent under PID 39026 Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Insurance Design Administrators ## 13315 Y FALSE 5010A2 G ICD-9 Payer ID Reports Insurance Administrators of America ## Insurance Management Services (Amarillo TX) ## 37279 N 15688 N Insurers Administrative Corporation I Par Plus ## 86304 Integra Group Additional Info Enrollment Submission Type FALSE 5010A2 G ICD-9 This Payer ID is only valid for claims submission address of P.O. Box 15688 Amarillo, TX 79105 FALSE 5010A2 G ICD-9 Y Prior to submitting claims: edihelp.iacusa.com FALSE 5010A2 G ICD-9 31127 Y Please contact Payer prior to submitting claims FALSE 5010A2 G ICD-9 Integra Administrative Group (Seaford , DE) 51020 N FALSE 5010A2 G ICD-9 Integral Quality Care ## Integranet I Par Plus Integrated Care Network (ICN) by Emerald Health ## Integrated Medical Solutions ## Integrity Benefit Network GA ## INTER UNION OF OPER15 ## 23229 INET1 34167 Y Y Y Valid for Claim address 110 S. Shipley Street, Seaford, DE 19973 only FALSE FALSE FALSE 5010A2 5010A2 5010A2 G T G ICD-9 ICD-9 ICD-9 20050 58200 37269 N Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 T G G ICD-9 ICD-9 ICD-9 56132 23252 23287 Y Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 48603 Y FALSE 5010A2 G ICD-9 39182 IMGIN Y Y FALSE FALSE 5010A2 5010A2 G T ICD-9 ICD-9 20435 Y FALSE PRINT G ICD-9 InTotal Health ** Iowa Benefits Inc. ## J1 MAC Medicare Part A California IHP02 41124 12M64 Y Y Y FALSE FALSE TRUE 5010A2 5010A2 5010A2 T G N ICD-9 ICD-9 ICD-9 JI Sepcialty Services, Inc. I Par Plus JISSP Y FALSE 5010A2 T ICD-9 JMH - SFCCN PHT (PSN, CMSN) ** 09822 R FALSE 5010A2 G ICD-9 John Alden Life Insurance Co. 41099 Y FALSE 5010A2 G ICD-9 CALL Y FALSE 5010A2 G ICD-9 John P. Pearl and Associates ## Johns Hopkins 37215 52189 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 Joplin Claims ## JP Farley Corporation 43178 34136 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 ## Interactive Medical Systems ## Inter-County Health Plan ** INTERGROUP SERVICES CORPORATION ## International Brotherhood of Boilermakers Employee Health Care Plan(IBBEHC) ## International Funding Inc. ## International Medical Group, Inc. I Par Plus INTGRITAS Benefit Group ## John Muir Trauma Physicians ## Located in New York, NY Claims will be printed and mailed to payer. Please contact John Muir Tra uma Physicians at 925-9475288 for Payer id information. New Submitters should send in their Billing NPI & Rendering servicing NPI (Formerly BMI) Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. JSL Administrators AKA Wells Fargo 37272 Y FALSE 5010A2 G Third Party Aministrators ## Kaiser Foundation Health Plan of 94135 Y FALSE 5010A2 T Northern CA ## Kaiser Foundation Health Plan of 94134 Y FALSE 5010A2 G Southern CA Kaiser Foundation Health Plan of COKSR Y FALSE 5010A2 C Colorado Kaiser Foundation Health Plan of NG010 Y FALSE 5010A2 C Georgia Kaiser Foundation Health Plan of the NG008 Y FALSE 5010A2 C Mid Atlantic Kanawha Insurance Co. ## 57038 Y FALSE 5010A2 G Kelsey Seybold - Institutional Claims I KELSI Y FALSE 5010A2 T Par Plus Kempton Company ## 73100 Y FALSE 5010A2 G 73100 Y FALSE 5010A2 G Kempton Group Administrators ## Kent County Health Plan ** Kentucky Health Cooperative ** Kentucky Spirit Health Plan ** Kern Health Systems Key Benefit Administrators ** Key Insurance Group ## KEY SELECT ** Keystone Mercy Health Plan ** KENT1 77894 68069 77039 37217 KEYIP 37321 23284 N Y Y N Y N Y Y Keystone Health Plan East ** Keystone VIP Choice ** Klais and Company ** LA Care (Now known as AmeriHealth Caritas Louisiana)## LA Care Health Plan ## LA Department of Corrections ** Lake Forest Managed Care Associates ## Lake Region Community Health Plan ## Lancaster General Health Group Preferred Health Care (IHS Payer) ** 12X25 84223 34145 27357 LBA Health Plans ## LEON MEDICAL CTR Health Plan I Par plus LIBERTY HEALTH ADVANTAGE ** Liberty Union ## Life Assurance Company ## LIFE TRAC ## LifePath Hospice Inc ** Lockard & Williams ## Loyal American Life ** Loma Linda University Health Plan ## Code Set ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 C G T T G T G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Y N Y Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G G G ICD-9 ICD-9 ICD-9 ICD-9 LACAR LADOC 37112 Y N Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G T G ICD-9 ICD-9 ICD-9 SISCO N FALSE 5010A2 P ICD-9 CALL N FALSE 5010A2 T ICD-9 52193 65055 N Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 11328 37281 37281 41136 76870 CB752 13193 33036 Y N N Y N Y N Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G G G G G G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Medicaid managed care. Payer requires registration and testing; please call (877) 234-4271. Contact Sherry Wolgemuth Vice President of Claims Operations for Preferred Health Care at (717) 5609290 ext. 124 for approval and the Payer ID. Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Lone Star TPA ** 45289 Y FALSE 5010A2 T Louisiana Health Cooperative ** 28680 Y FALSE 5010A2 T Louisiana Healthcare Connections ** 68069 Y FALSE 5010A2 T ICD-9 ICD-9 ICD-9 Payer ID Lovelace Health Plan ** Lovelace Salud ** (Older PID of SX159 is no longer valid.) Lovelace Sandia ** Lovelace Senior Options (LSO) ** Lovelace Senior Plan (LSP) ** Loyal American Life Magellan Health Services MAGNACARE ## Magnolia ** MAHP (MD IPA, Optimum Choice and MLH) UnitedHealthcare ** Maine Community Health Options ** Reports Additional Info Enrollment Submission Type 62310 09824 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 00790 62310 62310 13193 12X27 11303 U8062 87726 Y Y Y N Y Y N Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A3 5010A2 5010A2 5010A2 5010A2 G G G G G G T C ICD-9 ICD-9 ICD-9 ICD-10 ICD-9 ICD-9 ICD-9 ICD-9 45341 Y FALSE 5010A2 G ICD-9 MajestaCare ## Maksin Management Corporation ** 26372 22195 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 MAMSI Life and Health Insurance Co. (MLH) (Previously Payer ID 52148) 87726 Y FALSE 5010A2 C ICD-9 Managed Care Network ## Managed Care Services, LLC 22771 35162 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 Managed Health Services Indiana ** 68069 Y FALSE 5010A2 T ICD-9 Managed Health Services Wisconsin ** 68069 Y FALSE 5010A2 T ICD-9 Manulife W. J. Sutton Company ## 98010 Y FALSE 5010A2 G ICD-9 Maricopa Health Plan / Maricopa Care Advantage Marrick WRx ## Martin's Point Health Care USFHP/Generations Advantage Maryland Physicians Care ## MASHANTUCKET PEQUOT TRIBAL NATION ## Masters, Mates and Pilots Program ## Mayo Management Services, Inc ** 09908 Y FALSE 5010A2 G ICD-9 46478 MPHC2 N Y FALSE FALSE 5010A2 5010A2 G T ICD-9 ICD-9 22348 37121 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 12T52 Y FALSE 5010A2 G ICD-9 41154 Y FALSE 5010A2 T ICD-9 MBA Benefit Administrators ## MCA Administrators aka DGA Diversified ## Mcare 83028 25160 Y N FALSE FALSE 5010A2 5010A2 G T ICD-9 ICD-9 38264 Y FALSE PRINT G ICD-9 McLaren ** McLaren ABW-NHP ** 38338 3833N Y Y FALSE FALSE 5010A2 5010A2 C C ICD-9 ICD-9 ## Prior to submitting claims, please call Provider Relations Dept at 1-866296-8731 to verify your provider info is on file in the claim system. This will prevent rejections and allow payments to be made in a timely manner. Claims will be printed and routed to Payer Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. McLaren ABW-THPC ** 3833T Y FALSE 5010A2 C McLaren Health Advantage ** 3833A Y FALSE 5010A2 C McLaren Medicaid ** 3833C Y FALSE 5010A2 C McLarenAdvantage SNP ** 3833R Y FALSE 5010A2 C MD - Individual Practice Association, 87726 Y FALSE 5010A2 C Inc. (M.D. IPA) (Previously Payer ID 52148) MDWise Hoosier Alliance Health Plan 20475 Y FALSE 5010A2 G ** Mdwise, Inc. (formerly IU Health) ## 12K81 y FALSE 5010A2 G Code Set ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 MDWise Select Health Network ## MWSHN N FALSE 5010A2 G ICD-9 MDX Hawaii ** Med Pay ** Med3000 CMS Early Steps ## Med3000 CMS Safety Net ## Med3000 CMS Title 19 Reform ## Med3000 CMS Title 21 ## Med3000 Pedicare Title 19 ## Med3000 Pedicare Title 21 ## MedAdmin Solutions ## MDXHI 88058 EM350 EM284 EM843 EM205 EM039 EM522 58202 Y A N N N N Y N Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 P G G G G G G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 MedAdmin Solutions ## 58204 Y FALSE 5010A2 G ICD-9 MedBen (Newark, OH) ## MedCom ** MEDCOST BENEFIT SVCS ** 74323 59231 56205 Y Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 MedCost ** Medica 56162 94265 N Y FALSE FALSE 5010A2 5010A2 T C ICD-9 ICD-9 Medica Health Plan of Florida ## Medica2 ** Medicaid - TX Premier Plan I Par Plus 78857 12422 EPF02 Y Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 Medicaid of Alabama ** Medicaid of Arizona (AHCCCS) ** 75254 AZMCD Y Y FALSE FALSE 5010A2 5010A2 N N ICD-9 ICD-9 Medicaid of Arkansas ** Medicaid of California (MediCal) ** 12023 MDCAL Y Y FALSE TRUE 5010A2 5010A2 N N ICD-9 ICD-9 Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid 1548I 06127 77027 12K05 12K07 3501I 18049 47163 12K11 12K12 12K13 12007 5529I 12K37 12K16 77032 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE TRUE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 N N N N N N N N N N N N N N N N ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 of of of of of of of of of of of of of of of of Colorado CT ** Florida Georgia ** Idaho ** Indiana Iowa ** Kansas ** Kentucky ** Louisiana ** Maine ** Maryland ** Massachusetts Michigan ** Minnesota ** Mississippi ## (Formerly Advanced Data Solutions, Inc.) (Formerly Parity Healthcare.) Formerly Payer ID 56151 Medica requires a unique Medica assigned provider ID. Out-Patient claims only. Inpatient and Long-term claims will require testing. Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. of Missouri ** 12K15 Y TRUE 5010A2 N of Montana ** 12K77 Y TRUE 5010A2 N of Nebraska 1520I Y TRUE 5010A2 N of Nevada ** 12K20 Y TRUE 5010A2 N of New Jersey ** 12006 Y TRUE 5010A2 N of New Mexico ** 12K22 Y TRUE 5010A2 N of New York ** 12K35 Y TRUE 5010A2 N of North Carolina ## NCMCD Y FALSE 5010A2 T of Ohio 3509I Y TRUE 5010A2 N of Oregon ** 12K41 Y TRUE 5010A2 N of Pennsylvania ** 12008 Y TRUE 5010A2 N of Rhode Island ** 12K74 Y TRUE 5010A2 N of South Carolina ** 12K55 Y TRUE 5010A2 N of South Dakota ** 12K36 Y TRUE 5010A2 N of Tennessee ** 12K46 Y TRUE 5010A2 N of Texas 86916 Y For “Acute Care” claims only TRUE 5010A2 N ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Payer Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid Medicaid ID Reports Medicaid of Vermont ** Medicaid of Virginia Medicaid of Washington ** Medicaid of West Virginia ** Medicaid of Wisconsin Medicaid of Wyoming ** Medical Associates Health Plan ## 12K26 5538I 12K27 12K28 WIMCD 12K30 MAHP1 Y Y Y Y Y Medical Benefit Administrators Inc dba MBA of MD Inc ## Medical Benefits Administrations ## Additional Info Enrollment Submission Type Y TRUE TRUE TRUE FALSE FALSE TRUE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 N N N N N N G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 37298 Y FALSE 5010A2 G ICD-9 MBA01 Y FALSE 5010A2 G ICD-9 74323 Y FALSE 5010A2 G ICD-9 74323 Y FALSE 5010A2 G ICD-9 74323 74323 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 75229 Y FALSE 5010A2 G ICD-9 Medical Development International ## Medical Mutual of Ohio ** 52181 Y FALSE 5010A2 G ICD-9 29076 Y FALSE 5010A2 G ICD-9 MEDICAL MUTUAL OF OHIO CAREWORKS ## Medical Reimbursement Associates ## Medical Services Initiative ** Medical Value Plan - Ohio (MVP) Medicare J4 (WPS) Legacy ** Medicare of Alabama ** Medicare of Alaska ** 10010 Y FALSE 5010A2 G ICD-9 62177 Y FALSE 5010A2 G ICD-9 12057 38224 04911 12M01 AKMCR Y Y Y Y Y FALSE FALSE TRUE TRUE TRUE 5010A2 5010A2 5010A2 5010A2 5010A2 G G N N N ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Medicare of Arizona ** Medicare of Arkansas ** Medicare of California ** 53589 12022 01111 Y Y Y TRUE TRUE TRUE 5010A2 5010A2 5010A2 N N N ICD-9 ICD-9 ICD-9 Medicare Medicare Medicare Medicare Medicare 04111 3533I 12M63 3518I 3536I Y Y Y Y Y TRUE TRUE TRUE TRUE TRUE 5010A2 5010A2 5010A2 5010A2 5010A2 N N N N N ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Medical Benefits Administrators, Inc. (Newark, OH) ## Medical Benefits Companies (Newark, OH) ## Medical Benefits Mutual ## Medical Benefits Mutual (Newark, OH) ## Medical Control, Inc (ppoNext) ## of of of of of Colorado ** Connecticut DC ** Florida Georgia Provider's Medical Mutual assigned 12 digit ID number required. Per Provider Testing is Required Does not include J1 MAC, see 12M64. Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. of Idaho ** 12M07 Y TRUE 5010A2 N of Illinois ** 12M08 Y TRUE 5010A2 N of Indiana ** 12M09 Y TRUE 5010A2 N of Iowa ** 05101 Y TRUE 5010A2 N of Kansas 05201 Y TRUE 5010A2 N of Kentucky ** 15101 Y TRUE 5010A2 N of Louisiana ** 12M12 Y TRUE 5010A2 N of Maine 3547I Y TRUE 5010A2 N of Maryland 5554I Y TRUE 5010A2 N of Massachusetts 5527I Y TRUE 5010A2 N of Michigan ** 08201 Y TRUE 5010A2 N of Minnesota ** 06201 Y TRUE 5010A2 N of Mississippi ** MSMCR Y TRUE 5010A2 N of Missouri J5 ** 05301 Y TRUE 5010A2 N of Montana ** 12M77 Y TRUE 5010A2 N of Mutual of Omaha 05901 Y TRUE 5010A2 N of Nebraska ** 05401 Y TRUE 5010A2 N of New Jersey ** 12005 Y TRUE 5010A2 N of New Mexico ** 04211 Y TRUE 5010A2 N of New York ** 13201 Y TRUE 5010A2 N of North Carolina ** NCMCR Y TRUE 5010A2 N of North Dakota ** 12M82 Y TRUE 5010A2 N of Ohio ** 15201 Y TRUE 5010A2 N of Oklahoma ** 04311 Y TRUE 5010A2 N of Oregon ** 12M41 Y TRUE 5010A2 N of Pennsylvania ** 12M60 Y TRUE 5010A2 N of South Carolina ** 12M55 Y TRUE 5010A2 N of South Dakota ** 12M83 Y TRUE 5010A2 N of Tennessee ** 12M53 Y TRUE 5010A2 N of Texas ** 04411 Y TRUE 5010A2 N of Utah ** 12M84 Y TRUE 5010A2 N of Virginia ** 12004 Y TRUE 5010A2 N of Washington (Noridian) ** 12M45 Y TRUE 5010A2 N ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Payer Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare ID Reports Medicare of West Virginia ** Medicare of Wisconsin ** Medicare of Wyoming ** Medico Insurance ## Mediture ## Medpartners ## MedSolutions, Inc ## Medstar Select MEGA Life & Health (United Insurance Division) MEGA Life & Health Insurance Company - Insurance Center ## 12M28 00450 12M30 23160 20039 412MP 62160 251MS 97055 Y Y Y N Y N Y N Y 59221 Y MEGA Life & Health Starbridge StarHRG ** Memorial Clinical Associates/ SelectCare of Texas ## Memorial Hermann Health Network I Par Plus Mennonite Mutual Aid Association and Affiliates (Now known as Everence) ** Mental Health Network ## Mercy Care Plan of Arizona 59225 Additional Info Enrollment Submission Type TRUE TRUE TRUE FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 N N N N G T G T G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-10 ICD-9 FALSE 5010A2 G ICD-9 Y FALSE 5010A2 G ICD-9 62181 Y FALSE 5010A2 G ICD-9 MHHNP Y FALSE 5010A2 T ICD-9 35605 N FALSE 5010A2 G ICD-9 74289 86052 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 Claims United Ins. Div. Payer ID valid only if the addresses on the Health ID card matches the following P.O. Box 982009, North Richland Hills, TX 76182 Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Mercy Maricopa Integrated Care ## 33628 Y FALSE 5010A2 G ICD-9 Payer ID MERCYCARE WI (Call 608-758-7739 for PayerID.) Meridian Health Plan ** Meritain - Luminx ## Meritain Health (Formerly know as North American Administrators) ## Reports Additional Info Enrollment Submission Type CALL N FALSE 5010A2 C ICD-9 13189 65157 64157 Y Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 C G G ICD-9 ICD-9 ICD-9 41124 45150 65113 13265 10850 74289 37127 Y N N Y Y Y Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G G T G G G G ICD-9 ICD-9 Icd-9 ICD-9 ICD-9 ICD-9 ICD-9 Mid-America Associates Inc. ## Mid-American Benefits ** Midlands Health Partners Mid-Valley CareNet, Inc. ## Midwest Health Partners ## Midwest Health Plan ** Midwest Health Plans, Inc. I Par Plus 37281 22823 47080 31140 76079 MHP77 12T54 N N Y Y Y N Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G T T G G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Mid-West National Life Insurance Co. of Tennessee - Insurance Center ## 59224 Y FALSE 5010A2 G ICD-9 Mid-West Nat'l Life & Health Ins. Co. 97055 Y FALSE 5010A2 G ICD-9 MidWest Security Admin ## MID Rogue Oregon Health Plan ## 79480 MRIPA N Y FALSE FALSE 5010A2 5010A2 C T ICD-9 ICD-9 MISS SELECT HLTH CARE/SELECT ADMN SERVICE ## 64088 Y FALSE 5010A2 G ICD-9 Mississippi Physician Care Network ## 64084 N FALSE 5010A2 G ICD-9 Molina Healthcare of UTAH ** Molina Healthcare of California ** 12X09 38333 Y Y FALSE FALSE 5010A2 5010A2 N G ICD-9 ICD-9 Molina Molina Molina Salud Molina Healthcare of Florida Healthcare of Michigan ** Healthcare of New Mexico - 51062 38334 09824 N Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 Healthcare of New Mexico - SCI 04423 Y FALSE 5010A2 G ICD-9 of Ohio ** of Texas I Par Plus 20149 20554 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 of Washington I Par 38336 Y FALSE 5010A2 G ICD-9 of South Carolina ** 46299 Y FALSE 5010A2 G ICD-9 20934 IP095 Y N FALSE FALSE 5010A2 5010A2 G N ICD-9 ICD-9 Meritain Health Minneapolis ## Meritus Health Partners ## Metcare Health Plan ## Metro Plus Health Plan ## Metropolitan Health Plan MHNET ## Michael Reese Physicians Group Molina Healthcare Molina Healthcare ** Molina Healthcare Plus ** Molina Healthcare Molina Illinois ** Monarch IPA ## ## Payer ID valid only if the addresses on the Health ID card matches the following P.O. Box 982017, North Richland Hills, TX 76182 Also Select Administrative Services (SAS Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Monitor Life ** 01759 y Payer accepts secondary FALSE 5010A2 G claims only, and Medicare cannot be the primary payer Montefiore Contract Management 13174 Y FALSE 5010A2 G Organization ** Montefiore HMO ** 46161 N FALSE 5010A2 G Monumental Life ## MMLIC Y FALSE 5010A2 N MORRIS ASSOCIATES ## 35092 Y FALSE 5010A2 T Mountain States ## 86040 Y FALSE 5010A2 G MPEEBT(MISSISSIPPI PUBLIC ENTITY) 37233 Y FALSE 5010A2 G ## MPLAN, Inc./HealthCare Group, LLC 95444 Y FALSE 5010A2 G ## MS BCBS State Employees 12B82 Y TRUE 5010A2 N Multiplan Wisconsin Preferred Provider 34080 Y TRUE 5010A2 C Network ** Muskegon Care ** A1681 N FALSE 5010A2 C Mutual Assurance ## 37256 Y FALSE 5010A2 G Mutual of Omaha Insurance Company 71412 Y FALSE 5010A2 G Mutually Preferred MVP - Ohio MVP Health Plan of NY 71412 38224 14165 Y Y Y N.W. Ironworkers Health & Security Trust Fund - Group # F15 ## 91136 Y N.W. Roofers & Employers Health & Security Trust Fund -Group #F26 ## 91136 Y N.W. Textile Processors - Group # F14 ## 91136 Y NAA (North Americal Administrators, LP - Nashville, TN.) ## 65085 Y NALC/Affordable NaphCare, Inc ** National Association of Letter Carriers 53011 58182 53011 National Association of Letter Carriers/NALC ** National Benefits Administrators - New Jersey ## National Benefits Administrators North Carolina ## National Health Benefit ** National Health Benefits CorportationNHBC02 ## National Imaging Associates, I Par Plus National Rural Letter Carrier Association (Policy Number GMG1846) Code Set ICD_9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 FALSE 5010A2 G ICD-9 Group submitting FALSE 5010A2 G ICD-9 Group submitting FALSE 5010A2 G ICD-9 FALSE 5010A2 G ICD-9 Y A Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 53011 Y FALSE 5010A2 G ICD-9 56175 Y FALSE 5010A2 G ICD-9 56176 Y FALSE 5010A2 G ICD-9 88057 88050 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 NIA11 Y FALSE 5010A2 T ICD-9 71412 Y FALSE 5010A2 G ICD-9 MVP Health Plan (Mohawk Valley) (providers should contact MVP at 877-4614911 before submitting claims) Please include Number when claims. Please include Number when claims. Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Nationwide Specialty Health (Formerly 31417 Y FALSE 5010A2 G Nationwide Health Plans) ** ICD-9 Native Care Health ** NCAS - Fairfax, VA ## NCAS-CHARLOTTE ## NCTA ## 19191 75190 75191 52103 N Y Y Y Neighborhood Doctors Organization ## Neighborhood Health Partnership (NHP) ## Neighborhood Health Plan of MA Neighborhood Health Providers/Suffolk Health Plan ** 51909 Payer ID Reports Additional Info Enrollment Submission Type FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G G G ICD-9 ICD-9 ICD-9 ICD-9 N FALSE 5010A2 G ICD-9 96107 Y FALSE 5010A2 C ICD-9 04293 11325 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 NESIKA HEALTH GROUP ## NETCARE LIFE HLTH INS ## Network Health Insurance CorpMedicare ## Network Health MA ## Network Healthplan of Wisconsin ## 37255 66055 77076 Y Y N FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 04332 39144 Y N FALSE FALSE 5010A2 5010A2 G C ICD-9 ICD-9 Nevada Health Coop ** New Avenues Inc. ** New ERA ## New Mexico Health Connections ** 90091 95998 75281 45129 Y N Y N FALSE FALSE FALSE FALSE 5020A2 5010A2 5010A2 5010A2 G G G G ICD-9 ICD-9 ICD-9 ICD-9 New West Health Plan ## New York Life - Long Term Care I Par Plus NGS American, Inc NHI Billing ** Nippon Life Insurance Company of America ## NJ CARPENTERS HEALTH ** North American Benefits ## 84141 NYL11 N Y FALSE FALSE 5010A2 5010A2 N N ICD-9 ICD-9 38225 14043 81264 Y N Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G T G ICD-9 ICD-9 ICD-9 22603 34159 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 NORTH AMERICAN MED ## E3510 Y FALSE 5010A2 G ICD-9 Northeast Iowa Community Health Plan ## Northern Ill HealthPlan ## Northern Nevada Trust Fund ## North Shore - LIJ (Healthfirst) ** SISCO N FALSE 5010A2 P ICD-9 36347 88027 17516 Y Y N FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 Claims for Dates of Service after 1-1-14 should be sent to UMR. PID of 39026 (Use this payer ID for Dates of Service prior to 6/1/13. For later claims,use 80141) Payer id 39144 now valid for hospital and medical claims that have a submission address of PO Box 568 Menasha, WI 54952. Payer id 39111 has been merged to this payer id. Valid for billing address of P O Box 94928, Cleveland, OH 44101-4928 or P. O. Box 89476, Cleveland, OH 44101-5476 Contact 1-800-956-8000 prior to initial submission of claims. Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. North Shore - LIJ CareConnect 46227 N FALSE 5010A2 G Insurance Company ** Northwest Community Health Partners NANWC Y After June 30, 2013 claims FALSE 5010A2 G should be billed to payerID 35199. Northwest Diagnostic Clinic I Par Plus 62119 Y FALSE 5010A2 N (Old PayerID of NWDC1 is no longer valid.) Northwest Physicians Network ## NPN11 Y FALSE 5010A2 G NOVA Healthcare Administrators NY 16644 Y FALSE 5010A2 G ## Novasys Health Network ## 71080 Y FALSE 5010A2 G NTCS STAFF ## 52104 Y Claims for Dates of Service FALSE 5010A2 G after 1-1-14 should be sent to UMR. PID of 39026 Code Set ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Nyhart ## NYS DOH UCP ** Oak West Primary Physician Association ODS Health Plan ## Ohio Health Choice, PPO ## Ohio PPO Connect ** Olympus Managed Health Care ## 37299 14142 NAOAK Y N Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G N G ICD-9 ICD-9 ICD-9 13350 34189 74431 65074 Y Y N Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G G T ICD-9 ICD-9 ICD-9 ICD-9 One Call Medical ## ONE Health Plan of California, Inc. 22321 80705 Y Y FALSE FALSE 5010A2 5010A2 G C ICD-9 ICD-9 ONE Health Plan of Colorado, Inc. ONE Health Plan of Georgia, Inc. ONE Health Plan of Illinois, Inc. ONE Health Plan of Texas, Inc. ONE Health Plan, Inc. OneNet PPO ## Operating Engineers Locals 302 & 612 Health & Security Fund #F12 ## 80705 80705 80705 80705 80705 52149 91136 Y Y Y Y Y Y Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 C C C C C C G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Optima Health Plan ## Optimum Healthcare Inc ## Option Services Group Optum Health - Physical Health (Includes Oxford), formerly ACN, former payer IDs 41159, 41160, ACN01 ** 54154 20133 37125 41161 N N Y N FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 N G G C ICD-9 ICD-9 ICD-9 ICD-9 87726 Y FALSE 5010A2 C ICD-9 87726 Y FALSE 5010A2 C ICD-9 41194 Y FALSE 5010A2 C ICD-9 87726 87726 Y Y FALSE FALSE 5010A2 5010A2 C C ICD-9 ICD-9 OptumHealth (OptumHealth Behavior Solutions) formerly United Behavioral Health and PacifiCare Behavioral Health), former payer ID 33053 OptumHealth (OptumHealth Behavioral Solutions of NM) ** OptumHealth (OptumHealth Care Solutions), formerly United Resources Networks, former payer ID 52190 ** OptumHealth Behavior Solutions OptumHealth Behavioral Solutions of NM (OptumHealth) ** Please include Group Number when submitting claims. Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. OptumHealth Care Solutions (formerly 41194 Y FALSE 5010A2 C United Resources Networks) (OpumHealth) ** ORTHONET CORPORATION ## 13381 Y Orthonet-Aetna OSF HealthPlans ## P5 Health ** PA PREFERRED HEALTH 13383 61101 87068 CALL Y Y N Y PacifiCare Behavioral Health PacifiCare Life and Health Insurance Company (UnitedHealthOne) ## 33053 81400 Y Y PacifiCare of Colorado PacifiCare PPO - All States PacificSource Commercial ## PacificSource Medicare ## Paramount Health ## Parkland Community Health Plan COPHS 95999 93029 20377 SX158 66917 Partners Behavioral Health ## Passport Health Plan ** PATIENT ADVOCATE,LLC ## Patient Services, Inc. ** Payer Fusion ## Peach State Health Plan ** ICD-9 FALSE 5010A2 G ICD-9 FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G T T G ICD-9 ICD-9 ICD-9 ICD-9 FALSE FALSE 5010A2 5010A2 C C ICD-9 ICD-9 Y Y N N N Y FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 C C T T N G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 52613 61129 10525 CB733 27048 68069 Y Y Y Y A Y FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G G G T G T ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Pedicare Title 21 I Par Plus PEHP - Utah Public Employee Health Plan ** Penn Behavioral Health ** Pennsylvania Pace ## PEOPLES HEALTH NETWORK ## M3FL8 SX106 Y N FALSE TRUE 5010A2 5010A2 T N ICD-9 ICD-9 53226 20172 72126 A N Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 Personal Insurance Administrators, Inc. ## PHCS Savility 95397 N FALSE 5010A2 G ICD-9 13306 N FALSE 5010A2 G ICD-9 Phoenix Group Services, Inc. ## 06143 Y FALSE 5010A2 G ICD-9 Phoenix Health Plan ** PHP of Northern Indiana ## Physician Health Partners Physician Health Partners Medicare 03440 12399 PHPMC PHPMD Y N N N FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G G T ICD-9 ICD-9 ICD-9 ICD-9 Physicians Health Plan ** Physicians Care Network (Rockford IL only) 37330 36345 N Y FALSE FALSE 5010A2 5010A2 P G ICD-9 ICD-9 ## CIGNA (NY,CT, & NJ) HMO/POS outpatient therapy claims only Code Set Call Manager of PPHN Claims Operations (410) 349-3222 Prior to submitting claims, please call Provider Relations Dept at 1-866874-0633 to verify your provider info is on file in the claim system. This will prevent rejections and allow payments to be made in timely manner. Network ID required on claim ONLY for Savility card members Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Physician's Health Choice - Claims I PHCS1 Y FALSE 5010A2 C Par Plus PHYSICIANS HEALTH COLLABORATIVE 20398 Y FALSE 5010A2 G ## Physicians Mutual ## 47027 Y FALSE 5010A2 G Physicians Plus Insurance Corporation 39156 Y FALSE 5010A2 C ** Piedmont Administrators ## 56151 Y FALSE 5010A2 G Piedmont WellStar Health Plan ** 251PD N FALSE 5010A2 G Pinnacle Claims Management, Inc. 24735 N FALSE 5010A2 G ## PINNACOL ASSURANCE ## 84109 Y FALSE 5010A2 G Pittman & Associates ## 37224 Y FALSE 5010A2 G PLANNED ADMINISTRATOR ## 37287 Y FALSE 5010A2 G Podiatry Network FL ## 59324 N FALSE 5010A2 G POLY AMERICA MEDICAL ## 32680 Y FALSE 5010A2 G POMCO ** 16111 Y FALSE 5010A2 G PPO Plus, LLC ** 72148 Y FALSE 5010A2 T PPOM, LLC 38335 Y FALSE 5010A2 C Prairie States Enterprises, Inc. ## 36373 Y FALSE 5010A2 G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Preferred Administrator I Par Plus PREFERRED BEN ADMIN Preferred Care - NY ** PREFERRED CARE PARTNERS ## EPF10 61665 12X04 65088 Y Y Y Y Preferred Community Choice/PCCSelect/CompMed ** Preferred Health Plan (Louisville, KY) ## Preferred Health Professionals (PHP Kansas City) ## PREFERRED HEALTH SYSTEM Preferred Network Access ## Preferred One ** Premier Health Network ## Premier Health Plan ** Premier Healthcare Exchange ## Premier Healthcare Exchange (Cypress) ## Presbyterian (NM) ** Presbyterian Salud ** Prestige Health Choice ## Prestige Health Choice ** 73145 Y 61106 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 FALSE FALSE TRUE FALSE 5010A2 5010A2 5010A2 5010A2 T G G G ICD-9 ICD-9 ICD-9 ICD-9 FALSE 5010A2 G ICD-9 Y FALSE 5010A2 G ICD-9 31478 Y FALSE 5010A2 G ICD-9 60110 36401 41147 37119 251PR 88051 88056 Y Y Y Y Y N N FALSE FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G G T G G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 05003 PRESA 45056 77003 Y Y Y Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G T G G ICD-9 ICD-9 ICD-9 ICD-9 Prevea Health Plan ## Primary Health Network ## Primary Health Plan I Par Plus Primary PhysicianCare, Inc. ## Prime West Health Plan ## Print claims that will be mailed to payer 39185 82048 PRIME 56144 61604 PRINT Y Y Y Y Y N FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 PRINT T G T G G N ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Priority Health 38217 Y FALSE 5010A2 C ICD-9 Claims for the Miami Florida area only Payer is effective 5/1/2014 Managed Medicaid Plan. For EDI Support, please email edi.phc@amerihealthcaritas. com or call 800-617-5727 These claims will be printed and mailed to payer at current charges. Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. PRO CARE HEALTH PLAN ## 38329 Y Valid: PO Box 3160 AND PO FALSE 5010A2 G Box 3590 Detroit MI 48203 ICD-9 Payer ID Reports ProCare Health Plan Medicaid ## PROCLAIM DBA PROFESSIONAL CLAIM ADMIN ## Professional Benefit Administrators, Inc (Oak Brook, IL) ## 70259 41163 Y Y 36331 Y Professional Claims Management (Canton OH) ## 37242 Y Professional Risk Management ## 34134 Y PROVIDENT ProviDRs Care Network ## PsychCare, LLC ## Puget Sound Benefits Trust - Group # F25 ## 62308 48100 51052 91136 Y No Y Y Puget Sound Electrical Workers Trust Group # F33 ## 91136 Y Pyramid Life Insurance Company Quad Cities Community Health Plan ## QUAD MED LLC ## Qual Choice of Arkansas ## QualCare, Inc. ## Quality Care Partners ** QuikTrip ## 48055 SISCO Y N 39197 35174 23342 89461 73067 Y Y Y R N RBMS, LLC ## REGIONAL CARE INC ## Renaissance Physicians Organization ## Reserve National Insurance ** RESOURCEONE ADMINISTRATORS FKA ADMINONE ## 91176 47076 76066 Y Y Y 73066 37278 N Y RESURRECTION HEALTH CARE PREFERRED ## 36396 Y Resurrection Physicians Group I Par Plus RPPG1 Y Additional Info Payor ID is only valid for claims with billings submission name, city and state of Professional Benefit Administrators, Inc (Oak Brook, IL) Payer ID only valid for claims with a billing submission address of P.O. Box 35276 Canton OH 44735-5278 Please include Number when claims. Please include Number when claims. Group submitting Group submitting Payer does not return a Claim Status or u277 report. Providers will need to reach out to the payer at the number below if they have claim status questions: The QuikTrip provider line number: 918615-7972 Call (773) 572-8311 or( 773) 572-8309 prior to your first submission Enrollment Submission Type FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 FALSE 5010A2 G ICD-9 FALSE 5010A2 G ICD-9 FALSE 5010A2 G ICD-9 FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 C G G G ICD-9 ICD-9 ICD-9 ICD-9 FALSE 5010A2 G ICD-9 FALSE FALSE 5010A2 5010A2 G P ICD-9 ICD-9 FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 G G G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 FALSE FALSE FALSE 5010A2 5010A2 5010A2 G T G ICD-9 ICD-9 ICD-9 FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 FALSE 5010A2 G ICD-9 FALSE 5010A2 T ICD-9 Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. RevClaims ## RVC01 No RevClaims provides TPL FALSE 5010A2 C benefits services for Providers. Providers must be contracted with RevClaims to submit claims. For more information, call 601-3458500 Right Care from Scott & White ** 74205 N FALSE 5010A2 G RightChoice Benefits Administrators 37331 N FALSE 5010A2 T ## Riverside Health Inc ## 45281 N FALSE 5010A2 G RMSCO,INC. ** 16117 Y FALSE 5010A2 G Rocky Mountain Health Plan Grand 84065 Y TRUE 5010A2 G Junction ## Rooney Life Inc. ** 37602 Y FALSE 5010A2 C Rosemont of Des Plaines, IL 36215 Y FALSE 5010A2 G 5010A2 G Royal Health On Behalf of Extended 46166 N For Claims with service FALSE Care MLTC ** dates/statement dates after 12/1/2013 Rush Prudential Health Plans (HMO 36389 Y FALSE 5010A2 G Only) ## S & S Healthcare Strategies 31441 Y FALSE 5010A2 G Sagamore Health Network 35164 Y FALSE 5010A2 T San Diego County Low Income Health MSO77 R FALSE 5010A2 G Program/Coverage Initiative ## San Diego County Medical Services ## San Diego County Primary Care Services San Diego County Ryan White Primary Care Program ## Sanford Health Plan ## Santa Clara Family Health Plans ## Code Set ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 MSO11 R FALSE 5010A2 G ICD-9 MSO44 R FALSE 5010A2 G ICD-9 MSO33 R FALSE 5010A2 G ICD-9 MNSHP 24077 N N FALSE FALSE 5010A2 5010A2 T G ICD-9 ICD-9 Satellite Health Plan Inc ## 45552 N Satellite Health Plan is a MA ESRD C-SNP effective 1/1/14. First Time submitters, please fax a W9 to 650-625-6083 FALSE 5010A2 G ICD-9 SCAN Encounters ** 99157 N FALSE 5010A2 N ICD-9 SCAN HEALTH PLAN ## Scan Health Plan Arizona ## SCAN Long Term Care ## Scott & White I Par Plus Screen Actors Guild ** SECURE HEALTH PLANS GA ## SecureHorizons MedicareComplete (SecureHorizons by UnitedHealthcare) ** 72261 73172 20460 88030 99289 28530 87726 Y Y N Y N Y Y "Diversified Data Design (DDD)" FALSE FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G G G N G G C ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 SecureHorizons MedicareDirect (SecureHorizons by UnitedHealthcare) ** Security Health Plan ## SELECT BENEFIT ADMIN ## 87726 Y FALSE 5010A2 C ICD-9 39045 37282 Y Y FALSE FALSE 5010A2 5010A2 C G ICD-9 ICD-9 Valid for P.O. Box 440, Ashland, WI 54806. Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Select Benefit Administrators (Des 42137 Y Payer ID only valid for FALSE 5010A2 G Moines Iowa) ## claims with a billing submission address of P.O. Box 8339 Des Moines Iowa 50301 Select Benefit Administrators, Inc. ## 93031 N FALSE 5010A2 G Select Health of South Carolina ** 23285 Y SELECT HEALTH IHC INTERMOUNTAIN HEALTH ** 12X37 Y SelectCare ** SelectCare of Texas (HPN) Heritage Physicians Network ## Self Insured Plans ## Self-Funded Plans, Inc (IL, PA, OH) ## Sendero Health ** Senior Smart Choice Senior Whole Health Care ## SENTINEL MANAGEMENT ## Sentry Life ## 00014 76045 Code Set ICD-9 ICD-9 FALSE 5010A2 G ICD-9 FALSE 5010A2 N ICD-9 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 36404 34131 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 36426 95444 83035 23249 39033 N N Y Y Y FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 G G G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Seton Employee Plan Care Program I Par Plus Seton Employee Plan I par Plus Seton Health Plan - CHIP I Par Plus SHCAR Y FALSE 5010A2 T ICD-9 SHEBP SHPCH Y Y FALSE FALSE 5010A2 5010A2 T T ICD-9 ICD-9 Seton Map Program (Mediview) I Par Plus Seton Star ## Seven Corners ## Sierra Health and Life (Encounter claims) (SecureHorizons by UnitedHealthcare)** SHMAP Y FALSE 5010A2 T ICD-9 STAR1 25404 76343 N N R FALSE FALSE FALSE 5010A2 5010A2 5010A2 T G C ICD-9 ICD-9 ICD-9 76343 R FALSE 5010A2 C ICD-9 76342 R FALSE 5010A2 C ICD-9 Sierra Health and Life ** Sierra Health Systems ** Sierra Health Systems Encounters 76342 76342 76343 R R R FALSE FALSE FALSE 5010A2 5010A2 5010A2 C C C ICD-9 ICD-9 ICD-9 SIHO ## Silver Cross Managed Care Organization Simply HealthCare Plans ** SISCO ## Sloan's Lake Managed Care ## Smith Administrators ** Smokey Mountain Center ## NTWKS NASCR N Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 27094 SISCO 84096 02057 13010 N N Y Y Y FALSE FALSE FALSE FALSE TRUE 5010A2 5010A2 5010A2 5010A2 5010A2 G P G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Sierra Health and Life (Encounters) ** Sierra Health and Life (FFS claims) (SecureHorizons by UnitedHealthcare) ** (Contact payer at 801-4425442 before sending claims to verify provider numbers.) Requires Sentry Life Insurance Co group and subscriber numbers. Contact Sentry Customer Service at (800) 426-7234 Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Sound Health (now known as First 91131 Y FALSE 5010A2 G Choice Health Network) Soundpath Health ## 42172 R Formerly known as Pugent FALSE 5010A2 G Sound Health Partners, Inc. SOUTH CENTRAL PREFERR CALL Y Southeastern Indiana Health (SIHO) ## SOUTHERN BENEFIT SERV ## 77153 N 37318 Southwest Service Life/Galaxy Health ## SPECTRUM ADMINISTRATION (Populytics) ** Spohn Health ST MARYS HEATLH PLAN ## St. Barnabas System Health Plan ## St. James PHO ** St. Johns/First Health ## St. Therese Physician Association Code Set ICD-9 ICD-9 Call Provider Relations (717) 851-6715 IU Healthplans FALSE 5010A2 T ICD-9 FALSE 5010A2 G ICD-9 Y No longer process claims for Brockman Enterprises and SPS International FALSE 5010A2 T ICD-9 37266 Y FALSE 5010A2 G ICD-9 23253 Y Requires unique policy number or ID card. Valid for billing address of PO Box 982005 Ft. Worth, TX 76182 FALSE 5010A2 T ICD-9 SPOHN 88029 22240 Y Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 11158 37264 37116 N Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 Standard Life and Accident ** 01758 N TRUE 5010A2 N ICD-9 Standard Life & Accident Insurance Company ** 73099 Y FALSE 5010A2 G ICD-9 Starmark ## State Employees Group Benefits State Farm Medical ** State Farm Casualty & Property Claims ** STATE OF TX DENTAL ## Sterling Medicare Advantage ## 61425 12B12 31053 31059 Y Y N N FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G N G G ICD-9 ICD-9 ICD-9 ICD-9 57254 67829 Y Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 Sterling Option 1 Student Resources (UnitedHealthcare) ## SummaCare Health Plan ** Summit Healthplan I Par Plus Superier Health ## 91151 74227 Y Y FALSE FALSE 5010A2 5010A2 T C ICD-9 ICD-9 95202 20197 75274 Y Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G T G ICD-9 ICD-9 ICD-9 Superior Benefits 23218 Y FALSE 5010A2 G ICD-9 ## Payer accepts secondary claims only, and Medicare cannot be the primary payer Payer only accepts Secondary claims and then only if Primary payer is not Medicare. Located in Lousiana Claims containing Dates of service after 4-30-2014, claims should be sent to Wellcare, PayerID 14163." Valid for claims with the following mailing address: P.O. Box 2388, Stow, OH 44224 Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Superior Health Plan ** 68069 Y Prior to submitting claims, FALSE 5010A2 T please call provider relations dept @ 1-800-2187453 to verify provider info is on file in the claim system. This will prevent rejections and allow payments to be made timely manner. Superior Health/Centene Corp I Par Plus Swedish Covenant Hospital ## Tall Trees Administrators ## Tarrant Health Services ## Team Choice - Alpha Care Gold I Par Plus Team Choice PPO Team Choice UMC Teamcare Teamsters (UT/ID/MT) Group Benefit Admin ** Teamsters Benefit Trust ## Teamsters Local Union #301 ## Texan Plus/Selectcare of TX (Kelsey) I Par Plus Texas Children ## Texas Children's Health Plan ## Texas Healthspring I Par Plus Texas Municipal League Group TexasFirst Health Plan ## THE BOON GROUP The Care Network ** The City of Odessa ## The Ford Meter ## THE HEALTH EXCHANGE ## The Health Plan (Upper Ohio Valley) ## The Loomis ** Code Set ICD-9 SHP11 Y FALSE 5010A2 T ICD-9 36411 88067 37228 ADSL1 A Y N Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G G T ICD-9 ICD-9 ICD-9 ICD-9 75133 75134 36215 88054 Y Y Y A FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G G G ICD-9 ICD-9 ICD-9 ICD-9 94304 36612 KLSY1 N Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G T ICD-9 ICD-9 ICD-9 75228 76048 THS01 74214 13185 BOONG 68423 75600 37305 20356 34150 Y Y Y Y Y Y Y Y Y Y Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G G T C G T G G G G T ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 23223 Y Call Provider Relations at 610-374-4040 ext. 2438 for procedures prior to submitting electronically FALSE 5010A2 T ICD-9 The MEGA Life & Health Insurance Company - Insurance Center ## 59221 Y Payer ID valid only if the addresses on the Health ID card matches the following P.O. Box 982009, North Richland Hills, TX 76182 FALSE 5010A2 G ICD-9 The MEGA Life and Health Insurance Company-OKC ** The Preferred Healthcare System PPO Altoona, PA ** Third Party Administrators Inc. ## 59227 Y FALSE 5010A2 G ICD-9 04320 Y FALSE 5010A2 T ICD-9 37225 Y FALSE 5010A2 G ICD-9 Three Rivers Provider Network (Now known as Unison Health Plan.) 25175 Y FALSE 5010A2 C ICD-9 (Call Julie Blasek at 630416-1111 x156 to verify if you should be sending claims to TPA, Inc. in Maperville, IL) Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. TLD Advantage in Sioux Falls TLC01 A FALSE 5010A2 G Today's Health I Par Plus WITH1 Y FALSE 5010A2 T Today's Health Wisconsin ## 20081 Y FALSE 5010A2 G Today's Option I Par Plus 48055 Y FALSE 5010A2 G Tooling & Manufacturing Association 61425 Y FALSE 5010A2 G ## Total Carolina Care ** 68069 Y Prior to submitting claims, FALSE 5010A2 T please call Provider Relations Dept at 1-866433-6041 to verify your provider info is on file in the claim system. Total Community Care ## Total Health Care Touchstone Health PSO ## Touchstone Health/Health Net Smart Choice ## 31182 38201 23856 13402 Y Y Y Y TPSC - IPN ## TR PAUL INC ## Transamerican Life ## 91078 37230 59222 Y Y Y Transchoice - First Administrators ## 20807 TransChoice Key Benefit Administrators ** Travis County Hospital District MAP I Par Plus Tricare for Life ** Tricare North ** Tricare South ** TRICARE West (UnitedHealthcare Military & Veterans) ** TriHealth Physician Solutions ** Trilogy Health Assurance ** Triplefin, LLC ** Trilogy Health Network ** True Choice USA - Christus Healthplan I Par Plus Trusted Health Plan ** Trustmark ## Tufts Health Plan TYSON FOODS UC Davis Health Systems ** Ucare of Minnesota UCS (Electrical Workers Insurance Fund Local 5800) ## UHIS-UnitedHealth Integrated Services (UnitedHealthcare) ** UICI - Administrators ** UICI - Administrators - State of Nevada ** Ultimate Health Plan ## Ultra Benefits, Inc. ** UMC Health Plan ** Code Set ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G C G G ICD-9 ICD-9 ICD-9 ICD-9 FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 N FALSE 5010A2 G ICD-9 37284 N FALSE 5010A2 G ICD-9 TCHD1 Y FALSE 5010A2 T ICD-9 TDDIR 8503I 6594I 99726 Y Y Y Y TRUE TRUE TRUE TRUE 5010A2 5010A2 5010A2 5010A2 G N N N ICD-9 ICD-9 ICD-9 ICD-9 31144 98514 64300 62777 TCUCH N N Y Y Y FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 G G G G T ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 L0230 61425 04298 62308 UCDMG 52629 93235 N Y Y Y N Y y FALSE FALSE TRUE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 G G T C G G T ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 39026 Y FALSE 5010A2 C ICD-9 75240 74223 Y Y FALSE FALSE 5010A2 5010A2 G C ICD-9 ICD-9 77022 41206 75130 N N Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 After 7-10-13, Claims should be submitted to PID 23856 Payer ID valid only if the address on the Health ID Card matches the following: P.O. Box 982009, North Richland Hills, TX 76182. Accepting claims only for the State of Nevada. Institutional Claim Payers List (02/02/2015) Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. UMR (formerly UMR Onalaska) former 79480 Y FALSE 5010A2 C payer ids 74223, 95266 ## ICD-9 Payer ID Reports Additional Info Enrollment Submission Type UMR (formerly UMR Wausau) former payer ids 31107, 33108, 74223, 75196, 75243 ** UMR Wausau/UHIS ** UMWA - UNITED MINE WORKERS ASSOC ** UNICARE Major Accounts UNICARE Special Accounts Unified Group Services ## Unified Health Services ## Unified Physicians Network ** 39026 Y FALSE 5010A2 C ICD-9 39026 52180 Y Y FALSE FALSE 5010A2 5010A2 C G ICD-9 ICD-9 80314 65099 35198 62170 34638 Y Y Y Y N FALSE FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 G G G G G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Union Pacific ** Unison DE, PA, SC / UnitedHealthcare Community Plan (former payer ids 86003, 86049) ** 87042 25175 Y N FALSE FALSE 5010A2 5010A2 G C ICD-9 ICD-9 Unison OH (UnitedHealthcare Community Plan) ** Unison Health Plan (Formerly Three Rivers Provider Network.) United Medical Alliance ## United Medical Resources 87726 Y FALSE 5010A2 C ICD-9 25175 Y FALSE 5010A2 C ICD-9 84132 31107 N Y FALSE FALSE 5010A2 5010A2 G C ICD-9 ICD-9 United of Omaha UnitedHealthcare 71412 87726 Y Y FALSE FALSE 5010A2 5010A2 G C ICD-9 ICD-9 87726 Y FALSE 5010A2 C ICD-9 UnitedHealthcare (MAHP - MD IPA, Optimum Choice, MLH) formerly MAMSI former payer ID 52148 ** UnitedHealthcare (Student Resources ) ## UnitedHealthcare (UHISUnitedHealthcare Integrated Services) ** UnitedHealthcare / All Savers Alternate Funding ## UnitedHealthcare / All Savers Insurance ## UnitedHealthcare / UnitedHealthcare Plan of the River Valley, former PayerID 95378 87726 Y FALSE 5010A2 C ICD-9 74227 Y FALSE 5010A2 C ICD-9 39026 Y FALSE 5010A2 C ICD-9 81400 Y FALSE 5010A2 C ICD-9 81400 Y FALSE 5010A2 C ICD-9 87726 Y FALSE 5010A2 C ICD-9 UnitedHealthcare Arizona Physicians IPA (Arizona Physicians IPA) formerly know as APIPA ## 03432 Y FALSE 5010A2 C ICD-9 87726 Y FALSE 5010A2 C ICD-9 UnitedHealthcare (Empire Plan) ** UnitedHealthcare Community Plan DE, FL, HI, LA, MD, MS CAN, NM, OH, PA, RI, TX, WA, WI (formerly AmeriChoice or Unison) former payer ids 25175, 86003, 86049 ** For Claim rejections, please contact Unified Physicians clm depart at 847-7631700 This payer id is valid for all claims addresses on UMR member ID cards with a listed payer id of 31107 Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. UnitedHealthcare Community Plan 96385 Y FALSE 5010A2 C KS / KanCare ** 87726 Y FALSE 5010A2 C UnitedHealthcare Community Plan MS CHIP (formerly AmeriChoice MSCHIP) former payer id 95378 ** UnitedHealthcare Community Plan 87726 Y FALSE 5010A2 C NE (formerly AmeriChoice of Nebraska) ** 87726 Y FALSE 5010A2 C UnitedHealthcare Community Plan / IA, hawk-i (formerly AmeriChoice of Iowa) former payer id 95378 86047 Y FALSE 5010A2 C UnitedHealthcare Community Plan / NJ (formerly AmeriChoice NJ Medicaid, NJ Family Care, NJ Personal Care Plus) former payer id 86001 ** 87726 Y FALSE 5010A2 C UnitedHealthcare Community Plan / NY (formerly AmeriChoice by UnitedHealthcare, AmeriChoice NY Medicaid & Child Health Plus, AmeriChoice NY Personal Care Plus) former payer ids 86002, 86048 ** UnitedHealthcare Community Plan / SC (formerly Unison) claims with DOS to 10-01-2013 Code Set ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 25175 N FALSE 5010A2 C ICD-9 (formerly AmeriChoice TN: TennCare, Secure Plus Complete) 95378 Y FALSE 5010A2 C ICD-9 UnitedHealthcare Group Medicare Advantage (UnitedHealthcare Medicare Solutions) ** UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareComplete (formerly SecureHorizons) ** 87726 Y FALSE 5010A2 C ICD-9 87726 Y FALSE 5010A2 C ICD-9 UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareDirect (formerly SecureHorizons) ** 87726 Y FALSE 5010A2 C ICD-9 UnitedHealthcare West (formerly PacifiCare) (UnitedHealthcare) ** UnitedHealthcare West / UnitedHealthcare (formerly PacifiCare) former payer ids 95962, 95964, 95959, 95999 ** UnitedHealthcare West Encounters (formerly known as PacifiCare) (UnitedHealthcare) ** 95958 Y FALSE 5010A2 C ICD-9 87726 Y FALSE 5010A2 C ICD-9 95958 Y FALSE 5010A2 C ICD-9 UnitedHealthcare/Oxford ## UnitedHealthOne / UnitedHealthcare Life Insurance Company (formerly American Medical Security) ## 06111 81400 Y Y FALSE FALSE 5010A2 5010A2 C C ICD-9 ICD-9 UnitedHealthcare Community Plan TN Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. 81400 Y FALSE 5010A2 C UnitedHealthOne / UnitedHealthcare Life Insurance Company (formerly American Medical Security) ## 81400 Y FALSE 5010A2 C UnitedHealthOne / PacifiCare Life and Health Insurance Company ## Unity Health Insurance ** 66705 Y FALSE 5010A2 C Univera Healthcare SSA WNY, PPO, 12X19 Y TRUE 5010A2 G Traditional ## Universal Care - California ## 33001 Y FALSE 5010A2 G University Family Care ## 09830 Y FALSE 5010A2 G University Health Alliance - HI 02910 Y FALSE 5010A2 G University Healthcare Marketplace ** 45437 Y FALSE 5010A2 G University of Utah ** University of Washington Students & Graduate Appts. -Group #P67 ## SX155 91136 N Y University Physicians Healthcare Group UPMC Health Plan Upper Peninsula Health Plan ## Upper Peninsula Health Plan ## US Department of Labor ## US Family Health Plan ## USAA (United States Automobile Association) ## USFHP St Vincent Catholic Med Center NY VA Patient Centered Community Care Program Regions 1, 2 and 4 ## 07503 Y 23281 38337 93092 12X31 12T48 74095 Code Set ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 TRUE FALSE 5010A2 5010A2 N G ICD-9 ICD-9 FALSE 5010A2 G ICD-9 N Y Y Y Y Y FALSE FALSE FALSE TRUE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 5010A2 5010A2 T G G G T G ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 13407 Y FALSE 5010A2 T ICD-9 68021 Y FALSE 5010A2 G ICD-9 VA Premier Complete Care ## Valley Baptist Health ## Value Options ** Value Options / MBHP ** VPCCI 82420 12X56 43307 N N Y N TRUE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 N T N N ICD-9 ICD-9 ICD-9 ICD-9 VANTAGE HLTH PLAN INC ## Verity National Group ** Veterans Administration Fee Basis Programs ** VIDA CARE (Now known as Amida Care) ## VillageCareMAX ## Virginia Premier Health Plan ** VIVA Health ## 72128 75256 12115 N Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 24818 Y FALSE 5010A2 G ICD-9 26545 12K83 63114 N Y N FALSE TRUE FALSE 5010A2 5010A2 5010A2 G N G ICD-9 ICD-9 ICD-9 VNA Homecare Options ** 31626 N FALSE 5010A2 G ICD-9 Please include Group Number when submitting claims. For Claims rejections, please contact esupportServices@valueoptio ns.com or 888-247-9311 (8am-6pm, M-F) VIVA Health requires a complete member ID number, including suffix on all claim submissions. Pls use the following site to verify member information: https://estepp.cschcg.com/ TRI_provider/doEntry.jsp Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. VNS CHOICE Medicare (Formerly 77073 Y FALSE 5010A2 G Visiting Nurses Service) ## VOLUSIA HEALTH NETWORK ## 59266 Y FALSE 5010A2 G Vytra Healthcare ** 22264 Y FALSE 5010A2 G WA Blue Cross Regence (UMP) ** RGBLS N FALSE 5010A2 N WA Blue Shield Regence ** RGBLS N FALSE 5010A2 N Waterstone Benefit Administrators ## 73155 N FALSE 5010A2 T Wausau Insurance Companies - aka Employers Insurance of Wausau (Now known as UMR Wausau/UHIS) ** 39026 Y WEA Insurance Group ## 39151 Y Wellcare Choice I Par Plus Wellcare Health Plans, Inc. (Encounters) Wellcare HMO, Inc. ** Wellcare of CT ** Wellcare of FL ## Wellmed Medical (Claims) I Par Plus M3FL4 59354 Y Y 14163 14164 59608 WELM2 Wellmed Medical (Encounters) I Par Plus Wells Fargo Third Party Aministrators AKA Healthsmart Benefit Solutions.## Code Set ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 FALSE 5010A2 C ICD-9 FALSE 5010A2 G ICD-9 FALSE FALSE 5010A2 5010A2 T G ICD-9 ICD-9 Y Y N Y FALSE FALSE FALSE FALSE 5010A2 5010A2 5010A2 5010A2 G G G C ICD-9 ICD-9 ICD-9 ICD-9 WELMD Y FALSE 5010A2 C ICD-9 37272 Y FALSE 5010A2 G ICD-9 Wenatchee Valley Medical Center ## 91064 N FALSE 5010A2 G ICD-9 WEST & SOUTHERN FINANCIAL GROUP ## West Coast Stationary Engineers Health & Security Trust Fund - Group #F13 ## West Suburban Health Providers ** 31048 Y FALSE 5010A2 G ICD-9 91136 Y FALSE 5010A2 G ICD-9 80942 N FALSE 5010A2 G ICD-9 Western Grower's Assurance Trust 24735 Y FALSE 5010A2 G ICD-9 Western Grower's Insurance Company 24735 Y FALSE 5010A2 G ICD-9 WESTERN MUTUAL INS ## WestLake Financial Group, Inc. ## 37247 WESTL Y Y FALSE FALSE 5010A2 5010A2 T G ICD-9 ICD-9 Weyco Inc. ## WILLIAM C EARHART ** Willis Administrative Services Corporation (Now known as UMR Kansas.) ## Wilson-McShane ## Windsor Medicare Extra 38232 93050 62061 Y Y Y FALSE FALSE FALSE 5010A2 5010A2 5010A2 G G G ICD-9 ICD-9 ICD-9 41095 62153 N Y FALSE FALSE 5010A2 5010A2 G G ICD-9 ICD-9 WINhealth Partners/Wyoming Health Solutions ** Wisconsin Auto and Truck Dealers ## 27327 A FALSE 5010A2 G ICD-9 39200 Y FALSE 5010A2 G ICD-9 Wisconsin Dept. of Corrections ## VEST1 N FALSE 5010A2 C ICD-9 Payer doesn't accept secondary claims electroncally. For DOS before 4/30/14 For DOS 5-1-14 and later, submit claims to 14163 Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Wisconsin Physicians Service 12X29 Y Subscriber ID - 9 digits, FALSE 5010A2 G Insurance Corporation ** WPS Provider ID qualifier G2 WPPN ** 34080 Y TRUE 5010A2 C Worksite Benefit Systems ## 20333 Y FALSE 5010A2 G World Insurance Company (Submit CARD N FALSE 5010A2 G claims electronically to the payerID listed on the patient's Insurance card) ## WPP Eldercare Wisconsin ## 77080 Y FALSE 5010A2 G Code Set ICD-9 ICD-9 ICD-9 ICD-9 ICD-9 Institutional Claim Payers List (02/02/2015) Payer ID Reports Additional Info Enrollment Submission Type Payer Type Code Set Highlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these payers. Report Codes Meaning L LATER DATE - ENS WILL PROVIDE REPORTS FROM THE INSURANCE COMPANY WHEN Y YES - REPORTS ARE PROVIDED N NO- REPORTS ARE NOT PROVIDED S SUMMARY - REPORTS ONLY R REJECTION - REPORTS TBD TO BE DETERMINED General Payer Information P PAR Payers, Direct Connections C Contracted Restricted, Direct Connections T Transitional, Direct and NonDirect Connections G Gateway, NonDirect Connections N NonPar Payers, Direct and NonDirect Connections Secondary claim submission is supported by X12 submitters only. If neither ## or ** is listed for secondary claims, you should contact the payer for specifics. ** ## Payer Doesn't accept secondary claims. If neither ## or ** is listed for secondary claims, you should contact the payer for specifics.
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