OptumInsight Eligibility Payer List ANSI HIPAA 270/271 (As of 1/19/2016)

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1 Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is setup correctly for this payer AARP-UnitedHealthcare Ins Co ALL Loop 2100B should contain Tax Identification Number and/or NPI. FALSE 5010A1 T Advantage by Bridgeway Health Solutions CBRIA ALL Loop 2100B mut contain a Tax Identification Number or NPI. Aetna Health Plans (AHP) ALL Loop 2100B must contain the NPI. Aetna Health Plans PPO ALL Loop 2100B must contain the NPI. Affinity Health Plan AFNTY ALL Loop 2100B must contain either the Tax Identification Number or NPI. Aftra Health Fund AFTRA ALL Loop 2100B must contain the Provider Tax ID Number. This Payer does not work with the NPI at this time. AHP of New Jersey, Parsippany ALL Loop 2100B must contain the NPI. AHP of New Jersey, Purchase, NY ALL Loop 2100B must contain the NPI. Alabama Blue Cross (Institutional) ALBLC AL Loop 2100B must contain the Provider NPI. The Provider's NPI must be set-up with AL Blue Cross / Blue Shield for EDI 270/271 Transactions (separate from the Claims set-up). Please contact the OptumInsight Enrollments Department at enrollments@enshealth.com for complete details. Alabama Blue Shield (Professional) ALBLS AL Loop 2100B must contain the Provider NPI. The Provider's NPI must be set-up with AL Blue Cross / Blue Shield for EDI 270/271 Transactions (separate from the Claims set-up). Please contact the OptumInsight Enrollments Department at enrollments@enshealth.com for complete details. Alabama Medicaid ALMCD AL Loop 2100B must contain the NPI. Enrollment required: Bontact information for enrollment and forms can be found on the following enrollment website, _Enrollment.aspx Alabama Medicare CMSEL AL Enrollment required. Form and instructions at Alaska Medicare CMSEL AK Enrollment required. Form and instructions at AllSavers Life Insurance Company ALL Loop 2100B must be Medicare Provider number or NPI. FALSE 5010A1 T Altius Health Plans ALL Loop 2100B must contain Service Provider Number assigned by the payer or NPI. American Medical Security (AMS) ALL Loop 2100B must be Medicare Provider number or NPI. FALSE 5010A1 T American Postal Workers Union Health Plan AMPWS ALL Loop 2100B must contain the NPI. American Republic Insurance Company (ARIC) ALL Loop 2100B should contain Tax ID or NPI. American Samoa Medicare CMSEL AS Enrollment required. Form and instructions at AmeriChoice - Community and State NJ Loop 2100B must contain the NPI. FALSE 5010A1 T AmeriGroup ALL Loop 2100B must contain the NPI. AmeriHealth Mercy Health Plan AHMHP ALL Loop 2100B must contain the NPI. Arizona Blue Cross Blue Shield AZBLS AZ Loop 2100B must contain the NPI. Arizona Medicaid (AHCCCS) AZMCD AZ Loop 2100B must contain the NPI. Arizona Medicare CMSEL AZ Enrollment required. Form and instructions at Arizona Physicians IPA - Community and State AZ Loop 2100B must contain the NPI. FALSE 5010A1 T

2 Arkansas Blue Cross Blue Shield ARBLS AR Enrollment required. Go to select Download Center, select EMC Agreements, enter your Optum User Id, Select State Arkansas, and the Arkansas BCBS Agreement. TRUE 5010A1 NP Arkansas Medicaid ARMCD AR Loop 2100B must contain the NPI. FALSE 5010A1 NC Arkansas Medicare CMSEL AK Enrollment required. Form and instructions at Assurant Health-John Alden Life ALL Loop 2100B should contain Tax ID or NPI. Assurant Health-Time Insurance AHTIN ALL Loop 2100B should contain Tax ID or NPI. Assurant Health-Union Security Insurance AHUSY ALL Loop 2100B should contain Tax ID or NPI. Best Life and Health BSTLH ALL Loop 2100B must contain the Provider Tax ID Number. This Payer does not work with the NPI at this time. Better Health Plans (Unison Health Plan) TN Loop 2100B should contain Tax ID or NPI. FALSE 5010A1 T Boston Medical Center Health Plan BMCHN MA Loop 2100B must contain the NPI. Bravo Health BRAVO ALL Loop 2100B must contain the NPI. Bridgeway Arizona CBRID ALL Loop 2100B must contain the NPI. California Anthem Blue Cross (WellPoint Health CA Loop 2100B must contain the NPI. FALSE 5010A1 NC California Blue Shield CABLS CA Loop 2100B must contain the NPI. California Medicaid (Medi-Cal) CAMCD CA Loop 2100B must contain the NPI, with a REF*4A = 7 digit Provider PIN. California Medicare CMSEL CA Enrollment required. Form and instructions at Caresource of Ohio OH Loop 2100B must contain the NPI. Cariten Healthcare (Commercial) TN Loop 2100B: Either the Federal Tax ID, Provider ID or NPI is required. CeltiCare CELTI All Loop 2100B must contain the NPI. CHAMPVA ALL Loop 2100B should contain Tax ID or NPI. CIGNA ALL Loop 2100B must contain the NPI. Colorado Anthem Blue Cross Blue Shield (WellPoint Health COBLS CO Loop 2100B must contain the NPI. FALSE 5010A1 NC Colorado Medicaid COMCD CO Loop 2100B must contain the NPI. Colorado Medicare CMSEL CO Enrollment required. Form and instructions at ConnectiCare ALL Loop 2100B should contain Tax ID or NPI. Connecticut Anthem Blue Cross Blue Shield (WellPoint Health CTBLS CT Loop 2100B must contain the NPI. FALSE 5010A1 NC Connecticut General Life ALL Loop 2100B should contain Tax ID or NPI. Connecticut Medicaid CTMCD CT Loop 2100B must contain the NPI. Connecticut Medicare CMSEL CT Enrollment required. Form and instructions at Cooperative Benefit Administrators CBENA ALL Loop 2100B must contain the NPI. CoreSource (IL, IN, MD, NC & PA) CRSC1 IL,IN,MD, NC,PA Loop 2100B should contain Tax ID or NPI. Coventry Health Care Carelink WV Loop 2100B should contain Tax ID or NPI.

3 Coventry Health Care Carelink Medicaid WV Loop 2100B should contain Tax ID or NPI. Coventry Health Care CareNet VA Loop 2100B should contain Tax ID or NPI. Coventry Health Care Group Health Plan (GHP) IL,MO Loop 2100B should contain Tax ID or NPI. Coventry Health Care Health America/ Health Assurance of Pennsylvania (HAPA) PA,OH Loop 2100B should contain Tax ID or NPI. Coventry Health Care of Carolinas/WellPath NC,SC Loop 2100B should contain Tax ID or NPI. Coventry Health Care of Delaware DE Loop 2100B should contain Tax ID or NPI. Coventry Health Care of Georgia GA Loop 2100B should contain Tax ID or NPI. Coventry Health Care of Iowa IA Loop 2100B should contain Tax ID or NPI. Coventry Health Care of Kansas (Kansas City & Wichita) KS,MO Loop 2100B should contain Tax ID or NPI. Coventry Health Care of Louisiana LA Loop 2100B should contain Tax ID or NPI. Coventry Health Care of Nebraska IA,NE Loop 2100B should contain Tax ID or NPI. Coventry Health Care Southern Health Services VA Loop 2100B should contain Tax ID or NPI. Coventry Health Care Texas (includes Coventry Advantra Freedom) ALL Loop 2100B should contain Tax ID or NPI. Coventry Health Care USA (HCUSA) MO Loop 2100B should contain Tax ID or NPI. Coventry Health of Illinois/ Personal Care IL Loop 2100B should contain Tax ID or NPI. Definity Health ALL Loop 2100B should contain Tax ID or NPI. FALSE 5010A1 T Delaware Blue Cross Blue Shield DEBLS DE Loop 2100B must contain the Provider NPI. Delaware Medicaid DEMCD DE Loop 2100B must contain the Provider NPI. Delaware Medicare CMSEL DE Enrollment required. Form and instructions at Deseret Mutual (DMBA) DMBAU UT Loop 2100B must contain the Rendering Provider TIN and NPI. Rendering Provider NPI must already be enrolled for Claim s before they can send RTT to Deseret Mutual (DMBA). FALSE 5010A1 NC Diamond Plan (Maryland Medicaid) MD Loop 2100B should contain Tax ID or NPI. Directors Guild Health Fund DGAHF ALL Loop 2100B must contain the Provider NPI. FALSE 5010A1 NC District of Columbia Medicare CMSEL DC Enrollment required. Form and instructions at Emblem Health EMBLM ALL Loop 2100B must contain the Provider NPI. Excellus Health Plan ECLLS NY Loop 2100B must contain the Provider NPI. Fallon Community Health Plan FALLN ALL Loop 2100B should contain Tax ID or NPI. Federated Mutual Insurance Company FEDMI ALL Loop 2100B must contain the Provider NPI. Federated States of Micronesia Medicare CMSEL FM Enrollment required. Form and instructions at Fidelis (CenterCare) FIDEL ALL Loop 2100B must contain the Provider NPI. First Ameritas of NY ALL Loop 2100B should contain Tax ID or NPI. First Health Coventry Health Care National Network ALL Loop 2100B should contain Tax ID or NPI.

4 First Health Mail Handlers Benefit Plan ALL Loop 2100B should contain Tax ID or NPI. Florida Blue Cross Blue Shield FLBLS FL Loop 2100B should contain BCBSFL Facility or Provider ID and/or NPI. FALSE 5010A1 NC Florida Health Care Plan FL Loop 2100B must contain the NPI. Florida Medicaid FLMCD FL Loop 2100B should contain Provider Number or NPI. Florida Medicare CMSEL FL Enrollment required. Form and instructions at Georgia Anthem Blue Cross Blue Shield (WellPoint Health GABLS GA Loop 2100B must contain the NPI. FALSE 5010A1 NC Georgia Medicaid GAMCD GA Loop 2100B must contain the NPI. FALSE 5010A1 NC Georgia Medicare CMSEL GA Enrollment required. Form and instructions at Golden Rule Insurance ALL Loop 2100B must contain the NPI. FALSE 5010A1 T Government Employees Health Association (GEHA) ALL Loop 2100B should contain either the Tax ID or NPI. FALSE 5010A1 P Great West ALL Loop 2100B should contain Tax ID or NPI. Guam Medicare CMSEL GU Enrollment required. Form and instructions at Harken Health ALL Loop 2100B must contain the NPI. Enrollment Required. Call (702) or Toll Free (800) FALSE 5010A1 T Harmony Health Plan (Illinois & Indiana) IL,IN Loop 2100B must contain the NPI. Harvard Pilgrim HPHCS ALL Loop 2100B must contain the NPI. Hawaii Medicare CMSEL HI Enrollment required. Form and instructions at Health Choice of Arizona HECHA AZ Loop 2100B must contain either the Tax ID or NPI. Health Net National AZ,CT,NJ, NY,PA Loop 2100B should contain Tax ID or NPI. NOTE: Health Net of Arizona and Health Net of the Northeast are now known as Health Net National. Health Net of California CA Loop 2100B should contain Tax ID or NPI. Health Partners Pennsylvania HPART PA Loop 2100B should contain NPI. Healthcare Inc ALL Loop 2100B should contain NPI. HealthEase ALL Loop 2100B must contain the Provider NPI. HealthEase Kids ALL Loop 2100B must contain the Provider NPI. HealthFirst of New York HF1NY NY Loop 2100B should contain Legacy ID or NPI. HealthPartners of Minnesota MN 2100B must contain NPI. Enrollment required. Form and instructions TRUE 5010A1 NP at Healthsmart Benefit Solutions HSBES ALL Loop 2100B must contain the Provider NPI. Humana ALL Loop 2100B should contain Tax ID or NPI. Idaho Medicaid IDMCD ID Loop 2100B should contain Payer Assigned Provider ID Number or NPI. Idaho Medicare CMSEL ID Enrollment required. Form and instructions at Illinois Blue Cross Blue Shield ILBLS IL Loop 2100B should contain Service Provider Number assigned by the payer or NPI.

5 Illinois Medicaid ILMCD IL Loop 2100B should contain Service Provider Number assigned by the payer or NPI. Illinois Medicare CMSEL IL Enrollment required. Form and instructions at Indiana Anthem Blue Cross Blue Shield (WellPoint Health INBLS IN Loop 2100B must contain the NPI. FALSE 5010A1 NC Indiana Medicaid INMCD IN Loop 2100B must contain the NPI. FALSE 5010A1 NC Indiana Medicare CMSEL IN Enrollment required. Form and instructions at Iowa Blue Cross Blue Shield IABLS IA Loop 2100B must contain the NPI. Iowa Medicaid IAMCD IA Loop 2100B must contain the NPI. FALSE 5010A1 NC Iowa Medicare CMSEL IA Enrollment required. Form and instructions at Johns Hopkins Health Plan JHOHP ALL Loop 2100B must contain the NPI. Kaiser Permanente of Northern CA KS003 CA Loop 2100B must contain the NPI. Kaiser Permanente of Southern CA KS001 CA Loop 2100B must contain the NPI. Kansas Blue Cross Blue Shield KSBLS KS Enrollment required. Go to select Download TRUE 5010A1 NP Center, select EMC Agreements, enter your Optum User Id, Select State Kansas, and the Kansas BCBS Agreement. Kansas City Blue Cross Blue Shield KCBLS KS Loop 2100B must contain the NPI. Kansas Medicaid KSMCD KS Loop 2100B must contain the NPI. FALSE 5010A1 NC Kansas Medicare CMSEL KS Enrollment required. Form and instructions at Kentucky Anthem Blue Cross Blue Shield (WellPoint Health KYBLS KY Loop 2100B must contain the NPI. FALSE 5010A1 NC Kentucky Medicaid KYMCD KY Loop 2100B should contain Payer Assigned Prov ID Number or NPI. Provider must be an active KYMCD Provider, prior to sending RT 270 Requests. Call KY Prov Enrollment at Kentucky Medicare CMSEL KY Enrollment required. Form and instructions at Keystone Mercy KEYST PA Loop 2100B must contain the NPI. Louisiana Blue Cross Blue Shield LABLS LA Loop 2100B should contain Service Provider Number assigned by the payer and/or NPI. Louisiana Medicaid LAMCD LA Loop 2100B must contain the Provider NPI. Louisiana Medicare CMSEL LA Enrollment required. Form and instructions at MAHP/MAMSI ALL Loop 2100B must be should contain Service Provider Number and/or NPI. FALSE 5010A1 T Maine Anthem Blue Cross Blue Shield (WellPoint Health MEBLS ME Loop 2100B must contain the NPI. FALSE 5010A1 NC Maine Medicaid MEMCD ME Loop 2100B must contain the NPI. Maine Medicare CMSEL ME Enrollment required. Form and instructions at Marshall Islands Medicare CMSEL MH Enrollment required. Form and instructions at Maryland Blue Cross Blue Shield (CareFirst) MDBLS MD Loop 2100B must contain the NPI. Maryland Medicaid MDMCD MD Loop 2100B must contain the NPI. FALSE 5010A1 NC Maryland Medicare CMSEL MD Enrollment required. Form and instructions at

6 Massachusetts Blue Cross Blue Shield MA Loop 2100B should contain either the 6-character Provider ID or NPI. FALSE 5010A1 T Massachusetts Medicaid MAMCD MA Loop 2100B must contain the NPI. Massachusetts Medicare CMSEL MA Enrollment required. Form and instructions at Medica Health Plans ALL Loop 2100B should contain Service Provider ID or NPI. FALSE 5010A1 T Medical Mutual of Ohio OH Loop 2100B should contain Service Provider number or NPI. Michigan Blue Cross Blue Shield MIBLS MI Loop 2100B must contain the NPI. FALSE 5010A1 NC Michigan Medicaid MIMCD MI Loop 2100B must contain the NPI. This NPI must be enrolled with MI BCBS for Claims prior to sending RT Eligibility Requests. Michigan Medicare CMSEL MI Enrollment required. Form and instructions at Minnesota Blue Cross Blue Shield MNBLS MN Loop 2100B must contain the NPI. FALSE 5010A1 NC Minnesota Medicaid MNMCD MN Loop 2100B must contain the NPI. FALSE 5010A1 NC Minnesota Medicare CMSEL MN Enrollment required. Form and instructions at Mississippi Blue Cross Blue Shield MSBLS MS Loop 2100B must contain the NPI. Mississippi Medicaid MSMCD MS Loop 2100B must contain the NPI. Mississippi Medicare CMSEL MS Enrollment required. Form and instructions at Missouri Anthem Blue Cross Blue Shield (WellPoint Health MOBLS MO Loop 2100B must contain the NPI. FALSE 5010A1 NC Missouri Medicaid MOMCD MO Loop 2100B should contain Tax Identification Number or NPI. FALSE 5010A1 NC Missouri Medicare CMSEL MO Enrollment required. Form and instructions at Molina of California MOLCA CA Loop 2100B must contain the NPI. Montana Medicaid MTMCD MT Loop 2100B must contain the NPI. Montana Medicare CMSEL MT Enrollment required. Form and instructions at Mutual of Omaha ALL Loop 2100B should contain Tax Identification Number or NPI. MVP Health Plan MVPHP ALL Loop 2100B must contain the NPI. National Association of Letter Carriers (NALC) ALL Loop 2100B should contain Tax Identification Number or NPI. Nationwide Specialty Health NATSH ALL Loop 2100B should contain Tax Identification Number or NPI. Nebraska Medicare CMSEL NE Enrollment required. Form and instructions at Neighborhood Health Plan NBRHP MA Loop 2100B must contain the NPI. Network Health NETWH MA Loop 2100B must contain the NPI. Nevada Anthem Blue Cross Blue Shield (WellPoint Health NVBLS NV Loop 2100B must contain the NPI. FALSE 5010A1 NC Nevada Medicaid NVMCD NV Loop 2100B must contain the NPI. Nevada Medicare CMSEL NV Enrollment required. Form and instructions at

7 New Hampshire Anthem Blue Cross Blue Shield (WellPoint Health NHBLS NH Loop 2100B must contain the NPI. FALSE 5010A1 NC New Hampshire Medicaid NHMCD NH Loop 2100B must contain the NPI. FALSE 5010A1 NC New Hampshire Medicare CMSEL NH Enrollment required. Form and instructions at New Jersey Blue Cross Blue Shield (Horizon) NJ Loop 2100B should contain Tax ID or NPI. New Jersey Medicaid NJMCD NJ Loop 2100B should contain Service Provider number or NPI. New Jersey Medicare CMSEL NJ Enrollment required. Form and instructions at New Mexico Blue Cross Blue Shield NMBLS NM Loop 2100B must contain the NPI. New Mexico Medicaid NMMCD NM Loop 2100B must contain the NPI. New Mexico Medicare CMSEL NM Enrollment required. Form and instructions at New York Blue Cross Blue Shield (Empire) NYBLS NY Loop 2100B must contain the NPI. FALSE 5010A1 NC New York Medicaid NYMCD NY Loop 2100B should contain Service Provider number or NPI. FALSE 5010A1 N New York Medicare CMSEL NY Enrollment required. Form and instructions at Nippon Life Insurance (Principal Financial Group) ALL Loop 2100B should contain Tax Identification Number or NPI. North Carolina Blue Cross Blue Shield NCBLS NC Loop 2100B must contain the NPI. FALSE 5010A1 NC North Carolina Medicaid NCMCD NC Loop 2100B must contain the NPI. FALSE 5010A1 NC North Carolina Medicare CMSEL NC Enrollment required. Form and instructions at North Dakota Medicaid NDMCD ND Loop 2100B must contain the NPI. FALSE 5010A1 NC North Dakota Medicare CMSEL ND Enrollment required. Form and instructions at Northern Mariana Islands Northern Mariana Medicare CMSEL MP Enrollment required. Form and instructions at Ohana Health Plan ALL Loop 2100B must contain the NPI. Ohio Anthem Blue Cross Blue Shield (WellPoint Health OHBLS OH Loop 2100B must contain the NPI. FALSE 5010A1 NC Ohio Medicaid OHMCD OH Loop 2100B must contain the Provider ID. FALSE 5010A1 NC Ohio Medicare CMSEL OH Enrollment required. Form and instructions at Ohio Valley HMO, Cincinnati (Aetna) ALL Loop 2100B must contain the NPI. Oklahoma Blue Cross Blue Shield OKBLS OK Loop 2100B must contain the NPI. FALSE 5010A1 NC Oklahoma Medicaid MC030 OK Loop 2100B must contain the Provider NPI Oklahoma Medicare CMSEL OK Enrollment required. Form and instructions at OmniCare Health Plan ALL Loop 2100B must contain Service Provider Number assigned by the payer or NPI. OptumHealth Behavioral Solutions ALL Loop 2100B must contain the Provider NPI FALSE 5010A1 T

8 Oregon Medicaid ORMCD OR Loop 2100B must contain the NPI. FALSE 5010A1 NC Oregon Medicare CMSEL OR Enrollment required. Form and instructions at Oxford Health Plans ALL Loop 2100B must contain the NPI. FALSE 5010A1 T Palau Medicare CMSEL PW Enrollment required. Form and instructions at PEHP Utah PEHPU UT Loop 2100B must contain the Rendering Provider NPI. FALSE 5010A1 NC Pennsylvania Blue Cross Blue Shield (Highmark) PABLS PA Loop 2100B must contain the Group NPI and be enrolled at Highmark for claims prior to sending a 270 Request. If Group NPI is not enrolled, please refer to the CIC website for a copy of the enrollment form and instructions. PABLS includes Independence Blue Cross; see the Ingenix RT 270/271 CG for complete details. Pennsylvania Medicaid PAMCD PA Loop 2100B should contain Service Provider number (13 digit PA Provider Medicaid ID) TRUE 5010A1 T Pennsylvania Medicare CMSEL PA Enrollment required. Form and instructions at PHP of Georgia, Atlanta, Aetna ALL Loop 2100B must contain the NPI. PHP of North Ohio, Cleveland, Aetna ALL Loop 2100B must contain the NPI. Physicians Mutual Insurance Company PMICO ALL Loop 2100B must contain the NPI. Primary Choice (Aetna Health Plan of NY/NJ) ALL Loop 2100B must contain the NPI. Principal Life (Principal Financial Group) ALL Loop 2100B must be Medicare Provider number or NPI. Puerto Rico Medicare CMSEL PR Enrollment required. Form and instructions at QualChoice ALL Loop 2100B must contain Tax Identification Number or NPI. FALSE 5010A1 NC Railroad Medicare CMSEL ALL Enrollment required. Form and instructions at Rhode Island Medicare CMSEL RI Enrollment required. Form and instructions at Schaller Anderson Mercy Care AEMED AZ Formerly known as: Mercy Care Plan AZ Loop 2100B must contain the Service Provider Number. Select Choice (Aetna Health Plan of NY/NJ) ALL Loop 2100B must contain the NPI. SelectHealth SELHT UT Loop 2100B must contain the Rendering Provider NPI. FALSE 5010A1 NC Senior Choice (Aetna Health Plan of NY/NJ) ALL Loop 2100B must contain the NPI. South Carolina Blue Cross Blue Shield SCBLS SC Loop 2100B must contain the NPI. South Carolina Medicaid SCMCD SC Loop 2100B must contain the NPI. FALSE 5010A1 NC South Carolina Medicare CMSEL SC Enrollment required. Form and instructions at South Dakota Blue Cross Blue Shield SDBLS SD Loop 2100B must contain the NPI. South Dakota Medicaid SDMCD SD Loop 2100B must contain the NPI. South Dakota Medicare CMSEL SD Enrollment required. Form and instructions at

9 Southwest Health Plan (Aetna HMO) ALL Loop 2100B must contain the NPI. Star HRG STARH ALL Loop 2100B must contain the NPI. StayWell ALL Loop 2100B must contain the NPI. StayWell Kids ALL Loop 2100B must contain the NPI. Tennessee Blue Cross Blue Shield TNBLS TN Loop 2100B must contain the NPI. FALSE 5010A1 NC Tennessee Medicaid (TennCare) TNMCD TN Loop 2100B must contain the NPI. Tennessee Medicare CMSEL TN Enrollment required. Form and instructions at Texas Blue Cross Blue Shield TXBLS TX Loop 2100B must contain the NPI. FALSE 5010A1 NC Texas Medicaid TXMCD TX Loop 2100B must contain the NPI. Texas Medicare CMSEL TX Enrollment required. Form and instructions at TRICARE (Champus) ALL Loop 2100B should contain Service Provider Number or NPI. NOTE: covers TRICARE South, North and West Regions. Trustmark TRUST ALL Loop 2100B should contain Tax Identification Number or NPI. Tufts Health Plan ALL Loop 2100B must contain the NPI. UHCWest (Pacificare) ALL Loop 2100B must contain the NPI. FALSE 5010A1 T U.S. Minor Outlying Islands Medicare CMSEL UM Enrollment required. Form and instructions at UMR Wausau ALL Loop 2100B must contain either the Tax Identification Number, Provider Identification Number or NPI. UniCare (WellPoint Health UNI ALL Loop 2100B must contain the NPI. FALSE 5010A1 NC UnitedHealthcare ALL Loop 2100B must contain the NPI. FALSE 5010A1 T UnitedHealthcare UHC ALL Loop 2100B must contain the NPI. FALSE 5010A1 T UnitedHealthcare Community Plan - Kansas ALL Loop 2100B must contain the NPI. FALSE 5010A1 T UnitedHealthcare Community Plan (OH) OH Formerly known as: FALSE 5010A1 T Three Rivers Health Plan (Unison Health Plan) Loop 2100B must contain the NPI. UnitedHealthcare Community Plan (PA,SC) PA,SC Formerly known as: FALSE 5010A1 T Three Rivers Health Plan (Unison Health Plan) Loop 2100B should contain the Service Provider NPI only UnitedHealthcare Community Plan - Tennessee ALL Loop 2100B must contain the NPI. FALSE 5010A1 T UnitedHealthcare Dental ALL Loop 2100B must contain the NPI. FALSE 5010A1 T UnitedHealthcare Facets Pittsburgh - Community and State DC, DE, OH, PA, SC Loop 2100B must contain the NPI. FALSE 5010A1 T UnitedHealthcare Facets Detroit - Community and State ALL Loop 2100B must contain the NPI. FALSE 5010A1 T UnitedHealthcare Life Insurance Company ALL Loop 2100B must contain the NPI. FALSE 5010A1 T UnitedHealthcare Nevada Market ALL Loop 2100B must contain the NPI. Enrollment Required. Call (702) or Toll Free (800) FALSE 5010A1 T UnitedHealthcare River Valley ALL Loop 2100B must contain the NPI. FALSE 5010A1 T UnitedHealthcare Student Resources ALL Loop 2100B must contain the NPI. FALSE 5010A1 T

10 Utah Blue Cross Blue Shield (Regance) UTBLS UT Loop 2100B must contain Individual NPI. Enrollment Required. Follow instructions: /271 Eligibility 2. New Enrollment or Add Provider 3. Ingenix TP HT Utah Medicare CMSEL UT Enrollment required. Form and instructions at Vermont Medicaid VTMCD VT Loop 2100B must contain the NPI. FALSE 5010A1 NC Vermont Medicare CMSEL VT Enrollment required. Form and instructions at Virgin Islands of the U.S Medicare CMSEL VI Enrollment required. Form and instructions at Virginia Anthem Blue Cross Blue Shield (WellPoint Health VABLS VA Loop 2100B must contain the NPI. FALSE 5010A1 NC Virginia Medicaid VAMCD VA Loop 2100B must contain the NPI. Virginia Medicare CMSEL VA Enrollment required. Form and instructions at Washington Medicaid WAMCD WA Loop 2100B must contain the NPI. FALSE 5010A1 NC Washington Medicare CMSEL WA Enrollment required. Form and instructions at WEA Trust WI Loop 2100B must contain Service Provider NPI. FALSE 5010A1 NC WellCare Health Plans CT,FL,GA,HI, Loop 2100B must contain the NPI. IL,IN,LA,MO, NY,NJ,TX West Virginia Medicaid WVMCD WV Loop 2100B must contain the NPI. West Virginia Medicare CMSEL WV Enrollment required. Form and instructions at Wisconsin Anthem Blue Cross Blue Shield (WellPoint Health WIBLS WI Loop 2100B should contain Tax Identification Number or NPI. FALSE 5010A1 NC Wisconsin Medicaid WIMCD WI Loop 2100B should contain Service Provider number or NPI. FALSE 5010A1 NC Wisconsin Medicare CMSEL WI Enrollment required. Form and instructions at Writers Guild Health Fund WGAHF ALL Loop 2100B must contain the Provider Tax ID Number. This Payer does not work with the NPI at this time. Wyoming Medicaid WYMCD WY Loop 2100B should contain Medicaid Provider Number or NPI. Wyoming Medicare CMSEL WY Enrollment required. Form and instructions at