Commercial Claims Payer Listing

Transcription

1 National Benefit Fund COMMERCIAL M National Benefit Fund COMMERCIAL M Claims National Benefit Fund COMMERCIAL M ERA National Benefit Fund COMMERCIAL M EFT EFT enrollment is tax ID only st MN--Atlanta GA COMMERCIAL M Claims 1st Medical Network is part of the Medical Mutual Family of Companies. Former payer ID st Medical Network - Atlanta GA COMMERCIAL M Claims 1st Medical Network is part of the Medical Mutual Family of Companies. Former payer ID Call 21st Century Health & Benefits COMMERCIAL M st Century Insurance and Financial Services COMMERCIAL M ERA For MINNESOTA ONLY st Century Insurance and Financial Services COMMERCIAL M Claims For Minnesota Only P ADMIN COMMERCIAL M Claims P ADMIN COMMERCIAL M A & I Benefit Plan Administrators COMMERCIAL M A & I Benefit Plan Administrators COMMERCIAL M Claims Available through the Emdeon Payment Manager or other Revenue Cycle Management products offered by Emdeon. For more information about Payment Manager A & I Benefit Plan Administrators COMMERCIAL M EFT Enrollment requires your Tax ID Number plus a 4-digit Suffix that can be found on the same line as your provider TIN on your most recent explanation of benefits A.G.I.A. Inc. COMMERCIAL M Claims Claims are printed and mailed to the payer A.G.I.A. Inc. COMMERCIAL M AAG Benefit Plan Administrators Inc. COMMERCIAL M Claims AAG-American Administravie Group ( Formerly Icon Benefit Admin) COMMERCIAL M Claims AARP Hospital Indemnity Plans insured by UnitedHealthcare Insurance Co COMMERCIAL M Claims AARP Hospital Indemnity Plans insured by UnitedHealthcare Insurance Company COMMERCIAL M ERA AARP Medicare Supplement Plans insured by UnitedHealthcare Insurance Co COMMERCIAL M Claims LIFE1 AARP MedicareComplete insured through UnitedHealthcare/Lifeprint Network-AZ COMMERCIAL M EFT LIFE1 AARP MedicareComplete insured through UnitedHealthcare/Lifeprint Network-AZ COMMERCIAL M Claims AARP MedicareComplete through UHC / Oxford Medicare Network COMMERCIAL M Claims AARP MedicareComplete through UHC / Oxford Mosaic Network - AARP MedicareCo COMMERCIAL M Claims 6111 AARP MedicareComplete through UnitedHealthcare / Oxford Medicare Network COMMERCIAL M Claims Use Payer ID AARP MedicareComplete through UnitedHealthcare / Oxford Mosaic Network COMMERCIAL M Claims Use Payer ID Revised 02/18/2015 ICS Software, Ltd. Page 1 of 87

2 87726 AARP MedicareComplete through UnitedHealthcare/AARP MedicareComplete COMMERCIAL M Claims LIFE1 AARP MedicareComplete thru UnitedHealthcare / Lifeprint Network (AZ) COMMERCIAL M ERA Only claims from providers in Northern California. Please contact the EDI Dept for E3510 ABMA (Alta Bates Medical Assocs) Medical Corp (Hnet Sr. and Secure Horizon) COMMERCIAL M Claims North American Medical Management (NAMM) - Northern California Lead/Supervisor at prior to initial submission of claims ACMG COMMERCIAL M Claims Claims are processed by Benefit Plan Administrators ACS Benefit Services Inc. COMMERCIAL M Available through the Emdeon Payment Manager or other Revenue Cycle Management products offered by Emdeon. For more information about Payment Manager ACS Benefit Services Inc COMMERCIAL M ERA ACS Benefit Services Inc. COMMERCIAL M Claims ACS Benefit Services Inc. COMMERCIAL M ADOCS ADOC (Affiliated Doctor's of Orange County) COMMERCIAL M Claims ADV Medicare Advantage-CMCS COMMERCIAL M EFT ADVANCED DATA SOLUTIONS COMMERCIAL M Claims AFFINITY MEDICAL GROUP COMMERCIAL M Claims AFL-CIO Food & Beverage Dealer's Trust Fund (Toledo OH) COMMERCIAL M AFTRA Health Fund COMMERCIAL M Claims AGA COMMERCIAL M Claims Echo is returning 835s for payer ID Providers will need to enroll with Emdeon DO NOT send ACS/Health Net or ACS Inc. Medicaid claims to this payer ID. This payer ID is for ACS Benefit Services. Inc. ONLY. Available through the Emdeon Payment Manager or other Revenue Cycle Management products offered by Emdeon. For more information about Payment Manager AGC International Union of Operating Engineers Local 701 COMMERCIAL M ERA AGC International Union of Operating Engineers Local 701 COMMERCIAL M EFT AHPO (Cleveland OH) COMMERCIAL M Claims AIAPT insured by Trustmark Insurance COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon AIG Educational Markets COMMERCIAL M Claims Payer formely known as: Maksin Management Corporation AK United Food and Commercial Workers (AK UFCW) COMMERCIAL M EFT AK United Food and Commercial Workers (AK UFCW) COMMERCIAL M ERA ALICARE COMMERCIAL M Claims TH071 AMA Insurance Agency COMMERCIAL M Claims AMERIGROUP Community Care of New Mexico COMMERCIAL M Claims AMERIGROUP Georgia COMMERCIAL M Claims PROSP AMVI/Prospect Health Network (Prospect Medical Group) COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 2 of 87

3 PROSP APAC (Pinnacle Health Resources) (Prospect Medical Group) COMMERCIAL M Claims APEX Healthcare COMMERCIAL M Claims APS Healthcare Inc. COMMERCIAL M Claims ARAZ Group COMMERCIAL M Claims ARISE COMMERCIAL M ERA ARISE COMMERCIAL M EFT ARISE COMMERCIAL M Claims ARM Grp COMMERCIAL M ARM Grp COMMERCIAL M Claims 6603 ASAGEHA COMMERCIAL M Claims ASAMT Insurance by Trustmark Insurance COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Call ASC of Oho COMMERCIAL M Claims To obtain the payer ID please call (440) ASR COMMERCIAL M Claims ASR Corporation COMMERCIAL M Claims ASR Health Benefits COMMERCIAL M Claims ATA-FL COMMERCIAL M Claims AVMED INC COMMERCIAL M Encounters AXA Assistance_USA COMMERCIAL M Claims ONLY Physical Occupational and Speech Therapy Claims for the following FLORIDA Health Plans should be submitted to this payer ID: Aetna Health Plan CarePlus JMH Health Plan Sunshine State Health Plan WellCare Health Plan Absolute Total Care COMMERCIAL M Claims Prior to submitting claims please call Provider Relations Dept at 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. TH067 Access Administrators COMMERCIAL M Claims Access Community Health Network. Chicago IL Family Health Network patients COMMERCIAL M Claims CARMO Access IPA COMMERCIAL M Claims REGAL Access IPA COMMERCIAL M Claims Access Medical Group COMMERCIAL M Claims Access Medicare (Cuatro LLC) COMMERCIAL M Claims Access Medicare (Cuatro LLC) COMMERCIAL M ERA Acclaim COMMERCIAL M Acclaim COMMERCIAL M Claims Activa Benefit Services LLC COMMERCIAL M Claims Adaptis COMMERCIAL M ERA NPI is required for ERA Enrollment Administration Systems Research Corporation COMMERCIAL M Claims Administrative Concepts Inc. COMMERCIAL M Claims Administrative Concepts Inc. COMMERCIAL M EFT Administrative Concepts Inc. COMMERCIAL M Available through the Emdeon Payment Manager or other Revenue Cycle Management products offered by Emdeon. For more information about Payment Manager - Revised 02/18/2015 ICS Software, Ltd. Page 3 of 87

4 20405 Administrative Service Professionals COMMERCIAL M Administrative Services Inc. COMMERCIAL M Claims Advanced Physician's Association Chicago IL MG#118 COMMERCIAL M Claims Advantage Health IPA-CMCS COMMERCIAL M EFT Advantage Health Solutions COMMERCIAL M Advantage Health Solutions COMMERCIAL M Claims NMM01 Advantage Med Grp COMMERCIAL M Claims Advantage by Bridgeway Health Solutions COMMERCIAL M Claims Advantage by Buckeye Community Health Plan COMMERCIAL M Claims Advantage by Managed Health Services COMMERCIAL M Claims Advantage by Peach State COMMERCIAL M Claims Advantage by Sunshine State COMMERCIAL M Claims Advantage by Superior HealthPlan COMMERCIAL M Claims Advantek Benefit Administrators COMMERCIAL M Claims Advantica Benefits COMMERCIAL M Claims Advantra Savings COMMERCIAL M Claims Adventist Health System West - Roseville CA COMMERCIAL M Claims Adventist Health System West - Roseville CA COMMERCIAL M Advicare COMMERCIAL M Claims Advocate Health Partners COMMERCIAL M Claims Advocate Medical Group - AMG (Legacy AHC) COMMERCIAL M Claims Please contact Advocate Physician Partners Debbie Motz at (847) for questions or more information for both payer IDs Advocate Medical Group - AMG (Legacy AHC) COMMERCIAL M ERA Advocate Medical Group - AMG (Legacy AHC) COMMERCIAL M Providers must be actively credentialed with and submitting claims to Advocate Health Centers prior to ERA enrollment. Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at Advocate Physician Partners COMMERCIAL M ERA Advocate Physician Partners COMMERCIAL M Providers must be actively credentialed with and submitting claims to Advocate Physician Partners prior to ERA enrollment. Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at Advocate Physician Partners COMMERCIAL M Claims Please contact Advocate Physician Partners Debbie Motz at (847) for questions or more information for both payer IDs. CB637 Aegis Administrative Services COMMERCIAL M Claims Aetna COMMERCIAL M Claims Aetna COMMERCIAL M Encounters Aetna COMMERCIAL M ERA Aetna - Aetna Health and Life Insurance Company COMMERCIAL M ERA Aetna - Aetna Life Insurance Company COMMERCIAL M EFT Medicare Supplemental Insurance Aetna - Aetna Life Insurance Company COMMERCIAL M ERA Aetna - Allianz Life Insurance Company of New York COMMERCIAL M EFT Medicare Supplemental Insurance Aetna - Allianz Life Insurance Company of New York. COMMERCIAL M ERA Aetna - American Continental Insurance Company COMMERCIAL M ERA Revised 02/18/2015 ICS Software, Ltd. Page 4 of 87

5 62118 Aetna - American Continental Insurance Company COMMERCIAL M EFT Medicare Supplemental Insurance Aetna - American General Life Insurance Company COMMERCIAL M ERA Aetna - American General Life Insurance Company COMMERCIAL M EFT Medicare Supplemental Insurance Aetna - Combined Insurance Company of America COMMERCIAL M EFT Medicare Supplemental Insurance Aetna - Combined Insurance Company of America COMMERCIAL M ERA Aetna - Continental Life Insurance Company of Brentwood Tennessee COMMERCIAL M EFT Medicare Supplemental Insurance Aetna - Continental Life Insurance Company of Brentwood Tennessee COMMERCIAL M ERA Aetna - Genworth - Genworth Life and Annuity Insurance Company COMMERCIAL M EFT Medicare Supplemental Insurance Aetna - Genworth Life Insurance Company COMMERCIAL M ERA Aetna - Genworth Life Insurance Company COMMERCIAL M EFT Medicare Supplemental Insurance Aetna - Union Fidelity Life Insurance Company COMMERCIAL M ERA Aetna - Union Fidelity Life Insurance Company COMMERCIAL M EFT Medicare Supplemental Insurance Aetna - Virginia Surety Company Inc COMMERCIAL M ERA Aetna - Washington National Insurance Company COMMERCIAL M ERA Aetna -Virginia Surety Company Inc COMMERCIAL M EFT Medicare Supplemental Insurance Aetna -Washington National Insurance Company COMMERCIAL M EFT Medicare Supplemental Insurance Aetna Affordable Health Choices (SM) - SRC COMMERCIAL M Claims Aetna Better Health Inc. COMMERCIAL M ERA Enroll with Payer Aetna Better Health Inc. COMMERCIAL M EFT Enroll with Payer Aetna Better Health Inc. COMMERCIAL M Claims Aetna Encounters COMMERCIAL M Encounters This is a BATCH ENCOUNTER payer. Please contact your Aetna Network Manager for submission requirements Aetna Medicare Supplement Insurance COMMERCIAL M EFT Medicare Supplemental Insurance Aetna Medicare Supplement Insurance COMMERCIAL M ERA Aetna- Genworth -Genworth Life and Annuity Insurance Company COMMERCIAL M ERA ADOCS Affiliated Doctors of Orange County (ADOC) COMMERCIAL M Claims Affiliated Physicians Group COMMERCIAL M Claims APG01 Affiliated Physicians Group COMMERCIAL M Claims Affinity Health Plan COMMERCIAL M ERA Affinity Health Plan COMMERCIAL M EFT Affinity Health Plan COMMERCIAL M Affinity Health Plan COMMERCIAL M Claims Affinity Medicare Advantage COMMERCIAL M ERA Affinity Medicare Advantage COMMERCIAL M EFT Affinity Medicare Advantage COMMERCIAL M Claims AffinityAccess COMMERCIAL M Claims To sign up for EFT provider's Tax ID is required with an optional provider number. Please contact Affinity at ( ) to obtain your provider number. When submitting to this payer ID please ensure the following: The claim is for a Medicaid Child Health Plus or Family Health Plus member and the subscriber ID is as printed on Member's ID Card When submitting to this payer ID please ensure the following: The claim is for a Medicare Advantage or Medicaid Advantage Member the date of service is equal to or greater than 1/1/10 and the subscriber ID you submit is 9 characters in length. Revised 02/18/2015 ICS Software, Ltd. Page 5 of 87

6 95426 Affordable Benefit Administrators Inc. COMMERCIAL M Claims Claims with the following address should only be sent to this payer id. ABA P.O. Box Burbank CA Agate Resources Inc. (LIPA) COMMERCIAL M Claims Please contact Risa Rhodes at (514) for the Agate Resources Inc. (LIPA) Payer ID Agency Services Inc COMMERCIAL M Claims Now known as Meritain Health Alask Carpenters COMMERCIAL M ERA Alask Carpenters COMMERCIAL M EFT Alaska Carpenters Trust COMMERCIAL M Claims Please enter Group Number (F40) when submitting claims Alaska Children's Services Inc. COMMERCIAL M Claims Please enter Group Number (P68) when submitting claims Alaska Electrical Health & Welfare Fund COMMERCIAL M Claims Alaska Hotel Employees Restaurant & Camp Employees (AK HERE) COMMERCIAL M ERA Alaska Hotel Employees Restaurant & Camp Employees (AK HERE) COMMERCIAL M EFT Alaska Laborers Construction Industry Health & Security Trust COMMERCIAL M ERA Alaska Laborers Construction Industry Health & Security Trust COMMERCIAL M EFT Alaska Laborers Construction Industry Trust COMMERCIAL M Claims Please enter Group Number (F23) when submitting claims Alaska Pipe Trades Local 375 COMMERCIAL M Claims Please enter Group Number (F24) when submitting claims Alaska Pipe Trades U A Local 375 COMMERCIAL M ERA Alaska Pipe Trades U A Local 375 COMMERCIAL M EFT Alaska Public Employees Association (APEA/JESS Health & WelfareTrust) COMMERCIAL M ERA Alaska Public Employees Association (APEA/JESS Health & WelfareTrust) COMMERCIAL M EFT Alaska United Food & Commercial Workers Health & Welfare Trust COMMERCIAL M Claims Please enter Group Number (F45) when submitting claims Alivio Family Medical Family Health Network patients only COMMERCIAL M Claims AllCare PEBB COMMERCIAL M Claims Allegeant COMMERCIAL M EFT Allegeant COMMERCIAL M Claims Formally known as LBA Health Plans Allegian Choice COMMERCIAL M Claims Allegiance Benefit Plan Management Inc. COMMERCIAL M Claims Alliance Healthcare/Florida for Stones River Regional IPA COMMERCIAL M Claims This Payer ID should be used for Stones River Regional IPA - Alliance Healthcare Florida claims only Alliant Health Plans of Georgia COMMERCIAL M Claims Alliant Health Plans of Georgia COMMERCIAL M ERA Allianz Global Assistance COMMERCIAL M Claims Formerly know as Mondial Assistance and World Access Canada Allied Benefit Systems COMMERCIAL M Claims SX156 Allied Health Systems Chiropractic COMMERCIAL M Claims Allied Metal Crafts Security Plan Trust Fund COMMERCIAL M EFT Allied Metal Crafts Security Plan Trust Fund COMMERCIAL M ERA NMM01 Allied Physicians COMMERCIAL M Claims TH085 Alpha Data COMMERCIAL M Claims Alpha Health Plan Inc. COMMERCIAL M Claims A0701 Alta Bates Medical Group COMMERCIAL M Claims Payer ID is only for dates of service after 7/1/2010. Revised 02/18/2015 ICS Software, Ltd. Page 6 of 87

7 Network ID required on all claims. Call Sutter Connect EDI Department at (800) 611- Call Alta Bates Medical Group COMMERCIAL M Claims 5191 to obtain Network ID prior to first submission. E3510 Alta Senior Care (Hnet Sr and Secure Horizons only) COMMERCIAL M Claims Alternative Risk Management Inc. COMMERCIAL M Claims Altius (Utah) COMMERCIAL M Claims Altius Health Plans COMMERCIAL M ERA Altius Health Plans COMMERCIAL M EFT AmFirst Insurance Company COMMERCIAL M ERA AmFirst Insurance Company COMMERCIAL M Claims Amalgamated Life COMMERCIAL M Amalgamated Life COMMERCIAL M Claims Amalgamated Life - PA / Alicare COMMERCIAL M Claims Amalgamated Life - PA / Alicare COMMERCIAL M Ambay Health Network COMMERCIAL M Claims Ambetter from Buckeye Community Health Plan COMMERCIAL M Claims Ambetter from CeltiCare Health Plan COMMERCIAL M Claims Ambetter from Magnolia Health COMMERCIAL M Claims Ambetter from Managed Health Services COMMERCIAL M Claims Ambetter from Peach State Health Plan COMMERCIAL M Claims Ambetter from Sunshine Health COMMERCIAL M Claims Ambetter from Superior Health COMMERCIAL M Claims Ambetter of Arkansas COMMERCIAL M Claims AmeraPlan COMMERCIAL M ERA AmeraPlan COMMERCIAL M Claims Only claims from providers in Northern California. Please contact the EDI Dept for North American Medical Management (NAMM) - Northern California Lead/Supervisor at prior to initial submission of claims. Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds AmeraPlan COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon AmeriBen Solutions Inc. COMMERCIAL M EFT For St. Luke's Group Only AmeriBen Solutions Inc. COMMERCIAL M AmeriBen Solutions Inc. COMMERCIAL M Claims AmeriHealth Administrators COMMERCIAL M Claims AmeriHealth Caritas Louisiana COMMERCIAL M ERA AmeriHealth Caritas Louisiana COMMERCIAL M AmeriHealth Caritas Louisiana COMMERCIAL M EFT I understand that payment and satisfaction of this claim will be from federal and state funds and that any false claims statements documents or concealment of a material fact may be prosecuted under applicable federal and/or state laws. Revised 02/18/2015 ICS Software, Ltd. Page 7 of 87

8 27357 AmeriHealth Caritas Louisiana COMMERCIAL M Claims AmeriHealth Caritas Pennsylvania COMMERCIAL M EFT AmeriHealth Caritas Pennsylvania COMMERCIAL M AmeriHealth Caritas Pennsylvania COMMERCIAL M ERA AmeriHealth Caritas Pennsylvania COMMERCIAL M Claims AmeriHealth Connect (AMERIHEALTH CARITAS) COMMERCIAL M ERA AmeriHealth Connect (AMERIHEALTH CARITAS) COMMERCIAL M Claims AmeriHealth Connect (AMERIHEALTH CARITAS) COMMERCIAL M EFT AmeriHealth HMO New Jersey and Delaware COMMERCIAL M Claims AmeriHealth NorthEast COMMERCIAL M ERA AmeriHealth NorthEast COMMERCIAL M AmeriHealth NorthEast COMMERCIAL M EFT AmeriHealth NorthEast COMMERCIAL M Claims AmeriHealth VIP Care PA COMMERCIAL M Claims AmeriHealth VIP Care PA COMMERCIAL M EFT AmeriHealth VIP Care PA COMMERCIAL M AmeriHealth VIP Care PA COMMERCIAL M ERA America's PPO COMMERCIAL M Claims America's TPA COMMERCIAL M Claims Americaid Community Care (Maryland) COMMERCIAL M Claims Americaid Community Care (New Jersey) COMMERCIAL M Claims American Administrative Group COMMERCIAL M Claims Call American Administrators (West Des Moines Iowa) COMMERCIAL M American Behavioral COMMERCIAL M Claims American Benefit Plan Administrators COMMERCIAL M Claims TH095 American Family Insurance COMMERCIAL M Claims American Family Medicare Supplement and PPO Policies Administered by Am Rep COMMERCIAL M EFT I understand that payment and satisfaction of this claim will be from federal and state funds and that any false claims statements documents or concealment of a material fact may be prosecuted under applicable federal and/or state laws. Medicaid managed care. For EDI support please [email protected] or call Medicaid managed care. For EDI support please [email protected] or call AmeriHealth Connect is effective 1/1/2015. Please note that this payer encourages early enrollment for EFT/ERA services. Please visit to early enroll. Pennsylvania Healthy PA Private Coverage Option? For EDI Support please [email protected] or call AmeriHealth Connect is effective 1/1/2015. Please note that this payer encourages early enrollment for EFT/ERA services. Please visit to early enroll. Managed Medicaid Plan part of the AmeriHealth Caritas Family of Companies.For EDI support please [email protected] or call Managed Medicaid Plan part of the AmeriHealth Caritas Family of Companies.For EDI support please [email protected] or call AmeriHealth VIP Care PA is effective 1/1/2013 Medicare Advantage Plan part of the AmeriHealth Caritas Family of Companies. Medicare Supplement COB claims only accepted via electronic Medicare crossover. Hospital/Medical LOB Revised 02/18/2015 ICS Software, Ltd. Page 8 of 87

9 56071 American Family Medicare Supplement and PPO Policies Administered by Am Rep COMMERCIAL M Claims Medicare Supplement COB claims only accepted via electronic Medicare crossover. Hospital/Medical LOB American Family Medicare Supplement and PPO Policies Administered by Am Rep COMMERCIAL M Medicare Supplement COB claims only accepted via electronic Medicare crossover. Hospital/Medical LOB American Family Medicare Supplement and PPO Policies Administered by Am Rep COMMERCIAL M ERA Medicare Supplement COB claims only accepted via electronic Medicare crossover. Hospital/Medical LOB American General COMMERCIAL M ERA American General COMMERCIAL M Claims L0220 American Health Medicare COMMERCIAL M ERA L0220 American Health Medicare COMMERCIAL M Claims 1066 American Healthcare Alliance COMMERCIAL M Claims American Imaging Management Inc. COMMERCIAL M Claims American National Ins. Co. (ANICO) COMMERCIAL M Claims American Postal Workers Union Health Plan COMMERCIAL M ERA American Postal Workers Union Health Plan COMMERCIAL M Claims American Progressive Life and Health Insurance Company COMMERCIAL M Claims American Republic Insurance COMMERCIAL M Providers wishing to receive ERA or issues with ERA must contact the payer Directly at to enroll. Do not contact Inmediata to enroll. Assigned Group Policy Plan ID is required. To obtain please call American Imaging Management Inc. at (800) Medicare Supplement COB claims only accepted via electronic Medicare crossover American Republic Insurance COMMERCIAL M EFT Medicare Supplement COB claims only accepted via electronic Medicare crossover American Republic Insurance COMMERCIAL M Claims Medicare Supplement COB claims only accepted via electronic Medicare crossover American Republic Insurance COMMERCIAL M ERA Medicare Supplement COB claims only accepted via electronic Medicare crossover American Specialty Health COMMERCIAL M Claims American Trust Administrators Inc. COMMERCIAL M Claims TH117 American Whole Health Networks COMMERCIAL M Claims American Worker Health Plan COMMERCIAL M Claims Americas 1st Choice Health Plans of North Carolina Inc. COMMERCIAL M Claims Americas 1st Choice Health Plans of South Carolina Inc. COMMERCIAL M Claims Americas Choice Healthplans LLC COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Amerigroup Community Care COMMERCIAL M Claims Amerigroup Corporation (Ft Worth) COMMERCIAL M Claims Formally Americaid Community Care (Dallas/Ft. Worth) Amerigroup Corporation (Houston) COMMERCIAL M Claims Formerly Americaid Community Care (Houston) Amerigroup Florida COMMERCIAL M Claims Amerigroup Illinois COMMERCIAL M Claims Amerigroup Ohio COMMERCIAL M Claims Amerigroup RealSolutions COMMERCIAL M EFT Providers must enroll with their Amerigroup PIN as the Provider ID. Medicaid providers can call Medicare providers can call Otherwise the PIN is located on the first page of the EOP under the Tax ID. Revised 02/18/2015 ICS Software, Ltd. Page 9 of 87

10 77002 Amerihealth District of Columbia COMMERCIAL M ERA For EDI support please edi.dc@ amerihealthdc.com or call Amerihealth District of Columbia COMMERCIAL M Claims For EDI support please edi.dc@ amerihealthdc.com or call Amerihealth District of Columbia COMMERCIAL M EFT Amerihealth District of Columbia COMMERCIAL M Amerihealth VIP Care- DC COMMERCIAL M ERA AmeriHealth VIP Care is effective 1/1/2014. Please note that this payer encourages early enrollment for EFT/ERA services. Please visit to early enroll Amerihealth VIP Care- DC COMMERCIAL M Amerihealth VIP Care- DC COMMERCIAL M EFT AmeriHealth VIP Care is effective 1/1/2014. Please note that this payer encourages early enrollment for EFT/ERA services. Please visit to early enroll Amerihealth VIP Care- DC COMMERCIAL M Claims Amerihealth VIP Select and Amerihealth VIP Care payer is effective 1/1/2014 Medicare Advantage Plan part of the AmeriHealth Caritas Family of Companies. All claims prior to 1/1/14 will be rejected Amerihealth VIP Care- LA COMMERCIAL M ERA AmeriHealth VIP Select is effective 1/1/2014. Please note that this payer encourages early enrollment for EFT/ERA services. Please visit to early enroll Amerihealth VIP Care- LA COMMERCIAL M Amerihealth VIP Care- LA COMMERCIAL M EFT AmeriHealth VIP Select is effective 1/1/2014. Please note that this payer encourages early enrollment for EFT/ERA services. Please visit to early enroll Amerihealth VIP Care- LA COMMERCIAL M Claims Amerihealth VIP Select and Amerihealth VIP Care payer is effective 1/1/2014 Medicare Advantage Plan part of the AmeriHealth Caritas Family of Companies. All claims prior to 1/1/14 will be rejected Amida Care COMMERCIAL M Claims Formerly known as VidaCare Amida Care Medicare COMMERCIAL M Claims Anchor Benefit Consulting Inc. COMMERCIAL M Claims Ancillary Benefit Services (ABS) COMMERCIAL M Claims 3172 Ancillary Care Management/ACM COMMERCIAL M Claims Angeles IPA (SynerMed) COMMERCIAL M EFT Angeles IPA (SynerMed) COMMERCIAL M Angeles IPA (SynerMed) COMMERCIAL M Claims Apex Benefit Services COMMERCIAL M Claims Apex is also a Medicaid payer and will accept claims with either a Medicaid or Commercial classification Apogee Health Partners Inc COMMERCIAL M Claims APP01 AppleCare Medical Management COMMERCIAL M Claims Arbor Health Plan COMMERCIAL M Arbor Health Plan COMMERCIAL M Claims Medicaid Managed Care Plan part of the Amerihealth Caritas Family of Companies.For EDI support please [email protected] or call Arbor Health Plan COMMERCIAL M EFT Revised 02/18/2015 ICS Software, Ltd. Page 10 of 87

11 52312 Arbor Health Plan COMMERCIAL M ERA Medicaid Managed Care Plan part of the Amerihealth Caritas Family of Companies.For EDI support please [email protected] or call Arcadian Management Services Inc COMMERCIAL M Claims Arcadian Management Services Inc COMMERCIAL M ARGUS Argus Dental Plans COMMERCIAL M Claims Arizona Foundation for Medical Care (AFMC) COMMERCIAL M Claims Arizona Priority Care Plus COMMERCIAL M Claims Arkansas Best Corporation - Choice Benefits COMMERCIAL M ERA Arkansas Best Corporation - Choice Benefits COMMERCIAL M Claims Arkansas Managed Care Organization Inc. (AMCO) COMMERCIAL M Claims Arnett Health Plan COMMERCIAL M Claims Former Payer ID NMM01 Arroyo Vista Family Health Center COMMERCIAL M Claims Asian Human Services Family Family Health Network patients only COMMERCIAL M Claims Aspen COMMERCIAL M Claims Aspire Health Plan COMMERCIAL M Claims Associated Administrators LLC. COMMERCIAL M Associated Benefits COMMERCIAL M Claims Associates for Health Care Inc. (AHC) COMMERCIAL M Claims Association Benefit Plan COMMERCIAL M Claims Association Services of WA COMMERCIAL M L0150 Association de Maestros ((PROSSAM) COMMERCIAL M Claims L0150 Association de Maestros ((PROSSAM) COMMERCIAL M ERA For issues with ERA contact the Payer at Assurant Health (IM & GROUP FULLY-INSURED) COMMERCIAL M ERA Assurant Health (IM & GROUP FULLY-INSURED) COMMERCIAL M EFT Assurant Health (IM & GROUP FULLY-INSURED) COMMERCIAL M Claims Assurant Health Self Funded COMMERCIAL M Claims MUST VERIFY ALL CLAIMS SHOULD GO TO ALLIED BENEFIT for Assurant Health self funded groups with plan effective dates after 5/1/ Assurant Health Self-Funded (Ft. Mill SC) COMMERCIAL M Claims MUST VERIFY ALL CLAIMS SHOULD GO TO KBA IN FT. MILL SC -Assurant Health self funded groups with plan effective dates prior to 5/1/ Assurant Health/ASA (Assurant Health members with ASA PPO Network) COMMERCIAL M Claims ASA PPO Network (aka Aetna Signature Administrators? PPO Network) Assured Benefits Administrators COMMERCIAL M Claims Asuris Northwest COMMERCIAL M Claims SX179 Asuris Northwest/MedAdvantage COMMERCIAL M Claims Payer must receive REF*1B*Provider ID in Billing and Rendering even when NPI is submitted Athens Area Health Plan Select COMMERCIAL M Claims Atlantic Medical Insurance COMMERCIAL M Claims Atlantis Health Plan COMMERCIAL M Claims Atlantis Health is now doing business as Easy Choice Health plan of New York TH004 Atlas Administrators COMMERCIAL M Claims Currently only accepts UCO Providers. The group number must be 8 characters in length. Only one of the characters can be a dash. If the group number is entered then the group name must also be entered Aultra Administrative Group COMMERCIAL M Claims Payer ID valid only for claims with a billing submission address of P.O. Box Canton OH Revised 02/18/2015 ICS Software, Ltd. Page 11 of 87

12 38259 Automated Benefit Services COMMERCIAL M Automated Benefit Services COMMERCIAL M Claims Automated Group Administration Inc. COMMERCIAL M Claims Auxiant COMMERCIAL M EFT Auxiant COMMERCIAL M Auxiant COMMERCIAL M ERA Please send these EDI claims to the Payer ID of the PPO shown on the Member's ID Card. If you have any questions please call (703) AvMed Inc. COMMERCIAL M Claims The Insured ID and Patient ID fro this payer must be the 11-digit Member ID AvMed Inc. COMMERCIAL M ERA Providers must enroll for EFT in order to receive electronic remittance AvMed Inc. COMMERCIAL M EFT Avera Health Plans COMMERCIAL M Claims AveraAdvantage COMMERCIAL M Claims Avesis Third Party Administrators COMMERCIAL M Claims This payer is live for VISION CLAIMS ONLY BCI Administrators Inc. COMMERCIAL M Claims BENEFIT MANAGEMENT SERVICES COMMERCIAL M Claims BHI (Behavioral Health Inc.) COMMERCIAL M ERA BHI (Behavioral Health Inc.) COMMERCIAL M EFT BMC HealthNet Plan COMMERCIAL M Claims Submissions to BMCHP must include the correct 12 digit BMCHP Provider ID # including all leading zeros BMI Health Plans COMMERCIAL M Call BSI COMMERCIAL M Claims To obtain the payer ID please call (440) BKRFM Bakersfield Family Medical Center COMMERCIAL M Claims SX145 Banner Health COMMERCIAL M ERA SX145 Banner Health COMMERCIAL M EFT SX145 Banner Health COMMERCIAL M 12X42 Banner Health - HealthNet Senior COMMERCIAL M 12X42 Banner Health - HealthNet Senior COMMERCIAL M EFT 12X42 Banner Health - HealthNet Senior COMMERCIAL M ERA 12X42 Banner Health - UHC Medicare Advantage COMMERCIAL M ERA 12X42 Banner Health - UHC Medicare Advantage COMMERCIAL M 12X42 Banner Health - UHC Medicare Advantage COMMERCIAL M EFT SX145 Banner Health AZ COMMERCIAL M Claims SX145 Banner Health Co - ROCKY MOUNTAIN HMO GREELEY COMMERCIAL M Claims SX145 Banner Health Co. - ANTERO GREELEY COMMERCIAL M Claims SX145 Banner Health Co. - ANTERO HIGH PLAINS COMMERCIAL M Claims SX145 Banner Health Co. - ANTERO MOUNTAIN SHADOWS COMMERCIAL M Claims SX145 Banner Health Co. - CHOICE PLUS COMMERCIAL M Claims Any providers wanting to receive ERAs from Banner Health please enroll with payer ID 12X42. Payer ID SX145 will no longer be used beginning January of EFT is LIVE however to receive EFT if submitting claims under SX145 you must enroll for EFT under 12X42. Revised 02/18/2015 ICS Software, Ltd. Page 12 of 87

13 SX145 Banner Health Co. - HMO GREELEY COMMERCIAL M Claims SX145 Banner Health Co. - HMO HIGH PLAINS COMMERCIAL M Claims SX145 Banner Health Co. - HMO MOUNTAIN SHADOWS COMMERCIAL M Claims SX145 Banner Health Co. - PACIFICARE GREELEY COMMERCIAL M Claims SX145 Banner Health Co. - PACIFICARE HIGH PLAINS COMMERCIAL M Claims SX145 Banner Health Co. - PACIFICARE MOUNTAIN SHADOWS COMMERCIAL M Claims SX145 Banner Health Co. - ROCKY MOUNTAIN HMO HIGH PLAINS COMMERCIAL M Claims SX145 Banner Health Co. - SECURE HORIZONS GREELEY COMMERCIAL M Claims SX145 Banner Health Co. - SECURE HORIZONS HIGH PLAINS COMMERCIAL M Claims SX145 Banner Health Co. - SECURE HORIZONS MOUNTAIN SHADOWS COMMERCIAL M Claims 12X42 Banner Plan Administration COMMERCIAL M ERA 12X42 Banner Plan Administration COMMERCIAL M 12X42 Banner Plan Administration COMMERCIAL M EFT 12X42 Banner Plan Administration COMMERCIAL M Claims 12X42 Banner Plan Administration - Choice Plus and Select 500 COMMERCIAL M 12X42 Banner Plan Administration - Choice Plus and Select 500 COMMERCIAL M EFT 12X42 Banner Plan Administration - Choice Plus and Select 500 COMMERCIAL M ERA Baptist Health South Florida COMMERCIAL M Claims NCH06 Bascom Palmer Eye Care Network - New Century Health COMMERCIAL M Claims Beacon Health Strategies COMMERCIAL M Claims Beech Street COMMERCIAL M Claims Behavioral Health Systems COMMERCIAL M Claims MPMOA Bella Vista Med Grp IPA COMMERCIAL M Claims Bellflower Hospital (Synermed) COMMERCIAL M Claims Benefit & Risk Management Services COMMERCIAL M Claims Benefit Administration Services COMMERCIAL M Benefit Administrative Systems COMMERCIAL M ERA Benefit Administrative Systems COMMERCIAL M Benefit Administrative Systems COMMERCIAL M Claims Benefit Assistance Corp. COMMERCIAL M Benefit Coordinators Corporation (Pittsburgh PA) COMMERCIAL M Claims Benefit Management Administrators COMMERCIAL M Claims Benefit Management Administrators COMMERCIAL M Benefit Management Administrators LLC COMMERCIAL M Beacon requires submission of the member's Plan ID. Please follow the link to our payer fact sheet for ID's and further instructions. Payer ID valid only for claims with a billing submission address of 111 Ryan Court Suite 300 Pittsburgh PA Revised 02/18/2015 ICS Software, Ltd. Page 13 of 87

14 36459 Benefit Management Group-NV COMMERCIAL M Claims Providers submit to for HSC Coalition Hospital Dental BHO or NON PPO CLAIMS ONLY. All others should be filed with CIGNA ID Benefit Management Services Inc. COMMERCIAL M Claims Benefit Management Systems Inc COMMERCIAL M Benefit Management Systems Inc COMMERCIAL M Claims Benefit Management Inc. of KS COMMERCIAL M Claims Benefit Plan Administrators COMMERCIAL M ERA Benefit Plan Administrators COMMERCIAL M Claims Benefit Plan Administrators Co. (Eau Claire WI) COMMERCIAL M Benefit Plan Administrators Co. (Eau Claire WI) COMMERCIAL M Claims Benefit Plan Administrators Inc COMMERCIAL M Claims Benefit Plan Administrators Inc. (Roanoke VA) COMMERCIAL M This payer will only accept medical and hospital claims for these groups listed: BMI187BMI219BMI234BMI236BMI214.BMI241BMI617 BMI245.BMI246 Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Payer ID valid for Benefit Plan Administrators (Eau Claire WI submission address only) and Custom Benefit Administrators Benefit Plan Services Inc COMMERCIAL M ERA Echo is returning 835s for payer ID. Providers will need to enroll with Emdeon for payer ID with Emdeon in order to receive these 835s for this payer Call Benefit Services COMMERCIAL M Benefit Systems & Services Inc. COMMERCIAL M Claims Now known as Total Broker Benefits Payer ID Berkshire Health Partners - PPO Wyomissing PA (IHS Gateway Payer) COMMERCIAL M Claims Berkshire Intergroup COMMERCIAL M Claims Berkshire Lehigh Partners COMMERCIAL M Claims Best Life & Health Insurance Co. COMMERCIAL M Claims Better Health Plans of South Carolina COMMERCIAL M Claims Better Health Plans Inc. COMMERCIAL M Claims Now known as Unison Health Plan 3036 Blue Benefit Administrators of MA COMMERCIAL M Claims Blue Cross Blue Shield of Arizona Advantage COMMERCIAL M ERA Blue Cross Blue Shield of Arizona Advantage COMMERCIAL M Claims This is a Medicare Advantage Plan Blue Cross Blue Shield of Arizona Advantage COMMERCIAL M Blue Cross Blue Shield of Arizona Advantage COMMERCIAL M EFT Blue Cross and Blue Shield of Vermont COMMERCIAL M Blue Cross and Blue Shield of Vermont COMMERCIAL M EFT Tax ID and Practice Group NPI are required for EFT enrollment Blue Shield of California - Medicare Advantage Encounters COMMERCIAL M Encounters BlueAdvantage HMO COMMERCIAL M Claims Bluegrass Family Health COMMERCIAL M EFT Bluegrass Family Health COMMERCIAL M ERA Bluegrass Family Health COMMERCIAL M Revised 02/18/2015 ICS Software, Ltd. Page 14 of 87

15 61124 Bluegrass Family Health COMMERCIAL M Claims All providers should send claims to Bluegrass Family Health PID Boilermakers National Health & Welfare Fund COMMERCIAL M Claims Boon-Chapman Benefit Administrators Inc. COMMERCIAL M Claims Boston Medical Center Health Plan Inc. COMMERCIAL M Claims Submissions to BMCHP must include the correct 12 digit BMCHP Provider ID # including all leading zeros Boston Medical Center Health Plan Inc. COMMERCIAL M Encounters Bravo Health COMMERCIAL M Claims Bravo Health Star Plus COMMERCIAL M EFT Bravo Health Star Plus COMMERCIAL M Claims Bravo Health Star Plus COMMERCIAL M ERA BRIDG BridgeSpan COMMERCIAL M Claims Bridgeway Arizona COMMERCIAL M Claims Prior to submitting claims please call Provider Relations Dept at 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 Bridgeway Arizona COMMERCIAL M ERA BritCay COMMERCIAL M Claims Brodart COMMERCIAL M Claims Brokerage Concepts COMMERCIAL M Claims Call Brokerage Service Inc COMMERCIAL M Claims To obtain the payer ID please call (440) Broward Health COMMERCIAL M Claims Brown & Toland Medical Group COMMERCIAL M Claims BTSS1 Brown & Toland Sutter Select COMMERCIAL M Claims Buckeye Community Health COMMERCIAL M ERA Buckeye Community Health COMMERCIAL M Claims Prior to submitting claims please call Provider Relations Dept at 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 Butler Benefit COMMERCIAL M Butler Benefit COMMERCIAL M Claims C&O Employees Hospital Association COMMERCIAL M Claims C. L. Frates & Co - OSMA Health COMMERCIAL M Claims C.A.S. COMMERCIAL M ERA Echo is returning 835s for payer ID CAS01. Providers will need to enroll with Emdeon CAM Administrative Services COMMERCIAL M CAP Management Systems COMMERCIAL M Claims CARE 1ST HEALTH PLAN OF CA COMMERCIAL M Claims 3036 CBA Blue COMMERCIAL M Claims Formerly known as Comprehensive Benefits Administrator Inc CBCA Administrators Inc COMMERCIAL M ERA Echo is returning 835s for payer ID. Providers will need to enroll with Emdeon for payer ID with Emdeon in order to receive these 835s for this payer CCHHS-FHN COMMERCIAL M Claims SX065 CDPHP COMMERCIAL M Claims Par for Billing CDS Group Health COMMERCIAL M Claims CHA Health COMMERCIAL M Claims CHAMPVA HAC MEDICARE CROSSOVER COMMERCIAL M ERA CHAMPVA - HAC COMMERCIAL M Claims CHAMPVA - HAC is not associated with and does not process claims for TRICARE (formerly CHAMPUS). Revised 02/18/2015 ICS Software, Ltd. Page 15 of 87

16 84146 CHAMPVA - HAC COMMERCIAL M ERA 835s are not returned on paper claims CHC of Delaware COMMERCIAL M EFT CHC of Florida COMMERCIAL M EFT CHC of Georgia COMMERCIAL M EFT CHC of Illinois COMMERCIAL M EFT CHC of Iowa COMMERCIAL M EFT CHC of Kansas COMMERCIAL M EFT CHC of Louisiana COMMERCIAL M EFT CHC of Missouri COMMERCIAL M EFT CHC of Nebraska COMMERCIAL M EFT CHC of Texas COMMERCIAL M EFT CHC of Virginia COMMERCIAL M EFT CHC of West Virginia COMMERCIAL M EFT CHCS Services COMMERCIAL M CHCS Services Inc. COMMERCIAL M ERA CHP DIRECT SUPERMED COMMERCIAL M Claims Call CHP/RPU (FABOH) COMMERCIAL M Claims CIGNA COMMERCIAL M ERA CIGNA COMMERCIAL M Claims CIGNA - PPA COMMERCIAL M Claims CIGNA - PPO COMMERCIAL M Claims SX071 CIGNA Behavioral Health COMMERCIAL M Claims Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Payer ID rendering provider and location number required to submit claims. Please call Dave Sell at (608) to obtain. Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at Revised 02/18/2015 ICS Software, Ltd. Page 16 of 87

17 62308 CIGNA Health Plan - HMO COMMERCIAL M Claims CIGNA Medicare Advantage COMMERCIAL M Claims CIGNA-Central Reserve Life Insurance Company COMMERCIAL M ERA CIGNA-Central Reserve Life Insurance Company COMMERCIAL M EFT NPI required CIGNA-Continental General Insurance Company COMMERCIAL M EFT NPI required CIGNA-Continental General Insurance Company COMMERCIAL M ERA CIGNA-Great American Life Insurance Company COMMERCIAL M EFT NPI required CIGNA-Great American Life Insurance Company COMMERCIAL M ERA CIGNA-Loyal American Life Insurance Company COMMERCIAL M EFT NPI required CIGNA-Loyal American Life Insurance Company COMMERCIAL M ERA CIGNA-Provident American Life & Health Insurance Company COMMERCIAL M ERA CIGNA-Provident American Life & Health Insurance Company COMMERCIAL M EFT NPI required CIGNA-United Teacher Associates Insurance Company COMMERCIAL M EFT NPI required CIGNA-United Teacher Associates Insurance Company COMMERCIAL M ERA EM843 CMS MMA SPECIALTY PLAN COMMERCIAL M ERA EM843 CMS MMA SPECIALTY PLAN COMMERCIAL M Claims EM843 CMS MMA SPECIALTY PLAN COMMERCIAL M EFT EM843 CMS MMA SPECIALTY PLAN COMMERCIAL M CNIC Health Solutions Inc. COMMERCIAL M ERA CNIC Health Solutions Inc. COMMERCIAL M Claims COMMUNITY HEALTH PLAN INC. COMMERCIAL M Claims Process to complete set up for ERA for this payer (CNIC Health Solutions): After working with Emdeon to complete their enrollment process please send Provider name and Tax Id # to CNIC directly at [email protected] to request to be set up for ERA COOPERATIVE MANAGED CARE SERVICES COMMERCIAL M Claims To obtain the payer ID for this payer please contact CMCS Customer Service at (800) CTI Administrators Inc. COMMERCIAL M EFT CTI Administrators Inc. COMMERCIAL M ERA CTI Administrators Inc. COMMERCIAL M Claims CWIBENEFITS INC. COMMERCIAL M Claims CWIBENEFITS INC. COMMERCIAL M Cadence Physician Group COMMERCIAL M Claims CALOP Cal-Optima Direct COMMERCIAL M Claims NCH05 California Eye Care - New Century Health COMMERCIAL M Claims California Health & Wellness COMMERCIAL M Claims The Provider Services # is California Pacific Medical Center COMMERCIAL M Claims CampusCare COMMERCIAL M Claims Cannon Cochran Management Services Inc. Metairie LA COMMERCIAL M EFT Cannon Cochran Management Services Inc. Metairie LA COMMERCIAL M Cannon Cochran Management Services Inc. Metairie LA COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 17 of 87

18 CX037 Capital Dental COMMERCIAL M SX065 Capital District Physician's Health Plan COMMERCIAL M Claims Par for Billing SX065 Capital District Physician's Health Plan COMMERCIAL M ERA Capital Health Plan COMMERCIAL M Claims Payer will accept either rendering provider UPIN or NPI on claims. Before submitting NPI please call Capital Health Plan at to register your NPI numbers with them Capitol Administrators COMMERCIAL M ERA Capitol Administrators COMMERCIAL M Capitol Administrators COMMERCIAL M Claims 6607 Cardinal Innovations Healthcare Solutions COMMERCIAL M Claims 6607 Cardinal Innovations Healthcare Solutions COMMERCIAL M ERA Care 1st Health Plan of Arizona COMMERCIAL M Claims Care Access Health Plan (CAHP) COMMERCIAL M Claims Care Access Health Plan (CAHP) COMMERCIAL M ERA Care Improvement Plus COMMERCIAL M ERA Care Improvement Plus COMMERCIAL M Claims Care To Care COMMERCIAL M Claims Care Wisconsin FIrst Inc COMMERCIAL M ERA Care Wisconsin FIrst Inc COMMERCIAL M Claims CareCentrix COMMERCIAL M ERA CareCentrix COMMERCIAL M Claims CareCore National COMMERCIAL M Claims CareCore National LLC (Aetna Radiology Claims) COMMERCIAL M Claims CareCore National LLC (Oxford Radiology Claims) COMMERCIAL M Claims CareCore/WCNY RAD COMMERCIAL M Claims CareFirst Administrators/NCAS COMMERCIAL M Echo is returning 835s for payer ID Providers will need to enroll with Emdeon First complete Emdeon setup then Click on the below link to learn more about the ERA/EFT Enrollment process with CareCentrix. <a href=' w.carecentrixportal.com/providerportal/homepage.do</a> Enrollment required prior to claim submission. Please contact [email protected] WellCare New York POS 11 Radiology Claims Only. Claims for members in the following counties should be submitted to WellCare: Monroe Erie Wayne and Onondaga CareFirst Administrators/NCAS COMMERCIAL M EFT Visit to enroll with Emdeon epayment online by through the mail or by fax. There is no cost to you to use Emdeon epayment and enrollment is FREE CareFirst Administrators/NCAS COMMERCIAL M Claims CareFirst Administrators/NCAS COMMERCIAL M Claims CareOregon Inc. COMMERCIAL M Claims NCH04 CarePlus Cardiology - New Century Health COMMERCIAL M Claims NCH01 CarePlus Dermatology - New Century Health COMMERCIAL M Claims CarePlus Health Plans Inc. COMMERCIAL M ERA Must call the payer and register for ERA #6# CarePlus Health Plans Inc. COMMERCIAL M Claims (Formerly Physicians Healthcare Plans Inc) NCH07 CarePlus Oncology - New Century Infusion Solutions COMMERCIAL M Claims NCH03 CarePlus Urology - New Century Health COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 18 of 87

19 KYCS1 CareSource KY COMMERCIAL M Claims CareSource OH COMMERCIAL M Claims Carelink Medicaid COMMERCIAL M Claims Carelink Medicaid COMMERCIAL M ERA CARMO Caremore COMMERCIAL M Claims CM001 Caremore COMMERCIAL M CM001 Caremore COMMERCIAL M EFT CM001 Caremore COMMERCIAL M ERA Carenet COMMERCIAL M ERA Carenet COMMERCIAL M Claims Carepoint Health Plans COMMERCIAL M ERA Carepoint Health Plans COMMERCIAL M Claims INCS1 Caresource Indiana Inc COMMERCIAL M Claims Careworks COMMERCIAL M Claims Carilion Clinic Medicare Health Plan COMMERCIAL M Claims Carolina Care Plan COMMERCIAL M Claims Carolina Care Plan is part of the Medical Mutual Family of Companies. Former payer ID CX101 Carpenters Health and Welfare Fund of Philadelphia COMMERCIAL M Claims Cedars-Sinai Medical Network Services COMMERCIAL M Claims Cedars-Sinai Medical Network Services COMMERCIAL M Encounters CeltiCare COMMERCIAL M Claims CeltiCare COMMERCIAL M ERA Celtic Insurance COMMERCIAL M Claims Celtic Insurance COMMERCIAL M Celtic Insurance COMMERCIAL M EFT Celtic Insurance COMMERCIAL M ERA Cement Masons & Plasterers Health & Welfare Trust COMMERCIAL M Claims Please enter Group Number (F16) when submitting claims Cement Masons and Plasterers Health & Welfare Trust COMMERCIAL M ERA Cement Masons and Plasterers Health & Welfare Trust COMMERCIAL M EFT Cenpatico - Arizona COMMERCIAL M Claims Cenpatico - FL COMMERCIAL M Claims Cenpatico - Georgia COMMERCIAL M Claims Cenpatico - Indiana COMMERCIAL M Claims Cenpatico - OHIO COMMERCIAL M Claims Cenpatico - WI COMMERCIAL M Claims Cenpatico Behavioral Health COMMERCIAL M Claims Prior to submitting claims please call Provider Relations Dept at 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. Prior to submitting claims please call Provider Relations Dept at 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. Prior to submitting claims please call Provider Relations Dept at 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. Revised 02/18/2015 ICS Software, Ltd. Page 19 of 87

20 68068 Cenpatico Behavioral Health Texas COMMERCIAL M Claims Cenpatico Massachuetts COMMERCIAL M Claims Cenpatico New Hampshire COMMERCIAL M Claims Cenpatico South Carolina COMMERCIAL M Claims Cenpatico TPA COMMERCIAL M Claims Centegra Health System COMMERCIAL M ERA Centegra Health System COMMERCIAL M Claims Centene Advantage Plans COMMERCIAL M Claims Centene TPA COMMERCIAL M Claims Center for Elders Independence COMMERCIAL M Claims CenterLight Healthcare COMMERCIAL M Claims CenterLight Healthcare COMMERCIAL M EFT CenterLight Healthcare COMMERCIAL M CenterLight Healthcare COMMERCIAL M ERA CenterPoint Human Services COMMERCIAL M Claims CenterPoint Human Services COMMERCIAL M ERA Central California Women's Health COMMERCIAL M Claims Central DuPage Physician Group COMMERCIAL M Claims Central Reserve Life COMMERCIAL M Central Reserve Life COMMERCIAL M EFT Prior to submitting claims please call Provider Relations Dept at 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. Payer Enrollment Necessary. Complete Enrollment Form and return to the payer Central Reserve Life COMMERCIAL M Claims Only Non Medicare Supplement and Dental lines of business administered under this payer ID Central Reserve Life COMMERCIAL M ERA Non Medicare Supplement Central Reserve Life Ins Co-Medicare Supplement COMMERCIAL M Claims Central SeniorCare COMMERCIAL M Claims Central States Health & Welfare Funds COMMERCIAL M Claims Central Susquehanna Healthcare Providers (CSHP) COMMERCIAL M Claims Central Valley Medical Group COMMERCIAL M Claims E3510 Central Valley Medical Group COMMERCIAL M Claims Call Centre for Health Care COMMERCIAL M Encounters Call Centre for Health Care COMMERCIAL M Claims Centro De Salud Esperanza COMMERCIAL M Claims Centurion COMMERCIAL M Claims Century Health Solutions COMMERCIAL M Claims Century PHO COMMERCIAL M Claims Century PHO INC COMMERCIAL M Claims Cerner HealthPlan Services COMMERCIAL M Claims Chautauqua County Healthcare Plan (Mayville NY) COMMERCIAL M Claims Only claims from providers in Northern California. Please contact the EDI Dept for North American Medical Management (NAMM) - Northern California Lead/Supervisor at prior to initial submission of claims. To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche [email protected] To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche [email protected] Revised 02/18/2015 ICS Software, Ltd. Page 20 of 87

21 59223 Chesapeake Life Insurance Company - Insurance Center COMMERCIAL M ERA Chesapeake Life Insurance Company - Insurance Center COMMERCIAL M Claims Payer ID valid only if the address on the Health ID Card matches the following: P.O. Box North Richland Hills TX Chesapeake Life Insurance Company - Insurance Center COMMERCIAL M EFT Chesapeake Life Insurance Company - Insurance Center COMMERCIAL M Chesterfield Resources Inc. COMMERCIAL M Chesterfield Resources Inc. COMMERCIAL M Claims Chicago Family Health Center Family Health Network patients only COMMERCIAL M Claims AMM03 Child Health and Disability Prevention Treatment COMMERCIAL M Claims Children First Medical Group COMMERCIAL M Claims For questions regarding claim status providers will need to contact payer: CFMG Provider Customer Service Children of Women Vietnam Veterans-VA HAC COMMERCIAL M ERA 835s are not returned on paper claims Children of Women Vietnam Veterans-VA HAC COMMERCIAL M Claims Children's Medical Services - Broward NORTH COMMERCIAL M Claims CPMG1 Childrens Physician Medical Group COMMERCIAL M Claims Chinese Community Health Plan COMMERCIAL M Claims Christian Brothers Services COMMERCIAL M Christian Brothers Services COMMERCIAL M Claims Christian Care Ministries COMMERCIAL M Claims Providers should check the member ID card and use the Household ID value as the member ID when submitting claims electronically Christian Community Health Center COMMERCIAL M Claims Christus Health Medicare Advantage COMMERCIAL M Claims Christus Health Medicare Advantage COMMERCIAL M ERA Christus Health New Mexico HIX COMMERCIAL M ERA Christus Health New Mexico HIX COMMERCIAL M Claims Cigna-Healthspring COMMERCIAL M Claims Cigna-Healthspring COMMERCIAL M EFT Cigna-Healthspring COMMERCIAL M ERA Cincinnati Financial Corporation COMMERCIAL M Claims Circle Family Healthcare Network COMMERCIAL M Claims Citizens Security Life Insurance COMMERCIAL M TH130 Citrus Health COMMERCIAL M TH130 Citrus Health COMMERCIAL M Claims CVPG1 Citrus Valley Physicians Medical Group COMMERCIAL M Claims TH107 City of Amarillo COMMERCIAL M Claims TKFMC City of Visalia COMMERCIAL M Claims Claims Development Corporation COMMERCIAL M Claims ClaimsBridge HPN COMMERCIAL M Claims ClaimsWare Inc. dba ManageMed COMMERCIAL M Claims Clearchoice Health Plan / COIHS COMMERCIAL M Claims SX009 CoOportunity Health COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 21 of 87

22 SX009 CoOportunity Health COMMERCIAL M ERA Coastal Administrative Services COMMERCIAL M Coastal Administrative Services COMMERCIAL M Claims Coastal TPA Inc COMMERCIAL M ERA Cofinity COMMERCIAL M Claims Colonial Medical COMMERCIAL M Claims Colorado Access COMMERCIAL M EFT Colorado Access COMMERCIAL M ERA Colorado Access COMMERCIAL M Claims Colorado Health OP COMMERCIAL M Claims Columbia United Providers COMMERCIAL M Columbia United Providers COMMERCIAL M EFT Columbia United Providers COMMERCIAL M Claims Commerce Benefits Group COMMERCIAL M Claims Commerce Benefits Group COMMERCIAL M EFT Commerce Benefits Group COMMERCIAL M Commonwealth Care Alliance COMMERCIAL M Claims Community Care Alliance of Illinois COMMERCIAL M Claims Community Care BHO COMMERCIAL M Claims Community Care Inc. - Family Care (Wisconsin) COMMERCIAL M Claims Community Care Inc. (Wisconsin) COMMERCIAL M Claims Community Care Managed Health Care Plans of Oklahoma COMMERCIAL M Claims Community Care Managed Health Care Plans of Oklahoma COMMERCIAL M ERA TH005 Community First COMMERCIAL M Claims Community First Health Plan COMMERCIAL M EFT Community First Health Plan COMMERCIAL M Community First Health Plan COMMERCIAL M ERA Community Health Alliance COMMERCIAL M Claims Community Health Alliance COMMERCIAL M ERA Community Health Alliance TN COMMERCIAL M Claims Community Health Choice COMMERCIAL M Claims Community Health Choice COMMERCIAL M ERA Community Health Electronic Claims/CHEC/webTPA COMMERCIAL M ERA Community Health Electronic Claims/CHEC/webTPA COMMERCIAL M Claims Community Health Electronic Claims/CHEC/webTPA COMMERCIAL M EFT Community Health Electronic Claims/CHEC/webTPA COMMERCIAL M SB613 Community Health Plan Washington COMMERCIAL M Claims Community Medical Group of the West Valley Inc. COMMERCIAL M Claims Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Payer requires registration at their site in addition to ERA Provider set up: Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 22 of 87

23 95192 CommunityConnect HealthPlan COMMERCIAL M Claims Provider Services: (877) Comp - Ohio (Austintown OH) COMMERCIAL M Claims CompBenefits Corporation COMMERCIAL M Claims Compcare (Wisconsin BadgerCare only) COMMERCIAL M Claims Provider Services: (866) Complete Benefits Solutions COMMERCIAL M ERA Call Complimentary Health Plan COMMERCIAL M Claims Compsych COMMERCIAL M Claims Conerstone Medical Group COMMERCIAL M Claims Conifer (formerly InforMed) COMMERCIAL M Claims Conifer Value-Based Care COMMERCIAL M Claims 6105 ConnectiCare Inc COMMERCIAL M Claims Echo is returning 835s for payer ID Providers will need to enroll with Emdeon 6105 ConnectiCare Inc COMMERCIAL M ERA Also setup Payer ID ConnectiCare Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at Connecticare - Medicare COMMERCIAL M ERA Payer Enrollment Required: Please call (212) [email protected] Connecticare - Medicare COMMERCIAL M Claims Connecticut Carpenters Health Fund COMMERCIAL M Claims Connecticut General (CIGNA) COMMERCIAL M Claims Consolidated Associates Railroad COMMERCIAL M Claims Consolidated Health Plans COMMERCIAL M Claims L0260 Constellation Health COMMERCIAL M Claims Consumer Mutual of Michigan COMMERCIAL M EFT Consumer Mutual of Michigan COMMERCIAL M Consumer Mutual of Michigan COMMERCIAL M Claims Consumers Choice Health SC COMMERCIAL M Claims Consumers Life Insurance Company COMMERCIAL M Claims Consumers Life insurance Company is part of the Medical Mutual Family of Companies Continental General Ins Co-Medicare Supplement COMMERCIAL M Claims Continental General Insurance Company COMMERCIAL M ERA Non Medicare Supplement Continental General Insurance Company COMMERCIAL M Continental General Insurance Company COMMERCIAL M EFT Continental General Insurance Company COMMERCIAL M Claims Only Non Medicare Supplemental lines of business administered under this payer ID Continuum Health Solutions LLC COMMERCIAL M Claims Contractors Laborers Teamsters & Engineers COMMERCIAL M Claims Conversion Plan-APWU COMMERCIAL M Claims THCP9 Cook Children Star Plan COMMERCIAL M Claims TH104 Cook Children's Health Group COMMERCIAL M Claims Cook Group Health Plan COMMERCIAL M Cook Group Health Plan COMMERCIAL M Claims Cooperative Benefit Administrators (CBA) COMMERCIAL M Claims Claims are printed and mailed to the payer.; For conversion plan members only. If filing a claim for a federal plan member please use payer ID Revised 02/18/2015 ICS Software, Ltd. Page 23 of 87

24 52132 Cooperative Benefit Administrators (CBA) COMMERCIAL M ERA Cooperative Managed Care Services COMMERCIAL M EFT Cooperative Managed Care Services COMMERCIAL M ERA Cooperative Managed Care Services LLC COMMERCIAL M Coordinated Medical Specialists COMMERCIAL M Claims Core Administrative Services COMMERCIAL M Claims Core Benefits Inc. COMMERCIAL M ERA Echo is returning 835s for payer ID COR01. Providers will need to enroll with Emdeon CoreSource COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon for payer ID with Emdeon in order to receive these 835s for this payer CoreSource AZ MN COMMERCIAL M Claims For assistance CoreSource AZ MN COMMERCIAL M ERA CoreSource KC COMMERCIAL M CoreSource KC COMMERCIAL M Claims For assistance send to [email protected] CoreSource KC COMMERCIAL M ERA CoreSource Little Rock COMMERCIAL M CoreSource Little Rock COMMERCIAL M Claims Only for claims where the "submit claims to address" on the medical ID card is a CoreSource address in Little Rock Arkansas. For assistance call CoreSource Little Rock COMMERCIAL M ERA Must Notify Payer CoreSource MD PA IL COMMERCIAL M CoreSource MD PA IL COMMERCIAL M Claims For assistance CoreSource NC IN COMMERCIAL M ERA CoreSource NC IN COMMERCIAL M Claims For assistance CoreSource OH COMMERCIAL M Claims Only for claims where the "submit claims to address" on the medical ID card is a CoreSource address in the state of Ohio. For assistance call CoreSource OH COMMERCIAL M ERA address is [email protected] CoreSource-Internal COMMERCIAL M Claims CORIZ Corizon Health Inc. COMMERCIAL M Claims Corizon Inc clams with address of Brentwood TN should be submitted to this Payer ID Corizon Inc. COMMERCIAL M Claims Corizon Inc (fka Correctional Medical Services) claims with address of St Louis MO should be submitted to this Payer ID Cornerstone Benefit Adminstrators COMMERCIAL M Claims CB268 Cornerstone Preferred Resources COMMERCIAL M Claims Corporate Benefits Service Inc. (NC) COMMERCIAL M Claims Payer ID valid only for claims with a claims submission address of P.O. Box Charlotte NC Correct Care Solutions COMMERCIAL M ERA Correct Care Solutions - FBOP COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 24 of 87

25 58102 Covenant Administrators Inc. (Atlanta GA) COMMERCIAL M Covenant Administrators Inc. (Atlanta GA) COMMERCIAL M Claims TH108 Covenant Management Systems COMMERCIAL M Claims Coventry Advantra Texas COMMERCIAL M Claims Coventry Health & Life (Oklahoma) COMMERCIAL M Claims Coventry Health & Life (Oklahoma) COMMERCIAL M ERA Coventry Health Care COMMERCIAL M Claims Coventry Health Care COMMERCIAL M Encounters Coventry Health Care COMMERCIAL M EFT Coventry Health Care Carelink - West Virginia only COMMERCIAL M Claims Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds Coventry Health Care Carelink Medicaid - West Virginia only COMMERCIAL M Claims Coventry Health Care National Network COMMERCIAL M Claims Coventry Health Care National Network COMMERCIAL M ERA Coventry Health Care of Delaware Inc COMMERCIAL M ERA Coventry Health Care of Florida COMMERCIAL M ERA Formerly CHC Florida/VISTA/Summit Coventry Health Care of Florida COMMERCIAL M Claims Formerly CHC Florida/VISTA/Summit Coventry Health Care of Florida Inc. COMMERCIAL M Claims Coventry Health Care of Georgia Inc COMMERCIAL M ERA Coventry Health Care of Georgia Inc. COMMERCIAL M Claims Coventry Health Care of Illinois COMMERCIAL M Claims Formerly PersonalCare/Coventry Health of Illinois Coventry Health Care of Illinois COMMERCIAL M ERA Formerly PersonalCare/Coventry Health of Illinois Coventry Health Care of Iowa Inc COMMERCIAL M ERA Coventry Health Care of Iowa Inc. COMMERCIAL M Claims Coventry Health Care of Kansas Inc COMMERCIAL M ERA Coventry Health Care of Kansas Inc. COMMERCIAL M Claims Coventry Health Care of Kansas Inc. COMMERCIAL M ERA Coventry Health Care of Louisiana Inc COMMERCIAL M ERA Coventry Health Care of Louisiana Inc. COMMERCIAL M Claims Coventry Health Care of Missouri COMMERCIAL M Claims Formerly Coventry Health Care/Group Health Plan Coventry Health Care of Missouri COMMERCIAL M ERA Formerly Coventry Health Care/Group Health Plan Coventry Health Care of Nebraska Inc COMMERCIAL M ERA Coventry Health Care of Nebraska Inc. COMMERCIAL M Claims Coventry Health Care of Nevada COMMERCIAL M ERA Formerly Coventry Health and Life Nevada Coventry Health Care of Nevada COMMERCIAL M Claims Formerly Coventry Health and Life Nevada Coventry Health Care of Virginia COMMERCIAL M Claims Formerly Southern Health Services Inc Coventry Health Care of Virginia COMMERCIAL M ERA Formerly Southern Health Services Inc Coventry Health Care of the Carolinas COMMERCIAL M Claims Formerly Wellpath Coventry Health Care of the Carolinas COMMERCIAL M ERA Formerly Wellpath Coventry Health and Life Insurance Company administered by PersonalCare COMMERCIAL M Claims Coventry Health and Life Insurance Company administered by PersonalCare COMMERCIAL M ERA Coventry Health and Life Insureance (Tennessee) COMMERCIAL M Claims Coventry Missouri COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 25 of 87

26 25133 Coventry National Accounts COMMERCIAL M EFT Coventry National Health Care Plans COMMERCIAL M ERA Coventry Summitt Health Plan Inc. COMMERCIAL M Claims Coventry of Health Care Delaware Inc. COMMERCIAL M Claims Coventry of the Carolinas COMMERCIAL M EFT CoventryCares of Kentucky COMMERCIAL M Claims CoventryCares of Kentucky COMMERCIAL M EFT CoventryCares of Kentucky COMMERCIAL M ERA Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds CoventryCares of Maryland COMMERCIAL M EFT Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds CoventryCares of Michigan COMMERCIAL M Claims Formerly OmniCare - A Coventry Health Plan CoventryCares of Michigan COMMERCIAL M ERA Formerly OmniCare - A Coventry Health Plan CoventryCares of Michigan COMMERCIAL M EFT Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds CoventryCares of Nebraska COMMERCIAL M EFT Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds CoventryCares of Nebraska COMMERCIAL M Claims Formerly Coventry Nebraska Medicaid CoventryCares of Nebraska COMMERCIAL M ERA Formerly Coventry Nebraska Medicaid CoventryCares of Pennsylvania COMMERCIAL M Claims Formerly Coventry Cares Providers enroll with only the Tax ID if one bank account will be used. Include the NPI CoventryCares of Pennsylvania COMMERCIAL M EFT only if there are multiple bank accounts to ensure proper distribution of funds CoventryCares of Pennsylvania COMMERCIAL M ERA Formerly Coventry Cares CoventryCares of Virginia COMMERCIAL M EFT CoventryCares of West Virginia COMMERCIAL M EFT Creative Medical Systems COMMERCIAL M Claims Creative Plan Administrators COMMERCIAL M Claims Crescent Health Solutions COMMERCIAL M Claims Croy-Hall Mgmt. Inc. COMMERCIAL M Claims Crusader Community Health Foundation COMMERCIAL M Claims Custom Benefit Administrators COMMERCIAL M Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Please enter the unique policy number or ID card when submitting claims. Payer ID valid only for claims with a billing submission address of PO Box Ft. Worth TX Revised 02/18/2015 ICS Software, Ltd. Page 26 of 87

27 58379 Custom Benefit Administrators COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Custom Design Benefits COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Custom Design Benefits Inc. COMMERCIAL M Custom Design Benefits Inc. COMMERCIAL M Claims Cypress Benefit Administrators COMMERCIAL M Call D.H. EVANS & ASSOC. COMMERCIAL M Claims Call Jessica for Payer id DELANO IPA COMMERCIAL M Claims DAK01 DakotaCare COMMERCIAL M ERA DAK01 DakotaCare COMMERCIAL M Claims CB987 Dart Member Care COMMERCIAL M Claims Dean Health Plan COMMERCIAL M ERA Dean Health Plan COMMERCIAL M EFT Dean Health Plan COMMERCIAL M Claims Delaware Physicians Care Inc. COMMERCIAL M Delaware Physicians Care Inc. COMMERCIAL M EFT Enroll with payer Delaware Physicians Care Inc. COMMERCIAL M Claims ERA setup form not required. Providers must enroll using the DPCI ERA Enrollment Delaware Physicians Care Inc. COMMERCIAL M ERA form and this must be submitted to [email protected] Delta Health Systems COMMERCIAL M Claims Patient ID cards should be reviewed for claims submission instruction Dental Blue COMMERCIAL M ERA Dental Blue Select COMMERCIAL M ERA Denver Health Medical Plan COMMERCIAL M Claims Denver Health Medical Plan Inc. - Medicare Choice COMMERCIAL M Claims Denver Health and Hospital Authority COMMERCIAL M Claims Denver Health and Hospital Authority - Indigent Care COMMERCIAL M Claims SX105 Deseret Mutual COMMERCIAL M ERA SX105 Deseret Mutual COMMERCIAL M Claims DESRT Desert Medical Group COMMERCIAL M Claims Detroit Medical Center COMMERCIAL M Claims Diamond Plan (Maryland Medicaid) COMMERCIAL M Claims 6102 Diversified Administration Corporation COMMERCIAL M Claims 6102 Diversified Administration Corporation COMMERCIAL M ERA APP01 Downey Select IPA (Applecare Medical Managment) COMMERCIAL M Claims Call Dr. Rivera COMMERCIAL M Claims Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Please verify the Payer ID on the Member ID card in addition to the Payer City and State before submitting claims to Diversified Admin (Payer ID 06102) To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche [email protected] Revised 02/18/2015 ICS Software, Ltd. Page 27 of 87

28 Call Dr. Rivera COMMERCIAL M Encounters To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche [email protected] DREYR Dreyer Health COMMERCIAL M Claims Driscoll Children's Health Plan COMMERCIAL M ERA Driscoll Children's Health Plan COMMERCIAL M Claims Dunn and Associates Benefits Administrators Inc. COMMERCIAL M Claims E-V Benefits Management Inc (Columbus OH) COMMERCIAL M Claims Now known as Meritain Health E.S. BEVERIDGE & ASSOCIATES COMMERCIAL M Claims Call EBC Mid-America COMMERCIAL M Claims To obtain the payer ID please call (440) EBMC COMMERCIAL M Claims SX182 EBMS COMMERCIAL M Claims EBS OF OHIO COMMERCIAL M Echo is returning 835s for payer ID Providers will need to enroll with Emdeon EBSO COMMERCIAL M ERA Call EBSO Inc fka EBC Inc COMMERCIAL M Claims To obtain the payer ID please call (440) EBSO Inc. COMMERCIAL M ERA ECHO Health Inc. COMMERCIAL M EGID (Employees Group Insurance Division) COMMERCIAL M Claims EGID (Employees Group Insurance Division) COMMERCIAL M ERA 4326 ELDER SERVICE PLAN OF THE NORTH SHORE COMMERCIAL M Claims ELECTRICAL INDUSTRY SERVICE BUREAU COMMERCIAL M EMI-KP Ambulance Claims COMMERCIAL M Claims EQUICOR COMMERCIAL M Claims EQUICOR - PPO COMMERCIAL M Claims TH110 ERISA COMMERCIAL M Claims ESSENCE HEALTHCARE COMMERCIAL M Claims ESSENCE HEALTHCARE COMMERCIAL M ERA TH084 Early Intervention Central COMMERCIAL M Claims Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Call East Bay Medical Network COMMERCIAL M Claims Network ID required on all claims. Call Sutter Connect EDI Department at (800) to obtain Network ID prior to first submission East Carolina Behavioral Health COMMERCIAL M Claims Payer does accept Secondary claims electronically East Carolina Behavioral Health COMMERCIAL M ERA East LA - APMG COMMERCIAL M Claims Call Eastern Life and Health COMMERCIAL M Eastland Medical Group COMMERCIAL M Claims SX110 Educators Mutual (EMIA) COMMERCIAL M Claims TH090 El Paso First - Chip COMMERCIAL M Claims MPMOA El Proyecto Del Barrio IPA COMMERCIAL M Claims ElderPlan Inc. COMMERCIAL M ERA ElderPlan Inc. COMMERCIAL M EFT EFT is Live for Elderplan Revised 02/18/2015 ICS Software, Ltd. Page 28 of 87

29 31625 ElderPlan Inc. COMMERCIAL M Claims Elderplan no longer requires enrollment & individual provider testing; However Elderplan Provider ID is necessary on all claim submissions. If you do not know your provider Id contact (718) Elmco COMMERCIAL M Elmco COMMERCIAL M Claims Emblem Health (GHI - New York Group Health Inc.) COMMERCIAL M ERA Any provider that wishes to receive 835 must be a participating provider with the payer. If they are non-participating they will not receive Emblem Health (GHI - New York Group Health Inc.) COMMERCIAL M Claims Emerald Health Network Inc. (All PPO Business) COMMERCIAL M Claims Emergency Medical Services Fund - Orange County CA COMMERCIAL M Claims Program is for Orange County California EMP01 Empire Physician's Medical Group COMMERCIAL M Claims Pilot Employee Benefit Administration & Management Corporation COMMERCIAL M Claims Call Employee Benefit Claims - Mid-America COMMERCIAL M Claims To obtain the payer ID please call (440) Call Employee Benefit Claims of WI COMMERCIAL M Claims To obtain the payer ID please call (440) Call Employee Benefit Claims of Wisconsin COMMERCIAL M Claims To obtain the payer ID please call (440) Employee Benefit Concepts (Farmington Hills MI) COMMERCIAL M Employee Benefit Concepts (Farmington Hills MI) COMMERCIAL M Claims Call Employee Benefit Consultants Inc. COMMERCIAL M Claims To obtain the payer ID please call (440) Employee Benefit Management Corp (EBMC) COMMERCIAL M Claims Employee Benefit Management Corp (EBMC) COMMERCIAL M Employee Benefit Services (Ft. Mill SC) COMMERCIAL M Employee Benefit Services (Ft. Mill SC) COMMERCIAL M ERA Payer is live with 4010 ERA format Emdeon to upconvert to Employee Benefit Services (Ft. Mill SC) COMMERCIAL M Claims MUST VERIFY ALL CLAIMS SHOULD GO TO PAYER IN FT. MILL SC TH109 Employee Benefit Services of San Antonio COMMERCIAL M Claims Employee Benefit Services Inc. COMMERCIAL M ERA Employee Benefit Systems COMMERCIAL M Claims Employee Benefits Corporation COMMERCIAL M ERA Echo is returning 835s for payer ID EBS01. Providers will need to enroll with Emdeon Echo is returning 835s for payer ID Providers will need to enroll with Emdeon 3036 Employee Benefits Plan Administration Inc. (E.B.P.A.) COMMERCIAL M Claims Employee Health System Medical Group COMMERCIAL M Employee Health System Medical Group COMMERCIAL M EFT Employee Health System Medical Group COMMERCIAL M Claims Employee Plans LLC COMMERCIAL M Claims Employee Plans LLC COMMERCIAL M CX031 Employer Plan Services Inc. COMMERCIAL M Employer's Direct Health - Employee Plan COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 29 of 87

30 75235 Employer's Direct Health - FI COMMERCIAL M Claims Employer's Direct Health - SF COMMERCIAL M Claims Employers Direct Health COMMERCIAL M Claims Employers Mutual Inc (Jacksonville Florida) COMMERCIAL M Claims Employers Mutual Inc. (Stuart Florida) COMMERCIAL M Claims For plan and claim requirements please contact the Employers Mutual Inc. (Stuart FL) Customer Service Department at (772) ext Encircle PPO COMMERCIAL M Claims Encore Health Network COMMERCIAL M Claims Enstar Natural Gas COMMERCIAL M Claims Please enter Group Number (P61) when submitting claims Entrust COMMERCIAL M Claims Electronic Payer ID for Claims printed and mailed to payer Equitable Plan Services (Oklahoma City OK) COMMERCIAL M Claims Payer ID valid only for claims with a billing submission address of P.O. Box Oklahoma City OK Equitable Plan Services (Oklahoma City OK) COMMERCIAL M Erie Family Health Center COMMERCIAL M Claims Everence COMMERCIAL M EFT Everence COMMERCIAL M Everence COMMERCIAL M Claims Evergreen COMMERCIAL M ERA Evergreen Health Cooperative COMMERCIAL M Claims Evolutions Healthcare Systems (New Port Richey FL) COMMERCIAL M Claims EXC01 Excel MSO COMMERCIAL M Claims ExclusiCare COMMERCIAL M Claims Eye Management Inc. (EMI) COMMERCIAL M Claims Eye Management Inc. (EMI) COMMERCIAL M ERA EyeQuest COMMERCIAL M Claims Call FABOH (CHP/RPU) COMMERCIAL M Claims FACS Group COMMERCIAL M Claims FARA Benefit Services Inc. COMMERCIAL M FHN- Risk COMMERCIAL M Claims FHN-Transportation COMMERCIAL M Claims FHN-UIHHSS COMMERCIAL M Claims FAMR1 FIRST ADMINISTRATORS INC COMMERCIAL M EFT FAMR1 FIRST ADMINISTRATORS INC COMMERCIAL M Claims FL Healthcare Plus COMMERCIAL M Claims FL MCO PHC/PHP COMMERCIAL M Claims Facey Medical Foundation COMMERCIAL M Claims Fairbanks North Star Borough COMMERCIAL M ERA Fairbanks North Star Borough COMMERCIAL M EFT Fairbanks North Star Borough School District Plan A (FNSBSD) COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Payer ID valid for claims with a submission address of PO Box 5001 New Port Richey FL Payer ID rendering provider and location number required to submit claims. Please call Dave Sell at (608) to obtain. You must enroll with your TIN and Sub TIN. To obtain your Sub TIN call Revised 02/18/2015 ICS Software, Ltd. Page 30 of 87

31 Fairbanks North Star Borough School District Plan A (FNSBSD) COMMERCIAL M EFT Fairbanks North Star Borough School District Plan B (FNSBSD) COMMERCIAL M EFT Fairbanks North Star Borough School District Plan B (FNSBSD) COMMERCIAL M ERA Fallon Community Health Plan COMMERCIAL M Claims Fallon Total Care COMMERCIAL M Claims Family Christian Health Center Family Health Network patients only COMMERCIAL M Claims Family Health Partners - Healthwave of Kansas COMMERCIAL M Claims Family Health Partners - Healthwave of Kansas COMMERCIAL M ERA TH045 Family Health Plan COMMERCIAL M Claims Family Medicine Specialist INC COMMERCIAL M Claims Family Medicine Specialist of Round Lake COMMERCIAL M Claims Farm Family Life COMMERCIAL M Claims Federal Employees Health Benefit Plan (MHBP) COMMERCIAL M ERA Federated Benefits COMMERCIAL M Claims Federated HR Services COMMERCIAL M Claims Federated Mutual Insurance COMMERCIAL M ERA Federated Mutual Insurance COMMERCIAL M Claims Fidelis Care New York COMMERCIAL M Claims Fidelis Seniorcare COMMERCIAL M Claims Fidelis Seniorcare COMMERCIAL M ERA First Agency COMMERCIAL M Claims First Carolina Care COMMERCIAL M Claims First Choice Health Administrators COMMERCIAL M Claims First Choice Health Network COMMERCIAL M Claims First Choice Health Network COMMERCIAL M First Choice VIP Care COMMERCIAL M ERA First Choice VIP Care COMMERCIAL M Claims First Choice VIP Care COMMERCIAL M EFT First Choice VIP Care COMMERCIAL M First Choice VIP Care Plus - SC COMMERCIAL M Claims First Choice VIP Care Plus - SC COMMERCIAL M ERA First Choice VIP Care Plus - SC COMMERCIAL M EFT First Choice VIP Care Plus - SC COMMERCIAL M First Choice of Midwest (PPO) COMMERCIAL M Claims First Health Network (f.k.a. CCN Managed Care Inc. & PPO Oklahoma) COMMERCIAL M Claims First Choice VIP Care is effective 1/1/2013 Medicare Advantage Plan part of the AmeriHealth Caritas Family of Companies. First Choice VIP Care Plus is a Medicare Medicaid Plan (MMP) part of the AmeriHealth Caritas Family of Companies. FIRST CHOICE VIP CARE PLUS is effective 2/1/2015. Please note that this payer encourages early enrollment for EFT/ERA services. Please visit to early enroll. FIRST CHOICE VIP CARE PLUS is effective 2/1/2015. Please note that this payer encourages early enrollment for EFT/ERA services. Please visit to early enroll. Revised 02/18/2015 ICS Software, Ltd. Page 31 of 87

32 29076 First Medical Network (FMN) - Atlanta GA COMMERCIAL M Claims 1st Medical Network is part of the Medical Mutual Family of Companies. Former payer ID First Priority COMMERCIAL M ERA Online Enrollment for ERA: First Priority COMMERCIAL M Claims Beginning 1/8/2007 all new providers must enroll with First Priority Health/Blue Cross of Northeastern PA prior to submitting electronic claims. Enrollment form available at: First Service Administrator's Inc Lakeland Florida COMMERCIAL M Claims Third Party Administrator's Also formally known as Florida 1st Florida First TH003 FirstCare COMMERCIAL M Claims FirstCare Health Plans COMMERCIAL M EFT FirstCare Health Plans COMMERCIAL M Fitzharris & Company Inc. COMMERCIAL M Claims Florida Health Administrators Inc COMMERCIAL M ERA Echo is returning 835s for payer ID FHA01. Providers will need to enroll with Emdeon Florida Health Care Plan COMMERCIAL M Claims Florida Hospital Healthcare Systems COMMERCIAL M Claims If Bill Prov NPI not present Render Prov NPI required -or- If Render Prov NPI is not present either Render Prov Network ID (REF*N5) or Commercial Num (REF*G2) is required. FHHS member ID must be 11 digits Florida Hospital Healthcare Systems COMMERCIAL M ERA Florida Hospital Waterman COMMERCIAL M Claims For assistance send to [email protected] Florida League of Cities Inc. COMMERCIAL M Claims Workers Comp Claims to be mailed to: Florida League of Cities c/o CorVel P.O. Box Lake Mary FL Florida True Health COMMERCIAL M EFT Florida True Health COMMERCIAL M Claims Florida True Health COMMERCIAL M Florida True Health COMMERCIAL M ERA Fnd For Medicare of Tulare & Kings Counties Inc COMMERCIAL M Fnd For Medicare of Tulare & Kings Counties Inc COMMERCIAL M ERA Fnd For Medicare of Tulare & Kings Counties Inc COMMERCIAL M EFT Foreign Service Benefit Plan COMMERCIAL M Claims Foundation Benefit Administrators /Contractor Employee BOONG Benefits Admin COMMERCIAL M Claims Managed Medicaid Plan part of the AmeriHealth Mercy Family of Companies. For EDI support please [email protected] or call Managed Medicaid Plan part of the AmeriHealth Mercy Family of Companies. For EDI support please [email protected] or call TKFMC Foundation for Medical Care of Tulare & Kings County COMMERCIAL M Claims Fox-Everett Inc. COMMERCIAL M Claims Freedom First COMMERCIAL M Claims Freedom Health Plan COMMERCIAL M Claims Fresenius Medical Care COMMERCIAL M ERA Fresenius Medical Care COMMERCIAL M Claims Fresno - ENH Medical Group COMMERCIAL M Claims Fresno - ENH Medical Group COMMERCIAL M EFT Revised 02/18/2015 ICS Software, Ltd. Page 32 of 87

33 75299 Fresno - ENH Medical Group COMMERCIAL M TKFMC Friant Water Users COMMERCIAL M Claims Friedell Managed Care Group COMMERCIAL M Claims Fringe Benefit Services COMMERCIAL M Fringe Benefits Coordinators COMMERCIAL M Claims FrontPath Health Coalition COMMERCIAL M Claims GEHA (Multiplan) COMMERCIAL M Claims GEHA (PHCS) COMMERCIAL M Claims MCS01 GEMCare (Golden Empire Managed Care System) COMMERCIAL M Claims GGMIT insured by Trustmark Insurance COMMERCIAL M ERA GHI HMO COMMERCIAL M Claims GHI HMO COMMERCIAL M ERA GIC Indemnity Plan COMMERCIAL M Claims GMS Inc. COMMERCIAL M Claims Galveston County Indigent Health Care COMMERCIAL M Claims Gardena Memorial Medical Center COMMERCIAL M Claims Gateway Health Plan - Medicare Assured COMMERCIAL M ERA Gateway Health Plan - Medicare Assured COMMERCIAL M Claims Gateway Health Plan Medicaid PA COMMERCIAL M ERA Gateway Health Plan Medicaid PA COMMERCIAL M Claims Gateway Health Plan OH- Medicare Assured COMMERCIAL M ERA Gateway Health Plan OH- Medicare Assured COMMERCIAL M Claims 5506 Gateway Healthy PA COMMERCIAL M Claims 5506 Gateway Healthy PA COMMERCIAL M ERA Gateway IPA (Pinnacle Health Resources) (Prospect Medical PROSP Group) COMMERCIAL M Claims Geisinger Health Plan COMMERCIAL M Claims Geisinger Health Plan COMMERCIAL M Geisinger Health Plan COMMERCIAL M ERA Gemcare Health Plan COMMERCIAL M Claims MCS03 Gemcare Health Plan COMMERCIAL M Claims Gemcare IPA COMMERCIAL M Claims Generations Healthcare COMMERCIAL M Claims Generations-Hillcrest COMMERCIAL M ERA Generations-Hillcrest COMMERCIAL M Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Gateway Health Plan - Medicare Assured; (Yellow Card). Please check the ID card to verify the Payer ID before submitting claims. If you have questions please contact Gateway Provider Servicing Department at Caution: Gateway Health Plan has several different Payer ID numbers please look for the Payer ID on the ID card before submitting. PA Medicaid 25169(Green Card). If you have questions contact Gateway Provider Servicing Department at Prior enrollment required. Please contact Geisinger Health Plan at extension to confirm credentialing prior to completing EDI Enrollment Forms. Revised 02/18/2015 ICS Software, Ltd. Page 33 of 87

34 46051 Generations-Hillcrest COMMERCIAL M EFT Generations-Hillcrest COMMERCIAL M Claims PROSP Genesis Healthcare COMMERCIAL M Claims 7205 Gilsbar Inc. COMMERCIAL M ERA 7205 Gilsbar Inc. COMMERCIAL M Claims AMM02 Glendale Physician's Alliance COMMERCIAL M Claims 7689 Global Care Inc. COMMERCIAL M Claims MPMOA Global Care Med Grp IPA COMMERCIAL M Claims GEM01 Global Excel Management COMMERCIAL M Claims GHOKC Global Health COMMERCIAL M Claims MBA01 Golden State Medical Group COMMERCIAL M Claims Golden Triangle Physician Alliance/SelectCare of Texas (GTPA) COMMERCIAL M Claims IP086 Good Samaritan Medical Practice Association COMMERCIAL M Claims Good Sheperd Hospice Inc COMMERCIAL M Claims Government Employees Health Association (GEHA) COMMERCIAL M EFT GEHA EFT enrollment requires tax ID plus GEHA provider ID. Please call GEHA at to get your GEHA provider ID Government Employees Health Association (GEHA) COMMERCIAL M Claims Government Employees Health Association (GEHA) COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at Grand Valley Health Plan COMMERCIAL M Claims Granite State Health Plan COMMERCIAL M Claims Great American Life Ins. Co-Medicare Supplement COMMERCIAL M Claims Great American Life Insurance Company COMMERCIAL M Great Chicago Medical Association COMMERCIAL M Claims Great-West Healthcare COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form for each Individual Provider at Also setup payer id Great-West Healthcare COMMERCIAL M Claims Great-West Healthcare (formerly American General) COMMERCIAL M Claims Greater Elgin Family Care Center COMMERCIAL M Claims NMM01 Greater Orange County Medical Group COMMERCIAL M Claims NMM01 Greater San Gabriel Med Grp COMMERCIAL M Claims Group Administrators Ltd. COMMERCIAL M Claims Please send these EDI claims to the Payer ID shown on the member's ID card. Our offices are located in Schaumburg IL. If you have any questions please call Group Administrators Ltd. COMMERCIAL M CB951 Group Benefit Services Inc. COMMERCIAL M Claims Group Health Alliance COMMERCIAL M Group Health Cooperative - WA State COMMERCIAL M Claims All GHC products; GHC Group Individual Medicare + Choice and Healthy Options can be submitted electronically Group Health Cooperative of Eau Claire COMMERCIAL M Claims Provider Services: (866) Revised 02/18/2015 ICS Software, Ltd. Page 34 of 87

35 39167 Group Health Cooperative of South Central Wisconsin COMMERCIAL M ERA Dual Enrollment is required. Emdeon requires enrollment Payer requires enrollment. Complete both the Payer Provider Setup Form along with Emdeon PSF Form. Submit the Payer's Form to the payer as designated on their Form for Enrollment. Submit Emdeon's Form to Emdeon for Enrollment Group Health Cooperative of South Central Wisconsin COMMERCIAL M Claims Group Health Options - WA State COMMERCIAL M Claims All GHO products; Options and Alliant can be submitted electronically Group Insurance Service Center Inc. COMMERCIAL M Claims Group Resources Inc COMMERCIAL M Group and Pension Administrators COMMERCIAL M Claims Guardian Healthcare INC. (SC) COMMERCIAL M Claims Guardian Life Insurance Company of America COMMERCIAL M ERA Guardian Life Insurance Company of America COMMERCIAL M Guardian Life Insurance Company of America COMMERCIAL M EFT For more information and to download forms please visit Guardian Life Insurance Company of America COMMERCIAL M Claims Gulf Guaranty Employee Benefit Services Inc. COMMERCIAL M ERA Echo is returning 835s for payer ID GGE01. Providers will need to enroll with Emdeon CB624 Gulf Stream-General Dynamics COMMERCIAL M Claims H.E.R.E.I.U Welfare Pension Funds COMMERCIAL M Claims HAA Preferred Partners COMMERCIAL M Claims HAP/AHL/Curanet COMMERCIAL M Claims HCH Administration COMMERCIAL M HCH Administration (Illinois) COMMERCIAL M HCH Administration (Illinois) COMMERCIAL M EFT Fully Insured blocks of business and OH providers only HCH Administration Inc. COMMERCIAL M HCS - Health Claims Service (Boise ID) COMMERCIAL M Claims Call HDM Benefit Solutions COMMERCIAL M Call HEALTH CARE DISTRICT COMMERCIAL M Claims Call Provider Services at for EDI Enrollment HFN Inc. COMMERCIAL M Claims HHH Choices Gold COMMERCIAL M Claims HIP - Health Insurance Plan of Greater New York COMMERCIAL M Claims HIP - Health Insurance Plan of Greater New York COMMERCIAL M HIP - Health Insurance Plan of Greater New York COMMERCIAL M ERA HMA Hawaii COMMERCIAL M ERA HMA Hawaii COMMERCIAL M HMA Hawaii COMMERCIAL M EFT HMA Hawaii COMMERCIAL M Claims HMC HealthWorks aka Health Management Co COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 35 of 87

36 51909 HMO Illinois/BCBS COMMERCIAL M Claims HN1 Therapy Network (HN1TN) COMMERCIAL M Claims HN1 Therapy Network (HN1TN) COMMERCIAL M ERA HP Administrative Services LLC COMMERCIAL M Claims HP Administrative Services LLC COMMERCIAL M ERA HS1 Medical Management COMMERCIAL M Claims HS1 Medical Management COMMERCIAL M ERA HSHS Medical Group IPA COMMERCIAL M Claims HSR Administrators Inc. COMMERCIAL M ERA Echo is returning 835s for payer ID. Providers will need to enroll with Emdeon for payer ID with Emdeon in order to receive these 835s for this payer Harbor Advantage (Abrazo Health Care) COMMERCIAL M Claims Harbor Choice COMMERCIAL M Claims Harbor Health Plan COMMERCIAL M Claims Harpeth IPA - Amerivantage COMMERCIAL M Claims Harrington Health Non-EPO COMMERCIAL M Claims Harrington Health-Kansas (formerly known as Fiserv Health- Kansas) COMMERCIAL M Claims (Formerly Willis Administrative Services Corporation) 4271 Harvard Pilgrim Health Care COMMERCIAL M Claims Hawaii 835 (ERA/EFT) line of business COMMERCIAL M ERA Hawaii 835 (ERA/EFT) line of business COMMERCIAL M EFT Hawaii Medical Assurance Association (HMAA/HWMG) COMMERCIAL M ERA Hawaii Medical Assurance Association (HMAA/HWMG) COMMERCIAL M EFT To obtain your Provider Number please call ext Hawaii Medical Assurance Association (HMAA/HWMG) COMMERCIAL M Claims Hawaii Medical Assurance Association (HMAA/HWMG) COMMERCIAL M Health Alliance Medical Plans COMMERCIAL M EFT Health Alliance Medical Plans COMMERCIAL M ERA Health Alliance Medical Plans COMMERCIAL M Health America Inc./Health Assurance/Advantra COMMERCIAL M Claims Health America Inc./Health Assurance/Advantra COMMERCIAL M ERA Health Care Network of Wisconsin (HCN) COMMERCIAL M Claims Health Choice Arizona COMMERCIAL M ERA Health Choice Arizona COMMERCIAL M Health Choice Arizona COMMERCIAL M Claims Health Choice Generations COMMERCIAL M ERA Health Choice Generations COMMERCIAL M Claims Health Choice Generations COMMERCIAL M Health Choice Insurance Co COMMERCIAL M Claims Health Cost Solutions COMMERCIAL M ERA Health Cost Solutions COMMERCIAL M Claims Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 36 of 87

37 34158 Health Design Plus (Hudson OH) COMMERCIAL M Claims Health First Health Plan Inc. COMMERCIAL M EFT Health First Health Plan Inc. COMMERCIAL M ERA Providers must enroll in EFT to receive ERAs Health First Health Plan Inc. COMMERCIAL M TH049 Health Management Administrators (HMA) COMMERCIAL M Claims Health Net - California (Professional Encounters ONLY) COMMERCIAL M Encounters Payer requires the Health Net assigned ID be sent on ENCOUNTERS only. To verify or obtain your Health Net assigned ID please send an message to: [email protected] Health Net - VA Patient Centered Community Care Program COMMERCIAL M Claims The Payor ID facilitates claim submission to Health Net Federal Services for services authorized under the Veterans Affairs Patient-Centered Community Care Program. Please include the VA authorization number when submitting claims Health Net of Arizona COMMERCIAL M ERA Electronic Advice (835) is available through payer ID for Health Net AZ. Pls submit form for Health Net of Arizona COMMERCIAL M Claims Payer requires NPI Health Net of California and Oregon - Claims COMMERCIAL M ERA Payer will receive auto enrollment . Also Payer Registration from is located on our website. Providers are to follow instructions on Health Net form and return the completed form to Healthnet and return the completed form to Health Net and Emdeon enrollment Health Net of California and Oregon - Claims COMMERCIAL M Claims 6108 Health Net of the Northeast Inc. COMMERCIAL M ERA Payer will receive auto enrollment . Also Payer Registration form is located on our website. Providers are to follow instructions on Health Net form and return the completed form to Health Net and Emdeon enrollment 6108 Health Net of the Northeast Inc. COMMERCIAL M Claims Payer requires NPI Health Network One COMMERCIAL M ERA Health Network One COMMERCIAL M Claims Call Health New England COMMERCIAL M Claims To obtain payer id please contact Joanne Shaw [email protected] SX030 Health Options of Florida COMMERCIAL M Claims Health Options of Illinois COMMERCIAL M Claims Health Partners - Jackson TN COMMERCIAL M Health Partners - Jackson TN COMMERCIAL M Claims Health Partners PA COMMERCIAL M Health Partners PA COMMERCIAL M Claims Health Payment Systems Inc. COMMERCIAL M Claims Health Plan Management Services (HPMS) COMMERCIAL M Claims Health Plan of Michigan COMMERCIAL M ERA To process ERA transactons send an to [email protected]. Required information is Provider NPI and Tax ID numbers. Please make sure ERA is to be sent through Emdeon Health Plan of Michigan COMMERCIAL M Health Plan of Michigan COMMERCIAL M Claims Health Plan of Nevada COMMERCIAL M ERA Health Plan of Nevada COMMERCIAL M Claims Health Plan of Nevada (Encounters) COMMERCIAL M Encounters Revised 02/18/2015 ICS Software, Ltd. Page 37 of 87

38 68035 Health Plan of San Joaquin COMMERCIAL M ERA Health Plan of San Joaquin COMMERCIAL M EFT Health Plan of San Joaquin COMMERCIAL M Claims Call Health Plan of San Mateo COMMERCIAL M Claims CONTACT PAYER FOR REGISTRATION AND PAYER ID. Endry Lo: or Ken Cottrell: Health Plans Inc. COMMERCIAL M Health Plans Inc. COMMERCIAL M Claims Health Plus PHSP (Brooklyn NY) COMMERCIAL M Health Plus PHSP (Brooklyn NY) COMMERCIAL M EFT Health Plus Physicians Organization COMMERCIAL M Claims Health Services Management COMMERCIAL M Claims Health Services Preferred (HSP) by Emerald Health COMMERCIAL M Claims Health Services Review COMMERCIAL M Health Services for Children with Special Needs COMMERCIAL M Claims Health Services for Children with Special Needs COMMERCIAL M Health Services for Children with Special Needs COMMERCIAL M EFT Health Services for Children with Special Needs COMMERCIAL M ERA HealthAmerica/HealthAssurance of Pennsylvania COMMERCIAL M EFT Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds HealthCare Partners IPA COMMERCIAL M HealthCare Partners IPA COMMERCIAL M EFT HealthCare Partners IPA COMMERCIAL M Claims Formerly Heritage New York Medical Group HealthCare USA COMMERCIAL M EFT HealthEZ COMMERCIAL M Claims HealthEdge Administrators (Bakersfield CA) COMMERCIAL M Claims HealthGroup Limited COMMERCIAL M Claims SX009 HealthPartners MN COMMERCIAL M Claims SX009 HealthPartners MN COMMERCIAL M ERA HealthPlan Services COMMERCIAL M Claims HealthPlus Amerigroup COMMERCIAL M ERA HealthPlus Amerigroup COMMERCIAL M Claims HealthPlus of Michigan COMMERCIAL M Claims HealthSCOPE Benefits COMMERCIAL M ERA HealthSCOPE Benefits Inc. COMMERCIAL M ERA HealthSCOPE Benefits Inc. COMMERCIAL M Claims HSM01 HealthSmart -Noble Mid Orange COMMERCIAL M Claims Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Payer ID valid for claims with a submission address of PO Box Bakersfield CA HealthPlus requires a Trading Partner Agreement. Providers should contact the EDI department at ( ) upon billing via Emdeon to request a TPA form. Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 38 of 87

39 37272 HealthSmart Benefit Solutions COMMERCIAL M ERA Formerly Wells Fargo TPA Inc. (Newnan GA and Fayetteville NC) HealthSmart Benefit Solutions COMMERCIAL M EFT EFT live for NEWNAN UTILITIES CAPE FEAR VALLEY HEALTH SYSTEM CUMBERLAND COUNTY SCHOOLS CITY OF JACKSONVILLE 1000 CHURCH STREET INC HICKORY DYEING & WINDING CO JACKSON COUNTY EES J T DAVENPORT & SONS INC PUBLIC WORKS COMMISSION SATILLA REMC SHOOK BUILDER SUPPLY CO and UNITED FORMING INC HealthSmart Benefit Solutions COMMERCIAL M Claims Formerly Wells Fargo TPA Inc. (Newnan GA and Fayetteville NC) HealthSmart Benefit Solutions COMMERCIAL M Formerly Wells Fargo TPA Inc. (Newnan GA and Fayetteville NC) HealthSmart Benefit Solutions COMMERCIAL M Claims HealthSmart Benefit Solutions COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon HealthSmart Benefit Solutions fka Wells Fargo TPA.Inc. COMMERCIAL M ERA formerly Wells Fargo TPA Inc. Charleston WV HealthSmart Benefit Solutions fka Wells Fargo TPA.Inc. COMMERCIAL M Claims formerly Wells Fargo TPA Inc. Charleston WV HealthSmart Benefit Solutions Inc. COMMERCIAL M ERA HealthSmart Preferred Care Inc. COMMERCIAL M Claims HealthSmart formerly AAG COMMERCIAL M ERA HSPAN HealthSpan Network Repricing COMMERCIAL M Claims HealthSpan Inc COMMERCIAL M Claims HealthSpring - STAR+PLUS Only COMMERCIAL M EFT HealthSpring - STAR+PLUS Only COMMERCIAL M ERA HealthSpring HMO/HealthSpring Medicare+Choice COMMERCIAL M Claims HealthSpring HMO/HealthSpring Medicare+Choice COMMERCIAL M HealthSpring HMO/HealthSpring Medicare+Choice COMMERCIAL M ERA Healthamerica COMMERCIAL M ERA MPMOA Healthcare La IPA COMMERCIAL M Claims Healthcare Management Administrators COMMERCIAL M ERA HCP01 Healthcare Partners COMMERCIAL M Claims Healthcare Resources NW COMMERCIAL M Claims Healthcare Solutions Group COMMERCIAL M Healthcare Solutions Group COMMERCIAL M Claims Healthcare USA COMMERCIAL M Claims Healthcare USA COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Echo is returning 835s for payer ID Providers will need to enroll with Emdeon It is no longer necessary to notify HealthSpring before submitting claims electronically. HealthSpring encourages electronic submission of all claims. Be sure to submit only the HealthSpring subscriber/member ID number found on the HealthSpring ID card *****MUST ALSO ENROLL PAYER ID For Provider Enrollment for ERA and EFT services please visit or call Enrollment Questions at Option 1 Echo is returning 835s for payer ID HMA01. Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 39 of 87

40 85729 Healthcomp Inc. COMMERCIAL M Claims Healthfirst Health Plan of New Jersey COMMERCIAL M ERA Providers must enroll for EFT to receive ERA.. EFT enrollment at Healthfirst Health Plan of New Jersey COMMERCIAL M Claims Healthfirst Inc. (New York) COMMERCIAL M Healthfirst Inc. (New York) COMMERCIAL M ERA Healthfirst Inc. (New York) COMMERCIAL M Claims Healthgram Inc COMMERCIAL M ERA Formerly known as Primary Physician Care Healthgram Inc COMMERCIAL M Claims Formerly known as Primary Physician Care Healthgram Inc COMMERCIAL M EFT Formerly known as Primary Physician Care. Providers should enroll with TIN and Vendor IDs. Vendor IDs usually include TIN and a suffix. To obtain Vendor IDs call or Healthgram Inc COMMERCIAL M Formerly know as Primary Physician Care Healthlink HMO COMMERCIAL M Healthlink HMO COMMERCIAL M EFT Healthlink HMO COMMERCIAL M Claims Please call Provider Relations Dept at (800) for unique provider number Healthlink HMO COMMERCIAL M ERA Healthlink PPO COMMERCIAL M Claims Customer Service phone number: ( ) 6108 Healthnet of Arizona COMMERCIAL M ERA Payer will receive auto enrollment . Also Payer Registration form is located on our website. Providers are to follow instructions on Health Net form and return the completed form to Health Net and Emdeon enrollment Healthnow Division COMMERCIAL M Claims Provider id = 12 digits with G2 qualifier Healthscope Benefits - EHC Repricing COMMERCIAL M Claims Healthsmart Accel COMMERCIAL M Claims 2041 Healthsource CMHC COMMERCIAL M Claims 2041 Healthsource Massachusetts Inc. COMMERCIAL M Claims Healthsource Provident COMMERCIAL M Claims Claims are edited under CIGNA's payer specific edits Payer ID Healthsource AR (Med) (CIGNA) COMMERCIAL M Claims Claims are edited under CIGNA's payer specific edits Payer ID Healthsource GA (CIGNA) COMMERCIAL M Claims Claims are edited under CIGNA's payer specific edits Payer ID Healthsource KY COMMERCIAL M Claims 1041 Healthsource ME COMMERCIAL M Claims Healthsource N. TX (CIGNA) COMMERCIAL M Claims Claims are edited under CIGNA's payer specific edits Payer ID Healthsource NC (CIGNA) COMMERCIAL M Claims Claims are edited under CIGNA's payer specific edits Payer ID Healthsource NH COMMERCIAL M Claims Healthsource OH COMMERCIAL M Claims 6119 Healthsource SC COMMERCIAL M Claims Healthsource Network Providers Only Pilot Healthsource SC COMMERCIAL M Encounters Healthsource TN (CIGNA) COMMERCIAL M Claims Claims are edited under CIGNA's payer specific edits Payer ID Healthspan COMMERCIAL M Claims HESUN Healthsun Health Plans COMMERCIAL M Claims Healthways WholeHealth Networks COMMERCIAL M Claims Call Healthy Palm Beaches COMMERCIAL M Claims Call Provider Services at for EDI Enrollment Healthy Texas COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 40 of 87

41 22251 Healthy York Network COMMERCIAL M Claims Call Jane Grove at Provider Relations for Healthy York Network (717) HealthyCT Inc - Brokers COMMERCIAL M EFT HealthyCT Inc COMMERCIAL M ERA HealthyCT Inc COMMERCIAL M EFT HealthyCT Inc COMMERCIAL M Claims Heartland Health Centers COMMERCIAL M Claims Heritage Consultants COMMERCIAL M Claims For faster payment please be sure to use only the 9-digit subscriber ID on all claims. TH011 Heritage Physician Network COMMERCIAL M Claims DESRT Heritage Provider Network COMMERCIAL M Claims REGAL Heritage Provider Network COMMERCIAL M Claims Hewitt Coleman COMMERCIAL M Highmark BCBSD Health Options Inc. COMMERCIAL M ERA Highmark BCBSD Health Options Inc. COMMERCIAL M Claims Highmark- Key Family COMMERCIAL M Claims 46 Hill Physicians Medical Group COMMERCIAL M Claims HPIPA Hispanic Physicians IPA COMMERCIAL M Claims Hollywood Presbyterian (Synermed) COMMERCIAL M Claims Hometown Health Plan Nevada COMMERCIAL M Claims Horizon NJ Health COMMERCIAL M Claims Medicaid managed care. For EDI support please [email protected] or call Horizon NJ Health COMMERCIAL M EFT Horizon NJ Health COMMERCIAL M ERA Medicaid managed care. For EDI support please [email protected] or call Horizon NJ Health COMMERCIAL M Hotel Employees & Restaurant Employees Health Trust COMMERCIAL M Claims Please enter Group Number (F19) when submitting claims Hotel Employees Restaurant Employees Health Trust (HERE) COMMERCIAL M ERA Hotel Employees Restaurant Employees Health Trust (HERE) COMMERCIAL M EFT Hudson Health Plan COMMERCIAL M Hudson Health Plan COMMERCIAL M EFT Hudson Health Plan COMMERCIAL M Claims NCH02 Humana Dermatology - New Century Health COMMERCIAL M Claims Humana Emphesys COMMERCIAL M Claims Humana Employers Health Insurance COMMERCIAL M Claims Humana Inc. COMMERCIAL M Claims Humana Inc. COMMERCIAL M ERA Humana Inc. Encounters COMMERCIAL M Encounters Humana Insurance Company Choice Care Network COMMERCIAL M Claims Registration forms located at Paper remits will cease upon enrollment. Payer enrollment TAT 2-3- weeks. Claims sent to payer id will NOT be paid. Payer ID is for ENCOUNTERS ONLY. Revised 02/18/2015 ICS Software, Ltd. Page 41 of 87

42 L0200 Humana PR COMMERCIAL M ERA If Issues with ERA- Please contact payer at Humana Veterans Healthcare Services COMMERCIAL M Claims VA ARCH claims should be submitted to this payer ID Humboldt-Del Norte Foundation for Medical Care COMMERCIAL M Claims I. E. Shaffer (West Trenton NJ) COMMERCIAL M I. E. Shaffer (West Trenton NJ) COMMERCIAL M Claims IAA COMMERCIAL M Claims IBG Administrators LLC COMMERCIAL M Claims IBM Business Transformation Outsourcing Insurance Services Corporate COMMERCIAL M Claims IHG Direct COMMERCIAL M Claims Valid for claims with the following mailing address: P.O. Box 2388 Stow OH ILCBH COMMERCIAL M Claims IMCare COMMERCIAL M Claims IMCare COMMERCIAL M ERA TH099 IMS Management Services COMMERCIAL M Claims IMX Easy COMMERCIAL M Claims INDECS Corporation COMMERCIAL M Claims INDECS Corporation COMMERCIAL M INDEPENDENT LIVING SYSTEMS COMMERCIAL M Claims INTEGRA Administrative Group COMMERCIAL M ERA 4604 IUOE LOCAL 4 HEALTH & WELFARE COMMERCIAL M IlliniCare COMMERCIAL M Claims Call Imperial County Physicians Medical Group COMMERCIAL M Claims Call Imperial County Physicians Medical Group COMMERCIAL M Encounters InHealth COMMERCIAL M ERA InTotal Health COMMERCIAL M Claims InTotal Health COMMERCIAL M ERA Independence Care System Inc COMMERCIAL M Claims MHM01 Independence Medical Group COMMERCIAL M Claims SX073 Independent Health COMMERCIAL M ERA SX073 Independent Health COMMERCIAL M EFT SX073 Independent Health COMMERCIAL M SX073 Independent Health COMMERCIAL M Claims Independent Physician Alliance COMMERCIAL M Claims Independent Mercy Chicago IL MG#155 COMMERCIAL M Claims SX171 Indian Health Services COMMERCIAL M Claims Echo is returning 835s for payer ID Providers will need to enroll with Emdeon To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche [email protected] To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche [email protected] Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Service dates prior to March 1st please submit to INTotal Health. Service dates after March 1st please use payer if to file your claims. Enrollment is required. Providers should contact BCBSNM Customer Service Department at Revised 02/18/2015 ICS Software, Ltd. Page 42 of 87

43 35600 Indiana Department of Health - Children's Health - Claims COMMERCIAL M Claims Please completed enrollment form located on the Provider Relations Page at Indiana Department of Health - Children's Health - Claims COMMERCIAL M ERA Please complete enrollment form located at Emdeon.com and the Provider Relations Page at Payer site: Indiana ProHealth Network COMMERCIAL M Claims Indiana Teamsters Health Benefits Fund (Indianapolis IN) COMMERCIAL M Claims Formerly known as Local 135 Health Benefits Fund (Indianapolis IN) Indiana University Health Plan COMMERCIAL M Claims Individual Health Insurance Companies COMMERCIAL M Claims Payer ID is for State Farm - Health line of business Inetico Inc. COMMERCIAL M Claims Infant Welfare Society of Chicago COMMERCIAL M Claims InforMed LLC COMMERCIAL M Claims Informed UHC COMMERCIAL M Claims Ingalls Provider Group COMMERCIAL M Claims IEHP1 Inland Empire Health Plan COMMERCIAL M Claims Inland Valleys IPA COMMERCIAL M Inland Valleys IPA COMMERCIAL M EFT Inland Valleys IPA COMMERCIAL M Claims Innovage COMMERCIAL M Claims Innovante Benefit Administrators COMMERCIAL M Innovante Benefit Administrators COMMERCIAL M Claims Innovation Health COMMERCIAL M Claims Innovative Health Strategies LLC COMMERCIAL M Claims Call Innovative Healthware Services Inc. COMMERCIAL M Claims Before submitting contact Jessica Picarde at (410) Call Innovative Healthware Services Inc. COMMERCIAL M Claims Call Jessica Picarde to obtain the payer id (410) Innovative Physician Associates LLC COMMERCIAL M Claims Innovative Physician Associates LLC. COMMERCIAL M Claims Insurance Administrators of America Inc. COMMERCIAL M Insurance Administrators of America Inc. COMMERCIAL M Claims Insurance Design Administrators COMMERCIAL M Insurance Design Administrators COMMERCIAL M Claims Insurance Management Services COMMERCIAL M ERA Insurance Management Services (Amarillo TX) COMMERCIAL M Claims Echo is returning 835s for payer ID Providers will need to enroll with Emdeon This Payer ID is only valid for claims with submission address of P.O. Box 15688; Amarillo TX Insurance Program Managers Group (IPMG) COMMERCIAL M EFT Formerly Known As (FKA) as Benefit Systems & Services and Total Brokers Benefits Insurance Program Managers Group (IPMG) COMMERCIAL M ERA Formerly Known As (FKA) as Benefit Systems & Services and Total Brokers Benefits TH012 Insurance Services of Lubbock COMMERCIAL M Claims Insurance Systems Inc COMMERCIAL M InsuranceTPA.com COMMERCIAL M Claims Insurers Administrative Corp. COMMERCIAL M Claims Please visit website prior to submitting claims: edihelp.iacusa.com Revised 02/18/2015 ICS Software, Ltd. Page 43 of 87

44 51020 Integra Administrative Group (Seaford DE) COMMERCIAL M Claims Payer ID valid only for claims with a billing submission address of 110 S. Shipley Street Seaford DE Integra Group COMMERCIAL M Claims Integra Group-CHA COMMERCIAL M Claims Integrated Care Network (ICN) by Emerald Health COMMERCIAL M Claims Integrated Medical Solutions LLC COMMERCIAL M Claims InterWest Health (Acceptius Gateway payer) COMMERCIAL M Claims Interactive Medical Systems COMMERCIAL M Claims Interactive Medical Systems COMMERCIAL M Interface EAP (IEAP) COMMERCIAL M Claims Intergroup Services Corporation COMMERCIAL M Claims International Brotherhood of Boilermakers COMMERCIAL M Claims International Brotherhood of Boilermakers Employee Health Care Plan(IBBEHC) COMMERCIAL M Claims TH105 International Medical Group COMMERCIAL M Claims J. F. Molloy and Associates Inc. COMMERCIAL M Claims JAS Inc COMMERCIAL M JAS Inc COMMERCIAL M TH033 JI Specialties COMMERCIAL M Claims 9822 JMH - SFCCN PHT (PSN CMSN) COMMERCIAL M Claims JOHN MORRELL COMPANY CO. - AHPBA COMMERCIAL M Claims Call JOHN MUIR TRAUMA PHYSICIANS COMMERCIAL M Claims Please contact John Muir Trauma Physicians at for Payer id information. Call JP Farley COMMERCIAL M JP Farley Corporation COMMERCIAL M JP Farley Corporation COMMERCIAL M Claims JW Terrill COMMERCIAL M John Alden Life Insurance Co. COMMERCIAL M John Alden Life Insurance Co. COMMERCIAL M EFT John Alden Life Insurance Co. COMMERCIAL M Claims John Alden Life Insurance Co. COMMERCIAL M ERA John Muir Mt. Diablo Health System COMMERCIAL M Claims Providers who have never submitted claims to John Muir are required to register Tax ID prior to initial claims submission. Please fax W-9 along with contact name and number to the attention of Patty Kan at (925) Allow 2 days for processing befo John Muir Physician Network COMMERCIAL M Claims Providers who have never submitted claims to John Muir are required to register Tax ID prior to initial claims submission. Please fax W-9 along with contact name and number to the attention of Patty Kan at (925) Allow 2 days for processing befo Johns Hopkins Healthcare (EHP/PP) COMMERCIAL M Revised 02/18/2015 ICS Software, Ltd. Page 44 of 87

45 52189 Johns Hopkins Healthcare (EHP/PP) COMMERCIAL M Claims New submitters should send in their Billing NPI and Rending/Servicing NPI Johns Hopkins Healthcare (EHP/PP) COMMERCIAL M EFT Johns Hopkins is allowing EFT pre-enrollment starting 8/1/14. Please confirm that your account is linked to JHHC Payer ID #s Johns Hopkins Health Care (EHP/PPMCO) and Johns Hopkins Health Care (USFHP) Johns Hopkins Healthcare (USFHP) COMMERCIAL M Claims New submitters should send in their Billing NPI and Rending/Servicing NPI Johns Hopkins Healthcare (USFHP) COMMERCIAL M EFT Johns Hopkins Healthcare (USFHP) COMMERCIAL M ERA Joplin Claims / Benefit Management Inc COMMERCIAL M Claims KPS01 KPS-Kitsap Physician Services COMMERCIAL M Claims KS - Cenpatico Kansas COMMERCIAL M Claims KS - Sunflower State Health COMMERCIAL M Claims KY - Cenpatico Kentucky COMMERCIAL M Claims Kaiser Foundation Health Plan of Colorado COMMERCIAL M Claims Kaiser Foundation Health Plan of Colorado COMMERCIAL M ERA Kaiser Foundation Health Plan of Northern CA Region COMMERCIAL M ERA Kaiser Foundation Health Plan of Northern CA Region COMMERCIAL M Claims Johns Hopkins is allowing EFT pre-enrollment starting 8/1/14. Please confirm that your account is linked to JHHC Payer ID #s Johns Hopkins Health Care (EHP/PPMCO) and Johns Hopkins Health Care (USFHP). Please call (510) for approval prior to submitting Northern California referral claims Kaiser Foundation Health Plan of Southern CA Region COMMERCIAL M Claims For more information please call (866) Payer Requires Provider Enrollment To Receive 835 Files. Contact: Kaiser Foundation Health Plan of Southern CA Region COMMERCIAL M ERA [email protected] Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. COMMERCIAL M Claims Providers enrolled for ERA will receive claim reporting at level Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. COMMERCIAL M ERA Kaiser Foundation of the Northwest COMMERCIAL M Claims Kaiser Health Plan Inc - Georgia Region COMMERCIAL M ERA Kaiser Permanente Health Plan of Hawaii COMMERCIAL M Claims Kaiser Permanente Health Plan of Hawaii COMMERCIAL M ERA Kaiser Permanente of Georgia COMMERCIAL M Claims Kaiser Permanente of Georgia COMMERCIAL M ERA Kaiser Self Funded COMMERCIAL M Claims Kanawha HealthCare Solutions Inc. COMMERCIAL M Claims Kanawha Insurance Co. COMMERCIAL M Claims Kanawha Insurance Co. COMMERCIAL M ERA Kane County IPA COMMERCIAL M Claims Call Kansas Building Trades Health & Welfare Trust Fund COMMERCIAL M This payer id can only be used to submit claims for Oregon and Washington Kaiser Permanente members. Providers must complete the ERA Provider Enrollment via Kaiser online portal at or call Please contact [email protected] for any production issues such as status of claim denials etc. Providers must complete the ERA Provider Enrollment via Kaiser online portal at or call Revised 02/18/2015 ICS Software, Ltd. Page 45 of 87

46 CX058 Kansas City Life COMMERCIAL M Katy Medical Claims COMMERCIAL M Claims TKFMC Kaweah Delta COMMERCIAL M Claims Keenan Associates (CA) COMMERCIAL M KELSE Kelseycare COMMERCIAL M Claims Kemper Benefits COMMERCIAL M Claims Kempton Company COMMERCIAL M Kempton Company COMMERCIAL M Claims Kempton Group Administrators COMMERCIAL M Claims Kentucky Health Administrators Inc. COMMERCIAL M Claims Kentucky Health Cooperative COMMERCIAL M Claims Kentucky Spirit Health Plan COMMERCIAL M Claims Kern County CDCR COMMERCIAL M Claims Kern Health Systems COMMERCIAL M Claims Key Benefit Administrators (Indianapolis IN) COMMERCIAL M ERA Key Benefit Administrators (Indianapolis IN) COMMERCIAL M Claims MUST VERIFY AL CLAIMS SHOULD GO TO PAYER IN INDIANAPOLIS IN Key Benefit Administrators (Indianapolis IN) COMMERCIAL M EFT Key Benefit Administrators (Indianapolis IN) COMMERCIAL M Key Gap COMMERCIAL M Claims Key Health Medical Solutions Inc COMMERCIAL M Claims IP082 Key Medical Group COMMERCIAL M Claims Key Select COMMERCIAL M Claims Keystone Connect (Amerihealth) COMMERCIAL M ERA Keystone Connect is effective 1/1/2015. Please note that this payer encourages early enrollment for EFT/ERA services. Please visit to early enroll Keystone Connect (Amerihealth) COMMERCIAL M Claims Keystone Connect (Amerihealth) COMMERCIAL M EFT Keystone First COMMERCIAL M ERA Keystone First COMMERCIAL M Keystone First COMMERCIAL M Claims Keystone First COMMERCIAL M EFT Keystone VIP Choice COMMERCIAL M Claims Keystone VIP Choice COMMERCIAL M EFT Keystone VIP Choice COMMERCIAL M Keystone VIP Choice COMMERCIAL M ERA Pennsylvania Healthy PA Private Coverage Option? For EDI Support please [email protected] or call Keystone Connect is effective 1/1/2015. Please note that this payer encourages early enrollment for EFT/ERA services. Please visit to early enroll. Medicaid managed care. For EDI support please [email protected] or call Medicaid managed care. For EDI support please [email protected] or call Keystone VIP Choice is effective 1/1/2013 Medicare Advantage Plan part of the AmeriHealth Caritas Family of Companies. Revised 02/18/2015 ICS Software, Ltd. Page 46 of 87

47 93063 Kipp & Company COMMERCIAL M Klais & Company COMMERCIAL M Claims 3414A Klais & Company (Repricing for HealthSpan Network Only) COMMERCIAL M Claims LACAR LA Care Health Plan COMMERCIAL M Claims LIFE Pittsburgh COMMERCIAL M Claims TH106 LIPA/Agate Resources COMMERCIAL M Claims La Rabida Childrens Hospital COMMERCIAL M Claims NMM02 LaSalle Medical Group COMMERCIAL M Claims Lake County Physicians Association COMMERCIAL M Claims LakeSide Medical Group COMMERCIAL M Claims Lakeside Comprehensive Healthcare COMMERCIAL M Claims LMG11 Lakeside Health Services COMMERCIAL M Claims Call Lancaster General Health Group - Preferred Health Care (IHS Payer) COMMERCIAL M Claims Land of Lincoln Health COMMERCIAL M ERA Land of Lincoln Health COMMERCIAL M Claims Land of Lincoln Health Ins. Co. COMMERCIAL M Claims Land of Lincoln Health Ins. Co. COMMERCIAL M LNDMK Landmark Healthcare Inc COMMERCIAL M ERA LNDMK Landmark Healthcare Inc COMMERCIAL M Claims Lawndale Christian Health Center COMMERCIAL M Claims Lawndale Christian Health Center COMMERCIAL M Claims Lawndale Christian Hlth Center COMMERCIAL M Claims Leon Medical Center Health Plan COMMERCIAL M Claims Liberty Health Advantage COMMERCIAL M Claims Liberty Union COMMERCIAL M Claims Life Assurance Company COMMERCIAL M Claims 33LGC Life Gift Cards COMMERCIAL M Claims TH120 Life Investors Insurance COMMERCIAL M Claims TH093 Life Investors of America - Long Term Care COMMERCIAL M Claims Life Re Insuracne Company COMMERCIAL M Life Trac COMMERCIAL M Claims LifePath Hospice Inc COMMERCIAL M Claims Contact Sherry Wolgemuth Vice President of Claims Operations for Preferred Health Care at (717) ext. 124 for approval and the Payer ID LifeWell COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon LifeWise Healthplan of Oregon COMMERCIAL M Claims Lifestyle Health Plans COMMERCIAL M Claims Institutional Claims should be submitted under Payer ID 2700u EBSRM Lifetime Benefit Solutions COMMERCIAL M Claims Lincoln Republic Insurance COMMERCIAL M EFT Medicare Supplement COB claims only accepted via electronic Medicare crossover Lincoln Republic Insurance COMMERCIAL M Claims Medicare Supplement COB claims only accepted via electronic Medicare crossover Revised 02/18/2015 ICS Software, Ltd. Page 47 of 87

48 42011 Lincoln Republic Insurance COMMERCIAL M Medicare Supplement COB claims only accepted via electronic Medicare crossover Lincoln Republic Insurance COMMERCIAL M ERA Medicare Supplement COB claims only accepted via electronic Medicare crossover LCB01 Line Construction Benefit Fund COMMERCIAL M Local 135 Health Benefits Fund (Indianapolis IN) COMMERCIAL M Claims Locals 302 & 612 of the Internation Union of Operating Engineers COMMERCIAL M EFT Locals 302 & 612 of the Internation Union of Operating Engineers COMMERCIAL M ERA CB752 Lockard & Williams COMMERCIAL M Claims Lockard & Williams Insurance Services Inc. COMMERCIAL M Loma Linda University Adventist Health Sciences Center Employee Health Plan COMMERCIAL M Claims Loma Linda University Adventist Health Sciences Centers COMMERCIAL M Claims Loma Linda University Behavioral Medicine Center Employee Health Plan COMMERCIAL M Claims Loma Linda University Employee Health Plan COMMERCIAL M Claims Loma Linda University Health Care Employee Health Plan COMMERCIAL M Claims Loma Linda University Health Care Managed Care Dept COMMERCIAL M Claims Loma Linda University Medical Center Employee Health Plan COMMERCIAL M Claims Loma Linda University Medical Center Residents Health Plan COMMERCIAL M Claims Loma Linda University Student Health Plan COMMERCIAL M Claims London Health Administrators COMMERCIAL M Louisiana Healthcare COMMERCIAL M ERA Louisiana Healthcare Connections COMMERCIAL M Claims Lovelace Sandia Health Plan COMMERCIAL M Claims Loyal American Life Ins Co-Medicare Supplement COMMERCIAL M Claims MANAGED HEALTH CARE ASSOCIATES COMMERCIAL M Claims MBA Benefit Administrators Inc (Salt Lake UT) COMMERCIAL M Claims MBA OF WYOMING INC COMMERCIAL M MBA OF WYOMING INC COMMERCIAL M Claims MBS COMMERCIAL M EFT MBS COMMERCIAL M ERA MBS COMMERCIAL M MBS COMMERCIAL M Claims Formerly Payer ID MCA ADMINISTRATORS COMMERCIAL M MCA ADMINISTRATORS COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 48 of 87

49 Call MCA Administrators Inc COMMERCIAL M Claims Please Call Keri Kudrav Provider (412) ext MD Wise- CMCS COMMERCIAL M EFT MDI Holdings (Formerly Medical Partners of America) COMMERCIAL M Claims MDWise Hoosier Alliance COMMERCIAL M ERA For EDI support please [email protected] or call MDWise Hoosier Alliance COMMERCIAL M Claims For EDI support please [email protected] or call MDWise Hoosier Alliance COMMERCIAL M MDWise Hoosier Alliance COMMERCIAL M EFT MDXHI MDX Hawaii COMMERCIAL M Claims MED PAY COMMERCIAL M Claims EM216 MED3000 COMMERCIAL M Claims EM350 MED3000 CMS EARLY STEPS COMMERCIAL M Claims EM350 MED3000 CMS EARLY STEPS COMMERCIAL M EFT EM350 MED3000 CMS EARLY STEPS COMMERCIAL M EM350 MED3000 CMS EARLY STEPS COMMERCIAL M ERA EM284 MED3000 CMS SAFETY NET COMMERCIAL M EM284 MED3000 CMS SAFETY NET COMMERCIAL M EFT EM284 MED3000 CMS SAFETY NET COMMERCIAL M Claims EM205 MED3000 CMS TITLE 21 COMMERCIAL M EM205 MED3000 CMS TITLE 21 COMMERCIAL M Claims EM205 MED3000 CMS TITLE 21 COMMERCIAL M EFT EM205 MED3000 CMS TITLE 21 COMMERCIAL M ERA EM521 MED3000 COVENTRY HEALTHY KIDS COMMERCIAL M Claims EM039 MED3000 PEDICARE TITLE 19 COMMERCIAL M Claims EM039 MED3000 PEDICARE TITLE 19 COMMERCIAL M EM039 MED3000 PEDICARE TITLE 19 COMMERCIAL M EFT EM522 MED3000 PEDICARE TITLE 21 COMMERCIAL M EFT EM522 MED3000 PEDICARE TITLE 21 COMMERCIAL M EM522 MED3000 PEDICARE TITLE 21 COMMERCIAL M ERA EM522 MED3000 PEDICARE TITLE 21 COMMERCIAL M Claims MAHC1 MEDICAL ASSOCIATES HEALTH PLAN COMMERCIAL M ERA MAHC1 MEDICAL ASSOCIATES HEALTH PLAN COMMERCIAL M Claims MAHC1 MEDICAL ASSOCIATES HEALTH PLAN COMMERCIAL M EFT MEDICAL DEVELOPMENT INTERNATIONAL COMMERCIAL M Claims Call MEMORIAL INTEGRATED HEALTHCARE COMMERCIAL M Claims PLEASE TRACY HARSWICK AT [email protected] FOR PAYER ID INFORMATION MFC & HealthPlus Peoria COMMERCIAL M Claims MHNET COMMERCIAL M EFT Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Revised 02/18/2015 ICS Software, Ltd. Page 49 of 87

50 74289 MHNET COMMERCIAL M ERA Paper RA will be turned off within 30 days of enrollment for ERA; PDFs are available through MHnet's provider portal MHNET COMMERCIAL M Claims MHP Systems COMMERCIAL M Claims MNDH1 MINNESOTA DEPARTMENT OF HEALTH COMMERCIAL M Claims MNDH1 MINNESOTA DEPARTMENT OF HEALTH COMMERCIAL M ERA Enrollment Required. Please Visit: MMA COMMERCIAL M Claims MO - Cenpatico Missouri COMMERCIAL M Claims MO - Missouri Home State Health Care COMMERCIAL M Claims MORRIS ASSOCIATES COMMERCIAL M ERA MORRIS ASSOCIATES COMMERCIAL M Claims MPE Services Inc. COMMERCIAL M Claims MPEEBT COMMERCIAL M Claims MS - Cenpatico Mississippi COMMERCIAL M Claims MSA Care Guard COMMERCIAL M Claims MSC (Medical Service Company) Group Inc COMMERCIAL M Claims MSC will require enrollment prior to taking claims please [email protected] to Enroll MVP Health Plan of NY COMMERCIAL M Claims SX089 MVP Health Rochester COMMERCIAL M Claims Formerly known as Preferred Care NY MacNeal Health Providers- CHS COMMERCIAL M Claims MacNeal Health Providers- CHS COMMERCIAL M ERA 1260 Magellan Health Services COMMERCIAL M Claims 1260 Magellan Health Services COMMERCIAL M ERA Magnacare COMMERCIAL M Claims Magnolia COMMERCIAL M Claims Mail Handlers COMMERCIAL M ERA Mail Handlers Benefit Plan COMMERCIAL M Claims Maine Community Health Options COMMERCIAL M Claims Maine Community Health Options COMMERCIAL M ERA Managed Care Services LLC COMMERCIAL M Claims Managed Care Systems COMMERCIAL M ERA Echo is returning 835s for payer ID MCS01. Providers will need to enroll with Emdeon MCS02 Managed Care Systems (Delano Regional Medical Group) COMMERCIAL M Claims MCS01 Managed Care Systems (Gemcare) COMMERCIAL M Claims Managed Health Network COMMERCIAL M ERA Managed Health Network COMMERCIAL M Claims Managed Health Services Indiana (Medicaid HMO) COMMERCIAL M Claims Managed Health Services Indiana (Medicaid HMO) COMMERCIAL M ERA Managed Health Services Wisconsin COMMERCIAL M Claims Managed Health Services Wisconsin COMMERCIAL M ERA Prior to submitting claims please call Provider Relations Dept at 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. Prior to submitting claims please call Provider Relations Dept at 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. Revised 02/18/2015 ICS Software, Ltd. Page 50 of 87

51 58379 ManagedCareSystems COMMERCIAL M ERA Manulife W. J. Sutton Company COMMERCIAL M Claims L0160 Mapfre (Canada Life) COMMERCIAL M Claims L0160 Mapfre (Canada Life) COMMERCIAL M ERA Mapfre Medicare Excel COMMERCIAL M Claims March Vision Care Inc. COMMERCIAL M Claims Marquette Life Insurance Company COMMERCIAL M Claims Marrick Medical Finance COMMERCIAL M Claims Martin's Point Health Care COMMERCIAL M ERA Martin's Point Health Care COMMERCIAL M Claims Maryland Medicaid COMMERCIAL M Claims Maryland Medicaid COMMERCIAL M ERA Maryland Physicians Care COMMERCIAL M Claims Maryland Physicians Care COMMERCIAL M ERA Maryland Physicians Care COMMERCIAL M Mashantucket Pequot Tribal Nation COMMERCIAL M Claims Echo is returning 835s for payer ID MCS01. Providers will need to enroll with Emdeon Payer will only do ERA if Provider participates in EFT Transactions. Please visit mapfrepr.com for more information or call Per payer dated 4/30/2014 Payer is no longer active- Per Anthony Cruz- Inmediata... Rendering provider id must contain 1D qualifier. Payer accepts zero dollar service line charges. Payer Registration not required. Autoenroll payer. ERA setup form not required. Providers must enroll using the Maryland Physicians Care ERA Enrollment form and this must be submitted to Maryland Physicians Care MasonryTrusts COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon TH111 Master Mates & Pilots Program COMMERCIAL M Claims Matrix - Health First Health Plan COMMERCIAL M Claims Max Specialty Benefits COMMERCIAL M Claims Mayo Clinic FL/GA COMMERCIAL M Claims Mayo Clinic Health Solutions COMMERCIAL M Claims Mayo Management Services Inc Mayo Clinic Health Solutions COMMERCIAL M ERA MHM02 McKinley Medical Group COMMERCIAL M Claims McLaren Health Plan COMMERCIAL M SX172 Mdwise Inc. (formerly IU Medical Group) COMMERCIAL M Claims MedAdmin Solutions COMMERCIAL M Claims MedAdmin Solutions COMMERCIAL M Claims MedBen (Newark OH) COMMERCIAL M Claims MedCom COMMERCIAL M MedCom COMMERCIAL M Claims MedCost Benefit Services COMMERCIAL M EFT MedCost Benefit Services COMMERCIAL M ERA MedCost Benefit Services COMMERCIAL M Revised 02/18/2015 ICS Software, Ltd. Page 51 of 87

52 56162 MedCost Inc. COMMERCIAL M Claims For questions on claim submission please contact Customer Service MedDirect COMMERCIAL M Claims MPMOA MedPOINT Management COMMERCIAL M Claims MedPartners Administrative Services COMMERCIAL M Claims Payer ID is only for claims with mailing address of: PO Box 2602 Fort Wayne IN MedPartners Administrative Services COMMERCIAL M EFT MedPartners Administrative Services COMMERCIAL M MedSolutions Inc COMMERCIAL M Claims MedSolutions Inc COMMERCIAL M ERA Medfocus COMMERCIAL M Claims MediGold COMMERCIAL M Claims MediGold COMMERCIAL M ERA Medica (UHC) COMMERCIAL M ERA Medica (UHC) COMMERCIAL M Claims Medica Health Care Plan (Florida) COMMERCIAL M Claims All requests for ERA must be authorized by the provider's office and not any third party affiliate. Providers call Provider Service to obtain the forms to be initiated and filled out by the provider's office. Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at Medica2 COMMERCIAL M Claims Medica2 payer is effective 1/1/2014. All claims prior to 1/1/14 will be rejected Medica2 COMMERCIAL M EFT Medica2 COMMERCIAL M ERA Medicaid Hawaii Waivers COMMERCIAL M Claims Call Medical Associates Health Plan COMMERCIAL M Medical Benefit Administrators Inc/dba MBA of MD Inc COMMERCIAL M Claims MBA01 Medical Benefits Administration COMMERCIAL M Claims Medical Benefits Administrators Inc. (Newark OH) COMMERCIAL M Claims Medical Benefits Companies (Newark OH) COMMERCIAL M Claims Medical Benefits Mutual (Newark OH) COMMERCIAL M Claims Medical Benefits Mutual Life Insrance Co. COMMERCIAL M Claims Medical Benefits Mutual Life Insurance Co. COMMERCIAL M ERA Medical Benefits Mutual Life Insurance Co. COMMERCIAL M Medical Benefits Mutual Life Insurance Co. COMMERCIAL M EFT L0170 Medical Card System ( MCS ) COMMERCIAL M ERA Call (Option 4) to Enroll for ERA L0170 Medical Card System ( MCS ) COMMERCIAL M Claims Medical Group of Swedish American COMMERCIAL M Claims Medical Mutual of Ohio COMMERCIAL M Claims Medical Mutual of Ohio COMMERCIAL M ERA This payers requires Electronic Registration Vendors should enroll and complete registration via Enrollment Wizard. Providers should complete setup form and Emdeon will facilitate electronic registration Medical Reimbursements of America COMMERCIAL M Claims Medical Services Initiative COMMERCIAL M Claims Medical Value Plan - Ohio (MVP) COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 52 of 87

53 L0210 Medicare y Mucho Mas ( MMM ) COMMERCIAL M Claims L0210 Medicare y Mucho Mas ( MMM ) COMMERCIAL M ERA If Issues with ERA Please call payer at Medico COMMERCIAL M ERA Medico COMMERCIAL M Medico COMMERCIAL M Claims Medicare Supplement COB claims only accepted via electronic Medicare crossover Medico COMMERCIAL M EFT Medico Insurance Co COMMERCIAL M STAR1 Mediview Inc. COMMERCIAL M Claims MedsaveUSA COMMERCIAL M f.k.a. Fringe Benefit Management and 21st Century Health and Benefits MedsaveUSA COMMERCIAL M Claims f.k.a. Fringe Benefit Management and 21st Century Health and Benefits Medsolutions Post accute Care COMMERCIAL M Claims 251MS Medstar Select/Medstar Medicare Choice COMMERCIAL M ERA 251MS Medstar Select/Medstar Medicare Choice COMMERCIAL M Claims Mega Life & Health Insurance Company - Insurance Center COMMERCIAL M Claims Payer ID valid only if the address on the Health ID Card matches the following: P.O. Box North Richland Hills TX Memorial Clinical Associates/ SelectCare of Texas (MCA) COMMERCIAL M Claims TH092 Memorial Herman Health Network Providers COMMERCIAL M Claims Memorial Integrated Healthcare/South Florida Community Care Network COMMERCIAL M Claims Mercy Benefit Administration COMMERCIAL M ERA Mercy Benefit Administration COMMERCIAL M Claims Mercy Care Plan (AHCCCS) COMMERCIAL M Claims Mercy Care Plan (AHCCCS) COMMERCIAL M ERA ERA setup form not required. Providers must enroll using the Mercy Care ERA Enrollment form and this must be submitted to [email protected] Mercy Care Plan (AHCCCS) COMMERCIAL M EFT Enroll with payer Mercy Care Plan (AHCCCS) COMMERCIAL M Mercy Diagnostic and Treatment Center COMMERCIAL M Claims Mercy Health Plans COMMERCIAL M Claims Call Mercy Health Plans COMMERCIAL M Mercy Maricopa Integrated Care COMMERCIAL M Claims Mercy Maricopa Integrated Care COMMERCIAL M EFT Enroll with payer Mercy Maricopa Integrated Care COMMERCIAL M Mercy Maricopa Integrated Care COMMERCIAL M ERA Providers must enroll using the Mercy Maricopa ERA Enrollment form and this must be submitted to [email protected] MercyCare COMMERCIAL M Claims Please call for payer id Meridian Health Plan COMMERCIAL M Claims Meridian Health Plan COMMERCIAL M ERA Meritain COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 53 of 87

54 58379 Meritain - SHARP COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Meritain Health COMMERCIAL M Meritain Health COMMERCIAL M Claims Meritain Health / Agency Services COMMERCIAL M Claims Formerly know as Agency Services Inc Meritain Health Minneapolis COMMERCIAL M Claims Meritus Health Partners COMMERCIAL M Claims MetroPlus Health Plan COMMERCIAL M ERA Please make sure all NPIs are listed on the MetroPlus Registration form as well as the Emdeon ERA PSF when enrolling with Metroplus MetroPlus Health Plan COMMERCIAL M Claims Metropolitan Health Plan COMMERCIAL M Claims Metropolitan Health Plan COMMERCIAL M ERA TH068 Metrowest HealthPlan COMMERCIAL M Claims TH069 Metrowest Star Medicaid COMMERCIAL M Claims Michael Reese Physicians Group COMMERCIAL M Claims Michigan Education Special COMMERCIAL M ERA Michigan Education Special COMMERCIAL M EFT Michigan Education Special COMMERCIAL M Michigan Employee Benefit COMMERCIAL M Mid-America Associates Inc. COMMERCIAL M Claims Call Mid-American Benefits COMMERCIAL M Claims Mid-American Benefits Inc. COMMERCIAL M ERA Mid-West National Life Insurance Co. of Tennessee Insurance Center COMMERCIAL M Claims Mid-West National Life Insurance Co. of Tennessee Insurance Center COMMERCIAL M EFT Mid-West National Life Insurance Co. of Tennessee Insurance Center COMMERCIAL M Mid-West National Life Insurance Co. of Tennessee Insurance Center COMMERCIAL M ERA MidCoast IPA COMMERCIAL M Claims Midlands Choice Inc. COMMERCIAL M Claims Midwest Group Administrators COMMERCIAL M Midwest Health Partners COMMERCIAL M Claims Registration and submission of the Billing Provider's NPI is required. If you have not registered please contact MHP Customer Service at (800) Claims will reject if the NPI is not registered and/or submitted on claims sent electronically. Providers must first contact provider services at for credential/contracting. Then complete the ERA PSF Form. Please call Jessica Picarde Manager of Claims Operations (410) for Payer ID information. Echo is returning 835s for payer ID MAM01. Providers will need to enroll with Emdeon Payer ID valid only if the address on the Health ID Card matches the following: P.O. Box North Richland Hills TX Revised 02/18/2015 ICS Software, Ltd. Page 54 of 87

55 TH074 Midwest Health Plans Inc. COMMERCIAL M Claims Accepts NPI only. Require the billing NPI to be the group NPI if using a Business Tax id. Service provider NPI required in servicing provider loop. No longer require 6 digit provider identifier. Provider must complete enrollment form on payers website Mile Square FQHC COMMERCIAL M Claims MPMG1 Mills Peninsula Medical Group COMMERCIAL M Claims Mills Peninsula Medical Group(SPS) COMMERCIAL M Claims STJOE Mission (St. Joseph Heritage Healthcare) COMMERCIAL M Claims MPMOA Mission Community IPA Med Grp COMMERCIAL M Claims Mississippi Health Partners COMMERCIAL M Claims Mississippi Physicians Care Network COMMERCIAL M Claims Mississippi Public Entity Employee Benefit Trust COMMERCIAL M Claims Mississippi Select Health Care COMMERCIAL M Claims Also doing business as Select Administrative Services (SAS) Missoula County Medical Benefits Plan COMMERCIAL M Claims ABRI1 Molina Health Care of WI COMMERCIAL M Claims Molina Healthcare South Carolina COMMERCIAL M Claims SX109 Molina Healthcare Utah (aka American Family Care) COMMERCIAL M Claims Molina Healthcare of CALIFORNIA COMMERCIAL M Claims Molina Healthcare of Florida COMMERCIAL M Claims Molina Healthcare of MICHIGAN COMMERCIAL M Claims 9824 Molina Healthcare of New Mexico - Salud COMMERCIAL M Claims 4423 Molina Healthcare of New Mexico -SCI COMMERCIAL M Claims Molina Healthcare of Ohio COMMERCIAL M Claims Molina Healthcare of Texas COMMERCIAL M Claims Molina Healthcare of WASHINGTON COMMERCIAL M Claims Molina Illinois COMMERCIAL M Claims Monarch COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon IP095 Monarch IPA COMMERCIAL M Claims Monitor Life Insurance Company COMMERCIAL M Claims Monitor Life Insurance Company COMMERCIAL M ERA Montefiore Contract Management Organization COMMERCIAL M ERA Montefiore Contract Management Organization COMMERCIAL M Claims Montifiore HMO COMMERCIAL M Claims Montifiore HMO COMMERCIAL M ERA TH094 Monumental Life Insurance Company COMMERCIAL M Claims TLINS Monumental Life Insurance Company COMMERCIAL M Claims PO Box 8043 Little Rock AR TRCLF Monumental Life Insurance Company COMMERCIAL M Claims 4333 Edgewood Road NE Cedar Rapids IA TRLTC Monumental Life Insurance Company COMMERCIAL M Claims PO Box Hurst TX TRLTC Monumental Life Insurance Company COMMERCIAL M Claims PO Box Plano TX TRP1E Monumental Life Insurance Company COMMERCIAL M Claims PO Box Baltimore MD TRP1E Monumental Life Insurance Company COMMERCIAL M Claims Claim Services Division Valley Forge PA TRP1E Monumental Life Insurance Company COMMERCIAL M Claims 100 Light Street Baltimore MD TRP1E Monumental Life Insurance Company COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA TRP1E Monumental Life Insurance Company COMMERCIAL M EFT TRP1E Monumental Life Insurance Company COMMERCIAL M Claims PO Box 97 Scranton PA TRP1P Monumental Life Insurance Company COMMERCIAL M Claims 2700 West Plano Parkway Plano TX IP083 Mosaic IPA Medical Group COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 55 of 87

56 99282 Motion Pictures Industry COMMERCIAL M Claims Mountain States Administrative Services (Tucson AZ) COMMERCIAL M Claims Mt. Carmel Health COMMERCIAL M Claims Mt. Carmel Health COMMERCIAL M ERA Multicultural Primary Care Medical Group (San Diego) (Synermed) COMMERCIAL M Multicultural Primary Care Medical Group (San Diego) (Synermed) COMMERCIAL M EFT Multicultural Primary Care Medical Group (San Diego) (Synermed) COMMERCIAL M Claims Multiplan Wisconsin Preferred Provider Network COMMERCIAL M Claims All requests for ERA must be authorized by the provider's office and not any third party affiliate. Providers call Provider Service to obtain the forms to be initiated and filled out by the provider's office Municipal Health Benefit Fund COMMERCIAL M ERA Pre-Enrollment is being taken. Expected Live Date is November 15th Municipal Health Benefit Fund COMMERCIAL M Claims Municipal Health Benefit Fund COMMERCIAL M EFT Pre-Enrollment is being taken. Expected Live Date is November 15th Mutual Assurance Administrators COMMERCIAL M Claims Mutual Group (The) (US) COMMERCIAL M Claims Mutual Health Services COMMERCIAL M Claims Payer formely known as: Antares Management Solutions Mutual Health Services COMMERCIAL M ERA This payers requires Electronic Registration Vendors should enroll and complete registration via Enrollment Wizard. Providers should complete setup form and Emdeon will facilitate electronic registration Mutual Health Services COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Mutual of Omaha Insurance Company COMMERCIAL M Claims Mutual of Omaha Insurance Company COMMERCIAL M ERA Mutually Preferred COMMERCIAL M Claims N.W. Ironworkers Health & Security Trust Fund COMMERCIAL M Claims Please enter Group Number (F15) when submitting claims N.W. Roofers & Employers Health & Security Trust Fund COMMERCIAL M Claims Please enter Group Number (F26) when submitting claims N.W. Textile Processors COMMERCIAL M Claims Please enter Group Number (F14) when submitting claims NAA (North America Administrators L.P.) (Nashville TN) COMMERCIAL M Claims NAA (North America Administrators L.P.) (Nashville TN) COMMERCIAL M NABN (Cleveland OH) COMMERCIAL M Claims NALC/Affordable COMMERCIAL M Claims L0110 NAMCI/Global Care COMMERCIAL M Claims NAMM CALIFORNIA (NORTH AMERICAN MED) COMMERCIAL M ERA Call NAMM CALIFORNIA (NORTH AMERICAN MED) COMMERCIAL M Claims NAPHCARE INC. COMMERCIAL M ERA NAPHCARE INC. COMMERCIAL M Claims Now known as Meritain Health. Payer ID valid only for claims with billing submission address of P.O. Box Cleveland OH or P.O. Box Cleveland OH Revised 02/18/2015 ICS Software, Ltd. Page 56 of 87

57 38225 NGS American Inc COMMERCIAL M NGS American Inc COMMERCIAL M ERA NGS American Inc COMMERCIAL M Claims NHBCAUX COMMERCIAL M NHBCAUX COMMERCIAL M Claims NHP/SHP (Neighborhood Health Providers and Suffolk Health Plan) COMMERCIAL M Claims NJ Carpenters Health Fund COMMERCIAL M Claims NORTH AMERICAN INSURANCE COMPANY d/b/a Oxford Life COMMERCIAL M EFT NPS COMMERCIAL M Claims NW Plumbers & Pipefitters Health & Welfare Trust COMMERCIAL M EFT NW Plumbers & Pipefitters Health & Welfare Trust COMMERCIAL M ERA TH088 Naperville Healthcare COMMERCIAL M Claims CB148 National Allied Workers Union Local 831 COMMERCIAL M Claims National Association of Letter Carriers COMMERCIAL M Claims National Association of Letter Carriers/NALC COMMERCIAL M Claims National Benefit Administrators - New Jersey COMMERCIAL M Claims National Benefit Administrators - North Carolina COMMERCIAL M Claims National Capital Preferred Provider Organization (NCPPO) COMMERCIAL M Claims Customer Service phone number: ( ) National Health Insurance Company COMMERCIAL M SX190 National Imaging Associates COMMERCIAL M Claims SX190 National Imaging Associates COMMERCIAL M ERA National Rural Electric Coop (NRECA) COMMERCIAL M Claims National Telecommunications Cooperative Association COMMERCIAL M ERA National Telecommunications Cooperative Association COMMERCIAL M Claims National Telecommunications Cooperative Association (NTCA - Staff) COMMERCIAL M Claims National Telecommunications Cooperative Association (NTCA) COMMERCIAL M Claims Nationwide Health Plans COMMERCIAL M ERA Nationwide Health Plans COMMERCIAL M Claims Nationwide Life Insurance Co. COMMERCIAL M ERA Native Care Health COMMERCIAL M Claims Native Care Health LLC COMMERCIAL M ERA Near North Health Service Corporation COMMERCIAL M Claims Neighborhood Doctors Organization COMMERCIAL M Claims Neighborhood Health Partnership (NHP) COMMERCIAL M Claims 4293 Neighborhood Health Plan (Boston MA) COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 57 of 87

58 4293 Neighborhood Health Plan (Boston MA) COMMERCIAL M Claims Neighborhood Health Plan RI - Exchange Unity Integrity COMMERCIAL M Claims 5047 Neighborhood Health Plan of Rhode Island (NHPRI) COMMERCIAL M Claims Nesika Health Group COMMERCIAL M Claims Netcare Life and Health Insurance (Hagatna Guam) COMMERCIAL M Claims Please call NHPRI at to obtain or confirm your provider and vendor number prior to your initial claims submission Network Health COMMERCIAL M Claims Before initiating submissions please go to and go to the Providers Tab then forms then Claims Forms and then EDI setup forms or Network Health at [email protected] for an EDI setup form Network Health COMMERCIAL M ERA For missing 835 files please send inquires to [email protected] 4332 Network Health COMMERCIAL M EFT Network Health Insurance Corp-Medicare COMMERCIAL M Claims Network Health Insurance Corp-Medicare COMMERCIAL M ERA Network Health Plan COMMERCIAL M ERA Network Health Plan COMMERCIAL M Claims Payer id now valid for hospital and medical claims that have a submission address of PO Box 568 Menasha WI Payer id has been merged to this payer id Network Health Plan COMMERCIAL M EFT Network Health Plan COMMERCIAL M NMM01 Network Medical Management COMMERCIAL M Claims Network TPA LLC COMMERCIAL M Claims Nevada Health Coop COMMERCIAL M Claims New Avenues Inc. COMMERCIAL M Claims NCH11 New Century Health - IEHP Oncology COMMERCIAL M Claims NCH09 New Century Health - Vista Cardiology COMMERCIAL M Claims New Era Employee Welfare Benefit Plan Trust COMMERCIAL M Claims New Era Life Insurance Company COMMERCIAL M Claims New Market Dimensions COMMERCIAL M Claims New Mexico Health Connections COMMERCIAL M ERA New Mexico Health Connections COMMERCIAL M Claims SX164 New West Health Services COMMERCIAL M Claims TH122 New York Life COMMERCIAL M Claims New York Network Management COMMERCIAL M Claims Nippon Life Benefits COMMERCIAL M ERA Nippon Life Insurance Company of America COMMERCIAL M Claims Nippon Life Insurance Company of America COMMERCIAL M ERA Nippon Life Insurance Company of America COMMERCIAL M PDT01 Noble AMA Select IPA COMMERCIAL M Claims North American Benefits Network (Cleveland OH) COMMERCIAL M Claims Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Now known as Meritain Health. Payer ID valid only for claims with billing submission address of P.O. Box Cleveland OH or P.O. Box Cleveland OH Revised 02/18/2015 ICS Software, Ltd. Page 58 of 87

59 E3510 North American Medical Management (NAMM) - Northern California COMMERCIAL M Claims Please contact the EDI Dept for North American Medical Management (NAMM) - Northern California Lead/Supervisor at prior to initial submission of claims. E3510 North American Medical Management (NAMM) - Southern California COMMERCIAL M Claims North Broward Hospital District COMMERCIAL M Claims Call North County Health Services COMMERCIAL M Encounters To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche [email protected] Call North County Health Services COMMERCIAL M Claims To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche [email protected] North County Select COMMERCIAL M Claims North Shore - LIJ (Healthfirst) COMMERCIAL M Claims North Shore - LIJ (Healthfirst) COMMERCIAL M ERA North Shore - LIJ CareConnect Insurance Company Inc. COMMERCIAL M Claims North Suburban Associated Physicians COMMERCIAL M Claims North Texas Healthcare Network COMMERCIAL M Claims PROSP North West Orange County Medical Group COMMERCIAL M Claims NorthShore Physician Associates COMMERCIAL M ERA NorthShore Physician Associates COMMERCIAL M Claims NorthShore University Health System Medical Group COMMERCIAL M Claims NSA01 NorthStar Advantage COMMERCIAL M Claims Northern California Sheet Metal Workers Health Care Plan COMMERCIAL M Claims Northern Illinois Health Plan COMMERCIAL M Claims Northern Nevada Trust Fund COMMERCIAL M Claims NMG01 Northridge Medical Group COMMERCIAL M Claims Northstar Advantage COMMERCIAL M Claims Northwest Administrators Inc. COMMERCIAL M ERA Northwest Administrators Inc. COMMERCIAL M Northwest Administrators Inc. COMMERCIAL M EFT Payer ID valid for claims with a submission address of PO Box 1138 San Ramon CA Please call (775) to verfiy if you should be sending claims to Northern Nevada Trust Fund Northwest Diagnostic Clinic/SelectCare of Texas (NWDC) COMMERCIAL M Claims Northwest Ironworkers Health & Security Fund COMMERCIAL M EFT Northwest Ironworkers Health & Security Fund COMMERCIAL M ERA NPN11 Northwest Physicians Network COMMERCIAL M Claims Northwest Roofers & Employers Health & Security Trust Fund COMMERCIAL M ERA Northwest Roofers & Employers Health & Security Trust Fund COMMERCIAL M EFT Northwest Suburban IPA (Illinois) COMMERCIAL M Claims Northwest Textile Processors and Service Trades COMMERCIAL M EFT Northwest Textile Processors and Service Trades COMMERCIAL M ERA Call Novanet COMMERCIAL M Claims Please contact the payer directly for payer id (770) Ext Novasys Health Network COMMERCIAL M Claims Novasys Health Network COMMERCIAL M Revised 02/18/2015 ICS Software, Ltd. Page 59 of 87

60 PROSP Nuestra Familia Medical Group (Prospect Medical Group) COMMERCIAL M Claims Nyhart COMMERCIAL M Claims OAK WEST PRIMARY PHYSICIAN ASSOCIATION COMMERCIAL M Claims ODS Health Plan COMMERCIAL M Claims OMNI/Medicore HP COMMERCIAL M Claims OSEEGIB (Oklahoma State and Education Employees Group Ins. Board) COMMERCIAL M Claims OSEEGIB (Oklahoma State and Education Employees Group Ins. Board) COMMERCIAL M ERA OSF Health Plans COMMERCIAL M Claims OSF Healthcare North COMMERCIAL M Claims OSMA Health - C. L. Frates COMMERCIAL M Claims Oak West Primary Physician Association COMMERCIAL M Claims DESRT Oasis IPA COMMERCIAL M Claims L0140 Ocular Benefits COMMERCIAL M Claims R0755 Ohio Benefit Administrators COMMERCIAL M EFT R0755 Ohio Benefit Administrators COMMERCIAL M Ohio Health Choice PPO COMMERCIAL M Claims Payer ID valid only for claims with a billing submission address of PO Box 3619 Akron OH or PO Box Ohio PPO Connect COMMERCIAL M Claims Olympus Managed Health Care COMMERCIAL M Olympus Managed Health Care COMMERCIAL M Claims OneCare COMMERCIAL M Claims OneNet PPO (formerly Alliance PPO / MAPSI) COMMERCIAL M Claims Operating Engineers Locals 302 & 612 Health & Security Fund COMMERCIAL M Claims Please enter Group Number (F12) when submitting claims OptiCare Managed Vision COMMERCIAL M Claims Optima Health Plan COMMERCIAL M Claims Optima Insurance Company COMMERCIAL M Claims Optimum Choice of the Carolinas Inc. (OCCI) COMMERCIAL M Claims Optimum Healthcare Inc. COMMERCIAL M Claims OptumHealth COMMERCIAL M Claims Note: Rendering Provider Network ID (E6-14) field is reqd. Field must be 5-7 chars positions 1-5 must be numeric only and positions 6&7 (if applicable) must be alpha only. Please contact Ydsia Slagle-Provider Relations at (757) Note: Rendering Provider Network ID (E6-14) field is reqd. Field must be 5-7 chars positions 1-5 must be numeric only and positions 6&7 (if applicable) must be alpha only. Please contact Ydsia Slagle-Provider Relations at (757) OptumHealth / OptumHealth Behavioral Solutions of NM COMMERCIAL M Claims OptumHealth Behavioral Solutions (formerly Pacificare Behavioral Health) COMMERCIAL M Claims Use Payer ID OptumHealth Behavioral Solutions (formerly United Behavioral Health) COMMERCIAL M Claims Former Payer ID OptumHealth Care Solutions (formerly United Resource Networks) COMMERCIAL M Encounters Former Payer ID Revised 02/18/2015 ICS Software, Ltd. Page 60 of 87

61 41194 OptumHealth Care Solutions (formerly United Resource Networks) COMMERCIAL M Claims Former Payer ID OptumHealth Care Solutions (formerly United Resources Networks COMMERCIAL M Claims User Payer ID OptumHealth Physical Health - includes Oxford (formerly ACN & ACNIPA) COMMERCIAL M Claims Use Payer ID OptumHealth Physical Health - includes Oxford (formerly ACN & ACNIPA) COMMERCIAL M Claims Former Payer IDs Orange County Health Care Agency COMMERCIAL M Claims Oregon's Health CO-OP COMMERCIAL M Claims Payer ID is to be used for claims with dates of service prior to Oregon's Health CO-OP COMMERCIAL M Claims Payer ID is to be used for claims with dates of service and greater Oregon's Health CO-OP COMMERCIAL M ERA Orthonet - Uniformed Services Family Health Plan COMMERCIAL M Claims Orthonet Corporation - CIGNA COMMERCIAL M Claims Orthonet- Aetna COMMERCIAL M Claims Orthonet-HealthNet COMMERCIAL M Claims Outsource One Inc COMMERCIAL M Ownership Rewards COMMERCIAL M ERA PAI COMMERCIAL M Claims PCC Community Wellness Center Family Health Network patients only COMMERCIAL M Claims PEF Clinic II LTD. COMMERCIAL M Claims Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Call PEHP - Utah Public Employee Health Plan COMMERCIAL M ERA Call EDI at or [email protected] to obtain the payer id. Call PEHP - Utah Public Employee Health Plan COMMERCIAL M Claims Call EDI at or [email protected] to obtain the payer id PHCS Claims (formerly American LIFECARE) COMMERCIAL M Claims Please enter the Group Number from ID card when submitting claims. Payer ID only valid for claims with a billing submission address of PO Box 5007 DePere WI (1100 Poydras Street Suite 2600 New Orleans LA is no longer an active claims submission address as of 1/1/11) PHCS Savility Payers COMMERCIAL M Claims PHPCarolinas COMMERCIAL M ERA PHYSICIAN'S ACCOUNTABLE CARE ORG COMMERCIAL M Claims PCN12 PHYSICIANS CARE NETWORK LLC/Polyclinic Seattle COMMERCIAL M Claims PODIATRY NETWORK FL COMMERCIAL M Claims POMCO COMMERCIAL M Claims POMCO COMMERCIAL M ERA POMCO COMMERCIAL M PPOM LLC COMMERCIAL M Claims UHNDC PPOONE COMMERCIAL M Claims PPOPlus LLC COMMERCIAL M Claims Echo is returning 835s for payer ID CB404. Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 61 of 87

62 58379 PSATS COMMERCIAL M ERA PSKW0 PSKW COMMERCIAL M Claims Pacific Alliance Medical Center COMMERCIAL M Claims Pacific Alliance Medical Group and Hospital (Synermed) COMMERCIAL M Claims PCFCI Pacific IPA COMMERCIAL M Claims PacificSource Health Plans COMMERCIAL M Claims PacificSource Health Plans COMMERCIAL M ERA L0180 Palic ( Panamerican Life Insurance Company of Puerto Rico ) COMMERCIAL M Claims 4218 Pan American Life Insurance Group COMMERCIAL M Claims SX158 Paramount COMMERCIAL M Claims SX158 Paramount COMMERCIAL M SX158 Paramount COMMERCIAL M EFT Call Park Terrace/Encompass Medical Group COMMERCIAL M Claims Call Park Terrace/Encompass Medical Group COMMERCIAL M Encounters Parkland Community Health Plan COMMERCIAL M Parkland Community Health Plan COMMERCIAL M ERA Parkland Community Health Plan COMMERCIAL M Claims Partners Behavioral Health Management COMMERCIAL M Claims Partners In Health Chicago IL MG#468 COMMERCIAL M Claims Passport Health Plan COMMERCIAL M Passport Health Plan COMMERCIAL M EFT Passport Health Plan COMMERCIAL M Claims Passport Health Plan COMMERCIAL M ERA Patient Advocates LLC COMMERCIAL M Claims CB733 Patient Services Inc COMMERCIAL M Claims Payer Fusion COMMERCIAL M Claims Peach State Health Plan COMMERCIAL M Claims Pediatric Associates COMMERCIAL M Pediatric Health Associates COMMERCIAL M Claims PROSP Pegasus Medical Group COMMERCIAL M Claims Pekin Life Insurance Company COMMERCIAL M Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Provider must contact Payer Client Services to request claims setup at (787) Claims will reject if provider is not enrolled. To obtain Payer ID and enroll with payer please contact Tristin Rausche [email protected] To obtain Payer ID and enroll with payer please contact Tristin Rausche [email protected] ERA setup form not required. Providers must enroll using the Parkland/Texas ERA Enrollment form Provider must have Trading Partner Agreement onfile with Partners BHM. t%20cover%20letter.pdf Medicaid managed care. For EDI support please [email protected] or call Medicaid managed care. For EDI support please [email protected] or call Prior to submitting claims please call Provider Relations Dept at 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. Revised 02/18/2015 ICS Software, Ltd. Page 62 of 87

63 53226 Penn Behavioral Health COMMERCIAL M Claims Penn Mutual COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Pennsylvania Pace COMMERCIAL M Claims Call Pennsylvania's Preferred Health Network COMMERCIAL M Claims Call Jessica Picarde Manager of PPHN Claims Operations(410) Peoples Health Network COMMERCIAL M ERA Peoples Health Network COMMERCIAL M Claims PerformCare-Select Health MH/SA COMMERCIAL M Claims For Behavioral Health EDI support please [email protected] Personal Insurance Administrators Inc. (Agoura Hills CA) COMMERCIAL M Claims Phoenix Choice COMMERCIAL M Claims 3440 Phoenix Health Plan (Medicaid) COMMERCIAL M Claims 3443 Phoenix Health Plans (Medicare - Abrazo) COMMERCIAL M Claims Physicans of Southwest Washington COMMERCIAL M Claims Physicans of Southwest Washington COMMERCIAL M EFT Physicans of Southwest Washington COMMERCIAL M ERA Physician Associates of Louisiana COMMERCIAL M Claims Call Physician Associates of the Greater San Gabriel Valley COMMERCIAL M Claims Please call David McGee or Art Tarin to obtain the Payer Id PA513 Physician Associates of the Greater San Gabriel Valley COMMERCIAL M Claims Physician Care Network LLC COMMERCIAL M Claims Physician Care Partners Inc COMMERCIAL M Claims Physician Health Cooperative/SRRIPA COMMERCIAL M Claims This Payer ID should be used for Stones River Regional IPA- Humana claims PHPMD Physician Health Partners COMMERCIAL M Claims Physician Partners of Dupage COMMERCIAL M Claims PDT01 Physician's Data Trust COMMERCIAL M Claims Physicians Care (ASR Corporation) COMMERCIAL M Claims Note: This is Physicians Care Network located in Michigan Physicians Care Health Plans (ASR Corporation) COMMERCIAL M Claims Note: This is Physicians Care Network located in Michigan Physicians Care Network (ASR Corporation) COMMERCIAL M Claims Note: This is Physicians Care Network located in Michigan Physicians Care Network (Rockford IL only) COMMERCIAL M Claims Physicians Care Partners COMMERCIAL M Claims Physicians Care of CA COMMERCIAL M Physicians Health Association of Illinois COMMERCIAL M Claims TH114 Physicians Health Choice - Encounters COMMERCIAL M Claims TH113 Physicians Health Claims - Claims COMMERCIAL M Claims Physicians Health Collaborative COMMERCIAL M Claims MHM03 Physicians Health Network COMMERCIAL M Claims 9173 Physicians Health Plan (PHP) - SC COMMERCIAL M Claims EXC01 Physicians Medical Group of San Jose COMMERCIAL M Claims Physicians Mutual Insurance Company COMMERCIAL M Physicians Mutual Insurance Company COMMERCIAL M EFT Physicians Mutual Insurance Company COMMERCIAL M ERA Physicians Mutual Insurance Company COMMERCIAL M Claims Please send all PPO and dental claims to the address on the back of the insured's ID Card Revised 02/18/2015 ICS Software, Ltd. Page 63 of 87

64 39156 Physicians Plus Insurance Corporation COMMERCIAL M Claims 251PD Piedmont WellStar Health Plan COMMERCIAL M Claims 251PD Piedmont WellStar Health Plan COMMERCIAL M ERA Pinnacle Claims Management Inc. COMMERCIAL M Claims PROSP Pinnacle Health Resources (Prospect Medical Group) COMMERCIAL M Claims Pinnacle Physician Management ORG COMMERCIAL M Claims Pinnacle TPA COMMERCIAL M Pinnacol Assurance COMMERCIAL M Claims PIONR Pioneer Medical Group COMMERCIAL M Claims Pittman & Associates COMMERCIAL M ERA Pittman & Associates COMMERCIAL M Claims Pittman & Associates COMMERCIAL M Pittman & Associates COMMERCIAL M ERA Pittsburgh Care Partnership Inc. COMMERCIAL M Claims Pittsburgh Care Partnership Inc. COMMERCIAL M ERA Pivotal Plan COMMERCIAL M Claims L0190 Plan de Salud Hospital Menonita COMMERCIAL M Claims Planned Administrators Inc. COMMERCIAL M Claims Planned Administrators Inc. COMMERCIAL M Podi Care Managed Care COMMERCIAL M Claims IP057 Pomona Valley Medical Group COMMERCIAL M Claims Prairie States Enterprises Inc. COMMERCIAL M Claims Preferred Community Choice/PCCSelect/CompMed COMMERCIAL M Claims Call Preferred Health Care - PPO Lancaster PA (IHS Gateway Payer) COMMERCIAL M Claims Call Preferred Health Choices LLC COMMERCIAL M Preferred Health Plan (Louisville KY) COMMERCIAL M Claims CB404 Preferred Health Plan of the Carolinas COMMERCIAL M Claims Preferred Health Professionals COMMERCIAL M Claims Preferred Health Systems Insurance Company COMMERCIAL M Claims Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Providers submitting claims as a Preferred Blue provider should not submit claims using payer ID Contact Sherry Wolgemuth Vice President of Claims Operations for Preferred Health Care at (717) ext. 124 for approval and the Payer ID Preferred Health Systems A Coventry Health Care Plan COMMERCIAL M ERA Preferred Health Systems A Coventry Health Care Plan COMMERCIAL M Claims PFIPA Preferred IPA COMMERCIAL M Claims L0250 Preferred Medicare COMMERCIAL M ERA If issues with ERA or questions please call payer directly at L0250 Preferred Medicare COMMERCIAL M Claims Preferred Network Access Inc. COMMERCIAL M Claims Preferred Plus of Kansas COMMERCIAL M Claims PreferredOne (MN) COMMERCIAL M Claims PreferredOne (MN) COMMERCIAL M ERA Revised 02/18/2015 ICS Software, Ltd. Page 64 of 87

65 43166 Premier Benefits Inc. COMMERCIAL M Claims Premier Eye Care COMMERCIAL M ERA Plan is effective 11/15/2013. Please note that this payer encourages early enrollment for EFT/ERA services. Please visit to early enroll Premier Eye Care COMMERCIAL M EFT Plan is effective 11/15/2013. Please note that this payer encourages early enrollment for EFT/ERA services. Please visit to early enroll Premier Eye Care COMMERCIAL M Claims 251PR Premier Health Plan COMMERCIAL M Claims 251PR Premier Health Plan COMMERCIAL M ERA Premier Health Plans COMMERCIAL M Claims Premier Health Systems Inc COMMERCIAL M Claims Premier Health Systems Inc. is part of the Medical Mutual Family of Companies. For claims with DOS prior to 4/1/09 use payer ID Claims with DOS 4/1/09 and after use their new payer ID Premier Health Systems Inc. COMMERCIAL M Claims Premier HealthCare Exchange COMMERCIAL M Claims Premier Healthcare Exchange Inc. (PHX) COMMERCIAL M Claims 5003 Presbyterian (NM) COMMERCIAL M Claims Presence Behavioral Health COMMERCIAL M Claims Presence Health Partners- FHN COMMERCIAL M Claims Prestige Health Choice COMMERCIAL M Claims Prestige Health Choice COMMERCIAL M Claims Prestige Health Choice COMMERCIAL M Prestige Health Choice COMMERCIAL M ERA Premier Health Systems Inc. is part of the Medical Mutual Family of Companies. Former payer ID Use Payer ID for claims with DOS 4/1/09 and after. For claims with DOS prior to 4/1/09 use former payer ID Payer effective 5/1/2014. Managed Medicaid Plan part of the AmeriHealth Caritas Family of Companies. For EDI support please [email protected] or call Payer effective 5/1/2014. Managed Medicaid Plan part of the AmeriHealth Caritas Family of Companies. For EDI support please [email protected] or call Prestige Health Choice COMMERCIAL M EFT Plan is effective May Payer is accepting early enrollment for ERA and EFT. IP079 Primary Care Associates Medical Group COMMERCIAL M Claims Primary Health Network COMMERCIAL M Claims Primary Health Network COMMERCIAL M Call PrimeSource Health Network (PSHN) - PPO Harrisburg PA (IHS Gateway Payer) COMMERCIAL M Claims Before submitting contact Jessica Picarde at (410) PrimeWest Health COMMERCIAL M ERA Prime West is a Medicare/Medicaid provider for counties in Minnesota ONLY PrimeWest Health COMMERCIAL M Claims Principal Financial Group COMMERCIAL M Claims Principal Financial Group COMMERCIAL M ERA Payer only accepts VISION and DENTAL claims Priority Health COMMERCIAL M ERA Priority Health COMMERCIAL M Claims Payer requests providers to contact them directly for 835 enrollment. Providers may call (800) x 8686 or [email protected] Revised 02/18/2015 ICS Software, Ltd. Page 65 of 87

66 37268 Prism Network Inc. COMMERCIAL M Claims Prism-Univera COMMERCIAL M Claims Pro Care Health Plan Inc. (Detroit MI) COMMERCIAL M Claims Payer ID valid for claims with the following submission addresses: PO Box 3160 Detroit MI AND PO Box 3590 Detroit MI PROSP ProCare (Prospect) COMMERCIAL M Claims IP057 ProMed HealthCare Administrators COMMERCIAL M Claims Professional Benefit Administrators Inc. (Oak Brook IL) COMMERCIAL M Claims Payer ID is valid only for claims with billing submission name city and state of Professional Benefit Administrators Inc. Oak Brook IL. Call Professional Benefit Services COMMERCIAL M Professional Benefits Services Inc. COMMERCIAL M Professional Benefits Services Inc. COMMERCIAL M EFT Professional Claims Management COMMERCIAL M ERA Professional Risk Management COMMERCIAL M Claims PROSP Prospect Health Network COMMERCIAL M Claims PROSP Prospect Medical Group COMMERCIAL M Claims Prospect Sherman Oaks Medical Group (Prospect Medical PROSP Group) COMMERCIAL M Claims Protective Life Insurance Company COMMERCIAL M Claims ProviDRs Care Network COMMERCIAL M Claims SX187 Providence PPO COMMERCIAL M Claims SX133 Providence of Oregon Health Plan COMMERCIAL M ERA SX133 Providence of Oregon Health Plan COMMERCIAL M Claims Provident American Life & Health Ins Co-Medicare Supplement COMMERCIAL M Claims Echo is returning 835s for payer ID PCM01. Providers will need to enroll with Emdeon For Claims Status please contact Susan or Debra Wallenstein at For Claims Status please contact Susan or Debra Wallenstein at Provident Life & Casualty COMMERCIAL M ERA Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Psychcare LLC COMMERCIAL M Claims Puget Sound Benefits Trust COMMERCIAL M ERA Puget Sound Benefits Trust COMMERCIAL M Claims Please enter Group Number (F25) when submitting claims Puget Sound Benefits Trust COMMERCIAL M EFT Puget Sound Electrical Workers Healthcare Trust (PSEW) COMMERCIAL M EFT Puget Sound Electrical Workers Healthcare Trust (PSEW) COMMERCIAL M ERA Puget Sound Electrical Workers Trust COMMERCIAL M Claims Please enter Group Number (F33) when submitting claims Pyramid Life Insurance Company COMMERCIAL M Claims QVI Risk Solutions Inc. COMMERCIAL M Claims Quad Med LLC (Pewaukee WI) COMMERCIAL M Claims Qual Choice of Arkansas COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 66 of 87

67 23342 QualCare Inc. COMMERCIAL M EFT Vendor ID is a nine digit number or a nine digit number with a three digit suffix. Vendor number can be found on your Explanation of Payment (EOP)". If your Vendor ID has a suffix please include the hyphen with no spaces (i.e ) QualCare Inc. COMMERCIAL M Claims QualCare Inc. COMMERCIAL M ERA QualCare Inc. COMMERCIAL M Quality Care Partners COMMERCIAL M Claims QuikTrip COMMERCIAL M Claims E-print address: QuikTrip P.O. Box 733 Buckeystown MD QuikTrip COMMERCIAL M ERA TKFMC R&N Market COMMERCIAL M Claims Call RADCON INC. COMMERCIAL M Claims Please contact Kathy (856) for Payer Id information RBMS LLC COMMERCIAL M Claims RBMS LLC COMMERCIAL M RGA COMMERCIAL M ERA RCMG1 RIVER CITY MEDICAL GROUP COMMERCIAL M Claims RMSCO INC. COMMERCIAL M RMSCO INC. COMMERCIAL M Claims Rady Children's Hospital COMMERCIAL M Claims Ravenswood Physician Assoc INC COMMERCIAL M Claims Reading Hospital Employer Group COMMERCIAL M Claims Redlands IPA (Synermed) COMMERCIAL M Claims REGAL Regal Medical Group COMMERCIAL M Claims Regency Employee Benefits COMMERCIAL M Claims Renaissance Physicians Organization COMMERCIAL M Claims Reserve National Insurance Company COMMERCIAL M Reserve National Insurance Company COMMERCIAL M ERA Echo is returning 835s for payer ID HMA01. Providers will need to enroll with Emdeon Reserve National Insurance Company COMMERCIAL M Claims For claims rejections please contact Reserve National Customer Service at (405) Reserve National Insurance Company COMMERCIAL M EFT RHA01 Resolve Health Plan Administrators LLC COMMERCIAL M Claims ResourceOne Administrators COMMERCIAL M Claims Resurrection Health Care Preferred/FKA Family Medical Network COMMERCIAL M Claims Please call (773) or( 773) prior to your first submission of claims Resurrection Health Preferred COMMERCIAL M Claims Retiree Health Trust COMMERCIAL M Claims Right Care from Scott & White COMMERCIAL M Claims Right Care from Scott & White COMMERCIAL M ERA RightChoice Benefit Administrators COMMERCIAL M Claims Risk Administration Management Inc. COMMERCIAL M Claims Riverside County Foundation For Medical Care COMMERCIAL M MPMOA Riverside Family Health Med Grp IPA COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 67 of 87

68 50664 Riverside San Bernaardino County Indian Health Inc COMMERCIAL M Call Riverside San Bernaardino County Indian Health Inc COMMERCIAL M Claims Rockford Health Physicians COMMERCIAL M Claims SX141 Rocky Mountain Health Plan - Grand Junction COMMERCIAL M Claims Royal Healthcare on Behalf of Extended Care MTC COMMERCIAL M Claims For Claims with Service Dates/Statement Dates prior to 12/1/2013 please submit claims to payer ID Claims submitted to that have service dates/statement dates prior to 12/1/2013 will be rejected by the payer Rural Carrier Benefit Plan COMMERCIAL M Claims Rush Health COMMERCIAL M Claims Rush Prudential Health Plans (HMO Only) COMMERCIAL M Claims AMM03 Ryan White Network COMMERCIAL M Claims S & S Healthcare Strategies COMMERCIAL M Claims SAMBA COMMERCIAL M ERA SANTA CLARA FAMILY HEALTH PLAN COMMERCIAL M Claims SCAN ENCOUNTERS COMMERCIAL M Claims Diversified Data Design (DDD) SCAN Health Plan COMMERCIAL M EFT SCAN Health Plan COMMERCIAL M Claims SCAN Long Term Care COMMERCIAL M Claims SCHC Total Care - ClaimsNet COMMERCIAL M Claims SENIOR WHOLE HEALTH COMMERCIAL M Claims SENIOR WHOLE HEALTH COMMERCIAL M Sacramento - Primary Care Practices of Sacramento - EHS COMMERCIAL M Providers must enroll with their SCAN Vendor ID. This is not the NPI. It is a 10 digit number with 4-5 leading zeroes and is listed in the top right corner of the mailed Advice. If you need assistance please contact SCAN at Sacramento - Primary Care Practices of Sacramento - EHS COMMERCIAL M EFT Sacramento - Primary Care Practices of Sacramento - EHS COMMERCIAL M Claims Sagamore Health Network COMMERCIAL M Claims Sage Technologies COMMERCIAL M Claims Saint Anthony PHO COMMERCIAL M Claims Saint Anthony Pho LLC COMMERCIAL M Claims Saint Mary's Health Plan COMMERCIAL M Claims Saint Mary's Health Plan (ENCOUNTERS) COMMERCIAL M Encounters CP001 Samaritan Health Plans COMMERCIAL M Claims MSO77 San Diego County Coverage Initiative (CI) COMMERCIAL M Claims MSO11 San Diego County Medical Services (CMS) COMMERCIAL M Claims MSO33 San Diego County Ryan White Care Act COMMERCIAL M Claims Call San Diego Physicians COMMERCIAL M Encounters Call San Diego Physicians COMMERCIAL M Claims under this payer ID you can submit claims for all of Samaritan Health Plans: Medicare Medicare Self-funded and Commercial. To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche [email protected] To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche [email protected] Revised 02/18/2015 ICS Software, Ltd. Page 68 of 87

69 Call San Diego Physicians Medical Group Central Region COMMERCIAL M Encounters To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche [email protected] Call San Diego Physicians Medical Group Central Region COMMERCIAL M Claims To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche [email protected] San Joaquin Health Administrators COMMERCIAL M Claims HSM01 San Judas Medical Group IPA COMMERCIAL M Claims San Louis Obispo Select COMMERCIAL M Claims Sanford Health Plan COMMERCIAL M ERA Sanford Health Plan COMMERCIAL M Claims Sanford Health Plan COMMERCIAL M EFT For more information and to download forms please visit Sante Health System and Affiliates COMMERCIAL M ERA Sante Health System and Affiliates COMMERCIAL M Claims Scan Health Plan Arizona COMMERCIAL M Claims School Sisters of Notre Dame COMMERCIAL M ERA Echo is returning 835s for payer ID. Providers will need to enroll with Emdeon for payer ID with Emdeon in order to receive these 835s for this payer TH002 Scott & White COMMERCIAL M EFT TH002 Scott & White COMMERCIAL M TH002 Scott & White COMMERCIAL M Claims TH002 Scott & White COMMERCIAL M ERA E4618 Seaside Health Plan COMMERCIAL M Encounters SVIPA Seaview IPA COMMERCIAL M Claims Secure Health Plans of Georgia LLC COMMERCIAL M Claims Security Health Plan COMMERCIAL M Claims Security Health Plan COMMERCIAL M ERA Please go to SHP Website to download form: Fax Completed Form to: Select Administrative Services (SAS) COMMERCIAL M Claims Also known as Mississippi Select Health Care Select Benefit Administrators of America COMMERCIAL M Select Benefit Administrators of America COMMERCIAL M Claims Payer ID valid only for claims with a billing submission address of P.O. Box 440 Ashland WI Select Benefit Administrators Inc. COMMERCIAL M Select Benefit Administrators Inc. COMMERCIAL M Claims Select Health Network- CMCS COMMERCIAL M ERA Select Health Network- CMCS COMMERCIAL M EFT Select Health of South Carolina COMMERCIAL M ERA For EDI support please [email protected] or call Select Health of South Carolina COMMERCIAL M Select Health of South Carolina COMMERCIAL M Claims For EDI support please [email protected] or call Select Health of South Carolina COMMERCIAL M EFT Select Senior Clinic COMMERCIAL M Claims D0014 SelectCare COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 69 of 87

70 76045 SelectCare of Texas (HPN) Heritage Physicians Network COMMERCIAL M EFT SelectCare of Texas (HPN) Heritage Physicians Network COMMERCIAL M ERA SelectCare of Texas (HPN) Heritage Physicians Network COMMERCIAL M SelectCare of Texas (HPN) Heritage Physicians Network COMMERCIAL M Claims SelectCare of Texas (Kelsey-Seybold) COMMERCIAL M Claims SX107 SelectHealth COMMERCIAL M Claims SelectHealth was formerly Intermountain Healthcare (IHC) SX107 SelectHealth COMMERCIAL M ERA Provider must be currently billing to payer or 835 ERA request will be rejected. Call Self Funded Amdinistrators COMMERCIAL M Self Insured Plans (Naples FL) COMMERCIAL M Self Insured Plans (Naples FL) COMMERCIAL M Claims Payer ID valid only for claims with a submission address of 1016 Collier Center Way Suite 200 Naples FL Please call Customer Service at (239) to verify claims submission to Self Insured Plans - Payer ID (Naples FL) Self-Funded Plans Inc. COMMERCIAL M Claims Sendero Health COMMERCIAL M ERA Sendero Health COMMERCIAL M Claims Senior Care Partners COMMERCIAL M Claims Senior Health Partners COMMERCIAL M ERA Senior Health Partners is effective 05/01/ Senior Health Partners (SHP) COMMERCIAL M Claims Senior Health Partners is effective 05/01/ Sentara Family Care COMMERCIAL M Claims Sentara Health Management COMMERCIAL M ERA Sentara Health Management COMMERCIAL M Claims Sentinel Management Services COMMERCIAL M Claims Sentinel Security Life Insurance Company COMMERCIAL M EFT Sentinel Security Life Insurance Company COMMERCIAL M ERA Sentry Insurance a Mutual Company COMMERCIAL M Claims Sentry Life Insurance Company COMMERCIAL M ERA Sentry Life Insurance Company COMMERCIAL M Claims Sentry Life of New York COMMERCIAL M Claims SMG01 Seoul Medical Group COMMERCIAL M Claims Note: Rendering Provider Network ID (E6-14) field is reqd. Field must be 5-7 chars positions 1-5 must be numeric only and positions 6&7 (if applicable) must be alpha only. Please contact Ydsia Slagle-Provider Relations at (757) Note: Rendering Provider Network ID (E6-14) field is reqd. Field must be 5-7 chars positions 1-5 must be numeric only and positions 6&7 (if applicable) must be alpha only. Please contact Ydsia Slagle-Provider Relations at (757) Claims must have the Sentry Life Insurance Co. Group and Subscriber Numbers. To verify you are using the correct number you may contact Sentry's Customer Service Department at Claims must have the Sentry Life Insurance Co. Group and Subscriber Numbers. To verify you are using the correct number you may contact Sentry's Customer Service Department at Claims must have the Sentry Life Insurance Co. Group and Subscriber Numbers. To verify you are using the correct number you may contact Sentry's Customer Service Department at Revised 02/18/2015 ICS Software, Ltd. Page 70 of 87

71 TKFMC Sequoia Beverage COMMERCIAL M Claims Seton CHIP COMMERCIAL M Claims Seton Employee Plan COMMERCIAL M Claims D2308 Seton Employee Plan COMMERCIAL M Claims TH079 Seton Health Plan - Exclusive COMMERCIAL M Claims TH081 Seton MAP Program COMMERCIAL M Claims Seven Corners COMMERCIAL M Claims Sheet Metal Workers Local 104 Health Care Plan (San Ramon CA) COMMERCIAL M Claims Payer ID valid for claims with a submission address of PO Box 1618 San Ramon CA Call Sheffield Olson & McQueen Inc COMMERCIAL M Claims Please contact Cate Ahlquist at Sheffield Olson & McQueen Inc. prior to submitting claims electronically. Phone number is Shenandoah Life Insurance Company COMMERCIAL M PROSP Sierra Family Network (Prospect Medical Group) COMMERCIAL M Claims Sierra Health and Life COMMERCIAL M EFT Sierra Health and Life COMMERCIAL M Sierra Health and Life COMMERCIAL M ERA Sierra Health and Life COMMERCIAL M Claims Sierra Health and Life (Encounters) COMMERCIAL M Encounters MBA01 Sierra Nevada Medical Association COMMERCIAL M Claims Significa Benefits Services Inc. COMMERCIAL M Claims Significa Benefits Services Inc. COMMERCIAL M ERA Silver Cross Managed Care Organization COMMERCIAL M Claims Silverback TPA COMMERCIAL M Claims Simplifi COMMERCIAL M ERA Sinai Medical Group COMMERCIAL M Claims Sinai Medical Group Chicago IL Family Health Network patients only COMMERCIAL M Claims Sinclair Health Plan COMMERCIAL M Claims Sloans Lake Preferred Health Networks COMMERCIAL M Claims 2057 Smith Administrators COMMERCIAL M 2057 Smith Administrators COMMERCIAL M Claims Smokey Mountain Center COMMERCIAL M Claims Smokey Mountain Center COMMERCIAL M ERA Call Solano Regional Medical Group COMMERCIAL M Claims Echo is returning 835s for payer ID. Providers will need to enroll with Emdeon for payer ID with Emdeon in order to receive these 835s for this payer Sutter Connect requires the providers to complete an application & get approval from us prior to sending claims to a clearinghouse. Contact Sutter Connect EDI (800) for payer ID Sound Health (now known as First Choice Health Network) COMMERCIAL M Claims Soundpath Health COMMERCIAL M Claims Formerly known as Puget Sound Health Partners Inc South Bay Hotel Employees Restaurant Employees Health Trust COMMERCIAL M EFT South Bay Hotel Employees Restaurant Employees Health Trust COMMERCIAL M ERA Revised 02/18/2015 ICS Software, Ltd. Page 71 of 87

72 Call South Central Preferred - PPO York PA (IHS Gateway Payer) COMMERCIAL M Claims Call Jane Grove at Provider Relations for South Central Preferred (717) South FL Community Care Network - NBHD COMMERCIAL M Claims South Point Hotel & Casino COMMERCIAL M Claims SouthCare/Healthcare Preferred COMMERCIAL M Claims TH116 Southeast Texas Govt Employees Benefit Pool COMMERCIAL M Claims TH116 Southeast Texas Govt Employees Benefit Pool COMMERCIAL M Southeastern Indiana Health (SIHO) COMMERCIAL M Claims IU Health Plans Southeastern Indiana Health (SIHO) COMMERCIAL M ERA Southern Benefit Services COMMERCIAL M Claims Southern Benefit Services will no longer process claims from the following Provider Groups: Brockman Enterprises and SPS International Southern Benefit Services COMMERCIAL M Southern CA Children's Network (SynerMed) COMMERCIAL M Claims SCP01 Southern Cal Physicians Managed Care Services COMMERCIAL M Claims Southern Illinois Laborers COMMERCIAL M Southwest Administrators COMMERCIAL M Southwest Service Life COMMERCIAL M Claims Please enter the unique policy number or ID card when submitting claims. Payer ID valid only for claims with a billing submission address of PO Box Ft. Worth TX Spectrum Administrators Inc. - TPA Allentown PA (IHS Gateway Payer) COMMERCIAL M Claims Spina Bifida - VA HAC COMMERCIAL M ERA 835s are not returned on paper claims Spina Bifida - VA HAC COMMERCIAL M Claims TH100 Spohn Health COMMERCIAL M Claims APP01 St Francis IPA COMMERCIAL M Claims STJOE St Joseph IPA COMMERCIAL M Claims STJOE St Jude Yorba Linda COMMERCIAL M Claims St. Anthony Memorial Healthcare Centers - MDWISE COMMERCIAL M Claims To obtain the payer ID for this payer please contact CMCS Customer Service at (800) St. Anthony- CMCS COMMERCIAL M EFT St. Barnabas System Health Plan COMMERCIAL M Claims Starting on January all claims with dates of service 1/1/15 and after should be submitted to Horizon BCBSNJ Payer ID St. Catherine Hospital PHO - MDWISE COMMERCIAL M Claims To obtain the payer ID for this payer please contact CMCS Customer Service at (800) St. Catherine-CMCS COMMERCIAL M EFT St. Francis Health Care COMMERCIAL M Claims St. Francis Health Care Chicago IL MG#112 COMMERCIAL M Claims St. Francis Health Network COMMERCIAL M Claims To obtain the payer ID for this payer please contact CMCS Customer Service at (800) St. Francis Health Network- CMCS COMMERCIAL M EFT St. James PHO COMMERCIAL M Claims St. James PHO-FHN COMMERCIAL M Claims STJOE St. Joseph Heritage Healthcare COMMERCIAL M Claims STJOE St. Jude (St. Joseph Heritage Healthcare) COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 72 of 87

73 35199 St. Margaret Mercy Healthcare Centers - MDWISE COMMERCIAL M Claims To obtain the payer ID for this payer please contact CMCS Customer Service at (800) St. Margaret- CMCS COMMERCIAL M EFT PDT01 St. Vincent IPA COMMERCIAL M Claims Standard Life and Accident Insurance Company COMMERCIAL M ERA Standard Life and Accident Insurance Company COMMERCIAL M Claims Star HRG COMMERCIAL M Claims Payer ID valid only if the address on the Health ID Card matches one of the following P.O. Boxes: P.O. Box Phoenix AZ Starmark COMMERCIAL M Claims State Auto Insurance Companies COMMERCIAL M Claims State Farm (Casualty & Property Claims) COMMERCIAL M ERA State Farm (Casualty & Property Claims) COMMERCIAL M Claims State Farm - Property & Casualty line of business is Payer ID State Farm Insurance Companies COMMERCIAL M ERA Provider must access payer website and fill EFT Questionnaire for Health Care Providers and Authorization Agreement. If enrollment forms are not submitted to STATE FARM ERA remits will not process State Farm Insurance Companies COMMERCIAL M Claims Payer ID is for State Farm - Health line of business State of Texas Dental Plan COMMERCIAL M Claims States General Life Insurance COMMERCIAL M Claims Sterling Medicare Advantage COMMERCIAL M Claims Sterling Medicare Advantage COMMERCIAL M ERA Sterling Medicare Advantage COMMERCIAL M Sterling Medicare Advantage COMMERCIAL M EFT Payer ID is for claims with Service Dates prior to May Claims with a Date of Service on or after May will reject for ACK/RETURNED - Claim submitted to incorrect payer. Please submit these claims directly to Sterling (Windsor) Sterling Option 1 COMMERCIAL M Claims Payer ID is for claims with Service Dates prior to May Claims with a Date of Service on or after May will reject for ACK/RETURNED - Claim submitted to incorrect payer. Please submit these claims directly to Sterling (Windsor). Call Stewart C Miller and Company COMMERCIAL M Stewart Miller and Company COMMERCIAL M TRLTC Stonebridge Life Insurance Company COMMERCIAL M Claims PO Box Plano TX TRLTC Stonebridge Life Insurance Company COMMERCIAL M Claims PO Box Hurst TX TRP1E Stonebridge Life Insurance Company COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA TRP1E Stonebridge Life Insurance Company COMMERCIAL M EFT TRP1E Stonebridge Life Insurance Company COMMERCIAL M Claims Claim Services Division Valley Forge PA TRP1P Stonebridge Life Insurance Company COMMERCIAL M Claims 2700 West Plano Parkway Plano TX Stoner and Associates (Cincinnati OH) COMMERCIAL M Claims Stones River IPA - Amerivantage COMMERCIAL M Claims Stones River Regional IPA/BCBST COMMERCIAL M Claims This Payer ID should be used for Stones River Regional IPA - BC/BS Tennessee claims. This Payer ID should be used for Stones River Regional IPA - Blue Grass Family Health Stones River Regional IPA/BHFG COMMERCIAL M Claims claims Revised 02/18/2015 ICS Software, Ltd. Page 73 of 87

74 15752 Stones River Regional IPA/Windsor COMMERCIAL M Claims Stowe Associates COMMERCIAL M SummaCare Health Plan COMMERCIAL M Claims Summit Administration Services Inc. COMMERCIAL M Claims Summit Administration Services Inc. COMMERCIAL M Summit America Insurance Services Inc. COMMERCIAL M Claims Student Accident and Sickness College Sports and NASCC claims only Sunshine State Health Plan COMMERCIAL M Claims Superior Administrators Inc (Santa Ana CA) COMMERCIAL M Superior Administrators Inc (Santa Ana CA) COMMERCIAL M Claims Payer ID valid for claims with a submission address of P.O. Box Santa Ana CA Superior Health Plan Texas COMMERCIAL M Claims Prior to submitting claims please call Provider Relations Dept at 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 Sutter Delta Medical Group COMMERCIAL M Claims Sutter East Bay Medical Foundation COMMERCIAL M Claims Sutter East Bay Regional Hospital COMMERCIAL M Claims Sutter East Bay Regional Hospital- Affinity COMMERCIAL M Claims Sutter Gould Medical Foundation COMMERCIAL M Claims Sutter Connect requires the providers to complete an application & get approval from us prior to sending claims to a clearinghouse. Contact Sutter Connect EDI (800) for payer ID. Call Sutter Independent Physicians COMMERCIAL M Claims Sutter Connect requires the providers to complete an application & get approval from us prior to sending claims to a clearinghouse. Contact Sutter Connect EDI (800) for payer ID Call Sutter Medical Foundation COMMERCIAL M Claims Sutter Connect requires the providers to complete an application & get approval from us prior to sending claims to a clearinghouse. Contact Sutter Connect EDI (800) for payer ID Sutter Medical Group of the Redwoods COMMERCIAL M Claims Sutter Connect requires the providers to complete an application & get approval from us prior to sending claims to a clearinghouse. Contact Sutter Connect EDI (800) for payer ID Swedish Covenant Hospital COMMERCIAL M Claims Swedish Covenant Managed Care Alliance COMMERCIAL M Claims TKFMC TASEBA COMMERCIAL M Claims TBT COMMERCIAL M Claims TEAMSTERS (UT/ ID / MT) - Group Benefit Admin COMMERCIAL M Claims Call TIC Time Ins Co COMMERCIAL M TOUCHSTONE HEALTH/HEALTH NET SMART CHOICE COMMERCIAL M Claims Claims submitted under are routed to payer id For (ERA) enroll under payer id TPA of Georgia COMMERCIAL M TPAC/Employee Benefit Management Corp COMMERCIAL M Claims TR Paul Inc. COMMERCIAL M Claims TRILOGY NETWORK COMMERCIAL M Claims Formerly known as TRLHN/EB TRIPLEFIN LLC COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 74 of 87

75 42137 TRISTAR Benefit Administrators (W. DesMoines IA) COMMERCIAL M Claims Please check the Insured ID card to verify the Payer ID before submitting claims. If you have questions please contact Provider Relations at TRISTAR Benefit Administrators (W. DesMoines IA) COMMERCIAL M TRLHN/AS COMMERCIAL M Claims TakeCare Insurance Company COMMERCIAL M Claims TALMG Talbert Medical Group COMMERCIAL M Claims Tall Tree Administrators COMMERCIAL M Claims Teachers Health Trust COMMERCIAL M EFT Teachers Health Trust COMMERCIAL M Claims Teachers Health Trust COMMERCIAL M Teachers Protective Mutual COMMERCIAL M Team Choice Gold COMMERCIAL M Claims Team Choice PNS COMMERCIAL M Claims Teamcare COMMERCIAL M Claims Teamsters Benefit Trust COMMERCIAL M Claims Temple Community Hospital COMMERCIAL M Claims Tethys Health Ventures COMMERCIAL M Claims Texas Children's Health Plan COMMERCIAL M ERA Texas Children's Health Plan COMMERCIAL M EFT Texas Children's Health Plan COMMERCIAL M Claims Texas Children's Health Plan COMMERCIAL M Call Texas Children's Star COMMERCIAL M Claims Provider ID required for all THIN payers. TXCSM Texas Childrens Health COMMERCIAL M Claims Texas Childrens Health Plan (Medicaid) COMMERCIAL M EFT Texas Childrens Health Plan (Medicaid) COMMERCIAL M Claims Texas Childrens Health Plan (Medicaid) COMMERCIAL M ERA Texas Childrens Health Plan (Medicaid) COMMERCIAL M Texas First Health Plans (TIOPA) COMMERCIAL M Claims Texas HealthSpring COMMERCIAL M Claims TH089 Texas Premier Plan COMMERCIAL M Claims TexasFirst Health Plan (NTX) COMMERCIAL M Claims TexasFirst Health Plan (NTX) COMMERCIAL M EFT TexasFirst Health Plan (NTX) COMMERCIAL M TexasFirst Health Plan (NTX) COMMERCIAL M ERA The Allen J Flood Companies Inc COMMERCIAL M The Alliance COMMERCIAL M Claims The Care Network/The Savannah Business Group COMMERCIAL M Claims The Childrens Clinic IWS COMMERCIAL M Claims The City of Odessa COMMERCIAL M Claims The EPOCH Group COMMERCIAL M Revised 02/18/2015 ICS Software, Ltd. Page 75 of 87

76 37305 The Ford Meter Box Company Inc. COMMERCIAL M The Ford Meter Box Company Inc. COMMERCIAL M Claims The Health Exchange (Cerner Corporation) COMMERCIAL M Claims The Health Plan (Massillon Ohio and St. Clairsville Ohio only) COMMERCIAL M Claims The Healthcare Group COMMERCIAL M Claims The Integrity Benefit Group Inc. COMMERCIAL M Claims The Loomis Company - TPA Wyomissing PA (IHS Gateway Payer) COMMERCIAL M Claims The MEGA Life & Health Insurance Company - Insurance Center COMMERCIAL M ERA The MEGA Life & Health Insurance Company - Insurance Center COMMERCIAL M Claims The MEGA Life & Health Insurance Company - Insurance Center COMMERCIAL M The MEGA Life & Health Insurance Company - Insurance Center COMMERCIAL M EFT The MEGA Life & Health Insurance Company - Starbridge StarHRG COMMERCIAL M Claims Services ordered by outside provider require referring provider on a HCFA and attending physician on a UB. Pease provide physician name and UPIN if available. Payer ID valid only if the P.O. Box on the Health ID card matches the following P.O. Box: P.O. Box North Richland Hills TX Payer ID valid only if the address on the Health ID Card matches one of the following P.O. Boxes: P.O. Box Phoenix AZ If the P.O. Box on the health ID card matches the following P.O. Box: P.O. Box Oklahoma City OK The MEGA Life & Health Insurance Company-OKC COMMERCIAL M Claims The National Radiology Network COMMERCIAL M Claims Electronic Payer ID for Claims printed and mailed to payer The Perfect Health Insurance Co. COMMERCIAL M The Physicians Assurance Corp (TPAC) /Employee Benefit Management Corp (EBM COMMERCIAL M Claims The Preferred Healthcare System (TPHS) - PPO Altoona PA Call (IHS GatewayPayer) COMMERCIAL M Claims Before submitting contact Jessica Picarde at (410) This id is open COMMERCIAL M Claims Thomas Cooper & Co Inc COMMERCIAL M SX160 Thomas H. Cooper COMMERCIAL M Claims Thorek Memorial Hospital Group COMMERCIAL M Claims Three Rivers Benefit Corporation COMMERCIAL M ERA Today's Health Wisconsin COMMERCIAL M ERA Today's Health Wisconsin COMMERCIAL M Claims Echo is returning 835s for payer ID THR01. Providers will need to enroll with Emdeon Today's Options (American Progressive and Pyramid Life) COMMERCIAL M Claims Today's Options (American Progressive and Pyramid Life) COMMERCIAL M EFT Today's Options (American Progressive and Pyramid Life) COMMERCIAL M Today's Options (American Progressive and Pyramid Life) COMMERCIAL M ERA Revised 02/18/2015 ICS Software, Ltd. Page 76 of 87

77 48055 Today's Options powered by CCRX COMMERCIAL M Claims Tongass Timber Trust COMMERCIAL M Claims Tooling & Manufacturing Association COMMERCIAL M Claims THIPA Torrance Hospital IPA COMMERCIAL M Claims Total Broker Benefits COMMERCIAL M Claims f.k.a. Benefit Systems & Services Inc Total Claims Administration COMMERCIAL M Claims Total Community Care COMMERCIAL M Claims Total Healthcare Inc. COMMERCIAL M Claims Total Long Term Care COMMERCIAL M Claims Touchstone Health PSO COMMERCIAL M ERA Claims submitted under are routed to payer id For (ERA) enroll under payer id Touchstone Health PSO COMMERCIAL M Claims Claims submitted under are routed to payer id For (ERA) enroll under payer id TKFMC Town & Country COMMERCIAL M Claims TransAmerica Life Insurance Company COMMERCIAL M TransAmerica Life Insurance Company COMMERCIAL M Claims Payer ID valid only if the address on the Health ID Card matches the following: P.O. Box North Richland Hills TX TransAmerica Life Insurance Company COMMERCIAL M ERA TransChoice-Key Benefit Administrators COMMERCIAL M EFT TransChoice-Key Benefit Administrators COMMERCIAL M TransChoice-Key Benefit Administrators COMMERCIAL M Claims TLINS Transamerica Financial Life Insurance Company COMMERCIAL M Claims PO Box 8043 Little Rock AR TRLTC Transamerica Financial Life Insurance Company COMMERCIAL M Claims PO Box Plano TX TRLTC Transamerica Financial Life Insurance Company COMMERCIAL M Claims PO Box Hurst TX TRP1E Transamerica Financial Life Insurance Company COMMERCIAL M Claims PO Box 97 Scranton PA TRP1E Transamerica Financial Life Insurance Company COMMERCIAL M Claims PO Box Baltimore MD TRP1E Transamerica Financial Life Insurance Company COMMERCIAL M EFT TRP1E Transamerica Financial Life Insurance Company COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA TRP1E Transamerica Financial Life Insurance Company COMMERCIAL M Claims Claim Services Division Valley Forge PA TRP1P Transamerica Financial Life Insurance Company COMMERCIAL M Claims 2700 West Plano Parkway Plano TX TLINS Transamerica Life Insurance Company COMMERCIAL M Claims PO Box 8043 Little Rock AR TRLTC Transamerica Life Insurance Company COMMERCIAL M Claims PO Box Plano TX TRLTC Transamerica Life Insurance Company COMMERCIAL M Claims PO Box Hurst TX TRP1E Transamerica Life Insurance Company COMMERCIAL M Claims PO Box 97 Scranton PA TRP1E Transamerica Life Insurance Company COMMERCIAL M EFT TRP1E Transamerica Life Insurance Company COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA TRP1E Transamerica Life Insurance Company COMMERCIAL M Claims PO Box Baltimore MD TRP1P Transamerica Life Insurance Company COMMERCIAL M Claims 2700 West Plano Parkway Plano TX TLINS Transamerica Premier Life Insurance Company COMMERCIAL M Claims PO Box 8043 Little Rock AR TRCLF Transamerica Premier Life Insurance Company COMMERCIAL M Claims 4333 Edgewood Road NE Cedar Rapids IA TRLTC Transamerica Premier Life Insurance Company COMMERCIAL M Claims PO Box Plano TX TRLTC Transamerica Premier Life Insurance Company COMMERCIAL M Claims PO Box Hurst TX TRP1E Transamerica Premier Life Insurance Company COMMERCIAL M Claims 100 Light Street Baltimore MD TRP1E Transamerica Premier Life Insurance Company COMMERCIAL M Claims Claim Services Division Valley Forge PA TRP1E Transamerica Premier Life Insurance Company COMMERCIAL M Claims PO Box Baltimore MD TRP1E Transamerica Premier Life Insurance Company COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA TRP1E Transamerica Premier Life Insurance Company COMMERCIAL M Claims PO Box 97 Scranton PA Revised 02/18/2015 ICS Software, Ltd. Page 77 of 87

78 TRP1E Transamerica Premier Life Insurance Company COMMERCIAL M EFT TRP1P Transamerica Premier Life Insurance Company COMMERCIAL M Claims 2700 West Plano Parkway Plano TX Transchoice or TransSmile - First Service Administrator's Inc COMMERCIAL M Claims Trellis Health Partners COMMERCIAL M Claims PDT01 TriCities IPA COMMERCIAL M Claims Tribute /SelectCare of Oklahoma COMMERCIAL M ERA Tribute /SelectCare of Oklahoma COMMERCIAL M Claims Tribute /SelectCare of Oklahoma COMMERCIAL M EFT Tribute /SelectCare of Oklahoma COMMERCIAL M Tribute Health Plan COMMERCIAL M Claims Tribute Health Plan COMMERCIAL M ERA SX163 Tricare Overseas COMMERCIAL M Claims Trihealth Physician Solutions COMMERCIAL M ERA Trihealth Physician Solutions COMMERCIAL M Claims Trihealth Physician Solutions - Concern COMMERCIAL M Claims Trusteed Plans Service Corporation COMMERCIAL M ERA Trusteed Plans Service Corporation COMMERCIAL M Claims Trustmark Insurance Company COMMERCIAL M ERA Trustmark Insurance Company COMMERCIAL M Claims Trustmark Life Insurance Co COMMERCIAL M ERA Trustmark insurance Company COMMERCIAL M ERA 4298 Tufts Health Plan COMMERCIAL M ERA Call Tufts Health Plan COMMERCIAL M Claims TH065 UFCW COMMERCIAL M UI Campus Care COMMERCIAL M Claims UIC College of Medicine at Rockford COMMERCIAL M Claims UICPG Chicago IL MG#141 COMMERCIAL M Claims UMC Health Plan COMMERCIAL M Claims UMC Health Plan COMMERCIAL M Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Please contact the Tufts Health Plan EDI Operations Department at ext for payer id UMR (formerly Harrington Benefit Services - Westerville) COMMERCIAL M Claims Use Payer ID UMR (formerly Harrington Benefit Services) COMMERCIAL M Claims Use Payer ID UMR (formerly Lexington / CommonWealth Administrative Group) COMMERCIAL M Claims UMR (formerly UMR Onalaska) COMMERCIAL M Claims Former Payer IDs UMR (formerly UMR Onalaska) COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at UMR (formerly UMR Onalaska) COMMERCIAL M EFT Went live with EFT on 3/3/14 Revised 02/18/2015 ICS Software, Ltd. Page 78 of 87

79 74223 UMR (formerly UMR San Antonio Benefit Planners) COMMERCIAL M Claims Use Payer ID or (see member's card if available) UMR (formerly UMR Wausau) COMMERCIAL M ERA UMR Westerville (formerly Harrington Health) COMMERCIAL M Claims Use Payer ID UMWA Health & Retirement Funds COMMERCIAL M Claims UNICARE COMMERCIAL M Claims UNICARE COMMERCIAL M ERA Available for Providers within Kansas Texas West Virginia Massachusetts and Illinois only. For questions call UNION PACIFIC RAILROAD EMPLOYES Health Systems COMMERCIAL M UNION PACIFIC RAILROAD EMPLOYES Health Systems COMMERCIAL M Claims UNITED FOOD & COMM. WORKERS MIDWEST UNIONS COMMERCIAL M Claims UPMC Health Plan COMMERCIAL M ERA UPMC Health Plan COMMERCIAL M Claims UPMC Vision Advantage COMMERCIAL M ERA Enrollment Required: Please go to SHP Website to download form: Fax Completed Form to: UPMC Vision Advantage COMMERCIAL M Claims US Benefits COMMERCIAL M Claims US Benefits COMMERCIAL M TH103 US Family Health Plan (USFHP) COMMERCIAL M Claims TX and LA only USAA (United Services Automobile Association) COMMERCIAL M Claims Property and Casualty Division Only USFHP - St. Vincent Catholic Medical Centers of New York COMMERCIAL M Claims Serving parts of New York NYC all of New Jersey Southeastern Pennsylvania and Western Connecticut. For member eligibility call UT- Altius (UHIN) COMMERCIAL M Claims UW Graduate Appointee Plan COMMERCIAL M Claims Please enter Group Number (F72) when submitting claims. SX178 Ucare Minnesota COMMERCIAL M Claims SX178 Ucare Minnesota COMMERCIAL M ERA Ultimate Health Plan COMMERCIAL M ERA Ultimate Health Plan COMMERCIAL M Claims Ultimate Health Plan COMMERCIAL M EFT Ultra Benefits Inc. COMMERCIAL M Claims Underwriters Safety & Claims COMMERCIAL M Unified Group Services COMMERCIAL M Claims Unified Health Services COMMERCIAL M Claims Worker's Compensation Claims Only Unified Physicians Network COMMERCIAL M ERA Unified Physicians Network COMMERCIAL M Claims For claims rejections please contact Unified Physicians Claims Department at TRP1E Union Labor Life Insurance Company - Admin By UBC COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA Call Union Pacific IPA COMMERCIAL M Claims To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche [email protected] Call Union Pacific IPA COMMERCIAL M Encounters To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche [email protected] Union Security Insurance Company COMMERCIAL M Union Security Insurance Company COMMERCIAL M EFT Union Security Insurance Company COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 79 of 87

80 70408 Union Security Insurance Company COMMERCIAL M ERA Unison Health Plan/Better Health Plans COMMERCIAL M Claims United Administrative Services Inc COMMERCIAL M ERA United Administrative Services Inc COMMERCIAL M United Administrative Services Inc COMMERCIAL M EFT UAGBT United Agriculture Benefit Trust COMMERCIAL M Claims Call United Claim Solutions COMMERCIAL M Claims Please refer to the Insured's ID Card for more information United Commercial Travelers COMMERCIAL M United Group Programs Inc. COMMERCIAL M United Group Programs Inc. COMMERCIAL M EFT United Medical Alliance COMMERCIAL M United Medical Alliance COMMERCIAL M Claims United Security Life & Health Ins Co COMMERCIAL M Claims Please do not submit claims on or after 1/1/2011 using payer ID Claims will need to be submitted on paper to United Security Life and Health PO Box Seattle WA For questions call United Teacher Assoc Ins Co-Medicare Supplement COMMERCIAL M Claims United of Omaha COMMERCIAL M Claims UnitedHealthCare / All Savers Alternate Funding COMMERCIAL M Claims UnitedHealthOne / Golden Rule COMMERCIAL M Claims UnitedHealthOne / Golden Rule COMMERCIAL M ERA Additional Payer ID is also required For ERA Setup and Enrollment UnitedHealthOne / PacifiCare Life and Health Insurance Company COMMERCIAL M Claims UnitedHealthcare COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at ERA's for payer ID are sent through payer ID UnitedHealthcare COMMERCIAL M Claims UnitedHealthcare (MAHP MD IPA Optimum Choice MAMSI) COMMERCIAL M ERA Use Payer ID UnitedHealthcare (MAHP MD IPA Optimum Choice MAMSI) COMMERCIAL M Claims Use Payer ID UnitedHealthcare (Oxford Health Plans) COMMERCIAL M ERA EFT is required Provider must call PNC at and press option #1. Available Monday-Friday from 8:30am to 5:30pm EST UnitedHealthcare (formerly Definity Health Plan) COMMERCIAL M Claims Use Payer ID UnitedHealthcare / All Savers Insurance COMMERCIAL M ERA Additional Payer ID is also required For ERA SetupAdditional Payer ID is also required For ERA Setup Payer Enrollment Form at UnitedHealthcare / Definity Health Plan COMMERCIAL M Claims Former Payer ID UnitedHealthcare / Empire Plan COMMERCIAL M Claims UnitedHealthcare / MAHP - MD IPA Optimum Choice MLH (formerly MAMSI) COMMERCIAL M Claims Former Payer ID UnitedHealthcare / Oxford COMMERCIAL M Claims UnitedHealthcare / UHIS-UnitedHealth Integrated Services COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 80 of 87

81 87726 UnitedHealthcare / UnitedHealthcare Plan of River Valley COMMERCIAL M Claims Former Payer ID (effective after 4/16/14) UnitedHealthcare / UnitedHealthcare Plan of River Valley COMMERCIAL M Claims Use Payer ID effective 4/16/ UnitedHealthcare / UnitedHealthcare West (formerly PacifiCare) COMMERCIAL M Claims Former Payer IDs UnitedHealthcare / UnitedHealthcare West Encounters (formerly PacifiCare) COMMERCIAL M Encounters 3432 UnitedHealthcare Community Plan / AZ (formerly AZ Physicians IPA APIPA) COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at UnitedHealthcare Community Plan / AZ (formerly AZ Physicians IPA APIPA) COMMERCIAL M Claims UnitedHealthcare Community Plan / DC DE OH PA SC (formerly Unison) COMMERCIAL M ERA Effective 3/1/14 -- use Payer ID 87726: Note: ERA will be delivered under Payer ID UnitedHealthcare Community Plan / DE MD OH PA COMMERCIAL M ERA Formerly Americhoice or Unison UnitedHealthcare Community Plan / IA hawk-i COMMERCIAL M ERA UnitedHealthcare Community Plan / IA hawk-i (formerly AmeriChoice of Iowa) COMMERCIAL M Claims Former Payer ID (effective after 4/16/14) UnitedHealthcare Community Plan / IA hawk-i (formerly AmeriChoice of Iowa) COMMERCIAL M Claims Use Payer ID effective 4/16/ UnitedHealthcare Community Plan / KS (KanCare) COMMERCIAL M ERA UnitedHealthcare Community Plan / KS (KanCare) COMMERCIAL M Claims UnitedHealthcare Community Plan / MI (formerly Great Lakes Health Plan) COMMERCIAL M Claims UnitedHealthcare Community Plan / MI (formerly Great Lakes Health Plan) COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at UnitedHealthcare Community Plan / MS CHIP (formerly AmeriChoice MS - CHIP) COMMERCIAL M Claims Former Payer ID (effective after 4/16/14) UnitedHealthcare Community Plan / MS CHIP (formerly AmeriChoice MS - CHIP) COMMERCIAL M Claims Use Payer ID effective 4/16/ UnitedHealthcare Community Plan / NE COMMERCIAL M Claims UFNEP UnitedHealthcare Community Plan / NE COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at UnitedHealthcare Community Plan / NJ COMMERCIAL M Claims Please use Payer ID UnitedHealthcare Community Plan / NJ COMMERCIAL M Claims Former Payer ID UnitedHealthcare Community Plan / NJ (formerly Americhoice NJ Medicaid) COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at UnitedHealthcare Community Plan / NY (formerly AmeriChoice NY Medicaid) COMMERCIAL M Claims Effective 9/1/13 Use Payer ID UnitedHealthcare Community Plan / NY (formerly AmeriChoice Personal Care) COMMERCIAL M Claims Effective 9/1/13 Use Payer ID NYU01 UnitedHealthcare Community Plan / NYU COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at UnitedHealthcare Community Plan / PA (formerly AmeriChoice PA Medicaid&CHIP COMMERCIAL M Claims Use Payer ID UnitedHealthcare Community Plan / PA (formerly AmeriChoice Personal Care ) COMMERCIAL M Claims Use Payer ID UnitedHealthcare Community Plan / SC COMMERCIAL M ERA Revised 02/18/2015 ICS Software, Ltd. Page 81 of 87

82 25175 UnitedHealthcare Community Plan / SC (formerly Unison) COMMERCIAL M Claims SC plan is for DOS prior to use Payer ID Former Payer IDs UnitedHealthcare Community Plan / TN (formerly AmeriChoice TN: TennCare COMMERCIAL M Claims TEX01 UnitedHealthcare Community Plan / TX COMMERCIAL M ERA UnitedHealthcare Community Plan / UnitedHealthcare Dual Complete COMMERCIAL M Claims UnitedHealthcare Community Plan / UnitedHealthcare Long Term Care COMMERCIAL M Claims WID01 UnitedHealthcare Community Plan / WI COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at UnitedHealthcare Community Plan Ohio COMMERCIAL M ERA Formerly Unison Ohio -- Effective 5/1/ use Payer ID UnitedHealthcare Community Plan of Delaware COMMERCIAL M ERA Effective 3/1/14 -- use Payer ID 87726: Note: ERA will be delivered under Payer ID UnitedHealthcare Community Plan of Louisiana COMMERCIAL M ERA Claims are processed under but ERAs will be delivered under UnitedHealthcare Community Plan of Louisiana COMMERCIAL M Claims Effective for dates of service on or after Feb all UnitedHealthcare Community Plan of Louisiana claims must be filed within 180 days from the date of service. Please note electronic remittance advice (ERA) enrollment and generation will be delivered under Payer ID UnitedHealthcare Community Plan of Pennsylvania COMMERCIAL M ERA Effective 3/1/14 -- use Payer ID 87726: Note: ERA will be delivered under Payer ID UnitedHealthcare Community Plan/DEFLHILAMDMS CANNMOHPARI TX WA COMMERCIAL M Claims Effective 3/1/14 -- use Payer ID Former Payer IDs UnitedHealthcare Community Plan/DEFLHILAMDMS CANNMOHPARITXWAWI COMMERCIAL M Claims Former PA payer ids UnitedHealthcare Community Plan/FLHILAMDMS CANNMOHRITXWI COMMERCIAL M Claims UnitedHealthcare Community Plan/NJ (formerly AmeriChoice Personal Care Pl COMMERCIAL M Claims Please use Payer ID UnitedHealthcare Medicare Solutions / UnitedHealthcare Chronic Complete COMMERCIAL M Claims UnitedHealthcare Medicare Solutions / UnitedHealthcare Group Medicare Advan COMMERCIAL M Claims UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareComplete COMMERCIAL M Claims UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareDirect COMMERCIAL M Claims UnitedHealthcare Medicare Solutions / UnitedHealthcare Nursing Home Plan COMMERCIAL M Claims UnitedHealthcare StudentResources COMMERCIAL M ERA UnitedHealthcare StudentResources COMMERCIAL M UnitedHealthcare StudentResources COMMERCIAL M EFT UnitedHealthcare StudentResources COMMERCIAL M Claims 773 UnitedHealthcare Vision COMMERCIAL M Claims 773 UnitedHealthcare Vision COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at UnitedHealthcare West (formerly PacifiCare PPO - All States) COMMERCIAL M Claims Use Payer ID Revised 02/18/2015 ICS Software, Ltd. Page 82 of 87

83 95964 UnitedHealthcare West (formerly PacifiCare of Arizona) COMMERCIAL M Claims Use Payer ID UnitedHealthcare West (formerly PacifiCare of Arizona) COMMERCIAL M ERA Use Payer ID UnitedHealthcare West (formerly PacifiCare of CA - Claims) COMMERCIAL M ERA Use Payer ID UnitedHealthcare West (formerly PacifiCare of CA - Claims) COMMERCIAL M Claims Use Payer ID UnitedHealthcare West (formerly PacifiCare of Colorado) COMMERCIAL M Claims Use Payer ID UnitedHealthcare West (formerly PacifiCare of Colorado) COMMERCIAL M ERA User Payer ID Unity Health Insurance COMMERCIAL M Claims SX087 Univera - Health Care Plan/ChoiceCare Buffalo COMMERCIAL M Claims SX086 Univera - Pre Paid Health Plan of NY COMMERCIAL M Claims SX088 Univera - Univera Health Southern Tier COMMERCIAL M Claims SX090 Univera SSA ENY COMMERCIAL M Claims SX091 Univera SSA WNY COMMERCIAL M Claims Universal American Financial Services COMMERCIAL M Claims TRP1E Universal Benefits - Admin For Chubb Life Insurance Company Of America COMMERCIAL M Claims PO Box Baltimore MD TRP1E Universal Benefits - Admin For City Of Bridgeport CT COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA TRP1E Universal Benefits - Admin For Hartford Life And Accident Insurance Co COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA TRP1E Universal Benefits - Admin For Hartford Life Insurance Company COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA Universal Care - California COMMERCIAL M Claims 9830 University Family Care COMMERCIAL M ERA 9830 University Family Care COMMERCIAL M Claims 7503 University Family Care - Healthcare Group COMMERCIAL M Claims See Comments University Family Care - Healthcare Group COMMERCIAL M ERA Use payer id for ERA's 9908 University Family Care - Maricopa Health Plan COMMERCIAL M Claims See Comments University Family Care - Maricopa Health Plan COMMERCIAL M ERA Use payer id for ERA's University Health Alliance COMMERCIAL M ERA University Health Alliance COMMERCIAL M Claims Payer Registration is required. EDI Enrollment form is available at University Health Care Advantage COMMERCIAL M Claims University Healthcare Marketplace COMMERCIAL M Claims University of Illinois at Chicago Div of Specialized Care for Children COMMERCIAL M Claims University of Miami Behavioral Health COMMERCIAL M Claims University of Missouri COMMERCIAL M Claims SX155 University of Utah Health Plans COMMERCIAL M ERA SX155 University of Utah Health Plans COMMERCIAL M Claims IP056 Upland Medical Group COMMERCIAL M Claims Upper Peninsula Health Group (TPA) COMMERCIAL M Claims Upper Peninsula Health Plan (Medicaid) COMMERCIAL M ERA Upper Peninsula Health Plan (Medicaid) COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 83 of 87

84 38337 Upper Peninsula Health Plan (Medicaid) COMMERCIAL M Upper Peninsula Health Plan (Medicaid) COMMERCIAL M EFT For more information and to download forms please visit VA Fee Basis Programs COMMERCIAL M ERA 835s are not returned on paper claims VA Fee Basis Programs COMMERCIAL M Claims VA-Patient-Centered Community Care Program (VAPCCC) Region 3 COMMERCIAL M Claims VA-Patient-Centered Community Care Program (VAPCCC) Region 5A COMMERCIAL M Claims VA-Patient-Centered Community Care Program (VAPCCC) Region 5B COMMERCIAL M Claims VA-Patient-Centered Community Care Program (VAPCCC) Region 6 COMMERCIAL M Claims VNA Homecare Options COMMERCIAL M ERA VNA Homecare Options COMMERCIAL M Claims VNS CHOICE Medicare COMMERCIAL M ERA VNS CHOICE Medicare COMMERCIAL M Claims Formerly listed as Visiting Nurses Service TH022 Valley Baptist Health Plan COMMERCIAL M Claims VCIPA Valley Care IPA COMMERCIAL M Claims Valley Health Plan COMMERCIAL M ERA Valley Mental Health COMMERCIAL M Claims Valley Preferred - PPO Allentown PA (IHS Gateway Payer) COMMERCIAL M Claims SX173 Value Options - Commercial COMMERCIAL M Claims Enrollment is required and forms can be located on Vantage Health Plan Inc. COMMERCIAL M Vantage Health Plan Inc. COMMERCIAL M Claims Vantage Health Plan Inc. COMMERCIAL M ERA PPM01 Vantage Medical Group COMMERCIAL M Claims VentureNet Healthcare COMMERCIAL M Claims Verdugo Hills Medical Group COMMERCIAL M Claims Verity National Group COMMERCIAL M Claims VVIPA Victor Valley IPA COMMERCIAL M Claims VVMG1 Victor Valley IPA COMMERCIAL M Claims Village Family Practice COMMERCIAL M Claims VillageCareMAX COMMERCIAL M Claims Virginia Coordinated Care-VCC COMMERCIAL M Claims Member id must be 10 digit member id for this payer CVAK1 Virginia Medicaid COMMERCIAL M Claims Virginia Premier Health Plan COMMERCIAL M Claims Virginia Premier enrollment forms located on Virginia Premier Health Plan COMMERCIAL M ERA ERA provider enrollment form is located at Vison Care Incorporated COMMERCIAL M Claims Vista Medicaid COMMERCIAL M EFT NCH08 Vista Oncology - New Century Infusion Solutions COMMERCIAL M Claims Viva Health Plan COMMERCIAL M ERA Providers enroll with only the Tax ID if one bank account will be used. Include the NPI only if there are multiple bank accounts to ensure proper distribution of funds. Revised 02/18/2015 ICS Software, Ltd. Page 84 of 87

85 63114 Viva Health Plan COMMERCIAL M Claims VIVA Health requires a complete member ID number including suffix on all claim submissions. Pls use the following site to verify member information: Viva Health Plan COMMERCIAL M EFT Viva Health Plan COMMERCIAL M Volusia Health Network COMMERCIAL M Claims Volusia Health Network COMMERCIAL M EFT Volusia Health Network COMMERCIAL M Vytra Healthcare COMMERCIAL M Claims WA - Washington Coordinated Care COMMERCIAL M Claims WEA Insurance Group COMMERCIAL M Claims WINhealth Partners/Wyoming Health Solutions COMMERCIAL M Claims WPP-ElderCare Wisconsin COMMERCIAL M Claims SX176 WPS - Tricare for Life COMMERCIAL M Claims SX176 WPS - Tricare for Life COMMERCIAL M ERA SX022 WPS Health Insurance COMMERCIAL M Claims SX022 WPS Health Insurance COMMERCIAL M ERA Wabash Memorial Hospital Association COMMERCIAL M Claims Providers should enroll with their Tax ID and Vendor IDs. Vendor IDs can normally be found on the EOP remittances listed under Claim Detail as "Vendor No". They usually include Tax ID and suffix. If you need assistance obtaining your Vendor IDs call Viva at or Waterstone Benefit Administrators (Oklahoma Providers) COMMERCIAL M Claims Waterstone Benefit Administrators (Outside Oklahoma) COMMERCIAL M Claims MPMOA Watts Healthcare Corp IPA COMMERCIAL M Claims Weiss Health Providers COMMERCIAL M Claims Welfare and Pension Administration Services COMMERCIAL M Well Sense Health Plan COMMERCIAL M Claims Submissions to Well Sense Health Plan must include the correct 12 digit BMCHP Provider ID # including all leading zeros. TH023 WellMed COMMERCIAL M TH023 WellMed COMMERCIAL M EFT TH023 WellMed COMMERCIAL M ERA TH023 WellMed COMMERCIAL M Claims WELM2 WellMed COMMERCIAL M Claims TH040 WellMed (Encounters) COMMERCIAL M Encounters Call WellNet Health Plans COMMERCIAL M Claims Please call for approval and the Payer ID WellSystems LLC COMMERCIAL M Claims Wellnet Healthcare Administrators COMMERCIAL M Wellnet Healthcare Administrators COMMERCIAL M ERA Wenatchee Valley Medical Center COMMERCIAL M Claims Echo is returning 835s for payer ID Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 85 of 87

86 30460 West Coast Administrators COMMERCIAL M West Covina Medical Group COMMERCIAL M Claims West Suburban Health Providers COMMERCIAL M Claims West Virginia Family Health Plan COMMERCIAL M Claims West Virginia Family Health Plan COMMERCIAL M ERA WestLake Financial Group Inc. COMMERCIAL M Claims WestLake Financial Group Inc. COMMERCIAL M Western Benefits Inc COMMERCIAL M Western Grower's Assurance Trust COMMERCIAL M Claims Western Grower's Insurance Company COMMERCIAL M Western Grower's Insurance Company COMMERCIAL M Claims Western Health Advantage COMMERCIAL M Claims Western Health Advantage COMMERCIAL M EFT Western Health Inc COMMERCIAL M Claims Western Health Inc COMMERCIAL M Western Mutual Insurance COMMERCIAL M Claims Western Mutual Insurance COMMERCIAL M TRLTC Western Reserve Life Insurance Company COMMERCIAL M Claims PO Box Plano TX TRLTC Western Reserve Life Insurance Company COMMERCIAL M Claims PO Box Hurst TX Western Southern Financial Group (Cincinnati OH) COMMERCIAL M Claims Weyco Inc. COMMERCIAL M Claims Weyco Inc. COMMERCIAL M William C. Earhart COMMERCIAL M Claims Wilson-McShane COMMERCIAL M Claims Wilson-McShane COMMERCIAL M Windsor Medicare Extra COMMERCIAL M ERA Windsor Medicare Extra COMMERCIAL M EFT IMPORTANT- To complete EFT registration please enter your Vendor ID# when asked for Provider ID#. The Vendor ID# is located in the upper portion of the EOP under Vendor Tax ID Windsor Medicare Extra COMMERCIAL M Windsor Medicare Extra COMMERCIAL M Claims Payer ID is for claims with Service Dates prior to May Claims with a Date of Service on or after May will reject for ACK/RETURNED - Claim submitted to incorrect payer. Please submit these claims directly to Windor Wisconsin Auto and Truck Dealers COMMERCIAL M Wisconsin Department of Corrections COMMERCIAL M Claims Women's Integrated Network Inc. (WIN Fertility) COMMERCIAL M Claims WIN Healthcare SX067 Workers Comp of West Virginia COMMERCIAL M Claims Worksite Benefit Services LLC COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 86 of 87

87 20333 Worksite Benefit Services LLC COMMERCIAL M Yale University Heath Plan COMMERCIAL M Claims STJOE Yorba Park COMMERCIAL M Claims STJOE Yorba Park (St. Joseph Heritage HealthCare) COMMERCIAL M Claims icare Health Solutions COMMERCIAL M Claims icircle of New York COMMERCIAL M Claims webtpa/community Health Electronic Claims/CHEC COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 87 of 87