Professional (Medical) Payer List Order Administrative of Kansas Updated August 2015 Administrative of Kansas (ASK) is Blue Cross and Blue Shield of Kansas DBA ASK. ASK 1
ASK accepts claims for the payers listed on this page at no charge to the trading partner. Participation in the Commercial Clearinghouse is not required for any transactions submitted for these payers. Additional Payers Available (Free) 47163 47171 00301 00801 00800 31478 31478 31478 55204 31478 31478 31478 PAYER NAME Blue Cross and Blue Shield of Kansas Blue Cross and Blue Shield of Kansas City BlueCross and BlueShield of Western New York BlueCross and BlueShield of Western New York BlueShield of Northeastern New York Freedom Network Freedom Network Select Health Partners of Kansas (HPK) HealthNow New York, Inc Mo-Kan Sheet Metal Workers Welfare Fund PHP (Preferred Health Professionals) Preferred Health Professionals PPO (PHP PPO) ASK 2
Professional (Medical) Payer List 00046 Hill Physicians Medical Group 00773 UnitedHealthcare / Spectera Eyecare Networks 01041 Healthsource ME 01066 American Healthcare Alliance 01260 Magellan Health 02038 Healthsource NH 02041 Healthsource CMHC 02041 Healthsource Massachusetts Inc. 02057 Smith Administrators 03432 UnitedHealthcare Community Plan / AZ (formerly AZ Physicians IPA APIPA) 03440 Phoenix Health Plan (Medicaid) 03443 Phoenix Health Plans (Medicare - Abrazo) 03964 Elderwood Health 04218 Pan American Life Insurance Group 04293 Neighborhood Health Plan (Boston MA) 04326 ELDER SERVICE PLAN OF THE NORTH SHORE 04332 Network Health 05003 Presbyterian (NM) 05047 Neighborhood Health Plan of Rhode Island (NHPRI) 05506 Gateway Healthy PA 06102 Diversified Administration Corporation - CT 06105 ConnectiCare Inc 06111 AARP MedicareComplete through UnitedHealthcare / Oxford Medicare Network 06111 AARP MedicareComplete through UnitedHealthcare / Oxford Mosaic Network 06111 UnitedHealthcare / Oxford 06119 Healthsource SC 06603 ASAGEHA 07689 Global Care Inc. 09173 Physicians Health Plan (PHP) - SC 09830 University Family Care 09908 University Family Care - Maricopa Health Plan 10262 InTotal Health 10629 Christus Health Medicare Advantage 10850 Metropolitan Health Plan 11244 Fitzharris & Company Inc. 11315 Fidelis Care New York 11334 New York Network Management 11345 CareCentrix 12057 Medical Initiative 12115 VA Fee Basis Programs 12422 Medica2 ASK 3
Professional (Medical) Payer List 128MI Aetna Better Health of Michigan 128MO Aetna Better Health of Missouri 13079 Alliance Healthcare/Florida for Stones River Regional IPA 13162 1199 National Benefit Fund 13174 Montefiore Contract Management Organization 13189 Meridian Health Plan 13193 Central Reserve Life Ins Co-Medicare Supplement 13193 Continental General Ins Co-Medicare Supplement 13193 Great American Life Ins. Co-Medicare Supplement 13193 Loyal American Life Ins Co-Medicare Supplement 13193 Provident American Life & Health Ins Co-Medicare Supplement 13193 United Teacher Assoc Ins Co-Medicare Supplement 13265 MetroPlus Health Plan 13306 PHCS Savility Payers 13315 Insurance Design Administrators 13335 Hudson Health Plan 13337 BMC HealthNet Plan 13337 Boston Medical Center Health Plan Inc. 13337 Boston Medical Center Health Plan Inc. Encounters 13337 Well Sense Health Plan 13343 Amalgamated Life - PA / Alicare 13346 AFTRA Health Fund 13350 ODS Health Plan 13360 CenterLight Healthcare 13381 Orthonet Corporation - CIGNA 13382 Orthonet - Uniformed Family Health Plan 13383 Orthonet- Aetna 13407 USFHP - St. Vincent Catholic Medical Centers of New York 13550 ALICARE 13550 Amalgamated Life 13551 Emblem Health (GHI - New York Group Health Inc.) 14140 Farm Family Life 14165 MVP Health Plan of NY 14179 CareCore National LLC (Aetna Radiology ) 14180 CareCore National LLC (Oxford Radiology ) 14182 CareCore National 14188 CareCore/WCNY RAD 15750 Stones River Regional IPA/BCBST 15752 Stones River Regional IPA/Windsor 15754 Stones River Regional IPA/BHFG 16098 Monitor Life Insurance Company 16117 RMSCO INC. 16120 ARAZ Group 16120 America's PPO ASK 4
Professional (Medical) Payer List 16146 SCHC Total Care - Net 16180 Aspen 16600 Chautauqua County Healthcare Plan (Mayville NY) 17516 North Shore - LIJ (Healthfirst) 19028 Concentrix Insurance Solutions 20048 Agate Resources Inc. (LIPA) 20356 Cerner HealthPlan 20356 The Health Exchange (Cerner Corporation) 20376 Gemcare Health Plan 20398 Physicians Health Collaborative 20413 3P ADMIN 20475 MDwise Excel Network 20807 Transchoice or TransSmile - First Service Administrator's Inc 20818 ESSENCE HEALTHCARE 20934 Molina Illinois 21062 Christus Health New Mexico HIX 21313 Kaiser Permanente of Georgia 22195 AIG Educational Markets 22240 St. Barnabas System Health Plan 22248 AmeriHealth Caritas Pennsylvania 22254 Fallon Community Health Plan 22326 Horizon NJ Health 22348 Maryland Physicians Care 22355 AmeriHealth VIP Care PA 22521 EGID (Employees Group Insurance Division) 22521 HP Administrative LLC 22521 OSEEGIB (Oklahoma State and Education Employees Group Ins. Board) 22603 NJ Carpenters Health Fund 22771 Managed Health Network 23051 Waterstone Benefit Administrators (Outside Oklahoma) 23160 Medico Life and Health Insurance Company 23218 Superior Administrators Inc (Santa Ana CA) 23241 First Priority 23249 Sentinel Management 23250 Significa Benefits Inc. 23281 UPMC Health Plan 23282 Community Care BHO 23283 Pittsburgh Care Partnership Inc. 23284 Keystone First 23285 Select Health of South Carolina 23287 Intergroup Corporation 23550 MFC & HealthPlus Peoria 23708 C&O Employees Hospital Association ASK 5
Professional (Medical) Payer List 24077 SANTA CLARA FAMILY HEALTH PLAN 24735 Pinnacle Management Inc. 24735 Western Grower's Assurance Trust 24735 Western Grower's Insurance Company 25133 Advantra Savings 25133 Altius (Utah) 25133 Association Benefit Plan 25133 Carelink Medicaid 25133 Carenet 25133 Coventry Advantra Texas 25133 Coventry Health & Life (Oklahoma) 25133 Coventry Health Care 25133 Coventry Health Care Encounters 25133 Coventry Health Care Carelink - West Virginia only 25133 Coventry Health Care Carelink Medicaid - West Virginia only 25133 Coventry Health Care National Network 25133 Coventry Health Care of Florida 25133 Coventry Health Care of Florida Inc. 25133 Coventry Health Care of Georgia Inc. 25133 Coventry Health Care of Illinois 25133 Coventry Health Care of Iowa Inc. 25133 Coventry Health Care of Kansas Inc. 25133 Coventry Health Care of Louisiana Inc. 25133 Coventry Health Care of Missouri 25133 Coventry Health Care of Nebraska Inc. 25133 Coventry Health Care of Nevada 25133 Coventry Health Care of Virginia 25133 Coventry Health Care of the Carolinas 25133 Coventry Health and Life Insurance Company administered by PersonalCare 25133 Coventry Health and Life Insureance (Tennessee) 25133 Coventry Missouri 25133 Coventry Summitt Health Plan Inc. 25133 Coventry of Health Care Delaware Inc. 25133 CoventryCares of Kentucky 25133 CoventryCares of Michigan 25133 CoventryCares of Nebraska 25133 CoventryCares of Pennsylvania 25133 Diamond Plan (Maryland Medicaid) 25133 Foreign Service Benefit Plan 25133 Health America Inc./Health Assurance/Advantra 25133 Healthcare USA 25133 Mail Handlers Benefit Plan 25133 Maryland Medicaid ASK 6
Professional (Medical) Payer List 25133 Rural Carrier Benefit Plan 25133 UT- Altius (UHIN) 25133 University of Missouri 25145 Benefit Coordinators Corporation (Pittsburgh PA) 25147 SouthCare/Healthcare Preferred 25160 MCA Administrators Inc. 25169 Gateway Health Plan Medicaid PA 25175 UnitedHealthcare Community Plan / SC (formerly Unison) 25175 UnitedHealthcare Community Plan/DEFLHILAMDMS CANNMOHPARI TX WA 25184 UPMC Vision Advantage 251MS Medstar Select/Medstar Medicare Choice 251PD Piedmont WellStar Health Plan 251PR Premier Health Plan 25404 Seven Corners 25681 Orthonet-HealthNet 26041 Central California Women's Health 26158 AllCare PEBB 26316 Retiree Health Trust 26492 Florida True Health 27005 Lifestyle Health Plans 27009 Delaware Physicians Care Inc. 27048 Payer Fusion 27133 Gemcare IPA 27154 Arizona Priority Care Plus 27357 AmeriHealth Caritas Louisiana 27514 AMERIGROUP Community Care of New Mexico 27514 AMERIGROUP Georgia 27514 Amerigroup Community Care 27514 Amerigroup Corporation (Ft Worth) 27514 HealthPlus Amerigroup 27515 Amerigroup Corporation (Houston) 27516 Americaid Community Care (New Jersey) 27517 Americaid Community Care (Maryland) 27518 Amerigroup Illinois 27518 Amerigroup Ohio 27519 Amerigroup Florida 28021 Kern County CDCR 28530 Secure Health Plans of Georgia LLC 28943 PHYSICIAN'S ACCOUNTABLE CARE ORG 29076 Consumers Life Insurance Company 29076 Medical Mutual of Ohio 29076 Premier Health Systems Inc. 30005 Galveston County Indigent Health Care ASK 7
Professional (Medical) Payer List 30862 Heritage Victor Valley Medical Group 30891 Sierra Medical Group 31053 Individual Health Insurance Companies 31053 State Farm Insurance Companies 31074 EBMC 31074 Employee Benefit Management Corp (EBMC) 31074 TPAC/Employee Benefit Management Corp 31074 The Physicians Assurance Corp (TPAC) /Employee Benefit Management Corp (EBM 31114 CareSource OH 31118 Tribute Health Plan 31121 Stoner and Associates (Cincinnati OH) 31127 Integra Group 31129 Integra Group-CHA 31138 AHPO (Cleveland OH) 31141 Healthsource OH 31182 Innovage 31182 Total Community Care 31182 Total Long Term Care 31417 Nationwide Health Plans 31434 HealthSpan Inc 31441 S & S Healthcare Strategies 31472 Family Health Partners - Healthwave of Kansas 31625 ElderPlan Inc. 31626 VNA Homecare Options 32006 Better Health Plans of South Carolina 33001 Universal Care - California 33036 Loma Linda University Health Care Managed Care Dept 33053 OptumHealth Behavioral Solutions (formerly Pacificare Behavioral Health) 33065 Rady Children's Hospital 33072 San Louis Obispo Select 33104 Texas HealthSpring 33373 Molina Healthcare of California - Encounters Only Encounters 33628 Mercy Maricopa Integrated Care 33LGC Life Gift Cards 33LGC Mediphe 34080 Multiplan Wisconsin Preferred Provider Network 34092 Healthspan 34097 Central Reserve Life 34131 Self-Funded Plans Inc. 34136 JP Farley Corporation 34145 Klais & Company 3414A Klais & Company (Repricing for HealthSpan Network Only) ASK 8
Professional (Medical) Payer List 34150 The Health Plan (Massillon Ohio and St. Clairsville Ohio only) 34158 Health Design Plus (Hudson OH) 34159 E-V Benefits Management Inc (Columbus OH) 34159 NABN (Cleveland OH) 34159 North American Benefits Network (Cleveland OH) 34167 Emerald Health Network Inc. (All PPO Business) 34167 Health Preferred (HSP) by Emerald Health 34167 Integrated Care Network (ICN) by Emerald Health 34171 FrontPath Health Coalition 34177 Comp - Ohio (Austintown OH) 34189 Ohio Health Choice PPO 34192 Mutual Health 34196 Apex Benefit 34638 Unified Physicians Network 34734 Aetna Better Health of NY 35092 MORRIS ASSOCIATES 35107 Indiana Teamsters Health Benefits Fund (Indianapolis IN) 35107 Local 135 Health Benefits Fund (Indianapolis IN) 35112 Employee Plans LLC 35161 Indiana ProHealth Network 35162 Managed Care LLC 35164 Sagamore Health Network 35174 Qual Choice of Arkansas 35186 Dunn and Associates Benefits Administrators Inc. 35199 COOPERATIVE MANAGED CARE SERVICES 35199 St. Anthony Memorial Healthcare Centers - MDWISE 35199 St. Catherine Hospital PHO - MDWISE 35199 St. Francis Health Network 35199 St. Margaret Mercy Healthcare Centers - MDWISE 35202 Cornerstone Benefit Adminstrators 35206 Encircle PPO 35206 Encore Health Network 35206 The Healthcare Group 35212 North Texas Healthcare Network 35245 WellSystems LLC 36149 Benefit Administrative Systems 36215 Central States Health & Welfare Funds 36215 Teamcare 36273 AARP Hospital Indemnity Plans insured by UnitedHealthcare Insurance Co 36273 AARP Medicare Supplement Plans insured by UnitedHealthcare Insurance Co 36312 MANAGED HEALTH CARE ASSOCIATES 36314 Central DuPage Physician Group ASK 9
Professional (Medical) Payer List 36320 Advocate Medical Group - AMG (Legacy AHC) 36326 Associates for Health Care Inc. (AHC) 36335 Arkansas Managed Care Organization Inc. (AMCO) 36335 HFN Inc. 36345 Physicians Care Network (Rockford IL only) 36346 Northwest Suburban IPA (Illinois) 36347 Northern Illinois Health Plan 36348 Ingalls Provider Group 36364 NorthShore University Health System Medical Group 36368 Health Options of Illinois 36369 American Imaging Management Inc. 36389 Rush Prudential Health Plans (HMO Only) 36390 Senior Care Partners 36393 Century PHO INC 36397 Trellis Health Partners 36400 Oak West Physician Association 36401 Preferred Network Access Inc. 36402 OAK WEST PRIMARY PHYSICIAN ASSOCIATION 36411 Swedish Covenant Hospital 36474 Centegra Health System 36609 Boilermakers National Health & Welfare Fund 36609 International Brotherhood of Boilermakers 36659 UNITED FOOD & COMM. WORKERS MIDWEST UNIONS 36878 Entrust 37105 Sage Technologies 37116 Lake County Physicians Association 37136 Physicians Health Association of Illinois 37137 HSHS Medical Group IPA 37227 CNIC Health Solutions Inc. 37230 TR Paul Inc. 37247 Western Mutual Insurance 37272 HealthSmart Benefit Solutions 37279 IAA 37279 Insurance Administrators of America Inc. 37282 Select Benefit Administrators of America 37283 HealthSmart Benefit Solutions 37287 PAI 37287 Planned Administrators Inc. 37331 RightChoice Benefit Administrators 37363 Compsych 37510 First Choice VIP Care 37602 UnitedHealthOne / Golden Rule 38201 Total Healthcare Inc. 38217 Priority Health ASK 10
Professional (Medical) Payer List 38224 HAP/AHL/Curanet 38224 Medical Value Plan - Ohio (MVP) 38232 Weyco Inc. 38238 Northern California Sheet Metal Workers Health Care Plan 38238 Sheet Metal Workers Local 104 Health Care Plan (San Ramon CA) 38241 Employee Benefit Concepts (Farmington Hills MI) 38254 Activa Benefit LLC 38259 Automated Benefit 38265 ASR 38265 ASR Corporation 38265 ASR Health Benefits 38265 Administration Systems Research Corporation 38265 Physicians Care (ASR Corporation) 38265 Physicians Care Health Plans (ASR Corporation) 38265 Physicians Care Network (ASR Corporation) 38309 Health Net of Arizona 38310 JOHN MORRELL COMPANY CO. - AHPBA 38329 Pro Care Health Plan Inc. (Detroit MI) 38333 Molina Healthcare of California ( only) 38334 Molina Healthcare of MICHIGAN 38335 Cofinity 38335 PPOM LLC 39033 Sentry Insurance a Mutual Company 39033 Sentry Life Insurance Company 39033 Sentry Life of New York 39045 Security Health Plan 39065 Assurant Health (IM & GROUP FULLY-INSURED) 39081 Benefit Plan Administrators Co. (Eau Claire WI) 39113 Dean Health Plan 39114 MercyCare 39126 Community Care Inc. (Wisconsin) 39156 Physicians Plus Insurance Corporation 39185 ARISE 39197 Quad Med LLC (Pewaukee WI) 39640 Great Lakes PACE 40025 Innovation Health 40585 INDECS Corporation 41041 Federated Mutual Insurance 41095 Wilson-McShane 41099 John Alden Life Insurance Co. 41124 Meritain Health Minneapolis 41136 Life Trac 41147 PreferredOne (MN) ASK 11
Professional (Medical) Payer List 41150 Health Management 41154 Mayo Clinic Health Solutions 41160 OptumHealth Physical Health - includes Oxford (formerly ACN & ACNIPA) 41161 OptumHealth Physical Health - includes Oxford (formerly ACN & ACNIPA) 41194 Optum? Complex Medical Conditions (CMC) (formerly OptumHealth Care Solutio 41194 OptumHealth Care Solutions (formerly United Resource Networks) 41194 OptumHealth Care Solutions (formerly United Resource Networks) Encounters 41206 Ultra Benefits Inc. 41600 IMCare 42011 American Republic Insurance 42102 Health Care Network of Wisconsin (HCN) 42138 Cenpatico TPA 42139 Centene TPA 42140 Centurion 42150 Butler Benefit 43056 Development Corporation 43146 American Specialty Health 43166 Mercy Health Plans 43166 Premier Benefits Inc. 43166 Premier Health Plans 43178 Joplin / Benefit Management Inc 43185 Mercy Provider Network 44054 Government Employees Health Association (GEHA) 44273 Health Plans Inc. 44444 American Postal Workers Union Health Plan 45048 INDEPENDENT LIVING SYSTEMS 45150 Meritus Health Partners 45235 GEHA (Multiplan) 45275 GEHA (PHCS) 45276 West Virginia Family Health Plan 45332 Oregon's Health CO-OP 45336 HealthyCT Inc 45437 University Healthcare Marketplace 45559 Fallon Total Care 46045 Avera Health Plans 46120 Crystal Run Health Plans 46156 Aspire Health Plan 46161 Montefiore HMO 46227 North Shore - LIJ CareConnect Insurance Company Inc. ASK 12
Professional (Medical) Payer List 46407 University Health Care Advantage 46450 State Auto Insurance Companies 46478 Continuum Health Solutions LLC 46594 AFFINITY MEDICAL GROUP 46871 Cincinnati Financial Corporation 47080 Midlands Choice Inc. 47083 GMS Inc. 47181 Highmark BCBSD Health Options Inc. 48100 ProviDRs Care Network 48123 Via Christi HOPE 48143 Group and Pension Administrators 48145 Community Health Choice 50701 VGM Homelink 50946 Informed UHC 51037 Brokerage Concepts 52095 Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. 52120 National Telecommunications Cooperative Association 52123 Johns Hopkins Healthcare (USFHP) 52149 OneNet PPO (formerly Alliance PPO / MAPSI) 52152 Optimum Choice of the Carolinas Inc. (OCCI) 52180 UMWA Health & Retirement Funds 52181 MEDICAL DEVELOPMENT INTERNATIONAL 52189 Johns Hopkins Healthcare (EHP/PP) 52190 OptumHealth Care Solutions (formerly United Resources Networks 52192 Bravo Health 52192 Bravo Health Star Plus 52192 Cigna-Healthspring 52196 Conifer (formerly InforMed) 52312 Arbor Health Plan 52429 Healthscope Benefits - EHC Repricing 52461 March Vision Care Inc. 53011 NALC/Affordable 53011 National Association of Letter Carriers 53011 National Association of Letter Carriers/NALC 53085 Anchor Benefit Consulting Inc. 53275 Martin's Point Health Care 54160 APS Healthcare Inc. 54176 Virginia Premier Health Plan 55544 Conversion Plan-APWU 55649 Allegian Choice 55649 Conifer Value-Based Care 55649 Harbor Choice 55649 Phoenix Choice ASK 13
Professional (Medical) Payer List 55912 VA-Patient-Centered Community Care Program (VAPCCC) Region 3 55915 VA-Patient-Centered Community Care Program (VAPCCC) Region 5A 55916 VA-Patient-Centered Community Care Program (VAPCCC) Region 5B 55917 VA-Patient-Centered Community Care Program (VAPCCC) Region 6 56071 American Family Medicare Supplement and PPO Policies Administered by Am Rep 56139 BENEFIT MANAGEMENT SERVICES 56144 Healthgram Inc 56147 Healthsource NC (CIGNA) 56162 MedCost Inc. 56190 OptiCare Managed Vision 56195 American Trust Administrators Inc. 56196 First Carolina Care 56240 Detroit Medical Center 57038 Kanawha HealthCare Solutions Inc. 57038 Kanawha Insurance Co. 57080 CWIBENEFITS INC. 57080 Ware Inc. dba ManageMed 57106 Tricare North Region 57115 CARE 1ST HEALTH PLAN OF CA 57116 Care 1st Health Plan of Arizona 57116 OneCare 57117 QVI Risk Solutions Inc. 57254 State of Texas Dental Plan 57492 Stones River IPA - Amerivantage 57549 Physician Health Cooperative/SRRIPA 57604 Aetna Affordable Health Choices (SM) - SRC 58202 ADVANCED DATA SOLUTIONS 58202 MedAdmin Solutions 58204 Coordinated Medical Specialists 58204 MedAdmin Solutions 58204 Network TPA LLC 58204 Physician Associates of Louisiana 58204 Physician Care Network LLC 58204 Podi Care Managed Care 58210 Healthsource GA (CIGNA) 58213 Healthways WholeHealth Networks 58305 Harbor Advantage (Abrazo Health Care) 58730 Assurant Health/ASA (Assurant Health members with ASA PPO Network) ASK 14
Professional (Medical) Payer List 59065 Memorial Integrated Healthcare/South Florida Community Care Network 59087 The National Radiology Network 59204 Fringe Benefits Coordinators 59230 Heritage Consultants 59231 MedCom 59274 AvMed Inc. 59275 AVMED INC Encounters 59276 First Service Administrator's Inc Lakeland Florida 59314 Advanzeon Solutions 59321 Florida Hospital Healthcare Systems 59324 PODIATRY NETWORK FL 59335 Alpha Health Plan Inc. 59355 Christian Care Ministry 59374 Advantica Benefits 60054 Aetna 60054 Aetna Encounters 60055 Aetna Encounters Encounters 60058 Northstar Advantage 60110 Preferred Health Systems Insurance Company 60110 Preferred Plus of Kansas 60280 Interface EAP (IEAP) 60495 Community Health Choice-Health Insurance Marketplace 60550 Gateway Health Plan - Medicare Assured 60995 Community Care Inc. - Family Care (Wisconsin) 61101 Humana Emphesys 61101 Humana Employers Health Insurance 61101 Humana Inc. 61101 Humana Insurance Company Choice Care Network 61102 Humana Inc. Encounters Encounters 61106 Preferred Health Plan (Louisville KY) 61120 Humana Veterans Healthcare 61124 Bluegrass Family Health 61125 Humana Military - Tricare South 61127 Healthsource KY 61271 J. F. Molloy and Associates Inc. 61271 Principal Financial Group 61604 PrimeWest Health 61665 Preferred Health Systems A Coventry Health Care Plan 62030 American General 62129 Healthsource TN (CIGNA) 62153 Windsor Medicare Extra 62157 Health Partners - Jackson TN 62170 Unified Health ASK 15
Professional (Medical) Payer List 62183 Better Health Plans Inc. 62183 Unison Health Plan/Better Health Plans 62308 CIGNA 62308 CIGNA - PPA 62308 CIGNA - PPO 62308 CIGNA Health Plan - HMO 62308 Connecticut General (CIGNA) 62308 EQUICOR 62308 EQUICOR - PPO 62308 Seton Employee Plan 62777 TRILOGY NETWORK 63092 HealthSpring HMO/HealthSpring Medicare+Choice 63665 Great-West Healthcare (formerly American General) 63719 Health Plan Management (HPMS) 63740 DentaQuest Vision 63740 EyeQuest 64009 Valir Pace 64071 Acclaim 64084 Mississippi Physicians Care Network 64088 Mississippi Select Health Care 64088 Select Administrative (SAS) 64090 AmFirst Insurance Company 64157 Meritain Health 64158 Agency Inc 64158 Meritain Health / Agency 64160 Pivotal Plan 65021 Orange County Health Care Agency 65031 CarePlus Health Plans Inc. 65085 NAA (North America Administrators L.P.) (Nashville TN) 65088 CareFlorida 65088 Preferred Care Partners Encounters 65088 Preferred Care Partners Florida 65093 Silver Cross Health Connection 66121 Community Medical Group of the West Valley Inc. 66122 Eastland Medical Group 66124 West Covina Medical Group 66125 LakeSide Medical Group 66126 Verdugo Hills Medical Group 66127 Lakeside Comprehensive Healthcare 66170 Community Health Group 66698 CentraCare 66705 Unity Health Insurance 66917 Parkland Community Health Plan 67829 Sterling Medicare Advantage ASK 16
Professional (Medical) Payer List 68021 Health Net - VA Patient Centered Community Care Program 68035 Health Plan of San Joaquin 68035 San Joaquin Health Administrators 68036 John Muir Mt. Diablo Health System 68036 John Muir Physician Network 68037 OMNI/Medicore HP 68047 California Health & Wellness 68068 Cenpatico - Arizona 68068 Cenpatico - FL 68068 Cenpatico - Georgia 68068 Cenpatico - Indiana 68068 Cenpatico - OHIO 68068 Cenpatico - WI 68068 Cenpatico Behavioral Health 68068 Cenpatico Behavioral Health Texas 68068 Cenpatico Massachuetts 68068 Cenpatico New Hampshire 68068 Cenpatico South Carolina 68068 Centene Advantage Plans 68068 ILCBH 68068 KS - Cenpatico Kansas 68068 KY - Cenpatico Kentucky 68068 MO - Cenpatico Missouri 68068 MS - Cenpatico Mississippi 68069 Absolute Total Care 68069 Advantage by Bridgeway Health Solutions 68069 Advantage by Buckeye Community Health Plan 68069 Advantage by Managed Health 68069 Advantage by Peach State 68069 Advantage by Sunshine State 68069 Advantage by Superior HealthPlan 68069 Ambetter from Buckeye Community Health Plan 68069 Ambetter from CeltiCare Health Plan 68069 Ambetter from Magnolia Health 68069 Ambetter from Managed Health 68069 Ambetter from Peach State Health Plan 68069 Ambetter from Sunshine Health 68069 Ambetter from Superior Health 68069 Ambetter of Arkansas 68069 Bridgeway Arizona 68069 Buckeye Community Health 68069 CeltiCare 68069 Granite State Health Plan 68069 IlliniCare ASK 17
Professional (Medical) Payer List 68069 KS - Sunflower State Health 68069 Kentucky Spirit Health Plan 68069 Louisiana Healthcare Connections 68069 MO - Missouri Home State Health Care 68069 Magnolia 68069 Managed Health Indiana (Medicaid HMO) 68069 Managed Health Wisconsin 68069 Michigan Fidelis Secure Care 68069 Peach State Health Plan 68069 Sunshine State Health Plan 68069 Superior Health Plan Texas 68069 WA - Washington Coordinated Care 68195 Healthsource Provident 70259 Harbor Health Plan 70408 Union Security Insurance Company 70454 PACE CNY 71075 Healthsource AR (Med) (CIGNA) 71404 Continental General Insurance Company 71412 ExclusiCare 71412 Mutual of Omaha Insurance Company 71412 Mutually Preferred 71412 United of Omaha 71498 LifeCircles PACE 72099 PHCS (formerly American LIFECARE) 72126 Peoples Health Network 72148 PPOPlus LLC 72261 SCAN Health Plan 73067 QuikTrip 73071 C. L. Frates & Co - OSMA Health 73071 OSMA Health - C. L. Frates 73099 Standard Life and Accident Insurance Company 73126 Equitable Plan (Oklahoma City OK) 73143 Community Care Managed Health Care Plans of Oklahoma 73145 Preferred Community Choice/PCCSelect/CompMed 73147 Healthcare Solutions Group 73155 Waterstone Benefit Administrators (Oklahoma Providers) 73159 First Health Network (f.k.a. CCN Managed Care Inc. & PPO Oklahoma) 73172 Scan Health Plan Arizona 74048 American National Ins. Co. (ANICO) 74095 USAA (United Automobile Association) 74101 Wisconsin Department of Corrections 74227 UnitedHealthcare StudentResources 74240 Assured Benefits Administrators ASK 18
Professional (Medical) Payer List 74289 MHNET 74323 MedBen (Newark OH) 74323 Medical Benefits Administrators Inc. (Newark OH) 74323 Medical Benefits Companies (Newark OH) 74323 Medical Benefits Mutual (Newark OH) 74323 Medical Benefits Mutual Life Insrance Co. 75126 Harpeth IPA - Amerivantage 75137 AmeriBen Solutions Inc. 75138 First Choice of Midwest (PPO) 75185 AAG-American Administravie Group ( Formerly Icon Benefit Admin) 75232 Employers Direct Health 75233 Employer's Direct Health - SF 75235 Employer's Direct Health - FI 75236 Employer's Direct Health - Employee Plan 75237 Healthsmart Accel 75240 AAG Benefit Plan Administrators Inc. 75240 American Administrative Group 75250 HealthSmart Preferred Care Inc. 75255 Healthsource N. TX (CIGNA) 75256 Verity National Group 75273 Geisinger Health Plan 75274 IHG Direct 75299 Angeles IPA (SynerMed) 75299 Bellflower Hospital (Synermed) 75299 East LA - APMG 75299 Employee Health System Medical Group 75299 Fresno - ENH Medical Group 75299 Gardena Memorial Medical Center 75299 Hollywood Presbyterian (Synermed) 75299 Inland Valleys IPA 75299 Multicultural Primary Care Medical Group (San Diego) (Synermed) 75299 Pacific Alliance Medical Center 75299 Pacific Alliance Medical Group and Hospital (Synermed) 75299 Redlands IPA (Synermed) 75299 Sacramento - Primary Care Practices of Sacramento - EHS 75299 Southern CA Children's Network (SynerMed) 75299 Temple Community Hospital 75600 The City of Odessa 76045 SelectCare of Texas (HPN) Heritage Physicians Network 76056 Seton CHIP 76066 Renaissance Physicians Organization 76079 Midwest Health Partners ASK 19
Professional (Medical) Payer List 76342 Health Plan of Nevada 76342 Sierra Health and Life 76343 Health Plan of Nevada (Encounters) Encounters 76343 Sierra Health and Life (Encounters) Encounters 76870 LifePath Hospice Inc 76923 Good Sheperd Hospice Inc 77001 AmeriHealth Caritas NorthEast 77002 Amerihealth Caritas District of Columbia 77003 Prestige Health Choice 77006 Amerihealth VIP Care- LA 77007 Amerihealth VIP Care- DC 77009 First Choice VIP Care Plus - SC 77012 MidCoast IPA 77013 AmeriHealth Caritas VIP Care Plus (Michigan) 77022 Ultimate Health Plan 77023 Carepoint Health Plans 77035 Central Valley Medical Group 77038 Sante Health System and Affiliates 77039 Kern Health Systems 77045 Arcadian Management Inc 77050 Keystone Connect (Amerihealth) 77051 AmeriHealth Connect (AMERIHEALTH CARITAS) 77054 Fidelis Seniorcare 77073 VNS CHOICE Medicare 77080 WPP-ElderCare Wisconsin 77082 Care Improvement Plus (CIP) 77124 DELANO IPA 77153 Southeastern Indiana Health (SIHO) 77201 Clearchoice Health Plan / COIHS 77302 Sutter Gould Medical Foundation 77304 Sutter Medical Group of the Redwoods 77318 Sutter Delta Medical Group 77894 Kentucky Health Cooperative 78375 Connecticare - Medicare 79480 UMR (formerly UMR Onalaska) 79966 Amida Care Medicare 80019 MSC (Medical Service Company) Group Inc 80026 MDI Holdings (Formerly Medical Partners of America) 80087 Innovative Physician Associates LLC 80141 Healthfirst Health Plan of New Jersey 80141 Healthfirst Inc. (New York) 80141 Senior Health Partners (SHP) 80314 GIC Indemnity Plan 80314 UNICARE ASK 20
Professional (Medical) Payer List 80705 Great-West Healthcare 81040 Allegiance Benefit Plan Management Inc. 81400 UnitedHealthCare / All Savers Alternate Funding 81400 UnitedHealthOne / PacifiCare Life and Health Insurance Company 81794 Molina Healthcare of Puerto Rico 82018 HCS - Health Service (Boise ID) 82048 Primary Health Network 83028 MBA Benefit Administrators Inc (Salt Lake UT) 83035 SENIOR WHOLE HEALTH 83077 Advantek Benefit Administrators 83253 Health Plan of Michigan 84096 Sloans Lake Preferred Health Networks 84109 Pinnacol Assurance 84131 Denver Health Medical Plan Inc. - Medicare Choice 84132 United Medical Alliance 84133 Denver Health and Hospital Authority 84134 Denver Health and Hospital Authority - Indigent Care 84135 Denver Health Medical Plan 84137 InterWest Health (Acceptius Gateway payer) 84146 CHAMPVA - HAC 84146 Children of Women Vietnam Veterans-VA HAC 84146 Spina Bifida - VA HAC 84223 Keystone VIP Choice 84806 Virginia Coordinated Care-VCC 85256 Wabash Memorial Hospital Association 85578 Ingalls Provider Group 85729 Healthcomp Inc. 86001 UnitedHealthcare Community Plan / NJ 86001 UnitedHealthcare Community Plan/NJ (formerly AmeriChoice Personal Care Pl 86002 UnitedHealthcare Community Plan / NY (formerly AmeriChoice Personal Care) 86003 UnitedHealthcare Community Plan / PA (formerly AmeriChoice Personal Care ) 86033 CIGNA Medicare Advantage 86040 Mountain States Administrative (Tucson AZ) 86047 UnitedHealthcare Community Plan / NJ 86048 UnitedHealthcare Community Plan / NY (formerly AmeriChoice NY Medicaid) 86049 UnitedHealthcare Community Plan / PA (formerly AmeriChoice PA Medicaid&CHIP 86052 Mercy Care Plan (AHCCCS) 86062 Ancillary Benefit (ABS) ASK 21
Professional (Medical) Payer List 86062 Arizona Foundation for Medical Care (AFMC) 86062 VentureNet Healthcare 86066 HMA Hawaii 86304 Insurers Administrative Corp. 87042 UNION PACIFIC RAILROAD EMPLOYES Health Systems AARP MedicareComplete through UHC / Oxford Medicare Network AARP MedicareComplete through UHC / Oxford Mosaic Network - AARP MedicareCo AARP MedicareComplete through UnitedHealthcare/AARP MedicareComplete Arnett Health Plan OptumHealth OptumHealth / OptumHealth Behavioral Solutions of NM OptumHealth Behavioral Solutions (formerly United Behavioral Health) UnitedHealthcare UnitedHealthcare / Definity Health Plan UnitedHealthcare / Empire Plan UnitedHealthcare / MAHP - MD IPA Optimum Choice MLH (formerly MAMSI) UnitedHealthcare / UnitedHealthcare Plan of River Valley UnitedHealthcare / UnitedHealthcare West (UnitedHealthcare of CA OK OR UnitedHealthcare Community Plan / IA hawk-i (formerly AmeriChoice of Iowa) UnitedHealthcare Community Plan / MS CHIP (formerly AmeriChoice MS - CHIP) UnitedHealthcare Community Plan / NE UnitedHealthcare Community Plan / UnitedHealthcare Dual Complete UnitedHealthcare Community Plan / UnitedHealthcare Long Term Care UnitedHealthcare Community Plan of Louisiana UnitedHealthcare Community Plan/DEFLHILAMDMS CANNMOHPARITXWAWI UnitedHealthcare Community Plan/FLHILAMDMS CANNMOHRITXWI UnitedHealthcare Medicare Solutions / UnitedHealthcare Chronic Complete UnitedHealthcare Medicare Solutions / UnitedHealthcare Group Medicare Advan UnitedHealthcare Medicare Solutions / UnitedHealthcare ASK 22
Professional (Medical) Payer List UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareDirect UnitedHealthcare Medicare Solutions / UnitedHealthcare Nursing Home Plan 87815 HealthSmart Benefit Solutions fka Wells Fargo TPA.Inc. 88019 Teachers Health Trust 88023 Hometown Health Plan Nevada 88027 Northern Nevada Trust Fund 88035 ARM Grp 88035 Alternative Risk Management Inc. 88035 Risk Administration Management Inc. 88050 NHBCAUX 88051 Premier Healthcare Exchange Inc. (PHX) 88052 Benefit Plan Administrators 88054 TEAMSTERS (UT/ ID / MT) - Group Benefit Admin 88055 First Agency 88056 Premier HealthCare Exchange 88058 MED PAY 88067 Tall Tree Administrators 88075 Louisiana Health Cooperative 88090 Mayo Clinic FL/GA 88461 The Alliance 90001 Healthlink PPO 90001 National Capital Preferred Provider Organization (NCPPO) 90091 Nevada Health Coop 90441 CHP DIRECT SUPERMED 90551 US Family Health Plan 91051 Group Health Cooperative - WA State 91051 Group Health Options - WA State 91064 Wenatchee Valley Medical Center 91078 Trusteed Plans Service Corporation 91131 First Choice Health Administrators 91131 First Choice Health Network 91131 Sound Health (now known as First Choice Health Network) 91136 Alaska Carpenters Trust 91136 Alaska Children's Inc. 91136 Alaska Laborers Construction Industry Trust 91136 Alaska Pipe Trades Local 375 91136 Alaska United Food & Commercial Workers Health & Welfare Trust 91136 Cement Masons & Plasterers Health & Welfare Trust 91136 Enstar Natural Gas 91136 Hotel Employees & Restaurant Employees Health Trust 91136 N.W. Ironworkers Health & Security Trust Fund ASK 23
Professional (Medical) Payer List 91136 N.W. Roofers & Employers Health & Security Trust Fund 91136 N.W. Textile Processors 91136 Operating Engineers Locals 302 & 612 Health & Security Fund 91136 Puget Sound Benefits Trust 91136 Puget Sound Electrical Workers Trust 91136 UW Graduate Appointee Plan 91151 Sterling Option 1 91162 Columbia United Providers 91176 RBMS LLC 91184 Sanford Health Plan 91617 Kaiser Foundation Health Plan of Colorado 91741 Gateway Health Plan OH- Medicare Assured 92620 Tongass Timber Trust 93029 PacificSource Health Plans 93031 Select Benefit Administrators Inc. 93044 A & I Benefit Plan Administrators 93050 William C. Earhart 93079 Kaiser Foundation of the Northwest 93092 US Benefits 93093 LifeWise Healthplan of Oregon 93221 Asuris Northwest 93975 CareOregon Inc. 94056 California Pacific Medical Center 94115 Mills Peninsula Medical Group(SPS) 94119 Sutter East Bay Regional Hospital- Non Sutter Group 94123 Kaiser Permanente Health Plan of Hawaii 94134 Kaiser Foundation Health Plan of Southern CA Region 94135 Kaiser Foundation Health Plan of Northern CA Region 94154 Humboldt-Del Norte Foundation for Medical Care 94235 Delta Health Systems 94265 Medica (UHC) 94269 Sutter East Bay Medical Foundation 94302 Chinese Community Health Plan 94312 Center for Elders Independence 94316 Brown & Toland Medical Group 94320 Kaiser Self Funded 94321 Children First Medical Group 95019 Matrix - Health First Health Plan 95112 Capital Health Plan 95166 Cedars-Sinai Medical Network 95167 Cedars-Sinai Medical Network Encounters 95170 American Benefit Plan Administrators 95192 CommunityConnect HealthPlan ASK 24
Professional (Medical) Payer List 95192 Compcare (Wisconsin BadgerCare only) 95192 Group Health Cooperative of Eau Claire 95202 SummaCare Health Plan 95213 HealthEdge Administrators (Bakersfield CA) 95321 Medfocus 95377 Beech Street 95378 UnitedHealthcare / UnitedHealthcare Plan of River Valley 95378 UnitedHealthcare Community Plan / IA hawk-i (formerly AmeriChoice of Iowa) 95378 UnitedHealthcare Community Plan / MS CHIP (formerly AmeriChoice MS - CHIP) 95380 Universal American Financial 95393 High Desert Medical Group 95399 CAP Management Systems 95411 FL MCO PHC/PHP 95424 Access Medical Group 95432 Facey Medical Foundation 95444 Indiana University Health Plan 95449 Regal Medical Group 95460 Key Health Medical Solutions Inc 95467 UnitedHealthcare Community Plan / MI (formerly Great Lakes Health Plan) 95567 Health Net of California and Oregon - 95570 Health Net - California (Professional Encounters ONLY) Encounters 95600 Emergency Medical Fund - Orange County CA 95604 Best Life & Health Insurance Co. 95655 MediGold 95655 Mt. Carmel Health 95691 Athens Area Health Plan Select 95958 UnitedHealthcare / UnitedHealthcare West Encounters (formerly PacifiCare) Encounters 95959 UnitedHealthcare West / UnitedHealthcare of CA OK OR TX WA 95962 UnitedHealthcare West (formerly PacifiCare of Colorado) 95964 UnitedHealthcare West (formerly PacifiCare of Arizona) 95999 UnitedHealthcare West (formerly PacifiCare PPO - All States) 96107 Neighborhood Health Partnership (NHP) 96176 Sutter East Bay Regional Hospital 96240 Neighborhood Health Plan RI - Exchange Unity Integrity 96385 UnitedHealthcare Community Plan / KS (KanCare) 96400 San Diego PACE 96475 Healthlink HMO 96490 InforMed LLC 97661 IEC Group - AmeriBen ASK 25
Professional (Medical) Payer List 98010 Manulife W. J. Sutton Company 98514 TRLHN/AS 99026 University Health Alliance 99208 Hawaii Medical Assurance Association (HMAA/HWMG) 99282 Motion Pictures Industry 99320 Benefit & Risk Management 99660 Fresno PACE A0701 Alta Bates Medical Group BTSS1 Brown & Toland Sutter Select CAIPA California IPA CB148 National Allied Workers Union Local 831 CB637 Aegis Administrative CCI01 Community Care IPA CMSP1 County Medical Program CORIZ Corizon Health Inc. CP001 Samaritan Employer Group Plans CP001 Samaritan Health Plans DREYR Dreyer Health E3510 ABMA (Alta Bates Medical Assocs) Medical Corp (Hnet Sr. and Secure Horizon) E3510 Alta Senior Care (Hnet Sr and Secure Horizons only) E3510 Central Valley Medical Group E3510 North American Medical Management (NAMM) - Northern California E3510 North American Medical Management (NAMM) - Southern California E4618 Seaside Health Plan Encounters EBSRM Lifetime Benefit Solutions EM039 MED3000 PEDICARE TITLE 19 EM205 MED3000 CMS TITLE 21 EM216 MED3000 EM284 MED3000 CMS SAFETY NET EM350 MED3000 CMS EARLY STEPS EM521 MED3000 COVENTRY HEALTHY KIDS EM522 MED3000 PEDICARE TITLE 21 EM843 CMS MMA SPECIALTY PLAN GEM01 Global Excel Management GHOKC Global Health HESUN Healthsun Health Plans HSPAN HealthSpan Network Repricing INCS1 Caresource Indiana Inc IP086 Good Samaritan Medical Practice Association KCIPA Kane County BCBS KELSE Kelseycare ASK 26
Professional (Medical) Payer List KYCS1 CareSource KY L0110 NAMCI/Global Care L0140 Ocular Benefits L0260 Constellation Health LIFE1 Optum Medical Network / AZ UT (formerly Lifeprint Network) LNDMK Landmark Healthcare Inc MAHC1 MEDICAL ASSOCIATES HEALTH PLAN MDXHI MDX Hawaii MSO11 San Diego County Medical (CMS) MSO33 San Diego County Ryan White Care Act MSO77 San Diego County Coverage Initiative (CI) NMM02 LaSalle Medical Group NPN11 Northwest Physicians Network PARTD Transact RX PCI01 Premier Care IPA PCN12 PHYSICIANS CARE NETWORK LLC/Polyclinic Seattle PHPMD Physician Health Partners PMGSC Physicians Medical Group of Santa Cruz County PSKW0 PSKW RCMG1 RIVER CITY MEDICAL GROUP RPPG1 Resurrection Physician Provider Group RX001 TransactRX Infusion and Specialty SCWI0 Tricare West SDCOM Scion Dental Commercial SIPA1 Southland BCBS SMG01 Seoul Medical Group STAR1 Mediview Inc. SX009 CoOportunity Health SX009 HealthPartners MN SX022 WPS Health Insurance SX071 CIGNA Behavioral Health SX109 Molina Healthcare Utah (aka American Family Care) SX133 Providence of Oregon Health Plan SX141 Rocky Mountain Health Plan - Grand Junction SX163 Tricare Overseas SX172 MDwise Inc. SX174 Health Plan of San Mateo SX187 Providence PPO SX190 National Imaging Associates THCP9 Cook Children Star Plan TLINS Monumental Life Insurance Company TLINS Transamerica Financial Life Insurance Company TLINS Transamerica Life Insurance Company TLINS Transamerica Premier Life Insurance Company ASK 27
Professional (Medical) Payer List TRCLF Monumental Life Insurance Company TRCLF Transamerica Premier Life Insurance Company TRLTC Monumental Life Insurance Company TRLTC Stonebridge Life Insurance Company TRLTC Transamerica Financial Life Insurance Company TRLTC Transamerica Life Insurance Company TRLTC Transamerica Premier Life Insurance Company TRLTC Western Reserve Life Insurance Company TRP1E Monumental Life Insurance Company TRP1E Stonebridge Life Insurance Company TRP1E Transamerica Financial Life Insurance Company TRP1E Transamerica Life Insurance Company TRP1E Transamerica Premier Life Insurance Company TRP1E Union Labor Life Insurance Company - Admin By UBC TRP1E Universal Benefits - Admin For Chubb Life Insurance Company Of America TRP1E Universal Benefits - Admin For City Of Bridgeport CT TRP1E Universal Benefits - Admin For Hartford Life And Accident Insurance Co TRP1E Universal Benefits - Admin For Hartford Life Insurance Company TRP1P Monumental Life Insurance Company TRP1P Stonebridge Life Insurance Company TRP1P Transamerica Financial Life Insurance Company TRP1P Transamerica Life Insurance Company TRP1P Transamerica Premier Life Insurance Company UHNDC PPONE WELM2 WellMed ASK 28