Commercial Claims Payer Listing

13162 1199 National Benefit Fund COMMERCIAL M 13162 1199 National Benefit Fund COMMERCIAL M Claims 13162 1199 National Benefit Fund COMMERCIAL M ERA 13162 1199 National Benefit Fund COMMERCIAL M EFT EFT enrollment is tax ID only. 29076 1st MN--Atlanta GA COMMERCIAL M Claims 1st Medical Network is part of the Medical Mutual Family of Companies. Former payer ID 58203. 29076 1st Medical Network - Atlanta GA COMMERCIAL M Claims 1st Medical Network is part of the Medical Mutual Family of Companies. Former payer ID 58203. Call 21st Century Health & Benefits COMMERCIAL M 51028 21st Century Insurance and Financial Services COMMERCIAL M ERA For MINNESOTA ONLY 51028 21st Century Insurance and Financial Services COMMERCIAL M Claims For Minnesota Only 20413 3P ADMIN COMMERCIAL M Claims 20413 3P ADMIN COMMERCIAL M 93044 A & I Benefit Plan Administrators COMMERCIAL M 93044 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 - http://www.emdeon.com/providersolutions/paymentmanager/index.php 93044 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. 95241 A.G.I.A. Inc. COMMERCIAL M Claims Claims are printed and mailed to the payer. 95241 A.G.I.A. Inc. COMMERCIAL M 75240 AAG Benefit Plan Administrators Inc. COMMERCIAL M Claims 75185 AAG-American Administravie Group ( Formerly Icon Benefit Admin) COMMERCIAL M Claims 36273 AARP Hospital Indemnity Plans insured by UnitedHealthcare Insurance Co COMMERCIAL M Claims 36273 AARP Hospital Indemnity Plans insured by UnitedHealthcare Insurance Company COMMERCIAL M ERA 36273 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 87726 AARP MedicareComplete through UHC / Oxford Medicare Network COMMERCIAL M Claims 87726 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 87726 6111 AARP MedicareComplete through UnitedHealthcare / Oxford Mosaic Network COMMERCIAL M Claims Use Payer ID 87726 Revised 02/18/2015 ICS Software, Ltd. Page 1 of 87

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 1-800-956-8000 prior to initial submission of claims. 37118 ACMG COMMERCIAL M Claims Claims are processed by Benefit Plan Administrators 72468 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 - http://www.emdeon.com/providersolutions/paymentmanager/index.php 58379 ACS Benefit Services Inc COMMERCIAL M ERA 72467 ACS Benefit Services Inc. COMMERCIAL M Claims 72467 ACS Benefit Services Inc. COMMERCIAL M ADOCS ADOC (Affiliated Doctor's of Orange County) COMMERCIAL M Claims 35199 ADV Medicare Advantage-CMCS COMMERCIAL M EFT 58202 ADVANCED DATA SOLUTIONS COMMERCIAL M Claims 46594 AFFINITY MEDICAL GROUP COMMERCIAL M Claims 34444 AFL-CIO Food & Beverage Dealer's Trust Fund (Toledo OH) COMMERCIAL M 13346 AFTRA Health Fund COMMERCIAL M Claims 37280 AGA COMMERCIAL M Claims Echo is returning 835s for payer ID 72467. 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 - http://www.emdeon.com/providersolutions/paymentmanager/index.php 91136 AGC International Union of Operating Engineers Local 701 COMMERCIAL M ERA 91136 AGC International Union of Operating Engineers Local 701 COMMERCIAL M EFT 31138 AHPO (Cleveland OH) COMMERCIAL M Claims 58379 AIAPT insured by Trustmark Insurance COMMERCIAL M ERA Echo is returning 835s for payer ID 61425. Providers will need to enroll with Emdeon 22195 AIG Educational Markets COMMERCIAL M Claims Payer formely known as: Maksin Management Corporation 91136 AK United Food and Commercial Workers (AK UFCW) COMMERCIAL M EFT 91136 AK United Food and Commercial Workers (AK UFCW) COMMERCIAL M ERA 13550 ALICARE COMMERCIAL M Claims TH071 AMA Insurance Agency COMMERCIAL M Claims 27514 AMERIGROUP Community Care of New Mexico COMMERCIAL M Claims 27514 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

PROSP APAC (Pinnacle Health Resources) (Prospect Medical Group) COMMERCIAL M Claims 51909 APEX Healthcare COMMERCIAL M Claims 54160 APS Healthcare Inc. COMMERCIAL M Claims 16120 ARAZ Group COMMERCIAL M Claims 39185 ARISE COMMERCIAL M ERA 39185 ARISE COMMERCIAL M EFT 39185 ARISE COMMERCIAL M Claims 88035 ARM Grp COMMERCIAL M 88035 ARM Grp COMMERCIAL M Claims 6603 ASAGEHA COMMERCIAL M Claims 58379 ASAMT Insurance by Trustmark Insurance COMMERCIAL M ERA Echo is returning 835s for payer ID 61425. Providers will need to enroll with Emdeon Call ASC of Oho COMMERCIAL M Claims To obtain the payer ID please call (440) 262-1160. 38265 ASR COMMERCIAL M Claims 38265 ASR Corporation COMMERCIAL M Claims 38265 ASR Health Benefits COMMERCIAL M Claims 65064 ATA-FL COMMERCIAL M Claims 59275 AVMED INC COMMERCIAL M Encounters 65101 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 68069 Absolute Total Care COMMERCIAL M Claims Prior to submitting claims please call Provider Relations Dept at 1-866-433-6041 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 51909 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 95424 Access Medical Group COMMERCIAL M Claims 19305 Access Medicare (Cuatro LLC) COMMERCIAL M Claims 19305 Access Medicare (Cuatro LLC) COMMERCIAL M ERA 64071 Acclaim COMMERCIAL M 64071 Acclaim COMMERCIAL M Claims 38254 Activa Benefit Services LLC COMMERCIAL M Claims 91173 Adaptis COMMERCIAL M ERA NPI is required for ERA Enrollment 38265 Administration Systems Research Corporation COMMERCIAL M Claims 22384 Administrative Concepts Inc. COMMERCIAL M Claims 22384 Administrative Concepts Inc. COMMERCIAL M EFT 22384 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 - http://www.emdeon.com/providersolutions/paymentmanager/index.php Revised 02/18/2015 ICS Software, Ltd. Page 3 of 87

20405 Administrative Service Professionals COMMERCIAL M 59141 Administrative Services Inc. COMMERCIAL M Claims 51909 Advanced Physician's Association Chicago IL MG#118 COMMERCIAL M Claims 35199 Advantage Health IPA-CMCS COMMERCIAL M EFT 35209 Advantage Health Solutions COMMERCIAL M 35209 Advantage Health Solutions COMMERCIAL M Claims NMM01 Advantage Med Grp COMMERCIAL M Claims 68069 Advantage by Bridgeway Health Solutions COMMERCIAL M Claims 68069 Advantage by Buckeye Community Health Plan COMMERCIAL M Claims 68069 Advantage by Managed Health Services COMMERCIAL M Claims 68069 Advantage by Peach State COMMERCIAL M Claims 68069 Advantage by Sunshine State COMMERCIAL M Claims 68069 Advantage by Superior HealthPlan COMMERCIAL M Claims 83077 Advantek Benefit Administrators COMMERCIAL M Claims 59374 Advantica Benefits COMMERCIAL M Claims 25133 Advantra Savings COMMERCIAL M Claims 95340 Adventist Health System West - Roseville CA COMMERCIAL M Claims 95340 Adventist Health System West - Roseville CA COMMERCIAL M 45423 Advicare COMMERCIAL M Claims 51909 Advocate Health Partners COMMERCIAL M Claims 36320 Advocate Medical Group - AMG (Legacy AHC) COMMERCIAL M Claims Please contact Advocate Physician Partners Debbie Motz at (847)635-4182 for questions or more information for both payer IDs. 36320 Advocate Medical Group - AMG (Legacy AHC) COMMERCIAL M ERA 36320 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 http://www.emdeon.com/enrollnow. 65093 Advocate Physician Partners COMMERCIAL M ERA 65093 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 http://www.emdeon.com/enrollnow. 65093 Advocate Physician Partners COMMERCIAL M Claims Please contact Advocate Physician Partners Debbie Motz at (847)635-4182 for questions or more information for both payer IDs. CB637 Aegis Administrative Services COMMERCIAL M Claims 60054 Aetna COMMERCIAL M Claims 60054 Aetna COMMERCIAL M Encounters 60054 Aetna COMMERCIAL M ERA 62118 Aetna - Aetna Health and Life Insurance Company COMMERCIAL M ERA 62118 Aetna - Aetna Life Insurance Company COMMERCIAL M EFT Medicare Supplemental Insurance 62118 Aetna - Aetna Life Insurance Company COMMERCIAL M ERA 62118 Aetna - Allianz Life Insurance Company of New York COMMERCIAL M EFT Medicare Supplemental Insurance 62118 Aetna - Allianz Life Insurance Company of New York. COMMERCIAL M ERA 62118 Aetna - American Continental Insurance Company COMMERCIAL M ERA Revised 02/18/2015 ICS Software, Ltd. Page 4 of 87

62118 Aetna - American Continental Insurance Company COMMERCIAL M EFT Medicare Supplemental Insurance 62118 Aetna - American General Life Insurance Company COMMERCIAL M ERA 62118 Aetna - American General Life Insurance Company COMMERCIAL M EFT Medicare Supplemental Insurance 62118 Aetna - Combined Insurance Company of America COMMERCIAL M EFT Medicare Supplemental Insurance 62118 Aetna - Combined Insurance Company of America COMMERCIAL M ERA 62118 Aetna - Continental Life Insurance Company of Brentwood Tennessee COMMERCIAL M EFT Medicare Supplemental Insurance 62118 Aetna - Continental Life Insurance Company of Brentwood Tennessee COMMERCIAL M ERA 62118 Aetna - Genworth - Genworth Life and Annuity Insurance Company COMMERCIAL M EFT Medicare Supplemental Insurance 62118 Aetna - Genworth Life Insurance Company COMMERCIAL M ERA 62118 Aetna - Genworth Life Insurance Company COMMERCIAL M EFT Medicare Supplemental Insurance 62118 Aetna - Union Fidelity Life Insurance Company COMMERCIAL M ERA 62118 Aetna - Union Fidelity Life Insurance Company COMMERCIAL M EFT Medicare Supplemental Insurance 62118 Aetna - Virginia Surety Company Inc COMMERCIAL M ERA 62118 Aetna - Washington National Insurance Company COMMERCIAL M ERA 62118 Aetna -Virginia Surety Company Inc COMMERCIAL M EFT Medicare Supplemental Insurance 62118 Aetna -Washington National Insurance Company COMMERCIAL M EFT Medicare Supplemental Insurance 57604 Aetna Affordable Health Choices (SM) - SRC COMMERCIAL M Claims 34734 Aetna Better Health Inc. COMMERCIAL M ERA Enroll with Payer 34734 Aetna Better Health Inc. COMMERCIAL M EFT Enroll with Payer 34734 Aetna Better Health Inc. COMMERCIAL M Claims 60055 Aetna Encounters COMMERCIAL M Encounters This is a BATCH ENCOUNTER payer. Please contact your Aetna Network Manager for submission requirements. 62118 Aetna Medicare Supplement Insurance COMMERCIAL M EFT Medicare Supplemental Insurance 62118 Aetna Medicare Supplement Insurance COMMERCIAL M ERA 62118 Aetna- Genworth -Genworth Life and Annuity Insurance Company COMMERCIAL M ERA ADOCS Affiliated Doctors of Orange County (ADOC) COMMERCIAL M Claims 51909 Affiliated Physicians Group COMMERCIAL M Claims APG01 Affiliated Physicians Group COMMERCIAL M Claims 13334 Affinity Health Plan COMMERCIAL M ERA 13334 Affinity Health Plan COMMERCIAL M EFT 13334 Affinity Health Plan COMMERCIAL M 13334 Affinity Health Plan COMMERCIAL M Claims 13333 Affinity Medicare Advantage COMMERCIAL M ERA 13333 Affinity Medicare Advantage COMMERCIAL M EFT 13333 Affinity Medicare Advantage COMMERCIAL M Claims 23334 AffinityAccess COMMERCIAL M Claims To sign up for EFT provider's Tax ID is required with an optional provider number. Please contact Affinity at (866.247.5678) 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

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 10787 Burbank CA 91510-0787 20048 Agate Resources Inc. (LIPA) COMMERCIAL M Claims Please contact Risa Rhodes at (514) 762-2165 for the Agate Resources Inc. (LIPA) Payer ID 64158 Agency Services Inc COMMERCIAL M Claims Now known as Meritain Health 91136 Alask Carpenters COMMERCIAL M ERA 91136 Alask Carpenters COMMERCIAL M EFT 91136 Alaska Carpenters Trust COMMERCIAL M Claims Please enter Group Number (F40) when submitting claims. 91136 Alaska Children's Services Inc. COMMERCIAL M Claims Please enter Group Number (P68) when submitting claims. 92600 Alaska Electrical Health & Welfare Fund COMMERCIAL M Claims 91136 Alaska Hotel Employees Restaurant & Camp Employees (AK HERE) COMMERCIAL M ERA 91136 Alaska Hotel Employees Restaurant & Camp Employees (AK HERE) COMMERCIAL M EFT 91136 Alaska Laborers Construction Industry Health & Security Trust COMMERCIAL M ERA 91136 Alaska Laborers Construction Industry Health & Security Trust COMMERCIAL M EFT 91136 Alaska Laborers Construction Industry Trust COMMERCIAL M Claims Please enter Group Number (F23) when submitting claims. 91136 Alaska Pipe Trades Local 375 COMMERCIAL M Claims Please enter Group Number (F24) when submitting claims. 91136 Alaska Pipe Trades U A Local 375 COMMERCIAL M ERA 91136 Alaska Pipe Trades U A Local 375 COMMERCIAL M EFT 91136 Alaska Public Employees Association (APEA/JESS Health & WelfareTrust) COMMERCIAL M ERA 91136 Alaska Public Employees Association (APEA/JESS Health & WelfareTrust) COMMERCIAL M EFT 91136 Alaska United Food & Commercial Workers Health & Welfare Trust COMMERCIAL M Claims Please enter Group Number (F45) when submitting claims. 51909 Alivio Family Medical Family Health Network patients only COMMERCIAL M Claims 26158 AllCare PEBB COMMERCIAL M Claims 52193 Allegeant COMMERCIAL M EFT 52193 Allegeant COMMERCIAL M Claims Formally known as LBA Health Plans. 55649 Allegian Choice COMMERCIAL M Claims 81040 Allegiance Benefit Plan Management Inc. COMMERCIAL M Claims 13079 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. 58234 Alliant Health Plans of Georgia COMMERCIAL M Claims 58234 Alliant Health Plans of Georgia COMMERCIAL M ERA 50749 Allianz Global Assistance COMMERCIAL M Claims Formerly know as Mondial Assistance and World Access Canada. 37308 Allied Benefit Systems COMMERCIAL M Claims SX156 Allied Health Systems Chiropractic COMMERCIAL M Claims 91136 Allied Metal Crafts Security Plan Trust Fund COMMERCIAL M EFT 91136 Allied Metal Crafts Security Plan Trust Fund COMMERCIAL M ERA NMM01 Allied Physicians COMMERCIAL M Claims TH085 Alpha Data COMMERCIAL M Claims 59335 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

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 88035 Alternative Risk Management Inc. COMMERCIAL M Claims 25133 Altius (Utah) COMMERCIAL M Claims 25133 Altius Health Plans COMMERCIAL M ERA 25133 Altius Health Plans COMMERCIAL M EFT 64090 AmFirst Insurance Company COMMERCIAL M ERA 64090 AmFirst Insurance Company COMMERCIAL M Claims 13550 Amalgamated Life COMMERCIAL M 13550 Amalgamated Life COMMERCIAL M Claims 13343 Amalgamated Life - PA / Alicare COMMERCIAL M Claims 13343 Amalgamated Life - PA / Alicare COMMERCIAL M 51909 Ambay Health Network COMMERCIAL M Claims 68069 Ambetter from Buckeye Community Health Plan COMMERCIAL M Claims 68069 Ambetter from CeltiCare Health Plan COMMERCIAL M Claims 68069 Ambetter from Magnolia Health COMMERCIAL M Claims 68069 Ambetter from Managed Health Services COMMERCIAL M Claims 68069 Ambetter from Peach State Health Plan COMMERCIAL M Claims 68069 Ambetter from Sunshine Health COMMERCIAL M Claims 68069 Ambetter from Superior Health COMMERCIAL M Claims 68069 Ambetter of Arkansas COMMERCIAL M Claims 38219 AmeraPlan COMMERCIAL M ERA 38219 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 1-800-956-8000 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. 58379 AmeraPlan COMMERCIAL M ERA Echo is returning 835s for payer ID 38219. Providers will need to enroll with Emdeon 75137 AmeriBen Solutions Inc. COMMERCIAL M EFT For St. Luke's Group Only 75137 AmeriBen Solutions Inc. COMMERCIAL M 75137 AmeriBen Solutions Inc. COMMERCIAL M Claims 54763 AmeriHealth Administrators COMMERCIAL M Claims 27357 AmeriHealth Caritas Louisiana COMMERCIAL M ERA 27357 AmeriHealth Caritas Louisiana COMMERCIAL M 27357 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

27357 AmeriHealth Caritas Louisiana COMMERCIAL M Claims 22248 AmeriHealth Caritas Pennsylvania COMMERCIAL M EFT 22248 AmeriHealth Caritas Pennsylvania COMMERCIAL M 22248 AmeriHealth Caritas Pennsylvania COMMERCIAL M ERA 22248 AmeriHealth Caritas Pennsylvania COMMERCIAL M Claims 77051 AmeriHealth Connect (AMERIHEALTH CARITAS) COMMERCIAL M ERA 77051 AmeriHealth Connect (AMERIHEALTH CARITAS) COMMERCIAL M Claims 77051 AmeriHealth Connect (AMERIHEALTH CARITAS) COMMERCIAL M EFT 23037 AmeriHealth HMO New Jersey and Delaware COMMERCIAL M Claims 77001 AmeriHealth NorthEast COMMERCIAL M ERA 77001 AmeriHealth NorthEast COMMERCIAL M 77001 AmeriHealth NorthEast COMMERCIAL M EFT 77001 AmeriHealth NorthEast COMMERCIAL M Claims 22355 AmeriHealth VIP Care PA COMMERCIAL M Claims 22355 AmeriHealth VIP Care PA COMMERCIAL M EFT 22355 AmeriHealth VIP Care PA COMMERCIAL M 22355 AmeriHealth VIP Care PA COMMERCIAL M ERA 16120 America's PPO COMMERCIAL M Claims 41178 America's TPA COMMERCIAL M Claims 27517 Americaid Community Care (Maryland) COMMERCIAL M Claims 27516 Americaid Community Care (New Jersey) COMMERCIAL M Claims 75240 American Administrative Group COMMERCIAL M Claims Call American Administrators (West Des Moines Iowa) COMMERCIAL M 63103 American Behavioral COMMERCIAL M Claims 95170 American Benefit Plan Administrators COMMERCIAL M Claims TH095 American Family Insurance COMMERCIAL M Claims American Family Medicare Supplement and PPO Policies 56071 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 e-mail edi@amerihealthcaritaspa.com or call 1-877-234-4272. Medicaid managed care. For EDI support please e-mail edi@amerihealthcaritaspa.com or call 1-877-234-4272. AmeriHealth Connect is effective 1/1/2015. Please note that this payer encourages early enrollment for EFT/ERA services. Please visit http://www.emdeon.com/epayment/ to early enroll. Pennsylvania Healthy PA Private Coverage Option? For EDI Support please email edi.amerihealthconnect@amerihealthcaritas.com or call 1-855-707-5823 AmeriHealth Connect is effective 1/1/2015. Please note that this payer encourages early enrollment for EFT/ERA services. Please visit http://www.emdeon.com/epayment/ to early enroll. Managed Medicaid Plan part of the AmeriHealth Caritas Family of Companies.For EDI support please e-mail edi.ahn@amerihealthnortheast.com or call 1-877-234-4272. Managed Medicaid Plan part of the AmeriHealth Caritas Family of Companies.For EDI support please e-mail edi.ahn@amerihealthnortheast.com or call 1-877-234-4272. 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

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 56071 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 56071 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 62030 American General COMMERCIAL M ERA 62030 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 36369 American Imaging Management Inc. COMMERCIAL M Claims 74048 American National Ins. Co. (ANICO) COMMERCIAL M Claims 44444 American Postal Workers Union Health Plan COMMERCIAL M ERA 44444 American Postal Workers Union Health Plan COMMERCIAL M Claims 48055 American Progressive Life and Health Insurance Company COMMERCIAL M Claims 42011 American Republic Insurance COMMERCIAL M Providers wishing to receive ERA or issues with ERA must contact the payer Directly at 1-866-620-2420 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) 252-2021. Medicare Supplement COB claims only accepted via electronic Medicare crossover 42011 American Republic Insurance COMMERCIAL M EFT Medicare Supplement COB claims only accepted via electronic Medicare crossover 42011 American Republic Insurance COMMERCIAL M Claims Medicare Supplement COB claims only accepted via electronic Medicare crossover 42011 American Republic Insurance COMMERCIAL M ERA Medicare Supplement COB claims only accepted via electronic Medicare crossover 43146 American Specialty Health COMMERCIAL M Claims 56195 American Trust Administrators Inc. COMMERCIAL M Claims TH117 American Whole Health Networks COMMERCIAL M Claims 37322 American Worker Health Plan COMMERCIAL M Claims 26078 Americas 1st Choice Health Plans of North Carolina Inc. COMMERCIAL M Claims 20553 Americas 1st Choice Health Plans of South Carolina Inc. COMMERCIAL M Claims 58379 Americas Choice Healthplans LLC COMMERCIAL M ERA Echo is returning 835s for payer ID 20029. Providers will need to enroll with Emdeon 27514 Amerigroup Community Care COMMERCIAL M Claims 27514 Amerigroup Corporation (Ft Worth) COMMERCIAL M Claims Formally Americaid Community Care (Dallas/Ft. Worth). 27515 Amerigroup Corporation (Houston) COMMERCIAL M Claims Formerly Americaid Community Care (Houston). 27519 Amerigroup Florida COMMERCIAL M Claims 27518 Amerigroup Illinois COMMERCIAL M Claims 27518 Amerigroup Ohio COMMERCIAL M Claims 27514 Amerigroup RealSolutions COMMERCIAL M EFT Providers must enroll with their Amerigroup PIN as the Provider ID. Medicaid providers can call 1-800-454-3730. Medicare providers can call 1-866-805-4589. 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

77002 Amerihealth District of Columbia COMMERCIAL M ERA For EDI support please e-mail edi.dc@ amerihealthdc.com or call 1-888-656-2383 77002 Amerihealth District of Columbia COMMERCIAL M Claims For EDI support please e-mail edi.dc@ amerihealthdc.com or call 1-888-656-2383 77002 Amerihealth District of Columbia COMMERCIAL M EFT 77002 Amerihealth District of Columbia COMMERCIAL M 77007 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 http://www.emdeon.com/epayment/ to early enroll. 77007 Amerihealth VIP Care- DC COMMERCIAL M 77007 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 http://www.emdeon.com/epayment/ to early enroll. 77007 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 77006 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 http://www.emdeon.com/epayment/ to early enroll. 77006 Amerihealth VIP Care- LA COMMERCIAL M 77006 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 http://www.emdeon.com/epayment/ to early enroll. 77006 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 24818 Amida Care COMMERCIAL M Claims Formerly known as VidaCare 79966 Amida Care Medicare COMMERCIAL M Claims 53085 Anchor Benefit Consulting Inc. COMMERCIAL M Claims 86062 Ancillary Benefit Services (ABS) COMMERCIAL M Claims 3172 Ancillary Care Management/ACM COMMERCIAL M Claims 75299 Angeles IPA (SynerMed) COMMERCIAL M EFT 75299 Angeles IPA (SynerMed) COMMERCIAL M 75299 Angeles IPA (SynerMed) COMMERCIAL M Claims 34196 Apex Benefit Services COMMERCIAL M Claims Apex is also a Medicaid payer and will accept claims with either a Medicaid or Commercial classification 51909 Apogee Health Partners Inc COMMERCIAL M Claims APP01 AppleCare Medical Management COMMERCIAL M Claims 52312 Arbor Health Plan COMMERCIAL M 52312 Arbor Health Plan COMMERCIAL M Claims Medicaid Managed Care Plan part of the Amerihealth Caritas Family of Companies.For EDI support please e-mail edi@arborhealthplan.com or call 1-877-693-8483. 52312 Arbor Health Plan COMMERCIAL M EFT Revised 02/18/2015 ICS Software, Ltd. Page 10 of 87

52312 Arbor Health Plan COMMERCIAL M ERA Medicaid Managed Care Plan part of the Amerihealth Caritas Family of Companies.For EDI support please e-mail edi@arborhealthplan.com or call 1-877-693-8483. 77045 Arcadian Management Services Inc COMMERCIAL M Claims 77045 Arcadian Management Services Inc COMMERCIAL M ARGUS Argus Dental Plans COMMERCIAL M Claims 86062 Arizona Foundation for Medical Care (AFMC) COMMERCIAL M Claims 27154 Arizona Priority Care Plus COMMERCIAL M Claims 75278 Arkansas Best Corporation - Choice Benefits COMMERCIAL M ERA 75278 Arkansas Best Corporation - Choice Benefits COMMERCIAL M Claims 36335 Arkansas Managed Care Organization Inc. (AMCO) COMMERCIAL M Claims 87726 Arnett Health Plan COMMERCIAL M Claims Former Payer ID 95440 NMM01 Arroyo Vista Family Health Center COMMERCIAL M Claims 51909 Asian Human Services Family Family Health Network patients only COMMERCIAL M Claims 16180 Aspen COMMERCIAL M Claims 46156 Aspire Health Plan COMMERCIAL M Claims 13788 Associated Administrators LLC. COMMERCIAL M 50266 Associated Benefits COMMERCIAL M Claims 36326 Associates for Health Care Inc. (AHC) COMMERCIAL M Claims 25133 Association Benefit Plan COMMERCIAL M Claims 37294 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 787-767-2020 39065 Assurant Health (IM & GROUP FULLY-INSURED) COMMERCIAL M ERA 39065 Assurant Health (IM & GROUP FULLY-INSURED) COMMERCIAL M EFT 39065 Assurant Health (IM & GROUP FULLY-INSURED) COMMERCIAL M Claims 75068 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 5/1/2013 37313 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 5/1/2013 58730 Assurant Health/ASA (Assurant Health members with ASA PPO Network) COMMERCIAL M Claims ASA PPO Network (aka Aetna Signature Administrators? PPO Network) 74240 Assured Benefits Administrators COMMERCIAL M Claims 93221 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. 95691 Athens Area Health Plan Select COMMERCIAL M Claims 22285 Atlantic Medical Insurance COMMERCIAL M Claims 13853 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. 37242 Aultra Administrative Group COMMERCIAL M Claims Payer ID valid only for claims with a billing submission address of P.O. Box 35276 Canton OH 44735-5276 Revised 02/18/2015 ICS Software, Ltd. Page 11 of 87

38259 Automated Benefit Services COMMERCIAL M 38259 Automated Benefit Services COMMERCIAL M Claims 37280 Automated Group Administration Inc. COMMERCIAL M Claims 26202 Auxiant COMMERCIAL M EFT 26202 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 260-489-6447 (703). 59274 AvMed Inc. COMMERCIAL M Claims The Insured ID and Patient ID fro this payer must be the 11-digit Member ID. 59274 AvMed Inc. COMMERCIAL M ERA Providers must enroll for EFT in order to receive electronic remittance http://www.emdeon.com/epayment/enrollment/index.php. 59274 AvMed Inc. COMMERCIAL M EFT 46045 Avera Health Plans COMMERCIAL M Claims 48055 AveraAdvantage COMMERCIAL M Claims 87098 Avesis Third Party Administrators COMMERCIAL M Claims This payer is live for VISION CLAIMS ONLY. 49153 BCI Administrators Inc. COMMERCIAL M Claims 56139 BENEFIT MANAGEMENT SERVICES COMMERCIAL M Claims 84129 BHI (Behavioral Health Inc.) COMMERCIAL M ERA 84129 BHI (Behavioral Health Inc.) COMMERCIAL M EFT 13337 BMC HealthNet Plan COMMERCIAL M Claims Submissions to BMCHP must include the correct 12 digit BMCHP Provider ID # including all leading zeros. 73139 BMI Health Plans COMMERCIAL M Call BSI COMMERCIAL M Claims To obtain the payer ID please call (440) 262-1160. 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 2015. 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

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 65026 Baptist Health South Florida COMMERCIAL M Claims NCH06 Bascom Palmer Eye Care Network - New Century Health COMMERCIAL M Claims 43324 Beacon Health Strategies COMMERCIAL M Claims 95377 Beech Street COMMERCIAL M Claims 63100 Behavioral Health Systems COMMERCIAL M Claims MPMOA Bella Vista Med Grp IPA COMMERCIAL M Claims 75299 Bellflower Hospital (Synermed) COMMERCIAL M Claims 99320 Benefit & Risk Management Services COMMERCIAL M Claims 32748 Benefit Administration Services COMMERCIAL M 36149 Benefit Administrative Systems COMMERCIAL M ERA 36149 Benefit Administrative Systems COMMERCIAL M 36149 Benefit Administrative Systems COMMERCIAL M Claims 81140 Benefit Assistance Corp. COMMERCIAL M 25145 Benefit Coordinators Corporation (Pittsburgh PA) COMMERCIAL M Claims 74266 Benefit Management Administrators COMMERCIAL M Claims 74266 Benefit Management Administrators COMMERCIAL M 27172 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 15205. Revised 02/18/2015 ICS Software, Ltd. Page 13 of 87

36459 Benefit Management Group-NV COMMERCIAL M Claims Providers submit to 36459 for HSC Coalition Hospital Dental BHO or NON PPO CLAIMS ONLY. All others should be filed with CIGNA ID 62308. 999 Benefit Management Services Inc. COMMERCIAL M Claims 37212 Benefit Management Systems Inc COMMERCIAL M 37212 Benefit Management Systems Inc COMMERCIAL M Claims 48611 Benefit Management Inc. of KS COMMERCIAL M Claims 58379 Benefit Plan Administrators COMMERCIAL M ERA 88052 Benefit Plan Administrators COMMERCIAL M Claims 39081 Benefit Plan Administrators Co. (Eau Claire WI) COMMERCIAL M 39081 Benefit Plan Administrators Co. (Eau Claire WI) COMMERCIAL M Claims 37118 Benefit Plan Administrators Inc COMMERCIAL M Claims 37118 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 39081. Providers will need to enroll with Emdeon Payer ID valid for Benefit Plan Administrators (Eau Claire WI submission address only) and Custom Benefit Administrators 58379 Benefit Plan Services Inc COMMERCIAL M ERA Echo is returning 835s for payer ID. Providers will need to enroll with Emdeon for payer ID 58370 with Emdeon in order to receive these 835s for this payer Call Benefit Services COMMERCIAL M 36342 Benefit Systems & Services Inc. COMMERCIAL M Claims Now known as Total Broker Benefits Payer ID 36342 23243 Berkshire Health Partners - PPO Wyomissing PA (IHS Gateway Payer) COMMERCIAL M Claims 10956 Berkshire Intergroup COMMERCIAL M Claims 95606 Berkshire Lehigh Partners COMMERCIAL M Claims 95604 Best Life & Health Insurance Co. COMMERCIAL M Claims 32006 Better Health Plans of South Carolina COMMERCIAL M Claims 62183 Better Health Plans Inc. COMMERCIAL M Claims Now known as Unison Health Plan 3036 Blue Benefit Administrators of MA COMMERCIAL M Claims 77078 Blue Cross Blue Shield of Arizona Advantage COMMERCIAL M ERA 77078 Blue Cross Blue Shield of Arizona Advantage COMMERCIAL M Claims This is a Medicare Advantage Plan 77078 Blue Cross Blue Shield of Arizona Advantage COMMERCIAL M 77078 Blue Cross Blue Shield of Arizona Advantage COMMERCIAL M EFT 77307 Blue Cross and Blue Shield of Vermont COMMERCIAL M 77307 Blue Cross and Blue Shield of Vermont COMMERCIAL M EFT Tax ID and Practice Group NPI are required for EFT enrollment. 99105 Blue Shield of California - Medicare Advantage Encounters COMMERCIAL M Encounters 51909 BlueAdvantage HMO COMMERCIAL M Claims 61124 Bluegrass Family Health COMMERCIAL M EFT 61124 Bluegrass Family Health COMMERCIAL M ERA 61124 Bluegrass Family Health COMMERCIAL M Revised 02/18/2015 ICS Software, Ltd. Page 14 of 87

61124 Bluegrass Family Health COMMERCIAL M Claims All providers should send claims to Bluegrass Family Health PID 61124 36609 Boilermakers National Health & Welfare Fund COMMERCIAL M Claims 74238 Boon-Chapman Benefit Administrators Inc. COMMERCIAL M Claims 13337 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. 13337 Boston Medical Center Health Plan Inc. COMMERCIAL M Encounters 52192 Bravo Health COMMERCIAL M Claims 52192 Bravo Health Star Plus COMMERCIAL M EFT 52192 Bravo Health Star Plus COMMERCIAL M Claims 52192 Bravo Health Star Plus COMMERCIAL M ERA BRIDG BridgeSpan COMMERCIAL M Claims 68069 Bridgeway Arizona COMMERCIAL M Claims Prior to submitting claims please call Provider Relations Dept at 1-866-475-3129 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. 68069 Bridgeway Arizona COMMERCIAL M ERA 22286 BritCay COMMERCIAL M Claims 35182 Brodart COMMERCIAL M Claims 51037 Brokerage Concepts COMMERCIAL M Claims Call Brokerage Service Inc COMMERCIAL M Claims To obtain the payer ID please call (440) 262-1160. 37314 Broward Health COMMERCIAL M Claims 94316 Brown & Toland Medical Group COMMERCIAL M Claims BTSS1 Brown & Toland Sutter Select COMMERCIAL M Claims 68069 Buckeye Community Health COMMERCIAL M ERA 68069 Buckeye Community Health COMMERCIAL M Claims Prior to submitting claims please call Provider Relations Dept at 1-866-296-8731 to verify your provider info is on file in the claim system. This will prevent rejections and allow payments to be made in a timely manner. 42150 Butler Benefit COMMERCIAL M 42150 Butler Benefit COMMERCIAL M Claims 23708 C&O Employees Hospital Association COMMERCIAL M Claims 73071 C. L. Frates & Co - OSMA Health COMMERCIAL M Claims 58379 C.A.S. COMMERCIAL M ERA Echo is returning 835s for payer ID CAS01. Providers will need to enroll with Emdeon 38247 CAM Administrative Services COMMERCIAL M 95399 CAP Management Systems COMMERCIAL M Claims 57115 CARE 1ST HEALTH PLAN OF CA COMMERCIAL M Claims 3036 CBA Blue COMMERCIAL M Claims Formerly known as Comprehensive Benefits Administrator Inc. 58379 CBCA Administrators Inc COMMERCIAL M ERA Echo is returning 835s for payer ID. Providers will need to enroll with Emdeon for payer ID 58370 with Emdeon in order to receive these 835s for this payer 51909 CCHHS-FHN COMMERCIAL M Claims SX065 CDPHP COMMERCIAL M Claims Par for Billing 88022 CDS Group Health COMMERCIAL M Claims 23171 CHA Health COMMERCIAL M Claims 80214 CHAMPVA HAC MEDICARE CROSSOVER COMMERCIAL M ERA 84146 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

84146 CHAMPVA - HAC COMMERCIAL M ERA 835s are not returned on paper claims 25133 CHC of Delaware COMMERCIAL M EFT 25133 CHC of Florida COMMERCIAL M EFT 25133 CHC of Georgia COMMERCIAL M EFT 25133 CHC of Illinois COMMERCIAL M EFT 25133 CHC of Iowa COMMERCIAL M EFT 25133 CHC of Kansas COMMERCIAL M EFT 25133 CHC of Louisiana COMMERCIAL M EFT 25133 CHC of Missouri COMMERCIAL M EFT 25133 CHC of Nebraska COMMERCIAL M EFT 25133 CHC of Texas COMMERCIAL M EFT 25133 CHC of Virginia COMMERCIAL M EFT 25133 CHC of West Virginia COMMERCIAL M EFT 59295 CHCS Services COMMERCIAL M 75895 CHCS Services Inc. COMMERCIAL M ERA 90441 CHP DIRECT SUPERMED COMMERCIAL M Claims Call CHP/RPU (FABOH) COMMERCIAL M Claims 62308 CIGNA COMMERCIAL M ERA 62308 CIGNA COMMERCIAL M Claims 62308 CIGNA - PPA COMMERCIAL M Claims 62308 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) 210-6656 to obtain. Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at http://www.emdeon.com/enrollnow/ Revised 02/18/2015 ICS Software, Ltd. Page 16 of 87

62308 CIGNA Health Plan - HMO COMMERCIAL M Claims 86033 CIGNA Medicare Advantage COMMERCIAL M Claims 58086 CIGNA-Central Reserve Life Insurance Company COMMERCIAL M ERA 58086 CIGNA-Central Reserve Life Insurance Company COMMERCIAL M EFT NPI required 58086 CIGNA-Continental General Insurance Company COMMERCIAL M EFT NPI required 58086 CIGNA-Continental General Insurance Company COMMERCIAL M ERA 58086 CIGNA-Great American Life Insurance Company COMMERCIAL M EFT NPI required 58086 CIGNA-Great American Life Insurance Company COMMERCIAL M ERA 58086 CIGNA-Loyal American Life Insurance Company COMMERCIAL M EFT NPI required 58086 CIGNA-Loyal American Life Insurance Company COMMERCIAL M ERA 58086 CIGNA-Provident American Life & Health Insurance Company COMMERCIAL M ERA 58086 CIGNA-Provident American Life & Health Insurance Company COMMERCIAL M EFT NPI required 58086 CIGNA-United Teacher Associates Insurance Company COMMERCIAL M EFT NPI required 58086 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 37227 CNIC Health Solutions Inc. COMMERCIAL M ERA 37227 CNIC Health Solutions Inc. COMMERCIAL M Claims 60495 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 jlouth@cnichs.com to request to be set up for ERA 35199 COOPERATIVE MANAGED CARE SERVICES COMMERCIAL M Claims To obtain the payer ID for this payer please contact CMCS Customer Service at (800) 352-7502 42141 CTI Administrators Inc. COMMERCIAL M EFT 42141 CTI Administrators Inc. COMMERCIAL M ERA 42141 CTI Administrators Inc. COMMERCIAL M Claims 57080 CWIBENEFITS INC. COMMERCIAL M Claims 57080 CWIBENEFITS INC. COMMERCIAL M 51909 Cadence Physician Group COMMERCIAL M Claims CALOP Cal-Optima Direct COMMERCIAL M Claims NCH05 California Eye Care - New Century Health COMMERCIAL M Claims 68047 California Health & Wellness COMMERCIAL M Claims The Provider Services # is 1-877-658-0305. 94056 California Pacific Medical Center COMMERCIAL M Claims 51909 CampusCare COMMERCIAL M Claims 71057 Cannon Cochran Management Services Inc. Metairie LA COMMERCIAL M EFT 71057 Cannon Cochran Management Services Inc. Metairie LA COMMERCIAL M 71057 Cannon Cochran Management Services Inc. Metairie LA COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 17 of 87

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 95112 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 850-523-7361 to register your NPI numbers with them. 58379 Capitol Administrators COMMERCIAL M ERA 68011 Capitol Administrators COMMERCIAL M 68011 Capitol Administrators COMMERCIAL M Claims 6607 Cardinal Innovations Healthcare Solutions COMMERCIAL M Claims 6607 Cardinal Innovations Healthcare Solutions COMMERCIAL M ERA 57116 Care 1st Health Plan of Arizona COMMERCIAL M Claims 65062 Care Access Health Plan (CAHP) COMMERCIAL M Claims 65062 Care Access Health Plan (CAHP) COMMERCIAL M ERA 77082 Care Improvement Plus COMMERCIAL M ERA 77082 Care Improvement Plus COMMERCIAL M Claims 41222 Care To Care COMMERCIAL M Claims 27004 Care Wisconsin FIrst Inc COMMERCIAL M ERA 27004 Care Wisconsin FIrst Inc COMMERCIAL M Claims 11345 CareCentrix COMMERCIAL M ERA 11345 CareCentrix COMMERCIAL M Claims 14182 CareCore National COMMERCIAL M Claims 14179 CareCore National LLC (Aetna Radiology Claims) COMMERCIAL M Claims 14180 CareCore National LLC (Oxford Radiology Claims) COMMERCIAL M Claims 14188 CareCore/WCNY RAD COMMERCIAL M Claims 75190 CareFirst Administrators/NCAS COMMERCIAL M Echo is returning 835s for payer ID 68011. 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='https://www.carecentrixportal.com/providerportal/homepage.do'>https://ww w.carecentrixportal.com/providerportal/homepage.do</a> Enrollment required prior to claim submission. Please contact EDIInfo@CareCentrix.com 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. 75190 CareFirst Administrators/NCAS COMMERCIAL M EFT Visit www.emdeon.com/epayment/enrollment to enroll with Emdeon epayment online by email through the mail or by fax. There is no cost to you to use Emdeon epayment and enrollment is FREE. 75190 CareFirst Administrators/NCAS COMMERCIAL M Claims 75191 CareFirst Administrators/NCAS COMMERCIAL M Claims 93975 CareOregon Inc. COMMERCIAL M Claims NCH04 CarePlus Cardiology - New Century Health COMMERCIAL M Claims NCH01 CarePlus Dermatology - New Century Health COMMERCIAL M Claims 65031 CarePlus Health Plans Inc. COMMERCIAL M ERA Must call the payer and register for ERA 866.220.5448.#6#4 65031 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

KYCS1 CareSource KY COMMERCIAL M Claims 31114 CareSource OH COMMERCIAL M Claims 25133 Carelink Medicaid COMMERCIAL M Claims 25133 Carelink Medicaid COMMERCIAL M ERA CARMO Caremore COMMERCIAL M Claims CM001 Caremore COMMERCIAL M CM001 Caremore COMMERCIAL M EFT CM001 Caremore COMMERCIAL M ERA 25133 Carenet COMMERCIAL M ERA 25133 Carenet COMMERCIAL M Claims 77023 Carepoint Health Plans COMMERCIAL M ERA 77023 Carepoint Health Plans COMMERCIAL M Claims INCS1 Caresource Indiana Inc COMMERCIAL M Claims 10010 Careworks COMMERCIAL M Claims 77015 Carilion Clinic Medicare Health Plan COMMERCIAL M Claims 29076 Carolina Care Plan COMMERCIAL M Claims Carolina Care Plan is part of the Medical Mutual Family of Companies. Former payer ID 57105. CX101 Carpenters Health and Welfare Fund of Philadelphia COMMERCIAL M Claims 95166 Cedars-Sinai Medical Network Services COMMERCIAL M Claims 95167 Cedars-Sinai Medical Network Services COMMERCIAL M Encounters 68069 CeltiCare COMMERCIAL M Claims 68069 CeltiCare COMMERCIAL M ERA 68063 Celtic Insurance COMMERCIAL M Claims 68063 Celtic Insurance COMMERCIAL M 68063 Celtic Insurance COMMERCIAL M EFT 68063 Celtic Insurance COMMERCIAL M ERA 91136 Cement Masons & Plasterers Health & Welfare Trust COMMERCIAL M Claims Please enter Group Number (F16) when submitting claims. 91136 Cement Masons and Plasterers Health & Welfare Trust COMMERCIAL M ERA 91136 Cement Masons and Plasterers Health & Welfare Trust COMMERCIAL M EFT 68068 Cenpatico - Arizona COMMERCIAL M Claims 68068 Cenpatico - FL COMMERCIAL M Claims 68068 Cenpatico - Georgia COMMERCIAL M Claims 68068 Cenpatico - Indiana COMMERCIAL M Claims 68068 Cenpatico - OHIO COMMERCIAL M Claims 68068 Cenpatico - WI COMMERCIAL M Claims 68068 Cenpatico Behavioral Health COMMERCIAL M Claims Prior to submitting claims please call Provider Relations Dept at 1-866-495-6748 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 1-800-947-0633 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 1-877-647-4848 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

68068 Cenpatico Behavioral Health Texas COMMERCIAL M Claims 68068 Cenpatico Massachuetts COMMERCIAL M Claims 68068 Cenpatico New Hampshire COMMERCIAL M Claims 68068 Cenpatico South Carolina COMMERCIAL M Claims 42138 Cenpatico TPA COMMERCIAL M Claims 36474 Centegra Health System COMMERCIAL M ERA 36474 Centegra Health System COMMERCIAL M Claims 68068 Centene Advantage Plans COMMERCIAL M Claims 42139 Centene TPA COMMERCIAL M Claims 94312 Center for Elders Independence COMMERCIAL M Claims 13360 CenterLight Healthcare COMMERCIAL M Claims 13360 CenterLight Healthcare COMMERCIAL M EFT 13360 CenterLight Healthcare COMMERCIAL M 13360 CenterLight Healthcare COMMERCIAL M ERA 56122 CenterPoint Human Services COMMERCIAL M Claims 56122 CenterPoint Human Services COMMERCIAL M ERA 26041 Central California Women's Health COMMERCIAL M Claims 36314 Central DuPage Physician Group COMMERCIAL M Claims 34097 Central Reserve Life COMMERCIAL M 34097 Central Reserve Life COMMERCIAL M EFT Prior to submitting claims please call Provider Relations Dept at 1-800-716-5650 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. www.cphs.org Complete Enrollment Form and return to the payer. 34097 Central Reserve Life COMMERCIAL M Claims Only Non Medicare Supplement and Dental lines of business administered under this payer ID. 34097 Central Reserve Life COMMERCIAL M ERA Non Medicare Supplement. www.americanrepublic.com 13193 Central Reserve Life Ins Co-Medicare Supplement COMMERCIAL M Claims 62218 Central SeniorCare COMMERCIAL M Claims 36215 Central States Health & Welfare Funds COMMERCIAL M Claims 55731 Central Susquehanna Healthcare Providers (CSHP) COMMERCIAL M Claims 77035 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 51909 Centro De Salud Esperanza COMMERCIAL M Claims 42140 Centurion COMMERCIAL M Claims 48120 Century Health Solutions COMMERCIAL M Claims 51909 Century PHO COMMERCIAL M Claims 36393 Century PHO INC COMMERCIAL M Claims 20356 Cerner HealthPlan Services COMMERCIAL M Claims 16600 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 1-800-956-8000 prior to initial submission of claims. To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche 858-824-7100 TRausche@scpmcs.org To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche 858-824-7100 TRausche@scpmcs.org Revised 02/18/2015 ICS Software, Ltd. Page 20 of 87

59223 Chesapeake Life Insurance Company - Insurance Center COMMERCIAL M ERA 59223 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 982017 North Richland Hills TX 76182. 59223 Chesapeake Life Insurance Company - Insurance Center COMMERCIAL M EFT 59223 Chesapeake Life Insurance Company - Insurance Center COMMERCIAL M 34154 Chesterfield Resources Inc. COMMERCIAL M 34154 Chesterfield Resources Inc. COMMERCIAL M Claims 51909 Chicago Family Health Center Family Health Network patients only COMMERCIAL M Claims AMM03 Child Health and Disability Prevention Treatment COMMERCIAL M Claims 94321 Children First Medical Group COMMERCIAL M Claims For questions regarding claim status providers will need to contact payer: CFMG Provider Customer Service 510-428-3154. 84146 Children of Women Vietnam Veterans-VA HAC COMMERCIAL M ERA 835s are not returned on paper claims 84146 Children of Women Vietnam Veterans-VA HAC COMMERCIAL M Claims 37314 Children's Medical Services - Broward NORTH COMMERCIAL M Claims CPMG1 Childrens Physician Medical Group COMMERCIAL M Claims 94302 Chinese Community Health Plan COMMERCIAL M Claims 38308 Christian Brothers Services COMMERCIAL M 38308 Christian Brothers Services COMMERCIAL M Claims 59355 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 51909 Christian Community Health Center COMMERCIAL M Claims 10629 Christus Health Medicare Advantage COMMERCIAL M Claims 10629 Christus Health Medicare Advantage COMMERCIAL M ERA 21062 Christus Health New Mexico HIX COMMERCIAL M ERA 21062 Christus Health New Mexico HIX COMMERCIAL M Claims 52192 Cigna-Healthspring COMMERCIAL M Claims 52192 Cigna-Healthspring COMMERCIAL M EFT 52192 Cigna-Healthspring COMMERCIAL M ERA 46871 Cincinnati Financial Corporation COMMERCIAL M Claims 51909 Circle Family Healthcare Network COMMERCIAL M Claims 61064 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 43056 Claims Development Corporation COMMERCIAL M Claims 11752 ClaimsBridge HPN COMMERCIAL M Claims 57080 ClaimsWare Inc. dba ManageMed COMMERCIAL M Claims 77201 Clearchoice Health Plan / COIHS COMMERCIAL M Claims SX009 CoOportunity Health COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 21 of 87

SX009 CoOportunity Health COMMERCIAL M ERA 77052 Coastal Administrative Services COMMERCIAL M 77052 Coastal Administrative Services COMMERCIAL M Claims 58379 Coastal TPA Inc COMMERCIAL M ERA 38335 Cofinity COMMERCIAL M Claims 22284 Colonial Medical COMMERCIAL M Claims 84129 Colorado Access COMMERCIAL M EFT 84129 Colorado Access COMMERCIAL M ERA 84129 Colorado Access COMMERCIAL M Claims 49718 Colorado Health OP COMMERCIAL M Claims 91162 Columbia United Providers COMMERCIAL M 91162 Columbia United Providers COMMERCIAL M EFT 91162 Columbia United Providers COMMERCIAL M Claims 34181 Commerce Benefits Group COMMERCIAL M Claims 34181 Commerce Benefits Group COMMERCIAL M EFT 34181 Commerce Benefits Group COMMERCIAL M 14315 Commonwealth Care Alliance COMMERCIAL M Claims 51909 Community Care Alliance of Illinois COMMERCIAL M Claims 23282 Community Care BHO COMMERCIAL M Claims 60995 Community Care Inc. - Family Care (Wisconsin) COMMERCIAL M Claims 39126 Community Care Inc. (Wisconsin) COMMERCIAL M Claims 73143 Community Care Managed Health Care Plans of Oklahoma COMMERCIAL M Claims 73143 Community Care Managed Health Care Plans of Oklahoma COMMERCIAL M ERA TH005 Community First COMMERCIAL M Claims 42723 Community First Health Plan COMMERCIAL M EFT 42723 Community First Health Plan COMMERCIAL M 42723 Community First Health Plan COMMERCIAL M ERA 35193 Community Health Alliance COMMERCIAL M Claims 58379 Community Health Alliance COMMERCIAL M ERA 27905 Community Health Alliance TN COMMERCIAL M Claims 48145 Community Health Choice COMMERCIAL M Claims 48145 Community Health Choice COMMERCIAL M ERA 75261 Community Health Electronic Claims/CHEC/webTPA COMMERCIAL M ERA 75261 Community Health Electronic Claims/CHEC/webTPA COMMERCIAL M Claims 75261 Community Health Electronic Claims/CHEC/webTPA COMMERCIAL M EFT 75261 Community Health Electronic Claims/CHEC/webTPA COMMERCIAL M SB613 Community Health Plan Washington COMMERCIAL M Claims 66121 Community Medical Group of the West Valley Inc. COMMERCIAL M Claims Echo is returning 835s for payer ID 77052. Providers will need to enroll with Emdeon Payer requires registration at their site in addition to ERA Provider set up: http://www.ccok.com/providers/forms.asp. Echo is returning 835s for payer ID 71063. Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 22 of 87

95192 CommunityConnect HealthPlan COMMERCIAL M Claims Provider Services: (877) 350-6074 34177 Comp - Ohio (Austintown OH) COMMERCIAL M Claims 37297 CompBenefits Corporation COMMERCIAL M Claims 95192 Compcare (Wisconsin BadgerCare only) COMMERCIAL M Claims Provider Services: (866) 563-3020 58379 Complete Benefits Solutions COMMERCIAL M ERA Call Complimentary Health Plan COMMERCIAL M Claims 37363 Compsych COMMERCIAL M Claims 51909 Conerstone Medical Group COMMERCIAL M Claims 52196 Conifer (formerly InforMed) COMMERCIAL M Claims 55649 Conifer Value-Based Care COMMERCIAL M Claims 6105 ConnectiCare Inc COMMERCIAL M Claims Echo is returning 835s for payer ID 39170. Providers will need to enroll with Emdeon 6105 ConnectiCare Inc COMMERCIAL M ERA Also setup Payer ID 78375 ConnectiCare Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at http://www.emdeon.com/enrollnow. 78375 Connecticare - Medicare COMMERCIAL M ERA Payer Enrollment Required: Please call (212) 615-4362 Email: EMCEDI@emblemhealth.com 78375 Connecticare - Medicare COMMERCIAL M Claims 37307 Connecticut Carpenters Health Fund COMMERCIAL M Claims 62308 Connecticut General (CIGNA) COMMERCIAL M Claims 75284 Consolidated Associates Railroad COMMERCIAL M Claims 87843 Consolidated Health Plans COMMERCIAL M Claims L0260 Constellation Health COMMERCIAL M Claims 58112 Consumer Mutual of Michigan COMMERCIAL M EFT 58112 Consumer Mutual of Michigan COMMERCIAL M 58112 Consumer Mutual of Michigan COMMERCIAL M Claims 45321 Consumers Choice Health SC COMMERCIAL M Claims 29076 Consumers Life Insurance Company COMMERCIAL M Claims Consumers Life insurance Company is part of the Medical Mutual Family of Companies. 13193 Continental General Ins Co-Medicare Supplement COMMERCIAL M Claims 71404 Continental General Insurance Company COMMERCIAL M ERA Non Medicare Supplement 71404 Continental General Insurance Company COMMERCIAL M 71404 Continental General Insurance Company COMMERCIAL M EFT 71404 Continental General Insurance Company COMMERCIAL M Claims Only Non Medicare Supplemental lines of business administered under this payer ID. 46478 Continuum Health Solutions LLC COMMERCIAL M Claims 47046 Contractors Laborers Teamsters & Engineers COMMERCIAL M Claims 55544 Conversion Plan-APWU COMMERCIAL M Claims THCP9 Cook Children Star Plan COMMERCIAL M Claims TH104 Cook Children's Health Group COMMERCIAL M Claims 35149 Cook Group Health Plan COMMERCIAL M 35149 Cook Group Health Plan COMMERCIAL M Claims 52132 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 44444. Revised 02/18/2015 ICS Software, Ltd. Page 23 of 87

52132 Cooperative Benefit Administrators (CBA) COMMERCIAL M ERA 35199 Cooperative Managed Care Services COMMERCIAL M EFT 35199 Cooperative Managed Care Services COMMERCIAL M ERA 35199 Cooperative Managed Care Services LLC COMMERCIAL M 58204 Coordinated Medical Specialists COMMERCIAL M Claims 58231 Core Administrative Services COMMERCIAL M Claims 58379 Core Benefits Inc. COMMERCIAL M ERA Echo is returning 835s for payer ID COR01. Providers will need to enroll with Emdeon 58379 CoreSource COMMERCIAL M ERA Echo is returning 835s for payer ID 35182 75136 35183 35187. Providers will need to enroll with Emdeon for payer ID 58370 with Emdeon in order to receive these 835s for this payer 35182 CoreSource AZ MN COMMERCIAL M Claims For assistance 800-689-0106 35182 CoreSource AZ MN COMMERCIAL M ERA 48117 CoreSource KC COMMERCIAL M 48117 CoreSource KC COMMERCIAL M Claims For assistance send email to HIPAA@f-m-h.com 48117 CoreSource KC COMMERCIAL M ERA 75136 CoreSource Little Rock COMMERCIAL M 75136 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 800-689-0106. 75136 CoreSource Little Rock COMMERCIAL M ERA Must Notify Payer 35182 CoreSource MD PA IL COMMERCIAL M 35182 CoreSource MD PA IL COMMERCIAL M Claims For assistance 800-689-0106 35182 CoreSource NC IN COMMERCIAL M ERA 35182 CoreSource NC IN COMMERCIAL M Claims For assistance 800-689-0106 35183 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 800-689-0106. CoreSource OH COMMERCIAL M ERA Email address is payorid35183@coresource.com 35187 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 43160 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 35202 Cornerstone Benefit Adminstrators COMMERCIAL M Claims CB268 Cornerstone Preferred Resources COMMERCIAL M Claims 56116 Corporate Benefits Service Inc. (NC) COMMERCIAL M Claims Payer ID valid only for claims with a claims submission address of P.O. Box 12953 Charlotte NC 28220. 58379 Correct Care Solutions COMMERCIAL M ERA 58379 Correct Care Solutions - FBOP COMMERCIAL M ERA Echo is returning 835s for payer ID 62111. Providers will need to enroll with Emdeon Echo is returning 835s for payer ID 62111. Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 24 of 87

58102 Covenant Administrators Inc. (Atlanta GA) COMMERCIAL M 58102 Covenant Administrators Inc. (Atlanta GA) COMMERCIAL M Claims TH108 Covenant Management Systems COMMERCIAL M Claims 25133 Coventry Advantra Texas COMMERCIAL M Claims 25133 Coventry Health & Life (Oklahoma) COMMERCIAL M Claims 25133 Coventry Health & Life (Oklahoma) COMMERCIAL M ERA 25133 Coventry Health Care COMMERCIAL M Claims 25133 Coventry Health Care COMMERCIAL M Encounters 25133 Coventry Health Care COMMERCIAL M EFT 25133 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. 25133 Coventry Health Care Carelink Medicaid - West Virginia only COMMERCIAL M Claims 25133 Coventry Health Care National Network COMMERCIAL M Claims 25133 Coventry Health Care National Network COMMERCIAL M ERA 25133 Coventry Health Care of Delaware Inc COMMERCIAL M ERA 25133 Coventry Health Care of Florida COMMERCIAL M ERA Formerly CHC Florida/VISTA/Summit 25133 Coventry Health Care of Florida COMMERCIAL M Claims Formerly CHC Florida/VISTA/Summit 25133 Coventry Health Care of Florida Inc. COMMERCIAL M Claims 25133 Coventry Health Care of Georgia Inc COMMERCIAL M ERA 25133 Coventry Health Care of Georgia Inc. COMMERCIAL M Claims 25133 Coventry Health Care of Illinois COMMERCIAL M Claims Formerly PersonalCare/Coventry Health of Illinois 25133 Coventry Health Care of Illinois COMMERCIAL M ERA Formerly PersonalCare/Coventry Health of Illinois 25133 Coventry Health Care of Iowa Inc COMMERCIAL M ERA 25133 Coventry Health Care of Iowa Inc. COMMERCIAL M Claims 25133 Coventry Health Care of Kansas Inc COMMERCIAL M ERA 25133 Coventry Health Care of Kansas Inc. COMMERCIAL M Claims 25133 Coventry Health Care of Kansas Inc. COMMERCIAL M ERA 25133 Coventry Health Care of Louisiana Inc COMMERCIAL M ERA 25133 Coventry Health Care of Louisiana Inc. COMMERCIAL M Claims 25133 Coventry Health Care of Missouri COMMERCIAL M Claims Formerly Coventry Health Care/Group Health Plan 25133 Coventry Health Care of Missouri COMMERCIAL M ERA Formerly Coventry Health Care/Group Health Plan 25133 Coventry Health Care of Nebraska Inc COMMERCIAL M ERA 25133 Coventry Health Care of Nebraska Inc. COMMERCIAL M Claims 25133 Coventry Health Care of Nevada COMMERCIAL M ERA Formerly Coventry Health and Life Nevada 25133 Coventry Health Care of Nevada COMMERCIAL M Claims Formerly Coventry Health and Life Nevada 25133 Coventry Health Care of Virginia COMMERCIAL M Claims Formerly Southern Health Services Inc 25133 Coventry Health Care of Virginia COMMERCIAL M ERA Formerly Southern Health Services Inc 25133 Coventry Health Care of the Carolinas COMMERCIAL M Claims Formerly Wellpath 25133 Coventry Health Care of the Carolinas COMMERCIAL M ERA Formerly Wellpath 25133 Coventry Health and Life Insurance Company administered by PersonalCare COMMERCIAL M Claims 25133 Coventry Health and Life Insurance Company administered by PersonalCare COMMERCIAL M ERA 25133 Coventry Health and Life Insureance (Tennessee) COMMERCIAL M Claims 25133 Coventry Missouri COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 25 of 87

25133 Coventry National Accounts COMMERCIAL M EFT 25133 Coventry National Health Care Plans COMMERCIAL M ERA 25133 Coventry Summitt Health Plan Inc. COMMERCIAL M Claims 25133 Coventry of Health Care Delaware Inc. COMMERCIAL M Claims 25133 Coventry of the Carolinas COMMERCIAL M EFT 25133 CoventryCares of Kentucky COMMERCIAL M Claims 25133 CoventryCares of Kentucky COMMERCIAL M EFT 25133 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. 25133 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. 25133 CoventryCares of Michigan COMMERCIAL M Claims Formerly OmniCare - A Coventry Health Plan 25133 CoventryCares of Michigan COMMERCIAL M ERA Formerly OmniCare - A Coventry Health Plan 25133 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. 25133 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. 25133 CoventryCares of Nebraska COMMERCIAL M Claims Formerly Coventry Nebraska Medicaid 25133 CoventryCares of Nebraska COMMERCIAL M ERA Formerly Coventry Nebraska Medicaid 25133 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 25133 CoventryCares of Pennsylvania COMMERCIAL M EFT only if there are multiple bank accounts to ensure proper distribution of funds. 25133 CoventryCares of Pennsylvania COMMERCIAL M ERA Formerly Coventry Cares 25133 CoventryCares of Virginia COMMERCIAL M EFT 25133 CoventryCares of West Virginia COMMERCIAL M EFT 64068 Creative Medical Systems COMMERCIAL M Claims 37320 Creative Plan Administrators COMMERCIAL M Claims 56213 Crescent Health Solutions COMMERCIAL M Claims 37266 Croy-Hall Mgmt. Inc. COMMERCIAL M Claims 51909 Crusader Community Health Foundation COMMERCIAL M Claims 39170 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 982005 Ft. Worth TX 76182. Revised 02/18/2015 ICS Software, Ltd. Page 26 of 87

58379 Custom Benefit Administrators COMMERCIAL M ERA Echo is returning 835s for payer ID 39170. Providers will need to enroll with Emdeon 58379 Custom Design Benefits COMMERCIAL M ERA Echo is returning 835s for payer ID 82056. Providers will need to enroll with Emdeon 82056 Custom Design Benefits Inc. COMMERCIAL M 82056 Custom Design Benefits Inc. COMMERCIAL M Claims 39199 Cypress Benefit Administrators COMMERCIAL M Call D.H. EVANS & ASSOC. COMMERCIAL M Claims Call Jessica Picarde @ 410-349-3222 for Payer id. 77124 DELANO IPA COMMERCIAL M Claims DAK01 DakotaCare COMMERCIAL M ERA DAK01 DakotaCare COMMERCIAL M Claims CB987 Dart Member Care COMMERCIAL M Claims 39113 Dean Health Plan COMMERCIAL M ERA 39113 Dean Health Plan COMMERCIAL M EFT 39113 Dean Health Plan COMMERCIAL M Claims 27009 Delaware Physicians Care Inc. COMMERCIAL M 27009 Delaware Physicians Care Inc. COMMERCIAL M EFT Enroll with payer 27009 Delaware Physicians Care Inc. COMMERCIAL M Claims ERA setup form not required. Providers must enroll using the DPCI ERA Enrollment 27009 Delaware Physicians Care Inc. COMMERCIAL M ERA form and this must be submitted to DPCIProviderRelations@aetna.com 94235 Delta Health Systems COMMERCIAL M Claims Patient ID cards should be reviewed for claims submission instruction. 58379 Dental Blue COMMERCIAL M ERA 58379 Dental Blue Select COMMERCIAL M ERA 84135 Denver Health Medical Plan COMMERCIAL M Claims 84131 Denver Health Medical Plan Inc. - Medicare Choice COMMERCIAL M Claims 84133 Denver Health and Hospital Authority COMMERCIAL M Claims 84134 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 56240 Detroit Medical Center COMMERCIAL M Claims 25133 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 72467. Providers will need to enroll with Emdeon Echo is returning 835s for payer ID 72467. 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 858-824-7100 TRausche@scpmcs.org Revised 02/18/2015 ICS Software, Ltd. Page 27 of 87

Call Dr. Rivera COMMERCIAL M Encounters To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche 858-824-7100 TRausche@scpmcs.org DREYR Dreyer Health COMMERCIAL M Claims 74284 Driscoll Children's Health Plan COMMERCIAL M ERA 74284 Driscoll Children's Health Plan COMMERCIAL M Claims 35186 Dunn and Associates Benefits Administrators Inc. COMMERCIAL M Claims 34159 E-V Benefits Management Inc (Columbus OH) COMMERCIAL M Claims Now known as Meritain Health. 34108 E.S. BEVERIDGE & ASSOCIATES COMMERCIAL M Claims Call EBC Mid-America COMMERCIAL M Claims To obtain the payer ID please call (440) 262-1160. 31074 EBMC COMMERCIAL M Claims SX182 EBMS COMMERCIAL M Claims 34166 EBS OF OHIO COMMERCIAL M Echo is returning 835s for payer ID 27257. Providers will need to enroll with Emdeon 58379 EBSO COMMERCIAL M ERA Call EBSO Inc fka EBC Inc COMMERCIAL M Claims To obtain the payer ID please call (440) 262-1160. 58379 EBSO Inc. COMMERCIAL M ERA 58379 ECHO Health Inc. COMMERCIAL M 22521 EGID (Employees Group Insurance Division) COMMERCIAL M Claims 22521 EGID (Employees Group Insurance Division) COMMERCIAL M ERA 4326 ELDER SERVICE PLAN OF THE NORTH SHORE COMMERCIAL M Claims 94606 ELECTRICAL INDUSTRY SERVICE BUREAU COMMERCIAL M 59299 EMI-KP Ambulance Claims COMMERCIAL M Claims 62308 EQUICOR COMMERCIAL M Claims 62308 EQUICOR - PPO COMMERCIAL M Claims TH110 ERISA COMMERCIAL M Claims 20818 ESSENCE HEALTHCARE COMMERCIAL M Claims 20818 ESSENCE HEALTHCARE COMMERCIAL M ERA TH084 Early Intervention Central COMMERCIAL M Claims Echo is returning 835s for payer ID 37257. 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) 611-5191 to obtain Network ID prior to first submission. 56089 East Carolina Behavioral Health COMMERCIAL M Claims Payer does accept Secondary claims electronically. 56089 East Carolina Behavioral Health COMMERCIAL M ERA 75299 East LA - APMG COMMERCIAL M Claims Call Eastern Life and Health COMMERCIAL M 66122 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 31625 ElderPlan Inc. COMMERCIAL M ERA 31625 ElderPlan Inc. COMMERCIAL M EFT EFT is Live for Elderplan Revised 02/18/2015 ICS Software, Ltd. Page 28 of 87

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) 921-7979. 37253 Elmco COMMERCIAL M 37253 Elmco COMMERCIAL M Claims 13551 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 835 13551 Emblem Health (GHI - New York Group Health Inc.) COMMERCIAL M Claims 34167 Emerald Health Network Inc. (All PPO Business) COMMERCIAL M Claims 95600 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) 262-1160. Call Employee Benefit Claims of WI COMMERCIAL M Claims To obtain the payer ID please call (440) 262-1160. Call Employee Benefit Claims of Wisconsin COMMERCIAL M Claims To obtain the payer ID please call (440) 262-1160. 38241 Employee Benefit Concepts (Farmington Hills MI) COMMERCIAL M 38241 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) 262-1160. 31074 Employee Benefit Management Corp (EBMC) COMMERCIAL M Claims 31074 Employee Benefit Management Corp (EBMC) COMMERCIAL M 37216 Employee Benefit Services (Ft. Mill SC) COMMERCIAL M 37216 Employee Benefit Services (Ft. Mill SC) COMMERCIAL M ERA Payer is live with 4010 ERA format Emdeon to upconvert to 5010. 37216 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 58379 Employee Benefit Services Inc. COMMERCIAL M ERA 42149 Employee Benefit Systems COMMERCIAL M Claims 58379 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 37257. Providers will need to enroll with Emdeon 3036 Employee Benefits Plan Administration Inc. (E.B.P.A.) COMMERCIAL M Claims 75299 Employee Health System Medical Group COMMERCIAL M 75299 Employee Health System Medical Group COMMERCIAL M EFT 75299 Employee Health System Medical Group COMMERCIAL M Claims 35112 Employee Plans LLC COMMERCIAL M Claims 35112 Employee Plans LLC COMMERCIAL M CX031 Employer Plan Services Inc. COMMERCIAL M 75236 Employer's Direct Health - Employee Plan COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 29 of 87

75235 Employer's Direct Health - FI COMMERCIAL M Claims 75233 Employer's Direct Health - SF COMMERCIAL M Claims 75232 Employers Direct Health COMMERCIAL M Claims 59298 Employers Mutual Inc (Jacksonville Florida) COMMERCIAL M Claims 59331 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) 287-7650 ext. 4052. 35206 Encircle PPO COMMERCIAL M Claims 35206 Encore Health Network COMMERCIAL M Claims 91136 Enstar Natural Gas COMMERCIAL M Claims Please enter Group Number (P61) when submitting claims. 36878 Entrust COMMERCIAL M Claims Electronic Payer ID for Claims printed and mailed to payer. 73126 Equitable Plan Services (Oklahoma City OK) COMMERCIAL M Claims Payer ID valid only for claims with a billing submission address of P.O. Box 720460 Oklahoma City OK 73172. 73126 Equitable Plan Services (Oklahoma City OK) COMMERCIAL M 51909 Erie Family Health Center COMMERCIAL M Claims 35605 Everence COMMERCIAL M EFT 35605 Everence COMMERCIAL M 35605 Everence COMMERCIAL M Claims 58379 Evergreen COMMERCIAL M ERA 45319 Evergreen Health Cooperative COMMERCIAL M Claims 59313 Evolutions Healthcare Systems (New Port Richey FL) COMMERCIAL M Claims EXC01 Excel MSO COMMERCIAL M Claims 71412 ExclusiCare COMMERCIAL M Claims 65062 Eye Management Inc. (EMI) COMMERCIAL M Claims 65062 Eye Management Inc. (EMI) COMMERCIAL M ERA 63740 EyeQuest COMMERCIAL M Claims Call FABOH (CHP/RPU) COMMERCIAL M Claims 37300 FACS Group COMMERCIAL M Claims 37289 FARA Benefit Services Inc. COMMERCIAL M 51909 FHN- Risk COMMERCIAL M Claims 51909 FHN-Transportation COMMERCIAL M Claims 51909 FHN-UIHHSS COMMERCIAL M Claims FAMR1 FIRST ADMINISTRATORS INC COMMERCIAL M EFT FAMR1 FIRST ADMINISTRATORS INC COMMERCIAL M Claims 12611 FL Healthcare Plus COMMERCIAL M Claims 95411 FL MCO PHC/PHP COMMERCIAL M Claims 95432 Facey Medical Foundation COMMERCIAL M Claims 91136 Fairbanks North Star Borough COMMERCIAL M ERA 91136 Fairbanks North Star Borough COMMERCIAL M EFT Fairbanks North Star Borough School District Plan A 91136 (FNSBSD) COMMERCIAL M ERA Echo is returning 835s for payer ID 45319. Providers will need to enroll with Emdeon Payer ID valid for claims with a submission address of PO Box 5001 New Port Richey FL 34656. Payer ID rendering provider and location number required to submit claims. Please call Dave Sell at (608) 210-6656 to obtain. You must enroll with your TIN and Sub TIN. To obtain your Sub TIN call 1-800-206-0827. Revised 02/18/2015 ICS Software, Ltd. Page 30 of 87

Fairbanks North Star Borough School District Plan A 91136 (FNSBSD) COMMERCIAL M EFT 91136 Fairbanks North Star Borough School District Plan B (FNSBSD) COMMERCIAL M EFT 91136 Fairbanks North Star Borough School District Plan B (FNSBSD) COMMERCIAL M ERA 22254 Fallon Community Health Plan COMMERCIAL M Claims 45559 Fallon Total Care COMMERCIAL M Claims 51909 Family Christian Health Center Family Health Network patients only COMMERCIAL M Claims 31472 Family Health Partners - Healthwave of Kansas COMMERCIAL M Claims 31472 Family Health Partners - Healthwave of Kansas COMMERCIAL M ERA TH045 Family Health Plan COMMERCIAL M Claims 51909 Family Medicine Specialist INC COMMERCIAL M Claims 51909 Family Medicine Specialist of Round Lake COMMERCIAL M Claims 14140 Farm Family Life COMMERCIAL M Claims 25133 Federal Employees Health Benefit Plan (MHBP) COMMERCIAL M ERA 37300 Federated Benefits COMMERCIAL M Claims 37300 Federated HR Services COMMERCIAL M Claims 41041 Federated Mutual Insurance COMMERCIAL M ERA 41041 Federated Mutual Insurance COMMERCIAL M Claims 11315 Fidelis Care New York COMMERCIAL M Claims 77054 Fidelis Seniorcare COMMERCIAL M Claims 77054 Fidelis Seniorcare COMMERCIAL M ERA 88055 First Agency COMMERCIAL M Claims 56196 First Carolina Care COMMERCIAL M Claims 91131 First Choice Health Administrators COMMERCIAL M Claims 91131 First Choice Health Network COMMERCIAL M Claims 91131 First Choice Health Network COMMERCIAL M 37510 First Choice VIP Care COMMERCIAL M ERA 37510 First Choice VIP Care COMMERCIAL M Claims 37510 First Choice VIP Care COMMERCIAL M EFT 37510 First Choice VIP Care COMMERCIAL M 77009 First Choice VIP Care Plus - SC COMMERCIAL M Claims 77009 First Choice VIP Care Plus - SC COMMERCIAL M ERA 77009 First Choice VIP Care Plus - SC COMMERCIAL M EFT 77009 First Choice VIP Care Plus - SC COMMERCIAL M 75138 First Choice of Midwest (PPO) COMMERCIAL M Claims First Health Network (f.k.a. CCN Managed Care Inc. & PPO 73159 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 http://www.emdeon.com/epayment/ 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 http://www.emdeon.com/epayment/ to early enroll. Revised 02/18/2015 ICS Software, Ltd. Page 31 of 87

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 58203. 23241 First Priority COMMERCIAL M ERA Online Enrollment for ERA: https://www.bcnepa.com/era835/ 23241 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: http://www.bcnepa.com/edi/registrationform.aspx 59276 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 49096 FirstCare Health Plans COMMERCIAL M EFT 49096 FirstCare Health Plans COMMERCIAL M 11244 Fitzharris & Company Inc. COMMERCIAL M Claims 58379 Florida Health Administrators Inc COMMERCIAL M ERA Echo is returning 835s for payer ID FHA01. Providers will need to enroll with Emdeon 59322 Florida Health Care Plan COMMERCIAL M Claims 59321 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. 59321 Florida Hospital Healthcare Systems COMMERCIAL M ERA 48116 Florida Hospital Waterman COMMERCIAL M Claims For assistance send email to HIPAA@f-m-h.com 59698 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 953757 Lake Mary FL 32795-3757 26492 Florida True Health COMMERCIAL M EFT 26492 Florida True Health COMMERCIAL M Claims 26492 Florida True Health COMMERCIAL M 26492 Florida True Health COMMERCIAL M ERA 85362 Fnd For Medicare of Tulare & Kings Counties Inc COMMERCIAL M 85362 Fnd For Medicare of Tulare & Kings Counties Inc COMMERCIAL M ERA 85362 Fnd For Medicare of Tulare & Kings Counties Inc COMMERCIAL M EFT 25133 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 e-mail EDI@floridatruehealth.com or call 1-866-496-2722. Managed Medicaid Plan part of the AmeriHealth Mercy Family of Companies. For EDI support please e-mail EDI@floridatruehealth.com or call 1-866-496-2722. TKFMC Foundation for Medical Care of Tulare & Kings County COMMERCIAL M Claims 64069 Fox-Everett Inc. COMMERCIAL M Claims 31313 Freedom First COMMERCIAL M Claims 41212 Freedom Health Plan COMMERCIAL M Claims 23130 Fresenius Medical Care COMMERCIAL M ERA 23130 Fresenius Medical Care COMMERCIAL M Claims 75299 Fresno - ENH Medical Group COMMERCIAL M Claims 75299 Fresno - ENH Medical Group COMMERCIAL M EFT Revised 02/18/2015 ICS Software, Ltd. Page 32 of 87

75299 Fresno - ENH Medical Group COMMERCIAL M TKFMC Friant Water Users COMMERCIAL M Claims 51909 Friedell Managed Care Group COMMERCIAL M Claims 84068 Fringe Benefit Services COMMERCIAL M 59204 Fringe Benefits Coordinators COMMERCIAL M Claims 34171 FrontPath Health Coalition COMMERCIAL M Claims 45235 GEHA (Multiplan) COMMERCIAL M Claims 45275 GEHA (PHCS) COMMERCIAL M Claims MCS01 GEMCare (Golden Empire Managed Care System) COMMERCIAL M Claims 58379 GGMIT insured by Trustmark Insurance COMMERCIAL M ERA 25531 GHI HMO COMMERCIAL M Claims 25531 GHI HMO COMMERCIAL M ERA 80314 GIC Indemnity Plan COMMERCIAL M Claims 47083 GMS Inc. COMMERCIAL M Claims 30005 Galveston County Indigent Health Care COMMERCIAL M Claims 75299 Gardena Memorial Medical Center COMMERCIAL M Claims 60550 Gateway Health Plan - Medicare Assured COMMERCIAL M ERA 60550 Gateway Health Plan - Medicare Assured COMMERCIAL M Claims 25169 Gateway Health Plan Medicaid PA COMMERCIAL M ERA 25169 Gateway Health Plan Medicaid PA COMMERCIAL M Claims 91741 Gateway Health Plan OH- Medicare Assured COMMERCIAL M ERA 91741 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 75273 Geisinger Health Plan COMMERCIAL M Claims 75273 Geisinger Health Plan COMMERCIAL M 75273 Geisinger Health Plan COMMERCIAL M ERA 20376 Gemcare Health Plan COMMERCIAL M Claims MCS03 Gemcare Health Plan COMMERCIAL M Claims 27133 Gemcare IPA COMMERCIAL M Claims 46050 Generations Healthcare COMMERCIAL M Claims 46051 Generations-Hillcrest COMMERCIAL M ERA 46051 Generations-Hillcrest COMMERCIAL M Echo is returning 835s for payer ID 61425. Providers will need to enroll with Emdeon Gateway Health Plan - Medicare Assured; 60550 (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 1-800-685-5205. 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 1-800-685-5205. Prior enrollment required. Please contact Geisinger Health Plan at 1-570-271-5555 extension 55317 to confirm credentialing prior to completing EDI Enrollment Forms. Revised 02/18/2015 ICS Software, Ltd. Page 33 of 87

46051 Generations-Hillcrest COMMERCIAL M EFT 46051 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 72189 Golden Triangle Physician Alliance/SelectCare of Texas (GTPA) COMMERCIAL M Claims IP086 Good Samaritan Medical Practice Association COMMERCIAL M Claims 76923 Good Sheperd Hospice Inc COMMERCIAL M Claims 44054 Government Employees Health Association (GEHA) COMMERCIAL M EFT GEHA EFT enrollment requires tax ID plus GEHA provider ID. Please call GEHA at 800-821-6136 to get your GEHA provider ID. 44054 Government Employees Health Association (GEHA) COMMERCIAL M Claims 44054 Government Employees Health Association (GEHA) COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at http://www.emdeon.com/enrollnow/ 95453 Grand Valley Health Plan COMMERCIAL M Claims 68069 Granite State Health Plan COMMERCIAL M Claims 13193 Great American Life Ins. Co-Medicare Supplement COMMERCIAL M Claims 58086 Great American Life Insurance Company COMMERCIAL M 51909 Great Chicago Medical Association COMMERCIAL M Claims 80705 Great-West Healthcare COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form for each Individual Provider at http://www.emdeon.com/enrollnow/. Also setup payer id 62308. 80705 Great-West Healthcare COMMERCIAL M Claims 63665 Great-West Healthcare (formerly American General) COMMERCIAL M Claims 51909 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 36338 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 800-323- 1683. 36338 Group Administrators Ltd. COMMERCIAL M CB951 Group Benefit Services Inc. COMMERCIAL M Claims 82058 Group Health Alliance COMMERCIAL M 91051 Group Health Cooperative - WA State COMMERCIAL M Claims All GHC products; GHC Group Individual Medicare + Choice and Healthy Options can be submitted electronically 95192 Group Health Cooperative of Eau Claire COMMERCIAL M Claims Provider Services: (866) 563-3020 Revised 02/18/2015 ICS Software, Ltd. Page 34 of 87

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. 39167 Group Health Cooperative of South Central Wisconsin COMMERCIAL M Claims 91051 Group Health Options - WA State COMMERCIAL M Claims All GHO products; Options and Alliant can be submitted electronically 37276 Group Insurance Service Center Inc. COMMERCIAL M Claims 58142 Group Resources Inc COMMERCIAL M 48143 Group and Pension Administrators COMMERCIAL M Claims 77010 Guardian Healthcare INC. (SC) COMMERCIAL M Claims 64246 Guardian Life Insurance Company of America COMMERCIAL M ERA 64246 Guardian Life Insurance Company of America COMMERCIAL M 64246 Guardian Life Insurance Company of America COMMERCIAL M EFT For more information and to download forms please visit http://emdeon.com/epayment 64246 Guardian Life Insurance Company of America COMMERCIAL M Claims 58379 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 37114 H.E.R.E.I.U Welfare Pension Funds COMMERCIAL M Claims 65101 HAA Preferred Partners COMMERCIAL M Claims 38224 HAP/AHL/Curanet COMMERCIAL M Claims 37110 HCH Administration COMMERCIAL M 37111 HCH Administration (Illinois) COMMERCIAL M 37111 HCH Administration (Illinois) COMMERCIAL M EFT Fully Insured blocks of business and OH providers only 37215 HCH Administration Inc. COMMERCIAL M 82018 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 866-930-1002 for EDI Enrollment 36335 HFN Inc. COMMERCIAL M Claims 20552 HHH Choices Gold COMMERCIAL M Claims 55247 HIP - Health Insurance Plan of Greater New York COMMERCIAL M Claims 55247 HIP - Health Insurance Plan of Greater New York COMMERCIAL M 55247 HIP - Health Insurance Plan of Greater New York COMMERCIAL M ERA 86066 HMA Hawaii COMMERCIAL M ERA 86066 HMA Hawaii COMMERCIAL M 86066 HMA Hawaii COMMERCIAL M EFT 86066 HMA Hawaii COMMERCIAL M Claims 75318 HMC HealthWorks aka Health Management Co COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 35 of 87

51909 HMO Illinois/BCBS COMMERCIAL M Claims 65062 HN1 Therapy Network (HN1TN) COMMERCIAL M Claims 65062 HN1 Therapy Network (HN1TN) COMMERCIAL M ERA 22521 HP Administrative Services LLC COMMERCIAL M Claims 22521 HP Administrative Services LLC COMMERCIAL M ERA 65062 HS1 Medical Management COMMERCIAL M Claims 65062 HS1 Medical Management COMMERCIAL M ERA 37137 HSHS Medical Group IPA COMMERCIAL M Claims 58379 HSR Administrators Inc. COMMERCIAL M ERA Echo is returning 835s for payer ID. Providers will need to enroll with Emdeon for payer ID 58370 with Emdeon in order to receive these 835s for this payer 58305 Harbor Advantage (Abrazo Health Care) COMMERCIAL M Claims 55649 Harbor Choice COMMERCIAL M Claims 70259 Harbor Health Plan COMMERCIAL M Claims 75126 Harpeth IPA - Amerivantage COMMERCIAL M Claims 59143 Harrington Health Non-EPO COMMERCIAL M Claims 62061 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 40523 Hawaii 835 (ERA/EFT) line of business COMMERCIAL M ERA 40523 Hawaii 835 (ERA/EFT) line of business COMMERCIAL M EFT 99208 Hawaii Medical Assurance Association (HMAA/HWMG) COMMERCIAL M ERA 99208 Hawaii Medical Assurance Association (HMAA/HWMG) COMMERCIAL M EFT To obtain your Provider Number please call 800-621-6998 ext 304 99208 Hawaii Medical Assurance Association (HMAA/HWMG) COMMERCIAL M Claims 99208 Hawaii Medical Assurance Association (HMAA/HWMG) COMMERCIAL M 77950 Health Alliance Medical Plans COMMERCIAL M EFT 77950 Health Alliance Medical Plans COMMERCIAL M ERA 77950 Health Alliance Medical Plans COMMERCIAL M 25133 Health America Inc./Health Assurance/Advantra COMMERCIAL M Claims 25133 Health America Inc./Health Assurance/Advantra COMMERCIAL M ERA 42102 Health Care Network of Wisconsin (HCN) COMMERCIAL M Claims 62179 Health Choice Arizona COMMERCIAL M ERA 62179 Health Choice Arizona COMMERCIAL M 62179 Health Choice Arizona COMMERCIAL M Claims 62180 Health Choice Generations COMMERCIAL M ERA 62180 Health Choice Generations COMMERCIAL M Claims 62180 Health Choice Generations COMMERCIAL M 46221 Health Choice Insurance Co COMMERCIAL M Claims 58379 Health Cost Solutions COMMERCIAL M ERA 62111 Health Cost Solutions COMMERCIAL M Claims Echo is returning 835s for payer ID 62111. Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 36 of 87

34158 Health Design Plus (Hudson OH) COMMERCIAL M Claims 15064 Health First Health Plan Inc. COMMERCIAL M EFT 15064 Health First Health Plan Inc. COMMERCIAL M ERA Providers must enroll in EFT to receive ERAs. 15064 Health First Health Plan Inc. COMMERCIAL M TH049 Health Management Administrators (HMA) COMMERCIAL M Claims 95570 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 email message to: ENC_team@healthnet.com. 68021 Health Net - VA Patient Centered Community Care Program COMMERCIAL M Claims The Payor ID 68021 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. 38309 Health Net of Arizona COMMERCIAL M ERA Electronic Advice (835) is available through payer ID 06108 for Health Net AZ. Pls submit form for 06108. 38309 Health Net of Arizona COMMERCIAL M Claims Payer requires NPI 95567 Health Net of California and Oregon - Claims COMMERCIAL M ERA Payer will receive auto enrollment e-mail. 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. 95567 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 e-mail. 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. 65062 Health Network One COMMERCIAL M ERA 65062 Health Network One COMMERCIAL M Claims Call Health New England COMMERCIAL M Claims To obtain payer id please contact Joanne Shaw 413-233-3444 jshaw@hne.com SX030 Health Options of Florida COMMERCIAL M Claims 36368 Health Options of Illinois COMMERCIAL M Claims 62157 Health Partners - Jackson TN COMMERCIAL M 62157 Health Partners - Jackson TN COMMERCIAL M Claims 80142 Health Partners PA COMMERCIAL M 80142 Health Partners PA COMMERCIAL M Claims 20270 Health Payment Systems Inc. COMMERCIAL M Claims 63719 Health Plan Management Services (HPMS) COMMERCIAL M Claims 83253 Health Plan of Michigan COMMERCIAL M ERA To process ERA transactons send an email to eftrequest@mhplan.com. Required information is Provider NPI and Tax ID numbers. Please make sure ERA is to be sent through Emdeon. 83253 Health Plan of Michigan COMMERCIAL M 83253 Health Plan of Michigan COMMERCIAL M Claims 76342 Health Plan of Nevada COMMERCIAL M ERA 76342 Health Plan of Nevada COMMERCIAL M Claims 76343 Health Plan of Nevada (Encounters) COMMERCIAL M Encounters Revised 02/18/2015 ICS Software, Ltd. Page 37 of 87

68035 Health Plan of San Joaquin COMMERCIAL M ERA 68035 Health Plan of San Joaquin COMMERCIAL M EFT 68035 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: 650-616-2017 or Ken Cottrell: 650-616-2021 44273 Health Plans Inc. COMMERCIAL M 44273 Health Plans Inc. COMMERCIAL M Claims 11324 Health Plus PHSP (Brooklyn NY) COMMERCIAL M 11324 Health Plus PHSP (Brooklyn NY) COMMERCIAL M EFT 63363 Health Plus Physicians Organization COMMERCIAL M Claims 41150 Health Services Management COMMERCIAL M Claims 34167 Health Services Preferred (HSP) by Emerald Health COMMERCIAL M Claims 11072 Health Services Review COMMERCIAL M 37290 Health Services for Children with Special Needs COMMERCIAL M Claims 37290 Health Services for Children with Special Needs COMMERCIAL M 37290 Health Services for Children with Special Needs COMMERCIAL M EFT 37290 Health Services for Children with Special Needs COMMERCIAL M ERA 25133 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. 11328 HealthCare Partners IPA COMMERCIAL M 11328 HealthCare Partners IPA COMMERCIAL M EFT 11328 HealthCare Partners IPA COMMERCIAL M Claims Formerly Heritage New York Medical Group. 25133 HealthCare USA COMMERCIAL M EFT 41178 HealthEZ COMMERCIAL M Claims 95213 HealthEdge Administrators (Bakersfield CA) COMMERCIAL M Claims 23274 HealthGroup Limited COMMERCIAL M Claims SX009 HealthPartners MN COMMERCIAL M Claims SX009 HealthPartners MN COMMERCIAL M ERA 59140 HealthPlan Services COMMERCIAL M Claims 27514 HealthPlus Amerigroup COMMERCIAL M ERA 27514 HealthPlus Amerigroup COMMERCIAL M Claims 38216 HealthPlus of Michigan COMMERCIAL M Claims 58379 HealthSCOPE Benefits COMMERCIAL M ERA 71063 HealthSCOPE Benefits Inc. COMMERCIAL M ERA 71063 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 11210 Bakersfield CA 93389. HealthPlus requires a Trading Partner Agreement. Providers should contact the EDI department at (810-230-2084) upon billing via Emdeon to request a TPA form. Echo is returning 835s for payer ID 71063. Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 38 of 87

37272 HealthSmart Benefit Solutions COMMERCIAL M ERA Formerly Wells Fargo TPA Inc. (Newnan GA and Fayetteville NC) 37272 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 37272 HealthSmart Benefit Solutions COMMERCIAL M Claims Formerly Wells Fargo TPA Inc. (Newnan GA and Fayetteville NC) 37272 HealthSmart Benefit Solutions COMMERCIAL M Formerly Wells Fargo TPA Inc. (Newnan GA and Fayetteville NC) 37283 HealthSmart Benefit Solutions COMMERCIAL M Claims 58379 HealthSmart Benefit Solutions COMMERCIAL M ERA Echo is returning 835s for payer ID 34145. Providers will need to enroll with Emdeon 87815 HealthSmart Benefit Solutions fka Wells Fargo TPA.Inc. COMMERCIAL M ERA formerly Wells Fargo TPA Inc. Charleston WV 87815 HealthSmart Benefit Solutions fka Wells Fargo TPA.Inc. COMMERCIAL M Claims formerly Wells Fargo TPA Inc. Charleston WV 58379 HealthSmart Benefit Solutions Inc. COMMERCIAL M ERA 75250 HealthSmart Preferred Care Inc. COMMERCIAL M Claims 58379 HealthSmart formerly AAG COMMERCIAL M ERA HSPAN HealthSpan Network Repricing COMMERCIAL M Claims 31434 HealthSpan Inc COMMERCIAL M Claims 52192 HealthSpring - STAR+PLUS Only COMMERCIAL M EFT 52192 HealthSpring - STAR+PLUS Only COMMERCIAL M ERA 63092 HealthSpring HMO/HealthSpring Medicare+Choice COMMERCIAL M Claims 63092 HealthSpring HMO/HealthSpring Medicare+Choice COMMERCIAL M 63092 HealthSpring HMO/HealthSpring Medicare+Choice COMMERCIAL M ERA 25133 Healthamerica COMMERCIAL M ERA MPMOA Healthcare La IPA COMMERCIAL M Claims 58379 Healthcare Management Administrators COMMERCIAL M ERA HCP01 Healthcare Partners COMMERCIAL M Claims 56731 Healthcare Resources NW COMMERCIAL M Claims 73147 Healthcare Solutions Group COMMERCIAL M 73147 Healthcare Solutions Group COMMERCIAL M Claims 25133 Healthcare USA COMMERCIAL M Claims 25133 Healthcare USA COMMERCIAL M ERA Echo is returning 835s for payer ID 37256. Providers will need to enroll with Emdeon Echo is returning 835s for payer ID 37272. 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 52192 - For Provider Enrollment for ERA and EFT services please visit http://www.emdeon.com/epayment/ or call Enrollment Questions at 1-866-506-2830 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

85729 Healthcomp Inc. COMMERCIAL M Claims 80141 Healthfirst Health Plan of New Jersey COMMERCIAL M ERA Providers must enroll for EFT to receive ERA.. EFT enrollment at www.healthfirstny.com 80141 Healthfirst Health Plan of New Jersey COMMERCIAL M Claims 80141 Healthfirst Inc. (New York) COMMERCIAL M 80141 Healthfirst Inc. (New York) COMMERCIAL M ERA 80141 Healthfirst Inc. (New York) COMMERCIAL M Claims 56144 Healthgram Inc COMMERCIAL M ERA Formerly known as Primary Physician Care. 56144 Healthgram Inc COMMERCIAL M Claims Formerly known as Primary Physician Care. 56144 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 800.446.5439 or 704.523.2758. 56144 Healthgram Inc COMMERCIAL M Formerly know as Primary Physician Care 96475 Healthlink HMO COMMERCIAL M 96475 Healthlink HMO COMMERCIAL M EFT 96475 Healthlink HMO COMMERCIAL M Claims Please call Provider Relations Dept at (800) 624-2356 for unique provider number. 96475 Healthlink HMO COMMERCIAL M ERA 90001 Healthlink PPO COMMERCIAL M Claims Customer Service phone number: (800 624-2356) 6108 Healthnet of Arizona COMMERCIAL M ERA Payer will receive auto enrollment e-mail. 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 55204 Healthnow Division COMMERCIAL M Claims Provider id = 12 digits with G2 qualifier 52429 Healthscope Benefits - EHC Repricing COMMERCIAL M Claims 75237 Healthsmart Accel COMMERCIAL M Claims 2041 Healthsource CMHC COMMERCIAL M Claims 2041 Healthsource Massachusetts Inc. COMMERCIAL M Claims 68195 Healthsource Provident COMMERCIAL M Claims Claims are edited under CIGNA's payer specific edits Payer ID 62308. 71075 Healthsource AR (Med) (CIGNA) COMMERCIAL M Claims Claims are edited under CIGNA's payer specific edits Payer ID 62308. 58210 Healthsource GA (CIGNA) COMMERCIAL M Claims Claims are edited under CIGNA's payer specific edits Payer ID 62308. 61127 Healthsource KY COMMERCIAL M Claims 1041 Healthsource ME COMMERCIAL M Claims 75255 Healthsource N. TX (CIGNA) COMMERCIAL M Claims Claims are edited under CIGNA's payer specific edits Payer ID 62308. 56147 Healthsource NC (CIGNA) COMMERCIAL M Claims Claims are edited under CIGNA's payer specific edits Payer ID 62308. 2038 Healthsource NH COMMERCIAL M Claims 31141 Healthsource OH COMMERCIAL M Claims 6119 Healthsource SC COMMERCIAL M Claims Healthsource Network Providers Only Pilot Healthsource SC COMMERCIAL M Encounters 62129 Healthsource TN (CIGNA) COMMERCIAL M Claims Claims are edited under CIGNA's payer specific edits Payer ID 62308. 34092 Healthspan COMMERCIAL M Claims HESUN Healthsun Health Plans COMMERCIAL M Claims 58213 Healthways WholeHealth Networks COMMERCIAL M Claims Call Healthy Palm Beaches COMMERCIAL M Claims Call Provider Services at 866-930-1002 for EDI Enrollment. 68064 Healthy Texas COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 40 of 87

22251 Healthy York Network COMMERCIAL M Claims Call Jane Grove at Provider Relations for Healthy York Network (717) 851-6715. 66866 HealthyCT Inc - Brokers COMMERCIAL M EFT 77180 HealthyCT Inc COMMERCIAL M ERA 77180 HealthyCT Inc COMMERCIAL M EFT 45336 HealthyCT Inc COMMERCIAL M Claims 51909 Heartland Health Centers COMMERCIAL M Claims 59230 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 57029 Hewitt Coleman COMMERCIAL M 47181 Highmark BCBSD Health Options Inc. COMMERCIAL M ERA 47181 Highmark BCBSD Health Options Inc. COMMERCIAL M Claims 35145 Highmark- Key Family COMMERCIAL M Claims 46 Hill Physicians Medical Group COMMERCIAL M Claims HPIPA Hispanic Physicians IPA COMMERCIAL M Claims 75299 Hollywood Presbyterian (Synermed) COMMERCIAL M Claims 88023 Hometown Health Plan Nevada COMMERCIAL M Claims 22326 Horizon NJ Health COMMERCIAL M Claims Medicaid managed care. For EDI support please e-mail edi.horizonnjhealth@amerihealthcaritas.com or call 1-877-234-4273 22326 Horizon NJ Health COMMERCIAL M EFT 22326 Horizon NJ Health COMMERCIAL M ERA Medicaid managed care. For EDI support please e-mail edi.horizonnjhealth@amerihealthcaritas.com or call 1-877-234-4273 22326 Horizon NJ Health COMMERCIAL M 91136 Hotel Employees & Restaurant Employees Health Trust COMMERCIAL M Claims Please enter Group Number (F19) when submitting claims. 91136 Hotel Employees Restaurant Employees Health Trust (HERE) COMMERCIAL M ERA 91136 Hotel Employees Restaurant Employees Health Trust (HERE) COMMERCIAL M EFT 13335 Hudson Health Plan COMMERCIAL M 13335 Hudson Health Plan COMMERCIAL M EFT 13335 Hudson Health Plan COMMERCIAL M Claims NCH02 Humana Dermatology - New Century Health COMMERCIAL M Claims 61101 Humana Emphesys COMMERCIAL M Claims 61101 Humana Employers Health Insurance COMMERCIAL M Claims 61101 Humana Inc. COMMERCIAL M Claims 61101 Humana Inc. COMMERCIAL M ERA 61102 Humana Inc. Encounters COMMERCIAL M Encounters 61101 Humana Insurance Company Choice Care Network COMMERCIAL M Claims Registration forms located at http://www.emdeon.com/payerlists/payer_enrollment_forms.php Paper remits will cease upon enrollment. Payer enrollment TAT 2-3- weeks. Claims sent to payer id 61102 will NOT be paid. Payer ID 61102 is for ENCOUNTERS ONLY. Revised 02/18/2015 ICS Software, Ltd. Page 41 of 87

L0200 Humana PR COMMERCIAL M ERA If Issues with ERA- Please contact payer at 1-800-448-6262 61120 Humana Veterans Healthcare Services COMMERCIAL M Claims VA ARCH claims should be submitted to this payer ID 94154 Humboldt-Del Norte Foundation for Medical Care COMMERCIAL M Claims 22175 I. E. Shaffer (West Trenton NJ) COMMERCIAL M 22175 I. E. Shaffer (West Trenton NJ) COMMERCIAL M Claims 37279 IAA COMMERCIAL M Claims 81810 IBG Administrators LLC COMMERCIAL M Claims 19028 IBM Business Transformation Outsourcing Insurance Services Corporate COMMERCIAL M Claims 75274 IHG Direct COMMERCIAL M Claims Valid for claims with the following mailing address: P.O. Box 2388 Stow OH 44224 68068 ILCBH COMMERCIAL M Claims 41600 IMCare COMMERCIAL M Claims 41600 IMCare COMMERCIAL M ERA TH099 IMS Management Services COMMERCIAL M Claims 86070 IMX Easy COMMERCIAL M Claims 40585 INDECS Corporation COMMERCIAL M Claims 40585 INDECS Corporation COMMERCIAL M 45048 INDEPENDENT LIVING SYSTEMS COMMERCIAL M Claims 58379 INTEGRA Administrative Group COMMERCIAL M ERA 4604 IUOE LOCAL 4 HEALTH & WELFARE COMMERCIAL M 68069 IlliniCare COMMERCIAL M Claims Call Imperial County Physicians Medical Group COMMERCIAL M Claims Call Imperial County Physicians Medical Group COMMERCIAL M Encounters 58379 InHealth COMMERCIAL M ERA 10262 InTotal Health COMMERCIAL M Claims 10262 InTotal Health COMMERCIAL M ERA 13396 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 51909 Independent Physician Alliance COMMERCIAL M Claims 51909 Independent Physicians @ Mercy Chicago IL MG#155 COMMERCIAL M Claims SX171 Indian Health Services COMMERCIAL M Claims Echo is returning 835s for payer ID 51020. Providers will need to enroll with Emdeon To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche 858-824-7100 TRausche@scpmcs.org To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche 858-824-7100 TRausche@scpmcs.org Echo is returning 835s for payer ID 71063. 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 10262 to file your claims. Enrollment is required. Providers should contact BCBSNM Customer Service Department at 1-800-225-0241 Revised 02/18/2015 ICS Software, Ltd. Page 42 of 87

35600 Indiana Department of Health - Children's Health - Claims COMMERCIAL M Claims Please completed enrollment form located on the Provider Relations Page at http://cshcs.isdh.in.gov 35600 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: http://www.in.gov 35161 Indiana ProHealth Network COMMERCIAL M Claims 35107 Indiana Teamsters Health Benefits Fund (Indianapolis IN) COMMERCIAL M Claims Formerly known as Local 135 Health Benefits Fund (Indianapolis IN) 95444 Indiana University Health Plan COMMERCIAL M Claims 31053 Individual Health Insurance Companies COMMERCIAL M Claims Payer ID 31053 is for State Farm - Health line of business. 43471 Inetico Inc. COMMERCIAL M Claims 51909 Infant Welfare Society of Chicago COMMERCIAL M Claims 96490 InforMed LLC COMMERCIAL M Claims 50946 Informed UHC COMMERCIAL M Claims 36348 Ingalls Provider Group COMMERCIAL M Claims IEHP1 Inland Empire Health Plan COMMERCIAL M Claims 75299 Inland Valleys IPA COMMERCIAL M 75299 Inland Valleys IPA COMMERCIAL M EFT 75299 Inland Valleys IPA COMMERCIAL M Claims 31182 Innovage COMMERCIAL M Claims 31172 Innovante Benefit Administrators COMMERCIAL M 31172 Innovante Benefit Administrators COMMERCIAL M Claims 40025 Innovation Health COMMERCIAL M Claims 51909 Innovative Health Strategies LLC COMMERCIAL M Claims Call Innovative Healthware Services Inc. COMMERCIAL M Claims Before submitting contact Jessica Picarde at (410) 349-3222 Call Innovative Healthware Services Inc. COMMERCIAL M Claims Call Jessica Picarde to obtain the payer id (410) 349-3222. 80087 Innovative Physician Associates LLC COMMERCIAL M Claims 51909 Innovative Physician Associates LLC. COMMERCIAL M Claims 37279 Insurance Administrators of America Inc. COMMERCIAL M 37279 Insurance Administrators of America Inc. COMMERCIAL M Claims 13315 Insurance Design Administrators COMMERCIAL M 13315 Insurance Design Administrators COMMERCIAL M Claims 58379 Insurance Management Services COMMERCIAL M ERA 15688 Insurance Management Services (Amarillo TX) COMMERCIAL M Claims Echo is returning 835s for payer ID 15688. 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 79105 36342 Insurance Program Managers Group (IPMG) COMMERCIAL M EFT Formerly Known As (FKA) as Benefit Systems & Services and Total Brokers Benefits 36342 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 13784 Insurance Systems Inc COMMERCIAL M 39182 InsuranceTPA.com COMMERCIAL M Claims 86304 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

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 19973. 31127 Integra Group COMMERCIAL M Claims 31129 Integra Group-CHA COMMERCIAL M Claims 34167 Integrated Care Network (ICN) by Emerald Health COMMERCIAL M Claims 20050 Integrated Medical Solutions LLC COMMERCIAL M Claims 84137 InterWest Health (Acceptius Gateway payer) COMMERCIAL M Claims 56132 Interactive Medical Systems COMMERCIAL M Claims 56132 Interactive Medical Systems COMMERCIAL M 60280 Interface EAP (IEAP) COMMERCIAL M Claims 23287 Intergroup Services Corporation COMMERCIAL M Claims 36609 International Brotherhood of Boilermakers COMMERCIAL M Claims 48603 International Brotherhood of Boilermakers Employee Health Care Plan(IBBEHC) COMMERCIAL M Claims TH105 International Medical Group COMMERCIAL M Claims 61271 J. F. Molloy and Associates Inc. COMMERCIAL M Claims 37453 JAS Inc COMMERCIAL M 37543 JAS Inc COMMERCIAL M TH033 JI Specialties COMMERCIAL M Claims 9822 JMH - SFCCN PHT (PSN CMSN) COMMERCIAL M Claims 38310 JOHN MORRELL COMPANY CO. - AHPBA COMMERCIAL M Claims Call JOHN MUIR TRAUMA PHYSICIANS COMMERCIAL M Claims Please contact John Muir Trauma Physicians at 925-947-5288 for Payer id information. Call JP Farley COMMERCIAL M 34136 JP Farley Corporation COMMERCIAL M 34136 JP Farley Corporation COMMERCIAL M Claims 43183 JW Terrill COMMERCIAL M 41099 John Alden Life Insurance Co. COMMERCIAL M 41099 John Alden Life Insurance Co. COMMERCIAL M EFT 41099 John Alden Life Insurance Co. COMMERCIAL M Claims 41099 John Alden Life Insurance Co. COMMERCIAL M ERA 68036 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) 941-2026. Allow 2 days for processing befo 68036 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) 941-2026. Allow 2 days for processing befo 52189 Johns Hopkins Healthcare (EHP/PP) COMMERCIAL M Revised 02/18/2015 ICS Software, Ltd. Page 44 of 87

52189 Johns Hopkins Healthcare (EHP/PP) COMMERCIAL M Claims New submitters should send in their Billing NPI and Rending/Servicing NPI. 52189 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 52189 - Johns Hopkins Health Care (EHP/PPMCO) and 52123 - Johns Hopkins Health Care (USFHP). 52123 Johns Hopkins Healthcare (USFHP) COMMERCIAL M Claims New submitters should send in their Billing NPI and Rending/Servicing NPI. 52123 Johns Hopkins Healthcare (USFHP) COMMERCIAL M EFT 52123 Johns Hopkins Healthcare (USFHP) COMMERCIAL M ERA 43178 Joplin Claims / Benefit Management Inc COMMERCIAL M Claims KPS01 KPS-Kitsap Physician Services COMMERCIAL M Claims 68068 KS - Cenpatico Kansas COMMERCIAL M Claims 68069 KS - Sunflower State Health COMMERCIAL M Claims 68068 KY - Cenpatico Kentucky COMMERCIAL M Claims 91617 Kaiser Foundation Health Plan of Colorado COMMERCIAL M Claims 91617 Kaiser Foundation Health Plan of Colorado COMMERCIAL M ERA 94135 Kaiser Foundation Health Plan of Northern CA Region COMMERCIAL M ERA 94135 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 52189 - Johns Hopkins Health Care (EHP/PPMCO) and 52123 - Johns Hopkins Health Care (USFHP). Please call (510) 987-4639 for approval prior to submitting Northern California referral claims. 94134 Kaiser Foundation Health Plan of Southern CA Region COMMERCIAL M Claims For more information please call (866) 285-0361 Payer Requires Provider Enrollment To Receive 835 Files. Contact: 94134 Kaiser Foundation Health Plan of Southern CA Region COMMERCIAL M ERA tina.c.cheung@kp.org 52095 Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. COMMERCIAL M Claims Providers enrolled for ERA will receive claim reporting at level 4. 52095 Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. COMMERCIAL M ERA 93079 Kaiser Foundation of the Northwest COMMERCIAL M Claims 21313 Kaiser Health Plan Inc - Georgia Region COMMERCIAL M ERA 94123 Kaiser Permanente Health Plan of Hawaii COMMERCIAL M Claims 94123 Kaiser Permanente Health Plan of Hawaii COMMERCIAL M ERA 21313 Kaiser Permanente of Georgia COMMERCIAL M Claims 21313 Kaiser Permanente of Georgia COMMERCIAL M ERA 94320 Kaiser Self Funded COMMERCIAL M Claims 57038 Kanawha HealthCare Solutions Inc. COMMERCIAL M Claims 57038 Kanawha Insurance Co. COMMERCIAL M Claims 57038 Kanawha Insurance Co. COMMERCIAL M ERA 51909 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 https://providernet.adminisource.com or call 877-389-1160. Please contact NEHBO@kp.org for any production issues such as status of claim denials etc. Providers must complete the ERA Provider Enrollment via Kaiser online portal at https://providernet.adminisource.com or call 877-389-1160. Revised 02/18/2015 ICS Software, Ltd. Page 45 of 87

CX058 Kansas City Life COMMERCIAL M 81812 Katy Medical Claims COMMERCIAL M Claims TKFMC Kaweah Delta COMMERCIAL M Claims 95279 Keenan Associates (CA) COMMERCIAL M KELSE Kelseycare COMMERCIAL M Claims 61453 Kemper Benefits COMMERCIAL M Claims 73100 Kempton Company COMMERCIAL M 73100 Kempton Company COMMERCIAL M Claims 73100 Kempton Group Administrators COMMERCIAL M Claims 27215 Kentucky Health Administrators Inc. COMMERCIAL M Claims 77894 Kentucky Health Cooperative COMMERCIAL M Claims 68069 Kentucky Spirit Health Plan COMMERCIAL M Claims 28021 Kern County CDCR COMMERCIAL M Claims 77039 Kern Health Systems COMMERCIAL M Claims 37217 Key Benefit Administrators (Indianapolis IN) COMMERCIAL M ERA 37217 Key Benefit Administrators (Indianapolis IN) COMMERCIAL M Claims MUST VERIFY AL CLAIMS SHOULD GO TO PAYER IN INDIANAPOLIS IN 37217 Key Benefit Administrators (Indianapolis IN) COMMERCIAL M EFT 37217 Key Benefit Administrators (Indianapolis IN) COMMERCIAL M 35317 Key Gap COMMERCIAL M Claims 95460 Key Health Medical Solutions Inc COMMERCIAL M Claims IP082 Key Medical Group COMMERCIAL M Claims 37321 Key Select COMMERCIAL M Claims 77050 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 http://www.emdeon.com/epayment/ to early enroll. 77050 Keystone Connect (Amerihealth) COMMERCIAL M Claims 77050 Keystone Connect (Amerihealth) COMMERCIAL M EFT 23284 Keystone First COMMERCIAL M ERA 23284 Keystone First COMMERCIAL M 23284 Keystone First COMMERCIAL M Claims 23284 Keystone First COMMERCIAL M EFT 84223 Keystone VIP Choice COMMERCIAL M Claims 84223 Keystone VIP Choice COMMERCIAL M EFT 84223 Keystone VIP Choice COMMERCIAL M 84223 Keystone VIP Choice COMMERCIAL M ERA Pennsylvania Healthy PA Private Coverage Option? For EDI Support please email edi.keystoneconnect@amerihealthcaritas.com or call 1-800-707-5821 Keystone Connect is effective 1/1/2015. Please note that this payer encourages early enrollment for EFT/ERA services. Please visit http://www.emdeon.com/epayment/ to early enroll. Medicaid managed care. For EDI support please e-mail edi@keystonefirstpa.com or call 1-877-234-4271 Medicaid managed care. For EDI support please e-mail edi@keystonefirstpa.com or call 1-877-234-4271 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

93063 Kipp & Company COMMERCIAL M 34145 Klais & Company COMMERCIAL M Claims 3414A Klais & Company (Repricing for HealthSpan Network Only) COMMERCIAL M Claims LACAR LA Care Health Plan COMMERCIAL M Claims 25181 LIFE Pittsburgh COMMERCIAL M Claims TH106 LIPA/Agate Resources COMMERCIAL M Claims 51909 La Rabida Childrens Hospital COMMERCIAL M Claims NMM02 LaSalle Medical Group COMMERCIAL M Claims 37116 Lake County Physicians Association COMMERCIAL M Claims 66125 LakeSide Medical Group COMMERCIAL M Claims 66127 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 90096 Land of Lincoln Health COMMERCIAL M ERA 90096 Land of Lincoln Health COMMERCIAL M Claims 62741 Land of Lincoln Health Ins. Co. COMMERCIAL M Claims 62741 Land of Lincoln Health Ins. Co. COMMERCIAL M LNDMK Landmark Healthcare Inc COMMERCIAL M ERA LNDMK Landmark Healthcare Inc COMMERCIAL M Claims 36333 Lawndale Christian Health Center COMMERCIAL M Claims 51909 Lawndale Christian Health Center COMMERCIAL M Claims 51909 Lawndale Christian Hlth Center COMMERCIAL M Claims 37316 Leon Medical Center Health Plan COMMERCIAL M Claims 87071 Liberty Health Advantage COMMERCIAL M Claims 37281 Liberty Union COMMERCIAL M Claims 37281 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 74228 Life Re Insuracne Company COMMERCIAL M 41136 Life Trac COMMERCIAL M Claims 76870 LifePath Hospice Inc COMMERCIAL M Claims Contact Sherry Wolgemuth Vice President of Claims Operations for Preferred Health Care at (717) 560-9290 ext. 124 for approval and the Payer ID. 58379 LifeWell COMMERCIAL M ERA Echo is returning 835s for payer ID 35182. Providers will need to enroll with Emdeon 93093 LifeWise Healthplan of Oregon COMMERCIAL M Claims 27005 Lifestyle Health Plans COMMERCIAL M Claims Institutional Claims should be submitted under Payer ID 2700u EBSRM Lifetime Benefit Solutions COMMERCIAL M Claims 42011 Lincoln Republic Insurance COMMERCIAL M EFT Medicare Supplement COB claims only accepted via electronic Medicare crossover 42011 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

42011 Lincoln Republic Insurance COMMERCIAL M Medicare Supplement COB claims only accepted via electronic Medicare crossover 42011 Lincoln Republic Insurance COMMERCIAL M ERA Medicare Supplement COB claims only accepted via electronic Medicare crossover LCB01 Line Construction Benefit Fund COMMERCIAL M 35107 Local 135 Health Benefits Fund (Indianapolis IN) COMMERCIAL M Claims 91136 Locals 302 & 612 of the Internation Union of Operating Engineers COMMERCIAL M EFT 91136 Locals 302 & 612 of the Internation Union of Operating Engineers COMMERCIAL M ERA CB752 Lockard & Williams COMMERCIAL M Claims 22577 Lockard & Williams Insurance Services Inc. COMMERCIAL M 37267 Loma Linda University Adventist Health Sciences Center Employee Health Plan COMMERCIAL M Claims 37267 Loma Linda University Adventist Health Sciences Centers COMMERCIAL M Claims 37267 Loma Linda University Behavioral Medicine Center Employee Health Plan COMMERCIAL M Claims 37267 Loma Linda University Employee Health Plan COMMERCIAL M Claims 37267 Loma Linda University Health Care Employee Health Plan COMMERCIAL M Claims 33036 Loma Linda University Health Care Managed Care Dept COMMERCIAL M Claims 37267 Loma Linda University Medical Center Employee Health Plan COMMERCIAL M Claims 37267 Loma Linda University Medical Center Residents Health Plan COMMERCIAL M Claims 37267 Loma Linda University Student Health Plan COMMERCIAL M Claims 37226 London Health Administrators COMMERCIAL M 68069 Louisiana Healthcare COMMERCIAL M ERA 68069 Louisiana Healthcare Connections COMMERCIAL M Claims 90328 Lovelace Sandia Health Plan COMMERCIAL M Claims 13193 Loyal American Life Ins Co-Medicare Supplement COMMERCIAL M Claims 36312 MANAGED HEALTH CARE ASSOCIATES COMMERCIAL M Claims 83028 MBA Benefit Administrators Inc (Salt Lake UT) COMMERCIAL M Claims 87065 MBA OF WYOMING INC COMMERCIAL M 87065 MBA OF WYOMING INC COMMERCIAL M Claims 56205 MBS COMMERCIAL M EFT 56205 MBS COMMERCIAL M ERA 56205 MBS COMMERCIAL M 56205 MBS COMMERCIAL M Claims Formerly Payer ID 56151 25160 MCA ADMINISTRATORS COMMERCIAL M 25160 MCA ADMINISTRATORS COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 48 of 87

Call MCA Administrators Inc COMMERCIAL M Claims Please Call Keri Kudrav Provider Relations @ (412) 922-0780 ext. 175 35199 MD Wise- CMCS COMMERCIAL M EFT 80026 MDI Holdings (Formerly Medical Partners of America) COMMERCIAL M Claims 20475 MDWise Hoosier Alliance COMMERCIAL M ERA For EDI support please e-mail EDI@hoosieralliance.org or call 1-888-426-7690. 20475 MDWise Hoosier Alliance COMMERCIAL M Claims For EDI support please e-mail EDI@hoosieralliance.org or call 1-888-426-7690. 20475 MDWise Hoosier Alliance COMMERCIAL M 20475 MDWise Hoosier Alliance COMMERCIAL M EFT MDXHI MDX Hawaii COMMERCIAL M Claims 88058 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 52181 MEDICAL DEVELOPMENT INTERNATIONAL COMMERCIAL M Claims Call MEMORIAL INTEGRATED HEALTHCARE COMMERCIAL M Claims PLEASE EMAIL TRACY HARSWICK AT THARSWICK@MHS.NET FOR PAYER ID INFORMATION 23550 MFC & HealthPlus Peoria COMMERCIAL M Claims 74289 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

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 www.mhnetprovider.com 74289 MHNET COMMERCIAL M Claims 64068 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: https://forms.hewedi.com/forms/era.php 35316 MMA COMMERCIAL M Claims 68068 MO - Cenpatico Missouri COMMERCIAL M Claims 68069 MO - Missouri Home State Health Care COMMERCIAL M Claims 35092 MORRIS ASSOCIATES COMMERCIAL M ERA 35092 MORRIS ASSOCIATES COMMERCIAL M Claims 37233 MPE Services Inc. COMMERCIAL M Claims 37233 MPEEBT COMMERCIAL M Claims 68068 MS - Cenpatico Mississippi COMMERCIAL M Claims 20572 MSA Care Guard COMMERCIAL M Claims 80019 MSC (Medical Service Company) Group Inc COMMERCIAL M Claims MSC will require enrollment prior to taking claims please email Payables_EDIIntegration@onecallcm.com to Enroll 14165 MVP Health Plan of NY COMMERCIAL M Claims SX089 MVP Health Rochester COMMERCIAL M Claims Formerly known as Preferred Care NY 36334 MacNeal Health Providers- CHS COMMERCIAL M Claims 36334 MacNeal Health Providers- CHS COMMERCIAL M ERA 1260 Magellan Health Services COMMERCIAL M Claims 1260 Magellan Health Services COMMERCIAL M ERA 11303 Magnacare COMMERCIAL M Claims 68069 Magnolia COMMERCIAL M Claims 25133 Mail Handlers COMMERCIAL M ERA 25133 Mail Handlers Benefit Plan COMMERCIAL M Claims 45341 Maine Community Health Options COMMERCIAL M Claims 45341 Maine Community Health Options COMMERCIAL M ERA 35162 Managed Care Services LLC COMMERCIAL M Claims 58379 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 22771 Managed Health Network COMMERCIAL M ERA 22771 Managed Health Network COMMERCIAL M Claims 68069 Managed Health Services Indiana (Medicaid HMO) COMMERCIAL M Claims 68069 Managed Health Services Indiana (Medicaid HMO) COMMERCIAL M ERA 68069 Managed Health Services Wisconsin COMMERCIAL M Claims 68069 Managed Health Services Wisconsin COMMERCIAL M ERA Prior to submitting claims please call Provider Relations Dept at 877.647.4848 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 1-800-547-1647 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

58379 ManagedCareSystems COMMERCIAL M ERA 98010 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 52461 March Vision Care Inc. COMMERCIAL M Claims 48055 Marquette Life Insurance Company COMMERCIAL M Claims 20805 Marrick Medical Finance COMMERCIAL M Claims 53275 Martin's Point Health Care COMMERCIAL M ERA 53275 Martin's Point Health Care COMMERCIAL M Claims 25133 Maryland Medicaid COMMERCIAL M Claims 25133 Maryland Medicaid COMMERCIAL M ERA 22348 Maryland Physicians Care COMMERCIAL M Claims 22348 Maryland Physicians Care COMMERCIAL M ERA 22348 Maryland Physicians Care COMMERCIAL M 37121 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 787-250-5214 Per payer email 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. 58379 MasonryTrusts COMMERCIAL M ERA Echo is returning 835s for payer ID 60230. Providers will need to enroll with Emdeon TH111 Master Mates & Pilots Program COMMERCIAL M Claims 95019 Matrix - Health First Health Plan COMMERCIAL M Claims 27320 Max Specialty Benefits COMMERCIAL M Claims 88090 Mayo Clinic FL/GA COMMERCIAL M Claims 41154 Mayo Clinic Health Solutions COMMERCIAL M Claims Mayo Management Services Inc. 41154 Mayo Clinic Health Solutions COMMERCIAL M ERA MHM02 McKinley Medical Group COMMERCIAL M Claims 38338 McLaren Health Plan COMMERCIAL M SX172 Mdwise Inc. (formerly IU Medical Group) COMMERCIAL M Claims 58202 MedAdmin Solutions COMMERCIAL M Claims 58204 MedAdmin Solutions COMMERCIAL M Claims 74323 MedBen (Newark OH) COMMERCIAL M Claims 59231 MedCom COMMERCIAL M 59231 MedCom COMMERCIAL M Claims 56205 MedCost Benefit Services COMMERCIAL M EFT 56205 MedCost Benefit Services COMMERCIAL M ERA 56205 MedCost Benefit Services COMMERCIAL M Revised 02/18/2015 ICS Software, Ltd. Page 51 of 87

56162 MedCost Inc. COMMERCIAL M Claims For questions on claim submission please contact Customer Service 800-824-7406 38353 MedDirect COMMERCIAL M Claims MPMOA MedPOINT Management COMMERCIAL M Claims 35205 MedPartners Administrative Services COMMERCIAL M Claims Payer ID is only for claims with mailing address of: PO Box 2602 Fort Wayne IN 46801 35205 MedPartners Administrative Services COMMERCIAL M EFT 35205 MedPartners Administrative Services COMMERCIAL M 62160 MedSolutions Inc COMMERCIAL M Claims 62160 MedSolutions Inc COMMERCIAL M ERA 95321 Medfocus COMMERCIAL M Claims 95655 MediGold COMMERCIAL M Claims 95655 MediGold COMMERCIAL M ERA 94265 Medica (UHC) COMMERCIAL M ERA 94265 Medica (UHC) COMMERCIAL M Claims 78857 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 Line @ 1-800-991-9907 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 http://www.emdeon.com/enrollnow/ 12422 Medica2 COMMERCIAL M Claims Medica2 payer is effective 1/1/2014. All claims prior to 1/1/14 will be rejected 12422 Medica2 COMMERCIAL M EFT 12422 Medica2 COMMERCIAL M ERA 77059 Medicaid Hawaii Waivers COMMERCIAL M Claims Call Medical Associates Health Plan COMMERCIAL M 37298 Medical Benefit Administrators Inc/dba MBA of MD Inc COMMERCIAL M Claims MBA01 Medical Benefits Administration COMMERCIAL M Claims 74323 Medical Benefits Administrators Inc. (Newark OH) COMMERCIAL M Claims 74323 Medical Benefits Companies (Newark OH) COMMERCIAL M Claims 74323 Medical Benefits Mutual (Newark OH) COMMERCIAL M Claims 74323 Medical Benefits Mutual Life Insrance Co. COMMERCIAL M Claims 74323 Medical Benefits Mutual Life Insurance Co. COMMERCIAL M ERA 74323 Medical Benefits Mutual Life Insurance Co. COMMERCIAL M 74323 Medical Benefits Mutual Life Insurance Co. COMMERCIAL M EFT L0170 Medical Card System ( MCS ) COMMERCIAL M ERA Call 1-800-981-4766 (Option 4) to Enroll for ERA L0170 Medical Card System ( MCS ) COMMERCIAL M Claims 51909 Medical Group of Swedish American COMMERCIAL M Claims 29076 Medical Mutual of Ohio COMMERCIAL M Claims 29076 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 62177 Medical Reimbursements of America COMMERCIAL M Claims 12057 Medical Services Initiative COMMERCIAL M Claims 38224 Medical Value Plan - Ohio (MVP) COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 52 of 87

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 787-622-3000 23160 Medico COMMERCIAL M ERA 23160 Medico COMMERCIAL M 23160 Medico COMMERCIAL M Claims Medicare Supplement COB claims only accepted via electronic Medicare crossover. 23160 Medico COMMERCIAL M EFT 47012 Medico Insurance Co COMMERCIAL M STAR1 Mediview Inc. COMMERCIAL M Claims 59069 MedsaveUSA COMMERCIAL M f.k.a. Fringe Benefit Management and 21st Century Health and Benefits 59069 MedsaveUSA COMMERCIAL M Claims f.k.a. Fringe Benefit Management and 21st Century Health and Benefits 15395 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 59221 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 982009 North Richland Hills TX 76182. 62181 Memorial Clinical Associates/ SelectCare of Texas (MCA) COMMERCIAL M Claims TH092 Memorial Herman Health Network Providers COMMERCIAL M Claims 59065 Memorial Integrated Healthcare/South Florida Community Care Network COMMERCIAL M Claims 37264 Mercy Benefit Administration COMMERCIAL M ERA 37264 Mercy Benefit Administration COMMERCIAL M Claims 86052 Mercy Care Plan (AHCCCS) COMMERCIAL M Claims 86052 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 MercyCareProviderRelations@aetna.com 86052 Mercy Care Plan (AHCCCS) COMMERCIAL M EFT Enroll with payer 86052 Mercy Care Plan (AHCCCS) COMMERCIAL M 51909 Mercy Diagnostic and Treatment Center COMMERCIAL M Claims 43166 Mercy Health Plans COMMERCIAL M Claims Call Mercy Health Plans COMMERCIAL M 33628 Mercy Maricopa Integrated Care COMMERCIAL M Claims 33628 Mercy Maricopa Integrated Care COMMERCIAL M EFT Enroll with payer 33628 Mercy Maricopa Integrated Care COMMERCIAL M 33628 Mercy Maricopa Integrated Care COMMERCIAL M ERA Providers must enroll using the Mercy Maricopa ERA Enrollment form and this must be submitted to MercyMaricopaProviderRelations@aetna.com 39114 MercyCare COMMERCIAL M Claims Please call 608-758-7739 for payer id. 13189 Meridian Health Plan COMMERCIAL M Claims 13189 Meridian Health Plan COMMERCIAL M ERA 58379 Meritain COMMERCIAL M ERA Echo is returning 835s for payer ID 41124. Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 53 of 87

58379 Meritain - SHARP COMMERCIAL M ERA Echo is returning 835s for payer ID 41124. Providers will need to enroll with Emdeon 64157 Meritain Health COMMERCIAL M 64157 Meritain Health COMMERCIAL M Claims 64158 Meritain Health / Agency Services COMMERCIAL M Claims Formerly know as Agency Services Inc. 41124 Meritain Health Minneapolis COMMERCIAL M Claims 45150 Meritus Health Partners COMMERCIAL M Claims 13265 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. 13265 MetroPlus Health Plan COMMERCIAL M Claims 10850 Metropolitan Health Plan COMMERCIAL M Claims 10850 Metropolitan Health Plan COMMERCIAL M ERA TH068 Metrowest HealthPlan COMMERCIAL M Claims TH069 Metrowest Star Medicaid COMMERCIAL M Claims 37127 Michael Reese Physicians Group COMMERCIAL M Claims 38164 Michigan Education Special COMMERCIAL M ERA 38164 Michigan Education Special COMMERCIAL M EFT 38164 Michigan Education Special COMMERCIAL M 15529 Michigan Employee Benefit COMMERCIAL M 37281 Mid-America Associates Inc. COMMERCIAL M Claims Call Mid-American Benefits COMMERCIAL M Claims 58379 Mid-American Benefits Inc. COMMERCIAL M ERA Mid-West National Life Insurance Co. of Tennessee - 59224 Insurance Center COMMERCIAL M Claims Mid-West National Life Insurance Co. of Tennessee - 59224 Insurance Center COMMERCIAL M EFT Mid-West National Life Insurance Co. of Tennessee - 59224 Insurance Center COMMERCIAL M Mid-West National Life Insurance Co. of Tennessee - 59224 Insurance Center COMMERCIAL M ERA 77012 MidCoast IPA COMMERCIAL M Claims 47080 Midlands Choice Inc. COMMERCIAL M Claims 61144 Midwest Group Administrators COMMERCIAL M 76079 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) 303-9626. Claims will reject if the NPI is not registered and/or submitted on claims sent electronically. Providers must first contact provider services at 800-647-0550 for credential/contracting. Then complete the ERA PSF Form. Please call Jessica Picarde Manager of Claims Operations (410) 349-3222 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 982017 North Richland Hills TX 76182. Revised 02/18/2015 ICS Software, Ltd. Page 54 of 87

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. WWW.midwesthealthplan.com 51909 Mile Square FQHC COMMERCIAL M Claims MPMG1 Mills Peninsula Medical Group COMMERCIAL M Claims 94115 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 64068 Mississippi Health Partners COMMERCIAL M Claims 64084 Mississippi Physicians Care Network COMMERCIAL M Claims 37233 Mississippi Public Entity Employee Benefit Trust COMMERCIAL M Claims 64088 Mississippi Select Health Care COMMERCIAL M Claims Also doing business as Select Administrative Services (SAS). 37275 Missoula County Medical Benefits Plan COMMERCIAL M Claims ABRI1 Molina Health Care of WI COMMERCIAL M Claims 46299 Molina Healthcare South Carolina COMMERCIAL M Claims SX109 Molina Healthcare Utah (aka American Family Care) COMMERCIAL M Claims 38333 Molina Healthcare of CALIFORNIA COMMERCIAL M Claims 51062 Molina Healthcare of Florida COMMERCIAL M Claims 38334 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 20149 Molina Healthcare of Ohio COMMERCIAL M Claims 20554 Molina Healthcare of Texas COMMERCIAL M Claims 38336 Molina Healthcare of WASHINGTON COMMERCIAL M Claims 20934 Molina Illinois COMMERCIAL M Claims 58379 Monarch COMMERCIAL M ERA Echo is returning 835s for payer ID 61425. Providers will need to enroll with Emdeon IP095 Monarch IPA COMMERCIAL M Claims 16098 Monitor Life Insurance Company COMMERCIAL M Claims 16098 Monitor Life Insurance Company COMMERCIAL M ERA 13174 Montefiore Contract Management Organization COMMERCIAL M ERA 13174 Montefiore Contract Management Organization COMMERCIAL M Claims 46161 Montifiore HMO COMMERCIAL M Claims 46161 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 72203-8043 TRCLF Monumental Life Insurance Company COMMERCIAL M Claims 4333 Edgewood Road NE Cedar Rapids IA 52499 TRLTC Monumental Life Insurance Company COMMERCIAL M Claims PO Box 93019 Hurst TX 76053-3019 TRLTC Monumental Life Insurance Company COMMERCIAL M Claims PO Box 869093 Plano TX 75086-9093 TRP1E Monumental Life Insurance Company COMMERCIAL M Claims PO Box 17004 Baltimore MD 21203-7004 TRP1E Monumental Life Insurance Company COMMERCIAL M Claims Claim Services Division Valley Forge PA 19493 TRP1E Monumental Life Insurance Company COMMERCIAL M Claims 100 Light Street Baltimore MD 21202-0000 TRP1E Monumental Life Insurance Company COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA 52406-3350 TRP1E Monumental Life Insurance Company COMMERCIAL M EFT TRP1E Monumental Life Insurance Company COMMERCIAL M Claims PO Box 97 Scranton PA 18504-0097 TRP1P Monumental Life Insurance Company COMMERCIAL M Claims 2700 West Plano Parkway Plano TX 75075 IP083 Mosaic IPA Medical Group COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 55 of 87

99282 Motion Pictures Industry COMMERCIAL M Claims 86040 Mountain States Administrative Services (Tucson AZ) COMMERCIAL M Claims 95655 Mt. Carmel Health COMMERCIAL M Claims 95655 Mt. Carmel Health COMMERCIAL M ERA Multicultural Primary Care Medical Group (San Diego) 75299 (Synermed) COMMERCIAL M Multicultural Primary Care Medical Group (San Diego) 75299 (Synermed) COMMERCIAL M EFT Multicultural Primary Care Medical Group (San Diego) 75299 (Synermed) COMMERCIAL M Claims 34080 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 Line @ 1-800-991-9907 to obtain the forms to be initiated and filled out by the provider's office. 81883 Municipal Health Benefit Fund COMMERCIAL M ERA Pre-Enrollment is being taken. Expected Live Date is November 15th 2014. 81883 Municipal Health Benefit Fund COMMERCIAL M Claims 81883 Municipal Health Benefit Fund COMMERCIAL M EFT Pre-Enrollment is being taken. Expected Live Date is November 15th 2014. 37256 Mutual Assurance Administrators COMMERCIAL M Claims 59140 Mutual Group (The) (US) COMMERCIAL M Claims 34192 Mutual Health Services COMMERCIAL M Claims Payer formely known as: Antares Management Solutions 34192 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 58379 Mutual Health Services COMMERCIAL M ERA Echo is returning 835s for payer ID 29076. Providers will need to enroll with Emdeon 71412 Mutual of Omaha Insurance Company COMMERCIAL M Claims 71412 Mutual of Omaha Insurance Company COMMERCIAL M ERA 71412 Mutually Preferred COMMERCIAL M Claims 91136 N.W. Ironworkers Health & Security Trust Fund COMMERCIAL M Claims Please enter Group Number (F15) when submitting claims. 91136 N.W. Roofers & Employers Health & Security Trust Fund COMMERCIAL M Claims Please enter Group Number (F26) when submitting claims. 91136 N.W. Textile Processors COMMERCIAL M Claims Please enter Group Number (F14) when submitting claims. 65085 NAA (North America Administrators L.P.) (Nashville TN) COMMERCIAL M Claims 65085 NAA (North America Administrators L.P.) (Nashville TN) COMMERCIAL M 34159 NABN (Cleveland OH) COMMERCIAL M Claims 53011 NALC/Affordable COMMERCIAL M Claims L0110 NAMCI/Global Care COMMERCIAL M Claims 35101 NAMM CALIFORNIA (NORTH AMERICAN MED) COMMERCIAL M ERA Call NAMM CALIFORNIA (NORTH AMERICAN MED) COMMERCIAL M Claims 58182 NAPHCARE INC. COMMERCIAL M ERA 58182 NAPHCARE INC. COMMERCIAL M Claims Now known as Meritain Health. Payer ID valid only for claims with billing submission address of P.O. Box 94928 Cleveland OH 44101-4928 or P.O. Box 89476 Cleveland OH 44101-5476. Revised 02/18/2015 ICS Software, Ltd. Page 56 of 87

38225 NGS American Inc COMMERCIAL M 38225 NGS American Inc COMMERCIAL M ERA 38225 NGS American Inc COMMERCIAL M Claims 88050 NHBCAUX COMMERCIAL M 88050 NHBCAUX COMMERCIAL M Claims 11325 NHP/SHP (Neighborhood Health Providers and Suffolk Health Plan) COMMERCIAL M Claims 22603 NJ Carpenters Health Fund COMMERCIAL M Claims 76112 NORTH AMERICAN INSURANCE COMPANY d/b/a Oxford Life COMMERCIAL M EFT 22262 NPS COMMERCIAL M Claims 91136 NW Plumbers & Pipefitters Health & Welfare Trust COMMERCIAL M EFT 91136 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 53011 National Association of Letter Carriers COMMERCIAL M Claims 53011 National Association of Letter Carriers/NALC COMMERCIAL M Claims 56175 National Benefit Administrators - New Jersey COMMERCIAL M Claims 56176 National Benefit Administrators - North Carolina COMMERCIAL M Claims 90001 National Capital Preferred Provider Organization (NCPPO) COMMERCIAL M Claims Customer Service phone number: (800 272-5911) 75275 National Health Insurance Company COMMERCIAL M SX190 National Imaging Associates COMMERCIAL M Claims SX190 National Imaging Associates COMMERCIAL M ERA 52132 National Rural Electric Coop (NRECA) COMMERCIAL M Claims 52120 National Telecommunications Cooperative Association COMMERCIAL M ERA 52120 National Telecommunications Cooperative Association COMMERCIAL M Claims 52104 National Telecommunications Cooperative Association (NTCA - Staff) COMMERCIAL M Claims 52103 National Telecommunications Cooperative Association (NTCA) COMMERCIAL M Claims 31417 Nationwide Health Plans COMMERCIAL M ERA 31417 Nationwide Health Plans COMMERCIAL M Claims 58379 Nationwide Life Insurance Co. COMMERCIAL M ERA 19191 Native Care Health COMMERCIAL M Claims 58379 Native Care Health LLC COMMERCIAL M ERA 51909 Near North Health Service Corporation COMMERCIAL M Claims 51909 Neighborhood Doctors Organization COMMERCIAL M Claims 96107 Neighborhood Health Partnership (NHP) COMMERCIAL M Claims 4293 Neighborhood Health Plan (Boston MA) COMMERCIAL M ERA Echo is returning 835s for payer ID 61425. Providers will need to enroll with Emdeon Echo is returning 835s for payer ID 19191. Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 57 of 87

4293 Neighborhood Health Plan (Boston MA) COMMERCIAL M Claims 96240 Neighborhood Health Plan RI - Exchange Unity Integrity COMMERCIAL M Claims 5047 Neighborhood Health Plan of Rhode Island (NHPRI) COMMERCIAL M Claims 37255 Nesika Health Group COMMERCIAL M Claims 66055 Netcare Life and Health Insurance (Hagatna Guam) COMMERCIAL M Claims Please call NHPRI at 1-401-459-6020 to obtain or confirm your provider and vendor number prior to your initial claims submission. 4332 Network Health COMMERCIAL M Claims Before initiating submissions please go to www.network-health.org and go to the Providers Tab then forms then Claims Forms and then EDI setup forms or email Network Health at edi@network-health.org for an EDI setup form. 4332 Network Health COMMERCIAL M ERA For missing 835 files please send inquires to edi@network-health.org 4332 Network Health COMMERCIAL M EFT 77076 Network Health Insurance Corp-Medicare COMMERCIAL M Claims 77076 Network Health Insurance Corp-Medicare COMMERCIAL M ERA 39144 Network Health Plan COMMERCIAL M ERA 39144 Network Health Plan COMMERCIAL M Claims Payer id 39144 now valid for hospital and medical claims that have a submission address of PO Box 568 Menasha WI 54952. Payer id 39111 has been merged to this payer id. 39144 Network Health Plan COMMERCIAL M EFT 39144 Network Health Plan COMMERCIAL M NMM01 Network Medical Management COMMERCIAL M Claims 58204 Network TPA LLC COMMERCIAL M Claims 90091 Nevada Health Coop COMMERCIAL M Claims 95998 New Avenues Inc. COMMERCIAL M Claims NCH11 New Century Health - IEHP Oncology COMMERCIAL M Claims NCH09 New Century Health - Vista Cardiology COMMERCIAL M Claims 76031 New Era Employee Welfare Benefit Plan Trust COMMERCIAL M Claims 75281 New Era Life Insurance Company COMMERCIAL M Claims 65056 New Market Dimensions COMMERCIAL M Claims 45129 New Mexico Health Connections COMMERCIAL M ERA 45129 New Mexico Health Connections COMMERCIAL M Claims SX164 New West Health Services COMMERCIAL M Claims TH122 New York Life COMMERCIAL M Claims 11334 New York Network Management COMMERCIAL M Claims 58379 Nippon Life Benefits COMMERCIAL M ERA 81264 Nippon Life Insurance Company of America COMMERCIAL M Claims 81264 Nippon Life Insurance Company of America COMMERCIAL M ERA 81264 Nippon Life Insurance Company of America COMMERCIAL M PDT01 Noble AMA Select IPA COMMERCIAL M Claims 34159 North American Benefits Network (Cleveland OH) COMMERCIAL M Claims Echo is returning 835s for payer ID 81264. 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 94928 Cleveland OH 44101-4928 or P.O. Box 89476 Cleveland OH 44101-5476. Revised 02/18/2015 ICS Software, Ltd. Page 58 of 87

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 1-800-956-8000 prior to initial submission of claims. E3510 North American Medical Management (NAMM) - Southern California COMMERCIAL M Claims 37314 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 858-824-7100 TRausche@scpmcs.org Call North County Health Services COMMERCIAL M Claims To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche 858-824-7100 TRausche@scpmcs.org 77017 North County Select COMMERCIAL M Claims 17516 North Shore - LIJ (Healthfirst) COMMERCIAL M Claims 17516 North Shore - LIJ (Healthfirst) COMMERCIAL M ERA 46227 North Shore - LIJ CareConnect Insurance Company Inc. COMMERCIAL M Claims 36392 North Suburban Associated Physicians COMMERCIAL M Claims 35212 North Texas Healthcare Network COMMERCIAL M Claims PROSP North West Orange County Medical Group COMMERCIAL M Claims 48026 NorthShore Physician Associates COMMERCIAL M ERA 48026 NorthShore Physician Associates COMMERCIAL M Claims 36364 NorthShore University Health System Medical Group COMMERCIAL M Claims NSA01 NorthStar Advantage COMMERCIAL M Claims 38238 Northern California Sheet Metal Workers Health Care Plan COMMERCIAL M Claims 36347 Northern Illinois Health Plan COMMERCIAL M Claims 88027 Northern Nevada Trust Fund COMMERCIAL M Claims NMG01 Northridge Medical Group COMMERCIAL M Claims 60058 Northstar Advantage COMMERCIAL M Claims 91068 Northwest Administrators Inc. COMMERCIAL M ERA 91068 Northwest Administrators Inc. COMMERCIAL M 91068 Northwest Administrators Inc. COMMERCIAL M EFT Payer ID valid for claims with a submission address of PO Box 1138 San Ramon CA 94583. Please call (775) 826-7200 to verfiy if you should be sending claims to Northern Nevada Trust Fund. 62119 Northwest Diagnostic Clinic/SelectCare of Texas (NWDC) COMMERCIAL M Claims 91136 Northwest Ironworkers Health & Security Fund COMMERCIAL M EFT 91136 Northwest Ironworkers Health & Security Fund COMMERCIAL M ERA NPN11 Northwest Physicians Network COMMERCIAL M Claims 91136 Northwest Roofers & Employers Health & Security Trust Fund COMMERCIAL M ERA 91136 Northwest Roofers & Employers Health & Security Trust Fund COMMERCIAL M EFT 36346 Northwest Suburban IPA (Illinois) COMMERCIAL M Claims 91136 Northwest Textile Processors and Service Trades COMMERCIAL M EFT 91136 Northwest Textile Processors and Service Trades COMMERCIAL M ERA Call Novanet COMMERCIAL M Claims Please contact the payer directly for payer id (770)729-1997 Ext. 220 71080 Novasys Health Network COMMERCIAL M Claims 71080 Novasys Health Network COMMERCIAL M Revised 02/18/2015 ICS Software, Ltd. Page 59 of 87

PROSP Nuestra Familia Medical Group (Prospect Medical Group) COMMERCIAL M Claims 37299 Nyhart COMMERCIAL M Claims 36402 OAK WEST PRIMARY PHYSICIAN ASSOCIATION COMMERCIAL M Claims 13350 ODS Health Plan COMMERCIAL M Claims 68037 OMNI/Medicore HP COMMERCIAL M Claims 22521 OSEEGIB (Oklahoma State and Education Employees Group Ins. Board) COMMERCIAL M Claims 22521 OSEEGIB (Oklahoma State and Education Employees Group Ins. Board) COMMERCIAL M ERA 62171 OSF Health Plans COMMERCIAL M Claims 51909 OSF Healthcare North COMMERCIAL M Claims 73071 OSMA Health - C. L. Frates COMMERCIAL M Claims 51909 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 34189 Ohio Health Choice PPO COMMERCIAL M Claims Payer ID valid only for claims with a billing submission address of PO Box 3619 Akron OH 44309-3619 or PO Box 93538 74431 Ohio PPO Connect COMMERCIAL M Claims 65074 Olympus Managed Health Care COMMERCIAL M 65074 Olympus Managed Health Care COMMERCIAL M Claims 57116 OneCare COMMERCIAL M Claims 52149 OneNet PPO (formerly Alliance PPO / MAPSI) COMMERCIAL M Claims 91136 Operating Engineers Locals 302 & 612 Health & Security Fund COMMERCIAL M Claims Please enter Group Number (F12) when submitting claims. 56190 OptiCare Managed Vision COMMERCIAL M Claims 54154 Optima Health Plan COMMERCIAL M Claims 54154 Optima Insurance Company COMMERCIAL M Claims 52152 Optimum Choice of the Carolinas Inc. (OCCI) COMMERCIAL M Claims 20133 Optimum Healthcare Inc. COMMERCIAL M Claims 87726 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) 552-7477. 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) 552-7477. 87726 OptumHealth / OptumHealth Behavioral Solutions of NM COMMERCIAL M Claims 33053 OptumHealth Behavioral Solutions (formerly Pacificare Behavioral Health) COMMERCIAL M Claims Use Payer ID 87726 87726 OptumHealth Behavioral Solutions (formerly United Behavioral Health) COMMERCIAL M Claims Former Payer ID 33053 41194 OptumHealth Care Solutions (formerly United Resource Networks) COMMERCIAL M Encounters Former Payer ID 52190 Revised 02/18/2015 ICS Software, Ltd. Page 60 of 87

41194 OptumHealth Care Solutions (formerly United Resource Networks) COMMERCIAL M Claims Former Payer ID 52190 52190 OptumHealth Care Solutions (formerly United Resources Networks COMMERCIAL M Claims User Payer ID 41194 41160 OptumHealth Physical Health - includes Oxford (formerly ACN & ACNIPA) COMMERCIAL M Claims Use Payer ID 41161 41161 OptumHealth Physical Health - includes Oxford (formerly ACN & ACNIPA) COMMERCIAL M Claims Former Payer IDs 41159 41160 65021 Orange County Health Care Agency COMMERCIAL M Claims 21455 Oregon's Health CO-OP COMMERCIAL M Claims Payer ID 21455 is to be used for claims with dates of service prior to 01.01.2015. 45332 Oregon's Health CO-OP COMMERCIAL M Claims Payer ID 45332 is to be used for claims with dates of service 01.01.2015 and greater. 45332 Oregon's Health CO-OP COMMERCIAL M ERA 13382 Orthonet - Uniformed Services Family Health Plan COMMERCIAL M Claims 13381 Orthonet Corporation - CIGNA COMMERCIAL M Claims 13383 Orthonet- Aetna COMMERCIAL M Claims 25681 Orthonet-HealthNet COMMERCIAL M Claims 41173 Outsource One Inc COMMERCIAL M 58379 Ownership Rewards COMMERCIAL M ERA 37287 PAI COMMERCIAL M Claims PCC Community Wellness Center Family Health Network 51909 patients only COMMERCIAL M Claims 51909 PEF Clinic II LTD. COMMERCIAL M Claims Echo is returning 835s for payer ID 37257. Providers will need to enroll with Emdeon Call PEHP - Utah Public Employee Health Plan COMMERCIAL M ERA Call EDI at 801-366-7544 or email edi.helpdesk@pehp.org to obtain the payer id. Call PEHP - Utah Public Employee Health Plan COMMERCIAL M Claims Call EDI at 801-366-7544 or email edi.helpdesk@pehp.org to obtain the payer id. 72099 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 54115 (1100 Poydras Street Suite 2600 New Orleans LA 70163-2602 is no longer an active claims submission address as of 1/1/11). 13306 PHCS Savility Payers COMMERCIAL M Claims 58379 PHPCarolinas COMMERCIAL M ERA 28943 PHYSICIAN'S ACCOUNTABLE CARE ORG COMMERCIAL M Claims PCN12 PHYSICIANS CARE NETWORK LLC/Polyclinic Seattle COMMERCIAL M Claims 59324 PODIATRY NETWORK FL COMMERCIAL M Claims 16111 POMCO COMMERCIAL M Claims 16111 POMCO COMMERCIAL M ERA 16111 POMCO COMMERCIAL M 38335 PPOM LLC COMMERCIAL M Claims UHNDC PPOONE COMMERCIAL M Claims 72148 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

58379 PSATS COMMERCIAL M ERA PSKW0 PSKW COMMERCIAL M Claims 75299 Pacific Alliance Medical Center COMMERCIAL M Claims 75299 Pacific Alliance Medical Group and Hospital (Synermed) COMMERCIAL M Claims PCFCI Pacific IPA COMMERCIAL M Claims 93029 PacificSource Health Plans COMMERCIAL M Claims 93029 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 66917 Parkland Community Health Plan COMMERCIAL M 66917 Parkland Community Health Plan COMMERCIAL M ERA 66917 Parkland Community Health Plan COMMERCIAL M Claims 52613 Partners Behavioral Health Management COMMERCIAL M Claims 51909 Partners In Health Chicago IL MG#468 COMMERCIAL M Claims 61129 Passport Health Plan COMMERCIAL M 61129 Passport Health Plan COMMERCIAL M EFT 61129 Passport Health Plan COMMERCIAL M Claims 61129 Passport Health Plan COMMERCIAL M ERA 10525 Patient Advocates LLC COMMERCIAL M Claims CB733 Patient Services Inc COMMERCIAL M Claims 27048 Payer Fusion COMMERCIAL M Claims 68069 Peach State Health Plan COMMERCIAL M Claims 20472 Pediatric Associates COMMERCIAL M 51909 Pediatric Health Associates COMMERCIAL M Claims PROSP Pegasus Medical Group COMMERCIAL M Claims 37086 Pekin Life Insurance Company COMMERCIAL M Echo is returning 835s for payer ID 61425. Providers will need to enroll with Emdeon Provider must contact Payer Client Services to request claims setup at (787) 620-1414. Claims will reject if provider is not enrolled. To obtain Payer ID and enroll with payer please contact Tristin Rausche 858-824- 7100 TRausche@scpmcs.org To obtain Payer ID and enroll with payer please contact Tristin Rausche 858-824- 7100 TRausche@scpmcs.org 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. http://www.partnersbhm.org/_formsandmanuals/trading%20partner%20agreemen t%20cover%20letter.pdf Medicaid managed care. For EDI support please e-mail EDI.PHP@Amerihealthcaritas.com or call 1-877-234-4275. Medicaid managed care. For EDI support please e-mail EDI.PHP@Amerihealthcaritas.com or call 1-877-234-4275. Prior to submitting claims please call Provider Relations Dept at 1-866-874-0633 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

53226 Penn Behavioral Health COMMERCIAL M Claims 58379 Penn Mutual COMMERCIAL M ERA Echo is returning 835s for payer ID 61425. Providers will need to enroll with Emdeon 20172 Pennsylvania Pace COMMERCIAL M Claims Call Pennsylvania's Preferred Health Network COMMERCIAL M Claims Call Jessica Picarde Manager of PPHN Claims Operations(410) 349-3222 72126 Peoples Health Network COMMERCIAL M ERA 72126 Peoples Health Network COMMERCIAL M Claims 25176 PerformCare-Select Health MH/SA COMMERCIAL M Claims For Behavioral Health EDI support please e-mail edi@cbhnp.org 95397 Personal Insurance Administrators Inc. (Agoura Hills CA) COMMERCIAL M Claims 55649 Phoenix Choice COMMERCIAL M Claims 3440 Phoenix Health Plan (Medicaid) COMMERCIAL M Claims 3443 Phoenix Health Plans (Medicare - Abrazo) COMMERCIAL M Claims 91171 Physicans of Southwest Washington COMMERCIAL M Claims 91171 Physicans of Southwest Washington COMMERCIAL M EFT Physicans of Southwest Washington COMMERCIAL M ERA 58204 Physician Associates of Louisiana COMMERCIAL M Claims Call Physician Associates of the Greater San Gabriel Valley COMMERCIAL M Claims Please call David McGee 626-817-8354 or Art Tarin 626-817-8318 to obtain the Payer Id PA513 Physician Associates of the Greater San Gabriel Valley COMMERCIAL M Claims 58204 Physician Care Network LLC COMMERCIAL M Claims 51909 Physician Care Partners Inc COMMERCIAL M Claims 57549 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 51909 Physician Partners of Dupage COMMERCIAL M Claims PDT01 Physician's Data Trust COMMERCIAL M Claims 38265 Physicians Care (ASR Corporation) COMMERCIAL M Claims Note: This is Physicians Care Network located in Michigan 38265 Physicians Care Health Plans (ASR Corporation) COMMERCIAL M Claims Note: This is Physicians Care Network located in Michigan 38265 Physicians Care Network (ASR Corporation) COMMERCIAL M Claims Note: This is Physicians Care Network located in Michigan 36345 Physicians Care Network (Rockford IL only) COMMERCIAL M Claims 80065 Physicians Care Partners COMMERCIAL M Claims 30705 Physicians Care of CA COMMERCIAL M 37136 Physicians Health Association of Illinois COMMERCIAL M Claims TH114 Physicians Health Choice - Encounters COMMERCIAL M Claims TH113 Physicians Health Claims - Claims COMMERCIAL M Claims 20398 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 47027 Physicians Mutual Insurance Company COMMERCIAL M 47027 Physicians Mutual Insurance Company COMMERCIAL M EFT 47027 Physicians Mutual Insurance Company COMMERCIAL M ERA 47027 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

39156 Physicians Plus Insurance Corporation COMMERCIAL M Claims 251PD Piedmont WellStar Health Plan COMMERCIAL M Claims 251PD Piedmont WellStar Health Plan COMMERCIAL M ERA 24735 Pinnacle Claims Management Inc. COMMERCIAL M Claims PROSP Pinnacle Health Resources (Prospect Medical Group) COMMERCIAL M Claims 45985 Pinnacle Physician Management ORG COMMERCIAL M Claims 33081 Pinnacle TPA COMMERCIAL M 84109 Pinnacol Assurance COMMERCIAL M Claims PIONR Pioneer Medical Group COMMERCIAL M Claims 37224 Pittman & Associates COMMERCIAL M ERA 37224 Pittman & Associates COMMERCIAL M Claims 37224 Pittman & Associates COMMERCIAL M 58379 Pittman & Associates COMMERCIAL M ERA 23283 Pittsburgh Care Partnership Inc. COMMERCIAL M Claims 23283 Pittsburgh Care Partnership Inc. COMMERCIAL M ERA 64160 Pivotal Plan COMMERCIAL M Claims L0190 Plan de Salud Hospital Menonita COMMERCIAL M Claims 37287 Planned Administrators Inc. COMMERCIAL M Claims 37287 Planned Administrators Inc. COMMERCIAL M 58204 Podi Care Managed Care COMMERCIAL M Claims IP057 Pomona Valley Medical Group COMMERCIAL M Claims 36373 Prairie States Enterprises Inc. COMMERCIAL M Claims 73145 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 61106 Preferred Health Plan (Louisville KY) COMMERCIAL M Claims CB404 Preferred Health Plan of the Carolinas COMMERCIAL M Claims 31478 Preferred Health Professionals COMMERCIAL M Claims 60110 Preferred Health Systems Insurance Company COMMERCIAL M Claims Echo is returning 835s for payer ID 37224. Providers will need to enroll with Emdeon Providers submitting claims as a Preferred Blue provider should not submit claims using payer ID 37287 Contact Sherry Wolgemuth Vice President of Claims Operations for Preferred Health Care at (717) 560-9290 ext. 124 for approval and the Payer ID. 60110 Preferred Health Systems A Coventry Health Care Plan COMMERCIAL M ERA 61665 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 787-622-3000 L0250 Preferred Medicare COMMERCIAL M Claims 36401 Preferred Network Access Inc. COMMERCIAL M Claims 60110 Preferred Plus of Kansas COMMERCIAL M Claims 41147 PreferredOne (MN) COMMERCIAL M Claims 41147 PreferredOne (MN) COMMERCIAL M ERA Revised 02/18/2015 ICS Software, Ltd. Page 64 of 87

43166 Premier Benefits Inc. COMMERCIAL M Claims 65054 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 http://www.emdeon.com/epayment/ to early enroll. 65054 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 http://www.emdeon.com/epayment/ to early enroll. 65054 Premier Eye Care COMMERCIAL M Claims 251PR Premier Health Plan COMMERCIAL M Claims 251PR Premier Health Plan COMMERCIAL M ERA 43166 Premier Health Plans COMMERCIAL M Claims 90440 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 90440. Claims with DOS 4/1/09 and after use their new payer ID 29076. 29076 Premier Health Systems Inc. COMMERCIAL M Claims 88056 Premier HealthCare Exchange COMMERCIAL M Claims 88051 Premier Healthcare Exchange Inc. (PHX) COMMERCIAL M Claims 5003 Presbyterian (NM) COMMERCIAL M Claims 51909 Presence Behavioral Health COMMERCIAL M Claims 51909 Presence Health Partners- FHN COMMERCIAL M Claims 45056 Prestige Health Choice COMMERCIAL M Claims 77003 Prestige Health Choice COMMERCIAL M Claims 77003 Prestige Health Choice COMMERCIAL M 77003 Prestige Health Choice COMMERCIAL M ERA Premier Health Systems Inc. is part of the Medical Mutual Family of Companies. Former payer ID 90040. Use Payer ID 20976 for claims with DOS 4/1/09 and after. For claims with DOS prior to 4/1/09 use former payer ID 90440. Payer effective 5/1/2014. Managed Medicaid Plan part of the AmeriHealth Caritas Family of Companies. For EDI support please e-mail ediphc@amerihealthcaritas.com or call 800-617-5727. Payer effective 5/1/2014. Managed Medicaid Plan part of the AmeriHealth Caritas Family of Companies. For EDI support please e-mail ediphc@amerihealthcaritas.com or call 800-617-5727. 77003 Prestige Health Choice COMMERCIAL M EFT Plan is effective May 1 2014. Payer is accepting early enrollment for ERA and EFT. IP079 Primary Care Associates Medical Group COMMERCIAL M Claims 82048 Primary Health Network COMMERCIAL M Claims 82048 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) 349-3222 61604 PrimeWest Health COMMERCIAL M ERA Prime West is a Medicare/Medicaid provider for counties in Minnesota ONLY 61604 PrimeWest Health COMMERCIAL M Claims 61271 Principal Financial Group COMMERCIAL M Claims 61271 Principal Financial Group COMMERCIAL M ERA Payer only accepts VISION and DENTAL claims 38217 Priority Health COMMERCIAL M ERA 38217 Priority Health COMMERCIAL M Claims Payer requests providers to contact them directly for 835 enrollment. Providers may call (800) 942-0954 x 8686 or email edisetup@priority-health.com Revised 02/18/2015 ICS Software, Ltd. Page 65 of 87

37268 Prism Network Inc. COMMERCIAL M Claims 37315 Prism-Univera COMMERCIAL M Claims 38329 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 48203 AND PO Box 3590 Detroit MI 48203. PROSP ProCare (Prospect) COMMERCIAL M Claims IP057 ProMed HealthCare Administrators COMMERCIAL M Claims 36331 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 38303 Professional Benefits Services Inc. COMMERCIAL M 38303 Professional Benefits Services Inc. COMMERCIAL M EFT 58379 Professional Claims Management COMMERCIAL M ERA 34134 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 37309 Protective Life Insurance Company COMMERCIAL M Claims 48100 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 13193 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 Naanes @ 503-574-7441 or Debra Wallenstein at 503-574-7450. For Claims Status please contact Susan Naanes @ 503-574-7441 or Debra Wallenstein at 503-574-7450. 58379 Provident Life & Casualty COMMERCIAL M ERA Echo is returning 835s for payer ID 64125. Providers will need to enroll with Emdeon 51052 Psychcare LLC COMMERCIAL M Claims 91136 Puget Sound Benefits Trust COMMERCIAL M ERA 91136 Puget Sound Benefits Trust COMMERCIAL M Claims Please enter Group Number (F25) when submitting claims. 91136 Puget Sound Benefits Trust COMMERCIAL M EFT 91136 Puget Sound Electrical Workers Healthcare Trust (PSEW) COMMERCIAL M EFT 91136 Puget Sound Electrical Workers Healthcare Trust (PSEW) COMMERCIAL M ERA 91136 Puget Sound Electrical Workers Trust COMMERCIAL M Claims Please enter Group Number (F33) when submitting claims. 48055 Pyramid Life Insurance Company COMMERCIAL M Claims 57117 QVI Risk Solutions Inc. COMMERCIAL M Claims 39197 Quad Med LLC (Pewaukee WI) COMMERCIAL M Claims 35174 Qual Choice of Arkansas COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 66 of 87

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. 123456789-001) 23342 QualCare Inc. COMMERCIAL M Claims 23342 QualCare Inc. COMMERCIAL M ERA 23342 QualCare Inc. COMMERCIAL M 89461 Quality Care Partners COMMERCIAL M Claims 73067 QuikTrip COMMERCIAL M Claims E-print address: QuikTrip P.O. Box 733 Buckeystown MD 21717 73067 QuikTrip COMMERCIAL M ERA TKFMC R&N Market COMMERCIAL M Claims Call RADCON INC. COMMERCIAL M Claims Please contact Kathy King @ (856) 608-1350 for Payer Id information. 91176 RBMS LLC COMMERCIAL M Claims 91176 RBMS LLC COMMERCIAL M 58379 RGA COMMERCIAL M ERA RCMG1 RIVER CITY MEDICAL GROUP COMMERCIAL M Claims 16117 RMSCO INC. COMMERCIAL M 16117 RMSCO INC. COMMERCIAL M Claims 33065 Rady Children's Hospital COMMERCIAL M Claims 51909 Ravenswood Physician Assoc INC COMMERCIAL M Claims 44219 Reading Hospital Employer Group COMMERCIAL M Claims 75299 Redlands IPA (Synermed) COMMERCIAL M Claims REGAL Regal Medical Group COMMERCIAL M Claims 38221 Regency Employee Benefits COMMERCIAL M Claims 76066 Renaissance Physicians Organization COMMERCIAL M Claims 73066 Reserve National Insurance Company COMMERCIAL M 73066 Reserve National Insurance Company COMMERCIAL M ERA Echo is returning 835s for payer ID HMA01. Providers will need to enroll with Emdeon 73066 Reserve National Insurance Company COMMERCIAL M Claims For claims rejections please contact Reserve National Customer Service at (405) 848-7931 73066 Reserve National Insurance Company COMMERCIAL M EFT RHA01 Resolve Health Plan Administrators LLC COMMERCIAL M Claims 37278 ResourceOne Administrators COMMERCIAL M Claims 36396 Resurrection Health Care Preferred/FKA Family Medical Network COMMERCIAL M Claims Please call (773) 572-8311 or( 773) 572-8309 prior to your first submission of claims 51909 Resurrection Health Preferred COMMERCIAL M Claims 26316 Retiree Health Trust COMMERCIAL M Claims 74205 Right Care from Scott & White COMMERCIAL M Claims 74205 Right Care from Scott & White COMMERCIAL M ERA 37331 RightChoice Benefit Administrators COMMERCIAL M Claims 88035 Risk Administration Management Inc. COMMERCIAL M Claims 95211 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

50664 Riverside San Bernaardino County Indian Health Inc COMMERCIAL M Call Riverside San Bernaardino County Indian Health Inc COMMERCIAL M Claims 51909 Rockford Health Physicians COMMERCIAL M Claims SX141 Rocky Mountain Health Plan - Grand Junction COMMERCIAL M Claims 46166 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 45048. Claims submitted to 46166 that have service dates/statement dates prior to 12/1/2013 will be rejected by the payer. 25133 Rural Carrier Benefit Plan COMMERCIAL M Claims 51909 Rush Health COMMERCIAL M Claims 36389 Rush Prudential Health Plans (HMO Only) COMMERCIAL M Claims AMM03 Ryan White Network COMMERCIAL M Claims 31441 S & S Healthcare Strategies COMMERCIAL M Claims 37259 SAMBA COMMERCIAL M ERA 24077 SANTA CLARA FAMILY HEALTH PLAN COMMERCIAL M Claims 99157 SCAN ENCOUNTERS COMMERCIAL M Claims Diversified Data Design (DDD) 72261 SCAN Health Plan COMMERCIAL M EFT 72261 SCAN Health Plan COMMERCIAL M Claims 20460 SCAN Long Term Care COMMERCIAL M Claims 16146 SCHC Total Care - ClaimsNet COMMERCIAL M Claims 83035 SENIOR WHOLE HEALTH COMMERCIAL M Claims 83035 SENIOR WHOLE HEALTH COMMERCIAL M 75299 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 562-997-3197. 75299 Sacramento - Primary Care Practices of Sacramento - EHS COMMERCIAL M EFT 75299 Sacramento - Primary Care Practices of Sacramento - EHS COMMERCIAL M Claims 35164 Sagamore Health Network COMMERCIAL M Claims 37105 Sage Technologies COMMERCIAL M Claims 45307 Saint Anthony PHO COMMERCIAL M Claims 51909 Saint Anthony Pho LLC COMMERCIAL M Claims 88029 Saint Mary's Health Plan COMMERCIAL M Claims 88082 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 858-824-7100 TRausche@scpmcs.org To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche 858-824-7100 TRausche@scpmcs.org Revised 02/18/2015 ICS Software, Ltd. Page 68 of 87

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 858-824-7100 TRausche@scpmcs.org 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 858-824-7100 TRausche@scpmcs.org 68035 San Joaquin Health Administrators COMMERCIAL M Claims HSM01 San Judas Medical Group IPA COMMERCIAL M Claims 33072 San Louis Obispo Select COMMERCIAL M Claims 91184 Sanford Health Plan COMMERCIAL M ERA 91184 Sanford Health Plan COMMERCIAL M Claims 91184 Sanford Health Plan COMMERCIAL M EFT For more information and to download forms please visit http://emdeon.com/epayment 77038 Sante Health System and Affiliates COMMERCIAL M ERA 77038 Sante Health System and Affiliates COMMERCIAL M Claims 73172 Scan Health Plan Arizona COMMERCIAL M Claims 58379 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 58370 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 28530 Secure Health Plans of Georgia LLC COMMERCIAL M Claims 39045 Security Health Plan COMMERCIAL M Claims 39045 Security Health Plan COMMERCIAL M ERA Please go to SHP Website to download form: http://www.securityhealth.org/providers/?page=edi Fax Completed Form to:715-221-9699 64088 Select Administrative Services (SAS) COMMERCIAL M Claims Also known as Mississippi Select Health Care. 37282 Select Benefit Administrators of America COMMERCIAL M 37282 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 54806. 45976 Select Benefit Administrators Inc. COMMERCIAL M 93031 Select Benefit Administrators Inc. COMMERCIAL M Claims 35199 Select Health Network- CMCS COMMERCIAL M ERA 35199 Select Health Network- CMCS COMMERCIAL M EFT 23285 Select Health of South Carolina COMMERCIAL M ERA For EDI support please e-mail edi@selecthealthofsc.com or call 1-888-394-3100. 23285 Select Health of South Carolina COMMERCIAL M 23285 Select Health of South Carolina COMMERCIAL M Claims For EDI support please e-mail edi@selecthealthofsc.com or call 1-888-394-3100. 23285 Select Health of South Carolina COMMERCIAL M EFT 20415 Select Senior Clinic COMMERCIAL M Claims D0014 SelectCare COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 69 of 87

76045 SelectCare of Texas (HPN) Heritage Physicians Network COMMERCIAL M EFT 76045 SelectCare of Texas (HPN) Heritage Physicians Network COMMERCIAL M ERA 76045 SelectCare of Texas (HPN) Heritage Physicians Network COMMERCIAL M 76045 SelectCare of Texas (HPN) Heritage Physicians Network COMMERCIAL M Claims 61225 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 36404 Self Insured Plans (Naples FL) COMMERCIAL M 36404 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 34110. Please call Customer Service at (239) 403-7884 to verify claims submission to Self Insured Plans - Payer ID 36404 (Naples FL). 34131 Self-Funded Plans Inc. COMMERCIAL M Claims 36426 Sendero Health COMMERCIAL M ERA 36426 Sendero Health COMMERCIAL M Claims 36390 Senior Care Partners COMMERCIAL M Claims 80141 Senior Health Partners COMMERCIAL M ERA Senior Health Partners is effective 05/01/2011. 80141 Senior Health Partners (SHP) COMMERCIAL M Claims Senior Health Partners is effective 05/01/2011. 54154 Sentara Family Care COMMERCIAL M Claims 54154 Sentara Health Management COMMERCIAL M ERA 54154 Sentara Health Management COMMERCIAL M Claims 23249 Sentinel Management Services COMMERCIAL M Claims 87020 Sentinel Security Life Insurance Company COMMERCIAL M EFT Sentinel Security Life Insurance Company COMMERCIAL M ERA 39033 Sentry Insurance a Mutual Company COMMERCIAL M Claims 39033 Sentry Life Insurance Company COMMERCIAL M ERA 39033 Sentry Life Insurance Company COMMERCIAL M Claims 39033 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) 552-7477. 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) 552-7477. 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 1-800-426-7234 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 1-800-426-7234 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 1-800-426-7234 Revised 02/18/2015 ICS Software, Ltd. Page 70 of 87

TKFMC Sequoia Beverage COMMERCIAL M Claims 76056 Seton CHIP COMMERCIAL M Claims 62308 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 25404 Seven Corners COMMERCIAL M Claims 38238 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 94583. 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 651-695-2602 54307 Shenandoah Life Insurance Company COMMERCIAL M PROSP Sierra Family Network (Prospect Medical Group) COMMERCIAL M Claims 76342 Sierra Health and Life COMMERCIAL M EFT 76342 Sierra Health and Life COMMERCIAL M 76342 Sierra Health and Life COMMERCIAL M ERA 76342 Sierra Health and Life COMMERCIAL M Claims 76343 Sierra Health and Life (Encounters) COMMERCIAL M Encounters MBA01 Sierra Nevada Medical Association COMMERCIAL M Claims 23250 Significa Benefits Services Inc. COMMERCIAL M Claims 23250 Significa Benefits Services Inc. COMMERCIAL M ERA 36387 Silver Cross Managed Care Organization COMMERCIAL M Claims 37228 Silverback TPA COMMERCIAL M Claims 58379 Simplifi COMMERCIAL M ERA 51909 Sinai Medical Group COMMERCIAL M Claims Sinai Medical Group Chicago IL Family Health Network 51909 patients only COMMERCIAL M Claims 84076 Sinclair Health Plan COMMERCIAL M Claims 84096 Sloans Lake Preferred Health Networks COMMERCIAL M Claims 2057 Smith Administrators COMMERCIAL M 2057 Smith Administrators COMMERCIAL M Claims 13010 Smokey Mountain Center COMMERCIAL M Claims 13010 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 58370 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 Dept @ (800)611-5191 for payer ID. 91131 Sound Health (now known as First Choice Health Network) COMMERCIAL M Claims 42172 Soundpath Health COMMERCIAL M Claims Formerly known as Puget Sound Health Partners Inc. 91136 South Bay Hotel Employees Restaurant Employees Health Trust COMMERCIAL M EFT 91136 South Bay Hotel Employees Restaurant Employees Health Trust COMMERCIAL M ERA Revised 02/18/2015 ICS Software, Ltd. Page 71 of 87

Call South Central Preferred - PPO York PA (IHS Gateway Payer) COMMERCIAL M Claims Call Jane Grove at Provider Relations for South Central Preferred (717) 851-6715 37314 South FL Community Care Network - NBHD COMMERCIAL M Claims 35227 South Point Hotel & Casino COMMERCIAL M Claims 25147 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 77153 Southeastern Indiana Health (SIHO) COMMERCIAL M Claims IU Health Plans 77153 Southeastern Indiana Health (SIHO) COMMERCIAL M ERA 37318 Southern Benefit Services COMMERCIAL M Claims Southern Benefit Services will no longer process claims from the following Provider Groups: Brockman Enterprises and SPS International. 37318 Southern Benefit Services COMMERCIAL M 75299 Southern CA Children's Network (SynerMed) COMMERCIAL M Claims SCP01 Southern Cal Physicians Managed Care Services COMMERCIAL M Claims 37103 Southern Illinois Laborers COMMERCIAL M 95269 Southwest Administrators COMMERCIAL M 37266 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 982005 Ft. Worth TX 76182. 23253 Spectrum Administrators Inc. - TPA Allentown PA (IHS Gateway Payer) COMMERCIAL M Claims 84146 Spina Bifida - VA HAC COMMERCIAL M ERA 835s are not returned on paper claims 84146 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 35199 St. Anthony Memorial Healthcare Centers - MDWISE COMMERCIAL M Claims To obtain the payer ID for this payer please contact CMCS Customer Service at (800) 352-7502 35199 St. Anthony- CMCS COMMERCIAL M EFT 22240 St. Barnabas System Health Plan COMMERCIAL M Claims Starting on January 1 2015 all claims with dates of service 1/1/15 and after should be submitted to Horizon BCBSNJ Payer ID 22099. 35199 St. Catherine Hospital PHO - MDWISE COMMERCIAL M Claims To obtain the payer ID for this payer please contact CMCS Customer Service at (800) 352-7502 35199 St. Catherine-CMCS COMMERCIAL M EFT 51909 St. Francis Health Care COMMERCIAL M Claims 51909 St. Francis Health Care Chicago IL MG#112 COMMERCIAL M Claims 35199 St. Francis Health Network COMMERCIAL M Claims To obtain the payer ID for this payer please contact CMCS Customer Service at (800) 352-7502 35199 St. Francis Health Network- CMCS COMMERCIAL M EFT 11158 St. James PHO COMMERCIAL M Claims 51909 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

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) 352-7502 35199 St. Margaret- CMCS COMMERCIAL M EFT PDT01 St. Vincent IPA COMMERCIAL M Claims 73099 Standard Life and Accident Insurance Company COMMERCIAL M ERA 73099 Standard Life and Accident Insurance Company COMMERCIAL M Claims 59225 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 55270 30870 30888 54150 30069 55400 Phoenix AZ 85270-5270. 61425 Starmark COMMERCIAL M Claims 46450 State Auto Insurance Companies COMMERCIAL M Claims 31059 State Farm (Casualty & Property Claims) COMMERCIAL M ERA 31059 State Farm (Casualty & Property Claims) COMMERCIAL M Claims State Farm - Property & Casualty line of business is Payer ID 31059. 31053 State Farm Insurance Companies COMMERCIAL M ERA Provider must access payer website http://b2b.statefarm.com/b2b/roles/hcp_public/eft.asp 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. 31053 State Farm Insurance Companies COMMERCIAL M Claims Payer ID 31053 is for State Farm - Health line of business. 57254 State of Texas Dental Plan COMMERCIAL M Claims 75087 States General Life Insurance COMMERCIAL M Claims 67829 Sterling Medicare Advantage COMMERCIAL M Claims 67829 Sterling Medicare Advantage COMMERCIAL M ERA 67829 Sterling Medicare Advantage COMMERCIAL M 67829 Sterling Medicare Advantage COMMERCIAL M EFT Payer ID is for claims with Service Dates prior to May 1 2014. Claims with a Date of Service on or after May 1 2014 will reject for ACK/RETURNED - Claim submitted to incorrect payer. Please submit these claims directly to Sterling (Windsor). 91151 Sterling Option 1 COMMERCIAL M Claims Payer ID is for claims with Service Dates prior to May 1 2014. Claims with a Date of Service on or after May 1 2014 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 31522 Stewart Miller and Company COMMERCIAL M TRLTC Stonebridge Life Insurance Company COMMERCIAL M Claims PO Box 869093 Plano TX 75086-9093 TRLTC Stonebridge Life Insurance Company COMMERCIAL M Claims PO Box 93019 Hurst TX 76053-3019 TRP1E Stonebridge Life Insurance Company COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA 52406-3350 TRP1E Stonebridge Life Insurance Company COMMERCIAL M EFT TRP1E Stonebridge Life Insurance Company COMMERCIAL M Claims Claim Services Division Valley Forge PA 19493 TRP1P Stonebridge Life Insurance Company COMMERCIAL M Claims 2700 West Plano Parkway Plano TX 75075 31121 Stoner and Associates (Cincinnati OH) COMMERCIAL M Claims 57492 Stones River IPA - Amerivantage COMMERCIAL M Claims 15750 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 15754 Stones River Regional IPA/BHFG COMMERCIAL M Claims claims Revised 02/18/2015 ICS Software, Ltd. Page 73 of 87

15752 Stones River Regional IPA/Windsor COMMERCIAL M Claims 58128 Stowe Associates COMMERCIAL M 95202 SummaCare Health Plan COMMERCIAL M Claims 86083 Summit Administration Services Inc. COMMERCIAL M Claims 86083 Summit Administration Services Inc. COMMERCIAL M 37301 Summit America Insurance Services Inc. COMMERCIAL M Claims Student Accident and Sickness College Sports and NASCC claims only 68069 Sunshine State Health Plan COMMERCIAL M Claims 23218 Superior Administrators Inc (Santa Ana CA) COMMERCIAL M 23218 Superior Administrators Inc (Santa Ana CA) COMMERCIAL M Claims Payer ID valid for claims with a submission address of P.O. Box 27730 Santa Ana CA 92799-7730 68069 Superior Health Plan Texas COMMERCIAL M Claims Prior to submitting claims please call Provider Relations Dept at 1-800-218-7453 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. 77318 Sutter Delta Medical Group COMMERCIAL M Claims 94269 Sutter East Bay Medical Foundation COMMERCIAL M Claims 96176 Sutter East Bay Regional Hospital COMMERCIAL M Claims 94119 Sutter East Bay Regional Hospital- Affinity COMMERCIAL M Claims 77302 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 Dept @ (800)611-5191 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 Dept @ (800)611-5191 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 Dept @ (800)611-5191 for payer ID. 77304 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 Dept @ (800)611-5191 for payer ID. 36411 Swedish Covenant Hospital COMMERCIAL M Claims 51909 Swedish Covenant Managed Care Alliance COMMERCIAL M Claims TKFMC TASEBA COMMERCIAL M Claims 94304 TBT COMMERCIAL M Claims 88054 TEAMSTERS (UT/ ID / MT) - Group Benefit Admin COMMERCIAL M Claims Call TIC Time Ins Co COMMERCIAL M 13402 TOUCHSTONE HEALTH/HEALTH NET SMART CHOICE COMMERCIAL M Claims Claims submitted under 13402 are routed to payer id 11328. For (ERA) enroll under payer id 11328. 58167 TPA of Georgia COMMERCIAL M 31074 TPAC/Employee Benefit Management Corp COMMERCIAL M Claims 37230 TR Paul Inc. COMMERCIAL M Claims 62777 TRILOGY NETWORK COMMERCIAL M Claims Formerly known as TRLHN/EB 64300 TRIPLEFIN LLC COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 74 of 87

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 800-456-4584. 42137 TRISTAR Benefit Administrators (W. DesMoines IA) COMMERCIAL M 98514 TRLHN/AS COMMERCIAL M Claims 98022 TakeCare Insurance Company COMMERCIAL M Claims TALMG Talbert Medical Group COMMERCIAL M Claims 88067 Tall Tree Administrators COMMERCIAL M Claims 88019 Teachers Health Trust COMMERCIAL M EFT 88019 Teachers Health Trust COMMERCIAL M Claims 88019 Teachers Health Trust COMMERCIAL M 23139 Teachers Protective Mutual COMMERCIAL M 75139 Team Choice Gold COMMERCIAL M Claims 75133 Team Choice PNS COMMERCIAL M Claims 36215 Teamcare COMMERCIAL M Claims 94304 Teamsters Benefit Trust COMMERCIAL M Claims 75299 Temple Community Hospital COMMERCIAL M Claims 20212 Tethys Health Ventures COMMERCIAL M Claims 76048 Texas Children's Health Plan COMMERCIAL M ERA 76048 Texas Children's Health Plan COMMERCIAL M EFT 76048 Texas Children's Health Plan COMMERCIAL M Claims 76048 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 75228 Texas Childrens Health Plan (Medicaid) COMMERCIAL M EFT 75228 Texas Childrens Health Plan (Medicaid) COMMERCIAL M Claims 75228 Texas Childrens Health Plan (Medicaid) COMMERCIAL M ERA 75228 Texas Childrens Health Plan (Medicaid) COMMERCIAL M 76046 Texas First Health Plans (TIOPA) COMMERCIAL M Claims 33104 Texas HealthSpring COMMERCIAL M Claims TH089 Texas Premier Plan COMMERCIAL M Claims 13185 TexasFirst Health Plan (NTX) COMMERCIAL M Claims 13185 TexasFirst Health Plan (NTX) COMMERCIAL M EFT 13185 TexasFirst Health Plan (NTX) COMMERCIAL M 13185 TexasFirst Health Plan (NTX) COMMERCIAL M ERA 13192 The Allen J Flood Companies Inc COMMERCIAL M 88461 The Alliance COMMERCIAL M Claims 68423 The Care Network/The Savannah Business Group COMMERCIAL M Claims 51909 The Childrens Clinic IWS COMMERCIAL M Claims 75600 The City of Odessa COMMERCIAL M Claims 28777 The EPOCH Group COMMERCIAL M Revised 02/18/2015 ICS Software, Ltd. Page 75 of 87

37305 The Ford Meter Box Company Inc. COMMERCIAL M 37305 The Ford Meter Box Company Inc. COMMERCIAL M Claims 20356 The Health Exchange (Cerner Corporation) COMMERCIAL M Claims 34150 The Health Plan (Massillon Ohio and St. Clairsville Ohio only) COMMERCIAL M Claims 35206 The Healthcare Group COMMERCIAL M Claims 58200 The Integrity Benefit Group Inc. COMMERCIAL M Claims The Loomis Company - TPA Wyomissing PA (IHS Gateway 23223 Payer) COMMERCIAL M Claims The MEGA Life & Health Insurance Company - Insurance 59221 Center COMMERCIAL M ERA The MEGA Life & Health Insurance Company - Insurance 59221 Center COMMERCIAL M Claims The MEGA Life & Health Insurance Company - Insurance 59221 Center COMMERCIAL M The MEGA Life & Health Insurance Company - Insurance 59221 Center COMMERCIAL M EFT 59225 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 982009 North Richland Hills TX 76182 Payer ID valid only if the address on the Health ID Card matches one of the following P.O. Boxes: P.O. Box 55270 30870 30888 54150 30069 55400 Phoenix AZ 85270-5270. If the P.O. Box on the health ID card matches the following P.O. Box: P.O. Box 548801 Oklahoma City OK 73154 59227 The MEGA Life & Health Insurance Company-OKC COMMERCIAL M Claims 59087 The National Radiology Network COMMERCIAL M Claims Electronic Payer ID for Claims printed and mailed to payer 13522 The Perfect Health Insurance Co. COMMERCIAL M The Physicians Assurance Corp (TPAC) /Employee Benefit 31074 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) 349-3222 This id is open COMMERCIAL M Claims 71032 Thomas Cooper & Co Inc COMMERCIAL M SX160 Thomas H. Cooper COMMERCIAL M Claims 51909 Thorek Memorial Hospital Group COMMERCIAL M Claims 58379 Three Rivers Benefit Corporation COMMERCIAL M ERA 20081 Today's Health Wisconsin COMMERCIAL M ERA 20081 Today's Health Wisconsin COMMERCIAL M Claims Echo is returning 835s for payer ID THR01. Providers will need to enroll with Emdeon 48055 Today's Options (American Progressive and Pyramid Life) COMMERCIAL M Claims 48055 Today's Options (American Progressive and Pyramid Life) COMMERCIAL M EFT 48055 Today's Options (American Progressive and Pyramid Life) COMMERCIAL M 48055 Today's Options (American Progressive and Pyramid Life) COMMERCIAL M ERA Revised 02/18/2015 ICS Software, Ltd. Page 76 of 87

48055 Today's Options powered by CCRX COMMERCIAL M Claims 92620 Tongass Timber Trust COMMERCIAL M Claims 61425 Tooling & Manufacturing Association COMMERCIAL M Claims THIPA Torrance Hospital IPA COMMERCIAL M Claims 36342 Total Broker Benefits COMMERCIAL M Claims f.k.a. Benefit Systems & Services Inc. 37314 Total Claims Administration COMMERCIAL M Claims 31182 Total Community Care COMMERCIAL M Claims 38201 Total Healthcare Inc. COMMERCIAL M Claims 31182 Total Long Term Care COMMERCIAL M Claims 23856 Touchstone Health PSO COMMERCIAL M ERA Claims submitted under 23856 are routed to payer id 11328. For (ERA) enroll under payer id 11328 23856 Touchstone Health PSO COMMERCIAL M Claims Claims submitted under 23856 are routed to payer id 11328. For (ERA) enroll under payer id 11328 TKFMC Town & Country COMMERCIAL M Claims 59222 TransAmerica Life Insurance Company COMMERCIAL M 59222 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 982009 North Richland Hills TX 76182. 59222 TransAmerica Life Insurance Company COMMERCIAL M ERA 37284 TransChoice-Key Benefit Administrators COMMERCIAL M EFT 37284 TransChoice-Key Benefit Administrators COMMERCIAL M 37284 TransChoice-Key Benefit Administrators COMMERCIAL M Claims TLINS Transamerica Financial Life Insurance Company COMMERCIAL M Claims PO Box 8043 Little Rock AR 72203-8043 TRLTC Transamerica Financial Life Insurance Company COMMERCIAL M Claims PO Box 869098 Plano TX 75086-9098 TRLTC Transamerica Financial Life Insurance Company COMMERCIAL M Claims PO Box 93019 Hurst TX 76053-3019 TRP1E Transamerica Financial Life Insurance Company COMMERCIAL M Claims PO Box 97 Scranton PA 18504-0097 TRP1E Transamerica Financial Life Insurance Company COMMERCIAL M Claims PO Box 17004 Baltimore MD 21203-7004 TRP1E Transamerica Financial Life Insurance Company COMMERCIAL M EFT TRP1E Transamerica Financial Life Insurance Company COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA 52406-3350 TRP1E Transamerica Financial Life Insurance Company COMMERCIAL M Claims Claim Services Division Valley Forge PA 19493 TRP1P Transamerica Financial Life Insurance Company COMMERCIAL M Claims 2700 West Plano Parkway Plano TX 75075 TLINS Transamerica Life Insurance Company COMMERCIAL M Claims PO Box 8043 Little Rock AR 72203-8043 TRLTC Transamerica Life Insurance Company COMMERCIAL M Claims PO Box 869093 Plano TX 75086-9093 TRLTC Transamerica Life Insurance Company COMMERCIAL M Claims PO Box 93019 Hurst TX 76053-3019 TRP1E Transamerica Life Insurance Company COMMERCIAL M Claims PO Box 97 Scranton PA 18504-0097 TRP1E Transamerica Life Insurance Company COMMERCIAL M EFT TRP1E Transamerica Life Insurance Company COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA 52406-3350 TRP1E Transamerica Life Insurance Company COMMERCIAL M Claims PO Box 17004 Baltimore MD 21203-7004 TRP1P Transamerica Life Insurance Company COMMERCIAL M Claims 2700 West Plano Parkway Plano TX 75075 TLINS Transamerica Premier Life Insurance Company COMMERCIAL M Claims PO Box 8043 Little Rock AR 72203-8043 TRCLF Transamerica Premier Life Insurance Company COMMERCIAL M Claims 4333 Edgewood Road NE Cedar Rapids IA 52499 TRLTC Transamerica Premier Life Insurance Company COMMERCIAL M Claims PO Box 869093 Plano TX 75086-9093 TRLTC Transamerica Premier Life Insurance Company COMMERCIAL M Claims PO Box 93019 Hurst TX 76053-3019 TRP1E Transamerica Premier Life Insurance Company COMMERCIAL M Claims 100 Light Street Baltimore MD 21202-0000 TRP1E Transamerica Premier Life Insurance Company COMMERCIAL M Claims Claim Services Division Valley Forge PA 19493 TRP1E Transamerica Premier Life Insurance Company COMMERCIAL M Claims PO Box 17004 Baltimore MD 21203-7004 TRP1E Transamerica Premier Life Insurance Company COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA 52406-3350 TRP1E Transamerica Premier Life Insurance Company COMMERCIAL M Claims PO Box 97 Scranton PA 18504-0097 Revised 02/18/2015 ICS Software, Ltd. Page 77 of 87

TRP1E Transamerica Premier Life Insurance Company COMMERCIAL M EFT TRP1P Transamerica Premier Life Insurance Company COMMERCIAL M Claims 2700 West Plano Parkway Plano TX 75075 20807 Transchoice or TransSmile - First Service Administrator's Inc COMMERCIAL M Claims 36397 Trellis Health Partners COMMERCIAL M Claims PDT01 TriCities IPA COMMERCIAL M Claims 73117 Tribute /SelectCare of Oklahoma COMMERCIAL M ERA 73117 Tribute /SelectCare of Oklahoma COMMERCIAL M Claims 73117 Tribute /SelectCare of Oklahoma COMMERCIAL M EFT 73117 Tribute /SelectCare of Oklahoma COMMERCIAL M 31118 Tribute Health Plan COMMERCIAL M Claims 31118 Tribute Health Plan COMMERCIAL M ERA SX163 Tricare Overseas COMMERCIAL M Claims 31144 Trihealth Physician Solutions COMMERCIAL M ERA 31144 Trihealth Physician Solutions COMMERCIAL M Claims 31143 Trihealth Physician Solutions - Concern COMMERCIAL M Claims 58379 Trusteed Plans Service Corporation COMMERCIAL M ERA 91078 Trusteed Plans Service Corporation COMMERCIAL M Claims 61425 Trustmark Insurance Company COMMERCIAL M ERA 61425 Trustmark Insurance Company COMMERCIAL M Claims 58379 Trustmark Life Insurance Co COMMERCIAL M ERA 58379 Trustmark insurance Company COMMERCIAL M ERA 4298 Tufts Health Plan COMMERCIAL M ERA Call Tufts Health Plan COMMERCIAL M Claims TH065 UFCW COMMERCIAL M 51909 UI Campus Care COMMERCIAL M Claims 51909 UIC College of Medicine at Rockford COMMERCIAL M Claims 51909 UICPG Chicago IL MG#141 COMMERCIAL M Claims 75130 UMC Health Plan COMMERCIAL M Claims 75130 UMC Health Plan COMMERCIAL M Echo is returning 835s for payer ID 91078. Providers will need to enroll with Emdeon Echo is returning 835s for payer ID 61425. Providers will need to enroll with Emdeon Echo is returning 835s for payer ID 61425. Providers will need to enroll with Emdeon Please contact the Tufts Health Plan EDI Operations Department at 888-880-8699 ext. 4042. for payer id. 75196 UMR (formerly Harrington Benefit Services - Westerville) COMMERCIAL M Claims Use Payer ID 39026 75243 UMR (formerly Harrington Benefit Services) COMMERCIAL M Claims Use Payer ID 39026 37237 UMR (formerly Lexington / CommonWealth Administrative Group) COMMERCIAL M Claims 79480 UMR (formerly UMR Onalaska) COMMERCIAL M Claims Former Payer IDs 74223 95266 79480 UMR (formerly UMR Onalaska) COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at http://www.emdeon.com/enrollnow/ 79480 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

74223 UMR (formerly UMR San Antonio Benefit Planners) COMMERCIAL M Claims Use Payer ID 39026 or 79480 (see member's card if available) 39026 UMR (formerly UMR Wausau) COMMERCIAL M ERA 95266 UMR Westerville (formerly Harrington Health) COMMERCIAL M Claims Use Payer ID 79480 52180 UMWA Health & Retirement Funds COMMERCIAL M Claims 80314 UNICARE COMMERCIAL M Claims 80314 UNICARE COMMERCIAL M ERA Available for Providers within Kansas Texas West Virginia Massachusetts and Illinois only. For questions call 877-210-4083 87042 UNION PACIFIC RAILROAD EMPLOYES Health Systems COMMERCIAL M 87042 UNION PACIFIC RAILROAD EMPLOYES Health Systems COMMERCIAL M Claims 36659 UNITED FOOD & COMM. WORKERS MIDWEST UNIONS COMMERCIAL M Claims 23281 UPMC Health Plan COMMERCIAL M ERA 23281 UPMC Health Plan COMMERCIAL M Claims 25184 UPMC Vision Advantage COMMERCIAL M ERA Enrollment Required: Please go to SHP Website to download form: http://www.securityhealth.org/providers/?page=edi Fax Completed Form to:715-221-9699 25184 UPMC Vision Advantage COMMERCIAL M Claims 93092 US Benefits COMMERCIAL M Claims 93092 US Benefits COMMERCIAL M TH103 US Family Health Plan (USFHP) COMMERCIAL M Claims TX and LA only 74095 USAA (United Services Automobile Association) COMMERCIAL M Claims Property and Casualty Division Only 13407 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 1-800-241-4848 25133 UT- Altius (UHIN) COMMERCIAL M Claims 91136 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 77022 Ultimate Health Plan COMMERCIAL M ERA 77022 Ultimate Health Plan COMMERCIAL M Claims 77022 Ultimate Health Plan COMMERCIAL M EFT 41206 Ultra Benefits Inc. COMMERCIAL M Claims 61048 Underwriters Safety & Claims COMMERCIAL M 35198 Unified Group Services COMMERCIAL M Claims 62170 Unified Health Services COMMERCIAL M Claims Worker's Compensation Claims Only. 34638 Unified Physicians Network COMMERCIAL M ERA 34638 Unified Physicians Network COMMERCIAL M Claims For claims rejections please contact Unified Physicians Claims Department at 847-763- 1700 TRP1E Union Labor Life Insurance Company - Admin By UBC COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA 52406-3350 Call Union Pacific IPA COMMERCIAL M Claims To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche 858-824-7100 TRausche@scpmcs.org Call Union Pacific IPA COMMERCIAL M Encounters To obtain Payer ID and enroll with payer California providers should contact Tristin Rausche 858-824-7100 TRausche@scpmcs.org 70408 Union Security Insurance Company COMMERCIAL M 70408 Union Security Insurance Company COMMERCIAL M EFT 70408 Union Security Insurance Company COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 79 of 87

70408 Union Security Insurance Company COMMERCIAL M ERA 62183 Unison Health Plan/Better Health Plans COMMERCIAL M Claims 94174 United Administrative Services Inc COMMERCIAL M ERA 94174 United Administrative Services Inc COMMERCIAL M 94174 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. 31427 United Commercial Travelers COMMERCIAL M 59189 United Group Programs Inc. COMMERCIAL M United Group Programs Inc. COMMERCIAL M EFT 84132 United Medical Alliance COMMERCIAL M 84132 United Medical Alliance COMMERCIAL M Claims 36362 United Security Life & Health Ins Co COMMERCIAL M Claims Please do not submit claims on or after 1/1/2011 using payer ID 36362. Claims will need to be submitted on paper to United Security Life and Health PO Box 24655 Seattle WA 98124-0655. For questions call 1-800-875-4422. 13193 United Teacher Assoc Ins Co-Medicare Supplement COMMERCIAL M Claims 71412 United of Omaha COMMERCIAL M Claims 81400 UnitedHealthCare / All Savers Alternate Funding COMMERCIAL M Claims 37602 UnitedHealthOne / Golden Rule COMMERCIAL M Claims 37602 UnitedHealthOne / Golden Rule COMMERCIAL M ERA Additional Payer ID 81400 is also required For ERA Setup and Enrollment 81400 UnitedHealthOne / PacifiCare Life and Health Insurance Company COMMERCIAL M Claims 87726 UnitedHealthcare COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at http://www.emdeon.com/enrollnow. ERA's for payer ID 33053 are sent through payer ID 87726. 87726 UnitedHealthcare COMMERCIAL M Claims 52148 UnitedHealthcare (MAHP MD IPA Optimum Choice MAMSI) COMMERCIAL M ERA Use Payer ID 87726 52148 UnitedHealthcare (MAHP MD IPA Optimum Choice MAMSI) COMMERCIAL M Claims Use Payer ID 87726 6111 UnitedHealthcare (Oxford Health Plans) COMMERCIAL M ERA EFT is required Provider must call PNC at 1-877-597-5489 and press option #1. Available Monday-Friday from 8:30am to 5:30pm EST 64159 UnitedHealthcare (formerly Definity Health Plan) COMMERCIAL M Claims Use Payer ID 87726 81400 UnitedHealthcare / All Savers Insurance COMMERCIAL M ERA Additional Payer ID 37602 is also required For ERA SetupAdditional Payer ID 37602 is also required For ERA Setup Payer Enrollment Form at http://www.emdeon.com/enrollnow 87726 UnitedHealthcare / Definity Health Plan COMMERCIAL M Claims Former Payer ID 64159 87726 UnitedHealthcare / Empire Plan COMMERCIAL M Claims 87726 UnitedHealthcare / MAHP - MD IPA Optimum Choice MLH (formerly MAMSI) COMMERCIAL M Claims Former Payer ID 52148 6111 UnitedHealthcare / Oxford COMMERCIAL M Claims 39026 UnitedHealthcare / UHIS-UnitedHealth Integrated Services COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 80 of 87

87726 UnitedHealthcare / UnitedHealthcare Plan of River Valley COMMERCIAL M Claims Former Payer ID 95378 (effective after 4/16/14) 95378 UnitedHealthcare / UnitedHealthcare Plan of River Valley COMMERCIAL M Claims Use Payer ID 87726 effective 4/16/14 87726 UnitedHealthcare / UnitedHealthcare West (formerly PacifiCare) COMMERCIAL M Claims Former Payer IDs 95959 95962 95964 95999 95958 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 http://www.emdeon.com/enrollnow/ 3432 UnitedHealthcare Community Plan / AZ (formerly AZ Physicians IPA APIPA) COMMERCIAL M Claims 25175 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 04567 4567 UnitedHealthcare Community Plan / DE MD OH PA COMMERCIAL M ERA Formerly Americhoice or Unison 95378 UnitedHealthcare Community Plan / IA hawk-i COMMERCIAL M ERA 87726 UnitedHealthcare Community Plan / IA hawk-i (formerly AmeriChoice of Iowa) COMMERCIAL M Claims Former Payer ID 95378 (effective after 4/16/14) 95378 UnitedHealthcare Community Plan / IA hawk-i (formerly AmeriChoice of Iowa) COMMERCIAL M Claims Use Payer ID 87726 effective 4/16/14 96385 UnitedHealthcare Community Plan / KS (KanCare) COMMERCIAL M ERA 96385 UnitedHealthcare Community Plan / KS (KanCare) COMMERCIAL M Claims 95467 UnitedHealthcare Community Plan / MI (formerly Great Lakes Health Plan) COMMERCIAL M Claims 95467 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 http://www.emdeon.com/enrollnow 87726 UnitedHealthcare Community Plan / MS CHIP (formerly AmeriChoice MS - CHIP) COMMERCIAL M Claims Former Payer ID 95378 (effective after 4/16/14) 95378 UnitedHealthcare Community Plan / MS CHIP (formerly AmeriChoice MS - CHIP) COMMERCIAL M Claims Use Payer ID 87726 effective 4/16/14 87726 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 http://www.emdeon.com/enrollnow/ 86001 UnitedHealthcare Community Plan / NJ COMMERCIAL M Claims Please use Payer ID 86047 86047 UnitedHealthcare Community Plan / NJ COMMERCIAL M Claims Former Payer ID 86001 86047 UnitedHealthcare Community Plan / NJ (formerly Americhoice NJ Medicaid) COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at http://www.emdeon.com/enrollnow/ 86048 UnitedHealthcare Community Plan / NY (formerly AmeriChoice NY Medicaid) COMMERCIAL M Claims Effective 9/1/13 Use Payer ID 87726 86002 UnitedHealthcare Community Plan / NY (formerly AmeriChoice Personal Care) COMMERCIAL M Claims Effective 9/1/13 Use Payer ID 87726 NYU01 UnitedHealthcare Community Plan / NYU COMMERCIAL M ERA Please submit the Emdeon ERA PSF and complete the Payer Enrollment Form at http://www.emdeon.com/enrollnow/ 86049 UnitedHealthcare Community Plan / PA (formerly AmeriChoice PA Medicaid&CHIP COMMERCIAL M Claims Use Payer ID 25175 86003 UnitedHealthcare Community Plan / PA (formerly AmeriChoice Personal Care ) COMMERCIAL M Claims Use Payer ID 25175 25175 UnitedHealthcare Community Plan / SC COMMERCIAL M ERA Revised 02/18/2015 ICS Software, Ltd. Page 81 of 87

25175 UnitedHealthcare Community Plan / SC (formerly Unison) COMMERCIAL M Claims SC plan is for DOS prior to 10-1-2013-use Payer ID 87726 Former Payer IDs 86003 86049 95378 UnitedHealthcare Community Plan / TN (formerly AmeriChoice TN: TennCare COMMERCIAL M Claims TEX01 UnitedHealthcare Community Plan / TX COMMERCIAL M ERA 87726 UnitedHealthcare Community Plan / UnitedHealthcare Dual Complete COMMERCIAL M Claims 87726 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 http://www.emdeon.com/enrollnow/ 25175 UnitedHealthcare Community Plan Ohio COMMERCIAL M ERA Formerly Unison Ohio -- Effective 5/1/2013 -- use Payer ID 04567 25175 UnitedHealthcare Community Plan of Delaware COMMERCIAL M ERA Effective 3/1/14 -- use Payer ID 87726: Note: ERA will be delivered under Payer ID 04567 4567 UnitedHealthcare Community Plan of Louisiana COMMERCIAL M ERA Claims are processed under 87726 but ERAs will be delivered under 04567 87726 UnitedHealthcare Community Plan of Louisiana COMMERCIAL M Claims Effective for dates of service on or after Feb. 1 2015 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 04567. 25175 UnitedHealthcare Community Plan of Pennsylvania COMMERCIAL M ERA Effective 3/1/14 -- use Payer ID 87726: Note: ERA will be delivered under Payer ID 04567 25175 UnitedHealthcare Community Plan/DEFLHILAMDMS CANNMOHPARI TX WA COMMERCIAL M Claims Effective 3/1/14 -- use Payer ID 87726 Former Payer IDs 86003 86049 87726 UnitedHealthcare Community Plan/DEFLHILAMDMS CANNMOHPARITXWAWI COMMERCIAL M Claims Former PA payer ids 25175 86003 86049 87726 UnitedHealthcare Community Plan/FLHILAMDMS CANNMOHRITXWI COMMERCIAL M Claims 86001 UnitedHealthcare Community Plan/NJ (formerly AmeriChoice Personal Care Pl COMMERCIAL M Claims Please use Payer ID 86047 87726 UnitedHealthcare Medicare Solutions / UnitedHealthcare Chronic Complete COMMERCIAL M Claims 87726 UnitedHealthcare Medicare Solutions / UnitedHealthcare Group Medicare Advan COMMERCIAL M Claims 87726 UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareComplete COMMERCIAL M Claims 87726 UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareDirect COMMERCIAL M Claims 87726 UnitedHealthcare Medicare Solutions / UnitedHealthcare Nursing Home Plan COMMERCIAL M Claims 74227 UnitedHealthcare StudentResources COMMERCIAL M ERA 74227 UnitedHealthcare StudentResources COMMERCIAL M 74227 UnitedHealthcare StudentResources COMMERCIAL M EFT 74227 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 http://www.emdeon.com/enrollnow. 95999 UnitedHealthcare West (formerly PacifiCare PPO - All States) COMMERCIAL M Claims Use Payer ID 87726 Revised 02/18/2015 ICS Software, Ltd. Page 82 of 87

95964 UnitedHealthcare West (formerly PacifiCare of Arizona) COMMERCIAL M Claims Use Payer ID 87726 95964 UnitedHealthcare West (formerly PacifiCare of Arizona) COMMERCIAL M ERA Use Payer ID 87726 95959 UnitedHealthcare West (formerly PacifiCare of CA - Claims) COMMERCIAL M ERA Use Payer ID 87726 95959 UnitedHealthcare West (formerly PacifiCare of CA - Claims) COMMERCIAL M Claims Use Payer ID 87726 95962 UnitedHealthcare West (formerly PacifiCare of Colorado) COMMERCIAL M Claims Use Payer ID 87726 95962 UnitedHealthcare West (formerly PacifiCare of Colorado) COMMERCIAL M ERA User Payer ID 87726 66705 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 95380 Universal American Financial Services COMMERCIAL M Claims TRP1E Universal Benefits - Admin For Chubb Life Insurance Company Of America COMMERCIAL M Claims PO Box 17004 Baltimore MD 21203-7004 TRP1E Universal Benefits - Admin For City Of Bridgeport CT COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA 52406-3350 TRP1E Universal Benefits - Admin For Hartford Life And Accident Insurance Co COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA 52406-3350 TRP1E Universal Benefits - Admin For Hartford Life Insurance Company COMMERCIAL M Claims PO Box 3350 Cedar Rapids IA 52406-3350 33001 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 09830 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 09830 for ERA's 99026 University Health Alliance COMMERCIAL M ERA 99026 University Health Alliance COMMERCIAL M Claims Payer Registration is required. EDI Enrollment form is available at www.emdeon.com 46407 University Health Care Advantage COMMERCIAL M Claims 45437 University Healthcare Marketplace COMMERCIAL M Claims 37601 University of Illinois at Chicago Div of Specialized Care for Children COMMERCIAL M Claims 92579 University of Miami Behavioral Health COMMERCIAL M Claims 25133 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 37324 Upper Peninsula Health Group (TPA) COMMERCIAL M Claims 38337 Upper Peninsula Health Plan (Medicaid) COMMERCIAL M ERA 38337 Upper Peninsula Health Plan (Medicaid) COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 83 of 87

38337 Upper Peninsula Health Plan (Medicaid) COMMERCIAL M 38337 Upper Peninsula Health Plan (Medicaid) COMMERCIAL M EFT For more information and to download forms please visit http://emdeon.com/epayment 12115 VA Fee Basis Programs COMMERCIAL M ERA 835s are not returned on paper claims 12115 VA Fee Basis Programs COMMERCIAL M Claims 55912 VA-Patient-Centered Community Care Program (VAPCCC) Region 3 COMMERCIAL M Claims 55915 VA-Patient-Centered Community Care Program (VAPCCC) Region 5A COMMERCIAL M Claims 55916 VA-Patient-Centered Community Care Program (VAPCCC) Region 5B COMMERCIAL M Claims 55917 VA-Patient-Centered Community Care Program (VAPCCC) Region 6 COMMERCIAL M Claims 31626 VNA Homecare Options COMMERCIAL M ERA 31626 VNA Homecare Options COMMERCIAL M Claims 77073 VNS CHOICE Medicare COMMERCIAL M ERA 77073 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 94600 Valley Health Plan COMMERCIAL M ERA 94293 Valley Mental Health COMMERCIAL M Claims 23253 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 www.emdeon.com/enrollment 72128 Vantage Health Plan Inc. COMMERCIAL M 72128 Vantage Health Plan Inc. COMMERCIAL M Claims 72128 Vantage Health Plan Inc. COMMERCIAL M ERA PPM01 Vantage Medical Group COMMERCIAL M Claims 86062 VentureNet Healthcare COMMERCIAL M Claims 66126 Verdugo Hills Medical Group COMMERCIAL M Claims 75256 Verity National Group COMMERCIAL M Claims VVIPA Victor Valley IPA COMMERCIAL M Claims VVMG1 Victor Valley IPA COMMERCIAL M Claims 73743 Village Family Practice COMMERCIAL M Claims 26545 VillageCareMAX COMMERCIAL M Claims 84806 Virginia Coordinated Care-VCC COMMERCIAL M Claims Member id must be 10 digit member id for this payer CVAK1 Virginia Medicaid COMMERCIAL M Claims 54176 Virginia Premier Health Plan COMMERCIAL M Claims Virginia Premier enrollment forms located on www.emdeon.com/enrollment 54176 Virginia Premier Health Plan COMMERCIAL M ERA ERA provider enrollment form is located at www.emdeon.com 37297 Vison Care Incorporated COMMERCIAL M Claims 25133 Vista Medicaid COMMERCIAL M EFT NCH08 Vista Oncology - New Century Infusion Solutions COMMERCIAL M Claims 63114 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

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: https://estepp.cschcg.com/tri_provider/doentry.jsp 63114 Viva Health Plan COMMERCIAL M EFT 63114 Viva Health Plan COMMERCIAL M 59266 Volusia Health Network COMMERCIAL M Claims 59266 Volusia Health Network COMMERCIAL M EFT 59266 Volusia Health Network COMMERCIAL M 22264 Vytra Healthcare COMMERCIAL M Claims 68069 WA - Washington Coordinated Care COMMERCIAL M Claims 39151 WEA Insurance Group COMMERCIAL M Claims 27327 WINhealth Partners/Wyoming Health Solutions COMMERCIAL M Claims 77080 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 85256 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 800.294.7780 or 205.558.7474. 73155 Waterstone Benefit Administrators (Oklahoma Providers) COMMERCIAL M Claims 23051 Waterstone Benefit Administrators (Outside Oklahoma) COMMERCIAL M Claims MPMOA Watts Healthcare Corp IPA COMMERCIAL M Claims 36337 Weiss Health Providers COMMERCIAL M Claims 91136 Welfare and Pension Administration Services COMMERCIAL M 13337 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 1-800-442-1101 for approval and the Payer ID 35245 WellSystems LLC COMMERCIAL M Claims 12053 Wellnet Healthcare Administrators COMMERCIAL M 58379 Wellnet Healthcare Administrators COMMERCIAL M ERA 91064 Wenatchee Valley Medical Center COMMERCIAL M Claims Echo is returning 835s for payer ID 12053. Providers will need to enroll with Emdeon Revised 02/18/2015 ICS Software, Ltd. Page 85 of 87

30460 West Coast Administrators COMMERCIAL M 66124 West Covina Medical Group COMMERCIAL M Claims 80942 West Suburban Health Providers COMMERCIAL M Claims 45276 West Virginia Family Health Plan COMMERCIAL M Claims 45276 West Virginia Family Health Plan COMMERCIAL M ERA 90560 WestLake Financial Group Inc. COMMERCIAL M Claims 90560 WestLake Financial Group Inc. COMMERCIAL M 13787 Western Benefits Inc COMMERCIAL M 24735 Western Grower's Assurance Trust COMMERCIAL M Claims 24735 Western Grower's Insurance Company COMMERCIAL M 24735 Western Grower's Insurance Company COMMERCIAL M Claims 68039 Western Health Advantage COMMERCIAL M Claims 68039 Western Health Advantage COMMERCIAL M EFT 37306 Western Health Inc COMMERCIAL M Claims 37306 Western Health Inc COMMERCIAL M 37247 Western Mutual Insurance COMMERCIAL M Claims 37247 Western Mutual Insurance COMMERCIAL M TRLTC Western Reserve Life Insurance Company COMMERCIAL M Claims PO Box 869093 Plano TX 75086-9093 TRLTC Western Reserve Life Insurance Company COMMERCIAL M Claims PO Box 93019 Hurst TX 76053-3019 31048 Western Southern Financial Group (Cincinnati OH) COMMERCIAL M Claims 38232 Weyco Inc. COMMERCIAL M Claims 38232 Weyco Inc. COMMERCIAL M 93050 William C. Earhart COMMERCIAL M Claims 41095 Wilson-McShane COMMERCIAL M Claims 41095 Wilson-McShane COMMERCIAL M 62153 Windsor Medicare Extra COMMERCIAL M ERA 62153 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. 62153 Windsor Medicare Extra COMMERCIAL M 62153 Windsor Medicare Extra COMMERCIAL M Claims Payer ID is for claims with Service Dates prior to May 1 2014. Claims with a Date of Service on or after May 1 2014 will reject for ACK/RETURNED - Claim submitted to incorrect payer. Please submit these claims directly to Windor. 39200 Wisconsin Auto and Truck Dealers COMMERCIAL M 74101 Wisconsin Department of Corrections COMMERCIAL M Claims 13413 Women's Integrated Network Inc. (WIN Fertility) COMMERCIAL M Claims WIN Healthcare SX067 Workers Comp of West Virginia COMMERCIAL M Claims 20333 Worksite Benefit Services LLC COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 86 of 87

20333 Worksite Benefit Services LLC COMMERCIAL M 60646 Yale University Heath Plan COMMERCIAL M Claims STJOE Yorba Park COMMERCIAL M Claims STJOE Yorba Park (St. Joseph Heritage HealthCare) COMMERCIAL M Claims 26054 icare Health Solutions COMMERCIAL M Claims 33884 icircle of New York COMMERCIAL M Claims 75261 webtpa/community Health Electronic Claims/CHEC COMMERCIAL M Claims Revised 02/18/2015 ICS Software, Ltd. Page 87 of 87