Health Plan/Payer List Availity Clearinghouse and Web Portal Updated 10/07/2014 Availity P.O. Box 550857 Jacksonville, FL 32255-0857 Health Plan/Payer List Availity Clearinghouse and Web Portal Table of Contents Navigating the EDI Clearinghouse Health Plan Partners Section……......……………………………………………..…………3 Availity’s NPI Options………………………………………………………………………………………..………………………….4 Availity’s Electronic Data Interchange (EDI) Health Plans Partners.…………………………………...………….…...…...5 – 32 Availity’s Electronic Remittance Advice (ERA) Health Plan Partners...…………………………………………………….33 - 49 Availity’s Business to Business (B2B) Health Plan Partners...……………………………………………………………………50 Availity’s Web Portal Health Plan Partners...…………………………………………...…………………………….………51 – 54 Workers’ Compensation Payer List…..…………………………………………………...………………………………….55 - 138 2 of 138 Visit our web site: www.availity.com Health Plan/Payer List Availity Clearinghouse and Web Portal Navigating the EDI Clearinghouse Health Plan Partners Section Claim Enrollment Required: Denotes payers that require enrollment for EDI claims submission (837P/I). See EDI Requirements for enrollment details. Government Payer: Denotes Government payers. May not be a direct connection to the government entity. Remit (835): Electronic remittance advice sent by payers to communicate adjudication results and payment information for submitted claims. Receiving remits generally requires additional enrollment. Please enroll with Availity first. Please see the Electronic Remittance Advice (ERA) Health Plan Partners section of the list for registration details. NPI Option: The NPI is a unique identification number for covered health care providers. Availity is making every effort to confirm and communicate the status of our connected payers. For a detailed explanation of our NPI options please see page 4 of this document. (EDI) Electronic Data Interchange: Customers create batch transactions in their own practice management system (PMS) or hospital information system (HIS) and upload them to Availity. This functionality can be transparent to the end user if their system vendor offers a seamless solution. Availity also offers end users the ability to log onto the portal to upload batches directly. A list of vendor partners is available on the Availity web site. (B2B) Business to Business: Customers submit transactions in real-time or near real-time using their own practice management system (PMS) or hospital information system (HIS), often using the vendor’s user interface. A list of vendors that support this level of integration is available on the Availity web site. Please see Availity's B2B specification document for additional information. Premium ($): The “$” in the Premium column indicates that the payer requires enrollment in Availity Advanced Clearinghouse if the provider is based in Texas. Please click the link for more information: https://support.availity.com/attachments/token/awhf9mqcevwphcu/?name=AAC+Provider+FAQ+-+TX.pdf 3 of 138 Visit our web site: www.availity.com Health Plan/Payer List Availity Clearinghouse and Web Portal Availity’s NPI Options Option 1 Option 2 Option 3 Legacy ID Required Dual ID NPI per Mandate NPI allowed Legacy identifier required Allows all of the following scenarios: NPI only Legacy identifier only NPI and Legacy identifiers NPI required as Primary Identifier. Tax ID required as a secondary identifier on claims in 2010AA or 2010AB. Only specific non-Legacy qualifiers allowed as secondary identifiers in certain provider loops. 4 = Option 3 plus: Any other secondary identifiers as allowed in the Implementation Guide will also be accepted. Option 4 NPI per Mandate. Legacy ID also allowed. 4* = Option 3 plus: Tax IDs (EI, SY, TJ) as allowed in the Implementation Guide will also be accepted as secondary identifiers. # 4 = Option 3 plus: Location Numbers (LU) as allowed in the Implementation Guide will also be accepted as secondary identifiers. *A legacy identifier is any identifier that payers used to identify a provider as a health care provider before the NPI mandate. Legacy identifiers include OSCAR, NSC, PINs, UPINs, Blue Cross provider numbers, and other payer-designated identifiers. (+) Indicates the payer has requested a front-end taxonomy code edit. 4 of 138 Visit our web site: www.availity.com NPI Option Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) Institutional Claim (837) 3 2 2 3 3 2 2 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 4 4 4 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 13162 93044 48185 68069 AHS01 64071 37118 87815 72467 38254 75678 22384 59141 38265 37278 58202 51909 35209 77070 59374 25133 95340 65093 36320 65093 1199 NATIONAL BENEFIT FUND A & I BENEFIT PLAN ADMINISTRATORS ABC HEALTH PLAN ABSOLUTE TOTAL CARE ACCESS ADMINISTRATOR ACCLAIM ACMG ACORDIA NATIONAL ACS CONSULTING SERVICES, INC ACTIVA BENEFIT SERVICES, LLC ACTIVE CARE (UCS) ADMINISTRATIVE CONCEPTS, INC ADMINISTRATIVE SERVICES ADMINISTRATIVE SYSTEMS RESEARCH CORPORATION - ASR ADMINONE ADVANCED DATA SOLUTIONS, INC ADVANCED PHYSICIAN ASSN. (CHICAGO) ADVANTAGE HEALTH SOLUTION ADVANTAGE PREFERRED PLUS ADVANTICA ADVANTRA/HLTH AMERICA INC ADVENTIST HEALTH SYSTEM WEST - ROSEVILLE, CA ADVOCATE HEALTH PARTNERS ADVOCATE MEDICAL GROUP ADVOCATE PHYSICIAN PARTNERS $ 26337 AETNA - ILLINOIS MEDICAID 2 x x $ 60054 AETNA AFFORDABLE HEALTH CHOICES (SM) - SRC 2 x x $ 23225 AETNA BETTER HEALTH CONNECTICUT MEDICAID 2 x x 50023 AETNA BETTER HEALTH OF OHIO 2 x x $ 60054 AETNA INSURANCE COMPANY 2 x x $ 38692 AETNA TX MEDICAID & CHIP 2 x x 13334 AFFINITY HEALTH PLAN 2 x x 13346 64158 95327 91136 92600 91136 91136 2 2 4 2 2 2 2 x x x x x x x x x 2 x x 13550 AFTRA HEALTH FUND AGENCY SERVICES, INC. ALAMEDA ALLIANCE FOR HEALTH ALASKA CHILDREN’S SERVICES, INC. ALASKA ELECTRICAL HEALTH & WELFARE FUND ALASKA LABORERS CONSTRUCTION INDUSTRY TRUST ALASKA PIPE TRADERS LOCAL 375 ALASKA UNITED FOOD & COMMERCIAL WORKERS HEALTH & WELFARE TRUST ALICARE 2 x x PRINT ALL HEALTH PLAN PRINT (PRINT TO PAPER) 2 x x MRIPA 81040 ADSL1 88461 52149 58234 94177 37308 75261 A0701 25133 AMAIA 13550 68069 68069 68069 ALLCARE HEALTH PLAN ALLEGIANCE BENEFIT PLAN ALLIANCE - ALPHA CARE GOLD ALLIANCE HEALTHPLANS OF WISCONSIN ALLIANCE PPO, INC. ALLIANT HEALTH PLANS (GEORGIA) ALLIED ADMINISTRATORS (S.F., CA) ALLIED BENEFITS SYSTEMS ALPHA DATA SYSTEMS ALTA BATES MEDICAL GROUP ALTA HEALTH STRATEGIES AMA INSURANCE AGENCY AMALGAMATED LIFE AMBETTER FROM BUCKEYE COMMUNITY HEALTH PLAN AMBETTER FROM COORDINATED CARE AMBETTER FROM CELTICARE HEALTH PLAN 3 4 2 2 2 2 2 2 2 2 2 4 2 4 2 4 x x x x x x x x x x x x x x x 91136 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information payer ID 68055 may also be used formerly Advocate Health Centers EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. 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 Please contact Anet Quiambao at 510.747.6153 to join Alameda Alliance's EDI network To enroll for All Health Plan Print (Print To Paper), please complete and submit the APP Submitter Information and Enrollment Packet. Please note that claims cannot be converted to paper for payers with the state code of SC or MN. APP Submitter Information and Enrollment Packet Effective 8/1/2012, formerly known as Mid Rogue Oregon Health Plan NPI Option 68069 68069 68069 68069 68069 68069 75137 75185 Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) Institutional Claim (837) 4 4 4 4 4 4 2 2 x x x x x x x x x x x x x x x x 2 x x 2 2 2 2 2 2 4 2 2 2 2 2 4 2 2 3 2 2 2 2 2 3 2 2 2 2 2 2 2 2 2 2 2 2 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 63103 95170 ACN01 41161 41160 87726 AMF11 60801 98205 62030 01066 36369 81949 72099 60739 44444 56071 42011 37322 20553 20029 16120 86047 86001 86048 86002 86049 86003 26375 54763 23037 22248 79966 53085 AMBETTER FROM MAGNOLIA HEALTH AMBETTER FROM MANAGED HEALTH SERVICES AMBETTER FROM PEACH STATE HEALTH PLAN AMBETTER FROM SUNSHINE HEALTH AMBETTER FROM SUPERIOR HEALTH AMBETTER OF ARKANSAS AMERIBEN SOLUTIONS, INC. AMERICAN ADMINISTRATIVE GROUP - AAG AMERICAN ADMINISTRATIVE GROUP - AAG (FORMERLY GALLAGHER BENEFITS) AMERICAN BEHAVIORAL AMERICAN BENEFIT PLAN ADMINISTRATORS AMERICAN CHIROPRACTIC NETWORK AMERICAN CHIROPRACTIC NETWORK (PAN) AMERICAN CHIROPRACTIC NETWORK IPA OF N.Y. AMERICAN COMMERCIAL BARGE LINES AMERICAN FAMILY INSURANCE CO. AMERICAN FIDELITY ASSURANCE COMPANY AMERICAN FOUNDERS LIFE INSURANCE CO. AMERICAN GENERAL AMERICAN HEALTHCARE ALLIANCE AMERICAN IMAGING MANAGEMENT AMERICAN INSURANCE COMPANY OF TEXAS AMERICAN LIFECARE AMERICAN NATIONAL INSURANCE CO AMERICAN POSTAL WORKERS UNION AMERICAN REPUBLIC AMERICAN REPUBLIC INSURANCE AMERICAN WORKER HEALTH PLUS AMERICA'S 1ST CHOICE - SOUTH CAROLINA AMERICA'S CHOICE HEALTHPLANS/NMA AMERICA'S PPO (ARAZ) AMERICHOICE OF NEW JERSEY (MEDICAID NJ) AMERICHOICE OF NEW JERSEY PERSONAL CARE PLUS (MEDICARE) AMERICHOICE OF NEW YORK (MEDICAID NY) AMERICHOICE OF NEW YORK PERSONAL CARE PLUS (MEDICARE) AMERICHOICE OF PENNSYLVANIA MEDICAID/CHIP AMERICHOICE OF PENNSYLVANIA PERSONAL CARE PLUS (MEDICARE) AMERIGROUP AMERIHEALTH ADMINISTRATORS AMERIHEALTH HMO NEW JERSEY AND DELAWARE AMERIHEALTH MERCY HEALTH PLAN AMIDA CARE ANCHOR BENEFIT CONSULTING, INC 86062 ANCILLARY BENEFIT SYSTEMS/ARIZONA FOUNDATION FOR MEDICAL CARE 2 x x 47198 ANTHEM CA 3 x x 00050 ANTHEM CO 3 x x 00060 ANTHEM CT 3 x 00130 ANTHEM IN 3 00630 ANTHEM IN 3 00160 ANTHEM KY 3 00660 ANTHEM KY 3 37283 x Claim Status (276) Auth & Referral (278) Additional Information x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Eligibility & Benefits (270) This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). NPI Option Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) 00180 ANTHEM ME 3 00680 ANTHEM ME 3 x 00241 ANTHEM MO 3 x 00270 ANTHEM NH 3 00770 ANTHEM NH 3 x 00265 ANTHEM NV 3 x 00332 ANTHEM OH 3 00834 ANTHEM OH 3 x 00423 ANTHEM VA 3 x 00450 ANTHEM WI 3 00950 ANTHEM WI 3 x 34196 54160 61101 AZFMC 03432 27154 75278 62176 87726 ASRM1 ATPA1 36326 39065 APEX BENEFIT SERVICES APS HEALTHCARE, INC. ARCADIAN MGMT SERVICES ARIZONA FOUNDATION FOR MEDICAL CARE ARIZONA PHYSICIANS IPA ARIZONA PRIORITY CARE PLUS ARKANSAS BEST CORPORATION - CHOICE BENEFITS ARKANSAS MANAGED CARE ORG (AMCO) ARNETT HEALTH PLANS ASRM CORP (NJ) ASSOCIATED THIRD PARTY ADMINISTRATION ASSOCIATES FOR HEALTH CARE, INC ASSURANT HEALTH 2 2 4 2 2 2 2 2 2 4 2 2 2 x x x x x x x x x x x x x ASNTH ASSURANT HEALTH RE-PRICING VIA HEALTHSPAN 3 x 74240 93221 95691 13853 90956 ATRIO CMSEB 38259 37280 91136 46045 59275 59274 65026 SX145 ASSURED BENEFITS ADMINISTRATORS ASURIS NORTHWEST HEALTH ATHENS AREA HEALTH PLAN ATLANTIS HEALTH PLAN ATLAS LIFE INSURANCE COMPANY ATRIO HEALTH PLAN AUSTIN REGIONAL CLINIC EMPLOYEE BENEFIT PLAN AUTOMATED BENEFIT SERVICES (ABS) AUTOMATED GROUP ADMINISTRATION, INC. AUTOMOTIVE MACHINISTS LOCAL 289 HEALTH & WELFARE FUND AVERA HEALTH AVMED ENCOUNTERS AVMED, INC. BAPTIST HEALTH SOUTH FLORIDA BANNER HEALTH PLAN 2 4 2 2 2 4 4 2 2 2 4 4 4 2 2 x x x x x x x x x x x x x x x x Institutional Claim (837) Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). x x x x x x x x x x x x x x x x x Use payer ID ASNTH to submit professional or institutional Assurant Health claims to be routed for HealthSpan Re-Pricing. Use existing Payer IDs for claims for Assurant Health lines of business without re-pricing. x x x x x x x x x x Effective 8/20/12, payer ID 95440 will no longer be valid. Please use payer ID 87726. x x x x Additional Information x x $ $ Remit (835) NPI Option $ Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) 41204 06941 49153 43324 95377 BASIC PLUS BAY BRIDGE ADMINISTRATORS LLC BCI ADMINISTRATORS, INC. BEACON HEALTH STRATEGIES BEECH STREET CORPORATION 2 2 2 2 2 x x x x x x x x x x 60054 BELL ATLANTIC 2 x x 41205 36149 51037 25145 00999 37212 37118 39081 74223 36342 61425 95604 01508 62183 BSHS1 CX025 BV001 BV001 37308 BENEFIT ADMINISTRATIVE SERVICES (BAS) BENEFIT ADMINISTRATIVE SYSTEMS BENEFIT CONCEPTS BENEFIT COORDINATORS CORPORATION (PITTSBURGH, PA) BENEFIT MANAGEMENT SERVICES (BMS) BENEFIT MANAGEMENT SYSTEMS,INC BENEFIT PLAN ADMINISTRATORS (ROANOKE, VA) BENEFIT PLAN ADMINISTRATORS, CO (EAU CLAIRE, WI) BENEFIT PLANNERS, INC. BENEFIT SYSTEMS & SERVICES, INC (BSSI) BENEFIT TRUST LIFE BEST LIFE & HEALTH INSURANCE CO. BETTER HEALTH OF FLORIDA BETTER HEALTH PLANS, INC. BIENVIVIR SENIOR HEALTH PLAN BIG LOTS ASSOCIATES BENEFIT PLANS BLOCK VISION OF TEXAS BLOCK VISION, INC BLUE BELL BENEFITS TRUST 2 2 2 2 4 2 2 2 2 2 2 2 3 2 4 2 2 2 2 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 00610 BLUECROSS (BC) ID x 2 x 00520 BLUECROSS BLUESHIELD (BCBS) AR x 4+ x 53589 BLUECROSS BLUESHIELD (BCBS) AZ 4* x 00101 BLUECROSS BLUESHIELD (BCBS) GA 3 00601 BLUECROSS BLUESHIELD (BCBS) GA 00621 BLUECROSS BLUESHIELD (BCBS) IL HCSC 53120 Payer ID Payer Name x 3 x x x x x BLUECROSS BLUESHIELD (BCBS) LA 2 x 12B14 SB700 BLUECROSS BLUESHIELD (BCBS) MA BLUECROSS BLUESHIELD (BCBS) MA 2 2 x 220 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x 00220 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x 00222 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x 222 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x 720 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x 00720 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x 00722 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x 722 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x 4 2 4 4 4 3 2 2 x x x x x x x x x x x x x x BLUECROSS BLUESHIELD (BCBS) MT BLUECROSS BLUESHIELD (BCBS) NJ HORIZON BLUECROSS BLUESHIELD (BCBS) NM HCSC BLUECROSS BLUESHIELD (BCBS) OK HCSC BLUECROSS BLUESHIELD (BCBS) TX HCSC BLUEGRASS FAMILY HEALTH BLUESHIELD (BS) CALIFORNIA BLUESHIELD (BS) CALIFORNIA x x x x x x Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. x 4 BCBS 22099 00790 00840 84980 61124 94036 BS001 x Institutional Claim (837) x x Enrollment required. Please go to https://www.bcidaho.com/Edi_Clearinghouse/08-2913_Trading%20Partner%20Agreement%20Provider%20+%20BAA%209-5-2012.pdf to enroll. Availity's submitter id = 000000611 EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. All providers and facilities must first register to create a login and password. The link for provider or facilities to enroll is https://secure.ediservices.net/EDIS.Web/Login/Login.aspx. Availity Assigned Submitter ID - E0079. This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a G2 qualifier. Patient’s ID card will denote which payer id to use electronically. BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a G2 qualifier. Patient’s ID card will denote which payer id to use electronically. BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a G2 qualifier. Patient’s ID card will denote which payer id to use electronically. BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a G2 qualifier. Patient’s ID card will denote which payer id to use electronically. BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a G2 qualifier. Patient’s ID card will denote which payer id to use electronically. BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a G2 qualifier. Patient’s ID card will denote which payer id to use electronically. BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a G2 qualifier. Patient’s ID card will denote which payer id to use electronically. BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a G2 qualifier. Patient’s ID card will denote which payer id to use electronically. NPI Option Remit (835) Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) 36609 BOILERMAKERS NAT'L HEALTH & WELFARE 2 x x BOLL1 BOLLINGER, INC. 4 x x 74238 13337 38365 BRIDG 68069 51037 94316 BOON-CHAPMAN BENEFIT ADMINISTRATORS BOSTON MEDICAL CENTER HEALTH PLAN BRIDGE BENEFITS BRIDGESPAN BRIDGEWAY HEALTH SOLUTIONS BROKERAGE CONCEPTS BROWN & TOLAND MEDICAL SERVICES 4 3 2 3 3 2 3 x x x x x x x x x x x x x 84980 BRYAN INDEPENDENT SCHOOL DISTRICT 4 x x 3 2 2 2 3 2 2 2 2 2 2 2 x x x x x x x x x x x x x x 4 x x 2 2 2 3 2 3 2 4 2 2 2 2 3 2 2 2 2 2 2 2 2 2 2 3 2 3 3 3 3 3 3 3 3 3 3 3 3 3 2 3 2 2 3 2 2 4 2 3 x x x x x x x x x x x x x x x x x x x x x Payer ID 68069 42150 23708 CLFR2 68047 71057 23045 95112 68011 CAPHP GCVCP 57116 11345 SB580 SB690 25133 25133 93975 MRCHP 31114 56215 29076 56195 37060 03036 CCAI 88019 73159 00220 00720 83028 88022 44827 95166 95167 68063 68069 91136 68068 68068 68068 68068 68068 68068 68068 68068 68068 68068 68068 68068 68068 42138 68069 42139 31118 NACDM 02041 34097 CIPA1 36215 42140 Payer Name BUCKEYE COMMUNITY HEALTH PLAN BUTLER BENEFITS C&O EMPLOYEES HOSPITAL ASSOCIATION C.L. FRATES AND COMPANY CALIFORNIA HEALTH AND WELLNESS CANON COCHRAN MANAGEMENT SERVICES INC METAIRIE LA CAPITAL BLUE CROSS/CAIC CAPITAL HEALTH PLAN CAPITOL ADMINISTRATORS (GTESS) CAPROCK HEALTH PLANS - VERITY CARDIOVASCULAR CARE PROVIDERS, INC. (CVCP) CARE 1ST HEALTH PLAN OF ARIZONA CARECENTRIX CAREFIRST BCBS OF DC/NCA CAREFIRST BCBS OF MARYLAND CARELINK ADVANTRA CARELINK HEALTH PLAN CAREOREGON CARESOURCE HEALTH PLAN OF OREGON CARESOURCE OF OHIO CAROLINA BEHAVIORAL HEALTH ALLIANCE CAROLINA CARE PLAN, INC. CAROLINA SUMMIT HEALTHCARE, INC. CATERPILLAR CBA BLUE CCAI CCEA CCN CCSTPA CCSTPA CDO TECHNOLOGIES CDS GROUP HEALTH CEDAR VALLEY COMMUNITY HEALTH PLAN CEDARS-SINAI MEDICAL NETWORK SERVICES CEDARS-SINAI MEDICAL NETWORK SERVICES CELTIC INSURANCE CELTICARE HEALTH PLAN CEMENT MASONS & PLASTERERS HEALTH AND WELFARE TRUST CENPATICO - AZ CENPATICO - FL CENPATICO - GA CENPATICO - IL CENPATICO - IN CENPATICO - KS CENPATICO - KY CENPATICO - MA CENPATICO - MS CENPATICO - OH CENPATICO - SC CENPATICO - TX CENPATICO - WI CENPATICO TPA CENTENE MEDICARE CENTENE TPA CENTRAL BENEFITS LIFE CENTRAL DUPAGE MEDICAL GROUP CENTRAL MASSACHUSETTS HEALTH CARE CENTRAL RESERVE LIFE CENTRAL SENIOR CARE CENTRAL STATES HEALTH & WELFARE FUND CENTURION x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Institutional Claim (837) Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information Group number required for all claims; Policy holder claim form required for most groups on institutional/professional claims. x x payer ID 68054 may be used Please ensure that the group number is included in Loop 2000B SBR03 and the appropriate BISD subscriber id is used. payer ID 32004 may also be used x x x x x x x x x x x x x Please contact Network Services at 850.523.7361 to enroll. Providers will be required to send an EDI Enrollment Inquiry to EDIEnrollment@CareCentrix.com. The body of the email should contain the following: Provider NPI; Contact Name; Contact Email; Address; Contact Telephone formerly payer ID 57105 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x payer ID 68060 may also be used payer ID 68048 may also be used payer ID 68058 may also be used payer ID 68050 may also be used payer ID 68065 may also be used payer ID 68052 may also be used payer ID 68061 may also be used The payer will begin accepting claims starting 12/1/12. payer ID 68051 may also be used payer ID 68059 may also be used payer ID 68053 may also be used payer ID 68046 may also be used payer ID 68056 may also be used For 835, 270 and 276 transactions please use Payer ID: HPN11 $ $ NPI Option Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) Institutional Claim (837) 4 2 2 x x x x x x Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information 36393 23171 84146 CENTURYPHO CHA – COMMONWEALTH HEALTH ALLIANCE CHAMP VA - HAC 38520 CHAMPUS - TRICARE (NORTH & SOUTH) x 4 x x 57106 CHAMPUS - TRICARE (PALMETTO) x 4 x x 61125 CHAMPUS - TRICARE (PGBA) x 4 x x 99726 CHAT1 16600 75261 59223 34154 CHAMPUS TRICARE WEST CHATWINS HEALTHCARE ADMINISTRATORS CHAUTAUQUA COUNTY HEALTHCARE PLAN CHEC – A SUBSIDIARY OF SPRINT CHESAPEAKE LIFE INSURANCE CHESTERFIELD RESOURCES x 4 2 2 2 2 2 x x x x x x x x x x x x 86916 CHILDREN WITH SPECIAL HEALTHCARE NEEDS (CSHCN) x 4# x x CASD1 CASD2 ACN01 CHIROPRACTIC ASSOCIATION OF SD - DAKOTACARE CHIROPRACTIC ASSOCIATION OF SD - SANFORD HEALTH PLAN CHIROPRACTIC CARE OF MINNESOTA, INC. 4 4 2 x x x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. 60054 CHOICE PLUS (TRW) 2 x x 2 2 2 2 2 2 4* 4 2 2 2 3 4 2 2 2 2 2 2 2 2 2 2 2 4+ 2 4+ 2 4 2 2 2 2 2 2 2 2 3 2 2 2 2 2 2 2 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. 38308 SPOHN 62308 02331 95266 86033 10207 COA01 77201 CSI001 CSI01 35219 M3FL0012 49718 COKSR KSRCS 91162 34181 37237 25179 23282 73143 39126 38325 COMMF 35193 48145 75261 CHPWA 61733 95192 34177 95192 93101 59314 COMPU 33632 06105 78375 62308 02331 37135 75284 71404 35315 CHRISTIAN BROTHERS SERVICES CHRISTUS SPOHN NETWORK CIGNA CIGNA BEHAVIORAL HEALTH CIGNA FLEX CARE (NEW MEXICO ONLY) CIGNA SENIOR HEALTH PLAN CITRUS HEALTH PLAN CITY OF AMARILLO CLEARCHOICE HEALTH PLAN/COIHS CLINICAL SPECIALTIES, INC CLINICAL SPECIALTIES, INC CMCS ADVANTAGE HEALTH SOLUTIONS MEDICARE ADVANTAGE CMS MMA SPECIALTY PLAN COLORADO HEALTH INSURANCE COOPERATIVE COLORADO KAISER PERMANENTE COLORADO KAISER PERMANENTE (COLORADO SPRINGS ONLY) COLUMBIA UNITED PROVIDERS COMMERCE BENEFITS GROUP COMMONWEALTH ADMINISTRATORS COMMUNITY CARE BEHAVIOR HLTH ORG COMMUNITY CARE BHO COMMUNITY CARE MANAGED HEALTH CARE COMMUNITY CARE ORGANIZATION COMMUNITY CHOICE OF MICHIGAN COMMUNITY FIRST COMMUNITY HEALTH ALLIANCE COMMUNITY HEALTH CHOICE COMMUNITY HEALTH ELEC. CLEARINGHOUSE (CHEC) COMMUNITY HEALTH PLAN OF WASHINGTON COMMUNITY HEALTH SOLUTION COMMUNITYCONNECT HEALTHPLAN COMP - OHIO (AUSTINTOWN, OH) COMPARE (WISCONSIN BADGERCARE ONLY) COMPLEMENTARY HEALTHCARE PLANS COMPREHENSIVE BEHAVIORAL CARE COMPUSYS OF COLORADO CONCORDIA CARE INC CONNECTICARE CONNECTICARE - MEDICARE CONNECTICUT GENERAL - MEDICAL CLAIMS CONNECTICUT GENERAL - MENTAL HEALTH CLAIMS CONSOCIATE GROUP (DECATUR, IL) CONSOLIDATED ASSOCIATES RAILROAD CONTINENTAL GENERAL CONTINENTAL KEY FAMILY x x x Provider Enrollment may be found at www.mytricare.com. The 270 and 276 WEB transactions are only for TRICARE South Region. Trading Partner Name: Availity, LLC, Trading Partner ID: 7GW0429FL3 TRICARE PGBA, LLC EDI Help Desk (800- 325-5920) Provider Enrollment may be found at www.mytricare.com. The 270 and 276 WEB transactions are only for TRICARE South Region. Trading Partner Name: Availity, LLC, Trading Partner ID: 7GW0429FL3 TRICARE PGBA, LLC EDI Help Desk (800- 325-5920) Provider Enrollment may be found at www.mytricare.com. The 270 and 276 WEB transactions are only for TRICARE South Region. Trading Partner Name: Availity, LLC, Trading Partner ID: 7GW0429FL3 TRICARE PGBA, LLC EDI Help Desk (800- 325-5920) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x PO Box 3157, Eau Claire, WI 54702-3157 PO Box 3217, Eau Claire, WI 54702-3217 $ x x x Professional Claim (837) Institutional Claim (837) 4 4 2 4 2 2 3 2 2 2 2 x x x x x x x x x x x x x x x x x x x Payer ID valid only for claims with a billing submission address of P.O. Box 27267, Minneapolis, MN 55427-0267. The abbreviation for the institution should be entered as the patient’s address in Loop 2010BA, N3 segment. Institution’s city, state and zip should be entered in Loop 2010BA, N4 segment. Obtain info from the following link: https://www.correctcare.com/portal/Institution%20Abbreviation%20List.pdf x x x 41124 CORPORATE BENEFIT SRVC OF AMERICA (MERITAIN HEALTH) 2 x 56116 CORPORATE BENEFITS SERVICE, INC (NC) 2 x CCIH CORRECTCARE INTEGRATED HEALTH (CA PRISON HEALTH CARE SERVICES) 2 x x CORRECTIONAL MEDICAL SERVICES COUNTRY LIFE INSURANCE COMPANY COUNTYCARE COVENANT ADMINISTRATORS, INC. (ATLANTA, GA) COVENANT MGMT SYSTEMS EMPLOYEE BENEFIT PLAN COVENTRY HEALTH & LIFE (OKLAHOMA) COVENTRY HEALTH CARE IOWA COVENTRY HEALTH CARE KANSAS COVENTRY HEALTH CARE NEBRASKA COVENTRY HEALTH CARE OF CAROLINAS COVENTRY HEALTH CARE OF DELAWARE COVENTRY HEALTH CARE OF GEORGIA COVENTRY HEALTH LOUISIANA COVENTRY HEALTHCARE OF GEORGIA COVENTRY HLTH CRE LOUISIANA INC COVENTRY HLTH CRE NEBRASKA INC CREATIVE MEDICAL SYSTEMS CREATIVE PLAN ADMINISTRATORS CSI NETWORK SERVICES CSI OF MICHIGAN CUSTOM DESIGN BENEFITS 2 2 2 2 4 2 2 2 2 2 2 2 2 2 2 2 2 2 3 2 2 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 60054 CUSTOMCARE (PRUDENTIAL) 2 x x DAK01 06172 95748 39113 87726 27009 94235 DHS01 84135 DAKOTACARE DART MANAGEMENT CORP/DART CONTAINER CORP DC CHARTERED HEALTH PLAN DEAN DEFINITY SERVICES DELAWARE PHYSICIANS CARE, INC. DELTA HEALTH DELTA HEALTH SYSTEMS DENVER HEALTH MEDICAL PLAN 4 2 4 2 2 2 2 2 2 x x x x x x x x x x x 43160 62553 60827 58102 CMSEB 25133 25133 25133 25133 25133 25133 25133 25133 25127 25135 25136 64068 37320 34186 27136 82056 $ COOK CHILDREN'S HEALTH PLAN COOK CHILDREN'S STAR PLAN COOPERATIVE BENEFIT ADMINISTRATOR COOPERATIVE MANAGED CARE SERVICES (CMCS) COOPORTUNITY HEALTH CO-ORDINATED BENEFITS PLAN COORDINATED CARE CORE MANAGEMENT RESOURCES GP CORESOURCE OF AZ, IL, IN, MD, MN, NC, PA CORESOURCE, LITTLE ROCK CORNERSTONE BENEFIT ADMINISTRATORS NPI Option CCHP1 CCHP9 52132 35199 07003 14829 68069 58231 35182 75136 10850 Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners LABOR DEPARTMENT OF LABOR & INDUSTRY (WASHINGTON) 56240 BC001 25160 74284 35186 36434 62308 22521 EPF03 EPF37 EPF02 52192 31625 93235 ECISF 37253 DETROIT MEDICAL CENTER DIRECTORS GUILD OF AMERICA DIVERSIFIED GROUP ADMIN DRISCOLL CHILDREN'S HEALTH PLAN DUNN AND ASSOCIATES BENEFITS ADMINISTRATORS EARLY INTERVENTION CENTRAL BILLING EATON BENEFITS,OH EDS ADMIN SERVICES EL PASO FIRST HEALTH PLANS - CHIP EL PASO FIRST HEALTH PLANS - HCO (HEALTHCARE OPTIONS) EL PASO FIRST HEALTH PLANS - PREMIER PLAN (STAR MEDICAID HMO) CIGNA-HEALTHSPRING ELDERPLAN ELECTRICAL WORKERS INSURANCE FUND LOCAL 5800 ELLIS CONSULTANTS, INC. ELMCO x x x x x x x x 2 x 2 2 4 2 2 2 2 2 4 4 4 4 2 2 2 2 x x x x x x x x x x x x x x x x x x x x x Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Claims for payer ID 87068 (Health Plan Solutions of Utah) may be sent using payer ID DHS01 EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Click this link and complete the enrollment required to begin electronic billing with L&I: http://www.lni.wa.gov/Forms/pdf/F248-031-000.pdf Information necessary to complete the Clearinghouse/Intermediary Information section: Clearinghouse Name - Availity, L.L.C., Telephone - 800.282.4548, Contact - Availity Client Services, L&I Account Number – 0179379 x x x x x x x x x x x x x x x Please contact Provider Relations at (915)-532-3778 x1507 to enroll. Please contact Provider Relations at (915)-532-3778 x1507 to enroll. Please contact Provider Relations at (915)-532-3778 x1507 to enroll. Serving Members in Pennsylvania, Maryland, Delware, Texas, and Washington DC. Elderplan Provider ID required for all claims. Please contact (718)-921-7979 for Provider ID Remit (835) NPI Option $ Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) 34167 59299 EMERALD HEALTH NETWORK INC EMI - KP AMBULANCE CLAIMS 2 2 x x x 60054 EMORYCARE (PRUDENTIAL) 2 x x 00303 EMPIRE BC - NY 3 00803 EMPIRE BCBS - NY 3 X 95288 38241 EBC18 92135 31074 CX025 81039 EBSSA 37216 03036 75184 35112 74212 36335 75232 75236 75235 75233 27008 59298 35206 36364 91136 36878 62308 62308 75196 73126 74234 20818 59313 71412 75138 37300 93121 FCD01 FCM01 PHD01 FCR01 PHR01 43173 36396 14140 59069 33033 84980 41041 11315 77054 FAMR1 56196 91131 75138 87043 75232 23241 FS802 94999 94998 90060 90061 62061 EMPLOYEE BENEFIT ADMIN & MGMT EMPLOYEE BENEFIT CONCEPTS, INC. EMPLOYEE BENEFIT CONCEPTS, INC. EMPLOYEE BENEFIT LOGISTICS EMPLOYEE BENEFIT MANAGEMENT (EBMC) EMPLOYEE BENEFIT MANAGEMENT CORP. EMPLOYEE BENEFIT MANAGEMENT SYSTEM (EBMS) EMPLOYEE BENEFIT SERVICES (EBS) OF SAN ANTONIO EMPLOYEE BENEFIT SERVICES (SOUTH CAROLINA) EMPLOYEE BENEFITS PLAN ADMIN (E.B.P.A.) EMPLOYEE CLAIM ADJUDICATION SVCS EMPLOYEE PLANS, LLC EMPLOYER PLAN SERVICES INC (EPSI) EMPLOYERS COALITION ON HEALTH (ECOH) EMPLOYERS DIRECT HEALTH EMPLOYERS DIRECT HEALTH (EMPLOYEE PLAN) EMPLOYERS DIRECT HEALTH (FULLY INSURED) EMPLOYERS DIRECT HEALTH (SELF FUNDED PLAN) EMPLOYERS HEALTH COOPERATIVE (EHC) EMPLOYERS MUTUAL,INC.(FL) ENCORE HEALTH NETWORK ENH MEDICAL GROUP IPA ENSTAR NATURAL GAS G#P61 ENTRUST EQUICOR/EQUITABLE EQUICOR-PPO EQUIFAX / HEALTHCARE ADMIN (EHAS) EQUITABLE PLAN SERVICES ERISA ESSENCE HEALTHCARE EVOLUTIONS HEALTHCARE SYSTEMS EXCLUSICARE EYE SPECIALISTS OF ARIZONA FACS GROUP FAMILY CARE CCO FAMILY CARE MEDICAID FAMILY CARE MEDICAID MENTAL HEALTH FAMILY CARE MEDICAID PH FAMILY CARE MEDICARE FAMILY CARE MEDICARE FAMILY HEALTH PARTNERS - MISSOURI FAMILY MEDICAL NETWORK FARM FAMILY FBMC FCE BENEFIT ADMINISTRATORS FEDERAL EMPLOYEE PROGRAM (TX FEP) FEDERATED MUTUAL FIDELIS CARE NEW YORK FIDELIS SECURE CARE FIRST ADMINISTRATORS FIRST CAROLINA CARE FIRST CHOICE HEALTH NETWORK FIRST CHOICE OF MIDWEST (PPO) FIRST HEALTH FIRST INTEGRATED HEALTH FIRST PRIORITY FIRST SOLUTIONS FIRSTCARE FIRSTCARE “STAR” MEDICAID FIRSTGUARD HEALTH PLAN - KANSAS FIRSTGUARD HEALTH PLAN - MISSOURI FISERV HEALTH - KANSAS/TENNESSEE 2 2 2 2 4 4 3 4 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 4 2 2 2 3 2 3 2 2 2 2 4 4 4 2 2 2 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Payer ID Payer Name x x x x Institutional Claim (837) x Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal (www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal page or contact Availity Client Services (1.800.282.4548). x x x x x x x x x x x x x x x x Formerly payer ID 27008. x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x DOS 1/1/203 to current and must include members group ID. Administered by PH Tech NPI Option Remit (835) Claim Enroll Required Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) Institutional Claim (837) Premium Payer ID 11244 FITZHARRIS & COMPANY, INC. (FARMINGDALE, NY) 2 x $ 60054 FLEXCARE 2 x x 59276 FLORIDA 1ST WINTERHAVEN, FL 3 x x 00590 FLORIDA BLUE x 2 x x 59322 12611 59321 48116 65063 FLORIDA HEALTH CARE PLANS (FHCP) FLORIDA HEALTH CARE PLUS (FHP) FLORIDA HOSPITAL HEALTHCARE SYSTEMS (FHHS) FLORIDA HOSPITAL WATERMAN FLORIDA NETPASS x 4 4 2 2 2 x x x x x x x x x 60054 FLORIDA POWER & LIGHT (PRUDENTIAL) 2 x x FMH BENEFIT SERVICES, INC FORTIS BENEFITS INSURANCE COMPANY FORTIS INSURANCE COMPANY FOUNDATION HEALTH PLAN (SUNRISE FL) FOX VALLEY MEDICINE SITE 199 FOX VALLEY MEDICINE SITE 451 FOX-EVERETT, INC FREEDOM LIFE INSURANCE COMPANY OF AMERICA FREEDOM LIFE INSURANCE COMPANY OF AMERICA FRESENIUS MEDICAL CARE HEALTH PLAN FRINGE BENEFIT COORDINATORS GALVESTON COUNTY INDIGENT HEALTH GATEWAY HEALTH PLAN GATEWAY HEALTH/MEDICARE ASSURED GATEWAY HEALTH/MEDICARE ASSURED OHIO GBS GROUP BENEFIT SERVICES INC GEHA HEALTH GROUP (NEVADA) GEHA MENTAL HEALTH CLAIMS 2 2 2 2 2 2 2 4 2 4 2 2 2 2 2 2 2 2 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 2 x x 2 4 2 2 3 2 2 2 2 4 2 2 2 3 2 2 2 2 2 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x $ 48117 70408 39065 55248 FVMCH FVMC1 64069 62324 62324 FMCHP 59204 30005 25169 60550 91741 80241 GEHA9 87726 $ Payer Name x x 75273 GEISINGER HEALTH PLAN x 63665 GHEDI 25531 25133 80314 07205 91136 07689 37602 GTPA1 76923 44054 58204 68069 37234 HCP01 CX015 48143 36338 GENERAL AMERICAN LIFE INS CO GENERATIONS HEALTHCARE GHI HMO SELECT GHP (GROUP HEALTH PLAN) GIC INDEMNITY PLAN GILSBAR GLASSWORKERS HLTH & WELFARE GLOBAL CARE, INC. GOLDEN RULE GOLDEN TRIANGLE PHYSICIAN ALLIANCE GOOD SHEPHERD HOSPICE GOVERNMENT EMPLOYEES HEALTH ASSOCIATION (GEHA) GRADY HEALTHCARE GRANITE STATE HEALTH PLAN GRANT PHYSICIANS PRACTICE ASSOCIATION GREATER VALLEY GROUPLINK GROUP & PENSION ADMINISTRATORS GROUP ADMINISTRATORS 53120 GROUP BENEFITS - LOUISIANA 2 x 39167 91121 91051 95192 38194 25141 13551 37276 64246 39180 80705 37114 97258 MHP77 75126 HCP01 95266 GROUP HEALTH COOP/SO. CENTRAL WISCONSIN GROUP HEALTH COOPERATIVE - EAST (GHC OF PUGET SOUND) GROUP HEALTH COOPERATIVE - WEST (GHC OF PUGET SOUND) GROUP HEALTH COOPERATIVE OF EAU CLAIRE GROUP HEALTH MANAGERS GROUP HEALTH PLAN (GHP) GROUP HEALTH, INC (GHI) - NEW YORK GROUP INSURANCE SERVICE CENTER, INC. GUARDIAN, THE GUNDERSON LUTHERAN HEALTH PLAN, INC. GWH-CIGNA (FORMERLY GREAT-WEST HEALTHCARE) H.E.R.E.I.U. WELFARE PENSION FUNDS HAMMERMAN AND GAINER HAP MIDWEST HEALTH PLAN HARPETH IPA - AMERIVANTAGE HARRIMON JONES HARRINGTON BENEFIT SERVICES 2 4 4 2 2 2 2 2 2 4 2 2 2 2 2 2 2 x x x x x x x x x x x x x x x x x x x x x x Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. x x x Prior to submitting claims, please contact client services at 800.282.4548 (three to five days after approved Availity registration) to obtain a FLORIDA BLUE sender id. Note: FLORIDA BLUE assigned sender id is required, enter in loop 1000A segment NM109. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. x x x x x x x x x x x x x x x For 835, 270 and 276 transactions please use Payer ID: FMCHP Prior enrollment required. Please contact Geisinger Health Plan at 1-888-281-5338, option 3, to obtain an enrollment form; or download a PDF enrollment form at www.thehealthplan.com. GEHA HEALTH GROUP (NEVADA) EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Please use 91051 for all GHC Institutional Claims PO Box 3217, Eau Claire, WI 54702-3217 Formerly First Great West Life &Annuity Ins Co and Great-West Life and Annuity Ins Co COB claims can be accepted for this payer $ Remit (835) NPI Option $ Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) 48330 37111 37329 82018 77950 38224 25126 HAWAII MANAGEMENT ALLIANCE ASSOCIATION (HMAA) HCH ADMINISTRATION –PEORIA HCHA ALBQ – SELF FUNDED HCS – HEALTH CLAIMS SERVICE HEALTH ALLIANCE MEDICAL PLANS HEALTH ALLIANCE PLAN OF MICHIGAN HEALTH AMERICA/HEALTH ASSURANCE/ADVANTRA 4 2 2 3 2 2 2 x x x x x x x x x x x x x x 60054 HEALTH CARE ALLIANCE (SEARS) 2 x x 42102 HCP02 62180 75196 95019 75289 75234 34185 55247 81400 95570 38309 95567 95568 65062 04286 NAHOI 62157 80142 20270 76342 44273 28804 56731 41170 20896 37290 HEALTH CARE NETWORK OF WISCONSIN HEALTH CARE PARTNERS - AZ HEALTH CHOICE GENERATIONS HEALTH ECONOMICS - MICS CORP HEALTH FIRST HEALTH PLANS HEALTH FIRST TPA – AUSTIN HEALTH FIRST TPA – TYLER HEALTH FIRST TPS - HOUSTON HEALTH INSURANCE PLAN OF NEW YORK (HIP) HEALTH INSURANCE COMPANY HEALTH NET – CALIFORNIA (ENCOUNTERS) HEALTH NET OF ARIZONA HEALTH NET-CALIFORNIA & OREGON HEALTH NET-CALIFORNIA (ENCOUNTERS) HEALTH NETWORK ONE HEALTH NEW ENGLAND HEALTH OPTIONS OF ILLINOIS, INC HEALTH PARTNERS - JACKSON, TENN. HEALTH PARTNERS – PA HEALTH PAYMENT SYSTEMS INC. HEALTH PLAN OF NEVADA HEALTH PLANS INC. HEALTH PLUS PHSP HEALTH RESOURCES NW HEALTH RISK MANAGEMENT (HRM) HEALTH SERVICES CONSULTING GROUP (HSCG) HEALTH SERVICES FOR CHILDREN – SPECIAL NEEDS 2 2 2 2 4 2 2 2 2 2 2 3 3 2 2 4 2 2 2 2 2 2 2 2 2 2 2 41150 HEALTH SERVICES MANAGEMENT Payer ID HSM01 84980 CALL HMA01 20501 73147 25143 36335 62179 HCOMP 85729 41178 80141 59087 96475 90001 06108 Payer Name HEALTH SERVICES MANAGEMENT (HSM) HEALTHCARE BENEFITS HEALTHCARE DISTRICT PALM BEACH COUNTY HEALTHCARE MANAGEMENT ADMIN (HMA) HEALTHCARE PARTNERS OF NEVADA HEALTHCARE SOLUTIONS GROUP (HSG) HEALTHCARE USA HEALTHCARE’S FINEST NETWORK HEALTHCHOICE OF ARIZONA HEALTHCOMP (COMMUNITY FIRST - STAR HEALTH PLAN) HEALTHCOMP, INC HEALTHEZ HEALTHFIRST, INC HEALTHHELP NETWORK, INC (HHNI) HEALTHLINK HMO HEALTHLINK PPO HEALTHNET OF THE NORTHEAST x x x x x x x x x x x x x x x x x x x x 2 x 2 4 4 3 2 2 2 2 2 3 2 2 2 2 2 2 3 x x x x x x x x x x x x x x x x x x x Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. For DOS 5/1/2013 and forward x x x x x x x x x x x x x x x x x x x x x x x x x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Please contact HCDPBC to enroll and to obtain Payer ID (866-930-1002). x x x x x x 07003 HEALTHPARTNERS 2 x x 59140 95266 95009 71063 HEALTHPLAN SERVICES HEALTHPLAN SERVICES- HARRINGTON HEALTHPLUS OF LOUISIANA HEALTHSCOPE BENEFITS, INC 3 2 4 2 x x x x x x x x M3IL1 HEALTHSELECT BCBS OF FLORIDA 4 x HEALTHSMART ACCEL HEALTHSMART PREFERRED CARE (HSPC) HEALTHSOURCE OF NORTH TEXAS HEALTHSOURCE, AR HEALTHSOURCE, GA HEALTHSOURCE, KY HEALTHSOURCE, MA HEALTHSOURCE, ME HEALTHSOURCE, NC 2 2 2 2 2 2 2 2 2 x x x x x x x x x 75237 HSPC1 75255 71075 58210 61127 02041 01041 56147 x x x x x x x x x x x x x Institutional Claim (837) x x x x x x x x x Please call Provider Relations Dept at (800) 624-2356 for unique provider number. Please call Provider Relations Dept at (800) 624-2356 for unique provider number. Payer requires NPI Go to https://apps.availity.com/availity/documents/HealthPartners_Electronic_Claims_Enrollment.pdf and complete the required enrollment form named HealthPartners Electronic Claims Enrollment MED3000 EDI Support (805) 988-2280 ext 340 Provider Customer Service - (708) 633-1234 06119 62129 34092 63092 HESUN 58213 CALL 59230 HER01 11328 HPN11 91164 35145 00046 59347 86066 84980 84980 COHMO NAHLX 68069 34150 88023 88537 20475 91136 $ HEALTHSOURCE, SC HEALTHSOURCE, TN HEALTHSPAN HEALTHSPRING HMO/HEALTHSPRING MEDICARE + CHOICE HEALTHSUN HEALTH PLAN HEALTHWAYS WHOLEHEALTH NETWORKS HEALTHY PALM BEACH HERITAGE CONSULTANTS HERITAGE IPA HERITAGE NEW YORK MEDICAL GROUP HERITAGE PHYSICIAN NETWORK (HOUSTON) HIGHLINE MEDICAL SERVICES ORGANIZATION (HMSO) MOLINA HIGHMARK - KEY FAMILY HILL PHYSICIANS MEDICAL GROUP HILLCREST BENEFIT ADMINISTRATORS HMA HAWAII HMO BLUE HMO BLUE TEXAS HMO OF COLORADO HOLY CROSS HEALTH PARTNERS HOME STATE HEALTH PLAN HOMETOWN HEALTH NETWORK HOMETOWN HEALTH PLAN NEVADA HOMETOWN HEALTH PROVIDERS HOOSIER ALLIANCE HEALTH PLAN HOTEL EMPLOYEES & RESTAURANT EMPLOYEES HEALTH TRUST 13335 HUDSON HEALTH PLAN 95348 61101 61102 22175 HUMANA HEALTH PLANS OF OHIO HUMANA, INC. (CLAIMS) HUMANA, INC. (ENCOUNTERS) I.E. SHAFFER (WEST TRENTON, NJ) 60054 IBM MEDICAL PLANS x x x x x x x x NPI Option Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) Institutional Claim (837) 2 2 2 2 3 2 4 2 4 2 4 2 2 2 2 2 4 4 2 2 3 2 2 2 2 2 x x x x x x x x x x x x x x x x x x x x x x x x x 2 x x 3 3 4 2 x x x x x x 2 x x 4 3 2 2 2 2 4 2 2 2 2 2 2 x x x x x x x x x x x x x x x x x x x x Additional Information x x x x x x x x x x x x x x VAICE INS HEALTH SERVICES (IMMIGRATION HEALTH SERVICES) 4 x x 37279 13315 IMSMS ISL11 IAC01 51020 31127 31129 23229 34167 20050 54763 92649 37227 60280 23287 39182 IMGIN 37269 84137 IHP001 IHP002 41124 86068 IPAK1 INSURANCE ADMINISTRATOR OF AMERICA, INC. INSURANCE DESIGN ADMINISTRATORS INSURANCE MANAGEMENT SERVICES (IMS) OF TEXAS INSURANCE SERVICE OF LUBBOCK INSURER’S ADMINISTRATIVE CORPORATION INTEGRA ADMINISTRATIVE GROUP INTEGRA GROUP INTEGRA GROUP - CHA INTEGRAL QUALITY CARE INTEGRATED CARE NETWORK BY EMERALD INTEGRATED MEDICAL SOLUTION INTER COUNTY HEALTH PLAN INTER-AMERICAS INSURANCE CORPORATION, INC INTERCARE HEALTH PLANS, INC. INTERFACE EAP INTERGROUP SERVICES CORPORATION INTERNATIONAL FUNDING INTERNATIONAL MEDICAL GROUP INTERNATIONAL UNION OF OPERATING ENGINEERS, LOCAL 15 INTERWEST HEALTH (MONTANA) - PPO INTOTAL HEALTH INTOTAL HEALTH IOWA BENEFITS, INC IOWA HEALTH SOLUTIONS IPA OF KANE COUNTY 2 2 2 2 4 2 2 2 2 2 2 2 3 2 2 2 2 2 2 2 3 3 2 2 4 x x x x x x x x x x x x x x x x x x x x x x x x x x x Auth & Referral (278) Please contact Healthy Palm Beach to enroll and to obtain Payer ID (866-930-1002). ICARE (INDEPENDENT CARE HEALTH PLAN) ILLINICARE HEALTH PLAN ILLINOIS HEALTH PARTNERS IMCARE INDECS CORPORATION INDEPENDENT LIVING SERVICES INDIAN HEALTH SERVICES ACS INDIANA PRO HEALTH NETWORK INETICO INC INFORMED UHC INFORMED, LLC INGALLS PROVIDER GROUPS INNOVATIVE HEALTHWARE SOLUTIONS x x Claim Status (276) x x x x x 11695 68069 DMG01 41600 40585 45048 00290 35161 43471 50946 52196 NAING 04320 x Eligibility & Benefits (270) x x x x x x x x x x x x x x x x x x x x x Provider enrollment is required by the Payer. Please contact Janet Villablanca at 914.372.2753. x x x x x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. payer ID 68066 may also be used For institutional claims, please include the payer assigned "Treatment Authorization Code" in loop 2300 REF segment with a G1 qualifier. COKSR KSRCS KS001 57038 96385 KCIPA KMG11 KELSE KELSI 73100 37217 37321 23284 23045 34145 KPS01 27357 44827 44827 95415 CALL LNDMK 36333 52193 65055 98205 41136 RLH01 76870 LIFE1 61104 93093 $ JOHN ALDEN/ASSURANT HEALTH CARE SERVICE CORPORATION JOHN HANCOCK JOHN HOPKINS HEALTH CARE (EHP/PP) JOHN HOPKINS HEALTH CARE (USFHP) JOHN MORRELL JOHN MUIR HEALTH NETWORK JOHN P PEARL & ASSOCIATES JOHNS HOPKINS MEDICAL SERVICES CORP JOPLIN CLAIMS JP FARLEY CORPORATION JSL ADMINISTRATORS KAISER FOUNDATION HEALTH PLAN OF NORTHERN CA REGION KAISER FOUNDATION HEALTH PLAN OF SOUTHERN CA REGION KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES KAISER FOUNDATION OF THE NORTHWEST KAISER FOUNDATION PLAN OF GEORGIA KAISER NW REGION KAISER OF COLORADO KAISER PERMANENTE (COLORADO PLANS ONLY EXCEPT COLORADO SPRINGS) KAISER PERMANENTE (COLORADO SPRINGS ONLY) KAISER PERMANENTE (SO CAL ONLY) KANAWHA INSURANCE CO. KANCARE (UNITEDHEALTHCARE COMMUNITY PLAN - KS) KANE COUNTY IPA KATY MEDICAL GROUP KELSEY-SEYBOLD KELSEY-SEYBOLD (INSTITUTIONAL CLAIMS) KEMPTON COMPANY,KEMPTON GROUP ADM KEY BENEFIT ADMINISTRATORS, INC. (INDIANAPOLIS, IN) KEY SELECT KEYSTONE FIRST KEYSTONE HEALTH PLAN CENTRAL KLAIS & COMPANY KPS HEALTH PLANS LACARE LAKE REGION COMMUNITY HEALTH PLAN LAKES AREA COMMUNITY HEALTH PLAN LAKESIDE HEALTH SERVICES x LANCASTER GENERAL HEALTH GROUP LANDMARK HEALTHCARE LAWNDALE CHRISTIAN HEALTH PLAN LBA HEALTH PLANS LEON MEDICAL CENTER HEALTH PLAN LIFE & HEALTH INSURANCE COMPANY OF AMERICA LIFE TRAC LIFEMAP LIFEPATH HOSPICE LIFEPRINT LIFESYNCH LIFEWISE OF OREGON, A PREMERA HEALTH PLAN x x x NPI Option 41099 80314 52189 52123 38310 JMH01 37215 52123 43178 34136 37272 94135 94134 52095 93079 21313 KS007 91617 Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) Institutional Claim (837) 2 3 2 2 4 3 2 2 2 2 2 2 2 3 2 2 3 2 x x x x x x x x x x x x x x x x x x x x x x x 2 x 2 3 2 2 4 4 3 3 2 2 2 2 2 2 4 2 2 2 2 x x x x x x x 2 x 2 2 2 2 2 2 4 2 2 3 2 x x x x x x x x x x x x x x x x x x x x x x Additional Information x x x x x x x x x x x x x x x x x x x x Contact Sherry Wolgemuth at Prefferred Health Care at 717.560.9290 #124 for approval and payer id See ERA section for further details on ERA enrollment x x x x x Click this link and complete the required EDI registration for Lipa/Agate: https://www.trilliumchp.com/providers.php . 4 x LCM1 35107 37267 45289 LITTLE COMPANY OF MARY LOCAL 135 HEALTH BENEFITS FUND (INDIANAPOLIS, IN) LOMA LINDA UNIVERSITY ADVENTIST LONE STAR TPA 3 2 2 2 x x x x x x x 60054 LOS ALAMOS TOTAL CARE (PRU) 2 x x 68069 LOUISIANA HEALTHCARE CONNECTIONS 3 x x SX159 LOVELACE SALUD 2 x x 36334 HCP01 01260 11303 68069 25133 87726 22195 MACNEAL HEALTH PROVIDERS - CHS MAGAN MEDICAL CLINIC MAGELLAN HEALTH SERVICES MAGNACARE MAGNOLIA HEALTH PLAN MAILHANDLERS BENEFIT PLAN MAILHANDLERS MENTAL HEALTH CLAIMS MAKSIN MANAGEMENT CORPORATION 2 2 4 2 3 2 2 2 x x x x x x x x x x x x x x x x Auth & Referral (278) x LIPA/AGATE RESOURCES x Claim Status (276) x x x x x x x x x x LIPA1 x Eligibility & Benefits (270) x x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Effective 8/1/2013, Lovelace Salud will no longer accept and process MEDICAID claims with dates of service on and after 8/1/2013. Please submit the MEDICAID claims with dates of service on and after 8/1/2013 to MOLINA HEALTHCARE OF NEW MEXICO- Salud - payer ID 09824. Please note that this only pertains to MEDICAID claims submitted to Lovelace payer ID SX159. payer ID 68062 may also be used $ $ NPI Option Professional Claim (837) Institutional Claim (837) x 2 3 2 x x x x x 35162 68069 36312 MANAGED CARE SERVICES MANAGED HEALTH CARE SERVICES - IN MANAGED HEALTHCARE ASSOC (MHCA) 22771 MANAGED HEALTH NETWORKS (MHN) 3 x x 22771 68069 MANAGED HEALTH NETWORKS (MHN) MANAGED HEALTH SERVICES - WI 2 3 x x x x 60054 MARRIOTT 2 x x 2 3 2 2 2 2 2 2 2 2 2 2 2 2 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 x x x x x x x x x x x x x x x x 37121 MMPHB 41154 87065 87065 02331 59331 3833T 3833N 3833A 38338 3833C 3833R 06118 35199 35199 35199 35199 M3CA0001 M3CA1 M3FL0010 M3FL0011 M3FL0014 M3FL0003 M3IL0001 M3FL0009 M3FL0008 M3FL0006 M3IL0002 $ Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners x MASHANTUCKET PEQUOT TRIBAL NATION MASTERS, MATES AND PILOTS PLAN MAYO MANAGEMENT SERVICES, INC. MBA BENEFIT ADMINISTRATORS MBA OF WYOMING MCC BEHAVIORAL CARE MCCREARY CORPORATION MCLAREN ABC-THPC MCLAREN ABW-NHP MCLAREN HEALTH ADVANTAGE MCLAREN HEALTH PLAN MCLAREN MEDICAID MCLARENADVANTAGE SNP MD HEALTH PLAN MDWISE - SELECT HEALTH NETWORK MDWISE - ST. CATHERINE HEALTH NETWORK MDWISE - ST. MARGARET-MERCY HEALTH NETWORK MDWISE - ST. VINCENT HEALTH NETWORK MED3000 CALIFORNIA MED3000 CALIFORNIA AFFILIATED PHYSICIAN GROUP MED3000 CMS EARLY STEPS MED3000 CMS SAFETY NET MED3000 CMS TITLE 21 MED3000 COVENTRY HEALTHY KIDS MED3000 HEALTHSELECT IPA BCBS MED3000 HEALTHSPRINGS MED3000 PEDICARE TITLE 19 MED3000 PEDICARE TITLE 21 MED3000 SOUTHWEST IPA BCBS x x x x x x x x x x x x x x x x x 56205 56162 95321 94265 78857 MEDCOST BENEFIT SERVICES (MBS) MEDCOST, INC MEDFOCUS MEDICA CHOICE (ALLINA) MEDICA HEALTH CARE PLAN 2 2 2 2 2 x x x x x x x x 3 x x 2 x 4 x x 4 x x AIDID MEDICAID IDAHO x x IL621 MEDICAID ILLINOIS (HFS) x x $ AIDKY MEDICAID KENTUCKY x x x Contact MDOL EDI Submitter Enrollment at 888-499-5465 for Submitter Registration Information and setup. payer ID 39187 may also be used EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. x x $ payer ID 39186 may also be used x x x x Additional Information x x x x x 2 MEDICAID FLORIDA Auth & Referral (278) x x x x x x x x x x x x MEDCONNECTION (MARRIOTT) 77027 Claim Status (276) x 60054 x Eligibility & Benefits (270) x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. To register for Florida Medicaid, first complete the Availity FL Medicaid Registration https://apps.availity.com/availity/documents/Availity_FL_Medicaid_Registration_Instructions.pdf Once Florida Medicaid assigns your provider number, access the Availity portal, click Florida Medicaid Registration in the Value-Added Services section and follow the instructions. EDS will notify you within 30-45 days. Once you receive confirmation, you can receive files from the payer. Contact 1.866.686.4272 to enroll in EDI. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Providers must complete Kentucky's MAP380 form prior to submitting transactions. Visit http://chfs.ky.gov/NR/rdonlyres/F5C0E24B-5CEA-4B21BADF-9C79E428F029/0/MAP380Medicaid609.pdf to complete the required MAP380. Availity's submitter id = 9900004190. $ DPWMN $ 70029 $ MEDICAID MINNESOTA x MEDICAID MISSOURI x CNTNM MEDICAID NEW MEXICO PRESA x NPI Option Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) Institutional Claim (837) x 2 x x x 4 x x x 4+ x x MEDICAID NEW MEXICO PRESBYTERIAN SALUD x 4 x x MEDICAID OHIO x 4 x x $ MMISODJFS $ 86916 MEDICAID TEXAS x 4# x x $ 86916 MEDICAID TEXAS HEALTH STEPS x 4# x x $ AIDVA MEDICAID VIRGINIA x x 4 x $ AIDWA MEDICAID WASHINGTON PROVIDER 1 x x 4 x 37298 74323 52181 29076 BC004 CSMED 58203 38224 MEDICAL BENEFITS ADMINISTRATORS OF MARYLAND, INC. MEDICAL BENEFITS MUTUAL MEDICAL DEVELOPMENT INTERNATIONAL MEDICAL MUTUAL OF OHIO MEDICAL MUTUAL OF OHIO MEDICAL NETWORK OF COLORADO SPRINGS MEDICAL RESOURCE NETWORK MEDICAL VALUE PLAN - MVP - OHIO 2 2 2 2 3 2 2 2 x x x x x x x x $ 17003 MEDICARE DMERC REGION B (Covering: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin) x x x x x x 4* x Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Visit this link and complete the required EDI Submitter Enrollment Form: https://edocs.dhs.state.mn.us/lfserver/Public/DHS-4087-ENG Complete the ‘Submitter Information’ with the following: Submitter ID (UMPI) - A268453200 Submitter Name – Availity LLC Address – 740 E Campbell Rd, Ste 1000, Richardson, TX 75081 Phone – 800.282.4548 EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. NPI required in all loops, EIN or SSN required in 2310A, 2310B, 2420A and 2420F Please add provider number in 2010AA REF02 "or" 2310B REF02. Provider number is 11 digits or less. Contact 888.863.3638, #6 then #2 to obtain ID. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Please contact 1.800.686.1516 for EDI enrollment. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. NPI - No REF 0B. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Providers must enroll with Virginia Medicaid prior to submitting transactions. For enrollment questions please call 1.888.829.5373. For providers needing help interpreting Virginia Medicaid policy and procedures and in resolving problems with individual claims please contact the Virginia Department of Medical Assistance Services (DMAS) “HELPLINE” at 804.786.6273. To reach the Virginia Medicaid EDI Helpdesk please call 1.866.352.0766. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Click this link and complete the required EDI enrollment for ProviderOne: https://www.waproviderone.org/ . Availity’s ProviderOne Clearinghouse ID is 1054194. If you have questions, call 800.562.3022 ext. 16137 x x x x x x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. New Electronic Providers (Form 1 and 3 required) http://apps.ngsmedicare.com/applications/CEDIEnrollmentAgreement.aspx & http://apps.ngsmedicare.com/applications/CEDISupplierAuthForm.aspx Existing Electronic Enrolled Providers (Form 3 only) http://apps.ngsmedicare.com/applications/CEDISupplierAuthForm.aspx Form 1 – Complete the Submitter Information as follows: Submitter Status: Existing Submitter, Region B Submitter ID C08495979, Region C Submitter ID C08495979, Region D Submitter ID D08607230, Submitter Name: Availity LLC, Submitter Type: Clearinghouse Form 3 – Complete the Submitter and/or Receiver Information as follows: Entity Name - Availity LLC, Operating as a – Clearinghouse, Region B Submitter ID C08495979, Region C Submitter ID C08495979, Region D Submitter ID D08607230 Address - 740 E Campbell Rd, Ste 1000, Richardson, TX 75081, Contact Name - Availity Client Services, Contact Phone Number - 800.282.4548, Contact Email – support@availity.com. Ordering provider name and number are required on every service line. The information must go in Loop 2420E, NM109. $ $ $ 18003 19003 04111 MEDICARE DMERC REGION C (Covering: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands, Virginia and West Virginia.) MEDICARE DMERC REGION D (Covering: Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, N. Mariana Island,Oregon, South Dakota, Utah, Washington, and Wyoming.) MEDICARE PART A COLORADO $ 09101 MEDICARE PART A FLORIDA $ 12M08 MEDICARE PART A ILLINOIS x x x x x x x x x x NPI Option Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners 4* 4* 3 Professional Claim (837) Institutional Claim (837) Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. New Electronic Providers (Form 1 and 3 required) http://apps.ngsmedicare.com/applications/CEDIEnrollmentAgreement.aspx & http://apps.ngsmedicare.com/applications/CEDISupplierAuthForm.aspx Existing Electronic Enrolled Providers (Form 3 only) http://apps.ngsmedicare.com/applications/CEDISupplierAuthForm.aspx Form 1 – Complete the Submitter Information as follows: Submitter Status: Existing Submitter, Region B Submitter ID C08495979, Region C Submitter ID C08495979, Region D Submitter ID D08607230, Submitter Name: Availity LLC, Submitter Type: Clearinghouse Form 3 – Complete the Submitter and/or Receiver Information as follows: Entity Name - Availity LLC, Operating as a – Clearinghouse, Region B Submitter ID C08495979, Region C Submitter ID C08495979, Region D Submitter ID D08607230 Address - 740 E Campbell Rd, Ste 1000, Richardson, TX 75081, Contact Name - Availity Client Services, Contact Phone Number - 800.282.4548, Contact Email – support@availity.com. Ordering provider name and number are required on every service line. The information must go in Loop 2420E, NM109. CGS now supports DMERC Region C, but the NGS enrollment forms are still to be used. x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. New Electronic Providers (Form 1 and 3 required) http://apps.ngsmedicare.com/applications/CEDIEnrollmentAgreement.aspx & http://apps.ngsmedicare.com/applications/CEDISupplierAuthForm.aspx Existing Electronic Enrolled Providers (Form 3 only) http://apps.ngsmedicare.com/applications/CEDISupplierAuthForm.aspx Form 1 – Complete the Submitter Information as follows: Submitter Status: Existing Submitter, Region B Submitter ID C08495979, Region C Submitter ID C08495979, Region D Submitter ID D08607230, Submitter Name: Availity LLC, Submitter Type: Clearinghouse Form 3 – Complete the Submitter and/or Receiver Information as follows: Entity Name - Availity LLC, Operating as a – Clearinghouse, Region B Submitter ID C08495979, Region C Submitter ID C08495979, Region D Submitter ID D08607230 Address - 740 E Campbell Rd, Ste 1000, Richardson, TX 75081, Contact Name - Availity Client Services, Contact Phone Number - 800.282.4548, Contact Email – support@availity.com. Ordering provider name and number are required on every service line. The information must go in Loop 2420E, NM109. x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form: http://www.novitas-solutions.com/webcenter/content/conn/UCM_Repository/uuid/dDocName:00004541 Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section F: REQUEST TYPE: Select Add to existing submitter ID: 1937018 x 4* x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Before submitting claims, you must do the following: 1. Complete the EMC change of information form. FCSO requires each provider to complete this form in advance of any changes affecting the provider’s EDI connectivity to FSCO. The form is available at: http://medicare.fcso.com/EDI_forms/137486.pdf Enter all required data on the FAX coversheet and Enrollment Form Select EDI enrollment request and enter your Billing NPI Reason for Request – New Enrollment or Change Enrollment Line Of Business – Medicare A REQUEST TYPE Select - Add to existing submitter ID and enter P8467 as the submitter id Submit the completed form to FCSO. If you do not submit the completed form to FCSO, Availity will not be able to send claims to FCSO on your behalf. You will receive an acknowledgement from FCSO once your form is processed. After you receive the acknowledgement, you can begin sending your Florida Medicare Part A claims. Please contact your practice management system vendor if you need assistance adding this Payer ID to your system. x 2 x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. $ $ $ 06201 04211 04311 MEDICARE PART A MINNESOTA NGS MEDICARE PART A NEW MEXICO MEDICARE PART A OKLAHOMA x x x x MEDICARE PART A TEXAS x x $ 02001 MEDICARE PART A WASHINGTON x x $ 02102 MEDICARE PART B ALASKA x 3 x 04411 x Professional Claim (837) 3 x $ NPI Option Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners 3 4* x Institutional Claim (837) Auth & Referral (278) Additional Information x x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form: http://www.novitassolutions.com/webcenter/content/conn/UCM_Repository/uuid/dDocName:00004541 Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section F: REQUEST TYPE: Select Add to existing submitter ID: 1937020 x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form: http://www.novitassolutions.com/webcenter/content/conn/UCM_Repository/uuid/dDocName:00004541 Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section F: REQUEST TYPE: Select Add to existing submitter ID: 1937021 x 4* x x Claim Status (276) EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Please access enrollment forms through the links listed below. EDI Enrollment Agreement (New Provider) http://apps.ngsmedicare.com/applications/edienrollmentagreement.aspx?CatID=1 Complete with the following: Submitter Status: Existing Submitter, Submitter ID: CH00033, Submitter Name: Availity, L.L.C., Submitter Type: Clearinghouse, Contractor Code: Part A MN 06101. The information needed to complete the "EDI Third-Party Provider Authorization Form": Name: Availity LLC, Operating as a: Clearinghouse, Submitter ID: CH00033, Address: 10752 Deerwood Park Blvd. #110, City: Jacksonville State: FL Zip: 32256, Contact Name: Client Services, Phone Number: 800-282-4548, Email address: support@availity.com. EDI Third-Party Authorization Form (New/Existing (only changing clearinghouses) Provider) http://apps.ngsmedicare.com/applications/ediproviderauthform.aspx?CatID=1 Select the transactions the provider is authorizing Availity to exchange with NGS (837,276/277,835). ERA Enrollment Form (New/Existing Provider) http://apps.ngsmedicare.com/applications/edieraenrollmentform.aspx?CatID=1 Must be enrolled for ERAs with Availity before selecting 835 for your ERAs to be delivered 3 4* Eligibility & Benefits (270) EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form: http://www.novitassolutions.com/webcenter/content/conn/UCM_Repository/uuid/dDocName:00004541 Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section F: REQUEST TYPE: Select Add to existing submitter ID: S00532 EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Visit this link and complete the required enrollment: https://connect.edissweb.com a. Company Name – Availity LLC b. Trading Partner Id – CH00033 c. Do not select Availity LLC to ‘Manage Vendor’ account The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services at 800.967.7902. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Visit this link and complete the required enrollment: https://connect.edissweb.com a. Company Name – Availity LLC b. Trading Partner Id – CH00033 c. Do not select Availity LLC to ‘Manage Vendor’ account The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services at 800.967.7902. $ 03102 MEDICARE PART B ARIZONA x x x NPI Option Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners 4* Professional Claim (837) x Institutional Claim (837) Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Visit this link and complete the required enrollment: https://connect.edissweb.com a. Company Name – Availity LLC b. Trading Partner Id – CH00033 c. Do not select Availity LLC to ‘Manage Vendor’ account The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services at 800.967.7902. $ 04112 MEDICARE PART B COLORADO x x $ 09102 MEDICARE PART B FLORIDA x x $ $ 02202 06102 MEDICARE PART B IDAHO MEDICARE PART B ILLINOIS NGS x x x x x x x 3 x 4* x 4* 3 x x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form: http://www.novitassolutions.com/webcenter/content/conn/UCM_Repository/uuid/dDocName:00004541 Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section F: REQUEST TYPE: Select Add to existing submitter ID – Enter Submitter ID JBS00532 EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Before submitting claims, you must do the following: 1. Complete the EMC change of information form. FCSO requires each provider to complete this form in advance of any changes affecting the provider’s EDI connectivity to FSCO. The form is available at: http://medicare.fcso.com/EDI_forms/137486.pdf Enter all required data on the FAX coversheet and Enrollment Form Select EDI enrollment request and enter your Billing NPI Reason for Request – New Enrollment or Change Enrollment Line Of Business – Medicare B Complete all required data REQUEST TYPE Select - Add to existing submitter ID and enter P8467 as the submitter id Submit the completed form to FCSO. If you do not submit the completed form to FCSO, Availity will not be able to send claims to FCSO on your behalf. You will receive an acknowledgement from FCSO once your form is processed. After you receive the acknowledgement, you can begin sending your Florida Medicare Part A claims. Please contact your practice management system vendor if you need assistance adding this Payer ID to your system. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Visit this link and complete the required enrollment: https://connect.edissweb.com a. Company Name – Availity LLC b. Trading Partner Id – CH00033 c. Do not select Availity LLC to ‘Manage Vendor’ account The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services at 800.967.7902. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Please access enrollment forms through the following link: http://www.ngsmedicare.com/ngs/portal/ngsmedicare/welcome Go to the "Part B" column and select "EDI"; Accept the attestation terms; and in the ‘Enrollment Information section select "Enrollment Forms and Information". Select the transactions the provider is authorizing Availity to exchange with NGS (837,276/277,835). * You must already be enrolled for ERAs with Availity before selecting 835 for your ERAs to be delivered. If you are a new provider with NGS, please complete the “EDI Enrollment Agreement Form”and “EDI Third-Party Authorization Form” and “ERA Enrollment Form". If you are a current provider with NGS and you are only changing clearinghouses, then please complete only the “EDI Third-Party Authorization Form”. The “ERA Enrollment Form" is always required if you are a new/existing provider making any changes to the 835 transactions. The information needed to complete the "EDI Enrollment Agreement Form": Submitter Status: Existing Submitter, Submitter ID: 70000, Submitter Name: Availity, L.L.C., Submitter Type: Clearinghouse, Contractor Code: Part B IL 06102; Part B MN 06202; Part B WI 06302 (depending on the payer for which you are enrolling). The information needed to complete the "EDI Third-Party Provider Authorization Form": Name: Availity LLC, Operating as a: Clearinghouse, Submitter ID: 70000, Address: 10752 Deerwood Park Blvd. #110, City: Jacksonville State: FL Zip: 32256, Contact Name: Client Services, Phone Number: 800-282-4548, Email: support@availity.com $ $ $ $ $ 08202 06202 04212 04312 02302 MEDICARE PART B MICHIGAN MEDICARE PART B MINNESOTA NGS MEDICARE PART B NEW MEXICO MEDICARE PART B OKLAHOMA MEDICARE PART B OREGON x x x x x x x x x x NPI Option Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners 4* x x x x 3 3 3 4* Professional Claim (837) x Institutional Claim (837) Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Contact 877-567-7261 to enroll in EDI. The required Clearinghouse information needed to complete the EDI enrollment: Name: Availity LLC Address: 10752 Deerwood Park Blvd. #110 City: Jacksonville State: FL Zip: 32256 Contact: Client Services Contact Email address: support@availity.com Contact Phone Number: 800-282-4548 WPS Submitter Number: 70000 x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Please access enrollment forms through the following link: http://www.ngsmedicare.com/ngs/portal/ngsmedicare/welcome Go to the "Part B" column and select "EDI"; Accept the attestation terms; and in the ‘Enrollment Information section select "Enrollment Forms and Information". Select the transactions the provider is authorizing Availity to exchange with NGS (837,276/277,835). * You must already be enrolled for ERAs with Availity before selecting 835 for your ERAs to be delivered. If you are a new provider with NGS, please complete the “EDI Enrollment Agreement Form”and “EDI Third-Party Authorization Form” and “ERA Enrollment Form" . If you are a current provider with NGS and you are only changing clearinghouses, then please complete only the “EDI Third-Party Authorization Form”. The “ERA Enrollment Form" is always required if you are a new/existing provider making any changes to the 835 transactions. The information needed to complete the "EDI Enrollment Agreement Form": Submitter Status: Existing Submitter, Submitter ID: 70000, Submitter Name: Availity, L.L.C., Submitter Type: Clearinghouse, Contractor Code: Part B IL 06102; Part B MN 06202; Part B WI 06302 (depending on the payer for which you are enrolling). The information needed to complete the "EDI Third-Party Provider Authorization Form": Name: Availity LLC, Operating as a: Clearinghouse, Submitter ID: 70000, Address: 10752 Deerwood Park Blvd. #110, City: Jacksonville State: FL Zip: 32256, Contact Name: Client Services, Phone Number: 800-282-4548, Email address: support@availity.com. x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form: http://www.novitassolutions.com/webcenter/content/conn/UCM_Repository/uuid/dDocName:00004541 Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section F: REQUEST TYPE: Select Add to existing submitter ID – Enter Submitter ID JBS00532 x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form: http://www.novitas-solutions.com/webcenter/content/conn/UCM_Repository/uuid/dDocName:00004541 Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section F: REQUEST TYPE: Select Add to existing submitter ID – Enter Submitter ID JBS00532 x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Visit this link and complete the required enrollment: https://connect.edissweb.com a. Company Name – Availity LLC b. Trading Partner Id – CH00033 c. Do not select Availity LLC to ‘Manage Vendor’ account The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services at 800.967.7902. $ 04412 MEDICARE PART B TEXAS x x x NPI Option Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners 3 Professional Claim (837) x Institutional Claim (837) Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form: http://www.novitassolutions.com/webcenter/content/conn/UCM_Repository/uuid/dDocName:00004541 Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section F: REQUEST TYPE: Select Add to existing submitter ID – Enter Submitter ID JBS00532 EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Click this link and complete the required enrollment: http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%2011%20Part%2 0B~EDI~Enrollment~89BLL31745?open&navmenu=EDI||||InformationInformation $ 11302 MEDICARE PART B VIRGINIA x x 4* x Information necessary to complete the EDI Provider Information form: Section 2 - EDI Software Vendor Data, enter ‘Proprietary’. Section 3 - EDI Billing Service/Clearinghouse Data, enter Company Name: Availity L.L.C., Primary Contact: Availity Client Services, Phone: 1-800-282-4548, Submitter ID: S00532 For questions, call Palmetto GBA Technology Support Desk at 866.749.4301. Please note - Availity is not listed on the Palmetto GBA Part B Approved 5010 Errata Vendors list because Availity is not a software vendor. Availity is a clearinghouse who provides exemplary electronic service to the provider community. Palmetto GBA has granted Availity production approval for 5010 transactions. Providers using Availity to send claims to Palmetto GBA are not required to test. $ $ 02402 06302 MEDICARE PART B WASHINGTON MEDICARE PART B WISCONSIN NGS x x x x x 4* 3 x x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Visit this link and complete the required enrollment: https://connect.edissweb.com a. Company Name – Availity LLC b. Trading Partner Id – CH00033 c. Do not select Availity LLC to ‘Manage Vendor’ account The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services at 800.967.7902. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Please access enrollment forms through the following link: http://www.ngsmedicare.com/ngs/portal/ngsmedicare/welcome Go to the "Part B" column and select "EDI"; Accept the attestation terms; and in the ‘Enrollment Information section select "Enrollment Forms and Information". Select the transactions the provider is authorizing Availity to exchange with NGS (837,276/277,835). * You must already be enrolled for ERAs with Availity before selecting 835 for your ERAs to be delivered. If you are a new provider with NGS, please complete the “EDI Enrollment Agreement Form”and “EDI Third-Party Authorization Form” and “ERA Enrollment Form" . If you are a current provider with NGS and you are only changing clearinghouses, then please complete only the “EDI Third-Party Authorization Form”. The “ERA Enrollment Form" is always required if you are a new/existing provider making any changes to the 835 transactions. The information needed to complete the "EDI Enrollment Agreement Form": Submitter Status: Existing Submitter, Submitter ID: 70000, Submitter Name: Availity, L.L.C., Submitter Type: Clearinghouse, Contractor Code: Part B IL 06102; Part B MN 06202; Part B WI 06302 (depending on the payer for which you are enrolling). The information needed to complete the "EDI Third-Party Provider Authorization Form": Name: Availity LLC, Operating as a: Clearinghouse, Submitter ID: 70000, Address: 10752 Deerwood Park Blvd. #110, City: Jacksonville State: FL Zip: 32256, Contact Name: Client Services, Phone Number: 800-282-4548, Email address: support@availity.com. NPI Option Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) Institutional Claim (837) Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Visit this link and complete the required enrollment: http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Railroad%20Medicare~EDI~E nrollment~7GM24F7631?open $ 00882 23160 13123 412MP 35205 62160 00243 MCA11 MHHNP MHHNP 59064 59065 HCP01 74289 86052 22326 MER11 13189 14145 52563 64157 85035 87726 65113 62168 80314 13265 10850 87726 MWP01 92579 87726 37281 90956 47080 61146 59224 79480 MPMG1 $ 60054 MNDH1 64088 37275 13350 13350 38333 51062 38334 09824 20149 20554 38336 ABRI1 20934 50749 MEDICARE RAILROAD x x The following Availity information is necessary on page 9 of the Railroad Medicare EDI Enrollment Packet: Submitter ID - S00532, ERN Receiver ID - ER0073, Submitter Name - Availity LLC, Owner Name - Lloyd Beesing, Type of Submitter – Clearinghouse, Contact Person - Client Services, Phone 800-282-4548, Fax - 904-470-4773, Address - P.O. Box 550857, Jacksonville, FL 32255-0857, email support@availity.com, Claim Submission Mode of Communication - Connect Direct, Report/Electronic Remittance Mode of Communication - Connect Direct, Request Response Format - File, Data Compression - PKZIP. On page 16, check “Electronic Claims Submissions” and complete the remaining fields with your information. Contact the RR EDI help desk 866.749.4301, or email medicare.edi@palmettogba.com for questions. 4* x 2 2 2 2 2 3 4 4* 4* 2 2 2 2 2 x x x x x x x x x x x x x x x x x x x x x 2 x x 2 4 4 4 2 2 2 2 2 3 2 2 2 2 2 2 2 2 2 2 2 2 3 x x x x x x x x x x x x x x x x x x x x x x x x x x x x MINNEAPOLIS PRUDENTIAL 2 x x MINNESOTA DEPARTMENT OF HEALTH MISSISSIPPI SELECT HEALTH CARE MISSOULA COUNTY MEDICAL BENEFITS PLAN MODA HEALTH MODA HEALTH MOLINA HEALTHCARE OF CALIFORNIA MOLINA HEALTHCARE OF FLORIDA MOLINA HEALTHCARE OF MICHIGAN MOLINA HEALTHCARE OF NEW MEXICO MOLINA HEALTHCARE OF OHIO MOLINA HEALTHCARE OF TEXAS MOLINA HEALTHCARE OF WASHINGTON MOLINA HEALTHCARE OF WISCONSIN MOLINA ILLINOIS MONDIAL ASSISTANCE 4 2 2 3 2 2 2 2 2 2 2 2 2 1 2 x x x x x x x MEDICO INSURANCE COMPANY MEDIGOLD PPO MEDPARTNERS ADMIN SERVICES MEDPARTNERS ADMIN SERVICES (IN) MEDSOLUTIONS, INC. MEDSTAR FAMILY CHOICE MEMORIAL CLINICAL ASSOCIATES MEMORIAL HERMANN HEALTH INSURANCE COMPANY MEMORIAL HERMANN HEALTH SOLUTIONS MEMORIAL INTEGRATED HEALTHCARE MEMORIAL INTEGRATED HEALTHCARE MEMORIAL MEDICAL GROUP MENTAL HEALTH NETWORK (MHNET) MERCY CARE PLAN MERCY HEALTH PLAN OF NJ MERCY HEALTH PLANS MERIDIAN HEALTH PLAN MERIDIAN HEALTH PLAN OF IOWA MERIDIAN HEALTH PLAN OF MICHIGAN MERITAIN HEALTH MESA MENTAL HEALTH MET LIFE METCARE HEALTH PLANS METHODIST ASSOC HEALTH PLAN METHODIST CARE METRO PLUS HEALTH PLAN METROPOLITAN HEALTH PLAN (MHP) METROPOLITAN LIFE INS CO METROWEST HEALTH PLAN-PREFERRED CARE MIAMI BEHAVIORAL HEALTH MICHAEL REESE HMO MID-AMERICA ASSOCIATES, INC. MIDLAND NATIONAL LIFE INSURANCE CO MIDLANDS CHOICE MIDWEST GROUP BENEFITS MIDWEST NATIONAL LIFE INS CO – TN MIDWEST SECURITY MILLS PENINSULA MEDICAL GROUP x x x x x x x x x x x x x x x x x x x x x x x x Formerly Mhealth Formerly Mhealth Medicaid managed care. For EDI support, please e-mail edi.horizonnjhealth@kmhp.com; formerly Horizon Mercy Health Plan Formerly know as North American Administrators x x x x x x x x x x x x x x x x x x x x x x x x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. formerly ODS Health Plan formerly ODS Health Plan NPI Option Remit (835) Professional Claim (837) 13174 MMLI6 MMLI7 MMLI9 MMLI5 MMLI4 MMLI3 MONTEFIORE CONTRACT MANAGEMENT ORG. MONUMENTAL LIFE INS CO - BALTIMORE MONUMENTAL LIFE INS CO - BALTIMORE MONUMENTAL LIFE INS CO - PLANO MONUMENTAL LIFE INS CO - SCRANTON MONUMENTAL LIFE INS CO - VALLEY FORGE MONUMENTAL LIFE INS CO (HURST, TX) 2 4 4 4 4 4 4 x x x x x x x x x x x x x x MMLIC MONUMENTAL LIFE INS CO (LITTLE ROCK, AR) 4 x x MPI01 86040 80900 37233 95444 95655 34080 81883 37256 70408 71412 71412 14165 01757 01759 01758 91136 91136 91136 65085 NANPR 58182 56176 56175 90956 98205 NIA11 52132 53011 NTA11 52103 3 2 2 2 2 2 4 2 2 2 2 2 3 3 3 3 2 2 2 2 2 2 4 4 2 2 4 2 2 2 2 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 2 x x 31417 19191 75191 75190 95123 96107 04293 05047 11325 37255 66055 04332 77076 39144 95998 80705 75281 76031 65056 45129 NYL11 MOTION PICTURE INDUSTRY PENSION AND HEALTH PLAN MOUNTAIN STATES ADMINISTRATIVE SERVICES MPA - CUSTOM PROVIDER NETWORK MPE EMPLOYEE BENEFIT SERVICES, INC. MPLAN, INC/HEALTHCARE GROUP, LLC MT. CARMEL HEALTH PLAN MULTIPLAN WISCONSIN PREFERRED PROVIDER NETWORK (WPPN) MUNICIPAL HEALTH BENEFIT FUND MUTUAL ASSURANCE ADMINISTRATORS MUTUAL BENEFIT LIFE (MBL) MUTUAL OF OMAHA MUTUALLY PREFERRED MVP HEALTH PLAN OF NY MWA AMFIRST INSURANCE MWA MONITOR LIFE INSURANCE MWA STANDARD LIFE AND ACCIDENT N.W. IRONWORKERS HEALTH & SECURITY HEALTH FUND N.W. ROOFERS & EMPLOYERS HEALTH & SECURITY TRUST FUND N.W. TEXTILE PROCESSORS NAA - NORTH AMERICAN ADMINISTRATORS (NASHVILLE, TN) NAMM PARTNERS, INC NAPHCARE NATIONAL BENEFIT ADMIN. – N.C. NATIONAL BENEFIT ADMINISTRATORS – NEW JERSEY NATIONAL FINANCIAL INSURANCE COMPANY NATIONAL FOUNDATION LIFE INSURANCE COMPANY NATIONAL IMAGING ASSOCIATES NATIONAL RURAL ELECTRIC COOP (NRECA) NATIONAL RURAL LETTER CARRIER ASSOC (NALC) NATIONAL TEACHERS ASSOCIATION (NTA) NATIONAL TELECOMMUNICATIONS COOPERATIVE ASSOCIATION (NTCA) NATIONAL TELECOMMUNICATIONS COOPERATIVE ASSOCIATION (NTCA) STAFF MEMBERS NATIONWIDE SPECIALTY HEALTH NATIVE CARE HEALTH, LLC NCAS - CHARLOTTE, NC NCAS - FAIRFAX, VA NEIGHBORHOOD HEALTH PARTNERSHIP NEIGHBORHOOD HEALTH PARTNERSHIP OF FLORIDA NEIGHBORHOOD HEALTH PLAN NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND (NHPRI) NEIGHBORHOOD HEALTH PROVIDERS NESIKA HEALTH GROUP NETCARE LIFE AND HEALTH INSURANCE NETWORK HEALTH NETWORK HEALTH INS CORP - MEDICARE NETWORK HEALTH SOLUTIONS NEW AVENUES NEW ENGLAND FINANCIAL NEW ERA LIFE INSURANCE COMPANY NEW ERA WELFARE BENEFIT PLAN TRUST NEW MARKET DIMENSIONS NEW MEXICO HEALTH CONNECTIONS NEW YORK LIFE - LTC 2 2 2 2 2 2 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 x x x x x x x x x x x x x x x x x x x x x x x x x x x x 14179 NEW YORK MEDICAL IMAGING - MVP 4 x x 11334 38225 81264 34159 NEW YORK NETWORK MANAGEMENT NGS AMERICAN, INC. NIPPON LIFE INSURANCE CO NORTH AMERICA BENEFITS NETWORK 2 2 2 2 x x x x x x x 64157 NORTH AMERICAN ADMINISTRATORS 2 x x E3510 36392 NORTH AMERICAN ADMINISTRATORS NORTH SUBURBAN ASSOCIATED PHYS 2 2 x x x Payer ID 52104 $ Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Payer Name x x x x Institutional Claim (837) Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information Cancer Cancer Major Medical/Cancer Med Supp Med Supp Long Term Care Accident only, Cancer only, First occurrence invasive cancer, Heart disease attack or stroke only, Hospital confinement indemnity, Hospital intensive care For your MVP Provider number, call (800) 684-9286. x x x x x x x x x x x x x x x x x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Name has changed to Meritain Health Only claims from providers in Northern California. Please contact the EDI Dept for North American Medical Management (NAMM) - Northern California Lead/Supervisor at 800.956.8000 prior to initial submission of claims. NPI Option Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) Institutional Claim (837) 2 2 2 2 2 2 4 4 2 3 2 2 2 4 2 2 3 2 3 2 3 2 3 2 2 2 2 2 2 2 2 2 x x x x x x x x x x x x x x x x 2 x 44827 38238 36347 88027 48026 10850 35199 62119 NPN11 36346 16114 16644 06226 68069 37299 91135 14180 NAOAK 13350 OBA18 34189 95435 25150 22321 80705 95379 95569 95388 91136 56190 52152 41194 NORTHEAST IOWA COMMUNITY HEALTH PLAN NORTHERN CALIFORNIA SHEET METAL WORKERS INSURANCE PLAN NORTHERN ILLINOIS HEALTH PLAN NORTHERN NEVADA TRUST FUND NORTHSHORE PHYSICIAN ASSOCIATES NORTHSTAR ADVANTAGE (MHP) NORTHWEST COMMUNITY HEALTH PARTNERS NORTHWEST DIAGNOSTIC CLINIC NORTHWEST PHYSICIANS NETWORK NORTHWEST SUBURBAN IPA (ILLINOIS) NOVA CASUALTY CO. NOVA HEALTH ADMIN. (GRAND ISLAND, NY) NOVANET NOVASYS HEALTH NYHART NYLCARE ETHIX NORTHWEST NYMI OXFORD OAK WEST PRIMARY PHYSICIANS ASSOCIATION OEA CHOICE TRUST OGDEN BENEFITS ADMINISTRATION OHIO HEALTH CHOICE, PPO OHIO HEALTH GROUP OMNICARE, A COVENTRY HEALTH PLAN ONE CALL MEDICAL ONE HEALTH PLAN (ALL 50 STATES) ONE HEALTH PLAN OF CALIFORNIA, INC ONE HEALTH PLAN OF GEORGIA, INC ONE HEALTH PLAN OF ILLINOIS, INC OPERATING ENGINEERS LOCALS 302 & 612 HEALTH & SECURITY FUND OPTICARE EYE HEALTH NETWORK OPTIMUM CHOICE OF THE CAROLINAS OPTUMHEALTH CARE SOLUTIONS, FORMERLY U.R.N. $ AIDOR OREGON DHS OMAP/DMAP (MEDICAID) $ 13383 ORTHANET - AETNA 2 x x ORTHONET CORPORATION – CIGNA OSF CARE ADVANTAGE OSF HEALTH PLAN OSMA HEALTH OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER (OLOLRMC) OXFORD HEALTH PLANS P5 HEALTH PLAN SOLUTIONS OF UTAH 2 2 3 2 2 2 2 x x x x x x x x PACIFIC GAS AND ELECTRIC (PG &E) 2 x x COFHP 87726 87726 87726 87726 87726 87726 87726 87726 87726 93029 20377 58174 66917 13141 61129 PACIFICARE - COLORADO PACIFICARE / SECURE HORIZONS PACIFICARE OF ARIZONA PACIFICARE OF CALIFORNIA - HMO PACIFICARE OF COLORADO PACIFICARE OF OKLAHOMA - HMO (CLAIMS) PACIFICARE OF OREGON - HMO (CLAIMS) PACIFICARE OF TEXAS - HMO (CLAIMS) PACIFICARE OF WASHINGTON PACIFICARE PPO - ALL STATES PACIFICSOURCE HEALTH PLANS PACIFICSOURCE MEDICARE PARAGON BENEFITS, INC. PARKLAND COMMUNITY HEALTH PLAN PARTNERS BEHAVIORAL HEALTH MANAGEMENT PASSPORT HEALTH PLAN 3 2 2 2 2 2 2 2 2 2 2 2 2 2 3 2 x x x x x x x x x x x x x x x x PAN01 PATIENT ACCESS NETWORK 4 x 10525 22149 27048 37210 PATIENT ADVOCATES, LLC PAYER COMPASS KERN COUNTY PAYER FUSION PAYNET, INC 2 2 2 2 x x x x 13381 OSFMC 62171 CLFR2 OLRMC 06111 87068 $ 60054 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information Use this payer ID for claims with a Date of Service after 1/1/2013. x x x x x x x x x x x x x x x Formerly named as Health Pledge HMO. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Click this link and complete the required enrollment forms: http://www.oregon.gov/OHA/edi/Pages/reg_testing.aspx . Mail completed enrollment forms to: Availity L.L.C., Attn: Contracts and Legal, 10752 Deerwood Park Blvd S, Ste 110 Jacksonville, FL 32256. Secondary claims are not accepted electronically. Availity submitter ID: MB000026 EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Orthonet provider id is required in billing provider (2010AA) loop. x x x x x x x x x x x x x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Effective 8/20/12, payer ID 95959 will no longer be valid. Effective 8/20/12, payer ID 95964 will no longer be valid. Effective 8/20/12, payer ID 95964 will no longer be valid. Effective 8/20/12, payer ID 95962 will no longer be valid. Effective 8/20/12, payer ID 95959 will no longer be valid. Effective 8/20/12, payer ID 95959 will no longer be valid. Effective 8/20/12, payer ID 95959 will no longer be valid. Effective 8/20/12, payer ID 95959 will no longer be valid. Effective 8/20/12, payer ID 95962 will no longer be valid. Please use payer ID 87726. Please use payer ID 87726. Please use payer ID 87726. Please use payer ID 87726. Please use payer ID 87726. Please use payer ID 87726. Please use payer ID 87726. Please use payer ID 87726. Please use payer ID 87726. x x x Providers need to enter their Group Number in the 2000B SBR03 (Group or Policy Number) field. x x x $ NPI Option Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) Institutional Claim (837) 3 3 3 4 2 2 2 2 2 2 2 2 2 x x x x x x x x x x x x x x x x x x x x x x x Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information 65018 95885 68069 37086 72126 25133 25146 PHIF4 22729 74647 67814 67814 37330 PCA HEALTH PLAN OF FLORIDA PCA HEALTH PLANS OF TEXAS (HUMANA) PEACH STATE HEALTH PLAN PEKIN INSURANCE PEOPLE'S HEALTH NETWORK PERSONALCARE PERSONALCARE PHIFER WIRE PRODUCTS, INC. PHOENIX HEALTH PLAN (MEDICARE) PHOENIX HEALTH PLAN MEDICAID PHOENIX HOME LIFE PHOENIX MUTUAL PHYSICIAN HEALTH PLAN (PHP) PCN12 PHYSICIANS CARE NETWORK (POLYCLINIC) 2 x x 37136 PHCS1 20398 PHYSICIANS HEALTH ASSOCIATION OF ILLINOIS PHYSICIANS HEALTH CHOICE - CLAIMS PHYSICIANS HEALTH COLLABORATIVE PHYSICIANS HEALTH PLAN OF MID MICHIGAN (MEDICAID AND COMMERCIAL CLAIMS) PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA PHYSICIANS HEALTHCARE PLANS PHYSICIANS MUTUAL INSURANCE COMPANY PHYSICIANS PLUS INS. CORP PINNACLE PHYSICIAN MANAGEMENT ORG PINNACOL ASSURANCE PINNACOL ASSURANCE PITTMAN & ASSOCIATES PLANNED ADMINISTRATORS, INC. PODIATRY FIRST PODIATRY FIRST POLY AMERICA MEDICAL BENEFITS PLAN POMCO PPO OKLAHOMA PPO PLUS LLC PPOM PRAIRIE STATES ENTERPRISES, INC. PREFERRED ADMINISTRATORS PREFERRED ADMINISTRATORS - CHILDREN'S HOSPITAL PREFERRED BENEFIT ADMINISTRATOR (WICHITA, KS) 2 4 2 x x x x x x 2 x x 2 2 2 2 4 2 2 2 2 2 2 2 2 2 2 3 2 2 2 2 x x x x x x x x x x x x x x x x x x x x x x x x Please contact Provider Relations at (915)-532-3778 x1507 to enroll. Please contact Provider Relations at (915)-532-3778 x1507 to enroll. This payer processes claims for Florida only. Please check the address on the member’s ID card before submitting claims electronically. 37330 12399 65031 47027 39156 PPMO1 84109 CCIA1 37224 37287 POD1S POD1ST 32680 16111 73159 72148 PPOM1 36373 EPF10 EPF11 61665 x x x x x x x x x x x x x x PREFERRED BENEFIT ADMINISTRATORS (LONGWOOD, FL) 2 x x 65088 73145 61106 31478 60110 PMP01 36401 60110 41147 PREFERRED CARE PARTNERS IN FL PREFERRED COMMUNITY CHOICE PREFERRED HEALTH PLAN PREFERRED HEALTH PROFESSIONALS PREFERRED HEALTH SYSTEMS PREFERRED MEDICAL PLAN PREFERRED NETWORK ACCESS, INC. (DARIEN, IL) PREFERRED PLUS OF KANSAS (PPK) PREFERREDONE (MN) 2 2 2 2 2 4 2 2 2 x x x x x x x x x x x x x x x x x x $ 00934 PREMERA BLUE CROSS - AK 2 x $ 00934 PREMERA BLUE CROSS - WA 2 x PREMIER EYE CARE PRESBYTERIAN HEALTH PLAN (COMMERCIAL) PREVEA HEALTH INSURANCE PLAN PRIMARY CARE PARTNERS PRIMARY HEALTH PLAN PRIMARY PHYSICIAN CARE, INC PRIME CARE HEALTH PLAN PRIME VISION HEALTH PLAN PRIMECARE MED NETWORK - NAMM PRIMESOURCE HEALTH NETWORKS PRIMEWEST HEALTH PLAN PRINCETON PREMIER IPA PRINCIPAL FINANCIAL GROUP PRIORITY HEALTH PRISM - UNIVERA PRISM NETWORK, INC. PRIVATE HEALTH CARE (PHCS SAVILITY) 2 4 4 3 3 2 3 2 3 2 2 4 2 2 2 2 4 x x x x x x x x x x x x x x x x x 65054 PREHP 39185 NAPCP PRIME 56144 UH015 56190 IP079 23266 61604 PRI01 61271 38217 37315 37268 13306 x x Payer ID is valid as of 4/5/2013 EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. x x x 53476 x payer ID 68049 may also be used x x x x x x x x x x x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Payer Id has changed from 04320 to 23266 60054 91136 91136 42172 44827 39197 35174 QHPNY QUANM QMDCE QMDPO QCTPA RPAWC 91176 00851 00910 00932 00611 38221 47076 20481 RPPG1 CHAT1 74205 84980 16117 36339 $ $ Remit (835) NPI Option $ Professional Claim (837) PROFESSIONAL BENEFIT ADMINISTRATORS, INC. (OAK BROOK, IL) PROFESSIONAL CLAIMS MANAGEMENT PROFESSIONAL RISK MANAGEMENT PROGRESS HEALTH HMO PROVIDENCE CHOICE OPTION PROVIDENCE GOOD HEALTH PLAN PROVIDENCE HEALTH PLAN (PPO) PROVIDENCE INSURANCE AND ADMIN SERVICE PROVIDENT AMERICAN LIFE AND HEALTH INSURANCE COMPANY PROVIDENT LIFE AND ACCIDENT INS 2 2 2 3 3 2 3 2 2 2 x x x x x x x x x x x x x x PRUDENTIAL (ALL PLANS) 2 x x PUGET SOUND BENEFITS TRUST PUGET SOUND ELECTRICAL WORKERS PUGET SOUND HEALTH PARTNERS QUAD CITIES COMMUNITY HELATH PLAN QUADMED (WEST ALLIS, WI) QUAL CHOICE OF ARKANSAS QUALITY HEALTH PLANS OF NEW YORK QUAL-MED NEW MEXIICO QUAL-MED, COLORADO EPO QUAL-MED, PORTLAND (PO) QUANTUM CARE TPA RAVENWOODS PHYSICIAN ASSOCIATES RBMS, LLC REGENCE BLUECROSS BLUESHIELD OF OREGON REGENCE BLUECROSS BLUESHIELD OF UTAH REGENCE BLUESHIELD (WA) REGENCE BLUESHIELD OF IDAHO REGENCY EMPLOYEE BENEFITS REGIONAL CARE, INC. RESOLVE HEALTH PLAN ADMINISTRATORS RESURRECTION PHYSICIAN PROVIDERS GROUP REUNION INDUSTRIES RIGHT CARE FROM SCOTT & WHITE RIO GRANDE HMO RMSCO RUSH HEALTH ASSOCIATION 2 2 2 2 2 2 2 2 2 2 3 3 2 4 4 4 4 2 2 4 4 2 2 4 2 2 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Payer ID 36331 37242 34134 PHHMO PHP01 PHP01 PHP00 PAS01 71404 68195 Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Payer Name x x x x x Institutional Claim (837) x x x x x x x x x x x x x x x x RUSH PRUDENTIAL 2 x x 36389 63070 31441 35164 37105 62308 68069 RUSH PRUDENTIAL HMO RWDSU BENEFIT FUND S & S HEALTHCARE STRATEGIES SAGAMORE HEALTH NETWORK SAGE TECHNOLOGIES SAMBA SANDATA 2 2 2 2 2 2 3 x x x x x x x x x x x x x x 60054 SANDIA TRIPLE OPTIONAL PLUS 2 x x 91184 63665 SANFORD HEALTH PLAN SANUS- HMO/PPO ST LOUIS 2 2 x x x x 16146 SCHC TOTAL CARE 2 x 88030 SCOTT & WHITE HEALTHCARE 2 x x SECURE HEALTH PLANS OF GEORGIA, LLC SECURITY HEALTH PLAN SEECHANGE HEALTH INSURANCE SELECT ADMINISTRATIVE SERVICES (SAS) SELECT BENEFIT ADMINISTRATORS (DES MOINES, IA) SELECT BENEFIT ADMINISTRATORS INC. SELECT BENEFIT ADMINISTRATORS OF AMERICA (ASHLAND, WI) SELECT HEALTH NETWORK SELECT HEALTH OF SOUTH CAROLINA SELECTCARE SELECTCARE OF OKLAHOMA SELECTCARE OF TX (BEAUMONT) 2 2 2 2 2 2 2 4 2 2 4 4 x x x x x x x x x x x x x x x x x x x x x x x x 28530 39045 35098 64088 42137 93031 37282 35199 23285 00014 SCOK1 GTPA1 x x Claim Status (276) Auth & Referral (278) Additional Information Payer ID effective starting 4/5 x x x 60054 x Eligibility & Benefits (270) EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. x x x x x x x x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Enrollment for contracted providers - Mayra Martinez - 254.298.3278. Enrollment for non-contracted providers - Tracy Tharp 254.298.3274. Non-contracted providers need to fill out an EDI Intake Form before filing claims to SWHP for the first time. The EDI Intake Form (https://swhp.org/sites/default/files/837EDI_IntakeForm_0.pdf) is for S&W’s Configuration team to enter your provider information into their claims adjudication system. The EDI Authorization Form allows you to sign up to submit and receive certain HIPPA transactions. Patients’ Member Identification Numbers must be complete (and include the two-digit suffix) for a claim to be accepted electronically. $ $ SELECTCARE OF TX (HOUSTON) SELECTCARE OF TX (KELSEY-SEYBOLD) SELF INSURED PLANS SELF-FUNDED PLANS (OHIO) SENDERO HEALTH PLAN SENIOR WHOLE HEALTH SENTARA HEALTH MANAGEMENT SENTINEL MANAGEMENT SERVICES SENTRY INSURANCE A MUTUAL COMPANY SENTRY LIFE INSURANCE COMPANY SETON EMPLOYEE PLAN ARCHIVE SETON HEALTH PLAN - MAP PROGRAM SETON HEALTH PLAN (CHIP) SETON STAR SHASTA ADMINISTRATIVE SERVICES SHEFFIELD, OLSON, & MCQUEEN, INC. SHERMANCHOICE SIERRA HEALTH SERVICES (CLAIMS) SIERRA HEALTH SERVICES (ENCOUNTERS) SIGNIFICA BENEFITS SERVICES INC SIMPLY HEALTHCARE PLAN SINAI MEDICAL GROUP SINCLAIR HEALTH PLAN SISCO SLOAN'S LAKE MANAGED CARE SMITH ADMINISTRATORS SOUTH CENTRAL PREFERRED SOUTH COUNTY HEALTH ALLIANCE SOUTHCARE/HEALTHCARE PREFERRED SOUTHERN BENEFIT SERVICES LLC SOUTHERN HEALTH SERVICES SOUTHERN HEALTH SERVICES INC SOUTHLAND IPA NPI Option HPN11 KLSY1 36404 34131 36426 83035 54154 23249 39033 39033 SHEBP SHMAP SHPCH STAR1 75280 41143 SC359 76342 76343 23250 00199 SINAI 84076 00540 84096 02057 23266 41154 25147 37318 25133 25128 SIPA1 Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) Institutional Claim (837) x x 4 4 2 2 2 2 2 2 2 2 4 4 4 4 2 2 2 2 2 2 3 3 2 2 2 2 2 2 2 2 2 2 4 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information x x x x x x x x x x x x x x x x x x x x x x x M3IL2 SOUTHWEST BCBS OF FLORIDA 4 x 37266 SOUTHWEST SERVICE LIFE 2 x x 60054 SOUTHWESTERN BELL (MEDICAL) 2 x x 23253 35199 22240 35199 37264 SLCH1 88029 37116 STM01 59225 SPECTRUM ADMINISTRATORS, INC. - TPA ALLENTON, PA ST. ANTHONY MICHIGAN CITY ST. BARNABAS SYSTEM HEALTH PLAN ST. FRANCIS HEALTH NETWORK ST. JOHN’S CLAIMS ADMINISTRATION ST. LAWRENCE CO. HEALTHCARE PLAN ST. MARY'S HEALTH PLAN ST. THERESE PHYSICIAN ASSOC ST. THOMAS MEDICAL NETWORK (GULFQUEST) STAR HRG 2 4 2 4 2 2 2 2 3 2 x x x x x x x x x x x x x x x x x x 31053 STATE FARM 2 x x 57254 75087 67829 91151 STL01 06089 SLIC2 SLIC1 31121 74227 35199 95202 37301 STATE OF TEXAS DENTAL PLAN STATES GENERAL LIFE INSURANCE STERLING MEDICARE ADVANTAGE STERLING OPTION 1 STIRLING BENEFITS STIRLING BENEFITS (STIRLING & STIRLING) STONEBRIDGE LIFE INS CO (CEDAR RAPIDS IA) STONEBRIDGE LIFE INS CO (VALLEY FORGE PA) STONER AND ASSOCIATES (CINCINNATI, OH) STUDENT RESOURCES (UNITEDHEALTHCARE) SUBURBAN HEALTH ORGANIZATION SUMMACARE HEALTH PLAN SUMMIT AMERICA INSURANCE SERVICES 2 2 3 2 2 2 4 4 2 2 4 2 2 x x x x x x x x x x x x x x 60054 SUN TRUST BANK 2 x x 90956 68069 SUNAMERICA LIFE INSURANCE COMPANY SUNFLOWER STATE HEALTH PLAN x 2 3 x x x 68069 SUNSHINE HEALTH x 3 x x 23218 SUPERIOR BENEFITS 2 x x x Encounters only MED3000 EDI Support (805) 988-2280 ext 340 Provider Customer Service - (708) 633-1234 EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Click this link for information on electronic payment and remittance information: https://ProviderNet.adminisource.com x x x EPN - All dates of service, expanded EPN - 2008 date of service and after. x x x x x x x Med Supp Med Supp EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. The payer will begin accepting claims under this payer ID on 1/1/13. Prior to submitting claims, contact your Health Plan Provider Relations Department to verify your provider information is on file in the Health Plans claim system. This will prevent claim rejections and allow payments to be made in a timely manner. You may reach Provider Relations at 800.218.0530 or by visiting www.sunshinestatehealth.com and click on the Provider tab. Payer ID 68057 may also be used. Remit (835) NPI Option Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) 68069 SUPERIOR HEALTH PLAN x 3 x x 68069 SUPERIOR HEALTH PLAN x 4 x x 68069 SUPERIOR HEALTH PLAN CHIPS EPO x Payer ID 97802 IP091 CALL CALL 94269 HM059 91151 16146 HCP01 88067 37228 39157 ADSL1 75261 75261 75261 36215 GTPA1 HPN11 KLSY1 45210 76048 TXCSM TOPA1 13185 THS01 BOONG 75600 37305 20356 35206 58200 23223 59221 04320 THERA COTHE 95266 THRIV 39065 WITH1 TOPTN 92620 TCARE 38201 41202 37230 59222 TFLI4 TFLI6 TLIN7 TFLI5 TFLI2 TFLI3 TFLIC TLIN4 TLIN6 TLIN5 TLIN2 Payer Name SUPERIOR INSURANCE SERVICES SUTTER - GOULD MEDICAL FOUNDATION (CLAIMS/ENCOUNTERS) SUTTER - MEDICAL GROUP OF THE REDWOODS (CLAIMS/ENCOUNTERS) SUTTER - SIP, SMG, SWMG (CLAIMS/ENCOUNTERS) SUTTER EAST BAY MEDICAL FOUNDATION SUTTER SIP SMG SWMG (CLAIMS ENCOUNTERS) SYNERTECH HEALTH SYSTEMS SOLUTIONS (STERLING OPTION 1) SYRACUSE COMMUNITY HEALTH CENTER (SCHC) TALBERT MEDICAL GROUP TALL TREES ADMINISTRATORS TARRANT HEALTH SERVICES TBG ADMINISTRATIVE SERVICES TEAM CHOICE - ALPHA CARE GOLD TEAM CHOICE GOLD TEAM CHOICE PNS TEAM CHOICE UMC TEAMCARE TEXAN PLUS (BEAUMONT) TEXAN PLUS (HOUSTON) TEXAN PLUS (KELSEY-SEYBOLD) TEXAS - CHRISTUS HEALTH PLAN TEXAS CHILDREN'S HEALTH PLAN TEXAS CHILDREN'S STAR MEDICAID TEXAS FIRST HEALTH PLANS (TIOPA) TEXAS FIRST HEALTH PLANS NORTHTX TEXAS HEALTHSPRING THE BOON GROUP THE CITY OF ODESSA THE FORD METER BOX COMPANY, INC. THE HEALTH EXCHANGE - CERNER CORPORATION THE HEALTHCARE GROUP THE INTEGRITY BENEFIT NETWORK, INC. (MARRIETA, GA) THE LOOMIS COMPANY THE MEGA LIFE & HEALTH INS. CO. THE PREFERRED HEALTHCARE SYSTEM-PPO THERAPHYSICS THERAPHYSICS- COLORADO ONLY THIRD PARTY CLAIMS MANAGEMENT THRIVENT FINANCIAL TIME INSURANCE COMPANY TODAY'S HEALTH TODAY'S OPTION (AMERICAN PROGRESSIVE AND PYRAMID HEALTH) TONGASS TIMBER TRUST TOTAL CARE (NEW YORK) TOTAL HEALTHCARE OF MICHIGAN TOTAL PLAN SERVICES TR PAUL, INC. TRANSAMERICA TRANSAMERICA FINANCIAL LIFE INS - BALTIMORE TRANSAMERICA FINANCIAL LIFE INS - CEDAR RAPIDS TRANSAMERICA FINANCIAL LIFE INS - PLANO TRANSAMERICA FINANCIAL LIFE INS CO TRANSAMERICA FINANCIAL LIFE INS CO TRANSAMERICA FINANCIAL LIFE INS CO TRANSAMERICA FINANCIAL LIFE INS CO (HURST, TX) TRANSAMERICA LIFE INS CO TRANSAMERICA LIFE INS CO - BALTIMORE TRANSAMERICA LIFE INS CO - CEDAR RAPIDS TRANSAMERICA LIFE INS CO (HURST, TX) x x x x x x x x x Institutional Claim (837) 4 x x 2 2 2 2 2 3 2 2 2 2 2 2 2 2 2 2 2 4 4 4 2 2 2 4 4 2 2 2 2 2 2 2 2 2 2 2 2 2 4 2 4 2 2 4 2 2 2 2 4 4 4 4 4 4 4 4 4 4 4 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Eligibility & Benefits (270) Claim Status (276) Auth & Referral (278) Additional Information Prior to submitting claims, contact your Health Plan Provider Relations Department to verify your provider information is on file in the Health Plans claim system. This will prevent claim rejections and allow payments to be made in a timely manner. You may reach Provider Relations at 800.218.7453 or by visiting www.superiorhealthplan.com. Payer ID 39188 may also be used. 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. 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. Please contact Sutter to enroll (800-611-5191). Please contact Sutter to enroll (800-611-5191). Please contact Sutter to enroll (800-611-5191). x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x TLINS TRANSAMERICA LIFE INS CO (LITTLE ROCK, AR) 4 x x 37284 20807 TRAN1 TRANSCHOICE - KEY BENEFIT ADMINISTRATORS TRANSCHOICE-FIRST SERVICE ADMINISTRATORS TRANSWESTERN INSURANCE ADMIN, INC. 2 2 4 x x x x x Cancer Med Supp/Retiree Med Major Medical/Cancer Cancer only (specified disease) Med Supp Med Supp Long Term Care Med Supp Cancer Med Supp/Retiree Med Long Term Care Accident only, Cancer only, First occurrence invasive cancer, Heart disease attack or stroke only, Hospital confinement indemnity, Hospital intensive care NPI Option Remit (835) Claim Enroll Required Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) TCHD1 TRAVIS COUNTY HOSPITAL DISTRICT MAP 4 x x 31144 TRIHEALTH PHYSICIAN SOLUTIONS 3 x x 34185 91078 61425 TRISURANT TRUSTEED PLANS SERVICE CORPORATION TRUSTMARK 2 2 2 x x x x x x 04298 TUFTS HEALTH PLAN 2 x $ 60054 UC CARE (UNIV. OF CA) 2 x x $ 52629 UCARE 2 x x 97041 59573 60230 92805 52323 97736 20452 75240 74223 ULLIC 41206 75130 75196 39026 52180 80314 80314 80314 62170 51368 34638 75243 87042 25175 87726 UGP19 36273 31107 71412 84132 87726 81400 74227 2 2 2 2 2 2 2 2 2 4 2 2 2 2 2 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 2 x x 2 x x 2 x x 2 x x 87726 95958 81400 81400 UCS HEWITT COLEMAN UCS HOCKENBERGOS EQUIPMENTS UCS MASONRY INDUSTRY TRUST UCS MAXOR ADMINISTRATIVE SERVICES UCS NEBRASKA PLASTICS GROUP UCS RTG MEDICAL GROUP UCS WINSTON HOSPITALITY UICI-ADMINISTRATORS UICI-ADMINISTRATORS - ST OF NEVADA ULLICO INC. (VALLEY FORGE, PA) ULTRA BENEFITS UMC HEALTH PLAN (LUBBOCK) UMR - HARRINGTON UMR - WAUSAU/UHIS UMWA HEALTH & RETIREMENT FUNDS UNICARE INDIVIDUAL SMALL GROUP UNICARE MAJOR ACCOUNTS UNICARE SPECIAL ACCOUNTS UNIFIED HEALTH SERVICES UNIFIED IPA UNIFIED PHYSICIANS NETWORK UNIFORM MEDICAL PLAN/HARRINGTON UNION PACIFIC RAILROAD EMPLOYEES UNISON HEALTH PLAN UNITED BEHAVIORAL HEALTH UNITED GROUP PROGRAMS UNITED HEALTHCARE OVATIONS (AARP) UNITED MEDICAL RESOURCES UNITED OF OMAHA UNITED PHYSICIANS OF N. COLORADO UNITEDHEALTHCARE UNITEDHEALTHCARE ALL SAVERS INSURANCE UNITEDHEALTHCARE (STUDENTRESOURCES) UNITEDHEALTHCARE COMMUNITY PLAN - MI (FORMERLY GREAT LAKES HEALTH PLAN) UNITEDHEALTHCARE MEDICARE SOLUTIONS (UNITEDHEALTHCARE CHRONIC COMPLETE) FORMERLY EVERCARE UNITEDHEALTHCARE OF FLORIDA UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY (UNITEDHEALTHCARE COMMUNITY PLAN) FORMERLY JOHN DEERE HEALTHCARE UNITEDHEALTHCARE WEST UNITEDHEALTHCARE WEST (ENCOUNTERS) FORMERLY PACIFICARE UNITEDHEALTHONE PACIFICARE LIFE UNITEDHEALTHONE UNITEDHEALTHCARE LIFE INSURANCE COMPANY 2 2 2 2 x x x x Premium Payer ID 95467 87726 87726 95378 Payer Name x x x x x x x Institutional Claim (837) Claim Status (276) Auth & Referral (278) Additional Information Contact MDOL EDI Submitter Enrollment at 888-499-5465 for Submitter Registration Information and setup. EDI enrollment is required. Please go to this link and complete the form: http://media.capario.com/agreements/04298%20Inst.pdf EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Med Supp Formerly Fiserv Health - Wausau Benefits/Benesight Formerly Health Economics - MICS Corp x x x x x x x x x Use for professional encounters only. All claims currently submitted to Univera Healthcare, Payer ID HC001, should now be submitted to Payer ID UNINW. HC001 UNIVERA HEALTHCARE 3 x UNINW UNBCI UNBC2 33001 09908 11149 91136 UNIVERA HEALTHCARE UNIVERSAL BENEFITS CORPORATION UNIVERSAL BENEFITS CORPORATION - CEDAR RAPIDS UNIVERSAL CARE- CALIFORNIA UNIVERSITY FAMILY CARE - MARICOPA HEALTH PLAN UNIVERSITY MEDICAL CENTER UNIVERSITY OF WASHINGTON STUDENTS & GRADUATE APPTS. 3 4 4 2 2 2 2 x x x x x x x ATEND UNIVITA 4 x x UPMC HEALTH PLAN UPPER PENINSULA HEALTH PLAN US BENEFITS 2 2 2 x x x x x x 23281 38337 93092 Eligibility & Benefits (270) x x x x x Tricare Prior Authorization Number required (loop 2300, REF01 = G1); Example: 999999-99-999 or 999999-99999. Rendering Provider Number required (loop 2310B NM109). $ $ US FAMILY HEALTH PLAN (USFHP) - TEXAS AND LOUISIANA NPI Option USFHP Payer Name Remit (835) Payer ID Claim Enroll Required Premium Government Payer* Availity's Electronic Data Interchange (EDI) Health Plan Partners Professional Claim (837) x x 2 x EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. US IMAGING NETWORK (NY) 2 x US/HEALTHCARE (HMO) 2 x x 74095 13407 UT3F 12115 VAFSC 82238 82420 72128 VPA18 USAA (UNITED STATES AUTOMOBILE ASSOC) USFHP – ST. VINCENT CATHOLIC MEDICAL CENTER UTMB - 3 SHARE PROGRAM VA FEE BASIS PROGRAMS VA FINANCIAL SERVICES CENTER VALLEY BAPTIST ADVANTAGE VALLEY BAPTIST HEALTH PLAN VANTAGE HEALTH PLAN, INC. VARIABLE PROTECTION ADMINISTRATORS (VPA) 2 2 4 2 2 2 2 2 2 x x x x x x x x x x x x x x x x 60054 VARIAN HEALTH CARE PLAN 2 x x VERITY NATIONAL GROUP, INC. VERITY NATIONAL GROUP, INC. VESTACARE VILLAGE FAMILY PRACTICE VIPA VIRGINIA PREMIER COMPLETECARE VIRGINIA PREMIER COMPLETECARE VIRGINIA PREMIER COMPLETECARE VISION CARE INCORPORATED VISTA HEALTH PLAN VIVA HEALTH PLAN VNS CHOICE MEDICARE VYTRA HEALTHCARE W.C. BEELER & COMPANY WABASH MEMORIAL HOSPITAL ASSOCIATION WAGNER MEINERT WAL-MART (BLUE CARD CARRIERS) WATERSTONE BENEFIT ADMINISTRATORS WEA TRUST WEBTPA WEISS HEALTH PROVIDERS WELL PATH OF CAROLINA WELLMED (CLAIMS) WELLMED (ENCOUNTERS) WELLMED/SECURE HORIZONS WENATCHEE VALLEY MEDICAL CENTER 2 2 3 4 2 3 3 3 2 2 2 2 2 2 2 2 4 4 3 2 2 2 4 4 4 2 x x x x x x x x x WEST COAST STATIONARY ENGINEERS HEALTH & SECURITY TRUST FUND 2 x x WEST SUBURBAN HEALTH PROVIDERS WESTERN CARE WESTERN GROWER'S INS. CO. WESTERN MUTUAL INSURANCE WESTERN SOUTHERN FINANCIAL GROUP (CINCINNATI, OH) WEYCO WILLIAM C. EARHART, CO., INC. WILLIAM J. SUTTON & COMPANY WINDSOR MEDICARE EXTRA WINHEALTH PARTNERS WISCONSIN AUTO & TRUCK DEALERS INSURANCE PLAN WISCONSIN COMMERCIAL WISCONSIN PHYSICIANS SERVICE GROUP HEALTH (WPS) WOMEN'S INTEGRATED NETWORK, INC (WIN FERTILITY) WOODMAN ACCIDENT AND LIFE COMPANY 2 2 3 2 2 2 2 2 2 2 2 3 2 2 4 x x x x x x x x x x x x x x x x x x x x x x x x 2 x x 2 2 2 4 2 2 3 2 x x x x x x x x x x x x x x x 91136 80942 70408 24735 37247 31048 38232 93050 98010 62153 27327 39200 WPS01 SX022 13413 81949 VARIOUS 20333 75276 77080 10159 25133 62153 06121 60646 WORKERS' COMPENSATION WORKSITE BENEFIT SERVICES, LLC. WORLD INSURANCE COMPANY WPP - ELDERCARE WISCONSIN WPS PREVEA HEALTH PLAN WRITERS GUILD XANTUS HEALTHPLAN OF TENNESSEE YALE NEW HAVEN HEALTH - MSO INC YALE UNIVERSITY HEALTH PLAN x x x x x x x x x x x x x x x x x x x x x x Auth & Referral (278) To perform 837 transactions with the US Family Health Plan (USFHP), you will need to ensure that your NPI 1 and NPI 2 (if applicable) are on file with the Plan. Prior to performing 837 transactions with the US Family Health Plan, please confirm that your NPI is on file by contacting us at 800-678-7347. 50383 x Claim Status (276) x 60054 75256 GASA1 VESTA VFP11 BV001 VPCCI VPCCP VPHP1 37297 55248 63114 77073 22264 62111 85256 31650 84980 73155 39151 75261 36337 25133 WELM2 WELMD WELM2 91064 Eligibility & Benefits (270) Institutional Claim (837) x Additional Information EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. x x x Payer requires EDI enrollment. EDI_Enrollment_Form Payer requires EDI enrollment. EDI_Enrollment_Form x x x x x x x x x x x Enrollment Contact - (866) 703-1444 x x x Formerly payer ID WNHLT x Please see Availity's Workers' Compensation Companion Guide for more details: (https://apps.availity.com/availity/documents/AvailityWorkersCompensationCompanionGuide.pdf ) Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name 33 of 138 Payer ID ABSOLUTE TOTAL CARE 68069 ADVOCATE HEALTH PARTNERS 65093 ADVOCATE MEDICAL GROUP 36320 AETNA INSURANCE COMPANY ALLCARE HEALTH PLAN 60054 MRIPA AMBETTER FROM BUCKEYE COMMUNITY HEALTH PLAN 68069 AMBETTER FROM CELTICARE HEALTH PLAN 68069 AMBETTER FROM COORDINATED CARE 68069 AMBETTER FROM MAGNOLIA HEALTH 68069 AMBETTER FROM MANAGED HEALTH SERVICES 68069 AMBETTER FROM PEACH STATE HEALTH PLAN 68069 AMBETTER FROM SUNSHINE HEALTH 68069 AMBETTER FROM SUPERIOR HEALTH 68069 AMBETTER OF ARKANSAS 68069 AMERICAN COMMERCIAL BARGE LINES AMERIGROUP ASURIS NORTHWEST HEALTH ATRIO HEALTH PLAN 87726 27514 93221 ATRIO Additional Information Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. When enrolling for Advocate Health ERAs, please be sure to enroll for both Advocate Health Centers and Advocate Health Partners. When enrolling for Advocate Health ERAs, please be sure to enroll for both Advocate Health Centers and Advocate Health Partners. Please complete the Availity Multi-payer Form prior to the Aetna ERA form. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. NPI number is required on the Multi-payer Form for processing. Visit our web site: www.availity.com Availity Required Forms (links) Availity Multi-payer Form Payer Specific Forms (links) Centene_ERA_835_enrollment Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Electronic Remittance Advice and Electronic Funds Transfer Enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name BLUECROSS BLUESHIELD (BCBS) IL HCSC BLUECROSS BLUESHIELD (BCBS) MN BLUECROSS BLUESHIELD (BCBS) NM HCSC 00621 00220/00720 00790 BLUECROSS BLUESHIELD (BCBS) OK HCSC 00840 BLUECROSS BLUESHIELD (BCBS) TX HCSC BLUESHIELD (BC) CA BLUECROSS (BC) ID 84980 BS001 IDBLC BRIDGESPAN BRIDG BRIDGEWAY HEALTH SOLUTIONS 68069 BUCKEYE COMMUNITY HEALTH PLAN 68069 CALIFORNIA HEALTH AND WELLNESS 68047 CAREFIRST BCBS OF DC/NCA SB580 CAREFIRST BCBS OF MARYLAND CARESOURCE HEALTH PLAN OREGON CARITEN HEALTHCARE CARITEN SENIOR HEALTH CCSTPA 34 of 138 Payer ID SB690 MRCHP Additional Information Availity Required Forms (links) Please log in to the Availity Web Portal and select the Illinois region (if available). Click My Account | BCBS ERA Registration and then select your organization or enter a Clearinghouse Availity Customer ID. Click Submit to access the Blue Cross and Blue Shield of Illinois website and complete the enrollment. Payer Specific Forms (links) BCBSMN ERA Enrollment Please log in to the Availity Web Portal and select the New Mexico region (if available). Click My Account | BCBS ERA Registration and then select your organization or enter a Clearinghouse Availity Customer ID. Click Submit to access the Blue Cross and Blue Shield of New Mexico website and complete the enrollment. Please log in to the Availity Web Portal and select the Oklahoma region (if available). Click My Account | BCBS ERA Registration and then select your organization or enter a Clearinghouse Availity Customer ID. Click Submit to access the Blue Cross and Blue Shield of Oklahoma website and complete the enrollment. Please log in to the Availity Web Portal and select the Texas region (if available). Click My Account | BCBS ERA Registration and then select your organization or enter a Clearinghouse Availity Customer ID. Click Submit to access the Blue Cross and Blue Shield of Texas website and complete the enrollment. NPI number is required on the Multi-Payer Registration Form for processing. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Both NPI number and Tax ID/SSN are required on the MultiPayer Registration Form for processing. Both NPI number and Tax ID/SSN are required on the MultiPayer Registration Form for processing. 61101 61101 CCSTPA Visit our web site: www.availity.com Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form ERA/EFT Setup-Maintenance Request System ERA/EFT Setup-Maintenance Request System CCStpa ERA Enrollment Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name 35 of 138 Payer ID CELTICARE HEALTH PLAN 68069 CENPATICO - AZ 68068 CENPATICO - FL 68068 CENPATICO - GA 68068 CENPATICO - IL 68068 CENPATICO - IN 68068 CENPATICO - KS 68068 CENPATICO - KY 68068 CENPATICO - MA 68068 CENPATICO - MS 68068 CENPATICO - OH 68068 CENPATICO - SC 68068 CENPATICO - TX 68068 Additional Information Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Visit our web site: www.availity.com Availity Required Forms (links) Payer Specific Forms (links) Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name 36 of 138 Payer ID CENPATICO - WI 68068 CENPATICO BEHAVIORAL HEALTH 68068 CENTENE MEDICARE CENTRAL SENIOR CARE CIGNA 68069 CIPA1 62308 COMMUNITY HEALTH CHOICE COMMUNITY HEALTH PLAN OF WASHINGTON CONNECTICUT GENERAL - MEDICAL CLAIMS 48145 CHPWA 62308 COOK CHILDRENS HEALTH PLAN CCHP1 COOK CHILDRENS HEALTH PLAN - STAR CCHP9 COORDINATED CARE CORNERSTONE BENEFIT ADMINISTRATORS 68069 10850 DEFINITY SERVICES 87726 EAGLE CREEK MEDICAL PLAZA EATON BENEFITS, OH 61101 62308 EL PASO FIRST HEALTH PLANS - CHIP EL PASO FIRST HEALTH PLANS - HCO (HEALTHCARE OPTIONS) EL PASO FIRST HEALTH PLANS - PREMIER PLAN (STAR MEDICAID HMO) EMI HEALTH EPF03 EMPHESYS EQUICOR - PPO EQUICOR / EQUITABLE FAMILY CARE COORDINATED CARE ORG 61101 62308 62308 PHD01 FEDERAL EMPLOYEE PROGRAM (TX FEP) FIRSTCARE FIRSTCARE “STAR” MEDICAID 84980 94999 94998 Additional Information Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please use payer id HPN11 to register. Please complete the Availity Multi-payer Form prior to the Community Health Choice ERA form. Availity Required Forms (links) Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Availity Multi-payer Form EFT_ERA_Submittal Availity Multi-payer Form Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. NPI number is required on the Multi-Payer Registration Form for processing. Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form EPF37 EPF02 SX110 Administered by PH Tech. For DOS after 8/1/12. Availity Multi-payer Form Please log in to the Availity Web Portal and select the Texas region (if available). Click My Account | BCBS ERA Registration and then select your organization or enter a Clearinghouse Availity Customer ID. Click Submit to access the Blue Cross and Blue Shield of Texas website and complete the enrollment. Availity Multi-payer Form Availity Multi-payer Form Visit our web site: www.availity.com Payer Specific Forms (links) Cigna_ERA_835_Enrollment Cigna_ERA_835_Enrollment Electronic Fund Transfer Form revised 10.30.12.pdf Electronic Fund Transfer Form revised 10.30.12.pdf Centene_ERA_835_enrollment ERA/EFT Setup-Maintenance Request System Cigna_ERA_835_Enrollment Please contact Provider Relations at (915)532-3778 x1507 to enroll. Please contact Provider Relations at (915)532-3778 x1507 to enroll. Please contact Provider Relations at (915)532-3778 x1507 to enroll. Payer_Enrollment_Form ERA/EFT Setup-Maintenance Request System Cigna_ERA_835_Enrollment Cigna_ERA_835_Enrollment Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name FLORIDA BLUE 37 of 138 Payer ID 00590 FLORIDA HEALTH CARE PLANS (FHCP) FRESENIUS 59322 FMCHP GEHA MENTAL HEALTH CLAIMS GENERAL AMERICAN LIFE INS CO GENERATIONS HEALTHCARE GOLDEN TRIANGLE PHYSICIAN ALLIANCE 87726 63665 GHEDI GTPA1 GRANITE STATE HEALTH PLAN 68069 GWH-CIGNA (FORMERLY GREAT-WEST HEALTHCARE) HEALTH SERVICES MANAGEMENT 80705 41150 HEALTH VALUE MANAGEMENT 61101 HEALTHCARE MANAGEMENT ADMINISTRATORS HEALTHPARTNERS HMA01 07003 HEALTH PLUS PHSP HERITAGE PHYSICIAN NETWORK (HOUSTON) 11324 HPN11 HMO BLUE 84980 HMO BLUE TEXAS 84980 HOME STATE HEALTH PLAN 68069 HUMANA, INC. (CLAIMS) 61101 Additional Information NPI number is required on the Multi-Payer Form for processing. Contact FHCP at EDISupport@fhcp.com to complete your ERA enrollment after you complete the Availity Multi-payer Form. Please use payer id FMCHP to register. NPI number is required on the Multi-Payer Registration Form for processing. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Includes ERAs for plans formerly known as First Great West Life and Annuity Ins Co and Great-West Life and Annuity Ins Co. Availity Required Forms (links) Please log into the Availity Web Portal. Select the Florida region (if available). Click Payer Resources at the top of the screen. Click the link for Florida Blue then click Electronic Remittance Advice Registration. Select your Organization from the Organization dropdown and click Submit. You will be taken to the Florida Blue website to complete the enrollment. Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Payer requests providers to contact the EDI department at edi@healthplus-ny.org for 835/EFT enrollment. Cigna_ERA_835_Enrollment Centene_ERA_835_enrollment Cigna_ERA_835_Enrollment HSM 835 ERA ERA/EFT Setup-Maintenance Request System HMA ERA form HealthPartners 835 Enrollment Form Availity Multi-payer Form Availity Multi-payer Form Please log in to the Availity Web Portal and select the Texas region (if available). Click My Account | BCBS ERA Registration and then select your organization or enter a Clearinghouse Availity Customer ID. Click Submit to access the Blue Cross and Blue Shield of Texas website and complete the enrollment. Please log in to the Availity Web Portal and select the Texas region (if available). Click My Account | BCBS ERA Registration and then select your organization or enter a Clearinghouse Availity Customer ID. Click Submit to access the Blue Cross and Blue Shield of Texas website and complete the enrollment. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Availity Multi-payer Form Visit our web site: www.availity.com Payer Specific Forms (links) Centene_ERA_835_enrollment ERA/EFT Setup-Maintenance Request System Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name ILLINICARE HEALTH PLAN 68069 INTOTAL HEALTH IHP001 INTOTAL HEALTH IHP002 KAISER FOUNDATION OF OHIO KAISER FOUNDATION HEALTH PLAN OF SOUTHERN CALIFORNIA KATY MEDICAL GROUP KP014 94134 KMG11 KENTUCKY SPIRIT HEALTH PLAN 68069 LANDMARK HEALTHCARE LIFESYNCH LNDMK 61104 LINCOLN NATIONAL (HUMANA) 61101 LOUISIANA HEALTHCARE CONNECTIONS MAGELLAN HEALTH SERVICES 68069 01260 MAGNOLIA HEALTH PLAN 68069 MAILHANDLERS MENTAL HEALTH CLAIMS 87726 MANAGED CARE INDEMNITY 61101 MANAGED HEALTH SERVICES - IN 68069 MANAGED HEALTH SERVICES - WI 68069 MANAGED PRESCRIPTION SERVICES MARTINS POINT HEALTH CARE MAYO MANAGEMENT SERVICES MEDBENEFIXX INC 38 of 138 Payer ID Additional Information Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Amerigroup ERA form. Please complete the Availity Multi-payer Form prior to the Amerigroup ERA form. Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. NPI number is required on the Multi-payer Form for processing. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. NPI number is required on the Multi-payer Form for processing. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Availity Required Forms (links) Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form INTotal EDI 835 ERA Enrollment Form Availity Multi-payer Form INTotal EDI 835 ERA Enrollment Form Availity Multi-payer Form Kaiser Foundation of Ohio EDI Claim Remits Setup Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Visit our web site: www.availity.com ERA/EFT Setup-Maintenance Request System Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form ERA/EFT Setup-Maintenance Request System Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment ERA/EFT Setup-Maintenance Request System Availity Multi-payer Form Availity Multi-payer Form 61101 Centene_ERA_835_enrollment For 835 enrollments please click this link and fill out the payer enrollment form. Once you have received a confirmation email from the payer, you may submit the Availity Multi Payer Form to us to complete the enrollment process. Availity Multi-payer Form Availity Multi-payer Form 61101 MPHC1 41154 Payer Specific Forms (links) Martins Point Health Care USFHP ERA Enrollment Form ERA/EFT Setup-Maintenance Request System Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name MEDICA CHOICE (ALLINA) 94265 MEDICAID FLORIDA 77027 MEDICAID IDAHO AIDID MEDICAID KENTUCKY AIDKY MEDICAID MINNESOTA MEDICAID MISSOURI MEDICAID OHIO 39 of 138 Payer ID DPWMN 70029 MMISODJFS MEDICAID VIRGINIA AIDVA MEDICAL PLAN OF KANSAS CITY 61101 Additional Information Please note the providers will be automatically registered for UnitedHealthCare's 835s in order to ensure Medica ERA delivery. NPI number is required on the Multi-Payer Registration Form for processing. Availity Required Forms (links) Availity Multi-payer Form Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. To register for Florida Medicaid, please review the document at this link: http://portal.flmmis.com/FLPublic/Portals/0/StaticContent/P ublic/EDI%20REGISTRATION/ERA%20Enrollment%20Gui de.pdf. Please use Availity Trading Partner ID 89185. Availity Multi-payer Form Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. Availity Multi-payer Form Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. Availity's Trading Partner/Submitter ID is Availity Multi-payer Form 9900004190. Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. Once on the payer's site, complete the ‘Submitter Information’ with the following: Submitter ID (UMPI) - A268453200; Submitter Name – Availity LLC; Address – 740 E Campbell Rd, Suite 1000, Richardson, TX Availity Multi-payer Form 75081; Phone – 800.282.4548 Please complete the Availity Multi-payer Form prior to completing the 5010 Outbound Trading Partner Agreement Availity Multi-payer Form for FTP Users to avoid 835s delivering incorrectly. Please complete both enrollment forms and fax back to Availity. Availity will complete section III and forward the form to Ohio Department of Job and Family Services. Allow 10 business days for processing. Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. Availity's Service Center number is 1285. To reach the Virginia Medicaid EDI Helpdesk please call 1.866.352.0766. Availity Multi-payer Form Visit our web site: www.availity.com Payer Specific Forms (links) ERA Enrollment Form Please contact Idaho Medicaid at 866.686.4272 option 2 835/U277 Request form Electronic Remittance Advice (ERA) EDI Submitter Enrollment Form MoHealth_Net_ERA_enrollment Designation of an 835 or 834-820 Trading Partner Form Provider Service Center Authorization ERA/EFT Setup-Maintenance Request System Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name 40 of 138 Payer ID MEDICARE DMERC REGION B 17003 MEDICARE DMERC REGION C 18003 Additional Information Availity Required Forms (links) Electronic Remittance Advice (ERA) Enrollment Form as required by the CMS Change Request 8223 Phase III Electronic Remittance Advice (ERA) Enrollment Operating Rules (http://www.cms.gov/Outreach-andEducation/Medicare-Learning-NetworkMLN/MLNMattersArticles/Downloads/MM8223.pdf ). This form will be used by providers to enroll their DME Provider Transaction Access Number (PTAN) and National Provider Identifier (NPI) with CEDI to receive Medicare ERA files created by the DME MACs. *New Electronic Providers (Form 1 and 3 required), Existing Electronic Enrolled Providers (Form 3 only) Form 1 – Complete the Submitter Information with the following: Submitter Status: Existing Submitter, Submitter ID: Region B Submitter ID C08495979 Submitter Name: Availity LLC, Submitter Type: Clearinghouse Form 3 – Complete the Submitter and/or Receiver Information with the following: Entity Name - Availity LLC, Operating as a Clearinghouse, Submitter ID: Region B Submitter ID C08495979 Address - 740 E Campbell Road, Suite 1000, Richardson, TX 75081, Contact Name - Availity Client Services, Contact Phone Number - 800.282.4548, Contact Availity Multi-payer Form Email–support@availity.com. Electronic Remittance Advice (ERA) Enrollment Form as required by the CMS Change Request 8223 Phase III Electronic Remittance Advice (ERA) Enrollment Operating Rules (http://www.cms.gov/Outreach-andEducation/Medicare-Learning-NetworkMLN/MLNMattersArticles/Downloads/MM8223.pdf ). This form will be used by providers to enroll their DME Provider Transaction Access Number (PTAN) and National Provider Identifier (NPI) with CEDI to receive Medicare ERA files created by the DME MACs. *New Electronic Providers (Form 1 and 3 required), Existing Electronic Enrolled Providers (Form 3 only) Form 1 – Complete the Submitter Information with the following: Submitter Status: Existing Submitter, Submitter ID: Region C Submitter ID C08495979, Submitter Name: Availity LLC, Submitter Type: Clearinghouse Form 3 – Complete the Submitter and/or Receiver Information with the following: Entity Name Availity LLC, Operating as a - Clearinghouse, Submitter ID: Region C Submitter ID C08495979, Address - 740 E Campbell Road, Suite 1000, Richardson, TX 75081, Contact Name - Availity Client Services, Contact Phone Number - 800.282.4548, Contact Email support@availity.com. CGS now supports DMERC Region C, but the NGS enrollment forms are still to be used. Availity Multi-payer Form Visit our web site: www.availity.com Payer Specific Forms (links) EDI Submitter Action Request Form EDI Submitter Action Request Form Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name 41 of 138 Payer ID MEDICARE DMERC REGION D 19003 MEDICARE PART A FLORIDA 09101 Additional Information Electronic Remittance Advice (ERA) Enrollment Form as required by the CMS Change Request 8223 Phase III Electronic Remittance Advice (ERA) Enrollment Operating Rules (http://www.cms.gov/Outreach-andEducation/Medicare-Learning-NetworkMLN/MLNMattersArticles/Downloads/MM8223.pdf ). This form will be used by providers to enroll their DME Provider Transaction Access Number (PTAN) and National Provider Identifier (NPI) with CEDI to receive Medicare ERA files created by the DME MACs. *New Electronic Providers (Form 1 and 3 required), Existing Electronic Enrolled Providers (Form 3 only) Form 1 – Complete the Submitter Information with the following: Submitter Status: Existing Submitter, Submitter ID: Region D Submitter ID D08607230, Submitter Name: Availity LLC, Submitter Type: Clearinghouse Form 3 – Complete the Submitter and/or Receiver Information with the following: Entity Name - Availity LLC, Operating as a - Clearinghouse, Submitter ID: Region D Submitter ID D08607230, Address - 740 E Campbell Road, Suite 1000, Richardson, TX 75081, Contact Name - Availity Client Services, Contact Phone Number - 800.282.4548, Contact Email–support@availity.com. CGS now supports DMERC Region C, but the NGS enrollment forms are still to be used. Availity Required Forms (links) Availity Multi-payer Form Complete the EDI enrollment form. Select Florida, then Part A, then Customize. Click “EDI enrollment form.” Section A - Click the boxes for Part A and/or Part B, and Florida. Section B - Enter P8467 in the “Existing Submitter Number field”. Sections C and D - Enter your information in the fields marked with a red asterisk (*). Do not complete Section E. Section F - Click “Add to existing submitter ID” and enter P8467 in the blank. Select the “Electronic Remittance (835) change (section H)”. NOTE: To receive ERA files thru Availity, you must complete the Multi-Payer Electronic Remittance Advice Enrollment Form prior to submitting the EDI Enrollment form to Medicare. Section G - Complete this section if it applies to your business model. Section H - Complete this section. Check “An existing submitter/receiver ID” and enter submitter id P8467 in the blank. Do not complete Section I. Complete the EDI enrollment form, print, sign, date and return all pages to: FCSO Medicare EDI, P.O. Box 44071 - 3C, Jacksonville, FL 32031-4071 or Fax: (904) 361-0470. You will receive an acknowledgement from FCSO once they process your request form. For questions concerning the forms, contact the Medicare EDI help desk 888.670.0940. Availity Multi-payer Form Visit our web site: www.availity.com Payer Specific Forms (links) EDI Submitter Action Request Form EDI enrollment form Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name Payer ID Additional Information Availity Required Forms (links) Payer Specific Forms (links) Click this link and complete the required ERA enrollment: http://apps.ngsmedicare.com/applications/edisubmitteractio nrequest.aspx?CatID=2 Complete each field marked with an asterisk. The items below must contain Availity's information: Entity Name - Availity LLC, Street – P.O Box 550857, Contact Name - Availity Client Services City/State/Zip – Jacksonville, FL 32255, Phone Number 800.282.4548, Email – support@availity.com, Fax Number – 904-470-4773, Submitter ID - ZAHW, Contractor Code – Part A IL 00131, Are you a Clearinghouse or Third Party Service – Yes, Are you a Vendor – No, Network Service Vendor – IVANS MEDICARE PART A ILLINOIS (ADMINISTAR) 12M08 Contact the NGS EDI Help Desk at 877-273-4334 for any questions concerning the form. Availity Multi-payer Form See Additional Information for instructions Availity Multi-payer Form EDISS Total OnBoarding Availity Multi-payer Form EDISS Total OnBoarding Availity Multi-payer Form EDISS Total OnBoarding Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. Information required for payer enrollment: a. Company Name – Availity LLC b. Trading Partner Id – CH00033 c. Do not select Availity LLC to ‘Manage Vendor’ account MEDICARE PART A WASHINGTON 02001 The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services at 800.967.7902. Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. Information required for payer enrollment: a. Company Name – Availity LLC b. Trading Partner Id – CH00033 c. Do not select Availity LLC to ‘Manage Vendor’ account MEDICARE PART B ALASKA 00831 The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services at 800.967.7902. Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. Information required for payer enrollment: a. Company Name – Availity LLC b. Trading Partner Id – CH00033 c. Do not select Availity LLC to ‘Manage Vendor’ account MEDICARE PART B ARIZONA 42 of 138 03102 The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services at 800.967.7902. Visit our web site: www.availity.com Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name MEDICARE PART B FLORIDA Payer ID 09102 Additional Information Availity Required Forms (links) Complete the EDI enrollment form. Select Florida, then Part B, then Customize. Click “EDI enrollment form.” Section A - Click the boxes for Part A and/or Part B, and Florida. Section B - Enter P8467 in the “Existing Submitter Number field”. Sections C and D - Enter your information in the fields marked with a red asterisk (*). Do not complete Section E. Section F - Click “Add to existing submitter ID” and enter P8467 in the blank. Select the “Electronic Remittance (835) change (section H)”. NOTE: To receive ERA files thru Availity, you must complete the Multi-Payer Electronic Remittance Advice Enrollment Form prior to submitting the EDI Enrollment form to Medicare. Section G - Complete this section if it applies to your business model. Section H - Complete this section. Check “An existing submitter/receiver ID” and enter submitter id P8467 in the blank. Do not complete Section I. Complete the EDI enrollment form, print, sign, date and return all pages to: FCSO Medicare EDI, P.O. Box 44071 - 3C, Jacksonville, FL 32031-4071 or Fax: (904) 361-0470. You will receive an acknowledgement from FCSO once they process your request form. For questions concerning the forms, contact Availity Multi-payer Form the Medicare EDI help desk 888.670.0940. Payer Specific Forms (links) EDI enrollment form Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. Information required for payer enrollment: a. Company Name – Availity LLC b. Trading Partner Id – CH00033 c. Do not select Availity LLC to ‘Manage Vendor’ account MEDICARE PART B IDAHO 43 of 138 02202 The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services at 800.967.7902. Visit our web site: www.availity.com Availity Multi-payer Form EDISS Total OnBoarding Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name 44 of 138 Payer ID MEDICARE PART B ILLINOIS NGS 06102 MEDICARE PART B LOUISIANA 07202 Additional Information Please click the NGS_ERA enrollment form to the right. Go to the "Part B" column and select "EDI"; Accept the attestation terms; and in the ‘Enrollment Information section select "Enrollment Forms and Information". Select the transactions the provider is authorizing Availity to exchange with NGS (837,276/277,835). * You must already be enrolled for ERAs with Availity before selecting 835 for your ERAs to be delivered. If you are a new provider with NGS, please complete the “EDI Enrollment Agreement Form”and “EDI Third-Party Authorization Form” and “ERA Enrollment Form". If you are a current provider with NGS and you are only changing clearinghouses, then please complete only the “EDI Third-Party Authorization Form”. The “ERA Enrollment Form" is always required if you are a new/existing provider making any changes to the 835 transactions. The information needed to complete the "EDI Enrollment Agreement Form": Submitter Status: Existing Submitter, Submitter ID: 70000, Submitter Name: Availity, L.L.C., Submitter Type: Clearinghouse, Contractor Code: Part B IL 06102. The information needed to complete the "EDI Third-Party Provider Authorization Form": Name: Availity LLC, Operating as a: Clearinghouse, Submitter ID: 70000, Address: 10752 Deerwood Park Blvd. #110, City: Jacksonville State: FL Zip: 32256, Contact Name: Client Services, Phone Number: 800-282-4548, Email address: support@availity.com. Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section F: REQUEST TYPE: Select Add to existing submitter ID – Enter Submitter ID L0733 PAYER ERA ENROLLMENT FORM URL: https://www.novitassolutions.com/edi/enrollment/pdf/8292.pdf Visit our web site: www.availity.com Availity Required Forms (links) Availity Multi-payer Form Availity Multi-payer Form Payer Specific Forms (links) NGS_ERA_Enrollment_Form Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name MEDICARE PART B MINNESOTA NGS MEDICARE PART B NEW MEXICO 45 of 138 Payer ID 06202 04212 Additional Information Please click the NGS_ERA enrollment form to the right. Go to the "Part B" column and select "EDI"; Accept the attestation terms; and in the ‘Enrollment Information section select "Enrollment Forms and Information". Select the transactions the provider is authorizing Availity to exchange with NGS (837,276/277,835). * You must already be enrolled for ERAs with Availity before selecting 835 for your ERAs to be delivered. If you are a new provider with NGS, please complete the “EDI Enrollment Agreement Form” and “EDI Third-Party Authorization Form” and “ERA Enrollment Form". If you are a current provider with NGS and you are only changing clearinghouses, then please complete only the “EDI Third-Party Authorization Form”. The “ERA Enrollment Form" is always required if you are a new/existing provider making any changes to the 835 transactions. The information needed to complete the "EDI Enrollment Agreement Form": Submitter Status: Existing Submitter, Submitter ID: 70000, Submitter Name: Availity, L.L.C., Submitter Type: Clearinghouse, Contractor Code: Part B MN 06202. The information needed to complete the "EDI Third-Party Provider Authorization Form": Name: Availity LLC, Operating as a: Clearinghouse, Submitter ID: 70000, Address: 10752 Deerwood Park Blvd. #110, City: Jacksonville State: FL Zip: 32256, Contact Name: Client Services, Phone Number: 800-282-4548, Email address: support@availity.com. Availity Required Forms (links) Availity Multi-payer Form Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. ERA receiver number = EJ40230. For Novitas ERA Enrollment Form: Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section G: ELECTRONIC REMITTANCE ADVICE (ERA): Select Assign ERA to an existing submitter/receiver ID: enter submitter ID EJ40230. Availity Multi-payer Form Visit our web site: www.availity.com Payer Specific Forms (links) NGS_ERA_Enrollment_Form Novitas ERA Enrollment Form Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name MEDICARE PART B OKLAHOMA Payer ID 04312 Additional Information Availity Required Forms (links) Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. ERA receiver number = EJ40960. For Novitas ERA Enrollment Form: Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section G: ELECTRONIC REMITTANCE ADVICE (ERA): Select Assign ERA to an existing submitter/receiver ID: Availity Multi-payer Form enter submitter ID EJ40960. Payer Specific Forms (links) Novitas ERA Enrollment Form Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. Information required for payer enrollment: a. Company Name – Availity LLC b. Trading Partner Id – CH00033 c. Do not select Availity LLC to ‘Manage Vendor’ account MEDICARE PART B OREGON 02302 MEDICARE PART B TEXAS 04412 The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services at Availity Multi-payer Form 800.967.7902. Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. ERA receiver number = E13075. For Novitas ERA Enrollment Form: Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE INFORMATION: Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity. Availity does not prepare claims. Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC. Section G: ELECTRONIC REMITTANCE ADVICE (ERA): Select Assign ERA to an existing submitter/receiver ID: enter submitter ID E13075. Availity Multi-payer Form EDISS Total OnBoarding Novitas ERA Enrollment Form Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. Information required for payer enrollment: a. Company Name – Availity LLC b. Trading Partner Id – CH00033 c. Do not select Availity LLC to ‘Manage Vendor’ account MEDICARE PART B WASHINGTON 46 of 138 02402 The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services at 800.967.7902. Visit our web site: www.availity.com Availity Multi-payer Form EDISS Total OnBoarding Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name MEDICARE RAILROAD MEGA LIFE & HEALTH INS. (STUDENT INSURANCE) MEMORIAL CLINICAL ASSOCIATES 59221 MCA11 MET LIFE METROPOLITAN HEALTH PLAN (MHP) 87726 10850 METROPOLITAN LIFE INS CO 87726 MICHAEL REESE HMO 87726 MODA HEALTH (FORMERLY ODS HEALTH PLAN) MOLINA HEALTHCARE OF UTAH NATIONAL IMAGING ASSOCIATES NETWORK HEALTH NEW ENGLAND FINANCIAL NORTHSTAR ADVANTAGE (MHP) NORTHWEST DIAGNOSTIC CLINIC ONE HEALTH PLAN (ALL 50 STATES) ONE HEALTH PLAN OF CALIFORNIA, INC ONE HEALTH PLAN OF GEORGIA ONE HEALTH PLAN OF ILLINOIS 47 of 138 Payer ID 00882 13350 SX109 NIA11 04332 80705 10850 NWDC1 80705 62308 62308 62308 PCA HEALTH PLANS OF TEXAS (HUMANA) 95885 PCA STAR MEDICAID 61101 PEACH STATE HEALTH PLAN 68069 Additional Information The following Availity information is necessary on page 9 of the Railroad Medicare EDI Enrollment Packet: Submitter ID - S00532, ERN Receiver ID - ER0073, Submitter Name Availity LLC, Owner Name - Lloyd Beesing, Contact Person - Client Services, Phone - 800-282-4548, Fax - 904-4704773, Address - P.O. Box 550857, Jacksonville, FL 322550857, email - support@availity.com, Claim Submission Mode of Communication - Connect Direct, Report/Electronic Remittance Mode of Communication Connect Direct, Request Response Format - File, Data Compression - PKZIP. On page 16, check “Electronic Remittance” and complete the remaining fields with your information. You must complete the Availity Multi-Payer Form prior to submitting the EDI Enrollment form to Medicare. Contact the RR EDI help desk 866.749.4301, or email medicare.edi@palmettogba.com for questions NPI number is required on the Multi-Payer Registration Form for processing. NPI number is required on the Multi-payer Form for processing. NPI number is required on the Multi-payer Form for processing. NPI number is required on the Multi-payer Form for processing. Availity Required Forms (links) Availity Multi-payer Form Availity Multi-payer Form Availty Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Visit our web site: www.availity.com Railroad Medicare EDI Enrollment Packet (click link for EDI_Enroll_RR_Pack.pdf) Availity Multi-payer Form Availity Multi-payer Form Please complete Availity’s Multi-payer enrollment form prior to completing ERA enrollment form with the payer. Moda Health requires organizations to be set up with EFT when Availity Multi-payer Form requesting Electronic Remittance Advice (ERA). Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Payer Specific Forms (links) Availity Multi-payer Form Moda Health ERA Enrollment Form Cigna_ERA_835_Enrollment Cigna_ERA_835_Enrollment Cigna_ERA_835_Enrollment Cigna_ERA_835_Enrollment Cigna_ERA_835_Enrollment ERA/EFT Setup-Maintenance Request System ERA/EFT Setup-Maintenance Request System Centene_ERA_835_enrollment Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name PHOENIX HEALTH PLAN PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA PINNACLE PHYSICIAN MANAGEMENT ORG 48 of 138 Payer ID 74647 Additional Information If you are signing up for ERA, you must also sign up for EFT directly with this payer. Please review the Payers' EFT\ERA enrollment instructions. NOTE: The payer will notify you once EFT has been approved and will require you to complete\submit the Availity Multi-payer Form. 12399 PPMO1 Availity Required Forms (links) Availty Multi-payer Form Availty Multi-payer Form Availity Multi-payer Form PREFERRED ADMINISTRATORS PREFERRED ADMINISTRATORS - CHILDREN'S HOSPITAL PREFERREDONE (MN) PRESBYTERIAN NM EPF10 EPF11 41147 05003 Availity Multi-payer Form Availity Multi-payer Form PRIME BENEFITS SYSTEM PRIMEWEST HEALTH PLAN 61101 61604 Availity Multi-payer Form RANDMARK, INC 61101 REGENCE BLUECROSS BLUESHIELD OF OREGON 00851 REGENCE BLUECROSS BLUESHIELD OF UTAH 00910 REGENCE BLUESHIELD (WA) 00932 REGENCE BLUESHIELD OF IDAHO 00611 RESURRECTION PHYSICIANS PROVIDER GROUP SAMBA SANUS- HMO/PPO ST LOUIS SELECT SENIOR CLINIC SELECTCARE OF OKLAHOMA SELECTCARE OF TX (BEAUMONT) SELECTCARE OF TX (HOUSTON) SELECTCARE OF TX (KELSEY-SEYBOLD) SOUTH COUNTY HEALTH ALLIANCE RPPG1 62308 63665 HPN11 SCOK1 GTPA1 HPN11 KLSY1 41154 SUNFLOWER STATE HEALTH PLAN 68069 SUNSHINE HEALTH 68069 SUPERIOR HEALTH PLAN 68069 NPI number is required on the Multi-payer Form for processing. NPI number is required on the Multi-payer Form for processing. NPI number is required on the Multi-payer Form for processing. NPI number is required on the Multi-payer Form for processing. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Visit our web site: www.availity.com Payer Specific Forms (links) ERA AUTHORIZATION AGREEMENT FORM PHYSICIANS_HEALTH_PLAN_ERA_ENROL LMENT Please contact Provider Relations at (915)532-3778 x1507 to enroll. Please contact Provider Relations at (915)532-3778 x1507 to enroll. ERA/EFT Setup-Maintenance Request System ERA/EFT Setup-Maintenance Request System Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form To receive 835 transactions from payer RPPG1 (Resurrection Physicians Provider Group), please contact provider_services@msogl.com Cigna_ERA_835_Enrollment Cigna_ERA_835_Enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Availity Multi-payer Form Centene_ERA_835_enrollment Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Electronic Remittance Advice (ERA) Health Plan Partners Payer Name Additional Information Please complete the Availity Multi-payer Form prior to the Centene ERA form. Option available for ERA only providers. EFT providers must contact Centene for further instructions. Availity Required Forms (links) SUPERIOR HEALTH PLAN CHIPS EPO TEXAN PLUS (BEAUMONT) TEXAN PLUS (HOUSTON) TEXAN PLUS (KELSEY-SEYBOLD) TEXAS FIRST HEALTH PLANS TEXAS FIRST HEALTH PLANS (TIOPA) TODAYS HEALTH TRIBUTE (SELECTCAREOK) 68069 GTPA1 HPN11 KLSY1 TX1ST TOPA1 WITH1 SCOK1 UCARE 52629 UNITED BEHAVIORAL HEALTH 87726 UNITEDHEALTHCARE UNITEDHEALTHCARE COMMUNITY PLAN/TN (FORMERLY AMERICHOICE TN:TENNCARE, SECURE PLUS, COMPLETE) 87726 UNITEDHEALTHCARE OF FLORIDA 87726 Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment Availity Multi-payer Form with the payer. NPI number is required on the Multi-payer Form for processing. Availity Multi-payer Form NPI number is required on the Multi-payer Form for processing. Availity Multi-payer Form NPI number is required on the Multi-Payer Registration Form for processing. Availity Multi-payer Form NPI number is required on the Multi-payer Form for Availity Multi-payer Form processing. UNITEDHEALTHCARE OF THE MID ATLANTIC INC 04567 Availity Multi-payer Form 95378 UNITEDHEALTHCARE OVATIONS AARP UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY 36273 UNITEDHEALTHCARE WEST US FAMILY HEALTH PLAN (USFHP) - TEXAS AND LOUISIANA VILLAGE FAMILY PRACTICE VIRGINIA PREMIER COMPLETECARE VIRGINIA PREMIER COMPLETECARE WELLCARE HMO 87726 WISCONSIN EMPLOYERS GROUP WORKERS' COMPENSATION (ALL PAYERS) 49 of 138 Payer ID 95378 USFHP VFP11 VPCCI VPCCP 14163 61101 VARIOUS Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Please complete Availity’s Multi-payer enrollment form prior to visiting the payer’s site and completing ERA enrollment with the payer. Availity Multi-payer Form NPI number is required on the Multi-Payer Registration Form for processing. Availity Multi-payer Form NPI number is required on the Multi-Payer Registration Form for processing. Availity Multi-payer Form Select “835 EDI Enrollment Form” under Electronic Claims Filing area. Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Availity Multi-payer Form Please see Availity's Workers' Compensation Companion Guide for additional information Visit our web site: www.availity.com Availity Multi-payer Form Payer Specific Forms (links) Centene_ERA_835_enrollment Provider Payment Election Form The client will need to enroll for payer id 36273 in order to begin receiving electronic remits for Ovations AARP. Please have the provider use the provider portal https://aarpprovideronlinetool.uhc.com to access this specific remit online. Once they log in, they can access ACH Deposit information and download 835s by selecting the "Electronic Payments and Statements" page. USFHP ERA Enrollment Form ERA_Enrollment_Form ERA_Enrollment_Form ERA/EFT Setup-Maintenance Request System Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Business to Business (B2B) Health Plan Partners Supported Transactions & Payer Required Payer ID Payer Name Premium XML Receiver (Payer)Values Eligibility & Benefits (270) ABSOLUTE TOTAL CARE Claims Status (276) CENTENE 68069 68069 AETNA AETNA AETNA ASURIS AVMED BLUECROSS BLUESHIELD (BCBS) IL HCSC BLUECROSS BLUESHIELD (BCBS) KANSAS CITY BLUECROSS BLUESHIELD (BCBS) MN BLUECROSS BLUESHIELD (BCBS) NM HCSC BLUECROSS BLUESHIELD (BCBS) OK HCSC BLUECROSS BLUESHIELD (BCBS) TX HCSC BRIDGESPAN BRIDGEWAY HEALTH SOLUTIONS BUCKEYE COMMUNITY HEALTH PLAN CALIFORNIA HEALTH AND WELLNESS ASURIS_NORTHWEST_HEALTH AVMED BCBSIL BCBSKC BCBSMN BCBSNM BCBSOK BCBSTX BRIDGESPAN CENTENE CENTENE CENTENE 93221 592742907 G00621 BCBSKC 00720 G00790 G00840 G84980 BRIDG 68069 68069 68069 93221 CARESOURCE OF OHIO CARESOURCE OF OHIO 31114 31114 CELTICARE HEALTH PLAN CENPATICO BEHAVIORAL HEALTH CENTRAL SENIOR CARE CIGNA COORDINATED CARE FLORIDA BLUE FLORIDA HEALTH CARE PLANS FLORIDA TRUE HEALTH FRESENIUS MEDICAL CARE HEALTH PLAN GENERATIONS HEALTHCARE GOLDEN TRIANGLE PHYSICIAN ALLIANCE GRANITE STATE HEALTH PLAN HARMONY HEALTH PLAN HEALTHEASE HEALTHEASE KIDS HERITAGE PHYSICIAN NETWORK (HOUSTON) HOME STATE HEALTH PLAN HUMANA HUMANA-CARESOURCE ILLINICARE HEALTH PLAN KATY MEDICAL GROUP LOUISIANA HEALTHCARE CONNECTIONS MAGNOLIA MANAGED HEALTH SERVICES - WI MANAGED HEATLH SERVICES - IN CENTENE CENTENE XCLR003 CIGNA CENTENE BCBSF FLORIDA HEALTH CARE PLANS FLORIDATRUEHEALTH XCLR003 XCLR003 XCLR003 CENTENE WELLCARE_HEALTH_PLANS WELLCARE_HEALTH_PLANS WELLCARE_HEALTH_PLANS XCLR003 CENTENE HUMANA HUMANA-CARESOURCE CENTENE XCLR003 CENTENE CENTENE CENTENE CENTENE 68069 68068 HPN11 62308 68069 BCBSF 593222484 45408 FMCHP GHEDI HPN11 68069 14163 14163 14163 HPN11 68069 HUMANA KYCS1 68069 HPN11 68069 68069 68069 68069 68069 68068 HPN11 62308 68069 BCBSF 593222484 45408 FMCHP GHEDI HPN11 68069 14163 14163 14163 HPN11 68069 61101 KYCS1 68069 HPN11 68069 68069 68069 68069 FL_MEDICAID 77027 77027 XCLR003 XCLR003 CENTENE WELLCARE_HEALTH_PLANS CENTENE XCLR003 PRESTIGEHEALTHCHOICE REGENCE_BCBS_OF_OREGON REGENCE_BCBS_OF_UTAH REGENCE_BS_OF_WASHINGTON REGENCE_BS_OF_IDAHO XCLR003 XCLR003 XCLR003 XCLR003 XCLR003 XCLR003 WELLCARE_HEALTH_PLANS WELLCARE_HEALTH_PLANS CENTENE CENTENE CENTENE XCLR003 XCLR003 XCLR003 XCLR003 XCLR003 UNITEDHEALTHCARE XCLR003 WELLCARE_HEALTH_PLANS HPN11 HPN11 HPN11 HPN11 68069 14163 68069 HPN11 45056 00851 00910 00932 00611 HPN11 SCOK1 HPN11 HPN11 HPN11 HPN11 14163 14163 68069 68069 68069 HPN11 HPN11 TX1ST TX1ST WITH1 87726 HPN11 14163 AETNA MEDICAID FLORIDA MEMORIAL CLINICAL ASSOCIATES NORTHWEST DIAGNOSTIC CLINIC NOVASYS HEALTH OHANA HEALTH PLAN PEACH STATE HEALTH PLAN PINNACLE PHYSICIAN MANAGEMENT ORG PRESTIGE HEALTH CHOICE REGENCE BLUECROSS BLUESHIELD OF OREGON REGENCE BLUECROSS BLUESHIELD OF UTAH REGENCE BLUESHIELD (WA) REGENCE BLUESHIELD OF IDAHO SELECT SENIOR CLINIC SELECTCARE OF OKLAHOMA SELECTCARE OF TEXAS (BEAUMONT) SELECTCARE OF TEXAS (HOUSTON) SELECTCARE OF TEXAS (INTEGRANET) SELECTCARE OF TEXAS (KELSEY-SEYBOLD) STAYWELL STAYWELL KIDS SUNFLOWER STATE HEALTH PLAN SUNSHINE HEALTH SUPERIOR HEALTH PLAN TEXAN PLUS (INTEGRANET) TEXAN PLUS (KELSEY-SEYBOLD) TEXAS FIRST HEALTH PLANS TEXAS FIRST HEALTH PLANS (TIOPA) TODAY'S HEALTH UNITEDHEALTHCARE VILLAGE FAMILY PRATICE WELLCARE HEALTH PLAN 50 of 138 $ $ 14163 68069 HPN11 45056 00851 00910 00932 00611 HPN11 SCOK1 HPN11 HPN11 HPN11 HPN11 14163 14163 68069 68069 68069 HPN11 HPN11 TX1ST TX1ST WITH1 87726 HPN11 14163 Authorization & Referral (278) Health Care Claim (837) Health Care Encounters (837) Additional Information EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. G00621 BCBSKC 00720 G00790 G00840 G84980 BRIDG 68069 68069 68069 The dependent loop is not supported on inquiries. Patient is always subscriber. BCBSF BCBSF HUMANA 61101 Visit our web site: www.availity.com 61102 & 61105 EDI submitters located in the IL, NM, OK, OR, TX, and WA regions require Advanced Clearinghouse enrollment for this payer. Please contact your practice management vendor or advancedclearinghouse@availity.com for further details. Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Web Portal Health Plan Partners Payer Name Enrollment Required Prof Claims (837) Inst Claims (837) Claim Status Inquiry (276/277) Eligibility & Benefits Inquiry (270/271) SC SC SC ALL ALL ALL ABSOLUTE TOTAL CARE 68069 SC SC ADVOCATE MEDICAL GROUP 36320 TX TX ADVOCATE PHYSICIAN PARTNERS 65093 TX TX AETNA 60054 ALL ALL AMBETTER OF ARKANSAS 68069 AR AR AMBETTER FROM MAGNOLIA HEALTH PLAN 68069 AMBETTER FROM SUNSHINE HEALTH AMBETTER FROM BUCKEYE COMMUNITY HEALTH PLAN 68069 FL FL 68069 OH OH AMBETTER FROM PEACH STATE HEALTH PLAN 68069 GA GA AMBETTER FROM SUPERIOR HEALTH PLAN 68069 TX TX AMBETTER FROM MANAGED HEALTH SERVICES 68069 IN IN AMBETTER FROM COORDINATED CARE 68069 WA WA 68069 MA MA AMBETTER FROM CELTICARE HEALTH PLAN AMERICAS 1ST CHOICE HEALTH PLAN AMERICAS 1ST CHOICE INSURANCE OF NC (AFN) MS Online Remittance Advice (835) Remittance viewer Claim Reconciliation / Research Authorization & Referral Submission (278) Authorization & Referral Inquiry (278) ALL ALL Authorization & Referral Update (278) Patient cost estimator Card swipe Patient care summary Care Reminder Eligibility and Benefits Patient payment s Additional Information TX TX ALL MS AFS01 FL AFN01 FL AGPMEDICAID FL, GA, KS, LA, MD, NJ, NM, NV, TN, TX, WA FL, GA, KS, LA, MD, NJ, NM, NV, TN, TX, WA FL, GA, KS, LA, MD, NJ, NM, NV, TN, TX, WA FL, GA, KS, LA, MD, NJ, NM, NV, TN, TX, WA ANTHEM CA 47198 CA CA CA CA CA CA CA ANTHEM CO 00050 CO CO CO CO CO CO CO ANTHEM CT 00060 CT CT CT CT CT CT CT ANTHEM IN 00130 IN IN IN IN IN IN ANTHEM IN 00630 IN IN IN IN IN ANTHEM KY 00160 KY KY KY KY KY ANTHEM KY 00660 KY KY KY KY KY ANTHEM ME 00180 ME ME ME ME ME AMERIGROUP 51 of 138 Payer ID IN KY KY ME Visit our web site: www.availity.com Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Web Portal Health Plan Partners Payer Name 52 of 138 Payer ID Enrollment Required Prof Claims (837) Claim Status Inquiry (276/277) Eligibility & Benefits Inquiry (270/271) ME ME MO MO NH Care Reminder Eligibility and Benefits ME ME ME MO MO MO MO NH NH NH NH NH NH NH NH NH NH NV NV NV NV NV NV OH OH OH OH OH OH OH OH OH OH OH ANTHEM ME 00680 ME ANTHEM MO 00241 MO ANTHEM NH 00270 ANTHEM NH 00770 NH ANTHEM NV 00265 NV ANTHEM OH 00332 ANTHEM OH 00834 OH ANTHEM VA 423 VA VA VA VA ANTHEM WI 00950 WI WI WI WI WA WA ASURIS NORTHWEST HEALTH 93221 WA WA ATRIO HEALTH PLANS ATRIO ALL ALL AVMED 59274 FL FL BLUECROSS BLUESHIELD (BCBS) AZ 53589 AZ BLUECROSS BLUESHIELD (BCBS) GA 00601 GA BLUECROSS BLUESHIELD (BCBS) GA 00101 BLUECROSS BLUESHIELD (BCBS) IL HCSC 00621 BLUECROSS BLUESHIELD (BCBS) KANSAS CITY BLUECROSS BLUESHIELD (BCBS) KS BLUECROSS BLUESHIELD (BCBS) MN 00220 MN BLUECROSS BLUESHIELD (BCBS) MN 00720 BLUECROSS BLUESHIELD (BCBS) NM HCSC BLUECROSS BLUESHIELD (BCBS) OK HCSC BLUECROSS BLUESHIELD (BCBS) TX HCSC Online Remittance Advice (835) Remittance viewer Claim Reconciliation / Research Authorization & Referral Submission (278) Patient care summary Inst Claims (837) Authorization & Referral Inquiry (278) Authorization & Referral Update (278) Patient cost estimator Card swipe Additional Information Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . WI-Link WI WI Please complete the steps outlined in the Anthem Help topics to register users for Anthem Services which include: Radiology Precertification and Secure Messaging . WA ALL FL AZ GA GA GA GA GA GA GA GA GA IL IL IL 47171 KS, MO 47163 KS MN MN MN MN MN MN MN MN MN 00790 NM NM NM NM NM NM NM-Link 00840 OK OK OK OK OK OK OK-Link 84980 TX TX TX TX TX TX TX-Link IL Patient payment s IL IL IL-Link IL IL IL KS, MO KS, MO KS, MO KS KS KS Medical Policy Link available for BCBSMN members on Eligibility & Benefits Summary page Medical Policy Link available for BCBSMN members on Eligibility & Benefits Summary page Visit our web site: www.availity.com TX NM NM OK OK TX TX Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Web Portal Health Plan Partners Payer Name BRIDGESPAN BRIDG BRIDGEWAY HEALTH SOLUTIONS 68069 BUCKEYE COMMUNITY HEALTH PLAN 68069 CALIFORNIA HEALTH AND WELLNESS 68069 CARECENTRIX 11345 CAREPLUS 95092 CAREPLUS 95093 CARESOURCE OF OHIO 31114 CAROLINA CARE PLAN 29076 CCSTPA Enrollment Required X Inst Claims (837) Claim Status Inquiry (276/277) ID, OR, UT, WA AZ ID, OR, UT, WA AZ ID, OR, UT, WA AZ ID, OR, UT, WA AZ OH OH OH CA CA CA CA CA ALL ALL OH CCSTPA ALL ALL Authorization & Referral Inquiry (278) Authorization & Referral Update (278) Patient cost estimator Card swipe Patient care summary Care Reminder Eligibility and Benefits Patient payment s Additional Information OH ALL MA MA ALL ALL ALL FL FL WA WA CENPATICO TEXAS 68053 TX TX CIGNA CIGNA ALL ALL CITRUS HEALTH CARE 10207 35219 ALL ALL M3FL0012 ALL ALL COORDINATED CARE 68069 WA WA CORRECTCARE - INTEGRATED HEALTH CCIH CA CA OH ALL NH TX EMPIRE BC - NY 00303 X NY NY NY NY EMPIRE BCBS - NY 00803 X NY NY NY NY FLORIDA BLUE 00590 FL FL FL FL 59322 FL FLORIDA TRUE HEALTH 03024 FL FREEDOM 1ST (FRM) FRM01 ALL WA Please complete the steps outlined in the ANTHEM and Empire Help topics to register users for Anthem and Empire Services which include: American Specialty Health(AIM), Secure Messaging and Empire Provider and Empire Facility Portals. Please complete the steps outlined in the ANTHEM and Empire Help topics to register users for Anthem and Empire Services which include: American Specialty Health(AIM), Secure Messaging and Empire Provider and Empire Facility Portals. FL FL FL FL FL FL ALL ALL ALL FL FL FL FL ALL ALL ALL Patient Communication (Online Visits) offered for this payer FL FL FL FREEDOM HEALTH INC. (FRH) FRH01 FRESENIUS MEDICAL CARE FMCHP TX TX GENERATIONS GHEDI TX TX GOLDEN TRIANGLE PHYSICIANS GTPA1 TX TX GRANITE STATE HEALTH PLAN HARMONY HEALTH PLAN HEALTH CARE DISTRICT OF PALM BEACH COUNTY (HCDPBC) HEALTHEASE HEALTHEASE KIDS HEALTHPARTNERS 68069 14163 NH NH CALL FL FL X ALL TX NH IL, IN, MO NH IL, IN, MO FL FL FL FL ALL ALL AGPMEDICAID NY NY NY NY HEALTHSPAN INTEGRATED CARE KP014 OH OH OH OH OH HEALTHSUN HEALTH PLAN HESUN FL FL HERITAGE PHYSICIAN NETWORKS HPN11 TX TX HOME STATE HEALTH PLAN 68069 MO MO MO MO MO HUMANA 61101 ALL ALL ALL ALL HUMANA-CARESOURCE KYCS1 KY KY ILLINICARE HEALTH PLAN 68069 IL IL IL IL KATY MEDICAL GROUP (SELECTCARE TX) KMG11 TX TX KELSEY-SEYBOLD (SELECTCARE TX) KLSY1 TX TX LEON MEDICAL CENTER HEALTH PLAN 65055 FL FL LIFEMAP RLH01 OR OR LIFESYNCH 61104 ALL ALL LOUISIANA HEALTHCARE CONNECTIONS 68069 LA LA MAGNOLIA HEALTH PLAN 68069 MANAGED HEALTH SERVICES - IN 68069 MANAGED HEALTH SERVICES - WI Authorization & Referral Submission (278) AZ OH MA HEALTHPLUS AMERIGROUP Claim Reconciliation / Research ID, OR, UT, WA ALL 68068 14163 14163 07003 Remittance viewer FL 68069 FLORIDA HEALTH CARE PLAN (FHCP) Online Remittance Advice (835) FL CENPATICO BEHAVIORAL HEALTH CMS MMA SPECIALTY PLAN Eligibility & Benefits Inquiry (270/271) Prof Claims (837) CELTICARE HEALTH PLAN CMCS MEDICARE ADVANTAGE 53 of 138 Payer ID IN IN 68069 MED3000 CMS EARLY STEPS M3FL0010 ALL ALL MED3000 CMS SAFETY NET M3FL0011 ALL ALL MED3000 CMS TITLE 21 M3FL0014 ALL ALL MED3000 PEDICARE TITLE 21 M3FL0006 ALL ALL MED3000 TITLE COVENTRY HEALTHY KIDS M3FL0003 ALL ALL TX ALL ALL IL TX TX OR ALL LA LA LA MS MS MS IN IN IN WI WI WI Visit our web site: www.availity.com ALL Health Plan/Payer List Availity Clearinghouse and Web Portal Availity's Web Portal Health Plan Partners Payer Name Payer ID Enrollment Required Prof Claims (837) Inst Claims (837) Eligibility & Benefits Inquiry (270/271) Online Remittance Advice (835) Remittance viewer MEDICAID FLORIDA 77027 X FL FL FL MEDICAID KENTUCKY AIDKY X KY KY KY AIDVA X VA VA KY, IN, OH KY, IN, OH MEDICAID VIRGINIA MEDICAL MUTUAL OF OHIO 29076 MEMORIAL CLINICAL ASSOCIATES MCA11 NATIONAL MEDICARE/CMS NOVASYS HEALTH NW DIAGNOSTIC CLINIC (SELECTCARE TX) OHANA HEALTH PLAN OPTIMUM HEALTHCARE INC. (OPT) CMS TX TX PEACH STATE HEALTH PLAN PEDICARE TITLE 19 PINNACLE PHYS MGT (SELECTCARE TX) PODIATRYFIRST PRESTIGE HEALTH CHOICE QUANTUM CARE TPA REGENCE BLUECROSS BLUESHIELD OF OREGON Claim Reconciliation / Research Authorization & Referral Submission (278) 68069 TX 68069 GA GA M3FL0008 PPMO1 POD1ST 45056 QCTPA ALL TX FL ALL TX FL FL FL GA GA FL FL FL, IL, IN, KY, MO, NM, OH, OK, TX, WI TX OR OR OR OR UT UT UT UT UT REGENCE BLUESHIELD (WA) REGENCE BLUESHIELD OF IDAHO SELECT SENIOR CARE (SELECTCARE TX) SELECTCARE OF TEXAS (GTPA) SELECTCARE OF TEXAS (MCA) SENIOR CARE IPA (SELECTCARE TX) SIMPLY HEALTHCARE STAYWELL STAYWELL KIDS SUNFLOWER STATE HEALTH PLAN SUNSHINE HEALTH SUPERIOR HEALTH PLAN SUPERIOR HEALTH PLAN TEXAN PLUS (SOUTHEAST TEXAS AREA) TEXAS FIRST HEALTH PLANS (NORTH TEXAS) TEXAS FIRST HEALTH PLANS (TIOPA) TODAYS HEALTH TRIBUTE (SELECTCARE OK) 00932 00611 HPN11 GTPA1 MCA11 CIPA1 00199 14163 14163 68069 68069 68069 SHP11 HPN11 TX1ST TIOPA1 WITH1 SCOK1 WA ID TX TX TX TX FL WA ID TX TX TX TX FL WA ID WA ID WA ID TX TX TX TX WA ID FL TX TX TX TX TX WI OK FL TX TX TX TX TX WI OK FL FL KS FL TX FL FL KS X 87726 WORKERS' COMPENSATION VARIOUS Additional Information Complete Availity FL Medicaid Registration Instructions so that Availity can receive the 271s or 277s for your requests. GA UT 14163 Patient payment s X FL, OH, VA TX TX ALL ALL In the regions where Other Blue Plans is available as a payer, select this option to transact with all out of state Blue Plans. In regions where this is not an option, select the local Blue Plan to transact with all out of state Blue Plans.” FL OR WELLCARE HEALTH PLANS Care Reminder Eligibility and Benefits HI FL FL, IL, IN, KY, FL, IL, IN, KY, MO, NM, OH, MO, NM, OH, OK, TX, WI OK, TX, WI USFHP VFP11 Patient care summary TX HI 00910 US FAMILY HEALTH PLANS VILLAGE FAMILY PRAC (SELECTCARE TX) Card swipe AR TX 00851 UNITED HEALTHCARE Patient cost estimator TX X NWDC1 14163 OPT01 38520 Authorization & Referral Update (278) FL REGENCE BLUECROSS BLUESHIELD OF UTAH TRICARE SOUTH Authorization & Referral Inquiry (278) CA, CO, CT, FL, GA, ID, IL, IN, KS, KY, ME, MN, MO, NH, NM, NV, OH, OK, OR, TX, UT, VA, WA, WI OTHER BLUE PLANS 54 of 138 Claim Status Inquiry (276/277) TX TX TX WI OK KS FL TX TX TX TX TX WI OK Contact (800)-325-5920 to enroll. Provider Enrollment Form may be obtained at www.mytricare.com. The 270 & 276 WEB transactions are for TRICARE South Region Only. FL, OK, TX FL, OK, TX FL, OH, VA FL, OH, VA FL, OH, VA ALL ALL TX CT, FL, GA, LA, NJ, NY, OH, TX CT, FL, GA, LA, NJ, NY, OH, TX OR FL, OH, VA ALL ALL Visit our web site: www.availity.com Please see Availity's Workers' Compensation Guide for more details Workers' Compensation Payer List Payer Name 1st AUTO & CASUALTY 22125 ROSCOE CORP. AAA MINNESOTA/IOWA AAA NORTHERN CALIFORNIA, NEVADA & UTAH INSURANCE EXCHANGE ABC CONST. COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND INSURANCE CO OF AMERICA ACCURIDE CORPORATION ACE PROPERTY & CASUALTY INS CO ACUITY, A MUTUAL INSURANCE COMPANY AD-COMP ADELANTO CORRECTIONAL FACILITY (CA) ADELANTO SCHOOL DISTRICT (CA) ADMINISTAFF ADMINISTRATIVE CLAIM SERVICE, INC ADP TOTAL SOURCE INC. ADVANCE AMERICA CASH ADVANCE CENTERS AG FACILITIES OPERATIONS, LLC AGRI BEEF CO. AIG AIR LIQUIDE USA LLC ALA CARTE ALCOA FASTENERS SYSTEMS ALLEGHENY TECHNOLOGIES ALLIANZ ALLIED CONSTRUCTION ALLIED INSURANCE COMPANIES ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFITS INSURANCE COM ALLSTATE INSURANCE COMPANY (ALL STATES EXCEPT NJ) ALTA HEALTHCARE ALTEC ALTEC INDUSTRIES ALVEY SYSTEMS (AON RISK) ALVEY SYSTEMS (AON RISK) (AUTO ONLY) AMCO INS CO AMERICAN CASINO & ENTERTAINMENT PROPERTIES LLC AMERICA FIRST AMERICAN CLAIMS MANAGEMENT (ACM) AMERICAN COIN MERCHANDISING, INC AMERICAN CYANAMID AMERICAN FURNITURE WAREHOUSE AMERICAN HOME CRAFT AMERICAN INTERSTATE AMERICAN LIBERTY INSURANCE COMPANY AMERICAN SPECIALTY COMPANIES AMERICAN SPECIALTY INS. / MIB AMERIPRISE AUTO & HOME INSURANCE Payer ID J1585 41556 11983 41556 41556 J1477 J1790 J1024 41556 J1240 J1667 J1798 j1690 J1241 J1005 J1242 J1843 41556 41556 19402 J1516 J1243 J1244 J1245 J1452 J1118 J1550 J1550 J1589 C1037 41556 J1246 J1247 J1025 J1248 J1550 J1802 J1427 J1236 J1026 J1027 41556 J1250 J1852 41556 J1028 J1029 12504 TX Only MN Only x CA Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only x ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name AMERISAFE RISK SERVICES INC. AMERISURE INSURANCE AMERISURE MUTUAL INSURANCE AMGUARD INSURANCE COMPANY - GUARD DBA AMICA MUTUAL INSURANCE COMPANY ANACO ANAIC CIBUS ANHEUSER BUSH ANPAC ANTELOPE VALLEY RET. APPLIED UNDERWRITERS ARAMARK ARCADIA INSURANCE COMPANY ARCHER DANIELS MIDLAND COMPANY ARGENBRIGHT HOLDINGS LIMITED ARGONAUT INSURANCE COMPANY(ARGO) ARIZONA & 21ST CORP. DBA BERKLEY EAST CONV. HOSPITAL ASSURANCE COMPANY OF AMERICA (COMMERCIAL ONLY) ATLANTIC MUTUAL INSURANCE AUSTIN MUTUAL INS AUTO CLUB GROUP AUTO CLUB GROUP INSURANCE COMPANY AUTO CLUB INSURANCE (ACIA) AUTO CLUB INSURANCE ASSOCIATION AUTO CLUB PROPERTY-CASUALTY INSURANCE COMPANY AUTO-OWNERS \ HOME-OWNERS INSURANCE COMPANY AUTO-OWNERS \ OWNERS INSURANCE COMPANY AUTO-OWNERS \ PROPERTY-OWNERS INSURANCE CO AUTO-OWNERS \ SOUTHERN-OWNERS COMPANY AUTO-OWNERS INSURANCE COMPANY AUTO-OWNERS LIFE INSURANCE COMPANY AUTOMOBILE DEALERS INSURANCE COMPANY INC AVIR INC. AVIZENT AYERS TRUCKING BAKER TANKS, INC. BANK OF AMERICA BARI MANAGEMENT (MURPHY AND BEANE) BARNES BARRETT BUSINESS SERVICES INC (BBSI) BART - SAN FRANCISCO BAY AREA RAPID TRANSIT BASIC RESOURCES, INC. BEACON MUTUAL BEALL'S INC / MIDWEST EMPLOYERS BEAR VALLEY UNIFIED SCHOOL DISTRICT (CA) BEEVILLE ISD BENCHMARK INSURANCE BERKLEY AGRIBUSINESS RISK SPECIALISTS Payer ID J1447 J1206 J1205 J1453 12287 41556 41556 J1620 43101 41556 J1775 J1502 J1251 J1735 J1252 19801 41556 C1034 19895 J1682 11983 11983 11983 11983 11983 J1580 J1583 J1699 J688 J1556 J1596 J1861 41556 J1415 J1018 41556 J1729 J1533 J1503 J1686 J1770 41556 J1234 J1030 J1690 41556 J1257 J1477 TX Only MN Only x x x x CA Only x x x x x x x x x x x x x x x x x x x x x x x x NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only x x x x x ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name BERKLEY NATIONAL INSURANCE COMPANY BERKLEY NET UNDERWRITERS, LLC BERKLEY REGIONAL INSURANCE COMPANY BERKLEY RISK ADMINISTRATORS COMPANY, LLC BERKLEY SPECIALTY UNDERWRITERS BERKLEY VALLEY CONV HOSPITAL BERKSHIRE HATHAWAY HOMESTATE COMPANIES (BHHC) BERNARDO H. CO. CLUB BERWIND CORPORATION BEVERLY HILLS CARMEL BIG 5 CORP BIGHORN CONSTRUCTION BITUMINOUS FIRE AND MARINE BITUMINOUS INSURANCE COMPANY BLOOMINGDALE'S BMW MANUFACTURING CORP. BMW NORTH AMERICA BOBRICK WASHROOM BOISE CASCADE COMPANY BOULDER COMMUNITY HOSPITAL BREMCO CONSTRUCTION BRICKSTREET BRISTOL WEST BROADSPIRE, A CRAWFORD COMPANY BROTHERHOOD MUTUAL INSURANCE BROWNSVILLE INDEPENDENT SCHOOL DISTRICT BROWNYARD GROUP INC. (ARCH INSURANCE) BRUNSWICK CORPORATION BRUNSWICK CORPORATION (AUTO ONLY) BUFFETS INC (OLD COUNTRY BUFFETT, RYAN'S, HOMETOWN BUFFET, FIRE MOUNTAIN, COUNTRY BUFFETT, GRANNY'S BUFFETT) BUNCH AND ASSOCIATES BURLINGTON COAT FACTORY WAREHO BURTON WAY CARMEL BV GENERAL (MURPHY AND BEANE) BYCOR GEN CONTRACT CADET UNIFORM SUPPLY CALIFORNIA WATER SERVICE COMPANY CALLAHAN, MCCUNE CAMBRIDGE INTEGRATED SERVICES CAMPBELL UNION SCHOOL DISTRICT CAPITOL INDEMNITY CAPITOL INSURANCE COMPANIES CAPS-SIG CASITAS MUNICIPAL WATER DISTRICT (CA) CATHOLIC DIOCESE OF SAN DIEGO CATHOLIC MUTUAL - PREFERRED PROFESSIONAL INSURANCE COMPANY CATHOLIC MUTUAL - VIRGINIA SURETY COMPANY, INC. Payer ID J1477 J1523 J1477 J1526 TP019 41556 20044 41556 J1031 41556 J1738 41556 J1691 J1579 J1347 J1258 J1259 41556 J1801 41556 41556 J1761 J1764 TP021 J1445 41556 11150 J1032 J1261 TX Only x MN Only x x x x x CA Only x x x x x x x x x x x x x NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x J1501 x x x x x J1435 J1033 41556 J1533 41556 41556 41556 41556 J1819 41556 J1262 J1809 41556 J1630 41556 41556 41556 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name CBS STUDIOS (MURPHY AND BEANE) CCMSI CEDARS-SINAI HEALTH SYSTEM CENDANT CORPORATION CENTENNIAL INSURANCE COMPANY CENTRAL CONTRA COSTA TRANSIT AUTHORITY CENTRAL HOCKEY LEAGUE CHANDLER'S P. VERDES CHAPMAN CONVALESCENT CHARMING SHOPPES, INC. CHESTERFIELD SERVICES, INC. CHILDREN'S HOSPITAL COLORADO CHILDREN'S HOSPITAL OF ORANGE COUNTY - FIRST AID CHUBB & SON CHUBB SERVICES CHULA VISTA ELEMENTARY SCHOOL DISTRICT CHURCH MUTUAL INSURANCE COMPANY CHURCH MUTUAL INSURANCE COMPANY (AUTO ONLY) CHURCH MUTUAL INSURANCE COMPANY (WC ONLY) CIGA CIM INSURANCE CORPORATION CINCINNATI INSURANCE CITIZENS INSURANCE COMPANY OF AMERICA CITRUS VALLEY HEALTH PARTNERS CITY OF AMARILLO (AUSTIN) CITY OF AMES CITY OF ARLINGTON CITY OF ASHLAND CITY OF ATLANTA CITY OF BANNING (CA) CITY OF BARSTOW (CA) CITY OF BEAVERTON CITY OF BELMONT (SELF INSURED) CITY OF BLYTHE (CA) CITY OF BREA CITY OF CAMPBELL CITY OF CARLSBAD CITY OF CARMEL BY THE SEA CITY OF CARSON CITY OF CHULA VISTA CITY OF COLTON CITY OF CORONADO CITY OF DALLAS CITY OF DEL MAR CITY OF DES MOINES CITY OF DESERT HOT SPRINGS (CA) CITY OF EDINBURG, TEXAS CITY OF EL PASO Payer ID J1533 J1010 41556 J1034 19895 J1605 J1035 41556 41556 J1036 J1479 41556 41556 J1554 J1561 41556 J1266 J1264 J1265 J1532 C1028 J1562 J1582 J1613 J1267 J1118 A0033 41556 J1516 J1792 J1793 41556 41556 J1794 J1880 41556 41556 41556 41556 41556 41556 41556 J1441 41556 J1118 J1799 41556 A0046 TX Only MN Only x x x x x x x x x x x x x x x x x x x CA Only x x x x x x x x x x x NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only x ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name CITY OF ENCINITAS CITY OF ESCONDIDO CITY OF FORT WORTH (TX) CITY OF FOUNTAIN VALLEY (CA) CITY OF GARDENA (CA) CITY OF GLENDALE (AZ) CITY OF GRAND JUNCTION CITY OF HILLSBORO CITY OF HOUSTON CITY OF IMPERIAL BEACH CITY OF IMPERIAL BEACH (VOUCHER) CITY OF IRVING CITY OF JACKSONVILLE CITY OF LA MESA 11 (CA) CITY OF LAGUNA HILLS (CA) CITY OF LEMON GROVE CITY OF LEWISVILLE CITY OF LOS ALTOS CITY OF LOS ANGELES CITY OF MERCED CITY OF MINNEAPOLIS CITY OF MONROVIA (CA) CITY OF MONTEBELLO (CA) CITY OF MURIETA (CA) CITY OF NATIONAL CITY CITY OF OCEANSIDE CITY OF OMAHA (NE) CITY OF ORANGE CITY OF ONTARIO CITY OF PASADENA (CA) CITY OF PERRIS (CA) CITY OF REDDING CITY OF RICHARDSON CITY OF SALINAS CITY OF SAN JACINTO (CA) CITY OF SAN DIEGO CITY OF SAN MATEO (CA) CITY OF SANTEE CITY OF SNYDER (TX) CITY OF SOLANA BEACH CITY OF SOUTH SAN FRANCISCO CITY OF ST PAUL (MN) CITY OF STANTON (CA) CITY OF STOCKTON (CA) CITY OF TOPEKA (KS) CITY OF UPLAND (CA) CITY OF VISTA CITY OF WACO Payer ID 41556 41556 J1680 J1632 J1634 J1800 41556 41556 J1444 41556 41556 41556 J1504 J1711 J1653 41556 J1268 41556 J1536 41556 J1269 J1714 J1640 J1797 41556 41556 J1721 J1881 41556 J1657 J1795 J1617 41556 J1849 J1796 J1497 J1727 41556 J1598 41556 41556 J1602 J1636 J1664 J1607 J1645 41556 41556 TX Only x x MN Only x x CA Only NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name CITY OF WEST COVINA (CA) CITY OF WEST DES MOINES CITY OF WESTMINSTER (CA) CITY OF YORBA LINDA (CA) CITY OF YUMA CIVIL CONSTRUCTORS CLAIMS ADMINISTRATIVE SERVICES (CAS) CLASSIC RESIDENCE BY HYATT CLOUGHERTY PACKING LLC CNA INSURANCE CNA INSURANCE (AUTO ONLY) CO GRANDE CASINO COACH USA COAST CONVERTERS COCA-COLA ENTERPRISES INC. COLLIN COUNTY COLORADO CASUALTY COLORADO CONTRACTORS PROGRAM COLORADO HEALTHCARE ASSOC. - SAFETY NATIONAL CASUALTY CORP. COLORADO PRIME CORP. COLUMBIA SUSSEX CORPORATION COLUMBINE HEALTH SYSTEMS COMMUNITY DEVELOPMENT COMMISSION (CA) COMPASS GROUP USA, INC. COMPASS HEALTH (MURPHY AND BEANE) COMPTON UNIFIED SCHOOL DISTRICT (CA) CON-WAY INC. CONTECH CONSTRUCTION PRODUCTS CONTINENTAL AIRLINES CONTINENTAL WESTERN INSURANCE CO (CWG) CONTRA COASTAL COUNTY SCHOOLS INSURANCE GROUP (CCCSIG) CONVERGYS CORPORATION COOK & SOLIS CONST. CORINTHIAN COLLEGES CORRECTIONAL MANAGEMENT SERVICE CORRECTIONS CORP OF AMERICA COTTINGHAM & BULTER CLAIM SERVICES INC COUNTRY CASUALTY INSURANCE COMPANY COUNTRY INSURANCE \ MODERN SERVICE CASUALTY INSUR CO COUNTRY INSURANCE \ MSI PREFERRED INSURANCE COMPNAY COUNTRY INSURANCE \ MUTUAL SERVICE CASUALTY INSUR CO COUNTRY INSURNACE \ MOUNTAIN STATES INSURANCE COUNTRY MUTUAL INSURANCE COMPANY COUNTRY PREFERRED INSURANCE COMPANY COUNTRY VILLA HEALTH SERVICES - SNCC COUNTRY VILLA OX HLTH COUNTY OF ALAMEDA/AIG COUNTY OF HUMBOLDT (CA) Payer ID J1649 J1118 J1700 J1708 41556 41556 J1271 J1037 J1739 20443 C1035 41556 J1272 41556 J1038 41556 J1428 41556 41556 41556 J1039 41556 J1655 J1040 J1533 J1652 J1844 J1041 J1042 J1274 J1715 J1043 41556 J1517 J1044 J1045 J1683 J1684 J1712 J1591 J1709 J1572 J1702 J1705 41556 41556 41556 J1603 TX Only MN Only x x x x CA Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x WI Professional Institutional All States Only Claims Claims x x x x x x x x x x NY Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name COUNTY OF LOS ANGELES (AIMS SANTA CLARITA) COUNTY OF LOS ANGELES (CA) COUNTY OF LOS ANGELES (TRISTAR SANTA ANA) COUNTY OF MARIN COUNTY OF SAN DIEGO COUNTY OF SANTA BARBARA (CA) COUNTY OF SANTA BARBARA-CSAC (CA) COUNTY OF SANTA BARBARA-NON-CSAC (CA) COUNTY OF SHASTA (CA) COUNTY OF SONOMA (CA) COUNTY OF TULARE (CA) COURTYARD HEALTH C. COWORX STAFFING, LLC COX CONSTRUCTION CO CPS SECURITY SOLUTIONS CR&R CREATIVE RISK SOLUTIONS CRESTBROOK INSURANCE COMPANY CUCAMONGA SCHOOL DISTRICT (CA) CUMIS INSURANCE SOCIETY CVS/CAREMARK/MINUTE CLINIC CYPRESS INSURANCE COMPANY (MEMBER OF BHHC) DAHL'S FOODS DAIMLERCHRYSLER CORPORATION DAKOTA FIRE DAKOTA FIRE DAKOTA FIRE DALLAS COUNTY COMMUNITY COLLEGE DISTRICT DALLAS INDEPENDENT SCHOOL DISTRICT DANAHER CORPORATION DAVIS MECH SYSTEMS DAYLIGHT TRANSPORT DE BARTOLOS, INC DENVER PUBLIC SCHOOLS DEPART OF LABOR/DEPARTMENT OF ENERGY DEPARTMENT OF ENERGY DEPARTMENT OF LABOR BLACK LUNG DEPARTMENT OF WATER AND POWER OF THE CITY OF LOS ANGELES (LADWP) DEPOSITORS INS CO DESERT HOSPITAL DISTRICT DESERT PRINCESS DIAMOND FARMING COMPANY DIRECTORY DISTRIBUTING ASSOC. DISCOUNT TIRE DISCOVER RE (BURGER KING) DISCOVERY HY-VEE DOUGLAS COUNTY DUNN-EDWARDS CORPORATION Payer ID J1723 J1625 J1722 41556 J1513 J1631 J1631 J1631 J1616 J1662 J1666 41556 J1046 41556 41556 J1516 J1455 J1550 J1690 J1282 J1457 20044 J1118 41556 21415 C1029 J1433 41556 J1494 J1051 41556 41556 J1058 41556 J1438 J1449 J1448 J1514 J1550 41556 41556 41556 J1059 J1611 J1060 J1118 41556 J1061 TX Only MN Only CA Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name DURANGO COFFEE CO. DUSTROL DYNAMEX, INC. EAGLE PASS ISD EAST SAN GABRIEL VALLEY ROP (CA) EASTERN MUNICIPAL WATER DISTRICT (CA) EASTGUARD INSURANCE COMPANY - GUARD DBA ECHO PACIFIC DEVELOP EDIC EDINBURG CONSOLIDATED INDEPENDENT SCHOOL DISTRICT EDWARDS CLAIM ADMINISTRATION EL PASO COMMUNITY COLLEGE (TX JUR) EL PASO WATER UTIL TX JUR EL POLLO LOCO ELC ELECTRIC INC ELITE COMP EMC PROPERTY AND CASUALTY EMC PROPERTY AND CASUALTY EMC PROPERTY AND CASUALTY EMCASCO INSURANCE CO EMCASCO INSURANCE CO EMCASCO INSURANCE CO EMERITUS CORPORATION EMPLOYER INSURANCE GROUP (EIG) EMPLOYERS ASSURANCE COMPANY EMPLOYER'S CLAIM SERVICE, INC - CITY OF NAPERVILLE EMPLOYERS COMPENSATION INSURANCE COMPANY EMPLOYERS GENERAL INSURANCE GROUP EMPLOYERS MUTUAL CASUALTY EMPLOYERS MUTUAL CASUALTY EMPLOYERS MUTUAL CASUALTY EMPLOYERS PREFERRED INSURANCE COMPANY ENTERPRISE RENT A CAR ENVIROSOURCE ENVISION RADIOLOGY, LLC EPLICA, INC. ERICKSON-HALL CONSTR ERIE INSURANCE ERMC ESIS ESIS - FIRST AMERICAN INSURANCE CO ESIS - KELLY SERVICES ESIS - LOCKHEED MARTIN CORPORATION ESURANCE INSURANCE COMPANY EVOLUTION INSURANCE COMPANY EXXONMOBIL CORPORATION F&G GUARANTY INS CO/MAIN STREET PROGRAM COLORADO FACTORY 2 U Payer ID 41556 J1118 J1062 41556 J1690 J1639 J1453 41556 J1289 41556 Click Here A0106 J1017 J1737 41556 41556 21415 C1029 J1433 C1029 J1433 21407 J1679 J1232 J1232 J1559 J1232 J1696 C1029 J1433 21415 J1232 J1294 J1063 41556 41556 41556 J1734 J1022 TP043 J1064 J1451 J1454 25712 J1065 J1606 41556 J1019 TX Only MN Only x x x x x x x x x CA Only x x x x x x x x x x x x x x x x x x x x x x NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x Auto Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name FAIRCHILD FASTENERS FARM BUREAU MUTUAL INSURANCE COMPANY FAIRMONT SPECIALTY INSURANCE COMPANY - TX FAIRVIEW HEALTH SERVICES FAMILY HEALTH & HOUSING FAMSA, INC FARMERS \ CIVIC PROPERTY AND CASUALTY COMPANY FARMERS \ EXACT PROPERTY AND CASUALTY COMPANY FARMERS \ FIRE INSURANCE EXCHANGE FARMERS \ MID-CENTURY INSURANCE COMPANY FARMERS \ NEIGHBORHOOD SPIRIT PROPERTY AND CASUALTY COMPANY FARMERS \ TRUCK INSURANCE EXCHANGE FARMERS INSURANCE FARMERS INSURANCE COMMERCIAL (COMMERCIAL ONLY) FARMERS INSURANCE EXCHANGE (COMMERCIAL ONLY) FARMERS INSURANCE EXCHANGE (WC ONLY) FARMLAND MUTUAL INS CO FEDERATED CLAIMS SERVICE CORP. FEDERATED DEPARTMENT STORES, INC FEDERATED LINEN & UNIFORM FEDERATED MUTUAL INSURANCE COMPANY FEDERATED RURAL ELECTRIC (TX) FEDERATED SERVICES INSURANCE COMPANY FIREMAN'S FUND INSURANCE COMPANY FIREMEN'S INSURANCE COMPANY FIRSTCOMP FKI INDUSTRIES, INC. FOOD LION/DELHAIZE FOREMOST FORGE INDUSTRIAL STAFFING FRANCO CONSTRUCTION FRANKENMUTH MUTUAL FRESNO COUNTY OFFICE OF EDUCATION FRESNO COUNTY SELF INSURANCE GROUP FRONT PORCH (MURPHY AND BEANE) FULLERTON UNION HIGH SCHOOL DISTRICT (CA) GAB ROBBINS, INC. GAB ROBINS (FOR VAN TUYL COMPANIES ONLY) GALLAGHER BASSETT GARDEN GROVE UNIFIED SCHOOL DISTRICT GARDEN REGIONAL HOSPITAL & MED CENTER, INC. GATEGOURMET #836 GATES CORP DBA GATES RUBBER CO GATES O'DOHERTY GATES O'DOHERTY G&G GATEWAY TRANS., INC. GE AUTO GENERAL PARTS INTERNATIONAL Payer ID J1624 J1853 J1697 J1618 41556 J1807 J1687 J1703 J1706 J1710 J1701 J1713 C1025 C1034 C1034 J1563 J1551 J1297 J1297 41556 13935 11118 28304 21873 J1274 J1011 J1047 J1879 11185 J1529 41556 J1440 41556 41556 J1533 J1633 TP117 TP117 TP057 J1519 41556 J1302 J1066 41556 41556 41556 J1557 J1678 TX Only MN Only CA Only x x x x x x x x x x x x x x x x x x x x x x x x NY Only WI Professional Institutional Workers' All States Only Claims Claims Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only x x x x ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name GENESIS CONSTRUCTION GEO GLENDALE ELEMENTARY SCHOOL DISTRICT #40 GMAC INSURANCE COMPANY ONLINE, INC. GMAC INSURANCE MANAGEMENT CORPORATION GOLDEN CORRAL CORPORATION GOLDEN EAGLE GOLDEN STATE SUPPLY GOOD SAMARITAN HOSPITAL GOODRICH GOODWILL INDUSTRIES GRAND RIVER INSURANCE (WC ONLY) GRANGE MUTUAL CASUALTY COMPANY GRANGE WC GRAPHIC ARTS MUTUAL GREAT AMERICAN ALLIANCE INS CO. GREAT AMERICAN ASSURANCE CO. GREAT AMERICAN INS. CO. GREAT AMERICAN INS. CO. OF N.Y. GREAT CENTRAL GREAT DIVIDE INSURANCE GREAT WEST CASUALTY GREEN DIAMOND WA GREENE RAD MALONEY GREER CONSTRUCTON CO GREIF BROTHERS CORPORATION GREVE CLIFFORD WENGEL & PARAS GRIMMWAY ENTERPRISES, INC. GRINNELL REINSURANCE COMPANY GRINNELL SELECT GRUNDFOS MANUFACTURING CORPORATION GS METALS GSE LINING TECHNOLOGY, INC. GUARD GUIDEONE ELITE INSURANCE GUIDEONE MUTUAL INSURANCE H&R HAMILTON MUTUAL HAMILTON MUTUAL HAMILTON MUTUAL HANNAFORD HANOVER INSURANCE COMPANY HANOVER LLOYD'S INSURANCE COMPANY HARLEYSVILLE INSURANCE COMPANY HARTFORD ACCIDENT AND INDEMNITY COMPANY HARTFORD CASUALTY INSURANCE COMPANY HARTFORD DEALERSHIP ADVANTAGE PROGRAM - WC HARTFORD FIRE INSURANCE COMPANY Payer ID 41556 J1461 41556 C1028 C1028 J1067 J1430 J1306 J1647 J1462 J1621 J1566 10322 14060 25984 26832 26344 16691 22136 J1308 25224 J1820 J1642 41556 41556 41556 41556 41556 J1571 J1541 41556 41556 J1068 J1453 J1590 J1574 J1672 21415 C1029 J1433 J1463 J1693 J1588 J1595 C1046 C1041 41556 C1040 TX Only MN Only x x x x CA Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name HARTFORD INS CO OF ILLINOIS HARTFORD INS CO OF THE SOUTHEAST HARTFORD INSURANCE COMPANY OF THE MIDWEST HARTFORD INSURANCE COMPANY OF THE MIDWEST (ALLIANT TECH SYSTEMS ONLY) HARTFORD INSURANCE COMPANY OF THE MIDWEST (AMERICOLD LOGISTICS ONLY) HARTFORD INSURANCE COMPANY OF THE MIDWEST (PFIZER, INC. ONLY) HARTFORD INSURANCE COMPANY OF THE MIDWEST (PUBLIX ONLY) HARTFORD INSURANCE COMPANY OF THE MIDWEST (QCS ONLY) HARTFORD INSURANCE COMPANY OF THE MIDWEST (RUBY TUESDAY ONLY) HARTFORD INSURANCE COMPANY OF THE MIDWEST (STERICYCLE ONLY) HARTFORD INSURANCE COMPANY OF THE MIDWEST (WELLS FARGO ONLY) HARTFORD INSURANCE COMPANY OF THE MIDWEST (WENDY’S ARBY’S GROUP ONLY) HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY HARTFORD LIFE AND ANNUITY INSURANCE COMPANY HARTFORD LIFE INSURANCE COMPANY HARTFORD UNDERWRITERS INSURANCE COMPANY HASTINGS COLLEGE OF THE LAW HAWKEYE HAYHOE CONSTRUCTION HCA-HOSPTIAL CORPORATION OF AMERICA HEALTHPARTNERS HEALTHSMART HEARTLAND EMPLOYMENT SERVICES, LLC HEARTLAND EXPRESS HELMSMAN MANAGEMENT SERVICES HEMET UNIFED SCHOOL DISTRICT (CA) HENNEPIN COUNTY COURT DIV HERITAGE GROUP HIGHLAND GOLF HILMAR CHEESE COMPANY HMSHOST HOGAN MOTOR LEASING HOGAN PERSONELL HOLLY FARMS CORP. HOME SWEET HOME HORTICA FLORIST MUTUAL INSURANCE HOUSEHOLD MERCH NNI HOUSING AUTHORITY EL PASO (TX) HOUSTON HUNTERS PATROL, INC HUGHES TOOL COMPANY HUTCHINSON TECHNOLOGY HY-VEE ICW (INSURANCE CO OF THE WEST) IDS PROPERTY CASUALTY INSURANCE COMPANY Payer ID C1040 C1040 C1043 TX Only MN Only CA Only NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x Workers' Comp Only J1314 x x x J1315 J1317 J1318 J1319 x x x x x x x x x x x x J1320 J1321 J1322 x x x x x x x x x J1323 C1044 C1047 C1047 C1042 41556 J1426 41556 J1450 44547 J1481 41556 J1677 33600 J1654 J1854 J1069 41556 J1833 J1612 41556 41556 J1070 41556 13978 J1071 A0107 J1020 J1072 J1626 J1118 27847 12504 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only x x x ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name ILLINOIS CASUALTY ILLINOIS EMCASCO ILLINOIS EMCASCO ILLINOIS EMCASCO IMPERIAL IRRIGATION DISTRICT INCONEN CORPORATION INDIANA INSURANCE INLAND VALLEY HOSPICE INNOVATIVE CLAIM SOLUTIONS (ICS) - RANCHO CORDOVA INNOVATIVE CLAIM SOLUTIONS (ICS) - SAN RAMON INSILCO CORP INTEGON CASUALTY INSURANCE CO. INTEGON GENERAL INSURANCE CORP. INTEGON INDEMNITY CORP. INTEGON NATIONAL INSURANCE CO. INTEGON PREFERRED INSURANCE CO. INTEGRITY MUTUAL INSURANCE COMPANY INTEGRITY WC INTERCARE INTERINSURANCE EXCHANGE OF THE AUTOMOBILE CLUB IREX CORPORATION IRONWORKING CONTRACT I.P. J B HUNT TRANSPORT INC. J.H. MCCORMACK CONST JD MECHANICAL JEFFERSON COUNTY TEXAS JI SPECIALTY SERVICES JOHN MUIR HEALTH JOHNSTON SCHOOLS JONES TRUCK LINES,INC. JUDSON ISD JUVENILE JAIL FACILITY MANAGEM KAUTZ VINYARDS KCI HOLDINGS USA KEENAN AND ASSOCIATES (EXCLUDING CITY OF PASADENA) KELLOGG COMPANIES KEMPER \ UNITRIN AUTO AND HOME KEMPER \ UNITRIN SAFEGUARD INS COMPANY KEMPER PREFERRED KEN DAVIS INDUSTRIES INC. KEY RISK MANAGEMENT SERVICES LLC KEYSTONE KING PAK POTATO COMPANY LLC KING RANCH KIRKLAND'S INC KTA CONSTRUCTION (COSD2) L. ARROWHEAD C. CLUB LACLEDE CHAIN Payer ID J1575 21415 C1029 J1433 41556 41556 J1425 41556 J1599 J1601 J1073 C1028 C1028 C1028 C1028 C1028 10322 14303 J1542 J1810 J1074 J1075 A0138 41556 41556 41556 J1006 41556 J1118 J1076 41556 J1077 41556 J1078 J1498 J1803 J1576 J1587 C1030 J1079 J1521 J1118 41556 41556 J1614 41556 41556 41556 TX Only x MN Only x CA Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only x x x x x x x x x x x x ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name LACLEDE STEEL LAKE ELSINORE SCHOOL DISTRICT LAMAR CONSOLIDATED ISD LAMESA ISD LANDMARK GOLF CO LANDMARK GRAD&PAVING LANDSTAR BCO WC PROGRAM LANE COUNTY LARIMER COUNTY - WC LB AUTO/PACIFIC PART LB AUTO/PACIFIC SUPP LEAGUE OF MINNESOTA CITIES INSURANCE TRUST LEKOS ELECTRIC LEVIN ENTERPRISES, INC. LFP CORPORATION LIBERTY MUTUAL LIBERTY MUTUAL MIDDLE MARKETS LIBERTY NORTHWEST LIBERTY WAUSAU LIVINGSTON ISD LK ARROWHEAD CO CLUB LODI MEMORIAL HOSPITAL LONG BEACH UNIFIED SCHOOL DISTRICT LONGS DRUGS LOWE'S LSG SKY CHEFS INTERNATIONAL LUBA CASUALTY INSURANCE COMPANY (TX) LUMBERMEN'S UNDERWRITING ALLIANCE LWCC - LOUISIANA WORKERS' COMPENSATION CORPORATION LYNWOOD UNIFI3ED SCHOOL DISTRICT (CA) MAC RISK (THE MOLLY ANNA COMPANY) MACYS (DALY CITY) MACYS (NEWPORT BEACH) MACYS CORPORATE SERVICES INC MADERA COMMUNITY HOSPITAL MAJOR LEAGUE BASEBALL 8 MANUFACTURERS ALLIANCE INSURANCE COMPANY MARCOTTE & HEARNE MARICOPA COUNTY COMMUNITY COLLEGE DISTRICT MARIPOSA COUNTY MARYLAND CASUALTY COMPANY (COMMERCIAL ONLY) MASSACHUSETTS BAY INSURANCE COMPANY MATAGORDA COUNTY MATHESON TRUCKING MATRIX ABSENCE MANAGEMENT MAXIM CRANE WORKS MAY DEPARTMENT STORES MAYO CLINIC/RECOVERY AND CLAIMS SERVICES Payer ID 41556 41556 41556 41556 41556 41556 J1080 41556 41556 41556 41556 J1527 41556 41556 J1650 33600 33600 33600 33600 41556 41556 41556 J1515 J1464 J1465 J1081 J1341 J1540 J1547 J1669 J1860 J1345 J1346 J1347 41556 J1082 41556 41556 41556 41556 C1034 J1689 41556 J1736 TP075 J1083 J1347 41193 TX Only MN Only x x CA Only x x x x x x x x x x x x x x x x x x x NY Only WI Professional Institutional Workers' All States Only Claims Claims Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List TX Only Payer ID MC DONALD'S-MCOPCO J1084 x MDSI PHYS GROUP INC 41556 MEADOWBROOK INSURANCE GROUP J1478 41556 MEDICAL BEN ADMIN MEEMIC 11983 MEMBER SELECT INSURANCE COMPANY 11983 MEMIC 11030 MEMORIAL HEALTH SERVICES 41556 MENDOTA INSURANCE COMPANY 33650 MERIDIAN CONSTRUCTION PROGRAM 41556 41556 MERITAGE CORPORATION MESA COUNTY COLORADO 41556 MESA COUNTY VALLEY SCHOOL DISTRICT 51 41556 METROPOLITAN COUNCIL J1355 METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY 87726 METROPOLITAN TRANSIT AUTHORITY J1238 x 41556 MEXICANA AIRLINES MIC GENERAL INSURANCE CORP. C1028 MIC PROPERTY AND CASUALTY INS. CORP C1028 MICHAEL HOGAN ASSOC 41556 MID CENTURY INSURANCE COMPANY (COMMERCIAL ONLY) C1034 MIDWEST DRYWALL J1119 x MIDWEST FAMILY MUTUAL INSURANCE CO J1685 x MIDWEST INSURANCE 10895 x J1482 MILLARD REFRIGERATED J1351 MINNESOTA COUNTIES INS TRUST (MCIT) MINNESOTA DEPARTMENT OF LABOR & INDUSTRY – CLAIMS SERVICES & INVESTIGATIONS J1436 UNIT 41556 MISSION AVIATION FELLOWSHIP MISSION LODGE SANITARIUM 41556 41556 MISSOULA CART CO, IN MITCHELL ENERGY & DEVEL J1085 x MITSUI SUMITOMO INSURANCE GROUP J1692 MITSUI SUMITOMO INSURANCE USA INC J1694 MMIC J1622 41556 MODESTO IRRIGATION DISTRICT J1424 MONTGOMERY A0179 x MONTGOMERY COUNTY TEXAS J1530 MONUMENT ADMINISTRATORS - CORNERSTONE COMP J1530 MONUMENT ADMINISTRATORS - ELITE COUNTRY CLUB J1644 MORENO VALLEY UNIFIED SCHOOL DISTRICT (CA) J1651) MORONGO BASIN TRANSIT AUTHORITY (CA) MORRIS MATERIAL HANDLING J1086 x MORRISON HEALTH CARE, INC. J1087 x MOTION PICTURE & TELEVISION FUND 41556 MOTORIST MUTUAL INSURANCE J1203 x MOTORS INSURANCE CORPORATION C1028 MTS J1641 MTV (MURPHY AND BEANE) J1533 Payer Name MN Only x CA Only x x x x x x x x x x x x x x x x x x x x x x NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name MUNFORD, INC. MUSCO NAP TOOLS NATIONAL AMERICAN INSURANCE CO (NAICO) NATIONAL CASUALTY COMPANY NATIONAL FARMERS UNION PROPERTY AND CASUALTY COMPANY - QBE DBA NATIONAL GENERAL ASSURANCE CO. NATIONAL GENERAL INSURANCE CO. NATIONAL INTERSTATE NATIONAL JEWISH HEALTH NATIONAL LIABILITY AND FIRE INSURANCE COMPANY NATIONAL LOSS PREVENTION, INC NATIONWIDE AFFINITY INS CO OF AMERICA (NAICOA) NATIONWIDE AGRIBUSINESS COMPANIES NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE INS CO OF AMERICA (NICOA) NATIONWIDE INSURANCE COMPANIES NATIONWIDE MUTUAL FIRE CO NATIONWIDE MUTUAL INSURANCE COMPANY NATIONWIDE PROPERTY AND CASUALTY INS CO NBC UNIVERSAL NC DEPARTMENT OF PUBLIC INSTRUCTION NCLM - NORTH CAROLINA LEAGUE OF MUNICIPALITIES NEW JERSEY MANUFACTURING NEW JERSEY MANUFACTURING NEW KOOSHAREM CORPORATION/SELECT STAFFING (DOI AFTER 7/31/2014) NEW SOUTH INSURANCE CO. NICKELODIAN (MURPHY AND BEANE) NONPROFIT INSURANCE TRUST NORDSTROM, INC. NORGUARD INSURANCE COMPANY - GUARD DBA NORTH AMERICA RISK SERVICES (NARS) NORTH CAROLINA FARM BUREAU NORTH CLACKAMAS SCHOOL DISTRICT #12 NORTH COUNTY TRANSIT DISTRICT NORTHERN COLORADO SCHOOL DISTRICTS WORKERS' COMPENSATION POOL NORTHLAND AUTO NORTHWEST INSURANCE NORWOOD NOVA DEALERSHIP ADVANTAGE PROGRAM - WC NOVA ELITE COMP PROGRAM NOVA METALS ADVANTAGE PLUS PROGRAM - WC NOVA PRO RISK SOLUTIONS NUEVO ENGINEERING NYSIF OAK RIVER INSURANCE COMPANY (MEMBER OF BHHC) OHIO CASUALTY GROUP Payer ID J1088 J1118 J1120 J1695 J1551 J1484 C1028 C1028 32620 41556 20044 J1021 J1552 J1551 J1551 J1552 J1552 J1552 J1552 J1552 J1359 J1660 J1772 12122 TX Only x x x x x MN Only x x x x x CA Only x x x x x x x x x x x x x x x x x x x x x x x x x C1048 J1875 C1028 J1533 J1845 J1360 J1453 J1882 J1825 41556 41556 41556 C1031 J1361 J1089 41556 41556 41556 J1056 41556 45052 20044 24074 x x x x x x x x x NY Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x Auto Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x ERA (835) x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name OLD REPUBLIC INSURANCE CO ONE BEACON ONE BEACON INSURANCE - AUTO O'REILLY AUTO PARTS ORANGE COUNTY FIRE AUTHORITY ORICA, INC. OUTRIGGER LODGING OVERHILL FARMS, INC. PACIFIC COAST BUILDING PRODUCTS PACIFIC DENTAL SERVICES PACIFIC HYDROTECH CO PACIFIC INSURANCE COMPANY LTD PACIFIC LUMBER COMPANY (MARATHON) PACIFIC MOTOR COMPANY PACIFIC SPECIALTY INSURANCE PACIFIC SUNWEAR PAJARO VLY COMNTY HEALTH TRUST PALADIN MANAGED CARE SERVICES, INC. PALO ALTO MEDICAL FOUNDATION PAPA JOHN'S INTERNATIONAL INC PARADIGM PARAMOUNT PICTURES (MURPHY AND BEANE) PARK DISTRICT RISK MANAGEMENT ASSOCIATION (PDRMA) PAS COFFEE ROASTERS PATTERSON BRO LIGHT. PEERLESS PEG DISCOVER RE PEG DISCOVER RE( FOOOD MERCHANT) PEGI-FAMILY DINING PENN MILLERS INSURANCE CO PENNSYLVANIA MANUFACTURERS' ASSOCIATION INSURANCE COMPANY PENNSYLVANIA MANUFACTURERS INDEMNITY COMPANY PENNSYLVANIA MANUFACTURING ASSOCIATES PEOPLE 2.0 PERMA PETALUMA VALLEY HOSPITAL PFLUGERVILLE ISD PHARMACIST MUTUAL INSURANCE CO PHH FLEETAMERICA PIER 1 INC. USA PIMA COUNTY PLAINVIEW ISD PLOTT HEALTH CARE POLY AMERICA LP POLY-AMERICA PONDEROSA LANDSCAPE PORT OF OAKLAND (CA) PRAIRIE MEADOWS Payer ID 24147 20621 C1026 J1670 J1876 J1090 41556 41556 J1808 J1806 41556 C1040 41556 J1364 41556 J1805 41556 J1475 41556 J1091 J1001 J1533 J1365 41556 41556 J1423 J1092 J1054 J1093 J1573 41556 41556 J1439 J1466 J1623 41556 41556 J1570 J1094 J1369 41556 41556 41556 J1370 41556 41556 J1627 J1118 TX Only x x x MN Only x x x CA Only x x x x x x x x x x x x x x x x x x x x x x x NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only x x ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name PREFERRED EMPLOYERS PREFERRED EMPLOYERS GROUP PREFERRED EMPLOYERS INSURANCE COMPANY (PEI) PRIME HEALTHCARE PROFESSIONAL CLAIMS MANAGEMENT PROPERTY & CASUALTY CO OF HARTFORD PROTECTIVE INSURANCE CO PRUDENTIAL OVERALL SUPPLY - AZ, CA QBE - GENERAL CASUALTY - EDEN PRAIRIE QBE - GENERAL CASUALTY - FARMERS UNION QBE - GENERAL CASUALTY - FREEPORT QBE - GENERAL CASUALTY - INDIANAPOLIS QBE - GENERAL CASUALTY - SIMSBURY QBE - GENERAL CASUALTY - SUN PRAIRIE QBE - GENERAL CASUALTY - WEST DES MOINES QBE - GENERAL CASUALTY CO OF WISCONSIN QPS EMPLOYMENT GROUP QUALITY CARE CONV QUALITY HEALTH M. G. QUEEN OF ANGELS - HOLLYWOOD RALEY'S FAMILY OF FINE STORES RAMPART INSURANCE COMPANY RAMSEY COUNTY (MN) RANCHO SANTIAGO COMMUNITY COLLEGE DISTRICT (CA) RCH PROTECTIVE - SNCC REBUPLIC WESTERN INS CO RECOLOGY RED OAK INDEPENDENT SCHOOL DISTRICT REDWOOD FIRE AND CASUALTY INSURANCE COMPANY (MEMBER OF BHHC) REGENT INSURANCE COMPANY - QBE DBA REGIS BRANDS REHAB CENTER OF BEVERLY HILLS REPUBLIC FRANKLIN INSURANCE REPUBLIC INDEMNITY COMPANY OF AMERICA RESCARE, INC. RESIDENTIAL SERVICES GROUP RESTAURANT REINSURANCE LIMITED RESTORATION PROF RETURN TO WORK REVMED RHONE-POULENC,INC. RICK CONCRETE CONST. RIETH-RILEY CONSTRUCTION COMPA RISK ADMINISTRATION SERVICES RISK ENTERPRISE MANAGEMENT (REM) RISK TRANSFER TECHNOLOGIES, INC. RIVERPORT INSURANCE (MN SCHOOL BOARD ASSOCIATION) RIVERPORT INSURANCE COMPANY Payer ID J1095 J1096 J1496 J1673 J1821 C1040 J1568 41556 J1485 J1483 J1486 J1487 J1488 J1489 J1490 J1484 J1609 41556 41556 41556 J1522 38512 J1663 J1635 41556 J1597 J1675 A0205 20044 J1484 J1467 41556 12475 J1008 J1376 J1097 J1098 41556 J1202 J1848 J1099 41556 J1100 J1828 Click Here J1101 J1546 J1477 TX Only x x MN Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x CA Only x x x x x x x x x x x x x x x x x x x x x x x x x x x NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only x ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name ROBSTOWN ISD ROCKFORD MUTUAL INSURANCE COMPANY ROCKWALL ISD ROSE GARDEN GUEST HO ROSEWOOOD EQUIPMENT ROSSI CONCRETE, INC ROTH STAFFING COMPANIES RSC INSURANCE SERVICES, LTD. RURAL SPECIAL DISTRICT INSURANCE PROGRAM RYDER SERVICES, INC. SA RECYCLING LLC SAFECO INSURANCE SAFETY-KLEEN CORPORATION SAINT LOUIS COUNTY (MN) SALT LAKE CITY CORPORATION SALT LAKE CITY CORPORATION SAM KANE BEEF PROCESSORS, INC. SAN BERNARDINO CITY UNIFIED SCHOOL DISTRICT SAN BERNARDINO COUNTY SUPERINTENDENT OF SCHOOLS (CA) SAN DIEGO / IMPERIAL SCHOOLS JPA (CA) SAN DIEGO COMMUNITY COLLEGE DISTRICT (CA) SAN DIEGO HOSPICE AND THE INSTITUTE FOR PALLIATIVE MEDICINE SAN DIEGO METROPOLITAN TRANSIT SYSTEM SAN DIEGO METROPOLITAN TRANSIT SYSTEM (SCHIP LIABILITY) SAN DIEGO TRANSIT CORP. SAN DIEGO TROLLEY, INC. SAN JOAQUIN COUNTY SANTA CLARA CO OFFICE OF EDUC SANTA CLARA VALLEY TANSPORTATION AUTHORITY SCHLUMBERGER TECHNOLOGY SCHNEIDER GAIN SCHNUCK MARKET, INC SCIF AZ SCOTTS MIRACLE-GRO COMPANY SEABRIGHT (SBIC) SECURA INSURANCE A MUTUAL COMPANY SEDGWICK / CARGILL INC SEENO CONSTRUCTION (CHARTIS) SEENO HOMES SELA HEALTH CARE SELECT STAFFING (KOOSHAREM, REAL TIME STAFFING, REMEDY, SELECT/REMEDY & WESTAFF) SELECTIVE SELF-INSURED SCHOOLS OF CALIFORNIA (SISC) SELMAN BREITMAN SENTINEL INSURANCE COMPANY LTD SENTRY AUTO SENTRY INSURANCE Payer ID 41556 27065 41556 41556 41556 41556 J1516 J1102 41556 J1009 J1728 24740 J1103 J1658 J1730 41556 41556 J1741 J1690 J1656 j1656 41556 41556 41556 41556 41556 41556 41556 J1518 J1104 41556 J1560 J1538 J1049 J1499 J1379 J1661 41556 41556 41556 TX Only MN Only x x x x x x x x x x x x x x x x CA Only x x x J1446 12572 J1520 41556 C1040 C1033 J1417 x x x x x x x NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Auto Comp Only Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name SERVICE LLOYDS INSURANCE CO SFN GROUP (SPHERION, TECHNISOURCE, TATUM, THE MERGIS GROUP, SOURCERIGHT SOLUTIONS, & TODAY'S OFFICE PROFESSIONALS) SHARYLAND INDEPENDENT SCHOOL DISTRICT SHAWS/STARMARKET SIERRA NEVADA MEMORIAL SILBERBERGER ENGN SKB CORPORATION SMART AND FINAL SNAP-ON INCORPORATED SOLVAY AMERICA INC SONIC AUTOMOTIVE INC. SONOMA VALLEY HEALTHCARE DISTRICT SONOMA VALLEY HLTH SOUTH COAST AREA TRANSIT (CA) SOUTHERN CALIFORNIA EDISON SOUTHERN CALIFORNIA RISK MANAGEMENT SOUTHERN TEXTILE RECYCLING INC (CA) SOUTHWEST AIRLINES (SWA) SOUTHWEST GAS CORPORATION SPECIALTY COFFEE SPOONER'S WOODWORKS SPROUTS FARMERS MARKET, INC. ST. ROSE HOSPITAL STANDARD FORWARDING STANDARD FRUIT & VEG STANLEY WORKS, INC. STANT CORPORATION STATE ACCIDENT INSURANCE FUND (SAIF) CORPORATION STATE COMPENSATION INSURANCE FUND (SCIF) STATE FARM STATE FUND MUTUAL STATE OF MINNESOTA - DOER STATE OF NORTH CAROLINA STATE OFFICE OF RISK MANAGEMENT STIMSON LUMBER COMPANY - MT, OR, WA STONINGTON C. CLUB SUA INSURANCE COMPANY SUMMIT HEALTH LTD SUMMIT HOLDINGS SUN MAR HEALTHCARE SUNRISE COUNTRY CLUB SUNZ INSURANCE COMPANY SUPERIOR ACCESS INS SERVICES SUPERIOR INDUSTRIES INTERNATIONAL, INC. SUPERIOR READY MIX SUPREME COURT OF CALIFORNIA SUTTER HEALTH Payer ID J1593 TX Only MN Only CA Only NY Only WI Professional Institutional All States Only Claims Claims x x x Workers' Comp Only x J1456 x x x x 41556 J1468 41556 41556 41556 J1824 J1105 J1106 J1381 41556 41556 J1731 J1817 J1690 J1648 J1233 41556 41556 41556 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x J1850 41556 J1118 41556 J1385 J1107 J1720 35076 J1548 J1553 J1555 J1659 J1418 41556 41556 40134 J1108 J1437 J1610 41556 J1584 41556 41556 41556 J1804 J1512 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only x ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name SWIFT TRANSPORTATION T.H.E. INSURANCE TAN MEDICAL GROUP TANSGUARD INSURANCE COMPANY OF AMERICA TAYLOR CORPORATION (MURPHY AND BEANE) TD TILE TECHNOLOGY INSURANCE CO TEXAS A&M TEXAS ASSOCIATION OF SCHOOL BOARDS TEXAS BUILDERS INSURANCE CO TEXAS MUTUAL INSURANCE TEXAS MUTUAL LEAGUE (TML) TEXAS ROADHOUSE INC TEXAS SMALL BUSINESS POOL THE AUTO CLUB GROUP THE GAP INC THE GENERAL INSURANCE THE JONES FINANCIAL COMPANIES, LLP THE HARTFORD Payer ID J1109 J1791 41556 J1388 J1533 41556 J1855 A0235 A0234 J1581 22945 Click Here J1676 J1110 11983 J1671 C1050 TX Only x MN Only x CA Only x x x x x x x x x J1846 J1422 J1837 THE MAIN STREET AMERICA GROUP / AMERICA ASSURANCE J1834 THE MAIN STREET AMERICA GROUP / AUSTIN MUTUAL J1835 THE MAIN STREET AMERICA GROUP / GRAIN DEALERS MUTUAL J1836 THE MAIN STREET AMERICA GROUP / GREAT LAKES CASUALTY J1838 THE MAIN STREET AMERICA GROUP / INSURANCE PROTECTION J1839 THE MAIN STREET AMERICA GROUP / MSAIC SURPLUS/NON-ADMITTED J1840 THE MAIN STREET AMERICA GROUP / NGM THE MAIN STREET AMERICA GROUP / OLD DOMINION INSURANCE COMPANYJ1841 J1842 THE MAIN STREET AMERICA GROUP / SPRING VALLEY MUTUAL THE MENS WEARHOUSE INC J1615 THE SALVATION ARMY J1472 THE SCOTTS COMPANY J1111 THE ZENITH 13269 THERAPY DIRECT J1831 41556 THOMAS STAFFING SERVICES, INC/VENTURI STAFFING TIDEWATER MARINE WESTERN J1392 TOPA INSURANCE COMPANY J1537 TOPANGA ROSCOE CORP. 41556 TOTAL PETROLEUM, INC. J1112 TOWER ENERGY GROUP J1604 TOWER INSURANCE COMPANY (FORMERLY SUA INSURANCE) 40134 TOWN OF COLMA (CA) J1668 TRACTOR SUPPLY COMPANY J1505 TRAVELERS 19046 TRAVELERS AUTO C1032 TRI-CITY HEALTHCARE DISTRICT 41556 41556 TRI-CITY LINEN SUPPL 41556 TRICITY UNIFORM x x x x x x x x x x NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only x ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name TRIDENT INSURANCE TRILLIUM STAFFING SOLUTIONS TRINITY UNIVERSAL INSURANCE TRIPLE A TRI-STATE INSURANCE COMPANY TRUCK INSURANCE EXCHANGE (COMMERCIAL ONLY) TRUMBALL INSURANCE COMPANY TUCSON UNIFIED SCHOOL DIST WC TWIN CITIES FIRE INSURANCE CO TYSON FOODS INC. U.S. STEEL UNDERWRITERS SAFETY AND CLAIMS UNIGARD INSURANCE COMPANY - QBE DBA UNION INSURANCE COMPANY UNION INSURANCE COMPANY OF PROVIDENCE UNION INSURANCE COMPANY OF PROVIDENCE UNION INSURANCE COMPANY OF PROVIDENCE UNITED CONVALESCENT UNITED DOMINION REALTY TRUST UNITED FIRE UNITED STATES COLD STORAGE UNITED SELF INSURED SERVICES UNITED WISCONSIN INSURANCE COMPANY UNITRIN AUTO & HOME INSURANCE UNITRIN DIRECT AUTO INSURANCE UNITRIN DIRECT PROPERTY & CASUALTY COMPANY UNITRIN SAFEGUARD INSURANCE UNIVERSITY OF COLORADO USAA US FOODSERVICE, INC. US MOBILE WIRELESS US NATIONAL RESOURCES (AIGRM) USS-POSCO INDUSTRIES UTICA UTICA MUTUAL INSURANCE CO UTICA NATIONAL INSURANCE CO OF TEXAS V&M RESTORATION VALENZUELA ENG. INC VALLEY CASEWORK INC VALLEY HARVESTING & PACKING, INC. VALLEY HEALTH CARE MANAGEMENT SERVICES, LLC VALLEY HEALTH SYSTEM VALLEY MEMORIAL HOSPITAL VANLINERS INSURANCE COMPANY VENTURE PAC DEVELOP VERMEER VERTICAL CONCRETE VIACOM (MURPHY AND BEANE) Payer ID J1442 J1674 C1030 11983 J1477 C1034 C1040 41556 C1040 J1732 J1396 TP108 J1484 J1274 C1029 J1433 25844 41556 J1048 J1401 J1113 J1851 J1235 C1030 C1030 16063 C1030 41556 J1822 J1114 41556 J1115 J1534 C1027 25976 43478 41556 41556 41556 41556 41556 41556 41556 21172 41556 J1118 41556 J1533 TX Only x x x x MN Only CA Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only x x ERA (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Compensation Payer List Payer Name VIAD CORP VICORP RESTAURANTS, INC. VICTOR PLASTICS VICTORIA ISD VIRGINIA SURETY COMPANY, INC. VISTA HILLS C CLUB VOUGHT AIRCRAFT INDUSTRIES W CO RADIOLOGY CNTR WAL-MART WASHINGTON COUNTY WASHINGTON HOSPITAL WATKINS MANUFACTURING CORPORATION WATTSHEALTH FOUNDATION, INC. (SNCC) WAWONA PACKING WERNER ENTERPRISES WESCO INSURANCE COMPANY WESLACO INDEPENDENT SCHOOL DISTRICT WEST BEND MUTUAL INSURANCE CO. WEST COAST HOSPITALS, INC. WEST OSO ISD WEST TEXAS RURAL COUNTIES ASSOCIATION PREFERRED RISK POOL - WC WESTAMERICA/PHIL LONG DEALERSHIPS WESTERN NATIONAL WESTERN NATIONAL ASSURANCE WESTERN NATIONAL INSURANCE \ PIONEER SPECIALITIES WESTFIELD INSURANCE WESTGUARD INSURANCE COMPANY - GUARD DBA WILLAMETTE VIEW WILLIAMS & SONOMA WILMER-HUTCHINS ISD/DALLAS ISD WOODLAND FARMS WOODLAND PARK WEST WORKFORCE SAFETY AND INSURANCE (WSI) WYMAN-GORDON COMPANIES XCEL ENERGY XCHANGING, INC XL ENVIRONMENTAL, INC. XL SPECIALTY INSURANCE YMCA YORK CLAIM SERVICES ZACHRY CONSTRUCTION Z-NAT INSURANCE (ZENITH NATIONAL) ZURICH FARMERS ZURICH INSURANCE N.A. Payer ID J1403 J1116 J1118 41556 J1404 41556 J1405 41556 J1004 41556 41556 41556 41556 41556 J1856 J1857 41556 J1420 41556 41556 41556 41556 J1495 J1569 J1586 J1858 J1453 41556 J1473 41556 J1408 41556 J1500 J1117 J1628 J1412 J1055 J1823 41556 J1421 J1409 30120 J1015 16535 TX Only x x x x x x x x x MN Only x x x CA Only x x x x x x x x NY Only WI Professional Institutional All States Only Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto Only ERA (835) x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) ABERNATHY ABILENE TRANSIT-CITY OF ABILENE ADDISON ADRIAN AGUA DULCE AGUA SUD AIRLINE IMPROVEMENT DISTRICT ALAMO ALAMO AREA COG ALAMO HEIGHTS ALAMO HOUSING AUTHORITY ALAMO REGIONAL MOBILITY AUTHORITY ALBA ALBA HOUSING AUTHORITY ALBANY ALEDO ALICE ALICE HOUSING AUTHORITY ALLEN ALMA ALPINE ALPINE HOUSING AUTHORITY ALTO ALTO HOUSING AUTHORITY ALTON ALVARADO ALVIN ALVORD AMES AMHERST ANAHUAC ANDERSON ANDERSON CAD ANDERSON COUNTY HOUSING AUTHORITY ANDERSON MILL LIMITED DISTRICT ANDREWS ANGLETON ANGLETON DRAINAGE DISTRICT ANGUS ANNA ANNETTA ANNETTA SOUTH ANNONA ANSON 77 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) ANSON HOUSING AUTHORITY ANTHONY HOUSING AUTHORITY ANTHONY TOWN OF ANTON AQUILLA WATER SUPPLY DISTRICT ARANSAS COUNTY NAV DISTRICT #1 ARANSAS PASS ARANSAS PASS HOUSING AUTHORITY ARCHER CAD ARCHER CITY ARCHER CITY HOUSING AUTHORITY ARCOLA AREA METROPOLITAN AMBULANCE AUTHORITY ARGYLE ARK-TEX COG ARLINGTON ENTERTAINMENT AMD ARP ARTS OF COLLIN COUNTY COMM INC ASHERTON ASPERMONT ASPERMONT HOUSING AUTHORITY ATASCOSA CAD ATHENS ATHENS MUNICIPAL WATER AUTH ATLANTA ATLANTA HOUSING AUTHORITY AUBREY AURORA AUSTIN CAD AUSTIN COUNTY ESD #2/SEALY VFD AUSTIN COUNTY ESD #3 AUSTIN HOUSING AUTHORITY AUSTWELL AVERY AVERY HOUSING AUTHORITY AVINGER AVINGER HOUSING AUTHORITY AZLE BACLIFF MUD BAILEY BAILEY CENTRAL APPRAISAL DIST BAILEY'S PRAIRIE VILLAGE OF BAIRD BAIRD HOUSING AUTHORITY 78 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) BALCH SPRINGS BALCONES HEIGHTS BALLINGER BALLINGER HOUSING AUTHORITY BALMORHEA BALMORHEA HOUSING AUTHORITY BANDERA BANDERA COUNTY CENTRAL APPRAISAL DIST BANDERA COUNTY FWSD #1 BANDERA COUNTY RIVER AUTHORITY & GWD BANDERA SWCD BANGS BANGS HOUSING AUTHORITY BARDWELL BARSTOW BARTLETT BARTLETT HOUSING AUTHORITY BARTON SPRINGS/EDWARDS AQUIFER BARTONVILLE BASTROP BASTROP COUNTY ESD #1 BASTROP COUNTY MUD #1 BASTROP COUNTY SWCD #340 BASTROP COUNTY WCID #2 BASTROP COUNTY WCID #3 BASTROP HOUSING AUTHORITY BAY CITY BAY CITY HOUSING AUTHORITY BAYLOR CAD BAYOU VISTA BAYSIDE TOWN OF BAYTOWN HOUSING AUTHORITY BAYVIEW IRRIGATION DISTRICT #11 BAYVIEW MUD BAYVIEW TOWN OF BEACH CITY BEASLEY BEAUMONT HOUSING AUTHORITY BECKVILLE BECKVILLE HOUSING AUTHORITY BEDFORD BEDIAS BEE CAVE BEE DEVELOPMENT AUTHORITY 79 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) BEEVILLE BEEVILLE HOUSING AUTHORITY BELL COUNTY PUBLIC HEALTH DISTRICT BELL COUNTY WCID #2 BELLA VISTA MUD BELLAIRE BELLEVUE BELLMEAD BELLS BELLVILLE BELLVILLE HOUSING AUTHORITY BELTON BENAVIDES BENBROOK BENBROOK PUBLIC LIBRARY DISTRICT BENBROOK WATER AUTHORITY BENJAMIN BERRYVILLE BERTRAM BEVERLY HILLS BEVIL OAKS BEVIL OAKS MUD BEXAR APPRAISAL DISTRICT BEXAR COUNTY HOUSING AUTHORITY BEXAR COUNTY WCID #10 BEXAR METRO 911 DISTRICT BEXAR METROPOLITAN WATER DISTRICT BEXAR-MEDINA-ATASCOSA COUNTIES WCID #1 BIG BEND SWCD #227 BIG LAKE BIG SANDY BIG SANDY HOUSING AUTHORITY BIG SPRING BIG SPRING HOUSING AUTHORITY BIG WELLS BISHOP BISHOP HILLS VILLAGE OF BISTONE MWSD BLANCO BLANCO COUNTY SOUTH LIBRARY DIST/BLANCO BLANCO-PEDERNALES GCD BLANKET BLOCK HOUSE MUD BLOOMBURG 80 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) BLOOMING GROVE BLOOMING GROVE HOUSING AUTHORITY BLOSSOM BLOSSOM PRAIRIE HOUSING AUTHORITY BLUE MOUND BLUE RIDGE BLUM BOERNE BOGATA BOGATA HOUSING AUTHORITY BOIS D'ARC MUD BOLIVAR PENINSULA SUD BONHAM BONNEY VILLAGE OF BOOKER BORDER REGION MHMR BORGER BORGER HOUSING AUTHORITY BOSQUE COUNTY CENTRAL APPRAISAL DISTRICT BOVINA BOVINA HOUSING AUTHORITY BOWIE BOWIE COUNTY ESD #1 BOWIE COUNTY ESD #2 BOWIE COUNTY SWCD BOYD BRACKETTVILLE BRACKETTVILLE HOUSING AUTHORITY BRADY BRADY HOUSING AUTHORITY BRAZORIA BRAZORIA CAD BRAZORIA COUNTY CONS/RECL DIST #3 BRAZORIA COUNTY DRAINAGE DISTRICT #5 BRAZORIA COUNTY MUD #18 BRAZORIA COUNTY MUD #23 BRAZORIA COUNTY MUD #25 BRAZORIA COUNTY MUD #26 BRAZORIA COUNTY MUD #35 BRAZORIA DRAINAGE DISTRICT #4 BRAZORIA-FORT BEND COUNTY MUD #1 BRAZOS CAD BRAZOS COUNTRY BRAZOS COUNTY ESD #1 81 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) BRAZOS COUNTY ESD #2 BRAZOS COUNTY ESD #4 BRAZOS COUNTY EMERGENCY 911 BRAZOS RIVER AUTHORITY BRAZOS VALLEY COG BRAZOS VALLEY GCD BRAZOS VALLEY SWCD #557 BRECKENRIDGE BRECKENRIDGE HOUSING AUTHORITY BREMOND BREMOND HOUSING AUTHORITY BRENHAM BRENHAM HOUSING AUTHORITY BREWSTER CAD BRIARCLIFF VILLAGE OF BRIAROAKS BRIDGE CITY BRIDGEPORT BRIDGEPORT HOUSING AUTHORITY BRIGHT STAR-SALEM SUD BRISCOE CAD BRONTE BRONTE HOUSING AUTHORITY BROOKESMITH SUD BROOKSHIRE BROOKSHIRE MUNICIPAL WATER DISTRICT BROOKSIDE VILLAGE BROWNFIELD BROWNFIELD HOUSING AUTHORITY BROWNSBORO BROWNSVILLE BROWNSVILLE HOUSING AUTHORITY BROWNSVILLE NAVIGATION DISTRICT BROWNSVILLE PUBLIC UTILITIES BOARD BROWNWOOD BROWNWOOD HOUSING AUTHORITY BRUCEVILLE-EDDY BRUSHY CREEK MUD BRYAN HOUSING AUTHORITY BRYSON BRYSON HOUSING AUTHORITY BUCKHOLTS BUDA BUENA VISTA-BETHEL SUD 82 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) BUFFALO BUFFALO GAP BUFFALO HOUSING AUTHORITY BUFFALO SPRINGS BULLARD BULVERDE BULVERDE AREA RURAL LIBRARY DISTRICT BUNKER HILL VILLAGE BURKBURNETT BURKBURNETT HOUSING AUTHORITY BURLESON BURLESON COUNTY MUD #1 BURNET BURNET CENTRAL APPRAISAL DISTRICT BURNET HOUSING AUTHORITY BURNEY ROAD MUD BURTON BYERS BYNUM CACTUS CADDO BASIN SUD CADDO MILLS CADDO MILLS HOUSING AUTHORITY CALDWELL CALDWELL CAD CALDWELL HOUSING AUTHORITY CALDWELL-TRAVIS SWCD #304 CALHOUN COUNTY DD #11 CALHOUN COUNTY E911 ECD CALHOUN COUNTY NAVIGATION DISTRICT CALHOUN COUNTY WCID #1 CALLAHAN CAD CALLAHAN COUNTY NUTRITION PROJECT CALLISBURG CALVERT CALVERT HOUSING AUTHORITY CAMERON CAMERON APPRAISAL DISTRICT CAMERON COUNTY DD #3 CAMERON COUNTY HOUSING AUTHORITY CAMERON COUNTY ID #2 CAMERON HOUSING AUTHORITY CAMP CENTRAL APPRAISAL DISTRICT CAMP WOOD 83 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) CAMPBELL CANADIAN CANEY CITY CANEY CREEK MUD CANTON CANYON CANYON HOUSING AUTHORITY CANYON LAKE COMM LIBRARY DISTRICT CANYON REGIONAL WATER AUTHORITY CAPE ROYALE UTILITY DISTRICT CAPITAL AREA COG CAPITAL AREA RURAL TRANSPORTATION SYSTEM CAPITAL METRO TRANSPORTATION AUTHORITY CARMINE CARRIZO SPRINGS CARRIZO SPRINGS HOUSING AUTHORITY CARSON CAD CASH SUD CASS CAD CASS COUNTY ESD #1 CASTRO CAD CASTROVILLE CEDAR BAYOU PARK UTILITY DISTRICT CEDAR HILL CEDAR PARK CELESTE CELINA CENTER HOUSING AUTHORITY CENTERVILLE CENTERVILLE HOUSING AUTHORITY CENTRAL COLORADO RIVER AUTHORITY CENTRAL HARRIS COUNTY REGION WATER AUTH CENTRAL TEXAS COG CENTRAL TEXAS GCD CENTRAL TEXAS REGIONAL MOBILITY AUTH CENTRAL TEXAS RURAL TRANSIT DISTRICT CENTRAL WCID CHALK HILL SUD CHAMBERS COUNTY PUBLIC HOSP DIST #1 CHANDLER CHANNING CHARLOTTE CHATEAU WOODS MUD CHEROKEE CAD 84 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) CHICO CHILDRESS CHILDRESS CAD CHILDRESS HOUSING AUTHORITY CHILLICOTHE CHINA CHINA GROVE CITY OF CHIRENO CHISHOLM TRAIL SUD CHRISTINE CIBOLO CIBOLO CREEK MUNICIPAL AUTHORITY CIMARRON MUD CINCO MUD #1 CINCO MUD #7 CINCO MUD #9 CISCO CISCO HOUSING AUTHORITY CLARENDON CLARENDON HOUSING AUTHORITY CLARKSVILLE CLARKSVILLE CITY CLARKSVILLE HOUSING AUTHORITY CLAUDE CLAY ROAD MUD CLEAR BROOK CITY MUD CLEAR CREEK WATERSHED AUTHORITY CLEAR LAKE CITY WATER AUTHORITY CLEAR LAKE SHORES CLEBURNE CLEVELAND CLIFTON CLIFTON HOUSING AUTHORITY CLINT TOWN OF CLUTE CLYDE COAHOMA COASTAL BEND COG COASTAL PLAINS COMMUNITY MHMR CENTER COCKRELL HILL COKE COUNTY SWCD #219 COLDSPRING COLEMAN COLEMAN COUNTY SUD 85 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) COLEMAN HOUSING AUTHORITY COLLEYVILLE COLLIN CO CENTRAL APPRAISAL DIST COLLIN COUNTY SWCD COLLINSVILLE COLMESNEIL COLORADO CITY COLORADO CITY HOUSING AUTHORITY COLORADO VALLEY TRANSIT DISTRICT COLUMBUS COMAL CAD COMAL COUNTY ESD #1 COMAL COUNTY ESD #3 COMAL COUNTY ESD #5 COMAL COUNTY ESD #7 COMAL COUNTY WATER ORIENTED RECREAT DIST COMANCHE COMANCHE CENTRAL APPRAISAL DISTRICT COMANCHE HOUSING AUTHORITY COMBES COMBINE COMMERCE HOUSING AUTHORITY COMMODORE COVE IMPROVEMENT DISTRICT COMO COMO HOUSING AUTHORITY CONCHO CAD CONCHO SWCD #201 CONCHO VALLEY COG CONROE CONVERSE COOKE CAD COOLIDGE COOLIDGE HOUSING AUTHORITY COOPER COOPER HOUSING AUTHORITY COPEVILLE SUD COPPELL COPPER CANYON COPPERAS COVE COPPERAS COVE HOUSING AUTHORITY CORINTH CORINTHIAN POINT MUD #2 CORPUS CHRISTI DOWNTOWN MANAGEMENT DIST CORPUS CHRISTI HOUSING AUTHORITY 86 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) CORRIGAN CORRIGAN HOUSING AUTHORITY CORSICANA CORSICANA HOUSING AUTHORITY CORYELL CAD CORYELL CITY WATER SUPPLY DISTRICT COTTONWOOD CREEK MUD #1 COTTONWOOD SHORES COTULLA COTULLA HOUSING AUTHORITY COUNTY LINE SUD COVE COVINGTON COW CREEK GCD CRANDALL CRANE CRANFILLS GAP CRAWFORD CREEDMOOR CRESSON CROCKETT CROCKETT COUNTY GCD CROCKETT COUNTY SWCD CROCKETT COUNTY WCID #1 CROSBY CENTRAL APPRAISAL DISTRICT CROSBY MUD CROSBYTON CROSBYTON HOUSING AUTHORITY CROSS PLAINS CROSS PLAINS HOUSING AUTHORITY CROSS ROADS CROSS ROADS SUD CROSS TIMBER CROSS TIMBERS SWCD #556 CROWELL CROWELL HOUSING AUTHORITY CROWLEY CRYSTAL CITY CRYSTAL CITY HOUSING AUTHORITY CUERO CUERO COMMUNITY HOSPITAL CUERO HOUSING AUTHORITY CULBERSON CAD CULBERSON COUNTY GCD 87 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) CUMBY CUMBY HOUSING AUTHORITY CUNEY CUT AND SHOOT CYPRESS SPRINGS SUD DISH TOWN OF DAINGERFIELD DAINGERFIELD HOUSING AUTHORITY DAISETTA DALHART DALLAS CAD DALLAS COUNTY FLOOD CONTROL DIST #1 DALLAS COUNTY PARK CITIES MUD DALLAS COUNTY WCID #6 DALLAS HOUSING AUTHORITY DALWORTHINGTON GARDENS DANBURY DARROUZETT DARROUZETT HOSPITAL DISTRICT DAWSON DAWSON COUNTY CENTRAL APPRAISAL DISTRICT DAWSON HOUSING AUTHORITY DAYTON DAYTON HOUSING AUTHORITY DAYTON LAKES DE LEON DE LEON HOUSING AUTHORITY DEKALB DEKALB HOUSING AUTHORITY DESOTO DEWITT CAD DEAF SMITH CAD DECATUR DEER PARK DEL RIO DEL RIO HOUSING AUTHORITY DELL CITY DELTA CAD DELTA COUNTY MUD DELTA COUNTY SWCD DENCO AREA 911 DISTRICT DENISON DENISON HOUSING AUTHORITY DENTON CENTRAL APPRAISAL DISTRICT 88 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) DENTON COUNTY TRANSPORTATION AUTH DENTON HOUSING AUTHORITY DENVER CITY DEPORT DEPORT HOUSING AUTHORITY DETROIT DETROIT HOUSING AUTHORITY DEVERS DEVIL'S RIVER SWCD #224 DEVINE DEVINE HOUSING AUTHORITY DIANA SPECIAL UTILITY DISTRICT DIBOLL HOUSING AUTHORITY DICKENS DICKINSON DILLEY DILLEY HOUSING AUTHORITY DIMMIT CAD DIMMITT DIMMITT COUNTY EMS DODD CITY DOMINO DONLEY COUNTY HOSPITAL DISTRICT DONLEY COUNTY SWCD #127 DONNA DONNA HOUSING AUTHORITY DORCHESTER DOUBLE OAK TOWN OF DOUGLASSVILLE DRIFTWOOD ECONOMIC DEVELOPMENT MGMT DIST DRIPPING SPRINGS DRIPPING SPRINGS COMMUNITY LIBRARY DIST DRISCOLL DUBLIN DUBLIN HOUSING AUTHORITY DUMAS DUNCANVILLE DUVAL CAD DUVAL COUNTY CONS/RECL DISTRICT EAGLE LAKE EAGLE PASS EAGLE PASS HOUSING AUTHORITY EAGLE PASS WATERWORKS EARLY 89 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) EARTH EAST ALDINE MANAGEMENT DISTRICT EAST BERNARD EAST CEDAR CREEK FWSD EAST CENTRAL SUD EAST DOWNTOWN MANAGEMENT DISTRICT EAST FORK SUD EAST MEDINA COUNTY SUD EAST MOUNTAIN EAST TAWAKONI EAST TEXAS COG EAST TRAVIS GATEWAY LIBRARY DISTRICT EASTLAND EASTON ECTOR ECTOR COUNTY EMERGENCY COMM DISTRICT EDCOUCH EDCOUCH HOUSING AUTHORITY EDEN EDEN HOUSING AUTHORITY EDGECLIFF VILLAGE TOWN OF EDGEWOOD EDGEWOOD HOUSING AUTHORITY EDINBURG HOUSING AUTHORITY EDMONSON EDNA EDNA HOUSING AUTHORITY EDOM EDWARDS AQUIFER AUTHORITY EDWARDS PLATEAU SWCD EL CAMPO EL CAMPO HOUSING AUTHORITY EL LAGO EL PASO CENTRAL APPRAISAL DISTRICT EL PASO COUNTY 911 DISTRICT EL PASO COUNTY ESD #1 EL PASO COUNTY ESD #2 EL PASO COUNTY HOUSING AUTHORITY EL PASO COUNTY TORNILLO WID EL PASO COUNTY WCID #4 ELDORADO ELDORADO HOUSING AUTHORITY ELECTRA ELECTRA HOUSING AUTHORITY 90 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) ELGIN ELGIN HOUSING AUTHORITY ELKHART ELLIS CENTRAL APPRAISAL DISTRICT ELLIS COUNTY ESD #9 ELLIS-PRAIRIE SWCD ELM CREEK WATERSHED AUTHORITY ELMENDORF ELSA ELSA HOUSING AUTHORITY EMERALD BAY MUD EMHOUSE EMORY ENCHANTED OAKS ENCINAL ENGELMAN IRRIGATION DISTRICT ENNIS ENNIS HOUSING AUTHORITY ERATH CAD ESCOBARES ESTELLINE EULESS EUSTACE EVANT EVERMAN FAIR OAKS RANCH FAIRFIELD FAIRVIEW FALFURRIAS FALFURRIAS HOUSING AUTHORITY FALFURRIAS UTILITY BOARD FALLS CAD FALLS CITY FALLS CITY HOUSING AUTHORITY FANNIN CAD FANNIN COUNTY SWCD FARMERS BRANCH FARMERSVILLE FARWELL FATE FAYETTE CAD FAYETTE COUNTY GWCD FAYETTE COUNTY WCID FAYETTEVILLE 91 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) FERN BLUFF MUD FERRIS FERRIS HOUSING AUTHORITY FIRST COLONY LID FIRST COLONY MANAGEMENT DISTRICT FISHER COUNTY HOSPITAL DISTRICT FLAMINGO ISLES MUD FLATONIA FLATONIA HOUSING AUTHORITY FLORENCE FLORESVILLE FLORESVILLE ELECTRIC LIGHT/POWER SYSTEM FLORESVILLE HOUSING AUTHORITY FLOWER MOUND TOWN OF FLOYDADA FLOYDADA HOUSING AUTHORITY FLYING L PUBLIC UTILITY DIST FOARD CAD FOARD COUNTY HOSPITAL DISTRICT FOLLETT FOREST HILL FOREST HILL LIBRARY DISTRICT FOREST HILLS MUD FORNEY FORSAN FORT BEND COUNTY ESD #2 FORT BEND COUNTY FWSD #1 FORT BEND COUNTY FWSD #2 FORT BEND COUNTY MUD #189 FORT BEND COUNTY MUD #25 FORT BEND COUNTY MUD #5 FORT BEND COUNTY MUD #50 FORT BEND COUNTY MUD #67 FORT BEND ESD #3 FORT CLARK MUD FORT HANCOCK WCID FORT STOCKTON FORT WORTH HOUSING AUTHORITY FOUR WAY SUD FRANKLIN FRANKLIN CAD FRANKLIN HOUSING AUTHORITY FRANKSTON FREDERICKSBURG 92 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) FREEPORT FREER FREER WCID FREESTONE CENTRAL APPRAISAL DISTRICT FRIENDSWOOD FRIO CAD FRIONA FRISCO FRISCO HOUSING AUTHORITY FRITCH FROST FRUITVALE FRUITVALE HOUSING AUTHORITY FULSHEAR FULTON GAINES CENTRAL APPRAISAL DISTRICT GAINESVILLE GAINESVILLE HOUSING AUTHORITY GALENA PARK GALLATIN GALVESTON CENTRAL APPRAISAL DISTRICT GALVESTON COUNTY DD #1 GALVESTON COUNTY DD #2 GALVESTON COUNTY FWSD #6 GALVESTON COUNTY HEALTH DISTRICT GALVESTON COUNTY MUD #12 GALVESTON COUNTY MUD #15 GALVESTON COUNTY MUD #2 GALVESTON COUNTY MUD #29 GALVESTON COUNTY MUD #3 GALVESTON COUNTY MUD #39 GALVESTON COUNTY WCID #1 GALVESTON COUNTY WCID #19 GALVESTON HOUSING AUTHORITY GANADO GARDEN RIDGE GARRETT GARRISON GARY GASTONIA-SCURRY SUD GATESVILLE GATESVILLE HOUSING AUTHORITY GEORGE WEST GEORGETOWN 93 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) GEORGETOWN HOUSING AUTHORITY GIDDINGS GILLESPIE CENTRAL APPRAISAL DISTRICT GILLESPIE COUNTY SWCD #220 GILMER GILMER HOUSING AUTHORITY GLADEWATER GLADEWATER HOUSING AUTHORITY GLASSCOCK COUNTY SWCD GLASSCOCK GCD GLEN ROSE GLENN HEIGHTS GODLEY GOLDEN CRESCENT REGIONAL PLANNING COMM. GOLDSMITH GOLDTHWAITE GOLDTHWAITE HOUSING AUTHORITY GOLIAD GOLIAD HOUSING AUTHORITY GOLINDA GONZALES GONZALES COUNTY ESD #1 GONZALES COUNTY SWCD #338 GONZALES COUNTY UWCD GONZALES HOUSING AUTHORITY GOODLOW GOODRICH GORDON GOREE GORMAN GORMAN HOUSING AUTHORITY GRAFORD GRAHAM GRANBURY GRANBURY HOUSING AUTHORITY GRAND PRAIRIE GRAND SALINE GRAND SALINE HOUSING AUTHORITY GRANDFALLS GRANDFALLS HOUSING AUTHORITY GRANDVIEW GRANDVIEW HOUSING AUTHORITY GRANGER GRANGER HOUSING AUTHORITY 94 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) GRANITE SHOALS GRANJENO GRANT ROAD PUD GRAPELAND GRAPELAND HOUSING AUTHORITY GRAPEVINE GRAPEVINE HOUSING AUTHORITY GRAY CAD GRAYSON COUNTY HOUSING AUTHORITY GREATER EAST END MGMT DISTRICT GREATER NORTHSIDE MANAGEMENT DISTRICT GREEN VALLEY SUD GREENBELT MUNICIPAL & INDUSTRIAL WA GREENSPOINT DISTRICT GREENVILLE GREENVILLE HOUSING AUTHORITY GREGG CAD GREGORY GREGORY HOUSING AUTHORITY GREY FOREST GRIMES CAD GRIMES COUNTY MUD #1 GROESBECK GROESBECK HOUSING AUTHORITY GROOM GROVES GRUVER GULF COAST WATER AUTHORITY GUN BARREL CITY GUNTER GUSTINE HACIENDAS DEL NORTE WID HACKBERRY HALE CAD HALE CENTER HALE CENTER HOUSING AUTHORITY HALE COUNTY HOUSING AUTHORITY HALE COUNTY SWCD #132 HALL CAD HALL COUNTY HOSPITAL DISTRICT HALL-CHILDRESS SWCD #109 HALLETTSVILLE HALLSVILLE HALTOM CITY 95 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) HALTOM CITY HOUSING AUTHORITY HAMILTON HAMILTON CAD HAMILTON HOUSING AUTHORITY HAMILTON/CORYELL SWCD HAMLIN HAMLIN HOUSING AUTHORITY HANSFORD CAD HAPPY HARDIN HARDIN COUNTY ESD #2 HARDIN COUNTY WCID #1 HARKER HEIGHTS HARLINGEN HARLINGEN HOUSING AUTHORITY HARLINGEN IRRIGATION DISTRICT #1 HARRIS CAD HARRIS COUNTY ESD #1 HARRIS COUNTY ESD #13 HARRIS COUNTY ESD #24 HARRIS COUNTY ESD #5 HARRIS COUNTY ESD #6 HARRIS COUNTY FWSD #27 HARRIS COUNTY FWSD #47 HARRIS COUNTY FWSD #58 HARRIS COUNTY ID#3-UPPER KIRBY MGMT DIST HARRIS COUNTY IMPROVEMENT DIST #1 HARRIS COUNTY MUD #106 HARRIS COUNTY MUD #11 HARRIS COUNTY MUD #130 HARRIS COUNTY MUD #144 HARRIS COUNTY MUD #151 HARRIS COUNTY MUD #152 HARRIS COUNTY MUD #153 HARRIS COUNTY MUD #154 HARRIS COUNTY MUD #156 HARRIS COUNTY MUD #162 HARRIS COUNTY MUD #163 HARRIS COUNTY MUD #166 HARRIS COUNTY MUD #173 HARRIS COUNTY MUD #189 HARRIS COUNTY MUD #215 HARRIS COUNTY MUD #222 HARRIS COUNTY MUD #26 96 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) HARRIS COUNTY MUD #264 HARRIS COUNTY MUD #316 HARRIS COUNTY MUD #321 HARRIS COUNTY MUD #322 HARRIS COUNTY MUD #354 HARRIS COUNTY MUD #355 HARRIS COUNTY MUD #358 HARRIS COUNTY MUD #367 HARRIS COUNTY MUD #372 HARRIS COUNTY MUD #391 HARRIS COUNTY MUD #396 HARRIS COUNTY MUD #44 HARRIS COUNTY MUD #46 HARRIS COUNTY MUD #48 HARRIS COUNTY MUD #64 HARRIS COUNTY MUNICIPAL MGMT DIST #1 HARRIS COUNTY RFPD #46 HARRIS COUNTY ROAD IMPROVEMENT DIST #1 HARRIS COUNTY UTILITY DISTRICT #15 HARRIS COUNTY WCID #145 HARRIS COUNTY WCID #155 HARRIS COUNTY WCID #156 HARRIS COUNTY WCID #36 HARRIS COUNTY WCID #50 HARRIS COUNTY WCID #92 HARRISON CENTRAL APPRAISAL DISTRICT HARRISON COUNTY SWCD HART HARTLEY CAD HASKELL HASKELL CAD HASKELL HOUSING AUTHORITY HASLET HAWK COVE HAWKINS HAWLEY HAYS HAYS CENTRAL APPRAISAL DISTRICT HAYS COUNTY ESD #5 HAYS COUNTY ESD #6 HAYS COUNTY ESD #8 HAYS COUNTY MUD #5 HAYS COUNTY SWCD #351 HAYS TRINITY GCD 97 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) HEADWATERS GCD HEARNE HEARNE HOUSING AUTHORITY HEART OF TEXAS COG HEART OF TEXAS REGION MHMR CENTER HEATH HEDLEY HEDWIG VILLAGE HELOTES HEMPHILL HEMPHILL HOUSING AUTHORITY HEMPSTEAD HENDERSON HENDERSON COUNTY ESD #1 HENDERSON COUNTY HOSPITAL AUTHORITY HENDERSON HOUSING AUTHORITY HENRIETTA HENRIETTA HOUSING AUTHORITY HEREFORD HEWITT HICKORY CREEK SUD HICKORY CREEK TOWN OF HICKORY UWCD #1 HICO HICO HOUSING AUTHORITY HIDALGO HIDALGO CAD HIDALGO COUNTY DRAINAGE DISTRICT #1 HIDALGO COUNTY HOUSING AUTHORITY/WESLACO HIDALGO COUNTY IRRIGATION DISTRICT #6 HIDALGO COUNTY WCID #19 HIDALGO HOUSING AUTHORITY HIGGINS HIGGINS/LIPSCOMB HOSPITAL DISTRICT HIGHLAND HAVEN HIGHLAND PARK TOWN OF HIGHLAND SWCD #210 HIGHLANDS AT MAYFIELD RANCH MUD HILL CAD HILL COUNTRY TRANSIT DISTRICT HILL COUNTRY UWCD HILL COUNTRY VILLAGE HILL COUNTY BLACKLAND SWCD HILL COUNTY ESD #1 98 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) HILLCREST VILLAGE HILLSBORO HILSHIRE VILLAGE HITCHCOCK HOLIDAY LAKES TOWN OF HOLLAND HOLLIDAY HOLLYWOOD PARK HONDO HONEY GROVE HOOD CAD HOOKS HOPKINS CAD HOPKINS COUNTY SWCD HORIZON CITY HORSESHOE BAY HOUSTON CAD HOUSTON HOUSING AUTHORITY HOUSTON/GALVESTON AREA COG HOWARD CAD HOWARD COUNTY 911 HOWARD SWCD #243 HOWARDWICK HOWE HUBBARD HUBBARD HOUSING AUTHORITY HUDSON OAKS HUDSPETH COUNTY CONS/RECL DIST #1 HUDSPETH COUNTY ESD #1 HUDSPETH COUNTY UWCD #1 HUDSPETH COUNTY WCID #1 HUGHES SPRINGS HUGHES SPRINGS HOUSING AUTHORITY HULL FWSD HULL-DAISETTA ESD #2 HUMBLE HUNT CAD HUNTERS CREEK VILLAGE HUNTINGTON HOUSING AUTHORITY HUNTSVILLE HUNTSVILLE HOUSING AUTHORITY HURST HUTCHINS HUTCHINSON CAD 99 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) HUTTO HUXLEY IDALOU IDLEWOOD WCID #1 INDIAN LAKE INDUSTRY INGLESIDE INGLESIDE HOUSING AUTHORITY INGLESIDE ON THE BAY INGRAM INVERNESS FOREST ID IOLA IOWA COLONY VILLAGE OF IOWA PARK IRAAN IREDELL IRION CAD IRION COUNTY WATER CONSERVATION DISTRICT ISAACSON MUD ITALY ITASCA JACINTO CITY JACK CAD JACK COUNTY HOSPITAL DISTRICT JACKSBORO JACKSON CAD JACKSON COUNTY ESD #1 JACKSON COUNTY HOSPITAL DISTRICT JACKSON COUNTY WCID #2 JACKSONVILLE JACKSONVILLE HOUSING AUTHORITY JAMAICA BEACH JARRELL JAYTON JEFFERSON JEFFERSON COUNTY DRAINAGE DISTRICT #6 JEFFERSON HOUSING AUTHORITY JERSEY VILLAGE JEWETT JIM HOGG COUNTY HOUSING AUTHORITY JIM HOGG COUNTY WCID #2 JIM WELLS COUNTY FWSD #1 JOHNSON CITY JOHNSON CITY HOUSING AUTHORITY 100 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) JOHNSON COUNTY CENTRAL APPRAISAL DIST JOHNSON COUNTY ESD #1 JOHNSON COUNTY SUD JOHNSON COUNTY SWCD #541 JONAH WATER SUD JONES CAD JONES CREEK VILLAGE OF JONESTOWN JOSEPHINE JOSHUA JOURDANTON JOURDANTON HOUSING AUTHORITY JUNCTION JUNCTION HOUSING AUTHORITY JUSTIN KARNES CITY KARNES CITY HOUSING AUTHORITY KATY KAUFMAN KAUFMAN AREA RURAL TRANSPORTATION KAUFMAN CAD KAUFMAN-VAN ZANDT ROCKWALL COUNTY SWCD KEENE KELLER KELLY LANE WCID #1 KELLY LANE WCID #2 KEMAH KEMP KEMP HOUSING AUTHORITY KEMPNER KENDALL COUNTY WCID #1 KENEDY KENEDY HOUSING AUTHORITY KENEFICK KENNARD KENNEDALE KERENS KERENS HOUSING AUTHORITY KERMIT KERR CENTRAL APPRAISAL DISTRICT KERR COUNTY SWCD #217 KERR EMERGENCY 911 NETWORK KERRVILLE KERRVILLE PUBLIC UTILITY BOARD 101 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) KILGORE KILLEEN KILLEEN HOUSING AUTHORITY KIMBLE CENTRAL APPRAISAL DISTRICT KINGSLAND MUD KINGSVILLE KINGSVILLE HOUSING AUTHORITY KINNEY CAD KINNEY COUNTY GCD KIRBY KIRBYVILLE KIRBYVILLE HOUSING AUTHORITY KLEBERG CAD KNOLLWOOD KNOX CITY KNOX CITY HOUSING AUTHORITY KOSSE KOUNTZE KRESS KRUGERVILLE KRUM KURTEN KYLE KYLE HOUSING AUTHORITY LA COSTE LA FERIA LA FERIA IRRIGATION DIST #3 LA GRANGE LA GRANGE HOUSING AUTHORITY LA GRULLA LA JOYA LA JOYA HOUSING AUTHORITY LA MARQUE LA PORTE LA VILLA LACY-LAKEVIEW LADONIA LAGO VISTA LAGUNA MADRE WATER DISTRICT LAGUNA VISTA LAKE BRIDGEPORT LAKE CITIES MUA LAKE DALLAS LAKE JACKSON 102 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) LAKE MUD LAKE TANGLEWOOD LAKE TRAVIS COMM LIBRARY DIST LAKE WORTH LAKEPORT LAKESIDE (TARRANT CO) LAKESIDE CITY LAKEVIEW LAKEVIEW POLICE DEPARTMENT LAKEWAY LAKEWAY MUD LAKEWOOD VILLAGE LAMAR CAD LAMAR SWCD LAMESA LAMPASAS LAMPASAS CAD LANCASTER LAREDO LAREDO HOUSING AUTHORITY LAREDO TRANSIT LATEXO LAVACA COUNTY CENTRAL APPRAISAL DISTRICT LAVACA-NAVIDAD RIVER AUTHORITY LAVON LAZY RIVER IMPROVEMENT DISTRICT LEAGUE CITY LEAKEY LEANDER LEE CAD LEFORS LEON CAD LEON VALLEY LEONA LEONARD LEONARD HOUSING AUTHORITY LEVELLAND LEVELLAND HOUSING AUTHORITY LEXINGTON LIBERTY LIBERTY COUNTY DD #2 LIBERTY COUNTY DD #4 LIBERTY COUNTY ESD #3 LIBERTY COUNTY WCID #5 103 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) LIBERTY HILL LIBERTY HILL PUBLIC LIBRARY DISTRICT LIMESTONE CAD LIMESTONE COUNTY SENIOR SERVICES PROJECT LIMESTONE-FALLS SWCD LINDALE LINDEN LINDEN HOUSING AUTHORITY LINDSAY LIPAN LIPAN-KICKAPOO WCD LIPSCOMB CO CENTRAL APPRAISAL DIST LITTLE ELM LITTLE RIVER ACADEMY LITTLE RIVER-SAN GABRIEL SWCD #508 LITTLEFIELD LIVE OAK LIVERPOOL LIVINGSTON LIVINGSTON HOUSING AUTHORITY LLANO LLANO CENTRAL APPRAISAL DISTRICT LLANO COUNTY MUD #1 LLANO COUNTY SWCD #233 LLANO ESTACADO UWCD LLANO HOUSING AUTHORITY LOCKHART LOCKHART HOUSING AUTHORITY LOCKNEY LOCKNEY HOUSING AUTHORITY LOG CABIN LOMETA LOMETA HOUSING AUTHORITY LONE OAK LONE STAR LONE WOLF GCD LONGVIEW LORAINE LORAINE HOUSING AUTHORITY LORENA LORENZO LOS FRESNOS LOS FRESNOS HOUSING AUTHORITY LOS INDIOS 104 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) LOST CREEK MUD LOTT LOTT HOUSING AUTHORITY LOUETTA NORTH PUD LOUETTA ROAD UD LOWER CLEAR FORK/BRAZOS SWCD #551 LOWER RIO GRANDE VALLEY DEV COUNCIL LOWER TRINITY GCD LOWER VALLEY WATER DISTRICT LOWRY CROSSING LUBBOCK CENTRAL APPRAISAL DISTRICT LUBBOCK COUNTY WCID #1 LUBBOCK EMERGENCY COMMUNICATION DISTRICT LUBBOCK HOUSING AUTHORITY LUBBOCK-CITIBUS LUBBOCK/REESE REDEVELOPMENT AUTHORITY LUCAS LUCE BAYOU PUD LUEDERS LUELLA SUD LULING LULING HOUSING AUTHORITY LUMBERTON LUMBERTON MUD LYFORD LYNN CAD LYTLE MHMR OF TARRANT COUNTY MABANK MABANK HOUSING AUTHORITY MACBEE SUD MACEDONIA EYLAU MUD MACKENZIE MUNICIPAL WATER AUTHORITY MADISON CAD MADISONVILLE MADISONVILLE HOUSING AUTHORITY MAGNOLIA MALAKOFF MALAKOFF HOUSING AUTHORITY MALONE MANOR MANSFIELD MANVEL MARBLE FALLS 105 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) MARFA MARFA HOUSING AUTHORITY MARIETTA MARILEE SUD MARION MARION CASS SWCD MARION COUNTY HOSPITAL DISTRICT MARKHAM MUD MARLIN MARLIN HOUSING AUTHORITY MARQUEZ MARSHALL MARSHALL HARRISON COUNTY HEALTH DIST MARSHALL HOUSING AUTHORITY MART MART HOUSING AUTHORITY MARTIN COUNTY FRESH WATER DISTRICT MARTINDALE MASON MASON HOUSING AUTHORITY MASON SWCD #223 MATADOR MATADOR HOUSING AUTHORITY MATADOR WATER DISTRICT MATAGORDA COUNTY WCID #6 MATHIS MATHIS HOUSING AUTHORITY MAUD MAUD HOUSING AUTHORITY MAVERICK CAD MAVERICK COUNTY HOSPITAL DIST MAVERICK COUNTY WCID #1 MAVERICK SWCD #228 MAYPEARL MCALLEN HOUSING AUTHORITY MCCAMEY MCCULLOCH CAD MCCULLOCH SWCD #249 MCGREGOR MCGREGOR HOUSING AUTHORITY MCKINNEY MCKINNEY HOUSING AUTHORITY MCLEAN MCLEAN HOUSING AUTHORITY 106 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) MCLENDON-CHISHOLM MCLENNAN CAD MCLENNAN COUNTY WCID #2 MEADOW MEADOWLAKES MEADOWS PLACE MEDINA CAD MEDINA COUNTY 911 MEDINA COUNTY WCID #2 MEDINA VALLEY SWCD MEGARGEL MELISSA MELVIN MEMORIAL POINT UD MEMORIAL VILLAGES POLICE DEPT MEMORIAL VILLAGES WATER AUTHORITY MEMPHIS MEMPHIS HOUSING AUTHORITY MENARD MENARD COUNTY SWCD #215 MERCEDES HOUSING AUTHORITY MERIDIAN MERIDIAN HOUSING AUTHORITY MERKEL MERKEL HOUSING AUTHORITY MERTENS MERTZON MESA UWCD MESQUITE MESQUITE GROUNDWATER CONS DISTRICT MEXIA MEXIA HOUSING AUTHORITY MIAMI MIDDLE CONCHO SWCD MIDDLE RIO GRANDE COG MIDDLE TRINITY GCD MIDLAND CENTRAL APPRAISAL DISTRICT MIDLAND COUNTY HOUSING AUTHORITY MIDLAND EMERGENCY COMM DIST MIDLAND HOUSING AUTHORITY MIDLAND SWCD MIDLOTHIAN MIDLOTHIAN/WAXAHACHIE AIRPORT MIDWAY 107 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) MILAM CAD MILDRED MILFORD MILLS CAD MILLSAP MINEOLA MINEOLA HOUSING AUTHORITY MINERAL WELLS MINERAL WELLS HOUSING AUTHORITY MINGUS MISSION MISSION HOUSING AUTHORITY MISSOURI CITY MITCHELL COUNTY SWCD MOBEETIE MONAHANS MONAHANS HOUSING AUTHORITY MONT BELVIEU MONTAGUE COUNTY TAX APPRAISAL DIST MONTGOMERY MONTGOMERY COUNTY ECD MONTGOMERY COUNTY ESD #1 MONTGOMERY COUNTY ESD #10 MONTGOMERY COUNTY ESD #11 MONTGOMERY COUNTY ESD #12 MONTGOMERY COUNTY ESD #14 MONTGOMERY COUNTY ESD #2 MONTGOMERY COUNTY ESD #3 MONTGOMERY COUNTY ESD #4 MONTGOMERY COUNTY ESD #6 MONTGOMERY COUNTY ESD #7 MONTGOMERY COUNTY ESD #8 MONTGOMERY COUNTY ESD #9 MONTGOMERY COUNTY HOUSING AUTHORITY MONTGOMERY COUNTY WCID #1 MOODY MOODY HOUSING AUTHORITY MORAN MORGAN MORGAN'S POINT MORGAN'S POINT RESORT MORRIS CAD MORTON MOTLEY CAD 108 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) MOTLEY COUNTY HOSPITAL DISTRICT MOULTON MOUNT CALM MOUNT ENTERPRISE MOUNT PLEASANT MOUNT PLEASANT HOUSING AUTHORITY MOUNT VERNON MOUNT VERNON HOUSING AUTHORITY MOUNTAIN CITY MOUNTAIN PEAK SUD MUENSTER MULESHOE MULESHOE HOUSING AUTHORITY MUNDAY MUNDAY HOUSING AUTHORITY MURCHISON MURPHY MUSTANG RIDGE NACOGDOCHES HOUSING AUTHORITY NAPLES NAPLES HOUSING AUTHORITY NASH NASSAU BAY NATALIA NAVARRO CENTRAL APPRAISAL DISTRICT NAVARRO SWCD NAVASOTA NAVASOTA HOUSING AUTHORITY NAZARETH NECHES/TRINITY VALLEY GCD NEDERLAND NEEDVILLE NEVADA NEW BERLIN NEW BOSTON NEW BOSTON HOUSING AUTHORITY NEW BRAUNFELS NEW BRAUNFELS HOUSING AUTHORITY NEW BRAUNFELS UTILITIES NEW DEAL NEW FAIRVIEW NEW HOME NEW HOPE SUD NEW LONDON 109 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) NEW SUMMERFIELD NEW WAVERLY NEWARK NEWCASTLE NEWCASTLE HOUSING AUTHORITY NEWTON CENTRAL APPRAISAL DISTRICT NEWTON COUNTY ESD #5 NIEDERWALD NIXON NIXON HOUSING AUTHORITY NOCONA NOLANVILLE NOME NOONDAY NORDHEIM NORMANGEE NORTEX REGIONAL PLANNING COMMISSION NORTH CENTRAL TEXAS COG NORTH CENTRAL TEXAS MWA NORTH CHANNEL WATER AUTHORITY NORTH CONCHO RIVER SWCD NORTH GREEN MUD NORTH HARRIS CO REG WATER AUTH NORTH TEXAS TOLLWAY AUTHORITY NORTH ZULCH MUD NORTHAMPTON MUD NORTHEAST GAINES COUNTY ESD #1 NORTHEAST TEXAS PUBLIC HEALTH DISTRICT NORTHLAKE NORTHTOWN MUD NORTHWEST GRAYSON COUNTY WCID #1 NORTHWEST HARRIS COUNTY MUD #22 NORTHWEST HARRIS COUNTY MUD #30 NORTHWEST HARRIS COUNTY MUD #36 NUECES CAD NUECES COUNTY DD #2 NUECES COUNTY ESD #1 NUECES COUNTY ESD #4 NUECES COUNTY WCID #3 NUECES COUNTY WCID #4 NUECES COUNTY WCID #5 O'DONNELL O'DONNELL HOUSING AUTHORITY OST/ALMEDA CORRIDORS REDEVELOPMENT AUTH 110 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) OAK LEAF OAK POINT OAK RIDGE (COOKE CO) OAK RIDGE (KAUFMAN CO) OAK RIDGE NORTH OAKWOOD ODEM ODEM HOUSING AUTHORITY ODESSA HOUSING AUTHORITY OGLESBY OGLESBY HOUSING AUTHORITY OLD RIVER-WINFREE OLDHAM CAD OLMOS PARK OLNEY OLNEY HOUSING AUTHORITY OLTON OLTON HOUSING AUTHORITY OMAHA OMAHA HOUSING AUTHORITY ONALASKA OPDYKE WEST ORANGE ORANGE CAD ORANGE CO ESD #2/BRIDGE CITY VFD ORANGE COUNTY ESD #1 ORANGE COUNTY ESD #3 ORANGE COUNTY ESD #4 ORANGE COUNTY WCID #1 ORANGE COUNTY WCID #2 ORANGE GROVE ORANGE HOUSING AUTHORITY ORCHARD ORE CITY OVERTON OVERTON HOUSING AUTHORITY OVILLA OYSTER CREEK PADUCAH PADUCAH HOUSING AUTHORITY PAINT ROCK PALACIOS PALACIOS HOUSING AUTHORITY PALESTINE 111 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) PALISADES VILLAGE PALM VALLEY PALMER PALMHURST PALMVIEW PALO DURO RIVER AUTHORITY PALO PINTO APPRAISAL DISTRICT PALO PINTO SWCD #518 PALOMA LAKE MUD #1 PALOMA LAKE MUD #2 PAMPA PANHANDLE PANHANDLE REGIONAL PLNG COMM PANOLA CAD PANOLA COUNTY ESD #1 PANOLA COUNTY FWD #1 PANOLA SWCD #448 PANORAMA VILLAGE PANTEGO PARADISE PARIS PARIS HOUSING AUTHORITY PARKER PARKER CAD PARKER COUNTY SWCD #558 PARKSIDE AT MAYFIELD RANCH MUD PARMER CAD PASADENA PATTISON PATTON VILLAGE PAYNE SPRINGS PEARLAND PEARSALL PEARSALL HOUSING AUTHORITY PECAN BAYOU SWCD #553 PECAN HILL PECAN VALLEY GCD PECOS PECOS COUNTY WCID #1 PECOS COUNTY WID #2 PECOS COUNTY WID #3 PECOS HOUSING AUTHORITY PEDERNALES SWCD #218 PELICAN BAY 112 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) PENELOPE PENITAS PERMIAN BASIN REGIONAL PLANNING COMM PERMIAN BASIN UWCD PERRYTON PETROLIA PETTUS MUD PFLUGERVILLE PHARR PHARR HOUSING AUTHORITY PHELPS SUD PILOT POINT PINE FOREST PINEHURST PINEY POINT VILLAGE PITTSBURG PITTSBURG HOUSING AUTHORITY PLAINS PLAINVIEW PLAINVIEW HOUSING AUTHORITY PLANO HOUSING AUTHORITY PLATEAU UWCSD PLEAK PLEASANTON PLEASANTON HOUSING AUTHORITY PLEASURE ISLAND COMMISSION POINT POINT AQUARIUS MUD POINT COMFORT POINT HOUSING AUTHORITY POINT VENTURE POLITICAL SUBDIVISION WC ALLIANCE PONDER PORT ARANSAS PORT ARTHUR PORT ARTHUR HOUSING AUTHORITY PORT ISABEL PORT ISABEL HOUSING AUTHORITY PORT ISABEL/SAN BENITO NAVIGATION DIST PORT LAVACA PORT LAVACA HOUSING AUTHORITY PORT NECHES PORT OF CORPUS CHRISTI AUTHORITY PORT OF HARLINGEN AUTHORITY 113 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) PORT OF LIBERTY COMMISSION PORTER SUD PORTLAND POST POST HOUSING AUTHORITY POST OAK SUD POST OAK SAVANNAH GCD POTEET POTEET HOUSING AUTHORITY POTH POTTER-RANDALL COUNTY ECD POTTSBORO POYNOR PRAIRIE VIEW PREMONT PRESIDIO PRESIDIO CAD PRIMERA PRINCETON PROGRESO PROGRESO LAKES PROSPER PUBLIC TRANSIT SERVICES PUTNAM PYOTE QUAIL CREEK MUD QUAIL VALLEY UD QUANAH QUANAH HOUSING AUTHORITY QUEEN CITY QUINLAN QUINTANA QUITAQUE QUITMAN RAINS CAD RALLS RALLS HOUSING AUTHORITY RANCH AT CYPRESS CREEK MUD #1 RANCHO VIEJO RANGER RANGER HOUSING AUTHORITY RANKIN RANKIN HOUSING AUTHORITY RANSOM CANYON 114 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) RAYMONDVILLE REAL CAD REAL EDWARDS CONS/RECL DIST RED BLUFF WATER POWER CONTROL DIST RED OAK RED RIVER AUTHORITY OF TEXAS RED RIVER CAD RED RIVER SWCD RED SANDS GCD REDWATER REEVES CAD REEVES COUNTY WID #1 REFUGIO REFUGIO COUNTY WCID #1 REGIONAL TRANSPORTATION AUTHORITY REKLAW RENO RENO (PARKER COUNTY) RETREAT RHOME RICE RICHLAND RICHLAND HILLS RICHLAND SUD RICHLAND SPRINGS RICHMOND RICHWOOD RIESEL RIO GRANDE COG RIO GRANDE CITY RIO VISTA RISING STAR RISING STAR HOUSING AUTHORITY RIVER OAKS RIVER PLANTATION MUD RIVERSIDE RIVIERA WCID ROANOKE ROARING SPRINGS ROBERT LEE ROBERT LEE HOUSING AUTHORITY ROBERTSON CAD ROBINSON ROBSTOWN 115 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) ROBSTOWN HOUSING AUTHORITY ROBSTOWN UTILITY SYSTEMS ROBY ROBY HOUSING AUTHORITY ROCHESTER ROCKDALE ROCKDALE HOUSING AUTHORITY ROCKETT SUD ROCKPORT ROCKSPRINGS ROCKWALL ROCKWALL HOUSING AUTHORITY ROGERS ROGERS HOUSING AUTHORITY ROLLING PLAINS GCD ROLLING PLAINS MEMORIAL HOSPITAL DIST ROLLINGWOOD ROMA ROMA HOUSING AUTHORITY ROMAN FOREST ROMAN FOREST PUD #3 ROPESVILLE ROSCOE ROSE CITY ROSE HILL SUD ROSEBUD ROSEBUD HOUSING AUTHORITY ROSENBERG ROSENBERG HOUSING AUTHORITY ROTAN ROTAN HOUSING AUTHORITY (FMHA) ROUND ROCK ROUND ROCK HOUSING AUTHORITY ROUND TOP ROWLETT ROXTON ROYALWOOD MUD ROYSE CITY ROYSE CITY HOUSING AUTHORITY RULE RUNAWAY BAY RUNGE RUNGE HOUSING AUTHORITY RUNNELS CAD 116 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) RURAL ECONOMIC ASST LEAGUE INC RURAL TAYLOR COUNTY AGING SERVICE RUSK RUSK COUNTY ESD #1 RUSK COUNTY GCD RUSK COUNTY RURAL RAIL DISTRICT RUSK HOUSING AUTHORITY RUSK SWCD #447 SABINAL SABINE/NECHES NAVIGATION DISTRICT SACHSE SADLER SAGEMEADOW UTILITY DISTRICT SAGINAW SAINT GEORGE PL REDEV AUTH REINVEST Z#1 SAINT HEDWIG SAINT JO SAINT PAUL SALADO SALADO PUBLIC LIBRARY DISTRICT SALT FORK SWCD #133 SAN ANGELO HOUSING AUTHORITY SAN ANTONIO SAN ANTONIO HOUSING AUTHORITY SAN ANTONIO MUD #1 SAN AUGUSTINE HOUSING AUTH SAN BENITO SAN BENITO HOUSING AUTHORITY SAN DIEGO SAN DIEGO MUD #1 SAN FELIPE SAN JACINTO COUNTY ESD SAN JUAN SAN JUAN HOUSING AUTHORITY SAN LEANNA SAN LEON MUD SAN MARCOS SAN MARCOS HOUSING AUTHORITY SAN PATRICIO CAD SAN PATRICIO MWD SAN SABA SAN SABA CAD SAN SABA HOUSING AUTHORITY SAN SABA SWCD #250 117 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) SAN YGNACIO MUD SANDY POINT SANFORD SANGER SANSOM PARK SANTA ANNA SANTA ANNA HOUSING AUTHORITY SANTA CLARA SANTA CRUZ IRRIGATION DIST #15 SANTA FE SANTA RITA UWCD SANTA ROSA SAVOY SCHERTZ SCHERTZ HOUSING AUTHORITY SCHULENBURG SCHULENBURG HOUSING AUTHORITY SCOTLAND SCURRY CAD SEABROOK SEADRIFT SEAGOVILLE SEAGRAVES SEAGRAVES HOUSING AUTHORITY SEALY SEBASTIAN MUD SEGUIN SEGUIN HOUSING AUTHORITY SEIS LAGOS UD SELMA SEMINOLE SEVEN OAKS SEVEN POINTS SEYMOUR SEYMOUR HOUSING AUTHORITY SHACKELFORD CAD SHADY HOLLOW MUD SHADY SHORES SHALLOWATER SHAMROCK SHAVANO PARK SHELBY CAD SHELBY COUNTY SWCD SHELDON ROAD MUD 118 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) SHENANDOAH SHEPHERD SHERMAN SHERMAN CAD SHERMAN HOUSING AUTHORITY SHINER SHOREACRES SIESTA SHORES WCID SILSBEE SILVERTON SIMONTON SINTON SINTON HOUSING AUTHORITY SKELLYTOWN SLATON SLATON HOUSING AUTHORITY SMILEY SMILEY HOUSING AUTHORITY SMITH CAD SMITH COUNTY 911 COMM DIST SMITH COUNTY ESD #1 SMITH COUNTY MUD #1 SMITHVILLE SMITHVILLE HOUSING AUTHORITY SMYER SNOOK SOCORRO SOMERSET SOMERVELL CENTRAL APPRAISAL DISTRICT SOMERVELL COUNTY WATER DISTRICT SOMERVILLE SONORA SOUR LAKE SOUTH EAST TEXAS PLANNING COMMISSION SOUTH HOUSTON SOUTH PADRE ISLAND SOUTH PLAINS ASSOCIATION OF GOVERNMENTS SOUTH PLAINS PUBLIC HEALTH DISTRICT SOUTH PLAINS UWCD SOUTH TEXAS DEVELOPMENT COUNCIL SOUTH TEXAS WATER AUTHORITY SOUTH TEXAS WEATHER MODIFICATION ASSOC SOUTHEAST TEXAS GROUNDWATER CONS DIST SOUTHERN MONTGOMERY COUNTY MUD 119 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) SOUTHERN TRINITY GCD SOUTHLAKE SOUTHMAYD SOUTHSIDE PLACE SOUTHWEST FANNIN SUD SOUTHWEST TX RAIN ENHANCEMENT ASSOC SPEARMAN SPEARMAN HOUSING AUTHORITY SPLENDORA SPRING BRANCH MGMT DISTRICT SPRING VALLEY SPRINGLAKE SPRINGTOWN SPRINGWOODS MUD SPUR SPUR HOUSING AUTHORITY STAFFORD STAGECOACH STAMFORD STAMFORD HOUSING AUTHORITY STANTON STANTON HOUSING AUTHORITY STAR HARBOR STARR CAD STARR COUNTY HOUSING AUTHORITY STEPHENS CAD STEPHENS REGIONAL SUD STEPHENVILLE STERLING CITY STERLING COUNTY APPRAISAL DISTRICT STERLING COUNTY UWCD STINNETT STOCKDALE STOCKDALE HOUSING AUTHORITY STONEWALL RANCH MUD STONEWALL SWCD #167 STRATFORD STRAWN STRAWN HOUSING AUTHORITY STREETMAN SUDAN SUGAR LAND SULLIVAN CITY SULPHUR SPRINGS 120 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) SULPHUR-CYPRESS SWCD SUNBELT FWSD SUNDOWN SUNNYVALE SUNRAY SUNRISE BEACH VILLAGE SUNSET VALLEY SURFSIDE BEACH SUTTON COUNTY UWCD SWEENY SWEETWATER SWEETWATER HOUSING AUTHORITY SWISHER CAD TML TML-IEBP TML-IRP TRI SUD TAFT TAFT HOUSING AUTHORITY TAHOKA TALCO TALCO HOUSING AUTHORITY TALTY TARA GLEN MUD TARKINGTON SUD TARRANT COUNTY 911 DISTRICT TATUM TATUM HOUSING AUTHORITY TAX INCREMENT REINVESTMENT ZONE #1 TAX INCREMENT REINVESTMENT ZONE #11 TAYLOR TAYLOR HOUSING AUTHORITY TAYLOR LAKE VILLAGE TEAGUE TEAGUE HOUSING AUTHORITY TEHUACANA TEMPLE TEMPLE HOUSING AUTHORITY TENAHA TERRELL TERRELL HILLS TERRY MEMORIAL HOSPITAL DIST TEXANA MHMR CENTER TEXARKANA 121 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) TEXARKANA HOUSING AUTHORITY TEXARKANA WATER UTILITIES TEXARKANA-BOWIE CO FAM HEALTH CLINIC TEXAS ASSOC OF REGIONAL COUNCILS TEXAS CITY TEXAS CITY HOUSING AUTHORITY TEXAS CITY TIRZ #1 TEXAS HOUSING FOUNDATION TEXAS MUNICIPAL POWER AGENCY TEXAS MUNICIPAL RETIREMENT SYSTEM TEXHOMA TEXLINE TEXOMA AREA PARATRANSIT SYS INC TEXOMA AREA SOLID WASTE AUTH TEXOMA COG THE COLONY THE COLONY MUD #1A THE COLONY MUD #1B THE COLONY MUD #1C THE COLONY MUD #1D THE COLONY MUD #1E THE COLONY MUD #1F THE COLONY MUD #1G THE WOODLANDS TOWNSHIP THOMPSONS THORNDALE THORNDALE HOUSING AUTHORITY THORNTON THORNTONVILLE THRALL THREE RIVERS THREE RIVERS HOUSING AUTHORITY THROCKMORTON THROCKMORTON CENTRAL APPRAISAL DIST THROCKMORTON HOUSING AUTHORITY TIKI ISLAND TIMBERCREEK CANYON VILLAGE OF TIMPSON TIMPSON HOUSING AUTHORITY TIOGA TIOGA HOUSING AUTHORITY TITUS CAD TODD MISSION TOLAR 122 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) TOM BEAN TOMBALL TOOL TOYAH TOYAH-LIMPIA SWCD TRAVIS COUNTY ESD #1 TRAVIS COUNTY ESD #12 TRAVIS COUNTY ESD #14 TRAVIS COUNTY ESD #2 TRAVIS COUNTY ESD #3 TRAVIS COUNTY ESD #6 TRAVIS COUNTY ESD #9 TRAVIS COUNTY FIRE/RESCUE ESD #11 TRAVIS COUNTY HOUSING AUTHORITY TRAVIS COUNTY MUD #11 TRAVIS COUNTY MUD #12 TRAVIS COUNTY MUD #13 TRAVIS COUNTY MUD #16 TRAVIS COUNTY MUD #2 TRAVIS COUNTY WCID #17 TRAVIS COUNTY WCID #19 TRAVIS COUNTY WCID-POINT VENTURE TREASURE ISLAND MUD TRENT TRENTON TRINIDAD TRINIDAD HOUSING AUTHORITY TRINITY TRINITY GLEN ROSE GCD TROPHY CLUB TROUP TROY TULIA TULIA HOUSING AUTHORITY TURKEY TUSCOLA TWO WAY SUD TYE TYLER COUNTY ESD #1 TYLER COUNTY ESD #7 UHLAND UNCERTAIN UNIVERSAL CITY UNIVERSITY PARK 123 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) UPPER BRUSHY CREEK WCID UPPER CLEAR FORK SWCD UPPER GUADALUPE RIVER AUTHORITY UPPER KIRBY REDEV AUTH TIRZ 19 HOUSTON UPPER LEON RIVER MWD UPPER LEON SWCD #525 UPPER LLANOS SWCD UPPER PECOS SWCD UPPER SABINE SWCD UPPER TRINITY REGIONAL WATER DIST UPSHUR CAD UPSHUR-GREGG COUNTY SWCD UPTON CAD UPTON COUNTY ESD #1 UPTON COUNTY ESD #2 UPTON COUNTY WATER DISTRICT #1 UVALDE UVALDE CAD UVALDE COUNTY UWCD UVALDE HOUSING AUTHORITY VALLEY ACRES IRRIGATION DISTRICT VALLEY INTERNATIONAL AIRPORT VALLEY MUD #2 VALLEY MILLS VALLEY VIEW VAN VAN ALSTYNE VAN HORN VAN HORN HOUSING AUTHORITY VAN HOUSING AUTHORITY VAN ZANDT CAD VARNER CREEK UD VEGA VELASCO DRAINAGE DISTRICT VENUS VERNON VERNON HOUSING AUTHORITY VICTORIA VICTORIA COUNTY GCD VICTORIA COUNTY WCID #2 VICTORIA HOUSING AUTHORITY VIDOR VILLAGE OF THE HILLS VINTON 124 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) VISTA MUD VOLENTE WACO CITY OF WACO TRANSIT SYSTEM WACO HOUSING AUTHORITY WAELDER WAELDER HOUSING AUTHORITY WAKE VILLAGE WALKER COUNTY ESD #1 WALKER COUNTY ESD #2 WALKER COUNTY HOUSING AUTHORITY WALKER COUNTY SUD WALLER WALLER COUNTY RID #1 WALLIS WALNUT CREEK SUD WALNUT SPRINGS WALSH RANCH MUD WARD CAD WARD COUNTY WID #2 WARREN CITY WASKOM WATAUGA WATERWOOD MUD #1 WAXAHACHIE WAXAHACHIE HOUSING AUTHORITY WEATHERFORD WEATHERFORD HOUSING AUTHORITY WEBB CAD WEBBERVILLE WEBSTER WEIMAR WEIR WELLINGTON WELLINGTON HOUSING AUTHORITY WELLMAN WELLS WELLS BRANCH COMMUNITY LIBRARY WELLS BRANCH MUD WES-TEX GCD WESLACO HOUSING AUTHORITY WEST WEST BASTROP VILLAGE MUD WEST BRAZORIA COUNTY DD #11 WEST CEDAR CREEK MUD 125 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) WEST COLUMBIA WEST GREGG SUD WEST HARRIS COUNTY MUD #2 WEST HARRIS COUNTY MUD #9 WEST LAKE HILLS WEST NUECES-LAS MORAS SWCD WEST ORANGE WEST TAWAKONI WEST TEXAS WEATHER MOD ASSOC WEST TRAVIS COUNTY MUD #5 WEST TRAVIS COUNTY MUD #8 WEST UNIVERSITY PLACE WEST WISE SUD WESTBANK COMM LIBRARY DISTRICT WESTBROOK WESTCHASE DISTRICT WESTLAKE WESTON WESTON LAKES WESTON MUD WESTOVER HILLS WESTWOOD SHORES MUD WESTWORTH VILLAGE WHARTON WHEELER WHEELER CAD WHITE DEER WHITE OAK WHITE RIVER MUNICIPAL WATER DISTRICT WHITE ROCK SUD WHITE SETTLEMENT WHITEFACE WHITEHOUSE WHITESBORO WHITESBORO HOUSING AUTHORITY WHITEWRIGHT WHITNEY WHITNEY HOUSING AUTHORITY WICHITA APPRAISAL DISTRICT WICHITA FALLS HOUSING AUTHORITY WICKETT WICKSON CREEK SUD WILBARGER CREEK MUD #1 WILBARGER CREEK MUD #2 126 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) WILLACY CO NAV DIST/PORT MANS PUD WILLACY COUNTY DRAINAGE DISTRICT #1 WILLIAMSON COUNTY ESD #1 WILLIAMSON COUNTY ESD #4 WILLIAMSON COUNTY ESD #7 WILLIAMSON COUNTY MUD #10 WILLIAMSON COUNTY MUD #11 WILLIAMSON COUNTY MUD #15 WILLIAMSON COUNTY MUD #9 WILLIAMSON/TRAVIS CO WCID #1G WILLIS WILLOW FORK DD WILLOW PARK WILLS POINT WILLS POINT HOUSING AUTHORITY WILMER WILSON WIMBERLEY WIMBERLEY VILLAGE LIBRARY DISTRICT WINDCREST WINDOM WINDTHORST WINFIELD WINK WINK HOUSING AUTHORITY WINKLER CAD WINNSBORO WINNSBORO HOUSING AUTHORITY WINONA WINTERGARDEN GCD WINTERS WINTERS HOUSING AUTHORITY WISE CAD WISE COUNTY WCID #1 WISE SWCD #548 WIXON VALLEY WOLFE CITY WOLFE CITY HOUSING AUTHORITY WOLFFORTH WOOD CAD WOOD COUNTY SWCD WOODBRANCH VILLAGE WOODCREEK WOODCREEK MUD 127 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Texas Municipal League (TML) WOODCREEK RESERVE MUD WOODLOCH WOODRIDGE MUD WOODSBORO WOODVILLE HOUSING AUTHORITY WOODWAY WORTHAM WORTHAM HOUSING AUTHORITY WYLIE YANTIS YOAKUM YOAKUM HOUSING AUTHORITY YORKTOWN YORKTOWN HOUSING AUTHORITY YOUNG COUNTY SWCD ZAPATA CAD ZAPATA COUNTY WCID ZAVALA CAD ZAVALA COUNTY WCID #1 ZAVALLA 128 of 138 Payer ID A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 A0245 TX MN CA NY WI All Professional Institutional Only Only Only Only Only States Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Workers' Comp Only x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Edwards Claims Administration ABILENE ISD SELF-INSURED ABILENE ISD RUN-OFF ALAMO HEIGHTS ISD ALEDO ISD BELLVILLE ISD BENAVIDES ISD BIG SPRING ISD BIRDVILLE INDEPENDENDENT SCHOOL DISTRICT BRACKETT I.S.D. BRADY ISD BRECKENRIDGE ISD BROOKS COUNTY ISD BROWNFIELD ISD BURLESON COUNTY ALT SCHOOL BURLESON-MILAM CO-OP CALDWELL ISD CANYON ISD CARRIZO SPRINGS CISD CENTER POINT ISD CITY OF WICHITA FALLS CLARKSVILLE ISD COTULLA ISD CRYSTAL CITY ISD DALHART ISD DE SOTO ISD DEL VALLE I.S.D. DENVER CITY ISD DILLEY ISD DUMAS ISD DUNCANVILLE INDEPENDENT SCHOOL DISTRICT DUNCANVILLE ISD EAGLE MOUNTAIN-SAGINAW ISD EDINBURG CISD FLORESVILLE ISD FORNEY ISD FRENSHIP ISD FRIO COUNTY FT. SAM HOUSTON ISD GAINESVILLE ISD GARNER ISD GEORGETOWN ISD GODLEY ISD GRAFORD I.S.D. GRUVER ISD 129 of 138 Payer ID J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 TX MN CA NY WI All Only Only Only Only Only States x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Professional Institutional Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Edwards Claims Administration HIDALGO ISD HOWARD COUNTY HUDSPETH COUNTY HUFFMAN ISD JUNCTION ISD KARNES CITY ISD KENNEDALE ISD LA VERNIA ISD LA VILLA ISD LACKLAND ISD LAGO VISTA ISD LEVELLAND ISD LEWISVILLE ISD SELF-INSURED LIBERTY-EYLAU ISD MARBLE FALLS ISD MARLIN ISD MERCEDES ISD MEXIA ISD MIDLAND COUNTY MILLSAP ISD MISSION CISD MISSION CONSOLIDATED INDEPENDENT SCHOOL DISTRICT MOODY ISD MORTON ISD MULESHOE ISD NACOGDOCHES ISD NATALIA ISD NEW CANEY ISD NEW CANEY ISD SELF-INSURED PEARSALL ISD PERRYTON ISD PLAINS ISD PLEMONS-STINNETT-PHILLIPS CISD POOLVILLE I.S.D. POTH ISD POTTER COUNTY PSP CISD RANDALL COUNTY RIVER ROAD ISD SAN ANGELO ISD SEMINOLE ISD SILSBEE ISD SLATON ISD SNYDER ISD 130 of 138 Payer ID J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 TX MN CA NY WI All Only Only Only Only Only States x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Professional Institutional Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List Edwards Claims Administration SOMERSET ISD SOUTHLAND ISD SOUTHSIDE ISD SPEARMAN ISD SPRINGTOWN ISD STOCKDALE ISD STRATFORD ISD SUNRAY ISD TARRANT APPRAISAL DISTRICT UVALDE CISD WEATHERFORD ISD WEIMAR ISD WHITE DEER ISD WHITEFACE CISD YORKTOWN ISD 131 of 138 Payer ID J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 J1204 TX MN CA NY WI All Only Only Only Only Only States x x x x x x x x x x x x x x x Visit our web site: www.availity.com Professional Institutional Claims Claims x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Workers' Comp Only x x x x x x x x x x x x x x x Auto ERA Only (835) x x x x x x x x x x x x x x x Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List REM Employer Name **CA ONLY** BANCROFT NEUROHEAL 137654 CALIFORNIA, INC. 4D'S, LP DBA GEORGIAN HOTEL A J EDMUND COMPANY, INC. A.W.S. CONSTRUCTION ACCORD HUMAN RESOURCES OF CA ACCORD HUMAN RESOURCES OF OKLA ACCURATE AIR SYSTEMS ACME TRUCK PARTS ADVANCE PAPER BOX COMPANY ADVANCED ENGINE MANAGEMENT, IN ADVANCED REAL ESTATE SERVICES, AEROSPACE SERVICE & CONTROLS ALPHA PROPERTY MANAGEMENT, INC AMERICAN TILE & BRICK VENEER AMERICAN TOW & AUTO REPAIR (DB ANGELO BROTHERS COMPANY-CAAPPERSON PRINT MANAGEMENT (A C ARCADIAN DEVELOPMENT, INC. ARDEN CLEELAND DBA AVRIL AGENC ARROYO PARKWAY 76 & ATWATER 76 ARTEX MANUFACTURING COMPANY (A AUDIO DIGEST FOUNDATION AND AUTO MARINE ENGINEERING, INC. AUTO OUTLET, INC. AUTO-OWNERS INSURANCE COMPANY B.B. KINGS BLUES CLUB & RESTAU BANK PLUS CORPORATION BAS RECYCLING, INC. BATLA FOOD GROUP INC. BEACON BAY ENTERPRISES, INC. BEC ENTERPRISES INC. BELL TRUCKING CO INC BEMUS LANDSCAPE INC. BERRY'S SAWMILL BETTER CARE INCORPORATED BOARD FORD INC BOWSMITH, INC. BRAKE PARTS SUPPLY & DISTRIBUT BRINTNALL'S INC. BRION CORPORATION BUILDERS SUPPLY OF PALM SPRING BURLINGAME COUNTRY CLUB BURROWS, INC. 132 of 138 Payer ID J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1556 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 TX MN CA NY WI All Professional Institutional Workers' Auto ERA Only Only Only Only Only States Claims Claims Comp Only Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List REM Employer Name C.P.P., INC. CACIQUE, INC. CALIFORNIA CHAMBER OF COMMERCE CALIFORNIA HI-TECH FLOORS, INC CALIFORNIA LINEN RENTAL COMPAN CARRIAGE MOTORS, INC. CASTLE GROUP CALIFORNIA, INC. CATANIA HIJAR CORPORATION CENTURY LIGHTING, INC. CERTIFIED UNDERCAR PARTS, INC. CHECK INTO CASH CALIFORNIA, IN CHINO AUTO PARTS (A CORPORATIO CHRISTIAN BROTHERS HIGH SCHOOL CHUBB & SON CHUBB SERVICES CINCINNATI INSURANCE CLAUSEN ENTERPRISES INC. CLEAN STEEL INC. CLEUGH'S RHUBARB RANCH, INC.; CLW PACIFIC, INC. COMFORT SYSTEMS, USA COMMONWEALTH ENERGY CORPORATIO COMMUNITY OPTIONS CONNEX TCT, LLC CONTINENTAL MAINTENANCE INDUST COUNTY MOTOR PARTS COMPANY, IN CPE PEO INC. / DBA: CALIFORNIA CRAFTSMAN OFFICE FURNITURE, IN CREATIVE BENEFITS, INC. C-TAP, INC. CTL ENVIRONMENTAL SERVICES DAN'S LANDSCAPE SERVICE, INC. DANTEL INC. DEMKO, WILLIAM M. (AN IND) DENFRAN SYSTEMS, INC. DESERT VALLEY MEDICAL GROUP (A DESIGNS BY MARK DEW MANAGEMENT SERVICES INC DIABLO HILLS GOLF ASSOCIATION, DIAMOND W FLOOR COVERING, INC. DINUBA LUMBER COMPANY (A CORP) DUFOUR, INC. DUPREE, INC. DY DEE SERVICE OF PASADENA INC 133 of 138 Payer ID J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1554 J1561 J1562 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 TX MN CA NY WI All Professional Institutional Workers' Auto ERA Only Only Only Only Only States Claims Claims Comp Only Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List REM Employer Name E.B. MANNING & SON INC. E.H. SUMMIT, INC. ECOLOGY AUTO WRECKING EL MACERO COUNTRY CLUB ELECTRICAL REBUILDERS SALES IN ELITE LEATHER COMPANY EMCO FLUID SYSTEMS, INC. EMERGENCY PHYSICIANS MEDICAL G EMPI, INC. ENGEN ENTERPRISES INC. EQUITY HOTEL & SUPPLY COMPANY, ERNEST PAPER PRODUCTS, INC. EZELL NURSERY SUPPLY INC. FACILITY MASTERS, INC. (A CORP FAMILY TOYOTA, FAMILY HONDA FARMERS INSURANCE EXCHANGE (WC ONLY) FAST UNDERCAR - THOUSAND OAKS FEATHER RIVER WOOD & GLASS FELIX MANUFACTURING COMPANY, I FERRARI, DAN (AN INDIVIDUAL) FORECAST GROUP L.P. FREEMAN, RAYMOND K. FRIANT AND ASSOCIATES LLC FULLER THEOLOGICAL SEMINARY (A G L VENEER COMPANY INC. GARRISON, MIKE (AN INDIVIDUAL) GATEWAY LEARNING CORPORATION GE AUTO GLENDALE ASSOCIATES LTD GLENDALE FOOD SERVICE INC. GOMEZ, JOSE LUNA GRASS VALLEY FORD, LINCOLN, ME GREATER SAN DIEGO AIR CONDITIO GRIFFIN PRODUCE INC. H R N SERVICES, INC. H. L. HEGGSTAD, INC. H.J. COMPANY H.P DEVELPMENT INC. H.P. ENVIROVISION INC HAGEN-RENAKER, INC. HAIGHT, BROWN & BONESTEEL HARALAMBOS BEVERAGE COMPANY HARBOB SOUTHERN, INC. HAWTHORNE FINANCIAL CORPORATIO 134 of 138 Payer ID J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1563 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1557 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 TX MN CA NY WI All Professional Institutional Workers' Auto ERA Only Only Only Only Only States Claims Claims Comp Only Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List REM Employer Name HEALTHCARE MANAGEMENT SYSTEMS, HIGGINS BRICK COMPANY HOMEXX INTERNATIONAL CORPORATI HOSPITAL HOUSEKEEPING SYSTEMS HOUCK, GREGORY (PARTNER); WINN HOUSTON STEAK DELIVERY #1 LLC HUGHES REDWOOD COMPANY, INC. HYDROFORM - U.S.A. INC. IDEAL AUTO PARTS, INC. IMPERIAL VALLEY LUMBER COMPANY INNOVATIONS SUCCESSFUL SALON S INTERNATIONAL BAY CLUBS INC INVENTORY CONTROL SYSTEM IOM HOLDINGS,INC (A CORPORATIO J T CONTRACTORS, INC. J.C. WATTENBARGER & SONS, INC. JANICO BUILDING MAINTENANCE CO JCV TACOS INC. JERRY SOLOMON ENTERPRISES INC. JOHNSON, LARRY (AN INDIVIDUAL) KEISER (A CORP) KORDYE TURNER & CO., INC. KRIEGER, BERTIE (AN INDIVIDUAL KURT BOHMER PLUMBING, INC. KURTZ FINAN AUTO SUPPLY, INC. KUSTOM FIT MANUFACTURING COMPA LATICRETE INT'L INC. LEDTRONICS, INC. LEISURE WORLD UNION 76, INC. LIGHTS OF AMERICA INC LODGING DEVELOPEMENT AND MANAG LOS ALTOS GOLF & COUNTRY CLUB LUNDEEN PACIFIC CORPORATION MADISON RESEARCH CORPORATION MAINTENANCE PACESETTERS INC. MALLIS ASSOCIATES INC. MANIGLIA LANDSCAPE INC. MARFIELD COMPANY INC MARIN RADIOLOGY GROUP MARKRIST ENGINEERS MAXSYS TECHNOLOGIES CORPORATIO MCGEE ELECTRIC, INC. MEYLING, ALBERT (AN INDIVIDUAL MICHAEL MCELROY D/B/A 135 of 138 Payer ID J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 TX MN CA NY WI All Professional Institutional Workers' Auto ERA Only Only Only Only Only States Claims Claims Comp Only Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List REM Employer Name MISSION CORPS INTERNATIONAL IN MISSION ORGANICS MOFFATT CONTRACTING,INC MONARCH PLUMBING COMPANY, INC. MORENO VALLEY PONTIAC MOTHER'S NUTRITIONAL CENTER, I MRH ENTERPRISES NATEL ENGINEERING COMPANY INC. NATIONAL MAINTENANCE INC. NELSON NAMEPLATE COMPANY INC NEW CENTURY AUTO GROUP NIA HEALTH CARE SERVICES (A CO NICKOLAS ENVIRONMENTAL NORTH AMERICAN VIDEO CORP. NUMERO UNO MARKET INC. OAKWOOD INTERIORS INC ONE STOP BRAKE SUPPLY SANTA AN ONE STOP UNDERCAR RIVERSIDE, I ONTARIO METAL RECYCLING INC ONYX ACCEPTANCE CORPORATION ORIGINAL SID BLACKMAN PLUMBING OSI SYSTEMS INC. P.J. CAL #1, INC. PACIFIC DATA ELECTRIC, INC. PALLET DEPOT PALO ALTO HILLS GOLF & COUNTRY PARK MANAGEMENT GROUP, INC. PASTABRAVO RESTAURANTS, INC. PDQ AUTOMATIC TRANSMISSION PAR PENINSULA PONTIAC GMC BUICK PETRO-CHEM INDUSTRIES INC POLY PAK AMERICA, INC. POMEROY INVESTMENTS INC. POOL WATER PRODUCTS POPLUAR TEXTILE CORP. / POP ST PORTEOUS FASTENER COMPANY PRESTON HOLMES, INC. PROMPT FOOD SERVICE, INC. PURE FILL CORPORATION QAD, INC. QUICK-CROFT, INC. R KIDS TIRE AND SERVICE, INC. R.A. PHILLIPS INDUSTRIES INC. RABB BROTHERS TRUCKING, INC 136 of 138 Payer ID J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 TX MN CA NY WI All Professional Institutional Workers' Auto ERA Only Only Only Only Only States Claims Claims Comp Only Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List REM Employer Name RAMONA MANOR CONVALESCENT HOSP RAYPAK, INC. REDNAB INC. REESER ENTERPRISES INC. RELIABLE SERVICES, INC. RELIANCE BUILDING SERVICES INC RICK HITCH PLASTERING (A CORPO ROBERT MANN PACKAGING, INC. (A ROTHENBERGER USA INC. ROUNTREE PLUMBING & HEATING, I SACRAMENTO I.B.S.,INC. SAN FRANCISCO BATTERY, INC. SANTA FE EXTRUDERS, INC. SATELLITE DIALYSIS CENTERS, IN SECURA INSURANCE A MUTUAL COMPANY SERENDIPITY LAND YACHTS SHEPPARD, MULLIN, RICHTER & HA SITE STUDIOS INC. SMALL WORLD TOYS SMITH EMERY COMPANY SMITHCARE, INC. SOL'S BRAKE SUPPLY LLC SOS METALS INC. SPECIALTY TEAM PLASTERING, INC SPRING AIR CALIFORNIA/DELUXE B STANLEY PEST CONTROL, INC. - S STATE FUND MUTUAL STATE OF MINNESOTA – DOER STRIKO DYNARAD CORPORATION STYLES FOR LESS CORP. (CA ONLY SURFACE MOUNT DISTRIBUTION (A SURFACE PROTECTION INDUSTRIES TALBERT MEDICAL GROUP TARGET MEDIA PARTNERS, ET AL TEMPO INDUSTRIES, INC. (A CORP THE GARLIC COMPANY (A PARTNERS TIM'S AUTO PAINT & SUPPLY, INC TOMCO AUTO PRODUCTS, INC. TOMDAN ENTERPRISES TOM'S TRUCK CENTER, INC. TOTAL PLUMBING HEATING & AIR TRANS VALLEY TRANSPORT TRANSPACIFIC DEVELOPMENT COMPA TRI VALLEY ORTHOPEDIC & SPORTS 137 of 138 Payer ID J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1379 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1553 J1555 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 TX MN CA NY WI All Professional Institutional Workers' Auto ERA Only Only Only Only Only States Claims Claims Comp Only Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com Health Plan/Payer List Availity Clearinghouse and Web Portal Workers' Compensation Payer List REM Employer Name TRUE WORLD FOODS, INC. (A CORP U. S. WIRELESS CORPORATION UNITED EL SEGUNDO, INC. UNITED SURGICAL PARTNERS INTER UNIVERSAL FLOORING SYSTEMS, I VALHALLA BUILDERS & DEVELOPERS VALLEY FIG GROWERS INC VEG LAND INC., ET AL VEGTABLE GROWERS SUPPLY INC VERCO MANUFACTURING, INC., (PA VICRO-MAC VICTORIA TIRE CENTER, INC. VILLA MARINA UNOCAL, INC. VIP MOTOR CARS LTD. W.E. BEHEL, INC. W.T. BILLARD, INC. WALTER ANDERSON PLUMBING, INC. WCP, INC. WESSEX INDUSTRIES, INC.; HEALD WESTERN GOLF PROPERTIES, INC. WIDDICOMBE ENTERPRISES INC. WILSON & HAMPTON PAINTING CONT WOMEN'S HEALTHCARE ASSOCIATES WOODMONT REAL ESTATE SERVICES 138 of 138 Payer ID J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 J1491 TX MN CA NY WI All Professional Institutional Workers' Auto ERA Only Only Only Only Only States Claims Claims Comp Only Only (835) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Visit our web site: www.availity.com