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