Tuesday, February 14, 2006
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Emerging Medical Technologies – Payer List Last Updated - Tuesday, February 14, 2006 Medical Payer List Press Ctrl+F to search within this page Payer Name EMC Type Payer ID States Phone Contact 1199 Local Benefit Fund 009 13162 NY 646-473-6960 Renaud Dufresne 009 48185 NY 800-298-2431 Customer Service 800-984-9133 Customer Service Located in New York, New York ABC Health Plan of New York Located in New York New York. Unique Provider ID number required Access Behavioral Care 009 COACC CO 866 WC141 IN, MI 009 64071 ALL 662-791-2970 Customer Service AMS01 WI 800-308-3344 Customer Service 800-888-2565 Customer Service Located in Denver, Colorado Accident Fund WORK-COMP Acclaim Accountable Health Plan - Wisconsin 109 Only Only claims with the address of Wisconsin can be submitted electronically. ACE/ESIS 866 WC231 CA, CT, DC, DE, FL, GA, IL, MD, MT, NJ, OR, SC, TN, VA, WI 109 87815 ALL WORK COMP Acordia National Only claims with the City and State of Charleston, West Virgina ACS Consulting Services, Inc. 666 72467 ALL 336-759-2013 Customer Service 72468 ALL 336-759-2013 Provider Relations 099 38254 ALL 877-827-1414 Customer Service 940 37278 ALL 800-967-2077 Customer Service 372 93524 OR 541-677-7624 Ken Achterfoff 126 35209 IN 317-573-2719 Provider Services Located in Winston-Salem, North Carolina ACS Consulting Services, Inc. 372 Located in Winston-Salem, North Carolina Activa Benefit Services, LLC Located in Grand Rapids, Michigan AdminOne Located in Rogers, Arkansas Advantage Dental Plan Located in Roseburg, Oregon Advantage Health Solutions Admnistrative office: Indianapolis, Indiana Advantra GHP 340 00340 IL, MO 800-755-3901 Provider Services 847-298-6000 Customer Service 847-298-6000 Customer Service 847-298-6000 Customer Service 847-298-6000 Customer Service 847-298-6000 Customer Service IL 847-298-6000 Customer Service IL 847-298-6000 Customer Service IL 847-298-6000 Customer Service Unique Provider# Required Claims address - PO Box 8052, London, KY Advica - New York Community Health Plan 009 13373 NY NO LONGER HAS ELECTRONIC CAPABILITY. Advocate Bethany Health Partners 009 6509D IL Claims address: P.O. Box 0378 Mt Prospect, IL 60056-0378 - SEE NOTES Advocate Christ Health Partners 009 6509F IL Claims address: P.O. Box 0379 Mt Prospect, IL 60056-0379, - SEE NOTES Advocate Good Samaritan Health Partners 009 6509C IL Claims address: P.O. Box 0443 Mt Prospect, IL 60056-0443 Advocate Good Shepherd Health Partners 009 6509G IL Claims address: P.O. Box 0430 Mt Prospect, IL 60056-0430 Advocate Health Centers 009 36320 IL, MO Located in Mount Prospect, Illinois Claim office ID number required Advocate Health Partners 009 65093 Claim office ID must contain the Payer Sub ID. Advocate Illinois Masonic Health Partner 009 6509H Claim office ID must contain the Payer Sub ID. Advocate Lutheran General Health Partners 009 6509A Claims address: P.O. Box 0546 Mt Prospect, IL 60056-0546 - See Notes Aetna Health Plans 654 60054 ALL 800-599-2435 Customer Service Affinity Health Plan 666 13334 NY 866-247-5678 Provider Relations 009 34444 OH 440-720-0700 ext Kathy Myers 222 Located in Bronx, New York AFL-CIO Food & Beverage Dealer's Trust Fund only claims with the address: PO Box 457, Toledo, OH 43697-0457 AFTRA Health Fund 009 13346 NY 212-499-4800 ext Deborah Jankowski 274 940 64158 ALL 716-319-5483 Christy Pidanick 057 80705 ALL 800-537-2033 Customer Service 866 WC241 CT, DC, DE, MD, NJ, NY Located in New York, New York Agency Services, Inc. Located in Amherst, New York AH & L One Health Plan - Kansas/Missouri AIG WORK-COMP AKM Medical Group 109 IP080 CA 818-461-5554 Fed Villaluna Alaska Children's Services, Inc (Group # P68) 372 91136 ALL 206-441-7574 Alaska Children's Services, Inc. 009 91136 AK, WA 206-441-7574 Customer Service 206-441-7574 Customer Service IPA located in Encino, CA Group # P68 - Mailing address: PO Box 34203, Seattle, WA 98124 Alaska Children's Services, Inc. (Group #P68) 009 91136 AK, WA Group # P68 - Mailing address: PO Box 34203, Seattle, WA 98124 Alaska Laborers Construction Industry Trust 372 91136 ALL 206-441-7574 009 91136 AK, WA 206-441-7574 Group # F23 Alaska Laborers Construction Industry Trust Customer Service Group # F23 - Mailing address: PO Box 34567, Seattle, WA 98124 Alaska Pipe Trades Local 375 ( Group # F24 372 91136 ALL 206-441-7574 Alaska Pipe Trades Local 375 (Group # F24) 009 91136 AK, WA 206-441-7574 Customer Service Group # F24 - Mailing address PO Box 34203, Seattle, WA 98124 Alaska United Food & Commercial Workers 372 91136 ALL 206-441-7474 009 13550 ALL 212-539-5456 Nina Chalraborty 126 58213 ALL 440-720-0700 x205 Rebecca Karlinsky - EDI Group # F45 Alicare Located in New York, New York Alignis Only claims with address: 45 Eisenhower Drive, Paramus, NJ 07652-1416. All Savers Insurance Company 009 37602 ALL 317-297-4187 Client Services Alliance Blue Cross/ Blue Shield of Missouri 012 00012 IL, MO 800-470-9630 Provider Services Alliance Health Network 666 25126 PA 814-878-1771 Cathy Reichart Located in Lawrenceville, Illinois Located in Erie, PA - Effective 11/18 Payer ID 96218 was terminated. Alliance Partners 800 23172 OH See member id card Claims address: PO BOX 69319; HARRISBURG, PA 17106-9319 Alliance PPO, Inc. Provider ID Number required 109 52149 DE, MD, NC, PA, VA, WV 800-342-6141 Customer Service Alliance Select - Wisconsin Only 109 AMS01 ALL Only claims with the address of Wisconsin can be submitted electronically. Alliant Health Plans of Georgia 126 58234 AL, GA, TN 706-629-8848 Customer Service 94177 ALL 440-720-0700 x 222 Kathy Myers - EDI Only claims for Alliant Preferred and Select Allied Administrators 126 Only claims with address: PO Box 2500, San Francisco, CA 94126-2500 Allied Administrators 372 94177 ALL 440-720-0700 ext Kathy Myers 222 Only claims with address: PO Box 2500, San Francisco, California 94126-2500 Allied Benefit Systems, Inc. 666 37308 ALL 312-906-8050 Ray Zroback Claims add: 208 LaSalle St., Suite 1300, PO Boxes 909786 & 909799 in Chicago, IL Alternative Tech Resources 940 37231 CA 666 SX113 UT 801-933-3130 Madalyn Jewkes 372 50503 ALL 877-223-0588 Customer Service 940 AMAIA ALL 800-458-5736 Customer Service 009 13550 ALL 212-539-5456 Nina Chalraborty 940 75137 ID 800-786-7930 Customer Service 800-590-5745 Customer Service 440-720-0700 ext205 Rebecca Karlinksy Located in Saremento, California Altius Health Plan Located in South Jordan, Utah Altus Dental Located in Providence, Rhode Island AMA Insurance Agency, Inc. Located in Chicago, Illinois Amalgamated Life Located in New York, New York Ameriben Solutions, Inc. Claims mailing address - P O Box 7186, Boise, ID 83707 Americaid Community Care (Houston) 109 27515 TX Claims address: Po Box 62947, Virginia Beach, VA - Unique Provider ID required American Bankers Life Assurance Company 372 59067 ALL American Benefits Management 126 34187 ALL Claims address: PO Box 35008, North Canton, Ohio 44735 American Capitol Insurance Company 940 AMC11 ALL 713-974-2242 Customer Service 009 41161 ALL 800-236-9921 Provider Services 009 41160 NY 800-236-9921 Provider Services Located in Houston, Texas American Chiropractic Network (ACN) Located in Minneapolis, Minnesota American Chiropractic Network IPA of NY (ACNIPA) Located in Kingston, New York American Commercial Barge Lines 109 37128 ALL 630-718-8230 Mandy Rak American Community Mutual Insurance 009 60305 AR, AZ, GA, IA, IL, IN, KS, LA, MI, MO, NC, NE, OH, OK, PA, TN, SC, SD, UT, WI, WY 734-5914120ext4361 Cathy Shiek American General 009 62030 ALL 615-749-1026 David James 373 AHG99 ALL 800-861-5770 Customer Service 109 AMS01 WI Located in Jeffersonville, Indiana Located in Nashville, Tennessee American Health Group Located in Maumee, Ohio American Healthcare Plan Net Wisconsin Only Only claims with the address of Wisconsin can be submitted electronically. American Imaging Management, Inc. 009 36369 ALL 847-559-6511 David Kakon 72099 AL, AR, FL, LA, MS, OK, TN, TX 504-561-0600 Customer Service Assigned Group Policy ID is required. American LIFECARE 009 Only claims with 1100 Poydras, Suite 2600, New Orleans, LA 70163-2602 American Medical Security 372 CX001 ALL 800-232-5432 Customer Service 009 81400 ALL 800-232-5432 X15200 Customer Service 940 74048 ALL 800-899-6806 Customer Service American Postal Workers Union Health Plan (APWU) 372 44444 ALL 301-622-5739 Lynn Norris American Postal Workers Union Health Plan (APWU) 109 44444 ALL 301-622-5706 Mr. Tom Backer 009 42011 ALL 800-641-0366 Customer Service 726 87726 FL 866-503-1380 Physician's Helpline AmeriChoice of New Jersey Medicaid 009 and Family C 86047 NJ 888-336-4842 Provider Service 888-362-3368 Provider Services Located in Green Bay, Wisconsin American Medical Security, Inc. (AMS) Located in Green Bay, Wisconsin American National Insurance Company Located in Galveston, Texas Located in Silver Springs, Maryland American Republic Insurance Company Located in Des Moines, Iowa AmeriChoice of Florida Located in Sunrise, FL Claims address: PO Box 7760, Phoenix, AZ 85011 - Provider ID required AmeriChoice of New Jersey Medicare 009 86001 NJ Claims address: PO Box 16700, Phoenix, AZ 85011 - Provider ID required AmeriChoice of New York Medicaid 009 86048 NY 212-509-5999 Provider Service NY 888-336-4845 Provider Relations 800-345-3627 Provider Service 800-345-3627 Customer Service 800-454-3730 Customer Service 800-454-3730 Provider Inquiry Line 800-454-3730 Provider Line 800-454 3730 Customer Service 800-590-5745 Customer Service 800-454-3730 Provider Services 800-454-3730 Provider Services 800-841-5328 Provider Relations 800-595-3627 Customer Service 800-888-8211 Customer Service Claims address: PO Box 7720, Phoenix, Arizona 85011 AmeriChoice of New York Medicare 009 86002 Claims address: PO Box 16500, Phoenix, Arizona 85011 AmeriChoice of Pennsylvania Care Plus Medicare 009 86003 PA Payer ID for claims with DOS on or before 8/1/2005 - See notes for addresses. AmeriChoice of Pennsylvania Medicaid & KidChoic 009 86049 PA Old claims add: PO Box 16000 Phoenix, AZ new add: PO Box 659778, San Antonio TX Amerigroup Corporation (Dallas/Ft Worth) 109 27514 TX Claims address: PO Box 61117, Virginia Beach, VA - Unique Provider ID required. Amerigroup Florida 109 27519 FL Claims address: PO Box 61010, Virginia Beach, VA - Unique Provider ID required Amerigroup Illinois 940 27518 IL Claims address: PO Box 62469, Virginia Beach, VA - Unique Provider ID required. Amerigroup Maryland 109 27517 MD Claims: PO Box 61749, Virginia Beach, VA - Requires State Medicaid Provider ID Amerigroup New Jersey 109 27516 NJ Requires Provider's Medicaid Number or American Comm. unique ID Amerigroup/Americaid / Fort Worth, TX / 940 26375 TX Claim address: PO Box 61117, Virginia Beach, VA - Provider ID required. Amerigroup/Americaid / Houston 940 26374 TX Claim address: PO Box 62947, Virginia Beach, VA 23466-2947 Amerihealth Administrators, Inc. 763 54763 ALL Located in Horsham, Pennsylvania Unique Provider ID required Amerihealth Delaware - Non-HMO 688 93688 DE Located in Wilmington, Delware - Claims processed in Philadelphia, PA AmeriHealth HMO New Jersey and Delaware 504 95044 DE, NJ Claims add: PO Box 41574, Philadelphia, PA Unique Provider ID number required Amerihealth Mercy Health Plan 009 22248 PA 800-521-6007 Provider Service Amerihealth New Jersey - Non-HMO 606 60061 NJ 800-595-3627 Customer Service Medicaid Managed Care Located in Iselin, New Jersey - claims processed in Philadelphia, PA Ameritas Bankers Assurance 372 72630 ALL Ameritas Life Insurance Corp. 372 47009 ALL AMVI 109 IP080 CA 818-461-5554 Fed Villaluna 009 38255 ALL 616-787-4908 Angie Berg 940 53085 FL 800-845-7629 Customer Service Ancillary Care Management / testing 485 95485 ALL 84105 ALL 800-828-3677 Indiana Customer Service IPA located in Encino, CA Amway Corporation Located in Ada, MI Anchor Benefits Consulting, Inc. Located in Maitland, Florida testing Anthem BCBS (IN, OH & KY) 372 Administered by HMS in Colorado Springs, Colorado Anthem Health & Life Ins. Co. of New 057 Jersey 80705 ALL 800-537-2033 Customer Service APA Partners 372 16140 ALL 800-833-3650 Karen Matheson 009 16140 ALL 800-833-3650 Karen Matheson ALL 301-563-5718 EDI Provider Rep. ALL 301-622-5706 Mr. Tom Backer Located in Latham, New York APA Partners Corporate office: 13 British Ave. Blvd, Latham, NY APS Healthcare, Inc. 009 54160 See notes reagarding corporate office locations. APWU 109 44444 American Postal Workers Union Health Plan Aramark 866 WC731 ALL, EXCEPT FOR OH & WV 009 16120 MN 952-896-9154 Andrea Failla Arcadian Management Services, Inc. 009 77045 ALL 510-832-0311 Provider Services WC271 CA, CT, DC, DE, FL, MD, NJ, NY, PA, VA 800-624-4277 Provider Relations 800-445-1638 Provider Services WORK COMP Araz Located in Bloomington, MN Located in Oakland, California Argonaut 866 WORK COMP Arizona Foundation for Medical Care 009 AZFMC AZ Claims address: PO Box 2909, Phoeniz, Arizona 85062 Arizona Physicians IPA 009 M3432 AZ Claims address: PO Box 659421, San Antonio, Texas 78265 Arkansas Best Corporation 009 75278 AR 501-785-6178 Benefits Department 009 95440 IN 765-448-7483 EDI Coordinator Located in Fort Smith, Arkansas Arnett Health Plan Located in Lafayette, Indiana - Unique Provider ID number required Associates for Healthcare (AHC) 009 36326 MN, WI 414-784-9007 David Dobias Assurant Healthcare 009 39065 ALL 800-533-7654 Customer Service Claims address: PO Box 42033, Hazelwood, Missouri Assured Benefit Administrators 940 74240 TX 800-247-7114 Customer Service 009 95691 GA 800-293-6260 Provider Services 009 13853 NY 212-747-0877 Provider Services 940 ATLAD ALL 800-232-9659 Customer Service 009 MNAUL OH 800-344-8858 Provider Services 260-489-6447 Customer Service Located in El Paso, Texas Athens Health Plan Located in Athens, Georgia Atlantis Health Plan Located in New York, New York Atlas Administrators Located in Austin, Texs AultCare Located in Canton, Ohio - unique Provider ID required Automated Group Administration, Inc 940 37280 ALL 372 91136 ALL 372 91136 ALL 206-441-7574 009 91136 AK, WA 206-441-7574 Customer Service 109 IP080 CA 818-461-5554 Fed Villaluna 009 46045 SD 605-322-4500 Margaret Solma 109 95266 ALL 800-621-6360 Customer Service FL 800-452-8633 Network Support Services 00235 IA 800-407-0267 Provider Services 009 38338 MI 888-327-0671 Customer Service 940 37248 LA 337-234-1790 Processing Supervisor Located in Fort Wayne, Indiana Automotive Machinist Local 289 Group # F32 Automotive Machinists Local 289 Group # F32 Automotive Machinists Local 289 H&W Trust Group # F32 Avalon Medical Group IPA located in Encino, CA Avera Health Plans Located in Sioux City, South Dakota AVMA GHLIT Claims address: P. O. Box 909720, Chicago, Illinois 60690-9720 AvMed, Incorporated 109 59274 Located in Miami, Florida - Unique Provider ID required BAAI 235 now known as Wellmark Administrators, Inc. Barrien Health Plan Located in Flint, Michigan Bass Administrators, Inc. Located in Lafayette, Louisiana Beacon Health Stratagies - TESTING 963 96311 CT, MA, NH, NJ, NY, PA, RI, VT 781-994-7500 Provider Relations 95377 ALL 800-432-1776 Customer Service Lee Serota Located in Woburn, MA Beech Street Corporation 009 Only address: PO Box 853925. Richardson, TX 75085 - SEE NOTES for requirements BeneCare Dental Plans 372 23210 ALL 215-440-1018 62121 ALL 440-720-0700 ext Rebecca Karlinsky 205 Located in Philadelphia, Pennsylvania Benefit Administrators 372 Only claims with address: PO Box 10585, Knoxville, Tennessee 37939 Benefit Consultants, Inc 600 10006 ALL 800-434-4620 Claims Department 440-720-0700 EXT222 Kathy Myers 800-685-6100 Customer Service BMATP ALL 800-934-6302 Customer Service 43178 MO 888-294-1515 Customer Service Located in Ballwin, MO - Set-up is required for this payer contact Gateway EDI. Benefit Coordinators Corporation 372 23145 ALL Only claims with address: 111 Ryan Court, Suite 300, Pittsburg, PA 15205 Benefit Coordinators Corporation (Pittsburgh, PA) 126 25145 ALL Only claims with address: 111 Ryan Court, Suite 300, Pittsburgh, PA 15205 Benefit Management Administrators (BMA) 940 Located in San Antonio, Texas Benefit Management Inc., Joplin, MO 109 Located in Joplin, MO See notes regarding addresses. Benefit Management Systems, Inc. 940 37212 ALL 601-991-0060 Customer Service 009 37212 ALL 601-991-0060 Customer Service Benefit Plan Administrator of St. Louis, MO 009 13310 ALL 319-351-2667 x5610 Sue Hansen Benefit Plan Administrators (BPA) 372 88027 ALL 800-423-1841 Customer Service Benefit Plan Administrators Co.(Eau 126 Claire, WI) 39081 ALL 715-832-9717 Customer Service Located in Ridgeland, Mississippi Benefit Management Systems, Inc. Located in Ridgeland, Mississippi Located in Reno, Nevada Only claims with the address: PO Box 1128, Eau Claire, WI 54702-1128 Benefit Plan Administrators, Inc. 940 37118 ALL 630-428-5397 Gary Trebolo 940 37286 ND 800-554-3951 Customer Service 109 37222 ALL 877-642-7500 Customer Service 372 74223 ALL 210-558-2106 Lee deLuna Located in Roanoke, Virginia Benefit Plan Administrators/BPA Located in Fargo, North Dakota Benefit Plan Management Located in Rockland, Massachusetts Benefit Planners Located in Boerne, Texas Benefit Planners, Inc. 940 74223 ALL 800-292-5386 Tammy Bennack ONLY claims for P. O. Box 690450, San Antonio TX 109 34178 ALL 440-720-0700 ext Kathy Myers 222 Benefit Systems & Services, Inc. (BSSI) 009 36342 ALL 630-789-2082 Benefit Systems and Services, Inc. (BSSI) 372 36342 ALL 630-789-2082 ext Lynn Demme 211 940 38257 IL, IN, MI, OH, WI Benefit Services, Inc. (Akron, Ohio) Located in Akron, Ohio Lynn Demme Located in Westmont, Illinois BenefitSource, Inc. See notes Offices located in Monroe, Grand Rapids and Kalamazoo, Michigan Benesight 009 87265 ALL 719-595-2768 Customer Service Headquarters located in Lake Mary, Florida claims - PO Box 3060, Pueblo, CO Benesys Inc. 940 37248 LA 337-234-1790 Processing Supervisor 940 37248 LA 337-234-1790 Processing Supervisor 940 37248 LA 337-234-1790 Processing Supervisor 940 BENCP AR, GA, KS, IN, MO, NE.NV, OH, TX 800-837-1205 Customer Service 109 95604 ALL 800-433-0088 Customer Service 109 62183 PA, TN 800-600-9007 Provider Relations Located in Lafayette, Louisiana Benesys-LHP claims Unit Located in Lafayette, Louisiana Benesys/Benesys, Inc. Located in Lafayette, Louisiana Benicorp Insurance Company Located in Indianapolis, Indiana Best Life & Health Insurance Company Located in Irvine, California Better Health Plans, Inc. Located in Monroeville, Pennsylvania - Enrollment required Big Lots Associates Plan 800 CX025 OH 877-304-0761 Customer Service 340 00340 IL, MO 800-755-5242 Customer Service Located in Dublin, Ohio BJC/ASO/HMO 23 Unique Provider ID required. Claims mailing address: PO Box 7112, London, KY Blue Bell Benefits Trust 940 ECIBB TX Blue Care Family Plan (BC/BS of CT) 372 00700 CT Blue Choice (UB92) 112 90017 IL, MO 800-932-4480 Provider Services Blue Choice of Missouri 017 00017 IL, MO 800-470-9630 Provider Services Located in Brenham, Texas Located in St. Louis, Missouri Unique Provider ID number required Blue Cross and Blue Shield Michigan/Blue Care Net 779 77910 MI 800-662-6667 Customer Service 580 00580 AL 800-292-8868 Customer Service 00822 AK 800-435-2715 Customer Service 00500 AZ 800-232-2345 Customer Service 00181 AR 501-378-3291 Customer Service 00072 CO 800-332-3842 Provider Services 203-239-8293 ext8293 EDI Help Desk 800-334-3427 Customer Service Enrollment required Blue Cross and Blue Shield of Alabama Enrollment Required - Contact Gateway EDI Blue Cross and Blue Shield of Alaska/Premera 822 Enrollment required Contact Gateway EDI. Blue Cross and Blue Shield of Arizona 500 Requires Enrollment contact Gateway EDI Blue Cross and Blue Shield of Arkansas 181 Requires Enrollment contact Gateway EDI Blue Cross and Blue Shield of Colorado 072 Payer requires enrollment forms - Contact Gateway EDI Blue Cross and Blue Shield of Colorado Dental 372 84099 ALL Blue Cross and Blue Shield of Connecticut 103 00103 CT Enrollment required contact Gateway EDI. Blue Cross and Blue Shield of Connecticut Dental 372 65358 CT Blue Cross and Blue Shield of DC/Carefirst 209 SB580 DE, MD, VA Enrollment required. Claims address: P.O. Box 2410, Easton, MD 21601 Blue Cross and Blue Shield of Delaware 570 00570 DE 302-421-8428 Customer Service 372 53287 DE 302-421-8428 Andy Rumford Blue Cross and Blue Shield of Florida 592 59201 FL (866) 454-9007 General Information 00512 GA 888-883-2720 EDI Services 99500 HI 800-377-4672 EDI Support No enrollment required Blue Cross and Blue Shield of Delaware Dental Located in Wilmington, DE Provider Number required - Must be a Par Provider Blue Cross and Blue Shield of Georgia 512 Requires Enrollment contact Gateway EDI. Blue Cross and Blue Shield of 995 Hawaii/TESTING TESTING Blue Cross and Blue Shield of Illinois 002 00002 IL 312-856-1946 Provider Service Participating Providers require Unique Provider ID# and EDI Enrollment Form Blue Cross and Blue Shield of Indiana 715 00715 IN 800-470-9630 Customer Service 00234 IA 800-526-8995 Customer Service 800-432-0272 Provider Relations 800-892-6048 Provider Relations KY 800-470-9630 Customer Service LA 225-291-4334 EDI Help Desk LA 225-295-8427 Kristi Hymel ME 207-822-8385 Customer Service Enrollment Required Contact Gatwway EDI Blue Cross and Blue Shield of Iowa 234 Participating Providers require Unique Provider ID# and EDI Enrollment Form Blue Cross and Blue Shield of Kansas 031 00031 KS, MO Participating Providers require Unique Provider ID# and Enrollement Form Blue Cross and Blue Shield of Kansas City 041 00041 KS, MO Participating Providers require Unique Provider ID# and Enrollment Form Blue Cross and Blue Shield of Kentucky 660 00660 Anthem - - Contact Gateway EDI for enrollment Blue Cross and Blue Shield of Louisiana 237 23738 Enrollment required contact Gateway EDI, Inc. Blue Cross and Blue Shield of Louisiana - Dental 372 23739 Provider Enrollment Required before submitting claims Blue Cross and Blue Shield of Maine/Anthem 680 20180 BA0.16 has to be tax id with provider's 3 digit location code i.e 001 Blue Cross and Blue Shield of Maryland /Carefirst 209 SB690 MD 800-842-5975 Provider Services 64222 MA 800-266-2206 Help Desk 778 00778 MI 777 77710 MI 248-486-2292 EDI Help Desk 77911 MI Enrollment required contact Gateway EDI Blue Cross and Blue Shield of Massachusetts 642 Enrollment Required-contact Gateway EDI Blue Cross and Blue Shield of MI Medicare Plus TESTING ONLY Blue Cross and Blue Shield of Michigan Enrollment required contact Gateway EDI Blue Cross and Blue Shield of Michigan Federal 791 BCBS MI Federal Claims Only Payer ID Blue Cross and Blue Shield of Minnesota 956 00956 MN 800-711-9871 opt Help Desk 2 Several Submitter numbers--check carefully --no global approval-providers test Blue Cross and Blue Shield of Mississippi 730 00730 MS 601-664-4478 Sharon Boteler 00012 MO 800-470-9630 Provider Services 800-932-4480 Provider Services Enrollment Required contact Gateway EDI Blue Cross and Blue Shield of Missouri 012 Participating and Non-Participating Providers - (Requires Unique Provider I Blue Cross and Blue Shield of Missouri UB92 112 90012 Blue Cross and Blue Shield of Montana 309 MTBLS MT 800-447-7828 Customer Service 00260 NE (402) 398-3827 Dana Peterson IL, MO Enrollment required contact Gateway EDI. Blue Cross and Blue Shield of Nebraska 260 Enrollment required contact Gateway EDI Inc. Blue Cross and Blue Shield of Nevada/Anthem 265 00265 NV 800-992-6907 Provider Services 107 10770 NH 603-695-7000 Provider Services 22099 NJ 888-334-9242 EDI Help Desk 22099 NJ 800-969-3666 Gateway EDI Enrollment required. Blue Cross and Blue Shield of New Hampshire Enrollment required contact Gateway EDI, Inc. Blue Cross and Blue Shield of New Jersey 372 Enrollment Required contact Gateway EDI Blue Cross and Blue Shield of New Jersey (Horizon) 666 Enrollment Required call Gateway EDI - Includes all Products of Horizon BCBSNJ Blue Cross and Blue Shield of New Mexico/THIN 290 00290 NM 800-835-8699 Customer Service 00808 NY 800-920-8889 Provider Services NY 800-342-3494 Provider Relations NY 800-945-0556 Provider Call Center 800-462-0116 Provider Services Enrollment required contact Gateway EDI. Blue Cross and Blue Shield of New York Central 808 Enrollment required contact Gateway EDI. Claims: PO Box 4792, Syracuse, NY 13221 Blue Cross and Blue Shield of New York Empire 804 00804 Enrollment required contact Gateway EDI, Inc. Blue Cross and Blue Shield of New York Northeaster 080 00800 Northeastern - Located in Albany, New York-Claims:PO Box 80, Buffalo, NY 14240 Blue Cross and Blue Shield of New 807 00807 NY York Rochester TESTING Blue Cross and Blue Shield of New York Utica-Water 809 00809 NY 800-311-3536 Provider Service 00301 NY 800-950-0051 Provider Servcices 05536 NC 800-214-4844 Provider Relations 00250 ND 800-368-2312 Provider Services Enrollment required contact Gateway EDI. Blue Cross and Blue Shield of New York Western 301 Enrollment required contact Gateway EDI Blue Cross and Blue Shield of North 536 Carolina Enrollment required Blue Cross and Blue Shield of North 250 Dakota Enrollment and Provider Testing is required for this payer. Blue Cross and Blue Shield of Ohio (Anthem) 834 00834 OH 800-470-9630 Customer Service 00046 OK 800-722-3730 x2156 EMC Support OR 503-225-5221 Eric 86500 PA 800-992-0246 Customer Service 00870 RI 57028 SC 800-868-2505 Customer Service 88848 NE, SD 800-700-9137 Provider Services 00890 TN 800-468-9736 Customer Service Enrollment Required contact GatewayEDI Blue Cross and Blue Shield of Oklahoma 046 Participating Providers require Unique Provider ID# and Enrollment Form Blue Cross and Blue Shield of Oregon / Regence 850 00850 Provider enrollment required--contact Gateway EDI Blue Cross and Blue Shield of Pennsylvania-Highmar 860 Enrollment required contact Gateway EDI Blue Cross and Blue Shield of Rhode 870 Island Enrollment required contact Gateway EDI. Blue Cross and Blue Shield of South 028 Carolina Enrollment required contract Gateway EDI. Blue Cross and Blue Shield of South 848 Dakota TESTING Blue Cross and Blue Shield of Tennessee 890 Enrollment required contact Gateway EDI for enrollment forms. Blue Cross and Blue Shield of Tennessee UB92 390 00390 TN 423-755-5717 Customer Support 00021 TX 972-766-5480 Customer Service Enrollment required contact Gateway EDI. Blue Cross and Blue Shield of Texas 021 Participating Providers require Unique Provider ID# and Enrollment Form Blue Cross and Blue Shield of Texas 372 CB900 TX 800-969-3666 Gateway EDI 00152 UT 800-624-6519 Provider Service 915 00915 VT 309 SB915 VT 800-924-3494 Customer Service Requires Enrollment contact Gateway EDI Blue Cross and Blue Shield of Utah 152 Enrollment required contact Gateway EDI. Blue Cross and Blue Shield of Vermont testing Blue Cross and Blue Shield of Vermont Enrollment Required contact Gateway EDI for enrollment forms Blue Cross and Blue Shield of Virginia/Anthem 923 00923 VA 800-991-7259 Provider Services 943 00943 WV 800-543-7822 Provider Services 09500 WI 262-523-4782 Provider Services 40300 SC 800-868-2505 Customer Service 866-849-7246 Customer Service SC 800-868-2505 Customer Service Participating Providers only Blue Cross and Blue Shield of West Virgina Enrollment is required - Contact Gateway EDI Blue Cross and Blue Shield of Wisconsin 095 Enrollment required contact Gateway EDI. Blue Cross and Blue Shield Preferred 403 Health SC South Caroline BCBS Preferred Health Systems - HMO Blue-CONTACT GATEWAY TO TEST Blue Cross and Blue Shield South Carolina FEP 402 40200 SC South Carolina BCBS Federal Employee Program Only - Enrollment required Blue Cross and Blue Shield Wyoming/Noridian- 460 00460 WY Enrollment and Provider Testing is required for this payer. Blue Cross Blue Shield State Employees-SC Health 000 40000 South Carolina Health Plan - Requires enrollment. Blue Cross of California 471 47198 CA 800-227-3983 EDI Representative Blue Cross of California 372 47198 CA 818-610-6277 Cecil Nyein-Claim Payment Info Blue Cross of Idaho 054 00054 ID 888-224-3341 #3 Ken Russell Blue Cross of Washington & Alaska372 Dental 47570 AL, WA Blue Cross of Washington /Premera 00830 WA Contact Gateway EDI for set-up. Enrollment required contact Gateway EDI. 830 800-435-2715 Customer Service Enrollment required--contact Gateway EDI Blue Cross of Washington and Alaska-Dental 372 84097 AL, WA Blue Cross/Blue Shield of Nevada Dental 372 84101 ALL Blue Cross/Blue Shield of New Mexico Dental 372 84100 ALL Blue Shield of California 930 94036 CA 800-258-3091 Provider Service 052 00052 ID 800-713-1693 EDI Support WA 800-373-1477 (MCDN claims only) Group Number Required Blue Shield of Idaho/Regence No enrollment required. Unique Provider ID is required. Blue Shield of Washington / Regence 829 00829 Contact Gateway EDI to set up to send claims electronically. BlueCare - Blue Cross and Blue Shield of TN 892 00892 TN 423-755-5717 Customer Service TennCare MCO product. - Enrollment required Bluegrass Family Health 109 61124 KY 800-787-2680 Customer Service 017 00017 IL, MO 800-470-9630 Provider Services 372 36609 ALL 109 36609 ALL 913-371-2640 Customer Service 940 74238 ALL 512-454-2681 ext Brenda Haynes 140 109 13337 MA 617-414-6175 Sam Evans Located in Lexington, Kentucky BlueHorizons Medicare HMO of Missouri Formerly BlueChoice Senior Boilermakers National Health & Welfare Fund Located in Kansas City, Kansas Boilermakers National Health & Welfare Fund Located in Kansas City, Kansas Boon-Chapman Administrators Inc. Located in Austin, TX Boston Medical Center Healthnet Plan, Inc. Located in Boston, Massachusetts - Unique Provider ID required Boyd Brothers Transportation Inc./BoydCare 940 37273 ALL 800-700-2693 Customer Service 009 37285 ALL 800-237-8447 Customer Service 940 51037 ALL 630-718-8128 Pete Foskaris Located in Clayton, Alabama Bridgestone Claims Service Located in Akron, Ohio Brokerage Concepts Located in King of Prussia, Pennsylvania Brown and Brown Benefits 940 59069 AZ, CA, FL, GA, IN, NJ, NM, NV, OH, PA, TX 630-428-5397 Gary Trebolo 109 94316 CA 415-553-6512 Kirsten Varnau 940 BRISD TX 979-209-1000 Customer Service 324 32004 OH 800-225-2573 Customer Service Located In Daytona Beach, Florida Brown and Toland Medical Group Located in San Francisco, CA Bryan Independent School District Located in Bryan, Texas Buckeye Community Health Plan Enrollment required contact Gateway EDI - Provider ID required Butler Benefit Services, Inc. (BBSI) 940 42150 ALL 866-927-2200 ext Customer Service 226 009 23708 IN, KY, OH, VA, WV 800-679-9135 Customer Service 109 62413 ALL 800-707-5586 Customer Service Located in Davenport, Iowa C&O Employees' Hospital Association Located in Clifton Forge, Virginia CAC/Mailhandlers Claims address effective 8/17/05-PO Box 8402, London, KY-see notes for old add. Cambridge, ISG 009 59334 ALL 800-566-5663 ext Todd Breeden 114 372 37105 ALL 800-333-3841 Provider Services 126 37105 ALL 800-333-3841 Provider Services 109 IP080 CA 818-461-5554 Fed Villaluna 009 38245 MI 888-354-2273 opt Customer Service 4 Located in Exton, Pennsylvania Cannon Cochran Management Services, Inc. Located in Danville, Illinois Cannon Cochran Management Services, Inc. Located in Danville, Illinois Cap Management Systems IPA located in Encino, CA Cape Health Plan Located in Detroit, Michigan Rednering Provider Network ID required. Capital Blue Cross and Capital Advantage Ins. Co. 304 23045 PA 00065 NY 800-874-8433 Profession Provider Automation Enrollment required contact Gateway EDI. Capital District Physicians Health Plan/TESTING 065 Testing - Please contact Gateway EDI for testing information Capitol Administators 009 68011 ALL 800-331-5301 Customer Service 93975 OR 888-393-2450 Customer Service Located in Rancho Cordova, California Care Oregon 940 Claims address: PO Box 40328, Portland, Oregon Care Management Resources 340 00340 MO, IL 800-775-3540 Customer Service 304-231-5015 Provider Relations 304-231-5015 Provider Relations Unique Provider ID Required - Claims address PO Box 7121, Lexington, KY Carelink Advantra 666 25139 WV Located in Charleston, West Virginia Claims address: PO Box 7101, London, KY Carelink Health Plan Commercial 666 25139 WV Located in Charleston, West Virginia Claims address: PO Box 7373, London, KY Carelink Medicaid 666 25140 PA, WV 304-231-5015 Provider Relations 25142 VA 800-627-4872 Customer Service OH 800-488-0134 Customer Service IN 866-930-0017 Provider Services TN 800-284-0042 Customer Service 865-470-7563 Provider Services Claims address: PO Box 7773, London, KY Carenet 666 Claims address: P.O. Box 7702 London, KY 40742 Caresource 109 31114 Enrollment and Unique Provider ID required. Par Providers only can submit elec. Caresource of Indiana 009 37311 Claims address: PO Box 10310, Dayton, Ohio 45402 Cariten Healthcare - Commercial Claims Only 009 62073 Claims mailing address: PO Box 22987, Knoxville, TN. Group number is required Cariten Senior Health 009 62072 TN Claims mailing address: PO Box 22985, Knoxville, TN. Group number is required. Carolina Benefit Administrators, Inc. 009 37245 SC 864-573-6937 Customer Service 009 57105 SC 800-358-4471 Customer Service 800-755-5242 Provider Relations Located in Spartanburg, SC Carolina Care Plan, Inc. formerly, Physicians Health Plan, Inc. Located in Columbia, South Carolina Carpenters H & W Fund -- HCFA 125 25125 IL, MO Claims mailing address changed 7/2005 - PO Box 42031, Hazelwood, MO 63042 Cascade East Health Plans 109 93040 OR 866-577-8941 Customer Service Caterpillar 726 87726 ALL 800-447-6434 Customer Service Caterpillar, Inc 372 37060 ALL 309-494-2363 Provider Relations CBA - Cooperative Benefit Administrators 009 52132 ALL 402-483-9200 EDI Claim Service CBCA Administrators 009 55438 FL, MN, TX 888-314-3348 Customer Service Located in Hermiston, Oregon Claims address: Po Box 9000, London, Kentucky 40702 CBSA 372 41124 ALL CBSA (Corporate Benefit Services of 800 America) 41124 ALL 800-765-4224 Customer Service Claims with City & State Hopkins, MN & P. O. Box 27267, Minneapolis, MN 5542 CCEA Welfare Benefit Trust 372 88020 ALL 702-794-0272 Customer Support 009 88019 NV 702-794-0272 Customer Service 009 CELTC ALL 800-477-7870 Customer Service Located in Las Vegas, Nevada CCEA Welfare Benefit Trust Located in Las Vegas, Nevada Celtic Insurance Claims address: PO Box 06410, Chicago, Illinois 60606 Cemara Administrators, Inc. 847-234-8870 ext Customer Service 600 109 37250 ALL Cement Mason & Plasterers Health & 372 Welfare Trust 91136 ALL 009 91136 AK, WA 206-441-7574 Customer Service 109 IP080 CA 818-461-5554 Fed Villaluna 009 75243 ALL 614-464-8409 Jeff Mills Located in Tulsa, Oklahoma Group # F16 Cement Masons & Plasterers H&W Trust Group # F16 Centinela IPA IPA located in Encino, CA Centra Formerly Centra Benefits of Texas (MS, TX, WA) Central & Southwest Services 372 75177 ALL Central Benefits Life 009 31118 ALL Corp. Off. located in Westerville, Ohio Payer request Fed ID as Billing Provider Central Reserve Life 009 34097 ALL 800-321-3997 Customer Service Central States Joint Board Health & Welfare Trust 940 37214 IL 312-738-0822 Customer Service 009 36215 ALL 800-323-5000 Customer Support KY 800-457-5683 Lori Bruelheide 800-733-8387 Customer Service Customer Service Located in Chicago, Illinois Central States Southeast & Southwest Areas Only claims with the address in the state of Illinois CHA Health 009 23171 Located in Lexington, Kentucky, claims sent to Plano, Texas Champva - HAC 009 84146 ALL Claims address: PO Box 65024, Denver, Colorado 80206-9029 Chartered Health Plans 800 95748 DC 202-398-8683 Chautauqua County Healthcare Plan 126 16600 ALL 440-720-0700 ext Kathy Myers Located in Washington, DC - Mayville, NY 222 Located in Mayville, New York Cheapeake Life Insurance Company 109 59223 ALL 800-733-8880 Customer Service 800-373-1477 NDEX 877-238-8543 Customer Service 512-324-3125 Provider Relations Insured ID number is 9 digits, first two postions are alpha, the next 7 numeric. CHEC - A subsidiary of Sprint 940 CHECS TX Chehallis - Previously King County Medical 372 93200 ALL Lewis County Blue Shield - Requires Unique Provider ID CHIP-Choiceone (UTMB) 940 UHSCH TX Claims address: PO Box 15548, Austin, Texas 78761 CHIP-Seton Health Plan 940 SHPCH TX Claims address: Po Box 15507, Austin, Texas 78761 Choice One/UTMB CHIP 109 76049 TX 877-238-8543 Customer Service Choice Plus (TRW) 372 68241 ALL 800-544-4778 Customer Support Christian Brothers Services 372 61271 ALL 515-247-8051 Carla Houselog Christian Brothers Services 109 61271 ALL 515-247-8051 Carla Houselog 940 SPOHN TX 361-881-3167 Provider Relations 308 62308 Number on Card Refer to Regional Service Number on Card Refer to Regional Service Located in Austin, Texas Corporate office Des Moines, Iowa Christus Spohn Network Located in Corpus Christi, Texas CIGNA ALL Requires rendering Provider Address, City, State and Zip Code CIGNA (Connecticut General) 372 62308 ALL Requires rendering Provider Address, City, State and Zip Code. Cigna Behaviroral Health 009 MCCBV ALL 800-926-2273 Customer Service 372 62310 ALL Number on Card Refer to Regional Service 62308 ALL Number on Card Refer to Regional Service 800-472-7130 Customer Service Located in Eden Prairie, Minnesota CIGNA Flex Care (New Mexico ONLY) Payer no longer accepts electronic claims CIGNA Health Plan - HMO 308 Requires rendering Provider Address, City, State and Zip Code City of Jacksonville 866 WC811 FL 373 39141 WORK COMP Claim Management Service, Inc. ALL Located in Green Bay, Wisconsin ClaimsWare, Inc. 009 57080 ALL 864-234-8200 Customer Service 800.-971-0480 Customer Service 800-775-3540 Customer Service 301-306-3021 Mary Anne Beckette no longer have a connection to send electronic. Clarendon Kids Chip Program 940 EPOTX TX 863 00863 Located Austin, Texas Clarity Vision Medical PA Medical claims only, does not accept vision codes. CMR 340 00340 IL, MO Unique Provider ID number required. Contact Gateway EDI for set-up. CNA Insurance 940 71063 ALL 009 37123 MD, NY, PA, VA 009 COACC CO 720-744-5100 Customer Service 009 91162 WA 360-449-8873 Lori Martin 940 37271 ALL 630-428-5126 Ray Zroback 126 34181 ALL 440-720-0700ext 222 Kathy Myers Commonwealth Administrators, LLC 940 37237 KY 859-226-1559 Erica Mayers 009 25179 ALL 412-454-2129 Anthony Bradford 009 73143 OK 918-594-5295 ext4040 Customer Service 009 33005 ALL 858-654-2053 Tracy Morin New name is Healthscope Benefits Colonial Healthcare Located in Lanham, Maryland Colorado Access HMO Located in Denver, Colorado Columbia United Providers Located in Vancouver, Washington Combined Benefits, Inc. Located in Midland Park, New Jersey Commerce Benefits Group Headquaters in Cleveland, Ohio Located in Lexington, Kentucly Community Care Behavioral Health Organization Located In Pittsburgh, Pennsylvania Community Care Managed Healthcare Plans of OK Located in Tulsa, Oklahoma Community Care Network (CCN) Located in San Diego, CA - Group Number Required Community Care Organization 009 39126 WI 414-902-2371 Amber Heckendorf 330 00330 IL, MO 800-294-3557 Customer Service 800-488-0134 Customer Service 210- 227- 2347 Customer Service Located in Milwaukee, Wisconsin Community Care Plus Unique Provider ID number required - Contact Gateway EDI for set-up. Community Choice Michigan 009 38325 MI Located in Dayton, Ohio & Okemos, Michigan Community First Health Plans Located in San Antonio, Texas 940 COMMF TX Community Health Choice 940 48145 TX 888-760-2600 Provider Relations Located in Houston, Texas - Provider TPI/Medicaid Number is required Community Health Electronic Clearinghouse (CHEC) 372 75261 ALL 817-633-9224 Scott Davis Community Health Plan 009 90010 MO 816-271-7776 Lisa Wilcoxson Located in St. Joseph, Missouri Unique Provider ID number required Community Health Plan of Washington 940 CHPWA WA 800-440-1561 Provider Relations 109 32481 NY 631-360-3102 Jeanine Yetimoglu 372 34177 ALL 440-720-0700 ext Rebecca Karlinsky 205 Located in Seattle, Washington Community Premier Plus for Neighborhood Health Pro Located in New York, New York Comp - Ohio Only claims with address: 33 Fitch Boulvard, Austintown, Ohio 44515 Companion Health Care - South Carolina 922 92200 SC 126 34177 OH 440-720-0700 Customer Service 009 73145 OK 800-884-4776 Claims Customer Service 126 03036 ALL 800-525-8788 Provider Maintenance Dept. Enrollment required contact Gateway EDI. Compensation Programs of Ohio, Inc. Located in Austintown, Ohio Compmed Located in Tulsa, OK Comprehensive Benefit Administrator, Inc. Located in South Burlington, Vermont Comprehensive Care Management 800 CCMC1 NY 877-226-8500 Customer Service 057 80705 ALL 800-537-2033 Customer Service 06105 CT 800-282-3407 Provider Service 800-726-3388 Customer Service Refer to Ins. Card Refer to Regional Service 800-798-2422 Customer Service Located in Bronx, New York Confederation Life Insurance Company Now known as Great West Life Assurance Connecticare, Inc. 306 Located in Farmington, Connecticut - Unique Provider ID Number Required Connecticut General (CIGNA) 372 62308 ALL Requires Rendering Provider Address, City, State and Zip Code Connecticut General (CIGNA) 308 62308 ALL Requires Rendering Provider Address, City, State and Zip Code Consociate Group Located in Decatur, Illinois 126 37135 IL Consolidated Group Dental 372 61305 ALL Consumer Health Solutions 009 37295 ALL 877-573-9541 Customer Service 940 71404 ALL 800-545-8905 Customer Service 940 CCHP1 TX 800-964-2247 Provider Relations Located in Spartanburg, South Carolina Continental General Insurance Company Located in Omaha, Nebraska Cook Children's Health Plan Claims address: PO Box 300267, Houston, Texas 77230 Cooperative Benefit Administrators 009 CBA 52132 ALL 402-483-9200 EDI Claim Support Cooperative Benefit Administrators 372 CBA 52132 ALL 402-483-9200 EDI Claim Support Core Management Resources Group, Inc. 109 58231 GA 866-716-5463 IS Manager 940 41045 ALL 612-372-5466 EDI Support Line 666 35180 ALL 800-832-3332 Customer Service 009 35183 ALL 800-282-3920 Customer Service Located in Lincoln, Nebraska Located in Macon, Georgia Coresource AZ and MN Formerly Northwestern Mutual and Reliastar. CoreSource of North Carolina & Indiana Located in Charlotte, North Carolina Coresource of Ohio Claims address: PO Box 279, Sheldon, IA 51201-0279 Coresource PA, MD and IL 666 35182 ALL 717-295-9201 ext343 Mark Westwood 666 75136 ALL 501-221-9905 Customer Service 800-765-4224 Customer Service 501-221-9905 Customer Service 810-277-9476 Provider Relations 423-282-3420 Customer Service Located in Lancaster, Pennsylvania Coresource, Little Rock Claims address: PO Box 8215, Little Rock, AR 72221 Corporate Benefit Services of America 372 41124 ALL Corporate Benefit Services of America 800 41124 ALL Claims with City & State Hopkins, MN & P. O. Box 27267, Minneapolis, MN 5542 Corporate Benefit Solutions 666 75136 ALL New Name: Coresource, Little Rock Claims address: PO Box 8215, Little Rock, AR Corporate Benefits Services, Inc. 009 56116 ALL Only claims with the address: P. O. Box 12953, Charlotte, NC 28220 Corporate Systems Administration 009 37246 ALL Located in Johnson City, Tennesee Correctional Medical Services, Inc. 940 43160 ALL 314-919-9135 Customer Service 866 WC751 ALL, EXCEPT FOR AR, IA, KY, LA, ME, MS, ND, NE, OH, RI, SD, WV, WY 009 62553 ALL 372 58102 ALL 800-374-6101 Customer Service 126 58102 ALL 800-374-6101 Customer Service 009 62155 ALL 940 CMSEB TX 512.420.2769 Customer Service 666 25130 DE, NJ, MD, PA 800-833-7423 Customer Service 25127 GA 800-470-2004 Customer Service 25132 ALL 800-470-6352 Provider Relations Located in St. Louis, MO Costco WORK COMP Country Life Insurance Company Located in Bloomington, Illinois Covenant Administrators, Inc. Located in Atlanta, Georgia Covenant Administrators, Inc. Headquarters in Atlanta, Georgia Covenant Health Unique Provider ID required Covenant Management Systems Located in Austin, TX Coventry Health Care of Delaware, Inc. Claims address - PO Box 7713, London, KY . Coventry Health Care of Georgia, Inc. 666 Claims address - PO Box 7711, London, KY Coventry Health Care of Iowa, Inc. 666 Claims mailing address: PO Box 7709, London, KY 40742 Coventry Health Care of Kansas, Inc. 666 - Kansas City 25133 ALL 800-969-3343 Provider Relations 25134 ALL 800-664-9251 Provider Relations 25135 ALL 800-664-9521 Provider Relations 25136 ALL 800-471-0240 Provider Relations 666 25129 NC 800-470-4523 Customer Service 119 00119 AR, MO 417-269-2963 Provider Services 417-269-2963 Provider Services Claims address - PO Box 7109, London, KY Coventry Health Care of Kansas, Inc. 666 - Wichita Claims address - PO Box 7124, London, KY 40742 Coventry Health Care of Louisiana 666 Claims address - PO Box 7717, London, KY Coventry Health Care of Nebraska, Inc. 666 Claims address - PO Box 7705, London, KY Coventry Health Care of the Carolinas, Inc. Located in Pittsburg, PA Cox Freeman UB's Contact Gateway EDI to submit claims electronically. Unique Provider ID number. Cox Health Plan 019 00019 AR, MO Contact Gateway EDI to submit claims electronically. Unique Provider ID number. Creative Medical Systems 009 64068 ALL Culinary Workers Health Fund 109 59140 NV 800-237-7767 Customer Service 126 39170 WI 608-784-8442 Customer Service 372 68241 ALL 800-544-4778 Customer Support 109 DAK01 SD 800-325-5598 Customer Service 800-248-0457 Vicky Hanson 866-478-2273` Provider Services 800-287-9860 Provider Service Located in Las Vegas, Nevada Custom Benefit Administrators Located in La Crosse, Wisconsin CustomCare Southwestern Bell-Exec Dakotacare Located in Sioux Falls, South Dakota Enrollment Required. Dart Management Corporation/ Dart Container Corp. 940 DARTC ALL Call Vicky Hanson @ 800-248-0457 ext 2311 prior to submission of claims Definity Health Plan 009 64159 NY Corporate office: Minneapolis, MN., Claims address: PO Box 9525, Amherst, NY Delaware Physicians Care, Inc. 009 27009 DE Claims address: P.O. Box 61145 Phoenix, AZ 85082-1145 Delta Dental (Northeast) 372 02027 ALL 800-537-1715 Customer Service 372 94276 ALL 800-521-2651 Provider Relations See Notes for Specific edits Delta Dental Insurance Company AK, AL, FL, GA, LA, MS, MT, NV.TX, UT - Located in Alpharetta, Georgia Delta Dental of Arizona 372 86027 ALL 800-352-6132 Customer Service 372 77777 ALL 888-335-8227 Customer Service Delta Dental of Colorado 372 84056 ALL Delta Dental of Delaware 372 51022 ALL 800-932-0783 Customer Service Delta Dental of Idaho 372 82029 ALL Delta Dental of Illinois 372 05030 ALL Delta Dental of Maryland (Pennsylvania) 372 23166 ALL Delta Dental of Massachusetts 372 04614 ALL See Notes for Specific Edits Delta Dental of California - CA00 Claim Office See Notes for Specific Edits See Notes for Specific Edits Provider Requires Enrollment and Certification Delta Dental of Missouri 372 43090 ALL Delta Dental of Missouri in South Carolina 372 43091 ALL Delta Dental of New Jersey 372 22189 ALL Provider Requires Enrollment and Certification Delta Dental of New Mexico 372 85022 ALL 800-999-0963 Customer Service 372 11198 ALL 800-932-0783 Customer Service 372 56101 ALL 800-662-8856 Customer Service 372 23166 ALL 800-932-0783 Customer Service 372 05029 ALL 800-843-3582 Customer Service Delta Dental of South Dakota 372 54097 ALL Delta Dental of Washington D.C. 372 52147 ALL 800-554-1907 Customer Service 372 31096 ALL 800-932-0783 Customer Service Delta Dental of Wisconsin 372 39069 ALL Delta Health Systems, CA 109 DHS01 CA 800-422-6099 Customer Service See Notes for Specific Edits Delta Dental of New York See Notes for Specific Edits Delta Dental of North Carolina See Notes for Specific Edits Delta Dental of Pennsylvania (Include Maryland) See Notes for Specifuc Edits Delta Dental of Rhode Island See Notes for Specific Edits See Notes for Specific Edits Delta Dental of West Virginia See Notes for Specific Edits Located in Stockton, California Enrollment Required Dental Aetna Health Plans 372 60054 ALL 203-636-4504 Diane Fernandez Dental Benefit Management, Inc. 372 23210 ALL 215-440-1018 Lee Serota Located in Philadelphia, Pennsylvania, an affiliate of BeneCare Dental Plans Dental Benefit Providers 372 52133 ALL 301-718-7495 Wes Wright 372 34131 ALL 800-722-7374 ext7115 Tim Smith 372 04356 800-879-0288 Provider Relations 372 94146 916-386-1620 Provider Enrollment Located in Bethesda, Maryland Dental Self Funded Plans, Inc. Located in Cleveland, Ohio Dentaquest Located in Boston, Massachusetts Denti-Cal ALL Provider Requires Enrollment Diamond Plan Coventry Health Plan 666 25131 DE;MD 866-533-5154 Customer Service Claims address: PO Box 7136, London, KY 40742 Directors Guide of America 109 23706 ALL 323-866-2200 Shea Savash Diversified Adminstration 009 06102 ALL 203-295-9583 x217 Bob Coen DMERC - Region A - Healthnow 811 00811 ME, NH, NY, VT, PA, DE, NJ, CT, RI, MA 800-842-2052 Beneficiary Call Center 00635 MN, WI, IL, IN, MI, OH, WV, VA, DC, MD 877-273-4334 Beneficiary Call Center Located in Los Angeles, California Enrollment required contact Gateway EDI. DMERC - Region B - Administar Federal 635 Enrollment form required. Contact Gateway EDI for enrollment forms DMERC - Region C - Palmetto GBA 885 00885 CO, NM, TX, OK, AR, LA, MS, KY, TN, AL, FL, GA, SC, NC, PR, VI 800-583-2236 Beneficiary Call Center 05655 AK, AR, AZ, CA, HI, ID, IA, KS, MO, UT, MO, MT, NE, ND, NV, OR, SD, UT, WA, 866-224-3094 WY Beneficiary Call Center Enrollment Required contact Gateway EDI DMERC - Region D - Cigna 655 Enrollment form required. Contact Gateway EDI for enrollment forms Dollar General 866 AL, AR, DE, FL, GA, IL, IN, IA, KS, KY, WC781 LA, MO, MS, NC, OH, OK, PA, SC;TN;VA 940 DCHCH TX 877-451-5598 Customer Service 126 34159 800-321-4085 Cusomer Service WORK COMP Driscoll Children's Health Plan CHIP Located in Corpus Christi, Texas E-V Benefits Management, Inc. ALL Claims address: PO Box 94928 or PO Box 89476, Cleveland, OH 44101. Early Intevention Central 940 TH084 IL Do thru email EHI 372 73288 ALL 800-558-4444 X 7448 Bonnie or Jody - MIS Dept. EHI 611 61101 ALL 800-558-4444 X 7448 Bonnie or Jody - MIS Dept. 52192 PA 800-556-3507 Customer Service 31625 NY 718-921-7979 Customer Service Located in Springfield, Illinois Green Bay and Madison Wisconsin only Elder Health Inc., Pennsylvania 009 Located in Philadelphia, Pennsylvania ElderPlan Inc. 109 Located in Brooklyn, New York - Unique Provider ID required Ellis Consultants, Inc 940 ECISF TX info@ ellisconsultants.com Located in Bellaire, Texas 126 34167 ALL 216-479-2030 X 2119 Lisa Glermann EMPHESYS 372 73288 ALL 800-558-4444 X 7448 Bonnie ir Jody - MIS Dept. EMPHESYS 611 61101 ALL 800-558-4444 X 7448 Bonnie or Jody - MIS Dept. Customer Service Emerald Health Network Located in Cleveland, Ohio Green Bay and Madison Wisconsin only Empire Plan is Metropolitan 726 87726 ALL Members card Employee Benefit Concepts, Inc. 126 38241 MI 440-720-0700 ext EDI Contact - Kathy 222 Myers 37257 ALL 800-342-7407 Customer Service Located in Farmington Hills, Michigan Employee Benefit Consultants, Inc. 126 Located in Milwaukee, WI - SEE NOTES for claims addresses. Employee Benefit Management Corporation 800 CX025 ALL 877-304-0761 Customer Service 009 81039 ALL 800-777-3575 Customer Service MT 406-245-3575 ext Don Johnson 256 Located in Dublin, Ohio Employee Benefit Management Services, Inc (EBMS Located in Billings, Montana and Salt Lake City, Utah Employee Benefit Management Services, Inc. 372 81039 Located in Billings, Montana and Salt Lake City, Utah and Portland, Oregon Employee Benefit Plan Administration, Inc. 126 03036 ALL 800-525-8788 Provider Maintenance Dept. 37216 ALL 630-718-8230 Mandy Rak 800-256-2657 Customer Service 210-738-1414 Customer Service Located in Hampton, New Hampshire Employee Benefit Services 940 Address: 534 Rivercrossing Drive, Fort Mill, South Carolina 29715 Employee Benefit Services of Louisiana, Inc. (EBS) 940 41198 LA 940 EBSSA ALL Located in Shreveport, Louisiana Employee Benefit Services, Inc of San Antonio Located in San Antonio, Texas - Payer needs contacted to send claims Employee Benefits Corp (EBC) 009 37215 ALL 800-645-9972 Customer Service 372 35112 ALL 219-436-1616 *2 Customer Service Located in Peoria, Illinois Employee Plans, LLC Located in Fort Wayne, Indiana Employee Plans, LLC 219-436-1616 option Customer Service ALL 800-697-2235 Customer Service 75232 CA, NC, TX 800-550-8009 Customer Service 73288 ALL 800-558-4444 X 7448 Bonnie or Jody - MIS Dept. MIDSC AR 479-648-3432 Customer Service 73288 ALL 800-558-4444 X 7448 Bonnie or Jody - MIS Dept. 61101 ALL 800-558-4444 X 7448 Bonnie or Jody - MIS Dept. 940 37110 ALL 009 35206 IL, IN, KY, MI, OH 888-446-5844 Customer Service 888-364-6400 Customer Service 206-441-7574 Customer Service 009 35112 ALL Employee Security, Inc. 372 54098 ALL Employer Mutual, Inc. 009 59298 940 372 Located in Fort Wayne, Indiana Located in Jacksonville, Florida Employers Direct Health Home Office - Dallas, Texas Employers Health (Green Bay and Madison Wisconsin only) Employers Health Coalition (EHC) 009 Corporate offices are located in Onalaska, Wisonsin Employers Health Insurance 372 Green Bay and Madison Wisconsin only Employers Health Insurance 611 Green Bay and Madison Wisconsin only Encompass Located in Des Moines, Iowa Encore Health Network Only claims with PO Box 490, Hillview, KY and PO Box 5464, Ft. Wayne, IN ENH Medical Group IPA 940 36364 IL 372 91136 ALL 009 91136 AK, WA 158 00158 IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, 608-223-5857 SD, WI Pat ALL 800-255-6065 Customer Service ALL Number on card Refer to Regional Services Number on Card Refer to Regional Located in Evanston, Illinois Enstar Natural Gas Group # P61 Enstar Natural Gas (Group # P61) Group E P61 EPIC Life Insurance / WPS Enrollment Required Contact Gateway EDI, Inc. EPOCH 940 28777 Claims for the Kansas and St. Louis addresses EQUICOR 372 62308 Requires rendering Provider Address, City, State and Zip Code Equicor (Equitable) 308 62308 ALL Also, Equitable Life Assurance Co., which is owned by Cigna Equitable 372 62308 ALL Service Requires rendering Provider Address, City, State and Zip Code Equitable (CIGNA) 308 62308 ALL Number on Card Refer to Regional Service 800-749-2631 Customer Service Requires rendering Provider Address, City, State and Zip Code Equitable Plan Services 126 73126 ALL Only claims with address: PO Box 720460, Oklahoma City, OK 73172 Erie 866 WC301 PA 009 23250 ALL 800-433-9746 Provider Services 940 74234 ALL 800-933-7472 Customer Service 082 57082 MO 314-851-3600 Claims ALL 800-501-3471 Customer Service WORK COMP Erin Group Administrators Located in Lancaster, PA ERISA Administrative Services Located in Austin, Texas Essence Health Located in St. Louis, MO - Unique Provider ID required Essex Dental Benefits 372 43168 Claims addresses: PO Box 16993 and PO Box 8510. St. Louis, Missouri Ethix Northwest 372 91135 ALL 800-654-3250 X617 Debora Allen Everett-Previously known as King County Medical 372 93200 ALL 800-373-1477 NDEX Snohomish County Physicians Corp. - Requires Unique Provider ID Evergreen Health Plan 009 58233 ALL 888-294-9451 Customer Service 109 IP080 CA 818-461-5554 Fed Villaluna Exclusicare 009 71412 ALL 800-456-9292 Customer Service ExclusiCare 372 71412 ALL 800-456-9292 Customer Service FACS Group/Federated HR Services/Federated Benefit 940 37300 AZ, , FL, OH 800-337-2363 Customer Service/Tanya Lewis 209 SX072 MA 800-939-5433 Customer Service 109 IP080 CA 818-461-5554 Fed Villaluna Family Health Partners MC+ Missouri 173 43173 MO 800-347-9363 Provider Relations Located in Columbus, Georgia Exceptional Care Medical IPA located in Encino, CA Located in Mason, Ohio Fallon Community Health Enrollment Required contact Gateway EDI Family Choice Medical IPA located in Encino, CA Located in Kansas City, Missouri - Unique Provider ID number required Family Health Plan 940 96865 OH 419-251-0474 Provider Relations 940 37289 ALL 800-224-3272 Customer Service 940 14140 CT, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VT, WV. 806-473-2406 Desri Petrucci 940 33033 CA, TX 800-899-9355 ext Syria Castillo 246 41041 ALL Located in Toledo, Ohio Fara Benefit Services, Inc. Located in Metairie, Louisiana Farm Family Located in Albany, New York FCE Benefit Administrators, Inc. Claims offices located in San Antonio, TX Federated Mutual Health Insurance Company 009 See Members Card Home Office is located in Owatonna, Minnesota Fidelis Care New York 009 11315 NY 866 WC321 CT, DC, DE, IL, MD, NC, NJ, NY, PA, SC, TN, VA 109 FAMR1 ALL 888-343-3547 Provider Call Center 800-622-3339 Customer Service Located in Rego Park, New York Fireman's Fund WORK COMP First Administrators, Inc. Located in Des Moines, IA, Rapid City &Sioux Falls, SD-see notes for Provider ID First Carolina Care 009 56196 NC, SC 910-215-5268 Craig Humphrey 009 75138 CO, IA, ID, MN, MT, ND, NE, SD, UT, WY 888-246-9949 Dept. of Electronic Claims Located in Pinehurst, South Carolina First Choice of Midwest Located in Sioux Falls, South Dakota First Great-West Life & Annuity Insurance Company 057 80705 ALL 800-537-2033 Customer Service First Guard Kansas Plan 960 90060 KS 888-828-5698 Customer Care 888-828-5698 Customer Care Claims add: PO Box 3020, Farmington, MO Payer requires Provider ID be present. First Guard Missouri MC+ Plan 961 90061 MO Claims add: PO Box 3010, Farmington, MO - Requires a Unique Provider ID number First Health 372 87043 ALL 801-977-4916 Sharon Miller First Health (ALTA Health Stratagies) 109 87043 ALL 800-813-0397 Customer Service 23241 PA 800-451-4477 Customer Service 13317 ALL Claims address: P O Box 24220, Tucson, AZ 85734 First Priority Health 009 Located in Wilkes-Barre, Pennsylvania First Reliance Standard (N. Y. Business) 372 FirstCare 940 TH003 800-3651051ext6456 Customer Service ALL 615-360-2843 Rene' Ernst TX Unique Provider ID number required - Enrollment required contact Gateway EDI. Fiserv Health/Tennessee 009 62061 Formerly Willis Administrative Services Corporation FlexCare 372 68241 ALL 800-544-4778 Customer Support Florida 1st 009 59276 FL 813-293-0785 Pam Ortin 109 AMS01 FL Located Winter Haven, Florida Florida Health Choice (FL) Wisconsin Only Only claims with the address of Wisconsin can be submitted electronically. Florida Health Choice/Select (FL) Wisconsin Only 109 AMS01 FL Only claims with the address of Wisconsin can be submitted electronically. Florida Health Network - Wisconsin Only 109 AMS01 FL Only claims with the address of Wisconsin can be submitted electronically. Florida Hospital Healthcare Systems 009 59321 FL 800-741-4810 opt. Provider Relations 4 Located in Orlando, Florida - Rendering FHHS Provider ID or UPIN # required. Florida Hospital Waterman Employee 666 Benefit Plan 48116 FL 913-685-4740 Peter Rupp Located in Eustis, Florida Florida Power & Light 372 68241 ALL 800-544-4778 Customer Support FMH Benefit Services 666 48117 ALL 800-990-9058 Customer Service 866 WC771 DC, DE, GA, KY, MD, NC, PA, SC, TN, VA, WV 009 70408 ALL 414-299-6334 Elizabeth Kegel Located in Overland Park, Kansas Food Lion/Dalehaize WORK COMP Fortis Benefits Benefit Centers Located in TX, MO, KC, MN, GA & P. O. Box 3195, Milwaukee, WI Fortis Benefits Insurance Company 372 70408 ALL 414-299-6334 Dale Luedtke Fortis Self Funded Administrative Services 800 41124 ALL 800-765-4224 Provider Services Claims with City & State Hopkins, MN & P. O. Box 27267, Minneapolis, MN 5542 Fortis Self Funded Administrative Services 372 41124 ALL Fortis/Time 009 39065 ALL 414-299-6317 Dwayne Riekena Claims address: PO Box 624 and 501 West Michigan, Milwaukee, WI Fox Valley Medicine - Site 199 940 FVMCH IL 630-482-9758 Provider Services 009 64067 601-718-5291 Missy Senn 601-364-5291 Missy Senn Located in Batavia, Illinois Fox-Everett - Litton Ingalls Shipbuilding AL, LA, MS Located in Jackson, MS - Only claims for Litton Ingalls Shipbuilding employees Fox-Everett, Inc. 009 64069 ALL Located in Jackson & Gulfport Mississippi Frankenmuth 866 WC711 MI 800 62324 TX 800-725-1407 Customer Service 109 IP080 CA 818-461-5554 Fed Villaluna 009 67814 ALL 800-451-2513 Customer Service 800-451-2513 Customer Service 800-345-0109 Customer Service 800-392-1145 Provider Services WORK-COMP Freedom Life Insurance Company Located in Fort Worth, Texas Freeman IPA IPA located in Encino, CA G. E. Group Life Assurance Company formerly Phoenix American Life (PAL), Phoenix Home Life and Phoenix Mutual G. E. Group Life Assurance Company 009 67814 Gallagher Bassett Services, Inc. 866 WC661 ALL 940 37283 ALL WORK-COMP Gallagher Benefit Administrators ALL Claims offices in: Lisle, IL; San Antonio, TX; Jackson, MS & San Francisco, CA Gateway Health Plan 009 25169 PA Claims : P.O. Box 11-718, Albany, NY 12211-0718 - Provider ID required GE Group Administrators 009 75238 ALL 800-397-6241 Customer Service 009 06143 ALL 413-7897000ext.275 Joan Keefe 009 75273 PA 570-271-7135 Provider Network Located in Arlington, Texas GE Group Administrators (Agawam, MA) Located in Agawam, Massachusetts Geisinger Health Plan Located in Danville, Pennsylvania - Enrollment Required General American 057 80705 ALL 314-525-5226 Provider Relations General American Life Insurance Company 372 63665 ALL 314-252-5226 Provider Relations Genesis Healthcare (EMG) 109 IP087 CA Enrollment required contact Gateway EDI GEO 866 WC791 CA, CO, LA, MI, MS, NC, NM, NY, OK, PA, VA 666 13551 NY WORK COMP GHI - New York (Group Health Inc.) 212-615-4362 Providers Service 845-340-2338 EMC Department 978-474-5139 Terry Haneffant Claims address: PO Box 2832 & 2833, New York, New York 10116-2832 GHI - New York(Group Health Inc.) 372 13551 ALL GHI HMO Select 666 25531 NY Claims address: PO Box 4141, Kingston, NY 12402 GHP 340 00340 IL, MO Unique Provider# required - Contact Gateway EDI Customer Service Set-up GIC Indemnity Plan 314 80314 MA Claims mailing address: GIC Indemnity Plan, PO Box 9016, Andover, MA 01810-0916 Gilsbar, Inc. 372 07205 ALL 888-215-9841 Customer Service 009 07205 ALL 888-215-9841 Provider Services Glassworkers Health & Welfare Fund 372 91136 ALL 91136 AK, WA 206-441-7574 Customer Service 009 37602 ALL 317-297-4187 Client Services 940 GTPA1 TX 713-843-6780 Provider Services Located in Covington, Louisiana Gilsbar, Inc. Located in Covington, LA Group # F29 Glassworkers Health & Welfare Fund 009 Group # F29 Golden Rule Insurance Company See notes for claims addresses Golden Triangle Physician Associates Select Care of Texas - See Notes - Unique Provider ID required Government Employees Hospital Assn. (GEHA) 109 44054 ALL 800-821-6136 Customer Services 372 44054 ALL 800-821-6136 Customer Service 009 95467 MI 248-331-4348 Barbara VanRaaphorst 057 80705 ALL 888-836-4877 Customer Service 800-537-2033 Customer Service Located in Independence, Missouri Government Employees Hospital Association Located in Independence, Missouri Great Lakes Health Plan Located Southfield, Michigan Great West National Accounts Claims mailing address: 1000 Great-West Drive, Kennett, MO Great-West Life & Annuity Ins.Co. 372 80705 ALL Great-West Life Assurance Co. of 057 80705 ALL America Greater L.A. Health 109 IP080 CA 818-461-5554 Fed Villaluna 109 IP080 CA 818-461-5554 Fed Villaluna 372 36338 ALL 847-519-1880 ext Ron Lawlor 125 009 36338 ALL 847-519-1880 ext Ron Lawlor 225 009 48143 ALL 800-827-7223 Customer Service 126 72153 ALL 440-720-0700 ext205 Rebecca Karlinsky 800-919-4325 Provider Services 206-901-6347 Provider Services 608-251-4156 X4454 Customer Service 800-755-5242 Customer Service IPA located in Encino, CA Greater San Gabriel IPA located in Encino, CA Group Administrators, LTD Located in Schaumburg, IL Group Administrators, LTD Located in Schaumburg, IL Group and Pension Administrators, Inc. Corporate office, Richardson, Texas Group Benefit Administrators Only claims with address: 260 West Main St., Suite 215, Hendersonville, TN 37075 Group Health Cooperative (WA) 940 91051 WA Claims with zip code of 98xxx should be sent to this payer. Group Health Cooperative - East 940 91121 ID, WA Claims with zip code of 99xxx should be sent to this payer. Group Health Cooperative - Madison, 009 WI 39167 WI Located in Madison, Wisconsin Group Health Insurance - DE 611 61101 ALL Group Health Plan 340 00340 IL, MO Unique Provider# Required Claims address - PO Box 7374, London, KY Group Insurance Service Center, Inc. 940 37276 ALL 800-242-4472 ext Barb Tharp 136 Located in Pembroke, Massachusetts Guardian Life Insurance Co. of America 372 64246 ALL 414-749-6303 Vance Kramer Guardian Life Insurance Company 666 64246 ALL 414-749-6303 Vance Kramer 39180 WI 608-775-8026 Shari Oelke 608-775-8026 Shari Oelke Home office located in New York, New York Gundersen Lutheran Health Plan, Inc. 940 Before submitting electronic all providers must contact Shari Oelke. Gundersen Lutheran Health Plan, 009 39180 WI Inc. Before submitting electronic all providers must contact Shari Oelke. H.E.R.E.I.U. Welfare Pension Plan Funds 940 37114 ALL 630-428-5397 Gary Trebolo 109 36406 IL 312-516-4900 Customer Service 800-504-2766 Provider Services 614-470-7383 &7427 Gayle Hyslop & Lisa Phillips 888-888-4742 Customer Service Located in Aurora, Illinois Harmony Health Plan of Illinois Claims address: PO Box 06559, Chicago, IL 60606-0559 Harmony Health Plan of Indiana 009 36405 IN 109 95266 ALL Harrington Benefits, Inc. (Oklahoma) 109 59142 ALL Indiana Hoosier Healthwise Harrington Benefit Services Located in Oklahoma City, Oklahoma Hartford 866 WC121 ALL 427 04271 WORK COMP Harvard Pilgrim Health Plan ME, MA, NH, NY, VT Enrollment required contact Gateway EDI, Unique Provider ID required. HCH Administration 940 37111 ALL 630-718-8128 Pete Foskaris 940 37329 NM 309-282-1203 Paul Wann 940 HDMCO ALL 800-667-4824 Customer Service 940 34185 ALL 070 77950 IL, IN 217-278-8566 Provider Service Located in Peoria, IL HCHA-Albq, NM Self Funded Located in Peoria, Illinois HDM Benefit Solutions Located in Omaha, Nebraska Health Administration Service, Inc. Located in Richardson, Texas Health Alliance Medical Plans, Inc. Located in Urbana, IL - Rendering Provider Network ID Req. - Enrollment Req. Health Alliance Plan of Michigan 109 38224 MI, OH 248-443-8516 EDI Specialist 666 25126 OH, PA, WV 800-470-4272 Provider Relations OH, PA, WV 800-470-4272 Customer Service OH, PA, WV 800-470-4272 Customer Service 800-470-4272 Provider Services Unique Provider ID # required Health America of Ohio Claims address - PO Box 8103, London, Kentucky Health America of Pennsylvania EPA 666 25126 Claims address - PO Box 7089, London, Kentucky Health America of Pennsylvania WPA 666 25126 Claims address - PO Box 7088, London, Kentucky - Unique Provider ID number req Health Americaof Pennsylvania Advantra 666 25126 OH, PA, WV Claims address - PO Box 7087, London, Kentucky Health Care Savings 009 56142 NC 800-8332464ext2006 Provider Services Only Claims with address: 4530 Park Road, Suite 110, Charlotte, NC Health Choice, Inc. 940 22345 NJ 973-940-0120 Anthony Delbagno 126 82018 ALL 440-720-0700 x 205 Rebecca Karlinsky HCOMP ALL 800-442-7247 Customer Service 126 34158 ALL 440-720-0700 ext Kathy Myers 222 940 75234 ALL 972-980-0900 ext Kip Altman 218 800 95019 FL 800-716-7737 Customer Service ALL 541-618-7253 Kyle Wichelmann HMA01 ALL 800-869-7093 Customer Service 86066 239-598-3104 Customer Service ALL 818-676-7864 Misty Cheluis ALL 818-676-7864 Misty Chelius AZ 866-334-4638 EDI Department 203-385-5658 Provider Services Located in Newton, New Jersey Health Claims Service (Boise, ID) Claims address: P. O. Box 1067, Boise, ID 83701 Health Comp 109 Main office located in Fresno, California Health Design Plus Located in Findlay, Ohio Health First (Tyler, Texas) Located in Tyler, Texas Health First Health Plans Claims address: PO Box 565001 Rockledge, Florida 32956-5001 Health Future, LLC 372 30946 Located in Medford, Oregon Health Management Administrators 940 HMA Located in Bellevue, Washington Health Management Associates 009 ALL Located in Naples, Florida Unique Provider ID number required Health Net California - Commercial Claims 109 95567 Claims address: P.O. Box 14702 Lexington, KY 40512 Health Net California - Seniority Plus 109 Claims 95567 Claims address: P.O. Box 14703 Lexington, KY 40512 Health Net of Arizona 940 38309 Claims address: P.O. Box 14225 Lexington, KY- Rendering Provider ID required Health Net of the Northeast, Inc. 109 06108 CT, NJ, NY, PA Payer requires Unique Provider ID - claims address: PO Box 14700, Lexington, KY Health Net Oregon 109 95567 ALL Claims address: PO Box 14130, Lexington, KY 40512 Health Net Plus (TN) - Wisconsin Only 109 AMS01 TN Only claims with the address of Wisconsin can be submitted electronically. Health Net SmartChoice 109 13402 NY 877-870-7065 Provider Service 009 20199 ALL 732-676-2637 Ken Kline 800 04286 CT, MA 413-787-4000ext 5000 Network Development Located in New York, New York Health Network America Located in Eatontown, New Jersey Health New England Located in Springfield, Massachusetts Rendering Network ID required. Health Partners (Tennessee) 009 62157 TN 800-825-8929 Bill Jones Health Partners (Tennessee) Dental 372 62157 TN 800-825-8929 Bill Jones 070 M3411 MN 952-883-6000 Customer Service 009 80142 PA 215-991-4350 Provider Services Only the TPA Product Located in Jackson, Tennessee Health Partners of Minnesota Enrollment required. Health Partners of Philadelphia Located in Philadelphia, PA - Rendering Provider Network ID required Health Plan Management, Inc. 109 37221 IL 847-234-8870 ext Customer Service 600 162 00162 OH, WV 740-695-7906 Provider Services Located in Lake Bluff, Illinois Health Plan of Upper Ohio Valley Located in Saint Clairsville, OH - Contact Gateway EDI before sending Health Plan Service Harrington (Columbus, OH) 109 95266 ALL 372 59142 ALL 614-470-7383 or 7427 Gayle Hyslop or Lisa Phillips 109 59142 ALL 614-470-7383 & 7427 Gayle Hyslop & Lisa Phillips 372 59142 ALL 614-470-7383 Gayle Hyslop Health Plan Services (Tampa Only) 109 59140 ALL 800-282-4690 x4244 Diane Lutz Health Plans, Inc. 109 44273 ALL Health Plus of Louisiana 800 95009 LA 318-212-4765 Customer Service 009 11324 NY 718-491-8355 Edward Yuabov 009 41170 ALL 616-383-2300 Mary Beth Walsh Columbus, OH Health Plan Services (Oklahoma) Located in Oklahoma City, OK Health Plan Services (Oklahoma) Located in Oklahoma City, OK Health Plan Services (Oklahoma) Located in Oklahoma City, OK Located in Shreveport, Louisiana Health Plus, PHSP, Inc. Located in Brooklyn, New York Health Risk Management Corporate Headquarters. Minneapolis, Minnesota Health Risk Management (HRM) 372 41170 ALL Health Service Management 109 HSM01 IL, IN, IA, KY, MN, WI Health Services Preferred (HSP) by Emerald Health 126 34167 ALL Health Value Mgmt. --DE (Humana) 611 61101 ALL Healthcare Preferred 666 25147 MO AMS01 IA 616-383-2300 Mary Beth Walsh 651-287-4726 John Bould 800-843-1787 Customer Service Located in Woodberry, Minnesota See Notes Healthcare Preferred (IA) - Wisconsin 109 Only/TESTING Only claims with the address of Wisconsin can be submitted electronically. Healthcare Solutions Group 009 73147 ALL 806-473-2427 Customer Service 550 00550 MO 314-444-7249 Jodie 800-395-2545 Customer Service 405-499-4920 Customer Service 800-960-2530ext 1447 Tamara L. Allen 212-801-6078 Manny Vito Located in Muskogee, Oklahoma Healthcare USA - Medicaid MC+ Carrier Unique Provider ID Required Claims address - PO Box 7629, London, KY Healthcare, Inc. HMO/POS, PPO, MRN EPO 666 25127 GA Claims mailing address: PO Box 7128, London, KY 40742 Healthchoice - State of Oklahoma 109 59142 OK Located in Oklahoma City, Oklahoma HealthChoice of Memphis 009 62168 AR, MS, TN Healthease 009 59608 ALL Located in Tampa, Florida / Requires a 5-9 character Rendering Provider ID numbe Healthfirst Inc.-New York 940 80141 NY Located in New York, NY - Rendering Provider ID Number Required HealthGuard of Lancaster 009 23226 PA 800-581-4600 Provider Services 009 59087 ALL 281-447-7000 Customer Service 013 00013 AR, IL, MO 800-624-2356 Customer Service 800-624-2356 Customer Service Located in Lancaster, Pennsylvania HealthHelp Networks, Inc. (HHNI) Located in Houston, Texas Healthlink HMO Unique Provider ID# Required (Contact Gateway EDI Customer Service for Set-up) Healthlink PPO 014 00014 AR, IA, IL, IN, KY, MO, WV Unique Provider ID# Required (Contact Gateway EDI Customer Service for Set-up) Healthnow New York, Inc. 502 55204 NY Enrollment required contact Gateway EDI, Inc. Healthplex 372 11271 ALL Healthscope Benefits, Inc. 372 71063 ALL 501-376-9015 X310 Linda Shumate Healthscope Benefits, Inc. 940 71063 ALL 501-376-9015 x310 Linda Shumate Claims address: PO Box 8002 and 3823, Little Rock, AR 940 75250 ALL 210-684-2983 ext Sandy Davis 18 Healthsource Provident Administrators 372 68195 ALL 423-755-1416 Annie Rowland Healthsource Provident Insurance 372 68195 ALL 423-755-1416 Annie Rowland Healthspring HMO & Healthspring Medicare + Choice 109 25193 TN 615-291-7035 Provider Relations 800-743-7141 Provider Call Center HealthSmart Preferred Care, Inc. Located in Lubbock, Texas Located in Nashville, Tennessee. Not for PPO claims. Enrollment required. HealthSpring of Alabama 009 63092 AL Enrollment and Rendering Provider ID number required. 009 36332 ALL 708-673-3113 x2255 Courtney Turlington 109 00243 DC, MD 410- 574-3000 Provider Services 009 59230 FL 863-967-4139 Customer Service Heritage National Health Plan of TN, 666 Inc. (HMO) 95378 TN 800-527-4390 Customer Service 009 11328 NY 516-746-2200 X 222 Leo Irarangal 940 HPN11 TX 713-843-6780 Provider Services Healthstar, Inc. Located in Chicago, Illinois Helix Family Choice Located in Columbia, Maryland Heritage Consultants Located in Auburndale, Florida TennCare MCO Plan - Certification required Heritage New York Medical Group Located in Garden City, New York Heritage Physician Network Select Care of Texas - See notes - Unique Provider ID required HFN, Inc. 109 36335 ALL 630-954-1232 Dave Parsons 940 59347 FL 800-743-9264 Customer Service Located in Oak Brook, Illinois Hillcrest Benefit Administrators Located in Mt Dora, Florida Hills Physicians Medical Group 109 10046 CA 925-362-6259 Tina Loftus 55247 NY 800-447-8275 Provider Relations 890 00891 TN 423-755-5717 Customer Service 021 00021 TX 412-766-5480 Customer Service 800-637-0171 Customer Service CO 800-544-3879 Provider Services Unique Provider ID Number Required. HIP - Health Insurance Plan of Greater New York 666 Individual Provider Enrollment required HMO Blue - Blue Cross and Blue Shield of TN Health Maintenance Organization HMO Blue of Texas / Blue Cross & Blue Shield of TX Same requirement for Blue Cross/Blue Shield of Texas, Plan route code is ZGA HMO Blue Texas 021 00021 TX formerly NYLCARE - Effective 8/16/01 claims sent to BCBS TX HMO Colorado 072 00073 Payer requires enrollment forms - Contact Gateway EDI HMPK, Inc. 611 61101 ALL 800-367-7587 Customer Support Hollywood Presbyterian 109 IP080 CA 818-461-5554 Fed Villaluna 126 34150 OH 800-426-9013 Customer Service 009 22326 NJ 877-234-4273 Provider Services 009 91136 AK, WA 206-441-7574 Customer Service HPlan, Inc. 611 61101 ALL 800-367-7587 Customer Support HPS Paradigm, Inc. 126 58227 ALL SEE NOTES SEE NOTES IPA located in Encino, CA I HomeTown Health Network Located in Cleveland, Ohio Horizon Mercy Health Plan of New Jersey Payer Requires Rendering Provider ID# Hotel Employees & Restaurant Employees Health Group # F19 SEE NOTES FOR ADDRESSES AND PHONE NUMBERS HRM Claim Management 372 41170 ALL Humana (Encounters) 611 61102 ALL 611 61101 ALL 800-558-4444 X 7448 Bonnie or Jody 61101 ALL 800-367-7587 Customer Support ENCOUNTERS ONLY Humana - Employers Health Green Bay and Madison Wisconsin only Humana Care Plan 611 Humana Employers Health of Georgia, Inc. 611 61101 ALL Members ID Card Customer Service Claims mailing address: PO Box 14610, Lexington, KY 40512-4610 Humana Group Health Plan 611 61101 ALL 800-367-7587 Customer Support Humana Health Chicago Inc. 611 61101 ALL 800-367-7587 Customer Support Humana Health Chicago Ins. Co. 611 61101 ALL 800-367-7587 Customer Support Humana Health Plan 611 61101 ALL 800-448-6262 Customer Support Humana Insurance Agency 611 61101 ALL 800-367-7587 Customer Support Humana Insurance Company 611 61101 ALL 800-367-7587 Customer Support Humana Medical Plan-CA 611 61101 ALL 800-367-7587 Customer Support Humana Medical Plan-KY 611 61101 ALL 800-367-7587 Customer Support Humana Wisconsin Health Org. 611 61101 ALL 800-367-7587 Customer Support Formerly GHA of Washington DC formerly CareNetwork/Wisconsin Hlth. Org. HUMANA/Employers Health 611 61101 ALL 800-558-4444 X 7448 Bonnie or Jody - MIS Dept. Hunt Insurance Group/HRH TPA Services 109 37260 ALL 850-385-3636 ext.227 Cindy Clawson 109 IP080 CA 818-461-5554 Fed Villaluna 109 IP080 CA 818-461-5554 Fed Villaluna 372 22175 NJ, NY, PA 800-792-3666 Customer Service 800-792-3666 Customer Service Located in Tallahassee, Florida Huntington Park Medical Group IPA located in Encino, CA Huntington Park Mission IPA located in Encino, CA I. E. Shaffer Claims address: P. O. Box 1028, West Trenton, New Jersey, I. E. Shaffer 126 22175 ALL Claims address: 830 Bear Tavern Road, West Trenton, NJ 08268-1020 IBA Self Funded Group 009 38234 MI 800-722-3644 Customer Service 862 00862 PA 800-992-0246 Customer Service Located in Kalamazoo, Michigan IBC Personal Choice /Highmark Claims address: PO Box 890016, Camp Hill, PA 17089-0016 IBI 372 41124 ALL IBI (Iowa Benefits, Inc.) 800 41124 ALL 800-765-4224 Customer Service 217-782-0538 Provider Relations 217-782-0538 Provider Relations 563-359-9034 Provider Relations Claims with City & State Hopkins, MN & P. O. Box 27267, Minneapolis, MN 5542 IDPA (Illinois Department of Public Aid) 015 00015 IL Payer requires agreement for participation - contact Gateway EDI for forms Illinois Department of Public Aid (IDPA) 015 00015 IL Payer requires agreement for participation - contact Gateway EDI for forms Illinois Health Solutions 009 86069 IL Located in Bettendorf, Iowa Unique Provider ID number required. IMCARE 109 41600 MN 800-657-3613 Customer Service - EVS 109 40585 NJ 201-460-3214 June Simone 940 35204 IL, IN, KE, MI, OH 888-446-6670 Customer Service 373 35161 ALL 317-588-7565 ProHealth Customer Service Inercultural Physicians Network (IPN) 021 00021 TX 972-766-7203 Helen Jarrett Located in Grand Rapids, Minnesota Indecs Corporation Located in Lyndhurst, New Jersey Indiana Health Network Located in Indianapolis, Indiana Indiana Prohealth Network Located in Indianapolis, IN Claims are sent to Blue Cross & Blue Shield of Texas InforMed, LLC/Self Funding Administrators 126 52196 ALL 410-349-9750 Carla Denhardt Insurance Administrators of America, 940 Inc. 37279 ALL 888-599-1515 Customer Service 126 63082 ALL 440-720-0700 ext Kathy Myers 222 372 13315 ALL 201-337-0007 ext Wayne Shoupe 207 009 13315 ALL 201-337-0555 372 88006 ALL 440-720-0700 ext Tiffany Brown 215 372 88006 ALL 440-720- Located in Annapolis, Maryland Located in Cherry Hill, New Jersey Insurance Claims Service, Inc. Located in Birmingham, Alabama Insurance Design Administrators Located in Oakland, New Jersey Insurance Design Administrators Customer Service Located In Oakland, NJ Insurance Management Services Located in Elko, Nevada Insurance Management Services Tiffany Brown 0700ext215 Located in Elko, Nevada Insurance Management Services 126 88006 ALL 440-720-0700 x215 Tiffany Brown - EDI 806-373-5944 EDI operations Customer Service Only claims with address: PO Box 71, Elko, NV 89803 Insurance Management Services of Texas 940 IMSMS TX Claims address: PO Box 15688, Amarillo, Texas Insurers Administrative Corporation 940 IAC01 ALL 800-843-3106 126 51020 ALL 440-720-0700 ext Tiffany Brown 215 Located in Phoenix, Arizona Integra Administrative Group Only claims with the address: 110 South Shipley Street, Seaford, DE 19973 Integra Administrative Group 372 51020 ALL 440-720-0700 ext Tiffany Brown 215 Only claims with address: 110 S. Shipley Street, Seaford, Delaware 19973 Integra Group 009 31127 OH 513-459-1010 x 1177 126 58200 ALL 440-720-0700 ext Tiffany Brown 215 009 37227 CO 303-770-5710 Customer Service 940 60280 ALL 713-781-3364 Customer Service 109 23287 NJ, PA, WV 800-537-9389 Customer Service Tom Brackmann Located in Cincinnati, Ohio Integrity Benefit Network, Inc. Located in Marietta, Georgia InterCare Health Plans, Inc. ENTERED TWICE Interface EAP (IEAP) Located in Houston, Texas Intergroup Located in Malven, PA - Group Number is required International Union of Operating Engineers, Loc 009 37241 MA 781-861-1600 Customer Service 940 37269 NY 630-428-5126 Ray Zroback 800-613-1124 Customer Service 800-765-4224 Customer Serice No longer accepts electronic International Union of Operators Engineers - NY Local 15, 15A, 15C & 15D. A.F.L.-C.I.O. Located in New York, New York Interplan Health Group-Accountable Health Plan 009 AHP01 ALL Only claims with PO Box 90613, Arlington, TX 76006 - See note for more info. Iowa Benefits 372 41124 ALL Iowa Benefits, Inc. 800 41124 ALL Claims with City & State Hopkins, MN & P. O. Box 27267, Minneapolis, MN 5542 Iowa Health Solutions 009 86068 IA 800-928-8004 Provider Relations ALL 800-634-0173 Customer Service Located in Bettendorf. Iowas Unique Provider ID number required. J P Farley 126 34136 Claims address: PO Box 458022, Cleveland, Ohio J. F. Molloy & Associates, Inc. 109 61271 ALL 515-247-8051 Carla Houselog J. F. Molloy and Associates 372 61271 ALL 515-247-8051 Carla Houselog Jardine Group Services 372 14168 ALL JI Specialties 940 TH033 TX Corporate office Des Moines, Iowa Enrollment required contact Gateway EDI, Inc. John Alden Life Insurance Company 666 41099 ALL 800-328-4316 Customer Support John Deere Health 372 95378 ALL 309-765-0539 Joan Bennett John Deere Healthcare/Heritage 666 95378 ALL 800-527-4390 Customer Service 372 65099 ALL 617-572-7222 Claim Payment Check 314 80314 ALL 877-334-4286 Customer Support 314 80314 ALL 877-334-4286 Customer Support John Hancock Mutual Life Insurance 372 Co. 65099 ALL 617-572-7222 Claim Payment Check 65099 ALL 617-572-7222 Claim Payment Check 80314 ALL 877-334-4286 Customer Support JMH01 CA 925-952-2888 Customer Service 009 37215 ALL 800-447-4982 Customer Service 940 37272 ALL 888-295-4864 Georgia Customer Service 800-777-7902 Customer Service Certification required John Hancock Health Security Plan Now UNICARE Special Accounts John Hancock Health Security Plan Now UNICARE Special Accounts John Hancock Mutual Life Ins Co Now UNICARE Special Accounts Now UNICARE Special Accounts John Hancock Preferred Health Plan 372 Now UNICARE Special Accounts John Hancock Preferred Health Plan 314 Now UNICARE Special Accounts John Muir 109 Enrollment required contact Gateway EDI. John P. Pearl & Assoc., LTD Located in Peoria Heights, IL JSL Administrators Located in Newnan, Georgia & Fayetteville, North Carolina - See notes Kaiser Foundation Health Plan MidAtlantic Sta 009 52095 DC, MD, VA Located In Rockville, Maryland Kaiser Foundation Health Plan (Northern CA) 940 94135 CA 866-285-0362 Cheryl Robinson 866-285-0361 Tina Cheung 503-813-3354 Deborah Hillan Located in Oakland, California - Payer requires a Unique ID number Kaiser Foundation Health Plan of Southern CA 009 94134 CA Located in Los Angeles CA - Provider ID Number Required Kaiser NW Region 109 KS007 OR, WA Claims address: 500 NE Multnomah Street, Suite 100 Portland, OR 97232 Kaiser of Georgia 009 21313 GA 404-261-2825 Claims Services 009 57038 ALL 800-635-4242 Provider Services 940 KELSE TX 410-363-3816 Technical contact Kempton Company 372 73100 ALL 405-521-1711 Dwight Berry Kempton Company 009 73100 ALL 405-521-1711 Dwight Berry Kempton Group Administrators 372 73100 ALL 405-521-1711 Dwight Berry Kentucky Health Select 372 63076 ALL 888-895-0460 Provider Services Providers will need to be set-up. Kanawha Insurance Company Located Lancaster, SC Kelsey Seybold Located in Houston, Texas Located in Lexington, KY - Provider ID - Must contain provider's Medicaid Number Kentucky Kare 611 61101 ALL 800-367-7587 Customer Support Key Benefit Administrators, Inc. 940 37217 ALL 317-284-7100 Customer Service PA 800-874-8433 Provider Services 800-227-3119 Provider Services 877-234-4271 Provider Services Only claims with PO Box 55210, Indianapolis, IN 46205 Keystone Health Plan Central 239 23239 Claims add: P.O. Box 779521, Harrisburg, PA -Unique Provider ID req Keystone Health Plan East 950 95056 DE, NJ, PA Claim add: PO Box 898815, CampHill, PA&PO Box 41574, Philadelphia, PA SEE NOTES Keystone Mercy 009 23284 PA Claims add: PO Box 7115, London, KY - Enrollment & Provider ID required. Kindred Health Care 611 61101 ALL 800-448-6262 Customer Service 372 93207 ALL 800-373-1477 Customer Service NDEX 800-373-1477 Customer Service Located in Lexington, Kentucky King Count Medical-Grays Harbor Medical Bureau Now known as Aberdeen and Raymond - Requires Unique Provider ID King County Medical Blue Shield 372 93200 ALL Now known as Regance Washington Health - Requires Unique Provider ID King County Medical Blue ShieldFEP 372 93200 ALL 800-373-1477 Customer Service Now known as Regance Washington Health-FEP - Requires Unique Provider ID King County Medical Thurston County Blue Shield 372 93211 ALL King County Medical-Cowlitz Blue Shield - Now 372 93220 ALL 800-373-1477 Customer Service ALL 800-373-1477 Customer Service ALL 800-373-1477 Customer Service ALL 800-373-1477 Customer Service Now known as Longview - Requires Unique Provider ID King County Medical-Lewis County Blue Shield 372 93210 Now known as Chehallis - Requires Unique Provider ID King County Medical-Snohomish County Physicians 372 93219 Now known as Everett - Requires Unique Provider ID King County Medical-Yakima County 372 Blue Shield 93214 Now known as Yakama - Requires Unique Provider ID Klais & Company 940 34145 ALL 330-867-8443 x 214 Craig Sonntag 940 KPS01 ID, MT, WA 800-552-7114 ext6502 Provider Services 800-638-4557 Customer Service 877-311-2150 Customer Service 800-482-0945 Customer Service 319-398-8511 Customer Service Located in Akron, Ohio KPS Health Plan Corporate office located in Bremerton, Washington Lakeside Health Services 109 95416 ALL 009 LNDMK ALL Located in Glendale, California Landmark Healthcare, Inc. Located in Sacramento, California Lebanon Mutual Insurance Company 866 WC451 PA WORK COMP Leggett and PLatt 009 75279 ALL 866 WC461 CA, CT, DC, DE, FL, GA, IL, IN, MD, MO, NJ, NY, PA, SC, TN, VA Located in Carthage, Missouri Liberty Mutual - MedRisk WORK COMP - Specific CPT Codes only - Codes are specific to PT. Liberty Union Life Assurance Company 940 37281 ALL Life Insurance Company of Boston & 372 New York 78140 ALL Life Investors Company of America LIIC2 ALL Located in Madison Heights, Michigan 940 Located in Cedar Rapids, Iowa Lifewise Oregon 093 93093 OR 800-435-2715 EDI Department 611 61101 ALL 800-558-4444 X7448 Bonnie or Jody - MIS Dept. Located in Bend, Oregon Lincoln National EMPHESYS, Green Bay and Madison, WI only Lincoln National (WI) 372 73288 ALL 800-558-4444 X7448 Bonnie or Jody - MIS Dept. Lincoln National-Phoenix AZ 611 61101 ALL 800-367-7587 Customer Support 940 35107 IN 440-720-0700 ext Kathy Myers 222 009 37226 RI 401-435-4700 Customer Service 877-582-1849 EDI Coordinator Humana Local 135 Health Benefits (Indianapolis, IN) Located in Indianapolis, Indiana London Health Administrators Located in East Providence, Rhode Island Longs Drugs 866 WC801 CA, CO, GA, HI, IL, NM, OR, UT Louisiana Medicaid - KidMed 706 00706 LA Lovelace Health Plan 372 62310 ALL WORK COMP Payer no longer accepts electronic claims Lovelace Salud 940 90328 Lovelace Sandia Health Plans 940 90329 Lovelace Senior Options (LSO) 372 62310 ALL Payer no longer accepts electronic claims effective 4/30/04 Lovelace Senior Plan (LSP) 372 62310 ALL Payer no longer accepts electronic claims effective 4/30/04 Lowe's 866 WC741 ALL 009 54195 WORK COMP Lumenos ALL Located in Alexandria, VA - send claims to Po Box 69309, Harrisburg, PA 17106 Machigonne Benefit Administrators 372 10317 ALL 207-822-5893 Jane Dorr 940 37292 MO 314-739-6442 Customer Service 516-282-8350 Naren Lulla Located in Portland, Maine Machinist District 9 Welfare/Mental Health Only Located in Bridgeton, Missouri - Mental Health claims only - SEE NOTES MagnaCare 940 11303 ALL Located in Garden City, New York Mail Handlers Benefit Plan 109 62413 ALL 800-707-5586 Customer Service ALL 800-410-7778 Customer Service Claims address effective 8/17/05-PO Box 8402, London, KY-see notes for old add. Mailhandlers Benefit Plan/CAC 372 62413 Claims address - P.O. Box 24503 Tucson, AZ 85734 MAMSI Life and Health Insurance Co. (MLH) 009 52148 DE, DC, MD, NC, PA, VA, WV 800-257-6458 Provider Service 009 35162 ALL 219-373-9100 Customer Service Managed Dental Care Network (MDCN) 372 84097 ALL Managed Health Networks (MHN) 009 22771 ALL 888-898-6252 Practitioner Inquiry Line 800-414-9475 Customer Service 800-222-9831 Customer Service Rendering Provider ID required. Managed Care Services Located in Fort Wayne, Indiana Claims address:MHN/HMC P.O. Box 14621, Lexington, Kentucky 40512-4621 Managed Health Services Indiana/Maxicare 186 39186 IN Located in Indiana - Enrollment Required - aka - Risk Base Claims Managed Health Services Wisconsin 109 39187 WI Claims add: PO Box 3001, Farmington, MO - Enrollment-Provider ID required Managed Physical Network (MPN) 940 41159 ALL 800-236-9921 Provider Services 372 98010 ALL 416-366-2223ext 318 Brenda Best 800-544-4778 Customer Support 800-953-8854 Provider Services Located in Kingston, New York Manulife, W. J. Sutton Co. Claims address; 33 Yonge St., Suite 420, Toronto, Ontario, Canada M5E1S9 Marriott 372 68241 ALL Marriott International, Inc. 866 WC221 ALL 009 00247 WORK COMP Maryland Physicians Care MD Located in Baltimore, Maryland Unique Provider ID number required. Mashantucket Pequot Tribal Nation 109 37121 CT 630-718-8230 Mandy Rak Mass Mutual 314 80314 ALL 877-334-4286 Customer Support Mass Mutual 372 80314 ALL 413-744-7528 Support Team 314 80314 ALL 413-744-7528 Support Team 009 41154 MN 800-304-1928 Customer Service Located in Mashantucket., CT Now UNICARE Major Accounts Mass Mutual Now UNICARE Major Accounts Mayo Management Services, Inc. Located in Rochester, Minnesota Mcare 109 38264 MI 800-688-3290 Customer Service Provider Services Claims address: Po Box 130799, Ann Arbor, MI - Unique Rendering Prov ID req. McLaren Health Plan 009 38338 MI 888-327-0671 009 11338 NY 800-707-MDNY *3 Customer Service 130 00130 MO, IL 800-777-9087 Provider Services Located in Flint, Michigan MDNY Healthcare Located in Long Island, New York Med-Pay Group Number must match Med-Pay table Medcost Benefit Services (MSB) 372 56205 ALL 336-774-4419 Denise Porterfield MedCost, Inc. 009 56162 GA, NC, SC, TN.VA 800-433-9178 x4189 EDI Coordinator 009 95321 ALL 800-398-8999 Customer Service 940 94265 MN 00003 MO 573-751-2896 Customer Service 00582 AL 334-215-4152 Customer Service 602-417-4892 Customer Service AR 501-374-6608 Provider Service 916-636-1100 Customer Service Located in Winston-Salem, North Carolina MedFocus Located in Santa Monica, California Medica Medica requires a unique Provider ID. Medicaid Missouri - Dental 003 Enrollment Required contact Gateway EDI Medicaid of Alabama/EDS Federal Corp. 582 Contact Gateway EDI to send claims electronically. Medicaid of Alaska/AK DHSS 821 00821 AK Medicaid of Arizona/Need to Test 501 00501 AZ SEE NOTES REGARDING HEALTH PLANS THAT CAN NOT BE SENT ELECTRONIC. Medicaid of Arkansas / EDS Federal 185 Corp. 00185 Payer requires Enrollment - Contact Gateway EDI Medicaid of California--Claim type 5 148 00148 CA 016 77016 CO Medical Claims Form 05 only Medicaid of Colorado / ACS Enrollment required contact Gateway EDI. Inc. Medicaid of Connecticut 104 00104 CT 860- 424-5166 Provider Services 571 00571 DE 302-454-7154 Provider Relations 033 00033 DC 866-752-9233 Provider Enrollment Enrollment required contact Gateway EDI. Medicaid of Delaware / TESTING testing Medicaid of Dist of Columbia Enrollment required contact Gateway EDI. Medicaid of Florida / ACS 027 77027 FL (850) 386-7755 00084 GA 1.800.987.6715 Provider Services HI 888.333.5641 EDI Support 00053 ID 800-685-3757 EDI Support 00015 IL 217-782-0538 Provider Relations (317) 488-5160 opt 3 EDS Solutions Enrollment Required - Contact Gateway EDI Medicaid of Georgia /ACS 084 Payer requires Enrollment Form - Contact Gateway EDI Medicaid of Hawaii 996 99600 Enrollment required contact Gateway EDI, Inc. Medicaid of Idaho 053 Enrollment required contact Gateway EDI Medicaid of Illinois / BCBS of Illinois 015 Payer requires agreement for participation - contact Gateway EDI for forms Medicaid of Indiana / EDS 711 00711 IN 233 00233 IA 00034 KS, MO 800-933-6593 Provider Relations 00661 KY 800-205-4696 Provider Services 00703 LA 800-473-2783 Customer Service 704 00704 LA 800-473-2783 Customer Service 705 00705 LA 681 00681 ME (207) 287-4050 Valerie Howard Enrollment required Medicaid of Iowa / Noridian Enrollment Required contact Gateway EDI. Medicaid of Kansas/EDS 034 Payer requires Enrollment - Contact Gateway EDI Medicaid of Kentucky/Dept. Medicaid 661 Services Enrollment required contact Gateway EDI Medicaid of Louisiana - Physician Claims 703 Enrollment Required - Contact Gateway EDI Medicaid of Louisiana Ambulance Claims Requires testing Medicaid of Louisiana Rehab Requires Testing Medicaid of Maine/Health & Human Services Enrollment required contact Gateway EDI for enrollment forms. Medicaid of Maryland/State of MD Dept. Health 911 00911 MD 410-767-6860 Customer Service 00644 MA (617) 576-4030 Jim Turnbull MA 617-576-4436 Laurie Berry MI 800-803-7174 Customer Service Enrollment required contact Gateway EDI Medicaid of Mass - Form 9 Medical Services. 643 Enrollment Required Form 9 Medical Services Medicaid of Mass- Form 5 Physician 643 Claims 00643 Enrollment required - Form 5 Physician Claims Medicaid of Michigan 171 17111 Enrollment required contact Gateway EDI. Medicaid of Minnesota/DHS 955 00955 MN 800-366-5411 Customer Service 00514 MS 800-884-3222 Provider Services 00003 MO 573-751-2896 Customer Service 00430 MO 00261 NE 866-498-4357 EDI Help Desk 00266 NV 877-638-3472 EDI SKNH0 NH 603-271-4329 Customer Service NJ 800-776-6334 Customer Service SKNM0 NM 505- 246-0710 Customer Service SKNY0 NY 518-447-9830 Provider Services 00750 NC 919-851-8888 Customer Support 00164 OH 049 00049 OK 405-522-7300 Provider Services 845 00845 OR 503-220-3924 Electronic Media 00861 PA 717-975-6789 Carolyn Graves 00871 RI 401-784-3810 Customer Service 00029 SC 803-898-2500 Provider Services 80999 SD Enrollment required contact Gateway EDI Medicaid of Mississippi / ACS 514 Requires Enrollment contact Gateway EDI Medicaid of Missouri / Verizon 003 Enrollment Required contact Gateway EDI. Medicaid of Missouri UB92 Claims 430 Enrollment Required - Contact Gateway EDI Medicaid of Nebraska/ Health & Human Services 261 Enrollment Required contact Gateway ED Medicaid of Nevada / First Health 266 Enrollment required contact Gateway EDI. Medicaid of New Hampshire 108 Enrollment Required contact Gateway EDI, Inc. Medicaid of New Jersey 806 00806 Enrollment required contact Gateway EDI, Inc. Medicaid of New Mexico 309 Enrollment Required Contact Gateway EDI Medicaid of New York / Computer Science Corp 309 Enrollment Required - Contact Gateway EDI Medicaid of North Carolina/EDS Federal Corp 750 Enrollment Required contact Gateway EDI Medicaid of Ohio 164 Enrollment required contact Gateway EDI Medicaid of Oklahoma Contact Gateway EDI to send claims Medicaid of Oregon/OMAP Enrollment required conact Gateway EDI. Medicaid of Pennsylvania / EDS 861 Enrollment Required contact Gateway EDI Medicaid of Rhode Island 871 Enrollment required contact Gateway EDI, Inc. Medicaid of South Carolina/SC Dept 029 Health Enrollment required contact Gateway EDI. Medicaid of South Dakota 999 TESTING Medicaid of Texas 372 CKTX1 TX 800-969-3666 Gateway EDI 00024 TX 888-863-3638 Helpdesk SKUT0 UT 800-662-9651 Provider Enrollment 00914 VT 913 00913 VA 800-924-6741 EDI Medicaid of Washington/ ACS 838 00838 WA 800-562-6188 Customer Service Medicaid of West Virginia / Unisys 770 77026 WV 304-345-0101 Provider Services 00941 WI 00462 WY 800-672-4959 EDI Support 009 74323 IL, IN, OH 800-686-8425 Customer Service 372 74323 ALL 740-522-7383 Wayne Millard 009 04258 CT, MA, ME, NH, RI, VT 304-273-5384 Brian Johnson 52181 ALL 800-841-6288 Customer Service ALL 800-362-1279 Provider Inquiry Requires enrollment contact Gateway EDI Medicaid of Texas / TMHP 024 Enrollment required contact Gateway EDI. Medicaid of Utah 309 Enrollment required contact Gateway EDI. Medicaid of Vermont 914 Enrollment required contact Gateway EDI. Medicaid of Virginia/First Hlth Serv Corp Enrollment form can be faxed Enrollment required contact Gateway EDI Medicaid of Wisconsin / EDS 941 Enrollment required contact Gateway EDI. Medicaid of Wyoming 462 Enrollment required contact Gateway EDI Medical Benefits Companies - MCO Located in Newark, OH Medical Benefits Mutual Located in Newark, Ohio Medical Claims Service, Inc. Located in Ravenwood, West Virginia Medical Development International 940 Headquartered in Ponte Verda Beach, Florida Medical Mutual of Ohio 666 29076 Located in Cleveland, Ohio - Providers require a Unique Provider ID Medical Plan of Kansas City-MO 611 61101 ALL 800-367-7587 Customer Service Medicare of Alabama/Cahaba 581 00581 AL 800-292-8855 Customer Service 00831 AK 701-277-6781 Provider Services 877-908-8431 Provider Relations Enrollment Required - Contact Gateway EDI Medicare of Alaska/Noridian 831 Payer requires Enrollment Forms - Contact Gateway EDI Medicare of Arizona / BCBS of ND/Noridian 832 00832 AZ Payer requires Enrollment Forms - Contact Gateway EDI Medicare of Arkansas / BCBS of Arkansas 180 00180 AR 866-345-0274 Customer Service Provider Customer Service Payer requires Enrollment Forms - Contact Gateway EDI Medicare of California / Northern NHIC 147 00147 CA 877-591-7024 31146 CA 866-502-9054 opt Customer Support 1 Enrollment Required - Contact Gateway EDI Medicare of California /Southern/ NHIC 146 Enrollment required contact Gateway EDI for enrollment forms. Medicare of Colorado / Noridian 071 00071 CO 877-908-8431 Option2 Provider Call Center 102 10230 CT 203-639-3160 Customer Service 00902 DE (866) 749-4302 opt 1 Customer Service (866) 749-4302 opt 1 Customer Support Enrollment Required Medicare of Connecticut/FCSO Enrollment required contact Gateway EDI Medicare of Delaware/Trailblazer 902 Claims address: P. O. Box 650094, Dallas, TX - Enrollment required. Medicare of Dist of Columbia Area/Trailblazers 903 00903 MD, DE, VA, DC Claims address: P.O. Box 650092, Dallas, TX - Enrollment required. Medicare of Florida / First Coast Service Options 591 59100 FL (866) 454-9007 EDI 00511 GA 877-567-7271 press 0 Provider Services 00075 HI 877-908-8431 Customer Service Enrollment required - Contact Gateway EDI Medicare of Georgia / Cahaba GBA, 511 Division BCBS AL Enrollment required Medicare of Hawaii /Noridian 075 Payer requires Enrollment Forms - Contact Gateway EDI Medicare of Idaho - Cigna 051 05130 ID 866-520-4023 EDI Support 00007 IL 877-908-9499 Provider IVR 877-273-4334 EDI Support 877-908-8431 Option1 Provider Relations 866-839-2442 Provider Relations 800-892-6048 Help Desk Enrollment required contact Gateway EDI. Medicare of Illinois / WPS 007 Payer requires Enrollment Forms - Contact Gateway EDI Medicare of Indiana / Adminastar Federal, INC 710 00710 IN AdminaStar - Requires Enrollment contact Gateway EDI Medicare of Iowa /Noridian 230 00230 IA Payer requires Enrollment Forms - Contact Gateway EDI Customer Service Medicare of Kansas / BCBS of Kansas 030 00030 KS, MO Payer requires Enrollment Forms - Contact Gateway EDI Medicare of Kansas City / Admin Svc 040 00040 MO of Kansas Payer requires Enrollment Forms - Contact Gateway EDI Medicare of Kentucky / Administar Federal, Inc. 906 90660 KY 877-273-4334 Provider Relations LA 877-567-7204 Provider Services 781-749-7745 Lori (866) 749-4302 opt 1 Customer Service 781-741-3213 Customer Service Payer required enrollment - Contact Gateway EDI Medicare of Louisiana / Arkansas BCBS 701 00528 Enrollment Required call Gateway EDI for enrollment forms Medicare of Maine / NHIC 311 31142 ME Payer requires enrollment - Contact Gateway EDI for Forms Medicare of Maryland/ Trailblazer - 901 00901 MD Claims address: PO Box 660595, Dallas, TX - Enrollment required. Medicare of Massachusetts / NHIC 143 31143 MA Enrollment required contact Gateway EDI for enrollment forms. Medicare of Michigan / Wisconsin Physician Service 953 00953 MI 877-567-7201 Provider IVR 00954 MN 877-908-8470 Provider Services Enrollment required contact Gateway EDI Medicare of Minnesota /WPS 954 Enrollment required contact Gateway EDI, Inc. Medicare of Mississippi / Cahaba GBA 513 00513 MS 866-419-9454 Provider Services 523 00523 MO 866-539-5599 Provider Relations Enrollment required Medicare of Missouri / BCBS of Arkansas Payer requires enrollment forms and testing contact Gateway EDI Medicare of Nebraska/ Admin Svc of 150 KS 00150 NE 866-839-2438 Provider Relations Rep 00061 NV 701-277-6784 Provider Services 144 31144 NH 866-539-5595 Provider Servies 805 00805 NJ 866-488-0546 #1 Help Desk 521 00521 NM 877-567-9230 Provider Services 00801 NY 877-567-7173 Provider Relations Enrollment Required Contact Gateway EDI Medicare of Nevada/ BCBS ND/Noridian 061 Enrollment required - Contact Gateway EDI Medicare of New Hampshire/NHIC Enrollment required. Medicare of New Jersey / Empire Medicare Enrollment requiredMedicare of New Mexico/AR BCBS Enrollment required contact Gateway EDI. Medicare of New York (Upstate) 801 Enrollment required contact Gateway EDI. Medicare of New York BCBS/Empire 803 00803 NY 877-869-6504 Provider Services 00802 NY 877-868-7965 Customer Service 05535 NC 866-238-9651 Customer Service Enrollment required contact Gateway EDI. Medicare of New York GHI 802 Enrollment required contact Gateway EDI Medicare of North Carolina / Cigna 535 Enrollment required - Contact Gateway EDI Medicare of North Dakota/Noridian 251 00251 ND 800-933-0614 Provider Call Center Medicare of Ohio / Palmetto 163 16360 OH 877-567-9232 Provider Service 045 00045 OK 00835 OR 866-843-7243 EDI Customer Serv 865 00865 PA 800-537-8862 Provider Relations Medicare of Rhode Island /AR BCBS 524 00524 RI 1-866-582-3247 Provider Services 00880 SC 866-238-9654 Customer Servive 88849 NE, SD 877-908-8431 option2 Provider Services 160 00160 TN 866-502-9056 Provider Service 020 00020 TX 877-392-9865 Customer Service Enrollment required. Medicare of Oklahoma / Arkansas BCBS Gateway EDI Customer Service Enrollment required - Contact Gateway EDI Medicare of Oregon / BCBS ND/Noridian 835 Enrollment and Provider Testing required. Medicare of Pennsylvania / HGSA Enrollment Required Enrollment required contact Gatewayn EDI, Inc. Medicare of South Carolina /Palmetto 880 Enrollment required contact Gateway EDI. Medicare of South Dakota/Noridian 849 Enrollment required contact Gateway EDI Medicare of Tennessee / Cigna Enrollment Required Medicare of Texas / Trailblazer Payer requires Enrollment Forms - Contact Gateway EDI Medicare of Utah 151 00151 UT 866-539-5600 Provider Line 31145 VT 866-539-5595 Provider Services VA (866) 749-4302 opt 1 Provider enrollment 877-567-9232 Provider Call Center Enrollment required contact Gateway EDI Medicare of Vermont/NHIC 145 Enrollment required contract Gateway EDI Inc. Medicare of Virginia/ Trailblazer 904 00904 Claims address: P. O. Box 650208, Dallas, TX - Enrollment Required. Medicare of Washington-Noridian 836 00836 WA 00944 WV Enrollment required--Call Gateway EDI Medicare of West Virginia / Palmetto 944 Provider number is all numeric Medicare of Wisconsin / Wisconsin Physician Serv 951 00951 WI 877-567-7261 00461 WY 866-849-7246 Customer Service 109 IP080 CA 818-461-5554 Fed Villaluna 800 95655 OH 800-826-9346 Provider Relations 940 37304 ALL 800-318-1963 Customer Service 009 25175 PA 800-600-9007 Provider Relations ALL 615-468-0600 Customer Service Enrollment Required - Contact Gateway EDI Medicare of Wyoming/Noridian 461 Enrollment required contact Gateway EDI. Medicina Familiar Medical Group IPA located in Encino, CA MediGold Located in Westerville, Ohio Mediversal Located in Las Vegas, Nevada MedPlus of Tennessee Located in Monroeville, Pennsylvania Unique Provider ID required MedSolutions 009 62160 Service Center is located in Franklin, Tennessee MedSolutions 610 00610 IL, MO 800-467-6424 Claim Status 666 74227 ALL 800-767-0700 Customer Service See Notes Customer Service Call Gateway EDI before sending Mega Life & Health Insurance Student Insurance Claims: PO Box 890025, 809067, 809079, 809066, 809036, 809081, Dallas, TX Mega Life and Health Insurance Insurance Cent 009 59221 ALL Claims address: P. O Box 982009, North Richlands Hills, Texas 76182 Mega Life and Health Insurance Company - Dental 372 59226 ALL 817-255-3338 Teresa Howeth 940 86052 AZ 602-263-3000 Customer Service 314-214-8158 Provider Relations 314-214-8158 Provider Relations 909-371-8440 Customer Service Located in North Richland, Texas Mercy Care Plan Located in Phoenix, Arizona Rendering Network Provider ID number required. Mercy Health Plan 360 00360 MO, IL, TX Provider # required, patient info must match MHP eligibility file Mercy Health Plan Medicare UB92's 365 00365 MO, IL, TX Mercy Health Plan Premier Plus 00360 MO, IL, TX 360 MHP Medicare Product - Requires Unique Provider ID-Call Gateway EDI for set-up Mercy Health Plan UB92's 365 00365 MO, IL, TX Mercy Physicians Medical Group San Diego 109 IP079 CA Located in San Diego, California 009 77042 ALL 800-939-1100 X 271 David Cherryhomes Met Life Health Care Network - PPO 726 87726 ALL Members card Customer Service MetLife 87726 ALL See Number on Card Customer Service Meridian Health Care Management Located in Woodland Hill, California 726 Metlife Vision claims city and state, Utica, New York must be submitted on paper MetLife (Formerly Travelers) 372 87726 ALL 864-234-6164 Claim Status Check Metlife Dental 372 65978 ALL 800-942-0854 Customer Service Metrahealth 726 87726 ALL MetraHealth Elect 726 87726 ALL Members card Customer Service MetraHealth Healthcare Network HMO & PPO 726 87726 ALL Members card Customer Service MetraHealth or Metropolitan Life Ins. 726 Co. 87726 ALL Members card Customer Service MetraHealth or Travelers 726 87726 ALL Members card Customer Service Metropolitan Health Plan 009 10850 MN 612-347-6180 David Sell Metropolitan Life Insurance Co. 726 87726 ALL Members card Customer Service MetroWest Health Plan Preferred 940 MWP01 TX 817-665-5100 Customer Service 611 61101 ALL 800-367-7587 Customer Support 611 61101 ALL 800-367-7587 Customer Support 666 25147 ALL 800-632-4174 Provider Relations Mid Atlantic Psychiatric Services, Inc. 109 (MAPSI) 52149 ALL 800-342-6141 Customer Service 37281 ALL 800-482-0945 Customer Service Reinstated 6/1/02 Located in Minneapolis, MN Located in Fort Worth, Texas Michael Reese HMO Plan-IL Humana Michael Reese HMO Plan-IN Humana Mid America Health leased PPO Network SEE NOTES Provider ID number required Mid-America Associates, Inc. 940 Located in Madision Heights, Michigan Mid-Atlantic Health Plan 009 63079 ALL 800-999-3371 Provider EDI help Line 009 59224 ALL 800-733-8880 Customer Service 800-767-0700 Customer Service IA, NE 402-390-8364 Bob Hood ALL 402-390-8391 Customer Service 888-654-2200 Provider Services IA, IL, IN, OH, MI, WI 800-542-6642 Customer Service Sarah Holmes New Castle, Delaware Mid-West National Life Insurance Company of TN Claims mailing address: P. O. Box 982017, North Richland Hills, TX 73182-8017 Mid-west National Insurance Company 666 74227 ALL Claims address: PO Box 890025, 809067, 809079, 809066, 809036, 809081, Dallas TX Midlands Benefits Administrators 009 47081 Formerly, Healthcare Partners of MidAmerica (HPMA) Midlands Health Partners (Midlands Choice) 099 47080 Located in Omaha, Nebraska - Provider ID nmber required. Midwest Health Plans, Inc. 940 MHP77 MI Claims address: 5050 Schaefer Road, Dearborn, MI Midwest Security Insurance Company 009 MIDSC Corporate offices are located in Onalaska, Wisconsin Mississippi Public Entity Employee Benefit Trust 940 37233 MS 601-605-8170 126 64088 MS 440-720-0700 ext Tiffany Brown 215 940 37275 MT 406-523-4876 Risk and Benefit Office 530 00530 MO 800-322-6027 Provider Services Located in Jackson, Mississippi Mississippi Select Health Care (Gulfport, MS) Located in Gulfport, Mississippi Missoula County Medical Benefits Plan Located in Missoula, Montana Missouri Care Provider Number Required - Testing required on the first transmission of claims Missouri Medicaid Rural Health 430 00430 MO 009 62178 TN 615-377-0170 Customer Service CA 866-665-4622 HIPAA Provider Hotline 866-665-4622 HIPAA Provider Hotline 800-642-4509 Provider Services Contact Gateway EDI for Enrollment MMS, LLC TPO - Payer is a repricer, they do not pay the claims Molina Health Care - California Providers 009 38333 Only CA Providers, Located in Long Beach, CA - Rendering Provider # required. Molina Health Care - Washington Providers 009 38336 WA Only WA Providers, Located in Long Beach, CA. Rendering Provider ID required. Molina Health Care Indiana 042 57324 IN Claims address: PO Box 22717 Long Beach, CA Molina Healthcare of Michigan 009 38334 MI 940 CIMSA NM 866 WC691 CA, CT, DC, DE, FL, GA, IL, IN, MD, MO, NJ, NY, PA, SC, TN, VA Monumental Life Insurance Company 940 MMLI3 009 Provider ID required Molina Healthcare of New Mexico 888-825-9266 Provider Services ALL 410-685-2900 Customer Service 36111 ALL 480-441-7449 Shari Homyock 372 36111 ALL 480-441-7008 Matilda Jaeger 372 86040 ALL 440-720-0700 ext Tiffany Brown 215 Located in Albuquerque, New Mexico Montgomery Insurance (Liberty RAM) WORK COMP Home office located in Baltimore, Maryland Motorola Inc. Located in Scottsdale, Arizona Motorola, Inc. Located in Scottsdale, Arizona Mountain States Administrative Services Only claims with address: PO Box 32709, Tucson, Arizona 85751 Mountain States Administrative Services 126 86040 AZ 800-866-4731 Customer Service 800-816-7526 Provider Services Only claims with address: PO Box 32709, Tucson, AZ 85751 MPlan 009 95444 IN Located in Indianapolis, Indiana Unique Provider ID required Mutual Assurance Administrators 940 37256 ALL 405-848-1975 Client Services Located in Oklahoma City, Oklahoma Mutual Group, The (US) 009 70491 ALL 800-752-2557 Customer Support Mutual of Omaha Insurance Co. 009 71412 ALL 402-342-7600 x3580 Group Support Services Group Support Services Located in Omaha, Nebraska - See notes regarding edits Mutual of Omaha Insurance Co. 372 71412 ALL 402-342-7600 x3580 Mutual of Omaha Rural Health 410 00410 ALL 866-580-5981 Mutually Preferred 372 71412 ALL 402-342-7600 x7703 Pat Shannon Mutually Preferred 009 71412 ALL 402-342-7600 x7703 Pat Shannon MVP Health Plan of NY 109 14165 NY 800-684-9286 Customer Service Contact Gateway EDI for Enrollment For your MVP Provider Number, call 800-684-9286 N. W. International Assoc. of Machinist & 372 91136 ALL Aerospace Engineers Benefits Trust Dental Program (Group F39) N. W. Textile Processors 372 91136 ALL 372 91136 ALL 009 91136 AK, WA N.W. Roofers & Employers Health & 372 Security 91136 ALL 91136 009 009 Group # F14 N.W. Ironworkers Health & Security Trust Fund Group # F15 N.W. Ironworkers Health & Security Trust Fund 206-441-7574 Customer Service AK, WA 206-441-7574 Customer Service 91136 AK, WA 206-441-7574 Customer Service 53011 ALL 703-729-4677 Customer Service 53011 ALL 703-729-4677 Customer Service 009 36398 ALL 708-432-4025 Caroline Endless 109 AMS01 TX Customer Service Group # F19 Group # F26 N.W. Roofers & Employers Health & 009 Security Trust Group # F26 N.W. Textile Processors (Group # F14) 206-441-7574 NALC National Association of Letter Carriers NALC 009 National Association of Letter Carriers NAMM of Illinois Located in Hillside, Illinois National Assoc Preferred Provider (TX) - Wisconsin Only claims with the address of Wisconsin can be submitted electronically. National Assoc. of Letter Carriers/NALC 372 53011 ALL 703-729-4677 National Benefit Administrators - New 009 Jersey 56175 NJ 440-720-0700 ext Tiffany Brown 215 009 56176 NC 440-720-0700 ext Kathy Meyers 222 014 00014 DC, DE, MD, NJ, PA, VA, WV 800-624-2356 Customer Service 800-635-9671 Customer Service Located in Parsippany, New Jersey National Benefit Administrators North Carolin Located in Charlotte, North Carolina National Capital PPO (NCPPO) Located in Springfield, Virginia Unique Provider ID number required National Claim Administration, Inc. 109 37126 ALL Located in Garden City, New York National Rural Electric Coop-NRECA 009 52132 ALL 402-483-9200 EDI Claim Support 009 71412 ALL 402-978-5883 Customer Service National Rural Letter Carrier Assoc. 372 71412 ALL 402-978-5883 Customer Service National Telephone Coop Association 940 PV150 ALL 703-351-2000 Customer Service 009 31417 ALL 614-249-4555 Fred Richards 009 75190 VA 703-934-6297 Tammy Thacker 009 75191 ALL 704-364-3865 Customer Service 009 52118 MD 703-934-6215 Audria Tatken 009 96107 FL 305-715-4334 Provider Relations NY 631-360-3102 Provider Services Located in Lincoln, NE 68506 National Rural Letter Carrier Assoc. Policy # GMG1846 Located in Arlington, Virginia Nationwide Insurance Located in Columbus, Ohio NCAS- Fairfax located in Fairfax, Virginia NCAS-Charlotte Located in Charlotte, North Carolina NCAS-Owing Mills Located in Owings Mills, Maryland Neighborhood Health Partnership of Florida Claims address: PO Box 025680, Miami, Florida 33102-5680 Neighborhood Health Providers - NY 009 Medicaid HMO 11325 NY Medicaid HMO Plan - Unique Provider ID required Nesika Health Group 940 37255 OR 541-677-5508 Customer Service 126 66055 ALL 440-720-0700 x205 Rebecca Karlinsky Located in Roseburg, Oregon Netcare Life and Health Insurance Claims address: 424 W O'Brien Dr., Julale Center, Suite 107, Hagatna, Guam 96910 Network Health 009 04332 MA 617-806-8121 Diana Shaheen 009 39144 WI 800-826-0940 Customer Service NV 702-304-5500 Provider Relations 702-304-5500 Provider Relations 702-304-5500 Provider Relations 603-223-1305 Eleanor Vien Located in Cambridge, MA Network Health Plan Located in Menasha, WI - Unique Provider ID required Nevada Health Solutions 009 86067 Located in Las Vegas, Nevada Unique Provider ID numnber required NevadaCare 009 86067 NV Located in Las Vegas, Nevada Unique Provider ID number required NevadaCare Kids 009 86067 NV Located in Las Vegas, Nevada Unique Provider ID number required New England Dental Administrators 372 43351 ALL Located in Concord, NH New Era Life 009 75281 ALL 214-561-6424 Michael Newman 940 65056 ALL 270-796-3579 Susan Hampton 372 38332 ALL 800-624-0698 Customer Service ALL 800-624-0698 Customer Service NY 718-748-7316 Gary Singh Located in Dallas, Texas New Market Dimensions Located in Bowling Green, Kentucky New World Claims Services Only claims with address: 2624 North 5th Street, Niles, MI 43120 New World Claims Services 126 38332 Per IPN Payer no longer accepts claims electronically. New York Network Management, LLC 009 11334 Located in Brooklyn, New York Group Plan or Policy Number must be supplied. New York Presbyterian Community Health Plan 109 48186 NY 631-342-0063 Customer Service 009 38225 ALL 810-445-6841 Customer Service 009 62124 ALL 615-278-1230 Customer Serviice 800-937-6542 Customer Service Located in Islandia, NY NGS American Located in St. Clair Shore, MI NHC Health Benefit Plan Claims address: PO Box 7036, Murpheesboro, Tennessee Nippon Life Insurance Co. 109 81264 ALL Nippon Life Insurance Company 372 81264 ALL Noble Community 109 IP080 CA 818-461-5554 Fed Villaluna 126 65085 TN 440-720-0700 ext205 Rebecca Carlinsky 800-828-6922 Member Services Located in New York, New York IPA located in Encino, CA I North American Administrators Claims address: PO Box 1984 or PO Box 25207, Nashville, TN 37202 North American Administrators, Inc. 070 64157 ALL Located in Amherst, New York - Payer request Federal ID as Billing Provider North American Benefits Network 126 34159 ALL 800-321-4085 Customer Service 372 34159 ALL 800-321-4085 Customer Service Located in Cleveland, Ohio North American Benefits Network Only claims with address: P. O. Box 94928, Cleveland, Ohio 44101-4928 North American Medical Management - NAMM - CA 109 E3510 CA 510-450-1500 Reed Smoller 64157 ALL 800-828-6922 Member Services 800-828-6922 Member Services Corporate office located in Ontario, California North American Preferred 070 Located in Amherst, New York - Payer request Federal ID as Billing Provider North AmeriCare 070 64157 ALL Located in Amherst, New York - Payer request Federal ID as Billing Provider North Texas Healthcare Network 109 35212 ALL 800-444-3995 Customer Service Northeast Delta Dental (ME, NH, VT) 372 02027 ALL Northern California Sheet Metal Workers Health Pla 126 38238 CA 372 93525 OR 541-677-7624 Kent Achterfoff 940 36346 IL 372 41045 ALL 612-372-5466 EDI Support Line Nova Healthcare Administrators, Inc. 126 16644 NY 800-999-5703 Provider Services 71080 ALL 888-894-3557 Customer Service Located in Irving, Texas Sheet Metal Workers Local 104 Northwest Dental Services Located in Roseburg, Oregon Northwest Suburban IPA (Illinois) Located in Rockford, Illinois Northwestern National Life (Now ReliaStar) Located in Grand Island, New York NovaSys Health Network 940 Located in Little Rock, Arkansas Group number is required. Nyhart 940 37299 IN Corporate office Indianapolis, Indiana NYLCare ETHIX Northwest 372 91135 ALL NYLCare Health Plans Northwest 372 91166 ALL 800-654-3250 X617 Debora Allen Ochsner Health Plan 009 72127 LA 800-451-6581 Provider Call Center Customer Service Located in Metarie, Louisiana - Rendering Provider Network ID required ODS Health Plan 940 13350 OR 877-605-3229 126 34189 IN, KY, MI, OH, PA, WV 440-720-0700 ext Kathy Myers 222 Located in Portland, Oregon Ohio Health Choice, PPO Only claims with the address PO Box 93538, Cleveland, OH 44101-5538 OmniCare Health Plan, Inc. a Coventry Health Plan 666 25150 MI Claims address for claims after 10/1/04 PO Box 7150, London, Kentucky 40742 One Beacon (formerly CGU) 866 WC291 CT, NJ, NY 372 80705 WORK COMP One Health Plan of Alaska, Inc. ALL 866-314-3784 Provider Inquiry Line One Health Plan of Arizona, Inc. 372 80705 ALL One Health Plan of Florida, Inc. 372 80705 ALL One Health Plan of all States 057 80705 ALL One Health Plan of California, Inc. 372 95379 ALL One Health Plan of Colorado, Inc. 372 95412 ALL One Health Plan of Georgia, Inc. 372 96559 ALL One Health Plan of Illinois, Inc. 372 95388 ALL One Health Plan of Indiana, Inc. 372 80705 ALL One Health Plan of Kansas/Missouri, 372 Inc 80705 ALL One Health Plan of Maine, Inc 372 80705 ALL One Health Plan of Massachusetts, Inc. 372 80705 ALL One Health Plan of Michigan, Inc 372 80705 ALL Claim office on Members card One Health Plan of Minnesota, Inc 372 80705 ALL Claim office on Members card One Health Plan of Nevada, Inc. 372 80705 ALL One Health Plan of New Hampshire, 372 Inc. 80705 ALL One Health Plan of New Jersey, Inc. 372 80705 ALL One Health Plan of New York, Inc 372 80705 ALL One Health Plan of North Carolina, 372 80705 ALL 800-537-2033 Customer Service Claim office on Members card Claim office on Members card Inc. One Health Plan of Ohio, Inc. 372 80705 ALL One Health Plan of Oregon, Inc. 372 80705 ALL One Health Plan of Pennsylvania, Inc. 372 80705 ALL One Health Plan of South Carolina, Inc. 372 80705 ALL One Health Plan of Tennessee, Inc. 372 80705 ALL One Health Plan of Texas, Inc. 372 51459 ALL One Health Plan of the District of Columbia, Inc 372 80705 ALL One Health Plan of Virginia, Inc. 372 80705 ALL One Health Plan of Washington, Inc. 372 80705 ALL One Health Plan of Wisconsin, Inc. 372 80705 ALL One Health Plan of Wyoming, Inc. 372 80705 ALL One Health Plan, Inc. (Vermont) 372 80705 ALL Operating Engineers Locals 302 & 612 009 91136 AK, WA 372 91136 ALL 009 56190 ALL Claim office on Members card 206-441-7574 Customer Service 203-465-1457 Dick Markowich Group # F12) Operating Engineers Locals 302 & 612 Group # F12 OptiCare Located in Rocky Mount, North Carolina - Unique Provider ID Required Optimum Choice of the Carolinas 070 52152 NC 800-257-6458 Provider Representative 52148 DE, DC, MD, VA, WV 800-257-6458 Provider Services Rendering Provider ID number is required Optimum Choice, Inc. (OCI) 009 Rendering Provider Network ID required Orthonet Corporation ALL 914-681-8800 ext Angel Ayala 155 009 13381 009 OSFMC IL 009 OSFIL IL 800-673-4699 Provider Services 307 06111 CT, DE, NJ, NY, PA 800-666-1353 Provider Service Located in White Plains, New York OSF Care Advantage Located in Peoria, Illinois OSF Health Plans Located in Peoria, Illinois. Oxford Health Plans Par-Providers require Unique Provider # - Non-Par Does not require Unique Prov.# Oxford Health Plans 372 84104 ALL Pacific Mutual Life Insurance Company 109 67466 ALL 714-760-4420 Deanna Mooring 009 33053 AZ, CA, CO, NM, NV, OK, OR, TX, WA 800-716-1166 Customer Service Pacificare Health Systems Oklahoma 009 95959 OK 800-825-9355 Commercial HMO 009 95959 OR, WA 503-603-7104 Carolyn Anderson Oregon 009 95959 TX 800-825-9355 Commercial HMO 009 95964 AZ 800-344-3782 x4313 Tisha Mendoza CO (303) 714-2731 Colette Ward CO 719-522-6928 Lela Rae Nemmers Located in Phoenix, Arizona PacifiCare Behavioral Health Located in Laguna Hills, California Unique Provider ID required Pacificare Health Systems Oregon and Washington Located in Hillsboro, Oregon Pacificare Health Systems Texas Unique Provider ID required Pacificare of Arizona Provider Testing required contact Gateway EDI-see notes for testing procedures. Pacificare of Colorado-HMO, POS & 009 Secure Horizons 95962 Claims address: P.O. Box 6699, Englewood, CO 80155 Pacificare PPO - ALL STATES 009 95999 Claims address: PO Box 6099, Cypress, CA 90630 Pacificare/Secure Horizons California 009 95959 CA 800-624-8822 Customer Service PacificSource Health Plans 372 93029 ALL (541)686-1242 X251 Ralph Haynes PacificSource Health Plans 940 93029 ALL Palmetto GBA - RR Medicare Part B 320 00320 ALL 866-899-5227 Provider Relations Located in Eugene, Oregon Payer requires Enrollment Form - Call Gateway EDI for Forms Paramount Health Care 988 41988 MI, OH 800-462-3589 Customer Service Offices in Maumee, Ohio and Dundee, Michigan. Partners in Practice (TX) - Wisconsin 109 Only AMS01 TX Only claims with the address of Wisconsin can be submitted electronically. Partners National Health Plans of North Carolina 070 56152 NC, SC, VA 800-942-5695 Customer Service Partnership Health Plan of California 109 PHP02 CA 707-863-4130 Claims Department 109 IP080 CA 818-461-5554 Fed Villaluna 009 61129 KY 877-234-4275 Provider Services 866 WC821 DE, NJ, NY, PA Paul Revere / Provident 372 47009 ALL Peerless Insurance Company 866 WC491 CA, CT, DC, DE, FL, GA, IL, IN, MD, MO, NJ, NY, PA, SC, TN, VA 735 77035 PA 666 25146 IL 800-431-1211 Customer Service ALL 440-720-0700 x205 Rebecca Karlinsky Unique Provider ID number required. Located in Fairfield, California Pasadena Primary Care Physicians IPA located in Encino, CA Passport Health Plan Payer requires Unique Provider ID Pathmark WORK COMP WORK COMP Pennsylvania Magellan Plan / TESTING TESTING PersonalCare Claims address: PO Box 7141, London, KY 40742-7141 PHA Insurance Services 126 95183 Claims address: P. O. Box 620123, Orlando, FL 32862 Phoenix American 372 67814 ALL 800-451-2513 Customer Service Phoenix Group Services (Texas) 009 75238 ALL 817-4654463ext.236 Rhonda Howery Phoenix Home Life 372 67814 ALL 800-451-2513 Customer Service Phoenix Home Life Mutual Ins. Co. 009 67814 ALL 800-451-2513 Customer Service 800-544-3014 Customer Service located in Arlington, TX formerly Phoenix American Life (PAL), Phoenix Home Life and Phoenix Mutual PHP Kansas City 036 00036 KS, MO Claims address: PO Box 25938 or 26650, Shawnee Mission, Kansas PHP of Mid Michigan 726 87726 MI 517-327-2454 Customer Service PHP Tenncare 009 62155 TN 800-705-5248 Provider Services Claims mailing address: PO Box 22949, Knoxville, Tennessee Unique Provider ID . Phycisians Health Plan of South Michigan 726 87726 MI 800-394-7569 Customer Service 940 36345 IL 800-747-2264 Customer Service CT, NJ, NY, PA 203-402-4283 Provider Services Located in Jackson, Michigan Physician Care Network (PCN) Only claims with City & State: Rockford, Illinois Physicians Health Services 109 06108 Payer named changed to Healthnet of Northeast - See this Payer to set up. Physicians Care Network 803-771-9474 ext Wanda McCall 478 009 57098 SC 009 65018 ALL 940 37136 IL 888-642-2948 Customer Service 099 12399 IN 800-982-6257 x 549 Lori Sowle Located in Columbia, SC Physicians Corporation of America (Florida Plan ONLY) Physicians Health Association of Illinois (PHAI) Located in Rockford, Illinois Physicians Health Plan of Northern Indiana Located in Fort Wayne, Indiana SEE NOTES - Unique Provider ID required Physicians Healthcare Plans 009 65031 FL 800-807-7470 Provider Services 666 47027 ALL 888-932-7642 Customer Service 009 39156 WI 800-545-5015 Provider Service Located in Tampa, Florida Physicians Mutual Insurance Company Located in Omaha, Nebraska Physicians Plus Insurance Corporation Claims address: P.O. Box 2078 Madison, WI 53701-2078 Piedmont Administrators, Inc. 940 56151 ALL 336-544-2222 Provider Services 109 24735 ALL 949-863-1000 x 309 Connie Rich 009 73074 OK 918-280-4800 Customer Service 666 37224 ALL 630-718-8230 Mandy Rak 109 AMS01 IA Located in Greensboro, NC Pinnacle claims Management, Inc. Locate in Newport Beach, CA Pipeline Industry Benefit Fund Located in Tulsa, Oklahoma Pittman & Associates Located in Memphis, Tennessee Plaines (IA) - Wisconsin Only Only claims with the address of Wisconsin can be submitted electronically. Plaines Advisor ( WI) - Wisconsin Only 109 AMS01 WI Only claims with the address of Wisconsin can be submitted electronically. Plaines Advisor (FL) - Wisconsin Only 109 AMS01 FL Only claims with the address of Wisconsin can be submitted electronically. Planned Administrators, Inc. /BCBS SC Plan 086 00866 SC Enrollment required contact Gateway EDI, Inc. Plumbers and Pipefitters - Local 33 (DesMoines, IA 333 00333 IA Claims address: 2501 Bell Avenue, Des Moines, Iowa 50321-Set-up req contact us. PM Group (PMG) 109 67466 ALL 009 16111 ALL 372 93200 ALL 714-760-4420 Deanna Mooring Located in Phoenix Arizona POMCO Refer to Members ID Card Located in Syracuse, NY Port Angeles - Previously known as King County 800-373-1477 Customer Service NDEX 405-843-9551 Customer Service Help Desk 800-831-1166 Customer Service 888-965-1180 Customer Service Medical - Clallam County Physician Service - Requires Unique Provider ID PPO Oklahoma 009 73159 OK Located in Oklahoma City, Oklahoma Group Number is required on claim. PPOM, Located in Southfield, MI 109 38335 MI, OH, IN, KY, WI PPOM physician sign-up form must be completed prior to first claim submission PPOplus, LLC 109 72148 ALL Claims mailing address: P. O. Box 90802, Lubbock, Texas 79408-8802 Prairie Medical Group 109 IP080 CA 818-461-5554 Fed Villaluna 009 36373 ALL 920-208-5991 Mike D'Alton IPA located in Encino, CA Prairie States Enterprises, Inc. Located in Chicago, Illinois & Sheboygan, Wisconsin Preferred Blue South Carolina 481 48100 SC 810 00810 NY 009 65088 FL 305-670-8430 David Padron 009 73145 OK 800-884-4776 Claims Customer Service 372 68241 ALL 800-544-4778 Customer Support SC BCBS Preferred Blue plan Preferred Care New York TESTING ONLY Preferred Care Partners Located in Miami, Florida Preferred CommunityChoice PPO Located in Tulsa, OK Preferred Dental Organization Preferred Health Network 109 35173 MD 800-422-1996ext 883 Lorraine Rutkowski Located in Linthicam, Maryland - Provider Number Required Preferred Health Plan, Inc. 009 61106 IN, KY 502-339-7500 Norm Shelman Preferred Health Systems Insurance 009 Company (PHS 60110 KS, MO 877-609-2467 Provider Relations Located in Louisville, KY Located in Wichita, Kansas Unique Provider ID# required Preferred Healthcare System, Inc. 009 04320 PA 800-238-9900 Customer Service 126 36401 IA, IL, IN, WI 630-493-0905 Customer Service ALL (800) 451-9597 Customer Service CT 800-960-2530ext 1447 Tamara Allen (800) 435-2715 Help Desk 314-214-8158 Provider Relations 866-869-7737 Provider Care Unit 866-869-7738 Provider Care Unit Located in Altoona, Pennsylvania Preferred Network Access Claims address: PO Box 2248, Darien, Illinois 60561 Preferred One 070 41147 Located in Minneapolis, MN - Requires Provider ID Preferred one (CT)/First Choice 009 14162 Requires a 5-9 character Rendering Provider ID number Premera Health Plus 828 00828 WA Claims address: P. O. Box 2113, Seattle, WA 98111-2113. Not a Blue Shield. Premier Health Plan/Mercy Health Plan 360 00360 MO, IL, TX Located in Springfield, Missouri UPIN number required for Provider ID number. Presbyterian Health Plan 940 TH061 NM Claims address: PO Box 27489, Albuquerque, New Mexico-Provider ID req. Presbyterian Salud 940 TH060 NM Claims address: PO Box 92085, Albuquerque, New Mexico. Provider ID Prevea Health Insurance Plan 800 39185 ALL 847-887-8033 Deana Tilson 611 61101 ALL 800-558-4444 X 7448 Bonnie or Jody 940 PRIME ID, OR 800-688-5008 Customer Service 009 56144 ALL 704-523-2758 Robert Vinson Prime Benefit Systems, Inc.--MO 611 61101 ALL 800-367-7587 Customer Support Prime Benefits Systems, Inc. - MO 611 61101 ALL Located in Evanston, Illinois Primary Delivery Systems Green Bay and Madison Wisconsin only Primary Health Plan Located in Bend, Oregon Primary PhysicianCare, Inc. Located in Charlotte, NC Prime Health Kansas City Inc.--MO 611 61101 ALL 800-367-7587 Customer Support Prime Health Kansas City, Inc. - MO 611 61101 ALL Prime Health Mgmt. Services--MO 611 61101 ALL 800-367-7587 Customer Support Prime Health of Kansas, Inc.--MO 611 61101 KS 800-367-7587 Customer Support Prime West Health Plan 009 61604 MN 866-431-0802 Provider Relations Claims address: 822 South 3rd Street, Suite 150, Minneapolis, MN 55415 Principal Financial Group 109 61271 ALL 515-247-5368 Claim Status Inquiry 109 61271 ALL 515-247-5368 Claim Status Inquiry Principal Health Care of Georgia, Inc. 666 25127 GA 800-470-2004 Customer Service 372 61271 ALL 515-247-5368 Claim Status Inquiry 109 61271 ALL 515-247-5368 Claim Status Inquiry 009 38217 MI 616-975-8284 Wendell Broome Corporate office Des Moines, Iowa Principal Financial Group Corporate office Des Moines, IA Located in Atlanta, GA Principal Mutual Life Insurance Co. NOT Principal Healthcare Principal Mutual Life Insurance Co. Corporate office Des Moines, Iowa Priority Health Prior to submitting call to obtain the Pay to code, Refer to notes for Plan names Prism Network, Inc. 940 37268 CT, MA, NJ, NY, PA, VT 888-266-9041 Customer Service 940 31132 ALL 614-470-7383 Gayle Hyslop Located in Lancaster, New York Pro Health Compcare BWC Claim Number required as Member ID, contact Gayle Hyslop @ 614-470-7383 Professional Benefit Admins., Inc. (Oakbrook, IL) 126 36331 ALL 440-720-0700ext. Kathy Myers 222 Claims address: P.O. Box 4687, Oakbrook, IL 60522-4687. Professional Claim Administrators (Proclaim) 109 41163 ALL 952-546-0310 Sue Lebert 009 37242 ALL 800-325-8424 Customer Service 009 70408 ALL 800-800-1212 Customer Service 372 70408 ALL 205-909-5861 Jackie Irvin 800-878-4445 Customer Service Located oin Minnetonka, Minnesota Professional Claims Management Located in Canton, Ohio Protective Life Located in Kansas City, Missouri Protective Life Claims address: P. O. Box 830626, Birmingham, Alabama 35283 Providence Health Plan 109 PHP01 OR Enrollment required contact Gateway EDI Providence Preferred of Washington 009 91131 ALL 91131 OR, WA 800-878-4445 Customer Service (Sisters of Providence Health Plans) Providence Preferred of Washington 009 (Sisters of Providence Health Plans) Provident Life & Acc. Ins Co. of Am. 372 68195 ALL 615-755-1416 Annie Rowland Provident Life & Casualty Ins. Company 372 68195 ALL 615-755-1416 Annie Rowland Provident Life and Accident Ins. Co. 372 68195 ALL 615-755-1416 Annie Rowland Provident Preferred Network 372 68195 ALL 615-755-1416 Annie Rowland Provider Networks of America (PRONET) 940 51032 ALL Prucare HMO 372 68245 ALL 800-544-4778 Customer Service Capitated Claims Only (zero charges) - Do not enter number in Payer List Prudential (Managed HealthCare, Indemnity, POS, 654 60054 ALL Tradl. Plus, In & Out of Nwk, Select, Plus Select, Psych. Mgmt., Resource Mgmt. Prudential Dental Organization (PDO) 372 68241 ALL 800-544-4778 Claim Support Prudential HealthCare 654 60054 ALL 800-544-4778 Customer Service 302-283-6570 Renee Crumlish 302-283-6570 Renee Crumlish HMO, POS, PPO, SeniorCare, Comm. Plan-HMO Regional, Affiliates, Assoc., Metro Nwk PSU Plan A 666 25126 PA Rendering Provider must be Unique Provider ID number or UPIN number PSU State HealthPass 666 25126 PA Rendering Provider must be Unique Provider ID number or UPIN number Puget Sound Benefits Trust 372 91136 ALL 009 91136 AK, WA 206-441-7574 Customer Service 009 91136 AK, WA 206-441-7574 Customer Service 372 91136 ALL Group # F25 Puget Sound Benefits Trust Group # F25 Puget Sound Electrical Workers Trust Group # F33 Puget Sound Electrical Workers Trust Group # F33 009 35174 AR 501-228-7111 ext5059 Vicky McSwain 666 25128 VA 800-627-4872 Provider Services 39197 WI 800-992-6613 Provider Relations QUANM NM 505-889-8800 Customer Service 666 37129 IA, IL, MO 217-222-9157 ex 5151 Susan Dean R. E. Harrington, Inc 109 95266 ALL R. E. Harrington, Inc. 372 95266 ALL Railroad Medicare (Augusta, GA) 320 00320 ALL Qual Choice of Arkansas Requires a Unique Provider ID# Qual Choice of Virginia New name is Southern Health Services Qual Med - Wisconsin 126 Claims address: 555 S. 108th St., West Allis, WI Qualcare, Inc. 009 23342 NJ, NY Located in Piscataway, NJ No enrollment if participating provider Qualmed - New Mexico 940 Located in Albuquerque, New Mexico Quincy Health Care Management, Inc. Located in Quincy, Illinois Payer requires Enrollment Form - Call Gateway EDI for Forms RBMS, LLC 940 91176 ALL 800-770-3740 Customer Service 372 93200 ALL 800-373-1477 Customer Service NDEX 800-373-1477 Customer Service NDEX 308-635-2260 Scott Reisig Located in Anchorage, Alaska Regence Washington Health - FEP Previously known as King County Medical Blue Shield-FEP-Requires Unique Prov.ID# Regence Washington Health Previously known as 372 93200 ALL King County Medical Blue Shield - Requires Unique Provider ID Regional Care, Inc. 940 47076 ALL Reliance Standard 372 36088 ALL Reliastar 372 41045 ALL 612-372-5466 EDI Support Reynolds and Reynolds 940 37270 ALL 800-736-3539 Customer Service 666 37129 IA, IL, MO 800-637-7100 Customer Service 425 00425 ALL 877-296-6189 Customer Service Located in Scottsbluff, Nebraska Located in Dayton, Ohio River Quest Network, Inc. Located in Quincy, Illinois Riverbend Rural Health Contact Gateway EDI for Enrollment Rocky Mountain HMO 009 RMHMO CO 800-854-4558 Provider Service 317-297-4187 Client Services 800-638-8432 Customer Service Located in Grand Junction, Colorado Enrollment required contact Gateway EDI Rocky Mountain Life Dental 372 84102 ALL Rooney Life Inc. 009 37602 ALL Royal & Sun Alliance 866 WC171 CA, CT, DC, DE, GA, IL, IN, MD, MO, NC, NY, PA, SC, TN, TX, VA, WA 009 71412 ALL Rush Prudential Health Plans (HMO 009 Only) 36389 ALL S & S HealthCare Stratagies 009 31441 ALL # on member card Customer Service 373 SFG99 CA, FL, TX 800-635-4238 Provider Services 940 35164 ALL 317-580-8043 Michelle Marshall 009 22240 NJ 732-562-2834 Allison Hofmann 940 37288 CA 805-569-8220 Christine Gutierrez 009 77038 NY 559-228-5410 Customer Service 940 88030 TX 800-321-7947 Customer Service 009 13310 ALL 319-351-2667 x5610 Sue Hansen WORK COMP Rural Carrier Benefit Plan Located uin Charlotte, North Carolina Located in Cincinnati, Ohio Safeguard Vision Located in Laguna Hills, California Sagamore Health Network (IN) Located in Carmel, IN Saint Barnabas System Health Plan Located in Pisataway, New Jersey Santa Barbara Cottage Hospital Located in Santa Barbara, California Sante Health System and Affiliates Located in New York, New York Scott & White Health Plan Located in Temple, Texas Seabury & Smith Benefit Plan Admin. of St. Louis, MO & Office of the Admin., Wash., D.C. Secure Health Plan of Georgia, LLC 009 28530 GA 800-648-7563 Opt Customer Service 1 04298 MA 800-423-8080 Customer Service 800-548-1224 Provider Services UPIN # or 6 digit alpha numeric # required. Secure Horizons - Tufts Health Plan for Seniors 109 Tuft's Health Plan must be notified before submitting claims Security Health Plan Located in Marshfield, WI 009 39045 WI Sedgwick Claims Management Services, Inc. (TPA) 866 WC511 CA, CT, DC, DE, FL, GA, IL, MD, NC, NJ, PA, SC, TN, TX, VA, WI 126 42137 IA 800-397-0427 Customer Service ALL 800-497-3699 Customer Service 888-394-3100 Customer Service 800-858-9060 Provider Service WORK COMP Select Benefit Administrators (Des Moines, Iowa) Corporate Headquarters, West Des Moines, Iowa Select Benefits Administrators of America 126 37282 Only claims with address: PO Box 440, Ashland, WI 54806 Select Health of South Carolina 009 23285 SC Rendering Provider ID number required. Claims address: PO Box 7120 London, KY SelectCare 109 10014 MN, SD, WI Claims mailing address: PO Box 830489, Birmingham, AL 35283-0489 SelectCare (Coca Cola) 372 68241 ALL 800-544-4778 Customer Service Self Insured Benefit Administrators 126 59111 ALL 800-683-7422 Customer Service Only claims with address: 18167 US Highway 19 North, Suite 300, Clearwater, FL Self Insured Plans LLC 109 36404 ALL 941-403-7884 Customer Service Self-Funded Plans (IL, PA, OH) 126 34131 ALL 216-566-1455 x116 Debbie Phillips SensiCare--direct 340 00340 IL, MO Located in Naples, Florida Requires Unique Provider ID# - Call Gateway EDI Customer Service for set-up Sentara Health Plan 009 54154 VA 800-736-8272 Customer Service 109 23249 PA 717-299-2341 Robert Hettrick 109 IP080 CA 818-461-5554 Fed Villaluna 940 EPNSH TX 512-324-3125 Provider Relations 940 SHEBP TX 512-421-5667 Customer Service 214-561-6424 Michael Newman Entered Twice Sentinel Management Services Located in Lancaster, Pennsylvania Seoul Medical Group IPA located in Encino, CA Seton Health Plan - Exclusive Provider Network 22 locations in Central Texas Seton Healthcare Network Employee Health Plan Claims address: Po Box 15445, Austin, Texas 78781 Shasta Administrative Services 940 75280 ALL Jeld-Wen Claims only. PO Box 1747, Redmond, OR 97756 Sierra Health Services 009 76342 NV 702-242-7290 Leslie Hare 009 62159 TN 800-264-3060 Provider Service Located in Las Vegas, Nevada Signature Health Alliance (SHA) Only claims currently mailed to PO Box 22419, Nashville, Tennessee Sinclair Health Plan 940 84076 ALL 630-789-2082 Julie Weissmann 372 84076 ALL 630-789-2082 Julie Weissmann 540 00540 ALL 319-583-7344 009 84096 CO 800-850-2249 Customer Service 940 02057 ALL 806-473-2406 Desri Petrucci 109 AMS01 ALL 800-627-4872 Provider Service Located in South Temple, Utah Sinclair Health Plan -Dental Located in South Temple, Utah SISCO (Self Insured Services Company) An Iowa Corporation Sloans Lake Managed Care Located in Denver, Colorado Smith Administrators Located in Forth Worth, Texas Sooner Health Network - Wisconsin Only Only claims with the address of Wisconsin can be submitted electronically. Southern Health Services, Inc. 666 25128 VA Located in Richmond, VA - claims sent to PO Box 7704, London, KY Southwest Service Life 940 37266 ALL 800-966-7491 Customer Service Southwestern Bell 372 68241 ALL 800-544-4778 Customer Service Southwestern Bell Exec. - Custom Care 372 68241 ALL 800-544-4778 Customer Service Southwestern Bell Exec. Southwestern Bell 372 68241 ALL 800-544-4778 Customer Service Special Agents Mutual Benefit Association 109 37259 ALL 800-638-1440 Customer Service 109 52190 ALL 410-321-3568 Suzanne Connolly 773 00773 ALL 800-638-3120 Provider Services 630-428-5126 Ray Zroback Located in Fort Worth, Texas Located In Rockville, Maryland Special Risk International (SRI) Located in Lutherville, Maryland Spectera Located in Baltimore, Maryland - Unique Provider ID required. St. John's Claims Administration 940 37264 MO Located in Springfield, Missouri - claims address: PO Box 14230, Springfield, MO St. Paul Company (MetraComp) CA, CT, DC, DE, FL, GA, MD, NC, NJ, NY, PA.SC.TN, VA 866 WC521 866 WC161 ALL, Except for TX WORK COMP St. Paul Travelers WORK COMP St. Therese Physician Associates 940 37116 ALL 630-428-5397 Gary Trebolo Standard Insurance (OR) 372 93024 ALL State Employee Group Benefits 009 72087 LA 615-885-3700 Provider Service 009 31053 ALL 800-538-4643 Customer Service 14163 FL, GA 800-960-2530 ext1447 Tamara Allen 888-858-8551 Claims Status Customer Service Located in Hinsdale, Illinois Employees of the State of Louisiana State Farm Group Medical & Individual Health Only Group and Individual Health Claims. Staywell Health/Wellcare Choice 009 Requires a 5-9 character Rendering Provider ID number Sterling Option One 940 91151 ALL Medicare+Choice Plan - SEE NOTES REGARDING LAB CHARGES. Stirling and Stirling 940 06089 ALL 800-447-6689 372 31121 ALL 440-720-0700 ext Tiffany Brown 215 Located in Milford, Connecticut Stoner and Associates Only claims with address: 205 West 4th St., Suite 225, Cincinnati, Ohio 45202 Stoner and Associates 126 31121 OH 440-720-0700 x215 Tiffany Brown - EDI 440-720-0700 ext205 Rebecca Karlinsky 800-996-8401 Customer Service Only claims with address: 205 West Fourth St, Suite 225, Cincinnati, OH 45202 Stowe Associates 126 58128 ALL Claims address: 2872 Woodcock Blvd., Suite 200, Atlanta, GA 30341 SummaCare HMO 009 95202 OH Located in Akron, OH - Rendering Network Provider ID required. Summit 866 WC721 AL, AR, FL, GA, KY, LA, MS, SD, TX 126 23218 ALL 888-429-9090 Customer Service Superior Dental Care 372 31117 ALL 800-762-3159 Customer Service Superior Health Plan Texas 666 39188 TX See List Customer Service 940 37228 TX 817-740-8513 Diane Myrick 940 39157 ALL 800-826-0012 Customer Service WORK COMP Superior Administrators, Inc. Located in Santa Anna, California Provider ID and Enrollment required Tarrant Health Services Located in Fort Worth, Texas TBG Administrative Services Located in Wausau, Wisconsin Teamcare 009 36215 ALL 800-323-5000 Customer Support Only claims with the address in the state of Illinois Teamsters Local Union #301 009 36612 IL 630-789-2082 ext Marian Jacob 203 892 00892 TN 423-755-5717 Customer Service 00391 TN 423-755-5717 Customer Support 940 37293 TN 800-373-0374 Customer Service 940 76048 ALL 832-824-2600 Vicki Sublett 800-990-8247 Provider Relations Located in Waukegan, Illinois TennCare Select TennCare MCO - Enrollment required Tenncare Select UB 391 Enrollment Required contact Gateway EDI. Tennessee Benefit Administators Located in Memphis, Tennessee Texas Childrens Individual & CHIP Claims address: PO Box 300125, Houston, Texas 77230 Texas Childrens Star Medicaid 940 TXCSM TX Claims address: PO Box 300286, Houston, Texas 77230 - See notes Texas Municipal League Group 940 74214 ALL 800-348-7879 Customer Service 940 TH055 TX 800-683-4856 Customer Service 372 66893 ALL Third Party Administrators/American 109 Benefit Admin. 37225 ALL 630-416-1111 Customer Service Located in Austin, Texas Texas True Choice Headquarters in Plano, Texas The New England Located in Naperville, Illinois - SEE NOTES to verify if you should electronic. Third Party Claims Management 372 95266 ALL 800-237-9293 Customer Service Third Party Claims Management 109 95266 ALL 800-237-9293 Customer Service 315 00315 SC Time Insurance Company, A Fortis Company 372 39065 ALL 414-299-6317 Dwayne Riekena Time Insurance, A Fortis Company 009 39065 ALL 414-299-6317 Dwayne Riekena TLC Family Care Health Plan 800 36193 CO 901-725-7100 Customer Service Located in Dayton, Ohio Thomas Cooper - BCBS SC TESTING Located in Memphis, Tennessee Rendering Provider ID required TMG Life Insurance Co. 009 70491 ALL 800-752-2557 Customer Service TML Intergovernmental Employee 940 74214 ALL 800-348-7879 Customer Service Benefits Located in Austin, Texas / Formerly Texas Municipal League Tongass Timber Trust 940 92620 AK Total Care Management 726 87726 ALL TOTAL CARE/Syracuse PHSP 800 TCARE NY 806-473-2406 Desri Petrucci 800-223-7242 Customer Service Located in Ketchikan, Alaska Claims address: 819 South Salina St, PO Box 11507, Syracuse, NY 13218-1507 Total Claims Solutions 373 TCS99 ALL Tower Life Insurance Company 940 69493 ALL 210-554-4400 Customer Service TransAmerica Life Insurance Company 940 59222 ALL 800-527-2845 Customer Service Located in Green Bay, Wisconsin Insured's ID number will be a 10 digit numerical number. TransChoice-Key Benefit Administators 940 37284 ALL 866-867-6883 Customer Service TRAN1 AZ, CA 800-221-8942 Customer Service Located in Fort Mill, South Carolina Transwestern Insurance Admin, Inc. 940 Located in Fresno, California Travelers 726 87726 ALL Members card Customer Service Travelers 372 87726 ALL 864-234-6164 Claim Status Check Travelers Health Network 726 87726 ALL Members card Customer Service Travelers Plan Adminstrators 726 87726 ALL Members card Customer Service Travelers/CGT - PPO 726 87726 ALL Members card Customer Service Triad Healthcare, Inc. (Plainville, CT) 940 39181 ALL 800-550-0540 Provider Services Customer Service HMO & Care Option Located in Plainville, Connecticut Tricare North Region 385 57106 IL, IN, KY, MI, MO, NC, OH, VA, WI, WV 877-334-2524 Tricare South Region 385 61125 AL, AR, FL, GA, LA, MS, OK, SC, TN, TX 800-325-5920 opt. PGBA EDI Help Desk 2 AZ, CA, CO, IA, ID, KS, MN, MO, MT, NE, ND, NM, NV, OR, SD, TX, UT, WA, WY (608) 221-5056 Enrollment required please contact Gateway EDI. Tricare West Region 111 00111 Marcia Green Enrollment required contact Gateway EDI. see notes regarding provider number Trispan Rural Health 420 00420 LA, MO, MS 940 TCUSA TX 601-664-4995 Customer Service 800-251-9665 Customer Service 800-251-9665 Customer Service 440-720-0700 x222 Kathy Myers - EDI Contact Gateway EDI for Enrollment True Choice USA Claims address: PO Box 251369, Plano, TX 75025 True Choice USA - Christus Health Plans 940 TCUCH TX Claims address: PO Box 250089, Plano, TX 75025 Trusteed Plans Service Corporation 126 91078 WA Only claims for the following address: PO Box 1894, Tacoma, WA 98401-1894. Trusteed Plans Service Corportion 372 91078 ALL 440-720-0700 ext Kathy Myers 222 Only claims with address: PO Box 1894, Tacoma, Washington 98401-1894 Trustmark 009 61425 ALL 847-615-1500 Customer Service MA 800-423-8080 Customer Service (PPO Product) Corporate Office located in Lake Forest, Illinois Tufts Health Plan 109 04298 Tuft's Health Plan must be notified before submitting claims UGS 450 00450 MI, VA, WV (414) 226-5000 Provider Number Required Gateway contacts UGS to determine where to send claims UGS 453 00453 ALL Gateway contacts UGS to determine where to submit claims. UHC Medicare Complete 726 87726 IL, MO UICI - Administrators 009 75240 ALL UICI Administrator - State of Nevada 940 Only 74223 NV 972-443-2612 Wes Bell 52180 ALL 818-558-3630 Provider Services Formerly submitted under Payer ID 75245 UMWA Health & Retirement Funds 009 Payer does not accept DME claims electronic. Unicare 314 80314 ALL 314 80314 ALL Unicare Life and Health 314 80314 ALL 877-334-4286 Customer Support UniCARE Life & Health 314 80314 ALL Number on Card Customer Service Contact number on Member ID card, Unicare Individual - Small Group See notes regarding locator codes Now UNICARE Major Accounts - Group Number determines Payor ID UniCARE Life & Health 372 80314 ALL 372 80314 ALL Now UniCARE Major Accounts UniCare Major Accounts Number on Card Customer Service Number on Card Customer Service Formerly UNICARE Life & Health - Group number determines Payor ID UniCare Major Accounts 314 80314 ALL Formerly UNICARE Life & Health - Group number determines Payor ID Unicare Major Accounts 314 80314 ALL 877-334-4286 Customer Suppoer UniCare Special Accounts (Previously John Hancock 314 80314 ALL 877-334-4286 Customer Support 800-464-0967 Provider Services 800-241-4848 Customer Service 877-800-2956 Customer Service 800-547-0421 Customer Service Health Security Plan, Mutual Life Ins. Co, & Preferred Health Plan Uniform Medicare Plan/Harringon Benefits 009 75243 OR, WA Claims address: PO Box 34850, Seattle, Washington 98124 Uniformed Services Family Health Plan-St. Vince 009 13407 NY Only St. Vincent Catholic Medical Centers of New York-located in Staten Island. Union Labor Life Insurance Company 126 13142 ALL Only claims with address: P.O. Box 61593, King of Prussia, PA 19406 Union Pacific Railroad Employees Health System 009 87042 ALL Only claims with the address 795 North, 400 West, Salt Lake City, Utah 81043 United Behavioral Health 726 87726 ALL 726 87726 ALL CX002 ALL 800-969-3666 Gateway EDI CX013 ALL 800-969-3666 Gateway EDI CX007 ALL 800-969-3666 Gateway EDI 00012 MO 800-470-9630 Provider Services Entered Twice United Behavioral Health See notes Various Mailing addresses - See notes United Concordia (TRICARE FMDP) 372 Requires enrollment contact Gateway EDI United Concordia Dental Plus 372 Requires enrollment contact Gateway EDI United Concordia-Fee for Service 372 Requires enrollment contact Gateway EDI United Food and Commercial Workers Local 655 012 Must have Prefix 655 before Social Security Number United Health Services 009 62170 ALL United Healthcare MetraHealth/Metropolitan 726 87726 ALL Members card Customer Service United HealthCare MetraHealth 726 87726 ALL Members card Customer Service Formerly Travelers, Metlife, and Metroplitan Life United Healthcare of Alabama 726 87726 ALL United HealthCare of all states 726 87726 ALL 726 87726 FL 800-945-0137 Customer Service 800-688-9195 Customer Service 305-441-1140 x2050 Ana Falcon See notes for claims addresses United HealthCare of Florida Requires Unique Provider ID - Provider # Prefix - RAM United Healthcare of Tennessee 726 87726 TN United Healthcare of Wisconsin, Inc. 726 87726 WI 87726 FL Located in Milwaukee, WI United Healthcare Plan of Florida 726 United Healthcare Plans of Florida (old CAC/Ramsay/Coral Gables Plan ONLY United Medical Resources 009 31107 ALL United of Omaha 009 71412 ALL 402-342-7600 x4825 Provider Relations United of Omaha 372 71412 ALL 800-456-9292 Customer Service United Physicians of Northern Colorado 009 84132 CO 970-224-4600 Elaine McAvoy 372 13545 ALL 732-922-7116 Jacquie Lee 109 33001 CA 800-635-6668 ext5330 Grace Located in Fort Collins, CO United States Life Insurance Company Located in Neptune, New Jersey Universal Care of California Located in Signal Hill, California - Unique Provider ID number required Universal Health Care, Inc. (Florida) 940 UNIV1 FL 866-690-4UHC Provider Services 329 22329 NJ 800-780-2438 Provider Services 888-876-2756 Customer Service Based in St. Petersburg, Florida University Health Plan New Jersey Enrollment required contact Gateway EDI - Provider ID required University of Pittsburgh Medical Center (UPMC) 232 23281 PA Located in Pittsburgh, PA - only the commercial and UPMC for Life (Medicare). University of Washington Students & 009 Graduate Appts 91136 WA 206-441-7574 Customer Service 38337 MI 800-835-2556 Customer Service Group # P67 Upper Peninsula Health Plan 940 Located in Marquette, Michigan - Provider ID Number required US Benefits 009 93092 ALL 940 USFHP LA, TX 806-473-2406 Desi Petrucci 713-683-2018 Provider Services Located in Portland, Oregon US Family Health Plan Texas and Louisiana Providers Only. Enrollment Required. USAA (United States Automobile Association) 009 74095 ALL 210-456-2906 Carolyn Sullivan 009 74095 ALL 210-456-2906 Carolyn Sullivan VA Fee Basis Program 009 12115 ALL Value Options - TESTING 813 00813 ALL 109 72128 LA 318-361-0900 Annette Napier Varian Health Care Plan 372 68241 ALL VHP Community Care 009 23173 TN 800-457-5683 Lori Bruelheide 042 VPN01 VA 800-727-7536 Provider Services United States Automobile Assoc. USAA (United States Automobile Association) United States Automobile Assoc. TESTING Vantage Health Plan, Inc, Located in Monroe, Louisiana Located in Nashville, TN Virgina Premier Health Plan Located in Richmond, Virginia - see notes for specific claims addresses Vision Care Incorporated 940 37297 FL 800-393-2873 Customer Service 099 BVVP1 ALL 800-883-5747 Customer Service 109 55248 FL 800-833-2169 ext2206 Jim Gallagher ALL 613-694-4000 Nick Barbati 62111 ALL 615-533-8785 Bob Martin 93200 ALL 800-373-1477 Customer Service NDEX 888-533-6822 Customer Service Corporate office: Roswell, Georgia Vision Insurance Plan of America Located in Milwaukee, Wisconsin Vista Health Plan Located in Tallahassee. Florida-claims address-PO Box 45-9011, Sunrise FL, 33345 Vytra Healthcare 666 22264 Claims address: P.O. Box 9091 Melville, NY 11747 W. C. Beeler & Company 009 Located in Hendersonville, Tennessee Walla Walla Valley Medical Service Corp. 372 Previously known as King County Medical-Walla Walla Valley-Req. Unique Prov. ID Washington Dental Service 372 91062 ALL Washington Employers Trust 940 37294 ALL Located in Seattle, Washington Washington State Council of County 372 & City 91136 ALL 126 58082 GA 866 WC601 CA, CT, DC, DE, FL, GA, IL, MD, NC, NJ, NY, PA, SC, TN, VA, WI 372 39026 ALL 715-841-7399 Tammy Grosskurth 109 39026 ALL 715-847-7942 Jennifer Ress WEA Insurance Group 372 39151 ALL 608-276-0632 Lola Bieri WEA Insurance Group 009 39151 ALL 608-276-0632 Lola Bieri WebTPA 940 75261 TX 866-393-2872 Customer Service 866 WC611 PA 235 00235 IA 800-407-0267 Provider Services 940 WELM2 TX 210-617-4099 Wellmed Claims Department 666 25129 800-708-9355 Provider Services Customer Service Employees Dental Trust (Group # F36) Watkins Associated Industries, Inc. 440-720-0700 ext Tiffany Brown 215 Located in Atlanta, Georgia Wausau WORK COMP Wausau Benefits Located in Wausau, Wisconsin Wausau Insurance Companies Located in Wausau, Wisconsin Located in Grand Prarie, Texas Weis Markets WORK COMP Wellmark Administrators, Inc. previously known as BAAI WellMed Located in San Antonio, Texas WellPath of Carolina, Inc NC, SC Rendering Provider Network ID Required. Claims address - PO Box 7715, London, KY Wellpoint Dental 372 47198 ALL West Coast Stationary Engineers Health & Security 009 91136 AK, WA 206-441-7574 126 31048 ALL 440-720-0700 ext Rebecca Karlinsky 205 Group # F13 Western and Southern Financial Group Only claims with address: PO Box 5735, Cincinnati, Ohio 45201-5735 Western Growers Assurance Trust 109 24735 ALL 949-863-1000 x309 Connie Rich Western Growers Insurance 109 24735 ALL 949-863-1000 Connie Rich Company x309 109 24735 ALL 949-863-1000 X309 Connie Rich Western Mutual Insurance/WMI-TPA 940 37247 UT 801-263-8000 Customer Service 38232 ALL 440-720-0700 x205 Rebecca Karlinsky Western Growes/Pinnacle Claims Located in Murray, Utah Weyco Inc. 009 Claims address: PO Box 30132, Lansing, MI 48909 William J Sutton & Co. LTD 126 98010 ALL Claims address: 33 Yonge St, Suite 420, Toronto, Ontario, Canada M5E1S9 Willis Administrative Services Corporation 009 62061 ALL 615-360-2843 Rene' Ernst 009 52118 MD 703-934-6215 Audria Tatken 009 WNHLT WY 800-868-7670 Customer Service 866 WC761 AL, FL, GA, IN, KY, LA, MS, NC, OH, OK, SC, TN, TX, VA 126 39200 WI 608-251-5577 Customer Service 61101 ALL 800-558-4444 X 7448 Bonnie or Jody - MIS Dept. 00159 IA, IL, MN, WI 800-221-6925 Provider Relations 940 75276 ALL 800-786-7557 Customer Service 009 23710 CA 800-227-7863 Participant Services 372 62154 ALL 615-463-1696 Trenece Eady 866 WC601 CT, DC, DE, MD, NJ, NY, PA 866 WC641 CA, CT, DE, DE, FL, GA, IL, IN, MD, MO, Located in Nashville, Tennessee Willse (Carefirst AdministratorsMaryland) Located in Owing Mills, Maryland WinHealth Partners Located in Cheyenne, Wyoming Winn-Dixie WORK COMP Wisconsin Auto and Truck Dealers Claims address: P. O. Box 5345, Madision, WI 53705 Wisconsin Employers Group 611 Green Bay and Madison Wisconsin only Wisconsin Physician Services Commerical 159 Enrollment Required - Only Par Providers World Insurance Company Located in Omaha, Nebraska Writers' Guild Industry Health Plan Located in Burbank, California Xantus Health Plan - Tennessee Dental Located in Nashville, Tennessee Zenith WORK COMP Zurich NC, NJ, NY, PA, SC, TN, VAWI WORK COMP
