754 462 710 B14 B14DN 650 543 266 786 C49 355 341 CARRIER NUM CC CROSSWALK 90917 90651 90873 90087 90087 90814 90731 90468 90948 90191 90555 90541 563 CARRIER CODE CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE CARRIER ZIP CARRIER PHONE NO NY GA NJ NC NC TX OH NC NC AZ PA 101081007 31139 08034 271022000 271022000 75034 45342 271022000 27102 85018 19087 OH 44147 2187 NORTHLAKE PARKWAY SUITE 106 BLD #9 P.O. BOX 2490 P.O. BOX 725549 P.O.BOX 52188 NEW YORK ATLANTA CHERRY HILL WINSTON SALEM WINSTON SALEM FRISCO MIAMISBURG WINSTON SALEM WINSTON SALEM PHOENIX WAYNE BROADVIEW HEIGHTS TUCKER ALPHARETTA ATLANTA PHOENIX GA GA GA AZ 3008430023 31139 850722196 7709343953 6783390211 8664704959 4803914600 ADVANCED BENEFIT SOLUTIONS P.O. BOX 71490 PHOENIX AZ 85050 8884191094 90512 91207 91269 90222 91053 90050 91310 90303 90303 90303 90106 90939 90779 90491 91303 90815 90644 90544 90501 90403 90402 91359 90746 90816 90474 90710 90032 90612 90339 90319 90396 90765 90001 91353 ADVANCED DATA SOLUTIONS ADVANCED INSURANCE ADMINISTRATION ADVANTRA FREEDOM ADVENTIST RISK MANAGEMENT AETNA HEALTH PLANS OF THE CAROLINAS INC AETNA LIFE AND CASUALTY AETNA MEDICARE OPEN PLAN AETNA PHARMACY AETNA US HEALTHCARE AETNA US HEALTHCARE AFFINITY HEALTH PLAN AFID (ASSO. OF FRANCHISE AND INDEPENDENT DIST. AFLAC -AMERICAN FAMILY LIFE ASSO CO AFTRA HEALTH FUND AG ADMINISTRATORS AIKEN COUNTY ALASKA TEAMSTER TRUST ALIA CLAIMS DEPARTMENT ALICARE ALL AMERICAN LIFE INSURANCE CO. ALL OTHER CARRIERS ALLEGIANCE BENEFIT PLAN MANAGEMENT ALLEN MEDICAL CLAIMS ADMINISTRATORS ALLENDALE COUNTY ALLIANCE HEALTH BENEFIT PLAN ALLIANCE PPO, INC. ALLIANT HEALTH PLANS, INC. ALLIED BENEFITS SYSTEM ALLIED NATIONAL, INC. ALLSTATE INSURANCE ALLSTATE WORKPLACE DIVISION ALTA RX ALTERNATIVE BENEFITS PLANS, INC. ALTERNATIVE INSURANCE RESOURCE INC. P.O. BOX 723097 125 MERRILL DR. STE. 2000 P.O. BOX 7154 P.O. BOX 1928 3 CENTERVIEW DRIVE P.O. BOX 36890 P.O.BOX 14079 PO BOX 52444 PO BOX 14094 PO BOX 14079 P.O. BOX 981726 1 S. LIMESTONE ST STE. 301 1932 WYNNTON ROAD 261 MADISON AVE PO BOX 979 520 E 34TH AVENUE SUITE 107 P.O. BOX 9060 P.O. BOX 1447 8501 WEST HIGGINS ROAD PO BOX 3018 P.O. BOX 978 P O BOX 6443 P.O. BOX 934 P.O. BOX 21109 P.O. BOX 909786-60690 P.O. BOX 419233 P.O. BOX 7068 P.O.BOX 853916 P.O. BOX 30081 2920 BRANDYWINE RD. STE. 106 PO BOX 680787 GA AR KY TX NC KY KY AZ KY KY TX OH GA NY PA AK AZ NY IL MT GA MD MD VA IL MO SC TX UT GA AL 31139 72211 407427154 76099 27407 40232 405124079 850722444 40512 40512 799981726 45502 31999 10016 19482 995034116 850689060 10116 60631 598063018 310300978 20850 21705 24108 606909786 641416233 29202 750853916 84130 30341 352660787 8007425246 8882424800 8007135095 8006380589 8004591466 8004233289 8006240756 8002386279 8004517715 8003334432 8662475678 8667669016 8009923522 8005624690 8006348628 B96 90146 ALTERNATIVE RISK MANAGEMENTS (ARM LTD) 814 N.W. HIGHWAY IL 60004 8003921770 234 161 90436 90365 ALWAYSCARE BENEFITS INC AMA INSURANCE AGNECY, INC. P.O. BOX 80139 200 N. LASALLE ST. SUITE 400 ATLANTA LITTLE ROCK LONDON GRAPEVINE GREENSBORO LOUISVILLE LEXINGTON PHOENIX LEXINGTON LEXINGTON EL PASO SPRINGFIELD COLUMBUS NEW YORK VALLEY FORGE ANCHORAGE PHOENIX NEW YORK CHICAGO MISSOULA FT. VALLEY ROCKVILLE FREDERICK ROANOKE CHICAGO KANSAS CITY COLUMBIA RICHARDSON SALT LAKE CITY ATLANTA BIRMINGHAM ARLINGTON HEIGHTS BATON ROUGE CHICAGO LA IL 70898 606819785 8887295433 8004585736 1199 SEIU NATIONAL BENEFIT FUND 1ST MEDICAL NETWORK 21ST CENTURY HEALTH AND BENEFITS INC A.C.S. CONSULTING SERVICES, INC. A.C.S. CONSULTING SERVICES, INC. ABBEVILLE COUNTY ACHA/CAREINGTON INTERNATIONAL CORP ACMG ADMINISTRATORS OF SOUTH CAROLINA ACS BENEFIT SERVICES, INC. ACS CONSULTING SERVICES, INC. ACTIVA HEALTH GROUP ADMINISTRATIVE CONCEPTS INC. PO BOX 1007 P O BOX 724317 P.O. BOX 5037 P. O. BOX 2000 P. O. BOX 2000 P.O. BOX 2568 2570 TECHNICAL DRIVE P.O. BOX 2000 P O BOX 2000 4350 E. CAMELBACK RD. # 200 994 OLD EAGLE SCHOOL RD STE 1005 90749 ADMINISTRATIVE SERVICE CONSULTANTS 3301 E ROYALTON ROAD BLDG D 346 829 731 C15 90546 90987 90894 90162 ADMINISTRATIVE SERVICES, INC. ADMINISTRATIVE SOLUTIONS ADOVA HEALTH ADVANCE PCS D11 90223 310 C72 D33 C88 899 A55 D16 100RX 100DN 100 B43 776 595 289 E55 651 455 344 299 200 199 E54 560 652 272 521 A33 413 135 115 193 581 A02 E44 6464739200 8889806676 8003234890 3367592013 3367592013 8002900523 8002326242 8008495370 8008495370 6024689500 8882939229 8004784450 8008825707 2125395115 7733996645 CARRIER COMMENT CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA WAS PENN WESTERN CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA SEE CARRIER 471 CODE NOT REQUESTED BY MEDICAID ASSIGNED BY SCHA MEDICARE SUPPLEMENTAL PLAN THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN HMO PLAN ONLY THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN CODE IN OPEN STATUS BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. SCHA ASSIGNED 8007817204 8008255406 8003423289 8002350123 8002834927 8002882078 8008257531 8003668997 8009377039 8009985033 8002417319 8004514318 CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CARRIER WAS ALLIED GROUP INSURANCE TRUST THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA DENTAL PLAN CODE NOT REQUESTED BY MEDICAID. SCHA ASSIGNED CARRIER CODE CARRIER NUM CC CROSSWALK 297 C07 309 910 469 B61 968 271 488 B44DN B44 A93 D48 778 106 150 951 A57 118 C92DN C92 919 383 119 840 D38 B69 369 167 A62 532 120 B98 321 321DN 164 A05 722 C70 875 503 C82 253 125 90499 90156 90511 91059 90658 90119 91088 90473 90677 90107 90107 90073 91286 90941 90309 90354 91166 90052 90322 91229 91229 91064 90582 90323 90998 91241 91145 90569 90371 90055 90720 90324 90147 90523 90523 90368 90004 90885 91335 91029 90692 90217 90455 90329 AMALGAMATED LIFE INSURANCE AMERIBEN SOLUTIONS AMERICAN ADMINISTRATIVE GROUP AMERICAN ADMINISTRATIVE GROUP AMERICAN ASSOCIATION OF RETIRED PERSONS (AARP) AMERICAN BEHAVIORAL AMERICAN BENEFIT ADMINISTRATIVE SERVICES AMERICAN BENEFIT PLAN ADMINISTRATOR AMERICAN BENEFITS MANAGEMENT AMERICAN CHOICE HEALTH PLAN, LLC AMERICAN CHOICE HEALTH PLAN, LLC AMERICAN COLLEGE OF SURGEONS AMERICAN CONTINENTAL INSURANCE CO AMERICAN CONTINENTAL INSURANCE CO AMERICAN FIDELITY ASSURANCE BENEFITS AMERICAN GENERAL LIFE AND ACCIDENT INS CO AMERICAN GROUP ADMINISTRATORS AMERICAN GROUP ADMINISTRATORS, INC. AMERICAN HEALTH & LIFE INSURANCE AMERICAN HEALTH CARE AMERICAN HEALTH CARE AMERICAN HEALTH GROUP, INC. AMERICAN HEALTHCARE ALLIANCE AMERICAN HERITAGE LIFE INSURANCE AMERICAN INCOME LIFE INSURANCE COMPANY AMERICAN INSURANCE ADMINISTRATORS AMERICAN INSURANCE ADMINISTRATORS AMERICAN INTERNATIONAL GROUP AMERICAN INTERNATIONAL GROUP (AIG) ACCIDENT AMERICAN MEDICAL AND LIFE INSURANCE (AMLI) AMERICAN MEDICAL SECURITY AMERICAN NATIONAL INSURANCE COMPANY AMERICAN PIONEER LIFE INSURANCE COMPANY AMERICAN POSTAL WORKERS UNION HEALTH PLAN AMERICAN POSTAL WORKERS UNION HEALTH PLAN AMERICAN PROGRESSIVE INSURANCE AMERICAN PUBLIC LIFE INSURANCE CO. AMERICAN REPUBLIC INSURANCE COMPANY AMERICAN RETIREMENT LIFE AMERICAN SENTINEL AMERICAN SPECIAL RISK MANAGEMENT AMERICAN STANDARD LIFE & ACCIDENT INS. CO. AMERICAN STERLING INSURANCE SERVICES AMERICAN TRAVELERS LIFE INSURANCE COMPANY P.O. BOX 1451 P.O. BOX 7186 P.O. BOX 5227 P.O. BOX 5227 P O BOX 740819 3680 GRANDVIEW PARKWAY STE 100 P.O. BOX 0928 22OO-B ROSSELLE STREET 8310 PORT JACKSON AVE NORTHWEST P.O.BOX 922009 P.O.BOX 922043 P.O. BOX 2522 P.O. BOX 2368 P. O. BOX 5008 POST OFFICE BOX 25160 P.O. BOX 1500 101 CONVENTION CENTER DR. STE. 200 101 CONVENTION CENTER DR. STE 200 300 ST. PAUL PLACE 3001 DOUGLAS ST 3850 ATHERTON ROAD P.O. BOX 1500 P.O. BOX 8530 1776 AMERICAN HERITAGE LIFE DRIVE POST OFFICE BOX 2608 P O BOX 2348 P.O. BOX 2348 P.O. BOX 25050 P.O. BOX 26050 P.O. BOX 1353 P.O. BOX 19032 P O BOX 1790 P O BOX 130 POST OFFICE BOX 188004 P.O. BOX 1358 P.O. BOX 130 P.O. BOX 925 P O BOX 21670 PO BOX 30010 P.O. BOX 61140 509 SOUTH LENOLA RD. BLDG TWO P O DRAWER 3248, 224 NORTH INDEPENDENT P.O. BOX 26103 3220 TILLMAN DRIVE NEW YORK BOISE LISLE LISLE ATLANTA BIRMINGHAM BROOKFIELD JACKSONVILLE NORTH CANTON HOUSTON HOUSTON FORT WORTH BRENTWOOD BRENTWOOD OKLAHOMA CITY NASHVILLE LAS VEGAS LAS VEGAS BALTIMORE ROSEVILLE ROCKLIN MAUMEE KANSAS CITY JACKSONVILLE WACO COLUMBUS COLUMBUS WILMINGTON OVERLAND PARK CHICAGO GREENBAY GALVESTON PENSACOLA CHATTANOOGA GLEN BURNIE PENSACOLA JACKSON EAGAN AUSTIN HARRISBURG MOORESTOWN ENID OVERLAND PARK BEN SALEM 275 90477 AMERICAN TRUST ADMINISTRATORS P O BOX 87 496 D61 D23 557 D94 D51 D60 284 110 894 A10 210 B08 90685 91296 91245 91128 91302 91260 91295 90486 90313 91048 90009 90413 90084 AMERICAN VETERINARIAN MEDICINE ASSN. AMERICA'S 1ST CHOICE AMERICA'S HEALTH CHOICE MEDICAL PLANS,(HMO) AMERICORP INS. CO AMERIGROUP COMMUNITY CARE AMERIGROUP COMMUNITY CARE AMERIGROUP COMMUNITY CARE OF SC AMERIHEALTH ADMINISTRATORS AMERIHEALTH HMO, INC. AMERIHEALTH MERCY HEALTH PLAN AMERISCRIPT AMERITAS LIFE INSURANCE AMFIRST INSURANCE CO P.O. BOX 909720 P.O. BOX 210769 762 SOUTH US HWY. ONE PMB 224 P.O. BOX 3430 P.O. BOX 61010 P.O. BOX 61010 P.O. BOX 31789 720 BLAIR ROAD P.O. BOX 41574 P.O. BOX 7118 4301 DARROW RD. STE. 4200 P O BOX 82520 P.O. BOX 16708 CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE NY ID IL IL GA AL WI FL OH TX TX TX TN TN OK TN NE NV MD CA CA OH MO FL TX OH OH DE KS IL WI TX FL TN MD FL MS MN TX PA NJ OK KS PA CARRIER ZIP CARRIER PHONE NO 101161451 83707 605325227 605325227 30374 35243 53008 32204 44720 77292 77292 761132522 37024 37024 731250160 372021500 89109 89109 21202 95661 95765 43537 641140530 32224 76797 43216 432162348 19899 66225 60690 543079032 77553 32591 37422 21060 325910130 39205 55121 757553010 171061140 08057 73701 66225 19020 2124735700 8007867930 6304939252 8003545112 8005235880 8009258327 6304161111 8004685126 3309665500 8005989799 8006334226 8004331672 6153371300 8002644000 8006548489 8008882452 8008424742 8008424742 3013323000 8008728276 8008728276 8008728276 8772840102 8005358086 8177723050 8009221245 8009221245 8004687077 8887221668 8882641512 8002325432 8008996803 8005381053 8002222798 8002222798 8006268913 8002568606 8002472190 8664591755 8006927338 8003597475 4052334000 8772926037 2152441600 SHAWNEE MISSION KS 66201 9134514900 CHICAGO COLUMBIA VERO BEACH CARMEL VIRGINIA BEACH VIRGINIA BEACH VIRGINIA BEACH HORSHAM PHILADELPHIA LONDON STOW LINCOLN JACKSON 606049720 29210 32962 46082 234661010 234661010 234661789 19044 191011574 40742 44224 68501 39236 8006216360 8663213947 8003089823 8666994186 8006004441 8006004441 8006004441 8003454017 8886323862 8889917200 8006816912 8002559678 8888882519 IL SC FL IN VA VA VA PA PA KY OH NE MS CARRIER COMMENT CODE NOT REQUSTED BY MEDICAID. ASSIGNED BY SCHA WAS GALLAGER & BASSETT SERVICES THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN CODE ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA. REQUESTED BY THE SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE IN OPEN STATUS BY SCHA MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN MEDICAID HMO MEDICAID HMO CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CARRIER CODE CARRIER NUM CC CROSSWALK 653 330 X0YDN X0YRX X0Y 529 579 D65 171 523 705 90817 90532 91330 90250 90250 90717 91126 91315 90375 90712 90868 ANDERSON COUNTY ANNUITY BOARD OF SOUTHERN BAPTIST CONVENTION ANTHEM BLUE CROSS AND BLUE SHIELD ANTHEM BLUE CROSS AND BLUE SHIELD ANTHEM BLUE CROSS AND BLUE SHIELD ANTHEM HEALTH ANTHEM PRESCRIPITION MANAGEMENT ANTHEM SENIOR ADVANTAGE AON APA PARTNERS, INC. APS HEALTHCARE, INC. P.O. BOX 2190 P.O. BOX 659444 P.O. BOX 37010 P.O. BOX 105187 3575 KROGER BLVD.,SUITE 400 P O BOX 145433 P.O. BOX 37690 POST OFFICE BOX 66 P.O. BOX 1506 P.O. BOX 1307 NASHVILLE SAN ANTONIO LOUISVILLE ATLANTA DULUTH CINCINNATI LOUISVILLE WINSTON SALEM LATHAM ROCKVILLE TN TX KY GA GA OH KY NC NY MD 37234 78265 40233 30348 30316 45250 402337180 27102 121108006 20849 2147200511 8006224822 8006224822 8006224822 8008881966 8006620210 8882909160 8003683804 8008333650 8002218699 D13 91284 ARCADIAN P.O. BOX 4946 COVINA CA 91723 8007756490 CODE ORIGINALLY ASSIGNED AS MA IN ERROR USE CODE 816 FOR MA PLAN 816 981 A49 X1I B78 972 505 898 934 458 386 90974 91101 91163 90259 90134 91092 90694 91052 91167 90647 90585 ARCADIAN MEMBER CARE ARGUS HEALTH SYSTEMS ARIZONA FOUNDATION FOR MEDICAL CARE ARKANSAS BLUE CROSS AND BLUE SHIELD, INC ARM GROUP (OMNICARE) ASR CORP (ADMINISTRATION SYSTEM RESEARCH) ASSOCIATED ADMINISTRATORS ASSOCIATION & SOCIETY INS. CORP ASSOCIATION & SOCIETY INS. CORP. ASSOCIATION BENEFIT PLAN (MEDICARE) ASSURANT HEALTH P.O. BOX 4946 PO. BOX 419019 P.O. BOX 2909 P O BOX 2181 340 QUADRANGLE DR P.O. BOX 6392 P.O. BOX 27806 P.O. BOX 2510 P.O. BOX 2510 P.O. BOX 668587 P.O. BOX 2806 COVINA KANSAS CITY PHONEIX LITTLE ROCK BOILINGBROOK GRAND RAPIDS BALTIMORE ROCKVILLE ROCKVILLE CHARLOTTE CLINTON CA MO AZ AR IL MI MD MD MD NC IA 91723 64141 850622909 72203 60440 49516 212857806 20847 20847 282668587 527332806 8005738597 8005227487 6022318855 5013782010 8009687222 8009682449 8006382972 8006382610 8006382610 8006340069 8005537654 MEDICARE ADVANTAGE PLAN 386DN 90585 ASSURANT HEALTH P.O. BOX 2940 CLINTON IA 527332940 8004427742 DHHS INTERNAL RECOVERY CLAIMS BILLING MUST BE FAX TO: 414-224-0472 448 451 105 971 B34 122 B45 526 588 B82 C40 494 B58 A72 358 654 987 815 123 655 644 X0BDN X0MDN 867 C62 C63 643 656 881 C08 750 C79 E87 90637 90640 90308 91091 90099 90326 90108 90715 90772 91152 91204 90683 91168 91129 90558 90818 91107 90973 90327 90819 91127 91322 91331 91021 90203 90204 91153 90820 91035 91157 90913 90214 91366 ASSURANT HEALTH INSURANCE ASSURECARE RISK MANAGEMENT ATHENE ANNUITY AND LIFE ASSURANCE COMPANY ATLANTA ADMINISTRATIONS ATLANTA LIFE INSURANCE COMPANY ATLANTIC COAST LIFE INSURANCE COMPANY ATLANTICARE AULTCARE AUTOMATED BENEFIT SERVICES INC. AVANTE HEALTH AVERA HEALTH PLANS AVESIS PHARMACY NETWORK AVMED HEALTH BABB, INC. BAKERY & CONFECTIONERY UNION BAMBERG COUNTY BANKERS FIDELITY LIFE INS CO BANKERS FIDELITY LIFE INSURANCE COMPANY BANKERS LIFE & CASUALTY BARNWELL COUNTY BCBS OF GEORGIA BCBS OF GEORGIA DENTAL BCBS OF MASSACHUSETTS BCBS OF NC BCBS OF SC MEDICARE BLUE PRIVATE (PFFS) BCBS OF SC MEDICARE BLUE&MEDICARE BLUE PLUS (PPO) BCBS OF TENNESSEE BEAUFORT COUNTY BEHAVIORAL HEALTH SYSTEMS BENECARD BENEFIT ADMINISTRATIVE SERVICES BENEFIT ADMINISTRATIVE SYSTEM, LTD BENEFIT ADMINISTRATIVE SYSTEMS P O BOX 42033 340 QUANRINGLE BLVD POST OFFICE BOX 19038 135 BEAVER STREET 100 AUBURN AVENUE, NE PO BOX 20010 P.O. BOX 613 P.O. BOX 6910 P.O. BOX 321223 1111 E. HERNDON AVE STE. 308 P.O. BOX 381506 3724 N 3RD ST STE 300 P.O. BOX 569000 850 RIDGE AVE 10401 CONNECTICUT AVE STE 300 PO BOX 105652 P.O. BOX 260040 PO BOX 66927 P.O. BOX 9907 P.O. BOX 659444 P.O. BOX 986005 P O BOX 30087 P.O. BOX 100133 P.O. BOX 100133 730 CHESTNUT ST P.O. BOX 830724 P.O. BOX 2187 P.O. BOX 4509 P.O. BOX 17475 JOVANNA DR. SUITE 1B PO BOX 2920 HAZELWOOD BOILING BROOK GREENVILLE WALTHAM ATLANTA CHARLESTON HAMMONTON CANTON DETROIT FRESNO BIRMINGHAM PHOENIX MIAMI PITTSBURGH KENSINGTON ATLANTA PLANTO CHICAGO COLUMBUS SAN ANTONIO BOSTON DURHAM COLUMBIA COLUMBIA CHATTANOOGA BIRMINGHAM CLIFTON ROCKFORD HOMEWOOD MILWAUKEE MD IL SC MA GA SC NJ OH MI CA AL AZ FL PA MD GA TX IL GA TX MA NC SC SC TN AL NJ IL IL WI 63042 60440 29602 02452 30303 294130010 08037 44706 482321223 93720 35238 85012 332569000 15212 208953960 30348 75026 606660927 31908 78265 02298 27702 29202 29202 37402 352830724 07015 61110 60430 53201 8005537654 8007597422 8646091000 8005481256 4046592100 8437638680 8883282287 8003448858 8002751896 8664163617 8883222115 6022413400 8004528633 8002456102 3014683742 CODE ASSIGED BY SCHA CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE CARRIER ZIP CARRIER PHONE NO 4042665500 8664587499 8006213724 8004412273 4048428000 8002535219194897431 8006053256 8006053256 8772966189 8002451150 8007379528 8159699663 7087997400 8005250582 CARRIER COMMENT USE CARRIER A24 MEDICARE ADVANTAGE PLAN THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE ASSIGNED BY SCHA WAS FORTIS INSURANCE COMPANY THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THID CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE INTERMEDIARY DENTAL ONLY MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN MEDICARE INTERMEDIARY CARRIER CODE CARRIER NUM CC CROSSWALK B37DN B37 300 300DN 475 319 A86 C12 C11 C11DN 301 C28 311 980 772 127 90100 90100 90502 90502 90664 90521 90067 90159 90158 90158 90503 90173 90513 91100 90935 90331 BENEFIT ADMINISTRATORS BENEFIT ADMINISTRATORS BENEFIT ADMINISTRATORS INC BENEFIT ADMINISTRATORS INC BENEFIT ASSISTANCE CORP. BENEFIT CONCEPTS BENEFIT MANAGEMENT CO BENEFIT MANAGEMENT INC. BENEFIT MANAGEMENT SERVICES INC BENEFIT MANAGEMENT SERVICES INC BENEFIT PLAN ADMINISTRATORS BENEFIT PLAN MANAGEMENT BENEFIT PLANNERS, INC BENEFIT SUPPORT, INC. BENEFIT SYSTEMS INC BENEFITSOURCE, INC POST OFFICE BOX 1957 POST OFFICE BOX 21308 P O BOX 6279 P O BOX 6279 P.O. BOX 950 P.O. BOX 60608 P.O. BOX 269000 P.O. BOX 1090 P O BOX 1317 P O BOX 1178 2145 FORD PARKWAY, SUITE 300 P.O. BOX 536 P.O. BOX 682010 P.O. BOX 2977 P O BOX 6001 P.O. BOX 240 A25 90024 BENESCRIPT 8300 E. MAPLEWOOD AVE 985 A81 256 380 481 657 904 E29 D08 X2X 91105 90062 90458 90580 90670 90821 91185 91349 91225 91306 BENESIGHT BENESYS BENICOMP BENMARK, INC. BENOVATION BERKELEY COUNTY BEST CHOICE HEALTH PLAN BEST LIFE AND HEALTH INSURANCE CO. BIG LOTS ASSOCIATE BENEFIT PLAN BLUE CROSS BLUE SHIELD OF HAWAII 902 91278 C64 922 403 X2G X2W X1V X1H X0L CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE CARRIER ZIP CARRIER PHONE NO CARRIER COMMENT KY SC PA PA WV PA FL KS NC NC MN MA TX GA IN MI 41311 29221 16512 16512 25526 19406 333269000 66210 28106 28106 55116 02370 78269---30503 462066001 48161 8003258424 8778400936 8007772524 8007772524 3045621913 8002202600 8002629175 8002901368 8002281803 8002281813 8002778973 8776427500 2106991872 8007774782 8008243216 8004231028 CO 80111 8003453189 P.O. BOX 340 P.O. BOX 90082 8310 CLINTON PARK DR P.O. BOX 16767 3481 CENTRAL PARKWAY, STE 200 P.O. BOX 21128 PO BOX 890 P.O. BOX 9071 P.O. BOX 44500 BEATTYVILLE COLUMBIA ERIE ERIE HURRICANE KING OF PRUSSIA WESTON GREAT BEND MATTHEWS MATTHEWS ST. PAUL ROCKLYN SAN ANTONIO GAINSVILLE INDIANAPOLIS MONROE GREENWOOD VILLAGE PUEBLO LUBBOCK FT WAYNE JACKSON CINCINNATI FORT LAUDERDALE MERIDIAN DUBLIN HONOLULU CO TX IN MS OH FL ID OH HI 81002 79402 46825 39236 45223 33335 836800890 430170971 96801 8003621116 3372341789 8008377400 6013660596 8006816912 BLUE CHARE NETWORK OF MI P.O. BOX 68710 GRAND RAPID MI 49516 8006588878 CODE ASSIGNED BY SCHA. THIS IS THE HMO TO CC 504 WHICH IS THE POS 91201 91065 90602 90283 90299 90272 90258 90237 BLUE CHOICE HEALTH PLAN (PPO) BLUE CHOICE HEALTHPLAN BLUE CHOICE/MEDICAID BLUE CROSS & BLUE SHIELD CENTRAL NEW YORK, INC. BLUE CROSS & BLUE SHIELD OF ARIZONA, INC. BLUE CROSS & BLUE SHIELD OF COLORADO BLUE CROSS & BLUE SHIELD OF CONNECTICUT INC BLUE CROSS & BLUE SHIELD OF DELAWARE INC P.O. BOX 6170 POST OFFICE BOX 6170 PO BOX 6170 P O BOX 4809 P O BOX 13466 700 BROADWAY P O BOX 533 P O BOX 1991 COLUMBIA COLUMBIA COLUMBIA SYRACUSE PHOENIX DENVER NORTH HAVEN WILMINGTON SC SC SC NY AZ CO CT DE 29260 292606170 29260 132214809 850023466 80273 06473 19899 8772753256 8037868466 8772753256 3154483801 6028644100 3038312131 2032394961 3024210260 MEDICARE ADVANTAGE (PPO) WAS COMPANION HEALTHCARE NAME CHANGE EFFECTIVE 7/1/05 MEDICAID HMO X0B 90227 BLUE CROSS & BLUE SHIELD OF GEORGIA/ATLANTA INC P O BOX 9907 COLUMBUS GA 319086007 4048428000 X1M X2B X0U X1L X1Q X0I X01 X1K X0QDN X0Q X1P X0Z X2U X1U X0S X0SDN X0CDN X0C X2J 90263 90278 90246 90262 90267 90234 90252 90261 91329 90242 90266 90251 90297 90271 90244 90244 90228 90228 90286 BLUE CROSS & BLUE SHIELD OF KANSAS BLUE CROSS & BLUE SHIELD OF KANSAS CITY BLUE CROSS & BLUE SHIELD OF KENTUCKY INC BLUE CROSS & BLUE SHIELD OF LOUISIANA BLUE CROSS & BLUE SHIELD OF MAINE BLUE CROSS & BLUE SHIELD OF MARYLAND, INC. BLUE CROSS & BLUE SHIELD OF MARYLAND, INC. BLUE CROSS & BLUE SHIELD OF MEMPHIS BLUE CROSS & BLUE SHIELD OF MICHIGAN BLUE CROSS & BLUE SHIELD OF MICHIGAN BLUE CROSS & BLUE SHIELD OF MINNESOTA BLUE CROSS & BLUE SHIELD OF MISSISSIPPI INC BLUE CROSS & BLUE SHIELD OF MISSOURI BLUE CROSS & BLUE SHIELD OF NEBRASKA BLUE CROSS & BLUE SHIELD OF NEW JERSEY, INC. BLUE CROSS & BLUE SHIELD OF NEW JERSEY, INC. BLUE CROSS & BLUE SHIELD OF NORTH CAROLINA BLUE CROSS & BLUE SHIELD OF NORTH CAROLINA BLUE CROSS & BLUE SHIELD OF NORTH DAKOTA 1133 SOUTHWEST TOPEKA BLVD. P O BOX 419169 9901 LINN STATION ROAD P O BOX 98029 2 GANNETT DRIVE P O BOX 9836 PO BOX 14115 85 NORTH DANNY THOMAS BLVD P.O. BOX 49 P.O. BOX 312500 P O BOX 64338 P O BOX 1043 1831 CHESTNUT STREET P O BOX 3248, MAIN P.O. STATION P O BOX 1219 P O BOX 1311 P O BOX 2100 P O BOX 35 4510 13TH AVE. SW TOPEKA KANSAS CITY LOUISVILLE BATON ROUGE SOUTH PORTLAND BALTIMORE LEXINGTON MEMPHIS DETROIT DETROIT ST PAUL JACKSON ST LOUIS OMAHA NEWARK MINNEAPOLIS WINSTON SALEM DURHAM FARGO KS MO KY LA ME MD KY TN MI MI MN MS MO NE NJ MN NC NC ND 66629 641416169 40223 708989029 041066911 21204 40512 38103 48231 48231 55164 39215 63103 681800001 07101 55440 271022100 27702 581210001 7852914180 8008926048 5024232011 5042915370 2077751550 8005244555 8005244555 9015293111 8888268152 8004820898 8003822000 6019323800 3149234444 4023901820 8006241110 8003552583 9194897431 8002144844 8003682312 8008674446 8004330088 8772542363 8007764672 THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA FOR GEORGIA STATE EMPLOYEES USE CARRIER 419 GEORGIA STATE HEALTH BENEFIT PLAN USE CARRIER X01 AKA ALLIANCE BLUE CROSS BLUE SHIELD AKA HORIZON BCBS OF NEW JERSEY AKA HORIZON BCBS OF NEW JERSEY CARRIER CODE CARRIER NUM CC CROSSWALK X2T X1F X0P X0PDN X1W X2H 90296 90256 90241 90241 90273 90284 BLUE CROSS & BLUE SHIELD OF OKLAHOMA BLUE CROSS & BLUE SHIELD OF RHODE ISLAND BLUE CROSS & BLUE SHIELD OF TENNESSEE BLUE CROSS & BLUE SHIELD OF TENNESSEE BLUE CROSS & BLUE SHIELD OF UTAH BLUE CROSS & BLUE SHIELD OF UTICA-WATERTOWN, INC. P O BOX 3283 500 EXCHANGE STREET 1 CAMERON HILL CIRCLE 1 CAMERON HILL CIRCLE SUITE 0002 P O BOX 30270 12 RHOADS DRIVE, UTICA BUSINESS DISTRICT X2S 90295 BLUE CROSS & BLUE SHIELD OF VERMONT PO BOX 2365 X0F X2O X1J X0H X1D X0ODN 90231 90291 90260 90233 90254 91332 BLUE CROSS & BLUE SHIELD OF VIRGINIA BLUE CROSS & BLUE SHIELD OF WEST VIRGINIA INC BLUE CROSS & BLUE SHIELD OF WESTERN NEW YORK, INC. BLUE CROSS & BLUE SHIELD UNITED OF WISCONSIN BLUE CROSS /BLUE SHIELD OF NATIONAL CAPITAL AREA BLUE CROSS AND BLUE SHIELD OF ALABAMA X0O 90240 X0D CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE CARRIER ZIP CARRIER PHONE NO OK RI TN TN UT NY 74102 02903 374020002 374020002 841300270 13501 9185603535 4018317300 8004689736 8005659140 8013332100 3157984238 VT 54072365 8022472583 P O BOX 27401 P O BOX 1353 P O BOX 80 P O BOX 2025 550 12TH STREET SW P.O. BOX 830389 TULSA PROVIDENCE CHATTANOOGA CHATTANOOGA SALT LAKE CITY UTICA SOUTH BURLINGTON RICHMOND CHARLESTON BUFFALO MILWAUKEE WASHINGTON BIRMINGHAM VA WV NY WI DC AL 23279 25325 142400080 53201 20024 352830389 8009916061 3043477709 8008880757 4142246100 2024798000 8005176425 BLUE CROSS AND BLUE SHIELD OF ALABAMA P O BOX 2294 BIRMINGHAM AL 35201 8005176425 90229 BLUE CROSS AND BLUE SHIELD OF FLORIDA P O BOX 1798 JACKSONVILLE FL 322310014 8007272227 401 90600 BLUE CROSS AND BLUE SHIELD OF SC P.O.BOX 100300 COLUMBIA SC 29202 8037883860 401DN 90600 BLUE CROSS AND BLUE SHIELD OF SC 4101 PERCIVAL ROAD COLUMBIA SC 29219 8037883860 X0N X0NDN X2F 453 X2Y X1A X1FDN X0W D67 X0A 90239 91328 90282 90642 91307 90253 91371 90248 91316 90226 BLUE CROSS AND BLUE SHIELD OF TEXAS BLUE CROSS AND BLUE SHIELD OF TEXAS BLUE CROSS AND BLUE SHIELD OF THE ROCHESTER AREA BLUE CROSS ANTHEM MEDICARE ADVANTAGE BLUE CROSS BLUE SHIELD OF MONTANA BLUE CROSS BLUE SHIELD OF NEW MEXICO BLUE CROSS BLUE SHIELD OF RHODE ISLAND BLUE CROSS OF CALIFORNIA BLUE CROSS OF FLORIDA HEALTH OPTIONS BLUE CROSS OF GEORGIA/COLUMBUS INC P O BOX 660044 P.O. BOX 660247 P.O. BOX 22999 2100 CORPORATE CENTER P.O. BOX 5004 P.O. BOX 27630 PO BOX 69427 P.O. BOX 60007 P.O.BOX 1798 P O BOX 9907 DALLAS DALLAS ROCHESTER NEWBURY PARK GREAT FALLS ALBUQUERQUE HARRISBURG LOS ANGELES JACKSONVILLE COLUMBUS TX TX NY CA MT NM PA CA FL GA 752660044 75266 14692 913201431 59403 87125 171069427 90060 32231 319089907 8004510287 8004947218 7163253630 8006762583 4067914000 8007113795 8008312400 8006776669 8773522583 8004412273 X0ARX 90226 BLUE CROSS OF GEORGIA/COLUMBUS INC P O BOX 9907 COLUMBUS GA 319089907 8004412273 X2V X0TDN X0T X0M XOV X2L X1X X1E X2M X1YDN X1Y X0V D41 390 337 404 190 739 702 C22 854 D58 294 E89 852 E30 90298 90245 90245 90238 90225 90288 90274 90255 90289 90275 90275 90247 91244 90589 90538 90603 90393 90902 90865 90167 91009 91298 90496 91368 91121 91354 BLUE CROSS OF IDAHO HEALTH SERVICE, INC. BLUE CROSS OF ILLINOIS BLUE CROSS OF ILLINOIS BLUE CROSS OF MASSACHUSETTS INC BLUE CROSS OF NORTHEASTERN NEW YORK INC BLUE CROSS OF NORTHEASTERN PENNSYLVANIA BLUE CROSS OF OHIO BLUE CROSS OF PUERTO RICO BLUE CROSS OF WASHINGTON AND ALASKA BLUE SHEILD OF CALIFORNIA BLUE SHIELD OF CALIFORNIA BLUE SHIELD OF NORTHEASTERN NEW YORK BLUEGRASS FAMILY HEALTH BOARD OF PENSIONS EVANGELICAL LUTHERAN CHURCH BOARD OF PENSIONS OF THE PRESBYTERIAN CHURCH OF BOB JONES UNIVERSITY BOILERMAKERS NATIONAL HEALTH & WELFARE FUND BOLLINGER INC BOON CHAPMAN BENEFIT ADMINISTRATORS BOSTON MUTUAL LIFE INSURANCE COMPANY BOYD CARE (BOYD BROTHERS TRANSPORTATION) BRAVO HEALTH MEDICARE ADVANTAGE BRIDGESTONE/FIRESTONE COMPANIES BROADREACH MEDICAL RESOURCES BUILDERS MUTUAL INSURANCE CO BUSINESS ADMINISTRATORS AND CONSULTANTS, INC. P O BOX 7408 P O BOX 23059 P O BOX 805107 P.O. BOX 986020 P O BOX 15013 PO BOX 890179 P O BOX 956 P.O. BOX 366068 P O BOX 91059 P.O. BOX 272590 P O BOX 272540 P.O. BOX 15013 P.O. BOX 22738 P O BOX 59093 P.O. BOX 13896 1700 WADE HAMPTON BLVD. 754 MINNESOTA AVENUE, SUITE 522 P.O. BOX 727 P.O. BOX 9201 120 ROYALL STREET P.O. BOX 70 P.O, BOX 4433 P.O. BOX 26605 1350 BROADWAY #410 P.O. BOX 150006 PO BOX 107 BOISE BELLEVILLE CHICAGO BOSTON ALBANY CAMP HILL TOLEDO SAN JUAN SEATTLE CHICO CHICO ALBANY LEXINGTON MINNEAPOLIS PHILADELPHIA GREENVILLE KANSAS CITY SHORT HILLS AUSTIN CANTON CLAYTON BALTIMORE AKRON NEW YORK RALEIGH REYNOLDSBURG ID IL IL MA NY PA OH PR WA CA CA NY KY MN PA SC KS NJ TX MA AL MD OH NY NC OH 83707 62223 60680 022986020 12212 170890179 43696 009366068 981119159 959272590 95927 12212 40522 554590093 19101 29614 661012762 07078 787669201 02021 36016 21223 44319 10018 276240006 43068 2083447411 8668260914 8006348644 8002535210 5184385500 8008298599 8003621279 8097599898 8007221471 8887024171 8882351765 5184534600 8007872680 6123337651 8007737752 8643701800 9133426555 8662670092 8002529653 6178287000 3347751284 8005561570 8002378447 8887182375 8008094861 8005212654 CARRIER COMMENT DO NOT USE FOR MEDICARE.THIS CODE IS ONLY USED FOR HEALTH RELATED COVERAGE. DO NOT USE FOR MEDICARE.THIS CODE IS ONLY USED FOR HEALTH RELATED COVERAGE. ST. ADDRESS 4101 PERVICAL RD. COLA 29219 THIS CODE USED ONLY FOR DENTAL CLAIMS WHERE BCBS IS THE INSURANCE CARRIER TO VERIFY DENTAL COVERAGE CALL 1-800-724-1675 MEDICARE ADVANTAGE PLAN DENTAL ONLY MEDICARE ADVANTAGE PLAN POLICIES SHOULD BE ADDED WITH XOB. BCBS OF OF GA. DO NOT USE FOR MEDICARE.THIS CODE IS ONLY USED FOR HEALTH RELATED COVERAGE. CODE ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN CARRIER CODE CARRIER NUM CC CROSSWALK 304 262 658 973 832 998 X2K 274 966 166 128 D42 764 B92 151 471 280 903 B04 D21 945 A71 498 445 445DN 723 E12 559 623 C77 336 CAS 366 572 90506 90464 90822 91093 90990 91118 90287 90476 91086 90370 90332 91272 90927 91149 90355 90660 90482 91154 90081 91264 91075 91184 90687 90634 91361 90886 91299 90745 90801 91213 90537 90148 90566 91294 BUTLER BENEFIT SERVICE, INC. CAIC (CONTINENTAL AMERICAN INS. CO) CALHOUN COUNTY CAMBRIDGE INTERGRATED SERVICES GROUP INC. CAMERON AND ASSOCIATES CANADA LIFE ASSURANCE CO. CAPITAL BLUE CROSS CAPITAL DISTRICT PHYSICIANS PLAN CAPITOL ADMINISTRATORS OF THE SOUTHEAST CAPITOL AMERICAN LIFE INSURANCE COMPANY CAPITOL LIFE INSURANCE COMPANY CARE IMPROVEMENT PLUS CARE LINK HEALTH PLAN CARE SOURCE CARELINK CAREMARK CAREMARK PRESCRIPTION SERVICES CAREPLUS HEALTH PLAN CARITEN HEALTHCARE CARITEN SENIOR HEALTH CAROLINA ATLANTIC MEDICAL SERVICES ORGANIZATION CAROLINA BEHAVIORAL HEALTH ALLIANCE CAROLINA BENEFIT ADMINISTRATORS CAROLINA CARE PLAN/MEDICAL MUTUAL INS. CO. OF OHIO CAROLINA CARE PLAN/MEDICAL MUTUAL INS.CO. CAROLINA CONTINENTAL INSURANCE CAROLINA CRESCENT CAROLINA HOSPITAL SYSTEMS BENEFIT PLAN CAROLINA MEDICARE PRIME HMO CARPENTERS HOSPITALIZATION PLAN CASEBP (CATSKILL AREA SCHOOLS EMPLOYEE PLAN CASUALTY CASE CATALYST RX CATAMARAN P.O. BOX 3310 P.O. BOX 6080226 P.O. BOX 1687 6100 LAKE FOREST DRIVE 6201 POWERS FERRY RD. STE. 100 P O BOX 211457 P.O. BOX 66602 P.O. BOX 188061 P.O. BOX 94953 P.O. BXO 1200 P.O. BOX 4347 P.O. BOX 7373 ONE SOUTH MAIN P.O. BOX 7373 P.O. BOX 52195 P O BOX 52188 P.O. BOX 31286 P O BOX 22987 P.O. BOX 22885 P O BOX 22528 P.O. BOX 571137 P.O. BOX 3257 P.O. BOX 6018 PO BOX 6018 POST OFFICE BOX 427 1201 MAIN ST. STE 970 P.O. BOX 100569 201 EXECUTIVE CENTER DRIVE 3611 CHESTER AVE P O BOX 968022 P.O. BOX 968022 P.O. BOX 968022 DAVENPORT MISSION VIEJO GRAND RAPIDS ATLANTA ATLANTA EAGAN ALBANY CHATTANOOGA CLEVELAND DENVER SCRANTON LONDON DAYTON LONDON PHOENIX PHOENIX TAMPA KNOXVILLE KNOXVILLE CHARLESTON WINSTON SALEM SPARTANBURG CLEVELAND CLEVELAND COLUMBIA COLUMBIA FLORENCE COLUMBIA CLEVELAND SCHAUMBERG SCHAUMBERG SCHAUMBERG C66 90206 CATERPILLAR, INC. P O BOX 62920 COLORADO SPRINGS CO C04 90154 CBA BLUE P.O. BOX 2365 B11 339 907 X0X 273 C13 507 476DN 476 C84 A54 813 604 659 E66 D66 B71 660 A99 B03 661 91171 91192 91057 90249 90475 90160 90696 90665 90665 90219 91297 90971 90784 90823 91304 91293 90127 90824 90077 90080 90825 CBCA ADMINISTRATORS, INC. CELTIC INDIVIDUAL HEALTH CELTIC LIFE INSURANCE CO. CENTRAL BENEFITS MUTUAL INSURANCE COMPANY CENTRAL BENEFITS USA (CENBEN USA) CENTRAL RESERVE LIFE OF NORTH AMERICA INSURANCE CO CENTRAL STATES HEALTH & LIFE CO. OF OMAHA CENTRAL STATES, SOUTHEAST & SOUTHWEST CENTRAL STATES, SOUTHEAST & SOUTHWEST CENTRAL UNITED & CHRISTIAN MUTUAL LIFE INS. CO. CENTURY HEALTHCARE CENTURY PLANNER CHAMPVA CHARLESTON COUNTY CHCCARE OF SOUTH CAROLINA CHCCARES OF SOUTH CAROLINA CHCS SERVICES, INC. CHEROKEE COUNTY CHEROKEE INSURANCE CHESAPEAKE LIFE INS. CO. CHESTER COUNTY P.O. BOX 1339 P.O. BOX 33839 P O BOX 46337 P O BOX 16526 P.O. BOX 619059 17800 ROYALTON RD. POST OFFICE BOX 34350 P.O. BOX 5116 P.O. BOX 5116 2727 ALLEN PARKWAY P.O. BOX 2256 9201 WATSON RD, SUITE 350 PO BOX 469064 140 STONE RIDGE DR 140 STONE RIDGE DR P.O. BOX 12467 P.O. BOX 853925 P.O. BOX 809025 - CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY SOUTH BURLINGTON MINNEAPOLIS INDIANAPOLIS MADISON COLUMBUS DALLAS STRONGSVILLE OMAHA DEPLAINES DEPLAINES HOUSTON GRAPEVINE ST. LOUIS DENVER COLUMBIA COLUMBIA PENSACOLA RICHARDSON DALLAS - CARRIER STATE IA CA MI GA GA MN NY TN OH CO PA KY OH KY AZ AZ FL TN TN SC NC SC OH OH SC SC SC SC OH IL IL IL CARRIER ZIP CARRIER PHONE NO 528083310 926906080 49501 30328 30348 551213057 122066602 37422 441014953 80201 18505 407427373 45402 40742 850722195 850722196 336313286 37933 37933 29413 271571137 29304 441011018 441011018 29202 29201 295010659 29210 44114 60196 601968022 601968022 8669272200 8887302244 809622920 3094942363 VT 03036 8882229206 MN IN WI OH TX OH NE IL IL TX TX MO CO SC SC FL TX TX - 55440 462030839 53744 43216 85261 441365197 68134 60017 60017 770192115 76099 631261509 80246 29210 29210 325912457 750853925 753809025 - 8008243882 8004777870 8007662525 6144645870 8007725924 8003213997 4023971111 8003235000 8003235000 7135290045 8884441995 8007762453 3033317599 8007669780 8003879919 8003332542 8009622242 8009267526 8886506566 2166966400 8005252115 8666862506 8003482922 8004880134 8003482922 8003030187 8008415550 8008674445 8002840042 8656707790 8008100906 8004757900 8645736937 8003153143 800315 314 8032566265 8032516630 8436613875 8037507473 8004213959 8009626294 8009973784 8778398119 8668022474 8668022474 8888031780 8002010450 8887563534 CARRIER COMMENT USE CARRIER 171 AON PER HOSP. ASSO. 07/02, THIS IS STILL A VALID CARRIER MEDICARE ADVANTAGE PLAN MEDICAID HMO USE CARRIER 471 THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE IN OPEN STATUS BY SCHA MEDICARE ADVANTAGE PLAN DORMANT 8/06 ALSO KNOWN AS SUPERMED DENTAL ONLY ANOTHER PHONE # 800-232-3143 HEALTHY KIDS CONNECTION MEDICARE ADVANTAAGE PLAN THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA FORMERLY HEALTH TRANS CODE ASSIGNED BY SCHA NEIC 30018 MEDICAID HMO THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CARRIER CODE CARRIER NUM CC CROSSWALK 662 992 541 E51 535 B91 511 134RX 90826 91112 90729 91305 90723 91148 90700 90338 CHESTERFIELD COUNTY CHESTERFIELD RESOURCES, INC. CHILDRENS REHAB SERVICES CHOICE BENEFITS CHP DIRECT/SUPERMED CHRISTIAN BROTHERS EMPLOYEE BENEFIT TRUST CIGNA BEHAVIORAL HEALTH CIGNA CONN GENERAL LIFE INSURANCE P.O. BOX 1884 P.O. BOX 4217 3801 OLD GREENWOOD ROAD P.O. BOX 94648 1205 WINDHAM PARKWAY PO BOX 188022 P.O. BOX 42005 AKRON SPATANBURG FT. SMITH CLEVELAND ROMEOVILLE CHATTANOOGA PHOENIX OH SC AR OH IL TN AZ 44309 293054217 75278 441014648 60446 37422 850802005 8003210935 8645962227 8004516907 8007731445 8008070400 8003364091 8002510670 134DN 90338 CIGNA CONN GENERAL LIFE INSURANCE P.O. BOX 188037 CHATTANOOGA TN 37422 8002446224 134 90338 CIGNA CONN GENERAL LIFE INSURANCE P.O. BOX 182223 CHATTANOOGA TN 374227223 8008824462 136 999 452 D57 718 646 407 177 A63 839 D56 574 114 A41 219 A73 536 536DN 663 259 887 A51 C14 664 132 A06 175 133 609 974 457 986 B36 D18 911 287 X1S 416 433 B65 548 C56 A39 A58 853 882 412 90340 91119 90641 90224 90881 91124 90606 90381 91173 90997 91291 90759 90318 90040 90422 91130 90724 90724 90827 90461 91041 90048 90161 90828 90336 90005 90379 90337 90787 91094 90646 91106 91175 91262 91176 90489 90269 90615 90622 90123 90735 90198 90038 90053 91008 91036 90611 CIGNA FLEXCARE CIGNA HEALTHCARE OF SC/HEALTHSOURCE SC CIGNA INTERNATIONAL EXPATRIATE BENEFITS CIGNA MEDICARE ACCESS CIGNA PHARMACY SERVICES CIGNA-MEDICARE CINERGY HEALTH INS. CINERGY HEALTH PREFERRED PLAN CITIZENS INSURANCE CITIZENS SECURITY LIFE INS. CITRUS HEALTH CARE, INC. CITY OF AMARILLO GROUP HEALTH CLAIMEDIX INC. CLAIMS MANAGEMENT SERVICES CLAIMS PRO CLAIMS TECHNOLOGY, INC. CLAIMSWARE MANAGEMED CLAIMSWARE MANAGEMED CLARENDON COUNTY CNA HEALTHCARE PARTNERS CNIC HEALTH SOLUTIONS COAL MINE WORKERS COMP PROGRAM COASTAL LUMBER CO COLLETON COUNTY COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY COLONIAL PENN FRANKLIN LIFE INSURANCE COMPANY COLUMBIA UNIVERSAL LIFE INSURANCE CO. COMBINED INSURANCE COMPANY OF AMERICA COMM FOR BLIND COMMERCE BENEFIT GROUP COMMERCIAL TRAVELERS COMMON WEALTH BENEFIT ADMINISTRATORS COMMONWEALTH INDEMITY PLAN COMMUNITY CARE SENIOR HEALTH PLAN COMMUNITY HEALTH PARTNERS COMMUNITY HEALTH PLAN COMMUNITY MUTUAL INSURANCE COMPANY COMPANION BENEFIT ALTERNATIVES COMPANION LIFE COMPASS ROSE HEALTH PLAN COMPBENEFITS INSURANCE CO. COMPDENT COMPLETE BENEFITS SOLUTIONS COMPREHENSIVE BENEFITS COMPSYCH CORP. CONNECTICARE CONNECTICARE P.O. BOX 30575 P.O. BOX 190024 P O BOX 15050 P.O. BOX 22174 PO BOX 188053 P.O. BOX 671 1844 N. NOB HILL RD. #623 144 N BEVERWYCK RD #332 P.O. BOX 1627 P.O. BOX 436149 P.O. BOX 20547 P.O. BOX 15130 P.O. BOX 140067 PO BOX 10888 P.O. BOX 577 100 COURT AVE. SUITE 306 P.O. BOX 6125 P.O. BOX 6125 P. O. BOX 34197 P.O. BOX 3559 P.O. BOX 8300 P O BOX 1576 POST OFFICE BOX 1365 1818 MARKET STREET POST OFFICE BOX 200225 PO BOX 6700 CHARLOTTE CHARLESTON WILMINGTON TEMPE CHATTANOOGA NASHVILLE PLANTATION LAKE HIAWATHA ANDERSON LOUISVILLE TAMPA AMARILLO KANSAS CITY GREENBAY SOUTHFIELD DES MOINES GREENVILLE GREENVILLE LITTLE ROCK ENGLEWOOD LONDON WALTERBORO COLUMBIA PHILADELPHIA AUSTIN SCRANTON NC SC DE AZ TN TN FL NJ SC KY FL TX MO WI MI IA SC SC AK CO KY SC SC PA TX PA 282303211 294199024 19850 852852174 374228053 37202 33322 080341997 29622 402536149 33622 79105 64114 54307 48075 50309 29606 29606 72203 80155 407428300 29488 29202 191811250 787200225 18505 P.O. BOX 900 70 GENESSE ST 115 HANOVER STREET P.O. BOX 9016 P. O. BOX 3249 P.O. BOX 5787 P.O. BOX 14467 1351 WILLIAM HOWARD TAFT ROAD P.O. BOX 100185 P.O. BOX 100102 P.O. BOX 141501 P.O. BOX 804483 1930 BISHOP LANE SUIT 132 6071 CARMEL RD. STE 305 P.O. BOX 8955 P.O. BOX 8379 P.O. BOX 4000 P.O. BOX 546 ELYRIA UTICA ASHLAND ANDOVER TULSA SPARTANBURG CINCINNATI CINCINNATI COLUMBIA COLUMBIA NASHVILLE CHICAGO LOUISVILLE CHARLOTTE MELVILLE CHICAGO FARMINGTON FARRINGTON OH NY VA MA OK SC OH OH SC SC TN IL KY NC NY IL CT CT 44036 13502 23005 01810 741013249 29304 45250 45206 29202 29202 37214 606804106 40218 28226 11747 60680 06034 06034 CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE CARRIER ZIP CARRIER PHONE NO 8007203150 8004412668 8005779410 8006225579 6152445600 8008471148 8008471148 8643340090 5022442420 8667691157 8063784235 8009224262 8004727130 8008379600 8002458813 8642348200 8642348200 8005083772 8004267453 8663358319 8435382876 8037987000 8005234000 5123453200 8002254500 8002239941 8007563702 8005261677 8004429033 8006428065 8889628437 8888008717 5132821016 8008681032 8037880500 8775311159 8005940977 8006331262 8662702316 8008283605 8775955282 8772248230 8002517722 CARRIER COMMENT CODE ASSIGNED BY SCHA USE CARRIER CODE 718 DO NOT USE FOR MEDICARE.THIS CODE IS ONLY USED FOR HEALTH RELATED COVERAGE DO NOT USE FOR MEDICARE.THIS CODE IS ONLY USED FOR HEALTH RELATED COVERAGE CODE ASSIGNED BY SCHA BOUGHT BY CIGNA HEALTHCARE CC 134 MEDICARE ADVANTAGE PLAN MEDICARE INTERMEDIARY CODE IN OPEN STATUS BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN CODE IN OPEN STATUS BY SCHA CODE ASSIGNED BY SCHA RX CARRIER ONLY THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE IN OPEN STATUS BY SCHA THIS CARRIER PART OF CONSECO INSURANCE GROUP CODE ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE IN OPEN STATUS BY SCHA THIS CARRIER ASSIGNED BY SCHA NOT REQUESTED OR USED BY DHHS. CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CARRIER CODE CARRIER NUM CC CROSSWALK 331 525 C16 970 802 A04 154 C31 592 C39 895 A07 830 192 928 483 551 211 843 138 552DN 552 571 364 857 857DN A98 831 780 213 91178 90714 90163 91090 90963 90003 90358 90176 90776 90183 91049 90006 90988 90395 91179 90672 90738 90414 91001 90342 90739 90739 90757 90564 91012 91012 90076 90989 90943 90416 CONSECO HEALTH INS. CO CONSECO MEDICAL INSURANCE CO. CONSOLIDATED BENEFITS, INC CONSOLIDATED WORKERS ASSOCIATION (CWA) CONSTITUTION LIFE INSURANCE CO CONSULTEC PRESCRIPTION BENEFITS MANAGEMENT CONSUMER DRIVEN BENEFITS ASSO. CONSUMER HEALTH SOLUTIONS CONTEC CONTINENTAL GENERAL INSURANCE COMPANY CONTINENTAL LIFE INS. OF TENNESSEE CONTINENTAL LIFE INSURANCE CO. OF SOUTH CAROLINA CONTRACTORS EMPLOYEE BENEFIT ADM. (CEBA) CONVENTRY HEALTHCARE OF NEBRASKA, INC. COOK INSURANCE COOPERATIVE BENEFITS ADMINISTRATORS COOPERATIVE MANAGED CARE SERVICES LLC COORDINATED BENEFIT PLANS INC. CORE MANAGEMENT RESOURCES GROUP CORESOURCE CORESOURCE INC CORESOURCE INC CORESOURCE, INC. CORESTAR CORPORATE BENEFIT SERVICES INC CORPORATE BENEFIT SERVICES INC CORPORATE BENEFIT SERVICES OF AMERICA INC CORPORATE BENEFIT SOLUTIONS, INC. CORPORATE SYSTEMS ADMINISTRATION INC COVENANT ADMINISTRATORS P.O. BOX 66904 P.O. BOX 1205 P O BOX 23686 P.O. BOX 2647 P.O. BOX 130 9040 ROSWELL ROAD SUITE 700 P.O. BOX 6080-228 P.O. BOX 3492 525 LOCUS GROVE RD P.O. BOX 247007 P.O. BOX 1188 POST OFFICE BOX 6138 P.O. BOX 559017 P O BOX 7705 P.O. BOX 1029 POST OFFICE BOX 6249 P O BOX 502530 P O BOX 853925 P.O. BOX 840 P.O. BOX 2920 6100 FAIRVIEW ROAD PO BOX 2920 P.O. BOX 8215 P.O. BOX 1195 P.O. BOX 981800 P.O. BOX 12954 P.O. BOX 738 P.O. BOX 8215 P O BOX 4985 P.O. BOX 105738 CHICAGO ROCKFORD COLUMBIA CHINO HILLS PENSACOLA ATLANTA MISSION VIEIO SPARTANBURG SPARTANBURG OMAHA BRENTWOOD COLUMBIA AUSTIN LONDON BLOOMINGTON LINCOLN INDIANAPOLIS RICHARDSON MACON CLINTON CHARLOTTE CLINTON LITTLE ROCK MINNEAPOLIS EL PASO CHARLOTTE HOPKINS LITTLE ROCK JOHNSON CITY ATLANTA IL IL SC CA FL GA CA SC SC NE TN SC TX KY IN NE IN TX GA IA NC IA AR MN TX NC MN AR TN GA 606660904 61105 29224 91709 325910130 303501853 926906080 29304 29303 681247007 37024 29260 78755 40742 47402 68506 46250 750853925 31202 527332920 28210 52733 722218215 55440 79998 28220 55343 72221 376024985 30348 8005412254 8009470319 8037365088 8009195514 8007896364 8003654944 8884114208 8645739541 8645038333 4023973200 8002644000 8037824947 8002477724 8002883343 8005932080 4024839250 8668734516 8007531000 8887412673 8775433935 8003275462 8003275462 8886049397 8004446965 7043730447 7043730447 8007654224 8886049397 8002752847 7702396230 480 90669 COVENTRY HEALTH CARE OF THE CAROLINAS P.O. BOX 7715 LONDON KY 40742 8008891947 191 482 443 B22 246 879 245 632 155 169 420 E93 194 665 D74 A65 436 B09 B70 834 500 370DN 370 879DN C68 901 858 90394 90671 90632 91138 90448 91033 90447 90810 90359 90373 90619 91369 90397 90829 91323 91198 90625 90085 90126 90992 90689 90570 90570 91339 90208 91055 91195 COVENTRY HEALTHCARE OF DELAWARE, INC. COVENTRY HEALTHCARE OF GEORGIA COVENTRY HEALTHCARE OF KANSAS COVENTRY HEALTHCARE OF VIRGINIA COVENTRY HEATLH CARE RX COVENTRY OF THE CAROLINAS COVENTRY OF THE CAROLINA'S CRIME VICTIMS CROSSAMERICA HEALTH PLAN CROWN CORK & SEAL COMPANY, INC. CUNA MUTUAL INSURANCE GROUP CUSTOM DESIGN BENEFITS DAKOTACARE DARLINGTON COUNTY DART MANAGEMENT CORP DATARX DAVIS-GARVIN AGENCY DEARBORN NATIONAL DECARE DENTAL DEFINITY HEALTH DELTA DENTAL DELTAHEALTH SYSTEMS DELTAHEALTH SYSTEMS DENEX DENTAL DENTAL BENEFIT PROVIDERS DENTAL CARE PLUS DENTAQUEST P O BOX 7713 P.O. BOX 7711 P O BOX 7109 P.O. BOX 7704 P.O.BOX 8400 P O BOX 7102 P.O. BOX 7102 P.O. BOX 5778 930 BEAUMONT AVENUE POST OFFICE BOX 391 5589 CHEVIOT ROAD PO BOX 7406 P.O.BOX 318 5920 ODELLE ST #1 FERNANDINA COURT P.O. BOX 23060 P.O. BOX 1348 P.O. BOX 9525 PO BOX 1809 P.O. BOX 702500 P.O. BOX 9554 111 ROCKVILLE PIKE SUITE 700 P.O. BOX 389 100 CROWNE POINT PLACE P.O. BOX 2136 LONDON LONDON LONDON LONDON LONDON LONDON LONDON PARSIPPANY SPARTANBURG MADISON CINCINNATI SIOUX FALLS MASON CUMMINGS COLUMBIA BELLEVILLE MINNEAPOLIS AMHERST ALPHARETTA WEST VALLEY SALT LAKE ROCKVILLE ROCKVILLE CINCINNATI COLUMBIA KY KY KY KY KY KY KY NJ SC WI OH SD MI GA SC IL MN NY GA UT UT MD MD OH SC 40742 40742 39026 40742 40742 40742 40742 ----07054 29303 53701 45247 571177406 488540318 30040 29212 62223 55440 14226 30023 84170 84109 20850 20848 45241 29202 8008337423 8667321017 8667858077 8006274872 8009476824 8662083610 8009357284 CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE CARRIER ZIP CARRIER PHONE NO 8663027332 8645856456 6082385851 8005982929 8003255598 8002480457 8778231273 8037320060 8003484512 8003716561 8663334648 8005212651 8774740605 8774740605 8666904908 8004459090 8003679466 8003076553 CARRIER COMMENT USE CODE 282 WASHINGTON NATIONAL CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA THE CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE IN OPEN STATUS BY SCHA CODE IN OPEN STATUS BY SCHA COVENTRY HEALTH CARE IS PARENT CO. OF SOUTHERN HEALTH AND WELLPATH CODE ASSIGNED BY SCHA FORMALLY WELLPATH CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE ASSIGNED BY SCHA BROUGHT OUT BY UNITED HEALTCARE CARRIER 113 WAS P5 HEALTH PLUS SOLUCTIONS DENEX DENTAL IS A PLAN UNDER WELLPATH SELECT/COVENTRY NAIC 52040 MEDICAID DENTAL CLAIMS PROCESSOR CARRIER CODE CARRIER NUM CC CROSSWALK 621 179 450 955 611 610 629 627 628 613 612 625 626 615 630 725 554 666 707 516 258 474 667 849 567 B63 A14 668 137 C80 D25 B24 X0EDN X0E D64 C43 A90 499 869 506 446 345DN 345 761 317 CO9 D79 743 550 A97 247 130 C24 824 509 510 C94DN C94 180 90799 90382 90639 91270 90789 90788 90807 90805 90806 90791 90790 90803 90804 90793 90808 90888 90741 90830 90870 90705 90460 90663 90831 91006 90753 90121 90013 90832 90341 90215 91218 90092 90230 90230 91314 90186 90071 90688 91023 90695 90635 90545 90545 90924 90519 90150 91334 90906 90737 91180 90449 90334 90169 90982 90698 90699 91231 91231 90383 CARRIER TPL NAME DEPT CORRECTIONS DESERET MUTUAL BENEFIT ADMINISTRATOR DESERET SECURE DESIGN SAVERS PLAN DHEC C. CHILDREN DHEC CANCER DHEC FAMILY PLANNING DHEC HEART DHEC HEMOPHILIA DHEC HIGH RISK MATERNITY DHEC LOW RISK MATERNITY DHEC MIGRANT HEALTH DHEC SICKLE CELL DHEC STERILIZATION DHEC TB DIALYSIS CLINIC, INC. DIAMOND G EMPLOYEE BENEFIT TRUST DILLON COUNTY DILLON YARN MEDICAL BENEFITS DIRECT REIMBURSEMENT BENEFIT PLANS DIVERSIFIED ADMINISTRATION CORPORATION DIVERSIFIED PHARMACUETICAL DORCHESTER COUNTY E.O.S. HEALTH EASTERN BENEFIT SYSTEMS EASTERN LIFE AND HEALTH INSURANCE EB RX EDGEFIELD COUNTY EDUCATORS MUTUAL LIFE INSURANCE COMPANY ELDER HEALTH (MHN/HMC) ELDER PLAN, INC. (HMO) EMBLEM HEALTH CARE CO. EMPIRE BCBS DENTAL EMPIRE BLUE CROSS AND BLUE SHIELD EMPIRE HEALTHCHOICE ASSURANCE, INC. EMPLOYEE BENEFIT ADMINISTRATORS EMPLOYEE BENEFIT CLAIMS INC EMPLOYEE BENEFIT CONSULTANTS EMPLOYEE BENEFIT MANAGEMENT SERVICES EMPLOYEE BENEFIT PLAN ADMINISTRATORS EMPLOYEE BENEFIT SERVICES EMPLOYEE BENEFIT SERVICES INC EMPLOYEE BENEFIT SERVICES INC EMPLOYEE BENEFIT STRATEGIES EMPLOYEE BENEFITS MANAGEMENT CORPORATION EMPLOYEE BENEFITS TRUST EMPLOYEE HEALTH INSURANCE MANAGEMENT (EHIM) EMPLOYEE PLANS, INC. EMPLOYEE SECURITY, INC EMPLOYER PLAN SERVICES, INC. EMPLOYERS DIRECT HEALTH EMPLOYERS LIFE INSURANCE COMPANY ENCOMPASS HEALTH MANAGMENT SYSTEM ENVISION RX OPTIONS EQUITABLE LIFE AND CASUALTY EQUITABLE PLAN SERVICES ERIN GROUP ADMINISTRATORS ERIN GROUP ADMINISTRATORS ESIS CARRIER ADDRESS LINE CARRIER STATE CARRIER CITY CARRIER ZIP P O BOX 45530 P.O. BOX 45530 2814 SPRING RD. STE. 122 SALT LAKE CITY SALT LAKE CITY ATLANTA UT UT GA 84145 841450530 30339 - - - ------------- 203 FREEMONT AVENUE P O BOX 1298 1019 TITAN RD 1111 ALDERMAN DR SUITE 420 P.O. BOX 299 P.O. BOX 169052 P.O. BOX 27088 200 FREEWAY DR. E. P.O. BOX 10188 2045 MIDWAY DR POST OFFICE BOX 3149 P.O. BOX 4433 P.O. BOX 199100 P.O. BOX 3000 P.O. BOX 791 P.O. BOX 1407 CHURCH ST. STATION P.O.BOX 100300 CLAIMS PROCESSING P O BOX 5150 9501 WEST DEVON P.O. BOX 928 P.O. BOX 21367 PO BOX 2000 POST OFFICE BOX 9888 P.O. BOX 1929 P.O. BOX 1929 229 EAST MICHIGAN AVE. STE. 235 4789 RINGS ROAD P.O. BOX 1431 26711 NORTHWESTERN HWY STE 400 P.O. BOX 2362 7125 THOMAS EDISON DR SUITE 105 2180 NORTH LOOP WEST, STE. 400 5050 SPRING VALLEY ROAD P.O. BOX 6305 6000 WEST TOWN PARKWAY STE 350 2181 EAST AURORA RD STE 201 PO BOX 2460 P.O. BOX 720460 P.O. BOX 7777 P.O. BOX 7777 P O BOX 31122 SPARTANBURG GREENVILLE DILLON ALPHARETTA MARLBOROUGH DELUTH TEMPE EAST ORANGE LANCASTER TWINSBURG LANCASTER BALTIMORE BROOKLYN NEW YORK MINNEAPOLIS NEW YORK COLUMBIA GREENVILLE ROSEMONT FINDLAY BILLINGS EXETER SAVANNAH FORT MILL FORT MILL KALAMAZOO DUBLIN WICHITA FALLS SOUTHFIELD FT WAYNE COLUMBIA HOUSTON DALLAS SPARTANBURG DES MOINES TWINSBURG SALT LAKE CITY OKLAHOMA LANCASTER LANCASTER TAMPA SC TN SC GA CT MN AZ NJ PA OH PA MD NY NY MN NY SC SC IL OH MT NH GA SC SC MI OH TX MI IN MD TX TX SC IA OH UT OK PA PA FL ----29303 37744 29536 30202 06447 55816 85285 07018 17605 44087 17601 21223 11219 10116 554400791 10008 29204 29606 60018 45839 59104 03833 314120088 29716 29716 49007 43017 76307 48033 468012362 21046 77018 752443909 29304 50266 44087 84110 73172 17604 17604 33631 CARRIER PHONE NO 8007773622 8772200110 8006165709 CARRIER COMMENT MEDICARE ADVANTAGE PLAN CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA 8645852046 4236396145 8437747353 7706645594 8883222524 8002338065 USE CODE 333 EXPRESS SCRIPTS 8884568417 8005240227 8002330307 8008007153 7173972751 8887768851 7189218818 2125014444 8007228879 8003429816 8037888562 8642356474 3126963660 8005587798 8007773575 8002587298 8035778051 8002421510 8002421510 8003257477 8005520455 8177617611 8003113446 2606257500 8006381134 8004476588 8008729934 8889628437 8005113389 8003614542 8003525150 8007492631 8004333746 8004333746 8008847975 THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE MEDICARE ADVANTAGE PLAN USE CODE 345 EMPLOYEE BENEFIT SERVICES CODE ASSIGNED WITH LETTER O INSTEAD OF NUMERIC ZERO. THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CARRIER WAS FIRST INTERGRATED HEALTH CARRIER WAS COASTAL STATE LIFE INS. CO. ANOTHER PHONE NUMBER 717-581-1300 ANOTHER PHONE NUMBER 717-581-1300 CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CARRIER CODE CARRIER NUM CC CROSSWALK 461 90650 EVERCARE P.O. BOX 31350 SALT LAKE CITY C18 90165 EVOLUTIONS HEALTHCARE SYSTEMS P.O. BOX 5001 NEW PORT RICHEY, FL D20 333 A35 669 B49 A16 402 A50 441 290 769 738 205 941 A36 467 288 348 354 A74 775 B90 789 803 946 245RX 456 249 351 139 352 670 C75 719 913 B20 B05 A94 C02 870 393 B79 765 C83 587 842 842DN D54 864 442 845 C97 232 728 799 997 91311 90534 90034 90833 91140 90015 90601 91181 90630 90492 90932 90901 90408 91182 90035 90656 90490 90548 90554 91131 90938 90142 90951 90964 91076 90447 90645 90451 90551 90343 90552 90834 91212 90882 91061 90089 91183 91174 90152 91024 90592 90135 90928 90218 90771 91000 91000 91312 91018 90631 91002 91210 90434 90891 90960 91117 EXCELLUS MEDICARE BLUE CHOICE OPTIMUM EXPRESS SCRIPTS FABRI-KAL CORPORATION FAIRFIELD COUNTY FALLON COMMUNITY HEALTH PLAN FCE BENEFIT ADMINISTRATOR FEDERAL EMPLOYEE PLAN BLUE CROSS FEDERAL EMPLOYEES COMPENSATION ACT FEDERAL MOGUL HEALTHCARE FEDERATED MUTUAL INSURANCE COMPANY (REGIONAL) FEDEX FREIGHTWAYS FHA-TPA DIVISION FIDELITY LIFE SECURITY FIDELITY SECURITY LIFE INSURANCE CO FIELDCREST CANNON (CANNON MILLS) FIRSERV HEALTH FIRST ADMINISTRATORS, INC. FIRST AGENCY, INC. FIRST BENEFITS CORP FIRST CAROLINA CARE, INC. FIRST CHOICE BENEFITS MANAGEMENT FIRST CHOICE VIP CARE FIRST COMMUNITY HEALTH PLAN, INC. FIRST CONTINENTAL LIFE INSURANCE FIRST HEALTH FIRST HEALTH FIRST HEALTH (A COVENTRY HEALTH CARE CO) FIRST HEALTH WORKERS COMP ONLY FISERV FISERV HEALTH FISERV HEALTH-COLORADO FLORENCE COUNTY FLORIDA 1ST SERVICE ADMINISTRATORS, INC. FLORIDA HEALTH ALLIANCE FLORIDA HOSPITAL HEALTHCARE SYSTEM FMH BENEFIT SERVICES, INC. FOCUS HEALTHCARE MANAGEMENT, INC. FORETHOUGHT LIFE INSURANCE COMPANY FOUNDATION BENEFITS ADMINISTRATORS FOUNDATION HEALTH FOUNTAINHEAD ADMINISTRATORS, INC. FOX-EVERETT INC. FREEDOM HEALTH FREEDOM LIFE INSURANCE CO. OF AMERICA FUTURE SCRIPTS GARDNER AND WHITE INC GARDNER AND WHITE INC GATEWAY HEALTH PLAN MEDICARE ASSURED GE GROUP ADMINISTRATORS GE LIFE & ANNUITY ASSURANCE CO. GEISINGER HEALTH PLAN GOLD GEM GROUP GENERAL ADJUSTMENT BUREAU GENERAL PRESCRIPTION PROGRAMS INC GENWORTH FINANCIAL GENWORTH FINANCIAL P.O. BOX 41915 P.O. BOX 2902 POST OFFICE DRAWER C P.O. BOX 15121 4615 WALZEM ROAD STE 300 I-20 AT ALPINE ROAD P.O. BOX 8300 P O BOX 1999 P.O. BOS 31716 P O BOX 840 POST OFFICE BOX 327810 3130 BROADWAY 419 E MAIN ST P O BOX 5000 P O BOX 182173 P O BOX 9900 5071 WEST H AVE P.O. BOX 879 P.O. BOX 381686 P O BOX 658 P O BOX 307 PO BOX 382947 POST OFFICE BOX 1911 P.O. BOX 1377 P.O. BOX 23070 PO BOX 21680 P.O. BOX 23070 P.O. BOX 8077 P. O. BOX 30541 P.O. BOX 720 P.O. BOX 3607 P.O. BOX 10269 P.O. BOX 536847 P.O. BOX 25946 720 COOL SPRINGS BLVD P.O. BOX 981721 6300 BRIDGEPOINT PKWAY, BLDG 3 #400 P.O. BOX 453219 P O BOX 13188 P.O. BOX 6012 P.O. BOX 151348 P O BOX 1468 P.O. BOX 419019 POST OFFICE BOX 40619 POST OFFICE BOX 40619 P.O.BOX 11560 P.O. BOX 150809 P.O. BOX 6700 P.O. BOX 8200 1200 THREE GATEWAY CENTER P.O. BOX 81808 305 MADISON AVE STE 1166B P.O. BOX 8021 P O BOX 10821 ROCHESTER CLINTON PIEDMONT WORCHESTER SAN ANTONIO COLUMBIA LONDON DETROIT TAMPA HARRISON FT LAUDERDALE KANSAS CITY MIDDLETOWN EDEN COLUMBUS SIOUX CITY KALAMAZOO ANDERSON BIRMINGHAM BELOIT LINTHICUM BIRMINGHAM CARMEL THOMASVILLE TUCSON EAGAN TUCSON WAUSAU SALT LAKE CITY PUEBLO WINTER HAVEN JACKSONVILLE ORLANDO OVERLAND PARK FRANKLIN EL PASO AUSTIN SUNRISE BIRMINGHAM RIDGELAND TAMPA ARLINGTON KANSAS CITY INDIANAPOLIS INDIANAPOLIS ALBANY ARLINGTON LYNCHBURG DANVILLE PITTSBURGH ALTANTA NEW YORK SAN RAFAEL CLEARWATER CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE UT NY IA SC MA TX SC KY MI FL AR FL MO NY NC OH IA MI IN AL WI MD AL IN GA AZ MN AZ WI UT CO FL FL FL KS TN TX TX FL AL MI FL TX MO IN IN NY TX VA PA PA GA NY CA FL CARRIER ZIP CARRIER PHONE NO CARRIER COMMENT 841310350 8888668298 MEDICARE ADVANTAGE PLAN 34656 8008814474 THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA 14604 527332902 29773 01615 782181610 29260 407428300 48235 336313716 72602 333329711 641112406 10940 272895000 432182173 51102 490098501 46015 35238 535120658 210900307 35238 46032 31799 85734 551210680 85735 544028077 841300541 810020720 338853067 322470269 328536847 66225 37067 79998 78730 33345 35202 39158 33684 76004 64141 462400619 462400619 122110655 76015 24505 178218200 15222 30366 10165 949129974 33757 8778839577 8004516245 8642991720 MEDICARE ADVANTAGE PLAN 8008685200 8008999355 8037883860 8663358319 8005220041 8134968100 8008744723 8037988698 8006488624 8008267531 8002223693 8008482664 8002060827 2693816630 8008113298 8003035770 8005750418 8007347826 8005381235 8668478235 8005544954 8664775465 8005544954 8666848090 8008269781 8004468182 8002263155 9043548335 8007414810 8009909058 6157784000 8774925870 8883687910 8004415501 8009919155 8774766327 8004012740 8669734647 8886787012 3172579131 3172579131 8006855209 8882558961 8002530856 8004989731 8002428923 4044579555 8003412234 8008764582 8778259337 CODE IN OPEN STATUS BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE IN OPEN STATUS BY SCHA THE CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA USE CODE 139 THIS CODE ASSIGNED BY SCHA 8/28/07 CODE ASSIGNED BY SCHA THIS IS A MEDICARE ADVANTAGE PLAN. CODE IN OPEN STATUS BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA WAS WAUSAU INS. CO. CODE NOT REQUESTED BY MEDICAID. SCHA ASSIGNED THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN CODE ASSIGNED BY SCHA WAS G E FINANCIAL SERVICES CODE IN OPEN STATUS BY SCHA CARRIER CODE CARRIER NUM CC CROSSWALK 671 730 419 365 749 905 B88 183 459 A44 144 145 931 379 302 302DN B31 313 308 308DN 121 672 673 B99 181 745 343 906 508 889 889DN 389 A83 D46 727 236 362 283 418 237DN 237 176 674 A96 547 146 162 90835 90893 90618 90565 90912 91169 90141 90386 90648 90043 90348 90349 91068 90579 90504 91346 90097 91165 90510 90510 90325 90836 90837 91164 90384 90908 90543 91056 90697 91043 91043 90588 90064 91282 90890 90438 90562 90485 90617 90404 90439 90380 90838 90075 90734 90350 90366 GEORGETOWN COUNTY GEORGIA HEALTHCARE PARTNERSHIP GEORGIA STATE HEALTH BENEFIT PLAN GERBER CHILDRENS WEAR, INC. GERBER LIFE INSURANCE COMPANY GERBER LIFE MEDICARE SUPPLEMENT GETTYSBURG HEALTH ADMINISTRATORS GILSBAR INSURANCE COMPANY GLASS MOTORS & PLASTIC (GMPA) GLOBAL MEDICAL MANAGEMENT, INC GLOBE LIFE & ACCIDENT INSURANCE GMP EMPLOYERS RETIREE TRUST GOOD SAMARITAN PROGRAM GOODYEAR TIRE & RUBBER COMPANY GOVERNMENT EMPLOYEE HOSP. ASSN (GEHA) GOVERNMENT EMPLOYEE HOSP. ASSOC. (GEHA) GREAT AMERICAN LIFE INS. CO (GALIC) GREAT WEST HEALTHCARE GREAT WEST LIFE GREAT WEST LIFE GREATER HEALTHCARE GREENVILLE COUNTY GREENWOOD COUNTY GROUP & PENSION ADMINISTRATORS, INC. GROUP ADMINISTRATORS,LTD. GROUP BENEFIT SERVICES GROUP BENEFITS ADMINISTRATORS GROUP HEALTH ADMINISTRATOR INC GROUP HEALTH INC. /EMBLEM HEALTH COMPANY GROUP INSURANCE ADMINISTRATION INC GROUP INSURANCE ADMINISTRATION INC GROUP LINK GROUP RESOURCES INC GROUPHEALTH OPTIONS, INC GUARANTEE MUTUAL LIFE CO. GUARANTEE TRUST LIFE INSURANCE GUARDIAN HEALTHCARE GUARDIAN HEALTHCARE GUARDIAN INSURANCE COMPANY GUARDIAN LIFE INSURANCE CO. OF AMERICA GUARDIAN LIFE INSURANCE COMPANY OF AMERICA GUIDESTAR HEALTH SYSTEMS HAMPTON COUNTY HAMRICKS INC HARRINGTON HEALTH HARTFORD INSURANCE GROUP HARVARD PILGRIM HEALTHCARE P.O. BOX 16388 POST OFFICE BOX 38151 P.O. BOX 2126 P.O. BOX 2088 P.O. BOX 2271 P.O. BOX 1169 P O BOX 2947 5245 BIG PINE WAY, SE 33907 7901 SW 36TH ST. STE 100 204 N. ROBINSON 5245 BIG PINE WAY SE 5151 WEST HWY 40 P.O. BOX 677 DEPT. 609 POST OFFICE BOX 4665 PO BOX 2336 P.O. BOX 559002 1000 GREAT WEST DR PO BOX 188061 P.O.BOX 188037 P.O. BOX 3400 P.O. BOX 749075 450 E. REMINGTON RD. 1312 BELLONE AVENUE 70 GRAND AVENUE P O BOX 6244 PO BOX 3000 3350 PEACHTREE RD NE SUITE 1040 3350 PEACHTREE RD NE SUITE 1040 P.O. BOX 20593 P.O. BOX 100043 P.O. BOX 34585 8801 INDIAN HILLS DRIVE 1275 MILWAUKEE AVENUE P.O. BOX 4197 P.O. BOX 4197 P O BOX 8007 P.O. BOX 2459 P O BOX 8019 P.O. BOX 35238 742 PEACHOID ROAD P.O. BOX 30544 P O BOX 25600 P.O.BOX 656653 SAVANNAH ATLANTA GREENVILLE GRAND RAPIDS OMAHA FREDERICK COVINGTON FORT MYERS DAVIE OKLAHOMA CITY FORT MYERS BEACHGROVE AKRON INDEPENDENCE INDEPENDENCE AUSTIN KENNETT CHATTANOOGA CHATTANOOGA MONROE DALLAS SCHAUMBURG LUTHERVILLE RIVEREDGE CHARLOTTE NEW YORK ATLANTA ATLANTA INDIANAPOLIS DULUTH SEATTLE OMAHA GLENVIEW SCRANTON SCRANTON APPLETON SPOKANE APPLETON BIRMINGHAM GAFFNEY SALT LAKE CITY CHARLOTTE SAN ANTONIO A84 90065 HCC LIFE INSURANCE COMPANY PO BOX 2005 FARMINGTON HILLS MI 48333 8664004102 201 201DN 837 B87 823 264 B25 B84 713 748 90404 90404 90995 91147 90981 90466 90093 90138 90876 90911 HCH ADMINISTRATORS HCH ADMINISTRATORS HEALTH ADMINISTRATION SERVICES HEALTH ALLIANCE HEALTH ALLIANCE PLAN HEALTH AMERICA HEALTH AND WELFARE FUND LOCAL 218 HEALTH CARE CORPORATION HEALTH CARE CREDIT UNION ASSOC. HCCUA HEALTH CARE SAVINGS, INC. P.O. BOX 1986 P.O. BOX 1986 P.O. BOX 6724208 P.O. BOX 6003 PO BOX 02459 P.O. BOX 7089 POST OFFICE BOX 115027 203 JANDERS ROAD P.O. BOX 260957 4530 PARK RD PEORIA PEORIA HOUSTON URBANA DETROIT LONDON ATLANTA CARY PLANT CHARLOTTE 61656 61656 77267 616036003 48202 40742 30310 60013 750260957 28209 8003221516 8003221516 8008655440 8003227451 8004224641 8007888445 4047555665 CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE GA GA SC MI NE MD LA FL FL OK FL IN OH MO MO TX MO TN TN NC TX IL MD NJ NC NY GA GA IN GA WA NE IL PA PA WI WA WI AL SC UT NC TX IL IL TX IL MI KY GA IL TX NC CARRIER ZIP 314163088 30334 29602 49501 68103 21702 70434 33907 33328 73102 33907 46140 44309 640514665 64051 787553010 63857 374228061 37422 28110 75374 60173 21093 07661 282071018 101163000 30326 30326 46220 300969343 98124 68114 18505 77010 549128007 99210 54913 35238 29340 841300544 28212 82655 CARRIER PHONE NO 8005666710 8006266402 8649875200 8002533074 8776565425 8004974474 8002342643 8139366242 9543706404 9725406542 9419366242 3178942000 2167966531 8162575500 CARRIER COMMENT THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA DENTAL COVERAGE 8008802745 8006638081 8006638081 8776314227 7042258887 8662063224 8475191880 8006386085 2013433003 8002225790 2125014444 8006210683 8006210683 8003597408 7706238383 8887674670 8004624660 8476990600 8668501253 8668501256 8006854542 8005417846 8008734542 8005956949 8644877505 8777370769 7045366230 8004213550 8663736366 - GREAT WEST/CIGNA MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN CODE ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE IN OPEN STATUS BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CARRIER CODE CARRIER NUM CC CROSSWALK 203 562 A75 B75 960 286 B27 884 874 447 281 220 B01 B01DN C09 382 349 357 126 332 324 225 A79 90406 90748 91132 90131 91267 90488 90095 91038 91028 90636 90483 90423 90078 91333 91158 91199 90549 90557 90330 90533 90526 90428 90060 HEALTH CARE SUPPORT/PRIVATE HEALTH CARE SYSTEM HEALTH CLAIMS SERVICES,INC. HEALTH COST SOLUTIONS HEALTH DESIGN PLUS HEALTH EOS HEALTH EXCHANGE (TPA FOR CERNER HEALTH) HEALTH FIRST (PPO) HEALTH FIRST HEALTH PLANS HEALTH NET HEALTH NET HEALTH NETWORK AMERICA/TRIVERIS HEALTH NEW ENGLAND HEALTH PARTNERS HEALTH PARTNERS DENTAL HEALTH PLAN ADMINISTRATORS HEALTH PLAN OF NEVADA HEALTH PLAN SELECT HEALTH PLAN SERVICES HEALTH PLAN SERVICES (COVENTRY HEALTH CARE) HEALTH PLANS INC. HEALTH REIMBURSEMENT MANAGMENT PARTNERSHIP HEALTH SERVICES FOUNDATION HEALTH SPECIAL RISK 29 COLUMBIA HEIGHTS P.O. BOX 9615 P.O. BOX 1439 P.O. BOX 2584 P.O. BX 6090 PO BOX 165750 P O BOX 17709 P.O. BOX 565001 P.O. BOX 14700 P.O. BOX 14700 P.O. BOX 307 ONE MONARCH PLACE,STE 1500 P.O. BOX 1289 P.O. BOX 1172 P.O. BOX 2638 P.O. BOX 15645 P.O. BOX 382767 POST OFFICE BOX 30298 P.O. BOX 24146 P.O. BOX 5199 5 HUTCHINSON DR P O BOX 2109 4001 N. JOSEY LANE BROOKLYN DEERFIELD BEACH HENDERSONVILLE HUDSON DER PERE KANSAS CITY GREENVILLE ROCKLEDGE LEXINGTON LEXINGTON EATONTOWN SPRINGFIELD MINNEAPOLIS MINNEAPOLIS ROCKFORD LAS VEGAS BIRMINGHAM TAMPA SEATTLE WESTBOROUGH DANVERS LIVERMORE CARROLLTON A27 90026 HEALTHCARE SUPPORT 25 COLUMBIA HEIGHTS 758 814 E61 524 D19 639 387DN 387 577 753 440 A67 767 553DN 553 305 C32DN 920 876 519 D81 242 848 732 117 X1R D45 A78 B15 502 B81 A13 A68 984 90921 90972 91360 90713 91263 91247 91347 90586 90762 90916 90629 91172 90930 90740 90740 90507 90177 91161 91030 90708 91336 90444 91005 90895 90321 90268 91281 90059 91134 90691 91151 90012 90057 91104 HEALTHCHOICE HEALTHCOMP ADMINISTRATORS HEALTHEZ HEALTHFIRST HEALTHFIRST 65 PLUS HEALTHFIRST HMO HEALTHGRAM HEALTHGRAM HEALTHMARKETS CARE ASSURED HEALTHNET HEALTHNET HEALTHSCOPE BENEFITS HEALTHSCOPE BENEFITS HEALTHSCOPE BENEFITS, INC. HEALTHSCOPE BENEFITS, INC.. HEALTHSMART HEALTHSMART HEALTHSMART PREFERRED CARE HEALTHSOURCE OF NC INC HEALTHSOURE ADMINISTRATORS HEARTLAND NATIONAL LIFE INSURANCE CO. HELLER ASSOCIATES HERITAGE HERTZ CLAIM MANAGEMENT HEWITT COLEMAN AND ASSOCIATES HIGHMARK BLUE CROSS BLUE SHIELD HIGHMARK SECURITY BLUE HIGHWAY TO HEALTH (HTH) HILLCREST BENEFIT ADMINISTRATORS HIP HEALTH PLAN HM BENEFITS ADMINISTRATORS, INC. HOLDEN & COMPANY HOLLINGSWORTH SACO LOWELL CORP. HOMELAND HEALTHCARE P.O. BOX 24870 P.O. BOX 45018 PO BOX 398220 P.O. BOX 130217 P.O. BOX 5196 255 ENTERPRISE BLVE. STE. 20 PO BOX 11088 P.O. BOX 11088 P O BOX 69349 P.O. BXO 2226 P.O. BOX 14702 P.O.BOX 99005 P.O. BOX 619055 P.O. BOX 99005 P.O. BOX 99005 PO BOX 3262 PO BOX 3262 P.O. BOX 53010 PO BOX 28087 P.O. BOX 382617 PO BOX 2878 8228 MAYFIELD RD. STE 5B P.O. BOX 1730 P.O BOX 726 P O BOX 6708 P O BOX 890062 120 5TH AVE P.O. BOX 968 P.O. BOX 1516 P.O. BOX 2803 P.O. BOX 535078 PO BOX 10411 P O DRAWER 2327 P.O. BOX 3726 CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE NY FL TN OH WI MO SC FL KY KY NJ MA MN MN IL NV AL FL WA MA MA CA TX CARRIER ZIP CARRIER PHONE NO CARRIER COMMENT 11201 33442 37077 442362584 541156090 64116 29606 329565001 40512 405125225 07724 011441500 554401289 55440 61132 891145615 352382767 3363098124 01581 01923 94551 75007 8005544022 8002223560 8882295020 8008930777 8004355694 8002314015 8642893000 8007167737 8887477823 9004387886 8003371421 8003102835 8889222313 8889222313 8156335800 8007771840 8002936260 8002377767 8008610056 8005327575 8889994767 5104497070 9724926474 BROOKLYN HEIGHTS NY 112012482 8005544022 THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA OKLAHOMA FRESNO MINNEAPOLIS TYLER NEW YORK GREENVILLE CHARLOTTE CHARLOTTE HARRISBURG AUGUSTA LEXINGTON LUBBOCK DALLAS LUBBOCK LUBBOCK CHARLESTON CHARLESTON LUBBOCK RALEIGH BIRMINGHAM SALT LAKE CITY CHESTERLANDE AUBURNDALE PARK RIDGE GREENVILLE CAMPHILL PITTSBURGH HORSHAM MT. DORA NEW YORK PITTSBURGH SAVANNAH GREENVILLE SEATTLE 731270870 93718 55439 75713 10274 29615 28220 28220 17110 309032226 40512 794906831 752619055 79490 79490 25332 25332 794533010 27611 35238 84110 44026 33823 07656 29606 170890062 15222309 19044 32756 101162803 152535078 31412 29602 98124 8004892974 8004427247 8552809638 8004778957 8882601010 8644551100 8004465439 8004465439 8772195460 9009778221 8006417761 8009676831 8006006212 8009676831 8883736102 8668695597 8004354351 8064732500 8008499000 8778939294 8008723860 4405272955 8002822460 2013072177 8642405840 4125447000 8005473627 8883502002 8007439264 8004478255 8002792624 8004043344 8648593211 8004934240 CODE ASSIGNED BY SCHA OK CA MN TX NY SC NC NC PA GA KY TX TX TX TX WV WV TX NC AL UT OH FL NJ SC PA PA PA FL NY PA GA SC WA CODE ASSIGNED BY SCHA WAS LIFECARE CENTERS OF AMERICA CODE ASSIGNED BY SCHA. NOT REQUESTED BY MEDICAID CODE IN OPEN STATUS BY SCHA CODE IN OPEN STATUS BY SCHA THIS CODE NOT REQUESTED BY SCHA. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN CODE ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN CODE ASSIGNED BY SCHA CODE IN OPEN STATUS BY SCHA CODE ASSIGNED BY SCHA TPA MEDICARE ADVANTAGE PLAN MEDICAID HMO DENTAL - HEALTHGRAM FORMERLY PRIMARY PHYSICIANS CARE HEALTHGRAM FORMERLY PRIMARY PHYSICIAN CARE CODE ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA FORMALLY WELLS FARGO USE CODE 134 CIGNA HEALTHCARE REQUESTED BY THE SCHA CODE IN OPEN STATUS BY SCHA MEDICARE ADVANTAGE PLAN THIS CODE ASSIGNED BY SCHA. NOT REQUESTED BY MEDICAID MEDICARE ADVANTAGE PLAN DORMANT 8/06 CARRIER CODE CARRIER NUM CC CROSSWALK D36 239 238 675 782 878 C34 836 836DN C59 648 793 216 752 371 91239 90441 90440 90839 90945 91032 90178 90994 91348 90200 91160 90955 90419 90915 90571 HOP/PSERS HEALTH ADMINISTRATION UNIT HORACE MANN LIFE INSURANCE COMPANY HORIZON HEALTHCARE HORRY COUNTY HOUSING BENEFIT PLAN HRM CLAIM MANAGEMENT HTH HIGHWAY TO HELP HUMANA HUMANA HUMANA CHOICE (PPO) HUMANA GOLD CHOICE (PFFS) HUMANA GOLD PLUS HUMANA HEALTH INSURANCE OF FLORIDA HYGEIA CORPORATION ICON BENEFIT ADMINISTRATORS, INC. P.O. BOX 2921 1 HORACE MANN PLAZA P.O. BOX 1028 P O BOX 542077 P.O. BOX 4022 1 RADNOR CORP CTR STE 100 P.O. BOX 14601 PO BOX 14601 P.O .BOX 14605 P.O. BOX 7060 P.O. BOX 14601 P.O. BOX 19080-F 15500 NEW BARN ROAD P.O. BOX 53010 CLINTON SPRINGFIELD WEST TRENTON DALLAS KALAMAZOO RADNOR LEXINGTON LEXINGTON LEXINGTON CAMDEN LEXINGTON JACKSONVILLE MIAMI LAKES LUBBOCK 250 90452 IDEAL SCRIPTS 50 WHITE CAP DRIVE 801 B26 716 A08 X1G D44 892 975 B51 C60 C61 178 863 D02 149 756 726 C41 C41DN B80 735 484 B72 A45 465 809 C26 C54 129 D01 B76 983 101 189 464 473 454 411 A19 958 958DN 757 90962 90094 90879 90007 90257 91280 91046 91095 90112 90201 90202 91191 91017 91214 90353 90919 90889 90184 90184 90136 90898 90673 90128 90044 90654 90968 90171 90196 90333 91203 90132 91103 90304 90392 90653 90662 90643 90610 90018 91081 91081 90920 IMERICA LIFE AND HEALTH INS. CO IMSCO HEALTH PLAN INDECS CORP INDEPENDENCE AMERICAN INS. CO.(IHC HEALTH SOLUTION INDEPENDENCE BLUE CROSS INDEPENDENT HEALTH INDEPENDENT HEALTH INFORMED RX INNOVIANT INSTILL HEALTH SYSTEMS (FFS) INSTILL HEALTH SYSTEMS (PPO) INSURANCE & BENEFIT ADVOCATE, INC. INSURANCE ADMINISTRATION CORP. INSURANCE ADMINISTRATOR OF AMERICA INSURANCE COMPANY OF NORTH AMERICA (INA) INSURANCE MANAGEMENT ADMINISTRATORS (IMA) INSURANCE SERVICE AND BENEFITS INSUREX BENEFITS ADMINISTRATORS, INC. INSUREX BENEFITS ADMINISTRATORS, INC. INTEGRATED BEHAVIORAL HEALTH/IBH INTEGRITAS BENEFIT GROUP INTEGRITY BENEFITS NETWORK INTEGRITY NATIONAL LIFE INS. INTEQ GROUP INTER CARE BENEFIT SYSTEMS INTER VALLEY HEALTH PLAN INTERACTIVE MEDICAL SYSTEMS, INC. INTER-AMERICAS INS. CORP. (OOIDA) INTERGROUP SERVICES CORPORATION INTERLINK HEALTH SERVICES INTERNATIONAL ASSO. BENEFITS INTERNATIONAL BROTHERHOOD OF ELECTRICAL WORKERS INTERNATIONAL CLAIMS SERVICES INTERNATIONAL EDUCATION EXCHANGE SERVICES INTERNATIONAL MEDICAL GROUP INTERNATIONAL MISSION BOARD (IMB) INTERNATIONAL UNION OF OPERATING ENGINEERS INTERPLAN HEALTH GROUP ISLAND GROUP ADMINISTRATION, INC` ITPE-NMU HEALTH AND WELFARE FUND ITPE-NMU HEALTH AND WELFARE FUND J C PENNEY LIFE INSURANCE COMPANY P.O. BOX 3287 P.O. BOX 697 P.O. BOX 668 P O BOX 21456 PO BOX 69352 P.O. BOX 9066 P.O. BOX 9066 P.O. BOX 968022 P.O. BOX 8082 P.O. BOX 7061 P.O. BOX 7061 5838 W BRICK RD SUITE 106 P.O. BOX 39119 P.O. BOX 5082 195 BROADWAY 11TH FLOOR P.O. BOX 71120 3218 HIGHWAY 67 SUITE 218 PO BOX 41779 PO BOX 41779 P.O. BOX 30018 P O BOX 1447 PO BOX 4537 P.O. BOX 32350 5445 LASIERRA DR SUITE 400 P.O. BOX 3559 300 SOUTH PARK PO BOX 6002 P O BOX 19108 P.O. BOX 9510 101 LINDENWOOD DR, STE 150 4950 NE BELNAP CT #205 1747 PENNSYLVANIA AVE NORTH WEST 3901 E. WINSLOW AVE 27092 BURBANK ST P.O. BOX 370 407 N. FULTON STREET P.O. BOX 6767 166 WEST KELLY STREET P.O. BOX 90613 3 TOILSOME LANE POST OFFICE BOX 13817 POST OFFICE BOX 13817 POST OFFICE BOX 869090 CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE IA IL NJ TX MI PA KY KY KY SC KY FL FL TX CARRIER ZIP CARRIER PHONE NO 52733 62715 08628 753542077 490034022 19087 40512 40512 405784602 29020 405124601 32245 33014 794533070 8007737725 2177892500 8007923666 NORTH KINGSTOWN RI 02886 8007176614 ENGLEWOOD BUCKEYSTOWN LYNDHURST EAGON HARRISBURG BUFFALO BUFFALO SCHAUMBURG WAUSAU CAMDEN CAMDEN SOUTH BEND PHOENIX MT. LAUREL NEW YORK BOSSIER CITY MESQUITE MEMPHIS MEMPHIS LAGUNA NIGUEL CORDOVA MARIETTA LOUISVILLE DALLAS ENGLEWOOD POMONA RALEIGH WICHITA MALVERN HILLSBORO WASHINGTON PHOENIX FOOTHILL RANCH ITHACA INDIANAPOLIS RICHMOND METUCHEN ARLINGTON EAST HAMPTON SAVANNAH SAVANNAH PLANO 80155 217170697 07071 55121 171069352 14231 14231 601968022 54402 290207845 290207845 46628 85069 08054 100073100 711719944 75150 381741799 381741799 92607 38088 30061 40232 75231 801553559 917696002 27619 672770510 19355 97124 20006 85040 92610 148510307 46202 232300767 08840 76006 11937 31416 31416 750860909 8882738020 8009442833 8884463327 8664290608 8002752583 8666178585 8002471466 8006453332 8775592955 8774467845 8774467845 8662006700 8008433106 8009896739 2126184000 8007429944 8008783157 9017256435 9017256435 8003951616 9016858980 7704281604 5024261843 8009593953 3037705710 8002518191 9198468400 CO MD NJ MN PA NY NY IL WI SC SC IN AZ NJ NY LA TX TN TN CA TN GA KY TX CO CA NC KS PA OR DC AZ CA NY IN VA NJ TX NY GA GA TX 8009372036 8002530966 8665108780 8005584444 8005584444 8004574708 8775115000 8004574708 8004574708 8005912650 8006589777 CARRIER COMMENT CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN CODE ASSIGNED BY SCHA IMSCO - INTERNATIONAL MANAGEMENT SERVICE CO. THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN WAS NATIONAL MEDICAL HEALTH CARD MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN CODE NOT REQUESTED BY MEDICAID. SCHA ASSIGNED CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA 8005379389 5036402000 8002751171 6022340497 8779167920 8664337462 8006284664 8042191585 9085486662 8660511-47 8009262306 9123527169 9123527169 9728816000 THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CARRIER CODE CARRIER NUM CC CROSSWALK 827 996 335 676 109 514 D09 885 885DN 202 B12 C71 417 A69 104 528 C78 537 C47DN C47 153 153DN 868 E80 C30 677 760 936 893 D71 B66 318 900 711 320 678 679 D04 B59 680 978 D31 681 B62 943 540 243 B02 156 157 408 515 241 D87 B23 323 158 796 A53 90985 91116 90536 90840 90312 90703 91226 91039 91039 90405 91186 91206 90616 91187 90307 90716 90213 90725 90189 90189 90357 90357 91022 91363 90175 90841 90923 91071 91047 91318 90124 90520 91054 90874 90522 90842 90843 91221 90117 90844 91098 91266 90845 90120 91074 90728 90445 90079 90360 90361 90607 90704 90443 91340 90091 90525 90362 91279 91189 CARRIER TPL NAME J. SMITH LANIER J.F. MOLLOY & ASSO. J.P. FARLEY CORP. JASPER COUNTY JEFFERSON PILOT INSURANCE COMPANY JLT SERVICES (TPA FOR NY LIFE) JM FAMILY ENTERPRISES JOHN ALDEN INSURANCE COMPANY JOHN ALDEN INSURANCE COMPANY JOHN HANCOCK INSURANCE COMPANY JOHN HANCOCK LIFE AND HEALTH INSURANCE JOHNS HOPKINS HEALTHCARE JULY PRODUCTS KAISER FOUNDATION HEALTH PLAN OF SOUTHERN CA KAISER FOUNDATION HEALTH PLAN OF SOUTHERN CA. KAISER PERMANENTE KAISER PERMANENTE KAISER PERMANENTE-OHIO REGION KANAWHA BENEFIT SERVICES KANAWHA BENEFIT SERVICES KANAWHA LIFE INSURANCE COMPANY KANAWHA LIFE INSURANCE COMPANY KANSAS CITY LIFE KANSAS INDEPENDENT PHARMACY (KPSC) KEENAN AND COMPANY KERSHAW COUNTY KEY BENEFIT ADMINISTRATORS KEY BENEFITS-TRANSCHOICE PLUS KEYSTON HEALTH PLAN EAST KEYSTONE 65 KIRKE-VAN ORSDEL, INC. KLAIS & COMPANY KOHLER COMPANY LABORERS DISTRICT COUNCIL OF GA AND SC LAMAR LIFE INSURANCE COMPANY LANCASTER COUNTY LAURENS COUNTY LBA HEALTH PLANS, INC./PRIMARY SELECT LDI INTEGRATED PHARMACY SERVICES LEE COUNTY LEGGETT & PLATT LEON MEDICAL CENTER HEALTH PLAN LEXINGTON COUNTY LIBERTY DENTAL LIBERTY MUTUAL LIFE INSURANCE LIBERTY NATIONAL LIFE INSURANCE COMPANY LIFE & CASUALTY INSURANCE COMPANY OF TENNESSEE LIFE INSURANCE CO. OF ALABAMA LIFE INSURANCE COMPANY OF GEORGIA LIFE INSURANCE COMPANY OF VIRGINIA, THE LIFE INVESTORS INSURANCE COMPANY OF AMERICA LIFE OF THE SOUTH INSURANCE COMPANY LIFE REINSURANCE CO. LIFESTYLE HEALTHCARE LINCOLN FINANCIAL GROUP LINCOLN HERITAGE LIFE INSURANCE CO LINCOLN NATIONAL LIFE INSURANCE COMPANY LINECO LONGSHORE & HARBOR WORKERS COMP PROGRAM CARRIER ADDRESS LINE P.O. BOX 72749 P.O. BOX 68947 P.O. BOX 458022 POST OFFICE BOX 26011 P.O. BOX 1511 8019 BAYBERRY RD POST OFFICE BOX 020270 POST OFFICE BOX 020270 P.O. BOX 852 JOHN HANCOCK B5-03 200 BERKELEY STEET 6704 CURTIS COURT 5 GATEWAY CENTER STE 60 P.O. BOX 7004 P.O. BOX 7004 P.O. BOX 190849 P.O. BOX 190849 P.O. BOX 5316-9774 P O BOX 50098 P O BOX 50098 POST OFFICE BOX 6000 POST OFFICE BOX 6000 P.O. BOX 9040 4125 SOUTH WEST GAGE CENTER DR. SUITE 203 P.O. BOX 11431 P .O. BOX 55230 P.O. BOX 3252 P.O. BOX 8339 P.O.BOX 7799 P.O. BOX 9126 1867 WEST MARKET STREET 444 HIGHLAND DRIVE P O BOX 607 POST OFFICE BOX 880 P.O. BOX 17098 701 EMERSON RD. STE. 301 P.O. BOX 7687 P.O. BOX 65-9006 P.O. BOX 26110 5 HUTCHINSON DR POST OFFICE BOX 2612 AMERICAN GENERAL CENTER P.O. BOX 349 POST OFFICE BOX 105006 P O BOX 27601 POST OFFICE BOX 8043 P.O. BOX 45237 P.O. BOX 792070 345 N.RIVERVIEW SUITE 600 P.O. BOX 614008 P.O. BOX 10843 P O BOX 614008 821 PARKVIEW BLVD P.O. BOX 8300 CARRIER CITY NEWNAN INDIANAPOLIS WESTLAKE GREENSBORO LATHAM JACKSONVILLE MIAMI MIAMI BOSTON BOSTON GLEN BURNIE PITTSBURG DOWNEY DOWNEY ALTANTA ATLANTA CLEVELAND KNOXVILLE KNOXVILLE LANCASTER LANCASTER AUSTIN TOPEKA TORRANCE INDIANAPOLIS MILWAUKEE PHILADELPHIA PHILADELPHIA DES MOINES AKRON KOHLER JONESBORO JACKSON OWINGS MILL CREVE COEUR HIGH POINT MIAMI SANTA ANNA DANVERS BIRMINGHAM NASHVILLE GADSDEN ATLANTA RICHMOND LITTLE ROCK JACKSONVILLE SAN ANTONIO WICHITA ORLANDO CLEARWATER ORLANDO LOMBARD LONDON CARRIER STATE GA IN OH NC NY FL FL FL MA MA MD PA CA CA GA GA OH TN TN SC SC TX KS CA IN WI PA PA IA OH WI GA MS MD MO NC FL CA MA AL TN AL GA VA AR FL TX KS FL FL FL IL KY CARRIER ZIP 30271 46268 441468022 27420 12110 32256 33102 33102 02117 02116 21060 15222 902427004 90242 31119 31119 441010316 379500098 379500098 29721 29721 78766 66604 90510 46205 53201 19101 191017799 503069126 443136977 530441515 302370607 39201 211177098 63141 27264 33265 92799 01923 35202 37250 35902 303485006 23230 72203 32232 78279 67203 32861 337578843 32861 601483230 407428300 CARRIER PHONE NO 8882954864 8003313287 4402504300 3366913000 8007933773 8008920059 8003284316 8003284316 8002331449 8003777311 8002612393 8669008322 8003310420 8003903510 8006111811 4042612590 8006348816 8008221274 8008221274 8032862440 8032862440 8008745254 8002793022 8006533626 8003314757 8668676883 8002273116 8002273116 8002472192 3308678443 9204574441 4044771888 6019493100 8008158240 8665163121 8773112150 3055595366 8889020349 8889994767 2053252722 6157491000 8002262371 7709805100 8042816000 5013760426 8006616385 8002291024 8668276607 8004232765 8885868810 8004232765 8003237268 8663358319 CARRIER COMMENT SEE CARRIER 942 PRINCIPAL FINANCIAL GROUP NOT REQUESTED BY MEDCAID. ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. SCHA ASSIGNED THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN CODE ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN USE CODE 759 MEDIPLUS PER SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN CODE IN OPEN STATUS BY SCHA AKA AEGON THIS CODE ASSIGNED BY SCHA NOT A MEDICAID REQUEST FORMERLY MEDOVA HEALTHCARE CODE ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CARRIER CODE CARRIER NUM CC CROSSWALK 367 C85 492 B18 504 396 B16 90567 90220 90681 91137 90693 90595 91135 LOOMIS INSURANCE COMPANY LOYAL AMERICAN LIFE INSURANCE COMPANY LT11-LIFETRAC NETWORK LUMENOS M CARE MACY'S HR SERVICES MAGELLAN RX P O BOX 7011 P O BOX 559004 111100 WAYZATA BLVD P.O. BOX 69309 P.O. BOX 130799 P.O. BOX 850958 11013 WEST BROAD ST SUITE 500 A32 90031 MAGELLEN BEHAVIORAL HEALTH PO BOX 1659 B07 847 327 E23 159 438 860 915 835 A15 932 682 A26 683 268 709DN 405 531 569 226 B32 586 684 90083 91004 90529 91343 90363 90627 91014 91062 90993 90014 91069 90846 90025 90847 90470 90872 90604 90719 90755 90429 91177 90770 90848 MAGNACARE MAHONEY BENEFIT ADMINISTRATORS MAIL HANDLERS BENEFIT PLAN MAINE SENSE MAKSIN MANAGMENT CORP MAMSI LIFE AND HEALTH INSURANCE CO MANAGED HEALTH NETWORK MANAGED HEALTH RESOURCES MANAGED PHARMACY BENEFITS MANAGED PRESCRIPTIONS SERVICES (MPS) MANHATTAN INSURANCE GROUP MARION COUNTY MARKEL SMART STM MARLBORO COUNTY MARQUETTE NATIONAL LIFE INS. CO. MARSH ADVANTAGE AMERICA MARSH(INSURANCE TRUST PLAN-DELTA RETIREES) MARY BLACK HEALTHNETWORK MARYLAND PHYSICIANS CARE MASTER HEALTH PLAN MAXCARE MCA ADMINISTRATORS (MANAGED CARE OF AMERICA) MCCORMICK COUNTY P.O. BOX 1001 P.O. BOX 7260 P O BOX 8402 PO BOX 1959 CN98000 P.O. BOX 993 P.O.BOX 209010 P.O. BOX 30742 1100 NORTH LINDBERGH ONE CITY CENTRE SUITE 1100 P.O. BOX 925309 P.O. BOX 15953 P.O. BOX 130 501 NORTH BROADWAY, SUITE 500 P.O. BOX 10432 1690 SKYLYN DRIVE, SUITE,130 PO BOX 61778 P O BOX 16367 P.O. BOX 16430 MANOR OAK TWO, STE 605 1910 COCHRAN RD - 361 90561 MDI GOVERNMENT HEALTH SERVICES 822 HIGHWAY A1A NORTH STE 310 368 206 206DN 223 B38 798 873 C46 222 152 619 616 C98 295 781 781DN C25 822 539 X0RDN X0R 979 207 B39 X1N 90568 90409 90409 90426 90101 90959 91027 90188 90425 90356 90797 90794 91211 90497 90944 90944 90170 90980 90727 90243 90243 91099 90410 90102 90264 MED BENEFITS SYSTEM MED COST BENEFITS SERVICES MED COST BENEFITS SERVICES MED COST PREFERRED MEDBEN MEDCARE INTERNATIONAL MEDCO HEALTH MEDCO HEALTH SOLUTIONS MEDICA MEDICA MEDICAID, SC MEDICAID-OUT-OF-STATE MEDICAL BENEFIT ADM. OF MARYLAND, INC. MEDICAL BENEFIT ADMINISTRATORS MEDICAL CLAIMS MANAGEMENT CORP MEDICAL CLAIMS MANAGEMENT CORP MEDICAL CLAIMS SERVICES MEDICAL MUTUAL MEDICAL MUTUAL INSURANCE OF OHIO MEDICAL MUTUAL OF OHIO MEDICAL MUTUAL OF OHIO MEDICAL REIMBURSEMENT OF AMERICA MEDICAL SAVINGS HEALTH PLAN MEDICAL SAVINGS INSURANCE CO. MEDICAL SERVICE CORPORATION OF EASTERN WASHINGTON CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE CARRIER ZIP CARRIER PHONE NO PA TX MN PA MI TX VA 196107011 78755 55305 17106 481130779 75085 23060 8007820392 8006336752 MO 63043 8003592422 NY FL KY ME NJ MD TX NC MO MO TX TX FL MO IA SC AZ GA OK PA - 11530 33338 40742 04039 08110 21705 78720 28208 63132 631016922 772925309 79490 32591 63102 503060432 29307 85082 303919123 73113 15220 - 8666246259 8002807093 8004107778 8002908559 8002570625 8002576458 8008352094 7043555200 8006729540 8007596959 8006699030 FL 32082 8008416288 P O BOX 177 P.O. BOX 25307 P.O.BOX 25987 P.O. BOX 25437 P.O. BOX 1009 12480 WEST ATLANTIC BLVD. STE 2 P.O. BOX 8190 P O BOX 2902 P.O. BOX 30990 P.O. BOX 30990 WYOMISSING AUSTIN MINNEAPOLIS HARRISBURG ANN ARBOR RICHARDSON GLEN ALLEN MARYLAND HEIGHTS GARDEN CITY FORT LAUDERDALE LONDON GRAY PENNSAUKEN FREDRICKS AUSTIN CHARLOTTE ST. LOUIS ST LOUIS HOUSTON LUBBOCK PENSACOLA ST LOUIS DES MOINES SPARTANBURG PHOENIX AUGUSTA OKLAHOMA CITY PITTSBURGH PONTE VEDRA BEACH SOUTH BEND WINSTON SALEM WINSTON SALEM WINSTON SALEM NEWARK CORAL SPRINGS MADISON CLINTON SALT LAKE CITY SALT LAKE CITY IN NC NC NC OH FL WI IA UT UT 46601 271145307 27114 27114 43058 33071 537088190 527332902 84107 84130 2192370560 8007951023 8007951023 8008247406 8006868425 954-345-56 8002217006 8002727243 8009523455 8009523455 P.O .BOX 950 5940 SEMINOLE CENTER COURT PO BOX 25307 P O BOX 12995 1 WALL ST. STE 2A P.O.BOX 6018 P O BOX 94648 P.O. BOX 981800 PO BOX 6018 113 SEABOARD LANE 419 E. MAIN ST 5835 WEST 74TH ST P O BOX 3048 FORREST HILL MADISON WINSTON SALEM CHARLOTTE RAVENSWOOD CLEVELAND CLEVELAND EL PASO CLEVELAND FRANKLIN MIDDLETON INDIANAPOLIS SPOKANE MA WI NC NC WV OH OH TX OH TN NY IN WA 60631 53711 271145307 282202995 26164 44101 44101 79998 44101 37067 10940 462781758 99220 8885323467 6082731776 8003340609 8003340609 8882250522 8002582873 8003621279 2166877000 2166877000 6159633826 3173298222 3173298222 5095364900 CARRIER COMMENT CODE ASSIGNED BY SCHA 8774957223 2156578920 8003372363 8006594112 CODE IN OPEN STATUS BY SCHA CODE ASSIGNED BY SCHA THIS CARRIER BOUGHT OUT BY EXPRESS SCRIPTS. CODE ASSIGNED BY SCHA. NOT REQUESTED BY MEDICAID 8002792290 8009348203 8008687526 8773257265 8645733535 8009538854 7068635955 8002597765 4129220780 FORMERLY BENEFIT PLAN SERVICES CODE ASSIGNED BY SCHA CODE IN OPEN STATUS BY SCHA WAS DIVERSIFIED GROUP ADMINISTRATORS CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY THE SCHA USE CARRIER 333 EXPRESS SCRIPTS CODE NOT REQUESTED BY MEDICAID ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THIS CODE IS USED BY SCHA NOT AN ACTIVE MEDICAID CODE THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CARRIER CODE CARRIER NUM CC CROSSWALK D99 D32 618 620 D14 617 995 372 759 E96 B56 746 C96 E41 477 B50 709 833 377 A29 108 916 961 790 988 742 C95 D40 C06 820 545 774 597 227 148 460 D24 733 A12 X2P 993 432 A18 564 954 593 724 636 635 91290 91268 90796 90798 91277 90795 91115 90572 90922 91375 90115 90909 91209 91350 90666 91141 90872 90991 90577 90028 90311 91063 91082 90952 91108 90905 91232 91243 90155 90978 90732 90937 90781 90430 90352 90649 91246 90896 90011 90292 91113 90621 90017 90750 91080 90777 90887 91125 91122 MEDICARE ADVANTAGE MEDICARE COMPLETE (UNITED HEALTH CARE) MEDICARE PART A MEDICARE PART B ONLY MEDICARE PLUS BLUE (BCBS OF MICHIGAN) MEDICARE RAILROAD (PGBA) PROFESSIONAL PART B MEDIMPACT MEDIPLAN MEDIPLUS MEDPARTNERS ADMINISTRATIVE MEDSAVE USA MED-TAC CLAIMS MEDTRACK SERVICES MEDTRAK MEGA LIFE AND HEALTH INSURANCE COMPANY MEMBER HEALTH MERCER ADMINISTRATION MERCY HEALTH PLANS MERITAIN HEALTH MERITAN HEALTH METROPOLITAN LIFE INSURANCE COMPANY MHEALTH MHN (MANAGED HEALTH NETWORK) MHNET BEHAVIORAL HEALTH MID WEST NATIONAL LIFE INS. CO. MIDA DENTAL PLAN MIDWEST SECURITY MINNESOTA POWER HEALTH PLANS MISSIONARY MEDICAL MMSI MAYO MANAGEMENT SERVICES MOLINA HEALTHCARE OF OHIO MOLINA MEDICARE OPTIONS PLUS MONARCH DIRECT MONUMENTAL GENERAL INSURANCE COMPANY MONUMENTAL LIFE INSURANCE COMPANY MORRIS ASSOCIATES MOUNT CARMEL HEALTH PLAN (MCHP) MEDIGOLD (HMO) MOUNTAIN CLAIMS MANAGEMENT MOUNTAIN CLAIMS MANAGEMENT MOUNTAIN STATE BLUE CROSS & BLUE SHIELD, INC. MPI INTERNATIONAL, INC. M-PLAN CARDINAL HEALTH MSH MOBILITY BENEFITS MULTINATIONAL UNDERWRITERS MULTIPLAN MUTUAL ASSURANCE ADMINISTRATORS, INC MUTUAL MEDICAL PLANS MUTUAL OF OMAHA MUTUAL OF OMAHA P.O. BOX 659735 SAN ANTONIO TX 782659735 8778423210 27000 ELEVEN MILE RD P.O. BOX 10066 10680 TREENA ST,STOP 5 502 VALLEY ROAD P.O. BOX 9126 6920 POINT INVERNESS WAY 3035 LAKELAND HILLS BLVD P.O. BOX 9110 7101 COLLEGE BLVD. STE 1000 7101 COLLEGE BLVD., SUITE 1000 PO BOX 981606 P.O. BOX 391180 P.O. BOX 4546 PO BOX 4568 PO BOX 27267 P.O. BOX 80884 P.O. BOX 981282 P.O. BOX 742567 P.O. BOX 27018 P.O. BOX 7802 P.O. BOX 981606 2000 TOWN CENTER, SUITE 2200 2700 MIDWEST DR 30 W SUPERIOR ST P.O. BOX 45730 4001 41ST ST. WEST P.O. BOX 22712 P O BOX 22811 POST OFFICE BOX 9004 1111 N CHARLES STREET POST OFFICE BOX 61 P.O. BOX 50440 P.O. BOX 6111 P.O. BOX 1008 P.O. BOX 1008 P O BOX 1948 P.O. BOX 81913 P.O .BOX 357 P.O. BOX 77 P.O. BXO 863 115 5TH AVE P.O. BOX 42096 P.O. BOX 689 MUTUAL OF OMAHA PLAZA MUTUAL OF OMAHA PLAZA SOUTHFIELD AUGUSTA SAN DIEGO WAYNE DES MOINES FORT WAYNE LAKELAND NEWTON OVERLAND PARK OVERLAND PARK EL PASO CLEVELAND IOWA CITY SPRINGFIELD MINNEAPOLIS INDIANAPOLIS EL PASO HOUSTON LAS VEGAS LONDON EL PASO SOUTHFIELD ONALASKA DULUTH SALT LAKE CITY ROCHESTER LONGBEACH LONG BEACH SPRINGFIELD BALTIMORE DURHAM INDIANAPOLIS WESTERVILLE FRUITLAND FRUITLAND PARKERSBERG ROCHESTER LINTHICUM BEEBE PLAIN INDIANAPOLIS NEW YORK OKLAHOMA CITY PEORIA OMAHA OMAHA MI GA CA NJ IA IN FL MA KS KS TX OH IA MO MN IN TX TX NV KY TX MI WI MN UT NM CA CA MA MD NC IN OH ID ID WV MI MD VT IN NY OK IL NE NE 48034 30999 92131 07410 50309 46804 33805 02160 66210 66210 79998 44139 52244 658084568 554270267 46280 79998 77274 89126 40742 799981610 48075 54650 55802 84145 41154 90801 90801 01101 20201 27702 462500440 43086 83619 83616 26102 483081913 210900357 05823 46206 100031004 73123 61652 68175 68175 8002495103 8772887600 8007882949 9736963111 8002472192 8883129744 8002263155 8003479355 8007714648 8007714648 8005272845 8888685854 8008687526 8006472240 8009252272 8006064841 8006386626 8886425040 8004584642 8007527242 8007331110 8009376432 8002368672 8888128800 8007771647 8006356671 8006424148 8006651328 8006289000 8007529797 8004445431 3175549000 8002403870 2084527979 8669527979 3044247700 2488539010 8006752605 8888421530 8006052282 8005463887 8006489652 8004484689 107 90310 MUTUAL OF OMAHA MUTUAL OF OMAHA PLAZA OMAHA NE 68175 8002289090 C99 C35 937 937DN 291 522 312DN 312 91208 90179 91150 91370 90493 90711 90514 90514 MUTUAL PROTECTIVE MEDICO LIFE INS. CO. MUTUAL PROTECTIVE MEDICO LIFE INSURANCE COMPANIES MVP HEALTH CARE MVP HEALTH CARE NALC HEALTH BENEFIT PLAN NATIONAL AUTOMATIC SPRINKLER INDUSTRY NATIONAL BENEFIT ADMINISTRATORS NATIONAL BENEFIT ADMINISTRATORS 1515 S. 75TH ST 1515 S 75TH STREET PO BOX 2207 PO BOX 763 20547 WAVERLY COURT 800 CORPORATE DRIVE P.O. BOX 690903 P.O. BOX 690903 OMAHA OMAHA SCHENECTADY SCHENECTADY ASHBURN LANDOVER CHARLOTTE CHARLOTTE NE NE NY NY VA MD NC NC 68124 68124 12301 12301 20149 20785 282277016 282277016 8002286080 8002286080 8002295851 8004805640 7037294677 3015771700 8004826736 8004826736 CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE CARRIER ZIP CARRIER PHONE NO 4023427600 CARRIER COMMENT MEDICARE ADVANTAGE PLAN GENERIC CODE MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN AKA TROA WAS NORTH AMERICAN ADMINISTRATORS, INC. CODE ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE ASSIGNED BY SCHA SEE CARRIER CODE 536 CODE NOT REQUESTED BY MEDICAID. SCHA ASSIGNED MEDICARE ADVANTAGE PLAN CODE IN OPEN STATUS BY SCHA CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA MEDICARE INTERMEDIARY PART B MEDICARE INTERMEDIARY PART A DO NOT USE FOR MED ADV. THIS CODE IS ONLY USED FOR HEALTH RELATED COVERAGE. CARRIER WAS PREVIOUSLY C35. SEE CODE C99 NAME CHANGE ONLY 4/09. WAS PERFERRED CARE CARRIER CODE CARRIER NUM CC CROSSWALK C17 C74 C74DN 260 267 444 90164 90211 90211 90462 90469 90633 NATIONAL BENEFITS NATIONAL CLAIMS ADMINISTRATIVE SERVICES NATIONAL CLAIMS ADMINISTRATIVE SERVICES NATIONAL CLAIMS ADMINISTRATIVE SERVICES NATIONAL CLAIMS ADMINISTRATIVE SERVICES NATIONAL DISASTER MEDICAL SYSTEM 110 GIBRALTAR ROAD P O BOX 981610 P O BOX 220887 POST OFFICE BOX 10136 P.O. BOX 220887 HORSHAM EL PASO CHARLOTTE FAIRFAX CHARLOTTE PA TX NC VA NC 19044 799981610 28222 220388022 282220887 2154430404 7043643865 7043643865 8662199292 7043643865 599 90783 NATIONAL ELEVATOR INDUSTRY HEALTH BENEFITS PO BOX 477 NEWTOWN SQUARE PA 190730477 8005234702 A70 91193 NATIONAL EMPLOYEE BENEFIT ADMINISTRATORS 1920 N. FLORIDA MANGO RD WEST PALM BEACH FL 33409 8008225899 263 B53 472 90465 90113 90661 NATIONAL FINANCIAL COMPANY NATIONAL FOUNDATION LIFE INSURANCE COMPANY NATIONAL HEALTH CARE HEALTH BENEFITS PLAN(NHC) 110 WEST 7TH ST. SUITE 300 110 WEST 7TH ST. SUITE 300 POST OFFICE BOX 1398 TX TX TN 76102 76102 371331398 8007251407 8002219039 6158902020 929 91067 NATIONAL HEALTH INSURANCE COMPANY P O BOX 619999 TX 752619999 8002371900 828 495 334 C86 914 414 558 388 163 A52 518 B67 800 141 806 360 859 248 437 520 808 C89 165 D39 685 B54 90986 90684 90535 90221 91325 90613 90744 90587 90367 90049 90707 91144 90961 90345 90966 90560 91013 90450 90626 90709 90967 91220 90369 91242 90849 90114 NATIONAL PHARMACEUTICAL SERVICES NATIONAL PRESCRIPTION ADMINISTRATORS NATIONAL RURAL LETTER CARRIERS ASSOCIATION NATIONAL STATES INSURANCE COMPANY NATIONAL TEACHERS ASSO LIFE INSURANCE CO. NATIONAL TELEPHONE COOP. ASSN. NATIONAL TRAVELERS LIFE INS. CO. NATIONALWAY HEALTHCARE ASSOCIATES NATIONWIDE LIFE INSURANCE COMPANY NATIONWIDE SPECIALITY HEALTH CLAIMS NAT'L ASBESTOS WORKERS MED FUND NAVITUS HEALTH SOLUTIONS LLC NEBCO (TENNECO) NEOA HEALTH BENEFITS FUND NETWORK HEALTH PLAN NEW ENGLAND FINANCIAL NEW ENGLAND GROUP TRUST NEW ENGLAND LIFE INSURANCE NEW ERA LIFE INSURANCE CO NEW JERSERY CARPENTERS NEW MARKET DIMENSION NEW SOURCES BENEFITS NEW YORK LIFE INSURANCE COMPANY NEW YORK WELFARE FUND NEWBERRY COUNTY NGS AMERICAN INC P.O. BOX 407 P.O. BOX 1981 1750 PENNSYLVANIA AVE., NW P O BOX 27321, 1830 CRAIG PARK COURT P.O. BOX 2369 1 WEST PACK SQUARE, SUITE 600 P.O. BOX 9197 P O BOX 682708 POST OFFICE BOX 182202 P.O.BOX 420 PO BOX 188004 P.O. BOX 999 P.O. BOX 97 428 E SCOTT AVENUE - P O BOX 3070 P.O. BOX 568 P.O. BOX 190019 P.O. BOX 30466 25145 COUNTRY CLUB BLVD PO BOX 4884 P.O. BOX 7818 P.O. BOX 1338 P.O. BOX 6305 POST OFFICE BOX 105095 101-49 WOOKHAVEN BLVD PO BOX 2310 FT WORTH FORT WORTH MURFREESBORO DALLAS/FORT WORTH AIRPORT BOYSTOWN EAST HANOVER WASHINGTON ST LOUIS ADDISON ASHEVILLE DES MOINES HOUSTON COLUMBUS SPRINGFIELD CHATTANOOGA APPLETON SCRATNON KNOXVILLE MENASHA N. CHARLESTON TAMPA NORTH OLMSTED HOUSTON EDISON COCKEYVILLE SPARTANBURG ATLANTA OZONE PARK CLEMENS NE NJ DC MO TX NC IA TX OH MA TN WI PA TN WI SC FL OH TX NJ MD SC GA NY MI 68017 079361981 20006 63141 75001 28801 50306 77268 432182202 01101 37422 549120999 185040097 37927 54952 29419 33630 440705300 772104884 088180846 21031 29304 30348 11416 48046 8005465677 8005226727 8006388432 3148780101 8886716771 8282529776 8002325818 8008107856 6142497111 8005174791 8003863632 8662682501 8007177562 9207201300 8004087681 8006541731 8002558063 2813687200 8006243096 8005706745 8004761555 8003884580 7188455800 B97 91155 NIPPON LIFE INSURANCE CO. P.O. BOX 25951 SHAWNEE MISSION KS 662255951 8003741835 174 350 384 C36 359 594 A17 A64 170 686 821 982 591 C37 866 353 90378 90550 90583 90180 90559 90778 90016 90056 90374 90850 90979 91102 90775 90181 91020 90553 NMU PENSION & WELFARE FUND NORTH AMERICA ADMINISTRATORS NORTH AMERICAN BENEFIT NETWORK NORTH AMERICAN INSURANCE COMPANY NORTH CAROLINA MUTUAL LIFE INSURANCE NORWEST FINANCIAL NOVA HEALTHCARE ADMINISTRATORS NTCA (NAT'L TELECOMMUNICATIONS COOPERATIVE ASSO.) OCCIDENTAL LIFE INSURANCE COMPANY OF NC OCONEE COUNTY ODS HEALTH PLAN ADVANTAGE OFFICE OF GROUP BENEFITS STATE OF LOUISIANA OLD AMERICAN INSURANCE COMPANY OLD SURETY LIFE INSURANCE CO OLYMPIC HEALTH MANAGEMENT ONE HEALTH PLAN OF SC 360 WEST 31ST STREET, 3RD FL P O BOX 1984 P O BOX 94928 P O BOX 44160 411 W. CHAPEL HILL STREET 206 EIGHTH STREET 2680 GRAND ISLAND BLVD ONE WEST PACK SQUARE STE 600 PO BOX 10324 P.O. BOX 4030 P.O. BOX 44036 POST OFFICE BOX 418573 P O BOX 54407 P.O.BOX 5348 P.O. BOX 190019 NEW YORK NASHVILLE CLEVELAND MADISON DURHAM DES MOINES GRAND ISLAND ASHEVILLE RALEIGH PORTLAND BATON ROUGE KANSAS CITY OKLAHOMA CITY BELLINGHAM N CHARLESTON 10001 37203 441014928 53744 27701 50309 140720308 288013459 27605 972084030 708044036 64141 731541407 98227 29419 2123374900 6152563561 8003214085 6086621232 9196829201 5152432131 8003333195 8282819000 9198318189 CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE NY TN OH WI NC IA NY NC NC OR LA MO OK WA SC CARRIER ZIP CARRIER PHONE NO CARRIER COMMENT CODE IN OPEN STATUS BY SCHA CODE ASSIGNED BY SCHA BOUGHT OUT BY EXPRESS SCRIPTS CC333 INACTIVE 8/02 THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA USE CARRIER 859 NEW ENGLAND GROUP TRUST CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA 8107797676 8773370650 8002728451 8167534900 8002725466 3607349888 8003149010 CODE ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CARRIER CODE CARRIER NUM CC CROSSWALK 583 850 807 896 891 880 XYZ 687 603 624 696 697 698 215 D26 394 771 784 399 254 D03 747 787 766DN 766 B29 255 976 293 890 172 E24 A21 90767 91007 91289 91050 91045 91034 91308 90851 91227 90802 90860 90861 90862 90418 91228 90593 90934 90946 90598 90456 91215 90910 90949 90929 90929 91200 90457 91096 90495 91044 90376 91342 90020 ONE NATION BENEFIT ADMINISTRATORS ONENET PPO OPTIMA HEALTH PLAN OPTIMED HEALTH PLAN OPTIMUM CHOICE OF THE CAROLINAS INC OPTIMUM HEALTH PARTNERS OPTUM RX ORANGEBURG COUNTY OTHER INDIGENT (HOSPITAL CHARITY) OTHER SPONSOR OUT-OF-STATE GA OUT-OF-STATE NC OUT-OF-STATE OTHER OXFORD LIFE INSURANCE COMPANY OXFORD MEDICARE ADVANTAGE (HMO) P5 HEALTH PLAN SOLUTIONS PACIFIC FIDELITY LIFE INSURANCE CO (P.F.L.) PACIFIC HEALTH ADMINISTRATORS PACIFIC LIFE AND ANNUITY PACIFIC MUTUAL LIFE INSURANCE COMPANY PACIFIC SOURCE PACIFICARE PACIFICARE SENIOR SUPPLEMENT PLAN PALMER & CAY/CARSWELL, INC. PALMER & CAY/CARSWELL, INC. PANAMERICAN BENEFIT SOLUTIONS PAN-AMERICAN LIFE INSURANCE COMPANY PARAGON BENEFITS, INC. PARAMOUNT HEALTH CARE PARTNERS NATIONAL HEALTH PLANS OF NORTH CAROLINA PAUL REVERE LIFE INSURANCE COMPANY PBM PLUS PC HEALTH PLAN ADMINISTRATION P.O. BOX 528 P.O. BOX 934 P O BOX 5028 4 TERRY DRIVE, STE 1 4 TAFT COURT PO BOX 2243 P.O. BOX 29044 - COLUMBUS FREDERICK TROY NEWTOWN ROCKVILLE GREENVILLE HOT SPRINGS - OH MD MI PA MD SC AR SC 43216 217050934 460071199 18940 20850 29602 71093 - P.O. BOX 46518 P.O. BOX 7082 P.O. BOX 9554 P O BOX 982009 P.O. BOX 620123 P.O. BOX 34799 700 NEWPORT CENTER DRIVE P.O. BOX 7068 P.O. BOX 6099 P.O. BOX 6072 POST OFFICE BOX 1286 POST OFFICE BOX 1286 P.O. BOX 981644 POST OFFICE BOX 981644 P.O. BOX 12288 P.O. BOX 497 P O BOX 17368 P.O. BOX 15118 300 TECHNECENTER DRIVE SUITE C P.O BOX 1377 MADISON BRIDGEPORT SALT LAKE CITY N RICHLAND HILLS ORLANDO PHOENIX NEWPORT BEACH EUGENE CYPRESS CYPRESS SAVANNAH SAVANNAH EL PASO EL PASO COLUMBUS TOLEDO WINSTON SALEM WORCESTER MILFORD THOMASVILLE WI CT UT TX FL AZ CA OR CA CA GA GA TX TX GA OH NC MA OH GA 53744 06601 84109 761828009 328620123 85067 92660 97401 90630 906300072 31402 31402 799981644 79998 31917 43697 271167368 016150118 45150 31799 8774693073 8002341228 8774740605 8176566040 8007766070 8007332285 8004512513 8006246052 8663169776 8008513802 9122346621 9122346621 8006949888 8006949888 7062776710 8888912564 8009425695 5087994441 8002632178 8884261937 363 90563 PEARCE ADMINISTRATION P.O. BOX 2437 FLORENCE SC 29503 8886226001 GM SOUTHWEST IS THE CLAIMS PROCESSOR FOR PEARCE ADMINISTRATION 538 805 182 C49DN X0J 173 770 862 708 325 90726 91250 90385 90191 90235 90377 90933 91016 90871 90527 PENN GENERAL SERVICES PENN TREATY NETWORK AMERICA (PTNA) PENN TREATY NETWORK AMERICA INS. CO. PENN WESTERN BENEFITS, INC PENNSYLVANIA BLUE SHIELD PENNSYLVANIA LIFE INSURANCE COMPANY PEOPLES BENEFIT LIFE INSURANCE PERFORMAX PERFORMAX PERSONAL CARE P.O. BOX 72077 P.O. BOX 130 P.O. BOX 7066 P O BOX 2000 P.O. BOX 890089 P.O. BOX 130 P O BOX 484 300 CORPORATE PARKWAY P.O. BOX 61505 P.O. BOX 7141 ATLANTA PENSACOLA ALLENTOWN WINSTON SALEM CAMP HILL PENSACOLA VALLEY FORGE AMHERST KING OF PRUSSIA LONDON GA FL PA NC PA FL PA NY PA KY 303581535 325910130 181057066 27102 17089 325910100 19493 11226 19406 40742 8004441535 8006357418 8003620700 8008465370 8006373493 8002757366 8005237900 8777776076 8885547629 8004311211 CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA 740 90903 PHARMACARE P.O. BOX 52188 PHOENIX AZ 850722196 8002376184 964 314 B47 257 B33 948 555 468 561 533 326 590 91084 90516 90110 90459 90098 91077 90742 90657 90747 90721 90528 90774 PHARMACEUTICAL CARE NETWORK PHARMACY ADVANTAGE NETWORK PHARMACY DATA MANAGEMENT, INC PHARMACY NETWORK NATIONAL OF N.C. PHARMAVAIL DRUG COMPANY PHILADELPHIA AMERICAN LIFE INS. CO. PHILADELPHIA AMERICAN LIFE INSURANCE CO PHOENIX HEALTHCARE PHOENIX MUTUAL LIFE INSURANCE COMPANY PHYSICIANS CARE NETWORK PHYSICIANS HEALTH PLAN OF MID MICHIGAN PHYSICIANS HEALTH SERVICES 9343 TECH CENTER DR. 50 LENNOX POINTE 1170 E WESTERN RESERVE RD 4000 OLD WAKEFOREST RD SUITE 101 3380 TRICKHUM RD. BLDG 400, UNIT 100 P.O. BOX 2465 P.O. BOX 4884 P.O. BOX 150809 ONE AMERICAN ROW P.O. BOX 101111 P.O. BOX 247 P.O. BOX 981 SACRAMENTO ATLANTA POLAND RALEIGH WOODSTOCK HOUSTON HOUSTON ARLINGTON HARTFORD COLUMBIA ALPHARETTA BRIDGEPORT CA GA OH NC GA TX TX TX CT SC GA CT 95826 30324 44514 27609 30188 77252 772104882 76015 06115 292111111 300090247 06601 8007770074 8887275560 8007740890 8003317108 8009333734 8005527879 8005527879 8003976241 8004512513 8883239271 8008329186 8008484747 CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE CARRIER ZIP CARRIER PHONE NO 8008246796 8003423289 8002291199 8004828770 8003438205 8642134992 8007887871 CARRIER COMMENT NAME CHANGE WAS ANTHEM BENEFIT ADMINISTRATORS CODE ASSIGNED BY SCHA FORMERLY PRESCRIPTION SOLUTIONS MEDICARE ADVANTAGE PLAN CODE NOT REQUESTED BY MEDICAID. SCHA ASSIGNED USE CODE 477 MEGA LIFE CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA WAS US NOW INSURANCE GROUP CODE ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDCAID. ASSIGNED BY SCHA AS OF 1/1/08 CO. MERGED WITH CAREMARK (471) ADD NEW POLICIES WITH 471 SEE CARRIER 366 CATALYST RX SEE CARRIER 366 CATALYST RX CODE ASSIGNED BY SCHA THIS CARRIER PURCHASED BY CC864 GE GROUP ADMINISTRATORS CARRIER CODE CARRIER NUM CC CROSSWALK 773 90936 PHYSICIANS MUTUAL INSURANCE COMPANY P.O. 2018 OMAHA NE 681032018 8002289100 228 688 A22 804 434 487 B10 395 B21 792 338 C55 276 886 886DN 706 585 751DN 751RX 751 589 391 385 A66 168 877 A11 486 91249 90852 90021 90965 90623 90676 90086 90594 90090 90954 90539 90197 90478 91040 91040 90869 90769 90914 90914 90914 90773 90590 90584 91374 90372 91031 90010 90675 PHYSICIANS PLUS INS. CO. PICKENS COUNTY PIEDMONT ADMINISTRATORS PIEDMONT COMMUNITY HEALTHCARE INC. PIEDMONT HEALTH ALLIANCE PIEDMONT INS COMPANY PILGRIM HEALTH & LIFE INSURANCE PINNACLE CLAIMS MANAGEMENT INC PIONEER HEALTH PIONEER LIFE INSURANCE COMPANY OF ILLINOIS PITTMAN & ASSOCIATES, INC. PLAN ADMINISTRATORS (MATURE AMERICAN) PLAN HANDLERS PLANNED ADMINISTRATORS INC PLANNED ADMINISTRATORS INC PLUMBERS & PIPEFITTERS LOCAL NO. 421 PLUMBERS & STEAMFITTERS WELFARE FUND POLARIS BENEFIT ADMINISTRATORS POLARIS BENEFIT ADMINISTRATORS POLARIS BENEFIT ADMINISTRATORS POLY AMERICA LP POMCO POSTMASTERS BENEFIT PLAN PRAIRIE STATES ENTERPRISES, INC. PRECISE BENEFIT ADMINISTRATORS PRE-EXISTING CONDITION INSURANCE PLAN (PCIP) PREFERRED ADMINISTRATORS PREFERRED CARE P.O. BOX 909953 PO BOX 25307 P.O. BOX 14408 116 BONHAM CT. P.O. BOX 979 POST OFFICE BOX 897 1630 E SHAW AVE STE 190 P.O. BOX 6600 P O BOX 1250 P.O. BOX 111047 734 15TH STREET NW SUITE 500 930 CANTERBURY PLACE POST OFFICE BOX 6927 POST OFFICE BOX 6927 P.O. BOX 840 1024 MCKINLEY ST P O BOX 1008 P O BOX 1008 P O BOX 2010 2000 W MARSHALL DR P O BOX 6329 1019 N. ROYAL STREET PO BOX 23 P.O. BOX 9064 P.O. BOX 300 15560 NORTH FLW BLVD P O BOX 22920 MILWAUKEE WINSTON-SALEM CINCINNATI ANDERSON MARION ATLANTA FRESNO HOLYOKE ROCKFORD MEMPHIS WASHINGTON ESCONDIDO COLUMBIA COLUMBIA MACON PEEKSILL DELAWARE DELAWARE WESTERVILLE GRAND PRAIRIE SYRACUSE ALEXANDRIA SHEBOYGAN JERICHO INDEPENDENCE SCOTTSDALE ROCHESTER WI PA OH SC SC GA CA MA IL TN DC CA SC SC GA NY OH OH OH TX NY VA WI NY MO AZ NY 53209 271145307 452500408 29621 29571 30303 93710 01041 611051250 38111 20005 92025 29260 29260 312020840 10566 43015430154308675051 13217 22314 530820023 11753 640510300 85260 146922920 8005455015 347 90547 PREFERRED CARE INC (PCI) 1300 VIRGINIA DIRVE SUITE 315 FORT WASHINGTON PA 19034 8002223085 909 909DN 270 303 933 B86 A43 939 C65 397 844 A42 479 942 817 940 B35 578 965 A20 A20DN 316 534 91058 91058 90472 90505 91070 90140 90042 91072 90205 90596 91188 90041 90668 91073 90975 91283 91170 90763 91085 90019 90019 90518 90722 PREFERRED HEALTH ALLIANCE CORP. PREFERRED HEALTH ALLIANCE CORP. PREFERRED HEALTH PLAN OF THE CAROLINAS PREFERRED HEALTH PLAN, INC. PREFERRED HEALTHCARE SYSTEMS PREFERRED ONE ADMINISTRATIVE SERVICES PREMIER BENEFIT MANAGEMENT , INC. PREMIER HEALTH SYSTEMS PRESBYTERIAN HEALTHCARE SERVICES PRIME THERAPEUTIC PRIME TIME HEALTH PLAN PRIMERICA LIFE INSURANCE COMPANY PRIMEXTRA PRINCIPAL FINANCIAL GROUP PRIORITY HEALTH PRIVATE HEALTH CARE SYSTEMS (PHCS) PROCARE RX PBM PROFESSIONAL ADMINISTRATORS, INC. PROFESSIONAL BENEFIT ADMINISTRATORS, INC. (PBA) PROFESSIONAL CLAIMS MANAGEMENT PROFESSIONAL CLAIMS MANAGEMENT PROFESSIONAL INSURANCE CORPORATION PROVANTAGE PRESCRIPTION BENEFIT MANAGEMENT SERVICE P.O. BOX 382048 PO BOX 382048 P.O, BOX 220397 P O BOX 24125 620 HOWARD AVE P.O. BOX 59212 7070-A KAIGHN AVE P.O. BOX 1640 P.O. BOX 27489 P.O. BOX 25136 P.O. BOX 6905 3120 BRECKINRIDGE BOULEVARD P.O. BOX 1088 P.O. BOX 10357 PO BOX 232 P.O. BOX 2914 1267 PROFESSIONAL PARKWAY 3751 MAGUIRE BLVD. STE. 100 P.O. BOX 4687 PO BOX 35276 PO BOX 35276 2610 WYCLIFF RD P.O. BOX 1662 BIRMINGHAM BIRMINGHAM CHARLOTTE LOUISVILLE ALTOONA MINNEAPOLIS PENSAUKEN COLUMBIA ALBUQUERQUE LEHIGH VALLEY CANTON DULUTH TWINSBURG DES MOINES GRAND RAPIDS DES PLAINES GAINSVILLE ORLANDO OAKBROOK CANTON CANTON RALEIGH WAUKEHA 35238 35238 28222 40224 166014899 55459 08109 292021640 87125 18002 44706 30199 44087 503060357 49501 600172914 30507 32814 605223755 443155276 443155276 27607 53187 8007228477 2059691155 8666360239 5023397500 A92 91196 PROVIDENT AMERICAN LIFE & HEALTH INS. P.O. BOX 29158 SHAWNEE MISSION KS 66201915 8007535133 485 381 90674 90581 PROVIDENT HEALTH PLAN PROVIDENT INDEMNITY LIFE INSURANCE COMPANY P.O. BOX 3125 PO BOX 511 PORTLAND NORRISTOWN 972083125 19404 8006283912 8005199175 CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE AL AL NC KY PA MN NJ SC NM PA OH GA OH IA MI IL GA FL IL OH OH NC WI OR PA CARRIER ZIP CARRIER PHONE NO 8008527040 8004007247 8643759661 8434235541 4046592100 8006499121 8004234586 8159875000 8002381344 2023936600 8005385512 8037540041 8037540041 8887412673 9147377220 8002340225 8002340225 8002340225 8007855301 8002344393 7036835585 8008157020 5163906000 8002207898 8772767198 8009993920 CARRIER COMMENT DO NOT USE THIS CODE FOR MEDICARE ADVANTAGE PLANS OFFERED BY THIS CARRIER CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE IN OPEN STATUS BY SCHA CODE ASSIGNED BY SCHA USE CODE 282 WASHINGTON NATIONAL CODE IN OPEN STATUS BY SCHA MEDICARE ADVANTAGE PLAN CODE ASSIGNED BY SCHA 8009971750 8032968999 8003562219 8004231973 8006177446 4043811000 8004334893 8002474695 8004465674 8005317662 8006993542 8007410521 6306553755 8003258424 8003258424 8002891122 2627844600 CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE ASSIGNED BY SCHA 6/18/07 CODE ASSIGNED BY SCHA CARRIER CODE CARRIER NUM CC CROSSWALK 110RX 328 111 251 D28 90314 90530 90315 90453 91234 PROVIDENT/CAREMARK PROVIDER SELECT, INC. PRUDENTIAL INSURANCE COMPANY OF AMERICA PYMARID LIFE INSURANCE CO. PYRAMID LIFE INSURANCE CO (PFFS) P.O. BOX 686005 P.O. BOX 330070 841 PRUDENTIAL DRIVE P.O. BOX 12922 P.O. BOX 958465 SAN ANTONIO FORT WORTH JACKSONVILLE PENSACOLA LAKE MARY 230 90432 PYRAMID LIFE INSURANCE COMPANY P O BOX 772 221 A85 A48 X0KRS X0KRX XOKRX X0K 795 187 197 B19 296 375 A95 689 398 214 546 A30DN A30 218 278 762 406 A09 B89 C44 185 410 690 570 231 489 142 E91 C20 846 435 818 596 D62 D27 D12 865 184 D15 C27 C27DN E81 B48 E37 883 90424 90066 90047 91321 91321 91321 90236 90957 90390 90400 90088 90498 90575 90074 90853 90597 90417 90733 90029 90029 90421 90480 90925 90605 90008 91146 90187 90388 90609 90854 90756 90433 90678 90346 91367 90166 91003 90624 90976 90780 91313 91233 91238 91019 90387 91276 90172 90172 91362 90111 91300 91037 QUAL CARE QUALCHOICE QUALMED OF OREGON REGENCE BCBS OF OREGON REGENCE BCBS OF OREGON REGENCE BCBS OF OREGON RX PLAN REGENCE BLUE CROSS BLUE SHIELD OF OREGON REGIONAL MEDICAL ADMINISTRATORS INC. RELIANCE STANDARD LIFE INS. CO. RELIANCE STANDARD SPECIALTY PRODUCTS ADM RENAISSANCE DENTAL RESERVE NATIONAL INSURANCE RESTAT REYNOLDS & REYNOLDS RICHLAND COUNTY RIGHT CHOICE BENEFITS ADMINISTRATORS RISK BENEFIT MANAGEMENT SERVICES, LLC (RBMS) RISK MANGEMENT SERVICES RMSCO, INC. RMSCO, INC. ROCKY MOUNTAIN HEALTH PLAN (RMHP) ROCKY MOUNTIAN HEALTH PLAN ROYAL NEIGHBORS OF AMERICA RURAL CARRIER BENEFIT PLAN RX AMERICA RXEDO S C MEDICAL ASSOCIATION-MEMBERS INSURANCE TRUST S&S HEALTHCARE STRATEGIES SAFECO INSURANCE COMPANY SALUDA COUNTY SAMBA HEALTH BENEFIT PLAN SAVERS LIFE INSURANCE COMPANY SAVRX SC DEPT OF DISABILITIES AND SPECIAL NEEDS SCOTT AND WHITE HEALTH PLAN SCREEN ACTORS GUILD-PRODUCERS HEALTH PLAN SCRIPT CARE, INC. SEABURY AND SMITH COMPANY, INC. SEAFARERS HEALTH & BENEFIT PLAN (SHBP) SECURE HORIZONS SECURE HORIZONS DIRECT (UNITED HEALTHCARE) SECURE HORIZONS PACIFICARE SECUREHORIZONS DIRECT PFFS SECURIAN DENTAL PLANS SECURITY LIFE INSURANCE CO. OF AMERICA SECURITYCHOICE ENHANCED PLUS SELECT BENEFIT ADMINISTRATORS SELECT BENEFIT ADMINISTRATORS SELECT ADMINISTRATIVE SERVICES (SAS) SELECT HEALTH SELECT HEALTH SELECT HEALTH OF SOUTH CAROLINA INC P.O. BOX 249 P.O. BOX 25610 PO BOX 286 P.O. BOX 12625 MAILSTOP S4P P.O .BOX 12625 MAILSTOP S4P P.O. BOX 12625 MAILSTOP S4P P O BOX 1271 P.O. BOX 4128 P.O. BOX 82510 505 S LENOLA RD, SUITE 231 P O BOX 17250 P.O. BOX 26620 11900 WESTLAKE PARK DRIVE P.O. BOX 1272 12250 WEBER HILL RD. STE 100 P.O. BOX 241569 P.O. BOX 6309 P.O. BOX 678 P.O. BOX 678 P O BOX 4517 P.O. BOX 10600 P.O. BOX 10850 P O BOX 7404 221 N CHARLES LINDBERG DR 7800 DALLAS PARKWAY STE 460 P O BOX 6927 P.O. BOX 46511 P.O. BOX 34699 11301 OLD GEORGETOWN RD 8064 NORTH POINT BLVD SUITE 201 P.O. BOX 8 P.O. BOX 4706 P O BOX 21800 P.O. BOX 7830 6380 FOLSOM DR P.O. BOX 2545 P.O. BOX 380 P.O. BOX 659787 P.O.BOX 31353 P.O. BOX 25032 P.O. BOX 12466 P.O. BOX 9385 POST OFFICE BOX 3199 P O BOX 795180 PO BOX 3245 P.O. BOX 440 PO BOX 3209 P.O. BOX 30192 P.O. BOX 7120 7410 NORTHSIDE DRIVE SUITE 208 CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE TX TX FL FL FL CARRIER ZIP CARRIER PHONE NO 78268 76163 32207 325912922 327958465 8008415550 8667747766 8003463778 8006581413 4076281776 SHAWNEE MISSION KS 66201 8004440321 PISCATHAWAY LITTLE ROCK CLACKMAS SALEM OREGON SALEM SALEM PORTLAND GLEN RAVEN LINCOLN MOORESTOWN INDIANAPOLIS OKLAHOMA CITY MILWAUKEE DAYTON ST LOUIS ANCHORAGE SYRACUSE LIVERPOOL LIVERPOOL ENGLEWOOD GRAND JUNCTION CLEARWATER LONDON SALT LAKE CITY PLANO COLUMBIA CINCINNATI REDMOND, ROCKVILLE WINSTON SALEM FREEMONT COLUMBIA EAGAN BURBANK BEAUMONT NASHVILLE PINEY POINT SAN ANTONIO SALT LAKE CITY SANTA ANA PENSACOLA MINNEAPOLIS WINSTON-SALEM SAN ANTONIO MILWAUKEE ASHLAND GULFPORT SALT LAKE CITY LONDON CHARLESTON 08855 722219914 970150286 97309 97309 97309 97207 272150901 68501 08057 46217 73126 53224 45401 63127 99524 13217 130880678 130880678 80155 81502 337578850 40742 84116 75024 29260 45216 981241699 20852 27106 68026 29240 55121 915107830 77706 37219 20674 782659787 84131 927995032 325912466 554409385 27102 78279 53201 54806 39503 84123 40742 29420 8009926613 8002357111 8005685628 8884371508 8884371508 8884371508 5032255221 3362267950 8004977044 8663750775 8883589484 8006549106 8009265858 8007363539 NJ AR OR OR OR OR OR NC NE NJ IN OK WI OH MO AK NY NY NY CO CO FL KY UT TX SC OH WA MD NC NE SC MN CA TX TN MD TX UT CA FL MN NC TX WI WI MS UT KY SC 8003659036 8007703740 3154489000 8772047086 8772047086 8884792000 8008544558 8778158857 8006388432 8007708014 8888797336 8037986207 8888008717 2068678000 8006386589 8006420483 8003506714 8038989795 8003217947 8007774013 8008809988 8005822498 8002524674 8665798811 8665798774 7148253828 8882024340 8002349009 8003009566 8884458916 8004973699 8004973699 8008476621 8005385038 8882762020 8435691759 CARRIER COMMENT USE CODE 280 CAREMARK CODE NOT REQUESTED BY MEDICAID. SCHA ASSIGNED THIS CARRIER BOUGHT OUT BY AETNA CC100 CODE IN OPEN STATUS BY SCHA MEDICARE SUPPLEMENTAL PLAN G MEDICARE ADVANTAGE PLAN DORMANT 8/06 RX PLAN ONLY MM CODE X0K RX PLAN ONLY MM PLAN IS X0K THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN NAIC 93742 MEDICARE ADVANTAGE PLAN HEALTHY KIDS CONNECTION CODE IN OPEN STATUS BY SCHA CARRIER CODE CARRIER NUM CC CROSSWALK 637 392 204 229 378 744 930 A23 D10 235 490 A28 838 631 208 D53 C87 E82 568 B95 576 A77 D22 478 298 329 D82 B06 A87 D43 888 C48 897 897DN B30 D06 B73 224 B57 990 B52 186 691 811 A89 736 741 573 512 A46 C42 C38 188 307 B74 90812 90591 90407 90431 90578 90907 91327 90022 91324 90437 90679 90027 90996 90809 90411 91265 91217 91364 90754 90145 90761 90058 91248 90667 90500 90531 91337 90082 90068 91273 91042 90190 91051 91345 91162 91224 90129 90427 90116 91110 91142 90389 90855 90970 90070 90899 90904 90758 90701 90045 90185 90182 90391 90509 90130 SELECT HEALTH/FIRST CHOICE SELF FUNDED GROUP INSURANCE ADMINISTRATORS SELF INSURED BENEFIT ADMINISTRATORS SELF INSURED PLANS LLC SELF INSURERS SERVICE INC. SENIOR DIMENSIONS SENTRY LIFE INSURANCE COMPANY SERV U PRESCRIPTION SEVEN CORNERS INC SHAW INDUSTRIES SHEET METAL LOCAL 20 SHENANDOAH LIFE INSURANCE CO SHESFIELD, OLSON & MCQUEEN SHRINERS SIEBA, LTD SIERRA OPTIMA PLUS CLAIMS SIHO INSURANCE SERVICES SIMPLE BENEFIT PLANS SIMPLIFI SINCLAIR HEALTH SERVICES SIOUX VALLEY HEALTH SISCO SMART VALUE (BC OF GA) (PFFS) SMITH ADMINISTRATORS SMITH PREMIERE PHARMACY PLAN SMITHFIELD FOODS HEALTHCARE SOLSTICE SOUTHCARE HEALTHCARE PREFERRED SOUTHEAST COMMUNITY CARE (ARCADIAN HEALTH) SOUTHEAST COMMUNITY CARE BY ARCADIAN HEALTH SOUTHEASTERN BENEFIT PLANS INC. SOUTHERN ADMINISTRATIVE SERVICES SOUTHERN BENEFIT ADM. SOUTHERN BENEFITS ADMINISTRATORS DENTAL SOUTHERN BENEFITS, SOUTHEASTERN PIPE TRADERS SOUTHERN CALIFORNIA BAKERY & CONFECTIONARY SOUTHERN CALIFORNIA PIPE TRADES TRUST FUND SOUTHERN ELEC. HEALTH FUND SOUTHERN FARM BUREAU LIFE INS. CO. SOUTHERN GROUP ADMINISTRATORS, INC. SOUTHERN PLANNED ADMINISTRATORS SOUTHLAND LIFE INSURANCE COMPANY SPARTANBURG COUNTY SPARTANBURG REGIONAL HEALTHCARE SYSTEM SPECIAL INSURANCE SERVICES (SIS) SPECTERA SPENCER & ASSOCIATES INS. ST JOHN'S CLAIMS ADMINISTRATION ST11-STRATEGIC HEALTH STANDARD INSURANCE COMPANY STANDARD CORPORATION STANDARD LIFE & ACCIDENT INSURANCE COMPANY STANDARD LIFE & CASUALTY INSURANCE COMPANY STANDARD SECURITY LIFE INS. CO OF NEW YORK STAR HRG P.O. BOX 7120 P O BOX 1719 18167 US HWY 19N 1016 COLLIER CENTER WAY STE. 200 2218 SOUTH PRIEST DRIVE PO BOX 15645 P.O. BOX 8025 PO BOX 26096-0096 P.O. BOX 3430 P.O. BOX 10 PO BOX 42489 PO BOX 12847 P.O. BOX 16608 P.O. BOX 5000 P.O. BOX 15645 P.O. BOX 1787 2810 PREMIER PARKWAY SUITE 400 P.O. BOX 922043 P O BOX 30827 P.O. BOX 91110 P.O. BOX 389 P.O. BOX 3897 P.O. BOX 163289 P.O. BOX 5824 P.O. BOX 158 PO BOX 14009 1100 CIRCLE 75 PARKWAY, STE 1400 P.O. BOX 4946 P.O. BOX 4946 335 ARCHDALE DRIVE P O BOX 8069 PO BOX 188006 5305 VIRGINIA BEACH BLVD. P.O. BOX 1449 P.O. BOX 22041 501 SHATTO PLACE, 5TH FLOOR 3928 VOLUNTEER DRIVE P.O. BOX 78 200 SOUTH MARSHALL ST. P.O. BOX 218180 POST OFFICE BOX 105006 P.O. BOX 1000 P.O. BOX 250349 2811 LORD BALTIMORE DR. 1 S. LIMESTONE ST STE 301 P.O. BOX 14409 9501 NE 2ND AVE PO BOX 82622 1400 MAIN STREET STE 1300 P O BOX 1800 POST OFFICE DRAWER 1514 P.O. BOX 828 P.O. BOX 54150 LONDON KALAMAZOO CLEARWATER LOS ANGELES TEMPE LAS VAGAS STEVENS POINT MILWAUKEE CARMEL DALTON INDIANAPOLIS ROANOKE ST PAUL ENDICOTT LAS VEGAS COLUMBUS DULUTH HOUSTON SALT LAKE CITY SIOUX FALLS DUDUQUE SCRANTON FORT WORTH SPARTANBURG SMITHFIELD LEXINGTON ATLANTA COVINA COVINA CHARLOTTE COLUMBUS CHATTANOOGA NORFOLK GOODLETTSVILLE COMMERCE LOS ANGELES CHATTANOOGA JACKSON WINSTON SALEM HOUSTON ATLANTA LANCASTER PLANO BALTIMORE SPRINGFIELD SPRINGFIELD MIAMI SHORES LINCOLN COLUMBIA GALVESTON FORT MILL PARK RIDGE PHOENIX KY MI FL CA AZ NV WI WI IN GA IN VA MN NY NV IN GA TX UT SD IA PA TX SC VA KY GA CA CA NC GA TN VA TN CA CA TN MS NC TX GA SC TX MD OH MO FL NE SC TX SC IL AZ 40742 490051790 33764 90080 85282 891145645 54481 53226 46082 30722 43242 24029 55116 ----13761 891145645 47202 30097 772922043 84130 57109 52004 18505 76161 29304 23431 40512 30339 91723 91723 282174246 31908 37422 23502 370701449 90022 90020 37416 39205 27101 77218 303485006 29721 750250349 212442644 45502 65814 33138 68501 29201 775531800 29716 60068 850784150 8882762020 8003421895 7275320400 8004212342 240 90442 STARBRIDGE P.O. BOX 55270 PHOENIX AZ 85078 8003085948 952 91078 STARK TRUSS CO., INC. P.O. BOX 2080C STOW OH 44224 8004564002 CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE CARRIER ZIP CARRIER PHONE NO 8009257455 8004267234 8007593203 8666994186 8003211855 8002482141 8008485433 8883308408 8002524624 8882742207 8008732022 8002704158 8884465710 8888002230 8007525863 8004574725 8668659329 8008672582 8002474526 8008095916 8777602247 8004702004 8005738597 8005738597 7045295400 8004268803 8006784656 7574618091 8008314914 3237227171 2133856161 4238992593 8004579611 8003348159 2818291033 7709805100 8007676811 8006383120 8667669016 8778757700 CARRIER COMMENT MEDICAID HMO CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN FORMELY CBCA ADMINISTRATORS MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA 5033217000 8037716785 8883501488 8035483657 8665131479 8002881474 THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA POLICIES BEGINNING WITH"R" NEED TO BE "E" INDICATORS AND GO TO POBOX188004, CHATTANOOGA, TN 37422.POLICIES WITH PH SSN STAYS AS "C". THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CARRIER CODE CARRIER NUM CC CROSSWALK A03 90002 STARMARK P O BOX 2942 CLINTON IA 52733 8005221246 400 373 147 B60 B83 A91 A47 244 233 645 140 374 714 734 C05 A40 C93 A61 209 692 342 861 C45 C19 712 C50 C01 497 B94 C33 269 785 E43 763 B28 542 315 315DN A01 463 322 265 797 E46 755 D69 D55 B40 B46 C03 A80 D47 A76 X3B C52 788 856 10599 90573 90351 90118 90137 90072 90046 90446 90435 91123 90344 90574 90877 90897 91156 90039 91230 91373 90412 90856 90542 91015 91205 91159 90875 90192 90151 90686 90144 91202 90471 90947 91352 90926 90096 90730 90517 90517 90000 90652 90524 90467 90958 91357 90918 91317 91292 90103 90109 90153 90061 91285 91133 91320 90194 90950 91011 STATE EMPLOYEES HEALTH PLAN BLUE CROSS STATE FARM INSURANCE COMPANIES STATE MUTUAL INSURANCE STATE MUTUAL LIFE ASSURANCE COMPANY OF AMERICA STATE OF LOUISIANA EMPLOYEES STATES GENERAL LIFE INS. CO STATESMAN NATIONAL LIFE INSURANCE COMPANY STERLING INVESTORS LIFE INS. CO. STERLING LIFE INSURANCE STERLING MEDICARE CHOICE HMO STERLING OPTION I (PFFS) STONEBRIDGE LIFE INSURANCE CO. STOWE ASSOCIATES STRATEGIC OUTBURSTING INC. STRATEGIC OUTSOURCING, INC. (SOI) STRATEGIC RESOURCE COMPANY STUDENT ASSURANCE INSURANCE SERVICES SUMMACARE HEALTH PLAN SUMMIT AMERICA INSURANCE SERVICES SUMTER COUNTY SUN LIFE INSURANCE COMPANY OF CANADA SUPERIOR ESSEX TALL TREE ADMINISTRATORS TAYLOR BENEFIT RESOURCES, INC. TDI MANAGED CARE SERVICES TENNESSEE BENEFIT ADMINISTATORS TERMINIX SERVICE TEXAS INTERNATIONAL THE CAPELLA GROUP THE DESTINY HEALTH PLAN THE EPOCH GROUP THE HARVEST INSURANCE CO. THE HEALTH PLAN INSURANCE CO. THE PROVIDENT THE STANDARD THIRD PARTY ADMINISTRATORS/AMERICAN BENEFIT THOMAS COOPER AND COMPANY THOMAS COOPER AND COMPANY THRIVENT FINANCIAL FOR LUTHERANS TIM BAR CORP TIME INSURANCE COMPANY TODAY'S OPTION TODAY'S OPTIONS UNIVERSAL AMERICAN TOLEDO FIREFIGHTERS HEALTH PLAN TOTAL BENEFIT SERVICES INC TOTAL CARE/HEALTHSPRING TOTAL CAROLINA CARE, INC TOTAL CLAIMS SOLUTION (TCS) TOTAL CLAIMS SOLUTION (TCS) TOTAL PLAN SERVICES, INC. TOTAL SCRIPT TOUCHSTONE HEALTH PSO TOWER LIFE INS. CO. TPA EXCHANGE TPA OF GEORGIA TRANSAMERICA LIFE INSURANCE CO. TRANSAMERICA OCCIDENTAL LIFE 4101 PERCIVAL ROAD 7401 CYPRESS GARDENS BLVD P.O. BOX 10811 1100 31ST STREET P.O. BOX 44036 115 WEST 7TH ST. SUITE 1200 3815 MONTROSE BOULEVARD P.O. BOX 10844 P.O. BOX 5348 P.O. BOX 70 P.O. BOX 5348 2700 W. PLANO PARKWAY 2872 WOODCOCK BLVD. #200 P O BOX 241508 P.O. BOX 241508 PO BOX 14079 P.O. BOX 196 PO BOX 3620 P.O. BOX 25936 ONE SUN LIFE EXECUTIVE PARK P.O. BOX 724907 P.O. BOX 71747 P.O. BOX 6580 620 EPSILON DRIVE P.O. BOX 3257 P.O. BOX 2627 P.O. BOX 11007 P.O. BOX 200368 P.O. BOX 4628 POST OFFICE BOX 12170 P.O. BOX 956003 52160 NATIONAL ROAD EAST P.O. BOX 31499 P.O. BOX 82622 1733 PARK ST. P.O. BOX 22557 P.O. BOX 22557 4341 N. BALLARD RD P.O. BOX 449 P.O. BOX 981602 PO BOX 391883 P.O. BOX 742528 PO BOX 5810 PO BOX 30180 P.O. BOX 20000 1441 MAIN ST P.O. BOX 10888 P.O. BOX 10888 P.O. BOX 251369 10901 WEST 120TH AVE. STE 110 P.O. BOX 33519 310 S. MARY ST P.O. BOX 4363 4574 LAWRENCEVILLE HWY, STE 201 P.O. BOX 97 POST OFFICE BOX 2101 TERMINAL ANNEX COLUMBIA WINTERHAVEN, CLEARWATER DOWNERS GROVE BATON ROUGE FORT WORTH HOUSTON CLEARWATER BELLINGHAM LINTHIEUM BELLINGHAM PLANO ATLANTA CHARLOTTE CHARLOTTE LEXINGTON STILL WATER AKRON OVERLAND PARK WELLESLEY ATLANTA SALT LAKE CITY THOMASVILLE PITTSBURG SPARTANBURG COLUMBIA WINSTON SALEM ARLINGTON OAKBROOK OVERLAND PARK LAKE MARY ST. CLAIRSVILLE TAMPA LINCOLN NAPERVILLE CHARLESTON CHARLESTON APPLETON HANOVER EL PASO CAMBRIDGE HOUSTON TROY NEW ORLEANS NASHVILLE COLUMBIA GREEN BAY GREEN BAY PLANO BROOMFIELD INDIANAPOLIS SAN ANTONIO ST AUGUSTINE LILBURN SCRANTON LOS ANGELES SC FL FL IL LA TX TX FL WA MD WA TX GA NC NC KY MN OH KS MA GA UT GA PA SC SC NC TX IL KS FL OH FL NE IL SC SC WI PA TX MA TX MI LA TN SC WI WI TX CO IN TX FL GA PA CA 29219 338880007 337578811 60515 70804 761027012 77006 337578844 98227 21900 982270010 75075 30341 28224 28224 40512 55085 743893628 662255936 02181 31139 841710747 31758 15238 29304 29202 27116 76006 60522 66212 327950856 43950 33631 68501 60563 29413 29413 54919 17331 799980624 02139 77274 480075810 70190 372024070 29210 543070888 54307 75025 80021 462030519 78205 32085 30047 185040097 90051 8008682520 8633183000 8887806388 8003233359 8002728451 8007828375 7135266000 8776045240 8006880010 6152445600 CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE CARRIER ZIP CARRIER PHONE NO 8003319955 8005337896 8888367764 8888367764 8887729682 8003282739 8009968701 8772466997 8002253950 8772917920 8774534201 8883525246 8005815300 8037721783 8663074711 8884113888 8668269345 8002556065 8002530856 7406996273 8005257268 8005479515 8006315917 8437222115 8437222115 8008474836 7176324727 8005537654 8662225137 8664225009 4192555314 8007437141 8664336031 8003760110 8003760110 8009695238 8007522211 8887770204 8006606077 8885022789 7704517550 8008203372 2137422111 CARRIER COMMENT THIS CARRIER HANDLES GROUPS WITH LESS THAN 50 EMPLOYEES. SEE CC212 FFOR GROUPS OVER 50 EMPLOYEES. CLAIMS SHOULD BE SENT TO THE ATTN OF SARAH TOWNES AX-B10 CODE IN OPEN STATUS BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSSIGNED BY SCHA MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CARRIER BOUGHT OUT BY PHARMACARE CC 740 THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA USE 386 ASSURANT HEALTH MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN MEDICAID HMO CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN CODE ASSIGNED BY SCHA CARRIER CODE CARRIER NUM CC CROSSWALK 112 642 819 614 E73 C29 E42 E95 90316 91120 90977 90792 91365 90174 91351 91372 TRAVELERS INSURANCE COMPANY TRICARE FOR LIFE TRICARE OVERSEAS PROGRAM TRICARE SOUTH REGION TRISTAR BENEFIT ADMINISTRATORS TRUE CHOICE USA TRUE RX TRUESCRIPTS P O BOX 473500 P.O. BOX 7890 P.O. BOX 7985 P.O. BOX 7031 PO BOX 65887 P.O. BOX 251369 4 WILLIAMS BROTHERS DRIVE PO BOX 921 CHARLOTTE MADISON MADISON CAMDEN WEST DES MOINES PLANO WASHINGTON WASHINGTON NC WI WI SC IA TX IN IN 282473500 537077890 537077985 290217031 50265 75025 47501 47501 7045443665 8667730404 8009826257 8004033950 8004564584 8002519665 8669214047 8442571955 212 90415 TRUSTMARK INSURANCE CO. P.O. BOX 2942 CLINTON IA 52733 8476151500 703 B85 376 729 261 B17 143 356 139DN 143DN B42 812 967 701 160DN 160 D29 556 566 E45 517 195 693 501 306 C73 439 E38 638 449 277 871 A37 196 565 103 124 737 794 704 421 340 715 584 113 113DN 963 825 923 90866 90139 90576 90892 90463 91136 90347 90556 90343 91338 90105 91190 91087 90864 90364 90364 91235 90743 90752 91356 90706 90398 90857 90690 90508 90210 90628 91301 90813 90638 90479 91025 90036 90399 90751 90306 90328 90900 90956 90867 90620 90540 90878 90768 90317 90317 91194 90983 91066 TUCKER COMPANY & ADMINISTRATORS TUFTS HEALTHCARE TUFTS HEATH PLAN U.A. LOCAL 446 PLUMBERS AND PIPEFITTERS UICI ADMINISTRATORS ULTRA BENEFITS UMR UMR UMR UMR UMR UMR UNDERWRITERS SAFETY AND CLAIMS UNI-CARE CHOICE HEALTH BENEFITS UNICARE HEALTH AND LIFE INSURANCE UNI-CARE HEALTH AND LIFE INSURANCE CO UNICARE LIFE & HEALTH INS. CO (PFFS) UNIFIED GROUP SERVICES UNIFIED GROUP SERVICES UNIFIED LIFE INSURANCE UNIFORM MEDICAL PLAN UNION BANKERS INSURANCE COMPANY UNION COUNTY UNION FIDELITY INSURANCE COMPANY UNION LABOR LIFE INSURANCE UNION PACIFIC RAILROAD EMPLOYEES HEALTH UNION SECURITY INSURANCE CO UNISON HEALTH PLAN UNISON HEALTH PLAN HMO UNITED SERVICE ASSO. FOR HEALTHCARE UNITED AMERICAN INSURANCE COMPANY UNITED BEHAVIORAL HEALTH UNITED BEHAVIORAL/DENTAL SYSTEMS UNITED BENEFIT LIFE INSURANCE UNITED BENEFITS UNITED CLAIMS SOLUTIONS UNITED COMMERCIAL TRAVELERS OF AMERICA UNITED CONCORDIA UNITED FAMILY LIFE INSURANCE COMPANY UNITED FOOD & COMMERCIAL WORKERS (UFCW) UNITED FOOD & COMMERICAL WORKER HEALTH&WELFARE UNITED HEALTCARE PLAN OF RIVER VALLEY UNITED HEALTH & LIFE INSURANCE COMPANY UNITED HEALTH ONE UNITED HEALTHCARE UNITED HEALTHCARE UNITED HEALTHCARE CLAIMS UNITED HEALTHCARE COMMUNITY PLAN UNITED HEALTHCARE COMMUNITY PLAN 9140 ARROW POINT BLVD. #200 P.O. BOX 9185 P O BOX 9171 P.O. BOX 191030 P.O. BOX 30087 P.O. BOX 763 P.O. BOX 30541 P.O. BOX 2697 POST OFFICE BOX 30541 PO BOX 30541 P.O. BOX 266 P.O. BOX 30541 P.O. BOX 23507 P.O. BOX 51130 PO BOX 659444 P.O. BOX 4458 233 S WACKER DR. STE. 3900 P.O. BOX 10 P.O. BOX 10 PO BOX 25326 P.O. BOX 34850 POST OFFICE BOX 655433 4850 STREET ROAD 111 MASSACHUSETTS AVENUE, NW 795 NORTH 400 WEST P O BOX 981602 250 BERRYHILL RD 250 BERRYHILL RD P.O. BOX 6080-288 POST OFFICE BOX 8080 P.O. BOX 169053 PO BOX 30755 3909 HULEN ST P.O. BOX 2480 10835 N. 25TH AVE. 105 P.O. BOX 159019 P.O. BOX 69421 POST OFFICE BOX 2204 1800 PHOENIX BLVD. SUITE 310 911 RIDGEBROOK RD 3800 23RD AVE OF THE CITIES, STE 200 P.O. BOX 169050 PO BOX 31374 PO BOX 740800 P.O. BOX 30567 PO BOX 29130 P.O. BOX 8207 P.O. BOX 6170 CHARLOTTE WATERTOWN WATERTOWN SACRAMENTO RENO WESTBORO SALT LAKE CITY WICHITA SALT LAKE CITY SALT LAKE CITY ONALASKA SALT LAKE CITY LOUISVILLE SPRINGFIELD SAN ANTONIO CHICAGO CHICAGO PENDLETON PENDLETON OVERLAND SEATTLE DALLAS TREVOSE WASHINGTON SALT LAKE EL PASO COLUMBIA COLUMBIA MISSION VAIEJO MCKINNEY DULUTH SALT LAKE CITY FT. WORTH DAYTONA BEACH PHOENIX COLUMBUS HARRISBURG ATLANTA ATLANTA SPARKS MOLINE DULUTH SALT LAKE CITY ATLANTA SALT LAKE CITY HOT SPRINGS KINGSTON COLUMBIA NC MA MA CA NV MA UT KS UT UT WI UT KY MA TX IL IL IN IN KS WA TX PA DC UT TX SC SC CA TX MN UT TX FL AZ OH PA GA GA MD IL MN UT GA UT AR NY SC 282738102 02471 024719171 958191030 895203087 01581 841300541 67201 84130 841300541 546568764 841300541 40223 01151 75265 606804458 68606 46064 46064 662255326 98124 752655433 1904920001 84103 79998 29210 29210 926906080 750708080 55816 84130 76107 321152480 85029 43215 17106 30371 30349 211529451 61265 558168200 841310374 303740800 84130 71903 12402 292606170 7045259666 8004238080 8004620224 9164570821 8003153440 8668587223 8008269781 8008269781 8008269781 8008269781 8002368672 8008269781 8006781536 8002888630 8772179677 8772179677 3123247000 7657781535 7657781535 9136852233 8007626004 2149547840 CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE CARRIER ZIP CARRIER PHONE NO 8005236599 8004438087 8005470421 8004446254 8037985852 8037985852 8008721187 9725295085 8008776003 8005575745 8007320657 8004344890 8667448482 8008480123 8003320366 4046593300 8002417701 8006382972 8002246602 8005262414 8006578205 8778423210 8005215505 8882014111 8006009007 8008682528 CARRIER COMMENT USE CODE 113 UNITED HEALTHCARE INACTIVE 8-02 CODE ASSIGNED BY SCHA 6/07/10 INTERNET WWW.MYTRICARE.COM THIS CODE NOT REQUESTED BY MEDCAID. ASSIGNED BY SCHA RX USE THIS CARRIER FOR GROUPS WITH MORE THAN 50 EMPLOYEES. USE CCA03 FOR GROUPS LESS THAN 50 EMPLOYEES CODE IN OPEN STATUS BY SCHA USE CODE 139 WAS WAUSAU INS. CO. THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA WAS MASS MUTUAL MEDICARE ADVANTAGE PLAN CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA USE 386 ASSURANT HEALTH HEALTHY KIDS CONNECTION MEDICAID HMO CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA WAS POE & BROWN CODE ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA THIS COMPANY BOUGHT OUT JOHN DEERE INS. CO. 6/29/07 USE CC113 UNITED HEALTHCARE FORMALLY GOLDEN RULE MEDICARE ADVANTAGE PLAN MEDICAID MCO PLAN CARRIER CODE CARRIER NUM CC CROSSWALK 927 A82 D30 A38 B77 91326 90063 91236 90037 90133 UNITED HEALTHCARE HERITAGE PLUS UNITED HEALTHCARE INDEMNITY UNITED HEALTHCARE INS. CO (PPO) UNITED HEALTHCARE OF NC UNITED HEALTHCARE PLAN ADMINISTRATORS UHC OF RIVER VALLEY PO BOX 5230 P.O. BOX 740801 P.O. BOX 150450 PO BOX 2604 P O BOX 121212 KINGSTON ATLANTA HARTFORD GREENSBORO MARIETTA NY GA CT NC GA 124025230 303740801 061150450 274386304 300670092 8002246602 8008488406 8607025000 8009991147 8005627079 872 91026 UNITED HEALTHCARE PLAN OF RIVER VALLED 3800 23RD AVE. #200 MOLINE IL 61215 8002246602 279 B64 720 C81 994 810 721 X3A 493 217 791 A31 989 D63 530 198 D34 B93 855 B68 D05 409 D85 777 B55 717 953 582 131 513 466 633 962 491 606 608 E20 A56 B41 549 282 841 139RX B13 B13DN 779 C32 D17 D52 292 X2A X1O 90481 90122 90883 90216 91114 90969 90884 91309 90682 90420 90953 90030 91109 91288 90718 90401 91271 90143 91010 90125 91222 90608 91355 90940 91143 90880 91079 90766 90335 90702 90655 20811 91083 90680 90785 90786 91341 90051 90104 90736 90484 90999 90343 91139 91344 90942 90177 91274 91261 90494 90277 90265 UNITED INSURANCE COMPANY OF AMERICA UNITED MEDICAL RESOURCES INC. UNITED MINE WORKERS HEALTH & RETIREMENT FUND UNITED PAYORS & UNITED PROVIDERS UNITED PROVIDER SERVICES UNITED RESOURCE NETWORK UNITED RESOURCE NETWORK UNITED TEACHERS ASSO. INS. CO. UNITED TEACHERS ASSOCIATION UNITED WORLD LIFE INS. CO. UNITEDHEALTH INTEGRATED SERVICES UNITY HEALTH INSURANCE UNIVERA HEALTHCARE UNIVERA SENIOR CHOICE SECURE UNIVERSAL BENEFITS CORPORATION UNIVERSAL FIDELITY LIFE INS. CO. UNIVERSAL HEALTH CARE UNIVERSITY HEALTH ALLIANCE UNIVERSITY HEALTH PLANS UPMC HEALTH BENEFITS, INC UPMC HEALTH BENEFITS, INC. UPSTATE ADMINISTRATIVE SERVICES US FIRE INSURANCE COMPANY US HEALTH AND LIFE US SCRIPTS USA HEALTH CARE (MVP HEALTH CARE) USA HEALTHCARE ORGANIZATION USAA GENERAL INDEMNITY CO. USI VALUE OPTIONS VALUE RX VETERANS ADMINISTRATION VICARE PLUS VISION SERVICE PLAN VOCA.REHAB GENERAL VOCATIONAL REHAB DISABILITY VRX PHARMACY SERVICES VULCAN MATERIALS COMPANY VYTRA HEALTHCARE WAL-MART STORES GROUP HEALTH PLAN WASHINGTON NATIONAL INSURANCE COMPANY WATKINS ASSOCIATED INDUSTRIES WAUSAU INSURANCE COMPANY WEB TPA WEB TPA WEB-TPA AMERICAN FIDELITY ASSURANCE CO WELL FARGO INSURANCE WELLCARE WELLCARE OF GEORGIA WELLMARK ADMINISTRATORS WELLMARK BLUE CROSS BLUE SHIELD OF IOWA WELLMARK BLUE CROSS BLUE SHIELD OF IOWA 1 E WACKER DRIVE P.O. BOX 30541 ROUTE 2 BOX 218A 2273 RESEARCH BLVD P.O. BOX 820277 P.O. BOX 30758 P.O. BOX 30758 P.O. BOX 30010 P.O. BOX 30010 3316 FARNAM STREET P.O. BOX 30783 P.O. BOX 610 P.O. BOX 23000 P O BOX 23000 P.O. BOX 97 P.O. BOX 1428 P.O. BOX 3211 700 BISHOP ST. STE. 300 P.O. BOX 830926 DEPT 003 P.O. BOX 2999 P.O. BOX 2999 P.O. BOX 6589 3195 LINWOOD ROAD, SUITE 201 P O BOX 37504 2425 WEST SHAW AVE P.O. BOX 22920 7301 N. 16TH ST STE 201 P.O. BOX 15506 POST OFFICE BOX 9888 P.O. BOX 1347 PO BOX 421150 P.O. BOX 1710 PO BOX 997100 CHICAGO SALT LAKE CITY BIG STONE GAP ROCKVILLE FORT WORTH SALT LAKE CITY SALT LAKE CITY AUSTIN AUSTIN OMAHA SALT LAKE CITY SAUK CITY ROCHESTER ROCHESTER SCRANTON DUNCAN ST PETERSBURG HONOLULU BIRMINGHAM PITTSBURGH PITTSBURGH SYRACUSE CINCINNATI OAK PARK FRESNO ROCHESTER PHOENIX SACRAMENTO SAVANNAH LATHAM PLYMOUTH SUFFOLK SACRAMENTO IL UT VA MD TX UT UT TX TX NE UT WI NY NY PA OK FL HI AL PA PA NY OH MI CA NY AZ CA GA NY MN VA CA 60601 84130 24219 20850 76182 84130 84130 78755 787553010 68175 841300786 535831374 14692 15692 185040097 735344 33731 968134100 35283 15230 15230 132176589 45208 482370504 93711 146922920 85020 958521506 31412 12110 554420150 23439 958997100 8007778467 5136193000 8006549763 8002474144 8005198374 877-801-35 8778013507 8008808824 8668808824 8776175587 8665968447 8003623308 8772429464 8006171114 8007470622 8003668355 8666904842 8005324000 8778780914 8773813764 8773813764 3154221533 8005132981 8002259674 8004608988 8009993920 8008723860 8005318222 9126911551 8002880882 8009554879 PO BOX 9780 P O BOX 530187 P O BOX 9091 922 W WALNUT STE A P.O. BOX 1934 P.O. BOX 1738 POST OFFICE BOX 8013 P.O. BOX 99906 PO BOX 99906 P O BOX 99906 P O BOX 2801 P.O. BOX 795184 P.O. BOX 31224 P.O. BOX 9901 P O BOX 5023 P.O. BOX 5023 SALT LAKE CITY BIRMINGHAM MELVILLE ROGERS DES PLAINES ATLANTA WAUSAU, GRAPEVINE GRAPEVINE GRAPEVINE CHARLESTON SAN ANTONIO TAMPA SIOUX CITY SIOUX FALLS SIOUX FALLS UT AL NY AR IL GA WI TX TX TX WV TX FL IO SD SD 84109 352530187 11747 72756 320 60017 30301 544028013 760999706 76099 760999706 253302801 78279 33531 51102 571175023 57104 8778799722 8642772371 8668089399 5016212929 8009470319 8003333841 8008269781 8007582851 8007582851 8663932872 8004354351 8662352770 8662311821 8005265710 8005268995 5152454500 CARRIER TPL NAME CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE CARRIER ZIP CARRIER PHONE NO CARRIER COMMENT THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN USE CODE 985 BENESIGHT CODE ASSIGNED BY SCHA THESE COMPANY BOUGHT OUT JOHN DEERE INS. CO. THIS WAS THE HMO FOR JOHN DEERE 6/29/07 CARRIER BOUGHT OUT BY CC 740 PHARMACARE CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN CODE ASSIGNED BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN THIS CODE NOT REQUESTED BY SCHA. ASSIGNED BY SCHA CODE ASSIGNED BY SCHA CODE ASSIGNED BY SCHA THIS CARRIER BOUGHT JONES, HILL & MERCER INS. USE CODE 333 EXPRESS SCRIPTS 8779344403 8006227444 DORMANT 8/06 USE CODE 401 BLUE CROSS BLUE SHIELD OF SC CODE ASSIGNED BY SCHA DORMANT 8/06 MEDICARE ADVANTAGE PLAN MEDICARE ADVANTAGE PLAN USE CARRIER CODE X2A CARRIER CODE CARRIER NUM CC CROSSWALK X2ADN 252 A24 912 991 D37 C76 415 415DN 969 694 116 826 D75 A88 575 768 598 285 A34 622 580 C57 607 C51 470 695 C10 977 91358 90454 90023 91060 91111 91240 90212 90614 90614 91089 90858 90320 90984 91319 90069 90760 90931 90782 90487 90033 90800 90764 90199 91237 90193 90659 90859 90157 91097 CARRIER TPL NAME WELLMARK BLUE CROSS BLUE SHIELD OF IOWA WELLNET HEALTHCARE WELLPOINT NEXT RX WELLS FARGO TPA-NC OFFICES WEST PORT BENEFITS WEST VIRGINIA LOCAL 152 HEALTH & WELFARE WESTERN AND SOUTHERN GROUPS WEYCO, INC. WEYCO, INC. WHP HEALTH INITIATIVE WILLIAMSBURG COUNTY WILLIS CORROON ADMINISTRATIVE SERVICES WILLSE & ASSOCIATES, INC. WINDSOR MEDICARE EXTRA WINDSOR STERLING WISCONSIN ELECTRICAL EMPLOYEES WISCONSIN PHYSICIANS SERVICES WJB DORN VA MEDICAL CENTER WOODMAN OF THE WORLD LIFE INSURANCE SOCIETY WOODS & GROOM WORKMEN'S COMP WORLD INSURANCE COMPANY WORLD TRAVEL PROTECTION WPS TRICARE FOR LIFE YALE HEALTH PLAN YODER BROTHERS YORK COUNTY ZAVATA ZENITH ADMINISTRATION CARRIER ADDRESS LINE CARRIER CITY CARRIER STATE CARRIER ZIP CARRIER PHONE NO P O BOX 9354 57 STREET RD PO BOX 2902 POST OFFICE BOX 2857 P.O. BOX 66743 5 HOT METAL ST. SUITE 200 P.O.BOX 5735 P O BOX 30132 P O BOX 30132 PO BOX 968022 POST OFFICE BOX 305154 P O BOX 1196 P.O. BOX 269025 P.O. BOX 269003 P.O. BOX 2430 1717 WEST BROADWAY STREET 6439 GARNERS FERRY RD 1700 FARNAM STREET 2549 17TH STREET DES MOINES SOUTH HAMPTON CLINTON FAYETTEVILLE ST. LOUIS PITTSBURGH CINCINNATI LANSING LANSING SCHAUMBERG NASHVILLE BALTIMORE PLANTO PLANO BROOKFIELD MADISON COLUMBIA OMAHA COLUMBUS IA PA IA NC MO PA OH MI MI IL TN MD TX TX WI WI SC NE IN 503069354 18966 527332902 28302 63166 15203 45201 48909 48909 601968022 372305154 21203 750269025 750269003 53008 53708 292091639 68102 47202 8773330164 8007271733 8009627378 8003376288 8883065299 8668258152 8004248622 5173497010 5173497010 8002072568 P.O. BOX 3160 4600 WITMER INDUSTRIAL ESTATES #2 P.O. BOX 7889 P.O.BOX 208217 1001 LEBANON RD P O BOX 1208 26359 OMAHA NIAGARA FALLS MADISON NEW HAVEN PENDLETON AMERICUS LAS VEGAS NE NY WI CT SC GA NV 681030160 14305 537077889 065208217 29670 31709 89126 4024968000 8004564553 8667730404 2034320250 8646468331 8002558109 4105470454 8662705223 8888588551 6082769111 8889154158 8037764000 8002253108 8003683429 8008417735 8004265980 CARRIER COMMENT DENTAL USE CARRIER 333 EXPRESS SCRIPTS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA MEDICARE ADVANTAGE PLAN CODE IN OPEN STATUS BY SCHA CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA DORMANT 8/06 THIS CODE NOT REQUESTED BY MEDCAID. ASSIGNED BY SCHA THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA WAS PARADIGM CARE PLAN DORMANT 8/06
© Copyright 2026 Paperzz