All States Payer List
UB04
*****Requires Pre-Enrollment
ALL STATES
Pre.Enr.
Payer ID
13162
59069
59069
51028
20413 93044
37283
75185
75240
87726
87726
87726
*****
64071
21356
72467
36112
91173 38265 38265
59141
AMM01
AMM02
68056
68056
68056
68056
35209
ADVTK
25133
25133
95340
36320
65093
33898
60054
57604
23225
60054
23225
38692
ADOCS
13333
13334
95426
13346
37280
64158
91136
91136
91136
91136
13550
37602
81040
13079
HCP01
23172
52148
58234
Name
1199 National Benefit Fund
(Provider should submit claims with assigned Plan Provider ID, as 2 digit suffix is no longer require
d. Call Renaud Dufresne at (646) 473-6960 for a list of Network ID's.)
Claims Type
Comm
21st Century Health and Benefits
Comm
21st Century Health and Benefits
21st Century Insurance and Financial Services (For Minnesota only)
3P Admin
A & I Benefit Plan Administrators
AAG - American Administrative Group (Formerly Gallagher Benefit Admin)
AAG - American Administrative Group (Formerly Icon Benefit Admin)
AAG Benefit Plan Administrators, Inc
AARP - Payer ID valid only for claims with a billing submission address of PO Box 30968 Salt Lake
City, UT 84130
AARP - Payer ID valid only for claims with a billing submission address of PO Box 31361 Salt Lake
City, UT 84161
AARP - Payer ID valid only for claims with a billing submission address of PO Box 31362 Salt Lake
City, UT 84161
Acclaim
Acclaim Repricing
ACS Benefit Services Inc.
ACS Rewards Administration Center
Adaptis
Administration Systems Research Health Benefits
Administrative Systems Research Corporation
Administrative Systems, Inc.
Advanced Medical Management
Advanced Medical Management MSI
Advantage by Bridgeway Health Solutions
Advantage by Buckeye Community Health Plan
Advantage by Managed Health Services
Advantage by Superior HealthPlan
Advantage Health Solutions
Advantek Benefit Administrators
Advantra - Health Assurance - Health America, Inc.
Advantra Freedom
Adventist Health System West - Roseville, California Advocate Health Centers
Advocate Health Partners
Aegis Security Insurance Company
Aetna
Aetna Affordable Health Choices (SM)- SRC
Aetna Better Health
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Aetna Better Health - Connecticut Medicaid
Aetna Better Health - Connecticut Medicaid
Aetna TX Medicaid
Affiliated Doctor’s of Orange County (ADOC)
Affinity Health
Affinity Health Plan
Affordable Benefit Administrators, Inc.
AFTRA Health Fund
AGA
Agency Services Inc (Now known as Meritain Health)
Alaska Children's Services, Inc. Group #P68
Alaska Laborers Construction Industry Trust Group # F23
Alaska Pipe Trades Local Group # F24
Alaska UFCW Health & Welfare Trust Group # F45
ALICARE
All Savers Insurance Company
Allegiance Benefit Plan Management, Inc.
Alliance Healthcare - Stones River Regional IPA
Alliance IPA
Alliance Partners
Alliance PPO, LLC
Alliant Health Plans of Georgia
State
MN
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
CA
CA
IL
IL
PA
NY
CA
OH
GA
Page 1 of 22
Pre.Enr.
Payer ID
94177
37308
25133
25133
13550
13343 75137 27517
27516
75240
37283
42112
63103
34187
41161
41160
60305
AMF11
62030
01066
36369
81949
87726
72099
81400
74048
44444
48055
42011
17965
37322
86001
95378
87726
86001
86047
86002
86048
86003
*****
*****
95378
27519
27514
27518
27516
27518
27514
27514
27515
27514
22248
53085
86062
SYMED
34192
16140
34196
54160
54100
16120
77045
36356 75278
95440
36326
39065
Name
Allied Administrators - San Francisco, California
Allied Benefit Systems, Inc.
Altius Health Plan
Altius Health Plan- Coventry
Amalgamated Life
Amalgamated Life IPA Alicare
Ameriben Solutions
Americaid Community Care - Maryland
Americaid Community Care - New Jersey
American Administrative Group
American Administrative Group -AAG (Formerly Gallagher Benefit Admin)
American Administrators - West Des Moines, Iowa
American Behavioral
American Benefits Management - North Canton, Ohio
American Chiropractic Network (ACN)
American Chiropractic Network IPA of New York (ACNIPA)
American Community Mutual Insurance
American Family Insurance
American General Life & Accident
American Healthcare Alliance
American Imaging Management, Inc.
American Insurance Company of Texas
American International Group, Inc. (AIG) (Plan of United Healthcare)
American LIFECARE
American Medical Security
American National Insurance Company (ANICO)
American Postal Workers Union
American Progressive Life and Health Insurance Company
American Republic Insurance Company (ARIC)
American Sentinel Insurance Company
American Worker Health Plan
AMERICAS CHOICE
AmeriChoice - Tenncare
AmeriChoice of Connecticut
AmeriChoice of New Jersey Personal Care Plus (Medicare) (All claims require AmeriChoice
provider id - call 888-362-3368 to obtain.)
AmeriChoice of New Jersey, Inc. - Medicaid NJ
AmeriChoice of New York Personal Care Plus (Medicare) (All claims require AmeriChoice provider
id - call 888-362-3368 to obtain.)
AmeriChoice of New York, Inc. - Medicaid NY
AmeriChoice of Pennsylvania Personal Care Plus (Medicare) (All claims require AmeriChoice
provider id - call 888-345-3627 to obtain.)
AmeriChoice of Tennessee
Amerigroup - Florida
Amerigroup - Georgia Amerigroup - Illinois
AmeriGroup – New Jersey
Amerigroup - Ohio
Amerigroup Community Care
Amerigroup Community Care of New Mexico
Amerigroup Corporation - Houston, Texas
Amerigroup Corporation - Ft Worth, Texas
Amerihealth Mercy Health Plan
Anchor Benefit Consulting, Inc.
Ancillary Benefit Systems - Arizona Foundation for Medical Care
Angeles IPA (SynerMed)
Antares Management Solutions
APA Partners, Inc.
Apex Benefit Services
APS Healthcare, Inc.
APS Paper Claim
ARAZ
Arcadian Management Services, Inc.
Argus Health Systems
Arkansas Best Corporation
Arnett Health Plans
Associates for Health Care, Inc. (AHC)
Assurant Health
Claims Type
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
State
UT
CO
MD
NJ
OH
TX
PA
TN
CT
Comm
NJ
Comm
NJ
Comm
NY
Comm
NY
Comm
PA
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
TN
FL
GA
IL
NJ
OH
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
NM
TX
TX
AZ
CA
CA
Page 2 of 22
Pre.Enr.
*****
*****
*****
*****
*****
Payer ID
Name
37313
37323
88035
74240
95691
22304
13853
38259
37280
46045
59274
03432
BKRFM
37248
49153
95377
Assurant Health Self-Funded - Ft. Mill, South Carolina
Assurant Mini - Med Key Family
AssureCare, Inc.
Assured Benefits Administrators
Athens Area Health Plan Select
Atlanticare also known as Horizon HealthCare Admin (HHA)
Atlantis Health Plan
Automated Benefit Services
Automated Group Administration, Inc.
Avera Health Plans
AvMed, Inc.
AZ Physicians IPA
Bakersfield Family Medical Center (Regal)
Bass Administrators, Inc.
BCI Administrators, Inc.
Beech Street
63100
Behavioral Health Systems
SYMED
33192
36149
25145
20018
37212
39081
37118
37222
74223
38257
36342
87265
37248
95604
32006
62183
SB590
00590
SB690
Bellflower Hospital (Synermed)
Bencorp National Corporation
Benefit Administrative Systems
Benefit Coordinators Corporation (Pittsburgh, PA)
Benefit Management Group, Inc. (BMGI)
Benefit Management Systems, Inc
Benefit Plan Administrators Company - Eau Claire, Wisconsin
Benefit Plan Administrators, Inc. - Roanoke, Virginia
Benefit Plan Management, Inc.
Benefit Planners
Benefit Source, Inc.
Benefit Systems & Services, Inc. (BSSI)
Benesight (formerly The TPA)
Benesys Inc.
Best Life & Health Insurance Company
Better Health Plans of South Carolina
Better Health Plans, Inc.
Blue Cross Blue Shield DC National Region - CareFirst
Blue Cross Blue Shield of Florida
Blue Cross Blue Shield of Maryland Region - CareFirst
00720
Blue Cross Blue Shield of Minnesota
12000
Blue Cross Blue Shield of NCA Region - includes coverage for DC & Northern Virginia - CareFirst
22099 00840
BC001
BS001
61124
13337
36609
74238
BOONG 13337
37286
13310
52192 37285
68054
35182
51037
94316
94316
32004
42150
33192
33192
10301
CALOP
Blue Cross Blue Shield of New Jersey (Horizon)
Blue Cross Blue Shield of Oklahoma
Blue Cross of CA - Anthem
Blue Shield of CA
Bluegrass Family Health
BMC HealthNet Plan
Boilermakers National Health & Welfare Fund
Boon – Chapman Administrators, Inc.
Boon Group, The
Boston Medical Center Health Plan, Inc.
BPA/Benefit Plan Administrators (North Dakota)
BPS Inc.
Bravo Health (PA, MD, DE, TX and DC)
Bridgestone Claims Services
Bridgeway Arizona
Brodart
Brokerage Concepts
Brown & Toland
Brown & Toland
Buckeye Community Health
Butler Benefit
Cadent Administrators
Cadent Underwriters
Cahaba GBA (Medicare Part A Rural)– (formerly known as Riverbend)
CalOptima
Claims Type
State
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
SC
FL
CA
PA
WI
VA
SC
DC
FL
MD
Comm
DC
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Gov't
Comm & HMO
NJ
OK
CA
CA
KY
All States
CA
LA
71057
Cannon Cochran Management Services - Metairie, Louisana
(PO Box 6794, Metairie, LA 70009)
Comm
37105
Cannon Cochran Management Services, Inc.
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
MA
ND
CA
CA
Page 3 of 22
Pre.Enr.
Payer ID
Name
Claims Type
State
CAPMN
38245
23045
87726
68011
57116
Cap Management
Cape Health Plan
Capital Blue Cross - CAIC
Capital Community Health Plan
Capitol Administrators
Care 1st Health Plan of Arizona
Comm
Comm
Comm
Comm
Comm
Comm
CA
38269
Care Choices/Preferred Choices (Enrollment required; please contact Noreen at (248) 489-5281)
Comm
MI
77082
Care Improvement Plus
Carechoices Michigan - Mercy Healthplans
(Enrollment required; please contact Noreen at (248) 489-5281.)
CareCore National
CareCore National - Healthnet
CareCore National LLC - Health Net New Jersey
CareCore National LLC (Aetna Radiology)
CareCore National LLC (Oxford Radiology)
CareFirst BCBS NCA Region - includes coverage for DC and Northern Virginia
CareFirst BCBS of Maryland
Carelink Health Plan
Carenet
CareOregon, Inc.
CarePlus Health Plans
Caresource Health Plan of Oregon
CareSource of Indiana
CareSource of Ohio
Careworks
Cariten Healthcare
Cariten Senior Health
Carolina Behavioral Health Alliance
Carolina Care Plan Inc.
Carolina Summit Healthcare, Inc.
Carpenter's Health & Welfare Trust Fund of St. Louis
CBCA Administrators
CBCA Administrators (HRM)
CCN Managed Care Inc.
Comm
38269 *****
14182 14184
14185
14179
14180 12000
12011
25133
25133
93975
65031 MRCHP
37311
31114
10010
62073
62072
56215
57105
56195
25125
55438
41170
25133
87065
CDO Technologies
95167
95166
91136
Cedars Sinai Medical Network- Encounters
Cedars Sinai Medical Network- payable claims
Cement Masons & Plasterers Health & Welfare Trust Group# F16
Cenpatico Behavioral Health - Georgia (Prior to submitting claims, please call Provider Relations
Dept at 800-947-0633)
Cenpatico Behavorial Health - Arizona (Prior to submitting claims, please call Provider Relations
Dept at 800-947-0633)
Cenpatico Behavorial Health - Indiana (Prior to submitting claims, please call Provider Relations
Dept at 877-647-4848)
Cenpatico Behavorial Health - Kansas (Prior to submitting claims, please contact Provider
Relations Dept at 866-896-7293)
Centene Advantage Plans
CenterCare
Central Benefits Life
Central Benefits Mutual
Central Benefits National
Central Mass. Health Care (CMHC)
Central Reserve Life
Central SeniorCare
Central States Health & Welfare Funds
Central Valley Medical Group
Century Health Solutions
CHA Health
Champus - TriWest
CHAMPVA - HAC
Chartered Health Plan
Chautauqua County Healthcare Plan - Mayville, New York
CHCcares of South Carolina Chesapeake Life Insurance Company
68050
68048
68052
68047
68056
13357
31118
31118
31118
02041
34097
CIPA1
36215
IP079
48120
23171
WPSTC
84146
95748
16600
25151 59223
34154
Chesterfield Technologies
AMM03
80141
Child Health and Disabillity Prevention Treatment (Advanced Medical Management)
Childhealth Plus by Healthfirst (CHP)
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
OR
OR
IN
OH
NC
Comm
GA
Comm
AZ
Comm
IN
Comm
KS
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Govn't
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
CA
DC
NY
SC
CA
Page 4 of 22
Pre.Enr.
Payer ID
84146
94302
38692
33065
UHSCH
*****
61271
62308
62308
62308
86033
62308
75600
57080
33192
02041
AMM03
AMM01
37310
COAST
38335
37123
91162
34181
37237
14315
25179
23282
73143
39126
61948 38325
26231
SYMED
COMMF
35193
48145
75261
62149
90010
12T30
CMGWV
32481
34177
37297
59314
03036
78375
06105
37307
62308
37135
75284
87843
71404
55544
CCHP1
35149
52132
35199
58204
41045
75136
35182
35180
35183
35202
Name
Children of Women Vietnam Veterans - VA HAC
Chinese Community Health Plan
CHIP
CHOC - Children's Hospital of Orange County Health Alliance
Choice One/UTMB CHIP Health Plan (Please contact payer before sending claims-1-877-2388543)
Christian Brothers Services
CIGNA - PPO
CIGNA Health Plan
CIGNA Health Plan - HMO
CIGNA Healthcare for Seniors - Arizona Medicare
CIGNA PPA
City of Odessa
Claimsware, Inc. DBA ManageMed
Clarendon's Healthy Kids
CMHC
CMS - Custody Medical Services (c/o Advanced Medical Management)
CMS (Custody Medical Services) (Advanced Medical Management)
Coast Hotels & Casino, Inc. / DBA Coast Benefits
Coastal TPA
Cofinity
Colonial Healthcare
Columbia United Providers Commerce Benefits Group
Commonwealth Administrators, LLC.
Commonwealth Care Alliance
Community Care Behavioral Health Organization
Community Care BHO
Community Care Managed Health Care Plans of OK
Community Care Organization
Community Choice Health Plan of Westchester
Community Choice of Michigan
Community Claims Administration
Community Family Care (SynerMed)
Community First
Community Health Alliance
Community Health Choice
Community Health Electronic Claims/CHEC/webTPA
Community Health Network of Connecticut
Community Health Plan (located in St. Joseph, MO. Service Area includes NW Missiouri, NE
Kansas, SW Iowa, SE Nebraska)
Community Health Plan of Washington
Community Medical Group of the West Valley
Community Premier Plus for Neighborhood Health Providers
Comp - Ohio (Austintown, OH)
CompBenefits Corporation
Comprehensive Behavorial Care
Comprehensive Benefits Administrator, Inc.
Connecticare Medicare
Connecticare, Inc.
Connecticut Carpenters Health Fund
Connecticut General
Consociate Group
Consolidated Associates Railroad
Consolidated Health Plans
Continental General Insurance Company
Conversion Plan - APWU
Cook Childrens Health Plan
Cook Group Heath Plan
Cooperative Benefit Administrators (CBA)
Cooperative Managed Care Services
Coordinated Medical Specialists
CoreSource AZ MN
CoreSource Little Rock
CoreSource MD PA IL
CoreSource NC IN
CoreSource OH
Cornerstone Benefit Adminstrators
Claims Type
State
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
CA
OK
MI
CA
CT
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
OH
CT
CT
AR
OH
Page 5 of 22
Pre.Enr.
Payer ID
41124
56116
37246
43160
62553
MCS03
58102
25133
25133
25133
25133
25133
25133
25133
25133
25133
25133
64068
37320
37266
AMM03
39170
*****
*****
Name
Corp. Benefit Services/CBSA/Fortis Self Funded Admin (Now known as Meritain. Payer ID valid
only for claims with a billing submission address of P.O. Box 27267, Minneapolis, MN 55427-0267)
Corporate Benefits Service, Inc. (NC)
Corporate Systems Administration
Correctional Medical Services, Inc.
Country Life Insurance Company
County of Kern POS
Covenant Administrators, Inc. (Atlanta, GA)
Coventry Advantra (Texas, New Mexico, Arizona)
Coventry Health & Life – Oklahoma
Coventry Health Care National Network (f.k.a. First Health Direct)
Coventry Health Care of Delaware, Inc.
Coventry Health Care of Georgia, Inc.
Coventry Health Care of Nebraska, Inc.
Coventry Healthcare of Iowa
Coventry Healthcare of Kansas, Inc. - Wichita
Coventry Healthcare of Louisiana
Coventry Healthcare of Missouri
Creative Medical Systems
Creative Plan Administrators
Croy-Hall Management, Inc.
Custody Medical Services - CMS (c/o Advanced Medical Management)
Custom Benefit Administrators
82056
Custom Design Benefits
57080
95740
95748
95740
87726
27009
94235 84134
84133
84135
84131
36436 56240
25133
23706
06102
74284
35186
CWIBENEFITS, INC.
DC Chartered Health Plan, Inc. (Alliance)
DC Chartered Health Plan, Inc. (Medicaid & Alliance)
DC HealthCare Alliance
Definity Health
Delaware Physicians Care
Delta Health Systems
Denver Health - Indigent
Denver Health and Hospital Authority
Denver Health Medical Plan
Denver Health Medical Plan, In. - Medicare Choice
Destiny Health
Detroit Medical Center
Diamond Plan
Director's Guild of America - Producer Health Plans
Diversified Administration Corporation
Driscoll Children's Health Plan
Dunn & Associates Benefits Administrators, Inc
SYMED
East LA Doctors Hospital
EMG11
EBC01
Eastland Medical Group
EBC (Buffalo Rock) Birmingham
34166
EBS of Ohio (PO Box 2568, Mansfield, OH 44906)
73288
EPT03
52192
52192
31625
37253
31074
34167
AMM03
73288
73288
38241
37215
CX025
31074
03036
37216
41198
75184
SYMED
35112
EHI (Employers Health Insurance)
El Paso First - CHIP
Elder Health HMO of Pennsylvania
Elder Health Maryland HMO Inc.
ElderPlan, Inc.
Elmco
EMBC (Employee Benefit Management Corp)
Emerald Health Network, Inc. (All PPO Business)
Emergency Medical Service Fund (EMSF) (Advanced Medical Management)
EMI-KP Ambulance Claims
Emphesys
Employee Benefit Concepts
Employee Benefit Corporation
Employee Benefit Management Corp
Employee Benefit Management Corp. (EBMC) aka Big Lots Assoc Benefit Plan
Employee Benefit Plan Administration (E.B.P.A.)
Employee Benefit Services - Ft. Mill, South Carolina
Employee Benefit Services - Louisana
Employee Claim ADJ
Employee Health Systems
Employee Plans, LLC
Claims Type
State
Comm
Comm
Comm
Comm
Comm
NC
CA
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
OK
DE
GA
NE
IA
KS
LA
MO
DC
CO
CO
MI
AL
OH
PA
MD
OH
CA
OH
VT
CA
Page 6 of 22
Pre.Enr.
*****
*****
Payer ID
Name
74212
75232
75236
75235
75233
73288
59298
59331
AMM01
35206
35206
36364
91136
62308
62308
73126
23250
74234
34108
20818
34159
87726
07501
58233
59313 71412
91136
37300
22254
43173
31472
36396
37289
14140
33033
00932
37300
37300
41041
11315
56196
91131
14162
75138
25133 25133 25133
59276
94999
90061
62061
39026
11244 59321
48116
Employer Plan Services
Employers Direct Health
Employer's Direct Health - Employee Plan
Employer's Direct Health - Fully Insured
Employer's Direct Health - Self
Employers Health Insurance
Employers Mutual, Inc. (Jacksonville, Florida)
Employers Mutual, Inc. (Stuart, Florida)
EMSF (Emergency Medical Service Fund) (Advanced Medical Management)
Encircle PPO
Encore Health Network
ENH Medical Group IPA
Enstar Natural Gas, Group # P61
Equicor
Equicor - PPO
Equitable Plan Services - Oklahoma City, OK
Erin Group Administrators
ERISA
ES Beveridge & Associates
Essence Healthcare
E-V Benefits Management, Inc (Columbus, OH) - Now known as Meritain Health
Evercare
Evercare Star Plus
Evergreen Health Plan
Evolutions Healthcare Systems - New Port Richey, FL
Exclusicare
F40 Alaska Carpenters Trust
FACS Group
Fallon Community Health
Family Health Partners - MC + Missouri
Family Health Partners Healthcare of Kansas
Family Medical Network
FARA Benefit Services, Inc.
Farm Family Life
FCE Benefit Administrators
Federal Employees Plan WA (Regence Blue Shield)
Federated Benefits
Federated HR Services
Federated Mutual Health Insurance Company
Fidelis Care New York
First Carolina Care
First Choice Health Network
First Choice HealthPlans of Connecticut
First Choice of Midwest (PPO)
First Health (CCN Managed Care and PPO for OK)
First Health (CCN Managed Care and PPO for OK)
First Health (See..Coventry Health Care National Network - Effective 1/1/07)
First Service Administrators also known as Florida 1st
FirstCare
FirstGuard Missouri
Fiserv Health - Kansas & Tennessee
Fiserv Health - Wausau Benefits - Benesight
Fitzharris & Company, Inc.
Florida Hospital Healthcare Systems
Florida Hospital Waterman
59698
Florida League of Cities
48117
37305
25133
87066
39065
64069
FMH Benefit Services, Inc.
Ford Meter Box Company Inc., The
Foreign Service Benefit Plan
Formax, Inc.
Fortis (Formerly Time Insurance)
Fox-Everett
41212
Freedom Health Plan
62324
FMCHP
59069
59069
59204
Freedom Life Insurance Company
Fresenius Medical Care Fringe Benefit Management
Fringe Benefit Management
Fringe Benefits Coordinators
Claims Type
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
State
FL
CA
OK
OH
MO
WA
MN
NY
NC
MO
FL
FL
TX
Page 7 of 22
Pre.Enr.
Payer ID
34171
30005
60550
25169
76028
91741 37283
67815
75273
MCS01
MCS03
46050
46051
67815
23212
22937 13551
25531
25133
58204 80314
07205
AMM02
*****
*****
*****
*****
07689
75246
47083
37602
MBA01
68041
AMM01
44054
37234
95467
80705
HCP01
78521
36338
48143
72153
91121
95192
39167
39168
91051
91051
91051 38194
Name
FrontPath Health Coalition
Galveston County Indigent Health Care
Gateway Health Plan - Medicare Assured
Gateway Health Plan Medicaid PA
Gateway Health Plan of Ohio
Gateway Health Plan of Ohio - Medicare Assured
GBA
GEGLAC - G.E. Group Life
Geisinger Health Plans
(provider enrollment is required. Please call HIP Provider Relations to obtain the
enrollment form at (800) 447-8386 or e-mail at [email protected])
GEMCare (Golden Empire Managed Care System)
GemCare Health Plan, Kern County EPO
Generations Healthcare
Generations- Hillcrest
Genworth Life and Health Insurance Company (GLHIC) (Formerly GEGLAC)
Gettysburg Health Preferred
GHI - Medicare Private Fee for Service GHI - New York (Group Health, Inc.)
GHI HMO
GHP Group Health Plan
GI Innovative Management
GIC Indemnity Plan
Gilsbar
Glendale Physicians Alliance (GPA Medi-Cal and GPA Healthy Families claims only) (GPA Senior
and GPA Commercial claims should be sent through REGAL)
Global Care Inc.
GM Southwest
GMS, Inc.
Golden Rule Insurance Company
Golden State Medical Group
Golden State Physicians Medical Group
Good Samaritan Medical Practice Association (GSMPA)
Government Employees Hospital Association (GEHA)
Grant Physicians Practice Association
Great Lakes Health Plan
Great West Health Care
Greater Valley
Greentree Administrators
Group Administrators Ltd.
Group and Pension Administrators
Group Benefit Administrators (Hendersonville, TN)
Group Health Cooperative - East
Group Health Cooperative of Eau Claire
Group Health Cooperative of South Central Wisconsin
Group Health Cooperative of South Central Wisconsin
Group Health Cooperative, Healthy Options
Group Health Cooperative, Medicare Plus Choice
Group Health Cooperative, Washington State
Group Health Managers
Claims Type
State
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
CA
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
TX
CA
CA
TX
TN
WI
WI
WI
91051
Group Health Northwest
91051
91051
37276
68046
64246
39180
37114
38224
36405
36405
HCP01
95266
95266
Group Health Options, Alliant
Group Health Options, Washington State
Group Insurance Service Center
Group Practice Affiliates
Guardian Life (The Guardian)
Gunderson Lutheran Health Plan
H.E.R.E.I.U Welfare Pension Funds
HAP/AHL/Curanet
Harmony Health Plan of Illinois
Harmony Health Plan of Indiana
Harrimon Jones
Harrington Benefit Services, Inc.
Harrington Benefit Services, Inc. - Centra
59152
Harrington Benefits Services-Oklahoma, State of Oklahoma-Healthchoice, City of Oklahoma City,
Department of Rehabiltative Services, Department of Corrections, Mayes County Ja
Comm
OK
48330
37111
Hawaii Management Alliance Association (HMAA) HCH Administration (Illinois)
Comm
Comm
HI
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
WI
MI
IL
IN
CA
Page 8 of 22
Pre.Enr.
*****
*****
Payer ID
37215
37329
82018
20257
90023
23173
77950
38224
25133
42102
HCP01
56142
62111
34158
20356
16120 95019
30946
55247
62295 95567
95568
38309
95567
*****
*****
06108
20199
36368
HPAMN
62157
80142
52563
34150
44273
11324
55438
*****
Name
HCH Administration, Inc.
HCHA Albq-Self Funded
HCS - Health Claims Service (Boise, ID)
HDPC - Alliance Physicians (High Desert Primary Care Alliance)
HDPC - Premier Care (High Desert Primary Care Premier)
Health 1,2,3, Inc.
Health Alliance Medical Plan
Health Alliance Plan of Michigan
Health America Inc. - Health Assurance - Advantra
Health Care Network of Wisconsin (HCN)
Health Care Partners
Health Care Savings
Health Cost Solutions
Health Design Plus (Hudson, Ohio)
Health Exchange, The (Center Corporation)
Health EZ
Health First Health Plans
Health Future LLC
Health Insurance Plan of Greater NY (HIP)
Health Market Care Assured Health Net (Claims Only)
Health Net California (Institutional Encounters Only)
Health Net of Arizona - Payer requires unique provider ID; please call the Provider Call Unit at 800289-2818
Health Net of California & Oregon - Claims
Health Net of the Northeast - Payer requires unique provider ID; please call the Provider Call Unit
at 800-438-7886
Health Network America
Health Options of Illinois
Health Partners of Minnesota
Health Partners of Tennessee
Health Partners, PA
(All claims submitted require a valid Health Partners, PA, provider ID in the Rendering Provider Net
work ID field)
Health Plan of Michigan
Health Plan, The (Massillon, Ohio & St. Clairsville, Ohio only)
Health Plans, Inc.
Health Plus PHSP (Brooklyn, NY)
Health Risk Management
20896
Health Services Consulting Group
37290
34167
Health Services for Children with Special Needs
Health Services Preferred (HSP) by Emerald Health
27008
Health Systems International - ECOH
35206
11328
HCP01
73147
25143
36335
62179
85729
80141
80141
80141
80141
75234
Healthcare Group, The
Healthcare Partners IPA - New York
HealthCare Partners, IPA
Healthcare Solutions Group
Healthcare USA
Healthcare's Finest Network (HFN)
HealthChoice of Arizona
Healthcomp Inc.
Healthfirst 65 Plus
Healthfirst Family Health Plus (FHP)
Healthfirst Inc - New York (Commercial)
Healthfirst PHSP
Healthfirst TPA (Tyler, TX)
Healthlink HMO (Please call Provider Relations Dept at (800) 624-2356 for unique provider
number. )
Healthlink PPO (Please call Provider Relations Dept at (800) 624-2356 for unique provider number.
)
HealthPlan Services (Tampa Only)
HealthPlus of Louisiana
HealthSCOPE Benefits, Inc
HealthSmart Preferred Care
Healthsource CMHC
Healthsource Provident (CIGNA)
Healthsource, AR (Med) (CIGNA)
Healthsource, GA (CIGNA)
96475
90001
59140
95009
71063
75250
02041
68195
71075
58210
Claims Type
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
State
ID
CA
CA
MI
WI
OH
FL
NY
CA
Comm
AZ
Comm
CA
Comm
Comm
Comm
Comm
Comm
IL
MN
TN
Comm
PA
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
MI
NY
CA
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
LA
GA
Page 9 of 22
Pre.Enr.
*****
Payer ID
Claims Type
State
61127
02041
Healthsource, KY (CIGNA)
Healthsource, MA (CIGNA)
Comm
Comm
KY
01041
Healthsource, ME (Payer requires unique provider ID;please contact (800) 909-2227, ext.5760)
Comm
75255
56147
02038
31141
06119
62129
63092
36332
58213
22148
59230
33069
35145
Healthsource, N. TX (CIGNA)
Healthsource, NC (CIGNA)
Healthsource, NH (CIGNA)
Healthsource, OH (CIGNA)
Healthsource, SC (CIGNA)
Healthsource, TN (CIGNA)
HealthSpring HMO/HealthSpring Medicare+Choice
HealthStar, Inc.
Healthways WholeHealth Networks
Heavy & General Labors Fund of New Jersey
Heritage Consultants
High Desert Primary Care - Hesperia, California
Highmark - Key Family
35145
Highmark - Key Family
59347
HPFFS
86066
SYMED
CAPMN
22099 22304
22099 22326
37274
91136
58227
13335
61101
61101
61102
61101
61101
61125
72127
61101
OCH01
61101
65018
61101
HDNFC
37260
22175
37279
12X26
Hillcrest Benefit Administrators
Hispanic Physicians IPA Fee For Service - Encounters Only - Payer ID Required
HMA Hawaii
Hollywood Presbyterian (Synermed)
Hollywood Presbyterian Medical Group- (now known as Prudent Medical Group)
Horizon BCBS of New Jersey
Horizon HealthCare Admin (HHA)
Horizon Healthcare of New York
Horizon NJ Health
Hospital Benefits
Hotel Employees & Restaurant Employees Health Trust, Group # F19
HPS Paradigm
Hudson Health Plan (Please contact payer before sending claims- 914-631-1611)
Humana Emphesys
Humana Employers Health Insurance
Humana Encounters
BS001
*****
Name
37296
75274
41600
40585
35204
35161
35107
31053
52196
52212
37279
13315
88006
86304
51020
31127
31129
INET1
Humana Gold Choice
Humana Insurance Company Choice Care Network
Humana Military - Tricare South
Humana Ochsner 1
Humana Ochsner 1
Humana Ochsner 2
Humana Ochsner 2
Humana Puerto Rico
Humana, Inc.
Humboldt-Del Norte Foundation IPA
Hunt Insurance Group
I. E. Shaffer - West Trenton, NJ
IAA (Insurance Administrator of America, Inc.)
IBC Personal Choice
IBEW Local 6 - San Francisco Electrical Workers *They will all have a prefix code of "XEL" as
their member ID on the BSC card.
ICM - Interstate Choice Management
IHG Direct
IMCARE
INDECS Corporation
Indiana Health Network
Indiana ProHealth Network
Indiana Teamsters Health Benefits Fund (Indianapolis, IN)
Individual Health Insurance Companies
Informed, LLC
Injured Workers Insurance Fund
Insurance Administrator of America, Inc. (IAA)
Insurance Design Administrators
Insurance Management Services (Elko, NV)
Insurers Administrative Corp.
Integra Administrative Group (Seaford, DE)
Integra Group
Integra Group-CHA
Integranet
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
OH
CA
CA
NJ
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
IN
IN
NV
DE
Page 10 of 22
Pre.Enr.
Payer ID
74314
34167
68053
58200
37227
60280
23287
36609
37269
37296
84137
20435
41124
37272
61271
05014
41099
JMH01
*****
*****
*****
*****
52189
43178
34136
37272
94320
91617
KSRCS
COKSR
21313 KS005
KS001
52095
NW002
57038
57038
KMG11
73100
73100
MCS03
77039
37217
IP082
37321
23284
34145
KAMG1
KPS01
LACAR
72068
72602
72603
LMG11
Name
Integrant - SelectCare of Texas
Integrated Care Network (ICN) by Emerald Health
Integrated Mental Health Service (Prior to submitting claims, please call Provider Relations Dept at
1-800-716-5650 to verify your provider info is on file in the claim system)
Integrity Benefit Group, Inc.
InterCare Health Plans
Interface EAP (IEAP)
Intergroup Services Corporation
International Brotherhood of Boilermakers
International Union of Operating Engineers ~ Local 15, 15A, 15C & 15D
Interstate Choice Management
Interwest Health (Acceptius Gateway Payer)
Intgritas Benefit Group
Iowa Benefits
J. Smith Lanier & Co. Administrators
J.F. Molloy & Associates
Jackson Memorial Health Plan - Florida
John Alden Life Insurance Co.
John Muir Health Network (If you have never submitted claims to John Muir before, please fax your
W-9 with contact name and # to Patty Kan 925-941-2026)
Johns Hopkins Healthcare
Joplin Claims
JP Farley Corporation
JSL Administrators
Kaiser CSI - California Select for Individuals (formerly known as Kaiser PPO)
Kaiser Foundation Health Plan of Colorado
Kaiser Foundation Health Plan of Colorado ( Colorado Springs only)
Kaiser Foundation Health Plan of Colorado ( except Colorado Springs)
Kaiser Foundation Health Plan of Georgia
Kaiser Foundation Health Plan of Ohio
Kaiser Foundation Health Plan of Southern CA Region
Kaiser Foundation Health Plan of the Mid-Atlantic States (MD, VA and DC)
Kaiser Foundation Health Plan of the Northwest
Kanawha Healthcare Solutions
Kanawha Insurance Company
Katy Medical Claims
Kempton Company
Kempton Group Administrators
Kern County EPO, (GemCare Health Plan)
Kern Health Systems
Key Benefit Administrators - Indianapolis, Indiana
Key Medical Group
Key Select
Keystone Mercy Health Plan
Klais & Company
Korean American Medical Group
KPS Health Plans
LA Care
LA Carpenters Reg Council Health Benefit Trust Fund
LA Carpenters Reg Council Welfare Fund
LA Laborers Health & Welfare Fund
Lakeside Medical Group
36333
Lawndale Christian Health Center
52193
65055
37248
37281
87071
37281
37281
37281
41136
91049
91155
93093
73288
35107
LBA Health Plans
Leon Medical Center Health Plan
LHP Claims Unit
Liberty Union
Liberty Health Advantage
Liberty Union
Life Assurance Associates
Life Assurance Company
Life Trac
LifeWise (of Washington), A Premera Healthplan
LifeWise of Arizona, A Premera Healthplan
LifeWise of Oregon, A Premera Healthplan
Lincoln National (EMPHESYS)
Local 135 Health Benefits (Indianapolis, IN)
Claims Type
State
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
CO
CO
GA
OH
CA
CA
PA
WA
CA
LA
LA
WV
WA
AZ
OR
IN
Page 11 of 22
Pre.Enr.
*****
*****
Payer ID
37267
37267
37267
37267
33036
37267
23223
SYMED
SX159
90328
37292
Name
Loma Linda University Adventist Health Sciences Center
Loma Linda University Adventist Health Sciences Center Employee Health Plan
Loma Linda University Behavorial Medicine Center Employee Health Plan
Loma Linda University Employee Health Plan
Loma Linda University Healthcare - ManagedCare Claims
Loma Linda University Healthcare Employee Health Plan
Loomis Company, The - TPA Wyomissing, PA (IHS Gateway Payer)
Los Angeles Metro Medical Center
Lovelace Salud (Medicaid claims only)
Lovelace Sandia Health Plan
Machinist District 9 Welfare
36334
MacNeal Health Providers-CHS
HCP01
01260
12X27
11303
25133
22195 52149
52148
MCS03
35162
MCS02
MCS01
22771
Magan Medical Clinic
Magellan Behavioral Health Services
Magellan Health Services for UB
Magnacare
Mailhandlers Benefit Plan (CAC)
Maksin Management Corporation
MAMSI
MAMSI Life & Health Insurance Company (MLH)
Managed Care GemCare Health Plan
Managed Care Services
Managed Care Systems (Delano Regional Med. Grp.)
Managed Care Systems (GEMCARE)
Managed Health Network (MHN)
39186
Managed Health Services Indiana (Medicaid HMO) (Prior to submitting claims, please call Provider
Relations Dept at 800-944-9661 to verify your provider info is on file.)
39187
41159
Managed Health Services Wisconsin
Managed Physical Network
41555
98010
13310 22347
00247
37121
MMPHB
41154
87065
87065
56205
25160
38264
38338
52148
20475
58202
58204
74323
59231
56162
95321
94265
68041
37298
MBA01
74323
74323
74323
04258
75229
52181
29076
62177
Manatee Service Center - Bradenton, Florida
Manulife W.J. Sutton Company
Marsh Advantage
Maryland Health Insurance Plan
Maryland Physicians Care
Mashantucket Pequot Tribal Nation
Masters Mates and Pilots Program
Mayo Management Services, Inc. (MMSI)
MBA Benefit Administrators (Payer ID valid for claims with a submission address of PO
Box 651109, Salt Lake City, UT 84115)
MBA of Wyoming (Payer ID valid for claims with a submission address of PO Box 98,
Worland, WY 82401)
MBS - Formerly MedCost Benefit Services
MCA Admin (Formerly DGA)
Mcare
McLaren Health Plan
MD - Individual Practice Association, Inc. (M.D. IPA)
Mdwise Hoosier Alliance
MedAdmin Solutions
MedAdmin Solutions
MedBen - Newark, Ohio
MedCom
MedCost, Inc.
Medfocus
Medica
Medical Benefit Administration, Inc
Medical Benefit Administrators of Maryland
Medical Benefits Administrators
Medical Benefits Administrators, Inc. (Newark, OH)
Medical Benefits Companies (Newark, OH)
Medical Benefits Mutual Life Insurance Co.
Medical Claims Service, Inc.
Medical Control, Inc.
Medical Development International
Medical Mutual of Ohio
Medical Reimbursements of America
62117
Medical Reimbursements of America
58203
Medical Resource Network (MRN)
Claims Type
State
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
CA
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
CA
CA
CA
CA
Comm
IN
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
WI
MD
MD
Comm
UT
Comm
WY
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
PA
OH
OH
OH
OH
Page 12 of 22
Pre.Enr.
Payer ID
Name
*****
AMM02
MC051
38224
Medical Services For Indigents (MSI) (Advanced Medical Management)
MediCal type 04
Medical Value Plan (MVP) - Ohio
*****
*****
01001
Medicare CA
10301
95655
13123
62160
59221
59227
59225
Medicare Tennessee
Medigold
Medigold PPO
MedSolutions, Inc
Mega Life & Health Insurance Company - Insurance Center
Mega Life & Health Insurance Company, The - OKC
Mega Life & Health Insurance Company, The - Starbridge Star HRG
01047
MEMIC
MCA11
MHHNP
HCP01
13310
86052
MER11
IP079
Memorial Clinical Associates / SelectCare of Texas (MCA)
Memorial Hermann Health Net-Providers
Memorial Medical Group
Mercer Administrators
Mercy Care Plan (AHCCCS)
Mercy Health Plan
Mercy Physicians Medical Group (MPMG) (NAMM Southern CA)
Meritain Health (Formerly know was Weyco) – Payer ID valid for claims with billing submission
address of 2370 Science Parkway Okemos, Michigan 48864
Meritain Health (Formerly known as Corp. Benefit Services/CBSA/Fortis Self Funded Admin and
Performax, Inc. Payer ID valid only for claims with a billing submission address of P.O. Box
27267, Minneapolis, MN 55427-0267)
Meritain Health (Formerly known as E-V Benefits Management, Inc, Columbus, OH)
Meritain Health (Formerly known as NABN, Columbus, OH.) Payer ID valid only for claims with
billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476,
Cleveland, OH 44101-5476.
Meritain Health (Formerly known as North American Benefits Network, Cleveland, OH). Payer ID
valid only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928
or P.O. Box 89476, Cleveland, OH 44101-5476
Meritain Health (formerly North American Administrators, Inc.)
Meritain Health/Agency Services (formerly Agency Servicess, Inc.)
Meritain Health/North American Administrators Mesa Mental Health
Methodist First Choice
Metro Plus Health Plan
Metropolitan Health Plan
Metropolitan Health Plan
Michael Reese Physicians Group
Mid Atlantic Psychiatric Services, Inc. (MAPSI)
Mid Rogue Oregon Health Plan
Mid-America Associates Inc.
Mid-America Associates, Inc.
Mid-County Physicians Medical Group (San Diego) (Synermed)
38232 41124
34159
34159
34159
64157
64158
64157
85035
23550
13265
10850
10850
37127
52148
MRIPA
37281
37281
SYMED
47080
62168
MHP77
MPH77
59224
79480
79480
05018
SYMED
37233
64088
37275
43179
37265
51062
00076
38334
20676
NM505
20149
38336
50749
Claims Type
State
Comm & HMO
Govn't
Comm
CA
CA
OH
Gov
CA
Gov't
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
TN
OH
OH
GA
CA
AZ
AZ
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Midlands Choice, Inc.
Comm
MidSouth Administrative Group
Midwest Health Partners
Midwest Health Plans, Inc.
Mid-West National Life Insurance Company of Tennessee
MidWest Security Admin
Midwest Security Administration
MIPS
Mission Community Hospital of Huntington Park
Mississippi Public Entity Employee Benefit Trust (MPEEBT)
Mississippi Select Health Care
Missoula County Medical Benefits Plan
Missouri Care/MC
MLink
Molina Healthcare - Florida
Molina Healthcare - Indiana
Molina Healthcare - Michigan
Molina Healthcare - Nevada
Molina Healthcare - New Mexico
Molina Healthcare - Ohio
Molina Healthcare - Washington
Mondial Assistance
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
NM
MN
MN
OR
CA
MS
MS
MI
OH
WA
VA
Page 13 of 22
Pre.Enr.
Payer ID
Name
*****
13174
MMLI3
MMLIC
MMLI2
35092
IP083
36111
84095
86040
37233
35177 95444
AMM02
95655
SYMED
39634
34080
37256
59140
71412
71412
38224
14165
91136
91136
91136
Montefiore Contract Management Organization
Monumental Life Insurance Co (Hurst, TX)
Monumental Life Insurance Co (Little Rock, AR)
Monumental Life Insurance Co. (Louisville, KY)
Morris Associates
Mosaic Medical Group
Motorola
Mountain Medical Affiliates
Mountain States Administrative Services (Tucson, AZ)
MPE Services Inc.
MPLAN (Medicaid)
MPLAN, Inc. - HealthCare Group
MSI (Medical Services For Indigents) (Advanced Medical Management)
Mt Carmel
Multicultural Primary Care Medical Group (San Diego) (Synermed)
Multiplan Inc for American Family
Multiplan Wisconsin Preferred Provider Network
Mutual Assurance
Mutual Group (The) (US) Mutual of Omaha
Mutually Preferred
MVP - Ohio
MVP Health Plan of NY (For your MVP Provider number, call 800-684-9286)
N.W. Ironworkers Health & Security Trust Fund
N.W. Roofers & Employers Health & Security Trust Fund
N.W. Textile Processors
NABN (Columbus, OH) Now known as Meritain Health. Payer ID valid only for claims with billing
submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland,
OH 44101-5476
National Association of Letter Carriers (NALC)
National Benefit Administrators - New Jersey
National Benefit Administrators - North Carolina
National Capital Preferred Provider Organization (NCPPO) (To obtain your provider ID number,
please call the NCPPO Customer Service Department at (800) 272-5911. )
National Financial Insurance Co
National Foundation Life Insurance Co
National Health Insurance Company
National Imaging Assoc Inc
National Radiology Network, The
National Radiology Network, The (formerly Health Help Network)
National Rural Electric Cooperative Assoc.
National Rural Letter Carrier Assoc.
National Telecommunications Cooperative Association (NTCA - Staff)
National Telecommunications Cooperative Association (NTCA)
Nationwide Health Plans
NCAS - Charlotte, North Carolina
NCAS - Fairfax, Virginia
Neighborhood Health Plan - Boston, Massachusettes
Neighborhood Health Plan - Florida
Neighborhood Health Plan - Rhode Island
Neighborhood Health Providers & Suffolk Health Plan (NHP - SHP) (Please call 631-3603102 for your unique NHP/SHP provider number)
Nesika Health Group
Netcare Life & Health Insurance - Hagatna, Guam
Network Health (please contact Provider Relations at 617-806-8104 or [email protected]
for an EDI setup form)
*****
34159
53011
56175
56176
90001
*****
90956
98205
75275
NIA11
59087
59087
52132
71412
52104
52103
31417
75191
75190
04293
96107
05047
11325
37255
66055
04332
77076
Network Health Insurance Corporation - Medicare
39111
58204
76031
75281
65056
48186
24819
38225
81264
22603
65085
Network Health Plan - Wisconsin
Network TPA, LLC
New Era Employee Welfare Benefit
New Era Life Insurance Company
New Market Dimensions
New York Presbyterian Community Health Plan
New York Presbyterian System Select Health
NGS American
Nippon Life Insurance Company of America
NJ Carpenters Health Fund
North America Administrators (NAA) - Nashville, Tennessee
Claims Type
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
State
TX
AR
KY
CA
MS
CA
OH
OK
NY
Comm
OH
Comm
Comm
Comm
NJ
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
TX
TX
NC
CA
MA
FL
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
WI
NY
NY
TN
Page 14 of 22
Pre.Enr.
Payer ID
34159
IP079
64157
37314
35212
64157
38238
36347
88027
NWDC1
36346
16644
71080
37299
72127
*****
*****
*****
*****
13350
72087
14163
34189
95435
25133
22321 80705
80705
91136
52148
52148
20133
13383
25681
13382
13381
62171
06111
87068
SYMED
SYMED
93029
33053
95959
95962
95959
95959
95999
95964
95959
95959
37287
58174
58204
66917
76569
61129
10525
68049
20472
37086
72126
13522
Name
North American Benefits Network (Cleveland, OH). Now known as Meritain Health. Payer ID valid
only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or
P.O. Box 89476, Cleveland, OH 44101-5476
North American Medical Management - Southern California
North American Preferred (Now known as Meritain Health)
North Broward Hospital District
North Texas Healthcare Network
North American Administrators (Now known as Meritain Health)
Northern California Sheet Metal Workers Health Care Plan
Northern Illinois Health Plan
Northern Nevada Trust Fund
Northwest Diagnostic Clinic (NWDC)
Northwest Suburban IPA (Illinois)
Nova Healthcare Administrators, Inc. (Grand Island, NY)
Novasys Health Network
Nyhart
Ochsner Health Plan (Payor requires unique provider ID for each practitioner/provider; please
contact Jill Brant at (504) 219-6682 or [email protected])
ODS Health Plan
Office of Group Benefits - Louisiana
Ohana Health Plan
25133
Ohio Health Choice PPO
Ohio Health Group
Omnicare - A Coventry Health Plan
One Call Medical
One Health Plan of Georgia, Inc.
One Health Plan of Illinois, Inc.
Operating Engineers Locals 302 & 612 Health & Security Fund, Group # F12
Optimum Choice of the Carolina’s, Inc. (OCCI)
Optimum Choice, Inc. (OCI)
Optimum Healthcare
Orthonet - Aetna
Orthonet - Healthnet
Orthonet - Uniformed Services Family Health
Orthonet Corporation - CIGNA
OSF Health Plans
Oxford Health Plans
P5 Health Plan Solutions of Utah
Pacific Alliance Medical Center
Pacific Alliance Medical Group and Hospital (Synermed)
Pacific Source Health Plans
Pacificare Behavioral Health
Pacificare of California - Claims
PacifiCare of Colorado - Claims
Pacificare of Oregon -Secure Horizon/HMO claims only
Pacificare of Washington
Pacificare PPO - All States
PacificCare of Arizona - Claims
PacificCare of Oklahoma - Claims
PacificCare of Texas - Claims
PAI (Planned Administrators, Inc.)
Paragon Benefits, Inc.
Parity Healthcare
Parkland Community Health Plan
Passport Advantage (DOS 1-1-10 and forward only)
Passport Health Plan
Patient Advocates, LLC
Peach State Health Plan
Pediatric Associates
Pekin Insurance
Peoples Health Network
Perfect Health Insurance Company, The
Performax, Inc. (Now known as Meritain. Payer ID valid only for claims with a billing submission address of P.O. Box 27267, Minneapolis, M
N 55427-0267)
PersonalCare
13306
PHCS Savility Payers
41124
Claims Type
State
Comm
OH
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
CA
FL
IL
IL
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
LA
HI
OH
IL
CA
OR
CO
OR
WA
AZ
TX
IL
MN
Comm
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
Page 15 of 22
Pre.Enr.
*****
*****
*****
Payer ID
03440
58204
58204
PA513
38265
36345
37136
PHCS1
20398
37330
37330
62155
12399
47027
39156
24735
PPM01
84109
37224
64160
37287
72045
58204
32680
16111
72148
38335
04334
36373
53476
61665
59291
56178
65090 65088
73145
61106
31478
60110
36401
60110
41147
BC099
BC099
43166
43166
90440
PREHP
PRESA
Name
Phoenix Health Plan
Physician Associates - Louisiana
Physician Care Network
Physicians Associates of San Gabriel Valley - DOS 1-1-09
Physicians Care
Physicians Care Network - Rockford, Illinois only
Physicians Health Association - Illinois
Physicians Health Choice - claims
Physicians Health Collaborative
Physicians Health Plan - Mid Michigan
Physicians Health Plan - South Michigan
Physicians Health Plan - TennCare
Physicians Health Plan of Northern Indiana
Physicians Mutual Insurance Company
Physicians Plus Insurance Corporation
Pinnacle Claims Management, Inc.
Pinnacle Physician Management Organization
Pinnacol Assurance
Pittman and Associates
Pivotal Plan
Planned Administrators, Inc.
Plumbers & Steamfitters Health & Welfare Fund
Podi Care Managed Care
Poly America Medical & Dental Benefits Plan
POMCO
PPO Plus LLC
PPOM LLC
Practicare Inc
Prairie States Enterprises
Preferred Benefit Administrators
Preferred Benefits Administrator
Preferred Care FL
Preferred Care NC
Preferred Care Partners (Encounters)
Preferred Care Partners (Miami, Florida)
Preferred Community Choice
Preferred Health Plan, Inc. - Louisville, Kentucky
Preferred Health Professionals
Preferred Health Systems Insurance Company (PHSIC)
Preferred Network Access, Inc.
Preferred Plus of Kansas
PreferredOne
Premera Blue Cross - Washington
Premera Blue Cross Blue Shield - Alaska
Premier Benefits Inc.
Premier Health Plans
Premier Health Systems
Presbyterian Health Plan
Presbyterian Salud (NM)
45056
Prestige Health Choice
39185
IP079
82048
PRIME
56144
56190
IP079
IP079
IP079
IP079
IP079
IP079
IP079
IP079
IP079
IP079
IP079
11678
Prevea Health Plan
Primary Care Associates Medical Group (PCAMG) ( for DOS 1-1-09 and beyond)
Primary Health Network
Primary Health Plan
Primary Physician Care
Prime Vision Health
PrimeCare Medical Network - Chino
PrimeCare Medical Network - Citrus Valley
PrimeCare Medical Network - Corona
PrimeCare Medical Network - Hemet
PrimeCare Medical Network - Inland Valley
PrimeCare Medical Network - Moreno
PrimeCare Medical Network - Redlands
PrimeCare Medical Network - Riverside
Primecare Medical Network - San Bernardino
PrimeCare Medical Network - Sun City
PrimeCare Medical Network - Temecula
PrimeWest Health Systems
Claims Type
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm & HMO
Comm & HMO
Comm & HMO
Comm & HMO
Comm & HMO
Comm & HMO
Comm & HMO
Comm & HMO
Comm & HMO
Comm & HMO
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
State
IL
IL
MI
MI
IN
LA
FL
KY
MN
WA
AK
NM
NM
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
Page 16 of 22
Pre.Enr.
Payer ID
Name
61271
61271
38217
37303
37268
37315
38329
59296
36331
41163
37242
59041
34134
37309
CAPMN
09822
AMM03
91136
Principal Financial Group
Principal Life Insurance
Priority Health
Prism - First Health
Prism Network, Inc.
Prism-Univera
Procare Health Plan - Detroit, Michigan
Professional Benefit Administrators (Winter Park, FL)
Professional Benefit Administrators, Inc. (Oak Brook, IL ONLY)
Professional Claim Administrators
Professional Claims Management - Canton, Ohio
Professional Insurance Company (PIC) (Formerly GE Voluntary Benefits PIC)
Professional Risk Management
Protective Life Insurance
Prudent Medical Group (formerly known as Hollywood Presbyterian Medical Group)
PSN - Florida Medicaid (JMH)
Public Health Medical Services (Advanced Medical Management)
Puget Sound Benefits Trust
Claims Type
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
91136
Puget Sound Electrical Workers Trust
Comm
42172
Puget Sound Health Partners
Comm
48055 51052
39197
35174
23342
73067
37129
57117
91176
SYMED
00851
00910
00611
00932
00932
38221
47076
73066
37278
36396
16117
84065
37602
36215
Pyramid Life Insurance Company Pyschcare, LLC
Quad Med - Pewaukee, Wisconsin
Qual Choice of Arkansas
QualCare, Inc. (New Providers must enroll with QualCare at (800) 992-6613, option 5.)
Quick Trip Corporation
Quincy Health Care Management
QVI Risk Solutions Inc
RBMS, LLC
Redlands IPA (Synermed)
Regence Blue Cross Blue Shield of Oregon
Regence Blue Cross Blue Shield of Utah
Regence Blue Shield - Idaho
Regence Blue Shield WA only
Regence Care WA only
Regency Employee Benefits
Regional Care, Inc.
Reserve National Insurance
Resource Administrators
Resurrection Health Care Preferred/AKA Family Medical Network *Please call (773) 572-8311 or (
773) 572-8309 prior to your first submission of claims.
RMSCO, Inc.
Rocky Mountain Health Plan
Rooney Life Inc.
Rosemont of Des Plaines, IL
36339
Rush Health Association
36389
AMM03
31441
35164
62308
MSO77
Rush Prudential Health Plans - HMO Only
Ryan White Network (Advanced Medical Management)
S & S Healthcare Strategies
Sagamore Health Network
SAMBA
San Diego County Coverage Initiative (CI)
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
State
MI
FL
IL
CA
CA
WI
AR
OK
CA
OR
UT
ID
WA
WA
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
CA
IN
CA
Page 17 of 22
Pre.Enr.
Payer ID
MSO11
MSO22
MSO33
BS001
*****
68035
77038
SCAN1
16146
88030
60054
13310
28530
95959
95964
95962
95959
95959
95959
95959
39045
64088
42137
37282
37282
*****
SCOK1
23285
SSC11
00014
59111
36404
34131
83035
23249
39033
39033
76056
75280
76342
MBA01
62159
84076
84096
02057
91131
25133
STGEB
37318
SYMED
56131
25133
35227
37266
37259
52190
23253
84146
SLCH1
35199
22240
35199
35199
37264
STJOE
STJOE
Name
San Diego County Medical Services (CMS)
San Diego County Physician Emergency Services (PES)
San Diego County Ryan White Care Act
San Francisco Electrical Workers – IBEW Local 6 *They will all have a prefix code of "XEL" as their
member ID on the BSC card.
San Joaquin Health Administrators
Sante Health Systems and Affiliates
SCAN Health Plan
SCHC Total Care Inc
Scott & White Health Care Plan
Scripps Medical Plan
Seabury & Smith
Secure Health Plans of Georgia, LLC
Secure Horizon California- Pacificare
Secure Horizons Arizona - Claims
Secure Horizons Colorado - Claims
Secure Horizons Oklahoma - Claims
Secure Horizons Oregon - Claims
Secure Horizons Texas - Claims
Secure Horizons Washington - Claims
Security Health Plan
Select Administrative Services (SAS)
Select Benefit Administrators - Des Moines, Iowa
Select Benefit Administrators of America
Select Benefits Administrators of America (submission address of P.O. Box
440, Ashland, Wisconsin 54806.)
Select Care of Oklahoma - Tribute
Select Health of South Carolina
Select Senior Clinic
SelectCare
Self Insured Benefit Administrators (Clearwater, FL)
Self Insured Plans (Naples, FL)
Self-Funded Plans, Inc.
Senior Whole Health
Sentinel Management Services
Sentry Insurance a Mutual Company
Sentry Life of New York
Seton CHIP
Shasta Administrative Services
Sierra Health Services
Sierra Nevada Medical Associates
Signature Health Alliance
Sinclair Health Plan
Sloans Lake Preferred Health Networks
Smith Administrators
Sound Health (now known as First Choic Health Network)
SouthCare - Healthcare Preferred
SoutheastTexas GovEmp Bene Pool
Southern Benefit Services
Southern CA Children's Network (SynerMed)
Southern Group Administrators
Southern Health Services, Inc.
SouthPoint Hotel & Casino
Southwest Service Life
Special Agents Mutual Benefit Association
Special Risk International (SRI)
Spectrum Admin, Inc. TPA
Spina Bifida - VA HAC
St Lawrance Co Healthcare Plan
St. Anthony Memorial Healthcare Centers - MDWISE
St. Barnabas System Health Plan
St. Catherine Hospital PHO - MDWISE
St. Francis Health Network
St. John's Claim Administration
St. Joseph Hertiage HealthCare
St. Jude Hertiage HealthCare
Claims Type
State
Comm
Comm
Comm
CA
CA
CA
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
CA
CA
CO
MS
IA
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
OK
SC
FL
CA, NV
ID
TX
NY
CA
CA
Page 18 of 22
Pre.Enr.
*****
Payer ID
35199
88029
37116
59225 61425
31053
57254
75087
14163
91151
6089
31121
74227
95202
37301
Name
St. Margaret Mercy Healthcare Centers - MDWISE
St. Mary's Health Plan
St. Therese Physician Associates
Star Hrg Ins.
Starmark
State Farm Insurance Companies
State of Texas Dental Plan
States General Life Insurance
Staywell Health Plan
Sterling Option One
Stirling Benefits (Stirling & Stirling)
Stoner & Associates - Cincinnati, Ohio
Student Resources
Summacare Health Plan
Summit America Insurance Services, Inc.
12X52
Sun Health Corporation
68057
23218
Sunshine State Health Plan
Superior Administrators - Santa Ana, CA
Superior Health Plan Texas (Prior to submitting claims, please call Provider Relations Dept at 1800-218-7453)
Surburban Health Organization
SynerMed
Tall Tree Administrators
Tarrant Health Services
TBG Administrative Services
Teamcare
Teamsters Local Union #301
Temple Hospital
Texas Children's Health Plan
Texas Childrens Health Plan (Medicaid)
Texas First Healh Plans
39188
35199
SYMED
88067
37228 39157
36215
36612
SYMED
76048
75228
TX1ST
63092
Texas HealthSpring
TTCEC
THIPA
39065
74214
20081
48055
92620
61425
THIPA
31182
38201
38202
38201
97910
13402
23856
69493
37230
TFLIC
TLIN2
TLINS
TLIN3
59222
TOLIC
37284
36397
57106
38269
34185
TCUSA
TCUCH
91078
61425
Texas True Choice
THIPA
Time Insurance Company
TML Intergovernmental Employee Benefits Pool
Todays Health Wisconsin
Today's Option (American Progressive and Pyramid Life)
Tongass Timber Trust
Tooling and Manufacturing Assocation
Torrance Hospital IPA (THIPA)
Total Community Care
Total Health Care
Total Health Choice - Florida
Total Healthcare, Inc.
Touchpoint Health Plan HMO
Touchstone Health - Health Net SmartChoice
Touchstone Health PSO
Tower Life Insurance Company
TR Paul, Inc.
TransAmerica Financial Life Insurance Co (Hurst, TX)
TransAmerica Life Insurance Co (Hurst, TX)
TransAmerica Life Insurance Co (Little Rock, AR)
TransAmerica Life Insurance Co (Louisville, KY)
TransAmerica Life Insurance Company
TransAmerica Occidental Life Insurance Co (Kansas City, MO)
TransChoice - Key Benefit Administrators
Trellis Health Partners
Tricare North Region Claims
Trinity Health (Enrollment required; please contact Noreen at (248) 489-5281)
TriSurant (formerly Health Administration Services - HAS)
True Choice USA
True Choice USA - Christus
Trusteed Plans Service Corporation
Trustmark Insurance
Claims Type
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
NV
IL
WA
CT
OH
CA
Comm
TX
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
State
CA
CA
TX
TX
TX
TX
CA
TX
CA
FL
TX
TX
AR
KY
MO
MI
Page 19 of 22
Pre.Enr.
Payer ID
Name
Tufts Health Plan (Submitter must call the payer before submitting claims to to obtain payer id: 888880-8699 ext 4042)
*****
63092
RPF02
52629
33056
74223
37292
31107
39026
52180
80314
62170
HCP01
75243
13142
87042
70408
25175
62183
86049
87726
87726
87726
TX Healthspring
TX Premier Plan - Medicaid-THIN
UCare of Minnesota
UCMN - United Behavioral Health (Health Plan - HMO)
UICI - Administrators - State of Nevada
UMMH
UMR - Cincinnati
UMR - Wausau - UHIS
UMWA Health & Retirement Funds
Unicare
Unified Health Services (Workman's Comp Only)
Unified IPA
Uniform Medical Plan (Harrington Benefit Services)
Union Labor Life Insurance
Union Pacific Railroad Employees Health Systems
Union Security Insurance Company
Unison Health Plan - (formerly known as Three Rivers)
Unison Health Plan - Better Health Plans, Inc
United Americhoice of Pennsylvania
United Behavioral Health (UBH)
United HealthCare
United HealthCare (formerly MetraHealth Care Plans, Met Life, Metropolitan Life Ins Co,
MetraHealth Elect, MetraHealth Healthcare Network HMO) (no vision claims)
Claims Type
State
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
TX
TX
NV
CA
Comm
87726
United HealthCare (formerly MetraHealth Healthcare Network PPO, New York State Employees
(Empire), Travelers Ins Co, Travelers Plan Administrators) (no vision claims)
Comm
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
87726
84132
71412
41194
74095
33001
50528
09830
United HealthCare (formerly The Travelers, Travelers Health Network)
United HealthCare of Alabama
United HealthCare of Arizona
United HealthCare of Arkansas
United HealthCare of California - Northern California
United HealthCare of California - Southern California
United HealthCare of Colorado
United HealthCare of Florida
United HealthCare of Georgia
United HealthCare of Illinois
United HealthCare of Kentucky
United HealthCare of Louisiana
United HealthCare of Mississippi
United HealthCare of New England
United HealthCare of New Jersey
United HealthCare of New York
United HealthCare of North Carolina
United HealthCare of Ohio
United HealthCare of Tennesee
United HealthCare of Texas - Dallas
United HealthCare of Texas - Houston
United HealthCare of the Mid-Atlantic
United HealthCare of the Midlands - HMO (Choice Select)
United HealthCare of the Midlands - PPO (Choice Plus, Select Plus, Self Funded)
United HealthCare of the Midwest - Choice, Choice Plus, Select, Select Plus
United HealthCare of the Midwest - Medicare Complete
United HealthCare of Upstate New York
United HealthCare of Utah
United HealthCare of Virginia
United HealthCare of Wisconsin
United HealthCare Plans of Puerto Rico
United Medical Alliance (UMA)
United of Omaha
United Resources Network - (URN)
United States Automobile Association (USAA)
Universal Care - California
Universal Health Care, Inc.
University Family Care
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
AL
AZ
AR
CA
CA
CO
FL
GA
IL
KY
LA
MS
NJ
NY
NC
OH
TN
TX
TX
NY
UT
VA
WI
CO
CA
Page 20 of 22
Pre.Enr.
*****
*****
*****
*****
*****
*****
Payer ID
Name
09908
22329
25133 23281
38337
93092
USFHP
13407
12115
VAFSC
23253 23173
SYMED
72128
86062
VHMG1
23173
24818
VFP11
54176
University Family Care - Maricopa Health Plan
University Health Plan of New Jersey
University of Missouri UPMC Health Plan
Upper Peninsula Health Plan
US Benefits
US Family Health Plan (USFHP)
USFHP - St. Vincent Catholic Medical Centers of New York
VA Fee Basis Programs
VA Financial Services Center
Valley Preferred - PPO
Vanderbilt Health Plan
Vanguard Health Systems (SynerMed)
Vantage Health Plan, Inc.
VentureNet Healthcare
Verdugo Hills Medical Group
VHP Community Care
Vida Care
Village Family Practice
Virginia Premier Health Plan
12K83
Virginia Premier Health Plan (Medicaid)
37297
55248
59266
22264
37294
38356
73155
58082
75261
Vison Care Incorporated
Vista Health Plan
Volusia Health Network
Vytra Health Plans
Washington Employers Trust
Washtenaw Community Health Organization
Waterstone Benefit Administrators
Watkins Associated Industries
Web TPA/Community Health Electronic claims/CHEC
36337
Weiss Health Providers
87815
59354
14163
14164
59608
Well Fargo 3rd Party Administrators (formerly known as Acordia National)
Wellcare Health Plans (Encounters)
Wellcare HMO, Inc.
Wellcare of Conneticut
Wellcare of Florida
Wellcare of Georgia (Wellcare Provider ID is required. To obtain your provider ID, please call (866)
231-1821 option 2 then 4)
Wellcare of Louisiana
Wellcare of New York
WellCare of Ohio
WellCare of Texas
Wellcare Private Fee for Service Plans
WellPath
Wells Fargo 3rd Party Administrators, Inc. (Formerly Accordia)
West Covina Medical Group
Western Growers Assurance Trust
Western Growers Insurance Company
Western Health, Inc.
Western Mutual Insurance
Western Southern Financial Group - Cincinnati, Ohio
Weyco, Inc. (Now know as Meritain Health) – Payer ID valid for claims with billing submission
address of 2370 Science Parkway Okemos, Michigan 48864
William C. Earhart
Wilson-McShane
Windsor Home Network
Windsor Medicare Extra
Wisconsin Auto and Truck Dealers
Wisconsin Physicians Service
Worksite Benefit Services, LLC
World Insurance Company
WPPN
WPPN - HPO (HealthEOS)
WPS Tricare
Writer's Guild Industry Health Plan
Yavapai County
14163
*****
*****
14163
14164
14163
14163
77072
25133
87815
WCMG1
24735
24735
37306
37247
31048
38232
*****
93050 41095
11696
62153
39200
12X29
20333
75276
34080
34080
12X29
23710
09829
Claims Type
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm & HMO
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
State
NJ
TX
FL
NY
TX
CT
GA
NY
OH
TX
OH
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
Page 21 of 22
Pre.Enr.
Payer ID
75285
Name
Young Life
Claims Type
State
Comm
**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission
www.officeally.com 866.575.4120
Revised 04/06/2010
Payer List subject to change without notice
Page 22 of 22