(837I)

1 optuminsight electronic remittance advice payer List (ERA)(As of 10/08/2018) For up-to-date payer information, visit contact optuminsight Customer Service and Support at 866-367-9778 PAYER_NAMESTATEPAYER_IDENROLLMENTP ayer TypeAmerican Income Life Insurance Company (837I & P)ALL 60577 YG1199 National Benefit FundALL13162 YGAARP Hospital Indemnity Plans insured by UnitedHealthcare Insurance CompanyALL36273 YTAARP Medicare Supplement Plans insured by UnitedHealthcare Insurance CompanyALL36273 YTABS - US Health (837I & 837P)ALL38259 YGAdministrative Concepts (837I & 837P)ALL22384 YGAdvantek Benefit Administrators (837I & 837P)ALLADVTKYGA dventist Health System West (837I & P)ALL95340 YGAdvocate Health Centers (AHC) (837P)ALL36320 YGAdvocate Physicians Partners (PHO) (837P)ALL65093 YGAetna - American Continental Insurance Company (837I & 837P)ALL62118 YGAetna (837I & 837P)ALL60054 YGAetna Better Health - PA Medicaid (837P & 387I)ALL23228 YGAetna Better Health of NY (837P)NY34734 YGAetna Better Health of Florida (837I & 837P)FL128 FLYGA etna Better Health of IL (837I & 837P)IL26337 YGAetna Better Health of KY (837I & 837P)KY128 KYYGA etna Better Health of Louisiana (837I & 837P)LA128 LAYGA etna Better Health of Michigan (837I & 837P)MI128 MIYGA etna Better Health of New Jersey (837I & 837P) NJ46320 YGAetna Better Health of Ohio (837I & 837P)

2 OH50023 YGAetna Better Health of VirginiaVA128 VAYGA etna Better Health of West Virginia (837I)WV 128 WVYGA etna Better Health Plan of Nebraska (837I & 837P)NE42130 YGAetna TX Medicaid & CHIP (837I & 837P)TX38692 YGAffinity Essentials (837I & 837P)ALL23334 YGAffinity Health Plans (837I & 837P)ALL13334 YGAffinity Medicare Advantage (837I & 837P)ALL13333 YGAGC International Union of Operating Engineers Local 701 (837I & 837P)ALL91136 YGAK United Food and Commercial Workers (AK UFCW) (837I & 837P)ALL91136 YGAlaska Carpenters (837I & 837P)ALL91136 YGAlaska Hotel Employees Restaurant & Camp Employees (AK HERE) (837I & 837P)ALL91136 YGAlaska Laborers Construction Industry Health & Security Trust (837I & 837P)ALL91136 YGAlaska Pipe Trades U A Local 375 (837I & 837P)ALL91136 YGAlaska Public Employees Association (APEA/JESS Health & WelfareTrust) (837I & 837P)ALL91136 YGAllegiance Benefit Plan Management Inc (837I & P)ALL81040 YGAlliant Health Plans of Georgia (837I & 837P)GA58234 YGAllied Benefit Systems (837I & 837P)ALL37308 YGAllied Metal Crafts Security Plan Trust Fund (837I & 837P)ALL91136 YGHighlighted payers are new or have been altered in the last 90 days.

3 Please verify that your system is setup correctly for this payerOptumInsight electronic remittance advice payer List (ERA)(As of 10/08/2018) For up-to-date payer information, visit contact optuminsight Customer Service and Support at 866-367-9778 PAYER_NAMESTATEPAYER_IDENROLLMENTP ayer TypeHighlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for this payerAlohaCare (837I & 837P)ALLALOHAYGA malgamated (837I & 837P)ALL13550 YGAmeraplan (837I & 837P)ALL38219 YGAmeriben Solutions (837I & 837P)ALL75137 YGAmerican Administrative Group AAG (Gallagher Benefits) (837I & P) ALL37283 YGAmerican General (837I & 837P)ALL62030 YGAmerican Insurance Administrators (837I & 837P)ALL26119 YGAmerican National Insurance CO (ANICO) (837I & 837P)ALL74048 YGAmerican Postal Workers Union Health Plan (837I & P)ALL44444 YGAmerican Republic Insurance (837I & 837P)ALL42011 YGAmerican Republic Insurance Company (837I &P)ALL56071 YGAmerican Specialty Health (837I & 837P)

4 ALLASH01 YGAmerigroup (837I & 837P)ALL27514 YGAmerigroup (837I & 837P)IA, DC, MD, FL, GA, WA, TN, TX, NM26375 YGAmeriHealth Administrators (837I & 837P) (835s returned under PAKEY)ALL54763 YNAmerihealth Caritas Iowa (837I & 837P)IA77075 YGAmerihealth Caritas Louisiana (837I & 837P)LA27357 YGAmerihealth Caritas VIP Care (837I & P) ALL77062 YGAmeriHealth Caritas VIP Care Plus of MI (837I & 837P)MI77013 YGAmerihealth District of Columbia (837I & 837P)ALL77002 YGAmerihealth HMO (837I & 837P)ALL23037 YGAmerihealth HMO of Delaware and New Jersey (837I & P)DE, NJ95044 YGAmeriHealth Mercy Health PlanALL22248 YGAmeriHealth NorthEast (837I & 837P)ALL77001 YGAmerihealth-NJ (Non-HMO Claims) (837P)NJSX075 YNAmFirst Insurance Company (837I & 837P)AL64090 YGAnthem BCBS Kentucky (837I)KY00160 YGAnthem BCBS of Indiana (837I)IN00130 YGAnthem BCBS of Virginia (837I &P)VA00423 YGAnthem BCBS Ohio (837I)OH00332 YGAnthem of NevadaNVNVBLSYTAPEX Health Solutions (837I & 837P)ALL34196 YGArise (837I & 837P)ALL39185 YGAsian American Medical Group (837P)ALLAAMG1 YGASRM LLC (837I & 837P)ALLASRM1 YGAssociated Administrators LLC (837I & 837P)ALL13788 YGAuxiant (837I & 837P)ALLAUX01 YGAVERA (837I & 837P)ALL46045 YGAvMed (837I & 837P) Provider must enroll for EFT in order to receive electronic remittance , ALL59274 YGOptumInsight electronic remittance advice payer List (ERA)

5 (As of 10/08/2018) For up-to-date payer information, visit contact optuminsight Customer Service and Support at 866-367-9778 PAYER_NAMESTATEPAYER_IDENROLLMENTP ayer TypeHighlighted payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for this payerBankers Life And Casualty (837I & P)ALL36066 YGBanner Health (837I & 837P)ALL12X42 YGBC Illinois Medicare Advantage (837I & P) IL66006 YGBC Montana Medicare Advantage (837I & P) MT66006 YGBC New Mexico Medicare Advantage (837I & P) NM66006 YGBC Oklahoma Medicare Advantage (837I & P) OK66006 YGBC Texas Medicare Advantage (837I & P) TX66006 YGBCBSTX Medicaid STAR/CHIP TX66001 YGBeacon Health Options (previously ValueOptions) (837I & 837P)ALLVALOPYGB eacon Health Strategies (837I & 837P)ALL43324 YGBenefit Administrative Systems (837P & 837I)ALL36149 YGBenefit Management, Inc.

6 (837I & 837P)ALL48611 YGBenefit Plan Administrators Company (Eau Claire Wisconsin) (837P & IWI39081 YGBenefit Systems and Services, Inc. (837I & 837P)ALL36342 YGBeneSys, Inc. (837I & 837P)ALL37248 YGBetter Health Plan of Florida (837I & 837P)FL20488 YGBlue Advantage of Arkansas (837I & 837P)ARARBLSYTBlue Care Complete of Michigan (837I & 837P)MI32002 YGBlue Care of Virginia PPOVAVABLSYTBlue Chip of Rhode IslandRIRICHPYTBlue Choice Medicaid (837I & 837P)SC00403 YNBlue Cross Blue Shield of Alabama (837I)AL12B54 YNBlue Cross Blue Shield of Arizona Advantage (Formerly Banner Health Medisum) (837I & 837P)AZ77078 YGBlue Cross Community Options (837I & 837P)ALLMCDILYGBlue Cross of CaliforniaCABC001 YTBlue Cross of Georgia (837I)GA3537 IYTBlue Cross of IdahoIDIDBLCYTBlue Cross of Kansas (835s returned under KSBLS))

7 KS57325 YNBlue Cross of MichiganMI12B18 YNBlue Cross of Nebraska (835s returned under NEBLS)NE00260 YTBlue Cross of New York, Western (835s returned under N1 BLS)NY12B39 YTBlue Cross of North Carolina (835s returned under NCBLS)NC12B23 YTBlue Cross of Utah (835s returned under UTBLS)ALL12B42 YNBlue Cross of West Virginia (837I)WVSB941 YNBlue Medicare of NC (837I & 837P)This is Blue Cross Blue Shield NC Medicare Advantage Plan (835s returned under NCBLS)ALL56152 YNBlue Shield of Alabama (837I & 837P)ALALBLSYTBlue Shield of Alaska (835s returned under AC032)AKAKBLCYTBlue Shield of ArizonaAZAZBLSYTBlue Shield of California (for 837P & 837I claims)CABS001 YTBlue Shield of ColoradoCOCOBLSYTBlue Shield of ConnecticutCTCTBLSYTBlue Shield of DelawareDEDEBLSYTBlue Shield of FloridaFLFLBLSYTBlue Shield of GeorgiaGAGABLSYTO ptumInsight electronic remittance advice payer List (ERA)(As of 10/08/2018) For up-to-date payer information, visit contact optuminsight Customer Service and Support at 866-367-9778 PAYER_NAMESTATEPAYER_IDENROLLMENTP ayer TypeHighlighted payers are new or have been altered in the last 90 days.

8 Please verify that your system is setup correctly for this payerBlue Shield of HawaiiHIHIBLSYTBlue Shield of IdahoIDIDBLSYTBlue Shield of IllinoisILILBLSYTBlue Shield of Indiana ININBLSYTBlue Shield of Iowa IAIABLSYTBlue Shield of Kansas KSKSBLSYTBlue Shield of Kansas CityKSKCBLSYTBlue Shield of Kentucky KYKYBLSYTBlue Shield of Lousiana (837I & 837P)LALABLSYTBlue Shield of MaineMEMEBLSYTBlue Shield of MarylandMDSB690 YNBlue Shield of Massachusetts (837I & 837P)MAMABLSYTBlue Shield of MichiganMIMIBLSYTBlue Shield of MinnesotaMNMNBLSYTBlue Shield of MississippiMSMSBLSYTBlue Shield of MissouriMOMOBLSYTBlue Shield of MontanaMTMTBLSYTBlue Shield of NebraskaNENEBLSYTBlue Shield of NevadaNVNVBLSYNBlue Shield of New HampshireNHNHBLSYTBlue Shield of New JerseyALL22099 YNBlue Shield of New Mexico NMNMBLSYTBlue Shield of New York (Empire) (837I & 837P)NYNYBLSYTBlue Shield of New York, CentralNYN2 BLSYTBlue Shield of New York, UticaNYN4 BLSYTBlue Shield of New York, WesternNYN1 BLSYTBlue Shield of North CarolinaNCNCBLSYTBlue Shield of North DakotaNDNDBLSYTBlue Shield of Ohio OHOHBLSYTBlue Shield of Oklahoma (Remits will be returned with payerID OKBLS)

9 OK00840 YTBlue Shield of OregonORORBLSYTBlue Shield of PennsylvaniaPAPABLSYTBlue Shield of Rhode IslandRIRIBLSYTBlue Shield of South CarolinaSCSCBLSYTBlue Shield of South DakotaSDSDBLSYTBlue Shield of Tennessee (837I)TN5513 IYTBlue Shield of Tennessee (837P)TNTNBLSYTBlue Shield of Texas (includes Blue Cross of Texas)TXTXBLSYTBlue Shield of UtahUTUTBLSYNBlue Shield of VirginiaVAVABLSYTBlue Shield of West VirginiaWVWVBLSYTBlue Shield of WisconsinWIWIBLSYTBlue Shield of WyomingWYWYBLSYTB luegrass Family Health (837I & 837P)ALL61124 YGBMC HealthNet Plan (837I & 837P)ALL13337 YGBoonChapman (837I & 837P)ALL74238 YGOptumInsight electronic remittance advice payer List (ERA)(As of 10/08/2018) For up-to-date payer information, visit contact optuminsight Customer Service and Support at 866-367-9778 PAYER_NAMESTATEPAYER_IDENROLLMENTP ayer TypeHighlighted payers are new or have been altered in the last 90 days.

10 Please verify that your system is setup correctly for this payerBridgeSpan (837I & 837P)ALLBRIDGYGB right Health Plan (837I & 837P)ALLBHP01 YGBroadspire, A Crawford Company (837I & 837P)ALLTP021 YGBrown & Toland Medical Group (837I & 837P)ALL94316 YGBuckeye Community Health (837I & 837P)ALL68069 YGCALOPTIMA DIRECT (837I & P)ALLCALOPYGCamp Lejune Family Member Program (837I & 837P)ALLCLFM1 YGCapital District PHP *ALLSX065 YNCardinal Innovations (837I & 837P)ALL06607 YGCare Access PSN (837I & 837P)ALL65062 YGCare Wisconsin Health Plan (837I & 837P)ALL27004 YGCARE1ST Health Plan Califo