Assurance™ EDI - Claim Status Payer List

1 Assurance EDI - Claim Status Payer List To request a Claim Status connection to a Payer not on the list below, please submit a New Payer Connection Request. Reference the CAQH web site for CORE Certified payers. Batch and Real Time: Reference the ASC X12N/005010X212 ANSI health Care Claim Status Request and Response (276/277) guide to obtain the mapping of Claim Status transactions for Change Healthcare ASC X12N. Input. The Change Healthcare Claim Status Batch and Real Time Payer IDs below must be sent in all Batch and Real Time 276 transactions. Be aware all Claim Status transaction processing is a contracted service with Change Healthcare. Please contact your Account Executive if you are not contracted. See Legend for explanation of Payer List. Payer Name Change Change Associated Authorization Payer - Routing Must Submit Healthcare Healthcare Change Required assigned Method Claims to Change Claim Status Claim Status Healthcare Payer ID Healthcare - Batch or Real Portal Payer ID Claims CPIDs Batch and Real Time Payer ID Time only AARP AARP AARP1 5271/8940 Portal 36273 Real Time / No Portal Absolute Total Care CNTENE 8549/4272 No 68069 Real Time No Advantage By Buckeye (Bridgeway CNTENE 4793/9564 No 68069 Real Time No Advantage Plan).

2 AETNA AETNA AETNA1 4500/6400 Portal 60054 Real Time / No Portal Aetna Better health of Ohio ABHOH1 6876/7652 Portal 50023 Portal Aetna Better health of Virginia t CHCCN 1837/8538 No 25142 Real Time No Alabama Blue Shield (Professional) ALBCSP 2423 No 00510 Real Time No Alabama Blue Cross (Institutional) ALBCSI 5558 No 00010BC Real Time No Alabama Medicaid ALCAID 4479/5560/5587 No 752548221 Real Time No Alabama Medicare (Professional) 2468 2468 No 10102 Batch Yes Alabama Medicare (Institutional) 5559 5559 No 10101 Batch Yes Alaska Medicare (Institutional) 5521 5521 Batch 02001 Batch Yes Alliant health Plans ALLNT1 2589/3793 Portal 58234 Portal Allwell from Buckeye health Plan CNTENE 7776/7592 No 68069 Real Time No Allwell from health Net CNTENE 7766/7570 No 68069 Real Time No Allwell from Home State health CNTENE 7775/7591 No 68069 Real Time No Allwell from Louisiana Healthcare CNTENE 7773/7588 No 68069 Real Time No Connections Allwell from Managed health Services CNTENE 7770/7582 No 68069 Real Time No Allwell from Managed health Services health CNTENE 7786/8528 No 68069 Real Time No Wisconsin Allwell from Magnolia health CNTENE 7774/7589 No 68069 Real Time No Allwell from PA health & Wellness CNTENE 7783/8524 No 68069 Real Time No Allwell from Peach State health Plan CNTENE 7769/7581 No 68069 Real Time No Allwell from Sunflower health Plan CNTENE 7772/7586 No 68069 Real Time No Allwell from Sunshine health CNTENE 7768/7578 No 68069 Real Time No

3 Allwell from Superior HealthPlan CNTENE 7785/8527 No 68069 Real Time No Allwell from Buckeye health Plan CNTENE 7776/7592 No 68069 Real Time No Allwell from health Net CNTENE 7766/7570 No 68069 Real Time No Altius ALTIUS 1837/8538 No SX113 Real Time No Ambetter from health Net CNTENE 7808/8583 No 68069 Real Time No Ambetter from Homestate health CNTENE 7809/8584 No 68069 Real Time No Ambetter from Peach State health Plan CNTENE 6655/6756 No 68069 Real Time No Ambetter Illinicare health CNTENE 7286/9587 No 68069 Real Time No Ambetter New Hampshire Healthy Families CNTENE 7287/9588 No 68069 Real Time No American Postal Workers AMPWU 4503/6436 No 44444 Real Time No Amerigroup Corporation AMRGRP AMRGR1 1569/1741 Portal 27514 Real Time / No Portal AmeriHealth Caritas Delaware AHCDE 78507/7746 No 77799 Real Time No Anthem Blue Cross CABC 3511/4417 No 47198 Real Time No Arizona Blue Cross Blue Shield AZBCBS 4426/5547 No 53589 Real Time No Arizona Medicare (Professional) 1456 1456 Batch 03102 Batch Yes Arizona Medicare (Institutional) 5546 5546 Batch 03101 Batch Yes Arkansas Medicaid (Institutional) 1489 1489 No 716007869 Batch No Arkansas Medicaid (Institutional) 5597 5597 No 716007869 Batch No Arkansas Medicare (Professional) 2455 2455 No 07102 Batch Yes Arkansas Medicare (Institutional) 1526 1526 No 07101 Batch Yes Asuris Northwest Regence ASURNH 5942/4881 No 93221 Real Time No AvMed AVMED 1573/3802 No 59274 Real Time No Best Life and health BSTLFE No 95604 Real Time No Blue Care Network HMO (Professional) MIBCSP 2426 Real Time 00710 Real Time Yes Blue Care Network HMO (Institutional) MIBCSI 3532 Real Time 00210 Real Time Yes Blue Cross Blue Shield of National Capital DCBCBS 1509/2425 No 00080 Real Time No Area - CareFirst 00580.

4 Blue Cross Blue Shield of Western New York BWNYMC 1169/2516 No 00246 Real Time No Medicaid / CHP. Bridgeway health Solutions CNTENE 3922/4288 No 68069 Real Time No Buckeye Community health CNTENE 1962/4717 No 68069 Real Time No California Blue Shield CABS CABS1 1409/6569 No BS001 Real Time / No 94036 Portal California health and Wellness CNTENE 6646/6748 No 68069 Real Time No CareSource of Indiana CSRCIN 7143/7688 No INCS1 Real Time Yes CareSource of Kentucky - Humana CSRCKY 5624/6259 No KYCS1 Real Time Yes CareSource of Ohio CRSROH CRSRC1 2526/3826 Portal 31114 Batch / Portal Yes CareSource of West Virginia 2526 7263/8676 No WVCS1 Real Time Yes CeltiCare Massachusetts Behavioral health CENPAT 5957/2128 No 68068 Real Time No CeltiCare Massachusetts Medical CNTENE 5958/2129 No 68069 Real Time No Cenpatico Behavioral health Arizona CENPAT 4909/6136 No 68068 Real Time No Cenpatico Behavioral health Florida CENPAT 1630/2190 No 68068 Real Time No Cenpatico Behavioral health Georgia CENPAT 3912/4239 No

5 68068 Real Time No Cenpatico Behavioral health Illinois CENPAT 4663/6212 No 68068 Real Time No Cenpatico Behavioral health Indiana CENPAT 2985/3236 No 68068 Real Time No Cenpatico Behavioral health Kansas CENPAT 3663/5207 No 68068 Real Time No Cenpatico Behavioral health Mississippi CENPAT 5638/6268 No 68068 Real Time No Cenpatico Behavioral health Missouri CENPAT 4692/6215 No 68068 Real Time No Cenpatico Behavioral health Ohio CENPAT 1660/2175 No 68068 Real Time No Cenpatico Behavioral health South CENPAT 4676/6205 No 68068 Real Time No Carolina Cenpatico Behavioral health Texas CENPAT 3962/4746 No 68068 Real Time No Cenpatico Behavioral health Wisconsin CENPAT 4927/3220 No 68068 Real Time No Cenpatico Behavioral health of New CENPAT 5629/6263 No 68068 Real Time No Hampshire CHAMPVA / Spina Bifida / Children of CHMPVA No 84146 Real Time No Women Vietnam Veterans CIGNA CIGNA CGONL1 4509/6405 Portall 62308 Real Time / No Portal Colorado Blue Cross Blue Shield COBCBS 1415/1549 No 00050 Real Time No Colorado Medicare (Professional) 1449 1449 No 04112 Batch Yes Colorado Medicare (Institutional) 1547 1547 No 04111 Batch Yes Community health Choice COMHC 2538/3773 No 48145 Real Time No Community health Choice HIM COMHC 6687/6791 No 60495 Real Time No Connecticut Blue Cross Blue Shield CTBCBS 1420/3534 No 00060 Real Time No Connecticut Medicaid (Institutional) 3535 3535 No 061274678 Batch No Connecticut Medicaid (Professional) 4476 4476 No 061274678 Batch No Connecticut Medicare (Professional) 1452 1452 Batch 13102 Batch No Connecticut Medicare (Institutional)

6 3533 3533 Batch 13101 Batch No Continental General Insurance Company CONGEN 3865 No 71404 Real Time No Coordinated Care CNTENE 4665/6197 No 68069 Real Time No Cooperative Benefit Administrators CPBNAD 4532/6452 No 52132 Real Time No Coresource of Kansas CIty CSFMH No 48117 Real Time No Coresource of Little Rock ARCSRC 1983/3806 No 75136 Real Time No Coresource of Ohio OHCSRC 3524/4947 No 35183 Real Time No CoventryCares of Michigan OMNCRE 1837/8538 No 25150 Real Time No Coventry health and Life Nevada CVHLNV No 25133 Real Time No Coventry health and Life Oklahoma CVHLOK 1837/8538 No 25133 Real Time No Coventry health and Life Tennessee CVHLTN 1837/8538 No 25141 Real Time No Coventry health and Life WellPath WPCHC 1837/8538 No 25133 Real Time No Coventry health Care Advantra (Arizona, CHCADV 1837/8538 No 25152 Real Time No New Mexico, Texas only). Coventry health Care Advantra Freedom CHCADF 1837/8538 No 25152 Real Time No Coventry health Care CareLink CHCCL 1837/8538 No 25140 Real Time No Coventry health Care CoventryOne CHCCVT 1837/8538 No 25133 Real Time No Coventry health Care Delaware DECHC 8545 No 25130 Real Time No Coventry health Care Florida Vista Summit FLCHC 1837/8538 No 10551 Real Time No Coventry health Care Federal CHCFED 1837/8538 No Real Time No Coventry health Care Georgia GACHC 1837/8538 No 25127 Real Time No Coventry health Care Group health Plan CHCGHP No 25141 Real Time No Coventry health Care HealthAmerica CHCHA 1837/8538 No 25126 Real Time No Coventry health Care Illinois / Personal Care PRSNLC 1837/8538 No 25146 Real Time No Coventry health Care Iowa IACHC 1837/8538 No 25132 Real Time No Coventry health Care Kansas KSCHC No 10208 Real Time No Coventry health Care Louisiana LACHC 1837/8538 No 25135 Real Time No Coventry

7 health Care Missouri CHCMO 1837/8538 No 87043 Real Time No 25133. Coventry health Care National Network FRSTHL 2875/8538 No 73159 Real Time No (formerly First health ). Coventry health Care Nebraska NECHC 1837/8538 No 25136 Real Time No Coventry health Care Southern health CHCSHS 1837/8538 No 25128 Real Time No Systems Coventry health Care University of Missouri CHCUOM No Real Time No Coventry health Care Vista CHCVST 1837/8538 No 55248 Real Time No Delaware Highmark Blue Cross Blue Shield DEBCSP 7456 No 00570 Real Time Yes Professional Delaware Highmark Blue Cross Blue Shield - DEBCSI 1546 No 00070 Real Time Yes Institutional Delaware Medicaid (Professional) 2726 2726 No DE_TXIX Batch No Delaware Medicaid (Institutional) 1545 1545 No DE_TXIX Batch No Delaware Medicare (Professional) 2456 2456 No 12102 Batch Yes Delaware Medicare (Institutional) 5912 5912 No 12101 Batch Yes District of Columbia Medicare (Professional) 2459 2459 No 12202 Batch Yes District of Columbia Medicare (Institutional)

8 1522 1522 No 12201 Batch Yes Elder health Bravo health ELDRHL 1978/3839 No 52192 Real Time No Employee Benefit Management Services EBMS 2947/5483 No 81039 Real Time No EBMS Healtheweb Fallon Community health Plan FALLON 1537/3801 No FALLON83 Real Time No 7I. Federally Qualified Healthcare Clinics 1505 1505 Batch 06001 Batch No (FQHC). Federated Insurance Company FEDICO No 41041 Real Time No Florida Blue Shield 1414 FLBCS1 1414 Portal 00590 Batch / Portal No Florida Blue Cross 3517 FLBCS1 3517 Portal 00590 Batch / Portal No Florida health Care Plans FLHLTH 2150/3693 No 59322 Real Time Florida Medicaid FLCAID 1478/3516 No 77027 Real Time No Florida Medicare (Professional) 1448 1448 Batch 09102 Batch Yes Florida Medicare (Institutional) 3518 3518 Batch 09101 Batch Yes Gateway health Plan Medicaid PA GATEHP 4569/8472 No 25169 Real Time No Gateway health Plan Medicare Assured GATEHP 6641/6742 No 91741 Real Time No OH.

9 Gateway health Plan Medicare Assured GATEHP 2298/2912 No 60550 Real Time No PA. Geisinger health Plan GEISH1 2559/5473 No 75273 Portal Georgia Blue Cross Blue Shield GABCBS 1407/3537 No 00101 Real Time No 00601. Georgia Medicaid- Professional 1494 1494 No 77034 Batch No Georgia Medicaid - Institutional 3538 3538 No 77034 Batch No Georgia Medicare - Professional 1466 1466 No 10202 Batch Yes Georgia Medicare - Institutional 3536 3536 No 110201 Batch No Government Employee Hospital Association GEHA 1579/6467 No 44054 Real Time No (GEHA). Hawaii Blue Cross (Institutional) 1518 1518 Batch 990040115 Batch No Hawaii HMSA (Professional) 2714 2714 Batch 990040115 Batch No Hawaii Quest 1555 1555 No 990040115 Batch Yes health Alliance Plan of Michigan HLTMI1 6466/6513 Portal 382242827 Portal health Net of Arizona HLTHNT MCHLN1 2598/2445 Portal 38309 Real Time /. Portal health Net of Arizona, California, and CNTENE 7515/7751 No 68069 Real Time No Oregon health Net Individual Medicare Advantage Plan health Net Individual Family Plans health Net of California - Claims HLTHNT MCHLN1 2855/6514 Portal 95567 Real Time /.

10 Portal health Net of Oregon HLTHNT MCHLN1 5709 Portal 95567 Real Time /. Portal health Partners of Minnesota HLPRT1 1525/3411 Portal HEALTHPA Portal RTNERS. health Partners of Philadelphia HPPHIL 2822 No 80142 Real Time No Hennepin health METHPL 1566/2787 No Real Time No Highmark N+BCBS DE health Options GHPHHO 7148/7693 No 47181 Real Time No Home health Medicare Region IV Gulf Coast 3597 3597 No 11001 Batch No Home health Medicare Region IV Southwest 5544 5544 No 11001 Batch No Home health Medicare Region VII 1987 1987 No 15004 Batch No HomeState health Plan CNTENE 4652/6196 No 68069 Real Time No Horizon New Jersey health (Professional) HZMRCY 1709 No 22326 Real Time No Horizon New Jersey health (Institutional) HZMRCY 6534 No 22326 Real Time No Humana (Professional) 2449 HUMAN1 2449 Portal 61101 Batch / Portal No Humana (Institutional) 4544 HUMAN1 4544 Portal 61101 Batch / Portal No Idaho Blue Cross Blue Shield Regence IDBCS 3540/7426 No 00611 Real Time No Idaho Medicaid (Professional) 7427 7427 No 445454161 Batch Idaho Medicaid (Institutional)