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. Ref erence the CAQH web site for CORE Certified payers. Batch and Real Time: Ref erence 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.

2 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 Healthcare Claim Status Batch or Real Time Payer ID Change Healthcare Claim Status Portal Payer ID Associated Change Healthcare Claims CPIDs Authorization Required Payer -assigned Payer ID Routing Method Must Submit Claims to Change Healthcare - Batch and Real Time only 1199 National Benefit Fund 1199N1 4551/5405 Portal 13162 Portal AARP AARP AARP1 5271/8940 Portal 36273 Real Time / Portal No Absolute Total Care CNTENE 8549/4272 No 68069 Real Time No Administrative Concepts ADMCON 3228/3952

3 No 22384 Real Time No Advantage By Buckeye (Bridgeway Advantage Plan) CNTENE 4793/9564 No 68069 Real Time No AETNA AETNA AETNA1 4500/6400 Portal 60054 Real Time / Portal No Aetna Better Health of California ABHCA 1015/7838 No 128CA Real Time No Aetna Better Health of Illinois MMAI ABHILL 4623/6140 No 26337 Real Time No Aetna Better Health of Kansas AHBKS 1084/8111 No 128KS Real Time No Aetna Better Health of Kentucky COVCKY 7410/9626 No 128KY Real Time No Aetna Better Health of Louisiana ABHLA 7183/8621 No 128LA Real Time No Aetna Better Health of Maryland ABHMD 7554/7758 No

4 128MD Real Time No Aetna Better Health of Michigan ABHMI 7220/8637 No 128MI Real Time No Aetna Better Health of New Jersey ABHNJ 7190/8629 No 46320 Real Time No Aetna Better Health of New York ABHNY 6832/7612 No 34734 Real Time No Aetna Better Health of Ohio ABHOH ABHOH1 6876/7652 Portal 50023 Real Time / Portal Aetna Better Health of Pennsylvania ABHPA 3617/5823 No 23228 Real Time No Aetna Better Health of Texas ABHTX 2142/2933 No 38692 Real Time No Aetna Better Health of Virginia CHCCN 1837/8538 No 25142 Real Time No Aetna Better Health of West Virginia ABHWV 1147/1577 No 128WV Real Time No Aetna SSI ATNSSI 6870/7649 No 62118 Real Time No Alabama blue shield (Professional) ALBCSP ALBCS1 2423 Portal 00510 Real Time / Portal No Alabama blue cross (Institutional) ALBCSI ALBCS1 5558 Portal 00010BC Real Time / Portal No Alabama Medicaid ALCAID 4479/5560/5587 No 752548221 Real Time No Alabama Medicare (Professional) 2468 2468 No 10102 Batch Yes Alabama Medicare (Institutional)

5 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 Connections CNTENE 7773/7588 No 68069 Real Time No Allwell from Managed Health Services CNTENE 7770/7582 No 68069 Real Time No Allwell from Managed Health Services Health Wisconsin

6 CNTENE 7786/8528 No 68069 Real Time No 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 Silver Summit Health CNTENE 6025/9172 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 Allwell from Superior HealthPlan CNTENE 7785/8527 No 68069 Real Time No Allwell from Western Sky Community Care CNTENE 1075/8102 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 Meridian CNTENE 6030/9181 No 68069 Real Time No Ambetter from Peach State Health Plan CNTENE 6655/6756 No 68069 Real Time No Ambetter from Pennsylvania Health and Wellness CNTENE 4052/8793 No 68069 Real Time

7 No Ambetter from Sunflower Health Plan CNTENE 1079/8106 No 68069 Real Time No Ambetter from Tennessee CNTENE 4013/8741 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 / Portal No AmeriHealth Caritas Delaware AHCDE 78507/7746 No 77799 Real Time No AmeriHealth Caritas District of Columbia AHCDC 5670/6441 No 77002 Real Time No AmeriHealth Caritas Florida PHCMCO 2106/8963 No 77003 Real Time No AmeriHealth Caritas Louisiana LACAR 4368/6165 No 27357 Real Time No AmeriHealth Caritas New Hampshire AMNHP 2090/8239 No 87716 Real Time No AmeriHealth Caritas North Carolina AMNCN 4083/8859 No 81671 Real Time No AmeriHealth Caritas Pennsylvania AMHLTH 1710/4547 No 22248 Real Time No AmeriHealth Caritas VIP Care PA CommHealthChoices AMCVC 1268/6501 No 77062 Real Time No

8 AmeriHealth Caritas VIP Care Plus Michigan ACVMI 7212/8656 No 77013 Real Time No Anthem blue cross CABC 3511/4417 No 47198 Real Time No Anthem MaineHealth ANTHME 4069/8813 No 00958 Real Time No Arizona blue cross blue shield AZBCBS AZBCB1 4426/5547 Portal 53589 Real Time / Portal No Arizona Complete Health CNTENE 1405/7874 No 68069 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)

9 1526 1526 No 07101 Batch Yes Arkansas Total Care CNTENE 2003/8136 No 68069 Real Time No Ascension Complete CNTENE 2029/8299 No 68069 Real Time No Asuris Northwest Regence ASURNH 5942/4881 No 93221 Real Time No AultCare of Ohio AULTCR 4791/5927 No 341488123 Real Time No AvMed AVMED 1573/3802 No 59274 Real Time No Banner Medicare Advantage Plus PPO (BMAP) BMAPP 5046/88892 No 84324 Real Time No Banner Medicare Advantage Prime HMO (BMAH) BMAHMO 504/8893 No 84323 Real Time No Banner University Family Care BUFCR 1290/6548 No 66901 Real Time No blue Care Network HMO (Professional) MIBCSP 2426 Real Time 00710 Real Time Yes blue Care Network HMO (Institutional)

10 MIBCSI 3532 Real Time 00210 Real Time Yes blue cross blue shield of massachusetts MABCBS 2424/5528 No 00200 Real Time No blue cross blue shield of National Capital Area - CareFirst DCBCBS 1509/2425 No 00080 00580 Real Time No blue cross blue shield of Western New York Medicaid / CHP BWNYMC 1169/2516 No 00246 Real Time No blue cross Complete of Michigan BCCMI 5096/7409 No 32002 Real Time No blue Medicare Advantage BMADV 6013/9162 No 00772 Real Time No blue shield of California Promise Health Plan CABS 1627/6114 No BS001 94036 Real Time No Braven Health BRAVEN 5000/8844 No 84267 Real Time Yes Buckeye Community Health CNTENE 1962/4717 No 68069 Real Time No California blue shield CABS CABS1 1409/6569 No BS001 94036 Real Time / Portal No California Health and Wellness CNTENE 6646/6748 No 68069 Real Time No California Medi-Cal CACAI1 1473/3510 Portal 610442 Portal Care N Care Insurance Company CAREN 2013/8146 No 66