CLAIMS & ERA PAYER LIST December 10, 2021

1 IPDIPDIPDIPD1199 National Benefit Fund13162837 1199 National Benefit Fund13162835 1st Medical Network - Atlanta GA29076837 1st Medical Network - Atlanta GA29076835 1st MN--Atlanta GA29076837 1st MN--Atlanta GA29076835 21st Century Health and Benefits59069837 6 Degrees Health20446837 A & I Benefit Plan Administrators93044837 AAG Benefit Plan Administrators AAG-American Administravie Group ( Formerly Icon Benefit Admin)75185837 Effective immediately, please send all CLAIMS for PAYER 75185 to HealthSmart Benefit Solutions (EDI PAYER ID #37283). CLAIMS submitted under PAYER ID 75185 will be subject to claim rejection effective Q1 - UnitedHealthcare Insurance Company36273837 AARP - UnitedHealthcare Insurance Company36273835 AARP Dental Insurance PlanAARP1837 AARP Dental Insurance PlanAARP1835 AARP MedicareComplete through UnitedHealthcare/AARP MedicareComplete87726837 AARP MedicareComplete through UnitedHealthcare/AARP MedicareComplete87726835 AblePay HealthABLPY837 NotesCLAIMS & ERA PAYER LISTJ anuary 07, 2022 LEGEND: I = Institutional, P = Professional, D = DentalCOB = Coordination of BenefitsTransaction Column.

2 837 = CLAIMS , 835 = ERAA vailable Column: A Check-mark indicates that the transaction type is Column: A Check-mark indicates that enrollment is required for the transaction Column: A Check-mark Indicates that the PAYER accepts secondary CLAIMS electronically for the transaction : A Check-mark indicates that the PAYER accepts medical attachments electronically for the transaction type. PAYER NamePayer CodeTransactionCOBA vailableEnrollmentAttachmentsExperian Health PAYER ListPage 1 of 132 IPDIPDIPDIPDN otesPayer NamePayer CodeTransactionCOBA vailableEnrollmentAttachmentsAblePay HealthABLPY835 Abrazo Advantage Health Plan03443837 Also known as Phoenix AdvantageAbsolute Total Care68069837 Absolute Total Care68069835 ERA PAYER Code 68069.

3 ERA requires EFT enrollmentAccelerated CLAIMS Access AdministratorsAHS01837 Access Community Health NetworkACCOM837 Access IPAACC01837 Access IPAACC01835 Access Medical GroupAMG02837 Access Medical GroupAMG02835 Access Medicare19305837 Acclaim64071837 Acclaim64071835 Acclaim IPAIP095837 Accountable Care Management Group, LLC45328837 Accountable Healthcare IPA (AHCIPA)AHIPA837 ACMG37118837 ACS Benefit Services ACS Benefit Services ACTIN Care Groups24585837 Also known as Clifton Health SystemsActiva Benefit Services LLC38254837 Administration Systems Research Corporation38265837 ERA PAYER Code TLU02 Administration Systems Research CorporationTLU02835 Administrative Concepts Administrative Concepts Administrative Services ADVANCED DATA SOLUTIONS58202837 Advantage by Bridgeway Health Solutions68069837 Advantage by Bridgeway Health Solutions68069835 ERA PAYER Code 68069.

4 ERA requires EFT enrollmentAdvantage by Buckeye Community Health Plan68069837 Advantage by Buckeye Community Health Plan68069835 ERA PAYER Code 68069; ERA requires EFT enrollmentAdvantage by Managed Health Services68069837 Experian Health PAYER ListPage 2 of 132 IPDIPDIPDIPDN otesPayer NamePayer CodeTransactionCOBA vailableEnrollmentAttachmentsAdvantage by Managed Health Services68069835 ERA PAYER Code 68069; ERA requires EFT enrollmentAdvantage by Peach State68069837 Advantage by Peach State68069835 ERA PAYER Code 68069; ERA requires EFT enrollmentAdvantage by Sunshine State68069837 Advantage by Sunshine State68069835 ERA PAYER Code 68069; ERA requires EFT enrollmentAdvantage by Superior HealthPlan68069837 Advantage by Superior HealthPlan68069835 ERA PAYER Code 68069.

5 ERA requires EFT enrollmentAdvantage Care IPAACIPA837 Advantek Benefit Administrators83077837 Advantek Benefit Administrators83077835 ADVANTICA BENEFITS59374837 ADVANTICA BENEFITS59374835 Advanzeon Solutions59314837 Adventist HanfordMPM36837 Adventist Health Care NetworkMPM51837 Adventist Health Plan (AHP)MPM37837 Adventist Health System West - Roseville CA95340837 Adventist Health System West - Roseville CA95340835 Adventist White Memorial - Crown City Medical GroupMPM33837 Adventist White Memorial - Southland Gabriel ValleyMPM34837 Advisory Health AdministratorsCB159837 Advocate Medical Group - AMG (Legacy AHC)36320837 Advocate Medical Group - AMG (Legacy AHC)36320835 Advocate Physician Partners65093837 Advocate Physician Partners65093835 Aegis Administrative ServicesCB637837 Aetna60054837 Aetna60054835 Aetna (Professional Encounter CLAIMS - Not BULK)

6 60054837 Aetna Affordable Health Choices (SM) - SRC60054837 Aetna Affordable Health Choices (SM) - SRC60054835 Aetna Better Health of California128CA837 Aetna Better Health of California128CA835 Experian Health PAYER ListPage 3 of 132 IPDIPDIPDIPDN otesPayer NamePayer CodeTransactionCOBA vailableEnrollmentAttachmentsAetna Better Health of Florida128FL837 ERA PAYER Code 25133 Aetna Better Health of Florida25133835 Aetna Better Health of Illinois68024837 Aetna Better Health of Illinois68024835 Formerly IlliniCareAetna Better Health of Kansas128KS837 Aetna Better Health of Kansas128KS835 Aetna Better Health of Kentucky128KY837 Aetna Better Health of

7 Kentucky128KY835 Aetna Better Health of Louisiana128LA837 Aetna Better Health of Louisiana128LA835 Aetna Better Health of Maryland128MD837 Aetna Better Health of Maryland128MD835 Aetna Better Health of Michigan128MI837 Aetna Better Health of Michigan128MI835 Aetna Better Health of Nebraska (for CLAIMS with DOS prior to 1/1/17)25133835 Aetna Better Health of Nebraska (for CLAIMS with DOS prior to 1/1/17)42130837 ERA PAYER Code 25133 Aetna Better Health of New Jersey46320837 Aetna Better Health of New Jersey46320835 Aetna Better Health of New York34734837 Aetna Better Health of New York34734835 Aetna Better Health of Ohio50023837 Aetna Better Health of Ohio50023835 Aetna Better Health of Pennsylvania23228837 Aetna Better Health of Pennsylvania23228835 Aetna Better Health of Texas (Medicaid & CHIP)38692837 Aetna Better Health of Texas (Medicaid & CHIP)

8 38692835 Aetna Better Health of Virginia128VA837 Aetna Better Health of Virginia128VA835 Aetna Better Health of West Virginia128WV837 Aetna Better Health of West Virginia128WV835 Aetna Better Health Premier Plan (JVHL)M5 JVH837 Provider must be an approved JVHL labAetna Better Health Premier Plan (JVHL)M5 JVH835 Aetna Better Health Premier Plan MMAI26337837 Aetna Better Health Premier Plan MMAI26337835 Aetna Medicare60054837 Experian Health PAYER ListPage 4 of 132 IPDIPDIPDIPDN otesPayer NamePayer CodeTransactionCOBA vailableEnrollmentAttachmentsAetna Medicare60054835 Aetna Senior Supplement/American Continental62118835 Aetna Healthcare (JVHL)J1 JVH837 Provider must be an approved JVHL labAetna Healthcare (JVHL)

9 J1 JVH835 Affiliated Doctor's of Orange CountyADOCS837 Affiliated Partners IPAPOP09837 Affiliated Physicians IPAPOP06837 Affinity Health Plan13334837 Affinity Health Plan13334835 AFFINITY MEDICAL GROUP46594837 Affordable Benefit Administrators Affordable Benefit Administrators AFLAC (ERA Only)52080835 AFTRA Health Fund ( CLAIMS with DOS on or after 1/1/2015)62308837 AFTRA Health Fund ( CLAIMS with DOS on or after 1/1/2015)62308835 A-G Administrators LLC11370837 AGA37280837 Agate Resources Inc. (LIPA)20048837 Agency Services Inc64158837 AgeRight AdvantageARA01837 AgeRight AdvantageARA01835 Agewell New YorkAWNY6837 Agewell New YorkAWNY6835 AHP Provider NetworkMPM38837 AHPO (Cleveland OH)

10 31138837 Aither Health64884837 Aither Health64884835 AKM Medical GroupCAPMN837 Alabama Medicaid12K01837 Alabama Medicaid12K01835 Alabama MedicaidSKAL0837 Alabama MedicaidSKAL0835 Alabama Medicare10112837 Alabama Medicare10112835 Alameda Alliance for Health95327837 Experian Health PAYER ListPage 5 of 132 IPDIPDIPDIPDN otesPayer NamePayer CodeTransactionCOBA vailableEnrollmentAttachmentsAlameda Alliance for Health95327835 PAYER returns ERA's automatically once electronic claim submission begins. Alamitos IPAAIPAZ837 For DOS Prior to 5/1/2020. CLAIMS with DOS 5/1/20 and after use PAYER code IPACAPMN837 Alan Sturm & Associates DentalR7003837 Alaska Carpenters Trust91136837 Alaska Children's Services Alaska Children's Services Alaska Electrical Trust Funds60054837 Alaska Electrical Trust Funds60054835 Alaska Laborers Construction Industry Trust91136837 Alaska Medicaid77200837 Alaska Medicaid77200835 Alaska MedicareSMAK0837 Alaska MedicareSMAK0835 Alaska Pipe Trades Local 37591136837 Alaska United Food & Commercial Workers Health & Welfare Trust91136837 Albuquerque Public Schools85600837 Albuquerque