CLAIMS & REMITS PAYER LIST 02/08/2018 2ndary …

1 CLAIMS & REMITS PAYER LIST02/08/2018 PAYER CodeAccepts2ndaryClaimsENRR emitsENRP ayer Code Accepts2ndary ClaimsENR RemitsENR 1199 National Benefit Fund13162 NNY13162 NNY1st Medical Network - Atlanta GA29076 YNna29076 YNna1st MN--Atlanta GA29076 YNna29076 YNna21st Century Health and Benefits59069 NNna59069 NNna3P ADMIN20413 YNna20413 YNnaA & I Benefit Plan Benefit Plan Administrators Administravie Group ( Formerly Icon Benefit Admin)75185 YNna75185 YNnaAARP Medicare Supplement Plans36273 YNY36273 YNYAARP MedicareComplete through UnitedHealthcare/AARP MedicareComplete87726 YNY87726 YNYA brazo Advantage Health Plan03443 YNna03443 YNnaAbsolute Total Care68069 YNY68069 YNYA ccess Medical Group95424 YNnaAccess Medicare19305 NNY19305 NNYA cclaim64071 YNY64071 YNYA ccountable Healthcare IPA (AHCIPA)AHIPAYNnaAHIPAYNnaACMG37118 NNna37118 NNnaACS Benefit Services Benefit Services LLC38254 NNna38254 NNnaAdaptis ( REMITS only)

2 91173naY91173naYAdministration Systems Research Corporation38265 NNna38265 NNnaAdministrative Concepts Services DATA SOLUTIONS58202 NNna58202 NNnaAdvanced Health Systems12B17 YYYSB730 YYYA dvantage by Bridgeway Health Solutions68069 YNY68069 YNYA dvantage by Buckeye Community Health Plan68069 YNY68069 YNYA dvantage by Managed Health Services68069 YNY68069 YNYA dvantage by Peach State68069 YNY68069 YNYA dvantage by Sunshine State68069 YNY68069 YNYA dvantage by Superior HealthPlan68069 YNY68069 YNYA dvantage Care IPAACIPAYNnaACIPAYNnaAdvantage Health Solutions35209 NNna35209 NNnaAdvantek Benefit Administrators83077 NNna83077 NNnaADVANTICA BENEFITS59374 YNY59374 YNYA dvanzeon Solutions59314 NNna59314 NNnaAdventist Health System West - Roseville CA95340 NNY95340 NNYA dvicare (for CLAIMS with DOS prior to 9/1/16)45423 NNna45423 NNnaAdvocate Medical Group - AMG (Legacy AHC)36320 NNY36320 NNYA dvocate Physician Partners65093 NNY65093 NNYA etna60054 YNY60054 YNYINSTITUTIONALPROFESSIONAL Page 1 of 52 CLAIMS & REMITS PAYER LIST02/08/2018 PAYER CodeAccepts2ndaryClaimsENRR emitsENRP ayer Code Accepts2ndary ClaimsENR RemitsENR INSTITUTIONALPROFESSIONALA etna Affordable Health Choices (SM)

3 - SRC57604 YNna57604 YNnaAetna Better Health - PA Medicaid23228 YNna23228 YNnaAetna Better Health of Illinois26337 YNY26337 YNYA etna Better Health of Kentucky128 KYYNy128 KYYNyAetna Better Health of Louisiana128 LAYNy128 LAYNyAetna Better Health of Michigan128MI YNY128MI YNYA etna Better Health of Missouri128 MOYNY128 MOYNYA etna Better Health of Nebraska (for CLAIMS with DOS prior to 1/1/17)42130 YNY42130 YNYA etna Better Health of New Jersey46320 YNY46320 YNYA etna Better Health of NY34734 NNY34734 NNYA etna Better Health of Ohio50023 YNY50023 YNYA etna Better Health of Pennsylvania23228 YNY23228 YNYA etna Better Health of Virginia128 VAYNY128 VAYNYA etna Better Health of West Virginia128 WVYNY128 WVYNYA etna Better Health Premier Plan (JVHL)M5 JVHYYYM5 JVHYYYA etna Medicare60054 YNY60054 YNYA etna TX Medicaid & CHIP38692 NNY38692 NNYA etna (JVHL)J1 JVHYYYJ1 JVHYYYA etna-American Continental Insurance Company ( REMITS only)

4 62118 nanaY62118nanaYAffiliated Doctor's of Orange CountyADOCSNNnaADOCSNNnaAffilliated Physicians GroupAPG01 NNnaAPG01 NNnaAffinity Essentials23334 YNY23334 YNYA ffinity Health Plan13334 NYY13334 NYYAFFINITY MEDICAL GROUP46594 NNna46594 YNnaAffinity Medicare Advantage13333 NNN13333 NNNA ffordable Benefit Administrators Health Fund ( CLAIMS with DOS on or after 1/1/2015)62308 NNna62308 NNnaAGA37280 NNna37280 NNnaAgate Resources Inc. (LIPA)20048 NNnaAgency Services Inc64158 NNna64158 NNnaAHPO (Cleveland OH)31138 NNna31138 NNnaAlabama Medicaid12K01 YNYSKAL0 YNYA lamitos IPAAIPAZYNnaAIPAZYNnaAlaska Carpenters Trust91136 NNnaAlaska Children's Services Electrical Trust Funds60054 YNY60054 YNYA laska Laborers Construction Industry Trust91136 NNna91136 NNnaAlaska Medicaid77200 YYY Alaska MedicareSMAK0 YYYA laska Pipe Trades Local 37591136 NNna91136 NNnaAlaska United Food & Commercial Workers Health & Welfare Trust91136 NNna91136 NNnaAlexian Brothers Community Services of TN44423 NNna44423 NNna Page 2 of 52 CLAIMS & REMITS PAYER LIST02/08/2018 PAYER CodeAccepts2ndaryClaimsENRR emitsENRP ayer Code Accepts2ndary ClaimsENR RemitsENR INSTITUTIONALPROFESSIONALALICARE13550 NNY13550 NNYA lignment HealthcareAHCA1 NNnaAHCA1

5 NNnaAll Savers/UHC81400 YNY81400 YNyAllcare PEBB26158 NNna26158 NNnaAllegian Advantage82238 NNna82238 NNnaAllegian Choice55649 NNna55649 NNnaAllegian Health Plan82420 NNna82420 NNnaAllegiance Benefit Plan Management Behavioral Health23071 YYY23071 YYYA lliance IPAHCP01 NNnaAlliant Health Plans of Georgia58234 NNna58234 NNnaAllianz Global Assistance50749 NNna50749 NNnaAllied Benefit Systems37308 NNY37308 NNYA lpha Care Medical GroupMPM32 NNnaMPM32 NNnaAlta Bates Medical GroupA0701 NNnaA0701 NNnaALTA Health Strategies25133 YNY25133 YNYA ltius Health Plans25133 YNY25133 YNYA lvarado IPASYMEDNNnaSYMEDNNnaAMA Insurance AgencyAMAIANNYTH071 NNYA malgamated Life13550 NNY13550 NNYA malgamated Life - PA / Alicare13343 NNna13343 NNnaAmbay Health NetworkAMBHNNNnaAMBHNNNnaAmbetter of Illinois68069 YNY68069 YNYAMCO62176 NNna62176 NNnaAmeraPlan38219 NNY38219 NNYA meriBen Solutions Community Care (New Jersey)

6 27516 YNna27516 YNnaAmerican Administrative Group75240 YNna75240 YNnaAmerican Behavioral63103 NNna63103 NNnaAmerican Benefit Plan Administrators95170 NNna95170 NNnaAmerican Community Mutual Insurance60305 NNY60305 NNYA merican Family Insurance12T31 NNnaTH095 NNnaAmerican Family Medicare Sup and PPO Policies Administered by Am Rep56071 NNY56071 NNYA merican Fidelity Assurance Company60801 NNna60801 NNnaAmerican General62030 NNY62030 NNYA merican Healthcare Alliance01066 NNY01066 NNYA merican Heritage77083 NNnaAmerican Income Life Insurance Company ( REMITS only)60577nanaY60577nanaYAmerican Insurance Administrators (AIA) ( REMITS only)26119nanaY26119nanaYAmerican National Ins. Co. (ANICO)74048 NNY74048 NNYA merican Postal Workers Union Health Plan44444 NNY44444 NNYA merican Progressive Life and Health Insurance Company48055 NNY48055 NNY Page 3 of 52 CLAIMS & REMITS PAYER LIST02/08/2018 PAYER CodeAccepts2ndaryClaimsENRR emitsENRP ayer Code Accepts2ndary ClaimsENR RemitsENR INSTITUTIONALPROFESSIONALA merican Republic Insurance42011 NNY42011 NNYA merican Sentinel Specialty Health Plans43146 NNnaAmerican Trust Administrators Worker Health Plan37322 YNna37322 YNnaAmericas 1st Choice Health Plans of South Carolina 1st Choice of South Carolina.

7 Inc55349 NNna55349 NNnaAmerica's Choice Health Plans20029 NNY20029 NNYA merica's PPO16120 NNna16120 NNnaAmerica's TPA41178 NNna41178 NNnaAmeriChoice by UnitedHealthcare-New York ( REMITS only)NYU01naYNYU01naYAmerichoice Maryland and Washington ( REMITS only)04567naY04567naYAmerigroup Community Care27514 YNY27514 YNYA merigroup Corporation27514 YNY27514 YNYA merigroup Florida27519 YNY27519 YNYA merigroup Illinois27518 YNna27518 YNnaAmerigroup Ohio27518 YNna27518 YNnaAmeriHealth Administrators54763 YNY54763 YNYA meriHealth Administrators (BCBS) ( REMITS only)SX055naYSX055naYAmeriHealth Caritas Iowa77075 YNY77075 YNYA meriHealth Caritas Pennsylvania22248 YNY22248 YNYA merihealth Caritas VIP Care77062 YNY77062 YNYA meriHealth Caritus VIP Care Plus (Michigan)77013 NNna77013 NNnaAmeriHealth Delaware (Non-HMO)93688 YYY93688 YYYA merihealth District of Columbia77002 NNY77002 NNYA merihealth HMO NJ/DE95044 YYY95044 YYYA meriHealth HMO of NJ and Delaware ( REMITS only)SX055naYSX055naYAmeriHealth New Jersey (Non-HMO)60061 YYY60061 YYYA meriHealth NorthEast77001 YNY77001 YNYA meri-West Health AssociatesPPM01 YNnaPPM01 YNnaAmFirst Insurance Company ( PAYER only accepts Secondary CLAIMS )

8 64090 YNY64090 YNYA mida Care24818 NNna24818 NNnaAmida Care Medicare79966 NNna79966 NNnaAnchor Benefit Consulting Benefit Services (ABS)86062 YNna86062 YNnaAncillary Care Services ( REMITS only)A2004naYA2004naYAngeles IPAHSM01 NNnaHSM01 NNnaAntares Management Solutions34192 YNY34192 YNYA nthem Blue Cross Blue Shield of Connecticut12B04 YNYSB560 YNYA nthem Blue Cross Blue Shield of Georgia12015 YNYSB600 YNYA nthem Blue Cross Blue Shield of Indiana12B09 YNYSB630 YNYA nthem Blue Cross Blue Shield of Kentucky12B11 YNYSB660 YNY Page 4 of 52 CLAIMS & REMITS PAYER LIST02/08/2018 PAYER CodeAccepts2ndaryClaimsENRR emitsENRP ayer Code Accepts2ndary ClaimsENR RemitsENR INSTITUTIONALPROFESSIONALA nthem Blue Cross Blue Shield of Maine12B13 YNYSB680 YNYA nthem Blue Cross Blue Shield of Missouri12B65 YNYSB741 YNYA nthem Blue Cross Blue Shield of Nevada12B20 YNYSB765 YNYA nthem Blue Cross Blue Shield of New

9 Hampshire12B21 YNYSB770 YNYA nthem Blue Cross Blue Shield of Ohio12B24 YNYSB338 YNYA nthem Blue Cross Blue Shield of Virginia12002 YNYSB923 YNYA nthem Blue Cross Blue Shield of Wisconsin12B29 YNYSB950 YNYA nthem Blue Cross of California47198 YNY47198 YNYA nthem Blue Cross of Colorado12B03 YNYSB550 YNYApex Benefit Services34196 YNna34196 YNnaAraz Group16120 NNna16120 NNnaARC AdministratorsCXARCNNnaCXARCNNnaArcadian Management Services Inc77045 NNna77045 NNnaArch Health PartnersARCH1 NNYARCH1 NNYA rgus Dental Plans, Foundation for Medical Care (AFMC)86062 YNna86062 YNnaArizona MedicareSMAZ0 YYYA rizona Priority Care Plus27154 NNN27154 NNNA rkansas Best Corporation - Choice Benefits62308 NNY62308 NNYA rkansas Medicaid12023 YNYSKAR0 YNYA rkansas Medicare12022 YYYSMAR0 YYYARM, Health Network WMM01 YNnaASAGEHA06603 NNna06603 NNnaAspen Medical Associates16180 YNna16180 YNnaAspire Health Plan46156 YNY46156 YNYASR38265 NNna38265 NNnaASR Corporation38265 NNna38265 NNnaASR Health Benefits38265 NNna38265 NNnaASRM CorporationASRM1 NNYASRM1 NNYA ssociates for Health Care Inc.

10 (AHC)36326 NNna36326 NNnaAssurant Health Self Funded75068 YNna75068 YNnaAssured Benefits Administrators74240 YNY74240 YNYA suris NW Health93221 YNY93221 YNYA tlantic Medical Insurance22285 NNna22285 NNnaAtrio Health PlansATRIONNYATRIONNYAultCare341488123 YYna341488123 YYnaAultCare341488123 YYY341488123 YYYA ultra Administrative Group37242 NNna37242 NNnaAultra Administrative Group37242 NNY37242 NNYA utomated Benefit Services38259 YNY38259 YNY Page 5 of 52 CLAIMS & REMITS PAYER LIST02/08/2018 PAYER CodeAccepts2ndaryClaimsENRR emitsENRP ayer Code Accepts2ndary ClaimsENR RemitsENR INSTITUTIONALPROFESSIONALA utomated Group Administration ( REMITS only)26202naNAvalon Administrative ServicesAVA01 NYYA valon IPACAPMNNNnaCAPMNNNnaAvera Health Plans46045 NNY46045 NNYA veraAdvantage48055 NNY48055 NNYA vesis Third Party Administrators87098 YNnaAvMed Assistance_USA65101 NNna65101 NNnaAzeros Health Plans Family Medical Group77005 NNna77005 NNnaBanker's Life 99999-0178 NNYB anker's Life & Casualty ( REMITS only)36066 naY36066 naYBanner Health12X42 YNY12X42 YNYB anner Health AZSX145 YNYB anner Health Co - ROCKY MOUNTAIN HMO GREELEYSX145 YNYB anner Health Co.