Claims Payer List for UnitedHealthcare, Affiliates and ...

1 Claims Payer List for unitedhealthcare , Affiliates and Strategic AlliancesLine of Business (LOB)Brand Name / Plan Name or RegionMedical Payer IDDental Payer IDCOBS mart EditsCommentsCommercialArnett Health Plan87726 YYformer Payer id 95440 CommercialBind25463 YNCommercialHarvard Pilgrim04271 YNCommercialHarvard Pilgrim Passport Connect87726 NNCommercialNeighborhood Health Partnership (NHP)87726 NYCommercialThe Alliance88461 YNCommercialUMR3902639026 YNCommercialUnitedHealthcare87726 YYCommercialUnitedHealthcare / All Savers Alternate Funding 81400 YNCommercialUnitedHealthcare / All Savers Insurance81400 YNCommercialUnitedHealthcare / Definity Health Plan87726 YYformer Payer id 64159 CommercialUnitedHealthcare / Empire Plan87726YY* CommercialUnitedHealthcare / Oxford06111 YYCommercialUnitedHealthcare / unitedhealthcare of the Mid-Atlantic, MD IPA, Optimum Choice and MAMSI Life and Health (formerly MAMSI)87726 YYformer Payer id 52148 CommercialUnitedHealthcare / unitedhealthcare Plan of the River Valley (formerly John Deere Healthcare)

2 8772695378 YYformer medical Payer id 95378 CommercialUnitedHealthcare / unitedhealthcare Shared Services - UHSS (formerly UHIS)3902639026 YNCommercialUnitedHealthcare / unitedhealthcare StudentResources74227 YNCommercialUnitedHealthcare / Networks and Administrative ServicesUSN01 NNeffective 3/1/2020 CommercialUnitedHealthcare West / unitedhealthcare of CA, OK, OR, TX, WA and PacifiCare of AZ, CO, NV87726 YYformer Payer id 95959, 95962, 95964, 95999 CommercialUnitedHealthcare West / Encounters (formerly PacifiCare)95958 YNCommercialUnitedHealthOne / Golden Rule37602 YNCommercialUnitedHealthOne / unitedhealthcare Life Insurance company (formerly American Medical Security)81400CX001 YNCommercialUnitedHealthOne / unitedhealthcare Life Insurance company - Golden Rule37602 YNDentalUnitedHealthcare Dental (formerly OptumHealth Dental, Dental Benefit Providers/DBP and DBP of California)52133 NNMedicaid, Dual SNPU nitedHealthcare Community Plan / AZ, Long Term Care, Children's Rehabilitative Services (CRS)03432 YNMedicaid, Dual SNPU nitedHealthcare Community Plan / CA, DC, DE, FL, GA, HI, IA, KY, LA, MA, MD, MS, NC, NE, NM, NY, OH, OK, PA, RI, TX, VA, WA, WI (some are formerly AmeriChoice or Unison plans)

3 87726 YYformer Payer id 04567, 25175, 86002, 86003, 86048, 86049, 95378 Dual SNPU nitedHealthcare Community Plan / KS87726 YYMedicaidUnitedHealthcare Community Plan / KS - KanCare96385 YYMedicaid, Dual SNP, MIChildUnitedHealthcare Community Plan / MI (formerly Great Lakes Health Plan)95467 YYMedicaid, Dual SNPU nitedHealthcare Community Plan / MO86050 YYMedicaid, Dual SNPU nitedHealthcare Community Plan / NJ (formerly AmeriChoice NJ Medicaid, NJ Family Care, NJ Personal Care Plus)86047 YYformer Payer id 86001 Medicaid, Dual SNPU nitedHealthcare Community Plan / TN (formerly AmeriChoice TN: TennCare, Secure Plus Complete)95378 YYMedicaid, Dual SNPU nitedHealthcare Community Plan / unitedhealthcare Dual Complete (formerly Evercare)87726 YYMedicaid, Dual SNPU nitedHealthcare Community Plan / unitedhealthcare Long Term Care (formerly Evercare)87726 YYMedicare, RetirementAARP Hospital Indemnity Plans insured by unitedhealthcare Insurance Company36273 NNMedicare, RetirementAARP Medicare Supplement Plans insured by unitedhealthcare Insurance Company36273 YNMedicare, RetirementAARP MedicareComplete insured through unitedhealthcare / WellMedWELM2YN 2020 unitedhealthcare Services, 1 of 305/22/2020 Claims Payer List for unitedhealthcare , Affiliates and Strategic AlliancesLine of Business (LOB)

4 Brand Name / Plan Name or RegionMedical Payer IDDental Payer IDCOBS mart EditsCommentsMedicare, RetirementAARP MedicareComplete insured through unitedhealthcare (formerly AARP MedicareComplete from SecureHorizons)87726 YYMedicare, RetirementAARP MedicareComplete insured through unitedhealthcare / Oxford Medicare Network87726 YYformer Payer id 06111 Medicare, RetirementAARP MedicareComplete insured through unitedhealthcare / Oxford Mosaic Network87726 YYformer Payer id 06111 Medicare, RetirementMedica HealthCare Plans / FL78857 YYMedicare, RetirementOptumCare / AZ, NV, UT (formerly Optum Medical Network & Lifeprint Network)LIFE1 NNMedicare, RetirementOptumCare Network of ConnecticutE3287 NNMedicare, RetirementPreferred Care Partners / FL65088 YYMedicare, RetirementUnitedHealthcare Community Plan / unitedhealthcare Dual Complete - Oxford Medicare Network87726 YYMedicare, RetirementUnitedHealthcare Medicare / Care Improvement Plus (CIP), XLHealth87726 YYformer Payer id 77082 Medicare, RetirementUnitedHealthcare Medicare / unitedhealthcare Chronic Complete (formerly Evercare)87726 YYMedicare, RetirementUnitedHealthcare Medicare / unitedhealthcare Group Medicare Advantage87726 YYMedicare, RetirementUnitedHealthcare Medicare / unitedhealthcare MedicareComplete (formerly SecureHorizons)

5 87726 YYMedicare, RetirementUnitedHealthcare Medicare / unitedhealthcare MedicareDirect (formerly SecureHorizons)87726 YYMedicare, RetirementUnitedHealthcare Medicare / unitedhealthcare Nursing Home Plan (formerly Evercare)87726 YYMedicare, RetirementWellMedWELM2 YNMultipleHealth Plan of Nevada76342 YNMultipleHealth Plan of Nevada - Encounters 76343 YNMultipleMedica94265 YNMultipleRocky Mountain Health Plans (RMHP) / CO - Professional claimsSX141 YNMultipleRocky Mountain Health Plans (RMHP) / CO - Institutional claims84065 YNMultipleSierra Health and Life76342 YNMultipleSierra Health and Life - Encounters76343 YNOtherOptumHealth Behavioral Solutions (formerly United Behavioral Health and PacifiCare Behavioral Health)87726 YNformer Payer id 33053 OtherOptumHealth Behavioral Solutions of NM87726 YNOtherOptumHealth Complex Medical Conditions (CMC) (formerly OptumHealth Care Solutions and United Resource Networks)41194 YNformer Payer id 52190 OtherOptumHealth Physical Health - includes Oxford41161 YNformer Payer id 41159, 41160 OtherUnitedHealthcare / NDC Home Infusion Specialty Pharmacy Claims - NDC Claims onlyUHNDCNNA pplies only to 837P Claims .

6 Before submitting an EDI file using Payer ID UHNDC, you must successfully complete specific EDI testing. Contact your clearinghouse to begin the testing process. Refer to NDC claim Submission or call unitedhealthcare EDI Support at 800-842-1109 for more Affairs / Community Care Network (CCN)VACCNYNSee delivery schedule for effective dates of each region. Region 1: CT, DC, DE, MA, MD, ME, NC, NH, NJ, PA, RI, VA, VT, WV Region 2: IA, IL, IN, KS, KY, MI, MN, MO, ND, NE, OH, SD, WI Region 3: AL, AR, FL, GA, LA, MS, OK, PR, SC, TN, USVIV isionMarch Vision52461NN 2020 unitedhealthcare Services, 2 of 305/22/2020 Claims Payer List for unitedhealthcare , Affiliates and Strategic AlliancesLine of Business (LOB)Brand Name / Plan Name or RegionMedical Payer IDDental Payer IDCOBS mart EditsCommentsVisionUnitedHealthcare Vision00773NN*change or addition to previously published listMedical Payer ID applies to Professional (CMS-1500) and/or Institutional (UB-04) claimsCOB = Coordination of Benefits; indicates secondary/COB Claims accepted electronicallySmart Edits = Apply to electronic Claims submissions.

7 Not applicable to DSNP lines of business 2020 unitedhealthcare Services, 3 of 305/22/2020