ERA Payer List for UnitedHealthcare, Affiliates and ...

1 ERA Payer List for UnitedHealthcare, Affiliates and Strategic Alliances^Contact your EDI clearinghouse or vendor to enroll in Electronic Remittance Advice (ERA/835)BRAND NAME / PLAN NAME or REGIONPAYER IDSTATECOMMENTSAARP Hospital Indemnity Plans insured by UnitedHealthcare Insurance Company36273 ALLAARP Medicare Supplement Plans insured by UnitedHealthcare Insurance Company36273 ALLH arvard Pilgrim04271 ALLM edica94265 ALLM edica HealthCare Plans / FL78857 FLNeighborhood Health Partnership87726 ALLO ptumCare / AZ, UT (formerly Optum Medical Network & Lifeprint Network)LIFE1AZ, UTOptumHealth Complex Medical Conditions (CMC) (formerly OptumHealth Care Solutions and United Resource Networks)41194 ALLO ptumHealth Physical Health - includes Oxford41161 ALLP referred Care Partners / FL65088 FLSierra Health and Life 76342CA, NVUMR39026 ALLU nitedHealthcare87726 ALLU nitedHealthcare / All Savers Alternate Funding81400 ALLU nitedHealthcare / All Savers Insurance81400 ALLU nitedHealthcare / Oxford06111 ALLU nitedHealthcare / UnitedHealthcare of the Mid-Atlantic, MD IPA, Optimum Choice and MAMSI Life and Health (formerly MAMSI 52148)87726 ALLU nitedHealthcare Community Plan / AZ (formerly Arizona Physicians IPA and APIPA)03432AZ*UnitedHealthcare Community Plan / CA, DC, DE, FL, GA, HI, KY, LA, MA, MD, NC, NM, OH, OK, PA, RI, VA, WA (formerly AmeriChoice or Unison)

2 04567CA, DC, DE, FL, GA, HI, KY, LA, MA, MD, NC, NM, OH, OK, PA, RI, VA, WAKY effective 1/1/2019 UnitedHealthcare Community Plan / IA, hawk-i, IA Health Link95378 IAUnitedHealthcare Community Plan / KS - KanCare96385 KSUnitedHealthcare Community Plan / MI (formerly Great Lakes Health Plan)95467 MIUnitedHealthcare Community Plan / MO (effective 5/1/2017)86050 MOUnitedHealthcare Community Plan / MS CAN & CHIP95378 MSUnitedHealthcare Community Plan / NE (formerly Americhoice NE, ShareAdvantage and UnitedHealthcare of the Midlands)UFNEPNEU nitedHealthcare Community Plan / NJ (formerly AmeriChoice NJ Medicaid, NJ Family Care, NJ Personal Care Plus)86047 NJUnitedHealthcare Community Plan / NY (formerly AmeriChoice by UnitedHealthcare, AmeriChoice NY Medicaid & Child Health Plus, AmeriChoice NY Personal Care Plus)NYU01 NYUnitedHealthcare Community Plan / TN (formerly AmeriChoice TN.)

3 TennCare, Secure Plus Complete)95378 TNUnitedHealthcare Community Plan / TX (formerly AmeriChoice)TEX01 TXUnitedHealthcare Community Plan / WI (formerly AmeriChoice)WID01 WIUnitedHealthcare Dental (formerly OptumHealth Dental, Dental Benefit Providers/DBP and DBP of CA)52133 ALLU nitedHealthcare Medicare Solutions / Care Improvement Plus (CIP), XLHealth87726 ALLU nitedHealthcare Plan of the River Valley95378 ALLU nitedHealthcare StudentResources74227 ALLU nitedHealthcare Vision00773 ALLU nitedHealthcare West / UnitedHealthcare of CA, OK, OR, TX, WA and PacifiCare of AZ, CO, NV95959AZ, CA, CO, NV, OK, OR, TX, WAUnitedHealthOne / Golden Rule37602 ALLU nitedHealthOne / UnitedHealthcare Life Insurance Company (formerly American Medical Security)81400 ALL*change or addition to previously published list^not an exclusive list of all UnitedHeathcare and Affiliates offering ERA/835 2019 UnitedHealthcare Services, 1 of 18/21/2019