Institutional Claim Payers List (08/16/2018) - …

1 Institutional Claim Payers List(08/20/2018) payer ID ReportsEnter As NameAdditional InfoEnrollmentPayer Type1199 National Benefit Fund ##13162Y1199 NATIONAL BENFALSEG1ST MEDICAL NETWORK (MEDICAL RESOURCES) **58203 YMEDICAL RESOURCEFALSEG360 Alliance Gilsbar ##07205Y360 ALLIANCE PPOGFALSEG3P ADMIN **20413Y3P ADMINFALSEGA & I Benefit Plan Administrators ##93044NA AND I BENEFIT , INCC laims are printed and mailedFALSEGAAG - American Administrative Group **37283 YAMERICAN ADMINISTF ormerly Gallagher Benefit AdminFALSEGAARP - UnitedHealthcare Insurance Company36273 YAARP MEDICARE SUPM edicare Supplement and Hospital Indemnity Plans that carry the AARP name, but are insured by Hospital Indemnity Plans insured by UnitedHealthcare Insurance Company **36273 YAARP FALSECAARP Medicare Supplement Plans insured by UnitedHealthcare Insurance Company **36273 YAARP FALSECAARP MedicareComplete insured through UnitedHealthcare (formerly AARP MedicareComplete from SecureHorizons) **87726 YOXFORD MEDICARE NFALSECAARP MedicareComplete insured through UnitedHealthcare / Oxford Medicare Network, former payer id 06111 **87726 YAARP MEDICARECOMPFALSECA brazo Advantage Health Plan **03443 YABRAZO ADV HEALTHFALSEGAbri Healthplan (Now known as Molina Health Care of WI) **ABRI1 NABRI HEALTHPLANFALSEGA ccess AdministratorsAHS01 YACCESS ADMINISTRAFALSEGA ccess Medicare (Cuatro LLC)

2 ##19305 NACCESS MEDICAREFALSEGA cclaim **64071 YACCLAIMFALSEGA cordia National AKA Healthsmart Benefit Solutions ** 87815 YACORDIA NATIONALFALSEGACS Benefits payer Compass ##PA331 YACS BENEFITSFALSEGADMINISTRATIVE CONCEP ##22384 YADMIN CONCEPTS INFALSEGA dministrative Services ##59141 NADMIN SVCS INCFALSEGA dvantage Health Network IPA **NMM01 YADVANTAGE HLTH IPFALSEGADVANTAGE HEALTH SOLU ##35209 YADVANTAGE HEALTHFALSEGA dvantage Preferred Plans ##35219 YADVANTAGEC laims submitted with old payerID of 77070 may need to be resubmitted after May 23rd, 2014 FALSENA dvantek Benefit Administrators ##83077 NADVANTEK BENEFITFALSEGA dvantica Benefits **59374 AADVANTICA BENEFITFALSEGADVENTIST HEALTH SYSTEM ##95340 YADVENTIST HLTH SYFALSEGA dvocate Health Centers 36320 YADVOCATE HEALTHFALSEGH ighlighted Payers are new or have been altered in the last 90 days.

3 Please verify that your system is setup correctly for these Claim Payers List(08/20/2018) payer ID ReportsEnter As NameAdditional InfoEnrollmentPayer TypeHighlighted Payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these Health Partners65093 YADVOCATE HLTH PARFALSETA etna 60054 (Commercial only)60054 YAETNAFALSECA etna Affordable Health Choices **57604 YAETNA AFFORDABLEFALSEGA etna Better Health IL Medicaid **26337 NAETNA IL MCDFALSEGA etna Better Health Nevada ##128 NVNAETNA NVFALSEGA etna Better Health NY ##34734 NAETNA BET HLTH NYFALSEGA etna Better Health of Kentucky **128 KYYAETNA BET HLTH KYFALSEGA etna Better Health of Louisiana **128 LAYAETNA BH LOUISIANFALSEGA etna Better Health of Maryland ##128 MDYAETNA MDFALSEGA etna Better Health of Michigan **128 MIYAETNA BH MICHIGANFALSEGA etna Better Health of Missouri **128 MOYAETNA BH MISSOURIFALSEGA etna Better Health of New Jersey **46320 YAETNA BH NEW JERSFALSEGA etna Better Health of Ohio **50023 YAETNA BTTR HLTH OFALSEGA etna Better Health of Pennsylvania Medicaid **23228

4 YAETNA BH PA MEDICFALSEGA etna Better Health of Virginia ##128 VAYAETNA BH VAFALSEGA etna Better Health of West Virginia **128 WVYAETNA BTR HLTH WVFALSEGAETNA TEXAS MEDICAID ##38692 YAETNA TX MEDICAIDFALSEGA ffiliated Doctors of Orange County **ADOCSYAFFILIATED DRSFALSEGA ffiliated Physicians GroupM3CA1 YAFFILIATED PHYSFALSETA ffinity Health Plan ##13334 YAFFINITY HEALTH OContact or (718)794-7592 prior to sending claims. (For Medicaid, Child Health Plus and Essential Plan Members )FALSEGA ffinity Health Plans (TMG Health) ##13333 YAFFINITY HEALTH N(For Medicare Advantage and Medicaid Advantage Members )FALSEGA ffinityAccess**23334 YAFFINITYACCESS(For Qualified Health Plan Members )FALSEGA gency Services Inc ##64158 YAGENCY SERVICESFALSEGAHPO (Cleveland, OH) ##31138 YAHPO CLEVELAND OHFALSEGAIG Chartis ##19402 YAIG CHARTISFALSEGA laska Children's Services, Inc.

5 - Group # P68 ##91136 YALASKA CHILD SVCSP lease include Group Number when submitting Claim Payers List(08/20/2018) payer ID ReportsEnter As NameAdditional InfoEnrollmentPayer TypeHighlighted Payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these Laborers Construction Industry Trust - Group # F23 ##91136 YAK LABORERS TRUSTP lease include Group Number when submitting Pipe Trades Local 375 - Group # F24 ##91136 YAK PIPE LOCAL 375 Please include Group Number when submitting United Food & Commercial Workers Health & Welfare Trust - Group # F45 ##91136 YAK UNITED FOOD TRPlease include Group Number when submitting Public Schools ##85600 AALBUQUERQUE PSFALSEGA lexian Brothers Community Services of Tennessee ##44423yALEXIAN BROTHERSFALSEGALICARE 13550 YALICARE FALSEGA lignment Healthcare ##CCHPCYALIGNMENT HCAREFALSEGAll Savers Insurance / UnitedHealthcare ##81400 YALL SAVERSFALSECAllCare PEBB ##26158 YALLCARE

6 PEBBFALSEGA llegian Choice ##55649 YPHOENIX CHOICEFALSEGA llegiance Benefit Plan Management, Inc. ##81040 YALLEGIANCE BENEFALSEGA lliance Coal Health Plan ##93658 NALLIANCE COAL FALSEGA lliance PPO, LLC (Previously payer ID 52148)87726 YUHC OXFORDFALSECA lliance, The (Only for ID Cards showing PO Box 44365 Madison WI 53744 as mailing address. Call 608-210-6656 for payer ID. **CallYALLIANCEFALSETA lliant Health Plans of Georgia ##58234 YALLIANT GEORGIAFALSEGA llied Benefit Systems ##37308 YALLIED BENEFITFALSEGA llied Physicians of California IPA **NMM01 YALLIED PHYS OF CAFALSEGA lphacare Medical Group**MPM32 NALPHACARE MEDICALE ffective 12/1/17, all AlphaCare Medical Group claims should be submitted to payer ID MPM32. SynerMed no longer manages AlphaCare.)

7 FALSEGA lternative Opportunities ##16089 YALTERNATIVE OPPFALSEGAMA Insurance Agency##AMAIANAMA INSURANCEFALSEGAMA Insurance Agency, INSURANCEFALSEGI nstitutional Claim Payers List(08/20/2018) payer ID ReportsEnter As NameAdditional InfoEnrollmentPayer TypeHighlighted Payers are new or have been altered in the last 90 days. Please verify that your system is setup correctly for these Life ##13550 YALICAREFALSEGA malgamated Life - PA / Alicare ##13343 NAMALGAMATED LIFEFALSEGA meraPlan38219 YAMERAPLANFALSEGA meriben - IEC Group ##97661 YAMERIBEN IEC FALSEGAMERIBEN SOLUTIONS75137 YAMERIBEN SOLUTIONFALSEGA mericaid CC Tampa **06161 YAMERICAID CCFALSETA mericaid Community Care (Dallas/Ft. Worth) **27514 YAMERIGROUP GAFALSEGA mericaid Community Care (Houston) **27515 YAMERICAID HOUSTONFALSEGA mericaid Community Care (Maryland) **27517 YAMERICAID MDFALSEGA mericaid Community Care (New Jersey) **27516 YAMERICAID NJFALSEGA merican Behavior ##63103 NAMERICAN BEHAVIORFALSEGA merican Family Insurance ##12T31 YAMERICAN FAMILYFALSEGA merican Family Insurance (Administered by American Republic)

8 56071 NAM FAMILY INSURANFALSEGA merican Fidelity Assurance Company ##60801 YAMERICAN FIDELITYFALSEGAMERICAN GENERAL LIFE AND ACCIDENT ##62030 YAMERICAN GENERALFALSEGA merican Healthcare Alliance ##01066 YAM HEALTHCARE ALLFALSEGA merican Lifecare72099 YAMERICAN LIFECAREV alid for billing address of 1100 Poydras Street, Suite 2600, New Orleans, LA 70163-2602 FALSEGA merican NatIonal Insurance (ANICO) ##74048 YAMER NAT INSURANCFALSEGA merican Postal Workers Union Health Plan ##44444 YAMERICAN POSTAL WFALSEGA merican Republic Insurance Company ##42011 YARICFALSEGAMERICAN WORKER HEALTH PLUS **37322 YAMERICAN WORKER HFALSEGA mericas 1st Choice Health Plans of South Carolina ##20553 NAMERICAS FIRST CHFALSEGA mericas 1st Choice of South Carolina, Inc ##55349 YAM FIRST CHOICE SFALSEGA merica's Choice Health ##20029 NAMERICAS CHOICE NFALSEGA merica's Health Choice21810 YAMERICAS HEALTH CFALSETA merica's PPO (Formerly ARAZ)

9 ##16120 NAMERICAS PPO ARAZFALSEGA merica's PPO / America's TPA ##41178 YAMERICAS PPOFALSEGA merigroup ##28804 YAMERIGROUPFALSEGA merigroup Houston ##26374 YAMERIGROUP HOUSTC laims and EncountersFALSEGA merigroup Illinois ##27518 YAMERIGROUP ILClaims and EncountersFALSEGA merigroup Iowa ##26375 YAMERIGROUP IOWAFALSEGA merigroup Multiple States ##26378 YAMERIGROUP MULTIC laims and EncountersFALSEGA merigroup Ohio ##27518 YAMERIGROUP OHIOC laims and EncountersFALSEGA merigroup Vantage ##26375 YAMERIGROUP IOWAFALSEGA merihealth Administrators, Inc. **54763 YAMERIHEALTH ADMINFALSETI nstitutional Claim Payers List(08/20/2018) payer ID ReportsEnter As NameAdditional InfoEnrollmentPayer TypeHighlighted Payers are new or have been altered in the last 90 days.

10 Please verify that your system is setup correctly for these Caritas Iowa **77075 YAMERIH CARITAS IA For EDI Support, email or call Caritas Louisiana(Formerly known as LA Care)##27357 YLA CAREFALSEGA meriHealth Caritas VIP Care ##77062 NAMERIHLTH CARITASFALSEGA meriHealth Caritus VIP Care Plus (Michigan) #77013 YAH CARITUS VIP CAFALSEGA merihealth DC ##77002 YAMERIHEALTH DCFor EDI Support, please email or call 1-888-656-2383 FALSEGA merihealth Delaware **77799 YAMERIHEALTH DEFALSEGA merihealth HMO NJ and DE**95044 NAHLTH HMO NJ & DETRUENA merihealth Mercy Health Plan ##22248 YAMERIHEALTH MERCYFALSEGA merihealth NJ/DE - HMO **23037 YAMERIHEALTH HMOTRUEGA meriHealth NorthEast **77001 YAMERIHEALTH NEFALSEGA mfirst Insurance Company64090 YAMFIRST INS COFALSEGAM-First Insurance Morgan White **01757 NAM FIRST INS MORGP ayer accepts secondary claims only, and Medicare cannot be the primary payerFALSEGA mida Care Medicare ##79966 YAMIDA CARE MEDICAFALSEGA ngeles IPA (SynerMed)