Instructions for Submitting Claims for …

1 : All Optum trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners. This document contains information that is considered proprietary to OptumRx and should not be reproduced without express written consent of OptumRx. Doc #: PCA-1-003643-10072016_10212016 December 1, 2016 Beginning , 2017, please submit all medicare Claims with the appropriate Bank Identification Number (BIN), Processor Control Number (PCN) and Submitted group ( group ) code information as listed below and on our member identification (ID) cards. Market Product Name / Employer group Name Rx BIN Rx PCN Rx group AARP MedicareComplete (HMO) 610097 9999 COS SHCA SHCO SHOK SHOR SHTX AARP MedicareComplete Access (HMO) 610097 9999 COS AARP MedicareComplete Choice (PPO) 610097 9999 COS AARP MedicareComplete Choice (Regional PPO) 610097 9999 COS AARP MedicareComplete Choice Essential (PPO) 610494 9999 COS AARP MedicareComplete Choice Essential (Regional PPO) 610494 9999 COS AARP MedicareComplete Choice Plan 1 (PPO) 610097 9999 COS AARP MedicareComplete Choice Plan 2 (PPO) 610097 9999 COS AARP MedicareComplete Choice Plan 2 (Regional PPO) 610097 9999 COS AARP MedicareComplete Essential (HMO) 610494 9999 COS AARP MedicareComplete Focus (HMO) 610097 9999 COS AARP MedicareComplete Focus (PPO) 610097 9999 COS AARP MedicareComplete Focus Essential (HMO)

2 610494 9999 COS AARP MedicareComplete Mosaic (HMO) 610097 9999 COS Market Product Name / Employer group Name Rx BIN Rx PCN Rx group AARP MedicareComplete Plan 1 (HMO) 610097 9999 COS SHCA SHCO SHOK SHOR SHTX AARP MedicareComplete Plan 2 (HMO) 610097 9999 COS SHCA SHCO SHOK SHOR SHTX Instructions for Submitting Claims for unitedhealthcare medicare advantage Plans Effective Jan. 1, 2017 : All Optum trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners. This document contains information that is considered proprietary to OptumRx and should not be reproduced without express written consent of OptumRx. Doc #: PCA-1-003643-10072016_10212016 December 1, 2016 Market Product Name / Employer group Name Rx BIN Rx PCN Rx group AARP MedicareComplete Plan 3 (HMO) 610097 9999 COS SHCA SHCO SHOK SHOR SHTX AARP MedicareComplete Plan 4 (HMO) 610097 9999 COS AARP MedicareComplete Plan 5 (HMO) 610097 9999 COS AARP MedicareComplete Plan 6 (HMO) 610097 9999 COS AARP MedicareComplete Plan 7 (HMO) 610097 9999 COS AARP MedicareComplete Plan 8 (HMO) 610097 9999 COS AARP MedicareComplete Plus (HMO-POS) 610097 9999 COS AARP MedicareComplete Plus Plan 1 (HMO-POS) 610097 9999 COS AARP MedicareComplete Plus Plan 2 (HMO-POS) 610097 9999 COS AARP MedicareComplete Premier (HMO) 610097 9999 COS AARP MedicareComplete Profile (HMO) 610097 9999 COS AARP MedicareComplete SecureHorizons (HMO)

3 610097 9999 SHCA SHCO SHOK SHOR SHTX AARP MedicareComplete SecureHorizons Essential (HMO) 610494 9999 SHCA SHCO SHOK SHOR SHTX Market Product Name / Employer group Name Rx BIN Rx PCN Rx group AARP MedicareComplete SecureHorizons Plan 1 (HMO) 610097 9999 SHCA SHCO SHOK SHOR SHTX AARP MedicareComplete SecureHorizons Plan 2 (HMO) 610097 9999 SHCA SHCO SHOK SHOR SHTX AARP MedicareComplete SecureHorizons Plan 3 (HMO) 610097 9999 SHCA AARP MedicareComplete SecureHorizons Plan 4 (HMO) 610097 9999 SHCA AARP MedicareComplete SecureHorizons Premier (HMO) 610097 9999 SHCA AARP MedicareComplete SecureHorizons Value (HMO) 610097 9999 SHCA AARP MedicareComplete Value (HMO) 610097 9999 COS AARP MedicareRx Preferred (PDP) 610097 9999 PDPIND AARP MedicareRx Saver Plus (PDP) 610097 9999 PDPIND AARP MedicareRx Walgreens (PDP) 610097 9999 PDPIND Care Improvement Plus Dual advantage (Regional PPO SNP) 610097 9999 COS : All Optum trademarks and logos are owned by Optum, Inc.

4 All other brand or product names are trademarks or registered marks of their respective owners. This document contains information that is considered proprietary to OptumRx and should not be reproduced without express written consent of OptumRx. Doc #: PCA-1-003643-10072016_10212016 December 1, 2016 Market Product Name / Employer group Name Rx BIN Rx PCN Rx group Care Improvement Plus Gold Rx (PPO SNP) 610097 9999 COS Care Improvement Plus Gold Rx (Regional PPO SNP) 610097 9999 COS Care Improvement Plus medicare advantage (PPO) 610097 9999 COS Care Improvement Plus medicare advantage (Regional PPO) 610097 9999 COS Care Improvement Plus Silver Rx (Regional PPO SNP) 610097 9999 COS Erickson advantage Champion (HMO-POS SNP) 610097 9999 COS Erickson advantage Freedom (HMO-POS) 610097 9999 COS Erickson advantage Guardian (HMO-POS SNP) 610097 9999 COS Erickson advantage Signature with Drugs (HMO-POS) 610097 9999 COS Erickson advantage Signature without Drugs (HMO-POS) 610494 9999 COS Medica HealthCare Plans MedicareMax (HMO)

5 610097 9999 COS Medica HealthCare Plans MedicareMax Plus (HMO SNP) 610097 9999 COS Preferred Choice Broward (HMO) 610097 9999 COS Preferred Choice Dade (HMO) 610097 9999 COS Preferred Choice Palm Beach (HMO) 610097 9999 COS Preferred medicare Assist (HMO SNP) 610097 9999 COS Preferred medicare Assist Palm Beach (HMO SNP) 610097 9999 COS Preferred Special Care Miami-Dade (HMO SNP) 610097 9999 COS Sharp SecureHorizons Plan by unitedhealthcare (HMO) 610097 9999 SHCA Market Product Name / Employer group Name Rx BIN Rx PCN Rx group Symphonix Value Rx (PDP) 610097 9999 PDPIND unitedhealthcare Assisted Living Plan (HMO SNP) 610097 9999 COS unitedhealthcare Assisted Living Plan (HMO-POS SNP) 610097 9999 COS unitedhealthcare Assisted Living Plan (PPO SNP) 610097 9999 COS unitedhealthcare Chronic Complete (HMO SNP) 610097 9999 SHTX unitedhealthcare Dual Complete (HMO SNP) 610097 9999 COS SHCA SHCO SHOK SHOR SHTX MPDCSDE MPDCSLA MPDCSOH MPDCSPA MPDCSRI MPDCSTX MPDCSWA unitedhealthcare Dual Complete (HMO-POS SNP) 610097 9999 COS MPDCSKS MPDCSNM MPDCSOH unitedhealthcare Dual Complete (PPO SNP) 610097 9999 COS MPDCSHI MPDCSNM MPDCSTX unitedhealthcare Dual Complete Focus (HMO SNP) 610097 9999 COS : All Optum trademarks and logos are owned by Optum, Inc.

6 All other brand or product names are trademarks or registered marks of their respective owners. This document contains information that is considered proprietary to OptumRx and should not be reproduced without express written consent of OptumRx. Doc #: PCA-1-003643-10072016_10212016 December 1, 2016 Market Product Name / Employer group Name Rx BIN Rx PCN Rx group unitedhealthcare Dual Complete LP (HMO SNP) 610097 9999 MPDCSFL MPDCSWI unitedhealthcare Dual Complete LP1 (HMO SNP) 610097 9999 MPDCSWI unitedhealthcare Dual Complete ONE (HMO SNP) 610097 8500 9999 MPDACUNJ MPDCSPA unitedhealthcare Dual Complete RP (Regional PPO SNP) 610097 9999 MPDCSFL MPDCSHI unitedhealthcare Dual Complete RP ONE (Regional PPO SNP) 610097 9999 MPDCSFL unitedhealthcare MedicareComplete Choice (PPO) 610097 9999 COS unitedhealthcare MedicareComplete Choice Essential (Regional PPO) 610494 9999 COS unitedhealthcare MedicareComplete Choice Plan 1 (Regional PPO)

7 610097 9999 COS Market Product Name / Employer group Name Rx BIN Rx PCN Rx group unitedhealthcare MedicareComplete Choice Plan 3 (Regional PPO) 610097 9999 COS unitedhealthcare MedicareComplete Choice Plan 4 (Regional PPO) 610097 9999 COS unitedhealthcare MedicareComplete Essential (HMO) 610494 9999 COS unitedhealthcare MedicareComplete Plan 1 (HMO) 610097 9999 COS unitedhealthcare MedicareComplete Plan 2 (HMO) 610097 9999 COS unitedhealthcare MedicareComplete Plan 3 (HMO) 610097 9999 COS unitedhealthcare MedicareDirect Essential (PFFS) 610494 9999 COS unitedhealthcare MedicareDirect Rx (PFFS) 610097 9999 COS unitedhealthcare Nursing Home Plan (HMO SNP) 610097 9999 COS unitedhealthcare Nursing Home Plan (HMO-POS SNP) 610097 9999 COS unitedhealthcare Nursing Home Plan (PPO SNP) 610097 9999 COS unitedhealthcare The Villages MedicareComplete 1 (HMO) 610097 9999 COS unitedhealthcare The Villages MedicareComplete 2 (HMO-POS) 610097 9999 COS Senior Dimensions Southern Nevada (HMO) 610097 9999 SIE Senior Dimensions Greater Nevada (HMO) 610097 9999 SIE unitedhealthcare group medicare advantage (HMO) 610097 610494 9999 COS SHCA SHCO SHOK SHOR SHTX unitedhealthcare MedicareRx for Groups (PDP) 610097 9999 PDPIND unitedhealthcare group medicare advantage (PPO) 610494 9999 COS unitedhealthcare group medicare advantage (Regional PPO) 610097 9999 COS AARP Retiree Rx Plan 610097 9999 AWP CAPLERS 610097 8888 COS City of Milwaukee 610097 8888 PCMIL2 Diocesan Priests' Benefit Plan 610097 8888 WRAPGR HealthSelect medicare Rx (ERS of Texas) 610097 9999 ERSTX.

8 All Optum trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners. This document contains information that is considered proprietary to OptumRx and should not be reproduced without express written consent of OptumRx. Doc #: PCA-1-003643-10072016_10212016 December 1, 2016 Market Product Name / Employer group Name Rx BIN Rx PCN Rx group HP (Hewlett Packard) 610097 9999 HPA MHPA HP (Hewlett Packard) Enterprise 610097 9999 HPE MHPE John Deere 610494 610097 9999 DER Locals 302 & 612 IUOE 610097 9999 IUOEP1 Milwaukee County 610097 8888 9999 PMILC1 MMILC Market Product Name / Employer group Name Rx BIN Rx PCN Rx group North Carolina State Health Plan 610097 8888 COS Teamsters Benefit Trust 610097 8888 WRAPGR Transit Employees Health and Welfare Plan 610097 9999 TEHWP Virgin Islands Department of Human Services 610097 8888 WRAPGR If you have any questions or require assistance, please contact the OptumRx Help Desk, 24 hours a day, 7 days a week AARP MedicareComplete and unitedhealthcare MedicareComplete Plans.

9 877-889-6510 unitedhealthcare Dual Complete Plans: 877-889-6510 AARP MedicareRx, unitedhealthcare MedicareRx Plans: 877-889-6481 All other Plans: 800-788-7871 Please Distribute Immediately. Thank you.