MEDICARE PARTS A, B, AND DMERC CONTRACTOR …

1 MEDICARE PARTS A, B, AND DMERC CONTRACTOR payer ID Table 1 MEDICARE Part A CONTRACTOR payer IDs MEDICARE payer ID CONTRACTOR Name State Processed 00011 Cahaba Health Benefit Administration (RHHI) IA 00020 Pinnacle BSI AR 00130 National Government Services (NGS) IN 00131 National Government Services (NGS) IL 00160 National Government Services (NGS) KY 00230 Trispan LA 00320 Noridian Mutual Insurance Co. MN 00322 Noridian Mutual Insurance Co. AK and WA 00325 Noridian Mutual Insurance Co.

2 ID and OR 00326 Noridian Mutual Insurance Co. Roll-up for AK, WA, ID, OR 00332 National Government Services (NGS) OH 00380 Palmetto GBA SC 00382 Palmetto GBA NC 00450 National Government Services (NGS) WI 00452 National Government Services (NGS) MI 00453 Wisconsin Physicians Services (WPS) VA and WV 01001 Palmetto GBA Roll-up number for CA, HI and NV 01101 Palmetto GBA CA 01201 Palmetto GBA HI (includes American Samoa, Guam, and N.)

3 Mariana Islands) 01301 Palmetto GBA NV 03001 Noridian Administrative Services Roll-up number for AZ, MT, ND, SD, UT, and WY 03101 Noridian Administrative Services AZ 03201 Noridian Administrative Services MT 03301 Noridian Administrative Services ND 03401 Noridian Administrative Services SD 03501 Noridian Administrative Services UT 03601 Noridian Administrative Services WY 04001 TrailBlazer Health Enterprises Roll-up number for CO, NM, OK, and TX 04101 TrailBlazer Health Enterprises CO 04201 TrailBlazer Health Enterprises NM 04301 TrailBlazer Health Enterprises OK 04401 TrailBlazer Health Enterprises TX 05001 Wisconsin Physician Services (WPS) Roll-up number for IA, KS, MO, and NE 05101 Wisconsin Physician Services (WPS) IA 05201 Wisconsin Physician Services (WPS) KS 05301 Wisconsin Physician Services (WPS) MO 05401 Wisconsin Physician Services (WPS)

4 NE 09001 First Coast Service Options Roll-up number for FL, PR, and VI 09101 First Coast Service Options FL 09201 First Coast Service Options Puerto Rico and Virgin IslandsMedicare PARTS A, B, and DMERC CONTRACTOR payer IDs l July 2009 l 1 l MEDICARE payer ID CONTRACTOR Name State Processed 10101 Cahaba GBA AL 10201 Cahaba GBA GA 10301 Cahaba GBA TN 12001 Highmark MEDICARE Services Roll-up # for DC,MD,PA,NJ 12101 Highmark MEDICARE Services DE 12201 Highmark MEDICARE Services DC 12301 Highmark MEDICARE Services MD 12401 Highmark MEDICARE Services NJ 12501 Highmark MEDICARE Services PA 13001 National Government Services (NGS) Roll-up number for CT and NY 13101 National Government Services (NGS) CT 13201 National Government Services (NGS)

5 NY 14001 National Heritage ME 14003 National Heritage NH,VT 14201 National Heritage MA 14401 National Heritage RI 52280 Mutual of Omaha/WPS 48/50 states Table 2 MEDICARE DMERC CONTRACTOR payer IDs MEDICARE payer ID CONTRACTOR Name State Processed 16003 National Heritage Region A 17003 National Government Services (NGS) Region B 18003 Connecticut General Life (CIGNA) Region C 19003 Noridian Administrative Services Region D Table 3 MEDICARE Part B CONTRACTOR payer IDs MEDICARE payer ID CONTRACTOR Name State Processed 00512 Cahaba GBA MS 00520 Pinnacle BSI AR 00522 Pinnacle BSI OK 00528 Pinnacle BSI LA 00630 National Government Services (NGS) IN and KY 00836 Noridian Mutual Insurance Co.

6 AK, WA, and OR 00880 Palmetto GBA SC 00882 Palmetto RRB All states for Railroad 00883 Palmetto GBA OH and WV 00904 TrailBlazer Health Enterprises VA 00951 Wisconsin Physicians Services (WPS) WI 00952 Wisconsin Physicians Services (WPS) IL 00953 Wisconsin Physicians Services (WPS) MI 00954 Wisconsin Physicians Services (WPS) MN 01102 Palmetto GBA CA - northern 01192 Palmetto GBA CA - southern MEDICARE PARTS A, B, and DMERC CONTRACTOR payer IDs l July 2009 l 2 l MEDICARE PARTS A, B, and DMERC CONTRACTOR payer IDs l July 2009 l 3 l MEDICARE payer ID CONTRACTOR Name State Processed 01202 Palmetto GBA HI (includes American Samoa, Guam, and N.)

7 Mariana Islands) 01302 Palmetto GBA NV 02001 Palmetto GBA Roll-up number for CA, HI, and NV 03002 Noridian Administrative Services Roll-up number for AZ, MT, ND, SD, UT and WY 03102 Noridian Administrative Services AZ,MT and UT 03202 Noridian Administrative Services MT 03302 Noridian Administrative Services ND, SD, and WY 03502 Noridian Administrative Services UT 04102 TrailBlazer Health Enterprises CO 04202 TrailBlazer Health Enterprises NM 04302 TrailBlazer Health Enterprises OK 04402 TrailBlazer Health Enterprises TX 05002 Wisconsin Physicians Services (WPS) Roll-up number for IA, KS, MO, and NE 05130 Connecticut General Life (CIGNA) ID 05202 Wisconsin Physicians Services (WPS) KS, IA, MO-eastern 05302 Wisconsin Physicians Services (WPS) MO - western 05402 Wisconsin Physicians Services (WPS) NE 05535 Connecticut General Life (CIGNA)

8 NC 09002 First Coast Service Options Roll-up number for FL, PR, and VI 09102 First Coast Service Options FL 09202 First Coast Service Options Puerto Rico and Virgin Islands10102 Cahaba GBA AL 10202 Cahaba GBA GA 10302 Cahaba GBA TN 12002 Highmark MEDICARE Services Roll-up number for DE, DC, MD, NJ, and PA 12102 Highmark MEDICARE Services DE 12202 Highmark MEDICARE Services DC 12302 Highmark MEDICARE Services MD 12402 Highmark MEDICARE Services NJ 12502 Highmark MEDICARE Services PA 13002 National Government Services (NGS) Roll-up number for CT and NY 13102 National Government Services (NGS) CT 13202 National Government Services (NGS) NY (formerly Empire-NGS) 13282 National Government Services (NGS) NY (formerly Health Now) 13292 National Government Services (NGS) NY (formerly GHI)

9 14002 National Heritage MA, ME, NH, and VT 14402 National Heritage RI