Read Institutional (Hospital) Payer List - Payer ID Order text version

Institutional (Hospital) Payer List

Payer ID Order

Administrative Services of Kansas Updated October 2012

Administrative Services of Kansas (ASK) is Blue Cross and Blue Shield of Kansas DBA ASK.

ASK

1

ASK accepts claims for the payers listed on this page at no charge to the trading partner. Participation in the EDI Midwest Commercial Claims Clearinghouse is not required for any transactions submitted for these payers.

Additional Payers Available (Free)

Payer ID PAYER NAME

47163 47171 00301 00801 00800 31478 31478 31478 55204 31478 31478 31478

Blue Cross and Blue Shield of Kansas Blue Cross and Blue Shield of Kansas City BlueCross and BlueShield of Western New York BlueCross and BlueShield of Western New York BlueShield of Northeastern New York Freedom Network Freedom Network Select Health Partners of Kansas (HPK) HealthNow New York, Inc Mo-Kan Sheet Metal Workers Welfare Fund PHP (Preferred Health Professionals) Preferred Health Professionals PPO (PHP PPO)

ASK

2

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

00014 01041 01047 01066 02041 02041 02041 02041 02057 03036 03036 03036 03432 03440 03443 04293 04332 04423 05003 06102 06105 06108 06111 06119 06119 06172 06226 06607 07205 07503 07689 09822 09824 09830 09908 10010 10525 10850 10956 11303 11315 11324 11325

ASK

SelectCare Healthsource ME MEMIC American Healthcare Alliance CMHC Central Mass Heath Care Healthsource CMHC Healthsource Massachusetts Inc. Smith Administrators Blue Benefit Administrators of MA CBA Blue Employee Benefits Plan Administration Inc. (E.B.P.A.) Arizona Physicians IPA Phoenix Health Plan Abrazo Advantage Health Plan Neighborhood Health Plan (Boston MA) Network Health Molina Healthcare of New Mexico -SCI Presbyterian (NM) Diversified Administration Corporation ConnectiCare Inc Health Net of the Northeast Inc. Oxford Health Plans Healthsource SC Healthsource SC Dart Management Corporation Novanet Piedmont Behavioral Health Gilsbar Inc. University Family Care - Healthcare Group Global Care Inc. JMH - SFCCN PHT (PSN CMSN) Molina Healthcare of New Mexico - Salud University Family Care University Family Care - Maricopa Health Plan Careworks Patient Advocates LLC Metropolitan Health Plan Berkshire Intergroup Magnacare Fidelis Care New York Health Plus PHSP (Brooklyn NY) NHP/SHP (Neighborhood Health Providers and Suffolk Health Plan)

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Encounters Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

3

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

11328 11752 12057 12115 13162 13174 13185 13189 13193 13193 13193 13193 13193 13193 13265 13306 13315 13333 13334 13335 13337 13337 13337 13343 13346 13350 13381 13383 13402 13407 13550 13550 13551 13853 14043 14140 14165 14188 14315 15688 15749 16111 16114

ASK

HealthCare Partners IPA Claimsbridge West Medical Services Initiative VA Fee Basis Programs 1199 National Benefit Fund Montefiore Contract Management Organization TexasFirst Health Plan (NTX) Meridian Health Plan Central Reserve Life Ins Co- Medicare Supplement Continental General Ins Co- Medicare Supplement Great American Life Ins Co- Medicare Supplement Loyal American Life Ins Co- Medicare Supplement Provident American Life & Health Ins Co- Medicare Supplement United Teacher Assoc Ins Co- Medicare Supplement MetroPlus Health Plan PHCS Savility Payers Insurance Design Administrators Affinity Medicare Advantage Affinity Health Plan Hudson Health Plan BMC HealthNet Plan Boston Medical Center Health Plan Inc. Boston Medical Center Health Plan Inc. Amalgamated Life - PA / Alicare AFTRA Health Fund ODS Health Plan Orthonet Corporation - CIGNA Orthonet- Aetna TOUCHSTONE HEALTH/HEALTH NET SMART CHOICE USFHP - St. Vincent Catholic Medical Centers of New York ALICARE Amalgamated Life GHI - New York (Group Health Inc.) Atlantis Health Plan NHI BILLING SERVICES INC Farm Family Life MVP Health Plan of NY CareCore/WCNY RAD Commonwealth Care Alliance Insurance Management Services (Amarillo TX) Physicians Alliance/Stones River Regional IPA POMCO Nova Casualty Company

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Encounters Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

4

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

16117 16120 16120 16158 16600 19305 20050 20081 20133 20149 20172 20212 20257 20270 20333 20356 20356 20376 20381 20398 20413 20415 20460 20475 20553 20554 20572 20676 20807 20818 20896 21313 21356 22175 22195 22240 22248 22254 22264 22284 22285 22286 22304 22326

ASK

RMSCO INC. America's PPO Araz Group International Educational Exchange Services Inc. (IEES) Chautauqua County Healthcare Plan (Mayville NY) Access Medicare Integrated Medical Solutions LLC Today's Health Wisconsin Optimum Healthcare Inc. Molina Healthcare of Ohio Pennsylvania Pace Tethys Health Ventures HDPC/Alliance Physicians Health Payment Systems Inc. Worksite Benefit Services LLC Cerner HealthPlan Services The Health Exchange (Cerner Corporation) Gemcare Health Plan Boulder Administration Services Physicians Health Collaborative 3P ADMIN Select Senior Clinic SCAN Long Term Care MDWise Hoosier Alliance Americas 1st Choice Health Plans of South Carolina Inc. Molina Healthcare of Texas MSA Care Guard Molina Healthcare of Nevada Transchoice or TransSmile - First Service Administrator's Inc ESSENCE HEALTHCARE Health Services Consulting Group Inc. Kaiser Permanente of Georgia Acclaim Repricing I. E. Shaffer (West Trenton NJ) Maksin Management Corporation St. Barnabas System Health Plan AmeriHealth Mercy Health Plan Fallon Community Health Plan Vytra Healthcare Colonial Medical Atlantic Medical Insurance BritCay Horizon Inner Circle Tier 1/Rayant Horizon NJ Health

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

5

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

22348 22384 22521 22603 22771 23051 23130 23171 23212 23218 23223 23243 23249 23250 23253 23274 23281 23282 23283 23284 23285 23287 23342 23550 23706 23710 23856 24077 24735 24735 24735 24818 24819 25125 25133 25133 25133 25133 25133 25133 25133

ASK

Maryland Physicians Care Administrative Concepts Inc. OK State Employees & Educators (EDS) NJ Carpenters Health Fund Managed Health Network Waterstone Benefit Administrators (Outside Oklahoma) Fresenius Medical Care CHA Health American Medical and Life Insurance Superior Administrators Inc (Santa Ana CA) The Loomis Company - TPA Wyomissing PA (IHS Gateway Payer) Berkshire Health Partners - PPO Wyomissing PA (IHS Gateway Payer) Sentinel Management Services Significa Benefits Services Inc. Spectrum Administrators Inc. - TPA Allentown PA (IHS Gateway Payer) HealthGroup Limited UPMC Health Plan Community Care BHO Pittsburgh Care Partnership Inc. Keystone Mercy Health Plan Select Health of South Carolina Intergroup Services Corporation QualCare Inc. MFC & HealthPlus Peoria Directors Guild of America - Producer Health Plan Writers' Guild - Industry Health Plan Touchstone Health PSO SANTA CLARA FAMILY HEALTH PLAN Pinnacle Claims Management Inc. Western Grower's Assurance Trust Western Grower's Insurance Company Amida Care New York Presbyterian System Select Health Carpenter's Health and Welfare Trust Fund of St. Louis Advantra Freedom Advantra Savings Altius (Utah) Association Benefit Plan Carelink Health Plan Carelink Medicaid Carenet

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

6

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25145 25147 25160 25169 25175 25175 25176

ASK

Coventry Advantra Texas Coventry Health & Life (Oklahoma) Coventry Health Care Coventry Health Care Carelink - West Virginia only Coventry Health Care Carelink Medicaid - West Virginia only Coventry Health Care National Network Coventry Health Care of Florida Coventry Health Care of Georgia Inc. Coventry Health Care of Illinois Coventry Health Care of Iowa Inc. Coventry Health Care of Kansas Inc. Coventry Health Care of Louisiana Inc. Coventry Health Care of Missouri Coventry Health Care of Nebraska Inc. Coventry Health Care of Nevada Coventry Health Care of Virginia Coventry Health Care of the Carolinas Coventry Health Plan of Florida Coventry Health and Life Insurance Company administered by PersonalCare Coventry Health and Life Insureance (Tennessee) Coventry Missouri Coventry Summitt Health Plan Inc. Coventry of Health Care Delaware Inc. CoventryCares of Kentucky CoventryCares of Michigan CoventryCares of Nebraska CoventryCares of Pennsylvania Diamond Plan (Maryland Medicaid) Foreign Service Benefit Plan Health America Inc./Health Assurance/Advantra Healthcare USA Mail Handlers Benefit Plan Maryland Medicaid Rural Carrier Benefit Plan UT- Altius (UHIN) University of Missouri Benefit Coordinators Corporation (Pittsburgh PA) SouthCare/Healthcare Preferred MCA ADMINISTRATORS Gateway Health Plan Medicaid PA Three Rivers Health Plans Inc Unison Health Plan/Three Rivers PerformCare-Select Health MH/SA

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

7

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

25184 25404 25531 26078 26355 26545 27004 27009 27133 27154 27215 27327 27357 27514 27514 27514 27514 27515 27516 27517 27518 27518 27519 28021 28530 29076 29076 29076 29076 29076 29076 29076 30005 31048 31053 31053 31074 31074 31074 31074 31107 31114

ASK

UPMC Vision Advantage Seven Corners GHI HMO Americas 1st Choice Health Plans of North Carolina Inc. Averde Health VillageCareMAX Care Wisconsin Health Plan (Trizetto) Delaware Physicians Care Inc. Gemcare IPA Arizona Priority Care Plus Kentucky Health Administrators Inc. WINhealth Partners/Wyoming Health Solutions LACare AMERIGROUP Community Care of New Mexico AMERIGROUP Georgia Amerigroup Community Care Amerigroup Corporation (Ft Worth) Amerigroup Corporation (Houston) Americaid Community Care (New Jersey) Americaid Community Care (Maryland) Amerigroup Illinois Amerigroup Ohio Amerigroup Florida Kern County CDCR Secure Health Plans of Georgia LLC 1st MN--Atlanta GA 1st Medical Network - Atlanta GA Carolina Care Plan Consumers Life Insurance Company First Medical Network (FMN) - Atlanta GA Medical Mutual of Ohio Premier Health Systems Inc. Galveston County Indigent Health Care Western Southern Financial Group (Cincinnati OH) Individual Health Insurance Companies State Farm Insurance Companies EBMC Employee Benefit Management Corp (EBMC) TPAC/Employee Benefit Management Corp The Physicians Assurance Corp (TPAC) /Employee Benefit Management Corp (EBM UMR - Cincinnati (formerly known as United Medical Resources) CareSource OH

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

8

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

31118 31118 31118 31121 31127 31128 31138 31141 31143 31144 31172 31182 31313 31417 31441 31472 31625 32004 32006 33001 33010 33033 33053 33065 33069 33072 33104 34080 34080 34092 34097 34108 34131 34134 34136 34145 34150 34154 34158 34159 34159 34159 34167 34167

ASK

Central Benefits Life Central Benefits Mutual Central Benefits National Stoner and Associates (Cincinnati OH) Integra Group INTEGRA GROUP/HOME AHPO (Cleveland OH) Healthsource OH TRIHEALTH PHYSICIAN SOLUTIONS - CONCERN TRIHEALTH PHYSICIAN SOLUTIONS Innovante Benefit Administrators Total Community Care Freedom First Nationwide Health Plans S & S Healthcare Strategies Family Health Partners - Healthwave of Kansas ElderPlan Inc. Buckeye Community Health Better Health Plans of South Carolina Universal Care - California Cedars Sinai Medical Center FCE Benefit Administrators PacifiCare Behavioral Health CHOC - Children's Hospital Of Orange County Health Alliance High Desert Primary Care San Louis Obispo Select Texas HealthSpring Multiplan Wisconsin Preferred Provider Network WPPN Kaiser Foundation Health Plan of Ohio Central Reserve Life E.S. BEVERIDGE & ASSOCIATES Self-Funded Plans Inc. Professional Risk Management JP Farley Corporation Klais & Company The Health Plan (Massillon Ohio and St. Clairsville Ohio only) Chesterfield Resources Inc. Health Design Plus (Hudson OH) E-V Benefits Management Inc (Columbus OH) NABN (Cleveland OH) North American Benefits Network ((Cleveland OH) Emerald Health Network Inc. (All PPO Business) Health Services Preferred (HSP) by Emerald Health

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

9

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

34167 34171 34177 34181 34185 34187 34189 34192 34196 34638 34734 35092 35107 35107 35112 35145 35149 35161 35162 35164 35174 35182 35182 35182 35182 35183 35186 35187 35193 35199 35199 35199 35199 35199 35199 35202 35206 35206 35206 35209 35212 35227 35315 35316

ASK

Integrated Care Network (ICN) by Emerald Health FrontPath Health Coalition Comp - Ohio (Austintown OH) Commerce Benefits Group HealthFirst TPA (Houston TX) American Benefits Management (North Canton OH) Ohio Health Choice PPO Antares Management Solutions Apex Benefit Services Unified Physicians Network Aetna Better Health Inc. MORRIS ASSOCIATES Indiana Teamsters Health Benefits Fund (Indianapolis IN) Local 135 Health Benefits Fund (Indianapolis IN) Employee Plans LLC Highmark- Key Family Cook Group Health Plan Indiana ProHealth Network Managed Care Services LLC Sagamore Health Network Qual Choice of Arkansas Brodart CoreSource AZ MN CoreSource MD PA IL CoreSource NC IN CoreSource OH Dunn and Associates Benefits Administrators Inc. CoreSource-Internal Community Health Alliance COOPERATIVE MANAGED CARE SERVICES St. Anthony Memorial Healthcare Centers - MDWISE St. Catherine Hospital PHO - MDWISE St. Francis Health Network St. Margaret Mercy Healthcare Centers - MDWISE Suburban Health Organization Cornerstone Benefit Adminstrators Encircle PPO Encore Health Network The Healthcare Group Advantage Health Solutions North Texas Healthcare Network South Point Hotel & Casino Continental Key Family MMA

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

10

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

35317 35605 36149 36215 36215 36215 36234 36314 36320 36326 36331 36332 36333 36334 36335 36337 36338 36342 36342 36345 36346 36347 36348 36362 36364 36368 36369 36373 36385 36387 36389 36390 36392 36396 36397 36399 36401 36402 36404 36411 36412 36426 36459

ASK

KEY GAP Everence Benefit Administrative Systems Central States Health & Welfare Funds Rosemont of Des Plaines IL Teamcare NORTHWEST COMMUNITY HEALTH PARTNERS Central DuPage Physician Group Advocate Health Centers Associates for Health Care Inc. (AHC) Professional Benefit Administrators Inc. (Oak Brook IL) HealthStar Inc. Lawndale Christian Health Center MacNeal Health Providers- CHS HFN Inc. Weiss Health Providers Group Administrators Ltd. Benefit Systems & Services Inc. Total Broker Benefits Physicians Care Network (Rockford IL only) Northwest Suburban IPA (Illinois) Northern Illinois Health Plan Ingalls Provider Group United Security Life & Health Ins Co NorthShore University Health System Medical Group Health Options of Illinois American Imaging Management Inc. Prairie States Enterprises Inc. Hinsdale Physician Healthcare Silver Cross Managed Care Organization Rush Prudential Health Plans (HMO Only) Senior Care Partners North Suburban Associated Physicians Resurrection Health Care Preferred/FKA Family Medical Network Trellis Health Partners Elmcare LLC Preferred Network Access Inc. OAK WEST PRIMARY PHYSICIAN ASSOCIATION Self Insured Plans (Naples FL) Swedish Covenant Hospital Holy Cross Health Partners Sendero Health Benefit Management Group-NV

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

11

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

36609 36609 36878 37105 37114 37116 37118 37118 37121 37123 37127 37135 37136 37137 37212 37216 37217 37224 37227 37228 37230 37233 37233 37233 37237 37242 37246 37247 37248 37248 37248 37248 37253 37255 37256 37264 37266 37266 37267 37267 37267

ASK

Boilermakers National Health & Welfare Fund International Brotherhood of Boilermakers Entrust Sage Technologies H.E.R.E.I.U Welfare Pension Funds Lake County Physicians Association ACMG Benefit Plan Administrators Inc Mashantucket Pequot Tribal Nation Colonial Healthcare Michael Reese Physicians Group Consociate Group Physicians Health Association of Illinois HSHS Medical Group IPA Benefit Management Systems Inc Employee Benefit Services (Ft. Mill SC) Key Benefit Administrators (Indianapolis IN) Pittman & Associates CNIC Health Solutions Inc. Tarrant Health Services TR Paul Inc. MPE Services Inc. MPEEBT Mississippi Public Entity Employee Benefit Trust UMR - Lexington (formerly known as CommonWealth Administrative Group) Aultra Administrative Group Welborn Health Plans Western Mutual Insurance Bass Administrators Inc. Benesys Benesys Inc. LHP Claims Unit Elmco Nesika Health Group Mutual Assurance Administrators Mercy Benefit Administration Croy-Hall Mgmt. Inc. Southwest Service Life Loma Linda University Adventist Health Sciences Center Employee Health Plan Loma Linda University Adventist Health Sciences Centers Loma Linda University Behavioral Medicine Center Employee Health Plan

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

12

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

37267 37267 37267 37267 37267 37272 37272 37272 37272 37275 37276 37278 37279 37279 37280 37280 37281 37281 37281 37282 37283 37284 37286 37287 37287 37290 37298 37299 37300 37300 37300 37301 37305 37306 37307 37308 37309 37313 37314 37314 37314 37314 37314

ASK

Loma Linda University Employee Health Plan Loma Linda University Health Care Employee Health Plan Loma Linda University Medical Center Employee Health Plan Loma Linda University Medical Center Residents Health Plan Loma Linda University Student Health Plan ClubMD J. Smith Lanier & Co. Administrators JSL Administrators Wells Fargo Third Party Administrators Inc. (Formerly JSL Administrators) Missoula County Medical Benefits Plan Group Insurance Service Center Inc. ResourceOne Administrators IAA Insurance Administrators of America Inc. AGA Automated Group Administration Inc. Liberty Union Life Assurance Company Mid-America Associates Inc. Select Benefit Administrators of America HealthSmart Benefit Solutions TransChoice-Key Benefit Administrators BPA/Benefit Plan Administrators (North Dakota) PAI Planned Administrators Inc. Health Services for Children with Special Needs Medical Benefit Administrators Inc/dba MBA of MD Inc Nyhart FACS Group Federated Benefits Federated HR Services Summit America Insurance Services Inc. The Ford Meter Box Company Inc. Western Health Inc Connecticut Carpenters Health Fund Allied Benefit Systems Protective Life Insurance Company Assurant Health Self-Funded (Ft. Mill SC) Broward Health Children's Medical Services - Broward NORTH North Broward Hospital District South FL Community Care Network - NBHD Total Claims Administration

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

13

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

37316 37318 37320 37321 37322 37324 37330 37330 37331 37601 37602 37602 37602 38194 38201 38217 38221 38224 38224 38224 38225 38232 38238 38238 38241 38259 38265 38265 38265 38265 38265 38265 38265 38308 38309 38310 38325 38329 38333 38334 38335

ASK

Leon Medical Center Health Plan Southern Benefit Services Creative Plan Administrators Key Select American Worker Health Plan Upper Peninsula Health Group (TPA) Phyicians Health Plan (PHP) Mid-Michigan Physicians Health Plan PHP South Michigan RightChoice Benefit Administrators University of Illinois at Chicago Div of Specialized Care for Children All Savers Insurance Co. Golden Rule Insurance Company Rooney Life Inc. Group Health Managers Total Healthcare Inc. Priority Health Regency Employee Benefits HAP/AHL/Curanet MVP - Ohio Medical Value Plan - Ohio (MVP) NGS American Inc Weyco Inc. Northern California Sheet Metal Workers Health Care (San Ramon CA) Sheet Metal Workers Local 104 Health Care Plan (San Ramon CA) Employee Benefit Concepts (Farmington Hills MI) Automated Benefit Services ASR ASR Corporation ASR Health Benefits Administration Systems Research Corporation Physicians Care (ASR Corporation) Physicians Care Health Plans (ASR Corporation) Physicians Care Network (ASR Corporation) Christian Brothers Services Health Net of Arizona JOHN MORRELL COMPANY CO. - AHPBA Community Choice of Michigan Pro Care Health Plan Inc. (Detroit MI) Molina Healthcare of CALIFORNIA Molina Healthcare of MICHIGAN Cofinity

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

14

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

38335 38336 38337 39026 39033 39033 39033 39044 39045 39065 39065 39081 39111 39113 39126 39144 39156 39167 39182 39185 39186 39187 39188 39197 40585 41041 41095 41099 41124 41136 41147 41154 41178 41178 41194 41194 41206 41212 41222 41555 41600 42011 42102

ASK

PPOM LLC Molina Healthcare of WASHINGTON Upper Peninsula Health Plan (Medicaid) UMR - Wausau/UHIS (formerly Fiserv Health - Wausau Benefits/Benesight) Sentry Insurance a Mutual Company Sentry Life Insurance Company Sentry Life of New York Doctor's Choice Security Health Plan Assurant Health Time Insurance Company Benefit Plan Administrators Co. (Eau Claire WI) Network Health Plan of Wisconsin Dean Health Plan Community Care Inc. (Wisconsin) Network Health Plan of Wisconsin Inc. Physicians Plus Insurance Corporation Group Health Cooperative of South Central Wisconsin InsuranceTPA.com Prevea Health Plan Managed Health Services Indiana (Medicaid HMO) Managed Health Services Wisconsin Superior Health Plan Texas Quad Med LLC (Pewaukee WI) INDECS Corporation Federated Mutual Insurance Wilson-McShane John Alden Life Insurance Co. Meritain Health Minneapolis Life Trac PreferredOne (MN) MMSI America's TPA HealthEZ OptumHealth - CMC PacifiCare Encounters Ultra Benefits Inc. Freedom Health Plan Care To Care Manatee Service Center (Bradenton FL) I'Mcare American Republic Insurance Health Care Network of Wisconsin (HCN)

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

15

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

42137 42141 42149 42150 42172 42331 43160 43166 43166 43166 43173 43178 43179 43324 43471 44054 44219 44273 44444 45056 45289 45307 45985 46045 46050 46051 46450 46594 47027 47046 47076 47080 47083 48026 48055 48055 48055 48055 48055 48055 48116 48117 48120

ASK

American Administrators dba Select Benefit Administrators (W.DesMoines IA) CTI ADMINISTRATORS INC. Employee Benefit Systems Butler Benefit Soundpath Health FIRST PRIORITY HEALTH Corizon Inc. Mercy Health Plans Permier Health Plans Premier Benefits Inc. Family Health Partners/MC+ Missouri Joplin Claims / Benefit Management Inc Missouri Care/MC BEACON HEALTH STRATEGIES INETICO INC. Government Employees Hospital Association (GEHA) BHP-Unity Health Plans Inc. American Postal Workers Union Health Plan Prestige Health Choice Lone Star TPA Saint Anthony PHO Pinnacle Physician Management ORG Avera Health Plans Generations Healthcare Generations-Hillcrest State Auto Insurance Companies AFFINITY MEDICAL GROUP Physicians Mutual Insurance Company Contractors Laborers Teamsters & Engineers Regional Care Inc. Midlands Choice Inc. GMS Inc. NorthShore Physician Associates American Progressive Life and Health Insurance Company AveraAdvantage Marquette Life Insurance Company Pyramid Life Insurance Company Today's Options (American Progressive and Pyramid Life) Today's Options powered by CCRX Florida Hospital Waterman FMH Benefit Services Inc. Century Health Solutions

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

16

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

48143 48145 48611 49153 50528 50749 50946 51020 51028 51037 51052 51062 51909 51909 51909 51909 51909 51909 51909 51909 51909 51909 51909 51909 51909 52095 52103 52104 52120 52123 52132 52148 52148 52148 52148 52148

ASK

Group and Pension Administrators Community Health Choice Benefit Management Inc. of KS BCI Administrators Inc. Universal Health Care Inc Allianz Global Assistance Informed UHC Integra Administrative Group (Seaford DE) 21st Century Insurance and Financial Services Brockerage Concepts Inc. PSYCHCARE LLC Molina Healthcare of Florida Access Community Health Network. Chicago IL Family Health Network patients Advanced Physician's Association Chicago IL MG#118 Alivio Family Medical Family Health Network patients only Asian Human Services Family Family Health Network patients only Chicago Family Health Center Family Health Network patients only Family Christian Health Center Family Health Network patients only Independent Physicians Mercy Chicago IL MG#155 Neighborhood Doctors Organization PCC Community Wellness Center Family Health Network patients only Partners In Health Chicago IL MG#468 Sinai Medical Group Chicago IL Family Health Network patients only St. Francis Health Care Chicago IL MG#112 UICPG Chicago IL MG#141 Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. National Telecommunications Cooperative Association (NTCA) National Telecommunications Cooperative Association (NTCA Staff) National Telecommunications Cooperative Association Johns Hopkins Healthcare (USFHP) Cooperative Benefit Administrators (CBA) Alliance PPO LLC MAMSI Life and Health Insurance Co. (MLH) MD - Individual Practice Association Inc. (M.D. IPA) Mid Atlantic Psychiatric Services Inc. (MAPSI) Optimum Choice Inc. (OCI)

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

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EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

52148 52149 52180 52181 52189 52190 52192 52192 52193 52196 52312 52429 53011 53011 53011 53085 53275 54160 54210 55247 55438 55544 55731 56071 56089 56116 56132 56139 56144 56147 56162 56175 56176 56195 56196 56205 56211 56213 56240 56731 57038 57038 57080 57080

ASK

Optimum Choice of the Carolinas Inc. (OCCI) Alliance PPO Inc. (Maryland) UMWA Health & Retirement Funds MEDICAL DEVELOPMENT INTERNATIONAL Johns Hopkins Healthcare (EHP/PP) Special Risk International Bravo Health Bravo Health Star Plus LBA Health Plans Informed LLC Arbor Health Plan Healthscope Benefits - EHC Repricing NALC/Affordable National Association of Letter Carriers National Association of Letter Carriers/NALC Anchor Benefit Consulting Inc. MARTINS POINT HEALTH CARE APS Healthcare Inc. True Choice USA HIP - Health Insurance Plan of Greater New York CBCA Administrators Conversion Plan-APWU Central Susquehanna Healthcare Providers (CSHP) American Family PPO Policies Administered by Am Rep EAST CAROLINA BEHAVIORAL HEALTH Corporate Benefits Service Inc. (NC) Interactive Medical Systems BENEFIT MANAGEMENT SERVICES Primary PhysicianCare Inc. Healthsource NC (CIGNA) MedCost Inc. National Benefit Administrators - New Jersey National Benefit Administrators - North Carolina Carolina Summit Healthcare Inc. First Carolina Care MBS CM Administrators Inc Crescent Health Solutions Detroit Medical Center Healthcare Resources NW Kanawha HealthCare Solutions Inc. Kanawha Insurance Co. CWIBENEFITS INC. ClaimsWare Inc. dba ManageMed

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

18

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

57106 57115 57116 57254 57604 58102 58174 58182 58200 58202 58202 58204 58204 58204 58204 58204 58204 58210 58227 58231 58234 58730 59069 59069 59087 59140 59141 59143 59204 59221 59221 59222 59223 59224 59225 59225 59231 59266 59274 59275 59276

ASK

Tricare North Region CARE 1ST HEALTH PLAN OF CA Care 1st Health Plan of Arizona State of Texas Dental Plan Aetna Affordable Health Choices (SM) - SRC Covenant Administrators Inc. (Atlanta GA) Paragon Benefits Inc. NAPHCARE INC. The Integrity Benefit Group Inc. ADVANCED DATA SOLUTIONS MedAdmin Solutions Coordinated Medical Specialists MedAdmin Solutions Network TPA LLC Physician Associates of Louisiana Physician Care Network LLC Podi Care Managed Care Healthsource GA (CIGNA) HPS Paradigm Inc. Core Administrative Services Alliant Health Plans of Georgia Assurant Health/ASA 21st Century Health and Benefits Fringe Benefit Management The National Radiology Network HealthPlan Services Administrative Services Inc. Harrington Health Non-EPO Fringe Benefits Coordinators Mega Life & Health Insurance Company - Insurance Center The MEGA Life & Health Insurance Company - Insurance Center TransAmerica Life Insurance Company Chesapeake Life Insurance Company - Insurance Center Mid-West National Life Insurance Co. of Tennessee - Insurance Center Star HRG The MEGA Life & Health Insurance Company - Starbridge StarHRG MedCom VOLUSIA HEALTH NETWORK AvMed Inc. AVMED INC First Service Administrator's Inc Lakeland Florida

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Encounters Claims

19

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

59296 59298 59313 59314 59321 59322 59324 59331 59374 59698 60054 60054 60055 60058 60110 60280 60305 60550 60995 61101 61101 61101 61101 61106 61124 61125 61127 61129 61160 61225 61271 61271 61425 61425 61425 61604 61665 62030 62061 62111 62119 62129 62149

ASK

Professional Benefit Administrators (Winter Park FL) Employers Mutual Inc (Jacksonville Florida) Evolutions Healthcare Systems (New Port Richey FL) Comprehensive Behavioral Care Florida Hospital Healthcare Systems Florida Health Care Plan PODIATRY NETWORK FL Employers Mutual Inc. (Stuart Florida) ADVANTICA BENEFITS Florida League of Cities Inc. Aetna Aetna Aetna Encounters Northstar Advantage Preferred Health Systems Insurance Company Interface EAP (IEAP) American Community Mutual Insurance Gateway Health Plan - Medicare Assured Community Care Inc. - Family Care (Wisconsin) Humana Emphesys Humana Employers Health Insurance Humana Inc. Humana Insurance Company Choice Care Network Preferred Health Plan (Louisville KY) Bluegrass Family Health Humana Military - Tricare South Healthsource KY Passport Health Plan Humana Veterans Healthcare Services SelectCare of Texas (Kelsey-Seybold) J. F. Molloy and Associates Inc. Principal Financial Group Starmark Tooling & Manufacturing Association Trustmark Insurance Company Prime West Health Plan Preferred Benefits Administrator American General Harrington Health-Kansas (formerly known as Fiserv HealthKansas) Health Cost Solutions Northwest Diagnostic Clinic/SelectCare of Texas (NWDC) Healthsource TN (CIGNA) Community Health Network of CT

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Rosters Encounters Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

20

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

62153 62157 62160 62170 62171 62176 62177 62179 62180 62181 62183 62183 62218 62308 62308 62308 62308 62308 62308 62308 62553 62777 63070 63092 63100 63103 63114 63363 63665 63719 64068 64068 64068 64069 64071 64084 64088 64088 64157 64157 64157 64158 64158 64159

ASK

Windsor Medicare Extra Health Partners - Jackson TN MedSolutions Inc Unified Health Services OSF Health Plans AMCO Medical Reimbursements of America Health Choice Arizona Health Choice Generations Memorial Clinical Associates/ SelectCare of Texas (MCA) Better Health Plans Inc. Unison Health Plan/Better Health Plans Central SeniorCare CIGNA CIGNA - PPA CIGNA - PPO CIGNA Health Plan - HMO Connecticut General (CIGNA) EQUICOR EQUICOR - PPO Country Life Insurance Company TRLHN/EB RWDSU BENEFIT FUND HealthSpring HMO/HealthSpring Medicare+Choice Behavioral Health Systems American Behavioral Viva Health Plan Health Plus Physicians Organization Great-West Healthcare (formerly American General) Health Plan Management Services (HPMS) Creative Medical Systems MHP Systems Mississippi Health Partners Fox-Everett Inc. Acclaim Mississippi Physicians Care Network Mississippi Select Health Care Select Administrative Services (SAS) Meritain Health/North American Administrators North American Administrators Inc. North American Preferred Agency Services Inc Meritain Health / Agency Services Definity Health

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

21

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

64160 64246 64273 65056 65064 65085 65088 65088 65088 65093 65101 65101 66055 66121 66122 66124 66125 66126 66127 66917 67829 68011 68035 68037 68039 68046 68047 68048 68049 68050 68051 68052 68053 68054 68055 68056 68056 68056 68056 68056 68057 68058 68059 68060

ASK

Pivotal Plan Guardian Life Insurance Company of America Welborn Medicare Advantage New Market Dimensions ATA-FL NAA (North America Administrators L.P.) (Nashville TN) CareFlorida Preferred Care Partners Florida Preferred Care Partners Florida Advocate Physician Partners AXA Assistance_USA HAA Preferred Partners Netcare Life and Health Insurance (Hagatna Guam) Community Medical Group of the West Valley Inc. Eastland Medical Group West Covina Medical Group Lakeside Medical Group Verdugo Hills Medical Group Lakeside Comprehensive Healthcare Parkland Community Health Plan Sterling Medicare Advantage Capitol Administrators Health Plan of San Joaquin OMNI/Medicore HP Western Health Advantage Cenpatico - WI Cenpatico - Kansas Cenpatico - Arizona Peach State Health Plan Cenpatico - Georgia Cenpatico - OHIO Cenpatico - Indiana Cenpatico Behavioral Health Texas Bridgeway Arizona Absolute Total Care Advantage by Bridgeway Health Solutions Advantage by Buckeye Community Health Plan Advantage by Managed Health Services Advantage by Superior HealthPlan Centene Advantage Plans Sunshine State Health Plan Cenpatico - FL Cenpatico South Carolina CeltiCare

Claims Claims Claims Claims Claims Claims Claims Claims Encounters Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

22

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

68061 68062 68063 68064 68065 68066 68067 68068 68068 68069 68069 68069 68195 68423 69493 70259 70408 71057 71063 71075 71079 71080 71404 71412 71412 71412 71412 72087 72099 72126 72128 72148 72189 72261 72467 73066 73067 73071 73071 73100 73100 73117 73126

ASK

Cenpatico Massachuetts Magnolia Celtic Insurance Healthy Texas ILCBH IlliniCare Kentucky Spirit Health Plan Cenpatico Kentucky MO - Cenpatico Missuori Louisiana Healthcare Connections MO - Missouri Home State Health Care WA - Washington Coordinated Care Healthsource Provident The Care Network/The Savannah Business Group Tower Life Insurance Co. ProCare Health Plan Medicaid Union Security Insurance Company Cannon Cochran Management Services Inc. Metairie LA HealthSCOPE Benefits Inc. Healthsource AR (Med) (CIGNA) Molina Healthcare of Missouri Novasys Health Network Continental General Insurance Company ExclusiCare Mutual of Omaha Insurance Company Mutually Preferred United of Omaha Office of Group Benefits- Louisiana PHCS Claims (formerly American LIFECARE) Peoples Health Network Vantage Health Plan Inc. PPOPlus LLC Golden Triangle Physician Alliance/SelectCare of Texas (GTPA) SCAN Health Plan ACS Benefit Services Inc. Reserve National Insurance QuikTrip C. L. Frates & Co - OSMA Health OSMA Health - C. L. Frates Kempton Company Kempton Group Administrators Tribute /SelectCare of Oklahoma Equitable Plan Services (Oklahoma City OK)

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

23

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

73143 73145 73147 73155 73159 73172 73288 73288 73288 73288 73288 73743 74048 74095 74101 74205 74212 74223 74223 74227 74227 74227 74227 74227 74227 74238 74240 74266 74284 74289 74323 74323 74323 74323 74323 74431 75087 75130

ASK

Community Care Managed Health Care Plans of Oklahoma Preferred Community Choice/PCCSelect/CompMed Healthcare Solutions Group Waterstone Benefit Administrators (Oklahoma Providers) First Health Network (f.k.a. CCN Managed Care Inc. & PPO Oklahoma) Scan Health Plan Arizona EHI (Employers Health Insurance) EMPHESYS Employers Health Employers Health Insurance Lincoln National (EMPHESYS Green Bay and Madison WI only) Village Family Practice American National Ins. Co. (ANICO) USAA (United Services Automobile Association) Wisconsin Department of Corrections Right Care from Scott & White Employer Plan Services Benefit Planners Inc. UICI - Administrators - State of Nevada Mid-West National Life Insurance Co. of Tennessee - Student Insurance Student Insurance Student Insurance - Mid-West National Life Insurance Co. of Tenessee Student Insurance - The MEGA Life & Health Insurance Company The Chesapeake Life Insurance Company - Student Insurance The MEGA Life & Health Insurance Company - Student Insurance Boon-Chapman Benefit Administrators Inc. Assured Benefits Administrators BENEFIT MANAGEMENT ADMINISTRATORS DRISCOLL CHILDREN'S HEALTH PLAN MHNET MedBen (Newark OH) Medical Benefits Administrators Inc. (Newark OH) Medical Benefits Companies (Newark OH) Medical Benefits Mutual (Newark OH) Medical Benefits Mutual Life Insrance Co. Ohio PPO Connect States General Life Insurance UMC HEALTH PLAN

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

24

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

75136 75137 75138 75185 75190 75191 75196 75228 75232 75233 75234 75235 75236 75237 75240 75240 75243 75250 75255 75256 75261 75261 75273 75274 75276 75278 75280 75281 75284 75305 75600 76031 76045 76046 76048 76049 76056 76066 76079 76342 76569 76870

ASK

CoreSource Little Rock AmeriBen Solutions Inc. First Choice of Midwest (PPO) AAG-American Administravie Group ( Formerly Icon Benefit Admin) CareFirst Administrators/NCAS CareFirst Administrators/NCAS UMR -Harrington (formerly known as Harrington Benefit ServicesWesterville) Texas Childrens Health Plan (Medicaid) Employers Direct Health Employer's Direct Health - SF Healthfirst TPA (Tyler TX) Employer's Direct Health - FI Employer's Direct Health - Employee Plan Healthsmart Accel AAG Benefit Plan Administrators Inc. American Administrative Group Uniform Medical Plan/Harrington Benefit Services HealthSmart Preferred Care Inc. Healthsource N. TX (CIGNA) Verity National Group Community Health Electronic Claims/CHEC/webTPA webTPA/Community Health Electronic Claims/CHEC Geisinger Health Plan IHG Direct World Insurance Company Arkansas Best Corporation - Choice Benefits Shasta Administrative Services New Era Life Insurance Company Consolidated Associates Railroad Therapy Review Systems The City of Odessa New Era Employee Welfare Benefit Plan Trust SelectCare of Texas (HPN) Heritage Physicians Network Texas First Health Plans (TIOPA) Texas Children's Health Plan Choice One/UTMB CHIP Health Plan Seton CHIP Renaissance Physicians Organization Midwest Health Partners Sierra Health Services Passport Advantage LifePath Hospice Inc

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

25

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

76923 77010 77012 77015 77038 77039 77045 77052 77054 77073 77076 77078 77080 77082 77124 78375 79480 80026 80065 80141 80141 80141 80141 80141 80141 80141 80141 80142 80314 80314 80705 80900 80942 81040 81264 81400 81812 81883 82018 82048 82056 83028 83035

ASK

GOOD SHEPHERD HOSPICE INC Guardian Healthcare INC. (SC) MidCoast IPA Carilion Clinic Medicare Health Plan Sante Health System and Affiliates Kern Health Systems Arcadian Management Services Inc Coastal Administrative Services Fidelis Secure Care VNS CHOICE Medicare Network Health Insurance Corp-Medicare Banner Medisun WPP-ElderCare Wisconsin Care Improvement Plus DELANO IPA Connecticare - Medicare UMR - Onalaska (formerly known as Midwest Security of WI) MDI Holdings (Formerly Medical Partners of America) Family Health Network Childhealth Plus by Healthfirst (CHP) Healthfirst 65 Plus Healthfirst Family Health Plus (FHP) Healthfirst Health Plan of New Jersey Healthfirst Inc. (New York) Healthfirst New York (COMMERCIAL) Healthfirst PHSP Senior Health Partners (SHP) Health Partners PA GIC Indemnity Plan UNICARE Great-West Healthcare MDI Custom Provider Network (Formerly MPA - Custom Provider Network) West Suburban Health Providers Allegiance Benefit Plan Management Inc. Nippon Life Insurance Company of America American Medical Security Inc. Katy Medical Claims Municipal Health Benefit Fund HCS - Health Claims Service (Boise ID) Primary Health Network Custom Design Benefits Inc. CDO Technologies SENIOR WHOLE HEALTH

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

26

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

83077 83253 84065 84076 84096 84109 84131 84132 84133 84135 84146 84146 84146 85256 85729 86001 86002 86003 86033 86040 86047 86048 86049 86052 86062 86062 86062 86083 86304 87042 87065 87068 87071 87265 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726

ASK

Advantek Benefit Administrators Health Plan of Michigan Rocky Mountain Health Plan- Grand Junction Sinclair Health Plan Sloans Lake Preferred Health Networks Pinnacol Assurance Denver Health Medical Plan Inc. - Medicare Choice United Medical Alliance Denver Health and Hospital Authority Denver Health Medical Plan CHAMPVA - HAC Children of Women Vietnam Veterans-VA HAC Spina Bifida - VA HAC Wabash Memorial Hospital Association Healthcomp Inc. AmeriChoice of New Jersey Personal Care Plus (Medicare) AmeriChoice of New York Personal Care Plus (Medicare) AmeriChoice of Pennsylvania Personal Care Plus (Medicare) CIGNA Medicare Advantage Mountain States Administrative Services (Tucson AZ) AmeriChoice of New Jersey Inc. (Medicaid NJ) AmeriChoice of New York Inc. (Medicaid NY) United Americhoice of PA Mercy Care Plan (AHCCCS) Ancillary Benefit Services (ABS) Arizona Foundation for Medical Care (AFMC) VentureNet Healthcare Summit Administration Services Inc. Insurers Administrative Corp. UNION PACIFIC RAILROAD EMPLOYES Health Systems MBA of Wyoming (Worland WY) P5 Health Plan Solutions of Utah Liberty Health Advantage Benesight AARP Medicare Complete American International Group Inc. (AIG) Capital Community Health Plan Evercare PHP of South Michigan PHP of Southwest Michigan PHP of West Michigan UBH - United Behavioral Health (Health Plan - HMO) UnitedHealthCare West UnitedHealthcare

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

27

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87815 87843 88022 88023 88027 88029 88035 88050 88052 88054 88056 88058

ASK

UnitedHealthcare Plans of Puerto Rico UnitedHealthcare of Alabama UnitedHealthcare of Arizona Inc. UnitedHealthcare of Arkansas UnitedHealthcare of California - Northern California UnitedHealthcare of California - Southern California UnitedHealthcare of Colorado Inc. UnitedHealthcare of Florida UnitedHealthcare of Georgia UnitedHealthcare of Illinois UnitedHealthcare of Kentucky Ltd. UnitedHealthcare of Louisiana UnitedHealthcare of Mississippi UnitedHealthcare of New England UnitedHealthcare of New York (includes New York and New Jersey) UnitedHealthcare of North Carolina Inc. UnitedHealthcare of Ohio UnitedHealthcare of Tennessee UnitedHealthcare of Texas - Dallas UnitedHealthcare of Texas - Houston UnitedHealthcare of Upstate New York UnitedHealthcare of Utah UnitedHealthcare of Virginia UnitedHealthcare of Wisconsin Inc. UnitedHealthcare of the Mid-Atlantic UnitedHealthcare of the Midlands - HMO (Choice Select) UnitedHealthcare of the Midlands - PPO(Choice PlusSelect PlusSelf Funded) UnitedHealthcare of the Midwest - Choice Choice Plus Select Select Plus UnitedHealthcare of the Midwest - Medicare Complete Wells Fargo Third Party Administrators Inc. Consolidated Health Plans CDS Group Health Hometown Health Plan Nevada Northern Nevada Trust Fund SAINT MARY'S HEALTH PLAN ARM Grp NHBCAUX Benefit Plan Administrators TEAMSTERS (UT/ ID / MT) - Group Benefit Admin Activa Benefit Services MED PAY

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

28

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

88067 88537 89461 90001 90001 90023 90328 90440 90441 90560 91051 91051 91064 91078 91131 91131 91131 91136 91136 91136 91136 91136 91136 91136 91136 91136 91136 91136 91136 91136 91136 91136 91151 91162 91176 91184 91617 92600 92620 93029 93031 93044

ASK

Tall Tree Administrators Hometown Health Providers Quality Care Partners Healthlink PPO National Capital Preferred Provider Organization (NCPPO) HDPC - Premier Healthcare Lovelace Sandia Health Plan Premier Health Systems Inc CHP DIRECT SUPERMED WestLake Financial Group Inc. Group Health Cooperative - WA State Group Health Options - WA State Wenatchee Valley Medical Center Trusteed Plans Service Corporation First Choice Health Administrators First Choice Health Network Sound Health (now known as First Choice Health Network) Alaska Children's Services Inc. Alaska Laborers Construction Industry Trust Alaska Pipe Trades Local 375 Alaska United Food & Commercial Workers Health & Welfare Trust Cement Masons & Plasterers Health & Welfare Trust Enstar Natural Gas F40 Alaska Carpenters Trust Hotel Employees & Restaurant Employees Health Trust N.W. Ironworkers Health & Security Trust Fund N.W. Roofers & Employers Health & Security Trust Fund N.W. Textile Processors Operating Engineers Locals 302 & 612 Health & Security Fund Puget Sound Benefits Trust Puget Sound Electrical Workers Trust UW Graduate Appointee Plan Sterling Option 1 Columbia United Providers RBMS LLC Sanford Health Plan Kaiser Foundation Health Plan of Colorado Alaska Electrical Health & Welfare Fund Tongass Timber Trust PacificSource Health Plans Select Benefit Administrators Inc. A & I Benefit Plan Administrators

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

29

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

93050 93079 93092 93975 94134 94135 94177 94235 94265 94304 94304 94316 94320 95112 95164 95166 95167 95170 95192 95192 95192 95202 95213 95241 95266 95340 95377 95378 95397 95399 95426 95444 95467 95567 95568 95604 95606 95691 95740 95748 95930 95958

ASK

William C. Earhart Claims Kaiser Foundation of the Northwest Claims US Benefits Claims CareOregon Inc. Claims Kaiser Foundation Health Plan of Southern CA Region Claims Kaiser Foundation Health Plan of Northern CA Region Claims Allied Administrators (San Francisco CA) Claims Delta Health Systems Claims Medica Claims TBT Claims Teamsters Benefit Trust Claims Brown & Toland Medical Group Claims Kaiser CSI-California Select for Individuals (formerly known as Claims Kaiser PPO) Capital Health Plan Claims Cedars Sinai Medical Center Claims Cedars-Sinai Medical Network Services Claims Cedars-Sinai Medical Network Services Encounters American Benefit Plan Administrators Claims CommunityConnect HealthPlan Claims Compcare (Wisconsin BadgerCare only) Claims Group Health Cooperative of Eau Claire Claims SummaCare Health Plan Claims HealthEdge Administrators (Bakersfield CA) Claims A.G.I.A. Inc. Claims UMR - Harrington (formerly known as Harrington Benefit ServicesClaims Columbus) Adventist Health System West - Roseville CA Claims Beech Street Claims United Healthcare of River Valley Claims Personal Insurance Administrators Inc. (Agoura Hills CA) Claims CAP Management Systems Claims Affordable Benefit Administrators Inc. Claims Clarian Health Plans Inc. Claims Great Lakes Health Plan Claims Health Net of California and Oregon - Claims Claims Health Net - California (Institutional Encounters ONLY) Encounters Best Life & Health Insurance Co. Claims Berkshire Lehigh Partners Claims Athens Area Health Plan Select Claims DC Chartered Health Plan Inc. (Alliance) Claims DC Chartered Health Plan Inc. (Medicaid & Alliance) Claims Wisconsin Physician Services-Midlands Claims PacifiCare of California - Encounters Encounters

30

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

95959 95959 95959 95959 95959 95959 95959 95959 95959 95959 95962 95962 95964 95964 95998 95999 96107 96475 96490 98010 98514 99111 99208 99255 99282 99284 99289 99308 99320 12C01 12T30 12X27 12X27 12X29 12X43 12X51 12X59 33LGC A0701 ABRI1 BOONG CORIZ CP001

ASK

PacifiCare of California - Claims PacifiCare of Oklahoma - Claims PacifiCare of Oregon - Claims PacifiCare of Texas - Claims PacifiCare of Washington - Claims Secure Horizons California - Claims Secure Horizons Oklahoma - Claims Secure Horizons Oregon - Claims Secure Horizons Texas - Claims Secure Horizons Washington - Claims PacifiCare of Colorado - Claims Secure Horizons Colorado - Claims PacifiCare of Arizona - Claims Secure Horizons Arizona - Claims NEW AVENUES INC. PacifiCare PPO - All States Neighborhood Health Partnership of Florida Healthlink HMO InforMed LLC Manulife W. J. Sutton Company TRLHN/AS Cencal Health Hawaii Medical Assurance Association (HMAA/HWMG) Loma Linda Motion Pictures Industry Greater Covina Medical Group Screen Actors Guild Sutter Connect Medical Foundation Benefit & Risk Management Services WPS Tricare TriWest Community Health Plan of Washington Magellan Health Services National Imaging Assoc Inc / Magellan Health Services WPS Commercial WPS- Tricare For Life HealthPartners Global Healthcare Alliance Life Gift Cards Alta Bates Medical Group MOLINA HEALTHCARE Of WI FOUNDATION BENEFIT ADMINISTRATORS/CONTRACTOR EMPLOYEE BENEFITS ADMIN Corizon Health Inc. Samaritan Health Plans

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

31

EDI Midwest Institutional (Hospital) Payer List

EDI Midwest Payer ID Payer Name Services

E3510 EM039 EM205 EM216 EM284 EM350 EM521 EM522 EM843 GEM01 HSPAN L0110 LIFE1 MAHC1 RHA01 STAR1 SX133 SX159 SX187 TH073

North American Medical Management (NAMM) - Northern California MED3000 PEDICARE TITLE 19 MED3000 CMS TITLE 21 Healthspring MED3000 CMS SAFETY NET MED3000 CMS EARLY STEPS MED3000 COVENTRY HEALTHY KIDS MED3000 PEDICARE TITLE 21 MED3000 CMS TITLE 19 REFORM Global Excel Management HealthSpan Network Repricing NAMCI/Global Care Secure Horizons Lifeprint Arizona MEDICAL ASSOCIATES HEALTH PLAN Resolve Health Plan Administrators LLC Mediview Inc. Providence of Oregon Health Plan Lovelace Salud Providence PPO Dart Container Corporation

Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims Claims

ASK

32

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Institutional (Hospital) Payer List - Payer ID Order

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