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Payer 835 List

Payer ID

Payer Name

80705 80705 87815 60054 60054 47009 80705 25133 39065 R7003 32006 47171 55093 53589 CBAL1 47570 CBIA1 CBKS1 23739 CBMA1 CBMS1 CBMT1 CBNE1 22099 CX004 CB870 38520 47570 CBNY1 CBID2 47009 84147 34097 61271 61271 62308 62308 62308 52132 35182 35180 35183 35183 75136 35182 25133 25133 25133 25133 25133 25133 25133 07035 86027 05030 CDIN1

AH & L (Anthem Health & Life Ins of NJ)(Kennett, MO) ALTA Health & Life Ins. Co. (Kennett, MO) Accordia National (Charleston, WV) Adventis Risk Management Inc Aetna Ameritas Life Insurance Corp. (Lincoln, NE) Anthem Health & Life Insurance Co of New Jersey/AH&L Associated Benefit Plan (London, KY) Assurant Health Benefit, Inc. (Roseville, MN) Better health Plans of South Carolina Blue Cross Blue Shield of Kansas City (MO) Blue Cross Blue Shield of NY (Empire) Claims sent to MN Blue Cross of AZ (Phoenix, AZ) Blue Cross of Alabama (Birmingham, AL) Blue Cross of Alaska & Washington (Anchorage, AK) Blue Cross of Iowa (FEP claims only) Blue Cross of Kansas (Topeka, KS) Blue Cross of Louisiana (Baton Rouge, LA) Blue Cross of Massachusettes (North Quincy, MA) Blue Cross of Mississippi (Jackson, MS) Blue Cross of Montana (Helena, MT) Blue Cross of Nebraska (Omaha, NE) Blue Cross of New Jersey (Horizon) (Newark, NJ) Blue Cross of North Dakota (ND Dental Services) (Fargo, Blue Cross of Rhode Island (providence, RI) Blue Cross of South Carolina (Columbia/Charleston SC)(P Blue Cross of Washington & Alaska(Anchorage, AK) Blue Cross/Blue Shield of NY - Empire Blue Shield of Idaho(PO Box 31603 Salt Lake City, UT) Businessmen Assurance (NE) CHAMPVA - HAC - Denver, CO Central Reserve Life (Eagan, MN) Christian Brothers (Romeoville, IL) Christian Brothers Services (Colorado Springs, CO) Cigna Connecticut General (Bloomfield, CT) Continental Dental (Plantation, FL) Cooperative Benefit Administrators (CBA) (Lincoln, NE) Core Source (Po Box 2920, Clinton IA) CoreSource (NC, IN) (Charlotte, NC) CoreSource (Po Box 279, SHeldon IA) CoreSource OH - mailed to OH CoreSource of Little Rock (Little Rock, AK) CoreSource of PA MD IL (Lancaster, PA)(Clinton, IA) Coventry Health Coventry Health & Life OK Coventry Health (241508 Charlotte, NC) Coventry Health (PO Box 241508 Charlotte, NC) Coventry Health (PO Box 8403,8400,8402, London, KY) Coventry Health (PO box 8403,8400,8402, London, KY) Coventry Health Care of KS DeCare (PO Box 1348, Mpls., MN) Northwest Employees Delta Dental of Arizona Delta Dental of Illinois (Lisle, IL) Delta Dental of Indiana (Farmington Hills, MI)

Payer 835 List

Payer ID

Payer Name

CDKS1 CDMI0 CDMN1 CDNE1 56101 CDND1 CDOH1 39069 CX004 67814 94146 37272 CX079 62308 CX079 55093 CBNY1 47009 89070 72630 25133 25133 13317 39026 R7004 25133 39065 67814 44054 67814 67814 67814 07205 44054 80705 CX010 CX009 47009 25133 25133 11271 89070 22099 CX070 61271 41099 J1410 05030 41154 89070 R7005 25133 41154 CX026 CX026 CKAL1

Delta Dental of Kansas(Whichita, KS) Delta Dental of Michigan(Farmington Hills, MI) Delta Dental of Minnesota(Minneapolis, MN) Delta Dental of Nebraska(Minneapolis, MN) Delta Dental of North Carolina(Sacramento, CA & Mpls, Delta Dental of North Dakota(Bismark ND) Delta Dental of Ohio(Farmington Hills,MI) Delta Dental of Wisconsin Stevens Point, WI) Dental Service Corp (Fargo, ND) DenteMax (Wellesley Hills) Denti-Cal (Medicaid of California) (Sacramento, CA) Direct Reimbursement Benefits (Newnan, GA) EMIA-Educators Mutual (Murray, UT) EQUICOR Educators Mutual Ins. Assoc. (Murray, UT) Empire BCBS of NY (Minneapolis, MN) Empire Blue Cross Blue Shield (Mpls, MN) Employee Benefits Services (Lincoln, NE) Family Members Dental Plan (Harrisburg, PA) First Ameritas Life Ins Corp of New York (Lincoln, NE) First Health (Tucson, AZ - London, KY) First Health - Tucson, AZ - London, KY, Coraoplis, PA) First Reliance Standard (Lincoln, NE) Fiserv (Wausau, WI & Pueblo, CO) Flex Compensation (Mpls, MN) Foreign Service Benefit Plan (London, KY) Fortis Insurance Company - WI GEGLAC (Genworth Life & Health) GE Group GEHA Only (PO Box 4665, Independence, MO) Ge Group Life Assurance Co. Phoenix American Life (Gre Genworth Dental (PO Box 40011, Lynchburg, VA) Genworth Life & Health (GEGLAC)(GE Group LIfe) Gilsbar, Inc - Covington, LA & Jackson, MS (Covington, L Government Employees Hospital Assoc (GEHA) Only (PO Great-West Life and Annuity Ins. Co. (Kennett, MO) Health Partners of Minnesota (Medicaid) (Minneapolis, M Health Partners of Minnesota - Commercial (Minneapolis, Health Plan Services (Lincoln, NE) Health Right of CT (Medicaid Claims) HealthRight of CT (Medicaid claims to First Health Strata Healthplex, Inc. (Uniondale, NY) Highmark/HHIC (PO Box 69433 Harrisbury, PA) Horizon (Blue Cross of New Jersey) (Indianapolis, IN) Indiana Childrens Special HealthCare (Indianapolis, IN) J.F. Molloy and Associates, Inc.(Colorado Spring, CO) John Alden Life Ins. (501 W Michigan, Milwaukee, WI) Jopari Careworks (Columbus, OH) Local 731 (Burr Ridge, IL) MMSI-Mayo Clinic Health Solutions (Rochester, MN) MMSO (Military Medical Support) (Po Box 886999) MN Power (Duluth, MN) Mail Handlers Benefit Plan (Jacksonville, FL) Mayo Clinic Health Solutions-MMSI (Rocehster, MN) Medica of MN - PO Box 1328, Mpls, MN Medica of MN - PO Box 1519, Mpls, MN Medicaid of Alabama

Payer 835 List

Payer ID

Payer Name

CKAK1 CKAR1 94146 CKCO1 CKCT1 CKDE1 CKDC1 CKFL1 CKGA1 CKID1 CKIN1 CKIA1 CKKY1 CKME1 CKMI1 CKMN1 CKMS1 CKMO1 CKMT1 CKNV1 CKNH1 CKNJ1 CKNY1 CKNY2 CKNC1 CKOH1 CKOK1 CKOR1 CKPA1 CKRI1 CKTX1 CKUT1 CKVT1 CKWA1 CKWV1 CKWI1 CKWY1 CB833 CDMI0 89070 R7005 25133 89070 CKTX1 81264 47570 LX062 80705 80705 80705 80705 80705 80705 80705 80705 80705

Medicaid of Alaska Medicaid of Arkansas Medicaid of California (Denti-Cal) Medicaid of Colorado Medicaid of Connecticut (New Britton, CT) Medicaid of Delaware - New Castle, DE Medicaid of Disctrict of Columbia (Washington, DC) Medicaid of Florida Medicaid of Georgia Medicaid of Idaho (Boise, ID) Medicaid of Indiana (Boise, ID) Medicaid of Iowa (Des Moines, IA) Medicaid of Kentucky (Mequon , WI) Medicaid of Maine Medicaid of Michigan Medicaid of Minnesota Medicaid of Mississippi Medicaid of Missouri (Jefferson City, MO) Medicaid of Montana Medicaid of Nevada (San Antonio, TX) Medicaid of New Hampshire Medicaid of New Jersey (Trenton, NJ) Medicaid of New York Medicaid of New York (Dental Clinics Only) Medicaid of North Carolina (Raleigh, NC) Medicaid of Ohio (Administrated by Quadax) (Columbus, Medicaid of Oklahoma (Oklahoma City, OK) Medicaid of Oregon Medicaid of Pennsylvania (Harrisburg, PA) Medicaid of Rhode Island Medicaid of Texas Medicaid of Utah Medicaid of Vermont Medicaid of Washington Medicaid of West Virginia (Charelston, WY) Medicaid of Wisconsin (Madison. WI) Medicaid of Wyoming (Cheyenne, WY) Medical Mutual of Ohio (MMO) Michigan Conference of Teamsters (Farmingotn Hills, MI) Military Medical Support (MMSO) (Po Box 886999) Minnesota Power (Duluth, MN) Missouri Department of Transportation/MODot * St Louis Mountain State BCBS (MSBCBS(PO Box 69434, Harrisbur NHIC (Medicaid of TX) Nippon Life Insurance Company of America North Star Administrators Northern MN Dental (Duluth, MN) ONE Health Plan Inc of California ONE Health Plan Inc of Colorado ONE Health Plan Inc of Florida ONE Health Plan Inc of Georgia ONE Health Plan Inc of Idaho ONE Health Plan Inc of Indiana ONE Health Plan Inc of Iowa ONE Health Plan Inc of Kentucky ONE Health Plan Inc of Mississippi

Payer 835 List

Payer ID

Payer Name

80705 80705 80705 80705 80705 80705 80705 80705 80705 80705 80705 80705 80705 CX080 16111 93029 32069 47009 67814 67814 CX068 47570 61271 CX080 36088 RLHA1 25133 93742 41143 84147 13411 93024 R7003 67814 47009 47009 67814 CX088 60054 CDMI0 25175 39065 69493 89070 89070 62308 39026 39026 47009 25175 89070 12116 39026 87815 87815 37272

ONE Health Plan Inc of New Jersey ONE Health Plan Inc of New York ONE Health Plan Inc of North Carolina ONE Health Plan Inc of Oklahoma ONE Health Plan Inc of Texas ONE Health Plan Inc of The District of Columbia ONE Health Plan Inc of Vermont ONE Health Plan Inc of Virginia ONE Health Plan Inc of Washington ONE Health Plan Inc of Wisconsin ONE Health Plan Inc. of Alaska ONE Health Plan Inc. of Arizona One Health Plan Inc of Wyoming PEHP (Public Employees Health Program)(Salt Lake City, POMCO ( Syracuse, NY) PacificSource Health Plans - Eugene, OR Patriot Mutual Dental Programs(PO Box 192, MPLS, MN) Paul Revere / Provident Phoenix American (Greenfield, MA) Phoenix Home Life (Greenfield, MA) Physicians Mutual (Lincoln, NE) Premera Blue Cross (Seattle, WA) Principal (Coloradp Springs, CO) Public Employees Health Program (PEHP)(Salt Lake City, Reliance Standard Life (Lincoln, NE) Renaissance Life and Health (Indianpolis, IN) Rural Carrier Benefit Plan (Charlotte, NC) Securian Dental Plans (PO Box 9385, MPLS, MN) Delta of Sheffield, Olson & McQueen (2145 Ford Pkwy, St. Paul, Spina Bifida - VA HAC Standard Ins Co. of New York (PO Box 82520, Lincoln, N Standard Insurance of Oregon (Lincoln, NE) Sturm & Associates (Edina, MN) Sun Life (Po Box 81633, Wellesley Hills) Sun Life Canada Sun Life Financial Sun Life and Health (Formerly Genworth) Surency Life and Health (Wichita, KS) TRW Teamsters Welfare Fund (Farmington Hills, MI) Three Rivers Health Plan - (Monroeville, PA) Time Insurance - WI Tower Life Insurance (San Antonio, TX) Tricare Dental Plan (UCCI) Harris burg, PA) UCCI (United Concordia) UFT Welfare Fund UMR-Wausau (Salt Lake City, UT) UMR-Wausau (Wausau, WI & Pueblo, Co) Unifi Companies (Lincoln, NE) Unison - (Monroeville, PA) United Concordia (UCCI) VA Fee Basis Programs Wausau Insurance Companies, Wausau, WI Wells Fargo (Anchorage, AK) Wells Fargo (Charleston, WV) Wells Fargo TPA (JSL Administrators) (Newnan, GA)

Payer 835 List

Payer ID

Payer Name

R7002

Wilson, McShane (Mpls, MN)

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