Read 2-18-2010 All_State_Payer_List_NEW_(HCFA).xlsx text version

All States Payer List

ALL STATES

Pre.Enr. Payer ID 13162 59069 51028 20413 74234 93044 37283 75185 75240 87726 87726 87726 IP079 03443 AHS01 COACC CARMO 64071 21356 AHP01 AHIPA HPSVC 72467 36112 AHC01 22384 38265 59141 37278 TMG01 AMM01 AMM02 74234 68056 68056 68056 68056 35209 NMM01 ADVTK 25133 25133 25133 95340 36320 65093 60054 57604 23225 23225 60054 38692 ADOCS APG01 13334 95426 34444 13346 37280 64158 MAP01 CAPMN 06311 91136 92600

Professional Claims (HCFA 1500) *****Requires Pre-Enrollment

Name 1199 Local Benefit Fund (Provider should submit claims with assigned Plan Provider ID, as 2 digit suffix is no longer required. Call Renaud Du fresne at (646) 473-6960 for a list of Network ID's.) 21st Century Health and Benefits 21st Century Insurance and Financial Services (For Minnesota only) 3P Admin 8th District Elec A & I Benefit Plan Administrators AAG - American Administrative Group (Formerly Gallagher Benefit Admin) AAG - American Administrative Group (Formerly Icon Benefit Admin) AAG Benefit Plan Administrators, Inc. AARP - Payer ID valid only for claims with a billing submission address of PO Box 30968 Salt Lake City, UT 84130 AARP - Payer ID valid only for claims with a billing submission address of PO Box 31361 Salt Lake City, UT 84161 AARP - Payer ID valid only for claims with a billing submission address of PO Box 31362 Salt Lake City, UT 84161 ABMA Medical Corporation ABRAZO Advantage Health Plan Access Administrators Access Behavioral Care Access IPA (CareMore) Acclaim Acclaim Repricing Accountable Health Plan - Wisconsin & Iowa Accountable IPA (California) ACEC ACS Benefit Services, Inc. ACS Rewards Administration Center ActivHealthCare Administration Concepts, Inc. Administration Systems Research Corp Administrative Services, Inc. AdminOne Advanced Medical Associates (Testing of each provider is required by payer and done automatically by Office Ally once you start submitting claims for this payer.) Advanced Medical Management Advanced Medical Management MSI Advanstaff, Inc. Advantage by Bridgeway Health Solutions Advantage by Buckeye Community Health Plan Advantage by Managed Health Services Advantage by Superior HealthPlan Advantage Health Solutions Advantage Medical Group Advantek Benefit Administrators Advantra - Health Assurance - Health America, Inc. Advantra - Kansas City Medicare - Coventry Advantra Freedom Adventist Health System West - Roseville, California Advocate Health Centers Advocate Health Partners Aetna Aetna Affordable Health Choices (SM) - SRC Aetna Better Health Aetna Better Health - Connecticut Medicaid Aetna Student Health Aetna TX Medicaid Affiliated Doctor's of Orange County (ADOC) Affiliated Physicians Group (APG) Affinity Health Plan Please contact Affinitys EDI Coordinator before submitting claims electronically at [email protected] or call (718)794-7592. Affordable Benefit Administrators, Inc. AFL - CIO Food & Beverage Dealer's Trust Fund AFTRA Health Fund AGA Agency Services Inc. (Now known as Meritain Health) AIA- American Insurance Administrators (PO Box 2501 Bassett, CA and City of Industry addresses only) AKM Medical Group (Cap Managements Systems) Alabama Medical Surgical Associates Alaska Children's Services, Inc. Group #P68 Alaska Electrical Health & Welfare Fund Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm CA CA CA State

MN UT

CO

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NV

IL IL

TX CA IL

OH NY

CA CA

AK

**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Revised 2/18/2010

Payer List subject to change without notice

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Pre.Enr.

Payer ID 91136 91136 91136 13550 58213 37602 81040 13079 HCP01 20257 52149 88461 91131 58234 94177 37308 NMM01 SYMED 80705 IP079 25133 AMAIA 13550 13343 COMPU 75137 20029 27517 27516 75240 37283 42112 63103 HPSVC 34187 37128 60305 ACN01 CAPMN AMF11 62030 01066 36369 87726 72099 81400 74048 APSFL APBPN 62308 14190 48055 42011 ASHP1 37322 41161 41160 20029 95378 87726 87726 87726 87726 87726 86047 86001 86048 86002 86049 86003 87726 95378 ASRM1 27514

Name Alaska Laborers Construction Industry Trust Group # F23 Alaska Pipe Trades Local 375 Group # F24 Alaska UFCW Health & Welfare Trust Group # F45 ALICARE Alignis All Savers Insurance Company Allegiance Benefit Plan Management, Inc. Alliance Healthcare - Stones River Regional IPA Alliance IPA Alliance Physicians (High Desert Primary Care Alliance) Hesperia, CA Alliance PPO Alliance, The (A Wisconsin provider network) (Call Dave Sell at 608-210-6656 to pre-enroll) Alliant Health Plan (FCHN) Alliant Health Plans of Georgia Allied Administrators - San Francisco, California Allied Benefit Systems, Inc. Allied Physicians Medical Group Alpha Care Medical Group ALTA Health & Life Insurance Alta Senior Care Altius Health Plan- Coventry Ama Insurance Agency, Inc. Amalgamated Life Amalgamated Life IPA Alicare Amalgamated Transit Union Division 1001 Health & Welfare Fund Ameriben Solutions, Inc. America's Choice Americaid Community Care - Maryland Americaid Community Care - New Jersey American Administrative Group American Administrative Group (AAG) - Formerly Gallagher Benefit Admin American Administrators - West Des Moines, Iowa American Behavioral American Benefit Plan Administrators - HealthPlan Services, Inc. American Benefits Management - North Canton, Ohio American Commercial Barge Lines American Community Mutual Insurance American Complimentary Care Network American Family Health Providers - Cap Managements Systems American Family Insurance American General Life & Accident American Healthcare Alliance American Imaging Management, Inc. American International Group, Inc. (AIG) American Life Care American Medical Security American National Insurance Company (ANICO) American Pioneer - South Florida American Pioneer Brevard PHY Net American Postal Workers Union (Claims with DOS prior to 1/1/10 should use Payer ID 44444) American PPO American Progressive Life and Health Insurance Company American Republic Insurance Company (ARIC) American Specialty Health Plan American Worker Health Plan American Chiropractic Network (ACN) American Chiropractic Network IPA of New York (ACNIPA) Americas Health Choice AmeriChoice - Tenncare AmeriChoice of Connecticut AmeriChoice of Florida AmeriChoice of Illinois AmeriChoice of Maryland AmeriChoice of New England AmeriChoice of New Jersey Medicaid AmeriChoice of New Jersey Personal Care Plus (Medicare) (All claims require AmeriChoice provider id - call 888362-3368 to obtain.) AmeriChoice of New York Medicaid and Child Health Plus AmeriChoice of New York Personal Care Plus (Medicare) (All claims require AmeriChoice provider id - call 888-3623368 to obtain.) AmeriChoice of Pennsylvania Medicaid AmeriChoice of Pennsylvania Personal Care Plus (Medicare) (All claims require AmeriChoice provider id - call 888345-3627 to obtain.) AmeriChoice of Rhode Island AmeriChoice of Tennessee AmeriCorp Amerigroup Community Care of New Mexico

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm

State

CA CA

WA GA CA

CA CA UT CO

MD NJ

OH

CA

FL

NY TN CT FL IL MD NE NJ NJ NY NY PA PA RI TN NM

**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Revised 2/18/2010

Payer List subject to change without notice

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Pre.Enr.

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Payer ID 27514 28804 28805 27519 27514 28808 28808 54763 93688 95044 22248 60061 PPM01 AMILR PROSP CAPMN 53085 86062 HSM01 SYMED 34192 HDMDG 80705 16140 PROSP 34196 APP01 54160 44444 16120 AMS11 AMS11 AMS11 AMS11 36356 86062 03432 74234 75278 AMS11 95440 NMM01 HSM01 ASRM1 FAABC HSM01 ATPA1 36326 39065 37313 37323 88035 74240 93221 95691 22304 13853 38259 37280 CAPMN CAPMN AH001 46045 AV001 BKRFM SX145 37248 49153 43324 95377 63100 MPMOA SYMED 33192 36149

Name Amerigroup Community Care Amerigroup Corporation - Fort Worth, Texas Amerigroup Corporation - Houston, Texas Amerigroup Florida Healthy Kid Amerigroup Georgia Amerigroup Illinois Amerigroup Ohio AmeriHealth Administrator *Must also be a Highmark provider* Amerihealth Delaware Non-HMO (Highmark) *Must also be a Highmark provider* Amerihealth Delware - New Jersey HMO (Highmark) *Must also be a Highmark provider* Amerihealth Mercy Health Plan Amerihealth New Jersey Non-HMO (Highmark) *Must also be a Highmark provider* Ameri-West Health Associates AMIL - ARIA - Via Mediview AMVI - Prospect Health Network (Prospect Medical Group) AMVI (Cap Managements Systems) Anchor Benefit Consulting Inc. Ancillary Benefit Systems - Arizona Foundation for Medical Care Angel Medical Group DBA Superior Choice Medical Group Angeles IPA Antares Management Solutions Antelope Valley Medical Associates Anthem Health & Life Insurance Company of New Jersey APA Partners, Inc. APAC (Pinnacle Health Resources) (Prospect Medical Group) Apex Benefit Services AppleCare Medical Management APS Healthcare Inc. APWU - Affordable Network ARAZ Arcadian Community Care Arcadian Health Plan Arcadian Management Services Arcadian of Washington (Arcadian Mgmt Serv) Argus Health Systems Arizona Foundation for Medical Care Arizona Physicians IPA (APIPA) Arizona pipe Trades Health & Welfare Trust Fund Local Unions #469 & 741 Pipe Trades Health Plan Arkansas Best Corporation Arkansas Community Care Arnett Health Plans Arroyo Vista Family Health Center Asian Community Medical Group, Inc. ASRM Corp ASSOCIATED BENEFITS CORPORATION Associated Physicians Medical Group, Inc. Associated Third Party Admin Associates for Health Care, Inc. (AHC) Assurant Health Assurant Health Self-Funded - Ft. Mill, South Carolina Assurant MiniMed-Key Family AssureCare, Inc. Assured Benefits Administrators Asuris Northwest Health (via Regence BSWA) Athens Area Health Plan Select Atlanticare AKA Horizon HealthCare Admin (HHA) Atlantix Health Plan Automated Benefit Services Automated Group Administration Inc. Avalon IPA (Cap Managements Systems) Avalon Medical Group (Cap Managements Systems) Avante Health Avera Health Plans AVMED Healthplan Bakersfield Family Medical Center (Regal) Banner Health Company Bass Administrators, Inc. BCI Administrators, Inc. Beacon Health Strategies - Please use the following Plan IDs for block 11 on the 1500 form. Neighborhood Health Plan of MA=001; Hudson Health Plan=004;Fallon Community Plan=005; Neighborhood Health Plan of RI=006; Affinity Health Plan=009; DC Chartered Health Plan=013 Beech Street Behavioral Health Systems Bella Vista Medical Group IPA Bellflower Medical Center (Synermed) Bencomp National Corporation Benefit Administrative Systems

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm & HMO Comm Comm & HMO Comm & HMO Comm Comm & HMO Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm

State TX TX FL GA IL OH DE DE/NJ NJ TX CA CA AZ CA CA NJ CA CA

AZ LA OK CA WA AZ AZ AR

SC

WA

NY

CA CA

FL CA

CA

**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Revised 2/18/2010

Payer List subject to change without notice

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Pre.Enr.

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Payer ID 25145 BMATP 20018 00999 37212 39081 37118 37222 74223 34178 BSI01 38257 36342 74223 87265 37248 BNMK1 95604 32006 62183 00922 BC001 00520 00510 BC099 53589 00050 00060 SB580 00590 00601 HMSA1 00621 00630

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BCSIA 47163 47171 00660

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53120 00680 SB690 SB700 00710 00720 00230 00241 BCSMT SB580 23241 77780 00265 00770 00790 22099 SB810 00800 00801 00806 00805 00804 00834 00840 00851 54771 00870 BCSSC 88848 00390 84980 BCSVT 00923 00950

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Name Benefit Coordinators Corporation - Pittsburgh, Pennsylvania Benefit Management Admin (BMA) Benefit Management Group Inc. (BMGI) Benefit Management Services, Inc. (BCBS LA) (BCBS ID required, 5 or 10 characters long) Benefit Management Systems, Inc. Benefit Plan Administrators Company - Eau Claire, Wisconsin Benefit Plan Administrators, Inc. - Roanoke, Virginia Benefit Plan Management, Inc. Benefit Planners Benefit Services Benefit Solutions, Inc. Benefit Source, Inc. Benefit Systems & Services, Inc. (BSSI) Benefits Planners, Inc. Benesight (formerly The TPA) Benesys, Inc. BenMark - Mississippi Best Life & Health Insurance Company Better Health Plans of South Carolina Better Health Plans, Inc. Blue Choice of South Carolina Blue Cross (Cal-Optima - Medi-Cal) Blue Cross Blue Shield Arkansas - (Health Advantage, Blue Advantage, FEP, ITS and First Source) Blue Cross Blue Shield of Alabama Blue Cross Blue Shield of Alaska (Premera ) Blue Cross Blue Shield of Arizona Blue Cross Blue Shield of Colorado - Anthem Blue Cross Blue Shield of Connecticut Blue Cross Blue Shield of DC (Carefirst) Blue Cross Blue Shield of Florida Blue Cross Blue Shield of Georgia - Anthem Blue Cross Blue Shield of Hawaii Blue Cross Blue Shield of Illinois Blue Cross Blue Shield of Indiana - 12 provider number required. Please contact BCBS customer service at 800205-5870 option 9 if unknown. - Anthem Blue Cross Blue Shield of Iowa Blue Cross Blue Shield of Kansas Blue Cross Blue Shield of Kansas City Blue Cross Blue Shield of Kentucky - 12 provider number required. Please contact BCBS customer service at 800205-5870 option 9 if unknown. - Anthem Blue Cross Blue Shield of Louisiana Blue Cross Blue Shield of Maine - Anthem Blue Cross Blue Shield of Maryland (CareFirst ) Blue Cross Blue Shield of Massachusetts Blue Cross Blue Shield of Michigan Blue Cross Blue Shield of Minnesota Blue Cross Blue Shield of Mississippi Blue Cross Blue Shield of Missouri - Anthem Blue Cross Blue Shield of Montana Blue Cross Blue Shield of NCA Region ­ DC (Care First ) Blue Cross Blue Shield of NE Pennsylvania - - All new providers must enroll with First Priority Health/Blue Cross of Northeastern PA prior to submitting electronic claims. Enrollment form available at: http://www.bcnepa.com/EDI/registrationForm.aspx Blue Cross Blue Shield of Nebraska Blue Cross Blue Shield of Nevada - Anthem Blue Cross Blue Shield of New Hampshire - Anthem Blue Cross Blue Shield of New Mexico Blue Cross Blue Shield of New York & New Jersey Horizon Blue Cross Blue Shield of North Carolina (State Health Plan) Blue Cross Blue Shield of North East New York (HealthNow) (not the same as Empire BCBS) Blue Cross Blue Shield of North West New York (HealthNow) (not the same as Empire BCBS) Blue Cross Blue Shield of NY ­ Excellus ­ Utica Region Blue Cross Blue Shield of NY ­ Excellus Central Region Blue Cross Blue Shield of NY ­ Excellus Rochester Blue Cross Blue Shield of Ohio - 12 provider number required. Please contact BCBS customer service at 800-2055870 option 9 if unknown. - Anthem Blue Cross Blue Shield of Oklahoma Blue Cross Blue Shield of Oregon (Regence) Blue Cross Blue Shield of Pennsylvania (Highmark) Blue Cross Blue Shield of Rhode Island Blue Cross Blue Shield of South Carolina Blue Cross Blue Shield of South Dakota Blue Cross Blue Shield of Tennessee Blue Cross Blue Shield of Texas Blue Cross Blue Shield of Vermont Blue Cross Blue Shield of Virginia - Anthem Blue Cross Blue Shield of Wisconsin - Anthem

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm

State PA

LA WI VA

OH FL

MS SC SC CA AL AK AZ CO CT DC FL GA HI IL IN IA KS MO KY LA ME MD MA MI MN MS MO MT DC PA

Comm Comm Comm Comm Comm Comm Comm Comm Govn't Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm

NV NH NM NY, NJ NC NY NY NY NY NY OH OK OR PA RI SD TN TX VA WI

**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Revised 2/18/2010

Payer List subject to change without notice

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Pre.Enr.

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Payer ID BC001 23045 BC099 BS001 00611 00820 00932 00960 61124 13337 36609 BOLL1 74238 13337 38324 37286 13310 52192 38365 68054 BHP01 35182 51037 94316 BTSS1 84980 32004 42150 23708 33192 33192 REGAL HDNFC HSM01 AMS11 CALOP CAMAA 71057 37105 CAPMN 38245 23045 SX065 95112 65067 68011 GCVCP 57116 HPSM1 77082 00344 11345 38269 38269 14182 14184 14185 14179 14180 SB580 SB690 16147 25139 25139 25133 CLUHS CARMO CARMO 25133 39280 93975 22248 95093

Name Blue Cross of California Anthem Blue Cross of Pennsylvania (Capital / CAIC) Blue Cross of Washington State (Premera) Blue Shield - California / Blue Shield (FEP) Blue Shield of Idaho (Regence) Blue Shield of North Dakota Blue Shield of Washington State (Regence) Blue Shield of Wyoming Bluegrass Family Health BMC HealthNet Plan Boilermakers National Health & Welfare Fund Bollinger, Inc. Boon Chapman Administrators, Inc. Boston Medical Center Health Plan, Inc. Botsford Health Plan - Farmington Hills, Michigan BPA Benefit Plan Administrators - North Dakota BPS, Inc. Bravo Health (PA, MD, DE, TX and DC) Bridge Benefits Bridgeway Arizona Bright Health Physicians Brodart Brokerage Concepts Brown & Toland Medical Group Brown & Toland Sutter Select Bryan Independent School District Buckeye Community Health Plan Butler Benefit C & O Employees Hospital Association Cadent Aministrators Cadent Underwriters Caduceus Medical Group (Regal) California Care (Humboldt Del Norte) California Pacific Physicians medical Group, Inc. Cal-Net Physicians IPA Cal-Optima Direct Cameron & Associates Cannon Cochran Management Services - Metairie, Louisiana (PO Box 6794, Metairie, LA 70009) Cannon Cochran Management Services, Inc. Cap Management Systems Cape Health Plan Capital Blue Cross - CAIC Capital District Physicians Health Plan -CDPHP Capital Health Plan Capital International Management Services Capitol Administrators Cardiovascular Care Providers Care 1st Health Plan of Arizona Care Advantage Care Improvement Plus Care Management Resources CareCentrix - Enrollment required prior to claim submission. Please contact Tracy Greenlee at (813) 313-4226.

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm

State CA PA WA CA ID ND WA WY KY

MA MI ND

CA CA

CA CA

CA LA CA PA

AZ

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Carechoices Michigan - Mercy Healthplans (Enrollment required; please contact Noreen at (248) 489-5281) Carechoices Michigan - Mercy Healthplans (Enrollment required; please contact Noreen at (248) 489-5281) CareCore National CareCore National - HealthNet CareCore National, LLC - HealthNet New Jersey CareCore National, LLC (Aetna Radiology Claims) CareCore National, LLC (Oxford Radiology Claims) CareFirst Blue Cross Blue Shield - DC, National Capital Area CareFirst Blue Cross Blue Shield - Maryland Region CareGuide Carelink Advantra Carelink Health Plan Carelink Medicaid Carelink University Health System CareMore IPA CareMore Value Plus (CVP) Carenet CareOne Health Plan CareOregon Inc. CarePartners Careplus (Encounters)

MI

DC MD

CA

FL OR MO

**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Revised 2/18/2010

Payer List subject to change without notice

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Pre.Enr.

Payer ID 95092 MRCHP 37311 31114 35167 10010 62073 62072 57105 56195 COMPU 91131 25125 91131 COMPU 37060 SX183 41170 25133 87065 SX065 88022 HPIPA 95167 95166 CELTC 37250 91136 68048 68050 68052 68047 68056 USC02 UNC01 MER04 SCP01 13357 AMS11 75243 75196 31118 31118 31118 CCA01 CCA01

Name Careplus Health Plan Caresource Health Plan of Oregon CareSource of Indiana CareSource of Ohio Carewise Careworks Cariten Healthcare Cariten Senior Health Carolina Care Plan, Inc. Carolina Summit Healthcare, Inc. Carpenters' and Millwrights' Health Benefit Trust Fund Carpenters Health & Welfare (FCHN) Carpenter's Health and Welfare Trust Fund of St. Louis Carpenters Trust (FCHN) WA Only Carpet, Linoleum and Resilient Tile Layers Health and Welfare Fund Caterpillar, Inc. Catholic Healthcare West CBCA Administrators (HRM) CCN Managed Care, Inc. (Now Part of First Health Network) CDO Technologies CDPHP - Capital District Physicians Health Plan CDS Group Health Cedars Towers Surgical Medical Group ­ encounters only ­ payer id required Cedars-Sinai Medical Group - Non - Payable Claims (Capitated) Cedars-Sinai Medical Group - Payable Claims Celtic Cemara Administrators Cement Masons & Plasterers Health & Welfare Trust Group #F16 Cenpatico Behavioral Health - Arizona (Prior to submitting claims, please call Provider Relations Dept at 866-4956748) Cenpatico Behavioral Health - Georgia (Prior to submitting claims, please call Provider Relations Dept at 800-9470633) Cenpatico Behavioral Health - Indiana (Prior to submitting claims, please call Provider Relations Dept at 877-6474848) Cenpatico Behavioral Health - Kansas (Prior to submitting claims, please contact Provider Relations Dept at 866-8967293) Centene Advantage Plans Center Care (For Safety Claims) Center Care (For Unicare Claims) C t C Center Care PPO (M it i ) (Meritain) Center for Health Care Centercare Centinela Valley IPA Centra Centra Benefits - Houston, Texas Central Benefits Life Central Benefits Mutual Central Benefits National Central California Alliance for Health Central California Alliance for Health (before submitting claims go to http://www.ccah-alliance.org/claims_ecs.html to pre-enroll. The Alliance will contact you (800-700-3874 ext 5510) with approval.) Central Mass. Health Care (CMHC) Central Reserve Life Central SeniorCare Central States Health & Welfare Funds Central States Joint Board Health & Welfare Trust Fund Central Valley Medical Group (pre-enrollment under Sutter Connect) Century Health Solutions CHA Health CHAMPUS / TRICARE NORTH (Health Net Federal) : Connecticut, Delaware, Illinois, Indiana, Kentucky, Massachusetts, Maryland, Maine, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, Wash D.C., West Virginia and Wisconsin. CHAMPUS / TRICARE SOUTH (Humana Military) : Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee and Texas. CHAMPUS / TRIWEST (WPS): Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa(Except for the Rock Island Arsenal Area), Kansas, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon South Dakota, The Extreme Western Portion of Texas, Utah, Washington and Wyoming. ChampVA Chautauqua County Healthcare Plan - Mayville, New York CHC Cares of South Carolina CHEC - A Subsidiary of Sprint Chesapeake Life Insurance Company Chesterfield Technologies

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Govn't Govn't

State OR IN OH

CO WA MO WA CO

CA CA

AZ GA IN KS

CA CA TX

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02041 34097 CIPA1 36215 37214 SC027 48120 23171 CH002 CH002

IL CA

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WPSTC 84146 16600 25151 CHECS 59223 34154

Govn't Govn't Comm Comm Comm Comm Comm

NY SC

**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Revised 2/18/2010

Payer List subject to change without notice

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Payer ID AMM03 86048 94321 84146 CPMG1 CSSD2 94302 38692 CHIPA ACN01 LNDMK ACN01 SCH01 UHSCH 61271 SPOHN 62308 62308 CIGBH 62310 86033 86033 62308 62308 10207 AMS11 COA01 74234 75600 TKFMC 25133 57080 33192 HPSVC 77201 CRGMN AMM03 71063 71063 37310 CCPN1 77052 38335 37123 COACC COKSR COMPU AMS11 25351 91162 62308 34181 37237 14315 23171 23282 73143 39126 61948 38325 26231 SYMED COMMF 35193 CHCN1 48145 75261 62149 90010 CHPWA CMGWV 32481 34177 37297 CHP01 59314

Name Child Health and Disabillity Prevention Treatment (Advanced Medical Management) Child Health Plus and Americhoice of New York Medicaid Children First Medical Group Children of Women Vietnam Veterans - VA HAC Children's Physicians Medical Group Children's Specialists of San Diego II Chinese Community Health Plan CHIP CHIPA - College Health IPA ChiroCare Chiropractic Care of Minnesota Chiropractic Care of Wisconsin CHOC Health Alliance (Schaller Anderson) Choice One UTMB CHIP Health Plan (Please contact payer before sending claims-1-877-238-8543) Christian Brothers Services Christus Spohn Health Plan CIGNA CIGNA - PPO CIGNA Behavioral Health CIGNA Flex Care (New Mexico Only) CIGNA For Seniors CIGNA for Seniors - Arizona Medicare CIGNA Health Plan CIGNA Premier Plus Citrus Health Plan Citrus Valley Physician's Group City of Amarillo Group Health Plan City of Austin City of Odessa City of Visalia Claims Administration Corp. Claimsware, Inc. DBA ManageMed Clarendons Healthy Kids Clark County Clark County Clinical Resource Group CMS - Custody Medical Services (c/o Advanced Medical Management) CNA Health Partners CNA Health Partners (Formerly Coresource, AR) Coast Hotels & Casino Inc. DBA Coast Benefits Coastal Communities Physician Network (CCPN) Coastal TPA Cofinity Colonial Health Care Inc. Colorado Access Colorado Kaiser Permanente (Colorado plans only **EXCEPT COLORADO SPRINGS**) Colorado Laboreres Health & Welfare Fund Columbia Community Care Columbia Cornell Care Columbia United Providers CoMed - CIGNA Commerce Benefits Group Commonwealth Administrators, LLC Commonwealth Care Alliance Commonwealth Health Alliance (CHA) Community Care BHO Community Care Managed Health Care Plans of OK Community Care Organization Community Choice Health Plan of Westchester Community Choice of Michigan Community Claims Administration Community Family Care and CFC San Fernando Valley Community First Community Health Alliance Community Health Center Network - CHCN Community Health Choice Community Health Electronic Claims - CHEC - WEB TPA Community Health Network of Connecticut Community Health Plan (located in St. Joseph, MO. Service Area includes NW Missouri, NE Kansas, SW Iowa, SE Nebraska) Community Health Plan of Washington Community Medical Group of the West Valley Community Premier Plus for Neighborhood Health Providers Comp - Austintown, Ohio CompBenefits Corporation Complementary Healthcare Plan Comprehensive Behavioral Care

Claims Type Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm & HMO Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm & HMO Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm

State CA

MN WI CA

NM CA, MN

CA TX CA

NV MN

AR CA

CO CO CO WA

OK

MI CA

CT

CA OH

**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Revised 2/18/2010

Payer List subject to change without notice

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Payer ID 03036 CCMC1 74234 COMPU 74234 74234 74234 80705 78375 06105 37307 62308 63208 37135 75284 87843 37295 71404 55544 CCHP1 CCHP9 35149 52132 35199 58204 58231 41045 35182 35180 35182 75136 35182 35180 35183 35182 35202 41124 56116 37246 43160 62553 MCS03 41045 58102 CMSEB 25133 25133 25133 25141 25149 25133 25133 25133 25133 25133 25133 25133 25133 64068 37320 80705 37266 HPSVC AMM03 39170 82056 57080 06172 AMS11 AMS11 AMS11 95748 95748 39113 87726

Name Comprehensive Benefits Administrator, Inc. Comprehensive Care Management CompuSys - Erisa Group CompuSys (Incorporated) of Colorado CompuSys Inc - Arizona CompuSys Inc - New Mexico CompuSys Inc - Utah Confederation Administration Services & Life Insurance Connecticare Medicare Connecticare, Inc. Connecticut Carpenters Health Fund Connecticut General Connecticut PRI Consociate Group Consolidated Associates Railroad Consolidated Health Plans Consumer Health Solutions Continental General Insurance Company Conversion Plan - APWU Cook Childrens Health Plan Cook Childrens Star Plan Cook Group Heath Plan Cooperative Benefit Administrators (CBA) Cooperative Managed Care Services Coordinated Medical Specialists Core Management Resources CoreSource - Arizona CoreSource - Illinois CoreSource - Indiana CoreSource - Iowa CoreSource - Little Rock, Arkansas CoreSource - Maryland CoreSource - North Carolina CoreSource - Ohio CoreSource - Pennsylvania Cornerstone Benefit Adminstrators Corp. Benefit Services - CBSA - Fortis Self Funded Admin (Now known as Meritain. Payer ID valid only for claims with a billing submission address of P.O. Box 27267, Minneapolis, MN 55427-0267) Corporate Benefits Service Inc. - North Carolina Corporate Systems Administration Correctional Medical Services Inc Inc. Country Life Insurance Company County of Kern POS CourSource Minnesota Covenant Administrators Inc. - Atlanta, Georgia Covenant Mgnt Sys Employ Ben Coventry - Kansas City Medicare (Advantra) Coventry Advantra - Texas, New Mexico, Arizona Coventry Health & Life - Oklahoma Coventry Health and Life Insurance - Tennessee Coventry Health Care - Nevada Coventry Health Care National Network Coventry Health Care of Delaware Coventry Health Care of Georgia Coventry Health Care of Nebraska Coventry Healthcare of Iowa Coventry Healthcare of Louisiana Coventry Healthcare of Missouri Coventry Healthcare of Wichita, Kansas Creative Medical Systems Creative Plan Administrators Crown Life - Great West Croy - Hall Management, Inc. Culinary Workers Union Custody Medical Services - CMS (c/o Advanced Medical Management) Custom Benefit Administrators Custom Design Benefits Inc. CWIBENEFITS, INC. Dart Container Corporation Daughters of Charity Robert F. Kennedy Med Ctr (DCRFK) (Arcadian Mgmt Serv) Daughters of Charity St Francis Med Ctr (Arcadian Mgmt Serv) Daughters of Charity St. Vincent Med Ctr (Arcadian Mgmt Serv) DC Chartered Health Plan, Inc. (Medicaid & Alliance) DC Chartered Health Plan, Inc. (Medicaid & Alliance) Dean Health Plan Definity Health

Claims Type Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm

State VT NY TX CO AZ NM UT CT CT

TX

AZ IL IN IA AR MD NC OH PA

NC

CA MN

KS

DE GA NE IA LA MO KS

NV

CA CA CA DC WI

**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Revised 2/18/2010

Payer List subject to change without notice

Page 8 of 30

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Payer ID 63081 27009 DHS01 84134 84133 84135 84131 MC006 DNS22 DNS77 DNS44 AMS11 DESRT 36436 56240 25133 34639 23706 25160 25160 06102 16003 17003 00885 05655 AMS11 APP01 74284 37600 MC006 35186 75232 36434 DHS01 SYMED EMG11 62308 22262 34166 EPF03 EPF08 MPMOA 52192 52192 31625 NAELM 37253 34167 AMM03 AMM03 59299 73288 13202 EMP01 87726 38241 37215 81039 03036 37216 41198 37257 22262 75184 SYMED 35112 74212 MIDSC 75232 75236 75235 75233 MIDSC 73288 37249 59297

*****

Name Delaware Health Plan Consortium Delaware Physicians Care Delta Health Systems Denver Health - Indigent Denver Health and Hospital Authority Denver Health Medical Plan Denver Health Medical Plan - Medicare Choice Department of Social and Health Services - DSHS (Medicaid of WA) Dermatology Network Solutions, LLC BCBS (Payer requires 11 digit member ID Number) Dermatology Network Solutions, LLC Humana (Payer requires 11 digit member ID Number) Dermatology Network Solutions, LLC Vista (Payer requires 11 digit member ID Number) Desert Canyon Community Care Desert Medical Group (Regal) Destiny Health Detroit Medical Center Diamond Plan DiaTri, LLC Director's Guild of America - Producer Health Plans Diversified Group Administrators Diversified Group Brokerage (Marlb, CT) Diversified Group Brokerage/Healthplan Services DMERC Region A Medicare DMERC Region B Medicare DMERC Region C Medicare DMERC Region D Medicare Downey Regional Medical Center (Arcadian Mgmt Serv) Downey Select IPA (NOW KNOWN AS Applecare Medical Managment) Driscoll Childrens Health Plan DSCC DIV Special Care Children DSHS - Department of Social and Health Services (Medicaid of WA) Dunn and Associates Benefits Administrators E3 Health, Inc. Early Intervention Central Billing East Bay Drainage Drivers Security Fund East LA Doctors Hospital Eastland Medical Group IPA Eaton Benefits, Ohio EBA & M Employee Beneifts Administration and Management Corp EBS of Ohio (PO Box 2568, Mansfield, OH 44906) El Paso First - CHIP El Paso First Group Health El Proyecto del Barrio Elder Health HMO of Pennsylvania Elder Health Maryland HMO ElderPlan, Inc. Elderplan Provider ID is necessary on all claim submissions. If you do not know your provider Id, contact (718) 921-7979. ElmCare LLC Elmco Emerald Health Network (All PPO Business) Emergency Medical Service Fund (EMSF) (Advanced Medical Management) Emergency Medical Service Fund (EMSF) (Advanced Medical Management) EMI-KP Ambulance Claims Emphesys Empire Medicare New York Empire Physicians Medical Group Empire Plan- United Healthcare Employee Benefit Concepts Employee Benefit Corporation Employee Benefit Management Services Employee Benefit Plan Administration (E.B.P.A.) Employee Benefit Services - Ft. Mill, South Carolina Employee Benefit Services - Louisiana Employee Benefits Consultants Employee Beneifts Administration & Management Corp (EBA&M) Employee Claim ADJ Employee Health Systems Employee Plans, LLC Employer Plan Services Employers Coalition on Health (ECOH) Employers Direct Health Employer's Direct Health - Employee Plan Employer's Direct Health - Fully insured Employer's Direct Health - Self Employers Health Cooperative (EHC) Employers Health Insurance Employers Life Insurance Corporation Employers Mutual Inc.

Claims Type Comm Comm Comm Comm Comm Comm Comm Govn't Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Govn't Govn't Govn't Govn't Comm Comm & HMO Comm Comm Govn't Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm & HMO Comm Comm Govn't Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm

State

CA CO CO CO WA

AZ CA MI

PA CT

CA CA

WA

CA OH CA

CA PA MD

CA CA

NY

VT

CA CA

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Payer List subject to change without notice

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Payer ID 59298 59331 35206 35206 36364 91136 EPNSH 28777 62308 62308 62308 75196 73126 23250 74234 34108 20818 34159 87726 07501 58233 59313 EXC01 CAPMN 71412 37289 91136 95432 37300 SX072 FCM01 FCD01 FCR01 AMS11 CAPMN CAPMN 43173 31472 37289 14140 59069 33033 00402 37300 37300 41041 COFHP 11315 FAMR1 56196 56196 14162 91131 75138 80705 25133 25133 06108

Name Employers Mutual, Inc. - Jacksonville, Florida Employers Mutual, Inc. - Stuart, Florida Encircle PPO Encore Health Network ENH Medical Group IPA Enstar Natural Gas, Group # P61 EPN (Seton Health Plan) EPOCH Group, The Equicor Equicor - Equitable Equicor - PPO Equifax Healthcare Admin Service (EHAS) Equitable Plan Services - Oklahoma City, Oklahoma Erin Group Administrators Erisa Administrative Services ES Beveridge & Associates Essence Healthcare E-V Benefits Management, Inc. - Columbus, Ohio - Now known as Meritain Health Evercare Evercare Star Plus Evergreen Health Plan Evolutions Healthcare Systems - New Port Richey, Florida Excel MSO Exceptional Care Medical (Cap Managements Systems) Exclusicare F.A. Richard & Associates Inc. F40 Alaska Carpenters Trust Facey Medical Foundation FACS Group Fallon Community Health Family Care Medicaid Mental Health Family Care Medicaid Family Care Medicare Family Care Specialists (Arcadian Mgmt Serv) Family Choice Medical Family Health Alliance (Cap Managements Systems) Family Health Partners - MC + Missouri Family Health Partners Healthcare of Kansas FARA Benefit Services, Inc. Farm Family Life FBMC FCE Benefit Administrators Federal Employee Plan of SC Federated Benefits Federated HR Services Federated Mutual Health Insurance Company FHP of Colorado HMO Claims only Trading Partner Number Required Fidelis Care New York First Administrators First Carolina Care First Carolina Care First Choice - Connecticut First Choice Health Network First Choice of Midwest PPO First Great West Life & Annuity Ins. Co. First Health Network (CCN Managed Care and PPO for OK) First Health Network (Coventry) First Option Health Plan PHS HealthNet of the NE (Please call the EDI Team at 866-334-4638 to verify Provider ID) First Priority - All new providers must enroll with First Priority Health/Blue Cross of Northeastern PA prior to submitting electronic claims. Enrollment form available at: http://www.bcnepa.com/EDI/registrationForm.aspx First Seniority Freedom/Harvard Pilgrim First Service Administrators also known as Florida 1st First State Health Plan Firstcare Firstcare ­ Medicaid FirstGuard Missouri Fiserv Health - Kansas & Tennessee Fiserv Health - Wausau Benefits - Benesight Fiserv Health Harrington Fitzharris & Company, Inc. Flexcare Florida 1st - Winterhaven, Florida Florida Cenpatico Behavioral Health Florida Hospital Healthcare Systems Florida Hospital Waterman

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm

State FL FL

OK

OH

CA CA

OR OR OR CA CA CA MO

SC

MN CO NY NC

*****

23241 87726 59276 63080 94999 94998 90061 62061 39026 95266 11244 60054 59276 68058 59321 48116

PA

MO

FL FL FL

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Payer List subject to change without notice

Page 10 of 30

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Payer ID 48116 59698 65063 60054 APJAX 48117 37305 25133 87066 TKFMC 64069 FVMCH FVMC1 64069 41212 FMCHP DHS01 TKFMC 59069 59204 34171 37283 30005 60550 25169 91741 76028 PROSP 59041 06143 67815 44054 44054 75273 MCS01 MCS03 63665 63665 HDNFC 46050 46051 PROSP 11345 61271 61271 23212 22937 13551 25531 25141 58204 07205 COMPU AMM02 REGAL 07689 MPMOA 47083 37602 MBA01 GTPA1 AMM01 44054 37234 95467 80705 CAPMN NMM01 NMM01 CAPMN HCP01 80705 36338

Name Florida Hospital Waterman Employee Benefit Plan Florida League of Cities Florida NetPass Florida Power & Light (Prudential) Floridian Care - Jacksonville FMH Benefit Services, Inc. Ford Meter Box Company, Inc., The Foreign Service Benefit Plan Formax, Inc. Foundation for Medical Care of Tulare & Kings County Fox Everett - Ingalls Ship Building Fox Valley Medicine Site 199 Fox Valley Medicine Site 451 Fox-Everett, Inc. Freedom Health Plan Fresenius Med Care HTH Plan Fresno Unified Friant Water Users Fringe Benefit Management Fringe Benefits Coordinators FrontPath Health Coalition Gallagher Benefit Administrators, Inc (now AAG-American Administrative Group) Galveston County Indigent Health Care Gateway Health Plan - Medicare Assured Gateway Health Plan Medicaid Pennsylvania Gateway Health Plan of Ohio - Medicare Assured Gateway Health Plan of Ohio Gateway IPA (Pinnacle Health Resources) (Prospect Medical Group) GE Voluntary Benefits - PIC (GE Voluntary Benefits Professional Insurance Company) GEGA - Group Administrators, South Carolina GEGLAC - G.E. Group Life Assurance Company GEHA GEHA Ins. No. 372 Geisinger Health Plans (Prior enrollment required. Please contact Geisinger Health Plan at 888-281-5338, option 3, to obtain an enrollment form; or download a PDF enrollment form at www.thehealthplan.com) GEMCare (Golden Empire Managed Care System) GemCare Health Plan, Kern County EPO Gencare Health (St. Louis) Genelco (St. Louis Only) General Hospital (Humboldt Del Norte) Generations Healthcare Generations- Hillcrest Genesis Healthcare (EMG) (Prospect Medical Group) Gentiva Health Service Georgia Power Med. Benefits Pln (Health Care Services) Georgia Power Med. Benefits Pln (Hlth Care Srvcs) Gettysburg Health Preferred GHI - Medicare Private FFS GHI - New York (Group Health, Inc.) GHI HMO GHP Group Health Plan GI Innovative Management Gilsbar Glassworkers and Glaziers Health and Welfare Fund Trust Glendale Physicians Alliance (GPA Medi-Cal and GPA Healthy Families claims only) (GPA Senior and GPA Commercial claims should be sent through REGAL) Glendale Physicians Alliance (GPA Senior and GPA Commercial claims only) (GPA Medi-Cal and GPA Healthy Families claims should be sent through AMM02) Global Care Inc. Global Care Medical Group IPA GMS, Inc. Golden Rule Insurance Company Golden State Medical Group Golden Triangle Physican All Good Samaritan Medical Practice Association (GSMPA) Government Employees Hospital Association Grant Physicians Practice Association Great Lakes Health Plan Great West Health Care Greater L.A. Health (Cap Managements Systems) Greater Orange Medical Group Greater San Gabriel Medical Group Greater San Gabriel Valley Physicians (Cap Managements Systems) Greater Valley Great-West Life & Annuity Insurance Company Group Administrators Ltd.

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm & HMO Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm & HMO Comm Comm

State FL

FL FL

CA

CA CA

CA SC

CA MO MO CA

CA GA GA

CO

CA

CA CA

CA

CA CA

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Payer List subject to change without notice

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Payer ID 48143 72153 72087 91121 39167 39168 91051 91051 91051 38194 91051 91051 91051 25141 37276 68046 64246 RENBL RENGQ 91131 37114 36406 36405 HCP01 95266 95266 95266 95959 04271 48330 37111 37215 37329 82018 20257 33069 90023 34654 77950 38224 25133 60054 HCDPB MPMOA 42102 HCP01 34193 56142 61271 62180 34158 75196 20356 16120 30946 59087 55247 62295 20199 65062 55204 NAHOI HPAMN 62157 80142 20270 37221 52563 76342 HPSJ1 HPSM1 94254 HPSVC 44273 95435

Name Group and Pension Administrators Group Benefit Administrators (Hendersonville, TN) Group Benefits - Louisiana Group Health Cooperative - East Group Health Cooperative of South Central Wisconsin Group Health Cooperative of South Central Wisconsin Group Health Cooperative Medicare Plus Choice Group Health Cooperative Healthy Options Group Health Cooperative Washington State Group Health Managers Group Health Northwest Group Health Options, Alliant Group Health Options, Washington State Group Health Plan (GHP) Group Insurance Service Center Group Practice Affiliates Guardian Life (The Guardian) GULF QUEST IPA HMO BLUE Gulf Quest Renassaince H.E.R.E Health Trust H.E.R.E.I.U Welfare Pension Funds Harmony Health Plan of Illinois Harmony Health Plan of Indiana Harrimon Jones Harrington Benefit Services - Centra Harrington Benefit Services, Inc. Harrington Benefit Services, Inc. (Oklahoma) Harris Methodist Health Plan Harvard Pilgrim Health Care Hawaii Management Alliance Association (HMAA) HCH Administration - Illinois HCH Administration, Inc. HCHA Albq-Self Funded HCS - Health Claims Service - Boise, Idaho HDPC - Alliance Physicians (High Desert Primary Care Alliance) HDPC - High Desert Primary Care HDPC - Premier Care (High Desert Primary Care Premier) Health & Welfare fund of the Plumbers & Pipefitters Local Union#396 Health Alliance Medical Plan Health Alliance Plan of Michigan Health America Inc. - Health Assurance - Advantra Health Care Alliance (Sears) Health Care District Palm Beach Health Care LA, IPA Health Care Network of Wisconsin (HCN) Health Care Partners Health Care Payer's Coalition (HCPC) Health Care Savings Health Care Services, Georgia Power Health Choice Generations Health Design Plus - Hudson, Ohio Health Economics Corporation Health Exchange (Cerner Corp) Health EZ Health Future LLC Health Help Network, Inc. (HHNI) Health Insurance Plan of Greater NY (HIP) Health Market Care Assured Health Network America Health Network One Health Now New York Health Options of Illinois Health Partners of Minnesota Health Partners of Tennessee Health Partners, PA (All claims submitted require a valid Health Partners, PA, provider ID in the Rendering Provider Network ID field) Health Payment Systems, Inc. Health Plan Management Health Plan of Michigan Health Plan of Nevada Health Plan of San Joaquin Health Plan of San Mateo Health Plan of the Redwoods (Mediprime) Health Plan Services - Oklahoma Health Plans, Inc. Health Pledge HMO

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm & HMO Comm Comm Comm Comm

State TN LA WI WI

WA IL IN CA

OK

IL

ID CA CA CA OH MI

CA WI OH GA OH

NY

NY IL MN TN PA

MI CA, NV CA CA CA

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Payer List subject to change without notice

Page 12 of 30

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Payer ID 11324 55438 20896 37290 34167 37290 27008 61101 35206 HCP01 11328 56731 73147 25143 36335 62179 95376 85729 NAHOI HCPHM 80141 80141 75234 23226 59087 61101 96475 90001 95567 CH002 38309 06108 SX185 80142 59140 HPSVC 59256 68195 71063 M3IL1 75250 13335 02041 02041 68195 71075 58210 61127 01041 75255 56147 02038 31141 06119 62129 63092 36332 58213 HLTHQ 95827 22148 59230 REGAL HDMDG 33069 91161 91164 35145 HIL01 59347 36385 HPIPA HPFFS 61101 SYMED

Name Health Plus PHSP (Brooklyn, NY) Health Risk Management Health Services Consulting Group Health Services for Children with Special Needs Health Services Preferred (HSP) by Emerald Health Health Servs for Children w-Special Needs Health Systems International - ECOH Health Value Management - DE (Humana) Healthcare Group, The HealthCare Partners in CA Healthcare Partners IPA - New York Healthcare Resources NW Healthcare Solutions Group Healthcare USA Healthcare's Finest Network (HFN) HealthChoice of Arizona HealthChoice of Connecticut HealthComp Healthe Options of Illinois HealthFirst (HMO) Healthfirst Health Plan of New Jersey Healthfirst Inc -New York Healthfirst Tyler, TX HealthGuard of Lancaster HealthHelp Network, Inc. (HHNI) Healthhelp Networks, Inc. (HNNI) Healthlink HMO (Please call Provider Relations Dept at (800) 624-2356 for unique provider number. ) Healthlink PPO (Please call Provider Relations Dept at (800) 624-2356 for unique provider number. ) HealthNet of California, Oregon & Washington HealthNet Federal Services (TRICARE for North Region) HealthNet of Arizona HealthNet of the Northeast HealthNet Pearl HealthPartners, PA (All claims submitted require a valid Health Partners, PA, provider ID in the Rendering Provider Network ID field) HealthPlan Services (Tampa only) HealthPlan Services, Inc. (American Benefit) Healthplan Southeast HPSE Healthpoint Corp HealthSCOPE Benefits, Inc. HealthSelect BCBS of Florida HealthSmart Preferred Care HealthSource - Hudson Health Plan (Please contact payer before sending claims- 914-631-1611) Healthsource CMHC Healthsource Massachusetts, Inc. (CIGNA) Healthsource Provident Healthsource, AR (Med) (CIGNA) Healthsource, GA (CIGNA) Healthsource, KY (CIGNA) Healthsource, ME (Payer requires unique provider ID; please contact (800) 909-2227, ext.5760) Healthsource, N. TX (CIGNA) Healthsource, NC (CIGNA) Healthsource, NH (CIGNA) Healthsource, OH (CIGNA) Healthsource, SC (CIGNA) Healthsource, TN (CIGNA) HealthSpring HMO - HealthSpring Medicare+Choice HealthStar, Inc. Healthways WholeHealth Network Healthy Equation Healthy Palm Beaches, Inc. Heavy & General Labors Fund of NJ Heritage Consultants Heritage Provider Network High Desert Medical Group - Lancaster, California High Desert Primary Care - Hesperia, California Highline Medical Service Organization - PSHP Highline Medical Service Organization ­ Molina Highmark - Key Family Hill Physicians Medical Group Hillcrest Benefit Administrators Hinsdale Physicians Healthcare Hispanic Physician IPA ­ for encounters only ­ payer id required Hispanic Physicians IPA Fee For Service - Encounters Only - Payer ID Required HMPK, INC. (Humana) Hollywood Presbyterian Medical Group

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Govn't Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm

State NY

DE

NY

AZ CT CA TX NY TX FL

AZ

PA FL FL

FL

GA KY

OH

FL NJ CA CA CA

CA

CA

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Payer List subject to change without notice

Page 13 of 30

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Payer ID CAPMN NAHLX 88023 22099 22326 37274 91136 61101 94254 58227 41170 41150 13335 HBI01 61101 61101 61101 61101 61101 61101 61101 61101 95348 61101 61101 61101 61101 CH002 61101 61101 Z0005 65018 61160 61101 HDNFC 37260 CAPMN 13335 SX172 22175 38234 BS001 74234 74234 60054 11695 37296 75185 75274 IHORG 36600 91131 41600 SCP01 40585 54763 54704 IMG01 IMG02 35204 35161 35107 31053 COMPU 52196 NAING 91131 IEHP1 IHORG 04320 93112 60054 37279 63082 13315 IMSMS

*****

Name Hollywood Presbyterian Medical Group- (now known as Prudent Medical Group) Holy Cross Health Partners Hometown Health Plan Nevada Horizon Blue Cross Blue Shield of New York & New Jersey Horizon NJ Health Hospital Benefits Hotel Employees & Restaurant Employees Health Trust, Group # F19 HPLAN, INC. (Humana) HPR HPS Paradigm HRM Claim Management HSM - Health Services Management Hudson Health Plan (Please contact payer before sending claims- 914-631-1611) Human Behavior Institute Humana Care Plan Humana Gold Choice Humana Gold Plus Humana Health Humana Health Chicago Insurance Company Humana Health Chicago, Inc. Humana Health Plan Humana Health Plan - HMO Humana Health Plans of Ohio Humana Insurance Agency Humana Insurance Co. Humana Medical Plan - California Humana Medical Plan - Kentucky Humana Military Healthcare Services (TRICARE for South Region) Humana Ochsner 1 Humana Ochsner 2 Humana Ohio 2 Humana Puerto Rico Humana Veterans Healthcare Services Humana Wisconsin Health Organization (Formerly Carenetwork - Wisconsin Health Organization) Humboldt - Del Norte Foundation IPA Hunt Insurance Group Huntington Park Mission Medical Group (Cap Managements Systems) Husdon Health Plan (Please contact payer before sending claims- 914-631-1611) I U Medical Group Primary Care I. E. Shaffer - West Trenton, New Jersey IBA Self Funded Group IBEW Local 6 - San Francisco Electrical Workers *They will all have a prefix code of "XEL" as their member ID on They XEL the BSC card. IBEW Local 640 & AZ Chapter NECA Health & Welfare Trust IBEW Western Utilities or Local 57 IBM Medical Plans iCARE (Independent Care Health Plan) ICM ICON Benefit Administrators IHG Direct IHO (Inland Health Organization) Illinois Central Hospital Association - Tinley Park, Illinois ILWU Local 21 (FCHN) IMCARE Imperial County Physicians Med Group (SCPMCS) INDECS Corporation Independence Administrators Independence Blue Cross (Highmark) *Must also be a Highmark provider* Independence Medical Group - Kern County Independence Medical Group - Tulare County Indiana Health Network Indiana ProHealth Network Indiana Teamsters Health Benefits Fund - Indianapolis, Indiana Individual Health Insurance Companies Industrial Machine Specialties Informed Ingalls Provider Group Inland Empire Electrical Trust (FCHN) Inland Empire Health Plan Inland Health Organization (IHO) Innovative Healthware Solutions Inpronet, Portland, OR Institutes of Quality Insurance Administrator of America, Inc. (IAA) Insurance Claims Services - Birmingham, Alabama Insurance Design Administrators Insurance Management Services

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Govn't Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm

State CA NV NY, NJ

MN

OH

CA KY

OH

WI CA CA

NJ

WI

IL WA

PA CA CA IN IN CO

WA CA

OR

AL TX

**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Revised 2/18/2010

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Page 14 of 30

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Payer ID 88006 IAC01 51020 31127 31129 INET1 37124 34167 68053 58200 92649 37227 60280 23287 74234 36609 IMGIN 37269 84137 20435 41124 37272 61271 05014 JAI01 JISSP 41099 95378 JMH01 68013 37215 52189 43178 34136 37272 94320 91617 KSRCS COKSR 21313 94135 KS005 KS001 52095 NW002 KS006 57038 57038 44030 25133 HSM01 KMG11 TKFMC KELSE 73100 63077 61101 37124 MCS03 77039 37217 IP082 37321 23239 95056 23284 86049 86049 34145 KAMG1 KPS01 KPS01 LACAR LVCV1 LVIPA

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Name Insurance Management Services - Elko, Nevada Insurers Administrative Corp. Integra Administrative Group - Seaford, Deleware Integra Group Integra Group-CHA Integranet Integrated Benefit Services - Illinois Integrated Care Network (ICN) by Emerald Health Integrated Mental Health Service (Prior to submitting claims, please call Provider Relations Dept at 1-800-716-5650 to verify your provider info is on file in the claim system) Integrity Benefit Group, Inc. Inter-Americas Insurance InterCare Health Plans Interface EAP (IEAP) Intergroup Services Corporation Intermountain Ironworkers Trust Fund International Brotherhood of Boilermakers International Medica Group Inc International Union of Operating Engineers ~ Local 15, 15A, 15C & 15D Interwest Health (Acceptius Gateway Payer) Intgritas Benefit Group Iowa Benefits J. Smith Lanier & Co. Administrators J.F. Molloy & Associates Jackson Memorial Health Plan - Florida Jai Medical Systems Ji Specjality Services, Inc. John Alden Life Insurance Co. John Deere Health Care John Muir Mt. Diablo Health System (If you have never submitted claims to John Muir before, please fax your W-9 with contact name and # to Patty Kan 925-941-2026) John Muir Trauma Physicians John P. Pearl & Associates, Ltd. Johns Hopkins Healthcare Joplin Claims JP Farley Corporation JSL Administrators Kaiser CSI - California Select for Individuals (formerly known as Kaiser PPO) Kaiser Foundation Health Plan of Colorado Kaiser Foundation Health Plan of Colorado ( Colorado Springs only) Kaiser Foundation Health Plan of Colorado ( except Colorado Springs) Kaiser Foundation Health Plan of Georgia Kaiser Foundation Health Plan of Northern CA Region Kaiser Foundation Health Plan of Ohio Kaiser Foundation Health Plan of Southern California Kaiser Foundation Health Plan of the Mid-Atlantic States (MD, VA and DC) Kaiser Foundation Health Plan of the Northwest Kaiser HDHP (High Deductable Health Plan) Kanawha Healthcare Solutions Kanawha Insurance Company Kansas City Life Insurance Company Kansas City Medicare - Coventry (Advantra) Karing Physicians Medical Group, Inc. Katy Medical Claims Kaweah Delta Kelsey Seybold Kempton Group Administrators Kentucky Health Select Kentucky Kare (Humana) Kepple & Co. (Formerly Integrated Benefit Svcs.) Kern County EPO, (GemCare Health Plan) Kern Health Systems Key Benefit Administrators - Indianapolis, Indiana Key Medical Group Key Select Keystone Health Plan Central Keystone Health Plan East (KHP) (Highmark) *Must also be a Highmark provider* Keystone Mercy Health Plan KidsChoice Medicaid and AmeriChoice of Pennsylvania KidsChoice via Information Network Corp. Klais & Company Korean American Medical Group KPS - Kitsap Physicians Services KPS Health Plan LA Care La Vida Central Valley La Vida IPA

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm & HMO Comm Comm

State NV DE

IL

FL MD

CO CO CO GA CA OH CA

CA

KY IL CA CA

PA PA PA CA WA WA CA CA

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Payer ID 71037 LCHC1 LMG11 LNDMK BPA01 36333 52193 75279 65055 37248 37281 87071 37281 37281 37281 41136 LFGRD 91049 91155 93093 61101 73288 LOBH1 75283 LIPA1 35107 37267 37267 37267 37267 37267 33036 37226 23223 PPM01 SYMED SX159 SX159 90328 52148 CAPMN 37292 36334 HCP01 01260 11303 25133 22195 52148 MCS03 35162 MCS02 MCS01 22771 22771 39186 39187 41159 41555 75258 09908 13310 22347 00247 37121 80314 MMPHB 41154 87065 87065 87065 87065 56205 CSMED 59331

Name Lafayette Consolidated Government Lakeside Comprehensive Healthcare Lakeside Medical Group Landmark Laundry Workers Lawndale Christian Health Center LBA Health Plans Leggett & Platt Leon Medical Center Health Plan LHP Claims Unit Liberty Union Liberty Health Advantage Liberty Union Life Assurance Associates Life Assurance Company Life Trac Lifeguard LifeWise (of Washington), A Premera Healthplan LifeWise of Arizona, A Premera Healthplan LifeWise of Oregon, A Premera Healthplan Lincoln National - Phoenix, AZ (Humana) Lincoln National (EMPHESYS) Linden Oaks Behavioral Health Linn County Lipa-Agate Resources Hcfa Local 135 Health Benefits (Indianapolis, IN) 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 Loma Linda University Employee Health Plan Loma Linda University Health Care Employee Health Plan Loma Linda University Healthcare - ManagedCare Claims London Health Administrators Loomis Company, The - TPA Wyomissing, PA (IHS Gateway Payer) Los Angeles Medical Center (LAMC) Los Angeles Metro Medical Center Lovelace Medicaid Lovelace Salud (New Mexico Medicaid) Lovelace Sandia Health Plan M.D. Individual Practice Assoc. (M.D.IPA) Mabuhay Medical Group (Cap Managements Systems) Machinist District 9 Welfare MacNeal Health Providers - CHS Magan Medical Clinic Magellan Behavioral Health Services Magnacare Mailhandlers Benefit Plan (CAC) Maksin Management Corporation MAMSI Life & Health Insurance Company (MLH) Managed Care GemCare Health Plan Managed Care Services Managed Care Systems (Delano Regional Med. Grp.) Managed Care Systems (GEMCARE) Managed Health Network (MHN) Managed Health Network (MHN) Managed Health Services Indiana (Medicaid HMO) (Prior to submitting claims, please call Provider Relations Dept at 800-944-9661 to verify your provider info is on file.) Managed Health Services Wisconsin Managed Physical Network Manatee Service Center - Bradenton, FL Mapco, Inc. Maricopa Health Plan ­ University Family Care MARSH ADVANTAGE Maryland Health Insurance Plan Maryland Physicians Care Mashantucket Pequot Tribal Nation Mass Mutual Masters Mates and Pilots Plan Mayo Management Services, Inc. (MMSI) MBA Benefit Administrators (Payer ID valid for claims with a submission address of PO Box 651109, Salt Lake City, UT 84115) MBA Benefit Administrators, Inc. (Salt Lake City, UT) MBA of Wyoming (Payer ID valid for claims with a submission address of PO Box 98, Worland, WY 82401) MBA of Wyoming (Worland, WY) MBS - Formerly MedCost Benefit Services Mcare of Colorado Springs McCreary Corporation

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm

State LA CA

WA AZ OR AZ

IN

CA NM NM

Comm Comm & HMO Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm

CA

CA

CA CA CA

IN WI

MD MD

UT UT WY WY CO

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Payer List subject to change without notice

Page 16 of 30

Pre.Enr.

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***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** *****

Payer ID MHM02 38338 MDAPN MDC01 52148 20475 58204 58202 74323 59231 60054 MDCOR 56162 38353 95321 94265 78857 78857 MCDAK 77016 77027 MCDID MCDIL 18049 MCDKS MCDKY MCDMN MC008 MCDNH MCDNJ NMMAD NCXIX MCDOK ORDHS SCXIX TMHP1 EPF02 MC006 MCDWI MCDAZ MCDVA 37298 MBA01 74323 74323 74323 04258 75229 52181 BC004 CSMED 61101 AMM02 IP186 MC051 38224 MR010 MR008 MR086 MR001 MR002 MR004 13102 00902 00885 05655 MR025 10202 MR057 MR003 00952 MR089 05102 05202 MR088 00528

Name McKinley Medical Group (Magnolia Healthcare Mgmt) McLaren Health Plan MD Anderson Physician Network MD Care Health Plan MD - Individual Practice Association, Inc. (M.D. IPA) Mdwise Hoosier Alliance MedAdmin Solutions - Capitated claims- FL only MedAdmin Solutions - self funded plans MedBen (Newark, OH) MedCom Medconnection (Marriot) MedCore MedCost, Inc. MedDirect Medfocus Medica Medica Health Care Plan, Inc Medica Health Care Plan, INC. Medicaid - Alaska Medicaid - Colorado Medicaid - Florida Medicaid - Idaho Medicaid - Illinois Medicaid - Iowa Medicaid - Kansas Medicaid - Kentucky Medicaid - Minnesota Medicaid - Nevada Medicaid - New Hampshire Medicaid - New Jersey Medicaid - New Mexico Medicaid - North Carolina Medicaid - Oklahoma Medicaid - Oregon Medicaid - South Carolina Medicaid - Texas Medicaid - Texas-Premier Plan Medicaid - Washington - DSHS - Department of Social and Health Services Medicaid - Wisconsin Medicaid Arizona Medicaid -Virginia Medical Benefit Administrators of Maryland Medical Benefits Administrators Medical Benefits Administrators, Inc. (Newark, OH) Medical Benefits Companies (Newark, OH) Medical Benefits Mutual Medical Claims Services Inc. Medical Control Inc. Medical Development International Medical Mutual of Ohio Medical Network of Colorado Springs Medical Plan of Kansas City - MO (Humana) Medical Services For Indigents (MSI) (Advanced Medical Management) Medical Services Initiative MediCal Type 05 Medical Value Plan-MVP-OH Medicare - Alaska Medicare - Arizona Medicare - Arkansas Medicare - California (Northern California) Medicare - California (Southern California) Medicare - Colorado Medicare - Connectiuct Medicare - Deleware (Highmark) Medicare - DMERC Region C Medicare - DMERC Region D Medicare - Florida Medicare - Georgia Medicare - Hawaii Medicare - Idaho Medicare - Illinois Medicare - Indiana Medicare - Iowa Medicare - Kansas Medicare - Kentucky Medicare - Louisana

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm & HMO Comm Govn't Comm Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't

State

OH

MN

AK CO FL ID IL IA KS KY MN NV NH NJ NM NC OK OR SC TX WA WI VA MD CA OH OH

OH CO MO CA CA OH AK AZ AR CA CA CO CT DE

FL GA HI ID IL IN IA KS KY LA

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Payer List subject to change without notice

Page 17 of 30

Pre.Enr. ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** ***** *****

Payer ID 14102 00901 14202 00953 00954 05302 03202 00655 MR007 14302 12402 04202 13202 13292 13282 MR020 MR083 00883 04302 MR011 12502 MR018 00880 MR084 MR034 MR085 MR046 14502 00904 MR006 00903 00884 00951 MR074 CAPMN 94254 62160 82160 59221 59227 01047 MCA11 MHHNP

Name Medicare - Maine Medicare - Maryland (Highmark) Medicare - Massachusetts Medicare - Michigan Medicare - Minnesota Medicare - Missouri (East and West) Medicare - Montana Medicare - Nebraska Medicare - Nevada Medicare - New Hampshire Medicare - New Jersey Medicare - New Mexico Medicare - New York - Downstate - Empire Medicare - New York - Queens Medicare - New York - Upstate - Part B Medicare - North Carolina Medicare - North Dakota Medicare - Ohio Medicare - Oklahoma (Trailblazer) Medicare - Oregon Medicare - Pennsylvania Medicare - Railroad Medicare - South Carolina Medicare - South Dakota Medicare - Tennessee Medicare - Texas (Trailblazer) Medicare - Utah Medicare - Vermont Medicare - Virginia Medicare - Washington Medicare - Washington, DC (Highmark) Medicare - West Virginia Medicare - Wisconsin Medicare - Wyoming Medicina Familiar Medical Group (Cap Managements Systems) MediPrime MedSolutions, Inc. Medspan, Inc. Mega Life & Health Insurance Company - Insurance Center P.O. Box 982009, North Richland Hills, TX 76182 Mega Life & Health Insurance Company - OKC P.O. P O Box 548801, Oklahoma City, OK 73154 548801 City MEMIC Memorial Clinical Associates / SelectCare of Texas (MCA) Memorial Herman Health Net Memorial Integrated Healthcare (Please email Tracy Harswick at [email protected] before submitting claims.) Memorial Medical Group Memorial PSN/CMS (Please email Tracy Harswick at [email protected] before submitting claims.) Mental Health Network (MHNet) Mercy Care Plan (AHCCCS) Mercy Health Plan Mercy Physicians Medical Group (MPMG) (NAMM Southern CA) Meritain Health (Formerly know was Weyco) ­ Payer ID valid for claims with billing submission address of 2370 Science Parkway Okemos, Michigan 48864 Meritain Health (Formerly known as Corp. Benefit Services/CBSA/Fortis Self Funded Admin and Performax, Inc. Payer ID valid only for claims with a billing submission address of P.O. Box 27267, Minneapolis, MN 55427-0267) Meritain Health (Formerly known as E-V Benefits Management, Inc, Columbus, OH). Meritain Health (Formerly known as NABN, Columbus, OH. Payer ID valid only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476. Meritain Health (Formerly known as North American Benefits Network, Cleveland, OH). Payer ID valid only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476 Meritain Health (Formerly known as North American Administrators, Inc.) Meritain Health/Agency Services (Formaly known as Agency Services Inc.) Meritain Health (Formerly know as North American Administrators, Inc.) Meritain Health/North American Administrators Meritain Health/North American Administrators Mesa Mental Health Metcare Health Plans Methodist First Choice MethodistCare Metrahealth Network (HMO & Care Option:A United HealthCare Co.) Metrahealth Plan Administrators (A United HealthCare Co.) Metrahealth/Metrahealth Railroad (A United HealthCare Co.)

Claims Type Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Govn't Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm

State ME MD MA MI MN MO MT NE NV NH NJ NM NY NY NY NC ND OH OK OR PA MULTI SC SD TN TX UT VT VA WA DC WV MI WY CA GA

OK

***** *****

59065 HCP01 59065 74289 86052 MER11 IP079 38232 41124 34159 34159

CA

AZ

34159 64157 64158 64157 64157 64157 85035 65113 23550 95420 87726 87726 87726

Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm

NM

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Payer List subject to change without notice

Page 18 of 30

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*****

Payer ID 82135 13265 MHP01 61101 61101 37127 63079 52148 52149 MRIPA 37281 37281 63079 CAPMN AMS11 SYMED 47080 62168 61146 MHP77 59224 MIDSC 79480 MSI01 MPHS1 MPMG1 MCDMN 05018 STJOE SYMED MPMOA 37233 37233 64088 64088 37275 43179 37265 62178 51062 00076 38334 20676 NM505 20149 20554 38336 91128 82119 IP095 13174 MMLI2 MMLI3 MMLIC MMLI3 MMLIC 35092 IP083 MPI01 36111 84095 86040 MTNST 37233 95444 IP079 AMM02 SYMED 39634 34080 37256 59140 71412 71412 14165 91136 91136

Name Metro Alliance Metro Plus Health Plan Metropolitan Health Plan Michael Reese HMO Plan - IL Michael Reese HMO Plan - IN Michael Reese Physicians Group Mid Atlantic Health Plan Mid Atlantic Psychiatric Services, Inc. (MAPSI) Mid Atlantic Psychiatric Services, Inc. (MAPSI) Mid Rogue Oregon Health Plan Mid-America Associates Inc. Mid-America Associates, Inc. Mid-Atlantic Health Plan MidCities IPA (Cap Managements Systems) Midcoast Care Inc. (Arcadian) Mid-County Physicians Medical Group (San Diego) Midlands Choice, Inc. Midsouth Administrative Group Midwest Group Benefits Midwest Health Plans, Inc. Mid-West National Life Insurance Company of Tennessee Midwest Preferred Midwest Security Administration Midwester Preferred Mills Peninsula Health Services Mills Peninsula Medical Group Minnesota Health Care Program ( see Medicaid MN) MIPS Mission (St. Joseph Heritage Healthcare) Mission Community Hospital of Huntington Park Mission Community IPA Medical Group Mississippi Public Entity Employee Benefit Trust (MPEEBT) Mississippi Public Entity Employee Benefit Trust Mississippi Select Health Care Mississippi Select Health Care (Gulfport, MS) Missoula County Medical Benefits Plan Missouri Care (MC) MLink MMS, LLC. Molina Healthcare - Florida Molina Healthcare - Indiana Molina Healthcare - Michigan Molina Healthcare - Nevada Molina Healthcare - New Mexico Molina Healthcare - Ohio Molina Healthcare - Texas Molina Healthcare - Washington Molina Healthcare - Washington - ASO Molina Healthcare - Washington ASO - Encounters Claims Monarch Healthcare IPA Montefiore CMO Monumental Life Ins MMLI2 - Kentucky Monumental Life Ins MMLI3 - Texas Monumental Life Ins MMLI3 - Texas Monumental Life Insurance Co (Hurst, TX) Monumental Life Insurance Co (Little Rock, AR) Morris Associates Mosaic IPA Medical Group Motion Picture Industry Health Plan Motorola Mountain Medical Affiliates Mountain States Administrative Services Tucson, Arizona Mountain States Administrators (CO only) MPE Services Inc. MPLAN, Inc. - HealthCare Group MPMG (Mercy Physicians Medical Group) (NAMM Southern CA) MSI (Medical Services For Indigents) (Advanced Medical Management) Multicultural Primary Care Medical Group - San Diego, California Multiplan Inc for American Family Multiplan Wisconsin Preferred Network Mutual Assurance Mutual Group (The) (US) Mutual of Omaha Mutually Preferred MVP Health Plan of NY (For your MVP Provider number, call 800-684-9286) N.W. Ironworkers Health & Security Trust Fund, Group # F15 N.W. Roofers & Employers Health & Security Trust Fund, Group# F26

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm & HMO Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm

State

MN IL IN

OR

CA CA

CA CA

CA CA CA MS MS MS MS

IN MI NV NM OH TX WA WA WA CA KY TX AK TX AR CA CA

MS

CA CA

OK

NY

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Payer List subject to change without notice

Page 19 of 30

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Payer ID 91136 34159 NOD01 36398 NHCA1 53011 56175 56176 90001 NHAIN 75275 37231 NIA11 59087 52132 71412 52104 52103 31417 75191 75190 04293 96107 05047 11325 37255 66055 04332 77076 39144 NMM01 58204 NCH06 NCH05 NCH04 NCH01 NCH03 NCH11 NCH02 NCH10 NCH09 NCH07 NCH08 66893 76031 75281 HSM01 65056 74234 74234 74234 37312 84141 NYL11 48186 24819 38225 62124 11325 81264 22603 PDT01 CAPMN HSM01 65085 34159 64157 64157 36398

Name N.W. Textile Processors Group # F14 NABN (Cleveland, OH) Now known as Meritain Health. Payer ID valid only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476 Nacel Open Door ­ (Minnesota providers only) NAMM of Illinois Naperville Health Care National Association of Letter Carriers (NALC) National Benefit Administrators - New Jersey National Benefit Administrators - North Carolina National Capital Preferred Provider Organization (NCPPO) (To obtain your provider ID number, please call the NCPPO Customer Service Department at (800) 272-5911. ) National Health Administrators, Inc. National Health Insurance Company National Healthcare Exchange National Imaging Association National Radiology Network, The National Rural Electric Cooperative Assoc. National Rural Letter Carrier Assoc. National Telecommunications Cooperative Association (NTCA - Staff) National Telecommunications Cooperative Association (NTCA) Nationwide Insurance NCAS - Charlotte, North Carolina NCAS - Fairfax, Virginia Neighborhood Health Plan - Boston, Massachusettes Neighborhood Health Plan - Florida (Only valid for PO Box 025680, Miami, Florida 33102-5680 address) Neighborhood Health Plan - Rhode Island Neighborhood Health Providers & Suffolk Health Plan (NHP - SHP) (Please call 631-360-3102 for your unique NHP SHP provider number.) Nesika Health Group Netcare Life & Health Insurance - Hagatna, Guam Network Health (please contact Provider Relations at 617- 806-8104 or [email protected] for an EDI setup form) Network Health Insurance Corporation - Medicare Network Health Plan - Wisconsin Network Medical Management Network TPA, LLC New Century Health - Bascom Palmer Eye Care Network New Century Health - California Eye Care New Century Health - CarePlus Cardiology New Century Health - CarePlus Dermatology New Century Health - CarePlus Urology New Century Health ­ Humana Cardiology New Century Health - Humana Dermatology New Century Health - Humana Oncology New Century Health ­ Vista Cardiology - Summit New Century Infusion Solutions - CarePlus Oncology New Century Infusion Solutions - Vista Oncology New England, The New Era Employee Welfare Benefit New Era Life Insurance Company New Life Medical Group, Inc. dba Healthy New Life Medical Corp. New Market Dimensions New Mexico District Council of Carpenters New Mexico Painters & Allied Trades Local #823 New Mexico West Texas Multi-Craft New Source Benefits, LLC New West Health Plan New York Life Long Term Care New York Presbyterian Community Health Plan New York Presbyterian System Select Health NGS American NHC Health Benefit Plan NHP/SHP (Neighborhood Health Providers and Suffolk Health Plan) Nippon Life Insurance Company of America NJ Carpenters Health Fund Noble AMA Select IPA Noble Community Medical Associates LA (Cap Managements Systems) Noble Mid OC Orange County (Health Smart) North America Administrators (NAA) - Nashville, Tennessee North American Benefits Network - Cleveland, Ohio. Now known as Meritain Health. Payer ID valid only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476 North American Health Plan (Now known as Meritain Health) North American Health Plan (Now known as Meritain Health) North American Medical Management - Illinois

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm C Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm & HMO Comm & HMO Comm Comm Comm Comm Comm

State

OH

IL

NJ

NC CA MA FL RI

WI

FL CA FL FL FL CA FL FL FL

NM UT

NY NY

NJ CA CA CA TN OH

IL

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Payer List subject to change without notice

Page 20 of 30

Pre.Enr.

Payer ID E3510 IP079 64157 37314 SCP01 NSA01 35212 91131 PROSP 91131 64157 AMS11 38238 36347 88027 NMG01 NANWC NWDC1 NHN11 36346 16644 06226 71080 PROSP 41045 37299 NAOAK 95358 DESRT 72112 72127 13350 72087 13310 14163 34189 95435 AMS11 AMS11 22521 HDNFC MDCOR 25133 OMN02 22321 80705 80705 80705 80705 80705 80705 52149 BPA01 74234 BPA01 91136 52152 52148 37125 91131 87726 41160 41161 HSM01 OCFMC 25133 13383 13382 13381 25681 62171 36365 06111 91131 87068 SYMED

Name North American Medical Management - Northern California North American Medical Management - Southern California North American Preferred (Now known as Meritain Health) North Broward Hospital District North County Health Services North Star Advantage North Texas Healthcare Network North West Administrators (FCHN) North West Orange County Medical Group North West Sheet Metal Workers (FCHN) North American Administrators (Now known as Meritain Health) Northeast Community Care Northern California Sheet Metal Workers Health Care Plan Northern Illinois Health Plan Northern Nevada Trust Fund Northridge Medical Group Northwest Community Health Partners Northwest Diagnostic Clinic (NWDC) Northwest Physicians Network Northwest Suburban IPA (Illinois) Nova Healthcare Administrators, Inc. (Grand Island, New York) Novanet Novasys Health Network Nuestra Familia Medical Group (Prospect Medical Group) NW National Life (Reliastar) Nyhart Oak West Primary Physician Assoc Oaktree Health Plan Oasis IPA Oath For Louisiana, Inc., The (formerly, Southeast Medical Alliance) Ochsner Health Plan (Payor requires unique provider ID for each practitioner/provider; please contact Jill Brant at (504) 219-6682 or [email protected]) ODS Health Plan Office of Group Benefits - Louisiana Office of the Administrator (Seabury and Smith) Ohana Health Plan Ohio Health Choice, PPO Ohio Health Group Ojai Dual Risk (Arcadian Mgmt Serv) Ojai Valley Community Med. Group (Arcadian Mgmt Serv) OK State Employees & Educators (EDS) Omni Healthcare - Humboldt Del Norte California Norte, Omni IPA - Medcore HP Omnicare - A Coventry Health Plan Omnicare Medical Group (OMNI) One Call Medical One Health Plan One Health Plan One Health Plan (Except CA, CO, GA, IL, or TX) One Health Plan of Georgia, Inc. One Health Plan of Illinois, Inc. One Healthplan OneNet PPO, LLC OPEIU Locals 30& 537 Operating Engineers Local #53 Operating Engineers Local 501 Operating Engineers Locals 302 & 612 Health & Security Fund, Group # F12 Optimum Choice of the Carolina's (OCCI) Optimum Choice, Inc. (OCI) Option Services Group Options Health Plan OptumHealth Behavioral Solutions OptumHealth Care Solutions (ACN of NY) OptumHealth Care Solutions (ACN) Orange County Advantage Medical Group Orange County Foundation for Medical Care ORNDA Health D296Corp (First Health)+D312 Orthonet - Aetna Orthonet - Uniformed Services Family Health Plan Orthonet Corporation - CIGNA Orthonet-HealthNet OSF Health Plans Our Lady of the Resurrection Physician Association Oxford Health Plans P.S.E.W. Trust P5 Health Plan Solutions of Utah Pacific Alliance Medical Center

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm

State CA CA FL CA MN TX WA CA WA ME,NY CA IL CA

WA IL

CA

CA

LA DC HI OH OH CA CA CA

CA CA CO

UT

WA

UT CA

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Payer List subject to change without notice

Page 21 of 30

Pre.Enr.

Payer ID SYMED HSM01 PCFCI 93029 95999 95959 33053 95964 COFHP 95959 95959 95959 AMS11 58174 58204 66917

Name Pacific Alliance Medical Group Pacific Healthcare IPA Medical Associates, Inc. Pacific IPA Pacific Source Health Plans PacifiCare - PPO claims only PacifiCare - Secure Horizon - HMO claims only PacifiCare Behavioral Health PacifiCare of Arizona - For payable PacifiCare - Secure Horizons HMO claims only. Not for PPO claims PacifiCare of Colorado PacifiCare of Oregon -Secure Horizon/HMO claims only PacifiCare of TX (OK & TX)-Secure Horizon/HMO claims only PacifiCare of Washington-Secure Horizon/HMO claims only Palomar Pomerado Health (Arcadian Mgmt Serv) Paragon Benefits, Inc. Parity Healthcare Parkland Community Health Plan Partners National Health Plans of North Carolina (Contracted providers only. Please call Partners National Health Plan of NC provider services department at (888) 296-9790; option 2 for electronic claims set-up and payer id.)

Claims Type Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm & HMO Comm Comm

State CA CA OR CA AZ CO OR TX WA CA

***** CAPMN 76569 61129 10525 65018 95885 61101 68049 20472 HDMDG 72126 13522 41124 34173 25133 60054 95183 13306 75238 03440 PHYCR PA513 58204 58204 PHPMC 15749 HSM01 38265 57098 36345 PDT01 75297 37136 PHCEN PHCS1 20398 MHM03 12399 09173 37330 62155 65031 CPMG1 EXC01 47027 39156 10775 56151 06607 PGLTC 24735 PROSP PPM01 84109 COMPU 37224 64160

NC CA

Pasadena Primary Care Physicians (Cap Managements Systems) Passport Advantage (DOS 1-1-10 and forward only) Passport Health Plan Patient Advocates, LLC PCA Health Plan of Florida PCA Health Plans of Texas (Humana) PCA Star (Humana) Peach State Health Plan Pediatric Associates Pegasus Medical Group Peoples Health Network Perfect Health Insurance Company Performax, Inc. (Now known as Meritain. Payer ID valid only for claims with a billing submission address of P.O. Box 27267, Minneapolis, MN 55427-0267) Personal Physician Care PersonalCare PG&E (Pacific Gas & Electric) PHA Insurance Services - Orlando, Florida PHCS Savility Payers Phoenix Group Services - Texas Phoenix Health Plan Phycor Physician Associates of Greater San Gabriel Valley Physician Associates of Louisiana Physician Care Network Physician Health Partners Physicians Alliance - SRR IPA Physicians Alliance Network Physicians Care Physicians Care Network (North Carolina) Physicians Care Network-Rockford-IL only Physician's Data Trust Physicians Direct Physicians Health Association - Illinois Physicians Health Choice - Encounters Physicians Health Choice- HCFA Claims Physicians Health Collaborative Physicians Health Network (PHN) Physicians Health Plan - Northern Indiana Physicians Health Plan - South Carolina Physicians Health Plan - South Michigan Physicians Health Plan - TennCare Physicians Healthcare Plans Physicians Management Group Physicians Medical Group of San Jose Physicians Mutual Insurance Company Physicians Plus Insurance Corporation Physicians United Plan Piedmont Administrators Piedmont Behavioral Health Pinal / Gila Long Term Care Pinnacle Claims Management, Inc. Pinnacle Health Resources (Prospect Medical Group) Pinnacle Physician Management Organization Pinnacol Assurance Pipe Industry Health & Welfare Pittman and Associates Pivotal Plan

FL TX

CA

MN

FL TX CO CA

CO

NC IL CA

CA SC MI

CA

AZ CA CO CO

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Payer List subject to change without notice

Page 22 of 30

Pre.Enr.

***** ***** ***** *****

Payer ID 37287 37287 HPSVC 58204 POD1S 59324 59069 32680 16111 IP057 25133 72148 38335 04334 LVIPA 36373 EPF10 53476 61665 00481 59291 56178 65088 73145 73145 35173 61106 31478 60110 04320 PFIPA 36401 14162 60110 41147 BC099 BC099 91155 93093 43166 61101 90023 AMS11 PREYE 43166 90440 CAPMN 05003 PRESA 45056 39185 IP096 CAPMN PCAMG 73288 82048 PRIME 56144 PPM01 61101 63088 61101 61101 61101 56190 11678 IP079 IP079 IP079 IP079 IP079 IP079 IP079 IP079 IP079 IP079 IP079

Name Planned Administrators, Inc. Planned Administrators, Inc. (PAI) Plumbers and Pipefitters Podi Care Managed Care Podiatry First Podiatry Network Florida Poe & Brown Poly America Medical & Dental Benefits Plan POMCO Pomona Valley Medical Group (PVMG) ProMed PPO Oklahoma PPO Plus LLC PPOM Practicare Inc Prairie Medical Group (La Vida) Prairie States Enterprises Prefered Administrator Preferred Benefit Administrators Preferred Benefits Administrator Preferred Blue of South Carolina Preferred Care - Florida Preferred Care - North Carolina Preferred Care Partners - Miami, Florida Preferred Community Choice Preferred Community Choice - PCCSelect - CompMed Preferred Health Network (PHN) Preferred Health Plan, Inc. - Louisville, Kentucky Preferred Health Professionals Preferred Health Systems Insurance Company (PHSIC) Preferred Healthcare System - PPO Preferred IPA Preferred Network Access, Inc. Preferred One (CT), a Division of First Choice Preferred Plus of Kansas PreferredOne Premera Blue Cross - Washington Premera Blue Cross Blue Shield - Alaska Premera LifeWise of Arizona Premera LifeWise of Oregon Premier Benefits, Inc. Premier Benefits, Inc. Premier Care (High Desert Primary Care Premier) Hesperia CA Hesperia, Premier Care of Northern California (Arcadian Mgmt Serv) Premier Eye Care Premier Health Plans Premier Health Systems Premier Physicians Network & Valley Division (PPN) (Cap Managements Systems) Presbyterian Health Plan Presbyterian Salud Prestige Health Choice Prevea Health Plan Prima Health IPA Primary Care & Pediatrics IPA (PCPIPA) Primary Care Associates Medical Group (PCAMG) ( for DOS 1-1-09 and beyond) Primary Delivery System Primary Health Network Primary Health Plan Primary Physician Care Primary Provider Management Prime Benefits Systems Inc. - Missouri (Humana) Prime Health Prime Health Kansas City Inc. - Missouri (Humana) Prime Health Management Services - Missouri (Humana) Prime Health of Kansas City - Missouri (Humana) Prime Vision Health Prime West Health Systems PrimeCare Medical Network - Chino PrimeCare Medical Network - Citrus Valley PrimeCare Medical Network - Corona PrimeCare Medical Network - Hemet PrimeCare Medical Network - Inland Valley PrimeCare Medical Network - Moreno PrimeCare Medical Network - Redlands PrimeCare Medical Network - Riverside PrimeCare Medical Network - San Bernardino PrimeCare Medical Network - Sun City PrimeCare Medical Network - Temecula

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm & HMO Comm & HMO Comm & HMO Comm & HMO Comm & HMO Comm & HMO Comm & HMO Comm & HMO Comm & HMO Comm & HMO

State

NV

CA

SC

FL

KY

CA

KS MN WA AK AZ OR

CA CA

CA

NC

CA MO MO MO MO MN CA CA CA CA CA CA CA CA CA CA CA

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Payer List subject to change without notice

Page 23 of 30

Pre.Enr.

*****

Payer ID 04320 PRI01 61271 61271 38217 37303 37315 37268 31132 PROSP 38329 59296 36331 34176 41163 37242 34134 PADC1 IP057 61101 PROSP PROSP 37309 62308 62308 62308 62308 51032 PF101 HM015 SYMED CAPMN 09822 AMM03 91136 91136 42172 48055 51052 37330 39197 35174 23342 61101 QHP01 37129 57117 TKFMC 95266 MR018 91176 SYMED REGAL 00611 00932 00851 38221 HSM01 47076 REH55 41045 RENGQ RENRB RENRO 73066 37278 36396 RPPG1 37270 MPMOA 16117 75196 RMHMO 37602 36215 36339

*****

Name PrimeSource Health Network Princeton Premier IPA Principal Life Insurance (Principal Financial Group) Principal Mutual Life Insurance Company (Principal Mutual Life Assurance) Priority Health Prism - First Health Prism - Univera Prism Network, Inc. Pro Health Comp Care ProCare (Prospect) Procare Health Plan - Detroit, Michigan Professional Benefit Administrators - Winter Park, Florida Professional Benefit Administrators, Inc. - Oak Brook, Illinois ONLY Professional Benefits Administrators - Cuyahoga Falls, Ohio Professional Claim Administrators Professional Claims Management - Canton, Ohio Professional Risk Management Project Access of Durham County ProMed Health Care Administrators Promina Prospect Medical Group Prospect Sherman Oaks Medical Group (Prospect Medical Group) Protective Life Insurance Provident Healthsource (Cigna) Provident Life & Accident Provident Life & Casualty Provident Preferred Network Provider Network of America (Pro-Net) Providers First PPO PruCare HMO (Encounters Only) Prudent Care Medical Group Prudent Medical Group (formerly known as Hollywood Presbyterian Medical Group) PSN - Florida Medicaid (JMH) Public Health Medical Services (Advanced Medical Management) Puget Sound Benefits Trust, Group# F25 Puget Sound Electrical Workers Trust, Group# F33 Puget Sound Health Partners Pyramid Life Insurance Company Pyschcare, LLC Pysicians Health Plan - Mid Michigan Quad Med - Pewaukee, Wisconsin Qual Choice of Arkansas QualCare, Inc. (New Providers must enroll with QualCare at (800) 992-6613, option 5.) Qualicare Quality Health Plans Quincy Health Care Management. QVI Risk Solutions, Inc. R & N Market R.E. Harrington, Inc. Railroad Medicare RBMS, LLC Redlands IPA (San Bernardino) Regal Regence Blue Shield - Idaho Regence Blue Shield - Washington State Regence BlueCross BlueShield - Oregon Regency Employee Benefits Regent Medical Group, Inc. (Regent Family Practice of Glendale) Regional Care, Inc. Rehab Network, LLC Humana (Payer requires 11 digit member ID Number) Reliastar Employee Ben. (Northwestern Nat Life) Renaissance Gulf Quest RENASSAINCE RIVEROAKS BLUE RENASSAINCE-RIVER OAKS Reserve National Insurance ResourceOne Administrators Resurrection Health Care Preferred/AKA Family Medical Network *Please call (773) 572-8311 or ( 773) 572-8309 prior to your first submission of claims. Resurrection Physicians Group Reynolds & Reynolds Riverside Family Health Medical Group RMSCO, Inc. Rockwell International Rocky Mountain Health Plan - Grand Junction Rooney Life Inc. Rosemont of Des Plaines, Illinois Rush Health Association

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm & HMO Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Govn't Comm Comm & HMO Comm & HMO Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm

State

CA MI FL IL OH

CA CA

CA CA FL CA

MI WI AR

CA

CA CA ID WA OR

CA

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Payer List subject to change without notice

Page 24 of 30

Pre.Enr.

Payer ID 60054 36389 63070 AMM03 31441 35164 HSM01 62308 74234 SCP01 BS001 HSM01 AMS11 60054 91184 AMS11 10378 SANTE AMS11 SCAN1 SCH01 16146 88030 60054 13310 91131 SVIPA 28530 95959 87726 COFHP 42142 42142 39045 SCHP1 64088 42137 93031 37282 SCOK1 23285 SSC11 00014 59111 36404 34131 83035 60054 23249 39033 39033 39033 CAPMN TKFMC 38610 76056 SHEBP SHPCH SHMAP 87726 87726 SHP01 SCMG1 SCMG1 75280 38238 PROSP 76342 76343 HDMDG MBA01 62159 NASCR

Name Rush Prudential Rush Prudential Health Plans - HMO Only RWDSU Benefit Fund Ryan White Network - Advanced Medical Management S & S Healthcare Strategies Sagamore Health Network Saigon Medical Group, Inc. SAMBA same as above - Metal Trades Health Plan San Diego Physicians Med Group (SCPMCS) San Francisco Electrical Workers ­ IBEW Local 6 *They will all have a prefix code of "XEL" as their member ID on the BSC card. San Judas Medical Group IPA San Luis Obispo Select IPA (Arcadian Mgmt Serv) Sandia Triple Option Plan (Sandia Top) Sanford Health Plan Santa Barbara Select IPA (Arcadian Mgmt Serv) Santa Clara County IPA (SCCIPA) SANTE SBSI Appeals (Arcadian Mgmt Serv) SCAN Health Plan Schaller Anderson - CHOC Health Alliance SCHC Total Care Inc. (Acceptius Gateway payer) Scott & White Health Care Plan Scripps Medical Plan Seabury & Smith Seattle Area Plumbing Seaview IPA Secure Health Plans of Georgia Secure Horizon CA - Pacificare Secure Horizon Direct Secure Horizons of CO * SecureCare of Iowa Securecare of Iowa-Infotrust Security Health Plan SeeChange Health Plan Select Administrative Services (SAS) Select Benefit Administrators - Des Moines, Iowa Select Benefits Administrators - Portland, Oregon) Select Benefits Administrators of America (submission address of P.O. Box PO 440, Ashland, Wisconsin 54806.) Select Care of Oklahoma - Tribute Select Health of South Carolina Select Senior Clinic SelectCare Self Insured Benefit Administrators (Clearwater, FL) Self Insured Plans (Naples, FL) Self-Funded Plans, Inc. Senior Whole Health SeniorCare Sentinel Management Services Sentry Insurance a Mutual Company Sentry Life Insurance Company Sentry Life of New York Seoul Medical Group (Cap Managements Systems) Sequoia Beverage SET SEG Seton CHIP Seton Employee Plan Seton Health Plan Seton Map Program (Mediview) Share Health Plan - ILL/PPO Share Health Plan - ILX/HMO Sharp Health Plan Sharp Healthcare Sharp Healthcare Shasta Administrative Services Sheet Metal Workers Local 104 Health Care Plan (San Ramon, CA) Sierra Family Network (Prospect Medical Group) Sierra Health Services Sierra Health Services (encounters) Sierra Medical Group Sierra Nevada Medical Associates Signature Health Alliance Silver Cross Managed Care Org

Claims Type Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm & HMO Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm & HMO Comm Comm & HMO Comm & HMO Comm Comm

State

CA IN

CA

CA CA CA CA CA

WA CA CA CO IA

MS IA OR

SC

FL

CA CA

***** ***** *****

IL IL CA CA CA CA CA, NV CA CA

**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Revised 2/18/2010

Payer List subject to change without notice

Page 25 of 30

Pre.Enr.

*****

Payer ID 84076 84096 02057 AMS11 91131 91131 91131 91131 91131 91131 23266 25133 AMS11 72112 STGEB 37318 SYMED BPA01 SCP01 56131 25133 HSM01 HSM01 35227 SWSTA M3IL2 SPA98 37266 37259 52190 23253 84146 SPOHN AMS11 95286 22240 APP01 37264 STJOE STJOE STJOE 88029 HSM01 37116 STM01 PDT01 59225 31053 SB810 00400 75087 14163 91151 31121 58128 74227 88331 95202 37301 SX186 68057 23218 SHP11 39188

Name Sinclair Health Plan Sloans Lake Managed Care Smith Administrators Sonoma County Primary Care (Arcadian Mgmt Serv) Sound Health Sound Health Sound Health (Sisters of Providence) Sound Health (Sisters of Providence) Sound Health (Sisters of Providence) Sound Health Wellness Trust South Central Preferred SouthCare - Healthcare Preferred Southeast Community Care Southeast Medical Allience (The Oath For Louisiana, Inc.) Southeast Texas Govt Emps Ben Southern Benefit Services Southern California Children's Healthcare Network Southern California Lumber Southern California Physicians Managed Care Services Southern Group Administrators Southern Health Services, Inc. Southland Advantage Medical Group, Inc. Southland San Gabriel Valley Medical Group, Inc. SouthPoint Hotel & Casino Southwest Administrators Southwest BCBS of Florida Southwest Physicians Associates Southwest Service Life Special Agents Mutual Benefit Association Special Risk International (SRI) Spectrum Admin, Inc. TPA Spina Bifida - VA HAC Spohn Health Spokane Community Care SSM Exclusive Choice St. Barnabas System Health Plan St. Francis IPA (NOW KNOWN AS Applecare Medical Management) St. John's Claim Administration St. Joseph Heritage Healthcare St. Joseph IPA (St. Joseph Heritage Healthcare) St. Jude (St. Joseph Heritage Healthcare) St. St Mary's Health Plan St. Peter Medical Group, Inc. St. Therese Physician Associates ST. THOMAS MED NTWK GULFQUEST St. Vincent IPA Star HRG State Farm Insurance Company State Health Plan of North Carolina State Health Plan of SC States General Life Insurance Staywell Health Plan Sterling Option One Stoner & Associates - Cincinnati, Ohio Stowe Associates Student Resources Suffolk Health Plan of New York Summacare Health Plan (HMO) Summit America Insurance Services, Inc. Sun Health Corporation Sunshine State Health Plan Superior Administrators - Santa Ana, CA Superior Health Centene Corp Superior Health Plan Texas (Prior to submitting claims, please call Provider Relations Dept at 1-800-218-7453) Sutter Connect - Alta Bates Medical Group, Alta Bates Network (ABMG/ABN) (Claims/Encounters) Sutter Connect - Solano Regional Medical Foundation, (SRMF) (Claims/Encounters) Sutter Connect - Sutter Delta Medical Group Sutter Connect - Sutter Gould Medical Foundation (Claims/Encounters) Sutter Connect - Sutter Independent Physicians, Sutter Medical Group, Sutter West Medical Group (SIP/SMF/SWMG) (Claims/Encounters) Sutter Connect - Sutter Medical Group of the Redwoods, Santa Rosa Network (SMGR/SRN) (Claims/Encounters) Sutter Connect - Sutter Select Sutter East Bay Medical Foundation

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm & HMO Comm & HMO Comm & HMO Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm

State

CA ID MT ID MT WA PA GA,SC,NC

CA

TX TX

WA

CA CA CA CA NV IL CA

NC SC

WA OH

NY

CA TX CA CA CA CA CA CA CA CA

***** ***** ***** ***** ***** ***** ***** *****

SC006 SC016 SC018 SC003 SC004 SC008 SC025 SC020

**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Revised 2/18/2010

Payer List subject to change without notice

Page 26 of 30

Pre.Enr. *****

Payer ID SC028 NASWD SYMED TMG01 88067 37228 TKFMC COMPU 39157 BPA01 88019 ADSL1 36215 36612 91131 74234 SYMED 37293 KLSY1 AMS11 TTASB 76048 75228 AMS11 TX1ST TOPA1 63092 74214 TTCEC BOONG CRI01 75600 28777 37305 34150 35206 58200 72112 04320 38200 THERA COTHE THIPA 06131 00315 39065 PH017 74214 20081 48055 92620 61425 THIPA 31182 38201 38202 38201 87726 13402 23856 69493 TKFMC 60054 37230 TFLIC TLIN2 TLINS TLIN3 TLINS 59222 TOLIC 37284

Name Sutter Senior Care Swedish Covenant Managed Care SynerMed Talbert Medical Group (Testing of each provider is required by payer and done automatically by Office Ally once you start submitting claims for this payer. ) Tall Tree Administrators Tarrant Health Services TASEBA Tattered Cover, Inc. TBG Administrative Services TCU-LA MTA Teachers Health Trust Team Choice - Alpha Care Gold Teamcare Teamsters Local Union #301 Teamsters Welfare Trust Tech-Steel, Inc Temple Hospital Tennessee Benefit Administrators, LLC Texan Plusslctcare TX Kelsey Texarkana Community Care Texas Association of School Boards Texas Children's Health Plan Texas Childrens Health Plan (Medicaid) Texas Community Care Texas First Health Plans Texas First Health Plans (TIOPA) Texas HealthSpring Texas Municipal League (TML) Texas True Choice The Boon Group The Chesterfield Companies The City of Odessa The EPOCH Group The Ford Meter Box Company, Inc. The Health Plan (Massillon, Ohio and St. Clairsville, Ohio only) The Healthcare Group The Integrity Benefit Group, Inc. The Oath For Louisiana, Inc. (formerly, Southeast Medical Alliance) The Preferred Healthcare System - PPO The Wellness Plan Theraphysics (All but Colorado) Theraphysics (Colorado Only) THIPA Third Party Claims Management Thomas Cooper Time Insurance (A Fortis Company) Time Insurance Company TML Intergovernmental Employee Benefits Pool Todays Health Todays Option (American Progressive and Pyramid Life) Tongass Timber Trust Tooling and Manufacturing Assocation Torrance Hospital IPA (THIPA) Total Community Care Total Health Care Total Health Choice - Florida Total Healthcare, Inc. Touchpoint Touchstone Health - Health Net SmartChoice Touchstone Health PSO Tower Life Insurance Company Town & Country TPA Health Plan TR Paul Inc. TransAmerica Financial Life Insurance Co (Hurst, TX) TransAmerica Life Insurance Co (Hurst, TX) TransAmerica Life Insurance Co (Little Rock, AR) TransAmerica Life Insurance Co (Louisville, KY) TransAmerica Life Insurance Co. TransAmerica Life Insurance Company TransAmerica Occidental Life Insurance Co (Kansas City, MO) TransChoice - Key Benefit Administrators

Claims Type Comm Comm Comm & HMO Comm & HMO Comm Comm Comm & HMO Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm & HMO Comm & HMO Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm

State CA CA CA TX CA CO

WA CA

AR,TX TX TX TX TX TX TX TX

CO CA

TX

CA

FL

CA

TX TX AR KY

MO

**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Revised 2/18/2010

Payer List subject to change without notice

Page 27 of 30

Pre.Enr.

Payer ID 37284 74234 87726 87726 TCHD1 36397 TDDIR CH002

Name TransChoice-Key Benefit Administrators Transwestern General Agency Travelers - CGT - PPO Travelers Health Network - HMO (Metrahealth) Travis County Hospital District MAP Trellis Health Partners TriCare for Life TRICARE NORTH (Health Net Federal) formerly known as CHAMPUS: Connecticut, Delaware, Illinois, Indiana, Kentucky, Massachusetts, Maryland, Maine, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, Wash D.C., West Virginia and Wisconsin. TRICARE SOUTH (Humana Military) formerly known as CHAMPUS: Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee and Texas. TriCities IPA Trinity Health (Enrollment required; please contact Noreen at (248) 489-5281) TriSurant (formerly Health Administration Services-HAS) TRIWEST (WPS) formerly known as CHAMPUS: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa(Except for the Rock Island Arsenal Area), Kansas, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon South Dakota, The Extreme Western Portion of Texas, Utah, Washington and Wyoming. True Choice USA True Choice USA - CRSTS Healthplan Trusted Plans Service Corp. (TPSC) (FCHN) Trustee Plans (FCHN) Trusteed Insurance (FCHN) Trusteed Plans Service Corporation Trustmark Insurance Tufts Health Plan TX Healthspring UAHC Health Plan of Tennessee UBH Employer Division UBH Rios UC Care (University of California) UCare of Minnesota UICI - Administrators - Nevada (through Benefit Planners, Inc.) UICI Administrators UMMH UMR - Cincinnati UMR- Wausau - UHIS UMWA Health & Retirement Funds Unicare Unified Health Services (Workman's Comp Only) Unified IPA Uniform Medical Plan (Harrington Benefit Services) Uniformed Services Family Health Plan (USFHP) St. Vincent Catholic Medical Centers of New York UNIGARD (FCHN) Union Labor Life Insurance Union Pacific IPA (SCPMCS) Union Pacific Railroad Employees Health System Union Security Insurance Company Unison Health Plan - (formerly known as Three Rivers) Unison Health Plan - Better Health Plans, Inc. United Agriculture Benefit Trust United Behavioral Health (RIOS) United Behavioral Health (UBH) United Benefits (formerly Brown & Brown Benefits) United Care Medical Network (formerly United St. Joseph Mission [Cap Management]) United Employee Benefit Trust (FCHN) United HealthCare United HealthCare (formerly MetraHealth Care Plans, Met Life, Metropolitan Life Ins Co, MetraHealth Elect, MetraHealth Healthcare Network HMO) (no vision claims) United HealthCare (formerly MetraHealth Healthcare Network PPO, New York State Employees (Empire), Travelers Ins Co, Travelers Plan Administrators) (no vision claims) United HealthCare (formerly The Travelers, Travelers Health Network) United HealthCare of Alabama United HealthCare of Arizona United HealthCare of Arkansas United HealthCare of California - Northern California United HealthCare of California - Southern California United HealthCare of Colorado United HealthCare of Florida United HealthCare of Georgia United HealthCare of Illinois

Claims Type Comm Comm Comm Comm Comm Comm Govn't Govn't

State

CA

***** *****

*****

CH002 PDT01 38269 34185

Govn't Comm & HMO Comm Comm Govn't Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm AL AZ AR CA CA CO FL GA IL CA

*****

WPSTC TCUSA TCUCH 91131 91131 91131 91078 61425 04298 63092 SX192 87726 87726 60054 52629 74223 75240 37292 31107 39026 52180 80314 62170 HCP01 75243 13407 91131 13142 SCP01 87042 70408 25175 62183 UAGBT 87726 87726 59069 CAPMN 91131 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726

WA WA WA

*****

TX TN

CA NV

CA

WA

CA

CA WA

**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Revised 2/18/2010

Payer List subject to change without notice

Page 28 of 30

Pre.Enr.

Payer ID 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 87726 95378 87726 87726 87726 87726 84132 71412 84132 41194 74095 66705 UC001 UC002 50528 38298 09830 09908 UHA01 22329 25133 IP056 23281 37324 38337 93092 USFHP 60054 74234 74234 74234 12115 VCIPA VHP01 VHP02 77004 VALOP 23173 SYMED 72128 PPM01 60054 73288 86062 VHMG1 23173 VVMG1 24818 VFP11 91131 54176 37297 86079 55248 63114 59266 22264

Name United HealthCare of Kentucky United HealthCare of Mississippi United HealthCare of New England United HealthCare of New Jersey United HealthCare of New York United HealthCare of North Carolina United HealthCare of Ohio United HealthCare of Texas - Dallas United HealthCare of Texas - Houston United HealthCare of the Mid-Atlantic United HealthCare of the Midlands - HMO (Choice Select) United HealthCare of the Midlands - PPO (Choice Plus, Select Plus, Self Funded) United HealthCare of the Midwest - Choice, Choice Plus, Select, Select Plus United HealthCare of the Midwest - Medicare Complete United HealthCare of the River Valley (John Deere) United HealthCare of Upstate New York United HealthCare of Utah United HealthCare of Virginia United HealthCare Plans of Puerto Rico United Medical Alliance (UMA) United of Omaha United Physicians of Northern Colorado (UPNC) United Resources Network United States Automobile Association (USAA) Unity Health Insurance -Before submitting claims, please go to http://www.unityhealth.com/Providers/EDI/index.htm and complete EDI Sign Up Form and NPI Appendix A documents. Or call Joe Boerboom at 608-643-1531 to request these forms. Universal Care - California Universal Care Encounters Universal Health Care, Inc. Universal Standard Healthcare University Family Care University Family Care - Maricopa Health Plan University Health Alliance University Health Plan of New Jersey University of Missouri Upland Medical Group UPMC Health Plan Upper Peninsula Health Group (TPA) Upper Peninsula Health Plan US Benefits US Family Health Plan US Healthcare Utah Carpenters Utah Laborers Utah Pipe Trades VA Fee Basis Programs Valley Care IPA Valley Health Plan (Commercial) Valley Health Plan (Medi-Cal) Valley Physician's IPA Value Options - (For commercial claims only) Vanderbilt Health Plan (Formerly Health1-2-3) Vanguard Health Systems (SynerMed) Vantage Health Plan, Inc. (located in Louisiana) Vantage Medical Group (located in California) Varian Health Care Plan VENCOR VentureNet Healthcare Verdugo Hills Medical Group VHP Community Care Victor Valley IPA Vida Care Village Family Practice Virginia Mason Group Health Virginia Premier Health Plan Vison Care Incorporated Vista Del Sol Health Care Vista Health Plan Viva Health Plan Volusia Health Network Vytra Health Plans

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm & HMO Comm Comm & HMO Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm

State KY MS NJ NY NC OH TX TX

NY UT VA CO

CA

*****

NJ

UT UT UT CA

CA

*****

LA CA

CA

*****

FL

NY

**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Revised 2/18/2010

Payer List subject to change without notice

Page 29 of 30

Pre.Enr.

Payer ID 62111 91131 37294 91131 38356 73155 58082 MPMOA 75261 36337 59354 14163 14164 59608 14163 14163 14164 14163 14163 77072 WELM2 WELMD 38200 25133 87815 22925 WCMG1 75196 24735 24735 37306 37247 31048 74234 WESTL 38232 93050 98010 WCMAP 62061 11696 62153 WNHLT 39200 SX022 20333 75276 91131 34080 WPSTC WPS01 23710 91131 91131 09829 STJOE 75285 91131

Name W.C. Beeler & Company WA Teamster Washington Employers Trust Washington State Health Insurance Pool (WSHIP) Washtenaw Community Health Organization Waterstone Benefit Administrators Watkins Associated Industries Watts Healthcare Corp. Web TPA Weiss Health Providers Wellcare Health Plans (Encounters) Wellcare HMO, Inc. Wellcare of Conneticut Wellcare of Florida Wellcare of Georgia (Wellcare Provider ID is required. To obtain your provider ID, please call (866) 231-1821 option 2 then 4) Wellcare of Louisiana Wellcare of New York WellCare of Ohio Wellcare of Texas Wellcare Private Fee for Service Plans Wellmed Medical (Claims) Wellmed Medical Management Wellness Plan, The WellPath Wells Fargo 3rd Party Administrators (formerly known as Acordia National) WELS Benefit Plan Office West Covina Medical Group West Virginia State Employees (PEIA) Western Growers Assurance Trust Western Growers Insurance Company Western Health, Inc. Western Mutual Insurance Western Southern Financial Group - Cincinnati, Ohio Western Utilities or Local 57 Westlake Financial Group - HCFA Weyco, Inc. (Now know as Meritain Health) ­ Payer ID valid for claims with billing submission address of 2370 Science Parkway Okemos, Michigan 48864 William C. Earhart William J. Sutton & Company - Toronto, Canada Williams & County Map Willis Administrative Services (now known as Fiserv Health- Kansas) Windsor Home Network Windsor Medicare Extra WinHealth Wisconsin Auto and Truck Dealers Wisconsin Physicians Service Insurance Corporation Worksite Benefit Services, LLC World Insurance Company WPAS (FCHN) WPPN- HPO (HealthEOS) WPS (TRIWEST for West Region) WPS Commercial Writer's Guild Industry Health Plan WSHIP - Washington State Health Insurance Pool WVMC (FCNH) Yavapai County Yorba Park (St. Joseph Heritage HealthCare) Young Life Zenith (WA only) (FCHN)

Claims Type Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm Comm & HMO Comm Comm Comm Comm Comm Comm Govn't Govn't Comm Comm Comm Comm Comm & HMO Comm Comm

State TN WA

CA TX

CT FL GA LA NY OH TX

CA WV

OH

WA

*****

WA CA WA

*****

**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission www.officeally.com 866.575.4120 Revised 2/18/2010

Payer List subject to change without notice

Page 30 of 30

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