March 14, 2018 Damar Software/Claims Midwest

*** DENTAL PAYER LIST ***		 04:48:34 PM
1,411 Payers On-Line

Payer Name Payer
Id		 Card
Type		 Additional
Enrollment
3P Admin
PARTICIPATING PAYER / CLAIMS 		20413 No
A & I Benefit Plan Administrators
PARTICIPATING PAYER / CLAIMS, EFT
EFT: Enrollment requires your Tax ID Number plus a 4-digit Suffix that can be found on the same line as your provider TIN on your most recent explanation of benefits. 		93044 No
A&D Charitable Foundation, Inc. (dba GreatLakes PACE)
PARTICIPATING PAYER / CLAIMS 		39640 No
A.D.N. Administrators, Inc.
PARTICIPATING PAYER / CLAIMS 		CXADN No
AARP
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, ATTACHMENTS
ELIGIBILITY INQUIRY: AARP Claims with a mailing address of PO Box 2059, Mechanicsburg, PA
ELIGIBILITY INQUIRY: Detailed Benefits 		AARP1 No
ACS Benefit Services Inc
NON-PARTICIPATING PAYER / ERA 		58379 No
ACS Benefit Services Inc.
PARTICIPATING PAYER / CLAIMS 		72468 No
ACS Benefit Services, Inc.
PARTICIPATING PAYER / CLAIMS 		61474 No
AFLAC GA
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY 		58066 No
AFLAC GA - GRP
PARTICIPATING PAYER / CLAIMS 		58066 No
AFLAC NY
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY
ELIGIBILITY INQUIRY: This plan also shares the same mailing address as payer ID 58066 and the only difference between the plans is that the insured ID for the NY based plan begins with "PN" as "PNxxxxxx" (followed by 6+ digits)
ELIGIBILITY INQUIRY: Detailed Benefits 		52080 No
AFLAC NY - GRP
PARTICIPATING PAYER / CLAIMS 		52080 No
AGC International Union of Operating Engineers Local 701
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		91136 No
AIAPT insured by Trustmark Insurance
NON-PARTICIPATING PAYER / ERA 		58379 No
AK United Food and Commercial Workers (AK UFCW)
PARTICIPATING PAYER / CLAIMS, ERA 		91136 No
ARC Administrators
PARTICIPATING PAYER / CLAIMS 		CXARC No
ASAMT Insurance by Trustmark Insurance
NON-PARTICIPATING PAYER / ERA 		58379 No
ASR Corporation
PARTICIPATING PAYER / CLAIMS 		38265 No
Acceptius (Benefit Management Inc of MO (BMI)
PARTICIPATING PAYER / CLAIMS 		43178 No
Access Dental
PARTICIPATING PAYER / CLAIMS, EFT
EFT: via Performance Health Technology
EFT: Legacy ID - For Providers, use their Facility/Office NPI.  For Brokers, use their Agency ID which is either a 4 or 5 digit code.  The 4 digit code starts with a 5 and the 5 digit code start with a 2. 		CX097 No
Access Health
NON-PARTICIPATING PAYER / ERA 		58379 No
Acclaims
PARTICIPATING PAYER / CLAIMS 		64071 No
Activa Benefit Services, LLC/Dental
PARTICIPATING PAYER / CLAIMS 		38255 No
Administrative Concepts, Inc.
NON-PARTICIPATING PAYER / EFT 		22384 No
Administrative Services Only, Inc.
PARTICIPATING PAYER / CLAIMS 		CX076 No
Advantage Dental Plan, Inc.
PARTICIPATING PAYER / CLAIMS 		93524 No
Advantage by Superior
PARTICIPATING PAYER / CLAIMS 		CPPSA No
Advantek Benefit Administrators
PARTICIPATING PAYER / CLAIMS 		83077 No
Advantica Benefits
PARTICIPATING PAYER / CLAIMS, ERA, EFT, REAL TIME CLAIMS, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Detailed Benefits 		43168 No
Adventist Health System West - Roseville, CA
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		95340 No
Aetna
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, ATTACHMENTS
ELIGIBILITY INQUIRY: Detailed Benefits 		60054 No
Aetna
PARTICIPATING PAYER / ENCOUNTERS, ATTACHMENTS 		68246 No
Aetna Affordable Health Choices (SM) - SRC
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		57604 No
Aetna Better Health Plan of Lousiana
NON-PARTICIPATING PAYER / ERA, EFT 		128LA No
Aetna Better Health Plan of Missouri
NON-PARTICIPATING PAYER / ERA, EFT 		128MO No
Aetna Better Health Plan of New Jersey
NON-PARTICIPATING PAYER / ERA, EFT 		46320 No
Aetna Better Health of Illinois
NON-PARTICIPATING PAYER / ERA, EFT
EFT: Enroll with Payer 		26337 No
Aetna Better Health of Kentucky
NON-PARTICIPATING PAYER / ERA, EFT 		128KY No
Aetna Better Health of Michigan
NON-PARTICIPATING PAYER / ERA, EFT 		128MI No
Aetna Better Health of Nebraska
NON-PARTICIPATING PAYER / ERA, EFT 		42130 No
Aetna Better Health of New York
NON-PARTICIPATING PAYER / ERA, EFT 		34734 No
Aetna Better Health of Ohio
NON-PARTICIPATING PAYER / ERA, EFT 		50023 No
Aetna Better Health of Virginia
NON-PARTICIPATING PAYER / ERA, EFT 		128VA No
Aetna Better Health of WV
NON-PARTICIPATING PAYER / CLAIMS 		128WV No
Aetna Better Health of West Virginia
NON-PARTICIPATING PAYER / ERA, EFT
EFT: Enroll with Payer 		128WV No
Aetna Medicare EPO/PPO Dental
PARTICIPATING PAYER / CLAIMS, ERA, EFT, ATTACHMENTS 		18014 No
Affordable Benefits Admin.
PARTICIPATING PAYER / CLAIMS 		95426 No
Alameda Alliance
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Alask Carpenters
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		91136 No
Alaska Care Retiree LTC Plan
NON-PARTICIPATING PAYER / ERA 		58379 No
Alaska Electrical Health & Welfare Fund
PARTICIPATING PAYER / CLAIMS 		92600 No
Alaska Hotel Employees, Restaurant & Camp Employees (AK HERE)
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		91136 No
Alaska Laborers Construction Industry Health & Security Trust
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		91136 No
Alaska Machinists Health and Welfare Trust
PARTICIPATING PAYER / CLAIMS, ERA 		91136 No
Alaska Pipe Trades U A Local 375
PARTICIPATING PAYER / CLAIMS, ERA 		91136 No
Alaska Public Employees Association (APEA/JESS Health & WelfareTrust)
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		91136 No
Alexian Brothers Community Services of TN
PARTICIPATING PAYER / CLAIMS 		44423 No
AllCare CCO Dental
PARTICIPATING PAYER / CLAIMS 		CXALC No
Allegeant
PARTICIPATING PAYER / CLAIMS, EFT 		52193 No
Allegiance Benefit Plan
PARTICIPATING PAYER / CLAIMS 		81040 No
Alliant Services
PARTICIPATING PAYER / CLAIMS 		70106 No
Allied Benefit Systems
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		37308 No
Allied Metal Crafts Security Plan Trust Fund
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		91136 No
Altus
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS 		50503 No
AlwaysCare Benefit
NON-PARTICIPATING PAYER / CLAIMS 		STR01 No
AmFirst Insurance Company
NON-PARTICIPATING PAYER / ERA 		58379 No
Amalgamated Life - PA Alicare
PARTICIPATING PAYER / CLAIMS 		13343 No
AmeraPlan
NON-PARTICIPATING PAYER / ERA 		58379 No
Ameraplan
PARTICIPATING PAYER / CLAIMS 		38219 No
Ameriben Solutions
PARTICIPATING PAYER / CLAIMS 		75137 No
American Administrators dba Select Benefit Administrators (West Des Moines, IA)
PARTICIPATING PAYER / CLAIMS 		42137 No
American Benefit Corporation
PARTICIPATING PAYER / CLAIMS 		CX084 No
American Medical Security
PARTICIPATING PAYER / CLAIMS 		CX001 No
American National Life Insurance
NON-PARTICIPATING PAYER / ERA 		58379 No
American Postal Workers Union Health Plan
PARTICIPATING PAYER / CLAIMS 		44444 No
American Progressive Insurance
NON-PARTICIPATING PAYER / ERA 		58379 No
Americas Choice Healthplans LLC
NON-PARTICIPATING PAYER / ERA 		58379 No
Americas TPA
PARTICIPATING PAYER / CLAIMS, EFT 		41178 No
Amerihealth Administrators
PARTICIPATING PAYER / CLAIMS 		54763 No
Ameritas Life Insurance Corp.
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA 		47009 No
Ameritas Life insurance Corp. of New York
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA 		72630 No
Amway Corporation
PARTICIPATING PAYER / CLAIMS 		38255 No
Anchor Benefit
PARTICIPATING PAYER / CLAIMS 		53085 No
Antares Management Solutions
PARTICIPATING PAYER / CLAIMS 		34192 No
Anthem Blue Cross
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, ERA
ELIGIBILITY INQUIRY: f.k.a. Blue Cross of California; Wellpoint
ELIGIBILITY INQUIRY: Detailed Benefits. 		47198 No
Anthem HMO Colorado - HMO-B
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Anthem Health Plans - HMOD & HMOG
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Anthem Health Plans of Kentucky - OSB High & Low
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Anthem Health Plans of Kentucky - PPOB & PPOD
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Anthem Health Plans of Virginia - OSB High & Low
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Anthem Health Plans of Virginia - PPOB & PPOD
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Anthem Insurance - OSB High & Low
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Anthem Insurance - PPOB & PPOD
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Apostrophe, Inc.
PARTICIPATING PAYER / CLAIMS 		81312 No
Argus Dental Plans, Inc.
PARTICIPATING PAYER / CLAIMS 		ARGUS No
Arizona Blue Cross Blue Shield
NON-PARTICIPATING PAYER / CLAIMS, ERA 		53589 No
Arizona Medicaid
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS
CLAIMS: Yes/No Response
CLAIMS: Please visit http://www.azahcccs.gov/commercial/ProviderRegistration/registration.aspx for provider registration information prior to submitting claims. 		CKAZ1 No
Arkansas Best Corporation - Choice Benefits
PARTICIPATING PAYER / CLAIMS 		75278 No
Aspen
PARTICIPATING PAYER / CLAIMS 		16180 No
Association Benefit Plan
PARTICIPATING PAYER / CLAIMS, ERA
ERA: Formerly payer ID 62413. Now part of Coventry Consolidate payer ID. Including Combined Government Health Plan & Contract Health Insurance Plan.
ERA: Payer RA will be turned off within 30 days of enrollment; PDFs are available through Coventry's provider portal www.directprovider.com 		25133 No
Assurant Employee Benefits
PARTICIPATING PAYER / CLAIMS 		70408 No
Assurant, Inc,
PARTICIPATING PAYER / CLAIMS 		70408 No
Assured Benefits Administrators
PARTICIPATING PAYER / CLAIMS 		74240 No
Asuris
NON-PARTICIPATING PAYER / CLAIMS 		93221 No
Atlantic Dental Inc. (ADI) - Commercial
PARTICIPATING PAYER / CLAIMS 		CX085 No
Automated Benefit Services
PARTICIPATING PAYER / CLAIMS 		38259 No
Automated Group Administration, Inc. (AGA)
PARTICIPATING PAYER / CLAIMS 		37280 No
Avesis
PARTICIPATING PAYER / CLAIMS 		86098 No
BARINet
PARTICIPATING PAYER / CLAIMS 		CB369 No
BCBS MI Medicare Advantage
NON-PARTICIPATING PAYER / CLAIMS 		BBMDQ No
BCBS of Rochester New York
NON-PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY
ELIGIBILITY INQUIRY: Yes / No Response 		CBNYR No
BCBS of Western NY
PARTICIPATING PAYER / CLAIMS 		CBNYW No
BCI Administrators, Inc.
PARTICIPATING PAYER / CLAIMS 		49153 No
BEAM Insurance administrators
PARTICIPATING PAYER / CLAIMS 		BEAM1 No
BHP-Unity
PARTICIPATING PAYER / CLAIMS 		44219 No
BIA
PARTICIPATING PAYER / CLAIMS 		CXBMD No
BIA / Beam
PARTICIPATING PAYER / CLAIMS 		CXBMD No
BS of Northeastern NY
PARTICIPATING PAYER / CLAIMS 		CBNYE No
Banner Health Systems
PARTICIPATING PAYER / CLAIMS 		SX145 No
Banner Plan Administration
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		77078 No
Bay Area Automotive Group
PARTICIPATING PAYER / CLAIMS 		CHSBA No
Bay Area Delivery Drivers
PARTICIPATING PAYER / CLAIMS 		CHSBD No
Beam
PARTICIPATING PAYER / CLAIMS 		BEAM1 No
Beam
PARTICIPATING PAYER / CLAIMS 		CXBMD No
Beam Dental
PARTICIPATING PAYER / CLAIMS 		CXBMD No
Beam Ins Admin
PARTICIPATING PAYER / CLAIMS 		BEAM1 No
Beam Ins Admin
PARTICIPATING PAYER / CLAIMS 		CXBMD No
Beam Ins.
PARTICIPATING PAYER / CLAIMS 		BEAM1 No
Beam Ins.
PARTICIPATING PAYER / CLAIMS 		CXBMD No
Beam Insurance
PARTICIPATING PAYER / CLAIMS 		BEAM1 No
Beam Insurance
PARTICIPATING PAYER / CLAIMS 		CXBMD No
Beam Insurance Ad
PARTICIPATING PAYER / CLAIMS 		BEAM1 No
Beam Insurance Ad
PARTICIPATING PAYER / CLAIMS 		CXBMD No
Beam Insurance Admin
PARTICIPATING PAYER / CLAIMS 		BEAM1 No
Beam Insurance Admin
PARTICIPATING PAYER / CLAIMS 		CXBMD No
Beam Insurance Administrator
PARTICIPATING PAYER / CLAIMS 		BEAM1 No
Beam Insurance Administrator
PARTICIPATING PAYER / CLAIMS 		CXBMD No
Beam Insurance Administrators
PARTICIPATING PAYER / CLAIMS 		BEAM1 No
Bell Atlantic
PARTICIPATING PAYER / CLAIMS 		68241 No
BeneCare Dental Plans
PARTICIPATING PAYER / CLAIMS 		23210 No
Benefit Administrative Systems
PARTICIPATING PAYER / CLAIMS 		36149 No
Benefit Coordinators Corporation (Pittsburgh, PA)
PARTICIPATING PAYER / CLAIMS 		25145 No
Benefit Inc.
NON-PARTICIPATING PAYER / CLAIMS, ERA 		R7003 No
Benefit Management Administrators Inc.
NON-PARTICIPATING PAYER / ERA 		58379 No
Benefit Management Group NV
PARTICIPATING PAYER / CLAIMS 		36459 No
Benefit Management Services of MS
PARTICIPATING PAYER / CLAIMS 		37212 No
Benefit Management Services, Inc.
PARTICIPATING PAYER / CLAIMS 		56139 No
Benefit Management, Inc. of KS
PARTICIPATING PAYER / CLAIMS 		48611 No
Benefit Plan Administrators
NON-PARTICIPATING PAYER / ERA 		58379 No
Benefit Plan Administrators Co. (Eau Claire, WI)
PARTICIPATING PAYER / CLAIMS 		39081 No
Benefit Plan Services Inc
NON-PARTICIPATING PAYER / ERA 		58379 No
Benefits Administration Corporation, Inc.
PARTICIPATING PAYER / ERA, EFT 		44357 No
Blue BeneFit Administrators of MA
PARTICIPATING PAYER / CLAIMS 		03036 No
Blue Care Family Plan
PARTICIPATING PAYER / CLAIMS, ERA 		GWD01 No
Blue Care Family Plan (BCBS of CT)
PARTICIPATING PAYER / ERA, CLAIMS 		00700 No
Blue Cross of North Dakota (ND Dental Services)
NON-PARTICIPATING PAYER / CLAIMS, ERA 		CX004 No
Blue Cross Blue Shield Association - FEP Dental
PARTICIPATING PAYER / CLAIMS 		BCAFD No
Blue Cross Blue Shield Delaware Fully - Insured Dental Group Business
NON-PARTICIPATING PAYER / CLAIMS, ERA
ERA: Effective 5-18-13 FEP claims must be mailed to PO Box 1991, Wilmington, DE 19899
ERA: Administered by United Concordia 		53287 No
Blue Cross Blue Shield OH/KY (Anthem)
PARTICIPATING PAYER / CLAIMS, ERA 		84105 No
Blue Cross Blue Shield Wyoming
PARTICIPATING PAYER / CLAIMS, ERA 		CBWY1 No
Blue Cross Blue Shield of Kansas City MO
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: EDI enrollment is no longer required by ASK however the payer requires each provider register with them.
ELIGIBILITY INQUIRY: Yes / No Response 		47171 No
Blue Cross Blue Shield of Louisiana
PARTICIPATING PAYER / CLAIMS, ERA
ERA: Payer requires providers be tied to our submitter ID of P0003784
ERA: If a provider does not have a 10 byte (digit) alpha numeric Louisiana Blue Cross Blue Shield provider ID the provider must contact Louisiana Blue Cross Blue Shield to obtain one. Only in state providers may apply for a provider number. 		23739 No
Blue Cross Blue Shield of Michigan
NON-PARTICIPATING PAYER / CLAIMS, ERA, EFT
ERA: All enrollments for payer IDs CB621, CB900, SB840, SB790, 36123, CBMI1 and CBMT1 must be completed using Change Healthcare’s Dental Connect for Provider’s portal. Please log into your DC-p account or register for one at https://www.emdeondental.com/dps/ 		CBMI1 No
Blue Cross Blue Shield of Minnesota
NON-PARTICIPATING PAYER / CLAIMS 		CBMN1 No
Blue Cross Blue Shield of Montana
PARTICIPATING PAYER / CLAIMS, ERA, EFT
ERA: All enrollments for payer IDs CB621, CB900, SB840, SB790, 36123, CBMI1 and CBMT1 must be completed using Change Healthcare’s Dental Connect for Provider’s portal. Please log into your DC-p account or register for one at https://www.emdeondental.com/dps/ 		CBMT1 No
Blue Cross Blue Shield of North Carolina
PARTICIPATING PAYER / CLAIMS 		61474 No
Blue Cross Blue Shield of North Carolina
PARTICIPATING PAYER / CLAIMS 		61473 No
Blue Cross Blue Shield of North Carolina
PARTICIPATING PAYER / CLAIMS 		61472 No
Blue Cross Blue Shield of Oregon
NON-PARTICIPATING PAYER / CLAIMS 		CB850 No
Blue Cross Blue Shield of South Dakota
NON-PARTICIPATING PAYER / CLAIMS 		CBSD1 No
Blue Cross Blue Shield of Wisconsin - PPOD
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Blue Cross Dental
PARTICIPATING PAYER / CLAIMS 		CBMNU No
Blue Cross blue Shield of Oklahoma
NON-PARTICIPATING PAYER / CLAIMS, ERA, EFT
ERA: All enrollments for payer IDs CB621, CB900, SB840, SB790, 36123, CBMI1 and CBMT1 must be completed using Change Healthcare’s Dental Connect for Provider’s portal. Please log into your DC-p account or register for one at https://www.emdeondental.com/dps/ 		SB840 No
Blue Cross blue Shield of Oregon
NON-PARTICIPATING PAYER / ERA 		CB850 No
Blue Cross of Alabama
NON-PARTICIPATING PAYER / CLAIMS, ERA 		CBAL1 No
Blue Cross of Alaska and Washington
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Detailed Benefits 		47570 No
Blue Cross of Arkansas
NON-PARTICIPATING PAYER / CLAIMS, ERA
ERA: Mailing address for claims: Dental Claims Administrator PO Box 1206 Elk Grove Village IL 60009-1206.
ERA: Administered by United Concordia 		CBAR1 No
Blue Cross of California - OSB High & Low
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Blue Cross of California - PPOA
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Blue Cross of California - Plan SS10 & SS20
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Blue Cross of Colorado
PARTICIPATING PAYER / CLAIMS, ERA 		84099 No
Blue Cross of Idaho
NON-PARTICIPATING PAYER / CLAIMS 		CBID1 No
Blue Cross of Illinois
NON-PARTICIPATING PAYER / CLAIMS, ERA, EFT
ERA: All enrollments for payer IDs CB621, CB900, SB840, SB790, 36123, CBMI1 and CBMT1 must be completed using Change Healthcare’s Dental Connect for Provider’s portal. Please log into your DC-p account or register for one at https://www.emdeondental.com/dps/ 		CB621 No
Blue Cross of Iowa
NON-PARTICIPATING PAYER / CLAIMS, ERA 		CBIA2 No
Blue Cross of Iowa
NON-PARTICIPATING PAYER / ERA 		CBIA1 No
Blue Cross of Iowa (FEP Claims Only)
NON-PARTICIPATING PAYER / CLAIMS 		CBIA1 No
Blue Cross of Kansas
NON-PARTICIPATING PAYER / CLAIMS, ERA 		CBKS1 No
Blue Cross of Massachusetts
NON-PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ERA: ERAs returned for claims and pre-treatment estimates.
ELIGIBILITY INQUIRY: Detailed Benefits 		CBMA1 No
Blue Cross of Mississippi
NON-PARTICIPATING PAYER / CLAIMS, ERA
ERA: ERAs returned for claims and pre-treatment estimates. 		CBMS1 No
Blue Cross of Nebraska
PARTICIPATING PAYER / CLAIMS, ERA 		CBNE1 No
Blue Cross of Nevada
PARTICIPATING PAYER / CLAIMS, ERA 		84101 No
Blue Cross of New Mexico
NON-PARTICIPATING PAYER / CLAIMS 		CBNM1 No
Blue Cross of New Mexico
NON-PARTICIPATING PAYER / ERA, EFT 		SB790 No
Blue Cross of Rhode Island
NON-PARTICIPATING PAYER / CLAIMS, ERA
ERA: FEP transactions administered by RI BCBS Non FEP transaqctions administered by United Concordia 		CB870 No
Blue Cross of Tennessee
NON-PARTICIPATING PAYER / CLAIMS 		CBTN1 No
Blue Cross of Texas
NON-PARTICIPATING PAYER / CLAIMS, ERA, EFT
ERA: All enrollments for payer IDs CB621, CB900, SB840, SB790, 36123, CBMI1 and CBMT1 must be completed using Change Healthcare’s Dental Connect for Provider’s portal. Please log into your DC-p account or register for one at https://www.emdeondental.com/dps/ 		CB900 No
Blue Shield of Idaho
NON-PARTICIPATING PAYER / CLAIMS, ERA
ERA: Effective May 1, 2013, Regence requires all claim payments to be received via EFT. If not already receiving payments from Regence via EFT, please register using the automatic Deposit (EFT/ACH Credits) authorization agreement enrollment and / or update 		CBID2 No
Boilermakers National Health & Welfare Fund
PARTICIPATING PAYER / CLAIMS 		36609 No
Boon Administrative Services, Inc.
PARTICIPATING PAYER / CLAIMS, ERA, EFT
EFT: Not all employer groups are live for EFT 		BOONG No
Boon Chapman Benefit Administrators
PARTICIPATING PAYER / CLAIMS 		74237 No
Boulder Administration Services
NON-PARTICIPATING PAYER / ERA 		58379 No
BridgeSpan Health (Regence Group)
NON-PARTICIPATING PAYER / CLAIMS 		BRIDG No
Brokers National
PARTICIPATING PAYER / CLAIMS 		CX032 No
Broward Health
PARTICIPATING PAYER / CLAIMS 		37314 No
Butler Benefits
PARTICIPATING PAYER / CLAIMS 		42150 No
C. L. Frates
PARTICIPATING PAYER / CLAIMS 		CX075 No
C.A.S.
NON-PARTICIPATING PAYER / ERA 		58379 No
CA Blue Shield
PARTICIPATING PAYER / CLAIMS 		94036 No
CBA Blue
PARTICIPATING PAYER / CLAIMS 		03036 No
CBCA Administrators Inc
NON-PARTICIPATING PAYER / ERA 		58379 No
CCEA Teachers Health Trust
PARTICIPATING PAYER / CLAIMS 		88019 No
CDO Technologies
PARTICIPATING PAYER / CLAIMS 		83028 No
CDS Group Health
PARTICIPATING PAYER / CLAIMS 		88022 No
CHAMPVA - HAC
PARTICIPATING PAYER / CLAIMS, ERA 		84147 No
CIGNA
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, ATTACHMENTS, CLAIMS, ERA 		62308 No
CNIC Health Solutions Inc.
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		37227 No
CTI Administrators
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		42141 No
Cal Optimal -OneCare
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
California State Government Programs
PARTICIPATING PAYER / CLAIMS, ERA 		CPPCA No
Cannon Cochran Management Services, Inc. Metairie, LA
PARTICIPATING PAYER / CLAIMS, EFT 		71057 No
Capitol Administrators
NON-PARTICIPATING PAYER / ERA 		58379 No
Capitol Dental
PARTICIPATING PAYER / CLAIMS 		CX095 No
Caprock Health Plans
NON-PARTICIPATING PAYER / ERA 		58379 No
Care 1st Health Plan Medicare Advantage
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Care 1st PHP LA & San Bernadino County
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Care Source
NON-PARTICIPATING PAYER / ERA 		58379 No
CareFirst, Inc. Maryland BCBS
NON-PARTICIPATING PAYER / CLAIMS, ERA, EFT, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY 		00580 No
CareOregon
PARTICIPATING PAYER / CLAIMS 		93975 No
CareSource
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS 		CKOH2 No
Careington Benefit Solutions
PARTICIPATING PAYER / CLAIMS 		60601 No
Caresource GA
PARTICIPATING PAYER / CLAIMS 		GACS1 No
Caresource IN
PARTICIPATING PAYER / CLAIMS 		INCS1 No
Caresource KY
PARTICIPATING PAYER / CLAIMS 		KYCS1 No
Caresource WV
PARTICIPATING PAYER / CLAIMS 		WVCS1 No
Carolina Summit Healthcare
PARTICIPATING PAYER / CLAIMS 		56195 No
Carpenters Health and Welfare Fund of Philadelphia
PARTICIPATING PAYER / CLAIMS 		CX101 No
Caterpillar Inc.
NON-PARTICIPATING PAYER / CLAIMS 		37060 No
Cement Masons and Plasterers Health & Welfare Trust
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		91136 No
Central Reserve Life
PARTICIPATING PAYER / CLAIMS, ERA 		34097 No
Central States Health and Welfare Fund
PARTICIPATING PAYER / CLAIMS 		36215 No
Central Susquehanna Healthcare Providers (CSHP)
PARTICIPATING PAYER / CLAIMS 		55731 No
Chesterfield Resources, Inc. (Uniontown, OH)
PARTICIPATING PAYER / CLAIMS 		34154 No
Chewsi First Circle Solution / DD RI
PARTICIPATING PAYER / REAL TIME CLAIMS 		RICHW No
Choice Plus (TRW)
PARTICIPATING PAYER / CLAIMS 		68241 No
Christian Brothers Services
PARTICIPATING PAYER / CLAIMS 		38308 No
Citizens Security Life
PARTICIPATING PAYER / CLAIMS 		CX071 No
Civil Service Employees Association (CSEA)
PARTICIPATING PAYER / CLAIMS 		CX054 No
ClaimsBridge HPN
PARTICIPATING PAYER / CLAIMS 		11752 No
Coastal TPA Inc
NON-PARTICIPATING PAYER / ERA 		58379 No
Community Health Alliance
NON-PARTICIPATING PAYER / ERA 		58379 No
Community Health Alliance of TN
PARTICIPATING PAYER / CLAIMS 		27905 No
Community Health Electronic Claims/CHEC/webTPA
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		75261 No
Community Insurance - HMOA & PPOB
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Community Insurance - PPOD & PPOF
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
CompBenefits
PARTICIPATING PAYER / CLAIMS 		CX021 No
Companion Life
NON-PARTICIPATING PAYER / CLAIMS 		77828 No
Companion Life
NON-PARTICIPATING PAYER / ERA 		58379 No
Companion Life / KHP
PARTICIPATING PAYER / CLAIMS 		37322 No
Complete Benefits Solutions
NON-PARTICIPATING PAYER / ERA 		58379 No
Comprehensive Healthcare options
PARTICIPATING PAYER / CLAIMS 		CHCP1 No
CompuSys / Erisa Group, Inc.
PARTICIPATING PAYER / CLAIMS 		74234 No
Comsumers Choice Health Plan - State of SC
PARTICIPATING PAYER / CLAIMS 		45321 No
Conifer (Adventist)
NON-PARTICIPATING PAYER / ERA 		58379 No
Connecticut Carpenters Health Fund
PARTICIPATING PAYER / CLAIMS 		37307 No
Connecticut General (CIGNA)
PARTICIPATING PAYER / CLAIMS, ERA 		62308 No
Consolidated Group Dental
PARTICIPATING PAYER / CLAIMS 		61305 No
Constitution Life Insurance Company
NON-PARTICIPATING PAYER / ERA 		58379 No
Consumers' Choice Health Plan
NON-PARTICIPATING PAYER / ERA 		58379 No
Continental Benefits
PARTICIPATING PAYER / CLAIMS 		35245 No
Continuum Health Solutions
NON-PARTICIPATING PAYER / ERA 		58379 No
Cook Children's Dental
PARTICIPATING PAYER / CLAIMS 		CPPCC No
Cooperative Benefit Administrators (CBA)
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA
CLAIMS: Detailed Benefits
CLAIMS: Administered by UMR Wausau 		52132 No
Core Benefits Inc.
NON-PARTICIPATING PAYER / ERA 		58379 No
Core Management Resources Group
PARTICIPATING PAYER / CLAIMS, EFT 		58231 No
Core V
PARTICIPATING PAYER / CLAIMS 		60601 No
CoreSource
NON-PARTICIPATING PAYER / ERA 		58379 No
CoreSource AZ MN
PARTICIPATING PAYER / CLAIMS 		41045 No
CoreSource Detroit
PARTICIPATING PAYER / CLAIMS 		38225 No
CoreSource KC
PARTICIPATING PAYER / CLAIMS 		48117 No
CoreSource Little Rock
PARTICIPATING PAYER / CLAIMS, ERA 		75136 No
CoreSource MD PA IL
PARTICIPATING PAYER / CLAIMS, ERA 		35182 No
CoreSource NC IN
PARTICIPATING PAYER / CLAIMS, ERA 		35180 No
CoreSource OH
PARTICIPATING PAYER / CLAIMS 		35183 No
CoreStar
PARTICIPATING PAYER / CLAIMS 		41045 No
Corporate Plan Management
NON-PARTICIPATING PAYER / ERA 		58379 No
Correct Care Solutions - FBOP
NON-PARTICIPATING PAYER / ERA 		58379 No
Covenant Administrators Inc
NON-PARTICIPATING PAYER / ERA 		58379 No
Covenant Administrators, Inc. (Atlanta, GA)
PARTICIPATING PAYER / CLAIMS 		58102 No
Coventry Dental
PARTICIPATING PAYER / CLAIMS, ERA, EFT, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, ATTACHMENTS
ELIGIBILITY INQUIRY: Detailed Benefits 		CX049 No
Coventry Health Care
PARTICIPATING PAYER / CLAIMS 		25133 No
Coventry Health Care Carelink
PARTICIPATING PAYER / CLAIMS, ERA
ERA: West Virginia Only
ERA: Payer RA will be turned off within 30 days of enrollment; PDFs are available through Coventry's provider portal www.directprovider.com 		25133 No
Coventry Health Care Carelink Medicaid
PARTICIPATING PAYER / CLAIMS, ERA
ERA: West Virginia Only
ERA: Payer RA will be turned off within 30 days of enrollment; PDFs are available through Coventry's provider portal www.directprovider.com 		25133 No
Coventry Health Care National Network
PARTICIPATING PAYER / CLAIMS, ERA
ERA: Formerly payer ID 87043. Now part of Coventry Consolidated payer ID.
ERA: Payer RA will be turned off within 30 days of enrollment; PDFs are available through Coventry's provider portal www.directprovider.com 		25133 No
Coventry Health Care of Georgia
PARTICIPATING PAYER / CLAIMS 		25148 No
Coventry Healthcare of Georgia
NON-PARTICIPATING PAYER / ERA 		128FL No
Coventry Missouri
PARTICIPATING PAYER / CLAIMS, ERA
ERA: Formerly payer ID 87043. Now part of Coventry Consolidated payer ID.
ERA: Payer RA will be turned off within 30 days of enrollment; PDFs are available through Coventry's provider portal www.directprovider.com 		25133 No
CoventryCares
PARTICIPATING PAYER / CLAIMS 		86098 No
Creative Plan Administrators
PARTICIPATING PAYER / CLAIMS 		37320 No
Crescent Dental - Meritain Health
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX074 No
Crescent Health Solution
PARTICIPATING PAYER / CLAIMS 		56213 No
Custom Benefit Administrators
NON-PARTICIPATING PAYER / ERA 		58379 No
Custom Design Benefits
NON-PARTICIPATING PAYER / ERA 		58379 No
CustomCare
PARTICIPATING PAYER / CLAIMS 		68241 No
Cypress Ancillary Benefits
PARTICIPATING PAYER / CLAIMS 		TLZ04 No
DH Evans
PARTICIPATING PAYER / CLAIMS 		CX065 No
DQ/Emblem (Emblem Health Medicaid)
PARTICIPATING PAYER / CLAIMS, ERA 		EMBDQ No
Dart Management Corp.
PARTICIPATING PAYER / CLAIMS, ERA
ERA: ERAs are only returned to Change Healthcare if the claim is processed by Change Healthcare. 		06172 No
DeCare Dental Health Insurance
NON-PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Detailed Benefits 		07035 No
Dearborn National
NON-PARTICIPATING PAYER / CLAIMS, ERA, EFT
ERA: All enrollments for payer IDs CB621, CB900, SB840, SB790, 36123, and CBMI1 must be completed using Change Healthcare’s Dental Connect for Provider’s portal. Please log into your DC-p account or register for one at https://www.emdeondental.com/dps/regist 		36123 No
Delano Medical Group
NON-PARTICIPATING PAYER / ERA 		58379 No
Delaware Medicaid
NON-PARTICIPATING PAYER / CLAIMS, ERA 		CKDE1 No
Delhaize
NON-PARTICIPATING PAYER / ERA 		58379 No
Delta Dental Insurance Co. (DDIC) - All Payers
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA, ATTACHMENTS 		94276 No
Delta Dental Massachusetts
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA 		04614 No
Delta Dental Puerto Rico
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, ATTACHMENTS
ELIGIBILITY INQUIRY: Detailed Benefits 		66043 No
Delta Dental of Arizona
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, ERA, REAL TIME CLAIMS
ELIGIBILITY INQUIRY: Detailed Benefits 		86027 No
Delta Dental of Arkansas
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA
ERA: Detailed Benefits
ERA: ERAs are only returned to Change Healthcare if the claim is processed by Change Healthcare. 		CDAR1 No
Delta Dental of California - CA00 Claims Office
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA, ATTACHMENTS 		77777 No
Delta Dental of California/Tricare Retiree Dental
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA 		CDCA1 No
Delta Dental of Colorado
PARTICIPATING PAYER / CLAIMS 		84056 No
Delta Dental of Delaware
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA, ATTACHMENTS 		51022 No
Delta Dental of Florida (DDIC)
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS 		DDFL1 No
Delta Dental of Georgia (DDIC)
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS 		DDGA1 No
Delta Dental of Idaho
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		82029 No
Delta Dental of Illinois Group Plans
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA, REAL TIME CLAIMS
ERA: Detailed Benefits
ERA: Enrollment in Electronic Fund Transfer (EFT) is required for enrollment in ERAs. 		05030 No
Delta Dental of Illinois Individual Plan
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		IDIND No
Delta Dental of Indiana
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA
ERA: Detailed Benefits
ERA: ERAs are only returned to Change Healthcare if the claim is processed by Change Healthcare. 		CDIN1 No
Delta Dental of Iowa
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA, REAL TIME CLAIMS 		CDIA1 No
Delta Dental of Iowa Medicaid Program
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA, REAL TIME CLAIMS 		CDIAM No
Delta Dental of Kansas
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA 		CDKS1 No
Delta Dental of Kentucky
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA 		CDKY1 No
Delta Dental of Louisiana (DDIC)
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS 		DDLA1 No
Delta Dental of Maryland and Pennsylvania
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA, ATTACHMENTS 		23166 No
Delta Dental of Michigan
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA
ERA: Detailed Benefits
ERA: ERAs are only returned to Change Healthcare if the claim is processed by Change Healthcare. 		CDMI0 No
Delta Dental of Minnesota
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA 		CDMN1 No
Delta Dental of Mississippi (DDIC)
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS 		DDMS1 No
Delta Dental of Missouri
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, REAL TIME CLAIMS 		43090 No
Delta Dental of Montana (DDIC)
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS 		DDMT1 No
Delta Dental of Nebraska
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA 		CDNE1 No
Delta Dental of Nevada (DDIC)
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS 		DDNV1 No
Delta Dental of New Jersey
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA, ATTACHMENTS 		22189 No
Delta Dental of New Mexico
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA
ERA: Detailed Benefits
ERA: ERAs are only returned to Change Healthcare if the claim is processed by Change Healthcare. 		85022 No
Delta Dental of New York
PARTICIPATING PAYER / ATTACHMENTS, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA
ELIGIBILITY INQUIRY: Detailed Benefits 		11198 No
Delta Dental of North Carolina
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA
ERA: Detailed Benefits
ERA: ERAs are only returned to Change Healthcare if the claim is processed by Change Healthcare. 		56101 No
Delta Dental of North Dakota
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA 		CDND1 No
Delta Dental of Ohio
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA
ERA: Detailed Benefits
ERA: ERAs are only returned to Change Healthcare if the claim is processed by Change Healthcare. 		CDOH1 No
Delta Dental of Oklahoma
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA 		CDOK1 No
Delta Dental of Oregon (Oregon Dental Service)
NON-PARTICIPATING PAYER / CLAIMS 		CDOR1 No
Delta Dental of Rhode Island
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS 		05029 No
Delta Dental of South Carolina
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, REAL TIME CLAIMS 		43091 No
Delta Dental of South Dakota
PARTICIPATING PAYER / CLAIMS 		54097 No
Delta Dental of Tennessee
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA
ERA: Detailed Benefits
ERA: ERAs are only returned to Change Healthcare if the claim is processed by Change Healthcare. 		CDTN1 No
Delta Dental of Texas (DDIC)
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS 		DDTX1 No
Delta Dental of Utah (DDIC)
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS 		DDUT1 No
Delta Dental of Virginia
NON-PARTICIPATING PAYER / CLAIMS 		CDVA1 No
Delta Dental of Washington
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA, REAL TIME CLAIMS
CLAIM STATUS INQUIRY: Detailed Benefits. f.k.a. Washington Dental Service
CLAIM STATUS INQUIRY: Payer also supports RT status on Pre-Treatment Estimates. f.k.a Washington Dental Service
REAL TIME CLAIMS: Pretreatment Estimates only 		91062 No
Delta Dental of Washington DC
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA, ATTACHMENTS 		52147 No
Delta Dental of West Virginia
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA, ATTACHMENTS 		31096 No
Delta Dental of Wisconsin
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA, REAL TIME CLAIMS, ATTACH
ERA: Detailed Benefits
ERA: Enrollment in Electronic Fund Transfer (EFT) is required for enrollment in ERAs. 		39069 No
Delta Dental of Wyoming
PARTICIPATING PAYER / CLAIMS 		CDWY1 No
Delta Health Systems
PARTICIPATING PAYER / CLAIMS 		94235 No
DeltaCare USA Claims
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA, ATTACHMENTS
CLAIMS: Detailed Benefits
CLAIMS: f.k.a. PMI 		DDCA2 No
DeltaCare USA Encounters
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, ENCOUNTERS, ERA, ATTACHMENTS
ENCOUNTERS: Detailed Benefits
ENCOUNTERS: f.k.a. PMI 		DDCA3 No
Denex Dental
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Detailed Benefits 		CX049 No
DentaQuest - Government Plans
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA 		CX014 No
DentaQuest - Government Plans (FL)
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS 		CX052 No
DentaQuest - Government Plans (ID)
PARTICIPATING PAYER / CLAIM STATUS INQUIRY, ELIGIBILITY INQUIRY, CLAIMS
ELIGIBILITY INQUIRY: Detailed Befefits 		CKID1 No
DentaQuest - Government Plans (IL)
PARTICIPATING PAYER / CLAIM STATUS INQUIRY, ELIGIBILITY INQUIRY, CLAIMS
ELIGIBILITY INQUIRY: Detailed Benefits 		CKIL1 No
DentaQuest - Government Plans (KY)
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS 		CKKY3 No
DentaQuest - Government Plans (MD)
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS 		CKMD1 No
DentaQuest - Government Plans (SC)
PARTICIPATING PAYER / CLAIM STATUS INQUIRY, ELIGIBILITY INQUIRY, CLAIMS
ELIGIBILITY INQUIRY: Detailed Benefits 		CKSC1 No
DentaQuest - Government Plans (TN)
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS 		62154 No
DentaQuest - Government Plans (VA)
PARTICIPATING PAYER / CLAIM STATUS INQUIRY, ELIGIBILITY INQUIRY, CLAIMS
ELIGIBILITY INQUIRY: Detailed Benefits 		CKVA1 No
Dental Blue
NON-PARTICIPATING PAYER / ERA 		58379 No
Dental Blue Select
NON-PARTICIPATING PAYER / ERA 		58379 No
Dental Care Plus
PARTICIPATING PAYER / CLAIMS, EFT 		CX035 No
Dental Health Services of America
PARTICIPATING PAYER / CLAIMS 		CX094 No
Dental Network of MD
NON-PARTICIPATING PAYER / CLAIMS 		CX034 No
Dental Professionals of Wisconsin
PARTICIPATING PAYER / CLAIMS 		39148 No
Dental Select
NON-PARTICIPATING PAYER / CLAIMS, ERA, EFT 		CX093 No
Dental Transformation Initiative (DTI)
NON-PARTICIPATING PAYER / CLAIMS 		DTCA7 No
Dentaquest Commercial Plans (Group and Individual)
PARTICIPATING PAYER / CLAIMS 		04356 No
Dentegra
PARTICIPATING PAYER / CLAIMS, ERA, ATTACHMENTS 		88888 No
Denti-Cal / Medicaid of California
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		94146 No
Department of Economic Security
NON-PARTICIPATING PAYER / CLAIMS 		DESAZ No
Deseret Mutual Benefit Administrators
NON-PARTICIPATING PAYER / CLAIMS, ERA 		CX089 No
Dignity Health
NON-PARTICIPATING PAYER / ERA 		58379 No
District 9 Machinists Welfare Trust
NON-PARTICIPATING PAYER / ERA, EFT 		MWELT No
District of Columbia Medicaid
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKDC1 No
Diversified Administration Corporation
PARTICIPATING PAYER / CLAIMS 		CX040 No
Downstream Casino
PARTICIPATING PAYER / CLAIMS 		19191 No
Dunn & Associates Benefits Administrators, Inc.
PARTICIPATING PAYER / CLAIMS 		35186 No
E-V Benefits Management, Inc (Columbus, OH)
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		34159 No
EBC, Inc.
PARTICIPATING PAYER / CLAIMS 		37257 No
EBMC
PARTICIPATING PAYER / CLAIMS 		CX025 No
EBMS (Employee Benefit Management Services, Inc.)
PARTICIPATING PAYER / CLAIMS 		81039 No
EBS - RMSCO
PARTICIPATING PAYER / CLAIMS 		EBSRM No
EBS Benefit Solutions
NON-PARTICIPATING PAYER / CLAIMS 		CX043 No
EBSO
NON-PARTICIPATING PAYER / ERA 		58379 No
EHI
PARTICIPATING PAYER / CLAIMS 		73288 No
ELMCO
NON-PARTICIPATING PAYER / ERA 		58379 No
EMI Health
NON-PARTICIPATING PAYER / ERA, CLAIMS
CLAIMS: f.k.a. Educators Mutual Insurance Association
CLAIMS: f.k.a. Educators Mutual Insurance Association. Prior to accepting claims electronically EMIA requires the provider to call 801-262-7476 or 800-662-5850. Providers should advise EMIA that they will be submitting their claims through Change Healthcare Bu 		CX079 No
EMPHESYS
PARTICIPATING PAYER / CLAIMS 		73288 No
EPSI Dental II
PARTICIPATING PAYER / CLAIMS 		CX037 No
EQUICOR
PARTICIPATING PAYER / CLAIMS, ERA 		62308 No
ES Beveridge and Associates
PARTICIPATING PAYER / CLAIMS 		34108 No
EasyChoice Health Plan
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Echo Health, Inc
NON-PARTICIPATING PAYER / ERA 		58379 No
Eddy SeniorCare
PARTICIPATING PAYER / CLAIMS 		08754 No
Elderwood Health
PARTICIPATING PAYER / CLAIMS 		03964 No
Electrical Workers Welfare Trust
NON-PARTICIPATING PAYER / ERA, EFT 		52611 No
Emblem Health (GHI - New York Group Health Inc.)
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY 		13551 No
Empire Blue Cross Blue Shield
NON-PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY
ELIGIBILITY INQUIRY: FEP claims may not be sent electronically.
ELIGIBILITY INQUIRY: Detailed Benefits 		CBNY1 No
EmpireHealthChoice Assurance - OSB Low & PPOB
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
EmpireHealthChoice HMO
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Employee Benefit Concepts (Farmington Hills, MI)
PARTICIPATING PAYER / CLAIMS 		38241 No
Employee Benefit Consultants
PARTICIPATING PAYER / CLAIMS 		37257 No
Employee Benefit Management Corp (EBMC)
PARTICIPATING PAYER / CLAIMS 		CX025 No
Employee Benefits Corporation
NON-PARTICIPATING PAYER / ERA 		58379 No
Employee Benefits Plan Administration, Inc. (E.B.P.A.)
PARTICIPATING PAYER / CLAIMS 		03036 No
Employee Benefits Systems of IA
PARTICIPATING PAYER / CLAIMS 		42149 No
Employee Plans, LLC
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		35112 No
Employer Plan Services, Inc.
PARTICIPATING PAYER / CLAIMS 		CX031 No
Employers Direct Health
PARTICIPATING PAYER / CLAIMS 		75232 No
Employers Health
PARTICIPATING PAYER / CLAIMS 		73288 No
Employers Health Insurance
PARTICIPATING PAYER / CLAIMS 		73288 No
Employers Mutual, Inc.
PARTICIPATING PAYER / CLAIMS, ERA 		59297 No
Encara
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		WDENC No
Envolve Health
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		46278 No
Everence
PARTICIPATING PAYER / CLAIMS, EFT, ELIGIBILITY INQUIRY 		35605 No
Evergreen
NON-PARTICIPATING PAYER / ERA 		58379 No
Evergreen Health Co-Op
PARTICIPATING PAYER / CLAIMS, ERA 		93240 No
ExclusiCare
PARTICIPATING PAYER / CLAIMS, ERA 		71412 No
FL MCO PHC/PHP
PARTICIPATING PAYER / CLAIMS 		95411 No
Fairbanks North Star Borough
PARTICIPATING PAYER / CLAIMS, ERA 		91136 No
Fairbanks North Star Borough School District Plan A (FNSBSD)
PARTICIPATING PAYER / CLAIMS, ERA 		91136 No
Fairbanks North Star Borough School District Plan B (FNSBSD)
PARTICIPATING PAYER / CLAIMS, ERA 		91136 No
Family Dental
PARTICIPATING PAYER / CLAIMS 		CX096 No
Family Health Network
NON-PARTICIPATING PAYER / ERA 		58379 No
FamilyCare CCO
PARTICIPATING PAYER / CLAIMS 		CXFMC No
Federated Mutual Insurance
PARTICIPATING PAYER / CLAIMS 		41041 No
Fidelio Dental Insurance Company
PARTICIPATING PAYER / CLAIMS 		FDIC1 No
First Administrators
NON-PARTICIPATING PAYER / EFT 		FAMR1 No
First Care/Southwest Life & Health
PARTICIPATING PAYER / CLAIMS 		CX050 No
First Continental Life & Accident Insurance
PARTICIPATING PAYER / CLAIMS 		CX090 No
First Dental Health / BIA
PARTICIPATING PAYER / CLAIMS 		CXBMD No
First Dental Health of CA
PARTICIPATING PAYER / CLAIMS 		CX086 No
First Reliance Standard Life Ins. Co. (NY Business)
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA 		13317 No
FirstCare Health Plans
NON-PARTICIPATING PAYER / EFT 		49096 No
Flex Compensation
NON-PARTICIPATING PAYER / CLAIMS, ERA 		R7004 No
FlexCare
PARTICIPATING PAYER / CLAIMS 		68241 No
Florida Blue FEP
NON-PARTICIPATING PAYER / CLAIMS 		CBFLF No
Florida Combined Life
PARTICIPATING PAYER / CLAIMS, ERA
ERA: Administered by United Concordia 		CBFLU No
Florida Health Administrators Inc
NON-PARTICIPATING PAYER / ERA 		58379 No
Florida Medicaid
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA 		CKFL1 No
Florida Power & Light
PARTICIPATING PAYER / CLAIMS 		68241 No
Foreign Service Benefit Plan
PARTICIPATING PAYER / CLAIMS, ERA
ERA: Formerly payer ID 62413. Now part of Coventry Consolidated payer ID. Including AFSPA Staff Plan.
ERA: Payer RA will be turned off within 30 days of enrollment; PDFs are available through Coventry's provider portal www.directprovider.com 		25133 No
Formula Card Dental
NON-PARTICIPATING PAYER / CLAIMS 		LX050 No
Foundation Benefit Admin (FBA) - Boon Group
PARTICIPATING PAYER / CLAIMS, ERA, EFT
EFT: Not all employer groups are live for EFT 		BOONG No
Fox Everett, Inc.
PARTICIPATING PAYER / CLAIMS 		64069 No
Fraternal Order of Police - Dental Division (Philadelphia, PA)
PARTICIPATING PAYER / CLAIMS 		CX041 No
Fresenius Health Plans
NON-PARTICIPATING PAYER / ERA 		58379 No
Fresno PACE
PARTICIPATING PAYER / CLAIMS 		99660 No
Fringe Benefits Coordinators
PARTICIPATING PAYER / CLAIMS 		59204 No
GDS
PARTICIPATING PAYER / CLAIMS, ERA, EFT, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, ATTACHMENTS
ELIGIBILITY INQUIRY: Detailed Benefits 		CX036 No
GEMCare
NON-PARTICIPATING PAYER / ERA 		58379 No
GGMIT insured by Trustmark Insurance
NON-PARTICIPATING PAYER / ERA 		58379 No
GIC Indemnity Plan
PARTICIPATING PAYER / CLAIMS, ERA 		80314 No
Georgia BCBS
PARTICIPATING PAYER / CLAIMS, ERA 		CBGA1 No
Gerber
NON-PARTICIPATING PAYER / ERA 		58379 No
Gettysburg
PARTICIPATING PAYER / CLAIMS 		CX064 No
Gilsbar, Inc.
PARTICIPATING PAYER / CLAIMS 		07205 No
Golden State Health Plan
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Golden West Dental
PARTICIPATING PAYER / CLAIMS, ERA 		GWD01 No
Government Employees Hospital Association (GEHA)
PARTICIPATING PAYER / CLAIMS, ERA, EFT, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
EFT: GEHA EFT enrollment requires tax ID plus GEHA provider ID. In order to get your GEHA provider ID please contact GEHA at 816.257.5500.
ELIGIBILITY INQUIRY: Yes / No Response 		44054 No
Government Employees Hospital Association (GEHA)
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Yes / No Response 		57254 No
Great-West Healthcare
PARTICIPATING PAYER / ERA, CLAIMS, CLAIM STATUS INQUIRY 		80705 No
Great-West Healthcare
PARTICIPATING PAYER / CLAIMS, CLAIM STATUS INQUIRY 		63665 No
Grimmway Enterprises
NON-PARTICIPATING PAYER / ERA 		58379 No
Group Administrators Ltd.
PARTICIPATING PAYER / CLAIMS 		36338 No
Group Benefit Administrators
PARTICIPATING PAYER / CLAIMS, ERA
ERA: ERAs are only returned to Change Healthcare if the claim is processed by Change Healthcare. 		72153 No
Group Health Coop (Individual & Family, and Small Business Groups)
PARTICIPATING PAYER / CLAIMS 		89070 No
Group Insurance Service Center, Inc
PARTICIPATING PAYER / CLAIMS 		37276 No
Group Link of Indiana
NON-PARTICIPATING PAYER / CLAIMS 		CX015 No
Group Management Services (GMS)
NON-PARTICIPATING PAYER / ERA 		58379 No
Group and Pension Administrators
PARTICIPATING PAYER / CLAIMS 		48143 No
Guaranty (DINA)
PARTICIPATING PAYER / CLAIMS 		CX090 No
Guardian Life Insurance Company of America
PARTICIPATING PAYER / CLAIMS, ERA, EFT, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Detailed Benefits 		64246 No
Gulf Guaranty Employee Benefit Services Inc.
NON-PARTICIPATING PAYER / ERA 		58379 No
HCS - Health Claims Service (Boise, ID)
PARTICIPATING PAYER / CLAIMS 		82018 No
HSBS Memphis
PARTICIPATING PAYER / CLAIMS, ERA 		37224 No
HSBS Oklahoma City
PARTICIPATING PAYER / CLAIMS 		37256 No
HSHS Medical Group IPA
PARTICIPATING PAYER / CLAIMS 		37137 No
HSR Administrators Inc.
NON-PARTICIPATING PAYER / ERA 		58379 No
Hamaspik Choice
PARTICIPATING PAYER / CLAIMS 		47738 No
Harrington Health Colonial Dental
PARTICIPATING PAYER / CLAIMS 		59143 No
Hawaii - Mainland Administrators
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		86066 No
Hawaii Medical Service Association (HMSA)
PARTICIPATING PAYER / CLAIMS, ERA
ERA: Federal Employee claims cannot be sent electronically
ERA: Administered by United Concordia 		HMSA1 No
Health Choice Arizona
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY
ELIGIBILITY INQUIRY: Detailed Benefits 		62179 No
Health Choice Generations
NON-PARTICIPATING PAYER / ERA 		62180 No
Health Choice Insurance
PARTICIPATING PAYER / CLAIMS, ERA 		46221 No
Health Choice Integrated Care
PARTICIPATING PAYER / CLAIMS, ERA 		22100 No
Health Choice Utah
NON-PARTICIPATING PAYER / ERA 		45399 No
Health Cost Solutions
NON-PARTICIPATING PAYER / ERA 		58379 No
Health Economics Group, Inc.
NON-PARTICIPATING PAYER / CLAIMS 		CX039 No
Health Net 21 - LA & Sacramento
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Health Net Healthy Families A, B & C
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Health Net Los Angeles PHP
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Health Net Sacramento GMC
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Health Partners - Jackson, TN
PARTICIPATING PAYER / CLAIMS 		62157 No
Health Partners Plans
NON-PARTICIPATING PAYER / ERA 		58379 No
Health Plan Services
PARTICIPATING PAYER / CLAIMS 		59140 No
Health Plans Inc.
PARTICIPATING PAYER / CLAIMS 		CX055 No
Health Resources Incorporated (HRI)
PARTICIPATING PAYER / CLAIMS 		CX019 No
Health Safety Net
PARTICIPATING PAYER / CLAIMS, ERA 		CKHSN No
Health Services for Children with Special Needs
NON-PARTICIPATING PAYER / EFT 		37290 No
HealthE Exchange Inc.
PARTICIPATING PAYER / CLAIMS 		20356 No
HealthEZ
PARTICIPATING PAYER / CLAIMS, EFT 		41178 No
HealthPartners MN
NON-PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY
ELIGIBILITY INQUIRY: Detailed Benefits. Only Subscriber Requests are Supported. 		CX009 No
HealthPartners MN
NON-PARTICIPATING PAYER / CLAIMS, ERA 		CX010 No
HealthSCOPE Benefits
NON-PARTICIPATING PAYER / ERA 		58379 No
HealthSCOPE Benefits, Inc.(Formerly CNA Health Partners of Arkansas)
PARTICIPATING PAYER / CLAIMS, ERA 		71063 No
HealthShare CCO
PARTICIPATING PAYER / CLAIMS 		CXHSC No
HealthSmart Benefit Solutions
PARTICIPATING PAYER / CLAIMS 		37283 No
HealthSmart Benefit Solutions
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		37272 No
HealthSmart Benefit Solutions
PARTICIPATING PAYER / CLAIMS, ERA 		87815 No
HealthSmart Benefit Solutions
NON-PARTICIPATING PAYER / ERA 		58379 No
HealthSmart Benefit Solutions Inc.
NON-PARTICIPATING PAYER / ERA 		58379 No
HealthSmart formerly AAG
NON-PARTICIPATING PAYER / ERA 		58379 No
HealthTrans
PARTICIPATING PAYER / CLAIMS 		31172 No
Healthcare Management Administrators
NON-PARTICIPATING PAYER / ERA 		58379 No
Healthcare Management Administrators, Inc.
PARTICIPATING PAYER / CLAIMS 		HMA01 No
Healthchoice OK
PARTICIPATING PAYER / CLAIMS 		71064 No
Healthcomp, Inc.
PARTICIPATING PAYER / CLAIMS 		85729 No
Healthgram, Inc.
PARTICIPATING PAYER / CLAIMS 		56144 No
Healthnow of Northeastern NY
PARTICIPATING PAYER / CLAIMS 		CBNYE No
Healthnow of Western NY
PARTICIPATING PAYER / CLAIMS 		CBNYW No
Healthplex, Inc.
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, ATTACHMENTS 		11271 No
Healthways
NON-PARTICIPATING PAYER / ERA 		58379 No
Healthy Alliance Life Insurance - PPOB
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Healthy Michigan Dental
NON-PARTICIPATING PAYER / CLAIMS 		HMD01 No
Hometown Health Plans Nevada
PARTICIPATING PAYER / CLAIMS 		88023 No
Hoosier Dental (in Indianapolis, Indiana)
NON-PARTICIPATING PAYER / CLAIMS 		CX015 No
Horizon Healthcare Dental Services
NON-PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Detailed Benefits 		22099 No
Hotel Employees Restaurant Employees Health Trust (HERE)
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		91136 No
Humana
PARTICIPATING PAYER / CLAIMS 		73288 No
Humana, Inc.
PARTICIPATING PAYER / CLAIMS, ERA 		61101 No
I. E. Shaffer (West Trenton, NJ)
PARTICIPATING PAYER / CLAIMS 		22175 No
IBT - Local 145 Health Service & Ins Plan
PARTICIPATING PAYER / CLAIMS 		CXIBT No
IEHP
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
IMA Inc
NON-PARTICIPATING PAYER / ERA 		58379 No
IMCare
PARTICIPATING PAYER / CLAIMS 		41600 No
INTEGRA Administrative Group
NON-PARTICIPATING PAYER / ERA 		58379 No
InHealth
NON-PARTICIPATING PAYER / ERA 		58379 No
Indiana Children's Special Healthcare
NON-PARTICIPATING PAYER / CLAIMS, ERA 		CX070 No
Indiana Teamsters Health Benefits Fund (Indianapolis, IN)
PARTICIPATING PAYER / CLAIMS 		35107 No
Inetico
PARTICIPATING PAYER / CLAIMS 		43471 No
Innovante Benefit Administrators
PARTICIPATING PAYER / CLAIMS 		31172 No
Innovation Health
PARTICIPATING PAYER / CLAIMS 		40025 No
Insurance Administrators of America
PARTICIPATING PAYER / CLAIMS 		37279 No
Insurance Design Administrators
PARTICIPATING PAYER / CLAIMS 		13315 No
Insurance Management Services
PARTICIPATING PAYER / CLAIMS 		15688 No
Insurance Management Services
NON-PARTICIPATING PAYER / ERA 		58379 No
Insurance Systems Inc.
PARTICIPATING PAYER / CLAIMS 		74385 No
Insurers Administrative Corp.
PARTICIPATING PAYER / CLAIMS 		86304 No
Integra Administrative Group (Seaford, DE)
PARTICIPATING PAYER / CLAIMS 		51020 No
Integrity Administrators
NON-PARTICIPATING PAYER / ERA 		58379 No
International Brotherhood of Boilermakers
PARTICIPATING PAYER / CLAIMS 		36609 No
JP Farley Corporation
PARTICIPATING PAYER / CLAIMS 		34136 No
Jensen Administrative Services, Inc.
PARTICIPATING PAYER / CLAIMS 		CXJAS No
John Morrell Company - AHBPA
PARTICIPATING PAYER / CLAIMS 		38310 No
Joint Benefit Trust
PARTICIPATING PAYER / CLAIMS 		CHSJT No
KG Administrative Services
NON-PARTICIPATING PAYER / ERA 		58379 No
Kaiser
PARTICIPATING PAYER / CLAIMS, EFT, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Detailed Benefits 		CX073 No
Kalos Health
PARTICIPATING PAYER / CLAIMS 		40137 No
Kanawha Insurance Co.
PARTICIPATING PAYER / CLAIMS 		57038 No
Kansas City Life
PARTICIPATING PAYER / CLAIMS 		CX058 No
Keenan Associates
PARTICIPATING PAYER / CLAIMS 		95279 No
Kemper Benefits
PARTICIPATING PAYER / CLAIMS 		61453 No
Kempton Company
PARTICIPATING PAYER / CLAIMS 		73100 No
Kempton Group Administrators
PARTICIPATING PAYER / CLAIMS 		73100 No
Kentucky Health Co-Op
PARTICIPATING PAYER / CLAIMS 		77894 No
Kentucky Spirit
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		65030 No
Key Family
NON-PARTICIPATING PAYER / ERA, EFT 		37217 No
Key Solutions
PARTICIPATING PAYER / CLAIMS 		37323 No
Klais & Company
PARTICIPATING PAYER / CLAIMS 		34145 No
LA BCBS AdvantagePlus Network
PARTICIPATING PAYER / CLAIMS, ERA 		53021 No
LA Care Health Plan
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
LIFE St Mary`
PARTICIPATING PAYER / CLAIMS 		76184 No
LIFE St. Joseph of the Pines
PARTICIPATING PAYER / CLAIMS 		59847 No
Lake County Physicians Association
PARTICIPATING PAYER / CLAIMS 		37116 No
Land of Lincoln
PARTICIPATING PAYER / CLAIMS 		90096 No
Liberty Dental Plan
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Life Circles PACE
PARTICIPATING PAYER / CLAIMS 		71498 No
Life Gift Cards
PARTICIPATING PAYER / CLAIMS 		33LGC No
Life Insurance Company of Boston & New York
PARTICIPATING PAYER / CLAIMS 		78140 No
LifeMap Assurance Company
NON-PARTICIPATING PAYER / CLAIMS 		RLH01 No
LifeWell
NON-PARTICIPATING PAYER / ERA 		58379 No
Lifestyle Dental
PARTICIPATING PAYER / CLAIMS 		27005 No
Lifewise Health Plan of Oregon
PARTICIPATING PAYER / CLAIMS 		93093 No
Lincoln Financial Group
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: f.k.a. Jefferson Pilot
ELIGIBILITY INQUIRY: Detailed Benefits 		CX061 No
Lincoln National (WI)
PARTICIPATING PAYER / CLAIMS 		73288 No
Line Construction Benefit Fund
PARTICIPATING PAYER / CLAIMS 		LCB01 No
Local 135 Health Benefits Fund (Indianapolis, IN)
PARTICIPATING PAYER / CLAIMS 		35107 No
Local 17 Fund - International Association of Heat and Frost Insulators
PARTICIPATING PAYER / CLAIMS 		IAHFI No
Locals 302 & 612 of the Internation Union of Operating Engineers
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		91136 No
Lockard & Williams
PARTICIPATING PAYER / CLAIMS 		CB752 No
MAMSI
NON-PARTICIPATING PAYER / CLAIMS 		CX033 No
MAPFRE
NON-PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY
ELIGIBILITY INQUIRY: Completing this enrollment request will enroll the provider(s) for 3 transactions – Electronic Claims (837D), Electric Remittance Advice (835) and Real Time Eligibility Inquiry and Response (270/271) with all 3 payers listed above. Please ensure you have 		PRFRE No
MBA Benefit Administrators, Inc. (Salt Lake City, UT)
PARTICIPATING PAYER / CLAIMS 		83028 No
MBA of Wyoming (Worland, WY)
PARTICIPATING PAYER / CLAIMS 		87065 No
MBS
NON-PARTICIPATING PAYER / ERA, EFT 		56205 No
MCNA Dental
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		65030 No
MD Care Health Plan
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
MED3000 CMS Early Steps
NON-PARTICIPATING PAYER / ERA, EFT
EFT: Legacy ID Required to enroll and may be obtained by calling the payer at 800-664-0146 		EM350 No
MED3000 CMS Safety Net
NON-PARTICIPATING PAYER / ERA, EFT
EFT: Legacy ID Required to enroll and may be obtained by calling the payer at 800-664-0146 		EM284 No
MED3000 CMS Title 21
PARTICIPATING PAYER / CLAIMS 		EM205 No
MEDICA of Minnesota
NON-PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY
ELIGIBILITY INQUIRY: Detailed Benefits 		CX026 No
MGM Resorts International
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
MMA
NON-PARTICIPATING PAYER / EFT 		35316 No
MPEEBT/ MPE Services, Inc.
PARTICIPATING PAYER / CLAIMS 		37233 No
MSA CareGuard
PARTICIPATING PAYER / CLAIMS 		20572 No
MVP Health Care
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY 		14165 No
Mail Handlers Benefit Plan
PARTICIPATING PAYER / CLAIMS, ERA
ERA: Formerly payer ID 62413. Now part of Coventry Consolidated payer ID. Including AFSPA Staff Plan.
ERA: Payer RA will be turned off within 30 days of enrollment; PDFs are available through Coventry's provider portal www.directprovider.com 		25133 No
Maine Medicaid for FQHC
NON-PARTICIPATING PAYER / CLAIMS 		CKMEH No
Managed Care Services, LLC
PARTICIPATING PAYER / CLAIMS 		35162 No
Managed Care Systems
NON-PARTICIPATING PAYER / ERA 		58379 No
Managed Dental Guard
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY
ELIGIBILITY INQUIRY: Only for the individual marketplace, not for Group/SHOP business
ELIGIBILITY INQUIRY: Detailed Benefits 		GI813 No
ManagedCareSystems
NON-PARTICIPATING PAYER / ERA 		58379 No
Manulife W. J. Sutton Company
PARTICIPATING PAYER / CLAIMS 		98010 No
Marrick Medical
NON-PARTICIPATING PAYER / ERA 		58379 No
Masonry Institute/Administrative D.C. No. 1 Welfare Fund
PARTICIPATING PAYER / CLAIMS 		CX098 No
MasonryTrusts
NON-PARTICIPATING PAYER / ERA 		58379 No
Massachusetts Health Program
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA
CLAIMS: Yes/No Response
CLAIMS: Please place MASS Health or MA Medicaid or MASS Medicaid in the carrier name field. 		CKMA1 No
Mayo Clinic Health Solutions
PARTICIPATING PAYER / CLAIMS, ERA 		41154 No
McGregor PACE
PARTICIPATING PAYER / CLAIMS 		31149 No
Med3000 CMS Safety Net
PARTICIPATING PAYER / CLAIMS 		EM284 No
Med3000 CMS Title 19 Reform
PARTICIPATING PAYER / CLAIMS, ERA, EFT
EFT: Legacy ID Required to enroll and may be obtained by calling the payer at 800-664-0146 		EM843 No
Med3000 CMS Title 21
NON-PARTICIPATING PAYER / ERA, EFT
EFT: Legacy ID Required to enroll and may be obtained by calling the payer at 800-664-0146 		EM205 No
MedCost Benefit Services
NON-PARTICIPATING PAYER / ERA, EFT 		56205 No
MedPartners Administrative Services
NON-PARTICIPATING PAYER / EFT 		35205 No
Medi-Cal / Medicaid of Californai
NON-PARTICIPATING PAYER / CLAIMS 		57016 No
Medicaid of Alabama
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKAL1 No
Medicaid of Alaska
NON-PARTICIPATING PAYER / CLAIMS, ERA 		CKAK1 No
Medicaid of Arkansas
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKAR1 No
Medicaid of Colorado
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS 		CKCO1 No
Medicaid of Connecticut
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKCT1 No
Medicaid of Florida
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA 		CKFL1 No
Medicaid of Georgia
NON-PARTICIPATING PAYER / ERA, CLAIMS, ELIGIBILITY INQUIRY
ELIGIBILITY INQUIRY: Enroll with Payer
ELIGIBILITY INQUIRY: Yes/No Response 		CKGA1 No
Medicaid of Indiana
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKIN1 No
Medicaid of Iowa
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKIA1 No
Medicaid of Kansas
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKKS1 No
Medicaid of Kentucky
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, ERA, CLAIMS 		CKKY1 No
Medicaid of Maine
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKME1 No
Medicaid of Michigan
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKMI1 No
Medicaid of Minnesota
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKMN1 No
Medicaid of Mississippi
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKMS1 No
Medicaid of Missouri
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA 		CKMO1 No
Medicaid of Montana
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKMT1 No
Medicaid of Nebraska
NON-PARTICIPATING PAYER / CLAIMS, ERA
ERA: Enrollment in Electronic Fund Transfer (EFT) is required for enrollment in ERAs. 		CKNE1 No
Medicaid of Nevada
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKNV1 No
Medicaid of New Hampshire
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKNH1 No
Medicaid of New Jersey
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKNJ1 No
Medicaid of New York
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA
ERA: Yes/No Response
ERA: Providers must be currently linked to Change Healthcare Dental's ETIN 0Q2 for the submission of Dental Claims before submitting an ERA enrollment request. 		CKNY1 No
Medicaid of New York (Dental Clinics Only)
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA
ERA: Yes/No Response
ERA: Providers must be currently linked to Change Healthcare Dental's ETIN 0Q2 for the submission of Dental Claims before submitting an ERA enrollment request. 		CKNY2 No
Medicaid of North Carolina
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA
ERA: Yes/No Response
ERA: Effective July 1, 2013 all Provider Enrollment Applications and updates must be completed through the NCTracks system. You can learn more about how to register in NCTracks at the following DHHS website: http://nctracks.com/ 		CKNC1 No
Medicaid of Ohio
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKOH1 No
Medicaid of Oklahoma
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA
ERA: Yes/No Response
ERA: Provider logs into the secure web account for EACH ID and designates the Receiver of the transactions. This is a ONE TIME process and will remain in effect until designation is revoked. Secure web account can be accessed at: https://www.ohcaprovider. 		CKOK1 No
Medicaid of Oregon
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKOR1 No
Medicaid of Pennsylvania
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKPA1 No
Medicaid of Rhode Island
NON-PARTICIPATING PAYER / CLAIMS, ERA 		CKRI1 No
Medicaid of Texas
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKTX1 No
Medicaid of Utah
NON-PARTICIPATING PAYER / CLAIMS, ERA 		CKUT1 No
Medicaid of Vermont
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKVT1 No
Medicaid of Washington
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKWA1 No
Medicaid of West Virginia
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKWV1 No
Medicaid of Wisconsin
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKWI1 No
Medicaid of Wyoming
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKWY1 No
Medical Associate Health Plan (HEALTH CHOICES)
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		MAHC1 No
Medical Benefits Mutual Administrators (MedBen)
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		74323 No
Medical Card System (MCS)
NON-PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY
ELIGIBILITY INQUIRY: Completing this enrollment request will enroll the provider(s) for 3 transactions – Electronic Claims (837D), Electric Remittance Advice (835) and Real Time Eligibility Inquiry and Response (270/271) with all 3 payers listed above. Please ensure you have 		PRMCS No
Medical Mutual of Ohio
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS, ERA
ERA: Detailed Benefits
ERA: Please enroll under payer ID CB833. 		29076 No
Medical Mutual of Ohio
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Detailed Benefits 		CB833 No
Medico Insurance Company
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		23160 No
Merchants benefit Administrators
NON-PARTICIPATING PAYER / ERA 		58379 No
Mercy Benefit Administrators
PARTICIPATING PAYER / CLAIMS 		37264 No
Mercy Care Plan
PARTICIPATING PAYER / CLAIMS, ERA, EFT, ATTACHMENTS
ERA: Providers must enroll using the Mercy Care ERA Enrollment form, and this must be submitted to MercyCareProviderRelations@aetna.com 		86052 No
Mercy LIFE of Alabama
PARTICIPATING PAYER / CLAIMS 		63002 No
Mercy Maricopa Integrated Care
PARTICIPATING PAYER / CLAIMS, ERA, ATTACHMENTS 		33628 No
Meritain - SHARP
NON-PARTICIPATING PAYER / ERA 		58379 No
Meritain Health
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		38232 No
Meritain Health Minneapolis
PARTICIPATING PAYER / CLAIMS 		41124 No
MetLife
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, ATTACHMENTS, CLAIMS, ERA 		65978 No
Methodist First Choice
PARTICIPATING PAYER / CLAIMS 		23550 No
Michigan Regional Council of Carpenters Employees Benefit Plan
PARTICIPATING PAYER / CLAIMS 		38238 No
Michigan UFCW
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		27401 No
Mid-America Associates, Inc.
PARTICIPATING PAYER / CLAIMS 		37281 No
Mid-American Benefits
PARTICIPATING PAYER / CLAIMS 		22823 No
Mid-American Benefits Inc.
NON-PARTICIPATING PAYER / ERA 		58379 No
Midwest Dental Benefits
PARTICIPATING PAYER / CLAIMS 		41101 No
Missoula County Medical Benefits Plan
PARTICIPATING PAYER / CLAIMS 		37275 No
Molina HealthCare
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Momentum Insurance Plan
PARTICIPATING PAYER / CLAIMS 		31415 No
Monarch
NON-PARTICIPATING PAYER / ERA 		58379 No
Monitor Life Insurance Co of NY
NON-PARTICIPATING PAYER / ERA 		58379 No
Morgan White
NON-PARTICIPATING PAYER / ERA 		58379 No
Morris Associates
PARTICIPATING PAYER / CLAIMS 		35092 No
Motorola
PARTICIPATING PAYER / CLAIMS 		36111 No
Mountain States Administrative Services (Tucson, AZ)
PARTICIPATING PAYER / CLAIMS 		86040 No
MultiFlex Dental (Merchants Benefit)
PARTICIPATING PAYER / CLAIMS 		MBAAZ No
Municipal Health Benefit Fund
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		81883 No
Mutual Health Services
NON-PARTICIPATING PAYER / ERA 		58379 No
Mutual of Omaha Commercial
NON-PARTICIPATING PAYER / CLAIMS, ERA
ERA: ERAs are only returned to Change Healthcare if the claim is processed by Change Healthcare. 		CX087 No
Mutual of Omaha Insurance Company
PARTICIPATING PAYER / CLAIMS, ERA 		71412 No
Mutually Preferred
PARTICIPATING PAYER / CLAIMS, ERA 		71412 No
Mututal Assurance Admin.
NON-PARTICIPATING PAYER / ERA 		58379 No
MyDecision
PARTICIPATING PAYER / CLAIMS 		18840 No
NAA (North America Administrators, L.P.) (Nashville, TN)
PARTICIPATING PAYER / CLAIMS 		65085 No
NABN (Cleveland, OH)
PARTICIPATING PAYER / CLAIMS 		34159 No
NAPHCARE, Inc.
PARTICIPATING PAYER / CLAIMS 		58182 No
NCAS - Charlotte
PARTICIPATING PAYER / CLAIMS 		75191 No
NCAS - Fairfax, VA
PARTICIPATING PAYER / CLAIMS 		75190 No
NJ Delta DHMO
PARTICIPATING PAYER / CLAIMS 		22267 No
NNEBT (Northern New England Benefit Trust)
PARTICIPATING PAYER / CLAIMS 		38238 No
NW International Association of Machinists (NW IAM)
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		91136 No
NW Plumbers & Pipefitters Health & Welfare Trust
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		91136 No
NYS DOH UCP
PARTICIPATING PAYER / CLAIMS, ERA 		14142 No
National Elevator Industry Benefit Plan (NEIB)
PARTICIPATING PAYER / CLAIMS, ERA
ERA: Payer does not process 835s for payments. They only send 835s for non-payments. 		CX045 No
National Pacific of TX (NCFLEX)
PARTICIPATING PAYER / CLAIMS 		CX057 No
National Rural Letter Carrier Association
PARTICIPATING PAYER / CLAIMS, ERA 		71412 No
National Telecommunications Cooperative Association
PARTICIPATING PAYER / CLAIMS 		52120 No
Nationwide Employee Benefits
PARTICIPATING PAYER / CLAIMS 		314RV No
Nationwide Health Plans
PARTICIPATING PAYER / CLAIMS 		31417 No
Nationwide Life Insurance Co.
NON-PARTICIPATING PAYER / ERA 		58379 No
Native Care Health
PARTICIPATING PAYER / CLAIMS 		19191 No
Native Care Health LLC
NON-PARTICIPATING PAYER / ERA 		58379 No
Netcare Life and Health Insurance (NLH)
PARTICIPATING PAYER / CLAIMS 		66055 No
Nevad Dental Benefits
PARTICIPATING PAYER / CLAIMS 		NDB01 No
Nevada Health Co-Op
PARTICIPATING PAYER / CLAIMS 		90091 No
New England Dental Administrators
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		43351 No
New Mexico Medicaid
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS, ERA 		CKNM1 No
Next Level Health Partners, LLC
PARTICIPATING PAYER / CLAIMS 		69821 No
Nippon Life Benefits
NON-PARTICIPATING PAYER / ERA 		58379 No
Nippon Life Insurance Company of America
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Detailed Benefits 		81264 No
North American Benefits Network ((Cleveland, OH)
PARTICIPATING PAYER / CLAIMS 		34159 No
North American Co Life and Health
NON-PARTICIPATING PAYER / ERA 		58379 No
North American Ins Co of NY
NON-PARTICIPATING PAYER / ERA 		58379 No
North Broward Hospital District
PARTICIPATING PAYER / CLAIMS 		37314 No
North Dakota Dental Service
NON-PARTICIPATING PAYER / CLAIMS 		CX004 No
North Dakota Medicaid
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS
CLAIMS: Yes/No Response
CLAIMS: Additional enrollment is not required by the payer, however, providers wishing to submit Claims electronically must submit their ND Medicaid assigned provider ID(s) within the Claims.  Provider IDs are always 5 digits long and begin with the number 4.  		CKND1 No
NorthShore University Health System Medical Group
PARTICIPATING PAYER / CLAIMS 		36364 No
NorthStar Administrators
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Detailed Benefits 		47570 No
Northeast Delta Dental (ME, NH, VT)
PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, CLAIMS 		02027 No
Northern California Pipe Trades Trust Funds
PARTICIPATING PAYER / CLAIMS 		CX099 No
Northern Illinois Health Plan
PARTICIPATING PAYER / CLAIMS 		36347 No
Northern Minnesota Dental
NON-PARTICIPATING PAYER / CLAIMS 		LX062 No
Northern Nevada Trust Fund
PARTICIPATING PAYER / CLAIMS 		88027 No
Northwest Administrators
NON-PARTICIPATING PAYER / ERA, EFT 		91068 No
Northwest Dental Services
PARTICIPATING PAYER / CLAIMS 		93525 No
Northwest Ironworkers Health & Security Fund
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		91136 No
Northwest Roofers & Employers Health & Security Trust Fund
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		91136 No
Northwest Suburban IPA
PARTICIPATING PAYER / CLAIMS 		36346 No
Northwest Textile Processors and Service Trades
PARTICIPATING PAYER / CLAIMS, ERA 		91136 No
Nova Healthcare Administrators, Inc. (Grand Island, NY)
PARTICIPATING PAYER / CLAIMS 		16644 No
Nyhart
PARTICIPATING PAYER / CLAIMS 		37299 No
OH Dental / UHC Dental Government Programs
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, ATTACHMENTS
ELIGIBILITY INQUIRY: f.k.a. Optum Specialty Svcs / Americhoice of NJ
ELIGIBILITY INQUIRY: Yes / No Response. f.k.a. Optum Specialty Svcs / Americhoice of NJ 		GP133 No
OK DRS DOC
PARTICIPATING PAYER / CLAIMS 		71065 No
OK State Employees & Educators (EDS)
PARTICIPATING PAYER / CLAIMS, ERA 		22521 No
Ohana Health Plan
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Ohio AFSCME Care Plan
NON-PARTICIPATING PAYER / CLAIMS 		AFSOH No
Ohio Dept of Corrections (Careworks)
PARTICIPATING PAYER / CLAIMS, ERA 		J1410 No
Olympus Managed Health Care
PARTICIPATING PAYER / CLAIMS 		65074 No
OneCall Care Diagnostics
NON-PARTICIPATING PAYER / ERA 		58379 No
Ownership Rewards
NON-PARTICIPATING PAYER / ERA 		58379 No
Ozark Health Plan
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
PA Faculty Health & Welfare
PARTICIPATING PAYER / CLAIMS 		CX066 No
PACE CNY
PARTICIPATING PAYER / CLAIMS 		70454 No
PACE Greater New Orlean (NORLIN)
PARTICIPATING PAYER / CLAIMS 		21614 No
PACE Southeast Michigan
PARTICIPATING PAYER / CLAIMS 		86711 No
PALMS Casino Resort
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
PAN Foundation
NON-PARTICIPATING PAYER / ERA 		58379 No
PDO
PARTICIPATING PAYER / CLAIMS 		68241 No
PEHP (Public Employees Health Program)
NON-PARTICIPATING PAYER / CLAIMS, ERA 		CX080 No
PHPCarolinas
NON-PARTICIPATING PAYER / ERA 		58379 No
POMCO
PARTICIPATING PAYER / CLAIMS, ERA 		16111 No
PSATS
NON-PARTICIPATING PAYER / ERA 		58379 No
Pace of Southwest Michigan
PARTICIPATING PAYER / CLAIMS 		45114 No
Pacific Union
PARTICIPATING PAYER / CLAIMS 		CX056 No
PacificSource Administrators
PARTICIPATING PAYER / CLAIMS, ERA
ERA: a.k.a. Select Benefit Administrators
ERA: Use pacificSource payer ID 93029 to register for ERA 		93031 No
PacificSource Community
PARTICIPATING PAYER / CLAIMS 		CXPSC No
PacificSource Health Plans
PARTICIPATING PAYER / CLAIMS, ERA 		93029 No
Pacificare Dental and Vision HMO
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, ATTACHMENTS 		CX060 No
Pacificare Dental and Vision PPO
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, ATTACHMENTS 		CX053 No
Pan American Life Insurance Group
PARTICIPATING PAYER / CLAIMS 		04218 No
Pan-American Life Insurance Company
NON-PARTICIPATING PAYER / ERA 		58379 No
Partners Benefit Group
PARTICIPATING PAYER / CLAIMS 		PBGSM No
Partners Health Plan
PARTICIPATING PAYER / CLAIMS 		23213 No
Patient Advocates, LLC
PARTICIPATING PAYER / CLAIMS 		10525 No
Penn Mutual
NON-PARTICIPATING PAYER / ERA 		58379 No
Pennsylvania Blue Shield
NON-PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ERA: Administered by United Concordia
ELIGIBILITY INQUIRY: Detailed Benefits 		CB865 No
Pennsylvania Blue Shield Dental Plus
NON-PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ERA: Administered by United Concordia
ELIGIBILITY INQUIRY: Detailed Benefits 		CBPA2 No
Pequot Pharmaceutical
PARTICIPATING PAYER / CLAIMS 		37121 No
Personal Insurance Administrators, Inc
PARTICIPATING PAYER / CLAIMS 		95397 No
Physician Health Partners, Loc
PARTICIPATING PAYER / CLAIMS 		PHPMA No
Physicians Care Network
PARTICIPATING PAYER / CLAIMS 		36345 No
Physicians Health Associates of Illinois
PARTICIPATING PAYER / CLAIMS 		37136 No
Physicians Health Plan of Northern Indiana, Inc.
PARTICIPATING PAYER / CLAIMS 		12399 No
Physicians Mutual
PARTICIPATING PAYER / CLAIMS, ERA 		CX068 No
Physicians United Plan-PUP
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Pinnacle Claims Management, Inc.
PARTICIPATING PAYER / CLAIMS 		24735 No
Pittman & Associates
NON-PARTICIPATING PAYER / ERA 		58379 No
Planned Administrators, Inc.
PARTICIPATING PAYER / CLAIMS 		37287 No
Prairie States Enterprises, Inc.
PARTICIPATING PAYER / CLAIMS 		36373 No
Preferred Care Partners
NON-PARTICIPATING PAYER / ERA 		65088 No
Preferred Dental Organization
PARTICIPATING PAYER / CLAIMS 		68241 No
Preferred Health Plan of the Carolinas
PARTICIPATING PAYER / CLAIMS 		CB404 No
Preferred Health Professionals
PARTICIPATING PAYER / CLAIMS 		31478 No
Preferred One
PARTICIPATING PAYER / CLAIMS, ERA 		41147 No
Premera Blue Cross
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Detailed Benefits 		47570 No
Premier Access Insurance Company
PARTICIPATING PAYER / CLAIMS, EFT
EFT: Legacy ID - For Providers, use their Facility/Office NPI.  For Brokers, use their Agency ID which is either a 4 or 5 digit code.  The 4 digit code starts with a 5 and the 5 digit code start with a 2. 		CX078 No
Premier Access UT Government
PARTICIPATING PAYER / CLAIMS, EFT 		CX110 No
Premier Dental Plan of MN
NON-PARTICIPATING PAYER / CLAIMS 		CX029 No
Premier Employee Benefit Services (PBS)
NON-PARTICIPATING PAYER / ERA 		58379 No
Prime Health Choice
PARTICIPATING PAYER / CLAIMS 		81502 No
PrimeCare Administrators (PPO)
PARTICIPATING PAYER / CLAIMS 		PCA01 No
PrimeWest Health
NON-PARTICIPATING PAYER / CLAIMS, ERA 		LX049 No
Principal Financial Group
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, ATTACHMENTS
ELIGIBILITY INQUIRY: Payer Only accepts VISION and DENTAL claims.
ELIGIBILITY INQUIRY: Detailed Benefits 		61271 No
Priority Health
PARTICIPATING PAYER / CLAIMS, ERA 		38217 No
Professional Benefit Administrators, Inc. (Oak Brook, IL)
PARTICIPATING PAYER / CLAIMS 		36331 No
Prominence Health Plan
PARTICIPATING PAYER / CLAIMS 		88029 No
Provident Life & Casualty
NON-PARTICIPATING PAYER / ERA 		58379 No
Prudential HealthCare & Life Ins. Co of America
PARTICIPATING PAYER / CLAIMS 		68241 No
Prudential HealthCare HMO for Small Business
PARTICIPATING PAYER / CLAIMS 		68241 No
Prudential HealthCare Health Maintenance Organization
PARTICIPATING PAYER / CLAIMS 		68241 No
Prudential HealthCare POS for Small Business
PARTICIPATING PAYER / CLAIMS 		68241 No
Prudential HealthCare PPO for Small Business
PARTICIPATING PAYER / CLAIMS 		68241 No
Prudential Healthcare of America Inc.
PARTICIPATING PAYER / CLAIMS 		68241 No
Prudential for Health
PARTICIPATING PAYER / CLAIMS 		68241 No
Puget Sound Electrical Workers Healthcare Trust (PSEW)
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		91136 No
Quality Care Partners
PARTICIPATING PAYER / CLAIMS 		89461 No
Quality Plan Administrators Inc
PARTICIPATING PAYER / CLAIMS 		CX077 No
Quapaw Casino
PARTICIPATING PAYER / CLAIMS 		19191 No
Quapaw Tribal Member Plan
PARTICIPATING PAYER / CLAIMS 		19191 No
Quapaw Tribe Employee Plan
PARTICIPATING PAYER / CLAIMS 		19191 No
Quartz ASO
PARTICIPATING PAYER / CLAIMS 		46571 No
RBMS, LLC
PARTICIPATING PAYER / CLAIMS 		91176 No
RGA
NON-PARTICIPATING PAYER / ERA 		58379 No
RMSCO, INC.
PARTICIPATING PAYER / CLAIMS 		16117 No
Ram Mutual Insurance
NON-PARTICIPATING PAYER / ERA 		58379 No
Reading Hospital Employer Group
PARTICIPATING PAYER / CLAIMS 		44219 No
Regence Blue Shield
NON-PARTICIPATING PAYER / CLAIMS, ERA
ERA: Effective May 1, 2013, Regence requires all claim payments to be received via EFT. If not already receiving payments from Regence via EFT, please register using the automatic Deposit (EFT/ACH Credits) authorization agreement enrollment and / or update 		93200 No
Regence Blue Shield FEP
NON-PARTICIPATING PAYER / CLAIMS 		93200 No
Regence Northwest Health
NON-PARTICIPATING PAYER / CLAIMS 		93200 No
Regence UT BCBS
NON-PARTICIPATING PAYER / CLAIMS, ERA
ERA: Effective May 1, 2013, Regence requires all claim payments to be received via EFT. If not already receiving payments from Regence via EFT, please register using the automatic Deposit (EFT/ACH Credits) authorization agreement enrollment and / or update 		CBUT1 No
Regence UT BCBS FEP
NON-PARTICIPATING PAYER / CLAIMS, ERA
ERA: Effective May 1, 2013, Regence requires all claim payments to be received via EFT. If not already receiving payments from Regence via EFT, please register using the automatic Deposit (EFT/ACH Credits) authorization agreement enrollment and / or update f 		CBUTF No
Regency Employee Benefits
PARTICIPATING PAYER / CLAIMS 		38221 No
ReliaStar (now known as CoreStar formerly NW National Life)
PARTICIPATING PAYER / CLAIMS 		41045 No
Reliance Standard Life
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Yes/No Response 		36088 No
Reliastar
PARTICIPATING PAYER / CLAIMS, ERA 		80314 No
Renaissance Life and Health
NON-PARTICIPATING PAYER / CLAIMS, ERA 		RLHA1 No
Resolve / Solarte Health, Inc
PARTICIPATING PAYER / CLAIMS 		CB695 No
Resource One
NON-PARTICIPATING PAYER / ERA 		58379 No
Riverside San Bernardino County Indian Health Inc.
PARTICIPATING PAYER / CLAIMS 		50664 No
Rochester Public Schools
PARTICIPATING PAYER / CLAIMS 		41625 No
Rocky Mountain Hospital & Medical Service - OSB High & High
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Rocky Mountain Life Dental
PARTICIPATING PAYER / CLAIMS, ERA 		84102 No
Rural Carrier Benefit Plan
PARTICIPATING PAYER / CLAIMS, ERA
ERA: Formerly payer ID 62413. Now part of Coventry Consolidated payer ID. Including NRLCA Staff Plan.
ERA: Payer RA will be turned off within 30 days of enrollment; PDFs are available through Coventry's provider portal www.directprovider.com 		25133 No
S&S Health Strategies
PARTICIPATING PAYER / CLAIMS 		31441 No
SAMBA
PARTICIPATING PAYER / CLAIMS 		37259 No
SCION Dental
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		SCION No
SKYGEN USA
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		SKYGN No
STAR +Plus Value Added
PARTICIPATING PAYER / CLAIMS 		CPPSP No
SafeGuard PPO
PARTICIPATING PAYER / CLAIMS, ERA 		CX030 No
Safeguard HMO
PARTICIPATING PAYER / CLAIMS 		CX048 No
Sage Technologies
PARTICIPATING PAYER / CLAIMS 		37105 No
Salvation Army
PARTICIPATING PAYER / CLAIMS 		34154 No
San Diego PACE
PARTICIPATING PAYER / CLAIMS 		96400 No
Sands Bethworks Gaming
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Sanford Health Plan
PARTICIPATING PAYER / CLAIMS 		91184 No
Santa Clara Family Health Plan
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Scan Health Plan
NON-PARTICIPATING PAYER / EFT 		72261 No
School Sisters of Notre Dame
NON-PARTICIPATING PAYER / ERA 		58379 No
Scion Dental Commercial
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		SDCOM No
Scion Gateway Health Plan
PARTICIPATING PAYER / CLAIMS 		96938 No
Secure Health Plan of GA
NON-PARTICIPATING PAYER / ATTACHMENTS, ERA, EFT 		28530 No
SecureCare Dental
PARTICIPATING PAYER / CLAIMS 		86057 No
Securian
NON-PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, ERA
ELIGIBILITY INQUIRY: Detailed Benefits 		93742 No
Security Life Insurance Co of America
PARTICIPATING PAYER / CLAIMS 		CX092 No
Sele-Dent
PARTICIPATING PAYER / CLAIMS 		CX109 No
Select Benefit Administrators
PARTICIPATING PAYER / CLAIMS, ERA
ERA: a.k.a. PacificSource Administrators
ERA: Use PacificSource payer ID 93029 to Register for ERA 		93031 No
Select Health
NON-PARTICIPATING PAYER / CLAIMS, ERA
ERA: Electronic fund Transfer (EFT) is available from select health but not required for ERA enrollment. Please contact Select health directly to sign up for EFT. 801-442-5442 		CX107 No
SelectCare (Coca Cola)
PARTICIPATING PAYER / CLAIMS 		68241 No
Self Insured Services Company (SISCO)
PARTICIPATING PAYER / CLAIMS 		CX020 No
Self-Funded Plans, Inc.
PARTICIPATING PAYER / CLAIMS 		34131 No
Self-Insured Dental Services (SIDS)
PARTICIPATING PAYER / CLAIMS 		CX076 No
Self-Insured Plans, LLC
PARTICIPATING PAYER / CLAIMS 		36404 No
Senior Network Health - Utica
PARTICIPATING PAYER / CLAIMS 		15682 No
Sentry Life Insurance Company
PARTICIPATING PAYER / CLAIMS 		39033 No
Sheffield, Olson and McQueen
NON-PARTICIPATING PAYER / CLAIMS, ERA 		41143 No
Shelter Point Life
PARTICIPATING PAYER / CLAIMS 		81434 No
Sierra Health Services
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, ATTACHMENTS
ELIGIBILITY INQUIRY: A United Healthcare Payer
ELIGIBILITY INQUIRY: Sierra health Services requires that providers register for the eligibility service prior to submitting requests. Provider can regtister for eligibility by contact Sierra Health provider services directlfy at: 702-242-7086 in Las Vegas or toll free at 		76342 No
Significa Benefits Services, Inc.
PARTICIPATING PAYER / CLAIMS 		CX046 No
Simple (part of Covenant)
NON-PARTICIPATING PAYER / ERA 		58379 No
Simplifi
NON-PARTICIPATING PAYER / ERA 		58379 No
Simplified Funding Concepts
NON-PARTICIPATING PAYER / ERA 		58379 No
Sinclair Health Plan
PARTICIPATING PAYER / CLAIMS 		84076 No
Smith Premier Solutions
NON-PARTICIPATING PAYER / ERA 		58379 No
Solstice Benefits, Inc.
PARTICIPATING PAYER / CLAIMS 		76578 No
South Carolina BCBS
NON-PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Detailed Benefits 		38520 No
South Central Preferred - PPO York, PA (I H S Gateway Payer)
PARTICIPATING PAYER / CLAIMS 		23266 No
South Dakota Medicaid
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY, CLAIMS
CLAIMS: Yes/No Response
CLAIMS: South Dakota's Meddicaid contractor is South Dekota Delta 		CKSD1 No
South FL Community Care Network - NBHD
PARTICIPATING PAYER / CLAIMS 		37314 No
South Point Hotel & Casino
PARTICIPATING PAYER / CLAIMS 		35227 No
Southern Benefits Administration Inc
NON-PARTICIPATING PAYER / ERA, EFT 		38242 No
Southern Indiana Health Organization (SIHO)
PARTICIPATING PAYER / CLAIMS 		77153 No
Southwest Service Administrators
PARTICIPATING PAYER / CLAIMS 		CX100 No
Southwestern Bell
PARTICIPATING PAYER / CLAIMS 		68241 No
Southwestern Bell Exec
PARTICIPATING PAYER / CLAIMS 		68241 No
Southwestern Bell Exec. - Custom Care
PARTICIPATING PAYER / CLAIMS 		68241 No
Southwestern Bell Exec. - Southwestern Bell
PARTICIPATING PAYER / CLAIMS 		68241 No
Spectrum Admin.
PARTICIPATING PAYER / CLAIMS 		23253 No
Standard Ins. Co. (OR Business)
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Yes/No Response 		93024 No
Standard Insurance Company (NY)
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Yes/No Response 		13411 No
Standard Life & Accident Insurance
NON-PARTICIPATING PAYER / ERA 		58379 No
Star Health
PARTICIPATING PAYER / CLAIMS 		CX090 No
StarDent
PARTICIPATING PAYER / CLAIMS 		CX090 No
Starmark
NON-PARTICIPATING PAYER / ERA 		58379 No
State of Nevada Public Employees Benefit Program
NON-PARTICIPATING PAYER / ERA 		58379 No
State of Texas Dental Plan
PARTICIPATING PAYER / CLAIMS 		73288 No
Stoner and Associates (Cincinnati, OH)
PARTICIPATING PAYER / CLAIMS 		31121 No
Summit America Insurance Services
PARTICIPATING PAYER / CLAIMS 		37301 No
Sun Life and Health Insurance Company
PARTICIPATING PAYER / CLAIMS, ERA 		67814 No
Sunz Insurance Company
NON-PARTICIPATING PAYER / ERA 		58379 No
Superior Dental Care
PARTICIPATING PAYER / CLAIMS 		31117 No
SuperiorSTAR Pregnant Women
PARTICIPATING PAYER / CLAIMS 		CPPSW No
Supplemental Coverage
PARTICIPATING PAYER / CLAIMS 		ASHC1 No
Surency Life and Health
PARTICIPATING PAYER / CLAIMS, ERA 		CX088 No
TDC
PARTICIPATING PAYER / CLAIMS 		73288 No
TPAC/Employee Benefit Management Corp
PARTICIPATING PAYER / CLAIMS 		CX025 No
TR Paul, Inc.
PARTICIPATING PAYER / CLAIMS 		37230 No
TRICARE Dental Program
PARTICIPATING PAYER / CLAIMS 		89070 No
TRISTAR
NON-PARTICIPATING PAYER / ERA 		58379 No
Tall Tree Administrators
PARTICIPATING PAYER / CLAIMS 		88067 No
Tall Tree Administrators
NON-PARTICIPATING PAYER / ERA 		58379 No
Tennessee Medicaid
NON-PARTICIPATING PAYER / ELIGIBILITY INQUIRY 		CKTN1 No
The Dental Companies
PARTICIPATING PAYER / CLAIMS 		73288 No
The Dental Concern
PARTICIPATING PAYER / CLAIMS 		73288 No
The Dental Shop
NON-PARTICIPATING PAYER / EFT 		DSHOP No
The Hartford
NON-PARTICIPATING PAYER / ERA 		58379 No
The Humboldt-DelNorte
PARTICIPATING PAYER / CLAIMS 		CRIHB No
The Loomis Company - TPA Wyomissing, PA (IHS Gateway Payer)
PARTICIPATING PAYER / CLAIMS 		23223 No
The Physicians Assurance Corp (TPAC) /Employee Benefit Management Corp (EBMC)
PARTICIPATING PAYER / CLAIMS 		CX025 No
The health Plan of the Upper Ohio Valley
PARTICIPATING PAYER / CLAIMS 		34150 No
Three Rivers Benefit Corporation
NON-PARTICIPATING PAYER / ERA 		58379 No
Total Dental Administrators
PARTICIPATING PAYER / CLAIMS, ERA 		CX112 No
Total Senior Care - OLEAN
PARTICIPATING PAYER / CLAIMS 		12268 No
TransChoice - Key Benefit Administrators
NON-PARTICIPATING PAYER / ERA, EFT 		37284 No
Tri-Counties Welfare Trust Fund
PARTICIPATING PAYER / CLAIMS 		CHSWT No
TriState Benefit Solutions
PARTICIPATING PAYER / CLAIMS 		31144 No
Trigon Blue Cross Blue Shield - Colorado Dental Office
PARTICIPATING PAYER / CLAIMS, ERA 		84103 No
Trigon VA - BCBS (Dental)
PARTICIPATING PAYER / CLAIMS, ERA 		CB923 No
Triple-S Medicaid Advantage
NON-PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY
ELIGIBILITY INQUIRY: Completing this enrollment request will enroll the provider(s) for 3 transactions – Electronic Claims (837D), Electric Remittance Advice (835) and Real Time Eligibility Inquiry and Response (270/271) with all 3 payers listed above. Please ensure you have 		PRADV No
Triple-S Salud
NON-PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY 		CBPR1 No
TruAssure
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		ILDTA No
Trusteed Plans Service Corporation
PARTICIPATING PAYER / CLAIMS 		91078 No
Trustmark Insurance Company
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: Yes/No Response 		61425 No
Trustmark Life Insurance Co
NON-PARTICIPATING PAYER / ERA 		58379 No
Trustmark insurance Company
NON-PARTICIPATING PAYER / ERA 		58379 No
U. S. Virgin Island Medicaid
NON-PARTICIPATING PAYER / CLAIMS 		CUSVI No
UFCW Local 655
PARTICIPATING PAYER / CLAIMS 		CX111 No
UFCW National Fund
NON-PARTICIPATING PAYER / ERA 		58379 No
UMR - Cincinnati
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: f.k.a. United Medical Resources
ELIGIBILITY INQUIRY: Detailed Benefits 		33108 No
UMR - Harrington
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: f.k.a. Harrington Benefit Services (Westerville)
ELIGIBILITY INQUIRY: Detailed Benefits 		75196 No
UMR - Harrington
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: f.k.a. Harrington Benefit Services (Columbus)
ELIGIBILITY INQUIRY: Detailed Benefits 		95266 No
UMR - Lexington
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: f.k.a. Commonwealth Administrative Group
ELIGIBILITY INQUIRY: Detailed Benefits 		37237 No
UMR - Onalaska
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: f.k.a. Midwest Security of WI
ELIGIBILITY INQUIRY: Detailed Benefits 		79480 No
UMR - San Antonio
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ELIGIBILITY INQUIRY: f.k.a. Benefit Planners Inc., UICI Administrators - State of Nevada
ELIGIBILITY INQUIRY: Detailed Benefits 		74223 No
UMR - Wausau/UHIS
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY, ATTACHMENTS
ELIGIBILITY INQUIRY: f.k.a. Fiserv Health - Wausau Benefits/Benesight, Employers Insurance of Wisconsin
ELIGIBILITY INQUIRY: Detailed Benefits 		39026 No
UMWA Health & Retirement Funds
PARTICIPATING PAYER / CLAIMS, ERA 		52180 No
UNICARE
PARTICIPATING PAYER / CLAIMS, ERA 		80314 No
UPMC Health Plan
PARTICIPATING PAYER / CLAIMS, ERA 		23281 No
US Benefits Inc.
PARTICIPATING PAYER / CLAIMS 		93092 No
US Life Ins. Co.
PARTICIPATING PAYER / CLAIMS 		70106 No
USAA
NON-PARTICIPATING PAYER / ERA 		58379 No
UltraBenefits, Inc.
PARTICIPATING PAYER / CLAIMS 		41206 No
Unified Group Services
PARTICIPATING PAYER / CLAIMS 		35198 No
Uniform Medical Plan
PARTICIPATING PAYER / CLAIMS 		75243 No
Union Security Insurance Company
PARTICIPATING PAYER / CLAIMS 		70408 No
United Concordia - Dental Plus
NON-PARTICIPATING PAYER / CLAIMS, ERA, REAL TIME CLAIMS, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ERA: Administered by United Concordia
ELIGIBILITY INQUIRY: Detailed Benefits 		CX013 No
United Concordia - Fee for Service
NON-PARTICIPATING PAYER / CLAIMS, ERA, REAL TIME CLAIMS, ELIGIBILITY INQUIRY, CLAIM STATUS INQUIRY
ERA: Administered by United Concordia
ELIGIBILITY INQUIRY: Detailed Benefits 		CX007 No
United Food & Comm Workers union & Employers Midwest Health Benefit Funds
PARTICIPATING PAYER / CLAIMS 		36659 No
United HealthCare Insurance Company - Student Insurance
PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, ATTACHMENTS 		74227 No
United Healthcare of River Valley
PARTICIPATING PAYER / CLAIMS, ELIGIBILITY INQUIRY, ATTACHMENTS
ELIGIBILITY INQUIRY: A United Healthcare Payer
ELIGIBILITY INQUIRY: Yes/No Response 		95378 No
United States Life Insurance Company
PARTICIPATING PAYER / CLAIMS 		13545 No
United of Omaha
PARTICIPATING PAYER / CLAIMS, ERA 		71412 No
UnitedHealthcare Dental
NON-PARTICIPATING PAYER / CLAIMS, ERA, ELIGIBILITY INQUIRY, ATTACHMENTS 		52133 No
Unity Health Insurance Corp
PARTICIPATING PAYER / CLAIMS 		66705 No
University of Missouri
PARTICIPATING PAYER / CLAIMS, ERA
ERA: Formerly payer ID 87043. Now part of Coventry Consolidated payer ID.
ERA: Payer RA will be turned off within 30 days of enrollment; PDFs are available through Coventry's provider portal www.directprovider.com 		25133 No
Upper Peninsula Health Group (TPA)
PARTICIPATING PAYER / CLAIMS 		37324 No
VA Fee Basis Programs
PARTICIPATING PAYER / CLAIMS, ERA 		12116 No
Valir PACE
PARTICIPATING PAYER / CLAIMS 		64009 No
Valley Baptist Health Plan
PARTICIPATING PAYER / CLAIMS 		89070 No
Vantage Health Plan
PARTICIPATING PAYER / CLAIMS 		72128 No
Varian Health Care Plan
PARTICIPATING PAYER / CLAIMS 		68241 No
Venetian
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Verity National Group
PARTICIPATING PAYER / CLAIMS 		75256 No
Via Christi HOPE
PARTICIPATING PAYER / CLAIMS 		48123 No
VieCare - LIFE Armstrong
PARTICIPATING PAYER / CLAIMS 		25922 No
VieCare - LIFE Butler
PARTICIPATING PAYER / CLAIMS 		25293 No
VieCare Life Beaver and Life Lawrence Counties
PARTICIPATING PAYER / CLAIMS 		25924 No
Voluntary Benefits Plan
PARTICIPATING PAYER / CLAIMS 		70106 No
Volusia Health Network
PARTICIPATING PAYER / CLAIMS, EFT 		59266 No
W.C. Earhart Company
NON-PARTICIPATING PAYER / ERA 		58379 No
WI - BCBS (Dental)
PARTICIPATING PAYER / CLAIMS, ERA 		CB950 No
Wabash Memorial Hospital Association
NON-PARTICIPATING PAYER / ERA 		58379 No
Washington State Council of County & City Employees (WSCCCE)
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		91136 No
Waterstone Benefit Administrators (Oklahoma Providers)
PARTICIPATING PAYER / CLAIMS 		73155 No
Web TPA, Inc of TX
PARTICIPATING PAYER / CLAIMS, ERA 		59332 No
WellPoint
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Wellcare
PARTICIPATING PAYER / CLAIMS, ATTACHMENTS 		CX083 No
Wellnet Healthcare Administrators
NON-PARTICIPATING PAYER / ERA 		58379 No
Wells Fargo TPA, Inc (Charleston, WV)
PARTICIPATING PAYER / CLAIMS, ERA 		87815 No
Wells Fargo TPA, Inc. (Newnan, GA and Fayetteville, NC)
PARTICIPATING PAYER / CLAIMS, ERA, EFT 		37272 No
WestLake Financial Group, Inc. (Buffalo Grove, IL)
PARTICIPATING PAYER / CLAIMS 		90560 No
Western Grower's Assurance Trust
PARTICIPATING PAYER / CLAIMS 		24735 No
Western Grower's Insurance Company
PARTICIPATING PAYER / CLAIMS 		24735 No
Wichita and Affiliated Tribes
PARTICIPATING PAYER / CLAIMS 		19191 No
Willamette Valley
PARTICIPATING PAYER / CLAIMS 		CXWVC No
William C. Earhart
PARTICIPATING PAYER / CLAIMS 		93050 No
WilsonMcShane
NON-PARTICIPATING PAYER / CLAIMS, ERA 		R7002 No
Wisconsin Medicare Advantage
NON-PARTICIPATING PAYER / CLAIMS, ERA 		WIMAN No
Worksite Benefit Services, LLC
PARTICIPATING PAYER / CLAIMS 		20333 No
Zenith Administrators
NON-PARTICIPATING PAYER / CLAIMS 		R7001 No
fidelity / Key Select
PARTICIPATING PAYER / CLAIMS 		37321 No
iCircle Care of NY
PARTICIPATING PAYER / CLAIMS 		33884 No
nHealth
NON-PARTICIPATING PAYER / ERA 		58379 No