|
FLPAC
|
Florida Pace Centers Inc
|
N
|
NP
|
|
M/H
|
N
|
N
|
N
|
N
|
|
|
46891
|
UCS: Benefit Plan Administrators of Eau Claire, Inc.
|
N
|
P
|
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
OMNIA
|
OMNI Administrators
|
N
|
NP
|
|
M
|
N
|
N
|
N
|
N
|
|
|
27215
|
Kentucky Health Administrators, Inc.
|
N
|
NP
|
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
LNY01
|
Longevity NY
|
N
|
NP
|
NY
|
M/H
|
N
|
N
|
N
|
N
|
|
|
82275
|
Mutual of Omaha Medicare Advantage
|
N
|
NP
|
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-enrollment required for Electronic Remittance Advice.
|
|
OSFC9
|
OSF Healthcare Central
|
N
|
NP
|
|
M/H
|
N
|
N
|
N
|
N
|
|
|
OSFE9
|
OSF Healthcare East
|
N
|
NP
|
|
M/H
|
N
|
N
|
N
|
N
|
|
|
31401
|
Provider Partners Health Plan of Illinois
|
N
|
NP
|
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
VAP03
|
TriWest Healthcare Alliance PC3 (VAPCCC Regions 1-6)
|
Y
|
NP
|
|
M/H
|
N
|
N
|
Y
|
Y
|
Formerly VAPCCC Region 3. Customer Service: (855) 722-2838 option 3, 3. EDI enrollment form under Payer Enrollment Forms - All or Multiple States.
|
|
45282
|
University of Maryland Health Advantage
|
N
|
NP
|
|
M/H
|
N
|
N
|
N
|
N
|
|
|
25923
|
VieCare LIFE Butler
|
N
|
NP
|
|
M/H
|
N
|
N
|
Y
|
N
|
|
|
13162
|
1199 National Benefit Fund
|
N
|
P
|
|
M/H
|
N
|
N
|
Y
|
Y
|
IVR: (888) 819-1199. Customer Service: (646) 473-7160. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
59069
|
21st Century Health and Benefits
|
N
|
P
|
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
39081
|
3P Admin
|
N
|
NP
|
|
M/H
|
N
|
N
|
N
|
N
|
|
|
4YC01
|
4 YourChoice EPO/PPO Network
|
N
|
P
|
|
M/H
|
N
|
N
|
Y
|
Y
|
Payer returns ERA's automatically once electronic claim submission begins.
|
|
20446
|
6 Degrees Health, Inc.
|
N
|
P
|
|
M/H
|
N
|
N
|
N
|
N
|
|
|
74234
|
8th District Elec
|
N
|
P
|
UT
|
M
|
N
|
N
|
N
|
Y
|
Customer Service: (800) 628-6562
|
|
93044
|
A & I Benefit Plan Administrators
|
N
|
NP
|
|
M/H
|
N
|
N
|
N
|
Y
|
Customer Service: (800) 547-4457
|
|
75240
|
AAG - American Administrative Group
|
N
|
P
|
|
M/H
|
N
|
N
|
N
|
Y
|
Formerly Icon Benefit Admin
|
|
75240
|
AAG Benefit Plan Administrators, Inc.
|
N
|
P
|
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
36273
|
AARP Hospital Indemnity Plans insured by UnitedHealthcare Insurance Company
|
N
|
NP
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (800) 227-7789. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
36273
|
AARP Medicare Supplement Plans insured by UnitedHealthcare Insurance Company
|
N
|
NP
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (800) 227-7789. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
87726
|
AARP MedicareComplete insured through UnitedHealthcare (formerly AARP MedicareComplete from SecureHorizons)
|
N
|
NP
|
|
M/H
|
N
|
N
|
N
|
Y
|
Customer Service: (866) 633-2446.
|
|
87726
|
AARP MedicareComplete insured through UnitedHealthcare / Oxford Medicare Network - AARP MedicareComplete
|
N
|
NP
|
|
M/H
|
N
|
N
|
N
|
Y
|
Customer Service: (866) 633-2446
|
|
87726
|
AARP MedicareComplete insured through UnitedHealthcare / Oxford Mosaic Network - AARP MedicareComplete Mosaic
|
N
|
NP
|
|
M/H
|
N
|
N
|
N
|
Y
|
Customer Service: (866) 633-2446
|
|
03443
|
ABRAZO Advantage Health Plan
|
N
|
P
|
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
68069
|
Absolute Total Care - Medical
|
N
|
NP
|
SC
|
M/H
|
N
|
N
|
Y
|
Y
|
Customer Service: (866) 595-8133.
ERA enrollment forms will be listed under Centene Corporation.
|
|
AHS01
|
Access Administrators
|
N
|
NP
|
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
COACC
|
Access Behavioral Care
|
N
|
P
|
CO
|
M
|
N
|
N
|
N
|
Y
|
Customer Service: (800) 511-5010
|
|
ACC01
|
Access IPA
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
Y
|
Y
|
Payer returns ERA's automatically once electronic claim submission begins.
|
|
AMM06
|
Access Medical Group
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
N
|
N
|
Dates of service prior to 9/1 go to AMM06. Dates of service after 9/1 need to be sent to PROSP.
|
|
NMM01
|
Access Primary Care Medical Group (APCMG)
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
Y
|
Y
|
Effective January 1, 2018. Customer Service: (626) 282-0288. Please contact ProviderNetworkOperations.Dept@nmm.cc for ERA enrollment requests.
|
|
AMM06
|
Access Santa Monica
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
N
|
N
|
Dates of service prior to 9/1 go to AMM06. Dates of service after 9/1 need to be sent to PROSP.
|
|
64071
|
Acclaim
|
N
|
P
|
|
M
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
IP095
|
Acclaim IPA
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
IP095
|
Acclaim IPA (MHCAC)
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
AHIPA
|
Accountable Healthcare IPA (AHCIPA)
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
N
|
Y
|
Effective 12/1/17, all Accountable Healthcare claims should be submitted to Payer ID AHIPA. Payer ID MPM23 and MPM24 have been discontinued.
|
|
72467
|
ACS Benefit Services, Inc.
|
N
|
NP
|
|
M
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
24585
|
ACTIN Care Groups / Clifton Health Systems
|
N
|
P
|
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
75678
|
Active Care (UCS)
|
N
|
P
|
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
AHC01
|
ActivHealthCare
|
N
|
P
|
|
M
|
N
|
N
|
N
|
N
|
Customer Service: (888) 635-0459
|
|
38254
|
Activia Benefit Services
|
N
|
P
|
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment required for Electronic Remittance Advice.
|
|
38265
|
Administration Systems Research Corp
|
N
|
NP
|
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
38265
|
Administration Systems Research Health Benefits
|
N
|
NP
|
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
22384
|
Administrative Concepts Inc.
|
N
|
NP
|
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment required for Electronic Remittance Advice.
|
|
59141
|
Administrative Services Inc
|
N
|
P
|
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
37278
|
AdminOne
|
N
|
P
|
|
M/H
|
N
|
N
|
Y
|
N
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
WOAHM
|
Advanced Health CCO - Mental Health Claims Only (previously WOAH-Western Oregon Advanced Health CCO)
|
N
|
P
|
OR
|
M/H
|
N
|
N
|
Y
|
Y
|
Administered by PH Tech. Name change went into effect 3/1/18. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
AMDC1
|
Advanced Medical Doctors of CA
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
N
|
Y
|
Customer Service: (626) 943-7465
|
|
NMM01
|
Advanced Physicians IPA
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
Y
|
Y
|
Customer Service: (626) 282-0288. Please contact ProviderNetworkOperations.Dept@nmm.cc for ERA enrollment requests.
|
|
74234
|
Advanstaff, Inc.
|
N
|
P
|
|
M
|
N
|
N
|
N
|
N
|
|
|
ACIPA
|
Advantage Care IPA
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
N
|
Y
|
Customer Service: (626) 388-2300
|
|
35209
|
Advantage Health Solutions
|
N
|
P
|
|
M/H
|
N
|
N
|
N
|
N
|
|
|
35219
|
Advantage Health Solutions (CMCS) - Medicare Advantage
|
N
|
P
|
|
M/H
|
N
|
N
|
N
|
N
|
|
|
NMM01
|
Advantage Medical Group
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
Y
|
Y
|
Customer Service: (626) 282-0288. Please contact ProviderNetworkOperations.Dept@nmm.cc for ERA enrollment requests.
|
|
77070
|
Advantage Preferred Plus
|
N
|
P
|
|
M/H
|
N
|
N
|
N
|
N
|
|
|
ADVTK
|
Advantek Benefit Administrators (SANTE)
|
N
|
P
|
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
59374
|
Advantica Benefits
|
N
|
NP
|
|
M
|
N
|
N
|
N
|
Y
|
|
|
MPM36
|
Adventist Health Hanford AHP
|
N
|
P
|
CA
|
H
|
N
|
N
|
N
|
Y
|
Effective February 1, 2018.
|
|
MPM37
|
Adventist Health Plan
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
N
|
Y
|
Effective February 1, 2018.
|
|
95340
|
Adventist Health System West
|
N
|
NP
|
CA
|
M/H
|
N
|
N
|
N
|
Y
|
Roseville, California.
|
|
MPM33
|
Adventist White Memorial - Crown City Medical Group
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
N
|
Y
|
Effective January 1, 2018.
|
|
MPM34
|
Adventist White Memorial - Southland San Gabriel Valley
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
N
|
Y
|
Effective January 1, 2018.
|
|
36320
|
Advocate Health Centers
|
N
|
P
|
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
65093
|
Advocate Health Partners
|
N
|
NP
|
IL
|
M/H
|
N
|
N
|
N
|
Y
|
|
|
60054
|
Aetna Advantage
|
N
|
P
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (888) 632-3862. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
60054
|
Aetna Affordable Health Choices - SRC/Boone
|
N
|
P
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (888) 632-3862. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
66917
|
Aetna Better Health - Parkland (TX)
|
N
|
P
|
TX
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
128CA
|
Aetna Better Health of California
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
128FL
|
Aetna Better Health of Florida
|
N
|
P
|
FL
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
26337
|
Aetna Better Health of Illinois (Medicaid)
|
N
|
P
|
IL
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
128KS
|
Aetna Better Health of Kansas
|
N
|
P
|
KS
|
M/H
|
N
|
N
|
N
|
Y
|
Effective January 1, 2019
|
|
128KY
|
Aetna Better Health of Kentucky
|
N
|
P
|
KY
|
M/H
|
N
|
N
|
Y
|
Y
|
Formerly CoventryCares of Kentucky (25133). Pre-Enrollment is required for Electronic Remittance Advice.
|
|
128LA
|
Aetna Better Health of Louisiana
|
N
|
P
|
LA
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
128MD
|
Aetna Better Health of Maryland
|
N
|
P
|
MD
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
128MI
|
Aetna Better Health of Michigan
|
N
|
P
|
MI
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
46320
|
Aetna Better Health of New Jersey
|
N
|
P
|
NJ
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
34734
|
Aetna Better Health of New York
|
N
|
P
|
NY
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
50023
|
Aetna Better Health of Ohio
|
N
|
P
|
OH
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
23228
|
Aetna Better Health of Pennsylvania (Medicaid)
|
N
|
P
|
PA
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
38692
|
Aetna Better Health of Texas
|
N
|
P
|
TX
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
128VA
|
Aetna Better Health of Virginia
|
N
|
P
|
VA
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
128VA
|
Aetna Better Health of Virginia - CCC Plus
|
N
|
P
|
VA
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
128WV
|
Aetna Better Health of West Virginia
|
N
|
P
|
WV
|
M/H
|
N
|
N
|
Y
|
Y
|
Formerly known as Coventry Healthcare of West Virginia (25133). Pre-Enrollment required for Electronic Remittance Advice.
|
|
60054
|
Aetna Choice Plans
|
N
|
P
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (888) 632-3862. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
60054
|
Aetna Health, Inc.
|
N
|
P
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (888) 632-3862. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
60054
|
Aetna Healthcare
|
N
|
P
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (888) 632-3862. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
60054
|
Aetna HealthFund
|
N
|
P
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (888) 632-3862. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
26337
|
Aetna Illinois Medicaid
|
N
|
P
|
IL
|
M/H
|
N
|
N
|
Y
|
Y
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
60054
|
Aetna Life & Casualty Company
|
N
|
P
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (888) 632-3862. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
60054
|
Aetna Life Insurance Company
|
N
|
P
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (888) 632-3862. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
60054
|
Aetna Medicaid Plans
|
N
|
P
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (888) 632-3862. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
60054
|
Aetna Medicare
|
N
|
P
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (888) 632-3862. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
60054
|
Aetna Senior Plans
|
N
|
P
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (888) 632-3862. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
60054
|
Aetna Signature Administrators (ASA)
|
N
|
P
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (888) 632-3862. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
60054
|
Aetna Student Health
|
N
|
P
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (888) 632-3862. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
38692
|
Aetna TX Medicaid and CHIP
|
N
|
P
|
TX
|
M/H
|
N
|
N
|
Y
|
N
|
Pre-Enrollment is required for Electronic Remittance Advice.
|
|
60054
|
Aetna US Healthcare - AUSHC
|
N
|
P
|
|
M/H
|
Y
|
Y
|
Y
|
Y
|
Customer Service: (888) 632-3862. Pre-Enrollment is required for Electronic Remittance Advice.
|
|
ADOCS
|
Affiliated Doctor's of Orange County (ADOC) (Regal)
|
N
|
P
|
CA
|
M/H
|
N
|
N
|
N
|
N
|
|