All Available Payers with Office Ally Payer List

Office Ally may, at its sole option, add or remove Payers to the Services at any time. Office ally will use commercially reasonable efforts to provide Customer with written notice of such removals.
NOTICE: The Payer List page is currently unavailable due to scheduled maintanance
Payer Name
Payer ID
Transaction
Available
Non Par
Enrollment
NOTES
The Cheesecake Factory - CORVEL
Payer ID
J2181
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
The Health Plan
Payer ID
HPOUV
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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St. Clairsville and Massillon, Ohio / Morgantown and Charleston, West Virginia.
The Health Plan of Upper Ohio Valley
Payer ID
HPOUV
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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St. Clairsville and Massillon, Ohio.
The Health Plan of West Virginia (Medicaid)
Payer ID
HPOUV
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Morgantown and Charleston, West Virginia.
The Loomis Company
Payer ID
23223
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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The Macaluso Group
Payer ID
82694
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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The Mohegan Tribe of Indians of Connecticut
Payer ID
MOHEG
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
Therapy Direct Network
Payer ID
J1831
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
The Vitamin Shoppe - CORVEL
Payer ID
J3337
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
The Zenith - YMCA San Diego
Payer ID
J3922
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
THREE
Payer ID
J3769
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
Thrivent Financial
Payer ID
THRIV
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Thrivent Financial Aid Association for Lutheran Medicare
Payer ID
30167
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Thrivent Financial Lutheran Brotherhood Medicare
Payer ID
30166
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Tiffany & Co - CORVEL
Payer ID
J3736
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
TLC Benefit Solutions
Payer ID
TLC79
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Toll Brothers - CORVEL
Payer ID
J3746
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
Tooling and Manufacturing Assocation
Payer ID
61425
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Torrance Hospital IPA (THIPA)
Payer ID
TMIPA
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
Torrance Memorial Medical Center
Payer ID
TMMC1
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
Total Plan Concepts
Payer ID
80900
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Total Plan Services
Payer ID
41202
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Tower Insurance Company Of New York
Payer ID
J3961
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
Transamerica
Payer ID
TRP1E
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Transamerica Life Insurance
Payer ID
TLINS
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Triad Group LLC
Payer ID
J4229
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
Triangle Insurance
Payer ID
J1996
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
Tribute Health Plan of Oklahoma
Payer ID
31125
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Tricare East PGBA
Payer ID
99727
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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TriCare for Life
Payer ID
TDDIR
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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EDI enrollment form under Payer Enrollment Forms - All or Multiple States.
Tricare Overseas
Payer ID
FOREN
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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EDI enrollment form under Payer Enrollment Forms - All or Multiple States.
Tricare West
Payer ID
99726
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Coverage: AK, AZ, CA, CO, HI, ID, IA (Except for the Rock Island Arsenal Area), KS, MN, MO, MT NE, NV, NM, ND, OR, SD, West TX, UT, WA.
TriCities IPA
Payer ID
PDT01
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Form can be found under "Physicians Data Trust".
Tri-County Schools Insurance Group JPA
Payer ID
J3879
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
TriHealth Physician Solutions
Payer ID
31144
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Trillium Community Health Plans
Payer ID
68069
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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ERA enrollment forms will be listed under Centene Corporation.
Trillium Health Resources
Payer ID
56089
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Triple-S Advantage
Payer ID
973MA
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Triple-S Salud
Payer ID
SB980
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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TriStar (formerly Select Benefit Administrators)
Payer ID
42137
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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TriState Benefit Solutions
Payer ID
31144
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Tri-Valley Medical Group
Payer ID
20538
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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TriWest Healthcare Alliance
Payer ID
VAC45
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Region 4 & 5 States: American Samoa, Arizona, California, Colorado, Guam, Hawaii, Idaho, Montana, New Mexico, Nevada, Northern Mariana Islands, Oregon, Texas, Utah, Washington, Wyoming
TRU Community Care
Payer ID
TRUCO
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
Truli for Health
Payer ID
TRULI
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Trusteed Plans Service Corporation
Payer ID
91078
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Trustmark Insurance Company
Payer ID
61425
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Tufts Health Plan
Payer ID
04298
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Providers must email Tufts at edi_operations@tufts-health.com prior to electronic claims submission to verify Provider ID/NPI.
Tufts Health Public Plan (Network Health)
Payer ID
04332
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Twin City Fire Insurance Co.
Payer ID
C1040
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
Tyson Foods Inc.
Payer ID
J1732
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
UCare Individual & Family Plans (DOS on or After 1/1/2019)
Payer ID
55413
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UCare Minnesota
Payer ID
52629
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Enrollment is completed under 55413
UC Davis Health System
Payer ID
UCDMG
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins (via Office Ally ONLY). No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
UC Irvine Health (MemorialCare)
Payer ID
MMFUC
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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The ERA enrollment form will be listed under "MemorialCare".
UCLA Medical Group
Payer ID
USMBP
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. Note: Payer does not return 835s for claims submitted by paper.
UCSD Managed Care
Payer ID
UCSDH
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
UDR, Inc. - CORVEL
Payer ID
J3741
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
UFCW Northern California &Drug Employers H & W Trust Fund
Payer ID
BS001
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UHA Health Insurance
Payer ID
UHA01
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UHC Medicare Advantage
Payer ID
12X42
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Find the ERA Instructions under 'Banner University Care LTC' in the enrollment form library.
Ultimate Health Plans
Payer ID
77022
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Ultra Benefits Inc.
Payer ID
41206
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UMR (formerly UMR Wausau)
Payer ID
39026
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Former Payer IDs: 31107, 33108, 37237, 74214, 74223, 75196, and 75243.
Umwa Health & Retirement Funds
Payer ID
52180
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Underwriters Safety and Claims
Payer ID
TP108
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
Unicare
Payer ID
80314
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Unified Group Services
Payer ID
35198
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Uniform Medical Plan
Payer ID
00932
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Union Construction Workers' Comp Program
Payer ID
J1629
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
Union Hill Independent School District
Payer ID
J4731
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
Union Insurance Company of Providence
Payer ID
25844
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
Union Pacific Railroad
Payer ID
87042
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Enrollment form listed under Iron Road Healthcare
United American Insurance Company
Payer ID
92916
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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United Care Medical Group (UCMG) (Regal)
Payer ID
PROSP
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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United Concordia Companies, Inc.
Payer ID
89070
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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United Concordia - Dental Plus - PA Blue Shield
Payer ID
89070
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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United Concordia (Encounters)
Payer ID
89070
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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United Concordia - Tricare Dental Plan
Payer ID
89070
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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United Dominion Realty Trust
Payer ID
J1048
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Payer returns ERAs automatically once electronic claim submission begins. No payer Enrollment is required, but ensure you have an active ERA Delivery Change Form on file to retrieve ERA files.
UnitedHealthcare / All Savers Alternate Funding
Payer ID
81400
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UnitedHealthcare / All Savers Insurance
Payer ID
81400
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UnitedHealthcare Community Plan / AZ (formerly Arizona Physicians IPA and APIPA)
Payer ID
03432
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UnitedHealthcare Community Plan / CA, CO, DC, DE, FL, GA, HI, IN, KY, LA, MA, MD, NC, NM, OH, OK, PA, RI, VA, WA (formerly AmeriChoice or Unison)
Payer ID
04567
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Former Payer IDs: 25175, 86003, and 86049. Claims are submitted to 87726, and ERA enrollment completed under 04567.
UnitedHealthcare Community Plan / IA, hawk-i (formerly AmeriChoice of Iowa)
Payer ID
87726
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UnitedHealthcare Community Plan / KS (KanCare)
Payer ID
96385
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UnitedHealthcare Community Plan / MI (formerly Great Lakes Health Plan)
Payer ID
95467
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UnitedHealthcare Community Plan / MS (formerly AmeriChoice MS - CHIP)
Payer ID
87726
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UnitedHealthcare Community Plan / NE (formerly Americhoice NE, ShareAdvantage, and UnitedHealthcare of the Midlands)
Payer ID
87726
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UnitedHealthcare Community Plan / NJ (formerly AmeriChoice NJ Medicaid, NJ Family Care, NJ Personal Care Plus)
Payer ID
86047
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UnitedHealthcare Community Plan / NY (formerly AmeriChoice by UnitedHealthcare, AmeriChoice NY Medicaid & Child Health Plus, AmeriChoice NY Personal Care Plus)
Payer ID
87726
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UnitedHealthcare Community Plan of Missouri
Payer ID
86050
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Plan effective 5/1/17.
UnitedHealthcare Community Plan / SC (formerly Unison)
Payer ID
87726
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UnitedHealthcare Community Plan / TN (formerly AmeriChoice TN: TennCare, Secure Plus Complete)
Payer ID
95378
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UnitedHealthcare Community Plan / UnitedHealthcare Plan of the River Valley (formerly John Deere Healthcare)
Payer ID
87726
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UnitedHealthcare / MAHP - MD IPA, Optimum Choice and MLH (formerly MAMSI)
Payer ID
87726
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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UnitedHealthcare New Mexico Medicaid
Payer ID
04567
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Claims are submitted to 87748, and ERA enrollment completed under 04567
UnitedHealthcare Ohio Medicaid
Payer ID
88337
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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ERA Enrollment should be completed under Medicaid Ohio. If you are already approved to receive ERA for Medicaid of Ohio, you do not have to re-enroll.
UnitedHealthcare / Oxford
Payer ID
06111
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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EFT enrollment is required in order to activate ERAs. This payer also requires ERA enrollment in Payer ID 87726.
UnitedHealthcare Shared Services (UHSS)
Payer ID
39026
Payer ID
Transaction
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
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Former Payer IDs: 31107, 33108, 37237, 74214, 74223, 75196, and 75243.