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.
Payer Name
Payer ID
Transaction
Available
Non Par
Enrollment
NOTES
Concierge HMO IPA
Payer ID
CHHMO
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Payer returns ERAs automatically.
Concierge HMO IPA CHHMO 835
Conifer Health Solutions
Payer ID
CAPMN
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Conifer Health Solutions CAPMN 835
Connecticare - Medicare Advantage (Emblem)
Payer ID
78375
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
When enrolling for 78375 ERAs, you must also enroll under 25531, 13551, and 55247. Office Ally will handle 2016/2017 DOS based routing between Payer ID 78375 and 783PT.
Enrollment completed under 'Meritain Health' in ECHO.
Corporate Benefit Service (CBSA) 41124 835
Corvel
Payer ID
J4110
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Payer returns ERA automatically.
Corvel J4110 835
Covenant Administrators Inc.
Payer ID
58102
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Atlanta, GA.
Covenant Administrators Inc. 58102 835
Cox Health Plan
Payer ID
00019
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Cox Health Plan 00019 835
Custom Benefit Administrators
Payer ID
39081
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Custom Benefit Administrators 39081 835
Custom Design Benefits, Inc.
Payer ID
82056
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Custom Design Benefits, Inc. 82056 835
DHMN - Preferred IPA Hospital Risk
Payer ID
DHM02
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Automatic ERA enrollment upon electronic claim submission
DHMN - Preferred IPA Hospital Risk DHM02 835
DHMN Santa Cruz
Payer ID
DHM01
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Automatic ERA enrollment upon electronic claim submission
DHMN Santa Cruz DHM01 835
DMERC Region A Medicare
Payer ID
16003
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
EDI enrollment form under Payer Enrollment Forms - All or Multiple States. Coverage: CT, DE, District of Columbia, MA, ME, MD, NH, NJ, NY, PA, RI, and VT. Effective 6/30/16 (3pm EST), Jurisdiction A will transition from NGS to CGS (Contractor Code: 16013). Office Ally will handle all updates on the back end and no submitter action is required.
DMERC Region A Medicare 16003 835
DMERC Region B Medicare
Payer ID
17003
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
EDI enrollment form under Payer Enrollment Forms - All or Multiple States. Coverage: IL, IN, KY, MI, MN, OH, and WI. Effective 6/30/16 (3pm EST), Jurisdiction B will transition from NGS to CGS (Contractor Code: 17013). Office Ally will handle all updates on the back end and no submitter action is required.
DMERC Region B Medicare 17003 835
DMERC Region C Medicare
Payer ID
00885
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
EDI enrollment form under Payer Enrollment Forms - All or Multiple States. Coverage: AL, AR, CO, GA, FL, LA, MS, NC, NM, OK, SC, TN, TX, VA, WV, Puerto Rico, and US Virgin Islands. Contractor Code: 18003.
DMERC Region C Medicare 00885 835
DMERC Region D Medicare
Payer ID
05655
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
EDI enrollment form under Payer Enrollment Forms - All or Multiple States. Coverage: AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, and WY. Contractor Code: 19003.
DMERC Region D Medicare 05655 835
Dean Health Plan
Payer ID
39113
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Dean Health Plan 39113 835
Delano Regional Medical Group (Managed Care Systems)
Payer ID
MCS03
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Delano Regional Medical Group (Managed Care Systems) MCS03 835
Delaware First Health (Centene)
Payer ID
68069
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
ERA enrollment forms listed under Centene Corporation.
Delaware First Health (Centene) 68069 835
Delta Health Systems
Payer ID
DHS01
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Please Note: P5 Health Plan Solutions of Utah (87068) was taken over by Delta Health Systems and is no longer active. Providers should refer to the patient’s current healthcare ID card for the administrator of benefits and Payer ID.
Delta Health Systems DHS01 835
Department Rehabilitative Services - Oklahoma
Payer ID
71065
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Effective 1/1/18. Providers wishing to receive ERAs for this payer ID must enroll under UMR (39026)
Department Rehabilitative Services - Oklahoma 71065 835
Department of Corrections - Oklahoma
Payer ID
71065
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Effective 1/1/18. Providers wishing to receive ERAs for this payer ID must enroll under UMR (39026)
Department of Corrections - Oklahoma 71065 835
Department of Social and Health Services (DSHS)
Payer ID
MC006
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Department of Social and Health Services (DSHS) MC006 835
Deseret Mutual Benefit Administrators
Payer ID
SX105
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
A UHIN pass through few applies to this transaction.
Deseret Mutual Benefit Administrators SX105 835
Devoted Health
Payer ID
DEVOT
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Devoted Health DEVOT 835
Diamond Bar Medical Group
Payer ID
NMM01
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Diamond Bar Medical Group NMM01 835
Dignity Health - Mercy Medical Group / Woodland Clinic
Payer ID
PROH1
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Dignity Health - Mercy Medical Group / Woodland Clinic PROH1 835
Director's Guild of America - Producer Health Plans
Payer ID
BC001
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Director's Guild of America - Producer Health Plans BC001 835
District 9 Machinists Welfare Trust
Payer ID
MWELT
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
ERA only payer; Enrollment required.
District 9 Machinists Welfare Trust MWELT 835
Diversified Administration Corporation
Payer ID
06102
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Diversified Administration Corporation 06102 835
Diversified Group Brokerage
Payer ID
06102
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Diversified Group Brokerage 06102 835
Doctors Healthcare Plans
Payer ID
DRHCP
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Doctors Healthcare Plans DRHCP 835
Downey Select IPA
Payer ID
APP01
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Please use the enrollment form located under Optum Care Network.
Downey Select IPA APP01 835
Driscoll Childrens Health Plan
Payer ID
74284
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Driscoll Childrens Health Plan 74284 835
EMI Health
Payer ID
SX110
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
A UHIN pass through few applies to this transaction.
EMI Health SX110 835
ES Beveridge & Associates
Payer ID
34108
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
ES Beveridge & Associates 34108 835
ESIS Workers Comp
Payer ID
TP043
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Payer returns ERA automatically - no enrollment required.
ESIS Workers Comp TP043 835
East Bay Drainage Drivers Security Fund
Payer ID
DHS01
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
East Bay Drainage Drivers Security Fund DHS01 835
EastPointe Behavioral Health
Payer ID
08044
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Payer returns ERA's automatically once electronic claim submission begins.
EastPointe Behavioral Health 08044 835
Ebix Health Administration Exchange (EHAE)
Payer ID
55069
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Ebix Health Administration Exchange (EHAE) 55069 835
Edinger Medical Group
Payer ID
GNPMG
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
The ERA enrollment form will be listed under "MemorialCare".
Edinger Medical Group GNPMG 835
El Camino Health Alliance
Payer ID
ECL01
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Payer returns ERAs automatically.
El Camino Health Alliance ECL01 835
El Camino Health Medical Network
Payer ID
S9637
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Effective 9/1/2019 Previously known as San Jose Medical Group.
El Camino Health Medical Network S9637 835
El Paso First - CHIP
Payer ID
EPF03
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
El Paso First - CHIP EPF03 835
El Paso First Health Plans Premier Plan STAR Medicaid HMO
Payer ID
EPF02
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
El Paso First Health Plans Premier Plan STAR Medicaid HMO EPF02 835
ElderPlan, Inc.
Payer ID
31625
Payer ID
Transaction
All
Remits
835
Support
Available
Non Par
Non-participating payer
Enrollment
Enrollment required
View note
Hide note
View note
Hide note
Elderplan Provider ID is necessary on all claim submissions. If you do not know your provider ID, contact (718) 921-7979.