| New Payor |
Payor I.D. |
Payor Name |
Additional Enrollment Required |
9/10/2007
| TLU12
| 1199 National Benefit Fund
|
|
2/18/2010
| 59069
| 21st Century Health and Benefits
|
|
9/10/2007
|
20413
|
3P Admin
|
|
| 4/7/2004 |
CX044 |
A&I Benefits |
|
2/18/2010
| 75240
| AAG Benefit Plan Administrators, Inc.
|
|
2/18/2010
| 37283
| AAG-American Administrative Group Formerly Gallagher Ben
|
|
9/10/2007
|
AARP1
|
AARP Dental Insurance Plan
(Group # 1230 or 1231)
|
|
9/10/2007
|
PHP01
|
Abrazo Healthcare (Phoenix, AZ)
|
|
5/20/2005
|
AHP01
|
Abri Health Plan
|
|
9/10/2007
|
43178
|
Acceptius (Benefit Management
Inc of MO (BMI)
|
|
9/10/2007
|
AHS01
|
Access Administrators
|
Contact Payor to receive
provider I.D.
|
9/10/2007
|
TLU13
|
Accident Fund Insurance Company
of America
|
|
9/10/2007
|
64071
|
Acclaim
|
|
| 4/7/2004 |
87815 |
Accordia
National |
|
9/10/2007
|
61425
|
ACEC-Healthplan
|
|
9/10/2007
|
61473
|
ACS Benefit Solutions
|
|
|
72468 |
ACS Consulting Services, Inc. (PO Box 2000 Fort Valley, GA) |
|
|
38255 |
Activa Benefit Services, LLC (Grand Rapids, MI) |
|
9/10/2007
|
TLU14
|
ADENTA
|
|
9/10/2007
|
TLU87
|
Administration Services, Inc.
(ASI)
|
|
9/10/2007
|
TLU86
|
Administrative Concepts
|
|
2/18/2010
| CX076
| Adminstrative Services Only, Inc.
|
|
| 6/30/2003 |
93524 |
Advantage Dental Plan, Inc. |
|
9/10/2007
|
52133
|
Advantage Health Solutions
|
|
9/10/2007
|
60054
|
Adventis Risk Management, Inc.
(NAD Retirees)
|
|
9/10/2007
|
95340
|
Adventist Health
|
|
| 9/10/2007 |
TLX35
|
AEI (Administrative Enterprises
Inc) (AZ)
|
|
| 9/10/2007 |
57604
|
Aetna Affordable Health Choices
(SM) - SRC
|
|
|
68246 |
Aetna Healthcare Encounters (DMO)
|
|
|
60054 |
Aetna Life & Casualty Co. |
|
| 9/10/2007 |
TLW02
|
Affordable Benefit
Administrators, Inc.
|
|
|
58066 |
AFLAC - Georgia (1932 Wynnton Road, Columbus, GA 3199907251) |
|
2/18/2010
| 52080
| AFLAC - NY Plan
|
|
| 9/10/2007 |
91136
|
AGC-I.U.O.E Local 701 Trust Funds
|
|
|
80705 |
AH & L |
|
| 9/10/2007 |
TLW03
|
AHCP - American Healthcare
Partnership
|
|
| 9/10/2007 |
13545
|
AIG American General (US Life)
|
|
|
91136 |
Alaska Children's Services, Inc (Group #P68) |
|
2/7/2005
|
92600
|
Alaska Electric Health &
Welfare Fund
|
|
| 9/10/2007 |
91136
|
Alaska Hotel, Restaurant and Camp
|
|
|
91136 |
Alaska Laborers Construction Industry Trust (Group #F23) |
|
|
91136 |
Alaska Pipe Traders Local 375 (Group #F24) |
|
| 9/10/2007 |
91136
|
Alaska Plumbing and Pipefitting
Industry |
|
|
91136 |
Alaska United Food & Comm Workers Health & Welfare
Trust #F45 |
|
| 9/10/2007 |
TLU15
|
ALICARE
|
|
| 9/10/2007 |
TLU11
|
Allegiance Benefit Plan
Management
|
|
| 9/10/2007 |
ALMC1
|
Allen Lund Co
|
|
| inactive |
CX016 |
Allen Medical Claims Administrators |
|
| 4/7/2004 |
94177 |
Allied Administrators |
|
9/10/2007
|
TLX56 |
Allied Benefit Systems
|
|
|
69140 |
Allmerica Financial Services |
|
|
80705 |
ALTA Health & Life Insurance Company |
|
|
50503 |
Altus Dental (PO Box 1557, Providence, RI) |
|
2/18/2010
| STR01
| Always Care Benefits
|
|
9/10/2007
|
13343
|
Amalgamated Life - PA Alicare
|
|
| 11/13/2008 |
16120 |
America's TPA |
|
9/10/2007
|
75240
|
American Administrative Group,
Inc. (AAG)
|
|
| 11/13/2008 |
42112 |
American Administrators |
|
9/10/2007
|
TLU21
|
American Association of
Orthodontics (AAO-TPA)
|
|
9/10/2007
|
TLU24
|
American Benefit Plan
Administrators
|
|
|
E3750 |
American Bankers Life Assurance Co. |
|
6/25/2004
|
34187
|
American Benefits Management
(North Canton, Ohio)
|
|
9/10/2007
|
TLW04
|
American Community Mutual
Insurance Co
|
|
5/20/2005
|
ADP01
|
American Dental Payor of WI
|
|
| 9/10/2007 |
TAD01
|
American Dental
Professional Services
|
|
| 9/10/2007 |
TAD02
|
American Dental
Professional Services (Repriced Claims)
|
|
5/20/2005
|
AHG01
|
American Health Group
|
|
| 9/10/2007 |
TLU25
|
American Healthcare
|
|
9/10/2007
|
TLW75
|
American Heritage Life Insurance
Company
|
|
|
CX001 |
American Medical Security |
|
| 9/10/2007 |
74048
|
American National Insurance Co.
|
|
| 9/10/2007 |
TLU26
|
American Pioneer Life Insurance
|
|
|
44444 |
American Postal Workers Union Health Plan-APWU |
|
| 9/10/2007 |
TLX55
|
American Sentinel Insurance Inc
|
|
2/18/2010
| 86047
| Americhoice - New Jersey Medicaid
|
|
2/18/2010
| 86001
| Americhoice - New Jersey Medicare
|
|
2/18/2010
| 86048
| Americhoice - New York Medicaid
|
|
2/18/2010
| 86002
| Americhoice - New York Medicare
|
|
2/18/2010
| 86049
| Americhoice - Pennsylvania Medicaid
|
|
2/18/2010
| 86003
| Americhoice - Pennsylvania Medicare
|
|
2/18/2010
| CX014
| Amerigroup
|
|
2/18/2010
| CX014
| Amerihealth Mercy Health Plan
|
|
|
66667 |
Ameritas Bankers Assurance Co. |
|
|
66666 |
Ameritas Life Insurance Corp. |
|
9/10/2007
|
TLU23
|
Amierben Solutions (formerly IEC
Insurance)
|
|
| 9/10/2007 |
AML01
|
AMLICO - American Medical and
Life Insurance Company (Hicksville, NY)
|
|
|
38255 |
Amway Corporation |
|
| 9/10/2007 |
53085
|
Anchor Benefit Consulting, Inc.
|
|
| 9/10/2007 |
34192
|
Antares Management Solutions
|
|
|
H0098 |
Anthem - Blue Cross Blue Shield of Ohio (except FEP) |
|
2/18/2010
| 47198
| Anthem Blue Cross
|
|
2/18/2010
| CX014
| Anthem Blue Cross Blue Shield Partnership Plan 9-1-2006
|
|
|
80705 |
Anthem Health & Life Insurance Company of New Jersey |
|
|
16140 |
APA Partners of New York (for claims mailed to Latham, NY) |
|
| 9/10/2007 |
TLW68
|
APIPA (Arizona Physicians IPA) -
Claims ONLY
|
|
| 9/10/2007 |
TLX06
|
APIPA (Arizona Physicians IPA) -
Pre Determinations ONLY
|
|
| 9/10/2007 |
TLW65
|
Appalachian Benefit
Administrators
|
|
| 4/7/2004 |
75278 |
Arkansas Best Corporation - Choice Benefits |
|
| 9/10/2007 |
CX072
|
Ascent Benefits
|
|
| 9/10/2007 |
TLU87
|
ASEA / AFSCME Local 52
|
|
| 9/10/2007 |
TLU27
|
ASEA / AFSCME Local 52 Health
Benefit Trust
|
|
| 9/10/2007 |
TLU29
|
ASI
|
|
| 9/10/2007 |
TLU31
|
ASR
|
|
| 9/10/2007 |
TLU02
|
ASR Corporation
|
|
| 9/10/2007 |
TLU30
|
Associated Administrators
|
|
| 9/10/2007 |
TLU28
|
Associated Benefits
|
|
| 9/10/2007 |
70408
|
Assurant Employee Benefit -
Employee Claims
|
|
2/18/2010
| 39065
| Assurant Health
|
|
| 9/10/2007 |
TLW69
|
AssureCare, Inc. (IL)
|
|
| 9/10/2007 |
TLW70
|
AssureCare, Inc. (MI)
|
|
| 9/10/2007 |
TLW72
|
AssureCare, Inc. (MN)
|
|
| 9/10/2007 |
TLW71
|
AssureCare, Inc. (OH)
|
|
| 9/10/2007 |
95691
|
Athens Area Health Plan Select
|
|
| 9/10/2007 |
TLU32
|
Atlanta Plumbers & Steam
Fitters (Local 72)
|
|
2/7/2005
|
CX052
|
Atlantic Dental Inc
|
|
| 9/10/2007 |
TLU33
|
Atlas Administrators
|
|
| 9/10/2007 |
ATPA1
|
ATPA - Associated Third Party
Administrators
|
|
|
91136 |
Automotive Machinists Local 289 Health & Welfare Trust |
|
| 9/10/2007 |
86098
|
Avesis
|
|
9/10/2007
|
TLU34
|
Avesta Group Insurance
|
|
9/10/2007
|
TLU35
|
BAC
|
|
2/18/2010
| A2051
| BAC Local 15 Welfare Fund Kansas
|
|
| 6/30/2003 |
74227 |
Bankers United Life |
|
2/18/2010
| CX014
| BC Life CMSP 10-1-2005
|
|
6/25/2004
|
49153
|
BCI Administrators Inc
|
|
|
68241 |
Bell Atlantic |
|
2/18/2010
| 33192
| Bencomp National Corporation
|
|
|
23210 |
BeneCare Dental Plan (Chestnut St, Philadelphia, PA) |
|
| 9/10/2007 |
TLU36
|
Benefit Administration Services
|
|
| 9/10/2007 |
62121
|
Benefit Administrators, Inc.
(Erie, PA)
|
|
| 6/30/2003 |
25145 |
Benefit Coordinators Corporation |
|
| 9/10/2007 |
TLU37
|
Benefit Group (NE)
|
|
| R7003 | Benefit Inc. | |
| 9/10/2007 |
20018
|
Benefit Management Group
|
|
| 9/10/2007 |
TLW73
|
Benefit Management, Inc.
|
|
| 9/10/2007 |
TLU45
|
Benefit Management Services (BMS)
|
|
| 9/10/2007 |
TLU05
|
Benefit Management Services --
FEP CLAIMS (LA)
|
|
| 9/10/2007 |
TLU04
|
Benefit Management Services (LA)
|
|
| 9/10/2007 |
TLU38
|
Benefit Management Services (NC)
|
|
| 4/7/2004 |
39081 |
Benefit Plan Administrators Inc |
|
|
74223 |
Benefit Planners of Texas (for claims mailed to Boerne, TX) |
|
| 9/10/2007 |
TLU03
|
Benefit Services, Inc.
|
|
| 9/10/2007 |
TLU39
|
Benefit Source (MI)
|
|
| 9/10/2007 |
TLU40
|
Benefit Systems (IN)
|
|
|
36342 |
Benefit Systems & Services, Inc. (BSSI) |
|
5/20/2005
|
BMX01
|
Benemax
|
|
9/10/2007
|
87265
|
BeneSight
|
|
| 9/10/2007 |
37248
|
Benesys, Inc. (Lafayette, LA)
|
|
2/18/2010
| BNMK1
| BenMark Mississippi
|
|
| 6/30/2003 |
95604 |
Best Life & Health Insurance Company (For claims mailed
to Irvine, CA) |
|
2/7/2005
|
32006
|
Better Health Plans of South
Carolina
|
|
| 9/10/2007 |
CX025
|
Big Lots Associate Benefit Plan
(OH)
|
|
9/10/2007
|
TLU42
|
Blue Bell Benefit Trust
|
|
2/18/2010
| GWD01
| Blue Care Family Plan
|
|
2/18/2010
| TLY26
| Blue Cross Blue Shield of Arkansas - Blue Advantage
|
|
2/18/2010
| 00700
| Blue Cross Blue Shield of Connecticut - Blue Care Family Plan
|
|
| 11/13/2008 |
BBFL1 |
Blue Cross Blue Shield of Florida |
|
| 8/15/2003 |
H0143 |
Blue Cross Blue Shield of Georgia |
 |
|
CBMI1 |
Blue Cross Blue Shield of Michigan |
|
|
22099 |
Blue Cross Blue Shield of New Jersey |
|
| 9/10/2007 |
EXC02
|
Blue Cross Blue Shield of New
York (Central New York, Syracuse)
|
Call BCBS of NY for provider I.D. |
| 9/10/2007 |
CBNYR |
Blue Cross Blue Shield of New
York (Finger Lakes Region, Rochester, Utica/Watertown)
|
Call BCBS of NY for provider I.D.
|
2/18/2010
| 52133
| Blue Cross Blue Shield of North Carolina
|
|
|
H0098 |
Blue Cross Blue Shield of Ohio (Anthem) |
|
| 11/13/2008 |
BBOK1 |
Blue Cross Blue Shield of Oklahoma |
|
2/18/2010
| TLU43
| Blue Cross Blue Shield of Utah
|
|
| 9/10/2007 |
39141
|
Blue Cross and Blue Shield
United of Wisconsin (ONLY - PO Box 10888, Geen Bay, WI 54307)
|
Call BCBS for provider I.D. |
|
CBAL1 |
Blue Cross of Alabama |
|
|
47570 |
Blue Cross of Alaska |
|
|
CBAR1 |
Blue Cross of Arkansas |
Call UCCI @ 800-633-5430 for registration info. |
|
47198 |
Blue Cross of California (Wellpoint)
|
|
|
84099 |
Blue Cross of Colorado |
|
|
65358 |
Blue Cross of Connecticut (Anthem)
|
|
|
00700 |
Blue Cross of Connecticut Blue Care Family Plan |
|
|
53287 |
Blue Cross of Delaware |
|
|
CBID1 |
Blue Cross of Idaho |
|
|
BS018 |
Blue Cross of Illinois |
|
|
84105 |
Blue Cross of Indiana (Anthem)
|
|
|
CBIA1 |
Blue Cross of Iowa (FEP and Farm Bureau claims only) |
|
|
CBIA2 |
Blue Cross of Iowa (First Administrators and Wellmark) |
|
|
CBKS1 |
Blue Cross of Kansas |
|
|
84105 |
Blue Cross of Kentucky - Anthem (PO Box 37180, Louisville, KY) |
|
|
23738 |
Blue Cross of Louisiana |
Call BC of Louisiana @ 225-297-2758 for Provider I.D. |
|
CBMA1 |
Blue Cross of Massachusetts |
|
|
CBMA2 |
Blue Cross of Massachusetts PPO |
|
6/25/2004
|
CBNE1
|
Blue Cross of Nebraska
|
|
|
84101 |
Blue Cross of Nevada |
|
| 2/7/2005 |
CBNM1 |
Blue Cross of New Mexico (For claims mailed to Belleville, IL) |
|
|
CX004 |
Blue Cross of North Dakota (North Dakota Dental Services) |
|
|
66668 |
Blue Cross of Oregon |
|
|
53473 |
Blue Cross of Rhode Island |
|
|
CBTN1 |
Blue Cross of Tennessee |
|
|
84980 |
Blue Cross of Texas |
|
|
47570 |
Blue Cross of Washington (State) |
|
|
22226 |
Blue Cross of Wisconsin |
|
|
BLUEP |
Blue Plus (Delta Dental of Minnesota Medical Assistance) |
|
|
CBID2 |
Blue Shield of Idaho |
|
|
22223 |
Blue Shield of Pennsylvania |
Call UCCI @ 800-633-5430 for registration info. |
|
DPLUS |
Blue Shield of Pennsylvania Dental Plus |
Call UCCI @ 800-633-5430 for registration info. |
9/10/2007
|
TBT01
|
BlueCare Dental Traditional
|
|
|
36609 |
Boilermakers National Health & Welfare Fund of Kansas |
|
2/7/2005
|
74237
|
Boon-Chapman Benefit
Administrators
|
|
9/10/2007
|
14168
|
Boston Mutual Life Insurance -
Dental
|
|
| 9/10/2007 |
04210
|
Boston University Dental Health
Plan (Boston, MA)
|
|
|
CX028 |
Bridgeport LLC of Missouri (for claims mailed to St. Charles,
MO) |
|
|
CX032 |
Brokers National (other plans) |
|
|
CX031 |
Brokers National (plans Cavalier, Buccaneer, Brigadier,
Mansion) |
|
|
CX031 |
Brokers National (plans Homestead Homes, and Direct
Connection) |
|
2/18/2010
| 37314
| Broward Health
|
|
2/18/2010
| CX014
| Buckeye Health Plan
|
|
|
61492 |
Businessmens Assurance |
|
9/10/2007
|
42150
|
Butler Benefits
|
|
| 9/10/2007 |
CLF01
|
C. L. Frates
|
|
2/18/2010
| 33192
| Cadent Administrators (Underwriters)
|
|
|
80659 |
Canada Life (for claims mailed to Atlanta, GA only) |
|
| 6/30/2003 |
37105 |
Cannon Cochran Management Services, Inc.(Danville, IL) |
|
|
68011 |
Capitol Administrators (For claims mailed to PO Box 2318,
Rancho Cordova, CA and PO Box 346, Alpharetta, GA) |
|
| 9/29/2003 |
CX037 |
Capital Dental (for claims mailed to PO Box 2727, Houston, TX) |
|
9/10/2007
|
TLU47
|
Caprock Health Plan
|
|
9/10/2007
|
TLU48
|
Carolina Summit
|
|
| 9/10/2007 |
TLW16
|
Carpenter's Health & Welfare
Fund (Philadelphia, PA)
|
|
| 9/10/2007 |
TLW06
|
Carpenters Health and Welfare
Trust Funds (St. Louis, MO)
|
|
| 9/10/2007 |
TLU49
|
Carpenters Health & Welfare
(Los Angeles, CA)
|
|
|
37060 |
Caterpillar Company |
|
2/18/2010
| 41170
| CBCA Administrators HRM
|
|
9/10/2007
|
TLW14
|
CBCA - Comprehensive Benefits
& Claims Administrators
|
|
|
41124 |
CBSA Corporate Benefit Services of America |
|
9/10/2007
|
10050
|
CDH (Cigna Dental Care)
|
|
2/18/2010
| 87065
| CDO Technologies
|
|
9/10/2007
|
TLW07
|
CDPHP - Capital District
Physicians’ Health Plan, Inc. (NY)
|
|
9/10/2007
|
88022
|
CDS Group Health
|
|
|
91136 |
Cement Masons & Plasterers Health & Welfare Trust |
|
9/10/2007
|
TLW85
|
Cement Masons Union - Local 502
|
|
2/18/2010
| CX014
| CenterCare effective 10-1-2005
|
|
9/10/2007
|
TLU50
|
Central Laborers Local 703
|
|
9/10/2007
|
TLU51
|
Central PA Teamsters Health
& Welfare Fund
|
|
9/10/2007
|
TLW76
|
Central Reserve Life Insurance
Company
|
|
| 11/13/2008 |
36215 |
Central States Health & Welfare Funds |
|
| 8/15/2003 |
84146 |
CHAMPVA - HAC (for claims mailed to PO Box 65024, Denver, CO) |
|
9/10/2007
|
TLX40
|
CHEC (subsidiary of Sprint)
|
|
9/10/2007
|
TLA11
|
Chesterfield Companies
|
|
9/10/2007
|
84147
|
Children of Women Vietnam
Veterans - VA HAC |
|
|
UCCI1 |
CHIPS, a childrens low cost Texas health plan administered by
UCCI |
Call UCCI @ 800-633-5430 for Provider I.D. |
|
68241 |
Choice Plus (TRW) |
|
|
61271 |
Christian Brothers Services |
|
|
62308 |
CIGNA (Connecticut General) |
|
9/10/2007
|
10050
|
CIGNA (DHMO) - Encounters Only
|
|
|
62310 |
CIGNA Flex Care (New Mexico only) |
|
9/10/2007
|
TLU52
|
Citizens Security Life Insurance
Co
|
|
| 9/10/2007 |
TLW99
|
City of Blair
|
|
| 9/10/2007 |
TLW43
|
City of Mesa
|
|
| 9/10/2007 |
CX054
|
Civil Service Employee
Association (CSEA)
|
|
| 9/10/2007 |
CMS01
|
Claim Management Services (WI)
|
|
| 9/10/2007 |
TLX41
|
Claredon Kids CHIP Program EPO
|
Contact Payor to receive
provider I.D.
|
| 9/10/2007 |
CCS01
|
Clayton County Self Funded
Dental Plan
|
|
|
71063 |
CNA Health Partners of Arkansas |
|
| 9/10/2007 |
37310
|
Coast Hotels and Casinos, Inc. /
DBA Coast Benefits
|
|
2/18/2010
| 77052
| Coastal Administrative Services
|
|
2/18/2010
| TLX77
| Columbian Life Insurance Company (Mutual Insurance Company)
|
|
| 9/10/2007 |
TLU53
|
Combined Insurance Claims (FL)
|
|
| 9/10/2007 |
37237
|
CommonWealth Administrators
|
|
| 9/10/2007 |
61948
|
Community Choice Health Plan
Westchester
|
|
| 9/10/2007 |
PHP01
|
Community Connection (Phoenix,
AZ)
|
|
| 9/10/2007 |
TLX42
|
Community Health Choice
|
|
|
75261 |
Community Health Electronic Claims/CHEC/webTPA |
|
6/25/2004
|
34177
|
COMP - OHIO (Austintown, OH)
|
|
2/18/2010
| TSCS1
| Complete Benefit Solutions SC
|
|
| 9/10/2007 |
77828
|
Companion Life
|
Contact Payor to receive
provider I.D. |
|
CX021 |
CompDent (for claims mailed to Chicago, IL) |
|
9/10/2007
|
34177
|
Compensation Programs of Ohio
|
|
|
03036 |
Comprehensive Benefits Administrator, Inc (PO Box 2365,
Burlington) |
|
|
07000 |
Comprehensive Care Systems |
|
| 9/10/2007 |
TLX25
|
Comton, Inc.
|
|
| 9/10/2007 |
TLX09
|
CONN EN Life Insurance Co
|
|
| 9/10/2007 |
37307
|
CONN EN Life Insurance Co
|
|
|
62308 |
Connecticut General (CIGNA) |
|
|
E3170 |
Consolidated Group Claims - Lincoln |
|
|
61305 |
Consolidated Group Dental |
|
5/20/2005
|
62308
|
Continental Dental
|
|
2/18/2010
| 35149
| Cook Group Health Plan
|
|
| |
52132 |
Cooperative Benefit Administrators |
|
2/18/2010
| 58231
| Core Management Resources Group
|
|
| 9/10/2007 |
75136
|
CoreSource AR
|
|
| 9/10/2007 |
35180
|
CoreSource NC IN
|
|
| 9/10/2007 |
35183
|
CoreSource OH
|
|
9/29/2003
|
35182 |
CoreSource PA MD IL
|
|
|
41045 |
CoreStar |
|
| 6/30/2003 |
56117 |
Corporate Benefit Services (For claims mailed to Charlotte,
NC) |
|
|
41124 |
Corporate Benefit Services of America (CBSA) - Minneapolis, MN |
|
| 8/15/2003 |
58102 |
Covenant Administrators, Inc (for claims mailed to Atlanta,
GA) |
|
2/18/2010
| CX014
| Coventry Diamond Plan
|
|
3/31/2009
|
87043
|
Coventry Health Care National Network
|
|
6/25/2004
|
25148
|
Coventry Health Care of Georgia
|
|
9/10/2007
|
37320
|
Creative Plan Administrators
|
|
| 9/10/2007 |
TLU54
|
Crescent Dental
|
|
| 9/10/2007 |
TLU56
|
CT Carpenters Health Fund
|
|
9/10/2007
|
TLU55
|
CT Pipe Trades Health Fund
(Local 77)
|
|
2/7/2005
|
39170
|
Custom Benefit Administrators
|
|
2/18/2010
| 82056
| Custom Design Benefits Inc. of OH
|
|
|
68241 |
CustomCare (Southwestern Bell-Exec) |
|
9/10/2007
|
DEW01
|
D. Edward Wright TPA
|
|
| 9/10/2007 |
TLX43
|
Dart Container Corporation
|
Contact Payor to receive
provider I.D.
|
2/18/2010
| 06172
| Dart Management Corp.
|
|
2/18/2010
| DELTU
| DDP-USA
|
|
| 9/10/2007 |
TLW96
|
DDS, Inc.
|
|
| 9/10/2007 |
07035 |
DeCare Dental Health Insurance |
|
| 6/30/2003 |
94276 |
Delta Dental Insurance Company (DDIC)
|
|
|
02027 |
Delta Dental Northeast |
|
| 6/30/2003 |
94276 |
Delta Dental of Alabama |
|
| 6/30/2003 |
94276 |
Delta Dental of Alaska |
|
|
86027 |
Delta Dental of Arizona |
|
|
22225 |
Delta Dental of Arkansas |
|
|
77777 |
Delta Dental of California |
|
|
CDCA1 |
Delta Dental of California, Tricare Retiree Dental Program |
|
|
84056 |
Delta Dental of Colorado |
|
5/20/2005
|
22189
|
Delta Dental of Connecticut
|
|
|
51022 |
Delta Dental of Delaware |
|
| 6/30/2003 |
94276 |
Delta Dental of Florida |
|
| 6/30/2003 |
94276 |
Delta Dental of Georgia |
|
| inactive |
99010 |
Delta Dental of Hawaii |
|
|
47791 |
Delta Dental of Idaho |
|
|
05030 |
Delta Dental of Illinois |
|
|
22220 |
Delta Dental of Indiana |
|
|
55786 |
Delta Dental of Iowa |
|
|
E3960 |
Delta Dental of Kansas |
|
|
54674 |
Delta Dental of Kentucky |
|
| 6/30/2003 |
94276 |
Delta Dental of Louisiana |
|
|
23166 |
Delta Dental of Maryland |
|
|
22222 |
Delta Dental of Massachusetts (also QIS and Select)
|
|
|
22228 |
Delta Dental of Michigan |
|
|
07000 |
Delta Dental of Minnesota |
|
| 6/30/2003 |
94276 |
Delta Dental of Mississippi |
|
|
43090 |
Delta Dental of Missouri |
|
| 6/30/2003 |
94276 |
Delta Dental of Montana |
|
|
07025 |
Delta Dental of Nebraska |
|
| 6/30/2003 |
94276 |
Delta Dental of Nevada |
|
|
66669 |
Delta Dental of New Jersey |
|
|
85022 |
Delta Dental of New Mexico |
|
|
11198 |
Delta Dental of New York |
|
|
56101 |
Delta Dental of North Carolina |
|
|
07029 |
Delta Dental of North Dakota |
|
|
22221 |
Delta Dental of Ohio |
|
|
22229 |
Delta Dental of Oklahoma |
|
|
CDOR1 |
Delta Dental of Oregon |
|
|
23166 |
Delta Dental of Pennsylvania |
|
|
22224 |
Delta Dental of Rhode Island |
|
|
43091 |
Delta Dental of South Carolina |
|
|
54097 |
Delta Dental of South Dakota |
|
|
CDTN1 |
Delta Dental of Tennessee |
|
| 6/30/2003 |
94276 |
Delta Dental of Texas |
|
| 6/30/2003 |
94276 |
Delta Dental of Utah |
|
|
54084 |
Delta Dental of Virginia |
|
|
52147 |
Delta Dental of Washington D.C. |
|
|
91062 |
Delta Dental of Washington (State) |
|
|
31096 |
Delta Dental of West Virginia |
|
|
39069 |
Delta Dental of Wisconsin |
|
|
07027 |
Delta Dental of Wyoming |
|
9/10/2007
|
94235
|
Delta Health Systems
|
|
|
07000 |
Delta USA (Minnesota employers only) |
|
2/18/2010
| DDCA2
| DeltaCare USA - Claims
|
|
2/18/2010
| DDCA3
| DeltaCare USA - Encounters
|
|
2/18/2010
| CDCAP
| DeltaCare USA - Private Medical Care PMI
|
|
2/18/2010
| CDCA2
| DeltaCare USA - Private Medical Care PMI
|
|
9/23/2004
|
CX049
|
Denex/SG
|
|
5/20/2005
|
89070
|
DentaBenefits (Mutual of Omaha)
|
Contact UCCI @ 800-633-5430 to
obtain a provider I.D.
|
|
52133 |
Dental Benefit Providers (Bethesda, MD) |
|
| 6/30/2003 |
CX035 |
Dental Care Plus (for claims mailed to Cincinnati, OH) |
|
2/18/2010
| TFQ14
| Dental Claim Payors NY
|
|
9/10/2007
|
TLU57
|
Dental CPM
|
|
| 5/20/2005 |
64246
|
Dental Guard Prefered
|
|
9/10/2007
|
DHA01
|
Dental Health Associates
|
|
| 6/30/2003 |
CX034 |
Dental Network (for claims mailed to Towson, MD) |
|
5/20/2005
|
DNOA1
|
Dental Network of America
|
|
9/10/2007
|
TLU18
|
Dental Select, Inc.
|
|
| 9/10/2007 |
TLX01
|
Dental-Comp, Inc. (WI)
|
|
| 9/10/2007 |
TLW24
|
Dental-Pay, Inc. / The Dental
Shop
|
|
| inactive |
CX017 |
DentalComp (for claims mailed to PO Box 10599, Harrisburg, PA) |
|
|
04356 |
DentaQuest |
|
2/18/2010
| 11271
| Detectives Endowment Association New York
|
|
| 9/10/2007 |
A1004
|
Detroit Laborers (Metropolitan)
|
|
| 9/10/2007 |
CX065
|
DH Evans
|
|
|
DHS01 |
DHS (Delta Dental of Minnesota Medical Assistance) |
|
| 9/10/2007 |
TLX38
|
Direct Reimbursement Plan
(Newman, GA)
|
|
| 9/10/2007 |
TLW78
|
District 1199 Health &
Welfare
|
|
| 9/10/2007 |
TLW34
|
District Council 57 Benefit Fund
|
|
| 9/10/2007 |
HSP01
|
District Counsel 37 Health &
Welfare Fund
|
|
| 4/7/2004 |
CX040 |
Diversified Administration Corporation |
|
9/10/2007
|
TLW78
|
Diversified Group Administrators
|
|
| 9/10/2007 |
DOM01
|
Dominion Dental USA (DHMO and
Commercial)
|
|
|
CX014 |
Doral Dental (all states - all varieties)
|
|
9/10/2007
|
TLX44
|
DSCC (Div of Special Care
Children)
|
Contact Payor to receive
provider I.D.
|
| 9/10/2007 |
35186
|
Dunn & Associates (EHC
Central)
|
|
| 4/7/2004 |
34159 |
E-V Benefits Management Inc |
|
| inactive |
75232
|
E3 Health, Inc.
|
|
|
81039 |
EBMS Employee Benefit Management Services, Inc. |
|
2/18/2010
| 03036
| EBPA NH - CBA VT
|
|
| 4/7/2004 |
CX043 |
EBS Benefit Solutions |
|
9/10/2007
|
TLU58
|
ECIT Dental Plans
|
|
| 9/10/2007 |
TLU59
|
Educators Life Ins / Educators
Mutual
|
|
|
73288 |
EHI Employers Health of Wisconsin |
|
9/10/2007
|
52192 |
Elder Health
|
|
5/20/2005
|
EWF01
|
Electrical Workers Benefit Fund
(IBEW Local 481)
|
|
| 9/10/2007 |
TLW86
|
Elmco Insurance
|
|
|
73288 |
EMPHESYS Employers Health of Wisconsin |
|
|
55093 |
Empire Blue Cross Blue Shield of New York |
|
| 55093 | Empire Dental | |
| 9/10/2007 |
CX012
|
Employee Benefit Administrators
(Pembroke, MA)
|
|
| 9/10/2007 |
TLW29
|
Employee Benefit Claims of
Wisconsin, Inc.
|
|
| 4/7/2004 |
38241 |
Employee Benefit Concepts |
|
9/23/2004
|
37257
|
Employee Benefit Consultants,
Inc. (EBC)
|
|
|
81039 |
Employee Benefit Management Services, Inc. (EBMS) |
|
|
CX025 |
Employee Benefit Mgmnt Corp (EBMC) (Dublin, OH) |
|
| 6/30/2003 |
03036 |
Employee Benefit Plan Administration, Inc |
|
| 9/10/2007 |
47009
|
Employee Benefit Services (NE)
|
|
| 9/10/2007 |
41198
|
Employee Benefit Services of
Louisiana, Inc (EBS)
|
|
| 9/10/2007 |
TLW79
|
Employee Benefits Corporation
|
|
|
CX022 |
Employee Group Services (PO, Box 75008, Cedar Rapids, IA) |
|
| 9/10/2007 |
CX031
|
Employee Plan Services, Inc.
(EPSI)
|
|
|
35112 |
Employee Plans, LLC (PO Box 2362, Fort Wayne, IN) |
|
|
54098 |
Employee Security, Inc. |
|
|
CX031 |
Employer Plan Services, Inc. |
|
9/10/2007
|
TLW30
|
Employers Dental Trust
|
|
| 9/10/2007 |
75232
|
Employers Direct Health
|
|
| 9/10/2007 |
75236
|
Employers Direct Health -
Employee Plan
|
|
|
73288 |
Employers Health of Wisconsin (EHIC) (EMPHESYS) |
|
| 9/10/2007 |
TLW32
|
Employers Life Insurance Corp
(SC)
|
|
2/7/2005
|
59297
|
Employers Mutual, Inc
|
|
9/10/2007
|
88726
|
Encompass
|
|
| 9/10/2007 |
TLW87
|
Engineers Joint Welfare Fund /
IUOE (NY)
|
|
| 6/30/2003 |
91136 |
Enstar Natural Gas |
|
9/10/2007
|
TLU60
|
Epoch Group LC (Overland Park)
|
|
| 9/10/2007 |
TLX13
|
Epoch Group LC (St. Louis)
|
|
|
62308 |
EQUICOR (Equitable HCA Corp) |
|
|
62308 |
Equitable (CIGNA) |
|
| 9/29/2003 |
73126 |
Equitable Plan Services ( for claims mailed to PO Box 720460,
Oklahoma City,, OK) |
|
6/25/2004
|
CX046
|
Erin Group Administrators
|
|
| 9/10/2007 |
74234
|
ERISA
|
Contact Payor to receive
provider I.D.
|
9/10/2007
|
34108
|
ES Beveridge and Associates
|
|
6/25/2004
|
43168
|
Essex Dental Benefits
|
|
9/10/2007
|
TLW77
|
Evans D H Associates Inc
|
|
| 9/10/2007 |
CBNYR
|
Excellus, Inc.
|
Contact Payor to receive
provider I.D.
|
| 9/10/2007 |
EXC03
|
Excellus, Inc - FEDERAL Claims
Only
|
|
|
71412 |
ExclusiCare |
|
9/10/2007
|
TLX14
|
Family Care Claims (TX)
|
|
| 9/10/2007 |
TLU61
|
Family Health Administrators
|
|
| 9/10/2007 |
TLU62
|
Fara Benefit Services
|
|
| 9/10/2007 |
91136
|
FBX North Star Borough / School
District
|
|
9/23/2004
|
71056
|
Fed Ex Freight East, Inc.
|
|
2/18/2010
| CX014
| Fidelis Care New York
|
|
|
41041 |
Federated Mutual Insurance of Owatonna, MN |
|
9/10/2007
|
TLU69
|
Fidelio Insurance Co
|
|
| 9/10/2007 |
TLU67
|
First Administrators
|
|
|
69140 |
First Allmerica Financial Life Insurance Co. |
|
|
72630 |
First Ameritas Life Insurance Corporation of NY |
|
9/10/2007
|
TLX17
|
First Care/Southwest Life &
Health
|
|
| 9/10/2007 |
TLU68
|
First Choice Benefits
|
|
| 9/10/2007 |
TLU65
|
First Concord Group, Inc.
|
|
| 9/10/2007 |
TLU63
|
First Dental Health (FDH)
|
|
| 9/10/2007 |
70408
|
First Fortis Life Insurance
|
|
|
87043 |
First Health |
|
|
E3740 |
First Reliance Standard |
|
2/18/2010
| CX014
| FirstGuard Health Plan
|
|
9/10/2007
|
TLU66
|
Fiserv Health
|
|
| 4/7/2004 |
11244 |
FitzHarris & Company Inc |
|
| 9/10/2007 |
TLX53
|
FL League of Cities
|
|
| R7004 | Flex Compensation | |
|
68241 |
FlexCare |
|
| 9/10/2007 |
TLU70
|
Flexible Benefit Fund
|
|
| 9/10/2007 |
TLW93
|
Florida Benefit Administrators
|
|
2/18/2010
| 76031
| Florida FL Combined Life BCBS of FL
|
|
6/25/2004
|
48116
|
Florida Hospital Waterman
|
|
|
68241 |
Florida Power & Light |
|
6/25/2004
|
48117
|
FMH Benefit Services, Inc
|
|
9/10/2007
|
TLW97
|
Foreign Service Benefit Plan
|
|
2/18/2010
| AHS01
| Foresight TPA
|
|
| 9/2/2009 |
LX050
|
Formula Dental
|
|
|
70408 |
Fortis Benefits Insurance Company |
|
|
39065 |
Fortis Insurance Company (Individual plans - formerly Time
Ins) |
|
9/10/2007
|
TLU72
|
Foundation Benefits
Administration
|
|
| 9/10/2007 |
TLU71
|
Fox Valley Welfare Fund
|
|
| 64069 | Fox-Everett Inc. | |
| 4/7/2004 |
CX041 |
Fraternal Order of Police |
|
2/18/2010
| 59069
| Fringe Benefit Management
|
|
9/10/2007
|
TLX20
|
G.W. Lisk Co
|
|
| 9/10/2007 |
37283
|
Gallagher Benefit Administrators
|
|
| 9/10/2007 |
TLU73
|
Gardner Denver
|
|
| 9/10/2007 |
GCU01
|
GCU Local 8-M & 96B Health
& Welfare Fund
|
|
| 9/10/2007 |
TLW17
|
GE Financial Assurance
|
|
2/18/2010
| 67814
| GE Group Life - Administrators - Financial
|
|
| |
44054 |
GEHA (Government Employees Hospital Association) |
|
| 9/10/2007 |
TLX27
|
GEHA Connection Dental Plus (MO)
|
|
| 9/10/2007 |
75238
|
GEHA - G.E. Group Administrators
(TX)
|
Contact Payor to receive
provider I.D.
|
|
63665 |
General American Life |
|
|
67814 |
General Electric |
|
| 9/10/2007 |
67814
|
Genworth
|
|
2/18/2010
| 74227
| Gerber Life Insurance Company - Student Insurance
|
|
| 9/10/2007 |
TLU74
|
Gettysburg Insurance Services
|
|
|
13551 |
GHI (Group Health Insurance of New York) |
|
2/18/2010
| CX014
| GHI - Doral Dental
|
|
| 6/30/2003 |
80314 |
GIC |
|
|
07205 |
Gilsbar, Inc. (Covington, LA and Jackson, MS) |
|
|
91136 |
Glassworkers Health & Welfare Fund |
|
9/10/2007
|
TLX45
|
Global Healthcare (c/o People
1st)
|
|
| 9/10/2007 |
TLW18
|
Golden Rule Insurance Company
|
Contact Payor to receive
provider I.D.
|
5/20/2005
|
GWD01
|
Golden West
|
|
9/10/2007
|
44054
|
Government Employees Hospital
Association (GEHA)
|
|
|
63665 |
Great-West Life & Annuity Ins Co. (formerly General
American Life) |
|
|
80705 |
Great-West Life Assurance Company |
|
|
36338 |
Group Administrators (in Schaumburg, Illinois) |
|
| 48143 | Group and Pension Administrators | |
2/7/2005
|
72153
|
Group Benefit Administrators
|
|
| inactive |
CX011 |
Group Benefit Services (in East Lansing, Michigan) |
|
9/10/2007
|
CX036
|
Group Dental Service of
Maryland, Inc. / GDS-MD
|
|
| 9/29/2003 |
CX036 |
Group Dental Services (for claims mailed to PO Box 3827,
Houston, TX) |
|
|
13551 |
Group Health Insurance of New York (GHI) |
|
6/25/2004
|
38194
|
Group Health Managers
|
|
9/10/2007
|
37276
|
Group Insurance Service Center,
Inc
|
|
|
CX015 |
Group Link (in Indianapolis, Indiana) |
|
| 9/10/2007 |
TLU76
|
Group Resources, Inc. (TX)
|
|
| 9/10/2007 |
TLW81
|
Guarantee Trust Life Insurance Co
|
|
|
64246 |
Guardian Life Insurance Company |
|
| 3/31/2009 |
LX059 |
H & A Administrators |
|
|
95266 |
Harrington Benefit Services |
|
| 6/30/2003 |
59142 |
Harrington Benefit Services, Inc. (Oklahoma) |
|
| 9/10/2007 |
CX044
|
Harrison Electrical Trust Fund
|
|
| 9/10/2007 |
TLW11
|
Harvard Pilgrim Healthcare
|
|
| inactive |
99010 |
Hawaii Dental Services |
|
9/10/2007
|
TLU97
|
HCH Administration (NM)
|
|
| 9/10/2007 |
TLU98
|
HDM Benefit Solutions, Inc.
|
|
| 9/10/2007 |
TLW88
|
Health Alliance (IL)
|
|
| 9/10/2007 |
TLX24
|
Health Benefit Claims Dept
|
|
6/25/2004
|
22345
|
Health Choice Inc.
|
|
| 4/7/2004 |
82018 |
Health Claims Services |
|
2/18/2010
| DX029
| Health Comp
|
|
| 9/10/2007 |
TLA18
|
Health Cost Solutions
|
|
| 9/29/2003 |
CX039 |
Health Economics Group, Inc. (for claims mailed to Rochester,
NY) |
|
| 9/10/2007 |
TLW61
|
Health First TPA
|
|
9/23/2004
|
30946
|
Health Future, LLC
|
|
|
84097 |
Health Management Systems (Managed Dental Care Network) |
|
9/10/2007
|
TLW20
|
Health Net (CA)
|
|
| 9/10/2007 |
20199
|
Health Network of America
|
|
|
HLTHC |
Health Partners (Commercial Plan) |
|
|
HLTHP |
Health Partners (Minnesota Medical Assistance) |
|
|
62157 |
Health Partners of Tennessee (PO Box 3490, Jacson, TN) |
|
9/10/2007
|
47009 |
Health Plan Services (HPS) |
|
|
59142 |
Health Plan Services of OK (Oklahoma City, OK) |
|
9/10/2007
|
CX055
|
Health Plans, Inc.
|
|
|
CX019 |
Health Resources Inc (314 SE Riverside Dr, Evansville, IN
47713) |
|
|
87043 |
Health Right Inc. of Connecticut |
|
|
41170 |
Health Risk Management |
|
9/10/2007
|
HTD99
|
Health Traditions - MMSI
|
|
2/18/2010
| CX014
| HealthCare, USA - St. Louis
|
|
| 9/10/2007 |
HMA01
|
Healthcare Management
Administrators, Inc.
|
Contact Payor to receive
provider I.D.
|
| 9/10/2007 |
TLW60
|
HealthComp
|
|
| 9/10/2007 |
52133
|
HealthNet of Oregon
|
|
|
11271 |
Healthplex, Inc. |
|
|
71063 |
HealthSCOPE Benefits, Inc. |
|
|
68195 |
Healthsource Provident Administrators, Inc. |
|
|
68195 |
Healthsource Provident Insurance |
|
|
69140 |
Healthy Choice |
|
|
69140 |
Healthy Choice Plus |
|
2/18/2010
| TLZ34
| Healthy Families CA
|
|
9/10/2007
|
HGL01
|
Heavy & General Laborers
|
|
2/18/2010
| CX013
| Hershey Healthsmile
|
|
2/18/2010
| 54771
| HighMark Dental
|
|
| 9/10/2007 |
HMSA1
|
HMSA (Hawaii Medical Services) -
Commercial
|
|
| 9/10/2007 |
HMSA2
|
HMSA (Hawaii Medical Services) -
Federal
|
|
| 9/10/2007 |
88023
|
Hometown Health Plans Nevada
|
|
|
CX015 |
Hoosier Dental (in Indianapolis, Indiana) |
|
9/10/2007
|
22099
|
Horizon Healthcare of NY
|
|
|
91136 |
Hotel Employees & Restaurant Employees Health Trust |
|
|
41170 |
HRM Claim Management |
|
|
73288 |
Humana Military Healthcare Svcs (PO Box 19081, Green Bay, WI) |
|
|
73288 |
Humana |
|
9/10/2007
|
TLW82
|
I.B.P.A.T. District
Council #11
|
|
| 9/10/2007 |
IAT01
|
IATSE - International
Association of Theatrical Stage Employees Atlanta Health & Welfare
Fund
|
|
| 9/10/2007 |
38234
|
IBA Self Funded Group
|
|
| 9/10/2007 |
A1117
|
IBEW Local 117
|
|
| 9/10/2007 |
TLW62
|
IBEW Local 1249
|
|
| 9/10/2007 |
TLW90
|
IBEW Local 176 (In-State
Only)
|
|
| 9/10/2007 |
TLW91
|
IBEW Local 176 (Out-of-State)
|
|
| 9/10/2007 |
A1317
|
IBEW Local 38
|
|
| 9/10/2007 |
A1461
|
IBEW Local 461
|
|
| 9/10/2007 |
A4681
|
IBEW Local 481
|
|
| 9/10/2007 |
64246
|
IBEW Welfare Trust Fund (IL)
|
|
|
41124 |
IBI |
|
9/10/2007
|
91136
|
Idaho Pipe Trades
|
|
9/23/2004
|
22175
|
IE Shaffer
|
|
| 9/29/2003 |
36600 |
Illinois Central Hospital Association (for claims mailed to
Tinley Park, IL) |
|
2/18/2010
| CX014
| Illinois Medical Assistance Program
|
|
9/10/2007
|
TLW83
|
IMA Management, Inc. (LA)
|
|
| 9/10/2007 |
DELOK
|
Indian Health Services
|
|
| 9/10/2007 |
ICW01
|
Indiana Carpenters Welfare &
Pension Fund
|
|
| 9/10/2007 |
35107
|
Indiana Teamsters Health Benefit
Funds (formerly known as Local 135 Health Benefits Fund)
|
|
9/10/2007
|
52196
|
InforMed, LLC (Annapolis, MD)
|
|
|
13315 |
Insurance Design Administrators (Oakland, NJ) |
|
9/10/2007
|
TLW83
|
Insurance Management
Administrators Of Louisiana
|
|
| 6/30/2003 |
88006 |
Insurance Management Services (for claims mailed to Elko, NV) |
|
| 9/10/2007 |
TLW82
|
Insurance Programmers, Inc
|
|
9/10/2007
|
IAC01
|
Insurer's Administrative Corp
|
|
| 9/29/2003 |
51020 |
Integra Administrative Group (for claims mailed to Seaford,
DE) |
|
9/10/2007
|
TLW56
|
Interactive Medical Systems, Inc.
|
|
| 6/30/2003 |
36609 |
International Brotherhood of Boilermakers |
|
2/18/2010
| IHS01
| IntraHealth Solutions formerly D.Edward Wright, Inc.
|
|
2/18/2010
| CX014
| Ion Health, Inc
|
|
|
42234 |
Iowa Benefits, Inc. (IBI)
|
|
9/10/2007
|
TLX28
|
Iron Workers District (NY)
|
|
|
61271 |
J.F. Molloy and Associates, Inc. |
|
2/7/2005
|
34136
|
J.P. Farley Corporation
|
|
|
14168 |
Jardine Group Services |
|
9/10/2007
|
JPF01
|
Jefferson Pilot / Guarantee Life
Insurance Company (GLIC)
|
|
| 9/10/2007 |
JEN01
|
Jenkins & Associates (1299
Battlecreek Rd., Ste. 200 & PO Box 607, Jonesboro, GA 30237-0607)
|
|
| 9/10/2007 |
TLW64
|
JI Specialty Services Company
|
|
|
14168 |
JLT Services Corporation (Jardine Group Services) |
Contact Payor to receive provider I.D.
|
| 9/10/2007 |
41099
|
John Alden Life Insurance Co.
|
|
|
95378 |
John Deere |
|
|
65099 |
John Hancock Health Security Plan |
|
|
65099 |
John Hancock Mutual Life Insurance Co. |
|
|
65099 |
John Hancock Preferred Health Plan |
|
2/18/2010
| 38310
| John Morrell Company - AHBPA
|
|
2/18/2010
| CX073
| Kaiser Permanente Dental Choice
|
|
|
57038 |
Kanawha Insurance Company (Lancaster & Greenville) |
|
9/10/2007
|
KBT01
|
Kansas Building Trades (4101
Southgate Dr., Topeka, KS 66609 & PO Box 5168, Topeka, KS 66605)
|
|
| 9/10/2007 |
TKC01
|
Kansas City Life Insurance
Company
|
|
2/18/2010
| CX014
| Kansas Medical Assistance Program terminated 7-1-2006
|
|
| 9/10/2007 |
TLX46
|
Kelsey Seybold
|
Contact Payor to receive
provider I.D.
|
|
73100 |
Kempton Company |
|
9/10/2007
|
TLX29
|
Key Benefit Administrators, Inc.
|
|
9/10/2007
|
TPA01
|
Keylink Solutions
|
|
2/18/2010
| CX014
| Keystone Mercy Health Plan
|
|
|
93200 |
King County Blue Shield |
|
|
93213 |
King County Blue Shield Clallam |
|
|
93220 |
King County Blue Shield Cowlitz |
|
|
93207 |
King County Blue Shield Grays Harbor |
|
|
93210 |
King County Blue Shield Lewis |
|
|
93219 |
King County Blue Shield Snohomish |
|
|
93211 |
King County Blue Shield Thurston |
|
|
93221 |
King County Blue Shield Walla Walla Valley |
|
|
93214 |
King County Blue Shield Yakima |
|
2/18/2010
| A1004
| Laborers Metropolitan Detroit Healthcare Fund
|
|
9/10/2007
|
LSH01
|
Laborers Southeast Health &
Welfare Plan
|
|
| 9/10/2007 |
TLU99
|
Lawrence Paper Company
|
|
2/18/2010
| 52193
| LBA Healthplans
|
|
|
44066 |
Lewer Agency (Bartlesville, OK office only) |
|
2/18/2010
| CX083
| Liberty Dental Plan
|
|
|
78140 |
Life Insurance Company of Boston & New York |
|
|
65471 |
Life Insurance Company of Georgia |
|
9/23/2004
|
CX047
|
LifeRe
|
|
6/25/2004
|
91663
|
Lifewise/Washington Employers
Trust
|
|
| CX061 | Lincoln Financial Group | |
|
73288 |
Lincoln National of Wisconsin (in Madison or Green Bay) |
|
9/10/2007
|
TLX21
|
Line Construction Benefit (Line
Co)
|
|
| 9/29/2003 |
35107 |
Local 135 Health Benefits (for claims mailed to Indianapolis,
IN) |
|
| 9/10/2007 |
PCM01
|
Local 148 Health & Welfare
Fund
|
|
| 9/10/2007 |
TLX08
|
Local 388 Dental Fund
|
|
5/20/2005
|
GCU01
|
Local 8-M & 96B Health &
Welfare Fund
|
|
| 9/10/2007 |
91136
|
Locals 302 And 612 of the
I.U O.E.
|
|
| 9/10/2007 |
LAF01
|
Los Angeles Firemen’s Relief
Association (LAFRA)
|
|
|
62310 |
Lovelace Health Plan |
|
|
62310 |
Lovelace Senior Options (LSO) |
|
|
62310 |
Lovelace Senior Plan (LSP) |
|
9/10/2007
|
52133
|
M-Plan Dental
|
|
|
10317 |
Machigonne Benefit Administrators (Bangor or Portland, ME) |
|
| 9/10/2007 |
91136
|
Machinists Health
|
|
| 9/10/2007 |
TLW30
|
MAG Employee Benefits
|
|
| 4/7/2004 |
CX042 |
Mahoney Benefit Administration, LLC |
|
|
62413 |
Mail Handlers Benefit Plan |
|
| 9/10/2007 |
TLX08
|
Maloney Associates
|
|
| 6/30/2003 |
CX033 |
MAMSI (For claims mailed to Frederick, MD) |
|
|
CX014 |
Managed Health Services - WI State Employees |
|
|
98010 |
Manulife, W.J. Sutton Co. of Toronto, Ontario |
|
2/18/2010
| CX014
| Maricopa Health Systems Health Plans
|
|
|
60054 |
Marriot |
|
| 11/13/2008 | CX023 | Marsh Advantage | |
2/18/2010
| CX014
| Maryland HELIX
|
|
2/18/2010
| CX014
| Maryland Physicians Care MCO
|
|
9/10/2007
|
TLU77
|
Mashantucket Pequot
|
|
|
65935 |
Massachusetts Mutual |
|
2/18/2010
| 87065
| MBA Benefit Administrators, Inc. Salt Lake City, UT
|
|
2/18/2010
| 87065
| MBA of Wyoming Worland, WY
|
|
|
56205 |
MBS (MedCost Benefit Services - PO Box 25987, Winston Salem,
NC) |
|
9/10/2007
|
TLW63
|
Med Cost, Inc.
|
|
|
74323 |
MedBen (Newark, OH) |
|
|
56205 |
Medcost of North Carolina (PO Box 25987, Winston Salem, NC) |
|
|
07031 |
Medica Dental |
|
|
CKAL1 |
Medicaid of Alabama |
|
|
CKAL1 |
Medicaid of Alabama Change of Tax Identification Number Only |
|
|
CKAK1 |
Medicaid of Alaska |
|
9/10/2007
|
TLU09
|
Medicaid of Arizona
|
|
|
E0840 |
Medicaid of Arkansas |
|
|
94146 |
Medicaid of California (Denti-Cal) |
Call or email LTC |
|
CKCO1 |
Medicaid of Colorado |
|
|
22235 |
Medicaid of Connecticut |
|
|
CKDE1 |
Medicaid of Delaware |
|
9/10/2007
|
MDDC1
|
Medicaid of District of Columbia
(DC)
|
|
|
55555 |
Medicaid of Florida |
|
|
E0920 |
Medicaid of Georgia |
|
|
CX014 |
Medicaid of Georgia, Grady Healthcare, Inc. |
|
|
E0900 |
Medicaid of Idaho |
|
|
CKIL1 |
Medicaid of Illinois |
|
|
E0730 |
Medicaid of Indiana |
|
|
CKIA1 |
Medicaid of Iowa |
|
|
CKKS1 |
Medicaid of Kansas |
|
|
E0510 |
Medicaid of Kentucky |
|
|
CKKY3 |
Medicaid of Kentucky Region #3 (Doral Dental Services) |
|
9/10/2007
|
TLU10
|
Medicaid of Kentucky Region #5
(KY Health Select)
|
|
|
E3670 |
Medicaid of Louisiana (Adult 21 and older) |
|
|
22000 |
Medicaid of Louisiana (EPSDT) |
|
|
CKME1 |
Medicaid of Maine |
|
|
CX014 |
Medicaid of Maryland, PhysiciansCare MCO |
|
9/10/2007
|
MDMD1
|
Medicaid of Maryland (Dept of
Health & Mental Hygiene)
|
|
|
CKMA1 |
Medicaid of Massachusetts (diskette from Clearing House to
Payor) |
|
|
MIMD1 |
Medicaid of Michigan |
Call or email LTC |
|
MNMA1 |
Medicaid of Minnesota (Minnesota Medical Assistance) |
|
|
E3240 |
Medicaid of Mississippi |
|
|
CX014 |
Medicaid of Missouri, Blue Advantage |
|
|
CX014 |
Medicaid of Missouri, Community Care Plus-St. Louis |
|
|
CX014 |
Medicaid of Missouri, Community Health Plans |
|
|
CX014 |
Medicaid of Missouri, FirstGuard Health Plan |
|
|
CX014 |
Medicaid of Missouri, HealthCare USA-St. Louis |
|
|
CX014 |
Medicaid of Missouri, Healthnet |
|
| 6/30/2003 |
CKMO1 |
Medicaid of Missouri (Medicaid claims administered by GTE
Data Services Inc.) |
|
|
CX014 |
Medicaid of Missouri, TrumanCare-Family Health Partners |
|
|
MTMDC |
Medicaid of Montana CHIPS |
|
|
CKMT1 |
Medicaid of Montana (for claims mailed to PO Box 8000,
Helena, MT) |
|
|
CX014 |
Medicaid of Nebraska, United HealthCare of the Midlands |
|
| 9/23/2004 |
CKNV1 |
Medicaid of Nevada |
|
|
E3360 |
Medicaid of New Hampshire |
|
|
66665 |
Medicaid of New Jersey |
|
|
CX014 |
Medicaid of New Mexico, Cimmaron Health Plan |
|
|
CX014 |
Medicaid of New Mexico, Lovelace Community Health PLan |
|
| 6/30/2003 |
CKNM1 |
Medicaid of New Mexico (Medicaid claims administered by
Consultec/ACS) |
|
|
CX014 |
Medicaid of New Mexico, Presbyterian Salud |
|
|
CKNY1 |
Medicaid of New York |
|
|
CKNY2 |
Medicaid of New York (Clinics whose category of sevice is
0287) |
|
|
22219 |
Medicaid of North Carolina |
Call or email LTC |
9/10/2007
|
CKND1
|
Medicaid of North Dakota
|
Call ND Medicaid to obtian a
provider I.D. |
|
E0340 |
Medicaid of Ohio |
Call Ohio Medicaid to obtian a provider I.D.
|
|
CKOH2 |
Medicaid of Ohio CareSource |
|
|
CX014 |
Medicaid of Ohio, Emarald HMO and Medicare, Inc. |
|
|
CX014 |
Medicaid of Ohio, Health Power HMO, Cincinnati |
|
|
CX014 |
Medicaid of Ohio, Personal Physicians Care, Cleveland |
|
|
CX014 |
Medicaid of Ohio, United HealthCare, Inc. Medicare Complete |
|
|
E0880 |
Medicaid of Oklahoma |
|
|
CX014 |
Medicaid of Oklahoma, Community Care |
|
|
CX014 |
Medicaid of Oklahoma, Heartland Health Plan |
|
| 6/30/2003 |
CKOK1 |
Medicaid of Oklahoma (Medicaid claims administered by Unisys) |
|
|
CX014 |
Medicaid of Oklahoma, Unicare Health Plan |
|
|
CKOR1 |
Medicaid of Oregon |
|
|
CKPA1 |
Medicaid of Pennsylvania |
|
|
CX014 |
Medicaid of Pennsylvania, BestHealth Care, Pittsburg |
|
|
CX014 |
Medicaid of Pennsylvania, Gateway Health Plan, Pittsburg |
|
|
CX014 |
Medicaid of Pennsylvania, Health Partners, Philadelphia |
|
|
CX014 |
Medicaid of Pennsylvania, Oaktree |
|
|
22100 |
Medicaid of Rhode Island |
|
|
CKSC1 |
Medicaid of South Carolina |
|
| inactive |
CKTN1 |
Medicaid of Tennessee - Access Med Plus |
|
|
CX014 |
Medicaid of Tennessee, BlueCare |
|
|
30003 |
Medicaid of Texas |
Call Medicaid of Texas @ 800-925-9126 for enrollment info. |
|
CKUT1 |
Medicaid of Utah |
|
|
CKVT1 |
Medicaid of Vermont |
|
|
CKVA1 |
Medicaid of Virginia |
|
|
CX014 |
Medicaid of Virginia, HealthKeepers Plus |
|
5/20/2005
|
MDWA1 |
Medicaid of Washington (State) |
|
|
CKWV1 |
Medicaid of West Virginia |
|
|
MDWI1 |
Medicaid of Wisconsin |
|
|
CX014 |
Medicaid of Wisconsin, Humana/TDC |
|
|
CX014 |
Medicaid of Wisconsin, PrimeCare |
|
|
CKWY1 |
Medicaid of Wyoming |
|
|
CX024 |
Medical Benefit Administrators (For claims mailed to Madison,
WI) |
|
|
74323 |
Medical Benefits Mutual (for claims mailed to Newark, OH
43058) |
|
|
CB833 |
Medical Mutual of Ohio |
Call MMO @ 850-625-2583 to obtain a Provider I.D.
|
2/18/2010
| 84600
| Medical Network of Colorado Springs
|
|
6/25/2004
|
59226 |
MEGA Life & Health Insurance Company
|
|
9/10/2007
|
MHHNP
|
Memorial Herman Health Network
|
Contact Payor to receive
provider I.D.
|
| 9/10/2007 |
MNM01
|
Mennonite Mutual Aid
|
|
| 11/13/2008 | CX023 | Mercer Administrators | |
| 9/10/2007 |
TLW15
|
Mercy Care
|
|
| 11/13/2008 | TFQ16 | Meritain Health | |
|
65978 |
Met Elect |
|
2/18/2010
| 23550
| Methodist First Choice
|
|
|
65978 |
MetLife Healthcare Network-PPO/HMO |
|
|
MHP01 |
Metro Health Plan (Delta Dental of Minnesota Medical
Assistance) |
|
2/18/2010
| CX014
| Metro Plus
|
|
9/10/2007
|
A1004
|
Metropolitan Detroit Laborers
|
|
|
65978 |
Metropolitan Life Insurance Co. |
|
| 9/10/2007 |
22228
|
Michigan Conference of Teamsters
|
|
9/10/2007
|
A1432
|
Michigan Laborers
|
|
2/7/2005
|
38238
|
Michigan Regional Council of
Carpenters Employee Benefits Plan
|
|
| 9/10/2007 |
A1404
|
Michigan State Painters
|
|
| 9/10/2007 |
37281
|
Mid-America Associates, Inc.
|
|
9/10/2007
|
MAMS1
|
Mid-Atlantic Medical Services,
Inc. (MAMSI) (PO Box 940 Frederick, MD 21788)
|
|
9/10/2007
|
74227
|
Mid-West National Life Insurance
Co of Tennessee - Student Insurance (Payor ID valid only if the PO Box
on the Health ID Card matches one of the following PO Boxes: Box
890025, 809067, 809079, 809066, 809036, 809081, Dallas TX 75380-9025)
|
|
|
74227 |
Mid-West United Life |
|
| 9/10/2007 |
41101
|
Midwest Dental Benefits
|
|
| 9/10/2007 |
51233
|
Midwest Security Administrators,
Inc.
|
|
| 79480 | Midwest Security of WI | |
| 9/10/2007 |
A1402
|
Millrights
|
|
|
68241 |
Minneapolis Prudential Business |
|
9/10/2007
|
64088
|
Mississippi Select Healthcare
|
|
| 9/10/2007 |
37275
|
Missoula County Medical Benefits
Plan
|
|
| R7005 | MN Power | |
| 9/10/2007 |
TLX09
|
MO-KAN Welfare Fund
|
|
| 9/10/2007 |
TLX47
|
Molina Healthcare of New Mexico
|
Contact Payor to receive
provider I.D.
|
| 9/10/2007 |
52133
|
Morgan White
|
|
| 9/10/2007 |
TLU78
|
Morris Associates
|
|
| 6/30/2003 |
36111 |
Motorola |
|
| 9/10/2007 |
TLU79
|
Mountain Claims Management
|
|
| 4/7/2004 |
86040 |
Mountain States Administrative Services |
|
| 9/10/2007 |
37233
|
MPEEBT/ MPE Services, Inc.
|
|
|
69140 |
Mutual Alliance Plan (MAP) |
|
9/10/2007
|
37256
|
Mutual Assurance
|
|
|
71412 |
Mutual of Omaha Insurance Co. |
|
|
71412 |
Mutually Preferred |
|
9/10/2007
|
TLX30
|
MVP- Health Care
|
|
|
91136 |
N.W. Int Assoc of Machinists & Aerospace Eng Benefits
Trust |
|
|
91136 |
N.W. Iron Workers Health & Security Trust Fund |
|
|
91136 |
N.W. Roofers & enployers Health & Security Trust Fund |
|
|
91136 |
N.W. Textile Processors |
|
| 4/7/2004 |
34159 |
NABN |
|
| inactive |
53011 |
National Association of Letter Carriers (NALC) |
|
9/10/2007
|
TLX23
|
National Automatic Sprinkler
Industry
|
|
2/7/2005
|
56176
|
National Benefit Administrators
- NC
|
|
2/7/2005
|
56175
|
National Benefit Administrators
- NJ
|
|
6/25/2004
|
CX045
|
National Elevator Industry
Benefit Plans (NEIB)
|
|
9/10/2007
|
TLW49
|
National Employee Benefits
Administration Of Pennsylvania
|
|
9/10/2007
|
CX057
|
National Pacific of TX (NCFLEX)
|
|
|
71412 |
National Rural Letter Carrier Association |
|
2/7/2005
|
52120
|
National Telecommunications
Cooperative Association
|
|
9/10/2007
|
31417
|
Nationwide Health Plans
|
|
|
75190 |
NCAS |
|
2/7/2005
|
75191
|
NCAS Charlotte
|
|
2/18/2010
| TLX64
| NCAS Harrisburg, PA claims ONLY
|
|
2/18/2010
| 61474
| NCBCBS - DBS a.k.a. ACS Benefit Services
|
|
2/18/2010
| DX101
| Nevada Pacific Dental
|
|
|
54098 |
NEA Alaska Health Plan |
|
9/10/2007
|
66055
|
Netcare Life and Health
Insurance (NLH)
|
|
|
43351 |
New England Dental Administrators (PO Box 2006, Concord, NH) |
|
| 9/10/2007 |
66893
|
New England Financial
(Dental claims containing 'TN', 'PSI, or 'HPS' anywhere in the Group
policy and InsuredID numbers may NOT be submitted under this Payer
ID. Please begin using payer ID 80705 for this payer)
|
|
| 8/15/2003 |
38332 |
New World Claims Services (for claims mailed to Niles, MI) |
|
| inactive |
66915 |
New York Life Insurance Co. |
|
| 9/10/2007 |
NYT01
|
New York State Teamsters Union
(Local 118,182, 264, 294, 317, 375, 449, 529, 669, 687, 693, 791, 1149)
|
|
| 9/10/2007 |
TLX31
|
NGS American, Inc.
|
|
|
81264 |
Nippon Life Insurance Co. |
|
| 4/7/2004 |
65085 |
North America Administrators, L.P. |
|
| 4/7/2004 |
34159 |
North American Benefits Network |
|
| 9/10/2007 |
TLX02
|
North American Health Plans
|
|
2/18/2010
| 37314
| North Broward Hospital District
|
|
| 9/10/2007 |
61472
|
North Carolina Health Choice for
Children
|
|
|
E3400 |
North Dakota Dental Service |
|
9/10/2007
|
47570
|
North Star Administrators
|
|
|
02027 |
Northeast Delta |
|
| 9/10/2007 |
TLW42
|
Northern California Pipe Trades
Trust
|
|
2/18/2010
| 36347
| Northern Illinois Health Plan
|
|
| 3/31/2009 |
LX062 |
Northern Minnesota Dental |
|
|
88027 |
Northern Nevada Trust Fund (Reno, NV) |
|
2/18/2010
| 36364
| NorthShore University Health System Medical Group
|
|
| 6/30/2003 |
93525 |
Northwest Dental Services (For claims mailed to PO Box 1580,
Roseburg, OR) |
|
|
41045 |
Northwestern National Life Insurance |
|
| 6/30/2003 |
16644 |
Nova Healthcare Administrators, Inc. |
|
9/10/2007
|
91136
|
NW Plumbing & Pipefitting
Industry
|
|
2/18/2010
| CX014
| NY Presbyterian Community Health Plan
|
|
| 9/10/2007 |
37299
|
Nyhart
|
|
|
91135 |
NYLCare Ethix Northwest |
|
2/18/2010
| OAC01
| Ohio AFSCME Care Plan
|
|
|
91150 |
Olympic Health Management |
|
9/10/2007
|
TLW92
|
Omaha Industry Construction
|
|
|
80705 |
ONE Health Plan of AK, AZ, CA, CO, FL, GA, IL, IN, ME, MA,
NV, NH, NJ, NC, OH, TX |
|
|
80705 |
ONE Health Plan of OR,PA,SC,TN,TX,VA,WA,WI,WY and VT |
|
|
91136 |
Operating Engineers Locals 302 & 612 Health &
Security Fund |
|
|
CDOR1 |
Oregon Dental Services - ODS (administered by Delta Dental of
Oregon)
|
|
2/18/2010
| 22521
| OK State Employees Educators EDS
|
|
2/18/2010
| CLF01
| OSMA Health Formerly PLICO Oklahoma
|
|
9/10/2007
|
TLX34
|
Oxford Life Insurance (AZ)
|
|
2/18/2010
| 84104
| Oxford Health Plans United Healthcare
|
|
9/10/2007
|
CX066
|
PA Faculty Health & Welfare
|
|
| 9/10/2007 |
TLW59
|
Pacific Dental Benefits -
California
|
|
| 9/10/2007 |
TLW58
|
Pacific Dental Benefits - Nevada
|
|
| 9/10/2007 |
TLW57
|
Pacific Dental Benefits - Texas
|
|
|
67466 |
Pacific Life & Annuity (PO Box 33699 & 34799 &
100 W. Clarendon Ave) |
|
|
93029 |
Pacific Source Health Plan of Oregon |
|
| 9/10/2007 |
CX056
|
Pacific Union
|
|
| 9/10/2007 |
CX060
|
Pacificare Dental & Vision
Plan (DHMO Encounters Only)
|
|
| 9/10/2007 |
CX053
|
Pacificare Dental & Vision
Plan (PPO and IND Claims Only)
|
|
| 9/10/2007 |
TLX26
|
Paid Dental (TX)
|
|
|
CX001 |
Pan American (American Medical Security) |
|
2/18/2010
| DX106
| P.R.I.M.E Benefit Systems, Inc.
|
|
2/18/2010
| CX014
| Passport FFS - KY
|
|
2/18/2010
| CX014
| Passport Health Plan, Kentucky
|
|
9/10/2007
|
10525
|
Patient Advocates, LLC
|
|
| 32069 | Patriot Dental | |
| 9/10/2007 |
32069
|
Patriot Mutual Dental Programs
|
|
|
47009 |
Paul Revere/Provident |
|
| 9/10/2007 |
PRW01
|
Pavers & Roadbuilders
Welfare Fund
|
|
|
60054 |
PDO |
|
| 9/10/2007 |
TLW79
|
Pearl Insurance
|
|
| 9/10/2007 |
52133
|
Peoples Benefit Life Insurance
Company
|
|
| 9/10/2007 |
37121
|
Pequot Plus Health Benefit
Administrators
|
|
| 9/10/2007 |
TLX32
|
Performax, Inc.
|
|
2/18/2010
| TLX74
| Personal Choice PA (Contact payor, setup required thru Tesia-PCI)
|
|
|
67814 |
Phoenix American Life (PAL) |
|
9/10/2007
|
PHP01
|
Phoenix Health Plan (PHP) (AZ)
Claims ONLY
|
|
| 9/10/2007 |
PHP02
|
Phoenix Health Plan (PHP) (AZ)
Pre Determinations ONLY
|
|
|
67814 |
Phoenix Home Life |
|
|
67814 |
Phoenix Mutual Life Insurance |
|
9/10/2007
|
CX068
|
Physician's Mutual - Dental
|
|
| 9/10/2007 |
TLX05
|
Physicians Health Partners /
CDOC (CO)
|
|
|
CX014 |
Physicians Plus Insurance, Co., PrimeCare, Wisconsin State
Employees |
|
|
24735 |
Pinnacle Claims Management (Fresno, California only) |
|
9/10/2007
|
PIP01
|
Pipe Trades Industry Health
& Welfare Fund
|
|
| 9/10/2007 |
PIP02
|
Pipefitters 597 (Chicago,
IL)
|
|
| 9/10/2007 |
37224
|
Pitman & Associates
|
|
| 3/24/2010 |
37287
|
Planned Administrators, Inc. (PAI)
|
|
| 9/10/2007 |
PCM01
|
Plasterers' & Cement Masons'
Health & Welfare Fund
|
|
| 9/10/2007 |
TLX04
|
Plumbers & Steamfitters
Local 440
|
|
| 9/10/2007 |
TLW98
|
Plumbers & Steamfitters
Local 486
|
|
|
67466 |
PM Group |
|
| 9/10/2007 |
CDCAP
|
PMI
|
Contact Payor to receive
provider I.D. |
| 4/7/2004 |
32680 |
Poly America Medical & Dental Benefits Plan |
|
2/7/2005
|
16111
|
POMCO
|
|
2/7/2005
|
36373
|
Prairie States Enterprises, Inc.
|
|
2/18/2010
| 00621
| PreDent
|
|
9/10/2007
|
16112
|
Preferred Care (Gold & Gold
Value Claims ONLY)
|
|
| 9/10/2007 |
59291
|
Preferred Care (FL)
|
|
| 9/10/2007 |
56178
|
Preferred Care (NC)
|
|
|
68241 |
Preferred Dental Organization |
|
| 9/10/2007 |
31478
|
Preferred Health Professionals
|
|
2/18/2010
| 41147
| Preferred One
|
|
| 9/10/2007 |
47570
|
Premera Blue Cross
|
|
2/18/2010
| TLY54
| Premier Access Insurance
|
|
|
PREMD |
Premier Dental |
|
2/18/2010
| CX014
| Presbyterian Salud
|
|
|
56144 |
Primary Physician Care, Inc. (for claims mailed to Charlotte,
NC) |
|
| 3/17/2009
|
LX049 |
Prime West |
|
|
CX014 |
PrimeCare, Wisconsin State and Federal Emplyees and Medicaid |
|
|
61271 |
Principal Financial Group |
|
|
61271 |
Principal Mutual Life Insurance Co. |
|
2/18/2010
| 38217
| Priority Health
|
|
2/18/2010
| CX014
| Priority Partners
|
|
6/25/2004
|
36331
|
Professional Benefit
Administrators, Inc
|
|
| 9/10/2007 |
41163
|
Professional Claim Administrators
|
|
| 6/30/2003 |
70408 |
Protective Life Insurance Co. (For claims mailed to
Birmingham, AL) |
|
|
68195 |
Provident Life & Accident Insurance Co. |
|
|
68195 |
Provident Life & Casualty Insurance Co. |
|
|
68195 |
Provident Preferred Network |
|
|
68241 |
PruCare |
|
|
68241 |
PruCare HMO |
|
|
68241 |
PruCare Plus |
|
|
68241 |
Prudential |
|
|
68241 |
Prudential Dental Organization (PDO) |
|
|
68241 |
Prudential Health Care System (PHCS) |
|
|
68241 |
PruNetwork |
|
|
91136 |
Puget Sound Benefits Trust |
|
|
91136 |
Puget Sound Electrical Workers Trust |
|
9/10/2007
|
39197
|
Quad Med
|
|
| 9/10/2007 |
TLW95
|
Quality Benefits, LLC
|
|
2/18/2010
| CX077
| Quality Plan Administrators Inc
|
|
| 9/10/2007 |
TLX48
|
Qualmed - New Mexico
|
Contact Payor to receive
provider I.D.
|
|
30001 |
R.E. Harrington Group |
|
| 9/10/2007 |
91176
|
RBMS
|
|
2/18/2010
| 93200
| Regence Blue Shield
|
|
2/18/2010
| 93200
| Regence Northwest Health
|
|
2/18/2010
| 47076
| Regional Care, Inc.
|
|
2/18/2010
| RLHA1
| Renaissance Life and Health
|
|
| 9/10/2007 |
TLU81
|
Reynolds & Reynolds
|
|
6/25/2004
|
38221
|
Regency Employee Benefits
|
|
|
E3440 |
Reliance Standard Life |
|
|
80314 |
ReliaStar |
|
| 6/30/2003 |
41045 |
ReliaStar - now known as CoreStar formerly NW National Life
(For claims mailed to - PO Box 1195, Minneapolis, MN - 146 Industrial
Park Rd, Jackson, MN - 7830 East Broadway, Tucson, AZ |
|
| 9/10/2007 |
TLX22
|
RH Administrators
|
|
| 9/10/2007 |
TLU80
|
Risk and Benefit Management
Services
|
|
2/18/2010
| 50664
| Riverside San Bernardino County Indian Health Inc.
|
|
| 9/10/2007 |
16117
|
RMSCO
|
|
| 9/10/2007 |
TLX19
|
Rochester Laborers Welfare Fund
|
|
2/7/2005
|
41625
|
Rochester Public Schools
(Rochester, MN)
|
|
|
84102 |
Rocky Mountain Life Dental |
|
2/18/2010
| TRW01
| Roofers Waterproofers Local 136 HW Fund
|
|
7/10/2009
|
RR001 |
Royal Resources |
|
9/10/2007
|
TLW46
|
S & S Healthcare, Inc.
|
|
2/18/2010
| 37105
| Sage Technologies
|
|
2/18/2010
| 37137
| Sage Technologies - PBS
|
|
|
CX030 |
Safeguard |
|
| 9/10/2007 |
CX048
|
Safeguard HMO
|
|
| 34154 | Salvation Army | |
| 9/10/2007 |
37259
|
SAMBA
|
|
2/18/2010
| TFQ67
| Samba Federal Employee Benefit Assoc
|
|
2/18/2010
| 91184
| Sanford Health Plan
|
|
| 9/10/2007 |
TLU82
|
SBA Atlantic Coast Health Plan
|
|
| 9/10/2007 |
73172
|
Scan Health Plan Arizona
|
|
| 9/10/2007 |
20460
|
Scan Long Term Care
|
|
| 9/10/2007 |
TLW27
|
School Claim Services, LLC (PA)
|
|
| 9/10/2007 |
TLW26
|
School District #1 Health &
Welfare Fund
|
|
| 9/10/2007 |
TLX49
|
Scott & White
|
Contact Payor to receive
provider I.D.
|
|
CX023 |
Seabury & Smith (PO Box 1520, Iowa City, IA 53340) |
|
2/18/2010
| SCD01
| Secure Care Dental
|
|
9/10/2007
|
93742
|
Securian Dental Plan
|
|
| 3/31/2010 |
CX092
|
Security Life
|
|
| 9/10/2007 |
TLW45
|
Securus Group, Inc.
|
|
| 9/10/2007 |
TLU20
|
Sele-Dent, Inc.
|
|
| 9/10/2007 |
64088
|
Select Administrative Services
|
|
|
CX018 |
Select Benefit Administrators (For claims mailed to PO Box
8339, Des Moines, IA) |
|
|
68241 |
SelectCare (Coca Cola) |
|
| 9/29/2003 |
59111 |
Self Insured Benefit Administrators (for claims mailed to
Clearwater, FL) |
|
| 9/10/2007 |
TLX16
|
Self Insured Plans, Inc. (FL)
|
|
|
CX020 |
Self Insured Services Company (SISCO) (PO Box389, Dubuque, IA) |
|
|
34131 |
Self-Funded Plans, Inc. of Cleveland, OH |
|
9/10/2007
|
39033
|
Sentry Insurance Company, Sentry
Life of NY and Sentry Insurance A Mutual Co
|
|
| 9/29/2003 |
CX038 |
Serentas Dental Care Solutions (for claims mailed to PO Box
242840, Louisville, KY) |
|
| 9/10/2007 |
TSG01
|
Set Seg / Set, Inc.
|
|
| 9/10/2007 |
TLW25
|
SHASA Administrators
|
|
| 9/10/2007 |
SMW01
|
Sheet Metal 91 Health &
Welfare Fund
|
|
| 9/10/2007 |
30920
|
Sheet Metal Workers Local 20
(Must use member social security number, not Anthem Member ID number)
|
|
| 9/10/2007 |
TLW54
|
Sheet Metal Workers Local 46
|
|
| 9/10/2007 |
TLW55
|
Sheet Metal Workers Local 85
|
|
| 3/17/2009
|
41143 |
Sheffield Olson & McQueen |
|
| 9/10/2007 |
SLI01
|
Shenandoah Life Insurance Company
|
|
| 9/10/2007 |
TLX11
|
SHN Employee Dental
|
|
| 9/10/2007 |
76342
|
Sierra Health Services
|
|
6/25/2004
|
84076
|
Sinclair Health Plan
|
|
2/18/2010
| CX030
| Smile Saver
|
|
9/10/2007
|
TLW21
|
Smith Administrators
|
|
9/10/2007
|
91136
|
South Bay H.E.R.E. Funds
|
|
| 9/10/2007 |
23266
|
South Central Preferred - PPO
York, PA (I H S Gateway Payer)
|
|
2/18/2010
| 37314
| South FL Community Care Network - NBHD
|
|
| 9/10/2007 |
35227
|
South Point Hotel & Casino
|
|
| 9/10/2007 |
SEI01
|
Southeastern Service Employee
International Union (SEIU)
|
|
| 9/10/2007 |
TLU87
|
Southern Alaska Carpenters Trust
|
|
| 9/10/2007 |
37318
|
Southern Benefit Services
|
|
| 9/10/2007 |
TLW41
|
Southern California Pipe Trades
|
|
| 9/10/2007 |
SEF01
|
Southern Electrical Health Fund
|
|
6/25/2004
|
56131
|
Southern Group Administrators
|
|
| 9/10/2007 |
CX051
|
SouthWest Benefits
|
|
|
68241 |
Southwestern Bell |
|
|
68241 |
Southwestern Bell Executive-Custom Care |
|
|
68241 |
Southwestern Bell Executive-Southwestern Bell |
|
9/10/2007
|
84147
|
Spina Bifida - VA HAC
|
|
| 9/10/2007 |
TLW40
|
SRC (Strategic Resource Company)
|
|
| 9/10/2007 |
TSBM1
|
St. Louis Blue Cross of Missouri
|
|
| 9/10/2007 |
TLU84
|
St. Tammany Federation of
Teachers
|
|
2/18/2010
| 37116
| St. Therese Physician Association
|
|
5/20/2005
|
69019
|
Standard Insurance
|
|
| 5/20/2005 |
89009
|
Standard Insurance Co. of New
York
|
|
|
93024 |
Standard Insurance Co. of Oregon |
|
| 9/10/2007 |
TLW66
|
Star HRG / Star Administrative
Services
|
|
| 9/10/2007 |
STR01
|
Starmount Life Insurance Company
|
|
|
69140 |
State Mutual Life Assurance Company of America |
|
| 9/29/2003 |
57254 |
State of Texas Dental Plan (for claims mailed to
Independence, MO) |
|
| 9/10/2007 |
TLW31
|
Stirling & Stirling
|
|
| 4/7/2004 |
31121 |
Stoner and Associates |
|
6/25/2004
|
58128
|
Stowe Associates
|
|
| 9/10/2007 |
64246
|
Strategic Outsourcing, Inc.
(SOI) (Group V5019)
|
|
|
74227 |
Student Insurance Division |
|
2/18/2010
| CX014
| Suffolk County
|
|
| 9/10/2007 |
TLX37
|
SummaCare
|
|
| 11/13/2008 | 67814 | Sun Life and Health Insurance Company (formerly Genworth Life - GLHIC) | |
|
47009 |
Sun Life of Canada |
|
|
68241 |
Sun Trust Bank, Inc. |
|
|
31117 |
Superior Dental Care |
|
2/18/2010
| TLX77
| Symetra
|
|
9/10/2007
|
TLX50
|
TASB (TX Assn of School Boards)
|
|
|
73288 |
TDC (The Dental Companies)
|
Contact Payor to receive provider I.D.
|
| 9/10/2007 |
88020
|
Teachers Health Trust (PO Box
96238, Las Vegas, Nevada)
|
|
| 9/10/2007 |
TLW39
|
Teamster Health Welfare
|
|
| 9/10/2007 |
TLW37
|
Teamsters Local 618 Health Fund
|
|
| 9/10/2007 |
TLW38
|
Teamsters Local 671 Health Fund
|
|
| 9/10/2007 |
TLW36
|
Teamsters Local 72 Welfare Fund
|
|
| 9/10/2007 |
TLW35
|
Teamsters Union Local 677
|
|
| 9/10/2007 |
22228
|
Teamsters Welfare Fund (MI)
|
|
2/18/2010
| CX014
| TennCare
|
|
| 9/10/2007 |
CPPTX
|
Texas CHIP Dental Services
|
|
|
80659 |
The Canada Life Assurance Company (for claims mailed to
Atlanta,GA) |
|
9/10/2007
|
74227
|
The Chesapeake Life Insurance
Company - Student Insurance (Payor ID valid only if the PO Box on the
Health ID Card matches one of the following PO Boxes: Box 890025,
809067, 809079, 809066, 809036, 809081, Dallas, TX 75380-9025)
|
|
9/10/2007
|
TDN01
|
The Dental Network (in state
dentists only)
|
|
| 9/10/2007 |
TLW10
|
The Loomis Company
|
|
| 9/10/2007 |
74227
|
The MEGA Life & Health
Insurance Company - Student Insurance (Payor ID valid only if the PO
Box on the Health ID Card matches one of the following PO Boxes:
Box 890025, 809067, 809079, 809066, 809036, 809081, Dallas, TX
75380-9025)
|
|
| 9/10/2007 |
TLW84
|
The Plan Handlers, Inc.
|
|
|
87726 |
The Travelers |
|
| 9/10/2007 |
TLX54
|
Third Party Administrator
(Tucker, GA)
|
|
|
06131 |
Third Party Claims Management |
|
| 9/29/2003 |
25175 |
Three Rivers Health Plans, Inc. (for claims mailed to PO Box
967, Monroeville, PA) |
Call Three Rivers Health Plans for Provider I.D. |
| 9/10/2007 |
TIC01
|
TIC International, Inc.
|
|
| 9/10/2007 |
TLX02
|
TICUA Benefit Consortium
|
|
|
39065 |
Time Insurance (A Fortis Company) |
|
9/10/2007
|
TLU96
|
TML Group Benefits, Inc.
|
|
| 9/10/2007 |
TLX01
|
Total Administrative Services
Corp.
|
|
| 9/10/2007 |
TLU07
|
Total Benefit Services (LA)
|
|
| 11/13/2008 | TLY37 | Total Claim Service (TX) | |
| 9/10/2007 |
TCS01
|
Total Claims Solutions
|
Contact Payor to receive
provider I.D. |
2/7/2005
|
69493
|
Tower Life Insurance
|
|
2/18/2010
| CX025
| TPAC
|
|
| 9/10/2007 |
37230
|
TR Paul, Inc.
|
|
|
87726 |
Travelers Health Network (HMO & Care Option) |
|
|
87726 |
Travelers Plan Administrators |
|
5/20/2005
|
73288
|
Tricare Active Reservists (TSRDP
Dental Claims)
|
|
|
30000 |
Tricare Family Members Dental Plan |
Call UCCI @ 800-633-5430 for registration info. |
| 5/20/2005 |
DDPFS
|
Tricare Retiree Dental Program
|
|
|
84103 |
Trigon |
|
|
CB923 |
Trigon Blue Cross of Virginia |
Call Trigon for Provider I.D. |
|
CB923 |
Trigon Health Keepers, Inc. (Trigon Blue Cross of Virginia) |
Call Trigon for Provider I.D. |
| 4/7/2004 |
91078 |
Trusteed Plan Service Corporation |
|
| 9/10/2007 |
TLW23
|
Trustmark Insurance (Clinton, IA)
|
|
| 9/29/2003 |
61425 |
Trustmark Insurance (Lake Forest, IL) |
|
| 9/10/2007 |
60054
|
TRW
|
|
| 9/10/2007 |
73288
|
TSRDP Dental Claims (Claims ONLY
for PO Box 19081, Green Bay, WI)
|
|
| 9/10/2007 |
TLW09
|
Tube Light Company, Inc.
|
|
|
UCARE |
UCARE (Delta Dental of Minnesota Medical Assistance) |
|
| 9/10/2007 |
TLW49
|
UFCW Health & Welfare
Fund of PA
|
|
| 9/10/2007 |
UFW01
|
UFCW Local 1
|
|
| 9/10/2007 |
TLW52
|
UFCW Local 1996
|
|
| 9/10/2007 |
TLW94
|
UFCW Local 400, 534, 655, 881
Welfare Fund
|
|
| 9/10/2007 |
A5205
|
UFCW Local 400-5205
|
|
| 9/10/2007 |
TLW67
|
UFCW Local 56
|
|
| 9/10/2007 |
UFC01
|
UFCW of Central Ohio
|
|
| 9/10/2007 |
UFC02
|
UFCW of Cleveland
|
|
5/20/2005
|
62308
|
UFT Wellfare Fund
|
|
|
75245 |
UICI - Administrators - State of Nevada |
|
|
80314 |
UNICARE Individual - Small Group |
|
|
65099 |
UniCARE Life & Health (Formerly Mass Mutual) |
|
|
80314 |
UNICARE Major Accounts |
|
|
47195 |
Unicare of Texas |
|
|
65099 |
UniCARE Special Accounts (Formerly John Hancock) |
|
9/10/2007
|
47009
|
Unifi Companies
|
|
| 9/10/2007 |
TLA03
|
Unified Group Services
|
|
2/7/2005
|
75243
|
Uniform Medical Plan/Harrington
Benefit Services
|
|
9/10/2007
|
52133
|
Unimerica Dental
|
|
| 9/29/2003 |
13142 |
Union Labor Life Insurance Company (for claims mailed to King
of Prussia, PA) |
|
2/18/2010
| 70408
| Union Security Insurance Company
|
|
| 9/10/2007 |
52133
|
Unique Dentacare
|
|
2/18/2010
| CX014
| Unison Health Plan formerly Better Health Plan
|
|
2/18/2010
| 25175
| Unison Health Plan - Three Rivers
|
|
| 9/10/2007 |
TLW80
|
United Benefits (FBMC)
|
|
|
UCCI1 |
United Concordia |
|
|
UCCIP |
United Concordia Plus |
|
|
UCCI1 |
United Concordia Select |
|
|
30000 |
United Concordia - Tricare
Family Members Dental Plan |
|
| 9/10/2007 |
70408
|
United Dental - Texas
|
|
5/20/2005
|
52133
|
United Healthcare
|
|
2/7/2005
|
33108
|
United Medical Resources (UMR) - Cincinnati
|
|
2/18/2010
| 95266
| Untied Medical Resources (UMR) - Harrington (Columbus)
|
|
2/18/2010
| 75196
| Untied Medical Resources (UMR) - Harrington (Westerville)
|
|
2/18/2010
| 37237
| Untied Medical Resources (UMR) - Lexington
|
|
2/18/2010
| 79480
| Untied Medical Resources (UMR) - Onalaska
|
|
2/18/2010
| 74223
| Untied Medical Resources (UMR) - San Antonio
|
|
2/18/2010
| 39026
| Untied Medical Resources (UMR) - Wausau
|
|
|
71412 |
United of Omaha |
|
| 9/10/2007 |
TLW89
|
United Security Life
|
|
|
13545 |
United States Life Insurance Company |
|
| 9/10/2007 |
UNT01
|
Unity Health Plan
|
|
| 9/10/2007 |
16105 |
Univera Healthcare of New York |
Contact Payor to receive provider I.D. |
| 6/30/2003 |
91136 |
University of Washington Students & Graduate Appts. |
|
2/18/2010
| CX014
| UPMC Health Plan - Dental
|
|
9/10/2007
|
37324
|
Upper Peninsula Health Group
(TPA)
|
|
| 9/10/2007 |
TLW47
|
Upstate Administrative Services,
Inc.
|
|
| 9/10/2007 |
TLW48
|
US Benefits
|
|
| 9/10/2007 |
TLW22
|
US Plan Administrators
|
|
2/18/2010
| 76031
| USAble Life
|
|
| 9/10/2007 |
EXC02
|
Utica Blue Cross
|
Contact Payor to receive
provider I.D. |
| 8/15/2003 |
12115 |
VA Fee Basis Programs |
|
| 9/10/2007 |
VHP01
|
Valley Health Plan (WI)
|
Contact Payor to receive
provider I.D. |
|
68241 |
Varian Health Care Plan |
|
2/18/2010
| 75256
| Verity National Group
|
|
| 9/10/2007 |
TLX51
|
Via Care
|
Contact Payor to receive
provider I.D.
|
2/18/2010
| CX014
| Virginia Smiles for Children
|
|
|
91062 |
Washington Dental Services |
|
9/23/2004
|
37294
|
Washington Employers Trust
|
|
|
91136 |
Washington State Council of County & City Employees Trust |
|
9/10/2007
|
73155
|
Waterstone Benefit Administrators
|
|
| 9/10/2007 |
TLU85
|
Watkins Associated Industries
|
|
|
39026 |
Wausau Insurance Companies |
|
|
39151 |
WEA Insurance Group |
|
| 9/10/2007 |
10050
|
Webster Dental
|
|
|
75261 |
webTPS/Community Health Electronic Claims/CHEC |
|
9/10/2007
|
TLX10
|
Welfare Fund of the Int'l Unioin
of Operating Engineers Local (NY)
|
|
| 9/10/2007 |
91136
|
Welfare & Pension Service
Group Listing (Seattle, WA)
|
|
2/18/2010
| CX014
| Wellcare
|
|
|
47198 |
Wellpoint Dental |
|
2/18/2010
| 37272
| Wells Fargo Third Party Administrators f.k.a. JSL Admini
|
|
2/18/2010
| 87815
| Wells Fargo Third Party Administrators, Inc Charleston, NC
|
|
| 9/10/2007 |
TLW51
|
Wen-Neb Inc
|
|
| 6/30/2003 |
91136 |
West Coast Stationary Engineers Health & Security Trust
Fund |
|
| 9/10/2007 |
TLX18
|
West Lake TPA
|
|
7/28/2010
|
93128 |
Western Grocers Employee Benefit Trust |
|
|
24735 |
Western Growers (for claims mailed to Newport Beach,
California) |
|
9/10/2007
|
TLW34
|
Western PA Electrical Employees
Insurance Trust
|
|
| 9/10/2007 |
TLW33
|
Western PA Teamsters Fund
|
|
| 9/10/2007 |
91060
|
Western Teamsters Welfare Trust
|
|
2/18/2010
| 90560
| WestLake Financial Group, Inc. Buffalo Grove, IL
|
|
| 9/10/2007 |
TLW08
|
Westport Benefits
|
|
|
84098 |
Whatcom Medical Bureau |
|
2/18/2010
| CX014
| WI State Employees - Managed Health Services
|
|
| 9/10/2007 |
93050
|
William C. Earhart
|
|
| 9/10/2007 |
98010
|
William J Sutton & Co LTD
(Toronto, Ontario - Canada)
|
|
|
R7002 |
Wilson McShane |
|
| R7006 | Wisconsin Auto & Truck Dealers Assoc. (WATDA) | |
| 9/10/2007 |
TLA06
|
Woods & Grooms Benefit
Services
|
|
| 9/10/2007 |
20333
|
Worksite Benefit Services, LLC
|
|
|
62154 |
Xantus Health Plan (for claims mailed to Nashville, TN) |
|
|
R7001 |
Zenith Administrators |
|
