Lindsay Technical Consultants, Inc.
42496 Lindsay Drive
North Mankato, MN 56003
Tel 507-947-3070
Fax 507-947-3077
E-Mail: info@lindtech.com


Dental Claims Payor List as of 9/10/2007 sorted by Payor Name.

Note: For Payors issuing a Provider I.D. without requiring enrollment forms, call or email LTC with the assigned Provider I.D.

Downloads for additional enrollment forms are listed below or go to the download area. Call or email LTC if further help is needed.

If you need the Adobe Acrobat Reader in order to read the (.PDF) file format, download the free version here first...


New Payor Payor I.D. Payor Name Additional Enrollment Required
9/10/2007
TLU12
1199 National Benefit Fund

9/10/2007
20413
3P Admin

4/7/2004 CX044 A&I Benefits  
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

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 of Georgia (1932 Wynnton Road, Columbus, GA 3199907251)
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)
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


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)  

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

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

6/30/2003 74227 Bankers United Life
6/25/2004
49153
BCI Administrators Inc


68241 Bell Atlantic

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)

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)

07000 Benefits Inc. (Construction Suppliers group only)
5/20/2005
BMX01
Benemax

9/10/2007
87265
BeneSight

9/10/2007 37248
Benesys, Inc. (Lafayette, LA)

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

11/13/2008 BBFL1 Blue Cross Blue Shield of Florida
8/15/2003 H0143 Blue Cross Blue Shield of Georgia Download form (PDF)

CBMI1 Blue Cross Blue Shield of Michigan

22099 Blue Cross Blue Shield of New Jersey Download form (PDF)
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.

H0098 Blue Cross Blue Shield of Ohio (Anthem)  
11/13/2008 BBOK1 Blue Cross Blue Shield of Oklahoma
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 Download form (PDF)

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 Download form (PDF)

BS018 Blue Cross of Illinois Download form (PDF)

84105 Blue Cross of Indiana (Anthem)


CBIA1 Blue Cross of Iowa (FEP and Farm Bureau claims only) Download form (PDF)

CBIA2 Blue Cross of Iowa (First Administrators and Wellmark) Download form (PDF)

CBKS1 Blue Cross of Kansas Download form (PDF)

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 Download form (PDF)

CBMA2 Blue Cross of Massachusetts PPO Download form (PDF)
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) Download form (PDF)

66668 Blue Cross of Oregon Download form (PDF)

53473 Blue Cross of Rhode Island Download form (PDF)

CBTN1 Blue Cross of Tennessee Download form (PDF)

84980 Blue Cross of Texas Download form (PDF)

47570 Blue Cross of Washington (State)

22226 Blue Cross of Wisconsin Download form (PDF)

BLUEP Blue Plus (Delta Dental of Minnesota Medical Assistance)

CBID2 Blue Shield of Idaho Download form (PDF)

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)

61492 Businessmens Assurance
9/10/2007
42150
Butler Benefits

9/10/2007 CX075
C. L. Frates


80659 Canada Life (for claims mailed to Atlanta, GA only)
6/30/2003 37105 Cannon Cochran Management Services, Inc.(Danville, IL)
inactive 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
9/10/2007
TLW14
CBCA - Comprehensive Benefits & Claims Administrators


41124 CBSA Corporate Benefit Services of America
9/10/2007
10050
CDH (Cigna Dental Care)

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

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

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)

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

  52132 Cooperative Benefit Administrators  
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)  
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


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.
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

07027 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

56010 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

07025 Delta Dental of Wyoming
9/10/2007
94235
Delta Health Systems


07000 Delta USA (Minnesota employers only)
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)
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
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)
Download form (PDF)
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.
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
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.


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
9/10/2007
TLU66
Fiserv Health

4/7/2004 11244 FitzHarris & Company Inc  
9/10/2007 TLX53
FL League of Cities


68241 FlexCare
9/10/2007 TLU70
Flexible Benefit Fund

9/10/2007 TLW93
Florida Benefit Administrators

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

9/10/2007 TLU19
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 

4/7/2004 CX041 Fraternal Order of Police  
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

  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

9/10/2007 TLU74
Gettysburg Insurance Services


13551 GHI (Group Health Insurance of New York)
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)
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

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  
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

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
9/10/2007
HGL01
Heavy & General Laborers

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
Download form (PDF)

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)  
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

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 Download form (PDF)

65099 John Hancock Health Security Plan

65099 John Hancock Mutual Life Insurance Co.

65099 John Hancock Preferred Health Plan

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

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


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
9/10/2007
LSH01
Laborers' Southeast Health & Welfare Plan

9/10/2007 TLU99
Lawrence Paper Company


44066 Lewer Agency (Bartlesville, OK office only)

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


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 Download form (PDF)

98010 Manulife, W.J. Sutton Co. of Toronto, Ontario

68241 Marriot
11/13/2008CX023Marsh Advantage
9/10/2007
TLU77
Mashantucket Pequot  


65935 Massachusetts Mutual

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)

MEDIC Medica Commercial

MEPUB Medica Public Programs (Medica MA, MEDICAID, HMO)

CKAL1 Medicaid of Alabama Download form (PDF)

CKAL1 Medicaid of Alabama Change of Tax Identification Number Only Download form (PDF)

CKAK1 Medicaid of Alaska Download form (PDF)
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 Download form (PDF)

22235 Medicaid of Connecticut Download form (PDF)

CKDE1 Medicaid of Delaware
9/10/2007
MDDC1
Medicaid of District of Columbia (DC)


55555 Medicaid of Florida Download form (PDF)

E0920 Medicaid of Georgia Download form (PDF)

CX014 Medicaid of Georgia, Grady Healthcare, Inc. Download form (PDF)

E0900 Medicaid of Idaho Download form (PDF)

CKIL1 Medicaid of Illinois Download form (PDF)

E0730 Medicaid of Indiana Download form (PDF)

CKIA1 Medicaid of Iowa Download form (PDF)

CKKS1 Medicaid of Kansas Download form (PDF)

E0510 Medicaid of Kentucky Download form (PDF)

CKKY3 Medicaid of Kentucky Region #3 (Doral Dental Services) Download form (PDF)
9/10/2007
TLU10
Medicaid of Kentucky Region #5 (KY Health Select)


E3670 Medicaid of Louisiana (Adult 21 and older) Download form (PDF)

22000 Medicaid of Louisiana (EPSDT) Download form (PDF)

CKME1 Medicaid of Maine Download form (PDF)

CX014 Medicaid of Maryland, PhysiciansCare MCO Download form (PDF)
9/10/2007
MDMD1
Medicaid of Maryland (Dept of Health & Mental Hygiene)


CKMA1 Medicaid of Massachusetts (diskette from Clearing House to Payor) Download form (PDF)

MIMD1 Medicaid of Michigan Call or email LTC

MNMA1 Medicaid of Minnesota (Minnesota Medical Assistance) Download form (PDF)

E3240 Medicaid of Mississippi Call or email LTC

CX014 Medicaid of Missouri, Blue Advantage Download form (PDF)

CX014 Medicaid of Missouri, Community Care Plus-St. Louis Download form (PDF)

CX014 Medicaid of Missouri, Community Health Plans Download form (PDF)

CX014 Medicaid of Missouri, FirstGuard Health Plan Download form (PDF)

CX014 Medicaid of Missouri, HealthCare USA-St. Louis Download form (PDF)

CX014 Medicaid of Missouri, Healthnet Download form (PDF)
6/30/2003 CKMO1 Medicaid of Missouri (Medicaid claims administered by GTE Data Services Inc.) Download form (PDF)

CX014 Medicaid of Missouri, TrumanCare-Family Health Partners Download form (PDF)

MTMDC Medicaid of Montana CHIPS Download form (PDF)

CKMT1 Medicaid of Montana (for claims mailed to PO Box 8000, Helena, MT) Download form (PDF)

CX014 Medicaid of Nebraska, United HealthCare of the Midlands Download form (PDF)
9/23/2004 CKNV1 Medicaid of Nevada Download form (PDF)

E3360 Medicaid of New Hampshire Download form (PDF)

66665 Medicaid of New Jersey Download form (PDF)

CX014 Medicaid of New Mexico, Cimmaron Health Plan Download form (PDF)

CX014 Medicaid of New Mexico, Lovelace Community Health PLan Download form (PDF)
6/30/2003 CKNM1 Medicaid of New Mexico (Medicaid claims administered by Consultec/ACS) Download form (PDF)

CX014 Medicaid of New Mexico, Presbyterian Salud Download form (PDF)

CKNY1 Medicaid of New York Download form (PDF)

CKNY2 Medicaid of New York (Clinics whose category of sevice is 0287) Download form (PDF)

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 Call Caresource @ 937-224-8313 for Provider I.D.

CX014 Medicaid of Ohio, Emarald HMO and Medicare, Inc. Download form (PDF)

CX014 Medicaid of Ohio, Health Power HMO, Cincinnati Download form (PDF)

CX014 Medicaid of Ohio, Personal Physicians Care, Cleveland Download form (PDF)

CX014 Medicaid of Ohio, United HealthCare, Inc. Medicare Complete Download form (PDF)

E0880 Medicaid of Oklahoma Download form (PDF)

CX014 Medicaid of Oklahoma, Community Care Download form (PDF)

CX014 Medicaid of Oklahoma, Heartland Health Plan Download form (PDF)
6/30/2003 CKOK1 Medicaid of Oklahoma (Medicaid claims administered by Unisys) Download form (PDF)

CX014 Medicaid of Oklahoma, Unicare Health Plan Download form (PDF)

<