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Change Healthcare Dental Payer COMMERCIALGrou Enrolp#lA & I Benefit Plan Administrators93044A.D.N. Administrators, MERCIALYesNoClaimsYYAARPAARP1Acceptius (Benefit Management Inc of MO (BMI)43178ParCOMMERCIALYesNoAccess COMMERCIALYesClaimsClaimsNPI 50102041393044COMMERCIALNoNoService3P AdminA & I Benefit Plan AdministratorsAccess DentalYesYesPayer Enrollment TurnaroundTimeEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.30 Business DaysEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the msYY61474ParCOMMERCIALYesNoClaimsYYActiva Benefit Services, LYesCX076ParCOMMERCIALYesNoAdvantage by SuperiorCPPSAParCOMMERCIALYesYesAdvantage Dental Plan, Inc.Advantek Benefit AdministratorsAdvantica ALCOMMERCIALNoYesYesNoNoNoAdvantica Benefits43168COMMERCIALYes5-7 Business DaysAdvantica Benefits43168COMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.Advantica BenefitsAdvantica BenefitsAdventist Health System West - Roseville, entist Health System West - Roseville, CA95340COMMERCIALYes1-3 Business DaysAdventist Health System West - Roseville, CA95340COMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the NoEligibility InquiryClaim Status InquiryAetna68246ParCOMMERCIALYesNoEncountersAetna Affordable Health Choices (SM) - SRCAetna Medicare EPO/PPO DentalAffordable Benefits Admin.AFLAC Eligibility InquiryAFLAC GA - GRP58066ParCOMMERCIALYesNoAFLAC RCIALNoYClaimsRClaimsClaimsClaimsYYY35-40 Business DaysRequires EFT for ERAEnrollmentERA Payer Enrollment FormRequiredERA Paper RA Shut OffPayer accepts enrollment requestfrom Change Healthcare.NoNoImmediatelyPayer accepts enrollment requestfrom Change Healthcare.NoNoMinimum of 31 Business days or3 payment cyclesPayer accepts enrollment requestfrom Change Healthcare.NoNoMinimum of 31 Business days or3 payment cyclesPayer requires paper enrollmentform.NoYes30 DaysAARP Claims with a mailingaddress of PO Box 2059,Mechanicsburg, PATax ID & NPI requiredf.k.a. ACS Consulting Services,Inc.ACS Branded Dental Product(Formerly AmwayCorporation/Dental)Additional enrollment is notrequired by the payer, however,providers wishing to submitClaims electronically must becredentialed with the payer.Please ensure you havesuccessfully process one paperClaims with the payer prior tosubmitting your first electronicClaimsEffective only for Dates of Serviceprior to 2-01-13. CallDentaQuest at 800-896-2374 andMCNA Dental at 855-776-6262 forDates of Service 2-1-13 andgreaterYYYERATax ID / NPI CombinationEFTTax ID & NPI requiredDetailed BenefitsYYERATax ID onlyEFTClaimsERA Enrollment TypeTax ID onlyClaimsEligibility InquiryClaim Status InquiryClaimsNoTax ID & Provider ID requiredEFTAdministrative Services Only, Inc.Payer's discretionEnrollment requires your Tax IDNumber plus a 4-digit Suffix thatcan be found on the same line asyour provider TIN on your mostrecent explanation of benefits.Tax ID / NPI combinationEFTACS Benefit Services, Inc.22384ERA/EFT Enrollment Levelvia Performance HealthTechnologyLegacy ID - For Providers, usetheir Facility/Office NPI. ForBrokers, use their Agency IDwhich is either a 4 or 5 digitcode. The 4 digit code starts witha 5 and the 5 digit code start witha2ACS Benefit Services Inc.Administrative Concepts, Inc.SAdditional InfoYClaimsAcclaimsEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.ICD10Required asofComplianceDateICD1ICD100TestinReadgyTax ID onlyYERAYERAs returned for claims and pretreatment estimates.YDetailed BenefitsYYYRYYYYClaimsYYNoClaimsYYAFLAC NY52080NoEligibility InquiryAFLAC NY - ALYesNoClaimsYYUse this Payer ID for submittingDMO services only.Detailed BenefitsGroup Plan coverage please referto your ID card for groupcoverage/number verification.This plan also shares the samemailing address as payer ID58066 and the only differencebetween the plans is that theinsured ID for theNY basedplan begins with "PN" as"PNxxxxxx" (followed by 6 digits)Detailed BenefitsGroup Plan Coverage please referto your ID card for groupcoverage/number verification.Please enter group # F07 whensubmitting claims. A Welfare andPension Administration ServicespayerAGC International Union of Operating Engineers Local 7011Tax ID / NPI combination
Change Healthcare Dental Payer List8/16/2016StatePayerIDTypeModelGrou Enrolp#lPayer Enrollment TurnaroundTimeServiceNPI 5010ICD10Required asofComplianceDateICD1ICD100TestinReadgyAdditional InfoERA/EFT Enrollment LevelERA Enrollment TypeRequires EFT for ERAEnrollmentERA Payer Enrollment FormRequiredERA Paper RA Shut OffPayer accepts enrollment requestfrom Change Healthcare.NoNoMinimum of 31 Business days or3 payment cyclesTax ID onlyPayer accepts enrollment requestfrom Change Healthcare.NoNoMinimum of 31 Business days or3 payment cyclesPayer accepts enrollment requestfrom Change Healthcare.NoNoMinimum of 31 Business days or3 payment cyclesPayer accepts enrollment requestfrom Change Healthcare.NoNoMinimum of 31 Business days or3 payment cyclesPayer accepts enrollment requestfrom Change Healthcare.NoNoMinimum of 31 Business days or3 payment cyclesTax ID onlyPayer accepts enrollment requestfrom Change Healthcare.NoNoMinimum of 31 Business days or3 payment cyclesTax ID onlyPayer accepts enrollment requestfrom Change Healthcare.NoNoMinimum of 31 Business days or3 payment cyclesPayer accepts enrollment requestfrom Change Healthcare.NoNoMinimum of 31 Business days or3 payment cycles91136COMMERCIALYes1-3 Business DaysERATax ID only91136COMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.EFTTax ID onlyAGC International Union of Operating Engineers Local 701AGC International Union of Operating Engineers Local 70191136ParCOMMERCIALYesNoClaimsYPlease enter group # F45 whensubmitting claims. A Welfare andPension Administration ServicespayerYAK United Food and Commercial Workers (AK UFCW)91136AK United Food and Commercial Workers (AK UFCW)Alameda AllianceCOMMERCIALYes1-3 Business ERCIALYesNoClaimsYYAdmin by LIBERTY Dental PlanPlease enter group # F40 whensubmitting claims. A Welfare andPension Administration ServicespayerAlask Carpenters91136COMMERCIALYes1-3 Business DaysERATax ID only91136COMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.EFTTax ID onlyAlask CarpentersAlask CarpentersAlaska Electrical Health & Welfare IALYesNoClaimsYYPlease enter group # F41 whensubmitting claims. A Welfare andPension Administration ServicespayerAlaska Hotel Employees, Restaurant & Camp Employees (AK HERE)91136COMMERCIALYes1-3 Business DaysERATax ID only91136COMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.EFTTax ID onlyAlaska Hotel Employees, Restaurant & Camp Employees (AK HERE)Alaska Hotel Employees, Restaurant & Camp Employees (AK HERE)91136ParCOMMERCIALYesNoClaimsYPlease enter group # F23 whensubmitting claims. A Welfare andPension Administration ServicespayerYAlaska Laborers Construction Industry Health & Security Trust91136COMMERCIALYes1-3 Business DaysERATax ID only91136COMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.EFTTax ID onlyAlaska Laborers Construction Industry Health & Security TrustAlaska Laborers Construction Industry Health & Security Trust91136ParCOMMERCIALYesNoClaimsYPlease enter group # F21 whensubmitting claims. A Welfare andPension Administration ServicespayerYAlaska Machinists Health and Welfare Trust91136COMMERCIALYes1-3 Business DaysERAAlaska Machinists Health and Welfare Trust91136ParCOMMERCIALYesNoClaimsYPlease enter group # F24 whensubmitting claims. A Welfare andPension Administration ServicespayerYAlaska Pipe Trades U A Local 37591136COMMERCIALYes1-3 Business DaysERAAlaska Pipe Trades U A Local 37591136ParCOMMERCIALYesNoClaimsYPlease enter group # F60 whensubmitting claims. A Welfare andPension Administration ServicespayerYAlaska Public Employees Association (APEA/JESS Health & WelfareTrust)91136COMMERCIALYes1-3 Business DaysERATax ID only91136COMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.EFTTax ID onlyAlaska Public Employees Association (APEA/JESS Health & WelfareTrust)Alaska Public Employees Association (APEA/JESS Health & WelfareTrust)Alexian Brothers Community Services of TNAllCare CCO ClaimsYYAllegeant52193Allegiance Benefit Plan81040COMMERCIALParCOMMERCIALYesYesNoEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.via Performance HealthTechnologyf.k.a. LBA Health PlansEFTClaimsf.k.a. LBA Health PlansRY2Tax ID only
Change Healthcare Dental Payer List8/16/2016StatePayerGrou Enrolp#lTypeModel70106ParCOMMERCIALYesAllied Benefit Systems37308ParCOMMERCIALYesAllied Benefit Systems37308Alliant yer Enrollment TurnaroundTimeEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.NoServiceNPI 5010ClaimsRYClaimsYYICD10Required asofComplianceDateICD1ICD100TestinReadgyAdditional InfoRequires EFT for ERAEnrollmentERA Payer Enrollment FormRequiredERA Paper RA Shut OffPayer accepts enrollment requestfrom Change Healthcare.NoNoMinimum of 31 Business days or3 payment cyclesTax ID / NPI combinationChange Healthcare Creates anauto approval for each active ERAaccount upon submission of thefirst claim for the payer after theERA account is activated.NoNoNoneTax ID / NPI combinationChange Healthcare Creates anauto approval for each active ERAaccount upon submission of thefirst claim for the payer after theERA account is activated.NoNoNoneTax ID / NPI combinationPayer accepts enrollment requestfrom Change Healthcare.NoNoNoneTax ID / NPI combinationPayer accepts enrollment requestfrom Change Healthcare.NoNoNoneClaims mailing address of PO Box12009, Cheshire, CTEFTClaimsERA Enrollment TypeERA/EFT Enrollment LevelTax ID & Provider ID RequiredYPlease enter group # F18 whensubmitting claims. A Welfare andPension Administration ServicespayerYAllied Metal Crafts Security Plan Trust Fund91136COMMERCIALYes1-3 Business DaysERATax ID only91136COMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.EFTTax ID onlyAllied Metal Crafts Security Plan Trust FundAllied Metal Crafts Security Plan Trust FundAlwaysCare BenefitAmalgamated Life - PA AlicareAmeriben merican Administrators dba Select Benefit Administrators (West Des Moines, IA)42137ParCOMMERCIALYesNoClaimsYYAmerican Benefit CorporationCX084ParCOMMERCIALYesNoClaimsYAmerican Medical SecurityAmerican Postal Workers Union Health PlanAmericas s TPA41178Amerihealth AdministratorsAmeritas Life Insurance Corp.5476347009Ameritas Life Insurance Corp.47009Ameritas Life Insurance Corp.Ameritas Life Insurance Corp.Ameritas Life insurance Corp. of New York470094700972630Ameritas Life insurance Corp. of New oYesYesCOMMERCIAL1-3 Business DaysTax ID required NPI optionalRRERAEligibility InquiryClaim Status InquiryClaims1-3 Business LEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.YYYYes/No ResponseRERAYYAmeritas Life insurance Corp. of New YorkAmeritas Life insurance Corp. of New York7263072630NoNoEligibility InquiryClaim Status InquiryAmway Corporation38255ParCOMMERCIALYesNoClaimsYYAnchor BenefitAntares Management SolutionsAnthem Health Plans - HMOD & HMOGAnthem Health Plans of Kentucky - OSB High & LowAnthem Health Plans of Kentucky - PPOB & PPODAnthem Health Plans of Virginia - OSB High & LowAnthem Health Plans of Virginia - PPOB & PPODAnthem HMO Colorado - HMO-BAnthem Insurance - OSB High & LowAnthem Insurance - PPOB & PPODARC AdministratorsArgus Dental Plans, Inc.Arkansas Best Corporation - Choice BenefitsAspenASR YYYYYRRYRYYYYYYYYYYYYYYYYAssociation Benefit Plan25133ParCOMMERCIALYesNoClaimsYYAssociation Benefit Plan25133Assurant Employee BenefitsAssurant Health (IM & GROUP FULLY - INSURED )7040839065Assurant Health (IM & GROUP FULLY - INSURED )39065COMMERCIALYes1-3 Business DaysERAAssurant Health (IM & GROUP FULLY - INSURED )39065COMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.EFTSupplemental CoverageAssurant, Inc,Assured Benefits AdministratorsAtlantic Dental Inc. (ADI) - CommercialAutomated Group Administration, Inc. (AGA)AvesisBanner Health -3 Business DaysNoNoNoNoNoNoNoNoNoPlease check the Insured ID cardto verify the Payer ID beforesubmitting claims. If you havequestions, please contact ProviderRelations at 800-456-4584.Only limited plans may be sentelectronically. Group name isrequired with one of the followingplan names: Sheet Metal,Berekely, Boone, Carpenter,Cabell, Clarksbur, Doodridge,Hancock, Harrison, Marion,Monongalia, Mingo, Mineral,Morgan, Nicholas, Putnam,Taylor Tyler WetzelA United Healthcare PayerYes/No imsClaimsClaims(Formerly YYFormerly payer ID 62413. Nowpart of Coventry Consolidatepayer ID. Including CombinedGovernment Health Plan &Contract Health Insurance Plan.Payer RA will be turned off within30 days of enrollment; PDFs areavailable through Coventry'sprovider portalwww.directprovider.comPO Box 2877, Clinton, IA 52733PO Box 2806, Clinton, IA 52733YPO Box 2806, Clinton, IA 52733YYYbybybybybybybybyTax ID onlyYYRYYYRPO Box 2829 Clinton IA 52733PO Box 2877, Clinton, IA 52733YYYYYS3
Change Healthcare Dental Payer List8/16/2016StatePayerIDBanner Plan Administration77078Banner Plan Administration77078TypeModelParCOMMERCIALGrou Enrolp#lYesCOMMERCIALPayer Enrollment TurnaroundTimeNoYesServiceClaimsEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.NPI 5010RICD10Required l InfoEFTERA Enrollment TypeRequires EFT for ERAEnrollmentERA Payer Enrollment FormRequiredERA Paper RA Shut OffTax ID / NPI combinationPayer handles enrollment directlywith provider.NoNoImmediatelyPayer accepts enrollment requestfrom Change Healthcare.NoNoMinimum of 31 Business days or3 payment cyclesERA/EFT Enrollment LevelTax ID & NPI requiredAdministered by Health ServicesBenefit Administrators, Inc.(HSBA)Administered by Health ServicesBenefit Administrators, Inc.(HSBA)Bay Area Automotive GroupCHSBAParCOMMERCIALYesNoClaimsYBay Area Delivery DriversCHSBDParCOMMERCIALYesNoClaimsYYBCI Administrators, Inc.BEAM Dental InsuranceBell AtlanticBeneCare Dental PlansBenefit Administrative msYRYYYYYYYBenefit Coordinators Corporation (Pittsburgh, PA)25145ParCOMMERCIALYesNoClaimsYYBenefit Inc.R7003NonCOMMERCIALNoNoClaimsYYBenefit imsRRYYYYBenefit Plan Administrators Co. (Eau Claire, WI)39081ParCOMMERCIALYesNoClaimsYYBenefit Systems & Services, Inc. (BSSI)36342ParCOMMERCIALYesNoClaimsYBenefit Systems & Services, Inc. (BSSI)36342COMMERCIALYesPayer's discretionERATax ID / Legacy ID optionalBenefit Systems & Services, Inc. (BSSI)36342COMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.EFTTax ID required & Provider IDoptionalBenefits Administration Corporation, Inc.44357ParCOMMERCIALYes5-7 Business DaysERATax IDPayer accepts enrollment requestfrom Change Healthcare.YesNoMinimum of 31 Business days or3 payment cyclesBenefits Administration Corporation, Inc.44357ParCOMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.Best Life & Health Insurance rCOMMERCIALYesNoClaimsYYBlue BeneFit Administrators of MA03036ParCOMMERCIALYesNoClaimsYYBlue Care Family PlanGWD01ParCOMMERCIALNoNoClaimsRYBlue Care Family PlanGWD01Unknown as payer handlesdirectly with provider.Payer requires online enrollmentform be utilized.YesYes30 daysTax ID / NPI CombinationPayer accepts enrollment requestfrom Change Healthcare.NoNoMinimum of 31 Business days or3 payment cyclesBlueBlueBlueBlueBlueBlueBlueManagement Group NVManagement Services of MSManagement Services, Inc.Management, Inc. of KSCrossCrossCrossCrossCrossCrossCrossBlue Shield ofBlue Shield ofBlue Shield ofBlue Shield ofDentalof California of California -North CarolinaNorth CarolinaNorth CarolinaWisconsin - PPODCOMMERCIALYesBCBSYesPayer's discretionPayer's sClaimsClaimsClaimsClaimsClaimsClaimsYYYYYYYBoon Administrative Services, Inc.BOONGParCOMMERCIALYesNoClaimsYBoon Administrative Services, Inc.BOONGCOMMERCIALYes5-7 Business DaysERABoon Administrative Services, Inc.BOONGCOMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.EFTBlue Cross of California - PPOABoilermakers National Health & Welfare FundBoon Chapman Benefit AdministratorsBridgeSpan Health (Regence Group)Brokers NationalBroward HealthButler BenefitsC. L. FratesCal Optimal -OneCareCalifornia State Government NoNoNoNoYPayer ID valid for Benefit PlanAdministrators (Eau Claire, WIsubmission address only) andCustom Benefit AdministratorsAn Innovative HealthwareServices Payer. a.k.a. ReadingHospital Employer Groupa.k.a. CBA BlueAdministered by Golden West(Well OMMERCIALCOMMERCIALCOMMERCIALPayer ID valid only for Claimswith a submission address of 111Ryan Court, Suite 300,Pittsburgh PA ParParParAdministered by B High & LowPlan SS10 & imsClaimsClaimsEHB Pediatric Dental ClaimsDental Blue ProductDental Blue Select ProductAdmin by LIBERTY Dental PlanNon FEP claimsAdmin by LIBERTY Dental PlanAdmin by LIBERTY Dental PlanYYYRYYYNot all employer groups are livefor EFTYYYRYYYYYRYYYYYAdmin by LIBERTY Dental PlanYYYS4Admin by LIBERTY Dental PlanTax ID / NPI Combination
Change Healthcare Dental Payer List8/16/2016StatePayerCalifornia State Government ProgramsCannon Cochran Management Services, Inc. Metairie, LAIDTypeCPPCA71057ModelGrou Enrolp#lDELTA DENTALParCOMMERCIALYesYesCOMMERCIALPayer Enrollment TurnaroundTimeService30 Business DaysERANoYesClaimsEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.NPI 5010ICD10Required asofComplianceDateICD1ICD100TestinReadgyAdditional InfoYY71057Capitol DentalCX095ParCOMMERCIALYesNoClaimsRCare 1st Health Plan Medicare AdvantageCare 1st PHP LA & San Bernadino CountyCareFirst, Inc. Maryland eFirst, Inc. Maryland BCBS00580COMMERCIALYes1-3 Business DaysERARYCareFirst, Inc. Maryland BCBS00580COMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.EFTCareFirst, Inc. Maryland BCBSCareFirst, Inc. Maryland BCBSCareington Benefit SolutionsCareOregonCaresource INCaresource KYCaresource WVCarolina Summit HealthcareCarpenters Health and Welfare Fund of PhiladelphiaCaterpillar esNoNoNoNoNoNoNoNoNoNoEligibility InquiryClaim Status laimsCBA Blue03036ParCOMMERCIALYesNoCCEA Teachers Health TrustCDO TechnologiesCDS Group A Enrollment TypeRequires EFT for ERAEnrollmentERA Payer Enrollment FormRequiredERA Paper RA Shut OffTax ID / NPI combinationPayer accepts enrollment requestfrom Change Healthcare.NoNoImmediatelyPayer accepts enrollment requestfrom Change Healthcare.NoNoIf EFT is selected than shut offimmediately.Payer accepts enrollment requestfrom Change Healthcare.NoNoMinimum of 31 Business days or3 payment cyclesTax ID / NPI combinationPayer accepts enrollment requestfrom Change Healthcare.NoNoNoneTax ID / NPI combinationPayer accepts enrollment requestfrom Change Healthcare.NoNoNoneTax ID / NPI combination for each Payer accepts enrollment requestphysical locationfrom Change Healthcare.NoNoNoneTax ID / NPI combination for eachphysical locationNoNoMinimum of 31 Business days or3 payment cyclesPayer ID for claims with a mailingaddress of PO Box 6794, Metairie, LA 70009YCannon Cochran Management Services, Inc. Metairie, LAERA/EFT Enrollment LevelEFTTax ID required & NPI optiionalSvia Performance HealthTechnologyAdmin by LIBERTY Dental PlanAdmin by LIBERTY Dental PlanTax ID / NPI combinationTax ID & NPI RYYYYYClaimsYYSA United Healthcare Payerf.k.a. Comprehensive BenefitsAdministrators, Inc.Please enter group # F16 whensubmitting claims. A Welfare andPension Administration ServicespayerCement Masons and Plasterers Health & Welfare Trust91136COMMERCIALYes1-3 Business DaysERATax ID onlyCement Masons and Plasterers Health & Welfare Trust91136COMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.EFTTax ID onlyCentral Reserve Life34097Central Reserve Life34097Central States Health and Welfare Fund36215ParCOMMERCIALYesNoClaimsYYCentral Susquehanna Healthcare Providers (CSHP)55731ParCOMMERCIALYesNoClaimsYYCHAMPVA - HAC84147ParCOMMERCIALYesNoClaimsYCHAMPVA - HAC84147Chesterfield Resources, Inc. (Uniontown, OH)Choice Plus (TRW)Christian Brothers IALYesCIGNACIGNACitizens Security ALYesNoNoNoEligibility InquiryClaim Status InquiryClaimsYCivil Service Employees Association (CSEA)CX054ParCOMMERCIALYesNoClaimsYClaimsBridge HPNCNIC Health Solutions ClaimsClaimsRRCNIC Health Solutions Inc.37227Cement Masons and Plasterers Health & Welfare ERCIALNoYesYesYesYesYesClaims1-3 Business Days1-3 Business DaysNoNoNoNoYesERAERAClaimsClaimsClaimsClaims5-7 Business Days5-7 Business DaysRYOnly Non Medicare Supplementand Dental lines of businessadministered under this payer ID.YOnly Non Medicare Supplementand Dental lines of businessadministered under this payer ID.SAn Innovative HealthwareServices Payer.CHAMPVA - HAC is not associatedwith and does not process Claimsfor TRICARE (formerly CHAMPUS)YYYRYERAYYYYa.k.a. Salvation ArmyYDetailed BenefitsYYSERA5Provider ID number required. Maxof 50 procedure lines per Claims.ID number must be 5 charactersin length, numbers 6 in length &ending with a '1' are acceptedwhen '1' is removed. Numberswith leading zeros will haveleading zeros omitted. IDnumbers cannot contain an "-"Payer accepts enrollment requestfrom Change Healthcare
Change Healthcare Dental Payer List8/16/2016StatePayerIDTypeModelGrou Enrolp#l37227Commerce Benefits Group34181Commerce Benefits Group34181Community Health Alliance of TNCommunity Health Electronic Claims/CHEC/webTPA2790575261Community Health Electronic Claims/CHEC/webTPA75261COMMERCIALYes1-3 Business DaysCommunity Health Electronic Claims/CHEC/webTPA75261COMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.Community Insurance - HMOA & PPOBCommunity Insurance - PPOD & PPOFComp - Ohio (Austintown, OH)Companion LifeCompBenefitsComprehensive Healthcare Options.com Inc.CompuSys / Erisa Group, Inc.Comsumers Choice Health Plan - State of SCConnecticut Carpenters Health FundConnecticut General 0762308Connecticut General (CIGNA)62308Consolidated Group DentalCook Group Health PlanCooperative Benefit Administrators (CBA)613053514952132Cooperative Benefit Administrators (CBA)52132COMMERCIALYesCooperative Benefit Administrators (CBA)Core VCore Management Resources NoNoNoCore Management Resources Group58231CoreSource AZ MN41045ParCOMMERCIALYesCoreSource KCCoreSource Little Source Little Rock7513635182CoreSource MD PA IL35182ParCOMMERCIALYesEFT Enrollment is processedbetween the provider and ChangeHealthcare. Approval time isdependant upon the provider'sresponsiveness.CNIC Health Solutions Inc.CoreSource MD PA ILCOMMERCIALPayer Enrollment NoClaimsYYCovenant Administrators, Inc. (Atlanta, GA)Coventry DentalCoventry DentalCoventry DentalCoventry Health Care oNoNoClaimsClaimsEligibility InquiryClaim Status InquiryClaimsYYYYf.k.a. Benesys, Inc.YYCoventry Health Care Carelink25133Coventry Health Care Carelink Medicaid25133Coventry Health Care Carelink Medicaid25133Coventry Health Care National Network25133West Virginia OnlyPayer RA will be turned off within30 days of enrollment; PDFs areavailable through Coventry'sprovider portalwww directprovider comWest Virginia OnlyPayer RA will be turned off within30 days of enrollment; PDFs areavailable through Coventry'sprovider portalwww.directprovider.comFormerly payer ID 87043. Nowpart of Coventry Consolidatedpayer RCIALYesYes1-3 Business DaysNoNo1-3 Business DaysYERANoneTax ID / NPI combinationPayer accepts enrollment requestfrom Change Healthcare.NoNoNoneTax ID / NPI CombinationPayer accepts enrollment requestfrom Change Healthcare.NoNoNoneTax ID / NPI CombinationPayer accepts enrollment requestfrom Change Healthcare.NoNoNoneTax ID / NPI CombinationPayer accepts enrollment requestfrom Change Healthcare.NoNoNoneTax ID / NPI CombinationPayer accepts enrollment requestfrom Change Healthcare.NoNoNoneTax ID / NPI CombinationPayer accepts enrollment requestfrom Change Healthcare.NoNoNoneOnly for Claims where the"submit Claims to address" on themedical ID card is a CoreSourceaddress in the states of Arizonaor Minnesota. For assistance call800-698-0106.Detai
Legacy ID - For Providers, use their Facility/Office NPI. For Brokers, use their Agency ID which is either a 4 or 5 digit code. The 4 digit code starts with a 5 and the 5 digit code start with a 2 Tax ID & NPI required; Acclaims 64071 Par; COMMERCIAL Yes; No Claims; Y ACS Benefit Services
