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REMIT PAYER LIST10/06/20151199 National Benefit FundINSTITUTIONALERAPayer Code Enrollment13162Y21st Century Insurance and Financial ServicesPROFESSIONALERAEnrollmentPayer Code13162Y51028YAARP - UnitedHealthcare Insurance Company36273Y36273YAccess ate Medical Group - AMG (Legacy AHC)65093YAetnaAdvocate Physician Partners60054Y60054YAetna Better Health Inc.34734Y34734YNAetna Better Health of Illinois26337N26337Aetna Better Health of Louisiana128LAY128LAYAetna Better Health of Michigan128MIY128MINAetna Better Health of Nebraska42130N42130NAetna Better Health of New Jersey46320Y46320YAetna TX Medicaid & CHIP38692Y38692YAetna-American Continental Insurance Company62118Y62118YAffinity Health Plan13334Y13334YAffinity Medicare Advantage13333N13333NAlabama Medicaid12K01YSKAL0YALICARE13550Y13550YAll Savers/UHC81400Y81400YAlliance Behavioral Health23071Y23071YAltius Health Plans25133Y25133YAmalgamated Life13550Y13550YAmeraPlan38219Y38219YAmerican Community Mutual Insurance60305Y60305YAmerican Family Medicare Sup and PPO Policies Administered by Am Rep56071Y56071YAmerican General62030Y62030YAmerican Insurance Administrators (AIA)26119Y26119YAmerican Postal Workers Union Health Plan44444Y44444YAmerican Republic Insurance42011Y42011YAmeriChoice by UnitedHealthcare-New YorkNYU01YNYU01YAmerichoice Maryland and Washington04567Y04567YAmeriHealth AdministratorsSX055YSX055YAmeriHealth Caritas Pennsylvania22248Y22248YAmerihealth District of Columbia77002Y77002YAmeriHealth HMO of NJ and DelawareSX055YSX055YAmeriHealth Non-HMO (PPO) NJSX055YSX055YAmeriHealth Non-HMO (PPO) of DelawareSX055YSX055YAmeriHealth NorthEast77001Y77001YAmeriHealth VIP Care22355Y22355YAmeriHealth VIP Care - DC77007Y77007YAmeriHealth VIP Care - LA77006Y77006YAmFirst Insurance Company (Secondary Claims Only)64090Y64090YAncillary Care ServicesA2004YA2004YAntares Management Solutions34192Y34192YAnthem Blue Cross Blue Shield of Connecticut12B04YSB560YAnthem Blue Cross Blue Shield of Georgia12015YSB600YPage 1 of 12
REMIT PAYER LIST10/06/2015INSTITUTIONALERAPayer Code EnrollmentPROFESSIONALERAEnrollmentPayer CodeAnthem Blue Cross Blue Shield of Indiana12B09YSB630YAnthem Blue Cross Blue Shield of Kentucky12B11YSB660YAnthem Blue Cross Blue Shield of Maine12B13YSB680YAnthem Blue Cross Blue Shield of MissouriSB741YSB741YAnthem Blue Cross Blue Shield of Nevada12B20YSB765YAnthem Blue Cross Blue Shield of New Hampshire12B21YSB770YAnthem Blue Cross Blue Shield of Ohio12B24YSB338YAnthem Blue Cross Blue Shield of Virginia12002YSB923YAnthem Blue Cross Blue Shield of Wisconsin12B29YSB950YAnthem Blue Cross of California47198Y47198YAnthem Blue Cross of Colorado12B03YSB550YAR Medicare Part A (JH)12022YSMAR0YYAR Medicare Part B (JH)Arbor Health Plan52312Y52312Arch Health PartnersARCH1YARCH1YARISE39185Y39185YArkansas Best Corporation - Choice Benefits75278Y75278YArkansas Medicaid12023YSKAR0YAssurant Health (IM & GROUP FULLY-INSURED)39065Y39065YAutomated Benefit Services38259Y38259YAuxiant26202NAvMed Inc.59274YBanker's Life & Casualty59274Y99999-0178YBanner Health12X42YSX145YBCBS of AZ Advantage77078Y77078YBEACON HEALTH STRATEGIES43324Y43324YBenefit Administrative Systems36149Y36149YBenefit Systems & Services Inc.36342N36342NBlue Cross Blue Shield of Arkansas12021YSB520YBlue Cross Blue Shield of Illinois12B08YSB621YBlue Cross Blue Shield of Kansas47163Y47163YBlue Cross Blue Shield of Kansas City47171Y47171YBlue Cross Blue Shield of Massachusetts12B14YSB700YBlue Cross Blue Shield of MississippiSB730YSB730YBlue Cross Blue Shield of North Carolina12B23YSB810YBlue Cross Blue Shield of Oklahoma00840Y00840YBlue Cross Blue Shield of Rhode Island12B74YSB870YBlue Cross Blue Shield of South Carolina12B55YSB880YBlue Cross Blue Shield of Tennessee00390Y00390YBlue Cross Blue Shield of Texas84980Y84980YBlue Shield of CaliforniaBSCAIYBS001YBlueChoice HealthPlan00922Y00922YBoon-Chapman Benefit Administrators Inc.74238Y74238YBoston Health Net13337Y13337YBravo Health Star Plus52192Y52192YBridgeway Arizona68069Y68069YBrown & Toland94316Y94316YBuckeye Community Health68069Y68069YPage 2 of 12
REMIT PAYER LIST10/06/2015INSTITUTIONALERAPayer Code EnrollmentPROFESSIONALERAEnrollmentPayer CodeCA Medicare12M64California Medicaid (Medi-Cal)CAMC1YSKCA0YCare Access Health Plan (CAHP)65062Y65062YCare Improvement YCareFirst BlueCross BlueShield MD RegionSB690YSB690YCareFirst BlueCross BlueShield NCA RegionSB580YSB580YCarelink Health Plans Inc25133Y25133YCM001NCM001NCare Wisconsin Health Plan(Trizetto)YCarelink MedicaidCaremoreCarenet25133Y25133YCarepoint Health Plans77023Y77023YCareSource31114Y31114YCareSource KYKYCS1YKYCS1YCBHNP - HealthChoices65391N65391NYCeltic Insurance68063Y68063CeltiCare68069Y68069YCentegra Health System36474N36474NCenterPoint Human Services56122Y56122YCentral Reserve Life34097Y34097YCHAMPVA - HAC84146Y84146YCHAMPVA HAC MEDICARE CROSSOVER80214Y80214YCHCS Services, Inc75895Y75895YChildren of Women Vietnam Veterans-VA HAC84146Y84146YChristus Health Medicare Advantage10629Y10629YChristus Health New Mexico HIX21062Y21062YCIGNA62308Y62308YCIGNA Behavioral HealthMCCBVYCIGNA-Central Reserve Life Insurance Company58086Y58086YCNIC Health Solutions Inc.37227N37227NCO Medicare Part A (JH)12M03YSMCO0YCO Medicare Part B (JH)Coastal Care43141Y43141YCommon Ground77170Y77170YCommunity Care Inc. - Family Care (Wisconsin)60995Y60995YCommunity Care Inc. (Wisconsin)39126Y39126YCommunity Care Managed Health Care Plans of Oklahoma73143Y73143YCommunity First Health Plan, Inc.42723Y42723YCommunity Health Choice48145Y48145YCommunity Health Electronic Claims/CHEC/webTPA75261Y75261YCommunity Health GroupCHGRIYConnecticare - Medicare78375Y78375YConnectiCare Inc06105Y06105YConnecticut Medicaid12K04YSKCT0YConsociate, Inc.37135Y37135YContinental General Insurance Company71404Y71404YCooperative Benefit Administrators (CBA)52132Y52132YPage 3 of 12
REMIT PAYER LIST10/06/2015INSTITUTIONALERAPayer Code EnrollmentPROFESSIONALERAEnrollmentPayer CodeCoreSource AZ MN35182Y35182YCoreSource Little Rock75136Y75136YCoreSource NC IN35182Y35182YCoreSource OH35183Y35183YCountyCare42139Y42139YCovenant Administrators Inc. (Atlanta GA)58102Y58102YCoventry Health & Life (Oklahoma)25133Y25133YCoventry Health and Life Insurance Company administered by PersonalCare25133Y25133YCoventry Health Care National Network25133Y25133YCoventry Health Care of Delaware Inc25133Y25133YCoventry Health Care of Florida25133Y25133YCoventry Health Care of Georgia Inc.25133Y25133YCoventry Health Care of Illinois25133Y25133YCoventry Health Care of Iowa Inc25133Y25133YCoventry Health Care of Kansas Inc25133Y25133YCoventry Health Care of Louisiana Inc25133Y25133YCoventry Health Care of Missouri25133Y25133YCoventry Health Care of Nebraska Inc25133Y25133YCoventry Health Care of Nevada25133Y25133YCoventry Health Care of the Carolinas25133Y25133YCoventry Health Care of Virginia25133Y25133YCoventry National Health Care Plans25133Y25133YCoventryCares of Kentucky25133Y25133YCoventryCares of Michigan25133Y25133YCoventryCares of Nebraska25133Y25133YCoventryCares of Pennsylvania25133Y25133YCT Medicare Part A (J13 - NGS)12M04YSMCT0Y39113Y39113YDelaware Physicians Care Inc.27009Y27009YDeseret Mutual12X35YUH105YCT Medicare Part B (J13 - NGS)Dean Health PlanDistrict of Columbia MedicaidSKDC0YDiversified Administration Corporation06102N06102NDRISCOLL CHILDREN'S HEALTH PLAN74284Y74284YEAST CAROLINA BEHAVIORAL HEALTH56089Y56089YEBMS (Employee Benefit Management Services Inc.)81039Y81039YEGID (Employees Group Insurance Division)22521Y22521YElderPlan Inc.31625Y31625YEMCASCO INSURANCE CO.21415Y21415YEmployee Benefit Services37216Y37216YEquitable81779Y81779YESSENCE HEALTHCARE20818Y20818Y65062YEye Management, Inc. (EMI)Fallon Community Health Plan22254Y22254YFamily Health Partners - Healthwave of Kansas31472Y31472YFederal Employee Plan of South Carolina (BCBS SC)00402Y00402YFederal Employees Health Benefit Plan (MHBP)25133Y25133YFederated Mutual Insurance41041Y41041YPage 4 of 12
REMIT PAYER LIST10/06/2015INSTITUTIONALERAPayer Code EnrollmentPROFESSIONALERAEnrollmentPayer CodeFidelis Secure Care77054Y77054YFirst Carolina Care56196Y56196YFirst Choice VIP Care37510Y37510YFirst Choice VIP Care Plus77009Y77009YFirstCare94999Y94999YFL Medicare Part A (J9 First Coast)09101Y09102YFlorida Blue00590Y00590YFlorida Hospital Healthcare Systems59321Y59321YFlorida Medicaid77027Y77027YFlorida True Health26492Y26492YFMH Benefit Services y Health PA05506Y05506YGateway Health Plan - Medicare Assured60550Y60550YGateway Health Plan Medicaid PA25169Y25169YGateway Health Plan OH - Medicare Assured91741N91741NGateway Healthy PA05506Y05506YGeisinger Health Plan75273Y75273YGHI - New York (Group Health Inc.)13551Y13551YGHI HMO25531Y25531YGilsbar Inc.07205Y07205YGovernment Employees Hospital Association (GEHA)44054Y44054YGrand Valley Health Plan95453Y95453YGreat-West Healthcare80705Y80705YGroup Health Cooperative - WA State91051Y91051YGroup Health Cooperative of Eau Claire95192Y95192YGroup Health Cooperative of South Central Wisconsin39167Y39167YGuardian Life Insurance Company of America64246Y64246YHarmony Health Plan of Illinois36405Y36405YHarmony Health Plan of Indiana36405Y36405YHarvard Pilgrim Health Care04271Y04271YHawaii Medical Assurance Association (HMAA/HWMG)99208YFL Medicare Part B (J9 First Coast)Freedom Blue Medicare Advantage ClaimsHawaii Medical Service Association (HMSA)99208YSB971YHealth Alliance Medical Plans of Illinois77950Y77950YHealth Alliance Plan38224Y38224YHealth America Inc./Health Assurance/Advantra25133Y25133YHealth Choice Arizona62179Y62179YHealth Choice Generations62180Y62180YHealth Net of Arizona38309Y38309YHealth Net of California and Oregon - Claims95567Y95567YHealth Network One65062Y65062YHealth Partners PA80142Y80142YHealth Payment Systems (HPS)20270Y20270YHealth Plan of Michigan83253Y83253YHealth Plan of Nevada76342Y76342YHealth Plans Inc.44273Y44273YPage 5 of 12
REMIT PAYER LIST10/06/2015INSTITUTIONALERAPayer Code EnrollmentPROFESSIONALERAEnrollmentPayer CodeHealth Services for Children with Special re USA25133Y25133YHealthfirst Health Plan of New Jersey80141Y80141YHealthfirst Inc. (New York)80141Y80141YHealthgram Inc.56144Y56144YSX009YHealthPlus Amerigroup27514Y27514YHealthSCOPE Benefits Inc.71063Y71063YHealthSmart Benefit Solutions37272Y37272YHealthSmart Benefit Solutions fka Wells Fargo ring - STAR PLUS Only52192Y52192YHealthSpring HMO/HealthSpring Medicare Choice63092Y63092YHealthy CT77180Y77180YHeartland NationUHIN3YUHIN3YSMHI0YHIP - Health Insurance Plan of Greater New York55247Y55247YHN1 Therapy Network (HN1TN)65062Y65062YHealthPartners MNHI Medicare Part B (J1 - PGBA)Home Health & Hospice J10 Cahaba12M53YHome Health & Hospice J6 NGSRHHWIYHometown Health88023Y88023YHorizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ)22099Y22099YHorizon NJ Health22326Y22326YHP Administrative Services, LLC22521Y22521YHS1 Medical Management65062Y65062YHSBS Memphis37224Y37224YHumana Inc.61101Y61101YHumana Military - Tricare South61125Y61125YIA Medicare Part A(J5 - WPS)SMIA0YSMIA0YIAA37279Y37279YIBC Personal ChoiceSX055YSX055YIL Medicare Part A (J6)12M08YSMIL0Y68069Y68069YI'Mcare41600Y41600YIN Medicare Part A (J8)12M09YSMIN0YIA Medicare Part B (J5 - WPS)IL Medicare Part B (J6)IlliniCareIN Medicare Part B (J8)Independent Health Care Plan11695N11695NIndependent Living Systems, LLC45048Y45048YIndiana Department of Health - Children's Health - ClaimsIndiana Medicaid12K09N35600YSKIN0NIndiana ProHealth Network35161N35161NIndiana University Health Plan95444Y95444YIngalls Provider Group (DOS beginning 5/1/15)85578N85578YInnovAge31182Y31182YInsurance Design Administrators13315Y13315YPage 6 of 12
REMIT PAYER LIST10/06/2015INSTITUTIONALERAPayer Code EnrollmentINTotal Health10262YJ11 Medicare - HHH Jurisdiction C12M80YJ12 MEDICARE PART A LEGACY WPS (DC DE MD NJ PA)12M99YJohn Alden Life Insurance Co.41099Johns Hopkins Healthcare (EHP/PP)52189Johns Hopkins Healthcare (USFHP)PROFESSIONALERAEnrollmentPayer Code10262YY41099YY52189Y52123Y52123YKaiser Foundation Health Plan of Colorado91617Y91617YKaiser Foundation Health Plan of Northern CA Region94135Y94135YKaiser Foundation Health Plan of Southern CA Region94134Y94134YKaiser Foundation Health Plan of the Mid-Atlantic States Inc.52095Y52095YKaiser Foundation of the NorthwestNW002YNW002YKaiser Health Plan Inc - Georgia Region21313Y21313YKaiser Permanente of Georgia21313Y21313YKanawha Insurance Co.57038Y57038YKansas MedicaidMDKSIYMDKSPYKempton Group Administrators73100Y73100YKentucky Health Cooperative77894Y77894YKentucky Medicaid12K11YSKKY0YKey Benefit Administrators (Indianapolis IN)37217N37217YKeystone Connect (Amerihealth)77050Y77050YKeystone First23284Y23284YKeystone Health Plan EastSX055YSX055YKeystone VIP Choice84223Y84223YKS Medicare Part A (J5 - WPS)57324YSMKS0N12M11YSMKY0YLA Care Health PlanLACARYLACARYLA Medicare Part A (JH)12M12YLACare27357YLand of Lincoln Health90096YKS Medicare Part B (J5 - WPS)KY Medicare Part A (J15)KY Medicare Part B (J15)LA Medicare Part B (JH)Landmark Healthcare IncLincoln Republic Insurance42011YMA Medicare Part A (J14 - NHIC)12M14YMA Medicare Part B (J14 - NHIC)MacNeal Health Providers- lan Health Services01260Y01260YMagnolia68069Y68069YMaine Community Health Options45341YManaged Health Services Indiana (Medicaid HMO)45341Y68069YManaged Health Services Wisconsin68069Y68069YMaryland MedicaidSKMD0YSKMD0YMaryland Physicians Care22348YMassachusetts MedicaidMassachusetts Mutual80314YMD Medicare Part A J1212010YMD Medicare Part B J1222348YSKMA0Y80314YSMMD0YPage 7 of 12
REMIT PAYER LIST10/06/2015INSTITUTIONALERAPayer Code EnrollmentMDWise Hoosier Alliance20475YMDwise Inc. (formerly IU Health)12K81NMDwise Inc. (formerly IU Medical Group)PROFESSIONALERAEnrollmentPayer Code20475YSX172NYMedcost Benefit Services56205Y56205Medica94265Y94265YMEDICAL ASSOCIATES HEALTH PLANMAHC1NMAHC1NMedical Benefits Mutual Life Insurance Co.74323Y74323YMedical Mutual of Ohio29076Y29076YSDMEBYMedicare DME (All Jurisdictions)Medicare PPO (BCBS SC)00C63Y00C63YMedico Insurance Company23160N23160NMedSolutions Inc62160Y62160YMercy Benefit Administration37264N37264NMercy Care Plan (AHCCCS)86052Y86052YMeridian Health Plan13189Y13189YMeritain Health64157Y64157YMetroPlus Health Plan13265Y13265YMetropolitan Health Plan10850Y10850YMHNET74289Y74289YMI Medicare Part A (J8)SMMI0YSMMI0YMichigan Medicaid12K37YSKMI0YMississippi MedicaidSKMS0YSKMS0YMissouri Medicaid12K15YSKMO0YMMSI41154Y41154YMO Medicare Part A (J5 - WPS)12M15YSMMO0YModa Health13350Y13350YMOLINA HEALTHCARE Of SC46299Y46299YMI Medicare Part B (J8)MO Medicare Part B East (J5 - WPS)Molina Healthcare of WASHINGTON38336Y38336YMOLINA HEALTHCARE Of WIABRI1YABRI1YMonitor Life Insurance Company (Secondary claims only)16098Y16098YMontefiore Contract Management Organization13174YMontifiore HMO46161NMORRIS ASSOCIATESMS Medicare Part A (JH)46161N35092Y12M17YSMMS0YMt. Carmel Health Plan95655Y95655YMutual of Omaha Insurance Company71412Y71412YMVP Health Plan (Mohawk Valley)14165Y14165YNAA (North America Administrators L.P.) (Nashville TN)65085Y65085YNAMM-IL (Senior Care Partners)NANPRYNANPRYNAPHCARE, Inc.58182Y58182YNational Imaging AssociatesSX190YSX190YNational Telecommunications Cooperative Association52120Y52120YNationwide Health Plans31417Y31417YNeighborhood Health Plan (Boston, MA)04293Y04293YNeighborhood Health Plan Rhode Island05047Y05047YMS Medicare Part B (JH)Page 8 of 12
REMIT PAYER LIST10/06/2015INSTITUTIONALERAPayer Code EnrollmentPROFESSIONALERAEnrollmentPayer CodeNetwork Health04332Y04332YNetwork Health Insurance Corp-Medicare77076Y77076YNetwork Health Plan of Wisconsin Inc.39144Y39144YNew Jersey Medicaid Part A12006YSKNJ0YCKNJ2YNew Mexico Health Connections45129Y45129YNew York MedicaidSKNY0YSKNY0YNGS American Inc38225Y38225Y81264YSMNJ0YNew Jersey Medicaid Part BNew Jersey Medicaid-Charity CareNGS JK Home Health & HospiceJKHHHYNippon Life Insurance Company of America81264YNJ Medicare Part A J1212005YNJ Medicare Part B J12NM Medicare Part A (JH)12M22YSMNM0YE3510YE3510YNorth Carolina Medicaid12K23YSKNC0YNorth Carolina Medicare Part A12M23YSMNC0Y48026NNM Medicare Part B (JH)North American Medical Management (NAMM) - Northern CaliforniaNorth Carolina Medicare Part BNorthShore Physician Associates48026NNY Medicare Part B Upstate (J13 - NGS)SMNY1YNYS DOH UCP14142Y14142YOak West Physician Association36400Y36400YOH Medicare Part A (J15)12M24YSMOH0Y12M37YSMOK0YOK State Employees & Educators (EDS)22521Y22521YOklahoma Medicaid12K25YSKOK0YOregon's Health Co-op45332Y45332YPA Medicare Part A J1212M60YSMPA0Y93029Y93029Y66917YOH Medicare Part B (J15)OK Medicare Part A (JH)OK Medicare Part B (JH)PA Medicare Part B J12PacificSource Health PlansParkland Community Health Plan66917YPart A National - Legacy Claims52280YPassport AdvantageSX055YSX055YPassport Health Plan61129Y61129YPeach State Health Plan68069YVALHLTHYVALHLTHYPennsylvania Health Care PlanPeoples Health Network72126Y72126YPersonal Insurance Administrators (PIA)95397Y95397YPHCS Savility Payers13306Y13306YPhysicians Health Plan37330Y37330YPhysicians Health Plan of Northern Indiana, Inc12399Y12399YPhysicians Mutual Insurance Company47027Y47027YPhysicians Plus Insurance Corporation39156Y39156YPiedmont Wellstar Health Plan251PDY251PDYPIH HealthPIH01YPIH01YPage 9 of 12
REMIT PAYER LIST10/06/2015INSTITUTIONALERAPayer Code EnrollmentPROFESSIONALERAEnrollmentPayer CodePittsburgh Care Partnership Inc.23283Y23283YPlanned Administrators, Inc. (PAI)37287N37287NPOMCO16111Y16111YPrairie States Enterprises Inc.36373Y36373YPreferred Blue (SC)00481Y00481YPreferred Care Partners Florida65088Y65088YPreferred Health Systems A Coventry Health Care Plan60110Y60110YPreferredOne (MN)41147Y41147YPremier Health Plan251PRY251PRYPresbyterian Health Plan58234Y58234YPrestige Health Choice77003Y77003YPrevea 360 Health Plan39113Y39113YPrimary PhysicianCare Inc.56144Y56144YPrime West Health Plan61604Y61604YPrincipal Financial Group61271Y61271YPriority Health38217Y38217YProvidence of Oregon Health PlanSX133YSX133YQuikTrip73067YRailroad Medicare (PGBA)SRRGAYSKRI0YRhode Island Medicaid12K74YRI Medicare Part A (J14 - NHIC)12M74YRight Care from Scott & White74205NRural Health Clinic - Cahaba GBA12M53YSamaritan Health ServicesCP001Sanford Health PlanRI Medicare Part B (J14 - NHIC)SMRI0Y74205NYCP001Y91184Y91184Y77038YSCAN Health PlanSCAN1YSCAN1YScripps Health Plan ServicesSHPS1NSHPS1NSante Health System and AffiliatesSecurity Health Plan39045Y39045YSelect AdvantageSX055YSX055YSelect Health of South Carolina23285Y23285YSelectCare of Texas (HPN) Heritage Physicians Network76045Y76045YSelf Insured Services CompanySISCOYSISCOYSendero Health36426N36426NSenior Health a Health ManagementSentry Life Insurance CompanySharp Community Medical GroupSharp Rees-Sealy Medical GroupSRS83YSRS83YShasta Administrative Services75280Y75280YSierra Health and Life76342Y76342YSmokey Mountain Center13010Y13010YSouth Carolina Medicaid12K55YSKSC0YSouth Carolina Medicare Part A (J11)12M55YSMSC0YSouth Carolina Medicare Part B (J11)South Indiana Health Operations - HMOSX142YSX142YSpecial Agents Mutual Benefits Association (SAMBA)37259Y37259YPage 10 of 12
REMIT PAYER LIST10/06/2015INSTITUTIONALERAPayer Code EnrollmentPROFESSIONALERAEnrollmentPayer CodeSpina Bifida - VA HAC84146Y84146YStandard Life and Accident (Secondary claims only)73099Y73099YState Employee Plan (SC)00400Y00400YState Farm Insurance Companies31053Y31053YState of Texas Dental Plan (remits return under 44054)57254Y57254YSummit America Insurance Services37301Y37301YSuperior Health Plan Texas68069YSuperior Vision Services13374Y13374YTennessee Medicaid12K46YSKTN2YTexas Children's Health Plan76048N76048NTexas Childrens Health Plan (Medicaid)75228Y75228YTexas Medicaid12K64YSKTX0YTexasFirst Health Plan (NTX)13185Y13185YThe Health Plan/Hometown Health34150Y34150YTKSoftwareSX142YSX142YTN Medicare Part A (J10 - Cahaba)12M53YTN Medicare Part B (J10 - Cahaba)SMTN0YTouchstone Health PSO23856YTransact RXPARTDN73117YTribute /SelectCare of Oklahoma73117YTribute Health Plan31118YTricare North Region57106Y57106YTricare West99726Y99726YTRIHEALTH PHYSICIAN SOLUTIONS31144Y31144YTriWest VAPC3 Region 355912Y55912YTriWest VAPC3 Region 5A55915Y55915YTriWest VAPC3 Region 5B55916Y55916YTriWest VAPC3 Region 655917Y55917YTRUSTED HEALTH PLANL0230YL0230YTrustmark Insurance Company61425Y61425YTufts Associated Health04298Y04298YTX Medicare Part A and Indian Health Services J412M31YSMTX0YTX Medicare Part B and Indian Health Services J4UMR (formerly UMR Onalaska)79480Y79480YUMR (formerly UMR Wausau Fiserv Benesight)39026Y39026YUnicare Life & Health80314Y80314YUnified Health Services62170Y62170YUnified Physicians Network34638Y34638YUnion Security Insurance Company70408Y70408YUnited Americhoice of NebraskaUFNEPYUFNEPYUnited AmeriChoice of 2148YUnitedHealthcare (MAHP MD IPA Optimum Choice MAMSI)UnitedHealthcare (Oxford Health Plans)06111Y06111YUnitedHealthcare / UHIS - UnitedHealth Integrated Services39026Y39026YUnitedHealthcare / UnitedHealthcare Plan of the River Valley95378Y95378YUnitedHealthcare / UnitedHealthcare StudentResources74227Y74227YUnitedHealthcare Community Plan (formerly Unison Ohio)04567YPage 11 of 12
REMIT PAYER LIST10/06/2015UnitedHealthCare Community Plan (KS / KanCare)INSTITUTIONALERAPayer Code Enrollment96385YUnitedHealthcare Community Plan / SCPROFESSIONALERAEnrollmentPayer Code96385Y25175YUnitedHealthcare Community Plan / AZ (formerly AZ Physicians IPA APIPA)03432Y03432YUnitedHealthcare Community Plan / MI (formerly Great Lakes Health Plan)95467Y95467YUnitedHealthcare Community Plan / NJ (formerly Americhoice NJ Medicaid)86047Y86047YUnitedHealthcare Community Plan Ohio25175YUnitedHealthcare West (formerly PacifiCare of Arizona)95964YUnitedHealthcare West (formerly PacifiCare of CA - Claims)95959YUnitedHealthcare West (formerly PacifiCare of California - Claims)95959Y95962YUnitedHealthOne (formerly American Medical Security)81400Y81400YUnitedHealthOne (Golden Rule)37602Y37602YUnity Health66705Y66705YUniversity Family Care09830Y09830YUniversity Family Care - Healthcare Group09830Y09830YUniversity Family Care - Maricopa Health Plan09830Y09830YUniversity Health Alliance99026Y99026YUPMC Health Plan23281Y23281YUPMC Vision Advantage25184Y25184YUpper Peninsula Health Plan (Medicaid)38337Y38337YUS Imaging50383Y50383YVA Fee Basis Programs12115Y12115YValueOptions/MBHP (MA Behavioral Health Partnership)VALOPYVALOPYUnitedHealthcare West (formerly PacifiCare of Colorado)Vantage Health Plan Inc.72128N72128NVirginia Premier Health Plan54176Y54176YViva Health Plan63114Y63114YVNS CHOICE Medicare77073Y77073YWEA Insurance Group39151Y39151YWellcare Health Plan, Inc. (Fee for Service)14163Y14163YWellcare of CT14164Y14164YWellmedTH023NTH023NWI Medicare Part A & FQHC (J6)12M29YSMWI0YWI Medicare Part B (J6)WINHealth PartnersWNHLTYWNHLTYWisconsin Chronic Disease Program (WCDP)SKWIDYSKWIDYWisconsin MedicaidSKWI0YSKWI0YWisconsin Well Woman Program (WWWP)SKWIWYSKWIWYWPS - Tricare for Life12X43YSX176YWPS Commercial12X29YSX022YPage 12 of 12
Affinity Health Plan 13334: Y 13334: Y Affinity Medicare Advantage: 13333 N: 13333 N: Alabama Medicaid 12K01: Y SKAL0: Y ALICARE: 13550 Y: 13550 Y: All Savers/UHC 81400: Y 81400: Y . Gateway Health Plan OH - Medicare Assured; 91741 N; 91741 N; Gateway Healthy PA 05506; Y 05506; Y Geisinger Health Plan; 75273 Y; 75273 Y; GHI - New York (Group .
