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OptumInsight Eligibility Payer ListANSI HIPAA 270/271(As of 1/11/2022)Coventry Health Care of FloridaPayer ID2100ANM109ABHFLCoventry Health Care of GeorgiaPayer NameStateAdditional InformationEnrollmentTypeDELoop 2100B should contain Tax ID or NPI.FALSEG25127GALoop 2100B should contain Tax ID or NPI.FALSEGCoventry Health Care of Iowa25132IALoop 2100B should contain Tax ID or NPI.FALSEGCoventry Health Care of Kansas (Kansas City & Wichita)25133KS,MOLoop 2100B should contain Tax ID or NPI.FALSEGCoventry Health Care of Louisiana25135LALoop 2100B should contain Tax ID or NPI.FALSEGCoventry Health Care of Nebraska25136IA,NELoop 2100B should contain Tax ID or NPI.FALSEGCoventry Health Care Southern Health Services25128VALoop 2100B should contain Tax ID or NPI.FALSEGCoventry Health Care Texas (includes Coventry AdvantraFreedom)00453ALLLoop 2100B should contain Tax ID or NPI.FALSEGCoventry Health Care USA (HCUSA)00186MOLoop 2100B should contain Tax ID or NPI.FALSEGCoventry Health of Illinois/ Personal Care00179ILLoop 2100B should contain Tax ID or NPI.FALSEGCoventry MHNET Behavioral Health00514ALLLoop 2100B should contain Tax ID or NPI.FALSEGCoventry Missouri00507MOLoop 2100B should contain Tax ID or NPI.FALSEGCoventry Nebraska Medicaid00511NELoop 2100B should contain Tax ID or NPI.FALSEGCoventry OneCOVONALLLoop 2100B should contain Tax ID or NPI.FALSEGCoventry University of MissouriCOVUMMOLoop 2100B should contain Tax ID or NPI.FALSEGDean HealthDEANHALLLoop 2100B must contain the NPI.FALSEGDefinity Health87726ALLLoop 2100B should contain Tax ID or NPI.FALSETDelaware Blue Cross Blue ShieldDEBLSDELoop 2100B must contain the Provider NPI.FALSENPDelaware MedicaidDEMCDDELoop 2100B must contain the Provider NPI.FALSENPDelaware MedicareCMSELDETRUENCDefinity Health10828ALLEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI.FALSEGDeseret Mutual (DMBA)DMBAUUTFALSENCDistrict of Columbia MedicaidDCMCDDCLoop 2100B must contain the Rendering Provider TIN and NPI.Rendering Provider NPI must already be enrolled for ClaimSubmissions before they can send RTT to Deseret Mutual (DMBA).Loop 2100B must contain the Provider NPI.FALSENPDistrict of Columbia MedicareCMSELDCTRUENCEmblem HealthEMBLMALLEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the Provider NPI.FALSEGEssence HealthcareESSNCALLLoop 2100B must contain the NPI.FALSEGEvergreen Health Cooperative93240ALLLoop 2100B must contain the NPI.FALSEGExcellus Blue Cross Blue Shield New YorkECLLSNYLoop 2100B must contain the Provider NPI.FALSEGFallon Community Health PlanFALLNALLLoop 2100B should contain Tax ID or NPI.FALSEGFederated Mutual Insurance CompanyFEDMIALLLoop 2100B must contain the Provider NPI.FALSEGFederated States of Micronesia MedicareCMSELFMEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.TRUENC----------NP or NC: Non Participating Payers. OptumInsight charges a per transaction fee for non-par payersFor up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.enshealth.com

OptumInsight Eligibility Payer ListANSI HIPAA 270/271(As of 1/11/2022)Fidelis (CenterCare)Payer ID2100ANM109FIDELFirst Ameritas of NYPayer NameStateAdditional InformationEnrollmentTypeALLLoop 2100B must contain the Provider NPI.FALSENP00426ALLLoop 2100B should contain Tax ID or NPI.FALSEGFirst Carolina Care56196ALLLoop 2100B must contain the NPI.FALSEGFirst Health Coventry Health Care National Network87043ALLLoop 2100B should contain Tax ID or NPI.FALSEGFirst Health Mail Handlers Benefit Plan00251ALLLoop 2100B should contain Tax ID or NPI.FALSEGFlorida Blue Cross Blue ShieldFLBLSFLLoop 2100B should contain BCBSFL Facility or Provider ID and/orNPI.FALSENCFlorida Health Care Plan59322FLLoop 2100B must contain the NPI.FALSEGFlorida MedicaidFLMCDFLLoop 2100B should contain Provider Number or NPI.FALSENPFlorida MedicareCMSELFLTRUENCGateway Health PlanGATHPALLEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI.FALSEGGeisinger Health Plan75273ALLLoop 2100B must contain the NPI.FALSEGGEMcare11065ALLLoop 2100B must contain the NPI.FALSEGGeorgia Anthem Blue Cross Blue ShieldGABLSGALoop 2100B must contain the NPI.FALSENCGeorgia Anthem Blue Cross Blue Shield DentalGABLDGALoop 2100B must contain the NPI.FALSEGGeorgia MedicaidGAMCDGALoop 2100B must contain the NPI.FALSENCGeorgia MedicareCMSELGATRUENCGolden Rule Insurance37602ALLEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI.FALSETGovernment Employees Health Association (GEHA)44054ALLLoop 2100B should contain either the Tax ID or NPI.FALSEGGreat West80705ALLLoop 2100B should contain Tax ID or NPI.FALSEGGroup Health Incorporated10808ALLLoop 2100B must contain the Provider NPI.FALSEGGuam MedicareCMSELGUTRUENCHarken Health43313ALLEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI. Enrollment Required. Call (702)242-7088 or Toll Free (800) 745-7065FALSETHarmony Health Plan (Illinois & Indiana)14163IL,INLoop 2100B must contain the NPI.FALSEGHarvard PilgrimHPHCSALLLoop 2100B must contain the NPI.FALSEGHawaii Blue Cross Blue ShieldHIBLSHILoop 2100B must contain the NPI.FALSEGHawaii MedicaidHIMCDHILoop 2100B must contain the NPI.TRUEGHawaii MedicareCMSELHITRUENCHealth Alliance PlanHAPMCALLEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI.FALSEGHealth Choice of ArizonaHECHAAZLoop 2100B must contain either the Tax ID or NPI.FALSEGHealth First Health Plan10673ALLLoop 2100B must contain the NPI.FALSEGHealth Net National00213AZ,CT,NJ,NY,PALoop 2100B should contain Tax ID or NPI.NOTE: Health Net of Arizona and Health Net of the Northeast arenow known as Health Net National.FALSEG----------NP or NC: Non Participating Payers. OptumInsight charges a per transaction fee for non-par payersFor up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.enshealth.com

OptumInsight Eligibility Payer ListANSI HIPAA 270/271(As of 1/11/2022)Payer NameHealth Net of CaliforniaPayer ID2100ANM10995567StateAdditional InformationEnrollmentTypeCALoop 2100B should contain Tax ID or NPI.FALSEGHealth Partners PennsylvaniaHPARTPALoop 2100B should contain NPI.FALSEGHealth Tradition Health PlanHLTHTALLLoop 2100B must contain the NPI.FALSEGHealthcare HighwaysHCH01ALLLoop 2100B must contain the NPI.FALSEGHealthChoice71064ALLLoop 2100B must contain the Provider NPI.FALSEGHealthEase14163ALLLoop 2100B must contain the Provider NPI.FALSEGHealthEase Kids14163ALLLoop 2100B must contain the Provider NPI.FALSEGHealthFirst of New YorkHF1NYNYLoop 2100B should contain Legacy ID or NPI.FALSEGHealthnow10500ALLLoop 2100B must contain the NPI.FALSEGHealthPartners of Minnesota94267MNTRUENPHealthplans Incorporated10802ALL2100B must contain NPI. Enrollment required. Log into Optum(optumprovider.optum.com), Select Utilities/Enrollments/PayerEnrollment Forms to locate this form.Loop 2100B must contain the NPI.FALSEGHealthplus MichiganHLTPMMILoop 2100B must contain the NPI.FALSEGHealthscope Benefits Administrators71063ALLLoop 2100B must contain the NPI.FALSEGHealthscope HSB71084ALLLoop 2100B must contain the NPI.FALSEGHealthsmart Benefit SolutionsHSBESALLLoop 2100B must contain the Provider NPI.FALSEGHorizon New Jersey Health10337NJLoop 2100B must contain the NPI.FALSEGHumana00041ALLLoop 2100B should contain Tax ID or NPI.FALSEGIdaho Blue CrossIDBLCIDLoop 2100B must contain the Provider NPI.FALSENCIdaho Blue Shield (Regence)IDBLSIDLoop 2100B must contain the Provider NPI.FALSEGIdaho MedicaidIDMCDIDLoop 2100B should contain Payer Assigned Provider ID Number orNPI.FALSENPIdaho MedicareCMSELIDTRUENCIllinois Blue Cross Blue ShieldILBLSILEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B should contain Service Provider Number assigned by thepayer or NPI.FALSENPIllinois MedicaidILMCDILLoop 2100B should contain Service Provider Number assigned by thepayer or NPI.FALSENPIllinois MedicareCMSELILTRUENCIndiana Anthem Blue Cross Blue ShieldINBLSINEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI.FALSENCIndiana Anthem Blue Cross Blue Shield DentalINBLDINLoop 2100B must contain the NPI.FALSEGIndiana MedicaidINMCDINLoop 2100B must contain the NPI.FALSENCIndiana MedicareCMSELINTRUENCIndependent Health10536ALLEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI.FALSEGInland Empire Health PlanIEHP1ALLLoop 2100B must contain the NPI.FALSEGIowa Blue Cross Blue ShieldIABLSIALoop 2100B must contain the NPI.FALSENP----------NP or NC: Non Participating Payers. OptumInsight charges a per transaction fee for non-par payersFor up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.enshealth.com

OptumInsight Eligibility Payer ListANSI HIPAA 270/271(As of 1/11/2022)Iowa MedicaidPayer ID2100ANM109IAMCDIowa MedicarePayer NameStateAdditional InformationEnrollmentTypeIALoop 2100B must contain the NPI.FALSENCCMSELIATRUENCJohns Hopkins Health PlanJHOHPALLEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI.FALSEGKaiser Foundation ColoradoKSFCOCOLoop 2100B must contain the NPI.FALSEGKaiser Foundation Health Plan HawaiiKSRHIHILoop 2100B must contain the NPI.FALSEGKaiser Foundation Health Plan Hawaii (DHMO Choice)KSERDHILoop 2100B must contain the NPI.FALSEGKaiser Foundation Health Plan Washington10608WALoop 2100B must contain the NPI.FALSEGKaiser Foundation NorthwestKSFNWALLLoop 2100B must contain the NPI.FALSEGKaiser Foundation Mid AtlanticKSFMAALLLoop 2100B must contain the NPI.FALSEGKaiser Foundation OhioKSFOHOHLoop 2100B must contain the NPI.FALSEGKaiser Permanente GeorgiaKSPGAGALoop 2100B must contain the NPI.FALSEGKaiser Permanente KPICKPIC1ALLLoop 2100B must contain the NPI.FALSEGKaiser Permanente Northern CAKS003CATRUENPKaiser Permanente Southern CAKS001CATRUENPKansas Blue Cross Blue ShieldKSBLSKSEnrollment required. Go to www.enshealth.com select DownloadCenter, select EMC Agreements, enter your Optum User Id, SelectState – California, and the Kaiser Permanente Agreement.Enrollment required. Go to www.enshealth.com select DownloadCenter, select EMC Agreements, enter your Optum User Id, SelectState – California, and the Kaiser Permanente Agreement.Loop 2100B must contain the NPI.FALSENPKansas City Blue Cross Blue ShieldKCBLSKSLoop 2100B must contain the NPI.FALSEGKansas MedicaidKSMCDKSLoop 2100B must contain the NPI.FALSENCKansas MedicareCMSELKSTRUENCKentucky Anthem Blue Cross Blue ShieldKYBLSKYEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI.FALSENCKentucky Anthem Blue Cross Blue Shield DentalKYBLDKYLoop 2100B must contain the NPI.FALSEGKentucky MedicaidKYMCDKYTRUENCKentucky MedicareCMSELKYTRUENCKeystone MercyKEYSTPALoop 2100B should contain Payer Assigned Prov ID Number or NPI.Provider must be an active KYMCD Provider, prior to sending RT 270Requests. Call KY Prov Enrollment at 877-838-5085.Enrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI.FALSENPLifewise Health Plan Oregon10651ORLoop 2100B must contain the NPI.FALSEGLoomis CompanyLOOMSALLLoop 2100B must contain the NPI.FALSEGLouisiana Blue Cross Blue ShieldLABLSLALoop 2100B should contain Service Provider Number assigned by thepayer and/or NPI.FALSENPLouisiana MedicaidLAMCDLALoop 2100B must contain the Provider NPI.FALSENPLouisiana MedicareCMSELLATRUENCMagellan Health Services01260ALLEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI.FALSEGMagnacare10867ALLLoop 2100B must contain the NPI.FALSEGMAHP/MAMSI87726ALLLoop 2100B must be should contain Service Provider Number and/orNPI.FALSET----------NP or NC: Non Participating Payers. OptumInsight charges a per transaction fee for non-par payersFor up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.enshealth.com

OptumInsight Eligibility Payer ListANSI HIPAA 270/271(As of 1/11/2022)Payer NameMaine Anthem Blue Cross Blue ShieldPayer ID2100ANM109MEBLSStateAdditional InformationEnrollmentTypeMELoop 2100B must contain the NPI.FALSENCMaine Anthem Blue Cross Blue Shield DentalMEBLDMELoop 2100B must contain the NPI.FALSEGMaine MedicaidMEMCDMELoop 2100B must contain the NPI.FALSENPMaine MedicareCMSELMETRUENCMarch Vision Care52461ALLEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI.FALSETMarshall Islands MedicareCMSELMHMaryland Blue Cross Blue Shield (CareFirst)MDBLSMaryland MedicaidTRUENCMDEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI.FALSENPMDMCDMDLoop 2100B must contain the NPI.FALSENCMaryland MedicareCMSELMDTRUENCMaryland Physicians Care76498MDEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI.FALSEGMassachusetts Blue Cross Blue Shield00139MALoop 2100B should contain either the 6-character Provider ID or NPI.FALSETMassachusetts MedicaidMAMCDMALoop 2100B must contain the NPI.FALSENPMassachusetts MedicareCMSELMATRUENCMcLaren Health Care38338ALLEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI.FALSEGMedica Health Plans94265ALLLoop 2100B should contain Service Provider ID or NPI.FALSETMedica Health Plan Solutions71890ALLLoop 2100B must contain the NPI.FALSEGMedica Health Care Plan - Florida78857FLLoop 2100B must contain the NPI.FALSETMedical Mutual of Ohio29076OHLoop 2100B should contain Service Provider number or NPI.FALSEGMedigold Health Plans10800ALLLoop 2100B must contain the NPI.FALSEGMeridian Health Plan Illinois13189ALLLoop 2100B must contain the NPI.FALSEGMeridian Total, Meridian Complete, Illinois Complete,YouthCare and AmbetterMHPILALLLoop 2100B must contain the NPI.FALSEGMeritain HealthMTAINALLLoop 2100B must contain the NPI.FALSEGMetroPlus Health Plan13265ALLLoop 2100B must contain the NPI.FALSEGMichigan Blue Cross Blue ShieldMIBLSMITRUENCMichigan MedicaidMIMCDMITRUENPMichigan MedicareCMSELMITRUENCMichild MichiganMICHDMIEnrollment required. Go to www.enshealth.com select DownloadCenter, select EMC Agreements, enter your Optum User Id, SelectState – Michigan, and the Michigan BLS Agreement.The providers will need to designate Availity as the billing providerAgent - Availity Trading Partner ID is: 2728567 in the ChampsSystem, for additional support on how to add Availity as the BillingEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2100B must contain the NPI.Loop 2100B must contain the NPI.FALSEGMinnesota Blue Cross Blue ShieldMNBLSMNLoop 2100B must contain the NPI.FALSENCMinnesota Blue Cross Blue Shield Blue Plus Medicaid00562MNLoop 2100B must contain the NPI.FALSEGMinnesota MedicaidMNMCDMNLoop 2100B must contain the NPI.FALSENC----------NP or NC: Non Participating Payers. OptumInsight charges a per transaction fee for non-par payersFor up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.enshealth.com

OptumInsight Eligibility Payer ListANSI HIPAA 270/271(As of 1/11/2022)Payer NamePayer ID2100ANM109CMSELStateAdditional i Blue Cross Blue ShieldMSBLSMSEnrollment required. Form and instructions nrollment/MedicareEnrollmentForm.pdf. Loop 2

Altius Health Plans 00364. ALL; Loop 2100B must contain Service Provider Number assigned by the payer or NPI. FALSE G Ameriben Solutions Inc. 10985 ALL Loop 2100B must contain the NPI. FALSE G American Medical Security (AMS) 81400 ALL Loop 2100B must be Medicare Provider number or NPI. FALSE T