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eClaims Dental Payer List InformationPayer List Includes (18 pgs): Commercial PayersBlue Cross Blue Shield PayersDelta Dental PayersMedicaid PayersPayer ID 06126: Use this eClaim payer id for those insurance companies that are not onthe eClaim Payer ListGroup Number Column: Y the payer requires group numberN the group number is optionalEnroll Column: This column indicates whether or not the payer requires enrollmentY Payer requires enrollment please do the following for these payers:1. Within EagleSoft go to Online FAQ2. Under the Search by Keyword field type 44003. Click on the eClaims Additional Enrollment PaperworkN No paperwork is requiredAdditional Information Column: This column includes important information specific to the insurancecompaniesObtaining Current Payer Lists: Recommended every 2-3 months1. Go to Online FAQ2. Under the Search by Keyword field type 24533. Click on eClaims Payer List and Payer List ChangesFor any questions please contact eServices Support at 800.475.5036.
eClaims Dental Payer ListMarch 201021st Century Health and Benefits59069Group#Y21st Century Insurance and Financial Services51028YStPayerIDEnrollAdditional InfoNN3P Admin20413YNA & I Benefit Plan Administrators93044YNA & I Benefit Plan AdministratorsCX044YNAAG Benefit Plan Administrators, Inc.75240YNAARPAARP1YNAcceptius (Benefit Management Inc of MO (BMI)43178YNAccess DentalCX097YNAcClaims64071YNElectronic Payer ID for claims printed and mailed topayer.AARP Claims with a mailing address of PO Box2059, Mechanicsburg, PAvia Performance Health TechnologyACS Benefit Services a.k.a. NCBCBS - DBS61474YNACS Benefit Services Inc.72468YNf.k.a. ACS Consulting Services, Inc.Activa Benefit Services, LLC/Dental38255YN(Formerly Amway Corporation/Dental)Additional enrollment is not required by the payer,however, providers wishing to submit Claimselectronically must be credentialed with the payer.Please ensure you have successfully process onepaper Claims with the payer prior to submitting yourfirst electronic Claims.Adminstrative Services Only, Inc.CX076YNAdvantage Dental Plan, Inc.93524NNAdvantek Benefit Administrators83077YNAdventist Health System West - Roseville, CA95340YNAetna60054YNAetna Affordable Health Choices (SM) - SRC57604YNAffordable Benefits Admin.95426YNAFLAC58066YNAFLAC - NY Plan52080YNAlaska Children's Services, Inc.91136YNAlaska Electrical Health & Welfare Fund92600YNAlaska Laborers Construction Industry Trust91136YNAlaska Pipe Trades Local 37591136YNAlaska United Food & Commercial Workers Health &Welfare TrustAllen Medical Claims Administrator91136YNCX016YNAllied Administrators (San Francisco, CA)94177YNAllied Benefit Systems37308YNAmalgamated Life - PA Alicare13343YNAmerican Administrators (West Des Moines, IA)42112YNThis plan also shares the same mailing address aspayer ID 58066 and the only difference betweenthe plans is that the insured ID for the NY basedplan begins with "PN" as "PNxxxxxx" (followed by6 digits)Please enter Group Number when submittingClaims.Please enter Group Number when submittingClaims.Please enter Group Number when submittingClaims.Please enter Group Number when submittingClaims.Please check the Insured ID card to verify thePayer ID before submitting claims. If you havequestions, please contact Provider Relsations at800-456-4584.For an updated payer list, please visit our website at www.eaglesoft.netPage 1
eClaims Dental Payer ListMarch 2010StPayerAmerican Administrators dba Select BenefitAdministrators (West Des Moines, IA)ID42137Group#YEnrollNPlease check the Insured ID card to verify thePayer ID before submitting claims. If you havequestions, please contact Provider Relsations at800-456-4584.Only limited plans may be sent electronically.Group name is required 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, Wetzel.American Benefit CorporationCX084YNAmerican Benefits Management (North Canton, OH)34187NNAmerican Medical SecurityCX001YNAmerican Postal Workers Union Health Plan44444YNAmericas TPA41178YNAmerihealth Administrators54763YNAmeritas Life Insurance Corp.47009YNAmway Corporation38255YNAnchor Benefit53085YNAntares Management Solutions34192NNAPA Partners, Inc.16140YNArkansas Best Corporation - Choice Benefits75278YNAscent BenefitsCX072YNASR Corporation38265YNAssociation Benefit Plan25133Additional InfoYNA United Healthcare Payer(Formerly Amway Corporation/Dental)Formerly payer ID 62413. Now part of CoventryConsolidate payer ID. Including CombinedGovernment Health Plan & Contract HealthInsurance Plan.Assurant Employee Benefits70408YNAssurant Health39065YNf.k.a. Protective LifeAssurant, Inc,70408YNf.k.a. First Fortis Life InsuranceAthens Area Health Plan Select95691YNAtlantic Dental Inc. (ADI) - CommercialCX085YNAutomated Group Administration, Inc. (AGA)37280YNAvesis86098YNBCI Administrators, Inc.49153YNBell Atlantic68241YNBencomp National Corporation33192YNBeneCare Dental Plans23210YNBenefit Adminstrative Systems36149YNBenefit Coordinators Corporation (Pittsburgh, PA)25145YNBenefit Inc.R7003Benefit Management Services of MS37212YNBenefit Management Services, Inc.56139YNBenefit Management, Inc. of KS48611YNBenefit Plan Administrators Co. (Eau Claire, WI)39081YNPayer ID valid only for Claims with a submissionaddress of 111 Ryan Court, Suite 300, Pittsburgh,PA 15205.NBenefit Plan Administrators VA37118YNBenefit Systems & Services, Inc. (BSSI)36342YNBenesys, Inc.58102YNPayer ID valid only for Claims with a billingsubmission address of P.O. Box 1128, Eau Claire,WI 54702-1128.For an updated payer list, please visit our website at www.eaglesoft.netPage 2
eClaims Dental Payer ListMarch 2010Best Life & Health Insurance Co.95604Group#YBetter Health Plans of South Carolina32006YNGWD01NNBoilermakers National Health & Welfare Fund36609YNBoon Chapman Benefit Administrators74237YNBoulder Administration Services20381YNStPayerBlue Care Family PlanIDEnrollAdditional InfoNAdministered by Golden West (Well point)Provider ID numbers must be 9 digits and isgenerally the Providers SSN or TIN. The recipient'sID number is 8 digits in length. Maximum of 13procedure lines per Claims. Pre-determinationClaims cannot be sent electronically. Claims whereBridgeport LLC iBridgeport LLCCX028YNBrokers NationalCX032YNBroward Health37314YNButler Benefits42150YNC. L. FratesCX075YNCadent Administrators33192YNCadent Underwriters33192YNCapital DentalCX037YNCapitol Administrators68011YNCapitol DentalCX095YNCarolina Summit HealthcareCarpenter's Health and Welfare Trust Fund of St.LouisCaterpillar Inc.56195YN25125YN37060YNCBCA Administrators55438YNCBCA Administrators (HRM)41170YNCDO Technologies87065YNCDS Group Health88022YNCement Masons & Plasterers Health & Welfare Trust91136YNCentral Reserve Life34097YNCentral States Health and Welfare Fund36215YNCHAMPVA - HAC84147YNCHAMPVA - HAC is not associated with and doesnot process Claims for TRICARE (formerlyCHAMPUS)Chesterfield Resources, Inc. (Uniontown, OH)34154YNa.k.a. Salvation ArmyChildren of Women Vietnam Veterans - VA HAC84147YNChoice Plus (TRW)68241YNChristian Brothers Services61271YNCIGNA62308YNCIGNA Voluntary59225YNCitizens Security LifeCX071YNCivil Service Employees Association (CSEA)CX054YNClarendon's Healthy Kids33192YNCoastal Administrative Services77052YNCommunity Claims Administration26231YNvia Performance Health TechnologyA United Healthcare Payer[Formerly Health Risk Management (HRM)Provider ID number required. Max of 50 procedurelines per Claims. ID number must be 5 charactersin lenght, numbers 6 in lenght & ending with a '1'are accepted when '1' is removed. Numbers withleading zeros will have leading zeros omitted. IDnumbers cannot contain an "-".For an updated payer list, please visit our website at www.eaglesoft.netPage 3
eClaims Dental Payer ListMarch 2010IDGroup#EnrollCommunity Health Electronic Claims/CHEC/webTPA75261YNComp - Ohio (Austintown, OH)34177YNCompanion Life77828YYCompBenefitsCX021YNComprehensive Benefits Administrator, Inc.03036YNConnecticut Carpenters Health Fund37307YNConnecticut General (CIGNA)62308YNConsociate Dansig, Inc37135YNConsolidated Group Dental61305YNCook Group Health Plan35149YNCooperative Benefit Administrators (CBA)52132YNCore Management Resources Group58231YNCoreSource AZ MN41045YNCoreSource Little Rock75136YNStPayerCoreSource MD PA IL35182YAdditional InfoOnly for Claims where the "submit Claims toaddress" on the medical ID card is a CoreSourceaddress in the states of Arizona or Minnesota. Forassistance call 800-698-0106.NOnly for Claims where the "submit Claims toaddress" on the medical ID card is a CoreSourceaddress in the states of Maryland, Pennsylvania orIllinois. For assistance call 800-689-0106.Only for Claims where the "submit Claims toaddress" on the medical ID card is a CoreSourceaddress in the states of North Carolina or Indiana.For assistance call 800-689-0106.CoreSource NC IN35180YNCoreSource OH35183YNCoreStar41045YNCorporate Benefits Service, Inc. (NC)56116YNCovenant Administrators, Inc. (Atlanta, GA)58102YNCoventry Health Care25133YNCoventry Health Care National Network25133YNCoventry Health Care of Georgia25148YNCoventry Missouri25133YNCreative Plan Administrators37320NNCrescent Dental - Meritain HealthCX074YNCustom Benefit Administrators39170YNCustom Design Benefits Inc. of OH82056YNCustomCare68241YNDart Management Corp.06172YNDeCare Dental Health Insurance7035YNdeneX/SGCX049YNDental Benefit Providers52133YNDental Care PlusCX035YNOnly for Claims where the "submit Claims toaddress" on the medical ID card is a CoreSourceaddress in the states of Arizona or Minnesota. Forassistance call 800-698-0106.Coventry's consolidated payer ID. Claims for all ofthese legacy payer IDs may now be submitted tothis payer ID. 87043 and 62413Formerly payer ID 87043. Now part of CoventryConsolidated payer ID.Formerly payer ID 87043. Now part of CoventryConsolidated payer ID.A United Healthcare PayerFor an updated payer list, please visit our website at www.eaglesoft.netPage 4
eClaims Dental Payer ListMarch 2010Dental NetworkCX034Group#YDentalCompCX017YDeseret Mutual Benefit AdministratorsCX089YYDH EvansCX065YNDiversified Administration CorporationCX040YNStPayerIDEnrollNNEBC, Inc.37257NNEBMCCX025YNEBMS (Employee Benefit Management Services, Inc.)81039YNEBS Benefit SolutionsCX043NNEHI73288YNEMIA (Educators Mutual Insurance Assoc)Additional InfoCX079yNEMPHESYS73288YNEmployee Benefit AdministratorsCX012YNEmployee Benefit Concepts (Farmington Hills, MI)38241YNEmployee Benefit Consultants37257NNEmployee Benefit Management Corp (EBMC)CX025YNEmployee Benefit Services of Louisiana, Inc (EBS)41198YNEmployee Benefits Plan Administration, Inc.(E.B.P.A.)Employee Group Services03036YNCX022YNEmployee Plans, LLC35112YNEmployer Plan Services, Inc.CX031YNEmployers Direct Health75232YNEmployers Health73288YNEmployers Health Insurance73288YNEmployers Mutual, Inc.59297YNEnstar Natural Gas91136YNEQUICOR62308YNEquitable Plan Services (Oklahoma City, OK)73126YNES Beveridge and Associates34108YNEssex Dental Benefits43168YNE-V Benefits Management, Inc (Columbus, OH)34159YNExclusiCare71412YNFamily DentalCX096YNFederated Mutual Insurance41041YNFirst Ameritas Life Insurance Corporation of New York72630YNPayer Id valid only for Claims with a billingsubmission address of Employee BenefitConsultants, located in Broadview Hts, OH,Appleton, WI, Albuquergue, NM, Findlay, OH,Louisville, KY and Milwaukee, WIPrior to accepting claims electronically EMIArequires the provider to call 801-262-7476 or 800662-5850. Providers should advise EMIA that theywill be submitting their claims through EmdeonBusiness Services, Inc. UHIN submitter IDHT000214-001.Payer Id valid only for Claims with a billingsubmission address of Employee BenefitConsultants, located in Broadview Hts, OH,Appleton, WI, Albuquergue, NM, Findlay, OH,Louisville, KY and Milwaukee, WIPayer ID valid only for Claims with a billingsubmission address of P.O. Box 720460,Oklahoma City, OK 73172.via Performance Health TechnologyFor an updated payer list, please visit our website at www.eaglesoft.netPage 5
eClaims Dental Payer ListMarch 2010First Care/Southwest Life & HealthCX050Group#YFirst Continental Life & Accident InsuranceCX090YNFirst Dental Health of CACX086YNFirst Reliance Standard Life Ins. Co. (NY Business)13317YNFitzharris & Company, Inc.11244YNFlex CompensationR7004YNFlexCare68241YNFlorida Power & Light68241YNFMH Benefit Services, Inc.48117YNForeign Service Benefit Plan25133YNStPayerFormula Card DentalFoundation Benefit Admin (FBA) - Boon GroupFox Everett, Inc.Fraternal Order of Police - Dental Division(Philadelphia, PA)Fringe Benefit 69YNGerber Life Insurance Company - Student Insurance74227YNGettysburgCX064YNGHI - New York (Group Health Inc.)13551YNGIC Indemnity Plan80314YNGilsbar, Inc.07205YNGWD01NNGovernment Employees Hospital Association (GEHA)44054YNGreat-West Healthcare63665YNGreat-West Healthcare80705YNGroup Administrators Ltd.36338YNGolden West DentalAdditional InfoGroup and Pension Administrators48143YNGroup Benefit ServicesCX011YNGroup Dental ServicesCX036YNGroup Insurance Service Center, Inc37276YNGroup Link of IndianaCX015YNGuaranty (DINA)CX090YNGuardian Life Insurance Company of America64246YNH & A AdministratorsLX059YNHarvard Pilgrim Health Care (HPHC) - StudentInsurance74227YNHCS - Health Claims Service (Boise, ID)82018YNHealth Choice Arizona62179YNHealth Economics Group, Inc.CX039NNHealth Future LLC30946YNHealth Network America20199YNHealth Partners - Jackson, TN62157YNHealth Partners of Minnesota - CommercialCX009YNFormerly payer ID 62413. Now part of CoventryConsolidated payer ID. Including AFSPA StaffPlan.A United Healthcare Payer. Payer ID only valid ifthe P.O. Box on the Health ID Card matches one ofthe following P.O. Boxes: P.O. Box 890025,809067, 809079, 809066, 809036, 809081, 809027Dallas, Tx 75380-9025.f.k.a. General AmericanA United Healthcare Payer. Payer ID only valid ifthe P.O. Box on the Health ID Card matches one ofthe following P.O. Boxes: P.O. Box 890025,809067, 809079, 809066, 809036, 809081, 809027Dallas, Tx 75380-9025.For an updated payer list, please visit our website at www.eaglesoft.netPage 6
eClaims Dental Payer ListMarch 2010Health Plan Services59140Group#YHealth Plans Inc.CX055YNHealth Resources Incorporated (HRI)CX019YNHealth Risk Management41170YN[Formerly Health Risk Management (HRM)NThe insured ID number is required. Maximum of 25procedure lines per Claims. Secondary Claimscannot be sent electronically. Claims remarksexceeding 80 bytes in length cannot besentelectronically.StPayerIDEnrollAdditional InfoNHealthcare Management Administrators, Inc.HMA01YHealthcomp, Inc.85729YNHealthfirst of Austin75289YNHealthplex, Inc.HealthSCOPE Benefits, Inc.(Formerly CNA HealthPartners of Arkansas)HealthSmart Benefit Solutions11271YN71063YN37283YNHealthsource Provident62308YNClaims are edited under CIGNA's payer specificedits, Payer ID 62308.Hometown Health Plans Nevada88023YNHoosier Dental (in Inidanapolis, Indiana)Hotel Employees & Restaurant Employees HealthTrustHRM Claims ManagementCX015YN91136YN41170YNHumana73288YNI. E. Shaffer (West Trenton, NJ)Indiana Teamsters Health Benefits Fund(Indianapolis, IN)Insurance Design Administrators22175YN35107YN13315YNInsurers Administrative Corp.86304YNIntegra Administrative Group (Seaford, DE)51020YNInternational Brotherhood of Boilermakers36609YNJohn Alden Life Insurance Co.41099YNJohn Morrell Company - AHBPA38310YNJP Farley Corporation34136YNPayer ID valid only for Claims with a billingsubmission address of PO Box 458022, Westlake,OH 44145Kaiser Permanente Dental ChoiceCX073YNPayer ID valid only for claims with a billingsubmission address of PO Box 4360 Rockville, MDKanawha Insurance Co.57038YNKansas City LifeCX058NNKempton Company73100YNKempton Group Administrators73100YNLBA Healthplans52193YNLiberty Dental PlanCX083YNLife Insurance Company of Boston & New York78140YNLifewise Health Plan of Oregon93093YNLincoln Financial GroupCX061YNLincoln National (WI)73288YNLine Construction Benefit FundLCB01YNLocal 135 Health Benefits Fund (Indianapolis, IN)35107YNLovelace Sandia Health Plan90328YN[Formerly Health Risk Management (HRM)Formerly known as Local 135 Health Benefits Fund(Indianapolis, IN)Please visit website prior to submitting Claims:edihelp.iacusa.comPayer ID valid only for Claims with a billingsubmission address of 110 S. Shipley Street,Seaford, DE 19973.f.k.a. Jefferson PilotFor an updated payer list, please visit our website at www.eaglesoft.netPage 7
eClaims Dental Payer ListMarch 2010IDGroup#EnrollAdditional InfoMachigonne Benefit Administrators10317YNPlease include the rendering provider information orthe name of the dentist in RTE6. Payer will rejectthe Claims without this information.Mail Handlers Benefit Plan25133YNFormerly payer ID 62413. Now part of CoventryConsolidated payer ID. Including AFSPA StaffPlan.MAMSICX033NNManulife W. J. Sutton Company98010YNMarsh AdvantageMasonry Institute/Administrative D.C. No. 1 WelfareFundCX023YNCX098YNMBA Benefit Administrators, Inc. (Salt Lake City, UT)87065YNMBA of Wyoming (Worland, WY)87065YNMBS56205YNMCNA DENTAL65030NNStPayerMedBen (Newark, OH)74323YYMEDICA of MinnesotaCX026YNMedical Benefit AdministratorsCX024YNMedical Benefits Mutual (Neward, OH)74323YNMedical Mutual of Ohio (MMO)29076YNMedical Mutual of Ohio (MMO)CB833YNMedical Network of Colorado Springs84600YNMercer AdministratorsCX023YNMeritain Health MinneapolisMethodist First Choice41124YN23550YNMetLifeMichigan Regional Council of Carpenters EmployeesBenefit Plan (Troy, MI)Mid-America Associates, Inc.65978YN38238YN37281YNMidwest Dental Benefits41101YNMid-West National Life Insurance Co. of Tennessee Student Instuance74227YNMississippi Select Health Care64088YNMissoula County Medical Benefits Plan37275YNMN PowerR7005Morris Associates35092YNMotorola36111YNMountain States Administrative Services (Tucson, AZ)86040YNMPEEBT/ MPE Services, Inc.37233YNMutual of Omaha CommercialCX087YNMutual of Omaha Insurance Company71412YNMutually PreferredN.W. Int Assoc of Machinists & Aerospace EngBenefits Trust Dental Progam71412YN91136YNN.W. Ironworkers Health & Security Trust Fund91136YNN.W. Roofers & Employers Health & Security TrustFund91136YNFormerly MedCost Benefit Services.(formerly Travelers)A United Healthcare Payer. Payer ID only valid ifthe P.O. Box on the Health ID Card matches one ofthe following P.O. Boxes: P.O. Box 890025,809067, 809079, 809066, 809036, 809081, 809027Dallas, Tx 75380-9025.NPlease enter Group Number when submittingClaims.Please enter Group Number when submittingClaims.Please enter Group Number when submittingClaims.For an updated payer list, please visit our website at www.eaglesoft.netPage 8
eClaims Dental Payer ListMarch 2010IDGroup#EnrollN.W. Textile Processors91136YNNAA (North America Administrators, L.P.) (Nashville,TN)65085YNNABN (Cleveland, OH)34159YNNational Benefit Administrators - New Jersey56175NNNational Benefit Administrators - North Carolina56176YNNational Elevator Industry Benefit Plan (NEIB)CX045YNNational Pacific of TX (NCFLEX)CX057YNNational Rural Letter Carrier AssociationNational Telecommunications CooperativeAssociationNationwide Health Plans71412YN52120YN31417YNNCAS - Charlotte75191YNNCAS - Fairfax, VA75190YNNCBCBS - DBS a.k.a. ACS Benefit Services61474YNNetcare Life and Health Insurance (NLH)66055YNNew England Dental Administrators43351YNNGS AMERICAN38225YNNippon Life Insurance Company of America81264YNStPayerNorth American Benefits Network ((Cleveland, OH)34159YNNorth Broward Hospital District37314YNNorthern Illinois Health Plan36347YNNorthern Minnesota DentalLX062YNNorthern Nevada Trust Fund88027YNNorthShore University Health System Medical Group36364YNNorthwest Dental Services93525NNNorthwest Suburban IPANova Healthcare Administrators, Inc. (Grand Isl
1. Within EagleSoft go to Online _ FAQ 2. Under the Search by Keyword field type 4400 3. Click on the eClaims Additional Enrollment Paperwork N No paperwork is required Additional Information Column: This column includes important information specific to the insurance companies Obtai
