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OptumInsight Medical Payer List (08/31/2016)
1 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer (UCS) Masonry Industry Trust 60230 NOCD ALL Y UCS MASONRY IND T N FALSE 1199 SEIU National Benefit Fund 13162 NOCD ALL Y 1199 NATIONAL BEN Y FALSE 21st Century Insurance and Financial Services 51028 NOCD MN Y 21ST CENTURY INS Y FALSE 360 Alliance PPO Gilsbar 07205 NOCD ALL Y 360 ALLIANCE PPOG N FALSE 3P ADMIN 20413 NOCD ALL Y 3P ADMIN Y FALSE 8th Distric Electrical 74234 NOCD UT N 8TH DIST ELECTRIC N FALSE A & I Benefit Plan Administrators 93044 NOCD ALL N A AND I BENEFIT P Y FALSE AARP Hospital Indemnity Plans insured by UnitedHealthcare Insurance Company 36273 NOCD ALL Y AARP MEDICARE SUP Y FALSE AARP Medicare Supplement Plans insured by UnitedHealthcare Insurance Company 36273 NOCD ALL Y AARP MEDICARE SUP Y FALSE AARP MedicareComplete insured through UnitedHealthcare (AARP MedicareComplete Mosaic) 87726 NOCD ALL Y OXFORD MEDICARE N Y FALSE AARP MedicareComplete insured through UnitedHealthcare (formerly AARP MedicareComplete from SecureHorizons) 87726 NOCD ALL Y AARP MEDICARECOMP Y FALSE AARP MedicareComplete insured through UnitedHealthcare / Oxford Medicare Network, former payer id 06111 87726 NOCD ALL Y UHC OXFORD Y FALSE ABMG A0701 NOCD CA Y ABMG N FALSE Abrazo Advantage Health Plan 03443 NOCD ALL Y ABRAZO ADV HEALTH Y FALSE Abri Healthplan ABRI1 NOCD ALL N ABRI HEALTHPLAN Y FALSE Access Administrators AHS01 NOCD ALL N ACCESS ADMINISTRA N FALSE Access Behavioral Care COACC NOCD CO S ACCESS BEHAVIORAL Y FALSE Access Medical Group AMG01 NOCD All Y ALLIED MED GROUP N FALSE Access Medical Group 95424 NOCD ALL Y ACCESS MEDICAL GR N FALSE ACCLAIM 64071 NOCD All N ACCLAIM Y FALSE Acclaim IPA MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE Acclaim IPA (MHCAC) MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE Accountable HC IPA (Customer Service (562) 435-3333 for claims with DOS prior to 5/1/15) AHIPA NOCD ALL Y ACCOUNTABLE HC IP N FALSE Acordia National (Now known as Wells Fargo TPA) 87815 MCSI ALL Y ACORDIA NATIONAL Y FALSE ACS Benefit Services, inc. 72467 NOCD ALL Y ACS BENEFIT SERVI Y FALSE ACS Benefits Payer Compass PA331 NOCD ALL Y ACS BENE PAYER CO N FALSE Activa Benefits Services, LLC (Formerly Amway Corporation) 38254 NOCD ALL Y ACTIVA BENE SVCS N FALSE ActivHealthcare AHC01 NOCD ALL Y ACTIVHEALTHCARE N FALSE Administrative Services, Inc. 59141 NOCD ALL Y ADMIN SVCS INC Y FALSE Adminone 37278 NOCD ALL N ADMINONE N FALSE Adminstrative Concepts, Inc. 22384 NOCD ALL N ADMIN CONCEPTS IN Y FALSE Advanced Data Solutions 58202 NOCD ALL Y ADVANCED DATA SOL Y FALSE Advanced Medical Management AMM01 NOCD ALL A ADV MEDICAL MGMT N FALSE Advanstaff, Inc. 74234 NOCD ALL N ADVANSTAFF INC N FALSE Advantage Care IPA ACIPA NOCD CA N ADVANTAGE CARE IP Y FALSE Advantage Health Network IPA NMM01 NOCD ALL Y ADVANTAGE HLTH IP Y FALSE Advantage Health Solutions, Inc. 35209 NOCD ALL N ADVANTAGE HEALTH N FALSE Advantage Preferred Plus (Old payerID of 77070 will be valid for a limited time.) 35219 NOCD ALL Y ADVANTAGE PREFERR N FALSE Advantek Benefit Administrators 83077 NOCD ALL N ADVANTEK BENEFIT N FALSE Advantica Benefits 59374 NOCD ALL A ADVANTICA BENEFIT Y FALSE Advanzeon Solutions 59314 NOCD ALL Y ADVANZEON SOLUTIO N FALSE Adventist Health System 95340 NOCD ALL Y ADVENTIST HLTH SY Y FALSE Advicare 45423 NOCD ALL N ADVICARE N FALSE Advocate Health Centers (AHC) 36320 NOCD ALL Y ADVOCATE HEALTH N FALSE Advocate Health Partners (PHO) 65093 NOCD ALL Y ADVOCATE HLTH PAR N FALSE Aegis Administrative Services CB637 NOCD ALL Y AEGIS ADMIN SVCS N FALSE Aetna Affordable Health Choices (SM) - SRC 57604 NOCD ALL Y AETNA AFFORDABLE Y FALSE Aetna American Continental Insurance (Call Payer to obtain PayerID) CALL NOCD ALL N Call Payer N FALSE Aetna ASA PPO/Assurant Health (Signature Admin) 58730 NOCD ALL Y AETNA ASSURANT HE N FALSE Aetna Better Health - PA Medicaid 23228 NOCD PA Y AETNA BH PA MEDIC Y FALSE Aetna Better Health Medicaid IL 26337 NOCD IL N AETNA BH MCAID IL Y FALSE Aetna Better Health NY 34734 NOCD ALL N AETNA BET HLTH NY N FALSE Aetna Better Health of Kentucky 128KY NOCD KY Y AETNA BET HLTH KY Y FALSE Aetna Better Health of Louisiana 128LA NOCD LA Y AETNA BH LOUISIAN Y FALSE Aetna Better Health of Michigan 128MI NOCD MI Y AETNA BH MICHIGAN Y FALSE Aetna Better Health of Missouri 128MO NOCD MO Y AETNA BH MISSOURI Y FALSE Aetna Better Health of Nebraska 42130 NOCD ALL N AETNA BETR HLTH N Y FALSE Aetna Better Health of New Jersey 46320 NOCD NJ Y AETNA BH NEW JERS Y FALSE Aetna Better Health of Ohio 50023 NOCD ALL Y AETNA BTTR HLTH O Y FALSE Aetna Better Health of Virginia 128VA NOCD VA Y AETNA BH VA N FALSE Aetna Better Health of West Virginia 128WV NOCD WV Y AETNA BTR HLTH WV N FALSE Aetna Health Plan - PPO 60054 NOCD All Y AETNA HEALTH PLAN Y FALSE Aetna Life & Casualty Company 60054 NOCD All Y AETNA Y FALSE Aetna Life & Casualty Company 60054 NOCD All Y AETNA LIFE Y FALSE Aetna Life & Casualty Company 60054 NOCD All Y AETNA LIFE INSUR Y FALSE Aetna Life & Casualty Company 60054 NOCD All Y AETNA LIFE INSURA Y FALSE Aetna TX Medicaid & CHIP 38692 NOCD TX Y AETNA TX MEDICAID Y FALSE Affiliated Doctors of Orange County ADOCS NOCD CA Y AFFIL DOCS OF OC Y FALSE Affiliated Physicians IPA POP06 NOCD ALL Y AFF PHYSICIANS IP N FALSE Affinity Essentials 23334 NOCD ALL Y AFFINITY ESSENTIA Y FALSE Affinity Health Plans (Contact Affinity EDI Coordinator before submitting claims electronically at [email protected] or call 718-794-7592.) 13334 NOCD ALL Y AFFINITY HEALTH O Y FALSE For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G P G BOTH # C BOTH # C BOTH # C BOTH # C BOTH # BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH C G G G G P G G G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G G G G P G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N G G G G G G G G C BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G G G G G G G C C C C C C G G G BOTH G 2 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Affinity Health Plans (TMG Health) (Effective for Medicare claims with DOS on or after 01/01/2010) 13333 NOCD ALL Y AFFINITY HEALTH N Y FALSE AFFINITY MEDICAL GROUP 46594 NOCD ALL N AFFINITY MED GROU N FALSE Affordable Benefit Administrators, Inc. (Claims with the following address should only be sent to this payerID: ABA, PO BOX 10787, Burbank, CA 91510-0787) 95426 NOCD ALL N AFFORDABLE BENE A N FALSE AFL - CIO Food & Beverage Dealers Trust Fund (Toledo, OH) Agewell New York AGIA Inc (Claims are printed and mailed to the payer.) Agua Caliente AH & L AHPO (Cleveland, OH) AIG Educational Markets (Formerly Maksin Management Corporation) AKM Medical Group Alameda Alliance for Health (Provider must contact payer to be approved. Contact at Alameda is Anet Quiambao at 510-7476153 or [email protected]) Alamitos IPA (Customer Service 562-602-1563) Alaska Childrens Services, Inc Alaska Electrical Health & Welfare Fund Alaska Laborers Construction Industry Trust Alaska Pipe Trades Local 375 Alaska United Food & Commercial Workers Health & Welfare Trust Alexian Brothers Community Services of Tennessee AliCare Alignment Healthcare All Savers Insurance / UnitedHealthcare AllCare (Must contact AllCare, 800-564-6901 for setup and payerID.) AllCare PEBB Allegian Choice Allegiance Benefit Plan Management, Inc. Alliance Physicians High Desestt Alliant Health Plans of Georgia Allied Benefit Systems Allied Physicians of California IPA AlohaCare Alpha Care Medical Group AlphaCare Alta Bates Medical Group ALTA Health and Life Insurance Company Alternative Opportunities AMA Insurance Agency, INC Amalgamated Life - PA/Alicare Amalgamated Transit Union Division 1001 Health & Welfare Fund AmeraPlan Ameriben Solutions Americaid Community Care (Houston) Americaid Community Care (Maryland) Americaid Community Care (New Jersey) American Administrative Group - AAG (Formerly known as UICI Administrators American Administrative Group (formerly Gallagher Benefit) American Behavior American Benefit Plan Administrators American Benefits Plan Administrators (Las Vegas, NV) American Family (administered by American Republic) American Family Health Providers American Family Insurance American Fidelity Assurance Company American General American Health Medicare American Healthcare Alliance American Heritage American Insurance Company of TX American LIFECARE (Group Number required. Valid only for claims with a billing address of 1100 Poydras ST. #2600, New Orleans, LA 70163) American National Insurance Co American Postal Workers Union Health Plan American Postal Workers Union Health Plan American Republic Insurance Company American Sentinel Insurance Company American Specialty Health American Therapy Administrators ATA Wisconsin American Worker Health Plan Americas 1st Choice Health Plans of South Carolina Americas 1st Choice of South Carolina, Inc. Code Set (See Legend) Payer Type BOTH BOTH G G BOTH G 34444 AWNY6 95241 AGUA1 80705 31138 NOCD NOCD NOCD NOCD NOCD NOCD OH ALL ALL ALL ALL OH Y Y N Y N Y AFL CIO FOOD BEV AGEWELL NEW YORK AGIA INC AGUA CALIENTE AHL AHPO CLEVELAND OH Y N Y N N Y FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH G G G G C G 22195 IP080 NOCD NOCD ALL CA Y N AIG EDUC MARKETS AKM MEDICAL GROUP Y Y FALSE FALSE BOTH BOTH G G 95327 AIPAZ 91136 92600 91136 91136 NOCD NOCD NOCD NOCD NOCD NOCD ALL CA AK ALL AK AK Y N Y N Y Y ALAMEDA ALLIANCE ALAMITOS IPA ALASKA CHILD SVCS AK ELEC HLTH AND AK LABORERS TRUST AK PIPE LOCAL 375 N Y Y Y N N FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH T G G G G G 91136 44423 13550 CCHPC 81400 NOCD NOCD NOCD NOCD NOCD AK ALL All ALL ALL Y Y Y Y Y AK UNITED FOOD TR ALEXIAN BROTHERS ALICARE ALIGNMENT HCARE UNITEDHEALTHONE N N Y N Y FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH # G G G G C CALL 26158 55649 81040 22417 58234 37308 NMM01 ALOHA ACMG1 ALPHA A0701 80705 16089 TH071 13343 CALL NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL ALL ALL A;LL GA ALL ALL HI CA ALL CA ALL ALL ALL ALL N Y Y Y Y Y Y Y N N N Y N Y N Y CONTACT SUPPORT ALLCARE PEBB ALLEGIAN CHOICE ALLEGIANCE BENEFI ALL PHYS HIGH DES ALLIANT GEORGIA ALLIED BENEFIT ALLIED PHYS OF CA ALOHACARE ALPHA CARE MEDICA ALPHACARE ABMG ALTA HEALTH ALTERNATIVE OPPOR AMA INS AGENCY IN AMALGAMATED LIFE N N N Y Y N Y Y N N N N N N N Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE TRUE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G N G T G C G N G COMPU 38219 75137 27515 27517 27516 NOCD NOCD NOCD NOCD NOCD NOCD CO ALL ALL TX MD NJ N Y Y Y Y Y AMALG TRANSIT UNI AMERAPLAN AMERIBEN SOLUTION AMERICAID HOUSTON AMERICAID MD AMERICAID NJ N Y N Y Y Y FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH P G P T G G 75240 37283 63103 95170 59140 56071 IP080 TH095 60801 62030 66065 01066 77083 81949 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL ALL ALL NV ALL CA ALL ALL ALL PR ALL ALL ALL Y A N T A N N Y Y N Y N Y N AAG AMERICAN ADMINIST AMERICAN BEHAVIOR AM BENEFIT PLAN A AM BENEFITS PLAN AM FAMILY INSURAN AM FAMILY HLTH PR AMERICAN FAMILY I AMERICAN FIDELITY AMERICAN GENERAL AM HEALTH MCARE AM HEALTHCARE ALL AMERICAN HERITAGE AMER INS OF TEXAS N N Y Y Y N Y N N Y N Y N N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G G G N G G G 72099 74048 44444 44444 42011 17965 ASH01 ATHAL 37322 20553 55349 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL All All ALL ALL ALL ALL ALL ALL ALL Y Y Y Y N Y Y Y N R Y AMERICAN LIFECARE AMER NAT INSURANC AMERICAN POSTAL W APWU ARIC AMERICAN SENTINEL AM SPECIALTY HLTH ATA WISCONSIN AMERICAN WORKER H AMERICAS FIRST CH AM FIRST CHOICE S Y N Y Y N Y N N Y Y N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G G G G For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 3 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer America's Choice NMA 20029 NOCD ALL Y AMERICAS CHOICE N Y FALSE America's Health Choice 21810 NOCD ALL Y AMERICAS HEALTH C N FALSE America's PPO (Formerly known as ARAZ.) 16120 NOCD ALL Y AMERICAS PPO ARAZ Y FALSE America's PPO / America's TPA 41178 NOCD ALL Y AMERICAS PPO Y FALSE AmeriChoice NJ, Medicaid, NJ Family Care (UnitedHealthcare Community Plan) 86047 NOCD NJ Y UHC COMMUNITY NJ Y FALSE Amerigroup - Illlinois 28804 NOCD ALL Y AMERIGROUP N FALSE Amerigroup - Maryland and District of Columbia 28807 NOCD MD,DC N AMERIGROUP MD N FALSE Amerigroup - New Jersey 28806 NOCD NJ N AMERIGROUP NJ N FALSE Amerigroup of Iowa 26375 NOCD ALL Y AMERIGROUP IOWA N FALSE Amerigroup / Americaid - Houston 28805 NOCD TX Y AMERIGROUP HOUSTO N FALSE AMERIGROUP Georgia 27514 NOCD GA Y AMERIGROUP GA Y FALSE Amerigroup of Florida 28809 NOCD FL Y AMERIGROUP OF FL N FALSE AMERIGROUP Tennessee 27514 NOCD TN Y AMERIGROUP TN Y FALSE AmeriHealth - New Jersey (Non-HMO Claims) SX075 NOCD ALL Y AMERIHEALTH NJ Y TRUE AmeriHealth Administrators 54763 NOCD ALL Y AMERIHEALTH ADMIN N FALSE Amerihealth Caritas Iowa ( For EDI Support, email [email protected] or call 844-341-7644.) 77075 NOCD IA Y AMERIH CARITAS IA Y FALSE AmeriHealth Caritas Louisiana (Formerly known as LA Care) 27357 NOCD LA Y LA CARE N FALSE AmeriHealth Caritus VIP Care Plus (Michigan) 77013 NOCD MI Y AH CARITUS VIP CA N FALSE AmeriHealth Connect (Effective 1-1-2015. Pennsylvania Healthy PA Private Coverage Option.For EDI Support, please call 1-855-707-5823.) 77051 NOCD ALL Y AMERIHEALTH CONNE Y FALSE Amerihealth District of Columbia (For EDI Support, please email [email protected] or call 1-888-656-2383) 77002 NOCD ALL Y AMERIHEALTH DC N FALSE AmeriHealth HMO New Jersey and Delaware 23037 NOCD NJ,DE Y AMERIHEALTH HMO Y TRUE AmeriHealth Mercy Health Plan 22248 NOCD All Y AMERIHEALTH MERCY Y FALSE AmeriHealth NorthEast 77001 NOCD ALL Y AMERIHEALTH NE Y FALSE Amerihealth VIP Care - DC (Payer is effective 01-01-2014. Claims for Dates of service before this date will reject.) 77007 NOCD ALL N AMERIHEALTH VIPDC N FALSE AmeriHealth VIP Care (Medicare Advantage Plan Part of the AmeriHealth Mercy Family of Companies) 22355 NOCD ALL N AMERIHEALTH VIP Y FALSE Amerihealth VIP Care LA (Payer is effective 01-01-2014. Claims for Dates of service before this date will reject.) 77006 NOCD ALL N AMERIHEALTH VIPLA N FALSE Amerikids-Dallas/Ft. Worth 26374 NOCD TX Y AMERIKIDS DALLAS N FALSE Amerivantage 26375 NOCD ALL Y AMERIGROUP IOWA N FALSE Amfirst Insurance Company 64090 NOCD ALL Y AMFIRST INS CO N FALSE AM-First Insurance Morgan White (Payer accepts secondary claims only, and Medicare cannot be primary payer.) Amida Care (Formerly Vida Care.) Amida Care Medicare AMVI Amway Corporation Anaheim Memorial IPA (MHCAN) Anchor Benefit Consulting Ancillary Benefits/Arizona Foundation for Medical Care Anerican Founders Life Ins Co (NFL Plans only) Angeles IPA (SynerMed) Antares Management Solutions Anthem Blue Cross of California Anthem Health and Life Insurance Company of New Jersey Anthem Medicaid (WI) (Formerly BadgerCare) Anthem of Colorado Anthem of Nevada Apex Benefit Services (Claims must contain the rendering provider ID or the claim will reject.) ARAZ (Now known as America's PPO.) Arbor Health Arcadian Management Services, Inc (Group number should be entered if available. ) Arise Health Plan (Formerly Prevea Health) Arizona Foundation for Medical Care Arizona Medicaid (AHCCCS) Arizona Physicians IPA (APIPA) (UnitedHealthcare Community Plan) Arizona Pipe Trades Health and Welfare Trust Fund Local Union Nos. 469 & 741 Metal Trades Health Plan Arizona Pipe Trades Health and Welfare Trust Fund Local Union Nos. 469 & 741 Pipe Trades Health Plan Arizona Priority Care Plus Arkansas Best Corporation Arkansas Managed Care Organization (AMCO) Arnett Health Plan - former payer id 95440 Arroyo Viata Family Health Center Arta Health Network ASAGEHA Asian American Medical Group Aspen Insurance Aspire Health Plan ASR Corporation ASRM Corporation Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH G G G G BOTH # BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH C G T G G T G T G N T BOTH BOTH BOTH G G G BOTH G BOTH BOTH BOTH BOTH G G G G BOTH G BOTH G BOTH BOTH BOTH BOTH G G G G 01757 24818 79966 IP080 38254 MHIPA 53085 AZFMC 98205 75299 34192 BC001 80705 WIBLS COBLS NVBLS NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD BCBS NOCD ALL ALL ALL CA All CA ALL ALL ALL ALL ALL CA NJ WI CO NV Y N Y N Y N A Y N Y Y Y N N Y N AM FIRST INS MORG AMIDA CARE AMIDA CARE MEDICA AMVI AMWAY MEMORIAL HC IPA ANCHOR BENEFIT CO ANCILLARY BENEFIT AMERICAN FOUNDERS ANGELES IPA SYNER ANTARES MGMT SOLN CA BLUE CROSS ANTHEM LIFE NJ ANTHEM WI MEDICAI CO ANTHEM NV ANTHEM Y Y N Y N Y N Y N N Y Y N Y Y Y TRUE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G P G G G G C N N N 34196 16120 52312 NOCD NOCD NOCD ALL ALL ALL N Y N APEX BENE SERVICE ARAZ ARBOR HEALTH Y Y Y FALSE FALSE FALSE BOTH BOTH BOTH G G G 61101 39185 AZFMC AZMCD NOCD NOCD NOCD NOCD All ALL AZ AZ Y Y Y Y ARCADIAN MGMT SVS ARISE HEALTH PLAN AZ FOUNDATION MED AZ MEDICAID Y N Y Y FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH G T P N 03432 NOCD AZ Y UHC AZIPA Y FALSE BOTH # C 74234 NOCD AZ N AZ METAL TRADES N FALSE BOTH P 74234 27154 75278 62176 87726 NMM01 WMM01 06603 AAMG1 16180 46156 38265 ASRM1 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD AZ ALL ALL AR ALL ALL CA ALL CA ALL ALL ALL ALL N N Y Y Y Y N Y N N N Y Y AZ PIPE TRADES AZ PRIORITY CARE ARKANSAS BEST COR AR MCO ARNETT HEALTH PLA ARROYO VISTA FAM ARTA HLTH NETWORK ASAGEHA ASIAN AMERICAN MG ASPEN INSURANCE ASPIRE HEALTH PLA ASR CORPORATION ASRM CORP N N Y Y Y Y Y N N Y Y Y N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH # BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH P G G G C G G G G G G G G For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 4 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Assoc De Meastros 94027 NOCD PR N ASSOC DE MEASTROS N FALSE Associated Third Party Administration (ATPA) ATPA1 NOCD ALL N ATPA Y FALSE Associates for Healthcare 36326 NOCD ALL Y ASSOC HEALTHCARE Y FALSE Assurant Employee Benefits (Formerly Fortis Insurance) 39065 NOCD All N FORTIS N FALSE Assurant Health Re-Pricing via HealthSpan ASNTH NOCD ALL N ASSURANT HLTH REP N FALSE Assurant Health Self Fund (Verify that claims should go to Ft. Mill, SC) 37313 NOCD ALL Y ASSURANT HLTH SEL Y FALSE Assurant Health Self Funded (MUST VERIFY ALL CLAIMS SHOULD GO TO ALLIED BENEFIT for Assurant Health Self Funded groups with Plan effective dates after 5/1/2013) 75068 NOCD ALL N ASSURANT HLTH SLF Y FALSE Assured Benefits Administrators 74240 NOCD ALL Y ASSURED BENEFITS Y FALSE Asuris Northwest/MedAdvantage (REF*1B*Provider ID in Billing and Rendering required even when NPI is submitted.) SX179 NOCD ALL Y ASURIS NW MEDADVA Y FALSE Asuris NW Health 93221 NOCD ALL Y ASURIS NW HEALTH Y FALSE Atlantic Medical 22285 NOCD ALL N ATLANTIC MEDICAL N FALSE Atlantis Eye Care AEC01 NOCD ALL Y ATLANTIS EYE CARE Y FALSE Atlas Life Ins Co (NFIC Plan only) 90956 NOCD ALL N ATLAS LIFE INS CO N FALSE Atrio Health Plan (Formerly known as Marion Polk Health Plan Advantage) MPCHA NOCD ALL Y MARION POLK HP AD N TRUE Aultcare MNAUL NOCD OH N AULTCARE N TRUE Automated Benefit Services (ABS) 38259 NOCD ALL Y AUTOMATED BEN SVC N FALSE Automated Group Administration, Inc. 37280 NOCD ALL N AUTOMATED GROUP A Y FALSE Automotive Machinists Local 289 Health & Welfare Trust Grp#F32 91136 NOCD ALL Y AUTO GRP F32 N FALSE Avalon Healthcare Solutions (Must contact the payer directly at Provider Services @ 855-895-1676 prior to sending claims.) Avalon IPA Avante Health (Customer Service 559-261-9060) Avectus Healthcare Solutions (Call 855-AVECTUS) Avera Health Plans Avesis Third Part Administrators AVMED AVMED-Parity Healthcare (OB/GYN only) Axminister Medical Group AZ Integrated Physicians Bakersfield Family Medical Center Banner Health Banner Medisun Baptist Health Plan (Formerly Bluegrass Family Health) Baptist Health South Florida Baycare Life Management BCBS of Texas Medicaid (Plan effective December 1, 2015) BCI Administrators, Inc Beacon Health Options (Formerly Value Options) Beacon Health Strategies (Providers need to call Provider Relations Dept at 781-994-7576 to register before sending claims.) Beech Street Corp. (Payer requires that payer and employer information in box11 be attached.) Behavioral Health Systems Behavioral Healthcare, Inc. Bella Vista Med Grp IPA Benefit & Risk Management Services (Commercial Medicare under Med3000) Benefit Administration Services Benefit Administrative Systems Benefit Concepts Benefit Coordinators Corporation Benefit Management Services Benefit Management Systems, Inc of Mississippi Benefit Management, Inc. of KS (Only accepts claims for these groups BMI187,BMI219,BMI234,BMI236,BMI214,BMI241,BMI617 BMI246,BMI246.) Benefit Plan Administrators Benefit Plan Administrators Co. (Payer ID valid only for claims with a billing submission address of PO Box 1128, Eau Claire, WI 54702-1128) Benefit Plan Administrators, Inc (For DOS prior to 10-1-12. Use 57080 for DOS after 10-1-12) Benefit Systems and Services, Inc. Benefit Trust Life Insurance Company Benesight (formerly The TPA) BeneSys, Inc. (Now known as Sheet Metal Workers Local 104) Benmark Berkshire Health Partners Berkshire Intergroup Best Life & Health Insurance Co. Better Health Plan of Florida (For claims rejections, contact payer at 800-514-4561 and select provider services option.) Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH N P C G G BOTH G BOTH BOTH G G BOTH BOTH BOTH BOTH BOTH G G G G G BOTH BOTH BOTH BOTH G N G G BOTH G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G C G G P G G G G G G G G G G G G AVA01 IP080 AH001 MP001 46045 87098 59274 58204 AXM01 NCHON BKRFM 12X42 77078 61124 65026 59279 66001 49153 VALOP NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL CA ALL ALL ALL ALL FL FL ALL ALL ALL ALL ALL ALL ALL ALL TX ALL ALL Y N N N Y Y Y Y N N N Y N Y N N Y N N AVALON HC SOLUTIO AVALON IPA AVANTE HEALTH MEDPAY FIRST ONE AVERA HEALTH PLAN AVESIS TPA AVMED AVMED PARITY AXMINISTER MED GR AZ INTEGRATED PHY BAKERSFIELD FAMIL BANNER HEALTH BANNER MEDISUN BLUEGRASS FAM HLT BAPTIST HLTH S FL BAYCARE LIFE MGMT BCBS TEXAS MEDICA BCI ADMINISTRATOR BEACON HLTH OPTIO N Y Y Y Y Y Y Y N Y Y Y N N N N N N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE 43324 NOCD ALL Y BEACON HLTH STRAT N FALSE BOTH G 95377 63100 BHI00 MPM10 NOCD NOCD NOCD NOCD ALL ALL CO CA Y N Y N BEECH STREET BEHAVIORAL HS BEHAVIORAL HC INC BELLA VISTA MED G Y N Y N FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH G G P N 99320 41205 36149 51037 25145 56139 37212 NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL ALL ALL ALL ALL MS N Y Y Y N N Y BENE RISK MGMT SV BENEFIT ADMIN SVC BENE ADMIN SYSTEM BENEFIT CONCEPTS BENEFIT COOR CORP BENE MGMT SVCS BMS OF MS N Y Y N N Y Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G 48611 88052 NOCD NOCD ALL ALL N Y BENEFIT MGMT KS BENE PLAN ADMINIS N N FALSE FALSE BOTH BOTH G G 39081 NOCD WI Y BENEFIT PLAN WI N FALSE BOTH G 37118 36342 61425 87265 NOCD NOCD NOCD NOCD ALL All All ALL Y Y Y Y BENEFIT PLAN ADM BENEFIT SYSTEMS BENEFIT TRUST LIF BENESIGHT N Y N N FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH G G G G 38238 BNMK1 23243 10956 95604 NOCD NOCD NOCD NOCD NOCD ALL ALL ALL ALL ALL N N N Y N BENESYS INC MI BENMARK BERKSHIRE HLTH PA BERKSHIRE INTERGR BEST LIFE AND HEA N N Y N Y FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH G G G G G 20488 NOCD ALL N BETER HP OF FL Y FALSE BOTH G For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 5 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Beverly Alianza IPA POP05 NOCD ALL Y BEVERLY ALIANZA I N FALSE BHP-Unity 44219 NOCD ALL R BHP UNITY Y FALSE BHSF International 67668 NOCD ALL Y BHSF INTERNATIONA N FALSE Big Lots Associates Benefit Plans CX025 NOCD ALL N BIG LOTS ASSOC BE N FALSE Block Vision of Texas BVTX1 NOCD TX Y BLOCK VISION TX Y FALSE Block Vision, Inc. BV001 NOCD ALL Y BLOCK VISION INC Y FALSE Blue Advantage of Arkansas ARBLS NOCD AR Y AR BLUE ADVANTAGE Y TRUE Blue Care PPO VABLS BCBS VA Y BLUECARE PPO Y FALSE Blue Chip of Rhode Island RICHP NOCD RI Y RI BLUE CHIP Y FALSE Blue Choice Medicaid 00403 NOCD SC Y BLUE CHOICE MCAID Y FALSE Blue Choice of Rochester NY N6BLS NOCD NY N ROCHESTER BLUE CH Y FALSE Blue Choice of South Carolina 00922 NOCD SC N BLUE CHOICE OF SC N FALSE Blue Cross Blue Shield Michigan Medicare MIMCR NOCD MI Y BCBS MI MEDICARE Y TRUE Blue Cross Blue Shield of Arizona 53589 NOCD AZ Y AZ BLUE SHIELD Y FALSE Blue Cross Blue Shield of Florida FLBLS BCBS FL Y FL BLUE SHIELD Y FALSE Blue Cross Community Solutions (Effective 12-14-14. Payer was previously known as IL BCBS ICP with a payerID of 00621) Blue Cross Complete Blue Cross Complete of Michigan, LLC Blue Cross MI Blue Care Complete Blue Cross of California Blue Cross of Idaho Blue Grass Family Health (SRRIPA) Blue Lake Rancheria Blue Medicare of North Carolina (Contracted providers only. Call 888-296-9790) Blue Shield of Alabama Blue Shield of Alaska Blue Shield of Arizona Blue Shield of Arkansas Blue Shield of California Blue Shield of Central NY HMO/PPO Blue Shield of Colorado Blue Shield of Connecticut Blue Shield of Delaware Blue Shield of Georgia (State Health of GA) Blue Shield of Hawaii Blue Shield of Idaho (Per Provider Testing) Blue Shield of Illinois Blue Shield of Indiana Blue Shield of Iowa Blue Shield of Iowa (For Secondary claims only where Medicare is primary) (Provider must be enrolled with IABLS prior to sending to this payer. ) Blue Shield of Kansas Blue Shield of Kansas City Blue Shield of Kentucky Blue Shield of Louisiana Blue Shield of Maine Blue Shield of Maryland Blue Shield of Massachusetts Blue Shield of Michigan Blue Shield of Minnesota Blue Shield of Mississippi Blue Shield of Missouri Blue Shield of Montana Blue Shield of National Capital Area Blue Shield of Nebraska Blue Shield of Nevada Blue Shield of New Hampshire Blue Shield of New Jersey Blue Shield of New Mexico Blue Shield of New York (Empire) Blue Shield of North Carolina Blue Shield of North Dakota Blue Shield of Northeast NY Blue Shield of Ohio Blue Shield of Oklahoma Blue Shield of Oregon Blue Shield of Pennsylvania Blue Shield of Rhode Island Blue Shield of Rochester NY Blue Shield of South Carolina Blue Shield of South Dakota Blue Shield of Tennessee Blue Shield of Texas Blue Shield of Utah Blue Shield of Utica NY Blue Shield of Vermont Blue Shield of Virginia Blue Shield of West Virginia Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G N N N N N G N N N MCDIL 32002 MIBCN MIBCN BC001 IDBLC 15754 IP061 NOCD NOCD NOCD NOCD NOCD BCBS NOCD NOCD ALL ALL MI MI CA ID ALL CA Y Y Y N Y Y N N ILLINOIS BCBS ICP BLUE CROSS COMPLE BC COMPLETE OF MI MI BLUE CARE CA BLUE CROSS ID BLUE CROSS BLUE GRASS FAMILY BLUE LAKE RANCHER N Y N Y Y Y Y Y FALSE FALSE FALSE TRUE FALSE TRUE FALSE FALSE BOTH BOTH BOTH # BOTH # BOTH BOTH BOTH BOTH G G G N G N G G CALL ALBLS AKBLS AZBLS ARBLS BS001 N2BLS COBLS CTBLS DEBLS GABLS HIBLS IDBLS ILBLS INBLS IABLS NOCD NOCD NOCD NOCD NOCD NOCD NOCD BCBS NOCD BCBS BCBS NOCD BCBS BCBS NOCD BCBS NC AL AK AZ AR CA NY CO CT DE GA HI ID IL IN IA Y Y N Y Y Y Y Y Y Y Y N Y Y Y N CALL SUPPORT AL BLUE SHIELD AK BLUE SHIELD AZ BLUESHIELD AR BLUE SHIELD CA BLUE SHIELD CE NY BLUE SHIELD CO BLUE SHIELD CT BLUE SHIELD DE BLUE SHIELD GA BLUE SHIELD HI BLUE SHIELD ID BLUE SHIELD IL BLUESHIELD IN BLUE SHIELD IA BLUE SHIELD Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y FALSE FALSE FALSE FALSE TRUE FALSE FALSE FALSE FALSE TRUE FALSE TRUE FALSE FALSE FALSE TRUE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N N N N N G N N N N N N N N N N IABLM KSBLS KCBLS KYBLS LABLS MEBLS MDBLS MABLS MIBLS MNBLS MSBLS MOBLS MTBLS NCABS NEBLS NVBLS NHBLS 22099 NMBLS NYBLS NCBLS NDBLS N5BLS OHBLS OKBLS ORBLS PABLS RIBLS N7BLS SCBLS SDBLS TNBLS TXBLS UTBLS N4BLS VTBLS VABLS WVBLS NOCD BCBS NOCD NOCD NOCD NOCD BCBS NOCD NOCD NOCD NOCD NOCD BCBS NOCD BCBS NOCD NOCD NOCD NOCD NOCD NOCD BCBS NOCD NOCD BCBS NOCD NOCD NOCD NOCD NOCD BCBS BCBS NOCD NOCD NOCD NOCD BCBS NOCD IA KS KS,MS KY LA ME MD MA MI MN MS MO MT DC VA M NE NV NH NJ NM NY NC ND NY OH OK OR PA RI NY SC SD TN TX UT NY VT VA WV N Y Y Y N Y Y Y Y N Y Y Y Y Y Y Y Y Y N Y N Y Y Y Y Y Y N Y N Y Y Y Y N Y Y IA BLUE SHIELD CO KS BLUE SHIELD KC BLUE SHIELD KY BLUE SHIELD LA BLUE SHIELD ME BLUE SHIELD MD BLUE SHIELD MA BLUE SHIELD MI BLUE SHIELD MN BLUE SHIELD MS BLUE SHIELD MO BLUE SHIELD MT BLUE SHIELD NCA NE BLUE SHIELD NV BLUE SHIELD NH BLUE SHIELD NJ BLUESHIELD NM BLUE SHIELD NY BLUE SHIELD NC BLUE SHIELD ND BLUE SHIELD NE NY BLUE SHIELD OH BLUE SHIELD OK BLUE SHIELD OR BLUE SHIELD PA BLUE SHIELD RI BLUE SHIELD ROCHESTER BLUE SH SC BLUE SHIELD SD BLUE SHIELD TN BLUE SHIELD TX BLUE SHIELD UT BLUE SHIELD UTICA BLUE SHIELD VT BLUE SHIELD VA BLUE SHIELD WV BLUE SHIELD Y N N Y Y Y Y Y Y Y Y Y Y N Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y Y Y Y N Y Y TRUE TRUE TRUE FALSE TRUE FALSE FALSE TRUE TRUE FALSE TRUE FALSE FALSE TRUE FALSE FALSE FALSE TRUE FALSE FALSE FALSE TRUE TRUE FALSE FALSE FALSE TRUE FALSE FALSE FALSE TRUE TRUE FALSE FALSE FALSE FALSE FALSE TRUE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH # BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N G N N N N N For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 6 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Blue Shield of Western New York N1BLS NOCD NY Y NY BLUE SHIELD WE Y TRUE Blue Shield of Wisconsin WIBLS NOCD WI N WI BLUE SHIELD Y FALSE Blue Shield of Wyoming WYBLS BCBS WY Y WY BLUE SHIELD Y TRUE Bluebonnet Administrators 37121 NOCD LA N BLUEBONNET ADMINI Y FALSE Boilermakers national Health & Welfare Fund 36609 NOCD ALL Y BOILERMAKERS NATL Y FALSE Bollinger, INC. BOLL1 NOCD ALL N BOLLINGER INC Y FALSE Boon-Chapman Benefit Administrators, Inc. 74238 NOCD ALL Y BOON CHAPMAN BENE N FALSE Boston Medical Center Healthnet 13337 NOCD MA N BOSTON MED CENTER Y FALSE BPS Inc 48964 NOCD ALL Y BPS INC Y FALSE Bravo Health (Now CIGNA HealthSprings.) 52192 NOCD ALL Y BRAVO HEALTH Y FALSE BridgeSpan BRIDG NOCD ALL N BRIDGESPAN N FALSE Bridgeway Arizona 68069 NOCD AZ Y BRIDGEWAY ARIZONA Y FALSE Bright Health Physicians BHP01 NOCD CA Y BRIGHT HEALTH PHY N FALSE BritCay 22286 NOCD ALL Y BRITCAY N FALSE Brockerage Concepts, Inc (Benefit Concepts) 51037 NOCD ALL Y BROCKERAGE CONCEP N FALSE Brown & Brown Benefits 59069 NOCD All Y BROWN AND BROWN N FALSE Brown & Toland Medical Group 94316 NOCD ALL Y BROWN TOLAND Y FALSE Brown & Toland Sutter BTSS1 NOCD ALL N BROWN TOLAND SUTT N FALSE Brown & Toland SutterSelect BTSS1 NOCD ALL Y BROWN TOLAND SUT Y FALSE Buckeye Community Health 68069 NOCD IA Y BUCKEYE COMM HLTH Y FALSE Butler Benefits 42150 NOCD ALL Y BUTLER BENEFITS N FALSE C & O Employees Hospital Association 23708 NOCD ALL Y C AND 0 EMP HOSP Y FALSE C3 Health (fka Access Health Inc.) A1680 NOCD MI N ACCESS HEALTH PLA Y FALSE California Anthem Blue Cross BC001 NOCD CA Y CA BLUE CROSS Y FALSE California Blue Cross BC001 NOCD CA Y CA BLUE CROSS Y FALSE California Health and Wellness 68069 NOCD CA Y CA HEALTH WELLNES Y FALSE California IPA AMM14 NOCD CA N CALIFORNIA IPA N FALSE California Pacific Medical Center 94056 NOCD ALL Y CA PACIFIC MED CE Y FALSE California Water Services CWS99 NOCD CA Y CA WATER SERVICES N FALSE Cal-Optima Direct CALOP NOCD ALL Y CALOPTIMA DIRECT Y FALSE Cannon Cochran Management Services, Inc. LA (Claims for Payer address of Metairie, LA only.) 71057 NOCD LA N CANNON COCHRAN LA N FALSE CAP Management 95399 NOCD ALL N CAP MANAGEMENT Y FALSE Cap Management Systems IP080 NOCD CA N CAP MGMT SYSTEMS Y FALSE Capital Advantage Insurance Company (CAIC) PROFESSIONAL (BCBS ProviderID and Performing ProviderID required. Call 800-874-8433) 23045 NOCD PA Y CAPITAL ADV INS Y FALSE Capital Blue Cross PROFESSIONAL (BCBS ProviderID and Performing ProviderID required. Call 800-874-8433) 23045 NOCD PA Y CAPITAL BLUE CROS Y TRUE Capital District PHP SX065 NOCD ALL A CAPITAL DIST PHP Y FALSE Capital Health Plan 95112 NOCD All Y CAPITAL HEALTH PL Y FALSE Capital International Management Services 65067 NOCD ALL Y CAP INTL MGMT SVC Y FALSE Capitol Administrators 68011 NOCD ALL Y CAPITOL ADMINISTR Y FALSE CapRock HealthPlans CAPHP NOCD ALL N CAPROCK HEALTH PL Y FALSE Cardinal Innovations. (Formerly Piedmont Behavioral Health) 06607 NOCD ALL Y CARDINAL INNOVATI Y FALSE Cardiovascular Care Providers GCVCP NOCD ALL N CARDIOVASCULAR CA N FALSE Care 1st Health Plan of Arizona 57116 NOCD AZ Y AZ CARE FIRST HP Y FALSE Care 1st Health Plan of CA 57115 NOCD CA N CARE 1ST HP OF CA N FALSE Care Access PSN 65063 NOCD ALL N CARE ACCESS PSN N FALSE Care Choices HMO HM037 NOCD ALL N CARE CHOICES HMO Y FALSE Care Core National 14182 NOCD ALL Y CARE CORE NATIONA Y FALSE Care Improvement Plus (CIP), XLHealth 87726 NOCD ALL N CARE IMPROVEMENT Y FALSE Care Improvement Plus/CIP/XLHealth 77082 NOCD ALL N CARE IMPROVEMENT N FALSE Care N' Care 37228 NOCD ALL N CARE N CARE N FALSE Care Partners 43172 NOCD All Y CARE PARTNERS Y FALSE Care Plus 65031 NOCD ALL A CARE PLUS N FALSE Care to Care 41222 NOCD ALL N CARE TO CARE N FALSE Care Wisconsin Health Plan (Trizetto) 27004 NOCD ALL N CARE WI HEALTH PL Y FALSE CareCentrix 11345 NOCD ALL Y CARECENTRIX Y TRUE Carechoices Michigan - Mercy Healthplans (Enrollment required; please contact Noreen at (248) 489-5281.) 38269 NOCD MI Y CARECHOICES MI Y FALSE Carecore National Wellcare 14188 NOCD ALL N CARECORE NAT WELL N FALSE CareCore National, LLC - Health Net New Jersey 14185 NOCD ALL N CARECORE HNET NJ Y FALSE CareCore National, LLC (Aetna Radiology Claims) 14179 NOCD ALL N CARECORE NATIONAL N FALSE CareCore National, LLC (Radiology charges for Oxford) 14180 NOCD NY, NJ Y CARECORE OXFORD Y FALSE CareFirst BCBS - DC, National Capital Area SB580 NOCD MD,DC Y CAREFIRST NCA N TRUE Carelink Medicaid 25140 NOCD ALL Y CARELINK MEDICAID Y FALSE Caremore CM001 NOCD ALL Y CAREMORE N FALSE Caremore IPA CARMO NOCD ALL N CAREMORE IPA N FALSE CareMore Value Plus (CVP) CARMO NOCD ALL N CAREMORE IPA N FALSE Carenet of Virginia (Prepare to use consolidated Coventry payerID of 25133.) 25142 NOCD VA Y CARENET VIRGINIA Y FALSE CareOregon, Inc. 93975 NOCD OR Y CAREOREGON INC N FALSE CarePlus Cardiology - New Century Health NCH04 NOCD ALL N CAREPLUS CARDIO Y FALSE CarePlus Health Plan (Call payer for PayerID) CALL CALL ALL N CALL PAYER N FALSE Caresource Health Plan of Oregon MRCHP NOCD ALL N CARESOURCEHPOR N FALSE Caresource IN INCS1 NOCD IN Y CARESOURCE IN Y FALSE CareSource KY KYCS1 NOCD KY N CARESOURCE KY Y FALSE CareSource OH 31114 NOCD OH R CARESOURCE OH Y FALSE Careworks of Ohio 10010 NOCD OH N CAREWORKS OF OHIO N FALSE Cariten Commercial 62073 NOCD ALL N CARITEN HEALTHCAR Y FALSE Cariten Senior Health 62072 NOCD ALL N CARITEN SENIOR HE Y FALSE For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N N N G G N G G G G G G G G G G G G G G G G C G G G G G G G BOTH BOTH BOTH G G G BOTH N BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH # BOTH # BOTH BOTH BOTH BOTH BOTH BOTH N G C G G G G G G G N T G C C G G G G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G N G G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G N N G G G G G G G 7 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Carolina Behavioral Health Alliance 56215 NOCD NC N CAROLINA BEHAV HL N FALSE Carolina Care Plan (Part of the Medical Mutual Family of companies. Former payerID was 57105.) 29076 NOCD SC Y CAROLINA CARE PLA Y FALSE Carolina Crescent 68069 NOCD ALL Y CAROLINA CRESCENT Y FALSE Carolina Summit Healthcare, Inc 56195 NOCD ALL Y CAROLINA SUMMIT Y FALSE Carpenters' and Millwrights' Health Benefit Trust Fund COMPU NOCD CO N CARPENTERS HBTF N FALSE Carpenters Health and Welfare Fund of Philadelphia CX101 NOCD ALL N CARPENTERS HW FUN N FALSE Carpet, Linoleum and Resilient Tile Layers Health and Welfare Fund COMPU NOCD CO N CARPET TILE HWF N FALSE Cascade Health Partners 93102 NOCD All Y CASCADE HEALTH PA Y FALSE CBA Blue 03036 NOCD ALL Y CBA BLUE N FALSE CBA, Inc. (Cooperative Benefits Administrators, Inc.) (For Dates of Service after 01-01-2014, submit claims to 39026.) 52132 NOCD All Y CBA Y FALSE CBHA Carolina Behavioral Health Alliance 56215 NOCD ALL Y CBHA Y FALSE CBNHP Health Choices 65391 NOCD ALL Y CBHNP HEALTH CHOI N FALSE CBSA (Corporation Benefit Services of America) 41124 MCSI ALL Y CBSA N FALSE CCMC - Comprehensive Care Management Corp CCMC1 NOCD NY Y CCMC N FALSE CCS (aka Comprehensive Care Systems) MNBLS NOCD MN Y CCS COMPREHENSIVE Y FALSE CDO Technologies 87065 NOCD WY,UT Y CDO TECHNOLOGIES N FALSE CDS Group Health 88022 NOCD ALL Y CDS GROUP HEALTH Y FALSE Cedar Valley Community Health Plan SISCO NOCD ALL N SISCO N FALSE Cedars-Sinai Medical Network Services Claims 95166 NOCD ALL Y CEDARS SINAI CLAI Y FALSE Cedars-Sinai Medical Network Services Encounters 95167 NOCD ALL Y CEDARS SINAI ENCO Y FALSE Celtic Insurance CELTC NOCD ALL N CELTIC INS Y FALSE CeltiCare 68069 NOCD ALL Y CELTICARE Y FALSE Code Set (See Legend) Payer Type BOTH G BOTH BOTH BOTH BOTH BOTH G G G P G BOTH BOTH BOTH P G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G N G G P G G G G Cement Masons & Plasterers Health & Welfare Trust - Grp#F16 CenCal Health Cenpatico - Georgia Cenpatico - Kansas (Prior to submitting claims please call Provider Relations Dept at 866-896-7293 to verify your provider info is on file in the claim system.) Cenpatico (For multiple states) Cenpatico Behavioral Health - Wisconsin (Call 800-225-2573 ext 25525 prior to submitting claims.) Cenpatico Behavioral Health AZ (Prior to submission, contact 866-495-6748 to verify provider ID.) Cenpatico Florida Behavioral Health Cenpatico Indiana Cenpatico Massachusetts Cenpatico Ohio Centegra Health Systems Centene Advantage Plans Center for Elders Independence Center IPA CenterCare CenterLight Healthcare CenterPoint Human Services Centinela IPA CentraCare Central & Southwest Services Central Benefit National (Now known as Tribute Health Plan.) Central California Alliance for Health (Alliance EDI Support Unit 831-430-5510) 91136 95386 68069 NOCD NOCD NOCD ALL CA GA Y N Y CEMENT GRP F16 CENCAL HEALTH CENPATICO GA N N Y FALSE FALSE FALSE BOTH BOTH BOTH G G G 68068 68068 NOCD NOCD ALL ALL Y Y CENPATICO KANSAS CENPATICO Y Y FALSE FALSE BOTH BOTH G G 68068 NOCD ALL Y CENPATICO BHAV WI Y FALSE BOTH G 68068 68068 68068 68068 68068 36474 68069 94312 POP01 13357 13360 56122 IP080 66698 75177 31118 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD AZ FL ALL MA OH ALL ALL ALL ALL ALL ALL ALL CA ALL All ALL Y Y Y Y Y N Y N Y Y N Y N Y Y Y CENPATICO BH AZ CENPATICO FL BHV CENPATICO INDIANA CENPATICO MASSACH CENPATICO OHIO CENTEGRA HLTH SYS CENTENE ADVANTAGE CENTER ELDERS IND CENTER IPA CENTERCARE CENTERLIGHT HC CENTERPOINT HUMAN CENTINELA IPA CENTRACARE CENTRAL SOUTHWEST CENTRAL BENEFITS Y Y Y Y Y N Y Y N Y Y Y Y N Y Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G G G G G G G G G SX169 NOCD CA N CEN CAL ALLIANCE N FALSE BOTH N Central California Electricial Workers Health and Welfare Trust Central California Women's Health Central Health Medicare Central Reserve Life Central Reserve Life Ins.Co. (Formertly Loyal American Life (Medicare Supplement) ) Central States Southeast and Southwest Areas Health and Welfare and Pensions Funds Centurion of Tennessee Century PHO CHA - Commonwealth Health Alliance NWADM WH001 CHCPI 34097 NOCD NOCD NOCD NOCD CA CA ALL All N Y N Y CCEW HLTH WELFARE CENT CA WOMENS HE CENTRAL HLTH MEDI CENTRAL RESERVE L Y N Y N FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH G G G G 13193 NOCD ALL Y LOYAL AMERICAN L Y FALSE BOTH G 36215 42140 36393 23171 NOCD NOCD NOCD NOCD All ALL ALL ALL Y N N Y CENTRAL STATES SO CENTURION TENNESS CENTURY PHO CHA Y N N Y FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH G G G G 84146 NOCD ALL N CHAMPVA HAC Y FALSE BOTH G CHAT1 16600 NOCD NOCD ALL NY Y Y CHATWINS HLTHCARE CHAUTAUQUA HEALTH N N FALSE FALSE BOTH BOTH T G 94321 39113 CSSD2 NOCD NOCD NOCD ALL ALL SD N N Y CHILDREN FIRST MG CHILDRENS COMM HP CHILD SPEC OF SD N Y N FALSE FALSE FALSE BOTH BOTH BOTH G G G 94302 CHIPA 33070 CASD1 NOCD NOCD NOCD NOCD ALL ALL ALL SD Y N Y R CHINESE COMM HP COLLEGE HLTH IPA CHIROMETRICS INC CHIRO ASSOC SD Y N Y Y FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH G G G G CHAMPVA-HAC (CHAMPVA-HAC is not associated with and does not process claims for TRICARE (formerly CHAMPUS.) Chatwins Healthcare Administrators C Chautauqua County Health Plan (Mayville,NY) Children First Medical Group (For questions regarding claim status, providers will need to contact payer: CFMG Provider Customer Service 510-428-3154) Children's Community Health Plan Children's Specialists of South Dakota Chinese Community Health Plan (Unique Provider ID must be on claim.) CHIPA - College Health IPA Chirometrics Inc. Chiropractic Association of South Dakota For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 8 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Chiropractic Care of Minnesota, Inc. (For Dates of service before 1-01-08, continue to use payerID of ACN01.) LNDMK NOCD MN Y CHIRO CARE MN Y FALSE Chiropractic Health Plans (Enrollment required, please contact Provider Relations 801-352-7270) (NOTE that this payer accepts Chiropractic claims only.) U1439 NOCD UT N CHIROPRACTIC HP U Y TRUE CHOC - Childrens Hospital of Orange County Health Alliance 33065 NOCD CA Y CHOC HEALTH ALLIA Y FALSE Choice Physicians Net First Choice CPNFC NOCD ALL Y CHOICE PHY NET FI Y FALSE ChoiceOne IPA POP03 NOCD ALL Y CHOICEONE IPA N FALSE CHP/DMBA (Enrollment required, please contact Provider Relations 801-352-7270)(NOTE that this payer accepts Chiropractic claims only for Choice & Select Plans.) UH133 NOCD UT N DMBA CHP Y FALSE CHP/EMIA (Enrollment required, please contact Provider Relations 801-352-7270)(NOTE that this payer accepts Chiropractic claims only.) UH134 NOCD UT N EMIA CHP Y FALSE CHP/MEDICAID (Enrollment required, please contact Provider Relations 801-352-7270)(NOTE that this payer accepts Chiropractic claims only.) UH135 NOCD UT N MEDICAID CHP Y FALSE CHP/RPU (FABOH) (Facility physical address required on claim.) 39112 NOCD ALL Y CHP RPU FABOH Y FALSE CHP/UUHP (Enrollment required, please contact Provider Relations 801-352-7270)(NOTE that this payer accepts Chiropractic claims only.) UH137 NOCD UT N UUHP CHP Y FALSE Christian Brothers Services 38308 NOCD ALL N CHRISTIAN BROTHER N FALSE Christian Care Ministries (Medishare) (Providers should check the member ID card and use the Household ID value as the member ID when submitting claims electron 59355 NOCD ALL N CHRISTIAN CARE MI N FALSE Christie Student Helath Plan 75544 NOCD ALL Y CHRISTIE STUDENT N FALSE Christus Health Medicare Advantage 10629 NOCD ALL N CHRISTUS HLTH MC N FALSE Christus Health New Mexico,HIX 21062 NOCD NM N CHRISTUS HLTH NM N FALSE Christus Health Plan HIX 52106 NOCD ALL Y CHRISTUS HLTH HIX N FALSE Christus Health Plan Medicaid 45210 NOCD ALL Y CHRISTUS HLTH MED N FALSE Christus Spohn Health Network SPOHN NOCD ALL Y CHRISTUS SPOHN HE N FALSE CIGNA - PPO 62308 NOCD All Y CIGNA PPO Y FALSE CIGNA - PPO 62308 NOCD All Y CIGNA-PPO Y FALSE CIGNA Behavioral Health (We will also accept PID SX071 for these claims: use of either ID accomplishes the same routing.) CIGNA Health Plan - HMO CIGNA Healthcare for Seniors - Arizona Medicare CIGNA HealthSprings CIGNA Premier Plus Cimarron Salud (Receiver type 'D' - Claims are printed and mailed to the Payer.) Cinncinnati Financial Corporation Citrus Health Care Citrus Valley Physician's Group City of Amarillo Group Health City of Austin CL Frates Clackamas County Mental Health (Administered by PH Tech) Claims Development Corporation (Effective 2-2-15, Dermatology Networks Solutions claims will process under this payerID. ClaimsBridge HPN ClaimsWare, Inc. DBA ManageMed Clarian Health Plans Client First Clifton Health Systems D/B/A Actin Care Groups Clinical Resource Group Clover (Formerly Carepoint Health Plan) CNIC Health Solutions, Inc. Coastal Administrative Services Coastal Care Coastal Communities Physician Network (CCPN) Coastal Healthcare Management Cofinity (formerly Sloans Lake) Cofinity (formerly Sloans Lake) Colonial Medical Colorado Access HMO Colorado Choice Health Plans Colorado Health Insurance Cooperative Colorado Laborers Health and Welfare Fund Columbia Cornell Care Columbine Health Plan Commerce Benefits Group Commercial Travelers/PHX Common Ground Healthcare Cooperative CommonWealth Administrative Group Commonwealth Care Alliance Community Care Associates Community Care Behavioral Health Org. (For Dates of Service prior to October 1, 2007) Code Set (See Legend) Payer Type BOTH P BOTH BOTH BOTH BOTH N G G G BOTH N BOTH N BOTH N BOTH C BOTH BOTH N G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH # BOTH # G G G G G G G C C MCCBV 62308 86033 52192 62308 NOCD NOCD NOCD NOCD NOCD All All AZ ALL ALL Y Y N Y Y CIGNA BEHAVIORAL CIGNA HEALTH HMO CIGNA AZ SR HLTH BRAVO HEALTH CIGNA PREMIER PLU Y Y Y Y Y FALSE FALSE FALSE FALSE FALSE BOTH BOTH # BOTH BOTH BOTH # C C G G C PRINT 46871 10207 IP055 COA01 74234 CLFR2 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NM ALL ALL CA ALL TX ALL N Y Y N Y N Y CIMARRON SALUD CINNCINNATI FINAN CITRUS HEALTH CAR CITRUS VALLEY PHY AMARILLO GRP HLTH CITY OF AUSTIN CL FRATES N Y Y N N N N FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH N G C G G P G CCMMH NOCD OR N CLACKAMAS CTY MH Y FALSE BOTH G 43056 11752 57080 95444 41201 24585 CRGMN 77023 CHCNT 77052 43141 CCPN1 LIPAZ SLOAN 38335 22284 COACC H0657 49718 COMPU 25351 CHP02 34181 88091 77170 37237 14315 17902 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD SLON SLON NOCD COAC NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL ALL ALL ALL ALL ALL ALL All ALL ALL CA ALL CO CO ALL CO CO CO CO ALL ALL ALL ALL ALL ALL ALL MI Y N Y N Y Y N Y N Y N N N Y R N S N N N Y N Y Y N Y N N CLAIMS DEV CORP CLAIMSBRIDGE HPN CLAIMSWARE INC CLARIAN HEALTH PL CLIENT FIRST ACTIN CARE GROUPO CLINICAL RESOURCE CAREPOINT HEALTH CHOICENET COASTAL ADMIN SVC COASTAL CARE CCPN COASTAL HLTHCARE SLOANS COFINITY COLONIAL MEDICAL CO ACCESS HMO CO CHOICE HEALTH CO HLTH INS COOP CO LABORERS HWF COLUMBIA CORNELL COLUMBINE HEALTH COMMERCE BENEFITS COMMERCIAL TRAVEL COMMON GROUND HC COMMONWEALTH ADMI COMMWEALTH CARE A COMMUNITY CARE AS N Y Y N N N N N N Y N N N Y Y Y Y N Y N Y Y N N N Y Y N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE TRUE FALSE TRUE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH # BOTH BOTH G G G G G G G G P G N G N C C G P N G P G G G G G C G G 25179 NOCD All Y COMM CARE BEHAVIO Y FALSE BOTH G For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 9 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Community Care BHO (For Dates of Service after October 1, 2007) 23282 NOCD ALL Y COMMUNITY CARE BH Y FALSE Community Care Inc. (WI) 39126 NOCD ALL A COMMUNITY CARE WI Y FALSE Community Care Managed Health Care Plans of Oklahoma 73143 NOCD OK Y COMMUNITY CARE OK N FALSE Community Connect Medicaid 95192 NOCD ALL N COMM CONNECT MCAI N FALSE Community Eye Care CECVP NOCD ALL Y COMMUNITY EYE CAR N FALSE Community First Health Plan, Inc. COMMF NOCD ALL Y COMMUNITY FIRST H N FALSE Community Health 60495 NOCD ALL N COMMUNITY HEALTH N FALSE Community Health Alliance 35193 NOCD ALL Y COM HLTH ALLIANCE N FALSE Community Health Allliance TN 27905 NOCD ALL N COMMUNITY HLTH TN N FALSE Community Health Center Network CHCN1 NOCD NC N COMM HLTH CENTER N FALSE Community Health Choice (Please include TPI Number (Texas Medicaid Number) in Field FA0-23) 48145 NOCD ALL Y COMM HEALTH CHOIC N FALSE Community Health Electronic Claims/CHEC/webTPA 75261 NOCD ALL N CHEC TPA CLAIMS N FALSE Community Health Group 66170 NOCD ALL Y COMMUNITY HLTH GR N FALSE Community Health Plan of Washington SB613 NOCD WA Y COM HP WASHINGTON Y FALSE Community Health Solutions (Claims now route to Medicaid of Louisiana) LAMCD NOCD LA Y COMMUNITY HLTH SO N TRUE Community IPA AMM12 NOCD ALL Y COMMUNITY IPA N FALSE Community Medical Group of the West Valley CMGWV NOCD CA N COMM MED GRP W VA Y FALSE COMP - Ohio (Austintown, OH) 34177 NOCD OH N COMPENSATION PROG N FALSE CompFirst, LLC 23296 NOCD ALL Y COMPFIRST Y FALSE Complementary HealthCare Plans 93101 NOCD OR WA Y COMPLEMENTARY HCP Y FALSE CompManagement Health 15243 NOCD ALL Y COMPMANAGEMENT HE Y FALSE Comprehensive Benefits Administrator, Inc. (Now known as CBA Blue.) 03036 NOCD ALL Y COMPREHENSIVE BEN N FALSE Comprehensive Care Services (BCBSMN) 00720 NOCD ALL N COMP CARE SERVICE Y FALSE Comprehensive Medical/Vision Program AZ M0166 NOCD AZ Y COMP MED/VIS AZ N FALSE ComPsych 37363 NOCD ALL N COMPSYCH N FALSE CompuSys Incorporated (New Mexico) 74234 NOCD NM N COMPUSYS INC NM N FALSE CompuSys Incorporated of Arizona 74234 NOCD AZ N COMPUSYS INC AZ N FALSE CompuSys Incorporated of Colorado COMPU NOCD CO N COMPUSYS INC CO N FALSE CompuSys Incorporated of Utah 74234 NOCD UT N COMPUSYS INC UT N FALSE Compusys of Colorado COMPU COLO CO N COMPUSYS OF COLO N FALSE CompuSys/Erisa Group, Incorporated (AZ) 74234 NOCD AZ N CS ERISA GROUP AZ N FALSE CompuSys/Erisa Group, Incorporated (NM) 74234 NOCD NM N CS ERISA GROUP NM N FALSE CompuSys/Erisa Group, Incorporated (TX) 74234 NOCD TX N CS ERISA GROUP TX N FALSE Concordia Care Inc. 33632 NOCD ALL N CONCORDIA CARE IN N FALSE Confederation Admin Services 80705 NOCD ALL N CONFEDERATION ADI N FALSE Confederation Life Insurance 80705 NOCD ALL N CONFEDERATION LIF N FALSE Connecticare - Medicare 78375 NOCD ALL Y CONNECTICARE MCAR Y FALSE Connecticare, Inc. 06105 NOCD ALL Y CONNECTICARE N FALSE Connecticare, Inc. 06105 NOCD ALL Y CONNECTICARE INC N FALSE Connecticut Carpenters Health Fund 37307 NOCD CT Y CT CARPENTERS HLT N FALSE Consociate Group 37135 NOCD ALL Y CONSOCIATE GROUP Y FALSE Consolidated Associates Railroad 75284 NOCD ALL Y CONS ASSOC RAILRO Y FALSE Consolidated Group 59140 NOCD All Y CONSOLIDATED GROU N FALSE Consolidated Health Plans 87843 NOCD ALL N CONSOLIDATED HPS Y FALSE Constitution State / Travelers 19046 NOCD ALL N CONSTITUTION STAT N FALSE Consumer Mutual of Michigan 58112 NOCD ALL N CONSUMER MUTUAL M Y FALSE Consumers Choice Health SC 45321 NOCD ALL A CONSUMERS CHCE SC Y FALSE Continental General Insurance Co. 71404 NOCD ALL N CONTINENTAL GENER N FALSE Cook Children's Health Plan CCHP1 NOCD ALL N COOK CHILDRENS HP N FALSE Cook Children's Star Plan CCHP9 NOCD ALL Y COOK CHILDRENS ST Y FALSE Cook Group Health Plan 35149 NOCD ALL Y COOK GRP HLTH PLA Y FALSE Cooperative Benefit Administrators, Inc. 52132 NOCD All Y COOPERATIVE BENEF N FALSE Coordinated Benefit Plan 14829 NOCD ALL N COORDINATED BENE Y FALSE Coordinated Medical Specialists (CMS) 58204 NOCD ALL Y COORD MED SPECIAL N FALSE Core Administrative Services 58231 NOCD ALL N CORE ADMIN SERVIC Y FALSE Core Value (Part of Gettysburg Health.) 23274 NOCD ALL Y CORE VALUE GETTYS N FALSE CoreSource 35187 NOCD ALL Y CORESOURCE Y FALSE CoreSource Little Rock (For claims where the 'submit claims to address' on the medical ID card is an address in Little Rock. For assistance, call 800-689-0106) 75136 NOCD AR A CORESOURCE LR Y FALSE CoreSource of Illinois 35182 NOCD IL Y IL CORESOURCE Y FALSE CoreSource of IOWA 35182 NOCD IA Y IA CORESOURCE Y FALSE CoreSource of Maryland 35182 NOCD MD Y MD CORESOURCE Y FALSE CoreSource of North Carolina (Start using new PayerID of 35182. Old payerID will start rejecting soon.) 35180 NOCD NC Y NC CORESOURCE Y FALSE Coresource of OH 35183 NOCD OH N CORESOURCE OF OH Y FALSE CoreSource of Pennsylvania 35182 NOCD PA Y PA CORESOURCE Y FALSE CoreStar AZ MN (Start using new PayerID of 35182. Old payerID will start rejecting soon.) 41045 NOCD AZ, MN Y CORESTAR N FALSE Corizon Health Inc.(Claims with address of Brentwood,TN should be submitted to this Payer ID.) CORIZ NOCD ALL Y CORIZON HEALTH IN N FALSE Corizon, Inc. (fka Correctional Medical Services) Claims with address of St. Louis, MO should be submitted to this Payer ID. Cornerstone Benefit Administrators Cornerstone Preferred Resources CorrectCare Integrated Health CorrectCare Integrated Health 43160 35202 CB268 CCIHC LADOC NOCD NOCD NOCD NOCD NOCD ALL ALL ALL CA CA For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 N Y N N Y CORRECTIONAL MEDI CORNERSTONE BENEF CORNERSTONE PREF CORRECTCARE CORRECTCARE LA N N Y N N FALSE FALSE FALSE FALSE FALSE Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G G G BOTH BOTH BOTH BOTH G G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH N G G G G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G N G P P P P P P P P G C C G G G G G G G G G G G G G G G G G G G T G BOTH BOTH BOTH BOTH G G G G BOTH BOTH BOTH G G G BOTH G BOTH G BOTH BOTH BOTH BOTH BOTH G G G G G 10 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Correction Health Partners PHPMC NOCD ALL N CORR HLTH PARTNER Y FALSE County Care (Behavioral Health claims with a DOS prior to 4/1/16) 42138 NOCD ALL Y COUNTY CARE N FALSE County Care (Behavioral Health and regular claims with a DOS after 4/1/16) 06541 NOCD ALL Y COUNTY CARE N FALSE County Care (formerly Centene IPA ) Claims with a DOS prior to 4/1/16) 42139 NOCD ALL Y CENTENE IPA N FALSE COVA (Commonwealth of VA) VABLS BCBS VA Y COVA Y FALSE Covenant Administrators, Inc. 58102 NOCD ALL N COVENANT ADMINIST N FALSE Covenant Management Systems Employee Benefit plan CMSEB NOCD ALL N COVENANT MGMT SYS N FALSE Coventry Health Care (Coventry old Legacy Payer ID's are still accepted.) 25133 NOCD ALL Y COVENTRY HEALTH Y FALSE Coventry Health Care of Florida 128FL NOCD FL Y COVENTRY HC FL Y FALSE CoverColorado CHCNT NOCD CO N COVERCOLORADO N FALSE Cox Health Plan (Requires Provider ID in Box 33a. Contact Cox Health Plan for ID.) 00019 NOCD AR,MO N COX HEALTH PLAN N FALSE Creative Medical Systems 64068 NOCD ALL Y CREATIVE MED SYS Y FALSE Creative Plan Administrators 37320 NOCD ALL N CREATIVE PLAN ADM N FALSE Crescent PPO Health Solutions. CALL NOCD ALL N Call S&S Y FALSE Crown Life 80705 NOCD ALL N CROWN LIFE N FALSE Crystal Run Health Plans 46120 NOCD ALL Y CRYSTAL RUN HP Y FALSE CSI Network Services 34186 NOCD ALL N CSI NETWORK SVCS N FALSE CTI Administrators Inc 42141 NOCD ALL N CTI ADMINISTRATOR Y FALSE Cuatro LLC 19305 NOCD ALL N CUATRO LLC N TRUE Culinary Health & Welfare Fund (Las Vegas, NV) 59140 NOCD NV A CULINARY HFUND NV Y FALSE Custom Design Benefits, Inc. 82056 NOCD ALL Y CUSTOM DESIGN BE N FALSE D. H. Evans and Associates (Call Jessica Picarde @ 410-3493222 before sending this payerID.) 25172 NOCD ALL N DH EVANS AND ASSO Y FALSE DakotaCare DAK01 NOCD SD Y DAKOTACARE Y FALSE Dart Member Care CB987 NOCD ALL N DART MEMBER CARE Y FALSE Davis Vision 00157 NOCD ALL N DAVIS VISION N TRUE DCHS Medical Foundation DCHSF NOCD ALL Y DCHS MED FOUNDATI N FALSE Dean Health Plan DEAN1 NOCD WI N DEANCARE Y TRUE DelawareCare, Inc. 25137 NOCD DE Y DELAWARECARE Y FALSE Delta Health Systems DHS01 NOCD ALL N DELTA HEALTH SYST Y FALSE Dentemax AMS01 NOCD MI N DENTEMAX Y FALSE Dentemax/DPI (MI) AMS01 NOCD MI N DENTEMAX DPI MI Y FALSE Denver Health - Indigent 84134 NOCD CO Y DENVER HLTH INDIG Y FALSE Denver Health and Hospital Authority 84133 NOCD CO N DENVER HEALTH HOS Y FALSE Denver Health Medical Plan 84135 NOCD CO N DENVER HEALTH MED Y FALSE Denver Health Medical Plan, Inc. - Medicare Choice 84131 NOCD CO Y DENVER HLTH MCARE Y FALSE Department of Labor J1438 NOCD ALL Y DEPT OF LABOR N FALSE Dermatology Network Solutions BCBS for the Health Options HMO (Payer requires 11 digit member ID Number) 58204 NOCD All Y DBC Y FALSE Dermatology Network Solutions, LLC BCBS (Payer requires 11 digit member ID Number) 58204 NOCD All Y DERM NETWORK BCBS Y FALSE Dermatology Network Solutions, LLC Humana (Payer requires 11 digit member ID Number) 58204 NOCD All Y DERM NET HUMANA Y FALSE Dermatology Network Solutions, LLC Vista (Payer requires 11 digit member ID Number) 58204 NOCD All Y DERM NETWORK VIST Y FALSE Deseret Mutual SX105 NOCD UT N DESERET MUTUAL Y TRUE Desert Family Practice Association PPM01 NOCD ALL A DESERT FAM PRACTI Y FALSE Desert Medical Group DESRT NOCD CA N DESERT MED GROUP N FALSE Desert Valley Medical Group DVMC1 NOCD CA Y DESERT VALLEY MG N FALSE Detroit Medical Center 56240 NOCD ALL N DETROIT MED CENTE Y FALSE DGA - Diversified Group Administrators 25160 NOCD ALL N DGA N FALSE Direct Care Administrators DCA62 NOCD ALL N DIRECT CARE ADMIN N FALSE Directors Guild of America BC001 NOCD CA Y DIRECTORS GUILD A Y FALSE Diversified Group Brokerage 06102 NOCD All Y DIVERSIFIED GROUP Y FALSE DMERC Region A (Testing is required for claims requiring CMNs.) DMERA NOCD REG A N DMERC REGION A Y TRUE DMERC Region B (Testing is required for claims requiring CMNs.) DMERB NOCD REG B N DMERC REGION B Y TRUE DMERC Region C (Testing is required for claims requiring CMNs.) DMERC NOCD REG CA N DMERC REGION C Y TRUE DMERC Region D (Testing is required for claims requiring CMNs.) DMERD NOCD REG D N DMERC REGION D Y TRUE Donley & Company DNLY1 NOCD ALL A DONLEY AND COMPAN N FALSE Downey Select IPA (Applecare Medical Mgmt) APP01 NOCD ALL Y DOWNEY SELECT IPA N FALSE Dreyer Medical DREYR NOCD ALL Y DREYER MEDICAL Y FALSE Driscoll Childrens Health Plan 74284 NOCD ALL N DRISCOLL CHILDREN Y FALSE Driscoll Childrens Health Plan (CHIP) 74284 NOCD TX Y DRISCOLL CHILD HP N FALSE Dunn and Associates Benefits Administrators, Inc. 35186 NOCD ALL N DUNN ASSOC BENE Y FALSE E.S. Beveridge and Associates 34108 NOCD ALL A ES BEVERIDGE AND N FALSE E3 Health, Inc (Formerly First Integrated Health) 75232 NOCD ALL Y E3 HEALTH N FALSE Early Intervention Central Billing 36434 NOCD IL Y EARLY INTERVENTIO N FALSE East Bay Medical Network IP130 NOCD ALL Y EAST BAY MED NETW Y FALSE EAST CAROLINA BEHAVIORAL HEALTH 56089 NOCD ALL A E CAROLINA BH N FALSE Eastland Medical Group EMG11 NOCD ALL N EASTLAND MED GRP N FALSE Eastpointe 08044 NOCD ALL N EASTPOINTE Y TRUE Easy Choice Health Plan of NY 24770 NOCD ALL Y EASY CHOICE HP NY N FALSE EBC Inc. (To obtain the payerID, please call (440) 262-1160) CALL NOCD ALL Y CALL ENS FOR NAME Y FALSE For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 Code Set (See Legend) Payer Type BOTH # T BOTH G BOTH G BOTH BOTH BOTH BOTH G N G G BOTH BOTH BOTH G G P BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G C G G G N G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G N G N G G T T G G G G N BOTH G BOTH G BOTH G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G N G G G G G N G G BOTH N BOTH N BOTH N BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N T G G G G G G G G G G G N G G 11 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Eberle Vivian EV001 NOCD ALL Y EBERLE VIVIAN N FALSE EBMC CX025 NOCD ALL N EBMC N FALSE EBMS (Employee Benefit Management Services, Inc) 81039 NOCD ALL Y EBMS PROFESSIONAL N FALSE eComPPO 75277 NOCD ALL Y ECOMPPO N FALSE Economic Livelihood Partnership (HELP) 66004 NOCD ALL Y ECON LIVELIHOOD P N FALSE EDS Healthchoice 22521 NOCD OK Y EDS HEALTHCHOICE Y FALSE Educators Mutual (EMIA) (Enrollment required, contact EMIA to enroll 800-362-0533, Opt. 2) SX110 NOCD UT N EDUCATORS MUTUAL Y TRUE EHI (Employers Health Insurance) 73288 NOCD ALL Y EHI Y FALSE El Paso First - CHIP EPF03 NOCD ALL N ELPASO FIRST CHIP N FALSE El Proyecto Del Barrio IPA MPM04 NOCD CA N EL PROYECTO DEL B N FALSE Elder Service Plan of the North Shore. 04326 NOCD ALL Y ELDER SVC N SHORE N FALSE ElderPlan, Inc. (Elderplan Provider ID necessary on all claims. Contact (718)921-7979 for Provider ID.) 31625 NOCD ALL N ELDERPLAN INC Y FALSE Ellis Consultants, INC. ECISF NOCD ALL N ELLIS CONSULTANTS N FALSE Elmcare NAELM NOCD ALL Y ELMCARE Y FALSE Elmcare L.L.C. NAELM NOCE IL Y ELMCARE LLC Y FALSE Elmco 37253 NOCD NY Y ELMCO Y FALSE Emerald Health Network 34167 NOCD All Y EMERALD HEALTH Y FALSE Emerald Health Network, Inc. (All HMO Business) 34167 NOCD ALL Y EMERALD HLTH HMO Y FALSE EMI (Eye Management Inc) 65062 NOCD ALL T EYE MANAGEMENT IN Y FALSE Empire Physician's Medical Group EMP01 NOCD ALL Y EMPIRE PHYS MG Y FALSE Empire Plan (UnitedHealthcare) 87726 NOCD ALL Y EMPIRE PLAN Y FALSE Employee Benefit Administration & Management (EBA&M) 95288 NOCD CA Y EMP BENE ADMIN MA N FALSE Employee Benefit Concepts 38241 NOCD ALL N EMP BENE CONCEPTS N FALSE Employee Benefit Consultants (To obtain the payer ID, please call (440) 262-1160.) CALL CALL ALL A CALL SUPPORT N FALSE Employee Benefit Consultants, Inc. (Call (440) 262-1160 for PayerID.) CALL CALL ALL Y CALL ENS SUPPORT Y FALSE Employee Benefit Corporation 37215 NOCD ALL N EMP BENEFIT CORP Y FALSE Employee Benefit Management Corp. 31074 NOCD OH N EMP BENEFIT MGMT Y FALSE Employee Benefit Svcs (EBS) of San Antonio EBSSA NOCD TX Y EMP BENE SVCS SAN Y FALSE Employee Benefit System 42149 NOCD ALL Y EMPLOYEE BENE SYS N FALSE Employee Benefit Systems 37216 NOCD ALL Y EMPLOYEE BENEFIT N FALSE Employee Benefits Plan Administration, Inc. (EBPA) (Now known as CBA Blue.) 03036 NOCD ALL Y EBPA N FALSE Employee Logistics 92135 NOCD ALL N EMPLOYEE LOGIST N FALSE Employee Plans, LLC 35112 NOCD ALL Y EMPLOYEE PLAN Y FALSE Employee Security, Inc. 54098 NOCD ALL Y EMPLOYEE SECURITY Y FALSE Employer Plan Services, Inc. 74212 NOCD ALL y EMP PLAN SERVICES N FALSE Employers Coalition On Health (ECOH) 27008 NOCD All Y EHOC EMPLOYERS N FALSE Employers Direct Health - Employee Plan 75236 NOCD ALL Y EMPLOYERS DIRECT Y FALSE Employers Direct Health - FI 75235 NOCD ALL N EMPLOYERS DIR FI Y FALSE Employers Direct Health - SF 75233 NOCD ALL N EMPLOYERS DIR SF Y FALSE Employers Health Cooperative (EHC) 27008 NOCD All Y EHC EMPLOYERS HEA N FALSE Employers Mutual, Inc. (Florida Providers only) 59298 NOCD FL Y EMPLOYERS MUTUAL Y FALSE Encore Health Network (Note: Group Policy Number in HCFA Box 11 is required.) 35206 NOCD All N ENCORE HEALTH NET N FALSE ENH Medical Group IPA 36364 NOCD ALL Y ENH MED GROUP IPA N FALSE Enstar Natural Gas - Grp# P61 91136 NOCD ALL Y ENSTAR GAS GRPP61 N FALSE Entrust 47165 NOCD ALL Y ENTRUST N FALSE EPN - Seton Health Plan Exclusive (Provider ID required) EPNSH NOCD ALL N EPN SETON HEALTH N FALSE EQUICOR 62308 NOCD All Y EQUICOR Y FALSE EQUICOR - PPO 62308 NOCD All Y EQUICOR-PPO Y FALSE Equitable Plan Services 73126 NOCD ALL N EQUITABLE PLAN SV N FALSE Erin Group Administrators (Now known as Significa Benefit Services, Inc.) 23250 NOCD ALL Y ERIN GROUP ADMIN Y FALSE Erisa Administrative Services Incorporated 74234 NOCD AZ N ERISA ADMIN SVCS N FALSE Erisa Administrative Services, Inc. 74234 NOCD All N ERISA ADMIN N FALSE Essence Healthcare 57082 NOCD MO N ESSENCE HEALTHCAR N FALSE Everence 35605 NOCD ALL N EVERENCE Y FALSE Evergeen Health Coop 45319 NOCD ALL N EVERGREEN HLTH CO N FALSE Evergreen Health Cooperative (Please check the member ID Card for the correct Payer ID.) 93240 NOCD ALL Y EVERGREEN HLTH CO N FALSE Evolutions Healthcare 59313 NOCD ALL Y EVOLUTIONS HEALTH Y FALSE Exceedent LLC 22344 NOCD ALL Y EXCEEDENT LLC Y FALSE Exceptional Care Medical IP080 NOCD CA N EXCEP CARE MEDICA Y FALSE Exclusive Care (ALL providers must contact Exclusive Care prior to submitting claims electronically. Please contact Martha Cuevas at 951-955-8853) EC999 NOCD ALL Y EXCLUSIVE CARE N FALSE Eye Specialists (Provider ID number required in Box33a or Box24J) BVES1 NOCD CO N EYE SPECIALISTS Y FALSE EyeMed 31165 NOCD ALL Y EYEMED N TRUE EyeQuest 63740 NOCD ALL Y EYEQUEST Y FALSE Facey Medical Foundation 95432 NOCD ALL Y FACEY MED FOUNDAT Y FALSE FACS Group 37300 NOCD ALL N FACS GROUP N FALSE Fallon (Transplant claims) FT254 NOCD ALL Y FALLON TRANSPLANT N FALSE Fallon Community Health 22254 NOCD ALL Y FALLON COMM HLTH Y FALSE Family Care - Milwaukee WI 60995 NOCD WI N FAMILY CARE WI Y FALSE Family Care CCO (Admin by PH Tech. Use for claims with DOS of 08/01/2012 and later.) PHD01 NOCD ALL R FAMILY CARE CCO Y FALSE Family Care Medicaid (Admin by PH Tech) PHD01 NOCD ALL Y FAMCAR MC PHT Y FALSE For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH G G G N G G BOTH BOTH BOTH BOTH BOTH N G G N G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH # BOTH BOTH G N G G G G G G G C G G BOTH G BOTH BOTH BOTH BOTH BOTH BOTH G G G T G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G G G G BOTH BOTH BOTH BOTH BOTH BOTH # BOTH # BOTH G G G T G C C G BOTH BOTH BOTH BOTH BOTH BOTH G P P G G G BOTH BOTH BOTH BOTH G G G G BOTH G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G N G G G T G G BOTH BOTH P P 12 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Family Care Medicaid Mental Health FCM01 NOCD OR N FAM CARE MCAID ME Y FALSE Family Care Medicare (Admin by PH Tech) PHR01 NOCD ALL Y FAMCAR MC PHT Y FALSE Family Choice Medical IP080 NOCD CA N FAMILY CHOICE MED Y FALSE Family Health Alliance IP080 NOCD CA N FAM HLTH ALLIANCE Y FALSE Family Health Network 85468 NOCD ALL Y FAMILY HEALTH NET N FALSE Family Medical Network 36396 NOCD ALL Y FAMILY MEDICAL NE Y FALSE Farm Family 14140 NOCD ALL Y FARM FAMILY N FALSE FCE Benefit Administrators 33033 NOCD ALL Y FCE BENE ADMINIST N FALSE Federal Employee Program (Connecticut) C2BLS NOCD CT Y CT FED EMPLOYEE Y FALSE Federated Mutual Insurance 41041 NOCD ALL Y FEDERATED MUTUAL Y FALSE Fidelis Care New York 11315 NOCD ALL N FIDELIS CARE NY Y FALSE First Agency 88055 NOCD ALL N FIRST AGENCY N FALSE First Carolina Care 56196 NOCD ALL Y FIRST CAROLINA CA Y FALSE First Choice Health Network 91131 NOCD WA,OR, Y FIRST CHOICE HEAL Y FALSE First Choice Medical Group FCMG1 NOCD ALL N FIRST CHOICE MED Y FALSE First Choice of Midwest (PPO) 75138 NOCD ALL Y FIRST CHOICE MIDW N FALSE First Choice VIP Care 37510 NOCD ALL N FIRST CHOICE VIP N FALSE First Choice VIP Care Plus SC (First Choice VIP Care Plus is a Medicare Medicaid Plan (MMP), part of the AmeriHealth Caritas Family of Companies) 77009 NOCD ALL Y 1ST CHOICE VIP SC N FALSE First Great-West Life & Annuity 80705 NOCD ALL N FIRST GREAT WEST N FALSE First Health Network 73159 NOCD ALL Y FIRST HEALTH NETW Y FALSE First Seniority Freedom 87726 NOCD ALL Y FIRST SENIORITY F Y FALSE First Service Administrators 59276 NOCD FL Y FIRST SERVICE ADM N FALSE First Services Medicaid MC104 NOCD ALL Y FIRST SERVICES ME N FALSE First Solution FS802 NOCD ALL N FIRST SOLUTION N FALSE FirstCare 94999 NOCD ALL N FIRSTCARE Y FALSE FirstCare Star Medicaid 94998 NOCD ALL N FIRSTCARE MEDICAI Y FALSE FirstGuard Health Plan of Kansas (Contact Karen Joslin at (816)922-7225 to verify Firstguard ProviderID. Payer requires Insured ID of 8-11 numeric characters.) 90060 NOCD KS Y FIRSTGUARD HLTHKS Y FALSE FirstGuard Health Plan of Missouri 90061 NOCD MO Y FIRSTGUARD HLTHMO Y FALSE Fitzharris & Company 11244 NOCD ALL N FITZHARRIS AND CO N FALSE FL MCO PHC/PHP 95411 NOCD ALL Y FL MCO PHC PHP Y FALSE Florida 1st - Winterhaven, Florida 59276 NOCD FL Y FLORIDA 1ST N FALSE Florida Health Plan 59322 NOCD FL N FLORIDA HEALTH PL Y FALSE Florida Hospital VBR VB001 NOCD FL Y FL HOSPITAL VBR N FALSE Florida Hospital Waterman 48116 NOCD ALL Y FL HOSP WATERMAN Y FALSE FMH Benefit Services 48117 NOCD ALL Y FMH BENEFIT Y FALSE Forest County Potawatomi Ins Dept 25059 NOCD ALL Y FOREST CO POTAWA N FALSE Formax, Inc. 87066 NOCD ALL Y FORMAX INC N FALSE FORTIS (Formerly Time Insurance) 39065 NOCD All N FORTIS N FALSE Fortis (Western Life Ins. Benefit Plan) 39065 NOCD ALL Y FORTIS WESTERN LI N FALSE FORTIS BENEFITS (Kansas City) 70408 NOCD ALL N FORTIS BENEFIT KC Y FALSE Fortis Benefits, Inc. (Woodbury) PHCS Network Claims 39065 NOCD ALL Y FORTIS BENEFITS N FALSE Fortis Self Funded Administrative Services 41124 MCSI ALL Y FORTIS SELF FUND N FALSE FORTIS Western 39065 NOCD All Y FORTIS WESTERN N FALSE Foundation Health of CA FH001 NOCD CA N FOUNDATION HLT CA Y FALSE Foundation Health of Florida-Encounters FHFLE FLHL FL Y FL FOUNDATION ENC Y FALSE Fox Valley Medicine Site 199 FVMCH NOCD ALL Y FOX VALLEY ST 199 N FALSE Fox Valley Medicine Site 451 FVMC1 NOCD ALL N FOX VALLY MED 451 N FALSE Fox-Everett, Inc. 64069 NOCD ALL Y FOX EVERETT Y FALSE Freedom Health Plan 41212 NOCD ALL T FREEDOM HEALTH PL N FALSE Freedom Life Insurance Company 62324 NOCD ALL N FREEDOM LIFE INSU N FALSE FreedomBlue HHIC 71768 NOCD ALL Y FREEDOM BLUE HHIC Y TRUE Freeman IPA IP080 NOCD CA N FREEMAN IPA Y FALSE Fresenius Medical Care TH118 NOCD TX Y FRESENIUS MEDICAL Y FALSE Fresenius Total Health 43197 NOCD ALL Y FRESENIUS TOTAL H Y FALSE Fresno PACE 99660 NOCD ALL Y FRESNO PACE N FALSE Fringe Benefit Coordinators 59204 NOCD ALL Y FRINGE BENE COORD N FALSE FrontPath Health Coalition 34171 NOCD ALL Y FRONTPATH HEALTH Y FALSE G.E. Group Life Assurance Company 67814 NOCD ALL Y GE GROUP LIFE N FALSE Gateway Health Plan 25169 NOCD All N GATEWAY HEALTH PL N FALSE Gateway Health Plan - Gateway Healthplus 05506 NOCD ALL Y GWAY HP GWAY HEAL N FALSE Gateway Health Plan - Medicaid PA 25169 NOCD All N GATEWAY HEALTH N FALSE Gateway Health Plan - Medicare Assured Ohio 91741 NOCD ALL Y GATEWAYHP N FALSE Gateway Health Plan ((Yellow Card). Check the ID card to verify the Payer ID before submitting) 60550 NOCD ALL Y GATEWAY HLTH PLAN Y FALSE Gateway Health Plan of Ohio, Inc. 76028 NOCD OH Y GATEWAY HP OF OHI Y FALSE Gateway to Better Health 4317M NOCD ALL N GATEWAY TO BETTER Y TRUE GBS Global Benefit CB951 NOCD ALL Y GBS GLOBAL BENEFI N FALSE GEHA (Members in AR, CT, HI, IN, KY MA, ME, MI, NH, RI and VT ( PHCS Network) ) (Valid for Dates of Service before 1-12016. See patient's card for new payerID 45275 NOCD ALL N PHCS GEHA N FALSE GEHA Group Health Nevada Medicaid GEHA9 NOCD NV N GEHA GH NV MEDICA N FALSE Geisinger Health Plan 75273 NOCD PA Y GEISINGER HEALTH Y FALSE GEMCare (Golden Empire Managed Care System) MCS01 NOCD ALL Y GEMCARE Y FALSE Gemcare Health Plan MCS03 NOCD ALL Y GEMCARE HLTH PLAN N FALSE GenCare Health (St. Louis only) 63665 NOCD MO Y GENCARE HEALTH N FALSE Gencare Health (St. Louis) 63665 NOCD MO N GENCARE HEALTH SL N FALSE Genelco (St. Louis only) 63665 NOCD MO Y GENELCO N FALSE Genelco (St. Louis only) 63665 NOCD MO N GENELCO ST LOUIS N FALSE For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH P P G G G G G G N G G G G G G G G BOTH BOTH BOTH BOTH # BOTH BOTH BOTH BOTH BOTH G C G C G T G N G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G G G T G G G G G G G G G G G G G N G T G G G G G G G G T BOTH BOTH BOTH BOTH G G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G T T G G T T T T 13 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer General American (Sanus - East) 63665 NOCD MO N GEN AM SANUS EAST N FALSE General American Life Ins. Co. (Sanus, St. Louis) 63665 NOCD MO N GEN AM LIFE ST LO N FALSE General American Life Insurance Company 63665 NOCD All Y GENERAL AMERICAN N FALSE Generations Health 46050 NOCD ALL N GENERATIONS HEALT Y FALSE Genesis Health Care IP105 NOCD ALL N GENESIS HEALTHCAR N FALSE Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH T T T G N Georgia State Health Benefit Plan (Processed by GA BC/BS) GettingUsCovered Gettysburg Health (Including Core Value.) GHI HMO Select GHI Medicare Part B of New York GHP (Group Health Plan) GI Innovative Management Gilsbar, Inc Glassworkers and Glaziers Health and Welfare Fund Trust Glassworkers Health & Welfare Fund - Grp# F29 Global Care Inc Global Care Med Grp IPA Global Excel Management Global Health GMS, Inc. Gold Coast Golden Rule (UnitedHealthOne) Golden Triangle Physician Alliance Good Samaritan Medical Practice Association (GSMPA) Good Shepherd Hospice Government Employees Health Association,Inc. (GEHA) Government Employees Health Association,Inc. (GEHA) Grand Valley Health Plan GABLS CHCNT 23274 25531 GHMCR 25141 58204 07205 COMPU 91136 07689 MPM05 GEM01 GHOKC 47083 77160 37602 GTPA1 IP086 76923 44054 57254 95453 BCBS NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD GA CO ALL All NY ALL ALL ALL CO ALL ALL ALL ALL ALL ALL ALL All ALL CA ALL ALL ALL ALL Y N Y Y N A Y Y N Y Y N N Y A N N N N Y Y Y A GA ST HEALTH BENE GETTINGUSCOVERED GETTYSBURG HEALTH GHI HMO SELECT GHI MEDICARE NY GROUP HEALTH PLAN GI INNOVATIVE MAN GILSBAR INC GLASSWORKERS HBTF GLASSWORKERS F29 GLOBAL CARE INC GLOBAL CARE MED G GLOBAL EXCEL MGMT GLOBAL HEALTH GMS INC GOLD COAST GOLDEN RULE INS GOLDEN TRIANGLE GSMPA GOOD SHEPHERD HOS GOVERNMENT EMPLOY GEHA GRAND VALLEY HP Y N N Y Y N N N N N N N Y Y N N Y N Y Y Y Y Y FALSE FALSE FALSE FALSE TRUE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE TRUE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH # BOTH BOTH BOTH BOTH # BOTH BOTH N P T G N G G G P G G N G C G G C T G G C C G Great Lakes Health Plan (UnitedHealthcare Community Plan) Great Lakes PACE Great West (SF) Great West (WA) Great West Care Great West Denver 95467 39640 80705 80705 80705 80705 NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL CA WA ALL CO Y Y N N N N GREAT LAKES HEALT GREAT LAKES PACE GREAT WEST SF ONE HEALTH WA GREAT WEST CARE GREAT WEST DENVER Y N N N N N FALSE FALSE FALSE FALSE FALSE FALSE BOTH # BOTH BOTH BOTH BOTH BOTH C G C C C C Great West Life & Annuity (Claims for Kennett, Missouri ONLY) Great West Life Assurance Great West Life Assurance Company of America Greater Covina Medical Group Greater L. A. Health Greater Newport IPA Greater Orange IPA Greater Oregon Behavioral Health Greater San Gabriel Greater San Gabriel Valley Physicians IPA Greater Tricities IPA (Noble AMA Select) Great-West Bellevue Group Administrators Ltd. Group Administrators Self-Funded Alternative Group and Pension Administrators Group Health Cooperative (WA) Group Health Cooperative of Eau Claire 63665 80705 80705 GCMG1 IP080 GNPMG NMM01 GOBHI IP080 NMM01 PDT01 80705 36338 GASA1 48143 91051 95192 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD MO ALL All CA CA ALL ALL ALL CA ALL ALL WA ALL ALL ALL WA ALL Y N N N N Y Y Y N Y N N Y Y Y Y N GREAT WEST KENNET GREAT WEST LIFE GREAT-WEST LIFE GREATER COVINA ME GREATER LA HEALTH GREATER NEWPORT I GREATER ORANGE MG GREATER OR BEHAV GREATER SAN GABRI GR SAN GABRIEL VA GREATER TRICITIES GREAT WEST BELLEV GROUP ADMINISTRAT GROUP ADMIN SFA GROUP PENSION ADM GROUP HEALTH COOP GH COOP EAU CLAIR N N N N Y N Y Y Y Y N N Y N Y Y N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH T C C G G G G G G G G C G G G G G Group Health Cooperative of South Central Wisconsin Claims Group Health Cooperative of South Central Wisconsin Encounters Group Health Incorporated (GHI) (New York) Group Health Insurance - DE Group Health Northwest (Call Payer at 888-767-4670 prior to submitting electronic claims.) Group Health Options (Formerly KPS Health Plans) Group Insurance Service Center, INC Guardian Life Insurance Company of America Gulf Stream General Dynamics GulfQuest Gunderson Lutheran Health Plan GWL GWL & A H.E.R.E.I.U. Welfare Pension Funds HAA Preferred Partners Halcyon Behavioral Health Hamaspik Choice Inc. Hammerman & Gainer Harbor Advantage Harken Health Harmony Health Plan of Illinois (Wellcare Provider ID required, call (800) 960-2530 opt. 2 then 5) Harmony Health Plan of Indiana (Only claims for Indiana Hoosier Healthwise members can be sent to this payer electronically.) 39167 NOCD WI Y GHC SC WI CLAIMS Y FALSE BOTH G 39168 13551 61101 NOCD NOCD NOCD WI NY DE Y Y R GHC SC WI ENCOUNT GHI NYC GROUP HEALTH DE Y Y Y FALSE FALSE FALSE BOTH BOTH BOTH G G G 91121 91051 37276 64246 CB624 93100 39180 80705 80705 37114 65101 HALCY 47738 97258 58305 43313 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ID,WA ALL ALL All ALL ALL ALL ALL ALL ALL ALL ALL ALL ALL ALL ALL Y N N Y N Y Y N N N N Y Y Y N R GROUP HEALTH NW KPS HEALTH PLANS GROUP INS SVC CEN GUARDIAN LIFE GULF STREAM GD GULFQUEST GUNDERSON LUTH HP GWL GWLA HEREIU WELFARE HAA PREFERRED PAR HALCYON BEHAVIORA HAMASPIK CHOICE HAMMERMAN GAINER HARBOR ADVANTAGE HARKEN HEALTH N N N N N Y N N N N Y Y N N N Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH # G G G G G G G C C G G G G G G C 36406 NOCD IL Y HARMONY HP OF IL Y FALSE BOTH G 36405 NOCD IN Y INDIANA HARMONY H Y FALSE BOTH G For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 14 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Harrington Health - Kansas ((Formerly known as Fiserv HealthKansas) 62061 NOCD ALL Y HARRINGTON KS N FALSE Harrington Health BPO 59143 NOCD ALL Y HARRINGTON HLTH B N FALSE Harris Methodist Health Plan 87726 NOCD All Y HARRIS METHODIST Y FALSE Harvard Community Health Plan 04245 NOCD ALL Y HARVARD COMM HP N FALSE Harvard Pilgrim 04271 NOCD ALL Y HARVARD PILGRIM Y FALSE Harvard Pilgrim Passport Connect 87726 NOCD ALL Y HARVARD PILGRIM P Y FALSE Hawaii Medical Assurance Association (HMAA) 48330 NOCD HI N HAWAII HMAA N FALSE Hawaii Western Management (HWMG) 99208 NOCD ALL Y HI WESTERN MGMT N FALSE Hawki (Provider ID Required) 86068 NOCD ALL Y HAWKI Y FALSE HCC Life Insurance HCCMI NOCD ALL Y HCC LIFE INSURANC N FALSE HCH Administration 37111 NOCD ALL Y HCH ADMINISTRATIO N FALSE HCHA Albq - Self Funded 37329 NOCD ALL Y HCHA ALBQ N FALSE HCP Nevada 20501 NOCD ALL N HCP NEVADA Y FALSE HCSC Insurance Services Company 84980 NOCD ALL Y HCSC INSURANCE SE Y FALSE HDM Benefit Solutions HDMCO NOCD ALL N HDM BENE SOLUTION N FALSE HDPC - Premier Healthcare 90023 NOCD ALL Y PREMIER HC HDPC Y FALSE HDPC Alliance Physicians 20257 NOCD ALL N HDPC ALLIANCE PHY Y FALSE Health Administration Services, Inc 34185 NOCD All Y HEALTH ADMIN SVCS N FALSE Health Advantage of Arkansas ARBLS NOCD AR Y AR HEALTH ADVANTA Y TRUE Health Alliance Exclusive & Plus 23172 NOCD All N HLTH ALLIANCE EXC N FALSE Health Alliance Medical Plans of Illinois 77950 NOCD IL Y HLTH ALLIANCE PLA Y FALSE Health Alliance Plan of Michigan 38224 NOCD All Y HEALTH ALLIANCE P N FALSE Health Care District Palm Beach (Please contact HCDPBC to enroll and to obtain Payer ID 866-930-1002.) CALL NOCD FL Y CALL INGENIX SUPP Y FALSE Health Care Network of Wisconsin (HCN) 42102 NOCD ALL Y WI HEALTHCARE NET Y FALSE Health Care Partners - AZ (For Dates of Service of 5-01-13 and later.) HCP02 NOCD AZ N HLTHCARE PART AZ Y FALSE Health Choice Generations 62180 NOCD ALL Y HEALTH CHOICE GEN Y FALSE Health Choice Insurance 46221 NOCD ALL Y HEALTH CHOICE INS Y FALSE Health Choice Integrated Care (The Payer Id 22100 is valid only for DOS 10/01/2015 and after. Do not Submit claims with DOS prior to 10/1/2015) 22100 NOCD ALL Y HLTH CHOICE INTEG Y FALSE Health Choice of AZ 62179 NOCD AZ Y HEALTH CHOICE AZ Y FALSE Health Choice Utah 45399 NOCD UT Y HEALTH CHOICE UTA Y FALSE Health Claims Service 82018 NOCD ALL N HEALTH CLAIMS SVC N FALSE Health Cost Solutions 62111 NOCD ALL N HEALTH COST SOLUT Y FALSE Health Design Plus 34158 NOCD ALL N HEALTH DESIGN PLU N FALSE Health EZ 16120 NOCD All Y HEALTH EZ N FALSE Health First Health Plans 95019 NOCD ALL N HEALTH FIRST HLTH N FALSE Health First-Tyler, TX 75234 NOCD ALL Y HEALTH FIRST TX N FALSE Health Help Networks, Inc. 59087 NOCD All Y HEALTHHELP Y FALSE Health Information Plan (HIP) 43313 NOCD ALL R HARKEN HEALTH Y FALSE Health Management Associates (HMA, servicing Southeastern and Southwestern Regions) (Provider ID Required) Health Net (California Encounters Only.) Health Net (of California) Health Net of Arizona Health Net Oregon Health Network One Health New England Health Options of Florida (Blue Shield HMO) Health Options of Florida (Blue Shield HMO) ENCOUNTERS ONLY!! Health Options of Illinois Health Partners - Jackson,TN Health Partners, PA Health Payment Systems Code Set (See Legend) Payer Type BOTH BOTH BOTH # BOTH BOTH BOTH # BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G C G N C G G N G G G G G G G G G N G G G BOTH BOTH G C BOTH BOTH BOTH G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH # G G G G G G G G G G C 86066 HM001 95567 AZHNT 22340 65062 04286 FLHLT NOCD NOCD NOCD NOCD NOCD NOCD NOCD BCBS ALL CA CA AZ OR ALL ALL FL Y Y Y Y Y T N N HEALTH MGMT ASSOC CA HLTHNET ENC HEALTH NET HEALTHNET OF AZ HEALTH NET OREGON HEALTH NETWORK ON HEALTH NEW ENGLAN FL HEALTH OPTIONS Y Y Y N Y Y N N FALSE TRUE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N G G T G G G N FLENC NAHOI 62157 80142 20270 BCBS NOCD NOCD NOCD NOCD FL IL TN PA ALL N Y Y Y Y FL ENCOUNTERS HEA HEALTH OPTIONS IL HLTH PARTNERS TN HLTH PARTNERS PA HEALTH PAYMENT SY N Y Y Y Y TRUE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH N G G G G Health Plan of Michigan (Now known as Meridian Health Plan) Health Plan of Nevada (Encounter claims) Health Plan of Nevada (Encounter) Health Plan of San Joaquin Health Plan of San Mateo Health Plan Services, Tampa Office Health Plans Inc. Health Pledge HMO Health Plus of Michigan (Provider must call 810-230-2084 to request TPA form to send claims) Health Plus Physicians Organization Health Safety Network - MASS. Health Medical (Payer ID for Professional HSN (Health Safety Network) claims only) 83253 76343 76342 68035 HPSM1 59140 44273 95435 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL NV NV ALL CA All ALL ALL Y R R N Y N Y Y HEALTH PLAN OF MI HP OF NV ENCOUNTE HP OF NV FFS HLTH PLAN SAN JOA HEALTH PLAN OF SA HEALTH PLAN TAMPA HEALTH PLANS INC HEALTH PLEDGE HMO Y Y Y Y Y Y Y N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH # BOTH BOTH BOTH BOTH BOTH C C C G G G G G 38216 63363 NOCD NOCD MI ALL N Y HEALTHPLUS OF MIC HEALTH PLUS PHY O N N FALSE FALSE BOTH BOTH N G 00995 NOCD MA Y HLTH SAFE NETWORK Y TRUE BOTH N Health Select IPA (Enrollment required. Contact 866-703-1444.) Health Services for Children with Special Needs (HSCSN) Health Services Management, Inc. (NOTE: ANSI submitters can also submit to plans AHP, CMS, ONP, PCI, PHP and VHP with proper value in SBR04.) Health Services Management, Inc. for AHS Health Services Management, Inc. for BPA Health Services Management, Inc. for ECOH M3IL1 37290 NOCD NOCD ALL ALL Y N HEALTH SELECT IPA HSCSN N Y FALSE FALSE BOTH BOTH G G HSM01 HSM01 HSM01 HSM01 NOCD NOCD NOCD NOCD ALL ALL ALL ALL Y Y Y Y HEALTH SVCS MGMT HSM AHS HSM BPA HSM ECOH Y Y Y Y FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH G G G G For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 15 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Health Services Management, Inc. for EHC HSM01 NOCD ALL Y HSM EHC Y FALSE Health Services Management, Inc. for ENCR HSM01 NOCD ALL Y HSM ENCR Y FALSE Health Services Management, Inc. for FCM HSM01 NOCD ALL Y HSM FCM Y FALSE Health Services Management, Inc. for HF HSM01 NOCD ALL Y HSM HF Y FALSE Health Services Management, Inc. for HT HSM01 NOCD ALL Y HSM HT Y FALSE Health Services Management, Inc. for MMSI HSM01 NOCD ALL Y HSM MMSI Y FALSE Health Services Management, Inc. for MSHO HSM01 NOCD ALL Y HSM MSHO Y FALSE Health Services Management, Inc. for PNET HSM01 NOCD ALL Y HSM PNET Y FALSE Health Services Management, Inc. for PONE HSM01 NOCD ALL Y HSM PONE Y FALSE Health Services Management, Inc. for SC HSM01 NOCD ALL Y HSM SC Y FALSE Health Services Management, Inc. for WEA HSM01 NOCD ALL Y HSM WEA Y FALSE Health Span of Ohio (Payer has ceased operations using payerID 31434. claims should now be sent to Medical Mutual of Ohio, PayerID 29076_ 29076 NOCD OH Y HEALTH SPAN OH N FALSE Health Texas Medical Group HTHTX NOCD ALL N HEALTH TX MED GRP Y FALSE Health West / CHP (Enrollment required, please contact Provider Relations 801-352-7270) (NOTE that this payer accepts Chiropractic claims only.) U1439 NOCD UT N CHIROPRACTIC HP U Y TRUE Healthcare LA, IPA MPM06 NOCD CA N HEALTHCARE LA IPA N FALSE Healthcare Management Administrators, Inc. (also known as HMA, servicing Western Region) HMA01 NOCD WESTE N HLTHCARE MGMT ADM N FALSE Healthcare Partners HCP01 NOCD CA Y HEALTHCARE PARTNE Y FALSE HealthCare Partners, IPA (Formerly Heritage New York Medical Group) 11328 NOCD All Y HCARE PARTNERS IP Y FALSE Healthcare Resources NW 56731 NOCD ALL Y HLTHCARE RES NW Y FALSE HealthCare Solutions Group 73147 NOCD ALL A HEALTHCARE SOL GR N FALSE Healthcare USA 25133 NOCD ALL Y HEALTHCARE USA Y FALSE Healthcomp 85729 NOCD ALL Y HEALTHCOMP N FALSE Healthease 59608 NOCD FL Y HEALTHEASE N FALSE HealthEdge Administrators (PayerID valid for claims with a submission address of PO Box 11210, Bakersfield, CA 93389) HealthEZ Healthfirst of Austin TPA Healthfirst, Inc. (NY) HealthGram HealthGuard of Lancaster Healthkeeper HMO HEALTHLINK HMO HEALTHLINK PPO Healthnet of AZ HealthPartners of Minnesota Healthplus Amerigroup HealthPlus of Louisiana (Old PayerID of 95009 is no longer valid) Healthpoint Corporation HealthSCOPE Benefits, INC Healthsmart Accel HealthSmart Preferred Care Healthsource \ Hudson Health Plan (Provider enrollment is required by the payer. Must call (914) 372-2291 to obtain payerID) Healthsource Arkansas - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID Healthsource Indiana - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID Healthsource Kentucky - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID Healthsource Maine - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID Healthsource New Hampshire - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID Healthsource North Carolina - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID Healthsource North Texas - Claims must contain Healthsource specific Vendor ID & specific Rendering Provider ID Healthsource Provident Ins. Co. Healthsource, AR (Med) (CIGNA) Healthsource, GA (CIGNA) Healthsource, Inc. Healthsource, Mass Healthsource, OH Healthsource, TN (CIGNA) HealthSpan Integrated Care Healthspan Integrated Care (Formerly Kaiser Foundation Health Plan of Ohio) HealthSpan Network Repricing Healthspan, aka Kaiser of Ohio HealthSpring HealthSpring HMO/HealthSpring Medicare+Choice Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G G G G BOTH BOTH G G BOTH BOTH N N BOTH BOTH G N BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G 95213 41178 75289 80141 56144 23226 VABLS 96475 90001 38309 55764 27514 NOCD NOCD NOCD NOCD NOCD NOCD BCBS NOCD NOCD NOCD NOCD NOCD ALL ALL ALL NY ALL PA VA All All AZ ALL ALL Y Y Y Y Y N Y Y Y Y Y Y HEALTHEDGE ADMINS HEALTHEZ HEALTHFIRST AUSTI HEALTHFIRST NY PRIMARY PHYSICIAN HEALTHGUARD OF LA HEALTHKEEPER HMO HEALTHLINK HMO HEALTHLINK PPO HEALTHNET OF AZ MN HEALTH PARTNER HEALTHPLUS AMERIG N Y N Y N Y Y N Y N Y Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G N G G G T G 07205 68195 71063 75237 75250 NOCD NOCD NOCD NOCD NOCD LA All All ALL ALL Y Y Y Y A HEALTHPLUS OF LA HEALTHPOINT CORP HEALTHSCOPE BENEF HEALTHSMART ACCEL HEALTHSMART PREF N Y N Y N FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH G G G G G CALL CALL ALL Y CALL ENS SUPPORT N FALSE BOTH T 71074 NOCD AR Y HEALTHSOURCE ARK Y FALSE BOTH T 35167 NOCD IN Y HEALTHSOURCE ID Y FALSE BOTH G 61127 NOCD KY Y HEALTHSOURCE KY Y FALSE BOTH G 01041 NOCD ME Y HEALTHSOURCE ME Y FALSE BOTH G 02038 NOCD NH Y HEALTHSOURCE NH Y FALSE BOTH T 56147 NOCD NC Y HEALTHSOURCE NC Y FALSE BOTH T 75255 68195 71075 58210 HS001 02041 31141 62129 RH007 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD TX All AR GA ALL MA OH TN ALL Y Y Y Y N Y Y Y Y HEALTHSOURCE NTEX HEALTHSOURCE PROV HEALTHSOURCE AR M HEALTHSOURCE GA HEALTHSOURCE INC HEALTHSOURCE MASS HEALTHSOURCE OH HEALTHSOURCE TN HEALTHSPAN Y Y Y Y Y Y Y Y N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH T G G G G G G G T NG007 HSPAN NG007 HT001 63092 NOCD NOCD NOCD NOCD NOCD OH ALL OH ALL ALL Y N Y N N KAISER HP OF OHIO HEALTHSPAN NETWOR KAISER HP OF OHIO HEALTHSPRING HEALTHSPRING HMO Y N Y Y Y FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH T G T G G For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 16 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer HealthSun HESUN NOCD ALL N HEALTHSUN N FALSE Healthways WholeHealth Networks 58213 NOCD ALL N HEALTHWAYS WH NET N FALSE Healthy CT 77180 NOCD CT N HEALTHY CT N FALSE Healthy Texas 68064 NOCD TX Y HEALTHY TEXAS Y FALSE Healthy York Network (Call Jane Grove at Provider Relations for Healthy York Network (717) 851-6715) 22251 NOCD ALL N HEALTHY YORK NETW Y FALSE Helix Family Choice 00243 NOCD MD Y HELIS FAMILY CHOI Y FALSE Heritage Consultants (Must use 9-digit subscriber ID on all claims) 59230 NOCD ALL Y HERITAGE CONSULTA Y FALSE Heritage IPA HER01 NOCD ALL N HERITAGE IPA N FALSE HFN, Inc. 36335 NOCD ALL N HFNIN Y FALSE High Desert Medical Group (Lancaster, California) HDMDG NOCD CA N HIGH DESERT MED G N FALSE High Desert Primary Care STJOE NOCD ALL N HIGH DESERT PRIM Y FALSE Highline Medical Services MOLINA 91164 NOCD ALL Y HIGHLINE MOLINA N FALSE Highmark - Key Family 35145 NOCD ALL Y HIGHMARK KEY FAMI Y FALSE Highmark BCBSD Health Options. 47181 NOCD ALL Y HIGHMARK BCBSDHOP N FALSE Highmark Senior Health Company (PA Blue Shield Medicare Plan) 15460 NOCD PA Y HIGHMARK SHC PA Y TRUE Highmark Senior Solutions Company (WV Blue Shield Medicare Plan) 15459 NOCD WV Y HIGHMARK SSC WV Y TRUE Hill Physicians Medical Group HIL01 NOCD ALL Y HILL PHYSICIANS N FALSE Hillcrest Benefits Administrators 59347 NOCD ALL N HILLCREST BENEFIT N FALSE HIP-Health Insurance Plan of Greater NY 55247 MCSI NY Y HIP HEALTH INS NY Y FALSE Hispanic Physicians IPA HPFFS NOCD ALL N HISPANIC PHYS IPA N FALSE HMA (servicing HI, AZ and NV) (Provider ID is required and is 16 numeric characters in length. ) 86066 NOCD LISTED Y HMA N FALSE HMC Healthworks aka Health Management Co. 75318 NOCD ALL N HMC HEALTHWORKS N FALSE HMO Louisiana Blue Advantage 84555 NOCD LA N HMO LA BLUE ADVAN N FALSE Hockenberg's Equipment (UCS) 59573 NOCD ALL Y HOCKENBERS EQUIP N FALSE Hollywood Presbyterian IP080 NOCD CA N HOLLYWOOD PRESBYT Y FALSE Holy Cross Health Partners NAHLX NOCD IL Y HOLY CROSS HLTH P Y FALSE Holy Cross Health Partners (This PayerID is valid only for Dates of Service before Jan. 1, 2014) 36412 NOCD ALL Y HOLY CROSS HEALTH Y FALSE Home State Health Plan 68069 NOCD LA Y HOME STATE HP Y FALSE Homeland Security (ATTN: Deportation) VAICE NOCD ALL N HOMELAND SECURITY N FALSE Homelink 50701 NOCD ALL Y HOMELINK N FALSE Hometown Health Plan Nevada 88023 NOCD NV Y HOMETOWN HP OF NV Y FALSE Hometown Health Plan of Ohio (Now known as The Health Plan) 30757 NOCD OH A HOMETOWN HP OF OH N FALSE Hopkins Health Advantage 66003 NOCD ALL Y HOPKINS HLTH ADVA N FALSE Horace Mann Life Insurance HMLIC NOCD ALL Y HORACE MANN LIFE N FALSE Horizon Blue Cross Blue Shield of New Jersey 22099 NOCD NJ R HORIZON BCBS NJ Y TRUE Hotel Employees & Restaurant Employees Health Trust Grp#F19 91136 NOCD All Y HOTEL EMP GRPF19 N FALSE HPMS (Send claims to payerID listed on patient's insurance card.) CARD NOCD MI Y CALL INGENIX S&S N FALSE HSBS Memphis (Formerly Pittman and Associates) 37224 NOCD ALL Y PITTMAN AND ASSOC Y FALSE HSBS Oklahoma Cityi (Formerly Mutual Assurance Administrators) 37256 NOCD ALL N MUTUAL ASSURANCE N FALSE HSHS Medical Group IPA 37137 NOCD ALL Y HSHS MED GROUP IP Y FALSE Human Behavioral Institute HBI01 NOCD ALL N HUMAN BEHAVIORAL N FALSE Humana Military Tricare 61125 NOCD ALL Y HUMANA MILITARY Y FALSE Humana Puerto Rico L0200 NOCD PR N HUMANA PR N FALSE Humana Veterans Healthcare Services 61120 NOCD ALL Y HUMANA VETERANS H Y FALSE HUMANA, Claims only 61101 NOCD ALL R HUMANA CLAIMS Y FALSE HUMANA, Encounters Only 61102 NOCD All R HUMANA ENCOUNTERS N FALSE Huntington Park Medical Group IP080 NOCD CA N HUNTINGTON PK MED Y FALSE Huntington Park Mission IP080 NOCD CA N HUNTINGTON PK MIS Y FALSE Hylton Payroll (Benefit Plan Administrators) 19753 NOCD ALL Y HYLTON PAYROLL BP N FALSE I. E. Shaffer 22175 NOCD ALL N IE SHAFFER N FALSE IBA Self Funded Group 38234 NOCD ALL N IBA SELFFUNDED GP Y FALSE IBEW Local 640 & Arizona Chapter NECA Health & Welfare Trust 74234 NOCD AZ N IBEW 640 AZ NECA N FALSE IBEW Western Utilities or Local 57 74234 NOCD UT N IBEW WESTERN UTIL N FALSE IBG Administrators, LLC 81810 NOCD ALL N IBG ADMINISTRATOR N FALSE IBI 41124 NOCD All Y IBI N FALSE iCARE (Independent Care Health Plan) 11695 NOCD WI T ICARE Y FALSE ICARE Health Options TPA 26054 NOCD ALL N ICARE HEALTH OPTI Y FALSE iCircle of New Yok 33884 NOCD ALL Y ICIRCLE NEW YORK Y FALSE ICON Benefit Administrators 75185 NOCD ALL Y ICON BENEFIT ADMI N FALSE Idaho True Blue TRUEB BCBS ID Y TRUE BLUE N TRUE Illinicare Behavioral Health 68068 NOCD ALL Y ILLINICARE BH Y FALSE Illinicare Group Health 68069 NOCD ALL Y ILLINICARE GRP Y FALSE Illinois Health Plan (IHP) DMG01 NOCD ALL N IL HEALTH PLAN N FALSE Illinois Health Solutions ( ProviderID Required) 86069 NOCD IL Y IL HEALTH SOLUTIO Y FALSE IMA of Louisiana Inc. 72091 NOCD ALL N INS MGMT ADMINIST N FALSE IMC - First Medical 37624 NOCD PR Y IMC FIRST MEDICAL N FALSE IMCARE 41600 NOCD ALL N IMCARE Y FALSE INDECS Corporation 40585 NOCD ALL Y INDECS CORPORATIO Y FALSE Independence Administrators TA720 NOCD ALL Y INDEPENDENCE ADMI Y TRUE Independence Care Systems Community Care Plus FIDA-MMP 64284 NOCD NY For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 N INDEPENDENCE CARE N FALSE Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH G G G G BOTH BOTH G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G BOTH N BOTH BOTH BOTH BOTH BOTH N G T G G BOTH BOTH BOTH BOTJ BOTH BOTH N G G G G G BOTH BOTH BOTH BOTH BOTH G G G G G BOTH BOTH BOTH BOTH G G G N BOTH G BOTH BOTH G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G G G T G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH P P G G G G G G N G G G N G N G G G BOTH G 17 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Independence Medical Group MHM01 NOCD ALL Y INDEPENDENCE MEDI Y FALSE Independence Medical Group of Kern County IMG01 NOCD CA Y INDEPEND MG KERN N FALSE Independent BLC of PA (Also known as Personal Choice PPO of Pennsylvania.) 54704 NOCD PA N PA PERSONAL CHOIC Y TRUE Independent Health 95308 NOCD ALL Y INDEPENDENT HEALT Y TRUE Independent Living Systems 45048 NOCD ALL Y INDEP LIVING SYS Y FALSE Indian Health Services 00290 NOCD ALL N INDIAN HEALTH SER N FALSE Indiana Department of Health Children's Health 35600 NOCD IN N IN DEPT HLTH CHIL Y TRUE Indiana ProHealth Network 35161 NOCD IN Y INDIANA PROHEALTH N FALSE Indiana Teamsters Health Benefits Fund (Formerly known as Local 135 Health Benefits Fund) 35107 NOCD IN N INDIANA TEAMSTERS N FALSE Indiana University (Southeastern Indiana Health) 77153 NOCD ALL N IN UNIVERSITY SE N FALSE Industrial Machine Specialties COMPU NOCD CO N IND MACHINE SPECS N FALSE INETICO, Inc. 43471 NOCD ALL N INETICO INC Y FALSE Informed UHC Compass Rose 50946 NOCD ALL Y INFORMED UHC ROSE N FALSE InforMed, LLC 52196 NOCD ALL N INFORMED LLC N FALSE Ingalls Provider Group 85578 NOCD ALL Y INGALLS PROV GROU N FALSE Ingham Health Plan Corp. 38343 NOCD ALL Y INGHAM HP CORP N FALSE InHealth, Inc. 31112 NOCD All Y INHEALTH N FALSE Inland Empire Health Plan IEHP1 NOCD ALL A INLAND EMPIRE HP N FALSE Inland Faculty Medical Group (Call Chirs Gonzales at (323) 2577637 *277 to ensure you are approved to submit electronically. Payer ID required ) MVMM1 NOCD ALL N INLAND FAC MED GR N TRUE Innovation Health 40025 NOCD ALL N INNOVATION HEALTH N FALSE Innovative Physician Associates 80087 NOCD ALL A INNOVATIVE PHYSIC N FALSE INS Health Services VAICE NOCD ALL N INS HEALTH SERVIC N FALSE Insurance Administrator of America 37279 NOCD ALL N INS ADMIN OF AMER N FALSE Insurance Design Administrators 13315 NOCD ALL A INS DESIGN ADMINI Y FALSE Insurance Management Administrators 72091 NOCD ALL N INS MGMT ADMINIST N FALSE Insurance Management Services of Texas IMSMS NOCD TX Y INS MGMT SVCS TX N FALSE Insurance Management Services, (Amarillo TX)(This payerID is only valid for claims submission address of PO Box 15688 Amarillo, TX 79105) 15688 NOCD ALL N INSURMGMTSVCS TX N FALSE Insurance Service of Lubbock ISL11 NOCD All Y INS SERVICE LUBBO N FALSE Insurer's Administration Corporation IAC01 NOCD ALL N INSURERS ADM CORP N FALSE Insurers Administrative Corp. (Please visit website prior to submitting claims: edihelp.iacusa.com) 86304 NOCD ALL Y INSURERS ADMIN CO N FALSE INTEGRA Administrative Group, Inc. 51020 NOCD ALL N INTEGRA ADMIN GRO N FALSE Integra Group - CHA 31129 NOCD ALL N INTEGRA GRP CHA Y FALSE Integra Group (Also known as Rehab Provider Network, but not the same as Colorado payer of same name.) 31127 NOCD ALL A INTEGRA GROUP RPN Y FALSE Integra Managed Long Term Care 45302 NOCD ALL N INTEGRA MGD LONG Y FALSE Integral Quality Care 23229 NOCD ALL Y INTEGRAL QUALITY Y FALSE Integrated Medical Solutions 20050 NOCD ALL Y INTEGRATED MED SO N FALSE Integrated Mental Health Services 68068 NOCD ALL Y INTEGRATED MENTAL Y FALSE Integrity Administrators (Champion Chevrolet) 99795 NOCD ALL N INTEGRITY ADMIN N FALSE Interactive Medical Systems 56132 NOCD ALL Y INTERACTIVE MED S N FALSE Intercommunity Health Net INCHN NOCD ALL N INTERCOMM HLTH NE Y FALSE Interface EAP 60280 NOCD ALL Y INTERFACE EAP N FALSE Intergroup Services Corporation 23287 NOCD ALL N INTERGROUP SVCS Y FALSE Intermountain Health Care (Contact payer at 801-442-5442 before sending claims to verify provider numbers.) SX107 NOCD UT Y INTERMOUNTAIN HEA Y TRUE Intermountain Ironworkers Trust Fund 74234 NOCD AZ,ID,U N INTRMTN IRONWORKS N FALSE International Brotherhood of Boilermakers Employee Health Care Plan (IBBEHC) 48603 NOCD ALL Y IBBEHC Y FALSE International Funding Inc. 39182 NOCD ALL Y INTL FUNDING INC Y FALSE International Medical Group, INC IMGIN NOCD ALL N INT MEDICAL GROUP N FALSE International Union Operating Engineers 37269 NOCD ALL N INT UNION OP ENGI N FALSE InterWest Health PPO (Montana) 84137 NOCD MT Y INTERWEST HPPO MT Y FALSE INTotal Health (For Dates of service before July 1, 2016. For later DOS use payerID 3511A) 35115 NOCD ALL Y INTOTAL HEALTH N FALSE INTotal Health (For Dates of Service July 1, 2016 and later. For earlier DOS, use payerID 35115.) 3511A NOCD ALL Y INTOTAL HEALTH 16 N FALSE Iowa Benefits, Inc. 41124 NOCD IA Y IOWA BENEFITS N FALSE Iowa Health Solutions (Provider ID Required) 86068 NOCD IA Y IOWA HEALTH SOLUT Y FALSE IU Medical Group Primary Care SX172 NOCD ALL Y IU MEDICAL GROUP Y FALSE Jackson Care Connect JCC01 NOCD ALL Y JACKSON CARE CONN Y FALSE JAI Medical Systems JAI01 NOCD ALL N JAI MEDICAL SYSTE N FALSE John Alden Life Ins. 41099 NOCD All N JOHN ALDEN LIFE Y FALSE John Hopkins Healthcare (EHP/PP) (Submit Billing NPI and Rendering/Servicing NPI) 52189 NOCD ALL N JOHN HOPKINS HC Y FALSE John Morrell Company - AHPBA 38310 NOCD ALL Y J MORRELL CO AHPB Y FALSE John Muir Health Network JMH01 NOCD CA N JOHN MUIR HLTH NE Y FALSE John Muir Mt. Diablo Health System 68036 NOCD ALL Y JOHN MUIR MT DBLO Y FALSE John Muir Trauma Physicians (Please call 925-947-5288 for Payer ID information.) CALL CALL ALL Y CALL ENS S&S Y FALSE John P Pearl and Associates 37215 NOCD ALL Y JOHN P PEARL N FALSE Johns Hopkins (USFHP) (New submitter should send in their Billing NPI & Rendering servicing NPI) 52123 NOCD ALL Y JOHNS HOPKINS N FALSE Joplin Claims 43178 NOCD ALL Y JOPLIN CLAIMS Y FALSE JP Farley Corporation 34136 NOCD ALL Y JP FARLEY CORP N FALSE JPS Preferred Care MWP01 NOCD ALL N JPS PREFERRED CAR N FALSE For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 Code Set (See Legend) Payer Type BOTH BOTH G G BOTH BOTH BOTH BOTH BOTH BOTH N N G G N G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G P G G G G G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N G G G G G G G BOTH BOTH BOTH G G G BOTH BOTH BOTH G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G G G BOTH BOTH N P BOTH BOTH BOTH BOTH BOTH G G G G G BOTH G BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G N G G G G BOTH BOTH BOTH BOTH G G G G BOTH BOTH G G BOTH BOTH BOTH BOTH G G G N 18 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer JSL Administrators AKA Wells Fargo Third Party Administrators aka Healthsmart Benefits Solutions 37272 NOCD ALL N JSL ADMINISTRATOR Y FALSE Kaiser Foundation Health Plan of Colorado COKSR NOCD CO R CO KAISER PERMANE N FALSE Kaiser Foundation Health Plan of Georgia NG010 NOCD GA Y KAISER FOUND GA Y FALSE Kaiser Foundation Health Plan of Northern CA Region 94135 NOCD CA Y KAISER NORTH CA N FALSE Kaiser Foundation Health Plan of Northern California KS003 NOCD CA N N CA KAISER PERMA N FALSE Kaiser Foundation Health Plan of Southern CA Region 94134 NOCD CA Y KAISER FOUND S CA Y FALSE Kaiser Foundation Health Plan of Southern California KS001 NOCD CA N SCA KAISER PERMAN Y FALSE Kaiser Foundation Health Plan of the Mid-Atlantic NG008 NOCD ALL Y KAISER MID ATLANT Y FALSE Kaiser Foundation Health Plan of the NW NG009 NOCD OR,WA Y KAISER NW REGION Y FALSE Kaiser Foundation Health Plan PPO 94320 NOCD ALL Y KAISER PPO Y FALSE Kaiser Foundation of the Northwest 93079 NOCD ALL Y KAISER FOUND NW N FALSE Kaiser Permanente Hawaii RH011 NOCD HI Y KAISER PERM HAWAI N FALSE Kalos Health 40137 NOCD ALL Y KALOS HEALTH N FALSE Kansas City Life Insurance Company 44030 NOCD ALL Y KS CITY LIFE INS Y FALSE Keenan & Associates KEE01 NOCD CA N KEENAN AND ASSOCI Y FALSE Kelsey Seybold KELSE NOCD ALL N KELSEY SEYBOLD N FALSE Kemper Benefits 61453 NOCD ALL N KEMPER BENEFITS Y FALSE Kempton Group 73100 NOCD ALL N KEMPTON GROUP N FALSE Kent County Health Plan KENT1 NOCD MI N KENT COUNTY HP Y FALSE Kentucky Health Administrators, Inc. 27215 NOCD ALL N KY HEALTH ADMIN Y FALSE Kentucky Health Cooperative 77894 NOCD KY Y KY HEALTH COOP Y FALSE Kentucky Spirit Health Plan 68069 NOCD KY Y KENTUCKY SPIRIT H Y FALSE Kern County CDCR 28021 NOCD ALL A KERN COUNTY CDCR N FALSE Kern Health Care Network (Valid for dates of service prior to 0101-2016.) 22149 NOCD ALL Y KERN HC NETWORK N FALSE Kern Health Systems 77039 NOCD ALL N KERN HEALTH SYSTE Y FALSE Kern Legacy Health Plan 89890 NOCD ALL Y KERN LEGACY HP Y FALSE Key Benefit Administrators 37217 NOCD ALL Y KEY BENEFIT ADMIN N FALSE Key Health Medical Solutions 95460 NOCD ALL Y KEY HEALTH MED SO N FALSE Key Medical Group (Providers please contact Brandi Guinn @ 559-735-3892 x233 for authorization.) IP082 NOCD CA N KEY MEDICAL GROUP Y FALSE Key Select 37321 NOCD ALL Y KEY SELECT Y FALSE Key Solution 37323 NOCD ALL Y KEY SOLUTION Y FALSE Keycare PPO VABLS BCBS VA Y KEYCARE PPO Y FALSE Keystone Connect (Healthy PA Private Coverage QuestionS for EDI Support, please email [email protected] or call 1-800-7075821) 77050 NOCD PA Y KEYSTONE CONNECT Y FALSE Keystone Mercy Health Plan 23284 NOCD All Y KEYSTONE MERCY Y FALSE Keystone VIP Choice 84223 NOCD ALL N KEYSTONE VIP CHOI Y FALSE Klais and Company 31147 NOCD ALL Y KLAIS AND COMPANY N FALSE Klais and Company 34145 NOCD ALL Y KLAIS AND COMPANY N FALSE Klais and Company Repriced HealthSpan 3414A NOCD ALL T KLAIS CO REPRICED N FALSE KPIC - Kaiser Permanente (Valid in the states of CA,CO, DC, GA, HI, MD, OH and OR) KPIC1 NOCD LISTED N KPIC KAISER PERM N FALSE LA Care Health Plan LACAR NOCD ALL Y LA CARE HEALTH PL Y FALSE La Salle Medical Associates IPA NMM01 NOCD ALL Y LA SALLE MED ASSO Y FALSE LACH HealthNet by MedPoint MPM19 NOCD ALL Y LACH HEALTHNET Y FALSE Lafayette Consolidated Government 71037 NOCD LA Y LAFAYETTE CONSOLI Y FALSE Lake Region Community Health Plan SISCO NOCD ALL N SISCO N FALSE Lakeside Health Services 95415 NOCD All Y LAKESIDE HEALTH Y FALSE Lakeside Medical Group Inc. LMG11 NOCD ALL N LAKESIDE MEDICAL N FALSE Lancaster General Health Group - Preferred Health Care (Contact Sherry Wolgemuth at (717) 560-9290 ext. 124 for approval and the Payer ID.) CALL CALL ALL N CALL SUPPORT Y FALSE Land of Lincoln Health 90096 NOCD ALL Y LAND OF LINCOLN H N FALSE Landmark Healthcare Inc. LNDMK NOCD ALL Y LANDMARK Y FALSE Las Vegas Fire Fighters Local No 1285 Security Fund NWADM NOCD CA N LV FIRE LOC 1285 Y FALSE LaSalle Medical Associates NMM02 NOCD CA N LASALLE MED ASSOC N FALSE Lawndale Christian Health Center 36333 NOCD ALL Y LAWNDALE CHRISTIA Y FALSE LBA HealthPlans 52193 NOCD ALL N LBA HEALTHPLANS N FALSE Leisure World Managed Care LWMC1 NOCD ALL Y LEISURE WORLD MGD N FALSE Leon Medical Center Health Plan 37316 NOCD ALL Y LEON MEDCENTER HP Y FALSE Liberty Health Advantage 11328 NOCD ALL Y LIBERTY HLTH ADVA Y FALSE Life & Health Ins Co of America (NFL Plan only) 98205 NOCD ALL N LIFE HLTH INS CO N FALSE Life Beaver County 25924 NOCD ALL Y LIFE BEAVER COUNT N FALSE Life Investors Ins Co of America (Specialized claims only. Call 866-745-3545 with claim routing questions.) LIICA NOCD ALL N LIFE INVESTORS AM N FALSE Life St. Joseph of the Pines 59847 NOCD ALL Y LIFE ST JOSEPH PI N FALSE Life Trac 41136 NOCD ALL N LIFE TRAC Y FALSE LifeCircles PACE 71498 NOCD ALL Y LIFECIRCLES PACE N FALSE LifePath Hospice Inc. 76870 NOCD ALL N LIFEPATH HOSPICE Y FALSE Lifetime Benefits Solutions EBSRM NOCD ALL N LIFETIME BENEFITS N FALSE Lifewise A Premier Health Plan 93093 NOCD OR Y LIFEWISE Y FALSE Lifewise Health Plan of Oregon A Premier Health Plan 93093 NOCD OR Y OR LIFEWISE HP Y FALSE Lifewise Health Plan of Washington A Premier Health Plan 91049 NOCD WA Y WA LIFEWISE HP Y FALSE Linn County 75283 NOCD ALL Y LINN COUNTY Y FALSE Lipa/Agate Resources LIPA1 NOCD ALL N LIPA AGATE RESOUR N FALSE Little Company of Mary Health 4725P NOCD ALL Y LITTLE CO OF MARY N FALSE Local Choice VABLS BCBS VA Y LOCAL CHOICE Y FALSE Lockard & Williams CB752 NOCD ALL Y LOCKARD AND WILLI N FALSE For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH # BOTH BOTH G C C G G T G C C G G G G G G G G G C G G G G BOTH BOTH BOTH BOTH BOTH G G G G G BOTH BOTH BOTH BOTH N G G N BOTH BOTH BOTH BOTH BOTH BOTH G G G T G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G T P G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH T G P G G G G G G G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G N N N N G G N G 19 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Loma Linda University Adventist 37267 NOCD ALL N LOMA LINDA UN ADV N FALSE Loma Linda University Health Care 33036 NOCD ALL Y LOMA LINDA UNIV H N FALSE Lone Star TPA 45289 NOCD ALL Y LONE STAR TPA Y FALSE Long Beach Memorial IPA (MHCLB) MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE Louisiana Healthcare Connections 68069 NOCD LA Y LA HLTHCARE CONNE Y FALSE Lovelace Sandia Health Plan (Acquired by Blue Shield of New Mexico) NMBLS NOCD NM Y LOVELACE SANDIA Y FALSE Lutheran Preferred 39198 NOCD ALL Y LUTHERAN PREFERRE N FALSE Mabuhay Medical Group CAPMN NOCD ALL N MABUHAY MED GRP N FALSE MacNeal Health Providers - CHS (Contact 708-783-7100 prior to first submission.) 36334 NOCD ALL N MACNEAL HEALTH PR N FALSE Magellan Behavioral Health (All Non-AETNA Subscribers Provider ID Required) (Payer Address required on all claims.) Magellan Behavioral Health (For Dates of Service 1/1/2006 and After - Provider ID Required - AETNA Subscribers only.) Magellan Complete Care FL MAGNACARE Magnolia Mississippi Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH G G G G G BOTH BOTH BOTH N N G BOTH G 01260 NOCD ALL N MAGELLAN BEHAVIOR N FALSE BOTH G 60054 01260 11303 68069 NOCD NOCD NOCD NOCD ALL ALL ALL ALL Y N N Y MAGELLAN BHAVIOR MAGELLAN COMPLETE MAGNACARE MAGNOLIA MS N N Y Y FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH C G G G MAHP (MD IPA, Optimum Choice and MLH) UnitedHealthcare Maine Community Health Options Maksin Management Corporation (Now known as AIG Educational Markets) Managed Care Administrators / CHP (Enrollment required, please contact Provider Relations 801-352-7270) (NOTE that this payer accepts Chiropractic claims only. Managed Care Services, LLC Managed Care Systems (Delango Regional Medical) Managed Care Systems CDCR (Customer Service: (800) 4944662) Managed Health Care Admin EPS Managed Health Care Administration EPS Managed Health Care Associates Managed Health Networks (MHN) Managed Health Services Indiana Managed Health Services of Wisconsin (Please contact the payer @ 800-225-2573, ext 25525 to get setup to submit electronic claims.) Managed Healthcare Administration Inc- Blue Choice MAPCO Inc. Mapfre Life Commercial March Vision Health Plan Marin IPA Marrick Medical Finance, LLC Marrick WRx Martin's Point Health Care USFHP/Generations Advantage Maryland Physicians Care 87726 45341 NOCD NOCD MD ALL Y N MAMP ME COMMUNITY H OP Y Y FALSE FALSE BOTH # BOTH C G 22195 NOCD ALL Y MAKSIN MGMT CORP Y FALSE BOTH G U1439 35162 MCS02 NOCD NOCD NOCD UT ALL ALL N Y N CHIROPRACTIC HP U MANAGED CARE SERV DELANGO REGIONAL Y Y Y TRUE FALSE FALSE BOTH BOTH BOTH N G G MCS04 MHCA1 MHCA1 36312 22771 68069 NOCD NOCD NOCD NOCD NOCD NOCD CA ALL ALL ALL ALL IN N Y Y Y N Y MGD CARE SYS CDCR MGD HLTH CARE EPS MNGD HC ADMIN EPS MANAGED HEALTH MANAGED HEALTH NE IN MGD HEALTH SVC Y N Y N Y Y FALSE TRUE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G 68069 MHCA2 75258 46012 5246M IP097 20805 46478 MPHC2 22348 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD WI AL All ALL ALL CA ALL ALL ALL ALL Y N Y Y N N N N Y N MANAGEDHLTHSVCSWI MHCA BLUECHOICE MAPCO MAPFRE LIFE COMME MARCH VISION HP MARIN IPA MARRICK MED FINAN MARRICK WRX MARTINS PT HC MD PHYSICIANS CAR Y Y Y N N Y Y N N Y FALSE TRUE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G N G G G G G G G G Maryland PMHS ValueOptions (Use for ALL Dates of Service) Mashantucket Pequot Tribal Nation Mass Health (MA Medicaid) Massachusetts Mutual also known as Mass Mutual Masters, Mates and Pilots Plan Max Specialty Benefits Maxor Mayo Clinic FL/GA Mayo Management Services, Inc. MBA Benefit Administrators MBA of Wyoming M-CARE (Payer no longer accepting electronic claims. Claim will be printed and mailed to payer.) Mcare of Michigan (Payer no longer accepting electronic claims. Claim will be printed and mailed to payer.) 77063 37121 MAMCD 80314 MMPHB 27320 92805 88090 41154 83028 87065 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD MD ALL MA All ALL ALL ALL ALL ALL ALL WY,UT N Y Y Y N N Y Y N Y Y MARYLAND PMHS VO MASHANTUCKET PEQU MASS HEALTH MASSACHUSETTS MUT MASTERS MATES PIL MAX SPECIALTY BEN MAXOR MAYO CLINIC FL GA MAYO MANAGEMENT MBA BENEFIT ADMIN MBA OF WYOMING Y N Y Y N N N N Y N N TRUE FALSE TRUE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N G N P G G G G G G G MM001 NOCD MI N M CARE Y FALSE BOTH T 38264 NOCD MI Y MCARE Y FALSE BOTH G MCCBV 59331 31149 3833N 3833T 3833A 38338 3833C 3833R 6197P 66039 MDC01 MRIPA NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD All FL ALL ALL ALL ALL ALL ALL ALL PR ALL ALL ALL Y Y Y Y Y Y Y Y Y Y Y N N MCC BEHAVIORAL MCCREARY CORP MCGREGOR PACE MCLAREN ABW NHP MCLAREN ABW THPC MCLAREN HLTH ADVA MCLAREN MCLAREN MEDICAID MCLAREN ADV SNP MCS MCS LIFE MD CARE HP MD ROGUE OR HP Y Y N Y Y Y Y Y Y N N N N TRUE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH C G G C C C C C C N G G G 87726 NOCD All Y MD INDIVIDUAL PRA Y FALSE BOTH # C MCC Behavioral Care (We will also accept PID SX071 for these claims: use of either ID accomplishes the same routing.) McCreary Corporation McGregor Pace McLaren ABW-NHP McLaren ABW-THPC McLaren Health Advantage McLaren Health Plan McLaren Medicaid McLarenAdvantage SNP MCS MCS Life MD CARE HEALTH PLAN MD Rogue Oregon Health Plan MD-Individual Practice Association, Inc. (M.D. IPA) (Previously Payer ID 52148) For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 20 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer MDWise Hoosier Alliance (For Dates of Sevice after 01/01/2016,use payerID of SX172) 20475 NOCD ALL Y MDWISE HOOSIER AL Y FALSE MDWise Select Health Network 35199 NOCD ALL N MDWISE SELECT HN N FALSE MDX Hawaii MDXHI NOCD HI Y MDX HAWAII Y FALSE Med Pay (For claims repriced by Premier Health Care Exchange) 88058 NOCD ALL A MED PAY Y FALSE Med3000 CMS Early Steps EM350 NOCD ALL N MED3000 CMS EARLY N FALSE Med3000 CMS Safety Net EM284 NOCD ALL N MED3000 CMS SAFET N FALSE Med3000 CMS Title 19 Reform EM843 NOCD ALL N MED3000 CMS T19 R N FALSE Med3000 CMS Title 21 EM205 NOCD ALL N MED3000 CMS TTL21 N FALSE Med3000 HealthSpring EM216 NOCD ALL N MED3000 HLTHSPRIN N FALSE Med3000 Pedicare Title 19 (Now send claims to EM843) EM843 NOCD ALL N MED3000 PEDCARE19 N FALSE Med3000 Pedicare Title 21 (Now send claims to EM205) EM205 NOCD ALL N MED3000 PEDCARE21 N FALSE MedAdmin Sol Inc 58204 NOCD ALL Y MEDADMIN SOL INC N FALSE MedCom 59231 NOCD ALL N MEDCOM N FALSE MedCost 56162 NOCD All N MEDCOST Y FALSE MedCost / Liberty Health Share 90753 NOCD ALL Y LIBERTY HEALTH SH N FALSE MedCost Benefit Services 56205 NOCD ALL Y MEDCOST BENEFIT Y FALSE Medfocus 95321 NOCD ALL N MEDFOCUS Y FALSE MEDICA 94265 NOCD ALL Y MEDICA Y FALSE Medica HealthCare Plans / FL 78857 NOCD FL Y MEDICA HCARE PLAN Y FALSE Medica2 12422 NOCD ALL Y MEDICA2 Y FALSE Medicaid of Delaware DEMCD NOCD DE N DE MEDICAID Y TRUE Medicaid - TX Premier Plan (Please contact Provider Relations at (915)-532-3778 x1507 to enroll.) EPF02 NOCD TX Y TX PREMIER MEDICA N TRUE Medicaid of Alabama ALMCD NOCD AL Y AL MEDICAID Y FALSE Medicaid of Alaska AKMCD NOCD AK N AK MEDICAID Y TRUE Medicaid of Arizona (AHCCCS) AZMCD NOCD AZ Y AZ MEDICAID Y FALSE Medicaid of Arkansas ARMCD NOCD AR Y AR MEDICAID Y FALSE Medicaid of Colorado COMCD BCBS CO Y CO MEDICAID Y TRUE Medicaid of Connecticut CTMCD NOCD CT Y CT MEDICAID Y TRUE Medicaid of Florida FLMCD UNIS FL N FL MEDICAID Y TRUE Medicaid of GA GAMCD NOCD GA N GA MEDICAID Y TRUE Medicaid of Hawaii HIMCD NOCD HI N HI MEDICAID Y TRUE Medicaid of Idaho IDMCD NOCD ID R ID MEDICAID Y FALSE Medicaid of Illinois ILMCD NOCD IL Y IL MEDICAID Y FALSE Medicaid of Indiana INMCD NOCD IN N IN MEDICAID Y FALSE Medicaid of Iowa IAMCD CONS IA N IA MEDICAID Y TRUE Medicaid of Kansas KSMCD BCBS KS N KS MEDICAID Y FALSE Medicaid of Kentucky KYMCD NOCD KY Y KY MEDICAID Y TRUE Medicaid of Louisiana (Includes KidMed claims.) LAMCD NOCD LA Y LA MEDICAID Y TRUE Medicaid of Louisiana Rehab (for Rehabilitation claims) LAREH NOCD LA Y LA MEDICAID REHAB Y TRUE Medicaid of Maine MEMCD NOCD ME N ME MEDICAID N TRUE Medicaid of Maryland MDMCD NOCD MD N MD MEDICAID Y TRUE Medicaid of Massachusetts MAMCD NOCD MA Y MA MEDICAID Y TRUE Medicaid of Michigan MIMCD NOCD MI Y MI MEDICAID Y TRUE Medicaid of Minnesota MNMCD NOCD MN N MN MEDICAID Y TRUE Medicaid of Mississippi MSMCD NOCD MS Y MS MEDICAID N TRUE Medicaid of Missouri MOMCD NOCD MO Y MO MEDICAID Y FALSE Medicaid of Montana MTMCD CONS MT N MT MEDICAID Y FALSE Medicaid of Nebraska NEMCD NOCD NE Y NE MEDICAID N TRUE Medicaid of Nevada NVMCD NOCD NV N NV MEDICAID Y TRUE Medicaid of New Hampshire NHMCD NOCD NH N NH MEDICAID N TRUE Medicaid of New Jersey NJMCD NOCD NJ Y NJ MEDICAID Y TRUE Medicaid of New Mexico NMMCD NOCD NM Y NM MEDICAID N FALSE Medicaid of New York NYMCD NOCD NY Y NY MEDICAID Y TRUE Medicaid of North Carolina NCMCD NOCD NC N NC MEDICAID Y TRUE Medicaid of North Dakota NDMCD NOCD ND N ND MEDICAID Y TRUE Medicaid of Ohio OHMCD NOCD OH Y OH MEDICAID Y FALSE Medicaid of Oklahoma OKMCD NOCD OK N OK MEDICAID Y FALSE Medicaid of Oregon ORMCD NOCD OR N OR MEDICAID N TRUE Medicaid of Pennsylvania PAMCD NOCD PA Y PA MEDICAID Y TRUE Medicaid of Rhode Island RIMCD NOCD RI N RI MEDICAID Y TRUE Medicaid of South Carolina SCMCD NOCD SC Y SC MEDICAID Y TRUE Medicaid of South Dakota SDMCD NOCD SD N SD MEDICAID Y TRUE Medicaid of Tennessee (TennCare) TNMCD NOCD TN Y TN MEDICAID Y TRUE Medicaid of Texas TXMCD NOCD TX Y TX MEDICAID Y FALSE Medicaid of Utah UTMCD NOCD UT Y UT MEDICAID Y TRUE Medicaid of Vermont VTMCD NOCD VT N VT MEDICAID Y TRUE Medicaid of Virginia VAMCD NOCD VA N VA MEDICAID Y FALSE Medicaid of Washington DC DCMCD NOCD DC Y DC MEDICAID Y TRUE Medicaid of Washington State WAMCD NOCD WA Y WA MEDICAID Y TRUE Medicaid of West Virginia WVMCD NOCD WV Y WV MEDICAID Y FALSE Medicaid of Wisconsin WIMCD EDS WI N WI MEDICAID Y FALSE Medicaid of Wyoming WYMCD NOCD WY N WY MEDICAID Y TRUE Medical Associates Health Plan MAHP1 NOCD ALL Y MED ASSOC HLTH PL N FALSE Medical Benefit Administration, Inc. 68041 NOCD ALL Y MEDICAL BENEFIT A Y FALSE Medical Benefits Mutual 74323 NOCD ALL Y MEDICAL BENEFITS Y FALSE Medi-Cal by MedPoint MPM18 NOCD ALL N MEDPOINT MEDICAL N FALSE Medical Mutual of Ohio (Payer requires a 12 digit rendering provider ID#, which needs to be obtained from payer by calling 800-321-7223) 29076 NOCD OH Y MEDICAL MUTUAL OH Y FALSE For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 Code Set (See Legend) Payer Type BOTH BOTH BOTH G G P BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH # BOTH BOTH BOTH G G G G G G G G G G G T G G C C G T BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N G N N N N N N N N G G G G BOTH G 21 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer MediCal of California MDCAL NOCD CA N CA MEDICAL Y TRUE Medical Orange Coast Memorial IPA MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE Medical Reimbursements of America 62177 NOCD ALL Y MED REIMBURSE AME Y FALSE Medical Resource Network (MRN, INC) 58203 NOCD ALL Y MEDICAL RESOURCE Y FALSE Medical Select Management 13375 NOCD ALL Y MEDICAL SELECT MA Y FALSE Medical Services Initiative 12057 NOCD ALL Y MEDICAL SVCS INIT Y FALSE Medical Value Plan - Ohio (MVP) 38224 NOCD OH Y MEDICAL VALUE PLA Y FALSE Medicare Blue Advantage of South Carolina SCBLS NOCD SC Y SC BLUE SHIELD Y FALSE Medicare DME MAC Jurisdiction C 18003 NOCD ALL Y MEDICARE DME MAC N TRUE Medicare of Missouri (Includes both Eastern and Western Missouri.) KCMCR NOCD KS,MS Y KC MEDICARE Y TRUE Medicare of the Virgin Islands 09302 NOCD VI N VI MEDICARE N TRUE Medicare Part B GHI GHMCR NOCD NY N GHI MEDICARE NY Y TRUE Medicare Part B of Alabama ALMCR NOCD AL Y AL MEDICARE Y TRUE Medicare Part B of Alaska AKMCR NOCD AK N AK MEDICARE Y TRUE Medicare Part B of American Samoa HIMCR NOCD AM Sam Y HI MEDICARE Y TRUE Medicare Part B of Arizona AZMCR NOCD AZ Y AZ MEDICARE Y TRUE Medicare Part B of Arkansas ARMCR NOCD AR Y AR MEDICARE Y TRUE Medicare Part B of Colorado COMCR BCBS CO Y CO MEDICARE Y TRUE Medicare Part B of Connecticut CTMCR NOCD CT Y CT MEDICARE Y TRUE Medicare Part B of DC 00903 NOCD DC R DC MEDICARE Y TRUE Medicare Part B of Delaware 00902 NOCD DE R DE MEDICARE Y TRUE Medicare Part B of Florida FLMCR BCBS FL Y FL MEDICARE Y TRUE Medicare Part B of Georgia GAMCR AETN GA Y GA MEDICARE Y TRUE Medicare Part B of Guam HIMCR NOCD Guam Y HI MEDICARE Y TRUE Medicare Part B of Hawaii HIMCR BCBS HI Y HI MEDICARE Y TRUE Medicare Part B of Idaho IDMCR NOCD ID Y ID MEDICARE Y TRUE Medicare Part B of Illinois ILMCR BCBS IL Y IL MEDICARE Y TRUE Medicare Part B of Indiana INMCR NOCD IN N IN MEDICARE Y TRUE Medicare Part B of Iowa IAMCR BCBS IA Y IA MEDICARE Y TRUE Medicare Part B of Kansas KSMCR BCBS KS Y KS MEDICARE Y TRUE Medicare Part B of Kentucky KYMCR NOCD KY Y KY MEDICARE Y TRUE Medicare Part B of Louisiana LAMCR BCBS LA Y LA MEDICARE Y TRUE Medicare Part B of Maine MEMCR NOCD ME Y ME MEDICARE Y TRUE Medicare Part B of Maryland 00901 NOCD MD R MD MEDICARE Y TRUE Medicare Part B of Massachusetts MAMCR NOCD MA Y MA MEDICARE Y TRUE Medicare Part B of Michigan MIMCR NOCD MI Y MI MEDICARE Y TRUE Medicare Part B of Minnesota MNMCR NOCD MN Y MN MEDICARE Y TRUE Medicare Part B of Mississippi MSMCR NOCD MS Y MS MEDICARE Y TRUE Medicare Part B of Missouri (Eastern) (Specialty testing required) MOMCR NOCD MO N MO MEDICARE EAST Y TRUE Medicare Part B of Montana MTMCR NOCD MT Y MT MEDICARE Y TRUE Medicare Part B of Nebraska NEMCR BCBS NE Y NE MEDICARE Y TRUE Medicare Part B of Nevada NVMCR NOCD NV N NV MEDICARE Y TRUE Medicare Part B of New Hampshire NHMCR NOCD NH Y NH MEDICARE Y TRUE Medicare Part B of New Mexico NMMCR NOCD NM Y NM MEDICARE Y TRUE Medicare Part B of New York (Empire) NYMCR NOCD NY Y NY MEDICARE Y TRUE Medicare Part B of NJ (Specialty testing required) NJMCR NOCD NJ Y NJ MEDICARE Y TRUE Medicare Part B of North Carolina NCMCR NOCD NC Y NC MEDICARE Y TRUE Medicare Part B of North Dakota NDMCR NOCD ND N ND MEDICARE Y TRUE Medicare Part B of Northern California CNMCR NOCD CA Y CA MEDICARE NORTH Y TRUE Medicare Part B of Northern Mariana Islands HIMCR NOCD CNMI Y HI MEDICARE Y TRUE Medicare Part B of Northern Virginia (inc. Prince George, Montgomery, Fairfax and Arlington Counties and City of Alexandria) 00903 NOCD VA N VA NORTH MEDICARE Y TRUE Medicare Part B of Ohio OHMCR NOCD OH Y OH MEDICARE Y TRUE Medicare Part B of Oklahoma OKMCR NOCD OK Y OK MEDICARE Y TRUE Medicare Part B of Oregon ORMCR NOCD OR Y OR MEDICARE Y TRUE Medicare Part B of Pennsylvania PAMCR NOCD PA Y PA MEDICARE Y TRUE Medicare Part B of Rhode Island RIMCR NOCD RI Y RI MEDICARE Y TRUE Medicare Part B of South Carolina SCMCR NOCD SC Y SC MEDICARE Y TRUE Medicare Part B of South Dakota SDMCR NOCD SD N SD MEDICARE Y TRUE Medicare Part B of Southern California CSMCR NOCD CA Y CA MEDICARE SOUTH Y TRUE Medicare Part B of Tennessee TNMCR NOCD TN Y TN MEDICARE Y TRUE Medicare Part B of Texas TXMCR NOCD TX Y TX MEDICARE Y TRUE Medicare Part B of Upstate NY N1MCR NOCD NY Y UPSTATE NY MEDICA Y TRUE Medicare Part B of Utah UTMCR NOCD UT Y UT MEDICARE Y TRUE Medicare Part B of Vermont VTMCR NOCD VT Y VT MEDICARE Y TRUE Medicare Part B of Virginia VAMCR NOCD VA Y VA MEDICARE Y TRUE Medicare Part B of Washington WAMCR NOCD WA N WA MEDICARE Y TRUE Medicare Part B of West Virginia WVMCR NOCD WV Y WV MEDICARE B Y TRUE Medicare Part B of Western Missouri MWMCR NOCD MS Y W MO MEDICARE Y TRUE Medicare Part B of Wisconsin WIMCR WPS WI Y WI MEDICARE Y TRUE Medicare Part B of Wyoming WYMCR BCBS WY Y WY MEDICARE Y TRUE Medicare Railroad (MetraHealth Medicare) RRWMC TRAV All N RRW MEDICARE Y TRUE Medicare Supplemental VABLS BCBS VA Y VA MEDICARE SUPPL Y FALSE Medico Insurance Company 23160 NOCD ALL N MEDICO INS COMPAN N FALSE MEDIGOLD 95655 NOCD ALL N MEDIGOLD N FALSE Mediture 20039 NOCD ALL Y MEDITURE N FALSE Mediture IPA AMM11 NOCD ALL Y MEDITURE IPA N FALSE Medova Healthcare 27005 NOCD ALL N MEDOVA HEALTHCARE N FALSE For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N G G G G G G N N BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N N N N N N N N N N N N N N N N N N N N N N N N N N N N N BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N N N N N N N N N N N N BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N N N N N N N N N N N N N N N N N N N N N N G G G G G 22 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer MedPartners (PHCS Repricing) (PO Box 10240 Fort Wayne, In 46857) 441MP NOCD ALL Y MEDPARTNERS PHCS N FALSE MedPartners Admin Services 412MP NOCD ALL N MEDPARTNERS ADMIN N FALSE Med-Pay 00130 NOCD MO, IL Y MEDPAY N FALSE MedSolutions, Inc. 62160 NOCD ALL Y MEDSOLUTIONS Y FALSE MedStar Family Choice 39190 NOCD ALL N MEDSTAR FAM CHOIC N FALSE Medstar Physician Partners 00243 NOCD MD Y MEDSTAR PHYS PART Y FALSE Medstar Select 251MS NOCD ALL N MEDSTAR SEL N FALSE Memorial Clinical Associates MCA11 NOCD ALL N MEM CLINICAL ASSO N FALSE Memorial Healthcare IPA MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE Memorial Hermann Health Network MHHNP NOCD ALL N MEM HERMANN HLTH N FALSE Memorial Integrated Healthcare 59064 NOCD All N MEMORIAL INTEGRA Y FALSE MemorialCare Medical Foundation MMFMC NOCD ALL N MEMORIALCARE MED N FALSE Mendicina Familiar Medical Group IP080 NOCD CA N MEDICINA FAMILIAR Y FALSE Mennonite Mutual (Now known as Everence) 35605 NOCD ALL N MENNONITE MUTUAL Y FALSE Mental Health Network (Only claims for PO Box 209010 Austin TX 78720) 74289 NOCD ALL Y MENTAL HEALTH NET Y FALSE Mercy Health Plan (AHCCCS) 86052 NOCD AZ Y MERCY HP AHCCCS N FALSE Mercy Health Plan of AZ 86052 NOCD AZ Y MERCY HP AZ N FALSE Mercy Health Plan of New Jersey (Provider ID Required in Box33a - Contact (800) 682-9091 to obtain ID) 22326 NOCD All Y MERCY HLTH PL NJ Y FALSE Mercy LIFE of Alabama 63002 NOCD ALL Y MERCY LIFE OF AL N FALSE Mercy Maricopa Integrated Care 33628 NOCD ALL Y MERCY MARICOPA IC N FALSE Mercy Provider Network 43185 NOCD ALL Y MERCY PROV NETWOR N FALSE MercyCare of WI. (Call 608-758-7739 for PayerID.) CALL NOCD ALL N Call INGENIX supp N FALSE Meridian Health Plan 13189 NOCD ALL Y MERIDIAN HEALTH P Y FALSE Meritain - Luminx 65157 NOCD ALL Y MERITAIN LUMINX N FALSE Meritain Health (North American Health Plan.) 64157 NOCD ALL Y MERITAIN HLTH NAH N FALSE Meritain Health / Agency Services 64158 NOCD ALL Y MERITAIN HEALTH Y FALSE Meritain Health Minneapolis 41124 NOCD ALL Y MERITAIN MN N FALSE Meritus Health 45150 NOCD ALL N MERITUS HEALTH N FALSE MethodistCare, Inc. 95420 NOCD ALL Y METHODISTCARE Y FALSE Metro Plus Health Plan 13265 NOCD ALL A METRO PLUS HEALTH Y FALSE Metropolitan Health Plan 10850 NOCD ALL Y METRO HEALTH PLAN Y FALSE Miami Behavioral Health 92579 NOCD ALL Y MIAMI BEHAVIORAL N FALSE Michigan Blue Care HMO (BCN of Michigan) MIBCN NOCD MI N MI BLUE CARE Y TRUE Michigan Medicare PlusBlue MIMPB NOCD MI Y MI MEDICARE PLUSB Y TRUE Micron Tech 96598 NOCD ALL Y MICRON TECH Y FALSE Mid-America Associates 37281 NOCD ALL N MIDAMERICA ASSOC N FALSE Mid-American Benefits 22823 NOCD ALL N MID AMER BENEFITS Y FALSE Midland Management/MFC 23550 NOCD ALL Y MIDLAND MGMT MFC Y FALSE Midland National Life Ins Co (NFIC Plan only) 90956 NOCD ALL N MIDLAND NAT LIFE N FALSE Midlands Choice 47080 NOCD NE,IA Y MIDLANDS CHOICE Y FALSE Midlands Health Partners 47080 NOCD ALL Y MIDLANDS HEALTH Y FALSE Mid-West Behavioral Health Network MVBCN NOCD ALL Y MW BEHAV HLTH NET N FALSE Midwest Group Benefits 61146 NOCD ALL Y MIDWEST GROUP BEN N FALSE Midwest Health Partners 76079 NOCD ALL N MIDWEST HLTH PART N FALSE Midwest Health Plans, INC. MHP77 NOCD ALL N MIDWEST HLTH PLAN Y FALSE Midwest Physician Administrative Services TH088 NOCD ALL Y MW PHYS ADMIN SVC N FALSE Minuteman Health 01776 NOCD MA N MINUTEMAN HEALTH N FALSE Mission Community IPA Med Grp MPM07 NOCD CA N MISSION COMM IPA N FALSE Mission HospitalAffiliates STJOE NOCD CA Y MISSION HOSPITAL Y FALSE Missionary Medical SX105 NOCD UT N MISSIONARY MEDICA N TRUE Mississippi Health Partners 64068 NOCD ALL Y MS HEALTH PARTNER Y FALSE Mississippi Physicians Care Network 64084 NOCD ALL Y MS PHYS CARE NETW Y FALSE Mississippi Select Healthcare (Mississippi Select Health Care) Missoula County Medical Benefits MMM - Medicare y mucho Mas Molina Healcare of New Mexico - SCI Molina Health Care of South Carolina Molina Healthcare of CA - Encounters only. Molina Healthcare of California (Rendering provider must use Medi-Cal ID number or State License Number. Billing provider should use Federal TaxID only.) Molina Healthcare of Florida Molina Healthcare of Illinois Molina Healthcare of Michigan Molina Healthcare of Nevada Molina Healthcare of New Mexico Molina Healthcare of New Mexico Salud Molina Healthcare of Ohio Molina Healthcare of Texas Molina Healthcare of Washington (Rendering providers use DSHS Medicaid ID or State Licence Number.) Molina Healthcare Utah Monarch Healthcare IPA (Rendering provider ID# required on all claims.) Monitor Life (Payer accepts secondary claims only, and Medicare cannot be primary payer.) Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G T G G T G G G G G G BOTH BOTH BOTH G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH # BOTH # BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G C C T G N G G G G G G N N G G T G G T T G G G G G N N N N G G 64088 37275 88600 04423 46299 33373 NOCD NOCD NOCD NOCD NOCD NOCD All MT PR ALL ALL CA Y N N Y N Y MS SELECT HEALTHC MISSOULA COUNTY M MEDICARE Y MUCHO MOLINA HC NM SCI MOLINA HC SC MOLINA HC CA ENC N N N Y Y N FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH G G N G G G 38333 51062 20934 38334 20676 NM505 09824 20149 20554 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD CA ALL ALL MI ALL NM NM OH TX Y Y Y Y N Y N Y Y MOLINA HC OF CALI MOLINA HC OF FLOR MOLINA HC OF IL MOLINA HC OF MICH MOLINA HC OF NV MOLINA HC OF NEW MOLINA HC NM SALU MOLINA HC OF OHIO MOLINA HC OF TEX Y Y Y Y N Y Y Y Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G N G G G G 38336 SX109 NOCD NOCD WA UT Y Y MOLINA HC OF WASH MOLINA HCARE UT Y Y FALSE FALSE BOTH BOTH G N IP095 NOCD ALL N MONARCH HEALTH IP N FALSE BOTH N 01759 NOCD ALL Y MONITOR LIFE Y FALSE BOTH G For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 23 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Montefiore Contract Management Organization (Provider ID required, call 914-377-4400 for ID prior to first claims submissions.) 13174 NOCD ALL A MONTEFIORE CONTRA Y FALSE Montefiore HMO 46161 NOCD ALL N MONTEFIORE HMO Y FALSE Monterey Bay IPA MBIPA NOCD ALL Y MONTEREY BAY IPA N FALSE Monumental Life Ins Co. MMLIC NOCD ALL N MONUMENTAL LIFE N FALSE Morris Associates aka HealthScope Benefits 35092 NOCD ALL Y MORRIS ASSOCIATES Y FALSE Mosaic IPA Medical Group (Providers please contact Brandi Guinn @ 559-735-3892 x233 for authorization.) IP083 NOCD CA N MOSAIC IPA MEDICA Y FALSE Motion Picture Industry Health Plan (These claims now processed by Anthem BC of CA) MPI01 NOCD CA Y MOTIONPIXINDUS N FALSE Mountain States Administrators (COLORADO ONLY) MTNST NOCD CO N MOUNTAIN STATES Y FALSE MPE Employee Benefit Services 37233 NOCD ALL N EMP EMPLOYEE BENE N FALSE MPLAN Inc. Healthcare Group 95444 NOCD ALL A MPLAN INC HEALTH Y FALSE MPM Prospect MPM16 NOCD ALL N MPM PROSPECT Y FALSE MRIPA Allcare CCO (Medicaid Payer) 26161 NOCD ALL Y MRIPA ALLCARE CCO N FALSE MS BCBS State Employees SB731 NOCD MS Y MS BCBS SE N FALSE Mt. Carmel 95655 NOCD ALL N MOUNT CARMEL N FALSE Multiplan Wisconsin Preferred Provider Network 34080 NOCD ALL Y WI MULTIPLAN PPN Y FALSE Multnomah County MLTOT NOCD ALL Y MULTNOMAH COUNTY N FALSE Municipal Health Benefits Fund 81883 NOCD ALL N MUNI HEALTH BENEF N FALSE Muskegon Care A1681 NOCD MI N MUSKEGON CARE Y FALSE Mutual Benefit 39065 NOCD All Y MUTUAL BENEFIT N FALSE Mutual Benefit Life 39065 NOCD All Y MUTUAL BENEFIT LI N FALSE Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH G G G N G BOTH N BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G N G C G G C G G Mutual Health Services (fka Antares Management Solutions) Mutual of Omaha Insurance Company Mutual of Omaha Insurance Company Mutually Preferred MVP Health Care (Formerly Hudson Health Plan) MVP Health Plan of NY MVP Health Rochester (Formerly Preferred Care NY) My Family Medical Group MyNexus, Inc. N.W. Ironworkers Health & Security Trust Fund - Grp#F15 N.W. Roofers & Employers Health & Security Trust Fund Grp#F14 N.W. Textile Processors - Grp#F14 NAA (North America Administrators) NAMCI/Global Care NAMM Partners Naphcare Inc National Allied Workers Union Local 831 National Association of Letter Carriers National Association of Letter Carriers National Capital Area National Capital Preferred Provider Organization (NCPPO) (To obtain your provider ID number, please call the NCPPO Customer Service Department at (800) 272-5911 National Financial Insurance Company National Foundation Life Insurance Company National Health Administrators Inc. National Health Benefit National Health Benefits Corporation - NHBC02 National Rural Electric National Teachers Association (NTA) 34192 71412 71412 71412 13335 14165 SX089 33020 32043 91136 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NCOD NOCD NOCD ALL All All All ALL NY NY ALL ALL ALL Y N N N N Y Y Y Y Y ANTERES MGMT SOLN MUTUAL OF OMAHA MUTUAL OF OMAHA I MUTUALLY PREFERRE HUDSON HEALTH PLA MVP HEALTH NY PREFERRED CARE NY MY FAMILY MEDICAL MYNEXUS INC NW IRONWRKRS F15 Y N N N N Y Y N N N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH # BOTH # BOTH # BOTH BOTH BOTH BOTH BOTH BOTH G P P P G G N G G G 91136 91136 65085 L0110 NANPR 58182 CB148 53011 53011 NCABS NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL ALL ALL ALL ALL ALL All All DC VA M Y Y N Y Y A Y N N N NW ROOFERS F26 NW TEXTILE F14 NAA NAMCI GLOBAL CARE NAMM PARTNERS NAPHCARE INC NAT ALLIED LCL831 NALC NATIONAL ASSOCIAT NCA N N N Y N Y N Y Y N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE TRUE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G T T N 90001 90956 98205 NHAIN 88057 88050 52132 NTA11 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL ALL ALL ALL ALL All ALL N N N N Y Y Y A NAT CAPITAL PPO NAT FINANCIAL INS NAT FOUNDATION LI NAT HEALTH ADMIN NATL HEALTH BENEF NHBC02 NAT RURAL ELECT NTA Y N N Y Y Y N N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G C G G G G National Telecommunications Cooperative Association (NTCA) National Telecommunications Cooperative Association (NTCS Staff) National Vision Nationwide Group Nationwide Health Plans - HMO, PPO, POS Nationwide Insurance Nationwide Life and Health Nationwide Mutual Insurance 52103 NOCD ALL Y NAT TELECOMM COOP Y FALSE BOTH G 52104 NVADM 31417 31112 31417 31417 31417 NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL All ALL All All All Y N Y Y Y Y Y NTCS STAFF NATIONAL VISION NATIONWIDE GROUP NATIONWIDE HLTH P NATIONWIDE INS NATIONWIDE LIFE NATIONWIDE MUTUAL Y N Y N N N N FALSE TRUE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH G N G G G G G Nationwide Specialty Health (Formerly Nationwide Health Plans Native Care Health NCAS - Charlotte, VA NCAS - Fairfax, VA Neighborhood Doctors Organization Neighborhood Health Partnership (NHP) Neighborhood Health Partnership (NHP) Neighborhood Health Plan of Rhode Island (Contact NHPRI 401-459-6030 to verify provider and vendor number.) Neighborhood Health Plan RI- Exchange, Unity, Integrity (Patient ID cards will have 11 digit Ids that start with 135) Neighborhood Plan (Boston, MA) 31417 19191 75191 75190 51909 95123 96107 NOCD NOCD NOCD NOCD NOCD NOCD NOCD All ALL VA VA ALL ALL ALL Y N Y Y N Y Y NATIONWIDE SPECIA NATIVE CARE HEALT NCAS CHARLOTTE NCAS FAIRFAX NEIGHBORHOOD DOCT NEIGHBORHOOD HEAL NEIGH HLTH PARTNE Y Y Y Y N N N FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH # BOTH # G G G G G C C 05047 NOCD RI N RI NEIGHBORHOOD H Y FALSE BOTH G 96240 04293 NOCD NOCD RI ALL Y Y NEIGHBORHOOD HP R NGHBRHOOD PLAN MA N Y FALSE FALSE BOTH BOTH N G Nesika Health Group (Old payerID of 37255 is no longer valid.) 75280 Netcare Life and Health Insurance 66055 NOCD NOCD ALL ALL Y N NESIKA HEALTH GRP NETCARE LIFE HLTH N N FALSE FALSE BOTH BOTH G G For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 24 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Network Health (Before initiating submissions, please call Provider Relations at (617)806-8104 or www.network-health.org for an EDI startup plan.) CALL CALL ALL Y CALL ENS SUPPORT N FALSE Network Health Insurance Corp - Medicare 77076 NOCD ALL T NETWORK HLTH INSU Y FALSE Network Health Massachusetts 04332 NOCD ALL N NETWORKHEALTH MAS Y FALSE Network Health Plan of Wisconsin, Inc.(Prior to initial claims submission, please contact Network Health Plan EDI specialist at 920-720-1506.) 39144 NOCD ALL N WI NETWORK HEALTH Y FALSE Network Health PPO AMS01 NOCD ALL N NETWORK HEALTH PP Y FALSE Network Solutions IPA NSIPA NOCD ALL Y NETWORK SOLN IPA Y FALSE Nevada Health Coop 90091 NOCD ALL N NV HEALTH COOP N FALSE Nevada Health Solutions (Provider ID Required) 86067 NOCD NV Y NV HEALTH SOLUTIO Y FALSE NevadaCare (Provider ID Required) 86067 NOCD NV R NEVADACARE Y FALSE NevadaCare Kids (Provider ID Required) 86067 NOCD NV R NEVADACARE KIDS Y FALSE New Avenues, Inc. 95998 NOCD ALL N NEW AVENUES INC Y FALSE New Century Health NCHCA NOCD ALL Y NEW CENT HEALTH N FALSE New Century Health - Vista Cardiology NCH09 NOCD ALL N NEW CENTURY HEALT Y FALSE New Century Health Arizona Integrated Physicians NCHOR NOCD ALL N NEW CENTURY AZIP N FALSE New Century Health Urology NCH03 NOCD ALL N NEW CENT HLTH URO N FALSE New England, The 66893 NOCD All Y NEW ENGLAND N FALSE New England, The 66893 NOCD All Y THE NEW ENGLAND N FALSE New ERA Life 75281 NOCD ALL N NEW ERA LIFE Y FALSE New Hampshire Healthy Family 68069 NOCD NH Y NH HEALTHY FAMILY Y FALSE New Mexico District Council of Carpenters 74234 NOCD NM N NM DIST CARPENTER N FALSE New Mexico Health Connections 45129 NOCD ALL N NM HEALTH CONNECT Y FALSE New Mexico Painters and Allied Trades Local No 823 74234 NOCD UT N NM PAINTERS #823 N FALSE New Mexico-West Texas Multi-Craft (lso known as New Mexico Laborers) 74234 NOCD UT N NM MULTI-CRAFT N FALSE New West Health Plan 84141 NOCD MT Y NEW WEST HEALTH P Y FALSE New York Life - Long Term Care NYL11 NOCD ALL N NYL LONG TERM CAR N FALSE New York Medical Imaging-MVP 14179 NOCD NY Y NEW YORK MVP Y FALSE New York Network Management (Healthplus Amerigroup claims with Dates of service after March 1st, 2015 should be sent directly to the payer with payerID 27514) 11334 NOCD ALL Y NY NETWORK MGMNT Y FALSE Nexcaliber ADSL1 NOCD ALL Y NEXCALIBER N FALSE Next Level Health Partners 69821 NOCD ALL Y NEXT LEVEL HEALTH N FALSE NGS CoreSource 38225 NOCD ALL Y NGS AMERICAN Y FALSE Nippon Life Insurance Company 81264 NOCD All Y NIPPON LIFE INSUR N FALSE NJ Carpenters Health Fund 22603 NOCD NJ N NJ CARPENTERS HF Y FALSE Noble Community IP080 NOCD CA N NOBLE COMMUNITY Y FALSE North American Administrators, Inc. 64157 NOCD ALL Y NORTH AM ADMIN N FALSE North American Benefits Network (NABN) 34159 NOCD ALL N NORTH AMERICAN BE N FALSE North American Medical Management (Provider number must be in box 33a) IP079 NOCD All Y NORTH AMERICAN ME Y FALSE North Broward Hospital District 37314 NOCD FL Y NO BROWARD HOSPIT Y FALSE North Shore - LIJ (Healthfirst) 17516 NOCD ALL N NORTH SHORE LIJ Y FALSE North Shore - LIJ CareConnect Insurance Company 46227 NOCD ALL N NORTH SHORE CARE Y FALSE North Suburban Associated Physicians 36392 NOCD ALL N N SUB ASSOC PHYSI Y FALSE North Texas Healthcare Network 35212 NOCD All Y NORTH TEXAS HEALT Y FALSE North West Life PH018 NOCD All Y NORTH WEST Y FALSE Northeast Georgia Health Services 58169 NOCD ALL Y NE GA HLTH SVCS N FALSE Northeast Iowa Community Health Plan SISCO NOCD ALL N SISCO N FALSE NortheastGeorgia Health Services 58169 NOCD ALL Y NE GA HLTH SVCS N FALSE Northern California Advantage Medical Group NCA01 NOCD CA Y NOCAL ADV MED GRP N FALSE Northern Illinois Health Plan 36347 NOCD IL Y NO ILLINOIS HLTH Y FALSE Northern Nevada Trust Funds (Call 775-826-7200 prior to submitting claims.) 88027 NOCD NV A NO NV TRUST FUNDS Y FALSE Northridge Medical Group NMG01 NOCD ALL N NORTHRIDGE MED GP Y FALSE NorthShore Physicians Associates 48026 NOCD ALL N NO SHORE PHY ASSO Y FALSE Northwest Physicians Network NPN11 NOCD ALL Y NW PHYSICIANS NET N FALSE Northwest Suburban IPA (IL) 36346 NOCD IL Y NW SUBURBAN IPA N FALSE Northwestern National Life PH018 NOCD All Y NORTHWESTERN NATI Y FALSE Nova Healthcare Administrators, Inc. (Grand Island, NY) 16644 NOCD ALL Y NOVA HLTHCARE ADM N FALSE NovaNet (Please contact payer directly for payer ID (770)7291997 ext. 220.) CALL NOCD ALL Y CALL SUPPORT Y FALSE NOVASYS Health Network 68069 NOCD ALL Y NOVASYS HLTH NETW N FALSE NSLIJ Queens WTCHP NSLIJ NOCD ALL Y NSLIJ QUEENS WTC N FALSE NTL 37120 NOCD IA N NTL Y FALSE NW Diagnostic Clinic/SelectCare of Texas (NWDC) 62119 NOCD ALL Y NWDC SELECTCARE T N FALSE NY Central FEP (Federal Employee Program) Blue Shield N2FEP NOCD NY Y NY CENTRAL BS FEP Y TRUE Nyhart 37299 NOCD ALL N NYHART N FALSE NYS DOH UCP 14142 NOCD NY N NYS DOH UCP Y FALSE Oak West Physician Association 36400 NOCD ALL Y OAK WEST PHYSICIA N FALSE Oak West Primary Physician Association NAOAK NOCD ALL Y OAK WEST PRIMARY Y FALSE Oak West Primary Physician Association NAOAK NOCD IL Y OAK WEST PPA Y FALSE Occular Benefits L0140 NOCD ALL N OCCULAR BENEFITS N FALSE ODS Health Plan 13350 NOCD ALL A ODS HEALTH PLAN Y FALSE Ohio Health Choice PPO 34189 NOCD OH Y OHIO HLTH CHOICE N FALSE Ohio PPO Connect 74431 NOCD ALL N OHIO PPO CONNECT Y FALSE OLOLRMC Uninsured Patient Services Program OLRMC NOCD LA N OLOLRMC UNINSUR N FALSE Olympic Health Management Systems, Inc. 91150 NOCD All Y OLYMPIC HEALTH MA Y FALSE Olympus Management Health Care 65074 NOCD ALL Y OLYMPUS MGD HC N FALSE For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 Code Set (See Legend) Payer Type BOTH BOTH BOTH G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH C T G G N N N G G G G G P P G G P G P BOTH BOTH BOTH BOTH P G N G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G N G G G G G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G P G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G N G G G G N G G G G G G G G G G 25 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer OMNI Administrators / CHP (Enrollment required, please contact Provider Relations 801-352-7270) (NOTE that this payer accepts Chiropractic claims only.) U1439 NOCD UT N CHIROPRACTIC HP U Y TRUE OmniCare (For claims with Dates of Service after 10/01/04) 25150 NOCD ALL N OMNICARE Y FALSE Omnicare IPA OMN02 NOCD ALL Y OMNICARE IPA N FALSE Oncology Network of Orange County. ONOCI NOCD ALL N ONCOLOGY NW OC N FALSE One Call Medical 22321 NOCD ALL N ONE CALL MEDICAL Y FALSE One Health Plan Inc. 80705 NOCD ALL N ONE HEALTH PLAN N FALSE One Health Plan Michigan, Inc. 80705 NOCD MI N ONE HEALTH MI N FALSE One Health Plan New York, Inc. 80705 NOCD NY N ONE HEALTH NY N FALSE One Health Plan of Alaska 80705 NOCD AK N ONE HEALTH AK N FALSE One Health Plan of Arizona, Inc. 80705 NOCD AZ N ONE HEALTH AZ N FALSE One Health Plan of California 95379 NOCD CA Y ONE HEALTH CA N FALSE One Health Plan of Colorado 95412 NOCD CO Y ONE HEALTH COLO N FALSE One Health Plan of DC Inc, 80705 NOCD DC N ONE HEALTH DC N FALSE One Health Plan of Florida 80705 NOCD FL N ONE HEALTH FL N FALSE One Health Plan of Georgia 95569 NOCD GA Y ONE HEALTH GA N FALSE One Health Plan of Illinois 95388 NOCD IL Y ONE HEALTH IL N FALSE One Health Plan of Indiana, Inc. 80705 NOCD IN N ONE HEALTH IN N FALSE One Health Plan of Kansas and Missouri 80705 NOCD KS,MS N ONE HEALTH KM N FALSE One Health Plan of Maine, Inc. 80705 NOCD ME N ONE HEALTH ME N FALSE One Health Plan of Massachusetts, Inc. 80705 NOCD MA N ONE HEALTH MA N FALSE One Health Plan of Minnesota, Inc. 80705 NOCD MN N ONE HEALTH MN N FALSE One Health Plan of Nevada, Inc. 80705 NOCD NV N ONE HEALTH NV N FALSE One Health Plan of New Jersey 80705 NOCD NJ N ONE HEALTH NJ N FALSE One Health Plan of North Carolina 80705 NOCD NC N ONE HEALTH NC N FALSE One Health Plan of Ohio 80705 NOCD OH N ONE HEALTH OH N FALSE One Health Plan of Pennsylvania 80705 NOCD PA N ONE HEALTH PA N FALSE One Health Plan of South Carolina 80705 NOCD SC N ONE HEALTH SC N FALSE One Health Plan of Tennessee 80705 NOCD TN N ONE HEALTH TN N FALSE One Health Plan of Texas 80705 NOCD TX N ONE HEALTH TX N FALSE One Health Plan of Virginia, Inc. 80705 NOCD VA N ONE HEALTH VA N FALSE One Health Plan of Washington 80705 NOCD WA N ONE HEALTH WA N FALSE One Health Plan of Wisconsin, Inc. 80705 NOCD WI N ONE HEALTH WI N FALSE One Health Plan of Wyoming 80705 NOCD WY N ONE HEALTH WY N FALSE OneNet PPO (formerly Alliance PPO and MAPSI) (PayerID active through 3/15/17) 52149 NOCD ALL Y ALLIANCE PPO N FALSE OPEIU Locals 30 & 537 BPA01 NOCD ALL N OPEIU LOC 30 537 Y FALSE Operating Engineers Local No 53 74234 NOCD UT N OPER ENG LOCAL 53 N FALSE Operating Engineers Locals 302 & 612 Health & Security Fund Grp#F12 91136 NOCD ALL Y OPERATING ENGINEE N FALSE Opticare Eye Health Network 56190 MCSI ALL Y OPTICARE EYE HEAL Y FALSE Opticare of Utah OPCAU NOCD ALL Y OPTICARE OF UTAH Y FALSE Optima Insurance Company 54154 NOCD ALL Y OPTIMA INS COMPAN Y FALSE Optimum Choice of the Carolina's (MAMSI) 52152 NOCD NC,SC Y OPTIMUM CHOICE CA Y FALSE Optimum Healthcare, Inc. 20133 NOCD ALL N OPTIMUM HEALTHCAR Y FALSE OptumCare / AZ, UT (formerly Lifeprint Network) LIFE1 NOCD ALL R LIFEPRINT N FALSE OptumHealth (OptumHealth Behavior Solutions) formerly United Behavioral Health and Pacificare Behavioral Health), former payerID 33053 87726 NOCD ALL Y OPTUMHEALTH BEHAV Y FALSE OptumHealth (OptumHealth Behavioral Solutions of NM) 87726 NOCD ALL Y OPTUMHEALTH BEHAV Y FALSE OptumHealth Complex Medical Conditions (CMC) (formerly OptumHealth Care Solutions and United Resource Networks) (Former payerID 52190) 41194 NOCD ALL Y UNITED RESOURCES Y FALSE OptumHealth Physical Health - includes Oxford (former payer id 41159, 41160) 41161 NOCD ALL N OPTUMHEALTH Y FALSE OptumHealth Salt Lake County U6885 NOCD ALL Y OPTUMHEALTH SLC N FALSE Orange Coast Memorial IPA MHIPA NOCD CA N MEMORIAL HC IPA Y FALSE Oregon Health Mgmt OHMS aka Primary Health of Josephine Oregon's Health CO-OP Oregon's Health CO-OP (Oregon Health Co-op with Dates of Service 1/1/2015 and after should be sent using Payer ID 45332 ) Orthonet - AETNA Orthonet Corporation Orthonet-HealthNet Oscar Health OSF Health Plans OSG-Michael Reese Oxford Health Plans Oxford Medicare Network (AARP MedicareComplete insured through UnitedHealthcare ) Oxford Mosaic Network / AARP Medicare Complete insured through UnitedHealthcare P5 Health PA Preferred Health (Call PPHN Claims Operations at 410-3493222) PACE CNY Pace of Southwest Michigan Inc. Pace Southeast Michigan Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N G G G G C C C C C P P C C P P C C C C C C C C C C C C C C C C C BOTH # BOTH BOTH C G P BOTH BOTH BOTH BOTH BOTH # BOTH BOTH # G G G G C G C BOTH # BOTH # C C BOTH # C BOTH # BOTH BOTH C G G OHMSP NOCD 45332 NOCD ALL OR N N OR HEALTH MGMR OR HEALTH COOP N N FALSE FALSE BOTH BOTH G G 21455 13383 13381 25681 OSCAR 61101 37127 06111 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL ALL ALL ALL IL IL All N Y A Y Y Y N Y OR HEALTH COOPERA ORTHONET AETNA ORTHONET CORPORAT ORTHONETHEALTHNET OSCAR HEALTH OSF HEALTH PLANS OSG MICHAEL REESE OXFORD HEALTH PLA Y Y Y Y Y N N N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH # G G G G G G G C 87726 NOCD ALL Y OXFORD MEDICARE N Y FALSE BOTH # C 87726 87068 NOCD NOCD ALL ALL Y N OXFORD MOSAID NET P5 HEALTH Y Y FALSE FALSE BOTH # BOTH C G CALL 70454 45114 86711 CALL NOCD NOCD NOCD ALL ALL ALL ALL N Y Y Y CALL ENS SUPPORT PACE CNY PACE SW MICHIGAN PACE SE MICHIGAN Y N N N FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH T G G G For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 26 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer PacifiCare Life and Health Insurance Company (UnitedHealthOne) 81400 NOCD ALL T UNITEDHEALTHONE Y FALSE PacificSource Administrators 93031 NOCD ALL N SELECT BENE ADMIN n FALSE PacificSource Commercial 93029 NOCD ALL N PACIFICSOURCE COM N FALSE Pacificsource Medicare 20377 NOCD ALL N PACIFICSOURCE MCA Y FALSE Pacificsource OHP COIHS NOCD ALL N PACIFICSOURCE OHP Y FALSE PALIC 81240 NOCD PR N PALIC N FALSE Palladian Muscular Skeletal Health (Formerly Prism Health Networks) 37268 NOCD ALL A PALLADIAN MUSCULA N FALSE Palmetto Tricare 38520 NOCD VARIOU A PALMETTO TRICARE Y FALSE Palo Alto Medical Foundation IP132 NOCD ALL Y PALO ALTO MED FOU N FALSE Pan American Life Insurance 04218 NOCD ALL N PAN AMERICAN LIFE N FALSE Paper Claims (ENS will print and mail the claims submitted with the payerID of PRINT) PRINT NOCD ALL N PAPER CLAIMS N FALSE Paramount Health SX158 NOCD ALL N PARAMOUNT HEALTH N FALSE Parity Healthcare, Inc. 58204 NOCD ALL N PARITY HEALTHCARE N FALSE Parkland Community Health Plan 66917 NOCD ALL N PARKLAND COMM HP Y FALSE Partners Behavioral Health 13141 NOCD ALL N PARTNERS BEHAV HL Y TRUE Partners Health Plan 14966 NOCD ALL Y PARTNERS HLTH PLA N FALSE Partnership Health Plan (Client must contact OptumInsight Enrollments Department for enrollment forms.) PHP02 NOCD CA N PARTNERSHIP HP CA N TRUE Pasadena Primary Care Physicians IP080 NOCD CA N PASADENA PRIMARY Y FALSE Passport Advantage 97652 NOCD ALL Y PASSPORT ADVANTAG Y FALSE Passport Health Plan 61129 NOCD ALL Y PASSPORT HEALTH Y FALSE Patient Access PAN01 NOCD ALL Y PATIENT ACCESS Y FALSE Patient Advocates, LLC 10525 NOCD ALL Y PATIENT ADVOCATES Y FALSE PATIENTPAY 26335 NOCD ALL Y PATIENTPAY Y FALSE Payer Fusion 27048 NOCD ALL A PAYER FUSION N FALSE Peach State Health Plan (Behavioral Health) 68069 NOCD GA Y PEACH STATE HP BH Y FALSE Peach State Health Plan (Medicaid) (Call 800-225-2573 ext 25525 prior to submitting claims.) 68069 NOCD GA Y PEACH STATE HP MD Y FALSE Peak Pace Solutions 27034 NOCD ALL N PEAK PACE SOLUTIO N FALSE Pediatric Associates of Broward 20472 NOCD ALL Y PEDIATRIC ASSOCIA Y FALSE PEHP - Utah Public Employee Health Plan (Enrollment required, please contact Provider Relations 800-765-7347) SX106 NOCD UT N PEHP UTAH PUBLIC Y TRUE Peninsula Healthcare VABLS BCBS VA Y PENINSULA HEALTHC Y FALSE Penn Behavioral Health 53226 NOCD ALL A PENN BEHAV HEALTH Y TRUE Pennsylvania Keystone Health Plan East (claims only) PCBLS NOCD PA Y KEYSTONE HLTH CLA Y TRUE Pennsylvania Keystone Health Plan East (encounters only) PEBLS NOCD PA Y KEYSTONE HLTH ENC Y TRUE Pennsylvania Life Insurance 23130 NOCD PA Y PA LIFE INSURANCE Y FALSE Pennsylvania Pace 20172 NOCD ALL Y PENNSYLVANIA PACE N FALSE Peoples Health Network (Tenet) (Network ID must be on claim. Contact [email protected]) 72126 NOCD ALL N PEOPLES HLTH NETW Y FALSE Personal Choice PPO of Pennsylvania (Also know as Independent BLC) 54704 NOCD PA N PA PERSONAL CHOIC Y TRUE Personal Insurance Administrators 95397 NOCD ALL N PERSONAL INS ADMI N FALSE PHCS Savility (ONLY for Savility card members.) 13306 NOCD ALL N PHCS SAVILITY Y FALSE Phifer Wire Insurance (Per request from Payer, claims are printed and mailed.) PHIF4 NOCD ALL N PHIFER WIRE INSUR N FALSE Phoenix American Life 67814 0001 All Y PHOENIX AMERICAN N FALSE Phoenix Choice 55649 NOCD ALL Y PHOENIX CHOICE N FALSE Phoenix Health Plan 03440 NOCD AZ Y PHOENIX HEALTH PL Y FALSE Phoenix Home Life 67814 NOCD ALL Y PHOENIX HOME LIFE N FALSE Phoenix Home Life Mutual Ins. Co. 67814 NOCD ALL Y PHOENIX HOME MUTU N FALSE Phoenix Mutual 67814 NOCD ALL Y PHOENIX MUTUAL N FALSE Physician Associates of Greater San Gabriel Valley PA513 NOCD CA Y PA G SAN GABRIEL Y FALSE Physician Associates of Louisiana (PAL) 58204 NOCD LA Y PHYS ASSOC OF LA N FALSE Physician Health Cooperative/SRRIPA ( This Payer ID should be used for Stones River Regional IPA Humana Claims) Physician Partners IPA Physicians Care Network Physicians Care Network (Rockford, IL Only) PayerID valid only for claims with billing submission name, city and state of Physicians Care Network, Rockford, IL. Physicians Care Network/The Polyclinic Physicians Choice Medical Group of Santa Maria Physicians Choice Medical Grp of San Luis Obispo (formerly San Luis Obispo Select IPA) Physicians Corporation of America (Florida Plan Only) Physicians Health Association of Illinois Code Set (See Legend) Payer Type BOTH # BOTH BOTH BOTH BOTH BOTH C G G T G N BOTH BOTH BOTH BOTH G T G G BOTH BOTH BOTH BOTH BOTH BOTH N N G G N G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N G G G G G G G G BOTH BOTH BOTH G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH N N G N N G G BOTH G BOTH BOTH BOTH N G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N G G G G G G G G 57549 PPRT1 38265 NOCD NOCD NOCD ALL ALL ALL Y N Y PHYS HLTH COOP SR PHYS PARTNERS IPA PHYS CARE NETWORK Y N Y FALSE FALSE FALSE BOTH BOTH BOTH G N G 36345 PCN12 MCI01 NOCD NOCD NOCD IL ALL ALL Y N N PCN ROCKFORD IL PCN THE POLYCLINI PHY CHOICE SANTA N N N FALSE FALSE FALSE BOTH BOTH BOTH G G G SLOS1 65018 37136 NOCD NOCD NOCD ALL FL IL N Y Y PHY CH SANTA MARI PHYS CORP FL PHY HLTH ASSOC IL N Y N FALSE FALSE FALSE BOTH BOTH BOTH G G G Physicians Health Choice - Claims (Administered by Wellmed) Physicians Health Collaborative Physicians Health Network PHCS1 NOCD 20398 NOCD MHCM2 NOCD ALL ALL ALL N Y N PHY HLTH CHCE CLA PHYSICIANS HLTH C PHYS HLTH NETWORK N Y N FALSE FALSE FALSE BOTH BOTH BOTH C G G Physicians Health Plan (For behavioral Health claims processing, see documents sent to your office from the payer.) Physicians Health Plan (PHP-SC) Physicians Health Plan of Northern Indiana Physicians Healthways IPA Physicians Medical Group of Santa Cruz County 37330 09173 12399 PHIPA PMGSC ALL ALL IN CA CA N Y A N Y PHYSICIAN HLTH PL PHYSICIANS HP SC PHYS HLTHPLN N IN PHYS HEALTHWAYS I PHYS MG SANTACRUZ Y Y Y Y N FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH P G G G G NOCD NOCD NOCD NOCD NOCD For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 27 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Physicians Mutual Insurance Company 47027 NOCD ALL N PHYSICIANS MUTUAL Y FALSE Physicians of Southwest Washington 91171 NOCD ALL R PHYSICIANS SW WA N FALSE Physicians Plus Insurance Corp. 39156 NOCD ALL Y PHYSICIANS PLUS Y FALSE Physicians United Plan TH131 NOCD ALL Y PHYSICIANS UNITED Y FALSE PIA 95397 NOCD ALL N PERSONAL INS ADMI N FALSE Piedmont WellStar Health Plan 251PD NOCD ALL Y PIEDMONT WELLSTAR N FALSE Pinnacol Assurance CCIA1 CCIA CO Y PINNACOL ASSURANC Y FALSE Pioneer Provider Network PPNZZ NOCD CA Y PIONEER PROVIDER Y FALSE Pipe Industry Health & Welfare Fund of Colorado COMPU NOCD CO N PIPE INDUSTRY CO N FALSE Pittsburgh Care Partnership 23283 NOCD ALL Y PITTSBURGH CARE P N FALSE Planned Administrators, Inc. (PAI) 37287 NOCD ALL N PAI Y FALSE PMG of San Jose PMGSJ NOCD CA N PMG OF SAN JOSE N FALSE Podiatry Network FL 59324 NOCD FL N PODIATRY NETWK FL N FALSE Point Comfort Underwriters PCU01 NOCD ALL Y PTCOMFORT UNDERWR N FALSE Poly America Medical & Dental Benefit Plan 32680 NOCD ALL N POLY AMERICA MEDI Y FALSE POMCO 16111 NOCD ALL Y POMCO Y FALSE Pomona Valley Medical Group (PVMG) ProMed IP057 NOCD CA N POMONA VALLEY MG N FALSE Populytics (formerly Spectrum Administrators) 23253 NOCD ALL N SPECTRUM ADMIISTR Y FALSE PPO Oklahoma (WinterBrook HealthCare Management) 73159 NOCD OK Y PPO OKLAHOMA Y FALSE PPO Plus, LLC 72148 NOCD ALL Y PPO PLUS LLC Y FALSE Prairie States Enterprises, Inc. 36373 NOCD ALL N PRAIRE STATES ENT Y FALSE Preferred Administrator (Contact Provider Relations @ (915)532-2778, x1068) EPF10 NOCD TX Y TX PREFERRED ADMI N FALSE Preferred Benefit Administrators 53476 NOCD ALL Y PREFERRED BEN ADM N FALSE Preferred Care Partners (Encounters from delegated entities only. To get payerID, call Jeff Nehms at 305-670-8440.) CALL CALL FL N CALL ICS SUPPORT N FALSE Preferred Care Partners / FL 65088 NOCD FL N PREF CARE PARTNER Y FALSE Preferred Community Choice 73145 NOCD ALL Y PREF COMM CHOICE Y FALSE Preferred Health Care - PPO Lancaster, PA (IHS Gateway Payer) - Contact Sherry Wolgemuth at (717)560-9290 ext. 124 for approval and the Payer ID. CALL CALL PA Y CALL ENS SUPPORT Y FALSE Preferred Health Plan (Louisville, KY) 61106 NOCD KY Y PREFERRED HLTH KY Y FALSE Preferred Health Professionals 31478 NOCD ALL Y PREF HEALTH PROF Y FALSE Preferred Health Professionals Kansas City 00036 NOCD KS,MO N PREF HLTH PROF KC N FALSE Preferred Health Systems Insurance Co (PPO) 61665 NOCD ALL Y PREF HLTH SYS PPO Y FALSE Preferred Health Systems, Inc. 60110 NOCD ALL Y PREF HLTH SYSTEMS Y FALSE Preferred IPA PFIPA NOCD ALL N PREFERRED IPA Y FALSE Preferred Medicare L0250 NOCD ALL N PREFERRED MEDICAR N FALSE Preferred Network Access 36401 NOCD ALL N PREFERRED NET ACC N FALSE Preferred One 41147 NOCD ALL Y PREFERRED ONE Y FALSE Premier Care IPA PCI01 NOCD ALL Y PREMIER CARE IPA N FALSE Premier Eye Care 65054 NOCD ALL Y PREMIER EYE CARE Y FALSE Premier Health Plan 251PR NOCD ALL Y PREMIER HEALTH PL Y FALSE Premier Healthcare Exchange 88051 NOCD ALL N PREMIER HCX N FALSE Premier HealthCare Exchange (Cypress) 88056 NOCD ALL N PREMIER HCARE EXC N FALSE Presbyterian Health Plan (Commercial) (Provider ID is required. Contact (888) 923-5757, #6 then #2 to obtain ID. New Mexico Providers only.) PREHP NOCD NM Y PRESBYTERIAN HP N FALSE Presbyterian Salud (Please add provider number in 2010AA REF02 or 2310B REF02 Number is 11 digits or less. Contact 888-923-5757, #6,#2 to obtain ID.) PRESA NOCD NM N PRESBYTERIAN SALU N FALSE Presbyterian(NM) 05003 NOCD NM Y PRESBYTERIAN NM Y FALSE Prestige Health Choice (Payer is effective 5/1/2014 Managed Medicaid Plan. For EDI Support, please email [email protected] or call 800-617-5727) 77003 NOCD ALL Y PRESTIGE HLTH CHO Y FALSE Prevea Health Insurance Plan 39185 NOCD ALL A PREVEA HEALTH INS N FALSE Primary Care Assoc of California (Customer Service Phone Number 877-602-1563) PCACZ NOCD CA Y PRIMARY CARE CALI N FALSE Primary Choice (Aetna HP-NY/NJ) 60054 NOCD NY, NJ Y PRIMARY CHOICE Y FALSE Primary Delivery Systems 73288 NOCD ALL Y PRIMARY DELIVERY Y FALSE Primary Health Network 82048 NOCD ALL Y PRIMARY HLTH NETW Y FALSE Primary PhysicianCare, Inc.(Now known as HealthGram) 56144 NOCD ALL Y PRIMARY PHYSICIAN N FALSE Prime Community Care Central Valley MVCV1 NOCD ALL Y PRIME COMMCARE CV N FALSE Prime West Health Plan 61604 NOCD MN N PRIME WEST HEALT Y FALSE PrimeCare Health Plan IP079 NOCD CA Y PRIMECARE HLTH PL N FALSE PrimeSource Health Network 04320 NOCD ALL Y PRIMESOURCE HLTNT Y FALSE Principal Financial Group (Vision Claims only.) 61271 NOCD ALL Y PRINCIPAL FINANCI N FALSE Priority Health (Please contact Priority Health EDI Dept at 616464-8686 or email [email protected]) 38217 NOCD ALL Y PRIORITY HEALTH Y FALSE Priority Healthcare VABLS BCBS VA Y PRIORITY HEALTHCA Y FALSE Prism Health Networks (Now known as Palladian Muscular Skeletal Health ) 37268 NOCD ALL A PRISM HEALTH NETW N FALSE Prism Univera 37315 NOCD ALL N PRISM UNIVERA N FALSE Pro Care Health Plan, Inc. (Valid for PO Box 3160 and 3590, Detroit MI only.) 38329 NOCD MI Y PROCARE HEALTH PL Y FALSE ProCare Health Plan Medicaid 70259 NOCD ALL Y PROCARE HP MEDICA Y FALSE Producer's Exchange PEBSI NOCD ALL N PRODUCERS EXCHANG N FALSE Productive Processing Inc. 13396 NOCD ALL Y PRODUCTIVE PROCES N FALSE Professional Benefit Administrators, Inc. (Oak Brook, IL) 36331 NOCD IL A PROF BENE ADM IL N FALSE Professional Claims Management 37242 NOCD ALL Y PROF CLAIMS MGMT Y FALSE Professional Claims Manangement 56001 NOCD ALL T PROF CLAIMS MGMT N FALSE Professional Risk Management, Inc. 34134 NOCD ALL N PROFESSIONAL RISK N FALSE For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G C G G G P G P G G P G G G G G G G G G BOTH BOTH G G BOTH BOTH BOTH G C G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH T G G G G G G N G G G G G G G BOTH G BOTH BOTH G G BOTH BOTH G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G C G G G G G G G G BOTH BOTH T N BOTH BOTH G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G T G G G T G 28 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Promina 58226 NOCD ALL Y PROMINA Y FALSE Prominence Health Plan Encounters 88082 NOCD ALL Y PROMINENCE HP N FALSE Prominence Health Plan of Nevada 93082 NOCD ALL N PROMINENCE HP NV N FALSE Prominence Health Plan of Texas 80095 NOCD ALL N PROMINENCE HP TX N FALSE Prospect Medical Group PROSP NOCD CA Y PROSPECT MED GROU Y FALSE Protective Life Insurance Company 37309 NOCD ALL Y PROTECTIVE LIFE I Y FALSE Providence Choice Option PHP01 NOCD ALL Y PROVIDENCE CHOICE Y FALSE Providence Good Health Plan PHP01 NOCD ALL Y PROVIDENCE GOOD H Y FALSE Providence Health Plan SX133 NOCD ALL Y PROVIDENCE HEALTH N FALSE Providence Health PPO SX187 NOCD ALL Y PROVIDENCE H PPO N FALSE Providence Preferred (PPO) (ProviderID and Enrollment required.) PHP00 NOCD ALL Y PROVIDENCE PREFER Y TRUE Provident Life & Accident Insurance Company 68195 NOCD All Y PROVIDENT INS CO Y FALSE Provident Life & Accident Insurance Company of America 68195 NOCD All Y PROVIDENT LIFE Y FALSE Provident Life & Casualty Insurance Company 68195 NOCD All Y PROVIDENT CASUALT Y FALSE ProviDRs Care Network 48100 NOCD ALL N PROVIDERS CARE NE N FALSE PruCare HMO (Encounters Only) HM015 NOCD All Y PRUCARE HMO N FALSE Prudent Medical Group MPM25 NOCD ALL Y PRUDENT MED GROUP Y FALSE Prudential Encounters HM015 NOCD All Y PRU ENCOUNTERS N FALSE Pruitt Health Premier PH001 NOCD ALL Y PRUITT HLTH PREMI N FALSE Puget Sound Benefits Trust - Grp#F25 91136 NOCD WA Y PUGET GRP F25 N FALSE Puget Sound Electrical Workers Trust - Grp#33 91136 NOCD WA Y PUGET GRP 33 N FALSE Quad Cities Community Health Plan SISCO NOCD ALL N SISCO N FALSE Quad City Community Healthcare (QCCH) 40437 NOCD ALL Y QUAD CITY COMMUN N FALSE Qual Choice of Arkansas 35174 NOCD AR Y QUAL CHOICE AR Y FALSE Qual Choice of Ohio 01250 NOCD OH Y QUAL CHOICE OF OH Y FALSE Qualcare 23342 NOCD ALL Y QUALCARE Y FALSE Quality Care Partners 89461 NOCD ALL R QUALITY CARE PART Y FALSE QuantumCare (We Care Health Plan) QCTPA NOCD ALL N QUANTUMCARE N FALSE Questcare Medical (USC) 84562 NOCD ALL Y QUESTCARE MEDICAL N FALSE Quicktrip Corporation 73067 NOCD ALL N QUICKTRIP CORPORA Y FALSE QVI Risk Solutions, Inc. 57117 NOCD ALL N QVI RISK SOLUTION Y FALSE Radcon, Inc. (Please contact Kathy King @ 856-608-1350 for Payer ID information.) CALL NOCD ALL N CALL ENS SUPPORT Y FALSE Rady Children's Health Network RCHN1 NOCD ALL Y RADY CHILDRENS HE N FALSE RBMS, LLC 91176 NOCD ALL Y RBMS LLC Y FALSE Redlands IPA (Synermed) SYMED NOCD ALL N REDLANDS IPA Y FALSE Regal Medical Group REGAL NOCD ALL Y REGAL MEDICAL GRO Y FALSE Regence Blue Shield of Washington 00932 NOCD WA Y REGENCE BCBS Y FALSE Regional Care, Inc. 47076 NOCD ALL Y REGIONAL CARE INC N FALSE Rehn and Associates REHNA NOCD ALL Y REHN AND ASSOCIAT N FALSE RELIASTAR (Formerly NWNL) PH018 NOCD All Y RELIASTAR Y FALSE Renaissance Physicians Organization 76066 NOCD ALL Y RENAISSANCE PHYS Y FALSE Reserve National Insurance (For Claims rejections, please contact Reserve national Customer Service at (405)848-7931.) Resolve Health Plan Administrators (Authorization number required: begins with the number 5 and is 13 characters in length.) Resurrection Physician Provider Group Revclaims (Provides TPL benefits services for Providers. Providers must be contracted with RevClaims to submit claims. For more info, call 601-345-8500.) Right Care from Scott & White RightChoice Benefits Administrators RIVER CITY MEDICAL GROUP Riverside Family Health Med Grp IPA Riverside Health, Inc RMSCO, Inc. Rocky Mountain Health Plan Grand Junction Rocky Mountain HMO Rooney Life Ins. Royal Health on Behalf of Extended Care MLTC (For claims with service dates/statement dates after 12/1/2013.) Rush Prudential Health Plans (HMO Only) S & S Healthcare Strategies Sagamore Health Network, Inc. Sage Sage Plus Sage Technologies (Formerly CCMSI) (Claims for payer address of Rockford, IL ONLY.) Saint Anthony PHO Saint Marys Health Plan Samaritan Advantage Samaritan Choice Plan Samaritan Employer Group Plan San Diego County Low Income Health Program/Coverage Initiative San Diego County Medical Services (CMS) San Diego County Physician Emergency Services San Diego County Primary Care Services San Diego County Ryan White Primary Care Program Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G P G P G G G P G G T G G G G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G N G G G G 73066 NOCD ALL N RESERVE NAT INSUR Y FALSE BOTH G 20481 RPPG1 NOCD NOCD ALL ALL Y N RESOLVE HP ADMINI RESURRECTION PHY Y N FALSE FALSE BOTH BOTH G G RVC01 74205 37331 RCMG1 MPM08 45281 16117 SX141 RMHMO 37602 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL ALL CA CA ALL ALL ALL CO All N N N N N N Y Y Y N REVCLAIMS RIGHT CARE SCOTT RIGHTCHOICE BENEF RIVER CITY MG RIVERSIDE FAM HLT RIVERSIDE HEALTH RMSCO INC ROCKY MTN HP GJ ROCKY MOUNTAIN HM ROONEY LIFE INS N N Y Y N N Y N Y Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE TRUE TRUE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH # C G G G N G G G P C 46166 36389 31441 35164 MNDH1 MNDH1 NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL ALL All ALL ALL N Y A Y Y Y ROYAL HEALTH MLTC RUSH PRDENTL HMO S AND S HEALTHCAR SAGAMORE HEALTH N SAGE SAGE PLUS Y Y Y N Y Y FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH G G G P G G 37105 STA01 88029 SAMAD SAMCP SAM00 NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL ALL ALL ALL ALL Y N Y N N N SAGE TECHNOLOGIES ST ANTHONY PHO ST MARYS HEALTH P SAMARITAN ADVANTA SAMARITAN CHOICE SAMARITAN EMP GRP N N Y Y N N FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH G G G G G T MSO77 MSO11 MSO22 MSO44 MSO33 NOCD NOCD NOCD NOCD NOCD CA CA CA CA CA N N N N N SD COUNTY LOW INC SD COUNTY MED SVC SD COUNTY PHY EME SD COUNTY PRIMARY SD COUNTY RYAN WH Y Y Y Y Y FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH G G G G G For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 29 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer San Diego PACE 96400 NOCD ALL Y SAN DIEGO PACE N FALSE San Luis Obispo Select IPA 33072 NOCD ALL N SAN LUIS OBISPO S N FALSE Sandhills Center SHC30 NOCD ALL N SANDHILLS CENTER Y TRUE Sanford Health Plan MNSHP NOCD ALL Y SANFORD HEALTH PL Y FALSE Santa Clara County IPA SCACO NOCD ALL N SANTA CLARA CO IP N FALSE Santa Clara Family Health Plans 24077 NOCD CA N SANTA CLARA FAM H N FALSE Santa Clara IPA HMO 10378 NOCD ALL Y SANTA CLARA IPA H N FALSE Sante Health Systems 77038 NOCD ALL N SANTE HEALTH SYST N FALSE Sanus HMO-St. Louis (General America) 63665 NOCD All Y SANUS HMO-STLOUIS N FALSE Sanus PPO (General America) 63665 NOCD All Y SANUS PPO N FALSE Satellite Health Plan, Inc (Satellite Health Plan is a MA ESRD CSNP effective 1/1/14. First Time submitters, please fax a W9 to 650-625-6083) 45552 NOCD MA N SATELLITE HLTH PL N FALSE SC BCBS Companion Health SC922 NOCD SC Y SC COMPANION HEAL Y FALSE SC BCBS Planned Administrators SC886 NOCD SC Y SC PLANNED ADMINI Y FALSE SC BCBS State Employee Health Plan SC400 NOCD SC Y SC ST EMP HEALTH Y FALSE SC FEP Blue Cross SC402 NOCD SC Y SC FEP BLUE CROSS Y FALSE Scan CA SCAN1 NOCD CA N SCAN CA N FALSE SCAN Encounters (Diversified Data Design (DDD)) 99157 NOCD ALL N SCAN ENCOUNTERS Y FALSE SCAN Health Plan 72261 NOCD ALL Y SCAN HEALTH PLAN Y FALSE Scan Health Plan Arizona 73172 NOCD AZ Y SCAN HLTH PLAN AZ Y FALSE SCAN Long Term Care 20460 NOCD ALL N SCAN LONG TERM CA N FALSE Schaller Anderson CHOC Health Alliance SCH01 NOCD ALL N SCHALLER ANDERSON Y FALSE SCHC Total Care 16146 NOCD ALL Y SCHC TOTAL CARE Y FALSE Scott & White Health Care 88030 NOCD TX N SCOTT WHITE HEALT N FALSE Screen Actors Guild 99289 NOCD ALL N SCREEN ACTORS GUI Y FALSE Scripps Health Plan Services SHPS1 NOCD ALL Y SCRIPPS HP SERVIC Y FALSE Seaside Health Plan (Starting with DOS 9/1/2013) 46187 NOCD CA Y SEASIDE HEALTH PL N FALSE Seaview IPA SVIPA NOCD ALL N SEAVIEW IPA N FALSE Secure Health of Georgia 28530 NOCD GA Y SECURE HEALTH GA Y FALSE Security Administrative Systems 35202 NOCD ALL Y SECURITY ADMIN SY N FALSE Security Health Plan 39045 NOCD ALL Y SECURITY HEALTH N FALSE Sedgwick TP097 NOCD ALL Y SEDGWICK N FALSE SeeChange HealthPlan SCHP1 NOCD ALL Y SEECHANGE HEALTH N FALSE Select Benefit Administrators (PayerID valid for claims submission address of PO Box 8339, Des Moines, IA 50301) Select Benefit Administrators of America Select Choice Select Health of South Carolina SelectCare SelectCare of OK - Tribute SelectCare of Texas (HPN) Heritage Physicians Network SelectCare of TX (Beaumont) (Provider ID Required - Contact (713) 843-6780 to obtain ID.) SelectCare of TX (Houston) (Provider ID Required - Contact (713) 843-6780 to obtain ID.) SelectCare of TX (Kelsey-Seybold) (Provider ID Required Contact (713) 843-6780 to obtain ID.) SelectHealth (Formerly IHC) (Contact payer at 801-442-5442 before sending claims to verify provider numbers.) Self Insured Benefit Administrators Self Insured Plans, LLC Self-Funded Plans (IL, PA, OH) Selman Tricare Supplement Plans Sendero Health Senior Care Partners Senior Choice (Aetna HP-NY/NJ) Senior Smart Choice Senior Whole Health Sentara Family Plan Sentara Health Management Sentara Mental Health Professional Sentinel Management Services Sentry Insurance Co. (Sentry LIfe Insurance Co. Group and Subscriber numbers 800-426-7234) Seoul Medical Group Seoul Medical Group Seton CHIP (Provider ID required.) Seton Employee Plan Seton Map Program - Mediview (Provider ID required) Seton Star Seven Corners Sharp Community Medical Group Sharp Health Plan Sharp Rees-Stealy Med Group Shasta Administrative Services Sheakley Unicomp Sheet Metal Workers Local 104 (PayerID valid for submission add of PO Box 1138, San Ramon, CA 94583.) Sieba, LTD. Sierra Health and Life Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G T G G G G P T T BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G N N N N G N G G G G G N G G G G G G C G G 42137 37282 60054 23285 00014 SCOK1 76045 NOCD NOCD NOCD NOCD NOCD NOCD NOCD IA ALL All SC MO,IL OK TX A N Y N A A Y SELECT BENEFIT AD SELECT BEN ADM AM SELECT CHOICE SELECT HEALTH SC SELECTCARE SELECTCARE TRIBUT SELECTCARE TX HPN N N Y Y Y N Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G C G G T G GTPA1 NOCD TX A SELECTCARE BEAUMO N FALSE BOTH T HPN11 NOCD TX A SELECTCARE HOUSTO N FALSE BOTH T KLSY1 NOCD TX A SELECTCARE KELSEY N FALSE BOTH T UH107 59111 36404 34131 TRSEL 36426 NANPR 60054 95444 83035 54154 54154 5415M 23249 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD UT FL ALL IL,PA,O ALL ALL ALL All ALL ALL ALL ALL ALL ALL Y Y Y Y Y N Y Y N N Y Y N N SELECTHEALTH SELF INS BENE ADM SELF INSURED PLAN SELF FUNDED SELMAN TRICARE SU SENDERO HEALTH SENIOR CARE PARTN SENIOR CHOICE SENOIR SMART CHOI SENIOR WHOLE HEAL SENTARA FAMILY PL SENTARA HEALTH MA SENTARA MENTAL HE SENTINEL MGMT SVC Y N Y Y Y Y N Y N Y Y Y N Y TRUE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N G G G G G G C G G G G T G 39033 IP080 AMM07 SHPCH SHEBP SHMAP STAR1 25404 SCMG1 SHP01 SRS83 75280 10002 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL CA ALL ALL ALL ALL ALL ALL CA CA CA ALL ALL Y N N N N N N N N Y Y Y Y SENTRY INSURANCE SEOUL MEDICAL GRO SEOUL MEDICAL GRP SETON CHIP SETON EMPLOYEE PL SETON MAP PROBRAM SETON STAR SEVEN CORNERS SHARP COMM MED GR SHARP HEALTH PLAN SHARP REESSTEALY SHASTA ADMIN SVCS SHEAKLEY UNICOMP Y Y N N N N N N Y N N N N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE TRUE TRUE TRUE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G T G G G N N G T 38238 03699 76342 NOCD NOCD NOCD CA ALL CA,NV N Y R SHEET METAL 104 SIEBA LTD SIERRA HEALTH SVC N N Y FALSE FALSE FALSE BOTH BOTH BOTH # G G C For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 30 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Sierra Health and Life (Encounters) 76342 NOCD CA,NV R SIERRA HEALTH SVC Y FALSE Sierra Health and Life (FFS Claims) (SecureHorizons by UnitedHealthcare) 76342 NOCD ALL R SECUREHORIZONSFFS Y FALSE Sierra Health Services Encounters 76343 NOCD CA,NV R SIERRA HEALTH ENC Y FALSE Sierra Medical Group (Customer Service 661-480-2047) SMG01 NOCD CA N SIERRA MED GRP N FALSE Significa Benefit Services, Inc. 23250 NOCD ALL Y SIGNIFICA BENEFIT Y FALSE SIHO NTWKS NOCD ALL N SIHO N FALSE Silver Care Managed Care Organization 36387 NOCD IL Y SILVER CARE MCO Y FALSE Silver Cross Managed Care Organization NASCR NOCD IL Y SILVER CROSS MCO Y FALSE Silver Star Pace 97691 NOCD ALL Y SILVER STAR PACE N FALSE Silverback TPA 37228 NOCD ALL N SILVERBACK TPA N FALSE Simply HealthCare Plans 27094 NOCD ALL N SIMPLY HEALTHCARE N FALSE Sinclair Health Plan 84076 NOCD ALL N SINCLAIR HLTH PLN Y FALSE SISCO SISCO NOCD ALL N SISCO N FALSE Smith Administrators SMITH NOCD ALL A SMITH ADMINISTRAT N FALSE Smoky Mountain Center 13010 NOCD ALL Y SMOKY MTN CENTER Y TRUE Sound Health 91131 NOCD All Y SOUND HEALTH N FALSE Soundpath Health (Formerly known as Puget Sound Health Partners, Inc.) 42172 NOCD ALL Y PUGET SOUND HP N FALSE South Atlantic Medical Group SAMG1 NOCD CA Y SO ATLANTIC MED G Y FALSE South Carolina Solutions 42406 NOCD SC N SOUTH CAROLINA SO Y TRUE South Central Preferred - PPO York, PA (IHS Gateway Payer) ( Contact Jane Grove for South Central Preferred (717) 8516715.) CALL CALL ALL Y CALL ENS SUPPORT Y FALSE South Dakota Chiropractic (Sanford Health Plan) CASD2 NOCD SC R SANFORD HP SD CHI Y FALSE South Florida Common Services 59065 NOCD FL Y SO FL COMMON SVCS N FALSE South Florida Musculoskeletal Care 06294 NOCD ALL Y SO FL MUSCULO CAR N FALSE South Indiana Health Options - HMO SX142 NOCD IN Y SO INDIANA HEALTH Y FALSE Southcare / Healthcare Preferred 25147 NOCD ALL N SOUTHCARE HEALTHC Y FALSE Southeast Iowa Health Plan (Provider ID Required) 86068 NOCD IA Y SE IOWA HLTH PLAN Y FALSE Southern Benefit Services 37318 NOCD ALL N SOUTHERN BENE SVC N FALSE Southern Cal Physicians Managed Care Services SCP01 NOCD CA N SO CAL PHYSICIANS N FALSE Southern California Bakery Drivers Security Fund NWADM NOCD CA N SOCAL BAKERY DRIV Y FALSE Southern California Health Care System aka(CHS Alta Pod by Medpoint and SCHS Alto Pod by MedPoint MPM20 NOCD CA Y SOCAL HLTH CARE S Y FALSE Southern Illinois Healthcare SIHCA NOCD ALL Y SO ILLINOIS HEALT Y FALSE Southland IPA SIPA1 NOCD ALL Y SOUTHLAND IPA N FALSE Southwest Physicians Group SWPG1 NOCD ALL Y SW PHYSICIAN GRP Y FALSE Southwest Service Life 37266 NOCD ALL N SW SERVICE LIFE N FALSE Spectera 00773 NOCD ALL Y SPECTERA N FALSE Spencer Stuart ARM Ltd. 38416 NOCD ALL Y SPENCER STUART AR N FALSE St James PHO (Call payer for payer ID) CALL NOCD ALL N CALL PAYER Y FALSE St Joseph Health IP062 NOCD CA N ST JOSEPH HLTH CA Y FALSE St Mary's IPA SMIPA NOCD CA N ST MARYS IPA N TRUE St. Barnabas System Health Plan 22240 NOCD ALL N ST BARNABAS HEALT Y FALSE St. Joe High Desert JOEHD NOCD CA N ST JOE HIGH DESER N FALSE St. John's Claims Administration 37264 NOCD ALL N ST JOHNS CLMS ADM N FALSE St. Joseph Heritage Healthcare IP106 NOCD CA Y ST JOSEPH HERITAG N FALSE St. Joseph HUMBOLT County IP059 NOCD CA A ST JOE HUMBOLT CO Y FALSE St. Therese Physician Association 37116 NOCD ALL Y ST THERESE PHYSIC N FALSE St.. Mary's Health Plan Encounters 88082 NOCD ALL Y PROMINENCE HP N FALSE Standard Life & Accident (Payer accepts secondary claims only, and Medicare cannot be primary payer.) 01758 NOCD ALL Y STANDARD LIFE AND Y TRUE Standard Life & Accident Insurance Co.(Payer only accepts Secondary claims and then only if Primary payer is not Medicare.) 73099 NOCD ALL Y STANDARD LIFE ACC Y FALSE Starmark 61425 NOCD All Y STARMARK N FALSE State Employees Group Benefits LABLS NOCD LA Y LA STATE EMP GRP Y FALSE State Farm (Property & Casualty ) 31059 NOCD ALL N STATE FARM C AND Y FALSE State Farm Homeowners Group Medical Plans (Note that payer requires Insured's ID of 11 or 12 digits and exact structure. Otherwise claims will reject.) 31053 NOCD ALL N STATE FARM GROUP Y FALSE State Farm Workers Compensation Plans (Note that payer requires Insured's ID of 11 or 12 digits and exact structure. Otherwise claims will reject.) 31053 NOCD ALL N STATE FARM GROUP Y FALSE State Merit GA GABLS NOCD GA Y STATE MERIT GA Y FALSE States General Life Insurance 75087 NOCD ALL Y STATES GEN LIFE Y FALSE Sterling Medicare Advantage (Claims containing Dates of service after 4-30-2014, claims should be sent to Wellcare, PayerID 14163) 67829 NOCD ALL Y STERLING MCARE AD N FALSE Sterling Option 1 91151 NOCD ALL N STERLING OPTION 1 N FALSE Stoner & Associates 31121 NOCD ALL N STONER AND ASSOCI N FALSE Stones River IPA Amerivantage 57492 NOCD ALL Y STONES RVR IPA AM Y FALSE Stones River Regional IPA - The Physicians ACO 28943 NOCD TN N STONES RVR IPA TN Y FALSE Stones River Regional IPA - Windsor 15752 NOCD ALL Y STONES RVR IPA WI Y FALSE Stones River Regional IPA/BCBST 15750 NOCD ALL N STONES RIVER REG N FALSE Student Resources (UnitedHealthcare) 74227 NOCD ALL Y STUDENT RESOURCES Y FALSE SummaCare Health Plan 95202 NOCD ALL Y SUMMACARE HEALTH Y FALSE Summit Administration Services, Inc. 86083 NOCD ALL Y SUMMIT ADMIN SVCS N FALSE Summit America Insurance Services, Inc. (Student Accident and Sickness, College Sports and NASCC claims only.) 37301 NOCD ALL Y SUMMIT AMERICA IN Y FALSE SunAmerica Life Ins Co (NFIC Plan only) 90956 NOCD ALL N SUNAMERICA LIFE N FALSE For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 Code Set (See Legend) Payer Type BOTH # C BOTH # BOTH # BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH C C G G G G G G G G G P G G G BOTH BOTH BOTH G G N BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G N G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G C G G G G G G G N G G G BOTH G BOTH BOTH BOTH BOTH G G N G BOTH G BOTH BOTH BOTH G N G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH # BOTH BOTH G T G G N G G C G G BOTH BOTH G G 31 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Sunflower State Healthcare Plan 68069 NOCD IA Y SUNFLOWER STATE H Y FALSE Sunshine Health Plan 68069 NOCD ALL Y SUNSHINE HEALTH P Y FALSE Superior Administrators, Inc. 23218 NOCD ALL N SUPERIOR ADMINIST N FALSE Superior Health Plan 68069 NOCD TX Y SUPERIOR HEALTH P Y FALSE Superior Vision Services 13305 NOCD ALL N SUPERIOR VISION S N FALSE Sutter Connect - Central Valley Med Group (Claims) 77035 NOCD CA Y SUTTER CNTRL CLAI Y FALSE Sutter Connect - Delta - Claims IP100 NOCD CA Y SUTTER DELTA Y FALSE Sutter Connect - SIP, SMG, SWMG - Encounters only HM059 NOCD CA Y SUTTER CONNECT EN Y FALSE Sutter Connect - Solano Regional Medical Group - Claims IP099 NOCD CA Y SUTTER SRMG Y FALSE Sutter Connect - Sutter Gould Medical Foundation - Claims IP091 NOCD CA Y SUTTER SGMF Y FALSE Sutter Connect East Bay Med Foundation IP130 NOCD CA Y SUTTER CONNECT EA Y FALSE Sutter Connect East Bay Medical HM065 NOCD CA Y SUTTER EB MEDICA N FALSE Sutter Connect East Bay Regional Affinity Encounters HM069 NOCD CA Y SUTTER EB AFFINIT N FALSE Sutter Connect East Bay Regional Brown & Toland Encounters. Sutter Connect Sutter Medical Group (SMG,SWMG,SIP) (Please contact Sutter to get set up to send claims, 800-6115191) Per Provider Testing Required Sutter Connect-Palo Alto Medical Foundation Sutter East Bay Regional Hosp-Affinity Claims Sutter Medical Group of the Redwoods (SMGR) (Please contact Sutter to get setup to send Encounters, 800-611-5191) Sutter Senior Care SW Service Administrators Swedish Covenant Hospital Swift Glass Corporation TakeCare Insurance Company Talbert Medical Group Tall Trees Administrators Tattered Cover, Inc. Taylor Benefits Teachers Health Trust Teamcare Teamsters Benefit Trust Teamsters Local 631 Security Fund for Southern Nevada Teamsters Miscellaneous Security Trust Fund Tech-Steel, Inc. Telamon TennCare (Medicaid of Tennessee) Tethys Health Ventures Texas Agricultural Cooperative Trust Texas Children's Health Plan Texas Children's Health Plan (Medicaid) (After 10-08-16, submit claims with payerID TXCSM) Texas Childrens Star Medicaid (Enrollment verification calls should be directed to 800-990-TCHP (8247)) Texas First Health Plans Texas HealthSpring Texas Municipal League Group Benefits Risk Pool TexasFirst Health Plan The Alliance of Wisconsin (Only for ID Cards showing PO Box 44365 Madison WI 53744 as mailing address) The Benefit Group The Boon Group The Care Network The Chesterfield Companies The City of Amarillo The City of Odessa The Health Exchange (Cerner Corporation) The Health Plan (Formerly known as Hometown Health Plan of Ohio.) The Health Plan (Upper Ohio Valley) The Healthcare Group (THCG) The Integrity Benefit Network, Inc. The Loomis Company (Call Provider Relations at 610-374-4040 ext. 2438 for procedures prior to submitting electronically.) The MEGA Life and Health Insurance Company-OKC (Valid if PO BOX 548801 Oklahoma City OK 73154.) The Oath - Health Partners of Alabama (Now known as HealthSpring HMO/HealthSpring Medicare+Choice) Thomas Cooper (Provider must be enrolled with SC Blue Shield.) Three Rivers Preferred Time Insurance (A Fortis Company) TLC Advantage in Sioux Falls TLC Benefit Solutions Today's Health Todays Option (American Progressive and Pyramid Life) Tongass Timber Trust Tooling & Manufacturing Assoc. Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G N G T G G T G G G HM068 NOCD CA Y SUTTER EB BT ENC N FALSE BOTH G IP092 SC050 SC052 NOCD NOCD NOCD CA CA CA Y Y Y SUTTER MED GROUP SUTTER PALO ALTO SUTTER EB REG HOS Y Y N FALSE FALSE FALSE BOTH BOTH BOTH G G T HM057 SC028 53589 36411 07040 98022 TALMG 88067 COMPU TAYLR 88019 36215 94304 NWADM NWADM 74234 22483 TNMCD 20212 TXABA 76048 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD CA ALL AZ ALL ALL ALL ALL ALL CO ALL ALL All ALL CA CA ALL ALL TN ALL ALL TX Y Y Y A Y Y Y Y N N Y Y N N N N Y Y N Y Y SMG REDWOODS SUTTER SENIOR CAR SW SERVICE ADMINI SWEDISH COVENANT SWIFT GLASS CORP TAKECARE INS CO TALBERT MED GROUP TALL TREES ADMINI TATTERED COVER IN TAYLOR BENEFITS CCEA WELFARE BENE TEAMCARE TEAMSTES BENE TRU TEAMSTERS LOC 631 TEAMSTERS MISC SE TECH-STEEL INC TELAMON TENNCARE TETHYS HLTH VENTU TX AGRI COOP TRUS TX CHILDREN HLTH Y Y Y N N N Y Y N N Y N N Y Y N N Y Y N N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE TRUE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G N G G N G G P G G G G G G P G N G G G TXCSM NOCD TX Y TX CHILD HLTH MCD Y FALSE BOTH G TXCSM TX1ST THS01 74214 13185 NOCD NOCD NOCD NOCD NOCD TX TX TX TX ALL Y Y Y Y Y TX CHILD STAR MED TEXAS 1ST HEALTH TEXAS HEALTHSPRIN TEXAS MUNICIPAL TEXASFIRST HP N Y N N N FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH # BOTH G T G C G 88461 TBGNE BOONG 68423 34154 COA01 75600 20356 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL ALL ALL ALL TX ALL ALL Y Y Y Y N Y N Y ALLIANCE WI ONLY THE BENEFIT GROUP THE BOON GROUP THE CARE NETWORK THE CHESTERFIELD CITY OF AMARILLO THE CITY OF ODESS THE HEALTH EXCHAN Y N N Y N N Y Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH C G G G G G G G 30757 34150 35206 58200 NOCD NOCD NOCD NOCD OH ALL ALL ALL A Y N N HOMETOWN HP OF OH THE HEALTH PLAN THE HLTHCARE GRP INTEGRITY BEN NET N Y N N FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH G G G G 23223 NOCD ALL Y LOOMIS COMPANY Y FALSE BOTH G 59227 NOCD ALL N THE MEGA LIFE AND Y FALSE BOTH G 63092 NOCD ALL N THE OATH OF AL Y FALSE BOTH G SC315 MP340 39065 TLC01 TLC79 WITH1 48055 92620 61425 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD SC ALL All SD ALL ALL ALL AK All Y N Y R Y Y N N Y THOMAS COOPER THREE RIVERS PREF TIME INS TLC ADV IN SIOUX TLC BENE SOLUTION TODAYS HEALTH TODAYS OPTION APP TONGASS TIMBER TR TOOLING AND MAN Y Y N Y N Y N N N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N N G G G T G G G For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 32 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Torrance Hospital IPA THIPA NOCD ALL Y TORRANCE HOSP IPA N FALSE Total Care of NY TCARE NOCD NY N NY TOTAL CARE N FALSE Total Carolina Care 68069 NOCD ALL Y TOTAL CAROLINA CA Y FALSE Total Community Care 31182 NOCD ALL Y TOTAL COMMUNITY C Y FALSE Total Healthcare, Inc. 38201 NOCD MI Y TOTAL HEALTHCARE Y FALSE Touchpoint Solutions CRM TPS01 NOCD ALL Y TOUCHPOINT SOL CR Y FALSE Touchstone Health PSO 23856 NOCD ALL Y TOUCHSTONE HLTH P Y FALSE Touchstone Health/Health Net Smart 13402 NOCD ALL Y TOUCHSTONE HEALTH N FALSE TR Paul Inc. 37230 NOCD ALL N TR PAUL INC N FALSE Transamerica Life Ins. Co.(Specialized claims only. Call 501277-1284 for information.) TLINS NOCD ALL N TRANSAM LIFE SPEC N FALSE Transchoice - Key Benefit Admin 37284 NOCD ALL N TRNSCHOICE KEY BE N FALSE Transwestern General Agency 74234 NOCD ALL N TRANSWESTERN GEN N FALSE Transwestern Insurance Administrators, Inc. TRAN1 NOCD ALL N TRANSWE INS ADMIN N FALSE Travis County MAP - Mediview TCMAP NOCD ALL Y TRAVIS COUNTY MAP N FALSE Triad Healthcare Inc 39181 NOCD ALL N TRIAD HEALTHCARE N FALSE Tribute Health Plan (Formerly Central Benefits National.) 31118 NOCD ALL Y TRIBUTE HEALTH PL Y FALSE Tricare for Life (All Regions 1-12) TDDIR NOCD ALL Y TRICARE FOR LIFE Y TRUE Tricare North 38520 NOCD Various A TRICARE NORTH Y FALSE Tricare Overseas FOREN NOCD ALL Y TRICARE OVERSEAS Y FALSE Tricare South 38520 NOCD VARIOU A TRICARE SOUTH Y FALSE TRICARE West (UnitedHealthcare Military & Veterans) to use for claims w/DOS on/after 4/1/13) (formerly TriWest) 99726 NOCD MANY Y TRICARE Y TRUE TRICARE West / UnitedHealthcare Military & Veterans (formerly TriWest) 99726 NOCD MANY Y TRICARE Y TRUE TriHealth Physician Solutions 31144 NOCD ALL N TRIHEALTH PHY SOL N FALSE Trilogy Health Assurance 98514 NOCD ALL N TRILOGY HEALTH Y FALSE Trilogy Health Network 62777 NOCD ALL Y TRLHN EB N FALSE Triple S 97300 NOCD PR N TRIPLE S N FALSE Triplefin LLC 64300 NOCD ALL Y TRIPLEFIN LLC Y FALSE Trusted Health Plan L0230 NOCD ALL N TRUSTED HLTH PLAN Y FALSE Trusteed Plans Service Corporation 91078 NOCD ALL N TRUSTEED PLANS SV N FALSE Trustmark (Includes Starmark & TMA) 61425 NOCD All Y TRUSTMARK N FALSE Tuality Health THA01 NOCD ALL Y TUALITY HEALTH N FALSE Tuality Health Select THASC NOCD ALL Y TUALILTY HLTH SEL N FALSE Tufts Associated Health 04298 NOCD ALL Y TUFTS ASSOC HLTH Y TRUE TulareCare TULCR NOCD CA N TULARECARE N FALSE UC Davis Health Systems UCDMG NOCD ALL N UC DAVIS HLTH SYS Y FALSE Ucare of Minnesota 52629 NOCD MN N UCAREOFMN Y FALSE UC-Davis Health 94603 NOCD CA Y UC DAVIS HEALTH Y FALSE UCHealth Plan Administrators (As of 8/1/14 CSMED, UMA & Phycor combined) 84132 NOCD CO N UNITED MED ALLIAN N FALSE UCLA Medical Group USMBP NOCD ALL N UCLA MEDICAL GROU Y FALSE UCS (Electrical Workers Insurance Fund Local 5800) 93235 NOCD ALL Y UCS ELEC WORK 580 N FALSE UFCW Local 400-5205 (Submitters to UFCW must register with CA Blue Shield at www.blueshieldca.com/provider. If registration NOT completed, claims will reject.) BS001 NOCD CA Y UFCW LOC 400 5205 Y FALSE UICI Administrators - State of Nevada 75245 NOCD NV Y NEVADA UICI N FALSE Ultimate Health Plan 77022 NOCD ALL Y ULTIMATE HP N FALSE Ultra Benfits Inc. 41206 NOCD ALL N ULTRA BENEFITS IN Y FALSE UMC Health Plan 75130 NOCD ALL Y UMC HEALTH PLAN Y FALSE UMR (formerly UMR Onalaska; former payer ids 74223, 95266) Claims with 2015 DOS accepted through 8/31/2016 79480 NOCD ALL N UMR ONALASKA Y FALSE UMR (formerly UMR Wausau) former payer ids 31107, 33108, 74223, 75196, 75243 39026 NOCD All Y UMR WAUSAU Y FALSE UMWA Health & Retirement Funds 52180 NOCD All Y UMWA HEALTH N FALSE Unicare Life & Health Insurance Company 80314 NOCD All Y UNICARE LIFE HEAL Y FALSE Unified Group Services 35198 NOCD OH Y UNIFIED GRP SERVI Y FALSE Unified Health Services 62170 NOCD ALL Y UNIFIED HLTH SERV Y FALSE Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G C G G T G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N G P G G G G T T G T BOTH T BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH T G G G G G G G G T G T G G G G BOTH BOTH BOTH P G G BOTH BOTH BOTH BOTH BOTH G G G G G BOTH # C BOTH # BOTH BOTH BOTH BOTH C G P G G Unified Physicians Network (For Claims rejections, please contact Unified Physicians claim department at 847-763-1700) Uniformed Service Family Health Plan Union Pacific Railroad Employees Health Systems 34638 13407 87042 NOCD NOCD NOCD ALL ALL ALL N Y Y UNIFIED PHY NETWO UNIFORMED SVC FHP UP RAIL EMP HLTH Y Y Y FALSE FALSE FALSE BOTH BOTH BOTH G G G Unison Health Plan (Formerly Three Rivers Provider Network.) United Agriculture Benefit Trust United Benefits, Inc (a Brown & Brown Company) United Care Medical Group United Claim Solutions United Food & Commercial Workers UFCW Local 1529 United Food and Commmercial Workers Midwest Unions United of Omaha United Physicians International IPA UnitedHealthcare 25175 UABT1 59069 ADCUC A0047 21850 36659 71412 MPM15 87726 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL All ALL ALL ALL ALL All CA All N N Y N N Y Y N N R UNISON HEALTH PLA UNITED AG BENEFIT BROWN AND BROWN UNITED CARE MED G UNITED CLAIM SOLU UFCW LOCAL 1529 UNITED FOOD COMM UNITED OF OMAHA UNITED PHY INTERN UNITED HEALTHCARE Y Y N N N N N N N Y FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH # BOTH BOTH BOTH BOTH BOTH BOTH BOTH # BOTH BOTH # C G G G G G G P G C UnitedHealthcare (Definity Health Plan) former payer ID 64159 UnitedHealthcare (Empire Plan) UnitedHealthcare / All Savers Alternate Funding UnitedHealthcare / All Savers Insurance UnitedHealthcare / Oxford UnitedHealthcare / Spectera Eyecare Networks 87726 87726 81400 81400 06111 00773 NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL ALL ALL All ALL Y Y Y Y Y Y UHC DEFINITY HEAL UHC EMPIRE PLAN UHC ALL SAVERS UNITEDHEALTHONE OXFORD HEALTH PLA OPTUMHEALTH VISIO Y Y Y Y N N FALSE FALSE FALSE FALSE FALSE FALSE BOTH # BOTH # BOTH # BOTH # BOTH # BOTH C C C C C C For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 33 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer UnitedHealthcare / StudentResources 74227 NOCD TN Y STUDENT INSURANCE Y FALSE Code Set (See Legend) Payer Type BOTH # C UnitedHealthcare / UHIS-UnitedHealthcare Integrated Services 39026 UnitedHealthcare / UnitedHealthcare of the Mid-Atlantic, MD IPA, Optimum Choice and MAMSI Life and Health (formerly MAMSI) (Former payer ID 52148) 87726 UnitedHealthcare / UnitedHealthcare Plan of the River Valley (formerly John Deere Healthcare) former payer id 95378 87726 NOCD ALL Y UHIS UHC SERVICES Y FALSE BOTH # C NOCD ALL Y UHC MAHP Y FALSE BOTH # C NOCD ALL Y UHC RIVER VALLEY Y FALSE BOTH # C UnitedHealthcare Community Plan / Arizona Long Term Care UnitedHealthcare Community Plan / Arizona Long Term Care BH & SNP UnitedHealthcare Community Plan / AZ (formerly Arizona Physicians IPA and APIPA) UnitedHealthcare Community Plan / AZ (formerly Arizona Physicians IPA and APIPA) UnitedHealthcare Community Plan / CA, DE, FL, HI, IA, LA, MA. MD, MS, NE, NM, NY, OH, PA, RI, TX, WA, WI (formerly AmeriChoice or Unison) former payer id 25175, UnitedHealthcare Community Plan / Children's Rehabilitative Services (CRS) former payer id 87726 UnitedHealthcare Community Plan / KS - KanCare UnitedHealthcare Community Plan / MI (formerly Great Lakes Health Plan) UnitedHealthcare Community Plan / NJ (formerly AmeriChoice NJ Medicaid, NJ Family Care, NJ Personal Care Plus) former payer id 86001 UnitedHealthcare Community Plan / TN (formerly AmeriChoice TN: TennCare, Secure Plus Complete) UnitedHealthcare Community Plan / UnitedHealthcare Dual Complete (formerly Evercare) UnitedHealthcare Community Plan / UnitedHealthcare Long Term Care (formerly Evercare) UnitedHealthcare Dual Complete - Oxford Medicare Network (UnitedHealthcare Community) UnitedHealthcare Medicare Solutions (UnitedHealthcare Group Medicare Advantage) UnitedHealthcare Medicare Solutions / UnitedHealthcare Chronic Complete (formerly Evercare) UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareComplete (formerly SecureHorizons) UnitedHealthcare Medicare Solutions / UnitedHealthcare MedicareDirect (formerly SecureHorizons) UnitedHealthcare Medicare Solutions / UnitedHealthcare Nursing Home Plan (formerly Evercare) UnitedHealthcare Military & Veterans / TRICARE West UnitedHealthcare Vision UnitedHealthcare West / Encounters (formerly PacifiCare) UnitedHealthcare West / UnitedHealthcare of CA, OK, OR, TX, WA and PacifiCare of AZ, CO, NV UnitedHealthOne / UnitedHealthcare Life Insurance Company Golden Rule UnitedHealthOne / UnitedHealthcare Life Insurance Company (formerly American Medical Security) Unity Health Insurance Univera Community Health Univera Health Care Plan/ChoiceCare Buffalo Univera Healthcare - CNY Univera Healthcare (SSA) Univera Traditional PPO Universal Care - California (ProviderID required.) University Family Care University Family Care - Healthcare Group University Family Care - Maricopa Health Plan University Family Care - Maricopa Health Plan University Health Alliance University Health Care Advantage University Healthcare Marketplace University of Maryland Health Advantage University of Utah Health Plans University of Washington Students & Graduate Appts. Grp#P67 Upland Medical Group (Customer Service Phone number, (909) 291-4400) UPMC Health Plan Upper Peninsula Health Group TPA Upper Peninsula Health Plan US Benefits US Family Health Plan (USFHP) US Virgin Islands Medicaid USAA Utah Carpenters 87726 NOCD AZ Y UHC AZ LONG TERM N FALSE BOTH # C 03432 NOCD AZ Y UHC AZIPA Y FALSE BOTH # C 03432 NOCD AZ Y AZ PHYSICIANS IPA Y FALSE BOTH # C 03432 NOCD AZ Y UHC AZIPA Y FALSE BOTH # C 87726 NOCD ALL Y UNITED HEALTHCARE Y FALSE BOTH # C 03432 96385 NOCD NOCD AZ ALL Y Y UHC AZIPA KANCARE Y Y FALSE FALSE BOTH # BOTH # C C 95467 NOCD ALL Y GREAT LAKES HEALT Y FALSE BOTH # C 86047 NOCD NJ Y AMERICHOICE NJ Y FALSE BOTH # C 95378 NOCD ALL Y UHC COMMUNITY PLA Y FALSE BOTH # C 87726 NOCD ALL Y UHC DUAL COMPLETE Y FALSE BOTH # C 87726 NOCD ALL Y UHC LONG TERM CAR Y FALSE BOTH # C 87726 NOCD ALL Y OXFORD MEDICARE N Y FALSE BOTH # C 87726 NOCD ALL Y UHC GROUP MCARE A Y FALSE BOTH # C 87726 NOCD ALL Y UHC MEDICARE SOLU Y FALSE BOTH # C 87726 NOCD ALL Y UHC MEDICARECOMPL Y FALSE BOTH # C 87726 NOCD ALL Y UHC MEDICARE COMP Y FALSE BOTH # C 87726 99726 00773 95958 NOCD NOCD NOCD NOCD ALL MANY ALL ALL Y Y Y N UHC MEDICARE SOLU TRICARE OPTUMHEALTH VISIO UHC WEST ENCOUNTE Y Y N Y FALSE TRUE FALSE FALSE BOTH # BOTH BOTH BOTH # C T C C 87726 NOCD ALL Y UHC WEST Y FALSE BOTH # C 37602 NOCD All N GOLDEN RULE INS Y FALSE BOTH # C 81400 66705 15003 SX087 HC001 SX091 UNINW 33001 09830 07503 09908 09908 99026 46407 45437 45282 SX155 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL ALL ALL NY ALL ALL CA ALL ALL AZ ALL ALL ALL ALL ALL UT Y Y Y Y Y Y A Y Y Y Y Y Y N A Y N UNITEDHEALTHONE UNITY HLTH INSUR UNIVERA COMM HLTH UNIVERA CC BUFFA UNIVERA HC CNY UNIVERA HCARE SSA UNIVERA TRAD PPO UNIVERSAL CARE CA UNIVERSITY FAM CA UNIV FAMILY CARE MARICOPA HP UFC UNIV FAMCARE MARI UNIVERSITY HLTH A UNIV HC ADVANTAGE UNIVERSITY HC MAR UNIV MD HLTH ADVA UT UNIV HLTH PLAN Y Y N N Y Y N Y Y Y Y Y Y N Y Y Y FALSE FALSE FALSE TRUE TRUE TRUE FALSE FALSE FALSE FALSE FALSE FALSE TRUE FALSE FALSE FALSE TRUE BOTH # BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH C C G N N N N G G G G G G G G G N 91136 NOCD WA Y UNIVERSITY GRP67 N FALSE BOTH G IP056 23281 37324 38337 93092 USFHP SKV10 74095 74234 NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD CA ALL ALL ALL ALL ALL VI All UT Y Y Y A Y N Y Y N UPLAND MEDICAL GR UPMC HEALTH PLAN UP PENINSULA TPA UP HEALTH PLAN US BENEFITS USFHP US VI MEDICAID USAA UTAH CARPENTERS Y Y N Y N Y N Y N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G N G P For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 34 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Utah Laborers 74234 NOCD UT N UTAH LABORERS N FALSE Utah Pipe Trades 74234 NOCD UT N UTAH PIPE TRADES N FALSE Utica NY FEP (Federal Employee Program) Blue Shield N4FEP NOCD NY Y UTICA NY FEP Y TRUE VA Fee Basis Programs 12115 NOCD ALL N VA FEE BASIS PROG Y FALSE VA Patient Centered Community Care Program (VAPCCC) Region 3 VAP33 NOCD ALL Y VAPCCC REG 3 Y TRUE VA Patient Centered Community Care Program Regions 1,2 and 4 (Please include the VA authorization number when submitting claims.) 68021 NOCD ALL Y VAPCCC REG124 N FALSE VA Patient Centered Community Care Region 6 VAPC6 NOCD AK Y VA PCCC REGION 6 N TRUE VA Patient-Centered Community Care Program (VAPCCC) Region 5A VAPC3 NOCD ALL Y VAPCCC5A Y TRUE VA State Employer Funds VABLS BCBS VA Y VA STATE EMP FUND Y FALSE Valir PACE 64009 NOCD ALL Y VALIR PACE N FALSE Valley Baptist Health 82420 NOCD ALL N VALLEY BAPTIST HE N FALSE Valley Care IPA (Customer Service 805-604-3332) VCIPA NOCD CA N VALLEY CARE IPA Y FALSE Valley Health Administrators VHA11 NOCD ALL Y VALLEY HLTH ADMIN N FALSE Valley Mental Health 94293 NOCD ALL Y VALLEY MENTAL HEA N FALSE Value Options Colorado Medicaid 00815 NOCD CO N VALUE OP CO MCAID Y TRUE Value Options Commercial Claims 00813 NOCD ALL N VALUE OPT COMMERC N TRUE Value Options Maryland 00823 NOCD ALL Y VALUE OPTIONS MD N TRUE Value Options Pennsylvania Medicaid 00817 NOCD PA N VALUE OPT PAMCD N TRUE Value Options Texas Northstar 00818 NOCD TX N VAL OPT TX NORTHS N TRUE ValueOptions/MBHP (For claim rejections please contact [email protected] or 888-247-9311) 43307 NOCD MA Y VALUEOPTIONS MBHP Y TRUE Vantage Health Plan, Inc. 72128 NOCD ALL N VANTAGE HEALT PLA Y FALSE Vantage Medical Group PPM01 NOCD ALL A VANTAGE MED GROUP N FALSE VENCOR 73288 NOCD ALL Y VENCOR Y FALSE Ventura County Healthcare Plan VCHCP NOCD CA Y VENTURA CO HCP N FALSE Verity VMMH1 NOCD ALL Y VERITY Y FALSE Verity Medical Foundation (DCHS Medical Foundation) VMF01 NOCD ALL Y VERITY MEDICAL FO N FALSE Verity National Group 75256 NOCD ALL Y VERITY NATL GROUP Y FALSE Verity Plus VMMH2 NOCD ALL Y VERITY PLUS Y FALSE VestaCare / RH Admin VESTA NOCD ALL N VESTACARE Y FALSE Via Christi Hope 48123 NOCD ALL Y VIA CHRISTI HOPE N FALSE Vida Care (Now known as Amida Care.) 24818 NOCD ALL N VIDA CARE Y FALSE VillageCareMAX 26545 NOCD ALL N VILLAGECAREMAX N FALSE Virginia Coordinated Care 84806 NOCD ALL Y VA COORDINATED CA N FALSE Virginia Health Network,Inc (To get the payerID, call payer at (804)320-3837) CALL CALL ALL N CALL S&S SUPPORT N FALSE Virginia Premier Complete Care VPCCP NOCD ALL N VA PREMIER COMPL N TRUE Virginia Premier Health Plan 54176 NOCD VA Y VA PREMIER HP Y TRUE Vista Oncology New Century Infusion Solutions NCH08 NOCD ALL A VISTA ONCOLOGY NE N FALSE Viva Health Plan 63114 NOCD ALL Y VIVA HEALTH PLAN N FALSE VNA Homecare Options 31626 NOCD ALL N VNA HOMECARE OPTI Y FALSE VNS Choice Medicare (Formerly Visiting Nurse Service) 77073 NOCD ALL N VNS CHOICE MEDICA Y FALSE Volusia Health Network 59266 NOCD ALL N VOLUSIA HLTH NETW Y FALSE VYTRA Healthcare (Provider ID number required. Please call 1631-420-4100, opt 4, opt 4 for payer set-up and payer assigned provider ID number.) 22264 NOCD All Y VYTRA HEALTHCARE Y FALSE WA Blue Cross Regence (UMP) 00932 NOCD WA Y REGENCE BCBS UMP Y FALSE Wabash Memorial Hospital Association 85256 NOCD ALL Y WABASH MEM HOSPIT Y FALSE Washington County Health and Human Services WCHHS NOCD ALL Y WASH COUNTY HHS N FALSE Washington State Labor and Industry WALAI NOCD WA N WA LABOR AND INDU Y TRUE Washington State Premera Blue Cross WABLC NOCD WA Y WA PREMERA BC Y FALSE Waterstone Benefit Administrators 73155 NOCD OK Y WATERSTONE BEN AD Y FALSE Watts Healthcare Corp IPA MPM09 NOCD CA N WATTS HC CORP IPA N FALSE WEA Insurance Group 39151 NOCD ALL Y WEA INSURANCE GRO Y FALSE Weiss Health Providers 36337 NOCD ALL N WEISS HLTH PROVID N FALSE Wellcare Health Plan, Inc. (Encounters only) 59354 NOCD ALL Y WELLCARE HP ENCOU Y FALSE Wellcare HMO, Inc. 14163 NOCD ALL Y WELLCARE HMO Y FALSE Wellcare of CT 14164 NOCD CT Y WELLCARE CT Y FALSE Wellcare of NY 14164 NOCD NY Y WELLCARE OF NY Y FALSE WellMed (Claims) WELM2 NOCD ALL A WELLMED Y FALSE WellMed (Encounters) WELMD NOCD ALL A WELLMED ENC Y FALSE Wells Fargo TPA now known as Healthsmart Benefit Solutions 87815 WellSystems, LLC 35245 Wenatchee Valley Medical Center 91064 West Coast Stationary Engineers Health & Security Trust Fund Grp#F13 91136 West Suburban Health Providers 80942 West Virginia Family Health Plan 45276 Western 39065 Western Care 39065 Western Grower's Assurance Trust 24735 Western Grower's Insurance Company 24735 Western Life Ins. Benefit Plan (FORTIS) 39065 Western Mutual Insurance 37247 Western Oregon Advanced Health DOCSO Western Oregon Advanced Health WOAHM Western Southern Financial Group 31048 Code Set (See Legend) Payer Type BOTH BOTH BOTH BOTH P P G G BOTH N BOTH BOTH G N BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH N N G G G T G N N N N N BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH T G G G G G G G G G G G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G N G G G G G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G N G G N N T N G G G G G G C C NOCD NOCD NOCD ALL ALL ALL Y N N WELLS FARGO TPA WELLSYSTEMS LLC WENATCHEE VLY MED Y N Y FALSE FALSE FALSE BOTH BOTH BOTH G G G NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD NOCD ALL ALL WV All All ALL ALL All ALL ALL OR ALL Y N Y Y Y Y Y Y Y Y Y N WEST COAST GRPF13 W SUBURBAN HLTH P WV FAMILY HEALTH WESTERN WESTERN CARE WEST GROWERS TRUS WEST GROWERS INS WESTERN LIFE INS WESTERN MUTUAL IN WEST OR ADV HLTH WEST OR ADV HLTH W S FINANCIAL GRO N Y N N N Y Y N N N Y N FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G T G G G G G G G G G For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 35 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer WestLake Financial Group, Inc. 90560 NOCD ALL Y WESTLAKE FIN GROU Y FALSE Weyco Inc. 38232 NOCD ALL Y WEYCO Y FALSE Willamette Valley Community Health CCO (Formerly known as Marion Polk Health Plan) MPCHP NOCD ALL Y MARION POLK HP N TRUE William C. Earhart Co, Inc. 93050 NOCD GA Y WILLIAM C EARHART Y FALSE William J Sutton & Co. Ltd. 98010 NOCD ALL N WILLIAM J SUTTON N FALSE Willow Health WHLTH NOCD ALL Y WILLOW HEALTH Y FALSE Wilson-McShane 41095 NOCD ALL N WILSON MCSHANE N FALSE WIN Healthcare (Woman's Integrated Network, Inc.) 13413 NOCD ALL Y WIN HEALTHCARE Y FALSE WinHealth Partners/Wyoming Health Solutions 27327 NOCD ALL A WINHEALTH Y FALSE Wisconsin Auto & Truck Dealers Insurance Corporation 39200 NOCD WI N WI AUTO DEALERS I N FALSE Wisconsin Dept of Corrections VEST1 NOCD WI N WI DEPT OF CORR N FALSE Woodman Accident and Life Co (AICT Plans only) 81949 NOCD ALL N WOODMAN ACCIDENT N FALSE Worksite Benefit Services 20333 NOCD ALL N WORKSITE BENE SVC Y FALSE WPP Eldercare Wisconsin 77080 NOCD ALL N WPP ELDERCARE WIS Y FALSE WPPA-ProviDRs Care Network WP481 NOCD ALL Y WPPA PROVIDRS CAR N FALSE WPS Commercial OOWPS NOCD WI N WPS COMMERCIAL N TRUE Wyoming School Boards Association Insurance Trust WYSCH NOCD WY N WY SCHOOL BOARD A Y FALSE Yale University Health Plan 60646 NOCD ALL N YALE UNIVERSITY H Y FALSE Yam Hill CCO-PHTech YAMHL NOCD ALL Y YAM HILL CCO PHT Y FALSE Yerington Paiute Tribe 51350 NOCD ALL Y YERINGTON PAIUTE N FALSE Zebra Health HC 88858 NOCD ALL Y ZEBRA HEALTH Y FALSE ZoomCare ZOOM1 NOCD ALL Y ZOOMCARE N FALSE For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 Code Set (See Legend) Payer Type BOTH BOTH G G BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH BOTH G G G G G G G G C G G G G G T G G G G G 36 of 36 OptumInsight Medical Payer List (10/10/2016) Payer Name Claim Payer ID Office Number State Reports Entered As Secondary** Enrollment Code Set (See Legend) Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is set up correctly for this payer Legend for Report Types Meaning A ACKNOWLEDGEMENTS ONLY L Y N S R T LATER DATE - ENS HOPES TO PROVIDE REPORTS FROM THE INSURANCE COMPANY IN THE FUTURE YES - REPORTS ARE PROVIDED NO- REPORTS ARE NOT PROVIDED SUMMARY - REPORTS ONLY REJECTION - REPORTS TO BE DETERMINED General Payer Information P C T G N PAR Payers, Direct Connections Contracted Restricted, Direct Connections Transitional, Direct and NonDirect Connections Gateway, NonDirect Connections NonPar Payers, Direct and NonDirect Connections Footnotes ** Secondary claim submission is supported by X12 submitters only BOTH Payer will accept ICD-10 code sets for Dates of Service > 10-01-15 and ICD-9 codes for Dates of Service < 10-01-15 BOTH # Payer has requested that we reject claims using ICD-10 codes for Dates of service < 10-01-15 and claims using ICD-9 codes for Dates of Service > 10-01-15 For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.ingenix/connectivity or contact OptumInsight Customer Service and Support at 1-866-367-9778 Payer Type
