CLAIMS & ERA PAYER LIST February 14, 2020

CLAIMS & ERA PAYER LIST January 5, 2024

LEGEND: I = Institutional, P = Professional, D = Dental COB = Coordination of Benefits

Transaction Column: 837 = Claims, 835 = ERA Available Column: A Check-mark indicates that the transaction type is available. Enrollment Column: A Check-mark indicates that enrollment is required for the transaction type. COB Column: A Check-mark Indicates that the payer accepts secondary claims electronically for the transaction type. Attachments: A Check-mark indicates that the payer accepts medical attachments electronically for the transaction type.

Payer Name

1199 National Benefit Fund 1199 National Benefit Fund 1st Medical Network - Atlanta GA 1st Medical Network - Atlanta GA 1st MN--Atlanta GA 1st MN--Atlanta GA 21st Century Health and Benefits 6 Degrees Health A & I Benefit Plan Administrators A.G.I.A. Inc. A.G.I.A. Inc. AAG Benefit Plan Administrators Inc. AAG-American Administravie Group AAG-American Administravie Group AARP - UnitedHealthcare Insurance Company AARP - UnitedHealthcare Insurance Company AARP Dental Insurance Plan AARP Dental Insurance Plan AARP MedicareComplete through UnitedHealthcare/AARP MedicareComplete AARP MedicareComplete through UnitedHealthcare/AARP MedicareComplete AblePay Health AblePay Health Abrazo Advantage Health Plan

Payer Code

13162 13162 29076 29076 29076 29076 59069 20446 93044 95241 95241 75240 37283 37283 36273 36273 AARP1 AARP1 87726 87726 ABLPY ABLPY 03443

Transaction

837 835 837 835 837 835 837 837 837 837 835 837 837 835 837 835 837 835 837 835 837 835 837

Available Enrollment COB

I PD I PD I PD

Attachments I PD

Notes

Also known as Phoenix Advantage

Experian Health Payer List

Page 1 of 148

Absolute Total Care Absolute Total Care

Payer Name

Accelerated Claims Inc. Accendo Health Access Administrators Access Community Health Network Access IPA Access IPA Access Medical Group Access Medical Group Access Medicare Acclaim IPA Accountable Care Management Group, LLC Accountable Healthcare IPA (AHCIPA) Ace Property & Casualty Ins - MedSup (ERA Only) ACMG ACS Benefit Services Inc. ACS Benefit Services Inc. ACTIN Care Groups Activa Benefit Services LLC Administration Systems Research Corporation Administration Systems Research Corporation Administrative Concepts Inc. Administrative Concepts Inc. Administrative Services Inc. ADVANCED DATA SOLUTIONS Advantage by Bridgeway Health Solutions Advantage by Bridgeway Health Solutions

Advantage by Buckeye Community Health Plan

Experian Health Payer List

Payer Code

68069

68069

99999-0748 62118 AHS01 ACCOM ACC01 ACC01 AMG02 AMG02 19305 IP095 45328 AHIPA IAS21 37118 72467 72467 24585 38254 38265 TLU02 22384 22384 59141 58202 68069

68069

68069

Transaction

837

835

837 835 837 837 837 835 837 835 837 837 837 837 835 837 837 835 837 837 837 835 837 835 837 837 837

835

837

Available Enrollment COB

I PD I PD I PD

Attachments I PD

Notes

ERA Payer Code 68069; Payer requires EFT enrollment in order for ERA files to be returned. Centene will not produce an ERA file for any paper checks.

ERA Only

Also known as Clifton Health Systems ERA Payer Code TLU02

ERA Payer Code 68069; Payer requires EFT enrollment in order for ERA files to be returned. Centene will not produce an ERA file for any paper checks.

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Payer Name Advantage by Buckeye Community Health Plan

Advantage by Managed Health Services Advantage by Managed Health Services

Advantage by Peach State Advantage by Peach State

Advantage by Sunshine State Advantage by Sunshine State

Advantage by Superior HealthPlan Advantage by Superior HealthPlan

Advantage Care IPA Advantek Benefit Administrators Advantek Benefit Administrators ADVANTICA BENEFITS ADVANTICA BENEFITS Advanzeon Solutions Adventist Hanford Adventist Health Care Network Adventist Health Plan (AHP) Adventist Health System West - Roseville CA Adventist Health System West - Roseville CA Adventist White Memorial - Crown City Medical Group Adventist White Memorial - Southland Gabriel Valley Advisory Health Administrators Advocate Medical Group - AMG (Legacy AHC) Advocate Medical Group - AMG (Legacy AHC)

Experian Health Payer List

Payer Code

68069

68069

68069

68069

68069

68069

68069

68069

68069

ACIPA 83077 83077 59374 59374 59314 MPM36 MPM51 MPM37 95340 95340 MPM33 MPM34 CB159 36320 36320

Transaction

835

837

835

837

835

837

835

837

835

837 837 835 837 835 837 837 837 837 837 835 837 837 837 837 835

Available I PD

Enrollment COB I PD I PD

Attachments I PD

Notes

ERA Payer Code 68069; Payer requires EFT enrollment in order for ERA files to be returned. Centene will not produce an ERA file for any paper checks.

ERA Payer Code 68069; Payer requires EFT enrollment in order for ERA files to be returned. Centene will not produce an ERA file for any paper checks.

ERA Payer Code 68069; Payer requires EFT enrollment in order for ERA files to be returned. Centene will not produce an ERA file for any paper checks.

ERA Payer Code 68069; Payer requires EFT enrollment in order for ERA files to be returned. Centene will not produce an ERA file for any paper checks.

ERA Payer Code 68069; Payer requires EFT enrollment in order for ERA files to be returned. Centene will not produce an ERA file for any paper checks.

Page 3 of 148

Payer Name

Advocate Physician Partners Advocate Physician Partners Aegis Administrative Services Aetna Aetna Aetna (Professional Encounter Claims - Not BULK) Aetna Affordable Health Choices (SM) - SRC Aetna Affordable Health Choices (SM) - SRC Aetna Better Health of California Aetna Better Health of California Aetna Better Health of Florida Aetna Better Health of Florida Aetna Better Health of Illinois Aetna Better Health of Illinois Aetna Better Health of Kansas Aetna Better Health of Kansas Aetna Better Health of Kentucky Aetna Better Health of Kentucky Aetna Better Health of Louisiana Aetna Better Health of Louisiana Aetna Better Health of Maryland Aetna Better Health of Maryland Aetna Better Health of Michigan Aetna Better Health of Michigan Aetna Better Health of Nebraska (for claims with DOS prior to 1/1/17) Aetna Better Health of Nebraska (for claims with DOS prior to 1/1/17) Aetna Better Health of New Jersey Aetna Better Health of New Jersey Aetna Better Health of New York Aetna Better Health of New York Aetna Better Health of Ohio Aetna Better Health of Ohio Aetna Better Health of Pennsylvania Aetna Better Health of Pennsylvania Aetna Better Health of Texas (Medicaid & CHIP)

Experian Health Payer List

Payer Code

65093 65093 CB637 60054 60054 60054 60054 60054 128CA 128CA 128FL 128FL 68024 68024 128KS 128KS 128KY 128KY 128LA 128LA 128MD 128MD 128MI 128MI 25133 42130 46320 46320 34734 34734 50023 50023 23228 23228 38692

Transaction

837 835 837 837 835 837 837 835 837 835 837 835 837 835 837 835 837 835 837 835 837 835 837 835 835 837 837 835 837 835 837 835 837 835 837

Available Enrollment COB

I PD I PD I PD

Attachments I PD

Notes

ERA Payer Code 25133

Formerly IlliniCare

ERA Payer Code 25133

Page 4 of 148

Payer Name

Aetna Better Health of Texas (Medicaid & CHIP) Aetna Better Health of Virginia Aetna Better Health of Virginia Aetna Better Health of West Virginia Aetna Better Health of West Virginia Aetna Better Health Premier Plan (JVHL) Aetna Better Health Premier Plan (JVHL) Aetna Better Health Premier Plan MMAI Aetna Better Health Premier Plan MMAI Aetna Medicare Aetna Medicare Aetna OhioRISE

Aetna OhioRISE

Aetna Senior Supplement/American Continental Aetna U.S. Healthcare (JVHL) Aetna U.S. Healthcare (JVHL) Affiliated Doctor's of Orange County Affiliated Partners IPA Affiliated Physicians IPA Affinity by Molina Healthcare Affinity by Molina Healthcare

Affinity Health Plan Affinity Health Plan AFFINITY MEDICAL GROUP AFLAC (ERA Only) Aflac Benefits Solutions, Inc AFTRA Health Fund (claims with DOS on or after 1/1/2015) AFTRA Health Fund (claims with DOS on or after 1/1/2015) A-G Administrators LLC AGA Agate Resources Inc. (LIPA) Agency Services Inc AgeRight Advantage

Experian Health Payer List

Payer Code

38692 128VA 128VA 128WV 128WV M5JVH M5JVH 26337 26337 60054 60054

45221

SKOH0

62118 J1JVH J1JVH ADOCS POP09 POP06 16146

16146

13334 13334 46594 52080 ABS01 62308 62308 11370 37280 20048 64158 ARA01

Transaction

835 837 835 837 835 837 835 837 835 837 835

837

835

835 837 835 837 837 837 837

835

837 835 837 835 837 837 835 837 837 837 837 837

Available Enrollment COB

I PD I PD I PD

Attachments I PD

Notes

Provider must be an approved JVHL lab

Use for Medicaid claims with a DOS of 2/1/2023 or after Effective 2/1/2023, remittance returned under Ohio Medicaid

Provider must be an approved JVHL lab

Formerly known as TotalCare NY As of 8/29/22, Molina has designated ECHO Health as their ERA gateway to better meet provider's payment solutions needs For claims with DOS prior to 11/01/21

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