APPENDIX 2 CARRIER CODES
South Carolina Healthy Connections (Medicaid)
APPENDIX 2 CARRIER CODES CARRIER CODES: ARRANGED ALPHABETICALLY
03/01/19
Effective 01/01/19
CARR TPL NAME CO5 700 X1T
C53 X2C X21 X20 X2D C67 X25 C69 X2E X2Q A60 X1Z X2N C23 X2I X2R 102 X0G 754 1199 SEIU NATIONAL BENEFIT FUND 462 1ST MEDICAL NETWORK 710 21ST CENTURY HEALTH AND BENEFITS, INC. F27 3PADMINISTRATORS B14 A.C.S. CONSULTING SERVICES, INC.
ADDRESS LINE
PO BOX 1007 PO BOX 724317 PO BOX 5037 PO BOX 247 PO BOX 2000
CITY
ST
ZIP PHONE NUM CARRIER COMMENT
NEW YORK ATLANTA CHERRY HILL ONALASKA WINSTON-SALEM
NY 101081007 6464739200 GA 31139 8889806676 CODE ASSIGNED BY SCHA NJ 08034 8003234890 WI 54650 6087793000 DENTAL ONLY NC 271022000 3367592013
Appendix 2-1
South Carolina Healthy Connections (Medicaid)
APPENDIX 2 CARRIER CODES CARRIER CODES: ARRANGED ALPHABETICALLY
03/01/19
CARR TPL NAME B14DN A.C.S. CONSULTING SERVICES, INC. 650 ABBEVILLE COUNTY 543 ACHA/CAREINGTON INTERNATIONAL CORP 266 ACMG ADMINISTRATORS OF SOUTH CAROLINA 786 ACS BENEFIT SERVICES, INC.
C49 ACS CONSULTING SERVICES, INC. 355 ACTIVA HEALTH GROUP
341 ADMINISTRATIV E CONCEPTS, INC.
563 ADMINISTRATIV E SERVICE CONSULTANTS
346 ADMINISTRATIV E SERVICES, INC.
829 ADMINISTRATIV E SOLUTIONS 731 ADOVA HEALTH
C15 ADVANCE PCS D11 ADVANCED BENEFIT SOLUTIONS
ADDRESS LINE PO BOX 2000
CITY WINSTON-SALEM
PO BOX 2568 2570 TECHNICAL DR. PO BOX 2000
FRISCO MIAMISBURG WINSTON-SALEM
PO BOX 2000
4350 E. CAMELBACK RD. # 200 994 OLD EAGLE SCHOOL RD., STE. 1005 3301 E ROYALTON RD. BLDG. D
2187 NORTHLAKE PARKWAY STE. 106 BLDG #9
PO BOX 2490
PO BOX 725549
WINSTON-SALEM PHOENIX WAYNE BROADVIEW HEIGHTS TUCKER
ALPHARETTA ATLANTA
PO BOX 52188 PO BOX 71490
PHOENIX PHOENIX
310 ADVANCED DATA SOLUTIONS C72 ADVANCED INSURANCE ADMINISTRATION
D33 ADVANTRA FREEDOM C88 ADVENTIST RISK MANAGEMENT 899 AETNA HEALTH PLANS OF THE CAROLINAS, INC. A55 AETNA LIFE AND CASUALTY
D16 AETNA MEDICARE OPEN PLAN
PO BOX 723097
ATLANTA
125 MERRILL DR., STE. 2000 LITTLE ROCK
PO BOX 7154 PO BOX 1928 3 CENTERVIEW DR. PO BOX 36890
LONDON GRAPEVINE GREENSBORO LOUISVILLE
PO BOX 14079
LEXINGTON
ST
ZIP PHONE NUM CARRIER COMMENT
NC 271022000 3367592013 DENTAL ONLY
TX 75034 8002900523 CODE ASSIGNED BY SCHA OH 45342 8002326242 NC 271022000 8008495370 THIS CODE NOT REQUESTED BY
MEDICAID. ASSIGNED BY SCHA NC 27102 8008495370 WAS PENN WESTERN AZ 85018 6024689500
PA 19087 8882939229
OH 44147
GA 30084 7709343953
GA 30023 6783390211
GA 31139 8664704959 CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA
AZ 850722196 4803914600 SEE CARRIER 471
AZ 85050 8884191094 CODE NOT REQUESTED BY MEDICAID ASSIGNED BY SCHA MEDICARE SUPPLEMENTAL PLAN
GA 31139 8007425246
AR 72211 8882424800 THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA
KY 407427154 8007135095 MEDICARE ADVANTAGE PLAN
TX 76099 8006380589
NC 27407 8004591466 HMO PLAN ONLY
KY 40232 8004233289 THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA
KY 405124079 8006240756 MEDICARE ADVANTAGE PLAN
Appendix 2-2
South Carolina Healthy Connections (Medicaid)
APPENDIX 2 CARRIER CODES CARRIER CODES: ARRANGED ALPHABETICALLY
03/01/19
CARR TPL NAME 100RX AETNA PHARMACY 100 AETNA US HEALTHCARE 100DN AETNA US HEALTHCARE B43 AFFINITY HEALTH PLAN 776 AFID (ASSO. OF FRANCHISE AND INDEPENDENT
DIST.) 595 AFLAC -AMERICAN FAMILY LIFE ASSO CO 289 AFTRA HEALTH FUND
E55 AG ADMINISTRATORS 651 AIKEN COUNTY 455 ALASKA TEAMSTER TRUST 344 ALIA CLAIMS DEPARTMENT
299 ALICARE 200 ALL AMERICAN LIFE INSURANCE CO. 199 ALL OTHER CARRIERS F54 ALLEGIANCE
E54 ALLEGIANCE BENEFIT PLAN MANAGEMENT 560 ALLEN MEDICAL CLAIMS ADMINISTRATORS 652 ALLENDALE COUNTY 272 ALLIANCE HEALTH BENEFIT PLAN 521 ALLIANCE PPO, INC.
A33 ALLIANT HEALTH PLANS, INC. 413 ALLIED BENEFITS SYSTEM 135 ALLIED NATIONAL, INC.
115 ALLSTATE INSURANCE
ADDRESS LINE
PO BOX 52444 PO BOX 14079 PO BOX 14094 PO BOX 981726 1 S. LIMESTONE ST., STE. 301 1932 WYNNTON RD. 261 MADISON AVE.
CITY PHOENIX LEXINGTON LEXINGTON EL PASO SPRINGFIELD
COLUMBUS NEW YORK
PO BOX 979
VALLEY FORGE
520 E 34TH AVE., STE. 107 ANCHORAGE
PO BOX 9060
PHOENIX
PO BOX 1447 8501 WEST HIGGINS RD.
NEW YORK CHICAGO
PO BOX 3018
PO BOX 3018 PO BOX 978
MISSOULA
MISSOULA FT. VALLEY
PO BOX 6443 PO BOX 934
PO BOX 21109 PO BOX 909786-60690 PO BOX 419233
PO BOX 7068
ROCKVILLE FREDERICK
ROANOKE CHICAGO KANSAS CITY
COLUMBIA
ST
ZIP PHONE NUM CARRIER COMMENT
AZ 850722444 8002386279
KY 40512 8003334432
KY 40512 8004517715
TX 799981726 8662475678 OH 45502 8667669016 CODE IN OPEN STATUS BY
SCHA GA 31999 8009923522
NY 10016 8005624690 CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA
PA 19482 8006348628
AK 995034116 8004784450 CODE ASSIGNED BY SCHA
AZ 850689060 8008825707 CODE NOT REQUESTED BY MEDICAID. SCHA ASSIGNED
NY 10116 2125395115
IL
60631 7733996645
MT 59806 8559992271 ADDED BY SC REVENUE AND FISCAL AFFAIRS
MT 598063018 8008771122
GA 310300978 8008255406
MD 20850 8003423289
MD 21705 8002350123 CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA
VA 24108 8002834927
IL 606909786 8002882078
MO 641416233 8008257531 CARRIER WAS ALLIED GROUP INSURANCE TRUST
SC 29202 8003668997 THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA
Appendix 2-3
South Carolina Healthy Connections (Medicaid)
APPENDIX 2 CARRIER CODES CARRIER CODES: ARRANGED ALPHABETICALLY
03/01/19
CARR TPL NAME 193 ALLSTATE WORKPLACE DIVISION
581 ALTA RX A02 ALTERNATIVE BENEFITS PLANS, INC.
E44 ALTERNATIVE INSURANCE RESOURCE, INC. B96 ALTERNATIVE RISK MANAGEMENTS (ARM LTD) 234 ALWAYSCAREBENEFITS, INC. 161 AMA INSURANCE AGENCY, INC.
297 AMALGAMATED LIFE INSURANCE F57 AMBETTER PEACH STATE HEALTH PLAN
C07 AMERIBEN SOLUTIONS 309 AMERICAN ADMINISTRATIVE GROUP
910 AMERICAN ADMINISTRATIVE GROUP
469 AMERICAN ASSOCIATION OF RETIRED PERSONS (AARP)
B61 AMERICAN BEHAVIORAL
968 AMERICAN BENEFIT ADMINISTRATIVE SERVICES 271 AMERICAN BENEFIT PLAN ADMINISTRATOR 488 AMERICAN BENEFITS MANAGEMENT
B44 AMERICAN CHOICE HEALTH PLAN, LLC B44DN AMERICAN CHOICE HEALTH PLAN, LLC A93 AMERICAN COLLEGE OF SURGEONS
778 AMERICAN CONTINENTAL INSURANCE CO D48 AMERICAN CONTINENTAL INSURANCE CO
ADDRESS LINE PO BOX 853916
CITY RICHARDSON
PO BOX 30081 2920 BRANDYWINE RD., STE. 106 PO BOX 680787 814 N.W. HIGHWAY PO BOX 80139 PO BOX 804238
SALT LAKE CITY ATLANTA
BIRMINGHAM ARLINGTON HEIGHTS BATON ROUGE CHICAGO
PO BOX 1451 PO BOX 5010
NEW YORK FARMINGTON
PO BOX 7186 PO BOX 5227
BOISE LISLE
PO BOX 5227
LISLE
PO BOX 740819
ATLANTA
3680 GRANDVIEW PARKWAY STE. 100
PO BOX 0928
BIRMINGHAM BROOKFIELD
22OO-B ROSSELLE ST.
JACKSONVILLE
8310 PORT JACKSON AVE. NORTH CANTON NORTHWEST
PO BOX 922043
HOUSTON
PO BOX 922009
HOUSTON
PO BOX 2522
FORT WORTH
PO BOX 14770 PO BOX 2368
LEXINGTON BRENTWOOD
ST
ZIP PHONE NUM CARRIER COMMENT
TX 750853916 8009377039
UT 84130 8009985033 GA 30341 8002417319
AL 352660787 8004514318
IL
60004 8003921770
LA 70898 8887295433 DENTAL PLAN
IL
60680 8004585736 CODE NOT REQUESTED BY
MEDICAID. SCHA ASSIGNED
NY 101161451 2124735700
MD 636405010 8776871180 ADDED BY SC REVENUE AND FISCAL AFFAIRS
ID 83707 8007867930
IL 605325227 6304939252 CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA
IL 605325227 8003545112 WAS GALLAGER & BASSETT SERVICES
GA 30374 8005235880
AL 35243 8009258327
WI 53008 6304161111 FL 32204 8004685126 OH 44720 3309665500
TX 77292 8006334226 TX 77292 8005989799
TX 761132522 8004331672 THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA
KY 40512 8002644000
TN 37024 6153371300 MEDICARE ADVANTAGE PLAN
Appendix 2-4
South Carolina Healthy Connections (Medicaid)
APPENDIX 2 CARRIER CODES CARRIER CODES: ARRANGED ALPHABETICALLY
03/01/19
CARR TPL NAME 106 AMERICAN FIDELITY ASSURANCE BENEFITS 150 AMERICAN GENERAL LIFE AND ACCIDENT INS CO 951 AMERICAN GROUP ADMINISTRATORS
A57 AMERICAN GROUP ADMINISTRATORS, INC.
118 AMERICAN HEALTH & LIFE INSURANCE C92 AMERICAN HEALTH CARE C92DN AMERICAN HEALTH CARE 919 AMERICAN HEALTH GROUP, INC. 383 AMERICAN HEALTHCARE ALLIANCE 119 AMERICAN HERITAGE LIFE INSURANCE
840 AMERICAN, INCOME LIFE INSURANCE COMPANY B69 AMERICAN INSURANCE ADMINISTRATORS
ADDRESS LINE
CITY
PO BOX 25160
OKLAHOMA CITY
PO BOX 1500
NASHVILLE
101 CONVENTION CENTER DR., STE. 200
101 CONVENTION CENTER DR., STE. 200
300 ST. PAUL PLACE
LAS VEGAS LAS VEGAS BALTIMORE
3850 ATHERTON RD.
ROCKLIN
3001 DOUGLAS ST.
ROSEVILLE
PO BOX 1500
MAUMEE
PO BOX 8530
KANSAS CITY
1776 AMERICAN HERITAGE JACKSONVILLE LIFE DR.
PO BOX 2608
WACO
PO BOX 2348
COLUMBUS
D38 AMERICAN INSURANCE ADMINISTRATORS
PO BOX 2348
COLUMBUS
369 AMERICAN INTERNATIONAL GROUP
PO BOX 25050
167 AMERICAN INTERNATIONAL GROUP (AIG) ACCIDENT PO BOX 26050
A62 AMERICAN MEDICAL AND LIFE INSURANCE (AMLI) PO BOX 1353
532 AMERICAN MEDICAL SECURITY
PO BOX 19032
120 AMERICAN NATIONAL INSURANCE COMPANY
PO BOX 1790
B98 AMERICAN PIONEER LIFE INSURANCE COMPANY
PO BOX 130
321 AMERICAN POSTAL WORKERS UNION HEALTH PLAN PO BOX 188004
321DN AMERICAN POSTAL WORKERS UNION HEALTH PLAN PO BOX 1358
164 AMERICAN PROGRESSIVE INSURANCE
PO BOX 130
A05 AMERICAN PUBLIC LIFE INSURANCE CO.
PO BOX 925
722 AMERICAN REPUBLIC INSURANCE COMPANY
PO BOX 21670
C70 AMERICAN RETIREMENT LIFE
PO BOX 30010
WILMINGTON OVERLAND PARK CHICAGO GREEN BAY GALVESTON PENSACOLA CHATTANOOGA GLEN BURNIE PENSACOLA JACKSON EAGAN AUSTIN
ST
ZIP PHONE NUM CARRIER COMMENT
OK 731250160 8006548489 TN 372021500 8008882452 NE 89109 8008424742
NV 89109 8008424742 CODE ASSIGNED BY SCHA
MD 21202 3013323000 CA 95765 8008728276 CA 95661 8008728276 OH 43537 8008728276 MO 641140530 8772840102 FL 32224 8005358086
TX 76797 8177723050
OH 432162348 8009221245 THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA.
OH 43216 8009221245 CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA
DE 19899 8004687077
KS 66225 8887221668
IL
60690 8882641512
WI 543079032 8002325432
TX 77553 8008996803
FL 32591 8005381053
TN 37422 8002222798
MD 21060 8002222798
FL 325910130 8006268913
MS 39205 8002568606
MN 55121 8002472190
TX 757553010 8664591755 REQUESTED BY THE SCHA
Appendix 2-5
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