APPENDIX 2 CARRIER CODES

South Carolina Healthy Connections (Medicaid)

03/01/19

APPENDIX 2 CARRIER CODES

CARRIER CODES: ARRANGED ALPHABETICALLY

Effective 01/01/19

CARR

TPL NAME

ADDRESS LINE

CITY

ST

ZIP

PHONE NUM CARRIER COMMENT

754

1199 SEIU NATIONAL BENEFIT FUND

PO BOX 1007

NEW YORK

NY

101081007

462

1ST MEDICAL NETWORK

PO BOX 724317

ATLANTA

GA

31139

8889806676 CODE ASSIGNED BY SCHA

710

21ST CENTURY HEALTH AND BENEFITS, INC.

PO BOX 5037

CHERRY HILL

NJ

08034

8003234890

F27

3PADMINISTRATORS

PO BOX 247

ONALASKA

WI

54650

6087793000 DENTAL ONLY

B14

A.C.S. CONSULTING SERVICES, INC.

PO BOX 2000

WINSTON-SALEM

NC

271022000

CO5

700

X1T

C53

X2C

X21

X20

X2D

C67

X25

C69

X2E

X2Q

A60

X1Z

X2N

C23

X2I

X2R

102

X0G

6464739200

3367592013

Appendix 2-1

South Carolina Healthy Connections (Medicaid)

03/01/19

APPENDIX 2 CARRIER CODES

CARRIER CODES: ARRANGED ALPHABETICALLY

CARR

TPL NAME

B14DN A.C.S. CONSULTING SERVICES, INC.

ADDRESS LINE

CITY

ST

ZIP

PO BOX 2000

WINSTON-SALEM

NC

271022000

PHONE NUM CARRIER COMMENT

3367592013 DENTAL ONLY

650

ABBEVILLE COUNTY

543

ACHA/CAREINGTON INTERNATIONAL CORP

PO BOX 2568

FRISCO

TX

75034

8002900523 CODE ASSIGNED BY SCHA

266

ACMG ADMINISTRATORS OF SOUTH CAROLINA

2570 TECHNICAL DR.

MIAMISBURG

OH

45342

8002326242

786

ACS BENEFIT SERVICES, INC.

PO BOX 2000

WINSTON-SALEM

NC

271022000

C49

ACS CONSULTING SERVICES, INC.

PO BOX 2000

WINSTON-SALEM

NC

27102

8008495370 THIS CODE NOT REQUESTED BY

MEDICAID. ASSIGNED BY SCHA

8008495370 WAS PENN WESTERN

355

ACTIVA HEALTH GROUP

PHOENIX

AZ

85018

6024689500

341

ADMINISTRATIV E CONCEPTS, INC.

WAYNE

PA

19087

8882939229

563

ADMINISTRATIV E SERVICE CONSULTANTS

4350 E. CAMELBACK RD. #

200

994 OLD EAGLE SCHOOL

RD., STE. 1005

3301 E ROYALTON RD.

BLDG. D

BROADVIEW HEIGHTS

OH

44147

346

ADMINISTRATIV E SERVICES, INC.

2187 NORTHLAKE

PARKWAY STE. 106 BLDG

#9

TUCKER

GA

30084

7709343953

829

ADMINISTRATIV E SOLUTIONS

PO BOX 2490

ALPHARETTA

GA

30023

6783390211

731

ADOVA HEALTH

PO BOX 725549

ATLANTA

GA

31139

8664704959 CODE NOT REQUESTED BY

MEDICAID. ASSIGNED BY SCHA

C15

ADVANCE PCS

PO BOX 52188

PHOENIX

AZ

850722196

D11

ADVANCED BENEFIT SOLUTIONS

PO BOX 71490

PHOENIX

AZ

85050

8884191094 CODE NOT REQUESTED BY

MEDICAID ASSIGNED BY SCHA

MEDICARE SUPPLEMENTAL

PLAN

310

ADVANCED DATA SOLUTIONS

PO BOX 723097

ATLANTA

GA

31139

8007425246

C72

ADVANCED INSURANCE ADMINISTRATION

125 MERRILL DR., STE. 2000 LITTLE ROCK

AR

72211

8882424800 THIS CODE NOT REQUESTED BY

MEDICAID. ASSIGNED BY SCHA

D33

ADVANTRA FREEDOM

PO BOX 7154

LONDON

KY

407427154

C88

ADVENTIST RISK MANAGEMENT

PO BOX 1928

GRAPEVINE

TX

76099

8006380589

899

AETNA HEALTH PLANS OF THE CAROLINAS, INC.

3 CENTERVIEW DR.

GREENSBORO

NC

27407

8004591466 HMO PLAN ONLY

A55

AETNA LIFE AND CASUALTY

PO BOX 36890

LOUISVILLE

KY

40232

8004233289 THIS CODE NOT REQUESTED BY

MEDICAID. ASSIGNED BY SCHA

D16

AETNA MEDICARE OPEN PLAN

PO BOX 14079

LEXINGTON

KY

405124079

4803914600 SEE CARRIER 471

8007135095 MEDICARE ADVANTAGE PLAN

8006240756 MEDICARE ADVANTAGE PLAN

Appendix 2-2

South Carolina Healthy Connections (Medicaid)

03/01/19

APPENDIX 2 CARRIER CODES

CARRIER CODES: ARRANGED ALPHABETICALLY

CARR

TPL NAME

ADDRESS LINE

CITY

ST

ZIP

PHONE NUM CARRIER COMMENT

100RX

AETNA PHARMACY

PO BOX 52444

PHOENIX

AZ

850722444

8002386279

100

AETNA US HEALTHCARE

PO BOX 14079

LEXINGTON

KY

40512

8003334432

100DN

AETNA US HEALTHCARE

PO BOX 14094

LEXINGTON

KY

40512

8004517715

B43

AFFINITY HEALTH PLAN

PO BOX 981726

EL PASO

TX

799981726

8662475678

776

1 S. LIMESTONE ST., STE.

301

1932 WYNNTON RD.

SPRINGFIELD

OH

45502

595

AFID (ASSO. OF FRANCHISE AND INDEPENDENT

DIST.)

AFLAC -AMERICAN FAMILY LIFE ASSO CO

COLUMBUS

GA

31999

289

AFTRA HEALTH FUND

261 MADISON AVE.

NEW YORK

NY

10016

E55

AG ADMINISTRATORS

PO BOX 979

VALLEY FORGE

PA

19482

651

AIKEN COUNTY

455

ALASKA TEAMSTER TRUST

520 E 34TH AVE., STE. 107

ANCHORAGE

AK

995034116

8004784450 CODE ASSIGNED BY SCHA

344

ALIA CLAIMS DEPARTMENT

PO BOX 9060

PHOENIX

AZ

850689060

8008825707 CODE NOT REQUESTED BY

MEDICAID. SCHA ASSIGNED

299

ALICARE

PO BOX 1447

NEW YORK

NY

10116

2125395115

200

ALL AMERICAN LIFE INSURANCE CO.

8501 WEST HIGGINS RD.

CHICAGO

IL

60631

7733996645

199

ALL OTHER CARRIERS

F54

ALLEGIANCE

PO BOX 3018

MISSOULA

MT

59806

8559992271 ADDED BY SC REVENUE AND

FISCAL AFFAIRS

E54

ALLEGIANCE BENEFIT PLAN MANAGEMENT

PO BOX 3018

MISSOULA

MT

598063018

8008771122

560

ALLEN MEDICAL CLAIMS ADMINISTRATORS

PO BOX 978

FT. VALLEY

GA

310300978

8008255406

652

ALLENDALE COUNTY

272

ALLIANCE HEALTH BENEFIT PLAN

PO BOX 6443

ROCKVILLE

MD

20850

8003423289

521

ALLIANCE PPO, INC.

PO BOX 934

FREDERICK

MD

21705

8002350123 CODE NOT REQUESTED BY

MEDICAID. ASSIGNED BY SCHA

A33

ALLIANT HEALTH PLANS, INC.

PO BOX 21109

ROANOKE

VA

24108

8002834927

413

ALLIED BENEFITS SYSTEM

PO BOX 909786-60690

CHICAGO

IL

606909786

8002882078

135

ALLIED NATIONAL, INC.

PO BOX 419233

KANSAS CITY

MO

641416233

8008257531 CARRIER WAS ALLIED GROUP

INSURANCE TRUST

115

ALLSTATE INSURANCE

PO BOX 7068

COLUMBIA

SC

29202

8667669016 CODE IN OPEN STATUS BY

SCHA

8009923522

8005624690 CODE NOT REQUESTED BY

MEDICAID. ASSIGNED BY SCHA

8006348628

8003668997 THIS CODE NOT REQUESTED BY

MEDICAID. ASSIGNED BY SCHA

Appendix 2-3

South Carolina Healthy Connections (Medicaid)

03/01/19

APPENDIX 2 CARRIER CODES

CARRIER CODES: ARRANGED ALPHABETICALLY

CARR

TPL NAME

ADDRESS LINE

CITY

ST

ZIP

PHONE NUM CARRIER COMMENT

193

ALLSTATE WORKPLACE DIVISION

PO BOX 853916

RICHARDSON

TX

750853916

8009377039

581

ALTA RX

PO BOX 30081

SALT LAKE CITY

UT

84130

8009985033

A02

ALTERNATIVE BENEFITS PLANS, INC.

2920 BRANDYWINE RD.,

STE. 106

ATLANTA

GA

30341

8002417319

E44

ALTERNATIVE INSURANCE RESOURCE, INC.

PO BOX 680787

BIRMINGHAM

AL

352660787

8004514318

B96

ALTERNATIVE RISK MANAGEMENTS (ARM LTD)

814 N.W. HIGHWAY

ARLINGTON HEIGHTS

IL

60004

8003921770

234

ALWAYSCARE BENEFITS, INC.

PO BOX 80139

BATON ROUGE

LA

70898

8887295433 DENTAL PLAN

161

AMA INSURANCE AGENCY, INC.

PO BOX 804238

CHICAGO

IL

60680

8004585736 CODE NOT REQUESTED BY

MEDICAID. SCHA ASSIGNED

297

AMALGAMATED LIFE INSURANCE

PO BOX 1451

NEW YORK

NY

101161451

2124735700

F57

AMBETTER PEACH STATE HEALTH PLAN

PO BOX 5010

FARMINGTON

MD

636405010

8776871180 ADDED BY SC REVENUE AND

FISCAL AFFAIRS

C07

AMERIBEN SOLUTIONS

PO BOX 7186

BOISE

ID

83707

309

AMERICAN ADMINISTRATIVE GROUP

PO BOX 5227

LISLE

IL

605325227

6304939252 CODE NOT REQUESTED BY

MEDICAID. ASSIGNED BY SCHA

910

AMERICAN ADMINISTRATIVE GROUP

PO BOX 5227

LISLE

IL

605325227

8003545112 WAS GALLAGER & BASSETT

SERVICES

469

AMERICAN ASSOCIATION OF RETIRED PERSONS

(AARP)

PO BOX 740819

ATLANTA

GA

30374

8005235880

B61

AMERICAN BEHAVIORAL

3680 GRANDVIEW

PARKWAY STE. 100

BIRMINGHAM

AL

35243

8009258327

968

AMERICAN BENEFIT ADMINISTRATIVE SERVICES

PO BOX 0928

BROOKFIELD

WI

53008

6304161111

271

AMERICAN BENEFIT PLAN ADMINISTRATOR

22OO-B ROSSELLE ST.

JACKSONVILLE

FL

32204

8004685126

488

AMERICAN BENEFITS MANAGEMENT

8310 PORT JACKSON AVE.

NORTHWEST

NORTH CANTON

OH

44720

3309665500

B44

AMERICAN CHOICE HEALTH PLAN, LLC

PO BOX 922043

HOUSTON

TX

77292

8006334226

B44DN AMERICAN CHOICE HEALTH PLAN, LLC

PO BOX 922009

HOUSTON

TX

77292

8005989799

A93

AMERICAN COLLEGE OF SURGEONS

PO BOX 2522

FORT WORTH

TX

761132522

778

AMERICAN CONTINENTAL INSURANCE CO

PO BOX 14770

LEXINGTON

KY

40512

8004331672 THIS CODE NOT REQUESTED BY

MEDICAID. ASSIGNED BY SCHA

8002644000

D48

AMERICAN CONTINENTAL INSURANCE CO

PO BOX 2368

BRENTWOOD

TN

37024

6153371300 MEDICARE ADVANTAGE PLAN

8007867930

Appendix 2-4

South Carolina Healthy Connections (Medicaid)

03/01/19

APPENDIX 2 CARRIER CODES

CARRIER CODES: ARRANGED ALPHABETICALLY

CARR

TPL NAME

ADDRESS LINE

CITY

ST

ZIP

PHONE NUM CARRIER COMMENT

106

AMERICAN FIDELITY ASSURANCE BENEFITS

PO BOX 25160

OKLAHOMA CITY

OK

731250160

8006548489

150

AMERICAN GENERAL LIFE AND ACCIDENT INS CO

PO BOX 1500

NASHVILLE

TN

372021500

8008882452

951

AMERICAN GROUP ADMINISTRATORS

101 CONVENTION CENTER

DR., STE. 200

LAS VEGAS

NE

89109

8008424742

A57

AMERICAN GROUP ADMINISTRATORS, INC.

101 CONVENTION CENTER

DR., STE. 200

LAS VEGAS

NV

89109

8008424742 CODE ASSIGNED BY SCHA

118

AMERICAN HEALTH & LIFE INSURANCE

300 ST. PAUL PLACE

BALTIMORE

MD

21202

3013323000

C92

AMERICAN HEALTH CARE

3850 ATHERTON RD.

ROCKLIN

CA

95765

8008728276

C92DN AMERICAN HEALTH CARE

3001 DOUGLAS ST.

ROSEVILLE

CA

95661

8008728276

919

AMERICAN HEALTH GROUP, INC.

PO BOX 1500

MAUMEE

OH

43537

8008728276

383

AMERICAN HEALTHCARE ALLIANCE

PO BOX 8530

KANSAS CITY

MO

641140530

8772840102

119

AMERICAN HERITAGE LIFE INSURANCE

1776 AMERICAN HERITAGE

LIFE DR.

JACKSONVILLE

FL

32224

8005358086

840

AMERICAN, INCOME LIFE INSURANCE COMPANY

PO BOX 2608

WACO

TX

76797

8177723050

B69

AMERICAN INSURANCE ADMINISTRATORS

PO BOX 2348

COLUMBUS

OH

432162348

8009221245 THIS CODE NOT REQUESTED BY

MEDICAID. ASSIGNED BY SCHA.

D38

AMERICAN INSURANCE ADMINISTRATORS

PO BOX 2348

COLUMBUS

OH

43216

8009221245 CODE NOT REQUESTED BY

MEDICAID. ASSIGNED BY SCHA

369

AMERICAN INTERNATIONAL GROUP

PO BOX 25050

WILMINGTON

DE

19899

8004687077

167

AMERICAN INTERNATIONAL GROUP (AIG) ACCIDENT

PO BOX 26050

OVERLAND PARK

KS

66225

8887221668

A62

AMERICAN MEDICAL AND LIFE INSURANCE (AMLI)

PO BOX 1353

CHICAGO

IL

60690

8882641512

532

AMERICAN MEDICAL SECURITY

PO BOX 19032

GREEN BAY

WI

543079032

8002325432

120

AMERICAN NATIONAL INSURANCE COMPANY

PO BOX 1790

GALVESTON

TX

77553

8008996803

B98

AMERICAN PIONEER LIFE INSURANCE COMPANY

PO BOX 130

PENSACOLA

FL

32591

8005381053

321

AMERICAN POSTAL WORKERS UNION HEALTH PLAN PO BOX 188004

CHATTANOOGA

TN

37422

8002222798

321DN

AMERICAN POSTAL WORKERS UNION HEALTH PLAN PO BOX 1358

GLEN BURNIE

MD

21060

8002222798

164

AMERICAN PROGRESSIVE INSURANCE

PO BOX 130

PENSACOLA

FL

325910130

8006268913

A05

AMERICAN PUBLIC LIFE INSURANCE CO.

PO BOX 925

JACKSON

MS

39205

8002568606

722

AMERICAN REPUBLIC INSURANCE COMPANY

PO BOX 21670

EAGAN

MN

55121

8002472190

C70

AMERICAN RETIREMENT LIFE

PO BOX 30010

AUSTIN

TX

757553010

8664591755 REQUESTED BY THE SCHA

Appendix 2-5

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download