CLAIMS & ERA PAYER LIST April 10, 2020

[Pages:130]CLAIMS & ERA PAYER LIST October 15, 2021

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. AAG Benefit Plan Administrators Inc. AAG-American Administravie Group ( Formerly Icon Benefit Admin)

AARP - UnitedHealthcare Insurance Company

Payer Code

13162 13162 29076 29076 29076 29076 59069 20446 93044 95241 75240

75185

Trans action

837 835 837 835 837 835 837 837 837 837 837

837

Available I PD

Enrollment I PD

COB I PD

Attachments I PD

Notes

Effective immediately, please send all claims for Payer 75185 to HealthSmart Benefit Solutions (EDI Payer ID #37283). Claims submitted under payer ID 75185 will be subject to claim rejection effective Q1 2019.

36273

837

AARP - UnitedHealthcare Insurance Company AARP Dental Insurance Plan AARP Dental Insurance Plan

Experian Health Payer List

36273 AARP1 AARP1

835

837

835

Page 1 of 130

Payer Name

AARP MedicareComplete through UnitedHealthcare/AARP MedicareComplete AARP MedicareComplete through UnitedHealthcare/AARP MedicareComplete

AblePay Health

AblePay Health Abrazo Advantage Health Plan Absolute Total Care Absolute Total Care Accelerated Claims Inc.

Access Administrators Access Community Health Network Access IPA Access IPA Access Medical Group Access Medical Group Access Medicare Acclaim Acclaim Acclaim IPA Accountable Care Management Group, LLC Accountable Healthcare IPA (AHCIPA) 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

Experian Health Payer List

Payer Code 87726 87726

Trans action

837

835

Available I PD

Enrollment I PD

COB I PD

Attachments I PD

Notes

ABLPY

837

ABLPY 03443 68069 68069

835 837 837 835

99999-0748 837

AHS01 ACCOM ACC01 ACC01 AMG02 AMG02 19305 64071 64071 IP095 45328 AHIPA 37118 72467 72467 24585 38254 38265 TLU02 22384 22384 59141 58202 68069 68069

837

837

837

835

837

835

837

837

835

837

837

837

837

837

835

837

837

837

835

837

835

837

837

837

835

Also known as Phoenix Advantage ERA Payer Code 68069; ERA requires EFT enrollment

Also known as Clifton Health Systems ERA Payer Code TLU02

ERA Payer Code 68069; ERA requires EFT enrollment

Page 2 of 130

Payer Name

Advantage by Buckeye Community Health Plan

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) Advocate Physician Partners Advocate Physician Partners Aegis Administrative Services Aetna Aetna Aetna (Professional Encounter Claims - Not BULK)

Experian Health Payer List

Payer Code

68069

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 65093 65093 CB637 60054 60054 60054

Trans action

837

835

837

835

837

835

837

835

837

835

837

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

Available I PD

Enrollment I PD

COB

Attachments

I PD I PD

Notes

ERA Payer Code 68069; ERA requires EFT enrollment

ERA Payer Code 68069; ERA requires EFT enrollment

ERA Payer Code 68069; ERA requires EFT enrollment

ERA Payer Code 68069; ERA requires EFT enrollment

ERA Payer Code 68069; ERA requires EFT enrollment

Page 3 of 130

Payer Name

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) 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)

Experian Health Payer List

Payer Code

60054 60054 128CA 128CA 128FL 25133 68024 68024 128KS 128KS 128KY 128KY 128LA 128LA 128MD 128MD 128MI 128MI 42130 25133 46320 46320 34734 34734 50023 50023 23228 23228 38692 38692 128VA 128VA 128WV 128WV M5JVH

Trans action

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

Available I PD

Enrollment I PD

COB

Attachments

I PD I PD

Notes

ERA Payer Code 25133

Formerly IlliniCare

ERA Payer Code 25133

Provider must be an approved JVHL lab

Page 4 of 130

Payer Name

Aetna Better Health Premier Plan (JVHL) Aetna Better Health Premier Plan MMAI Aetna Better Health Premier Plan MMAI Aetna Medicare Aetna Medicare 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 Group Affiliated Physicians IPA Affinity Health Plan Affinity Health Plan AFFINITY MEDICAL GROUP Affordable Benefit Administrators Inc. Affordable Benefit Administrators Inc. AFLAC (ERA Only) 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 AgeRight Advantage Agewell New York Agewell New York AHP Provider Network AHPO (Cleveland OH) Aither Health Aither Health AKM Medical Group Alabama Medicaid Alabama Medicaid

Experian Health Payer List

Payer Code

M5JVH 26337 26337 60054 60054 62118 J1JVH J1JVH ADOCS POP09 APG01 POP06 13334 13334 46594 95426 95426 52080 62308 62308 11370 37280 20048 64158 ARA01 ARA01 AWNY6 AWNY6 MPM38 31138 64884 64884 CAPMN 12K01 SKAL0

Trans action

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

Available I PD

Enrollment I PD

COB

Attachments

I PD I PD

Notes

Provider must be an approved JVHL lab

Page 5 of 130

Alabama Medicaid Alabama Medicaid Alameda Alliance for Health Alameda Alliance for Health

Alamitos IPA

Payer Name

Alamitos IPA Alan Sturm & Associates Dental Alaska Carpenters Trust Alaska Children's Services Inc. Alaska Children's Services Inc. Alaska Electrical Trust Funds Alaska Electrical Trust Funds Alaska Laborers Construction Industry Trust Alaska Medicaid Alaska Medicaid Alaska Medicare Alaska Medicare Alaska Pipe Trades Local 375 Alaska United Food & Commercial Workers Health & Welfare Trust Albuquerque Public Schools Albuquerque Public Schools Alexian Brothers Community Services of TN ALICARE ALICARE Align Senior Care (MI)

Align Senior Care (MI)

Alignment Health Plan Alignment Health Plan Alignment Healthcare Alignment Healthcare All Savers/UHC All Savers/UHC

Experian Health Payer List

Payer Code

12K01 SKAL0 95327

95327

AIPAZ

CAPMN R7003 91136 91136 91136 60054 60054 91136 77200 77200 SMAK0 SMAK0 91136 91136 85600 85600 44423 13550 13550

ASMI1

ASMI1

CCHPC CCHPC AHCA1 AHCA1 81400 81400

Trans action

835 835 837

835

837

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

837

835

837 835 837 835 837 835

Available I PD

Enrollment I PD

COB I PD

Attachments I PD

Notes

Payer returns ERA's automatically once electronic claim submission begins. For DOS Prior to 5/1/2020. Claims with DOS

5/1/20 and after use payer code CAPMN.

Payer returns ERA's automatically once electronic claim submission begins. Payer returns ERA's automatically once electronic claim submission begins.

Page 6 of 130

Payer Name

AllCare Advantage Allcare Health CCO Allcare Health CCO AllCare IPA AllCare IPA Allegiance Benefit Plan Management Inc. Allegiance Benefit Plan Management Inc. Alliance Behavioral Health Alliance Behavioral Health Alliance Coal Health Plan Alliance Coal Health Plan Alliance IPA

Alliance Physicians High Desert Alliance Physicians High Desert

Alliance Physicians Medical Group Alliance Physicians Medical Group Alliant Health Plans of Georgia Alliant Health Plans of Georgia Allianz Global Assistance Allied Benefit Systems Allied Benefit Systems Allied Healthcare

Allied Healthcare

Allied Pacific of California Allied Pacific of California Allied Physicians Medical Group Allied Physicians Medical Group Allina Health Aetna Allina Health Aetna AllWays Health Partners

AllWays Health Partners

Experian Health Payer List

Payer Code

MRCHP MRIPA MRIPA AC101 AC101 81040 81040 23071 23071 93658 93658

HCP01

22417 22417 APP01 APP01 58234 58234 50749 37308 37308 ALLCA

ALLCA NMM01 NMM01 NMM01 NMM01 54398 54398 04293

04293

Trans action

837 837 835 837 835 837 835 837 835 837 835

837

837

835

837 835 837 835 837 837 835

837

835

837 835 837 835 837 835

837

835

Available I PD

Enrollment I PD

COB I PD

Attachments I PD

Notes

Former payer ID 26160

This payer is now part of OptumCare Network. Please submit claims using payer code OCN01. EFT enrollment is required in order to obtain ERA's

Payer Returns ERA Automatically

Payer returns ERA's automatically once electronic claim submission begins. Payer returns ERA's automatically once electronic claim submission begins.

Formerly known as Neighborhood Health Plan Formerly known as Neighborhood Health Plan

Page 7 of 130

Payer Name

Allwell of Arkansas Health & Wellness Allwell of Arkansas Health & Wellness

Alpha Care Medical Group Alpha Care Medical Group Alta Bates Medical Group ALTA Health Strategies AltaMed

AltaMed Altius Health Plans Altius Health Plans Alvarado IPA Always Care Vision AMA Insurance Agency AMA Insurance Agency AMA Insurance Agency AMA Insurance Agency Amalgamated Life Amalgamated Life Amalgamated Life - PA / Alicare Ambay Health Network I & P Ambetter of Illinois Ambetter of Illinois

AMCO AmeriBen Solutions Inc. AmeriBen Solutions Inc. Americaid Community Care (New Jersey) American Administrative Group American Behavioral American Benefit Plan Administrators American Benefit Plan Administrators American Family Insurance American Family Insurance American Family Medicare Sup and PPO Policies Administered by Am Rep

Experian Health Payer List

Payer Code

68069

68069

NMM04 NMM04 A0701 25133

ALTAM

ALTAM 25133 25133 SYMED ATR01 AMAIA TH071 AMAIA TH071 13550 13550 13343 AMBHN 68069

68069

62176 75137 75137 27516 75240 63103 95170 95170 12T31 TH095 56071

Trans action

837

835

837 835 837 837

837

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

835

837 837 835 837 837 837 837 835 837 837 837

Available I PD

Enrollment I PD

COB I PD

Attachments I PD

Notes

ERA Payer Code 68069; ERA requires EFT enrollment Former payer code MPM32.

Effective 3/27/19, the new payer ID is ALTAM

ERA Payer Code 25133

ERA Payer Code 68069; ERA requires EFT enrollment

Page 8 of 130

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