CLAIMS & ERA PAYER LIST September 10, 2021

[Pages:131]CLAIMS & ERA PAYER LIST November 12, 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

Transaction Available I PD

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

Enrollment I PD

COB Attachments I PD I P D

Notes

Effective immediately, please send all claims for Payer 75185 to HealthSmart Benefit Solutions (EDI

36273

837

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

Experian Health Payer List

36273 AARP1 AARP1 87726 87726

ABLPY

835

837

835

837

835

837

Page 1 of 131

Payer Name

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 Advantage by Buckeye Community Health Plan

Advantage by Buckeye Community Health Plan Advantage by Managed Health Services

Experian Health Payer List

Payer Code

ABLPY 03443 68069 68069 99999-0748

Available Transaction

I PD 835 837 837 835

837

Enrollment I PD

COB I PD

Attachments I PD

Notes

Also known as Phoenix Advantage

ERA Payer Code 68069; ERA requires EFT enrollment

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

68069

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

837

835

837

Also known as Clifton Health Systems ERA Payer Code TLU02

ERA Payer Code 68069; ERA requires EFT enrollment ERA Payer Code 68069; ERA requires EFT enrollment

Page 2 of 131

Payer Name

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) Aetna Affordable Health Choices (SM) - SRC Aetna Affordable Health Choices (SM) - SRC Aetna Better Health of California Aetna Better Health of California

Experian Health Payer List

Payer Code 68069 68069

Available Transaction

I PD 835

837

Enrollment I PD

COB I PD

Attachments I PD

Notes

ERA Payer Code 68069; ERA requires EFT

enrollment

68069 68069

835 837

ERA Payer Code 68069; ERA requires EFT enrollment

68069 68069

835 837

ERA Payer Code 68069; ERA requires EFT enrollment

68069 ACIPA

835 837

ERA Payer Code 68069; ERA requires EFT enrollment

83077

837

83077

835

59374

837

59374

835

59314

837

MPM36

837

MPM51

837

MPM37

837

95340

837

95340

835

MPM33

837

MPM34

837

CB159

837

36320

837

36320

835

65093

837

65093

835

CB637

837

60054

837

60054

835

60054

837

60054

837

60054

835

128CA

837

128CA

835

Page 3 of 131

Payer Name

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) Aetna Better Health Premier Plan (JVHL) Aetna Better Health Premier Plan MMAI Aetna Better Health Premier Plan MMAI Aetna Medicare

Experian Health Payer List

Payer Code

128FL 25133 68024 68024 128KS 128KS 128KY 128KY 128LA 128LA 128MD 128MD 128MI 128MI 25133 42130 46320 46320 34734 34734 50023 50023 23228 23228 38692 38692 128VA 128VA 128WV 128WV M5JVH M5JVH 26337 26337 60054

Available Transaction

I PD 837 835 837 835 837 835 837 835 837 835 837 835 837 835 835 837 837 835 837 835 837 835 837 835 837 835 837 835 837 835 837 835 837 835 837

Enrollment I PD

COB I PD

Attachments I PD

Notes

ERA Payer Code 25133

Formerly IlliniCare

ERA Payer Code 25133

Provider must be an approved JVHL lab

Page 4 of 131

Payer Name

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 Alabama Medicaid Alabama Medicaid Alameda Alliance for Health

Experian Health Payer List

Payer Code

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 12K01 SKAL0 SKAL0 95327

Available Transaction

I PD

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

835

837

835

837

Enrollment I PD

COB Attachments I PD I P D

Notes

Provider must be an approved JVHL lab

Page 5 of 131

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 AllCare Advantage Allcare Health CCO Allcare Health CCO

Experian Health Payer List

Payer Code

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 MRCHP MRIPA MRIPA

Available Transaction

I PD

835

837

837

837

837

837

835

837

835

837

837

835

837

835

837

837

837

835

837

837

835

837

835

837 835 837 835 837 835 837 837 835

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.

Former payer ID 26160

Page 6 of 131

Payer Name

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

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

Experian Health Payer List

Payer Code

AC101 AC101 81040 81040 23071 23071 93658 93658

HCP01

22417 22417

Available Transaction

I PD

837

835

837

835

837

835

837

835

837

837 835

Enrollment I PD

COB Attachments I PD I P D

Notes

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

APP01 APP01 58234 58234 50749 37308 37308

ALLCA

ALLCA

NMM01 NMM01 NMM01 NMM01 54398 54398

04293

04293

837 835 837 835 837 837 835

837

835

837 835 837 835 837 835

837

835

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

68069 68069

837 835

ERA Payer Code 68069; ERA requires EFT enrollment

Page 7 of 131

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

Payer Name

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 American Family Medicare Sup and PPO Policies Administered by Am Rep American Fidelity Assurance Company American General

Experian Health Payer List

Payer Code

NMM04 NMM04 A0701 25133 ALTAM

Available Transaction

I PD 837 835 837 837

837

Enrollment I PD

COB I PD

Attachments I PD

Notes

Former payer code MPM32.

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

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

68069

62176 75137 75137 27516 75240 63103 95170 95170 12T31 TH095 56071 56071 60801 62030

835

837

835

837

837

837

835

837

835

837

835

837

837

837

835

837

837

835

837

837

837

837

835

837

837

837

835

837

837

ERA Payer Code 25133

ERA Payer Code 68069; ERA requires EFT enrollment

Page 8 of 131

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