CLAIMS & ERA PAYER LIST November 12, 2021

[Pages:137]CLAIMS & ERA PAYER LIST December 2, 2022

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 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

Payer Code

13162 13162 29076 29076 29076 29076 59069 20446 93044 95241 75240

75185

36273 36273 AARP1 AARP1 87726

87726 ABLPY ABLPY

Transaction

837 835 837 835 837 835 837 837 837 837 837

837

837 835 837 835

Available I PD

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 Payer ID #37283). Claims submitted under payer ID 75185 will be subject to claim rejection effective Q1 2019.

837

835

837

835

Experian Health Payer List

Page 1 of 137

Payer Name

Abrazo Advantage Health Plan Absolute Total Care Absolute Total Care

Accelerated Claims Inc. Accendo Health 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) 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

03443 68069

68069

99999-0748 62118 AHS01 ACCOM ACC01 ACC01 AMG02 AMG02 19305 64071 64071 IP095 45328 AHIPA IAS21 37118 72467 72467 24585 38254 38265 TLU02 22384 22384 59141 58202 68069

68069

68069

Transaction

837 837

835

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

835

837

Available I PD

Enrollment I PD

COB I PD

Attachments IPD

Notes

Also known as Phoenix Advantage

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.

Page 2 of 137

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) Advocate Physician Partners Advocate Physician Partners Aegis Administrative Services

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 65093 65093 CB637

Transaction

835

837

835

837

835

837

835

837

835

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

Available I PD

Enrollment I PD

COB Attachments I PD I P D

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 137

Payer Name

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) Aetna Better Health of Texas (Medicaid & CHIP) Aetna Better Health of Virginia

Experian Health Payer List

Payer Code

60054 60054 60054 60054 60054 128CA 128CA 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

Transaction

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

Available I PD

Enrollment I PD

COB Attachments

I PD I P D

ERA Payer Code 25133

Formerly IlliniCare

835

837

ERA Payer Code 25133

837

835

837

835

837

835

837

835

837

835

837

Notes

Page 4 of 137

Payer Name

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 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 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

Experian Health Payer List

Payer Code

128VA 128WV 128WV M5JVH M5JVH 26337 26337 60054 60054 62118 J1JVH J1JVH ADOCS POP09 POP06 16146

16146

13334 13334 46594 95426 95426 52080 62308 62308 11370 37280 20048 64158 ARA01 ARA01 AWNY6 AWNY6

Transaction

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

835

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

Available I PD

Enrollment I PD

COB Attachments I PD I P D

Notes

Provider must be an approved JVHL lab

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

Page 5 of 137

Payer Name

AHP Provider Network AHPO (Cleveland OH) AIDS Healthcare Foundation Aither Health Aither Health AKM Medical Group Alabama Medicaid Alabama Medicaid Alabama Medicaid Alabama Medicaid Alabama Medicare Alabama Medicare Alameda Alliance for Health Alameda Alliance for Health Alamitos IPA

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

Experian Health Payer List

Payer Code

MPM38 31138 95422 64884 64884 CAPMN 12K01 12K01 SKAL0 SKAL0 10112 10112 95327 95327

AIPAZ

CAPMN R7003 91136 91136 91136 60054 60054 91136 77200 77200 SMAK0 SMAK0 91136

91136

85600 85600 44423 13550 13550

Transaction

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

837

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

Available I PD

Enrollment I PD

COB Attachments I PD I P D

Notes

For DOS Prior to 5/1/2020. Claims with DOS 5/1/20 and after use payer code CAPMN.

837

837

835

837

837

835

Page 6 of 137

Align Senior Care (CA)

Payer Name

Align Senior Care (CA)

Align Senior Care (FL)

Align Senior Care (FL)

Align Senior Care (MI)

Align Senior Care (MI)

Align Senior Care (VA)

Align Senior Care (VA)

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

Experian Health Payer List

Payer Code

ASCA1

ASCA1

ASFL1

ASFL1

ASMI1

ASMI1

ASVA1

ASVA1 CCHPC CCHPC AHCA1 AHCA1 81400 81400 MRCHP MRIPA MRIPA AC101 AC101 81040 81040 23071 23071 93658 93658 HCP01 22417 22417 APP01 APP01

Transaction

837

835

837

835

837

835

837

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

Available I PD

Enrollment I PD

COB I PD

Attachments IPD

Notes

Payer returns ERA's automatically once electronic claim submission

begins.

Payer returns ERA's automatically once electronic claim submission

begins.

Payer returns ERA's automatically once electronic claim submission

begins

Payer returns ERA's automatically once electronic claim submission

begins

Payer returns ERA's automatically once electronic claim submission

begins.

Payer returns ERA's automatically once electronic claim submission

begins.

Payer returns ERA's automatically once electronic claim submission

begins.

Payer returns ERA's automatically once electronic claim submission

begins

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

Page 7 of 137

Payer Name

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

Alpha Care Medical Group Alpha Care Medical Group Alta Bates Medical Group ALTA Health Strategies AltaMed AltaMed Alterwood Advantage Altius Health Plans Altius Health Plans Alvarado IPA Always Care Vision AMA Insurance Agency AMA Insurance Agency AMA Insurance Agency AMA Insurance Agency

Experian Health Payer List

Payer Code

58234 58234 50749 37308 37308

ALLCA

ALLCA

NMM01 NMM01 NMM01 NMM01 54398 54398 04293 04293 68069

68069

NMM04 NMM04 A0701 25133 ALTAM ALTAM RP016 25133 25133 SYMED ATR01 AMAIA AMAIA TH071 TH071

Transaction

837 835 837 837 835

837

835

837 835 837 835 837 835 837 835 837

835

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

Available I PD

Enrollment I PD

COB Attachments I PD I P D

Notes

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

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. Former payer code MPM32.

Payer code to be used for only DOS prior to 1/1/2020 Effective 3/27/19, the new payer ID is ALTAM Effective 1/1/22 Payer code to be used for only DOS prior to 1/1/2020 ERA Payer Code 25133

Page 8 of 137

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