List of Automatic Crossover Trading Partner (Insurers) In ...

List of Automatic Crossover Trading Partner (Insurers) In Production Do Not Include Number Shown Below on Incoming Claims

Trading Partner WELLMARK BCBS FEP THE REGENCE GROUP IDAHO THE REGENCE GROUP BLUE SHIELD THE REGENCE GROUP UTAH THE REGENCE GROUP OREGON TRANSAMERICA PREMIER LIFE INS CONNECTICUT GENERAL INSURANCE CO HORIZON BCBS OF NEW JERSEY WPS-COMMERCIAL WPS-COMMERCIAL BCBS OF MICHIGAN BCBS OF ALABAMA BCBS OF SOUTH CAROLINA HIGHMARK INC HIGHMARK INC GHI PPO GHI PPO GHI PPO GHI PPO GHI PPO GHI PPO HCSC-BCBS OF IL,OTHER B ONLY HCSC-BCBS OF NM-OTHER B ONLY HCSC-BCBS OF TX-OTHER B ONLY BCBS OF MICHIGAN AETNA, INC. BCBS OF MICHIGAN BLUE CARE NETWORK BCBS OF MISSISSIPPI BCBS OF MISSISSIPPI METROPOLITAN HEALTH PLAN TRIPLE-S INC CAREFIRST DC PART A ONLY CAREFIRST DC PART B ONLY MEDICAL MUTUAL OF OHIO BCBS OF TENNESSEE - SUPPLEMENTAL UNITEDHEALTHCARE UNITEDHEALTHCARE KAISER FOUNDATION HEALTH OF WA EMPIRE BLUE CROSS BLUE SHIELD I EMPIRE BLUE CROSS BLUE SHIELD II BCBS OF KANSAS

Updated: 03/31/2021

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s) Customer Contact

00004

Customer/Provider Services

00009

Customer Service

00010

Customer Service

00011

Customer Service

00012

Customer Service

00017

Customer Service

00018

Customer Service

00019

Customer Service

00025

Customer Service

00026

Customer Service

00027

Customer Service

00028

Customer Service

00029

Customer Service

00030

Customer Service

00031

Customer/Provider Services

00032

Customer Service

00033

Customer Service

00034

Customer Service

00035

Customer Service

00036

Customer Service

00037

Customer Service

00041

Customer Service

00042

Customer Service

00044

Customer Service

00055

Customer Service

00060

Customer Service

00061

Customer Service

00062

Customer Service

00067

Customer Service

00068

Customer Service

00072

Marilee Moritz

00074

Nanette Dumont Lopez

00075

Provider Services

00076

Provider Services

00080

Sue Robinson

00081

Customer Service

00082

Stewart McGehee

00083

Stewart McGehee

00087

Tammie Wallace

00091

Refer To Back Of ID Card

00092 00093

Refer To Back Of ID Card Customer Service

Contact Number (800) 584-9242 (800) 343-8915 (800) 343-8915 (800) 343-8915 (800) 343-8915 (800) 854-0186 (800) 244-6224 (800) 624-1110 (888) 253-2694 (888) 253-2694 (313) 225-9000 (205) 988-2200 (800) 760-9290 (800) 345-3806 (800) 345-3806 (212) 501-4444 (212) 501-4444 (212) 501-4444 (212) 501-4444 (212) 501-4444 (212) 501-4444 (888) 762-2189 (888) 762-2189 (888) 762-2189 (313) 225-9000 (860) 273-0123 (313) 225-9000 (800) 450-3680 (800) 257-5825 (800) 257-5825 (612) 543-1245 (787) 749-4949 (800) 842-5975 (800) 842-5975 (216) 687-6108 (800) 553-8158 (612) 383-4963 (612) 383-4963 (206) 630-4656

(800) 432-3990

List of Automatic Crossover Trading Partner (Insurers) In Production Do Not Include Number Shown Below on Incoming Claims

Trading Partner ANTHEM BCBS CONNECTICUT ANTHEM BCBS NEW HAMPSHIRE ANTHEM BCBS MAINE BLUE CROSS BLUE SHIELD OF LA WEA INSURANCE CORPORATION CAREFIRST DC PART A ONLY CAREFIRST DC PART B ONLY CAREFIRST MD PART B ONLY EMPIRE BLUE CROSS BLUE SHIELD II EMPIRE BLUE CROSS BLUE SHIELD II CARPENTERS TRUSTS OF W.WASHINGTON BLUE CROSS BLUE SHIELD OF NC CAPITAL BLUE CROSS BLUE CROSS BLUE SHIELD OF WNY BLUE CROSS BLUE SHIELD OF WNY BLUE CROSS BLUE SHIELD OF WNY BLUE CROSS BLUE SHIELD OF WNY BLUE CROSS BLUE SHIELD OF WNY BLUE CROSS BLUE SHIELD OF WNY BLUE CROSS BLUE SHIELD OF WNY HIGHMARK BCBS OF DELAWARE HEALTH ALLIANCE PLAN BCBS OF ARIZONA ALLEGIANCE BENEFIT PLAN MANAGEMENT EMPLOYEE BENEFIT MGMT CARE ANTHEM CENTRAL - FACETS ANTHEM NATIONAL BCBS OHIO CTRL EMPIRE BLUE CROSS BLUE SHIELD I ANTHEM NATIONAL BCBS IN CONTROL ANTHEM BCBS MAINE ANTHEM BCBS NEW HAMPSHIRE ANTHEM BCBS CONNECTICUT ANTHEM BCBS VIRGINIA MODA HEALTH PLAN INC ARKANSAS BCBS HEALTH ADVANTAGE PITTMAN & ASSOCIATES, INC. HEALTH ALLIANCE MEDICAL PLANS GRAPHIC COMMUNICATIONS NAT'L ANTHEM BCBS OF NEVADA EMPIRE BLUE CROSS BLUE SHIELD I BLUE CROSS OF CALIFORNIA

Updated: 03/31/2021

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s) Customer Contact

00095

Refer To Back Of ID Card

00096

Refer To Back Of ID Card

00097

Refer To Back Of ID Card

00099

Customer Service

00104

Rebecca Johnson

00105

Provider Services

00106

Provider Services

00107

Provider Services

00108

Refer To Back Of ID Card

00109

Refer To Back Of ID Card

00110

Darren Kong

00112

Customer Service

00113

Molly Kuntz

00114

Buffalo (CNY West)

00114

Albany Region II

00114

Albany (CNY East)

00115

Traditional Member

00115

Managed Care Member

00115

Provider Services

00116

Melissa Deboth

00118

Customer Service

00119

Michia Pippin

00122

Rebecca Garcia

00124

Customer Service

00127

Customer Service

00128

Refer To Back Of ID Card

00131

Refer To Back Of ID Card

00134

Refer To Back Of ID Card

00136

Refer To Back Of ID Card

00139

Refer To Back Of ID Card

00140

Refer To Back Of ID Card

00141

Refer To Back Of ID Card

00148

Refer To Back Of ID Card

00150

EDI Department

00151

Mia Moore

00153

Dee McKee

00156

Andy Glankler

00157

Lisa Parker

00160

Teresa Bauer

00166

Refer To Back Of ID Card

00168 00170

Refer To Back Of ID Card Refer To Back Of ID Card

Contact Number

(800) 599-2583 (608) 661-6620 (800) 842-5975 (800) 842-5975 (800) 842-5975

(206) 441-6514 (877) 258-3334 (717) 703-8672 (866) 638-9011 (800) 945-0566 (800) 856-0480 (800) 888-1238 (800) 459-7587 (800) 444-4552 (716) 887-8443 (800) 485-2889 (313) 664-8031 (602) 864-4818 (406) 721-2222 (800) 993-3262

(800) 852-5195 (501) 502-1686 (501) 212-8520 (901) 473-3344 (217) 902-8353 (412) 201-2242

List of Automatic Crossover Trading Partner (Insurers) In Production Do Not Include Number Shown Below on Incoming Claims

Trading Partner UNICARE LIFE & HEALTH INSURANCE HEALTH NET OF CALIFORNIA, INC. RESERVE NATIONAL INSURANCE CO BLUE CROSS OF IDAHO BLUE CROSS OF IDAHO ALLIED BENEFIT SYSTEMS, INC ALLIED BENEFIT SYSTEMS, INC NGS AMERICAN, INC HIGHMARK WEST VIRGINIA HIGHMARK WEST VIRGINIA UMR PA EMPLOYEES BENEFIT TRUST FUND PREMERA BLUE CROSS BCBS OF MASSACHUSETTS INC. HEALTHSMART BCBS OF VERMONT - SUPPLEMENTAL OXFORD HEALTH PLANS UNITED HEALTHCARE C & R CONSULTING CORESOURCE, INC CORESOURCE, INC CORESOURCE, INC BCBS OF KANSAS CITY BLUE CROSS BLUE SHIELD OF RI UNITED HEALTHCARE MERITAIN HEALTH ASURIS REGENCE BLUE SHIELD OF UTAH REGENCE BLUE SHIELD REGENCE BCBS OF OREGON REGENCE BLUE SHIELD OF IDAHO HCSC-BCBS OF IL-OTHER A ONLY HCSC-BCBS OF NM-OTHER A ONLY HCSC-BCBS OF TX-OTHER A ONLY KIDNEY DISEASE PROGRAM OF MD AMALAGAMATED LIFE/ALICARE HUMANA, INC. THE J.P. FARLEY CORPORATION FEDERATED ALLIED RETIREE ASSOC C&O EMPLOYEES HOSPITAL ASSOC PIPE FITTERS WELFARE FUND CONNECTICUT GENERAL INSURANCE CO

Updated: 03/31/2021

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s) Customer Contact

00171

Refer To Back Of ID Card

00173

Customer Service

00182

Juanita Phelps

00184

Customer Service

00185

Customer Service

00188

Outside IL

00188

IL Resident

00189

Customer Service

00190

Customer Service

00191

Customer Service

00192

Customer Service

00208

Rest of U.S.

00209

Customer Service

00212

Customer Service

00214

00217

Nicholas Hogan

00220

Provider Membership

00224

Stewart McGehee

00226

C&R Customer

00229

One Beacon Ins Grp

00229

Crompton Corp

00229

All others

00232

Kathy Currey

00236

Customer Service

00237

Stewart McGehee

00240

Customer Service

00246

Customer Service

00249

Customer Service

00250

Customer Service

00251

Customer Service

00252

Customer Service

00254

Customer Service

00255

Customer Service

00256

Customer Service

00259

Carol Manning

00267

Customer Service

00268

Customer Service

00280

Amanda Smolka

00288

Lorraine Piazza

00295

Anna Brooks

00299 00300

Customer Service

Contact Number

(800) 641-7761 (800) 654-9106 (866) 482-2253 (866) 482-2253 (800) 288-2078 (312) 906-8080 (800) 521-1555 (800) 543-7822 (800) 543-7822 (800) 826-9781 (800) 522-7279 (800) 508-4722 (800) 258-2226

(802) 371-3296 (800) 666-1353 (612) 383-4963 (212) 819-0792 (866) 889-7286 (866) 318-7173 (800) 223-3943 (816) 395-3877 (800) 267-0439 (612) 383-4963 (800) 828-6922 (800) 253-0838 (800) 253-0838 (800) 253-0838 (800) 253-0838 (800) 253-0838 (888) 762-2189 (888) 762-2189 (888) 762-2189 (410) 767-5004 (212) 539-5111 (866) 427-7478 (440) 250-4316 (631) 249-0500 (540) 862-5728

(800) 244-6224

List of Automatic Crossover Trading Partner (Insurers) In Production Do Not Include Number Shown Below on Incoming Claims

Trading Partner PLUMBERS WELFARE FUND,LCL 130 UA NATL ELEVATOR INDUSTRY HEALTH BE BLUE CROSS BLUE SHIELD OF NC ANTHEM BCBS VIRGINIA THE LOOMIS COMPANY WEBTPA EMPLOYER SERVICES SECURITY HEALTH PLAN OF WI, INC HCSC-BCBS OF OK -OTHER A ONLY HCSC-BCBS OF OK-OTHER B ONLY CAPITAL DISTRICT PHYSICIANS H P WEBTPA EMPLOYER SERVICES LIFETIME BENEFIT SOLUTIONS, INC. TIC - IBEW LOCAL 461 WELFARE FUN BLUE CARE COOPERATIVE PLUMBERS & PIPEFITTERS WELFARE DANA NON UNION RETIREE VEBA TRUST G.M.P. - EMPLOYERS RETIREE TRUST MEDICA, PART B ONLY MEDICA PART A ONLY CONNECTICUT GENERAL INSURANCE CO VANTAGE HEALTH PLAN, INC. AVMED HEALTH PLANS PIPELINE INDUSTRY BENEFIT FUND THE WILLIAM C. EARHART CO., INC MID CENTRAL OPERATING ENGINEERS HEALTH & WELFARE FUND SOUTHWEST LIFE & HEALTH INS.CO. FIRSTCARE WABASH MEMORIAL HOSPITAL ASSOC. AMERICAN BENEFIT CORPORATION TIC ? NECA IBEW LOCAL 364 HEALTH RIGHT CHOICE BENEFIT ADMIN. BCBS OF NEBRASKA BCBS OF NEBRASKA ADC 1 WELFARE FUND SFEW HEALTH & WELFARE TRUST IE SCHAFFER & CO C & R CONSULTING ARKANSAS BCBS EMBLEMHEALTH SVC COMPANY, LLC-HIP PLUMBERS & PIPEFITTERS LOCAL 630 OE LOCAL 139 HBF PIPE TRADES INDUSTRY H&W PLAN

Updated: 03/31/2021

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s) Customer Contact

00304

00305

National Elevator Industry

00306

Customer Serice

00308

Refer To Back Of ID Card

00310

00313

Shannon Junek

00314

Ken Baur

00317

Customer Service

00318

Customer Service

00321

Brian Freer

00322

Shannon Junek

00323

Teresa Behm

00329

Susan Esterhai

00341

Cathy Stitzer

00343

Nancy Winer

00352

Lorraine Piazza

00354

Debra Fulmer

00360

Stephanie Kelly

00361

Stephanie Kelly

00364

Customer Service

00365

Shanna Waters

00371

Customer Service

00372

Claims Supervisor

00374

Ann Mott

00375

Katricia Helton

00377

Melinda Rodriguez

00378

Gabriel Ramirez

00379

Angie Vorties

00380

Linda Sites

00386

Medical Claims Department

00387

Customer Service Right Choice

00388

Customer Service Center

00392

Customer Service Center

00406

Yolanda Alzati

00407

Lisa Schultz

00411

Terri Trasatti

00413

00417

Mia Moore

00423

Michele Podolak

00426

Noel Ries

00427 00428

Annette Kusick Megan Lucas

Contact Number

(800) 252-4611 (877) 258-3334

(210) 507-8801 (715) 221-9556 (888) 762-2189 (888) 762-2189 (518) 641-3820 (210) 507-8801 (315) 448-9001 (866) 461-4239 (570) 200-4540 (314) 355-1000 (631) 249-0500 (239) 936-6242 (952) 992-2592 (952) 992-2592 (800) 244-6224 (318) 361-0990 (800) 882-8633 (918) 280-4800 (503) 535-1431 (812) 232-4384 (806) 784-4378 (254) 298-3551 (217) 429-5246 (304) 525-0331 (800) 228-0048 (800) 365-9036 (800) 991-7392 (800) 991-7392 (630) 617-8630 (415) 263-3670 (609) 883-6688

(501) 502-1686 (315) 434-2447 (561) 478-0095 (262) 549-9190 (812) 877-2581

List of Automatic Crossover Trading Partner (Insurers) In Production Do Not Include Number Shown Below on Incoming Claims

Trading Partner HEALTH NET OF ARIZONA, INC. C&R CONSULTING BLUE SHIELD OF CALIFORNIA SCPT HEALTH & WELFARE FUND LIBERTY NATL LIFE INS CO - GMS QUARTZ HEALTH PLAN SENTARA HEALTH PLANS INC. INDIANA LABORERS WELFARE FUND INDIANA LABORERS WELFARE FUND AMERICAN BENEFIT CORPORATION BLUE CROSS BLUE SHIELD OF LA HEALTH CARE SERVICE CORP, BCBS HEALTH CARE SERVICE CORP, BCBS KAISER PERMANENTE MID-ATLANTIC INDEPENDENCE BLUE CROSS OPERATING ENGINEERS H&W FUND TIC-NECA IBEW LCL 150 FRINGE BF DELTA HEALTH SYSTEMS EXCELLUS HEALTH PLANS HARRINGTON HEALTH SERVICES, INC. BLUE CROSS/SHIELD OF GA KCSUP BLUE CROSS/SHIELD OF GA KCSUP EIGHTH DISTRICT ELECTRICAL BENEF MEDICAL ASSOC HEALTH PLAN INC NATIONAL BCBS GEORGIA DESERET MUTUAL REGENCE BLUE SHIELD WISCONSIN PHYSICIANS SERVICE WISCONSIN PHYSICIANS SERVICE DUNN & ASSOCIATES BENEFIT ADMIN HEALTHLINK HMO, INC INDEPENDENCE BLUE CROSS PEHP HEALTH CARE SERVICE CORPORATION HEALTH CARE SERVICE CORPORATION WELLMARK BCBS OF SD WELLMARK BCBS OF IA MIDWEST OPERATING ENGINEERS HEALTH NEW YORK WSG NEVADA ISG MAINE ISG WISSONSIN ISG

Updated: 03/31/2021

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s) Customer Contact

00429

Healthnet Provider Service

00431

00433

Tammy Rutters

00434

Nahuel Costilla

00435

Customer Service Department

00436

Debra Schiffman

00438

Medicare Customer Service Line

00439

Melissa Wade

00440

Melissa Wade

00445

Linda Sites

00455

Customer Service

00456

Blue Cross Blue Shield

00457

Blue Cross Blue Shield

00459

Member Service

00460

Customer Service

00462

Elisabeth Schaefer

00463

Jan Smith

00470

Christine Dugger-Praet

00472

Shannon Kowalski

00473

Customer Service

00475

Refer To Back Of ID Card

00476

Refer To Back Of ID Card

00478

Mary Kemp

00479

Laura Boge

00485

Refer To Back Of ID Card

00486

Donna Mcreavy

00489

Customer Service

00493

Kit Lee

00494

Kit Lee

00496

Tammy Shaw

00498

Karen Gotsch

00500

Customer Service

00501

Josie Hall

00502

Blue Cross/Blue Shield

00503

Blue Cross/Blue Shield

00506

Customer/Provider Services

00507

Customer/Provider Services

00508

Barbara Glembin

00509

Refer To Back Of ID Card

00510

Refer To Back Of ID Card

00511 00512

Refer To Back Of ID Card Refer To Back Of ID Card

Contact Number (800) 977-7522

(530) 351-6019 (213) 385-6161 (800) 755-2137 (608) 643-1408 (800) 927-6048 (812) 238-2551 (812) 238-2551 (304) 525-0331 (800) 599-2583 (888) 762-2189 (888) 762-2189 (800) 777-7902 (800) 645-3965 (626) 356-3560 (877) 478-4542 (559) 228-4185 (716) 250-7548 (800) 216-2166

(801) 973-1001 (563) 556-8070

(801) 578-5621 (800) 253-0838 (608) 226-3369 (608) 226-3369 (812) 378-9960 (314) 925-6166 (800) 645-3965 (801) 366-7519 (888) 762-2189 (888) 762-2189 (800) 584-9242 (800) 584-9242 (708) 579-6603

List of Automatic Crossover Trading Partner (Insurers) In Production Do Not Include Number Shown Below on Incoming Claims

Trading Partner KENTUCKY ISG VIRGINIA ISG NEW HAMPSHIRE ISG MISSOURI ISG OHIO ISG CALIFORNIA ISG COLORADO ISG CONNECTICUT ISG EMPIRE BLUE CROSS BLUE SHIELD I CONNECTICUT WGS INDIANA WGS KENTUCKY WGS MISSOURI WGS NEW YORK WGS OHIO WGS VIRGINIA WGS WISCONSIN WGS INDEPENDENCE BLUE CROSS INDEPENDENCE BLUE CROSS BLUE CROSS BLUE SHIELD OF NC BLUE SHIELD OF CALIFORNIA USABLE MUTUAL INS COMPANY BCBS of MINNESOTA BCBS of MINNESOTA WESTERN & SOUTHERN FINANCIAL GRP TEAMSTERS MEDICARE TRUST FOR RET. ANTHEM KY ANTHEM MO ANTHEM WI ANTHEM CA ANTHEM NV ANTHEM CO ANTHEM VA ANTHEM NY ANTHEM CT ANTHEM NH ANTHEM GA ANTHEM ME ANTHEM IN ANTHEM OH ANTHEM GREEN MERCER HEALTH & BENEFITS ADM. LLD

Updated: 03/31/2021

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s) Customer Contact

00513

Refer To Back Of ID Card

00514

Refer To Back Of ID Card

00515

Refer To Back Of ID Card

00516

Refer To Back Of ID Card

00517

Refer To Back Of ID Card

00518

Refer To Back Of ID Card

00519

Refer To Back Of ID Card

00520

Refer To Back Of ID Card

00521

Refer To Back Of ID Card

00522

Refer To Back Of ID Card

00523

Refer To Back Of ID Card

00524

Refer To Back Of ID Card

00526

Refer To Back Of ID Card

00528

Refer To Back Of ID Card

00529

Refer To Back Of ID Card

00530

Refer To Back Of ID Card

00531

Refer To Back Of ID Card

00532

Customer Service

00533

Customer Service

00535

Customer Service

00536

Tammy Rutters

00542

Deb Gunter

00544

Customer Service

00545

Customer Service

00554

John Kaising

00555

Insurance Teamsters

00556

Refer To Back Of ID Card

00557

Refer To Back Of ID Card

00558

Refer To Back Of ID Card

00559

Refer To Back Of ID Card

00560

Refer To Back Of ID Card

00561

Refer To Back Of ID Card

00562

Refer To Back Of ID Card

00563

Refer To Back Of ID Card

00564

Refer To Back Of ID Card

00565

Refer To Back Of ID Card

00566

Refer To Back Of ID Card

00567

Refer To Back Of ID Card

00568

Refer To Back Of ID Card

00569

Refer To Back Of ID Card

00570 00571

Refer To Back Of ID Card Daniel Surls

Contact Number

(800) 645-3965 (800) 645-3965 (877) 258-3334 (530) 351-6109 (501) 210-9043 (800) 531-6686 (800) 531-6686 (513) 357-4007 (314) 513-5888

(515) 365-3353

List of Automatic Crossover Trading Partner (Insurers) In Production Do Not Include Number Shown Below on Incoming Claims

Trading Partner IBEW LOCAL 701 HEALTH WELFARE FUND KY RURAL ELEC. COOP. EMP. BENEFIT NASI WELFARE FUND NEW JERSEY EDUCATION ASSOCIATION WELLMARK BCBS OF SD MED SUP WELLMARK BCBS OF IA MED SUP TOLEDO ELECTRICAL WELFARE FUND GROUP HEALTH COOP OF EAU CLAIRE QUARTZ HEALTH PLANS INSURANCE USABLE MUTUAL INS. COMPANY IBEW LOCAL NO 1 HEALTH & WELFARE NECA IBEW WELFARE TRUST FUND BLUE CROSS BLUE SHIELD OF VERMONT SC BAPTIST CONVENTION HEALTH PARTNERS MCLAREN HEALTH ADVANTAGE BLUE CROSS BLUE SHIELD OF ND BLUE CROSS BLUE SHIELD OF ND BLUE CROSS BLUE SHIELD OF WY BLUE CROSS BLUE SHIELD OF WY THP INSURANCE COMPANY ANTHEM INC. FCHP MMSI, INC. D/B/A MEDICA HPS BCBS OF ALABAMA HEALTH TRADITION HEALTH PLAN SMW AND PROGRAM OF THE SMWNHF WI PIPE TRADES HEALTH FUND PLUMBERS LOCAL 75 HEALTH FUND MADISON AREA CONSTRU EMPLOYEES IRONWORKERS LOCAL 383 HCP WISCONSIN MASONS HEALTH FUND ZENITH AMERICAN SOLUTIONS BCBS OF NEBRASKA BCBS OF NEBRASKA BCBS OF MINNESOTA INSURANCE ADMIN OF AMERICA ANTHEM CT ANTHEM ME ANTHEM NH MIDDLETOWN WORKS RETIREES

Updated: 03/31/2021

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s) Customer Contact

00575

Beverly Harrison

00576

Kathy Harley

00577

Customer Service

00578

Gabriella Merullo

00579

Customer/Provider Services

00580

Customer/Provider Services

00581

Customer Service

00582

Tera Polzer

00583

Debra Schiffman

00584

Kim Burgess

00588

Stephanie Labanon

00589

Leslie Devore

00590

Debbie Goodwin

00591

Roney Williams

00593

Provider Customer Service

00595

Customer Service

00596

Tracey Compson

00597

Tracey Compson

00599

Amber Zowada

00600

Amber Zowada

00603

Kim Geary

00604

Refer To Back Of ID Card

00605 00606

Customer Service Stephanie Kelly

00611

Rusty Redford

00615

Rebecca Johnson

00616

Jennifer Goostree

00618

Jackie Trad

00620

Jackie Trad

00621

Vickie Wilkin

00622

Vickie Wilkin

00623

Vickie Wilkin

00624

Amy Cook

00626 00627

Customer Service Customer Service

00628

Customer Service

00632

Alicia Darcy

00634

Refer To Back Of ID Card

00635

Refer To Back Of ID Card

00636 00639

Refer To Back Of ID Card Susan Pohlabeln

Contact Number (630) 393-1701 (859) 721-0799 (301) 429-4999 (800) 257-2038 (800) 584-9242 (800) 584-9242 (419) 666-4450 (715) 852-2616 (608) 643-1408 (501) 502-1691 (314) 752-2330 (217) 875-0254 (802) 371-3331 (800) 922-4966 (888) 663-6464 (888) 327-0671 (701) 282-1378 (701) 282-1378 (307) 432-2743 (307) 432-2743 (740) 695-7616

(800) 868-5200 (952) 992-2592 (205) 220-7839 (608) 661-6620 (615) 859-0131 (414) 577-3700 (414) 577-3700 (608) 278-9500 (608) 278-9500 (608) 278-9500 (203) 949-3239 (800) 991-7392 (800) 991-7392 (800) 531-6686 (856) 470-1200

(513) 217-4818

List of Automatic Crossover Trading Partner (Insurers) In Production Do Not Include Number Shown Below on Incoming Claims

Trading Partner WARREN RURAL ELECTRIC COOP CORP NEW IBEW FAMILY MEDICAL CARE PL TRANSAMERICA PREMIER LIFE INS UNITEDHEALTH GROUP TRANSAMERICA PREMIER LIFE INS HORIZON BCBS OF NEW JERSEY BCBS OF SOUTH CAROLINA HIGHMARK INC HIGHMARK INC HCSC-BCBS OF IL-NON-STD A & B HCSC-BCBS OF IL-STD A & B HCSC-BCBS OF NM-NON STD A & B HCSC-BCBS OF NM-STD A & B HCSC-BCBS OF TEXAS-NON STD A&B HCSC-BCBS OF TEXAS-STD A & B LIBERTY NATL LIFE INS CO - GMS LIBERTY NATIONAL LIFE INSURANCE GLOBE LIFE & ACCIDENTAL INS CO AMERICAN INCOME LIFE INSURANCE UNITED AMERICAN INSURANCE CO GLOBE LIFE INSURANCE COMPANY NY SILAC INSURANCE COMPANY BCBS OF MISSISSIPPI TRIPLE S, INC. - MEDIGAP BCBS OF TENNESSEE-MEDIGAP UNITED COMMERCIAL TRAVELERS STANDARD LIFE AND ACCIDENT INS AM. NATIONAL LIFE INS CO OF TX LOYAL AMERICAN LIFE INSURANCE CO GUARANTEE TRUST LIFE INS CO EMPIRE BLUE CROSS BLUE SHIELD I MEDICAL MUTUAL OF OHIO BCBS OF KANSAS BANKERS LIFE AD CASUALITY WASHINGTON NATIONAL INSURANCE CO ANTHEM BCBS NORTHEAST REGION CONSECO SERVICES - COLONIAL PENN SANFORD HEALTH PLAN OF MINNESOTA SANFORD HEALTH PLAN HEALTH ALLIANCE MEDICAL PLANS CONTINENTAL LIFE INS OF BRENTWOO AMERICAN CONTINENTAL INSU. PHYSICIANS MUTUAL INS.CO DEAN HEALTH PLAN

Updated: 03/31/2021

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s) Customer Contact

00645

Member Service

00646

Jeri Hill

30000

Jennifer Sali

30002

Customer Service

30006

Jennifer Sali

30013

Customer Service

30016

Judith Murray

30017

Customer Service

30018

Customer Service

30023

Customer Service

30024

Customer Service

30025

Customer Service

30026

Customer Service

30027

Customer Service

30028

Customer Service

30029

Customer Service

30030

Customer Service

30032

Customer Service

30033

Customer Service

30034

Customer Service

30035

Customer Service

30036

Donna Coleman-Fulk

30039

Customer Service

30042

Nanette Dumont Lopez

30047

Customer Service

30048

Jose Viri-Dunahue

30051

Jill Davis

30052

Jill Davis

30054

Customer Service

30055

Mark Pytel

30056

Refer To Back Of ID Card

30060

Sue Robinson

30062

Customer Service

30065

Customer Service

30066

Customer Service

30067

Refer To Back Of ID Card

30068

Customer Service

30069

Customer Service

30070

Customer Service

30071

Sheila Bell

30073

Ellen Martin

30074

Ellen Martin

30075 30076

Carolyn Brown Murielle Sago

Contact Number (855) 981-2583 (877) 937-9602 (610) 648-4990 (800) 523-5800 (610) 648-4990 (800) 624-1110 (803) 264-3889 (800) 345-3806 (800) 345-3806 (888) 762-2189 (888) 762-2189 (888) 762-2189 (888) 762-2189 (888) 762-2189 (888) 762-2189 (800) 755-2137 (800) 755-2137 (800) 755-2137 (800) 755-2137 (800) 755-2137 (800) 755-2137 (833) 657-1452 (800) 257-5825 (787) 749-4949 (800) 553-8158 (614) 487-9680 (281) 538-4890 (281) 538-4890 (866) 459-4272 (847) 904-5375

(216) 687-6108 (800) 432-3990 (800) 621-3724 (800) 621-3724

(800) 523-4000 (800) 752-5863 (800) 752-5863 (217) 902-9109 (800) 264-4000 (800) 264-4000 (402) 633-5757 (608) 827-4432

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