TPL Code Directory

TPL Code Directory

Illinois Department of Healthcare and Family Services

TPL CODE

Insuring Organization

136 ACADEMY LIFE INSURANCE COMPANY 903 ACCIDENTAL DEATH & DISMEMBER 001 AETNA 036 AETNA/PRUDENTIAL HEALTH PLANS 149 ALLMERICA 048 ALLSTATE LIFE INSURANCE 144 ALLSTATE WORKPLACE DIVISION 002 AMALGAMATED LIFE & HEALTH CO 041 AMALGAMATED LIFE INSURANCE CO 061 AMER FAMILY/AMER REPUBLIC INS 475 AMERICAN FEDERATION GOVT EMPL 042 AMERICAN FIDELITY ASSURANCE 103 AMERICAN GEN LIFE & ACCIDENT 105 AMERICAN INCOME LIFE INS CO 098 AMERICAN INDEPENDENCE LIFE INS 062 AMERICAN INTEGRITY--NOLHGA 161 AMERICAN INTERNATIONAL LIFE 063 AMERICAN LIBERTY LIFE INS CO 064 AMERICAN LIFE & ACCIDENT INS 065 AMERICAN LIFE INS CO 066 AMERICAN MUTUAL LIFE INS CO 056 AMERICAN NATIONAL INSURANCE CO 053 AMERICAN REPUBLIC INS CO 068 AMERICAN UNITED LIFE INS CO 453 APWU HEALTH PLAN 130 ASSURANT HEALTH 187 ASSURANT HEALTH - JOHN ALDEN 132 ASSURITY 485 ATKINSON TOPEKA & SANTA FE 486 AUTO MECHANICS LOCAL 701

Address

P O BOX 3074

P O BOX 981107 P O BOX 981107 440 LINCOLN ST N365 ALLSTATE PLAZA 1776 AMERICAN HERITAGE LIFE DRIVE 333 SOUTH ASHLAND BOULEVARD 333 WESTCHESTER AVENUE - SUITE N101 PO BOX 21801 80 F STREET NW 2000 CLASSEN CENTER P O BOX 1500 HEALTH CLAIMS P O BOX 2608 1867 AVENUE OF AMERICA P O BOX 834 P O BOX 727 WALL STREET STATION P O BOX 1568 P O BOX 1600 208 S LASALLE ST - SUITE 1440 611 5TH AVE P O BOX 10546 P O BOX 21670 P O BOX 368 P O BOX 1358 P O BOX 2806 P O BOX 2806 P O BOX 82533 P O BOX 1979 361 S FRONTAGE RD - STE 100

1

City

SOUTHEASTERN

EL PASO EL PASO WORCESTER NORTHBROOK JACKSONVILLE CHICAGO WHITE PLAINS EAGAN WASHINGTON OKLAHOMA CITY NASHVILLE WACO MONROE HORSHAM NEW YORK BIRMINGHAM DALLAS CHICAGO DES MOINES SPRINGFIELD EAGAN INDIANAPOLIS GLEN BURNIE CLINTON CLINTON LINCOLN TOPEKA BURR RIDGE

Posted August 2016

State

Zip

PA

19398

TX

79998

TX

79998

MA

01653

IL

60062

FL

32224

IL

60607

NY

10604

MN

55121

DC

20001

OK

73106

TN

37202

TX

73702

LA

71201

PA

19044

NY

10268

AL

35201

TX

75221

IL

60604

IA

50309

MO

65808

MN

55121

IN

46206

MD

21060

IA

52733

IA

52733

NE

68501

KS

66601

IL

60527

TPL Code Directory

Illinois Department of Healthcare and Family Services

Posted August 2016

430 AUTOMOTIVE WHOLESALERS OF ILL 460 BAKERY & CONFECTIONERY UNION 003 BANKERS LIFE & CASUALTY CO 086 BANNER LIFE INSURANCE CO 480 BC/BS IL- FED EMPLOYEE PROGRAM 070 BENEFICIAL STANDARD LIFE INS 044 BLUE CROSS BLUE SHIELD 433 BLUE CROSS BLUE SHIELD 006 BLUE CROSS BLUE SHIELD/HCSC 462 BOILERMAKER'S HEALTH & WELFARE 469 BRICKLAYER'S BENEFIT FUND 919 BTS 007 BUSINESS MEN'S ASSURANCE CO 008 CAPITOL LIFE INSURANCE CO 448 CARPENTERS H & W TRUST FUND 080 CENTRAL LIFE ASSURANCE CO 072 CENTRAL STATES HEALTH & LIFE 443 CENTRAL STATES JOINT BOARD 452 CENTRAL STATES SE & SW FUND 035 CIGNA HEALTH CARE 015 CIGNA/GREAT WEST HEALTHCARE 073 COLONIAL LIFE & ACCIDENT INS 051 COLUMBIA UNIVERSAL 084 COMBINED INSURANCE CO OF AMERI 047 COMBINED INSURANCE COMPANY 076 COMMONWEALTH LIFE & ACCIDENT 180 COMMUNITY HEALTH PLAN 077 CONFEDERATION LIFE INS CO 010 CONNECTICUT GENERAL LIFE INS 074 CONSECO 033 CONSTITUTION LIFE/PENN LIFE 011 CONTINENTAL CASUALTY 916 COPAYMENT - ADJUSTMENT

P O BOX 19252 ATTN: INSURANCE DEPT

SPRINGFIELD

IL

10401 CONNECTICUT AV -ATTN INS DEPT

KENSINGTON

MD

P O BOX 1935

CARMEL

IN

1701 RESEARCH BLVD

ROCKVILLE

MD

P O BOX 805107

CHICAGO

IL

3700 WILSHIRE BLVD

LOS ANGELES

CA

OUT OF STATE BCBS

VARIES

MD

600 E LAFAYETTE-P O BOX 1088

DETROIT

MI

300 EAST RANDOLPH

CHICAGO

IL

522 BROTHERHOOD BLDG - ATTN INS DEPT

KANSAS CITY

KS

124 SOUTHWEST ADAMS STREET- SUITE 430

PEORIA

IL

BMA TOWER - PENN VALLEY PARK P O BOX 1200 12 E. ERIE, ATTN: CLAIMS P O BOX 5620 P O BOX 34350 245 FENCL LN 9377 W HIGGINS ROAD 7555 GOODWIN ROAD P O BOX 188061 P O BOX 1365 P O BOX 19085 P O BOX 981625 P O BOX 981625 P O BOX 9000 P O BOX 372 ONE MOUNT PLEASANT ROAD P O BOX 188021 11825 N PENNSYLVANIA AVENUE P O BOX 130 P O BOX 64912

KANSAS CITY

MO

DENVER

CO

CHICAGO

IL

MADISON

WI

OMAHA

NE

HILLSIDE

IL

ROSEMONT

IL

CHATTANOOGA

TN

CHATTANOOGA

TN

COLUMBIA

SC

GREENVILLE

SC

EL PASO

TX

EL PASO

TX

LEAGUE CITY

TX

MATTOON

IL

TORONTO, ONTARIO M4Y 2Y5

CA

CHATTANOOGA

TN

CARMEL

IN

PENSACOLA

FL

ST PAUL

MN

62794 20895 46082 20850 60680 90010 00000 48226 60601 66101 61602

64108 80201 60611 53705 68134 60162 60018 37421 37422 29202 29602 79998 79998 77573 61938 00000 37422 46032 32591 55164

2

TPL Code Directory

Illinois Department of Healthcare and Family Services

915 COPAYMENT - RECIPIENT PAID 108 CORESOURCE 012 COUNTRY LIFE INSURANCE COMPANY 156 CUNA MUTUAL INSURANCE SOCIETY 911 ENROLLED MEDICARE PART A & B 013 EQUITABLE LIFE ASSURANCE 078 EQUITY NATIONAL LIFE INS. CO 171 FARMLAND INDUSTRIES 163 FEDERAL HOME LIFE INS CO 079 FEDERAL LIFE INSURANCE 183 FEDERATED MUTUAL INSURANCE 082 FIDELITY NATIONAL LIFE 431 FORD MOTOR COMPANY 197 GE FINANCIAL ASSURANCE/PHOENIX 014 GENAM BENEFIT/GREAT WEST LIFE 437 GENERAL ELECTRIC CO 432 GENERAL MOTORS CORPORATION 461 GLAZIERS UNION LOCAL 27 083 GLOBE LIFE & ACCIDENT INS CO 085 GOLDEN RULE INSURANCE COMPANY 459 GOVERNMENT EMPLOYEES HOSP ASSN 088 GUARANTEE TRUST LIFE 089 GUARDIAN LIFE INSURANCE CO 169 HARRINGTON BENEFIT 016 HARTFORD LIFE/MASS MUTUAL 196 HEALTH PARTNERS 090 HOLY FAMILY SOCIETY OF USA 017 HOME LIFE INSURANCE CO 018 HORACE MANN INSURANCE COMPANY 075 HUMANA HEALTH PLANS HMO 182 HUMANA INSURANCE COMPANY 043 ILL HOSPITAL & HEALTH SERVICES 019 ILL MUTUAL LIFE & CASUALTY CO 434 ILLINOIS BELL-BENEFIT DEPT

P O BOX 2920 P O BOX 10870 5910 MINERAL POINT RD

3 TRIAD CENTER - SUITE 200 P O BOX 8063 103 WEST 26TH AVENUE P O BOX 10821- MEDICARE CLAIMS CENTER 3750 W DEERFIELD RD 129 EAST BROADWAY P O BOX 8067 1000 LINCOLN HWY - ATTN EMP BENEFITS ONE AMERICAN ROW 13045 TESSON FERRY RD-CLAIMS P O BOX 414 1500 E ROUTE A 4225 LAWNDALE AVENUE 14000 PARKWAY PLAZA 712 ELEVENTH STREET P O BOX 4665 1275 MILWAUKEE AVE DO NOT USE 675 BROOKSEDGE BLVD HARTFORD PLAZA P O BOX 1289 P O BOX 2909 - CLAIM DEPT CN1367/NERGC 1 HORACE MANN PLAZA P O BOX 14601 P O BOX 14610 308 WEST STATE ST 300 SW ADAMS - BENEFITS DEPT. 300 EAST RANDOLPH

CLINTON CLEARWATER MADISON

SALT LAKE CITY LITTLE ROCK KANSAS CITY CLEARWATER RIVERWOODS OWATONNA DALLAS CHICAGO HEIGHTS HARTFORD ST LOUIS MILWAUKEE WENTZVILLE LYONS OKLAHOMA CITY LAWRENCEVILLE INDEPENDENCE GLENVIEW NO PLACE WESTERVILLE HARTFORD MINNEAPOLIS JOLIET PISCATAWAY SPRINGFIELD LEXINGTON LEXINGTON ROCKFORD PEORIA CHICAGO

3

Posted August 2016

IA

52733

FL

33757

WI

53705

UT

84180

AR

72203

MO

64116

FL

33757

IL

60015

MN

55060

TX

75205

IL

60411

CT

06115

MO

63128

WI

53201

MO

63385

IL

60534

OK

73184

IL

62439

MO

64051

IL

60025

IL

00000

OH

43081

CT

06115

MN

55440

IL

60434

NJ

08854

IL

62701

KY

40512

KY

40512

IL

61101

IL

61602

IL

60601

TPL Code Directory

Illinois Department of Healthcare and Family Services

474 ILLINOIS CENTRAL HOSPITAL ASSN 445 INDIANA LABORERS & HOD CARRIER 092 INDUSTRIAL LIFE INS CO 441 INTERNATIONAL FUNDS 467 INTERNTL LONGSHOREMAN'S ASSN 093 INTER-OCEAN INSURANCE COMPANY 470 IRON WORKERS H & W FUND 446 J C PENNEY COMPANY INC 145 JEFFERSON PILOT INS CO 071 JOHN DEERE LIFE INS CO. 020 JOHN HANCOCK LIFE INSURANCE 190 KAISER FOUNDATION HEALTH PLAN 162 KEY BENEFIT ADMINISTRATORS 451 LABORERS WELFARE FUND 021 LIBERTY LIFE ASSURANCE CO 095 LIBERTY NATIONAL LIFE INS CO 097 LIFE INVESTORS INSURANCE CO 022 LINCOLN NATIONAL LIFE INS CO 473 MAIL HANDLERS BENEFIT PLAN 917 MANDATORY IDPA RECIPIENT COPAY 099 MARQUETTE NATIONAL LIFE 024 MASSACHUSETTS MUTUAL/UNICARE 444 MEATCUTTERS & BUTCHERS #100 914 MEDICARE A & B & OTHER TPL 912 MEDICARE A & OTHER TPL PAYOR 913 MEDICARE B & OTHER TPL PAYOR 918 MEDICARE COB - DMERC 140 MEDICO 146 MENNONITE MUTUAL AID ASSN

025 METRAHEALTH/UNITED HEALTHCARE 457 MIDWESTERN TEAMSTERS H & W 994 MISCELLANEOUS TPL SOURCE 995 MISCELLANEOUS TPL SOURCE 996 MISCELLANEOUS TPL SOURCE

2024 HICKORY ROAD P O BOX 1587 2727 TURTLE CREEK BLVD 711 N COMMONS DR 3631 MARINE AVE - ATTN INS DEPT P O BOX 145497 5640 SOCKNESS DR ATTN INS DEPT P O BOX 869090 P O BOX 21008 110 NORTH EAST STREET P O BOX 852 - LTC DEPT P O BOX 12923 P O BOX 55210 11465 WEST CERMAK ROAD 100 LINCOLN WAY WEST 2001 THIRD AVENUE SOUTH P O BOX 39119 P O BOX 7807 P O BOX 8402

4800 N KENNETH AVENUE 4747 LINCOLN MALL DR-SUITE 500 1649 W ADAMS ST - ATTN HEALTH FUND

P O BOX 10386 P O BOX 483 P O BOX 500 18861 90TH AV. STE A

HOMEWOOD TERRE HAUTE DALLAS AURORA ST LOUIS CINCINNATI ROCKFORD PLANO GREENSBORO JACKSONVILLE BOSTON OAKLAND INDIANAPOLIS WESTCHESTER MISHAWAKA BIRMINGHAM PHOENIX FORT WAYNE LONDON

CHICAGO MATTESON CHICAGO

DES MOINES GOSHEN TULSA MOKENA

4

Posted August 2016

IL

60430

IN

47808

TX

75219

IL

60504

MO

63118

OH

45250

IL

61109

TX

75086

NC

27420

IL

62651

MA

02117

CA

94604

IN

46205

IL

60154

IN

46544

AL

35233

AZ

85069

IN

46801

KY

40742

IL

60630

IL

60443

IL

60612

IA

50306

IN

46527

OK

74101

IL

60442

TPL Code Directory

Illinois Department of Healthcare and Family Services

997 MISCELLANEOUS TPL SOURCE 998 MISCELLANEOUS TPL SOURCE 999 MISCELLANEOUS TPL SOURCE 888 MULTIPLE TPL SOURCES 058 MUTUAL BENEFIT LIFE 455 NATIONAL ASSOC LETTER CARRIERS 101 NATIONAL BENEFIT LIFE INS CO 104 NATIONAL LIBERTY LIFE INS CO 106 NATIONAL STATES INS CO 107 NATIONWIDE LIFE INS CO 458 NECA-IBEW WELFARE TRUST FUND 057 NEW ENGLAND MUTUAL LIFE INS CO 029 NEW YORK LIFE INSURANCE CO 122 NORTH AMERICAN BENEFIT NETWORK 139 NORTH AMERICAN CO LIFE&HEALTH 150 NORTH AMERICAN INSURANCE CO 030 NORTHWESTERN MUTUAL LIFE 109 OLD AMERICAN INSURANCE CO 168 OLD REPUBLIC LIFE INS 027 OMAHA HEALTH CARE/MUTUAL 456 OPERATING ENGINEERS H & W FUND 905 OTHER FEDERAL PROGRAM 904 OTHER STATE PROGRAM 032 PACIFIC MUTUAL LIFE INS 450 PAINTERS HEALTH & WELFARE 110 PAN-AMERICAN LIFE INSURANCE CO 909 PART A MEDICARE 910 PART B MEDICARE 906 PATIENT PAID 111 PAUL REVERE LIFE INSURANCE CO 112 PEKIN LIFE INSURANCE CO 113 PENN MUTUAL LIFE INS CO 902 PERSONAL INJURY SETTLEMENT

P O BOX 419876 20547 WAVERLY COURT P O BOX 2800 LIBERTY PARK 1830 CRAIG PARK CT P O BOX 2399 2120 HUBBARD AVENUE 501 BOYLSTON STREET 3316 FARNAM STREET P O BOX 94928 P O BOX 466 1232 FOURIER DRIVE 720 EAST WISCONSIN AVE P O BOX 418573 307 NORTH MICHIGAN AVE MUTUAL OF OMAHA PLAZA 10 EXECUTIVE WOODS COURT - ROUTE 159

KANSAS CITY ASHBURN AUSTIN FRAZER ST LOUIS COLUMBUS DECATUR BOSTON OMAHA CLEVELAND CHICAGO MADISON MILWAUKEE KANSAS CITY CHICAGO OMAHA BELLEVILLE

P O BOX 34799 3100 BROADWAY ST #511 P O BOX 981644

PHOENIX KANSAS CITY EL PASO

18 CHESTNUT STREET 2505 COURT STREET INDEPENDENCE SQUARE

WORCESTER PEKIN PHILADELPHIA

5

Posted August 2016

MO

64141

VA

20149

TX

78768

PA

19355

MO

63146

OH

43216

IL

62526

MA

02117

NE

68175

OH

44101

IL

60690

WI

53717

WI

53202

MO

64141

IL

60601

NE

68175

IL

62221

AZ

85067

MO

64111

TX

79998

MA

01608

IL

61558

PA

19172

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