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

GHI HMO WELLMARK BCBS FEP WELLMARK BCBS FEP WELLMARK BCBS FEP WELLMARK BCBS 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 WELLMARK BCBS OF IA WELLMARK BCBS OF SD WELLMARK BCBS OF SD 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 BLUE CROSS OF NORTHEASTERN PA BLUE CROSS OF NORTHEASTERN PA METROPOLITAN HEALTH PLAN TRIPLE-S INC CAREFIRST DC PART A ONLY

Updated: 09/30/2018

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s)

00002 00004 00005 00005 00006 00009 00010 00011 00012 00017 00018 00019 00020 00021 00023 00025 00026 00027 00028 00029 00030 00031 00032 00033 00034 00035 00036 00037 00041 00042 00044 00055 00060 00061 00062 00067 00068 00069 00070 00072 00074 00075

Customer Contact

Customer Service Customer/Provider Services Provider Services Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer/Provider Services Customer/Provider Services Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer/Provider Services Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Cathy Stitzer Cathy Stitzer Marilee Moritz Nayda Cruz Provider Services

Contact Number

(877) 244-4466 (800) 584-9242 (800) 524-9242 (800) 373-5348 (800) 524-9242 (800) 343-8915 (800) 343-8915 (800) 343-8915 (800) 343-8915 (800) 854-0186 (800) 244-6224 (800) 624-1110 (800) 524-9242 (800) 524-9242 (800) 524-9242 (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 (570) 200-4540 (570) 200-4540 (612) 543-1245 (787) 749-4949 (410) 998-4599

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

Trading Partner

CAREFIRST DC PART B ONLY BCBS OF NORTH DAKOTA BCBS OF WYOMING BCBS OF NORTH DAKOTA MEDICAL MUTUAL OF OHIO BCBS OF TENNESSEE - SUPPLEMENTAL UNITEDHEALTHCARE UNITEDHEALTHCARE GROUP HEALTH COOPERATIVE BCBS OF MINNESOTA BCBS OF MINNESOTA BCBS OF MINNESOTA EMPIRE BLUE CROSS BLUE SHIELD I EMPIRE BLUE CROSS BLUE SHIELD II BCBS OF KANSAS ANTHEM BCBS CONNECTICUT ANTHEM BCBS NEW HAMPSHIRE ANTHEM BCBS MAINE BLUE CROSS BLUE SHIELD OF LA NORTHEAST CARPENTERS HEALTH F226 MEDICA MMSI 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

Updated: 09/30/2018

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s)

00076 00077 00078 00079 00080 00081 00082 00083 00087 00088 00089 00090 00091 00092 00093 00095 00096 00097 00099 00102 00103 00104 00105 00106 00107 00108 00109 00110 00112 00113 00114 00114 00114 00115 00115 00115 00116 00118 00119 00122 00124 00127

Customer Contact

Provider Services Gina Bercherl Amber Zowada Gina Bercherl Sue Robinson Customer Service Customer Service Customer Service Michelle Anderson/Farmer Customer Service Customer Service Customer Service Refer To Back Of ID Card Refer To Back Of ID Card Customer Service Refer To Back Of ID Card Refer To Back Of ID Card Refer To Back Of ID Card Customer Service Rachel Corradi Customer Service Rebecca Johnson Part A only Part B only Part B only Refer To Back Of ID Card Refer To Back Of ID Card Min-Sug (Darren) Kong eSolutions Help Desk Nancy Herman Buffalo (CNY West) Albany Region II Albany (CNY East) Traditional Member Managed Care Member Provider Services Melissa Deboth Customer Service Laron Gaines Rebecca Garcia Customer Service Customer Service

Contact Number (410) 998-4599 (701) 277-2081 (307) 432-2743 (701) 277-2081 (216) 687-6108 (800) 553-8158 (866) 633-2446 (866) 633-2446 (206) 901-4588 (800) 531-6686 (800) 531-6686 (800) 531-6686

(800) 432-3990

(800) 392-4089 (732) 417-3900 ext. 272

(800) 635-6671 (608) 661-6620 (410) 998-4599 (410) 998-4599 (410) 998-4599

(206) 441-6514 (888) 333-8594 (717) 541-6274 (866) 638-9011 (800) 945-0566 (800) 856-0480 (800) 888-1238 (800) 459-7587 (800) 444-4552 (716) 887-8443 (302) 429-0260 (313) 664-7123 (602) 864-4818 (406) 721-2222 (800) 993-3262

Trading Partner ANTHEM CENTRAL - FACETS ANTHEM NATIONAL BCBS OHIO CTRL ANTHEM NATIONAL BCBS KY CONTROL 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 ANTHEM BCBS OF COLORADO BLUE CROSS OF CALIFORNIA UNICARE LIFE & HEALTH INSURANCE HEALTH NET OF CALIFORNIA, INC. INSURANCE PROGRAMMERS 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 POMCO, INC BCBS OF MASSACHUSETTS INC. HEALTHSMART BCBS OF VERMONT - SUPPLEMENTAL OXFORD HEALTH PLANS UNITEDHEALTHCARE C & R CONSULTING CORESOURCE, INC CORESOURCE, INC CORESOURCE, INC

Updated: 09/30/2018

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

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s)

00128 00131 00134 00136 00139 00140 00141 00148 00150 00151 00153 00156 00157 00160 00166 00168 00170 00171 00173 00180 00182 00184 00185 00188 00188 00189 00190 00191 00192 00208 00209 00210 00212 00214 00217 00220 00224 00226 00229 00229 00229

Customer Contact

Refer To Back Of ID Card Refer To Back Of ID Card Refer To Back Of ID Card Refer To Back Of ID Card Refer To Back Of ID Card Refer To Back Of ID Card Refer To Back Of ID Card Refer To Back Of ID Card EDI Department Mia Moore Dee McKee Andy Glankler Cindy Cargo Teresa Bauer Refer To Back Of ID Card Refer To Back Of ID Card Refer To Back Of ID Card Refer To Back Of ID Card Customer Service Amy Cook Juanita Phelps Customer Service Customer Service Outside IL IL Resident Customer Service Customer Service Customer Service Customer Service Rest of U.S. Customer Service Vivie Prichard Customer Service

Chantal Parent Customer Service Stewart McGehee C&R Customer One Beacon Ins Grp Crompton Corp All others

Contact Number

(800) 852-5195 (501) 502-1686 (501) 212-8520 (901) 473-3344 (217) 383-8208 (412) 201-2242

(800) 641-7761 (203) 269-7741 (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) 722-1471 (800) 830-2528 (800) 258-2226

(802) 371-3611 (888) 201-4133 (336) 540-7563 (212) 819-0792 (866) 889-7286 (866) 318-7173 (800) 223-3943

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

Trading Partner

BCBS OF KANSAS CITY BLUE CROSS BLUE SHIELD OF RI UNITED HEALTHCARE MERITAIN HEALTH ASURIS REGENCE BLUESHIELD OF UTAH REGENCE BLUESHIELD REGENCE BCBS OF OREGON REGENCE BLUESHIELD OF IDAHO , INC. 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 PLUMBERS WELFARE FUND,LCL 130 UA NATL ELEVATOR INDUSTRY HEALTH BE BLUE CROSS BLUE SHIELD OF NC ANTHEM BCBS VIRGINIA THE LOOMIS COMPANY BCBS OF WYOMING 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 TIC ? ELECTRICAL WORKERS FUND BLUE CROSS OF NORTHEASTERN PA BLUE CROSS OF NORTHEASTERN PA BLUE CROSS OF NORTHEASTERN PA BLUE CARE COOPERATIVE PLUMBERS & PIPEFITTERS WELFARE DANA NON UNION RETIREE VEBA TRUST

Updated: 09/30/2018

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s)

00232 00236 00237 00240 00246 00249 00250 00251 00252 00253 00254 00255 00256 00259 00267 00268 00280 00288 00295 00299 00300 00304 00305 00306

00308 00310 00312 00313 00314 00317

00318 00321 00322 00323 00329 00332 00333 00334

00335 00341 00343 00352

Customer Contact Kathy Currey Customer Service Stewart McGehee Customer Service Rebecca Thorn Rebecca Thorn Rebecca Thorn Rebecca Thorn Rebecca Thorn Customer Service Customer Service Customer Service Customer Service Carol Manning Customer Service Customer Service Amanda Smolka Lorraine Piazza Anna Brooks

Customer Service

ESolutions Help Desk Refer To Back Of ID Card

Amber Zowada Lisa Smith Ken Baur Customer Service Customer Service Brian Freer Lisa Smith Teresa Behm Susan Esterhai Jackie Neible Cathy Stitzer Cathy Stitzer Cathy Stitzer Cathy Stitzer Nancy Winer Lorraine Piazza

Contact Number (816) 395-3877 (800) 267-0439 (336) 540-7563 (800) 548-2041 (503) 375-4341 (503) 375-4341 (503) 375-4341 (503) 375-4341 (503) 375-4344 (817) 878-3300 (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

(888)333-8594

(307) 432-2743 (469) 417-1854 (715) 221-9556 (888) 762-2189 (888) 762-2189 (518) 641-3820 (469) 417-1854 (315) 448-9001 (866) 461-4239 (317) 923-4577 (570) 200-4540 (570) 200-4540 (570) 200-4540 (570) 200-4540 (314) 355-1000 (631) 249-0500

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

Trading Partner

BLUE CROSS OF NORTHEASTERN PA G.M.P. - EMPLOYERS RETIREE TRUST MEDICA, PART B ONLY MEDICA PART A ONLY CONNECTICUT GENERAL INSURANCE CO VANTAGE HEALTH PLAN, INC. BCBS OF MINNESOTA BCBS OF MINNESOTA BCBS OF MINNESOTA BCBS OF MINNESOTA BCBS OF MINNESOTA 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 COVENTRY NATIONAL ACCOUNTS EMBLEMHEALTH SVC COMPANY, LLC-HIP M.C.D.C HEALTH FUND PLUMBERS & PIPEFITTERS LOCAL 630 OE LOCAL 139 HBF PIPE TRADES INDUSTRY H&W PLAN HEALTH NET OF ARIZONA, INC. C&R CONSULTING BLUE SHIELD OF CALIFORNIA SCPT HEALTH & WELFARE FUND LIBERTY NATL LIFE INS CO - GMS GUNDERSEN LUTHERAN HEALTH PLAN SENTARA HEALTH PLANS INC. INDIANA LABORERS WELFARE FUND

Updated: 09/30/2018

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s)

00353 00354 00360 00361 00364 00365 00366 00367 00368 00369 00370 00371 00372 00374 00375 00377 00378 00379 00380 00386 00387 00388 00392 00406 00407 00411 00413 00417 00420 00423 00425 00426 00427 00428 00429 00431 00433 00434 00435 00436 00438 00439

Customer Contact Cathy Stitzer Debra Fulmer Stephanie Kelly Stephanie Kelly Customer Service Shanna Waters Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Claims Supervisor Ann Mott Katricia Helton Melinda Rodriguez Dahlia Kelly Debby Kunze Linda Sites Medical Claims Department Customer Service Right Choice Customer Service Center Customer Service Center Yolanda Alzati Lisa Schultz Terri Trasatti

Mia Moore Customer Service Michele Podolak Sandra Belot Amanda Ratcliff Annette Kusick Megan Lucas Healthnet Provider Service

Tammy Rutters Marcus Chin Customer Service Department Debra Schiffman Medicare Customer Service Line Melissa Wade

Contact Number (570) 200-4540 (239) 936-6242 (952) 992-2582 (952) 992-2582 (800) 244-6224 (318) 361-0990 (800) 531-6686 (800) 531-6686 (800) 531-6686 (800) 531-6686 (800) 531-6686 (800) 882-8633 (918) 280-4800 (503) 535-1431 (812) 232-4384 (806) 784-4378 (806) 784-4450 (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 (800) 937-6824 (315) 434-2447 (262) 970-5790 (954) 266-6322 (262) 549-9190 (812) 877-2581 (800) 977-7522

(530) 351-6019 (213) 385-6161 (972) 529-5085 (608) 643-1408 (800) 927-6048 (812) 238-2551

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