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 METROPOLITAN HEALTH PLAN TRIPLE-S INC CAREFIRST DC PART A ONLY CAREFIRST DC PART B ONLY BCBS OF NORTH DAKOTA

Updated: 03/31/2019

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 00072 00074 00075 00076 00077

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 Marilee Moritz Nayda Cruz Provider Services Provider Services Gina Bercherl

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 (612) 543-1245 (787) 749-4949 (410) 998-4599 (410) 998-4599 (701) 277-2081

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

Trading Partner 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 ANTHEM CENTRAL - FACETS ANTHEM NATIONAL BCBS OHIO CTRL

Updated: 03/31/2019

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s) 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 00128 00131

Customer Contact

Amber Zowada Gina Bercherl Sue Robinson Customer Service Customer Service Customer Service Tammy Francis 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 Andrea Butler Andrea Butler Andrea Butler 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 Michia Pippin Rebecca Garcia Customer Service Customer Service Refer To Back Of ID Card Refer To Back Of ID Card

Contact Number (307) 432-2743 (701) 277-2081 (216) 687-6108 (800) 553-8158 (866) 633-2446 (866) 633-2446 (509) 241-7106 (800) 531-6686 (800) 531-6686 (800) 531-6686

(800) 432-3990

(800) 599-2583 (732) 417-3900 ext. 272

(800) 635-6671 (608) 661-6620 (410) 998-7830 (410) 998-7830 (410) 998-7830

(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 (800) 485-2889 (313) 664-8031 (602) 864-4818 (406) 721-2222 (800) 993-3262

Trading Partner 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. 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 BCBS OF KANSAS CITY BLUE CROSS BLUE SHIELD OF RI UNITED HEALTHCARE MERITAIN HEALTH

Updated: 03/31/2019

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) 00134 00136 00139 00140 00141 00148 00150 00151 00153 00156 00157 00160 00166 00168 00170 00171 00173 00182 00184 00185 00188 00188 00189 00190 00191 00192 00208 00209 00210 00212 00214 00217 00220 00224 00226 00229 00229 00229 00232 00236 00237 00240

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 EDI Department Mia Moore Dee McKee Andy Glankler Lisa Parker 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 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 Provider Membership Stewart McGehee C&R Customer One Beacon Ins Grp Crompton Corp All others Kathy Currey Customer Service Stewart McGehee Customer Service

Contact Number

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

(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) 722-1471 (800) 830-2528 (800) 258-2226

(802) 371-3611 (800) 666-1353 (336) 540-7563 (212) 819-0792 (866) 889-7286 (866) 318-7173 (800) 223-3943 (816) 395-3877 (800) 267-0439 (336) 540-7563 (800) 828-6922

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

Trading Partner 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 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. BCBS OF MINNESOTA BCBS OF MINNESOTA

Updated: 03/31/2019

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s) 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 00341 00343 00352 00354 00360 00361 00364 00365 00366 00367

Customer Contact 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 Nancy Winer Lorraine Piazza Debra Fulmer Stephanie Kelly Stephanie Kelly Customer Service Shanna Waters Customer Service Customer Service

Contact Number (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 (314) 355-1000 (631) 249-0500 (239) 936-6242 (952) 992-2592 (952) 992-2592 (800) 244-6224 (318) 361-0990 (800) 531-6686 (800) 531-6686

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

Trading Partner 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 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

Updated: 03/31/2019

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s) 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 00440 00445 00455 00456 00457 00459 00460 00462

Customer Contact Customer Service Customer Service Customer Service Customer Service Claims Supervisor Ann Mott Katricia Helton Melinda Rodriguez Adrienne Columbus Angie Vorties 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 Nahuel Costilla Customer Service Department Debra Schiffman Medicare Customer Service Line Melissa Wade Melissa Wade Linda Sites Customer Service Blue Cross Blue Shield Blue Cross Blue Shield Member Service Customer Service Elisabeth Schaefer

Contact Number (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 (812) 238-2551 (304) 525-0331 (800) 599-2583 (888) 762-2189 (888) 762-2189 (800) 777-7902 (800) 645-3965 (626) 356-3560

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

Trading Partner 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 W MICH PLUMBERS LOCAL 174 HEALTH 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 ISG NEVADA ISG MAINE ISG WISSONSIN ISG KENTUCKY ISG VIRGINIA ISG NEW HAMPSHIRE ISG MISSOURI ISG OHIO ISG CALIFORNIA ISG COLORADO ISG CONNECTICUT ISG INDIANA ISG CONNECTICUT WGS INDIANA WGS KENTUCKY WGS MISSOURI WGS NEW YORK WGS OHIO WGS

Updated: 03/31/2019

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s) 00463 00470 00472 00473 00475 00476 00478 00479 00484 00485 00486 00489 00493 00494 00496 00498 00500 00501 00502 00503 00506 00507 00508 00509 00510 00511 00512 00513 00514 00515 00516 00517 00518 00519 00520 00521 00522 00523 00524 00526 00528 00529

Customer Contact

Jan Smith Christine Dugger-Praet Jennifer Barton Customer Service Refer To Back Of ID Card Refer To Back Of ID Card Mary Kemp Laura Boge Customer Service Refer To Back Of ID Card Donna Mcreavy Rebecca Thorn Kit Lee Kit Lee Tammy Shaw Karen Gotsch Customer Service Josie Hall Blue Cross/Blue Shield Blue Cross/Blue Shield Customer/Provider Services Customer/Provider Services Barbara Glembin 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 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 Refer To Back Of ID Card Refer To Back Of ID Card Refer To Back Of ID Card

Contact Number (877) 478-4542 (559) 228-4185 (315) 671-6985 (800) 216-2166

(801) 973-1001 (563) 556-8070 (219) 769-6944

(801) 578-5621 (503) 374-4341 (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 VIRGINIA WGS WISCONSIN WGS INDEPENDENCE BLUE CROSS INDEPENDENCE BLUE CROSS BLUE CROSS BLUE SHIELD OF NC BLUE SHIELD OF CALIFORNIA AFTRA HEALTH FUND USABLE MUTUAL INS COMPANY BCBS of MINNESOTA BCBS of MINNESOTA 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 MONROE PLUMBERS LOCAL UNION 671 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 UNITY HEALTH PLANS INSURANCE USABLE MUTUAL INS. COMPANY INFINEUM IBEW LOCAL NO 1 HEALTH & WELFARE NECA IBEW WELFARE TRUST FUND BLUE CROSS BLUE SHIELD OF VERMONT SC BAPTIST CONVENTION HEALTH PARTNERS

Updated: 03/31/2019

Coordination of Benefits Agreement National Crossover Process

Supplemental Payers and Insurers (Trading Partners)

Identification Number(s) 00530 00531 00532 00533 00535 00536 00537 00542 00544 00545 00555 00556 00557 00558 00559 00560 00561 00562 00563 00564 00565 00566 00567 00568 00569 00570 00571 00574 00575 00576 00577 00578 00579 00580 00581 00582 00583 00584 00585 00588 00589 00590 00591 00593

Customer Contact

Refer To Back Of ID Card Refer To Back Of ID Card Customer Service Customer Service Nakia Harrington Tammy Rutters Karen Ortolani Deb Gunter Customer Service Customer Service Insurance Teamsters 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 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 Dee Green Peggy Warner Beverly Harrison Kathy Harley Customer Service Gabriella Merullo Customer/Provider Services Customer/Provider Services Customer Service Krysta Zell Debra Schiffman Kim Burgess LaJuan Bryant Stephanie Labanon Kevin Cope Debbie Goodwin Roney Williams Provider Customer Service

Contact Number

(800) 645-3965 (800) 645-3965 (877) 258-3334 (530) 351-6109 (800) 562-4690 (501) 210-9043 (800) 531-6686 (800) 531-6686 (314) 513-5888

(515) 365-6374 (517) 327-2161 (630) 393-1701 (859) 721-0799 (301) 429-4999 (800) 257-2038 (800) 584-9242 (800) 584-9242 (419) 666-4450 (715) 852-5718 (608) 643-1408 (501) 502-1691 (813) 324-2948 (314) 752-2330 (217) 875-0254 (802) 371-3331 (800) 922-4966 (888) 663-6464

Trading Partner 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 THE HEALTH PLAN ANTHEM INC. FCHP MMSI, INC. D/B/A MEDICA HPS HOMETOWN HEALTH PLAN BCBS OF ALABAMA HEALTH TRADITION HEALTH PLAN 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 MINNESOTA TRANSAMERICA PREMIER LIFE INS UNITEDHEALTH GROUP WELLMARK BCBS OF SD WELLMARK BCBS OF IA TRANSAMERICA PREMIER LIFE INS HORIZON BCBS OF NEW JERSEY BCBS OF SOUTH CAROLINA HIGHMARK INC HIGHMARK INC GHI PPO GHI PPO 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 NATL LIFE INS CO - GMS GLOBE LIFE & ACCIDENTAL INS CO AMERICAN INCOME LIFE INS CO UNITED AMERICAN INSURANCE CO GLOBAL LIFE INSURANCE COMPANY NY EQUI LIFE & CASUALTY INS

Updated: 03/31/2019

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) 00595 00596 00597 00599 00600 00603 00604 00605 00606 00610 00611 00615 00618 00620 00621 00622 00623 00624 00628 30000 30002 30003 30004 30006 30013 30016 30017 30018 30019 30020 30023 30024 30025 30026 30027 30028 30029 30030 30032 30033 30034 30035 30036

Customer Contact Customer Service Tracey Compson Tracey Compson Amber Zowada Amber Zowada Kim Geary Refer To Back Of ID Card Customer Service Stephanie Kelly Amy Behbehani Rusty Redford Rebecca Johnson Jackie Trad Jackie Trad Vickie Wilkin Vickie Wilkin Vickie Wilkin Amy Cook Customer Service Jennifer Sali Customer Service Customer/Provider Services Provider Services Jennifer Sali Customer Service Judith Murray Customer Service Customer Service Michele Podolak Michele Podolak Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Customer Service Tristen Gaertner

Contact Number (888) 327-0671 (701) 282-1378 (701) 282-1378 (307) 432-2743 (307) 432-2743 (740) 695-7616

(800) 868-5200 (952) 992-2592 (775) 982-2726 (205) 220-7839 (608) 661-6620 (414) 577-3700 (414) 577-3700 (608) 278-9500 (608) 278-9500 (608) 278-9500 (203) 949-3239 (800) 531-6686 (610) 648-4990 (800) 523-5800 (800) 524-9242 (800) 524-9242 (610) 648-4990 (800) 624-1110 (803) 264-3889 (800) 345-3806 (800) 345-3806 (315) 434-2447 (315) 434-2447 (888) 762-2189 (888) 762-2189 (888) 762-2189 (888) 762-2189 (888) 762-2189 (888) 762-2189 (972) 529-5085 (972) 529-5085 (972) 529-5085 (972) 529-5085 (972) 529-5085 (972) 529-5085 (801) 579-3797

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