Payer list PDF dump - s3-us-west-2.amazonaws.com

RPRPA PA Payayer Liser Listt

Updated: 03/21/2022

UPDUPDAATEDTED

Date added since last publication. A = New Payer, U = Change to payer record.

PPARARTICIPTICIPAATING / NON-PTING / NON-PARARTICIPTICIPAATING / TRANSITIONAL (PTING / TRANSITIONAL (PAR / NON-PAR / NON-PAR / TRANS)AR / TRANS)

PParar - Payers which participate with Change Healthcare in efforts to increase EDI volumes by subsidizing all or a significant portion of the cost of electronic transmission.Non-PNon-Parar - Payers which do not participate with Change Healthcare in programs to increase EDI volumes by subsidizing the cost of electronic transmission.TTrransans - Payers which participate with Change Healthcare in efforts to increase EDI volume, but do not fully subsidize the cost of the electronic transaction.

PPAAYER IDYER ID

Used to route claims electronically to the payer. Each claim must be associated with a payer ID. If sending directly from your practice management system, speak to your practice management software vendor about where to store payer IDs.

PPAAYER TYPEYER TYPE

CCommerommercialcial - Commercial health plans and those participating Blue Cross/Blue Shield payers.GoGovvernmenernmentt - Medicare, Medicaid and non participating Blue Cross/Blue Shield payers.PPaperaper - Payers that can not receive claims electronically. Change Healthcare will attempt to match payer address to an electronic payer id to be submitted electronically prior to printing to paper and mailing to payer address noted on the claim.MedicMedicaidaid - Medicaid payersMedicMedicararee - Medicare payersWWorkorker's Cer's Compomp - Payers that accept Worker's Compensation E-BillsAAutouto - Payers that accept Auto Accident claims

SSTTAATE (STE (ST)T)

State specific payers have state abbreviation, payers in multiple states have MU, national payers are blank.

PPAAYER NAMEYER NAME

Common name used for payer and/or payer specific plans.

LINE OF BUSINESLINE OF BUSINESSS

PrProoffessionalessional - Medical claims.InsInstitutionaltitutional - Hospital claims.DenDentaltal - Dental claims.RRemittancemittancee - Electronic Remittance AdvisePrProoff. W. Work Cork Comp/ Insomp/ Inst. Wt. Work Cork Compomp - Workers Compensation for Professional and Institutional e-Bills.AAutouto - Payers that accept Auto Accident claims

EDI VERSION:EDI VERSION:

This column indicates what version of X12 the payer is receiving/submitting.

ENRENROLLMENT / AOLLMENT / AUTHORIZAUTHORIZATION:TION:

Payers marked require notification and/or enrollment prior to sending claims and/or receiving remittance. See RPA searchable Payer List for Enrollment documentation: http://www.capario.com/services/resource_center/payer/list/default_db.asp

RESPONSE LEVEL FRRESPONSE LEVEL FROM POM PAAYER:YER:

This column indicates the level of reporting the payer and/or trading partner returns to Change Healthcare:Change HealthcChange Healthcarare Ae Acknocknowledgemenwledgementt - Indicates that Change Healthcare acknowledges claim, but no response from payer.File LFile Leevvel Ael Acknocknowledgemenwledgementt - Indicates a file level response from the payer and/or trading partner.BaBatch Ltch Leevvel Ael Acknocknowledgemenwledgementt - Indicates a batch level response from the payer and/or trading partner.Claim LClaim Leevvel Ael Acknocknowledgemenwledgementt - Indicates a claim level response from the payer and/or trading partner.Claim LClaim Leevvel Rel Rejecejects Onlyts Only - Indicates a rejection response only from the payer and/or trading partner but no acceptance acknowledgement. For more information on the status message, please call the payer.Claim LClaim Leevvel Ael Accccepept/Rt/Rejecejectsts - Indicates a claim level acceptance or rejection from the payer and/or trading partner. For more information on the status message, please call the payer.

PPAAYER AYER ACCEPTCCEPTS COB:S COB:

Coordination of Benefits. This column indentifies payers who accept secondary claims electronically.

NONOTES/SPECIAL INSTES/SPECIAL INSTRUCTIONS:TRUCTIONS:

Notes or special instructions

PPAAYER TESYER TESTING REQUIRED:TING REQUIRED:

Prior to sending claims in production this payer requires testing through Change Healthcare. Contact Change Healthcare EDI Department for further instructions.

Updated: 03/21/2022

UPDUPDAATEDTEDPPARARTYPETYPE

PPAAYERYERIDID

PPAAYER TYPEYER TYPE SSTTAATETE PPAAYER NAMEYER NAME LLOBOBEDIEDIVERSIONVERSION

ENRENROLLMENTOLLMENT RESPONSE LEVELRESPONSE LEVEL COBCOB TESTESTINGTING NONOTESTES

A: 11/07/2019 Professional 5010A1

A: 07/27/2021 Non-Par 58379 CommercialAetna Senior Supplemental Insurance (formerlypayer id 62118)

Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID 62118.Providers will need to enroll for payerIDs 62118 and 58379 in order toreceive 835s for this payer

A: 12/10/2021 Non-Par TH071 Commercial AMA Insurance Agency Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDTH071. Providers will need to enrollfor payer IDs TH071 and 58379 inorder to receive 835s for this payer.

A: 09/08/2021 Non-Par 90886 Commercial MD ArmadaCare Remittance 5010A1 Enrollment

U: 07/27/2020 Non-Par SX073 Commercial NY Independent Health (IHA) (Formerly 95308) Institutional 5010A1 Enrollment

A: 11/15/2021 Non-Par 43471 Commercial Inetico, Inc. Remittance 5010A1 Enrollment

ECHO is returning 835s for payer ID43471. Providers will need to enrollfor payer IDs 43471 and 58379 inorder to receive 835s for this payer.

A: 08/25/2021 Non-Par JVHLW Commercial MI JVHL - Wellcare Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 12/01/2020 Non-Par 12422 Commercial Medica2 Institutional 5010A2Claim Level Accept /Reject

Yes

U: 07/28/2021 Non-Par SX170 Commercial MI Medicare Plus Blue Professional 5010A1 Enrollment Yes

This is a Medicare Advantage Plan forBCBS of Michigan. ERA enrollmentand processing is available underPayer ID: SB710

A: 02/18/2021 Non-Par 82832 Commercial IL Miami Children's Health Plan Remittance 5010A1 Enrollment

A: 07/27/2021 Non-Par 58379 Commercial Principal Financial Group (formerly payer id 61271) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID 61271.Providers will need to enroll for payerIDs 61271 and 58379 in order toreceive 835s for this payer.

A: 01/12/2022 Non-Par PROSP Commercial Prospect Medical Group Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDPROSP. Providers will need to enrollfor payer IDs PROSP and 58379 inorder to receive 835s for this payer.

A: 01/20/2022 Non-Par 31404 Commercial MO PROVIDERS PARTNERS HEALTH PLAN OF MISSOURI Remittance 5010A1 Enrollment

A: 10/07/2019 Non-Par TLINS Commercial NE Transamerica Financial Life Insurance Company Remittance 5010A1

A: 06/25/2021 Non-Par TWVA5 Commercial TriWest Region 5 CCN Institutional 5010A1 EnrollmentClaim Level Accept /Reject

A: 03/11/2022 Non-Par A0102 Commercial Vivida Health Plan Remittance 5010A1 Enrollment

U: 02/10/2012 Par 13162 Commercial 1199 National Benefit Fund Institutional 5010A1Claim Level Accept /Reject

U: 02/10/2012 Par 13162 Commercial 1199 National Benefit Fund Professional 5010A1Claim Level Accept /Reject

U: 11/14/2018 Non-Par 13162 Commercial 1199 SEIU National Benefit & Pension Fund Remittance 4010A1 Enrollment

U: 04/27/2016 Par 13162 Commercial 1199 SEIU National Benefit & Pension Fund Institutional 5010A1Claim Level Accept /Reject

Yes

U: 04/27/2016 Par 13162 Commercial 1199 SEIU National Benefit & Pension Fund Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/24/2014 Non-Par J1491 Workers' Comp MU 137654 CALIFORNIA, INC. Inst. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU 137654 CALIFORNIA, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 10/18/2019 Non-Par 2020E Commercial MU 2020 Eyecare Professional 5010A1Claim Level Accept /Reject

No

U: 03/24/2014 Non-Par 41556 Workers' Comp MU 21st Century Insurance Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU 21st Century Insurance Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU 22125 Roscoe Corp. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU 22125 Roscoe Corp. Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU 4d'S, Lp Dba Georgian Hotel Inst. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU 4d'S, Lp Dba Georgian Hotel Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/30/2019 Non-Par 26300 Commercial OH 888-OHIOCOMP Professional 5010A1 Enrollment File Level Ack.

U: 03/11/2013 Non-Par 74234 Commercial 8th District Electric - ERISA Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 93044 Commercial A & I Benefit Plan Administrators Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 93044 Commercial A & I Benefit Plan Administrators Institutional 5010A2Claim LevelAcknowledgement

A: 06/11/2020 Non-Par 11370 Commercial PA A G Administrators LLC Professional 5010A1Claim Level Accept /Reject

No

A: 06/11/2020 Non-Par 11370 Commercial PA A G Administrators LLC Institutional 5010A1Claim Level Accept /Reject

No

U: 03/24/2014 Non-Par J1491 Workers' Comp MU A J EDMUND COMPANY, INC. Inst. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU A J EDMUND COMPANY, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par 95241 Commercial A.G.I.A, Inc Professional 5010A1Claim LevelAcknowledgement

A: 08/08/2014 Non-Par 95241 Commercial A.G.I.A, Inc. Institutional 5010A2

U: 10/07/2019 Non-Par 95241 Commercial AZ A.G.I.A., Inc Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU A.W.S. Construction Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU A.W.S. Construction Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/28/2020 Non-Par 11983 Workers' Comp AAA Minnesota Remittance 5010A1 EnrollmentPayer id is for Automobile Medicalclaims for all states.

U: 09/23/2013 Non-Par 41556 Workers' Comp MUAAA Northern California, Nevada & Utah InsuranceExchange

Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MUAAA Northern California, Nevada & Utah InsuranceExchange

Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MUAAA Northern California, Nevada null InsuranceExchange


A: 12/24/2018 Non-Par 11983 Workers' Comp MN AAA PIP Prof. Work Comp 5010A1Claim Level Accept /Reject

Payer ID is for Automobile Medicalclaims for all states.

A: 03/27/2019 Non-Par 41556 Workers' Comp MU AAA PIP Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 04/19/2021 Non-Par 36273 Commercial AARP - UHC Ovations Insurance Solution Remittance 5010A1 Enrollment

U: 09/01/2016 Par 36273 Commercial AARP - UHC Ovations Insurance Solution Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 36273 CommercialAARP - United Healthcare Ovations InsuranceSolutions

Institutional 5010A2 Claim Level Rejects Only Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU ABC Const. Company Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU ABC Const. Company Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/01/2012 Par A0701 Commercial CA ABMG - Claims (DOS on or after 07 / 01 / 2010) Professional 5010A1Claim Level Accept /Reject

U: 01/01/2012 Par A0701 Commercial CA ABMG - Encounters (DOS on or after 07 / 01 / 2010) Professional 5010A1Claim Level Accept /Reject

U: 12/08/2020 Trans ABRI1 Commercial WI Abri Healthplan Professional 5010A1 Claim Level Rejects Only

ERA/835 are available for this payerby enrolling under payer id 20149. AllERA/835 will be delivered under payerid 20149.

U: 01/16/2015 Non-Par 68055 Commercial Absolute Total Care Institutional 5010A2 Yes

A: 07/27/2016 Trans TH067 Commercial MU Access Administrators (Formerly AHS01) Professional 5010A1Claim Level Accept /Reject

A: 07/27/2016 Trans TH067 Commercial MU Access Administrators (Formerly AHS01) Institutional 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

A: 07/02/2020 Non-Par INTEG Commercial Access Integra Remittance 5010A1 Enrollment

U: 01/09/2020 Non-Par INTEG Commercial NY Access Integra Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 08/04/2020 Non-Par AMG02 Commercial CA Access Medical Group Professional 5010A1Claim Level Accept /Reject

No

A: 08/04/2020 Non-Par AMG02 Commercial CA Access Medical Group Institutional 5010A2Claim Level Accept /Reject

No

A: 04/08/2019 Trans J1790 Workers' Comp MU ACCIDENT FUND WC Prof. Work Comp 5010A1

U: 09/01/2016 Par 64071 Commercial Acclaim Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 64071 Commercial Acclaim Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU ACCORD HUMAN RESOURCES OF CA Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU ACCORD HUMAN RESOURCES OF CA Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU ACCORD HUMAN RESOURCES OF OKLA Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU ACCORD HUMAN RESOURCES OF OKLA Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 08/07/2015 Non-Par AHIPA Commercial MU Accountable IPA Professional 5010A1

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Accurate Air Systems Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Accurate Air Systems Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Ace Property & Casualty Ins Co Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Ace Property & Casualty Ins Co Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Ace Property null Ins Co Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU ACME TRUCK PARTS Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU ACME TRUCK PARTS Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/16/2020 Non-Par 58379 Commercial ACS Benefit Services, Inc Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 04/06/2017 Non-Par 72467 Commercial ACS Benefit Services, Inc. Institutional 5010A2 ERA available under payer ID: 58379

U: 04/06/2017 Non-Par 72467 Commercial ACS Benefit Services, Inc. Professional 5010A1 No Response From Payer ERA available under payer ID: 58379

A: 08/08/2014 Non-Par 36112 Commercial ACS Rewards Administration Center Institutional 5010A2

U: 11/01/2012 Non-Par 36112 Commercial ACS Rewards Administration Center Professional 5010A1File LevelAcknowledgement

A: 09/01/2016 Par 38254 Commercial Activa Benefit Services, LLC Institutional 5010A2Claim Level Accept /Reject

U: 03/23/2012 Non-Par 38254 Commercial Activa Benefit Services, LLC Professional 5010A1Claim Level Accept /Reject

A: 09/13/2019 Par 66310 Commercial NJ Active Care Inc Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/13/2019 Par 66310 Commercial NJ Active Care Inc Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/09/2019 Par 38265 Commercial MI Administration System Research Corp Institutional 5010A2 No Response From Payer

U: 09/09/2019 Par 38265 Commercial MI Administration Systems Research Corp Institutional 5010A2 No Response From Payer

U: 09/09/2019 Par 38265 Commercial MI Administration Systems Research Corp. Institutional 5010A2 No Response From Payer

U: 02/11/2022 Trans 22384 Commercial PA Administrative Concepts, Inc. Institutional 5010A1Claim Level Accept /Reject

No

U: 02/11/2022 Trans 22384 Commercial PA Administrative Concepts, Inc. Professional 5010A1Claim Level Accept /Reject

No

A: 10/01/2019 Non-Par 22384 Administrative Concepts, Inc. Remittance 5010A1 Enrollment

U: 11/01/2012 Non-Par 59141 Commercial Administrative Services Inc. Institutional 5010A2File LevelAcknowledgement

Updated: 03/21/2022


PPAAYERYERIDID



U: 11/01/2012 Non-Par 59141 Commercial Administrative Services, Inc. Professional 5010A1 No Response From Payer

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Advance Paper Box Company Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Advance Paper Box Company Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 58202 Commercial Advanced Data Solutions, Inc. Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Advanced Engine Management, In Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Advanced Engine Management, In Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Advanced Real Estate Services, Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Advanced Real Estate Services, Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/11/2013 Non-Par 68056 Commercial Advantage by Buckeye Community Health Plan Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 68056 Commercial Advantage By Managed Health Services Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/09/2022 Non-Par ACIPA Commercial CA Advantage Care IPA Professional 5010A1Claim Level Accept /Reject

Yes

U: 12/06/2019 Par 83077 Commercial Advantek Benefit Administrators Professional 5010A1 No Response From Payer

U: 12/06/2019 Par 83077 Commercial Advantek Benefit Administrators Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 59374 Commercial MU Advantica Professional 5010A1Claim LevelAcknowledgement

Yes

A: 09/01/2016 Par 59374 Commercial Advantica Institutional 5010A2 Claim Level Ack. Yes

A: 09/01/2016 Par 59314 Commercial FL Advanzeon Solutions Institutional 5010A1 Claim Level Ack.

A: 09/01/2016 Par 59314 Commercial FL Advanzeon Solutions Professional 5010A1 Claim Level Ack.

A: 08/06/2021 Non-Par 95340 Commercial CA Adventist Health Remittance 5010A1 Enrollment

A: 09/04/2020 Non-Par 95340 Commercial CA Adventist Health Professional 5010A1Claim Level Accept /Reject

No

A: 09/04/2020 Non-Par 95340 Commercial CA Adventist Health Institutional 5010A1Claim Level Accept /Reject

No

U: 09/25/2019 Non-Par 36320 Commercial MU Advocate Health Centers Remittance 5010A1 Enrollment No Response From Payer

U: 09/01/2016 Par 36320 Commercial Advocate Health Centers Institutional 5010A2 Claim Level Rejects Only

U: 01/24/2012 Non-Par 36320 Commercial IL Advocate Health Centers Professional 5010A1Claim Level Accept /Reject

U: 09/03/2021 Par 65093 Commercial IL Advocate Health Partners Institutional 5010A2Claim Level Accept /Reject

Please contact Advocate PhysicianPartners Debbie Motz at(847)635-4182 for questions or moreinformation for both payer IDs.

U: 09/03/2021 Non-Par 65093 Commercial IL Advocate Health Partners Professional 5010A1Claim Level Accept /Reject

Please contact Advocate PhysicianPartners Debbie Motz at(847)635-4182 for questions or moreinformation for both payer IDs.

U: 09/03/2021 Non-Par 65093 Commercial IL Advocate Health Partners Remittance 5010A1 Enrollment

Providers must be activelycredentialed with and submittingclaims to Advocate Physician Partnersprior to ERA enrollment. ERA SETUPFORM IS REQUIRED TO ENROLL FOR835

A: 09/01/2016 Par CB637 Commercial Aegis Administrative Services Professional 5010A1 Claim Level Accept/Reject

A: 09/01/2016 Par CB637 Commercial Aegis Administrative Services Institutional 5010A2 Claim Level Rejects Only

U: 09/23/2013 Non-Par J1491 Workers' Comp MU AEROSPACE SERVICE & CONTROLS Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU AEROSPACE SERVICE & CONTROLS Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 60054 Commercial Aetna Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/16/2019 Par 60054 Commercial Aetna Professional 5010A1Claim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



U: 11/16/2021 Non-Par 60054 Commercial Aetna Remittance 5010A1 Enrollment

U: 09/01/2016 Par 57604 Commercial Aetna Affordable Health Choices (SM) - SRC Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 57604 Commercial Aetna Affordable Health Choices (SM) - SRC Professional 5010A1Claim Level Accept /Reject

Yes

U: 11/26/2019 Par 23228 Commercial PA Aetna Better Health - PA Medicaid Professional 5010A1Claim Level Accept /Reject

Yes

ERA setup form not required.Providers must enroll using the AetnaBetter Health ERA Enrollment form,and this must be submitted [email protected]

U: 09/01/2016 Par 23228 Commercial Aetna Better Health - PA Medicaid Institutional 5010A2Claim Level Accept /Reject

Yes

U: 11/21/2019 Non-Par 23228 Commercial PA Aetna Better Health - PA Medicaid Remittance 5010A1 Enrollment

A: 09/01/2016 Par 34734 Commercial NY Aetna Better Health Inc. (NY Medicaid Plan) Professional 5010A1Claim Level Accept /Reject

A: 01/19/2018 Par 128CA Commercial CA Aetna Better Health of California Institutional 5010A1Claim Level Accept /Reject

Yes

A: 01/19/2018 Par 128CA Commercial CA Aetna Better Health of California Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/02/2019 Non-Par 128CA Commercial CA Aetna Better Health of California Remittance 5010A1 Enrollment

A: 01/10/2022 Non-Par 128FL Commercial MU Aetna Better Health of Florida Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/10/2022 Non-Par 128FL Commercial MU Aetna Better Health of Florida Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/07/2019 Non-Par 128FL Commercial FL Aetna Better Health of Florida Remittance 5010A1 Enrollment

U: 09/01/2016 Par 26337 Commercial IL Aetna Better Health of IL Professional 5010A1 Yes

U: 09/01/2016 Par 26337 Commercial IL Aetna Better Health of IL Institutional 5010A2

U: 11/08/2021 Non-Par 26337 Commercial IL Aetna Better Health of IL Remittance 5010A1 Enrollment

A: 01/20/2021 Non-Par 68024 Commercial IL Aetna Better Health of Illinois Remittance 5010A1 Enrollment

A: 12/11/2020 Par 68024 Commercial IL Aetna Better Health of Illinois Professional 5010A1Claim Level Accept /Reject

No

A: 12/11/2020 Par 68024 Commercial IL Aetna Better Health of Illinois Institutional 5010A1Claim Level Accept /Reject

No

A: 03/17/2020 Par 128KS Commercial KS Aetna Better Health of Kansas Professional 5010A1Claim Level Accept /Reject

Yes

U: 08/19/2019 Non-Par 128KS Commercial AETNA BETTER HEALTH OF KANSAS Remittance 5010A1 Enrollment

A: 01/11/2019 Par 128KS Commercial KS Aetna Better Health of Kansas Institutional 5010A1Claim Level Accept /Reject

Yes

A: 02/09/2016 Par 128KY Commercial KY Aetna Better Health of Kentucky Professional 5010A1Claim Level Accept /Reject

U: 11/15/2019 Non-Par 128KY Commercial KY Aetna Better Health of Kentucky Remittance 5010A1 Enrollment

A: 02/09/2016 Par 128KY Commercial KY Aetna Better Health of Kentucky Institutional 5010A2Claim Level Accept /Reject

A: 09/01/2016 Par 128LA Commercial Aetna Better Health of Louisiana Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 128LA Commercial LA Aetna Better Health of Louisiana Institutional 5010A1Claim Level Accept /Reject

U: 03/02/2021 Non-Par 128LA Commercial LA Aetna Better Health of Louisiana Remittance 5010A1 Enrollment

A: 11/10/2017 Par 128MD Commercial MD Aetna Better Health of Maryland Institutional 5010A1Claim Level Accept /Reject

Yes

A: 11/10/2017 Par 128MD Commercial MD Aetna Better Health of Maryland Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/13/2020 Non-Par 128MD Commercial MD Aetna Better Health of Maryland Remittance 5010A1 Enrollment

U: 11/12/2019 Non-Par 128MI Commercial MI Aetna Better Health of Michigan Remittance 5010A1 Enrollment

A: 09/01/2016 Par 128MI Commercial MI Aetna Better Health of Michigan Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 128MI Commercial MI Aetna Better Health of Michigan Institutional 5010A1Claim Level Accept /Reject

U: 11/22/2019 Non-Par 46320 Commercial NJ Aetna Better Health of New Jersey Remittance 5010A1 Enrollment Enroll with Payer

A: 01/08/2016 Par 46320 Commercial NJ Aetna Better Health of New Jersey Institutional 5010A1Claim Level Accept /Reject

Enroll with Payer.

Updated: 03/21/2022


PPAAYERYERIDID



A: 07/09/2021 Non-Par 46320 Commercial NJ Aetna Better Health of New Jersey Professional 5010A1Claim Level Accept /Reject

Enroll with Payer

U: 04/01/2015 Non-Par 34734 Commercial NY Aetna Better Health of New York Institutional 5010A2

U: 11/12/2019 Non-Par 34734 Commercial NY Aetna Better Health of New York Remittance 5010A1 Enrollment

A: 09/01/2016 Par 50023 Commercial Aetna Better Health of Ohio Institutional 5010A2 Claim Level Accept/Reject Yes

U: 11/12/2019 Non-Par 50023 Commercial OH Aetna Better Health of Ohio Remittance 5010A1 Enrollment

A: 09/01/2016 Par 50023 Commercial OH Aetna Better Health of Ohio for Medicaid Professional 5010A1Claim Level Accept /Reject

Yes

A: 04/13/2016 Par 128VA Commercial VA Aetna Better Health of Virginia Institutional 5010A1Claim Level Accept /Reject

Yes

A: 04/13/2016 Par 128VA Commercial VA Aetna Better Health of Virginia Professional 5010A1Claim Level Accept /Reject

Yes

U: 11/15/2019 Non-Par 128VA Commercial VA Aetna Better Health of Virginia Remittance 5010A1 Enrollment

A: 10/05/2016 Par 128WV Commercial WV Aetna Better Health of West Virginia Institutional 5010A1Claim Level Accept /Reject

Yes

A: 10/05/2016 Par 128WV Commercial WV Aetna Better Health of West Virginia Professional 5010A1Claim Level Accept /Reject

Yes

U: 11/15/2019 Non-Par 128WV Commercial WV Aetna Better Health of West Virginia Remittance 5010A1 Enrollment

A: 11/09/2021 Non-Par 72700 Commercial MI Aetna Better Health Premier Plan JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 03/02/2019 Non-Par 72700 Commercial MI Aetna Better Health Premier Plan JVHL Remittance 5010A1

A: 11/09/2021 Non-Par 72700 Commercial MI Aetna Better Health Premier Plan JVHL Remittance 5010A1 Enrollment

U: 06/02/2015 Non-Par 99138 Commercial Aetna Encounters Institutional 5010A2 No Response From Payer Yes Diversified Data Design (DDD)

U: 04/29/2020 Par 60055 Commercial Aetna Encounters Professional 5010A1 Enrollment This is a BATCH ENCOUNTER payer.

U: 04/29/2020 Par 60055 Commercial Aetna Encounters Institutional 5010A1 Enrollment This is a BATCH ENCOUNTER payer.

U: 09/01/2016 Par 38692 Government Aetna Medicaid Professional 5010A1Claim Level Accept /Reject

U: 04/27/2017 Non-Par 38692 Commercial Aetna Medicaid Remittance 5010A1 Enrollment No Response From Payer

U: 07/27/2021 Non-Par 62118 Commercial MU Aetna Senior Supplemental Insurance Remittance 5010A1 Enrollment


U: 09/01/2016 Par 38692 Government Aetna TX Medicaid & CHIP Institutional 5010A2File LevelAcknowledgement

A: 10/18/2021 Non-Par 27600 Commercial MI Aetna US Healthcare - JVHL Remittance 5010A1

A: 10/18/2021 Non-Par 27600 Commercial MI Aetna US Healthcare JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 12/05/2014 Non-Par ADOCS Commercial Affiliated Doctors Of Orange Cnty Institutional 5010A2 Claim Level Ack.

U: 09/10/2012 Non-Par ADOCS Commercial Affiliated Doctors of Orange County Professional 5010A1 No Response From Payer

A: 11/17/2015 Par 27344 Commercial CA Affiliated Doctors of Orange County Professional 5010A1 No Response From Payer

A: 11/17/2015 Par 27344 Commercial CA Affiliated Doctors of Orange County Institutional 5010A1 No Response From Payer

U: 10/04/2017 Non-Par 13334 Commercial Affinity Health Plan Professional 5010A1Claim Level Accept /Reject

When submitting to this payer IDplease ensure the following: Theclaim is for a Medicaid, Child HealthPlus, or Family Health Plus memberand the subscriber ID is as printed onMember's ID Card. ERA availableunder payer ID: 58379

U: 10/04/2017 Non-Par 13334 Commercial Affinity Health Plan Institutional 5010A2Claim Level Accept /Reject

When submitting to this payer IDplease ensure the following: Theclaim is for a Medicaid, Child HealthPlus, or Family Health Plus memberand the subscriber ID is as printed onMember's ID Card. ERA availableunder payer ID: 58379

A: 09/20/2021 Non-Par 13334 Commercial Affinity Health Plan Remittance 5010A1 Enrollment


U: 09/20/2021 Non-Par 58379 Commercial Affinity Health Plan (Formerly 13334) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID 13334.

Updated: 03/21/2022


PPAAYERYERIDID



Providers will need to enroll for payerIDs 13334 and 58379 in order toreceive 835s for this payer.

U: 09/01/2016 Par 46594 Commercial Affinity Medical Group Professional 5010A1File LevelAcknowledgement

Yes

A: 09/01/2016 Par 46594 Commercial Affinity Medical Group Institutional 5010A2 No Response From Payer

U: 01/27/2012 Non-Par 95426 Commercial Affordable Benefit Adminidtrators Inc Institutional 5010A2File LevelAcknowledgement

U: 01/27/2012 Non-Par 95426 Commercial Affordable Benefit Administrators Inc. Professional 5010A1File LevelAcknowledgement

A: 12/02/2021 Non-Par 95426 Commercial Affordable Benefit Administrators Inc. Remittance 5010A1 Enrollment


A: 12/02/2021 Non-Par 58379 CommercialAffordable Benefit Administrators Inc. (Formerly95426)



U: 02/23/2017 Non-Par 13346 Commercial NY AFTRA Health Fund Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par 41556 Workers' Comp MU AG Facilities Operations, LLC Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU AG Facilities Operations, LLC Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/08/2014 Non-Par 37280 Commercial AGA Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 20048 Commercial Agate Resources Inc. (LIPA) Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 64158 Commercial Agency Services, Inc. Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 64158 Commercial Agency Services, Inc. Professional 5010A1Claim Level Accept /Reject

A: 09/25/2019 Non-Par ARA01 Commercial FL AgeRight Advantage Remittance 5010A1 Enrollment

A: 01/18/2017 Par ARA01 Medicare FL AgeRight Advantage Professional 5010A1Claim Level Accept /Reject

No

A: 01/18/2017 Par ARA01 Medicare FL AgeRight Advantage Institutional 5010A1Claim Level Accept /Reject

No

A: 02/23/2021 Non-Par AWNY6 Commercial NY AgeWell New York Remittance 5010A1 Enrollment

A: 02/23/2021 Par AWNY6 Commercial NY AgeWell New York Professional 5010A1 No Response From Payer Yes

A: 02/23/2021 Par AWNY6 NY AgeWell New York Institutional 5010A1 No Response From Payer Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Agri Beef Co. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Agri Beef Co. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 31138 Commercial AHPO (Cleveland OH) Professional 5010A1File LevelAcknowledgement

U: 09/01/2016 Par 31138 Commercial AHPO (Cleveland OH) Institutional 5010A2File LevelAcknowledgement

U: 01/16/2020 Non-Par 58379 Commercial AIAPT, insured by Trustmark Insurance Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 03/24/2014 Non-Par WC312 Workers' Comp AIG Prof. Work Comp 5010A1File LevelAcknowledgement

A: 01/28/2020 Non-Par WC312 Workers' Comp AIG Remittance 5010A1 Enrollment

A: 01/23/2018 Non-Par 12M47 Commercial AK AK - Medicare Part A (MAC JF) Remittance 5010A1 Enrollment

U: 04/02/2019 Par 95399 Commercial CA AKM Medical Group Professional 5010A1Claim Level Accept /Reject

U: 11/22/2019 Non-Par 12M01 Government AL Alabama - Medicare Part A (Formerly IR054) Institutional 5010A2 Enrollment

U: 11/18/2019 Non-Par 12M01 Government AL Alabama - Medicare Part A (Formerly IR054) Remittance 5010A1 Enrollment

A: 12/07/2018 Non-Par 95327 Commercial CA Alameda Alliance Institutional 5010A1Claim Level Accept /Reject

Yes

A: 02/02/2021 Non-Par 95327 Commercial CA Alameda Alliance Remittance 5010A1 Enrollment

U: 09/18/2019 Non-Par 95327 Commercial CA Alameda Alliance for Health Professional 5010A1 Enrollment Claim Level Accept / Yes

Updated: 03/21/2022


PPAAYERYERIDID



Reject

A: 10/16/2019 Non-Par AIPAZ ALAMITOS IPA COASTAL HEALTHCARE MANAGEMENT Professional 5010A1 Enrollment

U: 09/01/2016 Par 91136 Commercial Alaska Children's Services, Inc. Grp #P68 Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 91136 Commercial Alaska Childrens Services, Inc. Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 91136 Commercial Alaska Laborers Construction Industry Trust Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 91136 CommercialAlaska Laborers Construction Industry Trust Grp #F23

Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 91136 Commercial Alaska Pipe Trades Local 375 Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 91136 Commercial Alaska Pipe Trades Local Grp # F24 Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 91136 CommercialAlaska United Food & Commercial Workers Health &Welfare Trust

Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 91136 CommercialAlaska United Food & Commercial Workers Health &Welfare Trust Grp # F45


U: 08/15/2019 Non-Par 85600 Commercial NM Albuquerque Public Schools Remittance 5010A1 Enrollment

A: 02/07/2017 Trans 85600 Commercial NM Albuquerque Public Schools Professional 5010A1 Claim Level Ack. No

A: 02/07/2017 Trans 85600 Commercial NM Albuquerque Public Schools Institutional 5010A1 Claim Level Ack. No

A: 06/10/2016 Trans 44423 Commercial TN Alexian Brothers Community Services of TN Professional 5010A1 Claim Level Ack.

A: 06/10/2016 Trans 44423 Commercial TN Alexian Brothers Community Services of TN Institutional 5010A1 Claim Level Ack.

A: 10/04/2017 Non-Par 44423 Commercial TN Alexian Brothers Community Services of TN Remittance 5010A1 Enrollment

U: 08/02/2016 Par 13550 Commercial ALICARE Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 13550 Commercial ALICARE Professional 5010A1 Yes

A: 07/09/2019 Non-Par J1716 Workers' Comp Align Networks Prof. Work Comp 5010A1

A: 12/23/2019 Non-Par J1716 Commercial Align Networks Remittance 5010A1 Enrollment

A: 01/31/2020 Par ASMI1 Commercial MI Align Senior Care (MI) Professional 5010A1Claim Level Accept /Reject

No

A: 01/31/2020 Par ASMI1 Commercial MI Align Senior Care (MI) Institutional 5010A1Claim Level Accept /Reject

No

A: 02/03/2020 Par ASVA1 Commercial VA Align Senior Care (VA) Professional 5010A1Claim Level Accept /Reject

No

A: 02/03/2020 Par ASVA1 Commercial VA Align Senior Care (VA) Institutional 5010A1Claim Level Accept /Reject

No

A: 01/31/2020 Non-Par ASMI1 Commercial Align Senior Care - MI Remittance 5010A1 Enrollment

Provider must enroll with the payersas an in network provider. Providersneed to contact the payer forcredentialing at 1-844-205-7244

A: 02/12/2020 Non-Par ASVA1 Commercial Align Senior Care - VA Remittance 5010A1 Enrollment


A: 03/02/2016 Par AHCA1 Commercial MU Alignment Healthcare Professional 5010A1Claim Level Accept /Reject

A: 03/02/2016 Par AHCA1 Commercial MU Alignment Healthcare Institutional 5010A1Claim Level Accept /Reject

A: 08/17/2021 Non-Par ALIVI Commercial FL Alivi Health Professional 5010A1Claim Level Accept /Reject

No

A: 08/17/2021 Non-Par ATNET Commercial FL Alivi Therapy Network Professional 5010A1Claim Level Accept /Reject

No

U: 01/01/2012 Trans 37602 Commercial All Savers Insurance Co. Institutional 5010A2 No Response From Payer

U: 04/04/2016 Par 37602 Commercial All Savers Insurance Co. Professional 5010A1 No Response From Payer Yes

U: 02/25/2020 Non-Par 81400 Commercial All Savers Life (United Healthcare) Remittance 5010A1 Enrollment

A: 08/20/2021 Non-Par MRCHP Commercial MI Allcare Advantage Professional 5010A1Claim Level Accept /Reject

No

A: 08/20/2021 Non-Par MRCHP Commercial MI Allcare Advantage Institutional 5010A1Claim Level Accept /Reject

No

A: 10/08/2021 Non-Par MRIPA Commercial MI Allcare Health Plan Professional 5010A1Claim Level Accept /Reject

No

A: 10/08/2021 Non-Par MRIPA Commercial MI Allcare Health Plan Institutional 5010A1Claim Level Accept /Reject

No

Updated: 03/21/2022


PPAAYERYERIDID



A: 01/14/2019 Non-Par 24333 Commercial CA Allcare IPA Professional 5010A1Claim Level Accept /Reject

No

Please contact the ALLCare IPAProviders Relations Dept at(209.550.5200) prior to sendingclaims electronically.

A: 01/12/2022 Non-Par 24333 Commercial Allcare IPA Remittance 5010A1 Enrollment


A: 01/05/2022 Non-Par 58379 Commercial Allcare IPA (Formerly 24333 ) Remittance 5010A1 Enrollment


U: 04/27/2016 Non-Par 81040 Commercial Allegiance Benefit Plan Management Professional 5010A1Claim Level Accept /Reject

Yes

U: 04/27/2016 Non-Par 81040 Commercial Allegiance Benefit Plan Management Institutional 5010A2 Yes

U: 11/13/2019 Non-Par 81040 Commercial MU Allegiance Benefit Plan Mgmt Remittance 5010A1 Enrollment

U: 09/18/2019 Non-Par 23071 Commercial Alliance Behavioral Health Institutional 5010A1 EnrollmentClaim Level Accept /Reject

No

U: 09/30/2019 Non-Par 23071 Commercial Alliance Behavioral Health Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 02/03/2020 Non-Par 23071 Commercial NC Alliance Behavioral Health Remittance 5010A1 Enrollment

A: 09/09/2019 Non-Par 93658 Commercial OK Alliance Coal Health Plan Professional 5010A1Claim Level Accept /Reject

No

A: 09/09/2019 Non-Par 93658 Commercial OK Alliance Coal Health Plan Institutional 5010A1Claim Level Accept /Reject

No

A: 05/03/2013 Non-Par 13079 Commercial MU Alliance Healthcare / SRRIPA Professional 5010A1 No Response From Payer NoThis Payer ID should be used forStones River Regional IPA - AllianceHealthcare Florida claims only.

A: 08/08/2014 Non-Par 13079 Commercial MU Alliance Healthcare / SRRIPA Institutional 5010A2

U: 03/04/2016 Par 87726 Commercial Alliance PPO, LLC (Formerly 52148) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 01/01/2012 Trans AMS01 Commercial Alliance Select Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 88461 Commercial Alliance, The (A Wisconsin Provider Network) Institutional 5010A2 No Response From PayerID cards should show mailing addressof PO Box 44365, Madison, WI 53744.

A: 09/01/2016 Par 88461 Commercial Alliance, The (A Wisconsin Provider Network) Professional 5010A1Claim LevelAcknowledgement

U: 01/01/2012 Non-Par 58234 Commercial Alliant Health Plans of Georgia Institutional 5010A2 No Response From Payer

U: 01/24/2012 Non-Par 58234 Commercial GA Alliant Health Plans of Georgia Professional 5010A1Claim Level Accept /Reject

U: 10/07/2019 Par 58234 Commercial GA Alliant Health Plans Of Georgia Remittance 5010A1 Enrollment

A: 03/04/2013 Non-Par 50749 Commercial Allianz Global Assistance Professional 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par 50749 Commercial Allianz Global Assistance Institutional 5010A2 No Response From Payer

A: 09/24/2019 Non-Par 37308 Commercial Allied Benefit Systems Remittance 5010A1 Enrollment

A: 04/27/2016 Non-Par 37308 Commercial Allied Benefit Systems, Inc. Institutional 4010A1 No Response From Payer Yes

A: 04/27/2016 Non-Par 37308 Commercial Allied Benefit Systems, Inc. Professional 4010A1 No Response From Payer Yes

A: 11/02/2021 Non-Par 25757 Commercial KS ALLIED NATIONAL INC Remittance 5010A1 Enrollment

U: 05/06/2015 Non-Par NMM01 Commercial CA Allied Pacific of California Professional 5010A1Claim Level Accept /Reject

A: 04/06/2018 Par 54398 Commercial MN Allina Health | Aetna Professional 5010A1Claim Level Accept /Reject

Yes

A: 04/06/2018 Par 54398 Commercial MN Allina Health | Aetna Institutional 5010A1Claim Level Accept /Reject

Yes

A: 05/04/2016 Non-Par C1037 Commercial Allstate (except New Jersey) Remittance 5010A1 Enrollment

A: 04/11/2016 Non-Par C1037 Workers' Comp MU Allstate (except New Jersey) Prof. Work Comp 5010A1

A: 12/20/2019 LU610 Workers' Comp NJ Allstate New Jersey Prof. Work Comp 5010A1

A: 12/20/2019 LU610 Workers' Comp NJ Allstate New Jersey Inst. Work Comp 5010A1

A: 02/17/2022 Non-Par 58379 Commercial ALLWays Health Partners (Formerly 04293) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379* ECHO is

Updated: 03/21/2022


PPAAYERYERIDID



returning 835s for payer ID 04293.Providers will need to enroll for payerIDs 04293 and 58379 in order toreceive 835s for this payer.

U: 01/11/2019 Par 04293 Commercial MAALLWays Health Partners fka Neighborhood HealthPlan

Professional 5010A1

U: 02/17/2022 Non-Par 04293 Commercial MAALLWays Health Partners fka Neighborhood HealthPlan



U: 01/11/2019 Par 04293 Commercial MAALLWays Health Partners fka Neighborhood HealthPlan


U: 12/19/2019 Non-Par ALOHA Commercial HI Aloha Care Advantage Professional 5010A1 EnrollmentClaim Level Accept /Reject

U: 12/19/2019 Non-Par ALOHA Commercial HI Aloha Care Advantage Remittance 5010A1 Enrollment

A: 02/26/2021 Non-Par ALOHA Commercial HI Alohacare Advantage Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 04/27/2018 Non-Par MPM32 Commercial CA Alpha Care Medical Group Professional 5010A1 Claim Level Ack.

A: 12/09/2019 Non-Par NMM04 Commercial CA Alpha Care Medical Group NMM Professional 5010A1Claim Level Accept /Reject

No

A: 12/09/2019 Non-Par NMM04 Commercial CA Alpha Care Medical Group NMM Institutional 5010A1Claim Level Accept /Reject

No

A: 06/10/2016 Trans TH085 Commercial Alpha Data Professional 5010A1Claim Level Accept /Reject

U: 01/01/2012 Non-Par 75261 Commercial Alpha Data Systems Professional 5010A1File LevelAcknowledgement

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Alpha Property Management, Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Alpha Property Management, Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par A0701 Commercial CAAlta Bates Medical Group (ABMG) (Brown andToland)


U: 01/01/2012 Par A0701 Commercial CAAlta Bates Medical Group (ABMG) - Claims (DOS onor after 07 / 01 / 2010)


U: 01/01/2012 Par A0701 Commercial CAAlta Bates Medical Group (ABMG) - Encounters (DOSon or after 07 / 01 / 2010)


U: 03/11/2013 Non-Par 25133 Commercial Alta Health Strategies Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Alta Healthcare Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Alta Healthcare Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 06/28/2019 Par 95712 Commercial CA Altamed Health Services Institutional 5010A1 Claim Level Rejects Only No

A: 06/28/2019 Par 95712 Commercial CA Altamed Health Services Professional 5010A1 Claim Level Rejects Only No

A: 12/02/2021 Non-Par 95712 Commercial CA Altamed Health Services Remittance 5010A1 Enrollment

ECHO is returning 835s for payer ID95712 . Providers will need to enrollfor payer IDs 95712 and 58379 inorder to receive 835s for this payer.

A: 12/02/2021 Non-Par 58379 Commercial Altamed Health Services (Formerly 95712) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID 95712 .Providers will need to enroll for payerIDs 95712 and 58379 in order toreceive 835s for this payer.

A: 01/07/2022 Non-Par RP016 Commercial MD Alterwood Advantage Professional 5010A1Claim Level Accept /Reject

No

A: 01/07/2022 Non-Par RP016 Commercial MD Alterwood Advantage Institutional 5010A1Claim Level Accept /Reject

No

A: 12/07/2021 Non-Par 58379 Commercial AMA Insurance Agency (Formerly TH071) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID TH071.Providers will need to enroll for payerIDs TH071 and 58379 in order to

Updated: 03/21/2022


PPAAYERYERIDID



receive 835s for this payer.

U: 08/02/2016 Par 13550 Commercial Amalgamated Life Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 13550 Commercial Amalgamated Life Professional 5010A1 Yes

A: 10/08/2020 Non-Par 13550 Commercial Amalgamated Life Remittance 5010A1 Enrollment

U: 09/01/2016 Par 13343 Commercial Amalgamated Life - PA / Alicare Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 13343 Commercial Amalgamated Life - PA / Alicare Institutional 5010A2Claim LevelAcknowledgement

A: 02/09/2017 Par AMBHN Commercial IL Ambay Health Network Professional 5010A1 Claim Level Ack. No

A: 02/09/2017 Par AMBHN Commercial IL Ambay Health Network Institutional 5010A1 Claim Level Ack. No

U: 01/16/2020 Non-Par 58379 Commercial AmeraPlan Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 02/11/2013 Non-Par PPM01 Commercial CA Ameri-West Health Associates - Claims Only Professional 5010A1Claim Level Accept /Reject

Yes

U: 04/27/2016 Non-Par 75137 Commercial Ameriben Solutions Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 75137 Commercial AmeriBen Solutions Inc. Institutional 5010A2 Yes

U: 11/26/2019 Non-Par 75137 Commercial MU Ameriben Solutions, Inc. Remittance 5010A1 Enrollment

A: 03/26/2015 Non-Par 55349 Commercial SC America's 1st Choice of South Carolina, Inc. Professional 5010A1 File Level Ack.

A: 03/26/2015 Non-Par 55349 Commercial SC America's 1st Choice of South Carolina, Inc. Institutional 5010A1 File Level Ack.

U: 06/30/2012 Non-Par 63103 Commercial American Behavioral Professional 5010A1 No Response From Payer

U: 06/30/2012 Non-Par 63103 Commercial American Behavioral Institutional 5010A2 No Response From Payer

A: 11/16/2021 Non-Par AFLAC Commercial American Family Life Assurance Co. Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDAFLAC. Providers will need to enrollfor payer IDs AFLAC and 58379 inorder to receive 835s for this payer.

A: 11/16/2021 Non-Par 58379 CommercialAmerican Family Life Assurance Co. (FormerlyAFLAC)


*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID AFLAC.Providers will need to enroll for payerIDs AFLAC and 58379 in order toreceive 835s for this payer.

U: 03/24/2014 Non-Par 41556 Workers' Comp MU American Furniture Warehouse Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU American Furniture Warehouse Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 09/01/2016 Par 62030 Commercial American General Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 62030 Commercial American General Professional 5010A1Claim Level Accept /Reject

U: 08/15/2019 Non-Par 62030 Commercial American General Remittance 5010A1 Enrollment

A: 01/19/2022 Non-Par 31155 Commercial TX AMERICAN HEALTH ADVANTAGE OF TEXAS Remittance 5010A1 Enrollment

U: 09/01/2016 Trans 01066 Commercial American Healthcare Alliance Institutional 5010A2 No Response From Payer

U: 09/01/2016 Trans 01066 Commercial American Healthcare Alliance Professional 5010A1Claim Level Accept /Reject

U: 08/15/2019 Non-Par 26119 Commercial American Insurance Admin (AIA) Remittance 5010A1 Enrollment

U: 03/08/2016 Par 87726 Commercial American International Group, Inc. (AIG) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/08/2016 Par 87726 Commercial American International Group, Inc. (AIG) Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU American Liberty Insurance Company Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU American Liberty Insurance Company Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 72099 Commercial American LIFECARE Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 72099 Commercial American LIFECARE Professional 5010A1File LevelAcknowledgement

Yes

A: 11/12/2020 Non-Par 74048 Commercial American National Ins Co Remittance 5010A1 Enrollment

U: 09/01/2016 Par 74048 Commercial American National Insurance Company (ANICO) Institutional 5010A2 No Response From Payer Yes

U: 01/25/2021 Par 74048 Commercial American National Insurance Company (ANICO) Professional 5010A1Claim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



A: 10/10/2019 Par CB711 Commercial PAAmerican Plan Administrators (InnovativeHealthware Solutions)


No

A: 10/10/2019 Par CB711 Commercial PAAmerican Plan Administrators (InnovativeHealthware Solutions)

Institutional 5010A1Claim Level Accept /Reject

No

A: 09/01/2016 Par 44444 Commercial American Postal Workers Union Institutional 4010A1 No Response From Payer

U: 08/06/2014 Par 44444 Commercial American Postal Workers Union Professional 5010A1 No Response From Payer Yes

Secondary claims may be deniedrequesting further information. Pleasereview responses as part of normalworkflow

U: 02/01/2022 Non-Par 44444 Commercial American Postal Workers Union Health Plan Remittance 5010A1 Enrollment

Providers must enroll for payer id44444 in order to receive ERA/835from American Postal Workers forpayments prior to 1/1/2022. For ERAissues related to payments prior to 1/1/2022 contact PNC Bank [email protected] or877-597-5489.

A: 02/07/2022 Non-Par 58379 CommercialAmerican Postal Workers Union Health Plan(Formerly44444)


*This enrollment will setup all payernames under payer id 58379*Providers must enroll under Payer ID44444 for ERAs for payments madefrom this payer PRIOR to 1/1/2022.For claim payments made AFTER 1/1/2022, Providers must enroll underPayer ID 58379 ECHO.

A: 06/29/2020 Non-Par 43146 Commercial AMERICAN SPECIALTY HEALTH Remittance 5010A1 Enrollment

U: 03/07/2017 Non-Par 43146 Commercial American Specialty Health (Formerly ASH01) Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU American Tile & Brick Veneer Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU American Tile & Brick Veneer Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU AMERICAN TOW & AUTO REPAIR (DB Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU AMERICAN TOW & AUTO REPAIR (DB Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/24/2014 Non-Par TH117 Commercial American Whole Health Networks Professional 5010A1 Claim Level Ack. Yes

U: 03/11/2013 Trans 37322 Commercial American Worker Health Plan Professional 5010A1File LevelAcknowledgement

Yes

U: 09/01/2016 Trans 37322 Commercial American Worker Health Plan Institutional 5010A2 Yes

U: 01/16/2020 Non-Par 58379 Commercial Americas Choice Healthplans LLC Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 04/27/2016 Par 86047 Commercial NJAmerichoice NJ Medicaid & Family Care(UnitedHealthCare Community Plan)


Yes

U: 11/04/2021 Non-Par 86047 Commercial NJAmerichoice NJ Medicaid & Family Care(UnitedHealthCare Community Plan)


U: 04/27/2016 Par 86047 Commercial NJAmerichoice NJ Medicaid & FamilyCare(UnitedHealthCare Community Plan)

Professional 5010A1 Yes

U: 01/10/2020 Non-Par TEX01 Commercial TX Americhoice of Texas Remittance 5010A1 Enrollment

TEX01 is for remittance only. Claimsshould be submitted to Payer ID87726 ERA SETUP FORM IS REQUIREDTO ENROLL FOR 835

U: 04/27/2016 Par 86047 Commercial NJAmeriChoice of New Jersey Personal Care Plus(Medicare) (formerly 86001)


Yes

All claims require your AmeriChoiceassigned provider id number. Pleasecall AmeriChoice @ 866-362-3368 foryour provider id number

U: 03/04/2016 Par 87726 Commercial NYAmeriChoice of New York (Medicaid)(formerly86048)


U: 03/04/2016 Par 87726 Commercial NYAmeriChoice of New York (Medicare)(formerly86002)


U: 03/04/2016 Par 87726 Commercial NYAmeriChoice of New York Personal Care Plus(Medicare) (formerly 86002)

Professional 5010A1

U: 03/04/2016 Par 87726 Commercial NYAmeriChoice of New York, Inc. - Medicaid NY(formerly 86048)

Professional 5010A1

Updated: 03/21/2022


PPAAYERYERIDID



U: 03/04/2016 Par 87726 Commercial PA Americhoice of PA(Medicare) (formerly 25175) Professional 5010A1Claim Level Accept /Reject

U: 04/07/2016 Par MSO11 Commercial CAAmeriChoice of San Diego County Medical Services(CMS)


U: 04/18/2016 Par 87726 Commercial TNAmerichoice Tennessee (TennCare Secure PlusComplete) UHC Community Plan (formerly 95378)


U: 10/01/2021 Non-Par 95378 Commercial TNAmerichoice Tennessee (TennCare Secure PlusComplete) UHC Community Plan


*UHC Community Plans IA/FL/TennCare* *To receive ERA for thisPayer ID you must enroll in Payer ID's87726 & 04567 also*

U: 04/18/2016 Par 87726 Commercial TNAmerichoice Tennessee (TennCare Secure PlusComplete) UHC Community Plan (formerly 95378)


U: 03/04/2016 Par 87726 Commercial WI Americhoice Wisconsin Professional 5010A1Claim Level Accept /Reject

Yes

U: 04/30/2020 Non-Par 27514 Commercial MU Amerigroup Institutional 5010A2Claim Level Accept /Reject

Yes

U: 01/15/2020 Non-Par 27514 Commercial MU AMERIGROUP (Formerly 28804) Professional 5010A1Claim Level Accept /Reject

Yes

U: 11/11/2019 Non-Par 27514 Commercial AMERIGROUP (Formerly 28804) Remittance 5010A1 Enrollment Yes

U: 11/20/2019 Non-Par 54763 Commercial AmeriHealth / Independence Administrators Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes ERA is available under payer id SX055

U: 09/30/2019 Non-Par SX074 Commercial DEAmeriHealth - Delaware (Non-HMO Claims) (formerly93688)

Professional 5010A1 EnrollmentClaim Level Accept /Reject


A: 11/21/2019 Non-Par 12X28 Government NJAmeriHealth - New Jersey (Non HMO)(FormerlySX075 / 60061)



U: 09/30/2019 Non-Par SX075 Commercial NJAmeriHealth - New Jersey (Non-HMO Claims)(formerly 60061)



U: 09/24/2019 Non-Par 54763 Government PA AmeriHealth Administrators Institutional 5010A2 EnrollmentClaim Level Accept /Reject


A: 10/14/2021 Non-Par 54763 Commercial PA AmeriHealth Administrators Remittance 5010A1 Enrollment

*ERA payer ID is now SX055 for ERADIRECT from the payer. If the providerneeds the ERA from Instamed theyhave to enroll under 54763*

U: 05/29/2020 Non-Par SX055 Commercial PA AmeriHealth Administrators (Formerly 54763) Remittance 4010A1 Enrollment

A: 01/12/2018 Non-Par 77799 Commercial DE Amerihealth Caritas Delaware Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/12/2018 Non-Par 77799 Commercial DE Amerihealth Caritas Delaware Institutional 5010A1Claim Level Accept /Reject

Yes

A: 08/18/2021 Non-Par 77799 Commercial DE Amerihealth Caritas Delaware Remittance 5010A1 Enrollment

ECHO is returning 835s for payer ID77799. Providers will need to enrollfor payer ID 77799 and 58379 in orderto receive 835s for this payer.

U: 08/18/2021 Non-Par 58379 Commercial DEAmeriHealth Caritas Delaware (Formerly payer id77799)


*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID 77799.Providers will need to enroll for payerID 77799 and 58379 in order toreceive 835s for this payer.

U: 06/29/2021 Non-Par 77003 Commercial FL AmeriHealth Caritas Florida Professional 5010A1Claim Level Accept /Reject

Yes

U: 06/29/2021 Non-Par 77003 Commercial FL AmeriHealth Caritas Florida Institutional 5010A1Claim Level Accept /Reject

Yes

U: 07/06/2021 Non-Par 77003 Commercial AmeriHealth Caritas Florida Remittance 5010A1 Enrollment


U: 07/06/2021 Non-Par 58379 Commercial AmeriHealth Caritas Florida (formerly 77003) Remittance 5010A1 Enrollment


U: 05/13/2021 Non-Par 27357 Commercial LA AmeriHealth Caritas Louisiana Remittance 5010A1 EnrollmentECHO is returning 835s for payer ID27357. Providers will need to enroll

Updated: 03/21/2022


PPAAYERYERIDID



for payer IDs 27357 and 58379 inorder to receive 835s for this payer.

U: 05/26/2021 Non-Par 27357 Commercial LA AmeriHealth Caritas Louisiana Professional 5010A1Claim Level Accept /Reject

Yes

AmeriHealth Caritas Louisiana canaccept claim submissions via paperor electronically (EDI). For questionsabout claims submissions, callProvider Services at 1-888-922-0007

U: 05/26/2021 Non-Par 27357 Commercial LA AmeriHealth Caritas Louisiana Institutional 5010A2Claim Level Accept /Reject

Yes

AmeriHealth Caritas Louisiana canaccept claim submissions via paperor electronically (EDI). For questionsabout claims submissions, callProvider Services at 1-888-922-0007

U: 05/13/2021 Non-Par 58379 Commercial LA AmeriHealth Caritas Louisiana (27357) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

A: 09/03/2019 Non-Par 87716 Commercial NH AmeriHealth Caritas New Hampshire Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/03/2019 Non-Par 87716 Commercial NH AmeriHealth Caritas New Hampshire Institutional 5010A1Claim Level Accept /Reject

Yes

A: 11/10/2020 Non-Par 87716 Commercial NH AmeriHealth Caritas New Hampshire Remittance 5010A1 Enrollment


A: 11/10/2020 Non-Par 58379 Commercial NH AmeriHealth Caritas New Hampshire (87716) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

A: 01/11/2022 Non-Par 83148 Commercial NCAmeriHealth Caritas Next a Product of AmeriHealthCaritas North Carolina


Yes

A: 01/11/2022 Non-Par 83148 Commercial NCAmeriHealth Caritas Next a Product of AmeriHealthCaritas North Carolina


Yes

A: 06/15/2021 Non-Par 81671 Commercial AmeriHealth Caritas North Carolina Remittance 5010A1 Enrollment

*This plan is only for DOS 7/1/2021and forward* ECHO is returning 835sfor payer ID 81671.Providers will needto enroll for payer IDs 81671 and58379 in order to receive 835s for thispayer.

A: 06/25/2021 Non-Par 81671 Commercial NC AmeriHealth Caritas North Carolina Professional 5010A1Claim Level Accept /Reject

YesThis payer is available from 7/1/2021and encourages early on boarding

A: 06/25/2021 Non-Par 81671 Commercial NC AmeriHealth Caritas North Carolina Institutional 5010A1Claim Level Accept /Reject

YesThis payer is available from 7/1/2021and encourages early on boarding.

A: 06/15/2021 Non-Par 58379 CommercialAmeriHealth Caritas North Carolina (formerly payerid 81671)


*This plan is only for DOS 7/1/2021and forward* *This enrollment willsetup all payer names under payer id58379* ECHO is returning 835s forpayer ID 81671.Providers will need toenroll for payer IDs 81671 and 58379in order to receive 835s for this payer.

U: 05/26/2021 Non-Par 77062 Commercial PA AmeriHealth Caritas PA Community Health Choices Professional 5010A1Claim Level Accept /Reject

Yes

Community HealthChoice Plan- fordual-eligible individuals andindividuals with physical disabilitieswho qualify for the Department ofHuman Services' CommunityHealthChoices program.

U: 05/26/2021 Non-Par 77062 Commercial PA AmeriHealth Caritas PA Community Health Choices Institutional 5010A1Claim Level Accept /Reject

Yes

Community HealthChoice Plan- fordual-eligible individuals andindividuals with physical disabilitieswho qualify for the Department ofHuman Services' CommunityHealthChoices program.

A: 08/18/2021 Non-Par 77062 Commercial PA AmeriHealth Caritas PA Community Health Choices Remittance 5010A1 Enrollment


A: 08/18/2021 Non-Par 58379 Commercial PAAmeriHealth Caritas PA Community Health Choices(Formerly payer id 77062)


*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID 77062.Providers will need to enroll for payerID 77062 and 58379 in order to

Updated: 03/21/2022


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receive 835s for this payer.

U: 05/13/2021 Non-Par 22248 Commercial PA Amerihealth Caritas Pennsylvania Institutional 5010A2Claim Level Accept /Reject

YesHealthChoices Plan - Coverage inPennsylvania: Lehigh/Capital, NorthEast and New West

U: 05/13/2021 Non-Par 22248 Commercial PA Amerihealth Caritas Pennsylvania Professional 5010A1Claim Level Accept /Reject

YesHealthChoices Plan - Coverage inPennsylvania: Lehigh/Capital, NorthEast and New West

A: 08/18/2021 Non-Par 22248 Commercial PA AmeriHealth Caritas Pennsylvania Remittance 5010A1 Enrollment

*ECHO is returning 835s for payer ID22248. Providers will need to enrollfor payer ID 22248 and 58379 in orderto receive 835s for this payer.*

U: 08/18/2021 Non-Par 58379 Commercial PAAmeriHealth Caritas Pennsylvania (Formerly payer id22248)



U: 11/13/2019 Non-Par 77013 Commercial MI AmeriHealth Caritas VIP Care Remittance 5010A1 Enrollment

A: 05/13/2021 Non-Par 77062 Commercial PA AmeriHealth Caritas VIP Care Professional 5010A1Claim Level Accept /Reject

Yes

AmeriHealth Caritas VIP Care is aHMO-SNP Plan. We accept claimsubmissions via paper orelectronically (EDI). For questionsabout claims submissions, callAmeriHealth Caritas VIP Care ProviderServices at 1-800-521-6007

A: 05/13/2021 Non-Par 77062 Commercial PA AmeriHealth Caritas VIP Care Institutional 5010A1Claim Level Accept /Reject

Yes

AmeriHealth Caritas VIP Care is aHMO-SNP Plan. We accept claimsubmissions via paper orelectronically (EDI). For questionsabout claims submissions, callAmeriHealth Caritas VIP Care ProviderServices at 1-800-521-6007

A: 08/18/2021 Non-Par 77062 Commercial PA AmeriHealth Caritas VIP Care Remittance 5010A1 Enrollment


A: 08/18/2021 Non-Par 58379 Commercial PAAmeriHealth Caritas VIP Care (Formerly payer id77062)



U: 09/07/2021 Non-Par 77013 Commercial MIAmeriHealth Caritas VIP Care Plus (MichiganMedicaid)


No

AmeriHealth VIP Care Plus is aMedicare Medicaid Plan (MMP), partof the AmeriHealth Caritas Family ofCompanies

U: 09/07/2021 Non-Par 77013 Commercial MIAmeriHealth Caritas VIP Care Plus (MichiganMedicaid)


No

AmeriHealth VIP Care Plus is aMedicare Medicaid Plan (MMP), partof the AmeriHealth Caritas Family ofCompanies

U: 02/28/2017 Non-Par 77051 Commercial AmeriHealth Connect (AmeriHealth Caritas) Remittance 5010A1 Enrollment

U: 05/13/2021 Non-Par 77002 Commercial DC AmeriHealth District of Columbia Professional 5010A1Claim Level Accept /Reject

Yes

AmeriHealth Caritas DC can acceptclaim submissions via paper orelectronically(EDI). For questionsabout claim submissions, call ProviderServices at 1-888-656-2383

U: 11/10/2020 Non-Par 77002 Commercial DC AmeriHealth District of Columbia Remittance 5010A1 Enrollment

ECHO is returning 835s for payer ID77002. Providers will need to enrollfor payer IDs 77002 and 58379 inorder to receive 835s for this payer

U: 05/13/2021 Non-Par 77002 Commercial DC AmeriHealth District of Columbia Institutional 5010A2Claim Level Accept /Reject

Yes

AmeriHealth Caritas DC can acceptclaim submissions via paper orelectronically(EDI). For questionsabout claim submissions, call ProviderServices at 1-888-656-2383

A: 11/10/2020 Non-Par 58379 Commercial DC AmeriHealth District of Columbia (77002) Remittance 5010A1 Enrollment *This enrollment will setup all payer

Updated: 03/21/2022


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names under payer id 58379*

U: 09/18/2019 Non-Par 23037 Government MUAmeriHealth HMO New Jersey and Delaware(formerly 95044)

Institutional 5010A2 EnrollmentClaim Level Accept /Reject


U: 09/30/2019 Non-Par 23037 Commercial DEAmeriHealth HMO New Jersey and Delaware(formerly 95044)



U: 02/28/2017 Non-Par 77006 Commercial Amerihealth VIP Care - LA Remittance 5010A1 Enrollment

U: 02/28/2017 Non-Par 77007 Commercial DC Amerihealth VIP Care- DC Remittance 5010A1 Enrollment

A: 05/03/2018 Non-Par J1447 Commercial MU Amerisafe Risk Services Remittance 5010A1 Enrollment

A: 05/25/2018 Non-Par J1447 Workers' Comp Amerisafe Risk Services Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 04/08/2019 Trans J1206 Workers' Comp Amerisure Prof. Work Comp 5010A1

U: 10/18/2012 Par 01757 Commercial MU AMFirst Ins Morgan White Admin Professional 5010A1Claim LevelAcknowledgement

YesThe payer accept secondary claimsonly

A: 09/01/2016 Par 64090 Commercial AmFirst Insurance Company Professional 5010A1 Claim Level Accept/Reject

A: 09/01/2016 Par 64090 Commercial AmFirst Insurance Company Institutional 5010A2 No Response From Payer Yes

U: 10/07/2019 Non-Par 64090 Commercial AmFirst Insurance Company Remittance 5010A1 Enrollment

A: 09/01/2016 Par 79966 Commercial Amida Care Medicare Professional 5010A1 Claim Level Accept/Reject

A: 09/01/2016 Par 79966 Commercial Amida Care Medicare Institutional 5010A2 No Response From Payer

A: 06/30/2021 Non-Par 72947 Commercial MN Amplifon Remittance 5010A1 Enrollment


A: 06/30/2021 Non-Par 58379 Commercial MN Amplifon (formerly payer id 72947) Remittance 5010A1 Enrollment


A: 04/08/2019 Trans J1868 Workers' Comp MU Amtrust FL WC Prof. Work Comp 5010A1

A: 04/08/2019 Trans J1868 Workers' Comp MU Amtrust North America Inc - Tower Prof. Work Comp 5010A1

A: 11/09/2018 Non-Par PROSP CommercialAMVI/Prospect Health Network (Prospect MedicalGroup)

Professional 5010A1 Claim Level Ack.

U: 03/24/2014 Non-Par 41556 Workers' Comp MU ANACO Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU ANACO Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU ANAIC Cibus Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU ANAIC Cibus Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 53085 Commercial Anchor Benefit Consulting, Inc. Institutional 4010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 53085 Commercial Anchor Benefit Consulting, Inc. Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 86062 Commercial Ancillary Benefit Services (ABS) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 86062 Commercial Ancillary Benefit Systems Professional 5010A1 No Response From Payer Yes

U: 09/01/2016 Par 86062 CommercialAncillary Benefit Systems / Arizona Foundation ForMedical Care (AFMC)

Professional 5010A1 No Response From Payer Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU ANGELO BROTHERS COMPANY-CA- Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU ANGELO BROTHERS COMPANY-CA- Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/09/2021 Par 39856 Commercial Angle Health Professional 5010A1Claim Level Accept /Reject

No

A: 12/09/2021 Par 39856 Commercial Angle Health Institutional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Antelope Valley Ret. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Antelope Valley Ret. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 07/02/2020 Non-Par 00958 Commercial ME Anthem Maine Health Professional 5010A1 Claim Level Accept / Yes

Updated: 03/21/2022


PPAAYERYERIDID



Reject

A: 07/02/2020 Non-Par 00958 Commercial ME Anthem Maine Health Institutional 5010A1Claim Level Accept /Reject

Yes

A: 07/15/2020 Non-Par 00958 Commercial ME Anthem Maine Health Remittance 5010A1 Enrollment

U: 09/01/2016 Par 37331 Commercial Anthem OMHS Professional 5010A1Claim Level Accept /Reject

Yes

Please verify the payer ID appearingon the members ID card, Plansinclude but may not be limited to:Right Choice Benefit Administratorsand Self Insured Plans Inc.

A: 09/01/2016 Par 37331 Commercial Anthem OMHS Institutional 5010A2 No Response From Payer Yes

A: 11/09/2018 Non-Par PROSP CommercialAPAC (Pinnacle Health Resources) (Prospect MedicalGroup)


U: 09/01/2016 Par 34196 Commercial Apex Benefit Services Institutional 5010A2 No Response From Payer Yes

A: 09/25/2019 Non-Par 34196 Apex Benefit Services Remittance 5010A1 Enrollment

U: 09/01/2016 Par 34196 Commercial Apex Benefit Services (located in Akron, OH) Professional 5010A1Claim LevelAcknowledgement

YesClaims must contain the renderingprovider id or the claim will reject.

A: 01/20/2022 Non-Par 83112 Commercial FL Apex Health Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/20/2022 Non-Par 83112 Commercial FL Apex Health Institutional 5010A1Claim Level Accept /Reject

Yes

A: 03/27/2018 Par 81312 Commercial OK Apostrophe Institutional 5010A1 Claim Level Ack. No

A: 03/27/2018 Par 81312 Commercial OK Apostrophe Professional 5010A1 Claim Level Ack. No

A: 03/02/2021 Non-Par 81312 Commercial TX Apostrophe Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Apperson Print Management (A C Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Apperson Print Management (A C Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/10/2012 Non-Par IP116 CommercialApplecare Medical Group (Applecare MedicareManagement)

Professional 5010A1 No Response From Payer

U: 09/10/2012 Non-Par IP116 CommercialApplecare Medical Management (Applecare / St.Francis / Downey)


A: 05/10/2019 Non-Par J1775 Workers' Comp MU Applied Underwriters WC Prof. Work Comp 5010A1

A: 02/28/2020 Non-Par 66056 Commercial PR APS Healthcare of Puerto Rico Professional 5010A1Claim Level Accept /Reject

No

A: 02/28/2020 Non-Par 66056 Commercial PR APS Healthcare of Puerto Rico Professional 5010A1Claim Level Accept /Reject

No

A: 02/28/2020 Non-Par 66056 Commercial PR APS Healthcare of Puerto Rico Institutional 5010A1Claim Level Accept /Reject

No

U: 08/06/2014 Par 44444 Commercial APWU / Affordable Network Professional 5010A1 No Response From Payer Yes

Secondary claims may be deniedrequesting further information. Pleasereview responses as part of normalworkflow

U: 11/12/2021 Non-Par 12049 Commercial AR AR BC/First Pyramid Life Institutional 5010A1 Enrollment

A: 06/09/2021 Non-Par SKAR2 Medicaid AR AR Medicaid Encounters Institutional 5010A1 Claim Level Ack. No

A: 06/09/2021 Non-Par SKAR2 Medicaid AR AR Medicaid Encounters Professional 5010A1 Claim Level Ack. No

U: 01/29/2015 Non-Par WK001 Workers' Comp TX AR-CMI Wal-Mart TX Prof. Work Comp 5010A1

A: 04/13/2016 Par CXARC Commercial KY ARC Services, Inc. Professional 5010A1 Claim Level Ack. No

A: 04/13/2016 Par CXARC Commercial KY ARC Services, Inc. Institutional 5010A1 Claim Level Ack. No

U: 12/29/2021 Par 37105 Commercial MU Arcadia Healthcare Solutions Institutional 5010A2Claim Level Accept /Reject

U: 12/29/2021 Par 37105 Commercial MU Arcadia Healthcare Solutions Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Arcadian Development, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Arcadian Development, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 77045 Commercial Arcadian Management Services, Inc. Institutional 5010A2 No Response From Payer

A: 09/01/2016 Par 77045 Commercial Arcadian Management Services, Inc. Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par AMS11 Commercial Arcadian Management Services, Inc. Professional 5010A1Claim LevelAcknowledgement

Updated: 03/21/2022


PPAAYERYERIDID



A: 11/19/2019 Non-Par AR812 Commercial ARCHBOLD ED UNINSURED Remittance 5010A1 Enrollment

A: 07/15/2019 Par AR812 Commercial GA Archbold Ed Uninsured Professional 5010A1Claim Level Accept /Reject

No

A: 07/26/2019 Non-Par AR715 Commercial GA Archbold Medical Center Health Plan Professional 5010A1 No Response From Payer Yes

A: 07/26/2019 Non-Par AR715 Commercial GA Archbold Medical Center Health Plan Institutional 5010A1 No Response From Payer Yes

A: 11/19/2019 Non-Par AR715 Commercial Archbold Medical Center Health Plan Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU ARDEN CLEELAND DBA AVRIL AGENC Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU ARDEN CLEELAND DBA AVRIL AGENC Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/24/2014 Non-Par ARGUS Commercial Argus Dental Plans Professional 5010A1 Claim Level Ack.

A: 12/05/2014 Non-Par ARGUS Commercial Argus Dental Plans Institutional 5010A2 Claim Level Ack.

U: 03/04/2016 Par 39185 CommercialArise Health Plan (formerly Prevea Health InsurancePlan)

Institutional 5010A2

U: 03/04/2016 Par 39185 CommercialArise Health Plan (formerly Prevea Health InsurancePlan)

Professional 5010A1

U: 09/26/2019 Non-Par 39185 CommercialArise Health Plan (formerly Prevea Health InsurancePlan)


U: 03/24/2014 Non-Par 41556 Workers' Comp MU Arizona & 21st Corp. DBA Berkley East Conv. Hospital Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Arizona & 21st Corp. DBA Berkley East Conv. Hospital Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 09/01/2016 Par 86062 Commercial Arizona Foundation For Medical Care (AFMC) Professional 5010A1 No Response From Payer Yes

U: 09/01/2016 Par 86062 Commercial Arizona Foundation for Medical Care (AFMC) Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 03432 Commercial AZ Arizona Physicians IPA Institutional 5010A2Claim LevelAcknowledgement

U: 04/04/2016 Par 03432 Commercial AZ Arizona Physicians IPA / Americhoice Professional 5010A1

U: 04/28/2020 Non-Par 03432 Commercial AZArizona Physicians IPA (UnitedHealth care ArizonaPhysicians IPA)


U: 09/01/2016 Par 27154 Commercial MU Arizona Priority Care Plus Professional 5010A1 No Response From Payer

A: 09/01/2016 Par 27154 Commercial Arizona Priority Care Plus Institutional 5010A2 No Response From Payer

A: 03/08/2019 Par 12956 Medicaid AR Arkansas - EMPOWER Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/08/2019 Par 12956 Medicaid AR Arkansas - EMPOWER Institutional 5010A1Claim Level Accept /Reject

Yes

U: 01/01/2012 Non-Par 62176 Commercial AR Arkansas Managed Care Organization (AMCO) Professional 5010A1Claim LevelAcknowledgement

U: 01/01/2012 Non-Par 62176 Commercial AR Arkansas Managed Care Organization (AMCO) Institutional 5010A2Claim LevelAcknowledgement

U: 07/23/2013 Non-Par IC029 Government AR Arkansas Medicaid Institutional 5010A2 Claim Level Rejects Only Yes

A: 10/02/2018 Par 61184 Commercial AR Arkansas Superior Select Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/02/2018 Par 61184 Commercial AR Arkansas Superior Select Institutional 5010A1Claim Level Accept /Reject

Yes

A: 08/03/2021 Par 90886 Commercial MD ArmadaCare Professional 5010A1Claim Level Accept /Reject

No

A: 08/03/2021 Par 90886 Commercial MD ArmadaCare Institutional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Arroyo Parkway 76 & Atwater 76 Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Arroyo Parkway 76 & Atwater 76 Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU ARTEX MANUFACTURING COMPANY (A Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU ARTEX MANUFACTURING COMPANY (A Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 06603 Commercial MU ASAGEHA Professional 5010A1 File Level Ack. Yes

A: 09/01/2016 Par 06603 Commercial MU ASAGEHA Institutional 5010A2 File Level Ack. Yes

U: 01/16/2020 Non-Par 58379 Commercial ASAMT, Insurance by Trustmark Insurance Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

Updated: 03/21/2022


PPAAYERYERIDID



U: 10/08/2019 Non-Par AAMG1 Commercial CA Asian American Medical Group Remittance 5010A1 Enrollment

A: 11/22/2016 Par AAMG1 Commercial CA Asian American Medical Group Institutional 5010A1 No Response From Payer No

A: 08/03/2016 Par AAMG1 Commercial CA Asian American Medical Group Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 46156 Commercial Aspire Health Plan Professional 5010A1 No Response From Payer Yes

A: 09/01/2016 Par 46156 Commercial Aspire Health Plan Institutional 5010A2 No Response From Payer Yes

A: 07/09/2021 Non-Par 36483 Commercial MN Aspirus Medicare Advantage Remittance 5010A1 Enrollment

A: 02/01/2021 Non-Par 36483 Commercial MN Aspirus Medicare Advantage Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/01/2021 Non-Par 36483 Commercial MN Aspirus Medicare Advantage Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/09/2019 Par 38265 Commercial ASR Corporation Institutional 5010A2 No Response From Payer

U: 09/09/2019 Par 38265 Commercial MI ASR Health Benefits Institutional 5010A2 No Response From Payer

U: 06/29/2021 Par ASRM1 Commercial ASRM LLC Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 06/29/2021 Par ASRM1 Commercial ASRM LLC Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 10/07/2019 Non-Par 13788 Commercial MD Associated Administrators LLC Remittance 5010A1 Enrollment

A: 09/01/2016 Par 36326 Commercial Associates for Healthcare, Inc. (AHC) Institutional 5010A2 No Response From Payer

U: 08/29/2012 Non-Par 36326 Commercial Associates for Healthcare, Inc. (AHC) Professional 5010A1Claim LevelAcknowledgement

A: 07/26/2021 Non-Par L0150 Commercial Association de Maestros ((PROSSAM) Professional 5010A1 EnrollmentClaim Level Accept /Reject

A: 07/26/2021 Non-Par L0150 Commercial Association de Maestros ((PROSSAM) Institutional 5010A2 EnrollmentClaim Level Accept /Reject

U: 07/26/2021 Non-Par L0150 Commercial Association de Maestros ((PROSSAM) Remittance 5010A1 Enrollment

A: 11/24/2014 Non-Par 75068 Commercial Assurant Health Self Funded Professional 5010A1 No Response From Payer Yes

A: 12/05/2014 Non-Par 75068 Commercial Assurant Health Self Funded Institutional 5010A2 No Response From Payer Yes

A: 06/30/2020 Non-Par 75068 Commercial IL Assurant Health Self Funded Remittance 5010A1 Enrollment

A: 03/24/2017 Par ASHC1 Commercial IN Assurant Supplemental Insurance Professional 5010A1 No Response From Payer Yes

A: 03/24/2017 Par ASHC1 Commercial IN Assurant Supplemental Insurance Institutional 5010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 74240 Commercial Assured Benefits Professional 5010A1Claim LevelAcknowledgement

Yes

U: 02/18/2019 Non-Par 74240 Commercial MU Assured Benefits Remittance 5010A1 Enrollment

U: 09/01/2016 Par 74240 Commercial Assured Benefits Administrators Institutional 5010A2Claim Level Accept /Reject

Yes

U: 11/28/2016 Non-Par 93221 Commercial Asuris Northwest Health (Regence) Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 93221 Commercial Asuris Northwest Health (Regence) Institutional 5010A1 Claim Level Ack.

A: 06/22/2020 Par 87020 Commercial Atlantic Coast Life Insurance Professional 5010A1 No Response From Payer No

A: 06/22/2020 Par 87020 Commercial Atlantic Coast Life Insurance Institutional 5010A1 No Response From Payer No

A: 02/12/2021 Non-Par 58379 Commercial Atlantic Coast Life Insurance (87020) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 01/01/2012 Non-Par 22285 Commercial Atlantic Medical Insurance Professional 5010A1File LevelAcknowledgement

U: 01/01/2012 Non-Par 22285 Commercial Atlantic Medical Insurance Institutional 5010A2File LevelAcknowledgement

A: 04/06/2018 Non-Par J2007 Auto MU Atlantic PPO to Allstate Insurance Professional 5010A1

A: 04/06/2018 Non-Par J2030 Auto MU Atlantic PPO to GEICO Prof. Auto 5010A1 All states other than MN

U: 12/03/2019 Non-Par MPCHA Commercial MU Atrio fka Marion Polk Professional 5010A1

A: 12/17/2019 Non-Par MPCHA Commercial OR Atrio Health Plan Institutional 5010A1Claim Level Accept /Reject

No

A: 11/16/2021 Non-Par MPCHA Commercial ATRIO HEALTH PLANS Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Audio Digest Foundation And Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Audio Digest Foundation And Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 10/21/2019 Non-Par AULOH Commercial OH Aultcare of Ohio Institutional 5010A1Claim Level Accept /Reject

No

Updated: 03/21/2022


PPAAYERYERIDID



A: 10/21/2019 Non-Par AULOH Commercial OH Aultcare of Ohio Professional 5010A1Claim Level Accept /Reject

No

A: 12/02/2019 Non-Par AULOH Commercial OH AULTCARE of OHIO Remittance 5010A1 Enrollment

U: 06/30/2012 Non-Par 37242 Commercial Aultra Administrative Group Institutional 5010A2 No Response From PayerPayer ID valid only for claims with abilling submission address of P.O. Box35276 Canton, OH 44735-5276

U: 06/30/2012 Non-Par 37242 Commercial Aultra Administrative Group Professional 5010A1 No Response From PayerPayer ID valid only for claims with abilling submission address of P.O. Box35276 Canton, OH 44735-5276

A: 12/23/2021 Non-Par 61108 Commercial KY Author By Humana Remittance 5010A1 Enrollment

A: 03/12/2021 Non-Par 61108 Commercial KY Author By Humana Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/12/2021 Non-Par 61108 KY Author By Humana Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU AUTO MARINE ENGINEERING, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU AUTO MARINE ENGINEERING, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Auto Outlet, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Auto Outlet, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/09/2018 Non-Par J1556 Commercial MU Auto Owners Remittance 5010A1 Enrollment

A: 05/25/2018 Non-Par J1556 Workers' Comp Auto Owners Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/11/2013 Non-Par 38259 Commercial Automated Benefit Services Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 38259 Commercial MI Automated Benefit Services (ABS) Professional 5010A1File LevelAcknowledgement

Yes

A: 09/26/2019 Non-Par 38259 Automated Benefit Services (ABS) Remittance 5010A1 Enrollment

A: 04/09/2010 Non-Par 37280 Commercial Automated Group Administration, Inc. Institutional 4010A1 No Response From Payer

U: 11/01/2012 Non-Par 37280 Commercial IN Automated Group Administration, Inc. Professional 5010A1 No Response From Payer

Please send these EDI claims to thePayer ID of the PPO shown on theMembers ID Card. If you have anyquestions, please call 260-489-6447x703

U: 09/01/2016 Par 91136 CommercialAutomotive Machinists Local 289 Health & WelfareTrust Grp # F32


U: 05/15/2017 Par AVA01 Commercial Avalon Administrative Services Professional 5010A1

You must contact the payer directlyat Provider Services @ 855-895-1676and request to be set up forElectronic claims submission thruEMDEON.

U: 10/02/2019 Non-Par AVA01 Commercial Avalon Administrative Services Remittance 5010A1 Enrollment

You must contact the payer directlyat Provider Services @ 855-895-1676and request that ERAs be sent back toEMDEON.

A: 01/15/2019 Par AVA03 Commercial FL Avalon Administrative Services - Capital Blue Cross Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/31/2017 Par AVA02 Commercial NC Avalon Administrative Services- BCBSNC Professional 5010A1Claim Level Accept /Reject

No

A: 08/23/2019 Par AVA04 Commercial FL Avalon Adminstrative Services - BCBS Professional 5010A1Claim Level Accept /Reject

No

U: 04/02/2019 Par 95399 Commercial CA AVALON IPA Professional 5010A1Claim Level Accept /Reject

A: 12/14/2016 Par 47410 Commercial MS Avectus Healthcare Solutions Professional 5010A1 Claim Level Ack. Yes

A: 12/14/2016 Par 47410 Commercial MS Avectus Healthcare Solutions Institutional 5010A1 Claim Level Ack. Yes

U: 09/01/2016 Par 46045 Commercial Avera Health Plans Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 46045 Commercial Avera Health Plans Professional 5010A1Claim Level Accept /Reject

A: 12/20/2019 Non-Par 46045 Avera Health Plans Remittance 5010A1 Enrollment

A: 06/12/2020 Non-Par 87098 Commercial Avesis Third Party Admin Remittance 5010A1 Enrollment Providers must contact their Rep with

Updated: 03/21/2022


PPAAYERYERIDID



Avesis to complete enrollment prior toenrollment with CHC. Avesis customerservice number is 800-828-9341

U: 11/01/2012 Non-Par 87098 Commercial Avesis Third Party Administrators (Vision Claims Only) Professional 5010A1 No Response From Payer

A: 06/16/2016 Par 59275 Commercial Avmed (Encounters) Institutional 5010A1Claim Level Accept /Reject

U: 02/27/2012 Par 59275 Commercial FL AvMed Encounters Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 59274 Commercial AvMed Inc. Institutional 5010A2Claim Level Accept /Reject

Yes

U: 01/06/2022 Par 59274 Commercial FL AvMed, Inc. Professional 5010A1Claim Level Accept /Reject

YesThe Insured ID and Patient ID fro thispayer must be the 11-digit MemberID.

U: 01/06/2022 Non-Par 59274 Commercial AvMed, Inc. Remittance 5010A1 Enrollment


A: 01/06/2022 Non-Par 58379 Commercial AvMed, Inc. (Formerly 59274) Remittance 5010A1 Enrollment


U: 01/01/2012 Non-Par 65101 Commercial MU AXA Assistance USA / HAA Preffered Professional 5010A1File LevelAcknowledgement

A: 12/05/2014 Non-Par 65101 Commercial AXA Assistance_USA/HAA Preferred Institutional 5010A2 No Response From Payer

U: 09/10/2012 Non-Par AXM01 Commercial CA Axminister Medical Group Professional 5010A1File LevelAcknowledgement

U: 09/23/2013 Non-Par J1491 Workers' Comp MU B.B. KINGS BLUES CLUB & RESTAU Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU B.B. KINGS BLUES CLUB & RESTAU Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Baker Tanks, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Baker Tanks, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/27/2013 Non-Par BKRFM Commercial Bakersfield Family Medical Center Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 77005 Commercial CA Bakersfield Family Medical Group Professional 5010A1 No Response From Payer

A: 09/01/2016 Par 77005 Commercial CA Bakersfield Family Medical Group Institutional 5010A1 No Response From Payer

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Bancroft NeuroHealth **CA ONLY** Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Bancroft NeuroHealth **CA ONLY** Inst. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU BANK PLUS CORPORATION Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU BANK PLUS CORPORATION Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 06/16/2021 Non-Par 30152 Commercial Bankers Fidelity Remittance 5010A1 Enrollment

U: 06/30/2020 Non-Par 36066 Commercial Bankers Life & Casualty Remittance 5010A1 Enrollment

A: 10/23/2014 Non-Par 12X42 Commercial AZ Banner Health - Arizona Institutional 5010A2 File Level Ack. Yes

U: 02/12/2021 Non-Par 12X42 Commercial AZ Banner Health - Arizona Remittance 5010A1 Enrollment

ECHO is returning 835s for payer ID12X42. Providers will need to enrollfor payer IDs 12X42 and 58379 inorder to receive 835s for this payer.

A: 01/16/2015 Non-Par 12X42 Commercial AZ Banner Health - Arizona Professional 5010A1 File Level Ack.

A: 02/12/2021 Non-Par 58379 Commercial AZ Banner Health - Arizona (12X42) Remittance 5010A1 Enrollment

ECHO is returning 835s for payer ID12X42. Providers will need to enrollfor payer IDs 12X42 and 58379 inorder to receive 835s for this payer.*This enrollment will setup all payernames under payer id 58379*

A: 01/19/2018 Par 67895 Commercial CT Banner Health and Aetna Health Insurance Company Institutional 5010A1 Claim Level Accept / Yes

Updated: 03/21/2022


PPAAYERYERIDID



Reject

A: 01/19/2018 Par 67895 Commercial CT Banner Health and Aetna Health Insurance Company Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/12/2021 Par 84324 Medicare AZ Banner Medicare Advantage Plus PPO (BMAP) Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/12/2021 Par 84324 Medicare AZ Banner Medicare Advantage Plus PPO (BMAP) Institutional 5010A1Claim Level Accept /Reject

Yes

A: 02/16/2021 Par 84323 Medicare AZ Banner Medicare Advantage Prime PPO (BMAH) Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/16/2021 Par 84323 Medicare AZ Banner Medicare Advantage Prime PPO (BMAH) Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/20/2018 Non-Par 66901 Commercial AZ Banner-University Family Care (Univ AZ) Remittance 5010A1 Enrollment

If you are setting up to receive ERAfiles from Change Healthcare for thispayer, you will need to also set uppayer id 58379

A: 10/12/2017 Par 66901 Commercial AZBanner-University Family Care (University of ArizonaHealth Plans)

Institutional 5010A1 Claim Level Ack. Yes

A: 10/12/2017 Par 66901 Commercial AZBanner-University Family Care (University of ArizonaHealth Plans)

Professional 5010A1 Claim Level Ack. Yes

A: 07/02/2014 Non-Par 65026 Commercial MU Baptist Health South Florida Professional 5010A1 Enrollment File Level Ack.

A: 09/15/2017 Trans CB369 Commercial MD Barinet Professional 5010A1Claim Level Accept /Reject

No

A: 09/15/2017 Trans CB369 Commercial MD Barinet Institutional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU BAS RECYCLING, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU BAS RECYCLING, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Basic Resources, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Basic Resources, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 38238 Commercial MU Bass Administrators, Inc. Professional 5010A1File LevelAcknowledgement

No

A: 09/01/2016 Par 38238 Commercial MU Bass Administrators, Inc. Institutional 5010A2File LevelAcknowledgement

No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Batla Food Group Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Batla Food Group Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/07/2016 Par 59279 Commercial FL BayCare Life Management Professional 5010A1 Claim Level Ack.

A: 01/07/2016 Par 59279 Commercial FL BayCare Life Management Institutional 5010A1 Claim Level Ack.

A: 03/05/2019 Par 81079 Medicare MO BayCare Plus Medicare Advantage Professional 5010A1 File Level Ack. Yes

A: 03/05/2019 Par 81079 Medicare MO BayCare Plus Medicare Advantage Institutional 5010A1 File Level Ack. Yes

A: 12/02/2019 Non-Par 81079 Medicare BayCare Plus Medicare Advantage Remittance 5010A1 Enrollment

U: 01/09/2020 Non-Par 12B14 Commercial MA BC/BS of Mass(Institutional Only) Remittance 5010A1 Enrollment

U: 10/21/2019 Non-Par SB550 CommercialBCBS CO (Anthem) (Formerly BS020) [aka ANTHEMBLUE CROSS BLUE SHIELD (COLORADO)]


U: 11/18/2019 Non-Par SB600 CommercialBCBS Georgia (Anthem)(Formerly BS039) [aka BLUECROSS BLUE SHIELD OF GEORGIA]


A: 09/17/2018 Non-Par 12B09 Commercial INBCBS Indiana (Anthem) [aka ANTHEM BLUE CROSSBLUE SHIELD (INDIANA)]


U: 10/21/2019 Non-Par 12B09 Commercial INBCBS Indiana (Anthem) [aka ANTHEM BLUE CROSSBLUE SHIELD (INDIANA)]


U: 09/30/2019 Non-Par SB630BCBS Indiana (Anthem)(Formerly BS049) [akaANTHEM BLUE CROSS BLUE SHIELD (INDIANA)]


U: 09/19/2019 Non-Par 12B12 Commercial LA BCBS Louisiana Institutional 5010A1 Enrollment

U: 10/16/2019 Non-Par 12B12 Commercial LA BCBS Louisiana Remittance 5010A1 Enrollment

U: 10/21/2019 Non-Par SB680 CommercialBCBS Maine (Anthem)(Formerly BS034) [aka ANTHEMBLUE CROSS BLUE SHIELD (MAINE)]


A: 02/06/2019 Non-Par 00562 Commercial MN BCBS Minnesota Health Care Program Professional 5010A1 Claim Level Accept / Yes

Updated: 03/21/2022


PPAAYERYERIDID



Reject

A: 02/06/2019 Non-Par 00562 Commercial MN BCBS Minnesota Health Care Program Institutional 5010A1Claim Level Accept /Reject

Yes

A: 12/23/2021 Non-Par A5143 Commercial BCBS Minnesota Non Emergent Remittance 5010A1 Enrollment

U: 11/18/2019 Non-Par SB765 CommercialBCBS Nevada (Anthem) (Formerly BS019) [akaANTHEM BLUE CROSS BLUE SHIELD (NEVADA)]


A: 11/24/2014 Non-Par SB821 Commercial BCBS North Dakota Vision Professional 5010A1 Claim Level Accept/Reject Yes

U: 09/17/2018 Non-Par SB563 Commercial CTBCBS of Connecticut FEP [aka ANTHEM BLUE CROSSBLUE SHIELD (CONNECTICUT)]


ERAs for BCBS of Connecticut FEP(SB563) are processed and returnedunder payer ID SB560. Please requestenrollment under payer ID: SB560.

U: 10/21/2019 Non-Par SB560 CommercialBCBS of CT (Anthem)(Formerly BS043) [aka ANTHEMBLUE CROSS BLUE SHIELD (CONNECTICUT)]


U: 10/21/2019 Non-Par SB660 CommercialBCBS of KY (Anthem)(Formerly BS050) [aka ANTHEMBLUE CROSS BLUE SHIELD (KENTUCKY)]


U: 10/21/2019 Non-Par SB741 CommercialBCBS of MO (St. Louis)(Anthem) (Formerly BS025)[aka ANTHEM BLUE CROSS BLUE SHIELD (MISSOURI)]


U: 10/21/2019 Non-Par SB770 CommercialBCBS of NH (Anthem)(Formerly BS067) [aka ANTHEMBLUE CROSS BLUE SHIELD (NEW HAMPSHIRE)]


U: 10/21/2019 Non-Par SB338 Commercial OHBCBS of Ohio (Anthem)(Formerly BS051) [akaANTHEM BLUE CROSS BLUE SHIELD (OHIO)]


U: 09/07/2019 Non-Par 12B53 Commercial TN BCBS of Tennessee (Formerly BS032) Institutional 5010A1 Enrollment

A: 04/19/2017 Non-Par 44911 Medicaid NY BCBS of Western New York Medicaid/CHP Professional 5010A1Claim Level Accept /Reject

Yes

A: 04/19/2017 Non-Par 44911 Medicaid NY BCBS of Western New York Medicaid/CHP Institutional 5010A1Claim Level Accept /Reject

Yes

U: 10/21/2019 Non-Par 44911 Commercial NY BCBS of Western New York Medicaid/CHP Remittance 5010A1 Enrollment

A: 03/01/2016 Non-Par 12B59 Commercial OK BCBS Oklahoma Institutional 5010A1

U: 10/21/2019 Non-Par 12B59 Commercial OK BCBS Oklahoma Remittance 5010A1 Enrollment

U: 11/21/2019 Non-Par SB923 Commercial VABCBS VA (Anthem) (Formerly BS029) [aka ANTHEMBLUE CROSS BLUE SHIELD (VIRGINIA)]


U: 09/17/2018 Non-Par 12002 Commercial VABCBS VA (Anthem) [aka ANTHEM BLUE CROSS BLUESHIELD (VIRGINIA)]


U: 10/21/2019 Non-Par 12002 Commercial VABCBS VA (Anthem) [aka ANTHEM BLUE CROSS BLUESHIELD (VIRGINIA)]

Remittance 5010A1 Enrollment Institutional

U: 09/17/2018 Non-Par SB950 Commercial WIBCBS Wisconsin (Anthem) (Formerly BS053) [akaANTHEM BLUE CROSS BLUE SHIELD (WISCONSIN)]


U: 10/21/2019 Non-Par SB950 CommercialBCBS Wisconsin (Anthem)(Formerly BS053) [akaANTHEM BLUE CROSS BLUE SHIELD (WISCONSIN)]


A: 11/09/2021 Non-Par 52730 Government MI BCBSM Medicare Plus Blue PPL JVHL Remittance 5010A1 Enrollment

A: 11/09/2021 Non-Par 52730 Commercial MI BCBSM Medicare Plus Blue PPO JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 10/02/2019 Non-Par 22770 MI BCN - NON JVHL Network - JVHL Remittance 5010A1 EnrollmentClaim Level Accept /Reject

A: 01/11/2019 Non-Par 22770 Commercial MI BCN-NON JVHL Network - NVHL Professional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Beacon Bay Enterprises, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Beacon Bay Enterprises, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/25/2015 Non-Par 43324 Commercial Beacon Health Strategies Professional 5010A1 Claim Level Ack.

A: 08/25/2015 Non-Par 43324 Commercial Beacon Health Strategies Institutional 5010A1 File Level Ack.

A: 10/08/2021 Non-Par 43324 Commercial Beacon Health Strategies Remittance 5010A1 Enrollment

A: 11/04/2019 Non-Par 65432 Commercial CA Beacon of Life Professional 5010A1Claim Level Accept /Reject

No

A: 11/04/2019 Non-Par 65432 Commercial CA Beacon of Life Institutional 5010A1Claim Level Accept /Reject

No

A: 09/07/2018 Par 45967 Commercial CA Beaver Medical Group Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/19/2021 Non-Par 45967 Commercial BEAVER MEDICAL GROUP Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU BEC ENTERPRISES INC. Inst. Work Comp 4010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU BEC ENTERPRISES INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Beeville ISD Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Beeville ISD Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 01/20/2014 Non-Par 63100 Commercial Behavioral Health Systems Institutional 5010A2Claim Level Accept /Reject

U: 11/01/2012 Non-Par 63100 Commercial Behavioral Health Systems Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Bell Trucking Co Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Bell Trucking Co Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 04/09/2010 Non-Par MPM10 Commercial Bella Vista Medical Group IPA Professional 4010A1File LevelAcknowledgement

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Bemus Landscape Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Bemus Landscape Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 07/21/2020 Par 23243 Commercial PA Benebay Professional 5010A1 No Response From Payer No

A: 07/21/2020 Par 23243 Commercial PA Benebay Institutional 5010A1 No Response From Payer No

U: 09/01/2016 Par 99320 Commercial MU Benefit & Risk Management Services Professional 5010A1Claim LevelAcknowledgement

No

U: 09/01/2016 Par 99320 Commercial MU Benefit & Risk Management Services Institutional 5010A2 No Response From Payer No

U: 09/01/2016 Par 36149 Commercial Benefit Administration Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 36149 Commercial Benefit Administration Institutional 5010A2 Yes

U: 10/01/2019 Non-Par 36149 Commercial Benefit Administration Remittance 5010A1 Enrollment

U: 09/01/2016 Par 25145 Commercial Benefit Coordinators Corp (Pittsburgh, PA) Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 25145 Commercial PA Benefit Coordinators Corp. Professional 5010A1Claim LevelAcknowledgement

Only claims with a mailing address of:111 Ryan Ct./Suite 300/Pittsburgh, PA15205 should be sent to this payer id

U: 03/11/2013 Non-Par 36459 Commercial NV Benefit Management Group-NV Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/05/2014 Non-Par 36459 Commercial Benefit Management Group-NV Institutional 5010A2 No Response From Payer Yes

U: 01/01/2012 Non-Par 48611 Commercial Benefit Management Inc. of KS Professional 5010A1File LevelAcknowledgement

U: 01/01/2012 Non-Par 48611 Commercial Benefit Management Inc. of KS Institutional 5010A2File LevelAcknowledgement

A: 09/30/2019 Non-Par 48611 Benefit Management Inc. of KS Remittance 5010A1 Enrollment

A: 02/06/2017 Par 88092 Commercial AZ Benefit Management LLC/VBA Professional 5010A1 Claim Level Rejects Only Yes

A: 02/06/2017 Par 88092 Commercial AZ Benefit Management LLC/VBA Institutional 5010A1 Claim Level Rejects Only Yes

A: 09/01/2016 Par 56139 Commercial Benefit Management Services Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 56139 Commercial Benefit Management Services Institutional 5010A2 No Response From Payer

U: 03/11/2013 Non-Par 43178 Commercial MO Benefit Management, Inc. (Joplin, MO) Professional 5010A1Claim LevelAcknowledgement

Yes

A: 09/01/2016 Par 88052 Commercial Benefit Plan Administrators Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 88052 Commercial Benefit Plan Administrators Institutional 5010A2 No Response From Payer

U: 01/16/2020 Non-Par 58379 Commercial Benefit Plan Administrators Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

A: 01/31/2020 Non-Par 19753 Commercial VA Benefit Plan Administrators - Hylton Payroll Professional 5010A1 File Level Ack. No

A: 01/31/2020 Non-Par 19753 Commercial VA Benefit Plan Administrators - Hylton Payroll Institutional 5010A1 File Level Ack. No

U: 09/01/2016 Par 39081 Commercial Benefit Plan Administrators Co. (Eau Claire, WI) Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 39081 Commercial WI Benefit Plan Administrators Co. - Eau Claire, WI Professional 5010A1Claim Level Accept /Reject

Payer ID valid for only claims with abilling submission address of P.O. Box1128, Eau Claire, WI 54702-1128.

Updated: 03/21/2022


PPAAYERYERIDID



A: 12/08/2021 Non-Par 39081 Commercial Benefit Plan Administrators Co. - Eau Claire, WI Remittance 5010A1 Enrollment


A: 12/08/2021 Non-Par 58379 CommercialBenefit Plan Administrators Co. - Eau Claire, WI(Formerly 39081)



U: 01/12/2016 Non-Par 37118 Commercial VA Benefit Plan Administrators Inc. Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 88027 Commercial NV Benefit Plan Administrators Inc. (BPA) Professional 5010A1Claim LevelAcknowledgement

Only providers in the state of Nevadacan send claims to 88027

A: 08/08/2014 Non-Par 37118 Commercial VA Benefit Plan Administrators Inc. (Roanoke, VA) Institutional 5010A2 No Response From Payer

U: 01/16/2020 Non-Par 58379 Commercial Benefit Plan Services, Inc Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 09/23/2019 Non-Par 44357 Commercial MD Benefits Administration Corp Remittance 5010A1 Enrollment

A: 09/01/2016 Par 38238 Commercial MU Benesys Institutional 5010A2File LevelAcknowledgement

No

A: 09/26/2019 Non-Par 38238 Benesys Remittance 5010A1 Enrollment

A: 09/01/2016 Par 38238 Commercial MU Benesys - LHP Claims Unit Professional 5010A1File LevelAcknowledgement

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Berkley Valley Conv Hospital Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Berkley Valley Conv Hospital Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/24/2014 Non-Par 10956 Commercial Berkshire Intergroup Professional 5010A1 File Level Ack. Yes

U: 03/11/2013 Non-Par 95606 Commercial Berkshire Lehigh Partners Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/05/2014 Non-Par 95606 Commercial Berkshire Lehigh Partners Institutional 5010A2 File Level Ack. Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Bernardo H. Co. Club Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Bernardo H. Co. Club Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU BERRY'S SAWMILL Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU BERRY'S SAWMILL Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU BETTER CARE INCORPORATED Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU BETTER CARE INCORPORATED Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Beverly Hills Carmel Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Beverly Hills Carmel Inst. Work Comp 4010A1Claim Level Accept /Reject

A: 07/11/2017 Non-Par 84129 Commercial CO BHI (Behavioral Health, Inc.) (Formerly COACC) Professional 5010A1

A: 03/04/2013 Non-Par 44219 Commercial BHP-Unity Professional 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par 44219 Commercial BHP-Unity Institutional 5010A2 Claim Level Rejects Only Yes

A: 01/26/2016 Trans 67668 Commercial FL BHSF International Professional 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par 12X40 Commercial Bienvivir Institutional 5010A2 No Response From Payer

U: 11/08/2012 Non-Par BSHS1 Commercial MU Bienvivir Senior Health Services Professional 5010A1File LevelAcknowledgement

U: 05/19/2017 Par 31074 Commercial Big Lots Associates Benefit Plan Professional 5010A1 Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Bighorn Construction Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Bighorn Construction Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 07/21/2021 Non-Par 25463 Commercial BIND Remittance 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



A: 09/23/2019 Non-Par 25463 Commercial MN BIND Professional 5010A1Claim Level Accept /Reject

No

A: 07/21/2021 Non-Par 25463 Commercial MN BIND Institutional 5010A1Claim Level Accept /Reject

No

A: 05/03/2018 Non-Par J1579 Commercial MU Bituminous Insurance Company Remittance 5010A1 Enrollment

A: 04/27/2018 Non-Par BLOCK Commercial CA Block Vision Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Trans 03036 Commercial Blue Benefit Administrators of MA Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Trans 03036 Commercial Blue Benefit Administrators of MA Institutional 5010A2Claim LevelAcknowledgement

A: 09/09/2021 Non-Par JVHLB Commercial MI Blue Care Complete Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 07/14/2021 Non-Par JVHLB Commercial MI Blue Care Complete Remittance 5010A1 Enrollment

A: 07/15/2021 Non-Par JVHLB Commercial MI Blue Care Complete Institutional 5010A1 EnrollmentClaim Level Accept /Reject

No

U: 09/17/2018 Non-Par SB562 Commercial CTBlue Care Family/Anthem Medicaid - CT [akaANTHEM BLUE CROSS BLUE SHIELD (CONNECTICUT)]


U: 10/21/2019 Non-Par SB562 Commercial CTBlue Care Family/Anthem Medicaid [aka ANTHEMBLUE CROSS BLUE SHIELD (CONNECTICUT)]


U: 01/19/2022 Non-Par SB711 Commercial MI Blue Care Network (BCBS OF MI) Professional 5010A1 EnrollmentClaim Level Accept /Reject

YesERA enrollment and processing isavailable under SB710

U: 10/20/2021 Non-Par 12B58 Commercial MI Blue Care Network (BCBS OF MI) Institutional 5010A1 Enrollment

U: 09/17/2018 Non-Par SB742 Government MOBlue Choice - Missouri (Anthem) (Formerly BS062)[aka ANTHEM BLUE CROSS BLUE SHIELD (MISSOURI)]


Yes

U: 03/02/2016 Non-Par 00804 Commercial Blue Choice - NY Professional 5010A1Claim Level Accept /Reject

U: 09/17/2018 Non-Par 47198 Government CABlue Cross - California (Anthem) (Formerly BC001)[aka ANTHEM BLUE CROSS (CALIFORNIA)]


U: 09/17/2018 Non-Par 47198 Commercial CABlue Cross - California (Anthem) (Formerly BC001)[aka ANTHEM BLUE CROSS (CALIFORNIA)]


Yes

U: 06/08/2020 Non-Par 47198 Commercial CABlue Cross - California (Anthem)(Formerly BC001)[aka ANTHEM BLUE CROSS (CALIFORNIA)]


U: 12/06/2016 Non-Par 47200 Commercial CABlue Cross - California Care (Anthem BC) (FormerlyHM006)


U: 01/01/2012 Trans HM006 Commercial CABlue Cross - California Care - HMO (EncountersONLY)


Yes

U: 03/19/2021 Non-Par SB612 Government ID Blue Cross - Idaho (Formerly BC002) Professional 5010A1Claim Level Accept /Reject

Yes

U: 10/06/2021 Non-Par SB612 Government ID Blue Cross - Idaho (Formerly BC002) Remittance 5010A1 Enrollment

U: 06/25/2014 Non-Par 12B14 Commercial MABlue Cross / Blue Shield ofMassachusetts(Institutional Only)


A: 07/10/2017 Non-Par SB530 Commercial AZ Blue Cross Blue Shield - Arizona (Formerly BS046) Professional 5010A1Claim Level Accept /Reject

Yes

U: 11/10/2020 Non-Par SB530 Commercial AZ Blue Cross Blue Shield - Arizona (Formerly BS046) Remittance4010A1and5010A1

EnrollmentERA under SB530 is for bothprofessional (SB530) and Institutional(12B02)

A: 07/10/2017 Non-Par 12B02 Commercial AZ Blue Cross Blue Shield - Arizona (Formerly BS046) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/30/2019 Non-Par 23738 Commercial LA Blue Cross Blue Shield - Louisiana (Formerly BS038) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 09/24/2019 Non-Par 23738 Commercial LA Blue Cross Blue Shield - Louisiana (Formerly BS038) Remittance 5010A1 Enrollment

U: 10/30/2019 Non-Par SB730 Government MS Blue Cross Blue Shield - Mississippi (Formerly BS047) Remittance 5010A1 Enrollment

A: 08/12/2021 Non-Par SB730 Government MS Blue Cross Blue Shield - Mississippi (Formerly BS047) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 11/20/2018 Non-Par SB751 Government MT Blue Cross Blue Shield - Montana (Formerly BS036) Professional 5010A1Claim Level Accept /Reject

Yes

U: 11/18/2019 Non-Par SB751 Commercial MT Blue Cross Blue Shield - Montana (Formerly BS036) Remittance 4010A1 Enrollment

U: 12/16/2019 Non-Par SB760 Government NE Blue Cross Blue Shield - Nebraska (Formerly BS058) Remittance 5010A1 Enrollment

A: 07/10/2017 Non-Par SB760 Government NE Blue Cross Blue Shield - Nebraska (Formerly BS058) Professional 5010A1Claim Level Accept /Reject

Yes

A: 07/11/2017 Non-Par SB870 Government RI Blue Cross Blue Shield - Rhode Island (Formerly Remittance 4010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



BS075)

A: 07/11/2017 Non-Par SB870 Government RIBlue Cross Blue Shield - Rhode Island (FormerlyBS075)


Yes

U: 12/09/2021 Non-Par SB889 Government SDBlue Cross Blue Shield - South Dakota (FormerlyBS056)

Remittance 4010A1 Enrollment See ERA Enrollment under SB640

A: 02/10/2022 Non-Par 12B33 Government SDBlue Cross Blue Shield - South Dakota (FormerlyBS056)


Yes

U: 02/10/2022 Non-Par SB889 Government SDBlue Cross Blue Shield - South Dakota (FormerlyBS056)


Yes

A: 01/05/2022 Non-Par SB915 Government VT Blue Cross Blue Shield - Vermont (Formerly BS065) Professional 5010A1Claim Level Accept /Reject

A: 07/31/2017 Non-Par 12B32 Commercial Blue Cross Blue Shield - Vermont (Formerly BS065) Institutional 5010A2 Yes

U: 01/27/2022 Non-Par SB915 Commercial VT Blue Cross Blue Shield - Vermont (Formerly BS065) Remittance 5010A1 Enrollment

A: 07/12/2019 Non-Par A5143 Commercial FL Blue Cross Blue Shield Minnesota Non Emergent Professional 5010A1Claim Level Accept /Reject

No

U: 08/12/2021 Non-Par SB731 Commercial MSBlue Cross Blue Shield Mississippi State and TeacherEmployees

Professional 5010A1 Enrollment File Level Ack.

U: 11/03/2021 Non-Par SB520 Commercial AR Blue Cross Blue Shield of Arkansas Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 04/21/2021 Non-Par SB520 Commercial AR Blue Cross Blue Shield of Arkansas Remittance 5010A1 Enrollment

U: 11/03/2021 Non-Par 12021 Commercial AR Blue Cross Blue Shield of Arkansas Institutional 5010A1 Enrollment

U: 01/21/2021 Non-Par 12021 Commercial AR Blue Cross Blue Shield of Arkansas Remittance 5010A1 Enrollment

U: 06/15/2020 Non-Par SB590 Government FL Blue Cross Blue Shield of Florida (formerly BS022) Remittance 5010A1 Enrollment

A: 10/06/2016 Non-Par SB590 Government FL Blue Cross Blue Shield of Florida (formerly BS022) Professional 5010A1 Claim Level Rejects Only Yes

U: 03/25/2019 Non-Par 12B34 Government FLBlue Cross Blue Shield of Florida (formerly BS022/SB590)

Institutional 5010A2 No Response From Payer Yes Enroll payer id SB590 for ERA.

U: 06/28/2017 Non-Par SB650 Government KS Blue Cross Blue Shield of Kansas (formerly BS023) Professional 5010A1 Claim Level Rejects Only Yes

U: 03/05/2020 Non-Par SB650 Government KS Blue Cross Blue Shield of Kansas (formerly BS023) Remittance 4010A1 Enrollment

A: 06/28/2017 Non-Par SB740 Government MOBlue Cross Blue Shield of Kansas City, MO (formerlyBS024)

Professional 5010A1 Claim Level Rejects Only Yes

U: 09/04/2020 Non-Par SB740 Government MOBlue Cross Blue Shield of Kansas City, MO (formerlyBS024)


U: 06/28/2017 Non-Par SB651 Commercial KS Blue Cross Blue Shield of Kansas HMO FEP Professional 5010A1 File Level Ack.

U: 06/28/2017 Non-Par SB652 Commercial KS Blue Cross Blue Shield of Kansas HMO Regular Professional 5010A1 File Level Ack.

U: 06/28/2017 Non-Par SB653 Commercial KS Blue Cross Blue Shield of Kansas HMO Senior Plan Professional 5010A1 File Level Ack.

U: 01/19/2022 Non-Par SB710 Commercial MI Blue Cross Blue Shield of Michigan Professional 5010A1 Enrollment Yes

U: 01/19/2022 Non-Par SB710 Commercial MI Blue Cross Blue Shield of Michigan Remittance 5010A1 Enrollment

U: 10/19/2021 Non-Par 12B18 Commercial MI Blue Cross Blue Shield of Michigan (Formerly BS017) Institutional 5010A2 Enrollment Yes

A: 10/11/2017 Non-Par 12B22 Commercial NYBlue Cross Blue Shield of New Mexico (FormerlySB790)


U: 02/22/2022 Non-Par SB890 Commercial TN Blue Cross Blue Shield of Tennessee Remittance 5010A1 Enrollment

U: 02/24/2021 Non-Par SB890 Commercial TN Blue Cross Blue Shield of Tennessee Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

Single Enrollment with BCBS TNenables electronic claim submissionfor all BCBS TN payer ID's listed(enrollment is not 'plan specific').

U: 11/20/2019 Non-Par SB891 Commercial TNBlue Cross Blue Shield of Tennessee (ChattanoogaHMO Plans)

Professional 5010A1 Enrollment File Level Ack.

U: 11/12/2019 Non-Par SB892 Commercial TN Blue Cross Blue Shield of Tennessee (Memphis) Professional 5010A1 Enrollment File Level Ack.

U: 08/19/2019 Non-Par 66001 Commercial TX Blue Cross Blue Shield of Texas - Medicaid Remittance 5010A1 Enrollment

A: 04/21/2020 Trans 66001 Medicaid TX Blue Cross Blue Shield of Texas - Medicaid Professional 5010A1Claim Level Accept /Reject

A: 01/06/2016 Trans 66001 Medicaid TX Blue Cross Blue Shield of Texas - Medicaid Institutional 5010A2Claim Level Accept /Reject

U: 05/23/2017 Non-Par SX168 Commercial PABlue Cross Blue Shield PA - BlueCard Par Point ofService (POS)


YesThis payer id is to be used formember id alpha prefixes of:AMS,ATS, NJP, NRG or YHF.

U: 04/23/2020 Trans 66005 Commercial Blue Cross Community Options (formerly MCDIL) Professional 5010A1 No Response From Payer No

U: 11/20/2017 Trans 66005 Commercial Blue Cross Community Options (formerly MCDIL) Institutional 5010A1 No Response From Payer

U: 08/19/2019 Non-Par 66005 Commercial Blue Cross Community Options (formerly MCDIL) Remittance 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



A: 07/15/2021 Non-Par 12550 Commercial MI Blue Cross Complete - JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 03/02/2019 Non-Par 12550 Commercial MI Blue Cross Complete - JVHL Remittance 5010A1

A: 04/01/2021 Non-Par 12550 Commercial MI Blue Cross Complete - JVHL Remittance 5010A1

U: 11/10/2020 Non-Par 32002 Commercial MI Blue Cross Complete of Michigan Remittance 5010A1 Enrollment


A: 03/07/2017 Non-Par 32002 Commercial MI Blue Cross Complete of Michigan Institutional 5010A1Claim Level Accept /Reject

A: 03/07/2017 Non-Par 32002 Commercial MI Blue Cross Complete of Michigan Professional 5010A1Claim Level Accept /Reject

A: 11/10/2020 Non-Par 58379 Commercial MI Blue Cross Complete of Michigan (32002) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

A: 02/24/2017 Trans 66006 Commercial OK Blue Cross Medicare Advantage Institutional 5010A1 File Level Ack.

A: 02/24/2017 Trans 66006 Commercial OK Blue Cross Medicare Advantage Professional 5010A1 File Level Ack.

A: 02/24/2017 Trans 66006 Commercial NM Blue Cross Medicare Advantage Institutional 5010A1 File Level Ack.

A: 01/18/2017 Trans 66006 Commercial TX Blue Cross Medicare Advantage Professional 5010A1 File Level Ack. No

A: 01/18/2017 Trans 66006 Commercial TX Blue Cross Medicare Advantage Institutional 5010A1 No Response From Payer No

A: 02/24/2017 Trans 66006 Commercial NM Blue Cross Medicare Advantage Professional 5010A1 File Level Ack.

A: 01/18/2017 Trans 66006 IL Blue Cross Medicare Advantage Professional 5010A1Claim Level Accept /Reject

A: 01/18/2017 Trans 66006 Commercial IL Blue Cross Medicare Advantage Institutional 5010A1 File Level Ack.

A: 01/18/2017 Trans 66006 Commercial MT Blue Cross Medicare Advantage Professional 5010A1 File Level Ack.

A: 01/18/2017 Trans 66006 Commercial MT Blue Cross Medicare Advantage Institutional 5010A1 File Level Ack.

U: 09/20/2021 Non-Par 66006 Commercial Blue Cross Medicare Advantage Remittance 5010A1 Enrollment

**The payer has broken their formsup to five different states whichinclude: IL MT NM OK TX. Sendcompleted cover page & theenrollment for your valid state only**

A: 03/20/2020 Non-Par 12B07 Commercial Blue Cross of Idaho Institutional 5010A1 Enrollment

A: 01/07/2022 Non-Par RP016 Commercial MD Blue Hen Advantage Professional 5010A1Claim Level Accept /Reject

No

A: 01/07/2022 Non-Par RP016 Commercial MD Blue Hen Advantage Institutional 5010A1Claim Level Accept /Reject

No

A: 03/09/2022 Non-Par 00772 Commercial Blue Medicare Advantage Institutional 5010A1Claim Level Accept /Reject

Yes

A: 03/09/2022 Non-Par 00772 Commercial Blue Medicare Advantage Professional 5010A1Claim Level Accept /Reject

Yes

U: 05/12/2017 Non-Par 12B54 Commercial AL Blue Shield - Alabama Institutional 5010A1 Enrollment

U: 10/16/2019 Non-Par 12B54 Commercial AL Blue Shield - Alabama Remittance 5010A1 Enrollment

U: 10/26/2017 Non-Par SB510 Government AL Blue Shield - Alabama (Formerly BS054) Professional 5010A1

U: 09/02/2021 Non-Par SB510 Government AL Blue Shield - Alabama (Formerly BS054) Remittance 4010A1 Enrollment

U: 03/11/2013 Non-Par 53589 Commercial AZ Blue Shield - Arizona Professional 5010A1Claim LevelAcknowledgement

Yes

U: 12/14/2016 Non-Par 94036 Commercial CA Blue Shield - California (Formerly BS001) Institutional 5010A2Claim Level Accept /Reject

U: 02/23/2022 Non-Par 94036 Commercial CA Blue Shield - California (Formerly BS001) Remittance4010A1and5010A1

Enrollment

U: 12/14/2016 Non-Par 94036 Commercial CABlue Shield - California (Formerly BS001) / BlueShield (FEP)


U: 09/02/2021 Non-Par SB805 Government NY Blue Shield - Central New York (Formerly BS063) Remittance 5010A1 Enrollment

A: 07/28/2016 Non-Par SB805 Commercial NY Blue Shield - Central New York (Formerly BS063) Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/01/2017 Non-Par 12B37 Commercial NYBlue Shield - Central New York (Formerly BS063/SB805)


Yes

U: 09/17/2018 Non-Par SB550 Government COBlue Shield - Colorado --- Anthem (Formerly BS020)[aka ANTHEM BLUE CROSS BLUE SHIELD(COLORADO)]


Yes

A: 09/17/2018 Non-Par 12B03 Commercial CO Blue Shield - Colorado --- Anthem (Formerly BS020/ Institutional 5010A1 Claim Level Accept / Yes

Updated: 03/21/2022


PPAAYERYERIDID



SB550) [aka ANTHEM BLUE CROSS BLUE SHIELD(COLORADO)]

Reject

U: 04/08/2020 Non-Par SB560 Commercial CTBlue Shield - Connecticut --- Anthem (FormerlyBS043) [aka ANTHEM BLUE CROSS BLUE SHIELD(CONNECTICUT)]


Yes

U: 10/21/2019 Non-Par 12B04 Commercial CTBlue Shield - Connecticut [aka ANTHEM BLUE CROSSBLUE SHIELD (CONNECTICUT)]

Remittance 5010A1Claim Level Accept /Reject

U: 11/02/2018 Non-Par 12B04 Commercial CTBlue Shield - Connecticut [aka ANTHEM BLUE CROSSBLUE SHIELD (CONNECTICUT)]

Institutional 5010A1 Enrollment

A: 11/02/2017 Trans 12000 Commercial DC Blue Shield - DC (Carefirst) (Formerly SB580) Institutional 5010A2 No Response From Payer No

U: 09/01/2016 Par SB580 Commercial DC Blue Shield - DC, National Capital Area (CareFirst) Professional 5010A1Claim Level Accept /Reject

YesPayer only accepts COB claims ifprimary plan is Medicare

A: 02/10/2022 Non-Par 58379 Commercial Blue Shield - Delaware (Formerly 12B76) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 09/17/2018 Non-Par SB600 Government GABlue Shield - Georgia (Anthem) (Formerly BS039)[aka BLUE CROSS BLUE SHIELD OF GEORGIA]


Yes

U: 11/02/2018 Non-Par 12015 Commercial GABlue Shield - Georgia (Anthem) (Formerly BS039/SB600) [aka ANTHEM BLUE CROSS BLUE SHIELD(VIRGINIA)]


Yes

U: 10/21/2019 Non-Par SB611 Commercial ID Blue Shield - Idaho (Formerly BS002) Remittance 5010A1 Enrollment

U: 08/02/2018 Non-Par SB611 Commercial ID Blue Shield - Idaho (Formerly BS002) Professional 5010A1Claim Level Accept /Reject

Yes

U: 08/02/2018 Non-Par 12B88 Government ID Blue Shield - Idaho (Formerly BS002/SB611) Institutional 5010A1

U: 11/18/2019 Non-Par SB621 Government IL Blue Shield - Illinios (formerly BS018) Remittance 5010A1 Enrollment

U: 02/03/2020 Non-Par SB621 Commercial IL Blue Shield - Illinois Institutional 5010A2 Yes

A: 10/06/2016 Non-Par SB621 Government IL Blue Shield - Illinois (formerly BS018) Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/17/2018 Non-Par SB630 Government INBlue Shield - Indiana --- Anthem (Formerly BS049)[aka ANTHEM BLUE CROSS BLUE SHIELD (INDIANA)]


Yes

A: 02/10/2022 Non-Par 12B10 Commercial Blue Shield - Iowa Institutional 5010A1Claim Level Accept /Reject

U: 12/09/2021 Non-Par SB640 Government IA Blue Shield - Iowa (Formerly BS030) Remittance 4010A1 Enrollment

To receive ERA for SB889 Blue CrossBlue Shield - South Dakota (FormerlyBS056) See ERA Enrollment underSB640

A: 02/10/2022 Non-Par SB640 Commercial Blue Shield - Iowa (Formerly BS030) Professional 5010A1Claim Level Accept /Reject

U: 09/25/2017 Non-Par 57325 Commercial KS Blue Shield - Kansas Institutional 5010A1Institutional ERA will deliver underSB650

U: 09/17/2018 Non-Par SB660 Government KYBlue Shield - Kentucky --- Anthem (Formerly BS050)[aka ANTHEM BLUE CROSS BLUE SHIELD (KENTUCKY)]


Yes

A: 09/17/2018 Non-Par 12B11 Commercial KYBlue Shield - Kentucky --- Anthem (Formerly BS050/SB660) [aka ANTHEM BLUE CROSS BLUE SHIELD(KENTUCKY)]


Yes

U: 09/17/2018 Non-Par SB680 Government MEBlue Shield - Maine --- Anthem (Formerly BS034)[aka ANTHEM BLUE CROSS BLUE SHIELD (MAINE)]


Yes

A: 09/17/2018 Non-Par 12B13 Commercial MEBlue Shield - Maine --- Anthem (Formerly BS034/SB680) [aka ANTHEM BLUE CROSS BLUE SHIELD(MAINE)]


Yes

U: 08/14/2020 Non-Par SB690 Commercial MD Blue Shield - Maryland (CareFirst) Remittance 5010A1 Enrollment***Must also enroll in Payer SB580 toreceive remittance****

U: 09/01/2016 Par SB690 Commercial MD Blue Shield - Maryland (CareFirst) Professional 5010A1Claim Level Accept /Reject


A: 11/02/2017 Trans 12011 Commercial MD Blue Shield - Maryland (Carefirst) (FormerlySB690) Institutional 5010A2 No Response From Payer No

U: 12/01/2020 Non-Par SB700 Government MA Blue Shield - Massachusetts (Formerly BS059) Remittance 5010A1 Enrollment

A: 10/07/2016 Non-Par SB700 Government MA Blue Shield - Massachusetts (Formerly BS059) Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/06/2016 Non-Par SB720 Government MN Blue Shield - Minnesota (formerly BS085) Professional 5010A1 Yes

U: 11/14/2019 Non-Par SB720 Government MN Blue Shield - Minnesota (formerly BS085) Remittance 5010A1 Enrollment

A: 11/01/2017 Non-Par 12B16 Government MN Blue Shield - Minnesota (formerly BS085/SB720) Institutional 5010A1 Yes

U: 09/17/2018 Non-Par SB741 Commercial MO Blue Shield - Missouri (St. Louis)(Anthem) (Formerly Professional 5010A1 No Response From Payer Yes

Updated: 03/21/2022


PPAAYERYERIDID



BS025) [aka ANTHEM BLUE CROSS BLUE SHIELD(MISSOURI)]

U: 10/26/2017 Non-Par 12B66 Commercial MO Blue Shield - MO (Kansas City BS) Institutional 5010A1

U: 10/21/2021 Non-Par 12B66 Commercial MO Blue Shield - MO (Kansas City BS) Remittance 5010A1 Enrollment

U: 11/20/2018 Non-Par 12B77 Commercial MT Blue Shield - Montana Institutional 5010A1

U: 10/21/2021 Non-Par 12B77 Commercial MT Blue Shield - Montana Remittance 5010A1 Enrollment

U: 10/15/2019 Non-Par 12B19 Commercial NE Blue Shield - Nebraska Remittance 5010A1 Enrollment

U: 07/06/2017 Non-Par 12B19 Commercial NE Blue Shield - Nebraska Institutional 5010A1 Enrollment Yes

U: 09/17/2018 Non-Par SB765 Government NVBlue Shield - Nevada --- Anthem (Formerly BS019)[aka ANTHEM BLUE CROSS BLUE SHIELD (NEVADA)]


Yes

A: 09/17/2018 Non-Par 12B20 Commercial NVBlue Shield - Nevada --- Anthem (Formerly BS019/SB765) [aka ANTHEM BLUE CROSS BLUE SHIELD(NEVADA)]


Yes

U: 09/17/2018 Non-Par SB770 Government NHBlue Shield - New Hampshire --- Anthem (FormerlyBS067) [aka ANTHEM BLUE CROSS BLUE SHIELD (NEWHAMPSHIRE)]


Yes

A: 09/17/2018 Non-Par 12B21 Commercial NHBlue Shield - New Hampshire --- Anthem (FormerlyBS067/SB770) [aka ANTHEM BLUE CROSS BLUESHIELD (NEW HAMPSHIRE]


Yes

A: 10/06/2016 Non-Par SB790 Government NM Blue Shield - New Mexico (Formerly BS037) Professional 5010A1Claim Level Accept /Reject

Yes

U: 02/28/2022 Non-Par SB790 Commercial NM Blue Shield - New Mexico (Formerly BS037) Remittance 5010A1 Enrollment

U: 09/17/2018 Non-Par SB803 Commercial NYBlue Shield - New York (Empire) (Formerly BS033)[aka EMPIRE BLUE CROSS BLUE SHIELD]


U: 08/19/2019 Non-Par SB803 Commercial NYBlue Shield - New York (Empire) (Formerly BS033)[aka EMPIRE BLUE CROSS BLUE SHIELD]


A: 02/17/2016 Non-Par 12B23 Commercial NC Blue Shield - North Carolina Institutional 5010A1Claim Level Accept /Reject

U: 10/16/2019 Non-Par 12B23 Commercial NC Blue Shield - North Carolina Remittance 5010A1 Enrollment

U: 10/15/2019 Non-Par SB810 Government NC Blue Shield - North Carolina (Formerly BS003) Remittance 4010A1 Enrollment

A: 07/10/2017 Non-Par SB810 Commercial NC Blue Shield - North Carolina (Formerly BS003) Professional 5010A1Claim Level Accept /Reject

Yes

U: 11/21/2019 Non-Par SB820 Government ND Blue Shield - North Dakota (Formerly BS057) Remittance 4010A1 Enrollment

U: 06/14/2018 Non-Par SB820 Government ND Blue Shield - North Dakota (Formerly BS057) Professional 5010A1 Claim Level Rejects Only Yes

U: 06/14/2018 Non-Par 12B78 Government ND Blue Shield - North Dakota (Formerly BS057) Institutional 5010A1

U: 01/02/2020 Non-Par SB804 Commercial NY Blue Shield - NY - Rochester Remittance 5010A1 Enrollment

A: 02/20/2017 Non-Par SB804 Commercial NY Blue Shield - NY - Rochester (Formerly 00804) Professional 5010A1Claim Level Accept /Reject

Yes

A: 07/31/2017 Non-Par SB804 NY Blue Shield - NY - Rochester (Formerly BS061) Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/02/2017 Non-Par 12B40 NY Blue Shield - NY - Rochester (Formerly BS061/SB804) Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/17/2018 Non-Par SB338 Commercial OHBlue Shield - Ohio --- Anthem (Formerly BS051) [akaANTHEM BLUE CROSS BLUE SHIELD (OHIO)]


Yes

A: 09/17/2018 Non-Par 12B24 Commercial OHBlue Shield - Ohio --- Anthem (Formerly SB338 /BS051) [aka ANTHEM BLUE CROSS BLUE SHIELD(OHIO)]


Yes

A: 10/06/2016 Non-Par SB840 Government OK Blue Shield - Oklahoma (formerly BS041) Professional 5010A1Claim Level Accept /Reject

Yes

U: 10/21/2019 Non-Par SB840 Government OK Blue Shield - Oklahoma (formerly BS041) Remittance 5010A1 Enrollment

U: 11/18/2019 Non-Par SB850 Government OR Blue Shield - Oregon (Formerly BS026) Remittance 5010A1 Enrollment

U: 08/29/2018 Non-Par SB850 Government OR Blue Shield - Oregon (Formerly BS026) Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/02/2017 Non-Par 12B41 Commercial OR Blue Shield - Oregon (Formerly BS026/SB850) Institutional 5010A2 Yes

A: 02/10/2022 Non-Par 58379 CommercialBlue Shield - Pennsylvania Highmark (Central andWestern)(Formerly 12B81)

Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 10/17/2019 Non-Par 12B81 Commercial PA Blue Shield - Pennsylvania Highmark (Central) Institutional 5010A1 Enrollment

U: 09/16/2019 Non-Par 12B60 Commercial PA Blue Shield - Pennsylvania Highmark (Western) Institutional 5010A1 Enrollment

U: 10/15/2019 Non-Par 12B74 Commercial RI Blue Shield - Rhode Island Remittance 5010A1 Enrollment

U: 05/18/2016 Non-Par 12B74 Commercial RI Blue Shield - Rhode Island Institutional 5010A1

Updated: 03/21/2022


PPAAYERYERIDID



A: 11/02/2017 Non-Par 12B75 Commercial RIBlue Shield - Rhode Island Blue Chip (FormerlyBS175/SB871)


A: 07/10/2017 Non-Par 12B55 Commercial Blue Shield - South Carolina (Formerly BS028) Institutional 5010A2 Yes

A: 06/10/2020 Non-Par SB880 Government SCBlue Shield - South Carolina - CompanionTechnologies (Formerly BS028)


A: 07/10/2017 Non-Par SB880 Government SCBlue Shield - South Carolina - CompanionTechnologies (Formerly BS028)


Yes

U: 01/20/2022 Non-Par SB900 Government TX Blue Shield - Texas (formerly BS021) Remittance 5010A1 Enrollment

A: 10/06/2016 Non-Par SB900 Government TX Blue Shield - Texas (formerly BS021) Professional 5010A1Claim Level Accept /Reject

Yes

U: 04/03/2020 Non-Par SB900 Commercial TX Blue Shield - Texas (formerly BS021) Institutional 5010A2 Yes

U: 10/17/2019 Non-Par SB910 Government UT Blue Shield - Utah (Regence (Formerly BS088) Remittance 5010A1 Enrollment

U: 11/21/2016 Non-Par SB910 Government UT Blue Shield - Utah (Regence (Formerly BS088) Professional 5010A1 Claim Level Rejects Only Yes

U: 07/31/2017 Non-Par 12B42 Commercial UT Blue Shield - Utah (Regence (Formerly BS088) Institutional 5010A1

U: 01/03/2020 Non-Par SB806 Government Blue Shield - Utica/ Watertown (Formerly BS066) Remittance4010A1and5010A1

Enrollment

A: 11/06/2017 Non-Par 12B72 Commercial NY Blue Shield - Utica/Watertown Institutional 5010A1Claim Level Accept /Reject

A: 07/28/2016 Non-Par SB806 Commercial NY Blue Shield - Utica/Watertown (Formerly BS066) Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/17/2018 Non-Par SB923 Government VABlue Shield - Virginia (Anthem) (Formerly BS029)[aka ANTHEM BLUE CROSS BLUE SHIELD (VIRGINIA)]


Yes

A: 10/03/2016 Non-Par SB931 Commercial Blue Shield - Washington Federal (formerly 00932) Professional 5010A1Claim Level Accept /Reject

U: 09/18/2019 Non-Par 12B28 Commercial WV Blue Shield - West Virginia Institutional 5010A1 Enrollment

A: 02/10/2022 Non-Par 58379 Commercial Blue Shield - West Virginia (Formerly 12B28) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 09/17/2018 Non-Par SB950 Government WIBlue Shield - Wisconsin (Anthem) (Formerly BS053)[aka ANTHEM BLUE CROSS BLUE SHIELD(WISCONSIN)]


Yes

A: 09/17/2018 Non-Par 12B29 Commercial WIBlue Shield - Wisconsin (Anthem) (Formerly BS053/SB950) [aka ANTHEM BLUE CROSS BLUE SHIELD(WISCONSIN)]


Yes

U: 06/14/2018 Non-Par 12B30 Commercial WY Blue Shield - Wyoming Institutional 5010A1

U: 10/21/2019 Non-Par 12B30 Commercial WY Blue Shield - Wyoming Remittance 5010A1 Enrollment

U: 10/21/2019 Non-Par SB960 Government WY Blue Shield - Wyoming (formerly BS074) Remittance 4010A1 Enrollment

U: 06/14/2018 Non-Par SB960 Government WY Blue Shield - Wyoming (formerly BS074) Professional 5010A1 Claim Level Rejects Only Yes

A: 11/12/2019 Non-Par 12B45 Commercial TN Blue Shield -Tennessee Institutional 5010A1 Enrollment

U: 06/21/2017 Trans 94032 Commercial CA Blue Shield California - HMO (Encounters) Professional 5010A1Claim Level Accept /Reject

U: 06/21/2017 Trans 94032 Commercial CA Blue Shield California - HMO (Encounters) Institutional 5010A1Claim Level Accept /Reject

A: 03/03/2016 Non-Par 99105 Government CABlue Shield of California - Medicare AdvantageEncounters


A: 03/03/2016 Non-Par 99105 Government CABlue Shield of California - Medicare AdvantageEncounters

Institutional 5010A1 Claim Level Ack.

A: 11/02/2017 Non-Par SB871 Government RI BlueChip - Rhode Island (Formerly BS175) Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/21/2020 Non-Par 00403 Commercial SCBlueChoice Medicaid (Anthem) [aka BLUE CHOICEHEALTH PLANS SOUTH CAROLINA MEDICAID]


U: 11/27/2019 Non-Par 00403 Commercial SCBlueChoice Medicaid (Anthem) [aka BLUE CHOICEHEALTH PLANS SOUTH CAROLINA MEDICAID]


A: 09/17/2018 Non-Par 00403 CommercialBlueChoice Medicaid (Anthem) [aka BLUE CHOICEHEALTH PLANS SOUTH CAROLINA MEDICAID]

Institutional 5010A2 Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Board Ford Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Board Ford Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Bobrick Washroom Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/23/2013 Non-Par 41556 Workers' Comp MU Bobrick Washroom Inst. Work Comp 4010A1Claim Level Accept /Reject

A: 09/01/2016 Par 36609 Commercial Boilermakers National Health & Welfare Fund Institutional 4010A1 No Response From Payer

U: 09/01/2016 Par 36609 Commercial Boilermakers National Health & Welfare Fund Professional 5010A1 No Response From Payer Yes

A: 11/27/2019 Non-Par 57140 Commercial Boncura Health Solutions Remittance 5010A1 Enrollment

A: 08/31/2016 Par 47405 Commercial CA BookMD Inc Professional 5010A1 No Response From Payer Yes

A: 08/31/2016 Par 47405 Commercial CA BookMD Inc Institutional 5010A1 No Response From Payer Yes

A: 07/17/2020 Non-Par 74238 Commercial NY Boon - Chapman Administrators Inc Remittance 5010A1 Enrollment

A: 12/17/2019 Non-Par 74238 Commercial NY Boon Chapman Administrators Professional 5010A1Claim Level Accept /Reject

No

A: 12/17/2019 Non-Par 74238 Commercial NY Boon Chapman Administrators Institutional 5010A1Claim Level Accept /Reject

No

U: 10/05/2020 Non-Par 13337 Commercial Boston Medical Center Health Plan Institutional 5010A2 No Response From Payer Yes

A: 05/11/2021 Non-Par 13337 Commercial MA Boston Medical Center Health Plan Remittance 5010A1 Enrollment

U: 10/05/2020 Non-Par 13337 Commercial MA Boston Medical Center Healthnet Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Boulder Community Hospital Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Boulder Community Hospital Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Bowsmith, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Bowsmith, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/02/2019 Non-Par BSN01 Commercial TX Brain and Spine Network Remittance 5010A1

A: 06/12/2019 Par BSN01 Commercial TX Brain and Spine Network Professional 5010A1 Enrollment Claim Level Ack.

A: 06/12/2019 Par BSN01 Commercial TX Brain and Spine Network Institutional 5010A1 Enrollment Claim Level Ack.

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Brake Parts Supply & Distribut Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Brake Parts Supply & Distribut Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/21/2021 Non-Par UC001 Commercial CA Brand New Day Professional 5010A1Claim Level Accept /Reject

No

A: 05/21/2021 Non-Par UC001 Commercial CA Brand New Day Institutional 5010A1Claim Level Accept /Reject

No

A: 02/16/2021 Par 84423 Commercial TN Brandman Health Plan Professional 5010A1Claim Level Accept /Reject

No

A: 02/16/2021 Par 84423 Commercial TN Brandman Health Plan Institutional 5010A1Claim Level Accept /Reject

No

A: 02/07/2022 Non-Par 84423 Commercial TN Brandman Health Plan Remittance 5010A1 Enrollment


A: 02/07/2022 Non-Par 58379 Commercial TN Brandman Health Plan (Formerly 84423) Remittance 5010A1 Enrollment


A: 09/23/2021 Non-Par 84367 Commercial NJ Braven Health Remittance 5010A1 Enrollment

A: 01/20/2021 Par 84367 Commercial NJ Braven Health Professional 5010A1 Enrollment

A: 07/12/2021 Par 84367 Commercial NJ Braven Health Institutional 5010A1

A: 07/12/2021 Par 84367 Commercial NJ Braven Health Professional 5010A1

A: 10/19/2021 Non-Par BRKPN Commercial NV Breckpoint Professional 5010A1Claim Level Accept /Reject

No

A: 10/19/2021 Non-Par BRKPN Commercial NV Breckpoint Institutional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Bremco Construction Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Bremco Construction Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



A: 04/08/2019 Trans J2297 Workers' Comp MU BRENTWOOD SERVICES Prof. Work Comp 5010A1

A: 09/19/2016 Non-Par J1761 Workers' Comp MU Brickstreet Prof. Work Comp 5010A1Claim Level Accept /Reject

Pennsylvania jurisdiction claims mustbe submitted by paper as of 10/1/2016 to: BrickStreet Insurance,Medical Billing Unit, PO Box 3151,Charleston WV 25332-3151.

A: 12/17/2015 Non-Par J1761 Commercial Brickstreet Remittance 5010A1 Enrollment

U: 05/14/2015 Non-Par BRIDG CommercialID, OR,UT, WA

Bridgespan Professional 5010A1 Yes

U: 05/14/2015 Non-Par BRIDG Commercial MU Bridgespan Institutional 5010A1 Yes

A: 09/15/2016 Par FS802 Commercial FL Bridgeview Professional 5010A1 Claim Level Ack. No

U: 08/15/2019 Non-Par FS802 Commercial FL Bridgeview Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 68054 Commercial AZ Bridgeway Health Solutions Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 68054 Commercial AZ Bridgeway Health Solutions Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/05/2019 Non-Par BRT01 Commercial MN Bright Health - Medicare Advantage Professional 5010A1Claim Level Accept /Reject

No

A: 03/05/2019 Non-Par BRT01 Commercial MN Bright Health - Medicare Advantage Institutional 5010A1Claim Level Accept /Reject

No

A: 06/10/2020 Non-Par BRT01 Commercial Bright Health - Medicare Advantage Remittance 5010A1 Enrollment

A: 03/09/2022 Non-Par BRGHT Commercial Bright Health Medicare Advantage Institutional 5010A1Claim Level Accept /Reject

YesPlease use payer ID BRGHT for Datesof Service of 1/01/2022 and after.

A: 03/09/2022 Non-Par BRGHT Commercial Bright Health Medicare Advantage Professional 5010A1Claim Level Accept /Reject

YesPlease use payer ID BRGHT for Datesof Service of 1/01/2022 and after.

U: 09/10/2012 Non-Par BHP01 Commercial Bright Health Physicians Professional 5010A1Claim Level Accept /Reject

A: 01/18/2017 Par CB186 Commercial MD Bright Health Plan Professional 5010A1 Claim Level Rejects Only No

A: 01/18/2017 Par CB186 Commercial MD Bright Health Plan Institutional 5010A1 Claim Level Rejects Only No

A: 08/13/2021 Non-Par CB186 Commercial MD Bright Health Plan Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Brintnall'S Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Brintnall'S Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Brion Corporation Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Brion Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/10/2019 Non-Par J1764 Auto MU Bristol West PIP Prof. Auto 5010A1

U: 01/01/2012 Non-Par 22286 Commercial BritCay Professional 5010A1File LevelAcknowledgement

U: 01/01/2012 Non-Par 22286 Commercial BritCay Institutional 5010A2File LevelAcknowledgement

A: 03/01/2019 Par BBS19 Commercial NC Britton Benefit Services LLC Professional 5010A1 File Level Ack. Yes

A: 03/01/2019 Par BBS19 Commercial NC Britton Benefit Services LLC Institutional 5010A1 File Level Ack. Yes

A: 04/09/2010 Non-Par WK025 Workers' Comp Broadspire Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par WK025 Workers' Comp Broadspire Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/29/2014 Non-Par WK025 Workers' Comp Broadspire Remittance 4010A1 Enrollment

U: 09/01/2016 Par 51037 Commercial Brokerage Concepts Institutional 4010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 51037 Commercial Brokerage Concepts Professional 5010A1 No Response From Payer Yes

U: 06/06/2014 Par BTHS1 Commercial CA Brown & Toland Health Services Institutional 5010A2Claim Level Accept /Reject

No

U: 06/06/2014 Par BTHS1 Commercial CA Brown & Toland Health Services Professional 5010A1Claim Level Accept /Reject

No

U: 09/01/2016 Par 94316 Commercial Brown & Toland Medical Group Institutional 5010A2 No Response From Payer

U: 01/01/2012 Par 94316 Commercial CA Brown & Toland Medical Group Professional 5010A1Claim Level Accept /Reject

Responses could take up to 10business days

A: 07/13/2021 Non-Par 94316 Commercial Brown & Toland Medical Group Remittance 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



U: 10/19/2017 Par BTSS1 Commercial CA Brown & Toland Sutter Select Professional 5010A1 Claim Level Ack.

A: 12/21/2018 Non-Par BTSS1 Commercial Brown and Toland Remittance 5010A1 Enrollment

A: 12/12/2019 Non-Par BTHS1 Commercial Brown and Toland Health Services Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Brownsville Independent School District Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Brownsville Independent School District Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/11/2013 Non-Par 32004 Commercial OH Buckeye Community Health Plan - Centene Institutional 5010A2 No Response From Payer Yes

A: 08/15/2014 Par 68069 OH Buckeye Community Health Plan - Centene Professional 5010A1 Yes

A: 04/08/2019 Trans J1968 Workers' Comp MU BUILDERS MUTUAL INS Prof. Work Comp 5010A1

A: 01/28/2020 Non-Par J1968 Workers' Comp MU Builders Mutual Insurance Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU BUILDERS SUPPLY OF PALM SPRING Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU BUILDERS SUPPLY OF PALM SPRING Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Burlingame Country Club Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Burlingame Country Club Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU BURROWS, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU BURROWS, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Burton Way Carmel Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Burton Way Carmel Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 42150 Commercial Butler Benefit Institutional 4010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 42150 Commercial IA Butler Benefits Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Bycor Gen Contract Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Bycor Gen Contract Inst. Work Comp 4010A1Claim Level Accept /Reject

A: 08/30/2021 Non-Par 12090 Commercial OH Bywater Professional 5010A1Claim Level Accept /Reject

No

A: 08/30/2021 Non-Par 12090 Commercial OH Bywater Institutional 5010A1Claim Level Accept /Reject

No

A: 12/08/2021 Non-Par 23708 Commercial C & O Employees Hospital Association Remittance 5010A1 Enrollment


A: 12/08/2021 Non-Par 58379 CommercialC & O Employees Hospital Association (Formerly23708)



U: 09/01/2016 Par 23708 Commercial C & O Employees' Hospital Association Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU C-Tap, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU C-Tap, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 73071 Commercial C. L. Frates & Co - OSMA Health Institutional 5010A2File LevelAcknowledgement

U: 01/16/2020 Non-Par 58379 Commercial C.A.S. Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 09/23/2013 Non-Par J1491 Workers' Comp MU C.P.P., Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU C.P.P., Inc. Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

A: 03/04/2013 Non-Par NCH05 Commercial CA CA Eye Care / New Century Health Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 68047 Commercial CA CA Health & Wellness Institutional 5010A2 Enrollment Yes

To Enroll for Institutional Claimsplease contact the payers providerservices department at:1-877-658-0305 and inform them thatyou will be submitting claimselectronically through Emdeon.

U: 05/11/2017 Non-Par 68047 Commercial CA CA Health and Wellness Professional 5010A1 No Response From PayerProviders must call 1-877-658-0305and request to be set up to submitProfessional Claims through Emdeon.

U: 10/18/2019 Non-Par 12M98 Government CA Home Health & Hospice Institutional 5010A1 Enrollment

U: 09/14/2021 Non-Par 12M98 Government CA CA Home Health & Hospice Remittance 5010A1 Enrollment

U: 10/16/2019 Non-Par 12M64 Government MU CA, HI , NV Medicare A (MAC JE) (Formerly IR002) Remittance 5010A1 Enrollment

U: 10/16/2019 Non-Par 12M64 Government MU CA, HI , NV Medicare A (MAC JE) (Formerly IR002) Institutional 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Cacique, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Cacique, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Cadet Uniform Supply Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Cadet Uniform Supply Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 02/11/2013 Non-Par PPM01 Commercial CA Cal Care IPA - Claims Only Professional 5010A1Claim Level Accept /Reject

Yes

U: 11/01/2012 Trans PPM02 Commercial CA Cal Care IPA Encounters - Encounters Only Professional 5010A1Claim Level Accept /Reject

A: 07/16/2021 Non-Par CALOP Commercial CAL OPTIMA DIRECT Remittance 5010A1 Enrollment

U: 09/10/2012 Non-Par IP055 Commercial CA Cal-Net Physicians IPA Professional 5010A1File LevelAcknowledgement

U: 09/23/2013 Non-Par J1491 Workers' Comp MU California Chamber Of Commerce Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU California Chamber Of Commerce Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU California Hi-Tech Floors, Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU California Hi-Tech Floors, Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/02/2014 Non-Par J1532 Workers' Comp CA California Insurance Guarantee Association (CIGA) Prof. Work Comp 5010A1 No Response From Payer

U: 09/23/2013 Non-Par J1491 Workers' Comp MU CALIFORNIA LINEN RENTAL COMPAN Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU CALIFORNIA LINEN RENTAL COMPAN Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 08/12/2021 Non-Par SKCA0 Government CA California Medicaid - Medi-Cal (Formerly MC051) Professional 5010A1 Enrollment Yes

ERA enrollment and processing isavailable under payer id SKCA3.Additional Enrollment Requirementfor Providers in LA County. Please call(916) 636-1000 and ask for LA CountyUnit.

A: 08/12/2021 Non-Par SKCA3 Government CA California Medicaid - Medi-Cal (Formerly MC051) Remittance 5010A1 Enrollment

A: 09/30/2019 Non-Par 94056 Commercial MU California Pacific Medical Center Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU California Water Service Company Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU California Water Service Company Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Callahan, McCune Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Callahan, McCune Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/03/2019 Non-Par MPM27 Commercial CA CALMED Global Professional 5010A1Claim Level Accept /Reject

No

Updated: 03/21/2022


PPAAYERYERIDID



A: 12/03/2019 Non-Par MPM27 Commercial CA CALMED Global Institutional 5010A1Claim Level Accept /Reject

No

A: 07/07/2021 Non-Par MPM27 Commercial CALMED Global Remittance 5010A1 Enrollment

U: 09/10/2012 Non-Par CALOP Commercial CalOptima Direct Professional 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par CALOP Commercial CalOptima Direct Institutional 5010A2 Claim Level Ack.

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Campbell Union School District Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Campbell Union School District Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/27/2012 Non-Par 71057 CommercialCannon Cochran Management Services Inc. MetairieLA

Institutional 5010A2File LevelAcknowledgement

U: 01/27/2012 Non-Par 71057 Commercial Cannon Cochran Management Services, Inc. Professional 5010A1Claim Level Accept /Reject

A: 10/07/2019 Non-Par 71057 Commercial LACannon Cochran management Services, Inc.Metairie, LA


U: 03/11/2021 Non-Par 23045 Commercial PA Capital Blue Cross (Formerly 54720) Remittance 5010A1 Enrollment

U: 04/22/2019 Non-Par 23045 Government PA Capital Blue Cross (Formerly 54720) Professional 5010A1 Yes Yes

U: 04/22/2019 Non-Par 12B61 Commercial Capital Blue Cross (Formerly 54720) Institutional 5010A1 Enrollment

U: 04/22/2019 Non-Par 24705 Commercial PA Capital Blue Cross - Facility Professional 5010A1 EnrollmentClaim Level Accept /Reject

U: 10/20/2021 Non-Par 12B61 Commercial Capital BlueCross Remittance 5010A1 Enrollment

U: 03/04/2016 Par 87726 Commercial Capital Community Health Plan Institutional 5010A2Claim Level Accept /Reject

Yes

A: 04/27/2016 Non-Par SX065 Commercial Capital District Phys Hlth Plan Institutional 5010A2 Yes

U: 09/02/2021 Non-Par SX065 Commercial Capital District Physician's Health Plan Remittance 5010A1 Enrollment

U: 01/21/2021 Trans SX065 Commercial Capital District Physician's Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 95112 Commercial Capital Health Plan Professional 5010A1Claim Level Accept /Reject

No

U: 01/25/2018 Par 95112 Commercial Capital Health Plan Institutional 5010A2Claim Level Accept /Reject

A: 07/19/2021 Non-Par 95112 Commercial Capital Health Plan Remittance 5010A1 Enrollment

U: 04/06/2017 Non-Par 68011 Commercial Capitol Administrators Institutional 5010A2 No Response From Payer ERA available under payer ID: 58379

U: 04/06/2017 Non-Par 68011 Commercial Capitol Administrators Professional 5010A1 ERA available under payer ID: 58379

U: 10/24/2012 Non-Par CAPHP Commercial MU CapRock HealthPlans Professional 5010A1Claim LevelAcknowledgement

U: 03/24/2014 Non-Par 41556 Workers' Comp MU CAPS-SIG Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU CAPS-SIG Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 09/01/2016 Trans 06607 Commercial Cardinal Innovations Professional 5010A1 Claim Level Ack. Yes

U: 09/01/2016 Trans 06607 Commercial Cardinal Innovations Institutional 5010A2 Claim Level Ack.

A: 10/04/2019 Non-Par 06607 Commercial Cardinal Innovations Remittance 5010A1 Enrollment

U: 08/19/2020 Par 57116 Commercial AZ Care 1st Health Plan of Arizona Professional 5010A1Claim Level Accept /Reject

No

U: 08/19/2020 Par 57116 Commercial Care 1st Health Plan of Arizona Professional 5010A2Claim Level Accept /Reject

No

A: 03/04/2019 Non-Par 57116 Commercial AZ Care 1st Health Plan of Arizona Remittance 5010A1 Enrollment

U: 09/01/2016 Par 57115 Commercial CA Care 1st Health Plan of CA Professional 5010A1File LevelAcknowledgement

A: 09/01/2016 Par 57115 Commercial Care 1st Health Plan of CA Institutional 5010A2 No Response From Payer

U: 11/18/2021 Non-Par 57115 Commercial CA Care 1st Health Plan of CA Remittance 5010A1 Enrollment

A: 02/07/2017 Non-Par 12K89 Commercial FL Care Access PSN Institutional 5010A2Claim Level Accept /Reject

A: 11/18/2019 Non-Par 66010 Commercial CARE N CARE INSURANCE CO Remittance 5010A1 EnrollmentProvider must be enrolled for EFT inorder to receive ERA

A: 05/02/2019 Par 66010 Commercial TX Care N' Care Professional 5010A1Claim Level Accept /Reject

A: 05/02/2019 Par 66010 Commercial TX Care N' Care Institutional 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 01/01/2012 Non-Par 41222 Commercial Care To Care Professional 5010A1File LevelAcknowledgement

U: 01/01/2012 Non-Par 41222 Commercial Care To Care Institutional 5010A2File LevelAcknowledgement

A: 03/04/2013 Non-Par 27004 Commercial WI Care WI Health Plan / Trizetto Professional 5010A1Claim Level Accept /Reject

U: 01/09/2015 Non-Par 27004 Commercial WI Care WI Health Plan/Trizetto Institutional 5010A2 No Response From Payer

U: 10/01/2019 Non-Par 27004 Commercial Care WI Health Plan/Trizetto Remittance 5010A1 Enrollment

U: 07/17/2020 Non-Par 11345 Commercial CareCentrix Professional 5010A1Claim Level Accept /Reject

U: 11/24/2014 Non-Par 11345 Commercial CareCentrix Remittance 5010A1 Enrollment

U: 07/17/2020 Par 11345 Commercial CareCentrix Institutional 5010A2

A: 02/22/2022 Par 11349 Commercial MI CareCentrix BCBS MI Professional 5010A1Claim Level Accept /Reject

No

A: 05/29/2018 Par 11346 Commercial CT Carecentrix Cigna Professional 5010A1Claim Level Accept /Reject

No

A: 05/29/2018 Par 11346 Commercial CT Carecentrix Cigna Institutional 5010A1Claim Level Accept /Reject

No

A: 05/29/2018 Par 11347 Commercial CT Carecentrix Florida Blue Professional 5010A1Claim Level Accept /Reject

No

A: 05/29/2018 Par 11347 Commercial CT Carecentrix Florida Blue Institutional 5010A1Claim Level Accept /Reject

No

A: 05/29/2018 Par 11348 Commercial CT Carecentrix Horizon Professional 5010A1Claim Level Accept /Reject

No

A: 05/29/2018 Par 11348 Commercial CT Carecentrix Horizon Institutional 5010A1Claim Level Accept /Reject

No

U: 09/01/2016 Par 14188 Commercial MU CareCore / WCNY RAD Professional 5010A1File LevelAcknowledgement

No

WellCare New York, POS 11 RadiologyClaims Only. Claims for members inthe following counties should besubmitted to WellCare: Monroe, Erie,Wayne, and Onondaga.

U: 09/01/2016 Par 14182 Commercial CareCore National Professional 5010A1 No Response From Payer

U: 11/01/2012 Non-Par 75190 Commercial VACareFirst Administrators (Now known as NCAS -Fairfax, VA)

Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par SB580 Commercial DC CareFirst BCBS - DC, National Capital Area Professional 5010A1Claim Level Accept /Reject


U: 09/01/2016 Par SB690 Commercial MD CareFirst BCBS - Maryland Professional 5010A1Claim Level Accept /Reject


U: 08/14/2020 Non-Par SB580 Commercial DC CareFirst BCBS DC Remittance 5010A1 Enrollment***Must also enroll in Payer SB690 toreceive remittance****

U: 01/01/2012 Trans SB691 Commercial MD CareFirst Delmarva Health Plan Professional 5010A1Claim LevelAcknowledgement

A: 11/23/2016 Par 91136 Commercial WA Caremark WPAS, Inc., Grp #P62 Professional 5010A1Claim Level Accept /Reject

A: 11/23/2016 Par 91136 Commercial WA Caremark WPAS, Inc., Grp #P62 Institutional 5010A1 No Response From Payer

U: 09/01/2016 Par 91136 Commercial Caremark WPAS, Inc., Grp# P62 Professional 5010A1Claim Level Accept /Reject

A: 06/22/2020 Non-Par CARMO Commercial CA CareMore Institutional 5010A1Claim Level Accept /Reject

No

A: 06/22/2020 Non-Par CARMO Commercial CA CareMore Professional 5010A1Claim Level Accept /Reject

No

U: 11/17/2021 Non-Par CM001 Commercial CareMore (Formerly IP128) Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDCM001. Providers will need to enrollfor payer IDs CM001 and 58379 inorder to receive 835s for this payer.

A: 11/17/2021 Non-Par 58379 Commercial CareMore (Formerly IP128)(Formerly CM001) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID CM001.Providers will need to enroll for payerIDs CM001 and 58379 in order toreceive 835s for this payer.

Updated: 03/21/2022


PPAAYERYERIDID



U: 03/04/2020 Par 93975 Commercial CareOregon Professional 5010A1 Claim Level Ack.

U: 02/12/2018 Non-Par 93975 Commercial CareOregon Remittance 5010A1 Enrollment

U: 09/01/2016 Par 93975 Commercial CareOregon Inc. Institutional 5010A2Claim LevelAcknowledgement

A: 11/18/2019 Non-Par 16307 Medicare MA CarePartners of Connecticut Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 11/18/2019 Non-Par 16307 Medicare MA CarePartners of Connecticut Institutional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 03/04/2013 Non-Par NCH04 Commercial CarePlus Cardiology / New Century Professional 5010A1Claim Level Accept /Reject

U: 02/01/2022 Non-Par 65031 CommercialCarePlus Health Plan (formerly Physicians HealthcarePlan - 95092)


U: 02/01/2022 Non-Par 65031 CommercialCarePlus Health Plan (formerly Physicians HealthcarePlan - 95092)


A: 03/04/2013 Non-Par NCH03 Commercial CarePlus Urology / New Century Professional 5010A1Claim Level Accept /Reject

A: 01/13/2021 Non-Par GACS1 Commercial GA Caresource Georgia Institutional 5010A1Claim Level Accept /Reject

Yes

A: 01/13/2021 Non-Par GACS1 Commercial GA Caresource Georgia Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/16/2020 Non-Par 58379 Commercial Caresource Georgia (Formerly payer id GACS1) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

A: 09/01/2016 Par INCS1 Commercial IN Caresource Indiana Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par INCS1 Commercial IN Caresource Indiana Institutional 5010A1Claim Level Accept /Reject

A: 01/13/2021 Non-Par KYCS1 Commercial KY CareSource Kentucky Institutional 5010A2Claim Level Accept /Reject

Yes

A: 10/23/2014 Non-Par KYCS1 Commercial KY Caresource Kentucky Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/16/2020 Non-Par 58379 Commercial Caresource Kentucky (Formerly payer id KYCS1) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 03/11/2013 Non-Par 31114 Commercial OH CareSource OH Professional 5010A1Claim LevelAcknowledgement

Yes

U: 01/13/2021 Non-Par 31114 Commercial OH CareSource OH Institutional 5010A2 Claim Level Rejects Only Yes

A: 09/28/2021 Non-Par 31114 Commercial OH CareSource OH Remittance 5010A1 Enrollment


A: 09/28/2021 Non-Par 58379 Commercial OH CareSource OH (formerly 31114) Remittance 5010A1 Enrollment


A: 01/13/2021 Non-Par WVCS1 Commercial WV CareSource West Virginia Professional 5010A1 Claim Level Ack.

A: 01/13/2021 Non-Par WVCS1 Commercial WV CareSource West Virginia Institutional 5010A1 Claim Level Ack.

A: 10/16/2020 Non-Par 58379 Commercial CareSource West Virginia (Formerly payer id WVCS1) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 09/01/2016 Par 35167 Commercial Carewise Professional 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par 10010 Commercial Careworks Professional 5010A1Claim Level Accept /Reject

U: 01/01/2012 Non-Par 10010 Commercial Careworks Institutional 5010A2Claim Level Accept /Reject

A: 01/15/2021 Non-Par 56215 Commercial NC Carolina Behavioral Health Alliance Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/25/2021 Non-Par 56215 Commercial NC Carolina Behavioral Health Alliance Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 29076 Commercial Carolina Care Plan (formerly payer id 57105) Professional 5010A1Claim Level Accept /Reject

Yes

U: 08/02/2016 Par 29076 Commercial Carolina Care Plan (formerly payer id 57105) Institutional 5010A2 No Response From Payer Yes

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/01/2016 Par 56195 Commercial Carolina Summit Healthcare, Inc. Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 56195 Commercial Carolina Summit Healthcare, Inc. Institutional 5010A2 No Response From Payer

A: 03/04/2013 Non-Par CX101 Commercial PA Carpenters Health&Welfare Philadelphia Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Carriage Motors, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Carriage Motors, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 03/23/2020 Non-Par CHA01 Commercial OR Cascade Comprehensive Care Inc Professional 5010A1Claim Level Accept /Reject

No

A: 02/18/2021 Non-Par CHA01 Commercial OR Cascade Comprehensive Care Inc Institutional 5010A1Claim Level Accept /Reject

No

A: 02/18/2021 Non-Par CHA01 Commercial OR Cascade Comprehensive Care Inc Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU CASTLE GROUP CALIFORNIA, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU CASTLE GROUP CALIFORNIA, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Catania Hijar Corporation Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Catania Hijar Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Catholic Diocese of San Diego Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Catholic Diocese of San Diego Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 06/22/2020 Par 87020 Commercial UT Catholic Life Insurance Professional 5010A1 No Response From Payer No

A: 06/22/2020 Par 87020 Commercial UT Catholic Life Insurance Institutional 5010A1 No Response From Payer No

A: 02/12/2021 Non-Par 58379 Commercial Catholic Life Insurance (87020) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 09/23/2013 Non-Par 41556 Workers' Comp MUCatholic Mutual - Preferred Professional InsuranceCompany


U: 03/24/2014 Non-Par 41556 Workers' Comp MUCatholic Mutual - Preferred Professional InsuranceCompany


U: 03/24/2014 Non-Par 41556 Workers' Comp MU Catholic Mutual - Virginia Surety Company, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Catholic Mutual - Virginia Surety Company, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

A: 06/22/2020 Par 87020 Commercial Catholic United Financial Professional 5010A1 No Response From Payer No

A: 06/22/2020 Par 87020 Commercial Catholic United Financial Institutional 5010A1 No Response From Payer No

A: 02/12/2021 Non-Par 58379 Commercial Catholic United Financial (87020) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 09/01/2016 Trans 03036 Commercial CBA Blue Institutional 5010A2Claim LevelAcknowledgement

U: 09/01/2016 Trans 03036 Commercial CBA Blue Professional 5010A1Claim LevelAcknowledgement

U: 12/20/2019 Non-Par 03036 Commercial CBA Blue Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 41124 Commercial CBSA Professional 5010A1Claim LevelAcknowledgement

Yes

U: 09/01/2016 Par 41124 Commercial CBSA Institutional 5010A2Claim LevelAcknowledgement

Yes

U: 05/09/2014 Non-Par WK010 Workers' Comp MN, TX CCMSI Prof. Work Comp 5010A1

A: 01/28/2020 Non-Par WK010 Workers' Comp MN, TX CCMSI (TX,MN) Remittance 5010A1 Enrollment

U: 09/01/2016 Par 83028 Commercial MU CDO Technologies Institutional 5010A2Claim Level Accept /Reject

No

U: 09/01/2016 Par 83028 Commercial MU CDO Technologies Professional 5010A1Claim Level Accept /Reject

No

A: 08/08/2017 Par 95164 Commercial CA Cedars Sinai Medical Center Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 95164 Commercial Cedars Sinai Medical Center Institutional 5010A2 File Level Ack. Yes

A: 10/05/2021 Non-Par 95164 Commercial CA Cedars Sinai Medical Center Remittance 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/23/2013 Non-Par 41556 Workers' Comp MU Cedars-Sinai Health System Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Cedars-Sinai Health System Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/01/2012 Par 95167 Commercial CA Cedars-Sinai Medical Network (ENCOUNTERS) Professional 5010A1Claim Level Accept /Reject

U: 12/08/2016 Par 95167 Commercial CA Cedars-Sinai Medical Network (ENCOUNTERS) Institutional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 95166 Commercial Cedars-Sinai Medical Network Services Institutional 5010A2

U: 01/01/2012 Par 95166 Commercial CA Cedars-Sinai Medical Network Services (CLAIMS) Professional 5010A1Claim Level Accept /Reject

U: 03/11/2013 Non-Par 68063 Commercial MU Celtic Insurance Professional 5010A1File LevelAcknowledgement

Yes

U: 10/07/2019 Non-Par 68063 Commercial Celtic Insurance Remittance 5010A1 Enrollment

A: 12/05/2014 Non-Par 68063 Commercial Celtic Insurance Institutional 5010A2 File Level Ack. Yes

U: 03/11/2013 Non-Par 68060 Commercial CeltiCare Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 91136 Commercial Cement Masons & Plasterers Health & Welfare Trust Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 91136 CommercialCement Masons & Plasterers Hlth & Welfare TrustGrp# F16


A: 04/06/2018 Par 99111 Commercial CA Cencal Professional 5010A1 Claim Level Ack. Yes

A: 10/10/2017 Par 99111 Commercial Cencal (Formerly CEN01) Institutional 5010A2 No Response From Payer Yes

U: 10/17/2017 Non-Par 99111 Commercial CA Cencal (Formerly CEN01) Insitutional ONLY Remittance 5010A1 No Response From Payer

Enrollment requirement - send anemail to [email protected] the Provider name and NPI.Payer id 99111 is for InstitutionalONLY

U: 03/11/2013 Non-Par 68048 Commercial AZ Cenpatico - Arizona Institutional 5010A2Claim Level Accept /Reject

Yes

U: 07/16/2014 Par 68068 Commercial KS Cenpatico - Behavioral Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/25/2016 Par 68068 Commercial MU Cenpatico - Behavioral Institutional 5010A1Claim Level Accept /Reject

U: 03/11/2013 Non-Par 68052 Commercial IN Cenpatico - Indiana Institutional 5010A2Claim Level Accept /Reject

Yes

Prior to submitting claims, please callProvider Relations Dept at1-877-647-4848 to verify yourprovider info is on file in the claimsystem. This will prevent rejectionsand allow payments to be made in atimely manner

A: 09/03/2014 Non-Par 68068 Commercial NH Cenpatico - New Hampshire Remittance 5010A1 Enrollment

U: 08/15/2014 Non-Par 68068 Commercial AZ Cenpatico Arizona Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 68046 Commercial WI Cenpatico Behavioral Health - Wisconsin Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 68046 Commercial WI Cenpatico Behavioral Health - Wisconsin Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 68048 Commercial AZ Cenpatico Behavioral Health AZ Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 68053 Commercial Cenpatico Behavioral Health Texas Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

Prior to submitting claims, please callProvider Relations Dept at 1-800-716-5650 to verify your provider infois on file in the claim system. This willprevent rejections and allowpayments to be made in a timelymanner.

U: 08/15/2014 Non-Par 68068 Commercial FL Cenpatico Florida Remittance 5010A1 Enrollment

U: 03/28/2016 Par 68068 Commercial GA Cenpatico Georgia Professional 5010A1Claim Level Accept /Reject

Yes

(Prior to submitting claims,callProvider Relations Dept at866-296-8731 to verify your providerinfo is on file in the claim system. Thiswill prevent rejections and allowpayments to be made in a timelymanner)

Updated: 03/21/2022


PPAAYERYERIDID



U: 08/15/2014 Non-Par 68068 Commercial GA Cenpatico Georgia Remittance 4010A1 Enrollment

U: 03/16/2016 Non-Par 68068 Commercial IL Cenpatico Illinois (Illinicare) Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 68052 Commercial IN Cenpatico Indiana Professional 5010A1Claim Level Accept /Reject

Yes

Prior to submitting claims, please callProvider Relations Dept at1-877-647-4848 to verify yourprovider information is on file in theclaim system. This will preventrejections and allow payments to bemade in a timely manner.

U: 08/15/2014 Non-Par 68068 Commercial IN Cenpatico Indiana Remittance 5010A1 Enrollment

U: 07/16/2014 Par 68068 Commercial KS Cenpatico Kansas Professional 5010A1 Yes

U: 08/15/2014 Non-Par 68068 Commercial KS Cenpatico Kansas Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 68061 Commercial MA Cenpatico Massachusetts Professional 5010A1File LevelAcknowledgement

Yes

U: 08/15/2014 Non-Par 68068 Commercial MA Cenpatico Massachusetts Remittance 5010A1 Enrollment

U: 08/15/2014 Non-Par 68068 Commercial MO Cenpatico Missouri Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 68051 Commercial OH Cenpatico Ohio Professional 5010A1Claim Level Accept /Reject

Yes

U: 08/15/2014 Non-Par 68068 Commercial OH Cenpatico Ohio Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 68059 Commercial MU Cenpatico South Carolina Professional 5010A1Claim Level Accept /Reject

Yes

U: 08/15/2014 Non-Par 68068 Commercial SC Cenpatico South Carolina Remittance 5010A1 Enrollment

U: 08/15/2014 Non-Par 68068 Commercial TX Cenpatico Texas Remittance 5010A1 Enrollment

U: 08/15/2014 Non-Par 68068 Commercial WI Cenpatico Wisconsin Remittance 5010A1 Enrollment

A: 03/17/2014 Par 68069 Commercial Centene - Medical Institutional 5010A2Claim LevelAcknowledgement

U: 08/20/2020 Non-Par 68069 Commercial Centene - Medical Remittance 5010A1 Enrollment Not available at this time no ETA

A: 11/15/2013 Par 94312 Commercial CA Center for Elders' Independence Professional 5010A1 No Response From Payer No

A: 05/10/2017 Par 94312 Commercial CA Center for Elders' Independence Institutional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 13360 Commercial CenterLight Healthcare Institutional 5010A2File LevelAcknowledgement

Yes

A: 09/01/2016 Par 13360 Commercial CenterLight Healthcare Professional 5010A1 Claim Level Accept/Reject Yes

A: 09/06/2018 Non-Par CPHL1 Commercial NY Centers Plan for Healthy Living Institutional 5010A1Claim Level Accept /Reject

Yes

U: 01/24/2020 Non-Par CPHL1 Commercial NY Centers Plan for Healthy Living Remittance 5010A1 Enrollment

A: 04/27/2018 Non-Par CPHL1 Commercial NY Centers Plan for Healthy Living Professional 5010A1Claim Level Accept /Reject

Yes

U: 04/02/2019 Par 95399 Commercial CA Centinela Professional 5010A1Claim Level Accept /Reject

A: 12/26/2017 Non-Par MPM03 Commercial CA Centinela IPA Professional 5010A1 Claim Level Ack.

A: 03/23/2020 Non-Par 45564 Commercial NY Centivo Professional 5010A1Claim Level Accept /Reject

No

A: 03/23/2020 Non-Par 45564 Commercial NY Centivo Institutional 5010A1Claim Level Accept /Reject

No

A: 09/01/2016 Trans 66698 Commercial MN CentraCare Professional 5010A1 Claim Level Ack.

A: 09/01/2016 Trans 66698 Commercial MN CentraCare Institutional 5010A1 Claim Level Ack.

U: 08/15/2019 Non-Par 66698 Commercial MN CentraCare Remittance 5010A1 Enrollment

A: 12/05/2014 Non-Par SX169 Commercial Central CA Alliance for Health Institutional 5010A2 File Level Ack.

A: 03/02/2021 Non-Par SX169 Commercial CA Central CA Alliance for Health Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDSX169. Providers will need to enrollfor payer IDs SX169 and 58379 inorder to receive 835s for this payer.

A: 03/02/2021 Non-Par 58379 Commercial CA Central CA Alliance for Health (SX169) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID SX169.Providers will need to enroll for payerIDs SX169 and 58379 in order toreceive 835s for this payer.

U: 10/20/2016 Non-Par SX169 Commercial CA Central California Alliance for Health Professional 5010A1

A: 04/01/2014 Non-Par CHCPI Commercial CA Central Health Medicare Plan Professional 5010A1 File Level Ack. Yes

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/01/2016 Par 02041 Commercial Central Mass. Health Care (CMHC) Professional 5010A1 No Response From Payer Yes

U: 09/23/2019 Non-Par 23626 Commercial PA Central Pennsylvania Teamsters Fund Remittance 5010A1 Enrollment

A: 01/12/2021 Non-Par 36215 Commercial IL Central States Remittance 5010A1 Enrollment

U: 09/01/2016 Par 36215 Commercial Central States Health & Welfare Funds Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 36215 Commercial Central States Health Welfare Fund Institutional 5010A2 No Response From Payer

U: 03/11/2013 Non-Par 55731 Commercial Central Susquehanna Healthcare Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/05/2014 Non-Par 55731 Commercial Central Susquehanna Healthcare Institutional 5010A2 Claim Level Rejects Only Yes

A: 09/01/2016 Par 42140 Commercial Centurion Professional 5010A1 No Response From Payer

A: 09/01/2016 Par 42140 Commercial Centurion Institutional 5010A2 No Response From Payer

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Century Lighting, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Century Lighting, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU CERTIFIED UNDERCAR PARTS, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU CERTIFIED UNDERCAR PARTS, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/08/2014 Non-Par 23171 Commercial CHA - Commonwealth Health Alliance Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 23171 Commercial CHA - Commonwealth Health Alliance Professional 5010A1Claim LevelAcknowledgement

U: 02/08/2021 Non-Par 80214 Commercial CHAMP VA - HAC Crossover (ERA Only) Remittance 5010A1 Enrollment Must also Enroll 84146 for ERA

U: 02/08/2021 Non-Par 84146 Commercial CHAMPVA - HAC Remittance 5010A1 Enrollment Must also Enroll 80214 for ERA

U: 09/01/2016 Par 84146 Commercial CHAMPVA - HAC Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 84146 Commercial CHAMPVA - HAC Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Chandler's P. Verdes Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Chandler's P. Verdes Inst. Work Comp 4010A1Claim Level Accept /Reject

A: 04/13/2016 Par 88446 Commercial GA Change Healthcare Accident Claims Solutions Professional 5010A1 No

A: 04/13/2016 Par 88446 Commercial GA Change Healthcare Accident Claims Solutions Institutional 5010A1 No

A: 10/11/2019 Non-Par 57570 Commercial IL Change Healthcare Comp Billing Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/03/2019 Non-Par 57570 Commercial IL Change Healthcare Comp Billing Institutional 5010A1Claim Level Accept /Reject

Yes

U: 08/19/2019 Non-Par 57570 CHANGE HEALTHCARE COMP BILLING Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Chapman Convalescent Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 16600 Commercial Chautauqua County Healthcare Plan Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 16600 Commercial Chautauqua County Healthcare Plan Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 16600 Commercial Chautauqua County Healthcare Plan (Mayville, NY) Professional 5010A1Claim Level Accept /Reject

A: 12/06/2021 Non-Par ALASK Commercial CHCS Alaska Care Retiree LTC Plan Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDALASK. Providers will need to enrollfor payer IDs ALASK and 58379 inorder to receive 835s for this payer.

A: 12/06/2021 Non-Par 58379 Commercial CHCS Alaska Care Retiree LTC Plan (Formerly ALASK) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID ALASK.Providers will need to enroll for payerIDs ALASK and 58379 in order toreceive 835s for this payer.

A: 12/06/2021 Non-Par AMERP Commercial CHCS American Progressive Insurance Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDAMERP. Providers will need to enrollfor payer IDs AMERP and 58379 inorder to receive 835s for this payer.

A: 12/06/2021 Non-Par 58379 CommercialCHCS American Progressive Insurance (FormerlyAMERP)

Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379* ECHO is

Updated: 03/21/2022


PPAAYERYERIDID



returning 835s for payer ID AMERP.Providers will need to enroll for payerIDs AMERP and 58379 in order toreceive 835s for this payer.

A: 12/06/2021 Non-Par CONJN Commercial CHCS Constitution FBO Jackson National Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDCONJN. Providers will need to enrollfor payer IDs CONJN and 58379 inorder to receive 835s for this payer.

A: 12/06/2021 Non-Par 58379 CommercialCHCS Constitution FBO Jackson National (FormerlyCONJN)


*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID CONJN.Providers will need to enroll for payerIDs CONJN and 58379 in order toreceive 835s for this payer.

A: 12/06/2021 Non-Par CONSN Commercial CHCS Constitution FBO Nationwide Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDCONSN. Providers will need to enrollfor payer IDs CONSN and 58379 inorder to receive 835s for this payer.

A: 12/06/2021 Non-Par 58379 CommercialCHCS Constitution FBO Nationwide (FormerlyCONSN)


*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID CONSN.Providers will need to enroll for payerIDs CONSN and 58379 in order toreceive 835s for this payer.

A: 12/06/2021 Non-Par CONPL Commercial CHCS Constitution FBO Pennsylvania Life Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDCONPL. Providers will need to enrollfor payer IDs CONPL and 58379 inorder to receive 835s for this payer.

A: 12/06/2021 Non-Par 58379 CommercialCHCS Constitution FBO Pennsylvania Life (FormerlyCONPL)


*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID CONPL.Providers will need to enroll for payerIDs CONPL and 58379 in order toreceive 835s for this payer.

A: 12/10/2021 Non-Par CLIC0 Commercial CHCS Constitution Life Insurance Company Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDCLIC0. Providers will need to enroll forpayer IDs CLIC0 and 58379 in order toreceive 835s for this payer.

A: 12/10/2021 Non-Par 58379 CommercialCHCS Constitution Life Insurance Company (FormerlyCLIC0)


*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID CLIC0.Providers will need to enroll for payerIDs CLIC0 and 58379 in order toreceive 835s for this payer.

A: 12/07/2021 Non-Par NACLH Commercial CHCS North American Company Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDNACLH. Providers will need to enrollfor payer IDs NACLH and 58379 inorder to receive 835s for this payer.

A: 12/07/2021 Non-Par 58379 Commercial CHCS North American Company (Formerly NACLH) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID NACLH.Providers will need to enroll for payerIDs NACLH and 58379 in order toreceive 835s for this payer.

A: 12/07/2021 Non-Par NACNY CommercialCHCS North American Insurance Company of NewYork


ECHO is returning 835s for payer IDNACNY. Providers will need to enrollfor payer IDs NACNY and 58379 inorder to receive 835s for this payer.

A: 12/07/2021 Non-Par 58379 CommercialCHCS North American Insurance Company of NewYork (Formerly NACNY)


*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID NACNY.Providers will need to enroll for payerIDs NACNY and 58379 in order toreceive 835s for this payer.

A: 12/07/2021 Non-Par PYRAM Commercial CHCS Pyramid Life Insurance Company Remittance 5010A1 EnrollmentECHO is returning 835s for payer IDPYRAM. Providers will need to enrollfor payer IDs PYRAM and 58379 in

Updated: 03/21/2022


PPAAYERYERIDID



order to receive 835s for this payer.

A: 12/07/2021 Non-Par 58379 CommercialCHCS Pyramid Life Insurance Company (FormerlyPYRAM)


*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID PYRAM.Providers will need to enroll for payerIDs PYRAM and 58379 in order toreceive 835s for this payer.

U: 02/28/2017 Non-Par 75895 Commercial MU CHCS Services, Inc Remittance 5010A1 Enrollment

U: 01/01/2012 Non-Par 75261 Commercial CHEC - A subsidiary of Sprint Professional 5010A1File LevelAcknowledgement

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU CHECK INTO CASH CALIFORNIA, IN Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU CHECK INTO CASH CALIFORNIA, IN Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/09/2018 Par CHERO Commercial OK Cherokee Nation Comprehensive Care Agency Professional 5010A1 No Response From Payer No

A: 11/09/2018 Par CHERO Commercial OK Cherokee Nation Comprehensive Care Agency Institutional 5010A1 No Response From Payer No

A: 01/31/2020 Non-Par LS250 Workers' Comp Chesapeake Employee Insurance Fund (CEIC) Prof. Work Comp 5010A1 No Response From Payer

A: 01/31/2020 Non-Par LS250 Workers' Comp Chesapeake Employee Insurance Fund (CEIC) Inst. Work Comp 5010A1 No Response From Payer

U: 07/05/2018 Trans 34154 Commercial Chesterfield Resources, Inc. Professional 5010A1Claim Level Accept /Reject

U: 07/05/2018 Trans 34154 Commercial Chesterfield Resources, Inc. Institutional 5010A2 Yes

A: 09/23/2021 Non-Par 36222 Commercial IL CHICAGO REG CNCIL/CARPENTER WELFARE FUND Remittance 5010A1 Enrollment


A: 09/23/2021 Non-Par 58379 CommercialCHICAGO REG CNCIL/CARPENTER WELFARE FUND(Formerly 36222)



U: 09/01/2016 Par 60054 Commercial Chickering Benefit Planning Insurance Agency Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/04/2016 Par 87726 Commercial NY Child Health Plus Professional 5010A1

U: 09/01/2016 Par 80141 Commercial Childhealth Plus by Healthfirst (CHP) Institutional 5010A2Claim Level Accept /Reject

Yes

A: 02/01/2021 Non-Par 94321 Commercial CA Children First Medical Group Institutional 5010A1Claim Level Accept /Reject

No

U: 09/01/2016 Par 84146 Commercial Children of Women Vietnam Veterans - VA HAC Institutional 5010A2 No Response From Payer Yes

A: 01/11/2017 Par 251CC Commercial WI Children's Community Health Plan of Wisconsin Professional 5010A1Claim Level Accept /Reject

No

A: 01/11/2017 Par 251CC Commercial WI Children's Community Health Plan of Wisconsin Institutional 5010A1Claim Level Accept /Reject

No

U: 02/28/2012 Par 94321 Commercial Children's First Healthcare Network Professional 5010A1File LevelAcknowledgement

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Children's Hospital Colorado Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Children's Hospital Colorado Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Children's Hospital of Orange County - First Aid Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Children's Hospital of Orange County - First Aid Inst. Work Comp 4010A1Claim Level Accept /Reject

A: 09/01/2016 Par 94302 Commercial MU Chinese Community Health Plan Institutional 5010A1Claim Level Accept /Reject

No

A: 01/04/2022 Non-Par 94302 Commercial Chinese Community Health Plan Remittance 5010A1 Enrollment

U: 01/24/2012 Par 94302 Commercial Chinese Community Healthcare Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Chino Auto Parts (A Corporatio Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Chino Auto Parts (A Corporatio Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



A: 07/27/2016 Trans TH104 CommercialCHIPS (Cook Children's Health Plan) (FormerlyCCHP1)


A: 07/27/2016 Trans TH104 CommercialCHIPS (Cook Children's Health Plan) (FormerlyCCHP1)


A: 08/06/2021 Non-Par CCHP1 Commercial CHIPS Cook Childrens Health Plan Remittance 5010A1 Enrollment

U: 05/08/2015 Non-Par LNDMK Commercial ChiroCare Professional 5010A1 Yes

A: 03/21/2017 Par 33070 Chirometrics Institutional 5010A1 Yes

U: 09/01/2016 Par 33065 Commercial CA CHOC - Children's Hospital of Orange County Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 33065 Commercial CACHOC - Childrens Hospital of Orange County HealthAlliance


U: 03/29/2019 Non-Par CMG01 Commercial CA Choice Medical Group Professional 5010A1Claim Level Accept /Reject

A: 09/01/2020 Non-Par CPN01 Commercial CA Choice Physicians Network Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2020 Non-Par CPN01 Commercial CA Choice Physicians Network Institutional 5010A1Claim Level Accept /Reject

Yes

A: 03/17/2021 Non-Par CPN01 Commercial CA Choice Physicians Network Remittance 5010A1 Enrollment

A: 08/08/2014 Non-Par 39112 Commercial CHP / RPU (FABOH) Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 39112 Commercial CHP / RPU (FABOH) Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Christian Brothers High School Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Christian Brothers High School Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Trans 59355 Commercial MU Christian Care Ministry Professional 5010A1

Providers should check the memberID card and use the Household IDvalue as the member ID whensubmitting claims electronically

U: 09/01/2016 Trans 59355 Commercial MU Christian Care Ministry Institutional 5010A1

Providers should check the memberID card and use the Household IDvalue as the member ID whensubmitting claims electronically

U: 11/01/2012 Non-Par 38308 Commercial MU Christian Financial Services Professional 5010A1 No Response From Payer

U: 11/01/2012 Non-Par 38308 Commercial MU Christian Financial Services Institutional 5010A2 No Response From Payer

A: 09/01/2016 Par 10629 Commercial Christus Health Medicare Advantage Professional 5010A1

A: 09/01/2016 Par 10629 Commercial Christus Health Medicare Advantage Institutional 5010A1

U: 10/01/2019 Non-Par 10629 Commercial NM Christus Health Medicare Advantage Remittance 5010A1 Enrollment

A: 12/31/2019 Par 52106 Commercial TX Christus Health Plan of Texas and Louisiana Professional 5010A1 File Level Ack.

A: 12/31/2019 Par 52106 Commercial TX Christus Health Plan of Texas and Louisiana Institutional 5010A1 File Level Ack.

A: 02/05/2020 Non-Par 52106 Commercial Christus Health Plan of TX & LA Remittance 5010A1 Enrollment

U: 09/01/2016 Par 45210 Commercial TX Christus Texas Medicaid Professional 5010A1

U: 09/01/2016 Par 45210 Commercial TX Christus Texas Medicaid Institutional 5010A2

U: 09/20/2019 Non-Par 45210 Commercial TX Christus Texas Medicaid Remittance 5010A1 Enrollment

A: 04/08/2019 Trans J1554 Workers' Comp MU CHUBB Prof. Work Comp 5010A1

A: 12/27/2018 Non-Par J1561 Workers' Comp CHUBB PIP Prof. Work Comp 5010A1Claim Level Accept /Reject

This payer ID is for Workers' Compand Auto Claims for ALL states. Thepayer name may represent multipleaccounts (employers).

A: 01/28/2020 Non-Par J1561 Workers' Comp Chubb Services-Gallagher Bassett Remittance 5010A1 Enrollment

The Payer ID is for Auto and WorkersComp for ALL states. The above PayerName(s) may represent multipleAccounts (employers.

A: 01/28/2020 Non-Par J1554 Workers' Comp MU Chugg (legacy Chubb & Son) WC Remittance 5010A1 Enrollment

The Payer ID is for Auto and WorkersComp for ALL states. The above PayerName(s) may represent multipleAccounts (employers).

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Chula Vista Elementary School District Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/06/2018 Non-Par J1725 Workers' Comp Church Mutual Insurance Company Prof. Work Comp 5010A1Claim Level Accept /Reject

NoThis Payer ID is for Auto and WorkersComp Claims for ALL states. The

Updated: 03/21/2022


PPAAYERYERIDID



Payer Name(s) may representmultiple Accounts (employers).

A: 07/11/2018 Non-Par J1725 Commercial MU Church Mutual Insurance Company Remittance 5010A1 Enrollment

A: 10/07/2018 Non-Par J1725 Commercial MU Church Mutual Insurance Company Remittance 5010A1

This Payer ID is for Auto and WorkersComp Claims for ALL states. Theabove Payer Name(s) may representmultiple Accounts (employers).

U: 12/16/2019 Non-Par 62308 Commercial Cigna Remittance 4010A1 Enrollment

U: 08/02/2016 Par 62308 Commercial CIGNA Institutional 5010A2Claim Level Accept /Reject

Yes

U: 08/16/2021 Non-Par 80705 Commercial CIGNA (Formerly Great West) Remittance 5010A1 EnrollmentERA SETUP FORM IS REQUIRED TOENROLL FOR 835 Also setup payer id62308

U: 09/19/2019 Non-Par 62308 Commercial CIGNA (formerly NALC) Professional 5010A1Claim Level Accept /Reject

Yes

NALC claims with DOS on or after 01/01/08 must be submitted with payerid 62308. Only paper EOB will beprovided for claims of NALC members

A: 07/01/2021 Non-Par JVHKQ Commercial CIGNA (Health Partners) JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 07/01/2021 Non-Par JVHKQ Commercial CIGNA (Health Partners) JVHL Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62308 Commercial CIGNA - ERA Available Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/25/2021 Non-Par 58580 Commercial MI Cigna - NON-HAP Members Only - JVHL Remittance 5010A1 Enrollment

A: 03/25/2021 Non-Par 58580 Commercial MI Cigna - Non-Hap Members Only - JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 03/11/2021 Non-Par 58580 Commercial TN Cigna - NON-HAP Members Only - JVHL Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 08/02/2016 Par 62308 Commercial CIGNA - PPA Institutional 5010A2Claim Level Accept /Reject

Yes

U: 08/02/2016 Par 62308 Commercial CIGNA - PPO Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62308 Commercial CIGNA - PPO Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par MCCBV Commercial CIGNA Behavioral Health Professional 5010A1File LevelAcknowledgement

Yes

A: 12/05/2014 Non-Par 99139 Commercial Cigna Encounters Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 86033 Commercial Cigna for Seniors Professional 5010A1Claim LevelAcknowledgement

A: 01/24/2018 Par 13193 CommercialCigna Health & Life Insurance Company - MedicareSupplement


A: 01/24/2018 Par 13193 CommercialCigna Health & Life Insurance Company - MedicareSupplement

Institutional 5010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 62308 Commercial CIGNA Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

U: 08/02/2016 Par 62308 Commercial CIGNA Health Plan - HMO Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 86033 Commercial Cigna Medicare Advantage Institutional 5010A2 No Response From Payer

U: 03/11/2013 Non-Par 62308 Commercial CIGNA Premier Plus Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/27/2018 Non-Par J1562 Workers' Comp Cincinnati Ins PIP Prof. Work Comp 5010A1Claim Level Accept /Reject

This payer ID is for Workers' Compand Auto Claims for ALL states. Thepayer name may represent multipleaccounts (employers).

U: 10/03/2016 Non-Par TH130 Commercial FL Citrus Health Care (formerly 10207) Professional 5010A1 No Response From Payer Yes

U: 09/10/2012 Non-Par IP055 Commercial CA Citrus Valley Physician's Group Professional 5010A1File LevelAcknowledgement

U: 11/01/2012 Non-Par CVPG1 Commercial Citrus Valley Physicians Medical Group Professional 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Ashland Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Beaverton Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Belmont (Self Insured) Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Campbell Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Carlsbad Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Carmel By The Sea Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Carson Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Colton Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Coronado Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Del Mar Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Edinburg, Texas Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Encinitas Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Escondido Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Grand Junction Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Hillsboro Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Imperial Beach Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Imperial Beach (Voucher) Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Irving Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Lemon Grove Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Los Altos Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Merced Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of National City Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Oceanside Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 75600 Commercial City of Odessa Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 75600 Commercial City of Odessa Professional 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Ontario Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Richardson Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Santee Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Solana Beach Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of South San Francisco Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/18/2013 Non-Par TKFMC Commercial MU City of Visalia Professional 5010A1File LevelAcknowledgement

No

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Vista Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Waco Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 03/24/2014 Non-Par 41556 Workers' Comp MU City of Yuma Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Civil Constructors Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/23/2012 Non-Par CLFR2 Commercial CL Frates Professional 5010A1Claim Level Accept /Reject

U: 10/07/2019 Non-Par 38219 Commercial ClaimChoice Adminstrators (Formerly AmeraPlan) Remittance 5010A1 EnrollmentYou must also enroll for payer ID:58379

U: 07/11/2019 Non-Par 38219 Commercial MU ClaimChoice Adminstrators (Formerly AmeraPlan) Professional 5010A1 Enrollment No Response From Payer No

A: 07/11/2019 Non-Par 38219 Commercial ClaimChoice Adminstrators (Formerly AmeraPlan) Institutional 5010A2 No Response From Payer

A: 09/01/2016 Trans 43056 Commercial MU Claims Development Corporation Professional 5010A1 Claim Level Ack.

U: 03/11/2013 Non-Par 11752 Commercial ClaimsBridge HPN Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/05/2014 Non-Par 11752 Commercial ClaimsBridge HPN Institutional 5010A2 Claim Level Rejects Only Yes

A: 02/12/2021 Non-Par 83063 Commercial MI ClaimsChoice Administrators LLC Professional 5010A1 File Level Ack. Yes

A: 02/12/2021 Non-Par 83063 Commercial MI ClaimsChoice Administrators LLC Institutional 5010A1 File Level Ack. Yes

U: 06/30/2012 Non-Par 27008 Commercial Claimshop- Employers Coalition on Health Institutional 5010A2File LevelAcknowledgement

A: 09/01/2016 Par 57080 Commercial Claimsware, Inc dba ManageMed Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 57080 Commercial Claimsware, Inc., DBA ManageMed Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 95444 Commercial Clarian Health Plans Inc. Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 95444 Commercial Clarian Health Plans Inc. Institutional 5010A2 No Response From Payer

U: 09/23/2013 Non-Par J1491 Workers' Comp MU CLAUSEN ENTERPRISES INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU CLAUSEN ENTERPRISES INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU CLEAN STEEL INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU CLEAN STEEL INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 77201 Commercial Clear Choice Professional 5010A1Claim Level Accept /Reject

A: 01/13/2020 Non-Par CLEAR Commercial FL Clear Health Alliance Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/13/2020 Non-Par CLEAR Commercial FL Clear Health Alliance Institutional 5010A1Claim Level Accept /Reject

Yes

A: 10/01/2019 Non-Par CLEAR Clear Health Alliance Remittance 5010A1 Enrollment

A: 06/11/2021 Non-Par 85468 Commercial Clear Spring Health Remittance 5010A1 Enrollment


A: 02/16/2021 Par 85468 Medicare IL Clear Spring Health Professional 5010A1 No

A: 02/16/2021 Par 85468 Medicare IL Clear Spring Health Institutional 5010A1 No

A: 06/11/2021 Non-Par 58379 Commercial Clear Spring Health (formerly payer id 85468) Professional 5010A1 Enrollment


U: 09/23/2013 Non-Par J1491 Workers' Comp MU Cleugh'S Rhubarb Ranch, Inc.; Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Cleugh'S Rhubarb Ranch, Inc.; Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 02/04/2021 Non-Par 8422E Commercial CA Clever Care Health Plan Encounters Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/04/2021 Non-Par 8422E Commercial CA Clever Care Health Plan Encounters Institutional 5010A1Claim Level Accept /Reject

Yes

A: 02/04/2021 Non-Par 84227 Commercial CA Clever Care Health Plan Inc Professional 5010A1Claim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



A: 02/04/2021 Non-Par 84227 Commercial CA Clever Care Health Plan Inc Institutional 5010A1Claim Level Accept /Reject

Yes

A: 11/06/2018 Par 80950 Commercial OH Clinical Specialties Inc. Professional 5010A1 Claim Level Ack. Yes

A: 11/06/2018 Par 80950 OH Clinical Specialties Inc. Institutional 5010A1 Claim Level Ack. Yes

U: 09/01/2016 Par 77023 Commercial NJ Clover Health Professional 5010A1 Rejection Only

U: 09/01/2016 Par 77023 Commercial NJ Clover Health Institutional 5010A2 Claim Level Rejects Only

U: 10/07/2019 Non-Par 77023 Commercial NJ Clover Health Remittance 5010A1 Enrollment

A: 12/20/2019 Par 13285 Commercial CA Clover Health Professional 5010A1 Claim Level Ack. Yes

A: 12/20/2019 Par 13285 Commercial CA Clover Health Institutional 5010A1 Claim Level Ack. Yes

A: 01/08/2020 Non-Par 13285 Commercial Clover Health Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU CLW PACIFIC, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU CLW PACIFIC, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 02041 Commercial CMHC Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 02041 Commercial CMHC Central Mass Health Care Institutional 5010A2 No Response From Payer Yes

U: 01/29/2015 Non-Par WK001 Workers' Comp CA CMI Wal-Mart CA Prof. Work Comp 5010A1

U: 01/29/2015 Non-Par WK001 Workers' Comp MN CMI Wal-Mart MN Prof. Work Comp 5010A1

A: 07/03/2018 Non-Par 20443 Workers' Comp CNA Insurance Professional 5010A1Claim Level Accept /Reject

No

A: 06/20/2018 Non-Par 20443 Commercial MU CNA Insurance Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Co Grande Casino Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/15/2021 Non-Par 12M88 Government CO NM OK TX-MAC J4 Part A LEGACY Remittance 5010A1 Enrollment

U: 09/15/2021 Non-Par 12M88 Government CO NM OK TX-MAC J4 Part A LEGACY Institutional 5010A1 Enrollment

U: 01/10/2017 Trans E3510 Commercial CA Coachella Valley Physicians PrimeCare Professional 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Coast Converters Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/23/2019 Non-Par 79420 Commercial WA Coastal Administrative Services Professional 5010A1Claim Level Accept /Reject

No

A: 09/23/2019 Non-Par 79420 Commercial WA Coastal Administrative Services Institutional 5010A1Claim Level Accept /Reject

No

A: 08/26/2020 Non-Par 74120 Commercial WA Coastal Administrative Services Professional 5010A1Claim Level Accept /Reject

Yes

A: 08/26/2020 Non-Par 74120 Commercial WA Coastal Administrative Services Institutional 5010A1Claim Level Accept /Reject

Yes

U: 11/01/2018 Trans 47394 Commercial FL Coastal Care Services, Inc Professional 5010A1 No Response From Payer

A: 11/01/2018 Trans 47394 Commercial FL Coastal Care Services, Inc Institutional 5010A1 No Response From Payer Yes

A: 11/01/2018 Trans 47394 Commercial FL Coastal Care Services, Inc. Institutional 5010A1 No Response From Payer Yes

U: 09/01/2016 Par CCPN1 Commercial MU Coastal Communities Physician Network Professional 5010A1Claim LevelAcknowledgement

A: 11/17/2015 Par CCPN1 Commercial CA Coastal Communities Physician Network Institutional 5010A1 Claim Level Ack. No

A: 09/03/2019 Par 42049 Commercial GA Cofinity (Group Resources) Professional 5010A1 No

A: 09/03/2019 Par 42049 Commercial GA Cofinity (Group Resources) Institutional 5010A1 No

A: 07/07/2021 Non-Par 36479 Commercial Collective Health Remittance 5010A1 Enrollment


A: 07/07/2021 Non-Par 58379 Commercial Collective Health (formerly 36479) Remittance 5010A1 Enrollment


U: 03/24/2014 Non-Par 41556 Workers' Comp MU Collin County Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/01/2012 Non-Par 22284 Commercial Colonial Medical Professional 5010A1File LevelAcknowledgement

U: 01/01/2012 Non-Par 22284 Commercial Colonial Medical Institutional 5010A2 File Level

Updated: 03/21/2022


PPAAYERYERIDID



Acknowledgement

A: 01/16/2018 Non-Par 22287 Commercial MU Colonial Medical Insurance Institutional 5010A1 Claim Level Ack. No

A: 01/16/2018 Non-Par 22287 Commercial MU Colonial Medical Insurance Professional 5010A1 Claim Level Ack. No

U: 12/05/2019 Non-Par 37077 Commercial IN Colonial Penn Life Insurance Company Remittance 5010A1 EnrollmentYou must also enroll for payer ID:36066

A: 07/11/2017 Non-Par 84129 Commercial CO Colorado Access (Formerly COACC) Professional 5010A1

A: 07/11/2017 Trans 84129 Commercial Colorado Access (Formerly COACC) Institutional 5010A2 Yes

U: 08/15/2019 Non-Par 84129 Commercial CO Colorado Access (Formerly COACC) Remittance 5010A1 Enrollment

U: 09/17/2018 Non-Par 12B05 Commercial COColorado Blue Advantage/HMO of Colorado(HMOC)(formerly COHMO) [aka ANTHEM BLUE CROSSBLUE SHIELD (COLORADO)]


U: 09/17/2018 Non-Par SB550 Commercial COColorado Blue Advantage/HMO of Colorado(HMOC)(formerly COHMO) [ANTHEM BLUE CROSSBLUE SHIELD (COLORADO)]


A: 10/14/2019 Non-Par COCHA Commercial CO Colorado Community Health Alliance Professional 5010A1Claim Level Accept /Reject

No

A: 10/14/2019 Non-Par COCHA Commercial CO Colorado Community Health Alliance Institutional 5010A1Claim Level Accept /Reject

No

A: 12/22/2021 Non-Par COCHA Commercial CO Colorado Community Health Alliance Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Colorado Contractors Program Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/24/2014 Non-Par 49718 Commercial Colorado Health OP Professional 5010A1 Claim Level Accept/Reject

A: 12/05/2014 Non-Par 49718 Commercial Colorado Health OP Institutional 5010A2 Claim Level Rejects Only

U: 03/24/2014 Non-Par 41556 Workers' Comp MUColorado HealthCare Assoc. - Safety NationalCasualty Corp.


U: 11/15/2019 Non-Par SKCO0 Government CO Colorado Medicaid Remittance 5010A1 Enrollment

U: 11/15/2019 Non-Par SKCO0 Government CO Colorado Medicaid Professional 5010A1 Enrollment Claim Level Ack.

U: 09/07/2019 Non-Par 12K03 Government CO Colorado Medicaid (Formerly SKCO0) Institutional 5010A1 Enrollment Claim Level Ack.

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Colorado Prime Corp. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Columbine Health Systems Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/11/2013 Non-Par 62308 Commercial CoMed - CIGNA Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Comfort Systems, Usa Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Comfort Systems, Usa Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par CMGWV Commercial Comm Medical Grp Of The W. Valley Institutional 5010A2 Claim Level Ack.

A: 08/29/2014 Non-Par 77170 Commercial Common Ground Health Care Professional 5010A1 File Level Ack. No

A: 01/03/2020 Non-Par 77170 Commercial COMMON GROUND HEALTHCARE COOPERATIVE Remittance 5010A1 Enrollment

U: 01/27/2012 Non-Par 14315 Commercial Commonwealth Care Alliance Professional 5010A1 No Response From Payer

U: 01/27/2012 Non-Par 14315 Commercial Commonwealth Care Alliance Institutional 5010A2File LevelAcknowledgement

A: 09/24/2021 Non-Par 14315 Commercial Commonwealth Care Alliance Remittance 5010A1 Enrollment

A: 03/10/2022 Par 14316 Commercial Commonwealth Care Alliance - Medicare Advantage Institutional 5010A1 Claim Level Ack. Yes

A: 03/10/2022 Par 14316 Commercial Commonwealth Care Alliance - Medicare Advantage Professional 5010A1 Claim Level Ack. Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU COMMONWEALTH ENERGY CORPORATIO Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU COMMONWEALTH ENERGY CORPORATIO Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 02/25/2021 Non-Par JVHJW Commercial Community Care Associates JVHL Institutional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 02/25/2021 Non-Par JVHJW Commercial Community Care Associates JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

U: 09/01/2016 Par 23282 Commercial Community Care BHO Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 23282 Commercial Community Care BHO Institutional 5010A2

U: 09/25/2019 Non-Par 23282 Commercial Community Care BHO Remittance 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/01/2016 Par 60995 Commercial WI Community Care Inc. - Family Care (Wisconsin) Institutional 5010A2

U: 10/07/2019 Non-Par 60995 Commercial WI Community Care Inc. - Family Care (Wisconsin) Remittance 5010A1 EnrollmentYou must also enroll for payer ID:39126

U: 09/01/2016 Par 60995 Commercial WI Community Care Inc. - Family Care (Wisconsin) Professional 5010A1

A: 09/01/2016 Par CCI01 Commercial CA Community Care IPA Professional 5010A1 Claim Level Ack. No

A: 09/01/2016 Par CCI01 Commercial CA Community Care IPA Institutional 5010A1 Claim Level Ack. No

U: 09/01/2016 Par 73143 Commercial OK Community Care Managed Health Care Plans of OK Professional 5010A1Claim LevelAcknowledgement

Yes

U: 09/01/2016 Par 73143 CommercialCommunity Care Managed Health Care Plans ofOklahoma


U: 08/19/2019 Non-Par 73143 Commercial OK Community Care Managed Healthcare Plans of OK Remittance 5010A1 Enrollment

U: 09/01/2016 Par 39126 Commercial Community Care Organization Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 39126 Commercial Community Care Organization Institutional 5010A2File LevelAcknowledgement

U: 08/15/2019 Non-Par 39126 Commercial WI Community Care Organization Remittance 5010A1 EnrollmentYou must also enroll for payer ID:60995

A: 12/16/2019 Non-Par BHPP1 Commercial FL Community Care Plan (Broward Health PPUC) Professional 5010A1Claim Level Accept /Reject

No

A: 01/22/2021 Non-Par CCP65 Commercial FL Community Care Plan [Medicaid] Remittance 5010A1 Enrollment

A: 09/26/2019 Non-Par PBHD1 Commercial FL Community Care Plan [Palm Beach District] Professional 5010A1Claim Level Accept /Reject

No

A: 09/26/2019 Non-Par PBHD1 Commercial FL Community Care Plan [Palm Beach District] Institutional 5010A1Claim Level Accept /Reject

No

A: 04/22/2021 Non-Par CEC01 Commercial TN Community Eye Care Professional 5010A1Claim Level Accept /Reject

No

A: 02/04/2020 Non-Par NMM05 Commercial CA Community Family Care Professional 5010A1Claim Level Accept /Reject

No

A: 02/04/2020 Non-Par NMM05 Commercial CA Community Family Care Institutional 5010A1Claim Level Accept /Reject

No

U: 03/28/2012 Par HCOMP Commercial Community First - Star Health Plan Professional 5010A1File LevelAcknowledgement

U: 10/03/2016 Non-Par TH005 Commercial Community First Health Plan (formerly COMMF) Professional 5010A1Claim Level Accept /Reject

U: 01/13/2022 Non-Par TH005 Commercial Community First Health Plan (formerly COMMF) Remittance 5010A1 EnrollmentProviders will need to enroll for payerID 42723 in order to receive 835's forthis payer.

A: 10/03/2016 Non-Par TH005 Commercial Community First Health Plan (formerly COMMF) Institutional 5010A2 Claim Level Ack. Yes

U: 03/11/2013 Non-Par 35193 Commercial Community Health Alliance Institutional 4010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 35193 Commercial Community Health Alliance (CHA) Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/24/2014 Non-Par 27905 Commercial Community Health Alliance TN Professional 5010A1 No Response From Payer

A: 12/05/2014 Non-Par 27905 Commercial Community Health Alliance TN Institutional 5010A2 No Response From Payer

U: 04/24/2012 Non-Par CHCN1 Commercial Community Health Center Network Professional 5010A1Claim Level Accept /Reject

U: 12/16/2019 Non-Par CHCN1 Commercial MU Community Health Center Network Remittance 5010A1 Enrollment

U: 08/02/2016 Par 48145 Commercial Community Health Choice Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 48145 Commercial Community Health Choice Professional 5010A1Claim LevelAcknowledgement

A: 01/16/2020 Non-Par 58379 Commercial MU Community Health Choice Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835's for payer id 48145 .Providers will need to enroll withChange Healthcare payer id 58379 inorder to receive these 835s for thispayer

A: 11/15/2021 Non-Par 48145 Commercial Community Health Choice Remittance 5010A1 Enrollment


Updated: 03/21/2022


PPAAYERYERIDID



A: 11/15/2021 Non-Par 58379 Commercial Community Health Choice (Formerly 48145) Remittance 5010A1 Enrollment


A: 11/19/2019 Non-Par 60495 Commercial COMMUNITY HEALTH CHOICE TEXAS - HIM Remittance 5010A1 Enrollment

U: 01/01/2012 Non-Par 75261 Commercial Community Health Electronic Claims (CHEC) Professional 5010A1File LevelAcknowledgement

Yes

U: 01/01/2012 Non-Par 75261 CommercialCommunity Health Electronic Claims / CHEC /webTPA


A: 09/01/2016 Par 66170 Commercial CA Community Health Group Professional 5010A1 File Level Ack.

A: 09/01/2016 Par 66170 Commercial CA Community Health Group Institutional 5010A1 File Level Ack.

A: 10/01/2021 Non-Par 66170 Commercial CA Community Health Group Remittance 5010A1 Enrollment

A: 09/01/2016 Par 60495 Commercial COMMUNITY HEALTH PLAN INC. Professional 5010A1 Claim Level Accept/Reject Yes

A: 09/01/2016 Par 60495 Commercial COMMUNITY HEALTH PLAN INC. Institutional 5010A2 Claim Level Accept/Reject Yes

U: 03/11/2013 Non-Par SB613 Commercial Community Health Plan of Washington Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 12T30 Commercial Community Health Plan of Washington Institutional 5010A2Claim Level Accept /Reject

U: 08/02/2012 Par CMGWV Commercial CA Community Medical Group of the West Valley Professional 5010A1Claim Level Accept /Reject

No Payer Response, please contactpayer directly at 818-707-9603

U: 09/23/2013 Non-Par J1491 Workers' Comp MU COMMUNITY OPTIONS Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU COMMUNITY OPTIONS Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/07/2021 Non-Par CX021 Commercial CompBenefits Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDCX021. Providers will need to enrollfor payer IDs CX021 and 58379 inorder to receive 835s for this payer.

A: 12/07/2021 Non-Par 58379 Commercial CompBenefits (Formerly CX021) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID CX021.Providers will need to enroll for payerIDs CX021 and 58379 in order toreceive 835s for this payer.

U: 03/23/2012 Non-Par 93101 CommercialOR,WA

Complementary HealthCare Plans Professional 5010A1Claim Level Accept /Reject

A: 10/20/2014 Non-Par 15243 Commercial MU CompManagement Health Systems Professional 5010A1

A: 08/06/2014 Non-Par 86600 Commercial Comprehensive Medical & Dental Program Professional 5010A1Claim Level Accept /Reject

U: 10/07/2019 Non-Par 37363 Commercial Compsych Remittance 5010A1 Enrollment

A: 09/01/2016 Par 37363 Commercial MU Compsych Institutional 5010A1 File Level Ack.

A: 10/11/2013 Non-Par 37363 Commercial MU Compsych Professional 5010A1File LevelAcknowledgement

No

A: 09/01/2016 Par 19028 CommercialConcentrix Insurance Solutions (formerly IBMInsurance Outsourcing Services)


A: 09/01/2016 Par 19028 CommercialConcentrix Insurance Solutions (formerly IBMInsurance Outsourcing Services)


A: 12/09/2021 Non-Par 33632 Commercial MO Concordia Care Inc Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/09/2021 Non-Par 33632 Commercial MO Concordia Care Inc Institutional 5010A1Claim Level Accept /Reject

Yes

A: 11/07/2019 Non-Par CAPMN Commercial CONIFER HEALTH SOLUTIONS Remittance 5010A1 Enrollment

U: 04/02/2019 Non-Par 95399 CommercialConifer Health Solutions (formerly CAP ManagementSystems)


A: 04/02/2019 Par 95399 Commercial CAConifer Health Solutions (formerly CAP ManagementSystems)


A: 03/23/2020 Non-Par AGL03 Commercial TX Connected Senior Care Advantage Professional 5010A1Claim Level Accept /Reject

No

A: 03/23/2020 Non-Par AGL03 Commercial TX Connected Senior Care Advantage Institutional 5010A1Claim Level Accept /Reject

No

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/01/2016 Par 06105 Commercial Connecticare Institutional 5010A2 No Response From Payer

NOTE: This payer ID is to be used forcommercial line of business. Validmember ID's begin with 97 (total of11 digits).

U: 12/21/2021 Non-Par 06105 Commercial Connecticare Remittance 4010A1 Enrollment

You must also enroll for payer ID:78375 ECHO is returning 835s forpayer ID 06105. Providers will need toenroll for payer IDs 06105 and 58379in order to receive 835s for this payer.

A: 12/21/2021 Non-Par 58379 Commercial ConnectiCare (Formerly 06105) Remittance 5010A1 Enrollment


U: 09/08/2020 Par 78375 Medicare Connecticare - Medicare Institutional 5010A2Claim Level Accept /Reject

This payer ID is for ConnecticareMedicare line of business only. Forcommercial line of business use payerID 06105 (member ID begins with 97(total of 11 digits)

U: 09/01/2016 Par 78375 Medicare Connecticare - Medicare Professional 5010A1Claim Level Accept /Reject

This payer ID is for ConnecticareMedicare line of business only. Forcommercial line of business use payerID 06105 (member ID begins with 97(total of 11 digits)

U: 12/21/2021 Non-Par 78375 Medicare Connecticare - Medicare Remittance 5010A1 Enrollment

Any provider that wishes to receive835 must be a participating providerwith the payer. If they are non-participating they will not receive 835(Also setup 25531, 55247, 13551,06105 ) The payer can only return upto 12 characters in the 835 CLP01patient id ECHO is returning 835s forpayer ID 78375. Providers will need toenroll for payer IDs 78375 and 58379in order to receive 835s for this payer.

A: 12/21/2021 Non-Par 58379 Commercial Connecticare Medicare (Formerly 78375) Remittance 5010A1 Enrollment


U: 03/22/2012 Par 06105 Commercial Connecticare, Inc. Professional 5010A1Claim Level Accept /Reject

NOTE: This payer ID is to be used forcommercial line of business. Validmember ID's begin with 97 (total of11 digits).

U: 03/11/2013 Non-Par 62308 Commercial Connecticut General (CIGNA) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62308 Commercial Connecticut General Life Insurance Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU CONNEX TCT, LLC Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU CONNEX TCT, LLC Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/20/2014 Non-Par 75284 Commercial Consolidated Associates Railroad Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 75284 Commercial Consolidated Associates Railroad Professional 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par 87843 Commercial Consolidated Health Plans Institutional 5010A2File LevelAcknowledgement

Yes

U: 09/17/2019 Non-Par 87843 Commercial Consolidated Health Plans Professional 5010A1 Yes

U: 09/07/2019 Non-Par 87843 Commercial MU Consolidated Health Plans Remittance 5010A1 Enrollment

U: 04/06/2017 Non-Par 45321 Commercial Consumers Choice Health SC Professional 5010A1 Claim Level Ack. Yes ERA available under payer ID: 58379

U: 04/06/2017 Non-Par 45321 Commercial Consumers Choice Health SC Institutional 5010A2 Claim Level Ack. Yes ERA available under payer ID: 58379

A: 02/09/2017 Par 99433 Commercial TN Contessa Health Professional 5010A1 No Response From Payer No

A: 02/09/2017 Par 99433 Commercial TN Contessa Health Institutional 5010A1 No Response From Payer No

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/24/2019 Non-Par 99433 Commercial TN Contessa Health Remittance 5010A1 Enrollment

A: 01/24/2018 Par 13193 CommercialContinental General Insurance Company - MedicareSupplement


A: 01/24/2018 Par 13193 CommercialContinental General Insurance Company - MedicareSupplement


U: 09/23/2013 Non-Par J1491 Workers' Comp MU Continental Maintenance Indust Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Continental Maintenance Indust Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 46478 Commercial Continuum Health Solutions LLC Professional 5010A1 No Response From Payer

A: 09/01/2016 Par 46478 Commercial Continuum Health Solutions LLC Institutional 5010A2 No Response From Payer

A: 12/09/2021 Par 59557 Commercial CO CONTINUUM HEALTH SOLUTIONS WORKER COMP Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/09/2021 Par 59557 Commercial CO CONTINUUM HEALTH SOLUTIONS WORKER COMP Institutional 5010A1Claim Level Accept /Reject

Yes

U: 10/06/2021 Non-Par CNTRA Commercial CA Contra Costa County Health Plan Remittance 5010A1 Enrollment

U: 10/07/2021 Non-Par CNTRA Commercial CA Contra Costa County Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

U: 10/07/2021 Non-Par CNTRA Commercial CA Contra Costa County Health Plan Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 55544 Commercial Conversion Plan APWU Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 55544 Commercial Conversion Plan-APWU Institutional 5010A2 No Response From Payer

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Cook & Solis Const. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/01/2012 Non-Par 35149 Commercial Cook Group Health Plan Professional 5010A1Claim Level Accept /Reject

U: 01/01/2012 Non-Par 35149 Commercial Cook Group Health Plan Institutional 5010A2File LevelAcknowledgement

A: 04/06/2018 Trans 60065 Commercial IL Cook Medical Group Professional 5010A1 Claim Level Ack. Yes

A: 04/06/2018 Trans 60065 Commercial IL Cook Medical Group Institutional 5010A1 Claim Level Ack. Yes

U: 10/03/2016 Non-Par THCP9 Commercial TX Cooks Children Star Plan (formerly CCHP9) Professional 5010A1 Claim Level Rejects Only

A: 10/03/2016 Par THCP9 Commercial Cooks Children Star Plan (formerly CCHP9) Institutional 5010A2 Claim Level Rejects Only

U: 08/15/2014 Par 68069 Commercial Coordinated Care - Centene Professional 5010A1 Yes

U: 09/01/2016 Par 58204 Commercial Coordinated Medical Specialists Professional 5010A1Claim Level Accept /Reject

A: 12/08/2021 Non-Par COPAT Commercial COPATIENT Remittance 5010A1 Enrollment

A: 01/20/2022 Non-Par COPAT Commercial CT COPATIENT Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/20/2022 Non-Par COPAT Commercial CT COPATIENT Institutional 5010A1Claim Level Accept /Reject

Yes

A: 08/08/2014 Non-Par 58231 Commercial Core Administrative Services Institutional 5010A2 No Response From Payer

U: 11/26/2013 Non-Par 58231 CommercialCore Management Resources Group, Inc. (located inMacon, GA)


A: 09/01/2016 Par CORIZ Commercial Corizon Health Inc. Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par CORIZ Commercial Corizon Health Inc. Institutional 5010A2 Claim Level Rejects Only

U: 02/11/2014 Non-Par 43160 Commercial MUCorizon, Inc (Formerly known as Correctional MedicalServices)

Professional 5010A1File LevelAcknowledgement

No

U: 08/08/2014 Non-Par 43160 Commercial MUCorizon, Inc (Formerly known as Correctional MedicalServices)

Institutional 5010A2 No

A: 02/11/2014 Non-Par 43160 Commercial MUCorizon, Inc. (Formerly known as CorrectionalMedical Services)


No

U: 03/11/2013 Non-Par 35202 Commercial IN CornerStone Benefit Administrators Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 35202 Commercial Cornerstone Benefit Adminstrators Institutional 4010A1Claim LevelAcknowledgement

Yes

A: 11/24/2014 Non-Par CB268 Commercial Cornerstone Preferred Resources Professional 5010A1 Claim Level Accept/Reject

A: 12/05/2014 Non-Par CB268 Commercial Cornerstone Preferred Resources Institutional 5010A2 Claim Level Rejects Only

A: 12/08/2021 Non-Par CB268 Commercial CORNERSTONE PREFERRED RESOURCES Remittance 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/01/2016 Par 41124 Commercial Corporate Benefit Services of America Institutional 5010A2Claim LevelAcknowledgement

Yes

U: 03/11/2013 Non-Par 41124 Commercial Corporate Benefit Services of America / CBSA Professional 5010A1Claim LevelAcknowledgement

Yes

A: 10/20/2016 Par 64270 Commercial KS Corporate Plan Management, Inc. Professional 5010A1 No Response From Payer Yes

A: 10/20/2016 Par 64270 Commercial KS Corporate Plan Management, Inc. Institutional 5010A1 No Response From Payer Yes

A: 11/16/2021 Non-Par 64270 Commercial Corporate Plan Management, Inc. Remittance 5010A1 Enrollment


A: 11/16/2021 Non-Par 58379 Commercial Corporate Plan Management, Inc.(Formerly 64270) Remittance 5010A1 Enrollment


A: 12/14/2016 Par CCIH0 Commercial FL Correctcare Integrated Health Institutional 5010A1 Claim Level Ack. No

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Country Villa Health Services - SNCC Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Country Villa Ox Hlth Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 04/13/2016 Trans 06541 Commercial IL County Care Institutional 5010A1 No

A: 04/13/2016 Trans 06541 Commercial IL County Care Professional 5010A1 No

U: 03/24/2021 Non-Par 06541 Commercial County Care Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU County Motor Parts Company, In Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU County Motor Parts Company, In Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU County Of Alameda / AIG Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1722 Workers' Comp County of LA (Tristar Santa Ana) Prof. Work Comp 5010A1File LevelAcknowledgement

U: 04/14/2014 Non-Par CB280 Workers' Comp CA County of Los Angeles (COLA) - AIMS- Santa Clarita Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU County Of Marin Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/14/2016 Par EC999 Commercial FL County of Riverside Institutional 5010A1 Claim Level Ack. No

A: 12/14/2016 Par EC999 Commercial FL County of Riverside Professional 5010A1 Claim Level Ack. No

A: 09/01/2016 Par CMSP1 Commercial County Services Medical Program Professional 5010A1 File Level Ack.

A: 09/01/2016 Par CMSP1 Commercial County Services Medical Program Institutional 5010A1 File Level Ack.

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Courtyard Health C. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/16/2021 Non-Par 58102 Commercial Covenant Administrators Inc. Remittance 5010A1 Enrollment


A: 11/16/2021 Non-Par 58379 Commercial Covenant Administrators Inc.(Formerly 58102) Remittance 5010A1 Enrollment


U: 01/27/2012 Non-Par 58102 Commercial Covenant Administrators, Inc. Professional 5010A1Claim LevelAcknowledgement

U: 01/27/2012 Non-Par 58102 Commercial Covenant Administrators, Inc. (Atlanta, GA) Institutional 5010A2 No Response From Payer

A: 11/24/2014 Non-Par TH108 Commercial Covenant Management Systems Professional 5010A1 Claim Level Ack.

A: 12/05/2014 Non-Par TH108 Commercial Covenant Management Systems Institutional 5010A2 Claim Level Ack.

U: 10/03/2016 Non-Par TH108 Commercial MU Covenant MGMT Systems EB (formerly CMSEB) Professional 5010A1Claim Level Accept /Reject

Yes

U: 10/03/2016 Non-Par TH108 Commercial MU Covenant MGMT Systems EB (formerly CMSEB) Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 25133 Commercial Coventry Health & Life - Oklahoma Professional 5010A1 Claim Level Accept / Yes

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 03/11/2013 Non-Par 25133 Commercial Coventry Health & Life - Oklahoma Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/30/2019 Non-Par 25133 Commercial Coventry Health Care Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 25133 Commercial Coventry Health Care Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 25133 Commercial Coventry Health Care Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Advantra Freedom25152)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Advantra Freedom25152)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Carelink Advantra,WV and OH only 25139)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Carelink Advantra25139)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Carelink Health Plan25139)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Carelink Medicaid25140)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Carenet of Virginia25142)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly ClaimsAdministration Corp. ,Payer office ID is required,62413)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly CNA ,MailhandlersBenefit Plan, 62413)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Coventry - Nevada,25149)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Coventry - Nevada,25149)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Coventry CarelinkMedicaid 25140)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Coventry Carenet25142)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Coventry DiamondPlan 25131)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Coventry HealthCare National Network - 87043)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Coventry HealthCare National Network - 87043)


Yes

U: 03/11/2013 Non-Par 25133 Commercial DECoventry Health Care (Formerly Coventry HealthCare of Delaware, Inc. 25130)


Yes

U: 03/11/2013 Non-Par 25133 Commercial DECoventry Health Care (Formerly Coventry HealthCare of Delaware, Inc. 25130)


Yes

U: 03/11/2013 Non-Par 25133 Commercial GACoventry Health Care (Formerly Coventry HealthCare of Georgia, Inc. 25127)


Yes

U: 03/11/2013 Non-Par 25133 Commercial GACoventry Health Care (Formerly Coventry HealthCare of Georgia, Inc. 25127)


Yes

U: 03/11/2013 Non-Par 25133 Commercial INCoventry Health Care (Formerly Coventry HealthCare of Indiana, Inc. 25131)


Yes

U: 03/11/2013 Non-Par 25133 Commercial IACoventry Health Care (Formerly Coventry HealthCare of Iowa, Inc. 25132)


Yes

U: 03/11/2013 Non-Par 25133 Commercial IACoventry Health Care (Formerly Coventry HealthCare of Iowa, Inc. 25132)


Yes

U: 03/11/2013 Non-Par 25133 Commercial LACoventry Health Care (Formerly Coventry HealthCare of Louisiana, Inc. 25135)


Yes

U: 03/11/2013 Non-Par 25133 Commercial LACoventry Health Care (Formerly Coventry HealthCare of Louisiana, Inc. 25135)


Yes

U: 03/11/2013 Non-Par 25133 Commercial NECoventry Health Care (Formerly Coventry HealthCare of Nebraska, Inc. 25136)


Yes

U: 03/11/2013 Non-Par 25133 Commercial NE Coventry Health Care (Formerly Coventry Health Institutional 5010A2 Claim Level Accept / Yes

Updated: 03/21/2022


PPAAYERYERIDID



Care of Nebraska, Inc. 25136) Reject

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Coventry HealthCare of the Carolinas 25129)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Coventry HealthCareUSA 25143)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Coventry OmniCare25150)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly GHP ,Group HealthPlan, 25141)


Yes

U: 03/11/2013 Non-Par 25133 Commercial MOCoventry Health Care (Formerly Group Health Plan25141)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Health America, Inc./ Health Assurance / Advantra 25126)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Health America, Inc./ Health Assurance / Advantra 25126)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly HealthCare USA25143)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Mailhandlers BenefitPlan 62413)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Mailhandlers BenefitPlan,CNA ,62413)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly OmniCare, ACoventry Health Plan 25150)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Southern HealthServices, Inc 25128)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Southern HealthServices, Inc 25128)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Vista Health Plan55248)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care (Formerly Vista Health Plan55248)


Yes

U: 03/11/2013 Non-Par 25133 Commercial Coventry Health Care (Formerly WellPath 25129) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Care National Network (f.k.a FirstHealth Direct)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Plan (Formerly Personal PhysicianCare 34173)


Yes

U: 03/11/2013 Non-Par 25133 CommercialCoventry Health Plan (Formerly Personal PhysicianCare 34173)


Yes

U: 03/11/2013 Non-Par 25133 Commercial CoventryCares of Kentucky Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/02/2020 Trans 95964 Commercial MUCOVID-19 HRSA Uninsured Testing and TreatmentFund


U: 09/02/2020 Trans 95964 Commercial MUCOVID-19 HRSA Uninsured Testing and TreatmentFund


U: 03/24/2014 Non-Par 41556 Workers' Comp MU Cox Construction Co Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/25/2019 Non-Par 00019 Commercial Cox Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Cpe Peo Inc. / Dba: California Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Cpe Peo Inc. / Dba: California Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/31/2021 Par CB695 Commercial MU CPR Share Plans Institutional 5010A1 Claim Level Rejects Only

A: 08/31/2021 Par CB695 Commercial MU CPR Share Plans Professional 5010A1 Claim Level Rejects Only

U: 03/24/2014 Non-Par 41556 Workers' Comp MU CPS Security Solutions Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU CRAFTSMAN OFFICE FURNITURE, IN Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU CRAFTSMAN OFFICE FURNITURE, IN Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



A: 06/07/2017 Par CREA8 Commercial NY Create Professional 5010A1 Claim Level Ack. Yes

A: 06/07/2017 Par CREA8 Commercial NY Create Institutional 5010A1 Claim Level Ack. Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU CREATIVE BENEFITS, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU CREATIVE BENEFITS, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par 64068 Commercial Creative Medical Systems Professional 5010A1Claim LevelAcknowledgement

U: 11/01/2012 Non-Par 64068 Commercial Creative Medical Systems Institutional 5010A2 No Response From Payer

U: 02/13/2014 Non-Par 37320 Commercial Creative Plan Administrators Professional 5010A1

A: 08/08/2014 Non-Par 37320 Commercial Creative Plan Administrators Institutional 5010A2

U: 03/11/2013 Non-Par 56213 Commercial Crescent Health Solutions Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/05/2014 Non-Par 56213 Commercial Crescent Health Solutions Institutional 5010A2 No Response From Payer

A: 08/08/2014 Non-Par 37266 Commercial Croy-Hall Mgmt. Inc. Institutional 5010A2 No Response From Payer

A: 02/12/2018 Trans 46430 Commercial IL Crystal Run Health Plans Professional 5010A1 Claim Level Ack. Yes

This payer id is only valid for claimswith date of service on or after 1/1/2018. Claims mailing address: P.O.Box 211627, Eagan, MN 55121

A: 02/12/2018 Trans 46430 Commercial IL Crystal Run Health Plans Institutional 5010A1 Claim Level Ack. Yes

This payer id is only valid for claimswith date of service on or after 1/1/2018. Claims mailing address: P.O.Box 211627, Eagan, MN 55121

A: 05/03/2019 Non-Par 34186 Commercial OH CSI Network Services Professional 5010A1Claim Level Accept /Reject

No

A: 05/03/2019 Non-Par 34186 Commercial OH CSI Network Services Institutional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Ctl Environmental Services Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Ctl Environmental Services Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/16/2020 Non-Par 58379 Commercial Custom Design Benefits Inc. Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

A: 09/01/2016 Par 57080 Commercial CWIBENEFITS, Inc. Institutional 4010A1 No Response From Payer

A: 09/01/2016 Par 88056 Commercial Cypress Benefit Administrators Professional 5010A1File LevelAcknowledgement

A: 09/01/2016 Par 88056 Commercial Cypress Benefit Administrators Institutional 5010A2 No Response From Payer

U: 05/15/2014 Non-Par CALL Commercial D. H. Evans & Associates Professional 5010A1 No Response From PayerCall Jessica Picarde @ 410-349-3222for payer id

U: 12/19/2014 Non-Par CALL Commercial D.H. Evans & Assoc Institutional 5010A2 YesCall Jessica Picarde @ 410-349-3222for Payer id.

U: 03/24/2014 Non-Par 41556 Workers' Comp MU DaimlerChrysler Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 05/29/2012 Non-Par DAK01 Commercial SD DakotaCare Institutional 5010A1Claim Level Accept /Reject

U: 05/29/2012 Non-Par DAK01 Commercial SD DakotaCare Professional 5010A1Claim Level Accept /Reject

U: 09/18/2019 Non-Par DAK01 Commercial SD DakotaCare Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Dallas County Community College District Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Dan'S Landscape Service, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Dan'S Landscape Service, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU DANTEL INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU DANTEL INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/24/2014 Non-Par CB987 Commercial Dart Member Care Professional 5010A1 Claim Level Accept/Reject

A: 12/05/2014 Non-Par CB987 Commercial Dart Member Care Institutional 5010A2 Claim Level Rejects Only

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Davis Mech Systems Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

A: 05/10/2017 Non-Par V0QJA Commercial CA Davis Vision Professional 5010A1Claim Level Accept /Reject

No

A: 07/14/2021 Non-Par V0QJA Commercial CA Davis Vision Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Daylight Transport Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/07/2022 Non-Par RP016 Commercial MD DE Health Advantage Professional 5010A1Claim Level Accept /Reject

No

A: 01/07/2022 Non-Par RP016 Commercial MD DE Health Advantage Institutional 5010A1Claim Level Accept /Reject

No

U: 10/21/2016 Non-Par 39113 Commercial WI Dean Health Plan Professional 5010A1 No Response From Payer

U: 10/21/2016 Non-Par 39113 Commercial Dean Health Plan Institutional 5010A2

U: 08/15/2019 Non-Par 39113 Commercial WI Dean Health Plan Remittance 5010A1 Enrollment No Response From Payer

U: 03/04/2016 Par 87726 Commercial Definity Health Plan (formerly payer ID 64159) Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/04/2016 Par 87726 Commercial Definity Health Plan (formerly payer ID 64159) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/01/2016 Non-Par 77124 Commercial CA Delano Regional Medical Group (formerly MCS02) Professional 5010A1

U: 01/16/2020 Non-Par 58379 Commercial Delano Regional Medical Group (formerly MCS02) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

A: 08/20/2021 Non-Par DSCYF Medicaid DE Delaware Medicaid Enterprise System Professional 5010A1 Claim Level Ack. No

A: 08/20/2021 Non-Par DSCYF Medicaid DE Delaware Medicaid Enterprise System Institutional 5010A1 Claim Level Ack. No

A: 01/13/2020 Non-Par 74272 Commercial VA Dell Children's Health Plan Institutional 5010A1Claim Level Accept /Reject

Yes

A: 01/13/2020 Non-Par 74272 Commercial VA Dell Children's Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

U: 01/01/2012 Trans SB691 Commercial MD Delmarva Health Plan - Carefirst Professional 5010A1Claim LevelAcknowledgement

A: 06/07/2019 Non-Par DHS01 Commercial CA Delta Health Systems Professional 5010A1Claim Level Accept /Reject

Yes

A: 06/07/2019 Non-Par DHS01 Commercial CA Delta Health Systems Institutional 5010A1Claim Level Accept /Reject

Yes

A: 11/20/2019 Non-Par DHS01 Commercial DELTA HEALTH SYSTEMS Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU DEMKO, WILLIAM M. (AN IND) Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU DEMKO, WILLIAM M. (AN IND) Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU DENFRAN SYSTEMS, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU DENFRAN SYSTEMS, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 84134 Commercial Denver Health - Indigent Professional 5010A1Claim Level Accept /Reject

A: 08/08/2014 Non-Par 84134 Commercial Denver Health - Indigent Institutional 5010A2Claim Level Accept /Reject

U: 09/01/2016 Par 84133 Commercial Denver Health and Hospital Auth Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 84133 Commercial Denver Health and Hospital Authority Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 84135 Commercial Denver Health Medical Plan Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 84135 Commercial Denver Health Medical Plan Institutional 5010A2 No Response From Payer

A: 01/10/2020 Non-Par 65456 Commercial CO Denver Health Medical Plan Inc Professional 5010A1Claim Level Accept /Reject

No

A: 01/10/2020 Non-Par 65456 Commercial CO Denver Health Medical Plan Inc Institutional 5010A1Claim Level Accept /Reject

No

U: 09/01/2016 Par 84131 Commercial Denver Health Medical Plan Inc. - Medicare Choice Institutional 5010A2File LevelAcknowledgement

U: 09/01/2016 Par 84131 Commercial Denver Health Medical Plan Inc. - Medicare Choice Professional 5010A1File LevelAcknowledgement

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Denver Public Schools Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



A: 11/24/2014 Non-Par DESAZ Commercial Department of Economic Security Professional 5010A1 Claim Level Accept/Reject

A: 03/01/2019 Non-Par J1449 Workers' Comp MU Department of Energy Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 06/05/2020 Non-Par J1449 Workers' Comp Department of Energy Remittance 5010A1 Enrollment

A: 06/08/2020 Non-Par J1438 Commercial Department of Labor Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par J1438 Workers' Comp MU Department of Labor (formerly WX444) Prof. Work Comp 5010A1File LevelAcknowledgement

U: 09/30/2019 Non-Par SX105 Commercial Deseret Mutual Remittance 5010A1 Enrollment

U: 10/01/2019 Non-Par SX105 Commercial Deseret Mutual Professional 5010A1Claim Level Accept /Reject

Yes

U: 11/18/2019 Non-Par 12X35 Commercial UT Deseret Mutual Benefits Assoc Remittance 5010A1 Enrollment

A: 11/12/2015 Non-Par 12X35 Commercial UT Deseret Mutual Benefits Assoc Institutional 5010A1 Enrollment

Please call at 800-777-3622 Options1, 3 and then 4 to be setup forelectronic claims under TradingPartner Id HT001755-015 prior toclaims submission.

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Desert Hospital District Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par IP121 Commercial CA Desert Medical Group Professional 5010A1 No Response From Payer

U: 11/01/2012 Non-Par IP114 Commercial CA Desert Medical Group - Oasis Professional 5010A1 No Response From Payer

Please contact Desert Medical @(760) 323-2614 x 1580 and request tobe added to their Provider EligibilityList prior to submitting claims thruOffice Ally.

A: 09/27/2016 Par 44006 Commercial CA Desert Oasis HealthCare Professional 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Desert Princess Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Desert Valley Medical Group (A Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Desert Valley Medical Group (A Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU DESIGNS BY MARK Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU DESIGNS BY MARK Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/30/2019 Non-Par DEVOT Commercial MA Devoted Health Professional 5010A1 File Level Ack. Yes

A: 05/30/2019 Non-Par DEVOT Commercial MA Devoted Health Institutional 5010A1 File Level Ack. Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU DEW MANAGEMENT SERVICES INC Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU DEW MANAGEMENT SERVICES INC Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Diablo Hills Golf Association, Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Diablo Hills Golf Association, Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Diamond Farming Company Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU DIAMOND W FLOOR COVERING, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU DIAMOND W FLOOR COVERING, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/03/2019 Non-Par MPM28 Commercial CA Dignity CHMC - HCLA Professional 5010A1Claim Level Accept /Reject

No

A: 12/03/2019 Non-Par MPM28 Commercial CA Dignity CHMC - HCLA Institutional 5010A1Claim Level Accept /Reject

No

A: 03/02/2021 Non-Par 83247 Commercial Dignity Health Remittance 5010A1 Enrollment

A: 12/02/2019 Non-Par PROH1 CommercialDIGNITY HEALTH - MERCY and WOODLAND MEDICALGROUP


U: 01/13/2020 Non-Par HOSH1 Commercial CADignity Health - Sacramento Hosp Shop for MercyMed Group


No

Updated: 03/21/2022


PPAAYERYERIDID



U: 01/13/2020 Non-Par HOSH1 Commercial CADignity Health - Sacramento Hosp Shop for MercyMed Group


No

A: 12/03/2019 Non-Par PROH2 CommercialDIGNITY HEALTH MEDICAL FOUNDATION for SEQUOIAPHYS


A: 12/11/2019 Non-Par PROH1 Commercial CA Dignity Health Woodland Clinic Professional 5010A1Claim Level Accept /Reject

No

A: 12/11/2019 Non-Par PROH1 Commercial CA Dignity Health Woodland Clinic Institutional 5010A1Claim Level Accept /Reject

No

A: 07/31/2020 Non-Par 83247 Commercial LA Dignity HealthPlan (HMO I-SNP) Professional 5010A1Claim Level Accept /Reject

Yes

A: 07/31/2020 Non-Par 83247 Commercial LA Dignity HealthPlan (HMO I-SNP) Institutional 5010A1Claim Level Accept /Reject

Yes

A: 12/02/2019 Non-Par HOSH1 Commercial Dignity Hlth Sacramento Hsp(Mercy Care) Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU DINUBA LUMBER COMPANY (A CORP) Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU DINUBA LUMBER COMPANY (A CORP) Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 10/02/2018 Par DCA62 Commercial UT Direct Care Administrators Professional 5010A1Claim Level Accept /Reject

No

A: 02/19/2019 Par DCA62 Commercial UT Direct Care Administrators Institutional 5010A1Claim Level Accept /Reject

No

A: 07/07/2021 Non-Par DCA62 Commercial Direct Care Administrators Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDDCA62. Providers will need to enrollfor payer IDs DCA62 and 58379 inorder to receive 835s for this payer.

A: 07/07/2021 Non-Par 58379 Commercial Direct Care Administrators (formerly DCA62) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID DCA62.Providers will need to enroll for payerIDs DCA62 and 58379 in order toreceive 835s for this payer.

U: 03/01/2017 Non-Par MWELT Commercial MO District No.9 I.A.of M.&A.W. Welfare Trust Remittance 5010A1 Enrollment

U: 11/08/2019 Non-Par SKDC0 Government DC District of Columbia Medicaid (Formerly MC088) Professional 5010A1 Enrollment No Response From Payer Yes

A: 11/01/2019 Non-Par SKDC0 Government DC District of Columbia Medicaid (Formerly MC088) Remittance 5010A1 Enrollment

A: 09/01/2016 Par 06102 Commercial Diversified Administration Corporation Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 06102 Commercial CT Diversified Group Brokerage (Marlb, CT) Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 06102 Commercial Diversified Group Brokerage / Healthplan Services Professional 5010A1 No Response From Payer

A: 12/17/2019 Non-Par VAICE Commercial DC Division of Immigration Health Institutional 5010A1Claim Level Accept /Reject

No

A: 09/04/2019 Non-Par Z1412 Commercial MN DMEnsion Benefit Management Professional 5010A1Claim Level Accept /Reject

No

A: 10/08/2020 Non-Par Z1412 Commercial MN DMEnsion Benefit Management Remittance 5010A1 Enrollment

U: 10/07/2021 Non-Par SDMEA Government DMERC - Region A (formerly MR030) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 01/09/2020 Non-Par SDMEA Government DMERC - Region A (formerly MR030) Remittance 4010A1 Enrollment

U: 06/12/2020 Non-Par SDMEB Government DMERC - Region B (formerly MR031) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 04/17/2020 Non-Par SDMEB Government DMERC - Region B (formerly MR031) Remittance 4010A1 Enrollment

U: 10/07/2021 Non-Par SDMEC Government DMERC - Region C (formerly MR032) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 01/09/2020 Non-Par SDMEC Government DMERC - Region C (formerly MR032) Remittance 4010A1 Enrollment

U: 06/12/2020 Non-Par SDMED Government DMERC - Region D (formerly MR024) Remittance 4010A1 Enrollment

U: 10/07/2021 Non-Par SDMED Government DMERC - Region D (formerly MR024) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 07/26/2019 Non-Par DRHCP Commercial FL Doctors Healthcare Plans Professional 5010A1Claim Level Accept /Reject

No

A: 07/26/2019 Non-Par DRHCP Commercial FL Doctors Healthcare Plans Institutional 5010A1Claim Level Accept /Reject

No

A: 02/03/2017 Par DOLMG Commercial IL Dolton Medical Group Professional 5010A1 Claim Level Ack. No

A: 02/03/2017 Par DOLMG Commercial IL Dolton Medical Group Institutional 5010A1 Claim Level Ack. No

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Douglas County Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 09/10/2012 Non-Par IP116 Commercial CA Downey Select IPA (Applecare Medical Management) Professional 5010A1 No Response From Payer

A: 08/13/2021 Non-Par APP01 Commercial CADOWNEY SELECT IPA (APPLECARE MEDICALMANAGEMENT)


A: 09/21/2021 Non-Par APP01 Commercial CA Downey Select IPA (Applecare Medical Management) Institutional 5010A1Claim Level Accept /Reject

No

A: 12/02/2014 Non-Par CALL Commercial CA Dr. Rivera Professional 5010A1 No Response From Payer

To obtain Payer ID and enroll withpayer, California providers shouldcontact Tristin Rausche [email protected]

U: 09/01/2016 Par DREYR Commercial Dreyer Health Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/01/2019 Trans 74284 Commercial Driscoll Children's Health Plan Professional 5010A1 File Level Ack. Yes

U: 03/01/2019 Trans 74284 Commercial Driscoll Children's Health Plan Institutional 5010A2 File Level Ack. Yes

U: 09/30/2019 Non-Par 74284 Commercial Driscoll Childrens Health Plan Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Dufour, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Dufour, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 35186 Commercial Dunn & Associates Professional 5010A1File LevelAcknowledgement

Yes

A: 09/25/2019 Non-Par 35186 Dunn And Associates Remittance 5010A1 Enrollment

U: 09/01/2016 Par 35186 Commercial Dunn and Associates Benefits Administrators Inc. Institutional 5010A2File LevelAcknowledgement

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Dupree, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Dupree, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Durango Coffee Co. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Dy Dee Service Of Pasadena Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Dy Dee Service Of Pasadena Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU E.B. Manning & Son Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU E.B. Manning & Son Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU E.H. Summit, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU E.H. Summit, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/01/2012 Non-Par 34108 Commercial E.S. Beveridge & Associates Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 75232 Commercial E3 Health Inc. Professional 5010A1Claim LevelAcknowledgement

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Eagle Pass ISD Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 10/03/2016 Non-Par TH084 Commercial Early Intervention Central Billing (formerly 36434) Professional 5010A1Claim Level Accept /Reject

A: 02/23/2018 Non-Par 25849 Commercial MA East Boston Neighborhood PACE Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/23/2018 Non-Par 25849 Commercial MA East Boston Neighborhood PACE Professional 5010A1Claim Level Accept /Reject

Yes

A: 05/20/2020 Non-Par 25849 Commercial MA East Boston Neighborhood PACE Remittance 5010A1 Enrollment

A: 09/01/2016 Par 08044 Commercial East Pointe Behavioral Health Professional 5010A1 Claim Level Accept/Reject Yes

A: 09/01/2016 Par 08044 Commercial East Pointe Behavioral Health Institutional 5010A2 Yes

A: 04/08/2019 Trans J2143 Workers' Comp MU Eastern Alliance Prof. Work Comp 5010A1

A: 01/28/2020 J2143 Workers' Comp MU Eastern Alliance Professional 5010A1This Payer ID is for Workers CompClaims ONLY for All States. The abovePayer Name(s) may represent

Updated: 03/21/2022


PPAAYERYERIDID



multiple Accounts (employers).

U: 03/11/2013 Par EMG11 Commercial Eastland Medical Group Professional 5010A1Claim Level Accept /Reject

YesNo Payer Response, please contactpayer directly at 818-707-9603

A: 09/01/2016 Par EMG11 Commercial Eastland Medical Group Institutional 5010A2 Claim Level Ack.

A: 07/10/2018 Non-Par 20532 Commercial CA Easy Choice Health Plan of California Professional 5010A1Claim Level Accept /Reject

Yes

A: 07/10/2018 Non-Par 20532 Commercial AR Easy Choice Health Plan of California Institutional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62308 Commercial OH Eaton Benefits, OH Professional 5010A1Claim Level Accept /Reject

Yes

U: 05/19/2017 Par 31074 Commercial EBMC Professional 5010A1 Yes

U: 09/01/2016 Par 31074 Commercial EBMC Institutional 5010A1File LevelAcknowledgement

Yes

A: 07/28/2014 Non-Par 81039 Commercial MU EBMS (Employee Benefit Managment Srvcs) Remittance 5010A1 Enrollment

U: 06/30/2012 Non-Par 12X44 Commercial EBMS - Employee Benefit Management Services, Inc. Institutional 5010A2 No Response From Payer

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Echo Pacific Develop Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU ECOLOGY AUTO WRECKING Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU ECOLOGY AUTO WRECKING Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 10/12/2017 Trans 08754 Commercial NY Eddy SeniorCare Institutional 5010A1 Claim Level Ack. No

U: 01/16/2020 Non-Par 08754 Commercial NY Eddy SeniorCare Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Edinburg Consolidated Independent School District Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par SX110 Commercial Educators Mutual Insurance Assoc. (EMIA) Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU EL MACERO COUNTRY CLUB Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU EL MACERO COUNTRY CLUB Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 07/27/2016 Trans TH090 Commercial TX El Paso First - Chip (Formerly EPF02) Professional 5010A1Claim Level Accept /Reject

A: 07/27/2016 Trans TH090 Commercial TX El Paso First - Chip (Formerly EPF02) Institutional 5010A2 Claim Level Ack.

A: 04/09/2010 Non-Par MPM04 Commercial El Proyecto del Barrio Professional 4010A1File LevelAcknowledgement

U: 03/24/2014 Non-Par 41556 Workers' Comp MU ELC Electric Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par 31625 Commercial MU ElderPlan Inc. Institutional 5010A2

U: 01/01/2012 Non-Par 31625 Commercial ElderPlan, Inc. Professional 5010A1Claim Level Accept /Reject

U: 10/14/2019 Non-Par 31625 Commercial ElderPlan, Inc. Remittance 5010A1 Enrollment

A: 11/18/2020 Non-Par 05178 Commercial NY Elderserve Health Professional 5010A1Claim Level Accept /Reject

A: 11/18/2020 Non-Par 05178 Commercial NY Elderserve Health Institutional 5010A2Claim Level Accept /Reject

A: 11/19/2020 Non-Par 05178 Commercial NY Elderserve Health Remittance 5010A1 Enrollment

A: 09/01/2016 Par 03964 Commercial MN Elderwood Health Professional 5010A1 Claim Level Ack.

A: 09/01/2016 Par 03964 Commercial MN Elderwood Health Institutional 5010A1 Claim Level Ack.

U: 09/23/2019 Non-Par 03964 Commercial MN Elderwood Health Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Electrical Rebuilders Sales In Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Electrical Rebuilders Sales In Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 07/26/2021 Non-Par 04326 Commercial MA Element Care Remittance 5010A1 Enrollment

U: 12/09/2019 Par 04326 Commercial MA Element Care Professional 5010A1Claim Level Accept /Reject

U: 12/09/2019 Non-Par 04326 Commercial Element Care Institutional 5010A2

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Elite Comp Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/23/2013 Non-Par J1491 Workers' Comp MU ELITE LEATHER COMPANY Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU ELITE LEATHER COMPANY Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 02/14/2020 Non-Par MPM47 Commercial CA Emanate Health Med Center MDT MSO Professional 5010A1Claim Level Accept /Reject

No

A: 02/14/2020 Non-Par MPM47 Commercial CA Emanate Health Med Center MDT MSO Professional 5010A1Claim Level Accept /Reject

No

A: 02/14/2020 Non-Par MPM47 Commercial CA Emanate Health Med Center MDT MSO Institutional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU EMCO FLUID SYSTEMS, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU EMCO FLUID SYSTEMS, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/05/2014 SKNYT Commercial NY eMedNY Test System -NY Medicaid Professional 5010A1 No Response From Payer Yes

NY Medicaid offers a provider testenvironment as a platform to enableproviders to test claims using thesame validation and adjudicationmethods as the NY Medicaidproduction environment.

U: 03/23/2012 Non-Par 34167 Commercial Emerald Health Network Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 34167 Commercial Emerald Health Network, Inc. (All PPO Business) Institutional 5010A2 No Response From Payer

U: 06/11/2012 Par EMSF1 Commercial CA Emergency Medical Services Fund Professional 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par EMSF1 Commercial Emergency Medical Services Fund Institutional 5010A2 Claim Level Ack.

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Emergency Physicians Medical G Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Emergency Physicians Medical G Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 02/12/2018 Trans 16565 Commercial IL EMHS Employee Health Plan Professional 5010A1 Claim Level Ack. Yes

A: 02/12/2018 Trans 16565 Commercial IL EMHS Employee Health Plan Institutional 5010A1 Claim Level Ack. Yes

A: 02/25/2021 Non-Par 16565 Commercial IL EMHS Employee Health Plan Remittance 5010A1 Enrollment

U: 01/01/2012 Non-Par 59299 Commercial EMI-KP Ambulance Claims Professional 5010A1File LevelAcknowledgement

U: 09/23/2013 Non-Par J1491 Workers' Comp MU EMPI, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU EMPI, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 04/30/2020 Non-Par 27514 Commercial Empire Blue Cross Blue Shield HealthPlus Institutional 5010A2Claim Level Accept /Reject

Yes

U: 01/15/2020 Non-Par 27514 Commercial MU Empire Blue Cross Blue Shield HealthPlus Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/17/2018 Non-Par 12B36 CommercialEmpire Omnipro (BC NY City) [aka EMPIRE BLUECROSS BLUE SHIELD]


U: 06/08/2020 Non-Par 12B36 CommercialEmpire Omnipro (BC NY City) [aka EMPIRE BLUECROSS BLUE SHIELD]


A: 09/17/2018 Non-Par 12B35 CommercialEmpire Omnipro (BC NY State) [aka EMPIRE BLUECROSS BLUE SHIELD]


U: 01/02/2015 Non-Par IP115 Commercial CA Empire Physicians Medical Group (EMP01) Professional 5010A1 No Response From Payer

U: 03/04/2016 Par 87726 Commercial Empire Plan- United Healthcare Professional 5010A1Claim Level Accept /Reject

Yes

U: 06/30/2012 Non-Par 27008 Commercial Employee Coalition (ECOH) Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 38241 Commercial Employee Benefit Concepts Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 38241 Commercial Employee Benefit Concepts (Farmington Hills, MI) Institutional 5010A2 No Response From Payer

A: 07/20/2020 Non-Par 92135 Commercial MI Employee Benefit Logistics Professional 5010A1Claim Level Accept /Reject

Yes

A: 07/20/2020 Non-Par 92135 Commercial MI Employee Benefit Logistics Institutional 5010A1Claim Level Accept /Reject

Yes

A: 05/27/2021 Non-Par 92135 Commercial MI Employee Benefit Logistics Remittance 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/01/2016 Par 31074 Commercial Employee Benefit Management Corp (EBMC) Institutional 5010A1File LevelAcknowledgement

Yes

U: 05/19/2017 Par 31074 Commercial Employee Benefit Management Corp. Professional 5010A1 Yes

A: 02/25/2021 Non-Par SX182 Commercial Employee Benefit Mgmt Scvs, Inc (Formerly 81039) Remittance 5010A1 Enrollment

U: 11/30/2020 Non-Par SX182 Commercial MU Employee Benefit Mgmt Scvs,Inc. (formerly 81039) Professional 5010A1 Claim Level Rejects Only

U: 09/01/2016 Trans 03036 Commercial Employee Benefit Plan Administration (E.B.P.A.) Institutional 5010A2Claim LevelAcknowledgement

U: 09/01/2016 Trans 03036 Commercial Employee Benefit Plan Administration (E.B.P.A.) Professional 5010A1Claim LevelAcknowledgement

U: 03/11/2013 Trans 37216 Commercial Employee Benefit Services Professional 5010A1 No Response From Payer Yes

U: 09/01/2016 Trans 37216 Commercial Employee Benefit Services (Ft. Mill, SC) Institutional 5010A2 No Response From Payer Yes

U: 09/30/2019 Non-Par 37216 Commercial Employee Benefit Services EBS Remittance 5010A1 Enrollment

A: 03/04/2013 Non-Par 42149 Commercial Employee Benefit Systems Professional 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par 42149 Commercial Employee Benefit Systems Institutional 5010A2 No Response From Payer

A: 09/16/2020 Non-Par 42149 Commercial IA Employee Benefit Systems Remittance 5010A1 Enrollment

U: 04/06/2017 Trans 37257 Commercial Employee Benefits Consultants Professional 5010A1 ERA available under payer ID: 58379

U: 04/06/2017 Trans 37257 Commercial Employee Benefits Consultants Institutional 5010A2 Claim Level Ack. ERA available under payer ID: 58379

A: 06/15/2020 Non-Par 35112 Commercial Employee Plans LLC Remittance 5010A1 Enrollment

A: 09/01/2016 Par 35112 Commercial Employee Plans, LLC Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 35112 Commercial Employee Plans, LLC Professional 5010A1Claim Level Accept /Reject

U: 01/01/2012 Non-Par 59298 Commercial FL Employer's Mutual, Inc. (Jacksonville, FL) Professional 5010A1Claim LevelAcknowledgement

U: 01/01/2012 Non-Par 59298 Commercial FL Employer's Mutual, Inc. (Jacksonville, FL) Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 75232 Commercial Employers Direct Health Institutional 5010A2 No Response From Payer

A: 09/01/2016 Par 75232 Commercial Employers Direct Health Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 75236 Commercial Employers Direct Health - Employee Plan Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 75236 Commercial Employers Direct Health - Employee Plan Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 75235 Commercial Employers Direct Health - FL Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 75235 Commercial Employers Direct Health - FL Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 75233 Commercial Employers Direct Health - SF Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 75233 Commercial Employers Direct Health - SF Professional 5010A1Claim Level Accept /Reject

U: 10/03/2016 Non-Par 61101 CommercialEmployers Health Insurance/ Humana (formerly73288)

Professional 5010A1 Claim Level Rejects Only





U: 01/01/2012 Non-Par 59331 CommercialEmployers Mutual Inc. (Jacksonville, FL) / formerlyMcCreary Corp


U: 01/01/2012 Non-Par 59331 CommercialEmployers Mutual Inc. (Jacksonville, FL) / formerlyMcCreary Corp


For plan and claim requirementsplease contact the payer @561-287-7650 ext 4052

A: 05/12/2021 Par IHS01 Commercial MD Empower360 Professional 5010A1Claim Level Accept /Reject

No

A: 05/12/2021 Par IHS01 Commercial MD Empower360 Institutional 5010A1Claim Level Accept /Reject

No

A: 09/01/2016 Par L0240 Commercial EnableComp LLC Professional 5010A1 No Response From Payer

A: 09/01/2016 Par L0240 Commercial EnableComp LLC Institutional 5010A2 No Response From Payer

A: 03/19/2020 Non-Par L0241 Commercial TN Enablecomp MVA Professional 5010A1Claim Level Accept /Reject

No

A: 03/19/2020 Non-Par L0241 Commercial TN Enablecomp MVA Institutional 5010A1Claim Level Accept /Reject

No

A: 03/23/2020 Non-Par L0242 Commercial TN Enablecomp VET Professional 5010A1Claim Level Accept /Reject

No

Updated: 03/21/2022


PPAAYERYERIDID



A: 03/23/2020 Non-Par L0242 Commercial TN Enablecomp VET Institutional 5010A1Claim Level Accept /Reject

No

U: 09/01/2016 Par 35206 Commercial Encircle PPO Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 35206 Commercial Encore Health Network Institutional 5010A2 No Response From Payer

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Engen Enterprises Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Engen Enterprises Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 36364 Commercial ENH Medical Group IPA Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 36364 Commercial ENH Medical Group IPA Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 91136 Commercial Enstar Natural Gas Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 91136 Commercial Enstar Natural Gas, Grp P61 Professional 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Envision Radiology, LLC Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 56190 CommercialEnvolve Benefit Options (formerly OptiCare ManagedVision)


A: 09/24/2021 Non-Par 56190 CommercialEnvolve Benefit Options (formerly OptiCare ManagedVision)


U: 09/01/2016 Par 56190 CommercialEnvolve Benefit Options (formerly Prime VisionHealth)


U: 03/24/2014 Non-Par 41556 Workers' Comp MU Eplica, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/11/2013 Non-Par 62308 Commercial EQUICOR Professional 5010A1Claim Level Accept /Reject

Yes

U: 08/02/2016 Par 62308 Commercial EQUICOR Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62308 Commercial EQUICOR - PPO Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62308 Commercial EQUICOR - PPO Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62308 Commercial Equicor Insurance / Equitable Insurance Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU EQUITY HOTEL & SUPPLY COMPANY, Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU EQUITY HOTEL & SUPPLY COMPANY, Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Erickson-Hall Constr Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 04/08/2019 Trans J1734 Workers' Comp MU ERIE INS PIP Prof. Work Comp 5010A1

U: 09/01/2016 Par 23250 Commercial Erin Group Administrators Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 23250 Commercial Erin Group Administrators Professional 5010A1Claim Level Accept /Reject

U: 08/15/2019 Non-Par 23250 Commercial Erin Group Administrators Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Ernest Paper Products, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Ernest Paper Products, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/01/2012 Non-Par 34108 Commercial ES Beveridge and Associates Institutional 5010A2File LevelAcknowledgement

A: 04/09/2010 Non-Par WK018 Workers' Comp ESIS Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par WK018 Workers' Comp ESIS Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/03/2018 Non-Par TP043 Commercial MU ESIS Remittance 5010A1 Enrollment

A: 05/25/2018 Non-Par TP043 Workers' Comp ESIS Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/24/2018 Non-Par J1064 Workers' Comp ESIS PIP Prof. Work Comp 5010A1Claim Level Accept /Reject

Payer ID is for Workers Compensationclaims only for all states.

U: 09/01/2016 Par 20818 Commercial ESSENCE HEALTHCARE Institutional 5010A2 File Level

Updated: 03/21/2022


PPAAYERYERIDID



Acknowledgement

U: 09/01/2016 Par 20818 Commercial ESSENCE HEALTHCARE Professional 5010A1File LevelAcknowledgement

U: 03/10/2021 Non-Par 20818 Commercial ESSENCE HEALTHCARE Remittance 5010A1 Enrollment

A: 11/08/2019 Par EHPSC Commercial IL Essential Health Partners Professional 5010A1 No

A: 11/08/2019 Par EHPSC Commercial IL Essential Health Partners Institutional 5010A1 No

A: 02/28/2020 Par EIPA9 Commercial IL Essential Health Partners IPA Professional 5010A1Claim Level Accept /Reject

A: 02/28/2020 Par EIPA9 Commercial IL Essential Health Partners IPA Institutional 5010A1Claim Level Accept /Reject

A: 12/18/2018 25712 Workers' Comp Esurance PIP Professional 5010A1

A: 12/24/2018 Non-Par 25712 Workers' Comp MN Esurance PIP Prof. Work Comp 5010A1Claim Level Accept /Reject

Payer ID is for Automobile Medicalclaims for all states.

A: 01/19/2022 Par RP037 Commercial MA ETERNALHEALTH Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/19/2022 Par RP037 Commercial MA ETERNALHEALTH Institutional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 35605 Commercial Everence Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/05/2014 Non-Par 35605 Commercial Everence Institutional 5010A2 No Response From Payer Yes

A: 10/09/2019 Non-Par 35605 Everence Remittance 5010A1 Enrollment

A: 12/26/2017 Non-Par 32052 Commercial TX Everpointe Institutional 5010A1Claim Level Accept /Reject

Yes

A: 12/26/2017 Non-Par 32052 Commercial TX Everpointe Professional 5010A1Claim Level Accept /Reject

Yes

U: 01/27/2012 Non-Par 59313 Commercial Evolutions Healthcare Professional 5010A1 No Response From Payer

U: 01/27/2012 Non-Par 59313 Commercial Evolutions Healthcare Systems (New Port Richey FL) Institutional 5010A2Claim LevelAcknowledgement

A: 03/02/2016 Par 22344 Commercial WI Exceedent, LLC Professional 5010A1 Claim Level Ack.

A: 03/02/2016 Par 22344 Commercial WI Exceedent, LLC Institutional 5010A1 Claim Level Ack.

A: 10/23/2014 Non-Par EXC01 Commercial CA Excel MSO Professional 5010A1Claim Level Accept /Reject

A: 11/06/2017 Non-Par 12B71 Commercial NY Excellus - Blue Shield - Central New York RMSCO Institutional 5010A1Claim Level Accept /Reject

A: 11/06/2017 Non-Par 12B67 Commercial NY Excellus - Blue Shield - NY - Rochester Institutional 5010A1Claim Level Accept /Reject

A: 11/06/2017 Non-Par 12B73 Commercial NY Excellus - Blue Shield - NY - Rochester Area Institutional 5010A1Claim Level Accept /Reject

U: 11/06/2017 Non-Par 12B38 Commercial NYExcellus - Blue Shield - Utica/Watertown (FormerlyBS066/SB806)


Yes

U: 04/02/2019 Par 95399 Commercial CA Exceptional Care Professional 5010A1Claim Level Accept /Reject

U: 01/01/2012 Par 71412 Commercial ExclusiCare Institutional 5010A2Claim Level Accept /Reject

No

U: 01/01/2012 Par 71412 Commercial Exclusicare Professional 5010A1Claim LevelAcknowledgement

No

A: 12/09/2021 Par 83383 Commercial NC EXEMPLAR HEALTH Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/09/2021 Par 83383 Commercial NC EXEMPLAR HEALTH Institutional 5010A1Claim Level Accept /Reject

Yes

A: 12/05/2014 Non-Par 46166 Commercial Extended MLTC Institutional 5010A2 No Response From Payer Yes

U: 09/17/2019 Non-Par 85431 Commercial OH EyeMed Vision Care Professional 5010A1 EnrollmentClaim Level Accept /Reject

A: 09/01/2016 Par 63740 Commercial EyeQuest Institutional 5010A1 Claim Level Ack.

A: 09/01/2016 Par 63740 Commercial EyeQuest Professional 5010A1 No Response From Payer Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Ezell Nursery Supply Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Ezell Nursery Supply Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU F&G Guaranty Ins Co / Main Street Program Colorado Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 09/01/2016 Par 91136 Commercial F40 Alaska Carpenters Trust Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 95432 Commercial Facey Medical Foundation Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Facility Masters, Inc. (A Corp Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Facility Masters, Inc. (A Corp Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/08/2014 Non-Par 37300 Commercial FACS Group Institutional 5010A2 No Response From Payer

U: 01/24/2012 Non-Par 37300 Commercial FACS Group Professional 5010A1 No Response From Payer

U: 08/05/2021 Trans 22254 Commercial Fallon Community Health Professional 5010A1

U: 08/05/2021 Trans 22254 Commercial Fallon Community Health Plan Institutional 5010A2Claim Level Accept /Reject

A: 08/05/2021 Non-Par 22254 Commercial Fallon Community Health Plan Remittance 5010A1 Enrollment

U: 04/27/2012 Non-Par FCD01 Government Family Care Medicaid Professional 5010A1Claim LevelAcknowledgement

U: 08/13/2013 Non-Par PHR01 Commercial MU Family Care Medicare Professional 5010A1Claim Level Accept /Reject

Yes

U: 04/27/2012 Non-Par FCM01 Commercial Family Care MHO Professional 5010A1Claim LevelAcknowledgement

U: 11/01/2012 Non-Par FCS01 Commercial Family Care Specialists IPA Professional 5010A1File LevelAcknowledgement

U: 04/02/2019 Par 95399 Commercial CA Family Choice Professional 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Family Health & Housing Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 04/02/2019 Par 95399 Commercial CA Family Health Alliance Professional 5010A1Claim Level Accept /Reject

U: 01/01/2012 Trans AMS01 Commercial WI Family Health Network Professional 5010A1 No Response From Payer

U: 02/24/2017 Non-Par 31472 Commercial Family Health Partners - Healthwave Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Family Toyota, Family Honda Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Family Toyota, Family Honda Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 10/09/2019 Non-Par 62045 Commercial TN Farm Bureau Health Plans Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 14140 Commercial NY Farm Family Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 14140 Commercial Farm Family Life Institutional 4010A1Claim LevelAcknowledgement

Yes

A: 01/28/2020 Non-Par J1687 Workers' Comp Farmers (Civic Property and Casualty) Remittance 5010A1 EnrollmentPayer ID is for Workers Compensationclaims for all states

A: 01/28/2020 Non-Par C1025 Auto Farmers Insurance (AUTO ONLY) Remittance 5010A1 EnrollmentPayer ID is for Automobile Medicalclaims for all states.

A: 12/24/2018 Non-Par J1687 Workers' Comp Farmers PIP Prof. Work Comp 5010A1Claim Level Accept /Reject

Payer ID is for Workers Compensationclaims for all states.

A: 04/08/2019 Trans C1025 Workers' Comp MU FARMERS PIP Prof. Work Comp 5010A1

U: 09/23/2013 Non-Par J1491 Workers' Comp MU FAST UNDERCAR - THOUSAND OAKS Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU FAST UNDERCAR - THOUSAND OAKS Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 02/03/2015 Non-Par J1830 Workers' Comp FCCI Professional 5010A1Claim Level Accept /Reject

A: 08/08/2014 Non-Par 33033 Commercial FCE Benefit Administrators Institutional 5010A2 No Response From Payer

U: 02/13/2014 Non-Par 33033 Commercial FCE Benefit Administrators Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU FEATHER RIVER WOOD & GLASS Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU FEATHER RIVER WOOD & GLASS Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/08/2014 Non-Par 37300 Commercial Federated Benefits Institutional 5010A2 No Response From Payer

Updated: 03/21/2022


PPAAYERYERIDID



U: 01/24/2012 Non-Par 37300 Commercial Federated Benefits Professional 5010A1 No Response From Payer

A: 08/08/2014 Non-Par 37300 Commercial Federated HR Services Institutional 5010A2 No Response From Payer

U: 01/24/2012 Non-Par 37300 Commercial Federated HR Services / FACS Group Professional 5010A1 No Response From Payer

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Federated Linen & Uniform Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Felix Manufacturing Company, I Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Felix Manufacturing Company, I Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU FERRARI, DAN (AN INDIVIDUAL) Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU FERRARI, DAN (AN INDIVIDUAL) Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 11315 Commercial NY Fidelis Care of New York Institutional 5010A2 No Response From Payer No

U: 09/01/2016 Par 11315 Commercial NY Fidelis Care of New York Professional 5010A1Claim Level Accept /Reject

No

U: 12/23/2021 Non-Par 11315 Commercial NY Fidelis Care of New York Remittance 5010A1 Enrollment

A: 02/10/2016 Par 88055 Commercial MI First Agency Professional 5010A1Claim Level Accept /Reject

A: 02/10/2016 Par 88055 Commercial MI First Agency Institutional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 56196 Commercial First Carolina Care Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 56196 Commercial NC First Carolina Care Professional 5010A1Claim Level Accept /Reject

A: 09/24/2021 Non-Par FCC01 Commercial NC First Carolina Care Remittance 5010A1 Enrollment

A: 09/30/2019 Non-Par 56196 Commercial First Carolina Care Remittance 5010A1 Enrollment

A: 01/04/2021 Non-Par FCC01 Commercial NC First Carolina Care Professional 5010A1Claim Level Accept /Reject

No

A: 01/04/2021 Non-Par FCC01 Commercial NC First Carolina Care Institutional 5010A1Claim Level Accept /Reject

No

U: 05/26/2021 Non-Par 23285 Commercial SC First Choice by Select Health of South Carolina Institutional 5010A2Claim Level Accept /Reject

Yes

First Choice can accept claimsubmissions via paper orelectronically (EDI). For generalquestions about claims submissions,call Provider Claims Services at1-800-575-0418

U: 05/26/2021 Non-Par 23285 Commercial SC First Choice by Select Health of South Carolina Professional 5010A1Claim Level Accept /Reject

Yes

First Choice can accept claimsubmissions via paper orelectronically (EDI). For generalquestions about claims submissions,call Provider Claims Services at1-800-575-0418

A: 08/18/2021 Non-Par 23285 Commercial SC First Choice by Select Health of South Carolina Remittance 5010A1 Enrollment


U: 08/18/2021 Non-Par 58379 CommercialFirst Choice by Select Health of South Carolina(Formerly payer id 23285)



U: 01/26/2018 Par 91131 Commercial First Choice Health Network Institutional 5010A2Claim Level Accept /Reject

Yes

U: 01/26/2018 Par 91131 Commercial First Choice Health Network Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/31/2021 Non-Par 32456 Commercial SC First Choice VIP Care (SC - DSNP) Institutional 5010A1Claim Level Accept /Reject

Yes

A: 12/31/2021 Non-Par 32456 Commercial SC First Choice VIP Care (SC- DSNP) Professional 5010A1Claim Level Accept /Reject

Yes

U: 05/13/2021 Non-Par 77009 Commercial SCFirst Choice VIP Care Plus by Select Health of SouthCarolina


U: 05/26/2021 Non-Par 77009 Commercial SC First Choice VIP Care Plus by Select Health of South Professional 5010A1 Claim Level Accept / Yes First Choice VIP Care Plus is a Healthy

Updated: 03/21/2022


PPAAYERYERIDID



Carolina Reject

Connections Prime Medicare-Medicaid Plan offered by SelectHealth of South Carolina. We acceptclaim submissions via paper orelectronically (EDI). For questionsabout claims submissions, callProvider Services at 1-888-978-0862

U: 05/26/2021 Non-Par 77009 Commercial SCFirst Choice VIP Care Plus by Select Health of SouthCarolina


Yes

First Choice VIP Care Plus is a HealthyConnections Prime Medicare-Medicaid Plan offered by SelectHealth of South Carolina. We acceptclaim submissions via paper orelectronically (EDI). For questionsabout claims submissions, callProvider Services at 1-888-978-0862

A: 07/01/2021 Non-Par 41802 Commercial AL FIRST COMMUNITY HEALTH PLAN Remittance 5010A1 Enrollment

ERA enrollment is required by theproviders through the health plan.This is the link that providers needs tolog in to enroll for ERAs with thehealth plan. http://solutions.caqh.org

U: 03/11/2013 Non-Par 25133 Commercial First Health Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/26/2021 Non-Par 42723 Commercial MU First Health Life & Health Ins Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 73159 CommercialFirst Health Network (f.k.a CCN Managed Care Inc. &PPO Oklahoma)


Yes

U: 03/11/2013 Non-Par 73159 CommercialFirst Health Network (f.k.a CCN Managed Care Inc. &PPO Oklahoma)


Yes

A: 05/29/2018 Par 40270 Commercial NJ First Managed Care Options, Inc. Professional 5010A1Claim Level Accept /Reject

Yes

A: 05/29/2018 Par 40270 Commercial NJ First Managed Care Options, Inc. Institutional 5010A1Claim Level Accept /Reject

Yes

A: 09/07/2021 Non-Par 66064 Commercial PR First Medical Healthcare (Reform) Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 08/25/2021 Non-Par 66064 Commercial PR First Medical Healthcare (Reform) Institutional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 08/25/2021 Non-Par 66064 Commercial PR First Medical Healthcare (Reform) Remittance 5010A1 Enrollment

A: 08/08/2017 Non-Par TH003 Commercial TX Firstcare (Star Medicaid) - (Formerly 94999) Professional 5010A1Claim Level Accept /Reject

U: 09/28/2020 Non-Par TH003 Commercial Firstcare (Star Medicaid) - (Formerly 94999) Institutional 5010A2Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 95411 Commercial FL MCO PHC/PHP Professional 5010A1 Claim Level Accept/Reject Yes

A: 09/01/2016 Par 95411 Commercial FL MCO PHC/PHP Institutional 5010A2 No Response From Payer Yes

A: 07/23/2021 Non-Par FBM01 Commercial FL Florida Blue Medicare Professional 5010A1Claim Level Accept /Reject

A: 07/23/2021 Non-Par FBM01 Commercial FL Florida Blue Medicare Institutional 5010A1Claim Level Accept /Reject

A: 06/14/2019 Non-Par FLCCR Commercial FL Florida Community Care Professional 5010A1Claim Level Accept /Reject

Yes

A: 06/14/2019 Non-Par FLCCR Commercial FL Florida Community Care Institutional 5010A1Claim Level Accept /Reject

Yes

U: 01/18/2013 Non-Par 59322 Commercial Florida Health Care Plan Professional 5010A1File LevelAcknowledgement

A: 10/17/2019 Non-Par 59322 Commercial FLORIDA HEALTH CARE PLAN Remittance 5010A1 Enrollment

A: 12/05/2014 Non-Par 59322 Commercial Florida Healthcare Plan Institutional 5010A2 File Level Ack.

A: 11/06/2018 Non-Par VB001 Commercial FL Florida Hospital VBR Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/06/2018 Non-Par VB001 Commercial FL Florida Hospital VBR Institutional 5010A1Claim Level Accept /Reject

Yes

U: 01/01/2012 Non-Par 48116 Commercial Florida Hospital Waterman Institutional 5010A2 No Response From Payer

U: 01/01/2012 Non-Par 48116 Commercial FL Florida Hospital Waterman Employee Benefit Plan Professional 5010A1Claim LevelAcknowledgement

U: 02/07/2017 Non-Par 65063 Government FL Florida NetPass Professional 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



A: 12/03/2019 Non-Par FLPAC Commercial FL Florida PACE Centers Professional 5010A1Claim Level Accept /Reject

No

A: 08/23/2019 Non-Par FLPAC Commercial FL Florida PACE Centers Institutional 5010A1Claim Level Accept /Reject

No

A: 10/10/2019 Par FH205 Commercial PA Flume Health Inc (Innovative Healthware Solutions) Professional 5010A1Claim Level Accept /Reject

No

A: 10/10/2019 Par FH205 Commercial PA Flume Health Inc (Innovative Healthware Solutions) Institutional 5010A1Claim Level Accept /Reject

No

U: 01/16/2020 Non-Par 58379 Commercial FMH Benefit Services Inc. Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Forecast Group L.P. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Forecast Group L.P. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 10/12/2020 Non-Par 25059 Commercial WI Forest County Potawatomi Insurance Institutional 5010A1Claim Level Accept /Reject

Yes

A: 02/04/2021 Non-Par 25059 Commercial WI Forest County Potawatomi Insurance Remittance 5010A1 Enrollment

A: 10/12/2020 Non-Par 25059 Commercial WI Forest County Potawatomi Insurnace Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Trans BOONG CommercialFOUNDATION BENEFIT ADMINISTRATORS /CONTRACTOR EMPLOYEE BENEFITS ADMIN


U: 09/10/2021 Non-Par TKFMC Commercial MU Foundation for Medical Care Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDTKFMC. Providers will need to enrollfor payer IDs TKFMC and 58379 inorder to receive 835s for this payer

A: 10/01/2021 Non-Par 85362 Commercial CAFoundation for Medical Care of Tulare & KingsCounties



A: 10/01/2021 Non-Par 58379 CommercialFoundation for Medical Care of Tulare & KingsCounties(Formerly 85362)


*This enrollment will setup all payernames under payer id 58379*ECHO isreturning 835s for payer ID 85362.Providers will need to enroll for payerIDs 85362 and 58379 in order toreceive 835s for this payer

A: 11/18/2013 Non-Par TKFMC Commercial MUFoundation For Medical Care Of Tulare & KingsCounty


No

A: 10/01/2021 Non-Par 58379 Commercial MU Foundation for Medical Care(TKFMC) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379*ECHO isreturning 835s for payer ID TKFMC.Providers will need to enroll for payerIDs TKFMC and 58379 in order toreceive 835s for this payer

A: 10/05/2016 Par FVMCH Commercial IL Fox Valley Medicine Institutional 5010A1 Claim Level Ack. No

U: 01/24/2012 Non-Par FVMCH Commercial Fox Valley Medicine Site 199 Professional 5010A1Claim Level Accept /Reject

U: 08/29/2016 Trans 64069 Commercial MSFox-Everett, Inc. (previously Everett Ingalls ShipBuilding)

Institutional 5010A2 Claim Level Rejects Only No

U: 08/29/2016 Trans 64069 Commercial MSFox-Everett, Inc. (previously Everett Ingalls ShipBuilding)

Professional 5010A1 Claim Level Rejects Only No

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Franco Construction Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 07/19/2021 Non-Par 41212 Commercial FREEDOM HEALTH Remittance 5010A1 Enrollment

U: 01/01/2012 Non-Par 41212 Commercial Freedom Health Professional 5010A1File LevelAcknowledgement

U: 01/01/2012 Non-Par 41212 Commercial Freedom Health Plan Institutional 5010A2File LevelAcknowledgement

A: 02/02/2021 Non-Par 62324 Commercial TX Freedom Life Insurance Co. Professional 5010A1Claim Level Accept /Reject

A: 07/26/2019 Non-Par 62324 Commercial TX Freedom Life Insurance Company Institutional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU FREEMAN, RAYMOND K. Inst. Work Comp 4010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 03/24/2014 Non-Par J1491 Workers' Comp MU FREEMAN, RAYMOND K. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Fresno County Office of Education Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Fresno County Self Insurance Group Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Trans 99660 Commercial Fresno PACE Professional 5010A1 Claim Level Ack.

A: 09/01/2016 Trans 99660 Commercial Fresno PACE Institutional 5010A1 Claim Level Ack.

U: 10/07/2019 Non-Par 99660 Commercial Fresno PACE Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Friant And Associates Llc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Friant And Associates Llc Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/18/2013 Non-Par TKFMC Commercial MU Friant Water Users Professional 5010A1File LevelAcknowledgement

Yes

A: 04/19/2019 Non-Par H0657 Commercial CO Friday Health Plans of Colorado, Inc. Professional 5010A1Claim Level Accept /Reject

Yes

A: 04/19/2019 Non-Par H0657 Commercial CO Friday Health Plans of Colorado, Inc. Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 59204 Commercial Fringe Benefit Coordinators Institutional 5010A2 No Response From Payer Yes

U: 03/11/2013 Non-Par 59204 Commercial FL Fringe Benefit Coordinators Professional 5010A1Claim Level Accept /Reject

Yes

U: 04/27/2016 Non-Par 34171 Commercial Frontpath Health Coalition Professional 5010A1 No

A: 09/01/2016 Par 34171 Commercial FrontPath Health Coalition Institutional 4010A1 No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU FULLER THEOLOGICAL SEMINARY (A Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU FULLER THEOLOGICAL SEMINARY (A Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU G L VENEER COMPANY INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU G L VENEER COMPANY INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/18/2014 Non-Par WK020 Workers' Comp Gallagher Bassett Remittance 4010A1 Enrollment

U: 03/24/2014 Non-Par WK020 Workers' Comp Gallagher Bassett Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 37283 Commercial Gallagher Benefits Management Institutional 4010A1 No Response From Payer Yes

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Garden Regional Hospital & Med Center, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Garrison, Mike (An Individual) Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Garrison, Mike (An Individual) Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Gates O'Doherty Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Gates O'Doherty Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Gates O'Doherty G&G Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Gates O'Doherty G&G Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/02/2019 Non-Par SX078 Commercial Gateway Professional 5010A1 Yes

U: 10/22/2021 Non-Par 25169 Commercial Gateway Health Plan - Medicaid PA Institutional 5010A2 No Response From Payer

U: 10/22/2021 Non-Par 25169 Commercial Gateway Health Plan - Medicaid PA Professional 5010A1 No Response From Payer

U: 10/22/2021 Non-Par 25169 Commercial Gateway Health Plan - Medicare Assured Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 60550 Commercial Gateway Health Plan - Medicare Assured Professional 5010A1File LevelAcknowledgement

U: 09/01/2016 Par 60550 Commercial Gateway Health Plan - Medicare Assured Institutional 5010A2Claim Level Accept /Reject

A: 01/18/2022 Non-Par 58379 CommercialGateway Health Plan - Medicare Assured (Formerly60550)


Updated: 03/21/2022


PPAAYERYERIDID



A: 01/18/2022 Non-Par 58379 Commercial Gateway Health Plan Medicaid PA (Formerly 25169) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

A: 11/23/2015 Par 91741 Commercial OH Gateway Health Plan OH-Medicare Assured Professional 5010A1

A: 11/23/2015 Par 91741 Commercial OH Gateway Health Plan OH-Medicare Assured Institutional 5010A1

A: 11/09/2018 Non-Par PROSP CommercialGateway IPA (Pinnacle Health Resources) (ProspectMedical Group)


U: 09/23/2013 Non-Par J1491 Workers' Comp MU Gateway Learning Corporation Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Gateway Learning Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 02/16/2021 Non-Par U317M Commercial MO Gateway To Better Health Plan Institutional 5010A1Claim Level Accept /Reject

No

A: 02/17/2021 Non-Par U317M Commercial MO Gateway To Better Health Plan Remittance 5010A1 Enrollment

A: 02/18/2021 Non-Par 4317M Commercial MO Gateway To Better Health Plan Remittance 5010A1 Enrollment

A: 03/02/2021 Non-Par 4317M Commercial MO Gateway To Better Health Plan Professional 5010A1Claim Level Accept /Reject

No

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Gateway Trans., Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 44054 Commercial GEHA Ins. No. 372 Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/30/2018 Non-Par J1747 Auto GEICO (Auto) Prof. Auto 5010A1 No Response From Payer State of MN only

U: 08/25/2021 Par 75273 Commercial Geisinger Health Plans Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 75273 Commercial Geisinger Health Plans Professional 5010A1Claim Level Accept /Reject

Yes

A: 08/25/2021 Non-Par 75273 Commercial Geisinger Health Plans Remittance 5010A1 Enrollment

U: 09/01/2016 Non-Par 27133 Commercial MUGEMCare (Golden Empire Managed Care System)(formerly 20376)

Professional 5010A1

A: 09/01/2016 Par 27133 CommercialGEMCare (Golden Empire Managed Care System)(formerly 20376)


U: 09/01/2016 Non-Par 27133 Commercial CAGEMCare (Golden Empire Managed Care System)(formerly MCS01)


U: 01/16/2020 Non-Par 58379 CommercialGEMCare (Golden Empire Managed Care Systems)(formerly MCS01)


A: 09/01/2016 Par 27133 CommercialGEMCare (Golden Empire Managed Care Systems)(Formerly MCS01)


A: 09/01/2016 Par 27133 Commercial Gemcare IPA Institutional 5010A2 No Response From Payer Yes

A: 08/31/2016 Par 27133 Commercial Gemcare IPA Professional 5010A1Claim Level Accept /Reject

U: 01/27/2012 Non-Par 46050 Commercial Generations - OCC Professional 5010A1Claim Level Accept /Reject

U: 01/27/2012 Non-Par 46050 Commercial Generations Healthcare Institutional 5010A2File LevelAcknowledgement

Yes

U: 01/27/2012 Non-Par 46051 Commercial Generations-Hillcrest Institutional 5010A2File LevelAcknowledgement

Yes

U: 01/27/2012 Non-Par 46051 Commercial Generations-Hillcrest Professional 5010A1File LevelAcknowledgement

Yes

U: 02/27/2017 Non-Par 46051 Commercial Generations-Hillcrest Remittance 5010A1 Enrollment

A: 03/09/2021 Non-Par JVHMB Commercial MI Genesee County Health Plan - JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 03/09/2021 Non-Par JVHMB Commercial MI Genesee County Health Plan - JVHL Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Genesis Construction Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/09/2018 Non-Par PROSP Commercial Genesis Healthcare Professional 5010A1 Claim Level Ack.

A: 11/09/2018 Non-Par PROSP Commercial Genesis Healthcare Institutional 5010A1 Claim Level Ack.

U: 03/11/2013 Non-Par 25531 Commercial GHI HMO Select Institutional 5010A2 No Response From Payer Yes

U: 03/11/2013 Non-Par 25531 Commercial GHI HMO Select Professional 5010A1Claim Level Accept /Reject

Yes

U: 12/30/2021 Non-Par 25531 Commercial GHI HMO Select Remittance 5010A1 EnrollmentECHO is returning 835s for payer ID.Providers will need to enroll for payer

Updated: 03/21/2022


PPAAYERYERIDID



IDs 25531 and 58379 in order toreceive 835s for this payer.

A: 12/30/2021 Non-Par 58379 Commercial GHI HMO Select (Formerly 25531) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID. Providerswill need to enroll for payer IDs 25531and 58379 in order to receive 835s forthis payer.

U: 09/01/2016 Par 58204 Commercial GI Innovative Management Professional 5010A1Claim Level Accept /Reject

U: 01/15/2020 Non-Par 80314 Commercial GIC Indemnity Plan (Anthem) Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Trans 07205 Commercial Gilsbar, Inc. Institutional 5010A2 No Response From Payer Yes

U: 09/16/2019 Non-Par 07205 Commercial Gilsbar, Inc. Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/23/2020 Non-Par 07205 Commercial Gilsbar, Inc. Remittance 5010A1 Enrollment

U: 09/01/2016 Par 91136 Commercial Glassworkers Hlth & Welfare Fund, Grp F29 Professional 5010A1Claim Level Accept /Reject

.

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Glendale Associates Ltd Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Glendale Associates Ltd Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Glendale Elementary School District #40 Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Glendale Food Service Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Glendale Food Service Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par IP120 Commercial CA Glendale Physicians Alliance Professional 5010A1 No Response From Payer

A: 11/01/2019 Non-Par GLOBA Commercial CA Global 1 Ventures Professional 5010A1Claim Level Accept /Reject

No

A: 11/01/2019 Non-Par GLOBA Commercial CA Global 1 Ventures Institutional 5010A1Claim Level Accept /Reject

No

U: 03/11/2013 Non-Par 07689 Commercial GA Global Care Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 07689 Commercial Global Care Inc. Institutional 5010A2Claim Level Accept /Reject

Yes

A: 06/29/2021 Non-Par MPM05 Commercial CA Global Care Medical Group Remittance 5010A1 Enrollment

U: 08/29/2012 Non-Par MPM05 Commercial Global Care Medical Group IPA Professional 5010A1File LevelAcknowledgement

U: 09/01/2016 Par GEM01 Commercial MU Global Excel Management Professional 5010A1File LevelAcknowledgement

Yes

A: 09/01/2016 Par GEM01 Commercial Global Excel Management Institutional 5010A2 File Level Ack. Yes

U: 03/24/2017 Non-Par GHOKC Commercial MU Global Health Professional 5010A1 Yes

A: 09/01/2016 Par GHOKC Commercial Global Health Institutional 5010A2 Claim Level Accept/Reject Yes

A: 09/01/2016 Par 12X59 Commercial Global Healthcare Alliance Institutional 5010A2

A: 11/16/2021 Non-Par GMPER Commercial GMP Employers Retiree Trust Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDGMPER. Providers will need to enrollfor payer IDs GMPER and 58379 inorder to receive 835s for this payer.

A: 11/16/2021 Non-Par 58379 Commercial GMP Employers Retiree Trust (Formerly GMPER) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID GMPER.Providers will need to enroll for payerIDs GMPER and 58379 in order toreceive 835s for this payer.

A: 12/09/2021 Non-Par 85664 Commercial NY GMR HEALTH Professional 5010A1Claim Level Accept /Reject

No

A: 12/09/2021 Non-Par 85664 Commercial NY GMR HEALTH Institutional 5010A1Claim Level Accept /Reject

No

A: 11/15/2021 Non-Par 58379 Commercial GMS Inc (Formerly 47083) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID 47083.

Updated: 03/21/2022


PPAAYERYERIDID



Providers will need to enroll for payerIDs 47083 and 58379 in order toreceive 835s for this payer.

U: 09/01/2016 Par 47083 Commercial GMS Inc. Institutional 4010A1Claim LevelAcknowledgement

Yes

A: 11/15/2021 Non-Par 47083 Commercial GMS Inc. Remittance 5010A1 Enrollment


U: 03/11/2013 Non-Par 47083 Commercial GMS, Inc Professional 5010A1Claim Level Accept /Reject

Yes

U: 05/10/2012 Non-Par 77160 Commercial CA Gold Coast Professional 5010A1File LevelAcknowledgement

No

A: 01/13/2020 Non-Par 77160 Commercial CA Gold Coast Health Plan Institutional 5010A1Claim Level Accept /Reject

No

A: 07/21/2020 Non-Par 77160 Commercial CA Gold Coast Health Plan Remittance 5010A1 Enrollment

A: 12/09/2021 Par GCMSO Commercial CA GOLDEN COAST MSO Professional 5010A1Claim Level Accept /Reject

No

A: 12/09/2021 Par GCMSO Commercial CA GOLDEN COAST MSO Institutional 5010A1Claim Level Accept /Reject

No

U: 01/01/2012 Trans 37602 Commercial Golden Rule Insurance Company Institutional 5010A2 No Response From Payer

U: 04/04/2016 Par 37602 Commercial Golden Rule Insurance Company Professional 5010A1 No Response From Payer Yes

U: 01/10/2020 Non-Par 37602 Commercial MU Golden Rule Insurance Company Remittance 5010A1 EnrollmentAdditional Payer ID 81400 is alsorequired For ERA Setup andEnrollment

A: 07/26/2019 Non-Par NMM03 Commercial CA Golden Shore Medical Group Professional 5010A1Claim Level Accept /Reject

Yes

A: 07/26/2019 Non-Par NMM03 Commercial CA Golden Shore Medical Group Institutional 5010A1Claim Level Accept /Reject

Yes

A: 03/04/2013 Non-Par MBA01 Commercial Golden State Medical Group Professional 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par MBA01 Commercial Golden State Medical Group Institutional 5010A2 Claim Level Ack.

U: 09/23/2013 Non-Par J1491 Workers' Comp MU GOMEZ, JOSE LUNA Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU GOMEZ, JOSE LUNA Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 10/11/2019 Non-Par GMGSA Commercial IL Gonzaba Medical Group Professional 5010A1Claim Level Accept /Reject

No

A: 10/11/2019 Non-Par GMGSA Commercial IL Gonzaba Medical Group Institutional 5010A1Claim Level Accept /Reject

No

A: 11/09/2018 Non-Par PROSP Commercial CA Good Samaritan Medical Practice Association Professional 5010A1 Claim Level Ack.

A: 11/09/2018 Non-Par PROSP Commercial CA Good Samaritan Medical Practice Association Institutional 5010A1 Claim Level Ack.

A: 11/09/2018 Non-Par PROSP Commercial CA Good Samaritan Medical Practice Association Professional 5010A1 Claim Level Ack.

A: 09/01/2016 Par 76923 Commercial GOOD SHEPHERD HOSPICE INC Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 76923 Commercial GOOD SHEPHERD HOSPICE INC Institutional 5010A2 Claim Level Rejects Only Yes

A: 09/01/2016 Par 45235 CommercialGovernment Employees Health Association(Multiplan PPO Network)


A: 09/01/2016 Par 45235 CommercialGovernment Employees Health Association(Multiplan PPO Network)


A: 08/27/2019 Par 45275 Commercial Government Employees Health Association (PHCS) Institutional 5010A2Claim Level Accept /Reject

This payer ID is only for services datesprior to January 1, 2016.

A: 08/27/2019 Par 45275 Commercial Government Employees Health Association (PHCS) Professional 5010A1Claim Level Accept /Reject

This payer ID is only for service datesprior to January 1, 2016.

U: 09/01/2016 Par 44054 Commercial Government Employees Hospital Association Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 44054 Commercial Government Employees Hospital Association (GEHA) Institutional 5010A2 No Response From Payer

U: 04/16/2021 Non-Par 44054 Commercial Government Employees Hospital Association (GEHA) Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU GRASS VALLEY FORD, LINCOLN, ME Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU GRASS VALLEY FORD, LINCOLN, ME Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

A: 07/30/2020 Non-Par 13193 Commercial TX Great American Life Insurance Co Remittance 5010A1 Enrollment

A: 01/24/2018 Par 13193 CommercialGreat American Life Insurance Company - MedicareSupplement


A: 01/24/2018 Par 13193 CommercialGreat American Life Insurance Company - MedicareSupplement


U: 12/06/2019 Non-Par 95467 Commercial MUGreat Lakes Health Plan (UnitedHealthcareCommunity Plan)


A: 09/01/2016 Trans 39640 Commercial MI Great Lakes PACE Professional 5010A1 Claim Level Ack.

A: 09/01/2016 Trans 39640 Commercial MI Great Lakes PACE Institutional 5010A1 Claim Level Ack.

A: 10/04/2017 Non-Par 39640 Commercial MI Great Lakes PACE Remittance 5010A1 Enrollment

A: 05/04/2018 Non-Par GPNE1 Commercial NE Great Plains Medicare Advantage of NE Remittance 5010A1 Enrollment

A: 03/12/2018 Par GPNE1 Commercial NE Great Plains Medicare Advantage of Nebraska Professional 5010A1Claim Level Accept /Reject

No

A: 03/12/2018 Par GPNE1 Commercial NE Great Plains Medicare Advantage of Nebraska Institutional 5010A1Claim Level Accept /Reject

No

A: 03/12/2018 Par GPND1 Commercial ND Great Plains Medicare Advantage of North Dakota Professional 5010A1Claim Level Accept /Reject

No

A: 03/12/2018 Par GPND1 Commercial ND Great Plains Medicare Advantage of North Dakota Institutional 5010A1Claim Level Accept /Reject

No

A: 10/08/2019 Non-Par GPSD1 Government SD Great Plains Medicare Advantage of SD Remittance 5010A1 Enrollment

A: 03/12/2018 Par GPSD1 Commercial SD Great Plains Medicare Advantage of South Dakota Professional 5010A1Claim Level Accept /Reject

No

A: 03/12/2018 Par GPSD1 Commercial SD Great Plains Medicare Advantage of South Dakota Institutional 5010A1Claim Level Accept /Reject

No

A: 08/03/2020 Non-Par GSHTX Commercial CA Great States Health Administrators Professional 5010A1Claim Level Accept /Reject

No

A: 08/03/2020 Non-Par GSHTX Commercial CA Great States Health Administrators Institutional 5010A1Claim Level Accept /Reject

No

U: 08/02/2016 Par 80705 Commercial Great West (Formerly One Health Plan CA) Institutional 5010A2Claim Level Accept /Reject

U: 08/02/2016 Par 80705 Commercial Great West (Formerly One Health Plan CO) Institutional 5010A2Claim Level Accept /Reject

U: 08/02/2016 Par 80705 Commercial Great West (Formerly One Health Plan GA) Institutional 5010A2Claim Level Accept /Reject

U: 08/02/2016 Par 80705 Commercial Great West (Formerly One Health Plan IL) Institutional 5010A2Claim Level Accept /Reject

U: 08/02/2016 Par 80705 Commercial Great West (Formerly One Health Plan TX 95415) Institutional 5010A2Claim Level Accept /Reject

U: 08/02/2016 Par 80705 Commercial Great-West Healthcare Institutional 5010A2Claim Level Accept /Reject

U: 09/01/2016 Par 80705 Commercial MOGreat-West Healthcare (formerly Gencare Health -St.Louis / payer id 63665)


U: 09/01/2016 Par 80705 Commercial MOGreat-West Healthcare (formerly Genelco - St. LouisOnly / payer id 63665)


U: 09/01/2016 Par 80705 CommercialGreat-West Healthcare (formerly General American-Sanus - East / payer id 63665)


U: 09/01/2016 Par 80705 CommercialGreat-West Healthcare (formerly General AmericanLife / payer id 63665)


U: 09/01/2016 Par 80705 Commercial MOGreat-West Healthcare (formerly General AmericanLife Ins. Co. - Sanus, St. Louis / payer id 63665)


U: 09/01/2016 Par 80705 CommercialGreat-West Healthcare (formerly New EnglandFinancial / payer id 66893)


U: 09/01/2016 Par 80705 CommercialGreat-West Healthcare (formerly One Health Plan---- Except CA, CO, GA, IL, or TX)


U: 09/01/2016 Par 80705 Commercial CAGreat-West Healthcare (formerly One Health Plan ofCalifornia, Inc. / payer id 95379)


U: 09/01/2016 Par 80705 Commercial COGreat-West Healthcare (formerly One Health Plan ofColorado, Inc. / payer id 95412)


U: 09/01/2016 Par 80705 Commercial GAGreat-West Healthcare (formerly One Health Plan ofGeorgia, Inc / payer id 95569.)


Updated: 03/21/2022


PPAAYERYERIDID



U: 09/01/2016 Par 80705 Commercial ILGreat-West Healthcare (formerly One Health Plan ofIllinois, Inc. / payer id 95388)


U: 09/01/2016 Par 80705 Commercial TXGreat-West Healthcare (formerly One Health Plan ofTexas, Inc. / payer id 95415)


U: 09/01/2016 Par 80705 Commercial MOGreat-West Healthcare (formerly Sanus HMO - St.Louis -General American / payer id 63665)


U: 09/01/2016 Par 80705 CommercialGreat-West Healthcare (formerly Sanus PPO-General American - Sanus East / payer id 63665)


U: 08/02/2016 Par 80705 CommercialGreat-West Healthcare (FormerlyAmerican General63665)


U: 08/02/2016 Par 80705 Commercial Great-West Life Institutional 5010A2Claim Level Accept /Reject

U: 09/01/2016 Par GCMG1 Commercial CA Greater Covina Medical Group Professional 5010A1Claim Level Accept /Reject

No

U: 09/01/2016 Par GCMG1 Commercial CA Greater Covina Medical Group Institutional 5010A2 No Response From Payer

U: 04/02/2019 Par 95399 Commercial CA Greater Los Angeles Health Professional 5010A1Claim Level Accept /Reject

U: 03/03/2017 Par 33010 Commercial CA Greater Newport Physicans Medical Group Institutional 5010A2 Yes

U: 04/17/2017 Par 33010 Commercial CA Greater Newport Physicians Medical Group (GNPMG) Professional 5010A1 Claim Level Ack.

U: 11/21/2013 Non-Par NMM01 Commercial Greater Orange County Medical Group Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU GREATER SAN DIEGO AIR CONDITIO Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU GREATER SAN DIEGO AIR CONDITIO Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 04/02/2019 Par 95399 Commercial CA Greater San Gabriel Valley Professional 5010A1Claim Level Accept /Reject

U: 02/08/2013 Non-Par PDT01 Commercial MU Greater Tri City IPA Professional 5010A1File LevelAcknowledgement

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Greene Rad Maloney Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Greer Constructon CO Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Greif Brothers Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Greve Clifford Wengel & Paras Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU GRIFFIN PRODUCE INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU GRIFFIN PRODUCE INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Grimmway Enterprises, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par 36338 Commercial Group Administrators Ltd. Institutional 5010A2File LevelAcknowledgement

U: 11/01/2012 Non-Par 36338 Commercial Group Administrators Ltd. Professional 5010A1File LevelAcknowledgement

U: 09/01/2016 Par 48143 Commercial Group And Pension Administrators Institutional 5010A2 No Response From Payer

U: 09/24/2012 Non-Par 48143 CommercialGroup and Pension Administrators {Group # requiredon all claims}


A: 11/24/2014 Non-Par CB951 Commercial Group Benefit Services Inc. Professional 5010A1 Claim Level Accept/Reject

A: 12/05/2014 Non-Par CB951 Commercial Group Benefit Services Inc. Institutional 5010A2 Claim Level Accept/Reject

A: 12/15/2014 Non-Par 12X16 Commercial Group Health Co-op Institutional 5010A1

A: 04/21/2021 Non-Par 91051 Commercial WA GROUP HEALTH COOPERATIVE - WEST Remittance 5010A1 Enrollment

U: 09/17/2019 Non-Par 95192 Commercial Group Health Cooperative of Eau Claire Professional 5010A1 Yes

U: 11/16/2021 Non-Par 95192 Commercial Group Health Cooperative of Eau Claire Remittance 5010A1 Enrollment

A: 10/04/2019 Par 95192 Commercial WI Group Health Cooperative of Eau Claire Institutional 5010A1 File Level Ack. Yes

U: 12/02/2019 Non-Par 39167 CommercialGroup Health Cooperative of South CentralWisconsin


A: 08/08/2014 Non-Par 39168 CommercialGroup Health Cooperative of South CentralWisconsin


Updated: 03/21/2022


PPAAYERYERIDID



U: 09/26/2019 Non-Par 39167 Commercial WIGroup Health Cooperative of South CentralWisconsin


U: 12/02/2019 Non-Par 39167 Commercial WIGroup Health Cooperative of South CentralWisconsin (claims)


U: 11/01/2012 Non-Par 39168 Commercial WIGroup Health Cooperative of South CentralWisconsin (encounters)


U: 09/01/2016 Par 13551 Commercial NY Group Health Inc (GHI) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 13551 Commercial NY Group Health Inc (GHI) Professional 5010A1Claim Level Accept /Reject

Yes

A: 08/20/2021 Non-Par 13551 Commercial NY Group Health Inc (GHI) Remittance 5010A1 Enrollment


U: 08/20/2021 Non-Par 58379 Commercial NY Group Health Inc (GHI) (Formerly 13551) Remittance 5010A1 Enrollment


U: 08/05/2013 Non-Par 37276 Commercial Group Insurance Service Center Inc. Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 37276 Commercial Group Insurance Service Center, Inc. (GISC) Professional 5010A1 No Response From Payer

A: 04/24/2020 Non-Par 66701 Commercial MI Group Marketing Services Professional 5010A1Claim Level Accept /Reject

No

A: 04/24/2020 Non-Par 66701 Commercial MI Group Marketing Services Institutional 5010A1Claim Level Accept /Reject

No

U: 03/11/2013 Non-Par 68046 Commercial Group Practice Affiliates Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 68046 Commercial Group Practice Affiliates Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Grundfos Manufacturing Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU GS Metals Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/04/2016 Non-Par J1453 Commercial Guard Insurance Group Remittance 5010A1 Enrollment

U: 04/02/2016 Non-Par J1453 Workers' Comp MU Guard Insurance Group Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/01/2012 Non-Par 64246 Commercial Guardian Life Insurance Company of America Institutional 5010A2 No Response From Payer

U: 09/24/2019 Non-Par 64246 Commercial MU Guardian Life Insurance Company of America Remittance 5010A1 Enrollment

U: 01/01/2012 Non-Par 64246 CommercialGuardian Life Insurance Company Of America (TheGuardian)


A: 11/24/2014 Non-Par CB624 Commercial Gulf Stream-General Dynamics Professional 5010A1 Claim Level Accept/Reject Yes

A: 12/05/2014 Non-Par CB624 Commercial Gulf Stream-General Dynamics Institutional 5010A2 Claim Level Rejects Only Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU H R N SERVICES, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU H R N SERVICES, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU H. L. HEGGSTAD, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU H. L. HEGGSTAD, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/08/2014 Non-Par 37114 Commercial H.E.R.E.I.U. Welfare Pension Plan Funds Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 37114 Commercial H.E.R.E.I.U. Welfare Pension Plan Funds Professional 5010A1 No Response From Payer

U: 09/23/2013 Non-Par J1491 Workers' Comp MU H.J. COMPANY Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU H.J. COMPANY Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU H.P Develpment Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU H.P Develpment Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/23/2013 Non-Par J1491 Workers' Comp MU H.P. Envirovision Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU H.P. Envirovision Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Hagen-Renaker, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Hagen-Renaker, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Haight, Brown & Bonesteel Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Haight, Brown & Bonesteel Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/31/2020 Par 04273 Commercial MA Halifax Charity Claims Professional 5010A1Claim Level Accept /Reject

No

A: 01/31/2020 Par 04273 Commercial MA Halifax Charity Claims Institutional 5010A1Claim Level Accept /Reject

No

A: 10/28/2019 Trans 47738 Commercial MN Hamaspik Choice Institutional 5010A1 Claim Level Ack. Yes

A: 10/28/2019 Trans 47738 Commercial MN Hamaspik Choice Professional 5010A1 Claim Level Ack. Yes

A: 10/28/2019 Non-Par 47738 Commercial MN Hamaspik Choice Remittance 5010A1 Enrollment

A: 01/28/2020 Non-Par J1693 Workers' Comp Hanover Insurance Company Remittance 5010A1 Enrollment

This Payer ID is for Auto and WorkersComp Claims for all states. The abovePayer Name(s) may representmultiple Accounts (employers).

A: 12/24/2018 Non-Par J1693 Workers' Comp Hanover PIP Prof. Work Comp 5010A1Claim Level Accept /Reject

This payer ID is for Workers Comp andAuto Claims for all states. The payername may represent multipleaccounts (employers).

U: 01/02/2020 Par 38224 Commercial MI HAP / AHL / Curanet Professional 5010A1 Claim Level Rejects Only No

Secondary Claims are not acceptedat HAP for electronic processing. AllSecondary Claims should besubmitted on paper and a copy of thepayer EOB must be included. Addresson back of member id card should beused for mailing address to submitSecondary Claims. date of serviceafter Dec. 31, 2019 must be sent toHEALTH ALLIANCE PLAN (payer ID38224). Claims with dates of serviceprior to Dec. 31, 2019 can continue tobe sent to payer ID 70259.

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Haralambos Beverage Company Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Haralambos Beverage Company Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU HARBOB SOUTHERN, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU HARBOB SOUTHERN, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 08/19/2019 Non-Par 74080 Commercial MI Harbor Health Plan - JVHL Remittance 5010A1 Enrollment

A: 01/02/2020 Non-Par 74080 Commercial MI Harbor Health Plan- JVHL Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 75126 Commercial Harpeth IPA - Amerivantage Professional 5010A1 Claim Level Accept/Reject Yes

U: 06/30/2012 Non-Par 62061 Commercial Harrington Health - formerly Fiserv / Willis Professional 5010A1Claim Level Accept /Reject

U: 06/30/2012 Non-Par 62061 Commercial Harrington Health - formerly Fiserv / Willis Institutional 5010A2 No Response From Payer

A: 12/02/2011 Non-Par 59143 Commercial MU Harrington Health Non EPO Professional 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par 59143 Commercial Harrington Health Non_EPO Institutional 5010A2 Claim Level Accept/Reject

U: 03/24/2014 Non-Par WB109 Workers' Comp Hartford / Speciality Risk Services (SRS) Prof. Work Comp 5010A1File LevelAcknowledgement

A: 01/28/2020 Non-Par WB109 Workers' Comp Hartford - SRS Remittance 5010A1 Enrollment

A: 01/28/2020 Non-Par C1046 Auto Hartford Accident and Indemnity Co Remittance 5010A1 EnrollmentThis Payer ID is for Auto Claims Onlyfor ALL states. The above Payer

Updated: 03/21/2022


PPAAYERYERIDID



Name(s) may represent multipleAccounts (employers).

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Hartford Dealership Advantage Program - WC Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/27/2018 Non-Par C1046 Workers' Comp Hartford Ins PIP Prof. Work Comp 5010A1Claim Level Accept /Reject

This payer ID is for Workers' Compand Auto Claims ONLY for ALL states.The payer name may representmultiple accounts (employers).

A: 05/10/2019 Non-Par C1040 Workers' Comp MU Hartford Ins WC Prof. Work Comp 5010A1

A: 09/01/2016 Par 04245 Commercial Harvard Community Health Plan Professional 5010A1 Yes

A: 09/01/2016 Par 04245 Commercial Harvard Community Health Plan Institutional 5010A2 No Response From Payer Yes

U: 04/27/2016 Non-Par 04271 Commercial MA Harvard Pilgrim Health Plan Institutional 5010A2Claim Level Accept /Reject

Yes

U: 04/27/2016 Non-Par 04271 Commercial MA Harvard Pilgrim Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

U: 04/28/2021 Non-Par 04271 Commercial Harvard Pilgrim Health Plan Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Hastings College of the Law Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 02/21/2022 Non-Par 40523 Commercial HI Hawaii 835 (ERA/EFT) Remittance 5010A1 EnrollmentPayer does not offer claims under thispayer ID. This is for ERA only.

U: 10/21/2021 Non-Par 12B62 Commercial HI Hawaii Blue Cross (Formerly BS064) Institutional 5010A1 Enrollment

A: 11/01/2019 Non-Par 48330 Commercial HI Hawaii Management Alliance Association Professional 5010A1Claim Level Accept /Reject

No

A: 11/01/2019 Non-Par 48330 Commercial HI Hawaii Management Alliance Association Institutional 5010A1Claim Level Accept /Reject

No

U: 01/21/2021 Non-Par SB971 Commercial HIHawaii Medical Service Association (HMSA) (Formerly(BS064)


U: 07/09/2021 Non-Par SB971 Government HIHawaii Medical Service Association (HMSA) (Formerly(BS064)

Professional 5010A1 Enrollment No Response From Payer Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU HAWTHORNE FINANCIAL CORPORATIO Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU HAWTHORNE FINANCIAL CORPORATIO Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Hayhoe Construction Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 82018 Commercial HCS - Health Claims Service (Boise, ID) Institutional 5010A2 No Response From Payer

U: 11/13/2013 Non-Par 77950 Commercial MU Health Alliance Medical Plan Professional 5010A1Claim LevelAcknowledgement

Yes

U: 11/13/2013 Non-Par 77950 Commercial Health Alliance Medical Plans Institutional 5010A2 No Response From Payer

U: 10/07/2019 Non-Par 77950 Commercial Health Alliance Medical Plans Remittance 5010A1 Enrollment

A: 03/12/2021 Non-Par JVHJG Commercial MIHEALTH ALLIANCE PLAN (CAPITATED CONTRACTS) -JVHL


Yes

A: 03/12/2021 Non-Par JVHJG Commercial MIHEALTH ALLIANCE PLAN (CAPITATED CONTRACTS) -JVHL


Yes

U: 01/02/2020 Non-Par 38224 Commercial Health Alliance Plan (HAP) of MI Remittance 5010A2 EnrollmentClaim Level Accept /Reject

date of service after Dec. 31, 2019must be sent to HEALTH ALLIANCEPLAN (payer ID 38224). Claims withdates of service prior to Dec. 31, 2019can continue to be sent to payer ID70259.

U: 06/19/2015 Non-Par CALL Commercial MU Health Care District Palm Beach County Professional 4010A1Claim Level Accept /Reject

Please contact payer to obtain payer# at (866) 930-1002 and inform themyou will be submitting throughEMDEON. The Payer will give you anEDI Enrollment Request form thatmust be completed. When completingform please input the followinginformation under section II.Clearinghouse: Name: Emdeon/Contact: Enrollment Help Desk/Telephone: 866-924-4634/ Email:[email protected]/ Fax:615-231-4843

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/30/2021 Non-Par MPM06 Commercial CA Health Care LA IPA - Medpoint Professional 5010A1Claim Level Accept /Reject

U: 09/30/2021 Non-Par MPM06 Commercial CA Health Care LA IPA - Medpoint Institutional 5010A1Claim Level Accept /Reject

U: 09/30/2021 Non-Par MPM06 Commercial CA Health Care LA IPA - Medpoint Remittance 5010A1 Enrollment

A: 09/01/2016 Par 42102 Commercial Health Care Network of Wisconsin (HCN) Institutional 5010A2 No Response From Payer

U: 06/24/2019 Non-Par 62179 Medicaid AZ Health Choice Arizona Professional 5010A1Claim Level Accept /Reject

U: 10/07/2019 Non-Par 62179 Medicaid AZ Health Choice Arizona Remittance 5010A1 Enrollment

U: 06/24/2019 Non-Par 62179 Medicaid AZ Health Choice Arizona Institutional 5010A2Claim Level Accept /Reject

U: 06/24/2019 Non-Par 62180 Medicare Health Choice Generations Professional 5010A1Claim Level Accept /Reject

U: 06/24/2019 Non-Par 62180 Medicare Health Choice Generations Institutional 5010A2Claim Level Accept /Reject

U: 10/07/2019 Non-Par 62180 Medicare Health Choice Generations Remittance 5010A1 Enrollment

A: 04/29/2021 Non-Par 13054 Commercial Health Choice Generations Utah Remittance 5010A1 Enrollment

A: 04/29/2021 Par 13054 Commercial UT Health Choice Generations Utah Professional 5010A1Claim Level Accept /Reject

Yes

A: 04/29/2021 Par 13054 Commercial UT Health Choice Generations Utah Institutional 5010A1Claim Level Accept /Reject

Yes

A: 11/18/2021 Non-Par 45399 Commercial Health Choice Utah Professional 5010A1 Yes

A: 11/18/2021 Non-Par 45399 Commercial Health Choice Utah Institutional 5010A2 Yes

U: 10/07/2019 Non-Par 45399 Commercial Health Choice Utah Remittance 5010A1 Enrollment

U: 11/01/2012 Non-Par 62111 Commercial Health Cost Solutions Institutional 5010A2File LevelAcknowledgement

A: 01/19/2015 Non-Par 62111 Commercial TN Health Cost Solutions Professional 5010A1 Claim Level Ack.

U: 09/01/2016 Par 34158 Commercial Health Design Plus (Hudson, OH) Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 34158 Commercial OH Health Design Plus (Hudson, OH) Professional 5010A1 No Response From Payer

U: 03/29/2012 Non-Par 95019 Commercial FL Health First Health Plan Professional 5010A1Claim LevelAcknowledgement

A: 12/09/2021 Par 95019 Commercial FL Health First Health Plan Institutional 5010A1Claim Level Accept /Reject

Yes

A: 09/24/2019 Non-Par 15064 Commercial FL Health First Health Plan (Formerly 95019) Remittance 5010A1 Enrollment

A: 01/19/2022 Par RP039 Commercial NY HEALTH FIRST HEALTH PLANS Professional 5010A1 Claim Level Ack. No

A: 01/19/2022 Par RP039 Commercial NY HEALTH FIRST HEALTH PLANS Institutional 5010A1 Claim Level Ack. No

A: 01/24/2022 Non-Par RP039 Commercial NY HEALTH FIRST HEALTH PLANS Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 23274 Commercial Health Group Limited Professional 5010A1File LevelAcknowledgement

Yes

A: 12/05/2014 Non-Par 23274 Commercial Health Group Limited Institutional 5010A2 File Level Ack. Yes

U: 09/01/2016 Par 59087 Commercial Health Help Network Inc. (HHNI) Professional 5010A1Claim LevelAcknowledgement

A: 01/16/2015 Non-Par 75318 Commercial Health Management Concepts Professional 5010A1

A: 01/16/2015 Non-Par 75318 Commercial Health Management Concepts Institutional 5010A1

U: 04/21/2020 Trans 95567 Commercial CA Health Net California Professional 5010A1Claim Level Accept /Reject

No

U: 04/21/2020 Non-Par 95567 Commercial CA Health Net - California Institutional 5010A2 No Response From Payer Yes

U: 02/15/2022 Non-Par 95567 Commercial OR Health Net of California and Oregon Remittance 5010A1 Enrollment

U: 04/21/2020 Trans 95567 Commercial OR Health Net Oregon Professional 5010A1Claim Level Accept /Reject

No

U: 01/01/2012 Trans AMS01 Commercial TN Health Net Plus (TN) Professional 5010A1 No Response From Payer

U: 04/21/2020 Par 95567 Commercial OR Health Net- Oregon Institutional 5010A2 No Response From Payer

U: 02/07/2017 Non-Par 65062 Commercial Health Network One Professional 5010A1Claim Level Accept /Reject

U: 10/07/2019 Non-Par 65062 Commercial Health Network One Remittance 5010A1 Enrollment

A: 08/10/2021 Par 04286 Commercial MA Health New England Professional 5010A1Claim Level Accept /Reject

Yes

A: 08/10/2021 Non-Par 04286 Commercial Health New England Institutional 5010A1Claim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



U: 11/19/2019 Non-Par 04286 Commercial Health New England Remittance 5010A1 Enrollment

U: 09/01/2016 Par 62157 Commercial TN Health Partners (Tennessee) Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 62157 Commercial TN Health Partners - Jackson, TN Institutional 5010A2 No Response From Payer

U: 12/03/2021 Non-Par 80142 Commercial PA Health Partners of Philadelphia Institutional 5010A2 No Response From Payer

U: 12/03/2021 Non-Par 80142 Commercial PA Health Partners of Philadelphia Professional 5010A1Claim Level Accept /Reject

A: 12/03/2021 Non-Par 80142 Commercial Health Partners of Philadelphia Remittance 5010A1 Enrollment


A: 12/03/2021 Non-Par 58379 Commercial Health Partners of Philadelphia (Formerly 80142) Remittance 5010A1 Enrollment


A: 04/09/2010 Non-Par 20270 Commercial Health Payment Services Professional 4010A1Claim Level Accept /Reject

A: 04/09/2010 Non-Par 20270 Commercial Health Payment Systems Inc. Institutional 4010A1File LevelAcknowledgement

A: 11/09/2021 Non-Par 32130 Commercial MI Health Plan of Michigan - JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 11/09/2021 Non-Par 32130 Commercial MI Health Plan of Michigan - JVHL Remittance 5010A1 Enrollment

U: 09/01/2016 Par 68035 Commercial Health Plan of San Joaquin Professional 5010A1Claim LevelAcknowledgement

YesThis payer accepts NPI only, All non-NPI ID's will reject.

U: 09/01/2016 Par 68035 Commercial Health Plan of San Joaquin Institutional 5010A2Claim LevelAcknowledgement

YesThis payer accepts NPI only, All non-NPI ID's will reject.

U: 08/15/2019 Non-Par 68035 Commercial CA Health Plan of San Joaquin Remittance 5010A1 Enrollment

A: 12/20/2019 Non-Par SX174 Commercial CA Health Plan Of San Mateo Remittance 5010A1 Enrollment

U: 03/07/2017 Par SX174 Commercial Health Plan of San Mateo (Formerly HPSM1) Professional 5010A1 No Response From Payer

U: 03/08/2017 Par SX174 Commercial CA Health Plan Of San Mateo (Formerly HPSM1) Institutional 5010A2 Claim Level Ack.

U: 01/01/2012 Trans HP001 Commercial OH Health Plan of Upper Ohio Valley Professional 5010A1Claim LevelAcknowledgement

Yes

U: 02/27/2012 Par 59140 Commercial Health Plan Services Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 44273 Commercial Health Plans, Inc. Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 44273 Commercial Health Plans, Inc. Professional 5010A1Claim LevelAcknowledgement

A: 09/30/2019 Non-Par 44273 Health Plans, Inc. Remittance 5010A1 Enrollment

A: 05/26/2020 Non-Par 30103 Commercial NY Health Pointe NY Institutional 5010A1Claim Level Accept /Reject

No

A: 05/26/2020 Non-Par 30103 Commercial NY Health Pointe NY Professional 5010A1Claim Level Accept /Reject

No

U: 11/12/2019 Non-Par 12K48 Commercial MAHealth Safety Network- MA Medicaid (FormerlySKMA2)


A: 09/01/2021 Par SKMA2 Government MA Health Service - MA Medicaid Professional 5010A1 Enrollment No Response From PayerPayer ID only for Professional HSN(Health Safety Network) claims only

U: 09/30/2019 Par 41150 Commercial Health Service Management Professional 5010A1 EnrollmentClaim Level Accept /Reject

U: 09/10/2014 Non-Par 37290 CommercialHealth Services For Children with Special Needs(HSCSN)






U: 01/15/2020 Non-Par 41150 Commercial MU Health Services Management Remittance 5010A1 Enrollment

U: 09/01/2016 Par 34167 Commercial Health Services Preferred (HSP) by Emerald Health Institutional 5010A2 No Response From Payer

A: 05/29/2018 Par 77120 Medicaid OR Health Share of Oregon CCO - Mental Health Professional 5010A1Claim Level Accept /Reject

Yes

A: 05/29/2018 Par 77120 Medicaid OR Health Share of Oregon CCO - Mental Health Institutional 5010A1Claim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



A: 07/06/2020 Non-Par HSMSO Commercial CA Health Source MCO Professional 5010A1Claim Level Accept /Reject

No

A: 07/06/2020 Non-Par HSMSO Commercial CA Health Source MCO Institutional 5010A1Claim Level Accept /Reject

No

A: 05/26/2020 Non-Par 88350 Commercial NCHealth Team Management Diabetes and Heart CarePlan


No

A: 05/26/2020 Non-Par 88350 Commercial NCHealth Team Management Diabetes and Heart CarePlan


No

A: 07/21/2014 Non-Par HTHTX Commercial Health Texas Medical Group Professional 5010A1 File Level Ack. Yes

A: 12/07/2018 Non-Par HLTHT Commercial WI Health Traditions Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/07/2018 Non-Par HLTHT Commercial WI Health Traditions Institutional 5010A1Claim Level Accept /Reject

Yes

U: 01/14/2020 Non-Par HLTHT Commercial WI Health Traditions Remittance 5010A1 Enrollment

A: 09/28/2021 Non-Par HCH01 Commercial TX Healthcare Highways Remittance 5010A1 Enrollment

A: 08/24/2017 Trans HCH01 Commercial TX Healthcare Highways Institutional 5010A1Claim Level Accept /Reject

Yes

A: 08/24/2017 Trans HCH01 Commercial TX Healthcare Highways Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/03/2020 Non-Par HCHHP Commercial TX Healthcare Highways Professional 5010A1Claim Level Accept /Reject

No

A: 09/03/2020 Non-Par HCHHP Commercial TX Healthcare Highways Institutional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU HEALTHCARE MANAGEMENT SYSTEMS, Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU HEALTHCARE MANAGEMENT SYSTEMS, Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 06/21/2017 Non-Par HCP01 Commercial Healthcare Partners Professional 5010A1 Claim Level Ack. No

A: 06/21/2017 Non-Par HCP01 Commercial Healthcare Partners Institutional 5010A1 Claim Level Ack. No

U: 11/26/2019 Non-Par HCP01 Commercial CA Healthcare Partners Remittance 5010A1 Enrollment

A: 10/09/2017 Non-Par HCP01 Commercial CA Healthcare Partners (Formerly IP102) Professional 5010A1Claim Level Accept /Reject

A: 10/09/2017 Non-Par HCP01 Commercial CA Healthcare Partners (Formerly IP102) Institutional 5010A2 No Response From Payer

U: 03/11/2013 Non-Par 11328 Commercial HealthCare Partners IPA Institutional 5010A2 No Response From Payer Yes

U: 03/11/2013 Non-Par 11328 Commercial NYHealthCare Partners IPA (Formerly Heritage NYMedical Group)


U: 10/24/2012 Non-Par 20501 Commercial NV HealthCare Partners of Nevada Professional 5010A1Claim LevelAcknowledgement

U: 03/11/2013 Non-Par 90001 Commercial Healthcare Plan PPO Professional 5010A1Claim LevelAcknowledgement

Yes

A: 08/08/2014 Non-Par 56731 Commercial Healthcare Resources NW Institutional 5010A2

U: 11/27/2013 Non-Par 56731 Commercial Healthcare Resources NW Professional 5010A1File LevelAcknowledgement

A: 11/16/2021 Non-Par 73147 Commercial HealthCare Solutions Group Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 73147 Commercial HealthCare Solutions Group Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 73147 Commercial Healthcare Solutions Group Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/26/2012 Par 36335 Commercial Healthcare's Finest Network Professional 5010A1Claim Level Accept /Reject

A: 01/16/2018 Par 71064 Commercial OK Healthchoice Oklahoma Professional 5010A1Claim Level Accept /Reject

No

A: 01/16/2018 Par 71064 Commercial OK Healthchoice Oklahoma Institutional 5010A1Claim Level Accept /Reject

No

U: 03/28/2012 Par HCOMP Commercial CA HealthComp Professional 5010A1File LevelAcknowledgement

U: 07/18/2012 Par HCOMP Commercial CA HealthComp Institutional 5010A1Claim LevelAcknowledgement

A: 08/31/2021 Par 41178 Commercial MN Healthez Professional 5010A1Claim Level Accept /Reject

Yes

A: 08/31/2021 Par 41178 Commercial MN Healthez Institutional 5010A1 Claim Level Accept / Yes

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 09/01/2016 Par 80141 Commercial Healthfirst 65 Plus Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 80141 Commercial Healthfirst Family Health Plus (FHP) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 80141 Commercial Healthfirst Health Plan of New Jersey Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 80141 Commercial NY Healthfirst Inc. (New York) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 80141 Commercial NY Healthfirst New York (COMMERCIAL) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 80141 Commercial Healthfirst PHSP Institutional 5010A2Claim Level Accept /Reject

Yes

U: 01/01/2012 Non-Par 75234 Commercial TX Healthfirst Tyler, TX Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 80141 Commercial NY Healthfirst, Inc. Professional 5010A1Claim LevelAcknowledgement

YesContact the payer prior to submittingclaims to verify provider id.(212)801-6078)

U: 02/06/2019 Non-Par 80141 Commercial NY Healthfirst, Inc. - New York Remittance 5010A1 EnrollmentThis payer requires EFT whenrequesting ERA.

U: 09/01/2016 Par 56144 Commercial Healthgram Inc. (Formerly Primary Physician Care) Professional 5010A1

U: 09/01/2016 Par 56144 Commercial Healthgram Inc. (Formerly Primary Physician Care) Institutional 5010A2 Claim Level Ack.

A: 03/01/2021 Non-Par 56144 Commercial NC Healthgram, Inc. Remittance 5010A1 Enrollment

U: 01/15/2020 Non-Par 96475 Commercial Healthlink HMO Institutional 5010A2 No Response From Payer

U: 03/29/2012 Non-Par 96475 Commercial Healthlink HMO Professional 5010A1Claim LevelAcknowledgement

Contact payer at 800-624-2356 priorto submitting claims.

U: 08/15/2019 Non-Par 96475 Commercial Healthlink HMO Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 90001 Commercial Healthlink PPO Professional 5010A1Claim LevelAcknowledgement

Yes

U: 01/15/2020 Non-Par 90001 Commercial Healthlink PPO Institutional 5010A2 Yes

A: 01/08/2018 Non-Par 95570 Commercial CA HealthNet California Encounters Professional 5010A1 File Level Ack.

Providers must send their submitter idwith HealthNet in the REF G2 of 2310Bor encounters will be rejected. Toverify or obtain Health Net assignedID, please send an email message [email protected]

A: 01/13/2020 Non-Par 38309 Commercial AZ HealthNet of AZ (formerly listed as 06108) Remittance 5010A1 Enrollment DOS <10/1/18

A: 10/11/2017 Non-Par 12B68 Commercial NY HealthNow - BCBS Northeastern NY (Formerly SB800) Institutional 5010A1

U: 06/28/2017 Non-Par SB800 Government NYHealthNow Blue Cross Blue Shield of Northeastern NY(formerly BS086)


Yes

U: 06/28/2017 Non-Par SB801 Government NYHealthNow Blue Cross Blue Shield of Western NY(formerly BS087)


Yes

U: 11/10/2020 Non-Par SB801 Commercial NYHealthNow Blue Cross Blue Shield of Western NY(formerly BS087)


A: 07/21/2017 Non-Par 12B39 Commercial NYHealthNow Blue Cross Blue Shield of Western NY(formerly SB801 / BS087)


U: 06/28/2017 Non-Par 55204 Commercial NY HealthNow New York Professional 5010A1 Yes ERA Available under payer ID: SB801

U: 04/30/2021 Par SX009 Commercial MN HealthPartners (Minnesota) (Formerly 94267) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 10/15/2020 Non-Par SX009 Commercial MN HealthPartners (Minnesota) (Formerly 94267) Remittance 5010A1 Enrollment

U: 04/30/2021 Par 12X51 Commercial MN HealthPartners MN Institutional 5010A2 EnrollmentClaim Level Accept /Reject

Yes

U: 11/08/2018 Non-Par 12X51 Commercial MN HealthPartners MN Remittance 5010A1 Enrollment

U: 09/01/2016 Trans 59140 Commercial HealthPlan Services Institutional 5010A2Claim Level Accept /Reject

U: 09/01/2016 Par 68195 Commercial Healthpoint Corp. Professional 5010A1Claim Level Accept /Reject

Yes

A: 08/10/2016 Trans 71084 Commercial MU Healthscope Benefits Professional 5010A1Claim Level Accept /Reject

A: 08/10/2016 Trans 71084 Commercial MU Healthscope Benefits Institutional 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



A: 09/01/2016 Par 52429 Commercial Healthscope Benefits - EHC Repricin Professional 5010A1 Claim Level Ack.

A: 09/01/2016 Par 52429 Commercial Healthscope Benefits - EHC Repricin Institutional 5010A2 Claim Level Ack.

U: 08/10/2016 Non-Par 71063 Commercial HealthSCOPE Benefits, Inc. Professional 5010A1Claim Level Accept /Reject

Yes

U: 08/10/2016 Non-Par 71063 Commercial HealthSCOPE Benefits, Inc. Institutional 5010A2Claim Level Accept /Reject

Yes

A: 07/24/2018 Non-Par HSM01 Commercial CA HealthSmart - Noble Mid Orange Professional 5010A1 Claim Level Rejects Only

A: 12/16/2019 Non-Par HSM01 Commercial CA Healthsmart - Noble Mid Orange Professional 5010A1Claim Level Accept /Reject

No

U: 09/01/2016 Par 75237 Commercial Healthsmart Accel Institutional 4010A1File LevelAcknowledgement

Yes

U: 09/01/2016 Par 75237 Commercial MU Healthsmart Accel Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Par 87815 CommercialHealthSmart Benefit Solutions (formerly Wells FargoTPA, Inc., Charleston, WV)


U: 03/11/2013 Par 87815 CommercialHealthSmart Benefit Solutions (formerly Wells FargoTPA, Inc., Charleston, WV)


U: 08/15/2019 Non-Par 87815 Commercial MUHealthSmart Benefit Solutions (formerly Wells FargoTPA, Inc., Charleston, WV)


U: 08/09/2012 Non-Par 37272 CommercialHealthSmart Benefit Solutions (formerly J. SmithLanier & Co. Admin)


U: 09/01/2016 Par 37272 CommercialHealthSmart Benefit Solutions (formerly J. SmithLanier & Co. Administrators)


U: 08/15/2019 Non-Par 37272 CommercialHealthSmart Benefit Solutions (formerly JSLAdministrators


U: 09/01/2016 Par 37272 CommercialHealthSmart Benefit Solutions (formerly JSLAdministrators)


U: 08/09/2012 Non-Par 37272 CommercialHealthSmart Benefit Solutions (formerly JSLAdministrators)


U: 03/11/2013 Non-Par 37283 CommercialHealthSmart Benefit Solutions - Formerly GallagherBenefit Administrators, Inc. / GBA


Yes

U: 03/11/2013 Non-Par 37283 CommercialHealthSmart Benefit Solutions - Formerly PolyAmerica Medical Benefits Plan


Yes

U: 09/01/2016 Par 75250 Commercial Healthsmart Preferred Care, Inc. Institutional 4010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 75250 Commercial Healthsmart Preferred Care, Inc. Professional 5010A1Claim LevelAcknowledgement

Yes

U: 03/11/2013 Non-Par 62308 Commercial AR Healthsource - AR Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62308 Commercial AR Healthsource - AR (Medicare HMO) Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 71075 Commercial Healthsource - Arkansas (Med) (CIGNA) Institutional 5010A2 No Response From Payer Yes

A: 09/01/2016 Par 71075 Commercial Healthsource - Arkansas (Med) (CIGNA) Professional 5010A1 No Response From Payer

A: 09/01/2016 Par 58210 Commercial Healthsource - Georgia Institutional 5010A2 No Response From Payer Yes

U: 03/11/2013 Non-Par 62308 Commercial IN Healthsource - IN Professional 5010A1Claim Level Accept /Reject

Yes

A: 08/08/2014 Non-Par 35167 Commercial Healthsource - Indiana Institutional 5010A2 No Response From Payer

A: 09/01/2016 Par 61127 Commercial Healthsource - Kentucky Institutional 5010A2 No Response From Payer Yes

A: 09/01/2016 Par 61127 Commercial KY Healthsource - Kentucky Professional 5010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 62308 Commercial KY Healthsource - KY Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62308 Commercial MA Healthsource - MA Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 01041 Commercial ME Healthsource - Maine Professional 5010A1 No Response From Payer

A: 09/01/2016 Par 01041 Commercial ME Healthsource - Maine Institutional 5010A2 No Response From Payer

U: 03/11/2013 Non-Par 62308 Commercial ME Healthsource - ME Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62308 Commercial NC Healthsource - NC Professional 5010A1Claim Level Accept /Reject

Yes

A: 08/08/2014 Non-Par 02038 Commercial NH Healthsource - New Hampshire Institutional 5010A2 No Response From Payer Yes

U: 03/11/2013 Non-Par 62308 Commercial NH Healthsource - NH Professional 5010A1 Claim Level Accept / Yes

Updated: 03/21/2022


PPAAYERYERIDID



Reject

A: 09/01/2016 Par 56147 Commercial Healthsource - North Carolina (CIGNA) Institutional 5010A2 No Response From Payer Yes

A: 09/01/2016 Par 75255 Commercial Healthsource - North Texas Institutional 5010A2 No Response From Payer Yes

A: 09/01/2016 Par 75255 Commercial TX Healthsource - North Texas Professional 5010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 62308 Commercial TX Healthsource - North TX Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62308 Commercial OH Healthsource - OH Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 31141 Commercial Healthsource - Ohio Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 06119 Commercial SC Healthsource - SC Professional 5010A1 No Response From Payer Yes

U: 09/01/2016 Par 06119 Commercial SC Healthsource - SC Institutional 5010A2 No Response From Payer Yes

U: 03/11/2013 Non-Par 62308 Commercial SC Healthsource - SC Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 06119 Commercial SC Healthsource - South Carolina Institutional 5010A2 No Response From Payer Yes

A: 09/01/2016 Par 62129 Commercial Healthsource - Tennessee Institutional 5010A2 No Response From Payer Yes

U: 03/11/2013 Non-Par 62308 Commercial TN Healthsource - Tennessee Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 62129 Commercial Healthsource - Tennessee Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 02041 Commercial Healthsource CMHC Institutional 5010A2 No Response From Payer Yes

A: 09/01/2016 Par 58210 Commercial GA Healthsource GA (CIGNA) Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 02041 Commercial Healthsource Massachusetts, Inc. Institutional 5010A2 No Response From Payer Yes

A: 09/01/2016 Par 56147 Commercial NC Healthsource NC (CIGNA) Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 31141 Commercial Healthsource of Ohio Professional 5010A1Claim LevelAcknowledgement

Yes

U: 09/01/2016 Par 68195 Commercial Healthsource Provident Institutional 5010A2 No Response From Payer Yes

U: 03/11/2013 Non-Par 62308 Commercial Healthsource Provident Administrators Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62308 Commercial Healthsource Provident Ins. Co. Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 02038 Commercial NH Healthsource, New Hampshire Professional 5010A1File LevelAcknowledgement

Yes

U: 05/23/2014 Par HT001 Commercial TN HealthSpring Professional 5010A1 File Level Ack.

Claim level response reports areavailable for dates of service prior to1/1/2014 ERA is available underpayer id 52192

U: 09/30/2019 Non-Par 52192 Commercial HealthSpring (formerly Bravo Health) Remittance 5010A1 Enrollment

For Provider Enrollment for ERA andEFT services, please visithttp://www.emdeon.com/epayment/or call Enrollment Questions at1-866-506-2830, Option 1

U: 09/01/2016 Par 52192 Commercial HealthSpring (Formerly Bravo Health) Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 52192 Commercial HealthSpring (formerly Bravo Health) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 05/23/2014 Par 63092 Commercial HealthSpring HMO / HealthSpring Medicare+Choice Professional 5010A1 File Level Ack.

Claim level response reports areavailable for dates of service prior to1/1/2014 ERA is available underpayer id 52192

U: 09/01/2016 Par 63092 Commercial HealthSpring HMO / HealthSpring Medicare+Choice Institutional 5010A2 File Level Ack.

U: 09/01/2017 Non-Par 63092 Commercial MU HealthSpring HMO / HealthSpring Medicare+Choice Remittance 5010A1

ERA processing and enrollment forpayer id 63092 is available under52192. Please cancel this enrollmentand add 52192 to your Caparioaccount. Once added, complete/submit the enrollment form thatpopulates under payer ID: 52192.

U: 04/27/2012 Non-Par HESUN Commercial FL Healthsun health Plan Professional 5010A1File LevelAcknowledgement

A: 07/28/2020 Non-Par HESUN Commercial FL Healthsun Health Plan Institutional 5010A1Claim Level Accept /Reject

No

A: 10/16/2018 Non-Par 88250 Commercial NC HealthTeam Advantage Professional 5010A1 Claim Level Accept / Yes

Updated: 03/21/2022


PPAAYERYERIDID



Reject

A: 10/16/2018 Non-Par 88250 Commercial NC HealthTeam Advantage Institutional 5010A1Claim Level Accept /Reject

Yes

A: 06/30/2021 Non-Par 88250 Commercial NC Healthteam Advantage Remittance 5010A1 Enrollment

U: 09/01/2016 Par 58213 Commercial Healthways WholeHealth Network Professional 5010A1Claim LevelAcknowledgement

A: 06/22/2020 Non-Par 00551 Commercial LA Healthy Blue Dual Advantage Louisiana Professional 5010A1Claim Level Accept /Reject

Yes

A: 06/22/2020 Non-Par 00551 Commercial LA Healthy Blue Dual Advantage Louisiana Institutional 5010A1Claim Level Accept /Reject

Yes

A: 09/20/2017 Non-Par 58532 Medicaid LA Healthy Blue Louisiana Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/20/2017 Non-Par 58532 Medicaid LA Healthy Blue Louisiana Institutional 5010A1Claim Level Accept /Reject

Yes

A: 04/13/2020 Non-Par 58532 Commercial LA Healthy Blue Louisiana Remittance 5010A1 Enrollment

U: 07/19/2021 Non-Par 00541 Commercial MO Healthy Blue Missouri Remittance 5010A1 Enrollment

A: 02/12/2021 Non-Par 00541 Commercial MO Healthy Blue Missouri Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/12/2021 Non-Par 00541 Commercial MO Healthy Blue Missouri Institutional 5010A1Claim Level Accept /Reject

Yes

A: 02/04/2021 Non-Par 00544 Commercial NE Healthy Blue Nebraska Remittance 5010A1 Enrollment

A: 02/12/2021 Non-Par 00544 Commercial NE Healthy Blue Nebraska Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/12/2021 Non-Par 00544 Commercial NE Healthy Blue Nebraska Institutional 5010A1Claim Level Accept /Reject

Yes

A: 07/15/2021 Par 00602 Commercial NC Healthy Blue North Carolina Professional 5010A1Claim Level Accept /Reject

A: 07/15/2021 Par 00602 Commercial NC Healthy Blue North Carolina Institutional 5010A1Claim Level Accept /Reject

A: 07/16/2021 Non-Par 00602 Commercial NC Healthy Blue North Carolina Remittance 5010A1 Enrollment

U: 02/08/2013 Trans CALL Commercial Healthy Palm Beaches Professional 5010A1Claim Level Accept /Reject

Please contact Healthy Palm Beach(866)930-1002 to enroll and obtainpayer id. Be sure to inform them thatyou are connecting trough AVAILITY

A: 12/05/2014 Non-Par 22251 Commercial Healthy York Network Institutional 5010A2 No Response From Payer Yes

A: 12/05/2014 Non-Par 22251 Commercial MU Healthy York Network Professional 5010A1Claim Level Accept /Reject

YesCall Jane Grove at Provider Relationsfor Healthy York Network (717)851-6715

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Heartland Employment Services, LLC Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par WZ649 Workers' Comp Helmsman Mgmt. Services Prof. Work Comp 5010A1File LevelAcknowledgement

A: 12/18/2014 Non-Par WZ649 Auto Helmsman Mgmt. Services Prof. Auto 5010A1Claim Level Accept /Reject

A: 01/28/2020 Non-Par WZ649 Workers' Comp Helmsman Mgmt. Services Remittance 5010A1 Enrollment

U: 02/04/2020 Par CALL Commercial CA Hemet Community Medical Group Professional 5010A1 NoPlease contact the Payer HEMETCOMMUNITY MEDICAL GROUP at (951)791-1111 x268 to obtain the payer id

U: 02/04/2020 Par CALL Commercial CA Hemet Community Medical Group Institutional 5010A1 NoPlease contact the Payer HEMETCOMMUNITY MEDICAL GROUP at (951)791-1111 x268 to obtain the payer id

U: 02/08/2019 Par 60058 Commercial Hennepin Health Institutional 5010A2Claim Level Accept /Reject

U: 02/08/2019 Par 60058 Commercial Hennepin Health Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 59230 Commercial Heritage Consultants Professional 5010A1Claim Level Accept /Reject

A: 12/07/2016 Par 30862 Commercial MU Heritage Victor Valley Medical (Formerly IP123) Institutional 5010A1

A: 12/07/2016 Par 30862 Commercial MU Heritage Victor Valley Medical (Formerly IP123) Professional 5010A1

A: 01/25/2019 Par 17929 Commercial TX Hernando Pasco Hospice Professional 5010A1Claim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



A: 01/25/2019 Par 17929 Commercial TX Hernando Pasco Hospice Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 36335 Commercial HFN, Inc. Institutional 5010A2 No Response From Payer

U: 03/26/2012 Par 36335 Commercial HFN, Inc. Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Higgins Brick Company Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Higgins Brick Company Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par IP125 Commercial CAHigh Desert Medical Group (Heritage ProviderNetwork)


A: 09/01/2016 Par IP125 Commercial CAHigh Desert Medical Group (Heritage ProviderNetwork)


U: 03/24/2014 Non-Par 41556 Workers' Comp MU Highland Golf Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 47181 Commercial DE Highmark BCBS D Health Options Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 47181 Commercial PA Highmark BCBS D Health Options Institutional 5010A1Claim Level Accept /Reject

U: 10/07/2019 Non-Par 47181 Commercial Highmark BCBS D Health Options Remittance 5010A1 Enrollment

A: 02/10/2022 Non-Par 58379 CommercialHighmark Blue Cross & Blue Shield of Delaware(Formerly BS042 & SB570)


U: 10/16/2019 Non-Par SB570 Commercial DEHighmark Blue Cross & Blue Shield of Delaware(Formerly BS042)


Yes

U: 11/15/2019 Non-Par 12B76 Government DEHighmark Blue Cross & Blue Shield of Delaware(Formerly BS042)


A: 02/10/2022 Non-Par 58379 CommercialHighmark Blue Cross & Blue Shield of Pennsylvania(Formerly 54771 & SB865)


U: 03/24/2020 Non-Par SB865 GovernmentHighmark Blue Cross & Blue Shield of Pennsylvania(Formerly 54771)

Professional 5010A1 Enrollment

A: 02/10/2022 Non-Par 58379 CommercialHighmark Blue Cross & Blue Shield of West Virginia(Formerly BS055 & SB941)


U: 11/08/2019 Non-Par SB941 Government WVHighmark Blue Cross & Blue Shield of West Virginia(Formerly BS055)


U: 03/24/2020 Non-Par 95462 Commercial PA Highmark Senior Health Professional 5010A1 EnrollmentClaim Level Accept /Reject

For Highmark Med Advantage claimsof Pennsylvania - Existing HighmarkPayer ID's should be used for Servicedates prior to Jan 1, 2015. Goingforward, use this new payer ID forService Dates Jan 1, 2015 and on.

U: 10/25/2021 Non-Par 95462 Commercial PA Highmark Senior Health Institutional 5010A1 EnrollmentClaim Level Accept /Reject

For Highmark Med Advantage claimsof Pennsylvania - Existing HighmarkPayer ID's should be used for Servicedates prior to Jan 1, 2015. Goingforward, use this new payer ID forService Dates Jan 1, 2015 and on.

A: 02/10/2022 Non-Par 58379 Commercial Highmark Senior Health (Formerly 95462) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 12/29/2020 Non-Par 95461 Commercial WV Highmark Senior Solutions West Virginia Professional 5010A1 Enrollment Claim Level Ack.

For Highmark Med Advantage claimsof West Virginia- Existing HighmarkPayer ID's should be used for Servicedates prior to Jan 1, 2015. Goingforward, use this new payer ID forService Dates Jan 1, 2015 and on.

U: 10/25/2021 Non-Par 95461 Commercial WV Highmark Senior Solutions West Virginia Institutional 5010A1 Enrollment Claim Level Ack.

For Highmark Med Advantage claimsof West Virginia- Existing HighmarkPayer ID's should be used for Servicedates prior to Jan 1, 2015. Goingforward, use this new payer ID forService Dates Jan 1, 2015 and on.

A: 02/10/2022 Non-Par 58379 CommercialHighmark Senior Solutions West Virginia (Formerly95461)


A: 09/21/2021 Non-Par HLPAE Commercial CA Hill Professional 5010A1Claim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



A: 07/25/2019 Non-Par HLPBC Commercial CA Hill Physicians Blue Cross PPO Professional 5010A1Claim Level Accept /Reject

Yes

A: 07/25/2019 Non-Par HLPBS Commercial CA Hill Physicians Blue Shield PPO Professional 5010A1Claim Level Accept /Reject

Yes

A: 05/29/2020 Non-Par HLPCG Commercial CA Hill Physicians Cigna PPO Professional 5010A1Claim Level Accept /Reject

Yes

A: 05/25/2018 Par HLPHN Commercial Hill Physicians Health Net PPO Professional 5010A1Claim Level Accept /Reject

Yes

A: 05/28/2020 Non-Par 00046 Commercial Hill Physicians Med Grp, Inc Remittance 5010A1 Enrollment

U: 10/02/2017 Par 00046 Commercial CA Hill Physicians Medical Group Professional 5010A1 Claim Level Ack. YesCOB claims can be submitted withDOS on or after 05/31/2016

U: 11/07/2016 Par 00046 Commercial CA Hill Physicians Medical Group Institutional 5010A1Claim Level Accept /Reject

YesCOB claims can be submitted withDOS on or after 05/31/2016

A: 06/27/2018 Non-Par HLPUH Commercial Hill Physicians United Healthcare PPO Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/09/2018 Par HPU22 Commercial CA Hill UHC PPO Professional 5010A1Claim Level Accept /Reject

Yes

U: 01/27/2012 Non-Par 55247 Commercial HIP - Health Insurance Plan of Greater New York Institutional 5010A2Claim LevelAcknowledgement

Yes

U: 06/01/2012 Non-Par 55247 Commercial NY HIP - Health Insurance Plan of Greater New York Professional 5010A1Claim LevelAcknowledgement

Yes

A: 08/20/2021 Non-Par 55247 Commercial NY HIP - Health Insurance Plan of Greater New York Remittance 5010A1 Enrollment


U: 08/20/2021 Non-Par 58379 Commercial NYHIP - Health Insurance Plan of Greater New York(Formerly 55247)



U: 10/03/2016 Non-Par TH049 Commercial HMA - Health Management Admin (formerly HMA01) Professional 5010A1Claim Level Accept /Reject

A: 10/10/2017 Non-Par 12T11 CommercialHMA - Health Management Administrator (formerlyHMA01/ TH049)

Institutional 5010A2 Claim Level Ack. Yes

U: 09/17/2012 Non-Par 86066 CommercialHI, NV,AZ

HMA Inc. Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 86066 Commercial HMA Inc. (AZ / NV / HI) Institutional 5010A2 Claim Level Ack.

U: 06/22/2019 Non-Par 86066 Commercial HMA Inc. (AZ / NV / HI) Remittance 5010A1 Enrollment

U: 10/03/2016 Non-Par SB900 Commercial TX HMO Blue Shield Texas (HCSC) (formerly 84980) Professional 5010A1Claim Level Accept /Reject

U: 12/03/2019 Non-Par 84555 Commercial LA HMO Louisiana Inc (BCBS LA Medicare Advantage) Remittance 5010A1 Enrollment

A: 01/26/2016 Par 84555 Commercial LA HMO Louisiana Inc (BCBS LA Medicare Advantage) Professional 5010A1 File Level Ack.

A: 01/26/2016 Par 84555 Commercial LA HMO Louisiana Inc (BCBS LA Medicare Advantage) Institutional 5010A2 File Level Ack.

U: 01/06/2022 Non-Par 91164 Government WA HMSO - Highline Medical Service Organization Institutional 5010A2Claim Level Accept /Reject

Yes

U: 01/06/2022 Non-Par 91164 Government WA HMSO - Highline Medical Service Organization Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/24/2020 Non-Par HPPZZ Commercial CA Hoag Professional 5010A1Claim Level Accept /Reject

No

A: 02/24/2020 Non-Par HPPZZ Commercial CA Hoag Institutional 5010A1Claim Level Accept /Reject

No

A: 07/07/2021 Non-Par HPPZZ Commercial HOAG Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDHPPZZ. Providers will need to enrollfor payer IDs HPPZZ and 58379 inorder to receive 835s for this payer.

A: 07/07/2021 Non-Par 58379 Commercial Hoag (Formerly HPPZZ) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID HPPZZ.Providers will need to enroll for payerIDs HPPZZ and 58379 in order toreceive 835s for this payer.

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Hogan Motor Leasing Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Hogan Personell Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/10/2020 Par HLSTA Commercial WI Holista Professional 5010A1Claim Level Accept /Reject

Yes

A: 08/10/2020 Par HLSTA Commercial WI Holista Institutional 5010A2Claim Level Accept /Reject

Yes

A: 12/05/2019 Non-Par ATHAL Commercial WI Holista LLC Professional 5010A1Claim Level Accept /Reject

No

A: 12/05/2019 Non-Par ATHAL Commercial WI Holista LLC Institutional 5010A1Claim Level Accept /Reject

No

A: 08/10/2020 Non-Par HLSTA Commercial WI Holista/ Novant Health Direct-to-Employer Episodes Remittance 5010A1 Enrollment

U: 02/22/2021 Non-Par 12M97 Government WV Home Health & Hospice J15 Cigna Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 02/19/2021 Non-Par 12M97 Government WV Home Health & Hospice J15 Cigna Remittance 5010A1 Enrollment

U: 08/15/2014 Par 68069 Commercial MO Home State Health Plan - Centene Professional 5010A1 Yes

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Home Sweet Home Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Trans 88023 Commercial Hometown Health Plan Nevada Institutional 5010A2Claim LevelAcknowledgement

Yes

U: 09/01/2016 Trans 88023 Commercial Hometown Health Plan of Nevada Professional 5010A1Claim LevelAcknowledgement

Yes

A: 01/08/2020 Non-Par 88023 Commercial Hometown Health Plan Of NV Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Homexx International Corporati Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Homexx International Corporati Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/25/2016 Trans 66003 Medicare PA Hopkins Health Advantage Professional 5010A1Claim Level Accept /Reject

A: 01/25/2016 Trans 66003 Medicare PA Hopkins Health Advantage Institutional 5010A1Claim Level Accept /Reject

U: 09/26/2019 Non-Par 66003 Commercial PA Hopkins Health Advantage (TMG) Remittance 5010A1 Enrollment

U: 09/24/2019 Non-Par 22099 Commercial NJHorizon Blue Cross Blue Shield of New Jersey(Horizon BCBSNJ) (Formerly BS031)






A: 10/01/2019 Non-Par WB419 Workers' Comp Horizon Casualty Prof. Work Comp 5010A1

A: 10/01/2019 Non-Par WB419 Workers' Comp Horizon Casualty Inst. Work Comp 5010A1

A: 08/31/2016 Non-Par 22326 Commercial NJ Horizon New Jersey Health Professional 5010A1Claim Level Accept /Reject

A: 08/31/2016 Non-Par 22326 Commercial NJ Horizon New Jersey Health Institutional 5010A2Claim Level Accept /Reject

U: 02/24/2017 Non-Par 22326 Commercial NJ Horizon NJ Health / Mercy Health Plan of NJ Remittance 5010A1 Enrollment

A: 06/12/2018 Non-Par HVMG1 Commercial Horizon Valley Medical Group Professional 5010A1 Claim Level Ack.

U: 09/23/2013 Non-Par J1491 Workers' Comp MU HOSPITAL HOUSEKEEPING SYSTEMS Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU HOSPITAL HOUSEKEEPING SYSTEMS Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 91136 CommercialHotel Employees & restaurant Employees HealthTrust


U: 09/01/2016 Par 91136 CommercialHotel Employees & Restaurant Employees Hlth Trust,Grp# F19


U: 09/23/2013 Non-Par J1491 Workers' Comp MU Houck, Gregory (Partner); Winn Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Houck, Gregory (Partner); Winn Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU HOUSTON STEAK DELIVERY #1 LLC Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU HOUSTON STEAK DELIVERY #1 LLC Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

A: 01/16/2018 Par 38828 Commercial CA HPMC - Alta Med Clinincs (HPMC - AMC) Professional 5010A1 Claim Level Ack. No

A: 01/16/2018 Par 38828 Commercial CA HPMC - Alta Med Clinincs (HPMC - AMC) Institutional 5010A1 Claim Level Ack. No

A: 01/16/2018 Par 10910 Commercial CA HPMC - Preferred IPA (HPMC - PMG) Professional 5010A1 Claim Level Ack. No

A: 01/16/2018 Par 10910 Commercial CA HPMC - Preferred IPA (HPMC - PMG) Institutional 5010A1 Claim Level Ack. No

A: 01/16/2018 Par 73331 Commercial CA HPMC - San Judas IPA (HPMC - SJM) Institutional 5010A1 Claim Level Ack. No

A: 01/16/2018 Par 73331 Commercial CA HPMC - San Judas IPA (HPMC - SJM) Professional 5010A1 Claim Level Ack. No

A: 06/29/2021 Non-Par 19CAF Commercial MD HRSA COVID-19 COVERAGE ASSISTANCE FUND Remittance 5010A1 Enrollment

A: 12/30/2021 Non-Par 19CAF Commercial MD HRSA COVID-19 COVERAGE ASSISTANCE FUND Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 12/30/2021 Non-Par 19CAF Commercial MD HRSA COVID-19 COVERAGE ASSISTANCE FUND Institutional 5010A1 EnrollmentClaim Level Accept /Reject

No

U: 06/02/2017 Non-Par 37224 Commercial HSBS Memphis (formerly Pittman and Associates) Institutional 5010A1 No Response From Payer Yes ERA available under payer ID: 58379

U: 06/02/2017 Non-Par 37224 Commercial HSBS Memphis (formerly Pittman and Associates) Professional 5010A1 Yes ERA available under payer ID: 58379

U: 04/16/2015 Non-Par 37256 Commercial OKHSBS Oklahoma City (formerly Mutual AssuranceAdmin)


U: 04/16/2015 Non-Par 37256 CommercialHSBS Oklahoma City (formerly Mutual AssuranceAdmin)


A: 11/18/2021 Non-Par USICS Commercial MO HSICS Institutional 5010A1Claim Level Accept /Reject

Yes

A: 11/18/2021 Par HSICS Commercial MO HSICS Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Hughes Redwood Company, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Hughes Redwood Company, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/11/2013 Non-Par 61101 Commercial Humana (Formerly Cariten HealthCare, 62073) Professional 5010A1 Yes

U: 12/19/2019 Non-Par 61101 Commercial Humana (Formerly Cariten HealthCare, 62073) Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 61101 Commercial Humana (Formerly Cariten Senior Health, 62071) Professional 5010A1 Yes

U: 03/06/2019 Non-Par 61101 Commercial Humana (Formerly Cariten Senior Health, 62072) Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 61101 Commercial Humana (Formerly Cariten Senior Health, 62072) Institutional 5010A2Claim LevelAcknowledgement

Yes

U: 02/21/2022 Non-Par 61102 Commercial Humana - Encounters Professional 5010A1 File Level Ack.Payer ID 61102 is for ENCOUNTERSONLY. Claims sent to payer id 61102will NOT be paid.

U: 02/17/2019 Non-Par 67300 Government MI Humana - JVHL Remittance 5010A1 Enrollment

A: 11/10/2021 Non-Par 67300 Commercial MI Humana - JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 09/30/2019 Non-Par 34818 Commercial OH Humana ARC Professional 5010A1 Enrollment

A: 09/18/2019 Non-Par 34818 Commercial OH Humana ARC Institutional 5010A1 Enrollment

U: 10/03/2016 Non-Par 61101 Commercial Humana Choice Care (formerly 95348) Professional 5010A1 Claim Level Rejects Only

U: 03/11/2013 Non-Par 61101 Commercial Humana Emphesys Institutional 5010A2Claim LevelAcknowledgement

Yes

U: 03/11/2013 Non-Par 61101 Commercial Humana Employer Health Insurance Institutional 5010A2Claim LevelAcknowledgement

Yes

U: 03/06/2019 Non-Par 61101 Commercial Humana Inc Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 61101 Commercial Humana Insurance Company Choice Care Network Institutional 5010A2Claim LevelAcknowledgement

Yes

A: 02/21/2022 Non-Par 61115 Commercial KY Humana Long Term Care Professional 5010A1 Claim Level Ack. No

A: 02/21/2022 Non-Par 61115 Commercial KY Humana Long Term Care Institutional 5010A1 Claim Level Ack. No

U: 10/07/2019 Non-Par L0200 Commercial HI Humana Puerto Rico Remittance 5010A1 EnrollmentIf issues with ERA - Please contactpayer at 1-800-448-6262.

U: 03/11/2013 Non-Par 61101 Commercial Humana, Inc Professional 5010A1 Claim Level Rejects Only Yes

U: 03/11/2013 Non-Par 61101 Commercial Humana, Inc. Institutional 5010A2Claim LevelAcknowledgement

Yes

U: 11/24/2014 Non-Par 61101 Commercial Humana-Louisiana Professional 5010A1 Claim Level Rejects Only Yes

U: 05/31/2012 Par IP059 Commercial CA Humboldt-Del Norte Foundation / IPA Professional 5010A1 No Response From Payer Yes

U: 04/02/2019 Par 95399 Commercial CA HUNTINGTON PARK MISSION MEDICAL GROUP Professional 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



A: 04/08/2016 Par 54750 Commercial MI Huron PACE Professional 5010A1 Claim Level Ack.

A: 04/08/2016 Par 54750 Commercial MI Huron PACE Institutional 5010A1 Claim Level Ack.

U: 08/15/2019 Non-Par 54750 Commercial MI Huron PACE Professional 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Hydroform - U.S.A. Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Hydroform - U.S.A. Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/01/2012 Non-Par 22175 Commercial I.E. Shaffer Professional 5010A1Claim LevelAcknowledgement

U: 01/01/2012 Non-Par 22175 Commercial I.E. Shaffer Institutional 5010A2 No Response From Payer

A: 02/14/2022 Non-Par 22175 Commercial I.E. Shaffer Remittance 5010A1 Enrollment

U: 09/30/2019 Non-Par SX083 Commercial PA IBC Personal Choice (formerly 54704) Professional 5010A1 EnrollmentClaim Level Accept /Reject


A: 10/22/2021 Par 44602 Commercial MO IBEW Local 1 Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/22/2021 Par 44602 Commercial MO IBEW Local 1 Institutional 5010A1Claim Level Accept /Reject

Yes

A: 11/24/2014 Non-Par 81810 Commercial IBG Administrators LLC Professional 5010A1 No Response From Payer

A: 12/05/2014 Non-Par 81810 Commercial IBG Administrators LLC Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 41124 Commercial IBI Institutional 5010A2Claim LevelAcknowledgement

Yes

U: 03/11/2013 Non-Par 41124 Commercial IBI Professional 5010A1Claim LevelAcknowledgement

Yes

U: 02/24/2017 Non-Par 19028 Commercial IBM Insurance Outsourcing Services Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 26054 Commercial FL ICare Health Options (FL Optometric Phys) Professional 5010A1Claim Level Accept /Reject

Yes

U: 10/09/2019 Non-Par 11695 Commercial WI ICARE(Independent Care Hlth Plan) Professional 5010A1 Claim Level Ack.

U: 09/30/2019 Non-Par 42660 Commercial NY iCircle Care Remittance 5010A1 Enrollment

U: 04/16/2021 Non-Par 33884 Commercial NY iCircle Care of New York Remittance 5010A1 Enrollment*Enrollment is TemporarilyUnavailable*

A: 05/12/2021 Non-Par ICRCL Commercial NY ICircle Care of New York Professional 5010A1Claim Level Accept /Reject

No

A: 05/12/2021 Non-Par ICRCL Commercial NY ICircle Care of New York Institutional 5010A1Claim Level Accept /Reject

No

A: 05/25/2021 Non-Par ICRCL Commercial NY ICircle Care of New York Remittance 5010A1 Enrollment

U: 12/18/2018 Par 75185 Commercial ICON Benefits Administrators Institutional 4010A1 No Response From Payer YesPayer to be deactivated in 2019 -please use Payer ID 37283 for claimsubmissions.

U: 09/23/2013 Non-Par J1491 Workers' Comp MU IDEAL AUTO PARTS, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU IDEAL AUTO PARTS, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 10/11/2019 Non-Par MV440 IDEALCARE Remittance 5010A1 Enrollment

A: 09/01/2016 Par 97661 Commercial ID IEC Group - AmeriBen Professional 5010A1 File Level Ack.

A: 09/01/2016 Par 97661 Commercial ID IEC Group - AmeriBen Institutional 5010A1 File Level Ack.

U: 09/01/2016 Par 75274 Commercial IHG Direct Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 75274 Commercial IHG Direct Institutional 5010A2Claim LevelAcknowledgement

U: 03/16/2016 Par 68068 Commercial IL Illinicare Behavioral Health Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/16/2016 Par 68068 Commercial IL Illinicare Behavioral Health Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/16/2016 Par 68069 Commercial IL Illinicare Group Health Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/16/2016 Par 68069 Commercial IL Illinicare Group Health Institutional 5010A2Claim Level Accept /Reject

Yes

U: 10/03/2016 Non-Par TH088 Commercial Illinois Health Partners (IHP) (formerly DMG01) Professional 5010A1

A: 10/03/2016 Non-Par TH088 Commercial Illinois Health Partners (IHP) (formerly DMG01) Institutional 5010A2 No Response From Payer

A: 02/06/2017 Par IPA99 Commercial IL Illinois Physicians Alliance IPA Institutional 5010A1 Claim Level Ack. No

Updated: 03/21/2022


PPAAYERYERIDID



A: 02/03/2017 Par IPA99 Commercial IL Illinois Physicians Alliance IPA Professional 5010A1 Claim Level Ack. No

A: 07/25/2019 Par 40043 Commercial NY Imagework Technologies Corp Professional 5010A1 Claim Level Ack. No

A: 07/25/2019 Par 40043 Commercial NY Imagework Technologies Corp Institutional 5010A1 Claim Level Ack. No

U: 09/01/2016 Par 41600 Commercial IMCARE Institutional 5010A2Claim Level Accept /Reject

U: 09/01/2016 Par 41600 Commercial IMCARE Professional 5010A1Claim Level Accept /Reject

U: 08/15/2019 Non-Par 41600 Commercial IMCARE Remittance 5010A1 Enrollment

A: 05/29/2020 Non-Par IH400 Commercial TN Impact Health Share, Inc. Professional 5010A1Claim Level Accept /Reject

No

A: 05/29/2020 Non-Par IH400 Commercial TN Impact Health Share, Inc. Institutional 5010A1Claim Level Accept /Reject

No

A: 10/10/2014 Non-Par SCP01 Commercial CA Imperial County Physicians Med Group (SCPMCS) Professional 5010A1 Claim Level Ack.

A: 02/18/2019 Par 78448 Commercial CA Imperial Health Holdings Professional 5010A1 No

A: 02/18/2019 Par 78448 Commercial CA Imperial Health Holdings Institutional 5010A1 No

A: 07/16/2019 Non-Par IHHMG Commercial CA Imperial Health Plan of California Professional 5010A1Claim Level Accept /Reject

No

A: 07/16/2019 Non-Par IHHMG Commercial CA Imperial Health Plan of California Institutional 5010A1Claim Level Accept /Reject

A: 06/28/2019 Non-Par IICTX Commercial TX Imperial Insurance Company of Texas Professional 5010A1 No Response From Payer No

A: 06/28/2019 Non-Par IICTX Commercial TX Imperial Insurance Company of Texas Institutional 5010A1 No Response From Payer No

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Imperial Irrigation District Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Imperial Valley Lumber Company Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Imperial Valley Lumber Company Prof. Work Comp 5010A2Claim Level Accept /Reject

A: 12/05/2014 Non-Par 86070 Commercial IMX EZ Institutional 5010A2 Claim Level Ack.

U: 09/18/2019 Non-Par 35600 Commercial IN IN Dept of Health (Children) Institutional 5010A1 Enrollment

U: 09/25/2019 Non-Par 35600 Government IN IN Dept of Health (Children) Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Inconen Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 40585 Commercial INDECS Corporation Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 40585 Commercial INDECS Corporation Institutional 5010A2

U: 10/01/2019 Non-Par TA720 Commercial Independence Administrators Professional 5010A1Claim Level Accept /Reject

ERA is available under payer id SX055

A: 09/19/2016 Par CB231 Commercial MD Independence American Ins Co Institutional 5010A1Claim Level Accept /Reject

No

A: 09/19/2016 Par CB231 Commercial MD Independence American Ins Co Professional 5010A1Claim Level Accept /Reject

No

U: 11/12/2019 Non-Par 12X26 Commercial MU Independence BluCross&BluChoice-IBC Institutional 5010A2 EnrollmentClaim Level Accept /Reject

U: 02/05/2014 Non-Par IMG01 Commercial MU Independence Medical Group - Kern County Professional 5010A1File LevelAcknowledgement

A: 03/29/2019 Non-Par IMG02 Commercial Independence Medical Group - Tulare Professional 5010A1Claim Level Accept /Reject

Yes

U: 07/27/2020 Non-Par SX073 Commercial NY Independent Health (IHA) (Formerly 95308) Professional 5010A1 Enrollment Yes

U: 07/27/2020 Non-Par SX073 Commercial NY Independent Health (IHA) (Formerly 95308) Remittance 5010A1 Enrollment

U: 09/01/2016 Par 45048 Commercial Independent Living Systems Professional 5010A1 Claim Level Rejects Only Yes

A: 09/01/2016 Par 45048 Commercial Independent Living Systems Institutional 5010A2 Claim Level Rejects Only Yes

A: 01/11/2017 Par INDPM Commercial IL Independent Physicians at Mercy Institutional 5010A1 Claim Level Ack. No

A: 01/11/2017 Par INDPM Commercial IL Independent Physicians at Mercy Professional 5010A1 Claim Level Ack. No

A: 07/27/2016 Non-Par SX171 Commercial MU Indian Health Services (Formerly 00290) Professional 5010A1Claim Level Accept /Reject

U: 10/01/2019 Non-Par 35600 Commercial IN Indiana Department of Health - Children's Health Professional 5010A1 Enrollment File Level Ack.

A: 04/02/2013 Non-Par IC022 Government IN Indiana Medicaid Institutional 5010A2Claim LevelAcknowledgement

U: 05/25/2012 Non-Par 35161 Commercial IN Indiana ProHealth Professional 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 10/19/2021 Non-Par 35161 Commercial IN Indiana ProHealth Remittance 5010A1 Enrollment

U: 09/01/2016 Par 35161 Commercial Indiana ProHealth Network Institutional 5010A2Claim Level Accept /Reject

U: 09/30/2019 Non-Par 95444 Commercial Indiana University Health Plan Remittance 5010A1 Enrollment

A: 08/07/2017 Non-Par 26212 Commercial IN Indiana University Health Plan (Commercial IUHPLNS) Professional 5010A1Claim Level Accept /Reject

A: 08/07/2017 Non-Par 26212 Commercial IN Indiana University Health Plan (Commercial IUHPLNS) Institutional 5010A1Claim Level Accept /Reject

A: 11/06/2018 Non-Par 30360 Commercial OK Individual Assurance Company Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/06/2018 Non-Par 30360 Commercial OK Individual Assurance Company Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/24/2019 Non-Par 30360 Commercial OK Individual Assurance Company Remittance 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 09/01/2016 Par 31053 Commercial Individual Health Insurance Companies Institutional 5010A1 No Response From Payer

U: 09/01/2016 Par 31053 Commercial Individual Health Insurance Companies Professional 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par 43471 Commercial Inetico Inc. Institutional 5010A2 File Level Ack. Yes

A: 11/15/2021 Non-Par 58379 Commercial Inetico, Inc. (Formerly 43471) Remittance 5010A1 Enrollment


U: 03/11/2013 Non-Par 43471 Commercial MU Inetico,Inc. Professional 5010A1File LevelAcknowledgement

Yes

A: 08/19/2015 Non-Par 38343 Commercial MI Ingham Health Plan Corporation Professional 5010A1 Claim Level Ack.

A: 08/19/2015 Non-Par 38343 Commercial MI Ingham Health Plan Corporation Institutional 5010A1 Claim Level Ack.

U: 02/07/2020 Non-Par IEHP1 Commercial Inland Empire Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

U: 02/26/2020 Non-Par IEHP1 Commercial Inland Empire Health Plan Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/02/2021 Non-Par IEHP1 Commercial CA Inland Empire Health Plan Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Inland Valley Hospice Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/11/2013 Non-Par 31172 Commercial MU Innovante Benefit Administrator Professional 4010A1 No Response From Payer Yes

A: 12/05/2014 Non-Par 31172 Commercial Innovante Benefit Administrator Institutional 5010A2 No Response From Payer Yes

A: 10/10/2019 Par CB159 Commercial PA Innovated Healthware Solutions South Professional 5010A1Claim Level Accept /Reject

No

A: 09/01/2016 Par 40025 Commercial Innovation Health Professional 5010A1 No Response From Payer

A: 09/01/2016 Par 40025 Commercial Innovation Health Institutional 5010A2 No Response From Payer

U: 09/23/2013 Non-Par J1491 Workers' Comp MU INNOVATIONS SUCCESSFUL SALON S Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU INNOVATIONS SUCCESSFUL SALON S Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/01/2012 Non-Par 04320 Commercial Innovative Healthware Services Network - Plan B Institutional 5010A2 No Response From Payer

A: 07/29/2020 Trans CB733 Commercial PA Innovative Healthware Services West Professional 5010A1 No Response From Payer No

A: 07/29/2020 Trans CB733 Commercial PA Innovative Healthware Services West Institutional 5010A1 No Response From Payer No

U: 01/01/2012 Non-Par 04320 Commercial Innovative Healthware Services, Inc. Institutional 5010A2 No Response From Payer

U: 01/01/2012 Non-Par 04320 Commercial Innovative Healthware Solutions Professional 5010A1Claim Level Accept /Reject

A: 10/10/2019 Par CB122 Commercial PA Innovative Healthware Solutions Professional 5010A1Claim Level Accept /Reject

No

A: 10/10/2019 Par CB122 Commercial PA Innovative Healthware Solutions Institutional 5010A1Claim Level Accept /Reject

No

A: 04/22/2021 Par IHS10 Commercial MD Innovative Healthware Solutions 10 Professional 5010A1Claim Level Accept /Reject

No

A: 04/22/2021 Par IHS10 Commercial MD Innovative Healthware Solutions 10 Institutional 5010A1Claim Level Accept /Reject

No

Updated: 03/21/2022


PPAAYERYERIDID




No


No


No


No


No


No


No


No


No


No


No


No


No


No


No


No

A: 10/10/2019 Par CB159 Commercial PA Innovative Healthware Solutions South Institutional 5010A1Claim Level Accept /Reject

No

A: 07/21/2020 Par 23212 Commercial PA Innovative Payer 2 Professional 5010A1 No Response From Payer No

A: 07/21/2020 Par 23212 Commercial PA Innovative Payer 2 Institutional 5010A1 No Response From Payer No

A: 09/01/2016 Par 80087 Commercial Innovative Physician Associates LLC Professional 5010A1 Claim Level Ack.

A: 09/01/2016 Par 80087 Commercial Innovative Physician Associates LLC Institutional 5010A2 Claim Level Ack.

U: 01/05/2017 Par 37279 Commercial Insurance Administrator of America, Inc. (IAA) Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 37279 Commercial Insurance Administrator of America, Inc. (IAA) Professional 5010A1 No Response From Payer

U: 04/01/2016 Non-Par 27847 Workers' Comp MU Insurance Company of the West Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 04/28/2016 Non-Par 27847 Commercial Insurance Company of the West Remittance 5010A1 Enrollment

U: 09/01/2016 Par 13315 Commercial Insurance Design Administrators Institutional 5010A2 No Response From Payer

U: 12/02/2019 Par 13315 Commercial Insurance Design Administrators Professional 5010A1

A: 01/15/2019 Non-Par 72091 Commercial Insurance Management Administrators Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/15/2019 Non-Par 72091 Commercial Insurance Management Administrators Institutional 5010A1Claim Level Accept /Reject

Yes

A: 08/13/2018 Par 15688 Commercial TX Insurance Management Services (Amarillo, TX) Professional 5010A1 Claim Level Ack. YesThis Payer ID is only valid for claimswith submission address of P.O. Box15688; Amarillo, TX 79105

A: 08/13/2018 Par 15688 Commercial TX Insurance Management Services (Amarillo, TX) Institutional 5010A1 Claim Level Ack. YesThis Payer ID is only valid for claimswith submission address of P.O. Box15688; Amarillo, TX 79105

A: 07/27/2016 Trans TH099 Commercial MUInsurance Management Services (IMS) (FormerlyIMSMS)


A: 07/27/2016 Trans TH099 Commercial MUInsurance Management Services (IMS) (FormerlyIMSMS)


U: 01/01/2012 Non-Par 39182 Commercial Insurance TPA Institutional 5010A2File LevelAcknowledgement

Updated: 03/21/2022


PPAAYERYERIDID



U: 01/01/2012 Non-Par 39182 Commercial Insurance TPA Professional 5010A1File LevelAcknowledgement

U: 09/01/2016 Par 86304 Commercial Insurers Administrative Corp Professional 5010A1Claim LevelAcknowledgement

Please visit this website beforesubmitting claims:http://edihelp.iacusa.com/

U: 09/01/2016 Par 86304 Commercial Insurers Administrative Corp. Institutional 5010A2File LevelAcknowledgement

U: 04/06/2017 Non-Par 51020 Commercial Integra Administrative Group (Seaford, DE) Institutional 5010A2 No Response From Payer Yes ERA available under payer ID: 58379

U: 04/06/2017 Non-Par 51020 Commercial Integra Administrative Group (Seaford, DE) Professional 5010A1 Yes ERA available under payer ID: 58379

U: 09/01/2016 Par 31127 Commercial Integra Group Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 31127 Commercial Integra Group Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 31129 Commercial Integra Group - CHA Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 31128 Commercial INTEGRA GROUP / HOME Institutional 5010A2

A: 06/03/2016 Par 45302 Commercial NY Integra Managed Long Term Care Professional 5010A1Claim Level Accept /Reject

A: 06/03/2016 Par 45302 Commercial NY Integra Managed Long Term Care Institutional 5010A1Claim Level Accept /Reject

A: 02/17/2020 Non-Par INET1 Commercial TX Integranet Health Professional 5010A1Claim Level Accept /Reject

No

A: 02/17/2020 Non-Par INET1 Commercial TX Integranet Health Institutional 5010A1Claim Level Accept /Reject

No

U: 09/01/2016 Par 34167 Commercial Integrated Care Network (ICN) by Emerald Health Institutional 5010A2 No Response From Payer

A: 05/12/2021 Non-Par IHCS1 Commercial WI Integrated Homecare Services Professional 5010A1Claim Level Accept /Reject

No

A: 05/12/2021 Non-Par IHCS1 Commercial WI Integrated Homecare Services Institutional 5010A1Claim Level Accept /Reject

No

A: 05/25/2021 Non-Par IHCS1 Commercial Integrated Homecare Services Remittance 5010A1 Enrollment

A: 03/04/2013 Non-Par 20050 Commercial Integrated Medical Solutions LLC Professional 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par 20050 Commercial Integrated Medical Solutions LLC Institutional 5010A2 No Response From Payer

U: 09/30/2019 Non-Par SX079 Commercial PA Inter-County Health Plan Professional 5010A1 Enrollment File Level Ack.

A: 02/19/2021 Non-Par 87765 Commercial NC Interactive Medical Ssytem Remittance 5010A1 Enrollment

A: 09/10/2019 Non-Par 87765 Commercial NC Interactive Medical System Professional 5010A1Claim Level Accept /Reject

A: 09/10/2019 Non-Par 87765 NC Interactive Medical System Institutional 5010A1Claim Level Accept /Reject

No

U: 03/24/2014 Non-Par J1542 Workers' Comp MU Intercare Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/28/2020 Non-Par J1542 Workers' Comp Intercare Remittance 5010A1 Enrollment

The above Payer Name(s) mayrepresent multiple Accounts(employers). For a complete list,please refer directly to Emdeon'spublished Payer Listat:www.emdeon.com/PayerLists/payerlists.php Search the Payer Listusing the above Payer ID(s) toidentify them all.

U: 03/24/2014 Non-Par WX602 Workers' Comp Intercare Insurance Services (Orange) Prof. Work Comp 5010A1File LevelAcknowledgement

U: 11/24/2014 Non-Par WX602 Auto Intercare Insurance Services (Orange) Prof. Auto 5010A1

U: 09/01/2016 Par 60280 Commercial Interface EAP (IEAP) Institutional 4010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 60280 Commercial Interface EAP (IEAP) Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 23287 Commercial InterGroup Services Corporation Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 23287 Commercial InterGroup Services PPO Professional 5010A1Claim Level Accept /Reject

A: 12/09/2021 Non-Par 93116 Commercial OR Interlink Health Services Professional 5010A1Claim Level Accept /Reject

No

A: 12/09/2021 Non-Par 93116 Commercial OR Interlink Health Services Institutional 5010A1 Claim Level Accept / No

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU International Bay Clubs Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU International Bay Clubs Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 04/08/2016 Trans 11329 Commercial NY International Benefit Administrator Professional 5010A1 Claim Level Ack. Yes

A: 04/08/2016 Trans 11329 Commercial NY International Benefit Administrator Institutional 5010A1 Claim Level Ack. Yes

A: 09/01/2016 Par 36609 Commercial International Brotherhodd of Boilermakers Institutional 5010A2 No Response From Payer No

A: 07/27/2016 Trans TH105 Commercial International Medical Group (Formerly IMGIN) Professional 5010A1 Claim Level Ack.

A: 07/27/2016 Trans TH105 Commercial International Medical Group (Formerly IMGIN) Institutional 5010A1 Claim Level Ack.

U: 02/23/2012 Non-Par 84137 Commercial MT InterWest Health - PPO Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU INVENTORY CONTROL SYSTEM Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU INVENTORY CONTROL SYSTEM Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/30/2020 Non-Par 40753 Commercial TX Invicta Health Solutions Professional 5010A1Claim Level Accept /Reject

No

A: 11/30/2020 Non-Par 40753 Commercial TX Invicta Health Solutions Institutional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU IOM HOLDINGS,INC (A CORPORATIO Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU IOM HOLDINGS,INC (A CORPORATIO Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 41124 Commercial Iowa Benefits Inc. Institutional 5010A2Claim LevelAcknowledgement

Yes

U: 03/11/2013 Non-Par 41124 Commercial Iowa Benefits Inc. Professional 5010A1Claim LevelAcknowledgement

Yes

A: 02/03/2015 Non-Par J1887 Workers' CompIPMG Claims Mgmt Services (Insurance ProgramManagers Group)


A: 06/03/2020 Non-Par Commercial Island Home Insurance Remittance 5010A1 EnrollmentPlease send an email [email protected] obtain the payer ID#

A: 04/25/2017 Par 47262 Commercial IN IU Health Transplant Evaluation Program Professional 5010A1 Claim Level Ack. Yes

A: 04/25/2017 Par 47262 Commercial IN IU Health Transplant Evaluation Program Institutional 5010A1 Claim Level Ack. Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU J T Contractors, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU J T Contractors, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU J.C. WATTENBARGER & SONS, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU J.C. WATTENBARGER & SONS, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU J.H. Mccormack Const Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/15/2020 Non-Par 12M99 Government J12 MEDICARE PART A LEGACY WPS Remittance 5010A1 Enrollment

U: 09/15/2021 Non-Par 12M99 Government J12 MEDICARE PART A LEGACY WPS (DC DE MD NJ PA) Institutional 5010A1 Enrollment No Response From Payer

U: 09/23/2013 Non-Par J1491 Workers' Comp MU JANICO BUILDING MAINTENANCE CO Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU JANICO BUILDING MAINTENANCE CO Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Jcv Tacos Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Jcv Tacos Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU JD Mechanical Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Jefferson County Texas Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 02/06/2017 Par JCARE Commercial IL Jencare Medical Professional 5010A1 Claim Level Ack. No

A: 02/06/2017 Par JCARE Commercial IL Jencare Medical Institutional 5010A1 Claim Level Ack. No

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/23/2013 Non-Par J1491 Workers' Comp MU Jerry Solomon Enterprises Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Jerry Solomon Enterprises Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/13/2016 Par JLSFE Commercial FL JLS Family Enterprise Professional 5010A1 Claim Level Ack. Yes

A: 05/13/2016 Par JLSFE Commercial FL JLS Family Enterprise Institutional 5010A1 Claim Level Ack. Yes

A: 12/19/2019 Non-Par JHHCG Commercial MD John Hopkins Homecare Group Professional 5010A1Claim Level Accept /Reject

No

U: 09/01/2016 Par 38310 Commercial JOHN MORRELL COMPANY CO. - AHPBA Institutional 5010A2File LevelAcknowledgement

U: 09/01/2016 Par 38310 Commercial JOHN MORRELL COMPANY CO. - AHPBA Professional 5010A1File LevelAcknowledgement

U: 03/24/2014 Non-Par 41556 Workers' Comp MU John Muir Health Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 10/13/2016 Par 68036 Commercial CAJohn Muir Health Network/ Mt Diablo (formerlyJMH01)

Professional 5010A1 Claim Level Rejects Only YesPayer accepts COB claims with DOSafter 10/31/2013.

U: 09/02/2021 Non-Par 68036 Commercial John Muir Mt. Diablo Health Remittance 5010A1 Enrollment

A: 08/31/2016 Par 68036 Commercial CA John Muir Mt. Diablo Health Institutional 5010A1Claim Level Accept /Reject

No

A: 12/02/2014 Non-Par CALL Commercial CA JOHN MUIR TRAUMA PHYSICIANS Professional 5010A1 File Level Ack.Please contact John Muir TraumaPhysicians at 925-947-5288 for Payerid information.

U: 08/15/2019 Non-Par 52189 Commercial Johns Hopkins HCare (EHP/PP) Remittance 5010A1 Enrollment

U: 09/13/2017 Par 52189 Commercial Johns Hopkins Healthcare (EHP / PP) Professional 5010A1Claim Level Accept /Reject

U: 09/13/2017 Par 52189 Commercial Johns Hopkins Healthcare (EHP / PP) Institutional 5010A2Claim Level Accept /Reject

U: 08/15/2019 Non-Par 52123 Commercial Johns Hopkins Healthcare (USFHP) Remittance 5010A1 Enrollment

U: 09/01/2016 Par 52123 Commercial Johns Hopkins Healthcare (USFHP) Institutional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 52123 Commercial Johns Hopkins Healthcare (USFHP) Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU JOHNSON, LARRY (AN INDIVIDUAL) Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU JOHNSON, LARRY (AN INDIVIDUAL) Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 43178 Commercial Joplin Claims Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 34136 Commercial JP Farley Corporation Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 34136 Commercial JP Farley Corporation Professional 5010A1Claim LevelAcknowledgement

A: 09/01/2016 Trans 12T47 Commercial JP Specialties Institutional 5010A2 No Response From Payer Yes

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Judson ISD Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/23/2021 Non-Par JVHLW Commercial MI JVHL - Wellcare Remittance 5010A1 Enrollment

A: 08/25/2021 Non-Par JVHLW Commercial MI JVHL - Wellcare Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 05/14/2021 Non-Par JVHLR Commercial MI JVHL Reliance HMO Remittance 5010A1 Enrollment

A: 05/14/2021 Non-Par JVHLR Commercial MI JVHL Reliance HMO Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 05/14/2021 Non-Par JVHLR Commercial MI JVHL Reliance HMO Institutional 5010A1 EnrollmentClaim Level Accept /Reject

No

U: 02/10/2017 Non-Par 91617 Commercial CO Kaiser Colorado (Formerly COKSR) Professional 5010A1

A: 02/10/2017 Par 91617 Commercial Kaiser Colorado (Formerly COKSR) Institutional 5010A2 Claim Level Ack.

U: 09/01/2016 Par 94320 CommercialKaiser CSI-California Select for Individuals (FormerlyKaiser PPO) (Self Funded)

Professional 5010A1

U: 09/01/2016 Par 94320 CommercialKaiser CSI-California Select for Individuals (FormerlyKaiser PPO) (Self Funded)


U: 02/25/2022 Non-Par 91617 Commercial CO Kaiser Foundation Colorado (Formerly COKSR) Remittance 5010A1 Enrollment

U: 09/01/2016 Par 21313 Commercial GA Kaiser Foundation Health Plan of Georgia Professional 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 08/15/2017 Par 91051 Commercial WA Kaiser Foundation Health Plan Of Washington Institutional 5010A2Claim Level Accept /Reject

Yes

U: 08/15/2017 Non-Par 91051 Commercial WA Kaiser Foundation Health Plan Of Washington Professional 5010A1Claim Level Accept /Reject

Yes

U: 08/15/2017 Par 91051 Commercial WAKaiser Foundation Health Plan Of WashingtonOptions, Inc


Yes

U: 08/15/2017 Non-Par 91051 Commercial WAKaiser Foundation Health Plan Of WashingtonOptions, Inc


Yes

U: 03/06/2017 Par 93079 CommercialWA,OR

Kaiser Foundation Hospitals - North West Region(Formerly KS007)


U: 03/06/2017 Par 93079 CommercialKaiser Foundation Hospitals - North West Region(Formerly KS007)


U: 02/25/2022 Non-Par 93079 Commercial CAKaiser Foundation Hospitals - North West Region(Formerly KS007)


U: 03/06/2017 Par 52095 CommercialKaiser Health Plan - Mid Atlantic States (FormerlyKS008)

Institutional 5010A2 Claim Level Rejects Only

U: 03/06/2017 Par 52095 CommercialKaiser Health Plan - Mid Atlantic States (FormerlyKS008)


U: 09/01/2016 Par 21313 Commercial GA Kaiser Health Plan of Georgia Institutional 5010A2 No Response From Payer

U: 02/25/2022 Non-Par 21313 Commercial GA Kaiser Health Plan of Georgia Remittance 5010A1 Enrollment

A: 02/25/2022 Non-Par 52095 CommercialKaiser Hlth Plans - Mid Atlantic States (FormerlyKS008)


U: 03/06/2017 Par 94135 Commercial CA Kaiser Permanente (Northern CA) (Formerly KS003) Institutional 5010A2Claim Level Accept /Reject

U: 03/06/2017 Par 94135 Commercial CA Kaiser Permanente (Northern CA) (Formerly KS003) Professional 5010A1Claim Level Accept /Reject

U: 03/01/2022 Non-Par 94135 Commercial CA Kaiser Permanente (Northern CA) (Formerly KS003) Remittance 5010A1 Enrollment

U: 02/25/2022 Non-Par 94134 Commercial CAKaiser Permanente (Southern California) (FormerlyKS001)

Remittance 5010A1 EnrollmentPayer Requires Provider Enrollment ToReceive 835 Files.

U: 03/06/2017 Par 94134 Commercial CAKaiser Permanente (Southern California) (FormerlyKS001)


U: 03/06/2017 Par 94134 Commercial CAKaiser Permanente (Southern California) (FormerlyKS001)


U: 03/01/2022 Non-Par 94123 Commercial HI Kaiser Permanente Hawaii Remittance 5010A1 Enrollment

U: 09/01/2016 Par 94123 Commercial HI Kaiser Permanente Hawaii Professional 5010A1Claim Level Accept /Reject

"Please contact [email protected] forany production issues such as statusof claim, denials, etc."

U: 09/01/2016 Par 94123 Commercial HI Kaiser Permanente Hawaii Institutional 5010A1Claim Level Accept /Reject

"Please contact [email protected] forany production issues such as statusof claim, denials, etc."

A: 02/18/2021 Non-Par 94320 Commercial OH Kaiser Self-Funded Remittance 5010A1 Enrollment

A: 10/01/2018 Par 61185 Commercial AR Kalos Gold Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/01/2018 Par 61185 Commercial AR Kalos Gold Health Plan Institutional 5010A1Claim Level Accept /Reject

Yes

A: 02/17/2016 Par 40137 Commercial MN Kalos Health Professional 5010A1 Claim Level Ack.

A: 02/17/2016 Par 40137 Commercial MN Kalos Health Institutional 5010A1 Claim Level Ack.

U: 08/15/2019 Non-Par 40137 Commercial MN Kalos Health Remittance 5010A1 Enrollment

A: 09/01/2016 Par KCIPA Commercial Kane County BCBS Professional 5010A1 Claim Level Ack.

A: 09/01/2016 Par KCIPA Commercial Kane County BCBS Institutional 5010A1 Claim Level Ack.

A: 09/01/2016 Par IPAK1 Commercial IL Kane County Harmony Medicaid Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par IPAK1 Commercial IL Kane County Harmony Medicaid Institutional 5010A1Claim Level Accept /Reject

A: 02/13/2017 Non-Par 47163 KS Kansas Medicaid - Institutional (Formerly IC012) Institutional 5010A2

A: 02/12/2018 Trans 71066 Commercial KS Kansas Superior Select Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/12/2018 Trans 71066 Commercial KS Kansas Superior Select Institutional 5010A1Claim Level Accept /Reject

Yes

A: 12/03/2019 Non-Par 71066 Commercial KS Kansas Superior Select Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Kautz Vinyards Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 11/18/2013 Non-Par TKFMC Commercial MU Kaweah Delta Professional 5010A1File LevelAcknowledgement

No

U: 03/24/2014 Non-Par J1498 Workers' Comp MU Keenan and Associates Prof. Work Comp 5010A1

U: 12/19/2014 Non-Par J1498 Workers' Comp MU Keenan and Associates Remittance 5010A1 Enrollment

A: 12/16/2019 Non-Par 95279 Commercial CA Keenan and Associates Institutional 5010A1 No Response From Payer

A: 12/16/2019 Non-Par 95279 Commercial MU Keenan and Associates Professional 5010A1 File Level Ack. No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU KEISER (A CORP) Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU KEISER (A CORP) Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par KELSE Commercial Kelsey Sebold Professional 5010A1Claim LevelAcknowledgement

A: 09/01/2016 Par KELSE Commercial Kelsey Sebold Institutional 5010A2 Claim Level Rejects Only

A: 01/15/2019 Par 62480 Commercial TN Kemberton Healthcare Services Professional 5010A1 Claim Level Ack.

A: 01/15/2019 Par 62480 Commercial TN Kemberton Healthcare Services Institutional 5010A1 Claim Level Ack.

A: 11/24/2014 Non-Par 61453 Commercial Kemper Benefits Professional 5010A1 No Response From Payer Yes

A: 12/05/2014 Non-Par 61453 Commercial Kemper Benefits Institutional 5010A2 No Response From Payer Yes

U: 07/24/2020 Non-Par 73100 Commercial Kempton Company Remittance 5010A1

U: 01/27/2012 Non-Par 73100 Commercial Kempton Group Administrators Institutional 5010A2 No Response From Payer

A: 12/06/2019 Non-Par 73100 Commercial Kempton Group Administrators Professional 5010A1

A: 09/08/2021 Non-Par 82357 Commercial KY Kentucky Health Administrators Professional 5010A1Claim Level Accept /Reject

No

A: 09/08/2021 Non-Par 82357 Commercial KY Kentucky Health Administrators Institutional 5010A1Claim Level Accept /Reject

No

A: 10/21/2020 Non-Par 58379 CommercialKentucky Health Administrators, Inc FKA HSCGKentucky


A: 08/24/2021 Non-Par 27215 Commercial Kentucky Health Administrators, Inc. Remittance 5010A1 Enrollment


A: 08/24/2021 Non-Par 58379 Commercial Kentucky Health Administrators, Inc.(Formerly 27215) Remittance 5010A1 Enrollment


U: 12/24/2018 Non-Par SKKY0 Government KY Kentucky Medicaid Professional 5010A1 Enrollment

U: 11/20/2019 Non-Par SKKY0 Government KY Kentucky Medicaid Remittance 5010A1 Enrollment

A: 09/01/2016 Par 28021 Commercial Kern County CDCR Professional 5010A1 Claim Level Ack.

U: 09/01/2016 Par 28021 Commercial CA Kern County CDCR (formerly MCS03) Professional 5010A1

U: 09/01/2016 Par 28021 Commercial CA Kern County CDCR (formerly MCS03) Professional 5010A1

U: 01/16/2020 Non-Par 58379 Commercial CA Kern County CDCR (formerly MCS03) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 09/01/2016 Par 77039 Commercial CA Kern Family Health Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 77039 Commercial Kern Health Systems Institutional 5010A2Claim Level Accept /Reject

U: 09/01/2016 Trans 37217 Commercial Key Benefit Administrators Institutional 5010A2 No Response From Payer Yes

U: 03/11/2013 Trans 37217 Commercial Key Benefit Administrators Professional 5010A1 No Response From Payer Yes

A: 07/07/2021 Non-Par 37217 Commercial KEY BENEFIT ADMINISTRATORS Remittance 5010A1 Enrollment

U: 08/08/2014 Non-Par 35317 Commercial KEY GAP Institutional 5010A2 Yes

U: 02/13/2014 Non-Par 35317 Commercial KEY GAP Professional 5010A1File LevelAcknowledgement

Yes

A: 09/01/2016 Par 95460 Commercial Key Health Medical Solutions Professional 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par IP082 Commercial CA Key Medical Group Professional 5010A1 No Response From Payer

A: 07/03/2017 Non-Par IP083 Commercial CA Key Medical Group - Medicare Advantage Professional 5010A1 No Response From Payer

A: 03/02/2021 Non-Par IP083 Commercial CA Key Medical Group - Medicare Advantage Remittance 5010A1 Enrollment

A: 05/03/2018 Non-Par J1521 Commercial MU Key Risk Management Services Remittance 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



A: 05/25/2018 Non-Par J1521 Workers' Comp Key Risk Management Services Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Trans 37321 Commercial Key Select Institutional 5010A2 Yes

U: 03/11/2013 Trans 37321 Commercial Key Select Professional 5010A1 No Response From Payer Yes

U: 08/15/2019 Non-Par 37323 Commercial Key Solution Remittance 5010A1 Enrollment

A: 06/18/2015 Non-Par 37323 Commercial MU Key Solution Professional 5010A1 File Level Ack. Yes

A: 06/18/2015 Non-Par 37323 Commercial MU Key Solution Institutional 5010A2 Claim Level Ack. Yes

A: 01/31/2020 Non-Par KCMD1 Commercial FL Keycare Remittance 5010A1 Enrollment


A: 01/31/2020 Par KCMD1 Commercial FL Keycare Professional 5010A1Claim Level Accept /Reject

No

A: 01/31/2020 Par KCMD1 Commercial FL Keycare Institutional 5010A1Claim Level Accept /Reject

No

U: 02/28/2017 Non-Par 77050 Commercial Keystone Connect (Amerihealth) Remittance 5010A1 Enrollment

U: 05/13/2021 Non-Par 23284 Commercial PA Keystone First Institutional 5010A2Claim Level Accept /Reject

Yes

HealthChoices Plan - Coverage inSoutheastern Pennsylvania includingBucks, Chester, Delaware,Montgomery and Philadelphiacounties.

U: 05/13/2021 Non-Par 23284 Commercial PA Keystone First Professional 5010A1Claim Level Accept /Reject

Yes

HealthChoices Plan - Coverage inSoutheastern Pennsylvania includingBucks, Chester, Delaware,Montgomery and Philadelphiacounties.

A: 08/18/2021 Non-Par 23284 Commercial PA Keystone First Remittance 5010A1 Enrollment


U: 08/18/2021 Non-Par 58379 Commercial Keystone First (Formerly payer id 23284) Remittance 5010A1 Enrollment


A: 08/18/2021 Non-Par 42344 Commercial PA Keystone First Community HealthChoices Remittance 5010A1 Enrollment


A: 01/15/2019 Non-Par 42344 Commercial PA Keystone First Community HealthChoices Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/15/2019 Non-Par 42344 Commercial PA Keystone First Community HealthChoices Institutional 5010A1Claim Level Accept /Reject

Yes

A: 08/18/2021 Non-Par 58379 Commercial PAKeystone First Community HealthChoices (Formerlypayer id 42344)



A: 05/18/2021 Non-Par 77741 Commercial PA Keystone First PA Community Health Choices Professional 5010A1Claim Level Accept /Reject

Yes

A: 05/18/2021 Non-Par 77741 Commercial PA Keystone First PA Community Health Choices Institutional 5010A1Claim Level Accept /Reject

Yes

A: 08/18/2021 Non-Par 77741 Commercial PA Keystone First VIP Choice Remittance 5010A1 Enrollment


A: 08/18/2021 Non-Par 58379 Commercial PA Keystone First VIP Choice (Formerly payer id 77741) Remittance 5010A1 Enrollment


Updated: 03/21/2022


PPAAYERYERIDID



U: 11/11/2019 Non-Par SX055 Government PA Keystone Health Plan East (formerly 95056) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 11/22/2019 Non-Par 12X25 Commercial PA Keystone Health Plan East (Formerly SX055 / 95056) Institutional 5010A1 Enrollment

U: 11/11/2019 Non-Par SX056 Commercial PA Keystone Health Plan West Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 01/22/2020 Non-Par SB931 Government WA King Co Blue Shield-WA (Regence)(Formerly BS006) Remittance 5010A1 Enrollment

U: 05/28/2019 Non-Par SB931 Government WA King Co Blue Shield-WA (Regence)(Formerly BS006) Professional 5010A1Claim Level Accept /Reject

Yes

U: 05/28/2019 Non-Par 12B90 Commercial WAKing Co Blue Shield-WA (Regence)(Formerly BS006/SB931)


U: 03/24/2014 Non-Par 41556 Workers' Comp MU King Pak Potato Company LLC Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU King Ranch Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 02/01/2022 Par 83313 Commercial PA KISX CARD LLC Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/01/2022 Par 83313 Commercial PA KISX CARD LLC Institutional 5010A1Claim Level Accept /Reject

Yes

A: 12/05/2014 Non-Par KPS01 Commercial Kitsap Physician Services Institutional 5010A2 Claim Level Ack.

U: 11/27/2013 Non-Par KPS01 Commercial Kitsap Physicians Services Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 34145 Commercial KLAIS & Company Institutional 4010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 34145 Commercial KLAIS & Company Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Kordye Turner & Co., Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Kordye Turner & Co., Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Krieger, Bertie (An Individual Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Krieger, Bertie (An Individual Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU KTA Construction (COSD2) Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU KURT BOHMER PLUMBING, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU KURT BOHMER PLUMBING, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU KURTZ FINAN AUTO SUPPLY, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU KURTZ FINAN AUTO SUPPLY, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Kustom Fit Manufacturing Compa Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Kustom Fit Manufacturing Compa Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU L. Arrowhead C. Club Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/19/2021 Par 72107 Medicaid LA LA Blue Advantage Professional 5010A1 File Level Ack. Yes

A: 01/19/2021 Par 72107 Medicaid LA LA Blue Advantage Institutional 5010A1 File Level Ack. Yes

A: 05/25/2021 Non-Par 72107 Commercial LA LA Blue Advantage Remittance 5010A1 Enrollment

U: 05/20/2021 Par LACAR Commercial CA LA Care Health Plan Institutional 5010A2 Claim Level Ack.

U: 12/20/2019 Non-Par LACAR Commercial CA LA Care Health Plan Remittance 5010A1 Enrollment

U: 05/20/2021 Par LACAR Commercial CA LA Care Heath Plan Professional 5010A1 No Response From Payer

A: 05/01/2020 Non-Par 12LTC Government LA LA Medicaid Long Term Care Institutional 5010A2Claim Level Accept /Reject

No

U: 09/30/2019 Non-Par SX063 Commercial WA Labor and Industry (Formerly WC001) Remittance 5010A1 Enrollment

U: 09/02/2021 Non-Par SX063 Commercial WA Labor and Industry (Formerly WC001) Professional 5010A1 Enrollment

A: 09/02/2021 Non-Par SX063 Commercial WA Labor and Industry (Formerly WC001) Institutional 5010A2 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Laclede Chain Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Laclede Steel Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Lake Elsinore School District Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 66127 Commercial Lakeside Comprehensive Healthcare Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 66127 Commercial Lakeside Comprehensive Healthcare Institutional 5010A2 Claim Level Ack.

U: 08/01/2012 Par LMG11 Commercial Lakeside Medical Group Professional 5010A1 No Response From PayerNo Payer Response, please contactpayer directly at 818-707-9603

A: 09/01/2016 Par LMG11 Commercial Lakeside Medical Group Institutional 5010A2 Claim Level Ack.

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Lamar Consolidated ISD Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Lamesa ISD Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/02/2014 Non-Par CALL Commercial PALancaster General Health Group - Preferred HealthCare (IHS)

Professional 5010A1 File Level Ack. Yes

Contact Sherry Wolgemuth VicePresident of Claims Operations forPreferred Health Care at (717)560-9290 ext. 124 for approval andthe Payer ID.

U: 12/19/2014 Non-Par CALL CommercialLancaster General Health Group - Preferred HealthCare (IHS Payer)



U: 03/24/2014 Non-Par 41556 Workers' Comp MU Landmark Golf Co Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Landmark Grad&Paving Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 08/15/2019 Non-Par LNDMK Commercial Landmark Healthcare, Inc. Remittance 5010A1 Enrollment

(ONLY Clients of ChiroCare of MNpracticing in MN, WI, ND, SD, NE or IAcan get electronic remits at thistime.)

U: 05/08/2015 Non-Par LNDMK Commercial Landmark Healthcare, Inc. Professional 5010A1 Yes

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Lane County Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Larimer County - WC Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 12/07/2012 Non-Par NMM02 Commercial MU LaSalle medical Associates Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par NMM02 Commercial LaSalle Medical Associates Institutional 5010A2 No Response From Payer

U: 09/23/2013 Non-Par J1491 Workers' Comp MU LATICRETE INT'L INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU LATICRETE INT'L INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 02/03/2017 Par LAWND Commercial IL Lawndale Christian Health Center Professional 5010A1 Claim Level Ack. No

A: 02/03/2017 Par LAWND Commercial IL Lawndale Christian Health Center Institutional 5010A1 Claim Level Ack. No

U: 03/24/2014 Non-Par 41556 Workers' Comp MU LB Auto / Pacific Part Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU LB Auto / Pacific Supp Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/27/2012 Non-Par 52193 Commercial LBA Health Plans Professional 5010A1Claim LevelAcknowledgement

U: 01/27/2012 Non-Par 52193 Commercial LBA Health Plans Institutional 5010A2Claim LevelAcknowledgement

U: 09/23/2013 Non-Par J1491 Workers' Comp MU LEDTRONICS, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU LEDTRONICS, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 10/16/2019 Non-Par 12M65 Government Legacy Medicare Part A (CA, HI, NV) (MAC JE) Institutional 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Leisure World Union 76, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 03/24/2014 Non-Par J1491 Workers' Comp MU Leisure World Union 76, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Lekos Electric Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Trans 37316 Commercial Leon Medical Center Health Plan Institutional 5010A2File LevelAcknowledgement

U: 01/24/2012 Non-Par 37316 Commercial Leon Medical Center Health Plan Professional 5010A1 No Response From Payer

U: 11/04/2019 Non-Par 37316 Commercial Leon Medical Center Health Plan Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Levin Enterprises, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 38238 Commercial MU LHP Claims Unit Institutional 5010A2File LevelAcknowledgement

No

A: 09/01/2016 Par 38238 Commercial MU LHP Claims Unit Professional 5010A1File LevelAcknowledgement

No

A: 02/21/2018 Par LIB01 Commercial FL Liberty Advantage, LLC Professional 5010A1Claim Level Accept /Reject

No

A: 02/21/2018 Par LIB01 Commercial IL Liberty Advantage, LLC Institutional 5010A1Claim Level Accept /Reject

No

U: 11/01/2012 Non-Par 87071 Commercial Liberty Health Advantage Professional 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par 87071 Commercial Liberty Health Advantage Institutional 5010A2File LevelAcknowledgement

U: 03/24/2014 Non-Par WZ635 Workers' Comp Liberty Mutual Insurance Co Prof. Work Comp 5010A1File LevelAcknowledgement

U: 11/24/2014 Non-Par WZ635 Auto Liberty Mutual Insurance Co Prof. Auto 5010A1

A: 01/24/2013 Non-Par WZ635 Workers' CompLiberty Mutual Insurance Co (ERA for this payer istemporarily unavailable)

Remittance 4010A1 EnrollmentERA for this payer is temporarilyunavailable.

A: 08/08/2014 Non-Par 37281 Commercial Liberty Union Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 37281 Commercial Liberty Union Life Assurance Co. Professional 5010A1 No Response From Payer

A: 08/08/2014 Non-Par 37281 Commercial Life Assurance Company Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 37281 Commercial Life Assurance Company Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 33LGC Commercial Life Gift Cards Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 33LGC Commercial Life Gift Cards Institutional 5010A2 Claim Level Accept/Reject Yes

A: 11/24/2014 Non-Par TH120 Commercial Life Investors Insurance Professional 5010A1 Claim Level Accept/Reject Yes

A: 12/05/2014 Non-Par TH120 Commercial Life Investors Insurance Institutional 5010A2 No Response From Payer

A: 12/05/2014 Non-Par TH093 Commercial Life Investors of Am. - Long Term Institutional 5010A2 No Response From Payer

A: 11/24/2014 Non-Par TH093 Commercial Life Investors of Am.- Long Term Professional 5010A1 Claim Level Accept/Reject

A: 11/24/2014 Non-Par 25181 Commercial LIFE Pittsburgh Professional 5010A1 File Level Ack.

A: 12/05/2014 Non-Par 25181 Commercial LIFE Pittsburgh Institutional 5010A2 File Level Ack.

A: 02/02/2021 Non-Par 25181 Commercial PA Life Pittsburgh Remittance 5010A1 Enrollment

U: 09/01/2016 Par 41136 Commercial Life Trac Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 41136 Commercial Life Trac Institutional 5010A2 No Response From Payer

A: 10/11/2017 Par 25850 Commercial CA Lifecare Assurance Co Professional 5010A1 No Response From Payer Yes

A: 10/11/2017 Par 25850 Commercial CA Lifecare Assurance Co Institutional 5010A1 No Response From Payer Yes

A: 10/04/2017 Non-Par 71498 Commercial MI LifeCircles PACE Remittance 5010A1 Enrollment

A: 09/01/2016 Trans 71498 Commercial MI LifeCircles PACE Professional 5010A1 Claim Level Ack.

A: 09/01/2016 Trans 71498 Commercial MI LifeCircles PACE Institutional 5010A1 Claim Level Ack.

U: 09/01/2016 Par 76870 Commercial LifePath Hospice Inc Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 76870 Commercial LifePath Hospice Inc Institutional 5010A2 No Response From Payer Yes

A: 12/20/2013 Non-Par LIFE Commercial AZ Lifeprint Remittance 5010A1 Enrollment

A: 12/03/2021 Non-Par 27005 Commercial Lifestyle Health Plans Remittance 5010A1 Enrollment

ECHO is returning 835's for payer ID27005. Providers will need to enrollfor payer IDs 27005 and 58379 inorder to receive 835s for this payer.

A: 12/03/2021 Non-Par 58379 Commercial Lifestyle Health Plans (Formerly 27005) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379* ECHO is

Updated: 03/21/2022


PPAAYERYERIDID



returning 835's for payer ID 27005.Providers will need to enroll for payerIDs 27005 and 58379 in order toreceive 835s for this payer.

A: 09/01/2016 Par EBSRM Commercial Lifetime Benefit Solutions Professional 5010A1 File Level Ack.

A: 09/01/2016 Par EBSRM Commercial Lifetime Benefit Solutions Institutional 5010A1 Claim Level Ack.

U: 09/01/2016 Par 93093 Commercial LifeWise Health Plan of Oregon Professional 4010A1Claim LevelAcknowledgement

Yes

A: 09/25/2019 Non-Par LWA01 Commercial FL LifeWorks Advantage Remittance 5010A1 Enrollment

A: 01/24/2018 Par LWA01 Medicare FL LifeWorks Advantage Professional 5010A1 Claim Level Rejects Only No

A: 01/24/2018 Par LWA01 Medicare FL LifeWorks Advantage Institutional 5010A1 Claim Level Rejects Only No

A: 02/05/2019 Par 31828 Commercial IL Lighthouse Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/05/2019 Par 31828 Commercial IL Lighthouse Health Plan Institutional 5010A1Claim Level Accept /Reject

Yes

A: 08/24/2021 Non-Par 31828 Commercial IL Lighthouse Health Plan Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Lights Of America Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Lights Of America Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/08/2021 Non-Par LCB01 Commercial Line Construction Benefit Fund Remittance 5010A1 Enrollment

ECHO is returning 835's for payer IDLCB01. Providers will need to enrollfor payer ID LCB01 and 58379 in orderto receive 835's for this payer.

A: 12/08/2021 Non-Par 58379 Commercial Line Construction Benefit Fund (Formerly LCB01) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835's for payer ID LCB01.Providers will need to enroll for payerID LCB01 and 58379 in order toreceive 835's for this payer.

A: 02/03/2017 Par LCM10 Commercial IL Little Company of Mary Professional 5010A1 Claim Level Ack. No

A: 02/03/2017 Par LCM10 Commercial IL Little Company of Mary Institutional 5010A1 Claim Level Ack. No

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Livingston ISD Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Lk Arrowhead Co Club Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 07/15/2014 Non-Par CB752 Commercial Lockard & Williams Insurance Services Institutional 5010A2 Claim Level Rejects Only No

A: 07/15/2014 Non-Par CB752 Commercial Lockard & Williams Insurance Services Professional 5010A1 Claim Level Rejects Only No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Lodging Developement And Manag Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Lodging Developement And Manag Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Lodi Memorial Hospital Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 99255 Commercial Loma Linda Institutional 5010A2 No Response From Payer Yes

A: 09/01/2016 Par 33036 Commercial Loma Linda Univ HlthCR Mgd Care Institutional 5010A2 Claim Level Accept/Reject

U: 01/20/2014 Non-Par 37267 Commercial Loma Linda University Professional 5010A1 No Response From Payer

U: 11/01/2012 Non-Par 37267 Commercial Loma Linda University Adventist Health Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 37267 Commercial Loma Linda University Behavioral Medicine Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 37267 Commercial Loma Linda University Employee Health Plan Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 37267 CommercialLoma Linda University Health Care Employee HealthPlan


U: 09/01/2016 Par 33036 CommercialLoma Linda University Healthcare - ManagedCareClaims


A: 05/06/2020 Par 95352 Commercial CA Loma Linda University Medical Center (LLUMC) Professional 5010A1Claim Level Accept /Reject

A: 05/06/2020 Par 95352 Commercial CA Loma Linda University Medical Center (LLUMC) Institutional 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par 37267 Commercial Loma Linda University Student Health Plan Institutional 5010A2 No Response From Payer

U: 03/11/2013 Non-Par 45289 Commercial TX Lone Star TPA Professional 5010A1Claim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



A: 09/17/2020 Non-Par 45289 Commercial TX Lone Star TPA Institutional 5010A1Claim Level Accept /Reject

Yes

A: 10/15/2020 Non-Par 45289 Commercial Lone Star TPA Remittance 5010A1 Enrollment

A: 02/04/2020 Par LNJ01 Commercial NJ Longevity Health Plan (NJ) Professional 5010A1Claim Level Accept /Reject

No

A: 02/04/2020 Par LNJ01 Commercial NJ Longevity Health Plan (NJ) Institutional 5010A1Claim Level Accept /Reject

No

A: 02/04/2020 Par LOK01 Commercial OK Longevity Health Plan (OK) Professional 5010A1Claim Level Accept /Reject

No

A: 02/04/2020 Par LOK01 Commercial OK Longevity Health Plan (OK) Institutional 5010A1Claim Level Accept /Reject

No

A: 01/31/2020 Non-Par LFL01 Commercial Longevity Health Plan - FL Remittance 5010A1 Enrollment


A: 02/03/2020 Par LFL01 Commercial FL Longevity Health Plan - FL Professional 5010A1Claim Level Accept /Reject

No

A: 02/03/2020 Par LFL01 Commercial FL Longevity Health Plan - FL Institutional 5010A1Claim Level Accept /Reject

No

A: 01/31/2020 Non-Par LNJ01 Commercial NJ Longevity Health Plan - NJ Remittance 5010A1 Enrollment


A: 02/24/2021 Non-Par LOK01 Commercial OK Longevity Health Plan - OK Remittance 5010A1 Enrollment


A: 11/20/2019 Non-Par LIL01 Commercial LONGEVITY HEALTH PLAN OF IL Remittance 5010A1 Enrollment

A: 11/20/2019 Non-Par LIL01 Commercial LONGEVITY HEALTH PLAN OF IL Remittance 5010A1 Enrollment

A: 02/05/2019 Par LIL01 Commercial IL Longevity Health Plan of Illinois Professional 5010A1Claim Level Accept /Reject

No

A: 02/05/2019 Par LIL01 Commercial IL Longevity Health Plan of Illinois Institutional 5010A1Claim Level Accept /Reject

No

A: 02/05/2019 Par LNY01 Commercial NY Longevity Health Plan of New York Professional 5010A1Claim Level Accept /Reject

No

A: 02/05/2019 Par LNY01 Commercial NY Longevity Health Plan of New York Institutional 5010A1Claim Level Accept /Reject

No

A: 12/02/2019 Non-Par LNY01 Commercial NY LONGEVITY HEALTH PLAN OF NY Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Los Altos Golf & Country Club Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Los Altos Golf & Country Club Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 02/07/2014 Non-Par PPM01 Commercial CA Los Angeles medical Center (LAMC) Professional 5010A1File LevelAcknowledgement

Yes

U: 11/01/2012 Trans PPM02 Commercial CA Los Angeles Medical Center - Encounters Only Professional 5010A1Claim Level Accept /Reject

U: 08/15/2014 Par 68069 Commercial LA Louisiana health Care Connections - Centene Professional 5010A1 Yes

A: 05/28/2019 Par SKLA5 Medicaid LA Louisiana Medicaid (MED ADV) Professional 5010A1Claim Level Accept /Reject

Yes

Medicaid claims filed with this PAYERID are only for Medicaid recipientsthat have coverage with a MedicareAdvantage Plan as Primary andMedicaid as Secondary. Do not usefor traditional Medicare claims.

A: 05/28/2019 Non-Par 12K99 Medicaid LA Louisiana Medicaid (MED ADV) Institutional 5010A1Claim Level Accept /Reject

Yes

Medicaid claims filed with this PAYERID are only for Medicaid recipientsthat have coverage with a MedicareAdvantage Plan as Primary andMedicaid as Secondary. Do not usefor traditional Medicare claims.

U: 11/20/2019 Non-Par SKLA2 Commercial LA Louisiana Medicaid - Ambulance Professional 5010A1 Enrollment File Level Ack.

U: 12/22/2017 Non-Par SKLA3 Commercial LA Louisiana Medicaid - KidMed Claims Professional 5010A1 Enrollment Yes

A: 01/24/2018 Par 13193 CommercialLoyal American Life Insurance Company - MedicareSupplement


Updated: 03/21/2022


PPAAYERYERIDID



A: 01/24/2018 Par 13193 CommercialLoyal American Life Insurance Company - MedicareSupplement


A: 03/14/2022 Non-Par 37175 Commercial IL LOYOLA PHYSICIAN PARTNERS Remittance 5010A1 Enrollment

A: 05/25/2021 Non-Par LUCNT Commercial TN Lucent Health Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Lundeen Pacific Corporation Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Lundeen Pacific Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/24/2017 Par CB212 Commercial MD Luther Care Institutional 5010A1Claim Level Accept /Reject

No

A: 08/24/2017 Par CB212 Commercial MD Luther Care Professional 5010A1Claim Level Accept /Reject

No

U: 04/02/2019 Par 95399 Commercial CA Mabuhay Medical Group Professional 5010A1Claim Level Accept /Reject

U: 10/09/2019 Non-Par 52280 Government MU MAC J5 Part A Legacy Medicare Institutional 5010A1 Enrollment

U: 08/28/2020 Non-Par 52280 Government MU MAC J5 Part A Legacy Medicare Remittance 5010A1 Enrollment

U: 03/24/2015 Non-Par 36334 Commercial MacNeal Health Providers (CHS) Professional 5010A1Claim Level Accept /Reject

U: 08/15/2019 Non-Par 36334 Commercial MacNeal Health Providers (CHS) Remittance 5010A1 Enrollment

U: 03/24/2015 Non-Par 36334 Commercial MacNeal Health Providers- CHS Institutional 5010A2 File Level Ack.

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Madera Community Hospital Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Madison Research Corporation Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Madison Research Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 02/17/2021 Non-Par 58379 Commercial Magellan Behavior Health (01260) Remittance 5010A1 Enrollment


U: 03/11/2013 Par 01260 Commercial Magellan Behavioral Health Institutional 5010A2Claim LevelAcknowledgement

Yes

U: 03/11/2013 Par 01260 Commercial Magellan Behavioral Health Professional 5010A1Claim Level Accept /Reject

Yes

U: 07/19/2021 Non-Par 01260 Commercial MD Magellan Behavioral Health Remittance 4010A1 Enrollment


U: 01/01/2012 Par MBHCR Commercial Magellan Behavioral Health - Case Rate Professional 5010A1Claim Level Accept /Reject

A: 11/06/2018 Non-Par MCCVA Commercial VA Magellan Complete Care of Virginia Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/06/2018 Non-Par MCCVA Commercial VA Magellan Complete Care of Virginia Institutional 5010A1Claim Level Accept /Reject

Yes

A: 08/27/2021 Non-Par MCCVA Commercial VA MAGELLAN COMPLETE CARE of VIRGINIA Remittance 5010A1 Enrollment

A: 01/31/2020 Non-Par MCC02 Commercial Magellan Complete Care Of Virginia DSNP Remittance 5010A1 Enrollment

U: 05/03/2019 Trans 11303 Commercial Magnacare Institutional 5010A2 Claim Level Ack. Yes

U: 05/03/2019 Trans 11303 Commercial Magnacare Professional 5010A1 Claim Level Ack. Yes

U: 10/30/2019 Non-Par 11303 Commercial MU Magnacare Remittance 5010A1

A: 09/15/2020 Non-Par E1303 Commercial NY Magnacare Administrative Services Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 68062 Commercial MS Magnolia Health Plan Professional 5010A1Claim LevelAcknowledgement

Yes

A: 01/08/2018 Non-Par 45341 Commercial Maine Community Health Options Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/08/2018 Non-Par 45341 Commercial Maine Community Health Options Institutional 5010A2Claim Level Accept /Reject

Yes

A: 09/25/2020 Non-Par 45341 Commercial ME Maine Community Health Options Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Maintenance Pacesetters Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 03/24/2014 Non-Par J1491 Workers' Comp MU Maintenance Pacesetters Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Mallis Associates Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Mallis Associates Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 08/19/2019 Non-Par 87726 Commercial MD MAMSI Life and Health Ins (Formerly 52148) Remittance 5010A1 EnrollmentYou must also add/request Payer ID:04567

U: 09/01/2016 Par 35162 Commercial Managed Care Services Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 35162 Commercial Managed Care Services, LLC Institutional 5010A2 No Response From Payer

A: 09/01/2016 Par 36312 Commercial MANAGED HEALTH CARE ASSOCIATES Professional 5010A1 No Response From Payer

A: 09/01/2016 Par 36312 Commercial MANAGED HEALTH CARE ASSOCIATES Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 22771 Commercial Managed Health Network Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 22771 Commercial Managed Health Network Institutional 5010A2Claim Level Accept /Reject

U: 08/15/2019 Non-Par 22771 Commercial Managed Health Network Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 39187 Commercial WI Managed Health Services - Centene Institutional 5010A2 No Response From Payer Yes

A: 08/15/2014 Par 68069 Commercial IN Managed Health Services - Centene - IN Professional 5010A1 Yes

A: 09/02/2014 Par 68069 Commercial WI Managed Health ServIces - Centene - WI Professional 5010A1 Yes

U: 03/11/2013 Non-Par 39186 Commercial IN Managed Health Services Indiana (Medicaid HMO) Institutional 5010A2 EnrollmentClaim Level Accept /Reject

Yes

(Prior to submitting claims, callProvider Relations Dept. at866-475-3129 to verify your providerinfo is on file in the Health Plans claimsystem to avoid any rejections)

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Maniglia Landscape Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Maniglia Landscape Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Manufacturers Alliance Insurance Company Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 02/13/2014 Non-Par 75258 Commercial Mapco, Inc. Professional 5010A1Claim LevelAcknowledgement

A: 07/23/2021 Non-Par L0160 Commercial Mapfre (Canada Life) Professional 5010A1 EnrollmentClaim Level Accept /Reject

A: 07/23/2021 Non-Par L0160 Commercial Mapfre (Canada Life) Institutional 5010A2 EnrollmentClaim Level Accept /Reject

U: 07/22/2021 Non-Par L0160 Commercial MU Mapfre (Canada Life) Remittance 5010A1 Enrollment

Payer will only do ERA if Providerparticipates in EFT Transactions.Please visit mapfrepr.com for moreinformation or call 787-250-5214

A: 12/20/2019 Par 52461 Commercial March Vision Care Inc. Professional 5010A1Claim Level Accept /Reject

A: 12/02/2019 Non-Par 52461 Commercial March Vision Care Inc. Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Marcotte & Hearne Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Marfield Company Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Marfield Company Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Maricopa County Community College District Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU MARIN RADIOLOGY GROUP Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU MARIN RADIOLOGY GROUP Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Mariposa County Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU MARKRIST ENGINEERS Inst. Work Comp 4010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 03/24/2014 Non-Par J1491 Workers' Comp MU MARKRIST ENGINEERS Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par 20805 Commercial Marrick Medical Finance LLC Institutional 5010A2 No Response From Payer Yes

U: 03/14/2013 Non-Par 20805 Commercial Marrick Medical Finance, LLC Professional 5010A1File LevelAcknowledgement

Yes

A: 11/16/2021 Non-Par 20805 Commercial Marrick Medical Finance, LLC Remittance 5010A1 Enrollment

ECHO is returning 835's for payer ID20805. Providers will need to enrollfor payer ID 20805 and 58379 in orderto receive 835's for this payer.

A: 11/16/2021 Non-Par 58379 Commercial Marrick Medical Finance, LLC (Formerly 20805) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835's for payer ID 20805.Providers will need to enroll for payerID 20805 and 58379 in order toreceive 835's for this payer.

A: 03/26/2018 Par 53275 Commercial Martins Point Health Care Institutional 5010A1 Claim Level Ack. No

U: 03/09/2017 Par 53275 Commercial CA Martins Point Health Care (Formerly MPHC1) Professional 5010A1 No

A: 09/24/2019 Non-Par 53275 Commercial Martins Point Health Care (Formerly MPHC1) Remittance 5010A1 Enrollment

A: 01/23/2020 Non-Par 83269 Commercial Mary Washington Health Plan Remittance 5010A1 Enrollment

This payers requires ElectronicRegistration, Vendors should enrolland complete registration viaEnrollment Wizard and mark activitysent to Payer. Providers shouldcomplete setup form and ChangeHealthcare will facilitate electronicregistration.

A: 02/14/2020 Par 83269 Commercial Mary Washington Health Plan Professional 5010A1

A: 02/14/2020 Par 83269 Commercial Mary Washington Health Plan Institutional 5010A1

U: 09/01/2016 Par 22348 Commercial MD Maryland Physician's Care Institutional 5010A2Claim Level Accept /Reject

A: 07/10/2017 Par 22348 Commercial MD Maryland Physician's Care (Formerly 00247) Institutional 5010A2 No Response From Payer

A: 07/10/2017 Par 22348 Commercial MD Maryland Physician's Care (Formerly 00247) Professional 5010A1Claim Level Accept /Reject

U: 08/23/2017 Non-Par 22348 Commercial MD Maryland Physician's Care (Formerly 00247) Remittance 5010A1 Enrollment Enrollment is temporarily unavailable.

A: 03/17/2021 Par 76498 Commercial MD Maryland Physicians Care Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/17/2021 Par 76498 Commercial MD Maryland Physicians Care Institutional 5010A1Claim Level Accept /Reject

Yes

A: 11/18/2021 Non-Par 76498 Commercial Maryland Physicians Care Remittance 5010A1 Enrollment

A: 08/08/2014 Non-Par 37121 Commercial Mashantucket Pequot Tribal Nation Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 37121 Commercial Mashantucket Pequot Tribal Nation Professional 5010A1 No Response From Payer

U: 01/07/2022 Par 86220 Medicare MA Mass Advantage Professional 5010A1Claim Level Accept /Reject

Yes

U: 01/07/2022 Par 86220 Medicare MA Mass Advantage Institutional 5010A1Claim Level Accept /Reject

Yes

A: 01/24/2022 Non-Par 86220 Commercial MA Mass Advantage Remittance 5010A1 Enrollment

A: 11/24/2014 Non-Par TH111 Commercial Master Mates & Pilots Program Professional 5010A1 Claim Level Accept/Reject Yes

A: 12/05/2014 Non-Par TH111 Commercial Master Mates & Pilots Program Institutional 5010A2 Claim Level Accept/Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Matagorda County Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 03/04/2013 Non-Par 27320 Commercial Max Specialty Benefits Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU MAXSYS TECHNOLOGIES CORPORATIO Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU MAXSYS TECHNOLOGIES CORPORATIO Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/08/2015 Non-Par 88090 Commercial Mayo Clinic FL/GA Professional 5010A1Claim Level Accept /Reject

A: 01/08/2015 Non-Par 88090 Commercial Mayo Clinic FL/GA Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 83028 Commercial MU MBA Benefit Administrators Professional 5010A1Claim Level Accept /Reject

No

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/01/2016 Par 83028 Commercial MU MBA Benefit Administrators Institutional 5010A2Claim Level Accept /Reject

No

U: 08/15/2019 Non-Par 56205 Commercial MBS - MedCost Benefit Services Remittance 5010A1 Enrollment

U: 04/06/2017 Par 25160 Commercial MCA Administrators, Inc. Institutional 5010A2 ERA available under payer ID: 58379

U: 04/06/2017 Non-Par 25160 Commercial MCA Administrators, Inc. Professional 5010A1 Claim Level Ack. ERA available under payer ID: 58379

U: 09/23/2013 Non-Par J1491 Workers' Comp MU MCGEE ELECTRIC, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU MCGEE ELECTRIC, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par MHM02 Commercial McKinley Medical Group Professional 5010A1 No Response From Payer

U: 08/28/2013 Non-Par 3833R Government MU McLaren Advantage (HMO SNP) Professional 5010A1File LevelAcknowledgement

Yes

U: 03/19/2012 Trans 38338 Commercial McLaren Health Institutional 5010A2 No Response From Payer

U: 09/23/2019 Trans 38338 Commercial McLaren Health Professional 5010A1

A: 01/09/2020 Non-Par 38338 Commercial McLaren Health Remittance 5010A1 Enrollment

U: 08/28/2013 Non-Par 3833A Commercial MU McLaren Health Advantage Professional 5010A1File LevelAcknowledgement

Yes

A: 11/14/2019 Non-Par 3833A Commercial MI McLaren Health Advantage Institutional 5010A1Claim Level Accept /Reject

No

A: 03/16/2021 Non-Par JVHK7 Commercial MI McLaren Health Plan JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 03/16/2021 Non-Par JVHK7 Commercial MI McLaren Health Plan JVHL Institutional 5010A1Claim Level Accept /Reject

No

A: 01/07/2022 Non-Par RP016 Commercial MD MD Health Advantage Professional 5010A1Claim Level Accept /Reject

No

A: 01/07/2022 Non-Par RP016 Commercial MD MD Health Advantage Institutional 5010A1Claim Level Accept /Reject

No

U: 03/04/2016 Par 87726 CommercialMD-Individual Practice Assoc. (MD-IPA)(HCFA 1500only) (Formerly 52148)


Yes

U: 03/04/2016 Par 87726 CommercialMD-Individual Practice Association, Inc. (MD.IPA)(Formerly 52148)


Yes

A: 11/11/2021 Non-Par MDSAV Commercial MDSave Remittance 5010A1 Enrollment

A: 11/11/2021 Non-Par MDSAV Commercial MDSave Institutional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 11/24/2021 Non-Par MDSAV Commercial MDSave Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

U: 03/24/2014 Non-Par 41556 Workers' Comp MU MDSI Phys Group INC Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 02/15/2019 Par 3135M Commercial IN MDWise Health Indiana Plan Professional 5010A1Claim Level Accept /Reject

A: 02/15/2019 Par 3135M Commercial IN MDWise Health Indiana Plan Institutional 5010A1Claim Level Accept /Reject

U: 01/13/2020 Non-Par 3135M Commercial IN MDWise Healthy Indiana Plan Remittance 5010A1 Enrollment

A: 02/15/2019 Par 3519M Commercial IN MDWise Hoosier Healthwise Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/15/2019 Par 3519M Commercial IN MDWise Hoosier Healthwise Institutional 5010A1Claim Level Accept /Reject

Yes

U: 01/13/2020 Par 3519M Commercial IN MDWise Hoosier Healthwise Remittance 5010A1 Enrollment

A: 09/01/2016 Par MDXHI Commercial HI MDX Hawaii Institutional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par MDXHI Commercial HI MDX Hawaii Professional 5010A1Claim Level Accept /Reject

A: 12/23/2021 Non-Par MDXHI Commercial HI MDX Hawaii Remittance 5010A1 Enrollment

A: 03/09/2022 Non-Par WR778 Workers' Comp NE Meadowbrook Inc Inst. Work Comp 5010A1Claim Level Accept /Reject

A: 03/09/2022 Non-Par WR778 Workers' Comp NE Meadowbrook Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/16/2016 Non-Par J1478 Commercial MI Meadowbrook Insurance Group Remittance 5010A1 Enrollment

A: 12/14/2016 Non-Par J1478 Workers' Comp MI Meadowbrook Insurance Group Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/01/2016 Par 88058 Commercial MED PAY Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 88058 Commercial Med Pay Institutional 5010A2 Claim Level Ack. Yes

A: 09/01/2016 Par EM216 Commercial MED3000 Professional 5010A1 File Level Ack.

A: 09/01/2016 Par EM216 Commercial MED3000 Institutional 5010A2 File Level Ack.

U: 01/16/2020 Non-Par 58379 Commercial MED3000 CMS Early Steps Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 01/16/2020 Non-Par 58379 Commercial MED3000 CMS MMA Specialty Plan Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 01/16/2020 Non-Par 58379 Commercial MED3000 CMS Safety Net Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 01/16/2020 Non-Par 58379 Commercial MED3000 CMS Title 21 Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 10/14/2014 Non-Par CALL Commercial MU MED3000 Coventry Healthy Kids Professional 5010A1Claim Level Accept /Reject

Providers must CALL (866) 703-1444to obtain Payer ID.

U: 01/16/2020 Non-Par 58379 Commercial MED3000 Pedicare Title 19 Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 01/16/2020 Non-Par 58379 Commercial MED3000 Pedicare Title 21 Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 09/01/2016 Par 58202 Commercial MedAdmin Solutions Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 58204 Commercial MedAdmin Solutions Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 58204 Commercial MedAdmin Solutions Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 74323 Commercial MedBen (Newark, OH) Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 59231 Commercial MedCom (e-MedCom) Institutional 4010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 59231 Commercial MedCom (e-MedCom) Professional 5010A1Claim Level Accept /Reject

Yes

A: 06/11/2020 Non-Par 56162 Commercial Medcost Remittance 5010A1 Enrollment

U: 09/01/2016 Par 56162 Commercial Medcost, Inc. Institutional 5010A2 Enrollment YesFor questions on claim submission,please contact Customer Service(800)824-7406

U: 03/11/2013 Non-Par 56162 Commercial Medcost, Inc. Professional 5010A1Claim Level Accept /Reject

YesFor questions on claim submission,please contact Customer Service(800)824-7406

U: 02/13/2014 Non-Par 38353 Commercial MedDirect Professional 5010A1File LevelAcknowledgement

U: 09/01/2016 Par 95321 Commercial Medfocus Professional 5010A1Claim LevelAcknowledgement

U: 09/02/2021 Non-Par SKCA1 Commercial CA Medi-Cal (Vision) Professional 5010A1 Enrollment File Level Ack.

U: 09/02/2021 Non-Par 57016 Government CA Medi-Cal - California Institutional 5010A2 Enrollment No Response From PayerERA enrollment and processing isavailable under payer id SKCA3

U: 05/28/2020 Non-Par 94265 Commercial Medica - United Healthcare Remittance 5010A1 EnrollmentERA SETUP FORM IS REQUIRED TOENROLL FOR 835 Enroll under payer id87726 & 04567 for ERA

U: 04/07/2016 Par 94265 Commercial MN Medica - United Healthcare Institutional 5010A2 No Response From Payer Yes

U: 04/07/2016 Par 94265 Commercial MN Medica - United Healthcare Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/29/2021 Non-Par MEDM1 Commercial MN Medica Government Programs Professional 5010A1Claim Level Accept /Reject

No

A: 01/29/2021 Non-Par MEDM1 Commercial MN Medica Government Programs Institutional 5010A1Claim Level Accept /Reject

A: 02/11/2021 Non-Par MEDM1 Commercial MN Medica Government Programs Remittance 5010A1 Enrollment

U: 09/17/2014 Non-Par 78857 Commercial FL MEDICA HEALTH CARE PLAN INC. Professional 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par 78857 Commercial MEDICA HEALTH CARE PLAN INC. Institutional 5010A2 Claim Level Accept/Reject

A: 01/11/2019 Non-Par 71890 Commercial MN Medica Health Plan Solutions Professional 5010A1Claim Level Accept /Reject

Yes

U: 12/01/2020 Non-Par 71890 Commercial MN Medica Health Plan Solutions Remittance 5010A1 Enrollment

A: 12/01/2020 Non-Par 71890 Commercial MN Medica Health Plan Solutions Institutional 5010A1Claim Level Accept /Reject

Yes

U: 12/01/2020 Non-Par 12422 Commercial MU Medica2 Professional 5010A1 Claim Level Accept / Yes

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 10/28/2020 Non-Par 12422 Commercial Medica2 Remittance 5010A1 Enrollment

A: 10/31/2019 Non-Par 12K01 Government AL Medicaid - Alabama Institutional 5010A1

U: 11/04/2019 Non-Par 12K01 Government AL Medicaid - Alabama Remittance 5010A1 Enrollment

A: 07/11/2017 Non-Par SKAL0 Government AL Medicaid - Alabama (Formerly MC018) Professional 5010A1 Yes

A: 11/08/2019 Non-Par SKAL0 Government AL Medicaid - Alabama (Formerly MC018) Remittance 5010A1 Enrollment

U: 09/02/2021 Non-Par 12K86 Government AK Medicaid - Alaska (formerly MC093) Institutional 5010A1 Enrollment

U: 09/02/2021 Non-Par SKAK0 Government AK Medicaid - Alaska (formerly MC093) Professional 5010A1 Enrollment No Response From Payer Yes

U: 09/02/2021 Non-Par SKAK0 Government AK Medicaid - Alaska (formerly MC093) Remittance 4010A1 Enrollment

U: 03/11/2013 Non-Par SKAZ0 Government AZ Medicaid - Arizona Professional 5010A1File LevelAcknowledgement

Yes

U: 08/07/2015 Non-Par SKAZ0 Commercial AZ Medicaid - Arizona Institutional 5010A2 Yes

U: 05/29/2020 Non-Par SKAZ0 Government AZ Medicaid - Arizona Remittance 5010A1 EnrollmentTo enroll for ERAs please [email protected]

A: 11/16/2017 Non-Par SKAR0 Government AR Medicaid - Arkansas Institutional 5010A1 File Level Ack.

U: 11/16/2017 Non-Par SKAR0 Government AR Medicaid - Arkansas (Formerly MC029) Professional 5010A1 File Level Ack. Yes

U: 11/15/2019 Non-Par SKAR0 Government AR Medicaid - Arkansas (Formerly MC029) Remittance 4010A1 Enrollment

U: 11/04/2019 Non-Par 12K04 Government CT Medicaid - Connecticut Remittance 5010A1 Enrollment

U: 02/11/2020 Non-Par 12K04 Government CT Medicaid - Connecticut Institutional 5010A1

A: 06/22/2016 Par SKCT0 Medicaid CT Medicaid - Connecticut (Formerly MC039) Professional 5010A1 Claim Level Ack. Yes

U: 11/08/2019 Non-Par SKCT0 Government CT Medicaid - Connecticut (Formerly MC039) Remittance 4010A1 Enrollment

U: 11/27/2019 Non-Par SKDE0 Government DE Medicaid - Delaware (EDS) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 05/20/2020 Non-Par SKDE0 Government DE Medicaid - Delaware (EDS) Remittance 5010A1 Enrollment

U: 12/07/2017 Non-Par 12K87 Government DE Medicaid - Delaware (Formerly SKDE0) Institutional 5010A1 Enrollment

U: 12/23/2019 Non-Par SKFL0 Government FL Medicaid - Florida (Formerly MC010) Professional 5010A1 Enrollment No Response From Payer Yes

U: 10/23/2019 Non-Par SKFL0 Government FL Medicaid - Florida (Formerly MC010) Remittance 5010A1 Enrollment

A: 11/12/2019 Non-Par 12K34 Government FL Medicaid - Florida (Formerly MC010) Institutional 5010A1 Enrollment

U: 07/21/2021 Non-Par SKGA0 Government GA Medicaid - Georgia (Formerly MC020) Professional 5010A1 Enrollment Rejection Only Yes

U: 06/05/2020 Non-Par SKGA0 Government GA Medicaid - Georgia (Formerly MC020) Remittance 4010A1 Enrollment

U: 07/01/2020 Non-Par 12K05 Government GA Medicaid - Georgia (Formerly MC020) Institutional 5010A1 Enrollment

A: 11/06/2019 Non-Par SKHI0 Government HI Medicaid - Hawaii (ACS) Professional 5010A1 Enrollment

A: 11/12/2019 Non-Par 12K62 Government HI Medicaid - Hawaii (Formerly SKHI0) Institutional 5010A2 Enrollment Claim Level Ack. Yes

U: 12/06/2019 Non-Par SKID0 Government ID Medicaid - Idaho Professional 4010A1 No Response From Payer Yes

U: 12/06/2019 Non-Par SKID0 Government ID Medicaid - Idaho Remittance 5010A1 Enrollment

A: 11/01/2017 Non-Par 12K07 Government ID Medicaid - Idaho (Formerly SKID0) Institutional 5010A2 Claim Level Ack.

U: 09/05/2019 Non-Par SKIL0 Government IL Medicaid - Illinois (Formerly MC009) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 05/06/2020 Non-Par SKIN0 Government IN Medicaid - Indiana (Formerly MC022) Remittance 5010A1 Enrollment

A: 12/29/2016 Non-Par SKIN0 Medicaid IN Medicaid - Indiana (Formerly MC022) Professional 5010A1 Claim Level Ack.

A: 11/01/2017 Non-Par 12K09 Medicaid IN Medicaid - Indiana (Formerly MC022/SKIN0) Institutional 5010A1 Claim Level Ack. Yes

U: 10/17/2019 Non-Par 12K10 Government IA Medicaid - Iowa (Formerly IC026) Institutional 5010A1 Enrollment

U: 11/04/2019 Non-Par 12K10 Government IA Medicaid - Iowa (Formerly IC026) Remittance 5010A1 Enrollment

U: 05/10/2019 Non-Par SKIA0 Government IA Medicaid - Iowa (Formerly MC026) Professional 5010A1 Enrollment No Response From Payer Yes

U: 05/10/2019 Non-Par SKIA0 Government IA Medicaid - Iowa (Formerly MC026) Remittance 5010A1 Enrollment

A: 07/11/2017 Non-Par SKKS0 Government KS Medicaid - Kansas (Formerly MC012) Professional 5010A1 Yes

U: 05/13/2021 Non-Par SKKS0 Government KS Medicaid - Kansas (Formerly MC012) Remittance 4010A1 Enrollment

U: 10/31/2019 Non-Par 12K11 Government KY Medicaid - Kentucky Institutional 5010A1 Enrollment

U: 10/31/2019 Non-Par 12K11 Government KY Medicaid - Kentucky Remittance 5010A1 Enrollment

U: 10/06/2019 Non-Par 12K12 Government LA Medicaid - Louisiana Institutional 5010A1 Enrollment

U: 10/06/2019 Non-Par 12K12 Government LA Medicaid - Louisiana Remittance 5010A1 Enrollment

U: 09/20/2019 Non-Par SKLA0 Government LA Medicaid - Louisiana (Formerly MC089) Professional 4010A1 Enrollment Claim Level Rejects Only Yes

U: 05/07/2020 Non-Par SKLA0 Government LA Medicaid - Louisiana (Formerly MC128) Remittance 5010A1 Enrollment

U: 11/08/2019 Non-Par SKLA1 Government LA Medicaid - Louisiana - DME (Formerly MC128) Professional 4010A1 Enrollment Claim Level Rejects Only Yes

A: 10/26/2016 Non-Par SKLA1 Government LA Medicaid - Louisiana - DME (Formerly MC128) Institutional 5010A1

A: 11/08/2019 Non-Par SKME0 Government ME Medicaid - Maine Remittance 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



U: 10/31/2019 Non-Par 12K13 Government ME Medicaid - Maine (Formerly MC036 / SKME0) Institutional 5010A1 EnrollmentClaim Level Accept /Reject

U: 02/20/2019 Non-Par SKME0 Government ME Medicaid - Maine (Formerly MC036) Professional 5010A1 Claim Level Rejects Only Yes

U: 09/02/2021 Non-Par 12007 Government MD Medicaid - Maryland (Formerly MC091 / SKMD0) Institutional 5010A1 Enrollment

U: 09/02/2021 Non-Par SKMD0 Government MD Medicaid - Maryland (Formerly MC091) Professional 5010A1 Enrollment No Response From Payer No

U: 09/02/2021 Non-Par SKMD0 Government MD Medicaid - Maryland (Formerly MC091) Remittance 5010A1 Enrollment

U: 12/16/2019 Non-Par SKMA0 Government MA Medicaid - Massachusetts (Formerly MC054) Remittance 4010A1 Enrollment

A: 01/09/2020 Non-Par SKMA0 Government MA Medicaid - Massachusetts (Formerly MC054) Professional 5010A1 Enrollment Yes

A: 10/31/2019 Non-Par 12K14 Government MA Medicaid - Massachusetts (Formerly MC054) Institutional 5010A1 Enrollment

A: 12/03/2021 Non-Par SKMN0 Government MN Medicaid - Minnesota (Formerly MC053) Professional 5010A1 Enrollment No Response From Payer Yes

U: 12/03/2021 Non-Par SKMN0 Government MN Medicaid - Minnesota (Formerly MC053) Remittance 4010A1 Enrollment

A: 12/16/2019 Non-Par 12K16 Government MN Medicaid - Minnesota (Formerly MC053) Institutional 5010A1 Enrollment

U: 01/21/2022 Non-Par 12K17 Commercial Medicaid - Mississippi Remittance 5010A1 Enrollment

A: 12/24/2019 Non-Par 12K15 Medicaid MO Medicaid - Missouri Institutional 5010A1Claim Level Accept /Reject

A: 07/11/2017 Non-Par SKMO0 Government MO Medicaid - Missouri (Formerly MC011) Professional 5010A1 No Response From Payer Yes

U: 11/08/2019 Non-Par SKMO0 Government MO Medicaid - Missouri (Formerly MC011) Remittance 5010A1 Enrollment

A: 07/12/2017 Non-Par SKMT0 Government MT Medicaid - Montana (Formerly MC033) Professional 5010A1 No Response From Payer Yes

U: 11/08/2019 Non-Par SKMT0 Government MT Medicaid - Montana (Formerly MC033) Remittance 4010A1 Enrollment

A: 07/12/2017 Non-Par 12K77 Government Medicaid - Montana (Formerly MC033) Institutional 5010A2 Claim Level Rejects Only Yes

U: 11/04/2019 Non-Par 12K19 Government NE Medicaid - Nebraska Institutional 5010A1 Enrollment

U: 11/04/2019 Non-Par 12K19 Government NE Medicaid - Nebraska Remittance 5010A1 Enrollment

U: 09/01/2021 Non-Par SKNE0 Government NE Medicaid - Nebraska (Formerly MC007) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/20/2019 Non-Par SKNE0 Government NE Medicaid - Nebraska (Formerly MC007) Remittance 5010A1 EnrollmentThis payer requires EFT as part oftheir ERA enrollment.

A: 07/12/2017 Non-Par SKNH0 Government NH Medicaid - New Hampshire (Formerly MC059) Professional 5010A1 Claim Level Rejects Only Yes

U: 11/01/2019 Non-Par SKNH0 Government NH Medicaid - New Hampshire (Formerly MC059) Remittance 5010A1 Enrollment

A: 07/12/2017 Non-Par 12K90 Government Medicaid - New Hampshire (Formerly MC059) Institutional 5010A1 Enrollment

U: 07/28/2021 Non-Par SKNJ0 Government NJ Medicaid - New Jersey (Formerly MC087) Professional 5010A1 Enrollment Yes

U: 07/28/2021 Non-Par SKNJ0 Government NJ Medicaid - New Jersey (Formerly MC087) Remittance 4010A1 Enrollment

U: 06/29/2020 Non-Par 12K35 Government NY Medicaid - New York Remittance 5010A1 Enrollment

ERA will be returned under SKNY0.Providers wishing to receive ERA for12K35 must also enroll under SKNY0on RPA

U: 05/07/2020 Non-Par SKNC0 Government NC Medicaid - North Carolina (Formerly MC021) Professional 5010A1 Enrollment Yes

A: 05/07/2020 Non-Par SKNC0 Government NC Medicaid - North Carolina (Formerly MC021) Remittance4010A1and5010A1

Enrollment

U: 11/13/2019 Non-Par 12K23 Government NC Medicaid - North Carolina (Formerly MC021) Institutional 5010A1 Enrollment

A: 01/11/2018 Non-Par 12K78 Government ND Medicaid - North Dakota (Formerly IC101) Institutional 5010A2 Enrollment Yes ERA's will process under SKND0.

A: 07/12/2017 Non-Par SKND0 Government ND Medicaid - North Dakota (Formerly MC101) Professional 5010A1 Yes

U: 11/14/2019 Non-Par SKND0 Commercial ND Medicaid - North Dakota (Formerly MC101) Remittance 5010A1 Enrollment

A: 07/30/2013 Non-Par IC046 Government OH Medicaid - Ohio Institutional 5010A2Claim Level Accept /Reject

Yes

A: 02/03/2020 Non-Par SKOH0 Government OH Medicaid - Ohio (Formerly MC046) Remittance 5010A1 Enrollment

A: 02/03/2020 Non-Par SKOH0 Government OH Medicaid - Ohio (Formerly MC046) Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/18/2022 Non-Par SKOK0 Government OK Medicaid - Oklahoma (Formerly MC030) Remittance4010A1and5010A1

Enrollment

A: 01/14/2020 Non-Par SKOK0 Government OK Medicaid - Oklahoma (Formerly MC030) Professional 5010A1 No Response From Payer Yes

A: 07/12/2017 Non-Par 12K25 Government Medicaid - Oklahoma (Formerly MC030) Institutional 5010A2 Claim Level Ack. Yes

U: 09/02/2021 Non-Par SKOR0 Government OR Medicaid - Oregon (Formerly MC015) Professional 5010A1 Enrollment No Response From Payer Yes

U: 09/02/2021 Non-Par SKOR0 Government OR Medicaid - Oregon (Formerly MC015) Remittance 5010A1 Enrollment

U: 10/25/2019 Non-Par 12K41 Government OR Medicaid - Oregon (Formerly MC015) Institutional 5010A1 Enrollment

A: 01/10/2022 Non-Par SKPA0 Government PA Medicaid - Pennsylvania (Formerly MC016) Professional 5010A1Claim Level Accept /Reject

U: 09/25/2017 Non-Par SKPA0 Government PA Medicaid - Pennsylvania (Formerly MC016) Remittance 4010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



U: 11/08/2019 Non-Par SKRI0 Government RI Medicaid - Rhode Island (Formerly MC097) Professional 5010A1 Enrollment Yes

U: 11/08/2019 Non-Par SKRI0 Government RI Medicaid - Rhode Island (Formerly MC097) Remittance 4010A1 Enrollment

A: 10/20/2020 Non-Par 12K74 Government RI Medicaid - Rhode Island (Formerly MC097) Institutional 5010A1 EnrollmentFor ERA please enroll for payer IDSKRI0

U: 11/14/2019 Non-Par 12K55 Government SC Medicaid - South Carolina Remittance 5010A1 Enrollment

U: 11/12/2019 Non-Par 12K55 Government SC Medicaid - South Carolina Institutional 5010A1 Enrollment

U: 11/07/2019 Non-Par SKSC0 Government SC Medicaid - South Carolina (Formerly MC024) Professional 5010A1 Enrollment No Response From Payer Yes

U: 11/08/2019 Non-Par SKSC0 Government SC Medicaid - South Carolina (Formerly MC024) Remittance 4010A1 Enrollment

U: 07/12/2021 Non-Par SKSD0 Government SD Medicaid - South Dakota (Formerly MC102) Professional 5010A1 Enrollment YesSecondary claims note: Only acceptsMedicare Crossover claims

U: 07/12/2021 Non-Par SKSD0 Government SD Medicaid - South Dakota (Formerly MC102) Remittance 5010A1 Enrollment

U: 10/31/2019 Non-Par 12K36 Government SD Medicaid - South Dakota (Institutional) Institutional 5010A1 Enrollment Yes

U: 10/31/2019 Non-Par 12K36 Government SD Medicaid - South Dakota (Institutional) Remittance 5010A1 Enrollment

A: 07/10/2018 Non-Par 12K64 Government TX Medicaid - Texas Institutional 5010A1Claim Level Accept /Reject

U: 11/22/2019 Trans 12K42 Government UT Medicaid - Utah Institutional 5010A1 Enrollment

U: 11/14/2019 Non-Par 12K42 Government UT Medicaid - Utah Remittance 5010A1 Enrollment

U: 11/11/2019 Non-Par SKUT0 Government UT Medicaid - Utah (formerly MC044) Professional 5010A1 Enrollment No Response From Payer Yes

U: 11/08/2019 Non-Par SKUT0 Government UT Medicaid - Utah (formerly MC044) Remittance 5010A1 Enrollment

A: 09/13/2021 Non-Par SKVT0 Government VT Medicaid - Vermont (Formerly MC081) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 09/13/2021 Non-Par SKVT0 Government VT Medicaid - Vermont (Formerly MC081) Remittance 4010A1 Enrollment

U: 11/04/2019 Non-Par 12K26 Government VT Medicaid - Vermont (Formerly MC081) Institutional 5010A1 Enrollment

A: 05/05/2020 Non-Par 12K39 Commercial VI Medicaid - Virgin Islands Remittance 5010A1 Enrollment

A: 07/27/2017 Non-Par SKVA0 Government VA Medicaid - Virginia (Formerly MC017) Professional 5010A1 No Response From Payer Yes

U: 10/31/2019 Non-Par SKVA0 Government VA Medicaid - Virginia (Formerly MC017) Remittance 4010A1 Enrollment

A: 07/27/2017 Non-Par 12003 Government Medicaid - Virginia (Formerly MC017) Institutional 5010A2 Claim Level Ack. Yes

U: 11/11/2019 Par 12K27 Government WA Medicaid - Washington Institutional 5010A1 Enrollment

U: 11/11/2019 Non-Par 12K27 Government WA Medicaid - Washington Remittance 5010A1 Enrollment

U: 09/16/2019 Non-Par 12001 Government DC Medicaid - Washington DC Remittance 5010A1 Enrollment

U: 09/16/2019 Non-Par 12001 Government DC Medicaid - Washington DC Institutional 5010A1 Enrollment

A: 07/12/2017 Non-Par SKWV0 Government WV Medicaid - West Virginia (Formerly MC048) Professional 5010A1 Claim Level Rejects Only Yes

U: 08/20/2021 Non-Par SKWV0 Government WV Medicaid - West Virginia (Formerly MC048) Remittance 5010A1 Enrollment

A: 07/12/2017 Non-Par 12K28 Government Medicaid - West Virginia (Formerly MC048) Institutional 5010A2 Yes

A: 07/12/2017 Non-Par SKWI0 Government WI Medicaid - Wisconsin (Formerly MC049) Professional 5010A1 Enrollment No Response From Payer Yes

U: 11/14/2019 Non-Par SKWI0 Government WI Medicaid - Wisconsin (Formerly MC049) Remittance 4010A1 Enrollment

A: 07/12/2017 Non-Par 12K29 Government WI Medicaid - Wisconsin (Formerly MC049) Institutional 5010A2 Claim Level Ack. Yes

U: 09/30/2019 Non-Par 77059 Commercial HI Medicaid Hawaii Waivers Professional 5010A1 Enrollment File Level Ack.

U: 10/05/2015 Non-Par 00621 Government IL Medicaid Illinois IDPA Institutional 5010A2 Yes

U: 09/17/2021 Non-Par SKMS0 Government MS Medicaid Missisippi (Formerly MC019) Professional 5010A1 Enrollment No Response From Payer Yes

U: 09/01/2021 Non-Par SKMS0 Government MS Medicaid Missisippi (Formerly MC019) Remittance 5010A1 Enrollment

U: 01/21/2022 Non-Par 12K17 Government MS Medicaid Missisippi (Formerly MC019) Institutional 5010A1 Enrollment

A: 11/24/2014 Non-Par SKLA4 Government Medicaid of Louisiana Rehab Professional 5010A1 Claim Level Accept/Reject

U: 12/06/2019 Non-Par SKMI0 Medicaid MI Medicaid of Michigan (Formerly MC035) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 11/11/2019 Non-Par SKMI0 Medicaid MI Medicaid of Michigan (Formerly MC035) Remittance 5010A1 Enrollment

U: 11/12/2019 Non-Par 12K37 Government MI Medicaid of Michigan (Formerly SKMI0 / MC035) Institutional 5010A1 Enrollment

U: 01/12/2022 Non-Par 12K46 Commercial TN Medicaid- Tennessee Remittance 5010A1 Enrollment

U: 11/20/2019 Non-Par 12K46 Government TN Medicaid- Tennessee Institutional 5010A1 Enrollment

U: 11/04/2019 Non-Par 12K30 Government WY Medicaid- Wyoming Remittance 5010A1 Enrollment

U: 10/31/2019 Non-Par 12K30 Government WY Medicaid- Wyoming Institutional 5010A1 Enrollment

U: 09/01/2016 Par MAHC1 Commercial MU Medical Associates Health Plan Professional 5010A1Claim LevelAcknowledgement

A: 09/01/2016 Par MAHC1 Commercial Medical Associates Health Plan Institutional 5010A2 Claim Level Ack.

U: 10/07/2019 Non-Par MAHC1 Commercial MU Medical Associates Health Plan Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Medical Ben Admin Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

A: 01/20/2021 Non-Par MBA01 Commercial CA Medical Benefit Administrators Remittance 5010A1 Enrollment

A: 03/25/2021 Non-Par MBA01 Commercial Medical Benefit Administrators Institutional 5010A1Claim Level Accept /Reject

A: 03/25/2021 Non-Par MBA01 Commercial Medical Benefit Adminstrators Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 74323 Commercial Medical Benefits Administrators, Inc. (Newark, OH) Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 74323 Commercial Medical Benefits Companies (Newark, OH) Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 74323 Commercial Medical Benefits Mutual (Newark, OH) Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 74323 Commercial Medical Benefits Mutual (Newark, OH) Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 74323 Commercial Medical Benefits Mutual Life Insurance Co. Institutional 5010A2 No Response From Payer

U: 08/15/2019 Non-Par 74323 Commercial Medical Benefits Mutual Life Insurance Co. Remittance 5010A1 Enrollment

U: 12/23/2021 Non-Par L0170 Commercial PR Medical Card System (MCS) Puerto Rico Remittance 5010A1 EnrollmentCall 1-800-981-4766 (Option 4) toEnroll for ERA

U: 07/22/2021 Non-Par L0170 Commercial PR Medical Card System (MCS) Puerto Rico Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

Electronic Claim Processing is notavailable for US based providers.Providers in Puerto Rico and VirginIslands must be participating tosubmit electronic claims.

U: 07/22/2021 Non-Par L0170 Commercial PR Medical Card System (MCS) Puerto Rico Institutional 5010A2 EnrollmentClaim Level Accept /Reject

Electronic Claim Processing is notavailable for US based providers.Providers in Puerto Rico and VirginIslands must be participating tosubmit electronic claims.

A: 03/19/2018 Par 24245 Commercial CA Medical Eye Services Professional 5010A1 No Response From Payer No

U: 02/21/2017 Par 29076 Commercial Medical Mutual of Ohio (Formerly BC004) Institutional 5010A2 No Response From Payer Yes

U: 09/24/2019 Non-Par 29076 Commercial Medical Mutual of Ohio (Formerly BC004) Remittance 5010A1 Enrollment

U: 02/21/2017 Par 29076 Commercial Medical Mutual of Ohio (Formerly BC004) Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62177 Commercial Medical Reimbursements of America Institutional 4010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 62177 Commercial MU Medical Reimbursements of America Professional 5010A1Claim LevelAcknowledgement

Yes

A: 08/08/2014 Non-Par 58203 Commercial Medical Resource Network (MRN) Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 58203 Commercial Medical Resource Network (MRN) Professional 5010A1Claim Level Accept /Reject

A: 06/10/2016 Non-Par AMM02 Commercial Medical Services for Indigents Professional 5010A1Claim Level Accept /Reject

A: 06/10/2016 Non-Par AMM02 Commercial Medical Services for Indigents Institutional 5010A1Claim Level Accept /Reject

U: 01/02/2020 Par 38224 Commercial Medical Value Plan - Ohio (MVP) Institutional 5010A2Claim Level Accept /Reject

U: 06/25/2015 Par 38224 Commercial OH Medical Value Plan-MVP-OH Professional 5010A1 Claim Level Rejects Only No

Secondary Claims are not acceptedat MVP for electronic processing. AllSecondary Claims should besubmitted on paper and a copy of thepayer EOB must be included. Addresson back of member id card should beused for mailing address to submitSecondary Claims.

U: 04/30/2020 Non-Par SMAL0 Government AL Medicare - Alabama (Formerly MR054) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 04/29/2020 Non-Par SMAL0 Government AL Medicare - Alabama (Formerly MR054) Remittance 4010A1 Enrollment

U: 11/07/2019 Non-Par SMAK0 Government AK Medicare - Alaska (Formerly MR010) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/04/2021 Non-Par SMAK0 Government AK Medicare - Alaska (Formerly MR010) Remittance 5010A1 Enrollment

U: 11/12/2021 Non-Par SMAZ0 Government AZ Medicare - Arizona (Formerly MR008) Remittance 5010A1 Enrollment

U: 11/07/2019 Non-Par SMAZ0 Government AZ Medicare - Arizona (Formerly MR008) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/22/2019 Non-Par 12M02 Commercial AZ Medicare - Arizona Institutional (Formerly IR008) Institutional 5010A1 Enrollment Yes

U: 11/18/2019 Non-Par 12M02 Medicare AZ Medicare - Arizona Institutional (Formerly IR008) Remittance 5010A1 Enrollment

U: 01/13/2020 Non-Par SMAR0 Government AR Medicare - Arkansas (formerly MR055) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



U: 01/14/2020 Non-Par SMAR0 Government AR Medicare - Arkansas (formerly MR055) Remittance 5010A1 Enrollment

U: 01/13/2020 Non-Par 12022 Government AR Medicare - Arkansas Part A (formerly IR055) Institutional 5010A2 EnrollmentClaim Level Accept /Reject

Yes

U: 01/14/2020 Non-Par 12022 Commercial AR Medicare - Arkansas Part A (formerly IR055) Remittance 5010A1 Enrollment

U: 09/13/2021 Non-Par SMCA1 Government CAMedicare - California - Northern Region (FormerlyMR002)


U: 05/20/2020 Non-Par SMCA1 Government CAMedicare - California - Northern Region (FormerlyMR002)

Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 04/29/2020 Non-Par SMCA2 Government CAMedicare - California - Southern Region (FormerlyMR001)


U: 09/14/2021 Non-Par SMCA2 Government CAMedicare - California - Southern Region (FormerlyMR001)


U: 11/25/2019 Non-Par 12M03 Government CO Medicare - Colorado Institutional 5010A1 Enrollment

U: 11/18/2019 Non-Par 12M03 Government CO Medicare - Colorado Remittance 5010A1 Enrollment

U: 11/26/2019 Non-Par SMCO0 Government CO Medicare - Colorado (formerly MR004) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 11/06/2019 Non-Par SMCO0 Government CO Medicare - Colorado (formerly MR004) Remittance 5010A1 Enrollment

U: 09/21/2021 Non-Par SMCT0 Government CT Medicare - Connecticut (formerly MR049) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/05/2019 Non-Par SMCT0 Government CT Medicare - Connecticut (formerly MR049) Remittance 5010A1 Enrollment

A: 12/02/2015 Non-Par 12M04 Government CT Medicare - Connecticut Remittance 5010A1 Enrollment

U: 11/22/2019 Non-Par 12M04 Government CT Medicare - Connecticut Institutional 5010A1 Enrollment

U: 11/18/2019 Non-Par 12M04 Government CT Medicare - Connecticut Remittance 5010A1 Enrollment

U: 09/15/2021 Non-Par 12M76 Government DE Medicare - Delaware Institutional 5010A1 Enrollment

U: 01/15/2020 Non-Par 12M76 Government DE Medicare - Delaware Remittance 5010A1 Enrollment

U: 01/13/2020 Non-Par SMDE0 Government DE Medicare - Delaware (formerly MR039) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 01/15/2020 Non-Par SMDE0 Government DE Medicare - Delaware (formerly MR039) Remittance 4010A1 Enrollment

U: 01/15/2020 Non-Par SMDC0 Government DC Medicare - District of Columbia (formerly MR040) Remittance 4010A1 Enrollment

U: 01/13/2020 Non-Par SMDC0 Government DC Medicare - District of Columbia (formerly MR040) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 01/22/2020 Non-Par 12M34 Government FL Medicare - Florida Part A (J9 First Coast) Remittance 5010A1 Enrollment

U: 01/17/2020 Non-Par 12M34 Government FLMedicare - Florida Part A (J9 First Coast) (FormerlyMR025)


U: 09/03/2020 Non-Par SMFL0 Government FLMedicare - Florida Part B (J9 First Coast) (FormerlyMR025)


U: 09/03/2020 Non-Par SMFL0 Government FLMedicare - Florida Part B (J9 First Coast) (FormerlyMR025)


U: 11/20/2019 Non-Par SMGA0 Government GA Medicare - Georgia (Formerly MR015) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 11/20/2019 Non-Par SMGA0 Government GA Medicare - Georgia (Formerly MR015) Remittance 4010A1 Enrollment

U: 11/22/2019 Non-Par 12M05 Government GA Medicare - Georgia Institutional 5010A1 Enrollment

U: 11/18/2019 Non-Par 12M05 Government GA Medicare - Georgia Remittance 5010A1 Enrollment

U: 05/10/2019 Non-Par SMHI0 Government HI Medicare - Hawaii (Formerly MR057) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 05/10/2019 Non-Par SMHI0 Government HI Medicare - Hawaii (Formerly MR057) Remittance 5010A1 Enrollment

U: 11/22/2019 Non-Par 12M07 Government ID Medicare - Idaho Institutional 5010A1 Enrollment

U: 09/16/2021 Non-Par 12M07 Government ID Medicare - Idaho Remittance 5010A1 Enrollment

U: 05/10/2019 Non-Par SMID0 Government ID Medicare - Idaho (Formerly MR003) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/09/2021 Non-Par SMID0 Government ID Medicare - Idaho (Formerly MR003) Remittance 5010A1 Enrollment

U: 11/22/2019 Non-Par 12M08 Government IL Medicare - Illinois Institutional 5010A1 Enrollment

U: 11/18/2019 Non-Par 12M08 Government IL Medicare - Illinois Remittance 5010A1 Enrollment

U: 01/31/2022 Non-Par SMIL0 Government IL Medicare - Illinois (formerly MR023) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/18/2019 Non-Par SMIL0 Government IL Medicare - Illinois (formerly MR023) Remittance 5010A1 Enrollment

U: 10/16/2019 Non-Par SMIN0 Government IN Medicare - Indiana (Formerly MR041) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 11/12/2020 Non-Par SMIN0 Government IN Medicare - Indiana (Formerly MR041) Remittance 4010A1 Enrollment

U: 11/22/2019 Non-Par 12M10 Government IA Medicare - Iowa Institutional 5010A1 Enrollment

U: 11/18/2019 Non-Par 12M10 Government IA Medicare - Iowa Remittance 5010A1 Enrollment

U: 11/20/2019 Non-Par SMIA0 Government IA Medicare - Iowa (Formerly MR036) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 12/03/2020 Non-Par SMIA0 Government IA Medicare - Iowa (Formerly MR036) Remittance 4010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



and5010A1

U: 12/17/2019 Non-Par SMKS0 Government KS Medicare - Kansas (Formerly MR060) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 12/03/2020 Non-Par SMKS0 Government KS Medicare - Kansas (Formerly MR060) Remittance4010A1and5010A1

Enrollment

A: 10/15/2019 Non-Par 57324 Government KS Medicare - Kansas Part A (Formerly IR060) Institutional 5010A2 EnrollmentClaim Level Accept /Reject

Yes

A: 11/16/2021 Non-Par 57324 Commercial KS Medicare - Kansas Part A (Formerly IR060) Remittance 5010A1 Enrollment

A: 02/22/2021 Non-Par 12M11 Commercial KY Medicare - Kentucky (Formerly IR052) Institutional 5010A2 EnrollmentClaim Level Accept /Reject

Yes

A: 02/22/2021 Non-Par 12M11 Commercial KY Medicare - Kentucky (Formerly IR052) Remittance 5010A1 Enrollment

A: 07/15/2020 Non-Par SMKY0 Government KY Medicare - Kentucky (Formerly MR052) Remittance 4010A1 Enrollment

A: 07/15/2020 Non-Par SMKY0 Government KY Medicare - Kentucky (Formerly MR052) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 11/18/2019 Non-Par 12M12 Government LA Medicare - Louisiana Remittance 5010A1 Enrollment

U: 11/25/2019 Non-Par 12M12 Government LA Medicare - Louisiana Institutional 5010A1 Enrollment

U: 09/08/2021 Non-Par SMLA0 Government LA Medicare - Louisiana (formerly MR048) Remittance 5010A1 Enrollment

U: 09/08/2021 Non-Par SMLA0 Government LA Medicare - Louisiana (formerly MR048) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 11/22/2019 Non-Par 12M13 Government ME Medicare - Maine Institutional 5010A1 Enrollment

U: 11/18/2019 Non-Par 12M13 Government ME Medicare - Maine Remittance 5010A1 Enrollment

U: 11/06/2019 Non-Par SMME0 Government ME Medicare - Maine (formerly MR043) Remittance 5010A1 Enrollment

U: 11/06/2019 Non-Par SMME0 Government ME Medicare - Maine (formerly MR043) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 09/15/2021 Non-Par 12010 Government MD Medicare - Maryland (formerly IR038) Institutional 5010A2 EnrollmentClaim Level Accept /Reject

Yes

U: 01/15/2020 Non-Par 12010 Government MD Medicare - Maryland (formerly IR038) Remittance 5010A1 Enrollment

U: 09/02/2021 Non-Par SMMD0 Government MD Medicare - Maryland (formerly MR038) Remittance 4010A1 Enrollment

U: 09/02/2021 Non-Par SMMD0 Government MD Medicare - Maryland (formerly MR038) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/12/2019 Non-Par 12M14 Government MA Medicare - Massachusetts Institutional 5010A1 Enrollment

U: 11/12/2019 Non-Par 12M14 Government MA Medicare - Massachusetts Remittance 5010A1 Enrollment

U: 11/20/2019 Non-Par SMMA0 Government MA Medicare - Massachusetts (formerly MR061) Remittance 5010A1 Enrollment

U: 11/20/2019 Non-Par SMMA0 Government MA Medicare - Massachusetts (formerly MR061) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/20/2019 Non-Par 12M18 Government MI Medicare - Michigan Institutional 5010A1 Enrollment

U: 11/18/2019 Non-Par 12M18 Government MI Medicare - Michigan Remittance 5010A1 Enrollment

U: 12/03/2020 Non-Par SMMI0 Government MI Medicare - Michigan (Formerly MR017) Remittance4010A1and5010A1

Enrollment

U: 10/16/2019 Non-Par SMMI0 Government MI Medicare - Michigan (Formerly MR017) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/19/2019 Non-Par 12M16 Government MN Medicare - Minnesota Institutional 5010A1 Enrollment

U: 09/14/2021 Non-Par 12M16 Government MN Medicare - Minnesota Remittance 5010A1 Enrollment

U: 06/07/2019 Non-Par SMMN0 Government MN Medicare - Minnesota (formerly MR019) Remittance 5010A1 Enrollment

U: 06/07/2019 Non-Par SMMN0 Government MN Medicare - Minnesota (formerly MR019) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/06/2019 Non-Par SMMS0 Government MS Medicare - Mississippi (formerly MR050) Remittance 5010A1 Enrollment

U: 01/13/2020 Non-Par SMMS0 Government MS Medicare - Mississippi (formerly MR050) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/15/2019 Non-Par 12M17 Government MS Medicare - Mississippi (Part A) Remittance 5010A1 Enrollment

U: 11/25/2019 Non-Par 12M17 Government MS Medicare - Mississippi (Part A) Institutional 5010A1 Enrollment

U: 12/03/2020 Non-Par SMMO0 Government MO Medicare - Missouri (Formerly MR044) Remittance4010A1and5010A1

Enrollment

U: 10/16/2019 Non-Par SMMO0 Government MO Medicare - Missouri (Formerly MR044) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 10/16/2019 Non-Par 12M77 Government MT Medicare - Montana Institutional 5010A1 Enrollment

U: 09/16/2021 Non-Par 12M77 Government MT Medicare - Montana Remittance 5010A1 Enrollment

U: 11/15/2019 Non-Par SMMT0 Government MT Medicare - Montana (Formerly MR047) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 11/15/2019 Non-Par SMMT0 Government MT Medicare - Montana (Formerly MR047) Remittance 4010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



and5010A1

U: 12/03/2020 Non-Par SMNE0 Government NE Medicare - Nebraska (Formerly MR092) Remittance4010A1and5010A1

Enrollment

U: 10/16/2019 Non-Par SMNE0 Government NE Medicare - Nebraska (Formerly MR092) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 11/20/2019 Non-Par 12M19 Government NE Medicare - Nebraska (Formerly MR092) Institutional 5010A1 Enrollment

U: 11/14/2019 Non-Par SMNV0 Government NV Medicare - Nevada (Formerly MR007) Remittance 5010A1 Enrollment

U: 11/11/2019 Non-Par SMNV0 Government NV Medicare - Nevada (Formerly MR007) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/18/2019 Non-Par 12M21 Government NH Medicare - New Hampshire Remittance 5010A1 Enrollment

U: 09/19/2019 Non-Par 12M21 Government NH Medicare - New Hampshire Institutional 5010A1 Enrollment

A: 12/02/2015 Non-Par 12M21 Government NH Medicare - New Hampshire Remittance 5010A1 Enrollment

U: 11/06/2019 Non-Par SMNH0 Government NH Medicare - New Hampshire (formerly MR051) Remittance 5010A1 Enrollment

U: 11/06/2019 Non-Par SMNH0 Government NH Medicare - New Hampshire (formerly MR051) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 01/17/2020 Non-Par 12005 Government NJ Medicare - New Jersey (formerly IR035) Remittance 5010A1 Enrollment

U: 10/12/2021 Non-Par 12005 Government NJ Medicare - New Jersey (formerly IR035) Institutional 5010A2 EnrollmentClaim Level Accept /Reject

Yes

U: 11/26/2019 Non-Par SMNJ0 Government NJ Medicare - New Jersey (formerly MR035) Remittance 4010A1 Enrollment

U: 01/13/2020 Non-Par SMNJ0 Government NJ Medicare - New Jersey (formerly MR035) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 01/14/2020 Non-Par 12M22 Government NM Medicare - New Mexico Remittance 5010A1 Enrollment

U: 09/15/2021 Non-Par 12M22 Government NM Medicare - New Mexico Institutional 5010A1 Enrollment

A: 12/03/2015 Non-Par 12M22 Government NM Medicare - New Mexico Remittance 5010A1 Enrollment

U: 09/08/2021 Non-Par SMNM0 Government NM Medicare - New Mexico (formerly MR076) Remittance 5010A1 Enrollment

U: 09/08/2021 Non-Par SMNM0 Government NM Medicare - New Mexico (formerly MR076) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 09/19/2019 Non-Par 12M35 Government NY Medicare - New York (Part A) Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 10/11/2019 Non-Par 12M35 Government NY Medicare - New York (Part A) Remittance 5010A1 Enrollment

U: 11/26/2019 Non-Par SMNY2 Government NY Medicare - New York (Queens) ((formerly MR045) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/21/2019 Non-Par SMNY2 Government NY Medicare - New York (Queens) ((formerly MR045) Remittance 5010A1 Enrollment

U: 05/20/2020 Non-Par SMNC0 Government NC Medicare - North Carolina (Formerly MR020) Remittance 5010A1 Enrollment

U: 05/14/2020 Non-Par SMNC0 Government NC Medicare - North Carolina (Formerly MR020) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 10/17/2019 Non-Par 12M82 Government ND Medicare - North Dakota Institutional 5010A1 Enrollment

U: 11/15/2019 Non-Par 12M82 Government ND Medicare - North Dakota Remittance 5010A1 Enrollment

U: 05/09/2019 Non-Par SMND0 Government ND Medicare - North Dakota (Formerly MR083) Remittance 5010A1 Enrollment

U: 11/05/2019 Non-Par SMND0 Government ND Medicare - North Dakota (Formerly MR083) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/20/2019 Non-Par SMNY0 Government NY Medicare - NY (Downstate/Empire) (formerly MR042) Remittance 5010A1 Enrollment

U: 11/20/2019 Non-Par SMNY0 Government NY Medicare - NY (Downstate/Empire) (formerly MR042) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 10/25/2019 Non-Par SMNY1 Government NY Medicare - NY (Upstate/Albany) (formerly MR059) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 10/25/2019 Non-Par SMNY1 Government NY Medicare - NY (Upstate/Albany) (formerly MR059) Remittance 5010A1 Enrollment

A: 12/01/2020 Non-Par 12M24 Government OH Medicare - Ohio (Formerly IR033) Institutional 5010A2 Enrollment Claim Level Rejects Only Yes

A: 12/01/2020 Non-Par 12M24 Government OH Medicare - Ohio (Formerly MR033) Remittance 5010A1 Enrollment

U: 01/13/2020 Non-Par 12M37 Government OK Medicare - Oklahoma Institutional 5010A1 Enrollment

U: 01/14/2020 Non-Par 12M37 Government OK Medicare - Oklahoma Remittance 5010A1 Enrollment

U: 09/08/2021 Non-Par SMOK0 Government OK Medicare - Oklahoma (formerly MR013) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 09/08/2021 Non-Par SMOK0 Government OK Medicare - Oklahoma (formerly MR013) Remittance 5010A1 Enrollment

U: 09/16/2019 Trans 12M41 Government OR Medicare - Oregon Institutional 5010A1 Enrollment

U: 09/16/2021 Non-Par 12M41 Government OR Medicare - Oregon Remittance 5010A1 Enrollment

U: 06/16/2020 Non-Par SMOR0 Government OR Medicare - Oregon (Formerly MR011) Remittance 5010A1 Enrollment

U: 11/08/2019 Non-Par SMOR0 Government OR Medicare - Oregon (Formerly MR011) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 01/13/2020 Non-Par 12M60 Government PA Medicare - Pennsylvania (formerly IR027) Institutional 5010A2 EnrollmentClaim Level Accept /Reject

Yes

U: 01/15/2020 Non-Par 12M60 Commercial PA Medicare - Pennsylvania (formerly IR027) Remittance 5010A1 Enrollment

U: 09/08/2021 Non-Par SMPA0 Government PA Medicare - Pennsylvania (formerly MR027) Remittance 4010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/08/2021 Non-Par SMPA0 Government PA Medicare - Pennsylvania (formerly MR027) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 01/13/2020 Non-Par SMPR0 Government PR Medicare - Puerto Rico Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 09/16/2019 Non-Par 12M49 Government PR Medicare - Puerto Rico Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Yes ERA is processed under 12M52

U: 01/22/2020 Non-Par SMPR0 Government PR Medicare - Puerto Rico Remittance 5010A1 Enrollment

U: 10/16/2019 Non-Par 12M74 Government RI Medicare - Rhode Island Institutional 5010A1 Enrollment

U: 11/14/2019 Non-Par SMRI0 Government RI Medicare - Rhode Island (formerly MR075) Remittance 5010A1 Enrollment

U: 11/18/2019 Non-Par SMRI0 Government RI Medicare - Rhode Island (formerly MR075) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/27/2019 Non-Par SMSC0 Government SC Medicare - South Carolina (Formerly MR028) Remittance 5010A1 Enrollment

U: 11/08/2019 Non-Par SMSC0 Government SC Medicare - South Carolina (Formerly MR028) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 10/17/2019 Non-Par 12M83 Government SD Medicare - South Dakota (Formerly IR084) Institutional 5010A2 Enrollment Yes

U: 09/16/2021 Non-Par 12M83 Government SD Medicare - South Dakota (Formerly IR084) Remittance 5010A1 Enrollment

U: 11/14/2019 Non-Par SMSD0 Government SD Medicare - South Dakota (Formerly MR084) Remittance 5010A1 Enrollment

U: 11/08/2019 Non-Par SMSD0 Government SD Medicare - South Dakota (Formerly MR084) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 11/14/2019 Non-Par SMTN0 Government TN Medicare - Tennessee (Formerly MR034) Remittance 4010A1 Enrollment

U: 11/18/2019 Non-Par SMTN0 Government TN Medicare - Tennessee (Formerly MR034) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 10/14/2019 Non-Par 12M53 Government TN Medicare - Tennessee Part A (Formerly IR034) Remittance 4010A1 Enrollment

U: 10/15/2019 Non-Par 12M53 Government TN Medicare - Tennessee Part A (Formerly IR034) Institutional 5010A2 Enrollment Yes

U: 09/02/2021 Non-Par SMTX0 Government TX Medicare - Texas (formerly MR005) Remittance 5010A1 Enrollment

U: 09/02/2021 Non-Par SMTX0 Government TX Medicare - Texas (formerly MR005) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 09/15/2021 Non-Par 12M31 Government TX Medicare - Texas Part A (formerly IR005) Institutional 5010A2 Enrollment Yes

U: 01/14/2020 Non-Par 12M31 Government TX Medicare - Texas Part A (formerly IR005) Remittance 5010A1 Enrollment

U: 09/15/2021 Non-Par 12M84 Government UT Medicare - Utah Remittance 5010A1 Enrollment

U: 10/17/2019 Non-Par 12M84 Government UT Medicare - Utah Institutional 5010A1 Enrollment

U: 04/16/2020 Non-Par SMUT0 Government UT Medicare - Utah (Formerly MR046) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 04/17/2020 Non-Par SMUT0 Government UT Medicare - Utah (Formerly MR046) Remittance 5010A1 Enrollment

U: 09/19/2019 Non-Par 12M26 Government VT Medicare - Vermont Institutional 5010A1 Enrollment

U: 10/10/2019 Non-Par 12M26 Government VT Medicare - Vermont Remittance 5010A1 Enrollment

U: 11/20/2019 Non-Par SMVT0 Government VT Medicare - Vermont (formerly MR062) Remittance 5010A1 Enrollment

U: 11/18/2019 Non-Par SMVT0 Government VT Medicare - Vermont (formerly MR062) Professional 4010A1 Enrollment

U: 01/17/2020 Non-Par SMVI0 Government VI Medicare - Virgin Island Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 01/22/2020 Non-Par SMVI0 Commercial VI Medicare - Virgin Island (Part B) Remittance 5010A1 Enrollment

U: 10/12/2021 Non-Par 12004 Government VA Medicare - Virginia Institutional 5010A1 Enrollment

U: 09/16/2019 Non-Par 12004 Government VA Medicare - Virginia Remittance 5010A1 Enrollment

U: 09/16/2019 Non-Par 12M45 Government WA Medicare - Washington Institutional 5010A1 Enrollment

U: 09/16/2021 Non-Par 12M45 Government WA Medicare - Washington Remittance 5010A1 Enrollment

U: 11/04/2019 Non-Par SMWA0 Government WA Medicare - Washington (Formerly MR006) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 10/08/2019 Non-Par SMWA0 Government WA Medicare - Washington (Formerly MR006) Remittance 5010A1 Enrollment

U: 10/16/2019 Non-Par 12M63 Commercial DC Medicare - Washington DC (Institutional) Remittance 5010A1 Enrollment

ERA processing for Payer ID: 12M63will return ERAs under Payer ID:12010. Please request and completeenrollment under Payer ID: 12010 aswell.

U: 01/13/2020 Non-Par 12M63 Government DC Medicare - Washington DC (Institutional) Institutional 5010A1 Enrollment

U: 09/16/2019 Non-Par 12M28 Government WV Medicare - West Virginia Institutional 5010A1 Enrollment

U: 11/13/2019 Non-Par 12M28 Government WV Medicare - West Virginia Remittance 5010A1 Enrollment

ERA processing for Payer ID: 12M28will return ERAs under Payer ID:12004. Please request and completethe enrollment under Payer ID: 12004

A: 11/08/2019 Non-Par SMWV0 Government WV Medicare - West Virginia (Formerly MR056) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 11/26/2019 Non-Par SMWV0 Government WV Medicare - West Virginia (Formerly MR056) Remittance 4010A1 Enrollment

U: 10/10/2019 Non-Par 12M29 Government WI Medicare - Wisconsin (formerly IR053) Remittance 5010A1 Enrollment

U: 09/19/2019 Non-Par 12M29 Government WI Medicare - Wisconsin (formerly IR053) Institutional 5010A2 Enrollment YesWI Medicare Part A and FQHC sitesfor all states except AZ, MT, ND, SD,UT and WY

Updated: 03/21/2022


PPAAYERYERIDID



U: 02/02/2022 Non-Par SMWI0 Government WI Medicare - Wisconsin (formerly MR053) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 02/04/2022 Non-Par SMWI0 Government WI Medicare - Wisconsin (formerly MR053) Remittance 5010A1 Enrollment

U: 09/15/2021 Non-Par 12M30 Government WY Medicare - Wyoming (Formerly IR074) Remittance 5010A1 Enrollment

U: 09/16/2019 Non-Par 12M30 Government WY Medicare - Wyoming (Formerly IR074) Institutional 5010A2 EnrollmentClaim Level Accept /Reject

Yes

U: 11/08/2019 Non-Par SMWY0 Government WY Medicare - Wyoming (Formerly MR074) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 09/13/2021 Non-Par SMWY0 Government WY Medicare - Wyoming (Formerly MR074) Remittance 5010A1 Enrollment

U: 09/16/2019 Non-Par MADME Medicare CT Medicare Advantage DME (DMENSION) Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 10/08/2019 Non-Par GPND1 Commercial ND Medicare Advantage of North Dakota Remittance 5010A1 Enrollment

A: 02/16/2021 Non-Par 55892 Commercial NDMedicare Advantage Plan (NextBlue) /NextBlue ofNorth Dakota


Yes

A: 02/16/2021 Non-Par 55892 Commercial NDMedicare Advantage Plan (NextBlue) /NextBlue ofNorth Dakota


Yes

A: 11/24/2014 Non-Par SX263 Commercial Medicare Blue Professional 5010A1 Claim Level Ack.

A: 11/24/2014 Non-Par SX262 Commercial Medicare Blue Private Professional 5010A1 Claim Level Ack.

U: 11/04/2019 Non-Par 12HHA Commercial Medicare HHH (J14 - NHIC) Remittance 5010A1 Enrollment

U: 11/26/2019 Non-Par 12HHA Government MU Medicare Home Helath & Hospice (J14 - NHIC) Institutional 5010A1 Enrollment Includes CT, ME, MA, NH, RI, VT.

U: 11/22/2019 Non-Par 12M09 Government IN Medicare Indiana (Formerly IR041) Institutional 5010A2 EnrollmentClaim Level Accept /Reject

U: 11/18/2019 Non-Par 12M09 Commercial IN Medicare Indiana (Formerly IR041) Remittance 5010A1 Enrollment

U: 09/18/2019 Non-Par 52280 Government MOMedicare J5 National institutional (Former Mutual ofOmaha Workload) (Formerly IR063)


U: 11/18/2019 Non-Par 12M19 Commercial NE Medicare Nebraska (Formerly MR092) Remittance 5010A1 Enrollment

U: 09/16/2021 Non-Par 12M65 Government Medicare Part A (CAHINV) Remittance 5010A1 Enrollment

U: 07/11/2015 Non-Par SX170 Commercial MI Medicare Plus Blue Remittance 5010A1 Enrollment

This is a Medicare Advantage Plan forBCBS of Michigan. ERA processingand enrollment for payer id SX170 isavailable under SB710

U: 10/18/2019 12M74 Government RI Medicare Rhode Island Remittance 5010A1 Enrollment

U: 10/14/2019 Non-Par 12M52 Government VI Medicare Virgin Islands Institutional 5010A1 Enrollment

U: 01/22/2020 Non-Par 12M52 Government VI Medicare Virgin Islands Remittance 5010A1 EnrollmentIncludes ERA for 12M49 - Same Sub IDand Contractor Code

U: 03/01/2017 Non-Par L0210 Commercial PR Medicare y Mucho Mas (MMM) Remittance 5010A1 Enrollment

A: 06/06/2013 Non-Par L0210 Commercial PR Medicare y Mucho Mas (MMM) Professional 5010A1Claim Level Accept /Reject

No

A: 12/05/2014 Non-Par L0210 Commercial Medicare Y Mucho Mas (MMM) Institutional 5010A2 Claim Level Accept/Reject

A: 09/22/2021 Non-Par 23160 Commercial Medico Insurance Company Remittance 5010A1 Enrollment

U: 12/02/2019 Par 95655 Commercial MediGold Professional 5010A1

All requests for ERA must beauthorized by the provider's officeand not any third party affiliate.Providers call Provider Service Line @1-800-991-9907 to obtain the formsto be initiated and filled out by theprovider's office.

A: 08/24/2021 Non-Par Z9567 Commercial CA Medimpact Remittance 5010A1 Enrollment

A: 10/05/2016 Non-Par J1956 Workers' Comp MU Medrisk Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/22/2016 Non-Par J1956 Commercial Medrisk Remittance 5010A1 Enrollment

A: 11/24/2014 Non-Par 15395 Commercial Medsolutions Post accute Care Professional 5010A1 No Response From Payer

A: 12/05/2014 Non-Par 15395 Commercial Medsolutions Post accute Care Institutional 5010A2 No Response From Payer

U: 01/27/2012 Non-Par 62160 Commercial GA MedSolutions, Inc. Institutional 5010A2 No Response From Payer

U: 08/15/2019 Non-Par 62160 Commercial GA MedSolutions, Inc. Of Georgia Remittance 5010A1 Enrollment

U: 03/29/2012 Non-Par 62160 Commercial GA MedSolutions, Inc. of Georgia Professional 5010A1Claim LevelAcknowledgement

A: 10/23/2020 Non-Par DCMED Commercial WI MedStar DC Professional 5010A1Claim Level Accept /Reject

No

A: 10/23/2020 Non-Par DCMED Commercial WI MedStar DC Professional 5010A1Claim Level Accept /Reject

No

A: 10/23/2020 Non-Par DCMED Commercial WI MedStar DC Institutional 5010A1 Claim Level Accept / No

Updated: 03/21/2022


PPAAYERYERIDID



Reject

A: 10/23/2020 Non-Par DCMED Commercial WI MedStar DC Institutional 5010A1Claim Level Accept /Reject

No

U: 04/27/2016 Par 00243 Commercial MedStar Family Choice Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/25/2021 Par 39190 Commercial MU MedStar Family Choice Professional 5010A1Claim Level Accept /Reject

A: 03/25/2021 Par 39190 Commercial MU MedStar Family Choice Institutional 5010A1Claim Level Accept /Reject

U: 03/25/2021 Non-Par 39190 Commercial MedStar Family Choice Remittance 5010A1 Enrollment

A: 09/01/2016 Par 251MS Commercial Medstar Select- Medicare Choice Professional 5010A1 No Response From Payer Yes

A: 09/01/2016 Par 251MS Commercial Medstar Select- Medicare Choice Institutional 5010A2 No Response From Payer Yes

U: 11/11/2019 Non-Par 251MS Commercial Medstar Select- Medicare Choice Remittance 5010A1 Enrollment

A: 05/09/2014 Non-Par 11030 Workers' Comp MEMIC Prof. Work Comp 5010A1 File Level Ack.

A: 01/28/2020 Non-Par 11030 Workers' Comp MEMIC Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Memorial Health Services Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 10/03/2016 Non-Par TH092 Commercial Memorial Hermann Health (formerly MHHNP) Professional 5010A1

A: 10/03/2016 Trans TH092 Commercial Memorial Hermann Health (formerly MHHNP) Institutional 5010A2

A: 01/24/2022 Par 85461 Commercial CA Memorial Medical Center - Allcare Professional 5010A1Claim Level Accept /Reject

No

A: 12/07/2018 Par 85461 Commercial CA Memorial Medical Center - Allcare Institutional 5010A1Claim Level Accept /Reject

No

U: 01/25/2022 Non-Par 85461 Commercial MEMORIAL MEDICAL CENTER - ALLCARE Remittance 5010A1 Enrollment

By enrolling in this payer you areenrolling to receive ERAs from bothpayor IDs 77302 - Sutter GouldMedical Foundation & 85461 -Memorial Medical Center.

A: 03/08/2017 Par 26080 Commercial CAMemorialCare Medical Foundation (FormerlyMMFMC)


A: 03/08/2017 Par 26080 Commercial CAMemorialCare Medical Foundation (FormerlyMMFMC)


A: 09/27/2021 Non-Par 46187 Commercial CA MemorialCare Select Health Plan Professional 5010A1 No

A: 09/27/2021 Non-Par 46187 Commercial MemorialCare Select Health Plan Institutional 5010A1Claim Level Accept /Reject

A: 10/01/2021 Non-Par 46187 Commercial CA MemorialCare Select Health Plan Remittance 5010A1 Enrollment

A: 08/08/2014 Non-Par 36193 Commercial Memphis Managed Care / TLC Institutional 5010A2

A: 02/26/2018 Trans 37050 Commercial PA Mental Health Consultants, Inc Professional 5010A1 Claim Level Ack. No

A: 02/26/2018 Trans 37050 Commercial PA Mental Health Consultants, Inc. Institutional 5010A1 Claim Level Ack.

A: 09/14/2017 Par 86087 Commercial AZ Merchants Benefit Administration Professional 5010A1 No Response From Payer No

A: 09/14/2017 Par 86087 Commercial AZ Merchants Benefit Administration Institutional 5010A1 No Response From Payer No

U: 09/01/2016 Par 86052 Commercial AZ Mercy Care Plan (AHCCCS) Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 86052 Commercial AZ Mercy Care Plan (AHCCCS) Institutional 5010A2Claim Level Accept /Reject

U: 06/01/2020 Non-Par 86052 Commercial AZ Mercy Care Plan (AHCCCS) Remittance 5010A1 Enrollment

A: 07/29/2019 Non-Par 33628 CommercialMercy Care RBHA (formerly Mercy MaricopaIntegrated Care)


A: 07/29/2019 Par 33628 CommercialMercy Care RBHA (formerly Mercy MaricopaIntegrated Care)


U: 07/29/2019 Non-Par 33628 CommercialMercy Care RBHA (formerly Mercy MaricopaIntegrated Care)


U: 01/10/2017 Trans E3510 Commercial CA Mercy Physicians Medical Group - San Diego - MPMG Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 39114 Commercial Mercycare Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 39114 Commercial Mercycare Professional 5010A1Claim Level Accept /Reject

A: 12/06/2021 Non-Par 39114 Commercial MercyCare Remittance 5010A1 EnrollmentECHO is returning 835s for payer ID39114. Providers will need to enrollfor payer IDs 39114 and 58379 in

Updated: 03/21/2022


PPAAYERYERIDID



order to receive 835s for this payer.

A: 12/06/2021 Non-Par 58379 Commercial MercyCare (Formerly 39114) Remittance 5010A1 Enrollment


A: 04/22/2021 Non-Par MCCIL Commercial IL Meridian Complete Illinois Professional 5010A1Claim Level Accept /Reject

Yes

A: 04/22/2021 Non-Par MCCIL Commercial IL Meridian Complete Illinois Institutional 5010A1Claim Level Accept /Reject

Yes

A: 08/04/2021 Non-Par MCCIL Commercial IL Meridian Complete Illinois Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Meridian Construction Program Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 08/04/2021 Non-Par 13189 Commercial IL Meridian Health Plan of IL Institutional 5010A2Claim Level Accept /Reject

Yes

Claims with DOS on or prior to 6/30/2021 must be sent using payer id13189. DOS on or after 7/1/2021 mustbe sent using payer id MCCIL

U: 08/04/2021 Non-Par 13189 Commercial IL Meridian Health Plan of IL Professional 5010A1Claim Level Accept /Reject

Yes

Claims with DOS on or prior to 6/30/2021 must be sent using payer id13189. DOS on or after 7/1/2021 mustbe sent using payer id MCCIL

U: 09/09/2021 Non-Par 13189 Commercial IL Meridian Health Plan of IL Remittance 5010A1 EnrollmentERA for payer id 13189 is for claimswith DOS on or prior to 6/30/2021

U: 09/09/2021 Non-Par 83253 Commercial MI Meridian Health Plan of Michigan Remittance 4010A1 Enrollment

For request to change or add ERA,please contact your local ProviderNetwork Development Representativeor the Provider Services departmentat 888-773-2647.

U: 07/30/2021 Non-Par 83253 Commercial MI Meridian Health Plan of Michigan Institutional 5010A2Claim Level Accept /Reject

U: 07/30/2021 Non-Par 83253 Commercial MI Meridian Health Plan of Michigan Professional 5010A1Claim Level Accept /Reject

A: 04/12/2021 Non-Par MHPMI Commercial MI MeridianComplete Michigan Professional 5010A1Claim Level Accept /Reject

Yes

A: 04/12/2021 Non-Par MHPMI Commercial MI MeridianComplete Michigan Institutional 5010A1Claim Level Accept /Reject

Yes

A: 06/14/2021 Non-Par MHPMI Commercial MI MeridianComplete Michigan Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Meritage Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 10/22/2021 Par FC002 Commercial CA Meritage First Choice Professional 5010A1Claim Level Accept /Reject

No

A: 10/22/2021 Par FC002 Commercial CA Meritage First Choice Institutional 5010A1Claim Level Accept /Reject

No

U: 06/01/2012 Par IP097 Commercial CA Meritage Medical Network (formerly Marin IPA) Professional 5010A1Claim Level Accept /Reject

U: 10/03/2019 Par 64157 Commercial Meritain Health Professional 5010A1Claim Level Accept /Reject

To request ERAs please enroll underpayer id 58379

U: 10/03/2019 Par 64157 Commercial Meritain Health Institutional 5010A2Claim Level Accept /Reject

To request ERAs please enroll underpayer id 58379

U: 03/11/2013 Non-Par 41124 Commercial MI Meritain Health Professional 5010A1Claim LevelAcknowledgement

Yes

U: 09/01/2016 Par 41124 Commercial MI Meritain Health Institutional 5010A2Claim LevelAcknowledgement

Yes

A: 10/14/2020 Non-Par 58379 CommercialMeritain Health Minneapolis(Formerly payer id41124)


A: 10/14/2020 Non-Par 58379 Commercial Meritain Health/NAA(Formerly payer id 64157) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Mesa County Colorado Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Mesa County Valley School District 51 Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 02/14/2020 Non-Par LU658 Auto NJ MET LIFE (AUTO ONLY) NJ Prof. Auto 5010A1

Updated: 03/21/2022


PPAAYERYERIDID



A: 02/14/2020 Non-Par LU658 Auto NJ MET LIFE (AUTO ONLY) NJ Inst. Auto 5010A1

U: 09/01/2016 Par 23550 Commercial IL Methodist First Choice Professional 5010A1Claim Level Accept /Reject

U: 03/04/2016 Par 87726 CommercialMetrahealth / Metrahealth Railroad (A UnitedHealthCare Co.)


Yes

U: 09/01/2016 Par 13265 Commercial Metro Plus Health Plan Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 13265 Commercial Metro Plus Health Plan Institutional 5010A2File LevelAcknowledgement

U: 09/19/2019 Non-Par 13265 Commercial Metro Plus Health Plan Remittance 5010A1 Enrollment

A: 01/31/2020 Non-Par E5814 Workers' Comp Metropolitan Council Prof. Work Comp 5010A1 No Response From Payer

A: 01/31/2020 Non-Par E5814 Workers' Comp Metropolitan Council Prof. Work Comp 5010A1 File Level Ack. No

A: 01/31/2020 Non-Par E5814 Workers' Comp Metropolitan Council Inst. Work Comp 5010A1 No Response From Payer

A: 10/01/2021 Non-Par 10850 Commercial Metropolitan Health Plan Remittance 5010A1 Enrollment

fka METROPOLITAN HEALTH PLAN.Contact provider services at800-647-0550 for credential/contracting then complete the ERAPSF Form.

A: 12/06/2019 Non-Par WA060 Workers' Comp MNMetropolitan Property and Casualty InsuranceCompany (Met Life) [MN]

Prof. Work Comp 5010A1

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Mexicana Airlines Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU MEYLING, ALBERT (AN INDIVIDUAL Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU MEYLING, ALBERT (AN INDIVIDUAL Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 23550 Commercial MFC & HealthPlus Peoria Institutional 5010A2Claim LevelAcknowledgement

U: 03/11/2013 Non-Par 74289 Commercial MHNET Professional 5010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 74289 Commercial MHNET Institutional 5010A2File LevelAcknowledgement

Yes

U: 10/07/2019 Non-Par 74289 Commercial MHNET Behavioral Health Remittance 5010A1 Enrollment

U: 08/28/2013 Non-Par 3833C Commercial MU MHP Medicaid Professional 5010A1File LevelAcknowledgement

Yes

A: 12/20/2018 Par 82832 Commercial FL Miami Children's Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/20/2018 Par 82832 Commercial FL Miami Children's Health Plan Institutional 5010A1Claim Level Accept /Reject

Yes

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Michael Hogan Assoc Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Michael Mcelroy D / B / A Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Michael Mcelroy D / B / A Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/24/2014 Non-Par 37127 Commercial Michael Reese Physicians Group Professional 5010A1 File Level Ack.

A: 12/05/2014 Non-Par 12K38 Commercial Michigan Department of Community Health Institutional 5010A2 No Response From Payer Yes

U: 02/24/2017 Non-Par 38164 Commercial MI Michigan Education Special Remittance 5010A1 Enrollment

A: 11/17/2014 Non-Par SKMI1 Medicaid MI Michigan Medicaid - BCCCP Professional 5010A1 File Level Ack. Yes ERA are available under SKMI0

A: 08/08/2014 Non-Par 37281 Commercial Mid-America Associates, Inc Institutional 5010A2 No Response From Payer

A: 09/25/2020 Non-Par 37281 Commercial Mid-America Associates, Inc Remittance 5010A1 Enrollment

U: 11/01/2012 Non-Par 37281 Commercial Mid-America Associates, Inc. Professional 5010A1 No Response From Payer

A: 01/16/2020 Non-Par 58379 Commercial Mid-American Benefits Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

A: 12/02/2014 Non-Par CALL Commercial MD Mid-American Benefits Professional 5010A1Please call Jessica Picarde, Managerof Claims Operations, (410) 349-3222for Payer ID information.

U: 02/18/2015 Non-Par CALL Commercial Mid-American Benefits Institutional 5010A2 Claim Level Rejects Only YesPlease call Jessica Picarde Managerof Claims Operations (410) 349-3222for Payer ID information.

A: 10/10/2014 Non-Par SCP01 Commercial CA Mid-County Physicians Medical Group Professional 5010A1 Claim Level Ack.

U: 03/11/2013 Non-Par 47080 Commercial Midlands Choice, Inc. Institutional 5010A1 Claim Level Accept / Yes

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 03/11/2013 Non-Par 47080 Commercial Midlands Choice, Inc. Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 76079 Commercial Midwest Health Partners Institutional 5010A2

A: 09/01/2016 Par 76079 Commercial Midwest Health Partners Professional 5010A1 No Response From Payer

U: 08/05/2019 Trans TH074 Commercial MU Midwest Health Plans (Formerly MHP77) Professional 5010A1Claim Level Accept /Reject

Yes

Only for claims before 7/1/2019;Claims 7/1/2019 and after should goto payer ID 38224. Accepts NPI only.Requires the billing NPI to be thegroup NPI if using a Business Tax id.Service provider NPI required inservicing provider loop. No longerrequires 6 digit provider identifier.

U: 08/05/2019 Trans 12T54 Commercial MU Midwest Health Plans (Formerly MHP77) Institutional 5010A1 Claim Level Ack.

Only for claims before 7/1/2019;Claims 7/1/2019 and after should goto payer ID 38224. Accepts NPI only.Require the billing NPI to be the groupNPI if using a Business Tax id. Serviceprovider NPI required in servicingprovider loop. No longer require 6digit provider identifier. Provider mustcomplete enrollment form on payerswebsite.WWW.midwesthealthplan.com

A: 02/12/2014 Trans HM067 Commercial CAMills Peninsula Medical Group (Encounters Only) /SPS.


A: 05/30/2014 Non-Par IP132 Commercial CA Mills Peninsula Medical Group / SPS Professional 5010A1Claim Level Accept /Reject

U: 06/20/2017 Non-Par IP132 Commercial CA Mills Peninsula Medical Group / SPS Remittance 5010A1 Enrollment

U: 10/25/2019 Non-Par 00562 Commercial MNMINNESOTA BLUE CROSS BLUE SHIELD HEALTH CAREPROGR


A: 12/06/2019 Non-Par MNDH1 Commercial MINNESOTA DEPARTMENT OF HEALTH Professional 5010A1 Yes

A: 12/05/2014 Non-Par MNDH1 Commercial MINNESOTA DEPARTMENT OF HEALTH Institutional 5010A2 Claim Level Accept/Reject Yes

A: 12/17/2019 Non-Par MNDH1 Commercial MINNESOTA DEPARTMENT OF HEALTH Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Mission Aviation Fellowship Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par PHM10 Commercial CA Mission Community IPA Professional 5010A1File LevelAcknowledgement

A: 04/09/2010 Non-Par MPM07 Commercial Mission Community IPA Medical Group Professional 4010A1File LevelAcknowledgement

U: 09/23/2013 Non-Par J1491 Workers' Comp MU MISSION CORPS INTERNATIONAL IN Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU MISSION CORPS INTERNATIONAL IN Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/10/2012 Non-Par IP106 Commercial CA Mission Hospital Affiliated Physicians Professional 5010A1 No Response From Payer

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Mission Lodge Sanitarium Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU MISSION ORGANICS Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU MISSION ORGANICS Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 08/12/2021 Non-Par 12B17 Commercial MS Mississippi Blue Cross - Trispan Institutional 5010A1 Enrollment

A: 06/15/2021 Non-Par SKMS1 Medicaid MS Mississippi Medicaid - Medicare Advantage Professional 5010A1Claim Level Accept /Reject

Yes

A: 06/15/2021 Non-Par 12K18 Medicaid MS Mississippi Medicaid - Medicare Advantage Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 64084 Commercial Mississippi Physicians Care Network Professional 5010A1File LevelAcknowledgement

U: 01/24/2012 Non-Par 37233 Commercial MS Mississippi Public Employee Benefit Trust Professional 5010A1 No Response From Payer

U: 08/08/2014 Non-Par 37233 Commercial Mississippi Public Entity Employee Benefit Trust Institutional 5010A2

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Missoula Cart Co, In Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



A: 11/22/2016 Trans 26097 Commercial GA ML Healthcare Services Professional 5010A1 No Response From Payer No

A: 11/22/2016 Trans 26097 Commercial GA ML Healthcare Services Institutional 5010A1 No Response From Payer No

U: 02/13/2014 Non-Par 37265 Commercial MLink Professional 5010A1Claim LevelAcknowledgement

A: 09/08/2021 Non-Par 66065 Commercial PR MMM Healthcare Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 09/08/2021 Non-Par 66065 Commercial PR MMM Healthcare Institutional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 08/25/2021 Non-Par 66065 Commercial PR MMM HEALTHCARE (REFORM) Remittance 5010A1 Enrollment

A: 03/14/2022 Trans MMMFL Commercial FL MMM of Florida Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/14/2022 Trans MMMFL Commercial FL MMM of Florida Institutional 5010A1Claim Level Accept /Reject

Yes

A: 10/14/2019 Non-Par MMMFL Medicare FL MMM of Florida Remittance 5010A1 Enrollment

U: 12/06/2019 Non-Par 95655 Commercial MU Mnt Carmel Health Srvcs/ MediGold Remittance 5010A1 Enrollment

All requests for ERA must beauthorized by the provider's officeand not any third party affiliate.Providers call Provider Service Line @1-800-991-9907 to obtain the formsto be initiated and filled out by theprovider's office.

A: 09/01/2016 Par 95655 Commercial Mnt Carmel Health Srvcs/ MediGold Institutional 5010A2 File Level Ack. Yes

U: 03/10/2022 Non-Par 12M15 Commercial MO MO Medicare Part A (J5 - WPS) Remittance 5010A1 Enrollment

U: 11/11/2019 Non-Par 12M15 Government MO MO Medicare Part A (J5 - WPS) Institutional 5010A2 Enrollment No Response From Payer

A: 10/08/2020 Non-Par 13350 Commercial MODA Health Remittance 5010A1 Enrollment

U: 09/01/2016 Par 13350 Commercial MODA Health (Formerly ODS Health Plan) Professional 4010A1 File Level Ack. Yes

U: 09/01/2016 Par 13350 Commercial MODA Health (Formerly ODS Health Plan) Institutional 5010A2 No Response From Payer Yes

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Modesto Irrigation District Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU MOFFATT CONTRACTING,INC Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU MOFFATT CONTRACTING,INC Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 07/13/2021 Trans MCC01 Commercial AZ Molina Complete Care of Arizona Professional 5010A1Claim Level Accept /Reject

Yes

U: 08/16/2021 Non-Par MCC01 Commercial AZ Molina Complete Care of Arizona Remittance 5010A1Provider must be enrolled for EFT inorder to receive ERA.

U: 07/13/2021 Trans MCC01 Commercial AZ Molina Complete Care of Arizona Institutional 5010A1Claim Level Accept /Reject

Yes

U: 12/31/2021 Trans MCC02 Commercial VA Molina Complete Care of Virginia Professional 5010A1Claim Level Accept /Reject

Yes

U: 12/31/2021 Trans MCC02 Commercial VA Molina Complete Care of Virginia Institutional 5010A1Claim Level Accept /Reject

Yes

U: 05/27/2021 Trans NM505 Commercial NM Molina Health Care of New Mexico Professional 5010A1Claim Level Accept /Reject

Yes

ERA/835 are available for this plan byenrolling under payer id 20149. ERA/835 will be delivered under payer id20149

U: 05/27/2021 Trans NM505 Commercial NM Molina Health Care Of New Mexico Institutional 5010A2

ERA/835 transactions are availablefor this plan by enrolling at ChangeHealthcare under payer id 20149. AllERA/835 will be delivered under payerid 20149.

U: 05/27/2021 Trans 20554 Commercial TX Molina Health Care of Texas Professional 5010A1Claim Level Accept /Reject

Yes

ERA/835 are available for this payerby enrolling at Change Healthcareunder payer id 20149. All ERA/835 willbe delivered under payer id 20149

U: 05/27/2021 Trans 20554 Commercial TX Molina Health Care Of Texas Institutional 5010A2Claim Level Accept /Reject

Yes

ERA/835 are available for this payerby enrolling under payer id 20149.ERA/835 will be delivered under payerid 20149

U: 12/17/2021 Trans 38336 Commercial WA Molina Health Care of Washington (Claims Only) Institutional 5010A2Claim Level Accept /Reject

YesERA/835 are available for this plan byenrolling at Change Healthcare underpayer id 20149. All ERA/835 will be

Updated: 03/21/2022


PPAAYERYERIDID



delivered under payer id 20149

U: 05/27/2021 Trans 33373 Commercial CA Molina Healthcare California - ENCOUNTERS ONLY Professional 5010A1Claim Level Accept /Reject

U: 05/27/2021 Trans 33373 Commercial CA Molina Healthcare California - ENCOUNTERS ONLY Institutional 5010A1Claim Level Accept /Reject

U: 12/31/2021 Trans 38333 Commercial CA Molina Healthcare of California Institutional 5010A2 No Response From Payer Yes

ERA/835 area available for this planby enrolling under payer id 20149. AllERA/835 for this plan will be deliveredunder payer id 20149

U: 12/31/2021 Trans 38333 Commercial CA Molina Healthcare of California Professional 5010A1Claim Level Accept /Reject

Yes

ERA/835 are available for this plan byenrolling under payer id 20149. AllERA/835 will be delivered under payerid 20149

U: 12/08/2020 Trans 51062 Commercial FL Molina Healthcare of Florida Institutional 5010A1 Yes

ERA/835 transactions are availablefor this plan by enrolling at ChangeHealthcare under payer id 20149.ERA/835 transactions will be deliveredunder payer id 20149.

U: 12/08/2020 Trans 51062 Commercial FL Molina Healthcare of Florida Professional 5010A1 Yes


A: 06/16/2016 Trans 00513 Commercial FL Molina Healthcare of Florida (Encounters) Professional 5010A1Claim Level Accept /Reject

A: 01/19/2018 Trans 61799 Commercial ID Molina Healthcare of Idaho Institutional 5010A1Claim Level Accept /Reject

Yes

A: 01/19/2018 Trans 61799 Commercial ID Molina Healthcare of Idaho Professional 5010A1Claim Level Accept /Reject

Yes

U: 12/08/2020 Trans 20934 Commercial IL Molina Healthcare of Illinois Professional 5010A1 Yes


U: 12/08/2020 Trans 20934 Commercial IL Molina Healthcare of Illinois Institutional 5010A2 Yes


U: 12/31/2021 Trans 38334 Commercial MI Molina Healthcare of Michigan Institutional 5010A2 No Response From Payer Yes

ERA/835 are available for this payerby enrolling under payer id 20149. AllERA/835 will be delivered under payerid 20149

U: 12/31/2021 Trans 38334 Commercial MI Molina Healthcare of Michigan Professional 5010A1Claim Level Accept /Reject

Yes

ERA/835 are available for this payerby enrolling under payer id 20149.ERA/835 will be delivered under payerid 20149

A: 03/22/2019 Non-Par 22710 Commercial MI Molina Healthcare of Michigan PAR Institutional 5010A1 EnrollmentClaim Level Accept /Reject

A: 11/15/2018 Non-Par 77010 Commercial MS Molina Healthcare of Mississippi Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/15/2018 Non-Par 77010 Commercial MS Molina Healthcare of Mississippi Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/21/2021 Non-Par 77010 MOLINA HEALTHCARE of MISSISSIPPI Remittance 5010A1 Enrollment

A: 12/31/2021 Trans MLNNV Commercial NV Molina Healthcare of Nevada Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/31/2021 Trans MLNNV Commercial NV Molina Healthcare of Nevada Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Trans 04423 Commercial NM Molina Healthcare of New Mexico -SCI Institutional 5010A2File LevelAcknowledgement

Yes

U: 12/08/2020 Non-Par 16146 Commercial NY Molina Healthcare of NY (formerly Total Care NY) Institutional 5010A2 Claim Level Rejects Only Yes


Updated: 03/21/2022


PPAAYERYERIDID



U: 12/08/2020 Non-Par 16146 Commercial NY Molina Healthcare of NY (formerly Total Care of NY) Professional 5010A1 Claim Level Rejects Only Yes


U: 05/24/2021 Non-Par 20149 Commercial MU Molina Healthcare of Ohio Remittance 5010A1 Enrollment

The ERA for SWHNY, SX109, 38336,20554, 38333, 38334,09824, 51062,20934, 46299, ABRI1, 16146, 61325and NM505 are all processed under20149.

U: 05/27/2021 Trans 20149 Commercial OH Molina Healthcare of Ohio Professional 5010A1Claim Level Accept /Reject

Yes

U: 05/27/2021 Trans 20149 Commercial OH Molina Healthcare of Ohio Institutional 5010A2Claim Level Accept /Reject

Yes

U: 12/08/2020 Trans 81794 Commercial PR Molina Healthcare of Puerto Rico Professional 5010A1 File Level Ack.

U: 12/08/2020 Trans 81794 Commercial PR Molina Healthcare of Puerto Rico Institutional 5010A1 File Level Ack.

U: 05/27/2021 Trans SX109 Commercial UT Molina Healthcare of Utah Professional 5010A1Claim Level Accept /Reject

Yes

ERA/835 are available for this payerby enrolling under payer id 20149. AllERA/835 will be delivered under payerid 20149

U: 12/21/2016 Non-Par 12X09 Commercial UT Molina Healthcare of Utah (Claims Only) Institutional 5010A2 No Response From Payer

A: 06/24/2021 Trans 10101 Commercial VA Molina Healthcare of Virginia Encounters Institutional 5010A1Claim Level Accept /Reject

Yes

A: 06/24/2021 Trans 10101 Commercial VA Molina Healthcare of Virginia Encounters Professional 5010A1Claim Level Accept /Reject

Yes

U: 12/17/2021 Trans 38336 Commercial WA Molina Healthcare of Washington (Claims Only) Professional 5010A1Claim Level Accept /Reject

Yes

ERA/835 transactions are availablefor this plan by enrolling under payerid 20149. All ERA/835 for this plan willbe delivered under payer id 20149

U: 12/08/2020 Trans 43174 Commercial WA Molina Healthcare of Washington (Encounters) Professional 5010A1Claim Level Accept /Reject

U: 12/08/2020 Trans ABRI1 Commercial WI Molina Healthcare of Wisconsin Professional 5010A1 Claim Level Rejects Only


U: 12/08/2020 Trans ABRI1 Commercial WI Molina HealthCare of Wisconsin Institutional 5010A2 No Response From Payer Yes


U: 12/08/2020 Trans 46299 Commercial SC Molina Healthcare South Carolina Professional 5010A1Claim Level Accept /Reject


U: 12/08/2020 Trans 46299 Commercial SC Molina Healthcare South Carolina Institutional 5010A2Claim Level Accept /Reject

Yes


U: 04/06/2017 Par IP095 Commercial CA Monarch Healthcare IPA Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/13/2020 Non-Par IP095 Commercial CA Monarch IPA Institutional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Monarch Plumbing Company, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Monarch Plumbing Company, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 10/18/2012 Par 01759 Commercial MU Monitor Life Ins Morgan White Admin Professional 5010A1Claim LevelAcknowledgement

YesThe payer accept secondary claimsonly

A: 09/01/2016 Par 16098 Commercial Monitor Life Insurance Company Professional 5010A1 Claim Level Accept/Reject

A: 09/01/2016 Par 16098 Commercial Monitor Life Insurance Company Institutional 5010A2 No Response From Payer Yes

U: 10/01/2019 Non-Par 16098 Commercial Monitor Life Insurance Company Remittance 5010A1 Enrollment

U: 09/01/2016 Par 13174 Commercial Montefiore Contract Management Organization Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 13174 Commercial Montefiore Contract Management Organization Institutional 5010A2 No Response From Payer Yes

Updated: 03/21/2022


PPAAYERYERIDID



U: 10/01/2019 Non-Par 13174 Commercial MU Montefiore Contract Management Organization Remittance 5010A1 Enrollment

U: 09/01/2016 Par 46161 Commercial Montefiore HMO Professional 5010A1 No Response From Payer Yes

U: 09/01/2016 Par 46161 Commercial Montefiore HMO Institutional 5010A2 No Response From Payer Yes

U: 10/07/2019 Non-Par 46161 Commercial Montefiore HMO Remittance 5010A1 Enrollment

A: 12/10/2018 Par MBIPA Commercial Monterey Bay IPA Professional 5010A1Claim Level Accept /Reject

No

A: 09/01/2016 Par TRP1E Commercial Monumental Life Insurance Company Professional 5010A1 No Response From Payer Yes

A: 09/01/2016 Par TLINS Commercial Monumental Life Insurance Company Professional 5010A1 Yes

A: 09/01/2016 Par TRLTC Commercial Monumental Life Insurance Company Professional 5010A1 No Response From Payer Yes

A: 09/01/2016 Par TRCLF Commercial Monumental Life Insurance Company Professional 5010A1 No Response From Payer Yes

A: 09/01/2016 Par TRP1P Commercial Monumental Life Insurance Company Professional 5010A1 No Response From Payer Yes

A: 09/01/2016 Par TRP1P Commercial Monumental Life Insurance Company Institutional 5010A2 No Response From Payer

A: 09/01/2016 Par TRP1E Commercial Monumental Life Insurance Company Institutional 5010A2 No Response From Payer

A: 09/01/2016 Par TRLTC Commercial Monumental Life Insurance Company Institutional 5010A1 No Response From Payer

A: 09/01/2016 Par TLINS Commercial Monumental Life Insurance Company Institutional 5010A2 No Response From Payer

A: 09/01/2016 Par TRCLF Commercial Monumental Life Insurance Company Institutional 5010A2 No Response From Payer

A: 01/31/2020 Par 65465 Medicare IL Morecare Professional 5010A1Claim Level Accept /Reject

No

A: 01/31/2020 Par 65465 Medicare IL Morecare Institutional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU MORENO VALLEY PONTIAC Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU MORENO VALLEY PONTIAC Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 35092 Commercial MORRIS ASSOCIATES Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 35092 Commercial MORRIS ASSOCIATES Institutional 5010A2Claim Level Accept /Reject

U: 10/01/2019 Non-Par 35092 Commercial MORRIS ASSOCIATES Remittance 5010A1 Enrollment

U: 11/01/2012 Non-Par IP083 Commercial CA Mosaic IPA Medical Group Professional 5010A1 No Response From Payer

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Mother'S Nutritional Center, I Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Mother'S Nutritional Center, I Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Motion Picture & Television Fund Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 10/28/2020 Non-Par 07632 Commercial UT MotivHealth Insurance Company Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/28/2020 Non-Par 07632 Commercial UT MotivHealth Insurance Company Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 95655 Commercial Mount Carmel Services Services Professional 5010A1Claim LevelAcknowledgement

U: 01/27/2012 Non-Par 80900 Commercial MPA-Custom Provider Network Institutional 5010A2File LevelAcknowledgement

U: 01/01/2012 Non-Par 80900 Commercial MPA-Custom Provider Network Professional 5010A1File LevelAcknowledgement

U: 01/24/2012 Non-Par 37233 Commercial MS MPE Employee Benefit Services Professional 5010A1File LevelAcknowledgement

A: 08/08/2014 Non-Par 37233 Commercial MPE Employee Benefit Services Institutional 5010A2 No Response From Payer

U: 08/08/2014 Non-Par 37233 Commercial MPEEBT Institutional 5010A2

U: 01/24/2012 Non-Par 37233 Commercial MS MPEEBT Professional 5010A1File LevelAcknowledgement

U: 09/23/2013 Non-Par J1491 Workers' Comp MU MRH ENTERPRISES Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU MRH ENTERPRISES Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 08/12/2021 Non-Par 12B82 Commercial MS MS BC AHS State Network Institutional 5010A1 Enrollment

A: 09/01/2016 Par 64084 Commercial MS Physicians Care Ntwrk Institutional 5010A2 No Response From Payer

A: 11/24/2014 Non-Par 20572 Commercial MSA Care Guard Professional 5010A1 No Response From Payer Yes

Updated: 03/21/2022


PPAAYERYERIDID



A: 12/05/2014 Non-Par 20572 Commercial MSA Care Guard Institutional 5010A2 No Response From Payer Yes

U: 05/11/2017 Non-Par 80019 Commercial MSC (Medical Service Company) Group, Inc. Professional 5010A1 Claim Level Rejects Only

U: 05/11/2017 Non-Par 80019 Commercial MSC (Medical Service Company) Group, Inc. Institutional 5010A1 Claim Level Rejects Only

A: 03/09/2022 Par RP036 Commercial WA MultiCare Connected Care Institutional 5010A1 No Response From Payer Yes

A: 03/09/2022 Par RP036 Commercial WA MultiCare Connected Care Professional 5010A1 No Response From Payer Yes

A: 12/10/2021 Non-Par MBAAZ Commercial MultiFlex Dental (Merchants Benefit Administrators) Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDMBAAZ. Providers will need to enrollfor payer IDs MBAAZ and 58379 inorder to receive 835s for this payer.

A: 12/10/2021 Non-Par 58379 CommercialMultiFlex Dental (Merchants Benefit Administrators)(Formerly MBAAZ)


*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID MBAAZ.Providers will need to enroll for payerIDs MBAAZ and 58379 in order toreceive 835s for this payer.

U: 09/01/2016 Par 34080 Commercial Multiplan Wisconsin Preferred Provider Network Institutional 5010A2 No Response From Payer

U: 12/08/2011 Non-Par 34080 Commercial Multiplan Wisconsin Preferred Provider Network Professional 5010A1Claim Level Accept /Reject

U: 09/15/2020 Non-Par 81883 Commercial AR Municipal Health Benefit Fund Institutional 5010A2Claim Level Accept /Reject

No

U: 09/15/2020 Non-Par 81883 Commercial AR Municipal Health Benefit Fund Professional 5010A1Claim Level Accept /Reject

No

U: 10/07/2019 Non-Par 81883 Commercial Municipal Health Benefit Fund Remittance 5010A1 Enrollment

U: 06/08/2017 Non-Par 34192 Commercial OHMutual Health Services (FKA Antares ManagementSolutions)

Institutional 5010A2 Claim Level Rejects Only Yes ERA available under payer ID: 58379

U: 06/08/2017 Non-Par 34192 Commercial OHMutual Health Services (FKA Antares ManagementSolutions)


Yes ERA available under payer ID: 58379

U: 02/23/2021 Non-Par 71412 Commercial NE Mutual Of Omaha Insurance Co. Remittance 5010A1 Enrollment

U: 01/01/2012 Par 71412 Commercial Mutual Of Omaha Insurance Co. Institutional 5010A2Claim Level Accept /Reject

No

U: 01/01/2012 Par 71412 Commercial Mutual Of Omaha Insurance Co. Professional 5010A1Claim LevelAcknowledgement

No

U: 01/01/2012 Par 71412 Commercial Mutual of Omaha Insurance Company Institutional 5010A2Claim Level Accept /Reject

No

U: 01/01/2012 Par 71412 Commercial Mutual of Omaha Insurance Company Professional 5010A1Claim LevelAcknowledgement

No

A: 03/01/2019 Par 82275 Medicare MO Mutual of Omaha Medicare Advantage Professional 5010A1 File Level Ack. Yes

A: 03/01/2019 Par 82275 Medicare MO Mutual of Omaha Medicare Advantage Institutional 5010A1 File Level Ack. Yes

A: 12/18/2019 Non-Par 82275 Commercial Mutual of Omaha Medicare Advantage Remittance 5010A1 Enrollment

U: 01/01/2012 Par 71412 Commercial Mutually Preferred Institutional 5010A2Claim Level Accept /Reject

No

U: 01/01/2012 Par 71412 Commercial Mutually Preferred Professional 5010A1Claim LevelAcknowledgement

No

U: 09/01/2016 Par 38224 Commercial MVP - Ohio Institutional 5010A2Claim Level Accept /Reject

U: 03/11/2013 Par 14165 Commercial MVP Health Plan (Mohawk Valley) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/11/2013 Par 14165 Commercial NY MVP Health Plan (Mohawk Valley) Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/06/2020 Non-Par 14165 Commercial NY MVP Health Plan (Mohawk Valley) Remittance 5010A1 Enrollment

A: 05/13/2016 Par 18840 Commercial TX MyDecision Healthsmart Institutional 5010A1Claim Level Accept /Reject

Yes

A: 05/13/2016 Par 18840 Commercial TX MyDecision Healthsmart Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/31/2020 Non-Par 34010 Commercial myNEXUS Aetna Home Health Remittance 5010A1 Enrollment

U: 08/02/2021 Par 34010 Commercial TN myNEXUS Aetna Home Health Institutional 5010A1Claim Level Accept /Reject

Yes

A: 01/19/2018 Trans 34009 Commercial TN myNEXUS Anthem Institutional 5010A1Claim Level Accept /Reject

No

A: 01/19/2018 Trans 34009 Commercial TN myNEXUS Anthem Professional 5010A1Claim Level Accept /Reject

No

Updated: 03/21/2022


PPAAYERYERIDID



U: 11/19/2019 Non-Par 34009 Commercial TN MYNEXUS Anthem, L Remittance 5010A1**Enrollment Required at the payer.Contact the provider Network Teamdirectly at 615-610-5815 to Enroll.**

U: 09/01/2016 Par 91136 Commercial N.W. Ironworkers Health & Security Trust Fund Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 91136 Commercial N.W. Ironworkers Hlth & Security Trust Fund, Grp# F16 Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 91136 CommercialN.W. Roofers & Employers Health & Security TrustFund


U: 09/01/2016 Par 91136 CommercialN.W. Roofers & Employers Hlth & Security Trust Fund,Grp# F26


U: 09/01/2016 Par 91136 Commercial N.W. Textile Processors Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 91136 Commercial N.W. Textile Processors Grp# F14 Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 65085 Commercial NAA (North America Admin., L.P.) Nashville, TN Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 65085 CommercialNAA (North America Administrators, L.P.) (Nashville,TN)


A: 03/06/2017 Trans 67788 Commercial ME NAHGA Inc. Institutional 5010A1 Claim Level Ack. Yes

A: 03/06/2017 Trans 67788 Commercial ME NAHGA Inc. Professional 5010A1 Claim Level Ack. Yes

A: 09/01/2016 Par L0110 Commercial NAMCI/Global Care Professional 5010A1 Claim Level Accept/Reject Yes

A: 09/01/2016 Par L0110 Commercial NAMCI/Global Care Institutional 5010A2 Claim Level Accept/Reject Yes

A: 12/05/2014 Non-Par 58182 Commercial Naphcare Inc. Institutional 5010A2 Claim Level Ack. Yes

A: 03/04/2013 Non-Par 58182 Commercial Naphcare, Inc. Professional 5010A1Claim Level Accept /Reject

A: 09/23/2020 Non-Par 45529 Commercial PA Nascentia Health Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/23/2020 Non-Par 45529 Commercial PA Nascentia Health Institutional 5010A1Claim Level Accept /Reject

Yes

A: 06/11/2021 Non-Par 45529 Commercial PA Nascentia Health Remittance 5010A1 Enrollment

U: 07/01/2021 Par 31626 Commercial Nascentia Health Options Professional 5010A1 No Response From Payer

U: 07/01/2021 Par 31626 Commercial Nascentia Health Options Institutional 5010A2 No Response From Payer Yes

U: 07/01/2021 Non-Par 31626 Commercial Nascentia Health Options Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU NATEL ENGINEERING COMPANY INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU NATEL ENGINEERING COMPANY INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par CB148 Commercial National Allied Union Local 831 Professional 5010A1 Claim Level Accept/Reject

A: 09/01/2016 Trans CB148 Commercial National Allied Union Local 831 Institutional 5010A2 Claim Level Rejects Only

A: 10/25/2021 Non-Par 53011 Commercial National Assoc Of Letter Carriers Remittance 5010A1 Enrollment

A: 09/08/2017 Non-Par 53011 Commercial National Association of Letter Carriers (NALC) Professional 5010A1

U: 01/15/2020 Non-Par 90001 CommercialNational Capital Preferred Provider Organization(NCPPO)


U: 03/29/2012 Non-Par 90956 Commercial National Financial Insurance Co. Professional 5010A1Claim LevelAcknowledgement

A: 06/22/2020 Par 87020 Commercial National Guardian Life Insurance Professional 5010A1 No Response From Payer No

A: 06/22/2020 Par 87020 Commercial National Guardian Life Insurance Institutional 5010A1 No Response From Payer No

A: 02/12/2021 Non-Par 58379 Commercial National Guardian Life Insurance (87020) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 09/01/2016 Par 12X27 CommercialNational Imaging Assoc Inc / Magellan HealthServices


Yes

U: 09/01/2016 Par SX190 Commercial National Imaging Associates Professional 5010A1File LevelAcknowledgement

Yes

U: 09/30/2019 Non-Par SX190 Commercial National Imaging Associates Remittance 5010A1 Enrollment

A: 12/24/2018 Non-Par 32620 Workers' Comp National Interstate Prof. Work Comp 5010A1Claim Level Accept /Reject

Payer ID is for Workers Comp claimsfor all states.

U: 03/24/2014 Non-Par 41556 Workers' Comp MU National Jewish Health Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU NATIONAL MAINTENANCE INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU NATIONAL MAINTENANCE INC. Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 01/01/2012 Par 71412 Commercial National Rural Letter Carrier Association Institutional 5010A2Claim Level Accept /Reject

No

U: 01/01/2012 Par 71412 Commercial National Rural Letter Carrier Association Professional 5010A1Claim LevelAcknowledgement

No

A: 07/10/2017 Non-Par 52120 CommercialNational Telecommunications CooperativeAssociation (Formerly 52103)


A: 07/10/2017 Non-Par 52120 CommercialNational Telecommunications CooperativeAssociation (Formerly 52103)


U: 08/15/2019 Non-Par 52120 CommercialNational Telecommunications CooperativeAssociation (Formerly 52103)


U: 01/27/2012 Non-Par 52104 CommercialNational Telecommunications CooperativeAssociation (NTCA - Staff)


U: 01/27/2012 Non-Par 52104 CommercialNational Telecommunications CooperativeAssociation (NTCA - Staff)


A: 01/28/2020 Non-Par C1062 Auto Nationwide - AUTO ONLY Remittance 5010A1 Enrollment

A: 12/24/2018 Non-Par J1552 Workers' Comp Nationwide Auto PIP Prof. Work Comp 5010A1Claim Level Accept /Reject

Payer ID is for Workers Comp claimsfor states: TX, MN, CA and LA only.The above Payer Name mayrepresent multiple Accounts(employers).

A: 04/05/2019 Non-Par C1062 Workers' Comp MU Nationwide Auto PIP Prof. Work Comp 5010A1

A: 11/24/2014 Non-Par 19191 Commercial Native Care Health Professional 5010A1 No Response From Payer Yes

A: 12/05/2014 Non-Par 19191 Commercial Native Care Health Institutional 5010A2 No Response From Payer Yes

U: 11/01/2012 Non-Par 75191 Commercial NCAS - Charlotte Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 75191 Commercial NC NCAS - Charlotte Professional 5010A1Claim LevelAcknowledgement

U: 11/01/2012 Non-Par 75190 Commercial NCAS - Fairfax, VA Institutional 5010A2 No Response From Payer

U: 08/15/2019 Non-Par 75190 Commercial VA NCAS - Fairfax, VA Remittance 5010A1 Enrollment

U: 11/01/2012 Non-Par 75190 Commercial VA NCAS - Virginia Professional 5010A1Claim LevelAcknowledgement

A: 01/31/2017 Par 68069 Commercial NE Nebraska Total Care Institutional 5010A1 No Response From Payer Yes

A: 01/31/2017 Par 68069 Commercial NE Nebraska Total Care Professional 5010A1 No Response From Payer Yes

U: 02/23/2012 Non-Par 95123 Commercial Neighborhood Health Partnership Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 96107 Commercial FL Neighborhood Health Partnership of Florida Institutional 5010A2Claim Level Accept /Reject

U: 08/02/2017 Par 96107 Commercial FL Neighborhood Health Partnership of Florida Professional 5010A1Claim Level Accept /Reject

A: 09/08/2021 Non-Par 05047 Commercial RI Neighborhood Health Plan Of RI Remittance 5010A1 Enrollment

A: 09/01/2016 Par 05047 Commercial Neighborhood Health Plan Of RI Institutional 5010A2 No Response From Payer

A: 09/01/2016 Par 96240 Commercial RINeighborhood Health Plan RI - Exchange, Unity,Integrity

Professional 5010A1 File Level Ack.

A: 09/01/2016 Par 96240 Commercial RINeighborhood Health Plan RI - Exchange, Unity,Integrity

Institutional 5010A1 File Level Ack.

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Nelson Nameplate Company Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Nelson Nameplate Company Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 02/14/2017 Trans 66055 Commercial Netcare Life & Health Insurance (Hagatna, Guam) Institutional 5010A2 No Response From Payer

U: 02/14/2017 Trans 66055 Commercial Netcare Life & Health Insurance (Hagatna, Guam) Professional 5010A1

U: 09/23/2021 Non-Par 04332 Commercial Network Health Remittance 5010A1 EnrollmentProviders need to obtain their THPPVendor ID# prior to enrolling for ERAwith CHC.

A: 04/09/2010 Non-Par CALL Commercial Network Health Professional 4010A1 EnrollmentClaim LevelAcknowledgement

Before initiating submissions, pleasecontact Provider Relations at (888)257-1985 or [email protected]

A: 04/09/2010 Non-Par CALL Commercial Network Health Institutional 4010A1 Enrollment No Response From PayerBefore initiating submissions, pleasecontact Provider Relations at (888)257-1985 or [email protected]

U: 01/27/2012 Non-Par 77076 Commercial Network Health Insurance Corp-Medicare Institutional 5010A2 File Level

Updated: 03/21/2022


PPAAYERYERIDID



Acknowledgement

U: 06/22/2019 Non-Par 39144 Commercial WI Network Health Plan Of WI Remittance 5010A1 Enrollment

U: 10/01/2014 Non-Par 39144 Commercial WI Network Health Plan of Wisconsin Professional 5010A1 No Response From Payer

A: 07/17/2015 Non-Par 39144 Commercial WI Network Health Plan of Wisconsin Institutional 5010A1Claim Level Accept /Reject

U: 03/19/2012 Trans 77076 Commercial Network Platinum Plus Professional 5010A1 Claim Level Rejects Only

U: 09/13/2019 Non-Par 77076 Commercial Network Platinum Plus Remittance 5010A1 Enrollment

A: 11/22/2016 Par NSIPA Commercial NY Network Solutions IPA Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/04/2019 Non-Par 12K20 Government NV Nevada Medicaid (Formerly MC008) Institutional 5010A2 Enrollment

U: 02/21/2020 Non-Par SKNV0 Government NVNevada Medicaid - First Health Services Corp(Formerly MC008)


U: 12/17/2019 Non-Par SKNV0 Government NVNevada Medicaid - First Health Services Corp(Formerly MC008)


A: 12/05/2014 Non-Par 95998 Commercial New Avenues Inc. Institutional 5010A2 No Response From Payer Yes

U: 03/11/2013 Non-Par 95998 Commercial MU New Avenues, Inc Professional 5010A1 No Response From Payer Yes

U: 11/01/2012 Non-Par NCH07 Commercial MU New Century - Careplus Oncology Professional 5010A1Claim LevelAcknowledgement

U: 11/01/2012 Non-Par NCH08 Commercial MU New Century - Vista Oncology Professional 5010A1Claim LevelAcknowledgement

U: 09/23/2013 Non-Par J1491 Workers' Comp MU NEW CENTURY AUTO GROUP Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU NEW CENTURY AUTO GROUP Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/25/2019 Non-Par NCHON Commercial AZ New Century Health - Arizona Integra Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/04/2013 Non-Par NCH11 Commercial New Century Health - IEHP Oncology Professional 5010A1Claim Level Accept /Reject

U: 11/21/2013 Non-Par NCH09 Commercial New Century Health - Vista Cardiology Professional 5010A1File LevelAcknowledgement

A: 08/13/2019 Non-Par NDX99 Commercial FL New Directions Behavioral Health Professional 5010A1Claim Level Accept /Reject

No

A: 08/13/2019 Non-Par NDX99 Commercial FL New Directions Behavioral Health Institutional 5010A1Claim Level Accept /Reject

No

A: 10/22/2020 Non-Par 98798 Commercial TX New Era Life Insurance Company Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/22/2020 Non-Par 98798 Commercial TX New Era Life Insurance Company Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/22/2020 Non-Par 98798 Commercial TX New Era Life Insurance Company Institutional 5010A1Claim Level Accept /Reject

Yes

U: 08/15/2014 Par 68069 Commercial NH New Hampshire Healthy Families - Centene Professional 5010A1 Yes

U: 02/25/2021 Non-Par 12006 Government NJ New Jersey - Medicaid (Formerly IC087) Institutional 5010A2 Enrollment Claim Level Rejects Only Yes

U: 02/25/2021 Non-Par 12006 Commercial New Jersey - Medicaid (Formerly IC087) Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 12122 Workers' Comp NJ New Jersey Manufacturing Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/28/2020 Non-Par 12122 Workers' Comp New Jersey Manufacturing Remittance 5010A1 Enrollment

A: 01/28/2020 Non-Par 12122 Workers' Comp New Jersey Manufacturing Remittance 5010A1 EnrollmentPayer ID is for Workers Compensationclaims for all states.

U: 10/27/2020 Non-Par C1048 Auto NJ New Jersey Manufacturing - Auto Only Prof. Auto 5010A1Claim Level Accept /Reject

A: 08/28/2020 Non-Par 45129 Commercial NM New Mexico Health Connections Institutional 5010A1Claim Level Accept /Reject

Yes

A: 08/28/2020 Non-Par 45129 Commercial NM New Mexico Health Connections Professional 5010A1Claim Level Accept /Reject

Yes

A: 07/12/2017 Non-Par SKNM0 Government NM New Mexico Medicaid (Formerly MC034) Professional 5010A1 No Response From Payer Yes

U: 04/20/2020 Non-Par SKNM0 Government NM New Mexico Medicaid (Formerly MC034) Remittance 5010A1 Enrollment

A: 07/12/2017 Non-Par 12K22 Government New Mexico Medicaid (Formerly MC034) Institutional 5010A2 Yes

A: 12/02/2021 Non-Par HTLFD Commercial OH New York Hotel Funds MHAP Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 12/02/2019 Non-Par 7707C Commercial NY New York Hotel Trade Council Professional 5010A1 Claim Level Accept / Yes

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 03/11/2013 Non-Par TH122 Commercial New York Life Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/05/2014 Non-Par TH122 Commercial New York Life Institutional 5010A2 Claim Level Ack.

U: 09/01/2021 Non-Par SKNY0 Government NY New York Medicaid (Formerly MC066) Remittance 5010A1 Enrollment

U: 09/01/2021 Non-Par SKNY0 Government NY New York Medicaid (Formerly MC066) Professional 5010A1 Enrollment YesThis payer requires EFT to submitclaims.

U: 09/01/2021 Non-Par 12K35 Government NY New York Medicaid (Formerly SKNY0 / MC066) Institutional 5010A1 Enrollment

This payer requires EFT to submitclaims. ERA will be returned underSKNY0. Providers wishing to receiveERA for 12K35 must also enroll underSKNY0 on RPA

A: 12/09/2021 Par NYDFS Commercial NH NEW YORK MEDICAL INDEMNITY FUND Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/09/2021 Par NYDFS Commercial NH NEW YORK MEDICAL INDEMNITY FUND Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 11334 Commercial NY New York Network Management, LLC Professional 5010A1Claim LevelAcknowledgement

Claim must contain group plan orpolicy number and group name

A: 01/28/2020 Non-Par 45052 Workers' Comp New York State Insurance Fund (NYSIF) Remittance 5010A1 Enrollment

A: 05/17/2019 Par 81085 Medicaid MO Next Level Health Professional 5010A1Claim Level Accept /Reject

No

A: 05/17/2019 Par 81085 Medicaid MO Next Level Health Institutional 5010A1Claim Level Accept /Reject

No

U: 08/15/2019 Non-Par 69821 Commercial AL Next Level Health Partners Remittance 5010A1 Enrollment

A: 01/22/2016 Par 69821 Medicaid AL Next Level Health Partners Professional 5010A1Claim Level Accept /Reject

A: 01/22/2016 Par 69821 Medicaid AL Next Level Health Partners Institutional 5010A2Claim Level Accept /Reject

A: 10/27/2021 Non-Par 55892 Commercial ND NEXTBLUE OF NORTH DAKOTA Remittance 5010A1 Enrollment

A: 09/01/2016 Par 88050 Commercial NHBCAUX Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 88050 Commercial NHBCAUX Institutional 5010A2 No Response From Payer

A: 09/25/2019 Non-Par NHC01 Commercial FL NHC Advantage Remittance 5010A1 Enrollment

A: 01/24/2018 Par NHC01 Commercial FL NHC Advantage Professional 5010A1 Claim Level Rejects Only No

A: 01/24/2018 Par NHC01 Commercial FL NHC Advantage Institutional 5010A1 Claim Level Rejects Only No

A: 09/01/2016 Par 14043 Commercial NHI Billing Services Inc Institutional 5010A2 Claim Level Ack. Yes

A: 03/09/2021 Par 14043 Commercial CA NHI Billing Services Inc Professional 5010A1Claim Level Accept /Reject

No

U: 09/01/2016 Par 05047 Commercial RI NHPRI (Neighborhood Health Plan of Rhode Island) Professional 5010A1Claim Level Accept /Reject

Please call NHPRI at (401)459-6020 toobtain or confirm your provider andvendor number prior to your initialclaims submission.

U: 01/01/2012 Par NIA11 Commercial NIA - Magellan Health Services Professional 5010A1Claim LevelAcknowledgement

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Nia Health Care Services (A Co Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Nia Health Care Services (A Co Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU NICKOLAS ENVIRONMENTAL Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU NICKOLAS ENVIRONMENTAL Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 06/02/2017 Non-Par 81264 Commercial Nippon Life Insurance Co. Institutional 5010A2Claim Level Accept /Reject

ERA available under payer ID: 58379

U: 06/02/2017 Non-Par 81264 Commercial Nippon Life Insurance Co. Professional 5010A1Claim Level Accept /Reject


A: 12/06/2019 Non-Par J3926 Workers' Comp NJ NJ Property-Liability Ins Guaranty Assoc [NJPLIGA] Prof. Work Comp 5010A1

A: 12/06/2019 Non-Par J3926 Workers' Comp NJ NJ Property-Liability Ins Guaranty Assoc [NJPLIGA] Inst. Work Comp 5010A1

A: 11/07/2019 Non-Par LU552 Workers' Comp NJCure Professional 5010A1Claim Level Accept /Reject

A: 11/07/2019 Non-Par LU552 Workers' Comp NJCure Institutional 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 02/08/2013 Non-Par PDT01 Commercial MU Noble AMA Select IPA Professional 5010A1File LevelAcknowledgement

A: 01/03/2020 Non-Par PDT01 NOBLE AMA SELECT IPA Remittance 5010A1 Enrollment

U: 04/02/2019 Par 95399 Commercial CA Noble Community Professional 5010A1Claim Level Accept /Reject

A: 04/22/2021 Non-Par 66066 Commercial UT Nomi Health Professional 5010A1Claim Level Accept /Reject

No

A: 04/22/2021 Non-Par 66066 Commercial UT Nomi Health Institutional 5010A1Claim Level Accept /Reject

No

U: 08/15/2019 Par 76112 Commercial North American Insurance Company Remittance 5010A1 Enrollment

U: 01/10/2017 Trans E3510 Commercial CANorth American Medical Management - So.California


A: 01/05/2017 Par E3510 CANorth American Medical Mgmt - NAMM (FormerlyIP079)


A: 01/05/2017 Par E3510 Commercial CANorth American Medical Mgmt - NAMM (FormerlyIP079)


U: 09/02/2021 Par E3510 Commercial CA North American Medical Mgmt- NAMM Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU North American Video Corp. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU North American Video Corp. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/16/2019 Non-Par 12M23 Government NCNorth Carolina - Medicare Part A (J11) (FormerlyIR020)


Yes

A: 10/10/2019 Non-Par 12M23 Commercial NCNorth Carolina - Medicare Part A (J11) (FormerlyIR020)


A: 11/04/2020 Non-Par 74256 Commercial NC North Carolina Department of Public Safety (NCDPS) Institutional 5010A1 Claim Level Ack. Yes

A: 11/04/2020 Non-Par 74256 Commercial NC North Carolina Department of Public Safety (NCDPS) Professional 5010A1 Claim Level Ack. Yes

U: 03/24/2014 Non-Par 41556 Workers' Comp MU North Clackamas School District #12 Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/02/2014 Non-Par CALL Commercial CA North County Health Services Professional 5010A1 No Response From Payer


U: 03/24/2014 Non-Par 41556 Workers' Comp MU North County Transit District Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 17516 Commercial North Shore - LIJ (Healthfirst) Professional 5010A1 No Response From Payer Yes

A: 09/01/2016 Par 17516 Commercial North Shore - LIJ (Healthfirst) Institutional 5010A2 No Response From Payer Yes

U: 02/24/2017 Non-Par 17516 Commercial North Shore - LIJ (Healthfirst) Remittance 5010A1 Enrollment

A: 11/09/2018 Non-Par PROSP Commercial CA North West Orange County Medical Group Professional 5010A1 Claim Level Ack.

U: 09/23/2013 Non-Par 41556 Workers' Comp MUNorthern Colorado School Districts Workers'Compensation Pool


U: 03/24/2014 Non-Par 41556 Workers' Comp MUNorthern Colorado School Districts Workers'Compensation Pool


U: 09/01/2016 Par 36347 Commercial Northern Illinois Health Plan Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 36347 Commercial IL Northern Illinois Health Plan Professional 5010A1 No Response From Payer

A: 09/01/2016 Par 88027 Commercial Northern Nevada Trust Fund Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par NMG01 Commercial Northridge Medical Group Professional 5010A1

U: 03/11/2013 Non-Par 48026 Commercial MU NorthShore Physician Associates Professional 5010A1 No Response From Payer Yes

U: 10/23/2020 Non-Par 48026 Commercial NorthShore Physician Associates Remittance 5010A1 Enrollment

A: 12/05/2014 Non-Par 48026 Commercial NorthShore Physician Associates Institutional 5010A2 No Response From Payer Yes

U: 10/07/2019 Non-Par 91068 Commercial Northwest Administrators Remittance 5010A1 Enrollment

A: 03/13/2020 Par NWCHP Commercial IL Northwest Community Health Partners Institutional 5010A1Claim Level Accept /Reject

A: 03/13/2020 Par NWCHP Commercial IL Northwest Community Health Partners Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par NPN11 Commercial Northwest Physicians Network Institutional 5010A1 Claim Level Ack.

A: 07/15/2014 Non-Par NPN11 Commercial Northwest Physicians Network Professional 5010A1 File Level Ack. No

U: 09/01/2016 Par 36346 Commercial Northwest Suburban IPA (Illinois) Institutional 5010A2 No Response From Payer

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/01/2016 Par 36346 Commercial IL Northwest Suburban IPA (Illinois) Professional 5010A1Claim Level Accept /Reject

A: 02/01/2021 Par NWEST Commercial IL Northwestern Medicine Physicians Network Professional 5010A1 Claim Level Ack. No

A: 02/01/2021 Par NWEST Commercial IL Northwestern Medicine Physicians Network Institutional 5010A1 Claim Level Ack. No

A: 10/04/2018 Non-Par NWOOD Commercial MI Northwood Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/02/2019 Non-Par NWOOD Commercial NORTHWOOD Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Nova Dealership Advantage Program - WC Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Nova Dealership Advantage Program - WC Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Nova Elite Comp Program Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Nova Elite Comp Program Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 06/30/2020 Non-Par 16644 Commercial NY Nova Healthcare Administrators Remittance 5010A1 Enrollment

A: 06/05/2020 Non-Par 16644 Commercial NY Nova Healthcare Administrators, Inc. Professional 5010A1Claim Level Accept /Reject

Yes

A: 06/05/2020 Non-Par 16644 Commercial NY Nova Healthcare Administrators, Inc. Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Nova Metals Advantage Plus Program - WC Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Nova Metals Advantage Plus Program - WC Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/28/2019 Par HLSTA Commercial WI Novant Health Direct-to-Employer Episodes Institutional 5010A1Claim Level Accept /Reject

Yes

A: 05/28/2019 Par HLSTA Commercial WI Novant Health Direct-to-Employer Episodes Professional 5010A1Claim Level Accept /Reject

Yes

U: 11/01/2012 Non-Par 71080 Commercial Novasys Health Network Institutional 5010A2 No Response From Payer

U: 02/13/2014 Non-Par 71080 Commercial Novasys Health Network Professional 5010A1Claim LevelAcknowledgement

A: 01/20/2021 Non-Par PHMD1 Commercial OR NP Providence Health Plan Commercial Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/20/2021 Non-Par PHMD2 Medicare OR NP Providence Health Plan Medicare Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/20/2021 Non-Par PHMD3 Commercial OR NP Providence Health Plan OHP Professional 5010A1Claim Level Accept /Reject

Yes

A: 04/15/2021 Non-Par PHMD4 Commercial OR NP Yambill County CCO Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/24/2014 Non-Par 22262 Commercial NPS Professional 5010A1 Claim Level Ack.

A: 11/09/2018 Non-Par PROSP Commercial CANuestra Familia Medical Group (Prospect MedicalGroup)


U: 09/23/2013 Non-Par 41556 Workers' Comp MU Nuevo Engineering Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Nuevo Engineering Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Numero Uno Market Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Numero Uno Market Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 04/08/2019 Trans 45052 Workers' Comp MU NY STATE INS FUND [NYSIF] Prof. Work Comp 5010A1

U: 03/11/2013 Non-Par 14142 Commercial NY NYC Department of Health Professional 5010A1File LevelAcknowledgement

Yes

U: 03/11/2013 Non-Par 14142 Commercial NY NYC Department of Health Institutional 5010A2File LevelAcknowledgement

Yes

U: 10/01/2019 Non-Par 14142 Commercial NY NYC Department of Health Remittance 5010A1 Enrollment

U: 11/01/2012 Non-Par 37299 Commercial Nyhart Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 37299 Commercial IN Nyhart Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 14180 Commercial NYMI Oxford Professional 5010A1Claim LevelAcknowledgement

A: 02/09/2017 Par OAKST Commercial IL Oak Street Health Professional 5010A1 Claim Level Ack. No

Updated: 03/21/2022


PPAAYERYERIDID



A: 02/09/2017 Par OAKST Commercial IL Oak Street Health Institutional 5010A1 Claim Level Ack. No

A: 06/24/2015 Non-Par 36400 Commercial IL Oak West Physician Association Professional 5010A1 Claim Level Ack.

U: 08/15/2019 Non-Par 36400 Commercial IL Oak West Physician Association Remittance 5010A1 Enrollment

A: 06/24/2015 Non-Par 36400 Commercial IL Oak West Physician Association Institutional 5010A1 Claim Level Ack.

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Oakwood Interiors Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Oakwood Interiors Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par DESRT Commercial Oasis IPA Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par L0140 Commercial Ocular Benefits Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 34189 Commercial Ohio Health Choice PPO Institutional 5010A2 No Response From Payer

ONLY for claims with a billingsubmission address of PO Box 3619,Akron, OH 44309-3619 or PO Box93538

U: 09/01/2016 Par 34189 Commercial OH Ohio Health Choice PPO Professional 5010A1 No Response From Payer

ONLY for claims with a billingsubmission address of PO Box 3619,Akron, OH 44309-3619 or PO Box93538

A: 06/04/2020 Non-Par SMOH0 Government OH Ohio Medicare (Formerly MR033) Remittance 4010A1 Enrollment

A: 06/04/2020 Non-Par SMOH0 Government OH Ohio Medicare (Formerly MR033) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 03/21/2013 Non-Par 74431 Commercial MU Ohio PPO Connect Professional 5010A1 Yes

A: 12/05/2014 Non-Par 74431 Commercial Ohio PPO Connect Institutional 5010A2 No Response From Payer Yes

U: 09/10/2012 Non-Par SVIPA Commercial CAOjai Valley Community Med. Group now known asSeaView IPA


A: 04/05/2018 Non-Par 71065 Commercial OK Oklahoma DRS DOC Remittance 5010A1 Enrollment

A: 03/29/2018 Par 71065 Commercial OK Oklahoma DRS DOC Institutional 5010A1 Claim Level Ack. No

A: 03/29/2018 Par 71065 Commercial OK Oklahoma DRS DOC Professional 5010A1 Claim Level Ack. No

U: 03/23/2012 Non-Par CLFR2 Commercial Oklahoma State Medical Association Professional 5010A1Claim Level Accept /Reject

A: 10/09/2020 Non-Par 29237 Commercial OK Old Surety Life Insurance Company Remittance 5010A1 Enrollment

A: 11/24/2014 Non-Par 65074 Commercial Olympus Managed Health Care Professional 5010A1 File Level Ack. Yes

A: 12/05/2014 Non-Par 65074 Commercial Olympus Managed Health Care Institutional 5010A2 File Level Ack. Yes

U: 09/01/2016 Par 68037 Commercial OMNI / Medicore HP Institutional 5010A2File LevelAcknowledgement

U: 09/01/2016 Par 68037 Commercial OMNI / Medicore HP Professional 5010A1File LevelAcknowledgement

U: 11/01/2012 Non-Par MDCOR Commercial Omni IPA / Medicare HP Professional 5010A1Claim Level Accept /Reject

A: 11/04/2021 Non-Par 27590 Commercial MI Omnicare - JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 11/04/2021 Non-Par 27590 Commercial MI Omnicare - JVHL Remittance 5010A1 Enrollment

U: 07/07/2014 Par IP088 Commercial CA Omnicare Medical Group (OMNI) Professional 5010A1Claim Level Accept /Reject

U: 10/03/2016 Non-Par TH012 Commercial On Insurance Service Of Lubbock (formerly ISL11) Professional 5010A1Claim Level Accept /Reject

Yes

U: 11/01/2018 Par 22321 Commercial One Call Medical Institutional 5010A2 Claim Level Ack.

U: 11/01/2018 Par 22321 Commercial One Call Medical (OCM) Professional 5010A1 Claim Level Ack.

U: 09/23/2013 Non-Par J1491 Workers' Comp MU ONE STOP BRAKE SUPPLY SANTA AN Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU ONE STOP BRAKE SUPPLY SANTA AN Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU ONE STOP UNDERCAR RIVERSIDE, I Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU ONE STOP UNDERCAR RIVERSIDE, I Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Ontario Metal Recycling Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Ontario Metal Recycling Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/23/2013 Non-Par J1491 Workers' Comp MU Onyx Acceptance Corporation Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Onyx Acceptance Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/29/2018 Trans 86602 Commercial IL Operating Engineers Local 428 Professional 5010A1 Claim Level Ack. Yes

A: 05/29/2018 Trans 86602 Commercial IL Operating Engineers Local 428 Institutional 5010A1 Claim Level Ack. Yes

U: 09/01/2016 Par 91136 CommercialOperating Engineers Locals 302 & 612 Health &Security Fund


U: 09/01/2016 Par 91136 CommercialOperating Engineers Locals 302 & 612 Hlth &Security Fund, Grp# F12


U: 03/11/2013 Non-Par 54154 Commercial Optima Health Insurance Company Professional 5010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 54154 Commercial Optima Health Plan Institutional 5010A2 No Response From Payer Yes

U: 03/11/2013 Non-Par 54154 Commercial Optima Health Plan Professional 5010A1 No Response From Payer Yes

Rendering provider id is required. IDwill be 5-7 characters. Positions 1-5must be numeric, positions 6 and 7 (ifapplicable) must be alpha. Pleasecontact Ydsia Slagle with providerrelations @ 757-552-7477

U: 04/28/2020 Non-Par 54154 Commercial Optima Health Plan / Sentara Remittance 4010A1 Enrollment

U: 03/11/2013 Non-Par 54154 Commercial Optima Insurance Company Institutional 5010A2 No Response From Payer Yes

A: 05/27/2020 Par 96277 Commercial GA OptiMed Health Professional 5010A1Claim Level Accept /Reject

A: 05/27/2020 Par 96277 Commercial GA OptiMed Health Institutional 5010A1Claim Level Accept /Reject

U: 03/04/2016 Par 87726 Commercial Optimum Choice, Inc (OCI)(Formerly 52148) Institutional 5010A2 No Response From Payer Yes

U: 01/01/2012 Non-Par 20133 Commercial Optimum Healthcare Inc. Institutional 5010A2File LevelAcknowledgement

Yes

U: 01/01/2012 Non-Par 20133 Commercial Optimum Healthcare Inc. Professional 5010A1File LevelAcknowledgement

Yes

A: 05/09/2019 Non-Par 20133 OPTIMUM HEALTHCARE SERVICES Remittance 5010A1 Enrollment

U: 06/09/2021 Non-Par VACCN Commercial TNOptum - Veterans Affairs Community Care Network(CCN) Regions 1-3


Yes

A: 02/01/2021 Non-Par OCN01 Commercial MN Optum Care Network Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/01/2021 Non-Par OCN01 Commercial MN Optum Care Network Institutional 5010A1Claim Level Accept /Reject

Yes

A: 02/19/2021 Non-Par OCN01 Commercial MN Optum Care Network Remittance 5010A1 Enrollment

A: 06/15/2020 Non-Par OMDBH Commercial MD Optum Maryland Behavior Health Remittance 5010A1 Enrollment

A: 01/10/2020 Par OMDBH Commercial MD Optum Maryland Behavior Health Professional 5010A1Claim Level Accept /Reject

No

A: 01/10/2020 Par OMDBH Commercial MD Optum Maryland Behavior Health Institutional 5010A1Claim Level Accept /Reject

No

U: 01/21/2022 Par LIFE1 CommercialOptum Medical Network (formerly LIFEPRINTNetwork)


Yes

U: 01/21/2022 Non-Par LIFE1 CommercialOptum Medical Network (formerly LIFEPRINTNetwork)

Remittance 5010A1 EnrollmentEFT is a requirement to receive ERAtransactions from Lifeprint

A: 01/21/2022 Par LIFE1 CommercialOptum Medical Network (formerly LIFEPRINTNetwork)


Yes

A: 02/25/2021 Non-Par U6885 Commercial MN Optum Salt Lake County Public Sector Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 02/25/2021 Non-Par U6885 Commercial MN Optum Salt Lake County Public Sector Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 07/24/2020 Non-Par U6885 Commercial MN Optum Salt Lake Cty Public Sector Remittance 5010A1 Enrollment

U: 09/23/2021 Non-Par VACCN Commercial TNOptum- Veterans Affairs Community Care Network(CCN) Regions 1-3


U: 06/09/2021 Non-Par VACCN Commercial TNOptum- Veterans Affairs Community Care Network(CCN) Regions 1-3


Yes

A: 08/24/2018 Par E3287 Commercial CT OptumCare Network of Connecticut Institutional 5010A1Claim Level Accept /Reject

Yes

A: 08/24/2018 Par E3287 Commercial CT OptumCare Network of Connecticut Professional 5010A1Claim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



U: 11/27/2019 Non-Par E3287 Commercial CT Optumcare Network of Connecticut Remittance 5010A1

U: 04/04/2016 Par 41194 CommercialOptumHealth Care Solutions (Formerly UnitedResources Networks)


Yes

A: 04/27/2016 Par 41194 CommercialOptumHealth Care Solutions (Formerly UnitedResources Networks) (Formerly 52190)


U: 03/03/2022 Non-Par 41161 Commercial MU OptumHealth Physical Health Remittance 5010A1 Enrollment

A: 04/04/2016 Par 41161 CommercialOptumHealth Physicial Health / OptumHealth(formerly ACN01)


A: 09/01/2016 Par 65021 Commercial Orange County Health Care Agency Professional 5010A1 File Level Ack.

A: 09/01/2016 Par 65021 Commercial Orange County Health Care Agency Institutional 5010A1 Claim Level Ack.

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Original Sid Blackman Plumbing Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Original Sid Blackman Plumbing Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/11/2013 Non-Par 25133 Commercial ORNDA Health D296Corp (First Health)+D312 Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 13383 Commercial Orthonet - Aetna Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/24/2019 Non-Par 13383 Commercial Orthonet - Aetna Remittance 5010A1 Enrollment

U: 09/01/2016 Par 13382 Commercial Orthonet - Uniformed Service Family Health Plan Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 13383 Commercial Orthonet- Aetna Institutional 4010A1Claim Level Accept /Reject

Yes

U: 11/27/2019 Non-Par OSCAR Commercial NY Oscar Health Remittance 5010A1 Enrollment

A: 01/27/2016 Par OSCAR Commercial NY Oscar Health Insurance Professional 5010A1Claim Level Accept /Reject

A: 01/27/2016 Par OSCAR Commercial NY Oscar Health Insurance Institutional 5010A1Claim Level Accept /Reject

A: 08/08/2014 Non-Par 62171 Commercial OSF Health Plans Institutional 5010A2

A: 02/06/2017 Par OSFC9 Commercial IL OSF Healthcare Central Professional 5010A1 Claim Level Ack. No

A: 02/06/2017 Par OSFC9 Commercial IL OSF Healthcare Central Institutional 5010A1 Claim Level Ack. No

A: 02/03/2017 Par OSFE9 Commercial IL OSF Healthcare East Professional 5010A1 Claim Level Ack. No

A: 02/03/2017 Par OSFE9 Commercial IL OSF Healthcare East Institutional 5010A1 Claim Level Ack. No

U: 11/01/2012 Non-Par 62171 Commercial IL OSF Healthplans Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Osi Systems Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Osi Systems Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 73071 Commercial OSMA Health - C. L. Frates Institutional 5010A2File LevelAcknowledgement

U: 09/01/2016 Par 73071 Commercial OSMA Health - C. L. Frates Professional 5010A1File LevelAcknowledgement

A: 11/25/2015 Par 04430 Commercial GA Outpatient Services Professional 5010A1 Claim Level Ack.

A: 11/25/2015 Par 04430 Commercial GA Outpatient Services Institutional 5010A1 Claim Level Ack.

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Outrigger Lodging Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Outrigger Lodging Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Overhill Farms, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Overhill Farms, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 07/01/2020 Non-Par WB457 Workers' Comp OWCP Prof. Work Comp 5010A1 No Response From Payer NoWorkCompEDI's Billing Agent/ CHOWCP ID with DOL is ID# 700956700

A: 07/01/2020 Non-Par WB457 Workers' Comp OWCP Inst. Work Comp 5010A1 No Response From Payer NoWorkCompEDI's Billing Agent/ CHOWCP ID with DOL is ID# 700956700

A: 07/02/2020 Non-Par WB457 Commercial OWCP Remittance 5010A1 Enrollment

U: 04/27/2016 Par 06111 Commercial Oxford Health Plan Institutional 5010A2Claim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/18/2019 Par 06111 Commercial Oxford Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/02/2021 Non-Par 06111 Commercial Oxford Health Plan Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU P.J. Cal #1, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU P.J. Cal #1, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/23/2019 Non-Par 58375 Commercial MN P3 Health Partners Arizona Professional 5010A1Claim Level Accept /Reject

No

A: 08/23/2019 Non-Par 58375 Commercial MN P3 Health Partners Arizona Institutional 5010A1Claim Level Accept /Reject

No

A: 10/04/2019 Non-Par P3HNV Commercial NV P3 Health Partners Nevada Professional 5010A1Claim Level Accept /Reject

No

A: 10/04/2019 Non-Par P3HNV Commercial NV P3 Health Partners Nevada Institutional 5010A1Claim Level Accept /Reject

No

A: 10/02/2019 Non-Par 72436 Commercial IA PACE Central Iowa Remittance 5010A1 Enrollment

A: 10/21/2016 Trans 72436 Commercial IA PACE Central Iowa (MEDITURE LLC) Institutional 5010A1 Claim Level Ack. No

A: 10/21/2016 Trans 72436 Commercial IA PACE Central Iowa (MEDITURE LLC) Professional 5010A1 Claim Level Ack. No

A: 09/01/2016 Trans 70454 Commercial NY PACE CNY Professional 5010A1 Claim Level Ack.

A: 09/01/2016 Trans 70454 Commercial NY PACE CNY Institutional 5010A1 Claim Level Ack.

A: 07/03/2017 Trans 21614 Commercial LA PACE Greater New Orleans Institutional 5010A1Claim Level Accept /Reject

No

A: 07/03/2017 Trans 21614 Commercial LA PACE Greater New Orleans Professional 5010A1Claim Level Accept /Reject

No

U: 08/15/2019 Non-Par 21614 Commercial LA PACE Greater New Orleans Remittance 5010A1 Enrollment

A: 09/13/2019 Non-Par 35416 Commercial NE PACE Nebraska Remittance 5010A1 Enrollment

A: 10/21/2019 Trans 35416 Commercial NE PACE Nebraska (MEDITURE LLC) Institutional 5010A1 Claim Level Ack.

A: 10/21/2019 Trans 35416 Commercial NE PACE Nebraska (MEDITURE LLC) Professional 5010A1 Claim Level Ack.

A: 07/27/2016 Trans 45114 Commercial MI PACE of Southwest Michigan Professional 5010A1 Claim Level Ack. No

A: 07/27/2016 Trans 45114 Commercial MI PACE of Southwest Michigan Institutional 5010A1 Claim Level Ack. No

A: 09/13/2019 Non-Par 45114 Commercial MI PACE of Southwest Michigan, Inc Remittance 5010A1 Enrollment

A: 09/01/2016 Trans 86711 Commercial MI PACE Southeast Michigan Professional 5010A1 Claim Level Ack. No

U: 08/15/2019 Non-Par 86711 Commercial MI PACE Southeast Michigan Remittance 5010A1 Enrollment

A: 09/01/2016 Trans 86711 Commercial MI PACE Southeast Michigan Institutional 5010A1 Claim Level Ack.

A: 09/24/2019 Non-Par 53534 Commercial IA PACE SouthWest Iowa Remittance 5010A1 Enrollment

A: 10/21/2019 Trans 53534 Commercial IA PACE Southwest Iowa (MEDITURE LLC) Professional 5010A1 Claim Level Ack.

A: 10/21/2019 Trans 53534 Commercial IA PACE Southwest Iowa (MEDITURE LLC) Institutional 5010A1 Claim Level Ack.

A: 12/07/2021 Non-Par PCFAD Commercial Pacific Administrators Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDPCFAD. Providers will need to enrollfor payer IDs PCFAD and 58379 inorder to receive 835s for this payer.

A: 12/07/2021 Non-Par 58379 Commercial Pacific Administrators (Formerly PCFAD) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID PCFAD.Providers will need to enroll for payerIDs PCFAD and 58379 in order toreceive 835s for this payer.

U: 09/23/2013 Non-Par J1491 Workers' Comp MU PACIFIC DATA ELECTRIC, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU PACIFIC DATA ELECTRIC, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Pacific Hydrotech Co Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Pacific Hydrotech Co Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par PCFCI Commercial Pacific IPA Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Pacific Lumber Company (Marathon) Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Pacific Lumber Company (Marathon) Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Pacific Specialty Insurance Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Pacific Specialty Insurance Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/18/2016 Par 87726 Commercial PacifiCare (formerly 95959) Professional 5010A1Claim Level Accept /Reject

Yes

U: 05/06/2020 Par 87726 Commercial MUPacifiCare / Secure Horizons HMO claims only. Notfor PPO claims


U: 03/18/2016 Par 87726 Commercial Pacificare Behavioral Health (formerly 33053) Professional 5010A1Claim Level Accept /Reject

U: 01/14/2020 Non-Par 95959 Commercial MU Pacificare Health Systems Remittance 5010A1 Enrollment

U: 03/18/2016 Par 87726 Commercial Pacificare Health Systems, Inc. (formerly 95959) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/18/2016 Par 87726 CommercialPacifiCare PPO - All States (For payable PPO claimsonly. NOT for PacifiCare / Secure Horizons HMOclaims. (formerly 95999)


Pacificare ERA are available underPayer ID 95959. ERA enrollment andfile delivery appear under payer ID95959. For further questions, you mayinquire via email [email protected]

U: 03/18/2016 Par 87726 Commercial Pacificare PPO - All States (formerly 95999) Institutional 5010A2Claim Level Accept /Reject

U: 09/01/2016 Par 93031 CommercialPacificSource Administrators (AKA Select BenefitAdministrators Inc.)


U: 09/01/2016 Par 93031 CommercialPacificSource Administrators (AKA Select BenefitAdministrators Inc.)


A: 09/01/2016 Par 20416 Commercial OR PacificSource Community Solutions Professional 5010A1 Claim Level Ack.

A: 09/01/2016 Par 20416 Commercial OR PacificSource Community Solutions Institutional 5010A1 Claim Level Ack.

U: 05/01/2017 Non-Par 93029 Commercial PacificSource Health Plan Remittance 5010A1 EnrollmentYou must be actively submittingclaims to this payer prior torequesting ERAs

U: 09/01/2016 Par 93029 Commercial PacificSource Health Plan Institutional 5010A2 No Response From Payer Yes

U: 12/02/2019 Par 93029 Commercial PacificSource Health Plan Professional 5010A1 Yes

U: 09/01/2016 Par 20377 Commercial MU PacificSource Medicare Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 20377 Commercial PacificSource Medicare Institutional 5010A2 File Level Ack. Yes

U: 09/01/2016 Par 37287 Commercial PAI Institutional 5010A2 No Response From Payer

A: 01/31/2020 Non-Par 53483 Commercial MI Painters Union Insurance Fund Professional 5010A1Claim Level Accept /Reject

No

A: 01/31/2020 Non-Par 53483 Commercial MI Painters Union Insurance Fund Institutional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Pajaro Vly Comnty Health Trust Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Pajaro Vly Comnty Health Trust Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/24/2014 Non-Par L0180 Commercial Palic -Panamerican Life (PR) Professional 5010A1 Claim Level Accept/Reject

A: 12/05/2014 Non-Par L0180 Commercial Palic -Panamerican Life (PR) Institutional 5010A2 Claim Level Accept/Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU PALLET DEPOT Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU PALLET DEPOT Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU PALO ALTO HILLS GOLF & COUNTRY Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU PALO ALTO HILLS GOLF & COUNTRY Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/11/2013 Par IP132 Commercial CA Palo Alto Medical Foundation Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Palo Alto Medical Foundation Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 06/20/2017 Non-Par IP132 Commercial CA Palo Alto Medical Foundation Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Palo Alto Medical Foundation Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 08/19/2019 Non-Par 94115 Commercial MU Palo Alto Medical Foundation Remittance 5010A1 Enrollment

A: 08/14/2012 Trans HM067 Commercial CA Palo Alto Medical Foundation (Encounters Only) Professional 5010A1Claim Level Accept /Reject

A: 12/10/2021 Non-Par PA066 Commercial Pan American Insurance Company Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDPA066. Providers will need to enrollfor payer IDs PA066 and 58379 inorder to receive 835s for this payer.

A: 12/10/2021 Non-Par 58379 Commercial Pan American Insurance Company (Formerly PA066) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID PA066.Providers will need to enroll for payerIDs PA066 and 58379 in order toreceive 835s for this payer.

A: 09/01/2016 Par 04218 Commercial Pan American Insurance Group Professional 5010A1 File Level Ack. No

A: 09/01/2016 Par 04218 Commercial Pan American Insurance Group Institutional 5010A2 No Response From Payer

A: 06/22/2020 Par 87020 Commercial Pan American Life Insurance Professional 5010A1 No Response From Payer No

A: 06/22/2020 Par 87020 Commercial Pan American Life Insurance Institutional 5010A1 No Response From Payer No

A: 02/12/2021 Non-Par 58379 Commercial Pan American Life Insurance (87020) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 01/21/2015 Non-Par PAPER Paper Paper Claims (CMS 1500) Professional 5010A1 File Level Ack.

U: 01/21/2015 Non-Par PAPER Paper Paper Claims (UB04) Institutional 5010A2 File Level Ack.

U: 01/22/2015 PRINT Paper Paper Printed Professional 5010A1 File Level Ack. YesThis payer id is to be used to bypassthe PAPER to EDI process and alwaysprint to PAPER.

U: 01/22/2015 PRINT Paper Paper Printed Institutional 5010A2 File Level Ack. YesThis payer id is to be used to bypassthe PAPER to EDI process and alwaysprint to PAPER

A: 05/28/2019 Non-Par J1001 Workers' Comp Paradigm Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/28/2019 Non-Par J1001 Workers' Comp Paradigm Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 03/12/2021 Non-Par PARLN Commercial MO Parallon RCPS Institutional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 03/12/2021 Non-Par PARLN Commercial MO Parallon RCPS Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

U: 09/02/2021 Non-Par SX158 Commercial Paramount Health Care Remittance 5010A1 Enrollment

A: 01/11/2019 Non-Par SX158 Commercial OH Paramount Health Care Institutional 5010A1Claim Level Accept /Reject

Yes

A: 03/07/2017 Non-Par SX158 Commercial Paramount Health Care (Formerly PARHC) Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 58204 Commercial Parity Healthcare, LLC Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU PARK MANAGEMENT GROUP, INC.; Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU PARK MANAGEMENT GROUP, INC.; Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/02/2014 Non-Par CALL Commercial CA Park Terrace/Encompass Medical GP Professional 5010A1 No Response From PayerTo obtain Payer ID and enroll withpayer please contact Tristin Rausche858-824-7100 [email protected]

U: 04/26/2021 Non-Par 66917 Commercial Parkland Community Health Plan Institutional 5010A2 No Response From Payer

U: 04/26/2021 Non-Par 66917 Commercial Parkland Community Health Plan Professional 5010A1Claim Level Accept /Reject

U: 07/27/2021 Non-Par 66917 Commercial MU Parkland Community Health Plan Remittance 5010A1 Enrollment


A: 07/27/2021 Non-Par 58379 CommercialParkland Community Health Plan (formerly payer id66917)



Updated: 03/21/2022


PPAAYERYERIDID



U: 10/06/2021 Non-Par 52613 Commercial MU Partners Behavioral Health Management Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 06/24/2013 Non-Par 52613 Commercial MU Partners Behavioral Health Management Institutional 5010A2Claim Level Accept /Reject

Yes

A: 04/08/2016 Par 14966 Commercial TX Partners Health Plan Professional 5010A1Claim Level Accept /Reject

No

A: 04/08/2016 Par 14966 Commercial TX Partners Health Plan Institutional 5010A1Claim Level Accept /Reject

No

A: 01/11/2017 Par PARTH Commercial IL Partners in Health Institutional 5010A1 Claim Level Ack. No

A: 01/11/2017 Par PARTH Commercial IL Partners in Health Professional 5010A1 Claim Level Ack. No

U: 10/01/2019 Non-Par SX140 GovernmentPartnership Health Plan of California (FormerlyPHP02)


U: 09/30/2019 Non-Par SX140 GovernmentPartnership Health Plan of California (FormerlyPHP02)


U: 10/17/2019 Non-Par 12M81 GovernmentPartnership Health Plan of California (FormerlyPHP02)


U: 09/23/2013 Non-Par 41556 Workers' Comp MU Pas Coffee Roasters Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Pas Coffee Roasters Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 04/02/2019 Par 95399 Commercial CA Pasadena Primary Care Physicians Professional 5010A1Claim Level Accept /Reject

A: 07/17/2018 Par 66008 Commercial PA Passport Advantage Institutional 5010A1Claim Level Accept /Reject

Yes

A: 07/17/2018 Par 66008 Commercial PA Passport Advantage Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/07/2019 Non-Par 66008 Commercial PA Passport Advantage Remittance 5010A1

U: 12/31/2021 Trans 61325 Medicaid KY Passport Health Plan by Molina Healthcare Institutional 5010A1 Claim Level Ack. Yes


U: 12/31/2021 Trans 61325 Medicaid KY Passport Health Plan by Molina Healthcare Professional 5010A1Claim Level Accept /Reject

Yes

ERA/835 transactions are availablefor this plan by enrolling at ChangeHealthcare under payer id 20149.ERA/835 transactions for this plan willbe delivered under payer id 20149

U: 09/23/2013 Non-Par J1491 Workers' Comp MU PASTABRAVO RESTAURANTS, INC. ( Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU PASTABRAVO RESTAURANTS, INC. ( Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/11/2020 Non-Par 55489 Commercial ME Patient Advocates Professional 5010A1Claim Level Accept /Reject

No

A: 12/11/2020 Non-Par 55489 Commercial ME Patient Advocates Institutional 5010A1Claim Level Accept /Reject

No

A: 10/02/2018 Trans 20510 Commercial TX Patient Physician Cooperatives Professional 5010A1 Claim Level Ack. Yes

A: 10/02/2018 Trans 20510 Commercial TX Patient Physician Cooperatives Institutional 5010A1 Claim Level Ack. Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Patterson Bro Light. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Patterson Bro Light. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 27048 Commercial Payer Fusion Professional 5010A1 Claim Level Ack.

A: 09/01/2016 Par 27048 Commercial Payer Fusion Institutional 5010A2 Claim Level Ack.

Update Type:11/24/2014

Par/Non-Par/Trans

PayerID

Payer Type Payer Name Transaction TypeEDIVersion

Response LevelAcceptCOB

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Pdq Automatic Transmission Par Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Pdq Automatic Transmission Par Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 04/17/2019 Par 68069 Commercial GA Peach State Health Plan Professional 5010A1 Yes

A: 06/29/2021 Non-Par 27034 Commercial MO Peak PACE Solutions LLC Remittance 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



A: 04/27/2018 Non-Par 27034 Commercial MO Peak PACE Solutions, LLC Professional 5010A1Claim Level Accept /Reject

Yes

A: 04/27/2018 Non-Par 27034 Commercial MO Peak PACE Solutions, LLC Institutional 5010A1Claim Level Accept /Reject

Yes

A: 09/14/2016 Par PEF01 Commercial IL PEF Clinic Institutional 5010A1 Claim Level Ack. No

A: 09/14/2016 Par PEF01 Commercial IL PEF Clinic Professional 5010A1 Claim Level Ack. No

A: 11/09/2018 Non-Par PROSP Commercial CA Pegasus Medical Group Professional 5010A1 Claim Level Ack.

U: 09/23/2013 Non-Par J1491 Workers' Comp MU PENINSULA PONTIAC GMC BUICK Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU PENINSULA PONTIAC GMC BUICK Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/22/2017 Trans 53226 Commercial PA Penn Behavioral Health Institutional 5010A1 No

U: 09/22/2017 Non-Par 53226 Commercial Penn Behavioral Health Professional 5010A1 Enrollment Claim Level Ack. Yes

A: 01/10/2020 Non-Par VALHL Commercial PA Pennsylvania Health Care Plan Professional 5010A1Claim Level Accept /Reject

No

A: 08/23/2021 Non-Par VALHL Commercial PA Pennsylvania Health Care Plan Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Pennsylvania Manufacturers Indemnity Company Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MUPennsylvania Manufacturers' Association InsuranceCompany


U: 03/24/2014 Non-Par 41556 Workers' Comp MUPennsylvania Manufacturers' Association InsuranceCompany


A: 07/11/2017 Non-Par 12008 Government PA Pennsylvania Medicaid (Formerly IC016) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/19/2019 Non-Par 12008 Commercial PA Pennsylvania Medicaid (Formerly IC016) Remittance 5010A1 Enrollment

A: 03/04/2013 Non-Par 20172 Commercial PA Pennsylvania Pace Professional 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par 20172 Commercial Pennsylvania Pace Institutional 5010A2 No Response From Payer

A: 04/09/2010 Non-Par CALL Commercial MD Pennsylvania Preferred Health Network (PPHN) Professional 4010A1 No Response From PayerTo obtain payer id you MUST first callJessica Picarde, Manager of PPHNClaims Operations at (410)349-3222

A: 01/20/2022 Non-Par 23626 Commercial PA Pennsylvania Teamsters Fund Professional 5010A1 No Response From Payer No

A: 01/20/2022 Non-Par 23626 Commercial PA Pennsylvania Teamsters Fund Institutional 5010A1 No Response From Payer No

U: 12/19/2014 Non-Par CALL Commercial PA Pennsylvania's Preferred Health Network (PPHN) Institutional 5010A2 YesCall Jessica Picarde Manager of PPHNClaims Operations(410) 349-3222

U: 09/01/2016 Par 72126 Commercial Peoples Health Network Professional 5010A1Claim Level Accept /Reject

U: 08/16/2019 Non-Par 72126 Commercial Peoples Health Network Remittance 5010A1 Enrollment

A: 09/01/2016 Par 72126 Commercial Peoples Health Network Institutional 5010A2 Claim Level Accept/Reject

U: 09/01/2016 Par 41124 Commercial Performax, Inc. Institutional 5010A2Claim LevelAcknowledgement

Yes

U: 03/11/2013 Non-Par 41124 Commercial Performax, Inc. Professional 5010A1Claim LevelAcknowledgement

Yes

U: 05/13/2021 Non-Par 65391 Commercial PerformCare Professional 5010A1Claim Level Accept /Reject

Yes

U: 05/13/2021 Non-Par 65391 Commercial PA PerformCare Remittance 5010A1 Enrollment


U: 05/13/2021 Non-Par 65391 Commercial PerformCare Institutional 5010A1Claim Level Accept /Reject

Yes

A: 05/13/2021 Non-Par 58379 Commercial PerformCare (65391) Remittance 5010A1 Enrollment


A: 03/04/2013 Non-Par 95397 Commercial Personal Ins. Admin / Agoura Hills Professional 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par 95397 Commercial Personal Insurance Administrators Institutional 5010A2 File Level Ack.

A: 11/18/2021 Non-Par 95397 Commercial CA Personal Insurance Administrators, Inc. Remittance 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



U: 03/24/2014 Non-Par 41556 Workers' Comp MU Petaluma Valley Hospital Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Petro-Chem Industries Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Petro-Chem Industries Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Pflugerville ISD Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par 67814 Commercial Phoenix American Life (PAL) Professional 5010A1 No Response From Payer

U: 11/01/2012 Non-Par 67814 Commercial Phoenix Home Life (Phoenix Mutual Life) Professional 5010A1 No Response From Payer

U: 11/01/2012 Non-Par 67814 Commercial Phoenix Mutual Life (Phoenix Home Life) Professional 5010A1 No Response From Payer

U: 02/23/2012 Non-Par 00036 Commercial PHP of Kansas City Professional 5010A1Claim Level Accept /Reject

U: 03/04/2016 Par 87726 Commercial PHP of Michigan Institutional 5010A2Claim Level Accept /Reject

Yes

A: 11/24/2014 Non-Par 91171 Commercial Physicans of Southwest Washington Professional 5010A1 Claim Level Accept/Reject

A: 12/05/2014 Non-Par 91171 Commercial Physicans of Southwest Washington Institutional 5010A2 Claim Level Accept/Reject

U: 08/10/2021 Non-Par 91171 Commercial WA Physicans of Southwest Washington Remittance 5010A1 Enrollment


A: 08/10/2021 Non-Par 58379 Commercial Physicans of Southwest Washington (Formerly 91171) Remittance 5010A1 Enrollment


U: 09/01/2016 Par 58204 Commercial Physician Associates of Louisiana Professional 5010A1Claim Level Accept /Reject

A: 07/13/2021 Non-Par 12399 Commercial IN PHYSICIAN HEALTH PLAN of NORTHERN INDIANA - PHP Remittance 5010A1 Enrollment

A: 04/08/2015 Non-Par PPRT1 Government IL Physician Partners FHN Medicaid Professional 5010A1 Claim Level Ack.

A: 04/08/2015 Non-Par PPRT1 Government IL Physician Partners FHN Medicaid Institutional 5010A1 Claim Level Ack.

A: 09/01/2016 Par 28943 Commercial PHYSICIAN'S ACCOUNTABLE CARE ORG Professional 5010A1 Claim Level Accept/Reject

A: 09/01/2016 Par 28943 Commercial PHYSICIAN'S ACCOUNTABLE CARE ORG Institutional 5010A2 Claim Level Accept/Reject

U: 09/01/2016 Par 39156 Commercial Physician's Plus Insurance Corporation Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 39156 Commercial Physician's Plus Insurance Corporation Professional 5010A1Claim LevelAcknowledgement

U: 10/07/2019 Par 38265 Commercial MI Physicians Care Health Plan (ASR Corporation) Institutional 5010A2 No Response From Payer

U: 07/17/2020 Par 38265 Commercial MI Physicians Care Health Plan (ASR Corporation) Remittance 5010A1 Enrollment No Response From Payer

U: 09/01/2016 Par 36345 Commercial IL Physicians Care Network (Address Rockford, IL ONLY) Professional 5010A1Claim LevelAcknowledgement

U: 10/07/2019 Par 38265 Commercial MI Physicians Care Network (ASR Corporation) Professional 5010A2 No Response From Payer

U: 09/01/2016 Par 36345 Commercial Physicians Care Network (Rockford, IL only) Institutional 5010A2 No Response From Payer

A: 05/17/2021 Non-Par PCN12 Commercial WA Physicians Care Network, LLC Professional 5010A1Claim Level Accept /Reject

No

A: 05/17/2021 Non-Par PCN12 Commercial WA Physicians Care Network, LLC Institutional 5010A1Claim Level Accept /Reject

No

U: 10/31/2018 Par 33072 Commercial CAPhysicians Choice Medical Group of San Luis Obispo(formerly San Luis Obispo Select)

Professional 5010A1

A: 10/31/2018 Par 33072 Commercial CAPhysicians Choice Medical Group of San Luis Obispo(formerly San Luis Obispo Select)


A: 10/31/2018 Par 33072 Commercial CAPhysicians Choice Medical Group of San Luis Obispo(formerly San Luis Obispo Select)


U: 10/31/2018 Par 77012 CommercialPhysicians Choice Medical Group of Santa Maria(formerly Midcoast IPA)

Professional 5010A1

A: 10/31/2018 Par 77012 CommercialPhysicians Choice Medical Group of Santa Maria(formerly Midcoast IPA)


U: 09/01/2016 Par 37136 Commercial Physicians Health Assoc of Illinois Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 12T51 Commercial Physicians Health Choice Institutional 5010A2Claim Level Accept /Reject

A: 12/05/2014 Non-Par PHCS1 Commercial Physicians Health Choice Institutional 5010A2 No Response From Payer

Updated: 03/21/2022


PPAAYERYERIDID



A: 06/16/2016 Trans TH114 Commercial TX Physicians Health Choice (Encounters) Professional 5010A1Claim Level Accept /Reject

A: 03/04/2013 Non-Par MHM03 Commercial Physicians Health Network Professional 5010A1Claim Level Accept /Reject

U: 03/08/2016 Par 87726 Commercial NC Physicians Health Plan (PHP) - North Carolina Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/08/2016 Par 87726 Commercial SC Physicians Health Plan (PHP) - South Carolina Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/22/2019 Par 37330 Commercial MI Physicians Health Plan (PHP) Mid-Michigan Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/22/2020 Non-Par 83276 Commercial Physicians Health Plan Michigan Medicare Remittance 5010A1 Enrollment

This payers requires ElectronicRegistration, Vendors should enrolland complete registration viaEnrollment Wizard and mark activitysent to Payer. Providers shouldcomplete setup form and ChangeHealthcare will facilitate electronicregistration.

A: 03/01/2019 Non-Par 37330 Commercial MI PHYSICIANS HEALTH PLAN MID-MICHIGAN / PHP Remittance 5010A1 Enrollment

U: 05/04/2020 Non-Par 37330 MI PHYSICIANS HEALTH PLAN MID-MICHIGAN PHP Remittance 5010A1 Enrollment

U: 02/23/2012 Non-Par 12399 Commercial Physicians Health Plan Of Northern Indiana Professional 5010A1Claim Level Accept /Reject

A: 06/25/2018 Non-Par 12399 Commercial IN Physicians Health Plan of Northern Indiana Institutional 5010A1Claim Level Accept /Reject

No

A: 02/22/2019 37330 Commercial MI Physicians Health Plan PHP South Michigan Professional 5010A1Claim Level Accept /Reject

Yes

U: 05/06/2015 Non-Par NMM01 Commercial CA Physicians Healthways IPA Professional 5010A1Claim Level Accept /Reject

Customer Service: (626) 282-0288.For claims with DOS 4/1/15 and after.All other Physician Healthway claimsshould be directed to Payer ID PHIPA.

U: 11/01/2012 Non-Par IP118 Commercial CA Physicians Medical Group of San Jose Professional 5010A1 No Response From Payer

A: 10/23/2014 Non-Par EXC01 Commercial CA Physicians Medical Group of San Jose Professional 5010A1Claim Level Accept /Reject

U: 04/27/2016 Non-Par 47027 Commercial Physicians Mutual Insurance Company Institutional 5010A2 No Response From Payer Yes

U: 04/27/2016 Non-Par 47027 Commercial Physicians Mutual Insurance Company Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/20/2021 Non-Par 47027 Commercial Physicians Mutual Insurance Company Remittance 5010A1 Enrollment


A: 09/20/2021 Non-Par 58379 CommercialPhysicians Mutual Insurance Company(Formerly47027)



A: 09/15/2016 Par TH131 Commercial FL Physicians United Plan Institutional 5010A1 Claim Level Ack. Yes

A: 09/15/2016 Par TH131 Commercial FL Physicians United Plan Professional 5010A1 Claim Level Ack. Yes

A: 12/14/2016 Par 48008 Commercial CA PhysMetrics Professional 5010A1 Claim Level Ack. No

U: 09/01/2016 Trans 06607 Commercial Piedmont Behavioral Health Institutional 5010A2 Claim Level Ack. Yes

U: 09/01/2016 Trans 06607 Commercial Piedmont Behavioral Health Professional 5010A1 Claim Level Ack. Yes

U: 10/04/2019 Non-Par 06607 Commercial Piedmont Behavioral Health Remittance 5010A1 Enrollment

A: 01/20/2022 Par 55768 Commercial VA Piedmont Community Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/20/2022 Par 55768 Commercial VA Piedmont Community Health Plan Institutional 5010A1Claim Level Accept /Reject

Yes

A: 03/11/2022 Non-Par 55768 Commercial Piedmont Community Health Plan Remittance 5010A1 Enrollment

A: 08/31/2021 Non-Par PIH01 Commercial CA PIH Health Professional 5010A1Claim Level Accept /Reject

No

A: 08/31/2021 Non-Par PIH01 Commercial CA PIH Health Institutional 5010A1Claim Level Accept /Reject

No

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Pima County Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 09/01/2016 Par 24735 Commercial Pinnacle Claims Management, Inc. Institutional 5010A2 No Response From Payer

U: 01/01/2012 Par 24735 Commercial Pinnacle Claims Management, Inc. Professional 5010A1 No Response From Payer

A: 11/09/2018 Non-Par PROSP Commercial CA Pinnacle Health Resources (Prospect Medical Group) Professional 5010A1 Claim Level Ack.

A: 09/07/2018 Non-Par 95271 Commercial CA Pinnacle Medical Group Professional 5010A1Claim Level Accept /Reject

Yes

A: 08/25/2021 Non-Par 95271 Commercial CA Pinnacle Medical Group Remittance 5010A1 Enrollment

U: 09/01/2016 Par 84109 Commercial Pinnacol Assurance Institutional 4010A1Claim Level Accept /Reject

U: 03/29/2012 Non-Par CCIA1 Commercial CO Pinnacol Assurance Professional 5010A1Claim LevelAcknowledgement

(Contact Sandy Logstrom at303-361-4822 prior to submission offirst claims)

A: 09/01/2016 Par 84109 Commercial Pinnacol Assurance Professional 4010A1Claim Level Accept /Reject

A: 06/05/2020 Non-Par CB746 Workers' Comp Pinnacol Assurance Prof. Work Comp 5010A1 No Response From Payer No

A: 06/05/2020 Non-Par CB746 Workers' Comp Pinnacol Assurance Inst. Work Comp 5010A1 No Response From Payer No

A: 03/04/2013 Non-Par PIONR Commercial Pioneer Medical Group Professional 5010A1Claim Level Accept /Reject

U: 11/09/2015 Non-Par PPNZZ Commercial MUPioneer Provider Network, Coastal HealthcareManagement, LLC

Professional 5010A1

A: 09/01/2016 Par 23283 Commercial PA Pittsburgh Care Partnership Inc. Professional 5010A1Claim Level Accept /Reject

U: 10/01/2019 Non-Par 23283 Commercial PA Pittsburgh Care Partnership Inc. Remittance 5010A1 Enrollment

A: 09/01/2016 Par 23283 Commercial Pittsburgh Care Partnership Inc. Institutional 5010A2 Claim Level Rejects Only

U: 01/01/2012 Trans AMS01 Commercial IA Plaines (IA) Professional 5010A1 No Response From Payer

U: 01/01/2012 Trans AMS01 Commercial FL Plaines Advisor (FL) Professional 5010A1 No Response From Payer

U: 01/01/2012 Trans AMS01 Commercial WI Plaines Advisor (WI) Professional 5010A1 No Response From Payer

U: 01/01/2012 Trans AMS01 Commercial Plaines Networks - Envoy Professional 5010A1 No Response From Payer

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Plainview ISD Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/24/2014 Non-Par L0190 Commercial Plan de Salud Hospital Menonita Professional 5010A1 Claim Level Accept/Reject

A: 12/05/2014 Non-Par L0190 Commercial Plan de Salud Hospital Menonita Institutional 5010A2 Claim Level Accept/Reject

U: 10/07/2019 Non-Par L0190 Commercial PR Plan de Salud Hospital Menonita Remittance 5010A1 Enrollment

A: 07/12/2019 Par 66063 Commercial PR Plan De Salud Menonita (Reform) Professional 5010A1Claim Level Accept /Reject

No

A: 07/12/2019 Non-Par 66063 PR Plan De Salud Menonita (Reform) Institutional 5010A1Claim Level Accept /Reject

No

A: 09/14/2021 Non-Par 66063 Commercial PR PLAN DE SALUD MENONITA (REFORM) Remittance 5010A1 Enrollment

A: 07/24/2020 Non-Par 37287 Commercial SC Planned Administrators, Inc Remittance 5010A1 Enrollment

U: 09/01/2016 Par 37287 Commercial Planned Administrators, Inc. Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 37287 Commercial Planned Administrators, Inc. Professional 5010A1 No Response From PayerPAI Providers submitting claims as aPreferred Blue provider should notsubmit claims using payer ID 37287

U: 05/29/2012 Non-Par PCM99 Commercial Plasterers' & Cement Masons' Health & Welfare Fund Professional 5010A1Claim Level Accept /Reject

U: 03/23/2012 Non-Par CLFR2 Commercial PLICO Professional 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Plott Health Care Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/06/2019 Non-Par CB123 Workers' Comp NJ Plymouth Rock Prof. Work Comp 5010A1

A: 12/06/2019 Non-Par cb123 Workers' Comp NJ Plymouth Rock Inst. Work Comp 5010A1

A: 11/22/2013 Non-Par 41556 Workers' Comp MU PMA Insurance Company (formerly WB175) Prof. Work Comp 4010A1File LevelAcknowledgement

A: 11/22/2013 Non-Par 41556 Workers' Comp MU PMA Insurance Company (formerly WB175) Inst. Work Comp 4010A1File LevelAcknowledgement

U: 11/20/2014 Non-Par PMGSJ Commercial CA PMG of San Jose Professional 5010A1 Claim Level Rejects Only No

U: 09/01/2016 Par 58204 Commercial Podi Care Managed Care Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 59324 Commercial PODIATRY NETWORK FL Professional 5010A1 Claim Level

Updated: 03/21/2022


PPAAYERYERIDID



Acknowledgement

U: 09/01/2016 Par 59324 Commercial PODIATRY NETWORK FL Institutional 5010A2Claim LevelAcknowledgement

A: 04/03/2019 Non-Par PCU01 Commercial IN Point Comfort Underwriters Professional 5010A1Claim Level Accept /Reject

Yes

A: 04/03/2019 Non-Par PCU01 Commercial IN Point Comfort Underwriters Institutional 5010A1Claim Level Accept /Reject

Yes


Yes


Yes


No


No

A: 08/14/2020 Non-Par PCU04 Commercial IN Point Comfort Underwriters Travel Professional 5010A1Claim Level Accept /Reject

No

A: 08/14/2020 Non-Par PCU04 Commercial IN Point Comfort Underwriters Travel Professional 5010A1Claim Level Accept /Reject

No

A: 02/06/2019 Non-Par 78535 Commercial MI Pokagon Health Services Professional 5010A1 No Response From Payer Yes

A: 02/06/2019 Non-Par 78535 Commercial MI Pokagon Health Services Institutional 5010A1 No Response From Payer Yes

A: 06/22/2020 Par 87020 Commercial Polish Falcons of America Professional 5010A1 No Response From Payer No

A: 06/22/2020 Par 87020 Commercial Polish Falcons of America Institutional 5010A1 No Response From Payer No

A: 02/12/2021 Non-Par 58379 Commercial Polish Falcons of America (87020) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Poly Pak America, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Poly Pak America, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Poly-America Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 04/08/2019 Trans J2004 Workers' Comp POMCO Prof. Work Comp 5010A1

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Pomeroy Investments Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Pomeroy Investments Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/25/2019 Trans 95111 Commercial CA Pomona Valley Hospital Medical Center Professional 5010A1Claim Level Accept /Reject

No

A: 01/25/2019 Trans 95111 Commercial CA Pomona Valley Hospital Medical Center Institutional 5010A1Claim Level Accept /Reject

No

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Ponderosa Landscape Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/23/2021 Non-Par PAI02 Commercial CA Pool Adm-CA Dept Public Hlth 2ndary Clms Remittance 5010A1 Enrollment

A: 06/28/2019 Non-Par PAI01 Commercial CT Pool Administrators Inc Professional 5010A1Claim Level Accept /Reject

Yes

A: 07/12/2019 Par PAI02 Commercial CTPool Administrators Inc. (PAI) - CA Dept of PublicHealth Secondary Claims

Professional 5010A1 Claim Level Ack. Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Pool Water Products Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Pool Water Products Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Popluar Textile Corp. / Pop St Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Popluar Textile Corp. / Pop St Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 04/29/2021 Non-Par 23253 Commercial Populytics Inc Institutional 5010A2 Yes

U: 04/29/2021 Non-Par 23253 Commercial Populytics Inc Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU PORTEOUS FASTENER COMPANY Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU PORTEOUS FASTENER COMPANY Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 07/10/2014 Par 72148 Commercial PPO Plus, LLC Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par UHNDC Commercial PPOONE Professional 5010A1 Claim Level Accept/Reject Yes

U: 09/01/2016 Par 72148 Commercial PPOPlus, LLC Institutional 4010A1 No Response From Payer Yes

U: 04/27/2016 Non-Par 36373 Commercial Prairie States Enterprises, Inc. Professional 5010A1Claim Level Accept /Reject

Yes

U: 04/27/2016 Non-Par 36373 Commercial Prairie States Enterprises, Inc. Institutional 5010A2 No Response From Payer Yes

A: 11/27/2019 Non-Par 36373 Commercial Prairie States Enterprises, Inc. Remittance 5010A1 Enrollment

U: 12/05/2016 Par 65088 Commercial FL Preferred Care Partners (Miami , FL) Institutional 5010A2Claim Level Accept /Reject

U: 09/01/2016 Par 65088 Commercial FL Preferred Care Partners (Miami , FL) Professional 5010A1Claim Level Accept /Reject

U: 08/15/2019 Non-Par 65088 Commercial Preferred Care Partners (Miami, FL) Remittance 5010A1 Enrollment

U: 09/01/2016 Par 73145 Commercial Preferred Community Choice Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 73145 Commercial Preferred Community Choice Professional 5010A1Claim Level Accept /Reject

Yes

U: 12/19/2014 Non-Par CALL Commercial PAPreferred Health Care - PPO Lancaster PA (IHSGateway Payer)



A: 12/19/2014 Non-Par CALL Commercial PA Preferred Health Care PPO Institutional 5010A2 Claim Level Rejects Only Yes


A: 11/24/2014 Non-Par CB404 Commercial Preferred Health Plan Carolinas Professional 5010A1 Claim Level Accept/Reject

A: 12/05/2014 Non-Par CB404 Commercial Preferred Health Plan Carolinas Institutional 5010A2 Claim Level Rejects Only

U: 12/18/2018 Par 61106 Commercial KY Preferred Health Plan, Inc. (Louisville, KY) Institutional 5010A2 No Response From PayerPayer to be deactivated in 2019 -please use Payer ID 87815 for claimsubmission.

U: 12/18/2018 Par 61106 Commercial KY Preferred Health Plan, Inc. (Louisville, KY) Professional 5010A1Payer to be deactivated in 2019 -please use Payer ID 87815 for claimsubmission.

U: 09/01/2016 Par 31478 Commercial Preferred Health Professionals Institutional 5010A2File LevelAcknowledgement

Yes

U: 04/17/2017 Non-Par 31478 CommercialPreferred Health Professionals (FKA BCBS KansasFreedom Networks)


U: 11/25/2013 Non-Par PFIPA Commercial Preferred IPA Professional 5010A1Claim Level Accept /Reject

U: 08/15/2019 Non-Par 21524 Commercial AZ Preferred Medical Claim Solutions Remittance 5010A1 Enrollment

A: 07/10/2017 Non-Par L0250 Commercial Preferred Medicare Professional 5010A1 No Response From Payer

A: 07/18/2017 Non-Par L0250 Commercial Preferred Medicare (Formerly 92131) Professional 5010A1

A: 07/10/2017 Non-Par L0250 Commercial Preferred Medicare (Formerly 92131) Institutional 5010A2 No Response From Payer

A: 07/10/2017 Non-Par L0250 Commercial Preferred Medicare (Formerly 92131) Remittance 5010A1 Enrollment

U: 09/01/2016 Par 36401 Commercial Preferred Network Access Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 36401 Commercial Preferred Network Access Inc. Institutional 5010A2Claim LevelAcknowledgement

U: 03/11/2013 Trans 41147 Commercial Preferred One Institutional 5010A2Claim Level Accept /Reject

Yes

U: 08/15/2019 Non-Par 41147 Commercial Preferred One Remittance 5010A1 Enrollment

U: 03/11/2013 Trans 41147 Commercial MN PreferredOne Professional 5010A1Claim Level Accept /Reject

Yes

U: 10/16/2019 Non-Par 12B27 Commercial Premera Blue Cross Remittance 5010A1 Enrollment

A: 12/31/2018 Non-Par SB930 Government AK Premera Blue Cross (Formerly BS010 and BS011) Professional 5010A1Claim Level Accept /Reject

Yes

U: 11/07/2019 Non-Par SB930 Government Premera Blue Cross (Formerly BS010 and BS011) Remittance 5010A1 Enrollment

A: 07/31/2017 Non-Par 12B47 Commercial AK Premera Blue Cross (Formerly BS011) Institutional 5010A2 Yes

U: 01/12/2015 Non-Par 12B27 Commercial WA Premera Blue Cross Washington Institutional 5010A2 Claim Level Accept / Yes

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 03/11/2013 Non-Par 65054 Commercial Premier Eye Care Professional 5010A1Claim Level Accept /Reject

Yes

U: 10/07/2019 Non-Par 65054 Commercial Premier Eye Care Remittance 5010A1 Enrollment

U: 10/10/2019 Non-Par 251PR Commercial Premier Health Plan Remittance 5010A1 Enrollment

U: 11/27/2013 Non-Par 90440 Commercial Premier Health Systems Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 90440 Commercial Premier Health Systems Inc Institutional 5010A2Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 88051 Commercial Premier Healthcare Exchange Institutional 5010A2 No Response From Payer

A: 09/01/2016 Par 88051 Commercial Premier Healthcare Exchange, Inc Professional 5010A1 No Response From Payer

A: 05/14/2014 Non-Par MPM22 Commercial MU Premier Physician Network Professional 5010A1 Yes

U: 09/01/2016 Par 05003 Commercial NM Presbyterian (NM) Professional 5010A1Claim LevelAcknowledgement

Yes

U: 02/14/2017 Par 05003 Commercial NM Presbyterian (NM) Institutional 5010A2 Yes

U: 02/14/2017 Par 05003 Commercial NM Presbyterian Health Plan - Albuquerque Professional 5010A1 Yes

A: 02/21/2018 Par 46311 Commercial IL Presence ERC Professional 5010A1 No Response From Payer Yes

A: 02/21/2018 Par 46311 Commercial IL Presence ERC Institutional 5010A1 No Response From Payer Yes

U: 11/14/2017 Non-Par 36396 CommercialPresence Health Partners/FKA Resurrection HealthCare Preferred

Institutional 5010A2Please call (847) 493-4611 prior toyour first submission of claims.

U: 11/14/2017 Non-Par 36396 CommercialPresence Health Partners/FKA Resurrection HealthCare Preferred

Professional 5010A1 No Response From PayerPlease call (847) 493-4611 prior toyour first submission of claims.

U: 09/23/2013 Non-Par J1491 Workers' Comp MU PRESTON HOLMES, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU PRESTON HOLMES, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 10/10/2019 Par CB531 Commercial PA Prezzo (Innovative Healthware Solutions) Professional 5010A1Claim Level Accept /Reject

No

A: 10/10/2019 Par CB531 Commercial PA Prezzo (Innovative Healthware Solutions) Institutional 5010A1Claim Level Accept /Reject

No

U: 08/15/2019 Non-Par 13027 Commercial IN Primaria VillageMD Remittance 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 11/06/2018 Par 13027 Commercial IN Primaria VillageMD of Central Indiana Professional 5010A1Claim Level Accept /Reject

Yes

U: 04/02/2019 Par 95399 Commercial CA PRIMARY CARE & PEDIATRIC IPA Professional 5010A1Claim Level Accept /Reject

U: 01/10/2017 Trans E3510 Commercial CA Primary Care Associates Medical Group (PCA) Professional 5010A1Claim Level Accept /Reject

U: 10/16/2019 Non-Par PCACZ Commercial MU Primary Care Associates of California Medical Professional 5010A1 Enrollment

A: 09/14/2016 Par PCJOL Commercial IL Primary Care of Joliet Institutional 5010A1 Claim Level Ack. No

A: 09/14/2016 Par PCJOL Commercial IL Primary Care of Joliet Professional 5010A1 Claim Level Ack. No

A: 04/02/2019 Par 95399 Commercial CA Primary Care Physicians Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 82048 Commercial Primary Health Network Professional 5010A1File LevelAcknowledgement

U: 09/01/2016 Par 82048 Commercial Primary Health Network Institutional 5010A2File LevelAcknowledgement

U: 02/11/2013 Non-Par PPM01 Commercial CA Primary Provider Management - Claims Only Professional 5010A1Claim Level Accept /Reject

Yes

U: 11/01/2012 Trans PPM02 Commercial CA Primary Provider Management - Encounters Only Professional 5010A1Claim Level Accept /Reject

A: 08/09/2017 Trans 81502 Commercial NY Prime Health Choice Institutional 5010A1 File Level Ack. No

A: 01/19/2022 Non-Par 81502 Commercial NY Prime Health Choice Remittance 5010A1 Enrollment


A: 08/09/2017 Trans 81502 Commercial NY Prime Health Choice Professional 5010A1 File Level Ack. No

A: 01/19/2022 Non-Par 58379 Commercial Prime Health Choice (Formerly 81502) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID 81502 .Providers will need to enroll for payer

Updated: 03/21/2022


PPAAYERYERIDID



IDs 81502 and 58379 in order toreceive 835s for this payer.

U: 01/10/2017 Trans E3510 Commercial CA PrimeCare Medical Network - Chino Professional 5010A1Claim Level Accept /Reject

U: 01/10/2017 Trans E3510 Commercial CA PrimeCare Medical Network - Citrus Valley Professional 5010A1Claim Level Accept /Reject

U: 01/10/2017 Trans E3510 Commercial CA PrimeCare Medical Network - Corona Professional 5010A1Claim Level Accept /Reject

U: 01/10/2017 Trans E3510 Commercial CA PrimeCare Medical Network - Hemet Professional 5010A1Claim Level Accept /Reject

U: 01/10/2017 Trans E3510 Commercial CA PrimeCare Medical Network - Inland Valley Professional 5010A1Claim Level Accept /Reject

U: 01/10/2017 Trans E3510 Commercial CA PrimeCare Medical Network - Moreno Professional 5010A1Claim Level Accept /Reject

U: 01/10/2017 Trans E3510 Commercial CA PrimeCare Medical Network - Redlands Professional 5010A1Claim Level Accept /Reject

U: 01/10/2017 Trans E3510 Commercial CA PrimeCare Medical Network - Riverside Professional 5010A1Claim Level Accept /Reject

U: 01/10/2017 Trans E3510 Commercial CA PrimeCare Medical Network - San Bernardino Professional 5010A1Claim Level Accept /Reject

U: 01/10/2017 Trans E3510 Commercial CA PrimeCare Medical Network - Sun City Professional 5010A1Claim Level Accept /Reject

U: 01/10/2017 Trans E3510 Commercial CA PrimeCare Medical Network - Temecula Professional 5010A1Claim Level Accept /Reject

U: 05/01/2017 Par 61604 Commercial MN PrimeWest Health Plan Institutional 5010A2 No Response From Payer Yes

U: 12/31/2020 Par 61604 Commercial MN PrimeWest Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

U: 01/21/2021 Non-Par 61604 Commercial MN PrimeWest Health Plan Remittance 5010A1 Enrollment

U: 07/27/2021 Non-Par 61271 Commercial Principal Financial Group Remittance 5010A1 Enrollment


U: 07/27/2021 Par 61271 Commercial Principal Financial Group Professional 5010A1Claim Level Accept /Reject

Payer only accepts VISION andDENTAL claims.

U: 11/13/2019 Non-Par 38217 Commercial Priority Health Remittance 5010A1 Enrollment

U: 09/01/2016 Par 38217 Commercial Priority Health Institutional 5010A2File LevelAcknowledgement

Yes

U: 03/11/2013 Non-Par 38217 Commercial Priority Health Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/08/2021 Non-Par JVHJZ Commercial GA PRIORITY HEALTH - JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 03/08/2021 Non-Par JVHJZ Commercial GA Priority Health - JVHL Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 09/01/2016 Trans 37315 Commercial Prism - Univera - Professional 5010A1 No Response From Payer

U: 09/10/2012 Non-Par 37268 Commercial Prism Health Networks Professional 5010A1File LevelAcknowledgement

U: 09/10/2012 Non-Par 37268 Commercial Prism Network Professional 5010A1File LevelAcknowledgement

A: 08/08/2014 Non-Par 37268 Commercial Prism Network Inc. Institutional 5010A2

A: 11/09/2018 Non-Par PROSP Commercial CA ProCare (Prospect) Professional 5010A1 Claim Level Ack.

A: 01/31/2020 Par PTX01 Commercial TX Procare Advantage of Texas Professional 5010A1Claim Level Accept /Reject

No

A: 01/31/2020 Par PTX01 Commercial TX Procare Advantage of Texas Institutional 5010A1Claim Level Accept /Reject

No

A: 01/31/2020 Non-Par PTX01 Commercial Procare Advantage of TX Remittance 5010A1 Enrollment


A: 07/31/2020 Non-Par 87065 Commercial WY Prodegi Corporate Benefit Services Professional 5010A1Claim Level Accept /Reject

No

A: 07/31/2020 Non-Par 87065 Commercial WY Prodegi Corporate Benefit Services Institutional 5010A1Claim Level Accept /Reject

No

Updated: 03/21/2022


PPAAYERYERIDID



U: 01/27/2012 Non-Par 36331 Commercial IL Professional Benefit Administrators, Inc. Professional 5010A1Claim LevelAcknowledgement

Payer ID is valid only for claims withbilling address of Professional BenefitAdministrators, Inc., Oak Brook, IL

U: 01/27/2012 Non-Par 36331 CommercialProfessional Benefit Administrators, Inc. (Oak Brook,IL)


A: 06/26/2020 Non-Par 56724 Commercial MI Professional Benefit Services Inc Professional 5010A1Claim Level Accept /Reject

No

A: 06/26/2020 Non-Par 56724 Commercial MI Professional Benefit Services Inc Institutional 5010A1Claim Level Accept /Reject

No

U: 05/04/2016 Non-Par J1748 Auto MN Progressive (Auto) Prof. Auto 5010A1 No Response From PayerPayer accepts auto claims forMinnesota only.

A: 01/28/2020 Non-Par J1748 Auto MN Progressive (Auto) Remittance 5010A1 Enrollment

A: 01/28/2020 Non-Par J1779 Auto MN Progressive Commercial Casualty Remittance 5010A1 Enrollment

This Payer ID is for Auto Claims ONLYfor states: MN. The above PayerName(s) may represent multipleAccounts (employers).

A: 12/24/2018 Non-Par J1779 Workers' Comp MN Progressive Commercial Casualty Company Prof. Work Comp 5010A1Claim Level Accept /Reject

Payer ID is for Auto Claims ONLY forstates: MN. The above Payer Namemay represent multiple Accounts(employers).

A: 11/07/2019 Non-Par 24260 Workers' Comp NJ Progressive New Jersey Prof. Work Comp 5010A1

A: 11/07/2019 Non-Par 24260 Workers' Comp NJ Progressive New Jersey Inst. Work Comp 5010A1

A: 03/08/2019 Non-Par PROGY Commercial MU PROGYNY Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/08/2019 Non-Par PROGY Commercial MU PROGYNY Institutional 5010A1Claim Level Accept /Reject

Yes

A: 04/12/2021 Par 88022 Commercial NV Prominence Administrative Services Professional 5010A1 No Response From Payer No

A: 04/12/2021 Par 88022 Commercial NV Prominence Administrative Services Institutional 5010A1 No Response From Payer No

A: 09/01/2016 Par 93082 Commercial NV Prominence Health Plan of Nevada Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 93082 Commercial NV Prominence Health Plan of Nevada Institutional 5010A1Claim Level Accept /Reject

A: 03/11/2022 Non-Par 93082 Commercial Prominence Health Plan of Nevada Remittance 5010A1 Enrollment

A: 09/01/2016 Par 80095 Commercial TX Prominence Health Plan of Texas Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 80095 Commercial TX Prominence Health Plan of Texas Institutional 5010A1Claim Level Accept /Reject

A: 01/19/2021 Par 83352 Medicare NV Prominence Healthfirst of Florida Inc Professional 5010A1 No Response From Payer Yes

A: 01/19/2021 Par 83352 Medicare NV Prominence Healthfirst of Florida Inc Institutional 5010A1 No Response From Payer Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU PROMPT FOOD SERVICE, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU PROMPT FOOD SERVICE, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/09/2018 Non-Par PROSP Commercial CA Prospect Health Network Professional 5010A1 Claim Level Ack.

U: 09/30/2021 Non-Par MPM16 Commercial CA Prospect La Care - Medpoint Professional 5010A1Claim Level Accept /Reject

Handled by Medpoint Management -PO Box 573094, Tarzana, CA 91357.Only valid for claims with DOS of 7/1/2012 and later.

A: 11/09/2018 Non-Par PROSP Commercial CA Prospect Medical Group Professional 5010A1 Claim Level Ack.

A: 01/06/2022 Non-Par 58379 Commercial Prospect Medical Group (Formerly PROSP) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID PROSP.Providers will need to enroll for payerIDs PROSP and 58379 in order toreceive 835s for this payer.

A: 11/09/2018 Non-Par PROSP Commercial CAProspect Sherman Oaks Medical Group (ProspectMedical Group)


U: 11/01/2012 Non-Par 37309 Commercial Protective Life Insurance Company Professional 5010A1File LevelAcknowledgement

A: 08/08/2014 Non-Par 37309 Commercial Protective Life Insurance Company Institutional 5010A2 Claim Level Rejects Only

A: 01/19/2021 Non-Par 77350 Medicaid OR Providence Health Assurance Medicaid DC Professional 5010A1Claim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



A: 01/19/2021 Non-Par 77350 Medicaid OR Providence Health Assurance Medicaid DC Institutional 5010A1Claim Level Accept /Reject

Yes

A: 11/04/2021 Non-Par 77350 Commercial OR Providence Health Assurance Medicaid DC Remittance 5010A1 EnrollmentFor Dates of Service 1/1/2021 andafter

A: 02/26/2021 Non-Par 77500 Commercial OR Providence Health Assurance Medicare Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/26/2021 Non-Par 77500 Commercial OR Providence Health Assurance Medicare Institutional 5010A1Claim Level Accept /Reject

Yes

A: 06/14/2021 Non-Par 77500 Commercial OR Providence Health Assurance Medicare Remittance 5010A1 Enrollment

U: 08/13/2015 Par PHP00 Commercial Providence Health Plan (PPO) Institutional 5010A1Claim Level Accept /Reject

Yes

A: 10/07/2019 Non-Par SX133 Commercial Providence of Oregon Health Plan (Formerly PHP01) Remittance 5010A2 Enrollment

A: 07/18/2017 Par SX133 Commercial Providence of Oregon Health Plan (Formerly PHP01) Professional 5010A1Claim Level Accept /Reject

Yes

A: 07/18/2017 Par SX133 Commercial OR Providence of Oregon Health Plan (Formerly PHP01) Institutional 5010A1Claim Level Accept /Reject

U: 01/01/2012 Par PHP00 Commercial Providence Preferred (PPO) Professional 5010A1Claim Level Accept /Reject

A: 01/24/2018 Par 13193 CommercialProvident American Health & Life InsuranceCompany - Medicare Supplement


A: 01/24/2018 Par 13193 CommercialProvident American Health & Life InsuranceCompany - Medicare Supplement


U: 03/11/2013 Non-Par 62308 Commercial Provident Healthsource (Cigna) Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62308 Commercial Provident Life & Accident Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62308 Commercial Provident Life & Casualty Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 62308 Commercial Provident Preferred Network Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/04/2020 Non-Par 31401 Commercial MD Provider Partners Health Plan of Illinois Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/04/2020 Non-Par 31401 Commercial MD Provider Partners Health Plan of Illinois Institutional 5010A1Claim Level Accept /Reject

Yes

A: 02/18/2021 Non-Par 31401 Commercial MD Provider Partners Health Plan of Illinois Remittance 5010A1 Enrollment

A: 12/08/2021 Non-Par 31400 Commercial MD Provider Partners Health Plan of PA Professional 5010A1Claim Level Accept /Reject

No

A: 12/08/2021 Non-Par 31400 Commercial MD Provider Partners Health Plan of PA Institutional 5010A1Claim Level Accept /Reject

No

A: 02/01/2022 Non-Par 31404 Commercial MO Providers Partners Health Plan Missouri Professional 5010A1Claim Level Accept /Reject

No

A: 02/01/2022 Non-Par 31404 Commercial MO Providers Partners Health Plan Missouri Institutional 5010A1Claim Level Accept /Reject

No

A: 12/21/2021 Non-Par 31402 Commercial MD Providers Partners Health Plan of Ohio Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/21/2021 Non-Par 31402 Commercial MD Providers Partners Health Plan of Ohio Institutional 5010A1Claim Level Accept /Reject

No

A: 01/27/2014 Par 48100 Commercial ProviDRs Care Network Professional 5010A1File LevelAcknowledgement

A: 01/27/2016 Par 48100 Commercial KS ProviDRs Care Network Institutional 5010A1 File Level Ack.

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Prudential Overall Supply - AZ, CA Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/01/2017 Non-Par PH001 Commercial FL Pruitt Health Premier Remittance 5010A1 Enrollment

A: 10/05/2016 Par PH001 Commercial FL Pruitt Health Premier Institutional 5010A1Claim Level Accept /Reject

No

A: 10/05/2016 Par PH001 Commercial FL Pruitt Health Premier Professional 5010A1Claim Level Accept /Reject

No

A: 02/19/2019 Par PHPC1 Commercial MU Pruitthealth Premier NC SC Professional 5010A1Claim Level Accept /Reject

No

A: 02/19/2019 Par PHPC1 Commercial MU Pruitthealth Premier NC SC Institutional 5010A1Claim Level Accept /Reject

No

Updated: 03/21/2022


PPAAYERYERIDID



U: 03/01/2017 Non-Par PSKW0 Commercial NJ PSKW Remittance 5010A1 Enrollment

A: 02/07/2018 Par PSKW0 Commercial NJ PSKW Institutional 5010A1Claim Level Accept /Reject

No

A: 09/01/2016 Par PSKW0 Commercial PSKW Professional 5010A1 No Response From Payer Yes

U: 09/18/2019 Non-Par SX106 Commercial Public Employees Health Program Remittance 5010A1 Enrollment

A: 02/24/2021 Non-Par 12X36 Commercial Public Employees Health Program (Formerly SX106) Institutional 5010A1 Enrollment Yes

U: 05/06/2020 Non-Par SX106 Commercial UT Public Employees Health Programs Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 09/01/2016 Par 91136 Commercial Puget Sound Benefits Trust Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 91136 Commercial Puget Sound Benefits Trust, Grp# F25 Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 91136 Commercial Puget Sound Electrical Workers Trust Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 91136 Commercial Puget Sound Electrical Workers Trust, Grp# 33 Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU PURE FILL CORPORATION Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU PURE FILL CORPORATION Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU QAD, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU QAD, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/03/2018 Non-Par J1484 Commercial MU QBE - General Casualty Remittance 5010A1 Enrollment

A: 05/25/2018 Non-Par J1484 Workers' Comp QBE - General Casualty Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 08/15/2019 Non-Par 42636 Commercial GA QCPI Village MD of Georgia Remittance 5010A1Claim Level Accept /Reject

Yes

A: 11/06/2018 Par 42636 Commercial GA QCPI Village MD of Georgia (GA) Professional 5010A1Claim Level Accept /Reject

Yes

U: 06/08/2018 Par 35174 Commercial AR Qual Choice of Arkansas Institutional 5010A2 No Response From Payer ERA available under payer ID: 58379

U: 06/08/2018 Non-Par 35174 Commercial AR Qual Choice of Arkansas Professional 5010A1 No Response From Payer ERA available under payer ID: 58379

U: 01/16/2020 Non-Par 58379 Commercial AR Qual Choice Of Arkansas Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

A: 01/10/2020 Non-Par 83867 Commercial NJ Qual-Lynx Professional 5010A1Claim Level Accept /Reject

A: 01/10/2020 Non-Par 83867 Commercial NJ Qual-Lynx Institutional 5010A1Claim Level Accept /Reject

U: 08/15/2019 Par 23342 Commercial QualCare Inc Remittance 5010A1 Enrollment

A: 06/06/2014 Non-Par QCI01 Commercial CA Qualcare IPA (CA) Professional 5010A1 File Level Ack. No

U: 08/15/2019 Non-Par 22312 Commercial NJ QualCare, Inc (dba QANI Administrators) Remittance 5010A1 Enrollment

A: 12/07/2021 Non-Par 46122 Commercial QualChoice Remittance 5010A1 Enrollment


A: 12/07/2021 Non-Par 58379 Commercial QualChoice (Formerly 46122 ) Remittance 5010A1 Enrollment


U: 02/08/2013 Non-Par PDT01 Commercial MU Quality Care Professional 5010A1File LevelAcknowledgement

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Quality Care Conv Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par 89461 Commercial Quality Care Partners Institutional 5010A2 Claim Level Rejects Only Yes

A: 12/05/2014 Non-Par 89461 Commercial MU Quality Care Partners Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Quality Health M. G. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 04/08/2016 Trans CX077 Commercial MU Quality Plan Administrator, Inc Professional 5010A1 Claim Level Ack. Yes

U: 11/19/2021 Non-Par 39180 Commercial Quartz ASO Professional 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 11/19/2021 Non-Par 39180 Commercial Quartz ASO Institutional 5010A1Claim Level Accept /Reject

U: 01/10/2022 Non-Par 39180 Commercial Quartz ASO Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Queen of Angels - Hollywood Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU QUICK-CROFT, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU QUICK-CROFT, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 73067 Commercial QuikTrip Institutional 5010A2File LevelAcknowledgement

U: 09/01/2016 Par 73067 Commercial QuikTrip Professional 5010A1File LevelAcknowledgement

U: 10/07/2019 Non-Par 73067 Commercial QuikTrip Remittance 5010A1 Enrollment

U: 09/01/2016 Par 57117 Commercial QVI Risk Solutions Professional 5010A1Claim Level Accept /Reject

U: 11/18/2013 Non-Par TKFMC Commercial MU R & N Market Professional 5010A1File LevelAcknowledgement

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU R KIDS TIRE AND SERVICE, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU R KIDS TIRE AND SERVICE, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU R.A. Phillips Industries Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU R.A. Phillips Industries Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU RABB BROTHERS TRUCKING, INC Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU RABB BROTHERS TRUCKING, INC Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/02/2014 Non-Par CALL Commercial NJ RADCON INC. Professional 5010A1 No Response From PayerPlease contact Kathy King @ (856)608-1350 for Payer Id information.

U: 11/06/2019 Non-Par SRRGA Government Railroad Medicare - Palmetto GBA (Formerly MR018) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

A: 11/06/2019 Non-Par SRRGA Government Railroad Medicare - Palmetto GBA (Formerly MR018) Remittance 4010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Ramona Manor Convalescent Hosp Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Ramona Manor Convalescent Hosp Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Raypak, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Raypak, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU RCH Protective - SNCC Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/07/2018 Non-Par 18247 Commercial CA Redlands Yucaipa Medical Group Professional 5010A1Claim Level Accept /Reject

Yes

A: 07/08/2021 Non-Par 18247 Commercial CA Redlands Yucaipa Medical Groups Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU REDNAB INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU REDNAB INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU REESER ENTERPRISES INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU REESER ENTERPRISES INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/13/2020 Non-Par REGAL Commercial CA Regal Medical Group Professional 5010A1Claim Level Accept /Reject

U: 02/01/2018 Par 95449 Commercial CA Regal Medical Group Professional 5010A1 No Response From Payer

A: 05/13/2020 Non-Par REGAL Commercial CA Regal Medical Group Institutional 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 02/01/2018 Par 95449 Commercial Regal Medical Group Institutional 5010A2 Claim Level Ack.

A: 12/02/2019 Non-Par RGA01 Commercial OR Regence Group Administrators Professional 5010A1Claim Level Accept /Reject

No

A: 08/23/2019 Non-Par RGA01 Commercial OR Regence Group Administrators Institutional 5010A1Claim Level Accept /Reject

No

U: 11/01/2012 Non-Par 38221 Commercial Regency Employee Benefits Professional 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par 38221 Commercial Regency Employee Benefits Institutional 5010A2File LevelAcknowledgement

A: 04/14/2014 Non-Par 47076 Commercial MU Regional Care, Inc Professional 5010A1 Claim Level Ack. No

A: 04/14/2014 Non-Par 47076 Commercial MU Regional Care, Inc Institutional 5010A2 Claim Level Ack. No

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Rehab Center of Beverly Hills Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 03/25/2019 Non-Par REHNO Commercial WA Rehn and Associates Professional 5010A1Claim Level Accept /Reject

No

A: 03/25/2019 Non-Par REHNO Commercial WA Rehn and Associates Institutional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Reliable Services, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Reliable Services, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Reliance Building Services Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Reliance Building Services Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 04/15/2020 Non-Par RHP01 Commercial MI Reliance Medicare Advantage Professional 5010A1Claim Level Accept /Reject

Yes

A: 04/15/2020 Non-Par RHP01 Commercial MI Reliance Medicare Advantage Institutional 5010A2Claim Level Accept /Reject

Yes

A: 06/22/2020 Par 87020 Commercial UT Renaissance Life and Health Ins Co of America Professional 5010A1 No Response From Payer No

A: 06/22/2020 Par 87020 Commercial UT Renaissance Life and Health Ins Co of America Institutional 5010A1 No Response From Payer No

A: 02/12/2021 Non-Par 58379 CommercialRenaissance Life and Health Insurance Company ofAmerica (87020)


U: 09/01/2016 Par 76066 Commercial Renaissance Physicians Organization Institutional 5010A2File LevelAcknowledgement

U: 09/01/2016 Par 76066 Commercial Renaissance Physicians Organization Professional 5010A1File LevelAcknowledgement

A: 05/02/2018 Non-Par J1008 Commercial MU Republic Indemnity Company Remittance 5010A1 Enrollment

A: 05/25/2018 Non-Par J1008 Workers' Comp Republic Indemnity Company Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/10/2018 Non-Par 73066 Commercial OK Reserve National Insurance Professional 5010A1Claim Level Accept /Reject

Yes

A: 08/13/2018 Non-Par 73066 Commercial OK Reserve National Insurance Institutional 5010A1Claim Level Accept /Reject

Yes

U: 03/29/2012 Non-Par 20481 Commercial Resolve Health Plan Administrators Professional 5010A1Claim LevelAcknowledgement

A: 09/01/2016 Trans 20481 Commercial Resolve Health Plan Administrators Institutional 5010A2 Claim Level Rejects Only

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Restoration Prof Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par RPPG1 Commercial Resurrection Physician Providers Grop Professional 4010A1File LevelAcknowledgement

A: 12/23/2021 Non-Par RPPG1 Commercial IL Resurrection Physician Providers Group Remittance 5010A1 Enrollment

A: 09/01/2016 Par RPPG1 Commercial IL Resurrection Physicians Provider Group Institutional 5010A1Claim Level Accept /Reject

A: 01/13/2020 Non-Par RVC01 Commercial MS REVCLAIMS Professional 5010A1Claim Level Accept /Reject

No

A: 01/13/2020 Non-Par RVC01 Commercial MS REVCLAIMS Institutional 5010A1Claim Level Accept /Reject

No

U: 10/17/2019 Non-Par 12M80 Government RHHI JC (MAC J11) Institutional 5010A2

U: 10/17/2019 Non-Par 12M80 Government SC RHHI JC (MAC J11) Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Rick Concrete Const. Prof. Work Comp 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Rick Hitch Plastering (A Corpo Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Rick Hitch Plastering (A Corpo Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/11/2013 Non-Par 74205 Commercial Right Care from Scott & White Professional 5010A1Claim Level Accept /Reject

Yes

U: 10/07/2019 Non-Par 74205 Commercial Right Care from Scott & White Remittance 5010A1 Enrollment

A: 01/29/2015 Non-Par 74205 Commercial Right Care from Scott & White Institutional 5010A1

U: 05/02/2017 Non-Par 74205 Commercial RightCare from Scott & White Professional 5010A1Claim Level Accept /Reject

Yes

U: 12/19/2014 Non-Par J1491 Workers' Comp MU Risk Enterprise Management Remittance 5010A1 Enrollment

U: 10/07/2019 Non-Par RCMG1 Commercial MU River City Medical Group Remittance 5010A1 Enrollment

U: 07/18/2012 Non-Par RCMG1 Commercial MU River City medical Group Professional 5010A1File LevelAcknowledgement

A: 09/01/2016 Par RCMG1 Commercial River City Medical Group Institutional 5010A2 Claim Level Rejects Only

A: 01/25/2016 Par 45282 Medicare MD Riverside Advantage Professional 5010A1 No Response From Payer

A: 01/25/2016 Par 45282 Medicare MD Riverside Advantage Institutional 5010A1 No Response From Payer

U: 08/15/2019 Non-Par 45282 Commercial MD Riverside Advantage Remittance 5010A1 Enrollment

U: 01/01/2012 Par RMC01 Commercial CA Riverside Medical Clinic Professional 5010A1Claim LevelAcknowledgement

Will accept claims with a date ofservice of 08/01/11 or later only

A: 01/19/2021 Par RMC01 Commercial CA Riverside Medical Clinic Institutional 5010A1Claim Level Accept /Reject

No

A: 12/05/2014 Non-Par 50664 Commercial Riverside San Bernaardino County In Institutional 5010A2 File Level Ack.

A: 12/02/2014 Non-Par CALL Commercial CA Riverside San Bernardino County Indian Health Inc. Professional 5010A1 File Level Ack.

A: 10/04/2017 Non-Par 81781 Commercial NY RIVERSPRING STAR Remittance 5010A1 Enrollment

U: 09/01/2016 Par 16117 Commercial RMSCO INC. Institutional 5010A2File LevelAcknowledgement

Yes

U: 09/01/2016 Par 16117 Commercial RMSCO, Inc. Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU ROBERT MANN PACKAGING, INC. (A Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU ROBERT MANN PACKAGING, INC. (A Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Robstown ISD Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Rockwall ISD Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 06/20/2017 Non-Par 84065 Commercial Rocky Mountain Health Plan- Grand Junction Institutional 5010A2Claim Level Accept /Reject

U: 07/17/2017 Non-Par RMHMO Commercial CO Rocky Mountain HMO Remittance 5010A1 Enrollment is temporarily unavailable.

U: 10/26/2017 Non-Par SX141 Commercial CO Rocky Mountain HMO (Formerly RMHMO) Professional 5010A1

U: 09/30/2019 Non-Par SX141 Commercial CO Rocky Mountain HMO (Formerly RMHMO) Remittance 5010A1 Enrollment

U: 01/01/2012 Trans 37602 Commercial Rooney Life Inc. Institutional 5010A2 No Response From Payer

U: 04/04/2016 Par 37602 Commercial Rooney Life Inc. Professional 5010A1 No Response From Payer Yes

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Rose Garden Guest Ho Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 36215 Commercial Rosemont of Des Plaines, IL Institutional 5010A2 No Response From Payer

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Rosewoood Equipment Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Rossi Concrete, Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Rothenberger Usa Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Rothenberger Usa Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Rountree Plumbing & Heating, I Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Rountree Plumbing & Heating, I Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 11/14/2019 Non-Par 46166 Commercial NY Royal Healthcare on Behalf of Extended Care MTC Remittance 5010A1 Enrollment

U: 06/20/2014 Non-Par 46166 Commercial NY Royal Healthcare on Behalf of Extended Care MTC Professional 5010A1 File Level Ack.For claims with DOS on or after 12/01/2013

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Rural Special District Insurance Program Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 36389 Commercial Rush Prudential Health Plans (HMO Only) Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 36389 Commercial RUSH Prudential Health Plans (HMO Only) Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 31441 Commercial S & S Healthcare Strategies Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 31441 Commercial S & S Healthcare Strategies Professional 5010A1Claim LevelAcknowledgement

A: 12/09/2021 Non-Par AMM20 Commercial CASACRAMENTO COUNTY PHYSICIANS MEDICALSERVICES (PEMS)


No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU SACRAMENTO I.B.S.,INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU SACRAMENTO I.B.S.,INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/24/2018 Non-Par C1053 Workers' Comp Safeco Insurance Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/28/2020 Non-Par C1053 Workers' Comp Safeco Insurance Remittance 5010A1 Enrollment

U: 09/01/2016 Par 35164 Commercial Sagamore Health Network Institutional 5010A2 No Response From Payer

U: 03/23/2012 Par 35164 Commercial IN Sagamore Health Network Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 37137 Commercial Sage Technologies - PBS Institutional 5010A2File LevelAcknowledgement

U: 09/01/2016 Par 37137 Commercial Sage Technologies - PBS Professional 5010A1File LevelAcknowledgement

A: 12/05/2014 Non-Par 45307 Commercial Saint Anthony PHO Institutional 5010A2 Claim Level Ack.

A: 08/23/2019 Non-Par SJHC1 Commercial CA Saint Johns Health Clinic Professional 5010A1Claim Level Accept /Reject

No

A: 08/23/2019 Non-Par SJHC1 Commercial CA Saint Johns Health Clinic Institutional 5010A1Claim Level Accept /Reject

No

U: 01/01/2012 Non-Par 88029 Commercial SAINT MARY'S HEALTH PLAN Institutional 5010A2File LevelAcknowledgement

A: 11/24/2014 Non-Par 88082 Commercial Saint Mary's Health Plan-ENCOUNTERS Professional 5010A1 No Response From Payer

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Salt Lake City Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Sam Kane Beef Processors, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/29/2020 Non-Par SM325 Commercial IL Samaritan Given Institutional 5010A1Claim Level Accept /Reject

No

A: 06/19/2020 Non-Par SM325 Commercial MI Samaritan Given Professional 5010A1Claim Level Accept /Reject

No

U: 06/14/2021 Non-Par CP001 Commercial Samaritan Health Plans Remittance 5010A1 Enrollment

A: 09/01/2016 Par CP001 Commercial MU Samaritan Health Plans Professional 5010A1 Yes

A: 09/01/2016 Par CP001 Commercial Samaritan Health Plans Institutional 5010A2 No Response From Payer Yes

U: 09/25/2019 Non-Par 37259 Commercial SAMBA Remittance 5010A1 Enrollment

A: 04/22/2021 Non-Par U8053 Commercial CA Samera Health Institutional 5010A1Claim Level Accept /Reject

No

A: 03/23/2021 Non-Par U8053 Commercial CASamera Health (Formerly Benefits AdministrativeSolutions Inc)


No

U: 03/24/2014 Non-Par 41556 Workers' Comp MUSan Diego Hospice and The Prof.tute for PalliativeMedicine


U: 03/24/2014 Non-Par 41556 Workers' Comp MU San Diego Metropolitan Transit System Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MUSan Diego Metropolitan Transit System (SCHIPLiability)


A: 10/07/2019 Non-Par 96400 Commercial CA San Diego PACE Remittance 5010A1 Enrollment

A: 09/01/2016 Trans 96400 Commercial CA San Diego PACE Professional 5010A1 Claim Level Ack.

A: 09/01/2016 Trans 96400 Commercial CA San Diego PACE Institutional 5010A1 Claim Level Ack.

Updated: 03/21/2022


PPAAYERYERIDID



A: 10/10/2014 Non-Par SCP01 Commercial CA San Diego Physicians Med Group (SCPMCS) Professional 5010A1 Claim Level Ack.

U: 03/24/2014 Non-Par 41556 Workers' Comp MU San Diego Transit Corp. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU San Diego Trolley, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU San Francisco Battery, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU San Francisco Battery, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/26/2020 Non-Par SFHP1 Commercial CA San Francisco Health Plan Institutional 5010A1Claim Level Accept /Reject

Yes

A: 07/17/2014 Non-Par SFHP1 Commercial MU San Francisco Health Plan Professional 5010A1 File Level Ack. NoProviders Must be approved at thepayer to submit claims or claims willreject. Call to verify (800) 288-5555

A: 07/20/2020 Non-Par SFHP1 Commercial CA San Francisco Health Plan Remittance 5010A1 Enrollment

A: 12/31/2020 Non-Par SFHPE Commercial CA San Francisco Health Plan Encounters Professional 5010A1Claim Level Accept /Reject

No

A: 12/31/2020 Non-Par SFHPE Commercial CA San Francisco Health Plan Encounters Institutional 5010A1Claim Level Accept /Reject

No

U: 03/24/2014 Non-Par 41556 Workers' Comp MU San Joaquin County Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/16/2020 Non-Par 58379 Commercial San Louis Obispo Select (formerly SLOS1) Remittance 5010A1 Enrollment*This enrollment will setup all payernames under payer id 58379*

A: 08/30/2019 Non-Par 50114 Commercial MD Sana Benefits Professional 5010A1 Claim Level Ack. Yes

A: 08/30/2019 Non-Par 50114 Commercial MD Sana Benefits Institutional 5010A1 Claim Level Ack. Yes

A: 12/09/2021 Non-Par SHC30 Commercial Sandhills Center Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/11/2022 Non-Par SHC3U Commercial NC SANDHILLS CENTER Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 07/18/2017 Non-Par 91184 Commercial Sanford Health Plan (Formerly SVH01) Professional 5010A1

A: 07/18/2017 Non-Par 91184 Commercial Sanford Health Plan (Formerly SVH01) Institutional 5010A1

A: 09/23/2021 Non-Par 91184 Commercial Sanford Health Plan (Formerly SVH01) Remittance 5010A1 Enrollment

U: 11/01/2012 Non-Par SBIPA Commercial Santa Barbara Select IPA Professional 5010A1File LevelAcknowledgement

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Santa Clara Co Office Of Educ Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/16/2021 Non-Par 24077 Commercial SANTA CLARA FAMILY HEALTH PLAN Remittance 5010A1 Enrollment


U: 09/01/2016 Par 24077 Commercial SANTA CLARA FAMILY HEALTH PLAN Institutional 5010A2File LevelAcknowledgement

U: 09/01/2016 Par 24077 Commercial SANTA CLARA FAMILY HEALTH PLAN Professional 5010A1File LevelAcknowledgement

A: 11/16/2021 Non-Par 58379 Commercial SANTA CLARA FAMILY HEALTH PLAN (Formerly 24077) Remittance 5010A1 Enrollment


U: 09/23/2013 Non-Par J1491 Workers' Comp MU SANTA FE EXTRUDERS, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU SANTA FE EXTRUDERS, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/06/2019 Par SNTCC Commercial CA Sante Community Medical Center Professional 5010A1 File Level Ack. No

A: 12/06/2019 Par SNTCC Commercial CA Sante Community Medical Center Professional 5010A1 File Level Ack. No

A: 08/31/2016 Par SNTMC Commercial CA Sante Community Physicians Medical Group Corp Institutional 5010A1 Claim Level Ack. No

A: 08/31/2016 Par SNTMC Commercial CA Sante Community Physicians Medical Group Corp Professional 5010A1 Claim Level Ack. Yes

U: 12/06/2019 Non-Par 77038 Commercial CA Sante Health System Professional 5010A1 No Response From Payer

U: 12/06/2019 Non-Par 77038 Commercial Sante Health System Remittance 5010A1 Enrollment

U: 12/06/2019 Par 77038 Commercial Sante Health System and Affiliates Institutional 5010A2 No Response From Payer

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/23/2013 Non-Par J1491 Workers' Comp MU SATELLITE DIALYSIS CENTERS, IN Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU SATELLITE DIALYSIS CENTERS, IN Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 45552 Commercial Satellite Health Plan Inc. Professional 5010A1 No Response From Payer

A: 09/01/2016 Par 45552 Government Satellite Health Plan Inc. Institutional 5010A2 No Response From Payer

A: 01/13/2020 Non-Par SHM01 Commercial DC Saudi Health Mission Professional 5010A1Claim Level Accept /Reject

No

A: 01/13/2020 Non-Par SHM01 Commercial DC Saudi Health Mission Institutional 5010A1Claim Level Accept /Reject

No

U: 10/14/2019 Non-Par 12M55 Medicare MU SC Medicare Part A & SW/SE RHHI Institutional 5010A1 EnrollmentClaim Level Accept /Reject

SW Region RHHI (FL,GA,KY,NC,SC &TN) SE Region RHHI (AR, LA, NM, OK &TX)

U: 10/14/2019 Non-Par 12M55 Medicare MU SC Medicare Part A & SW/SE RHHI Remittance 5010A1 EnrollmentSW Region RHHI (FL,GA,KY,NC,SC &TN) SE Region RHHI (AR, LA, NM, OK &TX)

A: 09/02/2021 Non-Par 72261 Commercial MU SCAN Health Plan Remittance 5010A1 Enrollment

U: 09/01/2016 Par 72261 Commercial SCAN Health Plan Institutional 5010A2Claim LevelAcknowledgement

A: 05/20/2014 Trans SCANE Commercial SCAN Health Plan Institutional 5010A2 File Level Ack.

A: 05/20/2014 Trans SCANE Commercial SCAN Health Plan Professional 5010A1 File Level Ack.

U: 09/01/2016 Par 73172 Commercial AZ Scan Health Plan Arizona Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 73172 Commercial AZ Scan Health Plan Arizona Institutional 5010A2Claim LevelAcknowledgement

U: 03/08/2017 Par 72261 Commercial CA SCAN Health Plan California (Formerly SCAN1) Professional 5010A1Claim Level Accept /Reject

U: 01/01/2012 Non-Par 20460 Commercial SCAN Long Term Care Professional 5010A1Claim LevelAcknowledgement

U: 01/01/2012 Non-Par 20460 Commercial SCAN Long Term Care Institutional 5010A2Claim LevelAcknowledgement

A: 01/10/2020 Non-Par SCACO Commercial CA SCCIPA Anthem Blue Cross PPO Claims Professional 5010A1Claim Level Accept /Reject

No

A: 03/17/2021 Non-Par SCACO Commercial CA SCCIPA Anthem Blue Cross PPO Claims Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Schneider Gain Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par WR839 Workers' Comp SCIF (State Compensation Insurance Fund) Prof. Work Comp 5010A1File LevelAcknowledgement

A: 02/03/2020 Non-Par WR839 Commercial SCIF State Comp Ins Fund Remittance 5010A1 Enrollment

A: 05/12/2015 Non-Par SDCOM Commercial WI Scion Dental Professional 5010A1 Claim Level Ack. Medical Claims Only.

A: 02/12/2021 Non-Par 58379 Commercial Scott & White Health Care (TH002) Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDTH002. Providers will need to enrollfor payer IDs TH002 and 58379 inorder to receive 835s for this payer.*This enrollment will setup all payernames under payer id 58379*

U: 11/02/2016 Non-Par TH002 Commercial TX Scott & White Health Care Plan (formerly 88030) Professional 5010A1Claim Level Accept /Reject

U: 02/12/2021 Non-Par TH002 Commercial Scott & White Hlth Care Remittance 5010A1 Enrollment


A: 10/03/2016 Non-Par TH002 Commercial Scott & White Hlth Care (formerly 88030 Institutional 5010A2 Claim Level Ack. Yes

A: 01/11/2017 Par 33099 Commercial CA Scripps Health Plan Services Institutional 5010A1 No Response From Payer No

U: 08/15/2019 Non-Par 33099 Commercial CA Scripps Health Plan Services Remittance 5010A1 Enrollment

A: 01/11/2017 Par 33099 Commercial CA Scripps Health Plan Services Professional 5010A1 No Response From Payer No

A: 11/24/2014 Non-Par TH116 Commercial SE TX Govt Employees Benefit Pool Professional 5010A1 Claim Level Ack. Yes

U: 11/01/2012 Non-Par IP112 Commercial CA Sea View IPA Professional 5010A1 No Response From Payer

A: 01/30/2015 Non-Par E4618 Commercial Seaside Health Plan Professional 5010A1Claim Level Accept /Reject

A: 01/30/2015 Non-Par E4618 Commercial Seaside Health Plan Institutional 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 09/10/2012 Non-Par SVIPA Commercial CA Seaview IPA Professional 5010A1File LevelAcknowledgement

U: 10/02/2019 Non-Par 94119 Commercial MU SEBRH - Non Sutter Groups Remittance 5010A1

A: 05/03/2018 Non-Par J1379 Commercial MU SECURA Insurance A Mutual Company Remittance 5010A1 Enrollment

A: 05/25/2018 Non-Par J1379 Workers' Comp Secura Insurance A Mutual Company Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 05/17/2021 Non-Par 42561 Commercial GA Secure Health Professional 5010A1Claim Level Accept /Reject

No DOS after 123120

A: 05/17/2021 Non-Par 42561 Commercial GA Secure Health Institutional 5010A1Claim Level Accept /Reject

No DOS after 123120

U: 09/01/2016 Par 39045 Commercial Security Health Plan Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 39045 Commercial Security Health Plan Professional 5010A1 No Response From Payer Yes

U: 09/26/2019 Non-Par 39045 Commercial WI Security Health Plan Remittance 5010A1 Enrollment

U: 11/14/2019 Non-Par TP097 Workers' CompMN,TX, CA

Sedgwick CMS Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par TP097 Workers' CompMN,TX, CA

Sedgwick CMS Prof. Work Comp 5010A1

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Seeno Construction (Chartis) Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Seeno Homes Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Sela Health Care Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 37282 Commercial Select Benefit Admin of America Professional 5010A1Claim LevelAcknowledgement

U: 09/01/2016 Par 37282 Commercial Select Benefit Administrators of America Institutional 5010A2 No Response From Payer

A: 12/02/2021 Non-Par 37282 Commercial Select Benefit Administrators of America Remittance 5010A1 Enrollment


A: 12/02/2021 Non-Par 58379 CommercialSelect Benefit Administrators of America (Formerly37282)



U: 10/07/2019 Non-Par 76045 Commercial TXSelectCare of Texas (HPN) Heritage PhysiciansNetwork


A: 12/05/2014 Non-Par SX107 Commercial SelectHealth Institutional 5010A2 Claim Level Accept/Reject

U: 09/25/2014 Non-Par SX107 Commercial UT SelectHealth (Formerly Intermountain Healthcare) Professional 5010A1Claim Level Accept /Reject

U: 10/06/2020 Non-Par SX107 Government UT SelectHealth (Formerly Intermountain Healthcare) Remittance 5010A1 EnrollmentProvider must be currently billing topayer or 835 ERA request will berejected.

U: 03/21/2012 Non-Par 58102 Commercial Self Insured Benefit Administrators Professional 5010A1Claim LevelAcknowledgement

U: 03/21/2012 Non-Par 58102 CommercialSelf Insured Benefit Administrators(ClearwaterFL)Formerly 59111


U: 03/21/2012 Non-Par 58102 CommercialSelf Insured BenefitAdministrators(Clearwater,FL)Formerly 59111


U: 11/01/2012 Non-Par 36404 Commercial Self Insured Plans (Naples, FL) Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 36404 Commercial FL Self Insured Plans LLC Professional 5010A1 No Response From Payer

Payer ID valid only for claims with asubmission address of 1016 CollierCenter Way, Suite 200, Naples, FL34110. Please call Customer Serviceat (239) 403-7884 to verify claimssubmission to Self Insured Plans -Payer ID 36404

A: 03/18/2013 Non-Par SISCO Commercial MU Self Insured Services Company (SISCO) Professional 5010A1File LevelAcknowledgement

No

U: 07/24/2020 Non-Par SISCO Commercial MU Self Insured Services Company (SISCO) Remittance 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



A: 04/20/2020 Non-Par SISCO Commercial IA Self Insured Services Company (SISCO) Institutional 5010A2Claim Level Accept /Reject

No

U: 09/01/2016 Par 34131 Commercial Self-Funded Plans, Inc. Institutional 5010A2 No Response From Payer

U: 02/20/2017 Par 34131 Commercial Self-Funded Plans, Inc. Professional 5010A1 No Response From Payer

A: 02/19/2019 Par 52214 Commercial OH Selman & Company Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/19/2019 Par 52214 Commercial OH Selman & Company Institutional 5010A1Claim Level Accept /Reject

Yes

A: 07/22/2020 Non-Par 52214 Selman and Company Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Selman Breitman Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/25/2019 Non-Par TRSEL Commercial Selman Tricare Supp Remittance 5010A1 Enrollment

U: 12/19/2016 Par TRSEL Commercial MU Selman Tricare Supplement Professional 5010A1 No Response From Payer Yes

U: 12/19/2016 Par TRSEL Commercial MU Selman Tricare Supplement Institutional 5010A1 No Response From Payer Yes

A: 01/19/2021 Non-Par 78702 Commercial FL Seminole Tribe of Florida Professional 5010A1Claim Level Accept /Reject

No

A: 01/19/2021 Non-Par 78702 Commercial FL Seminole Tribe of Florida Institutional 5010A1Claim Level Accept /Reject

No

A: 12/05/2019 Non-Par UV440 Commercial Sendero Idealcare Remittance 5010A1 Enrollment

A: 02/06/2019 Non-Par MV440 Commercial TX Sendero Idealcare Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/06/2019 Non-Par MV440 Commercial TX Sendero Idealcare Institutional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2017 Par SCS17 Commercial TX Sendero Star and Chip Professional 5010A1Claim Level Accept /Reject

No

A: 09/01/2017 Par SCS17 Commercial TX Sendero Star and Chip Institutional 5010A1Claim Level Accept /Reject

No

A: 10/08/2019 Non-Par 15682 Commercial MN Senior Network Health Remittance 5010A1 Enrollment

A: 08/09/2017 Trans 15682 Commercial MN Senior Network Health - Utica Institutional 5010A1 Claim Level Ack. Yes

A: 08/09/2017 Trans 15682 Commercial MN Senior Network Health - Utica Professional 5010A1 Claim Level Ack. Yes

U: 10/07/2019 Non-Par 83035 Commercial Senior Whole Health Remittance 5010A1 Enrollment

A: 12/31/2021 Trans SWHMA Commercial MA Senior Whole Health of Massachusetts Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/31/2021 Trans SWHMA Commercial MA Senior Whole Health of Massachusetts Institutional 5010A1Claim Level Accept /Reject

Yes

A: 05/12/2021 Par SWHNY Commercial NY Senior Whole Health of New York Professional 5010A1Claim Level Accept /Reject

No

A: 05/12/2021 Par SWHNY Commercial NY Senior Whole Health of New York Institutional 5010A1Claim Level Accept /Reject

No

U: 03/11/2013 Non-Par 54154 Commercial Sentara Family Care Professional 5010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 54154 Commercial Sentara Health Management Professional 5010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 54154 Commercial Sentara Optima Plan Professional 5010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 54154 Commercial Sentera Family Care Institutional 5010A2 No Response From Payer Yes

U: 03/11/2013 Non-Par 54154 Commercial Sentera Health Management Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 23249 Commercial Sentinel Management Services Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 23249 Commercial PA Sentinel Management Services Professional 5010A1Claim LevelAcknowledgement

U: 02/12/2021 Non-Par 87020 Commercial Sentinel Security Life Ins Co Remittance 5010A1 EnrollmentProviders will need to enroll for payerIDs 87020 and 58379 in order toreceive 835s for this payer.

A: 02/12/2021 Non-Par 58379 Commercial Sentinel Security Life Ins Co (87020) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379*Providers will need to enroll for payerIDs 87020 and 58379 in order toreceive 835s for this payer

A: 06/22/2020 Par 87020 Commercial UT Sentinel Security Life Insurance Company Professional 5010A1 No Response From Payer No

A: 06/22/2020 Par 87020 Commercial UT Sentinel Security Life Insurance Company Institutional 5010A1 No Response From Payer No

A: 05/02/2018 Non-Par J1417 Commercial MU Sentry Insurance A Mutual Company Remittance 5010A1 Enrollment

A: 05/25/2018 Non-Par J1417 Workers' Comp Sentry Insurance A Mutual Company Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 04/10/2013 Par SMG01 Commercial CA Seoul Medical Group Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par SMG01 Commercial Seoul Medical Group Institutional 5010A1 Claim Level Ack.

U: 11/18/2013 Non-Par TKFMC Commercial MU Sequoia Beverage Professional 5010A1File LevelAcknowledgement

No

A: 08/10/2018 Par 54823 Commercial CA Sequoia Health IPA Professional 5010A1Claim Level Accept /Reject

No

A: 08/10/2018 Par 54823 Commercial CA Sequoia Health IPA Institutional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Serendipity Land Yachts Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Serendipity Land Yachts Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 05/19/2016 Par 62308 Commercial TX Seton Employee Plan (formerly payer id SHEBP) Professional 5010A1Claim Level Accept /Reject

A: 07/27/2016 Trans TH081 Commercial MU Seton Health MAP (Formerly SHMAP) Professional 5010A1 Claim Level Ack.

A: 07/25/2016 Trans TH079 Commercial Seton Health Plan - Exclusive Professional 5010A1Claim Level Accept /Reject

A: 07/25/2016 Trans TH079 Commercial Seton Health Plan - Exclusive Institutional 5010A2Claim Level Accept /Reject

U: 09/01/2016 Par 25404 Commercial Seven Corners Institutional 5010A2File LevelAcknowledgement

U: 09/01/2016 Par 25404 Commercial Seven Corners Professional 5010A1File LevelAcknowledgement

A: 05/12/2021 Non-Par 11789 Commercial FL SGIC Professional 5010A1Claim Level Accept /Reject

No

A: 05/12/2021 Non-Par 11789 Commercial FL SGIC Institutional 5010A1Claim Level Accept /Reject

No

U: 03/04/2016 Par 87726 Commercial IL Share Health Plan - PPO / HMO Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/28/2021 Non-Par SCMGP Commercial CA Sharp Community Group Remittance 5010A1 Enrollment

A: 12/09/2021 Par SCMGP Commercial CA Sharp Community Group Institutional 5010A1Claim Level Accept /Reject

A: 09/28/2021 Par SCMGP Commercial CA Sharp Community Medical Group Professional 5010A1Claim Level Accept /Reject

A: 10/28/2021 Non-Par SHPPN Commercial CA Sharp Health Plan Remittance 5010A1 Enrollment

A: 12/09/2021 Par SHPPN Commercial CA Sharp Health Plan Professional 5010A1 Claim Level Ack. No

A: 12/09/2021 Par SHPPN Commercial CA Sharp Health Plan Institutional 5010A1 Claim Level Ack. No

A: 09/28/2021 Par SRSMG Commercial CA Sharp Rees-Stealy Medical Group Professional 5010A1Claim Level Accept /Reject

A: 11/01/2021 Non-Par SRSMG Commercial CA Sharp Rees-Stealy Medical Group Remittance 5010A1 Enrollment

A: 12/09/2021 Par SRSMG Commercial CA Sharp Rees-Stealy Medical Group Institutional 5010A1Claim Level Accept /Reject

No

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Sharyland Independent School District Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/06/2021 Non-Par 75280 Commercial Shasta Administrative Services Remittance 5010A1 Enrollment

A: 01/30/2015 Non-Par 10002 Commercial Sheakley Unicomp Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 38238 Commercial MU Sheet Metal Workers Local 104 Professional 5010A1File LevelAcknowledgement

No

A: 11/29/2021 Non-Par 81778 Commercial Sheet Metal Workers Local 36 Remittance 5010A1 Enrollment


A: 11/29/2021 Non-Par 58379 Commercial Sheet Metal Workers Local 36 (Formerly 81778) Remittance 5010A1 Enrollment


U: 12/19/2014 Non-Par CALL Commercial Sheffield Olson & McQueen Inc Institutional 5010A2Please contact Cate Ahlquist atSheffield Olson & McQueen Inc. prior

Updated: 03/21/2022


PPAAYERYERIDID



to submitting claims electronically.Phone number is 651-695-2602

A: 12/02/2014 Non-Par CALL Commercial MN Sheffield, Olson, & McQueen, Inc Professional 5010A1 File Level Ack.

Please contact Cate Ahlquist atSheffield, Olson & McQueen, Inc. priorto submitting claims electronically.Phone number is 651-695-2602

U: 09/23/2013 Non-Par J1491 Workers' Comp MU SHEPPARD, MULLIN, RICHTER & HA Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU SHEPPARD, MULLIN, RICHTER & HA Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/09/2018 Non-Par PROSP Commercial CA Sierra Family Network (Prospect Medical Group) Professional 5010A1 Claim Level Ack.

U: 12/16/2019 Non-Par 76342 Commercial NV Sierra Health Services Remittance 5010A1 Enrollment EFT is required to receive ERA

U: 09/01/2016 Par 76342 Commercial Sierra Health Services Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/11/2013 Trans 76342 Commercial NV Sierra Health Services Professional 5010A1Claim Level Accept /Reject

Yes

U: 08/08/2017 Par 76343 Commercial NV Sierra Health Services - Encounters Professional 5010A1Claim Level Accept /Reject

ERAs for Payer ID: 76343 areprocessed and returned under payerID 76342. Providers are instructed tocancel their 76343 enrollment ID, andrequest enrollment under payer ID:76342.

A: 09/01/2016 Par 30891 Commercial CA Sierra Medical Group Professional 5010A1 No Response From Payer Yes

A: 09/01/2016 Par 30891 Commercial CA Sierra Medical Group Institutional 5010A1 No Response From Payer Yes

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Sierra Nevada Memorial Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Silberberger Engn Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/24/2019 Non-Par 97691 Commercial MN Silver Star PACE Remittance 5010A1 Enrollment

A: 07/27/2016 Trans 97691 Commercial MN Silver Star PACE Professional 5010A1 Claim Level Ack. No

A: 07/27/2016 Trans 97691 Commercial MN Silver Star PACE Institutional 5010A1 Claim Level Ack. No

A: 10/18/2017 Par 68069 Commercial NV Silver Summit Health Plan Professional 5010A1Claim Level Accept /Reject

A: 10/18/2017 Par 68069 NV Silver Summit Health Plan Institutional 5010A1Claim Level Accept /Reject

U: 01/13/2020 Non-Par SMPLY Commercial FL Simply Healthcare Professional 5010A1Claim Level Accept /Reject

Yes

Effective immediately, please sendSimply Healthcare and Better HealthPlans claims to payer ID SMPLY for alldates of service on or after Feb. 1,2019. Be sure to use the ID numberprinted on the members new card for2019 coverage.

A: 01/13/2020 Non-Par SMPLY Commercial FL Simply Healthcare Institutional 5010A1Claim Level Accept /Reject

Yes

A: 12/17/2019 Non-Par SMPLY Simply Healthcare Plans Remittance 5010A1 Enrollment

A: 02/21/2018 Par SIM01 Commercial AL Simpra Advantage Inc Professional 5010A1Claim Level Accept /Reject

No

A: 02/21/2018 Par SIM01 Commercial AL Simpra Advantage Inc Institutional 5010A1Claim Level Accept /Reject

No

A: 11/04/2019 Non-Par SIM01 Commercial AL Simpra Advantage, Inc. Remittance 5010A1 Enrollment

U: 11/01/2012 Non-Par 84076 Commercial Sinclair Health Plan Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 84076 Commercial Sinclair Health Plan Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Site Studios Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Site Studios Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU SKB Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/07/2018 Par SODRC Commercial OHSkygen Medical - Ohio Department of Rehab/Corrections


A: 12/07/2018 Par SODRC Commercial OH Skygen Medical - Ohio Department of Rehab/ Institutional 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Corrections Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU SMALL WORLD TOYS Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU SMALL WORLD TOYS Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 02057 Commercial TX Smith Administrators Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 02057 Commercial Smith Administrators Institutional 5010A2Claim LevelAcknowledgement

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU SMITH EMERY COMPANY Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU SMITH EMERY COMPANY Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Smithcare, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Smithcare, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Sol'S Brake Supply Llc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Sol'S Brake Supply Llc Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/14/2020 Non-Par SH777 Commercial AZ Solidarity Healthshare Professional 5010A1Claim Level Accept /Reject

No

A: 08/14/2020 Non-Par SH777 Commercial AZ Solidarity Healthshare Institutional 5010A1Claim Level Accept /Reject

No

A: 03/04/2013 Non-Par 76578 Commercial Solstice Benefits Professional 5010A1Claim Level Accept /Reject

A: 12/07/2021 Non-Par 76578 Commercial Solstice Benefits Remittance 5010A1 Enrollment


A: 12/07/2021 Non-Par 58379 Commercial Solstice Benefits (Formerly 76578) Remittance 5010A1 Enrollment


A: 10/05/2020 Non-Par 81508 Commercial IL Somos Anthem Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/05/2020 Non-Par 81508 Commercial IL Somos Anthem Institutional 5010A1Claim Level Accept /Reject

Yes

A: 06/30/2021 Non-Par 81508 Commercial IL SOMOS ANTHEM Remittance 5010A1 Enrollment

A: 10/23/2020 Non-Par 81336 Government IL Somos Emblem Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/23/2020 Non-Par 81336 Government IL Somos Emblem Institutional 5010A1Claim Level Accept /Reject

Yes

A: 06/30/2021 Non-Par 81336 Commercial IL SOMOS EMBLEM Remittance 5010A1 Enrollment

U: 11/01/2012 Non-Par SCPCI Commercial Sonoma County Primary Care IPA Professional 5010A1File LevelAcknowledgement

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Sonoma Valley Healthcare District Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Sonoma Valley Hlth Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU SOS METALS INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU SOS METALS INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/26/2018 Par 91131 CommercialSound Health (now knoown as First Choice HealthNetwork)


Yes

U: 01/26/2018 Par 91131 CommercialSound Health (Now known as First Choice HealthNetwork)


Yes

U: 08/21/2017 Non-Par 23266 Commercial PA South Central Preferred - PPO York PA (IHS Gateway Professional 5010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Payer) Reject

U: 08/21/2017 Non-Par 23266 Commercial PASouth Central Preferred - PPO York, PA (IHS GatewayPayer)


A: 01/14/2019 Non-Par 81600 Commercial MN South Country Health Alliance Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/14/2019 Non-Par 81600 Commercial MN South Country Health Alliance Institutional 5010A1Claim Level Accept /Reject

Yes

U: 01/17/2019 Non-Par 81600 Commercial MN South Country Health Alliance Remittance 5010A1 Enrollment

A: 08/03/2016 Par 06294 Commercial FL South Florida Musculoskeletal Care Professional 5010A1Claim Level Accept /Reject

No

A: 08/03/2016 Par 06294 Commercial FL South Florida Musculoskeletal Care Institutional 5010A1Claim Level Accept /Reject

No

U: 03/11/2013 Non-Par SX144 Commercial IN South Indiana Health Options - TPA Professional 5010A1Claim Level Accept /Reject

Yes

U: 11/01/2012 Non-Par 35227 Commercial South Point Hotel & Casino Professional 5010A1File LevelAcknowledgement

U: 11/01/2012 Non-Par 35227 Commercial South Point Hotel & Casino Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 25147 Commercial Southcare / Healthcare Preferred Institutional 5010A2 No Response From Payer Yes

U: 03/11/2013 Non-Par 25147 Commercial Southcare / Healthcare Preferred Professional 5010A1Claim LevelAcknowledgement

Yes

U: 09/01/2016 Par 77153 Commercial IN Southeastern Indiana health (SIHO) Professional 5010A1File LevelAcknowledgement

No

U: 10/07/2019 Non-Par 77153 Commercial IN Southeastern Indiana Health (SIHO) Remittance 5010A1 Enrollment

A: 09/01/2016 Par 77153 Commercial Southeastern Indiana Health (SIHO) Institutional 5010A2 No Response From Payer

U: 09/26/2019 Non-Par 38242 Commercial TN Southern Benefit Administrators Remittance 5010A1 EnrollmentProviders must enroll for EFT in orderto get ERA.

U: 10/10/2014 Non-Par SCP01 Commercial CA Southern Cal Physicians Managed Care Services Professional 5010A1

A: 01/13/2020 Non-Par MPM20 Commercial CA Southern California Healthcare System Professional 5010A1Claim Level Accept /Reject

No

A: 01/13/2020 Non-Par MPM20 Commercial CA Southern California Healthcare System Institutional 5010A1Claim Level Accept /Reject

No

A: 09/01/2016 Par SIPA1 Commercial Southland BCBS Professional 5010A1 Claim Level Ack. No

A: 09/01/2016 Par SIPA1 Commercial Southland BCBS Institutional 5010A1 Claim Level Ack. No

A: 12/10/2021 Non-Par SBS01 Commercial Southland Benefit Solutions Remittance 5010A1 Enrollment

ECHO is returning 835s for payer IDSBS01. Providers will need to enrollfor payer IDs SBS01 and 58379 inorder to receive 835s for this payer.

A: 12/10/2021 Non-Par 58379 Commercial Southland Benefit Solutions (Formerly SBS01) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID SBS01.Providers will need to enroll for payerIDs SBS01 and 58379 in order toreceive 835s for this payer.

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Southwest Gas Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/08/2014 Non-Par 37266 Commercial Southwest Service Life Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 37266 Commercial TX Southwest Service Life Professional 5010A1 No Response From Payer

Please enter the unique policynumber or ID card when submittingclaims. Payer ID valid only for claimswith a billing submission address ofPO Box 982005 Ft. Worth, TX 76182

A: 01/31/2022 Par 83245 Commercial TX Southwestern Health Resources Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/31/2022 Par 83245 Commercial TX Southwestern Health Resources Institutional 5010A1Claim Level Accept /Reject

Yes

U: 04/15/2016 Par 41194 Commercial Special Risk International (SRI) (formerly 52190) Professional 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Specialty Coffee Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU SPECIALTY TEAM PLASTERING, INC Inst. Work Comp 4010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 03/24/2014 Non-Par J1491 Workers' Comp MU SPECIALTY TEAM PLASTERING, INC Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/11/2013 Trans 00773 Commercial Spectera Unitedhealthcare Vision Professional 5010A1Claim Level Accept /Reject

Yes

U: 01/15/2020 Non-Par 00773 Commercial Spectera Unitedhealthcare Vision Remittance 5010A1 EnrollmentERA SETUP FORM IS REQUIRED TOENROLL FOR 835

U: 09/01/2016 Par 84146 Commercial Spina Bifida - VA HAC Institutional 5010A2 No Response From Payer Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Spooner's Woodworks Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Spooner's Woodworks Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Spring Air California / Deluxe B Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Spring Air California / Deluxe B Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 11/07/2014 Non-Par CALL Commercial MU St James PHO Professional 5010A1 Claim Level Ack. Yes

U: 02/08/2013 Non-Par PDT01 Commercial MU St Vincent IPA Professional 5010A1File LevelAcknowledgement

U: 09/10/2012 Non-Par IP116 Commercial CA St. Francis IPA (Applecare Medical Management) Professional 5010A1 No Response From Payer

U: 11/22/2013 Non-Par STJOE Commercial CA St. Joseph Affiliated Physicians Professional 5010A1Claim Level Accept /Reject

A: 10/30/2014 Non-Par STJOE Commercial MU St. Joseph Affiliated Physicians Institutional 5010A2 No

U: 09/10/2012 Non-Par IP106 Commercial CA St. Joseph Heritage Healthcare Professional 5010A1 No Response From Payer

U: 09/10/2012 Non-Par IP106 Commercial CASt. Joseph Heritage Medical Group (formerly YorbaPark Medical Group)


U: 09/10/2012 Non-Par IP106 Commercial CA St. Joseph Hospital Affiliated Physicians Professional 5010A1 No Response From Payer

U: 09/10/2012 Non-Par IP106 Commercial CA St. Jude Professional 5010A1 No Response From Payer

U: 09/10/2012 Non-Par IP106 Commercial CA St. Jude Affiliated Physicians Professional 5010A1 No Response From Payer

U: 09/10/2012 Non-Par IP106 Commercial CA St. Jude Heritage Medical Group Professional 5010A1 No Response From Payer

A: 11/18/2019 Non-Par SMIPA St. Mary IPA, Coastal Health Mngmt Professional 5010A1 Enrollment

A: 12/16/2019 Non-Par SMIPA Commercial CA St. Mary IPA, Coastal Health Mngmt Institutional 5010A1Claim Level Accept /Reject

No

U: 01/01/2012 Non-Par 88029 Commercial St. Marys Health Plan Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU St. Rose Hospital Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU St. Rose Hospital Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 37116 Commercial IL St. Therese Physician Associates Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 37116 Commercial St. Therese Physician Association Institutional 5010A2 No Response From Payer

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Standard Fruit & Veg Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Standard Fruit & Veg Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 08/15/2019 Non-Par 73099 Commercial MU Standard Life and Accident MWA (Formerly 01758) Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Stanley Pest Control, Inc. - S Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Stanley Pest Control, Inc. - S Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 04/29/2014 Non-Par J1720 Workers' Comp State Accident Insurance Fund (SAIF) Corporation Prof. Work Comp 5010A1 File Level Ack.

A: 01/28/2020 Non-Par J1720 Workers' Comp State Accident Insurance Fund Corp Remittance 5010A1 Enrollment

This Payer ID is for Workers CompClaims for ALL states. The abovePayer Name(s) may representmultiple Accounts (employers).

A: 01/28/2020 Non-Par J1548 Workers' Comp State Farm Remittance 5010A1 Enrollment

The above Payer Name(s) mayrepresent multiple Accounts(employers). For a complete list,please refer directly to Emdeon'spublished Payer List at:www.emdeon.com/PayerLists/payerlists.php Search the Payer List

Updated: 03/21/2022


PPAAYERYERIDID



using the above Payer ID(s) toidentify them all

A: 12/05/2014 Non-Par 31059 Commercial State Farm (Cas & Property Claims) Institutional 5010A2 Claim Level Ack. Yes

U: 10/01/2019 Non-Par 31059 Commercial State Farm (Cas & Property Claims) Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 31059 Commercial State Farm (Casualty & Property Claims) Professional 5010A1 Claim Level Rejects Only Yes

U: 09/01/2016 Par 31053 Commercial State Farm Insurance Companies Professional 5010A1Claim Level Accept /Reject

U: 01/29/2020 Non-Par 31053 Commercial State Farm Insurance Companies Remittance 5010A1 Enrollment

EFT Required. Please visithttp://b2b.statefarm.com/b2b/roles/hcp_public/hipaao.asp for requiredpayer EFT forms. Paper remits willcease upon enrollment for ERA.

U: 09/01/2016 Par 31053 Commercial State Farm Insurance Companies Institutional 5010A1 No Response From Payer

U: 01/24/2020 Non-Par J1548 Auto State Farm PIP Prof. Auto 5010A1Claim Level Accept /Reject

Payer name may represent multipleAccounts (employers).

A: 01/19/2018 Non-Par J1555 Workers' Comp MN State of Minnesota - Doer Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 03/19/2018 Non-Par J1555 Commercial MN State of Minnesota - Doer Remittance 5010A1 Enrollment

U: 09/01/2016 Par 57254 Commercial State of Texas Dental Plan Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 57254 Commercial State of Texas Dental Plan Institutional 5010A2Claim Level Accept /Reject

Yes

U: 03/09/2016 Par 42162 Commercial FL State Trust Group Professional 5010A1 Claim Level Ack.

A: 03/09/2016 Par 42162 Commercial FL State Trust Group Institutional 5010A2 Claim Level Ack.

A: 01/24/2018 Par 13193 CommercialSterling Life Insurance Company - MedicareSupplement


A: 01/24/2018 Par 13193 CommercialSterling Life Insurance Company - MedicareSupplement


U: 09/23/2013 Non-Par 41556 Workers' Comp MU Stimson Lumber Company - MT, OR, WA Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Stimson Lumber Company - MT, OR, WA Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par TRP1P Commercial Stonebridge Life Professional 5010A1 No Response From Payer Yes

A: 09/01/2016 Par TRP1P Commercial Stonebridge Life Institutional 5010A2 No Response From Payer

A: 09/01/2016 Par TRP1E Commercial Stonebridge Life Insurance Company Professional 5010A1 No Response From Payer Yes

A: 09/01/2016 Par TRLTC Commercial TX Stonebridge Life Insurance Company Professional 5010A1 No Response From Payer Yes

U: 09/30/2019 Non-Par TRP1P Commercial TX Stonebridge Life Insurance Company Remittance 5010A1

A: 09/01/2016 Par 57492 Commercial Stones River IPA - Amerivantage Professional 5010A1 Claim Level Accept/Reject Yes

U: 09/01/2016 Par 15752 Commercial Stones River Regional IPA- Windsor Professional 5010A1File LevelAcknowledgement

No

U: 09/01/2016 Par 15750 Commercial TN Stones River Regional IPA/BCBST Professional 5010A1 No Response From Payer NoThis Payer ID should be used forStones River Regional IPA - BC/BSTennessee claims.

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Stonington C. Club Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Stonington C. Club Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 08/14/2020 Par STORK Commercial CA Stork Club Fertility, Inc. Professional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Striko Dynarad Corporation Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Striko Dynarad Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU STYLES FOR LESS CORP. (CA ONLY Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU STYLES FOR LESS CORP. (CA ONLY Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 04/28/2020 Non-Par 95202 SummaCare Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 95202 Commercial SummaCare Health Plan Institutional 5010A2 No Response From Payer Yes

U: 04/28/2020 Non-Par 95202 Commercial Summacare Health Plan (HMO) Professional 5010A1Claim Level Accept /Reject

YesAll claims require a claim levelrendering provider id.

Updated: 03/21/2022


PPAAYERYERIDID



A: 04/08/2019 Trans J1108 Workers' Comp MU Summit Prof. Work Comp 5010A1

A: 09/17/2019 Non-Par 86083 Summit Administration Services Inc. Remittance 5010A1 Enrollment

U: 11/01/2012 Non-Par 37301 CommercialSummit America Insurance Services LC: StudentAccident and Sickness, College Sports and NASCCclaims only


A: 08/08/2014 Non-Par 37301 Commercial Summit America Insurance Services, Inc. Institutional 5010A2 No Response From Payer

A: 07/12/2019 Non-Par PASSE Commercial IN Summit Community Care Professional 5010A1Claim Level Accept /Reject

No

A: 07/12/2019 Non-Par PASSE Commercial IN Summit Community Care Institutional 5010A1Claim Level Accept /Reject

No

A: 08/23/2019 Non-Par PASSE Summit Community Care Remittance 5010A1 Enrollment

U: 01/06/2015 Non-Par 77078 Commercial AZ Sun Health / Medisun (BCBS Medicare Advantage) Professional 5010A1 Yes

U: 10/07/2019 Non-Par 77078 Commercial Sun Health / Medisun (BCBS Medicare Advantage) Remittance 5010A1 Enrollment

U: 01/06/2015 Non-Par 77078 Commercial AZ Sun Health/MediSun (BCBS Medicare Advantage) Institutional 5010A2 Yes

U: 08/15/2014 Par 68069 Commercial KS Sunflower State Health Plan - Centene Professional 5010A1 Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Sunrise Country Club Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Sunrise Country Club Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/20/2019 Non-Par SIL01 Commercial IL Sunrise Health Plan of IL Remittance 5010A1 Enrollment

A: 02/21/2018 Par SIL01 Commercial IL Sunrise Health Plan of Illiniois Professional 5010A1Claim Level Accept /Reject

No

A: 02/21/2018 Par SIL01 Commercial IL Sunrise Health Plan of Illiniois Institutional 5010A1Claim Level Accept /Reject

No

A: 02/20/2018 Par SNY01 Commercial NY Sunrise Health Plan of New York Professional 5010A1Claim Level Accept /Reject

A: 02/20/2018 Par SNY01 Commercial NY Sunrise Health Plan of New York Institutional 5010A1Claim Level Accept /Reject

U: 11/04/2019 Non-Par SNY01 Commercial NY Sunrise Health Plan of New York Remittance 5010A1 Enrollment

A: 02/21/2018 Par SPA01 Commercial PA Sunrise Health Plan of Pennsylvania Professional 5010A1Claim Level Accept /Reject

No

A: 02/21/2018 Par SPA01 Commercial PA Sunrise Health Plan of Pennsylvania Institutional 5010A1Claim Level Accept /Reject

No

A: 02/21/2018 Par SVA01 Commercial VA Sunrise Health Plan of Virginia Professional 5010A1Claim Level Accept /Reject

No

A: 02/21/2018 Par SVA01 Commercial VA Sunrise Health Plan of Virginia Institutional 5010A1Claim Level Accept /Reject

No

A: 05/04/2018 Non-Par SPA01 Commercial PA Sunrise Health Plan PA Remittance 5010A1 Enrollment

A: 08/09/2021 Non-Par SVA01 Commercial VA Sunrise Health Plan VA Remittance 5010A1 Enrollment

A: 04/17/2019 Par 68069 Commercial FL Sunshine State Health Plan - Centene Professional 5010A1 Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Superior Access Ins Services Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Superior Access Ins Services Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 04/18/2019 Par 68069 Commercial TX Superior Health Plan - Centene Professional 5010A1 Yes

A: 04/18/2019 Par 68069 Commercial TX Superior Health Plan - Centene Institutional 5010A2 No Response From Payer Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Superior Industries International, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Superior Industries International, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Superior Ready Mix Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Superior Ready Mix Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 03/22/2018 Non-Par 41352 Commercial CA Superior Vision Services Professional 5010A1 Claim Level Ack.

A: 01/03/2020 Non-Par 41352 Commercial CA Superior Vision Services Remittance 5010A1 Enrollment

A: 03/24/2017 Par ASHC1 Commercial IN Supplemental Coverage Institutional 5010A1 No Response From Payer Yes

A: 03/24/2017 Par ASHC1 Commercial IN Supplemental Coverage Professional 5010A1 No Response From Payer Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Surface Mount Distribution (A Inst. Work Comp 4010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 03/24/2014 Non-Par J1491 Workers' Comp MU Surface Mount Distribution (A Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Surface Protection Industries Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Surface Protection Industries Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/15/2018 Non-Par SOIPA Commercial IA Surgery One IPA Professional 5010A1Claim Level Accept /Reject

No

U: 08/19/2019 Non-Par 77318 Commercial MU Sutter - Delta Medical Grp Remittance 5010A1 Enrollment

U: 05/08/2019 Non-Par 77304 Commercial MU Sutter - Santa Rosa Netwk Remittance 5010A1 Enrollment

A: 09/01/2016 Par IP090 Commercial Sutter - Santa Rosa Netwk - Claims Institutional 5010A2 Claim Level Accept/Reject Yes

U: 07/07/2020 Non-Par 77306 Commercial MU Sutter - SIP, SMG, SWMG (formerly IP092) Remittance 5010A1

U: 06/27/2017 Non-Par IP090 Commercial CA Sutter Connect - Santa Rosa Network Remittance 5010A1 Enrollment

U: 07/07/2020 Par 77306 Commercial CASutter Connect - SIP, SMG, SWMG - Claims (formerlyIP092)


Yes

U: 12/17/2012 Trans HM059 Commercial CA Sutter Connect - SIP, SMG, SWMG - Encounters Professional 5010A1Claim Level Accept /Reject

This payer no longer requiresenrollment for submitting claims/encounters

U: 06/27/2017 Non-Par IP091 Commercial CA Sutter Connect - Sutter Gould Medical Foundation Remittance 5010A1 Enrollment

U: 05/03/2012 Par IP091 Commercial CASutter Connect - Sutter Gould Medical Foundation -Claims


U: 05/03/2012 Trans HM058 Commercial CASutter Connect - Sutter Gould Medical Foundation -Encounters


YesThis Sutter payer no longer requiresclaims enrollment

A: 09/01/2016 Par 99308 Commercial Sutter Connect Medical Foundation Institutional 5010A2 No Response From Payer Yes

A: 09/01/2016 Par 94269 Commercial MU Sutter East Bay Medical Foundation Institutional 5010A1 File Level Ack. Yes

U: 09/11/2020 Non-Par 94269 Commercial Sutter East Bay Medical Foundation (Formerly IP130) Remittance 5010A1 Enrollment

U: 09/16/2014 Par IP130 Commercial CA Sutter East Bay Medical Foundation Central Division Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/27/2017 Par 94269 Commercial CASutter East Bay Medical Foundation Diablo Division(Formerly IP100)


Yes

U: 01/02/2020 Non-Par 96176 Commercial MU Sutter East Bay Regional Hospital Remittance 5010A1 Enrollment

U: 02/19/2015 Par IP134 Commercial CASutter East Bay Regional Hospital-Claims (SEBRH NonSutter Groups)


U: 01/06/2022 Non-Par 77302 Commercial MU Sutter Gould Medical Foundation Remittance 5010A1

By enrolling in this payer you areenrolling to receive ERAs from bothpayor IDs 77302 - Sutter GouldMedical Foundation & 85461 -Memorial Medical Center.

A: 12/18/2014 Non-Par J1512 Workers' Comp MU Sutter Health Prof. Work Comp 5010A1 File Level Ack. No

A: 12/23/2019 Non-Par J1512 Commercial Sutter Health Remittance 5010A1 Enrollment

A: 04/06/2018 Par 60624 Commercial CA Sutter Health | Aetna Professional 5010A1Claim Level Accept /Reject

Yes

A: 04/06/2018 Par 60624 Commercial CA Sutter Health | Aetna Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/16/2014 Par IP099 Commercial CA Sutter Medical Foundation Solano Professional 5010A1Claim Level Accept /Reject

U: 09/16/2014 Par IP090 Commercial CA Sutter Pacific Medical Foundation - Encounters Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/16/2014 Trans HM057 Commercial CA Sutter Pacific Medical Foundation - Encounters Professional 5010A1Claim Level Accept /Reject

YesThis payer no longer requiresenrollment for submitting claims/encounters

A: 09/01/2016 Par HM057 Commercial CA Sutter Pacific Medical Foundation - Encounters Institutional 5010A2 File Level Ack. Yes

U: 03/11/2013 Non-Par 39026 Commercial MU Sutter Select Professional 5010A1Claim Level Accept /Reject

Yes

U: 05/08/2019 Non-Par 56621 Commercial CA Sutter Senior Care Remittance 5010A1 Enrollment

A: 09/24/2019 Par 56621 Commercial CA Sutter Senior Care Professional 5010A1 Claim Level Ack.

U: 08/27/2018 Par 56621 Commercial CA Sutter Senior Care Institutional 5010A1 Claim Level Ack.

U: 08/27/2018 Non-Par 77302 Commercial MUSutter Valley Medical Foundation dba Sutter GouldMedical Foundation

Professional 5010A1 Claim Level Ack. Yes Enrollment is temporarily unavailable.

U: 08/27/2018 Non-Par 77302 Commercial MUSutter Valley Medical Foundation dba Sutter GouldMedical Foundation

Institutional 5010A1 File Level Ack. Yes Enrollment is temporarily unavailable.

Updated: 03/21/2022


PPAAYERYERIDID



A: 10/31/2016 Par 36411 Commercial IL Swedish Covenant Hospital Institutional 5010A1 Claim Level Ack.

A: 10/31/2016 Par 36411 Commercial IL Swedish Covenant Hospital Professional 5010A1 Claim Level Ack.

A: 03/05/2021 Non-Par SNTRQ Commercial MS SYNTRIQ HEALTH SOLUTIONS Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 03/05/2021 Non-Par SNTRQ Commercial MS SYNTRIQ HEALTH SOLUTIONS Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/14/2015 Non-Par 98022 Commercial HI TakeCare Insurance Company Professional 5010A1 Claim Level Ack.

A: 12/14/2015 Par 98022 Commercial HI TakeCare Insurance Company Institutional 5010A1 Claim Level Ack.

U: 11/08/2021 Non-Par 98022 Commercial HI TakeCare Insurance Company Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Talbert Medical Group Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Talbert Medical Group Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 88067 Commercial Tall Tree Administrators Institutional 5010A2File LevelAcknowledgement

U: 09/01/2016 Par 88067 Commercial Tall Trees / Managed Care Administrators Professional 5010A1File LevelAcknowledgement

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Tan Medical Group Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Tan Medical Group Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Target Media Partners, Et Al Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Target Media Partners, Et Al Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/18/2013 Non-Par TKFMC Commercial MU TASEBA Professional 5010A1File LevelAcknowledgement

No

U: 09/23/2013 Non-Par 41556 Workers' Comp MU TD Tile Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU TD Tile Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 10/22/2021 Par 57549 Commercial TDS/1 Professional 5010A1 Yes

A: 10/22/2021 Par 57549 Commercial TN TDS/1 Institutional 5010A1Claim Level Accept /Reject

Yes

A: 10/22/2021 Non-Par 57549 Commercial TDS/1 Remittance 5010A1 Enrollment

A: 10/26/2021 Non-Par RP007 Commercial TN TDS/2 Remittance 5010A1 Enrollment

A: 10/26/2021 Par RP007 Commercial TN TDS/2 Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/26/2021 Par RP007 Commercial TN TDS/2 Institutional 5010A1Claim Level Accept /Reject

Yes



Yes


Yes


Yes


Yes


A: 10/22/2021 Par RP005 Commercial TN TDS/ATRIO Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/22/2021 Par RP005 Commercial TN TDS/ATRIO Institutional 5010A1Claim Level Accept /Reject

Yes

A: 10/22/2021 Non-Par RP005 Commercial TN TDS/ATRIO Remittance 5010A1 Enrollment

A: 10/22/2021 Non-Par RP013 Commercial TN TDS/Golden Times Remittance 5010A1 Enrollment

A: 10/22/2021 Par RP013 Commercial TN TDS/Golden Times Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/22/2021 Par RP013 Commercial TN TDS/Golden Times Institutional 5010A1Claim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



A: 10/26/2021 Non-Par RP006 Commercial TN TDS/Mid America ACO Remittance 5010A1 Enrollment

A: 10/26/2021 Par RP006 Commercial TN TDS/Mid America ACO Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/26/2021 Par RP006 Commercial TN TDS/Mid America ACO Institutional 5010A1Claim Level Accept /Reject

Yes

A: 10/22/2021 Par RP010 Commercial TN TDS/SRRIPA/AMERIVANTAGE Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/22/2021 Par RP010 Commercial TN TDS/SRRIPA/AMERIVANTAGE Institutional 5010A1Claim Level Accept /Reject

Yes

A: 10/22/2021 Non-Par RP010 Commercial TN TDS/SRRIPA/AMERIVANTAGE Remittance 5010A1 Enrollment

A: 10/22/2021 Non-Par RP012 Commercial TN TDS/SRRIPA/Clover Remittance 5010A1 Enrollment

A: 10/22/2021 Par RP012 Commercial TN TDS/SRRIPA/Clover Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/22/2021 Par RP012 Commercial TN TDS/SRRIPA/Clover Institutional 5010A1Claim Level Accept /Reject

Yes

A: 10/13/2021 Non-Par RP011 Commercial TN TDS/SRRIPA/WELLCARE Remittance 5010A1 Enrollment

A: 10/22/2021 Par RP011 Commercial TN TDS/SRRIPA/WELLCARE Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/22/2021 Par RP011 Commercial TN TDS/SRRIPA/WELLCARE Institutional 5010A1Claim Level Accept /Reject

Yes

A: 10/22/2021 Non-Par 15749 Commercial TN TDS/TOP Medical Group Remittance 5010A1 Enrollment

A: 10/22/2021 Par 15749 Commercial TN TDS/TOP Medical Group Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/22/2021 Par 15749 Commercial TN TDS/TOP Medical Group Institutional 5010A1Claim Level Accept /Reject

Yes

A: 10/22/2021 Non-Par 35749 Commercial TN TDS/TOP Physicians Group Remittance 5010A1 Enrollment

A: 12/09/2021 Par 35749 Commercial TDS/TOP Physicians Group Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/09/2021 Par 35749 Commercial TDS/TOP Physicians Group Institutional 5010A1Claim Level Accept /Reject

Yes

A: 10/21/2021 Non-Par RP004 Commercial TN TDS/TP-ACO Remittance 5010A1 Enrollment

A: 10/21/2021 Par RP004 Commercial TN TDS/TP-ACO Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/21/2021 Par RP004 Commercial TN TDS/TP-ACO Institutional 5010A1Claim Level Accept /Reject

Yes

U: 11/01/2012 Non-Par 75133 Commercial Team Choice PNS Institutional 5010A2 No Response From Payer

U: 11/01/2012 Non-Par 75133 Commercial Team Choice PNS Professional 5010A1Claim Level Accept /Reject

U: 01/01/2012 Non-Par 75261 Commercial Team Choice PNS Professional 5010A1File LevelAcknowledgement

Yes

U: 09/01/2016 Par 36215 Commercial Teamcare Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 36215 Commercial Teamcare Professional 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par 38238 Commercial MUTeamsters Local 631 Security Fund for SouthernNevada


No

A: 08/24/2017 Par 43619 Commercial MO Teamsters Medicare Trust for Retired Employees Professional 5010A1 Claim Level Ack. Yes

A: 08/24/2017 Par 43619 Commercial MO Teamsters Medicare Trust for Retired Employees Institutional 5010A1 Claim Level Ack. Yes

U: 01/13/2015 Non-Par NWADM Commercial NVTeamsters Miscellaneous Security Trust Fund(Northwest Administrators)


Yes

U: 06/30/2012 Non-Par 20212 Commercial Tehtys Health Ventures Professional 5010A1File LevelAcknowledgement

U: 06/30/2012 Non-Par 20212 Commercial Tehtys Health Ventures Institutional 5010A2Claim LevelAcknowledgement

U: 09/23/2013 Non-Par J1491 Workers' Comp MU TEMPO INDUSTRIES, INC. (A CORP Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU TEMPO INDUSTRIES, INC. (A CORP Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/12/2022 Non-Par SKTN2 Commercial TN Tennessee Medicaid Remittance 5010A1 Enrollment

U: 11/08/2019 Non-Par SKTN2 Commercial TN Tennessee Medicaid Professional 5010A1 Enrollment

U: 01/26/2022 Non-Par SKTX0 Government TX Texas - Medicaid (Formerly MC005) Remittance 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



A: 11/08/2019 Non-Par SKTX0 Government TX Texas - Medicaid (Formerly MC005) Professional 5010A1 No Response From Payer No

U: 01/01/2012 Non-Par 76048 Commercial TX Texas Children's Health Plan (CHIP) Institutional 5010A2 No Response From Payer

U: 01/24/2012 Non-Par 76048 Commercial TX Texas Children's Health Plan (CHIP) Professional 5010A1Claim Level Accept /Reject

U: 06/22/2019 Non-Par 76048 Commercial Texas Children's Health Plan (CHIP) Remittance 5010A1 Enrollment

U: 01/01/2012 Non-Par 75228 Commercial TX Texas Children's Health Plan (Medicaid) Professional 5010A1Claim LevelAcknowledgement

U: 01/01/2012 Non-Par 75228 Commercial TX Texas Children's Health Plan (Medicaid) Institutional 5010A2File LevelAcknowledgement

U: 10/07/2019 Non-Par 75228 Commercial Texas Children's Health Plan (Medicaid) Remittance 5010A1 Enrollment

A: 01/29/2014 Non-Par 75228 Commercial TX Texas Children's Star Medical Professional 5010A1Claim LevelAcknowledgement

A: 07/19/2017 Par 88221 Commercial TX Texas Health (Aetna) Professional 5010A1Claim Level Accept /Reject

Yes

A: 07/19/2017 Par 88221 Commercial TX Texas Health (Aetna) Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 33104 Commercial TX Texas HealthSpring Institutional 5010A2

A: 04/19/2017 Par 33104 Commercial TX Texas HealthSpring Professional 5010A1 No Response From Payer No

U: 05/28/2015 Non-Par 12K96 Commercial Texas Medicaid (TMHP) - Long Term Care (LTC) Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Providers must call 800 925 9126 #3and request to be set up to submitInstitutional Claims through Emdeon.

U: 09/02/2021 Non-Par SKTX1 Commercial UT Texas Medicaid Long Term Care (LTC) Remittance 5010A1 Enrollment

A: 09/02/2021 Non-Par SKTX1 Commercial TX Texas Medicaid Long Term Care (LTC) Professional 5010A1 Enrollment

A: 08/08/2017 Non-Par A0245 Workers' Comp TXTexas Municipal League (TML) Employees of IEBPOnly


No

A: 08/08/2017 Non-Par A0245 Workers' Comp TXTexas Municipal League (TML) Employees of IEBPOnly


No

U: 03/24/2014 Non-Par WK024 Workers' Comp TX Texas Municipal League Intergov Risk Pool Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/28/2020 Non-Par WK024 Workers' Comp Texas Municipal League Intergov RiskPool Remittance 5010A1 Enrollment

A: 01/13/2020 Non-Par A0245 Workers' Comp TX Texas Municipal League TML IEBP Employee Remittance 5010A1 EnrollmentERA should go through payer IDWK024.

A: 07/21/2017 Non-Par 22945 Workers' Comp TX Texas Mutual Insurance Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 07/28/2017 Non-Par 22945 Commercial TX Texas Mutual Insurance Remittance 5010A1 EnrollmentERA should be submitted using payerID WK002.

U: 12/19/2014 Non-Par WK002 Workers' Comp TX Texas Mutual Insurance Co. Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par WK002 Workers' Comp TX Texas Mutual Insurance Co. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par TH089 Commercial TX Texas Premier Plan Professional 5010A1Claim Level Accept /Reject

No

U: 10/07/2019 Non-Par 13185 Commercial TX TexasFirst Health Plan (North Texas Area) Remittance 5010A1 Enrollment

U: 01/24/2012 Non-Par BOONG Commercial The Boon Group Professional 5010A1Claim Level Accept /Reject

U: 03/11/2013 Non-Par 68423 Commercial MU The Care Network / The Savannah Business Group Professional 5010A1 Claim Level Rejects Only Yes

A: 12/05/2014 Non-Par 68423 Commercial The Care Network/Savannah Bus Grp Institutional 5010A2 Claim Level Rejects Only Yes

A: 03/09/2022 Par RP044 Commercial MI The Cascade Pace, INC., DBA Thome Pace Professional 5010A1 File Level Ack. Yes

A: 03/09/2022 Par RP044 Commercial MI The Cascade Pace, INC., DBA Thome Pace Institutional 5010A1 File Level Ack. Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU The Garlic Company (A Partners Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU The Garlic Company (A Partners Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/09/2015 Non-Par C1050 Workers' Comp MU The General Insurance Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1422 Workers' Comp MU The Hartford Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 20356 Commercial The Health Exchange Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 20356 Commercial The Health Exchange (Cerner Corporation) Institutional 5010A2Claim LevelAcknowledgement

A: 05/29/2020 Non-Par 95677 Commercial The Health Plan Remittance 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



U: 04/21/2021 Trans 34150 Commercial The Health Plan of West Virginia Professional 5010A1Claim Level Accept /Reject

YesERA for providers enrolling afterMarch 2019 is available under 95677

A: 04/21/2021 Par 34150 Commercial The Health Plan of West Virginia Institutional 5010A2Claim Level Accept /Reject

YesERA for providers enrolling afterMarch 2019 is available under 95677

U: 09/01/2016 Par 35206 Commercial The Healthcare Group Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 35206 Commercial The Healthcare Group Professional 5010A1Claim LevelAcknowledgement

U: 03/11/2013 Non-Par 23223 Commercial The Loomis Company Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 23223 CommercialThe Loomis Company - TPA Wyomissing PA (IHSGateway Payer)


Yes

A: 09/28/2018 Trans 82694 Commercial NJ The Macaluso Group Professional 5010A1 No Response From Payer Yes

A: 09/28/2018 Trans 82694 Commercial NJ The Macaluso Group Institutional 5010A1 No Response From Payer Yes

U: 09/10/2018 Non-Par 82694 Commercial NJ The Macaluso Group Remittance 5010A1

U: 11/01/2012 Non-Par 59227 Commercial The MEGA Life & Health Insurance Company - OKC Professional 5010A1Claim Level Accept /Reject

A: 08/08/2014 Non-Par 59227 Commercial The MEGA Life & Health Insurance Company - OKC Institutional 5010A2 No Response From Payer

A: 09/01/2016 Par 59087 Commercial The National Radiology Network Institutional 5010A2 No Response From Payer

A: 10/04/2017 Non-Par 57034 Commercial SC The Oaks PACE Remittance 5010A1 Enrollment

A: 04/19/2017 Trans 57034 Commercial SC The Oaks PACE (MEDITURE, LLC) Professional 5010A1 Claim Level Ack. No

A: 04/19/2017 Trans 57034 Commercial SC The Oaks PACE (MEDITURE, LLC) Institutional 5010A1 Claim Level Ack. No

U: 09/01/2016 Par 31074 CommercialThe Physicians Assurance Corp (TPAC) / EmployeeBenefit Management Corp (EBM


Yes

U: 10/10/2014 Non-Par 04320 CommercialThe Preferred Healthcare System (TPHS) - PPOAltoona PA (IHS GatewayPayer)


U: 12/19/2014 Non-Par WK017 Workers' Comp MU The Zenith Remittance 5010A1 Enrollment

U: 03/24/2014 Non-Par WK017 Workers' Comp The Zenith Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 06/12/2020 Non-Par 75296 Commercial OK The Zero Card LLC Professional 5010A1Claim Level Accept /Reject

No

A: 06/12/2020 Non-Par 75296 Commercial OK The Zero Card LLC Institutional 5010A1Claim Level Accept /Reject

No

U: 03/11/2013 Non-Par SX160 Commercial Thomas H. Cooper Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Thomas Staffing Services, Inc / Venturi Staffing Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Thomas Staffing Services, Inc / Venturi Staffing Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 10/01/2018 Non-Par THRIV Commercial WI Thrivent Financial Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/01/2018 Non-Par THRIV Commercial WI Thrivent Financial Institutional 5010A1Claim Level Accept /Reject

Yes

A: 10/27/2021 Non-Par THRIV Commercial WI THRIVENT FINANCIAL Remittance 5010A1 Enrollment

A: 10/04/2018 Non-Par 30167 Commercial MNThrivent Financial Aid Association for LutheranMedicare


Yes

A: 10/04/2018 Non-Par 30167 Commercial MNThrivent Financial Aid Association for LutheranMedicare


Yes

A: 10/04/2018 Non-Par 30166 Commercial WI Thrivent Financial Lutheran Brotherhood Medicare Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/04/2018 Non-Par 30166 Commercial WI Thrivent Financial Lutheran Brotherhood Medicare Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU TIM'S AUTO PAINT & SUPPLY, INC Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU TIM'S AUTO PAINT & SUPPLY, INC Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 06/22/2019 Non-Par 48055 Commercial MU Todays Option, Pyramid Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Tom'S Truck Center, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Tom'S Truck Center, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/23/2013 Non-Par J1491 Workers' Comp MU TOMCO AUTO PRODUCTS, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU TOMCO AUTO PRODUCTS, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Tomdan Enterprises Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Tomdan Enterprises Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Topanga Roscoe Corp. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Topanga Roscoe Corp. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 10/28/2014 Non-Par THIPA Commercial CA Torrance Hospital IPA Professional 5010A1Claim Level Accept /Reject

A: 12/05/2014 Non-Par THIPA Commercial Torrance Hospital IPA Institutional 5010A2 Claim Level Ack.

U: 01/16/2015 Non-Par 68055 Commercial SC Total Carolina Care Professional 5010A1Claim Level Accept /Reject

Yes

Prior to submitting claims, callProvider Relations Dept. at866-433-6041 to verify your providerinfo is on file in the Health Plans claimsystem to avoid any rejections

U: 09/01/2016 Par 31182 Commercial Total Community Care Institutional 5010A2File LevelAcknowledgement

U: 09/01/2016 Par 31182 Commercial Total Community Care Professional 5010A1File LevelAcknowledgement

A: 01/02/2020 Non-Par 31182 TOTAL COMMUNITY CARE Remittance 5010A1 Enrollment

U: 09/01/2016 Par 38201 Commercial Total Healthcare, Inc. Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 38201 Commercial Total Healthcare, Inc. Professional 5010A1Claim Level Accept /Reject

A: 05/25/2021 Non-Par 38201 Commercial MI Total Healthcare, Inc. Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU TOTAL PLUMBING HEATING & AIR Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU TOTAL PLUMBING HEATING & AIR Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 03/15/2018 Trans 12268 Commercial MU Total Senior Care Professional 5010A1Claim Level Accept /Reject

No

A: 03/15/2018 Trans 12268 Commercial MU Total Senior Care Institutional 5010A1Claim Level Accept /Reject

No

U: 11/27/2013 Non-Par 23856 Commercial Touchstone Health PSO Professional 5010A1Claim Level Accept /Reject

U: 11/27/2013 Non-Par 23856 Commercial Touchstone Health PSO Institutional 5010A2 No Response From Payer No

U: 11/18/2013 Non-Par TKFMC Commercial MU Town & Country Professional 5010A1File LevelAcknowledgement

No

U: 09/01/2016 Par 31074 Commercial TPAC / Employee Benefit Management Corp Institutional 5010A1File LevelAcknowledgement

Yes

U: 09/01/2016 Par 37230 Commercial TR Paul Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 37230 Commercial TR Paul Inc. Institutional 5010A2 No Response From Payer

U: 09/23/2013 Non-Par J1491 Workers' Comp MU TRANS VALLEY TRANSPORT Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU TRANS VALLEY TRANSPORT Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 10/07/2019 Non-Par PARTD Commercial Transact RX Part D Remittance 5010A1 Enrollment

A: 09/01/2016 Par PARTD Commercial Transact RX Part D Professional 5010A1Claim Level Accept /Reject

A: 02/17/2016 Par RX001 Commercial MU TransactRX Infusion and Specialty Professional 5010A1 File Level Ack.

U: 09/24/2019 Par RX001 Commercial TransactRX Infusion and Specialty Remittance 5010A1 Enrollment

A: 09/01/2016 Par TLINS Commercial Transamerica Financial Life Ins. Professional 5010A1 No Response From Payer Yes

A: 09/01/2016 Par TLINS Commercial Transamerica Financial Life Ins. Institutional 5010A2 No Response From Payer

A: 09/01/2016 Par TRP1E Commercial TransAmerica Life Insurance Company Professional 5010A1 No Response From Payer Yes

A: 09/01/2016 Par TRP1E Commercial TransAmerica Life Insurance Company Institutional 5010A2 No Response From Payer

U: 10/07/2019 Non-Par TRP1E Commercial TransAmerica Life Insurance Company Remittance 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



A: 10/07/2019 Non-Par TRCLF Commercial MU Transamerica Premier Life Ins Remittance 5010A1

A: 09/01/2016 Par TRCLF Commercial Transamerica Premier Life Insurance Company Professional 5010A1 No Response From Payer Yes

A: 09/01/2016 Par TRCLF Commercial Transamerica Premier Life Insurance Company Institutional 5010A2 No Response From Payer

A: 09/01/2016 Par TRP1P Commercial TX Transamerica Premier Life Insurance Company Professional 5010A1 No Response From Payer Yes

U: 03/11/2013 Trans 37284 Commercial TransChoice-KBA Professional 5010A1 No Response From Payer Yes

U: 09/01/2016 Trans 37284 Commercial TransChoice-Key Benefit Administrators Institutional 5010A2File LevelAcknowledgement

Yes

U: 03/11/2013 Trans 37284 Commercial TransChoice-Key Benefit Administrators Professional 5010A1 No Response From Payer Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU TRANSPACIFIC DEVELOPMENT COMPA Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU TRANSPACIFIC DEVELOPMENT COMPA Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/28/2020 Non-Par 19046 Workers' Comp Travelers Remittance 5010A1 EnrollmentPayer ID is for Workers Comp claimsfor all states.

U: 03/24/2014 Non-Par 19046 Workers' Comp MU Travelers (formerly WB102) Prof. Work Comp 5010A1File LevelAcknowledgement

U: 03/24/2014 Non-Par WP467 Workers' Comp Travelers Insurance Prof. Work Comp 5010A1File LevelAcknowledgement

A: 03/25/2019 Par TCMAP Commercial TX Travis County MAP Professional 5010A1Claim Level Accept /Reject

No

A: 03/25/2019 Par TCMAP Commercial TX Travis County MAP Institutional 5010A1Claim Level Accept /Reject

No

U: 09/30/2019 Non-Par TCMAP TRAVIS COUNTY MAP Remittance 5010A1 Enrollment

U: 09/01/2016 Par 36397 Commercial Trellis Health Partners Institutional 5010A2File LevelAcknowledgement

U: 09/01/2016 Par 36397 Commercial Trellis Health Partners Professional 5010A1File LevelAcknowledgement

U: 09/23/2013 Non-Par J1491 Workers' Comp MU TRI VALLEY ORTHOPEDIC & SPORTS Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU TRI VALLEY ORTHOPEDIC & SPORTS Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Tri-City Healthcare District Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Tri-City Healthcare District Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Tri-City Linen Suppl Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Tri-City Linen Suppl Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 12/10/2018 Trans 39181 Commercial MU Triad Healthcare Inc. Professional 5010A1 No Response From Payer No

A: 03/22/2019 Par 56155 Commercial NC TrialCard Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/22/2019 Par 56155 Commercial NC TrialCard Institutional 5010A1Claim Level Accept /Reject

Yes

A: 01/11/2022 Non-Par 56155 Commercial NC TRIALCARD Remittance 5010A1 Enrollment

U: 01/27/2012 Non-Par 73117 Commercial Tribute / SelectCare of Oklahoma Institutional 5010A2File LevelAcknowledgement

U: 01/27/2012 Non-Par 73117 Commercial Tribute / SelectCare of Oklahoma Professional 5010A1File LevelAcknowledgement

U: 10/01/2020 Non-Par 73117 Commercial Tribute / SelectCare of Oklahoma Remittance 5010A1 Enrollment

U: 09/01/2016 Par 31118 CommercialTribute Health Plan (formerly Central BenefitsNational)


Yes

U: 08/15/2019 Non-Par 31118 CommercialTribute Health Plan (formerly Central BenefitsNational)


A: 09/01/2016 Par 31118 CommercialTribute Health Plan (formerly Central BenefitsNational)


Yes

A: 09/23/2019 Non-Par 31125 Commercial OK Tribute Health Plan of Oklahoma Professional 5010A1Claim Level Accept /Reject

No

A: 09/23/2019 Non-Par 31125 Commercial OK Tribute Health Plan of Oklahoma Institutional 5010A1Claim Level Accept /Reject

No

A: 11/04/2020 Non-Par 12C01 Commercial TRICARE - West Region Institutional 5010A1 Enrollment

Updated: 03/21/2022


PPAAYERYERIDID



U: 11/04/2020 Non-Par SCWI0 Government TRICARE - West Region (Formerly CH003) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

A: 11/04/2020 Non-Par SCWI0 Government TRICARE - West Region (Formerly CH003) Institutional 5010A2 Claim Level Rejects Only Yes

U: 03/18/2020 Non-Par SCWI0 Government TRICARE - West Region (Formerly CH003) Remittance 5010A1 Enrollment

U: 11/11/2019 Par 68299 Commercial Tricare East Professional 5010A1Claim Level Accept /Reject

Yes

Providers are encouraged to contactTricare East Provider Services at1-800-444-5445 prior to completingEDI setup to ensure that your providerrecord on file with Tricare East is up todate with all service locations for yourTax ID(s).

U: 12/09/2021 Non-Par 68299 Commercial Tricare East Remittance 5010A1 Enrollment

U: 09/30/2019 Par 68299 Commercial Tricare East Institutional 5010A1Claim Level Accept /Reject

Yes

Providers are encouraged to contactTricare East Provider Services at1-800-444-5445 prior to completingEDI setup to ensure that your providerrecord on file with Tricare East is up todate with all service locations for yourTax ID(s).

U: 11/24/2021 Non-Par SX176 Government Tricare For Life (Formerly TDDIR) Remittance 5010A1 Enrollment

U: 10/01/2019 Non-Par SX176 Government Tricare For Life (Formerly TDDIR) Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 11/14/2019 Non-Par 12X43 Commercial Tricare For Life (Formerly TDDIR) Institutional 5010A2 EnrollmentClaim Level Accept /Reject

Yes

A: 12/02/2020 Non-Par SX163 Commercial Tricare Overseas Remittance 5010A1 Enrollment

U: 05/28/2020 Non-Par SX163 Government Tricare Overseas (Formerly FOREN) Professional 5010A1 EnrollmentClaim Level Accept /Reject

U: 05/28/2020 Non-Par 12X46 Commercial MU Tricare Overseas (Formerly FOREN/ SX163) Institutional 5010A1 Enrollment ERA is available under SX163

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Tricity Uniform Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Tricity Uniform Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/17/2018 Non-Par SB924 CommercialTrigon BCBS Virginia [aka ANTHEM BLUE CROSS BLUESHIELD (VIRGINIA)]


A: 11/18/2014 Non-Par 31144 Commercial TRIHEALTH PHYSICIAN SOLUTIONS Institutional 5010A1

U: 12/17/2013 Non-Par 31144 Commercial TRIHEALTH PHYSICIAN SOLUTIONS Professional 5010A1File LevelAcknowledgement

U: 08/15/2019 Non-Par 31144 Commercial TRIHEALTH PHYSICIAN SOLUTIONS Remittance 5010A1 Enrollment

A: 08/08/2014 Non-Par 31143 Commercial TRIHEALTH PHYSICIAN SOLUTIONS - CONCERN Institutional 5010A2

U: 11/01/2012 Non-Par 31143 Commercial TRIHEALTH PHYSICIAN SOLUTIONS - CONCERN Professional 5010A1File LevelAcknowledgement

A: 09/01/2016 Par 20048 Commercial OR Trillium Community Health Plan Professional 5010A1Claim Level Accept /Reject

U: 11/14/2019 Non-Par 20048 Commercial Trillium Community Health Plan Remittance 5010A1 Enrollment

U: 01/15/2021 Trans 56089 Commercial NC Trillium Health Resources Professional 5010A1Claim Level Accept /Reject

Yes

U: 01/15/2021 Non-Par 56089 Commercial NC Trillium Health Resources Remittance 5010A1 Enrollment

U: 01/15/2021 Trans 56089 Commercial NC Trillium Health Resources Institutional 5010A2Claim Level Accept /Reject

Yes

A: 05/31/2016 Par 68069 Commercial OR Trillium Medicare Advantage 2016 Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 62777 Commercial Trilogy Network Institutional 4010A1File LevelAcknowledgement

Yes

U: 09/01/2016 Par 62777 Commercial Trilogy Network Professional 4010A1File LevelAcknowledgement

Yes

A: 03/19/2018 Non-Par TRNPC Commercial MI Trinity Health PACE Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/19/2018 Non-Par TRNPC Commercial MI Trinity Health PACE Institutional 5010A1Claim Level Accept /Reject

Yes

A: 03/11/2021 Non-Par TRNPC Commercial MI TRINITY HEALTH PACE Remittance 5010A1 Enrollment

A: 11/19/2021 Non-Par 973MA Commercial PR Triple-S Advantage Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



A: 11/19/2021 Non-Par 973MA Commercial PR Triple-S Advantage Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 01/12/2022 Non-Par 973MA Commercial PR Triple-S Advantage Remittance 5010A1 Enrollment

U: 05/21/2021 Non-Par 12B48 Commercial PR Triple-S Salud (BCBS PR) Institutional 5010A1Claim Level Accept /Reject

U: 12/23/2021 Non-Par SB980 Commercial PR Triple-S, Inc. - Puerto Rico Remittance 5010A1 Enrollment

U: 09/02/2021 Non-Par SB980 Commercial PR Triple-S, Inc.- Puerto Rico Professional 5010A1 Enrollment No

A: 11/24/2014 Non-Par 64300 Commercial TRIPLEFIN LLC Professional 5010A1 Claim Level Accept/Reject Yes

A: 12/05/2014 Non-Par 64300 Commercial TRIPLEFIN LLC Institutional 5010A2 Claim Level Accept/Reject Yes

U: 01/27/2012 Non-Par 42137 Commercial IATriStar (formerly Select Benefit Administrators (DesMoines, IA))


U: 01/27/2012 Non-Par 42137 Commercial IA TriStar (formerly Select Benefit Administrators) Professional 5010A1 No Response From Payer

A: 01/28/2020 Non-Par 41556 Workers' Comp Tristar Risk Management Remittance 5010A1 EnrollmentPayer ID is for Workers Compensationclaims for all states.

A: 11/18/2014 Non-Par 31144 Commercial TriState Benefit Solutions Professional 5010A1 File Level Ack.

A: 11/18/2014 Non-Par 31144 Commercial TriState Benefit Solutions Institutional 5010A1

A: 07/02/2021 Non-Par TWVA4 Commercial TriWest Region 4 CCN Remittance 5010A1 Enrollment

A: 06/25/2021 Non-Par TWVA4 Commercial TriWest Region 4 CCN Professional 5010A1 EnrollmentClaim Level Accept /Reject


A: 07/29/2021 Non-Par TWVA5 Commercial TriWest Region 5 CCN Remittance 5010A1 EnrollmentYou must also add/request Payer ID:TWVA4


A: 07/29/2021 Non-Par TWVA6 Commercial TriWest Region 6 CCN Remittance 5010A1 EnrollmentYou must also add/request Payer ID:TWVA4



A: 10/10/2019 Par 83413 Commercial PA Tru Blue (Innovative Healthware Solutions) Professional 5010A1Claim Level Accept /Reject

No

A: 10/10/2019 Par 83413 Commercial PA Tru Blue (Innovative Healthware Solutions) Institutional 5010A1Claim Level Accept /Reject

No

U: 10/17/2019 Non-Par 12B84 Commercial ID True Blue / Blue Cross of Idaho Institutional 5010A1 Enrollment

A: 11/05/2019 Trans 82288 Commercial NM True Health New Mexico (Evolent Health) Institutional 5010A1 Claim Level Ack. Yes

A: 11/05/2019 Trans 82288 Commercial NM True Health New Mexico (Evolent Health) Professional 5010A1 Claim Level Ack. Yes

A: 01/06/2021 Non-Par 82288 Commercial NM True Health New Mexico (Evolent Health) Remittance 5010A1 Enrollment

A: 01/22/2020 Non-Par 85824 Commercial True Health New Mexico (SS&C) Remittance 5010A1 Enrollment

A: 01/31/2020 Par 85824 Commercial AL True Health New Mexico (SS&C) Professional 5010A1Claim Level Accept /Reject

No

A: 01/31/2020 Par 85824 Commercial AL True Health New Mexico (SS&C) Institutional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU True World Foods, Inc. (A Corp Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU True World Foods, Inc. (A Corp Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Par L0230 Commercial MU Trusted Health Plan Professional 5010A1File LevelAcknowledgement

Yes

U: 10/07/2019 Non-Par L0230 Commercial Trusted Health Plan Remittance 5010A1 Enrollment

A: 09/01/2016 Par L0230 Commercial Trusted Health Plan Institutional 5010A2 No Response From Payer Yes

U: 04/06/2017 Par 91078 Commercial Trusteed Plans Service Corporation Institutional 5010A2 No Response From Payer ERA available under payer ID: 58379

U: 04/06/2017 Par 91078 Commercial Trusteed Plans Service Corporation Professional 5010A1 ERA available under payer ID: 58379

U: 02/26/2020 Non-Par 38225 Commercial MI Trustmark Health Benefits (CoreSource Detroit) Institutional 5010A2 No Response From Payer Yes

U: 02/26/2020 Par 38225 Commercial MI Trustmark Health Benefits (CoreSource Detroit) Professional 5010A1 No Response From Payer Yes

U: 02/24/2020 Non-Par 35182 CommercialIL, MD,PA

Trustmark Health Benefits (CoreSource IL,MD,PA) Professional 5010A1 Yes

U: 02/26/2020 Non-Par 48117 Commercial Trustmark Health Benefits (CoreSource KC) Institutional 5010A2 Claim Level Accept / ERA available under payer ID: 58379

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 02/26/2020 Non-Par 48117 Commercial Trustmark Health Benefits (CoreSource KC) Professional 5010A1Claim Level Accept /Reject


U: 02/26/2020 Non-Par 58379 Commercial ARTrustmark Health Benefits (CoreSource Little Rock(Formerly 75136)


U: 02/26/2020 Non-Par 75136 Commercial AR Trustmark Health Benefits (CoreSource Little Rock) Institutional 5010A2

U: 02/26/2020 Non-Par 75136 Commercial AR Trustmark Health Benefits (CoreSource Little Rock) Professional 5010A1

Only for claims where the "submitclaims to" address on the medical IDcard is a CoreSource address in LittleRock, Arkansas. For assistance call(800)689-0106.

U: 02/24/2020 Non-Par 35182 Commercial AZ, MN Trustmark Health Benefits (CoreSource of AZ, MN) Professional 5010A1 Yes

U: 02/24/2020 Non-Par 35182 Commercial AZ, MN Trustmark Health Benefits (CoreSource of AZ, MN) Institutional 5010A2 Yes

U: 02/24/2020 Non-Par 35182 Commercial AZ, MN Trustmark Health Benefits (CoreSource of AZ, MN) Remittance 5010A1 EnrollmentThis payer requires EFT whenrequesting ERA.


Trustmark Health Benefits (CoreSource of IL, MD, PA) Institutional 5010A2 Yes


Trustmark Health Benefits (CoreSource of IL, MD, PA) Remittance 5010A1 EnrollmentThis payer requires EFT whenrequesting ERA.

U: 02/24/2020 Non-Par 35182 Commercial NC, IN Trustmark Health Benefits (CoreSource of NC, IN) Professional 5010A1 Yes

U: 02/24/2020 Non-Par 35182 Commercial NC, IN Trustmark Health Benefits (CoreSource of NC, IN) Remittance 5010A1 EnrollmentThis payer requires EFT whenrequesting ERA.

U: 02/24/2020 Non-Par 35182 Commercial NC, IN Trustmark Health Benefits (CoreSource of NC, IN) Institutional 5010A2 Yes

U: 02/26/2020 Non-Par 35183 Commercial OH Trustmark Health Benefits (CoreSource of OH) Institutional 5010A2 No Response From Payer Yes ERA available under payer ID: 58379

U: 02/26/2020 Non-Par 35183 Commercial OH Trustmark Health Benefits (CoreSource Of OH) Professional 5010A1Claim Level Accept /Reject

Yes

Only for claims where the "submitclaims to" address on the medical IDcard is a CoreSource address in thestate of OH. For assistance, call (800)689-0106. ERA available under payerID: 58379

U: 02/26/2020 Non-Par 35187 Commercial IA Trustmark Health Benefits (CoreSource-Internal) Professional 5010A1

U: 02/26/2020 Non-Par 35187 Commercial IA Trustmark Health Benefits (CoreSource-Internal) Institutional 5010A2 Yes

U: 02/26/2020 Non-Par 61425 Commercial Trustmark Small Business Benefits Institutional 5010A2 No Response From Payer ERA available under payer ID: 58379

U: 02/26/2020 Non-Par 61425 Commercial Trustmark Small Business Benefits Professional 5010A1 No Response From Payer ERA available under payer ID: 58379

A: 12/07/2021 Non-Par 15069 Commercial Tucker Administration, Inc Remittance 5010A1 Enrollment


A: 12/07/2021 Non-Par 58379 Commercial Tucker Administration, Inc (Formerly 15069) Remittance 5010A1 Enrollment


U: 09/23/2013 Non-Par 41556 Workers' Comp MU Tucson Unified School Dist WC Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Tucson Unified School Dist WC Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 02/01/2019 Non-Par 04298 Commercial MA Tufts Health Plan Institutional 5010A2Claim Level Accept /Reject

Yes

U: 02/01/2019 Non-Par 04298 Commercial Tufts Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/02/2021 Non-Par 12K96 Commercial TX TX - MEDICAID (TMHP) - LTC Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU U. S. Wireless Corporation Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU U. S. Wireless Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 07/01/2020 Non-Par CB986 Workers' Comp U.S. Dept of Labor (DOL) - Black Lung Prof. Work Comp 5010A1 No Response From Payer NoWorkCompEDI's Billing Agent/ CHOWCP ID with DOL is ID# 700956700

A: 07/01/2020 Non-Par CB986 Workers' Comp U.s. Dept of Labor (DOL) - Black Lung Inst. Work Comp 5010A1 No Response From Payer NoWorkCompEDI's Billing Agent/ CHOWCP ID with DOL is ID# 700956700

A: 07/01/2020 Non-Par LU964 Workers' Comp U.S. Dept of Labor (DOL) - Coal Mine Prof. Work Comp 5010A1 No Response From Payer No WorkCompEDI's Billing Agent/ CH

Updated: 03/21/2022


PPAAYERYERIDID



OWCP ID with DOL is ID# 700956700

A: 07/01/2020 Non-Par LU964 Workers' Comp U.S. Dept of Labor (DOL) - Coal Mine Inst. Work Comp 5010A1 No Response From Payer NoWorkCompEDI's Billing Agent/ CHOWCP ID with DOL is ID# 700956700

A: 06/19/2020 Non-Par CB986 Commercial U.S. Dept. of Labor (DOL) - Black Lung Remittance 5010A1 Enrollment

A: 06/19/2020 Non-Par LU964 Commercial U.S. Dept. of Labor (DOL) - Coal Mine Remittance 5010A1 Enrollment

A: 09/17/2020 Non-Par LS165 Workers' Comp MU U.S. DEPT. OF LABOR (DOL) - VETERANS ADMIN Prof. Work Comp 5010A1WorkCompEDI Billing Agent/ CHOWCP ID with DOL is ID# 700956700

A: 09/17/2020 Non-Par LS165 Workers' Comp MU U.S. DEPT. OF LABOR (DOL) - VETERANS ADMIN Inst. Work Comp 5010A1WorkCompEDI Billing Agent/ CHOWCP ID with DOL is ID# 700956700

A: 08/05/2020 Non-Par USN01 Commercial MN U.S. Networks and Administrative Services Professional 5010A1Claim Level Accept /Reject

No

A: 08/05/2020 Non-Par USN01 Commercial MN U.S. Networks and Administrative Services Institutional 5010A1Claim Level Accept /Reject

No

U: 03/04/2016 Par 87726 CommercialUBH - United Behavioral Health (RIOS) (ERA's are notavailable for UBH)


Yes

A: 09/01/2016 Par 94603 Commercial CA UC Davis Health Professional 5010A1 Claim Level Rejects Only

A: 09/01/2016 Par 94603 Commercial CA UC Davis Health Institutional 5010A1 Claim Level Rejects Only

A: 03/13/2020 Non-Par 52629 Commercial MN UCARE Professional 5010A1Claim Level Accept /Reject

No

A: 08/23/2021 Non-Par 52629 Commercial MN UCARE Remittance 5010A1 Enrollment

A: 01/14/2019 Non-Par 55413 Commercial MN Ucare Individual and Family Plans Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/14/2019 Non-Par 55413 MN Ucare Individual and Family Plans Institutional 5010A1Claim Level Accept /Reject

Yes

A: 12/30/2021 Non-Par 55413 Commercial MU Ucare Individual and Family Plans Remittance 5010A1 Enrollment

U: 07/28/2021 Non-Par SX178 Commercial MN Ucare of Minnesota Remittance 5010A1 Enrollment

U: 01/01/2012 Non-Par SX178 Commercial MN Ucare Of Minnesota Professional 5010A1Claim Level Accept /Reject

A: 01/11/2022 12X50 Commercial MN Ucare Of Minnesota (Formerly SX178) Institutional 5010A1 Enrollment YesDates of Service before 1/1/2022:UCare PMAP, MnCare, Connect,Connect + Medicare, MSC+, MSHO

A: 10/20/2021 Par 89789 Commercial CO UCHealth Plan Administrators Professional 5010A1Claim Level Accept /Reject

Yes

A: 10/20/2021 Par 89789 Commercial CO UCHealth Plan Administrators Institutional 5010A1Claim Level Accept /Reject

Yes

A: 01/31/2020 Non-Par 46891 Commercial AZ UCS Benefit Administrators of Eau Claire Professional 5010A1Claim Level Accept /Reject

No

A: 01/31/2020 Non-Par 46891 Commercial AZ UCS Benefit Administrators of Eau Claire Institutional 5010A1Claim Level Accept /Reject

No

A: 02/28/2020 Non-Par 63985 Commercial UCS CAM Administrative Services, Inc Professional 5010A1Claim Level Accept /Reject

No

A: 02/28/2020 Non-Par 63985 Commercial UCS CAM Administrative Services, Inc Institutional 5010A1Claim Level Accept /Reject

No

A: 01/31/2020 Non-Par 96436 Commercial UCS Insight Benefit Administrators Professional 5010A1Claim Level Accept /Reject

No

A: 01/31/2020 Non-Par 96436 Commercial UCS Insight Benefit Administrators Institutional 5010A1Claim Level Accept /Reject

No

A: 12/20/2019 Non-Par 86242 Commercial MI UCS SecureOne Preferred United Plans Professional 5010A1Claim Level Accept /Reject

No

A: 12/20/2019 Non-Par 86242 Commercial MI UCS SecureOne Preferred United Plans Institutional 5010A1Claim Level Accept /Reject

No

A: 09/18/2020 Non-Par 92006 Commercial AK Udelhoven Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/18/2020 Non-Par 92006 Commercial AK Udelhoven Health Plan Institutional 5010A1Claim Level Accept /Reject

Yes

A: 03/13/2018 Par 88008 Medicare TX UFCW Local 880 Medicare Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/13/2018 Par 88008 Medicare TX UFCW Local 880 Medicare Institutional 5010A1Claim Level Accept /Reject

Yes

U: 03/01/2022 Par 77022 Commercial MU Ultimate Health Plan Professional 5010A1Claim Level Accept /Reject

No

Updated: 03/21/2022


PPAAYERYERIDID



U: 03/01/2022 Par 77022 Commercial Ultimate Health plan Institutional 5010A2Claim Level Accept /Reject

No

U: 09/01/2016 Par 41206 Commercial Ultra Benefits Inc. Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 41206 Commercial Ultra Benefits Inc. Institutional 5010A2 No Response From Payer Yes

A: 07/28/2020 Non-Par UMHCJ Commercial MA UMASS Medical School Health and Criminal Justice Professional 5010A1Claim Level Accept /Reject

No

A: 07/28/2020 Non-Par UMHCJ Commercial MA UMASS Medical School Health and Criminal Justice Institutional 5010A1Claim Level Accept /Reject

No

U: 03/11/2013 Non-Par 75130 Commercial TX UMC HEALTH PLAN Professional 5010A1File LevelAcknowledgement

Yes

A: 12/05/2014 Non-Par 75130 Commercial UMC HEALTH PLAN Institutional 5010A2 File Level Ack. Yes

A: 01/16/2018 Par 77502 Commercial OR Umpqua Health Alliance Institutional 5010A1Claim Level Accept /Reject

Yes

A: 01/15/2018 Par 77502 Commercial OR Umpqua Health Alliance Professional 5010A1Claim Level Accept /Reject

Yes

A: 02/03/2021 Non-Par 77505 Commercial OR Umpqua Health Alliance Remittance 5010A1 Enrollment

U: 03/11/2013 Non-Par 39026 Commercial MUUMR - Wausau / UHIS (Formerly FIserv Health -Wausau Benefits / Benesight)


Yes

U: 03/11/2013 Non-Par 39026 Commercial MUUMR - Wausau / UHIS (Formerly Fiserv Health -Wausau Benefits / Benesight)


U: 06/11/2020 Non-Par 39026 Commercial MUUMR - Wausau / UHIS (Formerly Fiserv Health -Wausau Benefits / Benesight)


U: 09/01/2016 Par 52180 Commercial UMWA Health & Retirement Funds Institutional 4010A1 No Response From Payer Yes

U: 03/11/2013 Non-Par 52180 Commercial UMWA Health & Retirement Funds Professional 5010A1 No Response From Payer Yes

U: 01/15/2020 Non-Par 80314 Commercial UNICARE (Anthem) Institutional 5010A2 No Response From Payer Yes

U: 01/31/2020 Non-Par 80314 Commercial UNICARE (Anthem) Professional 5010A1Claim Level Accept /Reject

Yes

U: 01/31/2020 Non-Par 80314 Commercial UNICARE (Anthem) Remittance 5010A1 Enrollment

U: 01/15/2020 Non-Par 80314 CommercialUnicare (Old John Hancock) (Anthem) (Formerly65099)


U: 01/15/2020 Non-Par 80314 Commercial Unicare Of Texas - Hmo (Anthem) (Formerly 47195) Professional 5010A1

U: 08/17/2020 Trans 35198 Commercial Unified Group Services Professional 5010A1

A: 07/24/2020 Non-Par 35198 Commercial Unified Group Services Remittance 5010A1 Enrollment

A: 08/14/2020 Trans 35198 Commercial IN Unified Group Services Institutional 5010A1 No Response From Payer No

U: 09/01/2016 Par 62170 Commercial Unified Health Services Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 62170 Commercial Unified Health Services (Workman's Comp Only) Professional 5010A1 No Response From Payer

U: 09/01/2016 Par 13407 Commercial Uniformed Services Family Health Plan Professional 5010A1Claim Level Accept /Reject

U: 10/04/2019 Non-Par 13407 Commercial NY Uniformed Srvcs Family Hlth Plan Remittance 5010A1 Enrollment

A: 12/02/2014 Non-Par CALL Commercial CA Union Pacific IPA Professional 5010A1 No Response From Payer


U: 09/01/2016 Par 87042 Commercial Union Pacific Railroad Employees Health Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 87042 Commercial Union Pacific Railroad Employees Health System Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/02/2021 Non-Par 87042 Commercial Union Pacific Railroad Employees Health System Remittance 5010A1 Enrollment


A: 12/02/2021 Non-Par 58379 CommercialUnion Pacific Railroad Employees Health System(Formerly 87042)



U: 03/04/2016 Par 87726 Commercial Unison Administrative Services (formerly 25175) Professional 5010A1Claim Level Accept /Reject

A: 01/31/2020 Par UNITE Commercial AK Unite Here Health - Alaska Professional 5010A1 No Response From Payer No

A: 01/31/2020 Par UNITE Commercial AK Unite Here Health - Alaska Institutional 5010A1 No Response From Payer No

Updated: 03/21/2022


PPAAYERYERIDID



A: 09/04/2020 Par 59144 Commercial FL Unite Here Health LV Professional 5010A1Claim Level Accept /Reject

No

A: 09/04/2020 Par 59144 Commercial FL Unite Here Health LV Institutional 5010A1Claim Level Accept /Reject

No

U: 10/07/2019 Non-Par 94174 Commercial United Administrative Services (TPA) Remittance 5010A1 EnrollmentThis payer ID is for remittance/ERAonly.

U: 11/01/2012 Non-Par IP126 Commercial CA United Agriculture Benefit Trust Professional 5010A1 No Response From Payer

U: 11/10/2021 Non-Par SX175 Commercial TX United American Insurance Co. Remittance 5010A1 Enrollment Enrollment is Temporarily Unavailable

U: 01/13/2020 Non-Par UFNEP Commercial NE United Americhoice of Nebraska Remittance 5010A1 Enrollment

formerly AmeriChoice or UnisonComplete the Payer Enrollment Format http://www.emdeon.com/enrollnow/

A: 12/09/2019 Non-Par 38260 Commercial MI United Benefit Advisors Professional 5010A1Claim Level Accept /Reject

No

A: 12/09/2019 Non-Par 38260 Commercial MI United Benefit Advisors Institutional 5010A1Claim Level Accept /Reject

No

A: 09/15/2016 Par 80354 Commercial AZ United Claim Solutions Institutional 5010A1 Claim Level Ack. Yes

A: 09/15/2016 Par 80354 Commercial AZ United Claim Solutions Professional 5010A1 Claim Level Ack. Yes

A: 12/02/2014 Non-Par CALL Commercial AZ United Claim Solutions Professional 5010A1This is an unpublished payer id.Please refer to the Insured's ID Cardfor more information.

U: 12/19/2014 Non-Par CALL Commercial United Claim Solutions Institutional 5010A2 No Response From PayerPlease refer to the Insured's ID Cardfor more information

U: 09/23/2013 Non-Par 41556 Workers' Comp MU United Convalescent Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU United Convalescent Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU United El Segundo, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU United El Segundo, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/15/2014 Non-Par SCUFW Commercial United Food & Commerical Workers Unions Professional 5010A1File LevelAcknowledgement

U: 01/10/2020 Non-Par 87726 Commercial United Healthcare Remittance 5010A1 EnrollmentYou must also add/request Payer ID:04567

U: 03/04/2016 Par 87726 Commercial United HealthCare Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/08/2016 Par 87726 CommercialUnited HealthCare (formerly The Travelers, TravelersHealth Network)


Yes

A: 02/25/2021 Non-Par JVHKR Commercial MI United Healthcare (Golden Rule) JVHL Institutional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 02/25/2021 Non-Par JVHKR Commercial MI United Healthcare (Golden Rule) JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 02/22/2021 Par JVHJ5 Commercial MI United Healthcare (Non-Golden Rule) JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 02/22/2021 Par JVHJ5 Commercial MI United Healthcare (Non-Golden Rule) JVHL Institutional 5010A1 EnrollmentClaim Level Accept /Reject

No

U: 12/06/2019 Non-Par 86050 Commercial MN United Healthcare - Community Plan MO Remittance 5010A1 Enrollment

A: 12/06/2019 Non-Par 86050 Commercial MN United Healthcare - UHC Community Plan MO Professional 5010A1Claim Level Accept /Reject

No

A: 06/07/2017 Non-Par 86050 Commercial MN United Healthcare - UHC Community Plan MO Institutional 5010A1Claim Level Accept /Reject

No

A: 02/23/2021 Par JVHJR Commercial MI United Healthcare Community - JVHL Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

A: 02/23/2021 Par JVHJR Commercial MI United Healthcare Community - JVHL Institutional 5010A1 EnrollmentClaim Level Accept /Reject

No

U: 01/10/2020 Non-Par NYU01 Commercial NY United Healthcare Community Plan / NYU Remittance 5010A1 Enrollment

NYU01 is for Remittance only. Claimsshould be submitted to Payer ID87726 ERA SETUP FORM IS REQUIREDTO ENROLL FOR 835

U: 03/04/2016 Par 87726 Commercial United Healthcare Community Plan for Families Professional 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 03/04/2016 Par 87726 CommercialUnited Healthcare Community Plan for Families(Formerly 25175)


U: 03/04/2016 Par 87726 CommercialUnited Healthcare Community Plan for Families(Formerly 25175)


U: 07/10/2020 Non-Par 96385 Commercial KS United Healthcare Community Plan Kansas Remittance 5010A1 EnrollmentERA SETUP FORM IS REQUIRED TOENROLL FOR 835

U: 03/08/2016 Par 87726 Commercial AL United HealthCare of Alabama Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/08/2016 Par 87726 Commercial AZ United HealthCare of Arizona, Inc. Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/08/2016 Par 87726 Commercial AR United HealthCare of Arkansas Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/04/2016 Par 87726 Commercial CA United HealthCare of California Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/08/2016 Par 87726 Commercial CO United HealthCare of Colorado, Inc. Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/08/2016 Par 87726 Commercial FL United HealthCare of Florida Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/08/2016 Par 87726 Commercial GA United HealthCare of Georgia Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/08/2016 Par 87726 Commercial IL United HealthCare of Illinois Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/08/2016 Par 87726 Commercial KY United HealthCare of Kentucky, Ltd. Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/04/2016 Par 87726 Commercial MS United HealthCare of Mississippi Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/04/2016 Par 87726 Commercial United HealthCare of New England Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/04/2016 Par 87726 Commercial NYUnited HealthCare of New York (includes New Yorkand New Jersey)


Yes

U: 03/04/2016 Par 87726 Commercial NC United HealthCare of North Carolina, Inc. Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/04/2016 Par 87726 Commercial OH United HealthCare of Ohio Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/04/2016 Par 87726 Commercial TX United HealthCare of Texas -Dallas Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/08/2016 Par 87726 Commercial TX United HealthCare of Texas- Houston Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/04/2016 Par 87726 CommercialUnited HealthCare of the Mid-Atlantic - MAMSI Life &Health Ins.Co (MLH))HCFA 1500 only(Formerly 52148)


Yes

U: 03/04/2016 Par 87726 CommercialUnited HealthCare of the Mid-Atlantic - MAMSI LifeAnd Health CO. (MLH) (Formerly 52148)


U: 03/08/2016 Par 87726 CommercialUnited HealthCare of the Midwest - Choice, ChoicePlus, Select, Select Plus


Yes

U: 03/08/2016 Par 87726 Commercial NY United HealthCare of Upstate New York Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/08/2016 Par 87726 Commercial UT United HealthCare of Utah Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/08/2016 Par 87726 Commercial VA United HealthCare of Virginia Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/08/2016 Par 87726 Commercial PR United HealthCare Plans of Puerto Rico Professional 5010A1Claim Level Accept /Reject

Yes

U: 12/08/2016 Par 95958 Commercial United Healthcare West/ Pacificare Encounters Institutional 5010A1Claim Level Accept /Reject

A: 01/23/2014 Non-Par 39026 Commercial MU United Med Resources / UHIS Professional 5010A1Claim Level Accept /Reject

A: 01/23/2014 Non-Par 39026 Commercial MU United Med Resources / UHIS Institutional 5010A2Claim Level Accept /Reject

U: 09/01/2016 Par 84132 Commercial United Medical Alliance Institutional 5010A2 No Response From Payer

U: 01/01/2012 Non-Par 84132 Commercial United Physicians of Northern Colorado (UPNC) Professional 5010A1Claim LevelAcknowledgement

A: 12/05/2014 Non-Par SKVI0 Government United States Virgin Islands Medicaid Institutional 5010A2 No Response From Payer

Updated: 03/21/2022


PPAAYERYERIDID



A: 01/19/2015 Non-Par SKVI0 Government VI United States Virgin Islands Medicaid Professional 5010A1 File Level Ack.

U: 09/23/2013 Non-Par J1491 Workers' Comp MU UNITED SURGICAL PARTNERS INTER Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU UNITED SURGICAL PARTNERS INTER Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/24/2018 Par 13193 CommercialUnited Teacher Associates Insurance Company -Medicare Supplement


A: 01/24/2018 Par 13193 CommercialUnited Teacher Associates Insurance Company -Medicare Supplement


U: 11/24/2014 Non-Par WX956 Auto WI United Wisconsin Insurance Company Prof. Auto 5010A1Claim Level Accept /Reject

U: 03/04/2016 Par 87726 Commercial UnitedHealthcare Institutional 5010A2Claim Level Accept /Reject

Yes

U: 04/27/2016 Par 86047 Commercial NJUnitedHealthCare Community Plan (Americhoice NJMedicaid & Family Care)


U: 04/27/2016 Par 86047 Commercial NJUnitedHealthCare Community Plan (Americhoice NJMedicaid & Family Care)


Yes

U: 05/15/2013 Non-Par 86047 Commercial NJUnitedHealthCare Community Plan (Americhoice NJMedicaid & Family Care)


U: 03/04/2016 Par 87726 CommercialUnitedHealthcare Community Plan(UnitedHealthcare hawk-i)


U: 03/04/2016 Par 87726 CommercialUnitedHealthcare Community Plan(UnitedHealthcare hawk-i)


U: 03/17/2020 Non-Par 04567 CommercialUnitedHealthcare Community Plan / DE, FL, HI, LA,MA, MD, NC, NM, OH, OK, PA, VA, WA (some areformerly AmeriChoice or Unison)

Remittance 5010A1 EnrollmentClaims are processed under 87726but ERAs will be delivered under04567

U: 04/07/2016 Par 96385 Commercial KS UnitedHealthcare Community Plan / KS (KanCare) Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 96385 Commercial KY UnitedHealthcare Community Plan / KS (KanCare) Institutional 5010A2Claim Level Accept /Reject

Yes

U: 04/07/2016 Par 95467 Commercial MIUnitedHealthcare Community Plan / MI (formerlyGreat Lakes Health Plan)


Yes

U: 12/06/2019 Par 95467 Commercial MIUnitedHealthcare Community Plan / MI (formerlyGreat Lakes Health Plan)


Yes

U: 04/02/2020 Non-Par 87726 Commercial MUUnitedHealthcare Community Plan of DE, MD, OH, PA,MA, FL

Remittance 5010A1 EnrollmentYou must also add/request Payer ID:04567

U: 03/04/2016 Par 87726 CommercialUnitedHealthcare Community Plan of River Valley(formerly John Deere)


U: 03/04/2016 Par 87726 CommercialUnitedHealthcare Community Plan of River Valley(formerly John Deere)


U: 07/21/2020 Non-Par WID01 Commercial WIUNITEDHEALTHCARE COMMUNITY PLAN OFWISCONSIN


U: 04/04/2016 Par 81400 CommercialUnitedHealthcare Life Insurance Company (formerlyAmerican Medical Security)


U: 09/01/2016 Par 81400 CommercialUnitedHealthcare Life Insurance Company (formerlyAmerican Medical Security)

Institutional 5010A1 File Level Ack.

U: 05/25/2021 Par 74227 Commercial UnitedHealthcare StudentResources Professional 5010A1Claim Level Accept /Reject

Yes

U: 05/25/2021 Par 74227 Commercial UnitedHealthcare StudentResources Institutional 5010A2 File Level Ack. Yes

U: 05/25/2021 Non-Par 58379 CommercialUnitedHealthcare StudentResources (formerlyStudent Insurance 74227)


U: 05/25/2021 Non-Par 74227 CommercialUnitedHealthcare StudentResources (formerlyStudent Insurance)



U: 12/09/2016 Par 95958 Commercial MU UnitedHealthcare West Encounters (formerly HM012) Professional 5010A1Claim Level Accept /Reject

Please [email protected] tobe setup to submit Encounters

A: 04/04/2016 Par 81400 CommercialUnitedHealthOne / PacifiCare Life and HealthInsurance Company


U: 09/01/2016 Par 66705 Commercial Unity Health Insurance Professional 5010A1File LevelAcknowledgement

Updated: 03/21/2022


PPAAYERYERIDID



U: 06/30/2020 Non-Par 66705 Commercial Unity Health Insurance Remittance 5010A1 Enrollment

A: 09/01/2016 Par 66705 Commercial Unity Health Insurance Institutional 5010A2 Claim Level Rejects Only

A: 10/18/2021 Non-Par A1152 Commercial TN Unity Health Partners Professional 5010A1Claim Level Accept /Reject

No

A: 10/18/2021 Non-Par A1152 Commercial TN Unity Health Partners Institutional 5010A1Claim Level Accept /Reject

No

A: 08/05/2021 Non-Par 46407 Commercial Univ Health Care Advantage Remittance 5010A1 Enrollment

U: 05/04/2020 Non-Par SX086 Commercial Univera (Formerly HC001) Professional 5010A1Claim Level Accept /Reject

Yes

U: 05/04/2020 Non-Par SX086 Commercial Univera (Formerly HC001) Professional 5010A1 Yes

U: 05/04/2020 Non-Par SX086 Commercial Univera (Formerly UNINW) Professional 5010A1 No Response From Payer

U: 09/12/2016 Non-Par SX087 Commercial NY Univera - Health Care Plan/ChoiceCare Buffalo Professional 5010A1 File Level Ack.

U: 05/04/2020 Non-Par SX086 Commercial NYUnivera - Pre Paid health Plan of NY (FormerlyHC001)


U: 01/13/2017 Non-Par 12X17 Commercial Univera Healthcare CNY Institutional 5010A1

U: 01/13/2017 Non-Par SX090 Commercial NY Univera SSA ENY Professional 5010A1 File Level Ack.

A: 11/02/2017 Non-Par 12X20 Commercial NY Univera SSA ENY (Formerly SX090) Institutional 5010A1

U: 01/13/2017 Non-Par SX091 Commercial NY Univera SSA WNY Professional 5010A1 File Level Ack.

A: 11/03/2017 Non-Par 12X18 Commercial NY Univera SSA WNY (Formerly SX091) Institutional 5010A1

U: 01/24/2017 Non-Par 12X19 Commercial Univera SSA WNY PPO Traditional Institutional 5010A1

U: 09/01/2016 Par 33001 Commercial CA Universal Care - California Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 33001 Commercial CA Universal Care - California Professional 5010A1Claim LevelAcknowledgement

U: 09/23/2013 Non-Par J1491 Workers' Comp MU UNIVERSAL FLOORING SYSTEMS, I Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU UNIVERSAL FLOORING SYSTEMS, I Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 09830 Commercial University Family Care Professional 5010A1Claim LevelAcknowledgement

Yes

U: 09/01/2016 Par 09830 Commercial University Family Care Institutional 5010A2Claim LevelAcknowledgement

Yes

A: 12/31/2020 Non-Par 09830 Commercial MU University Family Care Remittance 5010A1 Enrollment

U: 09/01/2016 Par 09908 Commercial AZ University Family Care - Maricopa Professional 5010A1 Claim Level Rejects Only Yes

U: 09/01/2016 Par 09908 Commercial AZ University Family Care - Maricopa Institutional 5010A2 No Response From Payer Yes

U: 09/23/2019 Par 99026 Commercial HI University Health Alliance Professional 5010A1 Enrollment

U: 08/19/2019 Non-Par 99026 Commercial MU University Health Alliance Remittance 5010A1 Enrollment

A: 09/01/2016 Par 46407 Commercial MU University Health Care Advantage Professional 5010A1

A: 09/01/2016 Par 46407 Commercial MU University Health Care Advantage Institutional 5010A1

A: 09/01/2016 Par 45437 Commercial University Healthcare Marketplace Professional 5010A1 Claim Level Ack. Yes

A: 09/01/2016 Par 45437 Government University Healthcare Marketplace Institutional 5010A2 Claim Level Ack. Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU University of Colorado Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU University of Colorado Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 01/20/2017 Par UIC67 Commercial IL University of Illinois Professional 5010A1 Claim Level Ack. No

A: 01/20/2017 Par UIC67 Commercial IL University of Illinois Institutional 5010A1 Claim Level Ack. No

U: 12/17/2020 Non-Par 37601 CommercialUniversity of Illinois at Chicago Div of SpecializedCare for Children


U: 12/17/2020 Non-Par 37601 CommercialUniversity of Illinois at Chicago Div of SpecializedCare for Children


U: 08/31/2021 Non-Par 45281 Commercial MU University of Maryland Health Partners Institutional 5010A2 No Response From Payer No

Maryland Medicaid ElectronicProvider Revalidation and EnrollmentPortal (ePREP). The provider must beregistered to receive payment. Toenroll, the provider will need tocontact 1-844-463-7768. If theprovider has additional questions,they may [email protected].

A: 08/31/2021 Non-Par 45281 Commercial University of Maryland Health Partners Professional 5010A1 No Response From Payer Maryland Medicaid Electronic

Updated: 03/21/2022


PPAAYERYERIDID



Provider Revalidation and EnrollmentPortal (ePREP). The provider must beregistered to receive payment. Toenroll, the provider will need tocontact 1-844-463-7768. If theprovider has additional questions,they may [email protected].

U: 04/29/2021 Non-Par 45281 Commercial University of Maryland Health Partners Remittance 5010A1 Enrollment

A: 04/09/2010 Non-Par CALL Commercial University of Miami Behavioral Health Professional 4010A1 No Response From Payer

All submitters call for detailedinformation and Payer ID prior tosending claims. Contact UMBHProvider Relations (305) 243-7270

U: 03/11/2013 Non-Par 25133 Commercial University of Missouri Institutional 5010A2Claim Level Accept /Reject

Yes

U: 04/06/2017 Non-Par SX155 Commercial UT University of Utah Health Plans Professional 5010A1Claim Level Accept /Reject

Yes

U: 07/30/2021 Non-Par SX155 Commercial UT University of Utah Health Plans Remittance 5010A1 EnrollmentClaims are submitted under payer idSX155. Remits will return under payerid 65250.

A: 01/19/2018 Non-Par SX155 Commercial UT University of Utah Health Plans Institutional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 91136 CommercialUniversity of Washington Students & GraduateAppts., Grp# P67


A: 03/04/2013 Non-Par IP056 Commercial Upland Medical Group Professional 5010A1Claim Level Accept /Reject

U: 11/26/2019 Non-Par 23281 Commercial UPMC Health Plan Remittance 5010A1 Enrollment

U: 09/01/2016 Par 23281 Commercial UPMC Health Plan Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 23281 Commercial UPMC Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/01/2016 Par 25184 Commercial UPMC Vision Advantage Professional 5010A1Claim Level Accept /Reject

U: 10/06/2021 Non-Par 25184 Commercial UPMC Vision Advantage Remittance 5010A1 Enrollment

A: 09/01/2016 Par 25184 Commercial UPMC Vision Advantage Institutional 5010A2 Claim Level Rejects Only

U: 08/08/2014 Non-Par 37324 Commercial Upper Peninsula Health Group (TPA) Institutional 5010A2 No Response From Payer

U: 02/13/2014 Non-Par 37324 Commercial Upper Peninsula Health Group (TPA) Professional 5010A1 No Response From Payer

U: 01/27/2012 Non-Par 38337 Commercial Upper Peninsula Health Plan Institutional 5010A2 No Response From Payer

U: 01/01/2012 Non-Par 38337 Commercial Upper Peninsula Health Plan Professional 5010A1Claim LevelAcknowledgement

U: 08/15/2019 Non-Par 38337 Commercial Upper Peninsula Health Plan Remittance 5010A1 Enrollment

U: 05/13/2021 Non-Par 93092 Commercial US Benefits Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 93092 Commercial US Benefits Institutional 4010A1Claim LevelAcknowledgement

Yes

U: 09/07/2019 Non-Par 93092 US Benefits Remittance 5010A1 Enrollment

U: 09/01/2016 Par 90551 Commercial US Family Health Plan (USFHP) Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 90551 Commercial US Family Health Plan (USFHP) Institutional 5010A2Claim Level Accept /Reject

A: 02/14/2022 Non-Par 90551 Commercial US Family Health Plan (USFHP) Remittance 5010A1 Enrollment

A: 01/28/2021 Non-Par 50383 Commercial MN US Imagine Network Remittance 5010A1 Enrollment

A: 02/02/2021 Non-Par 50383 Commercial MN US Imaging Network Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU US Mobile Wireless Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU US Mobile Wireless Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 06/04/2020 Non-Par SKVI0 Government VI US Virgin Islands Medicaid Remittance 5010A1 Enrollment

U: 09/01/2016 Par 74095 Commercial USAA (United States Automobile Association) Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 74095 Commercial USAA (United States Automobile Association) Professional 5010A1

A: 12/03/2021 Non-Par USAAM Commercial USAA - Medicare Supplemental Remittance 5010A1 Enrollment ECHO is returning 835s for payer ID

Updated: 03/21/2022


PPAAYERYERIDID



USAAM. Providers will need to enrollfor payer IDs USAAM and 58379 inorder to receive 835s for this payer.

A: 12/03/2021 Non-Par 58379 Commercial USAA - Medicare Supplemental (Formerly USAAM) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID USAAM.Providers will need to enroll for payerIDs USAAM and 58379 in order toreceive 835s for this payer.

A: 10/27/2016 Non-Par SB910 Commercial UT UT Federal (Formerly BS188) Professional 5010A1 Claim Level Rejects Only Yes

A: 07/31/2017 Non-Par 12B1E Commercial UT Federal (Formerly BS188) Institutional 5010A2 Yes

A: 08/23/2019 Non-Par UTMBC Commercial TX UTMB Correctional Managed Care Professional 5010A1Claim Level Accept /Reject

No

A: 08/23/2019 Non-Par UTMBU Commercial TX UTMB Correctional Managed Care Institutional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par 41556 Workers' Comp MU V&M Restoration Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU V&M Restoration Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/12/2019 Non-Par 12115 Commercial VA Fee Basis Program Remittance 5010A1 Enrollment

U: 09/01/2016 Par 12115 Commercial VA Fee Basis Program Institutional 5010A2 No Response From Payer Yes

U: 09/01/2016 Par 12115 Commercial VA Fee Basis Programs Professional 5010A1Claim LevelAcknowledgement

Yes

A: 05/14/2020 Non-Par SMVA0 Government VA VA Medicare Part B (J11) (Formerly MR022) Remittance 4010A1 Enrollment

A: 11/14/2019 Non-Par SMVA0 Government VA VA Medicare Part B (J11) (Formerly MR022) Professional 5010A1 Enrollment Claim Level Rejects Only Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Valenzuela Eng. Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Valenzuela Eng. Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU VALHALLA BUILDERS & DEVELOPERS Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU VALHALLA BUILDERS & DEVELOPERS Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 09/01/2016 Trans 64009 Commercial OK Valir PACE Professional 5010A1 Claim Level Ack.

A: 09/01/2016 Trans 64009 Commercial OK Valir PACE Institutional 5010A1 Claim Level Ack.

U: 08/15/2019 Non-Par 64009 Commercial OK Valir Pace Remittance 5010A1 Enrollment

U: 10/28/2014 Non-Par VCIPA Commercial CA Valley Care IPA Professional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Valley Casework Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Valley Casework Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU VALLEY FIG GROWERS INC Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU VALLEY FIG GROWERS INC Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Valley Harvesting & Packing, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Valley Harvesting & Packing, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Valley Health Care Management Services, LLC Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Valley Health Care Management Services, LLC Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/30/2019 Non-Par VHP01 Commercial Valley Health Plan (Commercial) Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Valley Health System Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Valley Health System Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Valley Memorial Hospital Inst. Work Comp 4010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 03/24/2014 Non-Par 41556 Workers' Comp MU Valley Memorial Hospital Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 03/04/2013 Non-Par 94293 Commercial Valley Mental Health Professional 5010A1Claim Level Accept /Reject

U: 04/02/2019 Par 95399 Commercial CA Valley Presbyterian Professional 5010A1Claim Level Accept /Reject

A: 01/15/2019 Par 43259 Commercial AZ Valor Health Plan Professional 5010A1Claim Level Accept /Reject

A: 01/15/2019 Par 43259 Commercial AZ Valor Health Plan Institutional 5010A1Claim Level Accept /Reject

A: 02/12/2021 Non-Par 43259 Commercial Valor Health Plan Remittance 5010A1 Enrollment


A: 02/12/2021 Non-Par 58379 Commercial Valor Health Plan (43259) Remittance 5010A1 Enrollment


A: 12/05/2014 Non-Par 99297 Commercial Value Options (TX Northstar) Institutional 5010A2 File Level Ack.

A: 04/28/2021 Non-Par SX173 Commercial Value Options - Commercial Remittance 5010A1 Enrollment

U: 12/23/2020 Non-Par SX173 Commercial Value Options Commercial Professional 5010A1Claim Level Accept /Reject

Yes

U: 06/30/2012 Non-Par 12X56 Commercial Value Options Institutional Institutional 5010A2Claim Level Accept /Reject

U: 10/14/2018 Non-Par 12K1A Medicaid PA Value Options PA Institutional 5010A1 Yes

U: 12/30/2019 Non-Par SX069 Government MDValueOptions - Maryland Public Mental HealthSystem (PMHS)


U: 10/14/2018 Non-Par 22322 Commercial MD ValueOptions - Maryland Public Mental Health Institutional 5010A2

U: 01/31/2019 Non-Par 43307 Commercial MAValueOptions/MBHP (Massachusetts BehavioralHealth Plan)


For claims rejections, please [email protected] 888-247-9311 (8am-6pm, M-F

U: 01/31/2019 Non-Par 43307 Commercial MAValueOptions/MBHP (Massachusetts BehavioralHealth Plan)


A: 09/08/2021 Non-Par 43307 Commercial MAValueOptions/MBHP (Massachusetts BehavioralHealth Plan)


A: 05/06/2020 Non-Par BPSLL Commercial OR Vanderbilt Health Professional 5010A1Claim Level Accept /Reject

A: 05/06/2020 Non-Par BPSLL Commercial OR Vanderbilt Health Institutional 5010A1Claim Level Accept /Reject

U: 01/27/2012 Non-Par 72128 Commercial Vantage Health Plan Inc. Institutional 5010A2Claim Level Accept /Reject

U: 06/01/2012 Non-Par 72128 Commercial Vantage Health Plan, Inc. Professional 5010A1 No Response From Payer

U: 02/11/2013 Non-Par PPM01 Commercial CA Vantage Medical Group - Claims Only Professional 5010A1Claim Level Accept /Reject

Yes

U: 11/01/2012 Trans PPM02 Commercial CA Vantage Medical Group - Encounters Only Professional 5010A1Claim Level Accept /Reject

A: 04/22/2020 Non-Par 72187 Commercial MI Varipro Professional 5010A1Claim Level Accept /Reject

No

A: 04/22/2020 Non-Par 72187 Commercial MI Varipro Institutional 5010A2Claim Level Accept /Reject

No

A: 11/06/2019 Non-Par VAYAH Commercial NC Vaya Health Professional 5010A1Claim Level Accept /Reject

No

A: 11/01/2019 Non-Par VAYAH Commercial NC Vaya Health Institutional 5010A1Claim Level Accept /Reject

No

A: 11/06/2019 Non-Par VAYAH Commercial VAYA HEALTH Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Veg Land Inc., Et Al Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Veg Land Inc., Et Al Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/23/2013 Non-Par J1491 Workers' Comp MU Vegtable Growers Supply Inc Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Vegtable Growers Supply Inc Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 07/16/2016 Non-Par J1992 Commercial CA Velocity Vehicle Group (Corvel) Remittance 5010A1 Enrollment

A: 07/26/2016 Non-Par J1992 Workers' Comp CA Velocity Vehicle Group (Corvel) Professional 5010A1Claim Level Accept /Reject

A: 08/15/2014 Non-Par VCHCP Commercial CA Ventura County Health Care Plan Professional 5010A1 File Level Ack. No

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Venture Pac Develop Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Venture Pac Develop Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 86062 Commercial VentureNet Healthcare Institutional 5010A2 No Response From Payer Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU VERCO MANUFACTURING, INC., (PA Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU VERCO MANUFACTURING, INC., (PA Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 08/01/2012 Par VHMG1 Commercial Verdugo Hills Medical Group Professional 5010A1Claim Level Accept /Reject

No Payer Response, please contactpayer directly at 818-707-9603

A: 09/01/2016 Par VHMG1 Commercial Verdugo Hills Medical Group Institutional 5010A2 Claim Level Ack.No Payer Response, please contactpayer directly at 818-707-9603

U: 09/01/2016 Par 75256 Commercial Verity National Group Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/01/2016 Par 75256 Commercial Verity National Group Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Vertical Concrete Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Vertical Concrete Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 04/27/2016 Non-Par 243 Commercial Vestica Hcare LLC (MedStar PHP) Institutional 5010A2 No Response From Payer Yes

U: 04/27/2016 Par 00243 Commercial Vestica Healthcare LLC Professional 5010A1Claim Level Accept /Reject

Yes

A: 06/06/2013 Par 50701 Commercial VGM Homelink Professional 5010A1File LevelAcknowledgement

U: 09/30/2019 Non-Par 50701 Commercial VGM Homelink Remittance 5010A1 Enrollment

A: 09/01/2016 Trans 48123 Commercial KS Via Christi HOPE Professional 5010A1 Claim Level Ack.

A: 09/01/2016 Trans 48123 Commercial KS Via Christi HOPE Institutional 5010A1 Claim Level Ack.

A: 05/07/2020 Non-Par 48123 Commercial KS Via Christi HOPE Remittance 5010A1 Enrollment

A: 12/07/2018 Non-Par 15976 Commercial PA Vibra Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/07/2018 Non-Par 15976 Commercial PA Vibra Health Plan Institutional 5010A1Claim Level Accept /Reject

Yes

A: 06/08/2020 Non-Par 15976 Commercial VIBRA HEALTH PLAN Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Vicro-Mac Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Vicro-Mac Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Victoria ISD Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Victoria ISD Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Victoria Tire Center, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Victoria Tire Center, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/01/2012 Non-Par 24818 Commercial Vida Care Institutional 5010A2 No Response From Payer

U: 01/01/2012 Non-Par 24818 Commercial Vida Care Professional 5010A1Claim Level Accept /Reject

U: 02/15/2016 Trans 25922 Commercial PA VieCare Life Armstrong Professional 5010A1 Claim Level Ack.

U: 02/15/2016 Trans 25922 Commercial PA VieCare Life Armstrong Institutional 5010A1 Claim Level Ack.

Updated: 03/21/2022


PPAAYERYERIDID



A: 10/09/2019 Non-Par 25922 Commercial PA VieCare Life Armstrong Remittance 5010A1 Enrollment

U: 02/15/2016 Trans 25924 Commercial PA VieCare LIFE Beaver and LIFE Lawrence Counties Professional 5010A1 Claim Level Ack.

U: 02/15/2016 Trans 25924 Commercial PA VieCare LIFE Beaver and LIFE Lawrence Counties Institutional 5010A1 Claim Level Ack.

A: 10/08/2019 Non-Par 25924 Commercial PA VieCare Life Beaver and Life Lawrence Counties Remittance 5010A1 Enrollment

U: 02/15/2016 Trans 25923 Commercial PA VieCare LIFE Butler Professional 5010A1 Claim Level Ack.

U: 02/15/2016 Trans 25923 Commercial PA VieCare LIFE Butler Institutional 5010A1 Claim Level Ack.

A: 10/08/2019 Non-Par 25923 Commercial PA VieCare LIFE Butler Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU VILLA MARINA UNOCAL, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU VILLA MARINA UNOCAL, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 02/03/2017 Par VLGMD Commercial IL Village MD Professional 5010A1 Claim Level Ack. No

A: 02/03/2017 Par VLGMD Commercial IL Village MD Institutional 5010A1 Claim Level Ack. No

A: 03/08/2022 Par 36477 Commercial IL Village Practice Management Company Professional 5010A1Claim Level Accept /Reject

No

A: 03/08/2022 Par 36477 Commercial IL Village Practice Management Company Institutional 5010A1Claim Level Accept /Reject

No

A: 03/04/2013 Non-Par 26545 Commercial VillageCareMAX Professional 5010A1Claim Level Accept /Reject

U: 11/14/2019 Non-Par 26545 Commercial NY VillageCareMAX Remittance 5010A1 Enrollment

A: 12/05/2014 Non-Par 26545 Commercial VillageCareMAX Institutional 5010A2 No Response From Payer

A: 11/06/2018 Par 75838 Commercial IL VillageMD of Chicago Professional 5010A1Claim Level Accept /Reject

Yes

U: 08/15/2019 Non-Par 75838 Commercial IL VillageMD of Chicago Remittance 5010A1Claim Level Accept /Reject

Yes

A: 11/06/2018 Par 75545 Commercial NH VillageMD of New Hampshire Professional 5010A1Claim Level Accept /Reject

Yes

A: 09/30/2019 Non-Par 75545 Commercial NH VillageMD of New Hampshire Remittance 5010A1Claim Level Accept /Reject

Yes

A: 11/06/2018 Par 75386 Commercial IN VillageMD of Norther Indiana Professional 5010A1Claim Level Accept /Reject

Yes

U: 08/15/2019 Non-Par 75386 Commercial IN VillageMD of Northern Indiana Remittance 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 11/06/2018 Par 93170 Commercial TX VillageMD of SE TX (Houston) Professional 5010A1Claim Level Accept /Reject

Yes

A: 11/06/2018 Par 43036 Commercial KY VillageMD of Western Kentucky Professional 5010A1Claim Level Accept /Reject

Yes

U: 09/30/2019 Non-Par 43036 Commercial KY VillageMD of Western Kentucky Remittance 5010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Vip Motor Cars Ltd. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Vip Motor Cars Ltd. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 12/01/2013 Par 01260 Commercial Virginia Medicaid Behavioral Health Professional 5010A1Claim Level Accept /Reject

Yes

U: 02/28/2019 Non-Par MLTSS Commercial VA Virginia Premier Elite Plus Professional 5010A1Claim Level Accept /Reject

YesPayer IDs have merged. Pleasecomplete enrollment under VAPRM.

U: 02/28/2019 Non-Par MLTSS Commercial VA Virginia Premier Elite Plus Institutional 5010A1Claim Level Accept /Reject


U: 10/01/2018 Non-Par CHCN1 Commercial VA Virginia Premier Elite Plus Remittance 5010A1 Enrollment Enrollment is temporarily unavailable.

A: 02/28/2019 Non-Par MLTSS Virginia Premier Elite Plus Remittance 5010A1 EnrollmentPayer IDs have merged. Pleasecomplete enrollment under VAPRM.

U: 03/04/2019 Non-Par 54176 Commercial Virginia Premier Health Plan Remittance 5010A1 EnrollmentEnrollment completed under payer IDVAPRM

U: 01/08/2020 Par 12K83 Commercial Virginia Premier Health Plan Institutional 5010A2 EnrollmentClaim Level Accept /Reject

U: 03/04/2019 Non-Par 54176 Commercial Virginia Premier Health Plan (Formerly VPN01) Professional 5010A1 Enrollment YesEnrollment completed under payer IDVAPRM

U: 11/13/2019 Non-Par VAPRM Commercial VA Virginia Premier Medallion 4 Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



U: 11/13/2019 Non-Par VAPRM Commercial VA Virginia Premier Medallion 4 Institutional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 11/13/2019 VAPRM VA VIRGINIA PREMIER MEDALLION 4 Remittance 5010A1 Enrollment

U: 02/28/2019 Non-Par VPMAD Commercial VA Virginia Premier Medicare Advantage Professional 5010A1Claim Level Accept /Reject


U: 02/28/2019 Non-Par VPMAD Commercial VA Virginia Premier Medicare Advantage Remittance 5010A1 EnrollmentPayer IDs have merged. Pleasecomplete enrollment under VAPRM.

A: 02/28/2019 Non-Par VPMAD Commercial VA Virginia Premier Medicare Advantage Institutional 5010A1Claim Level Accept /Reject


U: 02/28/2019 Non-Par VPCCI Commercial VA Virginia Premiere Complete Care Professional 5010A1Claim Level Accept /Reject


A: 02/28/2019 Non-Par VPCCI Commercial VA Virginia Premiere Complete Care Remittance 5010A1 EnrollmentPayer IDs have merged. Pleasecomplete enrollment under VAPRM.

U: 02/28/2019 Non-Par VPCCI Commercial VA Virginia Premiere Complete Care Institutional 5010A1Claim Level Accept /Reject


A: 05/10/2017 Non-Par 94163 Commercial CA Vision Service Plan Professional 5010A1Claim Level Accept /Reject

No

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Vista Hills C Club Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Vista Hills C Club Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/01/2012 Non-Par 63114 Commercial Viva Health Plan Professional 5010A1Claim Level Accept /Reject

A: 01/09/2014 Non-Par 63114 Commercial MU Viva Health Plan Institutional 5010A2File LevelAcknowledgement

U: 10/07/2019 Non-Par 63114 Commercial Viva Health Plan Remittance 5010A1 Enrollment

A: 03/26/2021 Non-Par A0102 Commercial MN Vivada Health Plan Professional 5010A1Claim Level Accept /Reject

YesTHIS PAYER PLAN IS FOR DATE OFSERVICE AFTER 12/31/2020

A: 03/26/2021 Non-Par A0102 Commercial MN Vivada Health Plan Institutional 5010A1Claim Level Accept /Reject

YesTHIS PAYER PLAN IS FOR DATE OFSERVICE AFTER 12/31/2020

A: 01/11/2019 Par 45488 Commercial FL Vivida Health Institutional 5010A1Claim Level Accept /Reject

Yes

A: 01/11/2019 Par 45488 Commercial FL Vivida Health Professional 5010A1Claim Level Accept /Reject

Yes

U: 08/15/2019 Non-Par 93170 Commercial TX VMD of SE TX (Houston) Remittance 5010A1 EnrollmentClaim Level Accept /Reject

Yes

A: 11/11/2020 Par 84213 Commercial AZ VMD Primary Providers of Arizona Professional 5010A1Claim Level Accept /Reject

No

A: 11/11/2020 Par 84213 Commercial AZ VMD Primary Providers of Arizona Institutional 5010A1Claim Level Accept /Reject

No

A: 06/29/2021 Non-Par 84213 Commercial AZ VMD Primary Providers of Arizona Remittance 5010A1 Enrollment

U: 04/29/2021 Non-Par 77073 Commercial VNS CHOICE Medicare Institutional 5010A2

U: 04/29/2021 Non-Par 77073 Commercial VNS CHOICE Medicare Professional 5010A1

U: 04/16/2021 Non-Par 77073 Commercial VNS CHOICE Medicare Remittance 5010A1 Enrollment

U: 11/01/2012 Non-Par 59266 Commercial Volusia Professional 5010A1 No Response From Payer

U: 11/01/2012 Non-Par 59266 Commercial VOLUSIA HEALTH NETWORK Institutional 5010A2File LevelAcknowledgement

U: 03/11/2013 Non-Par 22264 Commercial NY Vytra Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 22264 Commercial Vytra Healthcare Institutional 5010A2 No Response From Payer Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU W Co Radiology Cntr Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU W Co Radiology Cntr Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 11/01/2012 Non-Par 62111 Commercial TN W.C. Beeler & Company Professional 5010A1Claim LevelAcknowledgement

U: 09/23/2013 Non-Par J1491 Workers' Comp MU W.E. Behel, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU W.E. Behel, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU W.T. Billard, Inc. Inst. Work Comp 4010A1 Claim Level Accept /

Updated: 03/21/2022


PPAAYERYERIDID



Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU W.T. Billard, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 85256 Commercial Wabash Memorial Hospital Association Institutional 5010A2File LevelAcknowledgement

U: 09/01/2016 Par 85256 Commercial Wabash Memorial Hospital Association Professional 5010A1File LevelAcknowledgement

A: 12/02/2021 Non-Par 85256 Commercial Wabash Memorial Hospital Association Remittance 5010A1 Enrollment


A: 12/02/2021 Non-Par 58379 CommercialWabash Memorial Hospital Association (Formerly85256)



U: 09/23/2013 Non-Par J1491 Workers' Comp MU WALTER ANDERSON PLUMBING, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU WALTER ANDERSON PLUMBING, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Washington County Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Washington County Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Washington Hospital Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Washington Hospital Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 01/28/2021 Non-Par SKWA0 Government WAWashington Medicaid - Provider One (FormerlyMC006)

Professional 5010A1 Enrollment Yes

U: 01/27/2021 Non-Par SKWA0 Government WAWashington Medicaid - Provider One (FormerlyMC006)


A: 01/08/2020 Non-Par 70319 Commercial Washington National Remittance 5010A1 Enrollment

A: 09/01/2016 Par 23051 Commercial Waterstone BA (outside OK) Professional 5010A1 File Level Ack.

A: 09/01/2016 Par 23051 Commercial Waterstone BA (outside OK) Institutional 5010A2 File Level Ack.

U: 09/01/2016 Par 73155 Commercial Waterstone Benefit Administrators Institutional 5010A2Claim LevelAcknowledgement

U: 09/01/2016 Par 73155 Commercial Waterstone Benefits Administrators Professional 5010A1

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Watkins Manufacturing Corporation Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Watkins Manufacturing Corporation Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 04/09/2010 Non-Par MPM09 Commercial Watts Healthcare Corp Professional 4010A1File LevelAcknowledgement

U: 09/23/2013 Non-Par 41556 Workers' Comp MU WATTSHealth Foundation, Inc. (SNCC) Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU WATTSHealth Foundation, Inc. (SNCC) Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Wawona Packing Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Wawona Packing Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU WCP, INC. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU WCP, INC. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/19/2012 Trans 39151 Commercial Wea Insurance Group Institutional 5010A2 No Response From Payer

U: 03/19/2012 Trans 39151 Commercial Wea Insurance Group Professional 5010A1Claim LevelAcknowledgement

A: 09/26/2019 Non-Par 39151 Wea Insurance Group Remittance 5010A1 Enrollment

U: 01/01/2012 Non-Par 75261 Commercial TX Web TPA Professional 5010A1 File Level Yes

Updated: 03/21/2022


PPAAYERYERIDID



Acknowledgement

U: 06/08/2020 Non-Par 75261 Commercial WebTPA Employer Services LLC Professional 5010A1 Yes

U: 06/08/2020 Non-Par 75261 Commercial WebTPA Employer Services LLC Institutional 5010A2 No Response From Payer

U: 06/08/2020 Non-Par 75261 Commercial WebTPA Employer Services LLC Remittance 5010A1 Enrollment

A: 04/09/2010 Non-Par 36337 Commercial Weiss Health Providers Institutional 4010A1File LevelAcknowledgement

A: 04/09/2010 Non-Par 36337 Commercial Weiss Health Providers Professional 4010A1Claim Level Accept /Reject

U: 02/28/2017 Non-Par 91136 Commercial Welfare & Pension Administration Remittance 5010A1 Enrollment

U: 10/05/2020 Non-Par 13337 Commercial NH Well Sense Health Plan Institutional 5010A2 No Response From Payer Yes

U: 10/05/2020 Non-Par 13337 Commercial NH Well Sense Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

A: 04/10/2018 Non-Par 14163 Commercial MU Wellcare Professional 5010A1Claim Level Accept /Reject

Yes

U: 03/16/2020 Non-Par 14163 Commercial Wellcare Remittance 5010A1 Enrollment

U: 02/27/2012 Non-Par 59354 Commercial Wellcare Health Plans - Encounters Professional 5010A1Claim Level Accept /Reject

A: 06/07/2017 Non-Par Commercial MU Wellcare Health Plans - Encounters Institutional 5010A1Claim Level Accept /Reject

No

A: 10/07/2019 Non-Par 59354 Commercial Wellcare Health Plans Encounters Remittance 5010A1 Enrollment

U: 02/27/2012 Non-Par 14163 Commercial NY Wellcare of New York, Inc. Institutional 5010A2Claim Level Accept /Reject

Yes

U: 09/17/2018 Non-Par SB803 Commercial NJWellChoice of NJ [aka EMPIRE BLUE CROSS BLUESHIELD]


A: 11/24/2014 Non-Par SB645 Commercial Wellmark BCBS - Medicare COB Professional 5010A1 Claim Level Accept/Reject Yes

A: 10/10/2017 Non-Par 12B92 Commercial Wellmark BCBS - Medicare COB (Formerly SB645) Institutional 5010A2 Yes

A: 07/18/2017 Trans TH023 Commercial WellMed Professional 5010A1

A: 11/19/2020 Non-Par TH023 Commercial WellMed Remittance 5010A1 Enrollment


A: 11/24/2014 Non-Par TH040 Commercial WellMed (Encounters) Professional 5010A1 No Response From Payer

U: 12/07/2021 Non-Par 58379 Commercial WellMed (Formerly WELM2) ( TH023) Remittance 5010A1 Enrollment

*This enrollment will setup all payernames under payer id 58379* ECHO isreturning 835s for payer ID TH023.Providers will need to enroll for payerIDs TH023 and 58379 in order toreceive 835s for this payer.

A: 12/02/2014 Non-Par CALL Commercial MU WellNet Health Plans Professional 5010A1 YesPlease call 1-800-442-1101 forapproval and the Payer ID

U: 12/19/2014 Non-Par CALL Commercial WellNet Health Plans Institutional 5010A2 Claim Level Ack. YesPlease call 1-800-442-1101 forapproval and the Payer ID

U: 09/17/2018 Non-Par 12B15 Commercial MOWellpoint Missouri [aka ANTHEM BLUE CROSS BLUESHIELD (MISSOURI)]


U: 09/17/2018 Non-Par 12B65 Commercial MOWellpoint Missouri [aka ANTHEM BLUE CROSS BLUESHIELD (MISSOURI)]


A: 09/15/2016 Par CB457 Commercial MD Wellspan Employee Assistance Program Professional 5010A1Claim Level Accept /Reject

No

A: 09/01/2016 Par 35245 Commercial WellSystems LLC Professional 5010A1 No Response From Payer

A: 09/01/2016 Par 35245 Commercial WellSystems LLC Institutional 5010A2 No Response From Payer

A: 11/12/2020 Non-Par 35245 Commercial WellSystems LLC Remittance 5010A1 Enrollment

A: 02/22/2021 Par WLTOK Commercial CO Welltok Professional 5010A1 EnrollmentClaim Level Accept /Reject

No

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Weslaco Independent School District Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Weslaco Independent School District Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Wessex Industries, Inc.; Heald Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Wessex Industries, Inc.; Heald Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 09/23/2013 Non-Par 41556 Workers' Comp MU West Coast Hospitals, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU West Coast Hospitals, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/11/2013 Par WCMG1 Commercial West Covina Medical Group Professional 5010A1Claim Level Accept /Reject

Yes

Responses could take up to 30-45business days. Please contact thepayer for further claim inquiry @(818) 707-9603, ext. 6014

A: 09/01/2016 Par WCMG1 Commercial West Covina Medical Group Institutional 5010A2 Claim Level Ack.

U: 09/23/2013 Non-Par 41556 Workers' Comp MU West Oso ISD Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU West Oso ISD Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/11/2013 Non-Par 80942 Commercial West Suburban Health Providers Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/05/2014 Non-Par 80942 Commercial West Suburban Health Providers Institutional 5010A2 No Response From Payer Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MUWest Texas Rural Counties Association Preferred RiskPool - WC


U: 03/24/2014 Non-Par 41556 Workers' Comp MUWest Texas Rural Counties Association Preferred RiskPool - WC


U: 09/23/2013 Non-Par 41556 Workers' Comp MU Westamerica / Phil Long Dealerships Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Westamerica / Phil Long Dealerships Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Western Golf Properties, Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Western Golf Properties, Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 24735 Commercial Western Growers Institutional 5010A2 No Response From Payer

U: 09/01/2016 Par 24735 Commercial Western Growers Assurance Trust Institutional 5010A2 No Response From Payer

U: 01/01/2012 Par 24735 Commercial Western Growers Assurance Trust Professional 5010A1 No Response From Payer

U: 01/01/2012 Par 24735 Commercial Western Growers Insurance Company Professional 5010A1 No Response From Payer

U: 01/27/2012 Non-Par 68039 Commercial Western Health Advantage Professional 5010A1File LevelAcknowledgement

U: 01/27/2012 Non-Par 68039 Commercial Western Health Advantage Institutional 5010A2Claim Level Accept /Reject

U: 09/01/2016 Par 37247 CommercialWestern Mutual Insurance / WMI-TPA (located inMurray, UT)


U: 09/01/2016 Par 37247 Commercial Western Mutual Insurance WMI-TPA Institutional 5010A2 No Response From Payer

A: 11/06/2018 Non-Par DOCSO Commercial OR Western Oregon Advanced Health Professional 5010A1Claim Level Accept /Reject

Yes

A: 12/03/2019 Non-Par UOCSO Commercial OR Western Oregon Advanced Health Institutional 5010A1Claim Level Accept /Reject

Yes

A: 10/07/2019 Non-Par TRLTC Commercial TX Western Reserve Life Insurance Co Remittance 5010A1

A: 09/01/2016 Par TRLTC Commercial Western Reserve Life Insurance Co. Professional 5010A1 No Response From Payer Yes

A: 09/01/2016 Par TRLTC Commercial Western Reserve Life Insurance Co. Institutional 5010A2 No Response From Payer

U: 02/20/2017 Trans 31048 Commercial Western Southern Financial Group Institutional 5010A2 No Response From Payer

U: 02/20/2017 Trans 31048 Commercial Western Southern Financial Group Professional 5010A1

U: 08/15/2019 Non-Par 31048 Commercial Western Southern Financial Group Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Widdicombe Enterprises Inc. Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Widdicombe Enterprises Inc. Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 10/21/2013 Non-Par 75261 Commercial Wilco Care indigent / Williamson Professional 5010A1File LevelAcknowledgement

Yes

A: 10/21/2013 Non-Par 75261 Commercial Wilco Care indigent / Williamson Institutional 5010A2 No Response From Payer

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Willamette View Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Willamette View Prof. Work Comp 5010A1Claim Level Accept /Reject

Updated: 03/21/2022


PPAAYERYERIDID



U: 03/11/2013 Non-Par 93050 Commercial William C Earhart Co., Inc. Professional 5010A1 No Response From Payer Yes

U: 09/01/2016 Par 93050 Commercial William C. Earhart Institutional 4010A1Claim Level Accept /Reject

Yes

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Wilmer-Hutchins ISD / Dallas ISD Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Wilmer-Hutchins ISD / Dallas ISD Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU Wilson & Hampton Painting Cont Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU Wilson & Hampton Painting Cont Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 03/11/2013 Non-Par 73159 Commercial Winterbrook Healthcare Professional 5010A1Claim Level Accept /Reject

Yes

A: 07/24/2015 Non-Par SKWI2 Commercial WI Wisconsin Chronic Disease Program Institutional 5010A1Claim Level Accept /Reject

A: 07/27/2015 Non-Par SKWI2 Commercial WI Wisconsin Chronic Disease Program Professional 5010A1Claim Level Accept /Reject

U: 09/01/2016 Par 74101 Commercial Wisconsin Department of Corrections Institutional 5010A2 Yes

U: 09/01/2016 Par 74101 Commercial Wisconsin Department of Corrections Professional 5010A1 Yes

A: 03/25/2019 Non-Par 74101 Commercial MU Wisconsin Department of Corrections Remittance 5010A1 Enrollment

U: 01/01/2012 Non-Par 95930 Commercial Wisconsin Physician Services-Midlands Institutional 5010A2File LevelAcknowledgement

Yes

A: 07/31/2015 Non-Par SKWI1 Commercial WI Wisconsin Well Woman Program Professional 5010A1Claim Level Accept /Reject

A: 07/31/2015 Non-Par SKWI1 Commercial WI Wisconsin Well Woman Program Institutional 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU WOMEN'S HEALTHCARE ASSOCIATES Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU WOMEN'S HEALTHCARE ASSOCIATES Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 02/13/2014 Non-Par 13413 Commercial Women's Integrated Network, Inc. Professional 5010A1 Claim Level Rejects Only

U: 09/23/2013 Non-Par 41556 Workers' Comp MU Woodland Park West Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU Woodland Park West Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 09/23/2013 Non-Par J1491 Workers' Comp MU WOODMONT REAL ESTATE SERVICES Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par J1491 Workers' Comp MU WOODMONT REAL ESTATE SERVICES Prof. Work Comp 5010A1Claim Level Accept /Reject

U: 07/17/2014 Non-Par SX067 CommercialWorkers Comp of West Virginia (formerly BrickstreetMutual)


EDI is currently unavailable for newproviders. We apologize for theinconvenience.

A: 01/30/2015 Non-Par 10074 Commercial Workstar Health Services Professional 5010A1 EnrollmentClaim Level Accept /Reject

U: 09/01/2016 Par 77080 Commercial WPP Eldercare CLA Professional 5010A1File LevelAcknowledgement

A: 09/01/2016 Par 77080 Commercial WPP-ElderCare Wisconsin Institutional 5010A2

U: 09/01/2016 Par 34080 Commercial WPPN (Multiplan Wisconsin Preferred Provider) Institutional 5010A2 No Response From Payer

U: 01/21/2022 Non-Par 12X29 Commercial WPS Commercial Remittance 5010A1 Enrollment

U: 11/21/2019 Par 12X29 Commercial WPS Commercial Institutional 5010A2 EnrollmentClaim Level Accept /Reject

Yes

U: 01/21/2022 Non-Par SX022 Commercial WI WPS Commercial (Formerly WPS01) Professional 5010A1 Enrollment Claim Level Rejects Only No

U: 03/10/2022 Non-Par SX022 Commercial WPS Commercial (Formerly WPS01) Remittance 5010A1 Enrollment

A: 08/07/2015 Non-Par 95937 Commercial WI WPS Optum Health Professional 5010A1 Claim Level Ack.

A: 08/07/2015 Non-Par 95937 Commercial WI WPS Optum Health Institutional 5010A1 Claim Level Ack.

U: 11/10/2021 Non-Par SKWY0 Commercial WY Wyoming Medicaid Remittance 5010A1 Enrollment

U: 11/10/2021 Non-Par SKWY0 Medicaid WY Wyoming Medicaid Professional 5010A1 EnrollmentClaim Level Accept /Reject

Yes

U: 03/11/2013 Non-Par 60646 Commercial Yale University Heath Plan Professional 5010A1Claim Level Accept /Reject

Yes

Updated: 03/21/2022


PPAAYERYERIDID



A: 01/14/2019 Non-Par 77946 Commercial MN Yamhill CCO Physical Health Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/14/2019 Non-Par 77946 Commercial MN Yamhill CCO Physical Health Institutional 5010A1Claim Level Accept /Reject

Yes

A: 12/19/2019 Non-Par 77946 Commercial Yamhill CCO Physical Health Remittance 5010A1 Enrollment

A: 01/15/2019 Non-Par 77130 Commercial OH Yamhill County CCO (Mental Health) Professional 5010A1Claim Level Accept /Reject

Yes

A: 01/15/2019 Non-Par 77130 Commercial OR Yamhill County CCO (Mental Health) Institutional 5010A1Claim Level Accept /Reject

Yes

A: 05/09/2019 Non-Par 77130 YAMHILL COUNTY CCO (MENTAL HEALTH) Remittance 5010A1 Enrollment

U: 09/23/2013 Non-Par 41556 Workers' Comp MU YMCA Inst. Work Comp 4010A1Claim Level Accept /Reject

U: 03/24/2014 Non-Par 41556 Workers' Comp MU YMCA Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 06/18/2019 Non-Par J1421 Commercial MU York Claim Services Remittance 5010A1 Enrollment Enrollment Temporarily Unavailable

A: 05/25/2018 Non-Par J1421 Workers' Comp York Claim Services Prof. Work Comp 5010A1Claim Level Accept /Reject

A: 03/19/2020 Non-Par 15003 Commercial NY Yourcare Health Plan Professional 5010A1Claim Level Accept /Reject

Yes

A: 03/19/2020 Non-Par 15003 Commercial NY Yourcare Health Plan Institutional 5010A1Claim Level Accept /Reject

Yes

A: 05/24/2021 Non-Par 15003 Commercial Yourcare Health Plan Remittance 5010A1 Enrollment

A: 10/01/2021 Par 83248 Commercial IL Zing Choice IL (HMO) Professional 5010A1Claim Level Accept /Reject

No

A: 10/01/2021 Par 83248 Commercial IL Zing Choice IL (HMO) Institutional 5010A2Claim Level Accept /Reject

No

U: 03/14/2014 Non-Par 16535 Workers' CompCA, LA,MN, TX

Zurich Insurance N.A. Inst. Work Comp 4010A1File LevelAcknowledgement

U: 09/29/2014 Non-Par 16535 Workers' CompLA,MN,TX, CA

Zurich Insurance N.A. (formerly WA039 and WA040) Remittance 5010A1 Enrollment

U: 03/14/2014 Non-Par 16535 Workers' CompLA,MN,TX, CA

Zurich Insurance N.A. (formerly WA039 and WA040) Prof. Work Comp 5010A1File LevelAcknowledgement

Updated: 03/21/2022

Payer list PDF dump - s3-us-west-2.amazonaws.com

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Transcript of Payer list PDF dump - s3-us-west-2.amazonaws.com