Availity® Health Information Network
Availity® Health Information Network
Availity® Health Information Network
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Availity, L.L.C.<br />
P.O. Box 550857<br />
Jacksonville, FL 32255-0857<br />
Availity ® <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Availity <strong>Health</strong> Plan Partners<br />
Updated 05/22/2013
Table of Contents<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Navigating the EDI Clearinghouse <strong>Health</strong> Plan Partners Section……......……………………………………………..…………3<br />
Availity’s NPI Options………………………………………………………………………………………..………………………….4<br />
Availity’s Electronic Data Interchange (EDI) <strong>Health</strong> Plans Partners.…………………………………...………….…...…...5 – 28<br />
Availity’s Electronic Remittance Advice (ERA) <strong>Health</strong> Plan Partners...…………………………………………………….29 - 41<br />
Availity’s Business to Business (B2B) <strong>Health</strong> Plan Partners...……………………………………………………………………42<br />
Availity’s Web Portal <strong>Health</strong> Plan Partners...…………………………………………...…………………………….………43 – 46<br />
Workers’ Compensation Payer List…..…………………………………………………...………………………………….47 - 124<br />
2 of 124 Visit our web site: www.availity.com
Navigating the EDI Clearinghouse <strong>Health</strong> Plan Partners Section<br />
Last Update Column:<br />
‘A’ means a payer has been added to the list<br />
‘D’ means a payer has been removed from the list<br />
‘U’ means a payer’s information or/and capabilities have been updated<br />
Claim Enrollment Required:<br />
Denotes payers that require enrollment for EDI claims submission (837P/I).<br />
See EDI Requirements for enrollment details.<br />
Government Payer:<br />
Denotes Government payers<br />
May not be a direct connection to the government entity<br />
Remit (835):<br />
Electronic remittance advice sent by payers to communicate adjudication results and payment information for submitted claims.<br />
Receiving remits generally requires additional enrollment. Please enroll with Availity first.<br />
Please see Availity’s Electronic Remittance Advice (ERA) <strong>Health</strong> Plan Partners list for registration details.<br />
NPI Option:<br />
The NPI is a unique identification number for covered health care providers.<br />
Availity is making every effort to confirm and communicate the status of our connected payers.<br />
For a detailed explanation of our NPI options please see the attached NPI Options Document.<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
(EDI) Electronic Data Interchange:<br />
Customers create batch transactions in their own practice management system (PMS) or hospital information system (HIS) and upload them to Availity.<br />
This functionality can be transparent to the end user if their system vendor offers a seamless solution.<br />
Availity also offers end users the ability to log onto the portal to upload batches directly.<br />
A list of vendor partners is available on the Availity web site.<br />
(B2B) Business to Business:<br />
Customers submit transactions in real-time or near real-time using their own practice management system (PMS) or hospital information system (HIS),<br />
often using the vendor’s user interface.<br />
A list of vendors that support this level of integration is available on the Availity web site.<br />
Please see Availity's B2B specification document for additional information.<br />
3 of 124 Visit our web site: www.availity.com
Option 1 Legacy ID Required<br />
Option 2<br />
Option 3<br />
Option 4<br />
Dual ID<br />
NPI per Mandate<br />
NPI per Mandate. Legacy ID also<br />
allowed.<br />
Availity’s NPI Options<br />
NPI allowed<br />
Legacy identifier required<br />
Allows all of the following scenarios:<br />
NPI only<br />
Legacy identifier only<br />
NPI and Legacy identifiers<br />
NPI required as Primary Identifier.<br />
Tax ID required as a secondary identifier on claims in 2010AA or 2010AB.<br />
Only specific non-Legacy qualifiers allowed as secondary identifiers in certain<br />
provider loops.<br />
4 = Option 3 plus:<br />
Any other secondary identifiers as allowed in the Implementation Guide will also be<br />
accepted.<br />
4* = Option 3 plus:<br />
Tax IDs (EI, SY, TJ) as allowed in the Implementation Guide will also be accepted<br />
as secondary identifiers.<br />
4 # = Option 3 plus:<br />
Location Numbers (LU) as allowed in the Implementation Guide will also be<br />
accepted as secondary identifiers.<br />
*A legacy identifier is any identifier that payers used to identify a provider as a health care provider before the NPI mandate. Legacy identifiers<br />
include OSCAR, NSC, PINs, UPINs, Blue Cross provider numbers, and other payer-designated identifiers.<br />
(+) Indicates the payer has requested a front-end taxonomy code edit.<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
For more information on NPIs and Atypical Providers, click http://www.availity.com/about-availity/what-is-availity/regulatory-compliance/NPI/<br />
4 of 124 Visit our web site: www.availity.com
Last<br />
Update<br />
Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
13162 1199 NATIONAL BENEFIT FUND 3 x x<br />
93044 A & I BENEFIT PLAN ADMINISTRATORS 2 x x<br />
48185 ABC HEALTH PLAN 2 x x<br />
03443 ABRAZO ADVANTAGE HEALTHPLAN 2 x<br />
68069 ABSOLUTE TOTAL CARE x 3 x x payer ID 68055 may also be used<br />
AHS01 ACCESS ADMINISTRATOR 3 x x<br />
64071 ACCLAIM 2 x x<br />
81400 ACCOUNTABLE HEALTHPLAN - WISC 2 x<br />
87815 ACORDIA NATIONAL 3 x x<br />
72467 ACS CONSULTING SERVICES, INC 2 x<br />
38254 ACTIVA BENEFIT SERVICES, LLC 2 x x<br />
22384 ADMINISTRATIVE CONCEPTS, INC 2 x x<br />
59141 ADMINISTRATIVE SERVICES 2 x x<br />
38265 ADMINISTRATIVE SYSTEMS RESEARCH CORPORATION - ASR 2 x x<br />
37278 ADMINONE 2 x x<br />
58202 ADVANCED DATA SOLUTIONS, INC 2 x x<br />
51909 ADVANCED PHYSICIAN ASSN. (CHICAGO) 2 x x<br />
35209 ADVANTAGE HEALTH SOLUTION 2 x x<br />
77070 ADVANTAGE PREFERRED PLUS 2 x x<br />
59374 ADVANTICA 2 x x<br />
25133 ADVANTRA FREEDOM 2 x x<br />
25133 ADVANTRA/HLTH AMERICA INC 2 x x<br />
95340 ADVENTIST HEALTH SYSTEM WEST - ROSEVILLE, CA 2 x x<br />
36320 ADVOCATE MEDICAL GROUP x 4 x x formerly Advocate <strong>Health</strong> Centers<br />
65093 ADVOCATE PHYSICIAN PARTNERS x 4 x x<br />
26337 AETNA - ILLINOIS MEDICAID 2 x x<br />
60054 AETNA AFFORDABLE HEALTH CHOICES (SM) - SRC 2 x x<br />
23225 AETNA BETTER HEALTH CONNECTICUT MEDICAID 2 x x<br />
60054 AETNA INSURANCE COMPANY x 2 x x<br />
38692 AETNA TX MEDICAID & CHIP x 2 x x<br />
13334 AFFINITY HEALTH PLAN 2 x<br />
13346 AFTRA HEALTH FUND 2 x x<br />
64158 AGENCY SERVICES, INC. 2 x x<br />
95327 ALAMEDA ALLIANCE FOR HEALTH x 4 x Please contact Anet Quiambao at 510.747.6153 to join Alameda Alliance's EDI network<br />
91136 ALASKA CHILDREN’S SERVICES, INC. 2 x x<br />
92600 ALASKA ELECTRICAL HEALTH & WELFARE FUND 2 x x<br />
91136 ALASKA LABORERS CONSTRUCTION INDUSTRY TRUST 2 x x<br />
91136 ALASKA PIPE TRADERS LOCAL 375 2 x x<br />
91136<br />
ALASKA UNITED FOOD & COMMERCIAL WORKERS HEALTH & WELFARE<br />
TRUST<br />
2 x x<br />
13550 ALICARE 2 x x<br />
PRINT ALL HEALTH PLAN PRINT (PRINT TO PAPER) x 2 x x<br />
Please contact Availity Client Services at 800-282-4548 for enrollment or see the All <strong>Health</strong> Plan<br />
Print Registration Enrollment Packet for more information. Please note that claims cannot be<br />
converted to paper for payers with the state code of SC or MN.<br />
MRIPA ALLCARE HEALTH PLAN 3 x x Effective 8/1/2012, formerly known as Mid Rogue Oregon <strong>Health</strong> Plan<br />
81040 ALLEGIANCE BENEFIT PLAN MANAGEMENT, INC. 2 x x<br />
ADSL1 ALLIANCE - ALPHA CARE GOLD 2 x x<br />
88461 ALLIANCE HEALTHPLANS OF WISCONSIN 2 x x<br />
52149 ALLIANCE PPO, INC. 2 x<br />
81400 ALLIANCE SELECT 2 x<br />
58234 ALLIANT HEALTH PLANS (GEORGIA) 2 x x<br />
GEN02 ALLIANZ LIFE INS CO OF AMERICA 2 x x<br />
94177 ALLIED ADMINISTRATORS (S.F., CA) 2 x x<br />
37308 ALLIED BENEFITS SYSTEMS 2 x x<br />
75261 ALPHA DATA SYSTEMS 2 x x<br />
25133 ALTA HEALTH STRATEGIES 2 x x<br />
AMAIA AMA INSURANCE AGENCY 4 x x<br />
13550 AMALGAMATED LIFE 2 x x<br />
75137 AMERIBEN SOLUTIONS, INC. 2 x x<br />
75185 AMERICAN ADMINISTRATIVE GROUP - AAG 2 x x<br />
37283<br />
AMERICAN ADMINISTRATIVE GROUP - AAG (FORMERLY GALLAGHER<br />
BENEFITS)<br />
2 x x<br />
63103 AMERICAN BEHAVIORAL 2 x x<br />
95170 AMERICAN BENEFIT PLAN ADMINISTRATORS 2 x x<br />
34187 AMERICAN BENEFITS MANAGEMENT (NORTH CANTON, OH) 2 x x<br />
ACN01 AMERICAN CHIROPRACTIC NETWORK 2 x<br />
41161 AMERICAN CHIROPRACTIC NETWORK (PAN) 2 x<br />
41160 AMERICAN CHIROPRACTIC NETWORK IPA OF N.Y. 2 x<br />
87726 AMERICAN COMMERCIAL BARGE LINES x 2 x x<br />
60305 AMERICAN COMMUNITY MUTUAL INSURANCE 2 x x<br />
GEN02 AMERICAN CONTINENTAL INSURANCE 2 x x<br />
AMF11 AMERICAN FAMILY INSURANCE CO. 4 x x<br />
98205 AMERICAN FOUNDERS LIFE INSURANCE CO. 2 x<br />
62030 AMERICAN GENERAL 2 x x<br />
GEN02 AMERICAN GENERAL LIFE AND ACC 2 x x<br />
01066 AMERICAN HEALTHCARE ALLIANCE 2 x x<br />
5 of 124 Visit our web site: www.availity.com
Last<br />
Update<br />
Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
36369 AMERICAN IMAGING MANAGEMENT 2 x x<br />
81949 AMERICAN INSURANCE COMPANY OF TEXAS 4 x<br />
72099 AMERICAN LIFECARE 2 x x<br />
81400 AMERICAN MEDICAL SECURITY 2 x x NPI required in all loops, EIN or SSN required in 2310A and/or 2310B loop<br />
60739 AMERICAN NATIONAL INSURANCE CO 2 x x<br />
44444 AMERICAN POSTAL WORKERS UNION 3 x x<br />
56071 AMERICAN REPUBLIC 2 x x<br />
42011 AMERICAN REPUBLIC INSURANCE 2 x x<br />
37322 AMERICAN WORKER HEALTH PLUS 2 x x<br />
20553 AMERICA'S 1ST CHOICE - SOUTH CAROLINA 2 x x<br />
20029 AMERICA'S CHOICE HEALTHPLANS/NMA 2 x x<br />
16120 AMERICA'S PPO (ARAZ) 3 x x<br />
86047 AMERICHOICE OF NEW JERSEY (MEDICAID NJ) 2 x x<br />
86001 AMERICHOICE OF NEW JERSEY PERSONAL CARE PLUS (MEDICARE) 2 x x<br />
86048 AMERICHOICE OF NEW YORK (MEDICAID NY) 2 x x<br />
86002 AMERICHOICE OF NEW YORK PERSONAL CARE PLUS (MEDICARE) 2 x x<br />
86049 AMERICHOICE OF PENNSYLVANIA MEDICAID/CHIP 2 x x<br />
86003 AMERICHOICE OF PENNSYLVANIA PERSONAL CARE PLUS (MEDICARE) 2 x x<br />
26375 AMERIGROUP 2 x x<br />
26374 AMERIGROUP HOUSTON 2 x x<br />
26378 AMERIGROUP MULTIPLE STATES 2 x x<br />
IHP001 AMERIGROUP OF VIRGINIA x 3 x<br />
IHP002 AMERIGROUP OF VIRGINIA x 3 x<br />
54763 AMERIHEALTH ADMINISTRATORS 2 x x<br />
23037 AMERIHEALTH HMO NEW JERSEY AND DELAWARE 2 x<br />
22248 AMERIHEALTH MERCY HEALTH PLAN 2 x x<br />
53085 ANCHOR BENEFIT CONSULTING, INC 2 x x<br />
86062 ANCILLARY BENEFIT SYSTEMS/ARIZONA FOUNDATION FOR MEDICAL CARE 2 x x<br />
47198 ANTHEM CA 3 x x<br />
00050 ANTHEM CO 3 x x<br />
00060 ANTHEM CT 3 x<br />
00630 ANTHEM IN 3 x<br />
00130 ANTHEM IN 3 x<br />
00660 ANTHEM KY 3 x<br />
00160 ANTHEM KY 3 x<br />
00180 ANTHEM ME 3 x<br />
00680 ANTHEM ME 3 x<br />
00241 ANTHEM MO 3 x x<br />
00270 ANTHEM NH 3 x<br />
6 of 124 Visit our web site: www.availity.com<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).
Last<br />
Update<br />
Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
00770 ANTHEM NH 3 x<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
00265 ANTHEM NV 3 x x<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
00834 ANTHEM OH 3 x<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
00332 ANTHEM OH 3 x<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
00950 ANTHEM WI 3 x<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
00450 ANTHEM WI 3 x<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
34196 APEX BENEFIT SERVICES 2 x<br />
54160 APS HEALTHCARE, INC. 2 x x<br />
61101 ARCADIAN MGMT SERVICES 4 x x<br />
AZFMC ARIZONA FOUNDATION FOR MEDICAL CARE 2 x<br />
03432 ARIZONA PHYSICIANS IPA 2 x x<br />
27154 ARIZONA PRIORITY CARE PLUS 2 x x<br />
75278 ARKANSAS BEST CORPORATION - CHOICE BENEFITS 2 x x<br />
62176 ARKANSAS MANAGED CARE ORG (AMCO) 2 x x<br />
87726 ARNETT HEALTH PLANS 2 x x Effective 8/20/12, payer ID 95440 will no longer be valid. Please use payer ID 87726.<br />
ASRM1 ASRM CORP (NJ) 4 x x<br />
ATPA1 ASSOCIATED THIRD PARTY ADMINISTRATION 2 x<br />
36326 ASSOCIATES FOR HEALTH CARE, INC 2 x x<br />
39065 ASSURANT HEALTH 2 x x<br />
Use payer ID ASNTH to submit professional or institutional Assurant <strong>Health</strong> claims to be routed for<br />
ASNTH ASSURANT HEALTH RE-PRICING VIA HEALTHSPAN 3 x x x x<br />
<strong>Health</strong>Span Re-Pricing. Use existing Payer IDs for claims for Assurant <strong>Health</strong> lines of business<br />
without re-pricing.<br />
74240 ASSURED BENEFITS ADMINISTRATORS 2 x<br />
93221 ASURIS NORTHWEST HEALTH x 4 x x<br />
95691 ATHENS AREA HEALTH PLAN 2 x x<br />
13853 ATLANTIS HEALTH PLAN 2 x<br />
90956 ATLAS LIFE INSURANCE COMPANY 2 x<br />
ATRIO ATRIO HEALTH PLAN 4 x x<br />
CMSEB AUSTIN REGIONAL CLINIC EMPLOYEE BENEFIT PLAN 4 x x<br />
38259 AUTOMATED BENEFIT SERVICES (ABS) 2 x x<br />
37280 AUTOMATED GROUP ADMINISTRATION, INC. 2 x x<br />
91136 AUTOMOTIVE MACHINISTS LOCAL 289 HEALTH & WELFARE FUND 2 x x<br />
46045 AVERA HEALTH 4 x x<br />
26355 AVERDE HEALTH 2 x x<br />
59275 AVMED ENCOUNTERS 4 x<br />
59274 AVMED, INC. 4 x x<br />
74227 BANKERS UNITED LIFE (STUDENT DIV) 2 x x<br />
SX145 BANNER HEALTH PLAN 2 x<br />
41204 BASIC PLUS 2 x x<br />
49153 BCI ADMINISTRATORS, INC. 2 x x<br />
43324 BEACON HEALTH STRATEGIES 2 x x<br />
95377 BEECH STREET CORPORATION 2 x x<br />
60054 BELL ATLANTIC 2 x x<br />
41205 BENEFIT ADMINISTRATIVE SERVICES (BAS) 2 x x<br />
36149 BENEFIT ADMINISTRATIVE SYSTEMS 2 x x<br />
51037 BENEFIT CONCEPTS 2 x x<br />
25145 BENEFIT COORDINATORS CORPORATION (PITTSBURGH, PA) 2 x x<br />
00999 BENEFIT MANAGEMENT SERVICES (BMS) 4 x x<br />
37212 BENEFIT MANAGEMENT SYSTEMS,INC 2 x x<br />
37118 BENEFIT PLAN ADMINISTRATORS (ROANOKE, VA) 2 x x<br />
39081 BENEFIT PLAN ADMINISTRATORS, CO (EAU CLAIRE, WI) 2 x x<br />
37286 BENEFIT PLAN ADMINISTRATORS, INC. (FARGO, NORTH DAKOTA) 2 x x<br />
74223 BENEFIT PLANNERS, INC. 2 x x<br />
36342 BENEFIT SYSTEMS & SERVICES, INC (BSSI) 2 x x<br />
61425 BENEFIT TRUST LIFE 2 x x<br />
37248 BENESYS, INC (LAFAYETTE, LA) 2 x x<br />
95604 BEST LIFE & HEALTH INSURANCE CO. 2 x x<br />
01508 BETTER HEALTH OF FLORIDA 3 x x<br />
7 of 124 Visit our web site: www.availity.com
Last<br />
Update<br />
Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
62183 BETTER HEALTH PLANS, INC. 2 x x<br />
BSHS1 BIENVIVIR SENIOR HEALTH PLAN 4 x<br />
CX025 BIG LOTS ASSOCIATES BENEFIT PLANS 2 x x<br />
BV001 BLOCK VISION OF TEXAS 2 x<br />
BV001 BLOCK VISION, INC 2 x x x x<br />
ECIBB BLUE BELL BENEFITS TRUST 2 x x<br />
00934 BLUECROSS (BC) AK (PREMERA) 2 x<br />
00610 BLUECROSS (BC) ID x 2 x<br />
00934 BLUECROSS (BC) WA (PREMERA) 2 x<br />
00520 BLUECROSS BLUESHIELD (BCBS) AR x 4+ x<br />
53589 BLUECROSS BLUESHIELD (BCBS) AZ 4* x x<br />
00601 BLUECROSS BLUESHIELD (BCBS) GA 3 x x x<br />
00101 BLUECROSS BLUESHIELD (BCBS) GA 3 x<br />
00611 BLUECROSS BLUESHIELD (BCBS) ID REGENCE x 4 x x<br />
Claim<br />
Status<br />
(276)<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
Enrollment required. Please go to<br />
https://www.bcidaho.com/Edi_Clearinghouse/20080515edienrollment.pdf to enroll. Availity's<br />
submitter id = 000000611<br />
The ARBCBS assigned submitter ID is required in loop 1000A, segment NM109. Enrollment is<br />
required. Go to<br />
www.arkansasbluecross.com/doclib/forms/providers/edi/2011%20edi_enrol_bc%20_tpa%20_3_.pdf<br />
. Complete the form. Check the box for Clearinghouse/Billing Agency in the 837 Claims section.<br />
Enter Availity, LLC for Name, and E0079 for Submitter Number.<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
This payer accepts EDI batch claims via the Availity portal only. To do so, log in to the Availity portal<br />
(www.availity.com), and then click EDI File Management | Send and Receive EDI Files. After<br />
selecting your organization, click SendFiles. For further assistance, click Help at the top of the portal<br />
page or contact Availity Client Services (1.800.282.4548).<br />
00621 BLUECROSS BLUESHIELD (BCBS) IL HCSC x 4 x x Please contact your Availity Account Manager to initiate the B2B submission enrollment process.<br />
53120 BLUECROSS BLUESHIELD (BCBS) LA 2 x<br />
SB700 BLUECROSS BLUESHIELD (BCBS) MA 2 x<br />
12B14 BLUECROSS BLUESHIELD (BCBS) MA 2 x<br />
00222 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x<br />
00722 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x<br />
720 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x<br />
722 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x<br />
220 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x<br />
222 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x<br />
00720 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x<br />
00220 BLUECROSS BLUESHIELD (BCBS) MN x 2 x x<br />
22099 BLUECROSS BLUESHIELD (BCBS) NJ HORIZON 2 x x<br />
BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a<br />
G2 qualifier. Patient’s ID card will denote which payer id to use electronically.<br />
BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a<br />
G2 qualifier. Patient’s ID card will denote which payer id to use electronically.<br />
BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a<br />
G2 qualifier. Patient’s ID card will denote which payer id to use electronically.<br />
BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a<br />
G2 qualifier. Patient’s ID card will denote which payer id to use electronically.<br />
BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a<br />
G2 qualifier. Patient’s ID card will denote which payer id to use electronically.<br />
BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a<br />
G2 qualifier. Patient’s ID card will denote which payer id to use electronically.<br />
BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a<br />
G2 qualifier. Patient’s ID card will denote which payer id to use electronically.<br />
BCBSMN requires atypical providers to submit their payer assigned provider id in the REF01 with a<br />
G2 qualifier. Patient’s ID card will denote which payer id to use electronically.<br />
00790 BLUECROSS BLUESHIELD (BCBS) NM HCSC x 4 x x x x Please contact your Availity Account Manager to initiate the B2B submission enrollment process.<br />
00840 BLUECROSS BLUESHIELD (BCBS) OK HCSC x 4 x x Please contact your Availity Account Manager to initiate the B2B submission enrollment process.<br />
00851 BLUECROSS BLUESHIELD (BCBS) OR REGENCE x 4 x x<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
84980 BLUECROSS BLUESHIELD (BCBS) TX HCSC x 4 x x Please contact your Availity Account Manager to initiate the B2B submission enrollment process.<br />
00932 BLUECROSS BLUESHIELD (BCBS) WA REGENCE x 4 x x<br />
61124 BLUEGRASS FAMILY HEALTH 3 x x<br />
BS001 BLUESHIELD (BS) CALIFORNIA x 2 x<br />
94036 BLUESHIELD (BS) CALIFORNIA x 2 x<br />
36609 BOILERMAKERS NAT'L HEALTH & WELFARE 2 x x<br />
BOLL1 BOLLINGER, INC. 4 x x<br />
Group number required for all claims; Policy holder claim form required for most groups on<br />
institutional/professional claims.<br />
74238 BOON-CHAPMAN BENEFIT ADMINISTRATORS 4 x<br />
13337 BOSTON MEDICAL CENTER HEALTH PLAN 3 x x<br />
38365 BRIDGE BENEFITS 2 x x<br />
68069 BRIDGEWAY HEALTH SOLUTIONS x 3 x x payer ID 68054 may be used<br />
51037 BROKERAGE CONCEPTS 2 x x<br />
94316 BROWN & TOLAND MEDICAL SERVICES 3 x x<br />
84980 BRYAN INDEPENDENT SCHOOL DISTRICT 4 x x<br />
Please ensure that the group number is included in Loop 2000B SBR03 and the appropriate BISD<br />
subscriber id is used.<br />
68069 BUCKEYE COMMUNITY HEALTH PLAN x 3 x x payer ID 32004 may also be used<br />
42150 BUTLER BENEFITS 2 x x<br />
23708 C&O EMPLOYEES HOSPITAL ASSOCIATION 2 x<br />
CLFR2 C.L. FRATES AND COMPANY 2 x x<br />
71057 CANNON COCHRAN MANAGEMENT SERVICES (CCMSI) - LA 2 x x<br />
37105 CANNON COCHRAN MANAGEMENT SERVICES, INC. 2 x x<br />
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Last<br />
Update<br />
Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
23045 CAPITAL BLUE CROSS/CAIC 2 x<br />
95112 CAPITAL HEALTH PLAN x 2 x x Please contact <strong>Network</strong> Services at 850.523.7361 to enroll.<br />
68011 CAPITOL ADMINISTRATORS (GTESS) 2 x x<br />
CAPHP CAPROCK HEALTH PLANS 2 x x<br />
GCVCP CARDIOVASCULAR CARE PROVIDERS, INC. (CVCP) 2 x<br />
57116 CARE 1ST HEALTH PLAN OF ARIZONA 2 x x<br />
77082 CARE IMPROVEMENT PLUS 3 x x<br />
Providers will be required to send an EDI Enrollment Inquiry to EDIINFO@CareCentrix.com. The<br />
11345 CARECENTRIX x 4 x<br />
body of the email should contain the following: Provider NPI; Contact Name; Contact Email; Address;<br />
Contact Telephone<br />
38269 CARECHOICES MICHIGAN - MERCY HEALTHPLANS 2 x<br />
SB580 CAREFIRST BCBS OF DC/NCA x 2 x x<br />
SB690 CAREFIRST BCBS OF MARYLAND x 2 x x<br />
25133 CARELINK ADVANTRA 2 x x<br />
25133 CARELINK HEALTH PLAN 3 x x<br />
93975 CAREOREGON 2 x x<br />
95092 CAREPLUS 4 x x<br />
MRCHP CARESOURCE HEALTH PLAN OF OREGON 3 x x<br />
31114 CARESOURCE OF OHIO 2 x<br />
56215 CAROLINA BEHAVIORAL HEALTH ALLIANCE 4 x x<br />
29076 CAROLINA CARE PLAN, INC. 2 x x formerly payer ID 57105<br />
56195 CAROLINA SUMMIT HEALTHCARE, INC. 2 x x<br />
37060 CATERPILLAR 2 x x<br />
03036 CBA BLUE 2 x x<br />
55438 CBCA ADMINISTRATORS 2 x x<br />
88019 CCEA 2 x<br />
WK010 CCMSI WORKER COMP 2 x x<br />
73159 CCN 2 x x<br />
00220 CCSTPA x 2 x<br />
00720 CCSTPA x 2 x<br />
88022 CDS GROUP HEALTH 2 x x<br />
95166 CEDARS-SINAI MEDICAL NETWORK SERVICES 3 x<br />
95167 CEDARS-SINAI MEDICAL NETWORK SERVICES 3 x<br />
68063 CELTIC INSURANCE 2 x x<br />
68069 CELTICARE HEALTH PLAN x 3 x x payer ID 68060 may also be used<br />
91136 CEMENT MASONS & PLASTERERS HEALTH AND WELFARE TRUST 2 x x<br />
68068 CENPATICO - AZ x 3 x x payer ID 68048 may also be used<br />
68068 CENPATICO - FL x 3 x x payer ID 68058 may also be used<br />
68068 CENPATICO - GA x 3 x x payer ID 68050 may also be used<br />
68068 CENPATICO - IL x 3 x x payer ID 68065 may also be used<br />
68068 CENPATICO - IN x 3 x x payer ID 68052 may also be used<br />
68068 CENPATICO - KS x 3 x x payer ID 68047 may also be used<br />
68068 CENPATICO - KY x 3 x x<br />
68068 CENPATICO - MA x 3 x x payer ID 68061 may also be used<br />
68068 CENPATICO - MS x 3 x x The payer will begin accepting claims starting 12/1/12.<br />
68068 CENPATICO - OH x 3 x x payer ID 68051 may also be used<br />
68068 CENPATICO - SC x 3 x x payer ID 68059 may also be used<br />
68068 CENPATICO - TX x 3 x x payer ID 68053 may also be used<br />
68068 CENPATICO - WI x 3 x x payer ID 68046 may also be used<br />
68069 CENTENE MEDICARE x 3 x x payer ID 68056 may also be used<br />
31118 CENTRAL BENEFITS LIFE 2 x x<br />
NACDM CENTRAL DUPAGE MEDICAL GROUP 3 x x<br />
02041 CENTRAL MASSACHUSETTS HEALTH CARE x 2 x x<br />
34097 CENTRAL RESERVE LIFE 2 x x<br />
CIPA1 CENTRAL SENIOR CARE x 4 x x For 835, 270 and 276 transactions please use Payer ID: HPN11<br />
36215 CENTRAL STATES HEALTH & WELFARE FUND 2 x x<br />
36393 CENTURYPHO 4 x x<br />
23171 CHA – COMMONWEALTH HEALTH ALLIANCE 2 x x<br />
84146 CHAMP VA - HAC 2 x x<br />
Provider Enrollment may be found at www.mytricare.com. The 270 and 276 WEB transactions are<br />
only for TRICARE South Region.<br />
38520 CHAMPUS - TRICARE (NORTH & SOUTH) x 4 x x<br />
Trading Partner Name: Availity, LLC, Trading Partner ID: 7GW0429FL3<br />
TRICARE PGBA, LLC EDI Help Desk (800- 325-5920)<br />
57106 CHAMPUS - TRICARE (PALMETTO) x 4 x x<br />
61125 CHAMPUS - TRICARE (PGBA) x 4 x x<br />
9 of 124 Visit our web site: www.availity.com<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Provider Enrollment may be found at www.mytricare.com. The 270 and 276 WEB transactions are<br />
only for TRICARE South Region.<br />
Trading Partner Name: Availity, LLC, Trading Partner ID: 7GW0429FL3<br />
TRICARE PGBA, LLC EDI Help Desk (800- 325-5920)<br />
Provider Enrollment may be found at www.mytricare.com. The 270 and 276 WEB transactions are<br />
only for TRICARE South Region.<br />
Trading Partner Name: Availity, LLC, Trading Partner ID: 7GW0429FL3<br />
TRICARE PGBA, LLC EDI Help Desk (800- 325-5920)
Last<br />
Update<br />
Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
99726 CHAMPUS TRICARE WEST x 4 x x<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
Provider Enrollment may be found at www.mytricare.com. The 270 and 276 WEB transactions are<br />
only for TRICARE South Region.<br />
Trading Partner Name: Availity, LLC, Trading Partner ID: 7GW0429FL3<br />
TRICARE PGBA, LLC EDI Help Desk (800- 325-5920)<br />
CHAT1 CHATWINS HEALTHCARE ADMINISTRATORS 2 x x<br />
16600 CHAUTAUQUA COUNTY HEALTHCARE PLAN 2 x x<br />
75261 CHEC – A SUBSIDIARY OF SPRINT 2 x x<br />
59223 CHESAPEAKE LIFE INSURANCE 2 x x<br />
34154 CHESTERFIELD RESOURCES 2 x x<br />
86916 CHILDREN WITH SPECIAL HEALTHCARE NEEDS (CSHCN) x 4# x x<br />
CASD1 CHIROPRACTIC ASSOCIATION OF SD - DAKOTACARE 4 x<br />
CASD2 CHIROPRACTIC ASSOCIATION OF SD - SANFORD HEALTH PLAN 4 x<br />
ACN01 CHIROPRACTIC CARE OF MINNESOTA, INC. 2 x<br />
60054 CHOICE PLUS (TRW) 2 x x<br />
38308 CHRISTIAN BROTHERS SERVICES 2 x x<br />
SPOHN CHRISTUS SPOHN NETWORK 2 x x<br />
62308 CIGNA x 2 x x<br />
02331 CIGNA BEHAVIORAL HEALTH 2 x<br />
95266 CIGNA FLEX CARE (NEW MEXICO ONLY) 2 x x<br />
86033 CIGNA SENIOR HEALTH PLAN 2 x x<br />
10207 CITRUS HEALTH PLAN 4* x x<br />
COA01 CITY OF AMARILLO 4 x<br />
TTCEC CITY OF SAN ANTONIO 2 x x<br />
77201 CLEARCHOICE HEALTH PLAN/COIHS 2 x<br />
CSI001 CLINICAL SPECIALTIES, INC 2 x x<br />
CSI01 CLINICAL SPECIALTIES, INC 2 x x<br />
COACC COLORADO ACCESS HMO 2 x<br />
COKSR COLORADO KAISER PERMANENTE 2 x<br />
KSRCS COLORADO KAISER PERMANENTE (COLORADO SPRINGS ONLY) 2 x<br />
91162 COLUMBIA UNITED PROVIDERS 2 x<br />
GEN02 COMBINED INS CO OF AMERICA 2 x x<br />
34181 COMMERCE BENEFITS GROUP 2 x x<br />
37237 COMMONWEALTH ADMINISTRATORS 2 x x<br />
23282 COMMUNITY CARE BHO 2 x x<br />
73143 COMMUNITY CARE MANAGED HEALTH CARE 2 x x<br />
39126 COMMUNITY CARE ORGANIZATION 2 x x<br />
71079 COMMUNITY CARE PLUS 2 x x Payer id only valid for claims with dates of service prior to 07/01/2012<br />
38325 COMMUNITY CHOICE OF MICHIGAN 2 x<br />
COMMF COMMUNITY FIRST 4+ x x<br />
35193 COMMUNITY HEALTH ALLIANCE 2 x<br />
48145 COMMUNITY HEALTH CHOICE 4+ x x<br />
75261 COMMUNITY HEALTH ELEC. CLEARINGHOUSE (CHEC) 2 x x<br />
CHPWA COMMUNITY HEALTH PLAN OF WASHINGTON x 4 x x<br />
61733 COMMUNITY HEALTH SOLUTION 2 x x<br />
95192 COMMUNITYCONNECT HEALTHPLAN 2 x x PO Box 3157, Eau Claire, WI 54702-3157<br />
34177 COMP - OHIO (AUSTINTOWN, OH) 2 x x<br />
95192 COMPARE (WISCONSIN BADGERCARE ONLY) 2 x x PO Box 3217, Eau Claire, WI 54702-3217<br />
93101 COMPLEMENTARY HEALTHCARE PLANS 2 x x<br />
59314 COMPREHENSIVE BEHAVIORAL CARE 2 x x<br />
COMPU COMPUSYS OF COLORADO 2 x<br />
06105 CONNECTICARE 3 x x<br />
78375 CONNECTICARE - MEDICARE 2 x x<br />
62308 CONNECTICUT GENERAL - MEDICAL CLAIMS 2 x x<br />
02331 CONNECTICUT GENERAL - MENTAL HEALTH CLAIMS 2 x<br />
37135 CONSOCIATE GROUP (DECATUR, IL) 2 x x<br />
75284 CONSOLIDATED ASSOCIATES RAILROAD 2 x x<br />
04274 CONSOLIDATED GROUP/HPS 3 x<br />
71404 CONTINENTAL GENERAL 2 x x<br />
35315 CONTINENTAL KEY FAMILY 2 x x<br />
CCHP1 COOK CHILDREN'S HEALTH PLAN 4 x x<br />
CCHP9 COOK CHILDREN'S STAR PLAN 4 x x<br />
52132 COOPERATIVE BENEFIT ADMINISTRATOR 2 x x<br />
14829 CO-ORDINATED BENEFITS PLAN 2 x x<br />
68069 COORDINATED CARE 3 x x<br />
35199 COOPERATIVE MANAGED CARE SERVICES (CMCS) 4 x x<br />
58231 CORE MANAGEMENT RESOURCES GP 2 x<br />
35182 CORESOURCE OF AZ, IL, IN, MD, MN, NC, PA 2 x x<br />
35183 CORESOURCE OF OHIO 2 x x<br />
75136 CORESOURCE, LITTLE ROCK 2 x x<br />
10850 CORNERSTONE BENEFIT ADMINISTRATORS x 2 x x<br />
41124 CORPORATE BENEFIT SRVC OF AMERICA (MERITAIN HEALTH) 2 x x<br />
Payer ID valid only for claims with a billing submission address of P.O. Box 27267, Minneapolis, MN<br />
55427-0267.<br />
56116 CORPORATE BENEFITS SERVICE, INC (NC) 2 x<br />
37246 CORPORATE SYSTEMS ADMINISTRATION 2 x<br />
10 of 124 Visit our web site: www.availity.com
Last<br />
Update<br />
Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
CCIH CORRECTCARE INTEGRATED HEALTH (CA PRISON HEALTH CARE SERVICES) 2 x x<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
The abbreviation for the institution should be entered as the patient’s address in Loop 2010BA, N3<br />
segment. Institution’s city, state and zip should be entered in Loop 2010BA, N4 segment. Obtain info<br />
from the following link: https://www.correctcare.com/portal/Institution%20Abbreviation%20List.pdf<br />
43160 CORRECTIONAL MEDICAL SERVICES 2 x<br />
62553 COUNTRY LIFE INSURANCE COMPANY 2 x x<br />
60827 COUNTYCARE 2 x x<br />
58102 COVENANT ADMINISTRATORS, INC. (ATLANTA, GA) 2 x x<br />
CMSEB COVENANT MGMT SYSTEMS EMPLOYEE BENEFIT PLAN 4 x x<br />
25133 COVENTRY HEALTH & LIFE (OKLAHOMA) 2 x x<br />
25133 COVENTRY HEALTH CARE IOWA 2 x x<br />
25133 COVENTRY HEALTH CARE KANSAS 2 x x<br />
25133 COVENTRY HEALTH CARE NEBRASKA 2 x x<br />
25133 COVENTRY HEALTH CARE OF CAROLINAS 2 x x<br />
25133 COVENTRY HEALTH CARE OF DELAWARE 2 x x<br />
25133 COVENTRY HEALTH CARE OF GEORGIA 2 x x<br />
25133 COVENTRY HEALTH LOUISIANA 2 x x<br />
64068 CREATIVE MEDICAL SYSTEMS 2 x x<br />
37320 CREATIVE PLAN ADMINISTRATORS 2 x x<br />
34186 CSI NETWORK SERVICES 2 x x<br />
27136 CSI OF MICHIGAN 2 x x<br />
82056 CUSTOM DESIGN BENEFITS 2 x x<br />
60054 CUSTOMCARE (PRUDENTIAL) 2 x x<br />
DAK01 DAKOTACARE 4 x x<br />
06172 DART MANAGEMENT CORP/DART CONTAINER CORP 2 x x<br />
95748 DC CHARTERED HEALTH PLAN 4 x<br />
39113 DEAN 2 x x<br />
87726 DEFINITY SERVICES x 2 x x<br />
27009 DELAWARE PHYSICIANS CARE, INC. 2 x x<br />
94235 DELTA HEALTH 2 x x<br />
DHS01 DELTA HEALTH SYSTEMS 2 x Claims for payer ID 87068 (<strong>Health</strong> Plan Solutions of Utah) may be sent using payer ID DHS01<br />
84135 DENVER HEALTH MEDICAL PLAN 2 x x<br />
Click this link and complete the enrollment required to begin electronic billing with L&I:<br />
http://www.lni.wa.gov/Forms/pdf/F248-031-000.pdf<br />
LABOR DEPARTMENT OF LABOR & INDUSTRY (WASHINGTON) x 2 x<br />
<strong>Information</strong> necessary to complete the Clearinghouse/Intermediary <strong>Information</strong> section:<br />
Clearinghouse Name - Availity, L.L.C., Telephone - 800.282.4548,<br />
Contact - Availity Client Services, L&I Account Number – 0179379<br />
56240 DETROIT MEDICAL CENTER 2 x x<br />
23706 DIRECTORS GUILD OF AMERICA – PRODUCER HEALTH PLAN 2 x x<br />
06102 DIVERSIFIED ADMINISTRATION 2 x<br />
25160 DIVERSIFIED GROUP ADMIN 4 x x<br />
74284 DRISCOLL CHILDREN'S HEALTH PLAN 2 x x<br />
35186 DUNN AND ASSOCIATES BENEFITS ADMINISTRATORS 2 x x<br />
36434 EARLY INTERVENTION CENTRAL BILLING 2 x<br />
62308 EATON BENEFITS,OH 2 x x<br />
TTCEC EBA - CITY OF SAN ANTONIO 2 x x<br />
22521 EDS ADMIN SERVICES 2 x x<br />
EPF03 EL PASO FIRST HEALTH PLANS - CHIP x x 4 x x Please contact Provider Relations at (915)-532-3778 x1507 to enroll.<br />
EPF37 EL PASO FIRST HEALTH PLANS - HCO (HEALTHCARE OPTIONS) x x 4 x x Please contact Provider Relations at (915)-532-3778 x1507 to enroll.<br />
EPF02 EL PASO FIRST HEALTH PLANS - PREMIER PLAN (STAR MEDICAID HMO) x x 4 x x Please contact Provider Relations at (915)-532-3778 x1507 to enroll.<br />
52192 ELDER HEALTH/BRAVO HEALTH 4 x x Serving Members in Pennsylvania, Maryland, Delware, Texas, and Washington DC.<br />
31625 ELDERPLAN 2 x x Elderplan Provider ID required for all claims. Please contact (718)-921-7979 for Provider ID<br />
ECISF ELLIS CONSULTANTS, INC. 2 x x<br />
NAELM ELMCARE LLC 2 x x<br />
37253 ELMCO 2 x x<br />
34167 EMERALD HEALTH NETWORK INC 2 x x<br />
59299 EMI - KP AMBULANCE CLAIMS 2 x<br />
60054 EMORYCARE (PRUDENTIAL) 2 x x<br />
95288 EMPLOYEE BENEFIT ADMIN & MGMT 2 x<br />
38241 EMPLOYEE BENEFIT CONCEPTS, INC. 2 x x<br />
EBC18 EMPLOYEE BENEFIT CONCEPTS, INC. 2 x x<br />
31074 EMPLOYEE BENEFIT MANAGEMENT (EBMC) 2 x x<br />
CX025 EMPLOYEE BENEFIT MANAGEMENT CORP. 4 x x<br />
81039 EMPLOYEE BENEFIT MANAGEMENT SYSTEM (EBMS) 3 x x<br />
EBSSA EMPLOYEE BENEFIT SERVICES (EBS) OF SAN ANTONIO 4 x<br />
37216 EMPLOYEE BENEFIT SERVICES (SOUTH CAROLINA) 2 x x<br />
03036 EMPLOYEE BENEFITS PLAN ADMIN (E.B.P.A.) 2 x x<br />
75184 EMPLOYEE CLAIM ADJUDICATION SVCS 2 x x<br />
35112 EMPLOYEE PLANS, LLC 2 x x<br />
74212 EMPLOYER PLAN SERVICES 2 x x<br />
36335 EMPLOYERS COALITION ON HEALTH (ECOH) 2 x Formerly payer ID 27008.<br />
75232 EMPLOYERS DIRECT HEALTH 2 x x<br />
75236 EMPLOYERS DIRECT HEALTH (EMPLOYEE PLAN) 2 x x<br />
75235 EMPLOYERS DIRECT HEALTH (FULLY INSURED) 2 x x<br />
75233 EMPLOYERS DIRECT HEALTH (SELF FUNDED PLAN) 2 x x<br />
11 of 124 Visit our web site: www.availity.com
Last<br />
Update<br />
Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
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(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
MIDSC EMPLOYERS HEALTH COOPERATIVE (EHC) 2 x<br />
59298 EMPLOYERS MUTUAL,INC.(FL) 2 x x<br />
35206 ENCORE HEALTH NETWORK 2 x<br />
36364 ENH MEDICAL GROUP IPA 2 x x<br />
91136 ENSTAR NATURAL GAS G#P61 2 x x<br />
36878 ENTRUST 2 x x<br />
62308 EQUICOR/EQUITABLE 2 x x<br />
62308 EQUICOR-PPO 2 x x<br />
75196 EQUIFAX / HEALTHCARE ADMIN (EHAS) 2 x x<br />
73126 EQUITABLE PLAN SERVICES 2 x x<br />
23250 ERIN GROUP ADMINISTRATORS 2 x x<br />
74234 ERISA 2 x<br />
20818 ESSENCE HEALTHCARE 2 x x<br />
87726 EVERCARE 2 x x<br />
59313 EVOLUTIONS HEALTHCARE SYSTEMS 2 x x<br />
71412 EXCLUSIVECARE 2 x x<br />
75138 EYE SPECIALISTS OF ARIZONA 2 x x<br />
37300 FACS GROUP 2 x x<br />
FCD01 FAMILY CARE MEDICAID 2 x<br />
FCM01 FAMILY CARE MEDICAID MENTAL HEALTH 2 x<br />
FCR01 FAMILY CARE MEDICARE 2 x<br />
31472 FAMILY HEALTH PARTNERS - HEALTHWAVE KANSAS 2 x x<br />
43173 FAMILY HEALTH PARTNERS - MISSOURI 2 x x<br />
36396 FAMILY MEDICAL NETWORK 2 x x<br />
14140 FARM FAMILY 2 x x<br />
59069 FBMC 2 x x<br />
33033 FCE BENEFIT ADMINISTRATORS 2 x x<br />
84980 FEDERAL EMPLOYEE PROGRAM (TX FEP) x 4 x x<br />
41041 FEDERATED MUTUAL 2 x x<br />
11315 FIDELIS CARE NEW YORK 2 x<br />
77054 FIDELIS SECURE CARE 2 x x<br />
FAMR1 FIRST ADMINISTRATORS 3 x x<br />
56196 FIRST CAROLINA CARE 2 x x<br />
91131 FIRST CHOICE HEALTH NETWORK 2 x x<br />
75138 FIRST CHOICE OF MIDWEST (PPO) 2 x x<br />
87043 FIRST HEALTH 2 x x<br />
75232 FIRST INTEGRATED HEALTH 2 x x<br />
23241 FIRST PRIORITY HEALTH 2 x<br />
FS802 FIRST SOLUTIONS x x 4 x<br />
Provider enrollment is required by the Payer. Please complete the form -<br />
http://www.availity.com/documents/First_Solutions_Electronic_Claims_Enrollment.pdf<br />
94999 FIRSTCARE x 4 x x<br />
94998 FIRSTCARE “STAR” MEDICAID x 4 x x<br />
90060 FIRSTGUARD HEALTH PLAN - KANSAS 2 x x<br />
90061 FIRSTGUARD HEALTH PLAN - MISSOURI 2 x x<br />
62061 FISERV HEALTH - KANSAS/TENNESSEE 2 x x<br />
11244 FITZHARRIS & COMPANY, INC. (FARMINGDALE, NY) 2 x<br />
60054 FLEXCARE 2 x x<br />
59276 FLORIDA 1ST WINTERHAVEN, FL 3 x x<br />
00590 FLORIDA BLUE x 2 x x<br />
Prior to submitting claims, please contact client services at 800.282.4548 (three to five days after<br />
approved Availity registration) to obtain a BCBSFL sender id. Note: BCBSFL assigned sender id is<br />
required, enter in loop 1000A segment NM109.<br />
59322 FLORIDA HEALTH CARE PLANS (FHCP) x 4 x x<br />
12611 FLORIDA HEALTH CARE PLUS (FHP) 4 x x<br />
81400 FLORIDA HEALTH CHOICE - WISCONSIN ONLY 2 x<br />
81400 FLORIDA HEALTH CHOICE / SELECT - WISCONSIN 2 x<br />
59321 FLORIDA HOSPITAL HEALTHCARE SYSTEMS (FHHS) 2 x x<br />
48116 FLORIDA HOSPITAL WATERMAN 2 x x<br />
65063 FLORIDA NETPASS 2 x<br />
60054 FLORIDA POWER & LIGHT (PRUDENTIAL) 2 x x<br />
48117 FMH BENEFIT SERVICES, INC 2 x x<br />
70408 FORTIS BENEFITS INSURANCE COMPANY 2 x x<br />
39065 FORTIS INSURANCE COMPANY 2 x x<br />
55248 FOUNDATION HEALTH PLAN (SUNRISE FL) 2 x x<br />
FVMCH FOX VALLEY MEDICINE SITE 199 2 x<br />
FVMC1 FOX VALLEY MEDICINE SITE 451 2 x<br />
64069 FOX-EVERETT, INC 2 x x<br />
62324 FREEDOM LIFE INSURANCE COMPANY OF AMERICA 4 x<br />
FMCHP FRESENIUS MEDICAL CARE HEALTH PLAN x 4 x x For 835, 270 and 276 transactions please use Payer ID: FMCHP<br />
59204 FRINGE BENEFIT COORDINATORS 2 x x<br />
30005 GALVESTON COUNTY INDIGENT HEALTH 2 x x<br />
25169 GATEWAY HEALTH PLAN 2 x x<br />
60550 GATEWAY HEALTH/MEDICARE ASSURED 2 x x<br />
91741 GATEWAY HEALTH/MEDICARE ASSURED OHIO 2 x x<br />
44054 GEHA 2 x x<br />
GEHA9 GEHA HEALTH GROUP (NEVADA) 2 x x<br />
87726 GEHA MENTAL HEALTH CLAIMS x 2 x x<br />
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Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
75273 GEISINGER HEALTH PLAN x 2 x x<br />
Prior enrollment required. Please contact Geisinger <strong>Health</strong> Plan at 1-888-281-5338, option 3, to<br />
obtain an enrollment form; or download a PDF enrollment form at www.thehealthplan.com.<br />
63665 GENERAL AMERICAN LIFE INS CO x 2 x x<br />
GHEDI GENERATIONS HEALTHCARE x 4 x x For 835, 270 and 276 transactions please use Payer ID: GHEDI<br />
GEN01 GENWORTH - CONTINENTAL LIFE INSURANCE 2 x x<br />
GEN02 GENWORTH - FINANCIAL 2 x x<br />
23212 GETTYSBURG HEALTH 2 x x<br />
25531 GHI HMO SELECT 2 x x<br />
25133 GHP (GROUP HEALTH PLAN) 2 x x<br />
80314 GIC INDEMNITY PLAN 3 x x<br />
07205 GILSBAR 2 x x<br />
91136 GLASSWORKERS HLTH & WELFARE 2 x x<br />
07689 GLOBAL CARE, INC. 2 x x<br />
75246 GM SOUTHWEST 4 x x<br />
37602 GOLDEN RULE 2 x x<br />
GTPA1 GOLDEN TRIANGLE PHYSICIAN ALLIANCE x 4 x x For 835, 270 and 276 transactions please use Payer ID: HPN11<br />
76923 GOOD SHEPHERD HOSPICE 2 x x<br />
44054 GOVERNMENT EMPLOYEES HOSP ASSOC 2 x x<br />
58204 GRADY HEALTHCARE 2 x x<br />
37234 GRANT PHYSICIANS PRACTICE ASSOCIATION 2 x x<br />
95467 GREAT LAKES HEALTH PLAN 2 x x<br />
48143 GROUP & PENSION ADMINISTRATORS 2 x<br />
36338 GROUP ADMINISTRATORS 2 x x<br />
39167 GROUP HEALTH COOP/SO. CENTRAL WISCONSIN 2 x x<br />
39168 GROUP HEALTH COOP/SO. CENTRAL WISCONSIN 2 x x<br />
91121 GROUP HEALTH COOPERATIVE - EAST (GHC OF PUGET SOUND) 4 x Please use 91051 for all GHC Institutional Claims<br />
91051 GROUP HEALTH COOPERATIVE - WEST (GHC OF PUGET SOUND) 4 x x<br />
95192 GROUP HEALTH COOPERATIVE OF EAU CLAIRE 2 x x PO Box 3217, Eau Claire, WI 54702-3217<br />
38194 GROUP HEALTH MANAGERS 2 x x<br />
13551 GROUP HEALTH, INC (GHI) - NEW YORK 2 x x<br />
37276 GROUP INSURANCE SERVICE CENTER, INC. 2 x x<br />
77010 GUARDIAN 2 x x<br />
64246 GUARDIAN, THE 2 x x<br />
39180 GUNDERSON LUTHERAN HEALTH PLAN, INC. 4 x x<br />
80705 GWH-CIGNA (FORMERLY GREAT-WEST HEALTHCARE) x 2 x x Formerly First Great West Life &Annuity Ins Co and Great-West Life and Annuity Ins Co<br />
37114 H.E.R.E.I.U. WELFARE PENSION FUNDS 2 x x<br />
95266 HARRINGTON BENEFIT SERVICES 2 x x<br />
75126 HARPETH IPA - AMERIVANTAGE 2 x<br />
48330 HAWAII MANAGEMENT ALLIANCE ASSOCIATION (HMAA) 4 x x<br />
37111 HCH ADMINISTRATION –PEORIA 2 x x<br />
37329 HCHA ALBQ – SELF FUNDED 2 x x<br />
82018 HCS – HEALTH CLAIMS SERVICE 3 x x<br />
77950 HEALTH ALLIANCE MEDICAL PLANS 2 x x<br />
38224 HEALTH ALLIANCE PLAN OF MICHIGAN 2 x x<br />
25126 HEALTH AMERICA/HEALTH ASSURANCE/ADVANTRA 2 x x<br />
60054 HEALTH CARE ALLIANCE (SEARS) 2 x x<br />
42102 HEALTH CARE NETWORK OF WISCONSIN 2 x<br />
62180 HEALTH CHOICE GENERATIONS 2 x<br />
75196 HEALTH ECONOMICS - MICS CORP 2 x x<br />
95019 HEALTH FIRST HEALTH PLANS 4 x x<br />
75289 HEALTH FIRST TPA – AUSTIN 2 x x<br />
75234 HEALTH FIRST TPA – TYLER 2 x<br />
34185 HEALTH FIRST TPS - HOUSTON 2 x x<br />
55247 HEALTH INSURANCE PLAN OF NEW YORK (HIP) x 2 x x<br />
95570 HEALTH NET – CALIFORNIA (ENCOUNTERS) 2 x<br />
38309 HEALTH NET OF ARIZONA 3 x x<br />
95567 HEALTH NET-CALIFORNIA & OREGON 3 x x<br />
95568 HEALTH NET-CALIFORNIA (ENCOUNTERS) 2 x<br />
65062 HEALTH NETWORK ONE 2 x<br />
04286 HEALTH NEW ENGLAND 4 x<br />
NAHOI HEALTH OPTIONS OF ILLINOIS, INC 2 x x<br />
62157 HEALTH PARTNERS - JACKSON, TENN. 2 x x<br />
80142 HEALTH PARTNERS – PA 2 x x<br />
20270 HEALTH PAYMENT SYSTEMS INC. 2 x x<br />
44273 HEALTH PLANS INC. 2 x x<br />
11324 HEALTH PLUS PHSB (BROOKLYN, NY) 2 x x<br />
56731 HEALTH RESOURCES NW 2 x<br />
41170 HEALTH RISK MANAGEMENT (HRM) 2 x x<br />
20896 HEALTH SERVICES CONSULTING GROUP (HSCG) 2 x x<br />
37290 HEALTH SERVICES FOR CHILDREN – SPECIAL NEEDS 2 x x<br />
41150 HEALTH SERVICES MANAGEMENT x 2 x<br />
HSM01 HEALTH SERVICES MANAGEMENT (HSM) 2 x<br />
84980 HEALTHCARE BENEFITS 4 x x<br />
CALL HEALTHCARE DISTRICT PALM BEACH COUNTY x 4 x Please contact HCDPBC to enroll and to obtain Payer ID (866-930-1002).<br />
HMA01 HEALTHCARE MANAGEMENT ADMIN (HMA) 3 x x<br />
20501 HEALTHCARE PARTNERS OF NEVADA 2 x x<br />
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Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
73147 HEALTHCARE SOLUTIONS GROUP (HSG) 2 x x<br />
25143 HEALTHCARE USA 2 x x<br />
36335 HEALTHCARE’S FINEST NETWORK 2 x x<br />
62179 HEALTHCHOICE OF ARIZONA 2 x x<br />
HCOMP HEALTHCOMP (COMMUNITY FIRST - STAR HEALTH PLAN) 3 x x<br />
85729 HEALTHCOMP, INC 2 x x<br />
41178 HEALTHEZ 2 x x<br />
80141 HEALTHFIRST, INC 2 x<br />
59087 HEALTHHELP NETWORK, INC (HHNI) 2 x x<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
96475 HEALTHLINK HMO x 2 x x Please call Provider Relations Dept at (800) 624-2356 for unique provider number.<br />
90001 HEALTHLINK PPO x 2 x x Please call Provider Relations Dept at (800) 624-2356 for unique provider number.<br />
06108 HEALTHNET OF THE NORTHEAST 3 x x Payer requires NPI<br />
07003 HEALTHPARTNERS x x 2 x x<br />
Go to http://www.availity.com/documents/<strong>Health</strong>Partners_Electronic_Claims_Enrollment.pdf and<br />
complete the required enrollment form named <strong>Health</strong>Partners Electronic Claims Enrollment<br />
59140 HEALTHPLAN SERVICES 3 x x<br />
95266 HEALTHPLAN SERVICES- HARRINGTON 2 x x<br />
95009 HEALTHPLUS OF LOUISIANA 4 x x<br />
71063 HEALTHSCOPE BENEFITS, INC 2 x x<br />
M3IL1 HEALTHSELECT BCBS OF FLORIDA 4 x x<br />
MED3000 EDI Support (805) 988-2280 ext 340<br />
Provider Customer Service - (708) 633-1234<br />
HSHARE HEALTHSHARE 4 x x<br />
75237 HEALTHSMART ACCEL 2 x x<br />
HSPC1 HEALTHSMART PREFERRED CARE (HSPC) 1 x x<br />
75255 HEALTHSOURCE OF NORTH TEXAS 2 x x<br />
71074 HEALTHSOURCE, AR 2 x x<br />
71075 HEALTHSOURCE, AR (MEDICARE HMO) 2 x x<br />
58210 HEALTHSOURCE, GA 2 x x<br />
61127 HEALTHSOURCE, KY 2 x x<br />
02041 HEALTHSOURCE, MA 2 x x<br />
01041 HEALTHSOURCE, ME 2 x x<br />
56147 HEALTHSOURCE, NC 2 x x<br />
06119 HEALTHSOURCE, SC 2 x<br />
62129 HEALTHSOURCE, TN 2 x x<br />
63092 HEALTHSPRING HMO/HEALTHSPRING MEDICARE + CHOICE 2 x x<br />
HESUN HEALTHSUN HEALTH PLAN 3 x<br />
58213 HEALTHWAYS WHOLEHEALTH NETWORKS 2 x<br />
CALL HEALTHY PALM BEACH x 4 x Please contact <strong>Health</strong>y Palm Beach to enroll and to obtain Payer ID (866-930-1002).<br />
59230 HERITAGE CONSULTANTS 2 x<br />
HER01 HERITAGE IPA 4 x<br />
11328 HERITAGE NEW YORK MEDICAL GROUP 2 x x<br />
HPN11 HERITAGE PHYSICIAN NETWORK (HOUSTON) x 4 x x For 835, 270, and 276 transactions please use Payer ID: HPN11<br />
91164 HIGHLINE MEDICAL SERVICES ORGANIZATION (HMSO) MOLINA 2 x<br />
35145 HIGHMARK - KEY FAMILY 2 x x<br />
00046 HILL PHYSICIANS MEDICAL GROUP 2 x<br />
59347 HILLCREST BENEFIT ADMINISTRATORS 2 x x<br />
NAHIN HINSDALE PHYSICIANS HEALTHCARE 2 x x<br />
84980 HMO BLUE x 4 x x<br />
84980 HMO BLUE TEXAS x 4 x x<br />
COHMO HMO OF COLORADO 2 x<br />
NAHLX HOLY CROSS HEALTH PARTNERS 2 x x<br />
68069 HOME STATE HEALTH PLAN 3 x x<br />
34150 HOMETOWN HEALTH NETWORK 2 x x<br />
88023 HOMETOWN HEALTH PLAN NEVADA 2 x x<br />
88537 HOMETOWN HEALTH PROVIDERS 2 x x<br />
20475 HOOSIER ALLIANCE HEALTH PLAN 2 x x<br />
91136 HOTEL EMPLOYEES & RESTAURANT EMPLOYEES HEALTH TRUST 2 x x<br />
58227 HPS PARADIGM, INC 2 x x<br />
13335 HUDSON HEALTH PLAN x 2 x x Provider enrollment is required by the Payer. Please contact Janet Villablanca at 914.372.2753.<br />
95348 HUMANA HEALTH PLANS OF OHIO 3 x x x<br />
61101 HUMANA, INC. (CLAIMS) x 3 x x x<br />
61102 HUMANA, INC. (ENCOUNTERS) 4 x<br />
22175 I.E. SHAFFER (WEST TRENTON, NJ) 2 x x<br />
60054 IBM MEDICAL PLANS 2 x x<br />
11695 ICARE (INDEPENDENT CARE HEALTH PLAN) 4 x x<br />
68069 ILLINICARE HEALTH PLAN x 3 x x payer ID 68066 may also be used<br />
DMG01 ILLINOIS HEALTH PARTNERS 2 x<br />
41600 IMCARE x 2 x x<br />
40585 INDECS CORPORATION 2 x x<br />
00290 INDIAN HEALTH SERVICES ACS 4 x x<br />
35161 INDIANA PRO HEALTH NETWORK 2 x<br />
43471 INETICO INC 2 x x<br />
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Last<br />
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Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
50946 INFORMED UHC 2 x x<br />
52196 INFORMED, LLC 2 x x<br />
NAING INGALLS PROVIDER GROUPS 2 x x<br />
04320 INNOVATIVE HEALTHWARE SOLUTIONS 2 x x<br />
VAICE INS HEALTH SERVICES (IMMIGRATION HEALTH SERVICES) 4 x x<br />
For institutional claims, please include the payer assigned "Treatment Authorization Code" in loop<br />
2300 REF segment with a G1 qualifier.<br />
37279 INSURANCE ADMINISTRATOR OF AMERICA, INC. 2 x x<br />
13315 INSURANCE DESIGN ADMINISTRATORS 2 x x<br />
IMSMS INSURANCE MANAGEMENT SERVICES (IMS) OF TEXAS 2 x x<br />
ISL11 INSURANCE SERVICE OF LUBBOCK 2 x<br />
IAC01 INSURER’S ADMINISTRATIVE CORPORATION 4 x x<br />
51020 INTEGRA ADMINISTRATIVE GROUP 2 x x<br />
31127 INTEGRA GROUP 2 x x<br />
31129 INTEGRA GROUP - CHA 2 x<br />
23229 INTEGRAL QUALITY CARE 2 x x<br />
34167 INTEGRATED CARE NETWORK BY EMERALD 2 x x<br />
20050 INTEGRATED MEDICAL SOLUTION 2 x x<br />
92649 INTER-AMERICAS INSURANCE CORPORATION, INC 3 x x<br />
37227 INTERCARE HEALTH PLANS, INC. 2 x x<br />
60280 INTERFACE EAP 2 x x<br />
23287 INTERGROUP SERVICES CORPORATION 2 x<br />
39182 INTERNATIONAL FUNDING 2 x x<br />
IMGIN INTERNATIONAL MEDICAL GROUP 2 x x<br />
37269 INTERNATIONAL UNION OF OPERATING ENGINEERS, LOCAL 15 2 x x<br />
84137 INTERWEST HEALTH (MONTANA) - PPO 2 x<br />
41124 IOWA BENEFITS, INC 2 x x<br />
IPAK1 IPA OF KANE COUNTY 4 x x<br />
61271 JF MOLLY & ASSOC 2 x x<br />
41099 JOHN ALDEN/ASSURANT HEALTH CARE SERVICE CORPORATION 2 x x<br />
95378 JOHN DEERE HEALTH CARE 2 x x<br />
80314 JOHN HANCOCK 3 x x<br />
52189 JOHN HOPKINS HEALTH CARE (EHP/PP) 2 x x<br />
52123 JOHN HOPKINS HEALTH CARE (USFHP) 2 x x<br />
38310 JOHN MORRELL 4 x x<br />
JMH01 JOHN MUIR HEALTH NETWORK 3 x<br />
37215 JOHN P PEARL & ASSOCIATES 2 x x<br />
52123 JOHNS HOPKINS MEDICAL SERVICES CORP 2 x<br />
43178 JOPLIN CLAIMS 2 x x<br />
34136 JP FARLEY CORPORATION 2 x x<br />
37272 JSL ADMINISTRATORS 2 x x<br />
94135 KAISER FOUNDATION HEALTH PLAN OF NORTHERN CA REGION 2 x x<br />
94134 KAISER FOUNDATION HEALTH PLAN OF SOUTHERN CA REGION 2 x x<br />
52095 KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES 3 x x<br />
KP014 KAISER FOUNDATION OF OHIO x 4 x x<br />
93079 KAISER FOUNDATION OF THE NORTHWEST 2 x x<br />
21313 KAISER FOUNDATION PLAN OF GEORGIA 2 x x<br />
KS007 KAISER NW REGION 3 x<br />
91617 KAISER OF COLORADO 2 x x<br />
COKSR<br />
KAISER PERMANENTE (COLORADO PLANS ONLY EXCEPT COLORADO<br />
SPRINGS)<br />
2 x<br />
KSRCS KAISER PERMANENTE (COLORADO SPRINGS ONLY) 2 x<br />
KS001 KAISER PERMANENTE (SO CAL ONLY) 3 x<br />
57038 KANAWHA INSURANCE CO. 2 x x<br />
KCIPA KANE COUNTY IPA 4 x x<br />
KMG11 KATY MEDICAL GROUP x 4 x x For 835, 270 and 276 transactions please use Payer ID: HPN11<br />
KELSE KELSEY-SEYBOLD 3 x<br />
KELSI KELSEY-SEYBOLD (INSTITUTIONAL CLAIMS) 3 x<br />
73100 KEMPTON COMPANY,KEMPTON GROUP ADM 2 x x<br />
68069 KENTUCKY SPIRIT HEALTH PLAN x 3 x x payer ID 68067 may be used<br />
37217 KEY BENEFIT ADMINISTRATORS, INC. (INDIANAPOLIS, IN) 2 x x<br />
37321 KEY SELECT 2 x x<br />
23045 KEYSTONE HEALTH PLAN CENTRAL 2 x<br />
23284 KEYSTONE MERCY HEALTH PLAN 2 x x<br />
34145 KLAIS & COMPANY 2 x x<br />
KPS01 KPS HEALTH PLANS 4 x x<br />
27357 LACARE 2 x x<br />
95415 LAKESIDE HEALTH SERVICES 2 x x<br />
CALL LANCASTER GENERAL HEALTH GROUP 2 x x<br />
Contact Sherry Wolgemuth at Prefferred <strong>Health</strong> Care at 717.560.9290 #124 for approval and payer<br />
id<br />
LNDMK LANDMARK HEALTHCARE x 2 x See ERA section for further details on ERA enrollment<br />
36333 LAWNDALE CHRISTIAN HEALTH PLAN 2 x x<br />
52193 LBA HEALTH PLANS 2 x x<br />
65055 LEON MEDICAL CENTER HEALTH PLAN 2 x x<br />
98205 LIFE & HEALTH INSURANCE COMPANY OF AMERICA 2 x<br />
41136 LIFE TRAC 2 x x<br />
RLH01 LIFEMAP 4 x x<br />
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Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
76870 LIFEPATH HOSPICE 2 x x<br />
LIFE1 LIFEPRINT 2 x x<br />
93093 LIFEWISE OF OREGON, A PREMERA HEALTH PLAN 2 x<br />
LIPA1 LIPA/AGATE RESOURCES x 4 x<br />
Click this link and complete the required EDI registration for Lipa/Agate:<br />
https://www.trilliumchp.com/providers.php .<br />
35107 LOCAL 135 HEALTH BENEFITS FUND (INDIANAPOLIS, IN) 2 x x<br />
37267 LOMA LINDA UNIVERSITY ADVENTIST 2 x x<br />
45289 LONE STAR TPA 2 x x<br />
60054 LOS ALAMOS TOTAL CARE (PRU) 2 x x<br />
68069 LOUISIANA HEALTHCARE CONNECTIONS x 3 x x<br />
SX159 LOVELACE SALUD 2 x x<br />
90328 LOVELACE SANDIA HEALTH PLANS (COMMERCIAL) 2 x x<br />
52148 M.D. INDIVIDUAL PRACTICE ASSOC. (M.D. IPA) 2 x<br />
36334 MACNEAL HEALTH PROVIDERS - CHS 2 x x<br />
01260 MAGELLAN HEALTH SERVICES x 4 x x<br />
11303 MAGNACARE 2 x x<br />
68069 MAGNOLIA HEALTH PLAN x 3 x x payer ID 68062 may also be used<br />
87726 MAILHANDLERS MENTAL HEALTH CLAIMS x 2 x x<br />
22195 MAKSIN MANAGEMENT CORPORATION 2 x x<br />
35162 MANAGED CARE SERVICES 2 x x<br />
68069 MANAGED HEALTH CARE SERVICES - IN x 3 x x payer ID 39186 may also be used<br />
22771 MANAGED HEALTH NETWORKS (MHN) 2 x x<br />
68069 MANAGED HEALTH SERVICES - WI x 3 x x payer ID 39187 may also be used<br />
60054 MARRIOTT 2 x x<br />
37121 MASHANTUCKET PEQUOT TRIBAL NATION 2 x x<br />
MMPHB MASTERS, MATES AND PILOTS PLAN 3 x x<br />
41154 MAYO MANAGEMENT SERVICES, INC. x 2 x x<br />
87065 MBA BENEFIT ADMINISTRATORS 2 x<br />
87065 MBA OF WYOMING 2 x x<br />
59331 MCCREARY CORPORATION 2 x x<br />
02331 MCC BEHAVIORAL CARE 2 x<br />
38338 MCLAREN HEALTH PLAN 4 x x<br />
06118 MD HEALTH PLAN 2 x<br />
35199 MDWISE - ST. CATHERINE HEALTH NETWORK 4 x x<br />
35199 MDWISE - ST. MARGARET-MERCY HEALTH NETWORK 4 x x<br />
35199 MDWISE - ST. VINCENT HEALTH NETWORK 4 x x<br />
35199 MDWISE - SELECT HEALTH NETWORK 4 x x<br />
M3CA0001 MED3000 CALIFORNIA 4 x<br />
M3CA1 MED3000 CALIFORNIA AFFILIATED PHYSICIAN GROUP 4 x<br />
M3FL0010 MED3000 CMS EARLY STEPS 4 x x<br />
M3FL0011 MED3000 CMS SAFETY NET 4 x x<br />
M3FL0013 MED3000 CMS TITLE 19 NONREFORM 4 x x<br />
M3FL0012 MED3000 CMS TITLE 19 REFORM 4 x x<br />
M3FL0014 MED3000 CMS TITLE 21 4 x x<br />
M3IL0001 MED3000 HEALTHSELECT IPA BCBS 4 x x<br />
M3FL0009 MED3000 HEALTHSPRINGS 4 x<br />
M3FL0008 MED3000 PEDICARE TITLE 19 4 x x<br />
M3FL0006 MED3000 PEDICARE TITLE 21 4 x x<br />
M3IL0002 MED3000 SOUTHWEST IPA BCBS 4 x<br />
60054 MEDCONNECTION (MARRIOTT) 2 x x<br />
56205 MEDCOST BENEFIT SERVICES (MBS) 2 x x<br />
56162 MEDCOST, INC 2 x x<br />
95321 MEDFOCUS 2 x<br />
94265 MEDICA CHOICE (ALLINA) x 2 x x<br />
78857 MEDICA HEALTH CARE PLAN 2 x<br />
77027 MEDICAID FLORIDA x x x 3 x x<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
To register for Florida Medicaid, first complete the Availity FL Medicaid Registration<br />
(http://www.availity.com/documents/Availity_FL_Medicaid_Registration_Instructions.pdf) . Once<br />
Florida Medicaid assigns your provider number, access the Availity portal, click Florida Medicaid<br />
Registration in the Value-Added Services section and follow the instructions. EDS will notify you within<br />
30-45 days. Once you receive confirmation, you can receive files from the payer.<br />
AIDID MEDICAID IDAHO x x x 2 x Contact 1.866.686.4272 to enroll in EDI.<br />
IL621 MEDICAID ILLINOIS (HFS) x x 4 x x Contact 217.782.5565 to enroll in EDI. Contact 877.782.5565 for EDI issues.<br />
Providers must complete Kentucky's MAP380 form prior to submitting transactions. Visit<br />
AIDKY MEDICAID KENTUCKY x x x 4 x x<br />
http://chfs.ky.gov/NR/rdonlyres/F5C0E24B-5CEA-4B21-BADF-<br />
9C79E428F029/0/MAP380Medicaid609.pdf to complete the required MAP380. Availity's submitter id<br />
= 9900004190.<br />
Visit this link and complete the required EDI Submitter Enrollment Form:<br />
https://edocs.dhs.state.mn.us/lfserver/Public/DHS-4087-ENG<br />
Complete the ‘Submitter <strong>Information</strong>’ with the following:<br />
DPWMN MEDICAID MINNESOTA x x x 2 x x<br />
Submitter ID (UMPI) - A268453200<br />
Submitter Name – Availity LLC<br />
Address – 740 E Campbell Rd, Ste 1000, Richardson, TX 75081<br />
Phone – 800.282.4548<br />
70029 MEDICAID MISSOURI x x 4 x x<br />
CNTNM MEDICAID NEW MEXICO x 4+ x x NPI required in all loops, EIN or SSN required in 2310A, 2310B, 2420A and 2420F<br />
16 of 124 Visit our web site: www.availity.com
Last<br />
Update<br />
Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
PRESA MEDICAID NEW MEXICO PRESBYTERIAN SALUD x 4 x x<br />
Please add provider number in 2010AA REF02 "or" 2310B REF02. Provider number is 11 digits or<br />
less. Contact 888.863.3638, #6 then #2 to obtain ID.<br />
MMISODJFS MEDICAID OHIO x x x 4 x x Please contact 1.800.686.1516 for EDI enrollment.<br />
86916 MEDICAID TEXAS x 4# x x<br />
86916 MEDICAID TEXAS HEALTH STEPS x 4# x x NPI - No REF 0B.<br />
Providers must enroll with Virginia Medicaid prior to submitting transactions. For enrollment questions<br />
please call 1.888.829.5373. For providers needing help interpreting Virginia Medicaid policy and<br />
AIDVA MEDICAID VIRGINIA x x x 4 x x<br />
procedures and in resolving problems with individual claims please contact the Virginia Department<br />
of Medical Assistance Services (DMAS) “HELPLINE” at 804.786.6273. To reach the Virginia<br />
Medicaid EDI Helpdesk please call 1.866.352.0766.<br />
Click this link and complete the required EDI enrollment for ProviderOne:<br />
AIDWA MEDICAID WASHINGTON PROVIDER 1 x x 4 x<br />
https://www.waproviderone.org/ . Availity’s ProviderOne Clearinghouse ID is 1054194. If you have<br />
questions, call 800.562.3022 ext. 16137<br />
37298 MEDICAL BENEFITS ADMINISTRATORS OF MARYLAND, INC. 2 x x<br />
74323 MEDICAL BENEFITS MUTUAL 2 x x<br />
52181 MEDICAL DEVELOPMENT INTERNATIONAL 2 x x<br />
29076 MEDICAL MUTUAL OF OHIO 2 x x<br />
BC004 MEDICAL MUTUAL OF OHIO 3 x<br />
CSMED MEDICAL NETWORK OF COLORADO SPRINGS 2 x<br />
58203 MEDICAL RESOURCE NETWORK 2 x x<br />
38224 MEDICAL VALUE PLAN - MVP - OHIO 2 x x<br />
17003<br />
18003<br />
19003<br />
MEDICARE DMERC REGION B<br />
(Covering: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin)<br />
MEDICARE DMERC REGION C<br />
(Covering: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi,<br />
New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee,<br />
Texas, Virgin Islands, Virginia and West Virginia.)<br />
MEDICARE DMERC REGION D<br />
(Covering: Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa,<br />
Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, N. Mariana<br />
Island,Oregon, South Dakota, Utah, Washington, and Wyoming.)<br />
x x x 4* x<br />
x x x 4* x<br />
x x x 4* x<br />
17 of 124 Visit our web site: www.availity.com<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
New Electronic Providers (Form 1 and 3 required)<br />
http://apps.ngsmedicare.com/applications/CEDIEnrollmentAgreement.aspx &<br />
http://apps.ngsmedicare.com/applications/CEDISupplierAuthForm.aspx<br />
Existing Electronic Enrolled Providers (Form 3 only)<br />
http://apps.ngsmedicare.com/applications/CEDISupplierAuthForm.aspx<br />
Form 1 – Complete the Submitter <strong>Information</strong> as follows:<br />
Submitter Status: Existing Submitter, Region B Submitter ID C08495979, Region C Submitter ID<br />
C08495979, Region D Submitter ID D08607230, Submitter Name: Availity LLC, Submitter Type:<br />
Clearinghouse<br />
Form 3 – Complete the Submitter and/or Receiver <strong>Information</strong> as follows:<br />
Entity Name - Availity LLC, Operating as a – Clearinghouse, Region B Submitter ID C08495979,<br />
Region C Submitter ID C08495979, Region D Submitter ID D08607230<br />
Address - 740 E Campbell Rd, Ste 1000, Richardson, TX 75081, Contact Name - Availity Client<br />
Services, Contact Phone Number - 800.282.4548, Contact Email – support@availity.com.<br />
Ordering provider name and number are required on every service line. The information must go in<br />
Loop 2420E, NM109.<br />
New Electronic Providers (Form 1 and 3 required)<br />
http://apps.ngsmedicare.com/applications/CEDIEnrollmentAgreement.aspx &<br />
http://apps.ngsmedicare.com/applications/CEDISupplierAuthForm.aspx<br />
Existing Electronic Enrolled Providers (Form 3 only)<br />
http://apps.ngsmedicare.com/applications/CEDISupplierAuthForm.aspx<br />
Form 1 – Complete the Submitter <strong>Information</strong> as follows:<br />
Submitter Status: Existing Submitter, Region B Submitter ID C08495979, Region C Submitter ID<br />
C08495979, Region D Submitter ID D08607230, Submitter Name: Availity LLC, Submitter Type:<br />
Clearinghouse<br />
Form 3 – Complete the Submitter and/or Receiver <strong>Information</strong> as follows:<br />
Entity Name - Availity LLC, Operating as a – Clearinghouse, Region B Submitter ID C08495979,<br />
Region C Submitter ID C08495979, Region D Submitter ID D08607230<br />
Address - 740 E Campbell Rd, Ste 1000, Richardson, TX 75081, Contact Name - Availity Client<br />
Services, Contact Phone Number - 800.282.4548, Contact Email – support@availity.com.<br />
Ordering provider name and number are required on every service line. The information must go in<br />
Loop 2420E, NM109.<br />
New Electronic Providers (Form 1 and 3 required)<br />
http://apps.ngsmedicare.com/applications/CEDIEnrollmentAgreement.aspx &<br />
http://apps.ngsmedicare.com/applications/CEDISupplierAuthForm.aspx<br />
Existing Electronic Enrolled Providers (Form 3 only)<br />
http://apps.ngsmedicare.com/applications/CEDISupplierAuthForm.aspx<br />
Form 1 – Complete the Submitter <strong>Information</strong> as follows:<br />
Submitter Status: Existing Submitter, Region B Submitter ID C08495979, Region C Submitter ID<br />
C08495979, Region D Submitter ID D08607230, Submitter Name: Availity LLC, Submitter Type:<br />
Clearinghouse<br />
Form 3 – Complete the Submitter and/or Receiver <strong>Information</strong> as follows:<br />
Entity Name - Availity LLC, Operating as a – Clearinghouse, Region B Submitter ID C08495979,<br />
Region C Submitter ID C08495979, Region D Submitter ID D08607230<br />
Address - 740 E Campbell Rd, Ste 1000, Richardson, TX 75081, Contact Name - Availity Client<br />
Services, Contact Phone Number - 800.282.4548, Contact Email – support@availity.com.<br />
Ordering provider name and number are required on every service line. The information must go in<br />
Loop 2420E, NM109.
Last<br />
Update<br />
Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
04111 MEDICARE PART A COLORADO x x 3 x<br />
09101 MEDICARE PART A FLORIDA x x x 4* x<br />
00320 MEDICARE PART A MINNESOTA x x 4* x<br />
04211 MEDICARE PART A NEW MEXICO x x 3 x<br />
04311 MEDICARE PART A OKLAHOMA x x 3 x<br />
04411 MEDICARE PART A TEXAS x x 3 x<br />
02102 MEDICARE PART B ALASKA x x x 4* x<br />
03102 MEDICARE PART B ARIZONA x x x 4* x<br />
Institutional<br />
Claim (837)<br />
18 of 124 Visit our web site: www.availity.com<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form:<br />
https://www.novitas-solutions.com/edi/enrollment/pdf/8292.pdf<br />
Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE<br />
INFORMATION:<br />
Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity.<br />
Availity does not prepare claims.<br />
Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC.<br />
Section F: REQUEST TYPE: Select Add to existing submitter ID: 1937018<br />
Before submitting claims you must do the following:<br />
1. Complete the EMC change of information form. FCSO requires each provider to complete this<br />
form in advance of any changes affecting the provider’s EDI connectivity to FSCO. The form is<br />
available at: http://medicare.fcso.com/EDI_Forms/. In Section A, under Type of Change being<br />
requested, select Add a Provider to an existing submitter number. In Section C, list P8467 for the<br />
submitter number. Submit the completed form to FCSO. If you do not submit the completed form to<br />
FCSO, Availity will not be able to send claims to FCSO on your behalf. You will receive an<br />
acknowledgement from FCSO once your form is processed. After you receive the acknowledgement,<br />
you can begin sending your Florida Medicare Part A claims. Please contact your practice<br />
management system vendor if you need assistance adding this Payer ID to your system. Note: These<br />
steps apply ONLY to Florida Medicare Part A (837I) and Part B (837P) Claims. This does not affect<br />
Eligibility and Benefits Inquiries (270/271), or how you currently receive your Electronic Remittance<br />
Advice (835) files or paper Remittance Advices from FCSO today. For questions concerning the<br />
forms, contact the Medicare EDI help desk 888.670.0940.<br />
Click this link and complete the required enrollment: https://www.noridianmedicare.com. Please use<br />
Availity’s Submitter ID of CH00033 on the enrollment form. After enrolling, your payer assigned<br />
submitted ID should go in loop 1000A NM109. For questions, call EDI Support Services at<br />
800.967.7902.<br />
Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form:<br />
https://www.novitas-solutions.com/edi/enrollment/pdf/8292.pdf<br />
Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE<br />
INFORMATION:<br />
Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity.<br />
Availity does not prepare claims.<br />
Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC.<br />
Section F: REQUEST TYPE: Select Add to existing submitter ID: 1937020<br />
Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form:<br />
https://www.novitas-solutions.com/edi/enrollment/pdf/8292.pdf<br />
Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE<br />
INFORMATION:<br />
Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity.<br />
Availity does not prepare claims.<br />
Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC.<br />
Section F: REQUEST TYPE: Select Add to existing submitter ID: 1937021<br />
Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form:<br />
https://www.novitas-solutions.com/edi/enrollment/pdf/8292.pdf<br />
Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE<br />
INFORMATION:<br />
Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity.<br />
Availity does not prepare claims.<br />
Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC.<br />
Section F: REQUEST TYPE: Select Add to existing submitter ID: S00532<br />
Visit this link and complete the required enrollment:<br />
https://noridian.totalonboarding.com/Account/Login?ReturnUrl=%2f<br />
a. Company Name – Availity LLC<br />
b. Trading Partner Id – CH00033<br />
c. Do not select Availity LLC to ‘Manage Vendor’ account<br />
The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services<br />
at 800.967.7902.<br />
Visit this link and complete the required enrollment:<br />
https://noridian.totalonboarding.com/Account/Login?ReturnUrl=%2f<br />
a. Company Name – Availity LLC<br />
b. Trading Partner Id – CH00033<br />
c. Do not select Availity LLC to ‘Manage Vendor’ account<br />
The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services<br />
at 800.967.7902.
Last<br />
Update<br />
Payer ID Payer Name<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
04112 MEDICARE PART B COLORADO x x 3 x<br />
09102 MEDICARE PART B FLORIDA x x x 4* x<br />
02202 MEDICARE PART B IDAHO x x x 4* x<br />
00952 MEDICARE PART B ILLINOIS x x x 4* x<br />
08202 MEDICARE PART B MICHIGAN x x 4* x<br />
00954 MEDICARE PART B MINNESOTA x x x 4* x<br />
04212 MEDICARE PART B NEW MEXICO x x x 3 x<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Institutional<br />
Claim (837)<br />
19 of 124 Visit our web site: www.availity.com<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form:<br />
https://www.novitas-solutions.com/edi/enrollment/pdf/8292.pdf<br />
Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE<br />
INFORMATION:<br />
Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity.<br />
Availity does not prepare claims.<br />
Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC.<br />
Section F: REQUEST TYPE:<br />
Select Add to existing submitter ID – Enter Submitter ID JBS00532<br />
Before submitting claims you must do the following:<br />
1. Complete the EMC change of information form. FCSO requires each provider to complete this<br />
form in advance of any changes affecting the provider’s EDI connectivity to FSCO. The form is<br />
available at: http://medicare.fcso.com/EDI_Forms/. In Section A, under Type of Change being<br />
requested, select Add a Provider to an existing submitter number. In Section C, list P8467 for the<br />
submitter number. Submit the completed form to FCSO. If you do not submit the completed form to<br />
FCSO, Availity will not be able to send claims to FCSO on your behalf. You will receive an<br />
acknowledgement from FCSO once your form is processed. After you receive the acknowledgement,<br />
you can begin sending your Florida Medicare Part B claims. Please contact your practice<br />
management system vendor if you need assistance adding this Payer ID to your system. Note: These<br />
steps apply ONLY to Florida Medicare Part A (837I) and Part B (837P) Claims. This does not affect<br />
Eligibility and Benefits Inquiries (270/271), or how you currently receive your Electronic Remittance<br />
Advice (835) files or paper Remittance Advices from FCSO today. For questions concerning the<br />
forms, contact the Medicare EDI help desk 888.670.0940.<br />
Visit this link and complete the required enrollment:<br />
https://noridian.totalonboarding.com/Account/Login?ReturnUrl=%2f<br />
a. Company Name – Availity LLC<br />
b. Trading Partner Id – CH00033<br />
c. Do not select Availity LLC to ‘Manage Vendor’ account<br />
The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services<br />
at 800.967.7902.<br />
Contact 877-567-7261 to enroll in EDI.<br />
The required Clearinghouse information needed to complete the EDI enrollment:<br />
Name: Availity LLC<br />
Address: 10752 Deerwood Park Blvd. #110<br />
City: Jacksonville State: FL Zip: 32256<br />
Contact: Client Services<br />
Contact Email address: support@availity.com<br />
Contact Phone Number: 800-282-4548<br />
WPS Submitter Number: 70000<br />
Contact 877-567-7261 to enroll in EDI.<br />
The required Clearinghouse information needed to complete the EDI enrollment:<br />
Name: Availity LLC<br />
Address: 10752 Deerwood Park Blvd. #110<br />
City: Jacksonville State: FL Zip: 32256<br />
Contact: Client Services<br />
Contact Email address: support@availity.com<br />
Contact Phone Number: 800-282-4548<br />
WPS Submitter Number: 70000<br />
Contact 877-567-7261 to enroll in EDI.<br />
The required Clearinghouse information needed to complete the EDI enrollment:<br />
Name: Availity LLC<br />
Address: 10752 Deerwood Park Blvd. #110<br />
City: Jacksonville State: FL Zip: 32256<br />
Contact: Client Services<br />
Contact Email address: support@availity.com<br />
Contact Phone Number: 800-282-4548<br />
WPS Submitter Number: 70000<br />
Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form:<br />
https://www.novitas-solutions.com/edi/enrollment/pdf/8292.pdf<br />
Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE<br />
INFORMATION:<br />
Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity.<br />
Availity does not prepare claims.<br />
Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC.<br />
Section F: REQUEST TYPE:<br />
Select Add to existing submitter ID – Enter Submitter ID JBS00532
Last<br />
Update<br />
Payer ID Payer Name<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
04312 MEDICARE PART B OKLAHOMA x x x 3 x<br />
02302 MEDICARE PART B OREGON x x x 4* x<br />
04412 MEDICARE PART B TEXAS x x x 3 x<br />
11302 MEDICARE PART B VIRGINIA x x 4* x<br />
02402 MEDICARE PART B WASHINGTON x x x 4* x<br />
00951 MEDICARE PART B WISCONSIN x x 3 x<br />
00882 MEDICARE RAILROAD x x x 4* x<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
HDM04 MEDICO INSURANCE COMPANY 4 x x<br />
Institutional<br />
Claim (837)<br />
20 of 124 Visit our web site: www.availity.com<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form:<br />
https://www.novitas-solutions.com/edi/enrollment/pdf/8292.pdf<br />
Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE<br />
INFORMATION:<br />
Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity.<br />
Availity does not prepare claims.<br />
Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC.<br />
Section F: REQUEST TYPE:<br />
Select Add to existing submitter ID – Enter Submitter ID JBS00532<br />
Visit this link and complete the required enrollment:<br />
https://noridian.totalonboarding.com/Account/Login?ReturnUrl=%2f<br />
a. Company Name – Availity LLC<br />
b. Trading Partner Id – CH00033<br />
c. Do not select Availity LLC to ‘Manage Vendor’ account<br />
The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services<br />
at 800.967.7902.<br />
Payer requires EDI enrollment. Visit this link and complete the required Novitas EDI Enrollment form:<br />
https://www.novitas-solutions.com/edi/enrollment/pdf/8292.pdf<br />
Section E: COMPLETE THE VENDOR, BILLING SERVICE, AND/OR CLEARINGHOUSE<br />
INFORMATION:<br />
Who will be preparing the electronic claims? Select which applies to you. Do not enter Availity.<br />
Availity does not prepare claims.<br />
Who will be submitting the electronic claim files? Select Clearinghouse and enter Availity LLC.<br />
Section F: REQUEST TYPE:<br />
Select Add to existing submitter ID – Enter Submitter ID JBS00532<br />
Click this link and complete the required enrollment:<br />
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%2011%20Part%<br />
20B~EDI~Enrollment~89BLL31745?open&navmenu=EDI||||<strong>Information</strong><strong>Information</strong><br />
<strong>Information</strong> necessary to complete the EDI Provider <strong>Information</strong> form:<br />
Section 2 - EDI Software Vendor Data, enter ‘Proprietary’.<br />
Section 3 - EDI Billing Service/Clearinghouse Data, enter Company Name: Availity L.L.C., Primary<br />
Contact: Availity Client Services, Phone: 1-800-282-4548, Submitter ID: S00532<br />
For questions, call Palmetto GBA Technology Support Desk at 866.749.4301. Please note - Availity<br />
is not listed on the Palmetto GBA Part B Approved 5010 Errata Vendors list because Availity is not a<br />
software vendor. Availity is a clearinghouse who provides exemplary electronic service to the<br />
provider community. Palmetto GBA has granted Availity production approval for 5010 transactions.<br />
Providers using Availity to send claims to Palmetto GBA are not required to test.<br />
Visit this link and complete the required enrollment:<br />
https://noridian.totalonboarding.com/Account/Login?ReturnUrl=%2f<br />
a. Company Name – Availity LLC<br />
b. Trading Partner Id – CH00033<br />
c. Do not select Availity LLC to ‘Manage Vendor’ account<br />
The Assigned Submitter ID must go in Loop 1000A, NM109. For questions, call EDI Support Services<br />
at 800.967.7902.<br />
Contact 877-567-7261 to enroll in EDI.<br />
The required Clearinghouse information needed to complete the EDI enrollment:<br />
Name: Availity LLC<br />
Address: 10752 Deerwood Park Blvd. #110<br />
City: Jacksonville State: FL Zip: 32256<br />
Contact: Client Services<br />
Contact Email address: support@availity.com<br />
Contact Phone Number: 800-282-4548<br />
WPS Submitter Number: 70000<br />
Visit this link and complete the required enrollment:<br />
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Railroad%20Medicare~EDI~<br />
Enrollment~7GM24F7631?open<br />
<strong>Information</strong> necessary to complete the form:<br />
Submitter ID - S00532, ERN Receiver ID - ER0073, Submitter Name – Availity LLC, Owner Name –<br />
Lloyd Beesing, Contact Person - Client Services, Phone - 800-282-4548, Fax - 904-470-4773,<br />
Address – P.O. Box 550857, Jacksonville, FL 32255-0857, email - support@availity.com, Response<br />
Format – File, Mode: Connect – Direct,<br />
Data Compression - PKZIP. For questions concerning the forms contact the EDI help desk<br />
866.749.4301.
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Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
13123 MEDIGOLD PPO 2 x x<br />
412MP MEDPARTNERS ADMIN SERVICES 2 x x<br />
35205 MEDPARTNERS ADMIN SERVICES (IN) 2 x x<br />
62160 MEDSOLUTIONS, INC. 2 x x<br />
00243 MEDSTAR FAMILY CHOICE 3 x<br />
74227 MEGA LIFE & HEALTH INS. (STUDENT INSURANCE) x 2 x x<br />
MCA11 MEMORIAL CLINICAL ASSOCIATES x 4 x x For 835, 270 and 276 transactions please use Payer ID: HPN11<br />
MHHNP MEMORIAL HERMANN HEALTH NETWORK 4* x x<br />
59064 MEMORIAL INTEGRATED HEALTHCARE 2 x x<br />
74289 MENTAL HEALTH NETWORK (MHNET) 2 x x<br />
86052 MERCY CARE PLAN 2 x x<br />
22326 MERCY HEALTH PLAN OF NJ x 2 x x<br />
Medicaid managed care. For EDI support, please e-mail edi.horizonnjhealth@kmhp.com; formerly<br />
Horizon Mercy <strong>Health</strong> Plan<br />
MER11 MERCY HEALTH PLANS 2 x x<br />
13189 MERIDIAN HEALTH PLAN OF ILLINOIS 4 x x<br />
14145 MERIDIAN HEALTH PLAN OF IOWA 4 x x<br />
52563 MERIDIAN HEALTH PLAN OF MICHIGAN 4 x x<br />
64157 MERITAIN HEALTH 2 x x Formerly know as North American Administrators<br />
85035 MESA MENTAL HEALTH 2 x<br />
87726 MET LIFE x 2 x x<br />
65113 METCARE HEALTH PLANS 2 x x<br />
62168 METHODIST ASSOC HEALTH PLAN 2 x x<br />
80314 METHODIST CARE 3 x x<br />
13265 METRO PLUS HEALTH PLAN 2 x<br />
10850 METROPOLITAN HEALTH PLAN (MHP) x 2 x x<br />
87726 METROPOLITAN LIFE INS CO x 2 x x<br />
MWP01 METROWEST HEALTH PLAN-PREFERRED CARE 2 x<br />
92579 MIAMI BEHAVIORAL HEALTH 2 x x<br />
87726 MICHAEL REESE HMO x 2 x x<br />
37281 MID-AMERICA ASSOCIATES, INC. 2 x x<br />
90956 MIDLAND NATIONAL LIFE INSURANCE CO 2 x<br />
47080 MIDLANDS CHOICE 2 x x<br />
61146 MIDWEST GROUP BENEFITS 2 x x<br />
MHP77 MIDWEST HEALTH PLAN 2 x x<br />
59224 MIDWEST NATIONAL LIFE INS CO – TN 2 x x<br />
MIDSC MIDWEST PREFERRED 2 x<br />
MIDSC MIDWEST SECURITIES 2 x<br />
79480 MIDWEST SECURITY 2 x x<br />
MIDSC MIDWEST SECURITY ADMINISTRATORS (MSA) 2 x<br />
MIDSC MIDWEST SECURITY INSURANCE CO. (MSIC) 2 x<br />
MPMG1 MILLS PENINSULA MEDICAL GROUP 3 x<br />
60054 MINNEAPOLIS PRUDENTIAL 2 x x<br />
68068 MISSISSIPPI CBH (CENPATICO) x 3 x x The payer will be available with this payer ID effective 12/1/12.<br />
64088 MISSISSIPPI SELECT HEALTH CARE 2 x x<br />
37275 MISSOULA COUNTY MEDICAL BENEFITS PLAN 2 x x<br />
13350 MODA HEALTH x 3 x formerly ODS <strong>Health</strong> Plan<br />
13350 MODA HEALTH x 2 x formerly ODS <strong>Health</strong> Plan<br />
38333 MOLINA HEALTHCARE OF CALIFORNIA 2 x x<br />
51062 MOLINA HEALTHCARE OF FLORIDA 2 x x<br />
38334 MOLINA HEALTHCARE OF MICHIGAN 2 x x<br />
09824 MOLINA HEALTHCARE OF NEW MEXICO 2 x x<br />
20149 MOLINA HEALTHCARE OF OHIO 2 x x<br />
20554 MOLINA HEALTHCARE OF TEXAS 2 x x<br />
38336 MOLINA HEALTHCARE OF WASHINGTON 2 x x<br />
ABRI1 MOLINA HEALTHCARE OF WISCONSIN 2 x x<br />
50749 MONDIAL ASSISTANCE 2 x x<br />
13174 MONTEFIORE CONTRACT MANAGEMENT ORG. 2 x x<br />
MMLI7 MONUMENTAL LIFE INS CO - BALTIMORE 4 x x Cancer<br />
MMLI6 MONUMENTAL LIFE INS CO - BALTIMORE 4 x x Cancer<br />
MMLI8 MONUMENTAL LIFE INS CO - CEDAR RAPIDS 4 x x Med Supp/Retiree Med<br />
MMLI9 MONUMENTAL LIFE INS CO - PLANO 4 x x Major Medical/Cancer<br />
MMLI5 MONUMENTAL LIFE INS CO - SCRANTON 4 x x Med Supp<br />
MMLI4 MONUMENTAL LIFE INS CO - VALLEY FORGE 4 x x Med Supp<br />
MMLI3 MONUMENTAL LIFE INS CO (HURST, TX) 4 x x Long Term Care<br />
MMLIC MONUMENTAL LIFE INS CO (LITTLE ROCK, AR) 4 x x<br />
Accident only, Cancer only, First occurrence invasive cancer, Heart disease attack or stroke only,<br />
Hospital confinement indemnity, Hospital intensive care<br />
MPI01 MOTION PICTURE INDUSTRY PENSION AND HEALTH PLAN 3 x x<br />
36111 MOTOROLA, INC. 2 x<br />
86040 MOUNTAIN STATES ADMINISTRATIVE SERVICES 2 x x<br />
80900 MPA - CUSTOM PROVIDER NETWORK 2 x x<br />
37233 MPE EMPLOYEE BENEFIT SERVICES, INC. 2 x x<br />
95444 MPLAN, INC/HEALTHCARE GROUP, LLC 2 x x<br />
95655 MT. CARMEL HEALTH PLAN 2 x x<br />
34080 MULTIPLAN WISCONSIN PREFERRED PROVIDER NETWORK (WPPN) 4 x x<br />
81883 MUNICIPAL HEALTH BENEFIT FUND 2 x x<br />
37256 MUTUAL ASSURANCE ADMINISTRATORS 2 x x<br />
21 of 124 Visit our web site: www.availity.com
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Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
70408 MUTUAL BENEFIT LIFE (MBL) 2 x x<br />
71412 MUTUAL OF OMAHA 2 x x<br />
71412 MUTUALLY PREFERRED 2 x x For your MVP Provider number, call (800) 684-9286.<br />
14165 MVP HEALTH PLAN OF NY x 3 x x<br />
91136 N.W. IRONWORKERS HEALTH & SECURITY HEALTH FUND 2 x x<br />
91136 N.W. ROOFERS & EMPLOYERS HEALTH & SECURITY TRUST FUND 2 x x<br />
91136 N.W. TEXTILE PROCESSORS 2 x x<br />
65085 NAA - NORTH AMERICAN ADMINISTRATORS (NASHVILLE, TN) 2 x x<br />
NANPR NAMM PARTNERS, INC 2 x x<br />
58182 NAPHCARE 2 x x<br />
56176 NATIONAL BENEFIT ADMIN. – N.C. 4 x x<br />
56175 NATIONAL BENEFIT ADMINISTRATORS – NEW JERSEY 4 x x<br />
37126 NATIONAL CLAIM ADMINISTRATION 2 x x<br />
90956 NATIONAL FINANCIAL INSURANCE COMPANY 2 x<br />
98205 NATIONAL FOUNDATION LIFE INSURANCE COMPANY 2 x<br />
NIA11 NATIONAL IMAGING ASSOCIATES x 4 x x<br />
52132 NATIONAL RURAL ELECTRIC COOP (NRECA) 2 x x<br />
53011 NATIONAL RURAL LETTER CARRIER ASSOC (NALC) 2 x x<br />
NTA11 NATIONAL TEACHERS ASSOCIATION (NTA) 2 x x<br />
52103 NATIONAL TELECOMMUNICATIONS COOPERATIVE ASSOCIATION (NTCA) 2 x x<br />
52104<br />
NATIONAL TELECOMMUNICATIONS COOPERATIVE ASSOCIATION (NTCA) -<br />
STAFF MEMBERS<br />
2 x x<br />
31417 NATIONWIDE SPECIALTY HEALTH 2 x x<br />
75191 NCAS - CHARLOTTE, NC 2 x x<br />
75190 NCAS - FAIRFAX, VA 2 x x<br />
95123 NEIGHBORHOOD HEALTH PARTNERSHIP 2 x x<br />
04293 NEIGHBORHOOD HEALTH PLAN 3 x x<br />
05047 NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND (NHPRI) 2 x<br />
11325 NEIGHBORHOOD HEALTH PROVIDERS 2 x x<br />
37255 NESIKA HEALTH GROUP 2 x x<br />
66055 NETCARE LIFE AND HEALTH INSURANCE 2 x x<br />
04332 NETWORK HEALTH 2 x x<br />
77076 NETWORK HEALTH INS CORP - MEDICARE 2 x x<br />
39144 NETWORK HEALTH SOLUTIONS 2 x<br />
95998 NEW AVENUES 2 x x<br />
80705 NEW ENGLAND FINANCIAL x 2 x x<br />
75281 NEW ERA LIFE INSURANCE COMPANY 2 x x<br />
76031 NEW ERA WELFARE BENEFIT PLAN TRUST 2 x x<br />
65056 NEW MARKET DIMENSIONS 2 x x<br />
NYL11 NEW YORK LIFE - LTC 2 x x<br />
14179 NEW YORK MEDICAL IMAGING - MVP 4 x<br />
11334 NEW YORK NETWORK MANAGEMENT 2 x<br />
38225 NGS AMERICAN, INC. 2 x x<br />
81264 NIPPON LIFE INSURANCE CO 2 x x<br />
34159 NORTH AMERICA BENEFITS NETWORK 2 x x Name has changed to Meritain <strong>Health</strong><br />
Only claims from providers in Northern California. Please contact the EDI Dept for North American<br />
64157 NORTH AMERICAN ADMINISTRATORS 2 x x<br />
Medical Management (NAMM) - Northern California Lead/Supervisor at 800.956.8000 prior to initial<br />
submission of claims.<br />
E3510 NORTH AMERICAN ADMINISTRATORS x 2 x<br />
36392 NORTH SUBURBAN ASSOCIATED PHYS 2 x x<br />
38238 NORTHERN CALIFORNIA SHEET METAL WORKERS INSURANCE PLAN 2 x<br />
36347 NORTHERN ILLINOIS HEALTH PLAN 2 x x<br />
88027 NORTHERN NEVADA TRUST FUND 2 x x<br />
48026 NORTHSHORE PHYSICIAN ASSOCIATES 2 x x<br />
10850 NORTHSTAR ADVANTAGE (MHP) x 2 x x<br />
NANWC NORTHWEST COMMUNITY HEALTH PARTNERS 2 x x Use this payer ID for claims with a Date of Service prior to 1/1/2013.<br />
35199 NORTHWEST COMMUNITY HEALTH PARTNERS 4 x x Use this payer ID for claims with a Date of Service after 1/1/2013.<br />
NWDC1 NORTHWEST DIAGNOSTIC CLINIC x 4 x x For 835, 270 and 276 transactions please use Payer ID: HPN11<br />
NPN11 NORTHWEST PHYSICIANS NETWORK 2 x x<br />
36346 NORTHWEST SUBURBAN IPA (ILLINOIS) 3 x x<br />
16114 NOVA CASUALTY CO. 2 x x<br />
16644 NOVA HEALTH ADMIN. (GRAND ISLAND, NY) 2 x x<br />
06226 NOVANET 2 x<br />
71080 NOVASYS 2 x<br />
37299 NYHART 2 x x<br />
91135 NYLCARE ETHIX NORTHWEST 2 x<br />
14180 NYMI OXFORD 3 x<br />
NAOAK OAK WEST PRIMARY PHYSICIANS ASSOCIATION 2 x x<br />
13350 OEA CHOICE TRUST 3 x x<br />
OBA18 OGDEN BENEFITS ADMINISTRATION 2 x x<br />
34189 OHIO HEALTH CHOICE, PPO 3 x x<br />
95435 OHIO HEALTH GROUP 2 x Formerly named as <strong>Health</strong> Pledge HMO.<br />
25150 OMNICARE, A COVENTRY HEALTH PLAN 3 x x<br />
22321 ONE CALL MEDICAL 2 x x<br />
80705 ONE HEALTH PLAN (ALL 50 STATES) x 2 x x<br />
95379 ONE HEALTH PLAN OF CALIFORNIA, INC x 2 x<br />
22 of 124 Visit our web site: www.availity.com
Last<br />
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Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
95569 ONE HEALTH PLAN OF GEORGIA, INC x 2 x<br />
95388 ONE HEALTH PLAN OF ILLINOIS, INC x 2 x<br />
91136 OPERATING ENGINEERS LOCALS 302 & 612 HEALTH & SECURITY FUND 2 x x<br />
56190 OPTICARE EYE HEALTH NETWORK 2 x<br />
52152 OPTIMUM CHOICE OF THE CAROLINAS 2 x x<br />
41194 OPTUMHEALTH CARE SOLUTIONS, FORMERLY U.R.N. 2 x x<br />
AIDOR OREGON DHS OMAP/DMAP (MEDICAID) x x 2 x<br />
Click this link and complete the required enrollment forms:<br />
http://www.oregon.gov/OHA/edi/Pages/reg_testing.aspx . Mail completed enrollment forms to: Availity<br />
L.L.C., Attn: Contracts and Legal, 10752 Deerwood Park Blvd S, Ste 110 Jacksonville, FL 32256.<br />
Secondary claims are not accepted electronically.<br />
13383 ORTHANET - AETNA 2 x x Orthonet provider id is required in billing provider (2010AA) loop.<br />
13381 ORTHONET CORPORATION – CIGNA 2 x x<br />
OSFMC OSF CARE ADVANTAGE 2 x<br />
62171 OSF HEALTH PLAN 3 x x<br />
CLFR2 OSMA HEALTH 2 x x<br />
06111 OXFORD HEALTH PLANS 2 x x<br />
60054 PACIFIC GAS AND ELECTRIC (PG &E) 2 x x<br />
87726 PACIFICARE 2 x x Effective 8/20/12, payer ID 95959 will no longer be valid. Please use payer ID 87726.<br />
COFHP PACIFICARE - COLORADO 3 x<br />
95958 PACIFICARE (ENCOUNTERS ONLY) 2 x<br />
87726 PACIFICARE / SECURE HORIZONS 2 x x Effective 8/20/12, payer ID 95959 will no longer be valid. Please use payer ID 87726.<br />
87726 PACIFICARE BEHAVIORAL HEALTH 2 x Effective 8/20/12, payer ID 33053 will no longer be valid. Please use payer ID 87726.<br />
87726 PACIFICARE OF ARIZONA 2 x Effective 8/20/12, payer ID 95964 will no longer be valid. Please use payer ID 87726.<br />
87726 PACIFICARE OF CALIFORNIA - HMO 2 x x Effective 8/20/12, payer ID 95964 will no longer be valid. Please use payer ID 87726.<br />
87726 PACIFICARE OF COLORADO 2 x x Effective 8/20/12, payer ID 95962 will no longer be valid. Please use payer ID 87726.<br />
87726 PACIFICARE OF OKLAHOMA - HMO (CLAIMS) 2 x x Effective 8/20/12, payer ID 95959 will no longer be valid. Please use payer ID 87726.<br />
87726 PACIFICARE OF OREGON - HMO (CLAIMS) 2 x x Effective 8/20/12, payer ID 95959 will no longer be valid. Please use payer ID 87726.<br />
87726 PACIFICARE OF TEXAS - HMO (CLAIMS) 2 x x Effective 8/20/12, payer ID 95959 will no longer be valid. Please use payer ID 87726.<br />
87726 PACIFICARE OF WASHINGTON 2 x x Effective 8/20/12, payer ID 95959 will no longer be valid. Please use payer ID 87726.<br />
87726 PACIFICARE PPO - ALL STATES 2 x x Effective 8/20/12, payer ID 95962 will no longer be valid. Please use payer ID 87726.<br />
93029 PACIFICSOURCE HEALTH PLANS 2 x x<br />
20377 PACIFICSOURCE MEDICARE 2 x<br />
58174 PARAGON BENEFITS, INC. 2 x<br />
66917 PARKLAND COMMUNITY HEALTH PLAN 2 x x<br />
61129 PASSPORT HEALTH PLAN 2 x x<br />
10525 PATIENT ADVOCATES, LLC 2 x x<br />
37210 PAYNET, INC 2 x x<br />
65018 PCA HEALTH PLAN OF FLORIDA 3 x<br />
95885 PCA HEALTH PLANS OF TEXAS (HUMANA) x 3 x x<br />
68069 PEACH STATE HEALTH PLAN x 3 x x payer ID 68049 may also be used<br />
37086 PEKIN INSURANCE 4 x x<br />
72126 PEOPLE'S HEALTH NETWORK 2 x x<br />
25133 PERSONALCARE 2 x x<br />
PHIF4 PHIFER WIRE PRODUCTS, INC. 2 x x<br />
74647 PHOENIX HEALTH PLAN 2 x x<br />
67814 PHOENIX HOME LIFE 2 x<br />
67814 PHOENIX MUTUAL 2 x Payer ID is valid as of 4/5/2013<br />
37330 PHYSICIAN HEALTH PLAN (PHP) 2 x x<br />
PCN12 PHYSICIANS CARE NETWORK (POLYCLINIC) 2 x x<br />
37136 PHYSICIANS HEALTH ASSOCIATION OF ILLINOIS 2 x x<br />
PHCS1 PHYSICIANS HEALTH CHOICE - CLAIMS 4 x x<br />
20398 PHYSICIANS HEALTH COLLABORATIVE 2 x x<br />
37330<br />
PHYSICIANS HEALTH PLAN OF MID MICHIGAN<br />
(MEDICAID AND COMMERCIAL CLAIMS)<br />
2 x x<br />
12399 PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA 2 x<br />
65031 PHYSICIANS HEALTHCARE PLANS 2 x<br />
47027 PHYSICIANS MUTUAL INSURANCE COMPANY 2 x<br />
39156 PHYSICIANS PLUS INS. CORP 2 x x Please contact 877.978.7776 to enroll.<br />
10775 PHYSICIANS UNITED PLAN x 2 x x<br />
PPMO1 PINNACLE PHYSICIAN MANAGEMENT ORG x 4 x x For 835, 270 and 276 transactions please use Payer ID: HPN11<br />
CCIA1 PINNACOL ASSURANCE 2 x<br />
84109 PINNACOL ASSURANCE 2 x<br />
37224 PITTMAN & ASSOCIATES 2 x<br />
37287 PLANNED ADMINISTRATORS, INC. 2 x x<br />
POD1S PODIATRY FIRST 2 x<br />
POD1ST PODIATRY FIRST 2 x<br />
32680 POLY AMERICA MEDICAL BENEFITS PLAN 2 x x<br />
16111 POMCO 2 x x<br />
73159 PPO OKLAHOMA 2 x x<br />
72148 PPO PLUS LLC 2 x x<br />
PPOM1 PPOM 3 x<br />
36373 PRAIRIE STATES ENTERPRISES, INC. 2 x x<br />
EPF10 PREFERRED ADMINISTRATORS x x 2 x x Please contact Provider Relations at (915)-532-3778 x1507 to enroll.<br />
EPF11 PREFERRED ADMINISTRATORS - CHILDREN'S HOSPITAL x 2 x x Please contact Provider Relations at (915)-532-3778 x1507 to enroll.<br />
61665 PREFERRED BENEFIT ADMINISTRATOR (WICHITA, KS) 2 x x<br />
23 of 124 Visit our web site: www.availity.com
Last<br />
Update<br />
Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
53476 PREFERRED BENEFIT ADMINISTRATORS (LONGWOOD, FL) 2 x x<br />
This payer processes claims for Florida only. Please check the address on the member’s ID card<br />
before submitting claims electronically.<br />
65088 PREFERRED CARE PARTNERS IN FL 2 x x<br />
73145 PREFERRED COMMUNITY CHOICE 2 x x<br />
61106 PREFERRED HEALTH PLAN 2 x x<br />
31478 PREFERRED HEALTH PROFESSIONALS 2 x x<br />
60110 PREFERRED HEALTH SYSTEMS 2 x x<br />
36401 PREFERRED NETWORK ACCESS, INC. (DARIEN, IL) 2 x x<br />
60110 PREFERRED PLUS OF KANSAS (PPK) 2 x x<br />
41147 PREFERREDONE (MN) x 2 x x<br />
65054 PREMIER EYE CARE 2 x x<br />
PREHP PRESBYTERIAN HEALTH PLAN (COMMERCIAL) 4 x x<br />
39185 PREVEA HEALTH INSURANCE PLAN 4 x x<br />
NAPCP PRIMARY CARE PARTNERS 3 x x<br />
PRIME PRIMARY HEALTH PLAN 3 x x<br />
56144 PRIMARY PHYSICIAN CARE, INC 2 x x<br />
UH015 PRIME CARE HEALTH PLAN 3 x<br />
56190 PRIME VISION HEALTH PLAN 2 x Payer Id has changed from 04320 to 23266<br />
IP079 PRIMECARE MED NETWORK - NAMM 3 x x<br />
23266 PRIMESOURCE HEALTH NETWORKS 2 x x<br />
61604 PRIMEWEST HEALTH PLAN x 2 x x<br />
PRI01 PRINCETON PREMIER IPA 4 x<br />
61271 PRINCIPAL HEALTHCARE 2 x x<br />
61271 PRINCIPAL MUTUAL LIFE INSURANCE CO 2 x x<br />
38217 PRIORITY HEALTH 2 x<br />
37303 PRISM - FIRST HEALTH 2 x<br />
37315 PRISM - UNIVERA 2 x x<br />
37268 PRISM NETWORK, INC. 2 x<br />
13306 PRIVATE HEALTH CARE (PHCS SAVILITY) 4 x x<br />
70259 PROCARE HEALTH PLAN MEDICAID 2 x x<br />
36331 PROFESSIONAL BENEFIT ADMINISTRATORS, INC. (OAK BROOK, IL) 2 x x<br />
37242 PROFESSIONAL CLAIMS MANAGEMENT 2 x x Payer ID effective starting 4/5<br />
34134 PROFESSIONAL RISK MANAGEMENT 2 x x<br />
PHP01 PROVIDENCE CHOICE OPTION 3 x<br />
PHP01 PROVIDENCE GOOD HEALTH PLAN 2 x<br />
PHP00 PROVIDENCE HEALTH PLAN (PPO) 3 x<br />
PAS01 PROVIDENCE INSURANCE AND ADMIN SERVICE 2 x x<br />
71404 PROVIDENT AMERICAN LIFE AND HEALTH INSURANCE COMPANY 2 x<br />
68195 PROVIDENT LIFE AND ACCIDENT INS 2 x x<br />
60054 PRUDENTIAL (ALL PLANS) 2 x x<br />
91136 PUGET SOUND BENEFITS TRUST 2 x x<br />
91136 PUGET SOUND ELECTRICAL WORKERS 2 x x<br />
42172 PUGET SOUND HEALTH PARTNERS 2 x x<br />
39197 QUADMED (WEST ALLIS, WI) 2 x x<br />
35174 QUAL CHOICE OF ARKANSAS 2 x x<br />
QHPNY QUALITY HEALTH PLANS OF NEW YORK 2 x x<br />
QUANM QUAL-MED NEW MEXIICO 2 x x<br />
QMDCE QUAL-MED, COLORADO EPO 2 x<br />
QMDPO QUAL-MED, PORTLAND (PO) 2 x x x<br />
QCTPA QUANTUM CARE TPA 3 x x<br />
91176 RBMS, LLC 2 x x<br />
38221 REGENCY EMPLOYEE BENEFITS 2 x x<br />
47076 REGIONAL CARE, INC. 2 x x<br />
20481 RESOLVE HEALTH PLAN ADMINISTRATORS 4 x x<br />
RPPG1 RESURRECTION PHYSICIAN PROVIDERS GROUP x 4 x x<br />
CHAT1 REUNION INDUSTRIES 2 x x<br />
74205 RIGHT CARE FROM SCOTT & WHITE 2 x x<br />
84980 RIO GRANDE HMO 4 x x<br />
16117 RMSCO 2 x X<br />
36339 RUSH HEALTH ASSOCIATION 2 x x<br />
60054 RUSH PRUDENTIAL 2 x x<br />
36389 RUSH PRUDENTIAL HMO 2 x x<br />
63070 RWDSU BENEFIT FUND 2 x x<br />
31441 S & S HEALTHCARE STRATEGIES 2 x x<br />
35164 SAGAMORE HEALTH NETWORK 2 x x<br />
NASTA SAINT ANTHONY PPO 3 x x<br />
62308 SAMBA 2 x x<br />
60054 SANDIA TRIPLE OPTIONAL PLUS 2 x x<br />
91184 SANFORD HEALTH PLAN 2 x x<br />
35182 SANTA BARBARA COTTAGE HOSPITAL 2 x x<br />
63665 SANUS- HMO/PPO ST LOUIS x 2 x x<br />
16146 SCHC TOTAL CARE 2 x<br />
Enrollment for contracted providers - Mayra Martinez - 254.298.3278. Enrollment for non-contracted<br />
providers - Tracy Tharp 254.298.3274.<br />
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Last<br />
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Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
88030 SCOTT & WHITE HEALTHCARE 2 x x<br />
Before filing claims to SWHP for the first time, non-contracted providers must fill out an EDI Intake<br />
Form and an EDI Authorization Form at http://www.swhp.org/homepage/providers/provider-forms or<br />
call SWHP at 1-800-321-7947 or 254-298-3000.<br />
28530 SECURE HEALTH PLANS OF GEORGIA, LLC 2 x x<br />
39045 SECURITY HEALTH PLAN 2 x x<br />
64088 SELECT ADMINISTRATIVE SERVICES (SAS) 2 x x<br />
42137 SELECT BENEFIT ADMINISTRATORS (DES MOINES, IA) 2 x x<br />
93031 SELECT BENEFIT ADMINISTRATORS INC. 2 x x<br />
37282 SELECT BENEFIT ADMINISTRATORS OF AMERICA (ASHLAND, WI) 2 x x<br />
35199 SELECT HEALTH NETWORK 4 x x<br />
23285 SELECT HEALTH OF SOUTH CAROLINA 2 x x<br />
SSC11 SELECT SENIOR CLINIC x 4 x x For 835, 270 and 276 transactions please use Payer ID: HPN11<br />
00014 SELECTCARE 2 x x<br />
SCOK1 SELECTCARE OF OKLAHOMA x 4 x x For 835, 270 and 276 transactions please use Payer ID: SCOK1<br />
GTPA1 SELECTCARE OF TX (BEAUMONT) x 4 x x For 835, 270 and 276 transactions please use Payer ID: HPN11<br />
HPN11 SELECTCARE OF TX (HOUSTON) x 4 x x For 835, 270 and 276 transactions please use Payer ID: HPN11<br />
KLSY1 SELECTCARE OF TX (KELSEY-SEYBOLD) x 4 x x For 835, 270 and 276 transactions please use Payer ID: HPN11<br />
36404 SELF INSURED PLANS 2 x x<br />
34131 SELF-FUNDED PLANS (OHIO) 2 x x<br />
36426 SENDERO HEALTH PLAN 2 x x<br />
83035 SENIOR WHOLE HEALTH 2 x x<br />
54154 SENTARA HEALTH MANAGEMENT 2 x x<br />
23249 SENTINEL MANAGEMENT SERVICES 2 x<br />
39033 SENTRY INSURANCE 2 x x<br />
EPNSH SETON EMPLOYEE PLAN ACTIVE 4 x x SHP I and II plans, 2007 and earlier date of service.<br />
SHEBP SETON EMPLOYEE PLAN ARCHIVE 4 x x<br />
SHMAP SETON HEALTH PLAN - MAP PROGRAM 4 x x<br />
SHPCH SETON HEALTH PLAN (CHIP) 4 x x<br />
STAR1 SETON STAR 4 x x<br />
75280 SHASTA ADMINISTRATIVE SERVICES 2 x x<br />
41143 SHEFFIELD, OLSON, & MCQUEEN, INC. 2 x x<br />
SC359 SHERMANCHOICE 2 x<br />
76342 SIERRA HEALTH SERVICES (CLAIMS) 2 x x<br />
76343 SIERRA HEALTH SERVICES (ENCOUNTERS) 2 x x<br />
NASCR SILVER CROSS MANAGED CARE ORGANIZATION 2 x x<br />
00199 SIMPLY HEALTHCARE PLAN 3 x x<br />
84076 SINCLAIR HEALTH PLAN 2 x x<br />
84096 SLOAN'S LAKE MANAGED CARE 2 x x<br />
02057 SMITH ADMINISTRATORS 2 x x<br />
81400 SOONER HEALTH NETWORK (WISCONSIN) 2 x<br />
23266 SOUTH CENTRAL PREFERRED 2 x x<br />
41154 SOUTH COUNTY HEALTH ALLIANCE x 2 x x<br />
25147 SOUTHCARE/HEALTHCARE PREFERRED 2 x x<br />
37318 SOUTHERN BENEFIT SERVICES LLC 2 x x<br />
81400 SOUTHERN DESERT HEALTH (WISCONSIN) 2 x<br />
25133 SOUTHERN HEALTH SERVICES 2 x x<br />
SIPA1 SOUTHLAND IPA 4 x x<br />
37266 SOUTHWEST SERVICE LIFE 2 x x<br />
M3IL2 SOUTHWEST BCBS OF FLORIDA 4 x x<br />
MED3000 EDI Support (805) 988-2280 ext 340<br />
Provider Customer Service - (708) 633-1234<br />
60054 SOUTHWESTERN BELL (MEDICAL) 2 x x<br />
52190 SPECIAL RISK INTERNATIONAL 2 x x<br />
23253 SPECTRUM ADMINISTRATORS, INC. - TPA ALLENTON, PA 2 x x<br />
35199 ST. ANTHONY MICHIGAN CITY 4 x x<br />
22240 ST. BARNABAS SYSTEM HEALTH PLAN 2 x x<br />
35199 ST. FRANCIS HEALTH NETWORK 4 x x<br />
37264 ST. JOHN’S CLAIMS ADMINISTRATION 2 x x<br />
SLCH1 ST. LAWRENCE CO. HEALTHCARE PLAN 2 x x<br />
88029 ST. MARY'S HEALTH PLAN 2 x x<br />
37116 ST. THERESE PHYSICIAN ASSOC 2 x x<br />
STM01 ST. THOMAS MEDICAL NETWORK (GULFQUEST) 3 x<br />
59225 STAR HRG 2 x x<br />
72087 GROUP BENEFITS - LOUISIANA 2 x<br />
53120 GROUP BENEFITS - LOUISIANA 2 x<br />
31053 STATE FARM 2 x x<br />
Click this link for information on electronic payment and remittance<br />
information: https://ProviderNet.adminisource.com<br />
57254 STATE OF TEXAS DENTAL PLAN 2 x x<br />
67829 STERLING MEDICARE ADVANTAGE 3 x x EPN - All dates of service, expanded EPN - 2008 date of service and after.<br />
91151 STERLING OPTION 1 2 x x<br />
STL01 STIRLING BENEFITS 2 x x<br />
06089 STIRLING BENEFITS (STIRLING & STIRLING) 2 x<br />
SLIC2 STONEBRIDGE LIFE INS CO (CEDAR RAPIDS IA) 4 x x Med Supp<br />
SLIC1 STONEBRIDGE LIFE INS CO (VALLEY FORGE PA) 4 x x Med Supp<br />
31121 STONER AND ASSOCIATES (CINCINNATI, OH) 2 x x<br />
95202 SUMMACARE HEALTH PLAN 2 x x<br />
25 of 124 Visit our web site: www.availity.com
Last<br />
Update<br />
Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
37301 SUMMIT AMERICA INSURANCE SERVICES 2 x x<br />
60054 SUN TRUST BANK 2 x x<br />
90956 SUNAMERICA LIFE INSURANCE COMPANY 2 x<br />
68069 SUNFLOWER STATE HEALTH PLAN x 3 x x The payer will begin accepting claims under this payer ID on 1/1/13.<br />
Prior to submitting claims, contact your <strong>Health</strong> Plan Provider Relations Department to verify your<br />
provider information is on file in the <strong>Health</strong> Plans claim system. This will prevent claim rejections and<br />
68069 SUNSHINE STATE HEALTH PLAN x 3 x x<br />
allow payments to be made in a timely manner. You may reach Provider Relations at 800.218.0530<br />
or by visiting www.sunshinestatehealth.com and click on the Provider tab. Payer ID 68057 may also<br />
be used.<br />
23218 SUPERIOR BENEFITS 2 x x<br />
68069 SUPERIOR HEALTH PLAN x 3 x x<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Prior to submitting claims, contact your <strong>Health</strong> Plan Provider Relations Department to verify your<br />
provider information is on file in the <strong>Health</strong> Plans claim system. This will prevent claim rejections and<br />
allow payments to be made in a timely manner. You may reach Provider Relations at 800.218.7453<br />
or by visiting www.superiorhealthplan.com. Payer ID 39188 may also be used.<br />
SHP11 SUPERIOR HEALTH PLAN x 4 x x<br />
Prior to submitting claims, please call Provider Relations Dept at 1-800-218-7453 to verify your<br />
provider info is on file in the claim system. This will prevent rejections and allow payments to be<br />
made in a timely manner.<br />
Prior to submitting claims, please call Provider Relations Dept at 1-800-218-7453 to verify your<br />
SHP11 SUPERIOR HEALTH PLAN CHIPS EPO x 4 x x<br />
provider info is on file in the claim system. This will prevent rejections and allow payments to be<br />
made in a timely manner.<br />
35199 SUBURBAN HEALTH ORGANIZATION 4 x x<br />
IP084 SUTTER - ALTA BATES MEDICAL GROUP (CLAIMS/ENCOUNTERS) x 2 x<br />
Please contact Sutter to enroll and to obtain Payer ID (800-611-5191). Payer ID is for all Alta Bates<br />
claims with a DOS of 07/01/10 and thereafter.<br />
IP091 SUTTER - GOULD MEDICAL FOUNDATION (CLAIMS/ENCOUNTERS) x 2 x Please contact Sutter to enroll (800-611-5191).<br />
CALL SUTTER - MEDICAL GROUP OF THE REDWOODS (CLAIMS/ENCOUNTERS) x 2 x Please contact Sutter to enroll (800-611-5191).<br />
CALL SUTTER - SIP, SMG, SWMG (CLAIMS/ENCOUNTERS) x 2 x Please contact Sutter to enroll (800-611-5191).<br />
94269 SUTTER EAST BAY MEDICAL FOUNDATION 2 x<br />
91151 SYNERTECH HEALTH SYSTEMS SOLUTIONS (STERLING OPTION 1) 2 x x<br />
16146 SYRACUSE COMMUNITY HEALTH CENTER (SCHC) 2 x<br />
88067 TALL TREES ADMINISTRATORS 2 x x<br />
37228 TARRANT HEALTH SERVICES 2 x<br />
39157 TBG ADMINISTRATIVE SERVICES 2 x x<br />
ADSL1 TEAM CHOICE - ALPHA CARE GOLD 2 x x<br />
75261 TEAM CHOICE GOLD 2 x x<br />
75261 TEAM CHOICE PNS 2 x x<br />
75261 TEAM CHOICE UMC 2 x x<br />
36215 TEAMCARE 2 x x<br />
GTPA1 TEXAN PLUS (BEAUMONT) x 4 x x For 835, 270 and 276 transactions please use Payer ID: HPN11<br />
HPN11 TEXAN PLUS (HOUSTON) x 4 x x For 835, 270 and 276 transactions please use Payer ID: HPN11<br />
KLSY1 TEXAN PLUS (KELSEY-SEYBOLD) x 4 x x<br />
45210 TEXAS - CHRISTUS HEALTH PLAN 2 x x<br />
76048 TEXAS CHILDREN'S HEALTH PLAN 2 x x<br />
TXCSM TEXAS CHILDREN'S STAR MEDICAID 2 x<br />
TX1ST TEXAS FIRST HEALTH PLANS x 4 x x For 835, 270 and 276 transactions please use Payer ID: TX1ST<br />
TOPA1 TEXAS FIRST HEALTH PLANS (TIOPA) x 4 x x For 835, 270 and 276 transactions please use Payer ID: TX1ST<br />
TTCEC TEXAS TRUE CHOICE 2 x x<br />
BOONG THE BOON GROUP 2 x x<br />
75600 THE CITY OF ODESSA 2 x x<br />
37305 THE FORD METER BOX COMPANY, INC. 2 x x<br />
20356 THE HEALTH EXCHANGE - CERNER CORPORATION 2 x x<br />
58200 THE INTEGRITY BENEFIT NETWORK, INC. (MARRIETA, GA) 2 x x<br />
23223 THE LOOMIS COMPANY 2 x x<br />
59221 THE MEGA LIFE & HEALTH INS. CO. 2 x x<br />
04320 THE PREFERRED HEALTHCARE SYSTEM-PPO 2 x x<br />
THERA THERAPHYSICS 2 x<br />
COTHE THERAPHYSICS- COLORADO ONLY 2 x<br />
95266 THIRD PARTY CLAIMS MANAGEMENT 2 x x<br />
THRIV THRIVENT FINANCIAL 4 x x<br />
39065 TIME INSURANCE COMPANY 2 x x<br />
WITH1 TODAY'S HEALTH x 4 x x For 835, 270 and 276 transactions please use Payer ID: WITH1<br />
TOPTN TODAY'S OPTION (AMERICAN PROGRESSIVE AND PYRAMID HEALTH) 2 x x<br />
92620 TONGASS TIMBER TRUST 2 x x<br />
TCARE TOTAL CARE (NEW YORK) 4 x<br />
38201 TOTAL HEALTHCARE OF MICHIGAN 2 x x<br />
41202 TOTAL PLAN SERVICES 2 x x<br />
13402 TOUCHSTONE HEALTH/HEALTH NET SMART CHOICE 2 x x<br />
69493 TOWER LIFE INSURANCE 2 x x<br />
37230 TR PAUL, INC. 2 x x<br />
59222 TRANSAMERICA 2 x<br />
TFLI4 TRANSAMERICA FINANCIAL LIFE INS - BALTIMORE 4 x x Cancer<br />
TFLI6 TRANSAMERICA FINANCIAL LIFE INS - CEDAR RAPIDS 4 x x Med Supp/Retiree Med<br />
TLIN7 TRANSAMERICA FINANCIAL LIFE INS - PLANO 4 x x Major Medical/Cancer<br />
TFLI2 TRANSAMERICA FINANCIAL LIFE INS CO 4 x x Med Supp<br />
TFLI3 TRANSAMERICA FINANCIAL LIFE INS CO 4 x x Med Supp<br />
TFLI5 TRANSAMERICA FINANCIAL LIFE INS CO 4 x x Cancer only (specified disease)<br />
26 of 124 Visit our web site: www.availity.com
Last<br />
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Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
TFLIC TRANSAMERICA FINANCIAL LIFE INS CO (HURST, TX) 4 x x Long Term Care<br />
TLIN4 TRANSAMERICA LIFE INS CO 4 x x Med Supp<br />
TLIN6 TRANSAMERICA LIFE INS CO - BALTIMORE 4 x x Cancer<br />
TLIN5 TRANSAMERICA LIFE INS CO - CEDAR RAPIDS 4 x x Med Supp/Retiree Med<br />
TLIN2 TRANSAMERICA LIFE INS CO (HURST, TX) 4 x x Long Term Care<br />
TLINS TRANSAMERICA LIFE INS CO (LITTLE ROCK, AR) 4 x x<br />
Accident only, Cancer only, First occurrence invasive cancer, Heart disease attack or stroke only,<br />
Hospital confinement indemnity, Hospital intensive care<br />
37284 TRANSCHOICE - KEY BENEFIT ADMINISTRATORS 2 x x<br />
20807 TRANSCHOICE-FIRST SERVICE ADMINISTRATORS 2 x x<br />
TRAN1 TRANSWESTERN INSURANCE ADMIN, INC. 4 x<br />
TCHD1 TRAVIS COUNTY HOSPITAL DISTRICT MAP 4 x x<br />
34185 TRISURANT 2 x x<br />
TCUSA TRUE CHOICE USA 2 x x<br />
TCUCH TRUE CHOICE USA-CHRISTUS HEALTH PLAN 2 x x<br />
91078 TRUSTEED PLANS SERVICE CORPORATION 2 x x<br />
61425 TRUSTMARK 2 x x<br />
04298 TUFTS HEALTH PLAN x 2 x<br />
87726 UBH-RIOS x 2 x x<br />
60054 UC CARE (UNIV. OF CA) 2 x x<br />
52629 UCARE x 2 x x<br />
75240 UICI-ADMINISTRATORS 2 x x<br />
74223 UICI-ADMINISTRATORS - ST OF NEVADA 2 x x<br />
ULLIC ULLICO INC. (VALLEY FORGE, PA) 4 x x Med Supp<br />
41206 ULTRA BENEFITS 2 x x<br />
75130 UMC HEALTH PLAN (LUBBOCK) 2 x x Formerly Fiserv <strong>Health</strong> - Wausau Benefits/Benesight<br />
75196 UMR - HARRINGTON 2 x x Formerly <strong>Health</strong> Economics - MICS Corp<br />
39026 UMR - WAUSAU/UHIS 2 x x<br />
52180 UMWA HEALTH & RETIREMENT FUNDS 2 x x<br />
80314 UNICARE MAJOR ACCOUNTS 3 x x<br />
80314 UNICARE SPECIAL ACCOUNTS 3 x x<br />
80314 UNICARE INDIVIDUAL SMALL GROUP 3 x x<br />
62170 UNIFIED HEALTH SERVICES 2 x x<br />
34638 UNIFIED PHYSICIANS NETWORK 2 x x<br />
75243 UNIFORM MEDICAL PLAN/HARRINGTON 2 x x<br />
GEN02 UNION FIDELITY LIFE INSURANCE 2 x x<br />
87042 UNION PACIFIC RAILROAD EMPLOYEES 2 x<br />
25175 UNISON HEALTH PLAN 2 x x<br />
87726 UNITED BEHAVIORAL HEALTH x 2 x x<br />
UBHRI UNITED BEHAVIORAL HEALTH – EMPLOYER DIVISION 2 x<br />
UGP19 UNITED GROUP PROGRAMS 2 x x<br />
96385 UNITED HEALTHCARE COMMUNITY PLAN OF KANSAS 2 x x<br />
36273 UNITED HEALTHCARE OVATIONS (AARP) x 2 x x<br />
31107 UNITED MEDICAL RESOURCES 2 x x<br />
71412 UNITED OF OMAHA 2 x x<br />
84132 UNITED PHYSICIANS OF N. COLORADO 2 x<br />
87726 UNITEDHEALTHCARE x 2 x x<br />
87726 UNITEDHEALTHCARE OF FLORIDA x 2 x x<br />
81400 UNITY/PRECISION HEALTH PLANS 2 x<br />
All claims currently submitted to Univera <strong>Health</strong>care, Payer ID HC001, should now be submitted to<br />
Payer ID UNINW.<br />
HC001 UNIVERA HEALTHCARE 3 x<br />
All claims currently submitted to Univera <strong>Health</strong>care, Payer ID HC001, should now be submitted to<br />
Payer ID UNINW.<br />
UNINW UNIVERA HEALTHCARE 3 x<br />
UNBCI UNIVERSAL BENEFITS CORPORATION 4 x x Tricare<br />
UNBC2 UNIVERSAL BENEFITS CORPORATION - CEDAR RAPIDS 4 x x<br />
33001 UNIVERSAL CARE- CALIFORNIA 2 x x<br />
09908 UNIVERSITY FAMILY CARE - MARICOPA HEALTH PLAN 2 x<br />
11149 UNIVERSITY MEDICAL CENTER 2 x x<br />
91136 UNIVERSITY OF WASHINGTON STUDENTS & GRADUATE APPTS. 2 x x<br />
ATEND UNIVITA 4 x<br />
Prior Authorization Number required (loop 2300, REF01 = G1); Example: 999999-99-999 or 999999-<br />
9-9999. Rendering Provider Number required (loop 2310B NM109).<br />
23281 UPMC HEALTH PLAN 2 x x<br />
38337 UPPER PENINSULA HEALTH PLAN 2 x x<br />
93092 US BENEFITS 2 x x<br />
To perform 837 transactions with the US Family <strong>Health</strong> Plan (USFHP), you will need to ensure that<br />
USFHP US FAMILY HEALTH PLAN (USFHP) - TEXAS AND LOUISIANA x x 2 x x<br />
your NPI 1 and NPI 2 (if applicable) are on file with the Plan. Prior to performing 837 transactions<br />
with the US Family <strong>Health</strong> Plan, please confirm that your NPI is on file by contacting us at 281-936-<br />
7011.<br />
50383 US IMAGING NETWORK (NY) 2 x<br />
60054 US/HEALTHCARE (HMO) 2 x x<br />
74095 USAA (UNITED STATES AUTOMOBILE ASSOC) 2 x x<br />
13407 USFHP – ST. VINCENT CATHOLIC MEDICAL CENTER 2 x x<br />
UT3F UTMB - 3 SHARE PROGRAM 4 x x<br />
12115 VA FEE BASIS PROGRAMS 2 x x<br />
VAFSC VA FINANCIAL SERVICES CENTER 2 x x<br />
82420 VALLEY BAPTIST HEALTH PLAN 2 x x<br />
72128 VANTAGE HEALTH PLAN, INC. 2 x<br />
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Last<br />
Update<br />
Payer ID Payer Name<br />
Availity's Electronic Data Interchange (EDI) <strong>Health</strong> Plan Partners<br />
Government<br />
Payer*<br />
Claim Enroll<br />
Required<br />
Remit (835)<br />
NPI Option<br />
Professional<br />
Claim (837)<br />
Institutional<br />
Claim (837)<br />
Eligibility &<br />
Benefits (270)<br />
Claim<br />
Status<br />
(276)<br />
Auth &<br />
Referral<br />
(278)<br />
Additional <strong>Information</strong><br />
VPA18 VARIABLE PROTECTION ADMINISTRATORS (VPA) 2 x x<br />
60054 VARIAN HEALTH CARE PLAN 2 x x<br />
GASA1 VERITY NATIONAL GROUP, INC. 2 x x<br />
75256 VERITY NATIONAL GROUP, INC. 2 x x<br />
VFP11 VILLAGE FAMILY PRATICE x 4 x x For 835, 270 and 276 transactions please use Payer ID: HPN11<br />
BV001 VIPA 2 x<br />
GEN02 VIRGINIA SURETY COMPANY 2 x x<br />
37297 VISION CARE INCORPORATED 2 x<br />
55248 VISTA HEALTH PLAN 2 x x<br />
63114 VIVA HEALTH PLAN 2 x<br />
77073 VNS CHOICE MEDICARE 2 x x<br />
22264 VYTRA HEALTHCARE 2 x x<br />
62111 W.C. BEELER & COMPANY 2 x<br />
85256 WABASH MEMORIAL HOSPITAL ASSOCIATION 2 x x<br />
84980 WAL-MART (BLUE CARD CARRIERS) 4 x x<br />
GEN02 WASHINGTON NATIONAL INSURANCE CO 2 x x<br />
73155 WATERSTONE BENEFIT ADMINISTRATORS 4 x x<br />
39151 WEA TRUST 3 x x<br />
75261 WEBTPA 2 x x<br />
36337 WEISS HEALTH PROVIDERS 2 x<br />
25133 WELL PATH OF CAROLINA 2 x x Enrollment Contact - (866) 703-1444<br />
WELM2 WELLMED (CLAIMS) 4 x x<br />
WELMD WELLMED (ENCOUNTERS) 4 x<br />
WELM2 WELLMED/SECURE HORIZONS 4 x x<br />
91064 WENATCHEE VALLEY MEDICAL CENTER 2 x x<br />
91136 WEST COAST STATIONARY ENGINEERS HEALTH & SECURITY TRUST FUND 2 x x<br />
80942 WEST SUBURBAN HEALTH PROVIDERS 2 x x<br />
70408 WESTERN CARE 2 x x<br />
24735 WESTERN GROWER'S INS. CO. 3 x x<br />
37247 WESTERN MUTUAL INSURANCE 2 x x<br />
31048 WESTERN SOUTHERN FINANCIAL GROUP (CINCINNATI, OH) 2 x x<br />
38232 WEYCO 2 x x<br />
93050 WILLIAM C. EARHART, CO., INC. 2 x x<br />
98010 WILLIAM J. SUTTON & COMPANY 2 x x<br />
62153 WINDSOR MEDICARE EXTRA 2 x x<br />
27327 WINHEALTH PARTNERS 2 x Formerly payer ID WNHLT<br />
39200 WISCONSIN AUTO & TRUCK DEALERS INSURANCE PLAN 2 x x<br />
WPS01 WISCONSIN COMMERCIAL 3 x<br />
SX022 WISCONSIN PHYSICIANS SERVICE GROUP HEALTH (WPS) 2 x<br />
13413 WOMEN'S INTEGRATED NETWORK, INC (WIN FERTILITY) 2 x<br />
81949 WOODMAN ACCIDENT AND LIFE COMPANY 4 x<br />
VARIOUS WORKERS' COMPENSATION x 2 x x<br />
20333 WORKSITE BENEFIT SERVICES, LLC. 2 x x<br />
75276 WORLD INSURANCE COMPANY 2 x x<br />
77080 WPP - ELDERCARE WISCONSIN 2 x x<br />
10159 WPS PREVEA HEALTH PLAN 4 x x<br />
25133 WRITERS GUILD 2 x x<br />
23710 WRITERS’ GUILD INDUSTRY HEALTH PLAN 2 x x<br />
62153 XANTUS HEALTHPLAN OF TENNESSEE 2 x x<br />
06121 YALE NEW HAVEN HEALTH - MSO INC 3 x x<br />
60646 YALE UNIVERSITY HEALTH PLAN 2 x<br />
88858 ZEBRAHEALTH 2 x x<br />
28 of 124 Visit our web site: www.availity.com<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Please see Availity's Workers' Compensation Companion Guide for more details:<br />
(https://apps.availity.com/availity/documents/AvailityWorkersCompensationCompanionGuide.pdf )
Availity's Electronic Remittance Advice (ERA) <strong>Health</strong> Plan Partners<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Payer Name Payer ID Additional <strong>Information</strong><br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Required Forms (links) Payer Specific Forms (links)<br />
ABSOLUTE TOTAL CARE 68069 Centene for further instructions.<br />
When enrolling for Advocate <strong>Health</strong> ERAs, please<br />
be sure to enroll for both Advocate <strong>Health</strong> Centers<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
ADVOCATE MEDICAL GROUP 36320 and Advocate <strong>Health</strong> Partners<br />
When enrolling for Advocate <strong>Health</strong> ERAs, please<br />
be sure to enroll for both Advocate <strong>Health</strong> Centers<br />
Availity Multi-payer Form<br />
ADVOCATE HEALTH PARTNERS 65093 and Advocate <strong>Health</strong> Partners Availity Multi-payer Form<br />
Electronic Remittance Advice and Electronic<br />
AETNA INSURANCE COMPANY 60054<br />
NPI number is required on the Multi-payer Form for<br />
Funds Transfer Enrollment<br />
AMERICAN COMMERCIAL BARGE LINES 87726 processing.<br />
Please complete the Availity Multi-payer Form prior<br />
Availity Multi-payer Form<br />
AMERIGROUP OF VIRGINIA IHP001 to the Amerigroup ERA form. Availity Multi-payer Form<br />
Electronic Remittance Advice (835)<br />
Amerigroup EDI 835 ERA Enrollment Form<br />
ASURIS NORTHWEST HEALTH 93221<br />
Enrollment Form<br />
ATRIO HEALTH PLAN ATRIO Availity Multi-payer Form<br />
NPI number is required on the Multi-payer Form for Electronic Remittance Advice (835)<br />
BLUECROSS BLUESHIELD (BCBS) ID REGENCE 00611 processing.<br />
Electronic Remittance Advice (ERA) files for BCBS<br />
providers in IL, NM, OK and TX are excluded from<br />
the Availity 835 aggregation/version processing.<br />
Enrollment Form<br />
They will not be combined with other payers’ ERA<br />
Electronic Remittance Advice (ERA)<br />
files. You must contact BCBS to request v5010 ERA<br />
Enrollment Form (HCSC ERA Enrollment<br />
BLUECROSS BLUESHIELD (BCBS) IL HCSC 00621 files<br />
Form)<br />
BLUECROSS BLUESHIELD (BCBS) MN 00220/00720<br />
Electronic Remittance Advice (ERA) files for BCBS<br />
providers in IL, NM, OK and TX are excluded from<br />
the Availity 835 aggregation/version processing.<br />
BCBSMN ERA Enrollment<br />
They will not be combined with other payers’ ERA<br />
Electronic Remittance Advice (ERA)<br />
files. You must contact BCBS to request v5010 ERA<br />
Enrollment Form (HCSC ERA Enrollment<br />
BLUECROSS BLUESHIELD (BCBS) NM HCSC 00790 files<br />
Electronic Remittance Advice (ERA) files for BCBS<br />
providers in IL, NM, OK and TX are excluded from<br />
the Availity 835 aggregation/version processing.<br />
Form)<br />
They will not be combined with other payers’ ERA<br />
Electronic Remittance Advice (ERA)<br />
files. You must contact BCBS to request v5010 ERA<br />
Enrollment Form (HCSC ERA Enrollment<br />
BLUECROSS BLUESHIELD (BCBS) OK HCSC 00840 files<br />
Form)<br />
NPI number is required on the Multi-payer Form for Electronic Remittance Advice (835)<br />
BLUECROSS BLUESHIELD (BCBS) OR REGENCE 00851 processing.<br />
Electronic Remittance Advice (ERA) files for BCBS<br />
providers in IL, NM, OK and TX are excluded from<br />
the Availity 835 aggregation/version processing.<br />
Enrollment Form<br />
They will not be combined with other payers’ ERA<br />
Electronic Remittance Advice (ERA)<br />
files. You must contact BCBS to request v5010 ERA<br />
Enrollment Form (HCSC ERA Enrollment<br />
BLUECROSS BLUESHIELD (BCBS) TX HCSC 84980 files<br />
Form)<br />
NPI number is required on the Multi-payer Form for Electronic Remittance Advice (835)<br />
BLUECROSS BLUESHIELD (BCBS) UT REGENCE 00910 processing.<br />
Enrollment Form<br />
NPI number is required on the Multi-payer Form for Electronic Remittance Advice (835)<br />
BLUECROSS BLUESHIELD (BCBS) WA REGENCE 00932 processing.<br />
Enrollment Form<br />
BLUESHIELD (BC) CA 87726 Availity Multi-payer Form<br />
29 of 124 Visit our web site: www.availity.com
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Availity's Electronic Remittance Advice (ERA) <strong>Health</strong> Plan Partners<br />
Payer Name Payer ID Additional <strong>Information</strong> Availity Required Forms (links) Payer Specific Forms (links)<br />
BRIDGEWAY HEALTH SOLUTIONS 68069<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
BUCKEYE COMMUNITY HEALTH PLAN 68069 Centene for further instructions.<br />
Both NPI number and Tax ID/SSN are required on<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
CAREFIRST BCBS OF DC/NCA SB580 the Multi-Payer Registration Form for processing.<br />
Both NPI number and Tax ID/SSN are required on<br />
Availity Multi-payer Form<br />
CAREFIRST BCBS OF MARYLAND SB690 the Multi-Payer Registration Form for processing. Availity Multi-payer Form<br />
ERA/EFT Setup-Maintenance Request<br />
CARITEN HEALTHCARE 61101<br />
System<br />
ERA/EFT Setup-Maintenance Request<br />
CARITEN SENIOR HEALTH 61101<br />
System<br />
CCSTPA 00220/00720<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
CCStpa ERA Enrollment<br />
CELTICARE HEALTH PLAN 68069 Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
CENPATICO - AZ 68068 Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
CENPATICO - FL 68068 Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
CENPATICO - GA 68068 Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
CENPATICO - IL 68068 Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
CENPATICO - IN 68068 Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
CENPATICO - KS 68068 Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
CENPATICO - KY 68068 Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
CENPATICO - MA 68068 Centene for further instructions. Availity Multi-payer Form Centene_ERA_835_enrollment<br />
30 of 124 Visit our web site: www.availity.com
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Availity's Electronic Remittance Advice (ERA) <strong>Health</strong> Plan Partners<br />
Payer Name Payer ID Additional <strong>Information</strong> Availity Required Forms (links) Payer Specific Forms (links)<br />
CENPATICO - MS 68068<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
CENPATICO - OH 68068 Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
CENPATICO - SC 68068 Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
CENPATICO - TX 68068 Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
CENPATICO - WI 68068 Centene for further instructions.<br />
Option available for ERA only providers. EFT<br />
providers must contact Centene for further<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
CENTENE MEDICARE 68069 instructions. Availity Multi-payer Form<br />
CENTRAL SENIOR CARE CIPA1 Please use payer id HPN11 to register. Availity Multi-payer Form<br />
CIGNA 62308 Cigna_ERA_835_Enrollment<br />
COMMUNITY HEALTH PLAN OF WASHINGTON CHPWA<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form<br />
COORDINATED CARE 68068 Centene for further instructions. Availity Multi-payer Form<br />
Metropolitan <strong>Health</strong> Plan Electronic<br />
Centene_ERA_835_enrollment<br />
CORNERSTONE BENEFIT ADMINISTRATORS 10850 NPI and UMPI numbers are required for processing.<br />
NPI number is required on the Multi-Payer<br />
Remittance Advice Enrollment From<br />
DEFINITY SERVICES 87726 Registration Form for processing. Availity Multi-payer Form<br />
ERA/EFT Setup-Maintenance Request<br />
EAGLE CREEK MEDICAL PLAZA 61101<br />
System<br />
Please contact Provider Relations at (915)-<br />
EL PASO FIRST HEALTH PLANS - CHIP EPF03<br />
532-3778 x1507 to enroll.<br />
EL PASO FIRST HEALTH PLANS - HCO<br />
Please contact Provider Relations at (915)-<br />
(HEALTHCARE OPTIONS) EPF37<br />
532-3778 x1507 to enroll.<br />
EL PASO FIRST HEALTH PLANS - PREMIER PLAN<br />
Please contact Provider Relations at (915)-<br />
(STAR MEDICAID HMO) EPF02<br />
532-3778 x1507 to enroll.<br />
ERA/EFT Setup-Maintenance Request<br />
EMPHESYS 61101<br />
System<br />
Electronic Remittance Advice (ERA)<br />
FEDERAL EMPLOYEE PROGRAM (TX FEP) 84980<br />
Enrollment Form<br />
FIRSTCARE 94999 Availity Multi-payer Form<br />
FIRSTCARE “STAR” MEDICAID 94998 Availity Multi-payer Form<br />
FIRST SOLUTIONS FS802 Availity Multi-payer Form<br />
835 <strong>Health</strong> Care Electronic Remittance<br />
FLORIDA BLUE 00590<br />
NPI number is required on the Multi-Payer Form for<br />
processing. Contact FHCP at<br />
EDISupport@fhcp.com to complete your ERA<br />
enrollment after you complete the Availity Multi-<br />
Advice (ERA) Request Form<br />
FLORIDA HEALTH CARE PLANS (FHCP) 59322 payer Form. Availity Multi-payer Form<br />
31 of 124 Visit our web site: www.availity.com
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Availity's Electronic Remittance Advice (ERA) <strong>Health</strong> Plan Partners<br />
Payer Name Payer ID Additional <strong>Information</strong> Availity Required Forms (links) Payer Specific Forms (links)<br />
FRESENIUS FMCHP Please use payer id FMCHP to register.<br />
NPI number is required on the Multi-Payer<br />
Availity Multi-payer Form<br />
GEHA MENTAL HEALTH CLAIMS 87726 Registration Form for processing. Availity Multi-payer Form<br />
GENERAL AMERICAN LIFE INS CO 63665 Cigna_ERA_835_Enrollment<br />
GENERATIONS HEALTHCARE GHEDI Please use payer id GHEDI to register. Availity Multi-payer Form<br />
GOLDEN TRIANGLE PHYSICIAN ALLIANCE GTPA1 Please use payer id GTPA1 to register.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form<br />
GRANITE STATE HEALTH PLAN 68068 Centene for further instructions.<br />
Includes ERAs for plans formerly known as First<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
GWH-CIGNA (FORMERLY GREAT-WEST<br />
Great West Life and Annuity Ins Co and Great-West<br />
HEALTHCARE) 80705 Life and Annuity Ins Co. Cigna_ERA_835_Enrollment<br />
HEALTH SERVICES MANAGEMENT 41150 Availity Multi-payer Form HSM 835 ERA<br />
ERA/EFT Setup-Maintenance Request<br />
HEALTH VALUE MANAGEMENT 61101<br />
System<br />
<strong>Health</strong>Partners Electronic Claims Enrollment<br />
HEALTHPARTNERS 07003<br />
Form<br />
HERITAGE PHYSICIAN NETWORK (HOUSTON) HPN11 Please use payer id HPN11 to register. Availity Multi-payer Form<br />
Electronic Remittance Advice (ERA)<br />
Enrollment Form (HCSC ERA Enrollment<br />
HMO BLUE 84980<br />
Form)<br />
Electronic Remittance Advice (ERA)<br />
Enrollment Form (HCSC ERA Enrollment<br />
HMO BLUE TEXAS 84980<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Form)<br />
HOME STATE HEALTH PLAN 68068 Centene for further instructions. Availity Multi-payer Form Centene_ERA_835_enrollment<br />
ERA/EFT Setup-Maintenance Request<br />
HUMANA, INC. (CLAIMS) 61101<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
System<br />
ILLINICARE HEALTH PLAN 68069 Centene for further instructions. Availity Multi-payer Form Centene_ERA_835_enrollment<br />
IMCARE 41600<br />
Please complete Availity’s Multi-payer enrollment<br />
Availity Multi-payer Form<br />
form prior to visiting the payer’s site and completing<br />
Kaiser Foundation of Ohio EDI Claim Remits<br />
KAISER FOUNDATION OF OHIO KP014 ERA enrollment with the payer Availity Multi-payer Form<br />
Setup Form<br />
KATY MEDICAL GROUP KMG11 Please use payer id HPN11 to register.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form<br />
KENTUCKY SPIRIT HEALTH PLAN 68069 Centene for further instructions. Availity Multi-payer Form Centene_ERA_835_enrollment<br />
For 835 enrollments please click this link and<br />
fill out the payer enrollment form. Once you<br />
have received a confirmation email from the<br />
payer, you may submit the Availity Multi Payer<br />
NPI number is required on the Multi-payer Form for<br />
Form to us to complete the enrollment<br />
LANDMARK HEALTHCARE LNDMK processing. Availity Multi-payer Form<br />
process.<br />
ERA/EFT Setup-Maintenance Request<br />
LINCOLN NATIONAL (HUMANA) 61101<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
System<br />
LOUISIANA HEALTHCARE CONNECTIONS 68069 Centene for further instructions. Availity Multi-payer Form Centene_ERA_835_enrollment<br />
32 of 124 Visit our web site: www.availity.com
Availity's Electronic Remittance Advice (ERA) <strong>Health</strong> Plan Partners<br />
Payer Name Payer ID Additional <strong>Information</strong> Availity Required Forms (links) Payer Specific Forms (links)<br />
MAGELLAN HEALTH SERVICES 01260 Availity Multi-payer Form<br />
MAGNOLIA HEALTH PLAN 68069<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Centene for further instructions.<br />
NPI number is required on the Multi-payer Form for<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
MAILHANDLERS MENTAL HEALTH CLAIMS 87726 processing. Availity Multi-payer Form<br />
ERA/EFT Setup-Maintenance Request<br />
MANAGED CARE INDEMNITY 61101<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
System<br />
MANAGED HEALTH SERVICES - IN 68069 Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
MANAGED HEALTH SERVICES - WI 68069 Centene for further instructions. Availity Multi-payer Form Centene_ERA_835_enrollment<br />
ERA/EFT Setup-Maintenance Request<br />
MANAGED PRESCRIPTION SERVICES 61101<br />
System<br />
MAYO MANAGEMENT SERVICES 41154 Availity Multi-payer Form<br />
ERA/EFT Setup-Maintenance Request<br />
MEDBENEFIXX INC 61101<br />
Please note the providers will be automatically<br />
registered for United<strong>Health</strong>Care's 835s in order to<br />
ensure Medica ERA delivery. NPI number is<br />
required on the Multi-Payer Registration Form for<br />
System<br />
MEDICA CHOICE (ALLINA) 94265 processing.<br />
Please complete Availity’s Multi-payer enrollment form prior to<br />
visiting the payer’s site and completing ERA enrollment with<br />
the payer. To register for Florida Medicaid, first complete the<br />
Availity FL Medicaid Registration Instructions. Once your<br />
Availity Multi-payer Form<br />
MEDICAID FLORIDA 77027 Florida<br />
Please complete Availity’s Multi-payer enrollment<br />
Availity Multi-payer Form Florida Medicaid Trading Partner Setup<br />
form prior to visiting the payer’s site and completing<br />
Please contact Idaho Medicaid at<br />
MEDICAID IDAHO AIDID ERA enrollment with the payer Availity Multi-payer Form<br />
866.686.4272 option 2<br />
MEDICAID KENTUCKY AIDKY<br />
MEDICAID MINNESOTA DPWMN<br />
MEDICAID MISSOURI 70029<br />
33 of 124 Visit our web site: www.availity.com<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Please complete Availity’s Multi-payer enrollment<br />
form prior to visiting the payer’s site and completing<br />
ERA enrollment with the payer. Availity's Trading<br />
835/U277 Request form Electronic<br />
Partner/Submitter ID is 9900004190.<br />
Please complete Availity’s Multi-payer enrollment<br />
form prior to visiting the payer’s site and completing<br />
ERA enrollment with the payer. Once on the payer's<br />
site, complete the ‘Submitter <strong>Information</strong>’ with the<br />
following: Submitter ID (UMPI) - A268453200;<br />
Submitter Name – Availity LLC; Address – 740 E<br />
Campbell Rd, Suite 1000, Richardson, TX 75081;<br />
Phone – 800.282.4548<br />
Availity Multi-payer Form<br />
Remittance Advice (ERA)<br />
Please complete the Availity Multi-payer Form prior<br />
to completing the 5010 Outbound Trading Partner<br />
Availity Multi-payer Form EDI Submitter Enrollment Form<br />
Agreement for FTP Users to avoid 835s delivering<br />
5010 Outbound Trading Partner Agreement<br />
incorrectly. Availity Multi-payer Form<br />
for FTP Users
Availity's Electronic Remittance Advice (ERA) <strong>Health</strong> Plan Partners<br />
Payer Name Payer ID Additional <strong>Information</strong> Availity Required Forms (links) Payer Specific Forms (links)<br />
MEDICAID OHIO MMISODJFS<br />
MEDICAID VIRGINIA AIDVA<br />
MEDICAL PLAN OF KANSAS CITY 61101<br />
MEDICARE DMERC REGION B 17003<br />
Please complete both enrollment forms and fax back<br />
to Availity. Availity will complete section III and<br />
forward the form to Ohio Department of Job and<br />
Family Services. Allow 10 business days for<br />
processing.<br />
34 of 124 Visit our web site: www.availity.com<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Designation of an 835 or 834-820 Trading<br />
Partner Form<br />
Please complete Availity’s Multi-payer enrollment<br />
form prior to visiting the payer’s site and completing<br />
ERA enrollment with the payer. Availity's Service<br />
Center number is 1285. To reach the Virginia<br />
Medicaid EDI Helpdesk please call 1.866.352.0766. Availity Multi-payer Form<br />
New Electronic Providers (Form 1 and 3 required) -<br />
http://apps.ngsmedicare.com/applications/CEDIEnro<br />
llmentAgreement.aspx &<br />
http://apps.ngsmedicare.com/applications/CEDISup<br />
plierAuthForm.aspx<br />
Existing Electronic Enrolled Providers (Form 3 only)<br />
http://apps.ngsmedicare.com/applications/CEDISup<br />
plierAuthForm.aspx<br />
Form 1 – Complete the Submitter <strong>Information</strong> with<br />
the following:<br />
Submitter Status: Existing Submitter, Submitter ID:<br />
Region B Submitter ID C08495979, Region C<br />
Submitter ID C08495979, Region D Submitter ID<br />
D08607230, Submitter Name: Availity LLC,<br />
Submitter Type: Clearinghouse<br />
Form 3 – Complete the Submitter and/or Receiver<br />
<strong>Information</strong> with the following:<br />
Entity Name - Availity LLC, Operating as a -<br />
Clearinghouse, Submitter ID: Region B Submitter ID<br />
C08495979, Region C Submitter ID C08495979,<br />
Region D Submitter ID D08607230, Address - 740 E<br />
Campbell Road, Suite 1000, Richardson, TX 75081<br />
Contact Name - Availity Client Services, Contact<br />
Phone Number - 800.282.4548, Contact Email –<br />
support@availity.com. Ordering provider name and<br />
number are required on every service line. The<br />
Provider Service Center Authorization<br />
ERA/EFT Setup-Maintenance Request<br />
System<br />
information must go in Loop 2420E, NM109. Availity Multi-payer Form EDI Submitter Action Request Form
Availity's Electronic Remittance Advice (ERA) <strong>Health</strong> Plan Partners<br />
Payer Name Payer ID Additional <strong>Information</strong> Availity Required Forms (links) Payer Specific Forms (links)<br />
MEDICARE DMERC REGION C 18003<br />
MEDICARE DMERC REGION D 19003<br />
35 of 124 Visit our web site: www.availity.com<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
New Electronic Providers (Form 1 and 3 required) -<br />
http://apps.ngsmedicare.com/applications/CEDIEnro<br />
llmentAgreement.aspx &<br />
http://apps.ngsmedicare.com/applications/CEDISup<br />
plierAuthForm.aspx<br />
Existing Electronic Enrolled Providers (Form 3 only)<br />
http://apps.ngsmedicare.com/applications/CEDISup<br />
plierAuthForm.aspx<br />
Form 1 – Complete the Submitter <strong>Information</strong> with<br />
the following:<br />
Submitter Status: Existing Submitter, Submitter ID:<br />
Region B Submitter ID C08495979, Region C<br />
Submitter ID C08495979, Region D Submitter ID<br />
D08607230, Submitter Name: Availity LLC,<br />
Submitter Type: Clearinghouse<br />
Form 3 – Complete the Submitter and/or Receiver<br />
<strong>Information</strong> with the following:<br />
Entity Name - Availity LLC, Operating as a -<br />
Clearinghouse, Submitter ID: Region B Submitter ID<br />
C08495979, Region C Submitter ID C08495979,<br />
Region D Submitter ID D08607230, Address - 740 E<br />
Campbell Road, Suite 1000, Richardson, TX 75081<br />
Contact Name - Availity Client Services, Contact<br />
Phone Number - 800.282.4548, Contact Email –<br />
support@availity.com. Ordering provider name and<br />
number are required on every service line. The<br />
information must go in Loop 2420E, NM109.<br />
New Electronic Providers (Form 1 and 3 required) -<br />
http://apps.ngsmedicare.com/applications/CEDIEnro<br />
llmentAgreement.aspx &<br />
http://apps.ngsmedicare.com/applications/CEDISup<br />
plierAuthForm.aspx<br />
Existing Electronic Enrolled Providers (Form 3 only)<br />
http://apps.ngsmedicare.com/applications/CEDISup<br />
plierAuthForm.aspx<br />
Form 1 – Complete the Submitter <strong>Information</strong> with<br />
the following:<br />
Submitter Status: Existing Submitter, Submitter ID:<br />
Region B Submitter ID C08495979, Region C<br />
Submitter ID C08495979, Region D Submitter ID<br />
D08607230, Submitter Name: Availity LLC,<br />
Submitter Type: Clearinghouse<br />
Form 3 – Complete the Submitter and/or Receiver<br />
<strong>Information</strong> with the following:<br />
Entity Name - Availity LLC, Operating as a -<br />
Clearinghouse, Submitter ID: Region B Submitter ID<br />
C08495979, Region C Submitter ID C08495979,<br />
Region D Submitter ID D08607230, Address - 740 E<br />
Campbell Road, Suite 1000, Richardson, TX 75081<br />
Contact Name - Availity Client Services, Contact<br />
Phone Number - 800.282.4548, Contact Email –<br />
support@availity.com. Ordering provider name and<br />
number are required on every service line. The<br />
Availity Multi-payer Form EDI Submitter Action Request Form<br />
information must go in Loop 2420E, NM109. Availity Multi-payer Form EDI Submitter Action Request Form
Availity's Electronic Remittance Advice (ERA) <strong>Health</strong> Plan Partners<br />
Payer Name Payer ID Additional <strong>Information</strong> Availity Required Forms (links) Payer Specific Forms (links)<br />
MEDICARE PART A FLORIDA 09101<br />
MEDICARE PART A ILLINOIS (ADMINISTAR) NONE<br />
MEDICARE PART B ALASKA 00831<br />
MEDICARE PART B ARIZONA 03102<br />
Complete the EDI enrollment form. Select Florida,<br />
then Part A, then Customize. Click “EDI enrollment<br />
form.” Section A - Click the boxes for Part A and/or<br />
Part B, and Florida. Section B - Enter P8467 in the<br />
“Existing Submitter Number field”. Sections C and D<br />
- Enter your information in the fields marked with a<br />
red asterisk (*). Do not complete Section E. Section<br />
F - Click “Add to existing submitter ID” and enter<br />
P8467 in the blank. Select the “Electronic<br />
Remittance (835) change (section H)”. NOTE: To<br />
receive ERA files thru Availity, you must complete<br />
the Multi-Payer Electronic Remittance Advice<br />
Enrollment Form prior to submitting the EDI<br />
Enrollment form to Medicare. Section G - Complete<br />
this section if it applies to your business model.<br />
Section H - Complete this section. Check “An<br />
existing submitter/receiver ID” and enter submitter id<br />
P8467 in the blank. Do not complete Section I.<br />
Complete the EDI enrollment form, print, sign, date Availity Multi-payer Form EDI enrollment form<br />
Click this link and complete the required ERA<br />
enrollment:<br />
http://apps.ngsmedicare.com/applications/edisubmitt<br />
eractionrequest.aspx?CatID=2<br />
Complete each field marked with an asterisk. The<br />
items below must contain Availity's information:<br />
Entity Name - Availity LLC, Street – P.O Box<br />
550857, Contact Name - Availity Client Services<br />
City/State/Zip – Jacksonville, FL 32255, Phone<br />
Number - 800.282.4548, Email –<br />
support@availity.com, Fax Number – 904-470-4773,<br />
Submitter ID - ZAHW, Contractor Code – Part A IL<br />
00131, Are you a Clearinghouse or Third Party<br />
Service – Yes, Are you a Vendor – No, <strong>Network</strong><br />
Service Vendor – IVANS<br />
36 of 124 Visit our web site: www.availity.com<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Contact the NGS EDI Help Desk at 877-273-4334<br />
for any questions concerning the form.<br />
Availity Multi-payer Form See Additional <strong>Information</strong> for instructions<br />
Please complete Availity’s Multi-payer enrollment<br />
form prior to visiting the payer’s site and completing<br />
ERA enrollment with the payer<br />
Please complete Availity’s Multi-payer enrollment<br />
form prior to visiting the payer’s site and completing<br />
Availity Multi-payer Form EDISS Total OnBoarding<br />
ERA enrollment with payer Availity Multi-payer Form EDISS Total OnBoarding
Availity's Electronic Remittance Advice (ERA) <strong>Health</strong> Plan Partners<br />
Payer Name Payer ID Additional <strong>Information</strong> Availity Required Forms (links) Payer Specific Forms (links)<br />
MEDICARE PART B FLORIDA 09102<br />
MEDICARE PART B IDAHO 02202<br />
MEDICARE PART B ILLINOIS 00952<br />
MEDICARE PART B MINNESOTA 00954<br />
Complete the EDI enrollment form. Select Florida,<br />
then Part B, then Customize. Click “EDI enrollment<br />
form.” Section A - Click the boxes for Part A and/or<br />
Part B, and Florida. Section B - Enter P8467 in the<br />
“Existing Submitter Number field”. Sections C and D<br />
- Enter your information in the fields marked with a<br />
red asterisk (*). Do not complete Section E. Section<br />
F - Click “Add to existing submitter ID” and enter<br />
P8467 in the blank. Select the “Electronic<br />
Remittance (835) change (section H)”. NOTE: To<br />
receive ERA files thru Availity, you must complete<br />
the Multi-Payer Electronic Remittance Advice<br />
Enrollment Form prior to submitting the EDI<br />
Enrollment form to Medicare. Section G - Complete<br />
this section if it applies to your business model.<br />
Section H - Complete this section. Check “An<br />
existing submitter/receiver ID” and enter submitter id<br />
P8467 in the blank. Do not complete Section I.<br />
Complete the EDI enrollment form, print, sign, date<br />
and return all pages to: FCSO Medicare EDI, P.O.<br />
Box 44071 - 3C, Jacksonville, FL 32031-4071<br />
or Fax: (904) 361-0470. You will receive an<br />
acknowledgement from FCSO once they process<br />
your request form. For questions concerning the<br />
forms, contact the Medicare EDI help desk<br />
888.670.0940.<br />
Please complete Availity’s Multi-payer enrollment<br />
form prior to visiting the payer’s site and completing<br />
Availity Multi-payer Form EDI enrollment form<br />
ERA enrollment with the payer Availity Multi-payer Form EDISS Total OnBoarding<br />
Please complete Availity’s Multi-payer enrollment<br />
form prior to visiting the payer’s site and completing<br />
ERA enrollment with the payer Availity Multi-payer Form<br />
Please complete Availity’s Multi-payer enrollment<br />
form prior to visiting the payer’s site and completing<br />
ERA enrollment with the payer Availity Multi-payer Form<br />
37 of 124 Visit our web site: www.availity.com<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
WPS Authorization Form for Electronic<br />
Remittance Advice Processing (ERA)<br />
WPS Authorization Form for Electronic<br />
Remittance Advice Processing (ERA)
Availity's Electronic Remittance Advice (ERA) <strong>Health</strong> Plan Partners<br />
Payer Name Payer ID Additional <strong>Information</strong> Availity Required Forms (links) Payer Specific Forms (links)<br />
MEDICARE PART B NEW MEXICO 04212<br />
MEDICARE PART B OKLAHOMA 04312<br />
MEDICARE PART B OREGON 02302<br />
MEDICARE PART B TEXAS 04412<br />
38 of 124 Visit our web site: www.availity.com<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Please complete Availity’s Multi-payer enrollment<br />
form prior to visiting the payer’s site and completing<br />
ERA enrollment with the payer. ERA receiver<br />
number = EJ40230.<br />
For Novitas ERA Enrollment Form:<br />
Section E: COMPLETE THE VENDOR, BILLING<br />
SERVICE, AND/OR CLEARINGHOUSE<br />
INFORMATION:<br />
Who will be preparing the electronic claims? Select<br />
which applies to you. Do not enter Availity. Availity<br />
does not prepare claims.<br />
Who will be submitting the electronic claim files?<br />
Select Clearinghouse and enter Availity LLC.<br />
Section H: ELECTRONIC REMITTANCE ADVICE<br />
(ERA): Select Assign ERA to an existing<br />
submitter/receiver ID: enter submitter ID EJ40230 Availity Multi-payer Form Novitas ERA Enrollment Form<br />
Please complete Availity’s Multi-payer enrollment<br />
form prior to visiting the payer’s site and completing<br />
ERA enrollment with the payer. ERA receiver<br />
number = EJ40960.<br />
For Novitas ERA Enrollment Form:<br />
Section E: COMPLETE THE VENDOR, BILLING<br />
SERVICE, AND/OR CLEARINGHOUSE<br />
INFORMATION: Who will be preparing the<br />
electronic claims? Select which applies to you. Do<br />
not enter Availity. Availity does not prepare claims.<br />
Who will be submitting the electronic claim files?<br />
Select Clearinghouse and enter Availity LLC.<br />
Section H: ELECTRONIC REMITTANCE ADVICE<br />
(ERA): Select Assign ERA to an existing<br />
submitter/receiver ID: enter submitter ID EJ40960<br />
Please complete Availity’s Multi-payer enrollment<br />
form prior to visiting the payer’s site and completing<br />
Availity Multi-payer Form Novitas ERA Enrollment Form<br />
ERA enrollment with the payer Availity Multi-payer Form EDISS Total OnBoarding<br />
Please complete Availity’s Multi-payer enrollment<br />
form prior to visiting the payer’s site and completing<br />
ERA enrollment with the payer. ERA receiver<br />
number = E13075.<br />
For Novitas ERA Enrollment Form:<br />
Section E: COMPLETE THE VENDOR, BILLING<br />
SERVICE, AND/OR CLEARINGHOUSE<br />
INFORMATION: Who will be preparing the<br />
electronic claims? Select which applies to you. Do<br />
not enter Availity. Availity does not prepare claims.<br />
Who will be submitting the electronic claim files?<br />
Select Clearinghouse and enter Availity LLC.<br />
Section H: ELECTRONIC REMITTANCE ADVICE<br />
(ERA): Select Assign ERA to an existing<br />
submitter/receiver ID: enter submitter ID E13075 Availity Multi-payer Form Novitas ERA Enrollment Form
Availity's Electronic Remittance Advice (ERA) <strong>Health</strong> Plan Partners<br />
Payer Name Payer ID Additional <strong>Information</strong> Availity Required Forms (links) Payer Specific Forms (links)<br />
MEDICARE PART B WASHINGTON 02402<br />
Please complete Availity’s Multi-payer enrollment<br />
form prior to visiting the payer’s site and completing<br />
ERA enrollment with the payer Availity Multi-payer Form EDISS Total OnBoarding<br />
MEDICARE RAILROAD 00882<br />
Click the link named “EDI_Enroll_RR_Pack.pdf” to<br />
open the form. The following Availity information is<br />
necessary on page 9 of the Medicare form:<br />
Submitter ID - S00532, ERN Receiver ID - ER0073,<br />
Submitter Name - Availity LLC, Owner Name - Lloyd<br />
Beesing, Contact Person - Client Services, Phone -<br />
800-282-4548, Fax - 904-470-4773, Address - P.O.<br />
Box 550857, Jacksonville, FL 32255-0857, email -<br />
support@availity.com, Claim Submission Mode of<br />
Communication - Connect Direct: (NDM),<br />
Report/Electronic Remittance Mode of<br />
Communication - Connect Direct: (NDM),<br />
Request Response Format - File, Data<br />
Compression - PKZIP. Check “Submit Claims”.<br />
Check the box “Receive Electronic Remittances”.<br />
NOTE: You must complete the Availity Multi-Payer<br />
Form prior to submitting the EDI Enrollment form to<br />
Medicare.<br />
Complete page 13. On page 16, check “Electronic<br />
Claims Submissions". Check “Electronic<br />
Remittance”. Complete page 16 with your<br />
information. Contact the EDI help desk<br />
866.749.4301, or email<br />
medicare.edi@palmettogba.com for questions. Availity Multi-payer Form<br />
MEGA LIFE & HEALTH INS. (STUDENT<br />
NPI number is required on the Multi-Payer<br />
INSURANCE) 59221 Registration Form for processing. Availity Multi-payer Form<br />
MEMORIAL CLINICAL ASSOCIATES MCA11 Please use payer id HPN11 to register. Availity Multi-payer Form<br />
39 of 124 Visit our web site: www.availity.com<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Railroad Medicare EDI Enrollment Packet<br />
(click link for EDI_Enroll_RR_Pack.pdf)
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Availity's Electronic Remittance Advice (ERA) <strong>Health</strong> Plan Partners<br />
Payer Name Payer ID Additional <strong>Information</strong> Availity Required Forms (links) Payer Specific Forms (links)<br />
MET LIFE 87726<br />
NPI number is required on the Multi-payer Form for<br />
processing. Availity Multi-payer Form<br />
Metropolitan <strong>Health</strong> Plan Electronic<br />
METROPOLITAN HEALTH PLAN (MHP) 10850 NPI and UMPI numbers are required for processing.<br />
NPI number is required on the Multi-payer Form for<br />
Remittance Advice Enrollment From<br />
METROPOLITAN LIFE INS CO 87726 processing.<br />
NPI number is required on the Multi-payer Form for<br />
Availity Multi-payer Form<br />
MICHAEL REESE HMO 87726 processing.<br />
Please complete Availity’s Multi-payer enrollment<br />
form prior to completing ERA enrollment form with<br />
the payer. ODS Companies requires organizations<br />
to be set up with EFT when requesting Electronic<br />
Availity Multi-payer Form<br />
MODA HEALTH (FORMERLY ODS HEALTH PLAN) 13350 Remittance Advice (ERA). Availity Multi-payer Form ODS ERA Enrollment Form<br />
NATIONAL IMAGING ASSOCIATES NIA11 Availity Multi-payer Form<br />
NEW ENGLAND FINANCIAL 80705<br />
Metropolitan <strong>Health</strong> Plan Electronic<br />
Cigna_ERA_835_Enrollment<br />
NORTHSTAR ADVANTAGE (MHP) 10850 NPI and UMPI numbers are required for processing. Remittance Advice Enrollment From<br />
NORTHWEST DIAGNOSTIC CLINIC NWDC1 Please use payer id HPN11 to register. Availity Multi-payer Form<br />
ONE HEALTH PLAN (ALL 50 STATES) 80705 Cigna_ERA_835_Enrollment<br />
ONE HEALTH PLAN OF CALIFORNIA, INC 95379 Cigna_ERA_835_Enrollment<br />
ONE HEALTH PLAN OF GEORGIA, INC 95569 Cigna_ERA_835_Enrollment<br />
ONE HEALTH PLAN OF ILLINOIS, INC 95388 Cigna_ERA_835_Enrollment<br />
ERA/EFT Setup-Maintenance Request<br />
PCA HEALTH PLANS OF TEXAS (HUMANA) 95885<br />
System<br />
ERA/EFT Setup-Maintenance Request<br />
PCA STAR MEDICAID 61101<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
System<br />
PEACH STATE HEALTH PLAN 68069 Centene for further instructions. Availity Multi-payer Form Centene_ERA_835_enrollment<br />
PINNACLE PHYSICIAN MANAGEMENT ORG PPMO1 Please use payer id HPN11 to register. Availity Multi-payer Form<br />
Please contact Provider Relations at (915)-<br />
PREFERRED ADMINISTRATORS EPF10<br />
532-3778 x1507 to enroll.<br />
PREFERRED ADMINISTRATORS - CHILDREN'S<br />
Please contact Provider Relations at (915)-<br />
HOSPITAL EPF11<br />
532-3778 x1507 to enroll.<br />
PREFERREDONE (MN) 41147 Availity Multi-payer Form<br />
ERA/EFT Setup-Maintenance Request<br />
PRIME BENEFITS SYSTEM 61101<br />
System<br />
PRIMEWEST HEALTH PLAN 61604 Availity Multi-payer Form<br />
ERA/EFT Setup-Maintenance Request<br />
RANDMARK, INC 61101<br />
System<br />
To receive 835 transactions from payer<br />
RPPG1 (Resurrection Physicians Provider<br />
Group), please contact<br />
RESURRECTION PHYSICIANS PROVIDER GROUP RPPG1<br />
provider_services@msogl.com<br />
SANUS- HMO/PPO ST LOUIS 63665 Cigna_ERA_835_Enrollment<br />
SELECT SENIOR CARE SSC11 Please use payer id HPN11 to register. Availity Multi-payer Form<br />
SELECTCARE OF OKLAHOMA SCOK1 Please use payer id SCOK1 to register. Availity Multi-payer Form<br />
SELECTCARE OF TX (BEAUMONT) GTPA1 Please use payer id HPN11 to register. Availity Multi-payer Form<br />
SELECTCARE OF TX (HOUSTON) HPN11 Please use payer id HPN11 to register. Availity Multi-payer Form<br />
SELECTCARE OF TX (KELSEY-SEYBOLD) KLSY1 Please use payer id HPN11 to register. Availity Multi-payer Form<br />
SOUTH COUNTY HEALTH ALLIANCE 41154<br />
NPI number is required on the Multi-payer Form for<br />
Availity Multi-payer Form<br />
STUDENT INSURANCE DIVISION 74227 processing. Availity Multi-payer Form<br />
40 of 124 Visit our web site: www.availity.com
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Availity's Electronic Remittance Advice (ERA) <strong>Health</strong> Plan Partners<br />
Payer Name Payer ID Additional <strong>Information</strong> Availity Required Forms (links) Payer Specific Forms (links)<br />
SUNFLOWER STATE HEALTH PLAN 68069<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
SUNSHINE STATE HEALTH PLAN 68069 Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
SUPERIOR HEALTH PLAN 68069 Centene for further instructions.<br />
Please complete the Availity Multi-payer Form prior<br />
to the Centene ERA form. Option available for ERA<br />
only providers. EFT providers must contact<br />
Availity Multi-payer Form Centene_ERA_835_enrollment<br />
SUPERIOR HEALTH PLAN CHIPS EPO SHP11 Centene for further instructions. Availity Multi-payer Form Centene_ERA_835_enrollment<br />
TEXAN PLUS (BEAUMONT) GTPA1 Please use payer id HPN11 to register. Availity Multi-payer Form<br />
TEXAN PLUS (HOUSTON) HPN11 Please use payer id HPN11 to register. Availity Multi-payer Form<br />
TEXAN PLUS (KELSEY-SEYBOLD) KLSY1 Please use payer id HPN11 to register. Availity Multi-payer Form<br />
TEXAS FIRST HEALTH PLANS TX1ST Please use payer id TX1ST to register. Availity Multi-payer Form<br />
TEXAS FIRST HEALTH PLANS (TIOPA) TOPA1 Please use payer id TX1ST to register. Availity Multi-payer Form<br />
TODAY'S HEALTH WITH1 Please use payer id WITH1 to register. Availity Multi-payer Form<br />
TRIBUTE SELECTCARE OF OKLAHOMA SCOK1 Please use payer id SCOK1 to register.<br />
NPI number is required on the Multi-Payer<br />
Availity Multi-payer Form<br />
UBH-RIOS 87726 Registration Form for processing.<br />
Please complete Availity’s Multi-payer enrollment<br />
form prior to visiting the payer’s site and completing<br />
Availity Multi-payer Form<br />
UCARE 52629 ERA enrollment with the payer.<br />
NPI number is required on the Multi-payer Form for<br />
Availity Multi-payer Form Provider Payment election Form<br />
UNITED BEHAVIORAL HEALTH 87726 processing.<br />
NPI number is required on the Multi-payer Form for<br />
Availity Multi-payer Form<br />
UNITEDHEALTHCARE 87726 processing. Availity Multi-payer Form<br />
UNITEDHEALTHCARE COMMUNITY PLAN TEXAS<br />
NPI number is required on the Multi-payer Form for<br />
TX TEX01 processing.<br />
NPI number is required on the Multi-payer Form for<br />
Availity Multi-payer Form<br />
UNITEDHEALTHCARE OF FLORIDA 87726 processing.<br />
The provider will need to enroll for payer id 36273 in<br />
order to begin receiving electronic remits for<br />
Ovations AARP. Use the provider portal<br />
https://aarpprovideronlinetool.uhc.com to access this<br />
specific remit online. Once they log in, they can<br />
Availity Multi-payer Form<br />
UNITEDHEALTHCARE OVATIONS AARP 36273 access AC Availity Multi-payer Form<br />
US FAMILY HEALTH PLAN (USFHP) - TEXAS AND<br />
Select “835 EDI Enrollment Form” under Electronic<br />
LOUISIANA USFHP Claims Filing area. USFHP ERA Enrollment Form<br />
VILLAGE FAMILY PRACTICE VFP11 Please use payer id HPN11 to register. Availity Multi-payer Form<br />
ERA/EFT Setup-Maintenance Request<br />
WISCONSIN EMPLOYERS GROUP 61101<br />
System<br />
Please see Availity's Workers' Compensation Workers' Compensation Electronic<br />
WORKERS' COMPENSATION (ALL PAYERS) VARIOUS Companion Guide for additional information Remittance Advice (ERA) Enrollment<br />
41 of 124 Visit our web site: www.availity.com
Availity's Business to Business (B2B) <strong>Health</strong> Plan Partners<br />
Supported Transactions & Payer Required Payer ID<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
Eligibility & Benefits (270) Claims Status (276) Authorization & Referral (278) <strong>Health</strong> Care Claim (837) <strong>Health</strong> Care Encounters (837) Additional <strong>Information</strong><br />
Payer Name<br />
XML Receiver (Payer)Values<br />
AETNA AETNA AETNA 60054<br />
AVMED AVMED 592742907<br />
BLUECROSS BLUESHIELD (BCBS) IL HCSC BCBSIL G00621 G00621<br />
Please contact your Availity Account Manager to initiate the B2B<br />
submission enrollment process<br />
BLUECROSS BLUESHIELD (BCBS) KANSAS CITY BCBSKC 47171 47171<br />
BLUECROSS BLUESHIELD (BCBS) MN BCBSMN 00720 00720<br />
BLUECROSS BLUESHIELD (BCBS) NM HCSC BCBSNM G00790 G00790<br />
Please contact your Availity Account Manager to initiate the B2B<br />
submission enrollment process<br />
BLUECROSS BLUESHIELD (BCBS) OK HCSC BCBSOK G00840 G00840<br />
Please contact your Availity Account Manager to initiate the B2B<br />
submission enrollment process<br />
BLUECROSS BLUESHIELD (BCBS) TX HCSC BCBSTX G84980 G84980<br />
Please contact your Availity Account Manager to initiate the B2B<br />
submission enrollment process<br />
CARESOURCE OF OHIO CARESOURCE OF OHIO 31114 31114<br />
The dependent loop is not supported on inquiries. Patient is always<br />
subscriber.<br />
CENTRAL SENIOR CARE XCLR003 HPN11 HPN11<br />
CIGNA CIGNA or XCLR001 CIGNA CIGNA<br />
FLORIDA BLUE BCBSF BCBSF BCBSF BCBSF BCBSF<br />
FLORIDA HEALTH CARE PLANS FLORIDA HEALTH CARE PLANS 593222484 593222484<br />
FLORIDA TRUE HEALTH FLORIDATRUEHEALTH 45408 45408<br />
FRESENIUS MEDICAL CARE HEALTH PLAN XCLR003 FMCHP FMCHP<br />
GENERATIONS HEALTHCARE XCLR003 GHEDI GHEDI<br />
GOLDEN TRIANGLE PHYSICIAN ALLIANCE XCLR003 HPN11 HPN11<br />
GREAT-WEST LIFE & ANNUITY INS CO CIGNA or XCLR001 CIGNA CIGNA<br />
HARMONY HEALTH PLAN WELLCARE_HEALTH_PLANS 14163 14163<br />
HEALTHEASE WELLCARE_HEALTH_PLANS 14163 14163<br />
HEALTHEASE KIDS WELLCARE_HEALTH_PLANS 14163 14163<br />
HERITAGE PHYSICIAN NETWORK (HOUSTON) XCLR003 HPN11 HPN11 61102 & 61105<br />
HUMANA HUMANA HUMANA 61101 HUMANA 61101<br />
HUMANA-CARESOURCE HUMANA-CARESOURCE KYCS1 KYCS1<br />
KATY MEDICAL GROUP XCLR003 HPN11 HPN11<br />
MEDICAID FLORIDA FL_MEDICAID 77027 77027<br />
MEMORIAL CLINICAL ASSOCIATES XCLR003 HPN11 HPN11<br />
NORTHWEST DIAGNOSTIC CLINIC XCLR003 HPN11 HPN11<br />
OHANA HEALTH PLAN WELLCARE_HEALTH_PLANS 14163 14163<br />
PINNACLE PHYSICIAN MANAGEMENT ORG XCLR003 HPN11 HPN11<br />
SELECT SENIOR CLINIC XCLR003 HPN11 HPN11<br />
SELECTCARE OF OKLAHOMA XCLR003 SCOK1 SCOK1<br />
SELECTCARE OF TEXAS (BEAUMONT) XCLR003 HPN11 HPN11<br />
SELECTCARE OF TEXAS (HOUSTON) XCLR003 HPN11 HPN11<br />
SELECTCARE OF TEXAS (INTEGRANET) XCLR003 HPN11 HPN11<br />
SELECTCARE OF TEXAS (KELSEY-SEYBOLD) XCLR003 HPN11 HPN11<br />
STAYWELL WELLCARE_HEALTH_PLANS 14163 14163<br />
STAYWELL KIDS WELLCARE_HEALTH_PLANS 14163 14163<br />
TEXAN PLUS (INTEGRANET) XCLR003 HPN11 HPN11<br />
TEXAN PLUS (KELSEY-SEYBOLD) XCLR003 HPN11 HPN11<br />
TEXAS FIRST HEALTH PLANS XCLR003 TX1ST TX1ST<br />
TEXAS FIRST HEALTH PLANS (TIOPA) XCLR003 TX1ST TX1ST<br />
TODAY'S HEALTH XCLR003 WITH1 WITH1<br />
UNITEDHEALTHCARE UNITEDHEALTHCARE 87726 87726<br />
VILLAGE FAMILY PRATICE XCLR003 HPN11 HPN11<br />
WELLCARE HEALTH PLAN WELLCARE_HEALTH_PLANS 14163 14163<br />
42 of 124 Visit our web site: www.availity.com
Payer Name Payer ID<br />
Enrollment<br />
Required<br />
Prof<br />
Claims<br />
(837)<br />
Inst Claims<br />
(837)<br />
Claim<br />
Status<br />
Inquiry<br />
(276/277)<br />
Eligibility &<br />
Benefits<br />
Inquiry<br />
(270/271)<br />
ABSOLUTE TOTAL CARE 68069 SC SC SC<br />
ADVOCATE MEDICAL GROUP 36320 TX TX<br />
ADVOCATE PHYSICIAN PARTNERS 65093 TX TX<br />
Availity's Web Portal <strong>Health</strong> Plan Partners<br />
Online<br />
Remittance<br />
Advice (835)<br />
Remit<br />
Reader<br />
Claim<br />
Reconcillation/Re<br />
search<br />
Authorization &<br />
Referral<br />
Submission (278)<br />
Authorization &<br />
Referral Inquiry<br />
(278)<br />
Authorization &<br />
Referral Update<br />
(278)<br />
AETNA 60054 ALL ALL ALL ALL ALL ALL ALL<br />
CareCost Estimator<br />
(Patient Financial<br />
Responsibility)<br />
CareRead<br />
(ID Card<br />
Swipe)<br />
CareProfile<br />
(<strong>Health</strong><br />
Records)<br />
Clinical<br />
Messaging via<br />
CareProfile &<br />
Eligibility &<br />
Benefits Inquiry<br />
ALL PAYER ALL ALL<br />
AMERICAS 1ST CHOICE INSURANCE HEALTH<br />
PLAN (AFS)<br />
20029 FL<br />
AMERICAS 1ST CHOICE INSURANCE OF NC<br />
(AFN)<br />
AFN01 FL<br />
ANTHEM CA 47198 CA CA CA CA CA CA CA<br />
ANTHEM CO 00050 CO CO CO CO CO CO CO<br />
ANTHEM CT 00060 CT CT CT CT CT CT CT<br />
ANTHEM IN 00130 IN IN IN IN IN IN<br />
ANTHEM IN 00630 IN IN IN IN IN IN<br />
ANTHEM KY 00160 KY KY KY KY KY KY<br />
ANTHEM KY 00660 KY KY KY KY KY KY<br />
ANTHEM ME 00180 ME ME ME ME ME ME<br />
ANTHEM ME 00680 ME ME ME ME ME ME<br />
ANTHEM MO 00241 MO MO MO MO MO MO MO<br />
43 of 124 Visit our web site: www.availity.com<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
CareCollect<br />
(Payment<br />
Collection)<br />
Additional <strong>Information</strong><br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .<br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .<br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .<br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .<br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .<br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .<br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .<br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .<br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .<br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .
Payer Name Payer ID<br />
Enrollment<br />
Required<br />
Prof<br />
Claims<br />
(837)<br />
Inst Claims<br />
(837)<br />
Claim<br />
Status<br />
Inquiry<br />
(276/277)<br />
Eligibility &<br />
Benefits<br />
Inquiry<br />
(270/271)<br />
Availity's Web Portal <strong>Health</strong> Plan Partners<br />
Online<br />
Remittance<br />
Advice (835)<br />
Remit<br />
Reader<br />
Claim<br />
Reconcillation/Re<br />
search<br />
Authorization &<br />
Referral<br />
Submission (278)<br />
Authorization &<br />
Referral Inquiry<br />
(278)<br />
Authorization &<br />
Referral Update<br />
(278)<br />
CareCost Estimator<br />
(Patient Financial<br />
Responsibility)<br />
ANTHEM NH 00270 NH NH NH NH NH NH<br />
ANTHEM NH 00770 NH NH NH NH NH NH<br />
ANTHEM NV 00265 NV NV NV NV NV NV NV<br />
ANTHEM OH 00332 OH OH OH OH OH OH<br />
ANTHEM OH 00834 OH OH OH OH OH OH<br />
ANTHEM WI 00950 WI WI WI WI WI-Link WI WI<br />
ASURIS NORTHWEST HEALTH 93221 WA WA<br />
ATRIO HEALTH PLANS ATRIO ALL ALL<br />
AVMED 59274 FL FL FL<br />
BLUECROSS BLUESHIELD (BCBS) AZ 53589 AZ AZ<br />
BLUECROSS BLUESHIELD (BCBS) GA 00601 GA GA GA GA GA<br />
BLUECROSS BLUESHIELD (BCBS) GA 00101 GA GA GA GA GA<br />
BLUECROSS BLUESHIELD (BCBS) ID REGENCE 00611 ID ID ID ID<br />
BLUECROSS BLUESHIELD (BCBS) IL HCSC 00621 IL IL IL IL IL IL-Link IL IL IL<br />
BLUECROSS BLUESHIELD (BCBS) KANSAS CITY 47171 KS, MO KS, MO KS, MO KS, MO<br />
CareRead<br />
(ID Card<br />
Swipe)<br />
CareProfile<br />
(<strong>Health</strong><br />
Records)<br />
Clinical<br />
Messaging via<br />
CareProfile &<br />
Eligibility &<br />
Benefits Inquiry<br />
BLUECROSS BLUESHIELD (BCBS) KS 47163 KS KS KS KS<br />
BLUECROSS BLUESHIELD (BCBS) MN 00220 MN MN MN MN<br />
BLUECROSS BLUESHIELD (BCBS) MN 00720 MN MN MN MN<br />
BLUECROSS BLUESHIELD (BCBS) NM HCSC 00790 NM NM NM NM NM NM-Link NM NM<br />
BLUECROSS BLUESHIELD (BCBS) OK HCSC 00840 OK OK OK OK OK OK-Link OK OK<br />
BLUECROSS BLUESHIELD (BCBS) OR REGENCE 00851 OR OR OR OR<br />
BLUECROSS BLUESHIELD (BCBS) TX HCSC 84980 TX TX TX TX TX TX-Link TX TX TX<br />
BLUECROSS BLUESHIELD (BCBS) UT REGENCE 00910 UT UT<br />
BLUECROSS BLUESHIELD (BCBS) WA REGENCE 00932 WA WA<br />
BRIDGEWAY HEALTH SOLUTIONS 68069 AZ AZ AZ<br />
BUCKEYE COMMUNITY HEALTH PLAN 68069 OH<br />
CARECENTRIX 11345 ALL<br />
CAREPLUS 95092 FL<br />
CAREPLUS 95093 FL<br />
CARESOURCE OF OHIO 31114 OH OH<br />
CAROLINA CARE PLAN 29076 OH OH<br />
CCSTPA 00220 ALL ALL TX TX<br />
44 of 124 Visit our web site: www.availity.com<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
CareCollect<br />
(Payment<br />
Collection)<br />
Additional <strong>Information</strong><br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .<br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .<br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .<br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .<br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .<br />
Please complete the steps<br />
outlined in the Anthem Help<br />
topics to register users for<br />
Anthem Services which include:<br />
Radiology Precertification and<br />
Secure Messaging .<br />
Medical Policy Link available for<br />
BCBSMN members on Eligibility<br />
& Benefits Summary page<br />
Medical Policy Link available for<br />
BCBSMN members on Eligibility<br />
& Benefits Summary page
Payer Name Payer ID<br />
Enrollment<br />
Required<br />
Prof<br />
Claims<br />
(837)<br />
Inst Claims<br />
(837)<br />
Claim<br />
Status<br />
Inquiry<br />
(276/277)<br />
Eligibility &<br />
Benefits<br />
Inquiry<br />
(270/271)<br />
CCSTPA 00720 ALL ALL TX TX<br />
CELTICARE HEALTH PLAN 68069 MA<br />
AZ, AR, FL,<br />
GA, KY, IL,<br />
CENPATICO BEHAVIORAL HEATLH 68069<br />
IN, KS, LA,<br />
MA, MS, MO,<br />
OH, SC, TX,<br />
WA, WI<br />
CENPATICO TEXAS 68053 TX TX<br />
CIGNA 62308 ALL ALL ALL ALL<br />
CITRUS HEALTH CARE 10207 FL FL<br />
CONSUMER LIFE INS 29076 OH<br />
COORDINATED CARE 68069 WA WA WA<br />
CORRECTCARE - INTEGRATED HEALTH CCIH CA CA<br />
Availity's Web Portal <strong>Health</strong> Plan Partners<br />
Online<br />
Remittance<br />
Advice (835)<br />
Remit<br />
Reader<br />
Claim<br />
Reconcillation/Re<br />
search<br />
Authorization &<br />
Referral<br />
Submission (278)<br />
Authorization &<br />
Referral Inquiry<br />
(278)<br />
Authorization &<br />
Referral Update<br />
(278)<br />
CareCost Estimator<br />
(Patient Financial<br />
Responsibility)<br />
CT, FL, GA, IL, IN,<br />
KS, KY, ME, MN,<br />
MO, NH, NM, OH,<br />
OK, TX, UT, VA, WI<br />
FLORIDA BLUE 00590 FL FL FL FL FL FL FL FL FL FL FL FL<br />
FLORIDA HEALTH CARE PLAN (FHCP) 59322 FL FL<br />
FLORIDA TRUE HEALTH 03024 FL FL<br />
FREEDOM 1ST (FRM) FRM01 FL<br />
FREEDOM HEALTH INC. (FRH) FRH0 FL<br />
FRESENIUS MEDICAL CARE FMCHP TX TX TX<br />
GENERATIONS GHEDI TX TX TX<br />
GOLDEN TRIANGLE PHYSICIANS GTPA1 TX TX<br />
GWH - CIGNA (FORMERLY GREAT-WEST<br />
HEALTHCARE)<br />
80705 ALL ALL ALL ALL<br />
HEALTH CARE DISTRICT OF PALM BEACH<br />
COUNTY (HCDPBC)<br />
CALL FL<br />
HEALTHPARTNERS 07003 ALL ALL<br />
HEALTHSHARE HSHARE MN MN<br />
HEALTHSPRING M3FL0009 ALL<br />
HEALTHSUN HEALTH PLAN HESUN FL<br />
HERITAGE PHYSICIAN NETWORKS HPN11 TX TX<br />
HOME STATE HEALTH PLAN 68069 MO MO MO<br />
HUMANA 61101 ALL ALL ALL ALL ALL ALL ALL ALL ALL ALL ALL ALL<br />
HUMANA-CARESOURCE KYCS1 KY KY<br />
ILLINICARE HEALTH PLAN 68069 IL IL IL<br />
KAISER FOUNDATION OHIO KP014 OH OH OH OH<br />
KATY MEDICAL GROUP (SELECTCARE TX) KMG11 TX TX<br />
KELSEY-SEYBOLD (SELECTCARE TX) KELSE TX<br />
KELSEY-SEYBOLD (SELECTCARE TX) KELSI TX<br />
KENTUCKY SPIRIT HEALTH PLAN 68069 KY<br />
LEON MEDICAL CENTER HEALTH PLAN 65055 FL FL<br />
LIFEMAP RLH01 OR OR<br />
LOUISIANA HEALTHCARE CONNECTIONS 68069 LA LA LA<br />
MAGNOLIA HEALTH PLAN 68069 MS<br />
MANAGED HEALTH SERVICES - IN 68069 IN IN IN<br />
MANAGED HEALTH SERVICES - WI 68069 WI WI WI<br />
MED3000 CMS EARLY STEPS M3FL0010 ALL ALL<br />
MED3000 CMS SAFETY NET M3FL0011 ALL ALL<br />
MED3000 TITLE 19 REFORM M3FL0012 ALL ALL<br />
MED3000 TITLE 21 M3FL0014 ALL ALL<br />
MED3000 TITLE COVENTRY HEALTHY KIDS M3FL0003 ALL ALL<br />
MEDICAID FLORIDA 77027 X FL FL FL<br />
MEDICAID KENTUCKY AIDKY X KY KY<br />
MEDICAID VIRGINIA AIDVA X VA<br />
MEDICAL MUTUAL OF OHIO 29076 KY, IN, OH KY, IN, OH<br />
MEDICARE PART A FLORIDA 09101 X FL<br />
MEDICARE PART B CONNECTICUT 04102 X CT<br />
MEDICARE PART B FLORIDA 09102 X FL<br />
MEDICARE PART B GEORGIA 10201 X GA<br />
MEDICARE PART B IDAHO 02202 X ID<br />
MEDICARE PART B ILLINOIS 00952 X IL<br />
45 of 124 Visit our web site: www.availity.com<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
CareRead<br />
(ID Card<br />
Swipe)<br />
CareProfile<br />
(<strong>Health</strong><br />
Records)<br />
Clinical<br />
Messaging via<br />
CareProfile &<br />
Eligibility &<br />
Benefits Inquiry<br />
CareCollect<br />
(Payment<br />
Collection)<br />
Additional <strong>Information</strong><br />
Patient Communication (Online<br />
Visits) offered for this payer<br />
Select CIGNA from the Payer<br />
dropdown.<br />
Complete Availity FL Medicaid<br />
Registration Instructions so that<br />
Availity can receive the 271s or<br />
277s for your requests.
Payer Name Payer ID<br />
Enrollment<br />
Required<br />
Prof<br />
Claims<br />
(837)<br />
Inst Claims<br />
(837)<br />
Claim<br />
Status<br />
Inquiry<br />
(276/277)<br />
Eligibility &<br />
Benefits<br />
Inquiry<br />
(270/271)<br />
MEDICARE PART B INDIANA 00630 X IN<br />
MEDICARE PART B KANSAS 05202 X KS<br />
MEDICARE PART B KENTUCKY 15201 X KY<br />
MEDICARE PART B MAINE 14102 X ME<br />
MEDICARE PART B MINNESOTA 00954 X MN<br />
MEDICARE PART B MISSOURI 05302 X MO<br />
MEDICARE PART B NEW HAMPSHIRE 14302 X NH<br />
MEDICARE PART B NEW MEXICO 04202 X NM<br />
MEDICARE PART B OHIO 15202 X OH<br />
MEDICARE PART B OKLAHOMA 04301 X OK<br />
MEDICARE PART B OREGON 02302 X OR<br />
MEDICARE PART B TEXAS 04412 X TX<br />
MEDICARE PART B VIRGINIA 11302 X VA<br />
MEDICARE PART B WISCONSIN 00951 X WI<br />
MEMORIAL CLINICAL ASSOCIATES MCA11 TX TX<br />
NOVASYS HEALTH 71080 AR<br />
NW DIAGNOSTIC CLINIC (SELECTCARE TX) NWDC1 TX TX<br />
OPTIMUM HEALTHCARE INC. (OPT) OPT01 FL<br />
OTHER BLUE PLANS<br />
FL, IL, IN,<br />
FL, IL, IN, KY,<br />
KY, MO,<br />
MO, NM, OH,<br />
NM, OH,<br />
OK, TX, WI<br />
OK, TX, WI<br />
PEACH STATE HEALTH PLAN 68069 GA GA GA<br />
PEDICARE TITLE 19 M3FL8 ALL ALL<br />
PEDICARE TITLE 21 M3FL6 ALL ALL<br />
PHYSICIANS UNITED PLAN 10775 FL FL<br />
PINNACLE PHYS MGT (SELECTCARE TX) PPMO1 TX TX<br />
PODIATRYFIRST POD1ST FL FL<br />
SELECT SENIOR CARE (SELECTCARE TX) SSC11 TX TX<br />
SELECTCARE OF TEXAS (GTPA) GTPA1 TX TX<br />
SELECTCARE OF TEXAS (HPN) HPN11 TX TX<br />
SELECTCARE OF TEXAS (MCA) MCA11 TX TX<br />
SENIOR CARE IPA (SELECTCARE TX) CIPA1 TX TX<br />
SUNFLOWER STATE HEALTH PLAN 68069 KS<br />
SUNSHINE STATE HEALTH PLAN 68057 FL FL FL<br />
SUPERIOR HEALTH PLAN SHP11 TX TX TX<br />
TEXAN PLUS (SOUTHEAST TEXAS AREA) HPN11 TX TX TX<br />
TEXAS FIRST HEALTH PLANS (NORTH TEXAS) TX1ST TX TX TX<br />
TEXAS FIRST HEALTH PLANS (TIOPA) TIOPA1 TX TX<br />
TODAYS HEALTH WITH1 WI WI WI<br />
TRIBUTE (SELECTCARE OK) SCOK1 OK OK OK<br />
TRICARE SOUTH 38520 X FL, OK, TX FL, OK, TX<br />
Availity's Web Portal <strong>Health</strong> Plan Partners<br />
Online<br />
Remittance<br />
Advice (835)<br />
Remit<br />
Reader<br />
Claim<br />
Reconcillation/Re<br />
search<br />
Authorization &<br />
Referral<br />
Submission (278)<br />
FL<br />
Authorization &<br />
Referral Inquiry<br />
(278)<br />
Authorization &<br />
Referral Update<br />
(278)<br />
CareCost Estimator<br />
(Patient Financial<br />
Responsibility)<br />
UNITED HEALTHCARE 87726<br />
FL, OH,<br />
VA<br />
FL, OH, VA FL, OH, VA FL, OH, VA<br />
US FAMILY HEALTH PLANS USFHP TX, LA ALL ALL<br />
VILLAGE FAMILY PRAC (SELECTCARE TX) VFP11 TX TX<br />
WELLCARE - HARMONY HEALTH PLAN 14163 IL, IN, MO IL, IN, MO<br />
WELLCARE - HEALTHEASE 14163 FL FL<br />
WELLCARE - HEALTHEASE KIDS 14163 FL FL<br />
WELLCARE - OHANA HEALTH PLAN 14163 HI HI<br />
WELLCARE - STAYWELL 14163 FL FL<br />
WELLCARE - STAYWELL KIDS 14163 FL FL<br />
WELLCARE HEALTH PLANS 14163<br />
WORKERS' COMPENSATION VARIOUS ALL ALL<br />
CT, FL, GA,<br />
LA, NJ, NY,<br />
OH, & TX<br />
CT, FL, GA,<br />
LA, NJ, NY,<br />
OH, & TX<br />
46 of 124 Visit our web site: www.availity.com<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
CareRead<br />
(ID Card<br />
Swipe)<br />
CareProfile<br />
(<strong>Health</strong><br />
Records)<br />
Clinical<br />
Messaging via<br />
CareProfile &<br />
Eligibility &<br />
Benefits Inquiry<br />
CareCollect<br />
(Payment<br />
Collection)<br />
Additional <strong>Information</strong><br />
In the regions where Other Blue<br />
Plans is available as a payer,<br />
select this option to transact with<br />
all out of state Blue Plans. In<br />
regions where this is not an<br />
option, select the local Blue Plan<br />
to transact with all out of state<br />
Blue Plans.”<br />
If you are a new E&B submitter,<br />
please contact 877.978.7776 to<br />
enroll.<br />
Contact (800)-325-5920 to<br />
enroll. Provider Enrollment Form<br />
may be obtained at<br />
www.mytricare.com. The 270 &<br />
276 WEB transactions are for<br />
TRICARE South Region Only.<br />
Please see Availity's Workers'<br />
Compensation Guide for more<br />
details
Workers' Compensation Payer List<br />
<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />
Electronic Data Interchange (EDI) & Web Solutions Companion Guides<br />
TX MN CA NY WI<br />
Professional Institutional Workers' Auto ERA<br />
Payer Name Payer ID Only Only Only Only Only All States Claims Claims Comp Only Only (835)<br />
21ST CENTURY INSURANCE 41556 x x x x<br />
22125 ROSCOE CORP. 41556 x x x x<br />
AAA MINNESOTA/IOWA 11983 x x x x x<br />
AAA NORTHERN CALIFORNIA, NEVADA & UTAH INSURANCE EXCHANGE 41556 x x x x<br />
ABC CONST. COMPANY 41556 x x x x<br />
ACADIA INSURANCE COMPANY J1477 x x x x x x<br />
ACCURIDE CORPORATION J1024 x x x x x x<br />
ACE PROPERTY & CASUALTY INS CO 41556 x x x x<br />
ACUITY, A MUTUAL INSURANCE COMPANY J1240 x x x<br />
ADMINISTAFF J1241 x x x<br />
ADP TOTAL SOURCE INC. J1242 x x x<br />
AG FACILITIES OPERATIONS, LLC 41556 x x x x<br />
AGRI BEEF CO. 41556 x x x x<br />
AIG 19402 x x x x<br />
AIR LIQUIDE USA LLC J1516 x x x x x<br />
ALA CARTE J1243 x x x x x<br />
ALCOA FASTENERS SYSTEMS J1244 x x x<br />
ALLEGHENY TECHNOLOGIES J1245 x x x<br />
ALLIANZ J1452 x x x x x<br />
ALLIED CONSTRUCTION J1118 x x x x x x x<br />
ALTA HEALTHCARE 41556 x x x x<br />
ALTEC J1246 x x x x<br />
ALTEC INDUSTRIES J1247 x x x x<br />
ALVEY SYSTEMS (AON RISK) J1025 x x x x x x<br />
ALVEY SYSTEMS (AON RISK) (AUTO ONLY) J1248 x x x x x<br />
AMERICA FIRST J1427 x x x x<br />
AMERICAN COIN MERCHANDISING, INC J1026 x x x x x x<br />
AMERICAN CYANAMID J1027 x x x x x x<br />
AMERICAN FURNITURE WAREHOUSE 41556 x x x x<br />
AMERICAN HOME CRAFT J1250 x x x x x<br />
AMERICAN LIBERTY INSURANCE COMPANY 41556 x x x x<br />
AMERICAN SPECIALTY COMPANIES J1028 x x x x x x<br />
AMERICAN SPECIALTY INS. / MIB J1029 x x x x x x<br />
AMERIPRISE AUTO & HOME INSURANCE 12504 x x x x x<br />
AMERISURE INSURANCE J1206 x x x x x<br />
AMERISURE MUTUAL INSURANCE J1205 x x x x x<br />
AMGUARD INSURANCE COMPANY - GUARD DBA J1453 x x x x x<br />
AMICA MUTUAL INSURANCE COMPANY 12287 x x x x x<br />
ANACO 41556 x x x x<br />
ANAIC CIBUS 41556 x x x x<br />
ANPAC 43101 x x x x<br />
ANTELOPE VALLEY RET. 41556 x x x x<br />
ARCADIA INSURANCE COMPANY J1251 x x x x x<br />
ARGENBRIGHT HOLDINGS LIMITED J1252 x x x x<br />
ARGONAUT INSURANCE COMPANY(ARGO) 19801 x x x x x x x<br />
ARIZONA & 21ST CORP. DBA BERKLEY EAST CONV. HOSPITAL 41556 x x x x<br />
ASSURANCE COMPANY OF AMERICA (COMMERCIAL ONLY) C1034 x x x x x<br />
ATLANTIC MUTUAL INSURANCE 19895 x x x x x x<br />
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Payer Name Payer ID Only Only Only Only Only All States Claims Claims Comp Only Only (835)<br />
AUTO CLUB GROUP 11983 x x x x x<br />
AUTO CLUB GROUP INSURANCE COMPANY 11983 x x x x x<br />
AUTO CLUB INSURANCE (ACIA) 11983 x x x x x<br />
AUTO CLUB INSURANCE ASSOCIATION 11983 x x x x x<br />
AUTO CLUB PROPERTY-CASUALTY INSURANCE COMPANY 11983 x x x x x<br />
AVIR INC. 41556 x x x x<br />
AYERS TRUCKING J1018 x x x x x x x<br />
BAKER TANKS, INC. 41556 x x x x<br />
BARI MANAGEMENT (MURPHY AND BEANE) J1533 x x x x x x<br />
BASIC RESOURCES, INC. 41556 x x x x<br />
BEACON MUTUAL J1234 x x x x x<br />
BEALL'S INC / MIDWEST EMPLOYERS J1030 x x x x x x<br />
BEEVILLE ISD 41556 x x x x<br />
BENCHMARK INSURANCE J1257 x x x x x<br />
BERKLEY AGRIBUSINESS RISK SPECIALISTS J1477 x x x x x x<br />
BERKLEY NATIONAL INSURANCE COMPANY J1477 x x x x x x<br />
BERKLEY NET UNDERWRITERS, LLC J1523 x x x x x<br />
BERKLEY REGIONAL INSURANCE COMPANY J1477 x x x x x x<br />
BERKLEY RISK ADMINISTRATORS COMPANY, LLC J1526 x x x x x<br />
BERKLEY SPECIALTY UNDERWRITERS TP019 x x x x x x x<br />
BERKLEY VALLEY CONV HOSPITAL 41556 x x x x<br />
BERKSHIRE HATHAWAY HOMESTATE COMPANIES (BHHC) 20044 x x x x x<br />
BERNARDO H. CO. CLUB 41556 x x x x<br />
BERWIND CORPORATION J1031 x x x x x x<br />
BEVERLY HILLS CARMEL 41556 x x x x<br />
BIGHORN CONSTRUCTION 41556 x x x x<br />
BLOOMINGDALE'S J1347 x x x x x<br />
BMW MANUFACTURING CORP. J1258 x x x<br />
BMW NORTH AMERICA J1259 x x x<br />
BOBRICK WASHROOM 41556 x x x x<br />
BOULDER COMMUNITY HOSPITAL 41556 x x x x<br />
BREMCO CONSTRUCTION 41556 x x x x<br />
BRIDGEFIELD CASUALTY INSURANCE COMPANY J1437 x x x x<br />
BRIDGEFIELD EMPLOYERS INSURANCE COMPANY J1437 x x x x<br />
BROADSPIRE, A CRAWFORD COMPANY TP021 x x x x<br />
BROTHERHOOD MUTUAL INSURANCE J1445 x x x x x x x x x<br />
BROWNSVILLE INDEPENDENT SCHOOL DISTRICT 41556 x x x x<br />
BROWNYARD GROUP INC. (ARCH INSURANCE) 11150 x x x x x x<br />
BRUNSWICK CORPORATION J1032 x x x x x x<br />
BRUNSWICK CORPORATION (AUTO ONLY) J1261 x x x x x<br />
BUNCH AND ASSOCIATES J1435 x x x x<br />
BURLINGTON COAT FACTORY WAREHO J1033 x x x x x x<br />
BURTON WAY CARMEL 41556 x x x x<br />
BV GENERAL (MURPHY AND BEANE) J1533 x x x x x<br />
BYCOR GEN CONTRACT 41556 x x x x<br />
CADET UNIFORM SUPPLY 41556 x x x x<br />
CALIFORNIA WATER SERVICE COMPANY 41556 x x x x<br />
CALLAHAN, MCCUNE 41556 x x x x<br />
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Payer Name Payer ID Only Only Only Only Only All States Claims Claims Comp Only Only (835)<br />
CAMPBELL UNION SCHOOL DISTRICT 41556 x x x x<br />
CAPITOL INDEMNITY J1262 x x x x x<br />
CAPS-SIG 41556 x x x x<br />
CATHOLIC DIOCESE OF SAN DIEGO 41556 x x x x<br />
CATHOLIC MUTUAL - PREFERRED PROFESSIONAL INSURANCE COMPANY 41556 x x x x<br />
CATHOLIC MUTUAL - VIRGINIA SURETY COMPANY, INC. 41556 x x x x<br />
CBS STUDIOS (MURPHY AND BEANE) J1533 x x x x x<br />
CCMSI WK010 x x x x x x<br />
CEDARS-SINAI HEALTH SYSTEM 41556 x x x x<br />
CENDANT CORPORATION J1034 x x x x x x<br />
CENTENNIAL INSURANCE COMPANY 19895 x x x x x x<br />
CENTRAL HOCKEY LEAGUE J1035 x x x x x x<br />
CHANDLER'S P. VERDES 41556 x x x x<br />
CHAPMAN CONVALESCENT 41556 x x x x<br />
CHARMING SHOPPES, INC. J1036 x x x x x x<br />
CHESTERFIELD SERVICES, INC. J1479 x x x x x x<br />
CHILDREN'S HOSPITAL COLORADO 41556 x x x x<br />
CHILDREN'S HOSPITAL OF ORANGE COUNTY - FIRST AID 41556 x x x x<br />
CHULA VISTA ELEMENTARY SCHOOL DISTRICT 41556 x x x x<br />
CHURCH MUTUAL INSURANCE COMPANY J1266 x x x<br />
CHURCH MUTUAL INSURANCE COMPANY (AUTO ONLY) J1264 x x x x<br />
CHURCH MUTUAL INSURANCE COMPANY (WC ONLY) J1265 x x x x<br />
CIM INSURANCE CORPORATION C1028 x x x x x<br />
CITY OF AMARILLO (AUSTIN) J1267 x x x x<br />
CITY OF AMES J1118 x x x x x x x<br />
CITY OF ARLINGTON A0033 x x x x x x x<br />
CITY OF ASHLAND 41556 x x x x<br />
CITY OF ATLANTA J1516 x x x x x<br />
CITY OF BEAVERTON 41556 x x x x<br />
CITY OF BELMONT (SELF INSURED) 41556 x x x x<br />
CITY OF CAMPBELL 41556 x x x x<br />
CITY OF CARLSBAD 41556 x x x x<br />
CITY OF CARMEL BY THE SEA 41556 x x x x<br />
CITY OF CARSON 41556 x x x x<br />
CITY OF CHULA VISTA 41556 x x x x<br />
CITY OF COLTON 41556 x x x x<br />
CITY OF CORONADO 41556 x x x x<br />
CITY OF DALLAS J1441 x x x x<br />
CITY OF DEL MAR 41556 x x x x<br />
CITY OF DES MOINES J1118 x x x x x x x<br />
CITY OF EDINBURG, TEXAS 41556 x x x x<br />
CITY OF EL PASO A0046 x x x x x x x<br />
CITY OF ENCINITAS 41556 x x x x<br />
CITY OF ESCONDIDO 41556 x x x x<br />
CITY OF GRAND JUNCTION 41556 x x x x<br />
CITY OF HILLSBORO 41556 x x x x<br />
CITY OF HOUSTON J1444 x x x x<br />
CITY OF IMPERIAL BEACH 41556 x x x x<br />
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Payer Name Payer ID Only Only Only Only Only All States Claims Claims Comp Only Only (835)<br />
CITY OF IMPERIAL BEACH (VOUCHER) 41556 x x x x<br />
CITY OF IRVING 41556 x x x x<br />
CITY OF LEMON GROVE 41556 x x x x<br />
CITY OF LEWISVILLE J1268 x x x x x<br />
CITY OF LOS ALTOS 41556 x x x x<br />
CITY OF MERCED 41556 x x x x<br />
CITY OF MINNEAPOLIS J1269 x x x x x<br />
CITY OF NATIONAL CITY 41556 x x x x<br />
CITY OF OCEANSIDE 41556 x x x x<br />
CITY OF ONTARIO 41556 x x x x<br />
CITY OF RICHARDSON 41556 x x x x<br />
CITY OF SAN DIEGO J1497 x x x x x<br />
CITY OF SAN JOSE J1528 x x x x x<br />
CITY OF SANTEE 41556 x x x x<br />
CITY OF SOLANA BEACH 41556 x x x x<br />
CITY OF SOUTH SAN FRANCISCO 41556 x x x x<br />
CITY OF VISTA 41556 x x x x<br />
CITY OF WACO 41556 x x x x<br />
CITY OF WEST DES MOINES J1118 x x x x x x x<br />
CITY OF YUMA 41556 x x x x<br />
CIVIL CONSTRUCTORS 41556 x x x x<br />
CLAIMS ADMINISTRATIVE SERVICES (CAS) J1271 x x x x x<br />
CLASSIC RESIDENCE BY HYATT J1037 x x x x x x<br />
CNA INSURANCE 20443 x x x x x<br />
CNA INSURANCE (AUTO ONLY) C1035 x x x x x<br />
CO GRANDE CASINO 41556 x x x x<br />
COACH USA J1272 x x x<br />
COAST CONVERTERS 41556 x x x x<br />
COCA-COLA ENTERPRISES INC. J1038 x x x x x x<br />
COLLIN COUNTY 41556 x x x x<br />
COLORADO CASUALTY J1428 x x x x<br />
COLORADO CONTRACTORS PROGRAM 41556 x x x x<br />
COLORADO HEALTHCARE ASSOC. - SAFETY NATIONAL CASUALTY CORP. 41556 x x x x<br />
COLORADO PRIME CORP. 41556 x x x x<br />
COLUMBIA SUSSEX CORPORATION J1039 x x x x x x<br />
COLUMBINE HEALTH SYSTEMS 41556 x x x x<br />
COMPASS GROUP USA, INC. J1040 x x x x x x<br />
COMPASS HEALTH (MURPHY AND BEANE) J1533 x x x x x<br />
CONTECH CONSTRUCTION PRODUCTS J1041 x x x x x x<br />
CONTINENTAL AIRLINES J1042 x x x x x x<br />
CONTINENTAL WESTERN INSURANCE CO (CWG) J1274 x x x x x x<br />
CONVERGYS CORPORATION J1043 x x x x x x<br />
COOK & SOLIS CONST. 41556 x x x x<br />
CORINTHIAN COLLEGES J1517 x x x x<br />
CORRECTIONAL MANAGEMENT SERVICE J1044 x x x x x x<br />
CORRECTIONS CORP OF AMERICA J1045 x x x x x x<br />
COUNTRY VILLA HEALTH SERVICES - SNCC 41556 x x x x<br />
COUNTRY VILLA OX HLTH 41556 x x x x<br />
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Payer Name Payer ID Only Only Only Only Only All States Claims Claims Comp Only Only (835)<br />
COUNTY OF ALAMEDA/AIG 41556 x x x x<br />
COUNTY OF MARIN 41556 x x x x<br />
COUNTY OF SAN DIEGO J1513 x x x x x<br />
COURTYARD HEALTH C. 41556 x x x x<br />
COWORX STAFFING, LLC J1046 x x x x x x<br />
COX CONSTRUCTION CO 41556 x x x x<br />
CPS SECURITY SOLUTIONS 41556 x x x x<br />
CR&R J1516 x x x x x<br />
CRUM & FORSTER INDEMNITY CO 31348 x x x x x x<br />
CUMIS INSURANCE SOCIETY J1282 x x x x x<br />
CYPRESS INSURANCE COMPANY (MEMBER OF BHHC) 20044 x x x x x<br />
DAHL'S FOODS J1118 x x x x x x x<br />
DAIMLERCHRYSLER CORPORATION 41556 x x x x<br />
DAKOTA FIRE 21415 x x x x x<br />
DAKOTA FIRE C1029 x x x x x<br />
DAKOTA FIRE J1433 x x x x<br />
DALLAS COUNTY COMMUNITY COLLEGE DISTRICT 41556 x x x x<br />
DALLAS INDEPENDENT SCHOOL DISTRICT J1494 x x x x x<br />
DANAHER CORPORATION J1051 x x x x x x<br />
DAVIS MECH SYSTEMS 41556 x x x x<br />
DAYLIGHT TRANSPORT 41556 x x x x<br />
DE BARTOLOS, INC J1058 x x x x x x<br />
DENVER PUBLIC SCHOOLS 41556 x x x x<br />
DEPART OF LABOR/DEPARTMENT OF ENERGY J1438 x x x x<br />
DEPARTMENT OF WATER AND POWER OF THE CITY OF LOS ANGELES (LADWP) J1514 x x x x x<br />
DESERT HOSPITAL DISTRICT 41556 x x x x<br />
DESERT PRINCESS 41556 x x x x<br />
DIAMOND FARMING COMPANY 41556 x x x x<br />
DILLARD'S STORE SERVICES J1480 x x x x x<br />
DIRECTORY DISTRIBUTING ASSOC. J1059 x x x x x x<br />
DISCOVER RE (BURGER KING) J1060 x x x x x x<br />
DISCOVERY HY-VEE J1118 x x x x x x x<br />
DOUGLAS COUNTY 41556 x x x x<br />
DUNN-EDWARDS CORPORATION J1061 x x x x x x<br />
DURANGO COFFEE CO. 41556 x x x x<br />
DUSTROL J1118 x x x x x x<br />
DYNAMEX, INC. J1062 x x x x x x<br />
EAGLE PASS ISD 41556 x x x x<br />
EASTGUARD INSURANCE COMPANY - GUARD DBA J1453 x x x x x<br />
ECHO PACIFIC DEVELOP 41556 x x x x<br />
EDIC J1289 x x x<br />
EDINBURG CONSOLIDATED INDEPENDENT SCHOOL DISTRICT 41556 x x x x<br />
EDWARDS CLAIM ADMINISTRATION Click Here x x x x x<br />
EL PASO COMMUNITY COLLEGE (TX JUR) A0106 x x x x x x x<br />
EL PASO WATER UTIL TX JUR J1017 x x x x x x x<br />
ELC ELECTRIC INC 41556 x x x x<br />
ELITE COMP 41556 x x x x<br />
EMC PROPERTY AND CASUALTY 21415 x x x x x<br />
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Payer Name Payer ID Only Only Only Only Only All States Claims Claims Comp Only Only (835)<br />
EMC PROPERTY AND CASUALTY C1029 x x x x x<br />
EMC PROPERTY AND CASUALTY J1433 x x x x<br />
EMCASCO INSURANCE CO C1029 x x x x x<br />
EMCASCO INSURANCE CO J1433 x x x x<br />
EMCASCO INSURANCE CO 21407 x x x x<br />
EMPLOYER INSURANCE GROUP (EIG) J1232 x x x x x<br />
EMPLOYERS ASSURANCE COMPANY J1232 x x x x x<br />
EMPLOYERS COMPENSATION INSURANCE COMPANY J1232 x x x x x<br />
EMPLOYERS MUTUAL CASUALTY C1029 x x x x x<br />
EMPLOYERS MUTUAL CASUALTY J1433 x x x x<br />
EMPLOYERS MUTUAL CASUALTY 21415 x x x x x<br />
EMPLOYERS PREFERRED INSURANCE COMPANY J1232 x x x x x<br />
ENTERPRISE RENT A CAR J1294 x x x x<br />
ENVIROSOURCE J1063 x x x x x x<br />
ENVISION RADIOLOGY, LLC 41556 x x x x<br />
EPLICA, INC. 41556 x x x x<br />
ERICKSON-HALL CONSTR 41556 x x x x<br />
ERMC J1022 x x x x x x x<br />
ESIS TP043 x x x x x<br />
ESIS - FIRST AMERICAN INSURANCE CO J1064 x x x x x x<br />
ESIS - KELLY SERVICES J1451 x x x x x<br />
ESIS - LOCKHEED MARTIN CORPORATION J1454 x x x x x<br />
ESURANCE INSURANCE COMPANY 25712 x x x x x<br />
EVOLUTION INSURANCE COMPANY J1065 x x x x x x<br />
F&G GUARANTY INS CO/MAIN STREET PROGRAM COLORADO 41556 x x x x<br />
F. A. RICHARD & ASSOCIATES (FARA) TP044 x x x x x<br />
FACTORY 2 U J1019 x x x x x x x<br />
FAMILY HEALTH & HOUSING 41556 x x x x<br />
FARMERS INSURANCE C1025 x x x x x<br />
FARMERS INSURANCE COMMERCIAL (COMMERCIAL ONLY) C1034 x x x x x<br />
FARMERS INSURANCE EXCHANGE (COMMERCIAL ONLY) C1034 x x x x x<br />
FEDERATED CLAIMS SERVICE CORP. J1297 x x x x x<br />
FEDERATED DEPARTMENT STORES, INC J1297 x x x x x<br />
FEDERATED LINEN & UNIFORM 41556 x x x x<br />
FEDERATED MUTUAL INSURANCE COMPANY 13935 x x x x x<br />
FEDERATED RURAL ELECTRIC (TX) 11118 x x x x x x<br />
FEDERATED SERVICES INSURANCE COMPANY 28304 x x x x x<br />
FIREMAN'S FUND INSURANCE COMPANY C1019 x x x x x<br />
FIREMAN'S FUND INSURANCE COMPANY 21873 x x x x x<br />
FIREMEN'S INSURANCE COMPANY J1274 x x x x x x x<br />
FIRSTCOMP J1011 x x x x<br />
FKI INDUSTRIES, INC. J1047 x x x x x x<br />
FOREMOST 11185 x x x x x x<br />
FORGE INDUSTRIAL STAFFING J1529 x x x x x<br />
FRANCO CONSTRUCTION 41556 x x x x<br />
FRANKENMUTH MUTUAL J1440 x x x x<br />
FRESNO COUNTY OFFICE OF EDUCATION 41556 x x x x<br />
FRESNO COUNTY SELF INSURANCE GROUP 41556 x x x x<br />
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Payer Name Payer ID Only Only Only Only Only All States Claims Claims Comp Only Only (835)<br />
FRONT PORCH (MURPHY AND BEANE) J1533 x x x x x<br />
GAB ROBBINS, INC. TP117 x x x x x x<br />
GAB ROBINS (FOR VAN TUYL COMPANIES ONLY) TP117 x x x x x x<br />
GALLAGHER BASSETT TP057 x x x x x<br />
GARDEN GROVE UNIFIED SCHOOL DISTRICT J1519 x x x x x<br />
GARDEN REGIONAL HOSPITAL & MED CENTER, INC. 41556 x x x x<br />
GATEGOURMET #836 J1302 x x x x x<br />
GATES CORP DBA GATES RUBBER CO J1066 x x x x x x<br />
GATES O'DOHERTY 41556 x x x x<br />
GATES O'DOHERTY G&G 41556 x x x x<br />
GATEWAY TRANS., INC. 41556 x x x x<br />
GENESIS CONSTRUCTION 41556 x x x x<br />
GLENDALE ELEMENTARY SCHOOL DISTRICT #40 41556 x x x x<br />
GMAC INSURANCE COMPANY ONLINE, INC. C1028 x x x x x<br />
GMAC INSURANCE MANAGEMENT CORPORATION C1028 x x x x x<br />
GOLDEN CORRAL CORPORATION J1067 x x x x x x<br />
GOLDEN EAGLE J1430 x x x x<br />
GOLDEN STATE SUPPLY J1306 x x x x x<br />
GRANGE MUTUAL CASUALTY COMPANY 10322 x x x x x<br />
GRANGE WC 14060 x x x x x<br />
GRAPHIC ARTS MUTUAL 25984 x x x x x x x<br />
GREAT AMERICAN ALLIANCE INS CO. 26832 x x x x x x x<br />
GREAT AMERICAN ASSURANCE CO. 26344 x x x x x x x<br />
GREAT AMERICAN INS. CO. 16691 x x x x x x x<br />
GREAT AMERICAN INS. CO. OF N.Y. 22136 x x x x x x x<br />
GREAT CENTRAL J1308 x x x x x<br />
GREAT DIVIDE INSURANCE 25224 x x x x x x x<br />
GREENE RAD MALONEY 41556 x x x x<br />
GREER CONSTRUCTON CO 41556 x x x x<br />
GREIF BROTHERS CORPORATION 41556 x x x x<br />
GREVE CLIFFORD WENGEL & PARAS 41556 x x x x<br />
GRIMMWAY ENTERPRISES, INC. 41556 x x x x<br />
GRUNDFOS MANUFACTURING CORPORATION 41556 x x x x<br />
GS METALS 41556 x x x x<br />
GSE LINING TECHNOLOGY, INC. J1068 x x x x x x<br />
GUARD J1453 x x x x x<br />
HAMILTON MUTUAL 21415 x x x x x<br />
HAMILTON MUTUAL C1029 x x x x x<br />
HAMILTON MUTUAL J1433 x x x x<br />
HARRIS COUNTY J1493 x x x x x<br />
HARTFORD DEALERSHIP ADVANTAGE PROGRAM - WC<br />
HARTFORD INSURANCE COMPANY OF THE MIDWEST (ALLIANT TECH SYSTEMS<br />
41556 x x x x<br />
ONLY)<br />
HARTFORD INSURANCE COMPANY OF THE MIDWEST (AMERICOLD LOGISTICS<br />
J1314 x x x<br />
ONLY) J1315 x x x<br />
HARTFORD INSURANCE COMPANY OF THE MIDWEST (PFIZER, INC. ONLY) J1317 x x x<br />
HARTFORD INSURANCE COMPANY OF THE MIDWEST (PUBLIX ONLY) J1318 x x x<br />
HARTFORD INSURANCE COMPANY OF THE MIDWEST (QCS ONLY) J1319 x x x<br />
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Only<br />
MN<br />
Only<br />
CA<br />
Only<br />
NY<br />
Only<br />
WI<br />
Only All States<br />
Professional<br />
Claims<br />
Institutional<br />
Claims<br />
Workers'<br />
Comp Only<br />
HARTFORD INSURANCE COMPANY OF THE MIDWEST (RUBY TUESDAY ONLY) J1320 x x x<br />
HARTFORD INSURANCE COMPANY OF THE MIDWEST (STERICYCLE ONLY) J1321 x x x<br />
HARTFORD INSURANCE COMPANY OF THE MIDWEST (WELLS FARGO ONLY) J1322 x x x<br />
HARTFORD INSURANCE COMPANY OF THE MIDWEST (WENDY’S ARBY’S GROUP<br />
ONLY) J1323 x x x<br />
HASTINGS COLLEGE OF THE LAW 41556 x x x x<br />
HAWKEYE J1426 x x x x<br />
HAYHOE CONSTRUCTION 41556 x x x x<br />
HCA-HOSPTIAL CORPORATION OF AMERICA J1450 x x x x x<br />
HEALTHPARTNERS 44547 x x x x x x<br />
HEALTHSMART J1481 x x x x x<br />
HEARTLAND EMPLOYMENT SERVICES, LLC 41556 x x x x<br />
HELMSMAN MANAGEMENT SERVICES 33600 x x x x<br />
HERITAGE GROUP J1069 x x x x x x<br />
HIGHLAND GOLF 41556 x x x x<br />
HOGAN MOTOR LEASING 41556 x x x x<br />
HOGAN PERSONELL 41556 x x x x<br />
HOLLY FARMS CORP. J1070 x x x x x x<br />
HOME SWEET HOME 41556 x x x x<br />
HORTICA FLORIST MUTUAL INSURANCE 13978 x x x x x x x<br />
HOUSEHOLD MERCH NNI J1071 x x x x x x<br />
HOUSING AUTHORITY EL PASO (TX) A0107 x x x x x x x<br />
HOUSTON HUNTERS PATROL, INC J1020 x x x x x x x<br />
HUGHES TOOL COMPANY J1072 x x x x x x<br />
HY-VEE J1118 x x x x x x x<br />
ICW (INSURANCE CO OF THE WEST) 27847 x x x x x<br />
IDS PROPERTY CASUALTY INSURANCE COMPANY 12504 x x x x x<br />
ILLINOIS EMCASCO 21415 x x x x x<br />
ILLINOIS EMCASCO C1029 x x x x x<br />
ILLINOIS EMCASCO J1433 x x x x<br />
IMPERIAL IRRIGATION DISTRICT 41556 x x x x<br />
INCONEN CORPORATION 41556 x x x x<br />
INDIANA INSURANCE J1425 x x x x<br />
INLAND VALLEY HOSPICE 41556 x x x x<br />
INSILCO CORP J1073 x x x x x x<br />
INTEGON CASUALTY INSURANCE CO. C1028 x x x x x<br />
INTEGON GENERAL INSURANCE CORP. C1028 x x x x x<br />
INTEGON INDEMNITY CORP. C1028 x x x x x<br />
INTEGON NATIONAL INSURANCE CO. C1028 x x x x x<br />
INTEGON PREFERRED INSURANCE CO. C1028 x x x x x<br />
INTEGRITY MUTUAL INSURANCE COMPANY 10322 x x x x x<br />
INTEGRITY WC 14303 x x x x x<br />
INTERCARE J1542 x x x x x<br />
IREX CORPORATION J1074 x x x x x x<br />
IRONWORKING CONTRACT I.P. J1075 x x x x x x<br />
J B HUNT TRANSPORT INC. A0138 x x x x x x x<br />
J.H. MCCORMACK CONST 41556 x x x x<br />
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Payer Name Payer ID Only Only Only Only Only All States Claims Claims Comp Only Only (835)<br />
JD MECHANICAL 41556 x x x x<br />
JEFFERSON COUNTY TEXAS 41556 x x x x<br />
JI SPECIALTY SERVICES WK006 x x x x x<br />
JOHN MUIR HEALTH 41556 x x x x<br />
JOHNSTON SCHOOLS J1118 x x x x x x x<br />
JONES TRUCK LINES,INC. J1076 x x x x x x<br />
JUDSON ISD 41556 x x x x<br />
JUVENILE JAIL FACILITY MANAGEM J1077 x x x x x x<br />
KAUTZ VINYARDS 41556 x x x x<br />
KCI HOLDINGS USA J1078 x x x x x x<br />
KEMPER PREFERRED C1030 x x x x x<br />
KEN DAVIS INDUSTRIES INC. J1079 x x x x x x<br />
KEY RISK MANAGEMENT SERVICES LLC J1521 x x x x x<br />
KEYSTONE J1118 x x x x x x x<br />
KING PAK POTATO COMPANY LLC 41556 x x x x<br />
KING RANCH 41556 x x x x<br />
KTA CONSTRUCTION (COSD2) 41556 x x x x<br />
L. ARROWHEAD C. CLUB 41556 x x x x<br />
LACLEDE CHAIN 41556 x x x x<br />
LACLEDE STEEL 41556 x x x x<br />
LAKE ELSINORE SCHOOL DISTRICT 41556 x x x x<br />
LAMAR CONSOLIDATED ISD 41556 x x x x<br />
LAMESA ISD 41556 x x x x<br />
LANDMARK GOLF CO 41556 x x x x<br />
LANDMARK GRAD&PAVING 41556 x x x x<br />
LANDSTAR BCO WC PROGRAM J1080 x x x x x x<br />
LANE COUNTY 41556 x x x x<br />
LARIMER COUNTY - WC 41556 x x x x<br />
LB AUTO/PACIFIC PART 41556 x x x x<br />
LB AUTO/PACIFIC SUPP 41556 x x x x<br />
LEAGUE OF MINNESOTA CITIES INSURANCE TRUST J1527 x x x x x<br />
LEKOS ELECTRIC 41556 x x x x<br />
LEVIN ENTERPRISES, INC. 41556 x x x x<br />
LIBERTY MUTUAL 33600 x x x x<br />
LIBERTY MUTUAL MIDDLE MARKETS 33600 x x x x<br />
LIBERTY NORTHWEST 33600 x x x x<br />
LIBERTY WAUSAU 33600 x x x x<br />
LIVINGSTON ISD 41556 x x x x<br />
LK ARROWHEAD CO CLUB 41556 x x x x<br />
LODI MEMORIAL HOSPITAL 41556 x x x x<br />
LSG SKY CHEFS INTERNATIONAL J1081 x x x x x x<br />
LUBA CASUALTY INSURANCE COMPANY (TX) J1341 x x x x x<br />
LUMBERMEN'S UNDERWRITING ALLIANCE J1540 x x x x x x x<br />
MACYS (DALY CITY) J1345 x x x x x<br />
MACYS (NEWPORT BEACH) J1346 x x x x x<br />
MACYS CORPORATE SERVICES INC J1347 x x x x x<br />
MADERA COMMUNITY HOSPITAL 41556 x x x x<br />
MAJOR LEAGUE BASEBALL 8 J1082 x x x x x x<br />
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Payer Name Payer ID Only Only Only Only Only All States Claims Claims Comp Only Only (835)<br />
MANUFACTURERS ALLIANCE INSURANCE COMPANY 41556 x x x x<br />
MARCOTTE & HEARNE 41556 x x x x<br />
MARICOPA COUNTY COMMUNITY COLLEGE DISTRICT 41556 x x x x<br />
MARIPOSA COUNTY 41556 x x x x<br />
MARYLAND CASUALTY COMPANY (COMMERCIAL ONLY) C1034 x x x x x<br />
MATAGORDA COUNTY 41556 x x x x<br />
MATRIX ABSENCE MANAGEMENT TP075 x x x x x<br />
MAXIM CRANE WORKS J1083 x x x x x x<br />
MAY DEPARTMENT STORES J1347 x x x x x<br />
MAYO CLINIC/RECOVERY AND CLAIMS SERVICES 41193 x x x x x x x<br />
MC DONALD'S-MCOPCO J1084 x x x x x x<br />
MCMC, LLC WK007 x x x x x<br />
MDSI PHYS GROUP INC 41556 x x x x<br />
MEADOWBROOK INSURANCE GROUP J1478 x x x x x<br />
MEDICAL BEN ADMIN 41556 x x x x<br />
MEEMIC 11983 x x x x x<br />
MEMBER SELECT INSURANCE COMPANY 11983 x x x x x<br />
MEMIC 11030 x x x x x<br />
MEMORIAL HEALTH SERVICES 41556 x x x x<br />
MENDOTA INSURANCE COMPANY 33650 x x x x x<br />
MERIDIAN CONSTRUCTION PROGRAM 41556 x x x x<br />
MERITAGE CORPORATION 41556 x x x x<br />
MESA COUNTY COLORADO 41556 x x x x<br />
MESA COUNTY VALLEY SCHOOL DISTRICT 51 41556 x x x x<br />
METROPOLITAN COUNCIL J1355 x x x x x<br />
METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY 87726 x x x x x<br />
METROPOLITAN TRANSIT AUTHORITY J1238 x x x x x<br />
MEXICANA AIRLINES 41556 x x x x<br />
MIC GENERAL INSURANCE CORP. C1028 x x x x x<br />
MIC PROPERTY AND CASUALTY INS. CORP C1028 x x x x x<br />
MICHAEL HOGAN ASSOC 41556 x x x x<br />
MID CENTURY INSURANCE COMPANY (COMMERCIAL ONLY) C1034 x x x x x<br />
MIDWEST DRYWALL J1119 x x x x x x<br />
MILLARD REFRIGERATED J1482 x x x x x x<br />
MINNESOTA COUNTIES INS TRUST (MCIT) J1351 x x x x x<br />
MINNESOTA DEPARTMENT OF LABOR & INDUSTRY – CLAIMS SERVICES & INVESTIGATIONS J1436 UNIT<br />
x x x x x<br />
MISSION AVIATION FELLOWSHIP 41556 x x x x<br />
MISSION LODGE SANITARIUM 41556 x x x x<br />
MISSOULA CART CO, IN 41556 x x x x<br />
MITCHELL ENERGY & DEVEL J1085 x x x x x x<br />
MODESTO IRRIGATION DISTRICT 41556 x x x x<br />
MONTGOMERY J1424 x x x x<br />
MONTGOMERY COUNTY TEXAS A0179 x x x x x x x<br />
MONUMENT ADMINISTRATORS - CORNERSTONE COMP J1530 x x x x x<br />
MONUMENT ADMINISTRATORS - ELITE COUNTRY CLUB J1530 x x x x x<br />
MORRIS MATERIAL HANDLING J1086 x x x x x x<br />
MORRISON HEALTH CARE, INC. J1087 x x x x x x<br />
MOTION PICTURE & TELEVISION FUND 41556 x x x x<br />
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Payer Name Payer ID Only Only Only Only Only All States Claims Claims Comp Only Only (835)<br />
MOTORIST MUTUAL INSURANCE J1203 x x x x x x<br />
MOTORS INSURANCE CORPORATION C1028 x x x x x<br />
MTV (MURPHY AND BEANE) J1533 x x x x x<br />
MUNFORD, INC. J1088 x x x x x x<br />
MUSCO J1118 x x x x x x x<br />
NAP TOOLS J1120 x x x x x x<br />
NATIONAL FARMERS UNION PROPERTY AND CASUALTY COMPANY - QBE DBA J1484<br />
x x x x x x x<br />
NATIONAL GENERAL ASSURANCE CO. C1028 x x x x x<br />
NATIONAL GENERAL INSURANCE CO. C1028 x x x x x<br />
NATIONAL INTERSTATE 32620 x x x x x x x<br />
NATIONAL JEWISH HEALTH 41556 x x x x<br />
NATIONAL LIABILITY AND FIRE INSURANCE COMPANY 20044 x x x x x<br />
NATIONAL LOSS PREVENTION, INC J1021 x x x x x x x<br />
NBC UNIVERSAL J1359 x x x<br />
NBSIA - NORTH BAY SCHOOLS INSURANCE AUTHORITY J1549 x x x x x<br />
NEW JERSEY MANUFACTURING 12122 x x x x x<br />
NEW SOUTH INSURANCE CO. C1028 x x x x x<br />
NICKELODIAN (MURPHY AND BEANE) J1533 x x x x x<br />
NORDSTROM, INC. J1360 x x x<br />
NORGUARD INSURANCE COMPANY - GUARD DBA J1453 x x x x x<br />
NORTH CLACKAMAS SCHOOL DISTRICT #12 41556 x x x x<br />
NORTH COUNTY TRANSIT DISTRICT 41556 x x x x<br />
NORTH RIVER INSURANCE COMPANY 31348 x x x x x x x x<br />
NORTHERN COLORADO SCHOOL DISTRICTS WORKERS' COMPENSATION POOL 41556 x x x x<br />
NORTHWEST INSURANCE J1361 x x x x x<br />
NORWOOD J1089 x x x x x x<br />
NOVA DEALERSHIP ADVANTAGE PROGRAM - WC 41556 x x x x<br />
NOVA ELITE COMP PROGRAM 41556 x x x x<br />
NOVA METALS ADVANTAGE PLUS PROGRAM - WC 41556 x x x x<br />
NOVA PRO RISK SOLUTIONS J1056 x x x x x x x<br />
NOVA PRO RISK SOLUTIONS (SAN DIEGO) J1057 x x x x x x x<br />
NUEVO ENGINEERING 41556 x x x x<br />
NYSIF 45052 x x x<br />
OAK RIVER INSURANCE COMPANY (MEMBER OF BHHC) 20044 x x x x x<br />
OHIO CASUALTY GROUP 24074 x x x x x x<br />
OLD REPUBLIC INSURANCE CO 24147 x x x x x x<br />
ONE BEACON 20621 x x x x x x x<br />
ONE BEACON INSURANCE - AUTO C1026 x x x x x<br />
ORICA, INC. J1090 x x x x x x<br />
OUTRIGGER LODGING 41556 x x x x<br />
OVERHILL FARMS, INC. 41556 x x x x<br />
PACIFIC HYDROTECH CO 41556 x x x x<br />
PACIFIC LUMBER COMPANY (MARATHON) 41556 x x x x<br />
PACIFIC MOTOR COMPANY J1364 x x x x x<br />
PACIFIC SPECIALTY INSURANCE 41556 x x x x<br />
PAJARO VLY COMNTY HEALTH TRUST 41556 x x x x<br />
PALADIN MANAGED CARE SERVICES, INC. J1475 x x x x x<br />
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Payer Name Payer ID Only Only Only Only Only All States Claims Claims Comp Only Only (835)<br />
PALO ALTO MEDICAL FOUNDATION 41556 x x x x<br />
PAPA JOHN'S INTERNATIONAL INC J1091 x x x x x x<br />
PARADIGM J1001 x x x x x x<br />
PARAMOUNT PICTURES (MURPHY AND BEANE) J1533 x x x x x<br />
PAS COFFEE ROASTERS 41556 x x x x<br />
PATTERSON BRO LIGHT. 41556 x x x x<br />
PEERLESS J1423 x x x x<br />
PEG DISCOVER RE J1092 x x x x x x<br />
PEG DISCOVER RE( FOOOD MERCHANT) J1054 x x x x x x<br />
PEGI-FAMILY DINING J1093 x x x x x x<br />
PENNSYLVANIA MANUFACTURERS' ASSOCIATION INSURANCE COMPANY 41556 x x x x<br />
PENNSYLVANIA MANUFACTURERS INDEMNITY COMPANY 41556 x x x x<br />
PENNSYLVANIA MANUFACTURING ASSOCIATES J1439 x x x x<br />
PETALUMA VALLEY HOSPITAL 41556 x x x x<br />
PFLUGERVILLE ISD 41556 x x x x<br />
PHH FLEETAMERICA J1094 x x x x x x<br />
PIER 1 INC. USA J1369 x x x<br />
PIMA COUNTY 41556 x x x x<br />
PLAINVIEW ISD 41556 x x x x<br />
PLOTT HEALTH CARE 41556 x x x x<br />
POLY AMERICA LP J1370 x x x x x<br />
POLY-AMERICA 41556 x x x x<br />
PONDEROSA LANDSCAPE 41556 x x x x<br />
PRAIRIE MEADOWS J1118 x x x x x x x<br />
PREFERRED EMPLOYERS J1095 x x x x x x<br />
PREFERRED EMPLOYERS GROUP J1096 x x x x x x<br />
PREFERRED EMPLOYERS INSURANCE COMPANY (PEI) J1496 x x x x x x<br />
PRINT AND MAIL PAPER x x x<br />
PRUDENTIAL OVERALL SUPPLY - AZ, CA 41556 x x x x<br />
QBE - GENERAL CASUALTY - EDEN PRAIRIE J1485 x x x x x x x<br />
QBE - GENERAL CASUALTY - FARMERS UNION J1483 x x x x x x x<br />
QBE - GENERAL CASUALTY - FREEPORT J1486 x x x x x x x<br />
QBE - GENERAL CASUALTY - INDIANAPOLIS J1487 x x x x x x x<br />
QBE - GENERAL CASUALTY - SIMSBURY J1488 x x x x x x x<br />
QBE - GENERAL CASUALTY - SUN PRAIRIE J1489 x x x x x x x<br />
QBE - GENERAL CASUALTY - WEST DES MOINES J1490 x x x x x x x<br />
QBE - GENERAL CASUALTY CO OF WISCONSIN J1484 x x x x x x x<br />
QUALITY CARE CONV 41556 x x x x<br />
QUALITY HEALTH M. G. 41556 x x x x<br />
QUEEN OF ANGELS - HOLLYWOOD 41556 x x x x<br />
RALEY'S FAMILY OF FINE STORES J1522 x x x x x<br />
RAMPART INSURANCE COMPANY 38512 x x x x x x<br />
RCH PROTECTIVE - SNCC 41556 x x x x<br />
RED OAK INDEPENDENT SCHOOL DISTRICT A0205 x x x x x x x<br />
REDWOOD FIRE AND CASUALTY INSURANCE COMPANY (MEMBER OF BHHC) 20044 x x x x x<br />
REGENT INSURANCE COMPANY - QBE DBA J1484 x x x x x x x<br />
REHAB CENTER OF BEVERLY HILLS 41556 x x x x<br />
REPUBLIC FRANKLIN INSURANCE 12475 x x x x x x x<br />
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Payer Name Payer ID Only Only Only Only Only All States Claims Claims Comp Only Only (835)<br />
REPUBLIC INDEMNITY COMPANY OF AMERICA WK008 x x x x x<br />
RESCARE, INC. J1376 x x x<br />
RESIDENTIAL SERVICES GROUP J1097 x x x x x x<br />
RESTAURANT REINSURANCE LIMITED J1098 x x x x x x<br />
RESTORATION PROF 41556 x x x x<br />
RETURN TO WORK J1202 x x x x x<br />
RHONE-POULENC,INC. J1099 x x x x x x<br />
RICK CONCRETE CONST. 41556 x x x x<br />
RIETH-RILEY CONSTRUCTION COMPA J1100 x x x x x x<br />
RISK ENTERPRISE MANAGEMENT (REM) Click Here x x x x x x x<br />
RISK TRANSFER TECHNOLOGIES, INC. J1101 x x x x x x<br />
RIVERPORT INSURANCE COMPANY J1477 x x x x x x<br />
RIVERPORT INSURANCE (MN SCHOOL BOARD ASSOCIATION) J1546 x x x x<br />
ROBSTOWN ISD 41556 x x x x<br />
ROCKWALL ISD 41556 x x x x<br />
ROSE GARDEN GUEST HO 41556 x x x x<br />
ROSEWOOOD EQUIPMENT 41556 x x x x<br />
ROSSI CONCRETE, INC 41556 x x x x<br />
ROTH STAFFING COMPANIES J1516 x x x x x x x<br />
RSC INSURANCE SERVICES, LTD. J1102 x x x x x x<br />
RURAL SPECIAL DISTRICT INSURANCE PROGRAM 41556 x x x x<br />
RYDER SERVICES, INC. WK009 x x x x x<br />
SAFECO INSURANCE 24740 x x x x x<br />
SAFETY-KLEEN CORPORATION J1103 x x x x x x<br />
SALT LAKE CITY CORPORATION 41556 x x x x<br />
SAM KANE BEEF PROCESSORS, INC. 41556 x x x x<br />
SAN DIEGO HOSPICE AND THE INSTITUTE FOR PALLIATIVE MEDICINE 41556 x x x x<br />
SAN DIEGO METROPOLITAN TRANSIT SYSTEM 41556 x x x x<br />
SAN DIEGO METROPOLITAN TRANSIT SYSTEM (SCHIP LIABILITY) 41556 x x x x<br />
SAN DIEGO TRANSIT CORP. 41556 x x x x<br />
SAN DIEGO TROLLEY, INC. 41556 x x x x<br />
SAN JOAQUIN COUNTY 41556 x x x x<br />
SANTA CLARA CO OFFICE OF EDUC 41556 x x x x<br />
SANTA CLARA VALLEY TANSPORTATION AUTHORITY J1518 x x x x x<br />
SCHLUMBERGER TECHNOLOGY J1104 x x x x x x<br />
SCHNEIDER GAIN 41556 x x x x<br />
SCOTTS MIRACLE-GRO COMPANY J1049 x x x x x x<br />
SEABRIGHT (SBIC) J1499 x x x x x x x<br />
SEDGWICK CMS TP097 x x x x x x x<br />
SEENO CONSTRUCTION (CHARTIS) 41556 x x x x<br />
SEENO HOMES 41556 x x x x<br />
SELA HEALTH CARE 41556 x x x x<br />
SELECTIVE 12572 x x x x x<br />
SELF-INSURED SCHOOLS OF CALIFORNIA (SISC) J1520 x x x x x<br />
SELMAN BREITMAN 41556 x x x x<br />
SENTRY INSURANCE J1417 x x x x x<br />
SHARYLAND INDEPENDENT SCHOOL DISTRICT 41556 x x x x<br />
SIERRA NEVADA MEMORIAL 41556 x x x x<br />
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Payer Name Payer ID Only Only Only Only Only All States Claims Claims Comp Only Only (835)<br />
SILBERBERGER ENGN 41556 x x x x<br />
SKB CORPORATION 41556 x x x x<br />
SNAP-ON INCORPORATED J1105 x x x x x x<br />
SOLVAY AMERICA INC J1106 x x x x x x<br />
SONIC AUTOMOTIVE INC. J1381 x x x<br />
SONOMA VALLEY HEALTHCARE DISTRICT 41556 x x x x<br />
SONOMA VALLEY HLTH 41556 x x x x<br />
SOUTHWEST AIRLINES (SWA) J1233 x x x x x<br />
SOUTHWEST GAS CORPORATION 41556 x x x x<br />
SPECIALTY COFFEE 41556 x x x x<br />
SPOONER'S WOODWORKS 41556 x x x x<br />
ST. ROSE HOSPITAL 41556 x x x x<br />
STANDARD FORWARDING J1118 x x x x x x x<br />
STANDARD FRUIT & VEG 41556 x x x x<br />
STANLEY WORKS, INC. J1385 x x x<br />
STANT CORPORATION J1107 x x x x x x<br />
STATE COMPENSATION INSURANCE FUND (SCIF) 35076 x x x x<br />
STATE FARM J1548 x x x x x<br />
STIMSON LUMBER COMPANY - MT, OR, WA 41556 x x x x<br />
STONINGTON C. CLUB 41556 x x x x<br />
SUA INSURANCE COMPANY 40134 x x x x x<br />
SUMMIT HEALTH LTD J1108 x x x x x x<br />
SUMMIT HOLDINGS J1437 x x x x<br />
SUNRISE COUNTRY CLUB 41556 x x x x<br />
SUPERIOR ACCESS INS SERVICES 41556 x x x x<br />
SUPERIOR INDUSTRIES INTERNATIONAL, INC. 41556 x x x x<br />
SUPERIOR READY MIX 41556 x x x x<br />
SUTTER HEALTH J1512 x x x x x<br />
SWIFT TRANSPORTATION J1109 x x x x x x<br />
TAN MEDICAL GROUP 41556 x x x x<br />
TANSGUARD INSURANCE COMPANY OF AMERICA J1388 x x x x<br />
TAYLOR CORPORATION (MURPHY AND BEANE) J1533 x x x x x<br />
TD TILE 41556 x x x x<br />
TEXAS A&M A0235 x x x x x<br />
TEXAS ASSOCIATION OF SCHOOL BOARDS A0234 x x x x x<br />
TEXAS MUTUAL INSURANCE WK002 x x x x x<br />
TEXAS MUTUAL LEAGUE (TML) Click Here x x x x x<br />
TEXAS SMALL BUSINESS POOL J1110 x x x x x x<br />
THE AUTO CLUB GROUP 11983 x x x x x<br />
THE HARTFORD J1422 x x x x<br />
THE SCOTTS COMPANY J1111 x x x x x x<br />
THE ZENITH 13269 x x x x x<br />
THOMAS STAFFING SERVICES, INC/VENTURI STAFFING 41556 x x x x<br />
TIDEWATER MARINE WESTERN J1392 x x x x x<br />
TOPA INSURANCE COMPANY J1537 x x x x x<br />
TOPANGA ROSCOE CORP. 41556 x x x x<br />
TOTAL PETROLEUM, INC. J1112 x x x x x x<br />
TOWER INSURANCE COMPANY (FORMERLY SUA INSURANCE) 40134 x x x x x<br />
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Payer Name Payer ID Only Only Only Only Only All States Claims Claims Comp Only Only (835)<br />
TRAVELERS 19046 x x x x<br />
TRI-CITY HEALTHCARE DISTRICT 41556 x x x x<br />
TRI-CITY LINEN SUPPL 41556 x x x x<br />
TRICITY UNIFORM 41556 x x x x<br />
TRIDENT INSURANCE J1442 x x x x x<br />
TRINITY UNIVERSAL INSURANCE C1030 x x x x x<br />
TRIPLE A 11983 x x x x x<br />
TRI-STATE INSURANCE COMPANY J1477 x x x x x x<br />
TRUCK INSURANCE EXCHANGE (COMMERCIAL ONLY) C1034 x x x x x<br />
TUCSON UNIFIED SCHOOL DIST WC 41556 x x x x<br />
U.S. STEEL J1396 x x x x<br />
UNDERWRITERS SAFETY AND CLAIMS TP108 x x x x x x<br />
UNIGARD INSURANCE COMPANY - QBE DBA J1484 x x x x x x x<br />
UNION INSURANCE COMPANY J1397 x x x x x x x<br />
UNION INSURANCE COMPANY OF PROVIDENCE C1029 x x x x x<br />
UNION INSURANCE COMPANY OF PROVIDENCE J1433 x x x x<br />
UNION INSURANCE COMPANY OF PROVIDENCE 25844 x x x x x<br />
UNITED CONVALESCENT 41556 x x x x<br />
UNITED DOMINION REALTY TRUST J1048 x x x x x x<br />
UNITED FIRE J1401 x x x x x x<br />
UNITED STATES COLD STORAGE J1113 x x x x x x<br />
UNITED STATES FIRE INSURANCE COMPANY 31348 x x x x x x x x<br />
UNITED WISCONSIN INSURANCE COMPANY J1235 x x x x x<br />
UNITRIN AUTO & HOME INSURANCE C1030 x x x x x<br />
UNITRIN DIRECT AUTO INSURANCE C1030 x x x x x<br />
UNITRIN DIRECT PROPERTY & CASUALTY COMPANY 16063 x x x x x<br />
UNITRIN SAFEGUARD INSURANCE C1030 x x x x x<br />
UNIVERSITY OF COLORADO 41556 x x x x<br />
US FOODSERVICE, INC. J1114 x x x x x x<br />
US MOBILE WIRELESS 41556 x x x x<br />
US NATIONAL RESOURCES (AIGRM) J1115 x x x x x x<br />
USS-POSCO INDUSTRIES J1534 x x x x x<br />
UTICA C1027 x x x x x<br />
UTICA MUTUAL INSURANCE CO 25976 x x x x x x x<br />
UTICA NATIONAL INSURANCE CO OF TEXAS 43478 x x x x x x x<br />
V&M RESTORATION 41556 x x x x<br />
VALENZUELA ENG. INC 41556 x x x x<br />
VALLEY CASEWORK INC 41556 x x x x<br />
VALLEY HARVESTING & PACKING, INC. 41556 x x x x<br />
VALLEY HEALTH CARE MANAGEMENT SERVICES, LLC 41556 x x x x<br />
VALLEY HEALTH SYSTEM 41556 x x x x<br />
VALLEY MEMORIAL HOSPITAL 41556 x x x x<br />
VANLINERS INSURANCE COMPANY 21172 x x x x x<br />
VENTURE PAC DEVELOP 41556 x x x x<br />
VERMEER J1118 x x x x x x x<br />
VERTICAL CONCRETE 41556 x x x x<br />
VIACOM (MURPHY AND BEANE) J1533 x x x<br />
VIAD CORP J1403 x x x x<br />
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Payer Name Payer ID Only Only Only Only Only All States Claims Claims Comp Only Only (835)<br />
VICORP RESTAURANTS, INC. J1116 x x x x x x<br />
VICTOR PLASTICS J1118 x x x x x x x<br />
VICTORIA ISD 41556 x x x x<br />
VIRGINIA SURETY COMPANY, INC. J1404 x x x x x<br />
VISTA HILLS C CLUB 41556 x x x x<br />
VOUGHT AIRCRAFT INDUSTRIES J1405 x x x<br />
W CO RADIOLOGY CNTR 41556 x x x x<br />
WAL-MART WK001 x x x x x<br />
WASHINGTON COUNTY 41556 x x x x<br />
WASHINGTON HOSPITAL 41556 x x x x<br />
WATKINS MANUFACTURING CORPORATION 41556 x x x x<br />
WATTSHEALTH FOUNDATION, INC. (SNCC) 41556 x x x x<br />
WAWONA PACKING 41556 x x x x<br />
WESLACO INDEPENDENT SCHOOL DISTRICT 41556 x x x x<br />
WEST COAST HOSPITALS, INC. 41556 x x x x<br />
WEST OSO ISD 41556 x x x x<br />
WEST TEXAS RURAL COUNTIES ASSOCIATION PREFERRED RISK POOL - WC 41556 x x x x<br />
WESTAMERICA/PHIL LONG DEALERSHIPS 41556 x x x x<br />
WESTERN NATIONAL J1495 x x x x x<br />
WESTGUARD INSURANCE COMPANY - GUARD DBA J1453 x x x x x<br />
WILLAMETTE VIEW 41556 x x x x<br />
WILMER-HUTCHINS ISD/DALLAS ISD 41556 x x x x<br />
WOODLAND FARMS J1408 x x x x x<br />
WOODLAND PARK WEST 41556 x x x x<br />
WYMAN-GORDON COMPANIES J1117 x x x x x x<br />
XCHANGING, INC J1412 x x x x<br />
XL ENVIRONMENTAL, INC. J1055 x x x x x x<br />
YMCA 41556 x x x x<br />
ZACHRY CONSTRUCTION J1409 x x x<br />
Z-NAT INSURANCE (ZENITH NATIONAL) 30120 x x x x x<br />
ZURICH FARMERS J1015 x x x x x x x<br />
ZURICH INSURANCE N.A. 16535 x x x x x x x<br />
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ABERNATHY A0245 x x x x x<br />
ABILENE TRANSIT-CITY OF ABILENE A0245 x x x x x<br />
ADDISON A0245 x x x x x<br />
ADRIAN A0245 x x x x x<br />
AGUA DULCE A0245 x x x x x<br />
AGUA SUD A0245 x x x x x<br />
AIRLINE IMPROVEMENT DISTRICT A0245 x x x x x<br />
ALAMO A0245 x x x x x<br />
ALAMO AREA COG A0245 x x x x x<br />
ALAMO HEIGHTS A0245 x x x x x<br />
ALAMO HOUSING AUTHORITY A0245 x x x x x<br />
ALAMO REGIONAL MOBILITY AUTHORITY A0245 x x x x x<br />
ALBA A0245 x x x x x<br />
ALBA HOUSING AUTHORITY A0245 x x x x x<br />
ALBANY A0245 x x x x x<br />
ALEDO A0245 x x x x x<br />
ALICE A0245 x x x x x<br />
ALICE HOUSING AUTHORITY A0245 x x x x x<br />
ALLEN A0245 x x x x x<br />
ALMA A0245 x x x x x<br />
ALPINE A0245 x x x x x<br />
ALPINE HOUSING AUTHORITY A0245 x x x x x<br />
ALTO A0245 x x x x x<br />
ALTO HOUSING AUTHORITY A0245 x x x x x<br />
ALTON A0245 x x x x x<br />
ALVARADO A0245 x x x x x<br />
ALVIN A0245 x x x x x<br />
ALVORD A0245 x x x x x<br />
AMES A0245 x x x x x<br />
AMHERST A0245 x x x x x<br />
ANAHUAC A0245 x x x x x<br />
ANDERSON A0245 x x x x x<br />
ANDERSON CAD A0245 x x x x x<br />
ANDERSON COUNTY HOUSING AUTHORITY A0245 x x x x x<br />
ANDERSON MILL LIMITED DISTRICT A0245 x x x x x<br />
ANDREWS A0245 x x x x x<br />
ANGLETON A0245 x x x x x<br />
ANGLETON DRAINAGE DISTRICT A0245 x x x x x<br />
ANGUS A0245 x x x x x<br />
ANNA A0245 x x x x x<br />
ANNETTA A0245 x x x x x<br />
ANNETTA SOUTH A0245 x x x x x<br />
ANNONA A0245 x x x x x<br />
ANSON A0245 x x x x x<br />
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ANSON HOUSING AUTHORITY A0245 x x x x x<br />
ANTHONY HOUSING AUTHORITY A0245 x x x x x<br />
ANTHONY TOWN OF A0245 x x x x x<br />
ANTON A0245 x x x x x<br />
AQUILLA WATER SUPPLY DISTRICT A0245 x x x x x<br />
ARANSAS COUNTY NAV DISTRICT #1 A0245 x x x x x<br />
ARANSAS PASS A0245 x x x x x<br />
ARANSAS PASS HOUSING AUTHORITY A0245 x x x x x<br />
ARCHER CAD A0245 x x x x x<br />
ARCHER CITY A0245 x x x x x<br />
ARCHER CITY HOUSING AUTHORITY A0245 x x x x x<br />
ARCOLA A0245 x x x x x<br />
AREA METROPOLITAN AMBULANCE AUTHORITY A0245 x x x x x<br />
ARGYLE A0245 x x x x x<br />
ARK-TEX COG A0245 x x x x x<br />
ARLINGTON ENTERTAINMENT AMD A0245 x x x x x<br />
ARP A0245 x x x x x<br />
ARTS OF COLLIN COUNTY COMM INC A0245 x x x x x<br />
ASHERTON A0245 x x x x x<br />
ASPERMONT A0245 x x x x x<br />
ASPERMONT HOUSING AUTHORITY A0245 x x x x x<br />
ATASCOSA CAD A0245 x x x x x<br />
ATHENS A0245 x x x x x<br />
ATHENS MUNICIPAL WATER AUTH A0245 x x x x x<br />
ATLANTA A0245 x x x x x<br />
ATLANTA HOUSING AUTHORITY A0245 x x x x x<br />
AUBREY A0245 x x x x x<br />
AURORA A0245 x x x x x<br />
AUSTIN CAD A0245 x x x x x<br />
AUSTIN COUNTY ESD #2/SEALY VFD A0245 x x x x x<br />
AUSTIN COUNTY ESD #3 A0245 x x x x x<br />
AUSTIN HOUSING AUTHORITY A0245 x x x x x<br />
AUSTWELL A0245 x x x x x<br />
AVERY A0245 x x x x x<br />
AVERY HOUSING AUTHORITY A0245 x x x x x<br />
AVINGER A0245 x x x x x<br />
AVINGER HOUSING AUTHORITY A0245 x x x x x<br />
AZLE A0245 x x x x x<br />
BACLIFF MUD A0245 x x x x x<br />
BAILEY A0245 x x x x x<br />
BAILEY CENTRAL APPRAISAL DIST A0245 x x x x x<br />
BAILEY'S PRAIRIE VILLAGE OF A0245 x x x x x<br />
BAIRD A0245 x x x x x<br />
BAIRD HOUSING AUTHORITY A0245 x x x x x<br />
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BALCH SPRINGS A0245 x x x x x<br />
BALCONES HEIGHTS A0245 x x x x x<br />
BALLINGER A0245 x x x x x<br />
BALLINGER HOUSING AUTHORITY A0245 x x x x x<br />
BALMORHEA A0245 x x x x x<br />
BALMORHEA HOUSING AUTHORITY A0245 x x x x x<br />
BANDERA A0245 x x x x x<br />
BANDERA COUNTY CENTRAL APPRAISAL DIST A0245 x x x x x<br />
BANDERA COUNTY FWSD #1 A0245 x x x x x<br />
BANDERA COUNTY RIVER AUTHORITY & GWD A0245 x x x x x<br />
BANDERA SWCD A0245 x x x x x<br />
BANGS A0245 x x x x x<br />
BANGS HOUSING AUTHORITY A0245 x x x x x<br />
BARDWELL A0245 x x x x x<br />
BARSTOW A0245 x x x x x<br />
BARTLETT A0245 x x x x x<br />
BARTLETT HOUSING AUTHORITY A0245 x x x x x<br />
BARTON SPRINGS/EDWARDS AQUIFER A0245 x x x x x<br />
BARTONVILLE A0245 x x x x x<br />
BASTROP A0245 x x x x x<br />
BASTROP COUNTY ESD #1 A0245 x x x x x<br />
BASTROP COUNTY MUD #1 A0245 x x x x x<br />
BASTROP COUNTY SWCD #340 A0245 x x x x x<br />
BASTROP COUNTY WCID #2 A0245 x x x x x<br />
BASTROP COUNTY WCID #3 A0245 x x x x x<br />
BASTROP HOUSING AUTHORITY A0245 x x x x x<br />
BAY CITY A0245 x x x x x<br />
BAY CITY HOUSING AUTHORITY A0245 x x x x x<br />
BAYLOR CAD A0245 x x x x x<br />
BAYOU VISTA A0245 x x x x x<br />
BAYSIDE TOWN OF A0245 x x x x x<br />
BAYTOWN HOUSING AUTHORITY A0245 x x x x x<br />
BAYVIEW IRRIGATION DISTRICT #11 A0245 x x x x x<br />
BAYVIEW MUD A0245 x x x x x<br />
BAYVIEW TOWN OF A0245 x x x x x<br />
BEACH CITY A0245 x x x x x<br />
BEASLEY A0245 x x x x x<br />
BEAUMONT HOUSING AUTHORITY A0245 x x x x x<br />
BECKVILLE A0245 x x x x x<br />
BECKVILLE HOUSING AUTHORITY A0245 x x x x x<br />
BEDFORD A0245 x x x x x<br />
BEDIAS A0245 x x x x x<br />
BEE CAVE A0245 x x x x x<br />
BEE DEVELOPMENT AUTHORITY A0245 x x x x x<br />
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BEEVILLE A0245 x x x x x<br />
BEEVILLE HOUSING AUTHORITY A0245 x x x x x<br />
BELL COUNTY PUBLIC HEALTH DISTRICT A0245 x x x x x<br />
BELL COUNTY WCID #2 A0245 x x x x x<br />
BELLA VISTA MUD A0245 x x x x x<br />
BELLAIRE A0245 x x x x x<br />
BELLEVUE A0245 x x x x x<br />
BELLMEAD A0245 x x x x x<br />
BELLS A0245 x x x x x<br />
BELLVILLE A0245 x x x x x<br />
BELLVILLE HOUSING AUTHORITY A0245 x x x x x<br />
BELTON A0245 x x x x x<br />
BENAVIDES A0245 x x x x x<br />
BENBROOK A0245 x x x x x<br />
BENBROOK PUBLIC LIBRARY DISTRICT A0245 x x x x x<br />
BENBROOK WATER AUTHORITY A0245 x x x x x<br />
BENJAMIN A0245 x x x x x<br />
BERRYVILLE A0245 x x x x x<br />
BERTRAM A0245 x x x x x<br />
BEVERLY HILLS A0245 x x x x x<br />
BEVIL OAKS A0245 x x x x x<br />
BEVIL OAKS MUD A0245 x x x x x<br />
BEXAR APPRAISAL DISTRICT A0245 x x x x x<br />
BEXAR COUNTY HOUSING AUTHORITY A0245 x x x x x<br />
BEXAR COUNTY WCID #10 A0245 x x x x x<br />
BEXAR METRO 911 DISTRICT A0245 x x x x x<br />
BEXAR METROPOLITAN WATER DISTRICT A0245 x x x x x<br />
BEXAR-MEDINA-ATASCOSA COUNTIES WCID #1 A0245 x x x x x<br />
BIG BEND SWCD #227 A0245 x x x x x<br />
BIG LAKE A0245 x x x x x<br />
BIG SANDY A0245 x x x x x<br />
BIG SANDY HOUSING AUTHORITY A0245 x x x x x<br />
BIG SPRING A0245 x x x x x<br />
BIG SPRING HOUSING AUTHORITY A0245 x x x x x<br />
BIG WELLS A0245 x x x x x<br />
BISHOP A0245 x x x x x<br />
BISHOP HILLS VILLAGE OF A0245 x x x x x<br />
BISTONE MWSD A0245 x x x x x<br />
BLANCO A0245 x x x x x<br />
BLANCO COUNTY SOUTH LIBRARY DIST/BLANCO A0245 x x x x x<br />
BLANCO-PEDERNALES GCD A0245 x x x x x<br />
BLANKET A0245 x x x x x<br />
BLOCK HOUSE MUD A0245 x x x x x<br />
BLOOMBURG A0245 x x x x x<br />
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BLOOMING GROVE A0245 x x x x x<br />
BLOOMING GROVE HOUSING AUTHORITY A0245 x x x x x<br />
BLOSSOM A0245 x x x x x<br />
BLOSSOM PRAIRIE HOUSING AUTHORITY A0245 x x x x x<br />
BLUE MOUND A0245 x x x x x<br />
BLUE RIDGE A0245 x x x x x<br />
BLUM A0245 x x x x x<br />
BOERNE A0245 x x x x x<br />
BOGATA A0245 x x x x x<br />
BOGATA HOUSING AUTHORITY A0245 x x x x x<br />
BOIS D'ARC MUD A0245 x x x x x<br />
BOLIVAR PENINSULA SUD A0245 x x x x x<br />
BONHAM A0245 x x x x x<br />
BONNEY VILLAGE OF A0245 x x x x x<br />
BOOKER A0245 x x x x x<br />
BORDER REGION MHMR A0245 x x x x x<br />
BORGER A0245 x x x x x<br />
BORGER HOUSING AUTHORITY A0245 x x x x x<br />
BOSQUE COUNTY CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />
BOVINA A0245 x x x x x<br />
BOVINA HOUSING AUTHORITY A0245 x x x x x<br />
BOWIE A0245 x x x x x<br />
BOWIE COUNTY ESD #1 A0245 x x x x x<br />
BOWIE COUNTY ESD #2 A0245 x x x x x<br />
BOWIE COUNTY SWCD A0245 x x x x x<br />
BOYD A0245 x x x x x<br />
BRACKETTVILLE A0245 x x x x x<br />
BRACKETTVILLE HOUSING AUTHORITY A0245 x x x x x<br />
BRADY A0245 x x x x x<br />
BRADY HOUSING AUTHORITY A0245 x x x x x<br />
BRAZORIA A0245 x x x x x<br />
BRAZORIA CAD A0245 x x x x x<br />
BRAZORIA COUNTY CONS/RECL DIST #3 A0245 x x x x x<br />
BRAZORIA COUNTY DRAINAGE DISTRICT #5 A0245 x x x x x<br />
BRAZORIA COUNTY MUD #18 A0245 x x x x x<br />
BRAZORIA COUNTY MUD #23 A0245 x x x x x<br />
BRAZORIA COUNTY MUD #25 A0245 x x x x x<br />
BRAZORIA COUNTY MUD #26 A0245 x x x x x<br />
BRAZORIA COUNTY MUD #35 A0245 x x x x x<br />
BRAZORIA DRAINAGE DISTRICT #4 A0245 x x x x x<br />
BRAZORIA-FORT BEND COUNTY MUD #1 A0245 x x x x x<br />
BRAZOS CAD A0245 x x x x x<br />
BRAZOS COUNTRY A0245 x x x x x<br />
BRAZOS COUNTY ESD #1 A0245 x x x x x<br />
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BRAZOS COUNTY ESD #2 A0245 x x x x x<br />
BRAZOS COUNTY ESD #4 A0245 x x x x x<br />
BRAZOS COUNTY EMERGENCY 911 A0245 x x x x x<br />
BRAZOS RIVER AUTHORITY A0245 x x x x x<br />
BRAZOS VALLEY COG A0245 x x x x x<br />
BRAZOS VALLEY GCD A0245 x x x x x<br />
BRAZOS VALLEY SWCD #557 A0245 x x x x x<br />
BRECKENRIDGE A0245 x x x x x<br />
BRECKENRIDGE HOUSING AUTHORITY A0245 x x x x x<br />
BREMOND A0245 x x x x x<br />
BREMOND HOUSING AUTHORITY A0245 x x x x x<br />
BRENHAM A0245 x x x x x<br />
BRENHAM HOUSING AUTHORITY A0245 x x x x x<br />
BREWSTER CAD A0245 x x x x x<br />
BRIARCLIFF VILLAGE OF A0245 x x x x x<br />
BRIAROAKS A0245 x x x x x<br />
BRIDGE CITY A0245 x x x x x<br />
BRIDGEPORT A0245 x x x x x<br />
BRIDGEPORT HOUSING AUTHORITY A0245 x x x x x<br />
BRIGHT STAR-SALEM SUD A0245 x x x x x<br />
BRISCOE CAD A0245 x x x x x<br />
BRONTE A0245 x x x x x<br />
BRONTE HOUSING AUTHORITY A0245 x x x x x<br />
BROOKESMITH SUD A0245 x x x x x<br />
BROOKSHIRE A0245 x x x x x<br />
BROOKSHIRE MUNICIPAL WATER DISTRICT A0245 x x x x x<br />
BROOKSIDE VILLAGE A0245 x x x x x<br />
BROWNFIELD A0245 x x x x x<br />
BROWNFIELD HOUSING AUTHORITY A0245 x x x x x<br />
BROWNSBORO A0245 x x x x x<br />
BROWNSVILLE A0245 x x x x x<br />
BROWNSVILLE HOUSING AUTHORITY A0245 x x x x x<br />
BROWNSVILLE NAVIGATION DISTRICT A0245 x x x x x<br />
BROWNSVILLE PUBLIC UTILITIES BOARD A0245 x x x x x<br />
BROWNWOOD A0245 x x x x x<br />
BROWNWOOD HOUSING AUTHORITY A0245 x x x x x<br />
BRUCEVILLE-EDDY A0245 x x x x x<br />
BRUSHY CREEK MUD A0245 x x x x x<br />
BRYAN HOUSING AUTHORITY A0245 x x x x x<br />
BRYSON A0245 x x x x x<br />
BRYSON HOUSING AUTHORITY A0245 x x x x x<br />
BUCKHOLTS A0245 x x x x x<br />
BUDA A0245 x x x x x<br />
BUENA VISTA-BETHEL SUD A0245 x x x x x<br />
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BUFFALO GAP A0245 x x x x x<br />
BUFFALO HOUSING AUTHORITY A0245 x x x x x<br />
BUFFALO SPRINGS A0245 x x x x x<br />
BULLARD A0245 x x x x x<br />
BULVERDE A0245 x x x x x<br />
BULVERDE AREA RURAL LIBRARY DISTRICT A0245 x x x x x<br />
BUNKER HILL VILLAGE A0245 x x x x x<br />
BURKBURNETT A0245 x x x x x<br />
BURKBURNETT HOUSING AUTHORITY A0245 x x x x x<br />
BURLESON A0245 x x x x x<br />
BURLESON COUNTY MUD #1 A0245 x x x x x<br />
BURNET A0245 x x x x x<br />
BURNET CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />
BURNET HOUSING AUTHORITY A0245 x x x x x<br />
BURNEY ROAD MUD A0245 x x x x x<br />
BURTON A0245 x x x x x<br />
BYERS A0245 x x x x x<br />
BYNUM A0245 x x x x x<br />
CACTUS A0245 x x x x x<br />
CADDO BASIN SUD A0245 x x x x x<br />
CADDO MILLS A0245 x x x x x<br />
CADDO MILLS HOUSING AUTHORITY A0245 x x x x x<br />
CALDWELL A0245 x x x x x<br />
CALDWELL CAD A0245 x x x x x<br />
CALDWELL HOUSING AUTHORITY A0245 x x x x x<br />
CALDWELL-TRAVIS SWCD #304 A0245 x x x x x<br />
CALHOUN COUNTY DD #11 A0245 x x x x x<br />
CALHOUN COUNTY E911 ECD A0245 x x x x x<br />
CALHOUN COUNTY NAVIGATION DISTRICT A0245 x x x x x<br />
CALHOUN COUNTY WCID #1 A0245 x x x x x<br />
CALLAHAN CAD A0245 x x x x x<br />
CALLAHAN COUNTY NUTRITION PROJECT A0245 x x x x x<br />
CALLISBURG A0245 x x x x x<br />
CALVERT A0245 x x x x x<br />
CALVERT HOUSING AUTHORITY A0245 x x x x x<br />
CAMERON A0245 x x x x x<br />
CAMERON APPRAISAL DISTRICT A0245 x x x x x<br />
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CENTRAL TEXAS COG A0245 x x x x x<br />
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CLEAR BROOK CITY MUD A0245 x x x x x<br />
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EMERALD BAY MUD A0245 x x x x x<br />
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ENCINAL A0245 x x x x x<br />
ENGELMAN IRRIGATION DISTRICT A0245 x x x x x<br />
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ENNIS HOUSING AUTHORITY A0245 x x x x x<br />
ERATH CAD A0245 x x x x x<br />
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FALLS CAD A0245 x x x x x<br />
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FANNIN CAD A0245 x x x x x<br />
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FARMERSVILLE A0245 x x x x x<br />
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FATE A0245 x x x x x<br />
FAYETTE CAD A0245 x x x x x<br />
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FOLLETT A0245 x x x x x<br />
FOREST HILL A0245 x x x x x<br />
FOREST HILL LIBRARY DISTRICT A0245 x x x x x<br />
FOREST HILLS MUD A0245 x x x x x<br />
FORNEY A0245 x x x x x<br />
FORSAN A0245 x x x x x<br />
FORT BEND COUNTY ESD #2 A0245 x x x x x<br />
FORT BEND COUNTY FWSD #1 A0245 x x x x x<br />
FORT BEND COUNTY FWSD #2 A0245 x x x x x<br />
FORT BEND COUNTY MUD #189 A0245 x x x x x<br />
FORT BEND COUNTY MUD #25 A0245 x x x x x<br />
FORT BEND COUNTY MUD #5 A0245 x x x x x<br />
FORT BEND COUNTY MUD #50 A0245 x x x x x<br />
FORT BEND COUNTY MUD #67 A0245 x x x x x<br />
FORT BEND ESD #3 A0245 x x x x x<br />
FORT CLARK MUD A0245 x x x x x<br />
FORT HANCOCK WCID A0245 x x x x x<br />
FORT STOCKTON A0245 x x x x x<br />
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FOUR WAY SUD A0245 x x x x x<br />
FRANKLIN A0245 x x x x x<br />
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FRANKLIN HOUSING AUTHORITY A0245 x x x x x<br />
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GALENA PARK A0245 x x x x x<br />
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GALVESTON COUNTY FWSD #6 A0245 x x x x x<br />
GALVESTON COUNTY HEALTH DISTRICT A0245 x x x x x<br />
GALVESTON COUNTY MUD #12 A0245 x x x x x<br />
GALVESTON COUNTY MUD #15 A0245 x x x x x<br />
GALVESTON COUNTY MUD #2 A0245 x x x x x<br />
GALVESTON COUNTY MUD #29 A0245 x x x x x<br />
GALVESTON COUNTY MUD #3 A0245 x x x x x<br />
GALVESTON COUNTY MUD #39 A0245 x x x x x<br />
GALVESTON COUNTY WCID #1 A0245 x x x x x<br />
GALVESTON COUNTY WCID #19 A0245 x x x x x<br />
GALVESTON HOUSING AUTHORITY A0245 x x x x x<br />
GANADO A0245 x x x x x<br />
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GARRETT A0245 x x x x x<br />
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GEORGE WEST A0245 x x x x x<br />
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GONZALES COUNTY SWCD #338 A0245 x x x x x<br />
GONZALES COUNTY UWCD A0245 x x x x x<br />
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GREENBELT MUNICIPAL & INDUSTRIAL WA A0245 x x x x x<br />
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HARRIS COUNTY MUD #215 A0245 x x x x x<br />
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HIDALGO COUNTY IRRIGATION DISTRICT #6 A0245 x x x x x<br />
HIDALGO COUNTY WCID #19 A0245 x x x x x<br />
HIDALGO HOUSING AUTHORITY A0245 x x x x x<br />
HIGGINS A0245 x x x x x<br />
HIGGINS/LIPSCOMB HOSPITAL DISTRICT A0245 x x x x x<br />
HIGHLAND HAVEN A0245 x x x x x<br />
HIGHLAND PARK TOWN OF A0245 x x x x x<br />
HIGHLAND SWCD #210 A0245 x x x x x<br />
HIGHLANDS AT MAYFIELD RANCH MUD A0245 x x x x x<br />
HILL CAD A0245 x x x x x<br />
HILL COUNTRY TRANSIT DISTRICT A0245 x x x x x<br />
HILL COUNTRY UWCD A0245 x x x x x<br />
HILL COUNTRY VILLAGE A0245 x x x x x<br />
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HOLLAND A0245 x x x x x<br />
HOLLIDAY A0245 x x x x x<br />
HOLLYWOOD PARK A0245 x x x x x<br />
HONDO A0245 x x x x x<br />
HONEY GROVE A0245 x x x x x<br />
HOOD CAD A0245 x x x x x<br />
HOOKS A0245 x x x x x<br />
HOPKINS CAD A0245 x x x x x<br />
HOPKINS COUNTY SWCD A0245 x x x x x<br />
HORIZON CITY A0245 x x x x x<br />
HORSESHOE BAY A0245 x x x x x<br />
HOUSTON CAD A0245 x x x x x<br />
HOUSTON HOUSING AUTHORITY A0245 x x x x x<br />
HOUSTON/GALVESTON AREA COG A0245 x x x x x<br />
HOWARD CAD A0245 x x x x x<br />
HOWARD COUNTY 911 A0245 x x x x x<br />
HOWARD SWCD #243 A0245 x x x x x<br />
HOWARDWICK A0245 x x x x x<br />
HOWE A0245 x x x x x<br />
HUBBARD A0245 x x x x x<br />
HUBBARD HOUSING AUTHORITY A0245 x x x x x<br />
HUDSON OAKS A0245 x x x x x<br />
HUDSPETH COUNTY CONS/RECL DIST #1 A0245 x x x x x<br />
HUDSPETH COUNTY ESD #1 A0245 x x x x x<br />
HUDSPETH COUNTY UWCD #1 A0245 x x x x x<br />
HUDSPETH COUNTY WCID #1 A0245 x x x x x<br />
HUGHES SPRINGS A0245 x x x x x<br />
HUGHES SPRINGS HOUSING AUTHORITY A0245 x x x x x<br />
HULL FWSD A0245 x x x x x<br />
HULL-DAISETTA ESD #2 A0245 x x x x x<br />
HUMBLE A0245 x x x x x<br />
HUNT CAD A0245 x x x x x<br />
HUNTERS CREEK VILLAGE A0245 x x x x x<br />
HUNTINGTON HOUSING AUTHORITY A0245 x x x x x<br />
HUNTSVILLE A0245 x x x x x<br />
HUNTSVILLE HOUSING AUTHORITY A0245 x x x x x<br />
HURST A0245 x x x x x<br />
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INGLESIDE ON THE BAY A0245 x x x x x<br />
INGRAM A0245 x x x x x<br />
INVERNESS FOREST ID A0245 x x x x x<br />
IOLA A0245 x x x x x<br />
IOWA COLONY VILLAGE OF A0245 x x x x x<br />
IOWA PARK A0245 x x x x x<br />
IRAAN A0245 x x x x x<br />
IREDELL A0245 x x x x x<br />
IRION CAD A0245 x x x x x<br />
IRION COUNTY WATER CONSERVATION DISTRICT A0245 x x x x x<br />
ISAACSON MUD A0245 x x x x x<br />
ITALY A0245 x x x x x<br />
ITASCA A0245 x x x x x<br />
JACINTO CITY A0245 x x x x x<br />
JACK CAD A0245 x x x x x<br />
JACK COUNTY HOSPITAL DISTRICT A0245 x x x x x<br />
JACKSBORO A0245 x x x x x<br />
JACKSON CAD A0245 x x x x x<br />
JACKSON COUNTY ESD #1 A0245 x x x x x<br />
JACKSON COUNTY HOSPITAL DISTRICT A0245 x x x x x<br />
JACKSON COUNTY WCID #2 A0245 x x x x x<br />
JACKSONVILLE A0245 x x x x x<br />
JACKSONVILLE HOUSING AUTHORITY A0245 x x x x x<br />
JAMAICA BEACH A0245 x x x x x<br />
JARRELL A0245 x x x x x<br />
JAYTON A0245 x x x x x<br />
JEFFERSON A0245 x x x x x<br />
JEFFERSON COUNTY DRAINAGE DISTRICT #6 A0245 x x x x x<br />
JEFFERSON HOUSING AUTHORITY A0245 x x x x x<br />
JERSEY VILLAGE A0245 x x x x x<br />
JEWETT A0245 x x x x x<br />
JIM HOGG COUNTY HOUSING AUTHORITY A0245 x x x x x<br />
JIM HOGG COUNTY WCID #2 A0245 x x x x x<br />
JIM WELLS COUNTY FWSD #1 A0245 x x x x x<br />
JOHNSON CITY A0245 x x x x x<br />
JOHNSON CITY HOUSING AUTHORITY A0245 x x x x x<br />
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JONAH WATER SUD A0245 x x x x x<br />
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JUNCTION A0245 x x x x x<br />
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JUSTIN A0245 x x x x x<br />
KARNES CITY A0245 x x x x x<br />
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KATY A0245 x x x x x<br />
KAUFMAN A0245 x x x x x<br />
KAUFMAN AREA RURAL TRANSPORTATION A0245 x x x x x<br />
KAUFMAN CAD A0245 x x x x x<br />
KAUFMAN-VAN ZANDT ROCKWALL COUNTY SWCD A0245 x x x x x<br />
KEENE A0245 x x x x x<br />
KELLER A0245 x x x x x<br />
KELLY LANE WCID #1 A0245 x x x x x<br />
KELLY LANE WCID #2 A0245 x x x x x<br />
KEMAH A0245 x x x x x<br />
KEMP A0245 x x x x x<br />
KEMP HOUSING AUTHORITY A0245 x x x x x<br />
KEMPNER A0245 x x x x x<br />
KENDALL COUNTY WCID #1 A0245 x x x x x<br />
KENEDY A0245 x x x x x<br />
KENEDY HOUSING AUTHORITY A0245 x x x x x<br />
KENEFICK A0245 x x x x x<br />
KENNARD A0245 x x x x x<br />
KENNEDALE A0245 x x x x x<br />
KERENS A0245 x x x x x<br />
KERENS HOUSING AUTHORITY A0245 x x x x x<br />
KERMIT A0245 x x x x x<br />
KERR CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />
KERR COUNTY SWCD #217 A0245 x x x x x<br />
KERR EMERGENCY 911 NETWORK A0245 x x x x x<br />
KERRVILLE A0245 x x x x x<br />
KERRVILLE PUBLIC UTILITY BOARD A0245 x x x x x<br />
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KINGSLAND MUD A0245 x x x x x<br />
KINGSVILLE A0245 x x x x x<br />
KINGSVILLE HOUSING AUTHORITY A0245 x x x x x<br />
KINNEY CAD A0245 x x x x x<br />
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KIRBY A0245 x x x x x<br />
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KLEBERG CAD A0245 x x x x x<br />
KNOLLWOOD A0245 x x x x x<br />
KNOX CITY A0245 x x x x x<br />
KNOX CITY HOUSING AUTHORITY A0245 x x x x x<br />
KOSSE A0245 x x x x x<br />
KOUNTZE A0245 x x x x x<br />
KRESS A0245 x x x x x<br />
KRUGERVILLE A0245 x x x x x<br />
KRUM A0245 x x x x x<br />
KURTEN A0245 x x x x x<br />
KYLE A0245 x x x x x<br />
KYLE HOUSING AUTHORITY A0245 x x x x x<br />
LA COSTE A0245 x x x x x<br />
LA FERIA A0245 x x x x x<br />
LA FERIA IRRIGATION DIST #3 A0245 x x x x x<br />
LA GRANGE A0245 x x x x x<br />
LA GRANGE HOUSING AUTHORITY A0245 x x x x x<br />
LA GRULLA A0245 x x x x x<br />
LA JOYA A0245 x x x x x<br />
LA JOYA HOUSING AUTHORITY A0245 x x x x x<br />
LA MARQUE A0245 x x x x x<br />
LA PORTE A0245 x x x x x<br />
LA VILLA A0245 x x x x x<br />
LACY-LAKEVIEW A0245 x x x x x<br />
LADONIA A0245 x x x x x<br />
LAGO VISTA A0245 x x x x x<br />
LAGUNA MADRE WATER DISTRICT A0245 x x x x x<br />
LAGUNA VISTA A0245 x x x x x<br />
LAKE BRIDGEPORT A0245 x x x x x<br />
LAKE CITIES MUA A0245 x x x x x<br />
LAKE DALLAS A0245 x x x x x<br />
LAKE JACKSON A0245 x x x x x<br />
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LAKESIDE (TARRANT CO) A0245 x x x x x<br />
LAKESIDE CITY A0245 x x x x x<br />
LAKEVIEW A0245 x x x x x<br />
LAKEVIEW POLICE DEPARTMENT A0245 x x x x x<br />
LAKEWAY A0245 x x x x x<br />
LAKEWAY MUD A0245 x x x x x<br />
LAKEWOOD VILLAGE A0245 x x x x x<br />
LAMAR CAD A0245 x x x x x<br />
LAMAR SWCD A0245 x x x x x<br />
LAMESA A0245 x x x x x<br />
LAMPASAS A0245 x x x x x<br />
LAMPASAS CAD A0245 x x x x x<br />
LANCASTER A0245 x x x x x<br />
LAREDO A0245 x x x x x<br />
LAREDO HOUSING AUTHORITY A0245 x x x x x<br />
LAREDO TRANSIT A0245 x x x x x<br />
LATEXO A0245 x x x x x<br />
LAVACA COUNTY CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />
LAVACA-NAVIDAD RIVER AUTHORITY A0245 x x x x x<br />
LAVON A0245 x x x x x<br />
LAZY RIVER IMPROVEMENT DISTRICT A0245 x x x x x<br />
LEAGUE CITY A0245 x x x x x<br />
LEAKEY A0245 x x x x x<br />
LEANDER A0245 x x x x x<br />
LEE CAD A0245 x x x x x<br />
LEFORS A0245 x x x x x<br />
LEON CAD A0245 x x x x x<br />
LEON VALLEY A0245 x x x x x<br />
LEONA A0245 x x x x x<br />
LEONARD A0245 x x x x x<br />
LEONARD HOUSING AUTHORITY A0245 x x x x x<br />
LEVELLAND A0245 x x x x x<br />
LEVELLAND HOUSING AUTHORITY A0245 x x x x x<br />
LEXINGTON A0245 x x x x x<br />
LIBERTY A0245 x x x x x<br />
LIBERTY COUNTY DD #2 A0245 x x x x x<br />
LIBERTY COUNTY DD #4 A0245 x x x x x<br />
LIBERTY COUNTY ESD #3 A0245 x x x x x<br />
LIBERTY COUNTY WCID #5 A0245 x x x x x<br />
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LIMESTONE-FALLS SWCD A0245 x x x x x<br />
LINDALE A0245 x x x x x<br />
LINDEN A0245 x x x x x<br />
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LINDSAY A0245 x x x x x<br />
LIPAN A0245 x x x x x<br />
LIPAN-KICKAPOO WCD A0245 x x x x x<br />
LIPSCOMB CO CENTRAL APPRAISAL DIST A0245 x x x x x<br />
LITTLE ELM A0245 x x x x x<br />
LITTLE RIVER ACADEMY A0245 x x x x x<br />
LITTLE RIVER-SAN GABRIEL SWCD #508 A0245 x x x x x<br />
LITTLEFIELD A0245 x x x x x<br />
LIVE OAK A0245 x x x x x<br />
LIVERPOOL A0245 x x x x x<br />
LIVINGSTON A0245 x x x x x<br />
LIVINGSTON HOUSING AUTHORITY A0245 x x x x x<br />
LLANO A0245 x x x x x<br />
LLANO CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />
LLANO COUNTY MUD #1 A0245 x x x x x<br />
LLANO COUNTY SWCD #233 A0245 x x x x x<br />
LLANO ESTACADO UWCD A0245 x x x x x<br />
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LOCKHART A0245 x x x x x<br />
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LOCKNEY A0245 x x x x x<br />
LOCKNEY HOUSING AUTHORITY A0245 x x x x x<br />
LOG CABIN A0245 x x x x x<br />
LOMETA A0245 x x x x x<br />
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LONE OAK A0245 x x x x x<br />
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LONGVIEW A0245 x x x x x<br />
LORAINE A0245 x x x x x<br />
LORAINE HOUSING AUTHORITY A0245 x x x x x<br />
LORENA A0245 x x x x x<br />
LORENZO A0245 x x x x x<br />
LOS FRESNOS A0245 x x x x x<br />
LOS FRESNOS HOUSING AUTHORITY A0245 x x x x x<br />
LOS INDIOS A0245 x x x x x<br />
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LOWER CLEAR FORK/BRAZOS SWCD #551 A0245 x x x x x<br />
LOWER RIO GRANDE VALLEY DEV COUNCIL A0245 x x x x x<br />
LOWER TRINITY GCD A0245 x x x x x<br />
LOWER VALLEY WATER DISTRICT A0245 x x x x x<br />
LOWRY CROSSING A0245 x x x x x<br />
LUBBOCK CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />
LUBBOCK COUNTY WCID #1 A0245 x x x x x<br />
LUBBOCK EMERGENCY COMMUNICATION DISTRICT A0245 x x x x x<br />
LUBBOCK HOUSING AUTHORITY A0245 x x x x x<br />
LUBBOCK-CITIBUS A0245 x x x x x<br />
LUBBOCK/REESE REDEVELOPMENT AUTHORITY A0245 x x x x x<br />
LUCAS A0245 x x x x x<br />
LUCE BAYOU PUD A0245 x x x x x<br />
LUEDERS A0245 x x x x x<br />
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LULING A0245 x x x x x<br />
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LYNN CAD A0245 x x x x x<br />
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MHMR OF TARRANT COUNTY A0245 x x x x x<br />
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MACBEE SUD A0245 x x x x x<br />
MACEDONIA EYLAU MUD A0245 x x x x x<br />
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MANOR A0245 x x x x x<br />
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MARLIN HOUSING AUTHORITY A0245 x x x x x<br />
MARQUEZ A0245 x x x x x<br />
MARSHALL A0245 x x x x x<br />
MARSHALL HARRISON COUNTY HEALTH DIST A0245 x x x x x<br />
MARSHALL HOUSING AUTHORITY A0245 x x x x x<br />
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MARTIN COUNTY FRESH WATER DISTRICT A0245 x x x x x<br />
MARTINDALE A0245 x x x x x<br />
MASON A0245 x x x x x<br />
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MASON SWCD #223 A0245 x x x x x<br />
MATADOR A0245 x x x x x<br />
MATADOR HOUSING AUTHORITY A0245 x x x x x<br />
MATADOR WATER DISTRICT A0245 x x x x x<br />
MATAGORDA COUNTY WCID #6 A0245 x x x x x<br />
MATHIS A0245 x x x x x<br />
MATHIS HOUSING AUTHORITY A0245 x x x x x<br />
MAUD A0245 x x x x x<br />
MAUD HOUSING AUTHORITY A0245 x x x x x<br />
MAVERICK CAD A0245 x x x x x<br />
MAVERICK COUNTY HOSPITAL DIST A0245 x x x x x<br />
MAVERICK COUNTY WCID #1 A0245 x x x x x<br />
MAVERICK SWCD #228 A0245 x x x x x<br />
MAYPEARL A0245 x x x x x<br />
MCALLEN HOUSING AUTHORITY A0245 x x x x x<br />
MCCAMEY A0245 x x x x x<br />
MCCULLOCH CAD A0245 x x x x x<br />
MCCULLOCH SWCD #249 A0245 x x x x x<br />
MCGREGOR A0245 x x x x x<br />
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MCKINNEY A0245 x x x x x<br />
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MEMORIAL VILLAGES POLICE DEPT A0245 x x x x x<br />
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MENARD A0245 x x x x x<br />
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MERIDIAN A0245 x x x x x<br />
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MERTZON A0245 x x x x x<br />
MESA UWCD A0245 x x x x x<br />
MESQUITE A0245 x x x x x<br />
MESQUITE GROUNDWATER CONS DISTRICT A0245 x x x x x<br />
MEXIA A0245 x x x x x<br />
MEXIA HOUSING AUTHORITY A0245 x x x x x<br />
MIAMI A0245 x x x x x<br />
MIDDLE CONCHO SWCD A0245 x x x x x<br />
MIDDLE RIO GRANDE COG A0245 x x x x x<br />
MIDDLE TRINITY GCD A0245 x x x x x<br />
MIDLAND CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />
MIDLAND COUNTY HOUSING AUTHORITY A0245 x x x x x<br />
MIDLAND EMERGENCY COMM DIST A0245 x x x x x<br />
MIDLAND HOUSING AUTHORITY A0245 x x x x x<br />
MIDLAND SWCD A0245 x x x x x<br />
MIDLOTHIAN A0245 x x x x x<br />
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MONTGOMERY COUNTY ESD #14 A0245 x x x x x<br />
MONTGOMERY COUNTY ESD #2 A0245 x x x x x<br />
MONTGOMERY COUNTY ESD #3 A0245 x x x x x<br />
MONTGOMERY COUNTY ESD #4 A0245 x x x x x<br />
MONTGOMERY COUNTY ESD #6 A0245 x x x x x<br />
MONTGOMERY COUNTY ESD #7 A0245 x x x x x<br />
MONTGOMERY COUNTY ESD #8 A0245 x x x x x<br />
MONTGOMERY COUNTY ESD #9 A0245 x x x x x<br />
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MORGAN A0245 x x x x x<br />
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MORGAN'S POINT RESORT A0245 x x x x x<br />
MORRIS CAD A0245 x x x x x<br />
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NEW BRAUNFELS UTILITIES A0245 x x x x x<br />
NEW DEAL A0245 x x x x x<br />
NEW FAIRVIEW A0245 x x x x x<br />
NEW HOME A0245 x x x x x<br />
NEW HOPE SUD A0245 x x x x x<br />
NEW LONDON A0245 x x x x x<br />
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NORTHWEST HARRIS COUNTY MUD #22 A0245 x x x x x<br />
NORTHWEST HARRIS COUNTY MUD #30 A0245 x x x x x<br />
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POINT HOUSING AUTHORITY A0245 x x x x x<br />
POINT VENTURE A0245 x x x x x<br />
POLITICAL SUBDIVISION WC ALLIANCE A0245 x x x x x<br />
PONDER A0245 x x x x x<br />
PORT ARANSAS A0245 x x x x x<br />
PORT ARTHUR A0245 x x x x x<br />
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PORT ISABEL A0245 x x x x x<br />
PORT ISABEL HOUSING AUTHORITY A0245 x x x x x<br />
PORT ISABEL/SAN BENITO NAVIGATION DIST A0245 x x x x x<br />
PORT LAVACA A0245 x x x x x<br />
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PORT NECHES A0245 x x x x x<br />
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POST OAK SUD A0245 x x x x x<br />
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POTEET A0245 x x x x x<br />
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POTTSBORO A0245 x x x x x<br />
POYNOR A0245 x x x x x<br />
PRAIRIE VIEW A0245 x x x x x<br />
PREMONT A0245 x x x x x<br />
PRESIDIO A0245 x x x x x<br />
PRESIDIO CAD A0245 x x x x x<br />
PRIMERA A0245 x x x x x<br />
PRINCETON A0245 x x x x x<br />
PROGRESO A0245 x x x x x<br />
PROGRESO LAKES A0245 x x x x x<br />
PROSPER A0245 x x x x x<br />
PUBLIC TRANSIT SERVICES A0245 x x x x x<br />
PUTNAM A0245 x x x x x<br />
PYOTE A0245 x x x x x<br />
QUAIL CREEK MUD A0245 x x x x x<br />
QUAIL VALLEY UD A0245 x x x x x<br />
QUANAH A0245 x x x x x<br />
QUANAH HOUSING AUTHORITY A0245 x x x x x<br />
QUEEN CITY A0245 x x x x x<br />
QUINLAN A0245 x x x x x<br />
QUINTANA A0245 x x x x x<br />
QUITAQUE A0245 x x x x x<br />
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RAINS CAD A0245 x x x x x<br />
RALLS A0245 x x x x x<br />
RALLS HOUSING AUTHORITY A0245 x x x x x<br />
RANCH AT CYPRESS CREEK MUD #1 A0245 x x x x x<br />
RANCHO VIEJO A0245 x x x x x<br />
RANGER A0245 x x x x x<br />
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RANKIN A0245 x x x x x<br />
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RICHLAND A0245 x x x x x<br />
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RICHLAND SUD A0245 x x x x x<br />
RICHLAND SPRINGS A0245 x x x x x<br />
RICHMOND A0245 x x x x x<br />
RICHWOOD A0245 x x x x x<br />
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RISING STAR A0245 x x x x x<br />
RISING STAR HOUSING AUTHORITY A0245 x x x x x<br />
RIVER OAKS A0245 x x x x x<br />
RIVER PLANTATION MUD A0245 x x x x x<br />
RIVERSIDE A0245 x x x x x<br />
RIVIERA WCID A0245 x x x x x<br />
ROANOKE A0245 x x x x x<br />
ROARING SPRINGS A0245 x x x x x<br />
ROBERT LEE A0245 x x x x x<br />
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ROBERTSON CAD A0245 x x x x x<br />
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ROMAN FOREST A0245 x x x x x<br />
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ROPESVILLE A0245 x x x x x<br />
ROSCOE A0245 x x x x x<br />
ROSE CITY A0245 x x x x x<br />
ROSE HILL SUD A0245 x x x x x<br />
ROSEBUD A0245 x x x x x<br />
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ROWLETT A0245 x x x x x<br />
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SAN ANTONIO A0245 x x x x x<br />
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SAN ANTONIO MUD #1 A0245 x x x x x<br />
SAN AUGUSTINE HOUSING AUTH A0245 x x x x x<br />
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SAN SABA CAD A0245 x x x x x<br />
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SHACKELFORD CAD A0245 x x x x x<br />
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TARRANT COUNTY 911 DISTRICT A0245 x x x x x<br />
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TAYLOR A0245 x x x x x<br />
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TEAGUE A0245 x x x x x<br />
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TENAHA A0245 x x x x x<br />
TERRELL A0245 x x x x x<br />
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THE COLONY A0245 x x x x x<br />
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ABILENE ISD SELF-INSURED J1204 x x x x x<br />
ABILENE ISD RUN-OFF J1204 x x x x x<br />
ALAMO HEIGHTS ISD J1204 x x x x x<br />
ALEDO ISD J1204 x x x x x<br />
BELLVILLE ISD J1204 x x x x x<br />
BENAVIDES ISD J1204 x x x x x<br />
BIG SPRING ISD J1204 x x x x x<br />
BIRDVILLE INDEPENDENDENT SCHOOL DISTRICT J1204 x x x x x<br />
BRACKETT I.S.D. J1204 x x x x x<br />
BRADY ISD J1204 x x x x x<br />
BRECKENRIDGE ISD J1204 x x x x x<br />
BROOKS COUNTY ISD J1204 x x x x x<br />
BROWNFIELD ISD J1204 x x x x x<br />
BURLESON COUNTY ALT SCHOOL J1204 x x x x x<br />
BURLESON-MILAM CO-OP J1204 x x x x x<br />
CALDWELL ISD J1204 x x x x x<br />
CANYON ISD J1204 x x x x x<br />
CARRIZO SPRINGS CISD J1204 x x x x x<br />
CENTER POINT ISD J1204 x x x x x<br />
CITY OF WICHITA FALLS J1204 x x x x x<br />
CLARKSVILLE ISD J1204 x x x x x<br />
COTULLA ISD J1204 x x x x x<br />
CRYSTAL CITY ISD J1204 x x x x x<br />
DALHART ISD J1204 x x x x x<br />
DE SOTO ISD J1204 x x x x x<br />
DEL VALLE I.S.D. J1204 x x x x x<br />
DENVER CITY ISD J1204 x x x x x<br />
DILLEY ISD J1204 x x x x x<br />
DUMAS ISD J1204 x x x x x<br />
DUNCANVILLE INDEPENDENT SCHOOL DISTRICT J1204 x x x x x<br />
DUNCANVILLE ISD J1204 x x x x x<br />
EAGLE MOUNTAIN-SAGINAW ISD J1204 x x x x x<br />
EDINBURG CISD J1204 x x x x x<br />
FLORESVILLE ISD J1204 x x x x x<br />
FORNEY ISD J1204 x x x x x<br />
FRENSHIP ISD J1204 x x x x x<br />
FRIO COUNTY J1204 x x x x x<br />
FT. SAM HOUSTON ISD J1204 x x x x x<br />
GAINESVILLE ISD J1204 x x x x x<br />
GARNER ISD J1204 x x x x x<br />
GEORGETOWN ISD J1204 x x x x x<br />
GODLEY ISD J1204 x x x x x<br />
GRAFORD I.S.D. J1204 x x x x x<br />
GRUVER ISD J1204 x x x x x<br />
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HIDALGO ISD J1204 x x x x x<br />
HOWARD COUNTY J1204 x x x x x<br />
HUDSPETH COUNTY J1204 x x x x x<br />
HUFFMAN ISD J1204 x x x x x<br />
JUNCTION ISD J1204 x x x x x<br />
KARNES CITY ISD J1204 x x x x x<br />
KENNEDALE ISD J1204 x x x x x<br />
LA VERNIA ISD J1204 x x x x x<br />
LA VILLA ISD J1204 x x x x x<br />
LACKLAND ISD J1204 x x x x x<br />
LAGO VISTA ISD J1204 x x x x x<br />
LEVELLAND ISD J1204 x x x x x<br />
LEWISVILLE ISD SELF-INSURED J1204 x x x x x<br />
LIBERTY-EYLAU ISD J1204 x x x x x<br />
MARBLE FALLS ISD J1204 x x x x x<br />
MARLIN ISD J1204 x x x x x<br />
MERCEDES ISD J1204 x x x x x<br />
MEXIA ISD J1204 x x x x x<br />
MIDLAND COUNTY J1204 x x x x x<br />
MILLSAP ISD J1204 x x x x x<br />
MISSION CISD J1204 x x x x x<br />
MISSION CONSOLIDATED INDEPENDENT SCHOOL DISTRICT J1204 x x x x x<br />
MOODY ISD J1204 x x x x x<br />
MORTON ISD J1204 x x x x x<br />
MULESHOE ISD J1204 x x x x x<br />
NACOGDOCHES ISD J1204 x x x x x<br />
NATALIA ISD J1204 x x x x x<br />
NEW CANEY ISD J1204 x x x x x<br />
NEW CANEY ISD SELF-INSURED J1204 x x x x x<br />
PEARSALL ISD J1204 x x x x x<br />
PERRYTON ISD J1204 x x x x x<br />
PLAINS ISD J1204 x x x x x<br />
PLEMONS-STINNETT-PHILLIPS CISD J1204 x x x x x<br />
POOLVILLE I.S.D. J1204 x x x x x<br />
POTH ISD J1204 x x x x x<br />
POTTER COUNTY J1204 x x x x x<br />
PSP CISD J1204 x x x x x<br />
RANDALL COUNTY J1204 x x x x x<br />
RIVER ROAD ISD J1204 x x x x x<br />
SAN ANGELO ISD J1204 x x x x x<br />
SEMINOLE ISD J1204 x x x x x<br />
SILSBEE ISD J1204 x x x x x<br />
SLATON ISD J1204 x x x x x<br />
SNYDER ISD J1204 x x x x x<br />
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SOMERSET ISD J1204 x x x x x<br />
SOUTHLAND ISD J1204 x x x x x<br />
SOUTHSIDE ISD J1204 x x x x x<br />
SPEARMAN ISD J1204 x x x x x<br />
SPRINGTOWN ISD J1204 x x x x x<br />
STOCKDALE ISD J1204 x x x x x<br />
STRATFORD ISD J1204 x x x x x<br />
SUNRAY ISD J1204 x x x x x<br />
TARRANT APPRAISAL DISTRICT J1204 x x x x x<br />
UVALDE CISD J1204 x x x x x<br />
WEATHERFORD ISD J1204 x x x x x<br />
WEIMAR ISD J1204 x x x x x<br />
WHITE DEER ISD J1204 x x x x x<br />
WHITEFACE CISD J1204 x x x x x<br />
YORKTOWN ISD J1204 x x x x x<br />
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**CA ONLY** BANCROFT NEUROHEAL J1491 x x x x x<br />
137654 CALIFORNIA, INC. J1491 x x x x x<br />
4D'S, LP DBA GEORGIAN HOTEL J1491 x x x x x<br />
A J EDMUND COMPANY, INC. J1491 x x x x x<br />
A.W.S. CONSTRUCTION J1491 x x x x x<br />
ACCORD HUMAN RESOURCES OF CA J1491 x x x x x<br />
ACCORD HUMAN RESOURCES OF OKLA J1491 x x x x x<br />
ACCURATE AIR SYSTEMS J1491 x x x x x<br />
ACME TRUCK PARTS J1491 x x x x x<br />
ADVANCE PAPER BOX COMPANY J1491 x x x x x<br />
ADVANCED ENGINE MANAGEMENT, IN J1491 x x x x x<br />
ADVANCED REAL ESTATE SERVICES, J1491 x x x x x<br />
AEROSPACE SERVICE & CONTROLS J1491 x x x x x<br />
ALPHA PROPERTY MANAGEMENT, INC J1491 x x x x x<br />
AMERICAN TILE & BRICK VENEER J1491 x x x x x<br />
AMERICAN TOW & AUTO REPAIR (DB J1491 x x x x x<br />
ANGELO BROTHERS COMPANY-CA- J1491 x x x x x<br />
APPERSON PRINT MANAGEMENT (A C J1491 x x x x x<br />
ARCADIAN DEVELOPMENT, INC. J1491 x x x x x<br />
ARDEN CLEELAND DBA AVRIL AGENC J1491 x x x x x<br />
ARROYO PARKWAY 76 & ATWATER 76 J1491 x x x x x<br />
ARTEX MANUFACTURING COMPANY (A J1491 x x x x x<br />
AUDIO DIGEST FOUNDATION AND J1491 x x x x x<br />
AUTO MARINE ENGINEERING, INC. J1491 x x x x x<br />
AUTO OUTLET, INC. J1491 x x x x x<br />
B.B. KINGS BLUES CLUB & RESTAU J1491 x x x x x<br />
BANK PLUS CORPORATION J1491 x x x x x<br />
BAS RECYCLING, INC. J1491 x x x x x<br />
BATLA FOOD GROUP INC. J1491 x x x x x<br />
BEACON BAY ENTERPRISES, INC. J1491 x x x x x<br />
BEC ENTERPRISES INC. J1491 x x x x x<br />
BELL TRUCKING CO INC J1491 x x x x x<br />
BEMUS LANDSCAPE INC. J1491 x x x x x<br />
BERRY'S SAWMILL J1491 x x x x x<br />
BETTER CARE INCORPORATED J1491 x x x x x<br />
BOARD FORD INC J1491 x x x x x<br />
BOWSMITH, INC. J1491 x x x x x<br />
BRAKE PARTS SUPPLY & DISTRIBUT J1491 x x x x x<br />
BRINTNALL'S INC. J1491 x x x x x<br />
BRION CORPORATION J1491 x x x x x<br />
BUILDERS SUPPLY OF PALM SPRING J1491 x x x x x<br />
BURLINGAME COUNTRY CLUB J1491 x x x x x<br />
BURROWS, INC. J1491 x x x x x<br />
C.P.P., INC. J1491 x x x x x<br />
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CACIQUE, INC. J1491 x x x x x<br />
CALIFORNIA CHAMBER OF COMMERCE J1491 x x x x x<br />
CALIFORNIA HI-TECH FLOORS, INC J1491 x x x x x<br />
CALIFORNIA LINEN RENTAL COMPAN J1491 x x x x x<br />
CARRIAGE MOTORS, INC. J1491 x x x x x<br />
CASTLE GROUP CALIFORNIA, INC. J1491 x x x x x<br />
CATANIA HIJAR CORPORATION J1491 x x x x x<br />
CENTURY LIGHTING, INC. J1491 x x x x x<br />
CERTIFIED UNDERCAR PARTS, INC. J1491 x x x x x<br />
CHECK INTO CASH CALIFORNIA, IN J1491 x x x x x<br />
CHINO AUTO PARTS (A CORPORATIO J1491 x x x x x<br />
CHRISTIAN BROTHERS HIGH SCHOOL J1491 x x x x x<br />
CLAUSEN ENTERPRISES INC. J1491 x x x x x<br />
CLEAN STEEL INC. J1491 x x x x x<br />
CLEUGH'S RHUBARB RANCH, INC.; J1491 x x x x x<br />
CLW PACIFIC, INC. J1491 x x x x x<br />
COMFORT SYSTEMS, USA J1491 x x x x x<br />
COMMONWEALTH ENERGY CORPORATIO J1491 x x x x x<br />
COMMUNITY OPTIONS J1491 x x x x x<br />
CONNEX TCT, LLC J1491 x x x x x<br />
CONTINENTAL MAINTENANCE INDUST J1491 x x x x x<br />
COUNTY MOTOR PARTS COMPANY, IN J1491 x x x x x<br />
CPE PEO INC. / DBA: CALIFORNIA J1491 x x x x x<br />
CRAFTSMAN OFFICE FURNITURE, IN J1491 x x x x x<br />
CREATIVE BENEFITS, INC. J1491 x x x x x<br />
C-TAP, INC. J1491 x x x x x<br />
CTL ENVIRONMENTAL SERVICES J1491 x x x x x<br />
DAN'S LANDSCAPE SERVICE, INC. J1491 x x x x x<br />
DANTEL INC. J1491 x x x x x<br />
DEMKO, WILLIAM M. (AN IND) J1491 x x x x x<br />
DENFRAN SYSTEMS, INC. J1491 x x x x x<br />
DESERT VALLEY MEDICAL GROUP (A J1491 x x x x x<br />
DESIGNS BY MARK J1491 x x x x x<br />
DEW MANAGEMENT SERVICES INC J1491 x x x x x<br />
DIABLO HILLS GOLF ASSOCIATION, J1491 x x x x x<br />
DIAMOND W FLOOR COVERING, INC. J1491 x x x x x<br />
DINUBA LUMBER COMPANY (A CORP) J1491 x x x x x<br />
DUFOUR, INC. J1491 x x x x x<br />
DUPREE, INC. J1491 x x x x x<br />
DY DEE SERVICE OF PASADENA INC J1491 x x x x x<br />
E.B. MANNING & SON INC. J1491 x x x x x<br />
E.H. SUMMIT, INC. J1491 x x x x x<br />
ECOLOGY AUTO WRECKING J1491 x x x x x<br />
EL MACERO COUNTRY CLUB J1491 x x x x x<br />
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ELECTRICAL REBUILDERS SALES IN J1491 x x x x x<br />
ELITE LEATHER COMPANY J1491 x x x x x<br />
EMCO FLUID SYSTEMS, INC. J1491 x x x x x<br />
EMERGENCY PHYSICIANS MEDICAL G J1491 x x x x x<br />
EMPI, INC. J1491 x x x x x<br />
ENGEN ENTERPRISES INC. J1491 x x x x x<br />
EQUITY HOTEL & SUPPLY COMPANY, J1491 x x x x x<br />
ERNEST PAPER PRODUCTS, INC. J1491 x x x x x<br />
EZELL NURSERY SUPPLY INC. J1491 x x x x x<br />
FACILITY MASTERS, INC. (A CORP J1491 x x x x x<br />
FAMILY TOYOTA, FAMILY HONDA J1491 x x x x x<br />
FAST UNDERCAR - THOUSAND OAKS J1491 x x x x x<br />
FEATHER RIVER WOOD & GLASS J1491 x x x x x<br />
FELIX MANUFACTURING COMPANY, I J1491 x x x x x<br />
FERRARI, DAN (AN INDIVIDUAL) J1491 x x x x x<br />
FORECAST GROUP L.P. J1491 x x x x x<br />
FREEMAN, RAYMOND K. J1491 x x x x x<br />
FRIANT AND ASSOCIATES LLC J1491 x x x x x<br />
FULLER THEOLOGICAL SEMINARY (A J1491 x x x x x<br />
G L VENEER COMPANY INC. J1491 x x x x x<br />
GARRISON, MIKE (AN INDIVIDUAL) J1491 x x x x x<br />
GATEWAY LEARNING CORPORATION J1491 x x x x x<br />
GLENDALE ASSOCIATES LTD J1491 x x x x x<br />
GLENDALE FOOD SERVICE INC. J1491 x x x x x<br />
GOMEZ, JOSE LUNA J1491 x x x x x<br />
GRASS VALLEY FORD, LINCOLN, ME J1491 x x x x x<br />
GREATER SAN DIEGO AIR CONDITIO J1491 x x x x x<br />
GRIFFIN PRODUCE INC. J1491 x x x x x<br />
H R N SERVICES, INC. J1491 x x x x x<br />
H. L. HEGGSTAD, INC. J1491 x x x x x<br />
H.J. COMPANY J1491 x x x x x<br />
H.P DEVELPMENT INC. J1491 x x x x x<br />
H.P. ENVIROVISION INC J1491 x x x x x<br />
HAGEN-RENAKER, INC. J1491 x x x x x<br />
HAIGHT, BROWN & BONESTEEL J1491 x x x x x<br />
HARALAMBOS BEVERAGE COMPANY J1491 x x x x x<br />
HARBOB SOUTHERN, INC. J1491 x x x x x<br />
HAWTHORNE FINANCIAL CORPORATIO J1491 x x x x x<br />
HEALTHCARE MANAGEMENT SYSTEMS, J1491 x x x x x<br />
HIGGINS BRICK COMPANY J1491 x x x x x<br />
HOMEXX INTERNATIONAL CORPORATI J1491 x x x x x<br />
HOSPITAL HOUSEKEEPING SYSTEMS J1491 x x x x x<br />
HOUCK, GREGORY (PARTNER); WINN J1491 x x x x x<br />
HOUSTON STEAK DELIVERY #1 LLC J1491 x x x x x<br />
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HUGHES REDWOOD COMPANY, INC. J1491 x x x x x<br />
HYDROFORM - U.S.A. INC. J1491 x x x x x<br />
IDEAL AUTO PARTS, INC. J1491 x x x x x<br />
IMPERIAL VALLEY LUMBER COMPANY J1491 x x x x x<br />
INNOVATIONS SUCCESSFUL SALON S J1491 x x x x x<br />
INTERNATIONAL BAY CLUBS INC J1491 x x x x x<br />
INVENTORY CONTROL SYSTEM J1491 x x x x x<br />
IOM HOLDINGS,INC (A CORPORATIO J1491 x x x x x<br />
J T CONTRACTORS, INC. J1491 x x x x x<br />
J.C. WATTENBARGER & SONS, INC. J1491 x x x x x<br />
JANICO BUILDING MAINTENANCE CO J1491 x x x x x<br />
JCV TACOS INC. J1491 x x x x x<br />
JERRY SOLOMON ENTERPRISES INC. J1491 x x x x x<br />
JOHNSON, LARRY (AN INDIVIDUAL) J1491 x x x x x<br />
KEISER (A CORP) J1491 x x x x x<br />
KORDYE TURNER & CO., INC. J1491 x x x x x<br />
KRIEGER, BERTIE (AN INDIVIDUAL J1491 x x x x x<br />
KURT BOHMER PLUMBING, INC. J1491 x x x x x<br />
KURTZ FINAN AUTO SUPPLY, INC. J1491 x x x x x<br />
KUSTOM FIT MANUFACTURING COMPA J1491 x x x x x<br />
LATICRETE INT'L INC. J1491 x x x x x<br />
LEDTRONICS, INC. J1491 x x x x x<br />
LEISURE WORLD UNION 76, INC. J1491 x x x x x<br />
LIGHTS OF AMERICA INC J1491 x x x x x<br />
LODGING DEVELOPEMENT AND MANAG J1491 x x x x x<br />
LOS ALTOS GOLF & COUNTRY CLUB J1491 x x x x x<br />
LUNDEEN PACIFIC CORPORATION J1491 x x x x x<br />
MADISON RESEARCH CORPORATION J1491 x x x x x<br />
MAINTENANCE PACESETTERS INC. J1491 x x x x x<br />
MALLIS ASSOCIATES INC. J1491 x x x x x<br />
MANIGLIA LANDSCAPE INC. J1491 x x x x x<br />
MARFIELD COMPANY INC J1491 x x x x x<br />
MARIN RADIOLOGY GROUP J1491 x x x x x<br />
MARKRIST ENGINEERS J1491 x x x x x<br />
MAXSYS TECHNOLOGIES CORPORATIO J1491 x x x x x<br />
MCGEE ELECTRIC, INC. J1491 x x x x x<br />
MEYLING, ALBERT (AN INDIVIDUAL J1491 x x x x x<br />
MICHAEL MCELROY D/B/A J1491 x x x x x<br />
MISSION CORPS INTERNATIONAL IN J1491 x x x x x<br />
MISSION ORGANICS J1491 x x x x x<br />
MOFFATT CONTRACTING,INC J1491 x x x x x<br />
MONARCH PLUMBING COMPANY, INC. J1491 x x x x x<br />
MORENO VALLEY PONTIAC J1491 x x x x x<br />
MOTHER'S NUTRITIONAL CENTER, I J1491 x x x x x<br />
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REM Employer Name Payer ID Only Only Only Only Only States Claims Claims Comp Only Only (835)<br />
MRH ENTERPRISES J1491 x x x x x<br />
NATEL ENGINEERING COMPANY INC. J1491 x x x x x<br />
NATIONAL MAINTENANCE INC. J1491 x x x x x<br />
NELSON NAMEPLATE COMPANY INC J1491 x x x x x<br />
NEW CENTURY AUTO GROUP J1491 x x x x x<br />
NIA HEALTH CARE SERVICES (A CO J1491 x x x x x<br />
NICKOLAS ENVIRONMENTAL J1491 x x x x x<br />
NORTH AMERICAN VIDEO CORP. J1491 x x x x x<br />
NUMERO UNO MARKET INC. J1491 x x x x x<br />
OAKWOOD INTERIORS INC J1491 x x x x x<br />
ONE STOP BRAKE SUPPLY SANTA AN J1491 x x x x x<br />
ONE STOP UNDERCAR RIVERSIDE, I J1491 x x x x x<br />
ONTARIO METAL RECYCLING INC J1491 x x x x x<br />
ONYX ACCEPTANCE CORPORATION J1491 x x x x x<br />
ORIGINAL SID BLACKMAN PLUMBING J1491 x x x x x<br />
OSI SYSTEMS INC. J1491 x x x x x<br />
P.J. CAL #1, INC. J1491 x x x x x<br />
PACIFIC DATA ELECTRIC, INC. J1491 x x x x x<br />
PALLET DEPOT J1491 x x x x x<br />
PALO ALTO HILLS GOLF & COUNTRY J1491 x x x x x<br />
PARK MANAGEMENT GROUP, INC. J1491 x x x x x<br />
PASTABRAVO RESTAURANTS, INC. J1491 x x x x x<br />
PDQ AUTOMATIC TRANSMISSION PAR J1491 x x x x x<br />
PENINSULA PONTIAC GMC BUICK J1491 x x x x x<br />
PETRO-CHEM INDUSTRIES INC J1491 x x x x x<br />
POLY PAK AMERICA, INC. J1491 x x x x x<br />
POMEROY INVESTMENTS INC. J1491 x x x x x<br />
POOL WATER PRODUCTS J1491 x x x x x<br />
POPLUAR TEXTILE CORP. / POP ST J1491 x x x x x<br />
PORTEOUS FASTENER COMPANY J1491 x x x x x<br />
PRESTON HOLMES, INC. J1491 x x x x x<br />
PROMPT FOOD SERVICE, INC. J1491 x x x x x<br />
PURE FILL CORPORATION J1491 x x x x x<br />
QAD, INC. J1491 x x x x x<br />
QUICK-CROFT, INC. J1491 x x x x x<br />
R KIDS TIRE AND SERVICE, INC. J1491 x x x x x<br />
R.A. PHILLIPS INDUSTRIES INC. J1491 x x x x x<br />
RABB BROTHERS TRUCKING, INC J1491 x x x x x<br />
RAMONA MANOR CONVALESCENT HOSP J1491 x x x x x<br />
RAYPAK, INC. J1491 x x x x x<br />
REDNAB INC. J1491 x x x x x<br />
REESER ENTERPRISES INC. J1491 x x x x x<br />
RELIABLE SERVICES, INC. J1491 x x x x x<br />
RELIANCE BUILDING SERVICES INC J1491 x x x x x<br />
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REM Employer Name Payer ID Only Only Only Only Only States Claims Claims Comp Only Only (835)<br />
RICK HITCH PLASTERING (A CORPO J1491 x x x x x<br />
ROBERT MANN PACKAGING, INC. (A J1491 x x x x x<br />
ROTHENBERGER USA INC. J1491 x x x x x<br />
ROUNTREE PLUMBING & HEATING, I J1491 x x x x x<br />
SACRAMENTO I.B.S.,INC. J1491 x x x x x<br />
SAN FRANCISCO BATTERY, INC. J1491 x x x x x<br />
SANTA FE EXTRUDERS, INC. J1491 x x x x x<br />
SATELLITE DIALYSIS CENTERS, IN J1491 x x x x x<br />
SERENDIPITY LAND YACHTS J1491 x x x x x<br />
SHEPPARD, MULLIN, RICHTER & HA J1491 x x x x x<br />
SITE STUDIOS INC. J1491 x x x x x<br />
SMALL WORLD TOYS J1491 x x x x x<br />
SMITH EMERY COMPANY J1491 x x x x x<br />
SMITHCARE, INC. J1491 x x x x x<br />
SOL'S BRAKE SUPPLY LLC J1491 x x x x x<br />
SOS METALS INC. J1491 x x x x x<br />
SPECIALTY TEAM PLASTERING, INC J1491 x x x x x<br />
SPRING AIR CALIFORNIA/DELUXE B J1491 x x x x x<br />
STANLEY PEST CONTROL, INC. - S J1491 x x x x x<br />
STRIKO DYNARAD CORPORATION J1491 x x x x x<br />
STYLES FOR LESS CORP. (CA ONLY J1491 x x x x x<br />
SURFACE MOUNT DISTRIBUTION (A J1491 x x x x x<br />
SURFACE PROTECTION INDUSTRIES J1491 x x x x x<br />
TALBERT MEDICAL GROUP J1491 x x x x x<br />
TARGET MEDIA PARTNERS, ET AL J1491 x x x x x<br />
TEMPO INDUSTRIES, INC. (A CORP J1491 x x x x x<br />
THE GARLIC COMPANY (A PARTNERS J1491 x x x x x<br />
TIM'S AUTO PAINT & SUPPLY, INC J1491 x x x x x<br />
TOMCO AUTO PRODUCTS, INC. J1491 x x x x x<br />
TOMDAN ENTERPRISES J1491 x x x x x<br />
TOM'S TRUCK CENTER, INC. J1491 x x x x x<br />
TOTAL PLUMBING HEATING & AIR J1491 x x x x x<br />
TRANS VALLEY TRANSPORT J1491 x x x x x<br />
TRANSPACIFIC DEVELOPMENT COMPA J1491 x x x x x<br />
TRI VALLEY ORTHOPEDIC & SPORTS J1491 x x x x x<br />
TRUE WORLD FOODS, INC. (A CORP J1491 x x x x x<br />
U. S. WIRELESS CORPORATION J1491 x x x x x<br />
UNITED EL SEGUNDO, INC. J1491 x x x x x<br />
UNITED SURGICAL PARTNERS INTER J1491 x x x x x<br />
UNIVERSAL FLOORING SYSTEMS, I J1491 x x x x x<br />
VALHALLA BUILDERS & DEVELOPERS J1491 x x x x x<br />
VALLEY FIG GROWERS INC J1491 x x x x x<br />
VEG LAND INC., ET AL J1491 x x x x x<br />
VEGTABLE GROWERS SUPPLY INC J1491 x x x x x<br />
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REM Employer Name Payer ID Only Only Only Only Only States Claims Claims Comp Only Only (835)<br />
VERCO MANUFACTURING, INC., (PA J1491 x x x x x<br />
VICRO-MAC J1491 x x x x x<br />
VICTORIA TIRE CENTER, INC. J1491 x x x x x<br />
VILLA MARINA UNOCAL, INC. J1491 x x x x x<br />
VIP MOTOR CARS LTD. J1491 x x x x x<br />
W.E. BEHEL, INC. J1491 x x x x x<br />
W.T. BILLARD, INC. J1491 x x x x x<br />
WALTER ANDERSON PLUMBING, INC. J1491 x x x x x<br />
WCP, INC. J1491 x x x x x<br />
WESSEX INDUSTRIES, INC.; HEALD J1491 x x x x x<br />
WESTERN GOLF PROPERTIES, INC. J1491 x x x x x<br />
WIDDICOMBE ENTERPRISES INC. J1491 x x x x x<br />
WILSON & HAMPTON PAINTING CONT J1491 x x x x x<br />
WOMEN'S HEALTHCARE ASSOCIATES J1491 x x x x x<br />
WOODMONT REAL ESTATE SERVICES J1491 x x x x x<br />
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