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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 />

8 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 />

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 />

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 />

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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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 />

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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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 />

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 />

14 of 124 Visit our web site: www.availity.com<br />

<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><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 />

<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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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 />

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.


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 />

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


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 />

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 />

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 />

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 />

24 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 />

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 />

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 />

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 />

27 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 />

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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TX MN CA NY WI<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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TX MN CA NY WI<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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Payer Name Payer ID<br />

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TX<br />

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 A0245 x x x x x<br />

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 />

CAMERON COUNTY DD #3 A0245 x x x x x<br />

CAMERON COUNTY HOUSING AUTHORITY A0245 x x x x x<br />

CAMERON COUNTY ID #2 A0245 x x x x x<br />

CAMERON HOUSING AUTHORITY A0245 x x x x x<br />

CAMP CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />

CAMP WOOD A0245 x x x x x<br />

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CANADIAN A0245 x x x x x<br />

CANEY CITY A0245 x x x x x<br />

CANEY CREEK MUD A0245 x x x x x<br />

CANTON A0245 x x x x x<br />

CANYON A0245 x x x x x<br />

CANYON HOUSING AUTHORITY A0245 x x x x x<br />

CANYON LAKE COMM LIBRARY DISTRICT A0245 x x x x x<br />

CANYON REGIONAL WATER AUTHORITY A0245 x x x x x<br />

CAPE ROYALE UTILITY DISTRICT A0245 x x x x x<br />

CAPITAL AREA COG A0245 x x x x x<br />

CAPITAL AREA RURAL TRANSPORTATION SYSTEM A0245 x x x x x<br />

CAPITAL METRO TRANSPORTATION AUTHORITY A0245 x x x x x<br />

CARMINE A0245 x x x x x<br />

CARRIZO SPRINGS A0245 x x x x x<br />

CARRIZO SPRINGS HOUSING AUTHORITY A0245 x x x x x<br />

CARSON CAD A0245 x x x x x<br />

CASH SUD A0245 x x x x x<br />

CASS CAD A0245 x x x x x<br />

CASS COUNTY ESD #1 A0245 x x x x x<br />

CASTRO CAD A0245 x x x x x<br />

CASTROVILLE A0245 x x x x x<br />

CEDAR BAYOU PARK UTILITY DISTRICT A0245 x x x x x<br />

CEDAR HILL A0245 x x x x x<br />

CEDAR PARK A0245 x x x x x<br />

CELESTE A0245 x x x x x<br />

CELINA A0245 x x x x x<br />

CENTER HOUSING AUTHORITY A0245 x x x x x<br />

CENTERVILLE A0245 x x x x x<br />

CENTERVILLE HOUSING AUTHORITY A0245 x x x x x<br />

CENTRAL COLORADO RIVER AUTHORITY A0245 x x x x x<br />

CENTRAL HARRIS COUNTY REGION WATER AUTH A0245 x x x x x<br />

CENTRAL TEXAS COG A0245 x x x x x<br />

CENTRAL TEXAS GCD A0245 x x x x x<br />

CENTRAL TEXAS REGIONAL MOBILITY AUTH A0245 x x x x x<br />

CENTRAL TEXAS RURAL TRANSIT DISTRICT A0245 x x x x x<br />

CENTRAL WCID A0245 x x x x x<br />

CHALK HILL SUD A0245 x x x x x<br />

CHAMBERS COUNTY PUBLIC HOSP DIST #1 A0245 x x x x x<br />

CHANDLER A0245 x x x x x<br />

CHANNING A0245 x x x x x<br />

CHARLOTTE A0245 x x x x x<br />

CHATEAU WOODS MUD A0245 x x x x x<br />

CHEROKEE CAD A0245 x x x x x<br />

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CHILDRESS A0245 x x x x x<br />

CHILDRESS CAD A0245 x x x x x<br />

CHILDRESS HOUSING AUTHORITY A0245 x x x x x<br />

CHILLICOTHE A0245 x x x x x<br />

CHINA A0245 x x x x x<br />

CHINA GROVE CITY OF A0245 x x x x x<br />

CHIRENO A0245 x x x x x<br />

CHISHOLM TRAIL SUD A0245 x x x x x<br />

CHRISTINE A0245 x x x x x<br />

CIBOLO A0245 x x x x x<br />

CIBOLO CREEK MUNICIPAL AUTHORITY A0245 x x x x x<br />

CIMARRON MUD A0245 x x x x x<br />

CINCO MUD #1 A0245 x x x x x<br />

CINCO MUD #7 A0245 x x x x x<br />

CINCO MUD #9 A0245 x x x x x<br />

CISCO A0245 x x x x x<br />

CISCO HOUSING AUTHORITY A0245 x x x x x<br />

CLARENDON A0245 x x x x x<br />

CLARENDON HOUSING AUTHORITY A0245 x x x x x<br />

CLARKSVILLE A0245 x x x x x<br />

CLARKSVILLE CITY A0245 x x x x x<br />

CLARKSVILLE HOUSING AUTHORITY A0245 x x x x x<br />

CLAUDE A0245 x x x x x<br />

CLAY ROAD MUD A0245 x x x x x<br />

CLEAR BROOK CITY MUD A0245 x x x x x<br />

CLEAR CREEK WATERSHED AUTHORITY A0245 x x x x x<br />

CLEAR LAKE CITY WATER AUTHORITY A0245 x x x x x<br />

CLEAR LAKE SHORES A0245 x x x x x<br />

CLEBURNE A0245 x x x x x<br />

CLEVELAND A0245 x x x x x<br />

CLIFTON A0245 x x x x x<br />

CLIFTON HOUSING AUTHORITY A0245 x x x x x<br />

CLINT TOWN OF A0245 x x x x x<br />

CLUTE A0245 x x x x x<br />

CLYDE A0245 x x x x x<br />

COAHOMA A0245 x x x x x<br />

COASTAL BEND COG A0245 x x x x x<br />

COASTAL PLAINS COMMUNITY MHMR CENTER A0245 x x x x x<br />

COCKRELL HILL A0245 x x x x x<br />

COKE COUNTY SWCD #219 A0245 x x x x x<br />

COLDSPRING A0245 x x x x x<br />

COLEMAN A0245 x x x x x<br />

COLEMAN COUNTY SUD A0245 x x x x x<br />

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COLLEYVILLE A0245 x x x x x<br />

COLLIN CO CENTRAL APPRAISAL DIST A0245 x x x x x<br />

COLLIN COUNTY SWCD A0245 x x x x x<br />

COLLINSVILLE A0245 x x x x x<br />

COLMESNEIL A0245 x x x x x<br />

COLORADO CITY A0245 x x x x x<br />

COLORADO CITY HOUSING AUTHORITY A0245 x x x x x<br />

COLORADO VALLEY TRANSIT DISTRICT A0245 x x x x x<br />

COLUMBUS A0245 x x x x x<br />

COMAL CAD A0245 x x x x x<br />

COMAL COUNTY ESD #1 A0245 x x x x x<br />

COMAL COUNTY ESD #3 A0245 x x x x x<br />

COMAL COUNTY ESD #5 A0245 x x x x x<br />

COMAL COUNTY ESD #7 A0245 x x x x x<br />

COMAL COUNTY WATER ORIENTED RECREAT DIST A0245 x x x x x<br />

COMANCHE A0245 x x x x x<br />

COMANCHE CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />

COMANCHE HOUSING AUTHORITY A0245 x x x x x<br />

COMBES A0245 x x x x x<br />

COMBINE A0245 x x x x x<br />

COMMERCE HOUSING AUTHORITY A0245 x x x x x<br />

COMMODORE COVE IMPROVEMENT DISTRICT A0245 x x x x x<br />

COMO A0245 x x x x x<br />

COMO HOUSING AUTHORITY A0245 x x x x x<br />

CONCHO CAD A0245 x x x x x<br />

CONCHO SWCD #201 A0245 x x x x x<br />

CONCHO VALLEY COG A0245 x x x x x<br />

CONROE A0245 x x x x x<br />

CONVERSE A0245 x x x x x<br />

COOKE CAD A0245 x x x x x<br />

COOLIDGE A0245 x x x x x<br />

COOLIDGE HOUSING AUTHORITY A0245 x x x x x<br />

COOPER A0245 x x x x x<br />

COOPER HOUSING AUTHORITY A0245 x x x x x<br />

COPEVILLE SUD A0245 x x x x x<br />

COPPELL A0245 x x x x x<br />

COPPER CANYON A0245 x x x x x<br />

COPPERAS COVE A0245 x x x x x<br />

COPPERAS COVE HOUSING AUTHORITY A0245 x x x x x<br />

CORINTH A0245 x x x x x<br />

CORINTHIAN POINT MUD #2 A0245 x x x x x<br />

CORPUS CHRISTI DOWNTOWN MANAGEMENT DIST A0245 x x x x x<br />

CORPUS CHRISTI HOUSING AUTHORITY A0245 x x x x x<br />

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CORRIGAN A0245 x x x x x<br />

CORRIGAN HOUSING AUTHORITY A0245 x x x x x<br />

CORSICANA A0245 x x x x x<br />

CORSICANA HOUSING AUTHORITY A0245 x x x x x<br />

CORYELL CAD A0245 x x x x x<br />

CORYELL CITY WATER SUPPLY DISTRICT A0245 x x x x x<br />

COTTONWOOD CREEK MUD #1 A0245 x x x x x<br />

COTTONWOOD SHORES A0245 x x x x x<br />

COTULLA A0245 x x x x x<br />

COTULLA HOUSING AUTHORITY A0245 x x x x x<br />

COUNTY LINE SUD A0245 x x x x x<br />

COVE A0245 x x x x x<br />

COVINGTON A0245 x x x x x<br />

COW CREEK GCD A0245 x x x x x<br />

CRANDALL A0245 x x x x x<br />

CRANE A0245 x x x x x<br />

CRANFILLS GAP A0245 x x x x x<br />

CRAWFORD A0245 x x x x x<br />

CREEDMOOR A0245 x x x x x<br />

CRESSON A0245 x x x x x<br />

CROCKETT A0245 x x x x x<br />

CROCKETT COUNTY GCD A0245 x x x x x<br />

CROCKETT COUNTY SWCD A0245 x x x x x<br />

CROCKETT COUNTY WCID #1 A0245 x x x x x<br />

CROSBY CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />

CROSBY MUD A0245 x x x x x<br />

CROSBYTON A0245 x x x x x<br />

CROSBYTON HOUSING AUTHORITY A0245 x x x x x<br />

CROSS PLAINS A0245 x x x x x<br />

CROSS PLAINS HOUSING AUTHORITY A0245 x x x x x<br />

CROSS ROADS A0245 x x x x x<br />

CROSS ROADS SUD A0245 x x x x x<br />

CROSS TIMBER A0245 x x x x x<br />

CROSS TIMBERS SWCD #556 A0245 x x x x x<br />

CROWELL A0245 x x x x x<br />

CROWELL HOUSING AUTHORITY A0245 x x x x x<br />

CROWLEY A0245 x x x x x<br />

CRYSTAL CITY A0245 x x x x x<br />

CRYSTAL CITY HOUSING AUTHORITY A0245 x x x x x<br />

CUERO A0245 x x x x x<br />

CUERO COMMUNITY HOSPITAL A0245 x x x x x<br />

CUERO HOUSING AUTHORITY A0245 x x x x x<br />

CULBERSON CAD A0245 x x x x x<br />

CULBERSON COUNTY GCD A0245 x x x x x<br />

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CUMBY HOUSING AUTHORITY A0245 x x x x x<br />

CUNEY A0245 x x x x x<br />

CUT AND SHOOT A0245 x x x x x<br />

CYPRESS SPRINGS SUD A0245 x x x x x<br />

DISH TOWN OF A0245 x x x x x<br />

DAINGERFIELD A0245 x x x x x<br />

DAINGERFIELD HOUSING AUTHORITY A0245 x x x x x<br />

DAISETTA A0245 x x x x x<br />

DALHART A0245 x x x x x<br />

DALLAS CAD A0245 x x x x x<br />

DALLAS COUNTY FLOOD CONTROL DIST #1 A0245 x x x x x<br />

DALLAS COUNTY PARK CITIES MUD A0245 x x x x x<br />

DALLAS COUNTY WCID #6 A0245 x x x x x<br />

DALLAS HOUSING AUTHORITY A0245 x x x x x<br />

DALWORTHINGTON GARDENS A0245 x x x x x<br />

DANBURY A0245 x x x x x<br />

DARROUZETT A0245 x x x x x<br />

DARROUZETT HOSPITAL DISTRICT A0245 x x x x x<br />

DAWSON A0245 x x x x x<br />

DAWSON COUNTY CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />

DAWSON HOUSING AUTHORITY A0245 x x x x x<br />

DAYTON A0245 x x x x x<br />

DAYTON HOUSING AUTHORITY A0245 x x x x x<br />

DAYTON LAKES A0245 x x x x x<br />

DE LEON A0245 x x x x x<br />

DE LEON HOUSING AUTHORITY A0245 x x x x x<br />

DEKALB A0245 x x x x x<br />

DEKALB HOUSING AUTHORITY A0245 x x x x x<br />

DESOTO A0245 x x x x x<br />

DEWITT CAD A0245 x x x x x<br />

DEAF SMITH CAD A0245 x x x x x<br />

DECATUR A0245 x x x x x<br />

DEER PARK A0245 x x x x x<br />

DEL RIO A0245 x x x x x<br />

DEL RIO HOUSING AUTHORITY A0245 x x x x x<br />

DELL CITY A0245 x x x x x<br />

DELTA CAD A0245 x x x x x<br />

DELTA COUNTY MUD A0245 x x x x x<br />

DELTA COUNTY SWCD A0245 x x x x x<br />

DENCO AREA 911 DISTRICT A0245 x x x x x<br />

DENISON A0245 x x x x x<br />

DENISON HOUSING AUTHORITY A0245 x x x x x<br />

DENTON CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />

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DENTON HOUSING AUTHORITY A0245 x x x x x<br />

DENVER CITY A0245 x x x x x<br />

DEPORT A0245 x x x x x<br />

DEPORT HOUSING AUTHORITY A0245 x x x x x<br />

DETROIT A0245 x x x x x<br />

DETROIT HOUSING AUTHORITY A0245 x x x x x<br />

DEVERS A0245 x x x x x<br />

DEVIL'S RIVER SWCD #224 A0245 x x x x x<br />

DEVINE A0245 x x x x x<br />

DEVINE HOUSING AUTHORITY A0245 x x x x x<br />

DIANA SPECIAL UTILITY DISTRICT A0245 x x x x x<br />

DIBOLL HOUSING AUTHORITY A0245 x x x x x<br />

DICKENS A0245 x x x x x<br />

DICKINSON A0245 x x x x x<br />

DILLEY A0245 x x x x x<br />

DILLEY HOUSING AUTHORITY A0245 x x x x x<br />

DIMMIT CAD A0245 x x x x x<br />

DIMMITT A0245 x x x x x<br />

DIMMITT COUNTY EMS A0245 x x x x x<br />

DODD CITY A0245 x x x x x<br />

DOMINO A0245 x x x x x<br />

DONLEY COUNTY HOSPITAL DISTRICT A0245 x x x x x<br />

DONLEY COUNTY SWCD #127 A0245 x x x x x<br />

DONNA A0245 x x x x x<br />

DONNA HOUSING AUTHORITY A0245 x x x x x<br />

DORCHESTER A0245 x x x x x<br />

DOUBLE OAK TOWN OF A0245 x x x x x<br />

DOUGLASSVILLE A0245 x x x x x<br />

DRIFTWOOD ECONOMIC DEVELOPMENT MGMT DIST A0245 x x x x x<br />

DRIPPING SPRINGS A0245 x x x x x<br />

DRIPPING SPRINGS COMMUNITY LIBRARY DIST A0245 x x x x x<br />

DRISCOLL A0245 x x x x x<br />

DUBLIN A0245 x x x x x<br />

DUBLIN HOUSING AUTHORITY A0245 x x x x x<br />

DUMAS A0245 x x x x x<br />

DUNCANVILLE A0245 x x x x x<br />

DUVAL CAD A0245 x x x x x<br />

DUVAL COUNTY CONS/RECL DISTRICT A0245 x x x x x<br />

EAGLE LAKE A0245 x x x x x<br />

EAGLE PASS A0245 x x x x x<br />

EAGLE PASS HOUSING AUTHORITY A0245 x x x x x<br />

EAGLE PASS WATERWORKS A0245 x x x x x<br />

EARLY A0245 x x x x x<br />

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EAST ALDINE MANAGEMENT DISTRICT A0245 x x x x x<br />

EAST BERNARD A0245 x x x x x<br />

EAST CEDAR CREEK FWSD A0245 x x x x x<br />

EAST CENTRAL SUD A0245 x x x x x<br />

EAST DOWNTOWN MANAGEMENT DISTRICT A0245 x x x x x<br />

EAST FORK SUD A0245 x x x x x<br />

EAST MEDINA COUNTY SUD A0245 x x x x x<br />

EAST MOUNTAIN A0245 x x x x x<br />

EAST TAWAKONI A0245 x x x x x<br />

EAST TEXAS COG A0245 x x x x x<br />

EAST TRAVIS GATEWAY LIBRARY DISTRICT A0245 x x x x x<br />

EASTLAND A0245 x x x x x<br />

EASTON A0245 x x x x x<br />

ECTOR A0245 x x x x x<br />

ECTOR COUNTY EMERGENCY COMM DISTRICT A0245 x x x x x<br />

EDCOUCH A0245 x x x x x<br />

EDCOUCH HOUSING AUTHORITY A0245 x x x x x<br />

EDEN A0245 x x x x x<br />

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EDGECLIFF VILLAGE TOWN OF A0245 x x x x x<br />

EDGEWOOD A0245 x x x x x<br />

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EDMONSON A0245 x x x x x<br />

EDNA A0245 x x x x x<br />

EDNA HOUSING AUTHORITY A0245 x x x x x<br />

EDOM A0245 x x x x x<br />

EDWARDS AQUIFER AUTHORITY A0245 x x x x x<br />

EDWARDS PLATEAU SWCD A0245 x x x x x<br />

EL CAMPO A0245 x x x x x<br />

EL CAMPO HOUSING AUTHORITY A0245 x x x x x<br />

EL LAGO A0245 x x x x x<br />

EL PASO CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />

EL PASO COUNTY 911 DISTRICT A0245 x x x x x<br />

EL PASO COUNTY ESD #1 A0245 x x x x x<br />

EL PASO COUNTY ESD #2 A0245 x x x x x<br />

EL PASO COUNTY HOUSING AUTHORITY A0245 x x x x x<br />

EL PASO COUNTY TORNILLO WID A0245 x x x x x<br />

EL PASO COUNTY WCID #4 A0245 x x x x x<br />

ELDORADO A0245 x x x x x<br />

ELDORADO HOUSING AUTHORITY A0245 x x x x x<br />

ELECTRA A0245 x x x x x<br />

ELECTRA HOUSING AUTHORITY A0245 x x x x x<br />

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ELKHART A0245 x x x x x<br />

ELLIS CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />

ELLIS COUNTY ESD #9 A0245 x x x x x<br />

ELLIS-PRAIRIE SWCD A0245 x x x x x<br />

ELM CREEK WATERSHED AUTHORITY A0245 x x x x x<br />

ELMENDORF A0245 x x x x x<br />

ELSA A0245 x x x x x<br />

ELSA HOUSING AUTHORITY A0245 x x x x x<br />

EMERALD BAY MUD A0245 x x x x x<br />

EMHOUSE A0245 x x x x x<br />

EMORY A0245 x x x x x<br />

ENCHANTED OAKS A0245 x x x x x<br />

ENCINAL A0245 x x x x x<br />

ENGELMAN IRRIGATION DISTRICT A0245 x x x x x<br />

ENNIS A0245 x x x x x<br />

ENNIS HOUSING AUTHORITY A0245 x x x x x<br />

ERATH CAD A0245 x x x x x<br />

ESCOBARES A0245 x x x x x<br />

ESTELLINE A0245 x x x x x<br />

EULESS A0245 x x x x x<br />

EUSTACE A0245 x x x x x<br />

EVANT A0245 x x x x x<br />

EVERMAN A0245 x x x x x<br />

FAIR OAKS RANCH A0245 x x x x x<br />

FAIRFIELD A0245 x x x x x<br />

FAIRVIEW A0245 x x x x x<br />

FALFURRIAS A0245 x x x x x<br />

FALFURRIAS HOUSING AUTHORITY A0245 x x x x x<br />

FALFURRIAS UTILITY BOARD A0245 x x x x x<br />

FALLS CAD A0245 x x x x x<br />

FALLS CITY A0245 x x x x x<br />

FALLS CITY HOUSING AUTHORITY A0245 x x x x x<br />

FANNIN CAD A0245 x x x x x<br />

FANNIN COUNTY SWCD A0245 x x x x x<br />

FARMERS BRANCH A0245 x x x x x<br />

FARMERSVILLE A0245 x x x x x<br />

FARWELL A0245 x x x x x<br />

FATE A0245 x x x x x<br />

FAYETTE CAD A0245 x x x x x<br />

FAYETTE COUNTY GWCD A0245 x x x x x<br />

FAYETTE COUNTY WCID A0245 x x x x x<br />

FAYETTEVILLE A0245 x x x x x<br />

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FERRIS A0245 x x x x x<br />

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FIRST COLONY LID A0245 x x x x x<br />

FIRST COLONY MANAGEMENT DISTRICT A0245 x x x x x<br />

FISHER COUNTY HOSPITAL DISTRICT A0245 x x x x x<br />

FLAMINGO ISLES MUD A0245 x x x x x<br />

FLATONIA A0245 x x x x x<br />

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FLORENCE A0245 x x x x x<br />

FLORESVILLE A0245 x x x x x<br />

FLORESVILLE ELECTRIC LIGHT/POWER SYSTEM A0245 x x x x x<br />

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FLOWER MOUND TOWN OF A0245 x x x x x<br />

FLOYDADA A0245 x x x x x<br />

FLOYDADA HOUSING AUTHORITY A0245 x x x x x<br />

FLYING L PUBLIC UTILITY DIST A0245 x x x x x<br />

FOARD CAD A0245 x x x x x<br />

FOARD COUNTY HOSPITAL DISTRICT A0245 x x x x x<br />

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 />

FORT WORTH HOUSING AUTHORITY A0245 x x x x x<br />

FOUR WAY SUD A0245 x x x x x<br />

FRANKLIN A0245 x x x x x<br />

FRANKLIN CAD A0245 x x x x x<br />

FRANKLIN HOUSING AUTHORITY A0245 x x x x x<br />

FRANKSTON A0245 x x x x x<br />

FREDERICKSBURG A0245 x x x x x<br />

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FRIENDSWOOD A0245 x x x x x<br />

FRIO CAD A0245 x x x x x<br />

FRIONA A0245 x x x x x<br />

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FRITCH A0245 x x x x x<br />

FROST A0245 x x x x x<br />

FRUITVALE A0245 x x x x x<br />

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FULSHEAR A0245 x x x x x<br />

FULTON A0245 x x x x x<br />

GAINES CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />

GAINESVILLE A0245 x x x x x<br />

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GALENA PARK A0245 x x x x x<br />

GALLATIN A0245 x x x x x<br />

GALVESTON CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />

GALVESTON COUNTY DD #1 A0245 x x x x x<br />

GALVESTON COUNTY DD #2 A0245 x x x x x<br />

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 />

GARDEN RIDGE A0245 x x x x x<br />

GARRETT A0245 x x x x x<br />

GARRISON A0245 x x x x x<br />

GARY A0245 x x x x x<br />

GASTONIA-SCURRY SUD A0245 x x x x x<br />

GATESVILLE A0245 x x x x x<br />

GATESVILLE HOUSING AUTHORITY A0245 x x x x x<br />

GEORGE WEST A0245 x x x x x<br />

GEORGETOWN A0245 x x x x x<br />

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GIDDINGS A0245 x x x x x<br />

GILLESPIE CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />

GILLESPIE COUNTY SWCD #220 A0245 x x x x x<br />

GILMER A0245 x x x x x<br />

GILMER HOUSING AUTHORITY A0245 x x x x x<br />

GLADEWATER A0245 x x x x x<br />

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GLEN ROSE A0245 x x x x x<br />

GLENN HEIGHTS A0245 x x x x x<br />

GODLEY A0245 x x x x x<br />

GOLDEN CRESCENT REGIONAL PLANNING COMM. A0245 x x x x x<br />

GOLDSMITH A0245 x x x x x<br />

GOLDTHWAITE A0245 x x x x x<br />

GOLDTHWAITE HOUSING AUTHORITY A0245 x x x x x<br />

GOLIAD A0245 x x x x x<br />

GOLIAD HOUSING AUTHORITY A0245 x x x x x<br />

GOLINDA A0245 x x x x x<br />

GONZALES A0245 x x x x x<br />

GONZALES COUNTY ESD #1 A0245 x x x x x<br />

GONZALES COUNTY SWCD #338 A0245 x x x x x<br />

GONZALES COUNTY UWCD A0245 x x x x x<br />

GONZALES HOUSING AUTHORITY A0245 x x x x x<br />

GOODLOW A0245 x x x x x<br />

GOODRICH A0245 x x x x x<br />

GORDON A0245 x x x x x<br />

GOREE A0245 x x x x x<br />

GORMAN A0245 x x x x x<br />

GORMAN HOUSING AUTHORITY A0245 x x x x x<br />

GRAFORD A0245 x x x x x<br />

GRAHAM A0245 x x x x x<br />

GRANBURY A0245 x x x x x<br />

GRANBURY HOUSING AUTHORITY A0245 x x x x x<br />

GRAND PRAIRIE A0245 x x x x x<br />

GRAND SALINE A0245 x x x x x<br />

GRAND SALINE HOUSING AUTHORITY A0245 x x x x x<br />

GRANDFALLS A0245 x x x x x<br />

GRANDFALLS HOUSING AUTHORITY A0245 x x x x x<br />

GRANDVIEW A0245 x x x x x<br />

GRANDVIEW HOUSING AUTHORITY A0245 x x x x x<br />

GRANGER A0245 x x x x x<br />

GRANGER HOUSING AUTHORITY A0245 x x x x x<br />

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GRANJENO A0245 x x x x x<br />

GRANT ROAD PUD A0245 x x x x x<br />

GRAPELAND A0245 x x x x x<br />

GRAPELAND HOUSING AUTHORITY A0245 x x x x x<br />

GRAPEVINE A0245 x x x x x<br />

GRAPEVINE HOUSING AUTHORITY A0245 x x x x x<br />

GRAY CAD A0245 x x x x x<br />

GRAYSON COUNTY HOUSING AUTHORITY A0245 x x x x x<br />

GREATER EAST END MGMT DISTRICT A0245 x x x x x<br />

GREATER NORTHSIDE MANAGEMENT DISTRICT A0245 x x x x x<br />

GREEN VALLEY SUD A0245 x x x x x<br />

GREENBELT MUNICIPAL & INDUSTRIAL WA A0245 x x x x x<br />

GREENSPOINT DISTRICT A0245 x x x x x<br />

GREENVILLE A0245 x x x x x<br />

GREENVILLE HOUSING AUTHORITY A0245 x x x x x<br />

GREGG CAD A0245 x x x x x<br />

GREGORY A0245 x x x x x<br />

GREGORY HOUSING AUTHORITY A0245 x x x x x<br />

GREY FOREST A0245 x x x x x<br />

GRIMES CAD A0245 x x x x x<br />

GRIMES COUNTY MUD #1 A0245 x x x x x<br />

GROESBECK A0245 x x x x x<br />

GROESBECK HOUSING AUTHORITY A0245 x x x x x<br />

GROOM A0245 x x x x x<br />

GROVES A0245 x x x x x<br />

GRUVER A0245 x x x x x<br />

GULF COAST WATER AUTHORITY A0245 x x x x x<br />

GUN BARREL CITY A0245 x x x x x<br />

GUNTER A0245 x x x x x<br />

GUSTINE A0245 x x x x x<br />

HACIENDAS DEL NORTE WID A0245 x x x x x<br />

HACKBERRY A0245 x x x x x<br />

HALE CAD A0245 x x x x x<br />

HALE CENTER A0245 x x x x x<br />

HALE CENTER HOUSING AUTHORITY A0245 x x x x x<br />

HALE COUNTY HOUSING AUTHORITY A0245 x x x x x<br />

HALE COUNTY SWCD #132 A0245 x x x x x<br />

HALL CAD A0245 x x x x x<br />

HALL COUNTY HOSPITAL DISTRICT A0245 x x x x x<br />

HALL-CHILDRESS SWCD #109 A0245 x x x x x<br />

HALLETTSVILLE A0245 x x x x x<br />

HALLSVILLE A0245 x x x x x<br />

HALTOM CITY A0245 x x x x x<br />

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HAMLIN A0245 x x x x x<br />

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HANSFORD CAD A0245 x x x x x<br />

HAPPY A0245 x x x x x<br />

HARDIN A0245 x x x x x<br />

HARDIN COUNTY ESD #2 A0245 x x x x x<br />

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HARKER HEIGHTS A0245 x x x x x<br />

HARLINGEN A0245 x x x x x<br />

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HARRIS CAD A0245 x x x x x<br />

HARRIS COUNTY ESD #1 A0245 x x x x x<br />

HARRIS COUNTY ESD #13 A0245 x x x x x<br />

HARRIS COUNTY ESD #24 A0245 x x x x x<br />

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HARRIS COUNTY ESD #6 A0245 x x x x x<br />

HARRIS COUNTY FWSD #27 A0245 x x x x x<br />

HARRIS COUNTY FWSD #47 A0245 x x x x x<br />

HARRIS COUNTY FWSD #58 A0245 x x x x x<br />

HARRIS COUNTY ID#3-UPPER KIRBY MGMT DIST A0245 x x x x x<br />

HARRIS COUNTY IMPROVEMENT DIST #1 A0245 x x x x x<br />

HARRIS COUNTY MUD #106 A0245 x x x x x<br />

HARRIS COUNTY MUD #11 A0245 x x x x x<br />

HARRIS COUNTY MUD #130 A0245 x x x x x<br />

HARRIS COUNTY MUD #144 A0245 x x x x x<br />

HARRIS COUNTY MUD #151 A0245 x x x x x<br />

HARRIS COUNTY MUD #152 A0245 x x x x x<br />

HARRIS COUNTY MUD #153 A0245 x x x x x<br />

HARRIS COUNTY MUD #154 A0245 x x x x x<br />

HARRIS COUNTY MUD #156 A0245 x x x x x<br />

HARRIS COUNTY MUD #162 A0245 x x x x x<br />

HARRIS COUNTY MUD #163 A0245 x x x x x<br />

HARRIS COUNTY MUD #166 A0245 x x x x x<br />

HARRIS COUNTY MUD #173 A0245 x x x x x<br />

HARRIS COUNTY MUD #189 A0245 x x x x x<br />

HARRIS COUNTY MUD #215 A0245 x x x x x<br />

HARRIS COUNTY MUD #222 A0245 x x x x x<br />

HARRIS COUNTY MUD #26 A0245 x x x x x<br />

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HARRIS COUNTY MUD #316 A0245 x x x x x<br />

HARRIS COUNTY MUD #321 A0245 x x x x x<br />

HARRIS COUNTY MUD #322 A0245 x x x x x<br />

HARRIS COUNTY MUD #354 A0245 x x x x x<br />

HARRIS COUNTY MUD #355 A0245 x x x x x<br />

HARRIS COUNTY MUD #358 A0245 x x x x x<br />

HARRIS COUNTY MUD #367 A0245 x x x x x<br />

HARRIS COUNTY MUD #372 A0245 x x x x x<br />

HARRIS COUNTY MUD #391 A0245 x x x x x<br />

HARRIS COUNTY MUD #396 A0245 x x x x x<br />

HARRIS COUNTY MUD #44 A0245 x x x x x<br />

HARRIS COUNTY MUD #46 A0245 x x x x x<br />

HARRIS COUNTY MUD #48 A0245 x x x x x<br />

HARRIS COUNTY MUD #64 A0245 x x x x x<br />

HARRIS COUNTY MUNICIPAL MGMT DIST #1 A0245 x x x x x<br />

HARRIS COUNTY RFPD #46 A0245 x x x x x<br />

HARRIS COUNTY ROAD IMPROVEMENT DIST #1 A0245 x x x x x<br />

HARRIS COUNTY UTILITY DISTRICT #15 A0245 x x x x x<br />

HARRIS COUNTY WCID #145 A0245 x x x x x<br />

HARRIS COUNTY WCID #155 A0245 x x x x x<br />

HARRIS COUNTY WCID #156 A0245 x x x x x<br />

HARRIS COUNTY WCID #36 A0245 x x x x x<br />

HARRIS COUNTY WCID #50 A0245 x x x x x<br />

HARRIS COUNTY WCID #92 A0245 x x x x x<br />

HARRISON CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />

HARRISON COUNTY SWCD A0245 x x x x x<br />

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HASKELL A0245 x x x x x<br />

HASKELL CAD A0245 x x x x x<br />

HASKELL HOUSING AUTHORITY A0245 x x x x x<br />

HASLET A0245 x x x x x<br />

HAWK COVE A0245 x x x x x<br />

HAWKINS A0245 x x x x x<br />

HAWLEY A0245 x x x x x<br />

HAYS A0245 x x x x x<br />

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HAYS COUNTY ESD #5 A0245 x x x x x<br />

HAYS COUNTY ESD #6 A0245 x x x x x<br />

HAYS COUNTY ESD #8 A0245 x x x x x<br />

HAYS COUNTY MUD #5 A0245 x x x x x<br />

HAYS COUNTY SWCD #351 A0245 x x x x x<br />

HAYS TRINITY GCD A0245 x x x x x<br />

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HICO A0245 x x x x x<br />

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HIDALGO COUNTY DRAINAGE DISTRICT #1 A0245 x x x x x<br />

HIDALGO COUNTY HOUSING AUTHORITY/WESLACO A0245 x x x x x<br />

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 />

HILL COUNTY BLACKLAND SWCD A0245 x x x x x<br />

HILL COUNTY ESD #1 A0245 x x x x x<br />

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HILLCREST VILLAGE A0245 x x x x x<br />

HILLSBORO A0245 x x x x x<br />

HILSHIRE VILLAGE A0245 x x x x x<br />

HITCHCOCK A0245 x x x x x<br />

HOLIDAY LAKES TOWN OF A0245 x x x x x<br />

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 />

HUTCHINS A0245 x x x x x<br />

HUTCHINSON CAD A0245 x x x x x<br />

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HUXLEY A0245 x x x x x<br />

IDALOU A0245 x x x x x<br />

IDLEWOOD WCID #1 A0245 x x x x x<br />

INDIAN LAKE A0245 x x x x x<br />

INDUSTRY A0245 x x x x x<br />

INGLESIDE A0245 x x x x x<br />

INGLESIDE HOUSING AUTHORITY A0245 x x x x x<br />

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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JOHNSON COUNTY ESD #1 A0245 x x x x x<br />

JOHNSON COUNTY SUD A0245 x x x x x<br />

JOHNSON COUNTY SWCD #541 A0245 x x x x x<br />

JONAH WATER SUD A0245 x x x x x<br />

JONES CAD A0245 x x x x x<br />

JONES CREEK VILLAGE OF A0245 x x x x x<br />

JONESTOWN A0245 x x x x x<br />

JOSEPHINE A0245 x x x x x<br />

JOSHUA A0245 x x x x x<br />

JOURDANTON A0245 x x x x x<br />

JOURDANTON HOUSING AUTHORITY A0245 x x x x x<br />

JUNCTION A0245 x x x x x<br />

JUNCTION HOUSING AUTHORITY A0245 x x x x x<br />

JUSTIN A0245 x x x x x<br />

KARNES CITY A0245 x x x x x<br />

KARNES CITY HOUSING AUTHORITY A0245 x x x x x<br />

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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KILGORE A0245 x x x x x<br />

KILLEEN A0245 x x x x x<br />

KILLEEN HOUSING AUTHORITY A0245 x x x x x<br />

KIMBLE CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />

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 />

KINNEY COUNTY GCD A0245 x x x x x<br />

KIRBY A0245 x x x x x<br />

KIRBYVILLE A0245 x x x x x<br />

KIRBYVILLE HOUSING AUTHORITY A0245 x x x x x<br />

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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LAKE MUD A0245 x x x x x<br />

LAKE TANGLEWOOD A0245 x x x x x<br />

LAKE TRAVIS COMM LIBRARY DIST A0245 x x x x x<br />

LAKE WORTH A0245 x x x x x<br />

LAKEPORT A0245 x x x x x<br />

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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LIBERTY HILL PUBLIC LIBRARY DISTRICT A0245 x x x x x<br />

LIMESTONE CAD A0245 x x x x x<br />

LIMESTONE COUNTY SENIOR SERVICES PROJECT A0245 x x x x x<br />

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 />

LINDEN HOUSING AUTHORITY A0245 x x x x x<br />

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 />

LLANO HOUSING AUTHORITY A0245 x x x x x<br />

LOCKHART A0245 x x x x x<br />

LOCKHART HOUSING AUTHORITY A0245 x x x x x<br />

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 />

LOMETA HOUSING AUTHORITY A0245 x x x x x<br />

LONE OAK A0245 x x x x x<br />

LONE STAR A0245 x x x x x<br />

LONE WOLF GCD A0245 x x x x x<br />

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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LOST CREEK MUD A0245 x x x x x<br />

LOTT A0245 x x x x x<br />

LOTT HOUSING AUTHORITY A0245 x x x x x<br />

LOUETTA NORTH PUD A0245 x x x x x<br />

LOUETTA ROAD UD A0245 x x x x x<br />

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 />

LUELLA SUD A0245 x x x x x<br />

LULING A0245 x x x x x<br />

LULING HOUSING AUTHORITY A0245 x x x x x<br />

LUMBERTON A0245 x x x x x<br />

LUMBERTON MUD A0245 x x x x x<br />

LYFORD A0245 x x x x x<br />

LYNN CAD A0245 x x x x x<br />

LYTLE A0245 x x x x x<br />

MHMR OF TARRANT COUNTY A0245 x x x x x<br />

MABANK A0245 x x x x x<br />

MABANK HOUSING AUTHORITY A0245 x x x x x<br />

MACBEE SUD A0245 x x x x x<br />

MACEDONIA EYLAU MUD A0245 x x x x x<br />

MACKENZIE MUNICIPAL WATER AUTHORITY A0245 x x x x x<br />

MADISON CAD A0245 x x x x x<br />

MADISONVILLE A0245 x x x x x<br />

MADISONVILLE HOUSING AUTHORITY A0245 x x x x x<br />

MAGNOLIA A0245 x x x x x<br />

MALAKOFF A0245 x x x x x<br />

MALAKOFF HOUSING AUTHORITY A0245 x x x x x<br />

MALONE A0245 x x x x x<br />

MANOR A0245 x x x x x<br />

MANSFIELD A0245 x x x x x<br />

MANVEL A0245 x x x x x<br />

MARBLE FALLS A0245 x x x x x<br />

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MARFA A0245 x x x x x<br />

MARFA HOUSING AUTHORITY A0245 x x x x x<br />

MARIETTA A0245 x x x x x<br />

MARILEE SUD A0245 x x x x x<br />

MARION A0245 x x x x x<br />

MARION CASS SWCD A0245 x x x x x<br />

MARION COUNTY HOSPITAL DISTRICT A0245 x x x x x<br />

MARKHAM MUD A0245 x x x x x<br />

MARLIN A0245 x x x x x<br />

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 />

MART A0245 x x x x x<br />

MART HOUSING AUTHORITY A0245 x x x x x<br />

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 />

MASON HOUSING AUTHORITY A0245 x x x x x<br />

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 />

MCGREGOR HOUSING AUTHORITY A0245 x x x x x<br />

MCKINNEY A0245 x x x x x<br />

MCKINNEY HOUSING AUTHORITY A0245 x x x x x<br />

MCLEAN A0245 x x x x x<br />

MCLEAN HOUSING AUTHORITY A0245 x x x x x<br />

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MCLENNAN CAD A0245 x x x x x<br />

MCLENNAN COUNTY WCID #2 A0245 x x x x x<br />

MEADOW A0245 x x x x x<br />

MEADOWLAKES A0245 x x x x x<br />

MEADOWS PLACE A0245 x x x x x<br />

MEDINA CAD A0245 x x x x x<br />

MEDINA COUNTY 911 A0245 x x x x x<br />

MEDINA COUNTY WCID #2 A0245 x x x x x<br />

MEDINA VALLEY SWCD A0245 x x x x x<br />

MEGARGEL A0245 x x x x x<br />

MELISSA A0245 x x x x x<br />

MELVIN A0245 x x x x x<br />

MEMORIAL POINT UD A0245 x x x x x<br />

MEMORIAL VILLAGES POLICE DEPT A0245 x x x x x<br />

MEMORIAL VILLAGES WATER AUTHORITY A0245 x x x x x<br />

MEMPHIS A0245 x x x x x<br />

MEMPHIS HOUSING AUTHORITY A0245 x x x x x<br />

MENARD A0245 x x x x x<br />

MENARD COUNTY SWCD #215 A0245 x x x x x<br />

MERCEDES HOUSING AUTHORITY A0245 x x x x x<br />

MERIDIAN A0245 x x x x x<br />

MERIDIAN HOUSING AUTHORITY A0245 x x x x x<br />

MERKEL A0245 x x x x x<br />

MERKEL HOUSING AUTHORITY A0245 x x x x x<br />

MERTENS A0245 x x x x x<br />

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 />

MIDLOTHIAN/WAXAHACHIE AIRPORT A0245 x x x x x<br />

MIDWAY A0245 x x x x x<br />

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MILDRED A0245 x x x x x<br />

MILFORD A0245 x x x x x<br />

MILLS CAD A0245 x x x x x<br />

MILLSAP A0245 x x x x x<br />

MINEOLA A0245 x x x x x<br />

MINEOLA HOUSING AUTHORITY A0245 x x x x x<br />

MINERAL WELLS A0245 x x x x x<br />

MINERAL WELLS HOUSING AUTHORITY A0245 x x x x x<br />

MINGUS A0245 x x x x x<br />

MISSION A0245 x x x x x<br />

MISSION HOUSING AUTHORITY A0245 x x x x x<br />

MISSOURI CITY A0245 x x x x x<br />

MITCHELL COUNTY SWCD A0245 x x x x x<br />

MOBEETIE A0245 x x x x x<br />

MONAHANS A0245 x x x x x<br />

MONAHANS HOUSING AUTHORITY A0245 x x x x x<br />

MONT BELVIEU A0245 x x x x x<br />

MONTAGUE COUNTY TAX APPRAISAL DIST A0245 x x x x x<br />

MONTGOMERY A0245 x x x x x<br />

MONTGOMERY COUNTY ECD A0245 x x x x x<br />

MONTGOMERY COUNTY ESD #1 A0245 x x x x x<br />

MONTGOMERY COUNTY ESD #10 A0245 x x x x x<br />

MONTGOMERY COUNTY ESD #11 A0245 x x x x x<br />

MONTGOMERY COUNTY ESD #12 A0245 x x x x x<br />

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 />

MONTGOMERY COUNTY HOUSING AUTHORITY A0245 x x x x x<br />

MONTGOMERY COUNTY WCID #1 A0245 x x x x x<br />

MOODY A0245 x x x x x<br />

MOODY HOUSING AUTHORITY A0245 x x x x x<br />

MORAN A0245 x x x x x<br />

MORGAN A0245 x x x x x<br />

MORGAN'S POINT A0245 x x x x x<br />

MORGAN'S POINT RESORT A0245 x x x x x<br />

MORRIS CAD A0245 x x x x x<br />

MORTON A0245 x x x x x<br />

MOTLEY CAD A0245 x x x x x<br />

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MOULTON A0245 x x x x x<br />

MOUNT CALM A0245 x x x x x<br />

MOUNT ENTERPRISE A0245 x x x x x<br />

MOUNT PLEASANT A0245 x x x x x<br />

MOUNT PLEASANT HOUSING AUTHORITY A0245 x x x x x<br />

MOUNT VERNON A0245 x x x x x<br />

MOUNT VERNON HOUSING AUTHORITY A0245 x x x x x<br />

MOUNTAIN CITY A0245 x x x x x<br />

MOUNTAIN PEAK SUD A0245 x x x x x<br />

MUENSTER A0245 x x x x x<br />

MULESHOE A0245 x x x x x<br />

MULESHOE HOUSING AUTHORITY A0245 x x x x x<br />

MUNDAY A0245 x x x x x<br />

MUNDAY HOUSING AUTHORITY A0245 x x x x x<br />

MURCHISON A0245 x x x x x<br />

MURPHY A0245 x x x x x<br />

MUSTANG RIDGE A0245 x x x x x<br />

NACOGDOCHES HOUSING AUTHORITY A0245 x x x x x<br />

NAPLES A0245 x x x x x<br />

NAPLES HOUSING AUTHORITY A0245 x x x x x<br />

NASH A0245 x x x x x<br />

NASSAU BAY A0245 x x x x x<br />

NATALIA A0245 x x x x x<br />

NAVARRO CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />

NAVARRO SWCD A0245 x x x x x<br />

NAVASOTA A0245 x x x x x<br />

NAVASOTA HOUSING AUTHORITY A0245 x x x x x<br />

NAZARETH A0245 x x x x x<br />

NECHES/TRINITY VALLEY GCD A0245 x x x x x<br />

NEDERLAND A0245 x x x x x<br />

NEEDVILLE A0245 x x x x x<br />

NEVADA A0245 x x x x x<br />

NEW BERLIN A0245 x x x x x<br />

NEW BOSTON A0245 x x x x x<br />

NEW BOSTON HOUSING AUTHORITY A0245 x x x x x<br />

NEW BRAUNFELS A0245 x x x x x<br />

NEW BRAUNFELS HOUSING AUTHORITY A0245 x x x x x<br />

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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NEW SUMMERFIELD A0245 x x x x x<br />

NEW WAVERLY A0245 x x x x x<br />

NEWARK A0245 x x x x x<br />

NEWCASTLE A0245 x x x x x<br />

NEWCASTLE HOUSING AUTHORITY A0245 x x x x x<br />

NEWTON CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />

NEWTON COUNTY ESD #5 A0245 x x x x x<br />

NIEDERWALD A0245 x x x x x<br />

NIXON A0245 x x x x x<br />

NIXON HOUSING AUTHORITY A0245 x x x x x<br />

NOCONA A0245 x x x x x<br />

NOLANVILLE A0245 x x x x x<br />

NOME A0245 x x x x x<br />

NOONDAY A0245 x x x x x<br />

NORDHEIM A0245 x x x x x<br />

NORMANGEE A0245 x x x x x<br />

NORTEX REGIONAL PLANNING COMMISSION A0245 x x x x x<br />

NORTH CENTRAL TEXAS COG A0245 x x x x x<br />

NORTH CENTRAL TEXAS MWA A0245 x x x x x<br />

NORTH CHANNEL WATER AUTHORITY A0245 x x x x x<br />

NORTH CONCHO RIVER SWCD A0245 x x x x x<br />

NORTH GREEN MUD A0245 x x x x x<br />

NORTH HARRIS CO REG WATER AUTH A0245 x x x x x<br />

NORTH TEXAS TOLLWAY AUTHORITY A0245 x x x x x<br />

NORTH ZULCH MUD A0245 x x x x x<br />

NORTHAMPTON MUD A0245 x x x x x<br />

NORTHEAST GAINES COUNTY ESD #1 A0245 x x x x x<br />

NORTHEAST TEXAS PUBLIC HEALTH DISTRICT A0245 x x x x x<br />

NORTHLAKE A0245 x x x x x<br />

NORTHTOWN MUD A0245 x x x x x<br />

NORTHWEST GRAYSON COUNTY WCID #1 A0245 x x x x x<br />

NORTHWEST HARRIS COUNTY MUD #22 A0245 x x x x x<br />

NORTHWEST HARRIS COUNTY MUD #30 A0245 x x x x x<br />

NORTHWEST HARRIS COUNTY MUD #36 A0245 x x x x x<br />

NUECES CAD A0245 x x x x x<br />

NUECES COUNTY DD #2 A0245 x x x x x<br />

NUECES COUNTY ESD #1 A0245 x x x x x<br />

NUECES COUNTY ESD #4 A0245 x x x x x<br />

NUECES COUNTY WCID #3 A0245 x x x x x<br />

NUECES COUNTY WCID #4 A0245 x x x x x<br />

NUECES COUNTY WCID #5 A0245 x x x x x<br />

O'DONNELL A0245 x x x x x<br />

O'DONNELL HOUSING AUTHORITY A0245 x x x x x<br />

OST/ALMEDA CORRIDORS REDEVELOPMENT AUTH A0245 x x x x x<br />

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OAK POINT A0245 x x x x x<br />

OAK RIDGE (COOKE CO) A0245 x x x x x<br />

OAK RIDGE (KAUFMAN CO) A0245 x x x x x<br />

OAK RIDGE NORTH A0245 x x x x x<br />

OAKWOOD A0245 x x x x x<br />

ODEM A0245 x x x x x<br />

ODEM HOUSING AUTHORITY A0245 x x x x x<br />

ODESSA HOUSING AUTHORITY A0245 x x x x x<br />

OGLESBY A0245 x x x x x<br />

OGLESBY HOUSING AUTHORITY A0245 x x x x x<br />

OLD RIVER-WINFREE A0245 x x x x x<br />

OLDHAM CAD A0245 x x x x x<br />

OLMOS PARK A0245 x x x x x<br />

OLNEY A0245 x x x x x<br />

OLNEY HOUSING AUTHORITY A0245 x x x x x<br />

OLTON A0245 x x x x x<br />

OLTON HOUSING AUTHORITY A0245 x x x x x<br />

OMAHA A0245 x x x x x<br />

OMAHA HOUSING AUTHORITY A0245 x x x x x<br />

ONALASKA A0245 x x x x x<br />

OPDYKE WEST A0245 x x x x x<br />

ORANGE A0245 x x x x x<br />

ORANGE CAD A0245 x x x x x<br />

ORANGE CO ESD #2/BRIDGE CITY VFD A0245 x x x x x<br />

ORANGE COUNTY ESD #1 A0245 x x x x x<br />

ORANGE COUNTY ESD #3 A0245 x x x x x<br />

ORANGE COUNTY ESD #4 A0245 x x x x x<br />

ORANGE COUNTY WCID #1 A0245 x x x x x<br />

ORANGE COUNTY WCID #2 A0245 x x x x x<br />

ORANGE GROVE A0245 x x x x x<br />

ORANGE HOUSING AUTHORITY A0245 x x x x x<br />

ORCHARD A0245 x x x x x<br />

ORE CITY A0245 x x x x x<br />

OVERTON A0245 x x x x x<br />

OVERTON HOUSING AUTHORITY A0245 x x x x x<br />

OVILLA A0245 x x x x x<br />

OYSTER CREEK A0245 x x x x x<br />

PADUCAH A0245 x x x x x<br />

PADUCAH HOUSING AUTHORITY A0245 x x x x x<br />

PAINT ROCK A0245 x x x x x<br />

PALACIOS A0245 x x x x x<br />

PALACIOS HOUSING AUTHORITY A0245 x x x x x<br />

PALESTINE A0245 x x x x x<br />

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PALM VALLEY A0245 x x x x x<br />

PALMER A0245 x x x x x<br />

PALMHURST A0245 x x x x x<br />

PALMVIEW A0245 x x x x x<br />

PALO DURO RIVER AUTHORITY A0245 x x x x x<br />

PALO PINTO APPRAISAL DISTRICT A0245 x x x x x<br />

PALO PINTO SWCD #518 A0245 x x x x x<br />

PALOMA LAKE MUD #1 A0245 x x x x x<br />

PALOMA LAKE MUD #2 A0245 x x x x x<br />

PAMPA A0245 x x x x x<br />

PANHANDLE A0245 x x x x x<br />

PANHANDLE REGIONAL PLNG COMM A0245 x x x x x<br />

PANOLA CAD A0245 x x x x x<br />

PANOLA COUNTY ESD #1 A0245 x x x x x<br />

PANOLA COUNTY FWD #1 A0245 x x x x x<br />

PANOLA SWCD #448 A0245 x x x x x<br />

PANORAMA VILLAGE A0245 x x x x x<br />

PANTEGO A0245 x x x x x<br />

PARADISE A0245 x x x x x<br />

PARIS A0245 x x x x x<br />

PARIS HOUSING AUTHORITY A0245 x x x x x<br />

PARKER A0245 x x x x x<br />

PARKER CAD A0245 x x x x x<br />

PARKER COUNTY SWCD #558 A0245 x x x x x<br />

PARKSIDE AT MAYFIELD RANCH MUD A0245 x x x x x<br />

PARMER CAD A0245 x x x x x<br />

PASADENA A0245 x x x x x<br />

PATTISON A0245 x x x x x<br />

PATTON VILLAGE A0245 x x x x x<br />

PAYNE SPRINGS A0245 x x x x x<br />

PEARLAND A0245 x x x x x<br />

PEARSALL A0245 x x x x x<br />

PEARSALL HOUSING AUTHORITY A0245 x x x x x<br />

PECAN BAYOU SWCD #553 A0245 x x x x x<br />

PECAN HILL A0245 x x x x x<br />

PECAN VALLEY GCD A0245 x x x x x<br />

PECOS A0245 x x x x x<br />

PECOS COUNTY WCID #1 A0245 x x x x x<br />

PECOS COUNTY WID #2 A0245 x x x x x<br />

PECOS COUNTY WID #3 A0245 x x x x x<br />

PECOS HOUSING AUTHORITY A0245 x x x x x<br />

PEDERNALES SWCD #218 A0245 x x x x x<br />

PELICAN BAY A0245 x x x x x<br />

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PERMIAN BASIN UWCD A0245 x x x x x<br />

PERRYTON A0245 x x x x x<br />

PETROLIA A0245 x x x x x<br />

PETTUS MUD A0245 x x x x x<br />

PFLUGERVILLE A0245 x x x x x<br />

PHARR A0245 x x x x x<br />

PHARR HOUSING AUTHORITY A0245 x x x x x<br />

PHELPS SUD A0245 x x x x x<br />

PILOT POINT A0245 x x x x x<br />

PINE FOREST A0245 x x x x x<br />

PINEHURST A0245 x x x x x<br />

PINEY POINT VILLAGE A0245 x x x x x<br />

PITTSBURG A0245 x x x x x<br />

PITTSBURG HOUSING AUTHORITY A0245 x x x x x<br />

PLAINS A0245 x x x x x<br />

PLAINVIEW A0245 x x x x x<br />

PLAINVIEW HOUSING AUTHORITY A0245 x x x x x<br />

PLANO HOUSING AUTHORITY A0245 x x x x x<br />

PLATEAU UWCSD A0245 x x x x x<br />

PLEAK A0245 x x x x x<br />

PLEASANTON A0245 x x x x x<br />

PLEASANTON HOUSING AUTHORITY A0245 x x x x x<br />

PLEASURE ISLAND COMMISSION A0245 x x x x x<br />

POINT A0245 x x x x x<br />

POINT AQUARIUS MUD A0245 x x x x x<br />

POINT COMFORT A0245 x x x x x<br />

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 />

PORT ARTHUR HOUSING AUTHORITY A0245 x x x x x<br />

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 />

PORT LAVACA HOUSING AUTHORITY A0245 x x x x x<br />

PORT NECHES A0245 x x x x x<br />

PORT OF CORPUS CHRISTI AUTHORITY A0245 x x x x x<br />

PORT OF HARLINGEN AUTHORITY A0245 x x x x x<br />

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PORT OF LIBERTY COMMISSION A0245 x x x x x<br />

PORTER SUD A0245 x x x x x<br />

PORTLAND A0245 x x x x x<br />

POST A0245 x x x x x<br />

POST HOUSING AUTHORITY A0245 x x x x x<br />

POST OAK SUD A0245 x x x x x<br />

POST OAK SAVANNAH GCD A0245 x x x x x<br />

POTEET A0245 x x x x x<br />

POTEET HOUSING AUTHORITY A0245 x x x x x<br />

POTH A0245 x x x x x<br />

POTTER-RANDALL COUNTY ECD A0245 x x x x x<br />

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 />

QUITMAN A0245 x x x x x<br />

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 />

RANGER HOUSING AUTHORITY A0245 x x x x x<br />

RANKIN A0245 x x x x x<br />

RANKIN HOUSING AUTHORITY A0245 x x x x x<br />

RANSOM CANYON A0245 x x x x x<br />

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RAYMONDVILLE A0245 x x x x x<br />

REAL CAD A0245 x x x x x<br />

REAL EDWARDS CONS/RECL DIST A0245 x x x x x<br />

RED BLUFF WATER POWER CONTROL DIST A0245 x x x x x<br />

RED OAK A0245 x x x x x<br />

RED RIVER AUTHORITY OF TEXAS A0245 x x x x x<br />

RED RIVER CAD A0245 x x x x x<br />

RED RIVER SWCD A0245 x x x x x<br />

RED SANDS GCD A0245 x x x x x<br />

REDWATER A0245 x x x x x<br />

REEVES CAD A0245 x x x x x<br />

REEVES COUNTY WID #1 A0245 x x x x x<br />

REFUGIO A0245 x x x x x<br />

REFUGIO COUNTY WCID #1 A0245 x x x x x<br />

REGIONAL TRANSPORTATION AUTHORITY A0245 x x x x x<br />

REKLAW A0245 x x x x x<br />

RENO A0245 x x x x x<br />

RENO (PARKER COUNTY) A0245 x x x x x<br />

RETREAT A0245 x x x x x<br />

RHOME A0245 x x x x x<br />

RICE A0245 x x x x x<br />

RICHLAND A0245 x x x x x<br />

RICHLAND HILLS A0245 x x x x x<br />

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 />

RIESEL A0245 x x x x x<br />

RIO GRANDE COG A0245 x x x x x<br />

RIO GRANDE CITY A0245 x x x x x<br />

RIO VISTA A0245 x x x x x<br />

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 />

ROBERT LEE HOUSING AUTHORITY A0245 x x x x x<br />

ROBERTSON CAD A0245 x x x x x<br />

ROBINSON A0245 x x x x x<br />

ROBSTOWN A0245 x x x x x<br />

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ROBSTOWN UTILITY SYSTEMS A0245 x x x x x<br />

ROBY A0245 x x x x x<br />

ROBY HOUSING AUTHORITY A0245 x x x x x<br />

ROCHESTER A0245 x x x x x<br />

ROCKDALE A0245 x x x x x<br />

ROCKDALE HOUSING AUTHORITY A0245 x x x x x<br />

ROCKETT SUD A0245 x x x x x<br />

ROCKPORT A0245 x x x x x<br />

ROCKSPRINGS A0245 x x x x x<br />

ROCKWALL A0245 x x x x x<br />

ROCKWALL HOUSING AUTHORITY A0245 x x x x x<br />

ROGERS A0245 x x x x x<br />

ROGERS HOUSING AUTHORITY A0245 x x x x x<br />

ROLLING PLAINS GCD A0245 x x x x x<br />

ROLLING PLAINS MEMORIAL HOSPITAL DIST A0245 x x x x x<br />

ROLLINGWOOD A0245 x x x x x<br />

ROMA A0245 x x x x x<br />

ROMA HOUSING AUTHORITY A0245 x x x x x<br />

ROMAN FOREST A0245 x x x x x<br />

ROMAN FOREST PUD #3 A0245 x x x x x<br />

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 />

ROSEBUD HOUSING AUTHORITY A0245 x x x x x<br />

ROSENBERG A0245 x x x x x<br />

ROSENBERG HOUSING AUTHORITY A0245 x x x x x<br />

ROTAN A0245 x x x x x<br />

ROTAN HOUSING AUTHORITY (FMHA) A0245 x x x x x<br />

ROUND ROCK A0245 x x x x x<br />

ROUND ROCK HOUSING AUTHORITY A0245 x x x x x<br />

ROUND TOP A0245 x x x x x<br />

ROWLETT A0245 x x x x x<br />

ROXTON A0245 x x x x x<br />

ROYALWOOD MUD A0245 x x x x x<br />

ROYSE CITY A0245 x x x x x<br />

ROYSE CITY HOUSING AUTHORITY A0245 x x x x x<br />

RULE A0245 x x x x x<br />

RUNAWAY BAY A0245 x x x x x<br />

RUNGE A0245 x x x x x<br />

RUNGE HOUSING AUTHORITY A0245 x x x x x<br />

RUNNELS CAD A0245 x x x x x<br />

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RURAL ECONOMIC ASST LEAGUE INC A0245 x x x x x<br />

RURAL TAYLOR COUNTY AGING SERVICE A0245 x x x x x<br />

RUSK A0245 x x x x x<br />

RUSK COUNTY ESD #1 A0245 x x x x x<br />

RUSK COUNTY GCD A0245 x x x x x<br />

RUSK COUNTY RURAL RAIL DISTRICT A0245 x x x x x<br />

RUSK HOUSING AUTHORITY A0245 x x x x x<br />

RUSK SWCD #447 A0245 x x x x x<br />

SABINAL A0245 x x x x x<br />

SABINE/NECHES NAVIGATION DISTRICT A0245 x x x x x<br />

SACHSE A0245 x x x x x<br />

SADLER A0245 x x x x x<br />

SAGEMEADOW UTILITY DISTRICT A0245 x x x x x<br />

SAGINAW A0245 x x x x x<br />

SAINT GEORGE PL REDEV AUTH REINVEST Z#1 A0245 x x x x x<br />

SAINT HEDWIG A0245 x x x x x<br />

SAINT JO A0245 x x x x x<br />

SAINT PAUL A0245 x x x x x<br />

SALADO A0245 x x x x x<br />

SALADO PUBLIC LIBRARY DISTRICT A0245 x x x x x<br />

SALT FORK SWCD #133 A0245 x x x x x<br />

SAN ANGELO HOUSING AUTHORITY A0245 x x x x x<br />

SAN ANTONIO A0245 x x x x x<br />

SAN ANTONIO HOUSING AUTHORITY A0245 x x x x x<br />

SAN ANTONIO MUD #1 A0245 x x x x x<br />

SAN AUGUSTINE HOUSING AUTH A0245 x x x x x<br />

SAN BENITO A0245 x x x x x<br />

SAN BENITO HOUSING AUTHORITY A0245 x x x x x<br />

SAN DIEGO A0245 x x x x x<br />

SAN DIEGO MUD #1 A0245 x x x x x<br />

SAN FELIPE A0245 x x x x x<br />

SAN JACINTO COUNTY ESD A0245 x x x x x<br />

SAN JUAN A0245 x x x x x<br />

SAN JUAN HOUSING AUTHORITY A0245 x x x x x<br />

SAN LEANNA A0245 x x x x x<br />

SAN LEON MUD A0245 x x x x x<br />

SAN MARCOS A0245 x x x x x<br />

SAN MARCOS HOUSING AUTHORITY A0245 x x x x x<br />

SAN PATRICIO CAD A0245 x x x x x<br />

SAN PATRICIO MWD A0245 x x x x x<br />

SAN SABA A0245 x x x x x<br />

SAN SABA CAD A0245 x x x x x<br />

SAN SABA HOUSING AUTHORITY A0245 x x x x x<br />

SAN SABA SWCD #250 A0245 x x x x x<br />

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SAN YGNACIO MUD A0245 x x x x x<br />

SANDY POINT A0245 x x x x x<br />

SANFORD A0245 x x x x x<br />

SANGER A0245 x x x x x<br />

SANSOM PARK A0245 x x x x x<br />

SANTA ANNA A0245 x x x x x<br />

SANTA ANNA HOUSING AUTHORITY A0245 x x x x x<br />

SANTA CLARA A0245 x x x x x<br />

SANTA CRUZ IRRIGATION DIST #15 A0245 x x x x x<br />

SANTA FE A0245 x x x x x<br />

SANTA RITA UWCD A0245 x x x x x<br />

SANTA ROSA A0245 x x x x x<br />

SAVOY A0245 x x x x x<br />

SCHERTZ A0245 x x x x x<br />

SCHERTZ HOUSING AUTHORITY A0245 x x x x x<br />

SCHULENBURG A0245 x x x x x<br />

SCHULENBURG HOUSING AUTHORITY A0245 x x x x x<br />

SCOTLAND A0245 x x x x x<br />

SCURRY CAD A0245 x x x x x<br />

SEABROOK A0245 x x x x x<br />

SEADRIFT A0245 x x x x x<br />

SEAGOVILLE A0245 x x x x x<br />

SEAGRAVES A0245 x x x x x<br />

SEAGRAVES HOUSING AUTHORITY A0245 x x x x x<br />

SEALY A0245 x x x x x<br />

SEBASTIAN MUD A0245 x x x x x<br />

SEGUIN A0245 x x x x x<br />

SEGUIN HOUSING AUTHORITY A0245 x x x x x<br />

SEIS LAGOS UD A0245 x x x x x<br />

SELMA A0245 x x x x x<br />

SEMINOLE A0245 x x x x x<br />

SEVEN OAKS A0245 x x x x x<br />

SEVEN POINTS A0245 x x x x x<br />

SEYMOUR A0245 x x x x x<br />

SEYMOUR HOUSING AUTHORITY A0245 x x x x x<br />

SHACKELFORD CAD A0245 x x x x x<br />

SHADY HOLLOW MUD A0245 x x x x x<br />

SHADY SHORES A0245 x x x x x<br />

SHALLOWATER A0245 x x x x x<br />

SHAMROCK A0245 x x x x x<br />

SHAVANO PARK A0245 x x x x x<br />

SHELBY CAD A0245 x x x x x<br />

SHELBY COUNTY SWCD A0245 x x x x x<br />

SHELDON ROAD MUD A0245 x x x x x<br />

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SHENANDOAH A0245 x x x x x<br />

SHEPHERD A0245 x x x x x<br />

SHERMAN A0245 x x x x x<br />

SHERMAN CAD A0245 x x x x x<br />

SHERMAN HOUSING AUTHORITY A0245 x x x x x<br />

SHINER A0245 x x x x x<br />

SHOREACRES A0245 x x x x x<br />

SIESTA SHORES WCID A0245 x x x x x<br />

SILSBEE A0245 x x x x x<br />

SILVERTON A0245 x x x x x<br />

SIMONTON A0245 x x x x x<br />

SINTON A0245 x x x x x<br />

SINTON HOUSING AUTHORITY A0245 x x x x x<br />

SKELLYTOWN A0245 x x x x x<br />

SLATON A0245 x x x x x<br />

SLATON HOUSING AUTHORITY A0245 x x x x x<br />

SMILEY A0245 x x x x x<br />

SMILEY HOUSING AUTHORITY A0245 x x x x x<br />

SMITH CAD A0245 x x x x x<br />

SMITH COUNTY 911 COMM DIST A0245 x x x x x<br />

SMITH COUNTY ESD #1 A0245 x x x x x<br />

SMITH COUNTY MUD #1 A0245 x x x x x<br />

SMITHVILLE A0245 x x x x x<br />

SMITHVILLE HOUSING AUTHORITY A0245 x x x x x<br />

SMYER A0245 x x x x x<br />

SNOOK A0245 x x x x x<br />

SOCORRO A0245 x x x x x<br />

SOMERSET A0245 x x x x x<br />

SOMERVELL CENTRAL APPRAISAL DISTRICT A0245 x x x x x<br />

SOMERVELL COUNTY WATER DISTRICT A0245 x x x x x<br />

SOMERVILLE A0245 x x x x x<br />

SONORA A0245 x x x x x<br />

SOUR LAKE A0245 x x x x x<br />

SOUTH EAST TEXAS PLANNING COMMISSION A0245 x x x x x<br />

SOUTH HOUSTON A0245 x x x x x<br />

SOUTH PADRE ISLAND A0245 x x x x x<br />

SOUTH PLAINS ASSOCIATION OF GOVERNMENTS A0245 x x x x x<br />

SOUTH PLAINS PUBLIC HEALTH DISTRICT A0245 x x x x x<br />

SOUTH PLAINS UWCD A0245 x x x x x<br />

SOUTH TEXAS DEVELOPMENT COUNCIL A0245 x x x x x<br />

SOUTH TEXAS WATER AUTHORITY A0245 x x x x x<br />

SOUTH TEXAS WEATHER MODIFICATION ASSOC A0245 x x x x x<br />

SOUTHEAST TEXAS GROUNDWATER CONS DIST A0245 x x x x x<br />

SOUTHERN MONTGOMERY COUNTY MUD A0245 x x x x x<br />

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SOUTHLAKE A0245 x x x x x<br />

SOUTHMAYD A0245 x x x x x<br />

SOUTHSIDE PLACE A0245 x x x x x<br />

SOUTHWEST FANNIN SUD A0245 x x x x x<br />

SOUTHWEST TX RAIN ENHANCEMENT ASSOC A0245 x x x x x<br />

SPEARMAN A0245 x x x x x<br />

SPEARMAN HOUSING AUTHORITY A0245 x x x x x<br />

SPLENDORA A0245 x x x x x<br />

SPRING BRANCH MGMT DISTRICT A0245 x x x x x<br />

SPRING VALLEY A0245 x x x x x<br />

SPRINGLAKE A0245 x x x x x<br />

SPRINGTOWN A0245 x x x x x<br />

SPRINGWOODS MUD A0245 x x x x x<br />

SPUR A0245 x x x x x<br />

SPUR HOUSING AUTHORITY A0245 x x x x x<br />

STAFFORD A0245 x x x x x<br />

STAGECOACH A0245 x x x x x<br />

STAMFORD A0245 x x x x x<br />

STAMFORD HOUSING AUTHORITY A0245 x x x x x<br />

STANTON A0245 x x x x x<br />

STANTON HOUSING AUTHORITY A0245 x x x x x<br />

STAR HARBOR A0245 x x x x x<br />

STARR CAD A0245 x x x x x<br />

STARR COUNTY HOUSING AUTHORITY A0245 x x x x x<br />

STEPHENS CAD A0245 x x x x x<br />

STEPHENS REGIONAL SUD A0245 x x x x x<br />

STEPHENVILLE A0245 x x x x x<br />

STERLING CITY A0245 x x x x x<br />

STERLING COUNTY APPRAISAL DISTRICT A0245 x x x x x<br />

STERLING COUNTY UWCD A0245 x x x x x<br />

STINNETT A0245 x x x x x<br />

STOCKDALE A0245 x x x x x<br />

STOCKDALE HOUSING AUTHORITY A0245 x x x x x<br />

STONEWALL RANCH MUD A0245 x x x x x<br />

STONEWALL SWCD #167 A0245 x x x x x<br />

STRATFORD A0245 x x x x x<br />

STRAWN A0245 x x x x x<br />

STRAWN HOUSING AUTHORITY A0245 x x x x x<br />

STREETMAN A0245 x x x x x<br />

SUDAN A0245 x x x x x<br />

SUGAR LAND A0245 x x x x x<br />

SULLIVAN CITY A0245 x x x x x<br />

SULPHUR SPRINGS A0245 x x x x x<br />

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SUNDOWN A0245 x x x x x<br />

SUNNYVALE A0245 x x x x x<br />

SUNRAY A0245 x x x x x<br />

SUNRISE BEACH VILLAGE A0245 x x x x x<br />

SUNSET VALLEY A0245 x x x x x<br />

SURFSIDE BEACH A0245 x x x x x<br />

SUTTON COUNTY UWCD A0245 x x x x x<br />

SWEENY A0245 x x x x x<br />

SWEETWATER A0245 x x x x x<br />

SWEETWATER HOUSING AUTHORITY A0245 x x x x x<br />

SWISHER CAD A0245 x x x x x<br />

TML A0245 x x x x x<br />

TML-IEBP A0245 x x x x x<br />

TML-IRP A0245 x x x x x<br />

TRI SUD A0245 x x x x x<br />

TAFT A0245 x x x x x<br />

TAFT HOUSING AUTHORITY A0245 x x x x x<br />

TAHOKA A0245 x x x x x<br />

TALCO A0245 x x x x x<br />

TALCO HOUSING AUTHORITY A0245 x x x x x<br />

TALTY A0245 x x x x x<br />

TARA GLEN MUD A0245 x x x x x<br />

TARKINGTON SUD A0245 x x x x x<br />

TARRANT COUNTY 911 DISTRICT A0245 x x x x x<br />

TATUM A0245 x x x x x<br />

TATUM HOUSING AUTHORITY A0245 x x x x x<br />

TAX INCREMENT REINVESTMENT ZONE #1 A0245 x x x x x<br />

TAX INCREMENT REINVESTMENT ZONE #11 A0245 x x x x x<br />

TAYLOR A0245 x x x x x<br />

TAYLOR HOUSING AUTHORITY A0245 x x x x x<br />

TAYLOR LAKE VILLAGE A0245 x x x x x<br />

TEAGUE A0245 x x x x x<br />

TEAGUE HOUSING AUTHORITY A0245 x x x x x<br />

TEHUACANA A0245 x x x x x<br />

TEMPLE A0245 x x x x x<br />

TEMPLE HOUSING AUTHORITY A0245 x x x x x<br />

TENAHA A0245 x x x x x<br />

TERRELL A0245 x x x x x<br />

TERRELL HILLS A0245 x x x x x<br />

TERRY MEMORIAL HOSPITAL DIST A0245 x x x x x<br />

TEXANA MHMR CENTER A0245 x x x x x<br />

TEXARKANA A0245 x x x x x<br />

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TEXARKANA WATER UTILITIES A0245 x x x x x<br />

TEXARKANA-BOWIE CO FAM HEALTH CLINIC A0245 x x x x x<br />

TEXAS ASSOC OF REGIONAL COUNCILS A0245 x x x x x<br />

TEXAS CITY A0245 x x x x x<br />

TEXAS CITY HOUSING AUTHORITY A0245 x x x x x<br />

TEXAS CITY TIRZ #1 A0245 x x x x x<br />

TEXAS HOUSING FOUNDATION A0245 x x x x x<br />

TEXAS MUNICIPAL POWER AGENCY A0245 x x x x x<br />

TEXAS MUNICIPAL RETIREMENT SYSTEM A0245 x x x x x<br />

TEXHOMA A0245 x x x x x<br />

TEXLINE A0245 x x x x x<br />

TEXOMA AREA PARATRANSIT SYS INC A0245 x x x x x<br />

TEXOMA AREA SOLID WASTE AUTH A0245 x x x x x<br />

TEXOMA COG A0245 x x x x x<br />

THE COLONY A0245 x x x x x<br />

THE COLONY MUD #1A A0245 x x x x x<br />

THE COLONY MUD #1B A0245 x x x x x<br />

THE COLONY MUD #1C A0245 x x x x x<br />

THE COLONY MUD #1D A0245 x x x x x<br />

THE COLONY MUD #1E A0245 x x x x x<br />

THE COLONY MUD #1F A0245 x x x x x<br />

THE COLONY MUD #1G A0245 x x x x x<br />

THE WOODLANDS TOWNSHIP A0245 x x x x x<br />

THOMPSONS A0245 x x x x x<br />

THORNDALE A0245 x x x x x<br />

THORNDALE HOUSING AUTHORITY A0245 x x x x x<br />

THORNTON A0245 x x x x x<br />

THORNTONVILLE A0245 x x x x x<br />

THRALL A0245 x x x x x<br />

THREE RIVERS A0245 x x x x x<br />

THREE RIVERS HOUSING AUTHORITY A0245 x x x x x<br />

THROCKMORTON A0245 x x x x x<br />

THROCKMORTON CENTRAL APPRAISAL DIST A0245 x x x x x<br />

THROCKMORTON HOUSING AUTHORITY A0245 x x x x x<br />

TIKI ISLAND A0245 x x x x x<br />

TIMBERCREEK CANYON VILLAGE OF A0245 x x x x x<br />

TIMPSON A0245 x x x x x<br />

TIMPSON HOUSING AUTHORITY A0245 x x x x x<br />

TIOGA A0245 x x x x x<br />

TIOGA HOUSING AUTHORITY A0245 x x x x x<br />

TITUS CAD A0245 x x x x x<br />

TODD MISSION A0245 x x x x x<br />

TOLAR A0245 x x x x x<br />

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TOMBALL A0245 x x x x x<br />

TOOL A0245 x x x x x<br />

TOYAH A0245 x x x x x<br />

TOYAH-LIMPIA SWCD A0245 x x x x x<br />

TRAVIS COUNTY ESD #1 A0245 x x x x x<br />

TRAVIS COUNTY ESD #12 A0245 x x x x x<br />

TRAVIS COUNTY ESD #14 A0245 x x x x x<br />

TRAVIS COUNTY ESD #2 A0245 x x x x x<br />

TRAVIS COUNTY ESD #3 A0245 x x x x x<br />

TRAVIS COUNTY ESD #6 A0245 x x x x x<br />

TRAVIS COUNTY ESD #9 A0245 x x x x x<br />

TRAVIS COUNTY FIRE/RESCUE ESD #11 A0245 x x x x x<br />

TRAVIS COUNTY HOUSING AUTHORITY A0245 x x x x x<br />

TRAVIS COUNTY MUD #11 A0245 x x x x x<br />

TRAVIS COUNTY MUD #12 A0245 x x x x x<br />

TRAVIS COUNTY MUD #13 A0245 x x x x x<br />

TRAVIS COUNTY MUD #16 A0245 x x x x x<br />

TRAVIS COUNTY MUD #2 A0245 x x x x x<br />

TRAVIS COUNTY WCID #17 A0245 x x x x x<br />

TRAVIS COUNTY WCID #19 A0245 x x x x x<br />

TRAVIS COUNTY WCID-POINT VENTURE A0245 x x x x x<br />

TREASURE ISLAND MUD A0245 x x x x x<br />

TRENT A0245 x x x x x<br />

TRENTON A0245 x x x x x<br />

TRINIDAD A0245 x x x x x<br />

TRINIDAD HOUSING AUTHORITY A0245 x x x x x<br />

TRINITY A0245 x x x x x<br />

TRINITY GLEN ROSE GCD A0245 x x x x x<br />

TROPHY CLUB A0245 x x x x x<br />

TROUP A0245 x x x x x<br />

TROY A0245 x x x x x<br />

TULIA A0245 x x x x x<br />

TULIA HOUSING AUTHORITY A0245 x x x x x<br />

TURKEY A0245 x x x x x<br />

TUSCOLA A0245 x x x x x<br />

TWO WAY SUD A0245 x x x x x<br />

TYE A0245 x x x x x<br />

TYLER COUNTY ESD #1 A0245 x x x x x<br />

TYLER COUNTY ESD #7 A0245 x x x x x<br />

UHLAND A0245 x x x x x<br />

UNCERTAIN A0245 x x x x x<br />

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UNIVERSITY PARK A0245 x x x x x<br />

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UPPER CLEAR FORK SWCD A0245 x x x x x<br />

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UPPER KIRBY REDEV AUTH TIRZ 19 HOUSTON A0245 x x x x x<br />

UPPER LEON RIVER MWD A0245 x x x x x<br />

UPPER LEON SWCD #525 A0245 x x x x x<br />

UPPER LLANOS SWCD A0245 x x x x x<br />

UPPER PECOS SWCD A0245 x x x x x<br />

UPPER SABINE SWCD A0245 x x x x x<br />

UPPER TRINITY REGIONAL WATER DIST A0245 x x x x x<br />

UPSHUR CAD A0245 x x x x x<br />

UPSHUR-GREGG COUNTY SWCD A0245 x x x x x<br />

UPTON CAD A0245 x x x x x<br />

UPTON COUNTY ESD #1 A0245 x x x x x<br />

UPTON COUNTY ESD #2 A0245 x x x x x<br />

UPTON COUNTY WATER DISTRICT #1 A0245 x x x x x<br />

UVALDE A0245 x x x x x<br />

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UVALDE COUNTY UWCD A0245 x x x x x<br />

UVALDE HOUSING AUTHORITY A0245 x x x x x<br />

VALLEY ACRES IRRIGATION DISTRICT A0245 x x x x x<br />

VALLEY INTERNATIONAL AIRPORT A0245 x x x x x<br />

VALLEY MUD #2 A0245 x x x x x<br />

VALLEY MILLS A0245 x x x x x<br />

VALLEY VIEW A0245 x x x x x<br />

VAN A0245 x x x x x<br />

VAN ALSTYNE A0245 x x x x x<br />

VAN HORN A0245 x x x x x<br />

VAN HORN HOUSING AUTHORITY A0245 x x x x x<br />

VAN HOUSING AUTHORITY A0245 x x x x x<br />

VAN ZANDT CAD A0245 x x x x x<br />

VARNER CREEK UD A0245 x x x x x<br />

VEGA A0245 x x x x x<br />

VELASCO DRAINAGE DISTRICT A0245 x x x x x<br />

VENUS A0245 x x x x x<br />

VERNON A0245 x x x x x<br />

VERNON HOUSING AUTHORITY A0245 x x x x x<br />

VICTORIA A0245 x x x x x<br />

VICTORIA COUNTY GCD A0245 x x x x x<br />

VICTORIA COUNTY WCID #2 A0245 x x x x x<br />

VICTORIA HOUSING AUTHORITY A0245 x x x x x<br />

VIDOR A0245 x x x x x<br />

VILLAGE OF THE HILLS A0245 x x x x x<br />

VINTON A0245 x x x x x<br />

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VOLENTE A0245 x x x x x<br />

WACO CITY OF WACO TRANSIT SYSTEM A0245 x x x x x<br />

WACO HOUSING AUTHORITY A0245 x x x x x<br />

WAELDER A0245 x x x x x<br />

WAELDER HOUSING AUTHORITY A0245 x x x x x<br />

WAKE VILLAGE A0245 x x x x x<br />

WALKER COUNTY ESD #1 A0245 x x x x x<br />

WALKER COUNTY ESD #2 A0245 x x x x x<br />

WALKER COUNTY HOUSING AUTHORITY A0245 x x x x x<br />

WALKER COUNTY SUD A0245 x x x x x<br />

WALLER A0245 x x x x x<br />

WALLER COUNTY RID #1 A0245 x x x x x<br />

WALLIS A0245 x x x x x<br />

WALNUT CREEK SUD A0245 x x x x x<br />

WALNUT SPRINGS A0245 x x x x x<br />

WALSH RANCH MUD A0245 x x x x x<br />

WARD CAD A0245 x x x x x<br />

WARD COUNTY WID #2 A0245 x x x x x<br />

WARREN CITY A0245 x x x x x<br />

WASKOM A0245 x x x x x<br />

WATAUGA A0245 x x x x x<br />

WATERWOOD MUD #1 A0245 x x x x x<br />

WAXAHACHIE A0245 x x x x x<br />

WAXAHACHIE HOUSING AUTHORITY A0245 x x x x x<br />

WEATHERFORD A0245 x x x x x<br />

WEATHERFORD HOUSING AUTHORITY A0245 x x x x x<br />

WEBB CAD A0245 x x x x x<br />

WEBBERVILLE A0245 x x x x x<br />

WEBSTER A0245 x x x x x<br />

WEIMAR A0245 x x x x x<br />

WEIR A0245 x x x x x<br />

WELLINGTON A0245 x x x x x<br />

WELLINGTON HOUSING AUTHORITY A0245 x x x x x<br />

WELLMAN A0245 x x x x x<br />

WELLS A0245 x x x x x<br />

WELLS BRANCH COMMUNITY LIBRARY A0245 x x x x x<br />

WELLS BRANCH MUD A0245 x x x x x<br />

WES-TEX GCD A0245 x x x x x<br />

WESLACO HOUSING AUTHORITY A0245 x x x x x<br />

WEST A0245 x x x x x<br />

WEST BASTROP VILLAGE MUD A0245 x x x x x<br />

WEST BRAZORIA COUNTY DD #11 A0245 x x x x x<br />

WEST CEDAR CREEK MUD A0245 x x x x x<br />

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WEST GREGG SUD A0245 x x x x x<br />

WEST HARRIS COUNTY MUD #2 A0245 x x x x x<br />

WEST HARRIS COUNTY MUD #9 A0245 x x x x x<br />

WEST LAKE HILLS A0245 x x x x x<br />

WEST NUECES-LAS MORAS SWCD A0245 x x x x x<br />

WEST ORANGE A0245 x x x x x<br />

WEST TAWAKONI A0245 x x x x x<br />

WEST TEXAS WEATHER MOD ASSOC A0245 x x x x x<br />

WEST TRAVIS COUNTY MUD #5 A0245 x x x x x<br />

WEST TRAVIS COUNTY MUD #8 A0245 x x x x x<br />

WEST UNIVERSITY PLACE A0245 x x x x x<br />

WEST WISE SUD A0245 x x x x x<br />

WESTBANK COMM LIBRARY DISTRICT A0245 x x x x x<br />

WESTBROOK A0245 x x x x x<br />

WESTCHASE DISTRICT A0245 x x x x x<br />

WESTLAKE A0245 x x x x x<br />

WESTON A0245 x x x x x<br />

WESTON LAKES A0245 x x x x x<br />

WESTON MUD A0245 x x x x x<br />

WESTOVER HILLS A0245 x x x x x<br />

WESTWOOD SHORES MUD A0245 x x x x x<br />

WESTWORTH VILLAGE A0245 x x x x x<br />

WHARTON A0245 x x x x x<br />

WHEELER A0245 x x x x x<br />

WHEELER CAD A0245 x x x x x<br />

WHITE DEER A0245 x x x x x<br />

WHITE OAK A0245 x x x x x<br />

WHITE RIVER MUNICIPAL WATER DISTRICT A0245 x x x x x<br />

WHITE ROCK SUD A0245 x x x x x<br />

WHITE SETTLEMENT A0245 x x x x x<br />

WHITEFACE A0245 x x x x x<br />

WHITEHOUSE A0245 x x x x x<br />

WHITESBORO A0245 x x x x x<br />

WHITESBORO HOUSING AUTHORITY A0245 x x x x x<br />

WHITEWRIGHT A0245 x x x x x<br />

WHITNEY A0245 x x x x x<br />

WHITNEY HOUSING AUTHORITY A0245 x x x x x<br />

WICHITA APPRAISAL DISTRICT A0245 x x x x x<br />

WICHITA FALLS HOUSING AUTHORITY A0245 x x x x x<br />

WICKETT A0245 x x x x x<br />

WICKSON CREEK SUD A0245 x x x x x<br />

WILBARGER CREEK MUD #1 A0245 x x x x x<br />

WILBARGER CREEK MUD #2 A0245 x x x x x<br />

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WILLACY COUNTY DRAINAGE DISTRICT #1 A0245 x x x x x<br />

WILLIAMSON COUNTY ESD #1 A0245 x x x x x<br />

WILLIAMSON COUNTY ESD #4 A0245 x x x x x<br />

WILLIAMSON COUNTY ESD #7 A0245 x x x x x<br />

WILLIAMSON COUNTY MUD #10 A0245 x x x x x<br />

WILLIAMSON COUNTY MUD #11 A0245 x x x x x<br />

WILLIAMSON COUNTY MUD #15 A0245 x x x x x<br />

WILLIAMSON COUNTY MUD #9 A0245 x x x x x<br />

WILLIAMSON/TRAVIS CO WCID #1G A0245 x x x x x<br />

WILLIS A0245 x x x x x<br />

WILLOW FORK DD A0245 x x x x x<br />

WILLOW PARK A0245 x x x x x<br />

WILLS POINT A0245 x x x x x<br />

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WILMER A0245 x x x x x<br />

WILSON A0245 x x x x x<br />

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WINDCREST A0245 x x x x x<br />

WINDOM A0245 x x x x x<br />

WINDTHORST A0245 x x x x x<br />

WINFIELD A0245 x x x x x<br />

WINK A0245 x x x x x<br />

WINK HOUSING AUTHORITY A0245 x x x x x<br />

WINKLER CAD A0245 x x x x x<br />

WINNSBORO A0245 x x x x x<br />

WINNSBORO HOUSING AUTHORITY A0245 x x x x x<br />

WINONA A0245 x x x x x<br />

WINTERGARDEN GCD A0245 x x x x x<br />

WINTERS A0245 x x x x x<br />

WINTERS HOUSING AUTHORITY A0245 x x x x x<br />

WISE CAD A0245 x x x x x<br />

WISE COUNTY WCID #1 A0245 x x x x x<br />

WISE SWCD #548 A0245 x x x x x<br />

WIXON VALLEY A0245 x x x x x<br />

WOLFE CITY A0245 x x x x x<br />

WOLFE CITY HOUSING AUTHORITY A0245 x x x x x<br />

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WOOD COUNTY SWCD A0245 x x x x x<br />

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WOODCREEK MUD A0245 x x x x x<br />

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ZAPATA CAD A0245 x x x x x<br />

ZAPATA COUNTY WCID A0245 x x x x x<br />

ZAVALA CAD A0245 x x x x x<br />

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Edwards Claims Administration Payer ID Only Only Only Only Only States Claims Claims Comp Only Only (835)<br />

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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TX MN CA NY WI All Professional Institutional Workers' Auto ERA<br />

Edwards Claims Administration Payer ID Only Only Only Only Only States Claims Claims Comp Only Only (835)<br />

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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TX MN CA NY WI All Professional Institutional Workers' Auto ERA<br />

REM Employer Name Payer ID Only Only Only Only Only States Claims Claims Comp Only Only (835)<br />

**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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<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />

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TX MN CA NY WI All Professional Institutional Workers' Auto ERA<br />

REM Employer Name Payer ID Only Only Only Only Only States Claims Claims Comp Only Only (835)<br />

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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TX MN CA NY WI All Professional Institutional Workers' Auto ERA<br />

REM Employer Name Payer ID Only Only Only Only Only States Claims Claims Comp Only Only (835)<br />

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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<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 All Professional Institutional Workers' Auto ERA<br />

REM Employer Name Payer ID Only Only Only Only Only States Claims Claims Comp Only Only (835)<br />

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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<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 All Professional Institutional Workers' Auto ERA<br />

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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<strong>Availity®</strong> <strong>Health</strong> <strong>Information</strong> <strong>Network</strong><br />

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TX MN CA NY WI All Professional Institutional Workers' Auto ERA<br />

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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