Professional Claim Payor Connections
State Plans
April 24, 2014

 
P/P ST PAYOR INTERMEDIARY AG TEST EMC
CPID
PAPER
CPID
SURCHG  
MI MICHIGAN HLTH BENEFITS CLAIM REVIEW FORM N N 1306 1306MI N/A  
WV WEST VIRGINIA BC BS OF PARKERSBURG N N 1308 1308WV N/A  
TX TEXAS WORKERS' COMPENSATION N N 1360 1360TX N/A  
WI WISCONSIN BLUE SHIELD WELLPOINT_ N N 1401 4323 N/A  
MN BEHAVIORAL HEALTH SERV. INC. (BHSI) N N 1402 4323 N/A  
MN MINNESOTA BLUE CROSS AND BLUE SHIELD N N 1402 4323 N/A  
OK OKLAHOMA BLUE SHIELD N N 1403 4323 N/A  
IA IOWA BLUE SHIELD WELLMARK EDS/EC SOL Y N 1404 4323 N/A  
IL ILLINOIS BLUE SHIELD N N 1405 4323 N/A  
TX TEXAS BLUE SHIELD N N 1406 4323 N/A  
GA GEORGIA BANKERS WELLPOINT_ N N 1407 4323 N/A  
GA GEORGIA BLUE CHOICE WELLPOINT_ N N 1407 4323 N/A  
GA GEORGIA BLUE SHIELD WELLPOINT_ N N 1407 4323 N/A  
GA STATE MERIT WELLPOINT_ N N 1407 4323 N/A  
MO MISSOURI BLUE SHIELD - ST LOUIS MO WELLPOINT_ N N 1408 4323 N/A  
CA CALIFORNIA BLUE CROSS - FEP only N N 1409 4323 N/A  
CA CALIFORNIA BLUE SHIELD N N 1409 4323 N/A  
MN MINNESOTA CC SYSTEMS N N 1410 4323 N/A  
NC NORTH CAROLINA BLUE SHIELD N N 1411 4323 N/A  
IN INDIANA BLUE SHIELD WELLPOINT_ N N 1412 4323 N/A  
VA VIRGINIA BLUE SHIELD WELLPOINT N N 1413 4323 N/A  
FL FLORIDA BLUE SHIELD N N 1414 4323 N/A  
CO COLORADO BLUE SHIELD ROCKY MTN HEALTH CARE N N 1415 4323 N/A  
NE NEBRASKA BLUE SHIELD N N 1417 4323 N/A  
CT CONNECTICUT BLUE SHIELD WELLPOINT N N 1420 4323 N/A  
MI MICHIGAN BLUE SHIELD MICHIGAN BCBS Y N 1421 4323 N/A  
MI MICHIGAN BLUE SHIELD FEP MICHIGAN BCBS Y N 1421 4323 N/A  
NY NEW YORK MEDICAID - PHASE II COMPUTER SCIENCES CORP Y N 1422 3307 N/A  
MN MINNESOTA BLUE CROSS/BLUE SHIELD HMO N N 1429 4323 N/A  
MN MINNESOTA BLUE PLUS N N 1429 4323 N/A  
WI WISCONSIN MEDICARE NATIONAL GOVERNMENT SERV. Y N 1434 4321 N/A  
MN MINNESOTA MEDICARE NATIONAL GOVERNMENT SERV. Y N 1435 4321 N/A  
CA NORTHERN CALIFORNIA MEDICARE NORIDIAN HEALTH SOLUTIONS Y N 1436 4321 N/A  
IL ILLINOIS MEDICARE NATIONAL GOVERNMENT SERV. Y N 1437 4321 N/A  
IA IOWA MEDICARE WPS Y N 1438 4321 N/A  
TX TEXAS MEDICARE NOVITAS SOLUTIONS, INC. Y N 1440 4321 N/A  
MO MISSOURI MEDICARE EASTERN WPS Y N 1441 4321 N/A  
VA VIRGINIA MEDICARE PALMETTO GBA Y N 1442 4321 N/A  
RETIRED RAILROAD MEDICARE PALMETTO GBA Y N 1443 4301 N/A  
CA SOUTHERN CALIFORNIA MEDICARE NORIDIAN HEALTH SOLUTIONS Y N 1444 4321 N/A  
IN INDIANA MEDICARE WPS Y N 1445 4321 N/A  
NV NEVADA MEDICARE NORIDIAN HEALTH SOLUTIONS Y N 1446 4321 N/A  
OH OHIO MEDICARE CIGNA GOVERNMENT SERVICES Y N 1447 4321 N/A  
FL FLORIDA MEDICARE FIRST COAST SERV OPTIONS Y N 1448 4321 N/A  
CO COLORADO MEDICARE NOVITAS SOLUTIONS, INC. Y N 1449 4321 N/A  
WV WEST VIRGINIA MEDICARE PALMETTO GBA Y N 1450 4321 N/A  
NE NEBRASKA MEDICARE WPS Y N 1451 4321 N/A  
CT CONNECTICUT MEDICARE NATIONAL GOVERNMENT SERV. Y N 1452 4321 N/A  
TN TENNESSEE MEDICARE CAHABA GBA Y N 1453 4321 N/A  
AK ALASKA MEDICARE NORIDIAN HEALTH SOLUTIONS Y N 1455 4321 N/A  
AZ ARIZONA MEDICARE NORIDIAN HEALTH SOLUTIONS Y N 1456 4321 N/A  
NM NEW MEXICO MEDICARE NOVITAS SOLUTIONS, INC. Y N 1457 4321 N/A  
OK OKLAHOMA MEDICARE NOVITAS SOLUTIONS, INC. Y N 1458 4321 N/A  
OR OREGON MEDICARE NORIDIAN HEALTH SOLUTIONS Y N 1459 4321 N/A  
LA LOUISIANA MEDICARE ARKANSAS BC BS Y N 1460 4321 N/A  
MI MICHIGAN MEDICARE WPS Y N 1461 4321 N/A  
WA WASHINGTON MEDICARE NORIDIAN HEALTH SOLUTIONS Y N 1462 4321 N/A  
NY NEW YORK MEDICARE (UPSTATE) NATIONAL GOVERNMENT SERV. Y N 1463 4321 N/A  
NC NORTH CAROLINA MEDICARE PALMETTO GBA Y N 1464 4321 N/A  
NJ NEW JERSEY MEDICARE NOVITAS SOLUTIONS, INC. Y N 1465 4321 N/A  
GA GEORGIA MEDICARE CAHABA GBA Y N 1466 4321 N/A  
WI WISCONSIN MEDICAID EDS - ELECTRONIC DATA SER N N 1467 4322 N/A  
MN MINNESOTA MEDICAID Y N 1468 4302 N/A  
IA IOWA MEDICAID NORIDIAN HEALTH SOLUTIONS Y N 1469 4322 N/A  
TX RIGHT CARE FROM SCOTT & WHITE HEALTH PLAN HP ENTERPRISE SERVICES Y N 1470 4322 N/A  
TX TEXAS MEDICAID HP ENTERPRISE SERVICES Y N 1470 4322 N/A  
MO MISSOURI MEDICAID INFOCROSSING HLTHCRE SERV N N 1471 4322 N/A  
VA VIRGINIA MEDICAID HP ENTERPRISE SERVICES N N 1472 4322 N/A  
CA CALIFORNIA MEDI-CAL EDS - ELECTRONIC DATA SER Y N 1473 4322 N/A  
IN INDIANA MEDICAID EDS - ELECTRONIC DATA SER N N 1474 4322 N/A  
LA LOUISIANA MEDICAID MOLINA INFORMATION SYSTEM Y N 1475 4322 N/A  
NE NEBRASKA MEDICAID Y N 1476 4322 N/A  
FL FLORIDA MEDICAID EDS - ELECTRONIC DATA SER Y N 1478 4322 N/A  
NC NORTH CAROLINA MEDICAID COMPUTER SCIENCES CORP Y N 1480 4302 N/A  
OR OREGON MEDICAID Y N 1481 4322 N/A  
WA WASHINGTON MEDICAID HP ENTERPRISE SERVICES Y N 1482 4302 N/A  
WA WASHINGTON STATE DEPARTMENT OF CORRECTIONS HP ENTERPRISE SERVICES Y N 1482 4302 N/A  
NJ NEW JERSEY MEDICAID MOLINA INFORMATION SYSTEM Y N 1483 4322 N/A  
SC SOUTH CAROLINA MEDICAID Y N 1484 4322 N/A  
KS KANSAS MEDICAID EDS - ELECTRONIC DATA SER N N 1485 4322 N/A  
UT UTAH MEDICAID UHIN Y N 1486 4302 C.1  
ND NORTH DAKOTA MEDICAID N N 1487 4322 N/A  
MD MARYLAND MEDICAID Y N 1488 4322 N/A  
AR ARKANSAS MEDICAID Y N 1489 4302 N/A  
MS MISSISSIPPI MEDICAID HP ENTERPRISE SERVICES Y N 1490 4302 N/A  
PA PENNSYLVANIA MEDICAID EDS - ELECTRONIC DATA SER N N 1491 4322 N/A  
NM NEW MEXICO MEDICAID HP ENTERPRISE SERVICES N N 1492 4322 N/A  
KY KENTUCKY MEDICAID EDS - ELECTRONIC DATA SER Y N 1493 4302 N/A  
GA GEORGIA MEDICAID HP ENTERPRISE SERVICES Y N 1494 4322 N/A  
CO COLORADO MEDICAID HP ENTERPRISE SERVICES Y N 1496 1391 N/A  
GA GEORGIA MEDICAID ANESTHESIA HP ENTERPRISE SERVICES Y N 1499 4322 N/A  
KY COVENTRYCARES OF KENTUCKY N N 1837 4320 N/A  
WELLCARE OF KENTUCKY N N 1844 4320 N/A  
AIG N N 2109 4300 N/A  
AMERICAN INTERSTATE - (TEXAS only) N N 2110 4300 N/A  
NEW YORK STATE INSURANCE FUND (NYSIF) N N 2117 4300 N/A  
BUNCH / COSTCO N N 2123 4300 N/A  
BUNCH / ARMARK N N 2124 4300 N/A  
STATE INSURANCE FUND of CALIFORNIA (SCIF) N N 2125 4300 N/A  
CELTICARE BEHAVIORAL HEALTH (CBA) - MASSACHUSETTS CENTENE CORPORATION Y N 2128 4322 N/A  
CELTICARE MASSACHUSETTS MEDICAL CENTENE CORPORATION Y N 2129 4322 N/A  
SEDGWICK CLAIMS MANAGEMENT N N 2147 4300 N/A  
USC - SECURA INSURANCE - APPLETON N N 2158 4300 N/A  
USC - KEMPER INSURANCE COMPANY N N 2166 4300 N/A  
TRAVELERS - P2P LINK - WORKERS COMPENSATION N N 2200 4300 N/A  
HARTFORD - P2P LINK - WORKERS COMPENSATION N N 2202 4300 N/A  
HARTFORD - SRS (P2P LINK) N N 2202 4300 N/A  
PRINT and MAIL - P2P LINK - WORKERS COMPENSATION N Y 2210 4300 N/A  
LA LOUISIANA MEDICAID - AMBULANCE MOLINA INFORMATION SYSTEM Y N 2236 4302 N/A  
TN STONES RIVER IPA forTN BLUE CROSS BLUE SHIELD only N N 2273 4323 N/A  
MI MEDICARE PLUS BLUE - MEDICARE ADVANTAGE PLAN MICHIGAN BCBS Y N 2287 4321 N/A  
FL FLORIDA WORKERS' COMPENSATION N N 2316 2316FL N/A  
MI MICHIGAN WORKERS' COMPENSATION N N 2319 2319MI N/A  
TN TENNESSEE BLUE SHIELD Y N 2401 4323 N/A  
TN VOLUNTEER STATE HEALTH PLAN Y N 2401 4323 N/A  
OR OREGON BLUE SHIELD N N 2404 4323 N/A  
SC SOUTH CAROLINA BLUE CROSS BLUE SHIELD STATE EMPLO N N 2410 4323 N/A  
SC BLUE CHOICE HEALTH PLAN N N 2410 4323 N/A  
SC CAROLINA BENEFIT ADMINISTRATORS N N 2410 4323 N/A  
SC EMPLOYEE BENEFIT SERVICES DBA KEY BENEFIT ADMIN N N 2410 4323 N/A  
SC PREFERRED BLUE N N 2410 4323 N/A  
SC SC BCBS PREFERRED HEALTH SYSTEMS - HMO BLUE N N 2410 4323 N/A  
SC SC BCBS STATE EMPLOYEE HEALTH PLAN N N 2410 4323 N/A  
SC SOUTH CAROLINA BLUE SHIELD N N 2410 4323 N/A  
SC THOMAS COOPER AGENCY N N 2410 4323 N/A  
ND NORTH DAKOTA BLUE SHIELD NORIDIAN HEALTH SOLUTIONS Y N 2411 4323 N/A  
UT UTAH BLUE SHIELD UHIN N N 2412 4323 C.1  
PA HEALTH KEEPERS, INC. HIGHMARK, INC. Y N 2413 4303 N/A  
PA PENINSULA HEALTH CARE HIGHMARK, INC. Y N 2413 4303 N/A  
PA PENNSYLVANIA BLUE CHOICE HIGHMARK, INC. Y N 2413 4303 N/A  
PA PENNSYLVANIA BLUE SHIELD HIGHMARK, INC. Y N 2413 4303 N/A  
PA PENNSYLVANIA PERSONAL CHOICE HIGHMARK, INC. Y N 2413 4303 N/A  
PA PRIORITY HEALTH CARE HIGHMARK, INC. Y N 2413 4303 N/A  
NJ HORIZON BLUE SHIELD OF NEW JERSEY Y N 2414 4303 N/A  
NJ HORIZON BLUE SHIELD OF NJ FEP Y N 2414 4303 N/A  
NJ HORIZON BLUE SHIELD OF NJ OUT OF AREA Y N 2414 4303 N/A  
NJ NEW JERSEY BLUE CHOICE Y N 2414 4303 N/A  
NJ NEW JERSEY BLUE SELECT Y N 2414 4303 N/A  
MS MISSISSIPPI BLUE SHIELD TRISPAN Y N 2415 4303 N/A  
MS MS BCBS - STATE EMPLOYEES TRISPAN Y N 2415 4303 N/A  
ARKANSAS BLUE SHIELD ARKANSAS BC BS Y N 2416 4303 N/A  
HEALTH ADVANTAGE ARKANSAS BC BS Y N 2416 4303 N/A  
PEACH STATE HEALTH PLAN CENTENE CORPORATION N N 2417 4322 N/A  
OHIO BLUE SHIELD WELLPOINT N N 2418 4323 N/A  
MD MARYLAND BLUE SHIELD - CAREFIRST N N 2419 4323 N/A  
KY ANTHEM BLUE ACCESS PRODUCTS WELLPOINT_ N N 2421 4323 N/A  
KY ANTHEM BLUE PREFERRED WELLPOINT_ N N 2421 4323 N/A  
KY ANTHEM BLUE PREFERRED PLUS WELLPOINT_ N N 2421 4323 N/A  
KY ANTHEM KY MEDICAID WELLPOINT_ N N 2421 4323 N/A  
KY FEP WELLPOINT_ N N 2421 4323 N/A  
KY KENTUCKY BLUE SHIELD WELLPOINT_ N N 2421 4323 N/A  
KY KY BCBS MEDICAID MANAGED CARE WELLPOINT_ N N 2421 4323 N/A  
KS KANSAS BLUE SHIELD - TOPEKA KANSAS BCBS Y N 2422 4303 N/A  
AL ALABAMA BLUE SHIELD ALABAMA BCBS Y N 2423 4303 N/A  
MA MASSACHUSETTS BLUE SHIELD Y N 2424 4323 N/A  
DC BLUE SHIELD OF NATIONAL CAPITOL AREA - CAREFIRST N N 2425 4323 N/A  
MI BCBS COMPLETE MICHIGAN BCBS Y N 2426 4323 N/A  
MI BLUE CARE NETWORK HMO MICHIGAN BCBS Y N 2426 4323 N/A  
MI MCARE MICHIGAN BCBS Y N 2426 4323 N/A  
CT CONNECTICUT BLUECARE FAM PLAN (MEDICAID) WELLPOINT N N 2427 4323 N/A  
MS MISSISSIPPI MEDICARE NOVITAS SOLUTIONS, INC. Y N 2451 4321 N/A  
SC SOUTH CAROLINA MEDICARE PALMETTO GBA Y N 2452 4321 N/A  
ND NORTH DAKOTA MEDICARE NORIDIAN HEALTH SOLUTIONS Y N 2453 4321 N/A  
SD SOUTH DAKOTA MEDICARE NORIDIAN HEALTH SOLUTIONS Y N 2454 4321 N/A  
AR ARKANSAS MEDICARE ARKANSAS BC BS Y N 2455 4321 N/A  
DE DELAWARE MEDICARE NOVITAS SOLUTIONS, INC. Y N 2456 4321 N/A  
PA PENNSYLVANIA MEDICARE NOVITAS SOLUTIONS, INC. Y N 2457 4321 N/A  
UT UTAH MEDICARE NORIDIAN HEALTH SOLUTIONS Y N 2458 4321 N/A  
DC WASHINGTON DC MEDICARE NOVITAS SOLUTIONS, INC. Y N 2459 4321 N/A  
VA VIRGINIA MEDICARE (ALEX, ARLGTN, FAIRFAX NOVITAS SOLUTIONS, INC. Y N 2461 4321 N/A  
KY KENTUCKY MEDICARE CIGNA GOVERNMENT SERVICES Y N 2462 4321 N/A  
KS KANSAS MEDICARE WPS Y N 2463 4321 N/A  
MD MARYLAND MEDICARE (MONTG, PRINCE GEORGE) NOVITAS SOLUTIONS, INC. Y N 2464 4321 N/A  
ID IDAHO MEDICARE NORIDIAN HEALTH SOLUTIONS Y N 2465 4321 N/A  
WY WYOMING MEDICARE NORIDIAN HEALTH SOLUTIONS Y N 2466 4321 N/A  
HI HAWAII MEDICARE NORIDIAN HEALTH SOLUTIONS Y N 2467 4321 N/A  
AL ALABAMA MEDICARE CAHABA GBA Y N 2468 4321 N/A  
MA MASSACHUSETTS MEDICARE NATIONAL GOVERNMENT SERV. Y N 2469 4321 N/A  
NH NEW HAMPSHIRE MEDICARE NATIONAL GOVERNMENT SERV. Y N 2470 4321 N/A  
VT VERMONT MEDICARE NATIONAL GOVERNMENT SERV. Y N 2471 4321 N/A  
ME MAINE MEDICARE NATIONAL GOVERNMENT SERV. Y N 2472 4321 N/A  
WV WEST VIRGINIA MEDICAID MOLINA INFORMATION SYSTEM N N 2477 4322 N/A  
MI MICHIGAN MEDICAID Y N 2480 4322 N/A  
OH OHIO MEDICAID N N 2481 4322 N/A  
IL ILLINOIS MEDICAID N N 2488 1369 C.01  
SD SOUTH DAKOTA BLUE SHIELD WELLMARK EDS/EC SOL Y N 2490 4323 N/A  
TN TENNESSEE BLUECARE TENNESSEE BC BS Y N 2495 4322 N/A  
SUPERIOR HEALTH PLAN - TEXAS CENTENE CORPORATION N N 2701 4322 N/A  
MANAGED HEALTH SERVICES - WISCONSIN CENTENE CORPORATION N N 2702 4322 N/A  
IN MANAGED HEALTH SERVICES - INDIANA CENTENE CORPORATION N N 2703 4322 N/A  
1-888-OHIOCOMP N N 2704 4300 N/A  
3-HAB N N 2704 4300 N/A  
ADVOCARE N N 2704 4300 N/A  
ALPS COMPCARE N N 2704 4300 N/A  
CAREWORKS N N 2704 4300 N/A  
COMPMANAGEMENT HEALTH SYSTEMS, INC. N N 2704 4300 N/A  
COMPONE N N 2704 4300 N/A  
CORVEL ? IN REGARDS TO OH BWC CLAIMS ONLY N N 2704 4300 N/A  
GENEX N N 2704 4300 N/A  
HEALTH MANAGEMENT SOLUTIONS N N 2704 4300 N/A  
HEALTH PLAN (THE) - OHIO WORKERS' COMP MCO'S N N 2704 4300 N/A  
HTP N N 2704 4300 N/A  
MEDICAL ADMINISTRATORS, INC. N N 2704 4300 N/A  
OHIO BWC N N 2704 4300 N/A  
OHIO EMPLOYEES HEALTH PARTNERSHIP N N 2704 4300 N/A  
OHIO WORKERS' COMP MCO'S N N 2704 4300 N/A  
PREMIER COMP N N 2704 4300 N/A  
PREMIER MANAGED CARE N N 2704 4300 N/A  
UNIVERSITY COMP CARE N N 2704 4300 N/A  
VANTAGE HEALTH PLAN, INC. N N 2704 4300 N/A  
WORKSTAR N N 2704 4300 N/A  
PA CAPITAL BLUE CROSS - FACILITY CONTRACTED PROVIDERS CAPITAL BLUE CROSS Y Y/15 2713 4323 N/A  
AKAMAI ADVANTAGE (MEDICARE ADVANTAGE PLAN) HMSA Y N 2714 4303 N/A  
HAWAII HMSA HMSA Y N 2714 4303 N/A  
HI HAWAII MEDICAID HP ENTERPRISE SERVICES Y N 2715 4302 N/A  
PA PENNSYLVANIA BLUE SHIELD CLARITY VISION HIGHMARK, INC. Y N 2718 4303 N/A  
DE DELAWARE MEDICAID EDS - ELECTRONIC DATA SER Y N 2726 4322 N/A  
OK OKLAHOMA MEDICAID EDS - ELECTRONIC DATA SER N N 2753 4322 N/A  
NY UNIVERA UNINW EXCELLUS Y N 2773 4323 N/A  
NY RMSCO UNIVERA EXCELLUS Y N 2779 4323 N/A  
NY UNIVERA EXCELLUS Y N 2779 4323 N/A  
NY UNIVERA COMMUNITY HEALTH EXCELLUS Y N 2779 4323 N/A  
NY UNIVERA ENY EXCELLUS Y N 2779 4323 N/A  
NY UNIVERA SNY EXCELLUS Y N 2779 4323 N/A  
NY UNIVERA WNY EXCELLUS Y N 2779 4323 N/A  
PA PENNSYLVANIA INDEPENDENCE BLUE CROSS INDEPENDENCE BLUE CROSS Y N 2781 4323 N/A  
FL JACKSON MEMORIAL HEALTH SFCCH PHT (PSN, CMSN) N N 2784 4320 N/A  
PR PUERTO RICO MEDICARE FIRST COAST SERV OPTIONS Y N 2785 4321 N/A  
UT UTAH BLUE SHIELD - FEP UHIN N N 2788 4323 C.1  
HEALTHSPRING INC. Y N 2795 4301 N/A  
AL HEALTHSPRING OF ALABAMA Y N 2795 4301 N/A  
IL HEALTHSPRING ILLINOIS Y N 2795 4301 N/A  
TN HEALTHSPRING TENNESSEE Y N 2795 4301 N/A  
TX HEALTHSPRING TEXAS Y N 2795 4301 N/A  
COTTINGHAM and BUTLER CLAIM SERVICES, INC. N N 3113 4300 N/A  
CT CONNECTICUT FEDERAL EMP HLTH BENEFITS N N 3419 4323 N/A  
CT CONNECTICUT MEDICARE BLUE(MEDICARE RISK) N N 3420 4323 N/A  
CA CENCAL HEALTH Y N 3447 4322 N/A  
CA SANTA BARBARA REGIONAL HEALTH AUTHORITY Y N 3447 4322 N/A  
NY NEW YORK BLUE SHIELD CENTRAL REGION EXCELLUS Y N 3449 4323 N/A  
LIBERTY MUTUAL - P2P LINK N Y 3455 4300 N/A  
FRANKENMUTH - P2P LINK N Y 4119 4300 N/A  
CNA INSURANCE N Y 4149 4300 N/A  
WA WASHINGTON WORKERS COMPENSATION Y N 4404 4300 N/A  
AZ ARIZONA MEDICAID AHCCCS N N 4405 4322 N/A  
NY NEW YORK BLUE SHIELD OF ROCHESTER EXCELLUS Y N 4408 4323 N/A  
NY BLUE SHIELD OF WESTERN NEW YORK Y N 4409 4303 N/A  
NY NEW YORK COMMUNITY BLUE HMO Y N 4409 4303 N/A  
ANTHEM BLUE CROSS N N 4417 4323 N/A  
ANTHEM BLUE CROSS CALIFORNIA N N 4417 4323 N/A  
DIRECTORS GUILD OF AMERICA N N 4417 4323 N/A  
WRITERS GUILD INDUSTRY HEALTH PLAN N N 4417 4323 N/A  
MO KANSAS CITY BLUE SHIELD - KANSAS CITY, MO KANSAS BCBS Y N 4419 4303 N/A  
DC DISTRICT OF COLUMBIA MEDICAID Y N 4425 4302 N/A  
AZ ARIZONA BLUE SHIELD ALL PAYOR NETWORK (APN) N N 4426 4323 N/A  
MT MONTANA MEDICAID HP ENTERPRISE SERVICES N N 4427 4322 N/A  
WV BRICKSTREET MUTUAL INSURANCE HP ENTERPRISE SERVICES Y N 4428 4300 N/A  
NY EMPIRE HEALTHCHOICE HMO NY N N 4437 4323 N/A  
NY NEW YORK EMPIRE BLUE SHIELD N N 4437 4323 N/A  
NY NEW YORK EMPIRE MEDICARE NATIONAL GOVERNMENT SERV. Y N 4442 4321 N/A  
MO MISSOURI NORTHWEST MEDICARE - KANSAS CITY, MO WPS Y N 4451 4321 N/A  
TRICARE - NORTH AND SOUTH REGION PALMETTO GBA Y N 4456 4320 N/A  
NY NEW YORK EMPIRE BLUE SHIELD - HEALTHNET N N 4459 4323 N/A  
CA CALIFORNIA BLUE SHIELD - HMO N N 4463 4323 N/A  
CONNECTICUT MEDICAID EDS - ELECTRONIC DATA SER N N 4476 4322 N/A  
SD SOUTH DAKOTA MEDICAID Y N 4478 4322 N/A  
AL ALABAMA MEDICAID N N 4479 4322 N/A  
VI VIRGIN ISLANDS MEDICARE FIRST COAST SERV OPTIONS Y N 4487 4321 N/A  
AK ALASKA MEDICAID FIRST HEALTH SERVICES Y N 4489 4302 N/A  
AK DENALI CARE FIRST HEALTH SERVICES Y N 4489 4302 N/A  
MA MASSACHUSETTS MEDICAID (FORMAT 9) EDS - ELECTRONIC DATA SER Y N 4491 4302 N/A  
MA MASSACHUSETTS MEDICAID (FORMAT 5) EDS - ELECTRONIC DATA SER Y N 4492 4322 N/A  
MN UCARE OF MINNESOTA N N 4496 4320 N/A  
BUCKEYE COMMUNITY HEALTH - OHIO CENTENE CORPORATION N N 4717 4322 N/A  
BUNCH / BARNES N Y 5118 4300 N/A  
BUNCH / FOOD LION / DELHAIZE N Y 5200 4300 N/A  
DEPARTMENT OF ENERGY N Y 5208 4300 N/A  
DEPARTMENT OF LABOR BLACK LUNG N Y 5209 4300 N/A  
BUNCH / GAP N Y 5210 4300 N/A  
BUNCH / LOWES N Y 5212 4300 N/A  
BUNCH / PEOPLE 2.0 N Y 5213 4300 N/A  
PMA - PENNSYLVANIA MANUFACTURING ASSOCIATES N Y 5214 4300 N/A  
BUNCH / SUPERVALUE N Y 5215 4300 N/A  
UNIMED - AMERICAN FIRST - P2P LINK N Y 5223 4300 N/A  
UNIMED - CITY of CARROLLTON/TRISTAR - P2P LINK N Y 5225 4300 N/A  
UNIMED - INTERNATIONAL SOLUTIONS - P2P LINK N Y 5227 4300 N/A  
WSI - P2P LINK N Y 5228 4300 N/A  
LA LOUISIANA MEDICAID - DME MOLINA INFORMATION SYSTEM Y N 5232 4302 N/A  
FARMERS INSURANCE N Y 5233 4300 N/A  
ONE BEACON N Y 5234 4300 N/A  
ME MAINE MEDICAID Y N 5259 4302 N/A  
BUNCH & ASSOCIATES - P2P LINK N Y 5275 4300 N/A  
AMERICAN RISK SERV INC. and ALL SUBS (AMERSAFE INS N N 5725 4300 N/A  
BROADSPIRE (MN AND TX ONLY) N N 5733 4300 N/A  
PR PUERTO RICO MMM INMEDIATA INMEDIATA (PR) Y N 5819 4300 N/A  
FIRSTCARE STAR MEDICAID N N 5854 4320 N/A  
RELAYHEALTH COMP BILLING Y N 5861 4320 N/A  
ST FRANCIS HEALTH NETWORK MEDICAID N N 5897 4320 N/A  
STERLING MEDICARE ADVANTAGE N N 6111 4320 N/A  
IL AETNA BETTER HEALTH - IL MEDICAID N N 6140 4320 N/A  
EVEREST ADMINISTRATORS Y N 6406 4300 N/A  
FAMILY CARE MEDICARE DOS > 12/31/2012 N N 6710 4320 N/A  
IOWA BLUE SHIELD MEDICARE CROSSOVER Y N 6733 4323 N/A  
AKAMAI ADVANTAGE HMSA Y N 6743 4303 N/A  
UT UTAH MEDICAID - MEDICARE CROSSOVER N C 6801 4302 C.1  
MT MONTANA MEDICARE NORIDIAN HEALTH SOLUTIONS Y N 7400 4321 N/A  
NY NEW YORK MEDICARE GHI NATIONAL GOVERNMENT SERV. Y N 7401 4321 N/A  
MD MARYLAND MEDICARE NOVITAS SOLUTIONS, INC. Y N 7402 4321 N/A  
NM NEW MEXICO BLUE SHIELD N N 7403 4323 N/A  
RI RHODE ISLAND MEDICARE NATIONAL GOVERNMENT SERV. Y N 7419 4321 N/A  
RI BLUE CHIP Y N 7420 4303 N/A  
RI RHODE ISLAND BLUE SHIELD Y N 7420 4303 N/A  
RI RHODE ISLAND WORKERS COMPENSATION Y N 7420 4303 N/A  
RI RHODE ISLAND MEDICAID Y N 7421 4322 N/A  
NH NEW HAMPSHIRE BLUE SHIELD WELLPOINT N N 7422 4323 N/A  
NH NEW HAMPSHIRE MEDICAID EDS - ELECTRONIC DATA SER Y N 7423 4302 N/A  
ID IDAHO BLUE SHIELD REGENCE N N 7426 4323 N/A  
ID IDAHO MEDICAID MOLINA MEDICAID SOLUTIONS Y N 7427 4322 N/A  
ID IDAHO BLUE CROSS BOISE Y N 7430 4303 N/A  
NY HMO BLUE EXCELLUS Y N 7432 4323 N/A  
NY NEW YORK BLUE CROSS UTICA/WATERTOWN EXCELLUS Y N 7432 4323 N/A  
NY NEW YORK BLUE SHIELD of NORTHEASTERN NEW YORK Y N 7433 4303 N/A  
AK BLUE CROSS WA/AK PREMERA BLUE CROSS PREMERA BLUE CROSS N N 7445 4323 N/A  
WA BLUE CROSS WA/AK PREMERA BLUE CROSS PREMERA BLUE CROSS N N 7445 4323 N/A  
ME MAINE BLUE SHIELD WELLPOINT N N 7446 4323 N/A  
VA VIRGINIA MEDICAID LAB HP ENTERPRISE SERVICES N N 7447 4322 N/A  
MT MONTANA BLUE SHIELD Y N 7450 4303 N/A  
WA WASHINGTON BLUE SHIELD REGENCE N N 7451 4323 N/A  
DE DELAWARE BLUE SHIELD HIGHMARK, INC. Y N 7456 4323 N/A  
WY WYOMING MEDICAID HP ENTERPRISE SERVICES Y N 7458 4302 N/A  
WV MOUNTAIN STATE BLUE SHIELD (WEST VIRGINIA) Y N 7474 4303 N/A  
MEDICARE DME MAC JURISDICTION A NATIONAL GOVERNMENT SERV. Y N 7475 4321 N/A  
MEDICARE DME MAC JURISDICTION B NATIONAL GOVERNMENT SERV. Y N 7476 4321 N/A  
MEDICARE DME MAC JURISDICTION C NATIONAL GOVERNMENT SERV. Y N 7477 4321 N/A  
MEDICARE DME MAC JURISDICTION D NATIONAL GOVERNMENT SERV. Y N 7478 4321 N/A  
NY HEALTHNOW NEW YORK BLUE SHIELD Y N 7485 4303 N/A  
WY WYOMING BLUE SHIELD NORIDIAN HEALTH SOLUTIONS Y N 7489 4303 N/A  
VT VERMONT MEDICAID EDS - ELECTRONIC DATA SER Y N 7492 4322 N/A  
VT VERMONT BLUE SHIELD N N 7493 4323 N/A  
NV NEVADA MEDICAID MAGELLAN MEDICAID ADMIN Y N 7495 4322 N/A  
NV NEVADA BLUE SHIELD WELLPOINT N N 7496 4323 N/A  

 

Legend

  P/P
 
Identifies if the payor is a Preferred Payor. These payors will pay a portion or all of the claims processing costs when claims are processed through RelayHealth.
  Y indicates Yes, this is a Preferred Payor
 
  ST The state code that is associated with the payor (if applicable).
 
  PAYOR The name of the payor.
 
  INTERMEDIARY The name of the intermediary associated with the payor.
 
  AG Identifies if a payor agreement is required.

N indicates that No payor agreement is required.
  Y indicates Yes a signed payor agreement and/or registration information is required.
 
  TEST Identifies if the payor requires testing.
  N indicates No individual payor testing is required by the payor.
  Y/n indicates Yes individual provider testing is required by the payor and the minimum number of claims (n) required for a test (when applicable). Reference the online payor guide for additional instructions.
  C indicates Conditional provider testing is required. Reference the online payor guide for details.
 
  EMC CPID The RelayHealth-assigned payor identification number used to process electronic claims. Clicking on this link will open the Payor Guide containing payor-specific information for processing electronic and paper claims through RelayHealth.
 
  PAPER CPID The RelayHealth-assigned payor identification number used to process paper claims.
 
  SURCHG
 
A per transaction fee charged to McKesson. This will be passed onto the customer. C.12 indicates a $0.12 per transaction surcharge for Claims and R.05 indicates a $0.05 per transaction surcharge for Remittance. C.12/R.05 indicates a surcharge for both Claims and Remittance.
 
  The last column indicates updates to the payor connections lists.
  * Indicates updates to the payor connection reports within the last 30 days

 


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