payor list 061404 - · pdf file83 1066 american healthcare alliance neic claims n 84 36369...

No PayorId Name RecvId Svcs NtwkId GrpId Enroll Comment1 31147 1-888-OHIOCOMP (OHIO BWC) NEIC N N N NON PARTICIPATING PAYOR. FOR OHIO WORKER'S COMP CLAIMS

ONLY (ADDED FEB 2003)2 13162 1199 NATIONAL BENEFIT FUND NEIC CLAIMS N N N PLEASE INCLUDE NETWORK ID WHEN SUBMITTING CLAIMS. CALL

RENAUD DUFRESNE AT 646-473-6960 FOR A LIST OF NETWORK IDS.

3 37225 3-HAB (OHIO BWC) NEIC N N N NON PARTICIPATING PAYOR. FOR OHIO WORKER'S COMP CLAIMS ONLY (ADDED FEB 2003)

4 31147 3-HAB (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR OHIO WORKERS COMP CLAIMS ONLY.

5 95241 A.G.I.A. INC. NEIC CLAIMS N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.6 37225 ABAS INC. NEIC N N N ALSO KNOWN AS TPA INC. THIRD PART ADMINISTRATORS INC AND

AMERICAN BENEFIT ADMINISTRATIVE SERVICES INC. (ADDED FEB 2003)

7 48185 ABC HEALTH PLAN NEIC CLAIMS N N N (ADDED FEB 2003)8 E3510 ABMA (ALTA BATES MEDICAL ASSOCS) MEDICAL

CORP (HNET SR. AND SECURE HORIZON)NEIC CLAIMS P ONLY CLAIMS FROM PROVIDERS IN NORTHERN CALIFORNIA. PLEASE

CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - NORTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

9 64071 ACCLAIM NEIC CLAIMS N N N10 21356 ACCLAIM REPRICING NEIC CLAIMS N11 Pilot ACCLAIM REPRICING NEIC Claims N N N12 87815 ACORDIA NATIONAL NEIC CLAIMS N N N13 72467 ACS BENEFIT SERVICES, INC. NEIC CLAIMS N N N DO NOT SEND ACS/HEALTH NET OR ACS INC MEDICAID CLAIMS TO

THIS PAYOR ID. THIS PAYOR ID IS FOR ACS BENEFIT SERVICES INC ONLY

14 38254 ACTIVA BENEFIT SERVICES, LLC NEIC Claims N N N (Formerly Amway Corporation)15 94323 ADESSO - SCOTTSDALE PHO NEIC CLAIMS N N N16 95285 ADMAR CORPORATION NEIC CLAIMS N N N17 CALL ADMINISTRATIVE SERVICE CONSULTANTS NEIC CLAIMS N TO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

18 37278 ADMINONE NEIC CLAIMS N19 58202 ADVANCED DATA SOLUTIONS INC. NEIC CLAIMS N N N20 61123 ADVANTAGE CARE NEIC CLAIMS N N N21 25126 ADVANTRA/HEALTH AMERICA, INC./HEALTH

ASSURANCENEIC CLAIMS Y N N CONTACT: RENEE CRUMLISH TEL:(302)283-6570. NETWORK ID

REQUIRED. TYPICALLY USE PROV MEDICARE UPIN

1, Non participating means the payor does not help paying for receiving claims electronically.2. payorid of 'CALL' means to call the payor to get the id. Next contact us and give us the id.3. PILOT means the payor is not yet live or in production, please check back with us at a later time.4. Some payor requires registrations, please make sure you check with them.

FreeClaims Payor list as of June 14, 2004

22 13373 ADVICA-NEW YORK HOSPITAL COMMUNITY HEALTH PLAN

NEIC CLAIMS N N N

23 13376 ADVICA/NORTHEAST GEORGIA HEALTH SYSTEM, NEIC CLAIMS N N N24 31147 ADVOCARE INCORPORATED (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR

OHIO WORKERS COMP CLAIMS ONLY.

25 36320 ADVOCATE HEALTH CENTERS NEIC N N N ADDED 23-SEP-2002.26 65093 ADVOCATE HEALTH PARTNERS NEIC CLAIMS N N N INSURED DATE OF BIRTH IS REQUIRED ON ALL CLAIMS.

27 60054 AETNA NEIC CLAIMS N N N28 60054 AETNA NEIC ENCOUNTERSN N N EXCLUDES CALIFORNIA29 60054 AETNA NEIC ROSTERSN N N30 95426 AFFORDABLE BENEFIT ADMINISTRATORS NEIC CLAIMS N31 34444 AFL-CIO FOOD & BEVERAGE DEALERS TRUST

FUND (TOLEDO, OH)NEIC Claims N N N Payer ID valid only for claims with a billing submission address of P. O. Box

457, Toledo, OH 43697-0457.32 TH041 AFL-CIO TRUST FUND NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

33 13346 AFTRA HEALTH FUND NEIC N N N ADDED 31-OCT-2002. PAYOR EDI: DEBORAH JANKOWSKI (212)499-4800 EXT 274

34 37280 AGA NEIC CLAIMS N35 64158 AGENCY SERVICES INC NEIC CLAIMS N36 80705 AH & L NEIC Claims N N N37 23251 AHP (LANCASTER, PA) NEIC Claims N N N Do NOT send Alliance PPO, Inc. claims to this payer ID. This payer ID is for

Alliance Health Plan ONLY.38 ALBCS ALABAMA BLUE CROSS BLUE SHIELD ALBCS Y Y N ENROLLMENT NEEDED. SUBMITTERID NEEDED. NETWORK ID

NEEDED. CONTACT PAYOR EDI AT 205-220-2533

39 SX045 ALABAMA HEALTH PARTNERS NEIC CLAIMS Y N Y NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

40 6311 ALABAMA MEDICAL SURGICAL ASSOCIATES, LLC NEIC CLAIMS N N N41 AKBCS ALASKA BLUE CROSS AKBCS Y Y Y ADDED 07/25/2002. (PREMERA)42 91136 ALASKA CHILDRENS SERVICES, INC. NEIC Claims N N N Please enter Group Number (P68) when submitting claims.

43 PILOT ALASKA ELECTRICAL HEALTH & WELFARE FUND NEIC CLAIMS N44 91136 ALASKA LABORERS CONSTRUCTION INDUSTRY

TRUSTNEIC Claims N N N Please enter Group Number (F23) when submitting claims.

45 91136 ALASKA PIPE TRADES LOCAL 375 NEIC Claims N N N Please enter Group Number (F24) when submitting claims.

46 91136 ALASKA UNITED FOOD & COMMERCIAL WORKERS HEALTH & WELFARE TRUST

NEIC Claims N N N Please enter Group Number (F45) when submitting claims.

47 37117 ALEXIAN BROTHERS NEIC CLAIMS N N N48 13550 ALICARE NEIC Claims N N N49 13550 ALICARE (ALSO KNOWN AS AMALGAMATED LIFE) NEIC CLAIMS N N N50 58213 ALIGNIS NEIC CLAIMS N51 39160 ALL SAINTS/ COVENANT-MILWAUKEE, WI THIN Y N Y52 CALL ALLIANCE (THE WI PROVIDERS ONLY) NEIC CLAIMS N PAYER ID, RENDERING PROVIDER AND LOCATION NUMBER

REQUIRED TO SUBMIT CLAIMS. PLEASE CALL DAVE SELL AT (608) 210-6656 TO OBTAIN.

53 23251 ALLIANCE HEALTH PLAN (PENNSYLVANIA) NEIC CLAIMS N N N54 52149 ALLIANCE PPO, INC. (MARYLAND) NEIC Claims Y N N55 81400 ALLIANCE SELECT THIN N N N56 58234 ALLIANT HEALTH PLANS OF GEORGIA NEIC CLAIMS N N N57 94177 ALLIED ADMINISTRATORS (SAN FRANCISCO, CA) NEIC CLAIMS N58 37308 ALLIED BENEFIT SYSTEMS NEIC CLAIMS N N N59 31147 ALPS COMPCARE (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


60 CALL ALTA BATES MEDICAL GROUP NEIC CLAIMS P NETWORK ID REQUIRED ON ALL CLAIMS. CALL SUTTER CONNECT EDI DEPARTMENT AT (800) 611-5191 TO OBTAIN NETWORK ID PRIOR TO FIRST SUBMISSION.

61 94318 ALTA BATES MEDICAL GROUP NEIC CLAIMS Y N N NETWORK ID REQUIRED ON ALL CLAIMS. CALL MERCY AGUAS AT (510) 627-4763 TO OBTAIN NETWORK ID PRIOR TO FIRST SUBMISSION.

62 80705 ALTA HEALTH & LIFE INSURANCE COMPANY NEIC Claims N N N63 87043 ALTA HEALTH STRATEGIES NEIC CLAIMS N N N64 E3510 ALTA SENIOR CARE (HNET SR AND SECURE

HORIZONS ONLY)NEIC CLAIMS P ONLY CLAIMS FROM PROVIDERS IN NORTHERN CALIFORNIA. PLEASE

CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - NORTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

65 37231 ALTERNATIVE TECHNOLOGY RESOURCES, INC. NEIC Claims N N N66 13550 AMALGAMATED LIFE NEIC Claims N N N67 37252 AMCARE NEIC N N N ADDED 23-SEP-2002.68 38219 AMERAPLAN NEIC CLAIMS N N N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

69 75137 AMERIBEN SOLUTIONS, INC. NEIC N N N ADDED 23-SEP-2002.70 27514 AMERICAID COMMUNITY CARE (DALLAS/FT. NEIC CLAIMS Y Y N71 27515 AMERICAID COMMUNITY CARE (HOUSTON) NEIC CLAIMS Y N N72 27517 AMERICAID COMMUNITY CARE (MARYLAND) NEIC CLAIMS N N N73 27516 AMERICAID COMMUNITY CARE (NEW JERSEY) NEIC CLAIMS N N N74 75240 AMERICAN ADMINISTRATIVE GROUP NEIC Claims N N N75 37225 AMERICAN BENEFIT ADMINISTRATIVE SERVICES,

INC.NEIC Claims N N N Also known as Third Party Administrators, Inc., TPA Inc., and ABAS Inc.

76 ACN01 AMERICAN CHIROPRACTIC NETWORK THIN N N N77 41161 AMERICAN CHIROPRACTIC NETWORK (ACN) NEIC N N N LOCATED IN MINNEAPOLIS, MINNESOTA. TEL:(800)236-9921.

78 41160 AMERICAN CHIROPRACTIC NETWORK IPA OF NEW YORK (ACNIPA)

NEIC N N N LOCATED IN KINGSTON, NEW YORK. TEL:(800)236-9921.

79 41160 AMERICAN CHIROPRACTIC NETWORK IPA OF NY (ACNIPA)

NEIC Claims N N N

80 37128 AMERICAN COMMERCIAL BARGE LINES NEIC CLAIMS N N N81 60305 AMERICAN COMMUNITY MUTUAL INSURANCE NEIC CLAIMS N N N82 62030 AMERICAN GENERAL NEIC CLAIMS N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.

83 1066 AMERICAN HEALTHCARE ALLIANCE NEIC CLAIMS N84 36369 AMERICAN IMAGING MANAGEMENT, INC. NEIC CLAIMS N N N ASSIGNED GROUP POLICY PLAN ID IS REQUIRED. TO OBTAIN, CALL

UTILIMED AT (800) 252-2021. (FORMERLY UTILIMED)

85 13311 AMERICAN INTERNATIONAL GROUP, INC. NEIC Claims N N N86 87726 AMERICAN INTERNATIONAL GROUP, INC. (AIG) NEIC CLAIMS N PLAN OF UNITEDHEALTHCARE87 87726 AMERICAN INTERNATIONAL GROUP, INC. (AIG) NEIC ERA N PLAN OF UNITEDHEALTHCARE88 72099 AMERICAN LIFECARE NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.89 SX001 AMERICAN MEDICAL SECURITY NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

90 AMS01 AMERICAN MEDICAL SECURITY (USE PAYORID THIN CLAIMS Y N Y91 81400 AMERICAN MEDICAL SECURITY, INC. NEIC Claims N N N92 44444 AMERICAN POSTAL WORKERS UNION HEALTH NEIC CLAIMS N N N93 14190 AMERICAN PPO NEIC CLAIMS N94 42011 AMERICAN REPUBLIC INSURANCE NEIC N N N ADDED 23-SEP-2002.95 86001 AMERICHOICE OF NEW JERSEY PERSONAL CARE

PLUS (MEDICARE)NEIC Y N N NETWORK ID NEEDED ON BLK 33, PIN FIELD. CONTACT

AMERICHOICE AT (888)362-3368 FOR YOUR PROVIDER ID NUMBER. ADDED 23-SEP-2002.

96 86047 AMERICHOICE OF NEW JERSEY, INC. (MEDICAID NEIC Claims N N N97 86002 AMERICHOICE OF NEW YORK PERSONAL CARE

PLUS (MEDICARE)NEIC Y N N NETWORK ID NEEDED ON BLK 33, PIN FIELD. CONTACT


98 86048 AMERICHOICE OF NEW YORK, INC. (MEDICAID NY) NEIC Claims N N N99 86003 AMERICHOICE OF PENNSYLVANIA PERSONAL

CARE PLUS (MEDICARE)NEIC Y N N NETWORK ID NEEDED ON BLK 33, PIN FIELD. CONTACT


100 86049 AMERICHOICE OF PENNSYLVANIA, INC. (MEDICAID NEIC Claims N N N101 27514 AMERIGROUP CORPORATION (FT WORTH) NEIC CLAIMS N FORMALLY AMERICAID COMMUNITY CARE (DALLAS/FT. WORTH).

102 27515 AMERIGROUP CORPORATION (HOUSTON) NEIC CLAIMS N FORMERLY AMERICAID COMMUNITY CARE (HOUSTON).

103 27519 AMERIGROUP FLORIDA NEIC Y N N LOCATED IN VIRGINIA BEACH, VIRGINIA. NETWORK ID REQUIRED. TEL:(800)590-5745

104 27518 AMERIGROUP ILLINOIS NEIC CLAIMS N105 26374 AMERIGROUP/AMERICAID-HOUSTON THIN Y N N ADDED 04/03/2002.106 23252 AMERIHEALTH ADMINISTRATORS NEIC N N N ADDED 23-SEP-2002.107 23037 AMERIHEALTH HMO NEW JERSEY AND DELAWARE NEIC CLAIMS N N N108 22248 AMERIHEALTH MERCY HEALTH PLAN NEIC CLAIMS N N N MEDICAID MANAGED CARE109 26375 AMERIKIDS-FORT WORTH THIN N N N ADDED 04/03/2002.110 26374 AMERIKIDS-HOUSTON THIN Y N N ADDED 04/03/2002.111 76052 AMIL / ARIA NEIC N N N ADDED 23-SEP-2002.112 AMILR AMIL/ARIA NEIC N N N113 38254 AMWAY CORPORATION NEIC CLAIMS N N N114 80705 ANTHEM HEALTH & LIFE INSURANCE COMPANY OF

NEW JERSEYNEIC Claims N N N

115 16140 APA PARTNERS, INC. NEIC CLAIMS N N N116 34196 APEX BENEFIT SERVICES NEIC Claims N N N

117 SX102 APIPA NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITIONS.

118 16120 ARAZ NEIC CLAIMS N N N119 77045 ARCADIAN MANAGEMENT SERVICES, INC NEIC N N N LOCATED IN COVINA, CALIFORNIA. CONTACT: DAVID LONTOK.

TEL:(626)771-1448.120 TH001 ARIZONA HEALTH CONCEPTS NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

121 53172 ARIZONA HEALTH CONCEPTS THIN N N N122 SX100 ARIZONA MERCY CARE (AHCCS) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

123 SX102 ARIZONA PHYSICIANS/IPA (AHCCS) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

124 75278 ARKANSAS BEST CORPORATION NEIC CLAIMS N N N125 75278 ARKANSAS BEST CORPORATION - CHOICE NEIC CLAIMS N126 ARBCS ARKANSAS BLUE CROSS ARBCS Y N N ADDED 04/29/2002. LIVE 02/25/2003127 95440 ARNETT HEALTH PLANS NEIC ERA P PLEASE CONTACT SHANNON HEGEL AT ARNETT HEATLH PLANS AT

(765) 448-7483 BEFORE ENROLLING FOR ERA WITH WEBMD ENVOY.

128 Pilot ARNETT HEALTH PLANS NEIC Claims N N N129 CALL ASC OF OHO NEIC CLAIMS N TO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

130 36326 ASSOCIATES FOR HEALTH CARE, INC. (AHC) NEIC CLAIMS N N N131 74240 ASSURED BENEFITS ADMINISTRATORS NEIC CLAIMS N132 95691 ATHENS AREA HEALTH PLAN SELECT NEIC CLAIMS N N N133 22304 ATLANTICARE [ALSO KNOWN AS HORIZON

HEALTHCARE ADMIN (HHA)]NEIC Claims N N N

134 22304 ATLANTICARE ADMINISTRATORS, INC NEIC CLAIMS N N N135 13853 ATLANTIS HEALTH PLAN NEIC CLAIMS N136 TH004 ATLAS ADMINISTRATORS NEIC N N N Currently only accepts UCO Providers. The group number must be 8

characters in length. Only one of the characters can be a dash. If the group number is entered, then the group name must also be entered.

137 ATLAD ATLAS ADMINISTRATORS THIN N N N USA MCO Provider Network138 31147 AULTCOMP MANAGED CARE ORGANIZATION (OHIO

BWC)NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


139 PHD01 AURORA ASSOCIATED PHYSICIANS INC NEIC N N N (**12 max lines FA0)140 37280 AUTOMATED GROUP ADMINISTRATION, INC. NEIC CLAIMS N PLEASE SEND THESE EDI CLAIMS TO THE PAYER ID OF THE PPO

SHOWN ON THE MEMBERS ID CARD. IF YOU HAVE ANY QUESTIONS, PLEASE CALL 260-489-6447 (703).

141 91136 AUTOMOTIVE MACHINISTS LOCAL 289 HEALTH & WELFARE TRUST


142 31147 AVATARCOMP (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR OHIO WORKERS COMP CLAIMS ONLY.

143 46045 AVERA HEALTH PLANS NEIC CLAIMS N N N

144 59274 AVMED, INC. NEIC Claims Y N N145 SX147 AZ FOUNDATION FOR MEDICAL CARE NEIC CLAIMS W146 SX145 BANNER HEALTH AZ NEIC CLAIMS W147 SX121 BANNER HEALTH CO, - ROCKY MOUNTAIN HMO

GREELEYNEIC CLAIMS E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

148 SX124 BANNER HEALTH CO. - ANTERO GREELEY NEIC CLAIMS E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

149 SX116 BANNER HEALTH CO. - ANTERO HIGH PLAINS NEIC CLAIMS E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

150 SX126 BANNER HEALTH CO. - ANTERO MOUNTAIN SHADOWS

NEIC CLAIMS E NON-PARTICIATPING PAYER - SEE LAST PAGE FOR DEFINITION.

151 SX115 BANNER HEALTH CO. - CHOICE PLUS NEIC CLAIMS E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

152 SX118 BANNER HEALTH CO. - HMO GREELEY NEIC CLAIMS E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

153 SX117 BANNER HEALTH CO. - HMO HIGH PLAINS NEIC CLAIMS E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

154 SX127 BANNER HEALTH CO. - HMO MOUNTAIN SHADOWS NEIC CLAIMS E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

155 SX123 BANNER HEALTH CO. - PACIFICARE GREELEY NEIC CLAIMS E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

156 SX119 BANNER HEALTH CO. - PACIFICARE HIGH PLAINS NEIC CLAIMS E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

157 SX128 BANNER HEALTH CO. - PACIFICARE MOUNTAIN SHADOWS

NEIC CLAIMS E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

158 SX120 BANNER HEALTH CO. - ROCKY MOUNTAIN HMO HIGH PLAINS


159 SX129 BANNER HEALTH CO. - ROCKY MOUNTAIN HMO MOUNTAIN SHADOWS


160 SX125 BANNER HEALTH CO. - SECURE HORIZONS GREELEY


161 SX122 BANNER HEALTH CO. - SECURE HORIZONS HIGH PLAINS


162 SX130 BANNER HEALTH CO. - SECURE HORIZONS MOUNTAIN SHADOWS


163 74275 BAPTIST HEALTHCARE NETWORK NEIC CLAIMS N N N164 37248 BASS ADMINISTRATORS, INC. NEIC Claims N N N165 16112 BATAVIA CITY SCHOOLS TRI-COUNTY MEDICAL NEIC Claims N N N166 95377 BEECH STREET CORPORATION NEIC N N N167 68241 BELL ATLANTIC NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS (PAYORID 68241)

WILL BE MIGRATE TO AETNA, PAYORID 60054

168 37125 BENEFIRST NEIC CLAIMS N N N PREVIOUS PAYER ID 37215169 25145 BENEFIT COORDINATORS CORPORATION

(PITTSBURGH, PA)NEIC Claims N N N Payer ID valid only for claims with a billing submission address of 111 Ryan

Court, Suite 300, Pittsburgh, PA 15205.

170 37212 BENEFIT MANAGEMENT SYSTEMS, INC NEIC Claims N N N

171 39081 BENEFIT PLAN ADMINISTRATORS CO. (EAU CLAIRE, WI)

NEIC Claims N N N Payer ID valid only for claims with a billing submission address of P.O. Box 1128, Eau Claire, WI 54702-1128.

172 88027 BENEFIT PLAN ADMINISTRATORS(BPA) NEIC CLAIMS N N N173 37118 BENEFIT PLAN ADMINISTRATORS, INC. NEIC CLAIMS N N N174 37118 BENEFIT PLAN ADMINISTRATORS, INC. (ROANOKE,

VA)NEIC Claims N N N Please call Mary Bender at (940) 345-2721 to verify if you should be sending

to the Benefit Plan Administrators, Inc., in Roanoke, VA.

175 37222 BENEFIT PLAN MANAGEMENT, INC. NEIC N N N ADDED 23-SEP-2002.176 74223 BENEFIT PLANNERS, INC. NEIC CLAIMS N N N177 2053 BENEFIT RESOURCES NEIC CLAIMS N178 34178 BENEFIT SERVICES, INC (AKRON, OH) NEIC N N N ADDED 23-SEP-2002.179 34178 BENEFIT SERVICES, INC. (AKRON, OH) NEIC Claims N N N180 36342 BENEFIT SYSTEMS & SERVICES, INC. (BSSI) NEIC CLAIMS N N N181 37211 BENEFIT SYSTEMS, INC NEIC N N N ADDED 23-SEP-2002.182 87265 BENESIGHT NEIC CLAIMS N (FORMERLY KNOWN AS THE TPA)183 37248 BENESYS NEIC Claims N N N184 37248 BENESYS | BENESYS, INC. | BASS

ADMINISTRATORS INC. | BENESYS-LHP CLAIMS UNIT

NEIC N N N LOCATE IN LAFAYETTE, LOUISIANA. TEL:(337)234-1790. NOTE: CLMS UTILIZING PPOPLUS NETWORK SHOULD CONTINUE TO BE SENT TO PPOPLUS. THESE GROUPS CAN BE IDENTIFIED BY THE PPOPLUS LOGO ON THE MEMBER ID CARD. PPOPLUS PAYORID IS 72148

185 37248 BENESYS, INC. NEIC Claims N N N186 95604 BEST LIFE & HEALTH INSURANCE CO. NEIC Claims N N N187 62183 BETTER HEALTH PLANS, INC. NEIC CLAIMS N N N188 Pilot BEXAR MEDICAL IPA NEIC Claims N N N189 SX002 BHSG OF TENNESSEE NEIC CLAIMS Y N Y NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

190 23738 BLUE CROSS AND BLUE SHIELD OF LOUISIANA NEIC Claims Y Y N NetworkId and or Group Network ID needed. Participating Payer - see last page for definition. For enrollment information, call (225) 295-2427.

191 SB700 BLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS

NEIC Y Y N PROVIDER MUST FIRST REGISTER (ENROLLMENT MATERIALS) WITH SB700 BEFORE SEND CLAIMS. CALL 800-845-6592 OPT 1

192 SB741 BLUE CROSS AND BLUE SHIELD OF MISSOURI NEIC CLAIMS Y Y Y PARTICIPATING PAYOR. CONTACT ALLIANCE PROVIDER SERVICES UNTI FOR ELECTRONIC NUMBER AT 800.392.8772 EXT 101.(NetworkId)

193 CALL BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA

NEIC CLAIMS N CLAIMS ARE PRINTED AND MAILED TO THE PAYER. CALL PAYER FOR PAYER ID.

194 84980 BLUE CROSS AND BLUE SHIELD OF TEXAS, INC. THIN Y Y Y195 SB580 BLUE CROSS BLUE SHIELD OF DC/NCA NEIC CLAIMS Y N Y PARTICIPATING PAYOR (NetworkId)196 621 BLUE CROSS BLUE SHIELD OF ILLINOIS THIN Y Y N197 SB690 BLUE CROSS BLUE SHIELD OF MD (CAREFIRST) NEIC CLAIMS Y N Y PARTICIPATING PAYOR (NetworkId)198 790 BLUE CROSS BLUE SHIELD OF NM (HCSC) NEIC Y Y Y "(**39 max lines FA0) **Receiver type ""G"""199 47198 BLUE CROSS OF CALIFORNIA NEIC CLAIMS Y Y Y PARTICIPATING PAYOR. CALIFORNIA LICENSE NUMBER

REQUIRED.(NetworkId)

200 FLBCS BLUE CROSS OF FLORIDA FLBCS Y Y Y201 610 BLUE CROSS OF IDAHO THIN CLAIMS Y Y Y TESTING BLUE CROSS OF IDAHO202 WABCS BLUE CROSS WASHINGTON STATE WABCS Y Y Y NETWORKID AND/OR GROUP NETWORKID NEEDED203 94036 BLUE SHIELD OF CA NEIC Rosters Y N N Participating Payer - see last page for definition.204 94036 BLUE SHIELD OF CALIFORNIA NEIC CLAIMS N PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. GROUP

NUMBER IS REQUIRED.205 94036 BLUE SHIELD OF CALIFORNIA NEIC ROSTERS N PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

206 CALL BLUE SHIELD OF CALIFORNIA NEIC ENCOUNTERS N PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. PLEASE CALL (800) 480-1221.

207 ORBCS BLUE SHIELD OF OREGON (REGENCE) ORBCS Y Y Y208 61124 BLUEGRASS FAMILY HEALTH NEIC CLAIMS N N N209 13337 BMC HEALTHNET PLAN NEIC CLAIMS N SUBMISSIONS TO BMCHP MUST INCLUDE THE CORRECT 12 DIGIT

BMCHP PROVIDER ID #, INCLUDING ALL LEADING ZEROS.

210 36609 BOILERMAKERS NATIONAL HEALTH & WELFARE NEIC CLAIMS N N N211 74238 BOON-CHAPMAN BENEFIT ADMINISTRATORS, INC. NEIC CLAIMS N N N212 13337 BOSTON MEDICAL CENTER HEALTH PLAN INC. NEIC Claims N N N LOCATE IN BOSTON, MA. PAYOR TEL:(617)414-6175. NETWORKID

REQUIRED213 13337 BOSTON MEDICAL CENTER HEALTH PLAN, INC. NEIC CLAIMS N SUBMISSIONS TO BMCHP MUST INCLUDE THE CORRECT 12 DIGIT

BMCHP PROVIDER ID #, INCLUDING ALL LEADING ZEROS.

214 13337 BOSTON MEDICAL CENTER HEALTH PLAN, INC. NEIC ENCOUNTERS N215 38324 BOTSFORD HEALTH PLAN (FARMINGTON HILLS, MI) NEIC Claims N N N216 37273 BOYD BROS. TRANSPORTATION, INC. NEIC CLAIMS N217 37273 BOYDCARE NEIC CLAIMS N218 37286 BPA/BENEFIT PLAN ADMINISTRATORS (NORTH NEIC CLAIMS N219 48964 BPS, INC. NEIC CLAIMS N N N FORMERLY KNOWN AS BENEFIT PLAN SERVICES, INC.

220 65005 BREATHCO/ICSL PULMONARY NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.221 37285 BRIDGESTONE CLAIMS SERVICES NEIC CLAIMS N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.222 51037 BROCKERAGE CONCEPTS, INC. NEIC CLAIMS N N N223 CALL BROKERAGE SERVICE INC NEIC CLAIMS N TO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

224 59069 BROWN & BROWN BENEFITS NEIC CLAIMS N N N225 94316 BROWN & TOLAND MEDICAL GROUP NEIC CLAIMS N N N226 CALL BSI NEIC CLAIMS N TO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

227 32004 BUCKEYE COMMUNITY HEALTH NEIC CLAIMS N228 50240 BUENAVENTURA MEDICAL GROUP, INC. NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO PAYOR.229 PILOT C & R CONSULTING, INC. NEIC CLAIMS N230 23708 C&O EMPLOYEES HOSPITAL ASSOCIATION NEIC Claims N N N231 59334 CAMBRIDGE ISG NEIC N N N ADDED 22-OCT-2002.232 37105 CANNON COCHRAN MANAGEMENT SERVICES, INC. NEIC Claims N N N233 38245 CAPE HEALTH PLAN NEIC CLAIMS N N N234 23045 CAPITAL BLUE CROSS/CAIC NEIC N N N ADDED 23-SEP-2002.235 87726 CAPITAL COMMUNITY HEALTH PLAN NEIC Claims N N N

236 SX065 CAPITAL DISTRICT PHYSICIANS HEALTH PLAN NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

237 68011 CAPITOL ADMINISTRATORS NEIC CLAIMS N N N238 HM037 CARE CHOICES HMO* NEIC N N Y Call our HelpLine (972) 766-5480239 11331 CARE MANAGEMENT GROUP OF GREATER NY, INC. NEIC CLAIMS N N N PREVIOUS PAYER ID 11311240 43172 CARE PARTNERS NEIC CLAIMS N N N MEDICAID MANAGED CARE. PAYER REQUIRES REGISTRATION AND

TESTING, CALL (877) 234-4274.241 Pilot CARE PLUS HEALTH NEIC Claims N N N242 Pilot CARECHOICES MICHIGAN - MERCY HEALTHPLANS NEIC Claims N N N Enrollment required; please contact Noreen at (248) 489-5281.

243 14182 CARECORE NATIONAL NEIC CLAIMS N244 14179 CARECORE NATIONAL, LLC (AETNA RADIOLOGY

CLAIMS)NEIC CLAIMS N

245 14180 CARECORE NATIONAL, LLC (OXFORD RADIOLOGY CLAIMS)

NEIC CLAIMS N

246 52118 CAREFIRST ADMINISTRATORS - MARYLAND NEIC CLAIMS N N N FORMERLY KNOWN AS WILLSE.247 SB580 CAREFIRST BLUE CROSS BLUE SHIELD OF DC /

NCANEIC Claims Y N N Participating Payer - see last page for definition. Includes coverage for DC

and Northern Virginia.248 SB690 CAREFIRST BLUE CROSS BLUE SHIELD OF MD NEIC Claims Y N N Participating Payer - see last page for definition.249 SB691 CAREFIRST DELMARVA HEALTH PLAN NEIC CLAIMS Y N Y PARTICIPATING PAYOR (NetworkId)250 25139 CARELINK ADVANTRA NEIC CLAIMS Y N N PROVIDER NUMBER (NETWORKID REQUIRED). WEST VIRGINIA

HEALTHASSURANCE AND CARELINK COMMERCIAL CLAIMS ONLY. FOR CARELINK MEDICAID, SEND ON PAPER TO P.O. BOX 7373, LONDON, KY 40742.

251 25139 CARELINK HEALTH PLAN NEIC CLAIMS Y N N PROVIDER NUMBER (NETWORKID REQUIRED). WEST VIRGINIA HEALTHASSURANCE AND CARELINK COMMERCIAL CLAIMS ONLY. FOR CARELINK MEDICAID, SEND ON PAPER TO P.O. BOX 7373, LONDON, KY 40742.

252 25140 CARELINK MEDICAID NEIC CLAIMS N N N253 25142 CARENET NEIC N N N ADDED 23-SEP-2002.254 65031 CAREPLUS HEALTH PLANS, INC. NEIC CLAIMS N (FORMERLY PHYSICIANS HEALTHCARE PLANS INC)255 31114 CARESOURCE NEIC Claims N N N256 31147 CAREWORKS (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


257 62073 CARITEN HEALTHCARE NEIC N N N ADDED 23-SEP-2002.258 62072 CARITEN SENIOR HEALTH NEIC N N N ADDED 23-SEP-2002.259 57105 CAROLIAN CARE PLAN NEIC CLAIMS N N N FORMERLY PHP OF SOUTH CAROLINA.260 37245 CAROLINA BENEFIT ADMINISTRATORS INC. NEIC N N N ADDED 23-SEP-2002.261 57105 CAROLINA CARE PLAN NEIC Claims N N N262 56195 CAROLINA SUMMIT HEALTHCARE, INC. NEIC CLAIMS N N N263 25125 CARPENTERS HEALTH AND WELFARE TRUST FUND

OF ST. LOUISNEIC CLAIMS N UTILIZES THE CMR NETWORK. CLAIMS ARE PRINTED AND MAILED TO

THE PAYER.264 93040 CASCADE EAST HEALTH PLANS NEIC Claims N N N265 93040 CASCADE HEALTH PARTNERS NEIC CLAIMS N N N

266 93102 CASCADE HEALTH PARTNERS NEIC CLAIMS N N N267 37060 CATERPILLAR INC. NEIC CLAIMS N N N268 Pilot CBCA ADMINISTRATORS NEIC Claims N N N269 55438 CBCA ADMINISTRATORS NEIC N N N270 VOID-31158 CBIZ BENEFITS & INSURANCE SERVICES(SAN NEIC CLAIMS N N N TERMINATED AS OF 1/31/2003.271 41124 CBSA NEIC CLAIMS N N N272 88019 CCEA WELFARE BENEFIT TRUST NEIC CLAIMS N N N273 33005 CCN NEIC CLAIMS N N N PLEASE INCLUDE GROUP NAME AND INSUREDS EMPLOYER NAME ON

CLAIMS.274 33005 CCN MANAGED CARE, INC. NEIC Claims N N N Please include Group Name and Insureds Employer Name on claims.

275 SX065 CDPHP NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

276 TH046 CEDAR RAPIDS ELECTRICAL WORKERS NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

277 95166 CEDARS-SINAI MEDICAL NETWORK SERVICES NEIC CLAIMS N N N278 95167 CEDARS-SINAI MEDICAL NETWORK SERVICES NEIC ENCOUNTERSN N N279 37250 CEMARA ADMINISTRATORS INC. NEIC N N N ADDED 23-SEP-2002.280 91136 CEMENT MASONS & PLASTERERS HEALTH &

WELFARE TRUSTNEIC Claims N N N Please enter Group Number (F16) when submitting claims.

281 75243 CENTRA NEIC CLAIMS N N N [FORMERLY CENTRA BENEFITS OF TEXAS (MS, TX, WA)]

282 75196 CENTRA (FORMERLY HEALTH ECONOMICS CORP.) NEIC CLAIMS N N N (FORMERLY HEALTH ECONOMICS CORP.)283 31118 CENTRAL BENEFITS LIFE NEIC CLAIMS N N N284 31118 CENTRAL BENEFITS MUTUAL NEIC CLAIMS N N N285 31118 CENTRAL BENEFITS NATIONAL NEIC CLAIMS N N N286 34097 CENTRAL RESERVE LIFE NEIC CLAIMS N N N287 36215 CENTRAL STATES HEALTH & WELFARE FUNDS NEIC CLAIMS N N N288 Pilot CENTRAL STATES JOINT BOARD HEALTH AND

WELFARE FUNDNEIC Claims N N N

289 37214 CENTRAL STATES JOINT BOARD HEALTH AND WELFARE FUND

NEIC CLAIMS N

290 E3510 CENTRAL VALLEY MEDICAL GROUP NEIC CLAIMS P ONLY CLAIMS FROM PROVIDERS IN NORTHERN CALIFORNIA. PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - NORTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

291 23171 CHA - COMMONWEALTH HEALTH ALLIANCE NEIC Claims N N N292 61125 CHAMPUS HUMANA MILITARY - TRICARE REGION 3

AND 4NEIC CLAIMS Y N N PARTICIPATING PAYOR FOR TRICARE REGION 3 AND 4.

293 57106 CHAMPUS TRICARE PALMETTO NEIC CLAIMS Y N N PARTICIPATING PAYOR. SERVING REGION 1,2,5,7,8,0,10,12.

294 REG11 CHAMPUS: REGION 11 NEIC Y N Y "(**12 max lines FA0) **Receiver type ""F or H"" Contact our HelpLine or Marsha Green (608)221-5056) to enroll. Champus will notify provider w/Auth # within 5 days of agreement."

295 84146 CHAMPVA - HAC NEIC CLAIMS N CHAMPVA - HAC IS NOT ASSOCIATED WITH AND DOES NOT PROCESS CLAIMS FOR TRICARE (FORMERLY CHAMPUS).

296 84146 CHAMPVA - HAC NEIC ERA N297 84147 CHAMPVA - HAC NEIC ERA N298 16600 CHAUTAUQUA COUNTY HEALTHCARE PLAN

(MAYVILLE, NY)NEIC Claims N N N

299 59223 CHESAPEAKE LIFE INSURANCE COMPANY NEIC Claims N N N300 59223 CHESAPEAKE LIFE INSURANCE COMPANY -

INSURANCE CENTERNEIC CLAIMS N PAYER ID VALID ONLY IF THE ADDRESS ON THE HEALTH ID CARD

MATCHES THE FOLLOWING: P.O. BOX 982017, NORTH RICHLAND HILLS, TX 76182.

301 59223 CHESAPEAKE LIFE INSURANCE COMPANY - INSURANCE CENTER

NEIC ERA N

302 84146 CHILDREN OF WOMEN VIETNAM VETERANS-VA NEIC CLAIMS N303 84146 CHILDREN OF WOMEN VIETNAM VETERANS-VA NEIC ERA N304 DCHCH CHIP- DRISCOLL CHILDRENS HEALTH PLAN TX NEIC N N N305 SHPCH CHIP- SETON HEALTH PLAN TX NEIC N N N306 TTPCH CHIP-TEENS TO TOTS / TX UNIVERSITY HEALTH TX NEIC N N N307 UPGCH CHIP-TX UNIVERSITY HEALTH PLAN UPG TX NEIC N N N308 88822 CHOICE 65 (MEDICARE SUPPLEMENT) NEIC N N Y (**12 max lines FA0) Prov ID reqd- contact (800)778-2341 to obtain ID

309 76049 CHOICE ONE/UTMB CHIP HEALTH PLAN NEIC N N N ADDED 06/18/2002.310 68241 CHOICE PLUS (TRW) NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS (PAYORID 68241)


311 CALL CHP/RPU (FABOH) NEIC CLAIMS N PAYER ID, RENDERING PROVIDER AND LOCATION NUMBER REQUIRED TO SUBMIT CLAIMS. PLEASE CALL DAVE SELL AT (608) 210-6656 TO OBTAIN.

312 61271 CHRISTIAN BROTHERS SERVICES NEIC CLAIMS N N N313 37288 CHS CLAIMS NEIC CLAIMS N314 62308 CIGNA NEIC CLAIMS N N N315 62308 CIGNA - PPA NEIC CLAIMS N N N316 62308 CIGNA - PPO NEIC CLAIMS N N N317 76051 CIGNA / ARIA NEIC N N N ADDED 23-SEP-2002.318 MCCBV CIGNA BEHAVIORAL HEALTH THIN N N N319 SX071 CIGNA BEHAVIORAL HEALTH NEIC CLAIMS P NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

ENROLLMENT REQUIRED. PLEASE CONTACT E-COMMERCE AT (800) 334-8925.

320 62310 CIGNA FLEX CARE (NEW MEXICO ONLY) NEIC CLAIMS N N N321 62308 CIGNA HEALTH PLAN - HMO NEIC CLAIMS N N N322 12345 CIGNA-BEHAVIORAL HEALTH (EDEN PRARIE, MN) THIN N N Y ADDED 06/18/2002. REGISTRATION REQUIRED. PLS CALL 888-259-6279.

323 CIGNR CIGNA/ ARIA PROVIDERS ONLY NEIC N N N ARIA PROVIDERS ONLY324 TH058 CIMARRON HEALTH PLAN NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

325 TH059 CIMARRON SALUD NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

326 39141 CLAIM MANAGEMENT SERVICES NEIC N N N ADDED 23-SEP-2002.327 39141 CLAIMS MANAGEMENT SERVICES NEIC CLAIMS N328 57080 CLAIMSWARE, INC. DBA MANAGEMED NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO PAYOR.329 TH006 CLARENDON KIDS CHIP PROGRAM NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

330 EPOTX CLARENDON KIDS CHIP PROGRAM (CKCP) EPO THIN N N ADDED 03/22/2002. USA MCO NETWORK PROVIDERS ONLY

331 71063 CNA HEALTH PARTNERS NEIC CLAIMS N N N332 48153 CNA HEALTH PARTNERS REPRICING - AR NEIC CLAIMS N N N333 36094 CNA INSURANCE COMPANY NEIC CLAIMS N N N334 16126 CNY MANAGED CARE NEIC CLAIMS N N N335 CALL COALITION FOR CARE/MEDTREX PAYER HS NEIC CLAIMS N PLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE

PAYER ID.336 CALL COALITION FOR CARE/MEDTREX PAYER WL NEIC CLAIMS N PLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE

PAYER ID.337 CALL COALITION FOR CARE/MEDTREX PAYERTC NEIC CLAIMS N PLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE

PAYER ID.338 CALL COALITION FOR CARE/MEDTRX GH NEIC CLAIMS N PLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE

PAYER ID.339 CALL COALITION FOR CARE/MEDTRX IX NEIC CLAIMS N PLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE

PAYER ID.340 CALL COALITION FOR CARE/MEDTRX L8 NEIC CLAIMS N PLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE

PAYER ID.341 CALL COALITION FOR CARE/MEDTRX PAYER EM NEIC CLAIMS N PLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE

PAYER ID.342 CALL COALITION FOR CARE/MEDTRX PAYER FI NEIC CLAIMS N PLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE

PAYER ID.343 CALL COALITION FOR CARE/MEDTRX PAYER HP NEIC CLAIMS N PLEASE CALL PROVIDER RELATIONS AT (201) 634-8700 FOR THE

PAYER ID.344 37123 COLONIAL HEALTHCARE NEIC N N N ADDED 23-SEP-2002.345 COACC COLORADO ACCESS HMO NEIC N N N346 PHD02 COLORADO ASSOCIATED PRIMARY CARE NEIC N N N347 COKSR COLORADO KAISER PERMANENTE NEIC N N N (**12 max lines FA0)348 SX114 COLORADO MEDICAID ACCESS NEIC CLAIMS E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

349 25351 COLUMBIA CORNELL CARE NEIC CLAIMS N N N350 91162 COLUMBIA UNITED PROVIDERS NEIC N N N ADDED 23-SEP-2002351 37271 COMBINED BENEFITS, INC. NEIC CLAIMS N352 34181 COMMERCE BENEFITS GROUP NEIC CLAIMS N N N353 37237 COMMONWEALTH ADMINISTRATIVE GROUP NEIC N N N ADDED 23-SEP-2002.354 TH026 COMMONWEALTH ADMINISTRATORS NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

355 25179 COMMUNITY CARE BEHAVIORAL HEALTH ORGANIZATION

NEIC CLAIMS N N N

356 73143 COMMUNITY CARE MANAGED HEALTH CARE PLANS OF OKLAHOMA

NEIC CLAIMS N N N

357 PILOT COMMUNITY CARE ORGANIZATION NEIC CLAIMS N358 Pilot COMMUNITY CARE PLUS NEIC Claims N N N

359 TH027 COMMUNITY CHOICE OF MICHIGAN (MEDICAID) NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

360 TH005 COMMUNITY FIRST NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

361 COMMF COMMUNITY FIRST NEIC N N N362 35193 COMMUNITY HEALTH ALLIANCE NEIC CLAIMS N363 48145 COMMUNITY HEALTH CHOICE NEIC Y Y N ADDED 23-SEP-2002.364 75261 COMMUNITY HEALTH ELECTRONIC

CLAIMS/CHEC/WEBTPANEIC CLAIMS N N N

365 62149 COMMUNITY HEALTH NETWORK OF CONNECTICUT NEIC N N N ADDED 22-OCT-2002. PAYOR CONTACT 203-237-4000 EXT 3056

366 62149 COMMUNITY HEALTH NETWORK OF CT NEIC Claims N N N Community Health Network of CT cannot accept electronic claims for Anesthesia. If you have questions on how to submit these claims, please contact LeAnn Olson, Director of Claims, at (203) 237-4000, ext. 3136.

367 90010 COMMUNITY HEALTH PLAN NEIC CLAIMS N N N368 39162 COMMUNITY HEALTH PLAN - MILWAUKEE, WI NEIC CLAIMS N N N CALL KAREN MILLS AT (262) 787-2705 PRIOR TO SUBMITTING CLAIMS.

369 CHPWA COMMUNITY HEALTH PLAN OF WA THIN N N N370 SB613 COMMUNITY HEALTH PLAN WASHINGTON NEIC CLAIMS W NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

371 Pilot COMMUNITY PREMIER PLUS NEIC Claims N N N372 32481 COMMUNITY PREMIER PLUS FOR NEIGHBORHOOD

HEALTH PROVIDERSNEIC CLAIMS N N N

373 34177 COMP - OHIO (AUSTINTOWN, OH) NEIC CLAIMS N374 31147 COMP ONE (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


375 37297 COMPBENEFITS CORPORATION NEIC CLAIMS N376 23296 COMPFIRST NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.377 SX004 COMPLETE HEALTH OF ALABAMA NEIC CLAIMS Y N Y NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

378 31147 COMPMANAGEMENT HEALTH SYSTEMS, INC. (OHIO BWC)

NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR OHIO WORKERS COMP CLAIMS ONLY.

379 31147 COMPMANAGEMENT/INTEGRATED COMP (OHIO BWC)


380 3036 COMPREHENSIVE BENEFITS ADMINISTRATOR, INC. NEIC Claims N N N381 31147 COMPREHENSIVE MEDICAL CARE (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


382 COMPU COMPUSYS OF COLORADO CO NEIC N N N383 80667 CONFED ADMIN SERVICES, INC. THIN N N N384 80705 CONFEDERATION ADMIN SERVICES NEIC CLAIMS N385 80705 CONFEDERATION LIFE INSURANCE NEIC CLAIMS N

386 6105 CONNECTICARE, INC NEIC CLAIMS Y N N NETWORKID REQUIRED (PROVIDER NO, HCFA BOX 33, PIN FIELD). PLEASE CONTACT PAYOR REPRESENTATIVE FOR YOUR NETWORKDID

387 62308 CONNECTICUT GENERAL (CIGNA) NEIC CLAIMS N N N388 35196 CONSECO SERVICES, LLC NEIC CLAIMS N N N389 37135 CONSOCIATE GROUP NEIC CLAIMS N N N390 75284 CONSOLIDATED ASSOCIATES RAILROAD NEIC CLAIMS N391 4284 CONSOLIDATED GROUP NEIC CLAIMS N N N392 4284 CONSOLIDATED GROUP/TRAVELERS NEIC CLAIMS N N N393 37295 CONSUMER HEALTH SOLUTIONS NEIC CLAIMS N394 71404 CONTINENTAL GENERAL INSURANCE COMPANY NEIC CLAIMS N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.395 35196 CONTINENTAL LIFE & ACCIDENT CO NEIC CLAIMS N N N396 13397 CONTINUUM ABC MSO NEIC CLAIMS N N N397 52132 COOPERATIVE BENEFIT ADMINISTRATORS (CBA) NEIC Claims N N N398 58204 COORDINATED MEDICAL SPECIALISTS NEIC Claims N N N399 58231 CORE ADMINISTRATIVE SERVICES NEIC CLAIMS N400 58231 CORE MANAGEMENT RESOURCES GROUP, INC. NEIC Claims N N N401 41045 CORESOURCE AZ MN NEIC CLAIMS N ONLY FOR CLAIMS WHERE THE "SUBMIT CLAIMS TO ADDRESS" ON

THE MEDICAL ID CARD IS A CORESOURCE ADDRESS IN THE STATES OF ARIZONA OR MINNESOTA. FOR ASSISTANCE CALL 800-698-0106.

402 75136 CORESOURCE LITTLE ROCK NEIC CLAIMS N ONLY FOR CLAIMS WHERE THE "SUBMIT CLAIMS TO ADDRESS" ON THE MEDICAL ID CARD IS A CORESOURCE ADDRESS IN LITTLE ROCK, ARKANSAS. FOR ASSISTANCE CALL 800-689- 0106.

403 35182 CORESOURCE MD PA IL NEIC N N N404 35180 CORESOURCE NC IN NEIC CLAIMS N ONLY FOR CLAIMS WHERE THE "SUBMIT CLAIMS TO ADDRESS" ON

THE MEDICAL ID CARD IS A CORESOURCE ADDRESS IN THE STATES OF NORTH CAROLINA OR INDIANA. FOR ASSISTANCE CALL 800-689-0106.

405 35180 CORESOURCE OF NORTH CAROLINA NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.406 35183 CORESOURCE OH NEIC CLAIMS N407 Pilot CORESOURCE, INDIANA NEIC Claims N N N408 41045 CORESTAR NEIC CLAIMS N N N (FORMERLY NORTHWESTERN NATIONAL LIFE)409 41124 CORPORATE BENEFIT SERVICES OF AMERICA NEIC CLAIMS N N N410 56116 CORPORATE BENEFITS SERVICE, INC. (NC) NEIC Claims N N N Claims are printed and mailed to the payer. Payer ID valid only for claims with

a claims submission address of P.O. Box 12953, Charlotte, NC 28220.

411 37246 CORPORATE SYSTEMS ADMINISTRATION NEIC N N N ADDED 23-SEP-2002.412 43160 CORRECTIONAL MEDICAL SERVICES NEIC CLAIMS N N N413 48146 CORSOLUTIONS NEIC N N N ADDED 22-OCT-2002. PAYOR CONTACT 800-433-2183

414 31147 CORVEL CORPORATION (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR OHIO WORKERS COMP CLAIMS ONLY.

415 37288 COTTAGE HEALTH SYSTEM NEIC CLAIMS N416 37288 COTTAGE HOSPITAL NEIC CLAIMS N417 62553 COUNTRY LIFE INSURANCE COMPANY NEIC CLAIMS N N N418 58102 COVENANT ADMINISTRATORS, INC. (ATLANTA, GA) NEIC N N N LOCATED IN ATLANTA, GEORGIA. CONTACT: KATHY MYERS

TEL:(440)720-0700 EXT. 222419 62155 COVENANT HEALTH NEIC CLAIMS N N N420 25144 COVENTRY - KANSAS CITY MEDICARE (ADVANTRA) NEIC Claims N N N421 25130 COVENTRY HEALTH CARE OF DELAWARE, INC. NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.422 25127 COVENTRY HEALTH CARE OF GEORGIA, INC. NEIC Claims N N N423 25131 COVENTRY HEALTH CARE OF INDIANA, INC. NEIC CLAIMS N N N424 25132 COVENTRY HEALTH CARE OF IOWA, INC. NEIC CLAIMS N N N425 25133 COVENTRY HEALTH CARE OF KANSAS, INC. -

KANSAS CITYNEIC CLAIMS N N N

426 25134 COVENTRY HEALTH CARE OF KANSAS, INC. - NEIC CLAIMS N N N427 25135 COVENTRY HEALTH CARE OF LOUISIANA, INC. NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER428 25136 COVENTRY HEALTH CARE OF NEBRASKA, INC. NEIC CLAIMS N N N429 25129 COVENTRY HEALTH CARE OF THE CAROLINAS,

INC./WELLPATHNEIC Claims N N N

430 31147 CRA MANAGED CARE (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR OHIO WORKERS COMP CLAIMS ONLY.

431 31147 CRAWFORD & COMPANY (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR OHIO WORKERS COMP CLAIMS ONLY.

432 64068 CREATIVE MEDICAL SYSTEMS NEIC CLAIMS N N N433 37266 CROY-HALL MGMT. INC. NEIC Claims N N N434 68241 CUSTOMCARE NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS (PAYORID 68241)


435 68241 CUSTOMCARE (SOUTHWESTERN BELL - EXEC.) NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

436 39113 DEAN HEALTH PLAN NEIC CLAIMS N437 64159 DEFINITY HEALTH NEIC CLAIMS N438 63081 DELAWARE HEALTH PLAN CONSORTIUM NEIC CLAIMS N N N439 25137 DELAWARECARE (CHC OF DELAWARE MEDICAID) NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.440 84135 DENVER HEALTH MEDICAL PLAN NEIC CLAIMS N441 58204 DERMATOLOGY NETWORK SOLUTIONS NEIC Claims N N N442 25131 DIAMOND PLAN NEIC CLAIMS N443 23706 DIRECTORS GUILD OF AMERICA NEIC N N N LOCATED IN LOS ANGELES, CALIFORNIA. CONTACT:SHEA SAVASH

TEL:(323)866-2200444 23706 DIRECTORS GUILD OF AMERICA - PRODUCER

HEALTH PLANNEIC Claims N N N

445 6102 DIVERSIFIED ADMINISTRATION NEIC Claims N N N

446 6102 DIVERSIFIED ADMINISTRATION CORPORATION NEIC CLAIMS N447 6102 DIVERSIFIED ADMINISTRATION NEIC CLAIMS N N N448 DMCRC DMERC REG C ONLY DMCRC Y Y Y LIVE AS OF 02/18/2003449 VABCS DO NOT USE VABCS Y Y N DO NOT USE450 VAMCR DO NOT USE VAMCR Y Y N DO NOT USE451 54763 DO NOT USE - TESTING NEIC N N N452 54704 DO NOT USE - TESTING NEIC N N N453 IDMCR DO NOT USE - TESTING IDMCR Y Y N454 TNMCR DO NOT USE - TESTING TNMCR Y Y N455 ORMCR DO NOT USE - TESTING ORMCR Y Y N456 KSMCR DO NOT USE - TESTING KSMCR Y Y N457 KSMCD DO NOT USE - TESTING KSMCD Y Y N458 COMCD DO NOT USE - TESTING COMCD Y Y N459 ARMCD DO NOT USE - TESTING - ARKANSAS MEDICAID ARMCD Y Y N460 FLMCD DO NOT USE - TESTING - FLORIDA MEDICAID FLMCD Y Y N461 95019 DO NOT USE - TESTING - HEALTHFIRST

HEALTHPLAN (FLORIDA)CLMNT Y Y N

462 NYMCQ DO NOT USE - TESTING - MEDICARE PART B (GHI-QUEENS) NEW YORK

NYMCQ Y Y N

463 NYMCU DO NOT USE - TESTING - MEDICARE PART B UPSTATE NEW YORK

NYMCU Y Y N

464 MSBCS DO NOT USE - TESTING - MISSISSIPPI BLUE MSBCS Y Y N465 NEBCS DO NOT USE - TESTING - NEBRASKA BLUE CROSS NEBCS Claims Y Y Y ADDED 02/18/2004466 NEMCR DO NOT USE - TESTING - NEBRASKA MEDICARE NEMCR Claims Y Y Y ADDED 02/18/2004467 NYBCS DO NOT USE - TESTING - NEW YORK BLUE CROSS

(EMPIRE)NYBCS Y Y N

468 NYMCD DO NOT USE - TESTING - NEW YORK MEDICAID NYMCD Y Y N469 OHBCS DO NOT USE - TESTING - OHIO BLUE CROSS

(ANTHEM-5241)OHBCS Y Y N

470 OKBCS DO NOT USE - TESTING - OKLAHOMA BLUE CROSS OKBCS Y Y N471 ORMCD DO NOT USE - TESTING - OREGON MEDICAID ORMCD Y Y N472 SCMCD DO NOT USE - TESTING - SOUTH CAROLINA SCMCD Y Y N473 TNMCD DO NOT USE - TESTING - TENNESSEE MEDICAID TNMCD Y Y N474 TNMCR DO NOT USE - TESTING - TENNESSEE MEDICARE TNMCR Y Y N475 WVBCS DO NOT USE - TESTING - WEST VIRGINIA BLUE WVBCS Y Y N476 KCMCR DO NOT USE - TESTING KANSAS CITY MEDICARE KCMCR Y Y N477 611 DO NOT USE-BLUE SHIELD OF IDAHO 611 Y Y Y DO NOT USE-TESTING478 DONOTUSEDO NOT USE-PAYOR CLOSED-QUAL CHOICE OF

NORTH CAROLINANEIC CLAIMS Y N N UNIQUE PROVIDER ID REQUIRED TO SUBMIT CLAIMS. PLEASE

CONTACT THE HELP DESK AT (800) 816-0911.

479 VOID-34075 DO NOT USE-TERMINATE-TRI-COUNTY BUILDING TRADES HEALTH FUND, OHIO

NEIC CLAIMS N N N PAYER ID VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION ADDRESS OF P.O. BOX 230, NILES, OH 44446.

480 VOID-76061 DO NOT USE-TERMINATED-AMCARE HEALTH PLANS

NEIC N N N TERMINATED 2/4/2003. CONTACT AMCARE AT (713)985-4100 FOR ADDITIONAL INFORMATION

481 VOID-00340 DO NOT USE-TERMINATED-GHP (GROUP HEALTH PLAN)

NEIC N N N TERMINATED AS OF 10/31/2002. GROUP HEALTH PLAN CLAIMS SHOULD BE SUBMITTED TO PAYOR ID 25141

482 VOID-34025 DO NOT USE-TERMINATED-GOODYEAR TIRE & RUBBER COMPANY

NEIC CLAIMS N N N

483 EPMCR DO NOT USE-TESTING EPMCR Y Y Y484 ALMCD DO NOT USE-TESTING-ALABAMA MEDICAID ALMCD Y Y N485 CTMCR DO NOT USE-TESTING-CONNECTICUT MEDICARE CTMCR Y Y Y ADDED 07/03/2002.486 DMCRA DO NOT USE-TESTING-DMERC REG A DMCRA Y Y Y DO NOT USE AT THIS TIME487 DMCRB DO NOT USE-TESTING-DMERC REG B DMCRB Y Y Y DO NOT USE AT THIS TIME488 DMCRD DO NOT USE-TESTING-DMERC REG D DMCRD Y Y Y DO NOT USE AT THIS TIME489 FEDBC DO NOT USE-TESTING-FEDERAL BLUE CROSS ALBCS Y Y N490 KYBCS DO NOT USE-TESTING-KENTUCKY BLUE CROSS

(ANTHEM)KYBCS Y Y N

491 MAMCR DO NOT USE-TESTING-MASSACHUSSETTS MEDICARE (NHIC-EDS)

MAMCR Y Y N

492 MSMCR DO NOT USE-TESTING-MEDICARE PART B OF MISSISSIPPI

MSMCR Y Y Y REGISTER WITH MEDICARE FIRST. PROVIDER NUMBER REQUIRED. ADDED 29-AUG-2002. LIVE ON 16-JAN-2003

493 MNBCS DO NOT USE-TESTING-MINNESOTA BLUE CROSS MNBCS Y Y N ADDED 04/25/2002. UNDER TEST-DO NOT USE494 FCNHP DO NOT USE-TESTING-NEIGHBORHOOD HEALTH

PLAN DIRECT CONNECTFCNHP N N N

495 NCMCD DO NOT USE-TESTING-NORTH CAROLINA MEDICAID NCMCD Y Y N496 72126 DO NOT USE-TESTING-PEOPLES HELATH

NETWORK (TENET)NEIC Y N N

497 SDBCS DO NOT USE-TESTING-SOUTH DAKOTA BLUE SDBCS Y Y Y DO NOT USE-ADDED 08/01/2002.498 FCVV1 DO NOT USE-TESTING-VIVRA HEALTHHARVARD

COMMUNITY HEALTH PLANFCVV1 N N N ADDED 23-SEP-2002.

499 VOID-96218 DO NOT USE-VOID-NEW ALLIANCE HEALTH PLAN NEIC CLAIMS N N N VOID AS OF 11/9/2002. NEW ALLIANCE MEMBER WILL MIGRATE TO COVENTRY'S HEALTH AMERICAN/ HEALTH ASSURANCE HEALTH PLAN, PAYOR ID 25126

500 DCHCH DRISCOLL CHILDRENS HEALTH PLAN (CHIP) TX NEIC N N N501 34159 E-V BENEFITS MANAGEMENT, INC NEIC CLAIMS N PAYER ID VALID ONLY FOR CLAIMS WITH BILLING SUBMISSION

ADDRESS OF P.O. BOX 94928, CLEVELAND, OH 44101- 4928 OR P.O. BOX 89476, CLEVELAND, OH 44101-5476.

502 75232 E3 HEALTH, INC. NEIC CLAIMS N N N503 65009 EAPPEAL SOLUTIONS NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO PAYOR.504 94318 EAST BAY MEDICAL NETWORK NEIC CLAIMS Y N N NETWORK ID REQUIRED ON ALL CLAIMS. CALL MERCY AGUAS AT

(510) 627-4763 TO OBTAIN NETWORK ID PRIOR TO FIRST SUBMISSION.

505 CALL EAST BAY MEDICAL NETWORK NEIC CLAIMS P NETWORK ID REQUIRED ON ALL CLAIMS. CALL SUTTER CONNECT EDI DEPARTMENT AT (800) 611-5191 TO OBTAIN NETWORK ID PRIOR TO FIRST SUBMISSION.

506 CALL EBC MID-AMERICA NEIC CLAIMS N TO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

507 CALL EBC, INC. NEIC CLAIMS N TO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

508 81039 EBMS (EMPLOYEE BENEFIT MANAGEMENT SERVICES, INC.)

NEIC CLAIMS N N N

509 73288 EHI (EMPLOYERS HEALTH INSURANCE) NEIC CLAIMS N N N510 98006 EHS GROUP HEALTH PLAN (MILWAUKEE, WI) NEIC CLAIMS N N N511 52192 ELDER HEALTH MARYLAND HMO INC. NEIC N N N CLAIMS ARE PRINTED AND MAILED TO PAYOR. ADDED 23-SEP-2002.

512 31625 ELDERPLAN, INC. NEIC CLAIMS N513 37253 ELMCO NEIC N N N LOCATE IN ELMIRA, NEW YORK. TEL:(607)734-5773.514 34167 EMERALD HEALTH NETWORK, INC. (ALL PPO NEIC CLAIMS N N N515 34555 EMERALD HMO (HMO CLAIMS ONLY) NEIC CLAIMS N N N516 68241 EMORYCARE NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE

MIGRATE TO AETNA, PAYORID 60054

517 73288 EMPHESYS NEIC CLAIMS N N N518 CALL EMPLOYEE BENEFIT CLAIMS - MID-AMERICA NEIC CLAIMS N TO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

519 CALL EMPLOYEE BENEFIT CLAIMS OF WI NEIC CLAIMS N TO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

520 CALL EMPLOYEE BENEFIT CLAIMS OF WISCONSIN NEIC CLAIMS N TO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

521 38241 EMPLOYEE BENEFIT CONCEPTS (FARMINGTON NEIC Claims N N N522 CALL EMPLOYEE BENEFIT CONSULTANTS, INC. NEIC CLAIMS N TO OBTAIN THE PAYER ID, PLEASE CALL (440) 262-1160.

523 37215 EMPLOYEE BENEFIT CORPORATION NEIC CLAIMS N524 37216 EMPLOYEE BENEFIT SERVICES NEIC CLAIMS N N N525 3036 EMPLOYEE BENEFITS PLAN ADMINISTRATION, INC.

(E.B.P.A.)NEIC Claims N N N

526 35112 EMPLOYEE PLANS, LLC NEIC CLAIMS N N N527 54098 EMPLOYEE SECURITY INC. NEIC CLAIMS N N N528 75232 EMPLOYERS DIRECT HEALTH NEIC CLAIMS N529 73288 EMPLOYERS HEALTH NEIC CLAIMS N N N530 73288 EMPLOYERS HEALTH INSURANCE NEIC CLAIMS N N N531 39026 EMPLOYERS INSURANCE OF WAUSAU - AKA NEIC CLAIMS N N N532 37249 EMPLOYERS LIFE INSURANCE CORP. NEIC N N N ADDED 23-SEP-2002.533 37249 EMPLOYERS LIFE INSURANCE CORPORATION NEIC CLAIMS N534 59298 EMPLOYERS MUTUAL, INC (FL) NEIC CLAIMS N N N535 59298 EMPLOYERS MUTUAL, INC (JACKSONVILLE, NEIC CLAIMS N536 59331 EMPLOYERS MUTUAL, INC. (STUART, FLORIDA) NEIC CLAIMS N FOR PLAN AND CLAIM REQUIREMENTS, PLEASE CONTACT THE

EMPLOYERS MUTUAL, INC. (STUART, FL) CUSTOMER SERVICE DEPARTMENT AT (772) 287-7650, EXT. 4052.

537 35206 ENCIRCLE PPO NEIC Claims N N N538 37110 ENCOMPASS NEIC CLAIMS N N N

539 35206 ENCORE HEALTH NETWORK NEIC Claims N N N540 36364 ENH MEDICAL GROUP IPA NEIC CLAIMS N N N541 91136 ENSTAR NATURAL GAS NEIC Claims N N N Please enter Group Number (P61) when submitting claims.

542 EPOTX EPO CHIP/MANAGED CARE THIN N N N543 62308 EQUICOR NEIC CLAIMS N N N544 62308 EQUICOR - PPO NEIC CLAIMS N N N545 75196 EQUIFAX HEALTHCARE ADMIN. SERVICES (EHAS) NEIC CLAIMS N N N546 62308 EQUITABLE (CIGNA) NEIC CLAIMS N N N547 73126 EQUITABLE PLAN SERVICES (OKLAHOMA CITY, OK) NEIC CLAIMS N PAYER ID VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION

ADDRESS OF P.O. BOX 720460, OKLAHOMA CITY, OK 73172.

548 23250 ERIN GROUP ADMINISTRATORS NEIC CLAIMS N N N549 74234 ERISA ADMINISTRATIVE SERVICES NEIC CLAIMS N N N550 SX008 ETHIX MID WEST NEIC CLAIMS Y N Y NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

551 87726 EVERCARE NEIC Claims N N N552 87726 EVERCARE (ALL STATES) NEIC CLAIMS N N N553 58233 EVERGREEN HEALTH PLAN NEIC CLAIMS N N N554 71412 EXCLUSICARE NEIC CLAIMS N N N555 37289 F.A. RICHARD & ASSOCIATES, INC. NEIC CLAIMS N556 CALL FABOH (CHP/RPU) NEIC CLAIMS N PAYER ID, RENDERING PROVIDER AND LOCATION NUMBER

REQUIRED TO SUBMIT CLAIMS. PLEASE CALL DAVE SELL AT (608) 210-6656 TO OBTAIN.

557 37300 FACS GROUP NEIC CLAIMS N558 SX072 FALLON COMMUNITY HEALTH NEIC Claims N N N559 43173 FAMILY HEALTH PARTNERS/MC+ MISSOURI NEIC N N N ADDED 23-SEP-2002.560 TH045 FAMILY HEALTH PLAN NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

561 31147 FAMILY HEALTH PLAN (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR OHIO WORKERS COMP CLAIMS ONLY.

562 39158 FAMILY HEALTH PLAN COOPERATIVE - MILWAUKEE, WI

NEIC CLAIMS N N N CALL KAREN MILLS AT (262) 787-2705 PRIOR TO SUBMITTING CLAIMS.

563 39162 FAMILY HEALTH SYSTEMS - WI - COMMUNITY HEALTH PLAN


564 39158 FAMILY HEALTH SYSTEMS - WI - FAMILY HEALTH PLAN COOP.


565 39164 FAMILY HEALTH SYSTEMS - WI - NEIGHBORLY CARE PLAN


566 39167 FAMILY HEALTH SYSTEMS - WI/GROUP HEALTH COOPERATIVE

NEIC CLAIMS N N N NOW KNOWN AS GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN. (FORMERLY FAMILY HEALTH SYSTEMS - WI/GROUP HEALTH COOPERATIVE)

567 39168 FAMILY HEALTH SYSTEMS - WI/GROUP HEALTH COOPERATIVE

NEIC ENCOUNTERSN N N NOW KNOWN AS GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN. (FORMERLY FAMILY HEALTH SYSTEMS - WI/GROUP HEALTH COOPERATIVE)

568 FPA11 FAMILY PRACTICE ASSOCIATES THIN Y N Y569 TH007 FAMILY PRACTICE ASSOCIATES NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION. PROVIDER

ID REQUIRED. PLEASE CALL (409) 721-5900 TO OBTAIN.

570 37289 FARA NEIC CLAIMS N571 37289 FARA BENEFIT SERVICES, INC. NEIC CLAIMS N572 PILOT FCE BENEFIT ADMINISTRATORS NEIC CLAIMS N573 37300 FEDERATED BENEFITS NEIC CLAIMS N574 37300 FEDERATED HR SERVICES NEIC CLAIMS N575 41041 FEDERATED MUTUAL INSURANCE NEIC CLAIMS N N N576 11315 FIDELIS CARE NEW YORK NEIC CLAIMS N577 11315 FIDELIS CARE NY NEIC CLAIMS N578 Pilot FIDELIS CARE NY NEIC Claims N N N579 69140 FIRST ALLMERICA FINANCIAL LIFE INS. CO. NEIC CLAIMS N N N (FORMERLY ALLMERICA FINANCIAL)580 56196 FIRST CAROLINA CARE NEIC CLAIMS N N N581 14162 FIRST CHOICE (CT) NEIC Claims Y N N Please note that all claims submitted require a 5-8 character Render Provider

Network ID.582 91131 FIRST CHOICE HEALTH NETWORK NEIC Claims N N N583 PILOT FIRST CHOICE OF MIDWEST (PPO) NEIC CLAIMS N584 75138 FIRST CHOICE OF MIDWEST (PPO) NEIC CLAIMS N585 14162 FIRST CHOICE(CT) NEIC CLAIMS Y N N PLEASE NOTE THAT ALL CLAIMS SUBMITTED REQUIRE A 5-8

CHARACTER RENDER PROVIDER NETWORK ID. (NetworkId)

586 87043 FIRST HEALTH NEIC CLAIMS N N N587 6108 FIRST OPTION HEALTH PLAN NEIC CLAIMS Y N N UNIQUE PROVIDER ID REQUIRED, CALL (203) 381-7618.

588 22324 FIRST OPTION HEALTH PLAN NEIC CLAIMS N N N EFFECTIVE IMMEDIATELY. PLEASE USE PHS PAYER ID 06108. CLAIMS SUBMITTED AFTER SEPTEMBER 1ST USING THE FOHP PAYER ID(22324) WILL BE REJECTED. BEFORE SUBMITTING YOUR FIRST EDI CLAIMS, PLEASE CONTACT AN FOHP/PHS REPRESENTATIVE AT (800) 848-4747, EXT. 5680.

589 23241 FIRST PRIORITY NEIC CLAIMS N N N590 63080 FIRST STATE HEALTH PLAN NEIC CLAIMS N N N PREVIOUSLY PAYER ID 51035591 94999 FIRSTCARE THIN Y N Y592 TH003 FIRSTCARE NEIC CLAIMS E TRANSITIONAL PAYER PROVIDER ID REQUIRED. PLEASE CALL

WebMD (800) 365-1051 EXT. 6456 FOR SUSAN OR EXT. 5141 FOR CHRIS TO OBTAIN.

593 TH003 FIRSTCARE "STAR" MEDICIAD NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION. PROVIDER ID REQUIRED. PLEASE CALL (800) 365-1051 TO OBTAIN. THE INSURED ID MUST BE 9 ALPHANUMERIC CHARACTERS AND 2 DIGITS.

594 90060 FIRSTGUARD HEALTH PLAN NEIC CLAIMS N N N

595 62061 FISERV HEALTH - KANSAS/TENNESSEE NEIC CLAIMS N (FORMERLY WILLIS ADMINISTRATIVE SERVICES CORPORATION)

596 11244 FITZHARRIS & COMPANY, INC. NEIC CLAIMS N597 68241 FLEXCARE NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE


598 59276 FLORIDA 1ST NEIC CLAIMS N N N599 59321 FLORIDA HOSPITAL HEALTHCARE SYSTEMS NEIC CLAIMS N IN-NETWORK FHHS PROVIDERS MUST SUBMIT EITHER THEIR UPIN

NUMBER OR FHHS PROVIDER ID, AS THE RENDERING PROVIDER NUMBER. OUT-OF-NETWORK PROVIDERS MUST CONTACT FHHS AT (407) 741-4893. THE FHHS MEMBER MEMBER ID MUST BE 11 DIGITS IN LENGTH.

600 Pilot FLORIDA HOSPITAL HEALTHCARE SYSTEMS NEIC Claims N N N601 48116 FLORIDA HOSPITAL WATERMAN NEIC CLAIMS N N N602 68241 FLORIDA POWER & LIGHT NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE


603 48117 FMH BENEFIT SERVICES, INC. NEIC CLAIMS N N N604 PILOT FORMAX, INC. NEIC CLAIMS N605 87066 FORMAX, INC. NEIC CLAIMS N606 70408 FORTIS BENEFITS NEIC CLAIMS N N N607 70408 FORTIS BENEFITS INSURANCE COMPANY NEIC CLAIMS N608 39065 FORTIS INSURANCE COMPANY NEIC CLAIMS N N N (FORMERLY TIME INSURANCE)609 FHFLC FOUNDATION HEALTH OF FLORIDA FL NEIC N N N610 59257 FOUNDATION HEALTH PLAN (SUNRISE, FL) NEIC N N N ADDED 23-SEP-2002.611 TH056 FOX VALLEY MEDICINE NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

612 64069 FOX-EVERETT, INC. NEIC CLAIMS N N N613 64067 FOXEVERETT - INGALLS SHIP BUILDING NEIC CLAIMS N N N614 MPI_REJECTFREECLAIMS INTERNAL CODE FOR REJECT CLAIMS MPI_REJECT N N N615 SPRNT FREECLAIMS INTERNAL ID FOR PAPER CLAIMS - ***

BILLABLE ***PAPER N N N ADDED 03/01/2002

616 MPI_PAPERFREECLAIMS PAPER CLAIMS SERVICE (BILL TO SUBMITTER)

PAPER N N N FREECLAIM HARDCODED PAYOR FOR PAPER CLAIMS ONLY

617 PAPER FREECLAIMS PAPER CLAIMS SERVICE (BILL TO SUBMITTER)

PAPER N N N FREECLAIMS HARDCODED FOR PAPER CLAIMS

618 59204 FRINGE BENEFITS COORDINATORS NEIC CLAIMS N619 67815 G.E. GROUP LIFE ASSURANCE COMPANY NEIC CLAIMS N620 67814 G.E. GROUP LIFE ASSURANCE COMPANY NEIC Claims N N N621 37283 GALLAGHER BENEFIT ADMINISTRATORS, INC/GBA NEIC CLAIMS N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.622 30005 GALVESTON COUNTY INDIGENT HEALTH CARE NEIC CLAIMS N623 31147 GATES MCDONALD HEALTH PLUS, INC. (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


624 25169 GATEWAY HEALTH PLAN NEIC CLAIMS N N N625 37283 GBA NEIC CLAIMS N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.

626 6143 GE GROUP ADMINISTRATORS NEIC CLAIMS N (FORMERLY PHOENIX GROUP SERVICES, INC.)627 75238 GE GROUP ADMINISTRATORS NEIC CLAIMS N628 6143 GE GROUP ADMINISTRATORS NEIC Claims N N N (Formerly Phoenix Group Services, Inc.)629 6143 GE GROUP ADMINISTRATORS, SOUTH CAROLINA NEIC CLAIMS N (FORMERLY PHOENIX GROUP SERVICES, INC.)630 75238 GE GROUP ADMINISTRATORS, TEXAS NEIC CLAIMS N (FORMERLY PHOENIX GROUP SERVICES - TEXAS)631 75273 GEISINGER HEALTH PLAN NEIC CLAIMS Y N Y PAYER REQUIRES ENROLLMENT. FOR AN ENROLLMENT FORM,

PLEASE CONTACT THE PAYER AT (570) 271-8077.

632 63665 GENELCO (ST. LOUIS) NEIC CLAIMS N N N633 63665 GENERAL AMERICAN LIFE INSURANCE COMPANY NEIC Claims N N N634 16112 GENESEE COUNTY MEDICAL PLAN NEIC Claims N N N635 31147 GENEX CARE OF OHIO (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


636 GABCS GEORGIA BLUE CROSS GABCS Claims Y Y Y ADDED 07/02/2002. LIVE 01/15/2004.637 58207 GEORGIA HEALTH PLUS NEIC CLAIMS N N N638 GAMCR GEORGIA MEDICARE PART-B GAMCR Y Y Y ADDED 07/02/2002.639 61271 GEORGIA POWER MEDICAL BENEFITS PLAN NEIC CLAIMS N N N640 91051 GH BASIC HEALTH PLAN NEIC Claims N N N Western Washington State. Please call (206) 901-6347 prior to first

submission of production claims.641 91051 GH INDIVIDUAL AND FAMILY PLAN NEIC Claims N N N Western Washington State. Please call (206) 901-6347 prior to first

submission of production claims.642 91051 GHC - COMMERCIAL NEIC Claims N N N Western Washington State. Please call (206) 901-6347 prior to first

submission of production claims.643 91051 GHC MEDICARE + CHOICE NEIC Claims N N N Western Washington State. Please call (206) 901-6347 prior to first

submission of production claims.644 13551 GHI - NEW YORK (GROUP HEALTH INC.) NEIC CLAIMS Y N N FOR ELECTRONIC GHI PROVIDERS PRIOR TO 1/1/98; CERTIFICATION

PROCESS IS REQUIRED. PLEASE CALL PROVIDER SUPPORT AT (212) 615-4EMC.

645 25531 GHI HMO NEIC Claims N N N646 25531 GHI HMO SELECT NEIC CLAIMS N N N647 25141 GHP (GROUP HEALTH PLAN) NEIC Y Y N CONTACT: RENEE CRUMLISH TEL:(302)283-6570. NETWORKID AND

GROUPNETWORKID NEEDED. CONTACT GHP PROVIDER REPS TO GET YOUR IDS.

648 58204 GI INNOVATIVE MANAGEMENT NEIC Claims N N N649 80314 GIC INDEMNITY PLAN NEIC Claims N N N650 7205 GILSBAR, INC. NEIC Claims N N N651 91136 GLASSWORKERS HEALTH & WELFARE FUND NEIC Claims N N N Please enter Group Number (F29) when submitting claims.

652 37602 GOLDEN RULE INSURANCE COMPANY NEIC CLAIMS N N N653 TH009 GOLDEN TRIANGE PHYSICIAN ASSOCIATES NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION. PAYER-

ASSIGNED PROVIDER ID REQUIRED. PLEASE CALL (409) 721- 5900 TO OBTAIN.

654 GTPA1 GOLDEN TRIANGLE PHYSICIAN SYSTEMS THIN Y N Y655 44054 GOVERNMENT EMPLOYEES HOSPITAL

ASSOCIATION (GEHA)NEIC CLAIMS N N N

656 37234 GRANT PHYSICIANS PRACTICE ASSOCIATION NEIC N N N ADDED 23-SEP-2002.657 95467 GREAT LAKES HEALTH PLAN NEIC CLAIMS N N N658 80705 GREAT-WEST HEALTHCARE NEIC CLAIMS N659 80705 GREAT-WEST LIFE & ANNUITY INS. CO. NEIC CLAIMS N N N660 80705 GREAT-WEST LIFE & ANNUITY INS. CO. NEIC ERA N N N661 TH010 GREENTREE ADMINISTRATORS NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

662 36338 GROUP ADMINISTRATORS LTD. NEIC CLAIMS N N N663 48143 GROUP AND PENSION ADMINISTRATORS NEIC CLAIMS N664 72153 GROUP BENEFIT ADMINISTRATORS

(HENDERSONVILLE, TN)NEIC CLAIMS N

665 38223 GROUP BENEFIT SERVICES, INC. NEIC CLAIMS N N N PAYER ID VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION ADDRESS OF P.O. BOX 1386, EAST LANSING, MI 48826-1386.

666 91121 GROUP HEALTH COOPERATIVE - EAST NEIC CLAIMS N N N EASTERN WASHINGTON STATE AND NORTHERN IDAHO. SIGNED PROVIDER AGREEMENT REQUIRED - PLEASE CALL (509) 241-7317 PRIOR TO SUBMITTING CLAIMS.

667 91051 GROUP HEALTH COOPERATIVE - WEST NEIC CLAIMS N N N WESTERN WASHINGTON STATE. PLEASE CALL (206) 901-6347 PRIOR TO FIRST SUBMISSION OF PRODUCTION CLAIMS.

668 39168 GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN

NEIC ENCOUNTERS N

669 39167 GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN

NEIC Claims N N N

670 61101 GROUP HEALTH INSURANCE - DE NEIC CLAIMS N N N671 38194 GROUP HEALTH MANAGERS NEIC CLAIMS N672 91051 GROUP HEALTH OPTIONS, INCORPORATED

ALLIANT PLUSNEIC Claims N N N Western Washington State. Please call (206) 901-6347 prior to first

submission of production claims.673 91051 GROUP HEALTH OPTIONS, INCORPORATED

ALLIANT SELECTNEIC Claims N N N Western Washington State. Please call (206) 901-6347 prior to first


OPTIONSNEIC Claims N N N Western Washington State. Please call (206) 901-6347 prior to first


OPTIONS PRIMENEIC Claims N N N Western Washington State. Please call (206) 901-6347 prior to first


OPTIONS SELECTNEIC Claims N N N Western Washington State. Please call (206) 901-6347 prior to first

submission of production claims.677 16126 GUARDIAN CHOICE, THE NEIC CLAIMS N N N678 64246 GUARDIAN LIFE INSURANCE COMPANY OF NEIC CLAIMS N N N679 39180 GUNDERSEN LUTHERAN HEALTH PLAN, INC. NEIC CLAIMS N BEFORE SUBMITTING ELECTRONICALLY TO GUNDERSEN LUTHERAN

HEALTH PLAN, INC., ALL PROVIDERS MUST CALL SHARI OELKE AT (608) 775-8026.

680 37114 H.E.R.E.I.U WELFARE PENSION FUNDS NEIC Claims N N N681 36406 HARMONY HEALTH PLAN OF ILLINOIS NEIC CLAIMS N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.682 36405 HARMONY HEALTH PLAN OF INDIANA NEIC N N N ADDED 23-SEP-2002.683 95266 HARRINGTON BENEFIT SERVICES THIN CLAIMS N N N

684 6131 HARRINGTON BENEFIT SERVICES, INC. NEIC CLAIMS N (FORMERLY TPCM)685 75196 HARRINGTON BENEFIT SERVICES, INC. NEIC CLAIMS N (FORMERLY CENTRA)686 95266 HARRINGTON BENEFIT SERVICES, INC. NEIC CLAIMS N687 6131 HARRINGTON BENEFIT SERVICES, INC. NEIC Claims N N N (Formerly TPCM)688 59142 HARRINGTON BENEFIT SERVICES, INC. NEIC Claims N N N689 4245 HARVARD COMMUNITY HEALTH PLAN NEIC N N N ADDED 23-SEP-2002.690 4271 HARVARD PILGRIM HEALTH CARE NEIC CLAIMS Y N N PROVIDER ENROLLMENT REQD, CALL (800) 742-8326, EXT. 68998.

691 HIBCS HAWAII BLUE CROSS PPO - LIVE AS OF 05/08/2002 HIBCS Y Y Y PROVIDER MUST REGISTER WITH HMSA. PLEASE CONTACT YOUR PROVIDER REP FROM HIBCS. ADDED 02/12/2002

692 HIMCD HAWAII MEDICAID HIMCD Y Y Y ADDED 06/10/2002.693 86065 HAWKI NEIC CLAIMS N N N694 37111 HCH ADMINISTRATION (ILLINOIS) NEIC Claims N N N695 37329 HCHA ALBQ-SELF FUNDED NEIC Claims N N N696 82018 HCS - HEALTH CLAIMS SERVICE (BOISE, ID) NEIC CLAIMS N697 34185 HEALTH ADMINISTRATION SERVICE, INC. NEIC CLAIMS N N N698 23172 HEALTH ALLIANCE EXCLUSIVE & PLUS NEIC CLAIMS N N N699 77950 HEALTH ALLIANCE MEDICAL PLANS NEIC CLAIMS N N N700 38224 HEALTH ALLIANCE PLAN OF MICHIGAN NEIC CLAIMS N N N701 25126 HEALTH AMERICA INC./HEALTH

ASSURANCE/ADVANTRANEIC CLAIMS Y N N CONTACT: RENEE CRUMLISH TEL:(302)283-6570. NETWORK ID

REQUIRED. TYPICALLY USE PROV MEDICARE UPIN

702 34654 HEALTH AND WELFARE FUND OF THE PLUMBERS AND PIPEFITTERS LOCAL UNION NO. 396, OHI


703 25126 HEALTH ASSURANCE/HEALTH AMERICA, INC./ADVANTRA

NEIC CLAIMS Y N N CONTACT: RENEE CRUMLISH TEL:(302)283-6570. NETWORK ID REQUIRED. TYPICALLY USE PROV MEDICARE UPIN

704 68241 HEALTH CARE ALLIANCE (SEARS) NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

705 34193 HEALTH CARE PAYERS COALITION (TOLEDO, OH) NEIC Claims N N N Payer ID valid only for claims with a billing submission address of P.O. Box 741, Toledo, OH 43697-0741.

706 56142 HEALTH CARE SAVINGS, INC. NEIC Claims N N N707 22345 HEALTH CHOICE INC. NEIC CLAIMS N708 37263 HEALTH CONNECTICUT NEIC CLAIMS N709 62111 HEALTH COST SOLUTIONS NEIC CLAIMS N710 34158 HEALTH DESIGN PLUS (HUDSON, OH) NEIC Claims N N N711 16112 HEALTH ECONOMICS GROUP, INC. NEIC Claims N N N712 16120 HEALTH EZ NEIC Claims N N N713 75234 HEALTH FIRST - TYLER, TX NEIC CLAIMS N N N714 PILOT HEALTH FUTURE, LLC. NEIC CLAIMS N715 30946 HEALTH FUTURE, LLC. NEIC CLAIMS N716 TH049 HEALTH MANAGEMENT ADMINISTRATORS (HMA) NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

717 86065 HEALTH MANAGEMENT ASSOCIATES (HMA) NEIC CLAIMS N N N

718 31147 HEALTH MANAGEMENT SOLUTIONS (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR OHIO WORKERS COMP CLAIMS ONLY.

719 95567 HEALTH NET - CALIFORNIA NEIC CLAIMS N N N720 95567 HEALTH NET - CALIFORNIA NEIC ROSTERSN N N721 95570 HEALTH NET - CALIFORNIA (PROFESSIONAL

ENCOUNTERS ONLY)NEIC EncountersY N N Must submit with Health Net Submitter ID. Please contact Karen Campbell at

(916) 935-1461 to obtain Health Net Submitter ID.

722 38309 HEALTH NET OF ARIZONA NEIC CLAIMS Y N723 95567 HEALTH NET OF CALIFORNIA AND OREGON -

CLAIMSNEIC Claims N N N Contact Health Nets EDI Department at (800) 977-3568 prior to first claims

submission.724 6108 HEALTH NET OF THE NORTHEAST, INC. NEIC Claims Y N N Payer requires unique provider ID; (866) 334-4638.725 6108 HEALTH NET OF THE NORTHEAST, INC. NEIC CLAIMS Y N N PAYER REQUIRES UNIQUE PROVIDER ID. CALL 866-334-4638

726 22340 HEALTH NET OREGON NEIC CLAIMS N N N727 955670000 HEALTH NET-CALIFORNIA NEIC ROSTERSN N N728 20199 HEALTH NETWORK AMERICA NEIC CLAIMS N729 PHD05 HEALTH NETWORKS OF COLORADO SPRINGS CO NEIC N N N730 4286 HEALTH NEW ENGLAND NEIC Claims N N N731 4286 HEALTH NEW ENGLAND NEIC CLAIMS N732 58216 HEALTH ONE ALLIANCE NEIC CLAIMS N N N733 25138 HEALTH OPTIONS CONNECT NEIC N N N734 FC001 HEALTH OPTIONS OF FLORIDA FLBCS CLAIMS Y N Y CHANGE FROM RCVID OF FC001 TO FLBCS ON 01/14/04

735 SX030 HEALTH OPTIONS OF FLORIDA NEIC CLAIMS E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

736 6137 HEALTH PARTNERS - CONNECTICUT CT NEIC N N N737 80142 HEALTH PARTNERS - JACKSON, TN NEIC CLAIMS N N N738 62157 HEALTH PARTNERS - JACKSON, TN NEIC CLAIMS N N N739 SX009 HEALTH PARTNERS - MINNESOTA NEIC CLAIMS Y N Y NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

740 63092 HEALTH PARTNERS OF ALABAMA, INC. NEIC CLAIMS P741 63092 HEALTH PARTNERS SOUTHEAST NEIC CLAIMS P742 80142 HEALTH PARTNERS, PA NEIC Claims N N N All claims submitted require a valid Health Partners, PA, provider ID in the

Rendering Provider Network ID field.

743 37221 HEALTH PLAN MANAGEMENT NEIC CLAIMS N N N744 VOID-94254 HEALTH PLAN OF THE REDWOODS NEIC CLAIMS N N N TERMINATED AS OF 2/1/2003745 59256 HEALTH PLAN SOUTHEAST NEIC N N N ADDED 31-OCT-2002. PAYOR CONTACT: CHRIS CHATELAIN (800)833-

2169 EXT 603746 59256 HEALTH PLAN SOUTHEAST (TALLAHASSEE, FL) NEIC Claims N N N747 44273 HEALTH PLANS INC. NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.748 95435 HEALTH PLEDGE HMO NEIC CLAIMS N N N749 Pilot HEALTH RISK MANAGEMENT NEIC Claims N N N750 55438 HEALTH RISK MANAGEMENT NEIC CLAIMS N751 41170 HEALTH RISK MANAGEMENT, INC. NEIC CLAIMS N N N752 16105 HEALTH SERVICES MEDICAL CORPORATION NEIC CLAIMS N N N

753 34167 HEALTH SERVICES PREFERRED (HSP) BY EMERALD HEALTH

NEIC CLAIMS N N N

754 TH044 HEALTH SERVICES PURCHASING COALITION NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

755 SX044 HEALTH STRATEGIES NEIC CLAIMS N N N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

756 61101 HEALTH VALUE MANAGEMENT - DE (HUMANA) NEIC CLAIMS N N N757 84980 HEALTHCARE BENEFITS, INC (HBI) 84980

HEALTHFIRST (HMO)THIN Y Y N

758 11328 HEALTHCARE PARTNERS, IPA NEIC CLAIMS N FORMERLY HERITAGE NEW YORK MEDICAL GROUP.759 31147 HEALTHCARE TRANSACTION PROCESSING, INC

(HTP)NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


760 25143 HEALTHCARE USA NEIC N N N ADDED 23-SEP-2002.761 62168 HEALTHCHOICE OF MEMPHIS NEIC CLAIMS N N N762 59608 HEALTHEASE NEIC Claims N N N Please note that all claims submitted require a 5-9 character Rendering

Provider Network ID.763 59608 HEALTHEASE/STAYWELL HEALTH PLAN NEIC CLAIMS N N N764 FCHF1 HEALTHFIRST CLMNT N N N DO NOT USE-TESTING765 75234 HEALTHFIRST - TYLER, TX NEIC Claims N N N766 80141 HEALTHFIRST, INC. (NEW YORK) NEIC Claims Y N N All claims submitted require a valid Healthfirst, Inc. (NY) provider ID in the

Rendering Provider Network ID field.

767 23226 HEALTHGUARD OF LANCASTER NEIC CLAIMS N N N768 59087 HEALTHHELP NETWORK, INC. (HHNI) NEIC CLAIMS N N N769 96475 HEALTHLINK HMO NEIC CLAIMS Y N N PLEASE CALL PROVIDER RELATIONS DEPT AT (800) 624-2356 FOR

UNIQUE PROVIDER NUMBER. (Hcfa blk 33, PIN field)

770 90001 HEALTHLINK PPO NEIC CLAIMS Y N N PLEASE CALL PROVIDER RELATIONS DEPT AT (800) 624-2356 FOR UNIQUE PROVIDER NUMBER. (Hcfa blk 33, PIN field)

771 SX010 HEALTHMARK PLUS/HEALTHPOINT NEIC CLAIMS Y N Y NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

772 43132 HEALTHNET - KANSAS CITY, MO NEIC CLAIMS N N N773 AZHNT HEALTHNET OF ARIZONA AZ NEIC N N N774 94267 HEALTHPARTNERS(MINNESOTA) NEIC CLAIMS N N Y PAYOR REQUIRES HPFIN(PROVIDER ID) AND TP NUMBER FOR EACH

FACILITY SUBMITTING EDI CLAIMS. PLEASE CALL 952.883.7505 OPTION 2.

775 95266 HEALTHPLAN SERVICE HARRINGTON (COLUMBUS, THIN CLAIMS N N N776 59142 HEALTHPLAN SERVICES (OKLAHOMA) NEIC CLAIMS N N N777 59140 HEALTHPLAN SERVICES (TAMPA ONLY) NEIC CLAIMS N N N778 31106 HEALTHPOWER HMO THIN N N N779 6142 HEALTHRIGHT, INC. NEIC CLAIMS N N N780 CALL HEALTHSCOPE BENEFITS INC (PCP ONLY) NEIC N N Y ADDED 31-OCT-2002. CALL JONDA BROWN (800)972-3025 FOR

PAYORID781 71063 HEALTHSCOPE BENEFITS, INC. NEIC Claims N N N782 Call HEALTHSCOPE BENEFITS, INC. (PCP ONLY) NEIC Claims N N N Call Jonda Brown (800) 972-3025 for Payer ID.

783 48153 HEALTHSCOPE BENEFITS, INC. (REPRICING AR) NEIC Claims N N N784 HSPC1 HEALTHSMART PREFERRED CARE (HSPC) THIN N N N GROUP NAME AND ID IS REQUIRED BY HSPC785 75250 HEALTHSMART PREFERRED CARE, INC. NEIC CLAIMS N786 2041 HEALTHSOURCE CMHC NEIC CLAIMS N787 2041 HEALTHSOURCE CMHC NEIC Claims N N N788 2041 HEALTHSOURCE MASSACHUSETTS INC. NEIC CLAIMS N N N789 2041 HEALTHSOURCE MASSACHUSETTS, INC. NEIC CLAIMS N N N790 68195 HEALTHSOURCE PROVIDENT NEIC CLAIMS N CLAIMS ARE EDITED UNDER CIGNAS PAYER SPECIFIC EDITS, PAYER

ID 62308.791 68195 HEALTHSOURCE PROVIDENT (CIGNA) NEIC CLAIMS N N N CLAIMS ARE EDITED UNDER CIGNAS PAYER SPECIFIC EDITS, PAYER

ID 62308.792 68195 HEALTHSOURCE PROVIDENT (CIGNA) NEIC ERA N N N793 71074 HEALTHSOURCE, AR NEIC CLAIMS N N N PAYER REQUIRES PROVIDER ID NUMBER, CALL (800) 831-6654.

794 71075 HEALTHSOURCE, AR (MED) (CIGNA) NEIC CLAIMS N N N CLAIMS ARE EDITED UNDER CIGNAS PAYER SPECIFIC EDITS, PAYER ID 62308.

795 58210 HEALTHSOURCE, GA (CIGNA) NEIC CLAIMS N N N CLAIMS ARE EDITED UNDER CIGNAS PAYER SPECIFIC EDITS, PAYER ID 62308.

796 35167 HEALTHSOURCE, IN NEIC CLAIMS N N N797 61127 HEALTHSOURCE, KY NEIC CLAIMS N N N798 1041 HEALTHSOURCE, ME NEIC CLAIMS N N N REQUIRES UNIQUE PROVIDER ID, CONTACT (800) 909-2227, EXT. 5760.

799 75255 HEALTHSOURCE, N. TX (CIGNA) NEIC CLAIMS N N N CLAIMS ARE EDITED UNDER CIGNAS PAYER SPECIFIC EDITS, PAYER ID 62308.

800 56147 HEALTHSOURCE, NC (CIGNA) NEIC CLAIMS N N N CLAIMS ARE EDITED UNDER CIGNAS PAYER SPECIFIC EDITS, PAYER ID 62308.

801 2038 HEALTHSOURCE, NH NEIC CLAIMS N N N PAYER REQUIRES UNIQUE PROVIDER ID FOR NEW PROVIDERS, PLEASE CONTACT PAYER.

802 16126 HEALTHSOURCE, NY NEIC CLAIMS N N N803 31141 HEALTHSOURCE, OH NEIC CLAIMS N N N804 6119 HEALTHSOURCE, SC NEIC CLAIMS N N N HEALTHSOURCE NETWORK PROVIDERS ONLY805 PILOT HEALTHSOURCE, SC NEIC ENCOUNTERS N806 62129 HEALTHSOURCE, TN (CIGNA) NEIC CLAIMS N N N CLAIMS ARE EDITED UNDER CIGNAS PAYER SPECIFIC EDITS, PAYER

ID 62308.807 CALL HEALTHSOURCE/HUDSON HEALTH PLAN NEIC N N Y ADDED 31-OCT-2002. CALL SAM GUTWILLIG (914)372-2291 FOR

PAYORID. ENROLLMENT REQUIRED ALSO

808 63086 HEALTHSOUTH MEDICAL PLAN ADMINISTRATORS NEIC CLAIMS N N N809 Pilot HEALTHSPRING HMO/HEALTHSPRING MED+CHOICE NEIC Claims N N N810 25193 HEALTHSPRING HMO/HEALTHSPRING

MEDICARE+CHOICENEIC CLAIMS N AN EDI APPLICATION MUST BE SUBMITTED PRIOR TO SUBMITTING

CLAIMS. PLEASE CONTACT PROVIDER RELATIONS AT (615) 291-7035 OR VISIT WWW.MYHEALTHSPRING.COM TO OBTAIN AN APPLICATION. THIS PAYER ID IS NOT FOR PPO CLAIMS.

811 63092 HEALTHSPRING OF ALABAMA NEIC CLAIMS P FORMERLY THE OATH - A HEALTH PLAN FOR ALABAMA. PLEASE NOTE THAT ALL CLAIMS SUBMITTED REQUIRE A 4-6 DIGIT RENDERING PROVIDER ID. PLEASE CONTACT HEALTHSPRING OF ALABAMA PROVIDER CALL CENTER AT (800) 743-7141 FOR PROVIDER ENROLLMENT.

812 36332 HEALTHSTAR, INC. NEIC CLAIMS N N N813 69140 HEALTHY CHOICE, HEALTHY CHOICE PLUS NEIC CLAIMS N N N814 91051 HEALTHY OPTIONS (DSHS) NEIC Claims N N N Western Washington State. Please call (206) 901-6347 prior to first

submission of production claims.815 4286 HEATH NEW ENGLAND NEIC CLAIMS N N N816 2041 HEATHSOURCE CMHC NEIC CLAIMS N N N817 CALL HEP ADMINISTRATORS (NON-PPO) NEIC N N Y ADDED 31-OCT-2002. CALL CUSTOMER SERVICE (262)679-9695 FOR

PAYORID. ENROLLMENT REQUIRED ALSO

818 CALL HEP ADMINISTRATORS (PPO) NEIC N N Y ADDED 31-OCT-2002. CALL CUSTOMER SERVICE (262)679-9695 FOR PAYORID. ENROLLMENT REQUIRED ALSO

819 Call HEP ADMINISTRATORS, INC. (NON-PPO) NEIC Claims N N N Prior enrollment is required. Please call customer service at (262) 567-9695.

820 59230 HERITAGE CONSULTANTS NEIC CLAIMS N N N FOR FASTER PAYMENT, PLEASE BE SURE TO USE ONLY THE 9-DIGIT SUBSCRIBER ID ON ALL CLAIMS.

821 11328 HERITAGE NEW YORK MEDICAL GROUP NEIC CLAIMS N N N822 TH011 HERITAGE PHYSICIAN NETWORK NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION. PAYER-

ASSIGNED PROVIDER ID REQUIRED. PLEASE CALL (409) 721- 5900 TO OBTAIN.

823 HPN11 HERITAGE PHYSICIAN NETWORK (HOUSTON) THIN Y N Y NETWORK ID REQUIRED (BOX 33,PIN FIELD). CALL 800-544-5428 TO OBTAIN ID

824 36335 HFN, INC. NEIC CLAIMS N N N825 46 HILL PHYSICIAN MEDICAL GROUP NEIC Y N N ADDED 04/22/2002. MUST HAVE NETWORKID ON CLAIM. CONTACT

TINA LOFTUS AT (800)455-5747 TO GET YOUR NETWORKID

826 Call HILL PHYSICIANS MEDICAL GROUP NEIC Claims N N N Please contact Tina Loftus at (800) 445-5747 for Payer ID.

827 37115 HINSDALE PHYSICIANS HEALTHCARE NEIC CLAIMS N N N828 55247 HIP - HEALTH INSURANCE PLAN OF GREATER NEW

YORKNEIC CLAIMS Y N N INDIVIDUAL PROVIDER ENROLLMENT AND TESTING IS REQUIRED BY

PAYER. PLEASE CALL HIP OF NY PROVIDER RELATIONS AT (212) 630-8711.

829 AXH01 HIPNYANESTHESIA NEIC CLAIMS N N N CALL CUSTOMER SERVICE (800) 424-5848.830 86065 HMA NEIC CLAIMS N N N831 86065 HMA, INC. (ARIZONA) NEIC Claims N N N832 MDHMO HMO BLUE MEDICAID TX THIN N N N "(**27 max lines FA0) **Receiver Type ""D"""833 TH001 HMO BLUE STAR PLUS NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION. PROVIDER

ID REQUIRED. PLEASE CONTACT (602) 331-5100, EXT. 5563 TO OBTAIN.

834 76058 HMO BLUE TEXAS / ARIA NEIC Y N N ADDED 23-SEP-2002.

835 COHMO HMO OF COLORADO CO NEIC N N N (**12 max lines FA0)836 61101 HMPK, INC. NEIC CLAIMS N N N837 34150 HOMETOWN HEALTH NETWORK NEIC CLAIMS N N N838 22099 HORIZON BLUE CROSS BLUE SHIELD OF NEW

JERSEY (HORIZON BCBSNJ)NEIC Claims Y N N Participating Payer - see last page for definition.

839 22304 HORIZON HEALTHCARE ADMIN (HHA) NEIC Claims N N N840 22326 HORIZON MERCY NEIC CLAIMS N N N MEDICAID MANAGED CARE. PAYER REQUIRES REGISTRATION AND

TESTING, CALL (877) 234-4273.841 91136 HOTEL EMPLOYEES & RESTAURANT EMPLOYEES

HEALTH TRUSTNEIC Claims N N N Please enter Group Number (F19) when submitting claims.

842 91136 HOTEL EMPLOYEES & RESTAURANT EMPLOYEES HEALTH TRUST - GRP# F19

NEIC CLAIMS N N N PLEASE INCLUDE GROUP NUMBER WHEN SUBMITTING CLAIMS.

843 61101 HPLAN, INC. NEIC CLAIMS N N N844 VOID-94254 HPR (HEALTH PLAN OF THE REDWOODS) NEIC CLAIMS N N N TERMINATED AS OF 2/1/2003845 58227 HPS PARADIGM, INC. NEIC CLAIMS N N N846 41170 HRM NEIC CLAIMS N N N847 41170 HRM CLAIM MANAGEMENT NEIC CLAIMS N N N848 61102 HUMANA NEIC ENCOUNTERSN N N849 73288 HUMANA - EMPLOYERS HEALTH INSURANCE NEIC CLAIMS N N N850 61101 HUMANA CARE PLAN NEIC CLAIMS N N N851 61101 HUMANA EMPHESYS NEIC CLAIMS N852 61101 HUMANA EMPLOYERS HEALTH INSURANCE NEIC CLAIMS N853 61101 HUMANA GROUP HEALTH PLAN NEIC CLAIMS N N N854 61101 HUMANA HEALTH CHICAGO NEIC CLAIMS N N N855 61101 HUMANA HEALTH CHICAGO INSURANCE COMPANY NEIC CLAIMS N N N856 61101 HUMANA HEALTH PLAN NEIC CLAIMS N N N857 61101 HUMANA INC. NEIC CLAIMS N858 61102 HUMANA INC. ENCOUNTERS NEIC EncountersN N N Claims sent to payer id 61102 will NOT be paid. Payer ID 61102 is for

ENCOUNTERS ONLY.859 61101 HUMANA INSURANCE AGENCY NEIC CLAIMS N N N860 61101 HUMANA INSURANCE COMPANY NEIC CLAIMS N N N861 61101 HUMANA INSURANCE COMPANY CHOICE CARE

NETWORKNEIC CLAIMS N DOES NOT INCLUDE HUMANA CHOICECARE OF CINCINNATI -

(HUMANA HEALTH PLANS OF OHIO)862 61101 HUMANA MEDICAL PLAN - CA NEIC CLAIMS N N N863 61101 HUMANA MEDICAL PLAN - KY NEIC CLAIMS N N N864 61125 HUMANA MILITARY - TRICARE: REGIONS 3 AND 4 NEIC Claims Y N N Participating Payer for TRICARE Regions 3 and 4 .865 65018 HUMANA PUERTO RICO NEIC Claims Y N N866 61101 HUMANA WISCONSIN HEALTH ORGANIZATION NEIC CLAIMS N N N867 61103 HUMANA WORKERS COMP - OHIO NEIC N N N868 HUMAR HUMANA/ARIA NEIC N N N869 37260 HUNT INSURANCE GROUP NEIC Claims N N N870 37260 HUNT INSURANCE GROUP / HRH TPA SERVICES NEIC N N N LOCATED IN TALLAHASSEE, FLORIDA. CONTACT: CINDY CLAWSON.

TEL:(850)385-3636 EXT 227.871 41600 I'MCARE NEIC CLAIMS N N N872 22175 I. E. SHAFFER (WEST TRENTON, NJ) NEIC CLAIMS N873 37279 IAA NEIC CLAIMS N874 38234 IBA SELF FUNDED GROUP NEIC N N N ADDED 23-SEP-2002.

875 41124 IBI NEIC CLAIMS N N N876 68241 IBM MEDICAL PLANS NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE


877 37296 ICM NEIC CLAIMS N878 AIDID IDAHO MEDICAID THIN Y Y N879 36600 ILLINOIS CENTRAL HOSPITAL ASSOCIATION

(TINLEY PARK, IL)NEIC CLAIMS N

880 41600 IMCARE NEIC CLAIMS N881 PILOT INDECS CORPORATION NEIC CLAIMS N882 CALL INDEPENDENT HEALTH NEIC CLAIMS E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

PLEASE CONTACT E-COMMERCE AT (716) 635-3911 PRIOR TO FIRST SUBMISSION OF CLAIMS.

883 SX073 INDEPENDENT HEALTH NEIC N N N884 35204 INDIANA HEALTH NETWORK NEIC N N N ADDED 23-SEP-2002.885 35161 INDIANA PROHEALTH NETWORK NEIC CLAIMS N N N886 31053 INDIVIDUAL HEALTH INSURANCE COMPANIES NEIC CLAIMS N N N887 52196 INFORMED, LLC NEIC Claims N N N888 52196 INFORMED,LLC NEIC CLAIMS N N N889 4320 INNOVATIVE HEALTHCARE SOLUTIONS NEIC CLAIMS N N N890 4320 INNOVATIVE HEALTHWARE SOLUTIONS NEIC Claims N N N891 4320 INNOVATIVE HEALTHWARE SOLUTIONS NEIC CLAIMS N892 68241 INSTITUTES OF QUALITY NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE


893 37279 INSURANCE ADMINISTRATORS OF AMERICA, INC. NEIC CLAIMS N894 63082 INSURANCE CLAIMS SERVICES, INC. (BIRMINGHAM, NEIC Claims N N N895 63082 INSURANCE CLAIMS SERVICES, INC.(BIRMINGHAM, NEIC CLAIMS N N N896 13315 INSURANCE DESIGN ADMINISTRATORS NEIC CLAIMS N N N897 88006 INSURANCE MANAGEMENT SERVICES (ELKO, NV) NEIC CLAIMS N898 ISL11 INSURANCE SERVICE OF LUBBOCK THIN N N N899 TH012 INSURANCE SERVICES OF LUBBOCK NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

900 SX011 INSURDATA/INSURNATIONAL NEIC CLAIMS Y N Y NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

901 IAC01 INSURER'S ADMINISTRATIVE CORPORATION THIN Y Y Y902 51020 INTEGRA ADMINISTRATIVE GROUP (SEAFORD, DE) NEIC CLAIMS N PAYER ID VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION

ADDRESS OF 110 S. SHIPLEY STREET, SEAFORD, DE 19973.

903 31127 INTEGRA GROUP NEIC CLAIMS N N N904 31129 INTEGRA GROUP-CHA NEIC CLAIMS N N N905 34167 INTEGRATED CARE NETWORK (ICN) BY EMERALD

HEALTHNEIC CLAIMS N N N

906 37227 INTERCARE HEALTH PLANS INC. NEIC Claims N N N907 37227 INTERCARE HEALTH PLANS, INC. NEIC CLAIMS N N N908 23287 INTERGROUP SERVICES CORPORATION NEIC CLAIMS N N N

909 36609 INTERNATIONAL BROTHERHOOD OF NEIC CLAIMS N910 37269 INTERNATIONAL UNION OF OPERATING

ENGINEERS ~ LOCAL 15, 15A, 15C & 15DNEIC CLAIMS N LOCATED IN NEW YORK, NY

911 37241 INTERNATIONAL UNION OF OPERATING ENGINEERS, LOCAL 4 HEALTH & WELFARE FUND

NEIC N N N ADDED 23-SEP-2002.

912 37269 INTERNATIONAL UNION OF OPERATION ENGINEERS ~ LOCAL 15, 15A, 15C & 15D

NEIC Claims N N N

913 41124 IOWA BENEFITS INC. NEIC CLAIMS N N N914 86065 IOWA HEALTH SOLUTIONS NEIC CLAIMS N N N915 TH043 IOWA IRON WORKERS LOCAL 189 HEALTH PLAN NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

916 TH043 IOWA LABORERS NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

917 TH042 IOWA OPERATING ENGINEERS NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

918 37241 IUOE LOCAL 4 NEIC CLAIMS N PAYER ID VALID ONLY IF BILLING SUBMISSION ADDRESS IS 177 BEDFORD STREET, P.O. BOX 4, LEXINGTON, MA 02420 AND GROUP NUMBER = 300. CONTACT JAMIE MACLAUCHLAN AT (781) 861-1600 EXT. 24 WITH QUESTIONS.

919 61271 J. F. MOLLOY AND ASSOCIATES, INC. NEIC CLAIMS N N N920 TH033 JI SPECIALTIES NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

921 JISSP JI SPECIALTY THIN N N N922 41099 JOHN ALDEN LIFE INSURANCE CO. NEIC CLAIMS N N N923 95378 JOHN DEERE HEALTH CARE/HERITAGE NATIONAL

HEALTHPLANNEIC CLAIMS Y N Y CERT. REQD - CALL (309) 765-1072.

924 52189 JOHN HOPKINS NEIC N N N ADDED 01/21/2002925 37215 JOHN P PEARL & ASSOCIATES NEIC CLAIMS N N N926 Pilot JOHNS HOPKINS HEALTHCARE NEIC Claims N N N927 43178 JOPLIN CLAIMS NEIC CLAIMS N N N928 34136 JP FARLEY CORPORATION NEIC CLAIMS N N N929 MWS01 JPS METROWEST START MEDICAID (TEXAS) THIN Y Y Y930 37272 JSL ADMINISTRATORS NEIC CLAIMS N931 21313 KAISER FOUNDATION HEALTH PLAN OF GEORGIA NEIC CLAIMS N N N932 CALL KAISER FOUNDATION HEALTH PLAN OF NORTHERN

CANEIC N N Y PAYORID=CALL TINA CHEUNG AT (626)405-6404. LOCATE IN LOS

ANGELES, CALIFORNIA. INSURED ID IS ALL NUMERIC UP TO 8 CHARACTERS

933 Call KAISER FOUNDATION HEALTH PLAN OF NORTHERN CA REGION

NEIC Claims N N N Contact Tina Cheung at (626) 405-6404 prior to first submission of claims.

934 94134 KAISER FOUNDATION HEALTH PLAN OF SOUTHERN CA REGION

NEIC CLAIMS Y N N COMMERCIAL PROVIDER ID REQUIRED BY KAISER. PLEASE CALL CATHY PLATTNER AT (626) 564-3725 PRIOR TO SUBMITTING CLAIMS.

935 52095 KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC.

NEIC CLAIMS N N N FOR MORE INFO, PLEASE CALL KENYA NEAL AT KAISER AT 301.625.2264

936 52095 KAISER FOUNDATION HEALTH PLAN OF THE MID- ATLANTIC STATES, INC.

NEIC CLAIMS N FOR MORE INFORMATION, PLEASE CONTACT KENYA NEAL AT KAISER AT (301) 625-2264.

937 52095 KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC.

NEIC Claims N N N For more information, please contact Kenya Neal at Kaiser at (301) 625-2264.

938 23742 KAISER PERMANETE - NORTHEAST DIVISION NEIC CLAIMS N N N CERT. REQD - CALL (518) 783-1864, EXT. 40422.939 23742 KAISER PERMANETE - NORTHEAST DIVISION NEIC ENCOUNTERSN N N CERT. REQD - CALL (518) 783-1864, EXT. 40422.940 57038 KANAWHA HEALTHCARE SOLUTIONS, INC. NEIC Claims N N N941 57038 KANAWHA INSURANCE CO. NEIC CLAIMS N N N942 44030 KANSAS CITY LIFE INSURANCE CO. NEIC CLAIMS N N N943 TH050 KELSEY-SEYBOLD NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

944 73100 KEMPTON COMPANY NEIC CLAIMS N N N945 73100 KEMPTON GROUP ADMINISTRATORS NEIC CLAIMS N N N946 63077 KENTUCKY HEALTH SELECT NEIC CLAIMS N N N947 61101 KENTUCKY KARE NEIC CLAIMS N N N948 37124 KEPPLE & COMPANY NEIC CLAIMS N N N (FORMERLY INTEGRATED BENEFIT SERVICES)949 37217 KEY BENEFIT ADMINISTRATORS NEIC CLAIMS N N N950 PILOT KEY HEALTH NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

951 23284 KEYSTONE MERCY HEALTH PLAN NEIC CLAIMS N N N MEDICAID MANAGED CARE. PAYER REQUIRES REGISTRATION AND TESTING, CALL (877) 234-4271.

952 KPS01 KIDSAP PHYSICIANS SERVICES THIN N N N953 73288 KINDRED HEALTH CARE NEIC CLAIMS N (FORMERLY KNOWN AS VENCOR) AS OF DECEMBER 1, 2002, PLEASE

SEND ALL MEDICAL AND HOSPITAL CLAIMS TO PAYER ID 61101. PLEASE SUBMIT ALL HUMANA ENCOUNTERS AND INFORMATIONAL CLAIMS TO PAYER ID 61102.

954 61101 KINDRED HEALTH CARE NEIC Claims N N N955 KPS01 KIRASP PHYSICIANS SERVICE NEIC N956 34145 KLAIS & COMPANY NEIC CLAIMS N957 31147 KLAIS & COMPANY (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


958 37112 LAKE FOREST MANAGED CARE ASSOCIATES NEIC CLAIMS N N N959 95415 LAKESIDE HEALTH SERVICES NEIC CLAIMS N N N960 75279 LEGGETT AND PLATT NEIC CLAIMS N N N961 37248 LHP CLAIMS UNIT NEIC Claims N N N962 11123 LIBERTY MUTUAL INSURANCE COMPANY NEIC CLAIMS N N N963 37281 LIBERTY UNION NEIC CLAIMS N964 37281 LIFE ASSURANCE COMPANY NEIC CLAIMS N965 41136 LIFE TRAC NEIC CLAIMS N966 94245 LIFEGUARD NEIC CLAIMS N967 LFGRD LIFEGUARD NEIC N (**12 max lines FA0)968 94245 LIFEGUARD (ADDED ON 12/27/2001) NEIC N N N969 TH001 LIFEMARK NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION. PROVIDER

ID REQUIRED. PLEASE CONTACT (602) 331-5100, EXT. 5563 TO OBTAIN.

970 93093 LIFEWISE - A PREMERA HEALTH PLAN NEIC CLAIMS N N N971 93093 LIFEWISE HEALTHPLAN OF OREGON NEIC CLAIMS N

972 37294 LIFEWISE/WASHINGTON EMPLOYERS TRUST NEIC CLAIMS N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.973 61101 LINCOLN NATIONAL NEIC Claims N N N974 73288 LINCOLN NATIONAL (EMPHESYS, GREEN BAY AND

MADISON, WI ONLY)NEIC CLAIMS N N N

975 61101 LINCOLN NATIONAL - PHOENIX, AZ (HUMANA) NEIC CLAIMS N N N976 75283 LINN COUNTY NEIC CLAIMS N977 35107 LOCAL 135 HEALTH BENEFITS FUND NEIC CLAIMS N N N978 37267 LOMA LINDA UNIVERSITY ADVENTIST HEALTH

SCIENCES CENTER EMPLOYEE HEALTH PLANNEIC CLAIMS N

979 37267 LOMA LINDA UNIVERSITY ADVENTIST HEALTH SCIENCES CENTERS

NEIC CLAIMS N

980 37267 LOMA LINDA UNIVERSITY BEHAVIORAL MEDICINE CENTER EMPLOYEE HEALTH PLAN

NEIC CLAIMS N

981 37267 LOMA LINDA UNIVERSITY EMPLOYEE HEALTH PLAN NEIC CLAIMS N982 37267 LOMA LINDA UNIVERSITY HEALTH CARE

EMPLOYEE HEALTH PLANNEIC CLAIMS N

983 37267 LOMA LINDA UNIVERSITY MEDICAL CENTER EMPLOYEE HEALTH PLAN

NEIC CLAIMS N

984 37267 LOMA LINDA UNIVERSITY MEDICAL CENTER RESIDENTS HEALTH PLAN

NEIC CLAIMS N

985 37267 LOMA LINDA UNIVERSITY STUDENT HEALTH PLAN NEIC CLAIMS N986 37226 LONDON HEALTH ADMINISTRATORS NEIC CLAIMS N N N987 68241 LOS ALAMOS TOTAL CARE (LATC) NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE


988 62310 LOVELACE SALUDE (Medicaid) NM NEIC N N N "Recieiver Type must be ""D"" for salude claims"989 62310 LOVELACE HEALTH PLAN NEIC CLAIMS N N N990 62310 LOVELACE SENIOR OPTIONS (LSO) NEIC CLAIMS N N N991 62310 LOVELACE SENIOR PLAN (LSP) NEIC CLAIMS N N N992 PILOT LUHR BROS INC. NEIC CLAIMS N TESTING REQUIRED: 20 INPATIENT AND 20 OUTPATIENT CLAIMS -

TEST CLAIMS SHOULD CONTAIN BILL TYPES THAT ARE REPRESENTATIVE OF PRODUCTION CLAIMS.

993 TH063 LUHR BROS INC. NEIC CLAIMS N PROVIDER ID REQUIRED FOR ALL THIN PAYERS.994 TH062 LUHR BROS INC./ IL&MO NEIC CLAIMS N PROVIDER ID REQUIRED FOR ALL THIN PAYERS.995 PILOT LUMENOS, INC. NEIC CLAIMS N996 54195 LUMENOS, INC. NEIC CLAIMS N997 37292 MACHINIST DISTRICT 9 WELFARE NEIC CLAIMS N998 22445 MAG MUTUAL HEALTHCARE SOLUTIONS NEIC CLAIMS N N N999 AXN17 MAGELLAN SPECIALTY HEALTH - CIGNA

CONNECTICUT, CARDIOLOGYNEIC CLAIMS N N N (FORMERLY ALLIED HEALTH GROUP)

1000 AXN16 MAGELLAN SPECIALTY HEALTH - CIGNA CONNECTICUT, GASTROENTEROLOGY

NEIC CLAIMS N N N (FORMERLY ALLIED HEALTH GROUP)

1001 AXN15 MAGELLAN SPECIALTY HEALTH - CIGNA CONNECTICUT, GENERAL SURGERY


1002 AXN18 MAGELLAN SPECIALTY HEALTH - CIGNA CONNECTICUT, ORTHOPEADIC


1003 AXN19 MAGELLAN SPECIALTY HEALTH - CIGNA CONNECTICUT, OTOLARYNGOLOGY


1004 AXN35 MAGELLAN SPECIALTY HEALTH - CIGNA CONNECTICUT, PHYSICAL THERAPY


1005 AXN20 MAGELLAN SPECIALTY HEALTH - CIGNA CONNECTICUT, RADIOLOGY


1006 AXM16 MAGELLAN SPECIALTY HEALTH - CIGNA MARYLAND/MID ATLANTIC,-MID-ATLANTIC HEART NETW

NEIC CLAIMS Y N Y (FORMERLY ALLIED HEALTH GROUP)

1007 AXM17 MAGELLAN SPECIALTY HEALTH - CIGNA MARYLAND/MID-ATLANTIC, CARDIOLOGY CARVE OUT


1008 AXM04 MAGELLAN SPECIALTY HEALTH - CIGNA MARYLAND/MID-ATLANTIC, DERMATOLOGY


1009 AXM02 MAGELLAN SPECIALTY HEALTH - CIGNA MARYLAND/MID-ATLANTIC, EAR, NOSE & THROAT


1010 AXM06 MAGELLAN SPECIALTY HEALTH - CIGNA MARYLAND/MID-ATLANTIC, NEUROSURGERY


1011 AXM05 MAGELLAN SPECIALTY HEALTH - CIGNA MARYLAND/MID-ATLANTIC, ORTHOPEADIC


1012 AXM07 MAGELLAN SPECIALTY HEALTH - CIGNA MARYLAND/MID-ATLANTIC, PLASTIC SURGERY


1013 AXM01 MAGELLAN SPECIALTY HEALTH - CIGNA MARYLAND/MID-ATLANTIC, SURGERY


1014 AXM03 MAGELLAN SPECIALTY HEALTH - CIGNA MARYLAND/MID-ATLANTIC, UROLOGY


1015 AXN09 MAGELLAN SPECIALTY HEALTH - CIGNA NEW JERSEY, CARDIOLOGY


1016 AXN13 MAGELLAN SPECIALTY HEALTH - CIGNA NEW JERSEY, DERMATOLOGY


1017 AXN08 MAGELLAN SPECIALTY HEALTH - CIGNA NEW JERSEY, GASTROENTEROLOGY


1018 AXN07 MAGELLAN SPECIALTY HEALTH - CIGNA NEW JERSEY, GENERAL SURGERY


1019 AXN14 MAGELLAN SPECIALTY HEALTH - CIGNA NEW JERSEY, OPHTHALMOLOGY


1020 AXN11 MAGELLAN SPECIALTY HEALTH - CIGNA NEW JERSEY, ORTHOPEADIC


1021 AXN12 MAGELLAN SPECIALTY HEALTH - CIGNA NEW JERSEY, OTOLARYNGOLOGY


1022 AXN10 MAGELLAN SPECIALTY HEALTH - CIGNA NEW JERSEY, UROLOGY


1023 AXN03 MAGELLAN SPECIALTY HEALTH - CIGNA NEW YORK, CARDIOLOGY

NEIC CLAIMS N N N

1024 AXN02 MAGELLAN SPECIALTY HEALTH - CIGNA NEW YORK, GASTROENTEROLOGY


1025 AXN01 MAGELLAN SPECIALTY HEALTH - CIGNA NEW YORK, GENERAL SURGERY


1026 AXN05 MAGELLAN SPECIALTY HEALTH - CIGNA NEW YORK, ORTHOPEADIC


1027 AXN06 MAGELLAN SPECIALTY HEALTH - CIGNA NEW YORK, OTOLARYNGOLOGY


1028 AXN04 MAGELLAN SPECIALTY HEALTH - CIGNA NEW YORK, UROLOGY


1029 AXC37 MAGELLAN SPECIALTY HEALTH - GUT MANAGEMENT, CIGNA FACILITY FEES


1030 AXC17 MAGELLAN SPECIALTY HEALTH - MAGELLAN UNITEDHEALTHCARE PLAN - GUT


1031 AXC05 MAGELLAN SPECIALTY HEALTH - MAGELLAN UNITEDHEALTHCARE PLAN - SKY


1032 PILOT MAGNACARE NEIC CLAIMS N1033 34103 MAHONING AND TRUMBULL COUNTY BUILDING

TRADES INSURANCE FUND, OHIONEIC CLAIMS N N N PAYER ID VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION

ADDRESS OF P.O. BOX 230, NILES, OH 44446.

1034 62413 MAIL HANDLERS BENEFIT PLAN NEIC CLAIMS N N N ALSO KNOWN AS MAILHANDLERS/CAC.1035 52148 MAMSI LIFE AND HEALTH INSURANCE CO. (MLH) NEIC CLAIMS Y N N1036 35162 MANAGED CARE SERVICES, LLC NEIC Claims N N N1037 35162 MANAGED CARE SERVICES,LLC NEIC CLAIMS N N N1038 39186 MANAGED HEALTH SERVICES INDIANA (MEDICAID

HMO)NEIC Claims N N N Please contact Debbi Sandberg at (800) 225-2573, ext. 25306, prior to

sending claims.1039 39186 MANAGED HEALTH SERVICES INDIANA/MAXICARE

(MEDICAID HMO)NEIC CLAIMS N N N

1040 39187 MANAGED HEALTH SERVICES WISCONSIN NEIC CLAIMS N N N1041 41159 MANAGED PHYSICAL NETWORK NEIC Claims N N N1042 41159 MANAGED PHYSICAL NETWORK (MPN) NEIC N N N LOCATED IN KINGSTON, NEW YORK. TEL:(800)236-9921.

1043 41555 MANATEE SERVICE CENTER (BRADENTON, FL) NEIC CLAIMS N N N1044 35196 MANHATTAN NATIONAL LIFE INSURANCE NEIC CLAIMS N N N1045 75258 MAPCO, INC. NEIC N N N1046 68241 MARRIOTT NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE


1047 SX069 MARYLAND HEALTH PARTNERS NEIC Claims N N N1048 37121 MASHANTUCKET PEQUOT TRIBAL NATION NEIC CLAIMS N N N1049 65935 MASSACHUSETTS MUTUAL THIN Y N N1050 2030 MATTHEW THORNTON HEALTH PLAN NEIC CLAIMS N N N PAYER REQUIRES UNIQUE PROVIDER ID FOR NEW PROVIDERS,

PLEASE CONTACT PAYER AT (603) 665-5447.

1051 41154 MAYO MANAGEMENT SERVICES, INC. NEIC CLAIMS Y N N1052 56205 MBS (MEDCOST BENEFIT SERVICES) NEIC Claims N N N1053 38264 MCARE NEIC CLAIMS N N N1054 59331 MCCREARY CORPORATION NEIC CLAIMS N N N FOR PLAN AND CLAIM REQUIREMENTS, PLEASE CONTACT

MCCREARY CORP. CUSTOMER SERVICE AT 561.287.7650 EXT 4052.

1055 36328 MCHENRY MEDICAL ASSOCIATES (IL) NEIC N N N ADDED 23-SEP-2002.1056 38338 MCLAREN HEALTH PLAN NEIC CLAIMS N1057 52148 MD - INDIVIDUAL PRACTICE ASSOCIATION, INC. NEIC CLAIMS Y N N

1058 11338 MDNY HEALTHCARE NEIC CLAIMS N N N1059 58204 MEDADMIN SOLUTIONS NEIC CLAIMS N1060 58202 MEDADMIN SOLUTIONS NEIC Claims N N N1061 74323 MEDBEN (NEWARK, OH) NEIC CLAIMS N N N1062 68241 MEDCONNECTION (MARRIOTT) NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE


1063 56205 MEDCOST BENEFIT SERVICES NEIC CLAIMS N N N1064 56162 MEDCOST, INC. NEIC CLAIMS Y N N PAYER REQUIRES UNIQUE PROVIDER ID FOR NEW PROVIDERS,

PLEASE CONTACT PAYER AT (800) 433-9178 , EXT. 4189.

1065 95321 MEDFOCUS NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO PAYOR1066 94265 MEDICA NEIC CLAIMS Y N N NETWORK ID REQUIRED. PLEASE CONTACT PAYOR1067 87726 MEDICA NEIC ERA N PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1068 MDHMO MEDICAID - TX (HMO-BLUE) TX THIN N N Y "(**28 max lines FA0) **Receiver type ""D"""1069 LAMCD MEDICAID OF LOUISIANA LAMCD Y Y Y1070 NJMCD MEDICAID OF NEW JERSEY NJMCD Y Y Y1071 86916 MEDICAID OF TEXAS (NHIC) THIN Y Y Y1072 31147 MEDICAL ADMINISTRATORS, INC. (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


1073 74323 MEDICAL BENEFITS ADMINISTRATORS, INC. (NEWARK, OH)

NEIC CLAIMS N N N

1074 74323 MEDICAL BENEFITS COMPANIES (NEWARK, OH) NEIC CLAIMS N N N1075 74323 MEDICAL BENEFITS MUTUAL NEIC CLAIMS N N N1076 74323 MEDICAL BENEFITS MUTUAL (NEWARK, OH) NEIC CLAIMS N N N1077 74323 MEDICAL BENEFITS MUTUAL LIFE INSRANCE CO. NEIC CLAIMS N1078 4258 MEDICAL CLAIMS SERVICE, INC. NEIC CLAIMS N N N1079 29076 MEDICAL MUTUAL OF OHIO NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1080 SX057 MEDICAL MUTUAL OF OHIO NEIC CLAIMS W TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION

1081 Pilot MEDICAL NETWORK INC. (MAINE) NEIC Claims N N N1082 CSMED MEDICAL NETWORK OF COLORADO SPRINGS CO NEIC N N N1083 98999 MEDICAL NETWORK ONE (BLUE CARE NETWORK) MEDNW Y Y N1084 33029 MEDICAL PATHWAYS NEIC CLAIMS N N N1085 61101 MEDICAL PLAN OF KANSAS CITY, MO NEIC CLAIMS N N N1086 58203 MEDICAL RESOURCE NETWORK (MRN) NEIC CLAIMS N1087 58203 MEDICAL RESOURCE NETWORK (MRN, INC) NEIC CLAIMS N N N1088 13375 MEDICAL SELECT MANAGEMENT NEIC CLAIMS N N N1089 38224 MEDICAL VALUE PLAN - OHIO (MVP) NEIC CLAIMS N N N1090 95436 MEDICARE EXTRA NEIC CLAIMS N N N1091 OKMCR MEDICARE PART B O FOKLAHOMA OKMCR Y Y Y REGISTRATION WITH MEDICARE NEEDED.1092 ALMCR MEDICARE PART B OF ALABAMA ALMCR Y Y Y REGISTER WITH MEDICARE FIRST. PROVIDER NUMBER REQUIRED.

ADDED 29-AUG-2002. LIVE ON 16-JAN-2003

1093 AKMCR MEDICARE PART B OF ALASKA (NORIDIAN) AKMCR Y Y Y ENROLL WITH EDI MEDICARE FIRST. PROVIDER NUMBER REQUIRED. ADDED 30-AUG-2002.

1094 AZMCR MEDICARE PART B OF ARIZONA AZMCR Y Y Y LIVE 02/25/2003. CONTACT PAYOR EDI DEPT TO ENROLL

1095 ARMCR MEDICARE PART B OF ARKANSAS ARMCR Y y y ADDED 04/29/2002. LIVE 02/25/2003. CONTACT PAYOR EDI DEPT TO ENROLL

1096 CAMCR MEDICARE PART B OF CALIFORNIA (SOUTHERN REGION ONLY)

CAMCR CLAIMS Y Y Y LIVE 07-FEB-2003. SOUTHERN REGION ONLY. CONTACT PAYOR EDI TO ENROLL

1097 CAMCN MEDICARE PART B OF CALIFORNIA (NORTHERN CAMCN Y Y Y1098 902 MEDICARE PART B OF DELAWARE THIN Y Y Y1099 FLMCR MEDICARE PART B OF FLORIDA FLMCR Y Y Y1100 HIMCR MEDICARE PART B OF HAWAII HIMCR Y Y N ENROLLMENT NEEDED. CONTACT HIMCR EDI AT 866-849-7243.

SUBMITTERID NEEDED. NETWORKID NEEDED.

1101 ILMCR MEDICARE PART B OF ILLINOIS ILMCR CLAIMS Y Y Y REGISTRATION WITH MEDICARE FIRST. PROVIDER NUMBER REQUIRED. ADDED 05-AUG-2002

1102 LAMCR MEDICARE PART B OF LOUISIANA LAMCR Y Y Y1103 901 MEDICARE PART B OF MARYLAND THIN Y Y Y1104 MOMCR MEDICARE PART B OF MISSOURI MOMCR Y Y Y LIVE 02-25-2003. CONTACT MOMCR EDI DEPT AT (501)378-2419 TO

ENROLL1105 NJMCR MEDICARE PART B OF NEW JERSEY NJMCR Y Y Y1106 521 MEDICARE PART B OF NEW MEXICO NM THIN Y N Y For enrollment Call THIN HelpLine 972-766-5480 **Receiver type C

1107 NYMCR MEDICARE PART B OF NEW YORK (EMPIRE) - FEE 10 CENTS PER CLAIM

NYMCR CLAIMS Y Y Y THIS IS NON-FREE PAYOR.

1108 NCMCR MEDICARE PART B OF NORTH CAROLINA NCMCR CLAIMS Y Y Y ADDED 03/28/2002. Enrollment with Medicare is required. Please contactl NC Medicare EDI dept. at 866.352.1608. You must fill out 2 forms and send original back to Medicare. Upon approval by Medicare, you can start send claims to FreeClaims.

1109 OHMCR MEDICARE PART B OF OHIO OHMCR CLAIMS Y Y Y1110 PAMCR MEDICARE PART B OF PENNSYLVANIA PAMCR Y Y Y1111 900 MEDICARE PART B OF TEXAS THIN Y Y Y1112 904 MEDICARE PART B OF VIRGINIA THIN Y Y Y1113 903 MEDICARE PART B OF VIRGINIA - DC METRO THIN Y Y Y1114 WAMCR MEDICARE PART B OF WASHINGTON STATE WAMCR Y Y Y LIVE 2/25/2003. CONTACT PAYOR EDI DEPT TO ENROLL

1115 WVMCR MEDICARE PART B OF WEST VIRGINIA WVMCR CLAIMS Y Y Y ADDED 07/15/2002. LIVE 08/27/2002. Register with WVMCR at 614-277-6100

1116 WIMCR MEDICARE PART B WISCONSIN WIMCR Y Y Y REGISTER WITH MEDICARE FIRST. PROVIDER NUMBER REQUIRED. ADDED 05-AUG-2002.

1117 COMCR MEDICARE PART-B OF COLORADO (NORIDIAN) COMCR Y Y Y NETWORK ID, GROUP NETWORK ID NEEDED1118 IAMCR MEDICARE PART-B OF IOWA (NORIDIAN) IAMCR Y Y Y NETWORK ID, GROUP NETWORK ID NEEDED1119 MIMCR MEDICARE PART-B OF MICHIGAN MIMCR Y Y Y NETWORK ID, GROUP NETWORK ID NEEDED1120 NVMCR MEDICARE PART-B OF NEVADA (NORIDIAN) NVMCR Y Y Y NETWORK ID, GROUP NETWORK ID NEEDED1121 NDMCR MEDICARE PART-B OF NORTH DAKOTA (NORIDIAN) NDMCR Y Y Y NETWORK ID, GROUP NETWORK ID NEEDED1122 ORMCR MEDICARE PART-B OF OREGON (NORIDIAN) ORMCR Y Y Y NETWORK ID, GROUP NETWORK ID NEEDED

1123 SDMCR MEDICARE PART-B OF SOUTH DAKOTA (NORIDIAN) SDMCR Y Y Y NETWORK ID, GROUP NETWORK ID NEEDED1124 WYMCR MEDICARE PART-B OF WYOMING (NORIDIAN) WYMCR Y Y Y NETWORK ID, GROUP NETWORK ID NEEDED1125 882 MEDICARE RAILROAD RRMCR Y Y Y "Receiver Type ""C"" To obtain a provider number, call Rail Road Medicare

Provider Enrollment at (866) 899-5227. For Rail Road Medicare Customer Service call (866) 855-9884. For EDI enrollment paperwork, call THIN @ 972-766-5480."

1126 58228 MEDICARE SMART NEIC CLAIMS N N N1127 VOID-94254 MEDIPRIME NEIC CLAIMS N N N TERMINATED AS OF 2/1/20031128 58216 MEDPLAN NEIC CLAIMS N N N1129 62160 MEDSOLUTIONS, INC NEIC CLAIMS N N N1130 82160 MEDSPAN, INC. NEIC CLAIMS N N N1131 59221 MEGA LIFE & HEALTH INSURANCE COMPANY NEIC Claims N N N1132 59221 MEGA LIFE & HEALTH INSURANCE COMPANY -

INSURANCE CENTERNEIC CLAIMS N PAYER ID VALID ONLY IF THE ADDRESS ON THE HEALTH ID CARD


1133 36193 MEMPHIS MANAGED CARE NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.1134 SX100 MERCY CARE PLAN NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1135 Pilot MERCY CARE PLAN NEIC Claims N N N1136 SX100 MERCY HEALTH CARE NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1137 43166 MERCY HEALTH PLANS NEIC CLAIMS N N N1138 Pilot MERCY HEALTHPLANS - CARECHOICES MICHIGAN NEIC Claims N N N Enrollment required; please contact Noreen at (248) 489-5281.

1139 33029 MERCY PHYSICIANS MEDICAL GROUP NEIC CLAIMS P PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - SOUTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

1140 77042 MERIDIAN HEALTH CARE MANAGEMENT NEIC CLAIMS N N N1141 SX046 MERIT OF ALABAMA NEIC CLAIMS Y N Y NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1142 85035 MESA MENTAL HEALTH NEIC Claims N N N Claims are printed and mailed to the payer.1143 Pilot METHODIST ASSOCIATE HEALTH PLAN NEIC Claims N N N1144 95420 METHODISTCARE, INC. NEIC CLAIMS N N N1145 65978 METLIFE NEIC CLAIMS N N N1146 65978 METRAHEALTH NEIC CLAIMS N N N1147 65978 METRAHEALTH ELECT NEIC CLAIMS N N N1148 65978 METRAHEALTH HEALTHCARE NETWORK - NEIC CLAIMS N N N1149 87726 METRAHEALTH OR TRAVELERS NEIC CLAIMS N N N1150 PILOT METRO ALLIANCE NEIC CLAIMS N1151 82135 METRO ALLIANCE NEIC CLAIMS N1152 13265 METRO PLUS HEALTH PLAN NEIC CLAIMS N1153 Pilot METRO PLUS HEALTH PLAN NEIC Claims N N N1154 10850 METROPOLITAN HEALTH PLAN NEIC CLAIMS N1155 65978 METROPOLITAN LIFE INSURANCE COMPANY NEIC CLAIMS N N N

1156 MWP01 METROWEST HEALTH PLAN-PREFERRED CARE THIN Y Y Y1157 61101 MICHAEL REESE HMO PLAN - IL NEIC CLAIMS N N N1158 61101 MICHAEL REESE HMO PLAN - IN NEIC CLAIMS N N N1159 37127 MICHAEL REESE PHYSICIANS GROUP NEIC CLAIMS N N N1160 MIBCS MICHIGAN BLUE CROSS MIBCS Y Y Y ADDED 05/24/2002. DO NOT USE - TESTING1161 43132 MID AMERICA HEALTH NEIC Claims N N N1162 52149 MID ATLANTIC PSYCHIATRIC SERVICES, INC. NEIC CLAIMS Y N N1163 37281 MID-AMERICA ASSOCIATES, INC. NEIC CLAIMS N1164 63079 MID-ATLANTIC HEALTH SYSTEM NEIC CLAIMS N N N PREVIOUSLY PAYER ID 510351165 31140 MID-VALLEY CARENET, INC. NEIC CLAIMS N N N1166 59224 MID-WEST NATIONAL LIFE INSURANCE CO. OF

TENNESSEE - INSURANCE CENTERNEIC CLAIMS N PAYER ID VALID ONLY IF THE ADDRESS ON THE HEALTH ID CARD


1167 59224 MID-WEST NATIONAL LIFE INSURANCE CO. OF TENNESSEE - INSURANCE CENTER

NEIC ERA N

1168 74227 MID-WEST NATIONAL LIFE INSURANCE CO. OF TENNESSEE - STUDENT INSURANCE

NEIC CLAIMS N PAYER ID ONLY VALID IF THE P.O. BOX ON THE HEALTH ID CARD MATCHES ONE OF THE FOLLOWING P.O. BOXES: P.O. BOX 890025, 809067, 809079, 809066, 809036, 809081, DALLAS, TX 75380-9025.

1169 47081 MIDLANDS BENEFITS ADMINISTRATORS NEIC Claims N N N1170 47080 MIDLANDS CHOICE, INC. NEIC Claims N N N1171 47080 MIDLANDS HEALTH PARTNERS NEIC CLAIMS N N N1172 62168 MIDSOUTH ADMINISTRATIVE GROUP NEIC CLAIMS N1173 59224 MIDWEST NATIONAL LIFE INSURANCE CO. OF

TENNESSEENEIC N N N ADDED 23-SEP-2002.

1174 MIDSC MIDWEST SECURITIES THIN N N N (**12 max lines FA0)1175 68241 MINNEAPOLIS PRUDENTIAL BUSINESS NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE


1176 37233 MISSISSIPPI PUBLIC ENTITY EMPLOYEE BENEFIT NEIC Claims N N N1177 64088 MISSISSIPPI SELECT HEALTH CARE NEIC Claims N N N Also doing business as Select Administrative Services (SAS).

1178 75203 MISSISSIPPI SELECT HEALTHCARE NEIC CLAIMS N N N1179 37275 MISSOULA COUNTY MEDICAL BENEFITS PLAN NEIC CLAIMS N1180 37265 MLINK NEIC N N N LOCATED IN INDIANAPOLIS, INDIANA. TEL:(859)226-1559

1181 31147 MMAC (MANAGED MEDICAL ASSURANCE CO., LTD.) (OHIO BWC)


1182 62178 MMS, LLC. NEIC Claims N N N1183 38333 MOLINA HEALTHCARE OF CALIFORNIA NEIC CLAIMS N1184 38336 MOLINA HEALTHCARE OF WASHINGTON NEIC CLAIMS N N N [FORMERLY QUAL-MED, SEATTLE (SE) AND QUAL-MED, SPOKANE

(SP)]1185 72135 MOMENTUM HEALTH SERVICES NEIC CLAIMS N N N

1186 13174 MONTEFIORE CONTRACT MANAGEMENT ORGANIZATION

NEIC CLAIMS Y N N PLEASE CONTACT PROVIDER RELATIONS OR CUSTOMER SERVICE AT 914.377.4400 FOR UNIQUE PROVIDER NUMBER (NetworkId)

1187 36111 MOTOROLA NEIC N N N ADDED 23-SEP-2002.1188 COMMA MOUNTAIN MEDICAL (MMA) NEIC N N N1189 86040 MOUNTAIN STATES ADMINISTRATIVE SERVICES

(TUCSON, AZ)NEIC CLAIMS N

1190 37233 MPE SERVICES INC. NEIC Claims N N N1191 37233 MPEEBT NEIC Claims N N N1192 95444 MPLAN, INC. / HEALTHCARE GROUP, LLC NEIC N N N ADDED 23-SEP-20021193 95444 MPLAN, INC./HEALTHCARE GROUP, LLC NEIC Claims N N N1194 69140 MUTUAL ALLIANCE PLAN (MAP) NEIC CLAIMS N N N1195 37256 MUTUAL ASSURANCE ADMINISTRATORS NEIC CLAIMS N1196 70491 MUTUAL GROUP (THE) (US) NEIC CLAIMS N N N1197 59140 MUTUAL GROUP (THE) (US) MUTUAL GROUP (THE)

(US)NEIC CLAIMS N PLEASE SUBMIT CLAIMS TO PAYER ID 59140, HEALTHPLAN SERVICES

(TAMPA ONLY).1198 71412 MUTUAL OF OMAHA INSURANCE COMPANY NEIC CLAIMS N N N1199 71412 MUTUALLY PREFERRED NEIC CLAIMS N N N1200 14165 MVP HEALTH PLAN OF NY NEIC CLAIMS N N N FOR YOUR MVP PROVIDER NUMBER, CALL (800) 684-9286.

1201 91136 N.W. IRONWORKERS HEALTH & SECURITY TRUST FUND


1202 91136 N.W. IRONWORKERS HEALTH & SECURITY TRUST FUND - GRP# F15


1203 91136 N.W. ROOFERS & EMPLOYERS HEALTH & SECURITY TRUST FUND


1204 91136 N.W. ROOFERS & EMPLOYERS HEALTH & SECURITY TRUST FUND - GRP# F26


1205 91136 N.W. TEXTILE PROCESSORS NEIC Claims N N N Please enter Group Number (F14) when submitting claims.

1206 91136 N.W. TEXTILE PROCESSORS - GRP# F14 NEIC CLAIMS N N N PLEASE INCLUDE GROUP NUMBER WHEN SUBMITTING CLAIMS.

1207 65085 NAA (NORTH AMERICA ADMINISTRATORS, L.P.) (NASHVILLE, TN)

NEIC CLAIMS N

1208 34159 NABN NEIC Claims N N N Payer ID valid only for claims with billing submission address of P.O. Box 94928, Cleveland, OH 44101-4928 or P.O. Box 89476, Cleveland, OH 44101-5476.

1209 53011 NALC/AFFORDABLE NEIC CLAIMS N N N1210 53011 NATIONAL ASSOCIATION OF LETTER CARRIERS NEIC CLAIMS N N N1211 53011 NATIONAL ASSOCIATION OF LETTER NEIC CLAIMS N N N1212 56175 NATIONAL BENEFIT ADMINISTRATORS NEIC N N N ADDED 22-OCT-2002. PAYOR FROM PARSIPPANY, NEW JERSEY.

PAYOR CONTACT (440)720-0700 EXT 215

1213 56175 NATIONAL BENEFIT ADMINISTRATORS - NEW NEIC Claims N N N1214 56176 NATIONAL BENEFIT ADMINISTRATORS - NORTH

CAROLINANEIC N N N ADDED 23-SEP-2002.

1215 90001 NATIONAL CAPITAL PREFERRED PROVIDER ORGANIZATION (NCPPO)

NEIC Claims Y N N To obtain your provider ID number, please call the NCPPO Customer Service Department at (800) 272-5911.

1216 58204 NATIONAL CHIROPRACTIC NETWORK NEIC Claims N N N1217 37126 NATIONAL CLAIM ADMINISTRATION NEIC N N N ADDED 23-SEP-2002.1218 35196 NATIONAL GROUP LIFE INSURANCE CO NEIC CLAIMS N N N1219 Pilot NATIONAL HEALTH INSURANCE COMPANY NEIC Claims N N N1220 75275 NATIONAL HEALTH INSURANCE COMPANY NEIC CLAIMS N1221 52132 NATIONAL RURAL ELECTRIC COOP (NRECA) NEIC CLAIMS N N N1222 71412 NATIONAL RURAL LETTER CARRIER ASSOCIATION NEIC Claims N N N Policy Number GMG18461223 71412 NATIONAL RURAL LETTER CARRIER ASSOCIATION

(POLICY #GMG1846)NEIC CLAIMS N N N

1224 37120 NATIONAL TRAVELERS LIF CO. NEIC CLAIMS N N N1225 37120 NATIONAL TRAVELERS LIFE CO. NEIC Claims N N N1226 31417 NATIONWIDE GROUP NEIC CLAIMS N N N1227 31417 NATIONWIDE HEALTH PLANS NEIC Claims N N N1228 31417 NATIONWIDE INDIVIDUAL LIFE AND HEALTH NEIC Claims N N N1229 31417 NATIONWIDE INSURANCE - NATIONWIDE HEALTH NEIC CLAIMS N N N1230 31417 NATIONWIDE LIFE AND HEALTH NEIC CLAIMS N N N1231 75191 NCAS - CHARLOTTE NEIC CLAIMS N N N1232 75190 NCAS - FAIRFAX, VA NEIC CLAIMS N N N1233 52118 NCAS - OWINGS MILLS, MD NEIC CLAIMS N (FORMERLY KNOWN AS WILLSE.)1234 4293 NEIGHBORHOOD HEALTH PLAN NEIC CLAIMS N N N1235 4293 NEIGHBORHOOD HEALTH PLAN (BOSTON, MA) NEIC CLAIMS N1236 4293 NEIGHBORHOOD HEALTH PLAN (BOSTON, MA) NEIC Claims N N N1237 11325 NEIGHBORHOOD HEALTH PROVIDERS NEIC CLAIMS N N N1238 39164 NEIGHBORLY CARE PLAN - MILWAUKEE, WI NEIC CLAIMS N N N CALL KAREN MILLS AT (262) 787-2705 PRIOR TO SUBMITTING CLAIMS.

1239 37255 NESIKA HEALTH GROUP NEIC CLAIMS N1240 66055 NETCARE LIFE AND HEALTH INSURANCE

(HAGATNA, GUAM)NEIC CLAIMS N

1241 CALL NETWORK HEALTH NEIC N N Y ADDED 31-OCT-2002. CALL KIM HOLWAY AT (617)806-8129 FOR PAYORID AND NETWORKID. ENROLLMENT REQUIRED ALSO

1242 39144 NETWORK HEALTH PLAN OF WISCONSIN, INC. NEIC CLAIMS N N N1243 86065 NEVADA HEALTH SOLUTIONS NEIC CLAIMS N N N1244 86065 NEVADACARE NEIC CLAIMS N N N1245 86065 NEVADACARE KIDS NEIC CLAIMS N N N1246 66893 NEW ENGLAND FINANCIAL NEIC CLAIMS N N N PLEASE BEGIN USING PAYER ID 80705 FOR THIS PAYER. (FORMERLY

THE NEW ENGLAND)1247 80705 NEW ENGLAND FINANCIAL NEIC CLAIMS N1248 80705 NEW ENGLAND FINANCIAL NEIC ERA E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1249 75281 NEW ERA LIFE NEIC CLAIMS N1250 84141 NEW WEST HEALTH PLAN NEIC CLAIMS N N N

1251 38332 NEW WORLD CLAIMS SERVICES NEIC CLAIMS N PAYER ID VALID ONLY FOR CLAIMS WITH A SUBMISSION ADDRESS OF 2624 NORTH 5TH STREET, NILES, MI 49120.

1252 14179 NEW YORK MEDICAL IMAGING - MVP NEIC CLAIMS N N N1253 14178 NEW YORK MEDICAL IMAGING - WELLCARE NEIC ERA N N N1254 11334 NEW YORK NETWORK MANAGEMENT NEIC N N N ADDED 23-SEP-2002. CLAIMS ARE PRINTED AND MAILED TO PAYOR

1255 48186 NEW YORK PRESBYTERIAN COMMUNITY HEALTH NEIC N N N ADDED 23-SEP-2002.1256 65978 NEW YORK STATE EMPLOYEES (EMPIRE) NEIC CLAIMS N N N1257 38225 NGS AMERICAN, INC NEIC CLAIMS N N N1258 62124 NHC HEALTH BENEFIT PLAN NEIC CLAIMS N PLEASE CALL NHC HEALTH BENEFIT PLAN @ 615-278-1230

REGARDING YOUR NHC PROVIDER NUMBER PRIOR TO SUBMITTING CLAIMS ELECTRONICALLY.

1259 11325 NHP/SHP (NEIGHBORHOOD HEALTH PROVIDERS AND SUFFOLK HEALTH PLAN)

NEIC Claims N N N Please submit claims with your unique NHP/SHP provider number. Please call (631) 360-3102 for your unique NHP/SHP provider number.

1260 81264 NIPPON LIFE INSURANCE COMPANY OF AMERICA NEIC CLAIMS N N N1261 22603 NJ CARPERNTERS HEALTH FUND NEIC CLAIMS N1262 Pilot NMCI NEIC Claims N N N1263 64157 NORTH AMERICAN ADMINISTRATORS, INC. NEIC CLAIMS N N N1264 34159 NORTH AMERICAN BENEFITS NETWORK NEIC CLAIMS N N N PAYER ID VALID ONLY FOR CLAIMS WITH BILLING SUBMISSION

ADDRESS OF P.O. BOX 94928, CLEVELAND, OH 44101-4928.

1265 64157 NORTH AMERICAN HEALTH PLAN NEIC CLAIMS N1266 93100 NORTH AMERICAN MEDICAL MANAGEMENT NEIC CLAIMS N N N ONLY CLAIMS FROM PROVIDERS IN HOUSTON, TX. PLEASE CONTACT

YOUR IPA PROVIDER RELATIONS AT (713) 881-9600.

1267 E3510 NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - NORTHERN CALIFORNIA

NEIC CLAIMS N N N ONLY CLAIMS FROM PROVIDERS IN NORTHERN CALIFORNIA. PLEASE CONTACT REED SMOLLER AT (510) 450-1500 FOR PROVIDER ENROLLMENT.

1268 33029 NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - SOUTHERN CALIFORNIA

NEIC CLAIMS P PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - SOUTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

1269 36398 NORTH AMERICAN MEDICAL MANAGEMENT - IL NEIC CLAIMS N N N1270 64157 NORTH AMERICAN PREFERRED NEIC CLAIMS N1271 NCBCS NORTH CAROLINA BLUE CROSS BLUE SHIELD NCBCS CLAIMS Y Y N ADDED 12-Apr-2002. Enrollment with Blue Cross is required.

1272 35212 NORTH TEXAS HEALTHCARE NETWORK NEIC CLAIMS N N N1273 NTX11 NORTH TEXAS HEALTHCARE NETWORK THIN N N N1274 88027 NORTHERN NEVADA TRUST FUND NEIC Claims N N N Please call (775) 826-7200 to verfiy if you should be sending claims to

Northern Nevada Trust Fund.1275 91068 NORTHWEST ADMINISTRATORS INC. NEIC N N N LOCATED IN SEATTLE, WASHINGTON. CONTACT: DANIELLE BRENNER

TEL:(206)726-3230

1276 91068 NORTHWEST ADMINISTRATORS INC. NEIC N N N LOCATE IN SEATTLE, WASHINGTON. CONTACT INFO: DANIELLE BRENNER TEL:(206)726-3230. CLAIMS ARE PRINTED AT NEIC AND MAILED TO PAYOR

1277 36346 NORTHWEST SUBURBAN IPA (ILLINOIS) NEIC Claims N N N1278 36346 NORTHWEST SUBURBAN IPA(ILLINOIS) NEIC CLAIMS N N N1279 16644 NOVA HEALTH ADMINISTRATORS,INC (GRAND

ISLAND,NY)NEIC CLAIMS N N N

1280 16644 NOVA HEALTHCARE ADMINISTRATORS, INC. (GRAND ISLAND, NY)

NEIC Claims N N N

1281 71080 NOVASYS HEALTH NETWORK NEIC N N N CLAIMS ARE PRINTED AND MAILED TO PAYOR. ADDED 23-SEP-2002.

1282 35197 NPPN\CONSECO NEIC CLAIMS N N N1283 37299 NYHART NEIC CLAIMS N1284 66916 NYLCARE HEALTH PLAN NEIC CLAIMS N N N1285 14179 NYMI - AETNA RADIOLOGY CLAIMS NEIC Claims N N N1286 14180 NYMI OXFORD NEIC CLAIMS N N N1287 31147 OCCUPATIONAL HEALTH MGMT, INC.

(HEALTHMANAGE) (OHIO BWC)NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


1288 72127 OCHSNER HEALTH PLAN NEIC CLAIMS N N N1289 72087 OFFICE OF GROUP BENEFITS- LOUISIANA NEIC Claims N N N Office of Group Benefits is located in the state of Louisiana.

1290 31147 OHIO BWC NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR OHIO WORKERS COMP CLAIMS ONLY.

1291 31147 OHIO COMP CHOICE, INC. (HMS) (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR OHIO WORKERS COMP CLAIMS ONLY.

1292 31147 OHIO EMPLOYEE HEALTH PARTNERSHIP (OHIO BWC)


1293 34189 OHIO HEALTH CHOICE NEIC CLAIMS N N N PAYER ID VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION ADDRESS OF P.O. BOX 93538, CLEVELAND, OH 44101-5538

1294 34189 OHIO HEALTH CHOICE, PPO NEIC Claims N N N Payer ID valid only for claims with a billing submission address of P. O. Box 93538, Cleveland, OH 44101 or P. O. Box 6086, Cleveland, OH 44101.

1295 OKMCD OKLAHOMA MEDICAID OKMCD Y Y Y1296 91150 OLYMPIC HLTH MANAGEMENT SYSTEMS NEIC N N N1297 38252 OMNICARE HEALTH PLAN OF MICHIGAN NEIC N N N ADDED 22-OCT-2002. PAYOR CONTACT 313-393-4537

1298 80705 ONE HEALTH PLAN NEW HAMPSHIRE, INC. NEIC CLAIMS N1299 80705 ONE HEALTH PLAN OF AK NEIC CLAIMS N1300 80705 ONE HEALTH PLAN OF AZ NEIC CLAIMS N1301 80705 ONE HEALTH PLAN OF CA NEIC CLAIMS N1302 80705 ONE HEALTH PLAN OF CALIFORNIA, INC. NEIC CLAIMS N

1303 80705 ONE HEALTH PLAN OF CALIFORNIA, INC. NEIC ERA E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1304 95379 ONE HEALTH PLAN OF CALIFORNIA, INC. NEIC CLAIMS N N N PLEASE BEGIN USING PAYER ID 80705 FOR THIS PAYER.

1305 80705 ONE HEALTH PLAN OF CO NEIC CLAIMS N1306 80705 ONE HEALTH PLAN OF COLORADO, INC. NEIC CLAIMS N1307 80705 ONE HEALTH PLAN OF COLORADO, INC. NEIC ERA E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1308 95412 ONE HEALTH PLAN OF COLORADO, INC. NEIC CLAIMS N N N PLEASE BEGIN USING PAYER ID 80705 FOR THIS PAYER.

1309 80705 ONE HEALTH PLAN OF FL NEIC CLAIMS N1310 80705 ONE HEALTH PLAN OF GA NEIC CLAIMS N1311 80705 ONE HEALTH PLAN OF GEORGIA, INC. NEIC CLAIMS N1312 80705 ONE HEALTH PLAN OF GEORGIA, INC. NEIC ERA E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1313 96559 ONE HEALTH PLAN OF GEORGIA, INC. NEIC CLAIMS N N N PLEASE BEGIN USING PAYER ID 80705 FOR THIS PAYER.

1314 80705 ONE HEALTH PLAN OF IL NEIC CLAIMS N1315 80705 ONE HEALTH PLAN OF ILLINOIS, INC. NEIC CLAIMS N1316 80705 ONE HEALTH PLAN OF ILLINOIS, INC. NEIC ERA E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1317 95388 ONE HEALTH PLAN OF ILLINOIS, INC. NEIC CLAIMS N N N PLEASE BEGIN USING PAYER ID 80705 FOR THIS PAYER.

1318 80705 ONE HEALTH PLAN OF IN NEIC CLAIMS N1319 80705 ONE HEALTH PLAN OF MA NEIC CLAIMS N1320 80705 ONE HEALTH PLAN OF ME NEIC CLAIMS N1321 80705 ONE HEALTH PLAN OF NEW JERSEY, INC. NEIC CLAIMS N1322 80705 ONE HEALTH PLAN OF NORTH CAROLINA, INC. NEIC CLAIMS N1323 80705 ONE HEALTH PLAN OF OHIO, INC. NEIC CLAIMS N1324 80705 ONE HEALTH PLAN OF OREGON, INC. NEIC CLAIMS N1325 80705 ONE HEALTH PLAN OF PENNSYLVANIA, INC. NEIC CLAIMS N1326 80705 ONE HEALTH PLAN OF SOUTH CAROLINA, INC. NEIC CLAIMS N1327 80705 ONE HEALTH PLAN OF TENNESSEE, INC. NEIC CLAIMS N1328 80705 ONE HEALTH PLAN OF TEXAS, INC. NEIC CLAIMS N1329 80705 ONE HEALTH PLAN OF TEXAS, INC. NEIC ERA E NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1330 51459 ONE HEALTH PLAN OF TEXAS, INC. NEIC CLAIMS N N N PLEASE BEGIN USING PAYER ID 80705 FOR THIS PAYER.

1331 80705 ONE HEALTH PLAN OF TX NEIC CLAIMS N1332 80705 ONE HEALTH PLAN OF VERMONT, INC. NEIC CLAIMS N1333 80705 ONE HEALTH PLAN OF VIRGINIA, INC. NEIC CLAIMS N1334 80705 ONE HEALTH PLAN OF WASHINGTON, INC. NEIC CLAIMS N1335 80705 ONE HEALTH PLAN OF WISCONSIN, INC. NEIC CLAIMS N1336 80705 ONE HEALTH PLAN OF WYOMING, INC. NEIC CLAIMS N1337 80705 ONE HEALTH PLAN, INC. NEIC ERA N N N1338 TH042 OPERATING ENGINEERS LOCAL 234 HEALTH PLAN NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1339 91136 OPERATING ENGINEERS LOCALS 302 & 612 HEALTH & SECURITY FUND


1340 91136 OPERATING ENGINEERS LOCALS 302 & 612 HEALTH & SECURITY FUND - GRP# F12


1341 6163 OPTICARE EYE HEALTH NETWORK NEIC CLAIMS N N N1342 56190 OPTICARE EYE HEALTH NETWORK NEIC CLAIMS N1343 54154 OPTIMA HEALTH PLAN NEIC Claims Y N N Please note that the Rendering Provider Network ID (E6-14) field is required.

The field must be 5-7 characters, positions 1-5 must be numeric only, and positions 6 and 7 (if applicable) must be alpha only. Please contact the Ydsia Slagle-Provider Relations

1344 54154 OPTIMA INSURANCE COMPANY NEIC Claims Y N N Please note that the Rendering Provider Network ID (E6-14) field is required. The field must be 5-7 characters, positions 1-5 must be numeric only, and positions 6 and 7 (if applicable) must be alpha only. Please contact the Ydsia Slagle-Provider Relations

1345 52151 OPTIMUM CHOICE OF PENNSYLVANIA THIN N N N1346 52152 OPTIMUM CHOICE OF THE CAROLINAS NEIC CLAIMS N N N1347 52152 OPTIMUM CHOICE OF THE CAROLINAS, INC. (OCCI) NEIC Claims N N N1348 52148 OPTIMUM CHOICE, INC. (OCI) NEIC CLAIMS Y N N1349 37125 OPTION SERVICES GROUP NEIC CLAIMS N N N PREVIOUS PAYER ID 372151350 851 OREGON BLUE CROSS (REGENCE BLUECROSS

BLUE SHIELD OF OREGON)THIN Claims Y Y Y ADDED 05/01/2002. PROVIDER MUST REGISTER WITH ORBCS AT (503)

220-3924 FIRST. NETWORKID REQUIRED, GROUPNETWORKID MAY BE NEEDED.

1351 13381 ORTHONET CORPORATION NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYOR1352 58204 ORTHOPEDIX NETWORK, INC. NEIC Claims N N N1353 TH053 OSF CARE ADVANTAGE NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1354 TH054 OSF HEALTH PLAN NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1355 OSFIL OSF HEALTH PLAN IL NEIC N N N **1356 36365 OUR LADY OF THE RESURRECTION PHYSICIAN

ASSOCIATION (ROCKFORD, IL)NEIC CLAIMS N N N

1357 6111 OXFORD HEALTH PLANS NEIC CLAIMS N N N PAYER REQUIRES UNIQUE PROVIDER ID FOR NEW PROVIDERS, PLEASE CONTACT PAYER.

1358 67466 PACIFIC LIFE & ANNUITY COMPANY NEIC CLAIMS N N N1359 76050 PACIFICARE / ARIA NEIC N N N ADDED 23-SEP-2002.1360 33053 PACIFICARE BEHAVIORAL HEALTH NEIC CLAIMS N1361 33053 PACIFICARE BEHAVIORAL HEALTH, INC NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO PAYOR1362 33053 PACIFICARE BEHAVIORAL HEALTH, INC. NEIC Claims N N N1363 Pilot PACIFICARE HEALTH SYSTEMS NEIC Rosters N N N1364 95964 PACIFICARE OF ARIZONA (CLAIMS ONLY NOT

ENCOUNTERS)NEIC Claims N N N Must first register with Pacificare before send claims. Contact Tishia Mendoza

at (800) 344-3782, ext. 4313 to become eligible to initiate the EDI process.

1365 CALL PACIFICARE OF ARIZONA - CLAIMS NEIC CLAIMS P PLEASE CONTACT COLETTE WARD AT (800) 877-6685 X42731 TO INITIATE THE EDI PROCESS.

1366 95959 PACIFICARE OF CALIFORNIA NEIC CLAIMS N FOR PAYABLE PACIFICARE/SECURE HORIZON HMO AND IN- AREA POS CLAIMS ONLY. NOT FOR PPO OR INDEMNITY CLAIMS. FOR MORE INFORMATION, PLEASE CALL THE PACFICARE CLAIMS EDI HOTLINE AT (714) 226-2442. EFFECTIVE 07/01/02, A SIGNED AGREEMENT IS NO LONGER

1367 95958 PACIFICARE OF CALIFORNIA NEIC ENCOUNTERSY N N MUST SUBMIT WITH PACIFICARE SUBMITTER ID CALL GINA GASILAN AT (714) 226-8832 TO OBTAIN.

1368 95959 PACIFICARE OF CALIFORNIA - CLAIMS NEIC CLAIMS N FOR PAYABLE PACIFICARE/SECURE HORIZON HMO CLAIMS ONLY. NOT FOR PPO CLAIMS. FOR FURTHER QUESTIONS, YOU MAY INQUIRE VIA EMAIL AT [email protected].

1369 95958 PACIFICARE OF CALIFORNIA - ENCOUNTERS NEIC ENCOUNTERS P MUSMUST SUBMIT WITH PACIFICARE SUBMITTER ID. PLEASE CALL GINA GASILAN AT (714) 226-8609 TO OBTAIN.

1370 Call PACIFICARE OF COLORADO NEIC Claims N N N Please call Lela Nemmers at PacfiCare of Colorado at (719) 522-6928 to enroll and to obtain the payer id.

1371 CALL PACIFICARE OF COLORADO - CLAIMS NEIC CLAIMS P PLEASE CALL COLETTE WARD AT (800) 877-6685 EXT.42731 TO INITIATE THE EDI PROCESS.

1372 95959 PACIFICARE OF OKLAHOMA NEIC CLAIMS N N N1373 95973 PACIFICARE OF OKLAHOMA NEIC ENCOUNTERSN N N MUST SUBMIT WITH PACIFICARE SUBMITTER ID. CALL KEN TENNISON

AT (210) 524-2184 TO OBTAIN.1374 95959 PACIFICARE OF OKLAHOMA - CLAIMS NEIC CLAIMS N FOR PAYABLE PACIFICARE/SECURE HORIZON HMO CLAIMS ONLY.

NOT FOR PPO CLAIMS. FOR FURTHER QUESTIONS, YOU MAY INQUIRE VIA EMAIL AT [email protected].

1375 95973 PACIFICARE OF OKLAHOMA - ENCOUNTERS NEIC ENCOUNTERS P MUST SUBMIT WITH PACIFICARE SUBMITTER ID. PLEASE CONTACT LORI CASTRO AT (714) 226-4959 TO OBTAIN.

1376 95959 PACIFICARE OF OREGON NEIC CLAIMS N FOR PAYABLE PACIFICARE/SECURE HORIZON HMO AND POS CLAIMS ONLY. NOT FOR PPO OR INDEMNITY CLAIMS. FOR MORE INFORMATION, PLEASE CALL THE PACIFICARE CLAIMS EDI HOTLINE AT (800) 203-7729 OR EMAIL: [email protected].

1377 95975 PACIFICARE OF OREGON NEIC ENCOUNTERSN N N MUST SUBMIT WITH PACIFICARE SUBMITTER ID. CALL CAROLYN M. ANDERSON AT (503) 603-7346 TO OBTAIN.

1378 95959 PACIFICARE OF OREGON - CLAIMS NEIC CLAIMS N FOR PAYABLE PACIFICARE/SECURE HORIZON HMO CLAIMS ONLY. NOT FOR PPO CLAIMS. FOR FURTHER QUESTIONS, YOU MAY INQUIRE VIA EMAIL AT [email protected].

1379 95975 PACIFICARE OF OREGON - ENCOUNTERS NEIC ENCOUNTERS P MUST SUBMIT WITH PACIFICARE SUBMITTER ID. PLEASE CALL GINA GASILAN AT (714) 226-8609 TO OBTAIN.

1380 77042 PACIFICARE OF OREGON/MERIDIAN HEALTH CARE MANAGEMENT

NEIC Claims N N N For information on how to decipher when this Payer ID should be used, please call PacifiCare EDI at (800) 203-7729 or send an e-mail to: [email protected].

1381 95959 PACIFICARE OF TEXAS NEIC CLAIMS N N N1382 95969 PACIFICARE OF TEXAS NEIC ENCOUNTERSY N N MUST SUBMIT WITH PACIFICARE SUBMITTER ID. CALL KEN TENNISON

AT (210) 524-2184 TO OBTAIN.1383 95959 PACIFICARE OF TEXAS - CLAIMS NEIC CLAIMS N FOR PAYABLE PACIFICARE/SECURE HORIZON HMO CLAIMS ONLY.

NOT FOR PPO CLAIMS. FOR FURTHER QUESTIONS, YOU MAY INQUIRE VIA EMAIL AT [email protected].

1384 95969 PACIFICARE OF TEXAS - ENCOUNTERS NEIC ENCOUNTERS P MUST SUBMIT WITH PACIFICARE SUBMITTER ID. PLEASE CONTACT LORI CASTRO AT (714) 226-4959 TO OBTAIN.

1385 95959 PACIFICARE OF WASHINGTON NEIC CLAIMS N FOR PAYABLE PACIFICARE/SECURE HORIZON HMO AND POS CLAIMS ONLY. NOT FOR PPO OR INDEMNITY CLAIMS. FOR MORE INFORMATION, PLEASE CALL THE PACIFICARE CLAIMS EDI HOTLINE AT (800) 203-7729 OR EMAIL: [email protected].

1386 95977 PACIFICARE OF WASHINGTON NEIC ENCOUNTERSN N N MUST SUBMIT WITH PACIFICARE SUBMITTER ID. CALL LYNNE JACOBY AT (206) 230-7313 TO OBTAIN.

1387 95959 PACIFICARE OF WASHINGTON - CLAIMS NEIC CLAIMS N FOR PAYABLE PACIFICARE/SECURE HORIZON HMO CLAIMS ONLY. NOT FOR PPO CLAIMS. FOR FURTHER QUESTIONS, YOU MAY INQUIRE VIA EMAIL AT [email protected].

1388 95977 PACIFICARE OF WASHINGTON - ENCOUNTERS NEIC ENCOUNTERS P MUST SUBMIT WITH PACIFICARE SUBMITTER ID. PLEASE CALL GINA GASILAN AT (714) 226-8609 TO OBTAIN.

1389 77042 PACIFICARE OF WASHINGTON/MERIDIAN HEALTH CARE MANAGEMENT

NEIC Claims N N N For information on how to decipher when this Payer ID should be used, please call PacifiCare EDI at (800) 203-7729 or send an e-mail to: [email protected]

1390 95999 PACIFICARE PPO NEIC N N N ADDED 04/18/2002. CLAIMS ARE PRINTED AND MAILED TO PAYOR

1391 95999 PACIFICARE PPO - ALL STATES NEIC CLAIMS N FOR PAYABLE PPO CLAIMS ONLY. NOT FOR PACIFICARE/SECURE HORIZONS HMO CLAIMS. FOR FURTHER QUESTIONS, YOU MAY INQUIRE VIA EMAIL AT [email protected].

1392 96964 PACIFICARE-HORIZON NEIC CLAIMS N N N MUST REGISTER WITH PAYOR FIRST BEFORE SEND FIRST CLAIM

1393 PACIR PACIFICARE/ARIA NEIC N N N1394 93029 PACIFICSOURCE HEALTH PLANS NEIC CLAIMS N N N1395 37287 PAI NEIC CLAIMS N

1396 31147 PARAMOUNT PREFERRED NETWORK (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR OHIO WORKERS COMP CLAIMS ONLY.

1397 58204 PARITY HEALTHCARE NEIC CLAIMS N N N1398 58204 PARITY HEALTHCARE LLC NEIC Claims N N N1399 66917 PARKLAND COMMUNITY HEALTH PLAN NEIC CLAIMS N N N1400 56152 PARTNERS NATIONAL HEALTH NEIC Y N N Network Id Needed. (Box 33, PIN field)1401 Call PARTNERS NATIONAL HEALTH PLANS OF NORTH

CAROLINA, INCNEIC Claims N N N Contracted Providers Only. Please call the Partners National Health Plans of

North Carolina, Inc., customer service department at (800) 942-5695 or (336) 760-4822, ext. 12005, for electronic claims set up.

1402 61129 PASSPORT HEALTH PLAN NEIC CLAIMS N N N MEDICAID MANAGED CARE. PAYER REQUIRES REGISTRATION AND TESTING, CALL (877) 234-4275.

1403 TH017 PATIENT-PHYSICIAN NETWORK NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1404 37210 PAYNET, INC. NEIC N N N ADDED 23-SEP-2002.1405 65018 PCA HEALTH PLAN OF FLORIDA NEIC CLAIMS Y N Y PROVIDERS THAT ARE CURRENTLY ENROLLED ONLY. NOT

CURRENTLY ENROLLING ANY NEW PHYSICIANS.

1406 65000 PCMC/ICSL ALLERGY NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.1407 65007 PCMC/ICSL CHIROPRACTIC NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.1408 65001 PCMC/ICSL DERMATOLOGY NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.1409 65003 PCMC/ICSL GASTROENTEROLOGY NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.1410 65004 PCMC/ICSL PHYSICAL THERAPY NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.1411 65002 PCMC/ICSL PODIATRY NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.1412 PILOT PEOPLES HEALTH NETWORK NEIC CLAIMS N1413 34173 PERSONAL PHYSICIAN CARE NEIC N N N1414 25146 PERSONALCARE NEIC CLAIMS N1415 68241 PG & E (PACIFIC GAS & ELECTRIC) NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE


1416 63088 PHA ADMIN. SERV NEIC CLAIMS N N N1417 95183 PHA INSURANCE SERVICES (ORLANDO, FL) NEIC CLAIMS N1418 67814 PHOENIX AMERICAN LIFE (PAL) NEIC CLAIMS N N N1419 75238 PHOENIX GROUP SERVICES (TEXAS) NEIC CLAIMS N N N1420 6143 PHOENIX GROUP SERVICES, INC. NEIC CLAIMS N N N1421 SX146 PHOENIX HEALTH PLAN NEIC CLAIMS W1422 67814 PHOENIX HOME LIFE NEIC CLAIMS N N N1423 67814 PHOENIX HOME LIFE MUTUAL INS. CO. NEIC CLAIMS N N N1424 67814 PHOENIX MUTUAL NEIC CLAIMS N N N1425 87726 PHP OF MID MICHIGAN NEIC CLAIMS N N N1426 87726 PHP OF MID-MICHIGAN NEIC Claims N N N1427 87726 PHP OF SOUTH CAROLINA NEIC CLAIMS N N N1428 87726 PHP OF SOUTH MICHIGAN NEIC CLAIMS N N N1429 87726 PHP OF SOUTHWEST MICHIGAN NEIC CLAIMS N N N1430 87726 PHP OF WEST MICHIGAN NEIC CLAIMS N N N1431 62155 PHP TENNCARE NEIC CLAIMS N N N

1432 6108 PHS HEALTH PLANS (PHYSICIANS HEALTH SERVICES)

NEIC CLAIMS Y N N UNIQUE PROVIDER ID REQUIRED, CALL (203) 381-7618.

1433 58204 PHYSICIAN ASSOCIATES OF LOUISIANA NEIC Claims N N N1434 95474 PHYSICIAN ASSOCIATES OF THE GREATER SAN

GABRIEL VALLEYNEIC N N N CALL ARMANDO HERNANDEZ AT (626)817-8517 FOR PAYORID. EDI

TEL:(626)817-84201435 CALL PHYSICIAN ASSOCIATES OF THE GREATER SAN

GABRIEL VALLEYNEIC CLAIMS N PLEASE CALL ARMANDO HERNANDEZ AT (626) 817-8517 TO OBTAIN

THE PAYER ID.1436 57098 PHYSICIANS CARE NETWORK NEIC CLAIMS N N N1437 36345 PHYSICIANS CARE NETWORK (ROCKFORD, IL

ONLY)NEIC CLAIMS N N N PAYOR ID VALID FOR BILLING ADDRESS OF PHYSICIAN CARE

NETWORK, ROCKFORD, IL.1438 65018 PHYSICIANS CORPORATION OF AMERICA (FLORIDA

PLAN ONLY)NEIC CLAIMS Y N Y PROVIDERS THAT ARE CURRENTLY ENROLLED ONLY. NOT

CURRENTLY ENROLLING ANY NEW PHYSICIANS.

1439 75297 PHYSICIANS DIRECT NEIC CLAIMS N1440 37136 PHYSICIANS HEALTH ASSOCIATION OF ILLINOIS NEIC CLAIMS N N N1441 PILOT PHYSICIANS HEALTH PLAN OF NORTHERN NEIC CLAIMS N1442 6108 PHYSICIANS HEALTH SERVICES NEIC CLAIMS Y N N UNIQUE PROVIDER ID REQUIRED, CALL (203) 381-7618.

1443 65031 PHYSICIANS HEALTHCARE PLANS INC NEIC Claims N N N1444 65031 PHYSICIANS HEALTHCARE PLANS INC. NEIC CLAIMS N N N1445 47027 PHYSICIANS MUTUAL INSURANCE COMPANY NEIC CLAIMS N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.1446 PHD03 PHYSICIANS NETWORK OF COLORADO SPRINGS NEIC N N N1447 39156 PHYSICIANS PLUS INSURANCE CORPORATION NEIC CLAIMS N N N1448 56151 PIEDMONT ADMINISTRATORS NEIC CLAIMS N N N1449 24735 PINNACLE CLAIMS MANAGEMENT, INC. NEIC CLAIMS N N N1450 35196 PIONEER LIFE INSURANCE CO NEIC CLAIMS N N N1451 73074 PIPELINE INDUSTRY BENEFIT FUND (TULSA, OK) NEIC Claims N N N1452 73074 PIPELINE INDUSTRY BENEFIT FUND(TULSA, OK) NEIC CLAIMS N N N1453 37224 PITTMAN & ASSOCIATES NEIC CLAIMS N N N1454 37287 PLANNED ADMINISTRATORS, INC. NEIC CLAIMS N PROVIDERS SUBMITTING CLAIMS AS A PREFERRED BLUE PROVIDER

SHOULD NOT SUBMIT CLAIMS USING PAYER ID 37287

1455 67466 PM GROUP NEIC CLAIMS N N N1456 PPN11 PMMR * PPN THIN N N N1457 58204 PODI CARE MANAGED CARE NEIC Claims N N N1458 58204 PODIATRY NETWORK SOLUTIONS NEIC Claims N N N1459 PILOT POLY AMERICA MEDICAL & DENTAL BENEFITS NEIC CLAIMS N1460 32680 POLY AMERICA MEDICAL & DENTAL BENEFITS NEIC CLAIMS N1461 16111 POMCO NEIC CLAIMS N N N1462 73159 PPO OKLAHOMA (WINTERBROOK HEALTHCARE

MANAGEMENT)NEIC Claims N N N

1463 72148 PPO PLUS LLC NEIC N N N ADDED 23-SEP-2002.1464 SX016 PPOM NEIC CLAIMS Y N Y NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1465 38335 PPOM, LLC NEIC CLAIMS N N N

1466 38335 PPOM, LLC PPOPLUS NEIC CLAIMS N EFFECTIVE JANUARY 01, 2003, ALL PPOPLUS CLAIMS MUST BE SUBMITTED TO PAYER ID 72148, PPOPLUS LLC.

1467 59333 PPOPLUS NEIC CLAIMS N N N1468 72148 PPOPLUS LLC NEIC Claims N N N1469 4334 PRACTICARE INC NEIC CLAIMS N N N1470 PILOT PRAIRIE STATES ENTERPRISES, INC. NEIC CLAIMS N1471 53476 PREFERRED BENEFIT ADMINISTRATORS NEIC CLAIMS N1472 SX089 PREFERRED CARE NEIC CLAIMS W NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1473 SX089 PREFERRED CARE NEIC ERA N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1474 PILOT PREFERRED CARE PARTNERS NEIC CLAIMS N1475 65088 PREFERRED CARE PARTNERS NEIC CLAIMS N1476 73145 PREFERRED COMMUNITY NEIC CLAIMS N N N1477 35173 PREFERRED HEALTH NETWORK (PHN) NEIC CLAIMS N N N1478 61106 PREFERRED HEALTH PLAN (LOUISVILLE, KY) NEIC CLAIMS N N N1479 60110 PREFERRED HEALTH SYSTEMS INSURANCE NEIC CLAIMS N N N1480 36401 PREFERRED NETWORK ACCESS, INC. NEIC CLAIMS N1481 41147 PREFERRED ONE NEIC CLAIMS N N N1482 14162 PREFERRED ONE (CT), A DIVISION OF FIRST

CHOICENEIC Claims Y N N Please note that all claims submitted require a 5-8 character Render Provider

Network ID.1483 60110 PREFERRED PLUS OF KANSAS NEIC Claims N N N1484 41147 PREFERREDONE (MN) NEIC Claims N N N1485 43166 PREMIER BENEFITS, INC. NEIC Claims N N N1486 31147 PREMIER COMP OF HOMETOWN HEALTH

NETWORK (OHIO BWC)NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


1487 37119 PREMIER HEALTH NETWORK NEIC CLAIMS N N N1488 43166 PREMIER HEALTH PLANS NEIC Claims N N N1489 31147 PREMIER MANAGED CARE, INC. (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


1490 TH061 PRESBYTERIAN HEALTH PLAN NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

1491 TH060 PRESBYTERIAN SALUD NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

1492 39185 PREVEA HEALTH INSURANCE PLAN NEIC CLAIMS N N N1493 61101 PRIMARY DELIVERY SERVICES NEIC Claims N N N1494 73288 PRIMARY DELIVERY SYSTEMS NEIC CLAIMS N N N1495 TH016 PRIMARY MEDICAL CARE NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1496 PMC11 PRIMARY MEDICAL CARE, INC. THIN N N N1497 56144 PRIMARY PHYSICIANCARE, INC. NEIC CLAIMS N N N PREVIOUS PAYER ID PPC1498 61101 PRIME BENEFITS SYSTEMS, INC. - MO NEIC CLAIMS N N N1499 63088 PRIME HEALTH NEIC Claims N N N1500 61101 PRIME HEALTH KANSAS CITY, INC. - MO NEIC CLAIMS N N N

1501 61101 PRIME HEALTH MANAGEMENT SERVICES - MO NEIC CLAIMS N N N1502 63088 PRIME HEALTH OF ALABAMA NEIC Claims N N N1503 61101 PRIME HEALTH OF KANSAS, INC. - MO NEIC Claims N N N1504 61101 PRIME HEALTH OF KANSAS, INC., - MO NEIC CLAIMS N N N1505 56190 PRIME VISION HEALTH PLAN/OPTICARE EYE

HEALTH NETWORKNEIC CLAIMS Y N N

1506 33029 PRIMECARE OF CHINO VALLEY NEIC CLAIMS P PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - SOUTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

1507 33029 PRIMECARE OF CORONA NEIC CLAIMS P PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - SOUTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

1508 33029 PRIMECARE OF HEMET VALLEY NEIC CLAIMS P PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - SOUTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

1509 33029 PRIMECARE OF INLAND VALLEY NEIC CLAIMS P PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - SOUTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

1510 33029 PRIMECARE OF MORENO VALLEY NEIC CLAIMS P PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - SOUTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

1511 33029 PRIMECARE OF REDLANDS NEIC CLAIMS P PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - SOUTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

1512 33029 PRIMECARE OF RIVERSIDE NEIC CLAIMS P PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - SOUTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

1513 33029 PRIMECARE OF SUN CITY NEIC CLAIMS P PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - SOUTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

1514 33029 PRIMECARE OF TEMECULA NEIC CLAIMS P PLEASE CONTACT THE EDI DEPT FOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - SOUTHERN CALIFORNIA LEAD/SUPERVISOR AT 1-800-956-8000 PRIOR TO INITIAL SUBMISSION OF CLAIMS.

1515 4320 PRIMESOURCE HEALTH NETWORK NEIC CLAIMS N1516 4320 PRIMESOURCE HEALTH NETWORK NEIC Claims N N N1517 61271 PRINCIPAL FINANCIAL GROUP NEIC CLAIMS N N N1518 61271 PRINCIPAL FINANCIAL GROUP NEIC ERA N N N1519 61271 PRINCIPAL LIFE INSURANCE CO. NEIC CLAIMS N N N1520 87056 PRINTING INDUSTRIES ASSOCIATION OF

SOUTHERN CALIFORNIA (PIASC)NEIC Claims N N N

1521 87056 PRINTING INDUSTRIES ASSOCIATION OF SOUTHERN CALIFORNIA/ PIASC

NEIC CLAIMS N N N

1522 87056 PRINTING INDUSTRIES OF NORTHERN CALIFORNIA NEIC Claims N N N1523 87056 PRINTING INDUSTRIES OF NORTHERN NEIC CLAIMS N N N1524 38217 PRIORITY HEALTH NEIC N N Y ADDED 05/15/2002. PLEASE CALL WENDELL BROOME AT (616)975-8284

PRIOR TO SUBMITTING CLAIMS

1525 37268 PRISM NETWORK, INC. NEIC CLAIMS N1526 31132 PRO HEALTH COMPCARE THIN N N N1527 36331 PROFESSIONAL BENEFIT ADMINISTRATORS, INC.

(OAK BROOK, IL)NEIC CLAIMS N N N PAYER ID IS VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION

NAME, CITY, AND STATE OF PROFESSIONAL BENEFIT ADMINISTRATORS, INC., OAK BROOK, IL.

1528 34176 PROFESSIONAL BENEFITS ADMINISTRATORS (CUYAHOGA FALLS, OH)

NEIC CLAIMS N PAYER ID VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION ADDRESS OF 2040 FRONT STREET, CUYAHOGA FALLS, OH 44221.

1529 41163 PROFESSIONAL CLAIM ADMINISTRATORS NEIC N N N ADDED 23-SEP-2002.1530 37242 PROFESSIONAL CLAIMS MANAGEMENT NEIC N N N ADDED 23-SEP-2002.1531 37242 PROFESSIONAL CLAIMS MANAGEMENT (CANTON,

OH)NEIC CLAIMS N PAYER ID VALID ONLY FOR CLAIMS WITH A BILLING SUBMISSION

ADDRESS OF P.O. BOX 35276 CANTON, OH 44735-5276

1532 58226 PROMINA NEIC CLAIMS N N N1533 31147 PROTEGRITY SERVICES (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


1534 SX131 PROVIDENCE OF OREGON CHOICE OPTION NEIC CLAIMS W1535 SX132 PROVIDENCE OF OREGON GOOD HEALTH PLAN NEIC CLAIMS W1536 SX133 PROVIDENCE OF OREGON HEALTH PLAN NEIC CLAIMS W1537 SX134 PROVIDENCE OF OREGON HEALTH PLAN HMO NEIC CLAIMS W1538 SX135 PROVIDENCE OF OREGON MEDICAID NEIC CLAIMS W1539 SX136 PROVIDENCE OF OREGON MEDICAID OPTION NEIC CLAIMS W1540 SX137 PROVIDENCE OF OREGON MEDICARE EXTRA NEIC CLAIMS W1541 SX138 PROVIDENCE OF OREGON OPTION NEIC CLAIMS W1542 SX139 PROVIDENCE OF OREGON TRADITIONAL OPTION NEIC CLAIMS W

1543 91131 PROVIDENCE PREFERRED OF WASHINGTON (SISTERS OF PROVIDENCE HEALTH PLANS)

NEIC CLAIMS N N N

1544 51032 PROVIDER NETWORKS OF AMERICA (PRO-NET) NEIC CLAIMS N N N1545 68241 PRU PLUS NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE


1546 68241 PRUCARE (OF CALIFORNIA, HMO, PLUS, WRAP, PRUCARE 1, PRUCARE 2000)

NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

1547 68241 PRUCHOICE NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

1548 68241 PRUDENTIAL NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

1549 68245 PRUDENTIAL NEIC ENCOUNTERSN N N1550 68241 PRUDENTIAL (HEALTH INSURANCE, MANAGED

HEALTHCARE, INDEMNITY, TRADITIONAL)NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE


1551 68241 PRUDENTIAL (PLUS, POINT OF SERVICE, IN-NETWORK, OUT-OF-NETWORK, SELECT, PLUS SEL


1552 68241 PRUDENTIAL (PSYCHIATRIC MGMT., RESOURCES MGMT.)


1553 68241 PRUDENTIAL FOR HEALTH NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

1554 68241 PRUDENTIAL HEALTHCARE & LIFE INS. CO OF AMERICA


1555 68241 PRUDENTIAL HEALTHCARE (HMO, REGIONAL NWK, HMO REGIONAL NWK, HMO METRO NWK, ASSOC


1556 68241 PRUDENTIAL HEALTHCARE (METRO NWK, AFFILIATES NWK, HMO AFFILIATES NWK, POS, PPO,


1557 68241 PRUDENTIAL HEALTHCARE HEALTH MAINTENANCE ORGANIZATION


1558 68241 PRUDENTIAL HEALTHCARE HMO FOR SMALL BUSINESS


1559 68241 PRUDENTIAL HEALTHCARE OF AMERICA INC. NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

1560 68241 PRUDENTIAL HEALTHCARE POS FOR SMALL BUSINESS


1561 68241 PRUDENTIAL HEALTHCARE PPO FOR SMALL BUSINESS


1562 68241 PRUNET NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

1563 68241 PRUNETWORK (PRUNETWORK PPO) NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

1564 68241 PRUPSYCH NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

1565 91136 PUGET SOUND BENEFITS TRUST NEIC Claims N N N Please enter Group Number (F25) when submitting claims.

1566 91136 PUGET SOUND BENEFITS TRUST - GRP# F25 NEIC CLAIMS N N N PLEASE INCLUDE GROUP NUMBER WHEN SUBMITTING CLAIMS.

1567 91136 PUGET SOUND ELECTRICAL WORKERS TRUST NEIC Claims N N N Please enter Group Number (F33) when submitting claims.

1568 91136 PUGET SOUND ELECTRICAL WORKERS TRUST - GRP# 33


1569 35174 QUAL CHOICE OF ARKANSAS NEIC CLAIMS Y N N1570 35171 QUAL CHOICE OF VIRGINIA NEIC CLAIMS N N N UNIQUE PROVIDER ID REQUIRED TO SUBMIT CLAIMS. CONTACT HELP

DESK AT (804) 975-1212, EXT. 6333.

1571 22300 QUAL-MED, ALBUQUERQUE (AL) NEIC CLAIMS N N N1572 22320 QUAL-MED, COLORADO (CO) NEIC CLAIMS N N N1573 22330 QUAL-MED, COLORADO EPO NEIC CLAIMS N N N1574 23342 QUALCARE, INC. NEIC CLAIMS N N N NEW PROVIDERS MUST ENROLL WITH QUALCARE AT (800) 992-6613,

OPTION 5.1575 37129 QUINCY HEALTH CARE MANAGEMENT INC. NEIC CLAIMS N N N1576 95266 R. E. HARRINGTON, THIN N N N1577 95266 R. E. HARRINGTON, INC THIN CLAIMS N N N1578 95266 R.E. HARRINGTON THIN CLAIMS N N N1579 38221 REGENCY EMPLOYEE BENEFITS NEIC CLAIMS N1580 57103 REGIONAL HEALTHPLUS NEIC CLAIMS N N N1581 RENGQ RENAISSANCE THIN1582 95203 RENAISSANCE ACHS SUMMIT MEDICAID NEIC CLAIMS N N N1583 37277 RESURRECTION HEALTH CARE HEALTH NEIC CLAIMS N1584 37270 REYNOLDS AND REYNOLDS NEIC CLAIMS N1585 75196 ROCKWELL INTERNATIONAL NEIC CLAIMS N N N1586 SX141 ROCKY MOUNTAIN HEALTH PLAN - GRAND NEIC CLAIMS W1587 RMHMO ROCKY MOUNTAIN HMO CO NEIC N N N1588 37602 ROONEY LIFE INC. NEIC CLAIMS N N N1589 36389 RUSH PRUDENTIAL HEALTH PLANS (HMO ONLY) NEIC CLAIMS N N N

1590 68241 RUSH PRUDENTIAL INSURANCE CO. (PPO & POS ONLY)


1591 31441 S & S HEALTHCARE STRATEGIES NEIC CLAIMS N N N PREVIOUS PAYER ID 311421592 35164 SAGAMORE HEALTH NETWORK NEIC CLAIMS N N N1593 37259 SAMBA NEIC CLAIMS N DO NOT SEND MEDICARE PRIMARY CLAIMS. WE RECEIVE CLAIMS

DIRECTLY FROM MEDICARE.1594 37236 SAN FRANCISCO ELECTRICAL WORKERS HEALTH &

WELFARENEIC Claims N N N

1595 68241 SANDIA TRIPLE OPTION PLAN (SANDIA TOP) NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

1596 37288 SANTA BARBARA COTTAGE HOSPITAL NEIC CLAIMS N1597 PILOT SANTE HEALTH SYSTEM AND AFFILIATES NEIC CLAIMS N1598 SX019 SANUS - TEXAS NEIC CLAIMS Y N Y NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1599 TH002 SCOTT & WHITE NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1600 88030 SCOTT & WHITE HEALTH CARE PLAN -TEXAS THIN Y N Y1601 13310 SEABURY & SMITH NEIC CLAIMS N N N1602 28530 SECURE HEALTH PLANS OF GEORGIA NEIC N N N ADDED 22-OCT-2002.1603 28530 SECURE HEALTH PLANS OF GEORGIA, LLC NEIC Claims N N N1604 42142 SECURECARE OF IOWA NEIC CLAIMS N N N1605 39045 SECURITY HEALTH PLAN NEIC CLAIMS N N N1606 64088 SELECT ADMINISTRATIVE SERVICES (SAS) NEIC Claims N N N Also known as Mississippi Select Health Care.1607 42137 SELECT BENEFIT ADMINISTRATORS THIN CLAIMS N N N 041003- CHANGED FROM NEIC TO THIN. CHANGE PAYOR ID FROM

34855 TO 42137. LOCATED IN WEST DES MOINES, IOWA. NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1608 42137 SELECT BENEFIT ADMINISTRATORS (DES MOINES, NEIC CLAIMS N N N1609 23285 SELECT HEALTH OF SOUTH CAROLINA NEIC CLAIMS N N N1610 13377 SELECT/PACIFICARE NEIC CLAIMS N N N1611 14 SELECTCARE NEIC CLAIMS N N N1612 68241 SELECTCARE (COCA COLA) NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE


1613 38253 SELECTCARE, INC. OF MICHIGAN NEIC CLAIMS N N N1614 38253 SELECTCARE, INC. OF MICHIGAN NEIC ERA N N N1615 59111 SELF INSURED BENEFIT ADMINISTRATORS

(CLEARWATER, FL)NEIC CLAIMS N PAYER ID VALID ONLY FOR CLAIMS WITH A SUBMISSION ADDRESS OF

18167 US HIGHWAY 19 NORTH, SUITE 300, CLEARWATER, FL 33764.

1616 36404 SELF INSURED PLANS NEIC CLAIMS N N N1617 34857 SELF INSURED SERVICES NEIC N N N1618 34131 SELF-FUNDED PLANS, INC. NEIC CLAIMS N N N1619 TH018 SEMNET NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINTION.

1620 68241 SENIORCARE NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

1621 54154 SENTARA FAMILY CARE NEIC Claims Y N N Please note that the Rendering Provider Network ID (E6-14) field is required. The field must be 5-7 characters, positions 1-5 must be numeric only, and positions 6 and 7 (if applicable) must be alpha only. Please contact the Ydsia Slagle-Provider Relations

1622 54154 SENTARA HEALTH MANAGEMENT NEIC CLAIMS Y N N Network Id needed. Please contact payor if you don't know your networkid

1623 23249 SENTINEL MANAGEMENT SERVICES NEIC N N N LOCATED IN LANCASTER, PENNSYLVANIA. CONTACT: ROBERT HETTRICK. TEL:(800)432-887?. NOTE: MUST HAVE INSURED GROUP ID

1624 76056 SETON CHIP NEIC N N N ADDED 23-SEP-2002.1625 TH036 SETON HEALTH PLAN NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1626 SHPCH SETON HEALTH PLAN (CHIP) TX NEIC N N N1627 SET22 SETON HEALTH PLAN (STAR MEDICAID) THIN Y Y Y1628 TH037 SETON HEALTH PLAN (STAR MEDICAID) NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1629 75280 SHASTA ADMINISTRATIVE SERVICES NEIC N N N LOCATED IN DALLAS, TEXAS. CONTACT: MICHAEL NEWMAN TEL:(214)561-6424

1630 31147 SHEAKLEY UNICOMP (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR OHIO WORKERS COMP CLAIMS ONLY.

1631 TH047 SHEET METAL WORKERS LOCAL 263 NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1632 34675 SHEET METAL WORKERS LOCAL 33 YOUNGSTOWN DISTRICT HEALTH AND WELFARE FUND, OHIO


1633 76342 SIERRA HEALTH SERVICES NEIC CLAIMS N1634 76343 SIERRA HEALTH SERVICES INC. NEIC ENCOUNTERS N1635 35206 SIGNATURE CARE HEALTH NETWORK NEIC CLAIMS N1636 62159 SIGNATURE HEALTH ALLIANCE NEIC CLAIMS N N N VALID FOR HCFA-1500 AT BILLING ADDRESS PO BOX 22419,

NASHVILLE, TN 37202-2419.1637 84076 SINCLAIR HEALTH PLAN NEIC CLAIMS N1638 84096 SLOANS LAKE MANAGED CARE NEIC CLAIMS N N N AS OF 12/27/2001, INSURED GROUP NUMBER MUST CONTAIN DOUBLE

COLON "::" FOLLOWS BY NUMERIC SLOANS LAKE INTERNAL GROUP NUMBER

1639 31147 SOLIDARITY MANAGED CARE ORGANIZATION (OHIO BWC)


1640 91131 SOUND HEALTH (NOW KNOWN AS FIRST CHOICE HEALTH NETWORK)

NEIC Claims N N N

1641 91131 SOUND HEALTH (SISTERS OF PROVIDENCE HEALTH PLANS) - NOW KNOWN AS PROVIDENCE PREF

NEIC CLAIMS N N N

1642 SX142 SOUTH INDIANA HEALTH OPTIONS - HMO NEIC CLAIMS W1643 SX143 SOUTH INDIANA HEALTH OPTIONS - PRIME CARE NEIC CLAIMS W

1644 SX144 SOUTH INDIANA HEALTH OPTIONS - TPA NEIC CLAIMS W1645 46114 SOUTHCARE NEIC CLAIMS N N N1646 25147 SOUTHCARE/HEALTHCARE PREFERRED NEIC CLAIMS N1647 86065 SOUTHEAST IOWA HEALTH PLAN NEIC CLAIMS N N N1648 25128 SOUTHERN HEALTH SERVICES, INC NEIC CLAIMS N N N1649 25128 SOUTHERN HEALTH SERVICES, INC. NEIC Claims N N N1650 37220 SOUTHERN NATIONAL LIFE NEIC Claims N N N1651 95269 SOUTHWEST ADMINISTRATORS NEIC CLAIMS N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.1652 SX021 SOUTHWEST PHYSICIANS ASSOCIATES NEIC CLAIMS Y N Y NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1653 37266 SOUTHWEST SERVICE LIFE NEIC Claims N N N1654 68241 SOUTHWESTERN BELL NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE


1655 68241 SOUTHWESTERN BELL EXEC. - CUSTOM CARE NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

1656 68241 SOUTHWESTERN BELL EXEC. - SOUTHWESTERN NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

1657 37259 SPECIAL AGENTS MUTUAL BENEFIT ASSOCIATION NEIC CLAIMS N1658 52190 SPECIAL RISK INTERNATIONAL NEIC CLAIMS N N N1659 84146 SPINA BIFIDA - VA HAC NEIC CLAIMS N1660 84146 SPINA BIFIDA - VA HAC NEIC ERA N1661 95286 SSM EXCLUSIVE CHOICE NEIC CLAIMS N N N1662 37264 ST JOHN'S CLAIMS ADMINISTRATION NEIC N N N LOCATED IN SPRINGFIELD, MISSOURI. CONTACT: RAY ZROBACK

TEL:(630)428-51261663 22240 ST. BARNABAS SYSTEM HEALTH PLAN NEIC CLAIMS N N N1664 37264 ST. JOHNS CLAIMS ADMINISTRATION NEIC Claims N N N1665 68033 ST. JOSEPTH HEALTH FOUNDATION OF NORTHERN

CALIFORNIANEIC CLAIMS N N N SONOMA COUNTY MANAGED CARE ONLY.

1666 37116 ST. THERESE PHYSICIAN ASSOCIATION NEIC CLAIMS N N N1667 59225 STAR HRG NEIC CLAIMS N CLAIMS ARE PRINTED AND MAILED TO THE PAYER. PAYER ID VALID

ONLY IF THE ADDRESS ON THE HEALTH ID CARD MATCHES ONE OF THE FOLLOWING P.O. BOXES: P.O. BOX 55270, 30870, 30888, 54150, 30069, 55400, PHOENIX, AZ 85270-5270.

1668 61425 STARMARK NEIC CLAIMS N N N1669 72087 STATE EMPLOYEES GROUP BENEFITS NEIC CLAIMS N N N1670 31053 STATE FARM GROUP MEDICAL & INDIVIDUAL

HEALTH INSURANCE COMPANIESNEIC CLAIMS N N N

1671 75087 STATES GENERAL LIFE INSURANCE NEIC Claims N N N1672 14163 STAYWELL HEALTH PLAN NEIC Claims N N N Please note that all claims submitted require a 5-9 character Rendering

Provider Network ID.1673 91151 STERLING OPTION 1 NEIC CLAIMS N N N1674 31121 STONER AND ASSOCIATES (CINCINNATI, OH) NEIC CLAIMS N

1675 FCSAS STUDENT ASSURANCE SERVICES INC FCSAS N N N1676 FCSAS STUDENT ASSURANCES SERVICES FCSAS N N Y DO NOT USE-TESTING1677 74227 STUDENT INSURANCE - BOSTON MUTUAL LIFE

INSURANCE COMPANYNEIC CLAIMS N N N

1678 74227 STUDENT INSURANCE - LIFE INSURANCE COMPANY OF BOSTON AND NEW YORK

NEIC CLAIMS N N N

1679 74227 STUDENT INSURANCE - MEGA LIFE & HEALTH INSURANCE COMPANY

NEIC CLAIMS N N N

1680 74227 STUDENT INSURANCE - MID-WEST NATIONAL LIFE INSURANCE CO. OF TENESSEE


1681 74227 STUDENT INSURANCE - MID-WEST NATIONAL LIFE INSURANCE COMPANY OF TENNESSEE

NEIC CLAIMS N N N

1682 74227 STUDENT INSURANCE - RELIANCE INSURANCE NEIC CLAIMS N N N1683 74227 STUDENT INSURANCE - RELIANCE NATIONAL

INSURANCE COMPANYNEIC CLAIMS N N N

1684 74227 STUDENT INSURANCE - THE MEGA LIFE & HEALTH INSURANCE COMPANY


1685 88331 SUFFOLK HEALTH PLAN OF NEW YORK NEIC CLAIMS N1686 95202 SUMMACARE HEALTH PLAN NEIC CLAIMS Y N N1687 37301 SUMMIT AMERICA INSURANCE SERVICES, INC. NEIC CLAIMS N1688 31147 SUMMITCORP (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


1689 68241 SUN TRUST BANK, INC. NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

1690 23218 SUPERIOR BENEFITS NEIC CLAIMS N N N1691 SHP11 SUPERIOR HEALTH PLAN NEIC N N Y (**32 max lines FA0) Contact Debbie Sandberg at (314) 725-4706 ext 25306

to enroll in EDI.1692 39188 SUPERIOR HEALTH PLAN TEXAS NEIC CLAIMS N N Y PAYOR REQUIREDS ENROLLEMENT. PLEASE CALL DEBBI SANDBERG

AT 800.225.2573 EXT 25306 OR LEISA HAMLINAT AT 800.225.2573 EXT 25319.

1693 TH024 SUPERIOR HEALTH PLANS NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1694 SN101 SURGINET (S FL) METRAHEALTH FL NEIC N N N1695 FCTLG T. L. GROSECLOSE ASSOCIATES INC FCTLG N N N HCFA-1500, UB92, 270 AND 276 TRANSACTIONS1696 37228 TARRANT HEALTH SERVICES NEIC CLAIMS N N N1697 88019 TEACHERS HEALTH TRUST NEIC CLAIMS N1698 75139 TEAM CHOICE GOLD NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1699 75133 TEAM CHOICE PNS NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1700 75133 TEAM CHOICE PPO NEIC CLAIMS N N N1701 75134 TEAM CHOICE UMC NEIC CLAIMS N N N1702 36215 TEAMCARE NEIC CLAIMS N N N1703 91068 TEAMSTER CONSTRUCTION INDUSTRY WELFARE NEIC Claims N N N Claims are printed and mailed to the payer.1704 91068 TEAMSTER CONSTRUCTION INDUSTRY WELFARE

TRUST (NORTHWEST ADMINISTRATORS INC.)NEIC N N N LOCATED IN SEATTLE, WASHINGTON. CONTACT: DANIELLE BRENNER

TEL:(206)726-32301705 36612 TEAMSTERS LOCAL UNION #301 NEIC N N N ADDED 23-SEP-2002.1706 37293 TENNESSEE BENEFIT ADMINISTRATORS, LLC NEIC CLAIMS N1707 TNBCS TENNESSEE BLUE CROSS BLUE SHIELD TNBCS Y Y Y download application from www.freeclaims.com/docs/forms, fill out and mail

to TNBCS. They will notify you.

1708 74249 TEXAS ASSOCIATION OF SCHOOL BOARDS NEIC CLAIMS N1709 76048 TEXAS CHILDRENS HEALTH PLAN NEIC CLAIMS N N N1710 TH019 TEXAS MEDICAL ASSN INSURANCE (TMAIT) NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1711 74214 TEXAS MUNICIPAL LEAGUE GROUP NEIC CLAIMS N N N1712 TPG11 TEXAS PODIATRY GROUP THIN N N N1713 TH055 TEXAS TRUE CHOICE NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

1714 59223 THE CHESAPEAKE LIFE INSURANCE CO. NEIC N N N ADDED 23-SEP-2002.1715 74227 THE CHESAPEAKE LIFE INSURANCE COMPANY -

STUDENT INSURANCENEIC CLAIMS N PAYER ID ONLY VALID IF THE P.O. BOX ON THE HEALTH ID CARD

MATCHES ONE OF THE FOLLOWING P.O. BOXES: P.O. BOX 890025, 809067, 809079, 809066, 809036, 809081, DALLAS, TX 75380-9025.

1716 25131 THE DIAMOND PLAN NEIC CLAIMS N1717 28777 THE EPOCH GROUP NEIC CLAIMS N N N1718 16126 THE GUARDIAN CHOICE NEIC CLAIMS N N N1719 31147 THE HEALTH PLAN (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


1720 35206 THE HEALTHCARE GROUP NEIC CLAIMS N N N1721 58200 THE INTEGRITY BENEFIT GROUP, INC. NEIC CLAIMS N1722 58200 THE INTEGRITY BENEFIT NETWORK, INC NEIC N N N ADDED 23-SEP-2002.1723 58200 THE INTEGRITY BENEFIT NETWORK, INC. NEIC Claims N N N1724 44066 THE LEWER AGENCY NEIC N N N1725 PILOT THE LOOMIS COMPANY NEIC CLAIMS N CALL PROVIDER RELATIONS AT 610-374-4040 EXT. 2438 FOR

PROCEDURES PRIOR TO SUBMITTING ELECTRONICALLY.

1726 59221 THE MEGA LIFE & HEALTH INS. CO. NEIC Claims N N N1727 59221 THE MEGA LIFE & HEALTH INSURANCE COMPANY -

INSURANCE CENTERNEIC CLAIMS N PAYER ID VALID ONLY IF THE P.O. BOX ON THE HEALTH ID CARD

MATCHES THE FOLLOWING P.O. BOX: P.O. BOX 982009, NORTH RICHLAND HILLS, TX 76182

1728 59221 THE MEGA LIFE & HEALTH INSURANCE COMPANY - INSURANCE CENTER

NEIC ERA N

1729 59225 THE MEGA LIFE & HEALTH INSURANCE COMPANY - STARBRIDGE STARHRG

NEIC CLAIMS N CLAIMS ARE PRINTED AND MAILED TO THE PAYER. PAYER ID VALID ONLY IF THE ADDRESS ON THE HEALTH ID CARD MATCHES ONE OF THE FOLLOWING P.O. BOXES: P.O. BOX 55270, 30870, 30888, 54150, 30069, 55400, PHOENIX, AZ 85270-5270.

1730 74227 THE MEGA LIFE & HEALTH INSURANCE COMPANY - STUDENT INSURANCE (US)


1731 59221 THE MEGA LIFT & HEALTH INS CO. NEIC N N N ADDED 23-SEP-2002.1732 70491 THE MUTUAL GROUP (US) NEIC CLAIMS N N N1733 72112 THE OATH NEIC CLAIMS N N N1734 63092 THE OATH - A HEALTH PLAN FOR ALABAMA, INC. NEIC CLAIMS P1735 63092 THE OATH - A HEALTH PLAN FOR ALABAMA NEIC CLAIMS Y N N NETWORK ID REQUIRED (4-6 DIGIT). PLEASE CONTACT THE OATH - A

HEALTH PLAN FOR ALABAMA PROVIDER CALL CENTER AT 800.743.7141 FOR ENROLLMENT.(NetworkId)

1736 72112 THE OATH FOR LOUISIANA NEIC Claims N N N1737 63092 THE OATH OF ALABAMA NEIC CLAIMS P1738 72112 THE OATH OF LOUISIANA NEIC CLAIMS N N N1739 4320 THE PREFERRED HEALTHCARE SYSTEM - PPO NEIC CLAIMS N1740 4320 THE PREFERRED HEALTHCARE SYSTEM - PPO NEIC Claims N N N1741 68241 THE PRUDENTIAL NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE


1742 13142 THE UNION LABOR LIFE INSURANCE COMPANY NEIC CLAIMS N1743 38200 THE WELLNESS PLAN NEIC CLAIMS N N N1744 THERA THERAPHYSICS NEIC N N N (**12 max lines FA0)1745 COTHE THERAPHYSICS- COLORADO ONLY CO NEIC N N N (**12 max lines FA0)1746 37225 THIRD PARTY ADMINISTRATORS, INC. NEIC N N N ADDED 23-SEP-2002.1747 6131 THIRD PARTY CLAIMS MANAGEMENT NEIC CLAIMS N N N1748 25175 THREE RIVERS HEALTH PLANS, INC NEIC CLAIMS Y N N NETWORK ID NEEDED1749 25175 THREE RIVERS HEALTH PLANS, INC. NEIC Claims Y N N1750 25175 THREE RIVERS HEALTH PLANS, INC. TMG LIFE

INSURANCE COMPANYNEIC CLAIMS N

1751 TH038 TIME TMG LIFE INSURANCE COMPANY NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1752 EYEPA TMAIT TMA11 THE EYEPA THIN N N N1753 70491 TMG LIFE INSURANCE COMPANY NEIC CLAIMS N N N1754 74214 TML INTERGOVERNMENTAL EMPLOYEE BENEFIT NEIC Claims N N N1755 TH041 TOLEDO PUBLIC SCHOOLS NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1756 61425 TOOLING & MANUFACTURING ASSOCIATION NEIC CLAIMS N N N1757 16126 TOTAL CARE CHOICE NEIC CLAIMS N N N1758 34153 TOTAL HEALTH CARE NEIC N N N

1759 31147 TOTAL HEALTH MANAGEMENT - PBM (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR OHIO WORKERS COMP CLAIMS ONLY.

1760 PILOT TOUCHSTONE HEALTH PARTNERSHIP, INC. NEIC CLAIMS N1761 69493 TOWER LIFE INSURANCE CO. NEIC CLAIMS N N N1762 PILOT TOWER ROCK STONE NEIC CLAIMS N TESTING REQUIRED: 20 INPATIENT AND 20 OUTPATIENT CLAIMS -


1763 TH064 TOWER ROCK STONE NEIC CLAIMS N PROVIDER ID REQUIRED FOR ALL THIN PAYERS1764 TXP11 TPA (Texas Plan Administrators) TX THIN N N Y Contact Amy Durham at 915-520-3865 to enroll for EDI

1765 TH020 TPA (TX PLAN ADMINISTRATORS) NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION. PLEASE CALL AMY DURHAM AT (915) 520-3865 TO ENROLL IN EDI.

1766 37225 TPA INC. NEIC Claims N N N Also known as Third Party Administartors, Inc., ABAS Inc., and American Benefit Administrative Services, Inc.

1767 37230 TR PAUL INC. NEIC Claims N N N1768 59222 TRANSAMERICA NEIC N N N ADDED 23-SEP-2002.1769 59222 TRANSAMERICA LIFE INSURANCE COMPANY NEIC CLAIMS N PAYER ID VALID ONLY IF THE ADDRESS ON THE HEALTH ID CARD


1770 59222 TRANSAMERICA LIFE INSURANCE COMPANY NEIC ERA N1771 37284 TRANSCHOICE-KEY BENEFIT ADMINISTRATORS NEIC CLAIMS N1772 87726 TRAVELERS NEIC CLAIMS N N N1773 87726 TRAVELERS NEIC ERA N N N1774 87726 TRAVELERS HEALTH NETWORK (HMO & CARE NEIC CLAIMS N N N1775 87726 TRAVELERS PLAN ADMINISTRATORS NEIC CLAIMS N N N1776 4284 TRAVELERS/CGT NEIC CLAIMS N N N1777 87726 TRAVELERS/CGT - PPO NEIC CLAIMS N N N1778 39181 TRIAD HEALTHCARE, INC (PLAINVILLE, CT) NEIC N N N ONLY FOR CHIROPRACTIC MEDICAL CLAIMS FROM PARTICIPATING

TRIAD NETWORK PROVIDERS. ADDED 23-SEP-2002.

1779 39181 TRIAD HEALTHCARE, INC. (PLAINVILLE, CT) NEIC Claims N N N Payer ID valid only for chiropractic medical claims from participating TRIAD network providers.

1780 REG06 TRICARE CHAMPUS/ WPS -REGION 6 (TX, LA, ARK, OK) (NOTE: PAYER ID CHANGE

THIN Y N Y

1781 57106 TRICARE PALMETTO NEIC Claims Y N N Participating Payer for TRICARE claims for regions 1, 2, 5, 7, 8, 9, 10, and 12.

1782 TH048 TRUE CHOICE USA - CHRISTUS HEALTH NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

1783 TCUCH TRUE CHOICE USA-CHRISTUS HEALTH PLAN THIN N N N1784 91078 TRUSTEED PLANS SERVICE CORPORATION NEIC CLAIMS N1785 61425 TRUSTMARK NEIC CLAIMS N N N1786 61425 TRUSTMARK INSURANCE COMPANY NEIC CLAIMS N1787 61425 TRUSTMARK INSURANCE COMPANY NEIC ERA N

1788 76055 TTPA CHIP NEIC N N N ADDED 23-SEP-2002.1789 76054 TTPA COMM NEIC N N N ADDED 23-SEP-2002.1790 TUFTS TUFTS ASSOCIATED HEALTH NEIC N N Y ADDED 31-OCT-2002. CALL SUSAN HOFFMAN AT (617)972-9400, EXT

4648, THEN CONTACT FREECLAIMS AND LET US KNOW THE PAYOR ID

1791 CALL TUFTS HEALTH PLAN NEIC CLAIMS P PLEASE CONTACT TUFTS EDI OPERATIONS AT (888) 880- 8699, EXT. 4042 OR E-MAIL EDI_OPERATIONS@TUFTS- HEALTH.COM PRIOR TO SUBMITTING EDI CLAIMS.

1792 TTPCH TX UNIVERSITY HEALTH PLAN - TEENS TO TOTS TX NEIC N N N1793 TTPER TX UNIVERSITY HEALTH PLAN - TTPA COMMERCIAL NEIC N N N1794 UPGCH TX UNIVERSITY HEALTH PLAN - UPG CHIP PLAN TX NEIC N N N1795 UPGUT TX UNIVERSITY HEALTH PLAN - UPG COMMERCIAL NEIC N N N1796 87726 UBH - UNITED BEHAVIORAL HEALTH (FORMER

METRAHEALTH - UNET)NEIC Claims N N N

1797 87726 UBH - UNITED BEHAVIORAL HEALTH (HEALTH PLAN - HMO)

NEIC Claims N N N

1798 16412 UBH RIOS NEIC CLAIMS N N N1799 68241 UC CARE (UNIVERSITY OF CA) NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE


1800 65006 UCSF/ICSL UROLOGY NEIC CLAIMS N N N CLAIMS ARE PRINTED AND MAILED TO THE PAYER.1801 PILOT UFCW NEIC CLAIMS N TESTING REQUIRED: 20 INPATIENT AND 20 OUTPATIENT CLAIMS -


1802 TH065 UFCW NEIC CLAIMS N PROVIDER ID REQUIRED FOR ALL THIN PAYERS1803 22329 UHP OF NEW JERSEY (CENTENE) NEIC Claims N N N1804 75240 UICI - ADMINISTRATORS NEIC CLAIMS N N N1805 75245 UICI - ADMINISTRATORS - STATE OF NEVADA NEIC CLAIMS N N N ACCEPTING CLAIMS ONLY FOR THE STATE OF NEVADA.

1806 74223 UICI - ADMINISTRATORS - STATE OF NEVADA UICI - ADMINISTRATORS - STATE OF NEVADA

NEIC CLAIMS N ACCEPTING CLAIMS ONLY FOR THE STATE OF NEVADA. PLEASE BEGIN USING PAYER ID 74223.

1807 37292 UMMH NEIC CLAIMS N1808 52180 UMWA HEALTH & RETIREMENT FUNDS NEIC CLAIMS N N N UNIQUE PROVIDER ID REQUIRED. PLEASE CALL (800) 606-5479.

1809 80314 UNICARE NEIC Claims N N N1810 47195 UNICARE INDIVIDUAL-SMALL GROUP NEIC CLAIMS N N N PLEASE USE PAYER ID 803141811 80314 UNICARE MAJOR ACCOUNTS NEIC CLAIMS N N N EFFECTIVE 6/1/98, PAYER ID 65935 WILL NO LONGER BE VALID.

PLEASE BEGIN SENDING CLAIMS FOR UNICARE MAJOR ACCOUNTS, PAYER ID 65935, TO PAYER ID 80314. (FORMERLY UNICARE LIFE & HEALTH & MASS MUTUAL)

1812 65099 UNICARE SPECIAL ACCOUNTS NEIC CLAIMS N N N (FORMERLY JOHN HANCOCK HEALTH SECURITY PLAN, JOHN HANCOCK PREFERRED HEALTH PLAN & JOHN HANCOCK HEALTH SECURITY PLAN)

1813 65099 UNICARE SPECIAL ACCOUNTS NEIC ERA N N N (FORMERLY JOHN HANCOCK MUTUAL LIFE INS. CO.)

1814 62170 UNIFIED HEALTH SERVICES NEIC CLAIMS N N N WORKERS COMPENSATION CLAIMS ONLY.1815 75243 UNIFORM MEDICAL PLAN NEIC CLAIMS N N N1816 75243 UNIFORM MEDICAL PLAN/HARRINGTON BENEFIT

SERVICESNEIC Claims N N N

1817 87042 UNION PACIFIC RAILROAD EMPLOYEES NEIC N N N ADDED 23-SEP-20021818 UBHRI UNITED BEHAVIORAL HEALTH (EMPLOYERS

DIVISION-FORMERLY METRAHEALTH))THIN N N N

1819 59069 UNITED BENEFITS NEIC Claims N N N1820 87726 UNITED HEALTH & LIFE NEIC CLAIMS N N N1821 65978 UNITED HEALTHCARE - NEIC CLAIMS N N N1822 87726 UNITED HEALTHCARE - TRAVELERS NEIC CLAIMS N N N1823 59129 UNITED HEALTHCARE OF FLORIDA (OLD

CAC/RAMSAY/CORAL GABLES PLAN ONLY)NEIC CLAIMS N N N CALL EDI SERVICES AT (813) 357-5483 WITH QUESTIONS.

1824 31107 UNITED MEDICAL RESOURCES NEIC CLAIMS N N N1825 71412 UNITED OF OMAHA NEIC CLAIMS N N N1826 84132 UNITED PHYSICIANS OF NORTHERN COLORADO NEIC CLAIMS N N N1827 41194 UNITED RESOURCES NETWORK NEIC CLAIMS N1828 13545 UNITED STATES LIFE INSURANCE COMPANY NEIC N N N1829 87726 UNITEDHEALTHCARE NEIC Claims N N N1830 87726 UNITEDHEALTHCARE (FORMER METRAHEALTH) NEIC CLAIMS N N N1831 87726 UNITEDHEALTHCARE OF ALABAMA NEIC CLAIMS N N N1832 87726 UNITEDHEALTHCARE OF ARIZONA, INC. NEIC Claims N N N1833 87726 UNITEDHEALTHCARE OF ARKANSAS NEIC CLAIMS N N N1834 87726 UNITEDHEALTHCARE OF CALIFORNIA - NORTHERN

CALIFORNIANEIC Claims N N N

1835 87726 UNITEDHEALTHCARE OF CALIFORNIA - SOUTHERN CALIFORNIA

NEIC Claims N N N

1836 87726 UNITEDHEALTHCARE OF COLORADO, INC. NEIC Claims N N N1837 87726 UNITEDHEALTHCARE OF FLORIDA NEIC CLAIMS N N N1838 87726 UNITEDHEALTHCARE OF GEORGIA NEIC CLAIMS N N N1839 87726 UNITEDHEALTHCARE OF ILLINOIS NEIC Claims N N N1840 87726 UNITEDHEALTHCARE OF KENTUCKY, LTD. NEIC Claims N N N1841 87726 UNITEDHEALTHCARE OF LOUISIANA NEIC CLAIMS N N N1842 87726 UNITEDHEALTHCARE OF MISSISSIPPI NEIC CLAIMS N N N1843 87726 UNITEDHEALTHCARE OF NEW ENGLAND NEIC CLAIMS N N N1844 87726 UNITEDHEALTHCARE OF NEW YORK (INCLUDES

NEW YORK AND NEW JERSEY)NEIC Claims N N N

1845 87726 UNITEDHEALTHCARE OF NORTH CAROLINA NEIC CLAIMS N N N1846 87726 UNITEDHEALTHCARE OF NORTH CAROLINA, INC. NEIC Claims N N N1847 87726 UNITEDHEALTHCARE OF OHIO NEIC Claims N N N1848 87726 UNITEDHEALTHCARE OF PUERTO RICO NEIC CLAIMS N N N1849 87726 UNITEDHEALTHCARE OF TENNESSEE NEIC CLAIMS N N N1850 87726 UNITEDHEALTHCARE OF TEXAS NEIC CLAIMS N N N1851 87726 UNITEDHEALTHCARE OF TEXAS - DALLAS NEIC Claims N N N1852 87726 UNITEDHEALTHCARE OF TEXAS - HOUSTON NEIC Claims N N N1853 87726 UNITEDHEALTHCARE OF THE MID-ATLANTIC NEIC Claims N N N1854 87726 UNITEDHEALTHCARE OF THE MIDLANDS NEIC CLAIMS N N N

1855 87726 UNITEDHEALTHCARE OF THE MIDLANDS - HMO (CHOICE, SELECT)

NEIC Claims N N N

1856 87726 UNITEDHEALTHCARE OF THE MIDLANDS - PPO(CHOICE PLUS,SELECT PLUS,SELF FUNDED)

NEIC Claims N N N

1857 87726 UNITEDHEALTHCARE OF THE MIDWEST (MISSOURI) NEIC CLAIMS N N N1858 87726 UNITEDHEALTHCARE OF THE MIDWEST - CHOICE,

CHOICE PLUS, SELECT, SELECT PLUSNEIC Claims N N N

1859 87726 UNITEDHEALTHCARE OF THE MIDWEST - MEDICARE COMPLETE

NEIC Claims N N N

1860 87726 UNITEDHEALTHCARE OF UPSTATE NEW YORK NEIC CLAIMS N N N1861 87726 UNITEDHEALTHCARE OF UTAH NEIC CLAIMS N N N1862 87726 UNITEDHEALTHCARE OF VIRGINIA NEIC CLAIMS N N N1863 87726 UNITEDHEALTHCARE OF WISCONSIN, INC. NEIC Claims N N N1864 87726 UNITEDHEALTHCARE PLANS OF PUERTO RICO NEIC Claims N N N1865 16108 UNIVERA HEALTH - SOUTHERN TIER NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1866 16108 UNIVERA HEALTH-SOTHERN TIER NEIC CLAIMS N N N1867 16107 UNIVERA HEALTHCARE NEIC CLAIMS N N N REQUIRES UNIQUE PROVIDER NUMBER, CALL (800) 617-1114.

1868 16105 UNIVERA HEALTHCARE - CNY NEIC CLAIMS N N N1869 33001 UNIVERSAL CARE - CALIFORNIA NEIC Claims N N N1870 33002 UNIVERSAL CARE - TENNESSEE NEIC N N N ADDED 23-SEP-2002.1871 TH057 UNIVERSAL HEALTH CARE NEIC CLAIMS N TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITIONS.

1872 38298 UNIVERSAL STANDARD HEALTHCARE, INC. NEIC CLAIMS N N N1873 31147 UNIVERSITY COMP CARE (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


1874 SX148 UNIVERSITY FAMILY CARE NEIC CLAIMS W1875 58248 UNIVERSITY HEALTH PLAN NEIC CLAIMS N N N1876 58247 UNIVERSITY HEALTH PLAN (MEDICAID) NEIC CLAIMS N N N1877 CALL UNIVERSITY HEALTH PLAN OF NEW JERSEY NEIC N N Y CALL DEBBI SANDBERG AT (800)225-2573 EXT. 25306 FOR PAYORID.

EDI TEL:(800)780-24381878 59000 UNIVERSITY HEALTH PLAN OF NEW JERSEY |

INFOTRUST | TRIZETTONEIC N N N CONTACT: STEVE WALLERT AT (847)887-8088 OR JERI KAVANAUGH AT

(847)887-80201879 59000 UNIVERSITY HEALTH PLAN OF NJ NEIC Claims N N N1880 58246 UNIVERSITY HEALTH PLANS OF GEORGIA NEIC CLAIMS N N N1881 13393 UNIVERSITY MSO NEIC CLAIMS N N N1882 91136 UNIVERSITY OF WASHINGTON STUDENTS &

GRADUATE APPTS.NEIC Claims N N N Please enter Group Number (P67) when submitting claims.

1883 76053 UPG CHIP NEIC N N N ADDED 23-SEP-2002.1884 23281 UPMC HEALTH PLAN NEIC CLAIMS N N N1885 38337 UPPER PENINSULA HEALTH PLAN NEIC N N N ADDED 12/31/20011886 23222 US HEALTHCARE NEIC CLAIMS N N N1887 23222 US HEALTHCARE NEIC ENCOUNTERSN N N1888 TH041 USA HEALTH AND WELNESS NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1889 74095 USAA (UNITED STATES AUTOMOBILE NEIC CLAIMS N N N1890 USC11 USC HEALTH SERVICES NEIC N N N1891 TH021 USC HEALTH SERVICES NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1892 13407 USFHP - ST VINCENT CATHOLIC MEDICAL CENTERS OF NEW YORK

NEIC N N N ADDED 23-SEP-2002.

1893 13407 USFHP - ST. VINCENT CATHOLIC MEDICAL CENTERS OF NEW YORK

NEIC Claims N N N

1894 23217 USI ADMINISTRATORS NEIC N N N1895 76049 UTMB HEALTHCARE SYSTEMS NEIC CLAIMS N N N PRIOR TO SUBMITTING PLEASE CALL PROVIDER RELATIONS AT (281)

652-8700.1896 12115 VA FEE BASIS PROGRAMS NEIC CLAIMS N1897 12115 VA FEE BASIS PROGRAMS NEIC ERA N1898 12116 VA FEE BASIS PROGRAMS NEIC ERA N1899 TH022 VALLEY BAPTIST HEALTH PLAN NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1900 77004 VALLEY PHYSICIANS, INC. NEIC CLAIMS N N N1901 FCVO1 VALUE OPTIONS - NORTH STAR MEDICAID ONLY FCVO1 Y N Y Provider Number Needed. EMC Submitter Number Needed. Contact Payor

at 888-247-9311. ADDED 06/10/2002. LIVE 16-JAN-2003

1902 72128 VANTAGE HEALTH PLAN, INC. NEIC CLAIMS N N N1903 31147 VANTAGE HEALTH PLAN, INC. (OHIO BWC) NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. FOR


1904 68241 VARIAN HEALTH CARE PLAN NEIC CLAIMS N N N AS OF 12/31/2002, PLEASE ALL PRUDENTIAL CLAIMS WILL BE MIGRATE TO AETNA, PAYORID 60054

1905 73288 VENCOR NEIC CLAIMS N N N1906 TH039 VENTANA HEALTH SYSTEMS NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1907 23173 VHP COMMUNITY CARE NEIC CLAIMS N N N1908 54182 VICARE ADMINISTRATIVE SERVICES NEIC N N N ADDED 23-SEP-2002.1909 37297 VISON CARE INCORPORATED NEIC CLAIMS N1910 86079 VISTA DEL SOL HEALTH CARE NEIC CLAIMS N N N1911 55248 VISTA HEALTH PLAN NEIC N N N ADDED 31-OCT-2002. PAYOR EDI: JIM GALLAGHER (850)668-3000 EXT

7091912 VNAET VIVRA - AETNA NEIC CLAIMS N N N1913 VNANT VIVRA - ANTERO NEIC CLAIMS N N N1914 VNBCO VIVRA - BLUE CHOICE OF COLORADO NEIC CLAIMS N N N1915 VNCAC VIVRA - CAC RAMSEY PLANS (CUBAN AMERICAN

CLINICS)NEIC CLAIMS N N N

1916 VNCIG VIVRA - CIGNA PLANS NEIC CLAIMS N N N1917 VNFHP VIVRA - FAMILY HEALTH PLAN NEIC CLAIMS N N N1918 VNFPL VIVRA - FAMILY PLUS PLANS NEIC CLAIMS N N N1919 VNFHC VIVRA - FLORIDA HEALTH CHOICE PLANS NEIC CLAIMS N N N1920 VNCFL VIVRA - FOUNDATION HEALTH PLANS (CARE NEIC CLAIMS N N N

1921 VNHOP VIVRA - HEALTH OPTIONS - BLUE CROSS FLORIDA PLANS

NEIC CLAIMS N N N

1922 VNHEL VIVRA - HELIXCARE PLANS NEIC CLAIMS N N N1923 VNHIP VIVRA - HIP PLANS (SUNRISE HEALTH PLAN) NEIC CLAIMS N N N1924 VNHUM VIVRA - HUMANA PLUS NEIC CLAIMS N N N1925 VNMCA VIVRA - MANAGED CARE OF AMERICA PLANS (PPO) NEIC CLAIMS N N N1926 VNMER VIVRA - MERIDIAN PLANS NEIC CLAIMS N N N1927 VNMET VIVRA - METRAHEALTH PLANS NEIC CLAIMS N N N1928 VNNHP VIVRA - NEIGHBORHOOD HEALTH PARTNERSHIP NEIC CLAIMS N N N1929 VNNYL VIVRA - NYLCARE PLANS (HEALTH PLUS) NEIC CLAIMS N N N1930 VNONE VIVRA - ONE SOURCE PLANS NEIC CLAIMS N N N1931 VNPAC VIVRA - PACIFICARE NEIC CLAIMS N N N1932 VNPHP VIVRA - PHP NEIC CLAIMS N N N1933 VNPCA VIVRA - PHYSICIANS CORPORATION OF AMERICA

PLANSNEIC CLAIMS N N N

1934 VNPRI VIVRA - PRINCIPAL PLANS NEIC CLAIMS N N N1935 VNPRU VIVRA - PRUDENTIAL PLANS NEIC CLAIMS N N N1936 VNRMN VIVRA - ROCKY MOUNTAIN NEIC CLAIMS N N N1937 VNTHC VIVRA - TOTAL HEALTH CHOICE PLANS NEIC CLAIMS N N N1938 VNUNI VIVRA - UNITED PLANS NEIC CLAIMS N N N1939 VOID-46112 VOID-HEALTH DATA SOLUTIONS NEIC CLAIMS N N N DO NOT USE-NEIC NO LONGER RECEIVING CLAIMS FROM THIS

PAYOR1940 VOID-46113 VOID-PPOI NEIC CLAIMS N N N DO NOT USE-NEIC NO LONGER RECEIVING CLAIMS FROM THIS

PAYOR1941 VOID-93114 VOID-PREMIER CARE OF NORTH WEST ARKANSAS NEIC CLAIMS N N N DO NOT USE-NEIC NO LONGER ACCEPT CLAIMS FOR THIS PAYOR AS

OF NOV 8, 20021942 VOID-46116 VOID-SUPERION NEIC CLAIMS N N N DO NOT USE-NEIC NO LONGER RECEIVING CLAIMS FROM THIS

PAYOR1943 VOID-46115 VOID-THE CALENDS GROUP NEIC CLAIMS N N N DO NOT USE-NEIC NO LONGER RECEIVING CLAIMS FROM THIS

PAYOR1944 22264 VYTRA HEALTHCARE NEIC CLAIMS N N N (FORMERLY CHOICECARE - LONG ISLAND)1945 62111 W.C. BEELER & COMPANY NEIC Claims N N N1946 75257 WAL-MART NEIC CLAIMS N N N ONLY STORES IN THE FOLLOWING STATES: AK, DE, ID, MT, ND, OR,

SD, VT, WA, WI, WY1947 SX063 WASHINGTON LABOR & INDUSTRY NEIC CLAIMS W NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1948 35196 WASHINGTON NATIONAL INSURANCE CO NEIC CLAIMS N N N1949 91068 WASHINGTON TEAMSTER WELFARE TRUST NEIC Claims N N N Claims are printed and mailed to the payer.1950 91068 WASHINGTON TEAMSTER WELFARE TRUST

(NORTHWEST ADMINISTRATORS INC.)NEIC N N N LOCATED IN SEATTLE, WASHINGTON. CONTACT: DANIELLE BRENNER

TEL:(206)726-32301951 TH043 WATERLOO MUNICIPAL EMPLOYEES HEALTH PLAN NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1952 58082 WATKINS ASSOCIATED INDUSTRIES INC (ATLANTA,GA)

NEIC N N N ADDED 31-OCT-2002. PAYOR CONTACT: TIFFIANY BROWN (440)720-0700 EXT 215

1953 58082 WATKINS ASSOCIATED INDUSTRIES, INC. NEIC Claims N N N1954 39026 WAUSAU BENEFITS, INC. NEIC Claims N N N

1955 39026 WAUSAU INSURANCE COMPANIES - AKA EMPLOYERS INSURANCE OF WAUSAU

NEIC CLAIMS N N N

1956 11123 WAUSAU INSURANCE COMPANY NEIC CLAIMS N NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION. WORKERS COMPENSATION CLAIMS ONLY.

1957 39151 WEA INSURANCE GROUP NEIC CLAIMS N N N1958 16112 WEBSTER PLASTICS INC. DOCTORS HEALTH PLAN NEIC Claims N N N1959 75261 WEBTPA/COMMUNITY HEALTH ELECTRONIC

CLAIMS/CHECNEIC CLAIMS N N N

1960 75261 WEBTPA/COMMUNITY HEALTH ELECTRONIC CLAIMS/CHEC WELL PATH OF CAROLINA, INC

NEIC CLAIMS N PLEASE SUBMIT CLAIMS TO PAYER ID 25129, COVENTRY HEALTH CARE OF THE CAROLINAS, INC./WELLPATH.

1961 14163 WELLCARE HMO, INC. NEIC CLAIMS N N N1962 14164 WELLCARE OF CT NEIC CLAIMS N N N NEW PROVIDERS MUST CONTACT KATHLEEN MARTIN PRIOR TO

SUBMITTING CLAIMS AT (914) 334-4173.

1963 14164 WELLCARE OF CT NEIC ENCOUNTERSN N N1964 14164 WELLCARE OF NY NEIC CLAIMS N N N NEW PROVIDERS MUST CONTACT KATHLEEN MARTIN PRIOR TO

SUBMITTING CLAIMS AT (914) 334-4173.

1965 14164 WELLCARE OF NY NEIC ENCOUNTERSN N N1966 TH023 WELLMED NEIC CLAIMS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1967 WELM2 WELLMED (CLAIMS) NEIC N N N1968 WELMD WELLMED (ENCOUNTERS) NEIC N N N1969 TH040 WELLMED (ENCOUNTERS) NEIC ENCOUNTERS E TRANSITIONAL PAYER - SEE LAST PAGE FOR DEFINITION.

1970 25129 WELLPATH NEIC CLAIMS N1971 25129 WELLPATH NEIC ERA E PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1972 91136 WEST COAST STATIONARY ENGINEERS HEALTH & SECURITY TRUST FUND


1973 FWLFG WEST LAKE FINANCIAL GROUP FWLFG Y Y N1974 WVMCD WEST VIRGINIA MEDICAID (CONSULTECT) WVMCD Y Y Y ADDED 06/20/2002. LIVE 06/02/2002. Please contact payor EDI dept at 800-

830-9024 to enroll.1975 24735 WESTERN GROWERS ASSURANCE TRUST NEIC CLAIMS N1976 24735 WESTERN GROWERS INSURANCE COMPANY NEIC CLAIMS N N N1977 37247 WESTERN MUTUAL INSURANCE NEIC Claims N N N1978 31048 WESTERN SOUTHERN FINANCIAL GROUP

(CINCINNATI, OH)NEIC CLAIMS N

1979 91068 WESTERN TEAMSTER WELFARE TRUST NEIC Claims N N N Claims are printed and mailed to the payer.1980 91068 WESTERN TEAMSTER WELFARE TRUST

(NORTHWEST ADMINISTRATORS INC.)NEIC N N N LOCATED IN SEATTLE, WASHINGTON. CONTACT: DANIELLE BRENNER

TEL:(206)726-32301981 38232 WEYCO INC. NEIC CLAIMS N N N1982 98010 WILLIAM J. SUTTON & COMPANY, LTD. (TORONTO,

CANADA)NEIC CLAIMS N

1983 62061 WILLIS ADMINISTRATIVE SERVICES CORPORATION NEIC CLAIMS N N N (FORMERLY WILLIS CORROON)1984 WNHLT WINHEALTH PARTNERS WY NEIC N N N

1985 39200 WISCONSIN AUTO AND TRUCK DEALERS NEIC CLAIMS N1986 SX022 WISCONSIN PHYSICIANS SVC GROUP HEALTH/WPS NEIC CLAIMS Y N Y NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1987 SX067 WORKERS COMP OF WEST VIRGINIA NEIC CLAIMS Y N Y1988 TWCCP WORKERS' COMPENSATION NEIC N N N1989 75276 WORLD INSURANCE COMPANY NEIC CLAIMS N N N1990 SX022 WPS ELECTRONIC DATA SERVICES NEIC CLAIMS Y N Y NON-PARTICIPATING PAYER - SEE LAST PAGE FOR DEFINITION.

1991 23710 WRITERS GUILD - INDUSTRY HEALTH PLAN NEIC Claims N N N1992 62153 XANTUS HEALTHPLAN OF TENNESSEE NEIC CLAIMS N N N (FORMERLY PHOENIX HEALTHCARE)1993 6121 YALE NEW HAVEN HEALTH - MSO INC. NEIC CLAIMS N N N1994 95376 YALE PREFERRED HEALTH/HEALTHCHOICE OF

CONNECTICUTNEIC CLAIMS N N N

1995 34083 YOUNGSTOWN AREA ELECTRICAL WELFARE FUND, OHIO


(1995 row(s ) affected)

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