Trojan DrDirect Dental Payor List       October   2016

Payor State Payor
ID
Enrollment
Required
Notes
3P ADMIN20413
A & I Benefit Plan Administrators93044
A. D. N. Administrators Inc.CXADN
AARPAARP1AARP claims with a mailing address of PO Box 2059 Mechanicsburg PA
Acceptius (Benefit Management Inc of MO (BMI)43178
Access DentalCX097via Performance Health Technology
Acclaim64071
ACS Benefit Services Inc.72468Formerly: ACS Consulting Services Inc.
ACS Benefit Services Inc.61474ACS Branded Dental Product
Activa Benefit Services LLC/Dental38255(Formerly Amway Corporation/Dental)
Adminstrative Services OnlyCX076Addt'l enrollment is not required by the payer. Providers wishing to submit claims electronically must be credentialed with the payer. Please ensure you have successfully processed one paper claim prior to submitting your first electronic claim.
Advantage Dental Plan Inc.93524
Advantek Benefit Administrators83077
Advantica Benefits43168
Adventist Health System West - Roseville CA95340
Aetna60054
Aetna Affordable Health Choices (SM) - SRC57604
Aetna Medicare EPO/PPO Dental18014
Affordable Benefit Administrators Inc.95426
AFLAC GA58066
AFLAC GA - GRP58066Group Plan coverage please refer to your ID card for group coverage/number verification.
AFLAC NY52080This plan also shares the same mailing address as payer ID 58066 and the only difference between the plans is that the insured ID for the NY based plan begins with "PN" as "PNxxxxxx" (followed by 6+ digits)
AFLAC NY - GRP52080Group Plan Coverage please refer to your ID card for group coverage/number verifcation.
AK United Food and Commercial Workers (AK UFCW)91136Please enter group # F45 when submitting claims. A Welfare and Pension Administration Services payer
Alabama MedicaidALCKAL1Yes
Alameda AllianceCX083Admin by LIBERTY Dental Plan
Alaska Carpenters Trust91136Please enter group # F40 when submitting claims. A Welfare and Pension Administration Services payer
Alaska Electrical Health & Welfare Fund92600
Alaska Hotel Employees Restaurant & Camp Employees (AK HERE)91136Please enter group # F41 when submitting claims. A Welfare and Pension Administration Services payer
Alaska Laborers Construction Industry Health & Security Trust91136Please enter group # F23 when submitting claims. A Welfare and Pension Administration Services payer
Alaska Machinists Health and Welfare Trust91136Please enter group # F21 when submitting claims. A Welfare and Pension Administration Services payer
Alaska MedicaidAKCKAK1Yes
Alaska Pipe Trades U A Local 37591136Please enter group # F24 when submitting claims. A Welfare and Pension Administration Services payer
Alaska Public Employees Association (APEA/JESS Health & WelfareTrust)91136Please enter group # F60 when submitting claims. A Welfare and Pension Administration Services payer
Alexian Brothers Community Services of TN44423
AllCare CCO DentalCXALCvia Performance Health Technology
Allegeant52193Formerly known as LBA Health Plans
Allegiance Benefit Plan81040
Alliant Services70106Claims mailing address PO Box 12009 Cheshire CT
Allied Benefit Systems37308
Allied Metal Crafts Security Plan Trust Fund91136Please enter group # F18 when submitting claims. A Welfare and Pension Administration Services payer
AltusRI50503
AlwaysCare BenefitsSTR01
Amalgamated Life - PA / Alicare13343
AmeriBen Solutions Inc.75137
America's TPA41178
American Benefit CorporationCX084Only limited plans may be sent electronically. Group name is required with one of the following names: Sheet Metal Berkeley Boone Carpenter Cabell Clarksburg Doddridge Hancock Harrison Marion Monongalia Mingo Mineral Morgan Nicholas Putnam Taylor Tyler
American Postal Workers Union Health Plan44444
American Trust Administrators Inc.56195
AmeriHealth Administrators54763
Ameritas Life Insurance Corp.47009
Ameritas Life Insurance Corp. of New York72630
Amway Corporation38255(Formerly Amway Corporation/Dental)
Anchor Benefit Consulting Inc.53085
Anthem Blue CrossCA47198Formerly: Blue Cross of California; Wellpoint
Anthem Blue Cross Blue Shield ConnecticutCT84105
Anthem Blue Cross Blue Shield ConnecticutIN84105
Anthem Blue Cross Blue Shield ConnecticutKY84105
Anthem Blue Cross Blue Shield ConnecticutME84105
Anthem Blue Cross Blue Shield ConnecticutNH84105
Anthem Blue Cross Blue Shield ConnecticutOH84105
Anthem Health Plans - HMOD & HMOGCX083Admin by LIBERTY Dental Plan
Anthem Health Plans of Kentucky - OSB High & LowCX083Admin by LIBERTY Dental Plan
Anthem Health Plans of Virginia - OSB High & LowCX083Admin by LIBERTY Dental Plan
Anthem Health Plans of Virginia - PPOB & PPODCX083Admin by LIBERTY Dental Plan
Anthem HMO Colorado - HMO-BCX083Admin by LIBERTY Dental Plan
Anthem Insurance - OSB High & LowCX083Admin by LIBERTY Dental Plan
Anthem Insurance - PPOB & PPODCX083Admin by LIBERTY Dental Plan
ARC AdministratorsCXARC
Argus Dental PlansARGUS
Arizona MedicaidCKAZ1Please visit http://www.azahcccs.gov/commercial/ProviderRegistration/registration.aspx for provider registration information prior to submitting claims.
Arkansas Best Corporation - Choice Benefits75278
Arkansas MedicaidARCKAR1
Aspen16180
Assurant Employee Benefits70408PO Box 2940 Clinton IA 52733
Assurant Health41099PO Box 2877 Clinton IA 52733
Assurant Health ( IM & GROUP FULLY - INSURED )39065PO Box 2806 Clinton IA 52733
Assurant Inc.70408PO Box 2940 Clinton IA 52733
Assured Benefits Administrators74240
Atlantic Dental Inc. (ADI) - CommercialCX085
Automated Group Administration Inc. (AGA)37280
Avesis86098
Banner HealthSX145
Bay Area Automotive GroupCHSBAAdministered by Health Services Benefit Administraors Inc. (HSBA)
Bay Area Delivery DriversCHSBDAdministered by Health Services Benefit Administrators Inc. (HSBA)
BCBS of Rochester New YorkNYCBNYR
BCBS of Western NYNYCBNYWYes
BCI Administrators Inc.49153
BEAM Dental InsuranceCXBMD
Bell Atlantic68241
BeneCare Dental Plans23210
Benefit Administrative Systems36149
Benefit Coordinators Corporation (Pittsburgh PA)25145Payer ID valid only for claims with a submission address of 111 Ryan Court Suite 300 Pittsburgh PA 15205.
Benefit Inc.R7003
Benefit Management Inc. of KS48611For Dental providers any group is accepted as long as the group number on the participant's card starts with BMI###.
Benefit Management Services Inc56139
Benefit Management Systems Inc37212
Benefit Plan Administrators Co. (Eau Claire WI)39081Payer ID valid for Benefit Plan Administrators (Eau Claire WI submission address only) and Custom Benefit Administrators
Benefit Systems & Services Inc.36342Now known as Total Broker Benefits Payer ID 36342
Best Life & Health Insurance Co.95604
BHP-Unity44219
Blue Benefit Administrators of MA03036
Blue Care Family PlanGWD01Administered by Golden West (Well point)
Blue Care Family Plan (BCBS of CT)CT00700Administered by Anthem of CT
Blue Cross of North Dakota (ND Dental Services)NDCX004Yes
Blue Cross and Blue Shield of ArizonaAZ53589
Blue Cross Blue of LouisianaLA23739Payer requires providers be tied to our submitter ID of P0003784
Blue Cross Blue Sheild Delaware Fully - Insured Dental Group BusinessDE53287Effective 5-18-13 FEP claims must be mailed to PO Box 1991 Wilmington DE 19899
Blue Cross Blue Shield Association - FEP DentalBCAFD
Blue Cross Blue Shield of Arizona Advantage77078
Blue Cross Blue Shield of Kansas City MO47171Yes
Blue Cross Blue Shield of MichiganMICBMI1
Blue Cross Blue Shield of MontanaMTCBMT1
Blue Cross Blue Shield of North Carolina61472EHB Pediatric Dental Claims
Blue Cross Blue Shield of North Carolina61472Federal Employee Claims.
Blue Cross Blue Shield of North Carolina61473Dental Blue Product
Blue Cross blue Shield of North Carolina61474Dental Blue Select Product
Blue Cross Blue Shield of OklahomaOKSB840
Blue Cross Blue Shield of South CarolinaSC38520
Blue Cross Blue Shield of South DakotaCBSD1
Blue Cross Blue Shield of Wisconsin - PPODCX083Admin by LIBERTY Dental Plan
Blue Cross DentalCBMNUNon FEP claims only
Blue Cross of AlabamaALCBAL1
Blue Cross of Alaska and WashingtonAK47570
Blue Cross of Alaska and WashingtonWA47570
Blue Cross of ArkansasARCBAR1Mailing address for claims: Dental Claims Administrator PO Box 1206 Elk Grove Village IL 60009-1206.
Blue Cross of California - OSB High & LowCX083Admin by LIBERTY Dental Plan
Blue Cross of California - Plan SS10 & SS20CX083Admin by LIBERTY Dental Plan
Blue Cross of California - PPOACX083Admin by LIBERTY Dental Plan
Blue Cross of ColoradoCO84099
Blue Cross of GeorgiaGACBGA1
Blue Cross of IdahoIDCBID1Yes
Blue Cross of IllinoisILCB621
Blue Cross of Indiana AnthemCT84105
Blue Cross of Indiana AnthemIN84105
Blue Cross of Indiana AnthemKY84105
Blue Cross of Indiana AnthemME84105
Blue Cross of Indiana AnthemNH84105
Blue Cross of Indiana AnthemOH84105
Blue Cross of IowaIACBIA2Yes
Blue Cross of Iowa (FEP Claims Only)IACBIA1Yes
Blue Cross of KansasKSCBKS1
Blue Cross of Kentucky AnthemCT84105
Blue Cross of Kentucky AnthemIN84105
Blue Cross of Kentucky AnthemKY84105
Blue Cross of Kentucky AnthemME84105
Blue Cross of Kentucky AnthemNH84105
Blue Cross of Kentucky AnthemOH84105
Blue Cross of MassachusettsMACBMA1
Blue Cross of MississippiMSCBMS1Yes
Blue Cross of NebraskaNECBNE1
Blue Cross of NevadaNV84101No FEP claims. Please send FEP claims on paper or use Payer ID 06126.
Blue Cross of New MexicoNMCBNM1
Blue Cross of Ohio AnthemCT84105
Blue Cross of Ohio AnthemIN84105
Blue Cross of Ohio AnthemKY84105
Blue Cross of Ohio AnthemME84105
Blue Cross of Ohio AnthemNH84105
Blue Cross of Ohio AnthemOH84105
Blue Cross of Rhode IslandRICB870
Blue Cross of TennesseeTNCBTN1Yes
Blue Cross of TexasTXCB900
Blue Cross of WisconsinWICB950
Blue Shield of CaliforniaCA94036
Blue Shield of Pennsylvania Dental PlusPACBPA2
BlueCross Blue Shield of MinnesotaCBMN1Use for claims mailed to PO Box 64338 St. Paul MN 55164-0338
Boilermakers National Health & Welfare Fund36609
Boon Administrative Services Inc.BOONG
Boon-Chapman Benefit Administrators Inc.74237
BridgeSpanBRIDG
Brokers NationalCX032
Broward Health37314
BS of Northeastern NYNYCBNYEYes
Butler Benefit42150
C. L. Frates and Company - OSMA HealthCX075
Cal Optimal -OneCareCX083Admin by LIBERTY Dental Plan
California State Government ProgramsCPPCA
Cannon Cochran Management Services Inc. Metairie LA71057Payer ID for claims with a mailing address of PO Box 6794 Metairie LA 70009
Capitol Administrators68011
Capitol DentalCX095via Performance Health Technology
Care 1st Health Plan Medicare AdvantageCX083Admin by LIBERTY Dental Plan
Care 1st PHP LA & San Bernadino CountyCX083Admin by LIBERTY Dental Plan
CareFirst Administrators/NCAS75190
CareFirst Administrators/NCAS75191
Carefirst of Maryland Inc.00580
CareOregon Inc.93975
CareSourceOHCKOH2No Response
Caresource Indiana IncINCS1
CareSource KYKYCS1
CareSource West VirginiaWVCS1
Carington Benefit Solutions60601
Carpenters Health and Welfare Fund of PhiladelphiaCX101
Caterpillar Inc.37060A United Healthcare payer
CBA Blue03036Formerly: Comprehensive Benefits Administrator Inc.
CDS Group Health88022
Cement Masons and Plasterers Health & Welfare Trust91136Please enter group # F16 when submitting claims. A Welfare and Pension Administration Services payer
Central Reserve Life34097Only Non Medicare Supplement and Dental lines of business administered under this payer ID.
Central States Health & Welfare Funds36215
Central Susquehanna Healthcare Providers (CSHP)55731An Innovative Healthware Services Payer
CHAMPVA - HAC84147CHAMPVA - HAC is not associated with and does not process claims for TRICARE (formerly CHAMPUS)
Chesterfield Resources Inc. (Uniontown OH)34154a.k.a. Salvation Army
Children of Women Vietnam Veterans - VA HAC84147
Choice Plus (TRW)68241
Christian Brothers Services38308
CIGNA62308
Citizens Security Life InsuranceCX071
Civil Service Employees Association (CSEA)CX054Provider ID number required. Max of 50 procedure lines per claim. ID number must be 5 characters in lenght numbers 6 in lenght & ending with a '1' are accepted when '1' is removed. Numbers with leading zeros will have leading zeros omitted. ID numbers ca
ClaimsBridge HPN11752
CMS MMA Specialty PlanEM843
CNIC Health Solutions Inc.37227
Colorado MedicaidCOCKCO1
Commerce Benefits Group34181
Community Health Alliance TN27905
Community Health Electronic Claims/CHEC/webTPA75261
Community Insurance - HMOA & PPOBCX083Admin by LIBERTY Dental Plan
Community Insurance - PPOD & PPOFCX083Admin by LIBERTY Dental Plan
Comp - Ohio (Austintown OH)34177
Companion Life77828
CompBenefitsCX021
Comprehensive Healthcare Options.com Inc.CHCP1
CompuSys / Erisa Group Inc.74234
Connecticut Carpenters Health Fund37307
Connecticut General (CIGNA)62308
Connecticut MedicaidCTCKCT1
Consolidated Group Dental61305
Consumers Choice Health SC45321
Cook Children's DentalTXCPPCC
Cook Group Health Plan35149
Cooperative Benefit Administrators (CBA)52132Administered by UMR Wausau PID: 39026
Core Administrative Services58231
Core V60601
CoreSource AZ MN41045Only 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.
CoreSource KC48117
CoreSource Little Rock75136
CoreSource MD PA IL35182Only for claims where the "submit claims to address" on the medical ID card is a CoreSource address in the states of Maryland Pennsylvania or Illinois. For assistance call 800-689-0106.
CoreSource OH35183
CoreStar41045Only 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.
Covenant Administrators Inc. (Atlanta GA)58102
Coventry DentalCX049
Coventry Health Care National Network25133
CoventryCares86098Kentucky Medicaid CoventryCares administered by Avesis
Creative Plan Administrators37320
Crescent Dental - Meritain HealthCX074
Crescent Health Solutions56213
CTI Administrators Inc.42141
CustomCare68241
Dart Management Corporation06172
Dearborn National36123
DeCare Dental Health Insurance07035
Delta Dental Insurance Co. (DDIC)AK94276
Delta Dental Insurance Co. (DDIC)AL94276
Delta Dental Insurance Co. (DDIC)FL94276
Delta Dental Insurance Co. (DDIC)GA94276
Delta Dental Insurance Co. (DDIC)LA94276
Delta Dental Insurance Co. (DDIC)MS94276
Delta Dental Insurance Co. (DDIC)MT94276
Delta Dental Insurance Co. (DDIC)NV94276
Delta Dental Insurance Co. (DDIC)TX94276
Delta Dental Insurance Co. (DDIC)UT94276
Delta Dental MassachusettsMA04614
Delta Dental of Alabama (DDIC)DDAL1
Delta Dental of Alabama (DDIC)AK94276
Delta Dental of Alabama (DDIC)AL94276
Delta Dental of Alabama (DDIC)FL94276
Delta Dental of Alabama (DDIC)GA94276
Delta Dental of Alabama (DDIC)LA94276
Delta Dental of Alabama (DDIC)MS94276
Delta Dental of Alabama (DDIC)MT94276
Delta Dental of Alabama (DDIC)NV94276
Delta Dental of Alabama (DDIC)TX94276
Delta Dental of Alabama (DDIC)UT94276
Delta Dental of Alaska (DDIC)AK94276
Delta Dental of Alaska (DDIC)AL94276
Delta Dental of Alaska (DDIC)FL94276
Delta Dental of Alaska (DDIC)GA94276
Delta Dental of Alaska (DDIC)LA94276
Delta Dental of Alaska (DDIC)MS94276
Delta Dental of Alaska (DDIC)MT94276
Delta Dental of Alaska (DDIC)NV94276
Delta Dental of Alaska (DDIC)TX94276
Delta Dental of Alaska (DDIC)UT94276
Delta Dental of ArizonaAZ86027
Delta Dental of ArkansasARCDAR1
Delta Dental of California - CA00 Claim OfficeCA77777
Delta Dental of California/Tricare Retiree DentalCACDCA1
Delta Dental of ColoradoCO84056
Delta Dental of DelawareDE51022
Delta Dental of Florida (DDIC)DDFL1
Delta Dental of Florida (DDIC)AK94276
Delta Dental of Florida (DDIC)AL94276
Delta Dental of Florida (DDIC)FL94276
Delta Dental of Florida (DDIC)GA94276
Delta Dental of Florida (DDIC)LA94276
Delta Dental of Florida (DDIC)MS94276
Delta Dental of Florida (DDIC)MT94276
Delta Dental of Florida (DDIC)NV94276
Delta Dental of Florida (DDIC)TX94276
Delta Dental of Florida (DDIC)UT94276
Delta Dental of Georgia (DDIC)DDGA1
Delta Dental of Georgia (DDIC)AK94276
Delta Dental of Georgia (DDIC)AL94276
Delta Dental of Georgia (DDIC)FL94276
Delta Dental of Georgia (DDIC)GA94276
Delta Dental of Georgia (DDIC)LA94276
Delta Dental of Georgia (DDIC)MS94276
Delta Dental of Georgia (DDIC)MT94276
Delta Dental of Georgia (DDIC)NV94276
Delta Dental of Georgia (DDIC)TX94276
Delta Dental of Georgia (DDIC)UT94276
Delta Dental of IdahoID82029
Delta Dental of Illinois Group PlansIL05030
Delta Dental of Illinois Individual PlanIDIND
Delta Dental of IndianaINCDIN1
Delta Dental of IowaIACDIA1
Delta Dental of Iowa - Dental Wellness PlanCDIAM
Delta Dental of KansasKSCDKS1
Delta Dental of KentuckyKYCDKY1
Delta Dental of Louisiana (DDIC)CDMS1
Delta Dental of Louisiana (DDIC)AK94276
Delta Dental of Louisiana (DDIC)AL94276
Delta Dental of Louisiana (DDIC)FL94276
Delta Dental of Louisiana (DDIC)GA94276
Delta Dental of Louisiana (DDIC)LA94276
Delta Dental of Louisiana (DDIC)MS94276
Delta Dental of Louisiana (DDIC)MT94276
Delta Dental of Louisiana (DDIC)NV94276
Delta Dental of Louisiana (DDIC)TX94276
Delta Dental of Louisiana (DDIC)UT94276
Delta Dental of Maryland and PennsylvaniaPA23166incl. Maryland
Delta Dental of MichiganMICDMI0
Delta Dental of MinnesotaMNCDMN1
Delta Dental of Mississippi (DDIC)DDMS1
Delta Dental of Mississippi (DDIC)AK94276
Delta Dental of Mississippi (DDIC)AL94276
Delta Dental of Mississippi (DDIC)FL94276
Delta Dental of Mississippi (DDIC)GA94276
Delta Dental of Mississippi (DDIC)LA94276
Delta Dental of Mississippi (DDIC)MS94276
Delta Dental of Mississippi (DDIC)MT94276
Delta Dental of Mississippi (DDIC)NV94276
Delta Dental of Mississippi (DDIC)TX94276
Delta Dental of Mississippi (DDIC)UT94276
Delta Dental of MissouriMO43090
Delta Dental of Montana (DDIC)DDMT1
Delta Dental of Montana (DDIC)AK94276
Delta Dental of Montana (DDIC)AL94276
Delta Dental of Montana (DDIC)FL94276
Delta Dental of Montana (DDIC)GA94276
Delta Dental of Montana (DDIC)LA94276
Delta Dental of Montana (DDIC)MS94276
Delta Dental of Montana (DDIC)MT94276
Delta Dental of Montana (DDIC)NV94276
Delta Dental of Montana (DDIC)TX94276
Delta Dental of Montana (DDIC)UT94276
Delta Dental of NebraskaNECDNE1
Delta Dental of Nevada (DDIC)DDNV1
Delta Dental of Nevada (DDIC)AK94276
Delta Dental of Nevada (DDIC)AL94276
Delta Dental of Nevada (DDIC)FL94276
Delta Dental of Nevada (DDIC)GA94276
Delta Dental of Nevada (DDIC)LA94276
Delta Dental of Nevada (DDIC)MS94276
Delta Dental of Nevada (DDIC)MT94276
Delta Dental of Nevada (DDIC)NV94276
Delta Dental of Nevada (DDIC)TX94276
Delta Dental of Nevada (DDIC)UT94276
Delta Dental of New JerseyNJ22189
Delta Dental of New MexicoNM85022
Delta Dental of New YorkNY11198
Delta Dental of North CarolinaNC56101
Delta Dental of North DakotaNDCDND1
Delta Dental of OhioOHCDOH1
Delta Dental of OklahomaOKCDOK1
Delta Dental of Oregon (Oregon Dental Service)ORCDOR1
Delta Dental of Rhode IslandRI05029
Delta Dental of South CarolinaSC43091
Delta Dental of South DakotaSD54097
Delta Dental of TennesseeTNCDTN1
Delta Dental of Texas (DDIC)DDTX1
Delta Dental of Texas (DDIC)AK94276
Delta Dental of Texas (DDIC)AL94276
Delta Dental of Texas (DDIC)FL94276
Delta Dental of Texas (DDIC)GA94276
Delta Dental of Texas (DDIC)LA94276
Delta Dental of Texas (DDIC)MS94276
Delta Dental of Texas (DDIC)MT94276
Delta Dental of Texas (DDIC)NV94276
Delta Dental of Texas (DDIC)TX94276
Delta Dental of Texas (DDIC)UT94276
Delta Dental of Utah (DDIC)AK94276
Delta Dental of Utah (DDIC)AL94276
Delta Dental of Utah (DDIC)FL94276
Delta Dental of Utah (DDIC)GA94276
Delta Dental of Utah (DDIC)LA94276
Delta Dental of Utah (DDIC)MS94276
Delta Dental of Utah (DDIC)MT94276
Delta Dental of Utah (DDIC)NV94276
Delta Dental of Utah (DDIC)TX94276
Delta Dental of Utah (DDIC)UT94276
Delta Dental of VirginiaVACDVA1
Delta Dental of WashingtonWA91062.k.a. Washington Dental Service
Delta Dental of Washington DCDC52147
Delta Dental of West VirginiaWV31096
Delta Dental of WisconsinWI39069
Delta Dental of WyomingWYCDWY1
Delta Dental Puerto Rico66043
Delta Dentoal of Utah (DDIC)DDUT1
Delta Health Systems94235
DeltaCare USA ClaimsDDCA2Detailed Benefits
DeltaCare USA EncountersDDCA3
Denex DentalCX049
Dental Care PlusCX035
Dental Health & Wellness46278
Dental Network of MDCX034
Dental Professionals of Wisconsin39148Formerly: Southeast Dental Associates. Effective 7-1-14 payer name must be listed as DPOW-CCHP OR DPOW-ANTHEM OR DPOW-ICA
Dental SelectCX093
DentaQuest - Commercial Plans (Group and Individual)04356
DentaQuest - Goverment PlansMDCKMD1
DentaQuest - Government Plans62154
DentaQuest - Government PlansFLCKSC1
DentaQuest - Government PlansFLCX052FL
DentaQuest - Government PlansID61254
DentaQuest - Government PlansIDCKID1
DentaQuest - Government PlansILCKIL1IL
DentaQuest - Government PlansKYCKKY3KY
DentaQuest - Government PlansVACKVA1
DentaQuest - Government PlansWICX014
Dentegra88888
Denti-Cal / Medicaid of CaliforniaCA94146Denti-Cal requires provider enrollment and has special data requirements. Contact Denti-Cal EDI Support at (916) 853-7373.
Department of Economic SecurityDESAZ
Deseret Mutual Benefit AdministratorsCX089Yes
DH EvansCX065An Innovative Healthware Services Payer
District of Columbia MedicaidDCCKDC1Yes
Diversified Administration CorporationCX040
Downstream Casino19191
Dunn and Associates Benefits Administrators Inc.35186
E-V Benefits Management Inc (Columbus OH)34159Now known as Meritain Health.
E.S. BEVERIDGE & ASSOCIATES34108An Innovative Healthware Services Payer
EasyChoice Health PlanCX083Admin by LIBERTY Dental Plan
EBMCCX025
EBMS (Employee Benefit Management Services Inc.)81039
EBS Benefit SolutionsCX043
EBSO Inc fka EBC Inc37257Payer Id valid only for claims with a billing submission address of Employee Benefit Consultants located in Broadview Hts OH Appleton WI Albuquergue NM Findlay OH Louisville KY and Milwaukee WI
Eddy SeniorCare08754
EDS - Medi-CalCA57016Yes
EHI73288
Elderwood Health03964
Emblem Health (GHI - New York Group Health Inc.)13551
EMI HealthCX079Formerly: Educators Mutual Insurance Association
EMPHESYS73288
Empire Blue Cross Blue ShieldNYCBNY1FEP claims may not be sent electroncially.
EmpireHealthChoice Assurance - OSB Low & PPOBCX083Admin by LIBERTY Dental Plan
EmpireHealthChoice HMOCX083Admin by LIBERTY Dental Plan
Employee Benefit Concepts (Farmington Hills MI)38241
Employee Benefit Consultants37257Payer Id valid only for claims with a billing submission address of Employee Benefit Consultants located in Broadview Hts OH Appleton WI Albuquergue NM Findlay OH Louisville KY and Milwaukee WI
Employee Benefit Management Corp (EBMC)CX025
Employee Benefit Systems42149
Employee Benefits Plan Administration Inc. (E.B.P.A.)03036
Employee Plans LLC35112
Employer Plan Services Inc.CX031
Employers Direct Health75232
Employers Health73288
Employers Health Insurance73288
Employers Mutual Inc.59297
EncaraWDENC
ENH Medical Group IPA36364
EPSI Dental IICX037Formerly: Capital Dental
EQUICOR62308
Equitable Plan Services (Oklahoma City OK)73126Payer ID valid only for claims with a billing submission address of P.O. Box 720460 Oklahoma City OK 73172.
Everence35605
Evergreen Health Cooperative93240
ExclusiCare71412
Fairbanks North Star Borough91136Please enter group # F62 when submitting claims. A Welfare and Pension Administration Services payer
Fairbanks North Star Borough School District Plan A (FNSBSD)91136Please enter group # F62 when submitting claims. A Welfare and Pension Administration Services payer
Fairbanks North Star Borough School District Plan B (FNSBSD)91136Please enter group # F62 when submitting claims. A Welfare and Pension Administration Services payer
Family DentalCX096via Performance Health Technology
FamilyCare CCOCXFMCvia Performance Health Technology
Federated Mutual Insurance41041
Fidelio Dental Insurance CompanyFDIC1
First Continental Life & Accident InsuranceCX090
First Dental Health of CACX086
First Reliance Standard (NY Business)13317
FirstCare/Southwest Life & HealthCX050To obtain EFTs please enroll using payer ID 49096.
Fitzharris & Company Inc.11244
Flex CompensionR7004
FlexCare68241
Florida Blue FEPCBFLFFL
Florida Combined LifeCBFLU
Florida MedicaidFLCKFL1Yes
Florida Power & Light68241
Formula Card DentalLX050
Foundation Benefit Admin (FBA) - Boon GroupBOONG
Fox-Everett Inc.64069
Fraternal Order of Police - Dental Division (Philadelphia PA)CX041
Fresno PACE99660
Fringe Benefits Coordinators59204
GDSCX036
Georgia MedicaidGACKGA1
GettysburgCX064An Innovative Healthware Services Payer
GIC Indemnity Plan80314
Gilsbar Inc.07205
Golden State Health PlanCX083Admin by LIBERTY Dental Plan
Golden West DentalGWD01
Government Employees Health Association (GEHA)44054
Government Employees Hospital Association (GEHA)57254
Great Lakes PACE39640
Great-West Healthcare63665Formerly: General American
Great-West Healthcare80705
Group Administrators Ltd.36338Please send these EDI claims to the Payer ID shown on the member's ID card. Our offices are located in Schaumburg IL. If you have any questions please call 800-323-1683.
Group and Pension Administrators48143
Group Benefit Administrators (Hendersonville TN)72153
Group Dental ServiceCX036
Group Health Coop (Indidivual & Family and Small Business Groups)89070
Group Health Cooperative of Eau Claire95192
Group Insurance Service Center Inc.37276
Group Link of IndianaCX015
Guaranty (DINA)CX090
Guardian Life Insurance Company of America64246
Hamaspik Choice47738
Harrington Health Colonial Dental59143
Hawaii Medical Service Association (HMSA)HMSA1
HCS - Health Claims Service (Boise ID)82018
Health Choice Arizona62179
Health Choice Insurance Co46221
Health Choice Integrated Care22100
Health Economics Group Inc.CX039
Health Net 21 - LA & SacramentoCX083Admin by LIBERTY Dental Plan
Health Net Healthy Families A B & CCX083Admin by LIBERTY Dental Plan
Health Net Los Angeles PHPCX083Admin by LIBERTY Dental Plan
Health Net Sacramento GMCCX083Admin by LIBERTY Dental Plan
Health Partners - Jackson TN62157
Health Plan of Nevada76342
Health Plans Inc.CX055
Health Resources Incorporated (HRI)CX019
Healthcare Management Administrators Inc.HMA01The insured ID number is required. Maximum of 25 procedure lines per claim. Secondary claims cannot be sent electronically. Claim remarks exceeding 80 bytes in length cannot besent electronically.
Healthcomp Inc.85729
HealthEZ41178
Healthgram Inc.56144Formally known as Primary Physician Care
Healthnow of Northeastern NYNYCBNYEYes
Healthnow of Western NYNYCBNYWYes
HealthPartners MNCX009Yes
HealthPartners MNMNCX010Yes
HealthPlan Services59140
Healthplex Inc.11271
HealthSCOPE Benefits Inc. (Formerly CNA Health Partners of Arkansas)71063
HealthShare CCOCXHSCvia Performance Health Technology
HealthSmart Benefit Solutions37272Formerly: Wells Fargo TPA Inc. (Newnan GA and Fayetteville NC)
HealthSmart Benefit Solutions37283
HealthTrans31172a.k.a. Innovante Benefit Administrators
Healthy Alliance Life Insurance - PPOBCX083Admin by LIBERTY Dental Plan
Healthy Michigan DentalHMD01
HMA Hawaii86066
Hometown Health Plan Nevada88023
Hoosier Dental (in Indianapolis Indiana)CX015
Horizon Healthcare Dental ServicesNJ22099
Horizon Healthcare Dental ServicesNY22099
Hotel Employees Restaurant Employees Health Trust (HERE)91136Please enter group # F19 when submitting claims. A Welfare and Pension Administration Services payer
HSBS Memphis37224
HSBS Oklahoma City37256
HSHS Medical Group IPA37137Hospital Sisters Health System Medical Group IPA
Humana73288
I. E. Shaffer (West Trenton NJ)22175
IBT - Local 145 Health Service & Ins PlanCXIBTOnly for claims with date of service prior to 1-1-16. Dates of service greater than 12-31-15 should be sent using payer ID 60054.
IEHPCX083Admin by LIBERTY Dental Plan
IMCare41600
Indiana Children's Special HealthcareINCX070
Indiana MedicaidINCKIN1
Indiana Teamsters Health Benefits Fund (Indianapolis IN)35107Formerly known as Local 135 Health Benefits Fund (Indianapolis IN)
Inetico Inc.43471An Innovative Healthware Services Payer
Innovante Benefit Administrators31172a.k.a. HealthTrans
Innovation Health40025
Insurance Administrators of America Inc.37279
Insurance Design Administrators13315
Insurance Management Services (Amarillo TX)15688
Insurance Program Managers Group (IPMG)36342
Insurance Systems Inc.74385
Insurers Administrative Corp.86304Please visit website prior to submitting claims: edihelp.iacusa.com
Integra Administrative Group (Seaford DE)51020Payer ID valid only for claims with a billing submission address of 110 S. Shipley Street Seaford DE 19973.
International Brotherhood of Boilermakers36609
Iowa MedicaidIACKIA1Yes
Jensen Administrative Services Inc.CXJAS
John Alden Life Insurance Co.41099PO Box 2877 Clinton IA 52733
JOHN MORRELL COMPANY CO. - AHPBA38310
Joint Benefit TrustCHSJT
JP Farley Corporation34136Payer ID valid only for claims with a billing submission address of PO Box 458022 Westlake OH 44145
KaiserCX073
Kalos Health40137
Kansas City LifeCX058
Kansas MedicaidKSCKKS1
Keenan Associates (CA)95279
Kempton Company73100
Kempton Group Administrators73100
Kentucky Health Cooperative77894
Kentucky MedicaidKYCKKY1Yes
Kentucky Spirit65030Kentucky Medicaid Kentucky Spirit administered by MCNA Dental
Key Solution37323
Klais & Company34145
LA BCBS AdvantagePlus Network53021
LA Care Health PlanCX083Admin by LIBERTY Dental Plan
Lake County Phyicians Association37116
Land of Lincoln Health90096
Liberty Dental PlanCX083
Life Gift Cards33LGC
Life Insurance Company of Boston & New York78140
LIFE St. Joseph of The Pines59847
LIFE St.Mary76184
LifeCircles PACE71498
LifeMap Assurance CompanyRLH01
Lifestyle Health Plans27005
Lifetime Benefit SolutionsEBSRM
LifeWise Healthplan of Oregon93093
Lincoln Financial GroupCX061
Lincoln National (WI)73288
Line Construction Benefit FundLCB01
Local 135 Health Benefits Fund (Indianapolis IN)35107
Local 17 Fund - International Association of Heat and Frost InsulatorsIAHFI
Locals 302 & 612 of the Internation Union of Operating Engineers91136Please enter group # F12 when submitting claims. A Welfare and Pension Administration Services payer
Lockard & WilliamsCB752
Mail Handlers Benefit Plan25133
Maine MedicaidMECKME1Yes
Maine Medicaid for FQHCCKMEHYes
MAMSICX033
Managed Care Services LLC35162
Managed Dental GuardGI813Only for the individual marketplace not for Group/SHOP business.
Manulife W. J. Sutton Company98010
MAPFREPRFRE
Masonry Institute/Administrative D. C. No. 1 Welfare FundCX098
Massachusetts Health ProgramMACKMA1Please place Mass Health or MA Medicaid or Mass Medicaid in the carrier name field.
Mayo Clinic Health Solutions41154
MBA Benefit Administrators Inc (Salt Lake UT)83028
MBA OF WYOMING INC87065
McGregor PACE31149
MCNA Dental65030
MD Care Health PlanCX083Admin by LIBERTY Dental Plan
MED3000 CMS SAFETY NETEM284
MED3000 CMS Title 21EM205
Medica of MinnesotaCX026
Medicaid of DelawareDECKDE1Yes
Medicaid of FloridaFLCKFL1Yes
Medicaid of MississippiMSCKMS1Yes
Medicaid of New York (Dental Clinics Only)NYCKNY2Yes
Medicaid of North CarolinaNCCKNC1tive July 1 2013 all Provider Enrollment Applications and updates must be completed through the NCTracks system. You can learn more about how to register in NCTracks at the following DHHS website: http://nctracks.com/
Medical Associates Health Plan/Health ChoicesMAHC1
Medical Benefits Mutual / MedBen74323
Medical Card System (MCS)PRMCS
Medical Mutual of Ohio29076
Medical Mutual of Ohio (MMO)CB833
Medico Life and Health Insurance Company23160Medicare Supplement COB claims only accepted via electronic Medicare crossover
Mediphe33LGC
MedsaveUSA59069Formerly: Fringe Benefit Management and 21st Century Health and Benefits
Mercy Care Plan (AHCCCS)86052
Mercy LIFE of Alabama63002
Mercy Maricopa Integrated Care33628
Meritain Health38232
Meritain Health Minneapolis41124
MetLife65978
MFC & HealthPlus Peoria23550
MGM Resorts InternationalCX083Admin by LIBERTY Dental Plan
Michigan MedicaidMICKMI1Yes
Michigan Regional Council of Carpenters Employee Benefit Plan38238
Michigan UFCW27401
Mid-America Associates Inc.37281
Mid-American Benefits22823
Midwest Dental Benefits41101
Minnesota MedicaidMNCKMN1Yes
Mississippi Select Health Care64088
Missoula County Medical Benefits Plan37275
Missouri MedicaidMOCKMO1
Molina HealthCareCX083Admin by LIBERTY Dental Plan
Momentum Insurance Plan31415
Montana MedicaidMTCKMT1
Morris Associates35092
Motorola36111
Mountain States Administrative Services (Tucson AZ)86040
MPEEBT/ MPE Services Inc.37233
MSA CareGuard20572
MultiFlex Dental (Merchants Benefit)MBAAZ
Municipal Health Benefit Fund81883
Mutual Health Services34192Payer formely known as: Antares Management Solutions
Mutual of Omaha CommercialCX087
Mutual of Omaha Insurance Company71412
Mutually Preferred71412
MyDecision HealthSmart18840
NAA (North America Administrators L.P.) (Nashville TN)65085
NABN (Cleveland OH)34159Now known as Meritain Health. 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.
NAPHCARE INC.58182
National Elevator Industry Benefit Plan (NEIB)CX045
National Pacific of TX (NCFLEX)CX057A United Healthcare payer
National Telecommunications Cooperative Association52120
Nationwide Employee Benefits314RV
Nationwide Health Plans31417
Nebraska MedicaidNECKNE1YesNE
Netcare Life and Health Insurance (NLH)66055
Nevada Health Coop90091
Nevada MedicaidNVCKNV1
New England Dental Administrators43351
New Hampshire MedicaidNHCKNH1
New Jersey MedicaidNJCKNJ1Yes
New Mexico MedicaidNMCKNM1Yes
New York MedicaidNYCKNY1Yes
Next Level Health Partners69821
NGS American Inc38225
Nippon Life Insurance Company of America81264
NNEBT (Northern New England Benefit Trust)38238
North American Benefits Network (Cleveland OH)34159Now known as Meritain Health. 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.
North Broward Hospital District37314
North Dakota Dental ServiceNDCX004Yes
North Dakota MedicaidNDCKND1Additional enrollment is not required by the payer however providers wishing to submit claims electronically must submit their ND Medicaid assigned provider ID(s) within the claim. Provider IDs are always 5 digits long and begin with the number 4.
Northeast Delta Dental (ME NH VT)ME02027
Northeast Delta Dental (ME NH VT)NH02027
Northeast Delta Dental (ME NH VT)VT02027
Northern California Pipe Trades Trust FundsCX099For Dates of Service beginning 1-1-15 please use payer ID 77777.
Northern Illinois Health Plan36347
Northern Minnesota DentalLX062
Northern Nevada Trust Fund88027Please call (775) 826-7200 to verfiy if you should be sending claims to Northern Nevada Trust Fund.
NorthStar AdministratorsAK47570
NorthStar AdministratorsWA47570
Northwest Dental Services93525
Northwest Ironworkers Health & Security Fund91136Please enter group # F15 when submitting claims. A Welfare and Pension Administration Services payer
Northwest Roofers & Employers Health & Security Trust Fund91136Please enter group # F26 when submitting claims. A Welfare and Pension Administration Services payer
Northwest Suburban IPA (Illinois)36346
Northwest Textile Processors and Service Trades91136Please enter group # F14 when submitting claims. A Welfare and Pension Administration Services payer
Nova HealthcareNY16644
NW International Association of Machinists (NW IAM)91136Please enter group # F39 when submitting claims. A Welfare and Pension Administration Services payer
NW Plumbers & Pipefitters Health & Welfare Trust91136Please enter group # F31 when submitting claims. A Welfare and Pension Administration Services payer
Nyhart37299
NYS DOH UCP14142
OH Dental / UHC Dental Government ProgramsGP133
Ohana Health PlanCX083Admin by LIBERTY Dental Plan
Ohio AFSCME Care PlanAFSOH
Ohio MedicaidOHCKOH1
OK State Employees & Educators (EDS)22521
Oklahoma MedicaidOKCKOK1
Olympus Managed Health Care65074
Oregon MedicaidORCKOR1Yes
OSMA Health - C. L. Frates and CompanyCX075
Ozark Health PlanCX083Admin by LIBERTY Dental Plan
PA Faculty Health & WelfareCX066An Innovative Healthware Services Payer
PACE CNY70454
PACE Southeast Michigan86711
Pacific UnionCX056A United Healthcare payer
Pacificare Dental and Vision HMOCX060A United Healthcare payer
Pacificare Dental and Vision PPOCX053A United Healthcare payer
PacificSource Administrators93031a.k.a. Select Benefit Administrators
PacificSource CommunityCXPSCvia Performance Health Technology
PacificSource Health Plans93029
PALMS Casino ResortCX083Admin by LIBERTY Dental Plan
Pan American Life Insurance Group04218
Partners Benefit GroupPBGSM
Partners health Plan23213
Patient Advocates LLC10525
PDO68241
PEHP (Public Employees Health Program)CX080YesPrior to accepting claims electronically PEHP requires the provider to call EDI Support at 801-366-7544 or 800-753-7818. Providers should advise PEHP that they will be submitting their claims through Emdeon Business Services Inc UHIN submitter ID HT0001
Pennsylvania Blue Shield (Camp Hill)PACB865
Pennsylvania MedicaidPACKPA1
Pequot Pharmaceutical37121
Pequot Plus Health Benefit Administrators37121
Personal Insurance Administrators Inc. (Agoura Hills CA)95397
Physicians Care Network (ASR Corporation)38265
Physicians Care Network (Rockford IL only)36345
Physicians Health Association of Illinois37136
Physicians Health Plan of Northern Indiana Inc12399
Physicians MutualCX068
Physicians United Plan-PUPCX083Admin by LIBERTY Dental Plan
Pinnacle Claims Management Inc.24735
Planned Administrators Inc.37287
Please enter group # F07 when submitting claims. A Welfare and Pension Adm91136Please enter group # F07 when submitting claims. A Welfare and Pension Administration Services payer
POMCO16111
Prairie States Enterprises Inc.36373
Preferred Dental Organization68241
Preferred Health Plan of the CarolinasCB404
Preferred Health Professionals31478Freedom Network Dental
PreferredOne (MN)41147
Premera Blue CrossAK47570
Premera Blue CrossWA47570
Premier Access Insurance CompanyCX078
Premier Access UT GovernmentCX110Formerly: UT CHIP & UT Medicaid
Premier Dental Plan of MNCX029
PrimeWest HealthLX049New providers learn about submitting your first claim. Please visit https://www.primewest.org/new-facility-claims
Principal Financial Group61271Payer only accepts VISION and DENTAL claims.
Priority Health38217
Professional Benefit Administrators Inc. (Oak Brook IL)36331Payer ID is valid only for claims with billing submission name city and state of Professional Benefit Administrators Inc. Oak Brook IL.
Prominence Health Plan88029
Prudential for Health68241
Prudential HealthCare & Life Ins. Co of America68241
Prudential HealthCare Health Maintenance Organization68241
Prudential HealthCare HMO for Small Business68241
Prudential Healthcare of America Inc.68241
Prudential HealthCare POS for Small Business68241
Prudential HealthCare PPO for Small Business68241
Puget Sound Electrical Workers Healthcare Trust (PSEW)91136Please enter group # F33 when submitting claims. A Welfare and Pension Administration Services payer
Quality Care Partners89461An Innovative Healthware Services Payer
Quality Plan Administrator IncCX077
Quapaw Casino19191
Quapaw Tribal Member Plan19191
Quapaw Tribe Employee Plan19191
Quartz ASO46571
RBMS LLC91176
Reading Hospital Employer Group44219
Regence Blue Cross Blue Shield of OregonORCB850
Regence Blue Cross Blue Shield of UtahUTCBUT1
Regence Blue Cross Blue Shield Of Utah FEPUTCBUTF
Regence Blue ShieldWA93200
Regence Blue Shield FEPWA93200
Regence Blue Shield of IdahoIDCBID2
Regence Northwest HealthWA93200
Regency Employee Benefits38221
Reliance Standard Life36088
Reliastar80314
ReliaStar (now known as CoreStar formerly NW National Life)41045Only 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.
Renaissance Life and HealthRLHA1
Rhode Island MedicaidRICKRI1
Riverside San Bernaardino County Indian Health Inc50664
RMSCO INC.16117
Rochester Public Schools41625
Rocky Mountain Hospital & Medical Service - OSB High & HighCX083Admin by LIBERTY Dental Plan
Rocky Mountain Life Dental84102
Rural Carrier Benefit Plan25133
S & S Healthcare Strategies31441
Safeguard HMOCX048
SafeGuard PPOCX030
Sage Technologies37105
Salvation Army34154a.k.a. Chesterfield Resources Inc. (Uniontown OH)
SAMBA37259
San Diego PACE96400
Sands Bethworks GamingCX083Admin by LIBERTY Dental Plan
Sanford Health Plan91184
Santa Clara Family Health PlanCX083Admin by LIBERTY Dental Plan
SCION DentalSCION
Scion Dental CommercialSDCOM
Scion Gateway Health Plan96938
Secure Health Plans of Georgia LLC28530
SecureCare Dental86057
Securian93742
Security Life Insurance Co of AmericaCX092
Sele-DentCX109
Select Administrative Services (SAS)64088
Select Benefit Administrators93031a.k.a. PacificSource Administrators
Select HealthCX107
SelectCare (Coca Cola)68241
Self Insured Services Company (SISCO)CX020
Self-Funded Plans Inc.34131
Self-Insured Dental Services (SIDS)CX076Addt'l enrollment is not required by the payer. Providers wishing to submit claims electronically must be credentialed with the payer. Please ensure you have successfully processed one paper claim prior to submitting your first electronic claim.
Self-Insured Plans LLC36404
Sendero Health Plans36426
Sentry Life Insurance Company39033Payer ID 39033 is only to be used for Sentry employees claims with dates of service through 2010
SET SEG38610
Sheet Metal Workers Local 104 Health Care Plan (San Ramon CA)38238
Sheffield Olson & McQueen Inc41143
Shelter Point Life81434
Sierra Health and Life76342
Significa Benefits Services Inc.CX046Formerly: Erin Group Admin.
Sinclair Health Plan84076
Solstice Benefits76578
South Central Preferred - PPO York PA (IHS Gateway Payer)23266An Innovative Healthware Services Payer
South Dakota MedicaidCKSD1
South FL Community Care Network - NBHD37314
South Point Hotel & Casino35227
Southeastern Indiana Health (SIHO)77153
Southern Benefit Services37318
Southwest Service AdministratorsCX100
Southwestern Bell68241
Southwestern Bell Exec68241
Southwestern Bell Exec. - Custom Care68241
Southwestern Bell Exec. - Southwestern Bell68241
Spectrum Admin23253
Spina Bifida - VA HAC84147
Standard Insurance Company (NY)13411
Standard Insurance Company (OR)93024
Star HealthCX090Use this payer ID for Dates of Service prior to June 1 2010
StarDentCX090
State of Texas Dental Plan73288
Stoner and Associates (Cincinnati OH)31121
Summit America Insurance Services Inc.37301
Sun Life and Health Insurance Company67814Formerly: Genworth Life and Health Insurance Company (GLHIC)
Superior Dental Care - Preferred Plan31117
Supplemental CoverageASHC1PO Box 2829 Clinton IA 52733
Surency Life and HealthCX088
Tall Tree Administrators88067
TDC73288
Teachers Health Trust88019
Texas MedicaidTXCKTX1Yes
The Dental Companies73288
The Dental Concern73288
The Health Exchange (Cerner Corporation)20356
The Health Plan of The Upper Ohio Valley34150
The Humboldt-DelNorteCRIHBFor select offices only. Please call 707-443-4563 for approval.
The Loomis Company - TPA Wyomissing PA (IHS Gateway Payer)23223An Innovative Healthware Services Payer
The Physicians Assurance Corp (TPAC)/Employee Benefit Management Corp (EBMCCX025
Total Broker Benefits36342Formerly: Benefit Systems & Services Inc.
Total Dental AdministratorsCX112
TPAC/Employee Benefit Management CorpCX025
TR Paul Inc.37230
Travelers (now MetLife)65978
Trellis Health Partners36397
Tri-Counties Welfare Trust FundCHSWT
Trigon Blue Cross Blue Shield - Colorado Dental OfficeCO84103Claims Mailing Address: Trigon Dental Admin 555 Middle Creek Parkway MS 400 Colorado Springs CO 80921.
Trigon Blue Cross of Virginia (Anth BCBS-VA/ BCBS Anth-VA formerly Trigon)VACB923
Triple-S Medicare AdvantagePRADV
Triple-S SaludCBPR1Yes
TRISTAR Benefit Administrators (W. DesMoines IA)42137Please check the Insured ID card to verify the Payer ID before submitting claims. If you have questions please contact Provider Relations at 800-456-4584.
Tristate Benefit Solutions (TPA)31144
TruAssureILDTA
Trusteed Plans Service Corporation91078
Trustmark Insurance Company61425
UFCW Local 655CX111
Ultra Benefits Inc.41206
UMC Health Plan75130
UMR (formerly UMR Onalaska)79480
UMR (formerly UMR Wausau)39026
UMR - Cincinnati33108Formerly: United Medical Resources
UMR - Harrington75196Formerly: Harrington Benefit Services (Westerville)
UMR - Harrington95266Formerly: Harrington Benefit Services (Columbus)
UMR - Lexington37237Formerly: Commonwealth Administrative Group
UMR - San Antonio74223Formerly: Benefit Planners Inc. UICI Administrators - State of Nevada
UNICARE80314
Unified Group Services35198
Uniform Medical Plan75243Formerly: Uniform Medical Plan / Harrington Benefit Services
Union Security Insurance Company70408PO Box 2940 Clinton IA 52733
United Concordia - Fee for ServiceCX007
United Concordia Dental PlusCX013
United Food & Comm. Workers Union & Employers Midwest Health Benefit Funds36659
United of Omaha71412
United States Life Insurance Company13545Formerly: America General
United States Virgin Islands MedicaidCUSV1
United States Virgin Islands MedicaidCUSVI
UnitedHealthcare / UnitedHealthcare Plan of the River Valley95378
UnitedHealthcare Dental52133Formerly OptumHealth Dental Dental Benefit Providers/DBP and DBP of California
UnitedHealthcare Dentalformerly OptumHealth Dental Dental Benefit Providers/DBP and DBP of California
UnitedHealthcare StudentResources74227
UnitedHealthOne / UnitedHealthcare Life Insurance CompanyCX001
Unity Health Insurance66705Only claims for Oral Surgery TMJ or Accidents can be sent electronically to this payer ID.
University of Missouri25133
UPMC Health Plan23281
Upper Peninsula Health Group (TPA)37324
US Benefits93092
US Life Ins. Co70106Claims mailing address PO Box 12009 Cheshire CT
Utah MedicaidUTCKUT1
VA Fee Basis Programs12116
Valir Pace64009
Valley Baptist Health Plan89070
Varian Health Care Plan68241
VenetianCX083Admin by LIBERTY Dental Plan
Verity National Group75256
Vermont MedicaidVTCKVT1Yes
Via Christi HOPE48123
VieCare Life Armstrong25922
VieCare Life Beaver and Life Lawrence Counties25924
VieCare LIFE Butler25923
Voluntary Benefits Plan70106Claims mailing address PO Box 12009 Cheshire CT
Volusia Health Network59266
Washington MedicaidWACKWA1Yes
Washington State Council of County & City Employees (WSCCCE)91136Please enter group # F36 when submitting claims. A Welfare and Pension Administration Services payer
Waterstone Benefit Administrators (Oklahoma Providers)73155
WEA Insurance Group39151
Web TPA Inc.of TX59332
webTPA/Community Health Electronic Claims/CHEC75261
WellcareCX083Admin by LIBERTY Dental Plan
WellPointCX083Admin by LIBERTY Dental Plan
Wells Fargo TPA Inc. (Charleston WV)87815
West Virginia MedicaidWVCKWV1Yes
Western Grower's Assurance Trust24735
Western Grower's Insurance Company24735
WestLake Financial Group Inc. (Buffalo Grove IL)90560
Wichita and Affiliated Tribes19191
Willamette ValleyCXWVCvia Performance Health Technology
William C. Earhart93050
WilsonMcShaneR7002
Wisconsin MedicaidWICKWI1
Worksite Benefit Services LLC20333
Wyoming MedicaidWYCKWY1Yes
Zenith AdministratorsR7001

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Revised 10/30/16