Trojan DrDirect Dental Payor List April 2019 | |||||
| Payor | State | Payor ID |
Enrollment Required |
Notes | |
|---|---|---|---|---|---|
| 3P ADMIN | 20413 | ||||
| A & I Benefit Plan Administrators | 93044 | ||||
| A BCBS FEP | TFQ45 | Yes | |||
| A. D. N. Administrators Inc. | CXADN | ||||
| AARP | AARP1 | AARP claims with a mailing address of PO Box 2059 Mechanicsburg PA | |||
| Acceptius (Benefit Management Inc of MO (BMI) | 43178 | ||||
| Access Dental | CX097 | via Performance Health Technology | |||
| Acclaim | 64071 | ||||
| ACS Benefit Services Inc. | 72468 | Formerly: ACS Consulting Services Inc. | |||
| ACS Benefit Services Inc. | 61474 | randed Dental Product | |||
| Activa Benefit Services LLC/Dental | 38255 | (Formerly Amway Corporation/Dental) | |||
| Administrative Service Inc. | CBFLU | A United Concordia Company | |||
| Administrative Services Inc | 59141 | ||||
| Adminstrative Services Only | CX076 | Addt'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 Administrators | 83077 | ||||
| Advantica Benefits | 43168 | ||||
| Adventist Health System West - Roseville CA | 95340 | ||||
| Aetna | 60054 | ||||
| Aetna Affordable Health Choices (SM) - SRC | 57604 | ||||
| Aetna Better Health of West Virginia | 128WV | ||||
| Aetna Medicare EPO/PPO Dental | 18014 | ||||
| Affordable Benefit Administrators Inc. | 95426 | ||||
| AFLAC GA | 58066 | ||||
| AFLAC GA - GRP | 58066 | Group Plan coverage please refer to your ID card for group coverage/number verification. | |||
| AFLAC NY | 52080 | This 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 - GRP | 52080 | Group Plan Coverage please refer to your ID card for group coverage/number verifcation. | |||
| AK United Food and Commercial Workers (AK UFCW) | 91136 | Please enter group # F45 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Alabama Medicaid | AL | CKAL1 | Yes | ||
| Alameda Alliance | CX083 | by LIBERTY Dental Plan | |||
| Alaska Carpenters Trust | 91136 | Please enter group # F40 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Alaska Electrical Health & Welfare Fund | 92600 | ||||
| Alaska Hotel Employees Restaurant & Camp Employees (AK HERE) | 91136 | Please enter group # F41 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Alaska Laborers Construction Industry Health & Security Trust | 91136 | Please enter group # F23 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Alaska Machinists Health and Welfare Trust | 91136 | Please enter group # F21 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Alaska Medicaid | AK | CKAK1 | Yes | ||
| Alaska Pipe Trades U A Local 375 | 91136 | Please enter group # F24 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Alaska Public Employees Association (APEA/JESS Health & WelfareTrust) | 91136 | Please enter group # F60 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Alexian Brothers Community Services of TN | 44423 | ||||
| AllCare CCO Dental | CXALC | via Performance Health Technology | |||
| Allegeant | 52193 | Formerly known as LBA Health Plans | |||
| Allegiance Benefit Plan | 81040 | ||||
| Alliant Services | 70106 | Claims mailing address PO Box 12009 Cheshire CT | |||
| Allied Benefit Systems | 37308 | ||||
| Allied Metal Crafts Security Plan Trust Fund | 91136 | Please enter group # F18 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Allina Health | Aetna | 54398 | ||||
| Altus | RI | 50503 | |||
| Alvin | 33LGC | ||||
| AlwaysCare Benefits | STR01 | ||||
| Amalgamated Life - PA / Alicare | 13343 | ||||
| AmeraPlan | 38219 | ||||
| AmeriBen Solutions Inc. | 75137 | ||||
| America's TPA | 41178 | ||||
| American Benefit Corporation | CX084 | Only 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 Plan | 44444 | ||||
| American Trust Administrators Inc. | 56195 | ||||
| AmeriHealth Administrators | 54763 | ||||
| Ameritas Life Insurance Corp. | 47009 | ||||
| Ameritas Life Insurance Corp. of New York | 72630 | ||||
| Amway Corporation | 38255 | (Formerly Amway Corporation/Dental) | |||
| Anchor Benefit Consulting Inc. | 53085 | ||||
| Anthem Blue Cross | CA | 47198 | Formerly: Blue Cross of California; Wellpoint | ||
| Anthem Health Plans - HMOD & HMOG | CX083 | by LIBERTY Dental Plan | |||
| Anthem Health Plans of Kentucky - OSB High & Low | CX083 | by LIBERTY Dental Plan | |||
| Anthem Health Plans of Virginia - OSB High & Low | CX083 | by LIBERTY Dental Plan | |||
| Anthem Health Plans of Virginia - PPOB & PPOD | CX083 | by LIBERTY Dental Plan | |||
| Anthem HMO Colorado - HMO-B | CX083 | by LIBERTY Dental Plan | |||
| Anthem Insurance - OSB High & Low | CX083 | by LIBERTY Dental Plan | |||
| Anthem Insurance - PPOB & PPOD | CX083 | by LIBERTY Dental Plan | |||
| Apostrophe | 81312 | ||||
| ARC Administrators | CXARC | ||||
| Argus Dental Plans | ARGUS | ||||
| Arizona Medicaid | CKAZ1 | Please visit http://www.azahcccs.gov/commercial/ProviderRegistration/registration.aspx for provider registration information prior to submitting claims. | |||
| Arkansas Medicaid | AR | CKAR1 | |||
| Arkansas Medicare Advantage | ARCMS | ||||
| Arkansas Superior Select | 61184 | ||||
| Assurant Employee Benefits | 70408 | PO Box 2940 Clinton IA 52733 | |||
| Assurant Inc. | 70408 | PO Box 2940 Clinton IA 52733 | |||
| Asuris Northwest | 93221 | ||||
| Atlantic Dental Inc. (ADI) - Commercial | CX085 | ||||
| Automated Benefit Services | 38259 | ||||
| Automated Group Administration Inc. (AGA) | 37280 | ||||
| Avesis | 86098 | ||||
| AZ BCBS | TBX01 | ||||
| Banner Health | SX145 | ||||
| Bay Area Automotive Group | CHSBA | Administered by Health Services Benefit Administraors Inc. (HSBA) | |||
| Bay Area Delivery Drivers | CHSBD | Administered by Health Services Benefit Administrators Inc. (HSBA) | |||
| BCBS MI Medicare Advantage | BBMDQ | ||||
| BCBS of Rochester New York | NY | CBNYR | |||
| BCI Administrators Inc. | 49153 | ||||
| Beam | CXBMD | ||||
| Beam Dental | BEAM1 | ||||
| Beam Dental | CXBMD | ||||
| BEAM Dental Insurance | BEAM1 | ||||
| BEAM Dental Insurance | CXBMD | ||||
| Beam Ins | BEAM1 | ||||
| Beam Ins | CXBMD | ||||
| Beam Ins Admin | BEAM1 | ||||
| Beam Ins Admin | CXBMD | ||||
| Beam Insurance | BEAM1 | ||||
| Beam Insurance | CXBMD | ||||
| Beam Insurance Admin | BEAM1 | ||||
| Beam Insurance Admin | CXBMD | ||||
| Beam Insurance Administrator | BEAM1 | ||||
| Beam Insurance Administrator | CXBMD | ||||
| Beam Insurance Administrators | CXBMD | ||||
| Bell Atlantic | 68241 | ||||
| BeneCare Dental Plans | 23210 | ||||
| Benefit Administrative Systems | 36149 | ||||
| Benefit Coordinators Corporation (Pittsburgh PA) | 25145 | Payer ID valid only for claims with a submission address of 111 Ryan Court Suite 300 Pittsburgh PA 15205. | |||
| Benefit Inc. | R7003 | ||||
| Benefit Management LLC | 48611 | For Dental providers any group is accepted as long as the group number on the participant's card starts with BMI###. | |||
| Benefit Plan Administrators Co. (Eau Claire WI) | 39081 | Payer ID valid for Benefit Plan Administrators (Eau Claire WI submission address only) and Custom Benefit Administrators | |||
| BIA | BEAM1 | ||||
| BIA | CXBMD | ||||
| BIA/Beam | BEAM1 | ||||
| BIA/Beam | CXBMD | ||||
| Blue Benefit Administrators of MA | 03036 | ||||
| Blue Care Family Plan | GWD01 | Administered by Golden West (Well point) | |||
| Blue Care Family Plan (BCBS of CT) | CT | 00700 | Administered by Anthem of CT | ||
| Blue Cross and Blue Shield of Arizona | AZ | 53589 | |||
| Blue Cross Blue of Louisiana | LA | 23739 | Payer requires providers be tied to our submitter ID of P0003784 | ||
| Blue Cross Blue Sheild Delaware Fully - Insured Dental Group Business | DE | 53287 | Effective 5-18-13 FEP claims must be mailed to PO Box 1991 Wilmington DE 19899. A United Concordia Company | ||
| Blue Cross Blue Shield Association - FEP Dental | BCAFD | ||||
| Blue Cross Blue Shield of Arizona Advantage | 77078 | ||||
| Blue Cross Blue Shield of Kansas City MO | 47171 | EDI enrollment is no longer required by ASK however the payer requires each provider register with them. | |||
| Blue Cross Blue Shield of Michigan | MI | CBMI1 | |||
| Blue Cross Blue Shield of Montana | MT | CBMT1 | |||
| Blue Cross blue Shield of North Carolina | 61474 | l Blue Select Product | |||
| Blue Cross Blue Shield of North Carolina | NC | 61472 | ediatric Dental Claims | ||
| Blue Cross Blue Shield of North Carolina | NC | 61472 | al Employee Claims. | ||
| Blue Cross Blue Shield of North Carolina | NC | 61473 | l Blue Product | ||
| Blue Cross Blue Shield of Oklahoma | OK | SB840 | |||
| Blue Cross Blue Shield of South Carolina | SC | 38520 | |||
| Blue Cross Blue Shield of South Dakota | CBSD1 | ||||
| Blue Cross Blue Shield of Wisconsin - PPOD | CX083 | by LIBERTY Dental Plan | |||
| Blue Cross Blue Shield OH/KY (Anthem) | CT | 84105 | |||
| Blue Cross Blue Shield OH/KY (Anthem) | IN | 84105 | |||
| Blue Cross Blue Shield OH/KY (Anthem) | KY | 84105 | |||
| Blue Cross Blue Shield OH/KY (Anthem) | ME | 84105 | |||
| Blue Cross Blue Shield OH/KY (Anthem) | NH | 84105 | |||
| Blue Cross Blue Shield OH/KY (Anthem) | OH | 84105 | |||
| Blue Cross Blue Shield Wyoming | CBWY1 | A United Concordia Company | |||
| Blue Cross Dental | CBMNU | Non FEP claims only. A United Concordia Company | |||
| Blue Cross of Alabama | AL | CBAL1 | |||
| Blue Cross of Alaska and Washington | AK | 47570 | |||
| Blue Cross of Alaska and Washington | WA | 47570 | |||
| Blue Cross of Arkansas | AR | CBAR1 | Mailing address for claims: Dental Claims Administrator PO Box 1206 Elk Grove Village IL 60009-1206. A United Concordia Company. | ||
| Blue Cross of California - OSB High & Low | CX083 | by LIBERTY Dental Plan | |||
| Blue Cross of California - Plan SS10 & SS20 | CX083 | by LIBERTY Dental Plan | |||
| Blue Cross of California - PPOA | CX083 | by LIBERTY Dental Plan | |||
| Blue Cross of Colorado | CO | 84099 | |||
| Blue Cross of Idaho | ID | CBID1 | Yes | ||
| Blue Cross of Illinois | IL | CB621 | |||
| Blue Cross of Iowa | IA | CBIA2 | Yes | ||
| Blue Cross of Iowa (FEP Claims Only) | IA | CBIA1 | Yes | ||
| Blue Cross of Kansas | KS | CBKS1 | EDI enrollment is no longer required by ASK however the payer requires each provider register with them. | ||
| Blue Cross of Massachusetts | MA | CBMA1 | |||
| Blue Cross of Mississippi | MS | CBMS1 | Yes | ||
| Blue Cross of Nebraska | NE | CBNE1 | |||
| Blue Cross of Nevada | NV | 84101 | No FEP claims. Please send FEP claims on paper or use Payer ID 06126. | ||
| Blue Cross of New Mexico | NM | CBNM1 | |||
| Blue Cross of North Dakota (ND Dental Services) | ND | CX004 | A United Concordia Company | ||
| Blue Cross of Rhode Island | RI | CB870 | A United Concordia Company | ||
| Blue Cross of Tennessee | TN | CBTN1 | Yes | ||
| Blue Cross of Texas | TX | CB900 | |||
| Blue Shield of California | CA | 94036 | |||
| Blue Shield of Pennsylvania Dental Plus | PA | CBPA2 | A United Concordia Company | ||
| BlueCross Blue Shield of Minnesota | CBMN1 | Use for claims mailed to PO Box 64338 St. Paul MN 55164-0338. 4/2018: Payer is advising providers to use 00220 for the federal claims and they should be sent using CBMN1. | |||
| BlueCross BlueShield of Western New York | NY | CBNYW | EDI enrollment is no longer required by ASK however the payer requires each provider register with them. | ||
| BlueShield of Northeastern New York | NY | CBNYE | EDI enrollment is no longer required by ASK however the payer requires each provider register with them. | ||
| Boilermakers National Health & Welfare Fund | 36609 | ||||
| Boon Administrative Services Inc. | BOONG | ||||
| BridgeSpan | BRIDG | ||||
| Brokers National | CX032 | ||||
| Butler Benefit | 42150 | ||||
| C. L. Frates and Company - OSMA Health | CX075 | ||||
| Cal Optimal -OneCare | CX083 | by LIBERTY Dental Plan | |||
| California State Government Programs | CPPCA | ||||
| Cannon Cochran Management Services Inc. Metairie LA | 71057 | Payer ID for claims with a mailing address of PO Box 6794 Metairie LA 70009 | |||
| Capitol Administrators | 68011 | ||||
| Capitol Dental | CX095 | via Performance Health Technology | |||
| Care 1st Health Plan Medicare Advantage | CX083 | by LIBERTY Dental Plan | |||
| Care 1st PHP LA & San Bernadino County | CX083 | by LIBERTY Dental Plan | |||
| CareFirst Administrators/NCAS | 75190 | ||||
| CareFirst Administrators/NCAS | 75191 | ||||
| Carefirst of Maryland Inc. | 00580 | ||||
| CareOregon Inc. | 93975 | ||||
| CareSource | OH | CKOH2 | No Response | ||
| CareSource Georgia | GACS1 | ||||
| Caresource Indiana Inc | INCS1 | ||||
| CareSource KY | KYCS1 | ||||
| CareSource West Virginia | WVCS1 | ||||
| Carington Benefit Solutions | 60601 | ||||
| Carpenters Health and Welfare Fund of Philadelphia | CX101 | ||||
| Cascade Health Alliance Inc | CHA01 | ||||
| Caterpillar Inc. | 37060 | A United Healthcare payer | |||
| CBA Blue | 03036 | Formerly: Comprehensive Benefits Administrator Inc. | |||
| CDS Group Health | 88022 | ||||
| Cement Masons and Plasterers Health & Welfare Trust | 91136 | Please enter group # F16 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Central Reserve Life | 34097 | Only Non Medicare Supplement and Dental lines of business administered under this payer ID. | |||
| Central States Health & Welfare Funds | 36215 | ||||
| Central Susquehanna Healthcare Providers (CSHP) | 55731 | An Innovative Healthware Services Payer | |||
| Cerner Health Plan Services | 20356 | ||||
| CGS Health | 77153 | ||||
| CHAMPVA - HAC | 84147 | CHAMPVA - HAC is not associated with and does not process claims for TRICARE (formerly CHAMPUS) | |||
| Chesterfield Resources Inc. (Uniontown OH) | 34154 | a.k.a. Salvation Army | |||
| Children of Women Vietnam Veterans - VA HAC | 84147 | ||||
| Choice Plus (TRW) | 68241 | ||||
| Christian Brothers Services | 38308 | ||||
| CIGNA | 62308 | ||||
| Citizens Security Life Insurance | CX071 | ||||
| Civil Service Employees Association (CSEA) | CX054 | Provider 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 HPN | 11752 | ||||
| CMS MMA Specialty Plan | EM843 | ||||
| Colorado Medicaid | CO | CKCO1 | |||
| Community Health Electronic Claims/CHEC/webTPA | 75261 | ||||
| Community Insurance - HMOA & PPOB | CX083 | by LIBERTY Dental Plan | |||
| Community Insurance - PPOD & PPOF | CX083 | by LIBERTY Dental Plan | |||
| Companion Life | 77828 | ||||
| Companion Life / KHP | 37322 | ||||
| CompBenefits | CX021 | ||||
| Comprehensive Healthcare Options.com Inc. | CHCP1 | ||||
| CompuSys / Erisa Group Inc. | 74234 | ||||
| Connecticut Carpenters Health Fund | 37307 | ||||
| Connecticut General (CIGNA) | 62308 | ||||
| Connecticut Medicaid | CT | CKCT1 | |||
| Consolidated Group Dental | 61305 | ||||
| Continental Benefits | 35245 | ||||
| Cook Children's Dental | TX | CPPCC | |||
| Cook Group Solutions | 77153 | ||||
| Core Administrative Services | 58231 | ||||
| Core V | 60601 | ||||
| CoreSource AZ MN | 41045 | 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. | |||
| CoreSource Detroit | 38225 | fka NGS American | |||
| CoreSource KC | 48117 | ||||
| CoreSource Little Rock | 75136 | ||||
| CoreSource MD PA IL | 35182 | Only 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 OH | 35183 | ||||
| CoreStar | 41045 | 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. | |||
| Covenant Administrators Inc. (Atlanta GA) | 58102 | ||||
| Coventry Dental | CX049 | ||||
| Coventry Health Care National Network | 25133 | ||||
| CoventryCares | 86098 | Kentucky Medicaid CoventryCares administered by Avesis | |||
| Creative Plan Administrators | 37320 | ||||
| Crescent Dental - Meritain Health | CX074 | ||||
| Crescent Health Solutions | 56213 | ||||
| CTI Administrators Inc. | 42141 | ||||
| CustomCare | 68241 | ||||
| Cypress Ancilliary Beneefits | TLZ04 | ||||
| Dart Management Corporation | 06172 | ||||
| DBP - Americhoice (NJ/PA) / UHC (MS) | GP133 | Please use payer ID GP133 for dental specific transactions | |||
| Dearborn National | 36123 | ||||
| DeCare Dental Health Insurance | 07035 | ||||
| Delta Dental Insurance Co. (DDIC) | AK | 94276 | |||
| Delta Dental Insurance Co. (DDIC) | AL | 94276 | |||
| Delta Dental Insurance Co. (DDIC) | FL | 94276 | |||
| Delta Dental Insurance Co. (DDIC) | GA | 94276 | |||
| Delta Dental Insurance Co. (DDIC) | LA | 94276 | |||
| Delta Dental Insurance Co. (DDIC) | MS | 94276 | |||
| Delta Dental Insurance Co. (DDIC) | MT | 94276 | |||
| Delta Dental Insurance Co. (DDIC) | NV | 94276 | |||
| Delta Dental Insurance Co. (DDIC) | TX | 94276 | |||
| Delta Dental Insurance Co. (DDIC) | UT | 94276 | |||
| Delta Dental Massachusetts | MA | 04614 | |||
| Delta Dental of Alabama (DDIC) | DDAL1 | ||||
| Delta Dental of Alabama (DDIC) | AK | 94276 | |||
| Delta Dental of Alabama (DDIC) | AL | 94276 | |||
| Delta Dental of Alabama (DDIC) | FL | 94276 | |||
| Delta Dental of Alabama (DDIC) | GA | 94276 | |||
| Delta Dental of Alabama (DDIC) | LA | 94276 | |||
| Delta Dental of Alabama (DDIC) | MS | 94276 | |||
| Delta Dental of Alabama (DDIC) | MT | 94276 | |||
| Delta Dental of Alabama (DDIC) | NV | 94276 | |||
| Delta Dental of Alabama (DDIC) | TX | 94276 | |||
| Delta Dental of Alabama (DDIC) | UT | 94276 | |||
| Delta Dental of Alaska (DDIC) | AK | 94276 | |||
| Delta Dental of Alaska (DDIC) | AL | 94276 | |||
| Delta Dental of Alaska (DDIC) | FL | 94276 | |||
| Delta Dental of Alaska (DDIC) | GA | 94276 | |||
| Delta Dental of Alaska (DDIC) | LA | 94276 | |||
| Delta Dental of Alaska (DDIC) | MS | 94276 | |||
| Delta Dental of Alaska (DDIC) | MT | 94276 | |||
| Delta Dental of Alaska (DDIC) | NV | 94276 | |||
| Delta Dental of Alaska (DDIC) | TX | 94276 | |||
| Delta Dental of Alaska (DDIC) | UT | 94276 | |||
| Delta Dental of Arizona | AZ | 86027 | |||
| Delta Dental of Arkansas | AR | CDAR1 | |||
| Delta Dental of California - CA00 Claim Office | CA | 77777 | |||
| Delta Dental of California/Tricare Retiree Dental | CA | CDCA1 | |||
| Delta Dental of Colorado | CO | 84056 | |||
| Delta Dental of Delaware | DE | 51022 | |||
| Delta Dental of Florida (DDIC) | DDFL1 | ||||
| Delta Dental of Florida (DDIC) | AK | 94276 | |||
| Delta Dental of Florida (DDIC) | AL | 94276 | |||
| Delta Dental of Florida (DDIC) | FL | 94276 | |||
| Delta Dental of Florida (DDIC) | GA | 94276 | |||
| Delta Dental of Florida (DDIC) | LA | 94276 | |||
| Delta Dental of Florida (DDIC) | MS | 94276 | |||
| Delta Dental of Florida (DDIC) | MT | 94276 | |||
| Delta Dental of Florida (DDIC) | NV | 94276 | |||
| Delta Dental of Florida (DDIC) | TX | 94276 | |||
| Delta Dental of Florida (DDIC) | UT | 94276 | |||
| Delta Dental of Georgia (DDIC) | DDGA1 | ||||
| Delta Dental of Georgia (DDIC) | AK | 94276 | |||
| Delta Dental of Georgia (DDIC) | AL | 94276 | |||
| Delta Dental of Georgia (DDIC) | FL | 94276 | |||
| Delta Dental of Georgia (DDIC) | GA | 94276 | |||
| Delta Dental of Georgia (DDIC) | LA | 94276 | |||
| Delta Dental of Georgia (DDIC) | MS | 94276 | |||
| Delta Dental of Georgia (DDIC) | MT | 94276 | |||
| Delta Dental of Georgia (DDIC) | NV | 94276 | |||
| Delta Dental of Georgia (DDIC) | TX | 94276 | |||
| Delta Dental of Georgia (DDIC) | UT | 94276 | |||
| Delta Dental of Idaho | ID | 82029 | |||
| Delta Dental of Illinois Group Plans | IL | 05030 | |||
| Delta Dental of Illinois Individual Plan | IDIND | ||||
| Delta Dental of Indiana | IN | CDIN1 | |||
| Delta Dental of Iowa | IA | CDIA1 | |||
| Delta Dental of Iowa - Dental Wellness Plan | CDIAM | ||||
| Delta Dental of Kansas | KS | CDKS1 | |||
| Delta Dental of Kentucky | KY | CDKY1 | |||
| Delta Dental of Louisiana (DDIC) | CDMS1 | ||||
| Delta Dental of Louisiana (DDIC) | AK | 94276 | |||
| Delta Dental of Louisiana (DDIC) | AL | 94276 | |||
| Delta Dental of Louisiana (DDIC) | FL | 94276 | |||
| Delta Dental of Louisiana (DDIC) | GA | 94276 | |||
| Delta Dental of Louisiana (DDIC) | LA | 94276 | |||
| Delta Dental of Louisiana (DDIC) | MS | 94276 | |||
| Delta Dental of Louisiana (DDIC) | MT | 94276 | |||
| Delta Dental of Louisiana (DDIC) | NV | 94276 | |||
| Delta Dental of Louisiana (DDIC) | TX | 94276 | |||
| Delta Dental of Louisiana (DDIC) | UT | 94276 | |||
| Delta Dental of Maryland and Pennsylvania | PA | 23166 | incl. Maryland | ||
| Delta Dental of Michigan | MI | CDMI0 | |||
| Delta Dental of Minnesota | MN | CDMN1 | |||
| Delta Dental of Mississippi (DDIC) | DDMS1 | ||||
| Delta Dental of Mississippi (DDIC) | AK | 94276 | |||
| Delta Dental of Mississippi (DDIC) | AL | 94276 | |||
| Delta Dental of Mississippi (DDIC) | FL | 94276 | |||
| Delta Dental of Mississippi (DDIC) | GA | 94276 | |||
| Delta Dental of Mississippi (DDIC) | LA | 94276 | |||
| Delta Dental of Mississippi (DDIC) | MS | 94276 | |||
| Delta Dental of Mississippi (DDIC) | MT | 94276 | |||
| Delta Dental of Mississippi (DDIC) | NV | 94276 | |||
| Delta Dental of Mississippi (DDIC) | TX | 94276 | |||
| Delta Dental of Mississippi (DDIC) | UT | 94276 | |||
| Delta Dental of Missouri | MO | 43090 | |||
| Delta Dental of Montana (DDIC) | DDMT1 | ||||
| Delta Dental of Montana (DDIC) | AK | 94276 | |||
| Delta Dental of Montana (DDIC) | AL | 94276 | |||
| Delta Dental of Montana (DDIC) | FL | 94276 | |||
| Delta Dental of Montana (DDIC) | GA | 94276 | |||
| Delta Dental of Montana (DDIC) | LA | 94276 | |||
| Delta Dental of Montana (DDIC) | MS | 94276 | |||
| Delta Dental of Montana (DDIC) | MT | 94276 | |||
| Delta Dental of Montana (DDIC) | NV | 94276 | |||
| Delta Dental of Montana (DDIC) | TX | 94276 | |||
| Delta Dental of Montana (DDIC) | UT | 94276 | |||
| Delta Dental of Nebraska | NE | CDNE1 | |||
| Delta Dental of Nevada (DDIC) | DDNV1 | ||||
| Delta Dental of Nevada (DDIC) | AK | 94276 | |||
| Delta Dental of Nevada (DDIC) | AL | 94276 | |||
| Delta Dental of Nevada (DDIC) | FL | 94276 | |||
| Delta Dental of Nevada (DDIC) | GA | 94276 | |||
| Delta Dental of Nevada (DDIC) | LA | 94276 | |||
| Delta Dental of Nevada (DDIC) | MS | 94276 | |||
| Delta Dental of Nevada (DDIC) | MT | 94276 | |||
| Delta Dental of Nevada (DDIC) | NV | 94276 | |||
| Delta Dental of Nevada (DDIC) | TX | 94276 | |||
| Delta Dental of Nevada (DDIC) | UT | 94276 | |||
| Delta Dental of New Jersey | NJ | 22189 | |||
| Delta Dental of New Mexico | NM | 85022 | |||
| Delta Dental of New York | NY | 11198 | |||
| Delta Dental of North Carolina | NC | 56101 | |||
| Delta Dental of North Dakota | ND | CDND1 | |||
| Delta Dental of Ohio | OH | CDOH1 | |||
| Delta Dental of Oklahoma | OK | CDOK1 | |||
| Delta Dental of Oregon (Oregon Dental Service) | OR | CDOR1 | |||
| Delta Dental of Rhode Island | RI | 05029 | |||
| Delta Dental of South Carolina | SC | 43091 | |||
| Delta Dental of South Dakota | SD | 54097 | |||
| Delta Dental of Tennessee | TN | CDTN1 | |||
| Delta Dental of Texas (DDIC) | DDTX1 | ||||
| Delta Dental of Texas (DDIC) | AK | 94276 | |||
| Delta Dental of Texas (DDIC) | AL | 94276 | |||
| Delta Dental of Texas (DDIC) | FL | 94276 | |||
| Delta Dental of Texas (DDIC) | GA | 94276 | |||
| Delta Dental of Texas (DDIC) | LA | 94276 | |||
| Delta Dental of Texas (DDIC) | MS | 94276 | |||
| Delta Dental of Texas (DDIC) | MT | 94276 | |||
| Delta Dental of Texas (DDIC) | NV | 94276 | |||
| Delta Dental of Texas (DDIC) | TX | 94276 | |||
| Delta Dental of Texas (DDIC) | UT | 94276 | |||
| Delta Dental of Utah (DDIC) | AK | 94276 | |||
| Delta Dental of Utah (DDIC) | AL | 94276 | |||
| Delta Dental of Utah (DDIC) | FL | 94276 | |||
| Delta Dental of Utah (DDIC) | GA | 94276 | |||
| Delta Dental of Utah (DDIC) | LA | 94276 | |||
| Delta Dental of Utah (DDIC) | MS | 94276 | |||
| Delta Dental of Utah (DDIC) | MT | 94276 | |||
| Delta Dental of Utah (DDIC) | NV | 94276 | |||
| Delta Dental of Utah (DDIC) | TX | 94276 | |||
| Delta Dental of Utah (DDIC) | UT | 94276 | |||
| Delta Dental of Virginia | VA | CDVA1 | |||
| Delta Dental of Washington | WA | 91062 | .k.a. Washington Dental Service | ||
| Delta Dental of Washington DC | DC | 52147 | |||
| Delta Dental of West Virginia | WV | 31096 | |||
| Delta Dental of Wisconsin | WI | 39069 | |||
| Delta Dental of Wyoming | WY | CDWY1 | |||
| Delta Dental Puerto Rico | 66043 | ||||
| Delta Dentoal of Utah (DDIC) | DDUT1 | ||||
| DeltaCare USA | CDCAP | Formerly: PMI | |||
| DeltaCare USA Claims | DDCA2 | Detailed Benefits | |||
| DeltaCare USA Encounters | DDCA3 | ||||
| Denex Dental | CX049 | ||||
| Dental Care Plus | CX035 | ||||
| Dental Health Services of America | CX094 | ||||
| Dental Network of MD | CX034 | ||||
| Dental Professionals of Wisconsin | 39148 | Formerly: Southeast Dental Associates. Effective 7-1-14 payer name must be listed as DPOW-CCHP OR DPOW-ANTHEM OR DPOW-ICA | |||
| Dental Select | CX093 | ||||
| Dental Transformation Initiative (DTI) | DTCA7 | There is no enrollment for claims submission. To become a participating provider an office must fill out a form (http://www.dhcs.ca.gov/provgovpart/denti-cal/Documents/Safety%20Net%20Clinic%20Opt-In%20Form(fin)Edits.docx) and email it to DTI@dhcs.ca.gov | |||
| DentaQuest - Goverment Plans | MD | CKMD1 | |||
| DentaQuest - Government Plans | 62154 | ||||
| DentaQuest - Government Plans | ID | 61254 | |||
| DentaQuest - Government Plans | ID | CKID1 | |||
| DentaQuest - Government Plans | IL | CKIL1 | IL | ||
| DentaQuest - Government Plans | KY | CKKY3 | KY | ||
| DentaQuest - Government Plans | VA | CKVA1 | |||
| DentaQuest - Government Plans | WI | CX014 | |||
| DentaQuest - Government Plans Florida | FL | CKSC1 | |||
| DentaQuest - Government Plans Florida | FL | CX052 | FL | ||
| Dentegra | 88888 | ||||
| Denti-Cal / Medicaid of California | CA | 94146 | Denti-Cal requires provider enrollment and has special data requirements. Contact Denti-Cal EDI Support at (916) 853-7373. | ||
| Dentist Direct LLC | UTUDD | ||||
| Department of Economic Security | DESAZ | ||||
| Deseret Mutual Benefit Administrators | CX089 | Yes | |||
| DH Cook Associates | 77153 | ||||
| DH Evans | CX065 | An Innovative Healthware Services Payer | |||
| District of Columbia Medicaid | DC | CKDC1 | Yes | ||
| Diversified Administration Corporation | CX040 | ||||
| Downstream Casino | 19191 | ||||
| DQ/Emblem (Emblem Health Medicaid) | EMBDQ | ||||
| Dunn and Associates Benefits Administrators Inc. | 35186 | ||||
| E-V Benefits Management Inc (Columbus OH) | 34159 | Now known as Meritain Health. | |||
| E.S. BEVERIDGE & ASSOCIATES | 34108 | An Innovative Healthware Services Payer | |||
| EasyChoice Health Plan | CX083 | by LIBERTY Dental Plan | |||
| EBMC | CX025 | ||||
| EBMS (Employee Benefit Management Services Inc.) | 81039 | ||||
| EBS Benefit Solutions | CX043 | ||||
| EBSO Inc fka EBC Inc | 37257 | Payer 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 SeniorCare | 08754 | ||||
| EDS - Medi-Cal | CA | 57016 | Yes | ||
| EHI | 73288 | ||||
| Elderwood Health | 03964 | ||||
| Emblem Health (GHI - New York Group Health Inc.) | 13551 | ||||
| EMI Health | CX079 | Formerly: Educators Mutual Insurance Association | |||
| EMPHESYS | 73288 | ||||
| Empire Blue Cross Blue Shield | NY | CBNY1 | FEP claims may not be sent electroncially. | ||
| EmpireHealthChoice Assurance - OSB Low & PPOB | CX083 | by LIBERTY Dental Plan | |||
| EmpireHealthChoice HMO | CX083 | by LIBERTY Dental Plan | |||
| Employee Benefit Concepts (Farmington Hills MI) | 38241 | ||||
| Employee Benefit Consultants | 37257 | Payer 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 Systems | 42149 | ||||
| Employee Benefits Plan Administration Inc. (E.B.P.A.) | 03036 | ||||
| Employee Plans LLC | 35112 | ||||
| Employer Plan Services Inc. | CX031 | ||||
| Employers Direct Health | 75232 | ||||
| Employers Health | 73288 | ||||
| Employers Health Insurance | 73288 | ||||
| Employers Mutual Inc. | 59297 | ||||
| Encara | WDENC | ||||
| Envolve Health | 46278 | Formerly: Dental Health & Wellness | |||
| EPSI Dental II | CX037 | Formerly: Capital Dental | |||
| EQUICOR | 62308 | ||||
| Everence | 35605 | ||||
| ExclusiCare | 71412 | ||||
| Fairbanks North Star Borough | 91136 | Please enter group # F62 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Fairbanks North Star Borough School District Plan A (FNSBSD) | 91136 | Please enter group # F62 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Fairbanks North Star Borough School District Plan B (FNSBSD) | 91136 | Please enter group # F62 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Family Dental | CX096 | via Performance Health Technology | |||
| FamilyCare CCO | CXFMC | via Performance Health Technology | |||
| Fidelio Dental Insurance Company | FDIC1 | ||||
| Fidelity / Key Select | 37321 | ||||
| First Continental Life & Accident Insurance | CX090 | ||||
| First Dental Health / BIA | BEAM1 | ||||
| First Dental Health / BIA | CXBMD | ||||
| First Dental Health of CA | CX086 | ||||
| First Reliance Standard (NY Business) | 13317 | ||||
| Flex Compension | R7004 | ||||
| FlexCare | 68241 | ||||
| Florida Blue FEP | CBFLF | FL | |||
| Florida Combined Life | CBFLU | A United Concordia Company | |||
| Florida Combined Life | XXFLU | A United Concordia Company | |||
| Florida Medicaid | FL | CKFL1 | Yes | ||
| Florida Power & Light | 68241 | ||||
| Formula Card Dental | LX050 | ||||
| Foundation Benefit Admin (FBA) - Boon Group | BOONG | ||||
| Fox-Everett Inc. | 64069 | ||||
| Fraternal Order of Police - Dental Division (Philadelphia PA) | CX041 | ||||
| Fresno PACE | 99660 | ||||
| Fringe Benefits Coordinators | 59204 | ||||
| GA - BCBS | GA | CBGA1 | |||
| GDS | CX036 | ||||
| Georgia Medicaid | GA | CKGA1 | |||
| Gettysburg | CX064 | An Innovative Healthware Services Payer | |||
| GIC Indemnity Plan | 80314 | ||||
| Gilsbar Inc. | 07205 | ||||
| Golden State Health Plan | CX083 | by LIBERTY Dental Plan | |||
| Golden West Dental | GWD01 | ||||
| Government Employees Health Association (GEHA) | 44054 | ||||
| Government Employees Hospital Association (GEHA) | 57254 | ||||
| Great Lakes PACE | 39640 | ||||
| Great-West Healthcare | 63665 | Formerly: General American | |||
| Great-West Healthcare | 80705 | ||||
| Group Administrators Ltd. | 36338 | Please 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 Administrators | 48143 | ||||
| Group Benefit Administrators (Hendersonville TN) | 72153 | ||||
| Group Benefit Services | CB951 | ||||
| Group Benefits | CB951 | ||||
| Group Dental Service | CX036 | ||||
| Group Health Coop (Indidivual & Family and Small Business Groups) | 89070 | A United Concordia Company | |||
| Group Health Cooperative of Eau Claire | 95192 | ||||
| Group Insurance Service Center Inc. | 37276 | ||||
| Group Link of Indiana | CX015 | ||||
| Guaranty (DINA) | CX090 | ||||
| Guardian Life Insurance Company of America | 64246 | ||||
| Hamaspik Choice | 47738 | ||||
| Harrington Health Colonial Dental | 59143 | ||||
| Hawaii Medical Service Association (HMSA) | HMSA1 | A United Concordia Company | |||
| HCS - Health Claims Service (Boise ID) | 82018 | ||||
| Health Choice Arizona | 62179 | ||||
| Health Choice Insurance Co | 46221 | ||||
| Health Choice Integrated Care | 22100 | ||||
| Health Economics Group Inc. | CX039 | ||||
| Health Net 21 - LA & Sacramento | CX083 | by LIBERTY Dental Plan | |||
| Health Net Healthy Families A B & C | CX083 | by LIBERTY Dental Plan | |||
| Health Net Los Angeles PHP | CX083 | by LIBERTY Dental Plan | |||
| Health Net Sacramento GMC | CX083 | by LIBERTY Dental Plan | |||
| Health Plan of Nevada | 76342 | ||||
| Health Plans Inc. | CX055 | ||||
| Health Resources Incorporated (HRI) | CX019 | ||||
| Health Safety Net | CKHSN | Yes | |||
| Healthcare Management Administrators Inc. | HMA01 | The 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. | |||
| HealthChoice Oklahoma | 71064 | Effective date 01.01.18 | |||
| Healthcomp Inc. | 85729 | ||||
| HealthEZ | 41178 | ||||
| Healthgram Inc. | 56144 | Formally known as Primary Physician Care | |||
| HealthPartners MN | CX009 | Yes | |||
| HealthPartners MN | MN | CX010 | Yes | ||
| HealthPlan Services | 59140 | ||||
| Healthplex Inc. | 11271 | ||||
| HealthSCOPE Benefits Inc. (Formerly CNA Health Partners of Arkansas) | 71063 | ||||
| HealthShare CCO | CXHSC | via Performance Health Technology | |||
| HealthSmart (EDI #34145) | 34145 | ||||
| HealthSmart (EDI #37224) | 37224 | ||||
| HealthSmart (EDI #37256) | 37256 | ||||
| HealthSmart (EDI #37283) | 37283 | ||||
| HealthSmart Benefit Solutions | 37272 | Formerly: Wells Fargo TPA Inc. (Newnan GA and Fayetteville NC) | |||
| HealthSmart MyDecision (EDI #18840) | 18840 | ||||
| HealthTrans | 31172 | a.k.a. Innovante Benefit Administrators | |||
| Healthy Alliance Life Insurance - PPOB | CX083 | by LIBERTY Dental Plan | |||
| Healthy Michigan Dental | HMD01 | ||||
| HMA Hawaii | 86066 | ||||
| Ho-Chunk Health Care Center | 46251 | ||||
| Hometown Health Plan Nevada | 88023 | ||||
| Hoosier Dental (in Indianapolis Indiana) | CX015 | ||||
| Horizon Healthcare Dental Services | NJ | 22099 | |||
| Horizon Healthcare Dental Services | NY | 22099 | |||
| Hotel Employees Restaurant Employees Health Trust (HERE) | 91136 | Please enter group # F19 when submitting claims. A Welfare and Pension Administration Services payer | |||
| HSB.NHP. | 45321 | ||||
| Humana | 73288 | ||||
| I. E. Shaffer (West Trenton NJ) | 22175 | ||||
| IBT - Local 145 Health Service & Ins Plan | CXIBT | Only 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. | |||
| iCircle Care of New York | 33884 | ||||
| IMCare | 41600 | ||||
| Indiana Children's Special Healthcare | IN | CX070 | |||
| Indiana Medicaid | IN | CKIN1 | |||
| Indiana Teamsters Health Benefits Fund (Indianapolis IN) | 35107 | Formerly known as Local 135 Health Benefits Fund (Indianapolis IN) | |||
| Inetico Inc. | 43471 | An Innovative Healthware Services Payer | |||
| Innovante Benefit Administrators | 31172 | a.k.a. HealthTrans | |||
| Innovation Health | 40025 | ||||
| Innovative Health Plan | CB951 | ||||
| Insurance Administrators of America Inc. | 37279 | ||||
| Insurance Design Administrators | 13315 | ||||
| Insurance Management Services (Amarillo TX) | 15688 | ||||
| Insurance Systems Inc. | 74385 | ||||
| Insurers Administrative Corp. | 86304 | Please visit website prior to submitting claims: edihelp.iacusa.com | |||
| Integra Administrative Group (Seaford DE) | 51020 | Payer ID valid only for claims with a billing submission address of 110 S. Shipley Street Seaford DE 19973. | |||
| International Brotherhood of Boilermakers | 36609 | ||||
| Iowa Medicaid | IA | CKIA1 | Yes | ||
| Jensen Administrative Services Inc. | CXJAS | ||||
| JOHN MORRELL COMPANY CO. - AHPBA | 38310 | ||||
| Joint Benefit Trust | CHSJT | ||||
| JP Farley Corporation | 34136 | Payer ID valid only for claims with a billing submission address of PO Box 458022 Westlake OH 44145 | |||
| Kaiser | CX073 | ||||
| Kalos Gold Health Plan | 61185 | ||||
| Kalos Health | 40137 | ||||
| Kansas Medicaid | KS | CKKS1 | |||
| Keenan Associates (CA) | 95279 | ||||
| Kemper Benefits | 61453 | ||||
| Kempton Company | 73100 | ||||
| Kempton Group Administrators | 73100 | ||||
| Kentucky Medicaid | KY | CKKY1 | Yes | ||
| Kentucky Spirit | 65030 | Kentucky Medicaid Kentucky Spirit administered by MCNA Dental | |||
| Key Solution | 37323 | ||||
| LA BCBS AdvantagePlus Network | 53021 | A United Concordia Company | |||
| LA Care Health Plan | CX083 | by LIBERTY Dental Plan | |||
| Liberty Dental Plan | CX083 | ||||
| Life Gift Cards | 33LGC | ||||
| Life Insurance Company of Boston & New York | 78140 | ||||
| LIFE St. Joseph of The Pines | 59847 | ||||
| LIFE St.Mary | 76184 | ||||
| LifeCircles PACE | 71498 | ||||
| LifeMap Assurance Company | RLH01 | ||||
| Lifestyle Health Plans | 27005 | ||||
| Lifetime Benefit Solutions | 16117 | ||||
| Lifetime Benefit Solutions | EBSRM | ||||
| LifeWise Healthplan of Oregon | 93093 | ||||
| Lincoln Financial Group | CX061 | ||||
| Lincoln National (WI) | 73288 | ||||
| Line Construction Benefit Fund | LCB01 | ||||
| Local 135 Health Benefits Fund (Indianapolis IN) | 35107 | ||||
| Local 17 Fund - International Association of Heat and Frost Insulators | IAHFI | ||||
| Locals 302 & 612 of the Internation Union of Operating Engineers | 91136 | Please enter group # F12 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Lockard & Williams | CB752 | ||||
| Maestro health Plan | 56139 | ||||
| Mail Handlers Benefit Plan | 25133 | ||||
| Maine Medicaid | ME | CKME1 | Yes | ||
| Maine Medicaid for FQHC | CKMEH | Yes | |||
| MAMSI | CX033 | ||||
| Managed Care Services LLC | 35162 | ||||
| Managed Dental Guard | GI813 | Only for the individual marketplace not for Group/SHOP business. | |||
| MAPFRE | PRFRE | ||||
| Masonry Institute/Administrative D. C. No. 1 Welfare Fund | CX098 | ||||
| Massachusetts Health Program | MA | CKMA1 | Please place Mass Health or MA Medicaid or Mass Medicaid in the carrier name field. | ||
| Mayo Clinic Health Solutions | 41154 | ||||
| MBA Benefit Administrators Inc (Salt Lake UT) | 83028 | ||||
| MBA Of Wyoming Inc | 87065 | ||||
| McGregor PACE | 31149 | ||||
| MCNA Dental | 65030 | ||||
| MD Care Health Plan | CX083 | by LIBERTY Dental Plan | |||
| MED3000 CMS SAFETY NET | EM284 | ||||
| MED3000 CMS Title 21 | EM205 | ||||
| Medica of Minnesota | CX026 | ||||
| Medicaid of Delaware | DE | CKDE1 | Yes | ||
| Medicaid of Florida | FL | CKFL1 | Yes | ||
| Medicaid of Mississippi | MS | CKMS1 | Yes | ||
| Medicaid of New York (Dental Clinics Only) | NY | CKNY2 | Yes | ||
| Medicaid of North Carolina | NC | CKNC1 | tive 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 Choices | MAHC1 | ||||
| Medical Benefits Mutual / MedBen | 74323 | ||||
| Medical Card System (MCS) | PRMCS | ||||
| Medical Mutual of Ohio | 29076 | ||||
| Medical Mutual of Ohio (MMO) | CB833 | ||||
| MedsaveUSA | Formerly: Fringe Benefit Management and 21st Century Health and Benefits | ||||
| Mercy Care Plan (AHCCCS) | 86052 | ||||
| Mercy LIFE of Alabama | 63002 | ||||
| Mercy Maricopa Integrated Care | 33628 | ||||
| Meritain Health Minneapolis | 41124 | ||||
| MetLife | 65978 | ||||
| MFC & HealthPlus Peoria | 23550 | ||||
| MGM Resorts International | CX083 | by LIBERTY Dental Plan | |||
| Michigan Medicaid | MI | CKMI1 | Yes | ||
| Michigan Regional Council of Carpenters Employee Benefit Plan | 38238 | ||||
| Michigan UFCW | 27401 | ||||
| Mid-America Associates Inc. | 37281 | ||||
| Mid-American Benefits | 22823 | ||||
| Midwest Dental Benefits | 41101 | ||||
| Minnesota Medicaid | MN | CKMN1 | Yes | ||
| Missouri Medicaid | MO | CKMO1 | |||
| Molina HealthCare | CX083 | by LIBERTY Dental Plan | |||
| Momentum Insurance Plan | 31415 | ||||
| Montana Medicaid | MT | CKMT1 | |||
| Morris Associates | 35092 | ||||
| Motorola | 36111 | ||||
| MPEEBT/ MPE Services Inc. | 37233 | ||||
| MSA CareGuard | 20572 | ||||
| MultiFlex Dental (Merchants Benefit) | MBAAZ | ||||
| Municipal Health Benefit Fund | 81883 | ||||
| Mutual Health Services | 34192 | Payer formely known as: Antares Management Solutions | |||
| Mutual of Omaha Commercial | CX087 | ||||
| Mutual of Omaha Insurance Company | 71412 | ||||
| Mutually Preferred | 71412 | ||||
| NAA (North America Administrators L.P.) (Nashville TN) | 65085 | ||||
| NABN (Cleveland OH) | 34159 | Now 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 General | ASHC1 | PO Box 2829 Clinton IA 52733 | |||
| National Pacific of TX (NCFLEX) | CX057 | A United Healthcare payer | |||
| National Telecommunications Cooperative Association | 52120 | ||||
| Nationwide Employee Benefits | 314RV | ||||
| Nationwide Health Plans | 31417 | ||||
| Nebraska Medicaid | NE | CKNE1 | Yes | NE | |
| Netcare Life and Health Insurance (NLH) | 66055 | ||||
| Nevada Dental Benefits | NDB01 | ||||
| Nevada Medicaid | NV | CKNV1 | |||
| New England Dental Administrators | 43351 | ||||
| New Hampshire Medicaid | NH | CKNH1 | |||
| New Jersey Medicaid | NJ | CKNJ1 | Yes | ||
| New Mexico Medicaid | NM | CKNM1 | Yes | ||
| New York Medicaid | NY | CKNY1 | Yes | ||
| Next Level Health Partners | 69821 | ||||
| Nippon Life Insurance Company of America | 81264 | ||||
| NJ Delta DHMO | 22267 | ||||
| NNEBT (Northern New England Benefit Trust) | 38238 | ||||
| North American Benefits Network (Cleveland OH) | 34159 | Now 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 Dakota Medicaid | ND | CKND1 | Additional 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) | ME | 02027 | |||
| Northeast Delta Dental (ME NH VT) | NH | 02027 | |||
| Northeast Delta Dental (ME NH VT) | VT | 02027 | |||
| Northern California Pipe Trades Trust Funds | CX099 | For Dates of Service beginning 1-1-15 please use payer ID 77777. | |||
| Northern Illinois Health Plan | 36347 | ||||
| Northern Minnesota Dental | LX062 | ||||
| Northern Nevada Trust Fund | 88027 | Please call (775) 826-7200 to verfiy if you should be sending claims to Northern Nevada Trust Fund. | |||
| NorthStar Administrators | AK | 47570 | |||
| NorthStar Administrators | WA | 47570 | |||
| Northwest Administrators Inc. (Dental) | 91060 | ||||
| Northwest Dental Services | 93525 | ||||
| Northwest Ironworkers Health & Security Fund | 91136 | Please enter group # F15 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Northwest Roofers & Employers Health & Security Trust Fund | 91136 | Please enter group # F26 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Northwest Suburban IPA (Illinois) | 36346 | ||||
| Northwest Textile Processors and Service Trades | 91136 | Please enter group # F14 when submitting claims. A Welfare and Pension Administration Services payer | |||
| NW International Association of Machinists (NW IAM) | 91136 | Please enter group # F39 when submitting claims. A Welfare and Pension Administration Services payer | |||
| NW Plumbers & Pipefitters Health & Welfare Trust | 91136 | Please enter group # F31 when submitting claims. A Welfare and Pension Administration Services payer | |||
| NY BCBS Central/Syracuse | EXC02 | ||||
| Nyhart | 37299 | ||||
| NYS DOH UCP | 14142 | ||||
| OH Dental / UHC Dental Government Programs | GP133 | Please use payer ID GP133 for dental specific transactions | |||
| Ohana Health Plan | CX083 | by LIBERTY Dental Plan | |||
| Ohio AFSCME Care Plan | AFSOH | ||||
| Ohio Medicaid | OH | CKOH1 | |||
| Oklahoma DRS DOC | 71065 | ||||
| Oklahoma Medicaid | OK | CKOK1 | |||
| Olympus Managed Health Care | 65074 | ||||
| Oregon Medicaid | OR | CKOR1 | Yes | ||
| OSMA Health - C. L. Frates and Company | CX075 | ||||
| Ozark Health Plan | CX083 | by LIBERTY Dental Plan | |||
| PA Faculty Health & Welfare | CX066 | An Innovative Healthware Services Payer | |||
| PACE Central Iowa | 72436 | ||||
| PACE CNY | 70454 | ||||
| PACE Greater New Orleans | 21614 | ||||
| PACE Nebraska | 35416 | ||||
| PACE of Southwest Michigan Inc | 45114 | ||||
| PACE Southeast Michigan | 86711 | ||||
| PACE SouthWest Iowa | 53534 | ||||
| Pacific Union | CX056 | A United Healthcare payer | |||
| Pacificare Dental and Vision HMO | CX060 | A United Healthcare payer | |||
| Pacificare Dental and Vision PPO | CX053 | A United Healthcare payer | |||
| PacificSource Administrators | 93031 | a.k.a. Select Benefit Administrators | |||
| PacificSource Community | CXPSC | via Performance Health Technology | |||
| PacificSource Health Plans | 93029 | ||||
| Pan American Life Insurance Group | 04218 | ||||
| Partners Benefit Group | PBGSM | ||||
| Partners health Plan | 23213 | ||||
| Patient Advocates LLC | 10525 | ||||
| PDO | 68241 | ||||
| PEHP (Public Employees Health Program) | CX080 | Yes | Prior 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) | PA | CB865 | A United Concordia Company | ||
| Pennsylvania Medicaid | PA | CKPA1 | |||
| Pequot Pharmaceutical | 37121 | ||||
| Pequot Plus Health Benefit Administrators | 37121 | ||||
| Personal Insurance Administrators Inc. (Agoura Hills CA) | 95397 | ||||
| PHC/PHP | 95411 | ||||
| Phoenix health Plan AZ Claims | PHP01 | ||||
| Physicians Care Network (ASR Corporation) | 38265 | ||||
| Physicians Health Plan of Northern Indiana Inc | 12399 | ||||
| Physicians Mutual | CX068 | ||||
| Physicians United Plan-PUP | CX083 | by LIBERTY Dental Plan | |||
| Pinnacle Claims Management Inc. | 24735 | ||||
| Planned Administrators Inc. | 37287 | ||||
| Please enter group # F07 when submitting claims. A Welfare and Pension Adm | 91136 | Please enter group # F07 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Prairie States Enterprises Inc. | 36373 | ||||
| Preferred Dental Organization | 68241 | ||||
| Preferred Health Plan of the Carolinas | CB404 | ||||
| Preferred Health Professionals | 31478 | Freedom Network Dental | |||
| PreferredOne (MN) | 41147 | ||||
| Premera Blue Cross | AK | 47570 | |||
| Premera Blue Cross | WA | 47570 | |||
| Premier Access Insurance Company | CX078 | ||||
| Premier Access UT Government | CX110 | Formerly: UT CHIP & UT Medicaid | |||
| Premier Dental Plan of MN | CX029 | ||||
| Prime Health Choice | 81502 | ||||
| PrimeCare Administrators (PPO) | PCA01 | ||||
| PrimeWest Health | LX049 | New providers learn about submitting your first claim. Please visit https://www.primewest.org/new-facility-claims | |||
| Principal Financial Group | 61271 | Payer only accepts VISION and DENTAL claims. | |||
| Priority Health | 38217 | ||||
| Professional Benefit Administrators Inc. (Oak Brook IL) | 36331 | Payer ID is valid only for claims with billing submission name city and state of Professional Benefit Administrators Inc. Oak Brook IL. | |||
| Prominence Health Plan | 88029 | ||||
| Prudential for Health | 68241 | ||||
| Prudential HealthCare & Life Ins. Co of America | 68241 | ||||
| Prudential HealthCare Health Maintenance Organization | 68241 | ||||
| Prudential HealthCare HMO for Small Business | 68241 | ||||
| Prudential Healthcare of America Inc. | 68241 | ||||
| Prudential HealthCare POS for Small Business | 68241 | ||||
| Prudential HealthCare PPO for Small Business | 68241 | ||||
| Puget Sound Electrical Workers Healthcare Trust (PSEW) | 91136 | Please enter group # F33 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Quality Care Partners | 89461 | An Innovative Healthware Services Payer | |||
| Quality Plan Administrator Inc | CX077 | ||||
| Quapaw Casino | 19191 | ||||
| Quapaw Tribal Member Plan | 19191 | ||||
| Quapaw Tribe Employee Plan | 19191 | ||||
| Quartz ASO | 46571 | ||||
| Quartz Health Solutions Inc. | 66705 | ||||
| Quest Behavioral Health | 44219 | An Innovative Healthware Services Payer | |||
| RBMS LLC | 91176 | ||||
| Regence Blue Cross Blue Shield of Oregon | OR | CB850 | |||
| Regence Blue Cross Blue Shield of Utah | UT | CBUT1 | |||
| Regence Blue Cross Blue Shield Of Utah FEP | UT | CBUTF | |||
| Regence Blue Shield | WA | 93200 | |||
| Regence Blue Shield FEP | WA | 93200 | |||
| Regence Blue Shield of Idaho | ID | CBID2 | |||
| Regence Northwest Health | WA | 93200 | |||
| Regency Employee Benefits | 38221 | ||||
| Reliance Standard Life | 36088 | ||||
| Reliastar | 80314 | ||||
| ReliaStar (now known as CoreStar formerly NW National Life) | 41045 | 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. | |||
| Renaissance Life and Health | RLHA1 | ||||
| Resolve/Solarte Health Inc. | CB695 | ||||
| ResourceOne Administrators | 20333 | ||||
| Rhode Island Medicaid | RI | CKRI1 | |||
| Riverside San Bernaardino County Indian Health Inc | 50664 | ||||
| Rochester Public Schools | 41625 | ||||
| Rocky Mountain Hospital & Medical Service - OSB High & High | CX083 | by LIBERTY Dental Plan | |||
| Rocky Mountain Life Dental | CO | 84102 | |||
| Rural Carrier Benefit Plan | 25133 | ||||
| S & S Healthcare Strategies | 31441 | ||||
| Safeguard HMO | CX048 | ||||
| SafeGuard PPO | CX030 | ||||
| Sage Technologies | 37105 | ||||
| Salvation Army | 34154 | a.k.a. Chesterfield Resources Inc. (Uniontown OH) | |||
| SAMBA | 37259 | ||||
| San Diego PACE | 96400 | ||||
| Sands Bethworks Gaming | CX083 | by LIBERTY Dental Plan | |||
| Sanford Health Plan | 91184 | ||||
| Santa Clara Family Health Plan | CX083 | by LIBERTY Dental Plan | |||
| SCION Dental | SCION | ||||
| Scion Dental Commercial | SDCOM | ||||
| Scion Gateway Health Plan | 96938 | ||||
| SE Svcs Emp Int'l Union | SEI01 | ||||
| Secure Health Plans of Georgia | 28530 | ||||
| SecureCare Dental | 86057 | ||||
| Securian | 93742 | ||||
| Security Life Insurance Co of America | CX092 | ||||
| Sele-Dent | CX109 | ||||
| Select Benefit Administrators | 93031 | a.k.a. PacificSource Administrators | |||
| Select Health | CX107 | ||||
| SelectCare (Coca Cola) | 68241 | ||||
| Self Insured Services Company (SISCO) | CX020 | ||||
| Self-Funded Plans Inc. | 34131 | ||||
| Self-Insured Dental Services (SIDS) | CX076 | Addt'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 LLC | 36404 | ||||
| Senior Network Health | 15682 | ||||
| Sentry Life Insurance Company | 39033 | Payer ID 39033 is only to be used for Sentry employees claims with dates of service through 2010 | |||
| Sheet Metal Workers Local 104 Health Care Plan (San Ramon CA) | 38238 | ||||
| Shelter Point Life | 81434 | ||||
| Sierra Health and Life | 76342 | ||||
| Significa Benefits Services Inc. | CX046 | Formerly: Erin Group Admin. | |||
| SimplePay | 27905 | ||||
| Sinclair Health Plan | 84076 | ||||
| SingleCare | 95456 | ||||
| SKYGEN USA | SKYGN | ||||
| Solstice Benefits | 76578 | ||||
| South Central Preferred - PPO York PA (IHS Gateway Payer) | 23266 | An Innovative Healthware Services Payer | |||
| South Dakota Medicaid | CKSD1 | ||||
| South Point Hotel & Casino | 35227 | ||||
| Southeastern Indiana Health (SIHO) | 77153 | ||||
| Southwest Service Administrators | CX100 | ||||
| Southwestern Bell | 68241 | ||||
| Southwestern Bell Exec | 68241 | ||||
| Southwestern Bell Exec. - Custom Care | 68241 | ||||
| Southwestern Bell Exec. - Southwestern Bell | 68241 | ||||
| Spectrum Admin | 23253 | ||||
| Spina Bifida - VA HAC | 84147 | ||||
| Standard Insurance Company (NY) | 13411 | ||||
| Standard Insurance Company (OR) | 93024 | ||||
| Star Health | CX090 | Use this payer ID for Dates of Service prior to June 1 2010 | |||
| StarDent | CX090 | ||||
| State of Texas Dental Plan | 73288 | ||||
| Summit America Insurance Services Inc. | 37301 | ||||
| Sun Life and Health Insurance Company | 67814 | Formerly: Genworth Life and Health Insurance Company (GLHIC) | |||
| Superior Dental Care - Preferred Plan | 31117 | ||||
| Surency Life and Health | CX088 | ||||
| Tall Tree Administrators | 88067 | ||||
| TDC | 73288 | ||||
| Teachers Health Trust | 88019 | ||||
| Texas Medicaid | TX | CKTX1 | Yes | ||
| The Dental Companies | 73288 | ||||
| The Dental Concern | 73288 | ||||
| The Health Plan of The Upper Ohio Valley | 34150 | ||||
| The Loomis Company - TPA Wyomissing PA (IHS Gateway Payer) | 23223 | An Innovative Healthware Services Payer | |||
| The Physicians Assurance Corp (TPAC)/Employee Benefit Management Corp (EBMC | CX025 | ||||
| Total Dental Administrators | CX112 | ||||
| Total Senior Care | 12268 | ||||
| TPAC/Employee Benefit Management Corp | CX025 | ||||
| TR Paul Inc. | 37230 | ||||
| Travelers (now MetLife) | 65978 | ||||
| Tri-Counties Welfare Trust Fund | CHSWT | ||||
| TRICARE Dental Program | 89070 | A United Concordia Company | |||
| Trigon Blue Cross Blue Shield - Colorado Dental Office | CO | 84103 | Claims Mailing Address: Trigon Dental Admin 555 Middle Creek Parkway MS 400 Colorado Springs CO 80921. | ||
| Trigon VA - BCBS (Dental) | VA | CB923 | |||
| Triple-S Medicare Advantage | PRADV | ||||
| Triple-S Salud | CBPR1 | Yes | |||
| TRISTAR Benefit Administrators (W. DesMoines IA) | 42137 | Please 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 | ||||
| TruAssure | ILDTA | ||||
| Trusteed Plans Service Corporation | 91078 | ||||
| Trustmark Insurance Company | 61425 | ||||
| UFCW Local 655 | CX111 | ||||
| Ultra Benefits Inc. | 41206 | ||||
| UMC Health Plan | 75130 | ||||
| UMR (formerly UMR Wausau) | 39026 | ||||
| UMR - Cincinnati | 33108 | Formerly: United Medical Resources | |||
| UMR - Harrington | 75196 | Formerly: Harrington Benefit Services (Westerville) | |||
| UMR - Harrington | 95266 | Formerly: Harrington Benefit Services (Columbus) | |||
| UMR - Lexington | 37237 | Formerly: Commonwealth Administrative Group | |||
| UMR - San Antonio | 74223 | Formerly: Benefit Planners Inc. UICI Administrators - State of Nevada | |||
| UMWA Health & Retirement Funds | 52180 | ||||
| UNICARE | 80314 | ||||
| Unified Group Services | 35198 | ||||
| Uniform Medical Plan | 75243 | Formerly: Uniform Medical Plan / Harrington Benefit Services | |||
| Union Security Insurance Company | 70408 | PO Box 2940 Clinton IA 52733 | |||
| United Concordia - Fee for Service | CX007 | A United Concordia Company | |||
| United Concordia Dental Plus | CX013 | A United Concordia Company | |||
| United Food & Comm. Workers Union & Employers Midwest Health Benefit Funds | 36659 | ||||
| United of Omaha | 71412 | ||||
| United States Life Insurance Company | 13545 | Formerly: America General | |||
| United States Virgin Islands Medicaid | CUSV1 | ||||
| United States Virgin Islands Medicaid | CUSVI | ||||
| UnitedHealthcare Dental | 52133 | Formerly OptumHealth Dental Dental Benefit Providers/DBP and DBP of California | |||
| UnitedHealthcare Dental | formerly OptumHealth Dental Dental Benefit Providers/DBP and DBP of California | ||||
| UnitedHealthcare StudentResources | 74227 | ||||
| UnitedHealthOne / UnitedHealthcare Life Insurance Company | CX001 | ||||
| Unity Health Insurance | 66705 | ||||
| Univeral Healthcare - NY | 16105 | ||||
| University of Missouri | 25133 | ||||
| UPMC Health Plan | 23281 | ||||
| Upper Peninsula Health Group (TPA) | 37324 | ||||
| US Benefits | 93092 | ||||
| US Life Ins. Co | 70106 | Claims mailing address PO Box 12009 Cheshire CT | |||
| Utah Medicaid | UT | CKUT1 | |||
| VA Fee Basis Programs | 12116 | ||||
| Valir Pace | 64009 | ||||
| Valley Baptist Health Plan | 89070 | A United Concordia Company | |||
| Valor Health Plan | 43259 | ||||
| Vantage Health Plan Inc. | 72128 | ||||
| Varian Health Care Plan | 68241 | ||||
| Venetian | CX083 | by LIBERTY Dental Plan | |||
| Verity National Group | 75256 | ||||
| Vermont Medicaid | VT | CKVT1 | Yes | ||
| Via Christi HOPE | 48123 | ||||
| VieCare Life Armstrong | 25922 | ||||
| VieCare Life Beaver and Life Lawrence Counties | 25924 | ||||
| VieCare LIFE Butler | 25923 | ||||
| Viva Health Plan | 63114 | ||||
| Voluntary Benefits Plan | 70106 | Claims mailing address PO Box 12009 Cheshire CT | |||
| Volusia Health Network | 59266 | ||||
| Washington Medicaid | WA | CKWA1 | Yes | ||
| Washington State Council of County & City Employees (WSCCCE) | 91136 | Please enter group # F36 when submitting claims. A Welfare and Pension Administration Services payer | |||
| Waterstone Benefit Administrators (Oklahoma Providers) | 73155 | ||||
| Web TPA Inc.of TX | 59332 | ||||
| webTPA/Community Health Electronic Claims/CHEC | 75261 | ||||
| Wellcare | CX083 | by LIBERTY Dental Plan | |||
| WellPoint | CX083 | by LIBERTY Dental Plan | |||
| Wells Fargo TPA Inc. (Charleston WV) | 87815 | ||||
| West Virginia Medicaid | WV | CKWV1 | Yes | ||
| Western Grower's Assurance Trust | 24735 | ||||
| Western Grower's Insurance Company | 24735 | ||||
| WI- BCBS (Dental) | WI | CB950 | |||
| Wichita and Affiliated Tribes | 19191 | ||||
| Willamette Valley | CXWVC | via Performance Health Technology | |||
| William C. Earhart | 93050 | ||||
| WilsonMcShane | R7002 | ||||
| Wisconsin Medicaid | WI | CKWI1 | |||
| Wisconsin Medicare Advantage | WIMAN | ||||
| Wyoming Medicaid | WY | CKWY1 | Yes | ||
| Wyoming PACE | 98543 | ||||
| Zenith Administrators | R7001 | ||||
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Revised 04/09/19