RELAY HEALTH PAYOR LIST AS OF 2/2/12 ST CPID PAYOR 2704 1-888-OHIOCOMP 5405 1199 NATIONAL BENEFIT FUND 4551

1199 NATIONAL BENEFIT FUND 5911 1ST MEDICAL NETWORK (MEDICAL RESOURCES) 2170 21ST CENTURY INSURANCE and FINANCIAL SERVICES 1654 28 CLAIM ADMINISTRATORS 2704 3-HAB 1925 3P ADMINISTRATORS 2430 3P ADMINISTRATORS 5280 742 ACCEL 9584 742 ACCEL 8934 A and I BENEFIT PLAN ADMINISTRATORS 3296 A and I BENEFIT PLAN ADMINISTRATORS 1963 AAG BENEFIT PLAN ADMINISTRATORS 3276 AAG BENEFIT PLAN ADMINISTRATORS, INC. 8949 AAG-AMERICAN ADMINISTRATIVE GROUP (AKA ICON) 5271 AARP 8940 AARP 4921 ABC HEALTH PLAN 1782 ABMA (ALTA BATEES MEDICAL ASSOCIATES) MEDICAL CORP 3637 ABRAZO ADVANTAGE HEALTH PLAN 2750 ABRAZO ADVANTAGE HEALTH PLAN 5951 ABRI HEALTH PLAN 2119 ABRI HEALTH PLAN 3794 ABW - BERRIEN COUNTY 5436 ACCENTURE 3421 ACCESS ADMINISTRATORS 1993 ACCESS ADMINISTRATORS 5430 ACCLAIM 4552 ACCLAIM 4946 ACCLAIM REPRICING 3813 ACCLAIM REPRICING 5283 ACE/ESIS (excludes SUNOCO) 3908 ACS BENEFIT SERVICES, INC. 1843 ACS CONSULTING SERVICES, INC. 2531 ACTIVA BENEFIT SERVICES, LLC 5404 ACTIVA BENEFITS SERVICES 3952 ADMINISTRATIVE CONCEPTS 3228 ADMINISTRATIVE CONCEPTS, INC. 4295 ADMINISTRATIVE SERVICES INC. 9565 ADMINISTRATIVE SERVICES, INC. 5967 ADVANCED MEDICAL MANAGEMENT MSI 9564 ADVANTAGE BY BUCKEYE CA 4628 ADVANTAGE CARE IPA CA 6141 ADVANTAGE CARE IPA 2911 ADVANTAGE HEALTH SOLUTIONS 2235 ADVANTAGE HEALTH SOLUTIONS 3943 ADVANTAGE PREFERRED PLANS 4280 ADVANTAGE PREFERRED PLUS 4793 ADVANTAGE by BUCKEYE 6122 ADVANTEK BENEFIT ADMINISTRATORS 1636 ADVANTEK BENEFIT ADMINISTRATORS 4621 ADVANTICA BENEFITS 6138 ADVANTICA BENEFITS 8538 ADVANTRA FREEDOM (COVENTRY) 1837 ADVANTRA FREEDOM (COVENTRY) 2114 ADVENTIST HEALTH SYSTEM 2932 ADVENTIST HEALTH SYSTEM 4173 ADVICA - NEW YORK HOSPITAL COMMUNITY HEALTH PLAN 2704 ADVOCARE 2801 ADVOCATE BETHANY HLTH PARTNERS 2801 ADVOCATE CHRIST HOSPITAL PARTNERS 2801 ADVOCATE GOOD SAMARITAN PARTNERS 2801 ADVOCATE GOOD SHEPHERD PARTNERS 2517 ADVOCATE HEALTH CENTERS 3704 ADVOCATE HEALTH CENTERS 2510 ADVOCATE HEALTH PARTNERS 2801 ADVOCATE HEALTH PARTNERS

INTERMEDIARY

PAYOR ID Agreement required 31147 No 13162 No 13162 No 58203 No 51028 No No 31147 No 20413 No 20413 No 75237 No 75237 No 93044 No 93044 No 75240 No 75240 No 75185 No 36273 No 36273 No 48185 No E3510 No 3443 No 3443 No ABRI1 No ABRI1 No 38338 No 86033 No TH067 No 12T33 No 64071 No 64071 No 21356 No 21356 No Yes 72467 No 72467 No 38254 No 38254 No 22384 No 22384 No 59141 No 59141 No AMM02 No 68056 No No No 35199 No 35199 No 77070 No 77070 No 68056 No 83077 No 83077 No 59374 No 59374 No 25133 No 25133 No 95340 No 95340 No No 31147 No 65093 No 65093 No 65093 No 65093 No 36320 No 36320 No 65093 No 65093 No

REMIT No Yes Yes No No No No No No No No No No No No No Yes Yes No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No Yes Yes No No No No No No No No No No No No

Claim type Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Professional Professional Professional Professional Professional Institutional Professional Institutional Professional

ST

IL IL

CPID 2801 2801 2801 4500 6400 6400 4500 6400 4500 4500 6400 6400 4500 4500 6400 6400 4500 4500 6400 6400 4500 4500 6400 4500 6400 6400 4500 6400 4500 6400 4500 4500 6400 4500 6400 4978 2760 6400 6400 4623 6140 5823 3617 5964 4764 3428 4500 6400 4500 6400 6400 4500 4500 6400 1667 5810 7910 5165 2247 1933 1933 2247 1933 2247 2247 1933 5282 1600 5217

PAYOR ADVOCATE LUTHERAN GENERAL PARTNERS ADVOCATE SOUTH SUBURBAN PARTNERS ADVOCATE TRINITY HLTH PARTNERS AETNA AETNA AETNA - AEXEL AETNA - AEXEL AETNA - CHOICE POS II AETNA - CHOICE POS II AETNA - ELECT CHOICE (EC) AETNA - ELECT CHOICE (EC) AETNA - EPO AETNA - EPO AETNA - GOLDEN CHOICE (MEDICARE ADVANTAGE PLAN) AETNA - GOLDEN CHOICE (MEDICARE ADVANTAGE PLAN) AETNA - GOLDEN MEDICARE (MEDICARE ADVANTAGE PLAN) AETNA - GOLDEN MEDICARE - MEDICARE ADVANTAGE PLAN AETNA - HMO AETNA - HMO AETNA - INDEMNITY AETNA - INDEMNITY AETNA - MANAGED CHOICE (MC) AETNA - MANAGED CHOICE (MC) AETNA - OPEN ACCESS HMO AETNA - OPEN ACCESS HMO AETNA - OPEN CHOICE (OC) AETNA - OPEN CHOICE (OC) AETNA - PPO AETNA - PPO AETNA - QPOS AETNA - QPOS AETNA - TRADITIONAL CHOICE (TC) AETNA - TRADITIONAL CHOICE (TC) AETNA - USACCESS AETNA - USACCESS AETNA -US HEALTHCARE - J1 AETNA -US HEALTHCARE - J1 - JVHL AETNA AFFORDABLE HEALTH CHOICES AETNA AFFORDABLE HEALTH CHOICES - SRC AETNA BETTER HEALTH - IL MEDICAID AETNA BETTER HEALTH - IL MEDICAID AETNA BETTER HEALTH - PENNSYLVANIA MEDICAID AETNA BETTER HEALTH - PENNSYLVANIA MEDICAID AETNA BETTER HEALTH PLAN AETNA BETTER HEALTH PLAN AETNA ENCOUNTERS SR. and JR. AETNA GOLDEN MEDICARE PLAN AETNA GOLDEN MEDICARE PLAN AETNA HEALTH FUND (AHF) AETNA HEALTH FUND (AHF) AETNA LIFE AND CASUALTY AETNA LIFE AND CASUALTY AETNA TEXAS MEDICAID CHIP AETNA TEXAS MEDICAID CHIP AFFILIATED DOCTORS OF ORANGE COUNTY (ADOC) AFFILIATED DOCTORS OF ORANGE COUNTY (ADOC) AFFILIATED PHYSICIANS GROUP AFFILIATED PHYSICIANS GROUP AFFINITY HEALTH PLAN AFFINITY HEALTH PLAN AFFINITY HEALTH PLAN CHILD HEALTH PLUS AFFINITY HEALTH PLAN CHILD HEALTH PLUS AFFINITY HEALTH PLAN FAMILY HEALTH PLUS AFFINITY HEALTH PLAN FAMILY HEALTH PLUS AFFINITY HEALTH PLAN MEDICAID AFFINITY HEALTH PLAN MEDICAID AFFINITY HEALTH PLAN MEDICARE ADVANTAGE AFFINITY HEALTH PLAN MEDICARE ADVANTAGE AFFINITY MEDICAL GROUP

INTERMEDIARY

DIVERSIFIED DATA DESIGN

PAYOR ID Agreement required 65093 No 65093 No 65093 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No Yes Yes 60054 No 60054 No 26337 No 26337 No 23228 No 23228 No 23225 Yes 23225 Yes 60055 Yes 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No 60054 No No ADOCS No No No 13334 No 13334 No 13334 No 13334 No 13334 No 13334 No 13334 No 13334 No 13333 No 13333 No 46594 No

REMIT No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes Yes No No No

Claim type Professional Professional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional

ST

AL AL AL AL AL AL AL

AK AK AK

CPID 3636 5297 4175 3946 3763 3878 2444 3900 4296 3981 3834 2109 5965 1518 2714 5558 2423 4479 5560 5587 2468 5559 1631 2173 1744 6591 3910 2242 1744 6591 4489 5524 1455 1744 6591 1744 6591 4509 6405 5403 4591 6483 4515 1651 2295 1935 2712 4730 5276 5987 2589 3793 2227 8573 1759 5962 3204 5231 2909 1706 4559 2704 5846 6408 4516 1782 4176 1837 1536

PAYOR AFFINITY MEDICAL GROUP AFFORDABLE BENEFIT ADMINISTATORS, INC AFL - CIO FOOD & BEV DEALERS TRST FND (TOLEDO, OH) AFTRA HEALTH FUND AFTRA HEALTH FUND AGA AGATE RESOURCES, INC. AGATE RESOURCES, INC. (LIPA) AHPO AHPO AIA TOBACCO FUND AIG AIG AKAMAI ADVANTAGE (MEDICARE ADVANTAGE PLAN) AKAMAI ADVANTAGE (MEDICARE ADVANTAGE PLAN) ALABAMA BLUE CROSS ALABAMA BLUE SHIELD ALABAMA MEDICAID ALABAMA MEDICAID - INPATIENT ALABAMA MEDICAID - OUTPATIENT ALABAMA MEDICARE ALABAMA MEDICARE ALAMEDA ALLIANCE ALAMEDA ALLIANCE ALASKA CHILDRENS SERVICES, INC. ALASKA CHILDRENS SERVICES, INC. ALASKA ELECTRICAL HEALTH ALASKA ELECTRICAL HEALTH and WELFARE FUND ALASKA LABORERS CONST. INDUSTRY GROUP ALASKA LABORERS CONST.R INDUSTRY TRUST(GROUP #F23) ALASKA MEDICAID ALASKA MEDICAID ALASKA MEDICARE ALASKA PIPE TRADES LOCAL 375 ALASKA PIPE TRADES LOCAL 375 (GROUP #F24) ALASKA UNITED FOOD & COMM WRKRS HLTH/WEL ALASKA UNITED FOOD & COMM WRKRS HLTH/WEL ALBUQUERQUE JPPO - NEW MEXICO ALBUQUERQUE PPO - NEW MEXICO ALICARE ALICARE ALL SAVERS INSURANCE ALL SAVERS INSURANCE CO. ALLEGIANCE BENEFIT PLAN MANAGEMENT INC. ALLEGIANCE BENEFIT PLAN MANAGEMENT, INC. ALLIANCE (THE) ALLIANCE (THE) - WI AND SURROUNDING STATES ALLIANCE IPA ALLIANCE PARTNERS ALLIANCE PARTNERS ALLIANT HEALTH PLANS of GEORGIA ALLIANT HEALTH PLANS of GEORGIA ALLIED ADMINISTRATORS - SAN FRANCISCO, CA ALLIED BENEFIT SYSTEM, INC. ALLIED BENEFIT SYSTEM, INC. ALLSTATE INSURANCE COMPANY ALLSTATE INSURANCE COMPANY ALOHACARE ALOHACARE ALPHA DATA SYSTEMS ALPHA DATA SYSTEMS ALPS COMPCARE ALTA BATES MEDICAL GROUP (ABMG) (DOS >=7/1/10) ALTA HEALTH & LIFE INSURANCE COMPANY ALTA HEALTH and LIFE INSURANCE COMPANY ALTA SENIOR CARE (HLTHNET SR. AND SECURE HORIZONS) ALTERNATIVE TECHNOLOGY RESOURCE (ATR) ALTIUS HEALTH PLAN ALTIUS HEALTH PLAN

INTERMEDIARY

PAYOR ID 95426 13346 13346 37280 20048 20048 31138 31138 443

HMSA HMSA ALABAMA BCBS ALABAMA BCBS

12B62 SB971 12B54 SB510 SKAL0 EDS - ELECTRONIC DATA SER 12K01 EDS - ELECTRONIC DATA SER 12K01 CAHABA GBA SMAL0 CAHABA GBA 12M01

91136 91136 92600 92600 91136 91136 FIRST HEALTH SERVICES SKAK0 FIRST HEALTH SERVICES SKAK0 NORIDIAN ADMIN. SERVICES SMAK0 91136 91136 91136 91136 62308 62308 13550 13550 37602 37602 81040 81040 88461 88461 HCP01

58234 58234 94177 37308 37308 77066 77066

75261 75261 31147 A0701 80705 80705 E3510 25133 SX113

UHIN

Agreement required No No No No No No Yes Yes No No Yes Yes Yes Yes Yes Yes Yes No No No Yes Yes Yes Yes No No No No No No Yes Yes Yes No No No No No No No No No No No No No Yes No No No No No No No No No No Yes Yes No No No No No No No No No No

REMIT No No No No No No No No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No Yes Yes Yes No No No No Yes Yes No No Yes Yes No No No No No Yes No No No No No No Yes Yes No No No No No No Yes Yes No No Yes Yes

Claim type Institutional Professional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Professional Professional Institutional

ST

CPID 5245 8933 4591 5403 4297 4177 4298 4554 2999 3755 4181 7913 4905 3276 7911 4178 5244 8935 5850 3964 7912 4179 2230 4180 3784 3270 4502 8411 9576 2138 4907 3680 5883 3949 3862 1959 3895 2188 8433 8518 4162 7969 3429 2110 7481 1941 3869 4974 6436 4503 3233 1553 2895 5725 4869 4875 3273 3989 3196 9578 5841 3638 4468 8932 2143 6986 9568 6442 4523

PAYOR AMA INSURANCE AGENCY AMA INSURANCE AGENCY AMALGAMATED LIFE AMALGAMATED LIFE INS CO AMALGAMATED LIFE aka ALICARE KOP PA LOC AMCARE HEALTH PLANS AMERAPLAN AMERAPLAN AMERIBEN SOLUTIONS AMERIBEN SOLUTIONS, INC. AMERICA'S HEALTH CHOICE AMERICA'S HEALTH CHOICE AMERICA'S PPO ARAZ GROUP AMERICAN ADMINISTRATIVE GROUP AMERICAN ADMINISTRATORS AMERICAN ADMINISTRATORS AMERICAN BEHAVIOR AMERICAN BEHAVIOR AMERICAN BEHAVIORAL FEP/ITS AMERICAN BENEFIT MANAGEMENT AMERICAN BENEFIT PLAN ADMINISTRATORS AMERICAN BENEFIT PLAN ADMINISTRATORS AMERICAN BENEFITS MANAGEMENT - NORTH CANTON, OH AMERICAN CAPITOL INSURANCE COMPANY AMERICAN CHIROPRACTIC NETWORK AMERICAN CHIROPRACTIC NETWORK IPA of NY (ACNIPA) AMERICAN COMMUNITY MUTUAL LIFE AMERICAN COMMUNITY MUTUAL LIFE AMERICAN FAMILY HEALTH PROVIDERS AMERICAN FAMILY INSURANCE AMERICAN FAMILY INSURANCE AMERICAN FAMILY administered by AMERICAN REPUBLIC AMERICAN FAMILY administered by AMERICAN REPUBLIC AMERICAN GENERAL LIFE and ACCIDENT AMERICAN GENERAL LIFE and ACCIDENT AMERICAN HEALTHCARE ALLIANCE AMERICAN HEALTHCARE ALLIANCE AMERICAN HERITAGE LIFE INSURANCE AMERICAN IMAGING MANAGEMENT, INC. AMERICAN IMAGING MGMT (UTILIMED) AMERICAN INSURANCE COMPANY OF TEXAS AMERICAN INSURANCE COMPANY OF TEXAS AMERICAN INTERNATIONAL GROUP, INC. (AIG) AMERICAN INTERSTATE - (TEXAS only) AMERICAN MEDICAL SECURITY (AMS) AMERICAN MEDICAL SECURITY, INC. AMERICAN NATIONAL INS. CO (ANICO) AMERICAN NATIONAL INSURANCE COMPANY AMERICAN POSTAL WORKERS UNION AMERICAN POSTAL WORKERS UNION AMERICAN PROGRESSIVE AMERICAN REPUBLIC INSURANCE AMERICAN REPUBLIC INSURANCE AMERICAN RISK SERV INC. and ALL SUBS (AMERSAFE INS AMERICAN SENTINEL INSURANCE COMPANY AMERICAN SPECIALTY HEALTH AMERICAN WORKER HEALTH PLAN AMERICAN WORKER HEALTH PLUS AMERICAS 1ST CHOICE HEALTH PLAN AMERICAS 1ST CHOICE HEALTH PLAN AMERICAS 1ST CHOICE PLANS of NORTH CAROLINA AMERICAS 1ST CHOICE PLANS of NORTH CAROLINA AMERICAS CHOICE HEALTHPLAN AMERICAS CHOICE HEALTHPLAN AMERICAS PPO ARAZ GROUP AMERICAS PPO ARAZ GROUP AMERICHOICE OF NY PERSONAL CARE PLUS (MEDICARE) AMERICHOICE TENNCARE AMERICHOICE TENNCARE

INTERMEDIARY

PAYOR ID

13550 13550 13343 38219 38219 75137 75137

41178 75240 42112 42112 63103 63103 63106 34187 95170 95170 34187 41161 41160 60305 60305 AMF11 AMF11 56071 56071 62030 62030 1066 1066 77083 36369 36369

87726 81400 81400 74048 74048 44444 44444 48055 42011 42011 17965 ASH01 37322 37322 20553 20553 26078 26078 20029 41178 16120 86002 95378 95378

Agreement required No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No Yes No No No No No No No No No No No No No No No No No No No No No No No No No

REMIT No No No No No No No No No No No No No No No No No No No No No No No No No No Yes No No Yes No Yes Yes No No No No No No No No No Yes No Yes Yes No No No No No Yes Yes No No No No No No No No No No No No No No Yes Yes

Claim type Professional Institutional Institutional Professional Professional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Professional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional

ST

KY CA CA KY KY

AZ AZ AZ AZ AZ

AZ AZ AZ AZ

AR AR

AR AR

CPID 6442 4523 2806 2853 2501 2541 2815 3748 2827 2500 3749 1741 1569 4555 2893 2800 1710 4547 1930 4182 3466 3940 3287 4269 8948 3811 2497 2290 2935 2421 4417 3511 2421 2421 9566 3287 2994 3814 5875 2444 1956 2248 4503 4509 6405 7424 2927 8456 5547 5547 5547 5547 4426 1570 3438 5548 4405 1456 5546 1585 3432 2540 2823 5596 2416 2141 5955 1489 5597

PAYOR AMERICHOICE hawk-i AMERICHOICE hawk-i AMERICHOICE of NJ (MEDICAID NJ) AMERICHOICE of NJ PERSONAL CARE PLUS (MEDICARE) AMERICHOICE of NJ PERSONAL CARE PLUS (MEDICARE) AMERICHOICE of NY (MEDICAID NY) AMERICHOICE of NY (MEDICAID NY) AMERICHOICE of NY PERSONAL CARE PLUS (MEDICARE) AMERICHOICE of PA (MEDICAID PA) AMERICHOICE of PA (MEDICAID PA) AMERICHOICE of PA PERSONAL CARE PLUS (MEDICARE) AMERIGROUP CORPORATION AMERIGROUP CORPORATION AMERIHEALTH ADMINISTRATORS AMERIHEALTH ADMINISTRATORS, INC. AMERIHEALTH HMO - NJ and DE AMERIHEALTH MERCY HEALTH PLAN AMERIHEALTH MERCY HEALTH PLAN - NORTHERN PA AMERIHEALTH NEW JERSEY/DELAWARE - HMO AMERIKIDS - DALLAS/FT. WORTH AMIDA CARE AMIDA CARE AMVI / PROSPECT HEALTH NETWORK ANCHOR BENEFIT CONSULTING ANCHOR BENEFIT CONSULTING ANCILLARY BENEFIT SYSTEMS ANGELES IPA ANTARES MANAGEMENT SOLUTIONS ANTARES MANAGEMENT SOLUTIONS ANTHEM BLUE ACCESS PRODUCTS ANTHEM BLUE CROSS ANTHEM BLUE CROSS ANTHEM BLUE PREFERRED ANTHEM BLUE PREFERRED PLUS APA PARTNERS, INC. APAC APEX BENEFIT SERVICES APEX BENEFIT SERVICES APOLLO HEALTHCARE IPA APROPO BENEFITS MANAGEMENT APS HEALTHCARE, INC. (AMERICAN PSYCH SYSTEMS) APS HEALTHCARE, INC. (AMERICAN PSYCH SYSTEMS) APWU HEALTH APWU HEALTH PLAN (ALL STATES EXCEPT USVI) APWU HEALTH PLAN (ALL STATES EXCEPT USVI) ARAZ ARCADIAN MANAGEMENT SERVICES ARCADIAN MANAGEMENT SERVICES ARIZONA BLUE CROSS ARIZONA BLUE CROSS - OUT OF AREA ARIZONA BLUE CROSS FEP ARIZONA BLUE CROSS HMO ARIZONA BLUE SHIELD ARIZONA FOUNDATION FOR MEDICAL CARE ARIZONA FOUNDATION for MEDICAL CARE ARIZONA MEDICAID ARIZONA MEDICAID ARIZONA MEDICARE ARIZONA MEDICARE ARIZONA PHYSICIANS IPA ARIZONA PHYSICIANS IPA ARKANSAS BEST CORP ARKANSAS BEST CORPORATION - CHOICE BENEFITS ARKANSAS BLUE CROSS ARKANSAS BLUE SHIELD ARKANSAS MANAGED CARE ORGANIZATION ARKANSAS MANAGED CARE ORGANIZATION ARKANSAS MEDICAID ARKANSAS MEDICAID

INTERMEDIARY

WELLPOINT_

WELLPOINT_ WELLPOINT_

ALL PAYOR NETWORK (APN) ALL PAYOR NETWORK (APN) ALL PAYOR NETWORK (APN) ALL PAYOR NETWORK (APN) ALL PAYOR NETWORK (APN)

AHCCCS NORIDIAN ADMIN. SERVICES NORIDIAN ADMIN. SERVICES

ARKANSAS BC BS ARKANSAS BC BS

EDS - ELECTRONIC DATA SER

PAYOR ID Agreement required 95378 No 95378 No 86047 No 86001 No 86001 No 86048 No 86048 No 86002 No 86049 No 86049 No 86003 No 27514 No 27514 No 54763 No 54763 No 23037 No 22248 No 22248 No 23037 No No 24818 No 24818 No PROSP No 53085 No 53085 No 86062 No SYMED No 34192 No 34192 No SB660 No 47198 No 47198 No SB660 No SB660 No 16140 No PROSP No 34196 No 34196 No MPM11 No 20048 Yes 54160 No 54160 No 44444 No 62308 No 62308 No 16120 No 77045 No 77045 No 12B02 No 12B02 No 12B02 No 12B02 No SB530 No 86062 No 86062 No 12K02 No SKAZ0 No SMAZ0 Yes 12M02 Yes 3432 No 3432 No 75278 No 75278 No 12021 Yes SB520 Yes 62176 No 62176 No SKAR0 Yes 12023 Yes

REMIT Yes Yes Yes No No No Yes No No No No Yes Yes No No No Yes Yes No No No No No No No No No No No Yes Yes Yes Yes Yes No No Yes Yes No No No No No Yes Yes No No No Yes Yes Yes Yes Yes No No Yes Yes Yes No Yes Yes No No Yes Yes No No Yes Yes

Claim type Professional Institutional Professional Professional Institutional Institutional Professional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional

ST AR AR

WI

CPID 1526 2455 6540 8457 1960 4294 5230 2689 4606 5898 2144 6428 4540 6103 4610 4299 2993 2683 4880 4265 2980 4881 5942 4477 1732 6579 9562 7502 5470 2856 4183 7453 5970 5927 4791 5927 4791 2704 2899 7560 4791 5927 8947 3230 3878 4931 1786 8561 3652 5857 6135 3802 1573 4783 4500 4241 3845 2275 5904 7914 3445 1575 5273 8942 2228 2732 2277 4268 4743

PAYOR ARKANSAS MEDICARE ARKANSAS MEDICARE ARNETT HEALTH PLANS ARNETT HEALTH PLANS ASR PHYSICIAN CARE ASR PHYSICIANS CARE ASRM CORPORATION ASRM CORPORATION ASSOCIATED BENEFITS CORPORATION ASSOCIATED BENEFITS CORPORATION ASSOCIATED THIRD PARTY ADMINISTRATION (ATPA) ASSURANT HEALTH ASSURANT HEALTH ASSURANT HEALTH REPRICING via HEALTHSPAN ASSURANT HEALTH REPRICING via HEALTHSPAN ASSURANT HEALTH SELF FUND ASSURANT HEALTH SELF FUND ASSURECARE of MINNESOTA ASSURECARE of MINNESOTA ASSURED BENEFITS ASSURED BENEFITS ADMINISTRATION ASURIS NORTHWEST ASURIS NORTHWEST ASURIS NORTHWEST MEDADVANTAGE ATHENS AREA HEALTH PLAN SELECT ATHENS AREA HEALTH PLAN SELECT ATLANTIC MEDICAL ATLANTICARE ATLANTICARE ATLANTIS HEALTH PLAN ATLAS ADMINISTRATORS (USA MC) ATRIUM HEALTH PLAN INC - MEDICAID HMO ATRIUM HEALTH PLAN INC - MEDICAID HMO AULTCARE HMO AULTCARE HMO AULTCARE of OHIO AULTCARE of OHIO AULTCOMP AULTRA ADMINISTRATIVE GROUP AULTRA ADMINISTRATIVE GROUP AULTRA ADMINISTRATIVE SERVICES AULTRA ADMINISTRATIVE SERVICES AUTOMATED BENEFIT SERVICES AUTOMATED BENEFIT SERVICES AUTOMATED GROUP ADMINISTRATION AUTOMATED GROUP ADMINISTRATORS AVERA HEALTH PLANS AVERA HEALTH PLANS AVERDE HEALTH AVERDE HEALTH AVESIS TPA AVMED, INC. AVMED, INC. AXMINSTER MEDICAL GROUP (AMG) Aetna Affordable Health Choices BAKERSFIELD FAMILY MEDICAL CENTER BANNER HEALTH ARIZONA BANNER MEDISUN formerly SUNHEALTH MEDISUN BANNER MEDISUN formerly SUNHEALTH MEDISUN BAPTIST HEALTHCARE NETWORK BASIC HEALTH BASS ADMINISTRATORS, INC. BCBS MICHIGAN MEDICARE PLUS BLUE PPO - JVHL BCBS MICHIGAN MEDICARE PLUS BLUE PPO - JVHL BCI ADMINISTRATORS, INC. BCN - JVHL BCN - non JVHL NETWORK - JVHL BCN REIMBURSABLE LABS - JVHL BEACON HEALTH STRATEGIES

INTERMEDIARY ARKANSAS BC BS ARKANSAS BC BS

PAYOR ID Agreement required 12022 Yes SMAR0 Yes 95440 No 95440 No 38265 No 38265 No No No No No ATPA1 No 39065 No 39065 No ASNTH No ASNTH No 37313 No 37313 No 88035 No 88035 No 74240 No 74240 No 93221 No 93221 No SX179 No 95691 No 95691 No 22285 No 22304 No 22304 No 13853 No No 95192 No 95192 No Yes Yes Yes Yes 31147 No 37242 No 37242 No Yes Yes 38259 No 38259 No 37280 No 37280 No 46045 No 46045 No 26355 No 26355 No 87098 No 59274 No 59274 No Yes 60054 No BKRFM No SX145 Yes 77072 No 77078 No No No 58102 No Yes Yes 49153 No Yes Yes Yes 43324 No

REMIT Yes Yes No No No No No No No No No Yes Yes No No No No No No No No Yes Yes No No No No No No No No Yes No Yes Yes Yes Yes No No No Yes Yes No No No No Yes Yes No No No Yes Yes No Yes No No No No No Yes No Yes Yes No Yes Yes Yes No

Claim type Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Institutional Professional Professional Professional Professional Institutional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Professional Professional Professional

ST

MN

MA MA

MI RI

CPID 5909 4979 2767 2586 3795 1402 6106 5874 2497 5849 3656 4287 2984 3864 4918 4109 6991 6118 1632 5946 2265 3226 2529 3754 1659 3255 3920 8482 3622 2882 5218 7526 9560 1889 4594 6472 3291 4504 8409 3877 1924 7455 7523 1575 3974 5216 1575 2942 1433 4925 3269 2809 3697 5896 7531 7531 2809 2972 3207 4185 3402 3737 7540 4981 4980 4982 2426 3532 7420

PAYOR BEACON HEALTH STRATEGIES BEAUMONT EMPLOYEE HEALTH PLAN - JVHL BEAUMONT EMPLOYEE HEALTH PLAN - JVHL BEECH STREET CORPORATION BEECH STREET CORPORATION BEHAVIORAL HEALTH SERV. INC. (BHSI) BEHAVIORIAL HEALTH SYSTEMS BELLA VISTA MEDICAL GROUP IPA BELLFLOWER HOSPITAL BENEFIT ADMINISTRATION SERVICES, LTD (BAS LTD) BENEFIT ADMINISTRATION SERVICES, LTD (BAS LTD) BENEFIT ADMINISTRATIVE SYSTEMS, LLC BENEFIT ADMINISTRATIVE SYSTEMS, LLC BENEFIT COORDINATORS CORPORATION (PITTSBURGH, PA) BENEFIT MANAGEMENT BENEFIT MANAGEMENT ADMIN BENEFIT MANAGEMENT ADMIN BENEFIT MANAGEMENT INC OF KS BENEFIT MANAGEMENT INC OF KS BENEFIT MANAGEMENT SERVICES of LOUISIANA BENEFIT MANAGEMENT SERVICES of LOUISIANA BENEFIT MANAGEMENT SERVICES of NORTH CAROLINA BENEFIT MANAGEMENT SYSTEMS of MISSISSIPPI BENEFIT MANAGEMENT SYSTEMS of MISSISSIPPI BENEFIT MANAGEMENT, INC. BENEFIT MANAGEMENT, INC. BENEFIT PLAN ADMINISTRATION INC BENEFIT PLAN ADMINISTRATORS BENEFIT PLAN ADMINISTRATORS CO. (EUA CLAIRE, WI) BENEFIT PLAN ADMINISTRATORS CO. (EUA CLAIRE, WI) BENEFIT PLAN ADMINISTRATORS, INC. BENEFIT PLAN ADMINISTRATORS, INC. BENEFIT PLAN MANAGEMENT, INC. BENEFIT PLAN MANAGEMENT, INC. BENEFIT PLANNERS, INC. BENEFIT PLANNERS, INC. BENEFIT SERVICES INC. BENEFIT SYSTEMS AND SERVICES, INC. BENEFIT SYSTEMS AND SERVICES, INC. BENEFITS, INC. dba CARE PROVIDER NETWORK BENEFITS, INC.dba CARE PROVIDER NETWORK BENESIGHT BENESIGHT BENESYS BENESYS BENESYS BENESYS, INC. BERKSHIRE HEALTH PLAN BERKSHIRE HEALTH PLAN BEST LIFE & HEALTH COMPANY BEST LIFE and HEALTH INSURANCE COMPANY BETTER HEALTH PLAN BETTER HEALTH PLAN of FLORIDA - DOS >11/21/2010 BETTER HEALTH PLAN of FLORIDA - DOS >11/21/2010 BETTER HEALTH PLANS OF SC BETTER HEALTH PLANS, INC. BETTER HEALTH PLANS, INC. BIENVIVIR SENIOR HEALTH SERVICES BIG LOTS ASSOCIATES BENEFIT PLAN BIG LOTS ASSOCIATES BENEFIT PLANS BLOCK VISION, INC. BLUE BENEFIT ADMINISTRATORS OF MA BLUE BENEFIT ADMINISTRATORS OF MA BLUE CARE NETWORK - COMMERCIAL LABS - JVHL BLUE CARE NETWORK - JVHL NETWORK - JVHL BLUE CARE NETWORK - REIMBURSABLE LABS - JVHL BLUE CARE NETWORK HMO BLUE CARE NETWORK HMO BLUE CHIP

INTERMEDIARY

LOUISIANA BCBS

MICHIGAN BCBS MICHIGAN BCBS

PAYOR ID Agreement required 43324 No Yes Yes 95377 No 95377 No SB720 No 63100 No MPM10 No SYMED No 32748 No No 36149 No 36149 No 25145 No 56139 No No No 48611 No 48611 No 999 No 999 No 56139 No 37212 No No 43178 No 43178 No 37286 No 37118 No 39081 No 39081 No 37286 No 37118 No No 44273 No 74223 No 74223 No 34178 No 36342 No 36342 No 42148 No 42148 No 87265 No 87265 No 58102 No 37248 No 37248 No 58102 No 23243 No 23243 No 95604 No 95604 No 25175 No 20488 No 20488 No 25175 No 25175 No 25175 No 12X40 No 31074 No CX025 No No 3036 No 3036 No Yes Yes Yes SB711 Yes 12B58 Yes SB871 Yes

REMIT No Yes Yes No No Yes No No No No No Yes Yes No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No Yes No No Yes Yes Yes No No No No No No Yes Yes Yes Yes Yes Yes

Claim type Institutional Institutional Professional Institutional Professional Professional Professional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Institutional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Professional Professional Professional Institutional Institutional Institutional Institutional Professional Institutional Professional

ST DC WA AK

DC NY

MI MI WV WV

TX OH OH

CA CA CA CA

CPID 1509 7445 7445 2104 4186 7514 7472 2425 4409 7428 5953 2121 1734 7522 6425 2591 4110 6992 8500 1777 4278 3818 2921 4187 1624 6109 4428 3590 8517 4120 4120 8517 4288 3922 8567 8562 1830 1750 5816 1406 4717 1962 5275 9577 7990 2124 7991 5118 7987 2123 7995 5200 7996 5210 7998 5212 5213 7999 5215 8511 8946 3250 2850 4221 5914 1409 6569 1409 4463

PAYOR BLUE CROSS OF NATIONAL CAPITAL AREA - CAREFIRST BLUE CROSS WA/AK PREMERA BLUE CROSS BLUE CROSS WA/AK PREMERA BLUE CROSS BLUE GRASS FAMILY HEALTH (SRRIPA) BLUE LAKE RANCHERIA BLUE MEDICARE NORTH CAROLINA BLUE MEDICARE NORTH CAROLINA BLUE SHIELD OF NATIONAL CAPITOL AREA - CAREFIRST BLUE SHIELD OF WESTERN NEW YORK BLUECHOICE HEALTH PLAN of SOUTH CAROLINA BLUECHOICE SOUTH CAROLINA MEDICAID BLUECHOICE SOUTH CAROLINA MEDICAID BLUEGRASS FAMILY HEALTH BLUEGRASS FAMILY HEALTH BOILERMAKERS NATIONAL HEALTH and WELFARE BOILERMAKERS NATIONAL HEALTH and WELFARE BOLLINGER INC. BOLLINGER INC. BOON CHAPMAN ADMINISTRATORS BOON CHAPMAN ADMINISTRATORS BOON GROUP (THE) BOSTON MEDICAL CENTER HEALTH PLAN BOSTON MEDICAL CENTER HEALTH PLAN BPS, INC. BREAST AND CERVICAL CANCER CONTROL PROGRAM (BCCCP) BREAST AND CERVICAL CANCER CONTROL PROGRAM (BCCCP) BRICKSTREET MUTUAL INSURANCE BRICKSTREET MUTUAL INSURANCE BRIDFEFIELD CASUALTY INSURANCE COMPANY - P2P LINK BRIDGEFIELD CASUALTY INSURANCE COMPANY - P2P LINK BRIDGEFIELD EMPLOYERS INSURANCE COMPANY - P2P LINK BRIDGEFIELD EMPLOYERS INSURANCE COMPANY - P2P LINK BRIDGEWAY ARIZONA BRIDGEWAY NETWORK BRITCAY MEDICAL BROKERAGE CONCEPTS BROKERAGE CONCEPTS BROWN and TOLAND MEDICAL GROUP BROWN and TOLAND SUTTER SELECT BRYAN INDEPENDENT SCHOOL BUCKEYE COMMUNITY HEALTH - OHIO BUCKEYE COMMUNITY HEALTH - OHIO BUNCH & ASSOCIATES - P2P LINK BUNCH & ASSOCIATES - P2P LINK BUNCH / ARAMARK BUNCH / ARMARK BUNCH / BARNES BUNCH / BARNES BUNCH / COSTCO BUNCH / COSTCO BUNCH / FOOD LION / DELHAIZE BUNCH / FOOD LION / DELHAIZE BUNCH / GAP BUNCH / GAP BUNCH / LOWES BUNCH / LOWES BUNCH / PEOPLE 2.0 BUNCH / PEOPLE 2.0 BUNCH / SUPERVALUE BUNCH / SUPERVALUE BUTLER BENEFIT BUTLER BENEFITS C and O EMPLOYEES HOSPITAL ASSN. CAL OPTIMA DIRECT CAL OPTIMA DIRECT CALIFORNIA BLUE CROSS - FEP only CALIFORNIA BLUE SHIELD CALIFORNIA BLUE SHIELD CALIFORNIA BLUE SHIELD - HMO

INTERMEDIARY PREMERA BLUE CROSS PREMERA BLUE CROSS

WELLPOINT WELLPOINT_

HP ENTERPRISE SERVICES

CENTENE CORPORATION

PAYOR ID Agreement required 12000 No SB930 Yes SB930 Yes 15754 No No 56152 No 56152 Yes SB580 No SB801 Yes No 403 No 403 No 61124 No 61124 No 36609 No 36609 No No No 74238 No 74238 No BOONG No 13337 No 13337 No No No No 77025 Yes 12X53 Yes Yes Yes Yes Yes 68054 No 68054 No 22286 No 51037 No 51037 No 94316 No BTSS1 No SB900 No 32004 Yes 32004 No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 42150 No 42150 No 23708 No CALOP No CALOP No 94036 No 94036 No 94036 No No

REMIT Yes Yes Yes No No No Yes Yes Yes Yes No Yes Yes Yes No Yes No No No No No Yes Yes No No No No No No No No No Yes Yes No No No Yes No Yes Yes Yes No No No No No No No No No No No No No No No No No No No No No No No Yes No Yes No

Claim type Institutional Professional Professional Professional Professional Institutional Professional Professional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Institutional Professional Professional Professional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional

ST

CA CA CA

PA

FL FL

CPID 4461 2730 1473 3510 3508 7916 4188 1516 4908 5832 5837 3551 5443 2713 2858 5599 3429 3786 2987 1985 4246 4189 2989 2810 5848 3654 5834 3623 2235 4276 2289 2949 1627 6114 7459 3591 7917 4190 2449 5967 4191 2830 5809 2680 4962 3894 2835 4960 4961 3859 4870 4963 2268 4964 1727 1837 8538 8538 1837 1837 8538 3293 8538 1837 2249 2551 1682 4281 6519

PAYOR CALIFORNIA CARE CALIFORNIA CARE (HUMBOLT DEL NORTE) CALIFORNIA MEDI-CAL CALIFORNIA MEDI-CAL CALIFORNIA MEDICARE CAMBRIDGE ISG CAMERON AND ASSOCIATES CANNON COCHRAN MANAGEMENT SERVICES CANNON COCHRAN MANAGEMENT SERVICES METAIRIE, LA CANNON COCHRAN MANAGEMENT SERVICES METAIRIE, LA CAP MANAGEMENT SYSTEMS CAPE HEALTH PLAN CAPE HEALTH PLAN CAPITAL BLUE CROSS - FACILITY CONTRACTED PROVIDERS CAPITAL BLUE CROSS -PHYSICIAN CONTRACTED PROVIDERS CAPITAL BLUE CROSS of PENNSYLVANIA CAPITAL COMMUNITY HEALTH PLAN CAPITAL DISTRICT PHYSICIANS HEALTH PLAN (CDPHP) CAPITAL DISTRICT PHYSICIANS HEALTH PLAN (CDPHP) CAPITAL HEALTH PLAN CAPITAL HEALTH PLAN CAPITAL INTERNATIONAL MANAGEMENT SERVICES CAPITOL ADMINISTRATOR CAPITOL ADMINISTRATORS CAPROCK HEALTH PLANS CAPROCK HEALTH PLANS CAPSTONE HEALTH PLAN CAPSTONE HEALTH PLAN CARDINAL HEALTH ALLIANCE CARDOVASCULAR CARE PROVIDERS INC. (CVCP) CARE 1ST HEALTH PLAN OF ARIZONA CARE 1ST HEALTH PLAN OF ARIZONA CARE 1ST HEALTH PLAN of CALIFORNIA CARE 1ST HEALTH PLAN of CALIFORNIA CARE CHOICES HMO/PREFERRED CHOICES OF MICHIGAN PPO CARE CHOICES HMO/PREFERRED CHOICES OF MICHIGAN PPO CARE MANAGEMENT GROUP OF GREATER NEW YORK, INC. CARE MANAGEMENT GROUP OF GREATER NEW YORK, INC. CARE NETWORK CARE NETWORK CARE PARTNERS CARE PLUS CARE WISCONSIN HEALTH PLAN CARE WISCONSIN HEALTH PLAN CARECORE NATIONAL CARECORE NATIONAL CARECORE AETNA RADIOLOGY CARECORE AETNA RADIOLOGY CARECORE HEALTHNET CARECORE HEALTHNET CARECORE NATIONAL WELLCARE HEALTH PLAN CARECORE NATIONAL, LLC - HEALTH NET OF NEW JERSEY CARECORE NATIONAL, LLC - HEALTH NET OF NEW JERSEY CARECORE OXFORD RADIOLOGY CARECORE OXFORD RADIOLOGY CARELINK ADVANTRA - WV and OH CARELINK ADVANTRA - WV and OH CARELINK HEALTH PLAN - WV and OH CARELINK HEALTH PLAN - WV and OH CARELINK MEDICAID CARELINK MEDICAID CAREMORE IPA CARENET of VIRGINIA CARENET of VIRGINIA CAREOREGON CAREOREGON CAREPLUS HEALTH PLANS, INC. CAREPLUS HEALTH PLANS, INC. CARESOURCE OF INDIANA

INTERMEDIARY

PAYOR ID Agreement required IP059 Yes 94154 No EDS - ELECTRONIC DATA SER SKCA0 Yes 57016 Yes PALMETTO GBA 57011 Yes No No 37105 No 71057 No 71057 No 95399 No 38334 No 38334 No CAPITAL BLUE CROSS Yes 23045 Yes CAPITAL BLUE CROSS 23045 Yes 87726 No SX065 No 12X03 No 95112 No 95112 No No 68011 No 68011 No No No 86044 No 86044 No 35199 No GCVCP No 57116 No 57116 No 57115 No 57115 No 38217 No 38217 No No No 61101 No AMM02 No No 65031 No 27044 No 27044 No 14182 No 14182 No 14179 No 14179 No 14184 No 14184 No 14188 No 14185 No 14185 No 14180 No 14180 No 25133 No 25133 No 25133 No 25133 No 25133 No 25133 No CM001 No 25133 No 25133 No 93975 No 93975 No No No 37311 No

REMIT No No Yes Yes Yes No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No No No Yes Yes No No Yes No No No No No No No No No No No No No No No No Yes Yes Yes Yes Yes Yes No Yes Yes No No No No No

Claim type Professional Professional Professional Institutional Institutional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional

ST

SC

CPID 1439 2526 3826 7986 4101 2492 1984 2704 3274 2870 7596 2869 7571 7964 5195 2410 3506 4423 4470 8550 3695 5466 3789 7575 5281 9583 4193 4194 3429 3550 4500 6400 9503 3846 6459 4197 4253 2979 3472 3295 5219 2128 5957 2129 5958 6591 1744 4909 3663 2175 1660 3220 2190 1630 4239 3912 3236 2985 5207 3962 7919 3792 6536 5868 6480 4198 1845 4505 4505

PAYOR CARESOURCE OF INDIANA CARESOURCE of OHIO CARESOURCE of OHIO CARESOURCE of OREGON CARESOURCE of OREGON CAREWEST CAREWEST CAREWORKS CAREWORKS CARITEN HEALTHCARE CARITEN HEALTHCARE CARITEN SENIOR HEALTH CARITEN SENIOR HEALTH CAROLINA BEHAVORIAL HEALTH ALLIANCE CAROLINA BEHAVORIAL HEALTH ALLIANCE - CBHA CAROLINA BENEFIT ADMINISTRATORS CAROLINA CARE PLAN INC. CAROLINA CARE PLAN, INC. CAROLINA CRESCENT HEALTH PLAN CAROLINA CRESCENT HEALTH PLAN CAROLINA SUMMIT HEALTHCARE, INC. CAROLINA SUMMIT HEALTHCARE, INC. CARPENTERS HEALTH AND WELFARE OF ST LOUIS CARPENTERS HEALTH and WELFARE TRUST OF ST. LOUIS CASCADE COMPREHENSIVE CARE CASCADE COMPREHENSIVE CARE CASCADE EAST HEALTH PLAN CASCADE HEALTH PARTNERS CATERPILLAR, INC CATERPILLAR, INC CATHOLIC HEALTHCARE WEST CATHOLIC HEALTHCARE WEST CBCA ADMINISTRATORS CBCA ADMINISTRATORS CBCA ADMINISTRATORS (HRM) CBIZ BENEFITS & INSURANCE SERVICES CDS GROUP HEALTH CDS GROUP HEALTH CEDARS SINAI MEDICAL ENCOUNTER CEDARS SINAI MEDICAL NETWORK CELTIC INSURANCE CELTICARE MASSACHUSETTS CBH CELTICARE MASSACHUSETTS CBH CELTICARE MASSACHUSETTS MEDICAL CELTICARE MASSACHUSETTS MEDICAL CEMENT MASONS & PLASTERERS HLTH/WEL TRUS CEMENT MASONS & PLASTERERS HLTH/WEL TRUS CENPATICO ARIZONA CENPATICO BEHAVIORAL HEALTH - KANSAS CENPATICO BEHAVIORAL HEALTH - OHIO CENPATICO BEHAVIORAL HEALTH - OHIO CENPATICO BEHAVIORAL HEALTH - WISCONSIN CENPATICO BEHAVIORAL HEALTH FLORIDA CENPATICO BEHAVIORAL HEALTH FLORIDA CENPATICO GEORGIA CENPATICO GEORGIA CENPATICO INDIANA CENPATICO INDIANA CENPATICO KANSAS CENPATICO TEXAS CENTER CARE (FOR SAFETY & CLAIMS) CENTERCARE CENTERCARE CENTINELLA VALLEY, IPA CENTRA BENEFIT SERVICES CENTRAL & SOUTHWEST SERVICES CENTRAL BENEFITS LIFE CENTRAL BENEFITS LIFE CENTRAL BENEFITS MUTUAL

INTERMEDIARY

CENTENE CORPORATION CENTENE CORPORATION CENTENE CORPORATION CENTENE CORPORATION

PAYOR ID Agreement required 37311 No 31114 No 31114 No No No DAKOTACARE No DAKOTACARE No 31147 No 10010 No 62073 No 62073 No 62072 No 62072 No No 56215 No SB880 No 29076 No 29076 No SX191 Yes 12K85 No 56195 No 56195 No 25125 No 25125 No No No No No 87726 No 87726 No 60054 No 60054 No 55438 No 55438 No 41170 No No 88022 No 88022 No 95167 No 95166 No 68063 No Yes Yes Yes Yes 91136 No 91136 No 68048 No 68047 No 68051 No 68051 No 68046 No 68058 No 68058 No 68050 Yes 68050 No 68052 No 68052 No 68047 No 68053 No No 11315 No 11315 No MPM03 No 75196 No No 31118 No 31118 No 31118 No

REMIT No Yes Yes No No No Yes No No Yes Yes Yes Yes No No Yes Yes Yes No No No No No No Yes Yes No No Yes Yes Yes Yes No No No No No No No No No No No No No No No No No No No No No No No No No No No No No Yes Yes No No No Yes Yes Yes

Claim type Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Professional Professional Professional Institutional Professional Professional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Professional Professional Professional Institutional Institutional

ST

CPID 1845 4505 1845 2997 2149 2149 6489 4506 6993 4111 4507 6492 1782 9515 3898 6405 4509 7525 5477 3807 1503 8517 4120 2496 2231 1706 4559 6465 4593 3713 8979 4245 3999 4163 1973 1854 1503 3807 2151 5967 3473 2135 4199 3265 8929 4283 5454 3288 3684 8928 2177 5984 6420 4528 8927 3282 6405 3653 5858 4509 1841 5943 3200 6405 4509 6405 4509 6405 6405

PAYOR CENTRAL BENEFITS MUTUAL CENTRAL BENEFITS NATIONAL CENTRAL BENEFITS NATIONAL CENTRAL CALIFORNIA ALLIANCE for HEALTH CENTRAL CALIFORNIA ALLIANCE for HEALTH CENTRAL COAST ALLIANCE for HEALTH CENTRAL RESERVE LIFE CENTRAL RESERVE LIFE OH CENTRAL SENIOR CARE CENTRAL SENIOR CARE CENTRAL STATES HEALTH & WELFARE FUNDS CENTRAL STATES HEALTH & WELFARE FUNDS CENTRAL VALLEY MEDICAL GROUP CENTURY HEALTH SOLUTIONS CENTURY HEALTH SOLUTIONS CGLIC, MILWAUKEE CGLIC, MILWAUKEE CHA HEALTH CHA-COMMONWEALTH HEALTH ALLIANCE CHAMPVA - HAC CHAMPVA - HAC CHARLOTTE COUNTY - P2P LINK CHARLOTTE COUNTY - P2P LINK CHATWINS HEALTHCARE ADMINISTRATORS CHAUTAUQUA COUNTY HEALTHCARE PLAN - MAYVILLE, NY CHEC - A SUBSIDIARY of SPRINT CHEC - A SUBSIDIARY of SPRINT CHESAPEAKE LIFE INSURANCE CO-STUDENT INSURANCE CHESAPEAKE LIFE INSURANCE CO-STUDENT INSURANCE CHESAPEAKE LIFE INSURANCE COMPANY CHESAPEAKE LIFE INSURANCE COMPANY CHESTERFIELD COMPANIES (THE) CHESTERFIELD RESOURCES, INC. CHICAGO LABORERS HEALTH & WELFARE FUND CHILDHEALTH PLUS by HEALTHFIRST (CHP) CHILDHEALTH PLUS by HEALTHFIRST (CHP) CHILDREN OF WOMEN VIETNAM VETERANS - VA HAC CHILDREN OF WOMEN VIETNAM VETERANS - VA HAC CHILDRENS MEDICAL GROUP CHILDRENS TREATMENT UNIT (CTU) CHINESE COMMUNITY HEALTH PLAN CHIROCARE CHIROPRACTIC ASSOCIATION OF SOUTH DAKOTA CHOC - CHILDRENS HOSPITAL of ORANGE COUNTY HEATLH CHOICE CARE (HUMANA HEALTH PLANS of OHIO CHOICE MEDICAL GROUP CHOICE ONE/UTMB CHIP HEALTH PLAN CHOICENET CHOICENET CHOICEONE UTMB CHIP CHP DIRECT/SUPERMED CHP DIRECT/SUPERMED CHRISTIAN BROTHERS SERVICES CHRISTIAN BROTHERS SERVICES CHRISTUS SPOHN CHRISTUS SPOHN CIGNA (CONNECTICUT GENERAL) CIGNA - NON-HAP MEMBERS ONLY - JVHL CIGNA - NON-HAP MEMBERS ONLY - JVHL CIGNA - PPO CIGNA BEHAVIORAL HEALTH CIGNA BEHAVIORAL HEALTH CIGNA ENCOUNTERS CIGNA HEALTH PLAN - ATLANTA CIGNA HEALTH PLAN - CALIFORNIA CIGNA HEALTH PLAN - CALIFORNIA CIGNA HEALTH PLAN - CHARLOTTE CIGNA HEALTH PLAN - CHARLOTTE CIGNA HEALTH PLAN - CHICAGO

INTERMEDIARY

DIVERSIFIED DATA DESIGN

DIVERSIFIED DATA DESIGN

PAYOR ID Agreement required 31118 No 31118 No 31118 No 12K82 Yes Yes Yes 34097 No 34097 No No No 36215 No 36215 No E3510 No 48120 No 48120 No 62308 No 62308 No 23171 No 23171 No 84146 No 84146 No Yes Yes CHAT1 No 16600 No 75261 No 75261 No 74227 No 74227 No 59223 No 59223 No 34154 No 34154 No No 80141 No 80141 No 84146 No 84146 No 94321 No AMM02 No 94302 No ACN01 No No 33065 No No No 76049 No CHCNT No CHCNT No No 90441 No 90441 No 61271 No 61271 No No TH100 No 62308 No Yes Yes 62308 No SX071 No SX071 No Yes 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No

REMIT Yes Yes Yes No No No Yes Yes No No No No No No No Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No Yes Yes Yes Yes No No No No No No No No No No No No No No Yes Yes No No Yes No No Yes Yes Yes No Yes Yes Yes Yes Yes Yes

Claim type Professional Institutional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Professional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional

ST

CPID 4509 4509 6405 6405 4509 6405 6405 4509 4509 6405 6405 4509 6405 4509 6405 4509 4509 6405 4509 6405 4509 6405 4509 6405 6405 4509 4509 6405 4509 6405 6405 4509 4509 6405 6405 4509 4509 4509 6405 6405 6405 4509 6405 4509 6405 4509 6405 4509 4509 6405 6405 4509 6405 4509 4509 6405 6405 4509 6405 4509 4509 6405 6405 4509 6405 4509 4509 6405 4509

PAYOR CIGNA HEALTH PLAN - CHICAGO CIGNA HEALTH PLAN - CIGNA PREMIER PLUS CIGNA HEALTH PLAN - CIGNA PREMIER PLUS CIGNA HEALTH PLAN - CINCINNATI CIGNA HEALTH PLAN - CLEVELAND CIGNA HEALTH PLAN - CLEVELAND CIGNA HEALTH PLAN - COLUMBUS CIGNA HEALTH PLAN - COLUMBUS CIGNA HEALTH PLAN - COMED CIGNA HEALTH PLAN - COMED CIGNA HEALTH PLAN - CONNECTICUT CIGNA HEALTH PLAN - CONNECTICUT CIGNA HEALTH PLAN - DALLAS CIGNA HEALTH PLAN - DALLAS CIGNA HEALTH PLAN - DAYTON CIGNA HEALTH PLAN - DAYTON CIGNA HEALTH PLAN - DELAWARE CIGNA HEALTH PLAN - DELAWARE CIGNA HEALTH PLAN - DENVER CIGNA HEALTH PLAN - DENVER CIGNA HEALTH PLAN - GEORGIA CIGNA HEALTH PLAN - GEORGIA CIGNA HEALTH PLAN - HMO CIGNA HEALTH PLAN - HMO (CHP) CIGNA HEALTH PLAN - HOUSTON CIGNA HEALTH PLAN - HOUSTON CIGNA HEALTH PLAN - KANSAS CITY CIGNA HEALTH PLAN - KANSAS CITY CIGNA HEALTH PLAN - KNOXVILLE PPO CIGNA HEALTH PLAN - KNOXVILLE PPO CIGNA HEALTH PLAN - LOS ANGELES CIGNA HEALTH PLAN - LOS ANGELES CIGNA HEALTH PLAN - LOUISIANA CIGNA HEALTH PLAN - LOUISIANA CIGNA HEALTH PLAN - MASSACHUSETTS CIGNA HEALTH PLAN - MASSACHUSETTS CIGNA HEALTH PLAN - MED ATLANTIC CIGNA HEALTH PLAN - MEMPHIS CIGNA HEALTH PLAN - MEMPHIS CIGNA HEALTH PLAN - MID ATLANTIC CIGNA HEALTH PLAN - NASHVILLE CIGNA HEALTH PLAN - NASHVILLE CIGNA HEALTH PLAN - NEW YORK CIGNA HEALTH PLAN - NEW YORK CIGNA HEALTH PLAN - NORTHERN CALIFORNIA CIGNA HEALTH PLAN - NORTHERN CALIFORNIA CIGNA HEALTH PLAN - NORTHERN LOUISIANA CIGNA HEALTH PLAN - NORTHERN LOUISIANA CIGNA HEALTH PLAN - NORTHERN NEW JERSEY CIGNA HEALTH PLAN - NORTHERN NEW JERSEY CIGNA HEALTH PLAN - OKLAHOMA CIGNA HEALTH PLAN - OKLAHOMA CIGNA HEALTH PLAN - ORLANDO CIGNA HEALTH PLAN - ORLANDO CIGNA HEALTH PLAN - PENNSYLVANIA CIGNA HEALTH PLAN - PENNSYLVANIA CIGNA HEALTH PLAN - PHOENIX CIGNA HEALTH PLAN - PHOENIX CIGNA HEALTH PLAN - RALEIGH CIGNA HEALTH PLAN - RALEIGH CIGNA HEALTH PLAN - RICHMOND CIGNA HEALTH PLAN - RICHMOND CIGNA HEALTH PLAN - SALINAS CIGNA HEALTH PLAN - SALINAS CIGNA HEALTH PLAN - SALT LAKE CITY CIGNA HEALTH PLAN - SALT LAKE CITY CIGNA HEALTH PLAN - SAN DIEGO CIGNA HEALTH PLAN - SAN DIEGO CIGNA HEALTH PLAN - SAN FRANCISCO

INTERMEDIARY

PAYOR ID Agreement required 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No

REMIT Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Claim type Institutional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Institutional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional

ST

AZ

AZ

WI WI

PA

CO CO CO CO CO CO

CPID 6405 4509 6405 4509 6405 4509 6405 6405 4509 4509 6405 4509 6405 6405 4509 4509 6405 6405 4509 4509 6405 2595 5436 6405 5436 2595 5436 5436 2595 6405 6408 4516 4741 7921 4773 8926 8517 4120 3245 8517 4120 2435 1900 2279 4120 8517 1401 5511 4975 1725 2718 6105 4149 5290 1623 4882 5708 9579 8999 5811 2431 1549 1415 7416 1496 1548 1547 1449 1787

PAYOR CIGNA HEALTH PLAN - SAN FRANCISCO CIGNA HEALTH PLAN - SOUTHERN CALIFORNIA CIGNA HEALTH PLAN - SOUTHERN CALIFORNIA CIGNA HEALTH PLAN - SOUTHERN FLORIDA CIGNA HEALTH PLAN - SOUTHERN FLORIDA CIGNA HEALTH PLAN - SOUTHERN NEW JERSEY CIGNA HEALTH PLAN - SOUTHERN NEW JERSEY CIGNA HEALTH PLAN - ST LOUIS CIGNA HEALTH PLAN - ST. LOUIS CIGNA HEALTH PLAN - TAMPA CIGNA HEALTH PLAN - TAMPA CIGNA HEALTH PLAN - TUCSON CIGNA HEALTH PLAN - TUCSON CIGNA HEALTH PLAN - TULSA CIGNA HEALTH PLAN - TULSA CIGNA HEALTH PLAN - WASHINGTON CIGNA HEALTH PLAN - WASHINGTON CIGNA HEALTH PLAN - WICHITA CIGNA HEALTH PLAN - WICHITA CIGNA HEALTH PLANS CIGNA HEALTH PLANS CIGNA HEALTHCARE for SENIORS CIGNA HEALTHCARE for SENIORS CIGNA INTERNATIONAL EXPATRIATE BENEFITS CIGNA MEDICARE ACCESS (PFFS) CIGNA MEDICARE ACCESS(PFFS) CIGNA MEDICARE ARIZONA CIGNA MEDICARE SELECT HMO CIGNA MEDICARE SELECT HMO CIGNA PPO CIGNA SELECT (formerly GREAT WEST HEALTHCARE) CIGNA SELECT (formerly GREAT WEST HEALTHCARE) CINCINNATI FINANCIAL CORPORATION CINCINNATI FINANCIAL CORPORATION CITRUS HEALTH CITRUS HEALTH CITY OF NORTH MIAMI BEACH - P2P LINK CITY OF NORTH MIAMI BEACH - P2P LINK CITY OF ODESSA (THE) CITY OF PLANT CITY - P2P LINK CITY OF PLANT CITY - P2P LINK CITY of SAN ANTONIO CL FRATES CL FRATES CLAIMS CENTER - P2P LINK CLAIMS CENTER - P2P LINK CLAIMS MANAGEMENT SERVICES, INC. CLAIMS MANAGEMENT SERVICES, INC. CLAIMS WARE, INC. CLAIMSWARE, INC. dba MANAGEMED CLARITY VISION CLINICAL RESOURCE GROUP CNA INSURANCE CO-ORDINATED BENEFIT PLAN, LLC CO-ORDINATED BENEFIT PLAN, LLC COASTAL ADMINISTRATIVE SERVICES COLONIAL HEALTHCARE COLONIAL HEALTHCARE COLONIAL MEDICAL COLONIAL MEDICAL COLORADO ACCESS COLORADO BLUE CROSS COLORADO BLUE SHIELD COLORADO HMO COLORADO MEDICAID COLORADO MEDICAID COLORADO MEDICARE COLORADO MEDICARE COLUMBIA CORNELL CARE, LLC

INTERMEDIARY

PAYOR ID Agreement required 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 86033 No 86033 No 62308 No 86033 No 86033 No 86033 No 86033 No 86033 No 62308 No 80705 No 80705 No 46871 No 46871 No 10207 No No Yes Yes 75600 No Yes Yes TTCEC No 73071 No 73071 No Yes Yes WELLPOINT_ SB950 No WELLPOINT_ 12B29 No 57080 No 57080 No HIGHMARK, INC. Yes No Yes No No 77052 No 37123 No 37123 No 22284 No 22284 No 84129 No WELLPOINT 12B03 Yes ROCKY MTN HEALTH CARE SB550 Yes WELLPOINT Yes HP ENTERPRISE SERVICES SKCO0 Yes HP ENTERPRISE SERVICES 12K03 Yes TRAILBLAZER HLTHENT-GPNET12M03 Yes TRAILBLAZER HLTHENT-GPNETSMCO0 Yes 25351 No

REMIT Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes No No No No No Yes Yes Yes No No No No No No No No No No No No No No Yes Yes No No No No No No No No No No No No No Yes Yes No Yes Yes Yes Yes No

Claim type Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Professional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Professional Institutional Institutional Professional Professional

ST

MA

WI WI

MA

CT CT CT CT CT CT CT CT CT

CPID 3772 1974 3759 2955 7559 3700 3437 1604 5221 8565 5844 1969 4248 1969 4248 1874 8560 2232 3938 3957 5431 1926 2497 3809 8925 1910 3820 3119 2538 3773 4559 1706 7519 2841 3445 1927 4883 4590 5402 3753 7595 5970 7453 2243 7453 5970 4884 3221 2704 2704 2952 3462 7540 7540 3737 6440 6500 4471 4969 3534 1420 1922 2427 3419 4509 4476 3535 1452 3533

PAYOR COLUMBIA UNITED PROVIDERS COLUMBIA UNITED PROVIDERS COMMERCE BENEFITS GROUP COMMERCE BENEFITS GROUP COMMONWEALTH ADMINISTRATOR, LLC COMMONWEALTH ADMINISTRATORS, INC. COMMONWEALTH CARE ALLIANCE COMMONWEALTH CARE ALLIANCE COMMONWEALTH INDUSTRIES - P2P LINK COMMONWEALTH INDUSTRIES - P2P LINK COMMUNITY CARE ASSOCIATES COMMUNITY CARE BEHAVIORAL HEALTH ORGANIZATION COMMUNITY CARE BEHAVIORAL HEALTH ORGANIZATION COMMUNITY CARE BHO COMMUNITY CARE BHO COMMUNITY CARE MANAGED. HEALTHCARE PLANS OF OK COMMUNITY CARE MGD HEALTHCARE PLANS OF OK COMMUNITY CARE ORGANIZATION COMMUNITY CARE ORGANIZATOIN COMMUNITY CHOICE HEALTH PLAN COMMUNITY CHOICE OF MICHIGAN COMMUNITY CHOICE of MICHIGAN COMMUNITY FAMILY CARE COMMUNITY FIRST COMMUNITY FIRST COMMUNITY HEALTH ALLIANCE COMMUNITY HEALTH ALLIANCE COMMUNITY HEALTH CENTER NETWORK COMMUNITY HEALTH CHOICE COMMUNITY HEALTH CHOICE COMMUNITY HEALTH ELECTRONIC CLAIMS -CHEC COMMUNITY HEALTH ELECTRONIC CLAIMS -CHEC COMMUNITY HEALTH NETWORK OF CONNECTICUT COMMUNITY HEALTH NETWORK of CONNECTICUT COMMUNITY HEALTH PLAN OF WA (CHPWA) COMMUNITY HEALTH PLAN OF WASHINGTON COMMUNITY MEDICAL GROUP OF THE WEST VALLEY COMMUNITY PREFERRED HEALTH PLAN COMMUNITY PREFERRED HEALTH PLAN COMMUNITY PREMIER PLUS FOR NEIGHBORHOOD HLTH PROV COMMUNITY PREMIER PLUS for NEIGHBORHOOD HLTH PROV COMMUNITYCONNECT HEALTHPLAN COMMUNITYCONNECT HEALTHPLAN COMPBENEFITS CORPORATION COMPCARE (WISCONSIN BADGERCARE ONLY) COMPCARE (WISCONSIN BADGERCARE ONLY) COMPFIRST, LLC COMPLIMENTARY HEALTH CARE COMPMANAGEMENT HEALTH SYSTEMS, INC. COMPONE COMPREHEN BEHAVIORAL COMPREHENSIVE BEHAVORIAL CARE COMPREHENSIVE BENEFITS ADMINISTRATORS, INC. COMPREHENSIVE BENFITS ADMINISTRATOR, IN COMPREHENSIVE BENFITS ADMINISTRATORS, IN CONNECTICARE CONNECTICARE CONNECTICARE MEDICARE CONNECTICARE MEDICARE CONNECTICUT BLUE CROSS CONNECTICUT BLUE SHIELD CONNECTICUT BLUECARE FAM PLAN (MEDICAID) CONNECTICUT BLUECARE FAM PLAN (MEDICAID) CONNECTICUT FEDERAL EMP HLTH BENEFITS CONNECTICUT GENERAL (CIGNA) CONNECTICUT MEDICAID CONNECTICUT MEDICAID - INPATIENT/OUTPATIENT CONNECTICUT MEDICARE CONNECTICUT MEDICARE

INTERMEDIARY

PAYOR ID Agreement required 91162 No 91162 No 34181 No 34181 No 37237 No 37237 No 14315 No 14315 No Yes Yes No 95216 No 95216 No 95216 No 95216 No 73143 No 73143 No 39126 No 39126 No 61948 No 38325 No 38325 No SYMED No TH005 No No 35193 No 35193 No No 48145 No 48145 No 75261 No 75261 No 62149 No 62149 No No 12T30 No No 39026 No 39026 No 32481 No 32481 No 95192 No 95192 No 37297 No 95192 No 95192 No No 93101 No 31147 No 31147 No 59314 No 59314 No 3036 No 3036 No 3036 No 6105 No 6105 No 78375 No 78375 No WELLPOINT 12B04 No WELLPOINT SB560 No WELLPOINT SB562 No WELLPOINT SB562 No SB563 No 62308 No EDS - ELECTRONIC DATA SER SKCT0 Yes EDS - ELECTRONIC DATA SER 12K79 Yes NATIONAL GOVERNMENT SERV. SMCT0 Yes NATIONAL GOVERNMENT SERV. 12M04 Yes

REMIT Yes Yes No No No No No No No No No Yes Yes Yes Yes No No No No No No No No No No No No No Yes Yes No No Yes Yes Yes No No Yes Yes No No No Yes No Yes No No No No No No No No No No Yes Yes No No Yes Yes No No No Yes Yes Yes Yes Yes

Claim type Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Professional Institutional Professional Professional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional

ST CT

SC

MO

CPID 3420 8575 3742 7557 2233 2410 2670 5803 3865 1535 5236 8575 4885 1957 1608 4751 8924 9580 4752 4460 3995 4532 6452 2911 2235 1892 3856 3923 4611 6107 4771 3806 1983 3791 2587 4947 3254 2587 3791 3983 4941 4412 3832 3939 5862 3658 1603 2831 4886 3961 2704 2587 3791 1711 7503 1606 5285 3828 1837 8538 1837 8538 8538 1837 1837 1837 8538 8538 1837

PAYOR CONNECTICUT MEDICARE BLUE(MEDICARE RISK) CONSECO MEDICAL CONSOCIATE GROUP CONSOCIATE GROUP CONSOLIDATED ASSOCIATES RAILROAD CONSOLIDATED BENEFITS INC. CONSOLIDATED HEALTH PLANS CONSOLIDATED HEALTH PLANS CONTINENTAL GENERAL INSURANCE CONTINENTAL KEY FAMILY CONTINENTAL KEY FAMILY CONTINENTAL LIFE & ACCIDENT CO. CONTINUUM ABC MSO CONTNENTAL GENERAL INSURANCE CONTRACTORS LABORERS TEAMSTERS and ENGINEERS COOK CHILDRENS HEALTH PLAN COOK CHILDRENS HEALTH PLAN COOK CHILDRENS STAR PLAN COOK CHILDRENS STAR PLAN COOK GROUP HEALTH PLAN COOK GROUP HEALTH PLAN COOPERATIVE BENEFIT ADMINISTRATORS (CBA) COOPERATIVE BENEFIT ADMINISTRATORS (CBA) COOPERATIVE MANAGED CARE SERIVCES COOPERATIVE MANAGED CARE SERVICES COORDINATED MEDICAL SPECIALISTS CORE ADMINISTRATIVE SERVICES CORE MGMT RESORCE GROUP CORESOURCE - ECHO CORESOURCE - ECHO CORESOURCE IOWA CORESOURCE LITTLE ROCK CORESOURCE LITTLE ROCK CORESOURCE OF NC CORESOURCE OF NC CORESOURCE OH CORESOURCE OHIO CORESOURCE PA MD IL CORESOURCE PA MD IL CORESOURCE-INTERNAL CORNERSTONE BENEFIT ASSOCIATES CORNERSTONE BENEFIT ASSOCIATES CORPORATE BENEFITS SERVICES CORPORATE BENEFITS SERVICES, INC. CORRECTCARE INTEGRATED HEALTH CORRECTCARE INTEGRATED HEALTH CORRECTIONAL MEDICAL SERVICES CORRECTIONAL MEDICAL SERVICES, INC. CORSOLUTIONS CORSOLUTIONS CORVEL IN REGARDS TO OH BWC CLAIMS ONLY COTTAGE HEALTH SYSTEM COTTAGE HEALTH SYSTEM COUNTRY LIFE INSURANCE COMPANY COUNTRY LIFE INSURANCE COMPANY COUNTY HEALTH PLANS COUNTY HEALTH PLANS COVENANT ADMINISTATORS, INC. (ATLANTA, GA) COVENTRY DIAMOND PLAN COVENTRY DIAMOND PLAN COVENTRY HEALTH & LIFE (OKLAHOMA) COVENTRY HEALTH & LIFE (OKLAHOMA) COVENTRY HEALTH CARE COVENTRY HEALTH CARE COVENTRY HEALTH CARE COVENTRY HEALTH CARE NATIONAL NETWORK COVENTRY HEALTH CARE NATIONAL NETWORK COVENTRY HEALTH CARE OF DELAWARE, INC. COVENTRY HEALTH CARE OF DELAWARE, INC.

INTERMEDIARY

PAYOR ID

37135 37135 75284 SB880 87843 87843 71404 35315 35315

71404 CCHP1 11345 CCHP9 CCHP9 35149 35149 52132 52132 35199 35199 58204 58231 58231

35187 75136 75136 35182 35182 35183 35183 35182 35182 35187 35202 35202 56116 56116

43160 43160 75235 31147 35182 35182 62553 62553 63719 63719 58102 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133 25133

Agreement required No Yes No No No No No No No No No Yes No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No

REMIT Yes No No No No Yes No No Yes No No No No Yes No No No No No No No Yes Yes No No No No No Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No Yes Yes No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Claim type Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Professional Institutional Institutional N/A Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Institutional Professional

ST

KY KY

DE DE

DE DE DE DE

CPID 8538 1837 1837 8538 1837 8538 8538 1837 1837 8538 8538 1837 1837 8538 2482 7534 5474 8997 4516 6408 3963 3244 6145 4626 8431 3643 5967 3622 2882 2103 5936 1725 2492 1984 4956 3994 2794 2543 3659 3581 1497 6535 3797 1546 7456 7924 4887 1545 2726 5912 2456 9501 3804 7925 4888 3931 2486 4889 3936 2943 4285 2433 7993 5208 7994 5209 4754 3932 2434

PAYOR COVENTRY HEALTH CARE OF GEORGIA, INC. COVENTRY HEALTH CARE OF GEORGIA, INC. COVENTRY HEALTH CARE OF IOWA, INC. COVENTRY HEALTH CARE OF IOWA, INC. COVENTRY HEALTH CARE OF LOUISIANA, INC COVENTRY HEALTH CARE OF LOUISIANA, INC. COVENTRY HEALTH CARE OF NEBRASKA, INC. COVENTRY HEALTH CARE OF NEBRASKA, INC. COVENTRY HEALTH CARE SOUTHERN HEALTH SYSTEMS, INC. COVENTRY HEALTH CARE SOUTHERN HEALTH SYSTEMS, INC. COVENTRY HEALTH CARE of the CAROLINAS COVENTRY HEALTH CARE of the CAROLINAS COVENTRYCARES OF KENTUCKY COVENTRYCARES OF KENTUCKY COX HEALTH PLAN CREATIVE MEDICAL SYSTEMS CREATIVE MEDICAL SYSTEMS CREATIVE PLAN ADMINISTRATORS CROWN LIFE CROWN LIFE CROY-HALL MANAGEMENT INC aka SOUTHEST SERVICE CROY-HALL MANAGEMENT INC. CSI NETWORK SERVICES CSI NETWORK SERVICES CULINARY HEALTH FUND CUSTODIAL MEDICAL SERVICES CUSTODY MEDICAL SERVICES (CMS) CUSTOM BENEFIT ADMINISTRATION CUSTOM BENEFIT ADMINISTRATORS CUSTOM DESIGN BENEFITS, INC. CUSTOM DESIGN BENEFITS, INC. CWIBENEFITS, INC. DAKOTACARE DAKOTACARE DART CONTAINER CORP DAVITA VILLIAGE HEALTH DC CHARTERED HEALTH PLAN INC. MEDICAID and ALLIANC DC CHARTERED HEALTH PLAN, INC. (MEDICAID / ALLIANC DC HEALTHCARE ALLIANCE DEAN HEALTH PLAN DEAN HEALTH PLANS DEFINITY HEALTH DEFINITY SERVICES DELAWARE BLUE CROSS DELAWARE BLUE SHIELD DELAWARE HEALTH PLAN CONSORTIUM DELAWARE HEALTH PLAN CONSORTIUM DELAWARE MEDICAID DELAWARE MEDICAID DELAWARE MEDICARE DELAWARE MEDICARE DELAWARE PHYSICIANS CARE, INC. DELAWARE PHYSICIANS CARE, INC. DELAWARECARE (CHC OF DELAWARE MEDICAID) DELAWARECARE, INC. DELTA HEALTH SYSTEMS DELTA HEALTH SYSTEMS DENVER HEALTH - INDIGENT DENVER HEALTH MED PLAN DENVER HEALTH MEDICAID CHOICE DENVER HEALTH MEDICAL PLAN DENVER HEALTH and HOSPITAL AUTHORITY DEPARTMENT OF ENERGY DEPARTMENT OF ENERGY DEPARTMENT OF LABOR BLACK LUNG DEPARTMENT OF LABOR BLACK LUNG DEPARTMENT of LABOR OFFICE of WORKER'S COMP DEPARTMENT of LABOR OFFICE of WORKER'S COMP DERMATOLOGY NETWORK SOLUTIONS - HEALTH OPTIONS

INTERMEDIARY

PAYOR ID Agreement required 25133 No 25133 No 25133 No 25133 No 25133 No 25133 No 25133 No 25133 No 25133 No 25133 No 25133 No 25133 No 25133 No 25133 No 19 No 64068 No 64068 No 37320 No 80705 No 80705 No 37266 No 37266 No No No 59140 No AMM03 No AMM02 No 39081 No 39081 No 82056 No 82056 No 57080 No DAKOTACARE No DAKOTACARE No 6172 No 33066 No 95748 Yes 95748 Yes 95740 No 39113 Yes 39113 Yes 64159 No 64159 No HIGHMARK, INC. SB570 Yes HIGHMARK, INC. SB570 Yes No No EDS - ELECTRONIC DATA SER Yes EDS - ELECTRONIC DATA SER SKDE0 Yes HIGHMARK MEDICARE SERVICE 12101 Yes HIGHMARK MEDICARE SERVICE SMDE0 Yes AETNA 27009 No AETNA 27009 No No No 94235 No 94235 No 84134 No 84135 No 84133 No 84135 No 84133 No Yes Yes Yes Yes Yes 12X31 Yes DNS22 No

REMIT Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No Yes Yes No No No No No No No No No No No No No Yes No No No No No Yes Yes No No Yes Yes No No No Yes Yes Yes No Yes No No No No No No No No No No No No No Yes Yes No

Claim type Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Institutional Professional Institutional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional

ST

DC DC

CPID 2797 2796 4728 8995 3284 3284 3285 2406 2913 6143 2180 3881 4902 4425 5550 1976 4738 3934 6481 9581 4790 4985 2442 2497 7975 4152 3234 3925 4890 2293 1914 4534 8430 3477 1809 4590 5402 4590 5402 4414 3951 7482 4566 4892 4778 5917 4410 5831 4566 7482 4544 8923 4289 5869 3839 1978 3839 1999 1853 4891 4911 1498 4734 8451 6503 7926 4893 5967 4544

PAYOR DERMATOLOGY NETWORK SOLUTIONS, LLC BCBS DERMATOLOGY NETWORK SOLUTIONS, LLC HUMANA DESERET MUTUAL BENEFIT ASSOCIATES (DMBA) DESERET MUTUAL BENEFIT ASSOCIATES (DMBA) DESERT FAMILY PRACTICE ASSOCIATION DESERT HOSPITAL DESERT MEDICAL GROUP DETROIT MEDICAL CENTER DETROIT MEDICAL CTR DH EVANS and ASSOCIATES DIATRI, LLC DIRECTORS GUILD OF AMERICA DIRECTORS GUILD OF AMERICA DISTRICT OF COLUMBIA MEDICAID DISTRICT OF COLUMBIA MEDICAID DIVERSIFIED GROUP ADMINISTRATORS DIVERSIFIED GROUP ADMINISTRATORS DIVERSIFIED GROUP BKG DIVERSIFIED GROUP BROKERAGE DIVISION OF IMMIGRATION HEALTH DIVISION of IMMIGRATOIN HEALTH SERVICES (DIHS) DMC CARE - JVHL DMC CARE - JVHL DOCTORS HOSPITAL OF MONTCLAIR (SAN BERNADINO) DONLEY & COMPANY DOWNEY SELECT IPA (APPLECARE MEDICAL MANAGEMENT) DRISCOLL CHILDRENS HEALTH PLAN DRISCOLL CHILDRENS HEALTH PLAN DSCC - DIVISION OF SPECIALIZED CARE FOR CHILDREN DUNN and ASSOCIATES DUNN and ASSOCIATES E-V BENEFITS MANAGEMENT, INC. (COLUMBUS, OH) E-V BENEFITS MANAGEMENT, INC. (COLUMBUS, OH) EARLY INTERVENTION CENTRAL BILLING EAST BAY MEDICAL NETWORK EAU CLAIRE HEALTH PROTECTION PLAN EAU CLAIRE HEALTH PROTECTION PLAN EAU CLAIRE PROVIDERS CHOICE EAU CLAIRE PROVIDERS CHOICE EBC INC EBC INC ECOH ECOH ECOMPPO EDS HEALTHCHOICE OF OK EDS HEALTHCHOICE OF OK EDUCATORS MUTUAL INSURANCE ASSOCIATION EDUCATORS MUTUAL MEDICARE ADVANTAGE EHC EHC EHI EL PASO FIRST CHIP EL PASO FIRST CHIP EL PROYECTO DEL BARRIO IPA ELDER HEALTH HMO OF PENNSYLVANIA ELDER HEALTH HMO of MD and PA - BRAVO HEALTH ELDER HEALTH MARYLAND HMO, INC. ELDERPLAN, INC. ELDERPLAN, INC. ELECTRONIC TRANSMISSION CORPORATION ELMCO ELMCO ELMHURST MEMORIAL EMERALD HEALTH NETWORK, INC. (ALL PPO BUSINESS) EMERALD HEALTH NETWORK, INC. (ALL PPO BUSINESS) EMERALD HMO (HMO CLAIMS ONLY) EMERALD HMO (HMO CLAIMS ONLY) EMERGENCY MEDICAL SERVICES FUND (EMSF) EMPHESYS

INTERMEDIARY

UHIN

HP ENTERPRISE SERVICES

UHIN

PAYOR ID Agreement required DNS22 No DNS77 No SX105 Yes 12X35 Yes PPM01 No PPM01 No DESRT No 56240 No 56240 No No 36439 No 23706 No 23706 No SKDC0 Yes 12001 Yes 25160 No 25160 No 6102 No 6102 No No No Yes Yes SYMED No No No 74284 No 74284 No No 35186 No 35186 No 34159 No 34159 No TH084 No 94318 No 39026 No 39026 No 39026 No 39026 No 37257 No 37257 No 79480 No 79480 No No 22521 No 22521 No SX110 No No 79480 No 79480 No 61101 No TH090 No TH090 No MPM04 No 52192 No 52192 No 52192 No 31625 No 31625 No No 37253 No 37253 No NAELM No 34167 No 34167 No No No AMM02 No 61101 No

REMIT No No No Yes No No No No No No No No No Yes Yes No No No No No No Yes Yes No No No No No No No No No No No No Yes Yes Yes Yes No No Yes Yes No No No Yes No Yes Yes Yes No No No Yes Yes Yes Yes Yes No No No No No No No No No Yes

Claim type Professional Professional Professional Institutional Professional Professional Professional Professional Institutional Professional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Institutional

ST

SC

SC

SC SC

CPID 4168 2146 5205 3705 7561 4449 2915 2986 3207 2947 5483 7540 2410 4796 7528 2836 2410 1934 3222 3672 5877 1790 8512 3737 4894 8548 1834 4895 3268 1628 3996 8994 4277 4948 4436 2218 3241 4544 5402 4590 2410 2410 3884 1716 2825 2594 2825 2594 8481 1744 6591 5827 4906 4447 4509 4509 6405 6405 6405 6505 4509 3911 3217 3405 4953 4120 8517 8993 2274

PAYOR EMPIRE MEDICAL GROUP EMPIRE PHYSICIANS MEDICAL GROUP EMPLOYEE BENEFIT ADMINISTRATORS MANAGEMENT EMPLOYEE BENEFIT CONCEPTS (FARMINGTON HILLS, MI) EMPLOYEE BENEFIT CONCEPTS (FARMINGTON HILLS, MI) EMPLOYEE BENEFIT CONSULTANTS (EBC) EMPLOYEE BENEFIT CONSULTANTS (EBC) EMPLOYEE BENEFIT MANAGEMENT CORP (EBMC) EMPLOYEE BENEFIT MANAGEMENT CORPORATION (EBMC) EMPLOYEE BENEFIT MANAGEMENT SERV (EBMS) HEALTHEWEB EMPLOYEE BENEFIT MANAGEMENT SERV (EBMS) HEALTHEWEB EMPLOYEE BENEFIT PLAN ADMIN, INC. (E.B.P.A.) EMPLOYEE BENEFIT SERVICES EMPLOYEE BENEFIT SERVICES (EBS) of SAN ANTONIO EMPLOYEE BENEFIT SERVICES - FT MILL, SC EMPLOYEE BENEFIT SERVICES - FT MILL, SC EMPLOYEE BENEFIT SERVICES DBA KEY BENEFIT ADMIN EMPLOYEE BENEFIT SERVICES OF LOUISIANA, INC. (EBS) EMPLOYEE BENEFIT SERVICES of LOUISIANA, INC. (EBS) EMPLOYEE BENEFIT SYSTEMS EMPLOYEE BENEFIT SYSTEMS EMPLOYEE BENEFITS CORPORATION EMPLOYEE BENEFITS CORPORATION EMPLOYEE BENEFITS PLAN ADMIN, INC. (E.B.P.A.) EMPLOYEE CLAIM ADJUDICATION SERVICES EMPLOYEE PLANS, LLC EMPLOYEE PLANS, LLC EMPLOYEE SECURITY, INC. EMPLOYER PLAN SERVICES EMPLOYER PLAN SERVICES EMPLOYER'S DIRECT SF EMPLOYERS COALITION EMPLOYERS COALITION on HEALTH (ECOH) EMPLOYERS DIRECT EMP EMPLOYERS DIRECT EMP EMPLOYERS DIRECT HEALTH - SF EMPLOYERS DIRECT HEALTH FI EMPLOYERS HEALTH EMPLOYERS INSURANCE OF WAUSAU EMPLOYERS INSURANCE OF WAUSAU EMPLOYERS LIFE INSURANCE EMPLOYERS LIFE INSURANCE COMPANY EMPLOYERS LIFE INSURANCE CORPORATION EMPLOYERS MUTUAL, INC. (FL) ENCIRCLE PPO ENCIRCLE PPO ENCORE HEALTH NETWORK ENCORE HEALTH NETWORK ENH MEDICAL GROUP IPA ENSTAR NATURAL GAS ENSTAR NATURAL GAS (GROUP #P61) ENTRUST EPIC LIFE INSURANCE (WISCONSIN PHYSICIAN SERVICES) EPIC LIFE INSURANCE COMPANY, THE EQUICOR EQUICOR - PPO EQUICOR HEALTH PLAN - HOUSTON EQUICOR PPO EQUICOR/EQUITABLE EQUIFAX HEALTHCARE ADMIN SERVICES EQUITABLE (CIGNA) EQUITABLE PLAN SERVICES EQUITABLE PLAN SERVICES ERISA ES BEVERIDGE ASC ESCAMBIA COUNTY - P2P LINK ESCAMBIA COUNTY - P2P LINK ESSENCE ESSENCE

INTERMEDIARY

PAYOR ID EMP01 38241 38241 EBC01 EBC01 31074 31074 12X44 SX182 3036 SB880 TH109 37216 37216 SB880 41198 41198 42149 42149 37111 37111 3036 75184 35112 35112 74212 74212 75233 27008 27008 75236 75236 75233 75235 61101 39026 39026 SB880 SB880 37249 59298 35206 35206 35206 35206 36364 91136 91136 36878 12X29

WPS 62308 62308 62308 62308 62308 75196 62308 73126 73126 TH110 34108

20818 57082

Agreement required No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No Yes No No No No No No No No No No No Yes Yes No No

REMIT No No No No No No No No No No No No Yes No No No Yes No No No No No No No No No No No No No No No No No No No No Yes Yes Yes Yes Yes No No No No No No No No No No No No Yes Yes Yes Yes Yes No Yes No No No No No No No No

Claim type Professional Professional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Professional Institutional Institutional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional

ST

WI WI

TX TX TX TX

KY

MN

CPID 3429 3550 3651 5131 5418 6570 3956 4438 2420 4530 2212 5817 4896 3854 1576 3801 1619 6110 4898 7927 5910 6132 3284 7989 3223 1950 3709 7517 2479 5967 4897 4910 4759 5919 4758 5910 8945 5876 5233 3253 3941 6467 1579 1579 6467 1505 1873 8592 2421 6536 3792 5906 4748 4147 4402 3599 8510 1804 8551 6453 6554 4562 2256 2875 4557 8992 1857 1402 1794

PAYOR EVERCARE EVERCARE EVERENCE EVERENCE EVERGREEN HEALTH PLAN EVERGREEN HEALTH PLAN EVOLUTIONS HEALTHCARE SYSTEMS, INC. EVOLUTIONS HEALTHCARE SYSTEMS, INC. EXCLUSICARE EXCLUSICARE EYE SPECIALIST of ARIZONA EYEMED VISION CARE FACEY MEDICAL FOUNDATION FACS GROUP FALLON COMMUNITY HEALTH PLAN FALLON COMMUNITY HEALTH PLAN FAMILY CARE - MILWAUKEE WI FAMILY CARE - MILWAUKEE WI FAMILY CARE MEDICAID MENTAL HEALTH FAMILY CARE MEDICAID MENTAL HEALTH FAMILY CARE MEDICARE FAMILY CARE SPECIALISTS IPA FAMILY CHOICE MEDICAL FAMILY DOLLAR FAMILY HEALTH PARTNERS - HEALTHWAVE of KANSAS FAMILY HEALTH PARTNERS - HEALTHWAVE of KANSAS FAMILY HEALTH PARTNERS MC + MISSOURI FAMILY HEALTH PARTNERS MC + MISSOURI FAMILY MEDICAL NETWORK FAMILY SENIORS MEDICAL GROUP FAMILY/SENIORS MED GROUP, INC. (LABS ONLY) - IPA FAMILYCARE FAMILYCARE (MEDICAID HMO) FAMILYCARE (MEDICAID HMO) FAMILYCARE (MEDICARE ADVANTAGE PLAN) FAMILYCARE MEDICARE ADVANTAGE PLAN FARM FAMILY FARM FAMILY FARMERS INSURANCE FCE BENEFIT ADMINISTRATORS FCE BENEFIT ADMINISTRATORS FEDERAL EMPLOYEES DENTAL AND VISION (FEDVIP) FEDERAL EMPLOYEES DENTAL AND VISION (FEDVIP) FEDERAL EMPLOYEES HEALTH BENEFIT PROGRAM (FEHB) FEDERAL EMPLOYEES HEALTH BENEFIT PROGRAM (FEHB) FEDERALLY QUALIFIED HEALTHCARE CLINICS FEDERATED MUTUAL INSURANCE FEDERATED MUTUAL INSURANCE FEP FIDELIS CARE of NEW YORK FIDELIS CARE of NEW YORK FIDELIS SECURE CARE FIDELIS SECURE CARE FIDELITY BENEFIT ADMINISTRATORS FIRST ADMINISTRATORS INC. (FAI) FIRST ADMINISTRATORS INC. (FAI) FIRST CAROLINA CARE FIRST CAROLINA CARE FIRST CHOICE FIRST CHOICE HEALTH NETWORK FIRST CHOICE HEALTH NETWORK FIRST CHOICE of MIDWEST - PPO FIRST CHOICE of MIDWEST - PPO FIRST HEALTH NETWORK FIRST HEALTH NETWORK FIRST INTEGRATED HEALTH FIRST INTEGRATED HEALTH FIRST PLAN OF MINNESOTA FIRST PRIORITY HEALTH

INTERMEDIARY

PAYOR ID Agreement required 87726 No 87726 No 35605 No No 58233 No 58233 No 59313 No 59313 No 71412 No 71412 No BVES1 No Yes 95432 No 37300 No 22254 No 22254 No 60095 No 60995 No No No FCR01 No No PPM01 No Yes 31472 No 31472 No 43173 No 43173 No 36396 No AMM02 No No 60995 No FCD01 No FCD01 No FCR01 No FCR01 No 14140 No 14140 No Yes 33033 No 33033 No 44054 No 44054 No 44054 No 44054 No UNITED GOVERNMENT SERVICE Yes 41041 No 41041 No WELLPOINT_ SB660 No 11315 No 11315 No 77054 No 77054 No No WELLMARK EDS/EC SOL FAMR1 No WELLMARK EDS/EC SOL No 56196 No 56196 No 14163 No 91131 No 91131 No 75138 No 75138 No 73159 No 73159 No 75232 No 75232 No SB720 No 23241 Yes

REMIT Yes Yes No No No No No No Yes Yes No No No No Yes Yes No No No No No No No No Yes Yes Yes Yes No No No No No No No No No No No No No Yes Yes Yes Yes No Yes Yes Yes Yes Yes No No No No No No No Yes No No No No No No No No Yes Yes

Claim type Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Professional

ST PA

FL FL

FL

FL FL FL FL

CPID 1583 1794 6507 5100 7928 7435 1995 1656 5267 3897 3688 3690 4142 3517 1414 6458 2150 3417 3561 3918 5414 5472 3642 7929 5101 3516 1478 1448 3518 2140 4120 8517 5102 5492 4568 2711 4932 4466 3850 2504 1760 4513 4540 6428 5104 2246 5433 6576 5440 7900 4119 5923 4781 4625 5864 2100 5981 2134 4745 4955 1862 8586 8944 5247 2299 1966 5851 8521 1806

PAYOR FIRST PRIORITY HEALTH FIRST PRIORITY LIFE INSURANCE FIRST SERVICE ADMINISTRATORS, INC. FIRST STATE HEALTH PLAN FIRST STATE HEALTH PLAN FIRSTCARE FIRSTCARE (VALLEY BAPTIST HEALTH PLAN) FIRSTCARE MCO/HMO FIRSTGUARD HEALTH PLAN KS FIRSTGUARD HEALTH PLAN MISSOURI FIRSTGUARD HEALTH PLAN of KANSAS FIRSTGUARD HEALTH PLAN of MISSOURI FITZHARRIS & COMPANY FLORIDA BLUE CROSS FLORIDA BLUE SHIELD FLORIDA FIRST FLORIDA HEALTH CARE PLAN FLORIDA HEALTH OPTIONS HMO FLORIDA HEALTH OPTIONS HMO FLORIDA HOSPITAL HC SYSTEM FLORIDA HOSPITAL HEALTHCARE SYSTEMS FLORIDA HOSPITAL WATERMAN FLORIDA HOSPITAL WATERMAN FLORIDA LEAGUE OF CITIES, INC. FLORIDA LEAGUE OF CITIES, INC. FLORIDA MEDICAID FLORIDA MEDICAID FLORIDA MEDICARE FLORIDA MEDICARE FLORIDA NETPASS FLORIDA RETAIL FEDERATION - P2P LINK FLORIDA RETAIL FEDERATION - P2P LINK FLORIDIANCARE FMH BENEFIT SERVICES FMH BENEFIT SERVICES, INC. FOND DU LAC AREA BUSINESS on HEALTH - FABOH FORD METER BOX IN (THE) FORD METER BOX IN (THE) FORMAX, INC. FORMAX, INC. FORTIS BENEFITS INSURANCE COMPANY FORTIS BENEFITS INSURANCE COMPANY FORTIS INSURANCE COMPANY FORTIS INSURANCE COMPANY FOUNDATION HEALTH OF FLORIDA-ENCOUNTERS FOUNDATION for MEDICAL CARE - TULARE AND KING CO. FOX EVERETT, INC. FOX EVERETT, INC. FOX VALLEY MEDICINE FRANKENMUTH - P2P LINK FRANKENMUTH - P2P LINK FREEDOM BLUE of WEST VIRGINIA FREEDOM BLUE of WEST VIRGINIA FREEDOM FIRST FREEDOM FIRST FREEDOM HEALTH FREEDOM HEALTH FREEDOM LIFE INSURANCE COMPANY FRESENIUS FRESENIUS MEDICAL CARE FRINGE BENEFIT MANAGEMENT FRINGE BENEFIT MANAGEMENT FRINGE BENEFITS COORDINATORS FRINGE BENEFITS COORDINATORS FRONTPATH HEALTH COALITION FRONTPATH HEALTH COALITION FUTURE CARE MEDICAL ASSOCIATES FiSERV HEALTH (KANSAS and TENNESSEE) FiSERV HEALTH (KANSAS and TENNESSEE)

INTERMEDIARY PA BC NORTHEASTERN

PAYOR ID 23241 59276

TH003 12T03

90061

11244 12B34 SB590 59276 59322 SX030 12B26 59321 59321 48116 48116 59698 12K34 SKFL0 SMFL0 12M34 65063

EDS - ELECTRONIC DATA SER EDS - ELECTRONIC DATA SER FIRST COAST SERV OPTIONS FIRST COAST SERV OPTIONS

48117 48117 39112 37305 37305 87066 87066 70408 70408 39065 39065 TKFMC 64069 64069 TH056

HIGHMARK, INC. 31313 31313 41212 62324 FMCHP 12T65 59069 59069 59204 59204 34171 34171 62061 62061

Agreement required Yes Yes No No No No No No No No Yes Yes No No No No No No No No No No No No No Yes Yes Yes Yes No Yes Yes No No No Yes No No No No No No No No No No No No No Yes Yes Yes Yes No No No No No No No No No No No No No No No No

REMIT No Yes No No No Yes No No No No No No No Yes Yes No No No Yes No No No No No No Yes Yes Yes Yes No No No No Yes Yes No No No No No Yes Yes Yes Yes No No No No No No No Yes Yes No No No No No No No No No No No No No No No No

Claim type Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional

ST

TX TX TX TX TX TX TX TX TX

GA GA GA GA GA GA GA GA GA

TX

CPID 3926 2722 2975 2497 8472 4569 2298 2912 3287 3676 1579 6467 1579 6467 1579 6467 1579 6467 1579 5473 2559 3219 6100 4607 7553 6408 4516 4115 6995 5826 8991 4240 4986 3278 2704 5266 6113 1626 7930 1407 1407 3537 1407 5105 1494 3538 1499 3536 1466 4772 2681 8405 6511 6511 8405 6511 8405 8405 6511 6405 6511 8405 6511 6467 7510 1578 1784 5867 3661

PAYOR GALLAGHER BENEFIT ADMINSTRATORS GALLAGHER BENEFITS ADMINISTRATOR / AAG GALVESTON COUNTY INDIGENT HEALTHCARE GARFIELD MEDICAL CENTER GATEWAY HEALTH PLAN - MEDICAID PA GATEWAY HEALTH PLAN - MEDICAID PA GATEWAY HEALTH PLAN - MEDICARE ASSURED GATEWAY HEALTH PLAN - MEDICARE ASSURED GATEWAY IPA GE GROUP ADMINISTRATORS, SOUTH CAROLINA GEHA CONNECTION DENTAL FEDERAL GEHA CONNECTION DENTAL FEDERAL GEHA CONNECTION DENTAL PLUS GEHA CONNECTION DENTAL PLUS GEHA HIGH DEDUCTIBLE HEALTH PLAN (HDHP) GEHA HIGH DEDUCTIBLE HEALTH PLAN (HDHP) GEHA HIGH OPTION GEHA HIGH OPTION GEHA STANDARD OPTION GEISINGER HEALTH PLAN GEISINGER HEALTH PLAN GEMCARE (GOLDEN EMPIRE MANAGED CARE SYSTEM) GEMCARE - KERN COUNTY GEMCARE - KERN COUNTY GENERAL AMERICAN LIFE INS CO GENERAL AMERICAN LIFE of ST. LOUIS GENERAL AMERICAN LIFE of ST. LOUIS GENERATIONS GLOBALHEALTH GENERATIONS GLOBALHEALTH GENERATIONS HEALTH GENERATIONS HEALTH GENESEE COUNTY HEATLH PLAN - JVHL GENESEE COUNTY HEATLH PLAN - JVHL GENESIS HEALTHCARE GENEX GENTIVE CARE CENTRIX GENWORTH - FINANCIAL GENWORTH - FINANCIAL GEORGE WASHINGTON HEALTH PLAN GEORGIA BANKERS GEORGIA BLUE CHOICE GEORGIA BLUE CROSS GEORGIA BLUE SHIELD GEORGIA HEALTH PLANS GEORGIA MEDICAID GEORGIA MEDICAID GEORGIA MEDICAID ANESTHESIA GEORGIA MEDICARE GEORGIA MEDICARE GETTYSBURG HEALTH GETTYSBURG HEALTH GHC - COMMERICAL GHC - COMMERICAL GHC BASIC HEALTH PLAN GHC BASIC HEALTH PLAN GHC FAMILY PLANS GHC FAMILY PLANS GHC HEALTHY OPTIONS GHC HEALTHY OPTIONS GHC INDIVIDUAL PLANS GHC INDIVIDUAL PLANS GHC MEDICARE + CHOICE GHC MEDICARE + CHOICE GHEA STANDARD OPTION GHI (GROUP HEALTH INC.) GHI HMO - NY GHI HMO - NY GHI MEDICARE PFFS GHI MEDICARE PFFS

INTERMEDIARY

WELLPOINT_ WELLPOINT_ WELLPOINT_ WELLPOINT_ HP ENTERPRISE SERVICES HP ENTERPRISE SERVICES HP ENTERPRISE SERVICES GEORGIA BCBS CAHABA GBA

PAYOR ID Agreement required 37283 No 37283 No 30005 No SYMED No 25169 No 25169 No 60550 No 60550 No PROSP No No 44054 No 44054 No 44054 No 44054 No 44054 No 44054 No 44054 No 44054 No 44054 No 75273 Yes 75273 Yes MCS01 No MCS03 No MCS03 No 34189 No 80705 No 80705 No No No 46050 No 46050 No Yes Yes AMM01 No 31147 No 11345 No No No No SB601 No SB601 No 12015 No SB601 No No SKGA0 Yes 12K05 Yes SKGA0 Yes 12M05 Yes SMGA0 Yes 23212 No 23212 No 91051 No 91051 No 91051 No 91051 No 91051 No 91051 No 91051 No 91051 No 62308 No 91051 No 91051 No 91051 No 44054 No 86047 No 25531 No 25531 No 22937 No 22937 No

REMIT No No No No Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes No No No No Yes Yes No No No No No No Yes Yes Yes Yes No Yes No Yes Yes Yes No No Yes No No Yes No Yes Yes No Yes No Yes No Yes Yes Yes Yes No No

Claim type Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional

ST

WI WI

CPID 1892 8473 4589 2557 2802 6591 1744 1937 2720 5870 5814 3629 7968 5199 4159 4919 5853 4616 6128 4515 6483 4945 3231 8922 3283 3279 7931 1579 4165 8577 1886 3216 4987 6408 4516 6408 4516 4516 6408 6408 4516 5402 4590 4154 4730 4590 5402 4590 5402 3423 6997 1770 8501 5107 8990 1877 7453 5970 7453 8405 6511 1876 7453 5970 6511 8405 6511 8405 2449

PAYOR GI INNOVATIVE MANAGEMENT GIC INDEMNITY PLAN GIC INDEMNITY PLAN GILSBAR INC. GILSBAR, INC. GLASSWORKERS HEALTH & WELFARE FUND GLASSWORKERS HEALTH & WELFARE FUND GLOBAL CARE GLOBAL CARE GLOBAL CARE MEDICAL GROUP IPA GLOBAL HEALTH OKC GLOBAL HEALTH OKC GM SOUTHWEST GM SOUTHWEST GMP EMPLOYERS RETIREE TRUST GMS INC GMS INC. GOLD COAST HEALTH PLAN GOLD COAST HEALTH PLAN GOLDEN RULE INSURANCE GOLDEN RULE INSURANCE GOLDEN STATE PHYSICIANS MEDICAL GROUP GOLDEN STATE PHYSICIANS MEDICAL GROUP GOLDEN TRIANGLE PHYSICAN ASSOCIATES GOLDEN TRIANGLE PHYSICIAN ASSOCIATES GOOD SAMARITAN MEDICAL PRACTICE ASSOC. (GSMPA) GOODYEAR TIRE & RUBBER COMPANY GOVERNMENT EMPLOYEE HOSPITAL ASSOCIATION (GEHA) GRAPHIC COMM UNION LOCAL 8-M & 96B HLTH & WLFR FND GREAT LAKES HEALTH PLAN GREAT LAKES HEALTH PLAN GREAT LAKES HEALTH PLAN - JVHL GREAT LAKES HEALTH PLAN - JVHL GREAT WEST CARE GREAT-WEST HEALTHCARE GREAT-WEST HEALTHCARE and ANNUITY INSURANCE CO. GREAT-WEST HEALTHCARE and ANNUITY INSURANCE CO. GREAT-WEST LIFE GREAT-WEST LIFE GREAT-WEST LIFE ASSURANCE CO (GWL) GREAT-WEST LIFE ASSURANCE CO (GWL) GREATER La CROSSE CARE 65+ GREATER La CROSSE CARE 65+ GREATER ORANGE COUNTY MEDICAL GROUP GREATER VALLEY GREATER WISCONSIN RAPIDS PROVIDER CHOICE GREATER WISCONSIN RAPIDS PROVIDER CHOICE GREEN BAY HEALTH PROTECTION PLAN GREEN BAY HEALTH PROTECTION PLAN GREEN TREE ADMINISTRATORS GREENTREE ADMINISTRATORS GROUP ADMINISTRATORS LTD. GROUP ADMINISTRATORS LTD. GROUP ADMINISTRATORS SELF-FUNDED ALTERNATIVE GROUP HEALTH - MADISON, WI GROUP HEALTH COOPERATIVE GROUP HEALTH COOPERATIVE - MEDICAID HMO GROUP HEALTH COOPERATIVE - MEDICAID HMO GROUP HEALTH COOPERATIVE OF EAU CLAIRE GROUP HEALTH COOPERATIVE OF THE NORTHWEST (EAST) GROUP HEALTH COOPERATIVE OF THE NORTHWEST (EAST) GROUP HEALTH COOPERATIVE SOUTH CENTRAL WISCONSIN GROUP HEALTH COOPERATIVE of EAU CLAIRE GROUP HEALTH COOPERATIVE of EAU CLAIRE GROUP HEALTH COOPERATIVE of the NORTHWEST GROUP HEALTH COOPERATIVE of the NORTHWEST GROUP HEALTH COOPERATIVE of the NW GROUP HEALTH COOPERATIVE of the NW GROUP HEALTH INSURANCE

INTERMEDIARY WELLPOINT WELLPOINT

PAYOR ID Agreement required 58204 No 80314 No 80314 No 7205 No 7205 No 91136 No 91136 No 7689 No 7689 No MPM05 No GHOKC Yes Yes No No No 47083 No 47083 No No No 37602 No 37602 No 68041 No 68041 No No 72189 No AMM01 No No 44054 No No 95467 No 95467 No Yes Yes 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 39026 No 39026 No NMM01 No HCP01 No 39026 No 39026 No 39026 No 39026 No 78521 No 78521 No 36338 No 36338 No No 39167 No 39168 No 95192 No 95192 No 95192 No 91051 No 91051 No 39167 No 95192 No 95192 No 91051 No 91051 No 91051 No 91051 No 61101 No

REMIT No Yes Yes No Yes No No No No No No No No No No No No No No Yes Yes No No No No No No Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes No No No No No No No Yes No Yes Yes No No Yes No No Yes No Yes Yes

Claim type Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional

ST

HI HI HI HI HI

CPID 4544 2449 6511 8405 8405 6511 8405 6511 8538 1837 8558 4450 3982 4927 3757 2936 4517 2161 5975 6409 3463 5948 3833 4516 6408 5845 2865 8532 5206 2769 6513 6466 1844 8551 4730 6431 7520 1683 8988 7988 2202 7988 2202 6512 2742 1518 2714 2715 2579 2467 5567 1555 8512 1790 1790 8512 2996 2731 3471 3913 4755 7500 3794 2592 5987 2509 2494 4988 5270

PAYOR GROUP HEALTH INSURANCE - DELAWARE GROUP HEALTH INSURANCE - DELEWARE GROUP HEALTH NORTHWEST GROUP HEALTH NORTHWEST GROUP HEALTH OPTIONS ALLIANT PLUS & ALLIANT SELECT GROUP HEALTH OPTIONS ALLIANT PLUS & ALLIANT SELECT GROUP HEALTH OPTIONS, OPTIONS SELECT/OPTIONS PRIME GROUP HEALTH OPTIONS, OPTIONS SELECT/OPTIONS PRIME GROUP HEALTH PLAN (GHP) GROUP HEALTH PLAN (GHP)/ADVANTRA GROUP HLTH COOP-MADISON WI (ENCOUNTERS) GROUP INSURANCE SERVICE CENTER GROUP INSURANCE SERVICE CENTER GROUP PRACTICE AFFILIATES GROUP and PENSION ADMINISTRATORS GROUP and PENSION ADMINISTRATORS GUARDIAN GUARDIAN HEALTHCARE GUARDIAN HEALTHCARE GUARDIAN LIFE INS CO OF AMERICA GULF QUEST RENAISSANCE GUNDERSEN LUTHERAN HEALTH PLAN GUNDERSEN LUTHERAN HEALTH PLAN GWL (GREAT-WEST LIFE) GWL (GREAT-WEST LIFE) Greater Newport Physicians H.E.R.E.I.U. WELFARE PENSION PLAN H.E.R.E.I.U. WELFARE PENSION PLAN HAA PREFERRED PARTNERS HAP - JVHL HAP/AHL/CURANET HAP/AHL/CURANET HARMONY HEALTH PLAN of ILLINOIS, INDIANA, MISSOURI HARMONY HEALTH PLAN of ILLINOIS, INDIANA, MISSOURI HARRIMON JONES HARRINGTON BENEFIT SERVICES HARRINGTON BENEFIT SERVICES, INC. HARRIS METHODIST HEALTH PLAN HARRIS METHODIST HEALTH PLAN (HMO MEDICAID) HARTFORD - P2P LINK - WORKERS COMPENSATION HARTFORD - P2P LINK - WORKERS COMPENSATION HARTFORD - SRS (P2P LINK) HARTFORD - SRS (P2P LINK) HARVARD PILGRIM HEALTH CARE HARVARD PILGRIM HEALTH CARE HAWAII BLUE CROSS HAWAII HMSA HAWAII MEDICAID HAWAII MEDICAID HAWAII MEDICARE HAWAII MEDICARE HAWAII QUEST HCH ADMINISTRATION HCH ADMINISTRATION HCHA ALBQ-SELF FUNDED HCHA ALBQ-SELF FUNDED HCPC ALLIANCE PHYSICI HDM BENEFIT SOLUTIONS HDPC ALLIANCE PHYSICIANS HDPC PREMIER HEALTHCA HDPC PREMIER HEALTHCARE HEALTH ADMINISTRATION SERV., INC. HEALTH ADVANTAGE BCCCP HEALTH ADVANTAGE BCCCP HEALTH ALLIANCE EXCLUSIVE HEALTH ALLIANCE MEDICAL PLAN of ILLINOIS HEALTH ALLIANCE MEDICAL PLAN of ILLINOIS HEALTH ALLIANCE PLAN (CAPITATED CONTRACTS) - JVHL HEALTH ALLIANCE PLAN (FEE for SERVICE) - JVHL

INTERMEDIARY

HMSA HMSA HMSA HP ENTERPRISE SERVICES PALMETTO GBA PALMETTO GBA HMSA

PAYOR ID Agreement required 61101 No 61101 No 91051 No 91051 No 91051 No 91051 No 91051 No 91051 No 25133 No 25133 No 39168 No 37276 No 37276 No 68046 No 48143 No 48143 No 64246 No 77010 No 77010 No 64246 No RENGQ No 39180 No 39180 No 80705 No 80705 No No 37114 No 37114 No 65101 No Yes 38224 No 38224 No 14163 No 14163 No HCP01 No 95266 No 95266 No No No Yes Yes Yes Yes 4271 No 4271 No 12B62 Yes SB971 Yes SKHI0 Yes Yes SMHI0 Yes Yes Yes 37111 No 37111 No 37111 No 37111 No 20257 No TH070 No 20257 No 90023 No 90023 No 34185 No 38338 No 38338 No No 77950 No 77950 No Yes Yes

REMIT Yes Yes No Yes Yes No Yes No Yes Yes No No No No No No No No No No No Yes Yes Yes Yes No No No No Yes Yes Yes Yes Yes No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No Yes Yes Yes Yes

Claim type Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Institutional Professional Institutional Professional

ST

FL

PA

CPID 4989 1837 8538 2148 8986 3232 2930 4878 8985 3267 3917 3805 5108 7552 2898 2964 2408 7424 1768 6568 3205 3612 5179 2413 2704 6514 2598 2445 8984 1432 5709 2855 4483 4586 5229 6432 3628 4736 5458 8520 2822 4572 4768 7551 2824 2704 8982 5263 2953 2262 4560 4990 3213 3469 4292 1909 1889 1988 1898 3928 1712 6503 8451 2297 1920 2105 4544 2449 2825

PAYOR HEALTH ALLIANCE PLAN (FEE for SERVICE) - JVHL HEALTH AMERICA INC HEALTH AMERICA, INC. HEALTH CARE DISTRICT PALM BEACH COUNTY HEALTH CARE SAVINGS HEALTH CHOICE ARIZONA HEALTH CHOICE ARIZONA HEALTH CHOICE GENERATIONS HEALTH CHOICE GENERATIONS HEALTH CLAIM SERVICES HEALTH COST SOLUTIONS HEALTH COST SOLUTIONS HEALTH DATA SOLUTIONS HEALTH DESIGN PLUS (HUDSON, OH) HEALTH DESIGN PLUS (HUDSON, OH) HEALTH EXCHANGE (THE) (CERNER CORPORATION) HEALTH EXCHANGE (THE) (CERNER CORPORATION) HEALTH EZ HEALTH FIRST (TYLER, TEXAS) HEALTH FIRST (TYLER, TEXAS) HEALTH FIRST HEALTH PLAN HEALTH FIRST TPA - AUSTIN HEALTH FIRST TPA - AUSTIN HEALTH KEEPERS, INC. HEALTH MANAGEMENT SOLUTIONS HEALTH NET CALIFORNIA and OREGON (CLAIMS) HEALTH NET OF ARIZONA, INC. HEALTH NET OF ARIZONA, INC. HEALTH NET OF CALIFORNIA - ENCOUNTERS HEALTH NET OF CALIFORNIA - ENCOUNTERS HEALTH NET OREGON HEALTH NET of CALIFORNIA and OREGON (CLAIMS) HEALTH NET of the NORTHEAST HEALTH NET of the NORTHEAST HEALTH NETWORK ONE HEALTH NEW ENGLAND HEALTH NEW ENGLAND HEALTH OPTIONS of ILLINOIS HEALTH PARTNERS - JACKSON TN HEALTH PARTNERS - JACKSON, TN HEALTH PARTNERS, PA HEALTH PARTNERS, PA HEALTH PAYMENT SYSTEMS, INC. HEALTH PLAN (THE) HEALTH PLAN (THE) HEALTH PLAN (THE) - OHIO WORKERS' COMP MCO'S HEALTH PLAN MANAGEMENT, INC. HEALTH PLAN MANAGEMENT, INC. HEALTH PLAN SERVICES HEALTH PLAN of MICHIGAN HEALTH PLAN of MICHIGAN HEALTH PLAN of MICHIGAN - JVHL HEALTH PLAN of MICHIGAN - JVHL HEALTH PLAN of SAN JOAQUIN HEALTH PLAN of SAN MATEO HEALTH PLANS, INC. HEALTH PLANS, INC. HEALTH PLUS PHSP (BROOKLYN, NY) HEALTH PLUS PHSP - BROOKLYN, NY HEALTH RISK MANAGEMENT HEALTH SERVICE MANAGEMENT HEALTH SERVICES PREFERRED (HSP) by EMERALD HEALTH HEALTH SERVICES PREFERRED (HSP) by EMERALD HEALTH HEALTH SERVICES for CHILDREN with SPECIAL NEEDS HEALTH SERVICES for CHILDREN with SPECIAL NEEDS HEALTH SUN HEALTH VALUE MANAGEMENT - DELAWARE HEALTH VALUE MGMT - DELEWARE HEALTHCARE GROUP (THE)

INTERMEDIARY

PAYOR ID 25133 25133 HCDPB 62179 62179 62180 62180 82018 62111 62111 34158 34158 20356 20356 16120 75234 75234 95019 75289 75289 SB865 31147 95567 38309 38309 95568 95570 22340 95567 6108 6108 65062 4286 4286 NAHOI 62157 62157 80142 80142 20270 34150 34150 31147

HIGHMARK, INC.

59140 83253 83253

68035 SX174 44273 44273 11324 11324 41170 HSM01 34167 34167 37290 37290 61101 61101 35206

Agreement required Yes No No Yes No No No No No No No No No No No No No No No No No No No Yes No No No No No Yes No No No No No No No No No No No No No No No No No No No No No Yes Yes No No No No No No No No No No No No No No No No

REMIT Yes Yes Yes No No Yes Yes Yes Yes No No No No No No No No No No No Yes No No Yes No Yes Yes Yes No No No Yes Yes Yes No Yes No No No No No No No Yes Yes No No No No Yes Yes Yes Yes No No No No Yes Yes No No No No No No No Yes Yes No

Claim type Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Professional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional

ST

NY

MI MI

CPID 2594 5931 1717 8920 5243 4730 2940 1723 2920 4730 4954 2174 3965 4267 8538 1837 4991 4261 7932 3206 2934 1844 8551 1844 8551 4592 6482 4571 3899 2971 3823 1854 1973 1854 1973 1973 1854 1973 1854 1973 1854 1854 1973 1973 1854 8439 6476 1817 8507 8508 4448 7485 1525 3411 8431 5435 2776 3566 2567 2258 5287 1618 5109 8413 4598 5894 3694 1517 2724

PAYOR HEALTHCARE GROUP (THE) HEALTHCARE MANAGEMENT ADMINISTRATORS HEALTHCARE MANAGEMENT ADMINISTRATORS HEALTHCARE MGMT ADMINISTRATORS - WESTERN REGION HEALTHCARE MGMT ADMINISTRATORS - WESTERN REGION HEALTHCARE PARTNERS HEALTHCARE PARTNERS HEALTHCARE PARTNERS IPA HERITAGE NY MEDICAL GROUP HEALTHCARE PARTNERS IPA HERITAGE NY MEDICAL GROUP HEALTHCARE PARTNERS in CALIFORNIA HEALTHCARE RESOURCES HEALTHCARE RESOURCES NORTHWEST HEALTHCARE SOLUTIONS HEALTHCARE SOLUTIONS GROUP HEALTHCARE USA HEALTHCARE USA HEALTHCHOICE - JVHL HEALTHCHOICE - JVHL HEALTHCHOICE OF CONNECTICUT/YALE PREFERRED HEALTH HEALTHCOMP INC. HEALTHCOMP, INC. HEALTHEASE FLORIDA HEALTHEASE FLORIDA HEALTHEASE KIDS FLORIDA HEALTHEASE KIDS FLORIDA HEALTHEOS ASSOCIATES FOR HEALTH CARE INC (AHC) HEALTHEOS ASSOCIATES FOR HEALTH CARE, INC. HEALTHEOS HEALTH CARE NETWORK OF WISCONSIN (HCN) HEALTHEOS HEALTHCARE NETWORK OF WISCONSIN (HCN) HEALTHEOS WISCONSIN PREFERRED PROVIDER NETWORKS HEALTHEOS WISCONSIN PREFERRED PROVIDER NETWORKS HEALTHFIRST 65 PLUS HEALTHFIRST 65 PLUS HEALTHFIRST FAMILY HEALTH PLUS (FHP) HEALTHFIRST FAMILY HEALTH PLUS (FHP) HEALTHFIRST HEALTH PLAN of NEW JjERSEY HEALTHFIRST HEALTH PLAN of NEW JjERSEY HEALTHFIRST NEW YORK (COMMERCIAL) HEALTHFIRST NEW YORK (COMMERCIAL) HEALTHFIRST PHSP HEALTHFIRST PHSP HEALTHFIRST of NEW YORK HEALTHFIRST of NEW YORK HEALTHFIRST, INC. (NEW YORK) HEALTHFIRST, INC. (NEW YORK) HEALTHGUARD OF LANCASTER HEALTHHELP NETWORKS, INC. (HHNI) HEALTHLINK HMO HEALTHLINK HMO HEALTHLINK PPO HEALTHLINK PPO HEALTHNOW NEW YORK BLUE SHIELD HEALTHPARTNERS of MINNESOTA HEALTHPARTNERS of MINNESOTA HEALTHPLAN SERVICES (TAMPA only) HEALTHPLEDGE HMO/PLUS HEALTHPLUS OF MICHIGAN HEALTHPLUS OF MICHIGAN HEALTHPLUS of LOUISIANA HEALTHPLUS of LOUISIANA HEALTHPLUS of MICHIGAN - JVHL HEALTHPLUS of MICHIGAN - JVHL HEALTHPOWER HMO HEALTHSCOPE BENEFITS, INC. HEALTHSCOPE BENEFITS, INC. HEALTHSELECT PPO PLAN HEALTHSELECT PPO PLAN HEALTHSMART PREFERRED CARE, INC. HEALTHSMART PREFERRED CARE, INC.

INTERMEDIARY

PAYOR ID Agreement required 35206 No 12T11 No TH049 No No HMA01 No HCP01 No HCP01 No 11328 No 11328 No HCP01 No 56731 No 56731 No 73147 No 73147 No 25133 No 25133 No Yes Yes No 85729 No 85729 No 14163 No 14163 No 14163 No 14163 No 36326 No 36326 No 42102 No 42102 No 34080 No 34080 No 80141 No 80141 No 80141 No 80141 No 80141 No 80141 No 80141 No 80141 No 80141 No 80141 No 80141 No 80141 No 80141 No 80141 No 23226 No 59087 No 96475 No 96475 No 90001 No 90001 No Yes SX009 Yes SX009 Yes 59140 No 95435 No 38216 Yes 38216 Yes 95009 No 95009 No Yes Yes No 71063 No 71063 No 81108 No 81108 No 75250 No 75250 No

REMIT No No No No No No No No No No No No No No Yes Yes Yes Yes No No No Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No Yes Yes Yes No No Yes Yes No No Yes Yes No Yes Yes No No No No

Claim type Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional

ST

IL

AL TN TX

FL

CPID 4509 6405 4509 6405 6405 4509 6405 4509 4509 6405 6405 4509 4509 6405 6405 4509 4509 6405 6405 4509 4509 6405 4509 6405 4509 6405 4609 6102 2795 1556 2795 1556 1556 2795 2795 1556 2795 1556 6527 8400 4740 3445 4763 3694 5894 2449 5840 HFST 4523 6442 2874 6442 4523 6442 4523 6442 8919 3286 5895 6442 4523 6442 4523 6442 4523 6442 4523 4120 8517

PAYOR HEALTHSOURCE OF ARKANSAS (MEDICARE) HEALTHSOURCE OF ARKANSAS (MEDICARE) HEALTHSOURCE OF INDIANA HEALTHSOURCE OF INDIANA HEALTHSOURCE OF KENTUCKY HEALTHSOURCE OF KENTUCKY HEALTHSOURCE OF MAINE HEALTHSOURCE OF MAINE HEALTHSOURCE OF MASSACHUSETTS HEALTHSOURCE OF MASSACHUSETTS HEALTHSOURCE OF NEW HAMPSHIRE HEALTHSOURCE OF NEW HAMPSHIRE HEALTHSOURCE OF NEW YORK HEALTHSOURCE OF NEW YORK HEALTHSOURCE OF NORTH CAROLINA HEALTHSOURCE OF NORTH CAROLINA HEALTHSOURCE OF NORTH TEXAS HEALTHSOURCE OF NORTH TEXAS HEALTHSOURCE OF OHIO HEALTHSOURCE OF OHIO HEALTHSOURCE OF SOUTH CAROLINA HEALTHSOURCE OF SOUTH CAROLINA HEALTHSOURCE OF TENNESSEE HEALTHSOURCE OF TENNESSEE HEALTHSOURCE PROVIDENT HEALTHSOURCE PROVIDENT HEALTHSPAN REPRICING HEALTHSPAN REPRICING HEALTHSPRING ILLINOIS HEALTHSPRING ILLINOIS HEALTHSPRING INC. HEALTHSPRING INC. HEALTHSPRING OF ALABAMA HEALTHSPRING OF ALABAMA HEALTHSPRING TENNESSEE HEALTHSPRING TENNESSEE HEALTHSPRING TEXAS HEALTHSPRING TEXAS HEALTHSTAR INC. HEALTHSTAR, INC. HEALTHWAYS WHOLEHEALTH NETWORKS HEALTHY OPTIONS HEALTHY PALM BEACHES HEALTHY SAVINGS HAS QUALIFIED PLAN HEALTHY SAVINGS HAS QUALIFIED PLAN HEALTHY VALUE HEATLHCARE LA, IPA HEATLHFIRST of NEW JERSEY HERITAGE CHOICE HERITAGE CHOICE HERITAGE CONSULTANTS HERITAGE NATIONAL HEALTH PLAN HERITAGE OPTIONS HRA HERITAGE OPTIONS HRA HERITAGE OPTIONS HSA HERITAGE OPTIONS HSA HERITAGE PHYSICIANS NETWORK HERITAGE PHYSICIANS NETWORK HERITAGE PHYSICIANS NETWORK/SELECTCARE OF TEXAS HERITAGE PPO (ILLINOIS ONLY) HERITAGE PPO (ILLINOIS ONLY) HERITAGE PREMIER HERITAGE PREMIER HERITAGE SELECT HERITAGE SELECT HERITAGE SELECT ADVANTAGE (IOWA ONLY) HERITAGE SELECT ADVANTAGE (IOWA ONLY) HERITAGE SUMMIT - P2P LINK HERITAGE SUMMIT - P2P LINK

INTERMEDIARY

PAYOR ID Agreement required 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No 62308 No HSPAN No HSPAN No 63092 Yes 63092 Yes 63092 Yes 63092 Yes 63092 Yes 63092 Yes 63092 Yes 63092 Yes 63092 Yes 63092 Yes 36332 No 36332 No 58213 No No 95827 Yes 81108 No 81108 No 61101 No MPM06 No No 95378 No 95378 No 59230 No 95378 No 95378 No 95378 No 95378 No 95378 No No TH011 No 76045 No 95378 No 95378 No 95378 No 95378 No 95378 No 95378 No 95378 No 95378 No Yes Yes

REMIT Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No No No Yes No No No Yes No No Yes Yes No Yes Yes Yes Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes No No

Claim type Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Professional Professional Institutional Professional Professional Professional N/A Institutional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional

ST

NY

NJ NJ NJ NJ NY

CPID 5402 2503 2717 6476 3290 2974 3470 4102 6984 4103 6985 4454 2846 5110 4733 1896 8599 7510 1981 4753 2280 1902 7432 4164 2449 4544 2497 4765 3597 5544 1987 2960 2839 3619 5825 5990 2189 5526 2414 2414 2414 5526 1709 6534 1744 6591 2449 4544 2580 3778 3503 2704 6516 6451 2449 4544 4544 2449 3890 4544 2449 4544 2449 2449 4544 2449 4544 2449 4544

PAYOR HEY HEALTH PLAN HFN, INC. HFN, INC. HHNI HIGH DESERT MEDICAL GROUP HIGH DESERT PRIMARY CARE HIGH DESERT PRIMARY CARE HIGHLINE MSO MOLINA HIGHLINE MSO MOLINA HIGHLINE MSO PSHP HIGHLINE MSO PSHP HIGHMARK HILL PHYSICIANS MEDICAL GROUP HILLCREST BENEFITS ADMINISTRATORS HINSDALE PHYSICIAN HEALTHCARE HIP-HEALTH INSURANCE PLAN OF GREATER NY HIP-HEALTH INSURANCE PLAN of GREATER NY HIP-NY STATE HMA HAWAII HMA HAWAII HMAA - HAWAII MANAGEMENT ALLIANCE ASSOCIATION HMAA - HAWAII MANAGEMENT ALLIANCE ASSOCIATION HMO BLUE HMO OF COLORADO (HMOC) HMPK, INC HMPK, INC. HOLLYWOOD PRESBYTERIAN HOLY CROSS HEALTH PARTNERS HOME HEALTH MEDICARE REGION IV GULF COAST HOME HEALTH MEDICARE REGION IV SOUTHWEST HOME HEALTH MEDICARE REGION VII HOMETOWN HEALTH HOMETOWN HEALTH PLAN NEVADA HOMETOWN HEALTH PROVIDERS HOMETOWN HEALTH PROVIDERS HORACE MANN HORACE MANN HORIZON BLUE CROSS OF NEW JERSEY HORIZON BLUE SHIELD OF NEW JERSEY HORIZON BLUE SHIELD OF NJ FEP HORIZON BLUE SHIELD OF NJ OUT OF AREA HORIZON HEALTHCARE OF NEW YORK HORIZON NJ HEALTH HORIZON NJ HEALTH HOTEL EMP & RESTAURANT EMP HEALTH TRUST HOTEL EMP & RESTAURANT EMP HEALTH TRUST HPLAN, INC HPLAN, INC. HPS PARADIGM INC HPS PARADIGM, INC. HTP HTP HUDSON HEALTH PLAN HUDSON HEALTH PLAN HUMANA HUMANA HUMANA CARE PLAN HUMANA CARE PLAN HUMANA ENCOUNTERS HUMANA GOLD PLAN HUMANA GOLD PLAN HUMANA GROUP HEALTH PLAN HUMANA GROUP HEALTH PLAN HUMANA HEALTH HUMANA HEALTH CHICAGO HUMANA HEALTH CHICAGO INS CO HUMANA HEALTH CHICAGO INSURANCE COMPANY HUMANA HEALTH PLAN HUMANA HEALTH PLAN (HCDS)

INTERMEDIARY

EXCELLUS

PALMETTO GBA PALMETTO GBA CAHABA GBA EDS/EC SOL

PAYOR ID Agreement required 39026 No 36335 No 36335 No 59087 No HDMDG No 33069 No 33069 No 91164 No 91164 No 91161 No 91161 No 35145 No 46 Yes No NAHIN No 55247 Yes 55247 No 86047 No 86066 No 86066 No 99208 No 99208 No SB806 Yes No 61101 No 61101 No SYMED No NAHLX No Yes Yes 12M97 Yes 88023 No 88023 No 88537 No 88537 No No No 22099 Yes 22099 Yes 22099 Yes 22099 Yes 22099 Yes 22326 No 22326 No 91136 No 91136 No 61101 No 61101 No 58227 No 58227 No 31147 No 31147 No 13335 Yes 13335 Yes 61101 No 61101 No 61101 No 61101 No 61102 No 61101 No 61101 No 61101 No 61101 No 61101 No 61101 No 61101 No 61101 No 61101 No 61101 No

REMIT Yes No No No No No No No No No No No No No No Yes Yes Yes No No No No No No Yes Yes No No Yes No Yes No No No No No No Yes Yes Yes Yes Yes Yes Yes No No Yes Yes No No No No No No Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Claim type Professional Institutional Professional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Professional Professional Institutional Institutional Institutional Professional Professional Institutional Professional Professional Professional Institutional Professional Professional Institutional Institutional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional

ST

ID ID ID ID ID ID ID ID

IL IL IL IL IL IL

PA CA CA

IN IN

IN IN IN IN

CPID 2449 2449 4544 2449 4544 2449 4544 4544 2449 5902 4739 4544 9573 3478 4930 3240 3993 5220 3429 8981 7527 5299 1907 2285 5111 4418 7430 5582 7426 3540 7427 5583 5581 2465 1635 6120 5508 1405 5112 1563 2488 5506 1437 3764 1942 4876 2946 3896 5113 2781 4242 6117 6119 5865 8921 3502 1412 6408 4516 4481 4976 3501 1474 1445 3500 1754 2990 7509 2826

PAYOR HUMANA HEALTH PLAN - HMO HUMANA INSURANCE AGENCY HUMANA INSURANCE AGENCY HUMANA INSURANCE CO HUMANA INSURANCE COMPANY HUMANA MEDICAL PLAN - CA HUMANA MEDICAL PLAN - CALIFORNIA HUMANA MEDICAL PLAN - KENTUCKY HUMANA MEDICAL PLAN - KY HUMANA VETERANS HEALTHCARE SERVICES HUMANA VETERANS HEALTHCARE SERVICES HUMANA WISCONSIN HEALTH ORGANIZATION HUMBOLDT-DEL NORTE FOUNDATION IPA HUNT INSURANCE GROUP HUNT INSURANCE GRP I E SHAFFER I E SHAFFER IBA SELF FUNDED GROUP IBA SELF FUNDED GROUP IBA SELF FUNDED GROUP IBA SELF FUNDED GROUP ICARE HEALTH OPTIONS TPA ICARE, INDEPENDENT CARE HEALTH PLAN ICARE, INDEPENDENT CARE HEALTH PLAN ICM ICON BENEFIT ADMINISTRATORS IDAHO BLUE CROSS BOISE IDAHO BLUE CROSS BOISE IDAHO BLUE SHIELD REGENCE IDAHO BLUE SHIELD REGENCE IDAHO MEDICAID IDAHO MEDICAID IDAHO MEDICARE IDAHO MEDICARE ILLINICARE GROUP HEALTH ILLINICARE GROUP HEALTH ILLINOIS BLUE CROSS ILLINOIS BLUE SHIELD ILLINOIS CENTRAL HOSPITAL ASSOCIATION ILLINOIS MEDICAID ILLINOIS MEDICAID ILLINOIS MEDICARE ILLINOIS MEDICARE IMCARE IMCARE IMG - INTERNATIONAL MEDICAL GROUP INDECS CORPORATION INDECS CORPORATOIN INDEPENDENCE ADMINISTRATORS INDEPENDENCE BLUE CROSS PERSONAL CHOICE INDEPENDENCE MEDICAL GROUP INDEPENDENCE MEDICAL GROUP - KERN COUNTY INDEPENDENCE MEDICAL GROUP - TULARE COUNTY INDIAN HEALTH SERVICES INDIAN HEALTH SERVICES INDIANA BLUE CROSS INDIANA BLUE SHIELD INDIANA HEALTH NETWORK INDIANA HEALTH NETWORK INDIANA HEALTH PLAN MDWISE INDIANA HEALTH PLAN MDWISE INDIANA MEDICAID INDIANA MEDICAID INDIANA MEDICARE INDIANA MEDICARE INDIANA PROHEALTH NETWORK INDIANA PROHEALTH NETWORK INDIANA TEAMSTERS HLTH BENEFITS FUND (INDIANAPOLIS INDIANA TEAMSTERS HLTH BENEFITS FUND (INDIANAPOLIS

INTERMEDIARY

PAYOR ID Agreement required 61101 No 61101 No 61101 No 61101 No 61101 No 61101 No 61101 No 61101 No 61101 No PALMETTO GBA 61160 No PALMETTO GBA 61160 No 61101 No HDNFC No 37260 No 37260 No 22175 No 22175 No No 87726 No No 31107 No 26054 No 11695 No 11695 No 37296 No 75185 No Yes Yes No 12B84 No MOLINA MEDICAID SOLUTIONS SKID0 Yes MOLINA MEDICAID SOLUTIONS SKID0 Yes NORIDIAN ADMIN. SERVICES 325 Yes NORIDIAN ADMIN. SERVICES SMID0 Yes 68066 No 68066 No 12B08 No SB621 No No No SKIL0 No NATIONAL GOVERNMENT SERV. 12M08 Yes WPS SMIL0 Yes 41600 No 41600 No 12T61 No 40585 No 40585 No TA720 No INDEPENDENCE BLUE CROSS SX083 No MHM01 No No 26274 No SX171 Yes SX171 Yes WELLPOINT_ 12B09 No WELLPOINT_ SB630 No 80705 No 80705 No No No EDS - ELECTRONIC DATA SER 12K09 No EDS - ELECTRONIC DATA SER SKIN0 No NATIONAL GOVERNMENT SERV. SMIN0 Yes NATIONAL GOVERNMENT SERV. 12M09 Yes 35161 No 35161 No 35107 No 35107 No

REMIT Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes No No No No No No Yes No Yes No Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes No Yes Yes No Yes No No No No No No Yes No No No No No Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes No No

Claim type Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Professional Professional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional

ST

IA IA IA IA IA IA

CPID 4481 4976 6573 5419 5295 1614 7590 3727 4497 4244 6134 2524 2814 5114 1595 3237 3906 2871 4445 8918 7425 4913 2484 3955 1864 3860 3646 5852 4116 6503 8451 4746 3712 7569 3968 6990 4108 4555 5115 2988 3720 5952 2122 8943 4441 5485 2961 2678 5808 5700 1638 2176 2688 1681 3260 4601 3451 1510 1404 2571 1469 1438 2537 3620 5829 6556 4528 6420 2676

PAYOR INDIANA UNIVERSITY MEDICAL GROUP INDIANA UNIVERSITY MEDICAL GROUP INDIVIDUAL HEALTH INSURANCE COMPANIES INDIVIDUAL HEALTH INSURANCE COMPANIES INFORMED UHC COMPASS ROSE INFORMED UHC COMPASS ROSE INFORMED, LLC INFORMED, LLC INGALLS PROVIDER GROUP INLAND EMPIRE HEALTH PLAN INNOVANTE BENEFIT ADMINISTRATOR INNOVATED HEALTHWARE SERVICES INNOVATED HEALTHWARE SERVICES INPRONET INSURANCE ADMINISTRATORS OF AMERICA (IAA) INSURANCE ADMINISTRATORS OF AMERICA, INC. INSURANCE DESIGN ADMINISTRATION INSURANCE DESIGN ADMINISTRATORS INSURANCE MANAGEMENT SERVICES (IMS) of TEXAS INSURANCE MGMT SVCS TEXAS INSURANCE SERVICES of LUBBOCK INSURERS ADMINISTRATION INSURERS ADMINISTRATIVE CORPORATION INTEGRA GROUP INTEGRA GROUP INTEGRA GROUP - CHA INTEGRAL QUALITY CARE INTEGRAL QUALITY CARE INTEGRANET INTEGRATED CARE NETWORK (ICN) by EMERALD HEALTH INTEGRATED CARE NETWORK (ICN) by EMERALD HEALTH INTEGRATED MENTAL HEALTH SERVICES (IMHS) INTEGRITY BENEFIT GROUP, INC. (THE) INTEGRITY BENEFIT GROUP, INC. (THE) INTER UNION OF OPER15 INTER-AMERICAS INSURANCE INTER-AMERICAS INSURANCE INTER-COUNTY HEALTH PLAN INTERACTIVE DIAGNOSTIC SERVICES, INC. INTERCARE HEALTH PLANS, INC. INTERCARE HEALTH PLANS, INC. INTERCOMMUNITY HEALTH NET INTERCOMMUNITY HEALTH NET INTERFACE EAP INTERFACE EAP IEAP INTERGROUP SERVICES CORP. INTERGROUP SERVICES CORPORATION INTERNATIONAL BROTHERHOOD of BOILERMAKERS EMP HLTH INTERNATIONAL BROTHERHOOD of BOILERMAKERS EMP HLTH INTERNATIONAL EDUCATIONAL EXCHANGE SERVICES, INC. INTERNATIONAL EDUCATIONAL EXCHANGE SERVICES, INC. INTERNATIONAL FUNDING INC. INTERNATIONAL FUNDING, INC. INTERNATIONAL MEDICAL GROUP INTERNATIONAL UNION of OPERATING ENGINEERS LOC 15 INTERWEST HEALTH (ACCEPTIUS GATEWAY PAYOR) INTERWEST HEALTH - ACCEPTIUS GATEWAY PAYOR IOWA BLUE CROSS IOWA BLUE SHIELD IOWA MEDICAID IOWA MEDICAID IOWA MEDICARE IOWA MEDICARE IPA of KANE COUNTY IPA of KANE COUNTY J. SMITH LANIER and CO. ADMINISTRATORS J.F. MOLLOY AND ASSOCIATES, INC. J.F. MOLLOY AND ASSOCIATES, INC. J1 MUTUAL of OMAHA CA, HI, NV

INTERMEDIARY

PAYOR ID

31053 31053 50946 50946 52196 52196 NAING IEHP1 31172 4320 4320 37279 37279 13315 13315 IMSMS 52104 TH012 86304 86304 31127 31127 31129 23229 23229 34167 34167 68053 58200 58200 37269

54763 37227 37227

60280 60280 23287 23287 48603 48603 16158 16158 39182 39182 37269 84137 84137 WELLMARK EDS/EC SOL 12B10 WELLMARK EDS/EC SOL SB640 NORIDIAN ADMIN. SERVICES 12K10 NORIDIAN ADMIN. SERVICES SKIA0 WPS SMIA0 WPS 12M10

37272 61271 61271 PALMETTO GBA

Agreement required No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No Yes No No No No No No No No No No No No No No Yes Yes Yes Yes Yes Yes No No No No No Yes

REMIT Yes Yes Yes Yes No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No Yes Yes Yes Yes Yes Yes No No No Yes Yes Yes

Claim type Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Professional Institutional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Institutional Professional Institutional

ST

FL

CA

KS KS MO MO

KS KS KS KS

CPID 3677 3650 5885 3683 3681 5884 2784 2777 1663 3682 4509 6405 4509 6405 8936 4153 3284 8917 6491 4522 4291 2284 4271 5432 1592 4959 4750 3255 1659 3771 2578 6556 3246 4293 7506 2819 1931 2439 8546 1846 2582 3781 2992 2259 4576 1703 2266 1544 5545 2837 5545 2837 5882 3679 5519 2422 5569 4419 7933 5116 5520 1485 2463 5518 5117 4117 6996 1428 5982

PAYOR J12 MUTUAL of OMAHA DC, DE, MD, NJ, PA J4 MUTUAL of OMAHA CO, NM, OK, TX JACKSON MEMORIAL HEALTH MEDICAID HMO JACKSON MEMORIAL HEALTH MEDICAID HMO JACKSON MEMORIAL HEALTH MEDICARE ADVANTAGE JACKSON MEMORIAL HEALTH MEDICARE ADVANTAGE JACKSON MEMORIAL HEALTH PLAN - MEDICAID JACKSON MEMORIAL HEALTH PLAN COMMERCIAL HMO JACKSON MEMORIAL HEALTH PLAN COMMERCIAL HMO JACKSON MEMORIAL HEALTH SFCCH PHT (PSN, CMSN) JACKSON PPO JACKSON PPO JACKSONVILLE PPO JACKSONVILLE PPO JAI MEDICAL SYSTEMS JENKINS & ASSOCIATES - GA JFK HOSPITAL JI SPECIALITY SERVICES JOHN ALDEN LIFE JOHN ALDEN LIFE INSURANCE JOHN MORRELL COMPANY - AHPBA JOHN MUIR MT. DIABLO HEALTH SYSTEM JOHN MUIR TRAUMA PHYSICIANS JOHNS HOPKINS HEALTHCARE JOHNS HOPKINS HEALTHCARE JOHNS HOPKINS MEDICAL SERVICE JOHNS HOPKINS MEDICAL SERVICE JOPLIN CLAIMS JOPLIN CLAIMS JP FARLEY CORPORATION JP FARLEY CORPORATION JSL ADMINISTRATORS JSL ADMINISTRATORS KAISER PERMANENTE INSURANCE COMPANY KAISER PERMANENTE MID-ATLANTIC STATES KAISER PERMANENTE MID-ATLANTIC STATES KAISER PERMANENTE of COLORADO KAISER PERMANENTE of COLORADO KAISER PERMANENTE of GEORGIA KAISER PERMANENTE of GEORGIA KAISER PERMANENTE of N CA REGION KAISER PERMANENTE of N CA REGION KAISER PERMANENTE of OHIO KAISER PERMANENTE of OHIO KAISER PERMANENTE of S CA REGION KAISER PERMANENTE of S CA REGION KAISER PERMANENTE of the NORTHWEST KAISER PERMANENTE of the NORTHWEST KANAWHA HEALTHCARE SOLUTIONS, INC. KANAWHA HEALTHCARE SOLUTIONS, INC. KANAWHA INSURANCE COMPANY KANAWHA INSURANCE COMPANY KANE COUNTY IPA KANE COUNTY IPA KANSAS BLUE CROSS - TOPEKA KANSAS BLUE SHIELD - TOPEKA KANSAS CITY BLUE CROSS - KANSAS CITY, MO KANSAS CITY BLUE SHIELD - KANSAS CITY, MO KANSAS CITY LIFE INSURANCE COMPANY KANSAS CITY LIFE INSURANCE COMPANY KANSAS MEDICAID KANSAS MEDICAID KANSAS MEDICARE KANSAS MEDICARE KAPIOLANI HEALTH COMMERCIAL KATY MEDICAL GROUP KATY MEDICAL GROUP KELSEY SEYBOLD KELSEY SEYBOLD

INTERMEDIARY PAYOR ID HIGHMARK MEDICARE SERVICE 16001 16001 59171 59171 9822 5014 5014 9822 62308 62308 62308 62308

PPM01 41099 41099 38310 68036 68013 52189 52189 52123 52123 43178 43178 34136 34136 37272 37272 94320 52095 52095 91617 91617 21313 21313 94135 94135 34092 34092 94134 94134 93079 93079 57038 57038 57038 57038

KANSAS BCBS KANSAS BCBS KANSAS BCBS KANSAS BCBS

57325 SB650 SB740

EDS - ELECTRONIC DATA SER SKKS0 WPS SMKS0 WPS 57324

TH050 TH050

Agreement required Yes Yes No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No Yes Yes Yes Yes No No No No Yes Yes No No No No No

REMIT Yes Yes No No No No No No No No Yes Yes Yes Yes No No No No Yes Yes No No No No No Yes Yes No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes No No Yes Yes Yes No No No No No No

Claim type Institutional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional

ST

KY KY

KY KY KY KY

CPID 8435 8435 4577 4577 5950 2118 5534 2421 4544 2449 5535 1493 2462 5533 4629 6149 3803 9500 4509 6405 2821 7505 4590 5402 4167 4933 5880 8475 6531 3567 7483 5787 1622 6555 5422 5988 7965 5196 5197 7966 7967 5198 5119 7978 7934 3649 9575 5886 8414 5262 8939 3294 6115 5120 3691 5121 7935 2282 2924 1575 3953 5974 3455 5968 2153 3907 3844 6101 4608

PAYOR KEMPTOM COMPANY KEMPTOM GROUP ADMINISTRATORS KEMPTON COMPANY KEMPTON GROUP ADMINISTRATORS KENT COUNTY HEALTH PLAN KENT COUNTY HEALTH PLAN KENTUCKY BLUE CROSS KENTUCKY BLUE SHIELD KENTUCKY KARE KENTUCKY KARE KENTUCKY MEDICAID KENTUCKY MEDICAID KENTUCKY MEDICARE KENTUCKY MEDICARE KENTUCKY SPIRIT HEALTH PLAN KENTUCKY SPIRIT HEALTH PLAN KERN HEALTH SYSTEMS KERN HEALTH SYSTEMS KERN PPO - CALIFORNIA KERN PPO - CALIFORNIA KEY BENEFIT ADMINISTRATORS, INC. KEY BENEFIT ADMINISTRATORS, INC. KEY HEALTH PLAN KEY HEALTH PLAN KEY MEDICAL GROUP KEY SELECT KEY SELECT KEYSTONE MERCY HEALTH PLAN KEYSTONE MERCY HEALTH PLAN KITSAP PHYSICIANS SERVICE (KPS) KITSAP PHYSICIANS SERVICE (KPS) KLAIS & CO REPRICING via HEALTHSPAN KLAIS & CO REPRICING via HEALTHSPAN KLAIS and COMPANY KLAIS and COMPANY LA CARE HEALTH PLAN LA CARPENTERS REG COUNCIL HEALTH BENEFITS TRST FND LA CARPENTERS REG COUNCIL HEALTH BENEFITS TRST FND LA CARPENTERS REGULAR COUNCIL WELFARE FUND LA CARPENTERS REGULAR COUNCIL WELFARE FUND LA LABORERS HEALTH & WELFARE FUND LA LABORERS HEALTH & WELFARE FUND LAFAYETTE CONSOLIDATED GOVERNMENT LAFAYETTE CONSOLIDATED GOVERNMENT LAKE FOREST MANAGED CARE ASSOCIATES LAKESIDE HEALTH SERVICES LAKESIDE MEDICAL GROUP LAKESIDE MEDICAL GROUP LAKESIDE MEDICAL GROUP, INC. LANCASTER GENERAL HEALTH GROUP LANCASTER GENERAL HEALTH GROUP LANDMARK INSURANCE LASALLE MEDICAL ASSOCIATES LAWNDALE CHRISTIAN HEALTH CENTER LBA HEALTH PLANS LBA HEALTHPLANS LEGGETT AND PLATT LEON MEDICAL CENTER HEALTH PLAN LEON MEDICAL CTR HEALTH LHP CLAIMS UNIT LIBERTY HEALTH ADVANTAGE LIBERTY MUTUAL LIBERTY MUTUAL - P2P LINK LIBERTY MUTUAL GROUP COMPANIES LIBERTY MUTUAL GROUP COMPANIES LIFE TRAC LIFE TRAC LIFEPRINT LIFEPRINT

INTERMEDIARY

PAYOR ID Agreement required 73100 No 73100 No 73100 No 73100 No No No WELLPOINT_ 12B11 No WELLPOINT_ SB660 No 61101 No 61101 No EDS - ELECTRONIC DATA SER 12K11 Yes EDS - ELECTRONIC DATA SER SKKY0 Yes CIGNA GOVERNMENT SERVICES SMKY0 Yes CIGNA GOVERNMENT SERVICES 12M11 Yes 68067 No 68067 No 77039 No 77039 No 62308 No 62308 No 37217 No 37217 No 39026 No 39026 No IP082 No 37321 No 37321 No 23284 No 23284 No NETWORK DATA EXPRESS KPS01 No KPS01 No No No 34145 No 34145 No LACAR No No No No No No No No No No No No No 95415 No 16109 No 16109 No LNDMK No No 36333 No 52193 No 52193 No No 37316 No 37316 No 58102 No 87071 No Yes 11123 Yes 77138 No 77138 No 41136 No 41136 No LIFE1 No LIFE1 No

REMIT No No No No No No Yes Yes Yes Yes No Yes Yes No No No No No Yes Yes No No Yes Yes No No No Yes Yes Yes Yes No No No No No No No No No No No No No No No No No No No No Yes No No No No No No No No No No No Yes Yes No No No No

Claim type Professional Professional Institutional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Institutional Institutional Professional Professional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional

ST

LA LA LA LA LA LA LA LA LA

ME ME ME ME ME ME

IN IN WI

CPID 2854 2581 7445 5522 2449 4544 2679 4121 5123 2826 7509 5124 5125 5541 5444 3580 2758 1475 3578 2236 5232 4249 3579 1460 3689 2251 1596 2250 4590 5402 5126 2270 7936 4730 5539 1419 1989 1704 5286 1611 1837 8538 3548 7446 5259 9582 3547 2472 4462 3960 3429 3550 2520 1878 4238 1955 1495 2703 1562 2702 4820 3504 3550 3429 3728 8977 8575 5251 5246

PAYOR LIFEWISE HEALTHPLAN of OREGON LIFEWISE HEALTHPLAN of OREGON LIFEWISE of WASHINGTON LIFEWISE of WASHINGTON LINCOLN NATIONAL - PHOENIX, AZ LINCOLN NATIONAL - PHOENIX, AZ LINDEN OAKS BEHAVIORAL HEALTH LINDEN OAKS BEHAVIORAL HEALTH LINN COUNTY LOCAL 135 HEALTH BENEFITS FUND (INDIANAPOLIS, IN) LOCAL 135 HEALTH BENEFITS FUND (INDIANAPOLIS, IN) LOMA LINDA UNIVERSITY ADVENTIST LONDON HEALTH ADMINISTRATORS LOOMIS COMPANY (THE) LOOMIS COMPANY (THE) LOUISIANA BLUE CROSS LOUISIANA BLUE SHIELD LOUISIANA MEDICAID LOUISIANA MEDICAID LOUISIANA MEDICAID - AMBULANCE LOUISIANA MEDICAID - DME LOUISIANA MEDICAID KIDMED LOUISIANA MEDICARE LOUISIANA MEDICARE LOVELACE SALUD LOVELACE SALUD LOVELACE SANDIA HEALTH PLAN LOVELACE SANDIA HEALTH PLAN La CROSSE CARE PLUS La CROSSE CARE PLUS MACHINIST DISTRICT 9 WELFARE MACNEAL HEALTH PROVIDERS - CHS MAG MUTUAL HEALTHCARE SOLUTIONS MAGAN MEDICAL CLINIC MAGELLAN HEALTH SERVICES (MAGELLAN BEHAVIORAL HLT) MAGELLAN HEALTH SERVICES (MAGELLAN BEHAVIORAL HLTH MAGNACARE MAGNACARE MAGNOLIA HEALTH PLAN (MISSISSIPPI) MAGNOLIA HEALTH PLAN - MISSISSIPPI MAIL HANDLERS BENEFIT PLAN MAIL HANDLERS BENEFIT PLAN MAINE BLUE CROSS MAINE BLUE SHIELD MAINE MEDICAID - DOS >08/31/10 MAINE MEDICAID - DOS >08/31/10 MAINE MEDICARE MAINE MEDICARE MAKSIN MANAGEMENT MAKSIN MANAGEMENT CORPORATION MAMSI LFE AND HLTH INS. CO. MAMSI LIFE & HEALTH INSURANCE CO. (MLH) MANAGED CARE SERVICES MANAGED CARE SERVICES MANAGED CARE SYSTEMS (DELANGO REGIONAL MEDICAL) MANAGED HEALTH NETWORK MANAGED HEALTH NETWORK MANAGED HEALTH SERVICES - INDIANA MANAGED HEALTH SERVICES - INDIANA MANAGED HEALTH SERVICES - WISCONSIN MANAGED HEALTH SERVICES - WISCONSIN MANAGED HEALTH SERVICES - WISCONSIN MANAGED PHYSICAL NETWORK MANAGED PHYSICAL NETWORK MANATEE SERVICE CENTER (BRADENTON, FL) MANATEE SERVICE CENTER - FLORIDA MANHATTAN NATIONAL LIFE INSURANCE MAPFRE MARCH VISION CARE

INTERMEDIARY

PAYOR ID Agreement required 93093 Yes PREMERA BLUE CROSS 93093 Yes PREMERA BLUE CROSS SB930 Yes PREMERA BLUE CROSS 12B27 Yes 61101 No 61101 No No No No 35107 No 35107 No 37267 No 37226 No 23223 No 23223 No 12B12 Yes 23738 Yes UNISYS SKLA0 Yes UNISYS 12K12 Yes UNISYS SKLA2 Yes UNISYS Yes UNISYS SKLA3 Yes PALMETTO GBA 12M12 Yes ARKANSAS BC BS SMLA0 Yes SX159 No SX159 No 90328 No 90328 No 39026 No 39026 No No 36334 No No HCP01 No 1260 No 1260 No 11303 No 11303 No 68062 No 68062 No 25133 No 25133 No WELLPOINT 12B13 No WELLPOINT SB680 No SKME0 Yes 12K13 Yes NATIONAL HERITAGE INS CO 14101 Yes NATIONAL HERITAGE INS CO 14102 Yes 22195 No 22195 No 87726 No 87726 No 35162 No 35162 No MCS02 No 22771 No 22771 No CENTENE CORPORATION 39186 Yes CENTENE CORPORATION 39186 Yes CENTENE CORPORATION 39187 Yes 39187 No 39187 Yes 87726 No 87726 No 41555 No 41555 No Yes Yes No

REMIT Yes Yes Yes Yes Yes Yes No No No No No No No No No Yes Yes Yes Yes Yes No Yes Yes Yes No No No No Yes Yes No Yes No No Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes No No No No No No No Yes Yes No Yes Yes No No No No No

Claim type Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional

ST

MD MD MD MD MD MD MD

MA MA MA MA MA MA MA

MI

CPID 2183 4798 5933 5934 4799 1639 5701 2164 5976 7518 2419 1488 5552 5554 7402 2464 3822 1597 8976 2818 5528 2424 5529 4492 4491 2469 5527 3476 4936 7577 2752 2752 7577 1923 2267 2426 3532 5128 2844 5927 4791 2592 3794 3794 2592 2592 3794 2592 2592 3794 2592 3794 2592 3794 3794 2592 2592 3794 3794 2592 2592 3794 2592 3794 2592 3794 2592 3794 2592

PAYOR MARIN IPA MARION POLK COMMUNITY HEALTH PLAN (MPCHP) MARION POLK COMMUNITY HEALTH PLAN (MPCHP) MARION POLK COMMUNITY HEALTH PLAN ADVANTAGE MARION POLK COMMUNITY HEALTH PLAN ADVANTAGE MARTINS POINT HEALTH CARE USFHP/GENERATIONS ADV MARTINS POINT HEALTH CARE USFHP/GENERATIONS ADV MARYLAND BEHAVIORAL HEALTH MARYLAND BEHAVIORAL HEALTH MARYLAND BLUE CROSS - CAREFIRST MARYLAND BLUE SHIELD - CAREFIRST MARYLAND MEDICAID MARYLAND MEDICAID MARYLAND MEDICARE MARYLAND MEDICARE MARYLAND MEDICARE (MONTG, PRINCE GEORGE) MARYLAND PHYSICIANS CARE MARYLAND PHYSICIANS CARE MASHANTUCKET PEQUOT TRIB MASHANTUCKET PEQUOT TRIBAL NAT. MASSACHUSETTS BLUE CROSS MASSACHUSETTS BLUE SHIELD MASSACHUSETTS MEDICAID MASSACHUSETTS MEDICAID (FORMAT 5) MASSACHUSETTS MEDICAID (FORMAT 9) MASSACHUSETTS MEDICARE MASSACHUSETTS MEDICARE MASTER, MATES, and PILOTS MASTERS, MATES, & PILOTS PROGRAM MAYO MANAGEMENT SERVCES, INC (MMSI) MAYO MANAGEMENT SERVCES, INC (MMSI) MAYO MANAGEMENT SOUTH COUNTRY MAYO MANAGEMENT SOUTH COUNTRY MBA of UTAH CDO TECHNOLOGIES MBA of UTAH and WYOMING MCARE MCARE MCC BEHAVORIAL CARE MCCREARY (EMI) CORPORATION MCKINLEY LIFE INSURANCE CO. MCKINLEY LIFE INSURANCE CO. MCLAREN ABW - BRANCH, HILLSDALE, ST. JOSEPH HEALT MCLAREN ABW - BRANCH, HILLSDALE, ST. JOSEPH HEALT MCLAREN ABW - WASHTENAW COUNTY PLAN MCLAREN ABW - WASHTENAW COUNTY PLAN MCLAREN ABW - BE HEALTHY PROGRAM MCLAREN ABW - BE HEALTHY PROGRAM MCLAREN ABW - BERRIEN COUNTY MCLAREN ABW - CALHOUN HEALTH PLAN MCLAREN ABW - CALHOUN HEALTH PLAN MCLAREN ABW - COALITION HEALTH ACCESS PROGRAM MCLAREN ABW - COALITION HEALTH ACCESS PROGRAM MCLAREN ABW - INGHAM HEALTH PLAN MCLAREN ABW - INGHAM HEALTH PLAN MCLAREN ABW - IONIA HEALTH PLAN MCLAREN ABW - IONIA HEALTH PLAN MCLAREN ABW - JACKSON HEALTH PLAN MCLAREN ABW - JACKSON HEALTH PLAN MCLAREN ABW - KALAMAZOO COUNTY HEALTH PLAN MCLAREN ABW - KALAMAZOO COUNTY HEALTH PLAN MCLAREN ABW - KENT HEALTH PLAN MCLAREN ABW - KENT HEALTH PLAN MCLAREN ABW - LIVINGSTON HEALTH PLAN MCLAREN ABW - LIVINGSTON HEALTH PLAN MCLAREN ABW - MEDICAL ACCESS PROGRAM MCLAREN ABW - MEDICAL ACCESS PROGRAM MCLAREN ABW - MID-MICHIGAN HEALTH PLAN MCLAREN ABW - MID-MICHIGAN HEALTH PLAN MCLAREN ABW - MONROE COUNTY HEALTH PLAN

INTERMEDIARY

PAYOR ID IP097

12011 SB690 SKMD0 12007 HIGHMARK MEDICARE SERVICE 12010 HIGHMARK MEDICARE SERVICE HIGHMARK MEDICARE SERVICE SMMD0 22348 22348 37121 37121 12B14 SB700 UNISYS 12K14 EDS - ELECTRONIC DATA SER SKMA0 EDS - ELECTRONIC DATA SER SKMA0 NATIONAL HERITAGE INS CO 14202 NATIONAL HERITAGE INS CO 14201 TH111 MMPHB 41154 41154 41154 41154 87065 87065 MICHIGAN BCBS SB711 MICHIGAN BCBS 12B58 59331

38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338 38338

Agreement required No Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes No No No No No No No No Yes Yes No No Yes Yes No No No No No No No No No No No No No No No No No No No No No No No No No No No No

REMIT No No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes No Yes Yes Yes No No Yes Yes Yes Yes No No Yes Yes No No Yes Yes No No No No No No No No No No No No No No No No No No No No No No No No No No No No

Claim type Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional

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CPID 3794 2592 3794 3794 2592 2592 3794 3794 2592 2592 3794 3794 2592 4795 5929 2592 3794 2592 3794 3616 3429 8531 4481 4976 1954 3214 1954 3214 4976 4481 4481 4976 2990 1754 2990 1754 4481 4976 4481 4976 6139 1761 7529 2911 2235 7558 7480 4724 4786 1587 4720 1590 4719 4721 1588 1919 4723 4725 1892 1707 8975 4939 3271 4266 8974 1880 6533 6474 3765

PAYOR MCLAREN ABW - MONROE COUNTY HEALTH PLAN MCLAREN ABW - NORTHERN HEALTH PLAN MCLAREN ABW - NORTHERN HEALTH PLAN MCLAREN ABW - NORTHERN HEALTH PLAN NE MCLAREN ABW - NORTHERN HEALTH PLAN NE MCLAREN ABW - STUDENT HEALTH SUBSIDY PROGRAM MCLAREN ABW - STUDENT HEALTH SUBSIDY PROGRAM MCLAREN ABW - TENCON HEALTH PLAN CORP MCLAREN ABW - TENCON HEALTH PLAN CORP MCLAREN BCCCP MCLAREN BCCCP MCLAREN HEALTH ADVANTAGE MCLAREN HEALTH ADVANTAGE MCLAREN HEALTH PLAN - JVHL MCLAREN HEALTH PLAN - JVHL MCLAREN HEALTH PLANS MCLAREN HEALTH PLANS MCLAREN MEDICAID MCLAREN MEDICAID MCOA MD-INDIVIDUAL PRACTICE ASSOC. MDNY HEALTHCARE MDWISE HEALTH INDIANA PLAN (HIP) DOS > 3/31/11 MDWISE HEALTH INDIANA PLAN (HIP) DOS > 3/31/11 MDWISE HOOSIER ALLIANCE HEALTH PLAN MDWISE HOOSIER ALLIANCE HEALTH PLAN MDWISE HOOSIER ALLIANCE HEALTH PLAN PSYCH MDWISE HOOSIER ALLIANCE HEALTH PLAN PSYCH MDWISE MEDICAID METHODIST IU NETWORK MDWISE MEDICAID METHODIST IU NETWORK MDWISE MEDICAID METHODIST PSYCH MDWISE MEDICAID METHODIST PSYCH MDWISE MEDICAID PROHEALTH NETWORK MDWISE MEDICAID PROHEALTH NETWORK MDWISE MEDICAID PROHEALTH PSYCH MDWISE MEDICAID PROHEALTH PSYCH MDWISE MEDICAID WISHARD IU NETWORK MDWISE MEDICAID WISHARD IU NETWORK MDWISE MEDICAID WISHARD PSYCH MDWISE MEDICAID WISHARD PSYCH MDWISE SELECT HEALTH NETWORK MDWISE SELECT HEALTH NETWORK/PSYCH MDWISE SELECT HEALTH NETWORK/PSYCH MDWISE ST VINCENT MDWISE ST VINCENT MED ELECT MED-PAY, INC. MED3000 HEALTH SELECT IPABCBS MED3000 HEALTHSPRINGS MED3000 HFN HEALTH KIDS MED3000 HFN HEALTH KIDS MED3000 HFN PEDICARE MED3000 HFN VISTA MED3000 HFN WELLCARE CHOICE MED3000 HFN WELLCARE CHOICE MED3000 MD MEDICARE CHOICE MED3000 PEDICARE MED3000 SOUTH WEST IPABCBS MEDADMIN SOLUTIONS MEDADMIN SOLUTIONS (ADS) MEDADMIN SOLUTIONS(ADS) MEDCOM MEDCOM MEDCORE HP MEDCOST BENEFIT SERVICES MEDCOST BENEFIT SERVICES (MBS) MEDCOST INC. MEDCOST, INC. MEDFOCUS

INTERMEDIARY

PAYOR ID Agreement required 38338 No 38338 No 38338 No 38338 No 38338 No 38338 No 38338 No 38338 No 38338 No 38338 No 38338 No 38338 No 38338 No Yes Yes 38338 No 38338 No 38338 No 38338 No 88054 No 87726 No 11338 No No No 20475 No 20475 No 20475 No 20475 No No No No No 35161 No 35161 No 35161 No 35161 No No No No No No 64157 No 64157 No 35199 No 35199 No No No Yes Yes M3FL0003 Yes Yes M3FL0006 Yes Yes No M3FL0004 No Yes Yes Yes 58204 No 58202 No 58202 No 59231 No 59231 No MDCOR No 56205 No 56205 No 56162 No 56162 No 95321 No

REMIT No No No No No No No No No No No No No Yes Yes No No No No No Yes No Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes No No No No No No No No No No No No No No No No No No No No No No No No No No

Claim type Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional

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PR SC SC

SC

PR MI MI

CPID 1431 8598 4243 8597 1419 5539 2704 1928 2772 3263 3985 3231 4945 1728 8513 1728 8513 1728 8513 1728 8513 1543 2410 2410 4581 2252 1598 3942 3506 4423 5129 5235 1524 4544 3523 5293 3744 5911 5130 5967 6466 6513 2145 2410 4229 4230 4231 4232 1591 2287 1913 4714 1584 5930 1617 6148 3698 8973 1825 3614 4775 7486 3885 6465 4593 2583 2894 1945 3209

PAYOR MEDICA MEDICA CHOICE - FEE FOR SERVICE MEDICA HEALTH CARE PLAN, INC. MEDICA PHP SHARE PRIMARY MEDICAID MAGELLAN PSYCH NETWORK MEDICAID MAGELLAN PSYCH NETWORK MEDICAL ADMINISTRATORS, INC. MEDICAL ASSOCIATES HEALTH PLANS MEDICAL ASSOCIATES HEALTH PLANS - FEE FOR SERVICE MEDICAL BENEFIT ADMIN, INC. / dba MBA OF MD, INC. MEDICAL BENEFIT ADMIN, INC. / dba MBA OF MD, INC. MEDICAL BENEFIT ADMINISTRATORS MEDICAL BENEFIT ADMINISTRATORS MEDICAL BENEFITS ADMINISTATORS, INC. (NEWARK, OH) MEDICAL BENEFITS ADMINISTRATORS (NEWARK, OH) MEDICAL BENEFITS COMPAINES (NEWARK, OH) MEDICAL BENEFITS COMPANIES (NEWARK, OH) MEDICAL BENEFITS MUTUAL (NEWARK, OH) MEDICAL BENEFITS MUTUAL (NEWARK, OH) MEDICAL BENEFITS MUTUAL LIFE INSURANCE COMPANY MEDICAL BENEFITS MUTUAL LIFE INSURANCE COMPANY MEDICAL CARD SYSTEMS (MCS) REFORMA MEDICAL CLAIMS MANAGEMENT CORP MEDICAL CLAIMS MANAGEMENT CORPORATION MEDICAL CONTROL INC. MEDICAL DEVELOPMENT INTERNATIONAL MEDICAL DEVELOPMENT INTERNATIONAL MEDICAL MUTUAL OF OHIO CAREWORKS MEDICAL MUTUAL OF OHIO - PROLINK MEDICAL MUTUAL of OHIO - PROLINK MEDICAL NETWORK OF COLORADO SPRINGS MEDICAL PARTNERS OF AMERICA MEDICAL PARTNERS OF AMERICA MEDICAL PLAN OF KANSAS CITY, MO MEDICAL REIMBURSEMENT ASSOCIATES MEDICAL REIMBURSEMENT ASSOCIATES MEDICAL RESOURCE NETWORK MEDICAL RESOURCE NETWORK MEDICAL SELECT MANAGEMENT MEDICAL SERVICES FOR INDIGENTS (MSI) MEDICAL VALUE PLAN - OHIO (MVP) MEDICAL VALUE PLAN - OHIO (MVP) MEDICARE ADVANTAGE DME (DMEnsion) MEDICARE BLUE MEDICARE DME MAC JURISDICTION A MEDICARE DME MAC JURISDICTION B MEDICARE DME MAC JURISDICTION C MEDICARE DME MAC JURISDICTION D MEDICARE MUCHO MAS (MMM) MEDICARE PLUS BLUE - MEDICARE ADVANTAGE PLAN MEDICARE PLUS BLUE - MEDICARE ADVANTAGE PLAN MEDIGOLD MEDIGOLD MEDIGOLD PPO MEDIVIEW MEDPARTNERS ADMINISTRATIVE SERVICES MEDPAY ASSURANCE MEDSOLUTIONS, INC. MEDSOLUTIONS, INC. MEDSTAR FAMILY CHOICE MEDSTAR FAMILY CHOICE MEDSTAR PHYSICIAN PARTNERS BALTIMORE MEGA LIFE & HEALTH INSURANCE CO - STARBRIDGE MEGA LIFE & HEALTH INSURANCE CO-STUDENT INSURANCE MEGA LIFE & HEALTH INSURANCE CO-STUDENT INSURANCE MEGA LIFE AND HEALTH INSURANCE CO. MEGA LIFE AND HEALTH INSURANCE COMPANY MEGA LIFE and HEALTH INSURANCE COMPANY - OKC MEGA LIFE and HEALTH INSURANCE COMPANY - OKC

INTERMEDIARY

PAYOR ID Agreement required 94265 No 94265 No 78857 No 94265 No 1260 No 1260 No 31147 No Yes Yes 37298 No 37298 No 68041 No 68041 No 74323 No 74323 No 74323 No 74323 No 74323 No 74323 No 74323 No 74323 No INMEDIATA (PR) 660396197P Yes SB880 No SB880 No 75229 No 52181 No 52181 No 10010 No 29076 No 29076 No No 80026 No 80026 No 61101 No 62177 No 62177 No 58203 No 58203 No No AMM02 No 38224 No 38224 No MICHIGAN BCBS Yes SB880 No NATIONAL GOVERNMENT SERV. SDMEA Yes SDMEB Yes SDMEC Yes NATIONAL GOVERNMENT SERV. SDMED Yes INMEDIATA (PR) 660588600 Yes MICHIGAN BCBS SX170 Yes MICHIGAN BCBS 210 Yes 95655 No 95655 No No No 35205 No Yes No 62160 No Yes Yes 243 No 59225 No 74227 No 74227 No 59221 No 59221 No 59227 No 59227 No

REMIT Yes Yes No Yes Yes Yes No No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes No No No Yes No No No No No No Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No No Yes Yes No No

Claim type Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Institutional Professional Professional Professional Institutional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Professional Professional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Institutional Professional Institutional Institutional Professional Institutional Professional Professional Professional Professional Institutional Institutional Professional Institutional Professional

ST

MI MI MI MI MI MI

CPID 1944 8978 5261 1961 3475 8915 2160 4730 5960 4787 1616 5298 3433 3530 2746 7550 1782 4777 5916 1761 7529 5260 4561 1708 3969 4282 5132 7558 8972 2296 2787 1566 7558 1421 2449 4544 4544 3675 2804 3514 3531 1421 3512 2480 3515 1461 5133 3429 8900 2113 1613 5294 3429 2497 7938 2584 3714 8565 5221 3229 1918 1742 6588 1742 6588 1796 4992 2764 1977

PAYOR MEGA LIFE and HEALTH STARBRIDGE STARHRG MEMIC MEMIC MEMORIAL CLINICAL ASSOCIATES/SELECTCARE OF TEXAS MEMORIAL HERMANN MEMORIAL HERMANN HEALTH MEMORIAL INTEGRATED HEALTHCARE MEMORIAL MEDICAL GROUP MENTAL HEALTH NETWORK - MHNET MENTAL HEALTH NETWORK - MHNET MERCY CARE MERCY CARE MERCY CARE PLAN of ARIZONA MERCY CARE PLAN of ARIZONA MERCY HEALTH PLAN (MHP) OF MISSOURI MERCY HEALTH PLAN (MHP) of MISSOURI MERCY PHYSICIANS MEDICAL GROUP MERIDIAN HEALTH PLAN MERIDIAN HEALTH PLAN MERITAIN HEALTH MERITAIN HEALTH MERITAIN HEALTH / AGENCY SERVICES MERITAIN HEALTH MINNEAPOLIS MERITAIN HEALTH MINNEAPOLIS METCARE HEALTH PLAN METCARE HEALTH PLANS METHODISTCARE, INC. METLIFE HEALTHCARE NETWORK - PPO/HMO METRO PLUS HEALTH PLAN METRO PLUS HEALTH PLAN METROPOLITAN HEALTH PLAN (MHP) METROPOLITAN HEALTH PLAN (MHP) METROPOLITAN LIFE INSURANCE CO. MI BCBS FEP MICHAEL REESE HMO PLAN MICHAEL REESE HMO PLAN - ILLINOIS MICHAEL REESE HMO PLAN - INDIANA MICHAEL REESE PHYSICIAN GROUP MICHAEL REESE PHYSICIANS GROUP MICHIGAN BLUE CROSS MICHIGAN BLUE CROSS (FEP) MICHIGAN BLUE SHIELD MICHIGAN MEDICAID MICHIGAN MEDICAID MICHIGAN MEDICARE MICHIGAN MEDICARE MICRON TECH MID ATLANTIC MEDICAL SERVICES, INC (MAMSI) MID ROGUE IPA MID ROGUE IPA MID-AMERICA ASSOCIATES MID-AMERICA ASSOCIATES MID-ATLANTIC PSYCHIATRIC SERV. INC. MAPS MID-COUNTY PHYSICIANS MEDICAL GROUP (SAN DIEGO) MID-VALLEY CARENET, INC. MID-WEST NATIONAL LIFE INS. CO. OF TN MID-WEST NATIONAL LIFE INSURANCE CO. OF TENNESSEE MIDDLESEX INSURANCE COMPANY - P2P LINK MIDDLESEX INSURANCE COMPANY - P2P LINK MIDLAND MANAGEMENT / MFC MIDLAND MANAGEMENT / MFC MIDLANDS BENEFITS ADMINISTRATORS MIDLANDS BENEFITS ADMINISTRATORS MIDLANDS CHOICE MIDLANDS CHOICE MIDWEST GROUP BENEFITS MIDWEST HEALTH PLAN - JVHL MIDWEST HEALTH PLAN - JVHL MIDWEST HEALTH PLANS

INTERMEDIARY

PAYOR ID Agreement required 59225 No 1047 No 1047 No 62181 No TH092 No No 59064 No HCP01 No 74289 No 74289 No 39114 No 39114 No AETNA 86052 No AETNA 86052 No 43166 No 43166 No E3510 No 13189 No 13189 No 64157 No 64157 No 64158 No 41124 No 41124 No 65113 No 65113 No No No 13265 No 13265 No 10850 No 10850 No No MICHIGAN BCBS SB710 Yes 61101 No 61101 No 61101 No 37127 No 37127 No MICHIGAN BCBS 12B18 Yes MICHIGAN BCBS Yes MICHIGAN BCBS SB710 Yes 12K37 Yes SKMI0 Yes UNITED GOVERNMENT SERVICE 12M18 Yes WPS SMMI0 Yes No 87726 No No MRIPA No 37281 No 37281 No 87726 No SYMED No No 59224 No 59224 No Yes Yes 23550 No 23550 No 47080 No 47080 No 47080 No 47080 No 61146 No Yes Yes 12T54 No

REMIT No No No No No No No No No No No No Yes Yes No No No Yes Yes Yes Yes No No No No No No No Yes Yes Yes Yes No Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes No Yes No No No No Yes No No Yes Yes No No No No No No No No No No No No

Claim type Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional

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MN MN MN MN MN MN MN MN MN

MS MS MS

MS MS MS MS

MO MO

MO MO MO MO

MT MT MT

CPID 3422 4593 6465 7482 4566 2115 2130 1513 1402 1429 1429 1410 1468 1568 1435 3521 3785 5871 3284 5555 5561 2415 6442 4523 5557 1490 5556 2451 2179 3933 3871 2951 3446 2597 1408 1479 5969 1471 5571 5572 1441 3539 8913 2272 3848 8914 2286 1908 1863 1423 4879 5443 3551 4993 4994 2271 2239 1951 4957 4226 4237 2561 5134 2475 5180 1669 5585 7450 5586

PAYOR MIDWEST HEALTH PLANS, INC. MIDWEST NATIONAL LIFE INS of TN-STUDENT INSURANCE MIDWEST NATIONAL LIFE INS of TN-STUDENT INSURANCE MIDWEST PREFERRED MIDWEST PREFERRED MIDWEST SECURITIES MILLS PENINSULA MEDICAL GROUP, INC. MINNESOTA BLUE CROSS MINNESOTA BLUE CROSS AND BLUE SHIELD MINNESOTA BLUE CROSS/BLUE SHIELD HMO MINNESOTA BLUE PLUS MINNESOTA CC SYSTEMS MINNESOTA MEDICAID MINNESOTA MEDICAID MINNESOTA MEDICARE MINNESOTA MEDICARE MISISSIPPI SELECT HEALTH CARE MISSION COMMUNITY IPA MEDICAL GROUP MISSION MEDICAL GROUP MISSISSIPPI BLUE CROSS MISSISSIPPI BLUE CROSS-STATE EMPLOYEE MISSISSIPPI BLUE SHIELD MISSISSIPPI CHILDRENS HEALTH INSURANCE PLAN - CHIP MISSISSIPPI CHILDRENS HEALTH INSURANCE PLAN - CHIP MISSISSIPPI MEDICAID MISSISSIPPI MEDICAID MISSISSIPPI MEDICARE MISSISSIPPI MEDICARE MISSISSIPPI PHYSICIANS CARE NETWORK MISSISSIPPI PUBLIC ENTITY MISSISSIPPI PUBLIC ENTITY EMPLOYEE BENEFIT TRUST MISSISSIPPI SELECT HEALTH CARE/SELECT ADMN SERVICE MISSOULA COUNTY MEDICAL BENEFITS PLAN MISSOURI BLUE CROSS - ST LOUIS MO MISSOURI BLUE SHIELD - ST LOUIS MO MISSOURI CARE MISSOURI CARE MISSOURI MEDICAID MISSOURI MEDICAID MISSOURI MEDICARE MISSOURI MEDICARE EASTERN MOLINA HEALTHCARE OF CALIFORNIA MOLINA HEALTHCARE OF FORIDA MOLINA HEALTHCARE OF MICHIGAN NON PAR - JVHL MOLINA HEALTHCARE OF NEW MEXICO MOLINA HEALTHCARE OF NEW MEXICO MOLINA HEALTHCARE OF OHIO MOLINA HEALTHCARE OF OHIO MOLINA HEALTHCARE OF WASHINGTON, INC. MOLINA HEALTHCARE of CALIFORNIA MOLINA HEALTHCARE of FLORIDA MOLINA HEALTHCARE of MICHIGAN MOLINA HEALTHCARE of MICHIGAN MOLINA HEALTHCARE of MICHIGAN (PAR) - JVHL MOLINA HEALTHCARE of MICHIGAN (non-PAR) - JVHL MOLINA HEALTHCARE of MICHIGAN PAR - JVHL MOLINA HEALTHCARE of MISSOURI MOLINA HEALTHCARE of MISSOURI MOLINA HEALTHCARE of TEXAS MOLINA HEALTHCARE of TEXAS MOLINA HEALTHCARE of UTAH MOLINA HEALTHCARE of WASHINGTON MOMENTUM HEALTH SERVICES MONARCH IPA MONDIAL ASSISTANCE MONDIAL ASSISTANCE MONTANA BLUE CROSS MONTANA BLUE SHIELD MONTANA MEDICAID

INTERMEDIARY

PAYOR ID Agreement required TH074 No 74227 No 74227 No 79480 No 79480 No MIDSC No MPMG1 No 12B16 No SB720 No SB720 No SB720 No SB720 No SKMN0 Yes 12K16 Yes WPS SMMN0 Yes NORIDIAN ADMIN. SERVICES 12M16 Yes 64088 No MPM07 No PPM01 No TRISPAN 12B82 Yes TRISPAN 230 Yes TRISPAN 230 Yes 95378 No 95378 No HP ENTERPRISE SERVICES Testi Yes HP ENTERPRISE SERVICES SKMS0 Yes PALMETTO GBA 12M17 Yes CAHABA GBA SMMS0 Yes 64084 No 37233 No 37233 No 64088 No 37275 No WELLPOINT_ 12B15 No WELLPOINT_ SB741 No 43179 No 43179 No INFOCROSSING HLTHCRE SERVSKMO0 No INFOCROSSING HLTHCRE SERV Yes WPS 242 Yes WPS SMMO0 Yes 38333 No 51062 No Yes 9824 No 9824 No 20149 No 20149 No 38336 No 38333 No 51062 No 38334 No 38334 No Yes Yes Yes 71079 No 71079 No 20554 No 20554 No SX109 Yes 38336 No No IP095 No No No 12B77 Yes SB751 Yes HP ENTERPRISE SERVICES No

REMIT No No No Yes Yes No No Yes Yes Yes Yes Yes Yes No Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes

Claim type Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Professional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Professional Institutional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional

ST MT MT MT

WV WV

MS

CPID 4427 5584 7400 7541 2817 7537 7535 4127 4126 4424 3998 4150 1714 2449 4544 2707 3990 3810 3589 7474 3871 3871 5479 2502 2415 6442 4523 7498 2497 5956 2167 3875 2959 2420 4530 2535 2420 4530 1748 6538 2410 1744 6591 1744 6591 6591 1744 3812 8430 4534 4509 6405 6989 4107 8912 2234 6405 4509 4509 6405 5549 3769 3768 8970 5201 7970 5203 7971 8575

PAYOR MONTANA MEDICAID MONTANA MEDICARE MONTANA MEDICARE MONTEFIORE CMO MONTEFIORE CMO MONUMENTAL LIFE INSURANCE CO (Little Rock, AR) MONUMENTAL LIFE INSURANCE COMPANY (Hurst, TX) MONUMENTAL LIFE INSURANCE COMPANY (Hurst, TX) MONUMENTAL LIFE INSURANCE COMPANY (Louisville, KY) MORRIS ASSOCIATES MORRIS ASSOCIATES MOSAIC IPA MEDICAL GROUP MOTION PICTURE INDUSTRY PENSIONS and HEALTH PLAN MOTOROLA, INC. MOTOROLA, INC. MOUNTAIN MEDICAL AFFILIATES MOUNTAIN STATE ADMINISTRATIVE SERVICES MOUNTAIN STATE ADMINISTRATIVE SERVICES (TUCSON, AZ MOUNTAIN STATE BLUE CROSS (WEST VIRGINIA) MOUNTAIN STATE BLUE SHIELD (WEST VIRGINIA) MPE SERVICES INC. MPEEBT MPLAN, INC. /HEALTHCARE GROUP, LLC MPLAN, INC. /HEALTHCARE GROUP, LLC MS BCBS - STATE EMPLOYEES MS CHIP MS CHIP MULTI COUNTY CAPCARE MULTICULTURAL PRIMARY CARE MEDICAL GROUP (SAN DIEG MUNICIPAL HEALTH BENEFIT FUND MUNICIPAL HEALTH BENEFIT FUND MUTUAL ASSURANCE ADMINISTRATORS MUTUAL ASSURANCE ADMINISTRATORS MUTUAL OF OMAHA MUTUAL OF OMAHA INSURANCE COMPANY MUTUAL OF OMAHA MEDICARE MUTUALLY PREFERRED MUTUALLY PREFERRED MVP HEALTH PLANS of NEW YORK MVP HEALTH PLANS of NEW YORK Medicare Blue N.W. IRONWORKERS HLTH & SECURITY TRUST N.W. IRONWORKERS HLTH & SECURITY TRUST N.W. ROOFERS & EMP HLTH & SECURITY TRUST N.W. ROOFERS & EMP HLTH & SECURITY TRUST N.W. TEXTILE PROCESSORS N.W.TEXTILE PROCESSORS NAA (NORTH AMERICAN ADMINISTRATORS, LP) (NASHVILLE NABN (CLEVELAND, OH) NABN (CLEVELAND, OH) NALC/AFFORDABLE NALC/AFFORDABLE NAMM PARTNERS INC NAMM PARTNERS INC NAPERVILLE HEALTHCARE NAPERVILLE HEALTHCARE NATIONAL ASSOCIATION OF LETTER CARRIERS NATIONAL ASSOCIATION OF LETTER CARRIERS NATIONAL ASSOCIATION OF LETTER CARRIERS/NALC NATIONAL ASSOCIATION OF LETTER CARRIERS/NALC NATIONAL BENEFIT ADMINISTATORS - NORTH CAROLINA NATIONAL BENEFIT ADMINISTRATORS - NC NATIONAL BENEFIT ADMINISTRATORS - NJ NATIONAL BENEFIT ADMINISTRATORS NEW JERSEY NATIONAL FINANCIAL INSURANCE COMPANY NATIONAL FINANCIAL INSURANCE COMPANY NATIONAL FOUNDATION LIFE INSURANCE COMPANY NATIONAL FOUNDATION LIFE INSURANCE COMPANY NATIONAL GROUP LIFE INSURANCE CO.

INTERMEDIARY PAYOR ID Agreement required HP ENTERPRISE SERVICES SKMT0 No NORIDIAN ADMIN. SERVICES Yes NORIDIAN ADMIN. SERVICES SMMT0 Yes 13174 No 13174 No No No No No 35092 No 35092 No IP083 No MPI01 Yes 61101 No 61101 No 84095 No 86040 No 86040 No 12B28 Yes SB941 Yes 37233 No 37233 No 95444 No 95444 No TRISPAN 230 Yes 95378 No 95378 No 13350 No SYMED No 81883 No 81883 No 37256 No 37256 No 71412 No 71412 No WPS 52280 Yes 71412 No 71412 No 14165 No 14165 No SB880 No 91136 No 91136 No 91136 No 91136 No 91136 No 91136 No 65085 No 34159 No 34159 No 62308 No 62308 No No No No TH088 No 62308 No 62308 No 62308 No 62308 No 56176 No 56176 No 56175 No 56175 No No No No No Yes

REMIT Yes Yes Yes No No No No No No No No No No Yes Yes No No No Yes Yes No No No No Yes Yes Yes No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No Yes Yes No No No No Yes Yes Yes Yes No No No No No No No No No

Claim type Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional

ST

NE NE NE NE NE NE

NV NV NV NV

NH NH NH NH NH NH NJ NJ NJ

CPID 5136 1637 5239 4485 6452 4532 4530 2420 7974 5847 2407 2977 6487 2914 3874 1730 4943 3987 5137 5138 1521 1417 1520 1476 1451 1519 1567 2721 8588 5457 3645 2487 7501 1811 3251 3903 4915 5475 2523 1615 2102 3574 1783 2906 7496 7495 1446 4275 7940 5238 5278 5237 5291 5292 5888 4516 6408 3973 1477 1512 7422 7423 2575 2470 2528 2414 2414 2214 5575

PAYOR NATIONAL HEALTH ADMINISTRATORS INC. NATIONAL HEALTH BENEFITS CORPORATION NATIONAL HEALTH BENEFITS CORPORATION NATIONAL IMAGING ASSOCIATES NATIONAL RURAL ELECTRIC COOP (NRECA) NATIONAL RURAL ELECTRIC COOP (NRECA) NATIONAL RURAL LETTER CARRIER ASSOC NATIONAL RURAL LETTER CARRIERS ASSOC NATIONAL TEACHERS ASSOCIATION NATIONAL TEACHERS ASSOCIATION NATIONAL TELECOMMUNICATIONS COOPERATIVE ASSOC. NATIONWIDE HEALTH PLANS NATIONWIDE HEALTH PLANS NCAS NCAS - CHARLOTTE NCAS - FAIRFAX, VA NCAS-CHARLOTTE NCTA NCTA - PLANVISTA CORPORATION NEA GROUP INSURANCE PROGRAM NEBRASKA BLUE CROSS NEBRASKA BLUE SHIELD NEBRASKA MEDICAID NEBRASKA MEDICAID NEBRASKA MEDICARE NEBRASKA MEDICARE NEIGHBORHOOD HEALTH PARTNERSHIP of FLORIDA NEIGHBORHOOD HEALTH PARTNERSHIP of FLORIDA NEIGHBORHOOD HEALTH PLAN (MASSACHUSETTS) NEIGHBORHOOD HEALTH PLAN (MASSACHUSETTS) NEIGHBORHOOD HEALTH PLAN of RHODE ISLAND NEIGHBORHOOD HEALTH PLAN of RHODE ISLAND NEIGHBORHOOD HEALTH PROVIDERS/SUFFOLK HEALTH PLAN NEIGHBORHOOD HEALTH PROVIDERS/SUFFOLK HEALTH PLAN NESIKA HEALTH GROUP NESIKA HEALTH GROUP NETCARE LIFE HEALTH INSURANCE NETWORK HEALTH NETWORK HEALTH NETWORK HEALTH INSURANCE CORPORATION NETWORK HEALTH INSURANCE CORPORATION NETWORK HEALTH PLAN OF WISCONSIN NETWORK HEALTH PLAN OF WISCONSIN NEVADA BLUE CROSS NEVADA BLUE SHIELD NEVADA MEDICAID NEVADA MEDICARE NEVADACARE NEW ALLIANCE HEALTH PLAN NEW CENTURY HEALTH - CAREPLUS CARDIOLOGY NEW CENTURY HEALTH - HUMANA CA NEW CENTURY HEALTH - VISTA CARDIOLOGY NEW CENTURY HEALTH-BASCOM PALMER EYE CARE NETWORK NEW CENTURY HEALTH-CALIFORNIA EYE CARE NEW CENTURY INFUSION SOLUTIONS - VISTA ONCOLOGY NEW ENGLAND FINANCIAL NEW ENGLAND FINANCIAL NEW ERA LIFE NEW ERA LIFE INSURANCE COMPANY NEW HAMPSHIRE BLUE CROSS NEW HAMPSHIRE BLUE SHIELD NEW HAMPSHIRE MEDICAID NEW HAMPSHIRE MEDICAID NEW HAMPSHIRE MEDICARE NEW HAMPSHIRE MEDICARE NEW JERSEY BLUE CHOICE NEW JERSEY BLUE SELECT NEW JERSEY CARPENTERS HEALTH FUND NEW JERSEY CHARITY CARE INPATIENT

INTERMEDIARY

PAYOR ID 88050 88050 NIA11 52132 52132 71412 71412

52103 31417 31417 75190 75191 75190 75191 52103

WPS WPS

12B19 SB760 12K19 SKNE0 SMNE0 12M19 96107 96107 4293 4293 5047 5047 11325 11325 37255 37255 66055 4332 4332 77076 77076 39111 39144

WELLPOINT SB765 MAGELLAN MEDICAID ADMIN SKNV0 PALMETTO GBA SMNV0 86067 NCH04 NCH11 NCH09

WELLPOINT WELLPOINT EDS - ELECTRONIC DATA SER EDS - ELECTRONIC DATA SER NATIONAL HERITAGE INS CO NATIONAL HERITAGE INS CO

NCH08 80705 80705 75281 75281 12B21 SB770 SKNH0 SKNH0 14302 14301 22099 22099 22603

UNISYS

Agreement required No No No No No No No No No No No No No No No No No No No No No No Yes Yes Yes Yes Yes No No No Yes No No No No No No No No No No No No Yes Yes Yes Yes No No No No No No No No No No No No No No Yes Yes Yes Yes Yes Yes No Yes

REMIT No No No No Yes Yes Yes Yes No No No Yes Yes No No No No No No No Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes No No No No No Yes Yes No No No No Yes Yes Yes Yes No No No No No No No No Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes No Yes

Claim type Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Professional Professional Institutional Professional Professional Professional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional

ST NJ NJ NJ NJ NJ NM NM NM NM NM NM

NY NY NY NY NY NY NY NY NY NY NY NY NY NY

NY NY NY NY NY NY

NY

CPID 5576 5505 1483 1465 5503 3892 5565 7403 1492 5562 5566 1457 8556 1865 1812 1650 3618 3528 7432 3526 3527 3525 3449 4408 7433 4409 3520 4437 4459 3519 4442 6509 2744 7941 3425 3545 3545 4403 1422 1501 1502 1500 1463 7401 2169 6538 1748 2948 5257 5863 3665 7558 2117 3598 8522 1773 7906 3699 6539 6443 4928 4155 1761 7529 2981 8430 4534 1761 7529

PAYOR NEW JERSEY CHARITY CARE OUTPATIENT NEW JERSEY MEDICAID NEW JERSEY MEDICAID NEW JERSEY MEDICARE NEW JERSEY MEDICARE NEW MARKET DIMENSIONS NEW MEXICO BLUE CROSS NEW MEXICO BLUE SHIELD NEW MEXICO MEDICAID NEW MEXICO MEDICAID NEW MEXICO MEDICARE NEW MEXICO MEDICARE NEW ORLEANS DIVISION of MULTIPLAN NEW ORLEANS DIVISION of MULTIPLAN NEW WEST HEALTH PLAN NEW WEST HEALTH PLAN NEW YORK BLUE CROSS CENTRAL REGION NEW YORK BLUE CROSS OF ROCHESTER NEW YORK BLUE CROSS UTICA/WATERTOWN NEW YORK BLUE CROSS UTICA/WATERTOWN NEW YORK BLUE CROSS WESTERN NEW YORK BLUE CROSS of NORTHEASTERN NEW YORK NEW YORK BLUE SHIELD CENTRAL REGION NEW YORK BLUE SHIELD OF ROCHESTER NEW YORK BLUE SHIELD of NORTHEASTERN NEW YORK NEW YORK COMMUNITY BLUE HMO NEW YORK EMPIRE BLUE CROSS NEW YORK EMPIRE BLUE SHIELD NEW YORK EMPIRE BLUE SHIELD - HEALTHNET NEW YORK EMPIRE MEDICARE NEW YORK EMPIRE MEDICARE NEW YORK GROUP HEALTH INC - GHI NEW YORK GROUP HEALTH INC - GHI NEW YORK HOSPITAL COMMUNITY HEALTH PLAN NEW YORK INDEPENDENT HEALTH ASSOC (IHA) - WESTERN NEW YORK INDEPENDENT HLTH ASSOC-WESTERN NEW YORK INDEPENDENT HLTH ASSOC-WESTERN - MEDICAID NEW YORK LIFE NEW YORK MEDICAID - PHASE II NEW YORK MEDICAID INPATIENT - PHASE II NEW YORK MEDICAID OUTPATIENT - PHASE II NEW YORK MEDICAID TITLE XIX - PHASE II NEW YORK MEDICARE (UPSTATE) NEW YORK MEDICARE GHI NEW YORK NETWORD MANAGEMENT (NYNM) NEW YORK PREFERRED CARE HMO NEW YORK PREFERRED CARE HMO NEW YORK PRESBYTERIAN SYSTEM SELECT NEW YORK PRESBYTERIAN SYSTEM SELECT HEALTH NEW YORK STATE DEPT of HEALTH UNCOMPENSATED CARE NEW YORK STATE DEPT of HEALTH UNCOMPENSATED CARE NEW YORK STATE EMPLOYEES (EMPIRE) NEW YORK STATE INSURANCE FUND (NYSIF) NEW YORK UNIVERA NGS AMERICAN, INC. NGS AMERICAN, INC. NHC HEALTH BENEFIT PLAN NHI BILLING SERVICES NIPPON LIFE INSURANCE COMPANY of AMERICA NIPPON LIFE INSURANCE COMPANY of AMERICA NJ CARPENTERS HEALTH NOBLE AMA SELECT IPA NORTH AMERICAN ADMINISTRATORS, INC./MERITAIN HLTH NORTH AMERICAN ADMINISTRATORS, INC./MERITAIN HLTH NORTH AMERICAN ADMINISTRATORS, LP NORTH AMERICAN BENEFITS NETWORK (CLEVELAND, OH) NORTH AMERICAN BENEFITS NETWORK (CLEVELAND, OH) NORTH AMERICAN HEALTH PLAN / MERITAIN HEALTH NORTH AMERICAN HEALTH PLAN / MERITAIN HEALTH

INTERMEDIARY PAYOR ID Agreement required UNISYS Yes UNISYS 12006 Yes UNISYS SKNJ0 Yes HIGHMARK MEDICARE SERVICE SMNJ0 Yes HIGHMARK MEDICARE SERVICE 12005 Yes 65056 No 12B22 No SB790 No HP ENTERPRISE SERVICES SKNM0 No HP ENTERPRISE SERVICES 12K22 No TRAILBLAZER HLTHENT-GPNET12M31 Yes TRAILBLAZER HLTHENT-GPNETSMNM0 Yes 72099 No 72099 No 84141 No 84141 No EXCELLUS 12B37 Yes EXCELLUS 12B73 Yes EXCELLUS SB806 Yes EXCELLUS Yes 12B68 Yes 12B68 Yes EXCELLUS SB805 Yes EXCELLUS SB804 Yes SB800 Yes SB801 Yes 303 Yes SB803 No SB803 No NATIONAL GOVERNMENT SERV. 12M35 Yes NATIONAL GOVERNMENT SERV. SMNY0 Yes 13551 No 13551 No No SX073 Yes 12X01 Yes 12X01 Yes NYL11 No COMPUTER SCIENCES CORP SKNY0 Yes COMPUTER SCIENCES CORP 12K35 Yes COMPUTER SCIENCES CORP 12K35 Yes COMPUTER SCIENCES CORP 12K35 Yes NATIONAL GOVERNMENT SERV. Yes NATIONAL GOVERNMENT SERV. SMNY2 Yes 11334 No 14165 No 14165 No 24819 No 24819 No 14142 No 14142 No No Yes EXCELLUS Yes 38225 No 38225 No No Yes 81264 No 81264 No 22603 No PDT01 No 64157 No 64157 No 65085 No 34159 No 34159 No 64157 No 64157 No

REMIT Yes Yes Yes Yes Yes No No Yes No No Yes Yes No No No No Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes Yes Yes Yes No Yes Yes No No No No No No No Yes Yes No No Yes Yes No No Yes Yes No No No Yes Yes

Claim type Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Institutional Institutional Professional Institutional Institutional Institutional Professional Professional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Institutional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Institutional Professional Institutional Institutional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Institutional

ST

NC NC NC NC NC NC ND ND ND ND ND ND

CA

OH

CPID 2931 1782 1782 1761 7529 2269 3562 1411 3564 1480 1464 3563 5593 2411 5594 1487 1523 2453 5140 1746 3287 3630 2219 1436 8969 2291 3721 7584 3227 2278 1901 4731 4128 7977 8911 3199 3736 5718 1692 5486 7583 1629 6104 3733 2511 5258 3944 5141 3287 3842 3586 4735 2851 4509 6405 2449 4544 2545 2576 7498 4264 8551 1844 4169 4792 5928 3505 2418 2704

PAYOR NORTH AMERICAN MEDICAL MANAGEMENT (NAMM - N CA) NORTH AMERICAN MEDICAL MANAGEMENT (NAMM) - S0.CA NORTH AMERICAN MEDICAL MGMT (NAMM)-N CALIFORNIA NORTH AMERICAN PREFERRED / MERITAIN HEALTH NORTH AMERICAN PREFERRED / MERITAIN HEALTH NORTH BROWARD HOSPITAL DISTRICT NORTH CAROLINA BLUE CROSS NORTH CAROLINA BLUE SHIELD NORTH CAROLINA MEDICAID NORTH CAROLINA MEDICAID NORTH CAROLINA MEDICARE NORTH CAROLINA MEDICARE NORTH DAKOTA BLUE CROSS NORTH DAKOTA BLUE SHIELD NORTH DAKOTA MEDICAID NORTH DAKOTA MEDICAID NORTH DAKOTA MEDICARE NORTH DAKOTA MEDICARE NORTH SUBURBAN ASSOCIATED PHYSICIANS NORTH TEXAS HEALTHCARE NETWORK NORTH WEST ORANGE COUNTY MEDICAL GROUP NORTHERN BRIDGES NORTHERN CA SHEET METAL WORKERS HEALTH CARE PLAN NORTHERN CALIFORNIA MEDICARE NORTHERN ILLINOIS HEALTH PLAN NORTHERN ILLINOIS HEALTH PLAN NORTHERN NEVADA TRUST FUND NORTHERN NEVADA TRUST FUND NORTHRIDGE MEDICAL GROUP NORTHSTAR ADVANTAGE NORTHSTAR ADVANTAGE NORTHWEST COMMUNITY NORTHWEST DIAGNOSTIC CLINIC NORTHWEST DIAGNOSTIC CLINIC I PAR PLUS NORTHWEST PHYSICIANS NETWORK NORTHWEST PHYSICIANS NETWORK NORTHWEST SUBURBAN IPA (ILLINOIS) NOVA CASUALTY COMPANY NOVA CASUALTY COMPANY NOVA HEALTHCARE ADMINISTRATORS, INC. (GRAND ISLAND NOVA HEALTHCARE ADMINISTRATORS, INC. (GRAND ISLAND NOVANET NOVANET NOVASYS HEALTH NETWORK NOVASYS HEALTH NETWORK NTCA STAFF NTCS STAFF NTL NUESTRA FAMILIA MEDICAL GROUP NYHART NYHART OAK WEST OATH (THE) - A HEALTH PLAN OF ALABAMA INC. OCALA PPO - FLORIDA OCALA PPO - FLORIDA OCHSNER HEALTH PLAN OCHSNER HEALTH PLAN ODESSA - THE CITY OF ODS HEALTH PLAN ODS HEALTH PLANS OFFICE ALLY - PROFESSIONAL OHANA HEALTH PLAN HAWAII OHANA HEALTH PLAN HAWAII OHIO AFSCME CARE PLAN OHIO BCMH OHIO BCMH OHIO BLUE CROSS OHIO BLUE SHIELD OHIO BWC

INTERMEDIARY

PAYOR ID Agreement required E3510 No E3510 No E3510 No 64157 No 64157 No 37314 No 12B23 Yes SB810 Yes EDS - ELECTRONIC DATA SER PILOT Yes EDS - ELECTRONIC DATA SER SKNC0 Yes PALMETTO GBA SMNC0 Yes PALMETTO GBA 12M23 Yes NORIDIAN ADMIN. SERVICES Yes NORIDIAN ADMIN. SERVICES SB820 Yes 12K78 No SKND0 No NORIDIAN ADMIN. SERVICES 12M82 Yes NORIDIAN ADMIN. SERVICES SMND0 Yes 36392 No 35212 No PROSP No Yes 38238 No PALMETTO GBA SMCA1 Yes 36347 No 36347 No 88027 No 88027 No NMG01 No METROPOLITAN HEALTH PLANNSA01 No METROPOLITAN HEALTH PLAN No NANWC No No No No No 36346 No 16114 No 16114 No 16644 No 16644 No 6226 No 6226 No 71080 No 71080 No 52104 No 52104 No No PROSP No 37299 No 37299 No NAOAK No 63092 No 62308 No 62308 No 61101 No 61101 No 75600 No 13350 No 13350 No No 14163 No 14163 No No No No WELLPOINT_ 12B24 No WELLPOINT_ SB338 No 31147 No

REMIT No No No Yes Yes No Yes Yes Yes Yes Yes Yes No Yes No No Yes No No No No No No Yes No No No No No Yes Yes No No No No No No No No No No No No No No No No No No No No No No Yes Yes Yes Yes No No No No Yes Yes No No No Yes Yes No

Claim type Institutional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Institutional Professional Professional Institutional Professional Professional Professional Institutional Institutional Professional Professional

ST

OH OH OH OH OK OK OK OK OK OK

CPID 2440 2704 1860 5435 2481 3509 3507 1447 2704 1514 1403 2753 3594 1558 1458 2279 1900 5142 4995 2759 1837 8538 4250 5234 4254 3696 4516 6408 4516 6408 6408 6408 4516 6408 4516 6408 4516 4516 6408 4516 6408 6408 4516 6408 4516 6408 4516 6408 4516 4516 6408 6408 4516 6408 4516 6408 4516 4516 6408 6408 4516 6408 4516 6408 4516 4516 6408 6408 4516

PAYOR OHIO CHOICECARE HMO OHIO EMPLOYEES HEALTH PARTNERSHIP OHIO HEALTH CHOICE, PPO OHIO HEALTH GROUP OHIO MEDICAID OHIO MEDICAID OHIO MEDICARE OHIO MEDICARE OHIO WORKERS' COMP MCO'S OKLAHOMA BLUE CROSS OKLAHOMA BLUE SHIELD OKLAHOMA MEDICAID OKLAHOMA MEDICAID OKLAHOMA MEDICARE OKLAHOMA MEDICARE OKLAHOMA STATE MEDICAL ASSOCIATION (OSMA HEALTH) OKLAHOMA STATE MEDICAL ASSOCIATION (OSMA HEALTH) OLYMPIC HEALTH MANAGEMENT SYSTEMS, INC. OMINCARE HEALTH PLAN - JVHL OMNICARE - JVHL OMNICARE, A COVENTRY HEALTH PLAN OMNICARE, A COVENTRY HEALTH PLAN OMPREHENSIVE CARE MANAGEMENT CORPORATION ONE BEACON ONE CALL MEDICAL ONE CALL MEDICAL ONE HEALTH PLAN OF ALASKA ONE HEALTH PLAN OF ALASKA ONE HEALTH PLAN OF ARIZONA ONE HEALTH PLAN OF ARIZONA ONE HEALTH PLAN OF CALIFORNIA ONE HEALTH PLAN OF COLORADO ONE HEALTH PLAN OF COLORADO ONE HEALTH PLAN OF FLORIDA ONE HEALTH PLAN OF FLORIDA ONE HEALTH PLAN OF GEORGIA ONE HEALTH PLAN OF GEORGIA ONE HEALTH PLAN OF ILLINOIS ONE HEALTH PLAN OF ILLINOIS ONE HEALTH PLAN OF INDIANA ONE HEALTH PLAN OF INDIANA ONE HEALTH PLAN OF KANSAS ONE HEALTH PLAN OF KANSAS ONE HEALTH PLAN OF MAINE ONE HEALTH PLAN OF MAINE ONE HEALTH PLAN OF MASSACHUSETTS ONE HEALTH PLAN OF MASSACHUSETTS ONE HEALTH PLAN OF NEVADA ONE HEALTH PLAN OF NEVADA ONE HEALTH PLAN OF NEW HAMPSHIRE ONE HEALTH PLAN OF NEW HAMPSHIRE ONE HEALTH PLAN OF NEW JERSEY ONE HEALTH PLAN OF NEW JERSEY ONE HEALTH PLAN OF NORTH CAROLINA ONE HEALTH PLAN OF NORTH CAROLINA ONE HEALTH PLAN OF OHIO ONE HEALTH PLAN OF OHIO ONE HEALTH PLAN OF OREGON ONE HEALTH PLAN OF OREGON ONE HEALTH PLAN OF PENNSYLVANIA ONE HEALTH PLAN OF PENNSYLVANIA ONE HEALTH PLAN OF SOUTH CAROLINA ONE HEALTH PLAN OF SOUTH CAROLINA ONE HEALTH PLAN OF TENNESSEE ONE HEALTH PLAN OF TENNESSEE ONE HEALTH PLAN OF TEXAS ONE HEALTH PLAN OF TEXAS ONE HEALTH PLAN OF VERMONT ONE HEALTH PLAN OF VERMONT

INTERMEDIARY

PAYOR ID Agreement required 95348 No 31147 No 34189 No 95435 No SKOH0 No 12K24 No CIGNA GOVERNMENT SERVICES 12M24 Yes CIGNA GOVERNMENT SERVICES SMOH0 Yes 31147 No 12B59 No SB840 No EDS - ELECTRONIC DATA SER SKOK0 No EDS - ELECTRONIC DATA SER 12K25 No TRAILBLAZER HLTHENT-GPNET12M37 Yes TRAILBLAZER HLTHENT-GPNET 4302 Yes 73071 No 73071 No No Yes Yes 25133 No 25133 No CCMC1 No Yes 22321 No 22321 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No

REMIT No No No No Yes No Yes Yes No No Yes Yes Yes No Yes No No No Yes Yes Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Claim type Professional Professional Professional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional

ST

OR OR OR OR OR OR

CPID 4516 6408 6408 4516 4516 6408 6408 4516 3777 3666 6591 1744 1795 7499 7567 7567 7499 7567 7499 3429 3429 4227 5891 3424 5516 2404 7498 1481 5517 5515 1459 4498 1540 2263 3208 3947 2264 4544 2449 4590 5402 4160 6549 6485 2217 2969 7417 4756 2939 2497 4170 2867 2944 2816 6597 8957 1593 3808 3439 2560 3429 3550 2740 1932 3550 3429 2428 8956 2741

PAYOR ONE HEALTH PLAN OF VIRGINIA ONE HEALTH PLAN OF VIRGINIA ONE HEALTH PLAN OF WASHINGTON ONE HEALTH PLAN OF WASHINGTON ONE HEALTH PLAN OF WISCONSIN ONE HEALTH PLAN OF WISCONSIN ONE HEALTH PLAN OF WYOMING ONE HEALTH PLAN OF WYOMING ONENET PPO, LLC (formerly ALLIANCE PPO, INC.) ONENET PPO, LLC. (ALLIANCE PPO, INC) (MAMSI) OPERATING ENG LOCALS 302/612 HLTH & SEC OPERATING ENG. LOCALS 302/612 HLT & SEC OPTICARE EYE HEALTH OPTIMA FAMILY CARE OPTIMA FAMILY PLAN OPTIMA HEALTH PLANS OPTIMA HEALTH PLANS OPTIMA INSURANCE COMPANY OPTIMA INSURANCE COMPANY OPTIMUM CHOICE OF THE CAROLINAS, INC. OPTIMUM CHOICE, INC. OPTIMUM HEALTHCARE OPTUM HEALTH SPECIALTY BENEFITS - VISION ONLY ORANGE COUNTY FOUNDATION for MEDICAL CARE OREGON BLUE CROSS OREGON BLUE SHIELD OREGON HEALTH PLAN OREGON MEDICAID OREGON MEDICAID OREGON MEDICARE OREGON MEDICARE OREGON SELECTCARE OREGON SELECTCARE ORTHONET - AETNA ORTHONET - HEALTHNET ORTHONET CORPORATION ORTHONET CORPORATION - CIGNA OSF HEALTH PLANS OSF HEALTH PLANS OSHKOSH AREA HEALTH PROTECTION PLAN OSHKOSH AREA HEALTH PROTECTION PLAN OUR LADY OF THE RESURRECTION PHYSICIAN ASSOCIATION OXFORD HEALTH PLANS OXFORD HEALTH PLANS P5 HEALTH PLAN SOLUTIONS OF UTAH P5 HEATLH PLAN SOLUTION PA INDEPENDENCE KEYSTONE HEALTH PLAN EAST - HMO PA PREFERRED HEALTH NETWORK - PPHN PA PREFERRED HEALTH NETWORK - PPHN PACIFIC ALLIANCE MEDICAL GROUP AND HOSPITAL PACIFIC IPA PACIFICARE BEHAVIORAL HEALTH PACIFICARE BEHAVIORAL HEALTH PACIFICARE CLAIMS (CA, OK, OR, TX, WA) PACIFICARE CLAIMS (CA, OK, OR, TX, WA) PACIFICARE HEALTH SYSTEMS - ENCOUNTERS PACIFICARE HEALTH SYSTEMS - PPO PACIFICARE HEALTH SYSTEMS - PPO PACIFICARE OF ARIZONA DOS <01/01/11 PACIFICARE OF ARIZONA DOS <01/01/11 PACIFICARE OF ARIZONA DOS >12/31/10 PACIFICARE OF ARIZONA DOS >12/31/10 PACIFICARE OF CALIFORNIA - ENCOUNTERS PACIFICARE of COLORADO - CLAIMS DOS <01/01/11 PACIFICARE of COLORADO - CLAIMS DOS >12/31/10 PACIFICARE of COLORADO - CLAIMS DOS >12/31/10 PACIFICARE of COLORADO DOS <01/01/11 PACIFICARE of OREGON ENCOUNTERS PACIFICARE of OREGON ENCOUNTERS

INTERMEDIARY

PAYOR ID Agreement required 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 80705 No 52149 No No 91136 No 91136 No 56190 No 54154 No 54154 No 54154 No 54154 No 54154 No 54154 No 87726 No 87726 No 20133 No No OCFMC No 12B41 No SB850 No 13350 No SKOR0 Yes SKOR0 Yes NORIDIAN ADMIN. SERVICES 12M41 Yes NORIDIAN ADMIN. SERVICES SMOR0 Yes SX133 No SX133 No 13383 No 25681 No 13381 No 13381 No 61101 No 61101 No 39026 No 39026 No No 6111 No 6111 No 87068 No 87068 No INDEPENDENCE BLUE CROSS SX055 No 6161 No 6161 No SYMED No PCFCI No 33053 No 33053 No 95959 No 95959 No No 95999 No 95999 No 95964 No 95964 No 87726 No 87726 No 95958 No 95962 No 87726 No 87726 No 95962 No No 95958 No

REMIT Yes Yes Yes Yes Yes Yes Yes Yes No No No No No Yes Yes Yes Yes Yes Yes Yes Yes No No No Yes Yes No Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes Yes No Yes Yes No No No No No No No No No Yes Yes No No No Yes Yes Yes Yes No Yes Yes Yes Yes No No

Claim type Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Professional Professional Professional Professional Professional Institutional Professional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Professional Institutional Professional Institutional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional

ST

GA GA

PA PA PA PA PA PA

PA PA PA PA PA PA

CPID 5468 5805 3627 4627 6147 4794 4972 5441 6575 6147 4627 3883 4877 3453 9572 3275 5977 1892 1763 8967 7497 3902 8523 4129 6473 4584 2963 3247 8565 5221 5143 1921 2417 4225 3287 5194 7963 2413 2413 3587 1582 2534 2413 4715 3557 4716 3558 3560 3559 5509 1491 2457 5598 2413 8455 2923 4236 8538 1837 8966 5855 1837 2152 8968 1655 3440 5945 2131 4452

PAYOR PACIFICARE of WASHINGTON ENCOUNTERS PACIFICSOURCE ADMINISTRATORS PACIFICSOURCE ADMINISTRATORS PACIFICSOURCE COMMUNITY HEALTH PLAN INC. PACIFICSOURCE COMMUNITY HEALTH PLAN INC. PACIFICSOURCE COMMUNITY SOLUTIONS, INC. PACIFICSOURCE COMMUNITY SOLUTIONS, INC. PACIFICSOURCE HEALTH PLANS PACIFICSOURCE HEALTH PLANS PACIFICSOURCE MEDICARE PACIFICSOURCE MEDICARE PAI PALLIDIAN PARAGON BENEFITS, INC. PARAGON BENEFITS, INC. PARAMOUNT PARAMOUNT PARITY HEALTHCARE LLC PARKLAND COMMUNITY HEALTH PLAN PARKLAND COMMUNITY HEALTHPLAN PARTNERSHIP HEALTH PLAN of CALIFORNIA PARTNERSHIP HEALTH PLAN of CALIFORNIA PASSPORT ADVANTAGE - DOS >12/31/09 PASSPORT ADVANTAGE - DOS >12/31/09 PASSPORT HEALTH PLAN PASSPORT HEALTH PLAN PATIENT ADVOCATE,LLC PATIENT ADVOCATES PATRIOT GENERAL INSURANCE COMPANY - P2P LINK PATRIOT GENERAL INSURANCE COMPANY - P2P LINK PCMC/ICSL - PODIATRY PEACH STATE HEALTH PLAN PEACH STATE HEALTH PLAN PEDIATRIC ASSOCIATES PEGASUS MEDICAL GROUP PEKIN INSURANCE PEKIN INSURANCE PENINSULA HEALTH CARE PENNSYLVANIA BLUE CHOICE PENNSYLVANIA BLUE CROSS PENNSYLVANIA BLUE CROSS NORTHEASTERN PENNSYLVANIA BLUE CROSS WESTERN PENNSYLVANIA BLUE SHIELD PENNSYLVANIA INDEPENDENCE AMERIHEALTH DE PPO PENNSYLVANIA INDEPENDENCE AMERIHEALTH HMO PENNSYLVANIA INDEPENDENCE AMERIHEALTH NJ PPO PENNSYLVANIA INDEPENDENCE AMERIHEALTH PPO PENNSYLVANIA INDEPENDENCE BLUE CROSS PENNSYLVANIA INDEPENDENCE KEYSTONE HLTH PLAN EAST PENNSYLVANIA MEDICAID PENNSYLVANIA MEDICAID PENNSYLVANIA MEDICARE PENNSYLVANIA MEDICARE PENNSYLVANIA PERSONAL CHOICE PEOPLES HEALTH NETWORK PEOPLES HEALTH NETWORK PERFECT HEALTH PERSONAL CARE PERSONAL CARE PERSONAL INSURANCE ADMINISTRATION PERSONAL INSURANCE ADMINISTRATORS PERSONAL PHYSICIAN CARE PHCS SAVILITY PHCS SAVILITY PHOENIX GROUP SERVICES (TEXAS) PHOENIX HEALTH PLANS PHOENIX HEALTH PLANS PHOENIX LIFE INSURANCE COMPANY PHP KANSAS CITY

INTERMEDIARY

PAYOR ID Agreement required 95958 No 93031 No 93031 No No No 50014 No 50014 No 93029 No 93029 No No No 37287 No 37268 No 58174 No 58174 No SX158 No SX158 No 58204 No 66917 No 66917 No SX140 Yes 12M81 Yes 76569 No 76569 No 61129 No 61129 No 10525 No 10525 No Yes Yes No CENTENE CORPORATION 68049 Yes CENTENE CORPORATION 68049 Yes 20472 No PROSP No No No HIGHMARK, INC. SB865 Yes HIGHMARK, INC. SB865 Yes HIGHMARK, INC. SB865 Yes Yes HIGHMARK, INC. Yes HIGHMARK, INC. SB865 Yes INDEPENDENCE BLUE CROSS SX074 No INDEPENDENCE BLUE CROSS 95044 No INDEPENDENCE BLUE CROSS SX075 No INDEPENDENCE BLUE CROSS 60061 No INDEPENDENCE BLUE CROSS 54704 No INDEPENDENCE BLUE CROSS 95056 No EDS - ELECTRONIC DATA SER 12008 No EDS - ELECTRONIC DATA SER SKPA0 No HIGHMARK MEDICARE SERVICE SMPA0 Yes HIGHMARK MEDICARE SERVICE 12501 Yes HIGHMARK, INC. SB865 Yes 72126 No 72126 No 13522 No 25133 No 25133 No 95397 No 95397 No 25133 No 13306 No 13306 No No 3440 No 3440 No 67814 No 31478 No

REMIT No No No No No No No Yes Yes No No No No No No Yes No No No No Yes Yes No No Yes Yes No No No No No Yes Yes No No No No Yes Yes Yes No Yes Yes No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes No No Yes No No No No No No No

Claim type Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Professional Professional Professional Institutional Professional Professional Institutional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Institutional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Professional

ST

CA CA

SC

SC

CPID 3429 3429 5146 2706 2687 1892 1759 8573 8965 5256 8964 3235 8960 2840 5932 4797 5147 3770 5944 2108 5255 3959 2498 1936 4455 3596 3815 6142 4624 3430 3889 4508 3978 5478 4785 1880 5149 7943 1735 6587 3287 4130 7901 2798 3905 8575 5151 7944 3743 7574 2410 3883 3927 2410 4171 5106 7979 5166 7980 5214 8506 5153 1892 4251 1661 5833 6442 4523 3997

PAYOR PHP OF SOUTHEAST MICHIGAN PHP OF WEST MICHIGAN PHYCOR (FT. COLLINS OFFICE ONLY) PHYSICIAN ASSOCIATES PHYSICIAN ASSOCIATES PHYSICIAN ASSOCIATES OF LOUISIANA PHYSICIAN BENEFIT TRUST PHYSICIAN BENEFIT TRUST PHYSICIAN HEALTH PARTNERS PHYSICIAN HEALTH PARTNERS PHYSICIAN UNITED PLAN PHYSICIANS ALLIANCE CORP / SRRIPA (THE) PHYSICIANS ALLIANCE CORP / SRRIPA (THE) PHYSICIANS CARE NETWORK (ROCKFORD, IL only) PHYSICIANS CHOICE ADVANTAGE (PC ADVANTAGE) PHYSICIANS CHOICE ADVANTAGE (PC ADVANTAGE) PHYSICIANS CORPORATION OF AMERICA (FLORIDA ONLY) PHYSICIANS HEALTH ASSOCIATION OF ILLINOIS PHYSICIANS HEALTH CHOICE PHYSICIANS HEALTH CHOICE PHYSICIANS HEALTH COLLABORATIVE PHYSICIANS HEALTH COLLABORATIVE PHYSICIANS HEALTH PLAN MID-MICHIGAN / PHP PHYSICIANS HEALTH PLAN MID-MICHIGAN / PHP PHYSICIANS HEALTH PLAN SOUTH CAROLINA PHYSICIANS HEALTH PLAN of NORTHERN INDIANA - PHP PHYSICIANS HEALTH PLAN of NORTHERN INDIANA - PHP PHYSICIANS HEALTHWAYS IPA PHYSICIANS HEALTHWAYS IPA PHYSICIANS MEDICAL GROUP of SAN JOSE PHYSICIANS MUTUAL INSURANCE COMPANY PHYSICIANS MUTUAL INSURANCE COMPANY PHYSICIANS PLUS INSURANCE CORP. PHYSICIANS PLUS INSURANCE CORPORATION PHYSICIANS UNITED PLAN PIEDMONT ADMINISTRATORS PIEDMONT BEHAVIORAL HEALTH PIEDMONT BEHAVIORAL HEALTH PINNACLE CLAIMS MANAGEMENT, INC. PINNACLE CLAIMS MANAGEMENT, INC. PINNACLE HEALTH RESOURCES PINNACLE PHYSICIAN MANAGEMENT ORG PINNACLE PHYSICIAN MANAGEMENT ORG PINNACOL PINNACOL ASSURANCE PIONEER LIFE INSURANCE CO. PIPEFITTERS LOCAL 597 PIPELINE INDUSTRY BENEFIT FUND (TULSA, OK) PITTMAN and ASSOCIATES PITTMAN and ASSOCIATES PLANNED ADMINISTRATORS, INC. PLANNED ADMINISTRATORS, INC. PLANNED ADMINISTRATORS, INC. (PREFERRED BLUE PROV) PLANNED ADMINISTRATORS, INC. (PREFERRED BLUE PROVI PLASTERERS' & CEMENT MASONS' HEALTH & WELFARE FUND PLUMBERS & STEAMFITTERS HEALTH and WELLFARE FUND PLUMBERS & STEAMFITTERS HEALTH and WELLFARE FUND PLUMBERS AND STEAMFITTERS LOCAL #106 PLUMBERS AND STEAMFITTERS LOCAL #106 PMA - PENNSYLVANIA MANUFACTURING ASSOCIATES PMA - PENNSYLVANIA MANUFACTURING ASSOCIATES PMG OF SAN JOSE PODI CARE MANAGED CARE PODIATRY FIRST PODIATRY NETWORK of FLORIDA PODIATRY NETWORK of FLORIDA POINT of SERVICE POINT of SERVICE POLY AMERICA MEDICAL and DENTAL BENEFITS PLAN

INTERMEDIARY

TRIZETTO TRIZETTO

PAYOR ID Agreement required 87726 No 87726 No No PA513 No PA513 No 58204 No 37308 No 37308 No No No No 15749 No 15749 No 36345 No Yes Yes No 37136 No PHCS1 No PHCS1 No 20398 No 20398 No 37330 No 37330 No 9173 No 12399 No 12399 No No No EXC01 No 47027 No 47027 No 39156 No 39156 No 10775 Yes 56205 No 6607 No 6607 No 24735 No 24735 No PROSP No No No 84109 No 84109 No Yes No No 37224 No 37224 No SB880 No 37287 No 37287 No SB880 No No No No No No Yes Yes No 58204 No PDFST No 59324 No 59324 No 95378 No 95378 No 32680 No

REMIT Yes Yes No No No No No No No No No No No No No No No No No No No No Yes Yes No Yes Yes No No No Yes Yes No No No No No No No No No No No No No No No No Yes No Yes No No Yes No No No No No No No No No No No No Yes Yes No

Claim type Professional Professional Professional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Professional Institutional Institutional

ST

TX TX

SC SC

CPID 2521 1779 4509 6405 8565 5221 5154 2522 5481 1888 3891 3984 1579 6467 1607 3189 5838 8909 1652 2970 3198 2432 2410 2410 2240 3929 1791 8515 2674 5253 6580 1807 1912 4452 2916 3767 2814 2524 3225 4536 3831 3410 3410 8578 3410 3767 7516 3448 5894 3694 8578 7550 2746 2704 6130 7946 2746 7550 2292 2704 2255 8908 5242 4744 4252 2106 8963 7579 2832

PAYOR POMCO POMCO PORTLAND PPO - OREGON PORTLAND PPO - OREGON PPG INDUSTRIES - P2P LINK PPG INDUSTRIES - P2P LINK PPOPLUS PPOPLUS LLC PPOPLUS LLC PRACTICARE PRAIRIE STATES ENTERPRISES PRAIRIE STATES ENTERPRISES, INC PRE-EXISTING CONDITION INSURANCE PLAN (PCIP) PRE-EXISTING CONDITION INSURANCE PLAN (PCIP) PREFERED MEDICAL PLAN PREFERED MEDICAL PLAN PREFERRED ADMINISTRATORS PREFERRED ADMINISTRATORS PREFERRED BENEFIT ADMINISTRATORS (LONGWOOD, FL) PREFERRED BENEFIT ADMINISTRATORS - WICHITA, KS PREFERRED BENEFITS ADMINISTRATION PREFERRED BENEFITS ADMINISTRATOR - WICHITA, KS PREFERRED BLUE PREFERRED BLUE SC PREFERRED CARE PARTNERS PREFERRED CARE PARTNERS PREFERRED COMMUNITY CHOICE/PCCSELECT/COMPMED PREFERRED COMMUNITY CHOICE/PCCSELECT/COMPMED PREFERRED HEALTH CARE of PENNSYLVANIA PREFERRED HEALTH CARE of PENNSYLVANIA PREFERRED HEALTH PLAN PREFERRED HEALTH PLAN, INC. PREFERRED HEALTH PROFESSIONALS (PHP KANSAS CITY) PREFERRED HEALTH PROFFESIONAL PREFERRED HEALTH SYSTEMS - KANSAS PREFERRED HEALTH SYSTEMS INSURANCE COMPANY-KANSAS PREFERRED HEALTHCARE SYSTEM - PPO - ALTOONA PA PREFERRED HEALTHCARE SYSTEM - PPO ALTOONA, PA PREFERRED IPA PREFERRED NETWORK ACCESS, INC. PREFERRED NETWORK ACCESS, INC. PREFERRED ONE PREFERRED ONE COMMUNITY HEALTH PLAN PREFERRED ONE COMMUNITY HEALTH PLAN PREFERRED ONE CORPORATION PREFERRED PLUS OF KANSAS PREFERRED PROVIDER OF MICHIGAN (PPOM) PREFERRED PROVIDER OF MICHIGAN (PPOM) PREFERRED VALUE HIGH DEDUCTIBLE PLAN PREFERRED VALUE HIGH DEDUCTIBLE PLAN PREFERRRED ONE PREMIER BENEFITS INC. PREMIER BENEFITS, INC. PREMIER COMP PREMIER EYE CARE PREMIER HEALTH NETWORK PREMIER HEALTH PLANS PREMIER HEALTH PLANS PREMIER HEALTH SYSTEMS, INC. PREMIER MANAGED CARE PRESBYTERIAN - NEW MEXICO PRESBYTERIAN HEALTH PLAN PRESBYTERIAN HEALTH PLAN PRESBYTERIAN PHP PRESBYTERIAN SALUD PRESTIGE HEALTH CHOICE PRESTIGE HEALTH CHOICE PREVEA HEALTH INSURANCE PLAN PREVEA HEALTH PLAN

INTERMEDIARY

PAYOR ID Agreement required 16111 No 16111 No 62308 No 62308 No Yes Yes No 72148 No 72148 No 4334 No 36373 No 36373 No 44054 No 44054 No No No No No No 61665 No 53476 No 61665 No SB880 No SB880 No 65088 No 65088 No 73145 No 73145 No No No 61106 No 61106 No 31478 No 31478 No 60110 No 60110 No 4320 No 4320 No PFIPA No 36401 No 36401 No 41147 No 41147 No 41147 No 41147 No 60110 No 38335 No 38335 No 81108 No 81108 No 41147 No 43166 No 43166 No 31147 No 65054 Yes No 43166 No 43166 No 90440 No 31147 No 5003 No No No No 5003 No 45056 No 45056 No 39185 No 39185 No

REMIT Yes Yes Yes Yes No No No No No No No No Yes Yes No No No No No No No No Yes Yes No No No No No No No No No No Yes Yes No No No No No Yes Yes Yes Yes Yes No No No No Yes No No No No No No No No No No No No No No No No No No

Claim type Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Institutional Institutional Professional Professional Professional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Professional Professional Professional Institutional Institutional Professional

ST

PA

CPID 1938 2729 5241 8907 1757 6595 3284 2449 4544 2449 4544 2449 4544 2449 4544 1795 2786 1565 1782 1782 1782 1782 1782 1782 1782 1782 1782 1782 3888 2926 5927 4791 5927 4791 4131 4528 6420 4528 6420 2210 4977 5157 4998 4260 2413 7459 3591 5432 1592 5158 5159 2675 5806 2954 1653 2126 3287 5277 4444 5161 2950 2807 4430 4916 4874 2976 5881 3674 5222

PAYOR PRIMARY HEALTH NETWORK PRIMARY HEALTH NETWORK PRIMARY HEALTH PLAN PRIMARY HEALTH PLAN PRIMARY PHYSICIAN CARE, INC. PRIMARY PHYSICIANCARE, INC. PRIMARY PROVIDER MANAGEMENT PRIME BENEFIT SYSTEMS, INC PRIME BENEFITS SYSTEMS, INC. - MISSOURI PRIME HEALTH KANSAS CITY PRIME HEALTH KANSAS CITY, INC. - MISSOURI PRIME HEALTH MANAGEMENT SERVICES PRIME HEALTH MANAGEMENT SERVICES - MISSOURI PRIME HEALTH OF KANSAS PRIME HEALTH OF KANSAS, INC. - MISSOURI PRIME VISION HEALTH PRIME WEST PRIME WEST PRIMECARE HEALTH PLAN PRIMECARE of CHINO VALLEY PRIMECARE of CORONA PRIMECARE of HEMET VALLEY PRIMECARE of INLAND VALLEY PRIMECARE of MARENO VALLEY PRIMECARE of REDLANDS PRIMECARE of RIVERSIDE PRIMECARE of SUN CITY PRIMECARE of TEMECULA PRIMESOURCE HEALTH NETWORK PPO - HARRISBURG, PA PRIMESOURCE HEALTH NETWORK PPO - HARRISBURG, PA PRIMETIME HEALTH PLAN PRIMETIME HEALTH PLAN PRIMETIME MEDICAL INSURANCE CO. PRIMETIME MEDICAL INSURANCE CO. PRINCETON PREMIER IPA PRINCIPAL FINANCIAL GROUP PRINCIPAL FINANCIAL GROUP PRINCIPAL LIFE INSURANCE COMPANY PRINCIPAL LIFE INSURANCE COMPANY PRINT and MAIL - P2P LINK - WORKERS COMPENSATION PRINT and MAIL - P2P LINK - WORKERS COMPENSATION PRINTING INDUSTRY ASSOCIATION OF S. CALIF (PIASC) PRIORITY HEALTH - JVHL PRIORITY HEALTH - JVHL PRIORITY HEALTH CARE PRIORITY HEALTH of MICHIGAN PRIORITY HEALTH of MICHIGAN PRIORITY PARTNERS MCO, EMPLOYEE HEALTH PLAN PPO PRIORITY PARTNERS MCO, EMPLOYEE HEALTH PLAN PPO PRISM FIRST HEALTH PRISM UNIVERA PRISON HEALTH SERVICES PRISON HEALTH SERVICES PRO CARE HEALTH PLAN PRO CARE HEALTH PLAN MEDICAID PRO CARE PLUS HP PROCARE PROCARE HEALTH PLAN MEDICAID PROCTECTIVE LIFE INSURANCE PRODUCER'S EXCHANGE PROFESSIONAL BENEFIT ADMINISTRATORS PROFESSIONAL BENEFIT ADMINISTRATORS (OAK BROOK,IL) PROFESSIONAL BENEFIT ADMINSTRATORS PROFESSIONAL BENEFIT ADMINSTRATORS PROFESSIONAL RISK MANAGEMENT PROFESSIONAL RISK MGM PROJECT ACCESS PROJECT ACCESS PROJECT ACCESS OF DURHAM COUNTY

INTERMEDIARY

HIGHMARK, INC.

PAYOR ID Agreement required 82048 No 82048 No No No 56144 No 56144 No PPM01 No 61101 No 61101 No 61101 No 61101 No 61101 No 61101 No 61101 No 61101 No 56190 No 61604 No 61604 No E3510 No E3510 No E3510 No E3510 No E3510 No E3510 No E3510 No E3510 No E3510 No E3510 No 23266 No 23266 No Yes Yes Yes Yes No 61271 No 61271 No 61271 No 61271 No Yes Yes No Yes Yes SB865 Yes 38217 No 38217 No 52189 No 52189 No 37303 No 37315 No Yes Yes 38329 No 70259 No 38329 No PROSP No 70259 No 37309 No No 36331 No 36331 No 59296 No 59296 No 34134 No 34134 No Yes Yes PADC1 No

REMIT No No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes No No Yes No No No No No No No No No No No No Yes Yes Yes Yes No Yes Yes Yes Yes No No No Yes Yes Yes Yes Yes No No No No No No No No No No No No No No No No No No No No No No

Claim type Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Professional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional

ST

PR PR PR

CPID 7947 5162 3287 4151 3287 5894 3694 7498 4498 1540 2403 1915 1915 2403 1915 2403 1915 2403 1915 2403 2133 8962 4619 6133 4498 1540 1915 2403 4727 5967 3544 3542 2785 1744 6591 6591 1744 4762 2929 3233 5274 9571 4912 2257 5164 1713 4548 5428 2593 2418 2107 8906 8937 1769 1948 3863 2497 5892 3292 2967 3266 5288 1609 5861 3657 3197 7948 2682 5812

PAYOR PROMINA PROMINA PROSPECT HEALTH NETWORK PROSPECT MEDICAL GROUP PROSPECT MEDICAL GROUP PROTECTOR PLUS FLEXIBLE PPO PLAN PROTECTOR PLUS FLEXIBLE PPO PLAN PROVIDENCE BEHAVIORAL PROVIDENCE HEALTH PLAN PROVIDENCE HEALTH PLAN PROVIDENCE PREFERRED PROVIDENCE PREFERRED PROVIDENCE PREFERRED PPO PROVIDENCE PREFERRED PPO PROVIDENCE PREFERRED SELECT PROVIDENCE PREFERRED SELECT PROVIDENCE PREFERRED VANTAGE PROVIDENCE PREFERRED VANTAGE PROVIDENCE PREFERRED VANTAGE SELECT PROVIDENCE PREFERRED VANTAGE SELECT PROVIDENT LIFE INSURANCE COMPANY PROVIDER NETWORKS OF AMERICA (PRO-NET) PROViDRs CARE NETWORK PROViDRs CARE NETWORK PUBLIC EMPLOYEE BENEFITS BOARD (PEBB) PUBLIC EMPLOYEE BENEFITS BOARD (PEBB) PUBLIC EMPLOYEE BENEFITS BOARD (PEBB) PPO PUBLIC EMPLOYEE BENEFITS BOARD (PEBB) PPO PUBLIC EMPLOYEES HEALTH PROGRAM (PEHP) PUBLIC HEALTH PROGRAM (THE) PUERTO RICO COSVI MEDICARE PUERTO RICO CRUZ AZUL PUERTO RICO MEDICARE PUGET SOUND BENEFITS TRUST PUGET SOUND BENEFITS TRUST PUGET SOUND ELECTRICAL WORKERS TRUST PUGET SOUND ELECTRICAL WORKERS TRUST PUGET SOUND HEALTH PARTNERS INC. PUGET SOUND HEALTH PARTNERS INC. PYRAMID LIFE PYSCHCARE LLC PYSCHCARE LLC QUAD MED LLC QUAD MED LLC - PEWAUKEE, WI QUAL CHOICE OF NORTH CAROLINA QUALCARE, INC QUALCARE, INC QUALCHOICE OF ARKANSAS QUALCHOICE OF ARKANSAS/QCA HEALTH PLANS QUALCHOICE of OHIO QUALITY HEALTH PLANS QUALITY HEALTH PLANS QUIKTRIP CORPORATION QVI RISK SOLUTIONS RBMS LLC (RISK BENEFIT MANAGEMENT SERVICES) RBMS, LLC REDLAND IPA (SYNERMED) REDLANDS YUCAIPA MEDICAL GROUP REGAL MEDICAL GROUP REGIONAL CARE INC REGIONAL CARE, INC. REHN and ASSOCIATES REHN and ASSOCIATES RELAYHEALTH COMP BILLING RELAYHEALTH COMP BILLING RENAISSANCE PHYSICIANS ORGANIZATION RENAISSANCE PHYSICIANS ORGANIZATION RESERVE NATIONAL INSURANCE RESERVE NATIONAL INSURANCE

INTERMEDIARY

PAYOR ID

PROSP PROSP 81108 81108 13350 SX133 SX133 SX187

SX187 SX187 SX187 SX187 68195 48100 48100 SX133 SX133 SX187 sx106 AMM02 468

UHIN FIRST COAST SERV OPTIONS INMEDIATA (PR) FIRST COAST SERV OPTIONS

91136 91136 91136 91136 42172 42172 48055 51052 51052 39197 39197 23342 23342 35174 35174 SB338 QHP01 73067 57117 91176 91176 SYMED REGAL 47076 47076

WELLPOINT_

76066 76066 73066 73066

Agreement required No No No No No No No No No No No No No No No No No No No No No No No No No No No No Yes No Yes Yes Yes No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No Yes Yes No No No No

REMIT No No No No No No No No Yes Yes No No No No No No No No No No No No No No Yes Yes No No Yes No Yes Yes Yes No No No No No No No No No No No No No No No No Yes No No No No No No No No No No No No No Yes Yes No No No No

Claim type Institutional Professional Professional Professional Professional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional

ST

RI RI RI RI RI RI RI RI

TN

CA CA

CPID 3673 5878 3257 4929 5167 4923 4270 1443 2496 1947 5579 7420 7421 5580 5588 5578 7419 7420 5807 2677 5872 3272 2958 6505 7470 4515 6483 4507 1506 4144 7949 5915 4776 3740 2518 6405 4509 5168 4262 6464 4543 3761 4747 1897 8590 4256 1851 5952 2122 5952 2122 5952 2122 2122 5952 5952 2122 4509 6405 5961 2116 7553 3568 3447 5860 5181 3613 5279 2281

PAYOR RESOLVE HEALTH PLAN ADMINISTRATORS RESOLVE HEALTH PLAN ADMINISTRATORS RESOURCEONE ADMINISTRATORS RESOURCEONE ADMINISTRATORS FKA ADMINONE RESURRECTION HEALTH CARE RESURRECTION HEALTH CARE PREFERRED RESURRECTION PHYSICIAN PROVIDERS GROUP RETIRED RAILROAD MEDICARE REUNION INDUSTRIES RHHI HOME HEALTH REGION V - SERVICE AREA 7 RHODE ISLAND BLUE CROSS RHODE ISLAND BLUE SHIELD RHODE ISLAND MEDICAID RHODE ISLAND MEDICAID - INPATIENT RHODE ISLAND MEDICAID - OUTPATIENT RHODE ISLAND MEDICARE RHODE ISLAND MEDICARE RHODE ISLAND WORKERS COMPENSATION RIGHTCHOICE BENEFITS ADMINISTRATORS RIGHTCHOICE BENEFITS ADMINISTRATORS RIVERSIDE FAMILY HEALTH MEDICAL GROUP IPA RMSCO, INC. RMSCO,INC. ROCKWELL INTERNATIONAL ROCKY MOUNTAIN HMO ROONEY LIFE INC. ROONEY LIFE, INC. ROSEMONT OF DES PLAINES, ILLINOIS RURAL HEALTH MEDICARE RUSH PRUDENTIAL HEALTH PLANS (HMO ONLY) RUSH PRUDENTIAL HEALTH PLANS (HMO ONLY) RWDSU RWDSU S and S HEALTHCARE STRATEGIES S and S HEALTHCARE STRATEGIES SACRAMENTO PPO SACRAMENTO PPO SAFEGUARD SAFEGUARD DENTAL and VISION SAGAMORE HEALTH NETWORK SAGAMORE HEALTH NETWORK, INC. SAGE TECHNOLOGIES SAGE TECHNOLOGIES - PBS SAINT BARNABAS SYSTEM HEALTH PLAN SAINT BARNABAS SYSTEM HEALTH PLAN SAINT MARYS HEALTH PLAN SAINT THERESE PHYSICIAN ASSOCIATES SAMARITAN ADVANTAGE (MEDICARE ADVANTAGE PLAN) SAMARITAN ADVANTAGE (MEDICARE ADVANTAGE PLAN) SAMARITAN CHOICE PLANS SAMARITAN CHOICE PLANS SAMARITAN HEALTH SERVICES SAMARITAN HEALTH SERVICES SAMARITAN HEALTHY KIDSCONNECT SAMARITAN HEALTHY KIDSCONNECT SAMARITAN SELECT SAMARITAN SELECT SAMBA SAMBA SANFORD HEALTH PLAN SANFORD HEALTH PLAN SANSUS PPO (GENERAL AMERICAN) SANTA BARBARA REGIONAL HEALTH AUTHORITY SANTA BARBARA REGIONAL HEALTH AUTHORITY SANTA BARBARA SELECT IPA SANTA CLARA FAMILY HEALTH PLAN SANTA CLARA FAMILY HEALTH PLAN SANTA CLARA IPA SANTE HEALTH SYSTEM AND AFFILIATES

INTERMEDIARY

PAYOR ID

37278 37278 36396 RPPG1 PALMETTO GBA SRRGA CHAT1 NATIONAL GOVERNMENT SERV. 12B74 SB871 SKRI0 EDS - ELECTRONIC DATA SER PILOT EDS - ELECTRONIC DATA SER PILOT NATIONAL HERITAGE INS CO 14401 ARKANSAS BC BS SMRI0 SB871 37331 37331 MPM08 16117 16117 75196 SX141 37602 37602 36215 CAHABA GBA 36389 36389 63070 63070 31441 31441 62308 62308 SFG99 35164 35164 37105 37137 22240 22240 88029 37116

62308 62308 SVH01 91184 34189

24077 24077 77038

Agreement required No No No No No No No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No Yes No No No Yes No No No No No No No No No No No No No No No No No No No Yes No Yes No Yes Yes No No Yes No No No No No Yes Yes No No No No No

REMIT No No No No No No No Yes No Yes Yes Yes Yes No No Yes Yes Yes No No No No No No No Yes Yes No Yes No No No No Yes Yes Yes Yes No No No No No No No No No No No No No No No No No No No No Yes Yes No No No Yes Yes No No No No No

Claim type Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Institutional Professional Professional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Professional Professional

ST SC SC SC SC

CPID 2410 2410 2410 2410 4901 4464 2983 5813 3608 5139 2928 3434 2254 4259 3774 2573 2438 5170 4588 5427 2147 3785 3988 3627 2536 1890 2747 7544 2890 7902 4134 1904 7449 4290 1991 5171 4480 1532 8587 6494 4922 2213 5471 4940 5599 3916 3443 7499 7567 2995 3256 5221 8565 1958 5252 8565 5221 8565 5221 5221 8565 5221 8565 4247 8904 3729 3641 3731 3609

PAYOR SC BCBS FEP SC BCBS PREFERRED HEALTH SYSTEMS - HMO BLUE SC BCBS STATE EMPLOYEE HEALTH PLAN SC FEDERAL EMPLOYEE HEALTH BENEFITS SCAN HEALTH ARIZONA SCAN HEALTH PLAN SCAN HEALTH PLAN SCAN HEALTH PLAN ARIZONA SCAN LONG TERM CARE SCAN LONG TERM CARE SCHALLER SUN HEALTH SCHS TOTAL CARE INC. SCOTT and WHITE HEALTH PLAN SEAVIEW SECURE HEALTH PLANS OF GEORGIA, LLC SECURE HEALTH PLANS of GEORGIA, LLC SECURE HORIZONS - TUFTS HEALTH PLAN FOR SENIORS SECURECARE OF IOWA SECURITY HEALTH PLAN SECURITY HEALTH PLAN SEDGWICK CLAIMS MANAGEMENT SELECT ADMINISTRATIVE SERVICES (SAS) SELECT BENEFIT ADMINISTRATION SELECT BENEFIT ADMINISTRATORS SELECT BENEFIT ADMINISTRATORS (DES MOINES, IA) SELECT BENEFIT ADMINISTRATORS (DES MOINES, IA) SELECT BENEFIT ADMINISTRATORS of AMERICA SELECT HEALTH of SOUTH CAROLINA SELECT HEALTH of SOUTH CAROLINA SELECT SENIOR CLINIC SELECT SENIOR CLINIC SELECTCARE SELECTCARE SELECTCARE of OKLAHOMA SELECTCARE of TEXAS SELECTCARE, INC. OF MICHIGAN SELECTHEALTH SELECTHEALTH SELF FUNDED PLANS SELF FUNDED PLANS (IL, PA, OH) SELF INSURED BENEFIT ADMINISTRATORS SELF INSURED BENEFITS ADMINISTRATORS (CLEARWATER, SELF INSURED PLANS (NAPLES, FL) SELF INSURED PLANS LLC SENIOR BLUE of PENNSYLVANIA (MEDICARE HMO) SENIOR WHOLE HEALTH SENIOR WHOLE HEALTH SENTARA HEALTH MANAGEMENT SENTARA HEALTH MANAGEMENT SENTINEL MANAGEMENT SENTINEL MANAGEMENT SERVICES SENTRY CASUALTY COMPANY - P2P LINK SENTRY CASUALTY COMPANY - P2P LINK SENTRY INSURANCE SENTRY INSURANCE SENTRY INSURANCE - TEXAS ONLY - P2P LINK SENTRY INSURANCE - TEXAS ONLY - P2P LINK SENTRY INSURANCE A MUTUAL COMPANY - P2P LINK SENTRY INSURANCE A MUTUAL COMPANY - P2P LINK SENTRY LLOYDS OF TEXAS - P2P LINK SENTRY LLOYDSY OF TEXAS SENTRY SELECT INSURANCE COMPANY SENTRY SELECT INSURANCE COMPANY - P2P LINK SETON EMPLOYEE PLAN - TEXAS SETON HEALTH PLAN SETON HEALTH PLAN - CHIP SETON HEALTH PLAN - CHIP SETON MAP PROGRAM SEVEN CORNERS

INTERMEDIARY

UHIN

CAPITAL BLUE CROSS

PAYOR ID Agreement required SB880 No SB880 No SB880 No SB880 No 73172 No 72261 No 72261 No 73172 No 20460 No 20460 No 12X52 No 16146 No TH002 Yes SVIPA No 28530 No 28530 No 4298 Yes No 39045 No 39045 No Yes 64088 No 37282 No 93031 No 42137 No 42137 No 37282 No 23285 No 23285 No No No 14 No 14 No SCOK1 No 61225 No No HT000015-0 Yes 12X37 No 34131 No 34131 No 59111 No 59111 No 36404 No 36404 No 23045 Yes 83035 No 83035 No 54154 No 54154 No 23249 No 23249 No Yes Yes 39033 No 39033 No Yes Yes Yes Yes Yes Yes Yes Yes TH080 No No 76056 No 76056 No TH081 No 25404 No

REMIT Yes Yes Yes Yes No No No No No No No No No No No No Yes No No No No No No No No No No Yes Yes No No No No No No No Yes No No No No No No No Yes No No Yes Yes No No No No Yes No No No No No No No No No No No No No No No

Claim type Professional Professional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Professional Professional Institutional Professional Professional Institutional Professional Professional Professional Institutional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional

ST

SC SC SC SC SC SC SC SC

SD SD SD SD SD SD

CA

CPID 5144 3847 2966 4156 1906 2283 3660 5866 1994 3880 3879 2685 3231 4945 5497 2568 7532 5469 5172 4732 4617 6129 3886 2491 1982 3448 7516 7950 3992 3467 5889 2410 2410 1559 2410 1484 5540 2452 1560 2926 3888 1510 2490 5173 5591 4478 2454 5589 4537 3825 2542 4406 4924 5704 2497 1444 1625 6112 3280 5174 3244 4509 6405 3745 2533 3436 3904 3807 1503

PAYOR SEVEN CORNERS SHASTA ADMINISTRATIVE SERVICES SHASTA ADMINISTRATIVE SERVICES SHEET METAL WORKERS LOCAL 91 SHEFFIELD, OLSON, and McQUEEN, INC. (ST. PAUL, MN) SHEFFIELD, OLSON, and McQUEEN, INC. (ST. PAUL, MN) SHERMAN CHOICE SHERMAN CHOICE SIERRA HEALTH SERVICES, INC. (CLAIMS) SIERRA HEALTH SERVICES, INC. (CLAIMS) SIERRA HEALTH SERVICES, INC. (ENCOUNTERS) SIERRA HEALTH SERVICES, INC. (ENCOUNTERS) SIERRA NEVADA MEDICAL ASSOCIATES SIERRA NEVADA MEDICAL ASSOCIATES SIGNATURE HEALTH ALLIANCE (SHA) SIGNATURE HEALTH ALLIANCE (SHA) SIGNIFICA BENEFIT SERVICES, INC. SIGNIFICA BENEFIT SERVICES, INC. SILVER CARE MANAGED CARE ORGANIZATION SILVER CROSS SIMPLY HEALTHCARE PLANS SIMPLY HEALTHCARE PLANS SINCLAIR HEALTH PLAN SISCO SISCO SLOANS LAKE PREFERRED HEALTH NETWORKS SLOANS LAKE PREFERRED HEALTH NETWORKS SMIPA/SFIPA SMITH ADMINISTATORS SMITH ADMINISTRATORS SONOMA COUNTY PRIMARY CARE IPA SOUTH CAROLINA BCBS PREFERRED HLTH SYS - HMO BLUE SOUTH CAROLINA BCBS STATE EMPLOYEES SOUTH CAROLINA BLUE CROSS SOUTH CAROLINA BLUE SHIELD SOUTH CAROLINA MEDICAID SOUTH CAROLINA MEDICAID SOUTH CAROLINA MEDICARE SOUTH CAROLINA MEDICARE SOUTH CENTRAL PREFERRED SOUTH CENTRAL PREFERRED SOUTH DAKOTA BLUE CROSS SOUTH DAKOTA BLUE SHIELD SOUTH DAKOTA CHIROPRACTIC (SANFORD HEALTH PLAN) SOUTH DAKOTA MEDICAID SOUTH DAKOTA MEDICAID SOUTH DAKOTA MEDICARE SOUTH DAKOTA MEDICARE SOUTHCARE / HEALTHCARE PREFERRED SOUTHCARE/HEALTHCARE PREFERRED SOUTHEASTERN INDIANA HEALTH ORGANIZATION - SIHO SOUTHEASTERN INDIANA HEALTH ORGANIZATION - SIHO SOUTHERN BENEFIT SERVICES SOUTHERN BENEFIT SERVICES SOUTHERN CALIFORNIA CHILDRENS NETWORK SOUTHERN CALIFORNIA MEDICARE SOUTHLAND IPA SOUTHLAND IPA SOUTHWEST ADMINISTRATORS (CA and NV) SOUTHWEST PHYSICIANS ASSOCIATES SOUTHWEST SERVICE LIFE SPECIAL AGENT MUTUAL BENEFIT ASSOCIATION SPECIAL AGENT MUTUAL BENEFIT ASSOCIATION SPECIAL RISK INTERNATIONAL (SRI) SPECIAL RISK INTERNATIONAL (SRI) SPECTRUM ADMINISTRATORS SPECTRUM ADMINISTRATORS SPINA BIFIDA - VA HAC SPINA BIFIDA - VA HAC

INTERMEDIARY

PAYOR ID Agreement required 25404 No 75280 No 75280 No No 41143 No 41143 No No No 76342 No 76342 No 76343 No 76343 No 68041 No 68041 No 62159 No 62159 No 23250 No 23250 No 36387 No NASCR No 27094 No 27094 No 84076 No No SISCO No 38335 No 38335 No No 2057 No 2057 No No SB880 No SB880 No 12B55 No SB880 No SKSC0 Yes Yes PALMETTO GBA SMSC0 Yes PALMETTO GBA 12M55 Yes 23266 No 23266 No WELLMARK EDS/EC SOL 12B10 Yes WELLMARK EDS/EC SOL SB889 Yes No 12K36 Yes SKSD0 Yes NORIDIAN ADMIN. SERVICES SMSD0 Yes NORIDIAN ADMIN. SERVICES 3401 Yes 25147 No 25147 No SX142 No SX142 Yes 37318 No 37318 No SYMED No PALMETTO GBA SMCA2 Yes No No SWADM No No 37266 No 62308 No 62308 No 52190 No 52190 No 23253 No 23253 No 84146 No 84146 No

REMIT No No No No No No No No Yes Yes No No No No No No Yes Yes No No No No No No Yes No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes No No Yes Yes Yes No No No No No No No Yes No No No No No Yes Yes No No No No Yes Yes

Claim type Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Professional Professional Professional Institutional Professional Institutional Institutional Institutional Professional Professional Professional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Professional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional

ST

GA TX TX

TN

CPID 3991 5492 4600 5897 3977 5175 9570 5830 3621 6116 2956 4135 7542 2235 2235 3414 3855 3412 2235 3885 4541 6401 5176 1832 8533 5419 6573 5971 2156 2125 1407 1579 6467 5425 1844 8551 8551 1844 6111 1620 8589 1899 1601 5226 2222 4469 2273 4593 6465 4593 6465 2235 7501 1811 2544 1755 1980 4769 8517 4120 2968 2253 7951 8517 4120 3454 2111 5947 4968

PAYOR SPOHN HEALTH SSM EXCLUSIVE CHOICE ST FRANCIS HEALTH NETWORK MEDICAID ST FRANCIS HEALTH NETWORK MEDICAID ST JOHN'S CLAIMS ADMINISTRATORS ST JOSEPH HEALTH ST JOSEPH HERITAGE ST LAWRENCE COUNTY HEALTHCARE PLAN ST LAWRENCE COUNTY HEALTHCARE PLAN ST LOUIS COUNTY ST MARYS HEATLH PLAN ST THOMAS MEDICAL NETWORK (GULFQUEST) ST VINCENT CATH MED CNTR OF NY ST. ANTHONY - MDWISE ST. CATHERINE - MDWISE ST. FRANCIS IPA ST. JOHNS CLAIMS ADMINISTRATION ST. JOSEPH HERITAGE HEALTHCARE ST. MARGARET MERCY - MDWISE STAR HRG STARMARK STARMARK STARMARK - 4MOST STATE EMPLOYEES GROUP BENEFITS PROGRAM STATE EMPLOYEES GROUP BENEFITS PROGRAM STATE FARM INSURANCE COMPANIES STATE FARM INSURANCE COMPANIES STATE FARM INSURANCE PROPERTY and CASUALTY STATE FARM INSURANCE PROPERTY and CASUALTY STATE INSURANCE FUND of CALIFORNIA (SCIF) STATE MERIT STATE OF TX DENTAL STATE of TEXAS DENTAL STATES GENERAL LIFE INSURANCE STAYWELL FLORIDA STAYWELL FLORIDA STAYWELL KIDS FLORIDA STAYWELL KIDS FLORIDA STERLING MEDICARE ADVANTAGE STERLING MEDICARE ADVANTAGE STERLING OPTION 1 STERLING OPTION 1 STIRLING and STIRLING STIRLING and STIRLING STONER AND ASSOCIATES - CINCINNATI, OH STONES RIVER IPA - WINDSOR STONES RIVER IPA forTN BLUE CROSS BLUE SHIELD only STUDENT INS.-MEGA LIFE & HEALTH INSURANCE CO STUDENT INSURANCE-MEGA LIFE & HEALTH INSURANCE CO STUDENT INSURANCE-MIDWEST NATIONAL LIFE INS of TN STUDENT INSURANCE-MIDWEST NATIONAL LIFE INS of TN SUBURBAN HEALTH ORGANIZATION SUFFOLK HEALTH PLAN of NEW YORK SUFFOLK HEALTH PLAN of NEW YORK SUMMACARE HEALTH PLAN SUMMACARE HEALTH PLAN SUMMERLIN LIFE AND HEALTH SUMMERLIN LIFE AND HEALTH INSURANCE SUMMIT - P2P LINK SUMMIT - P2P LINK SUMMIT AMERICA INSURANCE SUMMIT AMERICA INSURANCE SERVICES, INC. SUMMIT HEALTHPLAN I PAR PLUS SUMMIT HOLDINGS - P2P LINK SUMMIT HOLDINGS - P2P LINK SUN HEALTH CORPORATION SUNSHINE STATE HEALTH PLAN SUNSHINE STATE HEALTH PLAN SUPERIEN HEALTH

INTERMEDIARY

WELLPOINT_

PAYOR ID Agreement required 12T63 No 48117 No No No 37264 No No STJOE No No No Yes 88029 No No 13407 No 35199 No 35199 No APP01 No 37264 No STJOE No 35199 No 59225 No 61425 No 61425 No No 72087 No 72087 No 31053 No 31053 No No No Yes SB601 No 44054 No 44054 No 75087 No 14163 No 14163 No 14163 No 14163 No 67829 No 67829 No 91151 No 91151 No No No 31121 No 15752 No No 74227 No 74227 No 74227 No 74227 No 35199 No 11325 No 11325 No 95202 No 95202 No 86071 No 86071 No Yes Yes 37301 No 37301 No No Yes Yes SX186 No 68057 No 68057 No 75274 No

REMIT No Yes No No No No No No No No No No No No No No No No No No Yes Yes No No No Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes Yes No No No No No No No No No No No No No No No No Yes Yes No No No No No No No No No No Yes No No

Claim type Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Professional Professional Professional Professional Professional Institutional Professional Professional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Professional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Professional Institutional Institutional

ST

TX

TN TN TN TN TN TN TX TX

TX TX TX TX

CPID 3760 3662 3522 2701 5846 4789 4788 4705 4704 4274 4713 4712 4701 4700 4709 4708 4711 4710 4257 4495 2497 3413 4465 4935 3752 3644 1827 6146 7952 1706 4559 1706 4559 1822 1706 4559 5177 7953 5178 6492 4507 5513 2401 5514 2495 1453 5525 5842 5501 1406 1911 2483 6583 1729 4766 5926 4742 1470 5500 5502 1440 6456 6557 3286 4279 2435 1996 7976 5204

PAYOR SUPERIOR ADMINISTRATORS, INC. (SANTA ANA.CA) SUPERIOR BENEFITS SUPERIOR HEALTH PLAN - TEXAS SUPERIOR HEALTH PLAN - TEXAS SUTTER CONNECT - ABMG ENCOUNTERS SUTTER CONNECT - CENTRAL VALLEY MEDICAL GROUP-CLAI SUTTER CONNECT - CENTRAL VALLEY MEDICAL GROUP-ENC SUTTER CONNECT - DELTA CLAIMS SUTTER CONNECT - DELTA ENCOUNTERS SUTTER CONNECT - EAST BAY MEDICAL FOUNDATION SUTTER CONNECT - GOULD CLAIMS SUTTER CONNECT - GOULD ENCOUNTERS SUTTER CONNECT - SANTA ROSA CLAIMS SUTTER CONNECT - SANTA ROSA ENCOUNTERS SUTTER CONNECT - SIP, SMG, SWMG CLAIMS SUTTER CONNECT - SIP, SMG, SWMG ENCOUNTERS SUTTER CONNECT - SOLANO CLAIMS SUTTER CONNECT - SOLANO ENCOUNTERS SUTTER SELECT SWEDISH CONVENANT SYNERMED TALBERT MEDICAL GROUP TALL TREE ADMINISTRATION TALL TREE ADMINISTRATION TARRANT HEALTH SERVICES TARRANT HEALTH SERVICES TEACHERS HEALTH TRUST TEAM CHOICE - ALPHA CARE GOLD TEAM CHOICE - ALPHA CARE GOLD I PAR PLUS TEAM CHOICE GOLD TEAM CHOICE GOLD TEAM CHOICE PINS TEAM CHOICE PINS TEAM CHOICE PPO TEAM CHOICE UMC TEAM CHOICE UMC TEAM CHOICE UMC TEAM CHOICE UMC TEAM HEALTH GOLD TEAMCARE TEAMCARE TENNESSEE BLUE CROSS TENNESSEE BLUE SHIELD TENNESSEE BLUECARE TENNESSEE BLUECARE TENNESSEE MEDICARE TENNESSEE MEDICARE TETHYS HEALTH VENTURES TEXAS BLUE CROSS TEXAS BLUE SHIELD TEXAS CHILDRENS HEALTH PLAN (MEDICAID) TEXAS CHILDRENS HEALTH PLAN (MEDICAID) TEXAS CHILDRENS HEALTH PLAN - CHIP TEXAS CHILDRENS HEALTH PLAN - CHIP TEXAS FIRST HEALTH PLAN TEXAS FIRST HEALTH PLANS TEXAS HEALTHSPRING TEXAS MEDICAID TEXAS MEDICAID TEXAS MEDICARE TEXAS MEDICARE TEXAS MUNICIPAL LEAGUE TEXAS MUNICIPAL LEAGUE GROUP TEXAS PLUS TEXAS PREMIER PLAN - MEDICAID TEXAS TRUE CHOICE TEXAS TRUE CHOICE THE BENEFIT GROUP THE BENEFIT GROUP

INTERMEDIARY

PAYOR ID Agreement required 23218 No 23218 No 39188 Yes CENTENE CORPORATION 39188 Yes A0701 No IP131 Yes HM066 Yes IP100 Yes HM063 Yes No IP091 Yes HM058 Yes IP090 Yes HM057 Yes IP092 Yes HM059 Yes IP099 Yes HM062 Yes HM064 Yes NASWD No SYMED No TALMG No 88067 No 88067 No 37228 No 37228 No 88019 No No No 75261 No 75261 No 75261 No 75261 No 75133 No 75261 No 75261 No 75134 No 75134 No 75139 No 36215 No 36215 No TENNESSEE BC BS 12B45 Yes SB890 Yes TENNESSEE BC BS 12K46 Yes TENNESSEE BC BS SKTN2 Yes CAHABA GBA SMTN0 Yes CAHABA GBA 12M53 Yes 20212 No 12B31 No SB900 No 75228 No 75228 No 76048 No 76048 No TX1ST No No THS01 No HP ENTERPRISE SERVICES SKTX0 Yes HP ENTERPRISE SERVICES TESTI Yes TRAILBLAZER HLTHENT-GPNET12M31 Yes TRAILBLAZER HLTHENT-GPNETSMTX0 Yes 74214 No 74214 No TH011 No TH089 No TTCEC No TH055 No No No

REMIT No No No Yes No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No Yes Yes Yes Yes Yes Yes No Yes Yes No No No No No No No Yes Yes Yes Yes No No No No No No No No

Claim type Professional Institutional Institutional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Professional Institutional Institutional Professional

ST

SC

PR

CPID 3930 2545 5221 8565 5967 2139 1657 8959 6593 6410 6431 2410 6428 4540 5182 7954 8958 4286 3233 1968 4263 8938 6401 4541 4222 7973 4272 8549 1634 4770 4999 4490 2590 3852 5183 2973 2224 2919 4737 6577 5453 2941 3954 3242 4590 5402 1946 2892 3249 5991 2200 4136 8503 4456 6594 3552 7452 5913 4749 3610 5150 2444 4871 5938 5835 3624 3543 2756 1847

PAYOR THE BOON GROUP THE CITY OF ODESSA THE DIAL CORPORATION - P2P LINK THE DIAL CORPPRATION - P2P LINK THE PUBLIC HEALTH PROGRAM THERAPY REVIEW SYSTEMS THERAPY REVIEW SYSTEMS THIRD PARTY ADMIN/AMERICAN BENEFIT ADMIN THIRD PARTY ADMINISTRATORS THIRD PARTY ADMINISTRATORS, INC. THIRD PARTY CLAIMS MANAGEMENT THOMAS COOPER AGENCY TIME INSURANCE COMPANY TIME INSURANCE COMPANY TLC ADVANTAGE IN SIOUX FALLS TLC ADVANTAGE IN SIOUX FALLS TODAYS HEALTH TODAYS HEALTH TODAYS OPTION TODAYS OPTION TONGASS TIMBER TRUST TONGASS TIMBER TRUST TOOLING & MANUFACTURING ASSOC TOOLING & MANUFACTURING ASSOCIATION TORRANCE HOSPITAL IPA TOTAL CARE TOTAL CAROLINA CARE TOTAL CAROLINA CARE TOTAL COMMUNITY CARE TOTAL COMMUNITY CARE TOTAL HEALTH CARE - JVHL TOTAL HEALTH CARE - JVHL TOTAL HEALTH CARE INC. TOTAL HEALTHCARE, INC. TOUCHPOINT HEALTH PLAN HMO TOUCHSTONE HEALTH TOUCHSTONE HEALTH PARTNER TOUCHSTONE HEALTH PSO TOUCHSTONE HEALTH PSO TOWER LIFE INSURANCE COMPANY TOWER LIFE INSURANCE COMPANY TPSC - IPN TR PAUL INC TR PAUL INC. TRANS HEALTH PROTECTION PLAN (THE) TRANS HEALTH PROTECTION PLAN (THE) TRANSAMERICA TRANSAMERICA LIFE INSURANCE COMPANY TRANSCHOICE KEY BENEFIT ADMINISTRATORS TRAVELERS - P2P LINK - WORKERS COMPENSATION TRAVELERS - P2P LINK - WORKERS COMPENSATION TRAVIS COUNTY HOSPITAL DISTRICT TRICARE - NORTH REGION TRICARE - NORTH and SOUTH REGION TRICARE - SOUTH REGION TRICARE - WEST REGION TRICARE - WEST REGION TRICARE for LIFE TRICARE for LIFE TRIHEALTH PHYSICIAN SERVICES TRIHEALTH PHYSICIAN SERVICES TRILLIUM COMMUNITY HEALTH PLANS TRILOGY HEALTH TRILOGY HEALTH TRILOGY HEALTH NETWORK (TRLHN/EB) TRILOGY HEALTH NETWORK (TRLHN/EB) TRIPLE S - PUERTO RICO TRIPLE S - PUERTO RICO TRISURANT

INTERMEDIARY

PALMETTO GBA PALMETTO GBA PALMETTO GBA WPS WPS

PAYOR ID Agreement required BOONG No 75600 No Yes Yes AMM02 No 75305 No 75305 No No 87815 No 87815 No 95266 No SB880 No 39065 No 39065 No No No No 20081 No 48055 No 48055 No 92620 No 92620 No 61425 No 61425 No THIPA No No 68055 No 68055 No 31182 No 31182 No Yes Yes 38201 No 38201 No 97910 No 13402 No 13402 No 23856 No 23856 No 69493 No 69493 No 91078 No 37230 No 37230 No 39026 No 39026 No 59222 No 59222 No 37284 No Yes Yes No 57106 Yes 57106 Yes 61125 Yes WESTR Yes WESTR Yes TDDIR Yes TDDIR Yes 31144 Yes 31144 Yes 20048 Yes 98514 No 98514 No 62777 No 62777 No Yes Yes 34185 No

REMIT No No No No No No No No No Yes No Yes Yes Yes No No No No No No No No Yes Yes No No No No No No No No No No No No No No No No No No No No Yes Yes No Yes No Yes Yes No Yes Yes Yes Yes Yes Yes Yes No No No No No No No Yes Yes No

Claim type Institutional Institutional Professional Institutional Institutional Professional Institutional Institutional Institutional Professional Professional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional N/A Professional Institutional Professional Professional Professional Institutional Professional Institutional Institutional Professional Professional

ST

MN MN

CPID 5437 4914 4474 3967 2238 6401 4541 8504 2438 3678 4161 3429 3429 3429 1531 4496 4157 8565 5221 4594 7955 5184 1670 5711 7482 4566 5456 1621 2991 4589 8473 4542 3838 5420 7576 4730 6131 4618 8404 4558 7542 8568 5223 8571 5225 5227 6567 1426 7587 3724 4513 1760 7531 2809 3281 5296 3550 3429 4996 3215 3429 3429 3429 3429 3429 3429 3429 3429 3429

PAYOR TRUE CHOICE USA TRUE CHOICE USA TRUE CHOICE USA CHRISTUS HEALTH PLAN TRUE CHOICE USA CHRISTUS HEALTH PLAN TRUSTEED PLANS SERVICE CORPORATION TRUSTMARK INSURANCE COMPANY TRUSTMARK INSURANCE COMPANY TUFTS ASSOCIATED HEALTH PLAN TUFTS HEALTH PLANS TX PREMIER PLAN MEDICAID TXEN ALTPROS UBH - UNITED BEHAVIORAL HEALTH UBH - UNITED BEHAVIORAL HEALTH - HMO UBH-RIOS UCARE OF MINNESOTA UCARE OF MINNESOTA UFCW - CENTRAL OHIO UFP INSURANCE - P2P LINK UFP INSURANCE - P2P LINK UICI - ADMINISTRATORS - STATE of NEVADA UICI - ADMINISTRATORS - STATE OF NEVADA UICI - ADMINISTRATORS - STATE OF NEVADA UMC HEALTH PLAN UMC HEALTH PLAN UMR - MIDWEST SECURITIES UMR - MIDWEST SECURITIES UMR CINCINNATI REPRICING via HEALTHSPAN UMR CINCINNATI REPRICING via HEALTHSPAN UMWA - UNITED MINE WORKERS ASSOCIATION UNICARE UNICARE UNIFIED GROUP SERVICE UNIFIED GROUP SERVICES UNIFIED HEALTH SERVICES UNIFIED HEALTH SERVICES UNIFIED IPA UNIFIED PHYSICIANS NETWORK UNIFIED PHYSICIANS NETWORK UNIFORM MEDICAL PLAN/HARRINGTON BENEFIT SERVICES UNIFORM MEDICAL PLAN/HARRINGTON BENEFIT SERVICES UNIFORMED SERV FAMILY HLTH PLAN UNIMED - AMERICAN FIRST - P2P LINK UNIMED - AMERICAN FIRST - P2P LINK UNIMED - CITY of CARROLLTON/TRISTAR - P2P LINK UNIMED - CITY of CARROLLTON/TRISTAR - P2P LINK UNIMED - INTERNATIONAL SOLUTIONS - P2P LINK UNION LABOR LIFE INSURANCE UNION LABOR LIFE INSURANCE COMPANY (THE) UNION PACIFIC RAILROAD EMPLOYEE HEALTH SYSTEMS UNION PACIFIC RAILROAD EMPLOYEE HEALTH SYSTEMS UNION SECURITY INSURANCE COMPANY UNION SECURITY INSURANCE COMPANY UNISON HEALTH PLAN UNISON HEALTH PLAN UNITED AGRICULTURE BENEFIT TRUST UNITED FOOD AND COMMERCIAL WORKERS UNION UNITED HEALTHCARE UNITED HEALTHCARE UNITED HEALTHCARE - JVHL UNITED HEALTHCARE - JVHL UNITED HEALTHCARE OF ALABAMA UNITED HEALTHCARE OF ARIZONA, INC. UNITED HEALTHCARE OF ARKANSAS UNITED HEALTHCARE OF CALIFORNIA-NORTHERN CA UNITED HEALTHCARE OF CALIFORNIA-SOUTHERN CA UNITED HEALTHCARE OF COLORADO UNITED HEALTHCARE OF FLORIDA UNITED HEALTHCARE OF GEORGIA UNITED HEALTHCARE OF ILLINOIS

INTERMEDIARY

WELLPOINT WELLPOINT

PAYOR ID Agreement required 54210 No TCUSA No TCUCH No TCUCH No 91078 No 61425 No 61425 No 4298 Yes 4298 Yes 12T29 No No 87726 No 87726 No 87726 No 12X50 No SX178 No No Yes Yes 74223 No No No 75130 No 75130 No 79480 No 79480 No No No 52180 No 80314 No 80314 No 35198 No 35198 No 62170 No 62170 No HCP01 No 34638 No 34638 No 75243 No 75243 No 13407 No Yes Yes Yes Yes Yes 13142 No 13142 No 87042 No 87042 No 70408 No 70408 No 25175 No 25175 No UABT1 No No 87726 No 87726 No Yes Yes 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No

REMIT No No No No No Yes Yes Yes Yes No No Yes Yes Yes No Yes No No No No No No No No Yes Yes No No No Yes Yes No No Yes Yes No No No No No No No No No No No No No No No Yes Yes Yes Yes No No Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes

Claim type Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Professional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional

ST

NY NY

CPID 3429 3429 3429 3429 3429 3429 3429 3429 3429 3429 3429 3429 3429 3429 3429 3429 3429 3429 3429 3429 6442 6442 4523 1802 7527 5408 1758 2420 4530 4997 3824 9513 3694 5894 6477 2901 2791 2773 2779 3836 8983 5221 8565 1903 2405 5185 2704 2748 8955 2719 8954 2727 3210 2910 1569 1741 5186 5248 5920 4779 5894 3694 8903 5240 2803 7543 2532 3741 4970

PAYOR UNITED HEALTHCARE OF KENTUCKY, LTD. UNITED HEALTHCARE OF LOUISIANA UNITED HEALTHCARE OF MID-ATLANTIC UNITED HEALTHCARE OF MISSISSIPPI UNITED HEALTHCARE OF NEW ENGLAND UNITED HEALTHCARE OF NEW YORK/NEW JERSEY UNITED HEALTHCARE OF NORTH CAROLINA, INC. UNITED HEALTHCARE OF OHIO UNITED HEALTHCARE OF TENNESSEE UNITED HEALTHCARE OF TEXAS (DALLAS) UNITED HEALTHCARE OF TEXAS (HOUSTON) UNITED HEALTHCARE OF THE MIDLANDS - HMO UNITED HEALTHCARE OF THE MIDLANDS-PPO UNITED HEALTHCARE OF THE MIDWEST UNITED HEALTHCARE OF THE MIDWEST-MEDICARE COMPLETE UNITED HEALTHCARE OF UPSTATE NEW YORK UNITED HEALTHCARE OF UTAH UNITED HEALTHCARE OF VIRGINIA UNITED HEALTHCARE OF WISCONSIN, INC. UNITED HEALTHCARE PLANS OF PUERTO RICO UNITED HEALTHCARE of RIVER VALLEY UNITED HEALTHCARE of the RIVER VALLEY UNITED HEALTHCARE of the RIVER VALLEY UNITED MEDICAL ALLIANCE UNITED MEDICAL RESOURCES UNITED MEDICAL RESOURCES UNITED MINE WORKERS OF AMERICA (UMWA) UNITED OF OMAHA UNITED OF OMAHA UNITED PHYSICIANS HEALTH ASSOCIATION - JVHL UNITED RESOURCES NETWORK UNITED RESOURCES NETWORK UNITED SECURITY LIFE AND HEALTH UNITED SECURITY LIFE AND HEALTH UNITED SERVICES AUTOMOBILE ASSOCIATION ( UNITY HEALTH INSURANCE UNITY HEALTH INSURANCE UNIVERA UNINW UNIVERA WNY UNIVERSAL CARE - CALIFORNIA UNIVERSAL CARE OF CALIFORNIA UNIVERSAL FOREST PRODUCTS UNIVERSAL FOREST PRODUCTS - P2P LINK UNIVERSAL HEALTH CARE, INC. UNIVERSAL HEALTH CARE, INC. UNIVERSAL STANDARD HEALTHCARE, INC. UNIVERSITY COMP CARE UNIVERSITY FAMILY CARE - HEALTHCARE GROUP UNIVERSITY FAMILY CARE - HEALTHCARE GROUP UNIVERSITY FAMILY CARE - MARICOPA HEALTH PLAN UNIVERSITY FAMILY CARE - MARICOPA HEALTH PLAN UNIVERSITY FAMILY CARE - UNIVERSITY PHYSICIAN CARE UNIVERSITY HEALTH ALLIANCE - HAWAII UNIVERSITY HEALTH ALLIANCE - HAWAII UNIVERSITY HEALTH PLAN (UHP) OF NJ DOS >03/01/2010 UNIVERSITY HEALTH PLAN (UHP) OF NJ DOS >03/01/2010 UNIVERSITY MSO UNIVERSITY of MIAMI BEHAVIORAL HEALTH UNIVERSITY of UTAH HEALTH PLAN UNIVERSITY of UTAH HEALTH PLAN UNLIMITED ACCESS PLAN UNLIMITED ACCESS PLAN UNMSCI (MOLINA HEALTHCARE of UNM SCI) UNMSCI (MOLINA HEALTHCARE of UNM SCI) UPMC HEALTH PLAN UPMC HEALTH PLAN UPPER PENINSULA HEALTH PLAN UPPER PENINSULA HEALTH PLAN US BENEFITS

INTERMEDIARY

EXCELLUS EXCELLUS

UHIN

PAYOR ID Agreement required 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 87726 No 95378 No 95378 No 95378 No 84132 No 31107 No 31107 No 52180 No 71412 No 71412 No Yes 41194 No 41194 No 81108 No 81108 No 74095 No 1UNITY No 66705 No SX091 Yes Yes 33001 No 33001 No Yes Yes 50528 No 50528 No No 31147 No 7503 Yes No 9908 No No 9830 No Yes 990263440 Yes 27514 No 27514 No No No No No 81108 No 81108 No 4423 No 4423 No 23281 No 23281 No 38337 No 38337 No 93092 No

REMIT Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes No Yes Yes No No No No No No Yes Yes No Yes No No No No Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes No No No No Yes Yes No No No

Claim type Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Professional Professional Professional Institutional Professional Institutional Institutional Professional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Institutional Professional Professional Professional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional

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UT UT UT UT UT UT UT UT

CA

VT VT VT VT VT VT VT

VI VA VA VA VA VA VA VA VA VA VA

CPID 2241 4952 4493 6477 6561 2166 2158 2845 7959 1529 1530 2412 2788 1486 1528 2458 1527 5187 4158 4926 2112 6127 4615 5980 2172 2497 2704 1816 3924 1633 3284 2449 9569 4434 3966 4967 7493 7492 3569 3570 2471 5954 1507 3887 4104 6987 2891 5188 7904 4138 5189 4487 5537 1413 5538 1472 7447 1442 5536 2461 5903 2245 4258 5959 1837 8538 5949 4472 3970

PAYOR US BENEFITS US FAMILY HEALTH PLAN (USFHP) US FAMILY HEALTH PLAN (USFHP) USAA USAA (U.S. AUTOMOBILE ASSOCIATION) USC - KEMPER INSURANCE COMPANY USC - SECURA INSURANCE - APPLETON USFHP-ST. VINCENT CATHOLIC MEDICAL CENTER NEW YORK USI ADMINISTRATORS, INC. UTAH BLUE CROSS (REGUALR BUSINESS) UTAH BLUE CROSS - FEP UTAH BLUE SHIELD UTAH BLUE SHIELD - FEP UTAH MEDICAID UTAH MEDICAID UTAH MEDICARE UTAH MEDICARE VALLEY HEALTH ADMINISTRATORS VALLEY HEALTH PLAN VALUE OPTIONS VALUE OPTIONS VALUE OPTIONS MBHP VALUE OPTIONS MBHP VALUE OPTIONS PENNSYLVANIA BEHAVIORAL HEALTH VALUE OPTIONS PENNSYLVANIA BEHAVIORAL HEALTH VANGUARD HEALTH SYSTEMS VANTAGE HEALTH PLAN, INC. VANTAGE HEALTH PLAN, INC. VANTAGE HLTH PLAN INC VANTAGE MEDICAL GROUP VANTAGE MEDICAL GROUP VENCOR VERDUGO HILLS MEDICAL GROUP VERITY NATIONAL GROUP VERITY NATIONAL GROUP VERMONT BLUE CROSS VERMONT BLUE SHIELD VERMONT MEDICAID VERMONT MEDICAID INPATIENT VERMONT MEDICAID OUTPATIENT VERMONT MEDICARE VERMONT MEDICARE VETERANS ADMINISTRATION FEE BASIS PROGRAMS VETERANS ADMINISTRATION FEE BASIS PROGRAMS VETERANS AFFAIRS FINANCIAL SERVICES CENTER VETERANS AFFAIRS FINANCIAL SERVICES CENTER VHP COMMUNITY CARE VICARE ADMINISTRATIVE SERVICES VILLAGE FAMILY PRACTICE VILLAGE FAMILY PRACTICE VIPA VIRGIN ISLANDS MEDICARE VIRGINIA BLUE CROSS VIRGINIA BLUE SHIELD VIRGINIA MEDICAID VIRGINIA MEDICAID VIRGINIA MEDICAID LAB VIRGINIA MEDICARE VIRGINIA MEDICARE VIRGINIA MEDICARE (ALEX, ARLGTN, FAIRFAX VIRGINIA PREMIER HEALTH PLAN VIRGINIA PREMIER HEALTH PLAN VISITING NURSE SERVICE of NEW YORK VISITING NURSE SERVICE of NEW YORK VISTA HEALTH PLAN VISTA HEALTH PLAN VIVA HEALTH CARE and VIVA MEDICARE VIVA HEALTH CARE and VIVA MEDICARE VOLUSIA HEALTH NETWORK

INTERMEDIARY

PAYOR ID Agreement required 93092 No USFHP No USFHP No 74095 No 74095 No Yes Yes 13407 No No UHIN 12B42 Yes UHIN 12B42 Yes UHIN SB910 Yes UHIN Yes UHIN SKUT0 Yes Yes NORIDIAN ADMIN. SERVICES SMUT0 Yes NORIDIAN ADMIN. SERVICES 12M84 Yes No No 12X56 No SX173 Yes 43307 Yes No 12K1A No 12K1A No SYMED No 31147 No 72128 No 72128 No PPM01 No PPM01 No 61101 No No 75256 No 75256 No 12B32 No SB915 No EDS - ELECTRONIC DATA SER SKVT0 Yes EDS - ELECTRONIC DATA SER 12K26 Yes EDS - ELECTRONIC DATA SER 12K26 Yes NATIONAL HERITAGE INS CO 14502 Yes NATIONAL HERITAGE INS CO Yes 12115 No 12115 No VAFSC No VAFSC No 23173 No No No No No FIRST COAST SERV OPTIONS SMVI0 Yes WELLPOINT 12002 No WELLPOINT SB923 No HP ENTERPRISE SERVICES 12003 No HP ENTERPRISE SERVICES SKVA0 No HP ENTERPRISE SERVICES No PALMETTO GBA 12010 Yes UNITED GOVERNMENT SERVICE 12004 Yes HIGHMARK MEDICARE SERVICE SMVA0 Yes VPN001 Yes 54176 Yes 77073 No 77073 No 25133 No 25133 No 63114 No 63114 No 59266 No

REMIT No No Yes No No No No No No Yes Yes Yes Yes Yes Yes Yes No No No Yes Yes No No Yes Yes No No No No No No Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes No No Yes Yes No No No

Claim type Professional Institutional Professional Professional Institutional Professional Professional Professional Institutional Institutional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional N/A N/A Professional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional

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AK WA WA AK AK WA WA WA DC DC WA WA WA WA WA

WV WV WV

CPID 3239 8440 6562 3572 3572 4443 5522 5522 5521 5521 1997 7451 2459 1522 5523 1482 1462 8575 4404 5563 2592 3794 6592 2276 2588 5873 4590 5402 5402 4590 5402 1706 4559 6504 8551 4949 3211 1844 8551 8551 1844 1964 3746 1844 7923 3201 5843 6410 6593 5992 5824 3979 5890 5532 2477 1450 6408 5202 1735 6587 6587 1735 3980 3827 5415 2998 4435 7504 8402

PAYOR VOLUSIA HEALTH NETWORK VYTRA HEALTHCARE VYTRA HEALTHCARE WA & AK HLTHY OPTIONS/BASIC HLTH PL WA & AK HLTHY OPTIONS/BASIC HLTH PL WABASH MEMORIAL HOSPITAL WASHINGTON AND ALASKA BLUE CROSS WASHINGTON AND ALASKA BLUE CROSS WASHINGTON AND ALASKA MEDICARE WASHINGTON AND ALASKA MEDICARE WASHINGTON BLUE CROSS REGENCE WASHINGTON BLUE SHIELD REGENCE WASHINGTON DC MEDICARE WASHINGTON DC MEDICARE WASHINGTON MEDICAID WASHINGTON MEDICAID WASHINGTON MEDICARE WASHINGTON NATIONAL INSURANCE CO. WASHINGTON WORKERS COMPENSATION WASHINGTON WORKERS COMPENSATION WASHTENAW HEALTH PLAN ENCOUNTERS - MI (MEDICAID) WASHTENAW HEALTH PLAN ENCOUNTERS - MI (MEDICAID) WATERSTONE BENEFIT ADMINISTRATORS WATERSTONE BENEFIT ADMINISTRATORS WATKINS ASSOCIATED INDUSTRY WATTS HEALTHCARE CORPORATION IPA WAUSAU BENEFITS INC. WAUSAU BENEFITS INC. WAUSAU BENEFITS, INC. WAUSAU PREFERRED HEALTH PLANS WAUSAU PREFERRED HEALTH PLANS WEB TPA WEB TPA WEBTPA fka COMMUNITY HEALTH ELECT CLAIMS WELLCARE HEALTH PLAN / STAYWELL WELLCARE HEALTH PLAN ENCOUNTERS WELLCARE HEALTH PLAN ENCOUNTERS WELLCARE HEALTH PLANS / STAYWELL WELLCARE OF CT, FL, GA, LA, NJ, NY, OH, TX WELLCARE OF KENTUCKY WELLCARE OF KENTUCKY WELLCARE PFFS WELLCARE PFFS WELLCARE of CT, FL, GA, LA, NJ, NY, OH, TX WELLMED WELLMED WELLMED ENCOUNTERS WELLS FARGO THIRD PARTY ADMINISTRATORS, INC, WELLS FARGO THIRD PARTY ADMINISTRATORS, INC. WENATCHEE VALLEY MEDICAL CENTER WENATCHEE VALLEY MEDICAL CENTER WEST & SOUTHERN FINANCIAL GROUP WEST COVINA MEDICAL GROUP WEST VIRGINIA MEDICAID WEST VIRGINIA MEDICAID WEST VIRGINIA MEDICARE WESTERN WESTERN BENEFITS (WESTERN GROCERS) WESTERN GROWERS ASSURANCE TRUST WESTERN GROWERS ASSURANCE TRUST WESTERN GROWERS INSURANCE COMPANY WESTERN GROWERS INSURANCE COMPANY WESTERN MUTUAL INSURANCE WESTERN MUTUAL INSURANCE WESTERN SOUTHERN FINANCIAL GROUP (CINCINNATI, OH) WESTLAKE FINANCIAL GROUP WESTLAKE FINANCIAL GROUP WEYCO, INC. WEYCO, INC.

INTERMEDIARY

PAYOR ID Agreement required 59266 No 22264 No 22264 No PREMERA BLUE CROSS Yes PREMERA BLUE CROSS Yes 85256 No PREMERA BLUE CROSS 12B27 Yes PREMERA BLUE CROSS 12B27 Yes NORIDIAN ADMIN. SERVICES 12M45 Yes NORIDIAN ADMIN. SERVICES 12M45 Yes 932 No SB931 No HIGHMARK MEDICARE SERVICE SMDC0 Yes HIGHMARK MEDICARE SERVICE 12201 Yes HP ENTERPRISE SERVICES 12K27 Yes HP ENTERPRISE SERVICES SKWA0 Yes NORIDIAN ADMIN. SERVICES SMWA0 Yes Yes Yes Yes 38338 No 38338 No 73155 No 73155 No No MPM09 No 39026 No 39026 No 39026 No 39026 No 39026 No 75261 No 75261 No 59298 No 14163 No 59354 No 59354 No 14163 No 14163 No 14163 No 14163 No 77072 No 77072 No 14163 No No TH023 No TH040 No 87815 No 87815 No 91064 No 91064 No 31048 No 66124 No UNISYS 12K28 No UNISYS SKWV0 No PALMETTO GBA SMWV0 Yes 80705 No No 24735 No 24735 No 24735 No 24735 No 37247 No 37247 No 31048 No 90560 No 90560 No 38232 No 38232 No

REMIT No No No Yes Yes No Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes No Yes Yes No No No No No No Yes Yes Yes Yes Yes No No No Yes No No Yes Yes Yes Yes No No Yes No No No Yes No No No No No Yes Yes Yes Yes No No No No No No No No No No No No

Claim type Professional Professional Institutional Institutional Institutional Professional Institutional Institutional Institutional Institutional Institutional Professional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Institutional Institutional Institutional Institutional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Institutional Professional Professional Professional Professional Professional Institutional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional

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WI WI

WI WI WI WI

WY WY WY WY WY WY

WA

CPID 3919 3465 2226 4139 7905 3633 5839 5710 1953 2294 4761 8950 3259 5511 1401 4774 6564 4413 2449 1467 5510 5512 1434 1658 3243 2704 2849 7598 3202 5983 5191 4457 2900 2847 4937 5228 8594 3584 7489 7458 2577 2466 3583 1998 3435 2672 2165

PAYOR WILLIAM C. EARHART WILLIAM C. EARHART WILLIAM J. SUTTON and CO., LTD - TORONTO, CANADA WILLIAMS AND COUNTY MAP WILLIAMS AND COUNTY MAP WILSON MCSHANE WILSON MCSHANE WIN HEALTHCARE WINDSOR MEDICARE EXTRA WINDSOR MEDICARE EXTRA WINHEALTH WISCONSIN AUTO and TRUCK DEALERS WISCONSIN AUTO and TRUCK DEALERS WISCONSIN BLUE CROSS WISCONSIN BLUE SHIELD WISCONSIN DEPARTMENT OF CORRECTIONS WISCONSIN EDUCATORS ASSOCIATION (WEA) WISCONSIN EDUCATORS ASSOCIATION (WEA) WISCONSIN HEALTH WISCONSIN MEDICAID WISCONSIN MEDICAID WISCONSIN MEDICARE WISCONSIN MEDICARE WORKSITE BENEFIT SERVICES WORKSITE BENEFIT SERVICES WORKSTAR WORLD INSURANCE COMPANY WORLD INSURANCE COMPANY WPP ELDERCARE WPP ELDERCARE WPPA-PROVIDRS CARE NETWORK WPS REGULAR BUSINESS WPS REGULAR BUSINESS WRITERS GUILD INDUSTRY HEALTH PLAN WRITERS GUILD-INDUSTRY HEALTH PLAN WSI - P2P LINK WSI - P2P LINK WYOMING BLUE CROSS WYOMING BLUE SHIELD WYOMING MEDICAID WYOMING MEDICAID WYOMING MEDICARE WYOMING MEDICARE XL HEALTH CARE IMPROVEMENTS PLUS XL HEALTH CARE IMPROVEMENTS PLUS YAVAPAI COUNTY YAVAPAI COUNTY

INTERMEDIARY

PAYOR ID Agreement required 93050 No 93050 No 98010 No No No 41095 No 41095 No 13413 No 62153 No 62153 No No 39200 No 39200 No WELLPOINT_ 12B29 No WELLPOINT_ SB950 No 74101 Yes 39151 No 39151 No 61101 No EDS - ELECTRONIC DATA SER SKWI0 No Testi No UNITED GOVERNMENT SERVICE 12M29 Yes WPS SMWI0 Yes 20333 No 20333 No 31147 No 75276 No 75276 No 77080 No 77080 No No WPS SX022 Yes WPS SX022 Yes 23710 No 23710 No Yes Yes NORIDIAN ADMIN. SERVICES 12B30 Yes NORIDIAN ADMIN. SERVICES SB960 Yes HP ENTERPRISE SERVICES SKWY0 Yes HP ENTERPRISE SERVICES 12K30 Yes NORIDIAN ADMIN. SERVICES SMWY0 Yes NORIDIAN ADMIN. SERVICES 12M30 Yes 77082 No 77082 No 9829 No 9829 No

REMIT No No No No No No No No No No No No No Yes Yes No Yes Yes Yes Yes Yes Yes Yes No No No Yes Yes No No No Yes Yes No No No No Yes Yes Yes Yes Yes Yes No No No No

Claim type Institutional Professional Professional Professional Institutional Institutional Professional Professional Institutional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Professional Professional Institutional Institutional Professional Institutional Professional Professional Professional Institutional Professional Institutional Professional Professional Institutional Professional Institutional Professional Institutional Institutional Professional Professional Institutional Professional Institutional Institutional Professional Institutional Professional