ENS Eligibility Payer List(SDK) by Allisonmartin

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									       Ingenix Eligibility Payer List
       ANSI HIPAA 270/271
       (As of 7/16/09)



                                                                Payer ID
                                                                 2100A
Payer Name                                                       NM109          State       Additional Information                                              Type


AARP-United Healthcare Insurance Co                               36273          ALL        Loop 2100B should contain Tax Identification Number and/or NPI.      T

                                                                                            Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,
Aetna Health Plans (AHP)                                          60054          ALL        Organization Number Tax ID, or NPI.                                  P

                                                                                            Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,
Aetna Health Plans PPO                                            60054          ALL        Organization Number, Tax ID, or NPI.                                 P

                                                                                            Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,
AHP of New Jersey, Parsippany                                     60054          ALL        Organization Number, Tax ID, or NPI.                                 P

                                                                                            Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,
AHP of New Jersey, Purchase, NY                                   60054          ALL        Organization Number, Tax ID, or NPI.                                 P
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Alabama Medicare                                                  CMSEL           AL        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


Alabama Blue Cross (Institutional)                                ALBLC           AL        Loop 2100B must contain NPI.                                        NC


Alabama Blue Shield (Professional)                                ALBLS           AL        Loop 2100B must contain NPI.                                        NC


Alabama Medicaid                                                 ALMCD            AL        Loop 2100B must contain NPI.                                         NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Alaska Medicare                                                   CMSEL           AK        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


American Medical Security (AMS)                                   81400          ALL        Loop 2100B must be Medicare Provider number and/or NPI.              T


American Republic Insurance Company                               41099          ALL        Loop 2100B should contain Tax ID and/or NPI.                         NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
American Samoa Medicare                                           CMSEL           AS        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


AmeriChoice of NJ                                                 86047           NJ        Loop 2100B should contain Tax ID, SSN, and/or NPI                    NP


AmeriGroup                                                        28806          ALL        Loop 2100B should contain Tax ID and/or NPI.                         NP



Arizona BC/BS                                                     AZBLS           AZ        Loop 2100B must contain NPI.                                        NC


Arizona Medicaid (AHCCCS)                                        AZMCD            AZ        Loop 2100B must contain NPI.                                         NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Arizona Medicare                                                  CMSEL           AZ        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Arkansas Medicare                                                 CMSEL           AK        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


Assurant-Time Insurance Company                                   AHTIN          ALL        Loop 2100B should contain Tax ID and/or NPI.                         NP


Assurant-Union Security Insurance Company                         AHUSY          ALL        Loop 2100B should contain Tax ID and/or NPI.                         NP


California Blue Cross (WellPoint Health Network)                  00540           CA        Loop 2100B should contain Tax Identification Number and/or NPI.     NC

                                                                                            Loop 2100B must be Service Provider number, Personal ID number
California Medicaid                                              CAMCD            CA        (PIN), and/or NPI.                                                   NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
California Medicare                                               CMSEL           CA        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


Cariten Healthcare                                                62073           TN        Loop 2100B should contain Tax ID and/or NPI.                         NP



       -----------
       NP or NC: Non Participating Payers. Ingenix charges $0.35 per transaction conducted with non-par payers
       For up-to-date payer information, please access the payer list from the Ingenix website at: http://www.enshealth.com
        Ingenix Eligibility Payer List
        ANSI HIPAA 270/271
        (As of 7/16/09)



                                                                 Payer ID
                                                                  2100A
Payer Name                                                        NM109          State       Additional Information                                              Type



Cariten Senior Health                                              62072           TN        Loop 2100B should contain Tax ID and/or NPI.                         NP


CHAMPVA                                                            84146          ALL        Loop 2100B should contain Tax ID and/or NPI.                         NP


Cigna                                                              62308          ALL        Loop 2100B should contain Tax Identification Number and/or NPI.      T


Colorado BC/BS (WellPoint Health Network)                          COBLS           CO        Loop 2100B should contain Tax Identification Number and/or NPI.     NC


Colorado Medicaid                                                 COMCD            CO        Loop 2100B must contain NPI.                                         NP
                                                                                             Enrollment required. Form and instructions at
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Colorado Medicare                                                  CMSEL           CO        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


ConnectiCare, Inc                                                  06105          ALL        Loop 2100B should contain Tax Identification Number and/or NPI.      T


Connecticut BC/BS (WellPoint Health Network)                       CTBLS           CT        Loop 2100B should contain Tax Identification Number and/or NPI.     NC


Connecticut General Life                                           06105          ALL        Loop 2100B should contain Tax Identification Number and/or NPI.      T


Connecticut Medicaid                                              CTMCD            CT        Loop 2100B must contain NPI.                                         NP
                                                                                             Enrollment required. Form and instructions at
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Connecticut Medicare                                               CMSEL           CT        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


CoreSource (AZ & MN)                                               00234         AZ,MN       Loop 2100B should contain Tax Identification Number and/or NPI.      NP


CoreSource (MD, PA, & IL)                                          CRSC1        MD,PA,IL     Loop 2100B should contain Tax Identification Number and/or NPI.      T


CoreSource (NC & IN)                                               CRSC2         NC,IN       Loop 2100B should contain Tax Identification Number and/or NPI.      T

                                                                                             Loop 2100B must contain Service Provider Number assigned by the
Coventry Carelink Medicaid (West Virginia Medicaid)                00182           WV        payer and/or NPI.                                                    NP

                                                                                             Loop 2100B must contain Service Provider Number assigned by the
Coventry Health Care USA                                           00186           MO        payer and/or NPI.                                                    NP

                                                                                             Loop 2100B must contain Service Provider Number assigned by the
Coventry Health American/Health Assurance of Pennsylvania          00148         PA,OH       payer and/or NPI.                                                    NP

                                                                                             Loop 2100B must contain Service Provider Number assigned by the
Coventry Health Carelink                                           00160           WV        payer and/or NPI.                                                    NP

                                                                                             Loop 2100B must contain Service Provider Number assigned by the
Coventry Health CareNet                                            00190           VA        payer and/or NPI.                                                    NP

                                                                                             Loop 2100B must contain Service Provider Number assigned by the
Coventry Health Group Health Plan                                  00184         IL,MO       payer and/or NPI.                                                    NP

                                                                                             Loop 2100B must contain Service Provider Number assigned by the
Coventry Health of Carolinas/WellPoint                             25129         NC,SC       payer and/or NPI.                                                    NP

                                                                                             Loop 2100B must contain Service Provider Number assigned by the
Coventry Health of Delaware                                        25130           DE        payer and/or NPI.                                                    NP

                                                                                             Loop 2100B must contain Service Provider Number assigned by the
Coventry Health of Georgia                                         25127           GA        payer and/or NPI.                                                    NP

                                                                                             Loop 2100B must contain Service Provider Number assigned by the
Coventry Health of Iowa                                            25132           IA        payer and/or NPI.                                                    NP

                                                                                             Loop 2100B must contain Service Provider Number assigned by the
Coventry Health of Kansas (Kansas City)                            25133         KS,MO       payer and/or NPI.                                                    NP



        -----------
        NP or NC: Non Participating Payers. Ingenix charges $0.35 per transaction conducted with non-par payers
        For up-to-date payer information, please access the payer list from the Ingenix website at: http://www.enshealth.com
       Ingenix Eligibility Payer List
       ANSI HIPAA 270/271
       (As of 7/16/09)



                                                                Payer ID
                                                                 2100A
Payer Name                                                       NM109          State       Additional Information                                                  Type

                                                                                            Loop 2100B must contain Service Provider Number assigned by the
Coventry Health of Kansas (Wichita)                               25134         KS,MO       payer and/or NPI.                                                        NP

                                                                                            Loop 2100B must contain Service Provider Number assigned by the
Coventry Health of Louisiana                                      25135           LA        payer and/or NPI.                                                        NP

                                                                                            Loop 2100B must contain Service Provider Number assigned by the
Coventry Health of Nebraska                                       25136         IA,NE       payer and/or NPI.                                                        NP

                                                                                            Loop 2100B must contain Service Provider Number assigned by the
Coventry Health Southern Health Services                          25128           VA        payer and/or NPI.                                                        NP


Definity Health                                                   87726          ALL        Loop 2100B should contain Service Provider ID and/or NPI.                T
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Delaware Medicare                                                 CMSEL           DE        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                         NC


Diamond Plan (Maryland Medicaid)                                  00177           MD        Loop 2100B should contain Tax Identification Number and/or NPI.          NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
District of Columbia Medicare                                     CMSEL           DC        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                         NC
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Federated States of Micronesia Medicare                           CMSEL           FM        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                         NC

                                                                                            Loop 2100B should contain Tax ID, SSN, Service Provider ID, and/or
First Health - Mail Handlers                                      00251          ALL        NPI.                                                                     NP


First Ameritas of NY                                              00426          ALL        Loop 2100B should contain Tax ID and/or NPI.                             NP

                                                                                            Loop 2100B should contain Tax ID, SSN, Service Provider ID, and/or
First Health                                                      87043          ALL        NPI.                                                                     NP


Florida BC/BS                                                     FLBLS           FL        Loop 2100B should contain BCBSFL Facility or Provider ID and/or NPI.    NC


Florida Medicaid                                                  FLMCD           FL        Enrollment required. Call Chad Hilton at (719)277-7545 ext. 1265.        NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Florida Medicare                                                  CMSEL           FL        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                         NC


Georgia BC/BS (WellPoint Health Network)                          GABLS           GA        Loop 2100B should contain Tax Identification Number and/or NPI.         NC


Georgia Medicaid                                                 GAMCD            GA        Loop 2100B must contain NPI.                                             NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Georgia Medicare                                                  CMSEL           GA        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                         NC


Great West                                                        80705          ALL        Loop 2100B should contain Tax ID and/or NPI.                             T
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Guam Medicare                                                     CMSEL           GU        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                         NC
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Hawaii Medicare                                                   CMSEL           HI        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                         NC


Health Net of California (Claims)                                 95567           CA        Loop 2100B should contain Tax ID and/or NPI.                             T


Health Net of the Northeast and Arizona                           00213    AZ,CT,NJ,NY,PA Loop 2100B should contain Tax ID and/or NPI.                               NP


Health Partners                                                   HPART           PA        Loop 2100B should contain NPI.                                           T

                                                                                            2100B must contain NPI. Enrollment required. Form and instructions at
HealthPartners of Minnesota                                       94267           MN        http://www.enshealth.com/enspublic/Download/EMCagreement.asp.            NP



       -----------
       NP or NC: Non Participating Payers. Ingenix charges $0.35 per transaction conducted with non-par payers
       For up-to-date payer information, please access the payer list from the Ingenix website at: http://www.enshealth.com
         Ingenix Eligibility Payer List
         ANSI HIPAA 270/271
         (As of 7/16/09)



                                                                  Payer ID
                                                                   2100A
Payer Name                                                         NM109          State       Additional Information                                              Type



HealthFirst of New York                                             HF1NY           NY        Loop 2100B should contain Legacy ID and/or NPI.                      T

                                                                                              Loop 2100B should contain Service Provider Number assigned by the
HIP NY                                                              HIPNY           NY        payer, Tax ID, or NPI.                                               T


Humana                                                              00041          ALL        Loop 2100B should contain Tax ID and/or NPI.                         T
                                                                                              Enrollment required. Form and instructions at
                                                                                              http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Idaho Medicare                                                      CMSEL           ID        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC

                                                                                              Loop 2100B should contain Service Provider Number assigned by the
Illinois BC/BS                                                      ILBLS           IL        payer and/or NPI.                                                    NP

                                                                                              Loop 2100B should contain Service Provider Number assigned by the
Illinois Medicaid                                                   ILMCD           IL        payer and/or NPI.                                                    NP
                                                                                              Enrollment required. Form and instructions at
                                                                                              http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Illinois Medicare                                                   CMSEL           IL        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


Indiana BC/BS (WellPoint Health Network)                            INBLS           IN        Loop 2100B should contain Tax Identification Number and/or NPI.     NC

                                                                                              Loop 2100B should contain Service Provider Number assigned by the
Indiana Medicaid                                                    INMCD           IN        payer and/or NPI.                                                    NP
                                                                                              Enrollment required. Form and instructions at
                                                                                              http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Indiana Medicare                                                    CMSEL           IN        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC
                                                                                              Enrollment required. Form and instructions at
                                                                                              http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Iowa Medicare                                                       CMSEL           IA        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


John Alden Life Insurance Company                                   41099           ALL       Loop 2100B should contain Tax ID and/or NPI.                         NP


Kaiser Foundation Health Plan of Ohio                               00280          ALL        Loop 2100B should contain Tax ID and/or NPI.                         NP
                                                                                              Enrollment required. Form and instructions at
                                                                                              http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Kansas Medicare                                                     CMSEL           KS        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


Kentucky BC/BS (WellPoint Health Network)                           KYBLS           KY        Loop 2100B should contain Tax Identification Number and/or NPI.     NC


Kentucky Medicaid                                                    197            KY        Enrollment required. Call Chad Hilton at (719)277-7545 ext. 1265.    NP
                                                                                              Enrollment required. Form and instructions at
                                                                                              http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Kentucky Medicare                                                   CMSEL           KY        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC

                                                                                              Loop 2100B should contain NPI and Facility ID / Federal Tax ID
Keystone Mercy                                                      KEYST           PA        (2100B/REF02 for REF01=1J).                                          NP

                                                                                              Loop 2100B should contain Service Provider Number assigned by the
Louisiana BC/BS                                                     LABLS           LA        payer and/or NPI.                                                    NP

                                                                                              Loop 2100B should contain Service Provider Number assigned by the
Louisiana Medicaid                                                 LAMCD            LA        payer and/or NPI.                                                    NP
                                                                                              Enrollment required. Form and instructions at
                                                                                              http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Louisiana Medicare                                                  CMSEL           LA        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC

                                                                                              Loop 2100B must be should contain Service Provider Number and/or
MAHP/MAMSI                                                          52148          ALL        NPI.                                                                 T


Maine BC/BS (WellPoint Health Network)                              MEBLS           ME        Loop 2100B should contain Tax Identification Number and/or NPI.     NC
                                                                                              Enrollment required. Form and instructions at
                                                                                              http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Maine Medicare                                                      CMSEL           ME        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC
                                                                                              Enrollment required. Form and instructions at
                                                                                              http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Marshall Islands Medicare                                           CMSEL           MH        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC



         -----------
         NP or NC: Non Participating Payers. Ingenix charges $0.35 per transaction conducted with non-par payers
         For up-to-date payer information, please access the payer list from the Ingenix website at: http://www.enshealth.com
       Ingenix Eligibility Payer List
       ANSI HIPAA 270/271
       (As of 7/16/09)



                                                                Payer ID
                                                                 2100A
Payer Name                                                       NM109          State       Additional Information                                                Type



Maryland Medicaid (Diamond Plan)                                  00177           MD        Loop 2100B should contain Tax Identification Number and/or NPI.        NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Maryland Medicare                                                 CMSEL           MD        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC

                                                                                            Loop 2100B should contain either the 6-character Provider ID or 10-
Massachusetts BC/BS                                               00139           MA        character Facility ID, and/or NPI.                                     NP

                                                                                            Loop 2100B must be a Provider Medicaid ID, User Identification
Massachusetts Medicaid                                           MAMCD            MA        number, UPIN, and/or NPI.                                              NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Massachusetts Medicare                                            CMSEL           MA        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC


Medica Health Plans                                               94265          ALL        Loop 2100B should contain Service Provider ID and/or NPI.              T


Medical Mutual of Ohio                                            29076           OH        Loop 2100B should contain Service Provider number and/or NPI.          NP


Mega Life (Transamerica Life)                                     TLINS          ALL        Loop 2100B should contain Tax ID and/or NPI.                           NP


Mega Life and Health Insurance                                    59221          ALL        Loop 2100B should contain Tax ID and/or NPI.                           NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Michigan Medicare                                                 CMSEL           MI        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Minnesota Medicare                                                CMSEL           MN        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC


Mississippi BC/BS                                                 MSBLS           MS        Loop 2100B must contain NPI.                                           NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Mississippi Medicare                                              CMSEL           MS        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC


Missouri BC/BS (WellPoint Health Network)                        MOBLS            MO        Loop 2100B should contain Tax Identification Number and/or NPI.       NC


Missouri Medicaid                                                MOMCD            MO        Loop 2100B should contain Service Provider number and/or NPI.          NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Missouri Medicare                                                 CMSEL           MO        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Montana Medicare                                                  CMSEL           MT        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC


Mutual of Omaha Commercial                                        71412          ALL        Loop 2100B should contain Tax ID and/or NPI.                           T


National Association of Letter Carriers (NALC)                    53011          ALL        Loop 2100B should contain Tax ID and/or NPI.                           NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Nebraska Medicare                                                 CMSEL           NE        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC


Nevada BC/BS (WellPoint Health Network)                           NVBLS           NV        Loop 2100B should contain Tax Identification Number and/or NPI.       NC


Nevada Medicaid                                                  NVMCD            NV        Loop 2100B should contain NPI.                                         NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Nevada Medicare                                                   CMSEL           NV        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC


New Hampshire BC/BS (WellPoint Health Network)                    NHBLS           NH        Loop 2100B should contain Tax Identification Number and/or NPI.       NC
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
New Hampshire Medicare                                            CMSEL           NH        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC



       -----------
       NP or NC: Non Participating Payers. Ingenix charges $0.35 per transaction conducted with non-par payers
       For up-to-date payer information, please access the payer list from the Ingenix website at: http://www.enshealth.com
       Ingenix Eligibility Payer List
       ANSI HIPAA 270/271
       (As of 7/16/09)



                                                                Payer ID
                                                                 2100A
Payer Name                                                       NM109          State       Additional Information                                              Type


New Jersey BC/BS (Horizon)                                        22099           NJ        Loop 2100B should contain Tax ID and/or NPI.                         NP


New Jersey Medicaid                                              NJMCD            NJ        Loop 2100B should contain Service Provider number and/or NPI.        NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
New Jersey Medicare                                               CMSEL           NJ        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


New Mexico Medicaid                                              NMMCD            NM        Enrollment required. Call Chad Hilton at (719)277-7545 ext. 1265.    NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
New Mexico Medicare                                               CMSEL           NM        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
New York Medicare                                                 CMSEL           NY        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


New York BC/BS (Empire Health Choice)                             NYBLS           NY        Loop 2100B should contain Service Provider Number and/or NPI.        NP


New York Medicaid                                                NYMCD            NY                                                                             NP



Nippon Life (Principal Financial Group)                           81264          ALL        Loop 2100B should contain Tax ID and/or NPI.                         NP


North Carolina Medicaid                                          NCMCD            NC        Loop 2100B should contain Service Provider number and/or NPI.        NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
North Carolina Medicare                                           CMSEL           NC        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
North Dakota Medicare                                             CMSEL           ND        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Northern Mariana Islands Northern Mariana Medicare                CMSEL           MP        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


Ohio BC/BS (WellPoint Health Network)                             OHBLS           OH        Loop 2100B should contain Tax Identification Number and/or NPI.     NC


Ohio Medicaid                                                    OHMCD            OH        Loop 2100B must contain NPI.                                         NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Ohio Medicare                                                     CMSEL           OH        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


Ohio Valley HMO, Cincinnati (Aetna)                               60054          ALL        Loop 2100B should contain Tax ID and/or NPI.                         P


Oklahoma Medicaid                                                 00023           OK        Enrollment required. Call Chad Hilton at (719)277-7545 ext. 1265.    NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Oklahoma Medicare                                                 CMSEL           OK        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Oregon Medicare                                                   CMSEL           OR        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


Oxford Health Plans                                               06111          ALL        Loop 2100B should contain Oxford Provider ID and/or NPI.             T


PacifiCare Health Systems CA (Claims)                             PHSCA           CA        Loop 2100B should contain Tax ID and/or NPI.                         T


PacifiCare Health Systems CA (Claims)                             95959           CA        Loop 2100B should contain Tax ID and/or NPI.                         T


PacifiCare of Arizona (HMO)                                       95964           AZ        Loop 2100B should contain Tax ID and/or NPI.                         T


PacifiCare of Colorado (HMO)                                      95962           CO        Loop 2100B should contain Tax ID and/or NPI.                         T



       -----------
       NP or NC: Non Participating Payers. Ingenix charges $0.35 per transaction conducted with non-par payers
       For up-to-date payer information, please access the payer list from the Ingenix website at: http://www.enshealth.com
       Ingenix Eligibility Payer List
       ANSI HIPAA 270/271
       (As of 7/16/09)



                                                                Payer ID
                                                                 2100A
Payer Name                                                       NM109          State       Additional Information                                              Type


PacifiCare of Colorado (HMO)                                     COPHS            CO        Loop 2100B should contain Tax ID and/or NPI.                         T


PacifiCare of Nevada (HMO)                                        95970           NV        Loop 2100B should contain Tax ID and/or NPI.                         T


PacifiCare of Oklahoma (HMO)                                     PHSOK            OK        Loop 2100B should contain Tax ID and/or NPI.                         T


PacifiCare of Oregon (HMO)                                       PHSOR            OR        Loop 2100B should contain Tax ID and/or NPI.                         T


PacifiCare of Texas (HMO)                                         PHSTX           TX        Loop 2100B should contain Tax ID and/or NPI.                         T


PacifiCare of Washington (HMO)                                   PHSWA            WA        Loop 2100B should contain Tax ID and/or NPI.                         T


PacifiCare PPO (All States)                                       95999          ALL        Loop 2100B should contain Tax ID and/or NPI.                         T
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Palau Medicare                                                    CMSEL           PW        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC

                                                                                            Loop 2100B should contain Service Provider number (13 digit PA
Pennsylvania Medicaid                                            PAMCD            PA        Provider Medicaid ID)                                                NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Pennsylvania Medicare                                             CMSEL           PA        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC

                                                                                            Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,
PHP of Georgia, Atlanta, Aetna                                    60054          ALL        Organization Number, Tax ID, and/or NPI.                             P

                                                                                            Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,
PHP of North Ohio, Cleveland, Aetna                               60054          ALL        Organization Number, Tax ID, and/or NPI.                             P

                                                                                            Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,
Primary Choice (Aetna Health Plan of NY/NJ)                       60054          ALL        Organization Number, Tax ID, and/or NPI.                             P


Principal Financial Group (Principal Life)                        61271          ALL        Loop 2100B must be Medicare Provider number and/or NPI.              NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Puerto Rico Medicare                                              CMSEL           PR        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Railroad Medicare                                                 CMSEL          ALL        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Rhode Island Medicare                                             CMSEL           RI        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC

                                                                                            Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,
Select Choice (Aetna Health Plan of NY/NJ)                        60054          ALL        Organization Number, Tax ID, and/or NPI.                             P

                                                                                            Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,
Senior Choice (Aetna Health Plan of NY/NJ)                        60054          ALL        Organization Number, Tax ID, and/or NPI.                             P
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
South Carolina Medicare                                           CMSEL           SC        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
South Dakota Medicare                                             CMSEL           SD        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC

                                                                                            Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,
Southwest Health Plan (Aetna HMO)                                 60054          ALL        Organization Number, Tax ID, and/or NPI.                             P



Tennessee Medicaid (TennCare)                                    TNMCD            TN        Loop 2100B must contain Tax Identification Number.                   NP
                                                                                            Enrollment required. Form and instructions at
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Tennessee Medicare                                                CMSEL           TN        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                     NC


Texas Medicaid                                                   TXMCD            TX        Loop 2100B must contain NPI.                                         NP



       -----------
       NP or NC: Non Participating Payers. Ingenix charges $0.35 per transaction conducted with non-par payers
       For up-to-date payer information, please access the payer list from the Ingenix website at: http://www.enshealth.com
        Ingenix Eligibility Payer List
        ANSI HIPAA 270/271
        (As of 7/16/09)



                                                                 Payer ID
                                                                  2100A
Payer Name                                                        NM109          State       Additional Information                                                Type
                                                                                             Enrollment required. Form and instructions at
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Texas Medicare                                                     CMSEL           TX        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC

                                                                                             Loop 2100B should contain Service Provider number, Tax ID, Provider
Three Rivers Better Health Plan                                    00199           TN        Plan Network number, Provider Plan Facility Network ID, and/or NPI.    NP

                                                                                             Loop 2100B should contain Service Provider number, Tax ID, Provider
Three Rivers Health Plan / Unison MedPLUS Medicaid                 00198      OH,PA,TN,SC    Plan Network number, Provider Plan Facility Network ID, and/or NPI.    NP


Tricare (Champus)                                                  00080          ALL        Loop 2100B should contain Service Provider Number and/or NPI.          NP



Trustmark                                                          TRUST          ALL        Loop 2100B should contain Tax Identification Number and/or NPI.        T


Tufts                                                              04298          ALL        Loop 2100B should contain Tax Identification Number and/or NPI.        NP
                                                                                             Enrollment required. Form and instructions at
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
U.S. Minor Outlying Islands Medicare                               CMSEL           UM        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC


Unicare (WellPoint Health Network)                                  UNI           ALL        Loop 2100B should contain Tax Identification Number and/or NPI.       NC


United Healthcare                                                  87726          ALL        Loop 2100B should contain Service Provider ID and/or NPI.              T


United Healthcare                                                   UHC           ALL        Loop 2100B should contain Service Provider ID and/or NPI.              T
                                                                                             Enrollment required. Form and instructions at
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Utah Medicare                                                      CMSEL           UT        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC
                                                                                             Enrollment required. Form and instructions at
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Vermont Medicare                                                   CMSEL           VT        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC
                                                                                             Enrollment required. Form and instructions at
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Virgin Islands of the U.S Medicare                                 CMSEL           VI        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC


Virginia BC/BS (WellPoint Health Network)                          VABLS           VA        Loop 2100B should contain Tax Identification Number and/or NPI.       NC


Virginia Medicaid                                                 VAMCD            VA        Loop 2100B should contain Service Provider number and/or NPI.          NP
                                                                                             Enrollment required. Form and instructions at
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Virginia Medicare                                                  CMSEL           VA        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC
                                                                                             Enrollment required. Form and instructions at
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Washington Medicare                                                CMSEL           WA        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC

                                                                                             Loop 2100B must contain Service Provider Number assigned by the
West Virginia Medicaid (Coventry Carelink Medicaid)                00182           WV        payer and/or NPI.                                                      NP
                                                                                             Enrollment required. Form and instructions at
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
West Virginia Medicare                                             CMSEL           WV        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC


Wisconsin BC/BS (WellPoint Health Network)                         WIBLS           WI        Loop 2100B should contain Tax Identification Number and/or NPI.       NC


Wisconsin Medicaid                                                WIMCD            WI        Loop 2100B should contain Service Provider number and/or NPI.          NP
                                                                                             Enrollment required. Form and instructions at
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Wisconsin Medicare                                                 CMSEL           WI        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC


Wyoming Medicaid                                                  WYMCD            WY        Loop 2100B should contain Medicaid Provider Number and/or NPI.         NP
                                                                                             Enrollment required. Form and instructions at
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
Wyoming Medicare                                                   CMSEL           WY        lityEnrollmentForm.pdf. Loop 2100B must be NPI.                       NC




        -----------
        NP or NC: Non Participating Payers. Ingenix charges $0.35 per transaction conducted with non-par payers
        For up-to-date payer information, please access the payer list from the Ingenix website at: http://www.enshealth.com

								
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