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					        OptumInsight Eligibility Payer List
        ANSI HIPAA 270/271
        (As of 03/22/2012)


                                                          Payer ID
                                                                                                                                                                                    Submission
                          Payer Name                       2100A        State                         Additional Information                                           Enrollment                Type
                                                                                                                                                                                       Type
                                                           NM109
Payers highlighted are new or have been altered in the last 90 days. Please verify that your system is setup correctly for this payer
AARP-UnitedHealthcare Ins Co                                36273        ALL      Loop 2100B should contain Tax Identification Number and/or NPI.                        FALSE       DUAL USE     T


Aetna Health Plans (AHP)                                               60054           ALL       Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,             FALSE       5010A1       G
                                                                                                 Organization Number Tax ID, or NPI. AETNA Requires NPI
                                                                                                 Registration. http://www.aetna.com/healthcare-
                                                                                                 professionals/policies-guidelines/national_provider_identifier.html
Aetna Health Plans PPO                                                 60054           ALL       Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,             FALSE       5010A1       G
                                                                                                 Organization Number, Tax ID, or NPI. AETNA requires NPI
                                                                                                 registration. See following link: http://www.aetna.com/healthcare-
                                                                                                 professionals/policies-guidelines/national_provider_identifier.html
Affinity Health Plan                                                   AFNTY           ALL       Loop 2100B must contain either the Tax Identification Number or         FALSE       DUAL USE     G
                                                                                                 NPI.


AHP of New Jersey, Parsippany                                          60054           ALL       Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,             FALSE       5010A1       G
                                                                                                 Organization Number, Tax ID, or NPI. AETNA requires NPI
                                                                                                 registration. See following link: http://www.aetna.com/healthcare-
                                                                                                 professionals/policies-guidelines/national_provider_identifier.html
AHP of New Jersey, Purchase, NY                                        60054           ALL       Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,             FALSE       5010A1       G
                                                                                                 Organization Number, Tax ID, or NPI. AETNA requires NPI
                                                                                                 registration. See following link: http://www.aetna.com/healthcare-
                                                                                                 professionals/policies-guidelines/national_provider_identifier.html
Alabama Blue Cross (Institutional)                                     ALBLC            AL       Loop 2100B must contain the Provider NPI. The Provider's NPI must       TRUE        5010A1       NC
                                                                                                 be set-up with AL Blue Cross / Blue Shield for EDI 270/271
                                                                                                 Transactions (separate from the Claims set-up). Please contact the
                                                                                                 OptumInsight Enrollments Department at
                                                                                                 enrollments@enshealth.com for complete details.
Alabama Blue Shield (Professional)                                     ALBLS            AL       Loop 2100B must contain the Provider NPI. The Provider's NPI must       TRUE        5010A1       NC
                                                                                                 be set-up with AL Blue Cross / Blue Shield for EDI 270/271
                                                                                                 Transactions (separate from the Claims set-up). Please contact the
                                                                                                 OptumInsight Enrollments Department at
                                                                                                 enrollments@enshealth.com for complete details.
Alabama Medicaid                                                       ALMCD            AL       Loop 2100B must contain NPI.                                            FALSE       4010A1       NC


Alabama Medicare                                                       CMSEL            AL       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Alaska Medicare                                                        CMSEL            AK       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Altius Health Plans                                                    00364           ALL       Loop 2100B must contain Service Provider Number assigned by the         FALSE       DUAL USE     G
                                                                                                 payer and/or NPI.

American Medical Security (AMS)                                        81400           ALL       Loop 2100B must be Medicare Provider number and/or NPI.                 FALSE       5010A1       T


American Republic Insurance Company (ARIC)                             42011           ALL       Loop 2100B should contain Tax ID and/or NPI.                            FALSE       DUAL USE     G


American Samoa Medicare                                                CMSEL            AS       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
AmeriChoice of New Jersey                                              86047            NJ       Loop 2100B should contain Tax ID, SSN, and/or NPI                       FALSE       4010A1       G


AmeriGroup                                                             28806           ALL       Loop 2100B should only contain a Federal Tax ID Number.                 FALSE       DUAL USE     G


Arizona Blue Cross Blue Shield                                         AZBLS            AZ       Loop 2100B must contain NPI.                                            FALSE       DUAL USE     NC


Arizona Medicaid (AHCCCS)                                              AZMCD            AZ       Loop 2100B must contain NPI.                                            FALSE       DUAL USE    NP


Arizona Medicare                                                       CMSEL            AZ       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Arkansas Medicaid                                                      ARMCD            AR       Loop 2100B must contain NPI.                                            FALSE       5010A1       NC


Arkansas Medicare                                                      CMSEL            AK       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Assurant Health-John Alden Life                                        41099           ALL       Loop 2100B should contain Tax ID and/or NPI.                            FALSE       DUAL USE     G


Assurant Health-Time Insurance                                         AHTIN           ALL       Loop 2100B should contain Tax ID and/or NPI.                            FALSE       DUAL USE     G


Assurant Health-Union Security Insurance                               AHUSY           ALL       Loop 2100B should contain Tax ID and/or NPI.                            FALSE       DUAL USE     G


Better Health Plans (Unison Health Plan)                               00199            TN       Loop 2100B should contain Service Provider number, Tax ID,              FALSE       DUAL USE     G
                                                                                                 Provider Plan Network number, Provider Plan Facility Network ID,
                                                                                                 and/or NPI.
California Anthem Blue Cross (WellPoint Health Network)                00540            CA       Loop 2100B should contain Tax Identification Number and/or NPI.         FALSE       5010A1       NC


California Medicaid (Medi-Cal)                                         CAMCD            CA       Loop 2100B must be Service Provider number, Personal ID number          FALSE       DUAL USE    NP
                                                                                                 (PIN), and/or NPI.



        -----------
        NP or NC: Non Participating Payers. OptumInsight charges a per transaction fee for non-par payers
        For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.enshealth.com
        OptumInsight Eligibility Payer List
        ANSI HIPAA 270/271
        (As of 03/22/2012)


                                                                     Payer ID
                                                                                                                                                                                Submission
                           Payer Name                                 2100A           State                              Additional Information                    Enrollment                Type
                                                                                                                                                                                   Type
                                                                      NM109
California Medicare                                                   CMSEL             CA       Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Cariten Healthcare (Commercial)                                        62073            TN       Loop 2100B: Either the Federal Tax ID, Provider ID or NPI is        FALSE       DUAL USE     G
                                                                                                 required.

CHAMPVA                                                                84146           ALL       Loop 2100B should contain Tax ID and/or NPI.                        FALSE       DUAL USE     G


CIGNA                                                                  62308           ALL       Loop 2100B should contain Tax Identification Number and/or NPI.     FALSE       DUAL USE     T


Colorado Anthem Blue Cross Blue Shield (WellPoint Health               COBLS           CO        Loop 2100B should contain Tax Identification Number and/or NPI.     FALSE       5010A1       NC
Network)

Colorado Medicaid                                                      COMCD           CO        Loop 2100B must contain NPI.                                        FALSE       DUAL USE    NP


Colorado Medicare                                                      CMSEL            CO       Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
ConnectiCare                                                           06105           ALL       Loop 2100B should contain Tax Identification Number and/or NPI.     FALSE       DUAL USE     G


Connecticut Anthem Blue Cross Blue Shield (WellPoint Health            CTBLS            CT       Loop 2100B should contain Tax Identification Number and/or NPI.     FALSE       5010A1       NC
Network)

Connecticut General Life                                               06105           ALL       Loop 2100B should contain Tax Identification Number and/or NPI.     FALSE       DUAL USE     G


Connecticut Medicaid                                                   CTMCD            CT       Loop 2100B must contain NPI.                                        FALSE       DUAL USE     NP


Connecticut Medicare                                                   CMSEL            CT       Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
CoreSource (IL, IN, MD, NC & PA)                                       CRSC1        IL,IN,MD,    Loop 2100B should contain Tax Identification Number and/or NPI.     FALSE       DUAL USE     G
                                                                                      NC,PA

Coventry Health Care Carelink                                          00160           WV        Loop 2100B must contain Service Provider Number assigned by the     FALSE       DUAL USE     G
                                                                                                 payer and/or NPI.

Coventry Health Care Carelink Medicaid                                 00182           WV        Loop 2100B must contain Service Provider Number assigned by the     FALSE       DUAL USE     G
                                                                                                 payer and/or NPI.

Coventry Health Care CareNet                                           00190            VA       Loop 2100B must contain Service Provider Number assigned by the     FALSE       DUAL USE     G
                                                                                                 payer and/or NPI.

Coventry Health Care Group Health Plan (GHP)                           00184          IL,MO      Loop 2100B must contain Service Provider Number assigned by the     FALSE       DUAL USE     G
                                                                                                 payer and/or NPI.

Coventry Health Care Health America/ Health Assurance of               00148          PA,OH      Loop 2100B must contain Service Provider Number assigned by the     FALSE       DUAL USE     G
Pennsylvania (HAPA)                                                                              payer and/or NPI.

Coventry Health Care of Carolinas/WellPath                             25129          NC,SC      Loop 2100B must contain Service Provider Number assigned by the     FALSE       DUAL USE     G
                                                                                                 payer and/or NPI.

Coventry Health Care of Delaware                                       25130           DE        Loop 2100B must contain Service Provider Number assigned by the     FALSE       DUAL USE     G
                                                                                                 payer and/or NPI.

Coventry Health Care of Georgia                                        25127           GA        Loop 2100B must contain Service Provider Number assigned by the     FALSE       DUAL USE     G
                                                                                                 payer and/or NPI.

Coventry Health Care of Iowa                                           25132            IA       Loop 2100B must contain Service Provider Number assigned by the     FALSE       DUAL USE     G
                                                                                                 payer and/or NPI.

Coventry Health Care of Kansas (Kansas City & Wichita)                 25133         KS,MO       Loop 2100B must contain Service Provider Number assigned by the     FALSE       DUAL USE     G
                                                                                                 payer and/or NPI.

Coventry Health Care of Louisiana                                      25135            LA       Loop 2100B must contain Service Provider Number assigned by the     FALSE       DUAL USE     G
                                                                                                 payer and/or NPI.

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

Coventry Health Care Southern Health Services                          25128            VA       Loop 2100B must contain Service Provider Number assigned by the     FALSE       DUAL USE     G
                                                                                                 payer and/or NPI.

Coventry Health Care USA (HCUSA)                                       00186           MO        Loop 2100B must contain Service Provider Number assigned by the     FALSE       DUAL USE     G
                                                                                                 payer and/or NPI.

Coventry Health of Illinois/ Personal Care                             00179            IL       Loop 2100B must contain Service Provider Number assigned by the     FALSE       DUAL USE     G
                                                                                                 payer and/or NPI.

Definity Health                                                        87726           ALL       Loop 2100B should contain Service Provider ID and/or NPI.           FALSE       4010A1       T


Delaware Medicare                                                      CMSEL            DE       Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Deseret Mutual (DMBA)                                                  DMBAU            UT       Loop 2100B must contain the Rendering Provider TIN and NPI.         FALSE       5010A1       NC
                                                                                                 Rendering Provider NPI must already be enrolled for Claim
                                                                                                 Submissions before they can send RTT to Deseret Mutual (DMBA).




        -----------
        NP or NC: Non Participating Payers. OptumInsight charges a per transaction fee for non-par payers
        For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.enshealth.com
         OptumInsight Eligibility Payer List
         ANSI HIPAA 270/271
         (As of 03/22/2012)


                                                                      Payer ID
                                                                                                                                                                                    Submission
                           Payer Name                                  2100A           State                              Additional Information                       Enrollment                Type
                                                                                                                                                                                       Type
                                                                       NM109
Diamond Plan (Maryland Medicaid)                                       00177            MD        Loop 2100B should contain Tax Identification Number and/or NPI.        FALSE       DUAL USE     G


District of Columbia Medicare                                           CMSEL            DC       Enrollment required. Form and instructions at                          TRUE        5010A1       NC
                                                                                                  http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                  bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Federated States of Micronesia Medicare                                 CMSEL            FM       Enrollment required. Form and instructions at                          TRUE        5010A1       NC
                                                                                                  http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                  bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Fidelis (CenterCare)                                                     FIDEL          ALL       Loop 2100B must contain the Provider NPI.                              FALSE       DUAL USE     NP


First Ameritas of NY                                                    00426           ALL       Loop 2100B should contain Tax ID and/or NPI.                           FALSE       DUAL USE     G


First Health Coventry Health Care National Network                      87043           ALL       Loop 2100B should contain Tax ID, SSN, Service Provider ID, and/or     FALSE       DUAL USE     G
                                                                                                  NPI.

First Health Mail Handlers Benefit Plan                                 00251           ALL       Loop 2100B should contain Tax ID, SSN, Service Provider ID, and/or     FALSE       DUAL USE     G
                                                                                                  NPI.

Florida Blue Cross Blue Shield                                           FLBLS           FL       Loop 2100B should contain BCBSFL Facility or Provider ID and/or        FALSE       DUAL USE     NC
                                                                                                  NPI.

Florida Medicaid                                                        FLMCD            FL       Loop 2100B should contain Provider Number or NPI.                      FALSE       DUAL USE    NP


Florida Medicare                                                        CMSEL            FL       Enrollment required. Form and instructions at                          TRUE        5010A1       NC
                                                                                                  http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                  bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Georgia Anthem Blue Cross Blue Shield (WellPoint Health                 GABLS           GA        Loop 2100B should contain Tax Identification Number and/or NPI.        FALSE       5010A1       NC
Network)

Georgia Medicaid                                                        GAMCD            GA       Loop 2100B must contain NPI.                                           FALSE       5010A1       NP


Georgia Medicare                                                        CMSEL            GA       Enrollment required. Form and instructions at                          TRUE        5010A1       NC
                                                                                                  http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                  bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Government Employees Hospital Association (GEHA)                        44054           ALL       Loop 2100B should contain either the Tax ID or NPI.                    FALSE       5010A1       P


Great West                                                              80705           ALL       Loop 2100B should contain Tax ID and/or NPI.                           FALSE       DUAL USE     C


Guam Medicare                                                           CMSEL            GU       Enrollment required. Form and instructions at                          TRUE        5010A1       NC
                                                                                                  http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                  bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Harmony Health Plan (Illinois & Indiana)                                14163          IL,IN      Loop 2100B must contain NPI.                                           FALSE       DUAL USE     G


Hawaii Medicare                                                         CMSEL            HI       Enrollment required. Form and instructions at                          TRUE        5010A1       NC
                                                                                                  http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                  bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Health Net National                                                     00213        AZ,CT,NJ,    Loop 2100B should contain Tax ID and/or NPI.                           FALSE       DUAL USE     G
                                                                                      NY,PA       NOTE: Health Net of Arizona and Health Net of the Northeast are
                                                                                                  now known as Health Net National.
Health Net of California                                                95567            CA       Loop 2100B should contain Tax ID and/or NPI.                           FALSE       DUAL USE     G


Health Partners Pennsylvania                                            HPART            PA       Loop 2100B should contain NPI.                                         FALSE       DUAL USE     G


HealthEase                                                              14163           ALL       Loop 2100B must contain NPI.                                           FALSE       DUAL USE     G


HealthEase Kids                                                         14163           ALL       Loop 2100B must contain NPI.                                           FALSE       DUAL USE     G


HealthFirst of New York                                                 HF1NY            NY       Loop 2100B should contain Legacy ID and/or NPI.                        FALSE       DUAL USE     G


HealthMarkets-Mega Life and Health                                      59221           ALL       Loop 2100B should contain Tax ID and/or NPI.                           FALSE       DUAL USE     G
                                                                                                  NOTE: Mega Life and Health Insurance is now known as
                                                                                                  HealthMarkets-Mega Life and Health.
HealthMarkets-Transamerica Life                                         TLINS           ALL       Loop 2100B should contain Tax ID and/or NPI.                           FALSE       DUAL USE     G
                                                                                                  NOTE: Mega Life (TransAmerica Life) is now known as HealthMarkets-
                                                                                                  Transamerica Life.
HealthPartners of Minnesota                                             94267           MN        2100B must contain NPI. Enrollment required. Form and instructions     TRUE        5010A1      NP
                                                                                                  at
                                                                                                  http://www.enshealth.com/enspublic/Download/EMCagreement.asp.
HIP NY                                                                  HIPNY            NY       Loop 2100B should contain Service Provider Number assigned by the      FALSE       DUAL USE     G
                                                                                                  payer, Tax ID, or NPI.

Humana                                                                  00041           ALL       Loop 2100B should contain Tax ID and/or NPI.                           FALSE       DUAL USE     G


Idaho Medicaid                                                          IDMCD            ID       Loop 2100B should contain Payer Assigned Provider ID Number or         FALSE       DUAL USE    NP
                                                                                                  NPI.

Idaho Medicare                                                          CMSEL            ID       Enrollment required. Form and instructions at                          TRUE        5010A1       NC
                                                                                                  http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                  bilityEnrollmentForm.pdf. Loop 2100B must be NPI.




         -----------
         NP or NC: Non Participating Payers. OptumInsight charges a per transaction fee for non-par payers
         For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.enshealth.com
        OptumInsight Eligibility Payer List
        ANSI HIPAA 270/271
        (As of 03/22/2012)


                                                                     Payer ID
                                                                                                                                                                                    Submission
                          Payer Name                                  2100A           State                              Additional Information                        Enrollment                Type
                                                                                                                                                                                       Type
                                                                      NM109
Illinois Blue Cross Blue Shield                                        ILBLS            IL       Loop 2100B should contain Service Provider Number assigned by the       FALSE       DUAL USE    NP
                                                                                                 payer and/or NPI.

Illinois Medicaid                                                      ILMCD            IL       Loop 2100B should contain Service Provider Number assigned by the       FALSE       DUAL USE    NP
                                                                                                 payer and/or NPI.

Illinois Medicare                                                      CMSEL            IL       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Indiana Anthem Blue Cross Blue Shield (WellPoint Health                INBLS            IN       Loop 2100B should contain Tax Identification Number and/or NPI.         FALSE       5010A1       NC
Network)

Indiana Medicaid                                                       INMCD            IN       Loop 2100B should contain Service Provider Number assigned by the       FALSE       DUAL USE    NP
                                                                                                 payer and/or NPI.

Indiana Medicare                                                       CMSEL            IN       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Iowa Medicare                                                          CMSEL            IA       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Kaiser Foundation Health Plan of Ohio                                  00280           ALL       Loop 2100B should contain Tax ID and/or NPI.                            FALSE       DUAL USE     G


Kansas Medicaid                                                        KSMCD            KS       Loop 2100B must contain an NPI.                                         FALSE       DUAL USE    NC


Kansas Medicare                                                        CMSEL            KS       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Kentucky Anthem Blue Cross Blue Shield (WellPoint Health               KYBLS            KY       Loop 2100B should contain Tax Identification Number and/or NPI.         FALSE       5010A1       NC
Network)

Kentucky Medicaid                                                      KYMCD            KY       Loop 2100B should contain Payer Assigned Prov ID Number or NPI.         TRUE        5010A1      NC
                                                                                                 Provider must be an active KYMCD Provider, prior to sending RT 270
                                                                                                 Requests. Call KY Prov Enrollment at 877-838-5085.
Kentucky Medicare                                                      CMSEL            KY       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Keystone Mercy                                                         KEYST            PA       Loop 2100B should contain NPI and Facility ID / Federal Tax ID          FALSE       DUAL USE    NP
                                                                                                 (2100B/REF02 for REF01=1J).

Louisiana Blue Cross Blue Shield                                       LABLS            LA       Loop 2100B should contain Service Provider Number assigned by the       FALSE       DUAL USE    NP
                                                                                                 payer and/or NPI.

Louisiana Medicaid                                                     LAMCD            LA       Loop 2100B must contain the Provider NPI.                               FALSE       5010A1      NP


Louisiana Medicare                                                     CMSEL            LA       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
MAHP/MAMSI                                                             87726           ALL       Loop 2100B must be should contain Service Provider Number and/or        FALSE       4010A1       T
                                                                                                 NPI.

Maine Anthem Blue Cross Blue Shield (WellPoint Health                  MEBLS           ME        Loop 2100B should contain Tax Identification Number and/or NPI.         FALSE       5010A1       NC
Network)

Maine Medicaid                                                         MEMCD           ME        Loop 2100B must contain Payer Assigned Provider Number ID.              FALSE       DUAL USE     NP


Maine Medicare                                                         CMSEL            ME       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Marshall Islands Medicare                                              CMSEL           MH        Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Maryland Blue Cross Blue Shield (CareFirst)                            MDBLS           MD        Loop 2100B must contain an NPI.                                         FALSE       DUAL USE     NP


Maryland Medicaid                                                      MDMCD           MD        Loop 2100B must contain Payer Assigned Provider ID or NPI.              FALSE       DUAL USE    NP


Maryland Medicare                                                      CMSEL           MD        Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Massachusetts Blue Cross Blue Shield                                   00139           MA        Loop 2100B should contain either the 6-character Provider ID or 10-     FALSE       DUAL USE     G
                                                                                                 character Facility ID, and/or NPI.

Massachusetts Medicaid                                                 MAMCD           MA        Loop 2100B must be a Provider Medicaid ID, User Identification          FALSE       5010A1      NP
                                                                                                 number, UPIN, and/or NPI.

Massachusetts Medicare                                                 CMSEL           MA        Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Medica Health Plans                                                    94265           ALL       Loop 2100B should contain Service Provider ID and/or NPI.               FALSE       4010A1       T


Medical Mutual of Ohio                                                 29076           OH        Loop 2100B should contain Service Provider number and/or NPI.           FALSE       DUAL USE     G


Michigan Medicaid                                                      MIMCD            MI       Loop 2100B must contain NPI. This NPI must be enrolled with MI          FALSE       DUAL USE    NP
                                                                                                 BCBS for Claims prior to sending RT Eligibility Requests.




        -----------
        NP or NC: Non Participating Payers. OptumInsight charges a per transaction fee for non-par payers
        For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.enshealth.com
       OptumInsight Eligibility Payer List
       ANSI HIPAA 270/271
       (As of 03/22/2012)


                                                                    Payer ID
                                                                                                                                                                               Submission
                          Payer Name                                 2100A           State                              Additional Information                    Enrollment                Type
                                                                                                                                                                                  Type
                                                                     NM109
Michigan Medicare                                                    CMSEL             MI       Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Minnesota Medicare                                                    CMSEL           MN        Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Mississippi Blue Cross Blue Shield                                    MSBLS           MS        Loop 2100B must contain NPI.                                        FALSE       DUAL USE     NP


Mississippi Medicaid                                                  MSMCD           MS        Loop 2100B must contain NPI.                                        FALSE       DUAL USE     NP


Mississippi Medicare                                                  CMSEL           MS        Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Missouri Anthem Blue Cross Blue Shield (WellPoint Health              MOBLS           MO        Loop 2100B should contain Tax Identification Number and/or NPI.     FALSE       5010A1       NC
Network)

Missouri Medicaid                                                    MOMCD            MO        Loop 2100B should contain Service Provider number and/or NPI.       FALSE       DUAL USE    NP


Missouri Medicare                                                     CMSEL           MO        Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Montana Medicare                                                      CMSEL            MT       Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Mutual of Omaha                                                       71412           ALL       Loop 2100B should contain Tax ID and/or NPI.                        FALSE       5010A1       T


National Association of Letter Carriers (NALC)                        53011           ALL       Loop 2100B should contain Tax ID and/or NPI.                        FALSE       DUAL USE     G


Nebraska Medicare                                                     CMSEL            NE       Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Nevada Anthem Blue Cross Blue Shield (WellPoint Health                NVBLS           NV        Loop 2100B should contain Tax Identification Number and/or NPI.     FALSE       5010A1       NC
Network)

Nevada Medicaid                                                       NVMCD           NV        Loop 2100B should contain NPI.                                      FALSE       DUAL USE     NP


Nevada Medicare                                                       CMSEL            NV       Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
New Hampshire Anthem Blue Cross Blue Shield (WellPoint                NHBLS           NH        Loop 2100B should contain Tax Identification Number and/or NPI.     FALSE       5010A1       NC
Health Network)

New Hampshire Medicare                                                CMSEL            NH       Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
New Jersey Blue Cross Blue Shield (Horizon)                           22099            NJ       Loop 2100B should contain Tax ID and/or NPI.                        FALSE       DUAL USE     G


New Jersey Medicaid                                                   NJMCD            NJ       Loop 2100B should contain Service Provider number and/or NPI.       FALSE       5010A1      NP


New Jersey Medicare                                                   CMSEL            NJ       Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
New Mexico Medicaid                                                   NMMCD           NM        Loop 2100B must contain an NPI.                                     FALSE       DUAL USE    NP


New Mexico Medicare                                                   CMSEL           NM        Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
New York Blue Cross Blue Shield (Empire)                              NYBLS            NY       Loop 2100B must contain NPI.                                        FALSE       5010A1      NC


New York Medicaid                                                     NYMCD            NY                                                                           FALSE       DUAL USE    NP


New York Medicare                                                     CMSEL            NY       Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Nippon Life Insurance (Principal Financial Group)                     81264           ALL       Loop 2100B should contain Tax ID and/or NPI.                        FALSE       DUAL USE     G


North Carolina Medicaid                                               NCMCD           NC        Loop 2100B must contain Service Provider NPI.                       FALSE       5010A1      NP


North Carolina Medicare                                               CMSEL            NC       Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
North Dakota Medicare                                                 CMSEL           ND        Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Northern Mariana Islands Northern Mariana Medicare                    CMSEL            MP       Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Ohana Health Plan                                                     14163           ALL       Loop 2100B must contain NPI.                                        FALSE       DUAL USE     G




       -----------
       NP or NC: Non Participating Payers. OptumInsight charges a per transaction fee for non-par payers
       For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.enshealth.com
        OptumInsight Eligibility Payer List
        ANSI HIPAA 270/271
        (As of 03/22/2012)


                                                                     Payer ID
                                                                                                                                                                                    Submission
                          Payer Name                                  2100A           State                              Additional Information                        Enrollment                Type
                                                                                                                                                                                       Type
                                                                      NM109
Ohio Anthem Blue Cross Blue Shield (WellPoint Health                  OHBLS            OH        Loop 2100B should contain Tax Identification Number and/or NPI.         FALSE       5010A1       NC
Network)

Ohio Medicaid                                                          OHMCD           OH        Loop 2100B must contain the Provider's Legacy Provider ID in the        FALSE       5010A1      NP
                                                                                                 NM109. OH Medicaid does not accept the Provider's NPI at this
                                                                                                 time.
Ohio Medicare                                                          CMSEL           OH        Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Ohio Valley HMO, Cincinnati (Aetna)                                    60054           ALL       Loop 2100B should contain Tax ID and/or NPI.                            FALSE       5010A1       G


Oklahoma Medicaid                                                      MC030           OK        Loop 2100B must contain the Provider NPI                                FALSE       DUAL USE    NP


Oklahoma Medicare                                                      CMSEL            OK       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
OmniCare Health Plan                                                   00413           ALL       Loop 2100B must contain Service Provider Number assigned by the         FALSE       DUAL USE     G
                                                                                                 payer and/or NPI.

Oregon Medicare                                                        CMSEL            OR       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Oxford Health Plans                                                    06111           ALL       Loop 2100B should contain Oxford Provider ID and/or NPI.                FALSE       DUAL USE     T


PacifiCare of California (HMO)                                         PHSCA            CA       Loop 2100B should contain Tax ID and/or NPI.                            FALSE       DUAL USE     T


PacifiCare of California (HMO)                                         95959            CA       Loop 2100B should contain Tax ID and/or NPI.                            FALSE       DUAL USE     T


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


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


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


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


Palau Medicare                                                         CMSEL           PW        Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
PEHP Utah                                                              PEHPU            UT       Loop 2100B must contain the Rendering Provider NPI.                     FALSE       4010A1       NC


Pennsylvania Blue Cross Blue Shield (Highmark)                         PABLS            PA       Loop 2100B must contain the Group NPI and be enrolled at                TRUE        5010A1       T
                                                                                                 Highmark for claims prior to sending a 270 Request. If Group NPI is
                                                                                                 not enrolled, please refer to the CIC website for a copy of the
                                                                                                 enrollment form and instructions. PABLS includes Independence
                                                                                                 Blue Cross; see the Ingenix RT 270/271 CG for complete details.
Pennsylvania Medicaid                                                  PAMCD            PA       Loop 2100B should contain Service Provider number (13 digit PA          FALSE       DUAL USE    NP
                                                                                                 Provider Medicaid ID)

Pennsylvania Medicare                                                  CMSEL            PA       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
PHP of Georgia, Atlanta, Aetna                                         60054           ALL       Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,             FALSE       5010A1       G
                                                                                                 Organization Number, Tax ID, and/or NPI.

PHP of North Ohio, Cleveland, Aetna                                    60054           ALL       Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,             FALSE       5010A1       G
                                                                                                 Organization Number, Tax ID, and/or NPI.

Primary Choice (Aetna Health Plan of NY/NJ)                            60054           ALL       Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,             FALSE       5010A1       G
                                                                                                 Organization Number, Tax ID, and/or NPI.

Principal Life (Principal Financial Group)                             61271           ALL       Loop 2100B must be Medicare Provider number and/or NPI.                 FALSE       DUAL USE     G


Puerto Rico Medicare                                                   CMSEL            PR       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
QualChoice                                                             35174           ALL       Loop 2100B must contain Tax Identification Number or NPI.               FALSE       4010A1       G


Railroad Medicare                                                      CMSEL           ALL       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Rhode Island Medicare                                                  CMSEL            RI       Enrollment required. Form and instructions at                           TRUE        5010A1       NC
                                                                                                 http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                 bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Select Choice (Aetna Health Plan of NY/NJ)                             60054           ALL       Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,             FALSE       5010A1       G
                                                                                                 Organization Number, Tax ID, and/or NPI.

SelectHealth                                                           SELHT            UT       Loop 2100B must contain the Rendering Provider NPI.                     FALSE       5010A1      NC




        -----------
        NP or NC: Non Participating Payers. OptumInsight charges a per transaction fee for non-par payers
        For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.enshealth.com
       OptumInsight Eligibility Payer List
       ANSI HIPAA 270/271
       (As of 03/22/2012)


                                                                    Payer ID
                                                                                                                                                                                    Submission
                          Payer Name                                 2100A           State                              Additional Information                         Enrollment                Type
                                                                                                                                                                                       Type
                                                                     NM109
Senior Choice (Aetna Health Plan of NY/NJ)                           60054            ALL       Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,              FALSE       5010A1       G
                                                                                                Organization Number, Tax ID, and/or NPI.

South Carolina Medicare                                               CMSEL            SC       Enrollment required. Form and instructions at                            TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
South Dakota Medicare                                                 CMSEL            SD       Enrollment required. Form and instructions at                            TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Southwest Health Plan (Aetna HMO)                                     60054           ALL       Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,              FALSE       5010A1       G
                                                                                                Organization Number, Tax ID, and/or NPI.

StayWell                                                              14163           ALL       Loop 2100B must contain NPI.                                             FALSE       DUAL USE     G


StayWell Kids                                                         14163           ALL       Loop 2100B must contain NPI.                                             FALSE       DUAL USE     G


Tennessee Blue Cross Blue Shield                                      TNBLS            TN       Loop 2100B must contain Tax Identification Number.                       FALSE       5010A1       NC


Tennessee Medicaid (TennCare)                                         TNMCD            TN       Loop 2100B must contain Tax Identification Number.                       FALSE       DUAL USE     NP


Tennessee Medicare                                                    CMSEL            TN       Enrollment required. Form and instructions at                            TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Texas Blue Cross Blue Shield                                          TXBLS            TX       Loop 2100B should contain either the Provider ID or NPI.                 FALSE       DUAL USE     NP


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


Texas Medicare                                                        CMSEL            TX       Enrollment required. Form and instructions at                            TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Three Rivers Health Plan (Unison Health Plan)                         00198       OH,PA,TN,     Loop 2100B should contain Service Provider number, Tax ID,               FALSE       DUAL USE     G
                                                                                     SC         Provider Plan Network number, Provider Plan Facility Network ID,
                                                                                                and/or NPI.
TRICARE (Champus)                                                     00080           ALL       Loop 2100B should contain Service Provider Number and/or NPI.            FALSE       DUAL USE    NP


Trustmark                                                             TRUST           ALL       Loop 2100B should contain Tax Identification Number and/or NPI.          FALSE       DUAL USE     G


Tufts Health Plan                                                     04298           ALL       Loop 2100B should contain Tax Identification Number and/or NPI.          FALSE       DUAL USE     G


U.S. Minor Outlying Islands Medicare                                  CMSEL           UM        Enrollment required. Form and instructions at                            TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
UMR Wausau                                                            39026           ALL       Loop 2100B must contain either the Tax Identification Number,            FALSE       DUAL USE     G
                                                                                                Provider Identification Number or NPI.

UniCare (WellPoint Health Network)                                      UNI           ALL       Loop 2100B should contain Tax Identification Number and/or NPI.          FALSE       5010A1       NC


UnitedHealthcare                                                      87726           ALL       Loop 2100B should contain Service Provider ID and/or NPI.                FALSE       DUAL USE     T


UnitedHealthcare                                                       UHC            ALL       Loop 2100B should contain Service Provider ID and/or NPI.                FALSE       DUAL USE     T


Universal Health Care                                                 UNVHC            FL       Loop 2100B must contain Service Provider NPI.                            FALSE       5010A1       P


Utah Blue Cross Blue Shield (Regance)                                 UTBLS            UT       Loop 2100B must contain Individual NPI. Enrollment Required.             TRUE        5010A1      NC
                                                                                                https://www.regence.com/utreg/forms/redesign/EDIEnrollmentForm.html
                                                                                                Follow instructions: 1. 270/271 Eligibility 2. New Enrollment or Add
                                                                                                Provider 3. Ingenix TP HT005191-001
Utah Medicare                                                         CMSEL            UT       Enrollment required. Form and instructions at                            TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Vermont Medicare                                                      CMSEL            VT       Enrollment required. Form and instructions at                            TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Virgin Islands of the U.S Medicare                                    CMSEL            VI       Enrollment required. Form and instructions at                            TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Virginia Anthem Blue Cross Blue Shield (WellPoint Health              VABLS            VA       Loop 2100B should contain Tax Identification Number and/or NPI.          FALSE       5010A1       NC
Network)

Virginia Medicaid                                                     VAMCD            VA       Loop 2100B must contain NPI.                                             FALSE       DUAL USE    NP


Virginia Medicare                                                     CMSEL            VA       Enrollment required. Form and instructions at                            TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Washington Medicare                                                   CMSEL           WA        Enrollment required. Form and instructions at                            TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
WEA Trust                                                              CALL            WI       Contact Rick Hammes, rhammes@weatrust.com, prior to submission           FALSE       4010A1       NC
                                                                                                for Payer ID and approval.
                                                                                                Loop 2100B must contain Service Provider NPI.


       -----------
       NP or NC: Non Participating Payers. OptumInsight charges a per transaction fee for non-par payers
       For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.enshealth.com
       OptumInsight Eligibility Payer List
       ANSI HIPAA 270/271
       (As of 03/22/2012)


                                                                    Payer ID
                                                                                                                                                                               Submission
                         Payer Name                                  2100A           State                              Additional Information                    Enrollment                Type
                                                                                                                                                                                  Type
                                                                     NM109
WellCare Health Plans                                                14163       CT,FL,GA,HI, Loop 2100B must contain NPI.                                          FALSE       DUAL USE     G
                                                                                 IL,IN,LA,MO,
                                                                                   NY,NJ,TX
West Virginia Medicaid                                               WVMCD            WV      Loop 2100B must contain an NPI.                                       FALSE       DUAL USE    NP


West Virginia Medicare                                                CMSEL           WV        Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Wisconsin Anthem Blue Cross Blue Shield (WellPoint Health             WIBLS           WI        Loop 2100B should contain Tax Identification Number and/or NPI.     FALSE       5010A1       NC
Network)

Wisconsin Medicaid                                                    WIMCD           WI        Loop 2100B should contain Service Provider number and/or NPI.       FALSE       5010A1      NC


Wisconsin Medicare                                                    CMSEL            WI       Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Wyoming Medicaid                                                     WYMCD            WY        Loop 2100B should contain Medicaid Provider Number and/or NPI.      FALSE       DUAL USE    NP


Wyoming Medicare                                                      CMSEL           WY        Enrollment required. Form and instructions at                       TRUE        5010A1       NC
                                                                                                http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligi
                                                                                                bilityEnrollmentForm.pdf. Loop 2100B must be NPI.




       -----------
       NP or NC: Non Participating Payers. OptumInsight charges a per transaction fee for non-par payers
       For up-to-date payer information, please access the payer list from the OptumInsight website at: http://www.enshealth.com
Payers highlighted are new or have been
altered in the last 90 days. Please verify

				
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