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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            TRUE         5010A1     NC
                                                                                                                   must 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            TRUE         5010A1     NC
                                                                                                                   must 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 http://                   TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Alaska Medicare                                                                     CMSEL                  AK      Enrollment required. Form and instructions at http://                   TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://                   TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://                   TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://                   TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                    www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                    CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                    www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                    CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                    www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                    CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                    www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                    CMSEligibilityEnrollmentForm.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 http://                TRUE         5010A1     NC
                                                                                                                     www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                     CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Federated States of Micronesia Medicare                                               CMSEL                  FM      Enrollment required. Form and instructions at http://                TRUE         5010A1     NC
                                                                                                                     www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                     CMSEligibilityEnrollmentForm.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/     FALSE       DUAL USE     G
                                                                                                                     or NPI.

First Health Mail Handlers Benefit Plan                                               00251              ALL         Loop 2100B should contain Tax ID, SSN, Service Provider ID, and/     FALSE       DUAL USE     G
                                                                                                                     or 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 http://                TRUE         5010A1     NC
                                                                                                                     www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                     CMSEligibilityEnrollmentForm.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 http://                TRUE         5010A1     NC
                                                                                                                     www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                     CMSEligibilityEnrollmentForm.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 http://                TRUE         5010A1     NC
                                                                                                                     www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                     CMSEligibilityEnrollmentForm.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 http://                TRUE         5010A1     NC
                                                                                                                     www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                     CMSEligibilityEnrollmentForm.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                TRUE         5010A1      NP
                                                                                                                     instructions at http://www.enshealth.com/enspublic/Download/
                                                                                                                     EMCagreement.asp.
HIP NY                                                                                HIPNY                  NY      Loop 2100B should contain Service Provider Number assigned by        FALSE       DUAL USE     G
                                                                                                                     the 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 http://                TRUE         5010A1     NC
                                                                                                                     www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                     CMSEligibilityEnrollmentForm.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       FALSE       DUAL USE     NP
                                                                                                                   the payer and/or NPI.

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

Illinois Medicare                                                                   CMSEL                  IL      Enrollment required. Form and instructions at http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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       FALSE       DUAL USE     NP
                                                                                                                   the payer and/or NPI.

Indiana Medicare                                                                    CMSEL                  IN      Enrollment required. Form and instructions at http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Iowa Medicare                                                                       CMSEL                  IA      Enrollment required. Form and instructions at http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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       FALSE       DUAL USE     NP
                                                                                                                   the 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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
MAHP/MAMSI                                                                          87726              ALL         Loop 2100B must be should contain Service Provider Number and/      FALSE        4010A1      T
                                                                                                                   or 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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Marshall Islands Medicare                                                           CMSEL                  MH      Enrollment required. Form and instructions at http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Massachusetts Blue Cross Blue Shield                                                00139                  MA      Loop 2100B should contain either the 6-character Provider ID or     FALSE       DUAL USE     G
                                                                                                                   10-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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Minnesota Medicare                                                                  CMSEL                  MN      Enrollment required. Form and instructions at http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Montana Medicare                                                                    CMSEL                  MT      Enrollment required. Form and instructions at http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
North Dakota Medicare                                                               CMSEL                  ND      Enrollment required. Form and instructions at http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Northern Mariana Islands Northern Mariana Medicare                                  CMSEL                  MP      Enrollment required. Form and instructions at http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://                   TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://                   TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://                   TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://                   TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://                   TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://                   TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://                   TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Rhode Island Medicare                                                               CMSEL                  RI      Enrollment required. Form and instructions at http://                   TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://                     TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
South Dakota Medicare                                                               CMSEL                  SD      Enrollment required. Form and instructions at http://                     TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://                     TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://                     TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://                     TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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. https://     TRUE         5010A1     NC
                                                                                                                   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 http://                     TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Vermont Medicare                                                                    CMSEL                  VT      Enrollment required. Form and instructions at http://                     TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Virgin Islands of the U.S Medicare                                                  CMSEL                  VI      Enrollment required. Form and instructions at http://                     TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://                     TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
Washington Medicare                                                                 CMSEL              WA          Enrollment required. Form and instructions at http://                     TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.pdf. Loop 2100B must be NPI.
WEA Trust                                                                            CALL                  WI      Contact Rick Hammes, rhammes@weatrust.com, prior to                       FALSE        4010A1     NC
                                                                                                                   submission 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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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 http://               TRUE         5010A1     NC
                                                                                                                   www.enshealth.com/enspublic/Download/Enrollment/
                                                                                                                   CMSEligibilityEnrollmentForm.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
that your system is setup correctly for this
payer

				
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