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					        Ingenix Eligibility Payer List
        ANSI HIPAA 270/271
        (As of 07/21/2011)




                                                          Payer ID                                                                                                  Enrollment   Submission
                         Payer Name                        2100A         State                           Additional Information                                                     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        4010A1      T


Aetna Health Plans (AHP)                                          60054          ALL        Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,               FALSE        4010A1      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        4010A1      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 NPI.      FALSE        4010A1      G



AHP of New Jersey, Parsippany                                     60054          ALL        Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,               FALSE        4010A1      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        4010A1      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 NPI.                                              FALSE        4010A1      NC


Alabama Blue Shield (Professional)                                ALBLS           AL        Loop 2100B must contain NPI.                                              FALSE        4010A1      NC


Alabama Medicaid                                                  ALMCD           AL        Loop 2100B must contain NPI.                                              FALSE        4010A1      NP


Alabama Medicare                                                  CMSEL           AL        Enrollment required. Form and instructions at                             TRUE         4010A1      NC
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                            lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Alaska Medicare                                                   CMSEL           AK        Enrollment required. Form and instructions at                             TRUE         4010A1      NC
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                            lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Altius Health Plans                                               00364          ALL        Loop 2100B must contain Service Provider Number assigned by the           FALSE        4010A1      G
                                                                                            payer and/or NPI.

American Medical Security (AMS)                                   81400          ALL        Loop 2100B must be Medicare Provider number and/or NPI.                   FALSE        4010A1      T


American Republic Insurance Company (ARIC)                        41099          ALL        Loop 2100B should contain Tax ID and/or NPI.                              FALSE        4010A1      G


American Samoa Medicare                                           CMSEL           AS        Enrollment required. Form and instructions at                             TRUE         4010A1      NC
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                            lityEnrollmentForm.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        4010A1      G


Arizona Blue Cross Blue Shield                                    AZBLS           AZ        Loop 2100B must contain NPI.                                              FALSE        4010A1      NC


Arizona Medicaid (AHCCCS)                                        AZMCD            AZ        Loop 2100B must contain NPI.                                              FALSE        4010A1      NP


Arizona Medicare                                                  CMSEL           AZ        Enrollment required. Form and instructions at                             TRUE         4010A1      NC
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                            lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Arkansas Medicaid                                                ARMCD            AR        Loop 2100B must contain NPI.                                              FALSE        4010A1      NC


Arkansas Medicare                                                 CMSEL           AK        Enrollment required. Form and instructions at                             TRUE         4010A1      NC
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                            lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Assurant-Time Insurance Company                                   AHTIN          ALL        Loop 2100B should contain Tax ID and/or NPI.                              FALSE        4010A1      G


Assurant-Union Security Insurance Company                         AHUSY          ALL        Loop 2100B should contain Tax ID and/or NPI.                              FALSE        4010A1      G


California Anthem Blue Cross (WellPoint Health Network)           00540           CA        Loop 2100B should contain Tax Identification Number and/or NPI.           FALSE        4010A1      NC


California Medicaid (Medi-Cal)                                   CAMCD            CA        Loop 2100B must be Service Provider number, Personal ID number            FALSE        4010A1      NP
                                                                                            (PIN), and/or NPI.

California Medicare                                               CMSEL           CA        Enrollment required. Form and instructions at                             TRUE         4010A1      NC
                                                                                            http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                            lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Cariten Healthcare                                                62073           TN        Loop 2100B: If NPI is submitted in NM109, send a REF02 = Federal          FALSE        4010A1      G
                                                                                            Tax ID

CHAMPVA                                                           84146          ALL        Loop 2100B should contain Tax ID and/or NPI.                              FALSE        4010A1      G


CIGNA                                                             62308          ALL        Loop 2100B should contain Tax Identification Number and/or NPI.           FALSE        4010A1      C


Colorado Anthem Blue Cross Blue Shield (WellPoint Health          COBLS           CO        Loop 2100B should contain Tax Identification Number and/or NPI.           FALSE        4010A1      NC
Network)


        -----------
        NP or NC: Non Participating Payers. Ingenix charges a per transaction fee for non-par payers
        For up-to-date payer information, please access the payer list from the Ingenix website at: http://www.enshealth.com
       Ingenix Eligibility Payer List
       ANSI HIPAA 270/271
       (As of 07/21/2011)




                                                               Payer ID                                                                                        Enrollment   Submission
                           Payer Name                           2100A          State                             Additional Information                                        Type      Type
                                                                NM109
Colorado Medicaid                                               COMCD            CO        Loop 2100B must contain NPI.                                          FALSE        4010A1      NP


Colorado Medicare                                                CMSEL           CO        Enrollment required. Form and instructions at                         TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
ConnectiCare                                                     06105          ALL        Loop 2100B should contain Tax Identification Number and/or NPI.       FALSE        4010A1      G


Connecticut Anthem Blue Cross Blue Shield (WellPoint Health      CTBLS           CT        Loop 2100B should contain Tax Identification Number and/or NPI.       FALSE        4010A1      NC
Network)

Connecticut General Life                                         06105          ALL        Loop 2100B should contain Tax Identification Number and/or NPI.       FALSE        4010A1      G


Connecticut Medicaid                                            CTMCD            CT        Loop 2100B must contain NPI.                                          FALSE        4010A1      NP


Connecticut Medicare                                             CMSEL           CT        Enrollment required. Form and instructions at                         TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
CoreSource (AZ & MN)                                             00234         AZ,MN       Loop 2100B should contain Tax Identification Number and/or NPI.       FALSE        4010A1      G


CoreSource (MD, PA, & IL)                                        CRSC1        MD,PA,IL     Loop 2100B should contain Tax Identification Number and/or NPI.       FALSE        4010A1      G


CoreSource (NC & IN)                                             CRSC2         NC,IN       Loop 2100B should contain Tax Identification Number and/or NPI.       FALSE        4010A1      G


Coventry Carelink Medicaid                                       00182          WV         Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      G
                                                                                           payer and/or NPI.

Coventry Health American/Health Assurance of Pennsylvania        00148         PA,OH       Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      G
                                                                                           payer and/or NPI.

Coventry Health Care USA                                         00186           MO        Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      G
                                                                                           payer and/or NPI.

Coventry Health Carelink                                         00160          WV         Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      G
                                                                                           payer and/or NPI.

Coventry Health CareNet                                          00190           VA        Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      G
                                                                                           payer and/or NPI.

Coventry Health Group Health Plan                                00184         IL,MO       Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      G
                                                                                           payer and/or NPI.

Coventry Health of Carolinas/WellPath                            25129         NC,SC       Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      G
                                                                                           payer and/or NPI.

Coventry Health of Delaware                                      25130           DE        Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      G
                                                                                           payer and/or NPI.

Coventry Health of Georgia                                       25127           GA        Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      G
                                                                                           payer and/or NPI.

Coventry Health of Iowa                                          25132           IA        Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      G
                                                                                           payer and/or NPI.

Coventry Health Care of Illinois/ Personal Care                  00179           IL        Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      G
                                                                                           payer and/or NPI.

Coventry Health of Kansas (Kansas City)                          25133         KS,MO       Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      G
                                                                                           payer and/or NPI.

Coventry Health of Kansas (Wichita)                              25134         KS,MO       Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      G
                                                                                           payer and/or NPI.

Coventry Health of Louisiana                                     25135           LA        Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      G
                                                                                           payer and/or NPI.

Coventry Health of Nebraska                                      25136         IA,NE       Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      G
                                                                                           payer and/or NPI.

Coventry Health Southern Health Services                         25128           VA        Loop 2100B must contain Service Provider Number assigned by the       FALSE        4010A1      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         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Deseret Mutual (DMBA)                                           DMBAU            UT        Loop 2100B must contain the Rendering Provider TIN and NPI.           FALSE        4010A1      NC
                                                                                           Rendering Provider NPI must already be enrolled for Claim
                                                                                           Submissions before they can send RTT to Deseret Mutual (DMBA).
Diamond Plan (Maryland Medicaid)                                 00177           MD        Loop 2100B should contain Tax Identification Number and/or NPI.       FALSE        4010A1      G


District of Columbia Medicare                                    CMSEL           DC        Enrollment required. Form and instructions at                         TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Federated States of Micronesia Medicare                          CMSEL           FM        Enrollment required. Form and instructions at                         TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Fidelis (CenterCare)                                             FIDEL          ALL        Loop 2100B should contain Provider Number or NPI.                     FALSE        4010A1      NP



       -----------
       NP or NC: Non Participating Payers. Ingenix charges a per transaction fee for non-par payers
       For up-to-date payer information, please access the payer list from the Ingenix website at: http://www.enshealth.com
         Ingenix Eligibility Payer List
         ANSI HIPAA 270/271
         (As of 07/21/2011)




                                                                 Payer ID                                                                                            Enrollment   Submission
                           Payer Name                             2100A          State                             Additional Information                                            Type      Type
                                                                  NM109
First Ameritas of NY                                              00426           ALL        Loop 2100B should contain Tax ID and/or NPI.                              FALSE        4010A1      G


First Health                                                       87043          ALL        Loop 2100B should contain Tax ID, SSN, Service Provider ID, and/or        FALSE        4010A1      G
                                                                                             NPI.

First Health (Mail Handlers)                                       00251          ALL        Loop 2100B should contain Tax ID, SSN, Service Provider ID, and/or        FALSE        4010A1      G
                                                                                             NPI.

Florida Blue Cross Blue Shield                                     FLBLS           FL        Loop 2100B should contain BCBSFL Facility or Provider ID and/or NPI.      FALSE        4010A1      NC


Florida Medicaid                                                   FLMCD           FL        Loop 2100B should contain Provider Number or NPI.                         FALSE        4010A1      NP


Florida Medicare                                                   CMSEL           FL        Enrollment required. Form and instructions at                             TRUE         4010A1      NC
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                             lityEnrollmentForm.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        4010A1      NC
Network)

Georgia Medicaid                                                  GAMCD            GA        Loop 2100B must contain NPI.                                              FALSE        4010A1      NP


Georgia Medicare                                                   CMSEL           GA        Enrollment required. Form and instructions at                             TRUE         4010A1      NC
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                             lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Government Employees Hospital Association (GEHA)                   44054          ALL        Loop 2100B should contain either the Tax ID or NPI.                       FALSE        4010A1      P


Great West                                                         80705          ALL        Loop 2100B should contain Tax ID and/or NPI.                              FALSE        4010A1      C


Guam Medicare                                                      CMSEL           GU        Enrollment required. Form and instructions at                             TRUE         4010A1      NC
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                             lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Hawaii Medicare                                                    CMSEL           HI        Enrollment required. Form and instructions at                             TRUE         4010A1      NC
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                             lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Health Net of Arizona                                              00213           AZ        Loop 2100B should contain Tax ID and/or NPI.                              FALSE        4010A1      G


Health Net of California                                           95567           CA        Loop 2100B should contain Tax ID and/or NPI.                              FALSE        4010A1      G


Health Net of the Northeast                                        00213      CT,NJ,NY,PA    Loop 2100B should contain Tax ID and/or NPI                               FALSE        4010A1      G


HealthFirst of New York                                            HF1NY           NY        Loop 2100B should contain Legacy ID and/or NPI.                           FALSE        4010A1      G


HealthPartners                                                     HPART           PA        Loop 2100B should contain NPI.                                            FALSE        4010A1      G


HealthPartners of Minnesota                                        94267           MN        2100B must contain NPI. Enrollment required. Form and instructions at     TRUE         4010A1      NP
                                                                                             http://www.enshealth.com/enspublic/Download/EMCagreement.asp.

HIP NY                                                             HIPNY           NY        Loop 2100B should contain Service Provider Number assigned by the         FALSE        4010A1      G
                                                                                             payer, Tax ID, or NPI.

Humana                                                             00041          ALL        Loop 2100B should contain Tax ID and/or NPI.                              FALSE        4010A1      G


Idaho Medicaid                                                    IDMCD            ID        Loop 2100B should contain Payer Assigned Provider ID Number or NPI.       FALSE        4010A1      NP


Idaho Medicare                                                     CMSEL           ID        Enrollment required. Form and instructions at                             TRUE         4010A1      NC
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                             lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Illinois Blue Cross Blue Shield                                    ILBLS           IL        Loop 2100B should contain Service Provider Number assigned by the         FALSE        4010A1      NP
                                                                                             payer and/or NPI.

Illinois Medicaid                                                  ILMCD           IL        Loop 2100B should contain Service Provider Number assigned by the         FALSE        4010A1      NP
                                                                                             payer and/or NPI.

Illinois Medicare                                                  CMSEL           IL        Enrollment required. Form and instructions at                             TRUE         4010A1      NC
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                             lityEnrollmentForm.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        4010A1      NC
Network)

Indiana Medicaid                                                   INMCD           IN        Loop 2100B should contain Service Provider Number assigned by the         FALSE        4010A1      NP
                                                                                             payer and/or NPI.

Indiana Medicare                                                   CMSEL           IN        Enrollment required. Form and instructions at                             TRUE         4010A1      NC
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                             lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Iowa Medicare                                                      CMSEL           IA        Enrollment required. Form and instructions at                             TRUE         4010A1      NC
                                                                                             http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                             lityEnrollmentForm.pdf. Loop 2100B must be NPI.
John Alden Life Insurance Company                                  41099          ALL        Loop 2100B should contain Tax ID and/or NPI.                              FALSE        4010A1      G


Kaiser Foundation Health Plan of Ohio                              00280          ALL        Loop 2100B should contain Tax ID and/or NPI.                              FALSE        4010A1      G


Kansas Medicaid                                                   KSMCD            KS        Loop 2100B must contain an NPI.                                           FALSE        4010A1     NC



         -----------
         NP or NC: Non Participating Payers. Ingenix charges a per transaction fee for non-par payers
         For up-to-date payer information, please access the payer list from the Ingenix website at: http://www.enshealth.com
       Ingenix Eligibility Payer List
       ANSI HIPAA 270/271
       (As of 07/21/2011)




                                                               Payer ID                                                                                          Enrollment   Submission
                         Payer Name                             2100A          State                             Additional Information                                          Type      Type
                                                                NM109
Kansas Medicare                                                 CMSEL            KS        Enrollment required. Form and instructions at                           TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.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        4010A1      NC
Network)

Kentucky Medicaid                                               KYMCD            KY        Loop 2100B should contain Payer Assigned Prov ID Number or NPI.         TRUE         4010A1     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         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Keystone Mercy                                                   KEYST           PA        Loop 2100B should contain NPI and Facility ID / Federal Tax ID          FALSE        4010A1      NP
                                                                                           (2100B/REF02 for REF01=1J).

Louisiana Blue Cross Blue Shield                                 LABLS           LA        Loop 2100B should contain Service Provider Number assigned by the       FALSE        4010A1      NP
                                                                                           payer and/or NPI.

Louisiana Medicaid                                              LAMCD            LA        Loop 2100B should contain Service Provider Number assigned by the       FALSE        4010A1      NP
                                                                                           payer and/or NPI.

Louisiana Medicare                                               CMSEL           LA        Enrollment required. Form and instructions at                           TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.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        4010A1      NC
Network)

Maine Medicaid                                                  MEMCD            ME        Loop 2100B must contain Payer Assigned Provider Number ID.              FALSE        4010A1      NP


Maine Medicare                                                   CMSEL           ME        Enrollment required. Form and instructions at                           TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Marshall Islands Medicare                                        CMSEL           MH        Enrollment required. Form and instructions at                           TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Maryland Blue Cross Blue Shield (CareFirst)                      MDBLS           MD        Loop 2100B must contain both the Federal Tax ID and NPI.                FALSE        4010A1      NP


Maryland Medicaid                                               MDMCD            MD        Loop 2100B must contain Payer Assigned Provider ID or NPI.              FALSE        4010A1      NP


Maryland Medicare                                                CMSEL           MD        Enrollment required. Form and instructions at                           TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.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        4010A1      G
                                                                                           character Facility ID, and/or NPI.

Massachusetts Medicaid                                          MAMCD            MA        Loop 2100B must be a Provider Medicaid ID, User Identification          FALSE        4010A1      NP
                                                                                           number, UPIN, and/or NPI.

Massachusetts Medicare                                           CMSEL           MA        Enrollment required. Form and instructions at                           TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.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        4010A1      G


Mega Life (Transamerica Life)                                    TLINS          ALL        Loop 2100B should contain Tax ID and/or NPI.                            FALSE        4010A1      G


Mega Life and Health Insurance                                   59221          ALL        Loop 2100B should contain Tax ID and/or NPI.                            FALSE        4010A1      G


Michigan Medicaid                                               MIMCD            MI        Loop 2100B must contain NPI. This NPI must be enrolled with MI          FALSE        4010A1      NP
                                                                                           BCBS for Claims prior to sending RT Eligibility Requests.

Michigan Medicare                                                CMSEL           MI        Enrollment required. Form and instructions at                           TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Minnesota Medicare                                               CMSEL           MN        Enrollment required. Form and instructions at                           TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Mississippi Blue Cross Blue Shield                               MSBLS           MS        Loop 2100B must contain NPI.                                            FALSE        4010A1      NP


Mississippi Medicaid                                            MSMCD            MS        Loop 2100B must contain NPI.                                            FALSE        4010A1      NP


Mississippi Medicare                                             CMSEL           MS        Enrollment required. Form and instructions at                           TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.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        4010A1      NC
Network)

Missouri Medicaid                                               MOMCD            MO        Loop 2100B should contain Service Provider number and/or NPI.           FALSE        4010A1      NP


Missouri Medicare                                                CMSEL           MO        Enrollment required. Form and instructions at                           TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Montana Medicare                                                 CMSEL           MT        Enrollment required. Form and instructions at                           TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.

       -----------
       NP or NC: Non Participating Payers. Ingenix charges a per transaction fee for non-par payers
       For up-to-date payer information, please access the payer list from the Ingenix website at: http://www.enshealth.com
       Ingenix Eligibility Payer List
       ANSI HIPAA 270/271
       (As of 07/21/2011)




                                                                Payer ID                                                                                          Enrollment   Submission
                          Payer Name                             2100A         State                             Additional Information                                           Type      Type
                                                                 NM109
Mutual of Omaha                                                  71412          ALL        Loop 2100B should contain Tax ID and/or NPI.                             FALSE        4010A1      T


National Association of Letter Carriers (NALC)                   53011          ALL        Loop 2100B should contain Tax ID and/or NPI.                             FALSE        4010A1      G


Nebraska Medicare                                                CMSEL           NE        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.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        4010A1      NC
Network)

Nevada Medicaid                                                 NVMCD            NV        Loop 2100B should contain NPI.                                           FALSE        4010A1      NP


Nevada Medicare                                                  CMSEL           NV        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.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        4010A1      NC
Health Network)

New Hampshire Medicare                                           CMSEL           NH        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.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        4010A1      G


New Jersey Medicaid                                              NJMCD           NJ        Loop 2100B should contain Service Provider number and/or NPI.            FALSE        4010A1      NP


New Jersey Medicare                                              CMSEL           NJ        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
New Mexico Medicaid                                             NMMCD            NM        Loop 2100B must contain an NPI.                                          FALSE        4010A1      NP


New Mexico Medicare                                              CMSEL           NM        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
New York Blue Cross Blue Shield (Empire)                         NYBLS           NY        Loop 2100B must contain NPI.                                             FALSE        4010A1     NC


New York Medicaid                                                NYMCD           NY                                                                                 FALSE        4010A1      NP


New York Medicare                                                CMSEL           NY        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Nippon Life (Principal Financial Group)                          81264          ALL        Loop 2100B should contain Tax ID and/or NPI.                             FALSE        4010A1      G


North Carolina Medicaid                                         NCMCD            NC        Loop 2100B should contain Service Provider number and/or NPI.            FALSE        4010A1      NP


North Carolina Medicare                                          CMSEL           NC        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
North Dakota Medicare                                            CMSEL           ND        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Northern Mariana Islands Northern Mariana Medicare               CMSEL           MP        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Ohio Anthem Blue Cross Blue Shield (WellPoint Health Network)    OHBLS           OH        Loop 2100B should contain Tax Identification Number and/or NPI.          FALSE        4010A1      NC


Ohio Medicaid                                                   OHMCD            OH        Loop 2100B must contain the Provider's Legacy Provider ID in the         FALSE        4010A1      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         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Ohio Valley HMO, Cincinnati (Aetna)                              60054          ALL        Loop 2100B should contain Tax ID and/or NPI.                             FALSE        4010A1      G


Oklahoma Medicaid                                                MC030           OK        Enrollment required. Call Hope Richardson at (719)277-7545 ext. 1309     TRUE         4010A1      NP


Oklahoma Medicare                                                CMSEL           OK        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Oregon Medicare                                                  CMSEL           OR        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Oxford Health Plans                                              06111          ALL        Loop 2100B should contain Oxford Provider ID and/or NPI.                 FALSE        4010A1      T


PacifiCare of Arizona (HMO)                                      95964           AZ        Loop 2100B should contain Tax ID and/or NPI.                             FALSE        4010A1      T


PacifiCare of California (HMO)                                   PHSCA           CA        Loop 2100B should contain Tax ID and/or NPI.                             FALSE        4010A1      T


PacifiCare of California (HMO)                                   95959           CA        Loop 2100B should contain Tax ID and/or NPI.                             FALSE        4010A1      T


PacifiCare of Colorado (HMO)                                     95962           CO        Loop 2100B should contain Tax ID and/or NPI.                             FALSE        4010A1      T



       -----------
       NP or NC: Non Participating Payers. Ingenix charges a per transaction fee for non-par payers
       For up-to-date payer information, please access the payer list from the Ingenix website at: http://www.enshealth.com
       Ingenix Eligibility Payer List
       ANSI HIPAA 270/271
       (As of 07/21/2011)




                                                               Payer ID                                                                                               Enrollment   Submission
                           Payer Name                           2100A          State                              Additional Information                                              Type      Type
                                                                NM109
PacifiCare of Colorado (HMO)                                    COPHS            CO        Loop 2100B should contain Tax ID and/or NPI.                                 FALSE        4010A1      T


PacifiCare of Nevada (HMO)                                       95970           NV        Loop 2100B should contain Tax ID and/or NPI.                                 FALSE        4010A1      T


PacifiCare of Oklahoma (HMO)                                    PHSOK            OK        Loop 2100B should contain Tax ID and/or NPI.                                 FALSE        4010A1      T


PacifiCare of Oregon (HMO)                                      PHSOR            OR        Loop 2100B should contain Tax ID and/or NPI.                                 FALSE        4010A1      T


PacifiCare of Texas (HMO)                                        PHSTX           TX        Loop 2100B should contain Tax ID and/or NPI.                                 FALSE        4010A1      T


PacifiCare of Washington (HMO)                                  PHSWA           WA         Loop 2100B should contain Tax ID and/or NPI.                                 FALSE        4010A1      T


PacifiCare PPO (All States)                                      95999          ALL        Loop 2100B should contain Tax ID and/or NPI.                                 FALSE        4010A1      T


Palau Medicare                                                   CMSEL           PW        Enrollment required. Form and instructions at                                TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.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 Highmark            TRUE         4010A1      T
                                                                                           for claims prior to sending a 270 Request. If Group NPI is not enrolled,
                                                                                           please refer to the ICS website for a copy of the enrollment form and
Pennsylvania Medicaid                                           PAMCD            PA        Loop 2100B should contain Service Provider number (13 digit PA               FALSE        4010A1      NP
                                                                                           Provider Medicaid ID)

Pennsylvania Medicare                                            CMSEL           PA        Enrollment required. Form and instructions at                                TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
PHP of Georgia, Atlanta, Aetna                                   60054          ALL        Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,                  FALSE        4010A1      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        4010A1      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        4010A1      G
                                                                                           Organization Number, Tax ID, and/or NPI.

Principal Financial Group (Principal Life)                       61271          ALL        Loop 2100B must be Medicare Provider number and/or NPI.                      FALSE        4010A1      G


Puerto Rico Medicare                                             CMSEL           PR        Enrollment required. Form and instructions at                                TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.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         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Rhode Island Medicare                                            CMSEL           RI        Enrollment required. Form and instructions at                                TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.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        4010A1      G
                                                                                           Organization Number, Tax ID, and/or NPI.

SelectHealth                                                     SELHT           UT        Loop 2100B must contain the Rendering Provider NPI.                          FALSE        4010A1     NC


Senior Choice (Aetna Health Plan of NY/NJ)                       60054          ALL        Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,                  FALSE        4010A1      G
                                                                                           Organization Number, Tax ID, and/or NPI.

South Carolina Medicare                                          CMSEL           SC        Enrollment required. Form and instructions at                                TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
South Dakota Medicare                                            CMSEL           SD        Enrollment required. Form and instructions at                                TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Southwest Health Plan (Aetna HMO)                                60054          ALL        Loop 2100B Provider ID should contain Aetna PIN, Aetna PVN,                  FALSE        4010A1      G
                                                                                           Organization Number, Tax ID, and/or NPI.

Tennessee Blue Cross Blue Shield                                 TNBLS           TN        Loop 2100B must contain Tax Identification Number.                           FALSE        4010A1      NC


Tennessee Medicaid (TennCare)                                   TNMCD            TN        Loop 2100B must contain Tax Identification Number.                           FALSE        4010A1      NP


Tennessee Medicare                                               CMSEL           TN        Enrollment required. Form and instructions at                                TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Texas Blue Cross Blue Shield                                     TXBLS           TX        Loop 2100B should contain either the Provider ID or NPI.                     FALSE        4010A1      NP


Texas Medicaid                                                  TXMCD            TX        Loop 2100B must contain NPI.                                                 FALSE        4010A1      NP


Texas Medicare                                                   CMSEL           TX        Enrollment required. Form and instructions at                                TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Three Rivers Health Plan                                         00199           TN        Loop 2100B should contain Service Provider number, Tax ID, Provider          FALSE        4010A1      G
                                                                                           Plan Network number, Provider Plan Facility Network ID, and/or NPI.


       -----------
       NP or NC: Non Participating Payers. Ingenix charges a per transaction fee for non-par payers
       For up-to-date payer information, please access the payer list from the Ingenix website at: http://www.enshealth.com
       Ingenix Eligibility Payer List
       ANSI HIPAA 270/271
       (As of 07/21/2011)




                                                               Payer ID                                                                                           Enrollment   Submission
                         Payer Name                             2100A          State                                 Additional Information                                       Type      Type
                                                                NM109
Three Rivers Health Plan / Unison MedPLUS (Medicaid)            00198       OH,PA,TN,SC    Loop 2100B should contain Service Provider number, Tax ID, Provider      FALSE        4010A1      G
                                                                                           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        4010A1      NP


Trustmark                                                        TRUST          ALL        Loop 2100B should contain Tax Identification Number and/or NPI.          FALSE        4010A1      G


Tufts Health Plan                                                04298          ALL        Loop 2100B should contain Tax Identification Number and/or NPI.          FALSE        4010A1      G


U.S. Minor Outlying Islands Medicare                             CMSEL           UM        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
UMR Wausau                                                       39026          ALL        Loop 2100B must contain either the Tax Identification Number,            FALSE        4010A1      G
                                                                                           Provider Identification Number or NPI.

UniCare (WellPoint Health Network)                                UNI           ALL        Loop 2100B should contain Tax Identification Number and/or NPI.          FALSE        4010A1      NC


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


UnitedHealthcare                                                  UHC           ALL        Loop 2100B should contain Service Provider ID and/or NPI.                FALSE        4010A1      T


Utah Blue Cross Blue Shield (Regance)                            UTBLS           UT        Loop 2100B must contain Individual NPI. Enrollment Required.             TRUE         4010A1     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         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Vermont Medicare                                                 CMSEL           VT        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Virgin Islands of the U.S Medicare                               CMSEL           VI        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.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        4010A1      NC
Network)

Virginia Medicaid                                               VAMCD            VA        Loop 2100B must contain NPI.                                             FALSE        4010A1      NP


Virginia Medicare                                                CMSEL           VA        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Washington Medicare                                              CMSEL           WA        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.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.
West Virginia Medicaid                                          WVMCD           WV         Loop 2100B must contain an NPI.                                          FALSE        4010A1      NP


West Virginia Medicare                                           CMSEL           WV        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.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        4010A1      NC
Network)

Wisconsin Medicaid                                              WIMCD            WI        Loop 2100B should contain Service Provider number and/or NPI.            FALSE        4010A1      NP


Wisconsin Medicare                                               CMSEL           WI        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.
Wyoming Medicaid                                                WYMCD            WY        Loop 2100B should contain Medicaid Provider Number and/or NPI.           FALSE        4010A1      NP


Wyoming Medicare                                                 CMSEL           WY        Enrollment required. Form and instructions at                            TRUE         4010A1      NC
                                                                                           http://www.enshealth.com/enspublic/Download/Enrollment/CMSEligibi
                                                                                           lityEnrollmentForm.pdf. Loop 2100B must be NPI.




       -----------
       NP or NC: Non Participating Payers. Ingenix charges a per transaction fee for non-par payers
       For up-to-date payer information, please access the payer list from the Ingenix 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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Description: Tax Payer Information California document sample