Payer Connection - Electronic Claims Payer List

Address - Some payers have multiple locations, but claims go to the same electronic location
*Indicates claim is routed by paper. Several payers that DO receive claims electronically have been placed on this list for
having poor services available.

Name Payer ID ERA Paper* Address City State Zip

6 DEGREES HEALTH 20446 N
INCORPORATED
A I BENEFIT PLAN ADMIN AIBPA N 1220 SW MORRISON PORTLAND OR 97205
ST 300
AAI TEST N PO BOX 6680 PORTLAND OR 97228

AARP Medicare Supplement 36273 N PO BOX 30976 Salt Lake City UT 84130

AARP MedicareComplete from AARP N PO BOX 31362 SALT LAKE CITY UT 84131
SecureHorizons
ABA AFFORDABLE BENEFITS 95426 N PO BOX 10787 BURBANK CA 91510
ADMIN
ABC ASSOCIATED BENIFITS FAABC N PO BOX 71039 DES MOSINES IA 50325
CORP
AblePay Health ABLPY N

ACS Consulting Services 72467 N

ADMINISTRATIVE CONCEPTS 22384 N 994 OLD EAGLE RD WAYNE PA 19087

INC SUITE 1005

Administrative Services, Inc. 59141 N

ADMINISTRATORS WEST AWEST N Y 612 NE SAVANNAH DR BEND OR 97701

ADVANCED BENEFIT ADVBA N Y 6420 SW MACADAM PORTLAND OR 97201

ADMINISTRATOR AVE STE 380

ADVANTRA FREEDOM 25133 N

ADVENTIST HEALTH SYSTEM 95340 N PO BOX 619031 ROSEVILLE CA 95661

WEST
Aetna Affordable Health Choices 57604 N
(SM) - SRC
AETNA INSURANCE COMPANY 60054 N All Address

Affinity Medical Group 46594 N

AFL Hotel & Work Hlth & WTF 75309 N Y Po Box 29939 HONOLULU HI 96820

AFTRA HEALTH FUND 13346 N 261 Madison Ave New York NY 10016

AgeRight Advantage ARA01 N

AHA/FIRST HEALTH 01066 N

Alameda Alliance for Health 95327 N

Alaska Electrical Health & 92600 N

Welfare Fund
ALASKA LABORERS 91136 N P O Box 34567 Seattle WA 98124

Aliera Healthcare ALH01 N

AllCare Health Plan MRIPA N

Page 1 of 21 List Current As of 10/12/2021 5:00:10 AM

AllCare PEBB 26158 N 740 SE 7th Street Grant Pass OR 97526

ALLEGIANCE BENEFIT PLAN 81040 N 1000 GREAT WEST KENNETT MO 63857

DR
Alliance PPO Inc - OneNet PPO 52149 N

ALLIED ADMINISTRATORS 94177 N PO BOX 2500 SAN FRANCISO CA 94126

ALLIED BENEFITS SYSTEMS 37308 N PO BOX 909786-60690 CHICAGO IL 60690

AlohaCare Advantage ALOHA N Y 1357 Kapiolani Blvd Ste Honolulu HI 96814

1250
Alohacare Quest ALQST N Y 1357 Kapiolani Blvd Ste Honolulu HI 96814
1250
Alta Bates Medical Group ABMG A0701 N

AMA INSURANCE AGENCY AMAIA N 200 NORTH LASALLE CHICAGO IL 60601

ST SUITE 4
AMERIBEN SOLUTIONS INC 75137 N P O BOX 7186 BOISE ID 83707

America's Choice 20029 N

AMERICAN FAMILY INSURANCE AMF11 N 6000 AMERICAN MADISON WI 53783

PARKWAY
American Heritage 77083 N

AMERICAN MEDICAL SECURITY 81400 N PO BOX 19032 GREEN BAY WI 54307

American National Ins Co 74048 N

AMERICAN REPUBLIC INS 42011 N PO BOX 2975 CLINTON IA 52733

AMERICAN SPECIALTY HEALTH ASH01 N P O BOX 509001 P O BOX 509001 CA 92150

American Specialty Health ASH01 N

Americhoice NJ Medicaid & 86047 N

Family Care
Amerigroup 26375 N

AMERIGROUP NJ 28806 N

AMERIGROUP VA 28804 N P.O. Box 62509 Virginia Beach VA 23466250

9
AMERIHEALTH 54763 N 720 Blair Mill Road Horsham PA 19044
ADMINISTRATORS
AMERIHEALTH HMO NEW 23037 N
JERSEY AND DELAWARE
AMERIHEALTH MERCY HEALTH 22248 N 720 BLAIR MILL RD HORSHAM PA 19044
PLAN
Anthem BCBS Colorado 00050 N

Anthem BCBS Colorado (WGS ENCWGS N

Encounters)
Anthem BCBS Indiana 00130 N

Anthem BCBS Kentucky 00160 N

Anthem BCBS Maine 00180 N

Anthem BCBS Missouri 00241 N

Anthem BCBS Nevada 00265 N

Anthem BCBS New Hampshire 00270 N

Anthem BCBS Ohio 00332 N

Anthem BCBS Virginia 00423 N

Page 2 of 21 List Current As of 10/12/2021 5:00:10 AM

Anthem BCBS Wisconsin 00450 N

Anthem Blue Cross 00060 N PO Box 533 North Haven CT 06473

Anthem E Consult AECON N

ANTHEM HEALTH AND LIFE 80705A N

Anthem Telemedicine ATMED N

APWU AMERICAN POSTAL 44444 N

WORKERS UNION
Arizona Physicians IPA (APIPA) 03432 N
(UHC APIPA)
ARM LTD NORTHWEST ARMNW N Y 10200 SW Nimbus Ste PORTLAND OR 97223
G5
Arnett Health Plan - former 87726 N P O Box 6108 Lafayette IN 47903
payer id 95440
ASRM CORP ASRM1 N

ASSOCIATED ADMINISTRATORS AAIOR N PO BOX 1271 PORTLAND OR 97207

ASSOCIATES FOR HEALTHCARE 36326 N PO BOX 981 BROOKFIELD WI 53008

Assurant Employee Benefits - ASSUR N PO BOX 624 MILWAUKEE WI 53201

Formerly Fortis
ASSURANT HEALTH - AETNA 58730 N PO BOX 91604 LUBBOCK TX 79490
SIGNATURE ADMIN
ASSURECARE INC 88035 N

ASURIS NORTHWEST HEALTH 93221 N PO BOX 30271 SALT LAKE CITY UT 84130

Athens Area Health Plan Select 95691 N PO BOX 370 LOUISEVILLE KY 40233

ATPA ATPA1 N 7600 SW Mohawk St Tualatin OR 97062

ATRIO Health Plan / Marion Polk ATRIO N

Community Advantag
AUSTIN REGIONAL CLINIC CMSEB N
EMPLOYEE BENEFIT
AvMed 59274 N PO BOX 569000 MIAMI FL 33256

BANKERS LIFE BNKLI N Y PO BOX 1935 CHICAGO IL 60654

Banner Health SX145 N

BEECH STREET CORPORATION 95377 N P O BOX 57015 IRVINE CA 92619

BENEFIRST 37125 N Y 1020 Plain St Marshfield MA 02050

BENEFIT ADMINISTRATOR SYS 36149 N 17475 JOVANNA HOMEWOOD IL 60430

DRIVE 1B
BENEFIT AND RISK 99320 N PO BOX 2140 FOLSOM CA 95763
MANAGEMENT SVS FC
BENEFIT CONCEPTS 51037 N PO BOX C50 WARMINSTER PA 18974

BENEFIT COORDINATORS 25145 N 111 Ryan Court Suite Pittsburg PA 15205

CORPORATION 300

BENEFIT MGMT SERVICES 37220 N PO BOX 98044 BATON ROUGE LA 70898

Benefit Plan Administrators Inc. 19753 N

(BPA) - MA
Benefit Plan Administrators Inc. 88027 N
(BPA) - Nevada
BENEFIT PLANNERS, INC. 39026 N PO BOX 690450 SAN ANTONIO TX 78269

Page 3 of 21 List Current As of 10/12/2021 5:00:10 AM

BENESIGHT 87265 N PO BOX 375 PUEBLO CO 81002

BIG LOTS ASSOCIATES BENEFIT CX025 N P O Box 9071 Dublin OH 43017

PLANS
Bind Benefits Inc 25463 N PO Box 211758 Eagan MN 55121

BLUE CARE NETWORK HMO - HM710 N PO BOX 68767 GRAND RAPIDS MI 49516
BCBS MI
BLUE CROSS BLUE SHIELD AZ 53589 N

Blue Cross Blue Shield Georgia 00101 N

BLUE CROSS BLUE SHIELD MI 00710 N PO BOX 44407 DETROIT MI 48244

BLUE CROSS BLUE SHIELD MI P0710 N PO BOX 440 Southfield MI 48034

Medicare Plus
Blue Cross Blue Shield MT BCSMT N

BLUE CROSS BLUE SHIELD RI 00870 N 500 Exchange St PROVIDENCE RI 02903

BLUE CROSS CA - Anthem 47198 N PO BOX 60007 Los Angeles CA 90060

BLUE CROSS ID 00610 N PO BOX 7408 BOISE ID 83707

Blue Cross Medicare Advantage 66006 N

BLUE SHIELD CA 94036 N Chico CA

BLUE SHIELD NY (EMPIRE) 00303 N

BlueChoice HealthPlan Medicaid 00403 N

BLUECROSS BLUESHIELD IL 00621 N PO BOX 805107 CHICAGO IL 60680

(HCSC)
BlueCross BlueShield of Western 00246 N
New York
BLUEGRASS FAMILY HEALTH 61124 N Po Box 21921 LEXINGTON KY 40522

BOILERMAKERS HEALTH AND 36609 N

WELFARE
BOON-CHAPMAN BENEFIT 74238 N PO BOX 9201 AUSTIN TX 78766
ADMINISTRATORS
BOSTON MEDICAL CENTER 13337 N
HEALTH PLAN
BOULDER ADMINISTRATION 18768 N 23048 N 15TH AVE PHOENIX AZ 85027
SERVICES
Bridgespan Health BRIDG N

Bridgeway Health Solutions 68054 N

BRIGHTWOOD INS - KIP BRIGHT N PO BOX 1400 PORTLAND OR 97207

COMPANY
Brown & Toland Medical Group 94316 N PO Box 640469 San Francisco CA 94164

CAMBRIDGE ISG 59334 N 920 SW 6TH AVENUE PORTLAND OR 97204

CAPITOL ADMINISTRATORS 68011 N

CAPROCK HEALTH PLANS CAPHP N

Care 1st Health Plan of Arizona 57116 N

Care 1st Health Plan of CA 57115 N

CARE OREGON 93975 N PO BOX 403 PORTLAND OR 97204

CARE OREGON ADVANTAGE 93975M N PO BOX 40328 PORTLAND OR 97204

Page 4 of 21 List Current As of 10/12/2021 5:00:10 AM

CAREFIRST ADMINISTRATORS 52118 N PO BOX 1196 OWINGS MILLS MD 21117
MA
CareFirst BCBS SB580 N PO BOX 14116 Lexington KY 40512

CARESOURCE HEALTH PLAN OF MRCHP N 740 SE 7TH ST GRANTS PASS OR 97526

OREGON
CARESOURCE OF INDIANA 37311 N Y PO BOX 2920 CLINTON IA 52733

CARPENTERS HEALTH & 25133 N PO Box 42031 HAZELWOOD MO 63042

WELFARE
CASCADE HEALTH ALLIANCE CHA01 N

CASCADE HEALTH SERVICE CHLTH N PO BOX 85008 BELLEVUE WA 98015

CBCA ADMINISTRATORS 55438 N Y

CBSA 41124 N PO BOX 27267 MINNEAPOLIS MN 55427

CCN, MANAGED CARE INC 73159 N PO BOX 235 SAN DIEGO CA 92193

CDS GROUP HEALTH 88022 N PO BOX 50190 SPARKS NV

CELTIC INSURANCE CELTC N PO BOX 26440 LITTLE ROCK AR 72221

CEMENT MASONS PLASTERERS 91136 N PO BOX 34203 SEATTLE WA 98324

HEALTH
CENTRAL RESERVE LIFE 34097 N PO BOX 946 CLEVELAND OH 44101

CHAMP VA - HAC 84146 N PO BOX 65024 DENVER CO 80206

CHESTERFIELD RESOURCES 34154 N

Children's First Healthcare 94321 N

Network
CHOICE BENEFIT ADMIN 75278 N PO BOX 10048 FT SMITH AR 72917

CHRISTIAN BROTHERS SERVICES 38308 N 1205 WINDHAM PKWY ROMEOVILLE IL 60446

Christian Care - Medishare 59355 N

CIGNA 62308 N

CIGNA BEHAVIORAL HEALTH 02331 N

CIGNA MEDICARE ACCESS 86033 N PO BOX 696018 SAN ANTONIO TX 78269

CLAIM MANAGEMENT SERVICES 39141 N Y PO BOX 10888 GREEN BAY WI 54307

INC
CLAIMS CENTRAL 95340 N PO BOX 619031 ROSEVILLE CA 95661

CLEAR CHOICE COIHS 77201 N PO BOX 5729 BEND OR 97708

CNA - PHCS 71063 N PO BOX 305065 NASHVILLE TN 37230

CO FINITY PPO NETWORK 38335 N

COASTAL ADMINISTRATIVE 77052 N

SERVICES
COLONIAL HEALTHCARE 37123 N 399 Market Street Philadelphia PA 19181

Columbia Pacific CCO CPCCO N 315 SW Fifth Avenue, Portland OR 97204

Suite 900
COLUMBIA UNITED PROVIDERS 91162 N 19120 SE 34th #201 Vancouver WA 98683
CUP
COMMERCE BENEFITS GROUP 34181 N PO BOX 900 ELYRIS OH 44036

COMMONWEALTH 37237 N PO BOX 9016 ANDOVER MA 01810

ADMINISTRATIVE GROUP

Page 5 of 21 List Current As of 10/12/2021 5:00:10 AM

COMMUNITY HEALTH PLAN OF CHPWA N 720 OLIVE WAY #300 SEATTLE WA 98101
WASHINGTON
COMPLIMENTARY HEALTHCARE 93101 N
PLANS KAISER
Comprehensive Benefits 03036 N Po Box 8955 Melville NY 11747

CONNECTICARE INC 06105 N PO BOX 546 FARMINGTON CT 06034

CONNECTICUT GENERAL CONNG N P O BOX 29000 ATLANTA GA 30359

CONNECTICUT GENERAL - CONGE N PO BOX 9003 JERICHO NY 11753

MEDICAL ONLY
CONSOLIDATED GROUP/HPS 04274 N

Consolidated Health Plans 87843 N 2077 Roosevelt Avenue Springfield MA 01104

CONTINENTAL AMERICAN 35315 N PO BOX 2086 FT MILL SC 29716

INSURANCE
Continental Benefits 35245 N

CONTINENTAL GENERAL 71404 N PO BOX 24505 TUCSON AZ 85734

INSURANCE CO
Cook Group Health Plan 35149 N

COOPERATIVE BENEFIT ADMIN 52132 N PO BOX 145 LEXINGTON KY 14586

INC
COORDINATED BENEFIT PLAN 14829 N PO BOX 20594 TAMPA FL 33622

COORDINATED CARE 68069 N PO BOX 4030 FARMINGTON MO 63640

CORE MANAGEMENT 58231 N

RESOURCES
CORESOURCE LITTLE ROCK 75136 N PO BOX 8215 LITTLE ROCK AR 72221

CORESOURCE OF AZ & MN 41045 N 7830 E BROADWAY TUCSON AZ 85710

CORESOURCE OF FLORIDA COREP N Y PO BOX 5190 TAMPA FL 33675

CORESOURCE OF MD PA IL 35182 N

CORESOURCE OF NORTH 35180 N 6100 FAIRVIEW RD CHARLOTTE NC 28210

CAROLINA SUITE 1000

CORESTAR 41045 N PO BOX 1195 MINNEAPOLIS MN 55440

Corizon - Correctional Medical 43160 N

Services
CORPORATE BENEFITS SERVICE 56116 N PO BOX 12953 CHARLOTTE NC 28220

Correctional Health Partners PHPMC N

COUNTRY LIFE INSURANCE 62553 N

COVENANT ADMINISTRATORS, 58102 N PO BOX 105 ATLANTA GA 30348

INC
COVENTRY HEALTH CARE 25133 N PO BOX 8400 LONDON KY 40742

Cox Health Plan 00019 N PO BOX 5750 SPRINGFIELD MO 65801

CYPRESS BENEFIT 88056 N 5560 W GRANDE APPLETON WI 54913

ADMINISTRATORS MARKET DR

DAKOTACARE ADMIN SVC INC DAK01 N PO BOX 7406 SIOUX FALLS SD 57117

DEAN HEALTH PLAN ORDEA N Y PO BOX 56099 MADISON WI 53705

DEFINITY SERVICES 87726 N PO BOX 9525 AMHERST NY 14226

DELTA HEALTH SYSTEM DHS01 N PO BOX 311 STOCKTON CA 95201

Page 6 of 21 List Current As of 10/12/2021 5:00:10 AM

DESERET MUTUAL UH105 N Y

DESTINY HEALTH PLAN 36436 N PO BOX 4628 OAK BROOK IL 60522

DIRECTORS GUILD OF AMERICA 23706 N PO BOX 48127 LOS ANGELES CA 90048

DIVERSIFIED ADMINISTRATION 06102 N PO BOX 299 MARLBOROUGH CT 06447

CORP
DMERC REGION D 19003 N Y PO Box 6727 Fargo ND 58108

Eastern Oregon CCO EOCCO N

EBMC 31074 N 4789 RINGS RD DUBLIN OH 43017

EDS HEALTH CHOICE 22521 N PO BOX 24870 OKLAHOMA CITY OK 73124

Employee Benefit Administration 95288 N

& Management
EMPLOYEE BENEFIT CONCEPTS 38241 N
INC
EMPLOYEE BENEFIT 34145 N 1867 W MARKET AKRON OH 44313
CONSULTANT & ADMIN STREET

EMPLOYEE BENEFIT 81039 N PO BOX 21367 BILLINGS MT 59104

MANAGEMENT EBMS
EMPLOYEE BENEFIT SERVICES 37216 N

Employee Painters Trust EMPPT N Y 104 S Freya Ste 220 SPOKANE WA 99202

EMPLOYERS DIRECT HEALTH 75235 N

(FULLY)
EMPLOYERS HEALTH TRUST EMPHT N PO BOX 1188 PORTLAND OR

EMPLOYERS INS OF WAUSAU 39026 N PO BOX 801 WAUSAU WI 54402

EMPLOYERS LIFE INSURANCE 37249 N P O Box 5787 Spartanburg SC 29304

CORP.
Envolve Benefit Options 56190 N

EPREHS HEALTH 87042 N 795 NORTH 400 WEST SALT LAKE CITY UT 84103

EQUICOR EQUIC N P O Box 182015 COLUMBUS OH 43218

EQUIFAX HEALTHCARE ADMIN 75196 N

(EHAS)
Equitable Life and Casualty 87012 N
Insurance Company
EQUITABLE PLAN SERVICES 73126 N

ERIN GROUP ADMINISTRATORS 23250 N PO BOX 7777 LANCASTER PA 17604

Euro Center USA 65101 N

FAMILY CARE INC - PHD01 N PO BOX 5930 SALEM OR 97304

CCO/PHTECH
FAMILY CARE INC - MEDICAID FCD01 N 2121 SW BROADWAY PORTLAND OR 97201
STE #300
FAMILY CARE INC - MEDICARE PHR01 N

FAMILY CARE INC - MHO - FCM01 N

MENTAL HEALTH
FEDERATED MUTUAL 41041 N PO BOX 328 OWATONNA MN 55060

FIRST CHOICE (CT) 14162 N

FIRST CHOICE HEALTH CNN 91131 N POBox 3000 Scottsdale AZ 85271

Page 7 of 21 List Current As of 10/12/2021 5:00:10 AM

FIRST CHOICE HEALTH 91131 N PO BOX 12659 SEATTLE WA 98111
NETWORK
FIRST HEALTH 87043 N

FIRST HEALTH BENEFIT 25133 N

CONCEPTS
FIRST HEALTH NETWORK 75139 N PO BOX 11748 TUSCON AZ 85734

FIRST SERVICE 59276 N

ADMINISTRATOR'S LAKELAND
FL
FISERV HEALTH - 62061 N PO BOX 520 PUEBLO CO 81002
KANSAS/TENNESSEE
FISERV HEALTH - WAUSAU FISWAU N PO BOX 30541 SALT LAKE CITY UT 84123

FMH BENEFIT SERVICES INC 48117 N P O BOX 25946 OVERLAND PARK KS 66221

FORTIS BENEFITS INS COMPANY 70408 N PO BOX 624 MILWAUKEE WI 53204

FOUNDATION BENEFITS ADMIN BOONG N 6300 BRIDGEPOINT AUSTIN TX 78730

PARKWAY
FOX EVERETT INC 64069 N PO BOX 6012 RIDGELAND MS 39158

FREEDOM CARE FDMCR N

FRINGE BENEFITS 59204 N

COORDINATORS
GALLAGHER BENEFIT 37283 N PO BOX 5227 LISLE IL 60532
ADMINISTRATORS
GEHA ASA (Aetna Signature 06603 N
Administrators)
GEHA MO 44054 N PO BOX 466 INDEPENDENCE MO 64051

GENERAL AMERICAN LIFE INS 63665 N

GENAM
GHI - GROUP HEALTH INC 13551 N PO BOX 2832 NEW YORK CITY NY 10116

GHP (GROUP HEALTH PLAN) 25133 N PO BOX 3000 NEW YORK NY 10116

GIC INDEMNITY PLAN 65099 N PO BOX 406 SCHAUMBURG IL 60168

GILSBAR 07205 N PO BOX 2947 COVINGTON LA 70434

GLOBAL CARE 07689 N PO BOX 247 ALPHARETTA GA 30009

Global Excel Management GEM01 N PO BOX 9 Beebe Plain VT 05823

GOLDEN RULE INSURANCE CO 37602 N 7440 Woodland Drive Indianapolis IN 46278

GOVERNMENT EMPLOYEES 44054 N

HOSP ASSOC
GREAT WEST LIFE 80705 N 1000 GREAT WEST KENNETT MO 63857-
DRIVE 3749
GROUP - PENSION 48143 N PO BOX 830248 RICHARDSON TX 75083
ADMINISTRATORS
GROUP ADMINISTRATORS 36338 N 1880 NORTH SCHAUMBURG IL 60195
ROSELLE ROAD
Group Health Cooperative of 39167 N PO Box 44971 MADISON WI 53744
South Central WI
GROUP HEALTH COOPERATIVE 91051 N PO Box 34585 Seattle WA 98124
WEST
Group Health Inc 13551 N PO BOX 2832 NEW YORK NY 10116

GROUP HEALTH MANAGERS 38194 N

Page 8 of 21 List Current As of 10/12/2021 5:00:10 AM

GROUP HEALTH NW 91121 N PO BOX 200 SPOKANE WA 99210

GROUP INSURANCE SERVICE 37276 N PO BOX 9120 MARSHFIELD MA 02050

CTR
HARRINGTON BENEFIT SVCS 95266 N PO BOX 720 PUEBLO CO 81002

HARRINGTON HEALTH BPO 59143 N PO BOX 30537 SALT LAKE CITY UT 84130

HARVARD PILGRIM HEALTH 04271 N P O BOX 699183 QUINCY MA 02269

CARE
HAWAII MANAGEMENT 48330 N
ALLIANCE ASSOCIATION HMAA
HAWAII MEDICAL SERVICE HMSA2 N
ASSOCIATION
HCC MIS HCCMI N Y PO BOX 2005 Farmington Hills MI 48333-
2005
HCH ADMINISTRATION INC 37111 N PO BOX 1986 PERORIA IL

Health Alliance Medical Plans of 77950 N

Illinois
Health Alliance Plan of Michigan 38224 N

Health Choice Arizona 62179 N

Health Choice Generations 62180 N

HEALTH COMP 85729 N PO BOX 45018

HEALTH COST SOLUTIONS 62111 N

HEALTH DESIGNS PLUS 34158 N PO Box 5065 Findlay OH 45839

HEALTH EXCHANGE 20356 N

Health First 95019 N Po Box 565001 Rockledge FL 32956

HEALTH FIRST TPA 75234 N

HEALTH FUTURE 30946 N Y 825 E MAIN STREET MEDFORD OR 97504

#D
Health Management Assoc 86066 N PO BOX 135005 Honolulu HI 96801

HEALTH NET - AZ AZHNT N

HEALTH NET CA - OR 95567 N

Health Net Medicare 68069 N

Health Net Options Plus HNOPT N

HEALTH NET PEARL SX185 N

HEALTH NET VAPCCCP 68021 N

HEALTH NETWORK AMERICA 20199 N Y Po Box 65 West Long Branch NJ 07764

HEALTH NOW 55204 N Y PO Box 80 Buffalo NY 14240

HEALTH PARTNERS TENN 62157 N

Health Payment Systems Inc 20270 N PO BOX 510620 Milwaukee WI 53203

HEALTH PLAN PARTNERS PA 80142 N

HEALTH PLANS INC 44273 N BOX 5199 WESTBOROUGH MA 01581

HEALTH PLUS OF MICHIGAN 38216 N PO BOX 1700 FLINT MI 48501

Health Republic Insurance CHP01 N

Page 9 of 21 List Current As of 10/12/2021 5:00:10 AM

HEALTH SPRINGS MEDICARE 63092 N PO BOX 981904 EL PASO TX 79998

HEALTHCARE RESOURCES NW 56731 N

Healthcare Strategic Initiatives HSICS N

HealthComp 85729 N

HEALTHFIRST, INC 80141 N PO BOX 130217 TYLER TX 75713

HEALTHLINK HMO 96475 N PO Box 411580 St Louis MO 63141

HEALTHLINK PPO 90001 N PO BOX 419104 ST LOUIS MO 63141

HEALTHNET OF THE 06108 N

NORTHEAST
HEALTHPARTNERS 94267 N Y P.O. Box 1289 Minneapolis MN 55440

HEALTHPARTNERS SX009 N

HEALTHPLAN SERVICES - 59140 N PO BOX 30466 TAMPA FL 33630

TAMPA
HEALTHSCOPE BENEFITS INC 71063 N PO BOX 3687 LITTLE ROCK AR 72203

HealthShare Clackamas County CCMMH N

CCO/PHTECH
HealthShare Multnomah County VMMH1 N
Mental Health CCO
HealthShare Washington County WCHHS N
CCO/PHTECH
Healthsmart Benefit Solutions 87815 N P O Box 2621 Charleston WV 25329
(Wells Fargo TPA)
HEALTHSMART HSPC HSPC1 N Y PO BOX 53010 LUBBOCK TX 79453

HEALTHWAYS WHOLEHEALTH 58213 N

NETWORKS
Healthy CT 77180 N PO BOX 33728 Indianapolis IN 46203

HealthyBlue 00661 N

HERE WELFARE PENSION FUNDS 23172 N

Highmark Blue Cross Blue Shield 54771 N

PA
HILL PHYSICIANS MEDICAL HIL01 N PO BOX 8001 PARKRIDGE IL 60068
GROUP
HMA - HEALTHCARE HMA01 N PO BOX 85016 BELLEVUE WA 98015
MANAGEMENT ADM
HMA, INC 86066 N 1600 W Broadway Rd Tempe AZ 85282

HOME SERVICES NETWORK PR HOMEP N Y 1235 NE 47TH SUITE PORTLAND OR 97213

148
HOMETOWN HEALTH NETWORK 34150 N PO BOX 1217 PARK RIDGE IL 60068

HOMETOWN HEALTHPLAN 88023 N

HORIZON BCBS NJ 22099 N PO BOX 1609 NEWARK NJ 07101

HOTEL EMPLOYEES -HERE 91136 N PO BOX 34355 SEATTLE WA 98124

HRM CLAIM MANAGEMENT 41170 N PO BOX 1479 MINNEAPOLIS MN 55440

Humana Military - Tricare South 61125 N PO BOX 7032 CAMDEN SC 29020

Humana Vets (VA Heroes) 61120 N

Page 10 of 21 List Current As of 10/12/2021 5:00:10 AM

HUMANA, INC. (ALL CLAIM 61101 N
PLANS)
IBA SELF FUNDED 38234 N PO BOX 51719 49005

IBEW WESTERN UTILITES 74234 N PO Box 30261 Salt Lake City UT 84130

ILWU COASTWISE CLAIMS ILWU N Y

INDEPENDENCE BC PA 54704 N Y PO BOX 69352 HARRISBURG PA 17106

Individual Assurance Company 30360 N PO BOX 211635 Eagan MN 55121

Inetico Inc 43471 N

INNOVANTE BENEFIT 31172 N 1220 SW MORRISON PORTLAND OR 97205

ADMINISTRATORS ST 300

INSURANCE ADMINISTRATOR 37279 N PO BOX 5082 MT LAUREL NJ 08054

OF AMERICA
INSURANCE MGMT SVCS IMSMS N PO BOX 15688 AMARILLO TX 79105

INSURERS ADMINISTRATIVE IAC01 N PO BOX 828 PARK RIDGE IL 60068

CORPORATION
Integra BMS 56139 N PO BOX 1178 Matthews NC 28106

INTEGRANET HEALTH INET1 N

INTEGRATED BENEFIT SERVICES 37124 N Y PO BOX 3819 CHASWORTH CA 91313

Integrated Home Care Services IHCS1 N

IHCS
Integrity Administrators Inc 94770 N Y PO BOX 13128 SACRAMENTO CA 95813

INTERCARE HEALTH PLANS 37227 N PO BOX 355 ENGLEWOOD CO 80155

InterCommunity Health Network INTHP N PO BOX 887 CORVALLIS OR 97339

International Benefit 11329 N

Administration
INTERNATIONAL FUNDING LTD 39182 N

INTERNATIONAL MEDICAL IMGIN N PO BOX 88500 INDIANAPOLIS IN 46208

GROUP
JOHN ALDEN LIFE INS CO 41099 N P.O. BOX 1599 BOISE ID 83701

JOINT LABOR MGT RETAIL JLMRT N PO BOX 1187 PORTLAND OR

TRUST
JP FARLEY CORPORATION 34136 N PO BOX 458022 WESTLAKE OH 44145

KAISER EPO 94320 N PO BOX 30547 SALT LAKE CITY UT 84130

KAISER FOUNDATION HEALTH 91051 N

PLAN WASHINGTON
Kaiser of Colorado 91617 N CO

KAISER PERMANENTE CA 94135 N PO BOX 129 OAKLAND CA 94604

Kaiser Permanente Georgia 21313 N

KAISER PERMANENTE HI 94123 N PO BOX 12378 PORTLAND OR 97212

Kaiser Permanente Mid-Atlantic 52095 N

KAISER PERMANENTE 93079 N PO BOX 12378 PORTLAND OR 97212

NORTHWEST
KAISER PERMANENTE SO CAL 94134 N PO BOX 7004 DOWNEY CA 90242
ONLY
KANAWHA INSURANCE CO 57038 N PO BOX 1000 LANCASTER SC 29721

Page 11 of 21 List Current As of 10/12/2021 5:00:10 AM

KEMPTON COMPANY 73100 N PO BOX 6660 FOLSOM CA 95763

KEY BENEFIT ADMIN 37284 N PO BOX 1279 FORT MILL SC 29716

KEY BENEFIT ADMINISTRATORS 37217 N 8330 Allison Pointe INDIANAPOLIS IN 46250

Trail
KITSAP PHYSICIANS SERVICE KPS01 N P O BOX 339 BREMERTON WA 98310
KPS
KPIC KPIC1 N

LABOR AND INDUSTRIES WA LABOR N Y PO BOX 44269 OLYMPIA WA 98504

LES SCHWAB TIRE CENTER ORLES N Y PO BOX 5666 PORTLAND OR 97228

Lifemap RLH01 N

Lifeprint LIFE1 N LAS VEGAS NV 89114

LIFEWISE PREMERA OR WA 00430 N PO BOX 770 BEND OR 97708

LIPA/OHP - EHA - TRILLIUM LIPA N PO BOX 117 EUGENE OR 97440

LONDON CLAIMS LONDON N

LONE STAR TPA 45289 N

LONGVIEW FIBRE CO LONGV N 1220 SW MORRISON PORTLAND OR 97205

SUITE 300
LOVELACE SALUD SX159 N

LOVELACE SANDIA HEALTH 90328 N PO BOX 549 BUCKEYSTOWN MD 21717

PLANS (COMMERCIAL)
Loyal American Life (Medicare 13193 N
Supplement)
LUMENOS 54195 N PO BOX 69309 HARRISBURG PA 17106

MAGNACARE 11303 N PO BOX 1001 GARDEN CITY NY 11530

MAILHANDLERS PPO 25133 N PO BOX 8402 LONDON KY 40742

MAKSIN MANAGEMENT CORP 22195 N PO BOX 2647 CAMDEN NJ 08101

MANAGED HEALTH NETWORKS 22771 N PO BOX 14621 LEXINGTON KY 40512

MANAGED HEALTH MHN N Y 1120 NW 20TH AVE PORTLAND OR

NORTHWEST MHN STE 200

MARSH ADVANTAGE AMERICA 13310 N PO BOX 2305 SPOKANE WA 99210

Masonry Industry Trust 60230 N 9848 East Burnside Portland OR 97216

MASSACHUSETTS MUTUAL 65935 N 1867 WEST MARKET AKRON OH 44313

ST
MASTERS MATES AND PILOTS MMPHB N
PLAN
MASTERS, MATES AND PILOTS MMPHB N 5700 HAMMONDS LINTHICUM MD 21090
PLAN FERRY ROAD HEIGHTS

McLaren Health Plan 38338 N PO BOX 1511 Flint MI 48501

MDX HAWAII MDXHI N 500 Ala Moana Blvd Honolulu HI 96813

Ste 2-200
MED COST BENEFITS SERVICES 56205 N PO BOX 25987 WINSTON-SALEM NC 27114

MedCost / Liberty Health Share 90753 N PO BOX 36908 Canton OH 44735

MEDCOST INC 56162 N PO BOX 25307 WINSTON-SALEM NC 27114

MEDICA CHOICE (ALLINA) 94265 N PO BOX 659752 SAN ANTONIO TX 78265

MEDICA HEALTH CARE PLAN 78857 N

Page 12 of 21 List Current As of 10/12/2021 5:00:10 AM

MEDICAID AK AKMCD N

MEDICAID FL 77027 N Y PO BOX 7072 TALLAHASSEE FL 32314-

7072
MEDICAID HI HIMED N Y PO BOX 1220 HONOLULU HI 96807

MEDICAID MI MIMCD N Y Po Box 30043 LANSING MI 48909

MEDICAID NC MC021 N Raleigh NC 27603

MEDICAID OR DMAPP N 500 SUMMER STREET SALEM OR 97301031

NE 5
MEDICAL BENEFITS MUTUAL 74323 N

MEDICAL CLAIMS SERVICE INC 04258 N PO BOX 853925 RICHARDSON TX 75085

MEDICAL DEVELOPEMNT 52181 N

INTERNATIONAL
MEDICAL MUTUAL OF OHIO 29076 N PO BOX 6018 CLEVELAND OH 44101

Medicare AK - Noridian 00831 N PO BOX 6703 Fargo ND 58108-

6703
Medicare AZ - Noridian 00832 N PO BOX 6704 Fargo ND 58108-
6704
Medicare CA North - Noridian 01112 N

Medicare HI - Noridian 01212 N

Medicare MI - WPS 08202 N PO Box 5555 Marion IL 62959-

0967
Medicare OR - Noridian 00835 N PO BOX 6702 Fargo ND 58108-
6702
Medicare PA - Novitas 12502 N PO BOX 890418 Camp Hill PA 17089-
0418
Medicare TX - Trailblazer 04402 N Y PO BOX 660031 DALLAS TX 75266

MEDICARE VIRGINIA PARTB 11302 N

Medicare WA - Noridian 00836 N PO BOX 6700 Fargo ND 58108-

6700
Medico Insurance Company 23160 N PO BOX 21660 Eagan MN 55121-
0660
MEDSOLUTIONS INC 62160 N PO BOX 981612 EL PASO TX 79998

MEGA LIFE & HEALTH INS CO 59221 N PO Box 982017 NORTH TX 76182
RICHLAND HILLS
Memorial Hermann Health MHHNP N
Network
Merchants Benefit 86087 N
Administration
MERCY HEALTH PLANS MER11 N

MERCY HEALTHPLANS 43166 N

Meritain Health 41124 N

Meritain Health/NAA 64157 N PO BOX 9501 AMHERST NY 14226

MERITAN AGENCY SERVICES 64158 N

MICRON TECH 96598 N

MID ROGUE OREGON HEALTH MRIPA N 740 SE 7TH ST GRANTS PASS OR 97526
PLAN
MIDLANDS CHOICE 47080 N PO BOX 247017 OMAHA NE 68124

MIDWEST NATIONAL LIFE INS 59224 N TN

CO

Page 13 of 21 List Current As of 10/12/2021 5:00:10 AM

MIDWEST SECURITY MIDSC N 2700 MIDWEST DRIVE ONALASKA WI 54650
ADMINISTRATORS
MMSI 41154 N

MODA Health ORD01 N PO BOX 40384 PORTLAND OR 97240

MOLINA HEALTHCARE OF 38333 N PO BOX 22697 LONG BEACH CA 90801

CALIFORNIA
MOLINA HEALTHCARE OF 38334 N
MICHIGAN
MOLINA HEALTHCARE OF 38336 N WA 98041
WASHINGTON
MONUMENTAL LIFE INS CO MMLIC N
ACCIDENT/CANCER
MONUMENTAL LIFE INS CO MMLI3 N
LONG TERM CARE
MONUMENTAL LIFE INS CO MMLI2 N
MAJOR MED, LTC, LTC RIDER
MONUMENTAL LIFE INS CO MED MMLI4 N
SUPP
MONUMENTAL LIFE INS CO MED MMLI5 N
SUPP
MOTION PICTURE INDUSTRY MPI01 N PO BOX 1999 STUDIO CITY CA 91614

MOUNTAIN STATES 86040 N 13901 E EXPOSITION AURORA CO 80012

ADMINISTRATIVE AVE

MUTUAL ASSURANCE 37256 N PO BOX 42096 OKLAHOMA CITY OK 73123

ADMINISTRATORS
MUTUAL BENEFIT - FORTIS - now 39065 N PO BOX 624 MILWAUKEE WI 53204
Assurant
MUTUAL OF OMAHA 71412 N

MVP PLAN OF NY 14165 N PO BOX 2207 SCHENECTADY NY 12301

NAA (North America Admin., 65085 N PO BOX 1984 NASHVILLE TN 37202

L.P.)
NALC ASSOC LETTER CARRIER 53011 N 20547 WAVE ASHBURN VA 22093

NATIONAL BENEFIT ADMIN - NC 56176 N PO BOX 668329 CHARLOTTE NC 28266

NATIONAL BENEFIT ADMIN - NJ 56175 N

NATIONAL HEALTH INSURANCE 75275 N PO BOX 619999 DALLAS TX 75261

CO
NATIONAL RURAL ELECTRIC 52132 N PO BOX 6249 LINCOLN NE 68506
COOP - NRECA
NATIONAL TELE COOP ASSOC 52103 N ONE WEST PACK SQ ASHEVILLE NC 28801
NTCA STE 600

NATIONWIDE HEALTH PLANS 31417 N PO BOX 182690 COLUMBUS OH 43218

NCAS - FAIRFAX VA 75190 N PO BOX 862 FAIRFAX VA 22030

NCAS CHARLOTTE 75191 N PO BOX 221209 CHARLOTTE NC 28222

NDMSA NDMSA N

NESIKA HEALTH GROUP 37255 N NE STEPHENS ST. ROSEBURG OR 97470

STE 400
Netcare Life and Health 66055 N 424 West O'Brien Drive Hagatna GU 96910
Insurance
NEW ENGLAND FINANCIAL 80705N N

Page 14 of 21 List Current As of 10/12/2021 5:00:10 AM

New Payer ID N

New West Health Plan 84141 N 2132 Broadwater Ave, Billings MT 59102
Unit A-1
NGS AMERICAN INC 38225 N PO BOX 7676 ST CLAIR MI 48080
SHORES
NIPPON LIFE INSURANCE CO 81264 N PO BOX 39710 COLORADO CO 80949
SPRINGS
Northwest Physicians Network NPN11 N PO Box 2117 Tacoma WA 98401

NORTHWEST PRIMARY CARE NWPRI N Y PO BOX 22075 MILWAUKIE OR 97269

NOVA HEALTHCARE ADMIn 16644 N PO BOX 308 GRAND ISLAND NY 14072

OEA CHOICE OEA N PO BOX 23600 TIGARD OR 97281

Ohana Quest 14163 N PO BOX 31372 TAMPA FL 33631

OHANA Wellcare 14163 N PO BOX 31372 TAMPA FL 33631

OHP/DOCTORS OF OREGON DOCSO N

COAST
OLYMPIC HEALTH 91151 N P O Box 5348 Bellingham WA 98227
MANAGEMENT SYSTEMS
Olympus Managed Health Care 65074 N

ONE HEALTH PLAN ONEHL N

One Homecare Solutions ONEHC N

OPERATING ENGINEERS 302 612 91136 N PO BOX 28416 OAKLAND CA 94604

OPTIMUM CHOICE INC 52148 N 4 TAFT COURT ROCKVILLE MD 20850

Optimum HealthCare 20133 N PO Box 14130 Lexington KY 40512

OPTUM HEALTH 41161 N

OREGON DHS DMAP N 500 SUMMER STREET SALEM OR 97301031

NE 5
Oregon Medical Assistance OMAP N
Program
Oregons Health CO-OP 45332 N PO BOX 3948 Corpus Christi TX 78463

Oregons Health CO-OP DOS 21455 N PO Box 40048 Portland OR 97240

prior to 1/1/2015
OXFORD HEALTH PLANS 06111 N Po Box 7082 Bridgeport CT 06601-
7082
P5 ELECTRONIC HEALTH 87068 N PO Box 9554 Salt Lake City UT 84109
SERVICES
PACIFIC LIFE & ANNUITY 67466 N PO BOX 34799 PHOENIX AZ 85067

PACIFICARE 95959 N P O BOX 6090 CYPRESS CA 90630

PACIFICARE BEHAVIORAL 33053 N

HEALTH
PACIFICARE PPO ONLY 95999 N PO BOX 6090 CYPRESS CA 90630

PacificSource Community 20416 N

Solutions
PACIFICSOURCE HLTH PLNS 93029 N PO BOX 706 EUGENE OR 97401

PACIFICSOURCE MEDICARE 20377 N EUGENE OR 97401

Paper Claims With Attachment PAPERA N

PAPER MISCELLANEOUS PAYERS PAPER N Y

Page 15 of 21 List Current As of 10/12/2021 5:00:10 AM

PARAGON BENEFITS 58174 N

PARR LUMBER CO PARRL N PO BOX 1400 PORTLAND OR

Peoples Health Network 72126 N

PERSONAL CARE 25133 N

PERSONAL INSURANCE 95397 N PO BOX 6040 AGOURA HILLS CA 91376

ADMINISTRATORS
PHA INSURANCE SERVICES 95183 N Y PO BOX 620123 ORLANDO FL 32862

PHCS TUFTS 04298 N

PHILADELPHIA AMERICAN LIFE 98798 N

INSURANCE COMPANY
PHILLIPS ADMIN SERVICES PHYAS N Y PO BOX 219 ALBANY OR 97321

PHYSICIANS HEALTH CHOICE PHCS1 N

CLAIMS
PHYSICIANS HEALTHCARE PLAN 65031 N

PHYSICIANS MUTUAL 47027 N

PIONEER LIFE 35196 N Y PO BOX 5151 JANESVILLE WI 53547

PITTMAN - ASSOCIATES 37224 N PO BOX 111047 MEMPHIS OR 38111

PLANNED ADMINISTRATORS 37287 N PO BOX 6702 COLUMBIA SC 29260

INC PAI
PLUMBER STEAMFITTERS LOCAL LOC290 N 1305 SW 12TH PORTLAND OR 97201
290
PORTLAND PUBLIC SCHOOLS PDXPU N PO BOX 100 PORTLAND OR

PREFERRED CARE INC 23212 N PO BOX 1235 FREDRICK MD 21702

PREFERRED HEALTH PLAN 61106 N

Preferred Healthcare System 04320 N

Preferred One Administrative 41147 N

Service
PRESBYTERIAN HEALTH PLAN PREHP N PO Box 26267 Albuquerque NM 87125

Primary Health 97304 N Y PO BOX 5490 Salem OR 97304

PRIMARY PHYSICIAN CARE INC 56144 N PO BOX 11088 CHARLOTTE NC 28220

PrimeCare Medical Network - IP079 N

NAMM
PRINCIPAL MUTUAL LIFE 61271 N PO BOX 39710 COLORADO CO 80943
INSURANCE CO SPRINGS

Priority Health Insurance 38217 N

Company
PRISM UNIVERA 37315 N PO BOX 23000 ROCHESTER NY 14692

PRO AMERICA PROAM N Y PO BOX 9219 OAK BROOK IL 60523

PROFESSIONAL BENEFIT 36331 N PO BOX 4687 OAK BROOK IL 60522

ADMINISTRATORS
Prominence Health Plan 93082 N

PROVIDENCE ELDERPLACE ELDER N Y 13007 NE GLISAN PORTLAND OR

PROVIDENCE HEALTH PLAN PHP01 N PO BOX 3125 PORTLAND OR 97208

PROVIDENCE MEDICAID 77350 N

Page 16 of 21 List Current As of 10/12/2021 5:00:10 AM

PROVIDENCE PREFERRED PPOOR N PO BOX 3236 PORTLAND OR

PROVIDENT AMERICAN 71404 N

Provident Life & Accident 62308 N

PRUDENTIAL HEALTHCARE 68241 N PO BOX 13999 PHILADELPHIA PA 19187

PUBLIC EMPLOYEES HEALTH 87068P N 560 E. 200 SOUTH Salt Lake City UT 84102
PROGRAM
QUADMEDBEECHSTREET 39197 N

QVI RISK 57117 N

RAILROAD MEDICARE 00882 N PO BOX 10066 AUGUSTA GA 30999

RBMS LLC 91176 N

Regence BlueShield of ID 00611 N

Regence BlueShield of WA 00932 N

REGENCE GROUP RGA01 N AK

ADMINISTRATORS
Regence OR BCBS 00851 N Salt Lake City UT

REGIONAL CARE INC 47076 N 905 WEST 27TH ST SCOTTSBLUFF NE 69361

REYNOLDS AND REYNOLDS 37270 N PO BOX 2608 DAYTON OH 45401

RIGHT CHOICE BENEFIT 37331 N

ADMINISTRATORS
Rocky Mountain Health Plan SX141 N PO BOX 10600 Grand Junction CO 81502
Grand Junction
Samaritan Advantage SAMAD N PO BOX 1510 CORVALLIS OR 97339

Samaritan Choice Plan SAMCH N PO BOX 336 CORVALLIS OR 97339

Samaritan Employer Group SAM00 N

Samaritan Health Services SAMHS N PO BOX 1310 CORVALLIS OR 97339

Samaritan Healthy KidsConnect SAMHK N PO BOX 1310 CORVALLIS OR 97339

Samaritan Select SAMSE N PO BOX 1310 CORVALLIS OR 97339

SAMBA 37259 N 11301 OLD ROCKVILLE MD 20852

GEORGETOWN RD
SANFORD HEALTH PLAN 91184 N PO BOX 91110 SIOUX FALLS SD 57109

ScanOne - Samaritan Paper ICN01 N

Claims
SEABURY SMITH 13310 N PO BOX 1520 IOWA CITY IA 52244

SECURE HORIZONS 95959S N EXCEPT CYPRESS CA 90630

SECUREHORIZONS
DIRECT
SECURE HORIZONS DIRECT 87726S N PO BOX 31353 SALT LAKE CITY UT 84131

SECURITY HEALTH PLAN 39045 N PO BOX 8000 MARSHFIELD WI 54449

SELECT BENEFIT ADMIN - 37282 N PO BOX 440 ASHLAND WI 54806

ASHLAND WI
SELECT BENEFIT ADMIN - SBA01 N PO BOX 230519 PORTLAND OR 97281
OREGON
SELECT CARE 00014 N PO Box 830489 Birmingham AL 35283

SELECT HEALTH UH107 N PO BOX 30192 SALT LAKE CITY UT 84130

Page 17 of 21 List Current As of 10/12/2021 5:00:10 AM

SELECTCARE 00014 N

Sentinel Plan 23249 N Po Box 16960 CLEARWATER FL 33766

SENTRY INSURANCE 39033 N PO BOX 8025 STEVENS POINT WI 54481

SHASTA ADMIN SVC 75280 N PO BOX 174 BEND OR 97756

Sheet Metal Wokers CIGNA 38238 N PO Box 1138 San Ramon CA 94583

SIERRA HEALTH SERVICES 76342 N

Siletz Contract Health SCHOR N Y PO BOX 320 Siletz OR 97380

Simply Health Plans 00199 N

SMITH ADMINSTRATORS 02057 N PO BOX 161125 FORT WORTH TX 76161

SOUNDPATH HEALTH 42172 N

Spectera Unitedhealthcare Vision 00773 N

Standard Life & Accident - 01758 N Po Box 16708 Jackson MS 39236

Secondary Claims ONLY
STAR BRIDGE HRG 59225 N PO BOX 55270 PHEONIX AZ 85078

STATE EMPLOYEES GROUP 72087 N PO BOX 44035 BATON ROUGE LA 70804

BENEFITS - LOUISIANA
STATE FARM 31053 N PO BOX 297 CLINTON IA 52733

State of Texas Dental Plan 57254 N

Sterling Option 1 91151 N Y PO BOX 69314 HARRISBURG PA 17106

STRATEGIC RESOURCE 60054SRC N PO BOX 23759 COLUMBIA SC 29224

COMPANY
STUDENT RESOURCES 74227 N PO BOX 809025 DALLAS TX 75380

SUMMACARE 95202 N

Summerlin Life & Health 86071 N 1440 Kapiolani Blvd Honolulu HI 96814
Suite 1020
SUMMIT AMERICA INSURANCE 37301 N 5001 College Blvd Leawood KS 66211
SERVICES Ste216

SUPERIOR ADMINISTRATIORS 23218 N PO BOX 27730 SANTA ANA CA 92799

INC
Sutter East Bay Medical IP130 N CA
Foundation
Tall Trees/Managed Care Admin 88067 N PO BOX 71747 SALT LAKE CITY UT 84171

TEAMSTERS LOCAL UNION 301 36612 N Y PO BOX 3470 PORTLAND OR 97208

TEST PAYER ID TEST N

THE CHESTERFIELD COMPANIES CRI01 N PO BOX 1884 AKRON OH 44309

THE EPOCH GROUP 28777 N PO BOX 12170 OVERLAND PARK KS 66282

THE GUARDIAN 64246 N PO BOX 8007 APPLETON WI 54912

The Loomis Company 23223 N NON PPO Wyomissing PA 19610

CONTRACTS ONLY
TIMBER PRODUCTS MFG TIMBR N Y PO Box 4867 Missoula MT 59806

TIME INS CO FORTIS INSURANCE 39065 N 501 W MICH MILWAUKEE WI 53201

CO
TODAYS OPTIONS - PYRAMID 48055 N

TONGASS TIMBER TRUST 92620 N

Page 18 of 21 List Current As of 10/12/2021 5:00:10 AM

Total Health Care 38201 N Po Box 21486 SAINT PAUL MN 55121

TOWER LIFE INSURANCE CO 69493 N SAN ANTONIO TX 78205

TRANSWESTERN INSURANCE TRAN1 N Po Box 45019 FRESNO CA 93718

ADMINISTRATORS
TRICARE FOR LIFE TRILF N

TRICARE North - Palmetto - 57106 N PO Box 870140 Surfside Beach SC 29587

Healthport
Tricare West DOS after 04012013 99726 N

Tricare West WPS WESTR N PO BOX 8929 MADISON WI 53708

TRILLIUM COMMUNITY TRILL N PO BOX 117 EUGENE OR 97440

HEALTHPLAN DOS prior to
6/1/16
TRILLIUM COMMUNITY TRILC N PO BOX 117 Eugene OR 97440
HEALTHPLAN MEDICAID
TRILLIUM MEDICARE TRILM N

TRINITY HEALTHSHARE TRIN1 N PO BOX 28195 Atlanta GA 30358

TRISURANT 34185 N

TriWest Healthcare Alliance TWCCN N

TRUE CHOICE TTCEC N PO BOX 700307 DALLAS TX 75370

TRUSTEED PLANS SERVICE 91078 N TACOMA WA 98401

CORPORATION
TRUSTMARK 61425 N PO BOX 2942 CLINTON IA 52733

TUALITY HEALTH ALLIANCE THA01 N PO BOX 925 HILLSBORO OR 97123

TUALITY HEALTH SELECT THASC N TUALITY HEALTH TUALATIN OR

ALLIANCE
UFCW UFCW1 N P O Box 9000 Walnut Creek CA 94598

UHC Compass Rose 50946 N PO BOX 6430 ANNAPOLIS MD 21401

UHN UHN01 N PO BOX 33470 PORTLAND OR 97292

Umpqua Health Alliance 77503 N PO BOX 1047 Roseburg OR 97470

UMR MIDWEST SECURITY 79480 N

UMR/WAUSAU 39026 N PO BOX 8013 WAUSAU WI 54402

UMWA HEALTH & RETIREMENT 52180 N PO BOX 619099 DALLAS TX 75261

FUNDS
UNICARE 80314 N PO BOX 4058 SCHAUMBURG IL 60168

UNIFIED GROUP SERVICES 35198 N PO BOX 10 PENDLETON IN 46064

UNIFIED HEALTH SERVICES 62170 N

UNIFORM MEDICAL 75243 N PO BOX 34850 SEATTLE WA 98124

PLAN/CENTRA
UNION LABOR LIFE INSURANCE 13142 N KING OF PRUSSIA PA KING OF PA 19406
PRUSSIA
Unite Health Share Ministries 83173 N
UHSM
UNITED BEHAVIORAL HEALTH 87726B N PO BOX 30755 SALT LAKE CITY UT 84130

UNITED HEALTHCARE 87726 N

United Medical Alliance (UMA) 84132 N

Page 19 of 21 List Current As of 10/12/2021 5:00:10 AM

UNITED MEDICAL RESOURCES 39026 N P O BOX 145804 CINCINNATI OH 45250

UNITED RESOURCES NETWORK 41194 N P.O. BOX 4912

UnitedHealthcare of the River 95378 N PO BOX 5230 KINGSTON NY 12402

Valley
UNIVERSAL HEALTH CARE INC 50528 N

University Health Alliance UHA 99026 N 700 Bishop Street Suite Honolulu HI 96813
300
University of Utah Health Plans SX155 N

UPMC HEALTH PLAN 23281 N PO BOX 2999 PITTSBURGH PA 15230

Upper Peninsula Health Plan 38337 N PO BOX 190 Marquette MI 49855

UPREHS UNION PAC RAILROAD 87042 N 795 N 400 W SALT LAKE CITY UT 84103

US BENEFITS 93092 N 1919 NE PACIFIC PORTLAND OR 97232

SUITE 100
US HEALTH AND LIFE 38259 N

USAA UNITED STATES AUTO 74095 N P.O. BOX 659466 SAN ANTONIO TX 78265

USI ADMINISTRATORS 23217 N PO BOX 37 MINNEAPOLIS MN 55440

UTMB UTMBC N 301 UNIVERSITY GALVESTON TX 77555

BLVD
VA FEE BASIS PROGRAM 12115 N 3400 Lebanon Pike Murfreesboro TN 37129

VA Patient-Centered Community VAP5A N

Care
VALLEY BAPTIST HEALTH PLANS 94999 N 12940 N HWY 183 AUSTIN TX 78750

VALLEY HEALTH PLAN VHP01 N PO BOX 26160 SAN JOSE CA 95159

COMMERCIAL
VALUE OPTIONS SX173 N Y PO BOX 1290 LATHAM NY 12110

VHP Community Care 23173 N

VSP VISION SERVICE PLANS VSP01 N Attm: Claims Services Birmingham AL 35238-
5020
WA MEDICAID DSHS WAMCD N

WALMART 75257 N Y 922 W WALN ROGERS AR 72756

WASHINGTON EMPLOYERS 37294 N PO BOX 850898 RICHARDSON TX 75085

TRUST
WATERSTONE BENEFIT ADMIN 73155 N 4013 NW OKLAHOMA CITY OK 73116
EXPRESSWAY SUITE
575
WATKINS ASSOCIATED 58082 N P O Box 1738 ALANTA GA 30301
INDUSTRIES
WC BEELER & COMPANY 62111 N

WEA TRUST 39151 N PO BOX 8220 MADISON WI 53708-

8220
WEB TPA 75261 N P O Box 539508 Grand Prairie TX 75053

WELLCARE PPFS 77072 N PO BOX 795184 SAN ANTONIO TX 78279

WESTERN GROCERS 93128 N

WESTERN GROWERS INS 24735 N

WESTERN MUTUAL INSURANCE 37247 N PO BOX 572450 MURRAY UT 84157

Western Oregon Advanced DOCSO N

Health / DOCS Health Plan

Page 20 of 21 List Current As of 10/12/2021 5:00:10 AM

Willamette Valley Community WVCHP N
Hlth
WILLIAM C EARHART WIEAR N PO BOX 4148 PORTLAND OR 97208

WindsorSterling 67829 N PO BOX 269003 PLANO TX 75026

WINhealth Partners / Wyoming 27327 N

Health Solutions
WORLD INSURANCE COMPANY 75276 N PO BOX 3160 OMAHA NE 68103

WPS WISCONSIN PHYSICIAN SX022 N PO BOX 8190 MADISON WI 53708

SERVICES
WRITERS GUILD INDUSTRY 23710 N 1015 N HOLLYWOOD BURBANK CA 91505
HEALTH WAY

YALE NEW HAVEN HEALTH 06121 N Y 17 Hillhouse Ave New Haven CT 06520

Yamhill CCO 77946 N

Yamhill CCO Medical 93975 N

Yamhill CCO Mental Hlth & 50064 N

Substance Abuse-PHTech
Yamhill CCO Physical Health DOS 77940 N
after 01012019
YOUNG LIFE BENEFIT PLAN 75285 N PO BOX 520 COLORADO CO 80901
SPRINGS
ZENITH ADMINISTRATORS ZENITH N Y PO BOX 91014 SEATTLE WA 98111

ZOOMCARE ZOOM1 N

Page 21 of 21 List Current As of 10/12/2021 5:00:10 AM