Professional Claim Payor Connections - State Plans March 20, 2008 EMC PAPER P/P ST PAYOR INTERMEDIARY AG TEST CPID CPID SURCHG --- -- ----------------------------------- -------------------- -- ---- ------ ------ ------ HEALTHSPRING ILLINOIS Y N 2795 1350 N/A HEALTHSPRING INC. Y N 2795 1350 N/A HEALTHSPRING OF ALABAMA Y N 2795 1350 N/A HEALTHSPRING TENNESSEE Y N 2795 1350 N/A HEALTHSPRING TEXAS Y N 2795 1350 N/A STATE MERIT THE NETWORK GROUP N N 1407 4303 N/A AK ALASKA MEDICAID FIRST HEALTH SERVICE Y N 4489 4302 N/A AK ALASKA MEDICARE NORIDIAN ADMIN. SERV Y N 1455 4301 N/A AK BLUE CROSS WA/AK PREMERA BLUE CROSS PREMERA BLUE CROSS Y N 7445 4303 N/A AL ALABAMA BLUE SHIELD ALABAMA BCBS Y N 2423 4303 N/A AL ALABAMA MEDICAID N N 4479 4302 N/A AL ALABAMA MEDICARE CAHABA GBA Y N 2468 4301 N/A AR ARKANSAS BLUE SHIELD ARKANSAS BC BS Y N 2416 4303 N/A AR ARKANSAS MEDICAID Y N 1489 4302 N/A AR ARKANSAS MEDICARE ARKANSAS BC BS Y N 2455 4301 N/A AZ ARIZONA BLUE SHIELD ALL PAYOR NETWORK (A N N 4426 4303 N/A AZ ARIZONA MEDICAID AHCCCS N N 4405 4302 N/A AZ ARIZONA MEDICARE NORIDIAN ADMIN. SERV Y N 1456 4301 N/A CA CALIFORNIA BLUE CROSS WELLPOINT N N 4417 4303 N/A CA CALIFORNIA BLUE CROSS - FEP only N N 1409 4303 N/A CA CALIFORNIA BLUE SHIELD N N 1409 4303 N/A CA CALIFORNIA BLUE SHIELD - HMO N N 4463 4303 N/A CA CALIFORNIA MEDI-CAL EDS - ELECTRONIC DAT Y N 1473 4302 N/A CA NORTHERN CALIFORNIA MEDICARE NATIONAL HERITAGE IN Y N 1436 4301 N/A CA SANTA BARBARA REGIONAL HEALTH AUTHO Y N 3447 4302 N/A CA SOUTHERN CALIFORNIA MEDICARE NATIONAL HERITAGE IN Y N 1444 4301 N/A CO COLORADO BLUE SHIELD ROCKY MTN HEALTH CAR Y N 1415 4303 N/A CO COLORADO MEDICAID ACS Y N 1496 1391CO N/A CO COLORADO MEDICARE NORIDIAN ADMIN. SERV Y N 1449 4301 N/A CT CONNECTICUT BLUE SHIELD ANTHEM EAST N N 1420 4303 N/A CT CONNECTICUT BLUECARE FAM PLAN (MEDI ANTHEM EAST N N 2427 4302 N/A CT CONNECTICUT FEDERAL EMP HLTH BENEFI N N 3419 4303 N/A CT CONNECTICUT MEDICAID EDS - ELECTRONIC DAT Y N 4476 4302 N/A CT CONNECTICUT MEDICARE FIRST COAST SERV OPT Y N 1452 4301 N/A CT CONNECTICUT MEDICARE BLUE(MEDICARE N N 3420 4303 N/A DC BLUE SHIELD OF NATIONAL CAPITOL ARE N N 2425 2304DC N/A DC DISTRICT OF COLUMBIA MEDICAID Y N 4425 4302 N/A DC WASHINGTON DC MEDICARE TRAILBLAZER HLTHENT- Y N 2459 4301 N/A DE DELAWARE BLUE SHIELD (CAREFIRST) Y N 7456 4303 N/A DE DELAWARE MEDICAID EDS - ELECTRONIC DAT Y N 2726 4302 N/A DE DELAWARE MEDICARE TRAILBLAZER HLTHENT- Y N 2456 4301 N/A FL FLORIDA BLUE SHIELD N N 1414 4303 N/A FL FLORIDA MEDICAID ACS Y N 1478 4302 N/A FL FLORIDA MEDICARE FIRST COAST SERV OPT Y N 1448 4301 N/A FL FLORIDA WORKERS' COMPENSATION N N 2316 2316FL N/A FL JACKSON MEMORIAL HEALTH PLAN - MEDI N N 2784 1387 N/A GA GEORGIA BANKERS THE NETWORK GROUP N N 1407 4303 N/A GA GEORGIA BLUE CHOICE THE NETWORK GROUP N N 1407 4303 N/A GA GEORGIA BLUE SHIELD THE NETWORK GROUP N N 1407 4303 N/A GA GEORGIA MEDICAID ACS Y N 1494 4302 N/A GA GEORGIA MEDICAID ANESTHESIA ACS Y N 1499 4302 N/A GA GEORGIA MEDICARE CAHABA GBA Y N 1466 4301 N/A HI HAWAII HMSA HMSA Y N 2714 4303 N/A HI HAWAII MEDICAID ACS Y N 2715 4302 N/A HI HAWAII MEDICARE NORIDIAN ADMIN. SERV Y N 2467 4301 N/A IA IOWA BLUE SHIELD WELLMARK EDS/EC SOL Y N 1404 4303 N/A IA IOWA MEDICAID NORIDIAN ADMIN. SERV Y N 1469 4302 N/A IA IOWA MEDICARE WPS Y N 1438 4301 N/A ID IDAHO BLUE CROSS BOISE Y N 7430 4303 N/A ID IDAHO BLUE SHIELD REGENCE N N 7426 4303 N/A ID IDAHO MEDICAID EDS - ELECTRONIC DAT Y N 7427 4302 N/A ID IDAHO MEDICARE CIGNA GOVERNMENT SER Y N 2465 4301 N/A IL ILLINOIS BLUE SHIELD N N 1405 4303 N/A IL ILLINOIS MEDICAID N N 2488 1369IL N/A IL ILLINOIS MEDICARE WPS Y N 1437 4301 N/A IN INDIANA BLUE SHIELD ANTHEM MIDWEST N N 1412 4303 N/A IN INDIANA MEDICAID EDS - ELECTRONIC DAT N N 1474 4302IN N/A IN INDIANA MEDICARE ADMINASTAR FEDERAL, Y N 1445 4301 N/A Y IN MANAGED HEALTH SERVICES - INDIANA CENTENE CORPORATION Y N 2703 4302 N/A KS KANSAS BLUE SHIELD - TOPEKA BC BS OF KANSAS Y N 2422 4303 N/A KS KANSAS MEDICAID EDS - ELECTRONIC DAT N N 1485 4302 N/A KS KANSAS MEDICARE WPS Y N 2463 4301 N/A KY ANTHEM BLUE ACCESS PRODUCTS ANTHEM MIDWEST N N 2421 4303 N/A KY ANTHEM BLUE PREFERRED ANTHEM MIDWEST N N 2421 4303 N/A KY ANTHEM BLUE PREFERRED PLUS ANTHEM MIDWEST N N 2421 4303 N/A KY FEP ANTHEM MIDWEST N N 2421 4303 N/A KY KENTUCKY BLUE SHIELD ANTHEM MIDWEST N N 2421 4303 N/A KY KENTUCKY MEDICAID EDS - ELECTRONIC DAT Y N 1493 4302KY N/A KY KENTUCKY MEDICARE ADMINASTAR FEDERAL, Y N 2462 4301 N/A LA LOUISIANA BLUE SHIELD Y N 2758 4303 N/A LA LOUISIANA MEDICAID UNISYS Y N 1475 4302 N/A LA LOUISIANA MEDICAID - AMBULANCE UNISYS Y N 2236 4302 N/A LA LOUISIANA MEDICARE ARKANSAS BC BS Y N 1460 4301 N/A MA MASSACHUSETTS BLUE SHIELD Y N 2424 1301MA N/A MA MASSACHUSETTS MEDICAID (FORMAT 5) EDS - ELECTRONIC DAT Y N 4492 4302 N/A MA MASSACHUSETTS MEDICAID (FORMAT 9) EDS - ELECTRONIC DAT Y N 4491 4302 N/A MA MASSACHUSETTS MEDICARE NATIONAL HERITAGE IN Y N 2469 4301 N/A MD MARYLAND BLUE SHIELD - CAREFIRST N N 2419 1301MD N/A MD MARYLAND MEDICAID Y N 1488 4302 N/A MD MARYLAND MEDICARE TRAILBLAZER HLTHENT- Y N 7402 4301 N/A MD MARYLAND MEDICARE (MONTG, PRINCE GE TRAILBLAZER HLTHENT- Y N 2464 3401 N/A ME MAINE BLUE SHIELD ANTHEM EAST N N 7446 4303 N/A ME MAINE MEDICAID MAINE DEPT OF HUMAN Y N 7414 4302 N/A ME MAINE MEDICARE NATIONAL HERITAGE IN Y N 2472 4301 N/A MI BLUE CARE NETWORK HMO BC BS OF MICHIGAN Y N 2426 4303 N/A MI MICHIGAN BLUE SHIELD BC BS OF MICHIGAN Y N 1421 4303 N/A MI MICHIGAN HLTH BENEFITS CLAIM REVIEW N N 1306 1306MI N/A MI MICHIGAN MEDICAID Y N 2480 4302MI N/A MI MICHIGAN MEDICARE WPS Y N 1461 4301 N/A MI MICHIGAN WORKERS' COMPENSATION N N 2319 2319MI N/A MN BEHAVIORAL HEALTH SERV. INC. (BHSI) Y N 1402 4303 N/A MN MINNESOTA BLUE CROSS AND BLUE SHIEL Y N 1402 4303 N/A MN MINNESOTA BLUE CROSS/BLUE SHIELD HM Y N 1429 4303 N/A MN MINNESOTA BLUE PLUS Y N 1429 4303 N/A MN MINNESOTA CC SYSTEMS Y N 1410 4303 N/A MN MINNESOTA MEDICAID Y N 1468 1368MN N/A MN MINNESOTA MEDICARE WPS Y N 1435 4301 N/A MN UCARE OF MINNESOTA N N 4496 4302 N/A MO KANSAS CITY BLUE SHIELD - KANSAS CI BC BS OF KANSAS Y N 4419 4303 N/A MO MISSOURI BLUE SHIELD - ST LOUIS MO ANTHEM MIDWEST N N 1408 4303 N/A MO MISSOURI MEDICAID INFOCROSSING HLTHCRE Y N 1471 4302 N/A MO MISSOURI MEDICARE - ST. LOUIS ARKANSAS BC BS Y N 1441 4301 N/A MO MISSOURI NORTHWEST MEDICARE - KANSA WPS Y N 4451 4301 N/A MS MISSISSIPPI BLUE SHIELD TRISPAN Y N 2415 4303 N/A MS MISSISSIPPI MEDICAID ACS Y N 1490 4302 N/A MS MISSISSIPPI MEDICARE CAHABA GBA Y N 2451 4301 N/A MT MONTANA BLUE SHIELD Y N 7450 4303 N/A MT MONTANA MEDICAID ACS Y N 4427 4302MT N/A MT MONTANA MEDICARE NORIDIAN ADMIN. SERV Y N 7400 4301 N/A NC NORTH CAROLINA BLUE SHIELD Y N 1411 4303 N/A NC NORTH CAROLINA MEDICAID EDS - ELECTRONIC DAT Y N 1480 4302 N/A NC NORTH CAROLINA MEDICARE CIGNA GOVERNMENT SER Y N 1464 4301 N/A ND NORTH DAKOTA BLUE SHIELD NORIDIAN ADMIN. SERV Y N 2411 4303 N/A ND NORTH DAKOTA MEDICAID N N 1487 4302 N/A ND NORTH DAKOTA MEDICARE NORIDIAN ADMIN. SERV Y N 2453 4301 N/A NE NEBRASKA BLUE SHIELD Y N 1417 4303 N/A NE NEBRASKA MEDICAID Y N 1476 4302 N/A NE NEBRASKA MEDICARE WPS Y N 1451 4301 N/A NH NEW HAMPSHIRE BLUE SHIELD ANTHEM EAST N N 7422 4303 N/A NH NEW HAMPSHIRE MEDICAID EDS - ELECTRONIC DAT Y N 7423 4302 N/A NH NEW HAMPSHIRE MEDICARE NATIONAL HERITAGE IN Y N 2470 4301 N/A NJ HORIZON BLUE SHIELD OF NEW JERSEY Y N 2414 4303 N/A NJ HORIZON BLUE SHIELD OF NJ FEP Y N 2414 4303 N/A NJ HORIZON BLUE SHIELD OF NJ OUT OF AR Y N 2414 4303 N/A NJ NEW JERSEY BLUE CHOICE Y N 2414 4303 N/A NJ NEW JERSEY BLUE SELECT Y N 2414 4303 N/A NJ NEW JERSEY MEDICAID UNISYS Y N 1483 4302 N/A NJ NEW JERSEY MEDICARE HIGHMARK MEDICARE SE Y N 1465 4301 N/A NM NEW MEXICO BLUE SHIELD N N 7403 4303 N/A NM NEW MEXICO MEDICAID ACS N N 1492 4302 N/A NM NEW MEXICO MEDICARE TRAILBLAZER HLTHENT- Y N 1457 4301 N/A NV NEVADA BLUE SHIELD ANTHEM WEST Y N 7496 4303 N/A NV NEVADA MEDICAID FIRST HEALTH SERVICE Y N 7495 4302 N/A NV NEVADA MEDICARE NORIDIAN ADMIN. SERV Y N 1446 4301 N/A NY BLUE SHIELD OF WESTERN NEW YORK Y N 4409 4303 N/A NY HEALTHNOW NEW YORK BLUE SHIELD Y N 7485 4303 N/A NY HMO BLUE EXCELLUS Y N 7432 4303 N/A NY NEW YORK BLUE SHIELD CENTRAL REGIO EXCELLUS Y N 3449 4303 N/A NY NEW YORK BLUE SHIELD OF ROCHESTER EXCELLUS Y N 4408 4303 N/A NY NEW YORK BLUE SHIELD UTICA REGION EXCELLUS Y N 7432 4303 N/A NY NEW YORK BLUE SHIELD of NORTHEASTER Y N 7433 4303 N/A NY NEW YORK COMMUNITY BLUE HMO Y N 4409 4303 N/A NY NEW YORK EMPIRE BLUE SHIELD NEW YORK EMPIRE BC B Y N 4437 4303 N/A NY NEW YORK EMPIRE BLUE SHIELD - HEALT NEW YORK EMPIRE BC B Y N 4459 4303 N/A NY NEW YORK EMPIRE MEDICARE NATIONAL GOVERNMENT Y N 4442 4301 N/A NY NEW YORK MEDICAID - PHASE II COMPUTER SCIENCES CO Y N 1422 0000 N/A NY NEW YORK MEDICARE (UPSTATE) HEALTHNOW UPSTATE ME Y N 1463 4301 N/A NY NEW YORK MEDICARE GHI Y N 7401 4301 N/A NY UNIVERA UNINW EXCELLUS Y N 2773 4303 N/A NY UNIVERA WNY EXCELLUS Y N 2779 4303 N/A Y OH BUCKEYE COMMUNITY HEALTH - OHIO CENTENE CORPORATION Y N 4717 4302 N/A OH OHIO BLUE SHIELD ANTHEM MIDWEST N N 2418 4303 N/A OH OHIO MEDICAID N N 2481 4302 N/A OH OHIO MEDICARE PALMETTO GOV BENEFIT Y N 1447 4301 N/A OH OHIO WORKERS' COMP MCO'S N N 2704 1360 N/A OK OKLAHOMA BLUE SHIELD N N 1403 4303 N/A OK OKLAHOMA MEDICAID EDS - ELECTRONIC DAT N N 2753 4302 N/A OK OKLAHOMA MEDICARE TRAILBLAZER HLTHENT- Y N 1458 4301 N/A OR OREGON BLUE SHIELD N N 2404 4303 N/A OR OREGON MEDICAID Y N 1481 4302 N/A OR OREGON MEDICARE NORIDIAN ADMIN. SERV Y N 1459 4301 N/A PA CLARITY VISION HIGHMARK, INC. Y N 2718 4303 N/A PA HEALTH KEEPERS, INC. HIGHMARK, INC. Y N 2413 4303 N/A PA INDEPENDENCE BLUE CROSS PERSONAL CH INDEPENDENCE BLUE CR N N 2781 4303 N/A PA PENINSULA HEALTH CARE HIGHMARK, INC. Y N 2413 4303 N/A PA PENNSYLVANIA BLUE CHOICE HIGHMARK, INC. Y N 2413 4303 N/A PA PENNSYLVANIA BLUE SHIELD HIGHMARK, INC. Y N 2413 4303 N/A PA PENNSYLVANIA MEDICAID EDS - ELECTRONIC DAT N N 1491 4302 N/A PA PENNSYLVANIA MEDICARE HIGHMARK MEDICARE SE Y N 2457 4301 N/A PA PENNSYLVANIA PERSONAL CHOICE HIGHMARK, INC. Y N 2413 4303 N/A PA PRIORITY HEALTH CARE HIGHMARK, INC. Y N 2413 4303 N/A PA SENIOR BLUE OF PENNSYLVANIA CAPITAL BLUE CROSS Y Y/15 2713 4303 N/A PR PUERTO RICO MEDICARE Y N 2785 4301 N/A RI BLUE CHIP Y N 7420 4303 N/A RI RHODE ISLAND BLUE SHIELD Y N 7420 4303 N/A RI RHODE ISLAND MEDICAID Y N 7421 4302 N/A RI RHODE ISLAND MEDICARE ARKANSAS BC BS Y N 7419 4301 N/A RI RHODE ISLAND WORKERS COMPENSATION Y N 7420 4303 N/A SC CAROLINA BENEFIT ADMINISTRATORS N N 2410 4303 N/A SC CONSOLIDATED BENEFITS INC. N N 2410 4303 N/A SC EMPLOYEE BENEFIT SERVICES N N 2410 4303 N/A SC EMPLOYERS LIFE INSURANCE N N 2410 4303 N/A SC MEDICAL CLAIMS MANAGEMENT CORPORATI N N 2410 4303 N/A SC PLANNED ADMINISTRATORS, INC. N N 2410 4303 N/A SC PREFERRED BLUE N N 2410 4303 N/A SC SOUTH CAROLINA BCBS PREFERRED HLTH N N 2410 4303 N/A SC SOUTH CAROLINA BCBS STATE EMPLOYEES N N 2410 4303 N/A SC SOUTH CAROLINA BLUE SHIELD N N 2410 4303 N/A SC SOUTH CAROLINA MEDICAID Y N 1484 4302 N/A SC SOUTH CAROLINA MEDICARE PALMETTO GOV BENEFIT Y N 2452 4301 N/A SC THOMAS COOPER AGENCY N N 2410 4303 N/A SD SOUTH DAKOTA BLUE SHIELD WELLMARK EDS/EC SOL Y N 2490 4302 N/A SD SOUTH DAKOTA MEDICAID Y N 4478 4302 N/A SD SOUTH DAKOTA MEDICARE NORIDIAN ADMIN. SERV Y N 2454 4301 N/A TN STONES RIVER IPA forTN BLUE CROSS B N N 2273 4300 N/A TN TENNESSEE BLUE SHIELD Y N 2401 4303 N/A TN TENNESSEE BLUECARE TENNESSEE BC BS Y N 2495 4302 N/A TN TENNESSEE MEDICARE CIGNA GOVERNMENT SER Y N 1453 4301 N/A Y TX SUPERIOR HEALTH PLAN - TEXAS CENTENE CORPORATION Y N 2701 4300 N/A TX TEXAS BLUE SHIELD N N 1406 4303 N/A TX TEXAS MEDICAID ACS Y N 1470 4302 N/A TX TEXAS MEDICARE TRAILBLAZER HLTHENT- Y N 1440 4301 N/A TX TEXAS WORKERS' COMPENSATION N N 1360 1360TX N/A UT UTAH BLUE SHIELD UHIN Y N 2412 4303 C.12 UT UTAH BLUE SHIELD - FEP UHIN Y N 2788 4303 C.12 UT UTAH MEDICAID UHIN Y N 1486 4302 C.12 UT UTAH MEDICARE NORIDIAN ADMIN. SERV Y N 2458 4301 N/A VA VIRGINIA BLUE SHIELD ANTHEM EAST N N 1413 4303 N/A VA VIRGINIA MEDICAID FIRST HEALTH SERVICE N N 1472 4302 N/A VA VIRGINIA MEDICAID LAB FIRST HEALTH SERVICE N N 7447 4302 N/A VA VIRGINIA MEDICARE TRAILBLAZER HLTHENT- Y N 1442 4301 N/A VA VIRGINIA MEDICARE (ALEX, ARLGTN, FA TRAILBLAZER HLTHENT- Y N 2461 4301 N/A VT VERMONT BLUE SHIELD Y N 7493 4303 N/A VT VERMONT MEDICAID EDS - ELECTRONIC DAT Y N 7492 4302 N/A VT VERMONT MEDICARE NATIONAL HERITAGE IN Y N 2471 4301 N/A WA BLUE CROSS WA/AK PREMERA BLUE CROSS PREMERA BLUE CROSS Y N 7445 4303 N/A WA REGENCE BLUE SHIELD N N 7451 4303 N/A WA WASHINGTON MEDICAID ACS Y N 1482 4302 N/A WA WASHINGTON MEDICARE NORIDIAN ADMIN. SERV Y N 1462 4301 N/A WA WASHINGTON WORKERS COMPENSATION Y N 4404 4300 N/A WI ATRIUM HEALTH PLAN INC - MEDICAID H N N 7453 1387 N/A WI GROUP HEALTH COOPERATIVE - MEDICAID N N 7453 1387 N/A WI GROUP HEALTH COOPERATIVE OF EAU CLA N N 7453 1387 N/A Y WI MANAGED HEALTH SERVICES - WISCONSIN CENTENE CORPORATION Y N 2702 4302 N/A WI WISCONSIN BLUE SHIELD ANTHEM MIDWEST N N 1401 4303 N/A WI WISCONSIN MEDICAID EDS - ELECTRONIC DAT Y N 1467 4302 N/A WI WISCONSIN MEDICARE WPS Y N 1434 4301 N/A WV BRICKSTREET MUTUAL INSURANCE ACS Y N 4428 4300 N/A WV MOUNTAIN STATE BLUE SHIELD (WEST VI Y N 7474 4303 N/A WV WEST VIRGINIA MEDICAID UNISYS N N 2477 4302 N/A WV WEST VIRGINIA MEDICARE PALMETTO GOV BENEFIT Y N 1450 4301 N/A WY WYOMING BLUE SHIELD NORIDIAN ADMIN. SERV Y N 7489 4303 N/A WY WYOMING MEDICAID ACS Y N 7458 4302 N/A WY WYOMING MEDICARE NORIDIAN ADMIN. SERV Y N 2466 4301 N/A BENEFIT MANAGEMENT SERVICES (BMS) LOUISIANA BCBS N N 2265 4300 N/A MEDICARE DME MAC JURISDICTION A NATIONAL HERITAGE IN Y N 7475 4301 N/A MEDICARE DME MAC JURISDICTION B ADMINASTAR FEDERAL, Y N 7476 4301 N/A MEDICARE DME MAC JURISDICTION C PALMETTO GOV BENEFIT Y N 7477 4301 N/A MEDICARE DME MAC JURISDICTION D CIGNA GOVERNMENT SER Y N 7478 4301 N/A MEDICARE PLUS BLUE - MEDICARE ADVAN BC BS OF MICHIGAN Y N 2287 4301 N/A PEACH STATE HEALTH PLAN CENTENE CORPORATION Y N 2417 4302 N/A PHOENIX HEALTH PLANS N N 3440 1387 N/A PREFERRED BENEFITS ADMINISTRATOR N N 2432 1360 N/A RETIRED RAILROAD MEDICARE PALMETTO GOV BENEFIT Y N 1443 4301 N/A Y TRICARE - NORTH AND SOUTH REGION PALMETTO GOV BENEFIT Y N 4456 4300 N/A TRICARE - WEST REGION WPS Y N 7452 4300 N/A