Transcription

eClaims Dental Payer List InformationPayer IDs are required to send your claims electronically. When you add a new insurance company in your system,please use this payer list to find the Insurance Company’s Payer ID. Payer IDs can be entered by going to List Insurance Companies Edit the Insurance Company and enter the payerID number in the ‘Claim Payer Id field’If you are working with Blue Cross/Blue Shield or Medicaid you will also need to update the payment sourceaccordinglyPayer List Includes: Commercial Payers – Pages 1-15Blue Cross Blue Shield Payers – Pages 15-17Delta Dental Payers – Page 17-18Medicaid Payers – Pages 18-19Payer ID 06126: Use this eClaims payer id for those insurance companies that are not listed onthis eClaims Payer ListGroup Number Column: Yes the payer requires the group numberNo the group number is optionalEnroll Column: This column indicates whether or not the payer requires enrollment prior toaccepting your claims electronicallyYes Payer requires enrollment please do the following for these payers:1. Within EagleSoft go to Online FAQ2. Under the Search by Keyword field type 44003. Click on the eClaims Additional Enrollment PaperworkNo No paperwork is requiredReal Time Claims: Y Payer participates in Real Time ClaimsKnow what insurance companies will pay on the rendered services withinseconds and know the patient portion while the patient is still at the office.Real Time Pre Estimates: Y Payer participates in Real Time Pre EstimatesAdditional Information Column: This column includes important information specific to the insurancecompanies.Obtaining Current Payer List: Recommended every 2-3 months1. Go to Online FAQ or pattfaq.com2. Under the Search by Keyword field type 24533. Click on eClaims Payer List and Payer List ChangesFor additional questions, please contact the eServices Support Team by using Live Chat, Help Live Help,or calling 800-475-5036.

eClaims Dental Payer ListApril 2020StatePayerIDGroup # EnrollReal Time Claims*Real Time PreEstimates*Additional InfoA & I Benefit Plan AdministratorsA.D.N. Administrators, Inc.93044CXADNYesYesNoNoAARPAARP1YesNoAcceptius (Benefit Management Inc ofMO (BMI)Access DentalAcclaimsACS Benefit Services Inc.43178YesNoCX0976407172468YesYesYesNoNoNovia Performance Health TechnologyActiva Benefit Services, LLC/Dental38255YesNo(Formerly Amway Corporation/Dental)Administrative Services, Inc.59141YesNoAARP Claims with a mailing address of PO Box2059, Mechanicsburg, PAf.k.a. ACS Consulting Services, Inc.Administrative Services Only, Inc.CX076YesNoAdditional enrollment is not required by the payer,however, providers wishing to submit Claimselectronically must be credentialed with the payer.Please ensure you have successfully process onepaper Claims with the payer prior to submittingyour first electronic Claims.Advantage by SuperiorCPPSAYesYesEffective only for Dates of Service prior to 2-0113. Call DentaQuest at 800-896-2374 and MCNADental at 855-776-6262 for Dates of Service 2-113 and greater.Advantage Dental Plan, Inc.Advantek Benefit AdministratorsAdvantica BenefitsAetnaAetna Affordable Health Choices (SM) SRCAetna Medicare EPO/PPO DentalAffordable Benefits YesNo1801495426YesYesNoNoAFLAC GA - GRP58066YesNoGroup Plan coverage please refer to your ID cardfor group coverage/number verification.This plan also shares the same mailing addressas payer ID 58066 and the only differencebetween the plans is that the insured ID for theNY based plan begins with "PN" as "PNxxxxxx"(followed by 6 digits)AFLAC NY52080YesNoAFLAC NY - GRP52080YesNoAGC International Union of OperatingEngineers Local 70191136YesNoAK United Food and CommercialWorkers (AK UFCW)91136YesNoAlask Carpenters91136YesNoAlaska Electrical Health & WelfareFund92600YesNoAlaska Hotel Employees, Restaurant &Camp Employees (AK HERE)91136YesNoAlaska Laborers Construction IndustryHealth & Security Trust91136YesNoAlaska Machinists Health and WelfareTrust91136YesNoAlaska Pipe Trades U A Local 37591136YesNoAlaska Public Employees Association(APEA/JESS Health & WelfareTrust)91136YesNoYYFor an updated payer list please visit our website www.eaglesoft.netPage 1Group Plan Coverage please refer to your ID cardfor group coverage/number verification.Please enter group # F07 when submitting claims.A Welfare and Pension Administration ServicespayerPlease enter group # F45 when submitting claims.A Welfare and Pension Administration ServicespayerPlease enter group # F40 when submitting claims.A Welfare and Pension Administration ServicespayerPlease enter group # F41 when submitting claims.A Welfare and Pension Administration ServicespayerPlease enter group # F23 when submitting claims.A Welfare and Pension Administration ServicespayerPlease enter group # F21 when submitting claims.A Welfare and Pension Administration ServicespayerPlease enter group # F24 when submitting claims.A Welfare and Pension Administration ServicespayerPlease enter group # F60 when submitting claims.A Welfare and Pension Administration Servicespayer

eClaims Dental Payer ListApril 2020StatePayerIDGroup # EnrollAlexian Brothers Community Servicesof TNAllCare CCO DentalAllegeantAllegiance Benefit t Services70106YesNoAllied Benefit Systems37308YesNoAllied Metal Crafts Security Plan TrustFund91136YesNoAllina Health PlanAlwaysCare BenefitAmalgamated Life - PA AlicareAmeraplanAmeriben oNoAmerican Administrators dba SelectBenefit Administrators (West DesMoines, IA)42137YesNoAmerican Benefit CorporationCX084YesNoAmerican Medical SecurityAmerican Postal Workers Union HealthPlanAmericas TPAAmerihealth AdministratorsAmeritas Life Insurance Corp.Ameritas Life insurance Corp. of NewYorkAmway CorporationAnchor BenefitAntares Management SolutionsApostrophe, Inc.ARC AdministratorsArgus Dental Plans, Inc.Arkansas Superior DirectASR Association Benefit Plan25133YesNoAssurant Employee BenefitsAssurant, Inc,Asuris704087040893221YesYesYesNoNoNoAtlantic Dental Inc. (ADI) - CommercialCX085YesNoAutomated Benefit ServicesAutomated Group Administration, Inc.(AGA)AvesisBanner Health SystemsBanner Plan AdministrationBARINetBCI Administrators, Inc.BeamBeamBeam DentalBeam Ins AdminBeam Ins AdminBeam Ins.Beam Ins.Beam InsuranceBeam InsuranceBeam Insurance NoNoNoNoNoNoNoNoNoNoNoReal Time Claims*Real Time PreEstimates*For an updated payer list please visit our website www.eaglesoft.netPage 2Additional Infovia Performance Health Technologyf.k.a. LBA Health PlansClaims mailing address of PO Box 12009,Cheshire, CTPlease enter group # F18 when submitting claims.A Welfare and Pension Administration ServicespayerPlease check the Insured ID card to verify thePayer ID before submitting claims. If you havequestions, please contact Provider Relations at800-456-4584.Only limited plans may be sent electronically.Group name is required with one of the followingplan names: Sheet Metal, Berekely, Boone,Carpenter, Cabell, Clarksbur, Doodridge,Hancock, Harrison, Marion, Monongalia, Mingo,Mineral, Morgan, Nicholas, Putnam, Taylor, Tyler,Wetzel.A United Healthcare Payer(Formerly Amway Corporation/Dental)Formerly payer ID 62413. Now part of CoventryConsolidate payer ID. Including CombinedGovernment Health Plan & Contract HealthInsurance Plan.PO Box 2877, Clinton, IA 52733PO Box 2877, Clinton, IA 52733

eClaims Dental Payer ListApril 2020StatePayerIDGroup # EnrollBeam Insurance AdBeam Insurance AdminBeam Insurance AdminBeam Insurance AdministratorBeam Insurance AdministratorBEAM Insurance administratorsBeam Insurance AdministratorsBell AtlanticBeneCare Dental PlansBenefit Administrative oNoNoNoBenefit Coordinators Corporation(Pittsburgh, PA)25145YesNoBenefit Inc.Benefit Management Group NVR700336459NoYesNoNoBenefit Management Services of MS37212YesNoBenefit Management Services, Inc.Benefit Management, Inc. of KS5613948611YesYesNoNoBenefit Plan Administrators Co. (EauClaire, NoReal Time Claims*Real Time PreEstimates*Additional InfoPayer ID valid only for Claims with a submissionaddress of 111 Ryan Court, Suite 300, Pittsburgh,PA 15205.Payer ID valid for Benefit Plan Administrators(Eau Claire, WI submission address only) andCustom Benefit AdministratorsBIABIA / BeamBlue BeneFit Administrators of MABlue Care Family PlanBoilermakers National Health & WelfareFundBoon Administrative Services, Inc.36609YesNoBOONGYesNoBridgeSpan Health (Regence Group)BRIDGYesNoBrokers NationalBroward HealthButler BenefitsC. L. fornia State Government NoNoNoNoNoNoNoNoNoCX101YesNoCHA0137060YesYesNoNoA United Healthcare PayerCBA Blue03036YesNof.k.a. Comprehensive Benefits Administrators, Inc.CCEA Teachers Health TrustCDO TechnologiesCDS Group Health880198302888022YesYesYesNoNoNoCement Masons and Plasterers Health& Welfare Trust91136YesNoPlease enter group # F16 when submitting claims.A Welfare and Pension Administration ServicespayerCentral Reserve Life34097YesNoOnly Non Medicare Supplement and Dental linesof business administered under this payer ID.36215YesNo55731YesNoCannon Cochran ManagementServices, Inc. Metairie, LACapitol DentalCareFirst, Inc. Maryland BCBSCareington Benefit SolutionsCareOregonCaresource GACaresource INCaresource KYCaresource WVCarolina Summit HealthcareCarpenters Health and Welfare Fund ofPhiladelphiaCascade Health Alliance, Inc.Caterpillar Inc.Central States Health and WelfareFundCentral Susquehanna HealthcareProviders (CSHP)For an updated payer list please visit our website www.eaglesoft.netPage 3a.k.a. CBA BlueAdministered by Golden West (Well point)Payer ID for claims with a mailing address of POBox 6794, Metairie, LA 70009via Performance Health TechnologyAn Innovative Healthware Services Payer.

eClaims Dental Payer ListApril 2020StatePayerIDGroup # EnrollReal Time Claims*Real Time PreEstimates*Additional InfoCHAMPVA - HAC84147YesNoCHAMPVA - HAC is not associated with and doesnot process Claims for TRICARE (formerlyCHAMPUS)Chesterfield Resources, Inc.(Uniontown, OH)34154YesNoa.k.a. Salvation ArmyChewsi First Circle Solution / DD RIRICHWYesnOChoice Plus (TRW)Christian Brothers ServicesCIGNACitizens Security Life682413830862308CX071YesYesYesYesNoNoNoNoCivil Service Employees Association(CSEA)YYProvider ID number required. Max of 50 procedurelines per Claims. ID number must be 5 charactersin length, numbers 6 in length & ending with a '1'are accepted when '1' is removed. Numbers withleading zeros will have leading zeros omitted. IDnumbers cannot contain an "-".CX054YesNoClaimsBridge HPN11752Community Health Alliance of TN27905Community Health Electronic75261Claims/CHEC/webTPACompanion Life / KHP37322CompBenefitsCX021CHCP1Comprehensive Healthcare optionsCompuSys / Erisa Group, Inc.74234Comsumers Choice Health Plan - State45321of SCYesYesNoNoYesNoYesYesNoNoNoNoYesNoConnecticut Carpenters Health Fund37307YesNoConnecticut General (CIGNA)Consolidated Group DentalContinental Benefits623086130535245YesYesYesNoNoNoCore Management Resources Group58231YesNoCore V60601YesNoCoreSource AZ MN41045YesNoOnly for Claims where the "submit Claims toaddress" on the medical ID card is a CoreSourceaddress in the states of Arizona or Minnesota. Forassistance call 800-698-0106.CoreSource DetroitCoreSource KCCoreSource Little Rock382254811775136YesYesYesNoNoNof.k.a. FMH Benefit Services, Inc.CoreSource MD PA IL35182YesNoOnly for Claims where the "submit Claims toaddress" on the medical ID card is a CoreSourceaddress in the states of Maryland, Pennsylvaniaor Illinois. For assistance call 800-689-0106.Only for Claims where the "submit Claims toaddress" on the medical ID card is a CoreSourceaddress in the states of North Carolina or Indiana.For assistance call 800-689-0106.CoreSource NC IN35180YesNoCoreSource OH35183YesNoCoreStar41045YesNoOnly for Claims where the "submit Claims toaddress" on the medical ID card is a CoreSourceaddress in the states of Arizona or Minnesota. Forassistance call 800-698-0106.Covenant Administrators, Inc. (Atlanta,GA)Coventry DentalCoventry Health CareCoventry Health Care CarelinkCoventry Health Care CarelinkMedicaid58102YesNof.k.a. Benesys, Inc.CX0492513325133YesYesYesNoNoNoWest Virginia OnlyWest Virginia Only25133YesNoWest Virginia OnlyCoventry Health Care National Network25133YesNoFormerly payer ID 87043. Now part of CoventryConsolidated payer ID.Coventry Health Care of Georgia25148YesNoFor an updated payer list please visit our website www.eaglesoft.netPage 4

eClaims Dental Payer ListApril 2020StatePayerIDGroup # EnrollCoventry Missouri25133YesNoCoventryCares86098YesNoCreative Plan AdministratorsCrescent Dental - Meritain HealthCrescent Health SolutionCTI AdministratorsCustomCareCypress Ancillary BenefitsDart Management Corp.DeCare Dental Health InsuranceDenex DentalDental Care PlusDental Health Services of AmericaDental Network of oNoNoNoNoNoNoNoNoNoNoDental Professionals of Wisconsin39148YesNoDental SelectDentist DirectDentaquest Commercial Plans (Groupand et Mutual Benefit AdministratorsCX089YesYesDH EvansCX065YesNoDiversified Administration CorporationCX040YesNoDownstream Casino19191YesNoEMBDQNoNo35186YesNoDQ/Emblem (Emblem Health Medicaid)Dunn & Associates BenefitsAdministrators, Inc.8888837257NoNoEBMCEBMS (Employee Benefit ManagementServices, Inc.)EBS - RMSCOEBS Benefit SolutionsEHIEmblem Health (GHI - New York GroupHealth NoNo13551YesNoEMI HealthCX079YesNoEMPHESYSEmployee Benefit Concepts(Farmington Hills, MI)73288YesNo38241YesNoEmployee Benefit Management Corp(EBMC)Employee Benefits Plan Administration,Inc. (E.B.P.A.)Employee Benefits Systems of IAEmployee Plans, LLCReal Time PreEstimates*Additional InfoFormerly payer ID 87043. Now part of CoventryConsolidated payer ID.Kentucky Medicaid CoventryCares administeredby Avesisf.k.a. Southeast Dental Associates. Effective 7-114 payer name must be listed as DPOW-CCHPOR DPOW-ANTHEM OR DPOW-ICANoEBC, Inc.Employee Benefit ConsultantsReal Time esNoNoFor an updated payer list please visit our website www.eaglesoft.netPage 5An Innovative Healthware Services Payer.Payer Id valid only for Claims with a billingsubmission address of Employee BenefitConsultants, located in Broadview Hts, OH,Appleton, WI, Albuquerque, NM, Findlay, OH,Louisville, KY and Milwaukee, WIf.k.a. Educators Mutual Insurance Association.Prior to accepting claims electronically EMIArequires the provider to call 801-262-7476 or 800662-5850. Providers should advise EMIA thatthey will be submitting their claims throughChange Healthcare Business Services, Inc. UHINsubmitter ID HT000214-001.Payer Id valid only for Claims with a billingsubmission address of Employee BenefitConsultants, located in Broadview Hts, OH,Appleton, WI, Albuquerque, NM, Findlay, OH,Louisville, KY and Milwaukee, WIa.k.a. CBA Blue

eClaims Dental Payer ListApril 2020StatePayerIDGroup # EnrollReal Time Claims*Real Time PreEstimates*Additional InfoEmployer Plan Services, Inc.Employers Direct HealthEmployers HealthEmployers Health InsuranceEmployers Mutual, Inc.EncaraEnvolve HealthEPSI Dental IIEQUICORES Beveridge and AssociatesE-V Benefits Management, Inc(Columbus, OH)EverenceEvergreen Health oNoFairbanks North Star Borough91136YesNoFairbanks North Star Borough SchoolDistrict Plan A (FNSBSD)91136YesNoFairbanks North Star Borough SchoolDistrict Plan B YesNoNoNoNof.k.a. General AmericanAdministered by United ConcordiaFidelio Dental Insurance Companyfidelity / Key SelectFirst Continental Life & AccidentInsuranceFirst Dental Health / BIAFirst Dental Health of CAFirst Reliance Standard Life Ins. Co.(NY Business)FL MCO PHC/PHPFlex CompensationFlexCareFlorida Combined LifeFlorida Power & LightForeign Service Benefit PlanFormula Card DentalLX050Foundation Benefit Admin (FBA) - BoonBOONGGroupFox Everett, Inc.64069Fraternal Order of Police - DentalCX041Division (Philadelphia, PA)Fringe Benefits Coordinators59204GDSCX036GettysburgCX064GIC Indemnity Plan80314Gilsbar, Inc.07205Golden West DentalGWD01Government Employees Health44054AssociationGovernment Employees Hospital57254Association (GEHA)Great-West Healthcare63665Great-West Healthcare80705Group Administrators Ltd.36338Group and Pension Administrators48143Group Benefit Administrators72153Group Health Coop (Individual &Family, and Small Business Groups)89070YesNoGroup Insurance Service Center, Inc37276YesNoGroup Link of IndianaGuaranty (DINA)Guardian Life Insurance Company ofAmericaCX015CX090YesYesNoNo64246YesNoFor an updated payer list please visit our website www.eaglesoft.netPage 6f.k.a. Dental Health & Wellnessf.k.a. Capital DentalAn Innovative Healthware Services Payer.Please enter group # F62 when submitting claims.A Welfare and Pension Administration ServicespayerPlease enter group # F62 when submitting claims.A Welfare and Pension Administration ServicespayerPlease enter group # F62 when submitting claims.A Welfare and Pension Administration ServicespayerFormerly payer ID 62413. Now part of CoventryConsolidated payer ID. Including AFSPA StaffPlan.An Innovative Healthware Services Payer.

eClaims Dental Payer ListApril 2020StatePayerHamaspik ChoiceHarrington Health Colonial DentalHawaii - Mainland AdministratorsHawaii Medical Service Association(HMSA)HCS - Health Claims Service (Boise,ID)Healthchoice OKHealth Choice ArizonaHealth Choice InsuranceHealth Choice Integrated CareHealth Economics Group, Inc.Health Partners - Jackson, TNHealth Plan ServicesHealth Plans Inc.Health Resources Incorporated (HRI)MNIDGroup # Enroll477385914386066Real Time Claims*Real Time PreEstimates*Additional oNoNoNoNoCX019YesNoFederal Employee claims cannot be sentelectronicallyThe insured ID number is required. Maximum of25 procedure lines per Claims. Secondary Claimscannot be sent electronically. Claims remarksexceeding 80 bytes in length cannot be sentelectronically.Healthcare ManagementAdministrators, Inc.HMA01YesNoHealthcomp, Inc.HealthE Exchange Inc.HealthEZHealthgram, Inc.Healthgram, Inc.HealthPartners MNHealthPartners MNHealthplex, YesYesYesYesNoNoNoNoNoYesYesNoHealthSCOPE Benefits, Inc.(FormerlyCNA Health Partners of Arkansas)71063YesNoHealthSmart Benefit Solutions37272YesNoHealthSmart Benefit Solutions37283YesNoHealthSmart Benefit Solutions87815YesNof.k.a. Wells Fargo, TPA, Inc., Charleston, WV31172HMD01YesNoNoNoa.k.a. Innovante Benefit Administrators6251NoNoHealthTransHealthy Michigan DentalHo-Chunk Nation Department of HealthHometown Health Plans NevadaHoosier Dental (in Indianapolis,Indiana)88023YesNoCX015YesNoHotel Employees RestaurantEmployees Health Trust (HERE)91136YesNoHSBS MemphisHSBS Oklahoma CityHumanaHumana, Inc.I. E. Shaffer (West Trenton, oNoIBT - Local 145 Health Service & InsPlanCXIBTYesNoiCircle Care of NYIMCareIndiana Teamsters Health BenefitsFund (Indianapolis, IN)IneticoInnovante Benefit AdministratorsInnovation 5YesYesYesNoNoNoInsurance Administrators of America37279YesNoInsurance Design AdministratorsInsurance Management ServicesInsurance Systems Inc.133151568874385YesYesYesNoNoNoInsurers Administrative Corp.86304YesNoFor an updated payer list please visit our website www.eaglesoft.netPage 7f.k.a. Primary Physician Caref.k.a. Wells Fargo TPA, Inc., Newnan GA andFayetteville, NCPlease enter group # F19 when submitting claims.A Welfare and Pension Administration Servicespayerf.k.a. Pittman & Associatesf.k.a. Mutual Assurance AdministratorsOnly for claims with date of service prior to 1-1-16.Dates of service greater than 12-31-15 should besent using payer ID 60054.f.k.a Itasca Medical CareFormerly known as Local 135 Health BenefitsFund (Indianapolis, IN)An Innovative Healthware Services Payer.a.k.a. HealthTransPlease visit website prior to submitting Claims:edihelp.iacusa.com

eClaims Dental Payer ListApril 2020StatePayerIDGroup # EnrollReal Time Claims*Real Time PreEstimates*Additional InfoPayer ID valid only for Claims with a billingsubmission address of 110 S. Shipley Street,Seaford, DE 19973.Integra Administrative Group (Seaford,DE)51020YesNoInternational Brotherhood ofBoilermakers36609YesNoJensen Administrative Services, Inc.CXJASYesNoJohn Morrell Company - AHBPA38310YesNoJoint Benefit TrustCHSJTYesNoAdministered by Health Services BenefitAdministrators, Inc. (HSBA)JP Farley Corporation34136YesNoPayer ID valid only for Claims with a billingsubmission address of PO Box 458022, Westlake,OH 44145KaiserKalos Gold Health PlanKalos HealthKanawha Insurance Co.Keenan AssociatesKemper BenefitsKempton CompanyKempton Group AdministratorsKentucky Health ky Spirit65030YesNoKey SolutionsKlais & CompanyLA BCBS AdvantagePlus NetworkLand of LincolnLevelLife Gift CardsLife Insurance Company of Boston &New YorkLifeMap Assurance CompanyLifestyle DentalLifewise Health Plan of OregonLincoln Financial GroupLincoln National (WI)Line Construction Benefit FundLocal 135 Health Benefits Fund(Indianapolis, IN)Local 17 Fund - InternationalAssociation of Heat and NoIAHFIAdministered by United Concordiaf.k.a. Jefferson PilotNoLocals 302 & 612 of the InternationUnion of Operating Engineers91136YesNoLockard & WilliamsCB752YesNoMail Handlers Benefit Plan25133YesNoMAMSIManaged Care Services, LLCCX03335162NoNoNoManaged Dental YesNoNoNoNoNoNoMAPFREMasonry Institute/Administrative D.C.No. 1 Welfare FundMayo Clinic Health SolutionsMBA Benefit Administrators, Inc. (SaltLake City, UT)MBA of Wyoming (Worland, WY)McGregor PACEMCNA DentalMed3000 CMS Safety NetMed3000 CMS Title 19 ReformMED3000 CMS Title 21Kentucky Medicaid Kentucky Spirit administeredby MCNAFor an updated payer list please visit our website www.eaglesoft.netPage 8Please enter group # F12 when submitting claims.A Welfare and Pension Administration ServicespayerFormerly payer ID 62413. Now part of CoventryConsolidated payer ID. Including AFSPA StaffPlan.Only for the individual marketplace, not forGroup/SHOP business

eClaims Dental Payer ListApril 2020StatePayerMEDICA of MinnesotaMedical Associate Health Plan(HEALTH CHOICES)Medical Benefits Mutual Administrators(MedBen)Medical Card System (MCS)Medical Mutual of OhioMedical Mutual of OhioIDGroup # 3YesYesYesNoNoNoReal Time Claims*Real Time PreEstimates*Additional InfoNoOnly for Policy Numbers that begin with 000M1Dand claims mailed to PO Box 21660, Eagan, MN55121YesYesYesYesYesYesNoNoNoNoNoNof.k.a. Weycof.k.a. 0572YesYesNoNoMultiFlex Dental (Merchants Benefit)MBAAZYesNoMunicipal Health Benefit FundMutual of Omaha Commercial81883CX087YesYesNoNoMutual of Omaha Insurance Company71412YesNoMutually PreferredMyDecisionNAA (North America Administrators,L.P.) (Nashville, TN)7141218840YesNoNoNo65085YesNoMedico Insurance Company23160Mercy Care PlanMercy Maricopa Integrated CareMeritain HealthMeritain Health MinneapolisMethodist First n Regional Council ofCarpenters Employees Benefit PlanMichigan UFCWMid-America Associates, Inc.Mid-American BenefitsMidwest Dental BenefitsMomentum Insurance PlanMorris AssociatesMotorolaMountain States AdministrativeServices (Tucson, AZ)MPEEBT/ MPE Services, Inc.MSA CareGuardNABN (Cleveland, OH)NAPHCARE, Inc.National Elevator Industry Benefit Plan(NEIB)National Pacific of TX (NCFLEX)National Rural Letter CarrierAssociationNational TelecommunicationsCooperative AssociationNationwide Employee BenefitsNationwide Health PlansNative Care HealthNCAS - CharlotteNCAS - Fairfax, VANetcare Life and Health Insurance(NLH)Nevad Dental BenefitsNevada Health Co-OpNew England Dental AdministratorsNippon Life Insurance Company ofAmericaNNEBT (Northern New England YesYesNoNoNo81264YesNo38238YesNoFor an updated payer list please visit our website www.eaglesoft.netPage 9An Innovative Healthware Services Payer.Payer ID valid only for Claims with billingsubmission address of P.O. Box 94928,Cleveland, OH 44101-4928 or P.O. Box 89476,Cleveland, OH 44101-5476.A United Healthcare Payer

eClaims Dental Payer ListApril 2020StatePayerNorth American Benefits Network((Cleveland, OH)North Broward Hospital DistrictNorthern California Pipe Trades TrustFundsNorthern Illinois Health PlanNorthern Minnesota DentalNorthern Nevada Trust FundNorthShore University Health SystemMedical GroupNorthwest Dental ServicesIDGroup # esNoNo88027YesNo36364YesNo93525NoNoNorthwest Ironworkers Health &Security Fund91136YesNoNorthwest Roofers & Employers Health& Security Trust Fund91136YesNoNorthwest Suburban IPA36346YesNoNorthwest Textile Processors andService Trades91136YesNoNova Healthcare Administrators, Inc.(Grand Island, NY)16644YesNoNW International Association ofMachinists (NW IAM)91136YesNoNW Plumbers & Pipefitters Health &Welfare Trust91136YesNoNyhartOH Dental / UHC Dental GovernmentProgramsOhio AFSCME Care PlanOK DRS DOC37299YesNoGP133YesNoAFSOH71065YesNoNoOhio Dept of Corrections (Careworks)J1410YesNoOK State Employees & Educators(EDS)Olympus Managed Health CarePA Faculty Health & WelfarePACE Central Iowa22521YesNo65074CX06672436YesYesYesNoNoNoPACE Greater New Orlean sNoNoNoNoPACE NebraskaPACE Southwest IowaPace of Southwest MichiganPACE Southeast MichiganPacific UnionPacificare Dental and Vision HMOPacificare Dental and Vision PPOPacificSource AdministratorsPacificSource CommunityPacificSource Health PlansPan American Life Insurance GroupPartners Benefit GroupPartners Health PlanPatient Advocates, LLCPDOPEHP (Public Employees HealthProgram)CX080YesYesYesReal Time Claims*Real Time PreEstimates*YesFor an updated payer list please visit our website www.eaglesoft.netPage 10Additional InfoPayer ID valid only for Claims with billingsubmission address of P.O. Box 94928,Cleveland, OH 44101-4928 or P.O. Box 89476,Cleveland, OH 44101-5476.For Dates of Service beginning 1-1-15 please usepayer ID 77777.Please call (775) 826-7200 to verify if you shouldbe sending claims to Northern Nevada TrustFund.Please enter group # F15 when submitting claims.A Welfare and Pension Administration ServicespayerPlease enter group # F26 when submitting claims.A Welfare and Pension Administration ServicespayerPlease enter group # F14 when submitting claims.A Welfare and Pension Administration ServicespayerPlease enter group # F39 when submitting claims.A Welfare and Pension Administration ServicespayerPlease enter group # F31 when submitting claims.A Welfare and Pension Administration Servicespayerf.k.a. Optum Specialty Svcs / Americhoice of NJAn Innovative Healthware Services Payer.A United Healthcare PayerA United Healthcare PayerA United Healthcare Payera.k.a. Select Benefit Administratorsvia Performance Health TechnologyPrior to accepting claims electronically PEHPrequires the provider to call EDI Support at 801366-7544 or 800-753-7818. Providers shouldadvise PEHP that they will be submitting theirclaims through Change Healthcare BusinessServices, Inc UHIN submitter ID HT000158-001.

eClaims Dental Payer ListApril 2020StatePayerPequot PharmaceuticalPersonal Insurance Administrators, IncIDGroup # Enroll37121YesNo95397YesNoReal Time Claims*Real Time PreEstimates*Additional InfoPhysician Health Partners, LocPhysicians Health Plan of NorthernIndiana, Inc.Physicians MutualPinnacle Claims Management, Inc.Planned Administrators, Inc.Prairie States Enterprises, Inc.Preferred Dental 41YesYesYesYesYesNoNoNoNoNoPreferred Health Plan of the CarolinasCB404YesNoPreferred Health ProfessionalsPreferred One3147841147YesYesNoNoPremier Access Insurance CompanyCX078YesNoPremier Access UT GovernmentPremier Dental Plan of MNPrime Health ChoicePrimeCare Administrators West HealthLX049YesNoNew providers, learn about submitting your firstclaim. Please visit pal Financial Group61271YesNoPayer Only accepts VISION and DE

Obtaining Current Payer List: Recommended every 2-3 months 1. Go to Online FAQ or pattfaq.com 2. Under the Search by Keyword field type 2453 3. Click on eClaims Payer List and Payer List Changes For additional questions, please contact the eServices Support Team by using Live Chat, Help Live Help, or calling 800-475-5036.