Multi-Payer Set Up
Provider NameTax ID / Billing NPI
Address
City / State / Zip
Contact / Phone / Fax
Email / Date
Check the box next to each payer ID for EDI set up. Submit completed form to ClaimRemedi by attaching to an email addressed to . In the subject line, enter your provider name followed by “Payer Setup”.
ERA Enrollment Payers61184 / Access Health Services - Arkansas Superior Select
95340 / Adventist Health System West / 71066 / Kansas Superior Select – KS Health Advantage
65093 / Advocate Health Partners (PHO) / 37217 / Key Benefit Administrators
36320 / Advocate Medical Group / 23284 / Keystone First
60054 / Aetna / 77741 / Keystone First Community Health Choices
62118 / Aetna Senior Medicare Supplement / 36334 / MacNeal Health Providers-Chicago HealthSys.
ALH01 / Aliera Health Care / 22771 / Managed Health Networks
62030 / American General / 53275 / Martin’s Point Health Care
26119 / American Ins. Admin-EFT Required to receiveERA / 41154 / Mayo Management Services (MMIS)
77799 / AmeriHealth Caritas Delaware / 31354 / MDWise Healthy Indiana Plan (HIP)
27357 / AmeriHealth Caritas Louisiana / 35191 / MDWise Hoosier Healthwise
77075 / AmeriHealth Caritas Iowa / EM205 / MED3000 CMS Title 21
77062 / AmeriHealth Caritas VIP Care / EM843 / MED3000 Title 19 Reform – CMS MMA Specialty
77013 / AmeriHealth Caritas VIP Care Plus (Michigan) / 56205 / MedCost Benefit Services (MBS)
77001 / AmeriHealth Caritas Northwest / MAHC1 / Medical Assoc. Health Plan/Health Choices
22248 / AmeriHealth Caritas Pennsylvania / 74323 / Medical Benefits Mutual
77002 / AmeriHealth District of Columbia / 29076 / Medical Mutual of Ohio
11983 / Auto Club Insurance Association / CB833 / Medical Mutual of Ohio( Dental)
59274 / AvMed – EFT Required to receive ERA / 12422 / Medica2
36066 / Bankers Life (Also enroll 11285 & 37077) / 13189 / Meridian Health Plan of IL
12X42 / Banner Health Co(for claims, use Payer ID SX145) / 83253 / Meridian Health Plan of Michigan*
61124 / Baptist Health Plan fka Bluegrass Family Health / *Note: / Provider must also email payer at:
20488 / Better Health of Florida / with TIN and NPI
SB580 / BCBS – DC, CareFirst / to route ERA thru Emdeon to ClaimRemedi
SB690 / BCBS – MD, CareFirst (Also Enroll SB580) / 13265 / MetroPlus Health Plan
BOONGGGG / Boon Admin. Services-Foundation Benefit Admin. / 10850 / Metropolitan Health Plan
52192 / Bravo Health & Texas Healthspring / 74289 / MHNet
06607 / Cardinal Innovations Healthcare / 00710 / Michigan BC Complete (Enroll with 32002)
65031 / CarePlus Health Plans, Inc. *EFT is required / 13174 / Montefiore Contract Management Org.
23626 / Central PA Teamsters Fund / 81883 / Municipal Health Benefit Fund
80214 / ChampVA-HAC Medicare Crossover (84146) / 71412 / Mutual of Omaha Insurance Co
84146 / ChampVA-HAC (Also enroll with 80214)
84147 / ChampVA / 58182 / Naphcare, Inc.
77023 / Clover Health fka CarePoint Health Plans / 52132 / National Rural Electric Coop (NRECA)
37077 / Colonial Life (Also enroll 36066 & 11285) / 39144 / Network Health Plan of Wisconsin
COACC / Colorado Access (Enroll with 84129) / 45129 / New Mexico Health Connections
65391 / Community Behavioral Health Network of PA / 69821 / Next Level Health Partners
39126 / Community Care Inc. (WI) - Also enroll 60995 / 76112 / North American Ins Co dba Oxford Life
60995 / Community Care Inc Family Care – Also enroll 39126 / 58169 / Northeast Georgia Health Services
73143 / Community Care Managed Health Care of OK / 48026 / Northshore Physician Associates IPA
48145 / Community Health Choice (Includes Payer ID 60495) / 14142 / NYS DOH UCP (New York ADAP)
75261 / Community Health Electronic Claims/WEBTPA / 54154 / Optima Health / Sentara Health*EFT Required
37363 / Compsych / 13383 / Orthonet Corporation - Aetna
06105 / ConnectiCare (Also enroll 78375) / 93029 / PacificSource
66917 / Parkland Community Health Plan
61129 / Passport Health Plan
72126 / Peoples Health Network
251PD / Piedmont WellStar Health Plan
37224 / Pittman & Associates
37287 / Planned Administrations, Inc.
16111 / POMCO
65088 / Preferred Care Partners
60110 / Preferred Health Systems Insurance
65054 / Premier Eye Care
77003 / Prestige Health Choice
/ PacificSource
78375 / ConnectiCare – Medicare (Also enroll 06105) / 97652 / Passport Advantage
11285 / Conseco Services (Also enroll 36066 & 37077) / 72126 / Peoples Health Network
52132 / Cooperative Benefit Administrators (CBA) / 47027 / Physicians Mutual Insurance Company
35199 / Cooperative Managed Care Services / 16111 / POMCO
25133 / Coventry (all plans) / 65088 / Preferred Care Partners
39113 / Dean Health Plan / 60110 / Preferred Health Systems Insurance
07035 / DeCare Dental Health Insurance / 21524 / Preferred Medical Claims Services
CDIA1 / Delta Dental of Iowa / 65054 / Premier Eye Care
39069 / Delta Dental of Wisconsin / 77003 / Prestige Health Choice
64246 / Dental Guard Preferred / 61604 / PrimeWest Health Plan
CX093 / Dental Select / SX133 / Providence of Oregon Health Plan
74284 / Driscoll Children’s Health Plan / 23342 / QualCare, Inc.
22521 / Oklahoma State Education Employee Group (EDS) / 22312 / QualCare, Inc. (dba QANI Admin.)
31625 / ElderPlan / 74205 / Right Care from Scott & White
03964 / Elderwood Health / CP001 / Samaritan Health Plans
37216 / Employee Benefit Services – EFT is required / 37259 / SAMBA – ERA Only
73780 / EON Health / 91184 / Sanford Health Plan
20818 / Essence Healthcare / 77038 / Sante Health System and Affiliates
41041 / Federated Mutual Insurance / 88030 / Scott & White Health (Enroll with ID TH002)
77009 / First Choice VIP Care Plus – South Carolina / 28530 / Secure Health Plan of Georgia
60550 / Gateway Health-Med. Assured (Also enroll 25169, 91741, 45276, 47181) / 93742 / Securian Dental Plan
91741 / Gateway Health OH–Med. Assured(Also enroll 25169, 45276, 47181) / 76045 / SelectCare of Texas (HPN)
25169 / Gateway Health Plan PA (Also enroll 60550, 45276, 47181,91741) / 23285 / Select Health of South Carolina
25531 / GHI HMO (Also Enroll 13551, 55247, 78375) / 15682 / Senior Network Health
39167 / Group Health Cooperative of South Central WI / 83035 / Senior Whole Health
13551 / Group Health–NY (Also enroll 25531,55247,78375) / 27094 / Simply Healthcare
64246 / Guardian Life Insurance / 77153 / Southeastern Indiana Health Org.-IU Health
47738 / Hamaspik Choice / 38242 / Southern Benefit Admin. EFT Required
77950 / Health Alliance / 84146 / Spina Bifida - VA HAC
62180 / Health Choice Generations (AZ) / 31059 / State Farm (Casualty & Property Claims)
22100 / Health Choice Integrated Care / 31053 / State Farm Insurance Co. EFT Required
62179 / Health Choice of Arizona / 74227 / Student Insurance
45399 / Health Choice Utah / 67814 / Sun Life and Health Insurance Co.
68021 / Health Net – VA Patient Centered Comm. Care
98022 / TakeCare Insurance Company
95567 / Health Net of California & Oregon / 43619 / Teamsters Local 688 Ins. & Welfare
04286 / Health New England* / 76048 / Texas Children’s Health Plan
*Note: / Provider must also enroll at payers website: / 75228 / Texas Children’s Health Plan (Medicaid)
/ 23856 / Touchstone Health PSO(Enroll with ID 11328)
SectionB: / Vendor Name: Emdeon, Vendor Tax ID: 133052274 / TRP1E / Transamerica Life Insurance Company
Vendor Contact Phone: 866-924-4634 / 37284 / Transchoice – Key Benefit Administrators
Vendor Name (Appointed): Emdeon / 31118 / Tribute Health–Superior Select Health AR
CX009 / HealthPartners of Minnesota / L0230 / Trusted Health Plan
CX010 / Health Partners of Minnesota (Medicaid) / 04298 / Tufts Health Public Plans (Enroll with ID 04332)
11328 / Healthcare Partners, IPA / 77022 / Ultimate Health Plan
80141 / Healthfirst Inc.* - EFT Required to receive ERA / 34638 / Unified Physicians Network
*Note: / Provider must contact HealthFirst to complete / 45282 / University of Maryland Health Advantage
ERA/EFT Setup at 888-801-1660. / 38337 / Upper Peninsula Health Plan
96475 / Healthlink HMO / 13407 / USFHP-St. Vincent Catholic Medical Center
87815 / HealthSmart Benefit Solutions / 12115 / Veteran’s Administration (VA) Fee Basis Pgm.
52192 / HealthSpring - Star + / 12116 / Veteran’s Administration – Dental
63092 / HealthSpring HMO Medicare + Choice(Also 52192) / 63114 / Viva Health Plan
47181 / Highmark Health Options(Also enroll 25169, 45276, 91741) / 77073 / VNS Choice Medicare
55247 / HIP-Health Ins Plan Greater NY (13551,25531,78375) / 91136 / Welfare and Pension Admin. Service
86066 / HMA Hawaii / WELM2 / WellMed (enroll with TH023)
84555 / HMO Louisiana – Blue Medicare Advantage / 45276 / West Virginia Family Health Plan (Also enroll 25169, 91741, 47181)
66003 / Hopkins Health Advantage / WVS01 / West Virginia Senior Advantage
22326 / Horizon New Jersey Health / 31048 / Western Southern Financial Group
33884 / iCircle of New York
35161 / Indiana Prohealth Network
95444 / Indiana University Health Plans
52123 / Johns Hopkins Healthcare (Also Enroll 52189)
91617 / *Kaiser Foundation Health Plan of CO
21313 / *Kaiser Foundation Health Plan of GA
94123 / *Kaiser Foundation Health Plan of HI
94135 / *Kaiser Foundation Health Plan of Northern CA
52095 / *Kaiser Foundation Health Plan of Mid-Atlantic
94134 / *Kaiser Foundation Health Plan of So CA
*Note: / Provider must also complete enrollment at
all Kaiser plans
using the following information:
Clearinghouse: ChangeHealthcare
Trading Partner ID: 133052274
Claim Enrollment Payers
HIMCD / Hawaii Medicaid (Enroll with SKHI0)
Claim and ERA Enrollment Payers / PRBLS / Puerto Rico Blue Shield and 835
77078 / Banner Medisun (AZ BCBS Advantage)
22099 / Horizon Healthcare of New Jersey and 835
Page 1 of 32018-10-03