assurance™ edi - claim status payer list€¦ · assurance™ edi - claim status payer list to...

Assurance™ EDI - Claim Status Payer List

To request a claim status connection to a payer not on the list below, please submit a New Payer Connection

Request.

Reference the CAQH web site for CORE Certified payers.

Batch and Real Time: Reference the ASC X12N/005010X212 ANSI Health Care Claim Status Request and

Response (276/277) guide to obtain the mapping of claim status transactions for Change Healthcare ASC X12N

V.5010 Input.

The Change Healthcare Claim Status Batch and Real Time Payer IDs below must be sent in all Batch and Real

Time 276 transactions.

Be aware all Claim Status transaction processing is a contracted service with Change Healthcare. Please

contact your Account Executive if you are not contracted.

See Legend for explanation of Payer List.

Payer Name Change

Healthcare

Claim Status

Batch or Real

Time Payer ID

Change

Healthcare

Claim Status

Portal Payer ID

Associated

Change

Healthcare

Claims CPIDs

Authorization

Required

Payer-

assigned

Payer ID

Routing

Method

Must Submit

Claims to Change

Healthcare -

Batch and Real

Time only

AARP AARP AARP1 5271/8940 Portal 36273 Real Time /

Portal

No

Absolute Total Care CNTENE 8549/4272 No 68069 Real Time No

Advantage By Buckeye (Bridgeway

Advantage Plan)

CNTENE 4793/9564 No 68069 Real Time No

AETNA AETNA AETNA1 4500/6400 Portal 60054 Real Time /

Portal

No

https://agreements.transactions.mckhboc.com/Agreements/viewer.html

https://agreements.transactions.mckhboc.com/Agreements/viewer.html

http://www.caqh.org/benefits.php

Aetna Better Health of Ohio ABHOH1 6876/7652 Portal 50023 Portal

Aetna Better Health of Virginia t CHCCN 1837/8538 No 25142 Real Time No

Alabama Blue Shield (Professional) ALBCSP 2423 No 00510 Real Time No

Alabama Blue Cross (Institutional) ALBCSI 5558 No 00010BC Real Time No

Alabama Medicaid ALCAID 4479/5560/5587 No 752548221 Real Time No

Alabama Medicare (Professional) 2468 2468 No 10102 Batch Yes

Alabama Medicare (Institutional) 5559 5559 No 10101 Batch Yes

Alaska Medicare (Institutional) 5521 5521 Batch 02001 Batch Yes

Alliant Health Plans ALLNT1 2589/3793 Portal 58234 Portal

Allwell from Buckeye Health Plan CNTENE 7776/7592 No 68069 Real Time No

Allwell from Health Net CNTENE 7766/7570 No 68069 Real Time No

Allwell from Home State Health CNTENE 7775/7591 No 68069 Real Time No

Allwell from Louisiana Healthcare

Connections


Allwell from Managed Health Services CNTENE 7770/7582 No 68069 Real Time No

Allwell from Managed Health Services Health

Wisconsin


Allwell from Magnolia Health CNTENE 7774/7589 No 68069 Real Time No

Allwell from PA Health & Wellness CNTENE 7783/8524 No 68069 Real Time No

Allwell from Peach State Health Plan CNTENE 7769/7581 No 68069 Real Time No

Allwell from Sunflower Health Plan CNTENE 7772/7586 No 68069 Real Time No

Allwell from Sunshine Health CNTENE 7768/7578 No 68069 Real Time No

Allwell from Superior HealthPlan CNTENE 7785/8527 No 68069 Real Time No

Allwell from Buckeye Health Plan CNTENE 7776/7592 No 68069 Real Time No

Allwell from Health Net CNTENE 7766/7570 No 68069 Real Time No

Altius ALTIUS 1837/8538 No SX113 Real Time No

Ambetter from Health Net CNTENE 7808/8583 No 68069 Real Time No

Ambetter from Homestate Health CNTENE 7809/8584 No 68069 Real Time No

Ambetter from Peach State Health Plan CNTENE 6655/6756 No 68069 Real Time No

Ambetter Illinicare Health CNTENE 7286/9587 No 68069 Real Time No

Ambetter New Hampshire Healthy Families CNTENE 7287/9588 No 68069 Real Time No

American Postal Workers AMPWU 4503/6436 No 44444 Real Time No

Amerigroup Corporation AMRGRP AMRGR1 1569/1741 Portal 27514 Real Time /

Portal

No

AmeriHealth Caritas Delaware AHCDE 78507/7746 No 77799 Real Time No

Anthem Blue Cross CABC 3511/4417 No 47198 Real Time No

Arizona Blue Cross Blue Shield AZBCBS 4426/5547 No 53589 Real Time No

Arizona Medicare (Professional) 1456 1456 Batch 03102 Batch Yes

Arizona Medicare (Institutional) 5546 5546 Batch 03101 Batch Yes

Arkansas Medicaid (Institutional) 1489 1489 No 716007869 Batch No

Arkansas Medicaid (Institutional) 5597 5597 No 716007869 Batch No

Arkansas Medicare (Professional) 2455 2455 No 07102 Batch Yes

Arkansas Medicare (Institutional) 1526 1526 No 07101 Batch Yes

Asuris Northwest Regence ASURNH 5942/4881 No 93221 Real Time No

AvMed AVMED 1573/3802 No 59274 Real Time No

Best Life and Health BSTLFE No 95604 Real Time No

Blue Care Network HMO (Professional) MIBCSP 2426 Real Time 00710 Real Time Yes

Blue Care Network HMO (Institutional) MIBCSI 3532 Real Time 00210 Real Time Yes

Blue Cross Blue Shield of National Capital

Area - CareFirst

DCBCBS 1509/2425 No 00080

00580

Real Time No

Blue Cross Blue Shield of Western New York

Medicaid / CHP

BWNYMC 1169/2516 No 00246 Real Time No

Bridgeway Health Solutions CNTENE 3922/4288 No 68069 Real Time No

Buckeye Community Health CNTENE 1962/4717 No 68069 Real Time No

California Blue Shield CABS CABS1 1409/6569 No BS001

94036

Real Time /

Portal

No

California Health and Wellness CNTENE 6646/6748 No 68069 Real Time No

CareSource of Indiana CSRCIN 7143/7688 No INCS1 Real Time Yes

CareSource of Kentucky - Humana CSRCKY 5624/6259 No KYCS1 Real Time Yes

CareSource of Ohio CRSROH CRSRC1 2526/3826 Portal 31114 Batch / Portal Yes

CareSource of West Virginia 2526 7263/8676 No WVCS1 Real Time Yes

CeltiCare Massachusetts Behavioral Health CENPAT 5957/2128 No 68068 Real Time No

CeltiCare Massachusetts Medical CNTENE 5958/2129 No 68069 Real Time No

Cenpatico Behavioral Health – Arizona CENPAT 4909/6136 No 68068 Real Time No

Cenpatico Behavioral Health – Florida CENPAT 1630/2190 No 68068 Real Time No

Cenpatico Behavioral Health – Georgia CENPAT 3912/4239 No 68068 Real Time No

Cenpatico Behavioral Health – Illinois CENPAT 4663/6212 No 68068 Real Time No

Cenpatico Behavioral Health – Indiana CENPAT 2985/3236 No 68068 Real Time No

Cenpatico Behavioral Health – Kansas CENPAT 3663/5207 No 68068 Real Time No

Cenpatico Behavioral Health – Mississippi CENPAT 5638/6268 No 68068 Real Time No

Cenpatico Behavioral Health – Missouri CENPAT 4692/6215 No 68068 Real Time No

Cenpatico Behavioral Health – Ohio CENPAT 1660/2175 No 68068 Real Time No

Cenpatico Behavioral Health – South

Carolina

CENPAT 4676/6205 No 68068 Real Time No

Cenpatico Behavioral Health – Texas CENPAT 3962/4746 No 68068 Real Time No

Cenpatico Behavioral Health – Wisconsin CENPAT 4927/3220 No 68068 Real Time No

Cenpatico Behavioral Health of New

Hampshire

CENPAT 5629/6263 No 68068 Real Time No

CHAMPVA / Spina Bifida / Children of

Women Vietnam Veterans

CHMPVA No 84146 Real Time No

CIGNA CIGNA CGONL1 4509/6405 Portall 62308 Real Time / No

Portal

Colorado Blue Cross Blue Shield COBCBS 1415/1549 No 00050 Real Time No

Colorado Medicare (Professional) 1449 1449 No 04112 Batch Yes

Colorado Medicare (Institutional) 1547 1547 No 04111 Batch Yes

Community Health Choice COMHC 2538/3773 No 48145 Real Time No

Community Health Choice – HIM COMHC 6687/6791 No 60495 Real Time No

Connecticut Blue Cross Blue Shield CTBCBS 1420/3534 No 00060 Real Time No

Connecticut Medicaid (Institutional) 3535 3535 No 061274678 Batch No

Connecticut Medicaid (Professional) 4476 4476 No 061274678 Batch No

Connecticut Medicare (Professional) 1452 1452 Batch 13102 Batch No

Connecticut Medicare (Institutional) 3533 3533 Batch 13101 Batch No

Continental General Insurance Company CONGEN 3865 No 71404 Real Time No

Coordinated Care CNTENE 4665/6197 No 68069 Real Time No

Cooperative Benefit Administrators CPBNAD 4532/6452 No 52132 Real Time No

Coresource of Kansas CIty CSFMH No 48117 Real Time No

Coresource of Little Rock ARCSRC 1983/3806 No 75136 Real Time No

Coresource of Ohio OHCSRC 3524/4947 No 35183 Real Time No

CoventryCares of Michigan OMNCRE 1837/8538 No 25150 Real Time No

Coventry Health and Life Nevada CVHLNV No 25133 Real Time No

Coventry Health and Life Oklahoma CVHLOK 1837/8538 No 25133 Real Time No

Coventry Health and Life Tennessee CVHLTN 1837/8538 No 25141 Real Time No

Coventry Health and Life WellPath WPCHC 1837/8538 No 25133 Real Time No

Coventry Health Care Advantra (Arizona,

New Mexico, Texas only)

CHCADV 1837/8538 No 25152 Real Time No

Coventry Health Care Advantra Freedom CHCADF 1837/8538 No 25152 Real Time No

Coventry Health Care CareLink CHCCL 1837/8538 No 25140 Real Time No

Coventry Health Care CoventryOne CHCCVT 1837/8538 No 25133 Real Time No

Coventry Health Care Delaware DECHC 8545 No 25130 Real Time No

Coventry Health Care Florida Vista Summit FLCHC 1837/8538 No 10551 Real Time No

Coventry Health Care Federal CHCFED 1837/8538 No Real Time No

Coventry Health Care Georgia GACHC 1837/8538 No 25127 Real Time No

Coventry Health Care Group Health Plan CHCGHP No 25141 Real Time No

Coventry Health Care HealthAmerica CHCHA 1837/8538 No 25126 Real Time No

Coventry Health Care Illinois / Personal Care PRSNLC 1837/8538 No 25146 Real Time No

Coventry Health Care Iowa IACHC 1837/8538 No 25132 Real Time No

Coventry Health Care Kansas KSCHC No 10208 Real Time No

Coventry Health Care Louisiana LACHC 1837/8538 No 25135 Real Time No

Coventry Health Care Missouri CHCMO 1837/8538 No 87043

25133

Real Time No

Coventry Health Care National Network

(formerly First Health)

FRSTHL 2875/8538 No 73159 Real Time No

Coventry Health Care Nebraska NECHC 1837/8538 No 25136 Real Time No

Coventry Health Care Southern Health

Systems

CHCSHS 1837/8538 No 25128 Real Time No

Coventry Health Care University of Missouri CHCUOM No Real Time No

Coventry Health Care Vista CHCVST 1837/8538 No 55248 Real Time No

Delaware Highmark Blue Cross Blue Shield

– Professional

DEBCSP 7456 No 00570 Real Time Yes

Delaware Highmark Blue Cross Blue Shield -

Institutional

DEBCSI 1546 No 00070 Real Time Yes

Delaware Medicaid (Professional) 2726 2726 No DE_TXIX Batch No

Delaware Medicaid (Institutional) 1545 1545 No DE_TXIX Batch No

Delaware Medicare (Professional) 2456 2456 No 12102 Batch Yes

Delaware Medicare (Institutional) 5912 5912 No 12101 Batch Yes

District of Columbia Medicare (Professional) 2459 2459 No 12202 Batch Yes

District of Columbia Medicare (Institutional) 1522 1522 No 12201 Batch Yes

Elder Health Bravo Health ELDRHL 1978/3839 No 52192 Real Time No

Employee Benefit Management Services –

EBMS Healtheweb

EBMS 2947/5483 No 81039 Real Time No

Fallon Community Health Plan FALLON 1537/3801 No FALLON83

7I

Real Time No

Federally Qualified Healthcare Clinics

(FQHC)

1505 1505 Batch 06001 Batch No

Federated Insurance Company FEDICO No 41041 Real Time No

Florida Blue Shield 1414 FLBCS1 1414 Portal 00590 Batch / Portal No

Florida Blue Cross 3517 FLBCS1 3517 Portal 00590 Batch / Portal No

Florida Health Care Plans FLHLTH 2150/3693 No 59322 Real Time

Florida Medicaid FLCAID 1478/3516 No 77027 Real Time No

Florida Medicare (Professional) 1448 1448 Batch 09102 Batch Yes

Florida Medicare (Institutional) 3518 3518 Batch 09101 Batch Yes

Gateway Health Plan – Medicaid PA GATEHP 4569/8472 No 25169 Real Time No

Gateway Health Plan – Medicare Assured

OH

GATEHP 6641/6742 No 91741 Real Time No

Gateway Health Plan – Medicare Assured

PA

GATEHP 2298/2912 No 60550 Real Time No

Geisinger Health Plan GEISH1 2559/5473 No 75273 Portal

Georgia Blue Cross Blue Shield GABCBS 1407/3537 No 00101

00601

Real Time No

Georgia Medicaid- Professional 1494 1494 No 77034 Batch No

Georgia Medicaid - Institutional 3538 3538 No 77034 Batch No

Georgia Medicare - Professional 1466 1466 No 10202 Batch Yes

Georgia Medicare - Institutional 3536 3536 No 110201 Batch No

Government Employee Hospital Association

(GEHA)

GEHA 1579/6467 No 44054 Real Time No

Hawaii Blue Cross (Institutional) 1518 1518 Batch 990040115 Batch No

Hawaii HMSA (Professional) 2714 2714 Batch 990040115 Batch No

Hawaii Quest 1555 1555 No 990040115 Batch Yes

Health Alliance Plan of Michigan HLTMI1 6466/6513 Portal 382242827 Portal

Health Net of Arizona HLTHNT MCHLN1 2598/2445 Portal 38309 Real Time /

Portal

Health Net of Arizona, California, and

Oregon

Health Net Individual Medicare

Advantage Plan

Health Net Individual Family Plans


Health Net of California - Claims HLTHNT MCHLN1 2855/6514 Portal 95567 Real Time /

Portal

Health Net of Oregon HLTHNT MCHLN1 5709 Portal 95567 Real Time /

Portal

Health Partners of Minnesota HLPRT1 1525/3411 Portal HEALTHPA

RTNERS

Portal

Health Partners of Philadelphia HPPHIL 2822 No 80142 Real Time No

Hennepin Health METHPL 1566/2787 No Real Time No

Highmark N+BCBS DE Health Options GHPHHO 7148/7693 No 47181 Real Time No

Home Health Medicare Region IV Gulf Coast 3597 3597 No 11001 Batch No

Home Health Medicare Region IV Southwest 5544 5544 No 11001 Batch No

Home Health Medicare Region VII 1987 1987 No 15004 Batch No

HomeState Health Plan CNTENE 4652/6196 No 68069 Real Time No

Horizon New Jersey Health (Professional) HZMRCY 1709 No 22326 Real Time No

Horizon New Jersey Health (Institutional) HZMRCY 6534 No 22326 Real Time No

Humana (Professional) 2449 HUMAN1 2449 Portal 61101 Batch / Portal No

Humana (Institutional) 4544 HUMAN1 4544 Portal 61101 Batch / Portal No

Idaho Blue Cross Blue Shield Regence IDBCS 3540/7426 No 00611 Real Time No

Idaho Medicaid (Professional) 7427 7427 No 445454161 Batch

Idaho Medicaid (Institutional) 5583 5583 No 445454161 Batch

Idaho Medicare (Professional) 2465 2465 Batch 02202 Batch Yes

Idaho Medicare (Institutional) 5581 5581 Batch 02001 Batch Yes

Illinicare Group Health CNTENE 1635/6120 No 68069 Real Time No

Illinois Blue Cross Blue Shield ILBCBS 1405/5508 No 00621 Real Time No

Illinois Medicaid ILMCDP

ILMCDI

ILCAI1 1563/2488 No 37-1320188 Real Time /

Portal

Illinois Medicare (Professional) 1437 1437 Batch 06102 Batch No

Illinois Medicare (Institutional) 5506 5506 Batch 06101 Batch No

IMCare IMCARE 1942/3764 No 41600 Real Time No

Indiana Blue Cross Blue Shield INBCBS 1412/3502 No 00630

00130

Real Time No

Indiana Medicaid - Professional 1474 1474 No HP Batch No

Indiana Medicaid (Institutional) 3501 3501 No HP Batch No

Indiana Medicare (Professional) 1445 1445 Batch 08102 Batch Yes

Indiana Medicare (Institutional) 3500 3500 Batch 00130 Batch No

Iowa Medicaid (Professional) 1469 1469 Batch 18049 Batch Yes

Iowa Medicaid (Institutional) 2571 2571 Batch 18049 Batch Yes

Iowa Medicare (Professional) 1438 1438 Batch 05102 Batch Yes

Iowa Medicare (Institutional) 2537 2537 Batch 05101 Batch Yes

Iowa Wellmark Blue Cross Blue Shield IABCBS WLMRK1 1404/1510 No 88848 Real Time /

Portal

No

J5 National Part A 2535 2535 Batch 05901 Batch No

Kaiser Foundation Health Plan of Colorado COKAIS 1931/2439 No RH003 Real Time No

Kaiser Foundation Health Plan of Mid-

Atlantic

KAISMA 2819/7506 No RH010 Real Time No

Kaiser Foundation Health Plan of Northern

California Region

KSRNCA 2582/3781 No 94135

RH009

Real Time No

Kaiser Foundation Health Plan of Southern

California Region

KSRSCA 1703/4576 No 94134 Real Time No

Kaiser Foundation Health Plan of the

Northwest

KAISNW 1544/2266 No RH002 Real Time No

Kansas Blue Cross Blue Shield KSBCBS 2422/5519 No 47163 Real Time No

Kansas Medicare (Professional) 2463 2463 Batch 05202 Batch Yes

Kansas Medicare (Institutional) 5518 5518 Batch 05201 Batch Yes

Kentucky Blue Cross Blue Shield KYBCBS 2421/5534 No SB660 Real Time No

Kentucky Medicaid KYCAID 1493/5535 No KYMEDICA

ID

Real Time No

Kentucky Medicare - Professional 2462 2462 No 15102 Batch Yes

Kentucky Medicare (Institutional) 5533 5533 No 15101 Batch Yes

Louisiana Blue Shield 2758 2758 No 53120 Batch Yes

Louisiana Blue Cross 3580 3580 No 53120 Batch Yes

Louisiana Health Connections CNTENE 4639/6157 No 68069 Real Time No

Louisiana Medicare (Professional) 1460 1460 No 07202 Batch Yes

Louisiana Medicare (Institutional) 3579 3579 No 07201 Batch Yes

Magnolia Health Plan (Mississippi) CNTENE 1611/5286 No 68069 Real Time No

Mail Handlers Benefit Plan (formerly First

Health for Mail Handlers)

FHFMH 1837/8538 No 62413 Real Time No

Maine Blue Cross Blue Shield MEBCBS 3548/7446 No 20180

00680

Real Time No

Maine Medicaid MECAID 5259/9582 No ME_MMIA_

4MOLINA

Real Time No

Maine Medicare (Professional) 2472 2472 Batch 14112 Batch No

Maine Medicare (Institutional) 3547 3547 Batch 14011 Batch No

Managed Health Services - Indiana CNTENE 1562/2703 No 68069 Real Time No

Managed Health Services - Wisconsin CNTENE 3504/2702 No 68069 Real Time No

Maryland Blue Cross Blue Shield - CareFirst MDBCBS 2419/7518 No 00690

00190

Real Time No

Maryland Medicare (Professional) 7402 7402 No 12302 Batch Yes

Maryland Medicare (Institutional)) 5554 5554 No 12301 Batch Yes

Maryland Medicare (Montgomery, Prince

George) (Professional)

2464 2464 No 12202 Batch Yes

Maryland Physicians Care CNTENE 1597/2833 No 41001 Real Time No

Massachusetts Blue Cross Blue Shield MABCBS 2424/5528 No 00200 Real Time No

Massachusetts Medicaid (Professional) 4491, 4492 4491/4492 No DMA7384 Batch No

Massachusetts Medicaid (Institutional) 5529 5529 No DMA7384 Batch No

Massachusetts Medicare (Professional) 2469 2469 Batch 14212 Batch No

Massachusetts Medicare (Institutional) 5527 5527 Batch 14211 Batch No

Mayo Clinic Health Solutions MMSI 2752/7577 No 41154 Real Time No

MDWise, Inc. WISE 4481/4976 No SX172 /

12K81

Real Time No

Medica Health Plan UHC 3429/3550 No 87726 Real Time No

Medical Mutual of Ohio MMUTOH 3506/4423 No 29076 Real Time Yes

Medicare DME MAC Jurisdiction A 7475 7475 Batch 16013 Batch No

Medicare DME MAC Jurisdiction B 7476 7476 Batch 17013 Batch No

Medicare DME MAC Jurisdiction C 7477 7477 Batch 18003 Batch No

Medicare DME MAC Jurisdiction D 7478 7478 Batch 19003 Batch No

Medicare Plus Blue - Medicare Advantage

Plan (Professional)

MIBCSP 2287 Real Time 00710 Real Time Yes

Medicare Plus Blue - Medicare Advantage

Plan (Institutional)

MIBCSI 1913 Real Time 00210 Real Time Yes

Meridian Health Plan of Michigan MERID1 2262/4560 Portal 52563 Portal

Meritain Health Minneapolis MERMN1 1708/4561 Portal 41124 Portal

MetroPlus Health Plan METPL 2296/8972 No 13265 Real Time No

Michigan Blue Cross Blue Shield

(Professional)

MIBCSP 1421 Real Time 00710 Real Time Yes

Michigan Blue Cross Blue Shield

(Institutional)

MIBCSI 3514 Real Time 00210 Real Time Yes

Michigan Medicaid (Professional) 2480 2480 No D00111 Batch Yes

Michigan Medicaid (Institutional) 3512 3512 No D00111 Batch Yes

Michigan Medicare (Professional) 1461 1461 Batch 00953 Batch Yes

Michigan Medicare (Institutional) 3515 3515 Batch 08201 Batch Yes

Minnesota Blue Cross Blue Shield MNBCB1 1402/1513 Portal 00220 Portal

Minnesota Medicaid (Professional) 1468 1468 No 411674742 Batch No

Minnesota Medicaid (Institutional) 1568 1568 No 411674742 Batch No

Minnesota Medicare (Professional) 1435 1435 Batch 06202 Batch Yes

Minnesota Medicare (Institutional) 3521 3521 Batch 06201 Batch No

Mississippi Blue Cross Blue Shield MSBCBS 5555/2415 No 00230 Real Time No

Mississippi Medicaid MSCAID 1490/5557 No SKMS0 Real Time No

Mississippi Medicare (Professional) 2451 2451 No 07302 Batch Yes

Mississippi Medicare (Institutional) 5556 5556 No 07301 Batch Yes

Missouri Blue Cross Blue Shield - St. Louis

MO

MOBCBS MOBCS1 1408/2597 Portal 00241 Real Time /

Portal

No

Missouri Blue Cross Blue Shield of Kansas

City

KCBCBS 4419/5569 No 47171 Real Time No

Missouri Medicaid MOCAID 1471/5571 No 43175487

0954897

Real Time No

Missouri Medicare Eastern (Professional) 1441 1441 Batch 05302 Batch Yes

Missouri Medicare Eastern (Institutional) 5572 5572 Batch 05301 Batch Yes

Missouri Northwest Medicare - Kansas City,

MO

4451 4451 Batch 05302 Batch Yes

Molina Healthcare of California CAMLNA 1423/3539 No 38333 Real Time No

Molina Healthcare of Florida FLMLNA 4879/8913 No 51062 Real Time No

Molina Healthcare of Michigan MIMLNA 3551/5443 No 38334 Real Time No

Molina Healthcare of Texas TXMLNA 4226/4957 No 20554 Real Time No

Molina Healthcare of Utah UTMLNA 4237 No 12X09 Real Time No

Molina Healthcare of Washington WAMLNA 1863/2561 No 38336 Real Time No

Montana Blue Cross Blue Shield MTBCBS 5585/7450 No G00751 Real Time Yes

Mountain State Blue Cross Blue Shield

(West Virginia)

WVBCP

WVBCI

3589/7474 No 54828 Real Time Yes

Medical Mutual of Ohio MMUTOH 2290/2935 No 34192 Real Time Yes

Mutual of Omaha MUTOHM 2420/4530 No 71412 Real Time Yes

Nationwide Specialty Health NWHPLN 2977/6487 No 31417 Real Time No

Nebraska Blue Cross Blue Shield NEBCBS NEBCB1 1417/1521 Portal 00760

00260

Real-Time /

Portal

No

Nebraska Medicare (Professional) 1451 1451 Batch 05402 Batch Yes

Nebraska Medicare (Institutional) 1519 1519 Batch 05401 Batch Yes

Nebraska Total Care CNTENE 1164/2508 No 68069 Real Time No

Nevada Blue Cross Blue Shield NVBCBS 2906/7496 No 00265 Real Time No

Nevada Medicare (Professional) 1446 1446 Batch 01312 Batch Yes

Nevada Medicare (Institutional) 5907 5907 Batch 01311 Batch Yes

New Hampshire Blue Cross Blue Shield NHBCBS 1512/7422 No 12B21 Real Time No

New Hampshire Healthy Families CNTENE 5628/6262 No 00270

00770

Real Time No

New Hampshire Medicaid (Professional) 7423 7423 Batch 026000618 Batch No

New Hampshire Medicaid (Institutional) 2575 2575 Batch 026000618 Batch No

New Hampshire Medicare (Professional) 2470 2470 Batch 14312 Batch No

New Hampshire Medicare (Institutional) 2528 2528 Batch 14013 Batch No

New Jersey Blue Cross Blue Shield NJBCBS 2414/5526 No 22099 Real Time No

New Jersey Medicare (Institutional) 5503 5503 No 12401 Batch Yes

New Mexico Blue Cross Blue Shield NMBCBS 5565/7403 No 00790 Real Time No

New Mexico Medicare (Professional) 1457 1457 No 04212 Batch Yes

New Mexico Medicare (Institutional) 5566 5566 No 04211 Batch Yes

New York Empire Blue Cross Blue Shield EMHECH 3520/4437 No 00303

00803

Real Time No

New York Empire Medicare (Professional) 4442 4442 Batch 13202 Batch No

New York Empire Medicare (Institutional) 3519 3519 Batch 13201 Batch No

New York Excellus Blue Cross Blue Shield

Central Region

NYEXCL 3618/3449 No 00305

00805

Real Time No


Rochester

NYEXCL 3528/4408 No 00304

00804

Real Time No


Utica/Watertown

NYEXCL 3526/7432 No 00306

00806

Real Time No

New York Medicaid (Professional) 1422 1422 No 141797357 Batch Yes

New York Medicaid (Institutional) 1500 1500 No 141797357 Batch Yes

New York Medicare GHI (Professional) 7401 7401 Batch 13292 Batch No

New York Medicare (Upstate) (Professional) 1463 1463 Batch 13282 Batch No

Nippon Life Insurance Company of America NLICOA 6443/6539 No 81264 Real Time No

North Carolina Blue Cross Blue Shield NCBCBS 1411/3562 No 560894904 Real Time No

North Carolina Medicaid (Professional) 1480 NCCAI1 1480 Batch

Portal

DNC00 Batch / Portal No

North Carolina Medicaid (Institutional) 3564 NCCAI1 3564 Batch

Portal

DNC00 Batch / Portal No

North Carolina Medicare (Professional) 1464 1464 No 11502 Batch No

North Carolina Medicare (Institutional) 3563 3563 No 11501 Batch No

North Dakota Blue Cross Blue Shield

(Professional)


North Dakota Blue Cross Blue Shield

(Institutional)


North Dakota Medicaid (Institutional) NDCAID 5594 No NDDHSME

D

Real Time Yes

North Dakota Medicare (Professional) 2453 2453 Batch 03302 Batch Yes

North Dakota Medicare (Institutional) 1523 1523 Batch 03301 Batch Yes

Northern California Medicare 1436 1436 Batch 01112 Batch No

Ohio Blue Cross Blue Shield OHBCBS OHBCB1 2418/3505 No 00834

00332

Real Time /

Portal

No

Ohio Medicaid (Professional) 2481 2481 No MMISODJF

S

Batch No

Ohio Medicaid (Institutional) 3509 3509 No MMISODJF

S

Batch No

Ohio Medicare (Professional) 1447 1447 No 15202 Batch Yes

Ohio Medicare (Institutional) 3507 3507 No 15201 Batch Yes

Oklahoma Medicaid (Professional) 2753 2753 Batch 731476619 Batch Yes

Oklahoma Medicaid (Institutional) 3594 3594 Batch 731476619 Batch Yes

Oklahoma Medicare (Professional) 1458 1458 No 04312 Batch Yes

Oklahoma Medicare (Institutional) 1558 1558 No 04311 Batch Yes

Oregon Blue Cross Blue Shield Regence ORRBCS REBCS1 2404/5516 Portal 00851 Real Time /

Portal

No

Oregon Medicare (Professional) 1459 1459 Batch 02302 Batch Yes

Oregon Medicare (Institutional) 5515 5515 Batch 102001 Batch Yes

PA Health and Wellness CNTENE 6582/7740 No 68069 Real Time No

PacificSource Administrators (PSA) PSHLTH 3627/5805 No 93031 Real Time No

PacificSource Health Plans PSHLTH 5441/6575 No 93029 Real Time No

PacificSource Medicare PSHLTH 4627/6147 No 20377 Real Time No

Paramount (Professional) 3275 3275 No 419887250

0

Batch No

Paramount (Institutional) 5977 5977 No 419887250

0

Batch No

Peach State Health Plan (GA Medicaid

CMO)


Pennsylvania Blue Cross Blue Shield PABCBS 2413 No 54771 Real Time Yes

Pennsylvania Blue Cross Blue Shield Central PABCBS 2534/3587 No 54771W

54771C

Real Time Yes

Pennsylvania Blue Cross Western PABCBS 2534 No 54771W Real Time Yes

Pennsylvania Capital Blue Cross (Physician

Contracted Providers)

PACAPB 5599/7705 Real Time 361

23045

Real Time No

Pennsylvania Independence Blue Cross PAIBC1 2781/3560 No 54704 Portal

Pennsylvania Medicaid (Professional) 1491 1491 No 236003113 Batch Yes

Pennsylvania Medicaid (Institutional) 5509 5509 No 236003113 Batch Yes

Pennsylvania Medicare (Professional) 2457 2457 No 12502 Batch Yes

Pennsylvania Medicare (Institutional) 5598 5598 No 12501 Batch Yes

Physician Health Plan of Mid Michigan PHPMI 1936/2498 No 37330 Real Time

Physician Health Plan of Northern Indiana PHPNI 3596/3815 No 12399 Real Time Yes

Preferred One of Minnesota PRFON1 3410/8578 Portal 411479744 Portal

Prime West PRMWST 1565/2786 No 11678 Real Time No

Priority Health of Michigan (Professional) 7459 PRIRT1 7459 Portal PRIORITY Batch / Portal No

Priority Health of Michigan (Institutional) 3591 PRIRT1 3591 Portal PRIORITY

HEALTH

Batch / Portal No

Quartz ASO QUARTZ 7264/8677 No QUARTZAS

O

Real Time Yes

RHHI Home Health Region V - Service Area

7


Rhode Island Medicare (Professional) 7419 7419 Batch 14412 Batch No

Rhode Island Medicare (Institutional) 5578 5578 Batch 14411 Batch No

Rural Health Medicare 1506 1506 No 10301 Batch No

Significa Benefit Services, Inc. (formerly Erin

Group)

ERINGP 5469/7532 No 23250 Real Time No

Silver Summit Health Plan CNTENE 1263/5542 No 68069 Real Time No

South Carolina Blue Shield (Professional) 2410 2410 No 401 Batch No

South Carolina Blue Cross (Institutional) 1559 1559 No 401 Batch No

South Carolina Blue Cross Blue Shield SCBCBS SCBCB1 2410/1559 No 401 Real Time /

Portal

No

South Carolina Medicaid (Professional) 1484 1484 Batch SCXIX Batch No

South Carolina Medicaid (Institutional) 5540 5540 Batch SCXIX Batch No

South Carolina Medicare (Professional) 2452 2452 No 11202 Batch No

South Carolina Medicare (Institutional) 1560 1560 No 11001 Batch No

South Dakota Blue Cross Blue Shield IABCBS WLMRK1 1510/2490 No 88848 Real Time / No

Portal

South Dakota Medicaid (Professional) 4478 4478 No SD48MED Batch No

South Dakota Medicaid (Institutional) 5591 5591 SD48MED Batch No

Southern California Medicare 1444 1444 Batch 01182 Batch No

Sunflower State CNTENE 5613/6249 No 68069 Real Time No

Sunshine State CNTENE 5947/2111 No 68069 Real Time No

Superior Health Plan of Texas CNTENE 3522/2701 No 68069 Real Time No

Tennessee Blue Cross Blue Shield TNBCBS 2401/5513 No 00890

00390

Real-Time No

Tennessee BlueCare/TennCare TNBCBS 2495/5514 No 00890

00390

Real-Time No

Tennessee Medicare - Professional 1453 1453 No 10302 Batch Yes

Tennessee Medicare - Institutional 5525 5525 No 10301 Batch No

Texas Medicaid (Professional) 1470 1470 Batch 617591011

C21P

Batch No

Texas Medicaid (Institutional) 5500 5500 Batch 617591011

C21P

Batch No

Texas Medicare (Professional) 1440 1440 No 04412 Batch Yes

Texas Medicare (Institutional) 5502 5502 No 04411 Batch Yes

Three Rivers Health Plan (Unison Health

Plan) (PA)

TRHPLN 2809/7531 No 25175 Real Time No

TriCare – West Region TRICAR 5648/6286 No 99726 Real Time

UCare of Minnesota MNUCA1 1531/4496 Portal 363573805 Portal No

Ultimate Heath Plans ULTHP 6868/7646 No 77022 Real Time

United Healthcare UHC UHC2 3429/3550 Portal 87726 Real Time / Portal

United Medical Resources UMR1 4590/5402 Portal 39026 Portal

UnitedHealthcare Arizona Physicians IPA AZPIPA 1585/3432 No 03432 Real Time No

UnitedHealthcare Community Plan of Ohio TRHPLN 2809/7531 No 25175 Real Time No

Unity Health Insurance UNTYHP 2791/2901 No 1UNTY Real Time No

UPMC Health Plan UPMC1 2803/7543 Portal 95216 Portal

Utah Blue Cross Blue Shield Regence UTREBS 1529/2412 No HT000001-

001

HT000001-

100

Real Time No

Utah Medicaid UTCAID 1486/1528 No HT000004-

001

Real Time No

Utah Medicaid Crossover UTCAID 6640/6801 No HT000004-

005

Real Time No

Vermont Blue Cross Blue Shield VTBCBS 4967/7493 No BCBSVT Real Time No

Vermont Medicaid (Professional) 7492 7492 Batch 752548221 Batch No

Vermont Medicaid - Inpatient (Institutional) 3569 3569 Batch 752548221 Batch No

Vermont Medicaid - Outpatient (Institutional) 3570 3570 Batch 752548221 Batch No

Vermont Medicare (Professional) 2471 2471 Batch 14512 Batch No

Vermont Medicare (Institutional) 5954 5954 Batch 14013 Batch No

Veteran's Administration Fee Basis Program VETFBP 1507/3887 No 12115 Real Time No

Virginia Blue Cross Blue Shield VABCBS 1413/5537 No 058916206

CMSCOS

Real Time No

Virginia Medicaid (Professional) 1472 1472 Batch VMAP

FHSC FA

Batch No

Virginia Medicaid (Institutinal) 5538 5538 Batch VMAP

FHSC FA

Batch No

Virginia Medicaid Lab (Professional) 7447 7447 Batch VMAP

FHSC FA

Batch No

Virginia Medicare (Professional) 1442 1442 No 11302 Batch No

Virginia Medicare (Institutional) 5536 5536 No 11003 Batch No

Virginia Medicare

(Alexandria,Arlington,Fairfax) (Professional)

2461 2461 No 12202 Batch Yes

Washington and Alaska Medicare

(Institutional)

5521 5521 Batch 02001 Batch

Washington and Alaska Premera Blue Shield

(Professional)

7445 7445 No 00430 Batch No

Washington and Alaska Premera Blue Cross 5522 5522 No 00430 Batch No

(Institutional)

Washington Blue Cross Blue Shield Regence WARBCS 1997/7451 No 00932 Real Time No

Washington Medicaid WACADP

WACADI

1482/5523 No 77045 Real Time No

Washington Medicare (Professional) 1462 1462 Batch 02402 Batch

Wellcare Health Plan WELLCR WELLC1 1844/8551 Portal 14163 Real Time /

Portal

No

West Virginia Family Health Plan WVFMHP 6650/6752 No 45276 Real Time

West Virginia Blue Cross Blue Shield WVBCI

WVBCP

3589/7474 No 54828 Real Time

West Virginia Medicaid (Professional) 2477 2477 No WV_MMIS_

4MOLINA

Batch Yes

West Virginia Medicaid (Institutional) 5532 5532 No WV_MMIS_

4MOLINA

Batch Yes

West Virginia Medicare (Professional) 1450 1450 No 11402 Batch No

West Virginia Medicare (Institutional) 5530 5530 No 11003 Batch No

Wisconsin Blue Cross Blue Shield WIBCBS 1401/5511 No 00950

00450

Real Time No

Wisconsin Medicaid WICAID 1467/5510 No WISC_TXIX Real Time No

Wisconsin Medicare (Professional) 1434 1434 Batch 06302 Batch No

Legend

Payer Name

Change Healthcare Claim Status Payer ID - Batch and Real Time Only: Change Healthcare-assigned Claim Status Payer ID; must be sent in

the 276 transaction.

Change Healthcare Claim Status Portal Payer ID: Change Healthcare-assigned Claim Status Payer ID

Associated Change Healthcare Claims CPIDs: Change Healthcare-assigned payer identifier for 837 claim transactions is provided as a

reference to identify the destination payer that received the claim.

Authorization Required:

No: No authorization required; all other values indicate what routing method requires authorization.

Payer-Assigned Payer ID: NAIC payer identifier

Routing / Response Method:

Batch: 276 and 277 transactions will be sent to the payer and delivered to the customer by batch method.

Real Time: 276 and 277 transactions will be sent to the payer and delivered to the customer by real time method.

Must Submit Claims to Change Healthcare:

Yes: 837 claim transactions must be submitted to the payer through Change Healthcare in order for Batch and Real Time claim status

transactions to process through Change Healthcare.

No: 837 claim transactions do not need to be submitted to the payer through Change Healthcare in order for Batch and Real Time claim

status transactions to process through Change Healthcare.

© 2018 Change Healthcare Operations LLC and/or its subsidiaries or affiliates. All Rights Reserved.

This documentation contains confidential, proprietary and trade secret information of Change Healthcare Operations LLC and is protected under United States and international

copyright and other intellectual property laws. This documentation is subject to change without notice.

assurance™ edi - claim status payer list€¦ · assurance™ edi - claim status payer list to...

Documents