phicure, inc. 837 payer list - december 11, 2018€¦ · 00241 blue shield of missouri mo yes no...

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CONFIDENTIAL Payer ID Payer Name State Prof Claim Inst Claim UHP01 UHP Management All Yes Yes ABMS Advance Benefit Management Systems, USA Inc. (ABMS) All Yes Yes CX058 Kansas City Life Insurance Company And Healthy Choices All Yes No 88250 HealthTeam Advantage All Yes Yes 46311 Presence ERC All Yes Yes SPA01 Sunrise Advantage Plan Pennsylvania All Yes Yes 81600 South County Health Alliance All Yes Yes PROGY PROGYNY All Yes Yes UC001 Brand New Day (FFS) All Yes Yes 58200 ResourceOne Administrators All Yes Yes 78353 North Iowa Community Healthcare (NICH) All Yes No 44448 TPA Systems ALL Yes No 58200 The Integrity Benefit Network, Inc. All Yes Yes RVC01 Revclaims All Yes No 43101 ANPAC All Yes No 33010 Cedars Sinai Medical Center All No Yes A0245 Fairfield All Yes Yes A3268 Southwest Michigan Behavioral Health MI Yes Yes HLTHT Health Traditions All Yes Yes 00014 SelectCare MO,IL Yes Yes 00019 Cox Health Plan AR,MO Yes No 00036 Preferred Health Professionals Kansas City KS,MO Yes No 00046 Hill Physicians Medical Group All Yes No 00050 Anthem of Colorado CO Yes Yes 00060 Blue Shield of Connecticut CT Yes No 00130 MedPay MO,IL Yes No 00157 Davis Vision All Yes No 00200 Blue Shield of Massachusetts MA Yes No 00230 Blue Shield of Mississippi MS Yes No 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No 00247 Maryland Physicians Care All Yes No 00265 Blue Shield of Nevada NV Yes No 00290 Indian Health Services All Yes No 00330 Community Care PL All Yes No 00390 Blue Shield of Tennessee TN Yes Yes 00403 Blue Choice Medicaid SC Yes Yes 00430 Premera WA Yes Yes 00520 Blue Shield of Arkansas AR Yes No 00530 Missouri Care All Yes No 00540 SISCO All Yes No 00570 Blue Shield of Delaware DE Yes No 00580 Blue Shield of Alabama AL Yes No PHIcure, Inc. 837 Payer List - December 11, 2018

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Page 1: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

Payer ID Payer Name State Prof Claim Inst Claim

UHP01 UHP Management All Yes Yes

ABMS Advance Benefit Management Systems, USA Inc. (ABMS) All Yes Yes

CX058 Kansas City Life Insurance Company And Healthy Choices All Yes No

88250 HealthTeam Advantage All Yes Yes

46311 Presence ERC All Yes Yes

SPA01 Sunrise Advantage Plan Pennsylvania All Yes Yes

81600 South County Health Alliance All Yes Yes

PROGY PROGYNY All Yes Yes

UC001 Brand New Day (FFS) All Yes Yes

58200 ResourceOne Administrators All Yes Yes

78353 North Iowa Community Healthcare (NICH) All Yes No

44448 TPA Systems ALL Yes No

58200 The Integrity Benefit Network, Inc. All Yes Yes

RVC01 Revclaims All Yes No

43101 ANPAC All Yes No

33010 Cedars Sinai Medical Center All No Yes

A0245 Fairfield All Yes Yes

A3268 Southwest Michigan Behavioral Health MI Yes Yes

HLTHT Health Traditions All Yes Yes

00014 SelectCare MO,IL Yes Yes

00019 Cox Health Plan AR,MO Yes No

00036 Preferred Health Professionals Kansas City KS,MO Yes No

00046 Hill Physicians Medical Group All Yes No

00050 Anthem of Colorado CO Yes Yes

00060 Blue Shield of Connecticut CT Yes No

00130 MedPay MO,IL Yes No

00157 Davis Vision All Yes No

00200 Blue Shield of Massachusetts MA Yes No

00230 Blue Shield of Mississippi MS Yes No

00241 Blue Shield of Missouri MO Yes No

00243 Helix Family Choice MD Yes No

00243 Medstar Physician Partners MD Yes No

00247 Maryland Physicians Care All Yes No

00265 Blue Shield of Nevada NV Yes No

00290 Indian Health Services All Yes No

00330 Community Care PL All Yes No

00390 Blue Shield of Tennessee TN Yes Yes

00403 Blue Choice Medicaid SC Yes Yes

00430 Premera WA Yes Yes

00520 Blue Shield of Arkansas AR Yes No

00530 Missouri Care All Yes No

00540 SISCO All Yes No

00570 Blue Shield of Delaware DE Yes No

00580 Blue Shield of Alabama AL Yes No

PHIcure, Inc. 837 Payer List - December 11, 2018

Page 2: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

00590 Blue Shield of Florida FL Yes Yes

00601 Blue Shield of Georgia GA Yes Yes

00601 Georgia State Health Benefit Plan GA Yes Yes

00601 State Merit GA GA Yes Yes

00610 Blue Cross of Idaho ID Yes No

00611 Blue Shield of Idaho-Regence ID Yes Yes

00621 Blue Shield of Illinois IL Yes Yes

00630 Blue Shield of Indiana IN Yes Yes

00660 Blue Shield of Kentucky KY Yes No

00680 Blue Shield of Maine ME Yes No

00710 Blue Shield of Michigan MI Yes No

00720 Blue Shield of Minnesota MN Yes Yes

00720 Comprehensive Care Services MN Yes Yes

00770 Blue Shield of New Hampshire NH Yes No

00773 OptumHealth Vision All Yes No

00773 Spectera All Yes No

00773 UnitedHealthcare Vision All Yes No

00790 Blue Shield of New Mexico NM Yes Yes

00800 Blue Shield of Northeast NY NY Yes No

00801 Blue Shield of Western New York NY Yes No

00803 Blue Shield of New York NY Yes Yes

00804 Blue Choice of Rochester NY NY Yes Yes

00804 Blue Shield of Rochester NY NY Yes Yes

00805 Blue Shield of Central NY HMO/PPO NY Yes Yes

00806 Blue Shield of Utica NY NY Yes No

00813 Value Options Commercial Claims All Yes Yes

00814 Value Options Az Medicaid All Yes No

00815 Value Options Colorado Medicaid CO Yes No

00816 Value Options Massachusetts Behavioral Health Partnership MA Yes No

00817 Value Options Pennsylvania Medicaid PA Yes No

00818 Value Options Texas Northstar TX Yes No

00820 Blue Shield of North Dakota ND Yes No

00822 Blue Shield of Alaska AK Yes No

00823 Value Options Maryland All Yes No

00834 Blue Shield of Ohio OH Yes Yes

00840 Blue Shield of Oklahoma OK Yes No

00851 Blue Shield of Oregon OR Yes Yes

00870 Blue Chip of Rhode Island RI Yes No

00870 Blue Shield of Rhode Island RI Yes No

00910 Blue Shield of Utah UT Yes Yes

00922 Blue Choice of South Carolina SC Yes Yes

00923 Blue Shield of Virginia VA Yes No

00932 Regence Blue Shield of Washington WA Yes Yes

00934 Washington State Premera Blue Cross WA Yes No

00950 Blue Shield of Wisconsin WI Yes No

00960 Blue Shield of Wyoming WY Yes Yes

00995 Health Safety Network - Mass. Health Medical All Yes No

Page 3: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

00999 Benefit Management Services, Inc of Lousiana LA No Yes

01041 Healthsource Maine ME Yes Yes

01066 American Healthcare Alliance All Yes Yes

01250 Qual Choice of Ohio OH Yes No

01260 Magellan Health All Yes Yes

01508 Better Health Florida All Yes No

01691 Unified Physicians Network (UPN) All Yes No

01757 AM-First Insurance Morgan White All Yes No

01758 Standard Life & Accident All Yes Yes

01759 Monitor Life All Yes No

01776 Minuteman All Yes No

02038 Healthsource New Hampshire NH Yes No

02041 Healthsource, Mass MA Yes Yes

02057 Smith Administrators All Yes No

03036 CBA Blue All Yes Yes

03036 Comprehensive Benefits Administrator, Inc. All Yes Yes

03036 Employee Benefits Plan Administration, Inc. All Yes Yes

03432 Arizona Physicians IPA AZ Yes Yes

03432 Arizona Physicians IPA AZ Yes Yes

03440 Phoenix Health Plan AZ Yes Yes

03443 Abrazo Advantage Health Plan All Yes Yes

03699 Sieba LTD All Yes No

04218 Pan American Life Insurance All Yes No

04245 Harvard Community Health Plan All Yes Yes

04271 Harvard Pilgrim Health Care All Yes Yes

04286 Health New England All Yes Yes

04293 Neighborhood Plan All Yes Yes

04298 Tufts Associated Health All Yes Yes

04320 PrimeSource Health Network All Yes Yes

04326 Elder Service Plan of the North Shore. All Yes No

04332 Network Health All Yes Yes

04332 Network Health Massachusetts All Yes Yes

04334 Practicare All Yes No

04411 Indian Health Service/Tribal Organizations TX No Yes

04412 Indian Health Service/Tribal Organizations TX Yes No

04423 Molina Healcare of New Mexico - SCI All Yes Yes

05003 Presbyterian NM Yes Yes

05014 Jackson Memorial All Yes No

05047 Neighborhood Health Plan of Rhode Island RI Yes No

05506 Gateway Health Plan All Yes No

05536 Blue Shield of North Carolina NC Yes No

06057 Starmark 4Most All Yes No

06089 Stirling And Stir All Yes No

06102 Diversified Group Brokerage All Yes Yes

06105 Connecticare, Inc. All Yes Yes

06111 Oxford All Yes Yes

06111 Oxford Health Plans All Yes Yes

Page 4: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

06119 Healthsource South Carolina All Yes No

06161 Pennsylvania Preferred Health Network (PPHN) All Yes No

06172 Dart Container Co All Yes No

06294 South Florida Musculoskeletal Care All Yes No

06541 CCHS All Yes Yes

06603 Asageha All Yes Yes

06607 Piedmont Behavioral Health All Yes Yes

06941 Bay Bridge Administrators LLC All Yes No

07003 HealthPartners All Yes Yes

07040 Swift Glass Corporation All Yes No

07205 360 Alliance PPO Gilsbar All Yes Yes

07205 Gilsbar, Inc All Yes Yes

07503 University Family Care - Healthcare Group All Yes Yes

07689 Global Care Inc All Yes Yes

08044 Eastpointe All Yes No

08354 UCS NX Health Network All Yes No

08680 Container Graphics Corporation All Yes No

09173 Physicians Health Plan All Yes No

09824 Molina Healthcare of New Mexico Salud NM Yes No

09829 Yavapai County All Yes No

09830 University Family Care AZ Yes Yes

09908 University Family Care - Maricopa Health Plan All Yes Yes

09908 University Family Care - Maricopa Health Plan AZ Yes Yes

10001 Integrated Comp All Yes No

10002 Sheakley UniComp OH Yes No

10005 Compmgmt Health Systems All Yes No

10006 Health Mgmt Solutions All Yes No

10009 Gates Mcdonald Health Plus All Yes No

10010 Careworks All Yes Yes

10014 CRA Managed Care All Yes No

10016 Aultcomp MCO All Yes No

10207 Citrus Health Care All Yes Yes

10447 Advantra TX,NM,AZ No No

10525 Patient Advocates, LLC All Yes Yes

10629 Christus Health Medicare Advantage All Yes Yes

10850 Metropolitan Health Plan All Yes Yes

11001 Medicare HHH (Home Health And Hospice) J15 (CGS) All No Yes

11158 St James PHO All No Yes

11244 Fitzharris & Company All Yes No

11303 Magnacare All Yes Yes

11315 Fidelis Care New York All Yes Yes

11328 HealthCare Partners, IPA All Yes Yes

11328 Liberty Health Advantage All Yes Yes

11334 New York Network Management All Yes No

11345 CareCentrix All Yes Yes

11442 Centers Plan for Healthy Living All No Yes

11695 iCARE WI Yes No

Page 5: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

11752 ClaimsBridge HPN All Yes Yes

11789 SGIC All Yes Yes

12057 Medical Services Initiative All Yes No

12115 VA Fee Basis Programs All Yes Yes

12399 Physicians Health Plan of Northern Indiana IN Yes Yes

12422 Medica2 All Yes Yes

13010 Smokey Mountain Center All Yes Yes

13151 Partners Behavioral Health Mgmt All No No

13162 1199 SEIU National Benefit Fund All Yes Yes

13174 Montefiore Contract Management Organization All Yes Yes

13185 TexasFirst Health Plan All Yes No

13189 Meridian Health Plan All Yes Yes

13193 Loyal American All Yes Yes

13265 Metro Plus Health Plan All Yes Yes

13306 PHCS Savility All Yes Yes

13315 Insurance Design Administrators All Yes Yes

13333 Affinity Health Plans All Yes Yes

13334 Affinity Health Plans All Yes Yes

13335 Hudson Health Plan NY Yes Yes

13337 Boston Medical Center Healthnet MA Yes Yes

13343 Amalgamated Life - PA/Alicare All Yes Yes

13350 MODA Health All Yes Yes

13357 CenterCare All Yes Yes

13360 Centerlight Healthcare Inc. All Yes Yes

13381 Orthonet Corporation All Yes Yes

13383 Orthonet - AETNA All Yes Yes

13396 Productive Processing All Yes No

13402 Touchstone Health/Health Net Smart All Yes Yes

13407 Uniformed Service Family Health Plan All Yes Yes

13413 WIN Healthcare All Yes No

13550 Amalgamated Life Insurance Co. All Yes Yes

13551 Group Health Incorporated (GHI) NY Yes Yes

14140 Farm Family All Yes No

14142 NYS DOH UCP NY Yes Yes

14163 Wellcare HMO, Inc. All Yes Yes

14164 Wellcare of CT CT Yes Yes

14164 Wellcare of NY NY Yes Yes

14165 MVP Health Plan of NY NY Yes Yes

14179 CareCore National, LLC All Yes Yes

14179 New York Medical Imaging-MVP NY Yes Yes

14180 CareCore National, LLC NY, NJ Yes Yes

14182 Care Core National All Yes Yes

14185 CareCore National, LLC - Health Net New Jersey All No Yes

14188 Carecore National Wellcare All Yes No

14315 Commonwealth Care Alliance All Yes Yes

14633 Larson Group All Yes Yes

14829 Coordinated Benefit Plan All Yes Yes

Page 6: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

14966 Partners Health Plan All Yes Yes

15003 Univera Community Health All Yes No

15243 Compmanagement Health All Yes Yes

15459 WV Care Advantage Highmark Senior Health WV Yes No

15460 PA Care Advantage Highmark Senior Health PA Yes Yes

15682 Senior Network Health ALL Yes No

15688 Insurance Management Services All Yes No

15752 Stones River Regional IPA - Windsor All Yes No

15754 Blue Grass Family Health All Yes No

16003 DMERC Region A REG A Yes No

16109 Lancaster General Health Group All Yes No

16111 POMCO All Yes Yes

16114 Nova Casualty Company All Yes Yes

16120 America's PPO All Yes Yes

16120 Araz All Yes Yes

16120 Health EZ All Yes Yes

16146 SCHC Total Care NY Yes Yes

16180 Aspen All Yes Yes

16565 Eastern Main Healthcare Systems- EMHS ALL Yes Yes

16600 Chautauqua County Health Plan NY Yes No

16644 Nova Healthcare Administrators, Inc. All Yes Yes

16928 Metal Culverts All Yes Yes

16928 Metal Culverts All Yes Yes

17003 DMERC Region B REG B Yes No

17516 North Shore - LU MLTCP All Yes Yes

17902 Community Care Associates MI Yes No

17965 American Sentinel Insurance Company All Yes No

18003 DMERC Region C REG C Yes No

19003 DMERC Region D REG D Yes No

19028 IBM Business Toisc All Yes No

19046 Constitution State / Travelers All Yes Yes

19191 Native Care Health All Yes Yes

19305 Access Medicare All No Yes

19753 Benefit Plan Administrators All Yes Yes

19988 NEA Group Insuran All Yes No

20029 America's Choice NMA All Yes Yes

20039 Mediture All Yes Yes

20050 Integrated Medical Solutions All Yes Yes

20090 United Claim Solutions All Yes No

20133 Optimum Healthcare, Inc. All Yes Yes

20149 Molina Healthcare of Ohio OH Yes Yes

20172 Pennsylvania Pace All Yes Yes

20212 Tethys Health Ventures All Yes No

20257 HDPC Alliance Physicians All No Yes

20270 Health Payment Systems All Yes Yes

20333 Worksite Benefit Services All Yes Yes

20356 The Health Exchange All Yes Yes

Page 7: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

20376 Gemcare Health Plan All Yes No

20377 Pacificsource Medicare All Yes Yes

20381 Boulder Admin SVC All Yes No

20398 Physicians Health Collaborative All Yes Yes

20413 3P Admin All Yes No

20416 Pacificsource Community Solutions All Yes No

20446 6 Degrees Health Incorporated All Yes No

20452 UCS Winston Hospitality All Yes No

20460 SCAN Long Term Care All Yes Yes

20472 Pediatric Associates of Broward All Yes No

20475 MDWise Hoosier Alliance All No Yes

20481 Resolve Health Plan Administrators All Yes Yes

20488 Better Health Plan of Florida All Yes No

20501 HCP Nevada All Yes No

20552 HHH Choices Gold All Yes Yes

20553 Americas 1st Choice Health Plans of South Carolina All Yes Yes

20554 Molina Healthcare of Texas TX Yes Yes

20554 Molina Healthcare of Texas TX Yes Yes

20572 MSA Care Guard All Yes No

20618 SEIU Local 1 Cleveland Welfare Fund All Yes No

20676 Molina Healthcare Of Nevada All Yes No

20805 Marrick Medical Finance LLC All Yes No

20907 Paul Mueller All Yes No

20934 Molina Healthcare of Illinois All Yes Yes

21062 Christus Health New Mexico HIX All Yes Yes

21313 Kaiser Permanente Georgia All Yes No

21356 Acclaim Repricing All Yes No

21415 Employees MutualL (EMC) All Yes No

21455 Oregon'S Health CO-OP All Yes No

21524 Preferred Medical Claim Solutions All No No

21810 America's Health Choice All Yes Yes

21825 AMPS ALL Yes Yes

21825 AMPS ALL Yes Yes

21850 United Food And Commercial Workers UFCW Local 1529 All Yes No

22100 Health Choice Integrated Care All Yes No

22120 Elmira Savings Bank (UCS) All Yes No

22149 Kern Health Care Network All Yes No

22175 Ie Shaffer All Yes No

22195 AIG All Yes Yes

22240 St. Barnabas System Health Plan All Yes Yes

22248 AmeriHealth Mercy Health Plan All Yes No

22251 Healthy York Network All Yes No

22254 Fallon Community Health All Yes Yes

22264 VYTRA Healthcare All Yes Yes

22284 Colonial Medical All Yes Yes

22285 Atlantic Medical All Yes No

22286 Britcay All Yes No

Page 8: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

22304 Atlanticare Admin All Yes No

22312 Qualcare Alliance Networks Inc. (QANI) All Yes No

22321 One Call Medical All Yes Yes

22326 Mercy Health Plan of New Jersey All Yes Yes

22340 Health Net Oregon OR Yes No

22344 Exceedent LLC All Yes No

22348 Maryland Physicians Care All Yes Yes

22355 AmeriHealth VIP Care All Yes No

22384 Adminstrative Concepts, Inc. All Yes Yes

22417 Alliance Physicians High Desestt All Yes No

22483 Telamon All Yes No

22521 EDS Healthchoice OK Yes Yes

22603 NJ Carpenters Health Fund NJ Yes Yes

22729 Phoenix Health Plan All Yes No

22771 Managed Health Networks (MHN) All Yes Yes

22823 Mid-American Benefits All Yes No

22937 GHI Medicare PPFS All Yes No

23037 Amerihealth HMO DE,NJ Yes Yes

23045 Capital Advantage Insurance Company (CAIC) Professional PA Yes No

23045 Capital Blue Cross Professional PA Yes No

23051 Waterstone Benefit Administrators All Yes No

23071 Alliance Behavioral Healthcare All Yes No

23130 Pennsylvania Life Insurance PA Yes Yes

23160 Medico Insurance Company All Yes Yes

23160 Medico Insurance Company All Yes Yes

23171 CHA - Commonwealth Health Alliance All Yes Yes

23172 Health Alliance Exclusive & Plus All Yes No

23173 VPH Community Car All Yes No

23212 American Medical & Life All No Yes

23218 Superior Administrators, Inc. All Yes Yes

23223 The Loomis Company All Yes Yes

23225 Aetna Better Heal All Yes No

23226 HealthGuard of Lancaster PA No Yes

23228 Aetna Better Health - PA Medicaid PA Yes Yes

23229 Integral Quality Care All Yes Yes

23241 First Priority All Yes No

23243 Berkshire Health Partners All Yes Yes

23249 Sentinel Management Services All Yes Yes

23250 Erin Group Administrators All Yes Yes

23250 Significa Benefit Services, Inc. All Yes Yes

23253 Spectrum Administrators All Yes Yes

23266 South Central Preferred - PPO York, PA All Yes No

23274 Core Value All Yes No

23274 Gettysburg Health All Yes No

23281 UPMC Health Plan All Yes Yes

23282 Community Care BHO All Yes Yes

23283 Pittsburgh Care Partnership All Yes No

Page 9: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

23284 Keystone Mercy Health Plan All Yes Yes

23285 Select Health of South Carolina SC Yes Yes

23287 Intergroup Services Corporation All Yes Yes

23296 CompFirst, LLC All Yes No

23334 Affinity Essentials All Yes Yes

23342 Qualcare All Yes Yes

23550 Midland Management/MFC All Yes No

23706 DGA Producer HP All Yes No

23708 C & O Employees Hospital Association All Yes No

23710 Writers' Guild - Industry Health Plan All Yes No

23856 Touchstone Health PSO All Yes Yes

23861 Eastern Iowa Community Healthcare (EICH) All Yes No

24077 Santa Clara Family Health Plans CA Yes Yes

24585 Clifton Health Systems Dba Actin Care Groups All Yes No

24705 Capital BC Pennsylvania All Yes No

24735 Western Grower's Assurance Trust All Yes Yes

24735 Western Grower's Insurance Company All Yes Yes

24770 Easy Choice Health Plan of NY All Yes Yes

24818 Amida Care All Yes Yes

24818 Vida Care All Yes Yes

24819 NY Presbyterian S All Yes No

25059 Forest County Potawatomi Insurance Department All Yes No

25125 SL Carpenters Fun All Yes No

25126 Health America Incorporated Health Assurance Advantra All Yes No

25127 Coventry Healthcare Georgia All Yes No

25128 Southern Health Services Incorporated All Yes No

25132 Coventry Health Care Iowa All Yes No

25133 Coventry Health Care All Yes Yes

25133 Healthcare USA All Yes Yes

25135 Coventry Health Care Louisiana All Yes No

25136 Coventry Health Care Louisiana All Yes No

25139 Carelink All Yes No

25140 Carelink Medicaid All Yes Yes

25142 Carenet of Virginia VA Yes Yes

25143 Healthcare USA All Yes No

25145 Benefit Coordinators Corporation All Yes Yes

25146 Personalcare All Yes No

25147 Southcare / Healthcare Preferred All Yes Yes

25150 OmniCare All Yes No

25152 Advantra Freedom All No No

25160 DGA - Diversified Group Administrators All Yes Yes

25169 Gateway Health Plan All Yes Yes

25169 Gateway Health Plan Medicaid PA All Yes Yes

25172 D. H. Evans and Associates All Yes No

25175 Americhoice Personal Care Plus PA All Yes Yes

25175 Three Rivers Provider Network All Yes Yes

25175 Unison DC, DE, NJ, OH, PA, SC, TN DC,DE,NJ,OH,PA,SC,TNYes Yes

Page 10: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

25175 Unison Health Plan All Yes Yes

25179 Community Care Behavioral Health Org. All Yes Yes

25184 UPMC Vision Advantage All Yes No

25404 Seven Corners All Yes Yes

25449 PBS Oregon Alaska Industrial Hardware All Yes No

25531 GHI HMO Select All Yes Yes

25667 AMPS - CX ALL Yes Yes

25667 AMPS - CX ALL Yes Yes

25681 Orthonet-HealthNet All Yes No

25711 Wellnet Health Plans All Yes No

25831 Cameron Manufacturing And Design Incorporated (UCS) All Yes No

25924 Viecare Life Beaver And Life Lawrence Counties All Yes No

26048 Payer Fusion All Yes No

26054 Icare Health Options All Yes No

26078 America 1STCHO NC All Yes No

26097 ML Healthcare All Yes No

26119 American Insurance Administrators (AIA) All No No

26158 Allcare PEBB All Yes Yes

26160 Caresource All Yes No

26161 MRIPA Allcare CCO All Yes Yes

26224 PBS Oregon Construction Machinery Industrial All Yes No

26316 Retiree Health Trust All Yes No

26335 Patientpay All Yes No

26337 Aetna Better Health Medicaid IL IL Yes Yes

26374 Amerikids-Dallas/Ft. Worth TX Yes Yes

26375 Amerigroup Iowa All Yes Yes

26375 Amerivantage All Yes Yes

26378 Amerigroup Multiple States All Yes Yes

26492 Florida True Health All No Yes

26545 VillageCareMAX All Yes Yes

27004 Care Wisconsin Health Plan All Yes Yes

27005 Lifestyle Health Plans All Yes No

27008 Employers Coalition On Health (ECOH) All Yes Yes

27008 Employers Health Cooperative (EHC) All Yes Yes

27034 Peak Pace Solutions All Yes No

27048 Payer Fusion All Yes Yes

27094 Simply HealthCare Plans All Yes Yes

27133 Gemcare IPA All Yes No

27136 CSI Of Michigan All Yes No

27154 Arizona Priority Care Plus All Yes Yes

27215 Kentucky Health Administrators, Inc. All Yes No

27267 PBS Oregon Alaska Rubber And Supply All Yes No

27277 PBS Oregon Cascade Rubber Products All Yes No

27320 Max Specialty Benefits All Yes No

27327 WinHealth Partners/Wyoming Health Solutions All Yes Yes

27357 Amerihealth Caritas LA Yes Yes

27357 LA Care LA Yes Yes

Page 11: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

27514 Amerigroup Georgia GA Yes Yes

27514 Amerigroup Georgia GA Yes Yes

27514 Amerigroup Tennessee TN Yes Yes

27514 Amerigroup Tennessee TN Yes Yes

27514 Healthplus Amerigroup TX Yes Yes

27514 Healthplus Amerigroup TX Yes Yes

27515 Americaid Community Care (Houston) TX Yes Yes

27516 Americaid Community Care (New Jersey) NJ Yes Yes

27517 Americaid Community Care (Maryland) MD Yes Yes

27518 AMERIGROUP IL All Yes No

27905 Community Health Allliance TN All Yes Yes

28021 Kern County CDCR All Yes No

28530 Secure Health of Georgia GA Yes Yes

28580 South Tahoe Refuse All Yes No

28804 Amerigroup All Yes Yes

28804 Amerigroup IL TX,NM Yes Yes

28805 Amerigroup / Americaid - Houston TX Yes No

28806 Amerigroup - New Jersey NJ Yes Yes

28807 Amerigroup - Maryland, Virginia and District of Columbia MD,DC Yes No

28808 AMERIGROUP IL All Yes No

28809 Amerigroup of Florida FL Yes No

28943 Physicians Accountable Care Organization All Yes No

29018 The Health Plan Of Western Illinois (HOWI) All Yes No

29076 Carolina Care Plan SC Yes Yes

29076 Medical Mutual of Ohio OH Yes Yes

30005 Galveston County Indigent Health Care All Yes No

30360 Individual Assurance Company, Life, Health & Accident All No No

30757 Hometown Health Plan of Ohio OH Yes No

30757 The Health Plan OH Yes No

31048 Western Southern Financial Group All Yes Yes

31053 State Farm Group Medical & Ind Health Ins Co All Yes Yes

31059 State Farm All Yes Yes

31074 Employee Benefit Management Corp. OH Yes Yes

31107 UMR Cincinnati All Yes Yes

31107 United Medical Resources, Inc. All Yes Yes

31114 CareSource OH Yes Yes

31118 Central Benefit National All Yes Yes

31118 Central Benefits Life All Yes Yes

31118 Central Benefits Mutual All Yes Yes

31121 Stoner & Associates All Yes No

31127 Integra Group All Yes Yes

31129 Integra Group - CHA All Yes Yes

31138 AHPO (Cleveland, OH) OH Yes Yes

31141 Healthsource, OH OH Yes Yes

31143 Trihealth Physician Solutions Concern All Yes No

31144 TriHealth Physician Solutions All Yes Yes

31147 OH Workers Comp All Yes No

Page 12: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

31149 Mcgregor Pace All Yes No

31158 CBIZ Benefits All Yes No

31165 Eyemed All Yes No

31172 Innovante Benefit Administrators All Yes No

31182 Total Community Care All Yes Yes

31313 Freedom First All Yes No

31354 MDwise Hoosier Indiana Plan All Yes Yes

31417 Nationwide Group All Yes Yes

31417 Nationwide Insurance All Yes Yes

31417 Nationwide Life and Health All Yes Yes

31417 Nationwide Mutual Insurance All Yes Yes

31417 Nationwide Specialty Health All Yes Yes

31441 S & S Healthcare Strategies All Yes Yes

31478 Preferred Health Professionals All Yes Yes

31625 ElderPlan, Inc. All Yes Yes

31626 VNA Homecare Options All Yes Yes

31650 Wagner Meinert All Yes No

32002 BC Michigan Complete All Yes No

32004 Buckeye Community Health OH Yes Yes

32006 Better Health Plans South Carolina All Yes No

32043 Mynexus Incorporated All Yes No

32481 COMM Premier Plus All Yes No

32680 Poly America Medical & Dental Benefit Plan All Yes No

33001 Universal Care - California CA Yes Yes

33020 My Family Medical Group All Yes No

33033 FCE Benefit Administrators All Yes Yes

33036 Loma Linda University Health Care All Yes Yes

33053 Pacificare Behav All Yes No

33065 CHOC - Childrens Hospital of Orange County Health Alliance CA Yes Yes

33069 High Desert Primary Care All Yes Yes

33070 Chirometrics Incorporated All Yes No

33072 San Luis Obispo Select IPA All Yes No

33373 Molina Healthcare Of CA CA Yes No

33628 Mercy Maricopa Integrated Care All Yes No

33632 Concordia Care Inc All Yes Yes

33711 Willamette Valley Community All Yes No

33884 iCircle of New York All Yes No

33898 Preferred Health Care(PHC) All Yes No

34080 Multiplan Wisconsin Preferred Provider Network All Yes Yes

34092 Healthspan All Yes No

34097 Central Reserve Life All Yes Yes

34108 E.S. Beveridge and Associates All Yes Yes

34131 Self-Funded Plans (IL, PA, OH) IL,PA,OH Yes Yes

34134 Professional Risk Management, Inc. All No Yes

34136 JP Farley Corporation All Yes Yes

34145 Klais and Company All Yes Yes

34150 The Health Plan (Upper Ohio Valley) All Yes Yes

Page 13: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

34154 The Chesterfield Companies All Yes Yes

34158 Health Design Plus All Yes Yes

34159 North American Benefits Network (NABN) All Yes Yes

34167 Emerald Health Network All Yes Yes

34167 Emerald Health Network, Inc. All Yes Yes

34171 FrontPath Health Coalition All Yes Yes

34177 Compensation Programs of Ohio, Inc. OH Yes Yes

34178 Benefit Services (Akron OH) NULL Yes No

34181 Commerce Benefits Group All Yes Yes

34185 Health Administration Services, Inc All No Yes

34186 CSI Network Services All Yes Yes

34187 American Bene Mgt All Yes No

34189 Ohio Health Choice PPO OH Yes Yes

34192 Antares Management Solutions All Yes Yes

34192 Benefit Services, Inc. (Akron, OH) All Yes Yes

34196 Apex Benefit Services All Yes Yes

34555 Emerald HMO All Yes No

34638 Unified Physicians Network All Yes Yes

34734 Aetna Better Health NY All Yes Yes

35092 Morris Associates All Yes Yes

35098 Seechange Health Insurance All Yes No

35107 Indiana Teamsters Health Benefits Fund IN Yes Yes

35112 Employee Plans, LLC All Yes Yes

35115 Intotal Health All Yes No

35145 Highmark - Key Family All Yes No

35149 Cook Group Health Plan All Yes Yes

35161 Indiana ProHealth Network IN Yes Yes

35162 Managed Care Services, LLC All Yes Yes

35164 Sagamore Health Network, Inc. All Yes Yes

35172 Qual Choice NC All Yes No

35174 Qual Choice of Arkansas AR Yes Yes

35180 CoreSource of North Carolina NC Yes No

35182 CoreSource of Illinois IL Yes Yes

35182 CoreSource of Iowa IA Yes Yes

35182 CoreSource of Maryland MD Yes Yes

35182 CoreSource of Pennsylvania PA Yes Yes

35183 Coresource of OH OH Yes Yes

35186 Dunn and Associates Benefits All Yes No

35187 CoreSource All Yes No

35191 MDwise Hoosier Healthwise All Yes Yes

35193 Community Health Alliance All Yes Yes

35198 Unified Group Services OH Yes Yes

35199 Cooperative Managed Care Services All Yes Yes

35202 Cornerstone Benefit Administrators All Yes Yes

35205 Medpartners Admin All Yes No

35206 Encore Health Network All Yes Yes

35206 The Healthcare Group (THCG) All Yes Yes

Page 14: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

35209 Advantage Health Solutions, Inc. All Yes Yes

35212 North Texas Healthcare Network All Yes No

35219 Advantage Health Solutions Medicare Advantage All Yes No

35227 South Point Hotel And Casino All Yes No

35245 WellSystems LLC All Yes No

35315 Continental Key All Yes No

35316 MMA All Yes No

35317 Key Gap All Yes No

35416 Pace Nebraska All Yes No

35600 Indiana Department of Health Children's Health IN Yes Yes

35605 Everence All Yes Yes

36149 Benefit Administrative Systems All Yes Yes

36215 Central States Southeast and Southwest Areas Health and Welfare and Pensions FundsAll Yes Yes

36215 Teamcare All Yes Yes

36273 AARP Medicare Supplement/Fixed Indemity by UnitedHealthcare All Yes Yes

36273 AARP UnitedHealthcare Insurance Co. All Yes Yes

36312 Managed Healthcare Assoc (MHCA) All Yes No

36320 Advocate Health Centers (AHC) All Yes Yes

36326 Associates for Healthcare All Yes Yes

36331 Professional Benefit Administrators, Inc. IL Yes Yes

36332 Pponext All Yes No

36333 Lawndale Christian Health Center All Yes No

36334 MacNeal Health Providers - CHS All Yes No

36335 HFN, Inc. All Yes Yes

36337 Weiss Health Providers All Yes No

36338 Group Administrators Ltd. All Yes Yes

36342 Benefit Systems and Services, Inc. All Yes Yes

36345 Physicians Care Network IL Yes Yes

36346 Northwest Suburban IPA (IL) IL Yes No

36347 Northern Illinois Health Plan IL Yes Yes

36364 ENH Medical Group IPA All Yes No

36373 Prairie States Enterprises, Inc. All Yes Yes

36389 Rush Prudential Health Plans All Yes Yes

36392 North Suburban Associated Physicians All Yes No

36393 Century PHO All Yes Yes

36396 Family Medical Network All Yes Yes

36397 Trellis Health Partners All Yes No

36400 Oak West Physician Association All Yes Yes

36401 Preferred Network Access All Yes Yes

36402 Oak West Primary Physician Association All Yes Yes

36404 Self Insured Plans, LLC All Yes Yes

36405 Harmony Health Plan of Indiana IN Yes Yes

36406 Harmony Health Plan of Illinois IL Yes Yes

36411 Swedish Covenant Hospital All Yes No

36426 Sendero Health All Yes Yes

36434 Early Intervention Central Billing IL Yes No

36439 Diatri LLC All Yes No

Page 15: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

36474 Centegra Health System All Yes Yes

36493 UCS BASI: Consolidated Turbine ALL Yes Yes

36493 UCS BASI: Consolidated Turbine ALL Yes Yes

36582 UCS BASI: Carey Johnson Oil ALL Yes Yes

36582 UCS BASI: Carey Johnson Oil ALL Yes Yes

36609 Boilermakers national Health & Welfare Fund All Yes Yes

36659 United Food And Commercial Workers Midwest Unions All Yes No

36878 Entrust All Yes No

37060 Caterpillar Incorporated All Yes No

37086 Pekin Insurance All Yes No

37105 Sage Technologies All Yes Yes

37111 HCH Administration All Yes Yes

37114 H.E.R.E.I.U. Welfare Pension Funds All Yes Yes

37116 St. Therese Physician Association All Yes Yes

37118 Benefit Plan Administrators, Inc All Yes Yes

37121 Bluebonnet Administrators LA Yes Yes

37121 Mashantucket Pequot Tribal Nation All Yes Yes

37123 Colonial Healthca All Yes No

37127 OSG-Michael Reese IL Yes Yes

37135 Consociate Group All Yes Yes

37136 Physicians Health Association of Illinois IL Yes No

37137 Sage Technologies - PBS All Yes No

37212 Benefit Management Systems, Inc of Mississippi MS Yes Yes

37215 Employee Benefit Corporation All Yes Yes

37215 John P Pearl and Associates All Yes Yes

37216 Employee Benefit Systems All Yes Yes

37217 Key Benefit Administrators All Yes Yes

37221 Health Plan Manag All Yes No

37224 Pittman and Associates All Yes Yes

37226 London HealthADM All Yes No

37227 Intercare Health Plans All Yes Yes

37228 Care N Care All Yes Yes

37228 Silverback TPA All Yes Yes

37230 TR Paul Inc. All Yes Yes

37231 ATR All Yes No

37233 MPE Employee Benefit Services All Yes Yes

37237 CommonWealth Administrative Group All Yes Yes

37242 Professional Claims Management All Yes Yes

37247 Western Mutual Insurance All Yes Yes

37248 Benesys LHP Claim All Yes No

37249 Employers Life IN All Yes No

37253 Elmco NY Yes Yes

37256 Mutual Assurance Administrators All Yes Yes

37257 Employee Benefit Consultants, Inc. All Yes Yes

37259 Samba All No No

37260 Hunt Insurance GR All Yes No

37264 St. John's Claims Administration All Yes Yes

Page 16: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

37266 Southwest Service Life All Yes Yes

37267 Loma Linda University Adventist All Yes No

37268 Palladian Muscular Skeletal Health All Yes No

37268 Prism Health Networks All Yes No

37269 International Union Operating Engineers All Yes Yes

37272 JSL Administrators All Yes Yes

37275 Missoula County Medical Benefits MT Yes No

37276 Group Insurance Service Center, INC All Yes Yes

37278 Adminone All Yes Yes

37279 Insurance Administrator of America All Yes Yes

37280 Automated Group Administration, Inc. All Yes Yes

37281 Mid-America Associates All Yes Yes

37282 Select Benefit Administrators of America All Yes Yes

37283 American Administrative Group All Yes Yes

37284 Transchoice - Key Benefit Admin All Yes Yes

37286 Bene Plan Adminis All Yes No

37287 Planned Administrators, Inc. (PAI) All Yes Yes

37290 Health Services for Children with Special Needs (HSCSN) All Yes Yes

37292 Machinist District 9 Welfare All Yes No

37297 Compbenefits Corp All Yes No

37299 Nyhart All Yes Yes

37300 FACS Group All Yes No

37301 Summit America Insurance Services, Inc. All Yes No

37307 Connecticut Carpenters Health Fund CT Yes Yes

37308 Allied Benefit Systems All Yes Yes

37309 Protective Life Insurance Company All Yes No

37311 Caresource Of Ind All Yes No

37313 Assurant Health Self Fund All Yes Yes

37314 North Broward Hospital District FL Yes No

37315 Prism Univera All Yes No

37316 Leon Medical Center Health Plan All Yes No

37318 Southern Benefit Services All Yes Yes

37320 Creative Plan Administrators All Yes Yes

37321 Key Select All Yes Yes

37322 American Worker Health Plan All Yes Yes

37323 Key Solution All Yes No

37324 Upper Peninsula Health Group(TPA) All Yes No

37329 HCHA Albq - Self Funded All Yes Yes

37330 Physicians Health Plan (PHP) Mid-Michigan All Yes Yes

37331 RightChoice Benefits Administrators All Yes Yes

37363 ComPsych All Yes Yes

37510 First Choice VIP Care All Yes No

37601 University Of Illinois At Chicago Div Of Specialized Care All Yes No

37602 All Savers Insurance Co. All Yes Yes

37602 Golden Rule Insurance All Yes Yes

37602 Rooney Life Ins. All Yes Yes

38201 Total Healthcare, Inc. MI Yes Yes

Page 17: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

38216 Health Plus of Michigan MI Yes Yes

38217 Priority Health All Yes Yes

38217 Priority Health All Yes Yes

38219 AmeraPlan All Yes Yes

38221 Regency Employee Benefits All Yes No

38224 Health Alliance Plan of Michigan All Yes Yes

38224 Medical Value Plan - Ohio (MVP) OH Yes Yes

38225 NGS American, Inc. All Yes Yes

38232 Weyco Inc. All Yes Yes

38234 IBA Self Funded Group All Yes Yes

38238 BeneSys, Inc. All Yes Yes

38238 Sheet Metal Workers Local 104 CA Yes Yes

38241 Employee Benefit Concepts All Yes Yes

38254 Activa Benefits Services, LLC All Yes No

38254 Amway Corporation All Yes No

38259 Automated Benefit Services (ABS) All Yes Yes

38265 ASR Corporation All Yes Yes

38265 Physicians Care Network All Yes Yes

38298 Universalstandard All Yes No

38308 Christian Brothers Services All Yes Yes

38309 Healthnet of AZ AZ Yes Yes

38310 John Morrell Company - AHPBA All Yes No

38325 MI Community Choi All Yes No

38329 Pro Care Health Plan, Inc. MI No Yes

38333 Molina Healthcare of California CA Yes Yes

38334 Molina Healthcare of Michigan MI Yes Yes

38334 Molina Healthcare of Michigan MI Yes Yes

38335 Cofinity CO Yes Yes

38336 Molina Healthcare of Washington WA Yes Yes

38337 Upper Peninsula Health Plan All Yes Yes

38338 McLaren Health Plan All Yes Yes

38343 Ingham Health Plan Corporation All Yes No

38416 Spencer Stuart (ARM LTD) All Yes No

38520 Palmetto Tricare (Regions 1-6) Northern and Southern Region Various Yes No

38520 TriCare Palmetto (Regions 1-6) Northern and Southern Region Various Yes No

38692 Aetna TX Medicaid & CHIP TX Yes Yes

39026 UHIS-UnitedHealthcare Integrated Services All Yes Yes

39026 UMR Wausau/UHIS All Yes Yes

39026 Wausau Insurance Companies All Yes Yes

39033 Sentry Insurance Co. All No Yes

39045 Security Health Plan All Yes Yes

39045 Security Health Plan All Yes Yes

39065 Assurant Employee Benefits All Yes Yes

39065 Fortis All Yes Yes

39065 Fortis (Western Life Ins. Benefit Plan) All Yes Yes

39065 Fortis Benefits, Inc. (Woodbury) PHCS Network Claims All Yes Yes

39065 Fortis Western All Yes Yes

Page 18: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

39065 Mutual Benefit All Yes Yes

39065 Mutual Benefit Life All Yes Yes

39065 Time Insurance All Yes Yes

39065 Western All Yes Yes

39065 Western Care All Yes Yes

39065 Western Life Ins. Benefit Plan (FORTIS) All Yes Yes

39081 Benefit Plan Administrators Co. WI Yes Yes

39112 CHP/RPU (FABOH) All Yes Yes

39113 Children's Community Health Plan All Yes Yes

39114 Mercycare All Yes No

39126 Community Care Organization All Yes Yes

39144 Network Health Plan of Wisconsin, Inc. All Yes Yes

39151 WEA Insurance Group All Yes Yes

39156 Physicians Plus Insurance Corp. All Yes Yes

39157 TBG ADM Services All Yes No

39167 Group Health Cooperative of South Central Wisconsin Claims WI Yes Yes

39168 Group Health Cooperative of South Central Wisconsin Encounters WI Yes Yes

39180 Gunderson Lutheran Health Plan All Yes Yes

39181 Triad Healthcare Inc All Yes No

39182 International Funding Inc. All Yes Yes

39185 Prevea Health Insurance Plan / Arise Health Plan All Yes Yes

39186 IN Managed Health Services IN Yes Yes

39187 Managed Health Services WI All Yes Yes

39188 Superior Health All Yes No

39190 MedStar Family Choice All Yes No

39197 QuadMed (West Allis, WI) All No Yes

39198 Lutheran Preferred All Yes No

39200 Wisconsin Auto & Truck Dealers Insurance Corporation WI No Yes

39640 Great Lakes PACE All Yes No

40025 Innovation Health All Yes No

40137 Kalos Health All Yes No

40437 Quad City Community Healthcare(QCCH) All Yes No

40585 INDECS Corporation All Yes Yes

41041 Federated Mutual Insurance All Yes Yes

41045 CoreStar AZ MN AZ,MN Yes No

41095 Wilson-McShane All Yes Yes

41099 Assurant Health - John Alden Life Ins. All Yes Yes

41124 CBSA (Corporation Benefit Services of America) All Yes Yes

41124 Fortis Self Funded Administrative Services All Yes Yes

41124 IBI All Yes Yes

41124 Iowa Benefits, Inc. IA Yes Yes

41124 Meritain Health Minneapolis All Yes Yes

41136 Life Trac All Yes Yes

41143 Sheffield Olson And Mcqueen Incorporated All Yes No

41147 Preferred One All Yes Yes

41150 Health Services Management NULL Yes No

41154 Mayo Management Services, Inc. All Yes Yes

Page 19: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

41160 ACNIPA All Yes No

41161 American Chiropractic Network (PAN) All Yes Yes

41161 Optum Health - Physical Health All Yes Yes

41170 Health Risk Management (HRM) All Yes No

41178 America's PPO / America's TPA All Yes Yes

41178 HealthEZ All Yes Yes

41194 OptumHealth Care Solutions All Yes Yes

41194 OptumHealth Care Solutions All Yes Yes

41198 Emp Bene Svcs LA All Yes No

41201 Client First All Yes No

41202 Total Plan Services All Yes No

41204 Basic Plus All Yes No

41205 Benefit Administration Services All Yes No

41206 Ultra Benefits Inc All Yes Yes

41212 Freedom Health Plan All Yes Yes

41222 Care to Care All Yes Yes

41555 Manatee Services All Yes No

41600 Imcare All Yes Yes

42011 American Republic Insurance Company All Yes Yes

42102 Health Care Network of WI (HCN) WI Yes Yes

42102 Health Care Network of Wisconsin (HCN) All Yes Yes

42112 American Administ All Yes No

42130 Aetna Better Health of Nebraska All Yes Yes

42137 Select Benefit Administrators IA Yes Yes

42138 County Care Behavioral Health TPA All Yes No

42139 County Care All Yes No

42140 Centurion ALL Yes No

42141 CTI Administrators Inc All Yes No

42142 SecureCare of Iowa IA Yes No

42149 Employee Benefit System All Yes Yes

42150 Butler Benefits All Yes Yes

42172 Riverlink Health All Yes Yes

42172 Soundpath Health All Yes Yes

42406 South Carolina Solutions SC Yes No

42558 VHS- Cedar Valley Community Healthcare (CVHC) All Yes Yes

42723 Community First Health Plan All No No

43056 Claims Development Corporation All Yes No

43123 Imagine Health All Yes No

43141 Coastalcare (Dos Prior To 7 1 2015) All Yes No

43160 Correctional Medical Services All Yes Yes

43166 Premier Health PL All Yes No

43173 Family Health Partners/MC+Missouri MO Yes No

43174 Molina Healthcare Of Washington Encounters Only All Yes No

43178 Joplin Claims All Yes Yes

43185 Mercy Provider Network All Yes No

43197 Fresenius Health Partners All Yes No

43307 ValueOptions/MBHP MA Yes Yes

Page 20: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

43313 Harken Health All Yes Yes

43324 Beacon Health Strategies All Yes Yes

43471 Inetico, Inc. All Yes Yes

43905 Arnot Ogden Medical Center (UCS) All Yes No

44054 Government Employees Hospital Association,Inc. (GEHA) All Yes Yes

44219 BHP-Unity All Yes Yes

44273 Health Plans Inc. All Yes Yes

44423 Alexian Brothers Community Services Tennessee All Yes No

44444 American Postal Workers Union Health Plan All Yes Yes

44827 Quad Cities Community Health Plan All Yes No

45048 Independent Living Systems All Yes Yes

45114 Pace Of Southwest Michigan Incorporated All Yes No

45129 New Mexico Health Connections All Yes Yes

45150 Meritus Health All Yes No

45210 Christus Health Plan Medicaid All Yes No

45275 PHCS GEHA All Yes Yes

45276 West Virginia Family Health Plan WV Yes Yes

45281 Riverside Health Inc All Yes No

45282 University Of Maryland Health Advantage All Yes Yes

45289 Lone Star TPA All Yes Yes

45302 Integra Managed Long Term Care All Yes Yes

45321 Consumers Choice Health SC All Yes No

45332 Oregons Health CO-OP OR Yes Yes

45336 Healthyct Incorporated All Yes No

45341 Maine Community Health Options All Yes Yes

45399 Health Choice Utah UT Yes Yes

45423 Advicare All Yes No

45437 University Healthcare Marketplace All Yes Yes

45552 Satellite Health Plan MA Yes Yes

45559 Fallon Total Care All Yes Yes

45627 Mdwise Marketplace All Yes Yes

45985 Pinnacle Physician Management Organization All Yes No

46012 Mapfre Life Commercial All Yes No

46045 Avera Health Plans All Yes Yes

46050 Generations Health All Yes Yes

46051 Generations Hillcrest All Yes No

46120 Crystal Run Health Plans All Yes No

46156 Aspire Health Plan All Yes No

46161 Montifore HMO All Yes Yes

46166 Royal Health on Behalf of Extended Care MLTC All Yes Yes

46187 Seaside Health Plan CA Yes No

46221 Health Choice Insurance All Yes Yes

46227 North Shore - LIJ CareConnect Insurance Company All Yes Yes

46299 Molina Healthcare of South Carolina All Yes Yes

46320 Aetna Better Health NJ NJ Yes Yes

46407 University Health Care Advantage All Yes Yes

46450 State Auto Insurance Companies All Yes No

Page 21: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

46478 Marrick WRx All Yes Yes

46503 Aflac All No No

46594 Affinity Medical Group All Yes No

46871 Cinncinnati Financial Corporation All Yes Yes

47027 Physicians Mutual Insurance Company All Yes Yes

47076 Regional Care, Inc. All Yes Yes

47078 Midlands Choice All Yes No

47080 Midlands Choice NE,IA Yes Yes

47080 Midlands Health Partners All Yes Yes

47083 GMS, Inc. All Yes Yes

47163 Blue Shield of Kansas KS Yes Yes

47165 Core Benefits Multimatic Tennessee LLC All Yes No

47171 Blue Shield of Kansas City KS,MO Yes No

47181 Highmark BCBSD Health Options All Yes No

47198 Blue Cross of California CA Yes Yes

47738 Hamaspik Choice All Yes No

48026 NorthShore Physicians Associates All Yes No

48055 Todays Option (American Progressive and Pyramid Life) All Yes Yes

48100 Providrs Care Network All Yes Yes

48116 Florida Hospital Waterman All Yes Yes

48117 FMH Benefit Services All Yes Yes

48120 Century Health Solutions All No Yes

48123 Via Christi Hope All Yes No

48143 Group and Pension Administrators All Yes Yes

48145 Community Health Choice All Yes Yes

48330 Hawaii Management Alliance Association (HMAA) HI Yes Yes

48603 International Brotherhood of Boilermakers Employee Health Care Plan (IBBEHC)All Yes Yes

48611 Benefit Management, Inc. of KS All Yes Yes

48888 Employer Direct Healthcare All Yes No

48964 BPS Inc All Yes No

49718 Colorado Health Insurance Cooperative CO Yes Yes

50023 Aetna Better Health Of Ohio All Yes Yes

50383 Us Imaging Network (New York) All Yes No

50528 Universal Health All Yes No

50653 Occupational Eyewear Network Incorporated All Yes No

50701 Homelink All Yes No

50749 Mondial Assistance All Yes No

51020 INTEGRA Administrative Group, Inc. All Yes Yes

51028 21st Century Insurance and Financial Services MN Yes No

51037 Benefit Concepts All Yes Yes

51037 Brockerage Concepts, Inc (Benefit Concepts) All Yes Yes

51062 Molina Healthcare of Florida All Yes Yes

51350 Yerington Paiute Tribe All Yes No

51368 Unified IPA All Yes No

51909 Neighborhood Doctors Organization All Yes No

52095 Kaiser Foundation Health Plan Mid Atlantic All Yes No

52103 National Telecommunications Cooperative Association (NTCA) All Yes Yes

Page 22: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

52104 National Tellecommunications Cooperative Association (NTCS Staff)All Yes Yes

52106 Christus Health Plan Texas Hix All Yes No

52123 Johns Hopkins (USFHP) All Yes Yes

52132 CBA, Inc. (Cooperative Benefits Administrators, Inc.) All Yes Yes

52132 National Rural Electric All Yes Yes

52148 Unitedhealthcare Mahp Maryland Ipa Optimum Choice Mamsi All Yes No

52149 Alliance PPO Inc. All Yes Yes

52149 Mid Atlantic Psychiatric Services, Inc. (MAPSI) All Yes Yes

52149 OneNet PPO, LLC. MD Yes Yes

52152 Optimum Choice of the Carolina's (MAMSI) NC,SC Yes No

52180 UMWA Health & Retirement Funds All Yes Yes

52189 John Hopkins Healthcare (EHP/PP) All Yes Yes

52190 SRI URN MGD TRANS All Yes No

52192 Bravo Health All Yes Yes

52192 Elder Health Maryland HMO Inc. All Yes Yes

52193 LBA HealthPlans All Yes Yes

52196 InforMed, LLC All Yes Yes

52312 Arbor Health All Yes Yes

52323 UCS Nebraska Plastics Group All Yes No

52429 Healthscope Benefits Ehc Repricing All Yes No

52461 March Vision Care Incorporated All Yes No

52511 VHS- Lakes Area Community Healthcare (LACH) ALL Yes Yes

52511 VHS- Lakes Area Community Healthcare (LACH) ALL Yes Yes

52563 Health Plan of Michigan MI Yes No

52627 Northstar Advantage (MHP) NULL Yes No

52629 Ucare of Minnesota MN Yes Yes

53011 National Association of Letter Carriers All Yes Yes

53085 Anchor Benefit Consulting All Yes No

53120 Blue Shield of Louisiana LA Yes No

53122 Lassen Municipal Utility District All Yes No

53226 Penn Behavioral Health All Yes Yes

53275 Martins Point Health Care All Yes No

53476 Preferred Benefit Administrators All Yes No

53534 Pace Southwest Iowa All Yes No

53589 Blue Cross Blue Shield of Arizona AZ Yes Yes

53589 SW Service Administrators AZ Yes Yes

54154 Optima Insurance Company All Yes Yes

54154 Sentara Family Plan All Yes Yes

54154 Sentara Health Management All Yes Yes

54176 Virginia Premier Health Plan VA Yes No

54182 Vicare Admin Svcs All Yes No

54704 Independent BLC of PA PA Yes Yes

54704 Personal Choice PPO of Pennsylvania PA Yes Yes

54763 AmeriHealth Administrators All Yes Yes

54771 Blue Shield of Pennsylvania PA Yes Yes

54828 Blue Shield of West Virginia WV Yes No

55204 HealthNow NY NY Yes No

Page 23: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

55247 HIP-Health Insurance Plan of Greater NY NY Yes Yes

55248 Vista Health Plan & Foundation Health Plan All Yes No

55349 Americas 1st Choice of SC All Yes Yes

55438 CBCA Fort Worth All Yes No

55544 Conversion PlanAPWU All Yes No

55649 Allegian Choice All Yes Yes

55731 Central Susquehanna Healthcare Providers (CSHP) All Yes No

55744 Homelink HealthPartners ALL Yes No

55764 HealthPartners of Minnesota All Yes No

56001 Professional Claims Management All Yes No

56071 American Family All Yes Yes

56089 East Carolina Behavioral Health All Yes Yes

56122 Centerpoint Human Services All Yes Yes

56132 Interactive Medical Systems All Yes Yes

56139 Benefit Managaement Svcs All Yes Yes

56139 Benefit Management Services All Yes Yes

56144 HealthGram All Yes Yes

56144 Primary PhysicianCare, Inc. All Yes Yes

56147 Healthsource North Carolina NC Yes Yes

56151 Piedmont Administrators All Yes Yes

56152 Partners NAT HPNC All Yes No

56162 MedCost, Inc. All Yes Yes

56162 MedCost, Inc. All Yes Yes

56190 Opticare Eye Health Network All Yes No

56195 Carolina Summit Healthcare, Inc All Yes Yes

56196 First Carolina Care All Yes Yes

56205 MedCost Benefit Services All Yes Yes

56213 Crescent Health Solutions All Yes No

56215 CBHA Carolina Behavioral Health Alliance All Yes Yes

56240 Detroit Medical Center All Yes Yes

56731 Healthcare Resources NW All Yes Yes

56756 Lower Kuskokwim School District All Yes No

57038 Kanawha Healthcare Solutions All Yes Yes

57080 ClaimsWare, Inc. DBA ManageMed All Yes Yes

57082 Essence Healthcare MO Yes Yes

57106 Tricare North NULL Yes Yes

57106 Tricare South NULL Yes Yes

57115 Care 1st Health Plan of CA CA Yes Yes

57116 Care 1st Health Plan of Arizona AZ Yes Yes

57117 QVI Risk Solutions, Inc. All Yes No

57254 Government Employees Hospital Association,Inc. (GEHA) All Yes Yes

57492 Stones River IPA Amerivantage All Yes No

57549 Physician Health Cooperative/Srripa All Yes No

57604 Aetna Affordable Health Choices (SM) - SRC All Yes Yes

57610 Kuspuk School District All Yes No

57721 Careatc All Yes No

58102 Covenant Administrators, Inc. All Yes Yes

Page 24: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

58112 Consumer Mutual of Michigan All Yes Yes

58169 Northeast Georgia Health Services All Yes No

58174 Paragon Benefits All Yes No

58182 Naphcare Inc All Yes Yes

58202 Advanced Data Solutions All Yes Yes

58203 Medical Resource Network (MRN, INC) All Yes Yes

58204 AVMED-Parity Healthcare FL Yes Yes

58204 Coordinated Medical Specialists (CMS) All Yes Yes

58204 Dermatology Network Solutions BCBS for the Health Options HMO All Yes Yes

58204 Dermatology Network Solutions, LLC BCBS All Yes Yes

58204 Dermatology Network Solutions, LLC Humana All Yes Yes

58204 Dermatology Network Solutions, LLC Vista All Yes Yes

58204 GI Innovative Management All Yes Yes

58204 MedAdmin Sol Inc All Yes Yes

58204 Parity Healthcare, Inc. All Yes Yes

58204 Physician Associates of Lousiana (PAL) LA Yes Yes

58207 Georgia Health PL All Yes No

58210 Healthsource, GA (CIGNA) GA Yes Yes

58213 Healthways WholeHealth Networks All Yes No

58231 Core Administrative Services All Yes Yes

58233 Evergreen Hlth PL All Yes No

58234 Alliant Health Plans of Georgia GA Yes Yes

58305 Harbor Advantage All Yes No

58379 ECHO Health All No No

58600 Tift Regional All Yes No

58730 Aetna ASA PPO/Assurant Health All Yes No

59064 Memorial Integrated Healthcare All Yes No

59065 Memorial Integrated HC All Yes Yes

59065 South Florida Common Services FL Yes Yes

59069 Brown & Brown Benefits All Yes Yes

59069 United Benefits, Inc (a Brown & Brown Company) All Yes Yes

59087 Health Help Networks, Inc. All Yes Yes

59140 American Benefits Plan Administrators (Las Vegas, NV) NV Yes Yes

59140 Consolidated Group All Yes Yes

59140 Culinary Health & Welfare Fund (Las Vegas, NV) NV Yes Yes

59140 Health Plan Services, Tampa Office All Yes Yes

59141 Administrative Services, Inc. All Yes Yes

59143 Harrington Health BPO All Yes Yes

59204 Fringe Benefit Coordinators All Yes Yes

59222 TransAmerica Life Insurance Company All No Yes

59227 The MEGA Life and Health Insurance Company-OKC All Yes Yes

59230 Heritage Consultants All Yes No

59231 MedCom All Yes Yes

59266 Volusia Health Network All Yes Yes

59274 AVMED FL Yes Yes

59276 First Service Administrators FL Yes Yes

59276 Florida 1st - Winterhaven, Florida FL Yes Yes

Page 25: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

59279 Baycare Life Management All Yes No

59298 Employers Mutual, Inc. FL Yes Yes

59299 EMI KP Ambulance Claims All Yes No

59313 Evolutions Healthcare All Yes Yes

59314 Comprehensive BEH All Yes No

59321 Florida Hospital Healthcare Systems FL No Yes

59322 Florida Health Plan FL Yes Yes

59324 Podiatry Network FL FL Yes Yes

59331 McCreary Corporation FL Yes No

59333 PPO Plus NULL Yes No

59354 Wellcare Health Plan, Inc. All Yes Yes

59355 Christian Care Ministries All Yes Yes

59374 Advantica Benefits All Yes Yes

59573 UCS Hockenbergos Equipment All Yes No

59608 Healthease FL Yes Yes

59700 Pipefitters L 597 All Yes No

59847 Life St Joseph Of The Pines All Yes No

60054 Aetna Health Plan - PPO All Yes Yes

60054 Aetna Life & Casualty Company All Yes Yes

60054 Magellan Behavioral Health All Yes Yes

60054 Primary Choice (Aetna HP-NY/NJ) NY,NJ Yes Yes

60054 Select Choice All Yes Yes

60054 Senior Choice (Aetna HP-NY/NJ) All Yes Yes

60058 Northstar Advantage All Yes No

60061 AmeriHealth - New Jersey (Non-HMO Claims) All Yes Yes

60110 Preferred Health Systems, Inc. All Yes Yes

60221 Employee Benefit Services Incorporated (EBSI) All Yes No

60230 UCS Masonry Industry Trust All Yes No

60280 Interface EAP All Yes No

60305 American Communit All Yes No

60495 Community Health Plan Incorporated All Yes No

60550 Gateway Health Plan ((Yellow Card) All Yes Yes

60646 Yale University Health Plan All Yes No

60652 Gulf South Risk Services All Yes No

60739 American National Insurance Company All Yes No

60801 American Fidelity Insurance Company All Yes Yes

60827 County Care All Yes Yes

60995 Family Care - Milwaukee WI WI Yes Yes

61067 Harmony/ILS ALL Yes Yes

61101 Group Health Insurance - DE DE Yes Yes

61101 HUMANA All Yes Yes

61101 OSF Health Plans IL Yes Yes

61102 HUMANA All Yes No

61104 Humana Behavioral Health All Yes No

61106 Preferred Health Plan (Louisville, KY) KY Yes Yes

61115 Humana Long Term Care All Yes Yes

61120 Humana Veterans Healthcare Services All Yes No

Page 26: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

61124 Bluegrass Family Health All Yes Yes

61125 Humana Military Tricare All Yes Yes

61127 Healthsource Kentucky KY Yes Yes

61129 Passport Health Plan All Yes Yes

61146 Midwest Group Benefits All Yes No

61160 Humana Va Hero PR All Yes No

61225 Selectcare Texas (Kelsey Seybold) All Yes No

61271 Georgia Power Medical Benefits Plan GA Yes No

61271 JF Molloy All Yes No

61271 Principal Financial Group All Yes No

61271 Principal Mutual Life Insurance Company All Yes No

61325 Passport Health Plan ALL Yes Yes

61425 Benefit Trust Life Insurance Company All Yes Yes

61425 Starmark All Yes Yes

61425 Tooling & Manufacturing Assoc. All Yes Yes

61425 Trustmark All Yes Yes

61453 Kemper Benefits All Yes Yes

61604 Prime West Health Plan MN Yes Yes

61665 Preferred Health Systems Insurance Co (PPO) All Yes Yes

62030 American General All Yes Yes

62061 UMR Kansas All Yes Yes

62061 Willis Administrative Services Corporation All Yes Yes

62072 Cariten Senior Health All No Yes

62073 Cariten Commercial All No Yes

62111 Health Cost Solutions All Yes Yes

62118 Aetna American Continental All No Yes

62119 NW Diagnostic Clinic SelectCare of TX (NWDC) All Yes No

62129 Healthsource, TN (CIGNA) TN Yes Yes

62149 Comm Healthnet CT All Yes No

62157 Health Partners - Jackson,TN TN Yes Yes

62159 Signature Health NULL Yes No

62160 MedSolutions, Inc. All Yes Yes

62160 MedSolutions, Inc. All Yes Yes

62170 Unified Health Services All Yes Yes

62171 OSF HEALTH PLAN All Yes No

62176 Arkansas Managed Care Organization (AMCO) AR Yes No

62177 Medical Reimbursements of America All Yes Yes

62179 Health Choice of AZ AZ Yes Yes

62180 Health Choice Generations All Yes Yes

62181 Memorial Clinical Associates Selectcare Texas All Yes No

62183 Better Health Plans Incorporated All Yes No

62218 Central Senior Care All Yes No

62308 Cigna - PPO All Yes Yes

62308 Cigna Health Plan - HMO All Yes Yes

62308 Cigna Premier Plus All Yes Yes

62308 Equicor All Yes Yes

62308 Equicor - PPO All Yes Yes

Page 27: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

62324 Freedom Life Insurance Company All Yes Yes

62413 MailHandlers All Yes Yes

62553 Country Life All Yes No

62777 TRLHN/EB All Yes Yes

62956 Fair Price All Yes Yes

63002 Mercy Life Alabama All Yes No

63080 First State Healt All Yes No

63081 Delaware Health Plan Consort All Yes No

63092 HealthSpring HMO/HealthSpring Medicare+Choice All Yes Yes

63092 The Oath - Health Partners of Alabama All Yes Yes

63100 Behavioral Health Systems All Yes Yes

63103 American Behavior All Yes Yes

63114 Viva Health Plan All Yes Yes

63363 Health Plus Physicians Organization All Yes No

63665 GenCare Health MO Yes No

63665 Gencare Health (St. Louis) MO Yes No

63665 Genelco MO Yes No

63665 General American (Sanus - East) MO Yes No

63665 General American Life Ins. Co. (Sanus, St. Louis) MO Yes No

63665 General American Life Insurance Company All Yes No

63665 Great West Life & Annuity MO Yes No

63665 Sanus HMO-St. Louis (General America) All Yes No

63665 Sanus PPO (General America) All Yes No

63740 EyeQuest All Yes No

64009 Valir PACE All Yes No

64067 Foxeverett Ingall All Yes No

64068 Creative Medical Systems All Yes Yes

64069 Fox-Everett, Inc. All Yes Yes

64071 ACCLAIM All Yes Yes

64084 Mississippi Physicians Care Network All Yes Yes

64088 Mississippi Select Healthcare (Mississippi Select Health Care) All Yes Yes

64090 Amfirst Insurance Company All Yes Yes

64157 Meritain Health (North American Health Plan.) All Yes Yes

64157 North American Administrators, Inc. All Yes Yes

64158 Meritain Health / Agency Services All Yes No

64159 Definity Health All Yes No

64246 Guardian Life Insurance Company of America All Yes Yes

64270 Corporate Plan Management Incorporated All Yes No

64284 Independence Care System NY Yes Yes

64300 Triplefin LLC All Yes Yes

65018 Physicians Corporation of America FL Yes No

65021 Orange County Healthcare Agency All Yes No

65026 Baptist Health South Florida All Yes No

65031 Care Plus All Yes Yes

65054 Premier Eye Care All Yes No

65055 Leon Medical Center Health Plan NULL Yes Yes

65062 EMI (Eye Management Inc) All Yes No

Page 28: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

65062 Health Network One All Yes No

65063 Florida NetPass All Yes No

65067 Capital International Management Services All Yes No

65074 Olympus Management Healthcare All Yes No

65085 NAA (North America Administrators) All Yes Yes

65088 Preferred Care Partners (Miami,Florida) FL Yes Yes

65093 Advocate Physicians Partners (PHO) All Yes Yes

65101 HAA Preferred Partners All Yes Yes

65113 Metcare Health Plans All Yes No

65157 Meritain - Luminx All No Yes

65391 CBNHP Health Choices All Yes Yes

65449 Health Special Risk Incorporated All Yes No

66001 BCBS Texas Medicaid Star Chip All Yes No

66003 Hopkins Health Advantage All Yes No

66004 Health Economic Livelihood Partnership (Help) All Yes No

66006 Blue Cross Medicare Advantage MT,IL,TX,OK Yes Yes

66008 Passport Advantage ALL Yes No

66039 MCS Life All Yes No

66055 Netcare Life and Health Insurance All Yes Yes

66065 American Health Medicare PR Yes No

66121 Community Medical Group Of The West Valley Incorporated All Yes No

66122 Eastland Medical Group All Yes No

66124 West Covina Medical Group All Yes No

66125 Lakeside Medical Group All Yes No

66126 Verdugo Hills Medical Group All Yes No

66127 Lakeside Comprehensive Healthcare All Yes No

66170 Community Health Group All Yes No

66214 Heartland National Life All No No

66698 CentraCare All Yes No

66705 Unity Health Insurance All Yes Yes

66727 Midwest Physician Administrative Services All Yes No

66771 Operating Engineers Local 139 Health Benefit Fund All Yes Yes

66893 New England, The All Yes No

66917 Parkland Community Health Plan All Yes Yes

67202 Louisiana Health Cooperative LA Yes Yes

67524 Vital Protection All Yes No

67668 BHSF International All Yes No

67788 National Accident And Health General Agency Incorporated All Yes No

67829 Sterling Medicare Advantage All Yes Yes

68011 Capitol Administrators All Yes Yes

68013 John Muir Trauma Physicians All Yes No

68021 Health Net - VA All Yes Yes

68031 Integrity Dental Only All Yes No

68035 Health Plan of San Joaquin All Yes Yes

68036 John Muir Mt. Diablo Health System All Yes No

68037 Medcore Medical Group (OMNI IPA) All Yes No

68039 Western Health Advantage All Yes No

Page 29: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

68041 Medical Benefit Administration, Inc. All Yes No

68047 Cenpatico Health All Yes No

68048 Cenpatico Behavioral Health AZ AZ Yes Yes

68049 Peach State HP All Yes No

68050 Cenpatico - Georgia GA No Yes

68050 Peach State Health Plan (Behavioral Health) GA No Yes

68053 Cenpatico Texas All No Yes

68054 Bridgeway AZ AZ Yes No

68055 Total Carolina Care All Yes No

68056 Centene Advantage All Yes No

68057 Sunshine Health Plan All Yes No

68057 Sunshine Health Plan All Yes No

68059 Cenpatico - SC NULL No Yes

68060 Celticare All Yes No

68062 Magnolia All Yes No

68063 Celtic Insurance All Yes No

68064 Healthy Texas TX Yes Yes

68066 Illini Care Health All Yes No

68067 Kentucky Spirit Health All Yes No

68068 Cenpatico - Multiple States All Yes Yes

68068 Cenpatico Kansas All Yes Yes

68068 Integrated Mental Health Services All Yes Yes

68069 Bridgeway Arizona (Also 68054) AZ Yes Yes

68069 Buckeye Community Health (Also 32004) IA Yes Yes

68069 California Health and Wellness CA Yes Yes

68069 Carolina Crescent (Also 68055) All Yes Yes

68069 CeltiCare All Yes Yes

68069 Centene Advantage Plans (Also 68056) All Yes Yes

68069 Home State Health Plan LA Yes Yes

68069 Illinicare Group Health (Also 68066) All Yes Yes

68069 Kentucky Spirit Health Plan (Also 68067) KY Yes Yes

68069 Lousiana Healthcare Connections LA Yes Yes

68069 Magnolia Mississippi (Also 68062) All Yes Yes

68069 Managed Health Services Indiana (Also 39186) IN Yes Yes

68069 Managed Health Services of Wisconsin WI Yes Yes

68069 New Hampshire Healthy Family NH Yes Yes

68069 Peach State Health Plan (Behavioral Health) GA Yes Yes

68069 Peach State Health Plan (Medicaid) GA Yes Yes

68069 Sunflower State Healthcare Plan IA Yes Yes

68069 Sunshine Health Plan (Also 68057) All Yes Yes

68069 Superior Health Plan (Also 39188) TX Yes Yes

68069 Total Carolina Care (Also 68055) All Yes Yes

68195 Healthpoint Corporation All Yes Yes

68195 Healthsource Provident Ins. Co. All Yes Yes

68195 Provident Life & Accident Insurance Company All Yes Yes

68195 Provident Life & Accident Insurance Company of America All Yes Yes

68195 Provident Life & Casualty Insurance Company All Yes Yes

Page 30: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

68423 The Care Network All Yes Yes

68756 Bay Bridge Administrators/Protector 360 TX Yes Yes

69493 Tower Life Insura All Yes No

69821 Next Level Health All Yes Yes

70259 ProCare Health Plan Medicaid All Yes Yes

70408 Fortis Benefits (Kansas City) All Yes Yes

70454 Pace CNY All Yes No

70491 The Mutual Group All Yes No

71037 Lafayette Consolidated Government LA Yes No

71057 Cannon Cochran Management Services, Inc. LA LA Yes Yes

71063 HealthSCOPE Benefits, INC All Yes Yes

71064 Healthchoice ALL Yes Yes

71074 Healthsource Arkansas AR Yes No

71075 Healthsource, AR (Med) (CIGNA) AR Yes Yes

71079 Molina Hc Missour All Yes No

71404 Continental General Insurance Co. All Yes Yes

71404 Continental General Insurance Co. All Yes Yes

71412 Mutual of Omaha Insurance Company All Yes Yes

71412 Mutually Preferred All Yes Yes

71412 United of Omaha All Yes Yes

71498 LifeCircles PACE All Yes No

71768 FreedomBlue HHIC All Yes No

72087 State Employees Group Benefits LA Yes No

72091 IMA of Lousiana Inc. All Yes No

72091 Insurance Management Administrators All Yes No

72099 American Lifecare All Yes Yes

72112 SMA All Yes No

72112 SMA 65 All Yes No

72112 SMA Health Plan All Yes No

72112 SMA HMO All Yes No

72112 SmartPlan All Yes No

72112 SmartPlan 65 All Yes No

72112 Southeast Medical Alliance All Yes No

72126 Peoples Health Network (Tenet) All Yes Yes

72127 Ochsner Health Plan All Yes No

72128 Vantage Health Plan, Inc. All Yes Yes

72135 Momentum Health Services All Yes No

72148 PPO Plus, LLC All Yes Yes

72189 Selectcare Texas Beaumont & Golden Triangle All Yes No

72261 SCAN Health Plan All Yes Yes

72436 Pace Central Iowa All Yes No

72467 ACS Benefit Services, inc. All Yes Yes

72690 Northeast Iowa Area Agency All Yes No

73066 Reserve National Insurance All Yes Yes

73067 Quicktrip Corporation All Yes Yes

73071 Osma Health Cl Frates All Yes No

73099 Standard Life & Accident Insur Co All Yes Yes

Page 31: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

73100 Kempton Group All Yes Yes

73126 Equitable Plan Services All Yes Yes

73143 Community Care Managed Health Care Plans of Oklahoma OK Yes Yes

73145 Preferred Community Choice All Yes Yes

73147 HealthCare Solutions Group All Yes Yes

73155 Waterstone Benefit Administrators OK Yes Yes

73159 First Health Network All Yes Yes

73159 PPO Oklahoma (WinterBrook HealthCare Management) OK Yes Yes

73172 Scan Health Plan Arizona AZ Yes Yes

73236 Loren Cook All Yes No

73288 EHI (Employers Health Insurance) All Yes No

73288 Primary Delivery Systems All Yes No

73288 Vencor All Yes No

73624 PBS Oregon Peninsula Airways All Yes No

73743 Village Family Physician All Yes No

74048 American National Insurance Co All Yes Yes

74095 USAA All Yes Yes

74101 Wisconsin Department Of Corrections All Yes No

74205 Right Care from Scott & White All Yes Yes

74212 Employer Plan Services, Inc. All Yes No

74214 Texas Municipal League Group Benefits Risk Pool TX Yes Yes

74223 UMR San Antonio All Yes No

74227 Bankers United Life (Student Division) All Yes Yes

74227 MEGA Life & Health Ins. Co. (Student Division) All Yes Yes

74227 Mid-West United Life (Student Division) All Yes Yes

74227 Student Insurance All Yes Yes

74227 Student Insurance - Boston Mutual Life Insurance Company NY Yes Yes

74227 Student Insurance - Life Insurance Company of Boston and New YorkNY Yes Yes

74227 Student Insurance - MEGA Life & Health Insurance Company TN Yes Yes

74227 Student Insurance - Mid-West National Life Insurance Company of TennesseeTN Yes Yes

74227 Student Insurance - Reliance Insurance Company TN Yes Yes

74227 Student Insurance - Reliance National Insurance Company TN Yes Yes

74227 Student Insurance Division TN Yes Yes

74227 Student Resources International All Yes Yes

74234 8th Distric Electrical UT Yes No

74234 Advanstaff, Inc. All Yes No

74234 Arizona Pipe Trades Health and Welfare Trust Fund Local Union Nos. 469 & 741 Metal Trades Health PlanAZ Yes No

74234 Arizona Pipe Trades Health and Welfare Trust Fund Local Union Nos. 469 & 741 Pipe Trades Health PlanAZ Yes No

74234 City of Austin TX Yes No

74234 CompuSys Incorporated (New Mexico) NM Yes No

74234 CompuSys Incorporated of Arizona AZ Yes No

74234 CompuSys Incorporated of Utah UT Yes No

74234 CompuSys/Erisa Group, Incorporated (AZ) AZ Yes No

74234 CompuSys/Erisa Group, Incorporated (NM) NM Yes No

74234 CompuSys/Erisa Group, Incorporated (TX) TX Yes No

74234 Erisa Administrative Services Incorporated AZ Yes No

74234 Erisa Administrative Services, Inc. All Yes No

Page 32: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

74234 IBEW Local 640 & Arizona Chapter NECA Health & Welfare Trust AZ Yes No

74234 IBEW Western Utilities or Local 57 UT Yes No

74234 Intermountain Ironworkers Trust Fund AZ,ID,UT Yes No

74234 New Mexico District Council of Carpenters NM Yes No

74234 New Mexico Painters and Allied Trades Local No 823 UT Yes No

74234 New Mexico-West Texas Multi-Craft UT Yes No

74234 Operating Engineers Local No 53 UT Yes No

74234 Tech-Steel, Inc. All Yes No

74234 Transwestern General Agency All Yes No

74234 Utah Carpenters UT Yes No

74234 Utah Laborers UT Yes No

74234 Utah Pipe Trades UT Yes No

74238 Boon-Chapman Benefit Administrators, Inc. All Yes Yes

74238 Boon-Chapman Benefit Administrators, Inc. All Yes Yes

74240 Assured Benefits Administrators All Yes Yes

74272 Dell Children'S Health Plan All Yes No

74284 Driscoll Childrens Health Plan All Yes Yes

74284 Driscoll Childrens Health Plan (CHIP) TX Yes Yes

74289 Mental Health Network All Yes Yes

74323 Medical Benefits Mutual All Yes Yes

74431 Ohio PPO Connect All Yes Yes

75068 Assurant Health Self Funded All Yes Yes

75087 States General Life Insurance All Yes No

75126 Harpeth Ipa Amerivantage All Yes No

75130 UMC Health Plan All Yes Yes

75133 Team Choice PNS All Yes No

75134 Team Choice UMC All No Yes

75136 CoreSource Little Rock AR Yes Yes

75137 Ameriben Solutions All Yes Yes

75138 First Choice of Midwest (PPO) All Yes Yes

75184 Employee Claim Adjudication Services All Yes No

75185 ICON Benefit Administrators All Yes No

75190 NCAS - Fairfax, VA VA Yes Yes

75191 NCAS - Charlotte, VA VA Yes Yes

75196 West Virginia Sta All Yes No

75228 Texas Children's Health Plan (Medicaid) TX Yes Yes

75232 E3 Health, Inc All Yes Yes

75233 Employers Direct Health - SF All Yes Yes

75234 Health First-Tyler, TX TX Yes Yes

75235 Employers Direct Health - FI All Yes Yes

75236 Employers Direct Health - Employee Plan All Yes Yes

75237 Healthsmart Accel All Yes Yes

75238 Phoenix Group Ser All Yes No

75240 American Administrative Group - AAG All Yes Yes

75243 Centra Benefit Services All No Yes

75243 UMR Westerville (Harrington Health) All No Yes

75243 Uniform Medical Plan All No Yes

Page 33: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

75245 UICI Administrators - State of Nevada NV Yes No

75246 GM Southwest TX Yes No

75250 HealthSmart Preferred Care All Yes Yes

75255 Healthsource North Texas TX Yes Yes

75256 Verity National Group All Yes Yes

75261 Community Health Electronic Claims/CHEC/webTPA All Yes Yes

75273 Geisinger Health Plan PA Yes Yes

75274 IHG Direct All Yes No

75278 Arkansas Best Corporation All Yes Yes

75280 Shasta Administrative Services, All Yes Yes

75281 New ERA Life All Yes Yes

75283 Linn County All Yes No

75284 Consolidated Associates Railroad All Yes No

75289 Healthfirst of Austin TPA All Yes Yes

75299 Angeles IPA (SYNERMED) All Yes No

75305 Therapy Review Sy All Yes No

75309 Pacific Southwest Admininstrators (PSWA) All Yes No

75318 HMC Healthworks All Yes Yes

75544 Christie Student Health Plans All Yes No

75600 The City of Odessa All Yes Yes

75678 Active Care UCS All Yes No

75895 Hometown Health Plan Nevada All No No

76028 Gateway Health Plan of Ohio, Inc. OH Yes Yes

76031 New Era Welfare Benefit Plan Trust All Yes No

76045 SelectCare of Texas (HPN) Heritage Physicians Network TX Yes Yes

76046 Texas First Health Plan(TOPA) All Yes No

76048 Texas Children's Health Plan TX Yes Yes

76061 Amcare Health PLA All Yes No

76066 Renaissance Physicians Organization All Yes Yes

76079 Midwest Health Partners All Yes No

76112 North American Insurance Company All Yes No

76342 Health Plan of Nevada (FFS claims) NV Yes Yes

76342 Sierra Health and Life (FFS Claims) (SecureHorizons by UnitedHealthcare)All Yes Yes

76342 Sierra Health Services CA,NV Yes Yes

76343 Health Plan of Nevada (Encounter claims) NV Yes Yes

76343 Sierra Health and Life (Encounter claims) (SecureHorizons by UnitedHealthcare)All Yes Yes

76343 Sierra Health Services Encounters CA,NV Yes Yes

76569 Passportadvantage All Yes No

76870 LifePath Hospice Inc. All Yes No

76923 Good Shepherd Hospice All Yes No

77001 AmeriHealth NorthEast All Yes Yes

77002 Amerihealth District of Columbia All Yes Yes

77003 Prestige Health Choice All Yes Yes

77006 Amerihealth VIP Care-La All No Yes

77007 Amerihealth VIP Care - DC All Yes No

77009 First Choice VIP Care Plus SC. All Yes Yes

77012 Midcoast IPA All Yes No

Page 34: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

77013 Amerihealth Caritus VIP Michigan MI Yes Yes

77022 Ultimate Health Plan All Yes Yes

77023 Carepoint Health Plan All Yes Yes

77024 Seechange All Yes No

77025 West Virginia Workers Comp All Yes No

77035 Sutter Connect - Central Valley Med Group CA Yes No

77038 Sante Health Systems All Yes No

77039 Kern Health Systems All Yes Yes

77044 Dolabor Black Lun All Yes No

77045 Arcadian Management Services, Inc All Yes Yes

77051 AmeriHealth Connect All Yes Yes

77052 Coastal Administrative Services All Yes No

77054 Fidelis Secure Care All Yes Yes

77063 Maryland PMHS ValueOptions MD Yes No

77070 Advantage Preferr All Yes No

77072 Wcare Pri Fee Ser All Yes No

77073 VNS Choice Medicare All Yes Yes

77075 Amerihealth Caritas Iowa IA Yes Yes

77076 Network Health Insurance Corp - Medicare All Yes Yes

77078 Banner Medisun All Yes Yes

77080 WPP Eldercare Wisconsin All Yes Yes

77082 Care Improvement Plus All Yes Yes

77083 American Heritage All Yes Yes

77124 Delano IPA All Yes No

77153 Indiana University (Southeastern Indiana Health) All Yes Yes

77153 Southeastern Indiana Health SIHO All Yes Yes

77160 Gold Coast All Yes No

77170 Common Ground Healthcare Cooperative All Yes No

77180 HealthyCT CT Yes No

77201 Clearchoice Healt All Yes No

77318 Sutter Delta Medical Group All Yes No

77780 Blue Shield of Nebraska NE Yes No

77871 SIHRTE All Yes No

77894 Kentucky Health Cooperative KY Yes Yes

77950 Health Alliance Medical Plans of Illinois IL Yes Yes

78375 Connecticare - Medicare All Yes Yes

78521 Greentree All Yes No

78521 Greentree Administrators All Yes No

78857 Medica Health Care Plan, Inc. FL Yes Yes

79480 UMR-Midwest Securities All Yes Yes

79966 Amida Care Medicare All Yes Yes

80019 Medical Service Company Group Incorporated (MSC) All Yes No

80026 Med Partners Amer All Yes No

80087 Innovative Physician Associates All Yes No

80095 Prominence Health Plan of Texas All Yes Yes

80141 Healthfirst, Inc. (NY) NY Yes Yes

80142 Health Partners, PA PA Yes Yes

Page 35: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

80214 Champva Medicare All No No

80241 GBS GROUP BENEFIT SERVICES INCORPORATED All Yes Yes

80314 Unicare Life & Health ALL Yes Yes

80314 Unicare Life & Health ALL Yes Yes

80520 Hilliard Corporation (UCS) All Yes No

80705 AH & L All Yes Yes

80705 ALTA Health and Life Insurance Company All Yes Yes

80705 Anthem Health and Life Insurance Company of New Jersey NJ Yes Yes

80705 Confederation Admin Services All Yes Yes

80705 Confederation Life Insurance All Yes Yes

80705 Crown Life All Yes Yes

80705 First Great-West Life & Annuity All Yes Yes

80705 Great West (SF) CA Yes Yes

80705 Great West (WA) WA Yes Yes

80705 Great West Care All Yes Yes

80705 Great West Denver CO Yes Yes

80705 Great West Life Assurance All Yes Yes

80705 Great West Life Assurance Company of America All Yes Yes

80705 Great-West Bellevue WA Yes Yes

80705 GWL All Yes Yes

80705 GWL & A All Yes Yes

80705 One Health Plan Inc. All Yes Yes

80705 One Health Plan Michigan, Inc. MI Yes Yes

80705 One Health Plan New York, Inc. NY Yes Yes

80705 One Health Plan of Alaska AK Yes Yes

80705 One Health Plan of Arizona, Inc. AZ Yes Yes

80705 One Health Plan of DC Inc, DC Yes Yes

80705 One Health Plan of Florida FL Yes Yes

80705 One Health Plan of Indiana, Inc. IN Yes Yes

80705 One Health Plan of Kansas and Missouri KS,MS Yes Yes

80705 One Health Plan of Maine, Inc. ME Yes Yes

80705 One Health Plan of Massachusetts, Inc. MA Yes Yes

80705 One Health Plan of Minnesota, Inc. MN Yes Yes

80705 One Health Plan of Nevada, Inc. NV Yes Yes

80705 One Health Plan of New Jersey NJ Yes Yes

80705 One Health Plan of North Carolina NC Yes Yes

80705 One Health Plan of Ohio OH Yes Yes

80705 One Health Plan of Pennsylvania PA Yes Yes

80705 One Health Plan of South Carolina SC Yes Yes

80705 One Health Plan of Tennessee TN Yes Yes

80705 One Health Plan of Texas TX Yes Yes

80705 One Health Plan of Virginia, Inc. VA Yes Yes

80705 One Health Plan of Washington WA Yes Yes

80705 One Health Plan of Wisconsin, Inc. WI Yes Yes

80705 One Health Plan of Wyoming WY Yes Yes

80900 MPA - Custom Provider Network All Yes No

80942 West Suburban Health Providers All Yes Yes

Page 36: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

81039 EBMS (Employee Benefit Management Services, Inc) All Yes Yes

81040 Allegiance Benefit Plan Management, Inc. All Yes Yes

81044 Florida Health Solution Hmo Company All Yes No

81108 Unity Security Life And Health All Yes No

81240 Palic / Pan-American Health PR Yes No

81264 Nippon Life Insurance Company All Yes Yes

81400 All Savers Insurance All Yes Yes

81400 American Medical Security All Yes Yes

81400 American Medical Security All Yes Yes

81400 PacifiCare Individual Business Plan All Yes Yes

81810 IBG Administrators, LLC All Yes No

81812 Katy Medical Claims All Yes No

81883 Municipal Health Benefits Fund All Yes No

81949 American Insurance Company of TX All Yes No

81949 Woodman Accident and Life Co All Yes No

82018 Health Claims Service All Yes No

82048 Primary Health Network All Yes Yes

82056 Custome Design Benefits, Inc. All Yes Yes

82234 Homewood Resorts (UCS) All Yes No

82238 Allegian Advantage All Yes Yes

82347 Cook Group Solutions ALL Yes Yes

82347 Cook Group Solutions ALL Yes Yes

82420 Valley Baptist Health All Yes Yes

83028 MBA Benefit Administrators All Yes Yes

83035 Senior Whole Health All Yes Yes

83077 Advantek Benefit Administrators All Yes Yes

83253 Health Plan of Michigan All Yes Yes

83926 PBS Oregon TDX Corporation All Yes No

84041 Basil Castrovinci Associates All Yes No

84076 Sinclair Health Plan All Yes Yes

84096 Sloans Lake Managed Care All Yes No

84129 Colorado Access All Yes No

84131 Denver Health Medical Plan, Inc. - Medicare Choice CO Yes No

84132 United Medical Alliance (UMA) CO Yes Yes

84132 United Physicians of Northern Colorado CO Yes Yes

84133 Denver Health and Hospital Authority CO Yes Yes

84134 Denver Health - Indigent CO Yes No

84135 Denver Health Medical Plan CO Yes Yes

84137 InterWest Health PPO (Montana) MT Yes No

84141 New West Health Plan MT Yes Yes

84146 CHAMPVA-HAC All Yes Yes

84223 Keystone VIP Choice All Yes Yes

84223 Keystone VIP Choice All Yes Yes

84555 HMO Louisiana Blue Advantage LA Yes Yes

84562 Questcare Medical All Yes No

84806 Virginia Coordinated Care VCC All Yes No

84980 Blue Shield of Texas TX Yes Yes

Page 37: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

84980 Blue Shield of TX HCSC Insurance Services Company TX Yes Yes

85036 New Mexico Public Schools Insurance Authority All Yes No

85256 Wabash Memorial Hospital Association All Yes No

85468 Family Health Network All Yes Yes

85578 Ingalls Provider Group All Yes No

85600 Albuquerque Public Schools All Yes No

85729 Healthcomp All Yes Yes

86001 UHC Community NJ2 All Yes No

86002 UHC Community NY2 All Yes No

86003 AmeriChoice of Pennsylvania Personal Care Plus All Yes Yes

86033 Cigna Healthcare For Seniors - Arizona Medicare AZ Yes Yes

86040 MTN States Admini All Yes No

86044 Capstone Health P All Yes No

86047 AmeriChoice NJ, Medicaid, NJ Family Care NJ Yes Yes

86047 AmeriChoice of NJ Medicaid & Family Care NJ Yes Yes

86048 AmeriChoice NY Medicaid & Child Health Plus All Yes No

86048 AmeriChoice of NY Medicaid & Child Health Plus All Yes No

86049 AmeriChoice of PA Children's Health Insurance Program All Yes No

86049 AmeriChoice of PA Medicaid All Yes No

86049 AmeriChoice PA Medicaid & CHIP All Yes No

86050 UnitedHealthcare Community Plan Missouri All Yes Yes

86052 Mercy Health Plan (AHCCCS) AZ Yes Yes

86052 Mercy Health Plan (AHCCCS) AZ Yes Yes

86052 Mercy Health Plan of AZ AZ Yes Yes

86052 Mercy Health Plan of AZ AZ Yes Yes

86062 Ancillary Benefit Systems Arizona All Yes No

86066 Health Management Associates (HMA) All Yes Yes

86066 HMA (servicing HI, AZ and NV) All Yes Yes

86067 Nevada Health Solutions NV Yes No

86067 NevadaCare NV Yes No

86067 NevadaCare Kids NV Yes No

86068 Hawki All Yes No

86068 Iowa Health Solutions IA Yes No

86068 Southeast Iowa Health Plan IA Yes No

86069 Illinois Health Solutions IL Yes No

86071 Summerlin Life And Health All Yes No

86083 Summit Administration Services, Inc. All Yes No

86304 Insurers Administrative Corp All Yes No

86711 Pace Southeast Michigan All Yes No

86916 Medicaid Texas Health Steps & CSHCN All Yes No

87042 Union Pacific Railroad Employees Health Systems All Yes Yes

87043 First Health All Yes No

87056 PIASC All Yes No

87065 CDO Technologies WY,UT Yes Yes

87065 MBA of Wyoming WY,UT Yes Yes

87066 Formax, Inc. All Yes Yes

87068 P5 Health Plan Solutions of Utah All Yes Yes

Page 38: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

87071 Liberty Health Advantage All Yes No

87098 Avesis Third Part Administrators All Yes No

87265 Benesight All Yes Yes

87726 AARP MedicareComplete All Yes Yes

87726 American International Group, Inc. All Yes Yes

87726 AmeriChoice - CT, FL, MD, RI, TX, WI CT,FL,MD,RI,TX,WI Yes Yes

87726 AmeriChoice by UnitedHealthcare (NYU) All Yes Yes

87726 AmeriChoice MS - CHIP & CAN MS Yes Yes

87726 AmeriChoice of Florida FL Yes Yes

87726 AmeriChoice of Illinois IL Yes Yes

87726 AmeriChoice of Maryland MD Yes Yes

87726 AmeriChoice of Nebraska NE Yes Yes

87726 AmeriChoice of Nebraska NE Yes Yes

87726 AmeriChoice of Rhode Island RI Yes Yes

87726 Definity Health Plan All Yes Yes

87726 Definity Services All Yes Yes

87726 Empire Plan All Yes Yes

87726 Evercare Special Needs All Yes Yes

87726 Evercare Star Plus All Yes Yes

87726 First Seniority Freedom All Yes Yes

87726 Harvard Pilgrim Passport Connect All Yes Yes

87726 John Deere Healthcare All Yes Yes

87726 MAHP MD Yes Yes

87726 MD-Individual Practice Association, Inc. (M.D. IPA) All Yes Yes

87726 Optimum Choice, Inc. (OCI) All Yes Yes

87726 OptumHealth Behavior Solutions All Yes Yes

87726 OptumHealth Behavioral Solutions of NM NM Yes Yes

87726 OptumHealth New Mexico NM Yes Yes

87726 SecureHorizons MedicareComplete All Yes Yes

87726 SecureHorizons MedicareDirect All Yes Yes

87726 The Empire Plan All Yes Yes

87726 Touchpoint All Yes Yes

87726 UBH Employer Division All Yes Yes

87726 UBH RIOS All Yes Yes

87726 United Behavioral Health All Yes Yes

87726 UnitedHealthcare All Yes Yes

87726 UnitedHealthcare / MAMSI Life and Health Insurance Co. (MLH) All Yes Yes

87726 UnitedHealthcare Group Medicare Advantage All Yes Yes

87726 UnitedHealthcare hawk-I All Yes Yes

87726 UnitedHealthcare Plan of the River Valley All Yes Yes

87726 UnitedHealthcare River Valley All Yes Yes

87726 UnitedHealthcare West All Yes Yes

87815 Acordia National All Yes Yes

87815 Wells Fargo TPA All Yes Yes

87843 Consolidated Health Plans All Yes Yes

88019 Teachers Health Trust All Yes No

88022 CDS Group Health All Yes Yes

Page 39: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

88023 Hometown Health Plan Nevada NV Yes Yes

88027 Northern Nevada Trust Funds NV Yes Yes

88029 Saint Marys Health Plan All Yes Yes

88030 Scott & White Health Care TX Yes Yes

88033 Bridgestone Fires All Yes No

88035 AssureCare, Inc. All Yes Yes

88050 National Health Benefits Corporation - NHBC02 All Yes Yes

88051 Premier Healthcare Exchange All Yes Yes

88055 First Agency All Yes Yes

88056 Premier HealthCare Exchange (Cypress) All Yes Yes

88057 National Health Benefit All Yes Yes

88058 Med Pay All Yes Yes

88067 Tall Trees Administrators All Yes Yes

88082 Prominence-St. Mary'S Health Plan Encounters All Yes No

88090 Mayo Clinic FL/GA All Yes Yes

88091 Commercial Travelers All Yes No

88092 Benefit Management LLC (VBA) All Yes No

88461 Alliance Healthplans of WI WI Yes No

88537 Hometown Hlth Pro All Yes No

88600 MMM (Medicare y mucho mas) PR Yes No

88622 Quality Health Plans Of New York ALL Yes Yes

88848 Blue Shield of Iowa IA Yes No

88848 Blue Shield of South Dakota SD Yes No

88858 Zebrahealth NULL Yes No

89461 Quality Care Partners All Yes Yes

89890 Kern Legacy Health Plan All Yes No

90001 Healthlink PPO All Yes Yes

90001 National Capital Preferred Provider Organization (NCPPO) All Yes Yes

90023 HDPC - Premier Healthcare All Yes Yes

90060 FirstGuard Health Plan of Kansas KS No Yes

90061 FirstGuard Health Plan of Missouri MO No Yes

90091 Nevada Health Coop All Yes Yes

90096 Land of Lincoln Health All Yes Yes

90551 Us Family Health Plan All Yes No

90560 WestLake Financial Group, Inc. All Yes No

90753 MedCost / Liberty Health Share All Yes No

90956 Atlas Life Ins Co (NFIC Plan only) All Yes No

90956 Midland National Life Ins Co (NFIC Plan only) All Yes No

90956 National Financial Insurance Company All Yes No

90956 SunAmerica Life Ins Co (NFIC Plan only) All Yes No

91049 Lifewise Health Plan of Washington A Premier Health Plan WA Yes Yes

91051 Group Health Cooperative (WA) WA Yes Yes

91062 WA Dental Service All Yes No

91064 Wenatchee Valley Medical Center All Yes Yes

91068 Northwest Administrators Inc All No No

91078 Trusteed Plans Service Corporation All Yes Yes

91121 Group Health Northwest ID,WA Yes No

Page 40: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

91131 First Choice Health Network WA,OR,ID,AK Yes Yes

91131 Sound Health All Yes Yes

91136 Alaska Childrens Services, Inc AK Yes Yes

91136 Alaska Laborers Construction Industry Trust AK Yes Yes

91136 Alaska Pipe Trades Local 375 AK Yes Yes

91136 Alaska United Food & Commercial Workers Health & Welfare TrustAK Yes Yes

91136 Automotive Machinists Local 289 Health & Welfare Trust - Grp#F32All Yes Yes

91136 Cement Masons & Plasterers Health & Welfare Trust - Grp#F16 All Yes Yes

91136 Enstar Natural Gas - Grp# P61 All Yes Yes

91136 Glassworkers Health & Welfare Fund - Grp# F29 All Yes Yes

91136 Hotel Employees & Restaurant Employees Health Trust - Grp#F19 All Yes Yes

91136 N.W. Ironworkers Health & Security Trust Fund - Grp#F15 All Yes Yes

91136 N.W. Roofers & Employers Health & Security Trust Fund - Grp#F14 All Yes Yes

91136 N.W. Textile Processors - Grp#F14 All Yes Yes

91136 Operating Engineers Locals 302 & 612 Health & Security Fund - Grp#F12All Yes Yes

91136 Puget Sound Benefits Trust - Grp#F25 WA Yes Yes

91136 Puget Sound Electrical Workers Trust - Grp#33 WA Yes Yes

91136 University of Washington Students & Graduate Appts. - Grp#P67 WA Yes Yes

91136 West Coast Stationary Engineers Health & Security Trust Fund - Grp#F13All Yes Yes

91151 Sterling Option 1 All No Yes

91161 HighlinePSHP All Yes No

91164 Highline Medical Services MOLINA All Yes Yes

91171 Physicians of Southwest Washington All Yes No

91176 RBMS, LLC All Yes Yes

91184 Sanford Health Plan All Yes No

91313 MDwise Hoosier Care Connect All Yes Yes

91617 Kaiser Foundation Health Plan Colorado All Yes No

91741 Gateway Health Plan Medicare Ohio Assured All Yes No

92135 Employee Logistics All Yes Yes

92579 University of Miami Behavioral Health All Yes No

92600 Alaska Electrical Health & Welfare Fund All Yes Yes

92620 Tongass Timber Trust AK Yes No

92649 Inter-Americas Insurance NULL Yes No

92805 Maxor All Yes No

93029 PacificSource Health Plans All Yes Yes

93031 Select Benefit Administrators, Inc. All Yes Yes

93044 A & I Benefit Plan Administrators All Yes No

93050 William C. Earhart Co, Inc. GA Yes Yes

93079 Kaiser Foundation Health Plan Of The Northwest All Yes No

93082 Prominence Health Plan of Nevada All Yes Yes

93092 US Benefits All Yes Yes

93093 Lifewise A Premier Health Plan OR Yes Yes

93093 Lifewise Health Plan of Oregon A Premier Health Plan OR Yes Yes

93101 Complementary HealthCare Plans OR,WA Yes No

93121 Familycare Coordinated Care Organization All Yes No

93220 Universal Fidelity Administrators Company All Yes No

93221 Asuris NW Health All Yes Yes

Page 41: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

93235 UCS All Yes Yes

93240 Evergreen Health Cooperative All Yes No

93688 AmeriHealth - DE (PPO) All Yes Yes

93975 CareOregon, Inc. OR Yes Yes

94027 Asociacion de Maestros PR Yes No

94056 California Pacific Medical Center All Yes No

94115 Palo Alto Medical Foundation All Yes No

94123 Kaiser Permanente Health Plan Hawaii All Yes No

94134 Kaiser Foundation Health Plan of Southern CA Region CA Yes Yes

94135 Kaiser Foundation Health Plan of Northern CA Region CA Yes Yes

94154 Humboldt Del Norte Foundation For Medical Care All Yes No

94174 United Administrative Services All No No

94177 Allied Administra All Yes No

94235 Delta Health All Yes No

94254 HPR All Yes No

94254 MediPrime All Yes No

94265 Medica All Yes Yes

94269 Sutter East Bay Medical Foundation All Yes No

94293 Valley Mental Health All Yes No

94302 Chinese Community Health Plan All Yes No

94304 Teamsters Benefit Trust All No Yes

94312 Center for Elders Independence All Yes Yes

94316 Brown & Toland Medical Group All Yes Yes

94320 Kaiser PPO All Yes No

94321 Children First Medical Group All Yes No

94603 UC-Davis Health CA Yes No

94998 FirstCare Star Medicaid All Yes Yes

94999 FirstCare All Yes Yes

95019 Health First Health Plans All Yes Yes

95044 AmeriHealth HMO New Jersey and Delaware NJ,DE Yes Yes

95056 Pennsylvania Keystone Health Plan East PA Yes Yes

95056 Pennsylvania Keystone Health Plan East PA Yes Yes

95092 Careplus All Yes Yes

95112 Capital Health Plan All Yes Yes

95123 Neighborhood Health Partnership (NHP) All Yes Yes

95166 Cedars-Sinai Medical Network Services Claims All Yes Yes

95167 Cedars-Sinai Medical Network Services Encounters All Yes No

95170 American Benefit Plan Administrators All No Yes

95192 Community Connect Medicaid All Yes Yes

95192 Group Health Cooperative of Eau Claire All Yes Yes

95202 SummaCare Health Plan All Yes Yes

95213 HealthEdge Administrators All Yes No

95241 AGIA Inc All Yes No

95266 Umrwesterville 95 All Yes No

95288 Employee Benefit Administration & Management (EBA&M) CA Yes No

95308 Independent Health All Yes No

95321 Medfocus All Yes No

Page 42: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

95327 Alameda Alliance for Health All Yes No

95340 Adventist Health System All Yes Yes

95348 Humana Health Plans Ohio All Yes No

95375 UHC Community IA All Yes No

95376 Community Health Group All Yes No

95377 Beech Street Corp. All Yes Yes

95378 Americhoice of TN TN Yes Yes

95378 AmeriChoice TN: TennCare, Secure Plus Complete TN Yes Yes

95379 One Health Plan of California CA Yes No

95386 CenCal Health CA Yes No

95388 One Health Plan of Illinois IL Yes No

95393 High Desert Medical Group All Yes No

95397 Personal Insurance Administrators All Yes Yes

95397 PIA All Yes Yes

95399 CAP Management All Yes No

95411 FL MCO PHC/PHP All Yes Yes

95412 One Health Plan of Colorado CO Yes No

95415 Lakeside Health Services All Yes No

95424 Access Medical Group All Yes No

95426 Affordable Benefit Administrators, Inc. All Yes No

95432 Facey Medical Foundation All Yes No

95435 Health Pledge HMO All Yes No

95440 Arnett Health PLA All Yes No

95444 Indiana University Health Plan All Yes Yes

95453 Grand Valley Health Plan All Yes No

95460 Key Health Medical Solutions All Yes No

95467 Great Lakes Health Plan All Yes Yes

95467 Great Lakes Health Plan All Yes Yes

95567 Health Net (of California) CA Yes Yes

95569 One Health Plan of Georgia GA Yes No

95600 Emergency Medical Services Fund All Yes No

95604 Best Life & Health Insurance Co. All Yes Yes

95606 BERKSHIRE LEHIGH PARTNERS All Yes No

95655 Medigold All Yes No

95655 Mt. Carmel All Yes No

95748 Chartered Health Plan (DC Chartered Health Plan) DC Yes No

95827 Healthy Palm Beaches, Inc. FL Yes No

95828 Healthcare District Palm Beach County All Yes Yes

95885 PCA Healthplans Texas All Yes No

95958 PacifiCare of CA Encounters CA Yes Yes

95958 PacifiCare of OK Encounters OK Yes Yes

95958 PacifiCare of OR Encounters OR Yes Yes

95958 PacifiCare of TX Encounters TX Yes Yes

95958 PacifiCare of WA Encounters WA Yes Yes

95958 UnitedHealthcare West Encounters WA Yes Yes

95964 AZ Pacificare CLA All Yes No

95998 New Avenues Inc. All Yes No

Page 43: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

95999 PacifiCare PPO All Yes Yes

96107 Neighborhood Health Partnership (NHP) All Yes Yes

96240 Neighborhood Health Plan of RI - Integrity RI Yes Yes

96240 Neighborhood Health RI Exchange, Unity, Integrity Plans RI Yes Yes

96385 United Healthcare Community Plan Kansas All Yes Yes

96400 San Diego PACE All Yes No

96475 Healthlink HMO All Yes Yes

96490 Informed LLC All Yes No

96598 Micron Tech All Yes No

97041 UCS Hewitt Coleman All Yes No

97055 Mega Life & Health All No Yes

97258 Hammerman & Gainer All Yes No

97300 Triple S PR Yes No

97652 Passport Advantage All Yes Yes

97661 Ameriben IEC Group All Yes No

97691 Silver Star Pace All Yes No

97736 UCS RTG Medical Group All Yes No

97802 Superior Insurance Services All Yes No

98010 William J Sutton & Co. Ltd. All Yes Yes

98022 TakeCare Insurance Company All Yes No

98205 Anerican Founders Life Ins Co All Yes No

98205 Life & Health Ins Co of America All Yes No

98205 National Foundation Life Insurance Company All Yes No

98514 Trilogy Health All Yes Yes

99026 University Health Alliance All Yes Yes

99030 Aloha Care All Yes No

99157 SCAN Encounters (Diversified Data Design (DDD)) All Yes Yes

99208 Hawaii Western Management (HWMG) All Yes Yes

99282 Motion Picture Industry All Yes No

99284 Greater Covina Medical Group All Yes No

99289 Screen Actors Guild All No Yes

99320 Benefit & Risk Management Services All Yes Yes

99320 Benefit & Risk Mgtm Svcs All Yes Yes

99485 On Lok Senior Health Services Incorporated All Yes No

99486 Pacepartner Solutions All Yes No

99588 Allegiance Health Management All Yes No

99660 Fresno PACE All Yes No

99726 Tricare West NULL Yes Yes

99795 Champion Chevrolet All Yes No

00923 Blue Care PPO VA Yes No

00923 COVA (Commonwealth of VA) VA Yes No

00923 Healthkeeper HMO VA Yes No

00923 Keycare PPO VA Yes No

00923 Local Choice VA Yes No

00923 Medicare Supplemental VA Yes No

00923 Peninsula Healthcare VA Yes No

00923 Priority Healthcare VA Yes No

Page 44: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

00923 VA State Employer Funds VA Yes No

128FL Coventry Healthcare of FL FL Yes Yes

128KY Aetna Better Health of KY KY Yes No

128LA Aetna Better Health LA LA Yes Yes

128MI Aetna Better Health of Michigan MI Yes Yes

128MO Aetna Better Health MO MO Yes Yes

128VA Aetna Better Health of Virginia VA Yes Yes

128WV Aetna Better Health WV WV Yes Yes

12K81 MDWise All No Yes

12X09 Molina Medicaid - MNS All No Yes

12X18 Univera WNY All No Yes

12X19 Univera Traditional PPO All No Yes

12X56 Value Options All No Yes

251CC Childrens Community Health Plan Wisconsin All Yes No

251MS Medstar Select All Yes Yes

251PD Piedmond WellStar Health Plan All Yes No

251PR Premier Health Plan All Yes Yes

33LGC Life Gift Cards All Yes No

3414A Klais & Company All Yes No

36320MA AHC Misdirected Claims All Yes No

3833A McLaren Health Advantage All Yes Yes

3833C McLaren Medicaid All Yes Yes

3833N McLaren ABW-NHP All Yes Yes

3833R McLaren Advantage SNP All Yes Yes

3833T McLaren ABW-THPC All Yes Yes

412MP MedPartners Admin Services All Yes No

4317M Gateway to Better Health All Yes Yes

431YM Gateway To Better Health All Yes No

441MP Medpartners All Yes Yes

4725P Little Company of Mary Health All Yes No

5246M March Vision Health Plan All Yes No

5415M Sentara Mental Health Professional All Yes No

6197P MCS PR Yes No

9043P Medical Control All Yes No

9047P USC Health Services All Yes No

9048P Multiplan Incorporated All Yes No

A0003 Accelerated Claims Incorporated All Yes No

A0004 Coastal Care All Yes No

A0005 County Medical Services Program All Yes No

A0006 Golden Empire Managed Care All Yes No

A0008 Maricopa Health Plan All Yes No

A0009 PPOM LLC All Yes No

A0010 Revclaims LLC All Yes No

A0011 Trillium Healthcare Resources All Yes No

A0012 Unity Health Plan All Yes No

A0013 University Physicians Healthcare All Yes No

A0014 Well Sense Health Plan All Yes No

Page 45: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

A0016 Bluecare Family Plan All Yes No

A0047 United Claim Solutions All Yes No

A0701 ABMG CA Yes No

A0701 Alta Bates Medical Group CA Yes No

A1680 C3 Health (fka Access Health Inc.) MI Yes No

A1681 Muskegon Care MI Yes No

A7213 Greek Catholic Union All No No

AAMG1 Asian American Medical Group All Yes No

ABRI1 Abri Healthplan All Yes No

ACCOM Access Community Health Network All Yes No

ACIPA Advantage Care IPA CA Yes No

ACN01 American Chiropractic Network NY Yes No

ACN01 American Chiropractic Network IPA of NY NY Yes No

ACN01 American Chiropractic Network, Inc. NY Yes No

ACN01 American Complimentary Care Network, Inc. All Yes No

ACN01 ChiroCare All Yes No

ACN01 Chiropractic Care of Wisconsin, Inc. WI Yes No

ADCUC United Care Medical Group All Yes No

ADOCS Affiliated Doctors of Orange County CA Yes Yes

ADSL1 Nexcaliber All Yes No

AEC01 Atlantis Eyecare All Yes No

AGUA1 Agua Caliente All Yes No

AH001 Avante Health All Yes No

AHC01 Activhealthcare All Yes No

AHIPA Accountable IPA All Yes No

AHS01 Access Administrators All Yes Yes

AHTIN Assurant Health - Time Insurance All No No

AHUSY Assurant Health- Union Security Insurance All No No

AIPAZ Alamitos IPA CA Yes No

AKMCD Medicaid of Alaska AK Yes Yes

AKMCR Medicare Part A/B of Alaska AK Yes Yes

ALMCD Medicaid of Alabama AL Yes Yes

ALMCR Medicare Part A/B of Alabama AL Yes Yes

ALOHA AlohaCare HI Yes No

ALPHA ALPHACARE All Yes No

AMAIA AMA Insurance Agency All Yes Yes

AMAIA AMA Insurance Agency, INC All Yes Yes

AMBHN Ambay Health Network All Yes No

AMC11 AM Capitol Insura All Yes No

AMF11 American Family Insurance Company All Yes No

AMG01 Access Medical Group All Yes No

AMM07 Seoul Medical Group All Yes No

AMM11 Medichoice IPA All Yes No

AMM12 Community Care IPA All Yes No

AMM14 California IPA All Yes No

AMS01 Dentemax MI Yes No

AMS01 Dentemax/DPI (MI) MI Yes No

Page 46: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

AMS01 Network Health PPO All Yes No

APBPN FloridianCare All Yes No

APG01 Affiliated Physicians Group All Yes No

APP01 Downey Select IPA (Applecare Medical Mgmt) All Yes No

ARA01 Ageright Advantage All Yes No

ARBLS Blue Advantage Of Arkansas AR Yes No

ARGUS Argus Dental And Vision All Yes Yes

ARMCD Medicaid of Arkansas AR Yes Yes

ARMCR Medicare Part A/B of Arkansas AR Yes Yes

ASH01 American Specialty Health All Yes No

ASMCR Medicare Part B of American Samoa AM Samoa Yes No

ASNTH Assurant Health Re-Pricing via HealthSpan All Yes Yes

ASRM1 ASRM Corporation All Yes Yes

ATHAL American Therapy Administrators All Yes No

ATLAD Atlas Admin USAMC All Yes No

ATPA1 Associated Third Party Administration (ATPA) All Yes No

ATRIO Atrio Health Plans All Yes No

AVA01 Avalon Healthcare Solutions All Yes No

AWNY6 Age Well NY NY Yes Yes

AXM01 Axminister Medical Group All Yes No

AZFMC Ancillary Benefits/Arizona Foundation for Medical Care All Yes No

AZFMC Arizona Foundation for Medical Care AZ Yes No

AZHNT Health Net of Arizona AZ Yes No

AZMCD Medicaid of Arizona (AHCCCS) AZ Yes Yes

AZMCR Medicare Part A/B of Arizona AZ Yes Yes

BANK1 Bankers Fidelity Life Insurance Co All No No

BC001 Directors Guild Of America All Yes No

BCSAL Blue Cross Blue Shield Alabama AL Yes Yes

BCSMT Blue Shield of Montana MT Yes No

BHI00 Behavioral Healthcare, Inc. CO Yes No

BHP01 Bright Health Physicians CA Yes No

BHPMA Baptist Health Plan Advantage ALL Yes No

BKRFM Bakersfield Family Medical Center All Yes No

BMATP Benefit Management Admin NULL Yes Yes

BNMK1 Benmark All Yes No

BOLL1 Bollinger, INC. All Yes No

BOONG The Boon Group All Yes Yes

BPA01 OPEIU Locals 30 & 537 All Yes No

BRIDG Bridgespan All Yes Yes

BS001 Blue Shield of California CA Yes Yes

BS001 UFCW Local 400-5205 CA Yes Yes

BSHS1 Bienvivir NULL Yes No

BTHS1 Brown And Toland Health Services All Yes No

BTSS1 Brown & Toland Sutter All Yes No

BTSS1 Brown & Toland SutterSelect All Yes No

BV001 Block Vision, Inc. All Yes No

BVES1 Eye Specialists CO Yes No

Page 47: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

BVTX1 Block Vision of Texas TX Yes No

C1051 Midwest Family Mutual Insurance Company All Yes No

C1052 Chubb And Son All Yes No

C2BLS Federal Employee Program (Connecticut) CT Yes No

CALL Alliance, The All Yes No

CALL EBC Inc. All Yes No

CALL Healthsource \ Hudson Health Plan All Yes No

CALL PA Preferred Health All Yes No

CALL Preferred Health Care - PPO Lancaster, PA (IHS Gateway Payer) PA Yes No

CALL Puerto Rico Triple S (BCBS) PR Yes No

CALL Radcon, Inc. All Yes No

CALL Virginia Health Network,Inc All Yes No

CALOP Cal-Optima Direct All Yes Yes

CAMCD MediCal of California CA Yes Yes

CAPH2 Caprock Health Plans Verity All Yes No

CAPHP Caprock Health Plan All Yes Yes

CAPMN Premier Physicians Network All Yes No

CARD HPMS MI Yes No

CARMO Caremore IPA All Yes No

CARMO CareMore Value Plus (CVP) All Yes No

CAS01 Cascade East Health Plan OR Yes No

CASD1 Chiropractic Association of South Dakota SD Yes No

CASD2 South Dakota Chiropractic (Sanford Health Plan) SC Yes No

CB148 National Allied WU Local 831 All Yes No

CB186 Bright Health Plan All Yes No

CB231 Independence American Insurance Company All Yes No

CB268 Conerstone Preferred Resources All Yes No

CB404 Preferred Health Plan Of Carolinas (PHPC) All Yes No

CB457 Wellspan Employee Assistance Program All Yes No

CB624 Gulf Stream General Dynamics All Yes Yes

CB637 Aegis Admin Services All Yes No

CB695 Solarte Health Incorporated All Yes No

CB752 Lockard & Williams All Yes No

CB897 Dart Member Care All Yes No

CB951 GBS Global Benefits All Yes No

CB987 DART MEMBER CARE All Yes Yes

CCHP1 Cook Children's Health Plan All Yes Yes

CCHP9 Cook Children's Star Plan All Yes Yes

CCHPC Alignment Health Care All Yes No

CCIA1 Pinnacol Assurance CO Yes Yes

CCIH Correctcare Integrated Health (California Prison Healthcare) All Yes No

CCIHC CorrectCare Integrated Health (CA Prison Health Care Services) CA Yes No

CCIHJAIL Correctcare Integrated Health (Non-Louisiana Jails) All Yes No

CCMC1 CCMC - Comprehensive Care Management Corp NY Yes No

CCMMH Clackamas County Mental Health OR Yes No

CCPN1 Coastal Communities Physician Network (CCPN) CA Yes No

CCStpa CCSTPA Comprehensive Care Services All Yes No

Page 48: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

CDCR1 Clincas Del Camino Real All Yes No

CECVP Community Eye Care All Yes No

CELTC Celtic Insurance All Yes No

CH101 Contessa Health Security Health Plan All Yes No

CHAT1 Chatwins Healthcare Administrators CAll Yes No

CHCN1 Community Health Center Network NC Yes No

CHCNT CNIC Health Solutions, Inc. All Yes Yes

CHCNT CoverColorado CO Yes Yes

CHCNT GettingUsCovered CO Yes Yes

CHCPI Central Health Medicare All Yes No

CHIPA CHIPA - College Health IPA All Yes No

CHP01 Complementary Healthcare Plan All Yes No

CHP02 Columbine Health Plan All Yes No

CHPWA Community Health Plan of WA WA Yes Yes

CIPA1 Central Senior Care NULL Yes No

CLFR2 CL Frates All Yes Yes

CLFRS PLICO All Yes No

CM001 Caremore All Yes No

CMCHP Childrens Medical Center Health Plan All Yes No

CMGWV Community Medical Group of the West Valley CA Yes No

CMSEB Covenant Management Systems Employee Benefit plan All Yes Yes

CNMCR Medicare Part A/B of Northern California CA Yes Yes

COA01 The City of Amarillo TX Yes No

COACC Access Behavioral Care CO Yes No

COACC Colorado Access HMO CO Yes No

COFHP Co Secure Horizon All Yes No

COHMO HMO Colorado All Yes No

COIHS Pacificsource OHP All Yes No

COKSR Colorado Kaiser Permanente (Colorado plans only) CO Yes Yes

COMCD Medicaid of Colorado CO Yes Yes

COMCR Medicare Part A/B of Colorado CO Yes Yes

COMMA Mountain Medical - MMA All Yes No

COMMF Community First All Yes Yes

COMPU Amalgamated Transit Union Division 1001 Health & Welfare Fund CO Yes No

COMPU Carpenters' and Millwrights' Health Benefit Trust Fund CO Yes No

COMPU Carpet, Linoleum and Resilient Tile Layers Health and Welfare FundCO Yes No

COMPU Colorado Laborers Health and Welfare Fund CO Yes No

COMPU CompuSys Incorporated of Colorado CO Yes No

COMPU Compusys of Colorado CO Yes No

COMPU Glassworkers and Glaziers Health and Welfare Fund Trust CO Yes No

COMPU Industrial Machine Specialties CO Yes No

COMPU Pipe Industry Health & Welfare Fund of Colorado CO Yes No

COMPU Tattered Cover, Inc. CO Yes No

CORIZ Corizon Health Inc. All Yes Yes

COTHE Theraphysics Colorado Only All Yes No

CP001 Samaritan Health Plans All Yes No

CPNFC Choice Physicians Net First Choice All Yes No

Page 49: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

CRGMN Clinical Resource Group All Yes No

CSI001 Clinical Specialties Incorporated All Yes No

CSI01 Clinical Specialties Incorporated All Yes No

CSMCR Medicare Part A/B of Southern California CA Yes Yes

CSMED Mcare of Colorado Springs CO Yes No

CSMED Medical Network of Colorado Springs CO Yes No

CSSD2 Childrens Specialist Of San Diego II All Yes No

CTMCD Medicaid of Connecticut CT Yes Yes

CTMCR Medicare Part A/B of Connecticut CT Yes Yes

CWS99 Cal Water All Yes No

CX015 Grouplink All Yes No

CX025 Big Lots Associates Benefit Plans All Yes No

CX025 EBMC All Yes No

CX045 National Elevator Industry Benefit Plan (NEIB) All No No

CX100 Southwest Service Administrators All Yes No

CX101 Carpenters Health and Welfare Fund of Philadelphia All Yes No

DAK01 DakotaCare SD Yes Yes

DAKCH Chiropractic Association Of South Dakota All Yes No

DCA62 Direct Care Administrators All Yes No

DCHPMCAID Dell Childrens Health Plan All Yes No

DCHSF DCHS Medical Foundation All Yes No

DCMCD Medicaid of Washington DC DC Yes Yes

DCMCR Medicare Part A/B of DC DC Yes Yes

DEAN1 Dean Health Plan WI Yes No

DEMCD Medicaid of Delaware DE Yes Yes

DEMCR Medicare Part A/B of Delaware DE Yes Yes

DHS01 Delta Health Systems CA Yes No

DMG01 Illinois Health Plan (IHP) All Yes No

DNLY1 Donley & Company All Yes No

DOCSO Western Oregon Advanced Health (CCO) All Yes No

DOLMG Dolton Medical Group All Yes No

DREYR Dreyer Medical All Yes No

DVMC1 Desert Valley Medical Group CA Yes No

DWMH0 Detroit Wayne Mental Health Authority All Yes No

E3510 Prime Care All Yes No

EBSRM Lifetime Benefit Solutions All Yes Yes

EBSRM Lifetime Benefits Solutions All Yes Yes

EBSSA Employee Benefit Svcs (EBS) of San Antonio TX Yes No

EC999 Exclusive Care - County of Riverside All Yes No

ECIBB Blue Bell Benefits All Yes No

ECISF Ellis Consultants All Yes No

ECMSO United Physicians International(UPI) All Yes No

EM039 Med3000 Pedicare Title 19 All No Yes

EM205 Med3000 CMS Title 21 All Yes Yes

EM216 Med3000 HealthSpring All Yes No

EM284 Med3000 CMS Safety Net All Yes Yes

EM350 Med3000 CMS Early Steps All Yes Yes

Page 50: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

EM522 Med3000 Pedicare Title 21 All No Yes

EM843 Med3000 CMS Title 19 Reform All Yes Yes

EMBLM Emblem All No No

EMG11 Eastland Medical Group All Yes No

EMP01 Empire Physician's Medical Group All Yes No

ENDVR First Source (Endeavor) ALL Yes Yes

ENDVR First Source (Endeavor) ALL Yes Yes

ENMCR Medicare Part A/B of New York (Empire) NY Yes Yes

EPF02 Medicaid - TX Premier Plan TX Yes Yes

EPF03 El Paso First - CHIP All Yes Yes

EPF10 Preferred Administrator TX Yes Yes

EPF11 Preferred Administrators Childrens Hospital All Yes No

EPF37 Healthcare Options NULL Yes Yes

EPNSH EPN - Seton Health Plan Exclusive All Yes Yes

EV001 Eberle Vivian All Yes No

EXC01 Phys Med Group Of San Jose All Yes No

F75137 Ameriben Solutions All Yes No

FAABC Associated Benefits Corp All Yes No

FAMR1 First Admin SD All Yes No

FCD01 Family Care Medicaid OR Yes Yes

FCM01 Family Care Medicaid Mental Health OR Yes Yes

FCMG1 First Choice Medical Group All Yes No

FCS01 Familycare Specialist Medical Group All Yes No

FDMCR FreedomCare Benefits ALL Yes No

FDNYP Fire Dept City New York World Trade Center Health Plan All Yes No

FH001 Foundation Health of CA CA Yes No

FHFLE Foundation Health of Florida-Encounters FL Yes No

FLENC Health Options of Florida (Blue Shield HMO) FL Yes No

FLHLT Health Options of Florida (Blue Shield HMO) FL Yes No

FLMCD Medicaid of Florida FL Yes Yes

FLMCR Medicare Part A/B of Florida FL Yes Yes

FOREN Tricare Overseas All Yes No

FS802 First Solution All Yes No

FSTAG First Agency All Yes Yes

FT254 Fallon (Transplant Claims) All Yes No

FVMC1 Fox Valley Medicine Site 451 All Yes No

FVMCH Fox Valley Medicine Site 199 All Yes No

GABLS State Merit Ga GA Yes No

GACS1 Caresource Of GA ALL Yes Yes

GAMCD Medicaid of GA GA Yes Yes

GAMCR Medicare Part A/B of Georgia GA Yes Yes

GASA1 Group Administrators Self-Funded Alternative All Yes No

GCMG1 Greater Covina Medical Group CA Yes No

GCVCP Cardiovascular Care Providers NULL Yes Yes

GEHA9 Geha Health Group (Nevada) All Yes No

GEM01 Global Excel Management All Yes Yes

GHEDI Generations GlobalHealth NULL Yes No

Page 51: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

GHMCR Ghi Medicare Part B Of New York NY Yes No

GHOKC Global Health All Yes Yes

GNPMG Greater Newport Physicians All Yes No

GOBHI Greater Oregon Behavioral Health Incorporated All Yes No

GSMPA Good Samaritan Ipa (Coastal Healthcare Management) All Yes No

GTPA1 Golden Triangle Physician Alliance All Yes Yes

GTPA1 SelectCare of TX (Beaumont) TX Yes Yes

GUMCR Medicare Part B of Guam Guam Yes No

H0657 Colorado Choice Health CO Yes No

H6435 RiverSpring Health All No No

HALCY Halcyon Behavioral Health All Yes No

HBI01 Human Behavioral Institute All Yes No

HC001 Univera Healthcare - CNY NY Yes No

HCA77 HealthComp All Yes No

HCCMI HCC Life Insurance All Yes No

HCOMP Healthcomp (Community First Star Health Plan) All Yes No

HCP01 Healthcare Partners CA Yes Yes

HCP02 Health Care Partners - AZ AZ Yes Yes

HDMCO HDM Benefit Solutions All Yes No

HDMDG High Desert Medical Group (Regal) All Yes No

HER01 Heritage IPA All Yes No

HESUN HealthSun All Yes No

HIBCS Blue Shield of Hawaii HI Yes No

HIL01 Hill Physicians Medical Group All Yes No

HIMCD Medicaid of Hawaii HI Yes Yes

HIMCR Medicare Part A/B of Hawaii HI Yes Yes

HM001 Health Net (California Encounters Only.) CA Yes No

HM015 PruCare HMO (Encounters Only) All Yes No

HM015 Prudential Encounters All Yes No

HM037 Care Choices HMO All Yes No

HM057 Sutter Medical Group of the Redwoods (SMGR) CA Yes No

HM059 Sutter Connect - SIP, SMG, SWMG - Encounters only CA Yes No

HM065 Sutter Connect East Bay Medical CA Yes No

HM068 Sutter Connect East Bay Regional Brown & Toland Encounters. CA Yes No

HM069 Sutter Connect East Bay Regional Affinity Encounters CA Yes No

HMA01 Healthcare Management Administrators, Inc. WESTERN Yes Yes

HMLIC Horace Mann Life Insurance All Yes No

HOSH1 Dignity Health Sacramento Hospital Shop For Mercy Med All Yes No

HOSH4 Dignity Health Inland Empire High Risk All Yes No

HPAMN Cooportunity Health All Yes Yes

HPFFS Hispanic Physicians IPA All Yes No

HPN11 SelectCare of TX (Houston) TX Yes Yes

HPPO Health Plus Physician Organization All Yes No

HPSM1 Health Plan of San Mateo CA Yes No

HS001 Healthsource Inc. All Yes No

HSF01 Healthy San Francisco All Yes Yes

HSHAR Healthshare NULL Yes No

Page 52: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

HSM01 Health Services Management, Inc. All Yes No

HSM01 Health Services Management, Inc. for AHS All Yes No

HSM01 Health Services Management, Inc. for BPA All Yes No

HSM01 Health Services Management, Inc. for ECOH All Yes No

HSM01 Health Services Management, Inc. for EHC All Yes No

HSM01 Health Services Management, Inc. for ENCR All Yes No

HSM01 Health Services Management, Inc. for FCM All Yes No

HSM01 Health Services Management, Inc. for HF All Yes No

HSM01 Health Services Management, Inc. for HT All Yes No

HSM01 Health Services Management, Inc. for MMSI All Yes No

HSM01 Health Services Management, Inc. for MSHO All Yes No

HSM01 Health Services Management, Inc. for PNET All Yes No

HSM01 Health Services Management, Inc. for PONE All Yes No

HSM01 Health Services Management, Inc. for SC All Yes No

HSM01 Health Services Management, Inc. for WEA All Yes No

HSPAN HealthSpan Network Repricing All Yes No

HSPC1 Healthsmart Preferred Care (HSPC) All Yes No

HT001 HealthSpring HMO All Yes No

HTHTX Health Texas Medical Group All Yes No

HVMG1 Horizon Valley Medical Group All Yes No

IAC01 Insurer's Administration Corporation All Yes No

IAMCD Medicaid of Iowa IA Yes Yes

IAMCR Medicare Part A/B of Iowa IA Yes Yes

IDBLC Blue Cross Of Idaho ID Yes No

IDMCD Medicaid of Idaho ID Yes Yes

IDMCR Medicare Part A/B of Idaho ID Yes Yes

IEHP1 Inland Empire Health Plan All Yes Yes

IHCS1 Integrated Homecare Services All Yes No

IHP02 InTotal Health All No Yes

ILMCD Medicaid of Illinois IL Yes Yes

ILMCR Medicare Part A/B of Illinois IL Yes Yes

IMG01 Independence Medical Group Kern County All Yes No

IMG02 Independence Medical Group Tulare County All Yes No

IMGIN International Medical Group, INC All Yes Yes

IMSMS Insurance Management Services of Texas TX Yes No

INCHN Intercommunity Health Net All Yes No

INCS1 CareSource IN IN Yes Yes

INDPM Independent Physician At Mercy All Yes No

INET1 Integranet NULL No Yes

INMCD Medicaid of Indiana IN Yes Yes

INMCR Medicare Part A/B of Indiana IN Yes Yes

IP055 Citrus Valley Physicians Group CA Yes No

IP056 Upland Medical Group CA Yes No

IP057 Pomona Valley Medical Group (PVMG) ProMed CA Yes No

IP059 St. Joseph HUMBOLT County CA Yes No

IP061 Blue Lake Rancheria CA Yes No

IP062 St Joseph Health CA Yes No

Page 53: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

IP079 North American Medical Management All Yes No

IP079 PrimeCare Health Plan CA Yes No

IP080 AKM Medical Group CA Yes No

IP080 American Family Health Providers CA Yes No

IP080 AMVI CA Yes No

IP080 Avalon IPA CA Yes No

IP080 Cap Management Systems CA Yes No

IP080 Centinela IPA CA Yes No

IP080 Exceptional Care Medical CA Yes No

IP080 Family Choice Medical CA Yes No

IP080 Family Health Alliance CA Yes No

IP080 Freeman IPA CA Yes No

IP080 Greater L. A. Health CA Yes No

IP080 Greater San Gabriel CA Yes No

IP080 Hollywood Presbyterian CA Yes No

IP080 Huntington Park Medical Group CA Yes No

IP080 Huntington Park Mission CA Yes No

IP080 Mendicina Familiar Medical Group CA Yes No

IP080 Noble Community CA Yes No

IP080 Pasadena Primary Care Physicians CA Yes No

IP080 Seoul Medical Group CA Yes No

IP082 Key Medical Group CA Yes No

IP083 Mosaic IPA Medical Group CA Yes No

IP086 Good Samaritan Medical Practice Association (GSMPA) CA Yes No

IP088 Omnicare Medical Group All Yes No

IP091 Sutter Connect - Sutter Gould Medical Foundation - Claims CA Yes No

IP092 Sutter Connect Sutter Medical Group (SMG,SWMG,SIP) CA Yes No

IP095 Monarch Healthcare IPA All Yes Yes

IP097 Marin IPA CA Yes No

IP099 Sutter Connect - Solano Regional Medical Group - Claims CA Yes No

IP100 Sutter Connect - Delta - Claims CA Yes No

IP105 GENESIS HEALTH CARE All Yes No

IP106 St. Joseph Heritage Healthcare CA Yes No

IP130 East Bay Medical Network CA Yes No

IP130 Sutter Connect East Bay Med Foundation CA Yes No

IP132 Palo Alto Medical Foundation All Yes No

IPA99 Illinois Physicians Alliance IPA All Yes No

IPAK1 IPA of Kane County NULL Yes No

ISL11 Insurance Service of Lubbock All Yes Yes

IUHPL IU Health Plan ALL Yes Yes

J1236 American Claims Management (ACM) All Yes No

J1241 Administaff All Yes No

J1343 Mackinaw Administrators All Yes No

J1391 Builders Group Of Minnesota All Yes No

J1401 United Fire All Yes Yes

J1438 Department Of Labor All Yes No

J1496 Preferred Employers Insurance Company (PEI) All Yes Yes

Page 54: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

J1740 Allen Canning All Yes No

J1761 Brickstreet All Yes No

J1819 Cambridge Integrated Services All Yes No

J1821 Professional Claims Management All Yes No

J1822 USAA All Yes No

J1824 Smart And Final All Yes No

J1829 Companion Property And Casualty Insurance Company All Yes No

J1830 FCCI All Yes No

J1831 Therapy Direct Network All Yes No

J1866 Careworks Consultants Incorporated (Careworks Usa And Cci) All Yes No

J1883 Franciscan Alliance All Yes No

J1884 Fairfax County Government All Yes No

J1885 City And County Of San Francisco (CCSF) All Yes No

J1886 San Francisco Municipal Transportation Agency All Yes No

J1887 IPMG Claims Management All Yes No

J1888 Howard County Government (Maryland) All Yes No

J1889 Landrys All Yes No

J1890 Montgomery Country Government Self Ins Program (MCSIP) All Yes No

J1891 Prince Georges County Government Maryland All Yes No

J1893 Wilson Mutual Insurance All Yes No

J1894 Ram Mutual Insurance Company All Yes No

J1895 Genex Care For Ohio All Yes No

J1896 Advocare Mco Incorporated All Yes No

J1897 Publix Super Markets Incorporated All Yes No

J1900 CC Development Group Incorporated All Yes No

J1901 City Of Rialto California All Yes No

J1902 Coachella Valley Water District (California) All Yes No

J1903 Eastman Kodak Company All Yes No

J1904 OSI Group LLC All Yes No

J1905 Tri City Healthcare District All Yes No

J1907 Ingles Markets All Yes No

J1908 Chesapeake Insurance All Yes No

J1909 FFVA Mutual Insurance All Yes No

J1910 Florida Fruit And Vegetable Association All Yes No

J1911 Isurity All Yes No

J1912 Employers Insurance (Bunch) All Yes No

J1913 Pacific Compensation Insurance Company All Yes No

J1914 Athens All Yes No

J1915 Sempra Energy Employee Care Services All Yes No

J1916 Pacific Gas And Electric 115 All Yes No

J1919 Anchor Claims Management All Yes No

J1921 Texas Political Subdivisions Jsif All Yes No

J1922 Springfield Insurance Company All Yes No

J1923 Northern Claims Management All Yes No

J1924 Pegasus Risk Management California All Yes No

J1925 Comp West All Yes No

J1926 St Paul Insurance All Yes No

Page 55: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

J1927 Gillette Childrens Specialty Healthcare All Yes No

J1928 City Of Charlotte All Yes No

J1956 Medrisk All Yes Yes

JAI01 Jai Medical Systems All Yes No

JCARE Jencare Medical All Yes No

JCC01 Jackson Care Connect All Yes No

JMH01 John Muir Health Network CA Yes No

JOEHD St. Joe High Desert CA Yes No

KAMG1 Korean Medical All Yes No

KCIPA Kane County IPA NULL Yes No

KEE01 Keenan & Associates CA Yes No

KELSE Kelsey Seybold All Yes No

KENT1 Kent County Health Plan MI Yes No

KEYIP Key Insurance Group All Yes Yes

KGA15 KG Administrative Services All Yes No

KHMSI Key Health Medical Solutions Incorporated All Yes No

KLSY1 SelectCare of TX (Kelsey-Seybold) TX Yes Yes

KMG11 Katy Medical Group NULL Yes No

KPIC1 KPIC - Kaiser Permanente LISTED Yes No

KS001 Kaiser Permanente (Southern California Only) CA Yes Yes

KS003 CA Kaiser Permanente (Northern California Only) CA Yes No

KS007 Kaiser Northwest Region All Yes No

KSMCD Medicaid of Kansas KS Yes Yes

KSMCR Medicare Part A/B of Kansas KS Yes Yes

KSRCS Kaiser Permanente Colorado Springs All Yes No

KYCS1 CareSource KY KY Yes Yes

KYMCD Medicaid of Kentucky KY Yes Yes

KYMCR Medicare Part A/B of Kentucky KY Yes Yes

L0110 NAMCI Global Care All Yes No

L0140 Occular Benefits All Yes No

L0200 Humana Puerto Rico PR Yes No

L0230 Trusted Health Plan All Yes Yes

L0250 Preferred Medicare All Yes No

L0260 Constellation Health All Yes No

LABLS State Employees Group Benefits LA Yes No

LACAR LA Care Health Plan All Yes Yes

LADOC LA Dept Of Corrections All Yes No

LAMCD Medicaid of Lousiana LA Yes Yes

LAMCR Medicare Part A/B of Louisiana LA Yes Yes

LAWND Lawndale Christian Health Center All Yes No

LCM1 Little Company Of Mary All Yes No

LIFE1 Lifeprint All Yes Yes

LIICA Life Investors Ins Co of America All Yes No

LIPA1 Lipa/Agate Resources All Yes No

LIPAZ Coastal Healthcare Management All Yes No

LMG11 Lakeside Medical Group Inc. All Yes No

LNDMK Chiropractic Care of Minnesota, Inc. All Yes No

Page 56: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

LNDMK Landmark Healthcare Inc. All Yes No

LOBH1 Linden Oaks Beh H All Yes No

LWA01 Lifeworks Advantage All Yes No

LWMC1 Leisure World Managed Care All Yes No

M0166 Comprehensive Medical/Vision Program AZ AZ Yes Yes

M3CA0001 MED3000 California All Yes No

M3CA1 Affiliated Physicians Group LLC NULL No Yes

M3FL0010 MED3000 CMS Early Steps All Yes No

M3FL0011 MED3000 CMS Safety Net All Yes No

M3FL0012 CMS MMA Specialty Plan All Yes No

M3FL0014 MED3000 CMS Title 21 All Yes No

M3FL2 Vista - Tallahassee NULL Yes No

M3FL5 HFN Healthease NULL Yes Yes

M3FL6 Pedicare Title 21 NULL Yes No

M3FL8 Pedicare Title 19 NULL Yes Yes

M3IL1 Health Select IPA All Yes No

MAHC1 Medical Associates Health Plan All Yes No

MAHP1 Medical Associates Health Plan All Yes Yes

MAMCD Medicaid of Massachusetts MA Yes Yes

MAMCR Medicare Part A/B of Massachusetts MA Yes Yes

MBIPA MONTEREY BAY IPA All Yes No

MC104 First Services Medicaid All Yes No

MC721 Blue Cross Community Centennial All Yes No

MCA11 Memorial Clinical Associates All Yes No

MCCBV Cigna Behavioral Health All Yes Yes

MCCBV MCC Behavioral Care All Yes Yes

MCDIL Blue Cross Community Options All Yes Yes

MCI01 Physicians Choice Medical Santa Maria All Yes No

MCS01 GEMCare (Golden Empire Managed Care System) All Yes No

MCS02 Managed Care Systems (Delango Regional Medical) All Yes No

MCS03 Gemcare Health Plan All Yes No

MCS04 Managed Care Systems CA Yes No

MDC01 Md Care Health Plan All Yes No

MDMCD Medicaid of Maryland MD Yes Yes

MDMCR Medicare Part A/B of Maryland MD Yes Yes

MDWIS MDWIS HIP All Yes No

MDXHI MD Hawaii HI Yes No

MEMCD Medicaid of Maine ME Yes Yes

MEMCR Medicare Part A/B of Maine ME Yes Yes

MER11 Mercy Health Plans NULL Yes No

MHCA1 Managed Health Care Admin EPS All Yes No

MHCA2 Managed Healthcare Administration Inc- Blue Choice AL Yes No

MHCM2 Physicians Health Network All Yes No

MHHNP Memorial Hermann Health Network All Yes Yes

MHIPA Acclaim IPA CA Yes No

MHIPA Acclaim IPA (MHCAC) CA Yes No

MHIPA Anaheim Memorial IPA (MHCAN) CA Yes No

Page 57: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

MHIPA Long Beach Memorial IPA (MHCLB) CA Yes No

MHIPA Medical Orange Coast Memorial IPA CA Yes No

MHIPA Memorial Healthcare IPA CA Yes No

MHIPA Orange Coast Memorial IPA CA Yes No

MHM01 Independence Medical Group All Yes No

MHP77 Midwest Health Plans, INC. All Yes No

MIBCN Michigan Blue Care HMO (BCN of Michigan) MI Yes No

MIDSC Mwest Securities All Yes No

MIFEP Michigan FEP MI Yes No

MIMCD Medicaid of Michigan MI Yes Yes

MIMCR Medicare Part A/B of Michigan MI Yes Yes

MIMPB Michigan Medicare PlusBlue MI Yes No

MLINK Mecklink All Yes No

MLTOT Multnomah County All Yes No

MMFMC Memorial Care Medical Foundation All Yes No

MMLI3 Transamerica Premier Life Insurance Company (Monumental) All Yes No

MMLI4 Monumental Life Insurance Company Valley Forge All Yes No

MMLI5 Monumental Life Insurance Company Scranton All Yes No

MMLI6 Monumental Life Insurance Company Baltimore All Yes No

MMLI7 Monumental Life Insurance Company Baltimore All Yes No

MMLI9 Monumental Life Insurance Company Plano All Yes No

MMLIC Monumental Life Ins Co. All Yes Yes

MMPHB Masters, Mates and Pilots Plan All Yes No

MMS01 Missouri Medicare Select All Yes No

MNAUL Aultcare OH Yes No

MNBLS CCS (Comprehensive Care Systems) MN Yes No

MNDH1 Sage All Yes No

MNDH1 Sage Plus All Yes No

MNMCD Medicaid of Minnesota MN Yes Yes

MNMCR Medicare Part A/B of Minnesota MN Yes Yes

MNSHP Sanford Health Plan All Yes Yes

MOMCD Medicaid of Missouri MO Yes Yes

MOMCR Medicare Part A/B of Missouri (Eastern) MO Yes Yes

MP001 Avectus Healthcare Solutions All Yes No

MP340 Three Rivers Preferred All Yes No

MPCHA Atrio Health Plan All Yes No

MPCHP Marion Polk Health Plan All Yes No

MPHC2 Martin's Point Health Care USFHP/Generations Advantage All Yes Yes

MPI01 Motion Picture Industry Health Plan CA Yes No

MPM03 Centinela Valley IPA All Yes No

MPM04 El Proyecto Del Barrio IPA CA Yes No

MPM05 Global Care Med Grp IPA All Yes No

MPM06 Healthcare LA, IPA CA Yes No

MPM07 Mission Community IPA Med Grp CA Yes No

MPM09 Watts Healthcare Corp IPA CA Yes No

MPM10 Bella Vista Med Grp IPA CA Yes No

MPM16 MPM Prospect All Yes No

Page 58: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

MPM18 Medi-Cal by MedPoint All Yes No

MPM19 Lach Healthnet By Medpoint All Yes No

MPM20 Medpoint All Yes No

MPM22 Premier Physicians Network All Yes No

MPM23 Accountable IPA (MPM) All Yes No

MPM25 Prudent Medical Group All Yes No

MPM32 Alphacare Medical Group ALL Yes Yes

MRCHP Caresource Health Plan of Oregon All Yes No

MRIPA Allcare Healthplan OR Yes Yes

MRPEBB Allcare Pebb All Yes No

MSMCD Medicaid of Mississippi MS Yes Yes

MSMCR Medicare Part A/B of Mississippi MS Yes Yes

MSO11 San Diego County Medical Services (CMS) CA Yes Yes

MSO22 San Diego County Physician Emergency Services CA Yes No

MSO33 San Diego County Ryan White Primary Care Program CA Yes Yes

MSO44 San Diego County Primary Care Services CA Yes Yes

MSO55 San Diego County Sheriffs Department CA Yes No

MSO77 San Diego County Low Income Health Program/Coverage Initiative CA Yes Yes

MTMCD Medicaid of Montana MT Yes Yes

MTMCR Medicare Part A/B of Montana MT Yes Yes

MTNST Mountain States Administrators (Colorado Only) CO Yes No

MVBCN Mid Valley Behavioral Health Network All Yes No

MVCV1 Prime Community Care Central Valley All Yes No

MVMM1 Inland Faculty Medical Group All Yes No

MWMCR Medicare Part A/B of Western Missouri MO Yes Yes

MWP01 JPS Preferred Care All Yes No

MWSHN MDWise Select Health Network All Yes Yes

MX001 Medxoom All Yes No

N2FEP NY Central FEP (Federal Employee Program) Blue Shield NY Yes No

N4FEP Utica NY FEP Blue Shield NY Yes No

N6BLS Blue Choice Of Rochester NY NY Yes No

NAELM Elmcare All Yes Yes

NAELM Elmcare L.L.C. IL Yes Yes

NAHIN Hinsdale Phys All Yes No

NAHLX Holy Cross Health Partners IL Yes Yes

NAHOI Health Options of Illinois IL Yes Yes

NANWC Northwest Community Health Partners IL No Yes

NAOAK Oak West Primary Physician Association IL Yes Yes

NASCR Silver Cross Managed Care Organization IL Yes Yes

NASWD Swedish Covenant Hospital IL Yes No

NCA01 Northern California Advantage Medical Group All Yes No

NCABS Blue Shield of National Capital Area DC,VA,MD Yes No

NCABS National Capital Area DC,VA,MD Yes No

NCH03 New Century Health Urology All Yes No

NCH04 CarePlus Cardiology - New Century Health All Yes No

NCH08 Vista Oncology New Century Infusion Solutions All Yes No

NCH09 New Century Health - Vista Cardiology All Yes No

Page 59: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

NCHCA New Century Health Centers All Yes No

NCHON AZ Integrated Physicians All Yes No

NCHOR New Century Health Arizona Integrated Physicians All Yes No

NCMCD Medicaid of North Carolina NC Yes Yes

NCMCR Medicare Part A/B of North Carolina NC Yes Yes

NDMCD Medicaid of North Dakota ND Yes Yes

NDMCR Medicare Part A/B of North Dakota ND Yes Yes

NEMCD Medicaid of Nebraska NE Yes Yes

NEMCR Medicare Part A/B of Nebraska NE Yes Yes

NG007 Kaiser Foundation Health Plan of Ohio OH Yes Yes

NG008 Kaiser Mid-Atlantic All Yes Yes

NG009 Kaiser Foundation Health Plan of the NW OR,WA Yes No

NG010 Kaiser Foundation Health Plan of Georgia GA Yes Yes

NHAIN National Health Administrators Inc. All Yes No

NHC01 National Healtchare Corporation Advantage All Yes No

NHCA1 Naperville Health Care Associates All Yes No

NHMCD Medicaid of New Hampshire NH Yes Yes

NHMCR Medicare Part A/B of New Hampshire NH Yes Yes

NIA11 National Imaging Associates All No Yes

NJBCS Blue Shield of New Jersey NJ Yes No

NJMCD Medicaid of New Jersey NJ Yes Yes

NJMCR Medicare Part A/B of NJ NJ Yes Yes

NM505 Molina Healthcare of New Mexico NM Yes No

NMBLS Lovelace Sandia Health Plan NM Yes No

NMG01 Northridge Medical Group All Yes No

NMM01 Greater Orange Medical Group All Yes Yes

NMM02 LaSalle Medical Associates CA Yes No

NMMCD Medicaid of New Mexico NM Yes Yes

NMMCR Medicare Part A/B of New Mexico NM Yes Yes

NMPPO NM Blue Mcare PPO All Yes No

NPN11 Northwest Physicians Network NULL Yes Yes

NSIPA Network Solutions IPA All Yes No

NTA11 National Teachers Association (NTA) All Yes No

NVADM National Vision All Yes No

NVMCD Medicaid of Nevada NV Yes Yes

NVMCR Medicare Part A/B of Nevada NV Yes Yes

NWADM Central California Electricial Workers Health and Welfare Trust CA Yes No

NWADM Las Vegas Fire Fighters Local No 1285 Security Fund CA Yes No

NWADM Southern California Bakery Drivers Security Fund CA Yes No

NWADM Teamsters Local 631 Security Fund for Southern Nevada CA Yes No

NWADM Teamsters Miscellaneous Security Trust Fund CA Yes No

NWDC1 Northwest Diagnostic Clinic NULL Yes No

NYL11 New York Life - Long Term Care All Yes Yes

NYMCD Medicaid of New York NY Yes Yes

NYMCR Medicare Part A/B of New York (Upstate) NY Yes Yes

NYU01 UnitedHealthcare Community Plan - NYU All No No

OAKST Oak Street Health All Yes No

Page 60: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

OBA16 Group Management Services Incorporated All Yes No

OBA18 Ogden Benefits Administration All Yes No

OCFMC Oc Foundation Med All Yes No

OHMCD Medicaid of Ohio OH Yes Yes

OHMCR Medicare Part A/B of Ohio OH Yes Yes

OHMS Oregon Health Management Services (OHMS) All Yes No

OHMSP Oregon Health Mgmt OHMS All Yes No

OKMCD Medicaid of Oklahoma OK Yes Yes

OKMCR Medicare Part A/B of Oklahoma OK Yes Yes

OLRMC OLOLRMC Uninsured Patient Services Program LA Yes No

OMN02 Omnicare IPA All Yes No

ONEHC One Homecare Solutions All Yes No

ONOCI Oncology Network of Orange County All Yes No

OOWPS WPS Commercial WI Yes Yes

OPCAU Opticare of Utah All Yes No

ORMCD Medicaid of Oregon OR Yes Yes

ORMCR Medicare Part A/B of Oregon OR Yes Yes

OSCAR Oscar Health All Yes Yes

OSFC9 Innov_Osf Healthcare Central All Yes No

OSFE9 OSF Healthcare East All Yes No

OSFMC OSF Care Advantage All Yes No

P0001 Nascentia Health NY Yes Yes

PA331 ACS Benefits Payer Compass All Yes No

PA513 Physician Associates of Greater San Gabriel Valley CA Yes No

PAMCD Medicaid of Pennsylvania PA Yes Yes

PAMCR Medicare Part A/B of PA PA Yes Yes

PAN01 Patient Access All Yes No

PAPER Paper Claims All Yes No

PARTH Partners In Health All Yes No

PAS01 Providence Insurance And Administrative Services All Yes No

PAWVR Medicaid of Pennsylvania Waivers Claims ALL Yes No

PCACZ Primary Care Assoc of California CA Yes No

PCBLS Pennsylvania Keystone Health Plan East PA Yes No

PCI01 Premier Care IPA All Yes No

PCJOL Primary Care Of Joliet All Yes No

PCL01 Premier Care IPA All Yes No

PCN12 Physicians Care Network/The Polyclinic All Yes No

PCSNCHD Primary Care Services Nchd All Yes No

PCU01 Point Comfort Underwriters All Yes No

PCU02 Point Comfort Underwriters All Yes No

PDT01 Greater Tricities IPA All Yes No

PEBLS Pennsylvania Keystone Health Plan East PA Yes No

PEF01 PEF Clinic All Yes No

PFIPA Preferred IPA All Yes No

PH001 Pruitt Health Premier All Yes No

PH018 North West Life All Yes No

PH018 Northwestern National Life All Yes No

Page 61: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

PH018 Reliastar All Yes No

PHCEN Physicians Health Choice - Encounters All Yes No

PHCS1 Physicians Health Choice - Claims All Yes Yes

PHD01 Family Care CCO All Yes Yes

PHIF4 Phifer Wire Ins All Yes No

PHIPA Physicians Healthways IPA CA Yes No

PHM10 Mission Community IPA & Pacific Health MSO All Yes No

PHM11 Southland San Gabriel Valley All Yes No

PHP00 Providence Preferred (PPO) All Yes No

PHP01 Providence Choice Option All Yes No

PHP01 Providence Good Health Plan All Yes No

PHP02 Partnership Health Plan CA Yes No

PHPMC Correction Health Partners CO Yes Yes

PHPMC Physician Health Partners CO Yes Yes

PHR01 Family Care Medicare All Yes No

PHYCR Phycor CO Yes No

PMA86 Pima Health Syste All Yes No

PMGSC Physicians Medical of Santa Cruz CA Yes No

PMGSJ PMG of San Jose CA Yes No

PMP01 Preferred Health Plan All No Yes

POD1S Podiatry First NULL Yes No

POD1ST Podiatry First Inc NULL Yes No

POP01 Center IPA All Yes No

POP03 Choiceone IPA All Yes No

POP05 Beverly Alianza IPA All Yes No

POP06 Affiliated Physicians IPA All Yes No

PPM01 Desert Family Practice Association All Yes No

PPM01 Vantage Medical Group All Yes No

PPNZZ Pioneer Provider Network CA Yes No

PPOM1 PPOM LLC All Yes No

PPRT1 Physician Partners IPA All Yes No

PRADM Asociacion de Maestros (PROSSAM) PR Yes Yes

PRAHM Triple S (AHM) PR Yes Yes

PRCON Constellation Health PR Yes Yes

PREHP Presbyterian Health Plan (Commercial) NM Yes No

PRESA Presbyterian Salud NM Yes Yes

PRI01 Princeton Premier IPA NULL Yes No

PRINT Paper Claims All Yes Yes

PRMAP Mapfre Live Insurance PR Yes Yes

PRMCR Medicare Part B of Puerto Rico PR Yes Yes

PRMCS Medical Card System (MCS) PR Yes Yes

PRMMM MMM Multihealth Government Health PR Yes Yes

PRNLK Prnlink Mlk All Yes No

PROH1 Dignity Health Woodland Clinic All Yes No

PROH2 Dignity Health Sequoia Phys All Yes No

PROH4 Dignity Health Inland Empire All Yes No

PROSP Prospect Medical Group CA Yes No

Page 62: PHIcure, Inc. 837 Payer List - December 11, 2018€¦ · 00241 Blue Shield of Missouri MO Yes No 00243 Helix Family Choice MD Yes No 00243 Medstar Physician Partners MD Yes No

CONFIDENTIAL

PRSSS Blue Shield of Puerto Rico (Triple S) PR Yes Yes

PSKW0 PSKW All Yes No

QCTPA QuantumCare (We Care Health Plan) All Yes No

QMDCE Qual Medical Colorado All Yes No

QMDPO Qual Medical Portland All Yes No

QUANM Qual Medical New Mexico All Yes No

QUARTZASO Quartz Administrative Services Organization (Aso) All Yes No

QUMCR Medicare Part B of New York GHI NY Yes Yes

RCHN1 Rady Childrens Health Network All Yes No

RCMG1 River City Medical Group CA Yes No

REGAL Regal Medical Group All Yes No

REHNA Rehn and Associates All Yes No

RGA01 Regence Group Administrators All Yes Yes

RH007 Healthspan All Yes Yes

RH011 Kaiser Permanente Hawaii HI Yes No

RHA01 Resolve Health Plan Administrators LLC All Yes No

RICHP Blue Chip Of Rhode Island RI Yes No

RIMCD Medicaid of Rhode Island RI Yes Yes

RIMCR Medicare Part A/B of Rhode Island RI Yes Yes

RLH01 Lifemap All Yes No

RMC01 Riverside Medical Clinic All Yes No

RMHMO Rocky Mountain HMO CO Yes No

RMSCO RMSCO NY Yes No

RPAWC Ravenswood Physician Associates All Yes No

RPPG1 Resurrection Physician Provider Group All Yes Yes

RRMCR Railroad Medicare All Yes No

RX001 Transactrx Infusion And Specialty ALL Yes No

SA001 Signature Advantage All Yes Yes

SAM00 Samaritan Commercial Plan All Yes No

SAMAD Samaritan Advantage All Yes No

SAMCP Samaritan Choice Plan All Yes No

SAMG1 South Atlantic Medical Group CA Yes No

SB570 BCBS Delaware All Yes No

SB580 CareFirst BCBS - DC, National Capital Area MD,DC Yes No

SB613 Community Health Plan of Washington WA Yes Yes

SB690 BCBS of Maryland MD Yes Yes

SB700 BCBS Massachusetts All Yes No

SB731 MS BCBS State Employees MS Yes No

SB810 BCBS North Carolina All Yes No

SC028 Sutter Senior Care All Yes No

SC050 Sutter Connect-Palo Alto Medical Foundation CA Yes No

SC052 Sutter East Bay Regional Hosp-Affinity Claims CA Yes No

SC315 Thomas Cooper SC Yes Yes

SC359 Sherman Choice All Yes No

SC400 SC BCBS State Employee Health Plan SC Yes Yes

SC446 Employee Benefit Services DBA Key Benefit Administrators SC Yes Yes

SC481 Preferred Blue SC SC Yes Yes

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CONFIDENTIAL

SC886 SC BCBS Planned Administrators SC Yes Yes

SC922 SC BCBS Companion Health SC Yes Yes

SCACO Santa Clara County IPA All Yes No

SCAN1 Scan CA CA Yes No

SCBCS Blue Shield of South Carolina SC Yes Yes

SCH01 Schaller Anderson CHOC Health Alliance All Yes No

SCHP1 SeeChange HealthPlan All Yes No

SCMCD Medicaid of South Carolina SC Yes Yes

SCMCR Medicare Part A/B of South Carolina SC Yes Yes

SCMG1 Sharp Community Medical Group CA Yes No

SCP01 Southern Cal Physicians Managed Care Services CA Yes No

SDMCD Medicaid of South Dakota SD Yes Yes

SDMCR Medicare Part A/B of South Dakota SD Yes Yes

SHC30 Sandhills Center All Yes No

SHC303 Sandhills Center All Yes No

SHEBP Seton Employee Plan All Yes Yes

SHMAP Seton Map Program - Mediview All Yes Yes

SHP01 Sharp Health Plan All Yes No

SHP11 Superior Health/Centene Corp NULL Yes Yes

SHPCH Seton CHIP All Yes Yes

SHPM1 Scripps Health Plan Management Services Organization All Yes No

SHPS1 Scripps Health Plan Services All Yes No

SIHCA Southern Illinois Healthcare Association All Yes No

SIPA1 Southland IPA NULL Yes No

SISCO Cedar Valley Community Health Plan All Yes Yes

SISCO Lake Area Community Health Plan All Yes Yes

SISCO Lake Region Community Health Plan All Yes Yes

SISCO Northeast Iowa Community Health Plan All Yes Yes

SKTX1 Medicaid Texas LYC All Yes No

SKVI0 Medicaid United States Virgin Islands All Yes No

SLCH1 St Lawrence County Healthcare Plan All Yes No

SLIC1 Stonebridge Life Ins Company All Yes No

SLIC2 Stonebridge Life Ins Company All Yes No

SLOAN Cofinity CO Yes Yes

SLOS1 Physicians Choice Medical SLO All Yes No

SMG01 Sierra Medical Group CA Yes No

SMIPA St Mary's IPA CA Yes No

SMITH Smith Administrators All Yes Yes

SNTMC Sante Community Physicians Medical Group Corp All Yes No

SPOHN Christus Spohn Health Network All Yes Yes

SRS83 Sharp Rees Stealy Medical Group All Yes No

SSC11 Select Senior Clinic All Yes No

STA01 Saint Anthony PHO All Yes No

STAR1 Seton Star All Yes Yes

STJOE Mission Hospital Affiliates CA Yes No

STM01 St Thomas Medical Network NULL Yes No

SVIPA Seaview IPA All Yes No

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CONFIDENTIAL

SWPG1 Southwest Physicians Group All Yes No

SX022 Wps Health Insurance All Yes No

SX065 Capital District PHP All Yes Yes

SX073 Independent Health Of New Jersey. All Yes No

SX075 Amerihealth - NJ (NON-HMO) All Yes No

SX087 Univera Health Care Plan/Choicecare Buffalo All Yes No

SX089 Preferred Care NY NY Yes Yes

SX091 Univera Healthcare (SSA) All Yes No

SX105 Deseret Mutual UT Yes Yes

SX105 DMBA All Yes No

SX105 Missionary Medical UT Yes Yes

SX106 PEHP - Utah Public Employee Health Plan UT Yes Yes

SX107 Intermountain Healthcare UT Yes Yes

SX109 Molina Healthcare Utah UT Yes No

SX110 Educators Mutual (EMIA) UT Yes Yes

SX113 Altius Health Plans All No No

SX133 Providence Of Oregon Health Plan All Yes No

SX141 Rocky Mountain Health Plan Grand Junction CO Yes No

SX142 South Indiana Health Options - HMO IN Yes No

SX145 Banner Health Co. All Yes No

SX155 University of Utah Health Plans UT Yes Yes

SX158 Paramount Health All Yes Yes

SX169 Central California Alliance For Health CA Yes No

SX172 IU Medical Group Primary Care All Yes No

SX179 Asuris Northwest/MedAdvantage All Yes No

SX182 Employee Benefit Management System (EBMS) All Yes No

SX186 Sun Health Corpor All Yes No

SX187 Providence All Yes No

SX191 Carolina Crescent All Yes No

SYMED Redlands IPA (Synermed) All Yes No

TA720 Independence Administrators All Yes Yes

TALMG Talbert Medical Group All Yes No

TAYLR Tayler Benefits All Yes No

TBGNE The Benefit Group Incorporated All Yes No

TCARE Total Care of NY NY Yes No

TCC13 Pre Med Defender All Yes No

TCMAP Travis County Map Mediview All Yes No

TCUCH True Choice USA - Christus Healthplan NULL Yes Yes

TCUSA True Choice USA - Christus Healthplan All Yes No

TDDIR Tricare for Life All Yes Yes

TFLI2 Transamerica Financial Life Insurance Company All Yes No

TFLI3 Transamerica Financial Life Insurance Company All Yes No

TFLI4 Transamerica Financial Life Insurance Baltimore All Yes No

TFLI5 Transamerica Financial Life Insurance Company All Yes No

TFLI6 Transamerica Financial Life Insurance Cedar Rapids All Yes No

TFLIC Transamerica Financial Life Insurance Company Hurst Texas All Yes No

TH023 WellMed All No No

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CONFIDENTIAL

TH049 Healthcare Management Admin All Yes No

TH055 TX True Choice All Yes No

TH071 Ama Insurance Agency, Inc All Yes No

TH088 Midwest Physician Administrative Services All Yes No

TH095 American Family Insurance All Yes No

TH117 American Whole Network All Yes No

TH118 Fresenius Medical Care TX Yes No

TH131 Physicians United Plan All Yes No

THA01 Tuality Health All Yes No

THASC Tuality Health Select All Yes No

THERA Theraphysics All Yes No

THIPA Torrance Hospital IPA All Yes No

THRIV Thrivent Financial All Yes No

THS01 Texas HealthSpring TX Yes Yes

TLC01 TLC Advantage in Sioux Falls SD Yes Yes

TLC79 TLC Benefit Solutions All Yes No

TLIN7 Transamerica Financial Life Insurance Plano All Yes No

TLINS Transamerica Life Ins. Co. All Yes No

TLX77 Symtera Life Ins All No No

TMMC1 Torrance Memorial All Yes No

TNMCD Medicaid of Tennessee (TennCare) TN Yes Yes

TNMCR Medicare Part A/B of Tennessee TN Yes Yes

TP021 Broadspire A Crawford Company All No No

TP097 Sedgwick All Yes No

TPACE Trinity Health Pace ALL No Yes

TPS01 Touchpoint Solutions Touchpoint CRM All Yes No

TRAN1 Transwestern Insurance Administrators, Inc. All Yes No

TRCLF Transamerica Financial Life Insurance Company All Yes No

TREST Tricare East ALL Yes Yes

TRLTC Transamerica Financial Life Insurance Company All Yes No

TRP1E Transamerica Life Insurance Company All Yes No

TRP1P Transamerica Financial Life Insurance Company All Yes No

TRSEL Selman Tricare Supp All Yes No

TRUEB Idaho True Blue ID Yes No

TTCEC Texas True Choice TX Yes No

TX1ST Texas First Health Plans TX Yes No

TXABA Texas Agricultural Cooperative Trust All Yes No

TXBLS Blue Shield Of Texas TX Yes No

TXCSM Texas Childrens Star Medicaid TX Yes No

TXCSN Texas Children Plan for Texas Medicaid All Yes No

TXMCD Medicaid of Texas TX Yes Yes

TXMCR Medicare Part A/B of Texas TX Yes Yes

U1439 Chiropractic Health Plan (CHP) All Yes No

U6885 Optum Behavioral Health SLCO All Yes No

UABT1 United Agriculture Benefit Trust All Yes No

UCDMG UC Davis Health Systems All Yes Yes

UFWIF United Furniture Workers NULL Yes No

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CONFIDENTIAL

UGP19 United Group Programs All Yes Yes

UH136 PEHP Chirohlthpla All Yes No

UH138 CHP/WISE All Yes No

UHNDC PPO One All Yes No

UIC67 University Of Illinois All Yes No

ULLIC Ullico Incorporated All Yes No

UMHCJ Umass Medical School Health And Criminal Justice Program All Yes No

UMRC1 UMR Cincinnat HS All Yes No

UNBC2 Universal Benefits Corporation Cedar Rapids All Yes No

UNBCI Universal Benefits Corporation All Yes No

UNINW Univera Traditional PPO All Yes No

USFHP US Family Health Plan (USFHP) All Yes No

USMBP UCLA Medical Group All Yes No

UT3F UTMB 3 Share Program All Yes No

UTAMS United Teacher Associates ALL No No

UTMCD Medicaid of Utah UT Yes Yes

UTMCR Medicare Part A/B of Utah UT Yes Yes

V360H Mediview Vista 360 Health All Yes No

VABLS VA Plans VA Yes No

VAICE Homeland Security All Yes Yes

VAICE INS Health Services All Yes No

VALOP Beacon Health Options All Yes Yes

VALOP Beacon Health Options All Yes Yes

VAMCD Medicaid of Virginia VA Yes Yes

VAMCR Medicare Part A/B of Virginia VA Yes Yes

VAP33 VA Patient Centered Region 3 All Yes No

VAP5A VA Patient Centered Region 5A All Yes No

VAP5B VA Patient Centered Region 5B ALL Yes No

VAPC3 VA Patient Centered Region 5A All Yes No

VAPC6 VA Patient Centered Region 6 All Yes No

VB001 Florida Hospital All Yes No

VCHCP Ventura County Healthcare Plan CA Yes Yes

VCIPA Valley Care IPA All Yes No

VEST1 Wisconsin Dept of Corrections WI Yes No

VESTA VistaCare/RH Admin All Yes No

VFP11 Village Family Practice All Yes No

VHA11 Valley Health Administrators All Yes No

VIBCS Blue Cross Blue Shield of USVI VI Yes Yes

VIMCR Medicare of the Virgin Islands VI Yes No

VLGMD Village Md All Yes No

VMF01 DCHS Medical Foundation All Yes No

VMMH1 Verity All Yes No

VMMH2 Verity Plus All Yes No

VPA18 Variable Protection Administrators (VPA) All Yes No

VPCCP Virginia Premier Complete Care All Yes No

VPELT Virginia Premier Elite All Yes No

VTBCS Blue Shield of Vermont VT Yes No

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CONFIDENTIAL

VTBLS Blue Shield of Vermont VT Yes No

VTMCD Medicaid of Vermont VT Yes Yes

VTMCR Medicare Part A/B of Vermont VT Yes Yes

WABLC Washington State Premera Blue Cross WA Yes No

WALAI Washington State Dept of Labor & Industries WA Yes No

WAMCD Medicaid of Washington State WA Yes Yes

WAMCR Medicare Part A/B of Washington WA Yes Yes

WCHHS Washington County Health And Human Services All Yes No

WELM2 WellMed All Yes Yes

WELMD Wellmed Medical Management ENC NULL Yes Yes

WESTR Tricare West All Yes No

WH001 Central California Womens Health All Yes No

WHLTH Willow Health All Yes No

WIMCD Medicaid of Wisconsin WI Yes Yes

WIMCR Medicare Part A/B of Wisconsin WI Yes Yes

WITH1 Todays Health All Yes No

WK476 Progressive Insurance All Yes No

WMM01 Arta Health Network CA Yes No

WOAHM Western Oregon Advanced Health (CCO) All Yes No

WP481 WPPA-ProviDRs Care Network All Yes No

WPMCR Medicare Part A of Illinois WPS IL No Yes

WPS01 Wisconsin Commercial All Yes No

WVCH5 Willamette Valley Community Health All Yes No

WVCS1 Caresource West Virginia All Yes No

WVMCD Medicaid of West Virginia WV Yes Yes

WVMCR Medicare Part A/B of West Virginia WV Yes Yes

WVS01 West Virginia Senior Choice All Yes No

WYBLS Blue Shield Of Wyoming WY Yes No

WYMCD Medicaid of Wyoming WY Yes Yes

WYMCR Medicare Part A/B of Wyoming WY Yes Yes

WYSCH Wyoming School Boards Association Insurance Trust WY Yes No

YAMHL Yamhill Community Care Organization All Yes No

YESB Idaho Yes Blue (CCO) All Yes No

ZNTHW Zenith Administrators All Yes No

ZOOM1 Zoomcare All Yes No