[PDF] eAttachments Payer Identification Information Claims Processing





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CLAIMS & ERA PAYER LIST September 9 2022

Sep 9 2022 Payer 75185 to HealthSmart Benefit Solutions (EDI. Payer ID #37283). Claims submitted under payer ID. AARP - UnitedHealthcare Insurance ...



EPS Payer Id Payer Name Type 13162 1199 NATIONAL BENEFIT

EPS Payer Id. Payer Name. Type. 13162 1199 NATIONAL BENEFIT FUND 82018 HCS - HEALTH CLAIMS SERVICE (BOISE ID) ... 95279 Keenan Associates (CA).



Institutional (Hospital) and Professional (Medical) Payer Listing

Payer ID. Payer Name. Services. Hospital. (837I). Medical. (837P). 00046 Hill Physicians Medical Group 95279 Keenan Associates (CA).



Change Healthcare Dental Payer List 8/16/2016 1 State Payer ID

Aug 16 2016 ID. Type. Model. Grou p #. Enrol l. Payer Enrollment Turnaround ... Use this Payer ID for submitting ... 95279. Par. COMMERCIAL.



Payer Identification Information Claims Information Remittance

ID. Payer Name. Additional Info. Status. Enrollment. Required To submit to Payors not on this list use Payor ID "06126" ... 95279 Keenan Associates.



Change Healthcare Dental Payer List 8/16/2016 1 State Payer ID

Aug 16 2016 ID. Type. Model. Grou p #. Enrol l. Payer Enrollment Turnaround ... Use this Payer ID for submitting ... 95279. Par. COMMERCIAL.



Payer Claims List

Payer ID. Payer Name. Req. Enroll. 22384. Administrative Concepts (Wayne PA) 95279. Keenan Associates (Torrance



TPL Carrier File

ID. 83707. 8007867930. 10079. ABS. PO BOX 30570. PHOENIX. AZ 85046. 6238897200 95279. UNITED HEALTHCARE. P.O. BOX 30551. SALT LAKE CITY. UT 84130.



Payer list PDF dump

Aug 7 2015 Each claim must be associated with a payer ID. If sending directly from your ... 95279. Commercial. CA. Keenan and Associates. Institutional.



eAttachments Payer Identification Information Claims Processing

To submit to Payors not on this list use Payor ID "06126" 95279. Keenan Associates. Non Par. Batch. 73100. Kempton Company (OK).



Payer ID provider number reference — Professional

Payer ID provider number reference — Professional Rev January 2022 Use this guide as a reference tool when submitting professional claims The information was current at the time of publication We will announce changes on the Provider News Center and the Provider Engagement Analytics & Reporting (PEAR) portal



HRSA COVID-19 Coverage Assistance Fund Claim Submission Guide

submitting an EDI file using Payer ID UHNDC you must successfully complete specific EDI testing Contact your clearinghouse to begin the testing process Refer to NDC Claim Submission or call UnitedHealthcare EDI Support at 800-842-1109 for more information Other



Institutional Claim Payers List (05/08/2023) - Optum

complete enrollment form under payer ID 95044) 23037 Y AMERIHEALTH HMO TRUE G AmeriHealth NorthEast (Dates of Service on or before Dec 31 2020 may continue to use the following until Dec 31 2021 For dates of service 01/01/21 or after use payer ID 22248) ** 77001 Y AMERIHEALTH NE FALSE G Amerihealth PPO New Jersey** 12X28 N



Clearance EDI Eligibility Payer List - Change Healthcare

Payer-assigned Payer ID:Payer ID assigned by the payer Connectivity Type Available: Indicates X12 Portal or Both Authorization Required: X12 or Portal: Payer requires authorization for providers to submit through Change Healthcare for the Connectivity Type indicated No: No authorization required for the Connectivity Type indicated



Searches related to payer id 95279 filetype:pdf

This Payer Sheet applies to BIN 610279 Only CLAIM BILLING/CLAIM REBILL TRANSACTION For BIN 610297 we will select one of the following COB options: Scenario 1 - Other Payer Amount Paid Repetitions Only Scenario 2 – Other Payer -Patient Responsibility Amount Repetitions CLAIM BILLING/CLAIM REBILL PAID (OR DUPLICATE OF PAID) RESPONSE

What is payer ID 99999-0aqs?

    Payer ID 99999-0AQS has been established for the HRSA COVID-19 Coverage Assistance Fund, and claim submission to the Fund should be accomplished via providers’ regular electronic claim submission methods.

What is payer ID 45276?

    Payer ID 45276 West Virginia Family Health Plan will remain active only for claims for service dates prior to 7/1/2019. Providers should check member cards to ensure they send claims to the correct WV MCO plan for service dates 7/1/2019 and forward.

When to use payer ID 20976 or 90440?

    Use Payer ID 20976 for claims with DOS 4/1/09 and after. For claims with DOS prior to 4/1/09 use former payer ID 90440. Premier HealthCare Exchange GEC91953I 88056 GEC91953P Premier Managed Care Inc. (Ohio BWC) Presbyterian (NM) GEC91100P 05003 GEC91100I Prestige Health Choice GEC92596P 77003 Payer effective 5/1/2014.

What is payer ID 87726?

    The health care ID card for members who have transitioned indicates payer ID 87726. Link: UHCprovider.com/claimslink Online: UHCprovider.com/claims(policies, instructions and tips)

Tesia Clearinghouse

www.Tesia.com

1540 W Edgewood Drive

Indianapolis, IN 46217

Tel: (800) 724-7240

Clearinghouse Payer List

eAttachments

Payer IDPayer NameAdditional InfoStatus

Enrollment

RequiredType

270s

Available

Enrollment

RequiredType

Level of

ResponseEligibility Notes

835s

Available

Enrollment

Required

Paper EOBs

Shutoff

when

EnrolledERA Notes

Accepts Tesia

eAttachments CX044A & I Benefit Plan AdministratorsNon ParBatch

39640A&D Charitable Foundation Inc (dba GreatLakes PACE)a Mediture PayerNon ParBatch

AARP1AARP Dental Insurance PlanParBatchTRUERTDetailedTRUE

STRUETRUE

43178Acceptius (Benefit Management Inc of MO)Non ParBatch

TLZ17Access Administrators (CA ONLY)ParBatchTRUE

CX097Access DentalNon ParBatch

64071AcclaimsNon ParBatch

TLX81ACEC Health Plans (Salt Lake City, UT)ParBatchTRUESTRUEMust Enroll in EFT FirstTRUE

72468ACS Benefit Consulting Services, Inc.Non ParBatch

61474ACS Benefit SolutionsNon ParBatch

TLU02Administration Systems Research CorporationNon ParBatch CX076Administrative Services Only (ASO)ParRTTRUERTGeneralTRUE

TLX97ADN Administrators (MI)ParBatchTRUE

CCPSAAdvantage by Superior Non ParBatch93524Advantage Dental Plan, Inc. PlatinumRTTRUERTGeneralTRUEO

In-State, Credentialed

Providers OnlyTRUE

83077Advantek Benefit Administrators (Fresno, CA)Non ParBatch

43168Advantica (fka Essex Dental Benefits)ParRTTRUE

95340Adventist Health System West - Roseville, CANon ParBatch

60054Aetna ParBatchTRUERTDetailedTRUEWTRUETRUE

57604Aetna Affordable Health Choices (SM) - SRCParBatchTRUERTDetailedTRUEWTRUETRUE

128WVAetna Better Health of West VirginiaNon ParBatch

68246Aetna DMOParBatchTRUERTDetailedTRUEWTRUETRUE

18014Aetna MedicareNon ParBatch

TLW02Affordable Benefit Administrators, Inc.Non ParBatch

58066AFLAC of GeorgiaNon ParBatch

52080AFLAC of New YorkNon ParBatch

91136AGC International Union of Operating Engineers Local 701 (F07)Non ParBatch

91136AK United Food and Commercial Workers (AK UFCW) (F45)Non ParBatch

CX083Alameda Alliance (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

91136Alaska Carpenters (F40)Non ParBatch

AKEF1Alaska Electrical Health & Welfare FundNon ParBatch

91136Alaska Hotel Employees, Restaurant & Camp Employees (AK HERE) (F41)Non ParBatch

91136Alaska Laborers Construction Industry Health & Security Trust (F23)Non ParBatch

91136Alaska Machinists Health and Welfare Trust (F21)Non ParBatch

91136Alaska Pipe Trades U A Local 375 (F24)Non ParBatch

91136Alaska Public Employees Association (APEA/JESS Health & Welfare Trust) (F60)Non ParBatch

44423Alexian Brothers Community Services of TNa Mediture PayerNon ParBatch

ALH01Aliera HealthcareNon ParBatch

CXALCAllCare CCO DentalA Performance Health Technology PayerNon ParBatch TLU11Allegiance Benefit Plan ManagementNon ParBatch

93658Alliance CoalNon ParBatch

70106Alliant Services (aka Voluntary Benefits Plan and US Life Ins Co)Non ParBatch

TLX56Allied Benefit SystemsNon ParBatch

91136Allied Metal Crafts Security Plan Trust Fund (F18)Non ParBatch

50503Altus Dental ParBatch

STR01Always Care BenefitsNon ParBatch

13343Amalgamated Life / AliCareParBatch

TLU15Amalgamated Life / AliCareParBatch

TLY53Amalgamated Life / AliCareParBatch

TLU23Ameriben Solutions (formerly IEC Insurance)ParBatch

75240American Administrative Group, Inc. (AAG)Non ParBatch

42112American Administrators (IA)Non ParBatch

CX084American Benefits Corp (Huntington, WV)ParBatch CX001American Medical SecurityParBatchTRUESTRUEMust Enroll in EFT FirstTRUE

16120America's TPANon ParBatch

47009Ameritas Life Insurance CompanyParBatchTRUETRUE

38255Amway Corporation / DentalNon ParBatch

53085Anchor Benefit Consulting IncNon ParBatch

CX083Anthem Health Plans - HMOD & HMOG (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

CX083Anthem Health Plans of Kentucky - OSB High & Low (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

CX083Anthem Health Plans of Kentucky - PPOB & PPOD (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

CX083Anthem Health Plans of Virginia - OSB High & Low (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

CX083Anthem Health Plans of Virginia - PPOB & PPOD (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

CX083Anthem HMO Colorado - HMO-B (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

Payer Identification InformationClaims ProcessingEligibility and Benefits InformationRemittance InformationTo submit to Payors not on this list, use Payor ID "06126"

and be sure to submit all required fields, including Payor Name and Complete Address.(C) 2014 Tesia Clearinghouse

Tesia Dental Payer Listing - Website (v 11.27.19).xlsx

1 of 16

Tesia Clearinghouse

www.Tesia.com

1540 W Edgewood Drive

Indianapolis, IN 46217

Tel: (800) 724-7240

Clearinghouse Payer List

eAttachments

Payer IDPayer NameAdditional InfoStatus

Enrollment

RequiredType

270s

Available

Enrollment

RequiredType

Level of

ResponseEligibility Notes

835s

Available

Enrollment

Required

Paper EOBs

Shutoff

when

EnrolledERA Notes

Accepts Tesia

eAttachments

Payer Identification InformationClaims ProcessingEligibility and Benefits InformationRemittance Information

CX083Anthem Insurance - OSB High & Low (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

CX083Anthem Insurance - PPOB & PPOD (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

34196Apex Benefit ServicesNon ParBatchTRUEWTRUE

TLW68APIPA (Arizona Physicians IPA) - Claims ONLYParBatchTRUESTRUEMust Enroll in EFT FirstTRUE

TLX06APIPA (Arizona Physicians IPA) - Pre Determinations ONLYParBatchTRUESTRUEMust Enroll in EFT FirstTRUE

44444APWU Health PlanNon ParBatch

ARCMSAR Medicare AdvantageParBatchTRUEDetailedTRUESTRUE

CXARCARC AdministratorsNon ParBatch

ARGUSArgus Dental Plan (Encounters)Non ParBatch

81883Arkansas Municipal Health Benefit FundNon ParBatch

63240ARM LTDNon ParBatch

90475Arrow Benefits GroupNon ParBatch

TLX61ASEA / AFSCME Local 52ParBatchTRUERTGeneralTRUE

TLU02ASR CorporationNon ParBatch

TLU02ASR Health BenefitsNon ParBatch

ASHC1Assurant Health Supplemental DentalNon ParBatch

TLX83Assured Benefit AdministratorsNon ParBatch

93221AsurisNon ParBatchTRUE

ADN01Atlantic Dental (ADI)Non ParBatch

ATPA1ATPA - Associated Third Party Administrators (CA offices)Non ParBatch

AULTCAultCare Dental (OH)Non ParBatch

37242Aultra Administrative GroupNon ParBatch

38259Automated Benefit ServicesNon ParBatch

37280Automated Group Administration (AGA)Non ParBatch

86098Avesis ParBatchTRUE

A2051BAC Local 15 Welfare Fund (Kansas)Non ParBatch

TLY50Banner Health and Dental PlanNon ParBatch

77078Banner Plan AdministrationNon ParBatch

CHSBABay Area Automotive Group

Administered by Health Services Benefit

AdministratorsNon ParBatch

CHSBDBay Area Delivery Drivers

Administered by Health Services Benefit

AdministratorsNon ParBatch

47198BC - California (Wellpoint)Non ParBatchTRUEOTRUE

CBAL1BCBS - AlabamaNon ParBatchTRUERTGeneralTRUEWTRUE

47570BCBS - AlaskaParBatchTRUERTGeneral

TBX01BCBS - Arizona

Includes BCBS Arizona FEP Claims Previously

Submitted Under Payer ID TLZ14Non ParBatchTRUEWTRUE

83470BCBS - ArkansasParBatch TRUE RTDetailedTRUESTRUE

TFQ45BCBS - Arkansas FEP Claims ONLYNon ParOBatchTRUEW

84099BCBS - Colorado Non ParBatchTRUEOTRUE

65358BCBS - Connecticut Non ParBatchTRUEOTRUE

00700BCBS - Connecticut (Family Plan)Non ParBatchTRUEOTRUE

53287BCBS - Delaware Non ParBatch

TFL02BCBS - Florida - FEDERAL CLAIMSNon ParBatch

SB601BCBS - GeorgiaNon ParBatchTRUEOTRUE

CB621BCBS - Illinois

Includes BCBS Illinois FEP Claims Previously

Submitted Under Payer ID TLW12Non ParBatch

TLU89BCBS - Indiana (FEP)Non ParBatchTRUEOTRUE

84105BCBS - Indiana (Anthem)Non ParBatchTRUEOTRUE

CBIA2BCBS - Iowa (aka Wellmark Blue Dental)Non ParWBatch CBIA1BCBS - Iowa (FEP and Farm Bureau ONLY)Non ParWBatch

TLU90BCBS - Kentucky (FEP)Non ParBatchTRUEOTRUE

84105BCBS - Kentucky (Anthem) Non ParBatchTRUEOTRUE

23739BCBS - Louisiana

Includes BCBS - Louisiana FEP Claims Previously

Submitted Under Payer ID TLU05Non ParSBatchTRUERTGeneralTRUEW

BME01 BCBS - Maine (Anthem)Non ParBatchTRUEOTRUE

TLX88BCBS - Maryland / CareFirst

Includes Claims for BCBS MD CareFirst Previously

Submitted under Payer IDs TLX85, TLX86, TLX87,

TLZ09, and TLU18Non ParBatch

TRUERTDetailed

TRUESTRUETRUE

CBMA1BCBS - MassachusettsNon ParBatch

BCBSMBCBS - MichiganNon ParBatch

CBMI1BCBS - Michigan (FEP Claims Only)Non ParBatch

BXMN1BCBS - MinnesotaNon ParBatch

TLU22BCBS - Minnesota - Federal Employee Program (FEP)Non ParBatch

TBS01BCBS - Mississippi

Includes BCBS Mississippi FEP Claims Previously

Submitted Under Payer ID TBS02Non ParSBatchTRUES

TBS03BCBS - Mississippi (CHIP Claims ONLY)ParBatchTRUESTRUEMust Enroll in EFT FirstTRUE TBS04BCBS - Mississippi (SPECIAL)Non ParBatchTRUES

TLX52BCBS - Missouri Non ParBatchTRUEOTRUE

TLU06BCBS - MontanaNon ParBatch

TLU88BCBS - NebraskaNon ParBatch

To submit to Payors not on this list, use Payor ID "06126"

and be sure to submit all required fields, including Payor Name and Complete Address.(C) 2014 Tesia Clearinghouse

Tesia Dental Payer Listing - Website (v 11.27.19).xlsx

2 of 16

Tesia Clearinghouse

www.Tesia.com

1540 W Edgewood Drive

Indianapolis, IN 46217

Tel: (800) 724-7240

Clearinghouse Payer List

eAttachments

Payer IDPayer NameAdditional InfoStatus

Enrollment

RequiredType

270s

Available

Enrollment

RequiredType

Level of

ResponseEligibility Notes

835s

Available

Enrollment

Required

Paper EOBs

Shutoff

when

EnrolledERA Notes

Accepts Tesia

eAttachments

Payer Identification InformationClaims ProcessingEligibility and Benefits InformationRemittance Information

84101BCBS - NevadaNon ParBatchTRUEOTRUE

BNH01BCBS - New Hampshire (Anthem)Non ParBatchTRUEOTRUE

84100BCBS - New Mexico Non ParBatch

61473BCBS - North CarolinaNon ParBatch

61472BCBS - North Carolina (FEP Program & Health Choice for Children)Non ParBatch

52133BCBS - North Carolina (Salt Lake City, UT ONLY)ParBatchTRUERTGeneralTRUESTRUEMust Enroll in EFT FirstTRUE

84105BCBS - Ohio (Anthem)Non ParBatchTRUEOTRUE

TLU91BCBS - Ohio (FEP)Non ParBatchTRUEOTRUE

TBOK1BCBS - OklahomaNon ParBatch

CB870BCBS - Rhode Island

FEP claims should NOT be submitter under this

Payer ID - Please use Payer ID RIFEPParBatchTRUERTDetailedTRUES TRUE

RIFEPBCBS - Rhode Island FEP

Only FEP claims should be submitted under this

Payer IDNon ParBatchTRUERTDetailedTRUEWOnly in-state providers may enroll for ERA.

38520BCBS - South Carolina

Includes BCBS - South Carolina FEP Claims

Previously Submitter Under Payer ID TLW74Non ParBatch

TLY09BCBS - South DakotaNon ParWBatch

CBTN1BCBS - Tennessee (Claims ONLY - no PTE)Non ParWBatchTRUERTGeneralTRUEWL

84980BCBS - Texas Non ParBatch

84103BCBS - Virginia (Trigon)Non ParBatchTRUEOTRUE

47570BCBS - WashingtonParBatchTRUERTGeneral

TLY47BCBS - Washington DCNon ParBatchTRUERTDetailedTRUESTRUETRUE

00301BCBS - Western New YorkParBatchTRUEW

39141BCBS - Wisconsin

Includes BCBS WI Claims Previously Submitted

Under Payer ID CB950 & Claim Management

Services Claims Previously Submitted Under Payer

ID CMS01Non ParBatchTRUEOTRUE

TLX12BCBS - WyomingParBatchTRUESTRUE

BBMDQBCBS MI / BCBS MI Medicare AdvantageNon ParBatch

49153BCI Administrators, Inc.ParBatch

BEAM1Beam DentalParBatch

60054Bell AtlanticParBatchTRUERTDetailedTRUEWTRUETRUE

23210BeneCare Dental Plan ParBatchTRUE

41205Benefit Administration ServicesNon ParBatch

TFQ64Benefit Administrative Systems (BAS) (Homewood, IL)Non ParBatch

25145Benefit Coordinators Corporation (Pittsburgh, PA)Non ParBatch

R7003Benefit Inc. (MN)Non ParBatchTRUERTDetailedTRUESTRUE

43471Benefit Management / IneticoParBatch

36459Benefit Management Group (NV)Non ParBatch

48611Benefit Management of KansasNon ParBatch

TLU45Benefit Management Services (NC)Non ParBatch

37212Benefit Management Systems (MS)Non ParBatch

19753Benefit Plan Administrators IncNon ParBatch

39081Benefit Plan Administrators, Inc. (Eau Claire, WI)

Includes Custom Benefit Administrators Claims

Previously Submitter Under Payer ID 39170 and 3P

Administrator Claims Previously Submitted Under

Payer ID 20413ParBatchTRUE

07000Benefits Inc (Construction Suppliers Group only)Non ParBatchTRUERTDetailedTRUESTRUE

BMX01BeneMaxNon ParBatch

95604Best Life & Health Insurance CompanyNon ParBatch

TLY26Blue Advantage (BCBS of AR)ParBatch TRUE RTDetailedTRUESTRUE

47163Blue Cross Blue Shield of KansasNon ParBatchTRUEW

47171Blue Cross Blue Shield of Kansas CityNon ParBatchTRUEW

CX083Blue Cross Blue Shield of Wisconsin - PPOD (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

BCD01Blue Cross Dental (MD) / Dominion / Capital Blue CrossParBatchTRUERTGeneralTRUE CX083Blue Cross of California - OSB High & Low (Admin by LIBERTY Dental) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

CX083Blue Cross of California - Plan SS10 & SS20 (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

CX083Blue Cross of California - PPOA (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

CBID1Blue Cross of IdahoNon ParWBatchTRUEW

52133Blue Shield of California ParBatchTRUERTGeneralTRUESTRUEMust Enroll in EFT FirstTRUE

BSCA2Blue Shield of California (FEP Only)Non ParBatch CB865Blue Shield of Pennsylvania (Camp Hill)PlatinumRTTRUERTDetailedTRUESTRUE CBPA2Blue Shield of Pennsylvania - Dental Plus (UCCI)PlatinumRTTRUERTDetailedTRUESTRUE

36609Boilermakers National Health & Welfare Fund (Int'l Brotherhood of Boilermakers)Non ParBatch

TLX71Bollinger InsuranceParBatch

74237Boon-Chapman Benefit Administrators IncNon ParBatch

04210Boston University Dental Health PlanNon ParBatch

CX028Bridgeport LLC of Missouri (St. Charles, MO)ParRTTRUE

BRIDGBridgespan HealthNon ParBatchTRUE

51037Brokerage ConceptsNon ParBatch

To submit to Payors not on this list, use Payor ID "06126"

and be sure to submit all required fields, including Payor Name and Complete Address.(C) 2014 Tesia Clearinghouse

Tesia Dental Payer Listing - Website (v 11.27.19).xlsx

3 of 16

Tesia Clearinghouse

www.Tesia.com

1540 W Edgewood Drive

Indianapolis, IN 46217

Tel: (800) 724-7240

Clearinghouse Payer List

eAttachments

Payer IDPayer NameAdditional InfoStatus

Enrollment

RequiredType

270s

Available

Enrollment

RequiredType

Level of

ResponseEligibility Notes

835s

Available

Enrollment

Required

Paper EOBs

Shutoff

when

EnrolledERA Notes

Accepts Tesia

eAttachments

Payer Identification InformationClaims ProcessingEligibility and Benefits InformationRemittance Information

CX032Brokers National ParBatchTRUETRUE

00800BS Northeastern New YorkParBatchTRUEW

61301Businessmen's Assurance (NE)ParBatchTRUETRUE

42150Butler Dental (IA)Non ParBatch

CAS89C.A.S. Benefit PlansParBatch

CX083Cal Optimal - OneCare (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

71057Cannon Cochran Management Services, Inc. (LA Plan ONLY)Non ParBatch

CBC01Capital Blue Cross (CBC) / Blue Cross Dental (MD)ParBatchTRUERTGeneralTRUE

68011Capitol AdministratorsNon ParBatch

CX095Capitol Dental Plan (OR)Non ParBatch

CAPHPCaprock Health PlansNon ParBatch

CX083Care 1st Health Plan Medicare Advantage (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

CX083Care 1st PHP LA & San Bernadino County (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

TLY44Careington CorporationParBatchTRUE

93975CareOregonNon ParBatch

GACS1Caresource - GAParBatch

KYCS1Caresource - KYParBatchTRUE

WVCS1Caresource - WVParBatch

CKOH2Caresource (OH)ParBatch

INCS1CareSource of IN (Just4Me)ParBatch

TLU48Carolina Summit Healthcare IncNon ParBatch

TFQ25Carpenters Combined Funds (PA)PlatinumRTTRUERTDetailedTRUESTRUE TLW16Carpenter's Health & Welfare Fund (Philadelphia, PA)ParBatchTRUE TLW06Carpenters Health and Welfare Trust Funds (St. Louis, MO)ParRTTRUERTDetailedTRUE

CHA01Cascade Comprehensive Care IncNon ParBatch

37060Caterpillar IncParBatchTRUESTRUEMust Enroll in EFT FirstTRUE

03036CBA Blue Dental / Emp Benefit Plan AdminNon ParBatch

TLZ03CCPOA Benefit Trust FundNon PariBatch

88022CDS Group Health (NV)Non ParBatch

91136Cement Masons & Plasterers Health & Welfare Trust (F16)Non ParBatch

TLU51Central PA Teamsters Health & Welfare FundParBatchTRUESTRUETRUE TLW76Central Reserve Life Insurance CompanyNon ParBatch

36215Central States Health & Welfare Fund (IL)ParBatchTRUE

84147CHAMPVA - HAC

CHAMPVA-HAC is not associated with and does not

process claims for TRICARE (fka CHAMPUS)Non ParBatch

TLU92Chesterfield Resources, Inc.Non ParBatch

TLY40Chicago Regional Council of CarpentersParBatchTRUE

84147Children of Women Vietnam Veterans - VA HACNon ParBatch

60054Choice Plus (TRW)ParBatchTRUERTDetailedTRUEWTRUETRUE

38308Christian Brothers Services (CBS Health Benefits)Non ParBatch

62308CIGNA

Includes Cigna Flex Care (NM) Claims Previously

Submitted Under Payer ID TLX70ParBatchTRUES

Paper remittances turned off if

enrolled in EFT.

10050CIGNA (DHMO)ParBatchTRUES

Paper remittances turned off if

enrolled in EFT. TLU52Citizens Security Life Insurance CoNon ParBatch

38219ClaimChoice AdministratorsNon ParBatch

89461Claims Bridge NorthNon ParBatch

44219Claims Bridge NWNon ParBatch

55731Claims Bridge SouthNon ParBatch

TLU53Combined Insurance ServiceNon ParImages

27905Community Health Alliance of TNNon ParBatch

75261Community Health Electronic Claims (CHEC/Webta)Non ParBatch

CX083Community Insurance - HMOA & PPOB (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

CX083Community Insurance - PPOD & PPOF (Admin by LIBERTY Dental Plan) Includes Claims for Liberty Dental Plans Previously

Submitted Under TPC12ParBatchTRUE

48005Companion LifeNon ParBatch

77828Companion LifeNon ParBatch

CX021CompBenefits (Chicago, IL)Non ParBatch

PBGSMComprehensive Benefit AdministratorsNon ParBatch TLW14Comprehensive Benefits & Claims AdministratorsNon ParBatch

00720Comprehensive Care ServicesNon ParBatch

WT011Comprehensive Healthcare OptionsNon ParBatch

10166Comprehensive Medical and Dental Program CMDPNon ParBatch

37307Connecticut Carpenters Health FundParBatchTRUERTDetailedTRUESTRUETRUE

62308Connecticut General (CIGNA)ParBatchTRUES

Paper remittances turned off if

enrolled in EFT.

37135Consociate GroupNon ParBatch

61305Consolidated Group DentalNon ParBatch

45321Consumers Choice Health Plan - State of SCNon ParBatch

To submit to Payors not on this list, use Payor ID "06126"

and be sure to submit all required fields, including Payor Name and Complete Address.(C) 2014 Tesia Clearinghouse

Tesia Dental Payer Listing - Website (v 11.27.19).xlsx

4 of 16

Tesia Clearinghouse

www.Tesia.com

1540 W Edgewood Drive

Indianapolis, IN 46217

Tel: (800) 724-7240

Clearinghouse Payer List

eAttachments

Payer IDPayer NameAdditional InfoStatus

Enrollment

RequiredType

270s

Available

Enrollment

RequiredType

Level of

ResponseEligibility Notes

835s

Available

Enrollment

Required

Paper EOBs

Shutoff

when

EnrolledERA Notes

Accepts Tesia

eAttachments

Payer Identification InformationClaims ProcessingEligibility and Benefits InformationRemittance Information

52132Cooperative Benefit AdministratorsNon ParBatch

TLX80CORE Administrative ServicesNon ParBatch

TFQ74CoreFiveParBatchTRUE

75136CoreSource ARNon ParBatch

41045CoreSource AZ MNNon ParBatch

48117CoreSource KC (fka FMH Benefit Services Inc)Non ParBatch

35182CoreSource MD PA ILNon ParBatch

35180CoreSource NC INNon ParBatch

35183CoreSource OH (Clinton, IA)

Includes Coresource IA Claims Previously Submitted

Under Payer ID TFQ37Non ParBatch

58102Covenant AdministratorsNon ParBatch

25148Coventry Health Care of GeorgiaNon ParBatch

87043Coventry Healthcare National NetworkNon ParBatch

37320Creative Plan Administrators (MD)Non ParBatch

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