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

[PDF] Claims and Remits Payer List - Experian

12 mar 2021 · Effective 3/27/19, the new payer ID is ALTAM Always Care Keenan Associates (CA) 95279 837 ✓ ✓ Kelseycare KELSI 837 ✓ ✓

[PDF] Payer Identification Information Claims Processing - SpaceCraft

To submit to Payors not on this list, use Payor ID "06126" and be sure to submit all required fields, 95279 Keenan Associates Non Par Batch 73100 Kempton  

[PDF] Change Health Care Commercial Par Payer Listing: 8/9 - Helpjuice

9 août 2017 · Please send these EDI claims to the Payer ID of the PPO shown on the 95279 Keenan Associates (CA) Par COMMERCIAL M Claims

[PDF] Payer ID Name Service - Anvicare

27 déc 2001 · Payer ID Name Service 13162 1199 National Benefit Fund Claims 95279 Keenan Associates (Ca) Claims KELSE Kelsey-Seybold

[PDF] eClaims Dental Payer List Information - pattfaqcom

Payer ID 06126: Use this eClaims payer id for those insurance companies that 95279 No No Kemper Benefits 61453 Yes No Kempton Company 73100

[PDF] MedAvant Payer ID Table - Professional Claims - Lytec

8 jan 2007 · Each claim must be associated with a payer ID If using Yes Payer Claim Status N 04/13/07 Non-Par 95279 Comm University of Miami 

[PDF] EDI Midwest Clearinghouse New Payer List - ASK-EDI

Midwest Payer ID Payer Name Services Hospital (837I) Medical (837P) 00014 SelectCare Claims X X 95279 Keenan Associates (CA) Claims X X

[PDF] Payor Name ParEnrollServices ID Notes - TriZetto Provider Solutions

Please send these EDI claims to the Payer ID of the PPO shown on the Members ID Keenan Associates (CA) 95279 Y No Kelsey Seybold Clinic kelsi Y No

[PDF] Payer Claims List - Electronic Dental Services

Payer Claims List Payer ID Payer Name Req Enroll NULL 36575 No 95279 Keenan Associates (Torrance, CA) No 61453 Kemper (Milwaukee, WI) No

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

16 août 2016 · Enrollment requires your Tax ID Use this Payer ID for submitting Keenan Associates 95279 Par COMMERCIAL No No Claims R Y

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Change Healthcare Dental Payer List

8/16/2016

1

StatePayerTypeModelGrou

p #Enrol lPayer Enrollment Turnaround

TimeServiceNPI5010

ICD1 0 Read y ICD10

Testin

g ICD10

Required as

of

Compliance

Date Additional InfoERA/EFT Enrollment LevelERA Enrollment TypeRequires EFT for ERA

Enrollment ERA Payer Enrollment Form

RequiredERA Paper RA Shut Off

3P Admin20413ParCOMMERCIALYesNoClaimsYY

A & I Benefit Plan Administrators93044ParCOMMERCIALYesNoClaimsYY A & I Benefit Plan Administrators93044COMMERCIALYes

EFT Enrollment is processed

between the provider and Change

Healthcare. Approval time is

dependant upon the provider's responsiveness.EFT

Enrollment requires your Tax ID

Number plus a 4-digit Suffix that

can be found on the same line as your provider TIN on your most recent explanation of benefits.

Tax ID & Provider ID required

A.D.N. Administrators, Inc.CXADNParCOMMERCIALYesNoClaimsRY

AARPAARP1ParCOMMERCIALYesNoClaimsYYS

AARP Claims with a mailing

address of PO Box 2059,

Mechanicsburg, PA

AARPAARP1COMMERCIALYes30 Business DaysERAYTax ID / NPI combination

Payer accepts enrollment request

from Change Healthcare.

NoNoImmediately

Acceptius (Benefit Management Inc of MO (BMI)43178ParCOMMERCIALYesNoClaimsR

Access DentalCX097ParCOMMERCIALYesNoClaims R

via Performance Health

Technology

Access DentalCX097COMMERCIALYes

EFT Enrollment is processed

between the provider and Change

Healthcare. Approval time is

dependant upon the provider's responsiveness.EFT

Legacy ID - For Providers, use

their Facility/Office NPI. For

Brokers, use their Agency ID

which is either a 4 or 5 digit code. The 4 digit code starts with a 5 and the 5 digit code start with a 2

Tax ID & NPI required

Acclaims64071ParCOMMERCIALYesNoClaimsY

ACS Benefit Services Inc.72468ParCOMMERCIALYesNoClaimsYY f.k.a. ACS Consulting Services, Inc.

ACS Benefit Services, Inc.61474ParCOMMERCIALYesNoClaimsYYACS Branded Dental ProductActiva Benefit Services, LLC/Dental38255ParCOMMERCIALYesNoClaimsYY

(Formerly Amway

Corporation/Dental)

Administrative Concepts, Inc.22384COMMERCIALYes

EFT Enrollment is processed

between the provider and Change

Healthcare. Approval time is

dependant upon the provider's responsiveness.EFTTax ID only Administrative Services Only, Inc.CX076ParCOMMERCIALYesNoClaimsY

Additional enrollment is not

required by the payer, however, providers wishing to submit

Claims electronically must be

credentialed with the payer.

Please ensure you have

successfully process one paper

Claims with the payer prior to

submitting your first electronic

Claims

Advantage by SuperiorCPPSAParCOMMERCIALYesYesPayer's discretionClaims R

Effective only for Dates of Service

prior to 2-01-13. Call

DentaQuest at 800-896-2374 and

MCNA Dental at 855-776-6262 for

Dates of Service 2-1-13 and greater

Advantage Dental Plan, Inc.93524ParCOMMERCIALNoNoClaimsYY Advantek Benefit Administrators83077ParCOMMERCIALYesNoClaims YY Advantica Benefits 43168ParCOMMERCIALYesNoClaims YY Advantica Benefits 43168COMMERCIALYes5-7 Business DaysERATax ID / NPI Combination

Payer accepts enrollment request

from Change Healthcare.

NoNoMinimum of 31 Business days or

3 payment cycles

Advantica Benefits 43168COMMERCIALYes

EFT Enrollment is processed

between the provider and Change

Healthcare. Approval time is

dependant upon the provider's responsiveness.EFTTax ID & NPI required Advantica Benefits 43168COMMERCIALEligibility InquiryDetailed Benefits Advantica Benefits 43168COMMERCIALClaim Status Inquiry

Adventist Health System West - Roseville, CA95340ParCOMMERCIALYesNoClaimsYYAdventist Health System West - Roseville, CA95340COMMERCIALYes1-3 Business DaysERATax ID only

Payer accepts enrollment request

from Change Healthcare.

NoNoMinimum of 31 Business days or

3 payment cycles

Adventist Health System West - Roseville, CA95340COMMERCIALYes

EFT Enrollment is processed

between the provider and Change

Healthcare. Approval time is

dependant upon the provider's responsiveness.EFTTax ID only

Aetna60054ParCOMMERCIALYesNoClaimsYY

Aetna60054COMMERCIALYes35-40 Business DaysERAY

ERAs returned for claims and pre-

treatment estimates. Tax ID / NPI combinationPayer requires paper enrollment form.

NoYes30 Days

Aetna60054COMMERCIALNoEligibility InquiryDetailed Benefits Aetna60054COMMERCIALNoClaim Status InquiryAetna68246ParCOMMERCIALYesNoEncountersYY

Use this Payer ID for submitting

DMO services only.

Aetna Affordable Health Choices (SM) - SRC57604ParCOMMERCIALYesNoYY Aetna Medicare EPO/PPO Dental18014ParCOMMERCIALYesNoClaimsRY Affordable Benefits Admin.95426ParCOMMERCIALYesNoClaimsYY AFLAC GA58066COMMERCIALNoEligibility InquiryDetailed Benefits

AFLAC GA - GRP58066ParCOMMERCIALYesNoClaimsYY

Group Plan coverage please refer

to your ID card for group coverage/number verification.

AFLAC NY52080ParCOMMERCIALYesNoClaims YY

This plan also shares the same

mailing address as payer ID

58066 and the only difference

between the plans is that the insured ID for the NY based plan begins with "PN" as "PNxxxxxx" (followed by 6+ digits) AFLAC NY52080COMMERCIALNoEligibility InquiryDetailed Benefits

AFLAC NY - GRP52080ParCOMMERCIALYesNoClaims YY

Group Plan Coverage please refer

to your ID card for group coverage/number verification. AGC International Union of Operating Engineers Local 701

91136ParCOMMERCIALYesNoClaimsYY

Please enter group # F07 when

submitting claims. A Welfare and

Pension Administration Services

payer

Change Healthcare Dental Payer List

8/16/2016

2

StatePayerTypeModelGrou

p #Enrol lPayer Enrollment Turnaround

TimeServiceNPI5010

ICD1 0 Read y ICD10

Testin

g ICD10

Required as

of

Compliance

Date Additional InfoERA/EFT Enrollment LevelERA Enrollment TypeRequires EFT for ERA

Enrollment ERA Payer Enrollment Form

RequiredERA Paper RA Shut Off

AGC International Union of Operating Engineers Local 70191136COMMERCIALYes1-3 Business DaysERATax ID only

Payer accepts enrollment request

from Change Healthcare.

NoNoMinimum of 31 Business days or

3 payment cycles

AGC International Union of Operating Engineers Local 701

91136COMMERCIALYes

EFT Enrollment is processed

between the provider and Change

Healthcare. Approval time is

dependant upon the provider's responsiveness.EFTTax ID only

AK United Food and Commercial Workers (AK UFCW)

91136ParCOMMERCIALYesNoClaimsYY

Please enter group # F45 when

submitting claims. A Welfare and

Pension Administration Services

payer AK United Food and Commercial Workers (AK UFCW)91136COMMERCIALYes1-3 Business DaysERATax ID only

Payer accepts enrollment request

from Change Healthcare.

NoNoMinimum of 31 Business days or

3 payment cycles

Alameda Alliance CX083ParCOMMERCIALYesNoClaimsYYAdmin by LIBERTY Dental Plan

Alask Carpenters91136ParCOMMERCIALYesNoClaimsYY

Please enter group # F40 when

submitting claims. A Welfare and

Pension Administration Services

payer Alask Carpenters91136COMMERCIALYes1-3 Business DaysERATax ID only

Payer accepts enrollment request

from Change Healthcare.

NoNoMinimum of 31 Business days or

3 payment cycles

Alask Carpenters

91136COMMERCIALYes

EFT Enrollment is processed

between the provider and Change

Healthcare. Approval time is

dependant upon the provider's responsiveness.EFTTax ID only Alaska Electrical Health & Welfare Fund92600ParCOMMERCIALYesNoClaimsYY Alaska Hotel Employees, Restaurant & Camp Employees (AK HERE)91136ParCOMMERCIALYesNoClaimsYY

Please enter group # F41 when

submitting claims. A Welfare and

Pension Administration Services

payer

Alaska Hotel Employees, Restaurant & Camp Employees (AK HERE)91136COMMERCIALYes1-3 Business DaysERATax ID only

Payer accepts enrollment request

from Change Healthcare.

NoNoMinimum of 31 Business days or

3 payment cycles

Alaska Hotel Employees, Restaurant & Camp Employees (AK HERE)

91136COMMERCIALYes

EFT Enrollment is processed

between the provider and Change

Healthcare. Approval time is

dependant upon the provider's responsiveness.EFTTax ID only Alaska Laborers Construction Industry Health & Security Trust

91136ParCOMMERCIALYesNoClaimsYY

Please enter group # F23 when

submitting claims. A Welfare and

Pension Administration Services

payer

Alaska Laborers Construction Industry Health & Security Trust91136COMMERCIALYes1-3 Business DaysERATax ID only

Payer accepts enrollment request

from Change Healthcare.

NoNoMinimum of 31 Business days or

3 payment cycles

Alaska Laborers Construction Industry Health & Security Trust

91136COMMERCIALYes

EFT Enrollment is processed

between the provider and Change

Healthcare. Approval time is

dependant upon the provider's responsiveness.EFTTax ID only

Alaska Machinists Health and Welfare Trust

91136ParCOMMERCIALYesNoClaimsYY

Please enter group # F21 when

submitting claims. A Welfare and

Pension Administration Services

payer Alaska Machinists Health and Welfare Trust91136COMMERCIALYes1-3 Business DaysERATax ID only

Payer accepts enrollment request

from Change Healthcare.

NoNoMinimum of 31 Business days or

3 payment cycles

Alaska Pipe Trades U A Local 375

91136ParCOMMERCIALYesNoClaimsYY

Please enter group # F24 when

submitting claims. A Welfare and

Pension Administration Services

payer Alaska Pipe Trades U A Local 37591136COMMERCIALYes1-3 Business DaysERATax ID only

Payer accepts enrollment request

from Change Healthcare.

NoNoMinimum of 31 Business days or

3 payment cycles

Alaska Public Employees Association (APEA/JESS Health & WelfareTrust)

91136ParCOMMERCIALYesNoClaimsYY

Please enter group # F60 when

submitting claims. A Welfare and

Pension Administration Services

payer

Alaska Public Employees Association (APEA/JESS Health & WelfareTrust)91136COMMERCIALYes1-3 Business DaysERATax ID only

Payer accepts enrollment request

from Change Healthcare.

NoNoMinimum of 31 Business days or

3 payment cycles

Alaska Public Employees Association (APEA/JESS Health & WelfareTrust)

91136COMMERCIALYes

EFT Enrollment is processed

between the provider and Change

Healthcare. Approval time is

dependant upon the provider's responsiveness.

EFTTax ID only

Alexian Brothers Community Services of TN44423ParCOMMERCIALYesNoClaimsRY

AllCare CCO Dental

CXALCParCOMMERCIALYesNoClaimsRY

via Performance Health

Technology

Allegeant52193ParCOMMERCIALYesNoClaimsYYf.k.a. LBA Health Plans

Allegeant52193COMMERCIALYes

EFT Enrollment is processed

between the provider and Change

Healthcare. Approval time is

dependant upon the provider's responsiveness.

EFTf.k.a. LBA Health PlansTax ID only

Allegiance Benefit Plan81040ParCOMMERCIALYesNoClaimsRY

Change Healthcare Dental Payer List

8/16/2016

3

StatePayerTypeModelGrou

p #Enrol lPayer Enrollment Turnaround

TimeServiceNPI5010

ICD1 0 Read y ICD10

Testin

g ICD10

Required as

of

Compliance

Date Additional InfoERA/EFT Enrollment LevelERA Enrollment TypeRequires EFT for ERA

Enrollment ERA Payer Enrollment Form

RequiredERA Paper RA Shut Off

Alliant Services70106ParCOMMERCIALYesNoClaimsRY

Claims mailing address of PO Box

12009, Cheshire, CT

Allied Benefit Systems37308ParCOMMERCIALYesNoClaimsYY

Allied Benefit Systems37308COMMERCIALYes

EFT Enrollment is processed

between the provider and Change

Healthcare. Approval time is

dependant upon the provider's responsiveness.

EFTTax ID & Provider ID Required

Allied Metal Crafts Security Plan Trust Fund

91136ParCOMMERCIALYesNoClaimsYY

Please enter group # F18 when

submitting claims. A Welfare and

Pension Administration Services

payer Allied Metal Crafts Security Plan Trust Fund91136COMMERCIALYes1-3 Business DaysERATax ID only

Payer accepts enrollment request

from Change Healthcare.

NoNoMinimum of 31 Business days or

3 payment cycles

Allied Metal Crafts Security Plan Trust Fund

91136COMMERCIALYes

EFT Enrollment is processed

between the provider and Change

Healthcare. Approval time is

dependant upon the provider's responsiveness.

EFTTax ID only

AlwaysCare BenefitSTR01NonCOMMERCIALNoClaimsRY

Amalgamated Life - PA Alicare13343ParCOMMERCIALYesNoClaimsYY

Ameriben Solutions75137ParCOMMERCIALYesNoClaimsRY

American Administrators dba Select Benefit Administrators (West Des Moines, IA)42137ParCOMMERCIALYesNoClaims YY

Please check the Insured ID card

to verify the Payer ID before submitting claims. If you have questions, please contact Provider

Relations at 800-456-4584.

American Benefit CorporationCX084ParCOMMERCIALYesNoClaimsY

Only limited plans may be sent

electronically. Group name is required with one of the following plan names: Sheet Metal,

Berekely, Boone, Carpenter,

Cabell, Clarksbur, Doodridge,

Hancock, Harrison, Marion,

Monongalia, Mingo, Mineral,

Morgan, Nicholas, Putnam,

Taylor Tyler Wetzel

American Medical SecurityCX001ParCOMMERCIALYesNoClaimsYYA United Healthcare Payer American Postal Workers Union Health Plan44444ParCOMMERCIALYesNoClaimsYY

Americas TPA41178ParCOMMERCIALYesNoClaims RY

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