Real Time 270/271 Payer List

Payer Name Payer ID Notes

1199 National Benefit Fund 13162
AARP 10001
AARP by UnitedHealthcare 36273
Aetna Healthcare 60054
Affinity Health Plan AFNTY
Aftra Health Fund 10015
Alabama Medicaid 10018
American Community Mutual F6030500
American Republic Insurance 10045
AmeriChoice of New Jersey 00091
Amerigroup Corporation 28806
AmeriHealth Administrators 11039
APWU Health Plan 10043
Arise Health Plan (WPS) ARISE
Asuris Northwest Health 10064
AvMed Health Plans 10067
BCBS of Delaware 10084
BCBS of Hawaii 11141
BCBS of Illinois 10088
BCBS of Iowa 10090
BCBS of Kansas City 13111
BCBS of Louisiana 10093
BCBS of Mississippi 10099
BCBS of Montana 11144
BCBS of Nebraska 10101
BCBS of New Mexico 10105
BCBS of New York (Central) 12963
BCBS of New York (Rochester Area) 12967
BCBS of New York (Utica-Watertown) 12968
BCBS of North Carolina 10107
1
BCBS of Oklahoma 11150
BCBS of Rhode Island 10111
BCBS of South Carolina 10112

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BCBS of South Dakota 11153
BCBS of Tennessee 10113
BCBS of Texas 10114
BCBS of Vermont 11155
Blue Cross Blue Shield of Arizona 53589
Blue Cross Blue Shield of Florida BCBSF
Blue Cross Blue Shield of Massachusetts 10096
Blue Cross Blue Shield of Minnesota BCBSMN
Blue Cross Blue Shield of Oregon (Regence) 00851
Blue Cross Blue Shield of Utah (Regence) 00910
Blue Cross Independence (Pennsylvania) 10366
Blue Cross of California 10051
Blue Cross of Colorado 10029
Blue Cross of Connecticut 10030
Blue Cross of Georgia 10032
Blue Cross of Indiana 10258
Blue Cross of Kentucky 10259
Blue Cross of Maine 10036
Blue Cross of Missouri 10322
Blue Cross Of Nevada 10260
Blue Cross Of New Hampshire 10261
Blue Cross of New Jersey 10104
Blue Cross of Ohio 10044
Blue Cross of Pennsylvania PABLS
Blue Cross of Virginia 10049
Blue Cross Of Wisconsin 10299
Blue Shield of California 940360524
Blue Shield of Idaho (Regence) 00611
Blue Shield of Washington (Regence) 00932
BlueChoice HealthPlan South Carolina Medicaid 10121
Office Ally is
designated
CalOptima CALOP01 clearinghouse
for Real Time
Transactions.

Capital District Physicians Health Plan (CDPHP) 11213

CareFirst BCBS (MD, DC) 10095 2
CareMore Health Plan CARMO
CarePlus Health Plan 324

Office Ally, Inc| PO Box 872020 | Vancouver, WA 98687|(360) 975-7000

Caresource of Kentucky KYCS1
Central CA Alliance for Health 10884
CHAMPVA 84146
CHC Texas 00504
CIGNA Healthcare 62308
Colorado Access 11350
Colorado Medicaid 10161
Community First COMMF
Community Health Choice 48145
Office Ally is
designated
Community Health Group of SD 66170 clearinghouse
for Real Time
Transactions.

Community Health Plan of Washington CHPWA

Community Health Plan of Washington (CHPW) 11373
Office Ally is
designated
Complementry Healthcare Plans CHP01 clearinghouse
for Real Time
Transactions.

CONNECTICARE 10164
Connecticut General Life 6105
Continental General Insurance Company 10168
Cooperative Benefit Administrators 10170
CoreSource - Little Rock 10172
CoreSource - MD,PA,IL 10174
CoreSource - OH 10175
Coventry Health Care Carelink Medicaid 00182
Coventry Health Care of MO, MS, AK, TN(00184) 10205
Coventry Health Care of Georgia 10190
Coventry Health Care of Louisiana 10150
Coventry Health Care USA (HCUSA) 00186
Coventry National/University of MO(00250) 10196
Coventry National/University of MO(COVON) 13129
Coventry Wellpath Select 10153
DAKOTACARE 10208
3
Directors Guild F2370600
Employee Benefit Management Services 81039
Evergreen Health Cooperative 93240

Office Ally, Inc| PO Box 872020 | Vancouver, WA 98687|(360) 975-7000

 Office Ally is
designated
Exclusive Payer Care EC999 clearinghouse
for Real Time
Transactions.

Fidelis Care New York 10253

First Carolina Care 56196
Florida Health Care Plan 59322
Gateway Health Plan 11611
GEHA - Government Employees Hospital Association 10275
Geisinger Health Plan 10282
GHI Emblem Health EMBLM
Government Employees Hospital Association (GEHA) 44054
Great West 80705
Group Health Cooperative 11662
Health Choice of Arizona 11705
Health Net National 00213
Health Partners Pennsylvania HPART
Health Plan of San Mateo 11730
Healthfirst of New York HF1NY
HealthPlus of Michigan 10339
HealthSpring 11188
HIP Healthplan of NY 10345
Horizon New Jersey Health 10351
Humana 10353
Independence Administrators 11849
Independent Health 10368
Inland Empire Health (Medical Only) MED
Inland Empire Health (Medicare Only) CMC Member has Dual
coverage (Both
Medical &
Medicare) – using
their Medicare

Inland Empire Health (Medi-Cal Only) CCI Member has Dual

coverage (Both
Medical &
Medicare) – using
their Medi-Cal

Kaiser Foundation Health Plan of Colorado 10395 4

Kaiser Foundation Health Plan of Georgia 10396
Kaiser Foundation Health Plan of Mid-Atlantic 10403

Office Ally, Inc| PO Box 872020 | Vancouver, WA 98687|(360) 975-7000

Kaiser Foundation Health Plan of the Northwest 100707
Kaiser Permanente of Northern California 100708
Kaiser Permanente of Southern California 100709
Magellan Behavioral Health Services 11991
Magellan Complete Care VA MCCVA
MAMSI Health Plan 10442
Medica2 12422
Medica Health Plan Solutions 71890
Medicaid of Alaska 13094
Medicaid of Arizona (AHCCCS) 10057
Medicaid of Arkansas 10059
Medicaid of Connecticut 10165
Medicaid of District of Columbia 10209
Medicaid of Georgia 10281
Medicaid of Hawaii 10318
Medicaid of Idaho 10363
Medicaid of Illinois 10365
Medicaid of Iowa 10381
Medicaid of Kansas 10413
Medicaid of Kentucky 10416
Medicaid of Louisiana 10434
Medicaid of Maine 10441
Medicaid of Massachusetts 10450
Medicaid of Minnesota 10474
Medicaid of Mississippi 10477
Medicaid of Missouri 10479
Medicaid of Montana 10491
Medicaid of Nevada 10526
Medicaid of New Hampshire 10529
Medicaid of New Jersey 10530
Medicaid of New Mexico 10531
Medicaid of New York 10533
Medicaid of North Carolina 10539
Medicaid of North Dakota 10541
Medicaid of Ohio 10554
Medicaid of Oklahoma 10557
5
Medicaid of Oregon 10573
Medicaid of Pennsylvania 10594
Medicaid of South Carolina 10693

Office Ally, Inc| PO Box 872020 | Vancouver, WA 98687|(360) 975-7000

Medicaid of South Dakota 10695
Medicaid of Texas 10730
Medicaid of Utah 13169
Medicaid Vermont 10846
Medicaid Virginia 10851
Medicaid Washington 10857
Medicaid West Virginia 10871
Medicaid Wyoming 10892
Medical Mutual of Ohio 29076
Medicare Alabama AL200493
Medicare Alaska CH00102
Medicare Arizona CH00102
Medicare Arkansas E3472
Medicare Cahaba TN000214
Medicare California (Northern) BBB32858B
Medicare California (Southern) CH0000586
Medicare California Part A CH0000586
Medicare Colorado RR3426
Medicare Connecticut CHBC00657
Medicare Delaware 1926517
Medicare District Of Columbia 1926517
Medicare Florida P4888
Medicare Georgia GAF01-723
Medicare Hawaii CH00102
Medicare Idaho PB204N
Medicare Illinois 98366
Medicare Indiana ZH2C
Medicare Iowa 98366
Medicare Kansas 98366
Medicare Kentucky ZH2C
Medicare Louisiana L0022
Medicare Maine 7166
Medicare Maryland 1928772
Medicare Massachusetts 7166
Medicare Michigan 98366
Medicare Minnesota 98366
6
Medicare Mississippi 7021305
Medicare Missouri 98366
Medicare Montana CH00102

Office Ally, Inc| PO Box 872020 | Vancouver, WA 98687|(360) 975-7000

Medicare Nebraska 98366
Medicare Nevada CH00102
Medicare New Hampshire 7166
Medicare New Jersey 1925460
Medicare New Mexico RR3426
Medicare New York - Downstate CH0000586
Medicare New York - Queens CHBQ01000
Medicare New York Upstate Part B CHBU01653
Medicare North Carolina PB252R
Medicare North Dakota CH00102
Medicare Ohio N10917
Medicare Oklahoma RR3426
Medicare Oregon CH00102
Medicare Pennsylvania 1925460
Medicare Rhode Island 7166
Medicare South Carolina SC10002123
Medicare South Dakota CH00102
Medicare Tennessee TN200864
Medicare Texas RR3426
Medicare Utah CH00102
Medicare Vermont 7166
Medicare Virginia RR3426
Medicare Washington CH00102
Medicare West Virginia N10917
Medicare Wisconsin 98366
Medicare Wyoming CH00102
Mercy Care Plan (Arizona) 10462
Meritain Health 10463
MetroPlus Health Plan 13265
Metropolitan Health Plan (MHP) 10465
MMSI (Mayo Health) 10480
Moda Health (ODS) 13350
Molina Healthcare of California 10482
Molina Healthcare Of Florida 10483
Molina Healthcare of Illinois 13178
Molina Healthcare Of Michigan 10484
7
Molina Healthcare of New Mexico 10486
Molina Healthcare of Ohio 10487
Molina Healthcare of Texas 10488

Office Ally, Inc| PO Box 872020 | Vancouver, WA 98687|(360) 975-7000

Molina Healthcare of Utah 10489
Molina Healthcare Of Utah 10489
Molina Healthcare of Washington 00228
Molina Healthcare of Wisconsin 13147
Mutual of Omaha 10498
MVP Health Plan of New York 10500
National Association of Letter Carriers 10503
Nationwide Specialty Health fka Nationwide Health Plan 10521

Neighborhood Health Plan (RI) 13148

Optima/Sentara 10569
Oxford Benefit Management 6111
Pacific Source Health Plan 12395
Passport Health Plan 10589
Premera Blue Cross of Washington 00430
Providence Health Plan 12551
Public Employees Health Program 13150
Sana Benefits SANA1
Santa Clara Family Health Plan 12618
Select Health Utah 13161
Student Insurance F7422700
Tricare 10747
Tricare for Life 12807
Tufts Health Plan 13568
UCare of Minnesota 10756
UMR Wausau 39026
United HealthOne / Golden Rule 37602
UnitedHealthcare 87726
UnitedHealthcare Community Plan of Missouri 86050
University Family Care 12860
University Physicians Care Advantage (Arizona) 12864
University Physicians Healthcare Group (Arizona) 13168
USAA Life Insurance Company 10839
VA Fee Basis Programs 10841
WEA TRUST 10863
WellCare Health Plans 10868
8

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Office Ally, Inc| PO Box 872020 | Vancouver, WA 98687|(360) 975-7000