List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
GROUP HEALTH, INC. (GHI)- HMO - SUPPLEMENTAL
WELLMARK BCBS (FEP)
WELLMARK BCBS OF IOWA (FEP)
WELLMARK BCBS OF IOWA (FEP)
WELLMARK BCBS OF IOWA (FEP)
THE REGENCE GROUP (IDAHO-FEHBP)
THE REGENCE GROUP (BLUE SHIELD--FEHBP)
THE REGENCE GROUP (UTAH--FEHBP)
THE REGENCE GROUP (OREGON--FEHBP)
MONUMENTAL LIFE INSURANCE CO. (FORMERLY UNDER AEGON) - SUPPLEMENTAL
CONNECTICUT GENERAL LIFE INSURANCE CO. (CIGNA)
HORIZON BCBS OF NJ - SUPPLEMENTAL
WELLMARK BCBS OF IOWA
WELLMARK BCBS OF SD
WELLMARK BCBS OF SD
WISCONSIN PHYSICIAN SERVICES - COMMERCIAL
WISCONSIN PHYSICIAN SERVICES - COMMERCIAL
BCBS OF MICHIGAN
BCBS OF ALABAMA - SUPPLEMENTAL
BCBS OF SOUTH CAROLINA - SUPPLEMENTAL
HIGHMARK, INC. - SUPPLEMENTAL PART B & DMERC
HIGHMARK, INC. - SUPPLEMENTAL PART A ONLY
GROUP HEALTH, INC. (GHI) PPO - SUPPLEMENTAL
GROUP HEALTH, INC. (GHI) PPO - SUPPLEMENTAL
GROUP HEALTH, INC. (GHI) PPO - SUPPLEMENTAL
GROUP HEALTH, INC. (GHI) PPO - SUPPLEMENTAL
GROUP HEALTH, INC. (GHI) PPO - SUPPLEMENTAL
GROUP HEALTH, INC. (GHI) PPO - SUPPLEMENTAL
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF ILLINOIS - SUPPLEMENTAL
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF NEW MEXICO - SUPPLEMENTAL
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF TEXAS- SUPPLEMENTAL
BCBS OF MICHIGAN
AETNA, INC.
BCBS OF MICHIGAN
BCBS OF MICHIGAN - BCN (BLUE CARE NETWORK)
BLUE CROSS AND BLUE OF MISSISSIPPI - SUPPLEMENTAL
BLUE CROSS AND BLUE OF MISSISSIPPI - SUPPLEMENTAL
BLUE CROSS OF NORTHEASTERN PA - SUPPLEMENTAL (PART A ONLY)
BLUE CROSS OF NORTHEASTERN PA - SUPPLEMENTAL (PART A ONLY)
METROPOLITAN HEALTH PLAN - SUPPLEMENTAL
PRIMEWEST HEALTH PLAN - SUPPLEMENTAL
PRIMEWEST HEALTH PLAN - SUPPLEMENTAL
Updated: 03/31/2016

Identification Number(s)
00002
00004
00005
00005
00006
00009
00010
00011
00012
00017
00018
00019
00020
00021
00023
00025
00026
00027
00028
00029
00030
00031
00032
00033
00034
00035
00036
00037
00041
00042
00044
00055
00060
00061
00062
00067
00068
00069
00070
00072
00073
00073

Customer Contact
Customer Service
Customer/Provider Services
Provider Services
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer/Provider Services
Customer/Provider Services
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer/Provider Services
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Cathy Stitzer
Cathy Stitzer
Bonnie Hays
Provider Services
Mary Winter

Contact Number
(877) 244-4466
(800) 524-9242
(800) 524-9242
(800) 373-5348
(800) 524-9242
(800) 343-8915
(800) 343-8915
(800) 343-8915
(800) 343-8915
(800) 854-0186
(800) 244-6224
(800) 624-1110
(800) 524-9242
(800) 524-9242
(800) 524-9242
(888) 253-2694
(888) 253-2694
(313) 225-9000
(205) 988-2200
(800) 760-9290
(800) 345-3806
(800) 345-3806
(212) 501-4444
(212) 501-4444
(212) 501-4444
(212) 501-4444
(212) 501-4444
(212) 501-4444
(888) 762-2189
(888) 762-2189
(888) 762-2189
(313) 225-9000
(860) 273-0123
(313) 225-9000
(800) 450-3680
(800) 257-5825
(800) 257-5825
(570) 200-4540
(570) 200-4540
(612) 543-3338
(866) 431-0802
(320) 335-5239

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
TRIPLE S, INC. - SUPPLEMENTAL
CAREFIRST OF DC - PART A ONLY
CAREFIRST OF DC - PART B ONLY
BCBS OF NORTH DAKOTA
BCBS OF WYOMING - SUPPLEMENTAL (PART B & DMERC)
BCBS OF NORTH DAKOTA
MEDICAL MUTUAL OF OHIO - SUPPLEMENTAL
BCBS OF TENNESSEE - SUPPLEMENTAL
UNITED HEALTH CARE-UNET - SUPPLEMENTAL
UNITED HEALTH CARE - SUPPLEMENTAL
GROUP HEALTH COOPERATIVE - SUPPLEMENTAL
BLUE CROSS AND BLUE SHIELD OF MINNESOTA - SUPPLEMENTAL
BLUE CROSS AND BLUE SHIELD OF MINNESOTA - SUPPLEMENTAL
BLUE CROSS AND BLUE SHIELD OF MINNESOTA - SUPPLEMENTAL
EMPIRE BCBS - SUPPLEMENTAL
EMPIRE BCBS - SUPPLEMENTAL
BCBS OF KANSAS - SUPPLEMENTAL
KPS HEALTH PLANS- SUPPLEMENTAL
ANTHEM BCBS OF CT - SUPPLEMENTAL
ANTHEM BCBS OF NH - SUPPLEMENTAL
ANTHEM BCBS OF ME - SUPPLEMENTAL
BCBS OF LOUISIANA - SUPPLEMENTAL
NEW JERSEY CARPENTERS HEALTH FUND - SUPPLEMENTAL
MAYO MEDICAL SYSTEMS, INC. (MMSI) - SUPPLEMENTAL
WEA INSURANCE COMPANY - SUPPLEMENTAL
CAREFIRST OF DC - SUPPLEMENTAL
CAREFIRST OF DC - SUPPLEMENTAL
CAREFIRST OF MD - SUPPLEMENTAL
EMPIRE BCBS - SUPPLEMENTAL
EMPIRE BCBS - SUPPLEMENTAL
CARPENTERS TRUST OF WESTERN WASHINGTON
BLUE SHIELD OF CALIFORNIA - SUPPLEMENTAL
BCBS OF NORTH CAROLINA
CAPITAL BLUE CROSS - SUPPLEMENTAL
BCBS OF WESTERN NEW YORK - SUPPLEMENTAL
BCBS OF WESTERN NEW YORK - SUPPLEMENTAL
BCBS OF WESTERN NEW YORK - SUPPLEMENTAL
BCBS OF WESTERN NEW YORK - SUPPLEMENTAL
BCBS OF WESTERN NEW YORK - SUPPLEMENTAL
BCBS OF WESTERN NEW YORK - SUPPLEMENTAL
BCBS OF WESTERN NEW YORK - SUPPLEMENTAL
BLUE CROSS AND BLUE SHIELD OF DELAWARE - SUPPLEMENTAL
Updated: 03/31/2016

Identification Number(s)
00074
00075
00076
00077
00078
00079
00080
00081
00082
00083
00087
00088
00089
00090
00091
00092
00093
00094
00095
00096
00097
00099
00102
00103
00104
00105
00106
00107
00108
00109
00110
00111
00112
00113
00114
00114
00114
00115
00115
00115
00116
00118

Customer Contact
Jeannette Irizarry Velez
Provider Services
Provider Services
Gina Bercherl
Amber Zowada
Gina Bercherl
Sue Robinson
Customer Service
Customer Service
Customer Service
Michelle Anderson
Customer Service
Customer Service
Customer Service
Lora Tincher
Lora Tincher
Customer Service
Teresa Hiagh-Braget
Lora Tincher
Lora Tincher
Lora Tincher
Customer Service
Rachel Corradi
Customer Service
Shawn Lynn
Part A only
Part B only
Part B only
Customer Service
Customer Service
Min-Sug (Darren) Kong
Tammy Rutters
eSolutions Help Desk
Nancy Herman
Buffalo (CNY West)
Albany Region II
Albany (CNY East)
Traditional Member
Managed Care Member
Provider Services
Melissa Deboth
Customer Service

Contact Number
(787) 749-4949
(410) 998-4599
(410) 998-4599
(701) 277-2081
(307) 432-2743
(701) 277-2081
(800) 700-2583
(800) 553-8158
(866) 633-2446
(866) 633-2446
(206) 901-4588
(800) 531-6686
(800) 531-6686
(800) 531-6686
(502) 310-9374
(502) 310-9374
(800) 432-3990
(360) 478-2635
(502) 310-9374
(502) 310-9374
(502) 310-9374
(800) 392-4089
(732) 417-3900 ext. 272
(800) 635-6671
(608) 661-6617
(410) 998-4599
(410) 998-4599
(410) 998-4599
(800) 435-1385
(800) 435-1386
(206) 441-6514
(530) 351-6109
(888) 333-8594
(717) 541-6274
(866) 638-9011
(800) 945-0566
(800) 856-0480
(800) 888-1238
(800) 459-7587
(800) 444-4552
(716) 887-8443
(302) 429-0260

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
HEALTH ALLIANCE PLAN OF MICHIGAN - SUPPLEMENTAL
BCBS OF ARIZONA - SUPPLEMENTAL
MERCER HEALTH & BENEFITS, LLC
ALLEGIANCE BENEFIT PLAN MANAGEMENT
EMPLOYEE BENEFIT MANAGEMENT CARE - SUPPLEMENTAL
ANTHEM BCBS-CENTRAL (FACETS) -IN, KY, OH - SUPPLEMENTAL
HEALTH DESIGN PLUS
ANTHEM NATIONAL BCBS OF OHIO - SUPPLEMENTAL
ANTHEM NATIONAL BCBS OF KENTUCKY - SUPPLEMENTAL
ANTHEM NATIONAL BCBS OF INDIANA - SUPPLEMENTAL
ANTHEM BCBS OF ME - SUPPLEMENTAL
ANTHEM BCBS OF NH - SUPPLEMENTAL
ANTHEM BCBS OF CT - SUPPLEMENTAL
ANTHEM BCBS OF VIRGINIA - SUPPLEMENTAL
ODS HEALTH PLANS, INC. - SUPPLEMENTAL
ARKANSAS BCBS - SUPPLEMENTAL
ARKANSAS BCBS (HEALTH ADVANTAGE) - SUPPLEMENTAL
NATIONWIDE HEALTH PLANS - SUPPLEMENTAL
PITTMAN & ASSOCIATES, INC. - SUPPLEMENTAL
HEALTH ALLIANCE MEDICAL PLANS - SUPPLEMENTAL
GRAPHIC COMMUNICATIONS NAT'L
ANTHEM BCBS OF NEVADA
ANTHEM BCBS OF COLORADO
BLUE CROSS OF CALIFORNIA - SUPPLEMENTAL
UNICARE LIFE & HEALTH INSURANCE COMPANY - SUPPLEMENTAL
HEALTHNET, INC-- CA -SUPPLEMENTAL
INSURANCE PROGRAMMERS INC.
RESERVE NATIONAL INSURANCE CO
BC OF IDAHO - SUPPLEMENTAL
BC OF IDAHO - SUPPLEMENTAL
ALLIED BENEFIT SYSTEMS, INC - SUPPLEMENTAL
ALLIED BENEFIT SYSTEMS, INC - SUPPLEMENTAL
NGS AMERICAN - SUPPLEMENTAL
HIGHMARK WEST VIRGINIA
HIGHMARK WEST VIRGINIA
UMR
PENNSYLVANIA EMPLOYEE BENEFIT TRUST FUND (PEBTF) - SUPPLEMENTAL
PENNSYLVANIA EMPLOYEE BENEFIT TRUST FUND (PEBTF) - SUPPLEMENTAL
PREMERA BLUE CROSS - SUPPLEMENTAL
POMCO, INC. - SUPPLEMENTAL

Updated: 03/31/2016

Identification Number(s)
00119
00122
00123
00124
00127
00128
00130
00131
00134
00136
00139
00140
00141
00148
00150
00151
00153
00154
00156
00157
00160
00166
00168
00170
00171
00173
00180
00182
00184
00185
00188
00188
00189
00190
00191
00192
00208
00208
00209
00210

Customer Contact
Laron Gaines
Rebecca Garcia

Contact Number
(313) 664-7123
(602) 864-4818

Customer Service
Customer Service
Customer Service
Customer Service
Lora Tincher
Customer Service
Customer Service
Lora Tincher
Lora Tincher
Lora Tincher
Part A only
EDI Department
Mia Moore
Dee McKee
Customer Service
Andy Glankler
Cindy Cargo
Teresa Bauer
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Customer Service
Amy Cook
Reta Weaver
Customer Service
Customer Service
Outside IL
IL Resident
Customer Service
Customer Service
Customer Service
Customer Service
Rest of U.S.
In Pennsylvania
Customer Service
Vivie Prichard

(406) 721-2222
(800) 993-3262
(866) 649-2037
(800) 549-9114
(502) 310-9374
(800) 880-2583
(317) 287-5000
(502) 310-9374
(502) 310-9374
(502) 310-9374
(800) 451-0361
(800) 852-5195
(501) 502-1686
(501) 212-8520
(877) 234-2727
(901) 473-3344
(217) 383-8208
(412) 201-2242
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(800) 641-7761
(203) 269-7741
(800) 654-9106
(866) 482-2253
(866) 482-2253
(800) 288-2078
(312) 906-8080
(800) 521-1555
(800) 543-7822
(800) 543-7822
(800) 826-9781
(800) 522-7279
(717) 565-7410
(800) 722-1471
(800) 830-2528

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
BCBS OF MASS
HEALTHSMART
BCBS OF VERMONT - SUPPLEMENTAL
OXFORD HEALTH - SUPPLEMENTAL
UNITED HEALTH CARE- COSMOS - SUPPLEMENTAL
C & R CONSULTING - SUPPLEMENTAL
CORESOURCE, INC. - SUPPLEMENTAL
CORESOURCE, INC. - SUPPLEMENTAL
CORESOURCE, INC. - SUPPLEMENTAL
BCBS OF KANSAS CITY
BCBS OF RHODE ISLAND
UNITED HEALTHCARE (SUPPLEMENTAL)
MERITAIN HEALTH, INC.
ASURIS
REGENCE BLUESHIELD OF UTAH
REGENCE BLUESHIELD
REGENCE BCBS OF OREGON
REGENCE BLUESHIELD OF IDAHO
CLAIMSNET.COM, INC. - SUPPLEMENTAL
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF ILLINOIS - SUPPLEMENTAL
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF NEW MEXICO - SUPPLEMENTAL
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF TEXAS- SUPPLEMENTAL
KIDNEY DISEASE PROGRAM OF MARYLAND - SUPPLEMENTAL
AMALGAMATED LIFE/ALICARE - SUPPLEMENTAL
HUMANA, INC. - SUPPLEMENTAL
JP FARLEY
COMPREHENSIVE BENEFITS CONSULTANTS (A.K.A. "FEDERATED ALLIED RETIREE ASSOCIATION")SUPPLEMENTAL
UCARE MINNESOTA - SUPPLEMENTAL
UCARE MINNESOTA - SUPPLEMENTAL
C & O EMPLOYEE HOSPITAL - SUPPLEMENTAL
PIPE FITTERS WELFARE FUND
CONNECTICUT GENERAL LIFE INSURANCE CO. (CIGNA)
PLUMBER LOCAL 130 UA
NATIONAL ELEVATOR INDUSTRY HEALTH BE
BCBS OF NORTH CAROLINA
ANTHEM BCBS OF VIRGINIA - SUPPLEMENTAL
THE LOOMIS COMPANY
BCBS OF WYOMING -(PART A)
WEB TPA
SECURITY HEALTH PLAN OF WI, INC.

Updated: 03/31/2016

Identification Number(s)
00212
00214
00217
00220
00224
00226
00229
00229
00229
00232
00236
00237
00240
00246
00249
00250
00251
00252
00253
00254
00255
00256
00259
00267
00268
00280
00288
00292
00292
00295
00299
00300
00304
00305
00306
00308
00310
00312
00313
00314

Customer Contact
Customer Service

Contact Number
(800) 258-2226

Chantal Parent
Customer Service
Stewart McGehee
C&R Customer
One Beacon Ins Grp
Crompton Corp
All others
Kathy Currey
Customer Service
Stewart McGehee
Customer Service
Rebecca Thorn
Rebecca Thorn
Rebecca Thorn
Rebecca Thorn
Rebecca Thorn
Customer Service
Customer Service
Customer Service
Customer Service
Carol Manning
Customer Service
Customer Service
Amanda Smolka

(802) 371-3611
(888) 201-4133
(336) 540-7563
(212) 819-0792
(866) 889-7286
(866) 318-7173
(800) 223-3943
(816) 395-3877
(800) 267-0439
(336) 540-7563
(800) 548-2041
(503) 375-4341
(503) 375-4341
(503) 375-4341
(503) 375-4341
(503) 375-4344
(817) 878-3300
(888) 762-2189
(888) 762-2189
(888) 762-2189
(410) 767-5004
(212) 539-5111
(866) 427-7478
(440) 250-4316

Lorraine Piazza
Provider Customer Service
Member Assistance
Anna Brooks

(631) 249-0500
(888) 531-1493
(877) 523-1515
(540) 862-5728

Customer Service

(800) 244-6224

ESolutions Help Desk

Michael Bristoe

1(888)333-8594
(502) 727-7280

Amber Zowada
Lisa Smith
Ken Baur

(307) 432-2743
(469) 417-1854
(715) 221-9556

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF OK (OTHER A ONLY)
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF OK (OTHER B ONLY)
CAPITOL DISTRICT PHYSICIANS HEALTH PLAN
WEBTPA EMPLOYER SERVICES
RMSCO INC
TIC BAC LOCAL UNION 15 W.F.

Identification Number(s)
00317
00318
00321
00322
00323
00326

Customer Contact
Customer Service
Customer Service
Brian Freer
Lisa Smith
Jen Springler
Michelle Cockerham

Contact Number
(888) 762-2189
(888) 762-2189
(518) 641-3820
(469) 417-1854
(315) 448-9001
(913) 236-5490

TIC IBEW LOCAL 461 WELFARE FUND

TIC ELECTRICAL WORKERS FUND
BLUE CROSS OF NORTHEASTERN PA
BLUE CROSS OF NORTHEASTERN PA
BLUE CROSS OF NORTHEASTERN PA
BLUE CARE COOPERATIVE
PLUMBERS AND PIPEFITTERS WELFARE FUND
DANA NON UNION RETIREE VEBA TRUST
BLUE CROSS OF NORTHEASTERN PA
G.M.P. - EMPLOYERS RETIREE TRUST
MEDICA (PART B ONLY)
MEDICA (PART A ONLY)

00329
00332
00333
00334
00335
00341
00343
00352
00353
00354
00360
00361

Susan Esterhai
Jackie Neible
Cathy Stitzer
Cathy Stitzer
Cathy Stitzer
Cathy Stitzer
Nancy Winer
Lorraine Piazza
Cathy Stitzer
Amy Thomas
Stephanie Kelly
Stephanie Kelly

(866) 461-4239
(317) 923-4577
(570) 200-4540
(570) 200-4540
(570) 200-4540
(570) 200-4540
(314) 355-1000
(631) 249-0500
(570) 200-4540
(239) 936-6242
(952) 992-2582
(952) 992-2582

CONNECTICUT GENERAL LIFE INSURANCE CO.

BCBS OF MINNESOTA
BCBS OF MINNESOTA
BCBS OF MINNESOTA
BCBS OF MINNESOTA
BCBS OF MINNESOTA
AVMED HEALTH PLANS
PIPELINE INDUSTRY BENEFIT FUND
THE WILLIAM C. EARHART CO., INC
MID CENTRAL OPERATING ENGINEERS HEALTH & WELFARE FUND
SOUTHWEST LIFE & HEALTH INS. CO.
FIRSTCARE
WABASH MEMORIAL HOSPITAL ASSOC.
AMERICAN BENEFIT CORPORATION
TIC NECA IBEW LOCAL 364 HEALTH
RIGHT CHOICE BENEFIT ADMIN.
BCBS OF NEBRASKA
BCBS OF NEBRASKA
HP ADMINISTATIVE SERVICES, LLC
ADC 1 WELFARE FUND
BLUE SHIELD OF CALIFORNIA - SFEW

00364
00366
00367
00368
00369
00370
00371
00372
00374
00375
00377
00378
00379
00380
00386
00387
00388
00392
00402
00406
00407

Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Claims Supervisor
Pam Fleischman
Katricia Helton
Melinda Rodriguez
Melinda Rodriguez
Debby Kunze
Linda Sites
Medical Claims Department
Customer Service Right Choice
Customer Service Center
Customer Service Center
Jenny Ray
Yolanda Alzati
Lisa Schultz

(800) 244-6224
(800) 531-6686
(800) 531-6686
(800) 531-6686
(800) 531-6686
(800) 531-6686
(800) 882-8633
(918) 280-4800
(503) 331-8209
(812) 232-4384
(806) 784-4378
(806) 784-4378
(217) 429-5246
(304) 525-0331
(800) 228-0048
(800) 365-9036
(800) 991-7392
(800) 991-7392
(405) 416-1514
(630) 617-8630
(415) 263-3670

Updated: 03/31/2016

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
IE SCHAFFER & CO
C & R CONSULTING
ARKANSAS BCBS
COVENTRY NATIONAL ACCOUNTS
EMBLEMHEALTH SVC CO. LLC - VYTRA
EMBLEMHEALTH SVC COMPANY, LLC - HIP
M.C.D.C HEALTH FUND
PLUMBERS & PIPEFITTERS LOCAL 630
OE LOCAL 139 HBF
PIPE TRADES INDUSTRY H&W PLAN
HEALTHNET OF ARIZONA, INC.
C&R CONSULTING
BLUE SHIELD OF CALIFORNIA
SCPT HEALTH & WELFARE FUND
LIBERTY NATIONAL LIFE INSURANCE CO. - GMS
GUNDERSEN LUTHERAN HEALTH PLAN
SENTARA HEALTH PLANS INC.
INDIANA LABORERS WELFARE FUND
INDIANA LABORERS WELFARE FUND
AMERICAN BENEFIT CORPORATION
BCBS OF LOUISIANA
HEALTH CARE SERVICE CORP, BCBS
HEALTH CARE SERVICE CORP, BCBS
KAISER FOUNDATION HEALTH PLAN
INDEPENDENCE BLUE CROSS
OPERATING ENGINEERS H&W FUND
TIC-NECA IBEW LCL 150 FRINGE BF
FABIAN & BYRN LLC
DELTA HEALTH SERVICES, INC.
HARRINGTON HEALTH SERVICES, INC.
NECA FAMILY MEDICAL CARE PLAN
BLUE CROSS BLUE SHIELD OF GA KCSUP
BLUE CROSS BLUE SHIELD OF GA KCSUP
EIGHTH DISTRICT ELECTRICAL BENEF
MEDICAL ASSOC HEALTH PLAN INC
WEST MICH. PLUMBERS, FITTERS
NATIONAL BCBS GEORGIA
DESERET MUTUAL
Updated: 03/31/2016

Identification Number(s)
00411
00413
00417
00420
00422
00423
00425
00426
00427
00428
00429
00431
00433
00434
00435
00436
00438
00439
00440
00445
00455
00456
00457
00459
00460
00462
00463
00467
00470
00473
00474
00475
00476
00478
00479
00484
00485
00486

Customer Contact
Terri Trasatti

Contact Number
(609) 883-6688

Mia Moore
Customer Service
Robyn Callahan
Robyn Callahan
Sandra Belot
Amanda Ratcliff
Annette Kusick
Pam Lewis
Healthnet Provider Service

(501) 502-1686
(800) 937-6824
(631) 577-5091
(631) 577-5091
(262) 970-5790
(954) 266-6322
(262) 549-9190
(812) 877-2581
(800) 977-7522

Tammy Rutters
Marcus Chin
Customer Service Department
Ann Kiel
Todd Kelly
Melissa Wade
Melissa Wade
Linda Sites
Customer Service
Blue Cross Blue Shield
Blue Cross Blue Shield
Member Service
Sharelle Bond
Elisabeth Schaefer
Jan Smith
Talisha Douglas
Christine Dugger-Praet
Customer Service
Vicki Burrows
Lora Tincher
Lora Tincher
Mary Kemp
Laura Boge
Customer Service
Lora Tincher
Donna Mcreavy

(530) 351-6109
(213) 385-6161
(972) 529-5085
(608) 775-8070
(757) 552-7237
(812) 238-2551
(812) 238-2551
(304) 525-0331
(800) 392-4089
(888) 762-2189
(888) 762-2189
(800) 777-7902
(215) 241-9227
(626) 356-3560
(877) 478-4542
(973) 228-4200
(559) 228-4185
(800) 216-2166
(877) 937-9602
(502) 310-9374
(502) 310-9374
(801) 973-1001
(563) 556-8070
(219) 769-6944
(502) 310-9374
(801) 578-5621

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
REGENCE BLUE SHIELD
WISCONSIN PHYSICIANS SERVICE
WISCONSIN PHYSICIANS SERVICE
IAHFI LOCAL 17 WELFARE FUND
HEALTHLINK HMO, INC
INDEPENDENCE BLUE CROSS
PEHP
HEALTH CARE SERVICE CORPORATION
HEALTH CARE SERVICE CORPORATION
WELLMARK BCBS OF SD
WELLMARK BCBS OF IA
MIDWEST OPERATING ENGINEERS HEALTH
NEW YORK ISG
NEVADA ISG
MAINE ISG
WISSONSIN ISG
KENTUCKY ISG
VIRGINIA ISG
NEW HAMPSHIRE ISG
MISSOURI ISG
OHIO ISG
CALIFORNIA ISG
COLORADO ISG
CONNECTICUT ISG
INDIANA ISG
CONNECTICUT WGS
INDIANA WGS
KENTUCKY WGS
MISSOURI WGS
NEW YORK WGS
OHIO WGS
VIRGINIA WGS
WISCONSIN WGS
INDEPENDENCE BLUE CROSS
INDEPENDENCE BLUE CROSS
BCBS of NORTH Carolina
AFTRA HEALTH FUND
BCBS of MINNESOTA
BCBS of MINNESOTA
WESTERN & SOUTHERN FINANCIAL GROUP
MERCER HEALTH & BENEFITS ADM. LLD

Updated: 03/31/2016

Identification Number(s)
00489
00493
00494
00495
00498
00500
00501
00502
00503
00506
00507
00508
00509
00510
00511
00512
00513
00514
00515
00516
00517
00518
00519
00520
00521
00522
00523
00524
00526
00528
00529
00530
00531
00532
00533
00535
00537
00544
00545
00554
00571

Customer Contact
Rebecca Thorn
Kit Lee
Kit Lee
William Mangin
Karen Gotsch
Sharelle Bond
Josie Hall
Blue Cross/Blue Shield
Blue Cross/Blue Shield
Customer/Provider Services
Customer/Provider Services
Barbara Glembin
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Sharelle Bond
Sharelle Bond
Pam Stephenson
Karen Ortolani
Customer Service
Customer Service
John Kaising
Dee Green

Contact Number
(503) 375-4341
(608) 226-3369
(608) 226-3369
(708) 468-8000
(314) 925-6166
(215) 241-9227
(801) 366-7519
(888) 762-2189
(888) 762-2189
(800) 524-9242
(800) 524-9242
(708) 579-6603
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(215) 241-9227
(215) 241-9227
(919) 765-4379
(800) 562-4690
(800) 531-6686
(800) 531-6686
(513) 357-4007
(515) 365-6374

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
MONUMENTAL LIFE INSURANCE CO.
AARP/UNITED HEALTH CARE (DOING BUSINESS AS UNITED HEALTH GROUP) MEDIGAP
WELLMARK BCBS OF SD
WELLMARK BCBS OF IA
MONUMENTAL LIFE INSURANCE CO. (FORMERLY UNDER AEGON) MEDIGAP
HORIZON BCBS OF NJ - MEDIGAP
BCBS OF SC
HIGHMARK, INC. - MEDIGAP PAT B & DMERC
HIGHMARK, INC. - MEDIGAP PART A ONLY
GROUP HEALTH, INC. (GHI) PPO - MEDIGAP
GROUP HEALTH, INC. (GHI) PPO - MEDIGAP
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF ILLINOIS - MEDIGAP
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF ILLINOIS - MEDIGAP
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF NEW MEXICO - MEDIGAP
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF NEW MEXICO - MEDIGAP
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF TEXAS- MEDIGAP
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF TEXAS- MEDIGAP
LIBERTY NATIONAL LIFE INSURANCE CO. (AFFILIATED WITH TORCHMARK)
LIBERTY NATIONAL LIFE INSURANCE CO. (AFFILIATED WITH TORCHMARK)
GLOBAL LIFE & ACCIDENT INSURANCE CO. (AFFILIATED WITH TORCHMARK)
AMERICAN INCOME LIFE INSURANCE CO. (AFFILIATED WITH TORCHMARK)
UNITED AMERICAN INSURANCE COMPANY (TORCHMARK) - MEDIGAP
FIRST UNITED AMERICAN LIFE INS. CO.
EQUITABLE LIFE & CASUALITY INS. CO.
BLUE CROSS AND BLUE OF MISSISSIPPI - MEDIGAP
BLUE CROSS OF NORTHEASTERN PA - MEDIGAP (PART A ONLY)
BLUE CROSS OF NORTHEASTERN PA - MEDIGAP (PART A ONLY)
TRIPLE S, INC. - MEDIGAP
BCBS OF WYOMING - MEDIGAP (PART A, B, DMERC)
BCBS OF NORTH DAKOTA
BCBS OF TENNESSEE - MEDIGAP
UNITED COMMERCIAL TRAVELERS - MEDIGAP
STANDARD LIFE ACCIDENT INSURANCE COMPANY (SLA) - MEDIGAP
SLA/AMERICAN NATIONAL LIFE INSURANCE CO. (ANICO) OF TEXAS - MEDIGAP
LOYALAM/UNITEDTEACH/GREATAMLIFE
GUARANTEE TRUST LIFE INSURANCE COMPANY - MEDIGAP (DMERC IN ALL STATES AND PART-B IN
ALL STATES EXCEPT MN AND WI)
EMPIRE BCBS - MEDIGAP
BLUE CROSS AND BLUE SHIELD OF MINNESOTA - MEDIGAP
BLUE CROSS AND BLUE SHIELD OF MINNESOTA - MEDIGAP
BLUE CROSS AND BLUE SHIELD OF MINNESOTA - MEDIGAP

Updated: 03/31/2016

Identification Number(s)
30000
30002
30003
30004
30006
30013
30016
30017
30018
30019
30020
30023
30024
30025
30026
30027
30028
30029
30030
30032
30033
30034
30035
30036
30039
30040
30041
30042
30045
30046
30047
30048
30051
30052
30054
30055
30056
30057
30058
30059

Customer Contact
Jennifer Havens
Customer Service
Customer/Provider Services
Provider Services
Jennifer Havens
Customer Service
Judith Murray
Customer Service
Customer Service
Geraldine Holmes
Geraldine Holmes
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Laura Sarle
Customer Service
Cathy Stitzer
Cathy Stitzer
Jeannette Irizarry Velez
Amber Zowada
Gina Bercherl
Venessa Marsh
Jose Viri-Dunahue
Jill Davis
Jill Davis
Customer Service
Mark Pytel

Contact Number
(610) 648-4990
(800) 523-5800
(800) 524-9242
(800) 524-9242
(610) 648-4990
(800) 624-1110
(803) 264-3889
(800) 345-3806
(800) 345-3806
(315) 434-2437
(315) 434-2437
(888) 762-2189
(888) 762-2189
(888) 762-2189
(888) 762-2189
(888) 762-2189
(888) 762-2189
(972) 529-5085
(972) 529-5085
(972) 529-5085
(972) 529-5085
(972) 529-5085
(972) 529-5085
(801) 579-3464
(800) 257-5825
(570) 200-4540
(570) 200-4540
(787) 749-4949
(307) 432-2743
(701) 277-2081
(423) 535-4930
(614) 487-9680
(281) 538-4890
(281) 538-4890
(866) 459-4272
(847) 904-5375

Lora Tincher
MN only
non-MN
DMERC only

(502) 310-9374
(800) 531-6686
(800) 531-6686
(800) 531-6686

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
MEDICAL MUTUAL OF OHIO - MEDIGAP
KANSAS BCBS - MEDIGAP
PROVIDENCE HEALTH PLAN
KPS HEALTH PLANS- MEDIGAP (PART B ONLY)
BANKERS LIFE AD CASUALITY
CONSECO SERVICES, LLC - MEDIGAP
ANTHEM BCBS NORTHEAST REGION
CONSECO, LLC/ COLONIAL PENN -MEDIGAP
SANDFORD HEALTH PLAN OF MINNESOTA - MEDIGAP
SANFORD HEALTH PLAN
HEALTH ALLIANCE MEDICAL PLANS OF URBANA, IL - MEDIGAP
CONTINENTAL LIFE INS. CO OF BRENTWOOD, TN - MEDIGAP
AMERICAN CONTINENTAL INSURANCE
PHYSICIANS MUTUAL INSURANCE COMPANY - MEDIGAP
DEAN HEALTH PLAN, INC. - MEDIGAP
CAREFIRST OF MD (PART A ONLY) - MEDIGAP
PARAMOUNT HEALTH PLANS - MEDIGAP
UPMC FOR LIFE MEDICARE SELECT - MEDIGAP
BLUE SHIELD OF CALIFORNIA - MEDIGAP
CAPITAL BLUE CROSS
BLUE CROSS BLUE SHIELD OF WNY
BLUE CROSS BLUE SHIELD OF WNY
MUTUAL OF OMAHA INSURANCE COMP
MUTUAL OF OMAHA INSURANCE COMP
BLUE CROSS AND BLUE SHIELD OF DELAWARE - SUPPLEMENTAL
EVERENCE ASSN A FRATERNAL
BCBS OF ARIZONA - MEDIGAP
SIERRA HEALTH & LIFE - MEDIGAP
BCBS OF NORTH DAKOTA
ANTHEM BCBS-CENTRAL (FACETS) - IN, KY, OH - MEDIGAP
GUARANTEE TRUST LIFE INSURANCE COMPANY - MEDIGAP (PART-B IN MN AND WI ONLY)
ANTHEM BCBS OF VIRGINIA - MEDIGAP
ANTHEM BCBS OF VIRGINIA - MEDIGAP
ANTHEM BCBS NORTHEAST REGION
ODS HEALTH PLANS, INC. - MEDIGAP
ARKANSAS BCBS - MEDIGAP
INDEPENDENCE BLUE CROSS - MEDIGAP
CENTRAL UNITED LIFE INSURANCE COMPANY - MADIGAN
AFLAC OF CO - MEDIGAP
AFLAC OF NY - MEDIGAP

Updated: 03/31/2016

Identification Number(s)
30060
30062
30063
30064
30065
30066
30067
30068
30069
30070
30071
30073
30074
30075
30076
30077
30078
30080
30083
30087
30088
30089
30090
30091
30093
30094
30095
30096
30097
30098
30103
30104
30105
30107
30108
30109
30110
30111
30113
30114

Customer Contact
Sue Robinson
Customer Service
Customer Service
Teresa Hiagh-Braget
Customer Service
Customer Service
Lora Tincher
Customer Service
Tami Haberer
Tami Haberer
Cindy Cargo
Katrina Smithson
Katrina Smithson
Alan Schoening
Murielle Sago
Provider Services
Donya Hensley
Robert Burtner
Tammy Rutters
Nancy Herman
Melissa Deboth
Melissa Deboth
Customer Service
Customer Service
Customer Service
Customer Service
Rebecca Garcia
Gina Bercherl
Lora Tincher
Mark Pytel
Lora Tincher
Lora Tincher
Lora Tincher
EDI Department
Mia Moore
Sharelle Bond
Customer Service
Customer Service
Customer Service

Contact Number
(216) 687-6108
(800) 432-3990
(800) 603-2340
(360) 478-2635
(800) 621-3724
(800) 621-3724
(502) 310-9374
(800) 523-4000
(605) 328-6860
(605) 328-6860
(217) 383-8208
(800) 264-4000
(800) 264-4000
(402) 930-2785
(608) 827-4432
(800) 842-5975
(419) 887-2437
(412) 454-7889
(530) 351-6109
(717) 541-6274
(716) 887-8443
(716) 887-8443
(800) 775-1000
(800) 775-1000
(302) 429-0260
(574) 533-9511 ext. 380
(602) 864-4018
(701) 277-2081
(502) 310-9374
(847) 904-5375
(502) 310-9374
(502) 310-9374
(502) 310-9374
(503) 228-6554
(501) 502-1686
(215) 241-9227
(800) 669-9030
(800) 992-3522
(800) 992-3522

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
HIGHMARK WEST VIRGINIA
HIGHMARK WEST VIRGINIA
UNIFIED LIFE INS. CO. - MEDIGAP
ANTHEM BCBS OF NEVADA - MEDIGAP
ANTHEM BCBS OF COLORADO
BLUE CROSS OF CALIFORNIA - MEDIGAP
UNIFCARE LIFE & HEALTH INSURANCE COMPANY - MEDIGAP
HEALTHPLUS OF MICHIGAN - MEDIGAP
RESERVE NATIONAL INSURANCE CO
AMERICAN INSURANCE ADMINISTRATORS - MEDIGAP
BANKERS FIDELITY LIFE INS. CO. - MEDIGAP
BC OF IDAHO - MEDIGAP
BC OF IDAHO - MEDIGAP
NORTH AMERICAN INSURANCE
PEKIN LIFE INS. CO. - MEDIGAP
STATE FARM AUTOMOBILE INSURANCE COMPANY - MEDIGAP
THRIVENT FINANCIAL - MEDIGAP
THRIVENT FINANCIAL - MEDIGAP
BCBS OF MASS
BCBS OF VERMONT - MEDIGAP
BCBS OF KANSAS CITY
AMERICAN REPUBLIC INSURANCE COMPANY - MEDIGAP
WORLD INSURANCE
CENTRAL STATES HEALTH & LIFE CO. OF OMAHA - MEDIGAP
BCBS OF RHODE ISLAND
MARSH AFFINITY GROUP SERVICES - MEDIGAP
ASURIS
REGENCE BLUESHIELD OF UTAH
REGENCE BLUESHIELD
REGENCE BLUESHIELD OF UTAH
BCBS OF FLORIDA - MEDIGAP (FEP)
BCBS OF FLORIDA - MEDIGAP (SUPPLEMENTAL)
AMERI HEALTH ADMINISTRATOR- MEDIGAP
COMMUNITYCARE LIFE & HEALTH - MEDIGAP
AMERICAN REPUBLIC INSURANCE COMPANY - MEDIGAP
REGENCE BCBS OF OREGON
BCBS OF WISCONSIN
BCBS OF WYOMING -(PART A)
NATIONWIDE MUTUAL INS CO
AMERICAN REPUBLIC INSURANCE COMPANY - MEDIGAP

Updated: 03/31/2016

Identification Number(s)
30117
30124
30129
30131
30135
30136
30137
30138
30149
30151
30152
30153
30154
30155
30156
30159
30166
30167
30168
30169
30171
30176
30180
30181
30184
30185
30187
30188
30189
30190
30192
30193
30203
30205
30208
30209
30220
30224
30225
30227

Customer Contact
Customer Service
Customer Service
Jana Shrum
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Venus Pope
Reta Weaver
Bob Fabbi

Contact Number
(800) 543-7822
(800) 543-7822
(913) 871-7312
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(810) 230-2018
(800) 654-9106
(727) 726-0726

Julie Tauber
Customer Service
Customer Service
Rebecca Freeman
Rebecca Freeman
Debra Wilson
Chantal Parent
Kathy Currey
Customer Service
Customer Service
Melissa Matthys
Anne Brunson

(800) 627-4282
(800) 322-0160
(866) 855-1212
(920) 628-2329
(920) 628-2329
(617) 246-7665
(802) 371-3611
(816) 395-3877
(800) 247-2190
(800) 786-5443
(281) 368-7131
(800) 267-0439

Rebecca Thorn
Rebecca Thorn
Rebecca Thorn
Rebecca Thorn
Customer Service
Customer Service
Robert Johnston
Roxanne King
Customer Service
Rebecca Thorn
Lora Tincher
Amber Zowada
Tom Litton
Customer Service

(503) 375-4341
(503) 375-4341
(503) 375-4341
(503) 375-4341
(800) 352-2583
(800) 352-2583
(215) 793-3042
(918) 594-5295
(800) 247-2190
(503) 375-4341
(502) 310-9374
(307) 432-2743
(614) 677-3788
(800) 247-2190

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
AMERICAN REPUBLIC INSURANCE COMPANY - MEDIGAP
ROCKY MOUNTAIN HEALTH PLAN
OLD SURETY LIFE INSURANCE CO.
HEALTH ALLIANCE PLAN
UNITED AMERICAN INSURANCE CO-GMS
MEDICO WI PART A
MEDICO WI PART B
MEDICO PART A
MEDICO PART B
BCBS OF MINNESOTA
BCBS OF MINNESOTA
BCBS OF MINNESOTA
BCBS OF MINNESOTA
BCBS OF MINNESOTA
ACTUARIAL MANAGEMENT RESOURCES
FIRST COMMUNITY HEALTH PLAN, INC
HEALTH CARE SERVICE BCBS-STD
HCSC,BCBS NON-STD
BCBS OF NEBRASKA
BCBS OF NEBRASKA
BLUE CROSS BLUE SHIELD OF NC
HEARTLAND NATIONAL LIFE INS., CO.
INSURANCE ADMINISTRATIVE SOLUTIONS, LLC - MEDIGAP
INSURANCE ADMINISTRATIVE SOLUTIONS, LLC - MEDIGAP
INSURANCE ADMINISTRATIVE SOLUTIONS, LLC - MEDIGAP
INSURANCE ADMINISTRATIVE SOLUTIONS, LLC - MEDIGAP
INSURANCE ADMINISTRATIVE SOLUTIONS, LLC - MEDIGAP
INSURANCE ADMINISTRATIVE SOLUTIONS, LLC - MEDIGAP
INSURANCE ADMINISTRATIVE SOLUTIONS, LLC - MEDIGAP
INSURANCE ADMINISTRATIVE SOLUTIONS, LLC - MEDIGAP
INSURANCE ADMINISTRATIVE SOLUTIONS, LLC - MEDIGAP
INSURANCE ADMINISTRATIVE SOLUTIONS, LLC - MEDIGAP
INSURANCE ADMINISTRATIVE SOLUTIONS, LLC - MEDIGAP
INSURANCE ADMINISTRATIVE SOLUTIONS, LLC - MEDIGAP

Identification Number(s)
30228
30229
30231
30232
30233
30236
30237
30238
30239
30242
30243
30244
30245
30246
30248
30250
30253
30254
30255
30256
30257
30275
30276
30276
30276
30276
30276
30276
30276
30276
30276
30276
30276
30276

INSURANCE ADMINISTRATIVE SOLUTIONS, LLC - MEDIGAP

INSURANCE ADMINISTRATIVE SOLUTIONS, LLC - MEDIGAP

Updated: 03/31/2016

Customer Contact
Customer Service
Kris Malean

Contact Number
(800) 247-2190
(970) 248-5056

Laron Gaines
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Donna Coleman-Fulk
Regina Ratley
Customer Service
Customer Service
Customer Service Center
Customer Service Center
Pam Stephenson
Laura Sarle
See Designated Group
Puritan Life
Gerber Life Insurance
Idealife Insurance Company
Lincoln Heritage Life
PrincipalLifeInsurance
Royal Neighbors of America
Shenandoah Life Insurance
State Mutual Insurance
Sterling Investors Life
KSKJ Life
Central States Indemnity Co. of Omaha

(313) 664-7123
(972) 529-5085
(800) 247-2190
(800) 247-2190
(800) 247-2190
(800) 247-2190
(800) 531-6686
(800) 531-6686
(800) 531-6686
(800) 531-6686
(800) 531-6686
(336) 714-2910
(256) 532-2786
(888) 762-2189
(888) 762-2189
(800) 991-7392
(800) 991-7392
(919) 765-4379
(801) 579-3464
(866) 398-9305
(800) 838-0080
(866) 398-9310
(888) 586-8810
(800) 447-4701
(877) 815-8877
(866) 322-2856
(877) 872-5500
(877) 604-5240
(866) 671-5755
(855) 664-5517

30276

UNIFIED LIFE INSURANCE COMPANY

(877) 807-2143

30276

AMERICO FINANCIAL LIFE AND

ANNUITY INSURANCE

(877) 212-2346

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
AMERICAN ENTERPRISE - WIA
AMERICAN ENTERPRISE - WIB
AMERICAN ENTERPRISE - A
AMERICAN ENTERPRISE - B
ASSURED LIFE ASSOCIATION
TUFTS INSURANCE COMPANY
ARKANSAS BCBS
GERBER LIFE INS. CO.
STANDARD LIFE AND ACCIDENT INS.
UNITED NATIONAL LIFE INSURANCE COMPANY
UNITED NATIONAL LIFE INSURANCE COMPANY
BLUE CROSS OF CALIFORNIA
BLUE CROSS OF COLORADO
BLUE CROSS OF GEORGIA
BLUE CROSS OF NEVADA
BLUE CROSS OF WISCONSIN
NEW ERA LIFE INS. CO. - MEDIGAP
BLUE SHIELD OF CALIFORNIA
PRIORITY HEALTH
CT PINPE TRADES HEALTH
GOVERNMENT PERSONNEL MUTUAL LIFE
COLUMBIAN MUTUAL LIFE INSURANCE
AULTCARE
HARVARD PILGRIM HEALTH CARE, INC.
BLUE CROSS BLUE SHIELD OF WNY
GEISINGER HP/GOLD MEDICARE
COLONIAL PENN LIFE INSURANCE CO.
BCBS OF ALABAMA
HEALTH FIRST INSURANCE
CAPITAL DISTRICT PHYSICIANS
HARVARD PILGRIM HEALTH CARE, INC.
PBA INC.
BLUE CROSS BLUE SHIELD OF GA
UNIVERSAL FIDELITY LIFE INS. CO.
OLYMPIC HEALTH MANAGEMENT SYSTEM
GUARANTEE TRUST LIFE INS. CO.
GUARANTEE TRUST LIFE INS. CO.
GUARANTEE TRUST LIFE INS. CO.
NATIONAL GUARDIAN LIFE INS. CO.
NATIONAL GUARDIAN LIFE INS. CO.
NATIONAL GUARDIAN LIFE INS. CO.
MEMBERS HEALTH INSURANCE CO.
Updated: 03/31/2016

Identification Number(s)
30277
30278
30279
30280
30281
30283
30285
30289
30291
30292
30293
30294
30295
30296
30297
30298
30299
30302
30305
30307
30308
30309
30313
30317
30319
30323
30326
30327
30328
30329
30330
30331
30332
30333
30335
30337
30338
30339
30340
30341
30342
30343

Customer Contact
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
EDI Operations
Angela Winston
Customer Service
Jill Davis
Mark Pytel
Mark Pytel
Annie Pressley-Mitchell
Annie Pressley-Mitchell
Annie Pressley-Mitchell
Annie Pressley-Mitchell
Annie Pressley-Mitchell
Isabel Gonzalez
Tammy Rutters
Carol Nowak
Stephanie Doyle
Customer Service
Customer Service
Ty Pruette
Michael Comerford
Melissa Deboth
Joanne Minium
Customer Service
Customer Service
Angie Vazquez
Kerri Petersen
Michael Comerford
Kathy Carpenter
Lora Tincher
Becky Morris
Wendi Western
Mark Pytel
Mark Pytel
Mark Pytel
Mark Pytel
Mark Pytel
Mark Pytel
Geri Cayce

Contact Number
(888) 755-3064
(888) 755-3064
(888) 755-3064
(888) 755-3064
(877) 223-4244
(617) 972-9400
(501) 210-2074
(877) 656-5424
(281) 538-4890
(847) 904-5375
(847) 904-5375
(404) 848-2185
(404) 848-2185
(404) 848-2185
(404) 848-2185
(404) 848-2185
(281) 368-7108
(530) 351-6109
(616) 575-4914
(856) 910-9099
(866) 865-7631
(866) 703-7223
(330) 363-4234
(617) 509-1411
(716) 887-8443
(570) 271-5555
(800) 621-3724
(205) 988-2200
(321) 434-4206
(518) 641-3820
(617) 509-1411
(630) 655-3755
(502) 310-9374
(800) 366-8354
(360) 392-9465
(847) 904-5375
(847) 904-5375
(847) 904-5375
(847) 904-5375
(847) 904-5375
(847) 904-5375
(931) 560-0041

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
LOYAL AMERICAN LIFE INSURANCE CO.
AVERA HEALTH PLANS, INC.
NCSCBF
HEALTH CARE SERVICE CORPORATION
HEALTH CARE SERVICE CORPORATION
SENTINEL SECURITY LIFE INS. CO
SECURE ADMINISTRATIVE SOLUTIONS
LOYAL CHRISTIAN BENEFIT ASSOC.
INDIVIDUAL ASSURANCE COMPANY
HOMETOWN HEALTH SENIOR CARE PLUS
GREEK CATHOLIC UNION
WELLMARK BCBS OF SD MEDIGAP
WELLMARK BCBS OF SD MEDIGAP
TN RURAL HEALTH IMPROVEMENT ASS.
QUALCHOICE LIFE HEALTH INSURANCE
BCBS of Minnesota
BCBS of Minnesota
SISCO
MERCER HEALTH & BENEFITS ADM LLC

Updated: 03/31/2016

Identification Number(s)
30344
30352
30353
30354
30355
30357
30358
30359
30360
30362
30363
30364
30365
30367
30368
30369
30370
30371
30374

Customer Contact
Customer Service
Karen Mikuska
Lori Eslinger
Customer Service
Customer Service
Linda Jonides
Linda Jonides
Laura Sarle
Laura Sarle
Ryan Hopkins
Laura Sarle
Wellmark BCBS
Wellmark BCBS
Geri Cayce
Ashley Matthews
Customer Service
Customer Service
Kara Kessler
Dee Green

Contact Number
(866) 459-4272
(605) 322-4502
(715) 835-3174
(866) 459-4272
(888) 762-2189
(801) 478-4041
(801) 478-4041
(801) 579-3464
(801) 579-3464
(775) 982-3239
(801) 579-3464
(800) 587-9242
(800) 587-9242
(931) 560-3097
(501) 228-7111
(800) 531-6686
(800) 531-6686
(563) 587-5204
(515) 365-6374

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
BANKERS LIFE AND CASUALTY
GLOBE LIFE & ACCIDENTAL INS CO
AMERICAN INCOME LIFE INSURANCE
FIRST UNITED AMERICAN LIFE INS
UNITED AMERICAN INSURANCE CO
LIBERTY NATIONAL LIFE INSURANCE
GOLDEN RULE INSURANCE CO
ACTUARIAL MANAGEMENT RESOURCES
SHELTER LIFE INSURANCE COMPANY
TRICARE FOR LIFE (ADMINISTERED BY WISCONSIN PHYSICIAN SERVICES) - TRICARE
HORIZON BCBS OF NJ - OTHER/FEHBP
BCBS OF MICHIGAN - FEP
BCBS OF ALABAMA - OTHER
BCBS OF SC
HIGHMARK, INC. - OTHER LIMITED B & DMERC
HIGHMARK, INC. - OTHER PART A ONLY
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF ILLINOIS - OTHER
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF NEW MEXICO - OTHER
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF TEXAS- OTHER
CBA INC.
NATIONAL ASSOCIATION OF LETTER CARRIERS HEALTH PLAN - OTHER
BLUE CROSS AND BLUE OF MISSISSIPPI - OTHER/FEHBP
BLUE CROSS OF NORTHEASTERN PA - OTHER (LIMITED PART A ONLY)
BLUE CROSS OF NORTHEASTERN PA - OTHER
BLUE CROSS OF NORTHEASTERN PA - OTHER
BLUE CROSS OF NORTHEASTERN PA - OTHER (LIMITED PART A ONLY)
TRIPLE S, INC. - OTHER
BCBS OF ALABAMA - OTHER
BCBS OF NORTH DAKOTA (OTHER)
HAWAII MEDICAL SERVICES ASSOCIATION -OTHER
HAWAII MEDICAL SERVICES ASSOCIATION -OTHER
BCBS OF TENNESSEE - OTHER
HAWAII MEDICAL SERVICES ASSOCIATION -OTHER
BLUE CROSS AND BLUE SHIELD OF MINNESOTA - OTHER
KANSAS BCBS - OTHER/FEHBP
ADMINISTRATIVE SERVICES ONLY, INC. OTHER
KPS HEALTH PLANS - OTHER
ANTHEM BCBS FEP OF IN - OTHER

Updated: 03/31/2016

Identification Number(s)
55000
55001
55002
55003
55004
55005
55009
55010
55015
60000
80003
80004
80005
80006
80007
80008
80009
80011
80012
80013
80015
80016
80017
80018
80019
80020
80021
80022
80023
80024
80025
80026
80027
80029
80030
80031
80032
80033

Customer Contact
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
James Anderson
Donna Coleman-Fulk
Carla Lind
Customer Service
Customer Service
Customer Service
Customer Service
Cynthia Lagatore
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Carol Lea
Stephanie Smith
Customer Service
Carol Stitzer
Carol Stitzer
Carol Stitzer
Carol Stitzer
Jeannette Irizarry Velez
Customer Service
Shelly Stalpes
Debbie Ruiz
Amy Jampel
Venessa Marsh
George Yamada
MN only
Customer Service
Laura Lombardo
Teresa Hiagh-Braget
Lora Tincher

Contact Number
(800) 621-3724
(972) 529-5085
(972) 529-5085
(972) 529-5085
(972) 529-5085
(972) 529-5085
(317) 715-7200
(336) 714-2910
(573) 214-4128
(866) 773-0404
(800) 624-1110
(800) 482-3600
(205) 988-2200
(803) 264-3326
(800) 345-3806
(800) 345-3806
(888) 762-2189
(888) 762-2189
(888) 762-2189
(802) 846-8038
(703) 729-4677 ext. 8235
(800) 932-7724
(570) 200-4540
(570) 200-4540
(570) 200-4540
(570) 200-4540
(787) 749-4949
(205) 988-2200
(701) 282-1476
(808) 952-7636
(808) 948-6597
(423) 535-4930
(808) 948-5534
(800) 531-6686
(800) 432-3990
(516) 394-9434
(360) 478-2635
(502) 310-9374

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
ANTHEM BCBS FEP OF CO - OTHER
ANTHEM BCBS FEP OF KY - OTHER
ANTHEM BCBS FEP OF CT - OTHER
ANTHEM BCBS FEP OF OH - OTHER
ANTHEM BCBS FEP OF NV - OTHER
ANTHEM BCBS FEP OF VA - OTHER
ANTHEM BCBS FEP OF ME - OTHER
ANTHEM BCBS FEP OF NH - OTHER
STIRLING & STIRLING - OTHER
BCBS OF LOUISIANA - OTHER
AULTCARE - OTHER
BLUE SHIELD OF CALIFORNIA - OTHER
BLUE CROSS BLUE SHIELD OF NC
CAPITAL BLUE CROSS- OTHER
BLUE CROSS BLUE SHIELD OF WNY
BLUE CROSS BLUE SHIELD OF WNY
GOVERNMENT EMPLOYEES HOSPITAL ASSOCIATION (GEHA) - OTHER
EMPIRE BCBS- OTHER/FEHBP
EMPIRE BCBS- OTHER/FEHBP
BLUE CROSS AND BLUE SHIELD OF DELAWARE - OTHER
SPECIAL AGENTS MUTUAL BENEFIT ASSOC. (SAMBA) - OTHER
BCBS OF ARIZONA - OTHER
BCBS OF WYOMING - OTHER (LIMITED TO PART B)
BCBS OF NORTH DAKOTA
ARKANSAS BCBS FEP - OTHER/FEHBP
USAABLE ADMINISTRATORS - OTHER
BLUE ADVANTAGE ADMIN OF ARKANSAS - OTHER
USAABLE LIFE - OTHER
NORTHWEST ADMINISTRATORS - OTHER
BC OF IDAHO- OTHER
BC OF IDAHO- OTHER
APWU HEALTH PLAN - OTHER
HIGHMARK WEST VIRGINIA
HIGHMARK WEST VIRGINIA
HIGHMARK WEST VIRGINIA
HIGHMARK WEST VIRGINIA
CHCS SERVICES, INC. - OTHER, FEHBP (A ONLY)
CHCS SERVICES, INC. - OTHER, FEHBP
CHCS SERVICES, INC. - OTHER, FEHBP (A ONLY)
CHCS SERVICES, INC. - OTHER, FEHBP
BCBS OF MASS
KLAIS & COMPANY - OTHER
NATIONAL CAPITAL ADMINISTRATIVE SERVICES (NCAS) - OTHER
Updated: 03/31/2016

Identification Number(s)
80034
80035
80036
80037
80038
80039
80040
80041
80042
80043
80044
80045
80046
80047
80048
80050
80054
80055
80056
80057
80058
80059
80061
80062
80065
80066
80067
80068
80070
80073
80074
80075
80076
80076
80077
80077
80078
80079
80080
80081
80086
80089
80090

Customer Contact
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Monica Strong
Customer Service
Ty Pruett
Tammy Rutters
Pam Stephenson
Nancy Herman
Melissa Deboth
Melissa Deboth
Daryl Evans
Lora Tincher
Annie Pressley-Mitchell
Customer Service
Customer Service
Zoila Buruato
Amber Zowada
Shelly Stalpes
Shawana Coleman
Martha Campbell
Martha Campbell
Martha Campbell
Danielle Brenner
Laurie Warren
Laurie Warren
Loretta Demby
Member Customer Service
Provider Customer Service
Member Customer Service
Provider Customer Service
Insurance Service Service
Insurance Service Service
Insurance Service Service
Insurance Service Service
Customer Service
Customer Service
Customer Service

Contact Number
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(203) 647-0630
(800) 392-4089
(330) 363-4234
(530) 351-6109
(919) 765-4379
(717) 541-6274
(716) 887-8443
(716) 887-8443
(816) 257-5000
(502) 310-9374
(404) 848-2185
(302) 429-0260
(800) 638-6589
(602) 864-4814
(307) 432-2743
(701) 282-1476
(501) 378-2506
(501) 378-2958
(501) 378-2958
(501) 378-2958
(206) 726-3230
(208) 331-7641
(208) 331-7641
(410) 424-1544
(888) 809-9121
(800) 543-7822
(888) 809-9121
(800) 543-7822
(850) 435-8000
(850) 435-8000
(850) 435-8000
(850) 435-8000
(800) 433-7766
(800) 331-1096
(800) 873-5781

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS
HEALTH SCOPE BENEFITS - OTHER
BCBS OF KANSAS CITY
BENESYS - OTHER
BENESYS - OTHER
BCBS OF RHODE ISLAND
PRIORITY HEALTH - OTHER
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF ILLINOIS - OTHER
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF NEW MEXICO - OTHER
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF TEXAS- OTHER
COVENTRY PERSONAL CARE INSURANCE OF ILLINOIS, INC.
COMMUNITY FIRST HEALTH PLANS - OTHER
EXCELLUS HEALTH PLAN (INCLUDING BCBS OF UTICA, SYRACUSE, & ROCHESTER) - OTHER
NORTHWEST ADMINISTRATORS, INC.
ROCKY MOUNTAIN
COVENTRY GROUP HEALTH PLAN, INC. - OTHER
COVENTRY HEALTH CARE (FIRST HEALTH GROUP)
COVENTRY HEALTH CARE OF NEBRASKA - OTHER
COVENTRY HEALTH CARE OF IOWA - OTHER
COVENTRY HEALTH CARE (FIRST HEALTH GROUP)
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF OK (FEP A ONLY)
HEALTH CARE SERVICES CORPORATION (HCSC) BCBS OF OK (FEP B ONLY)
BCBS OF WYOMING
COVENTRY HEALTH CARE (HEALTHAMERICA OF PENNSYLVANIA, INC.)
COVENTRY HEALTH CARE OF LOUISIANA
COVENTRY HEALTH CARE OF GEORGIA, INC.
COVENTRY HEALTH CARE (CARELINK HEALTH PLAN, INC.)
Updated: 03/31/2016

Identification Number(s)
80091
80091
80091
80091
80091
80091
80091
80091
80091
80091
80091
80091
80091
80091
80091
80091
80091
80091
80092
80093
80094
80096
80098
80102
80103
80104
80105
80110
80113
80114
80116
80118
80119
80120
80121
80122
80123
80124
80128
80129
80131
80132
80133

Customer Contact
WC Bradley
Neff Company
ENPRO
CAC
Auto Systems
Phillips
KRAFT
Emerson Svc Ctr
CNAF
Southwest Electric
American Greetings Svc Ctr
Whirlpool Svc Ctr
Ball Corporation
Alcoa Svc Ctr
Adams
Loews/Lorillard
Goodrich
See Designated Group
Kathy Currey
Customer Service
Customer Service
Customer Service
Carol Nowark
Customer Service
Customer Service
Customer Service
Customer Service
Rose Allen
Jill Kohler
Danielle Brenner
Kris Malean
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service

Contact Number
(877) 883-5352
(877) 624-1325
(877) 616-7421
(877) 240-0139
(877) 240-0136
(877) 226-2051
(800) 972-3025
(800) 913-9982
(800) 892-7182
(800) 851-5644
(800) 827-7026
(800) 660-6212
(800) 493-9552
(800) 426-3070
(800) 314-5366
(800) 262-9247
(800) 262-2066
(816) 395-3877
(800) 572-2525
(800) 572-2525
(800) 267-0439
(616) 575-4914
(888) 762-2189
(888) 762-2189
(888) 762-2189
(302) 203-6570
(210) 358-6192
(315) 272-1210
(206) 726-3230
(970) 248-5056
(302) 203-6570
(302) 203-6570
(302) 203-6570
(302) 203-6570
(302) 203-6570
(888) 762-2189
(888) 762-2189
(888) 762-2189
(302) 203-6570
(302) 203-6570
(302) 203-6570
(302) 203-6570

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
COVENTRY HEALTH CARE (SOUTHERN HEALTH SERVICES, INC.)
COVENTRY HEALTH CARE OF DELAWARE, INC.
COVENTRY HEALTH CARE (WELLPATH SELECT, INC.)
C.L. FRATES AND COMPANY
ANTHEM BCBS FEP OF CA - OTHER
HEALTH SMART BENEFIT SOLUTIONS
BCBS MO FEP
BCBS WI FEP
BCBS OF MINNESOTA
BCBS OF MINNESOTA
BCBS OF MINNESOTA
BCBS OF MINNESOTA
BCBS OF MINNESOTA
BCBS OF MINNESOTA
BCBS OF MINNESOTA
BCBS OF MINNESOTA
BCBS OF MINNESOTA
PRAIRIE STATES ENTERPRISES, INC.
INNOVATIVE HEALTHWARE SERVICES
BENEFITS MANAGEMENT GROUP, INC.
LIPMAN INSURANCE ADMINISTRATORS, INC.
CDS GROUP HEALTH
GROUP AND PENSION ADMINISTRATORS, INC.
WELFARE AND PENSION ADMIN SERVICE
MAGNACARE ADMIN SERVICES
SHASTA ADMINISTRATIVE SERVICES
COVENTRY HEALTH CARE (FEDRAL PLAN)
PREMERA BS FEP/EASTERN WA
PREMERA BC FEP/WASHINGTON
PREMERA BCBS FEP/ALASKA
PREMERA BCBS FEP/ALASKA
GROUP ADMINSITRATORS, LTD.
AMERIBEN
KAISER FOUNDATION HEALTH PLAN
BENESYS, INC
BCBS OF NEBRASKA
INDEPENDENCE BLUE CROSS
BCBS OF NEBRASKA
KEMPTON COMPANY
BENESYS, INC
GILSBAR, INC.
GILSBAR, INC.
Updated: 03/31/2016

Identification Number(s)
80134
80135
80136
80138
80140
80142
80145
80146
80147
80148
80149
80150
80151
80152
80153
80154
80155
80156
80158
80160
80161
80162
80163
80165
80166
80181
80187
80189
80190
80191
80192
80193
80194
80195
80196
80197
80198
80199
80202
80204
80209
80210

Customer Contact
Customer Service
Customer Service
Customer Service
Rick Franklin
Annie Pressley-Mitchell
John Campbell
Lora Tincher
Lora Tincher
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Kathie Horness
Jessica Picarde
Lisa Frasco
Sylvia Sanchez
Customer Service Department
Customer Service
Heidi Campbell
Customer Service Center
Sheryl Petrakis-Wood
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Kim Ufkes
Carrie Hatch
Phyllis Tennant

Contact Number
(302) 203-6570
(302) 203-6570
(302) 203-6570
(405) 290-5744
(404) 848-2185
(214) 574-3582
(502) 310-9374
(502) 310-9374
(800) 531-6686
(800) 531-6686
(800) 531-6686
(800) 531-6686
(800) 531-6686
(800) 531-6686
(800) 531-6686
(800) 531-6686
(800) 531-6686
(920) 451-7020
(410) 349-3222
(630) 230-3911
(510) 796-4676
(800) 455-4236
(972) 238-7900
(206) 695-0985
(888) 352-6465
(541) 504-2772
(800) 410-7778
(800) 722-1471
(800) 722-1471
(800) 722-1471
(800) 722-1471
(847) 519-1880
(208) 947-9229
(440) 268-2741

Customer Service Center

Sharelle Bond
Customer Service Center
Dwight Berry

(800) 223-5584
(215) 241-2000
(800) 223-5584
(405) 556-5125

Customer Contact Center

Customer Contact Center

(888) 472-4352
(888) 472-4352

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
WESTERN GROWERS ASSURANCE TRUST
PINNACLE CLAIMS MANAGEMENT, INC.
CHAMPVA-VA HEALTH ADMIN CTR
MERITAIN HEALTH
INFORMED, LLC
ZENITH ADMINISTRATORS, U054
COVENTRY- CHC OF FLORIDA
ZENITH ADMINISTRATORS, K630
ZENITH ADMINISTRATORS, B0131
ZENITH ADMINISTRATORS, A0033
ZENITH ADMINISTRATORS, A0001
ZENITH ADMINISTRATORS, U614
ZENITH ADMINISTRATORS, U320
COOPERATIVE BENEFIT ADMIN/NRECA
ZENITH AMERICAN SOLUTIONS, N011
ZENITH AMERICAN SOLUTIONS, N026
ZENITH AMERICAN SOLUTIONS, N589
ZENITH AMERICAN SOLUTIONS, N115
ALLIED BENEFIT SYSTEMS, INC.
AMA INSURANCE AGENCY, INC.
HEALTHCOMP
ZENITH AMERICAN SOLUTIONS, K639
ZENITH AMERICAN SOLUTIONS, K297
ZENITH AMERICAN SOLUTIONS, H0185
CAREFIRST ADMINISTRATORS
BCBS GA FEP
ZENITH AMERICAN SOLUTIONS, N351
HEALTH PLANS INC.
SCOTT & WHITE HEALTH PLAN
CHCS SERVICES INC
CHCS SERVICES INC
CHCS SERVICES INC
CHCS SERVICES INC
CHCS SERVICES INC
CHCS SERVICES INC
CHCS SERVICES INC
HEALTH CARE SERVICE CORPORATION
HEALTH CARE SERVICE CORPORATION
LINE CONTRUCTION BENEFIT FUND
ASSOCIATED THIRD PARTY ADMIN
APEX HEALTH SOLUTIONS
EMPLOYEE BENEFIT MGMT SERVICES
Updated: 03/31/2016

Identification Number(s)
80212
80213
80214
80216
80217
80219
80220
80223
80224
80226
80228
80230
80231
80232
80233
80235
80238
80239
80240
80241
80242
80244
80245
80246
80248
80250
80251
80252
80253
80254
80255
80256
80257
80258
80259
80260
80261
80262
80264
80267
80268
80269

Customer Contact
Lara Hassan
Lara Hassan
HAC Customer Service Center
Customer Service
George govatos Jr.
Tracy Weston
Customer Service
Irene Newman
Kathleen Linzmeier
Rosie Bailey
Rosie Bailey
Lisa Pasby
Lisa Pasby
Mikki McGuire
Trini Caoili
Trini Caoili
Trini Caoili
Trini Caoili
Terry Jones
Customer Service
Charles Johnson
Karen May
Karen May
Kathy Leonard
Fred Ellerbe
Annie Pressley-Mitchell
Becky Placek
Chris Parr
Noel Rivas
Insurance Service Center
Insurance Service Center
Insurance Service Center
Insurance Service Center
Insurance Service Center
Insurance Service Center
Insurance Service Center
Blue Cross Blue Shield
Blue Cross Blue Shield
Customer Service
Marilyn Haynes
Betsy Gossard
Lisa Rel

Contact Number
(949) 885-2309
(949) 885-2309
(800) 733-8387
(800) 925-2272
(410) 972-2028
(206) 352-9751
(866) 847-8235
(317) 248-3272
(608) 846-1742
(651) 256-1786
(651) 256-1786
(509) 532-2246
(509) 532-2247
(402) 483-9268
(415) 536-8290
(415) 536-8290
(415) 536-8290
(415) 536-8290
(312) 906-8080
(800) 458-5736
(559) 499-2450
(414) 476-3742
(414) 476-3742
(314) 209-3110
(877) 889-2478
(404) 848-2185
(415) 536-8268
(508) 475-6104
(254) 298-3233
(850) 435-8000
(850) 435-8000
(850) 435-8000
(850) 435-8000
(850) 435-8000
(850) 435-8000
(850) 435-8000
(888) 762-2189
(888) 762-2189
(800) 323-7268
(925) 288-4017
(330) 996-8400
(406) 245-3575

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
HEALTH PLAN SYSTEMS SERVICES COR
STONER AND ASSOCIATES
QUALCHOICE QCA HEALTH PLAN INC

Updated: 03/31/2016

Identification Number(s)
80270
80272
80273

Customer Contact
Satish Kurian
Linda Sites
Ashley Matthews

Contact Number
(732) 362-2011
(304) 525-0331
(501) 228-7111

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
ANTHEM CENTRAL - FACETS
ANTHEM CENTRAL - FACETS
ANTHEM BCBS VIRGINIA
ANTHEM BCBS VIRGINIA
ANTHEM BCBS VIRGINIA
ANTHEM BCBS VIRGINIA
EMPIRE BLUE CROSS BLUE SHIELD I
EMPIRE BLUE CROSS BLUE SHIELD II
EMPIRE BLUE CROSS BLUE SHIELD II
EMPIRE BLUE CROSS BLUE SHIELD II
EMPIRE BLUE CROSS BLUE SHIELD I
EMPIRE BLUE CROSS BLUE SHIELD I
EMPIRE BLUE CROSS BLUE SHIELD I
ANTHEM BCBS CONNECTICUT
ANTHEM BCBS NEW HAMPSHIRE
ANTHEM BCBS MAINE
ANTHEM BCBS MAINE
ANTHEM BCBS NEW HAMPSHIRE
ANTHEM BCBS CONNECTICUT
ANTHEM BCBS NORTHEAST REGION
ANTHEM BCBS NORTHEAST - PART B
ANTHEM NATIONAL BCBS OHIO CTRL
ANTHEM NATIONAL BCBS KY CONTROL
ANTHEM NATIONAL BCBS IN CONTROL
BLUE CROSS OF CALIFORNIA
UNICARE LIFE & HEALTH INSURANCE
BLUE CROSS OF CALIFORNIA
UNICARE LIFE & HEALTH INSURANCE
BLUE CROSS BLUE SHIELD OF WI
ANTHEM BCBS OF NEVADA
ANTHEM BCBS OF COLORADO
ANTHEM BCBS OF NEVADA
ANTHEM BCBS OF COLORADO
ANTHEM FEP INDIANA
ANTHEM FEP COLORADO
ANTHEM FEP KENTUCKY
ANTHEM FEP CONNECTICUT
ANTHEM FEP OHIO
ANTHEM FEP NEVADA
ANTHEM FEP VIRGINIA

Updated: 03/31/2016

Identification Number(s)
88005
88007
88009
88010
88011
88012
88013
88014
88015
88016
88017
88018
88019
88020
88021
88022
88023
88024
88025
88026
88027
88033
88036
88038
88039
88040
88041
88042
88043
88044
88045
88046
88047
88048
88049
88050
88051
88052
88053
88054

Customer Contact
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher

Contact Number
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
ANTHEM FEP MAINE
ANTHEM FEP NEW HAMPSHIRE
ANTHEM FEP CALIFORNIA
BCBS MO FEP
BCBS WI FEP
NALC HEALTH BENEFIT PLAN
BCBS OF ALABAMA
BCBS OF ALABAMA
BCBS OF ALABAMA
MUTUAL OF OMAHA INSURANCE COMP
BLUE SHIELD OF CALIFORNIA
BLUE SHIELD OF CALIFORNIA
BLUE SHIELD OF CALIFORNIA
AR FEDERAL EMPLOYEE PROGRAM
USAABLE ADMINISTRATORS
BLUE ADVANTAGE ADMIN OF ARKANSAS
USABLE LIFE
ARKANSAS BCBS
ARKANSAS BCBS
PHYSICIANS MUTUAL INS.CO
CORESOURCE, INC
NATIONAL CAPITAL ADMIN SVCS
OLD SURETY LIFE INSURANCE COMP
THRIVENT FINANCIAL FOR LUTHERANS
THRIVENT FINANCIAL FOR LUTHERANS
ASURIS
REGENCE BCBS OF OREGON
REGENCE BLUESHIELD OF IDAHO
REGENCE BLUESHIELD OF UTAH
REGENCE BLUESHIELD
NORTH AMERICAN INSURANCE COMPANY
PEKIN LIFE INSURANCE COMPANY
PIPE FITTERS WELFARE FUND
HEALTH ADVANTAGE
MEDICO WI PART A
MEDICO WI PART B
MEDICO WI PART A
MEDICO WI PART B
AMERICAN ENTERPRISE - WIA
AMERICAN ENTERPRISE - WIB
AMERICAN ENTERPRISE - A
AMERICAN ENTERPRISE - B
Updated: 03/31/2016

Identification Number(s)
88055
88057
88058
88059
88060
88061
88062
88063
88064
88067
88068
88069
88070
88073
88074
88075
88076
88078
88079
88081
88084
88085
88086
88087
88088
88092
88098
88105
88110
88117
88121
88122
88123
88124
88125
88126
88127
88128
88129
88130
88131
88132

Customer Contact
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
David Hardesty
Customer Service
Customer Service
Customer Service
Customer Service
Tammy Rutters
Tammy Rutters
Tammy Rutters
Shawana Coleman
Martha Campbell
Martha Campbell
Martha Campbell
Angela Winston
Angela Winston
Alan Schoening
Kurt Henry
Fred Ellerbe

Contact Number
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(703) 729-4677
(205) 988-2200
(205) 988-2200
(205) 988-2200
(800) 775-1000
(530) 351-6109
(530) 351-6109
(530) 351-6109
(501) 378-2506
(501) 378-2958
(501) 378-2958
(501) 378-2958
(501) 210-2074
(501) 210-2074
(402) 633-2785
(800) 354-8233
(800) 888-6227

Rebecca Freeman
Rebecca Freeman
Rebecca Thorn
Rebecca Thorn
Rebecca Thorn
Rebecca Thorn
Rebecca Thorn
Julie Tauber
Customer Service

(920) 628-2329
(920) 628-2329
(503) 375-4341
(503) 375-4341
(503) 375-4341
(503) 375-4341
(503) 375-4341
(800) 627-4282
(800) 322-0160

Dee McKee
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service

(501) 212-8520
(800) 247-2190
(800) 247-2190
(800) 247-2190
(800) 247-2190
(888) 755-3064
(888) 755-3064
(888) 755-3064
(888) 755-3064

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
AMERICAN REPUBLIC INSURANCE CO
AMERICAN REPUBLIC INSURANCE CO
AMERICAN REPUBLIC INSURANCE CO
AMERICAN REPUBLIC INSURANCE CO
WORLD INSURANCE COMPANY
INSURANCE ADMIN SOLUTIONS, LLC
INSURANCE ADMIN SOLUTIONS, LLC
INSURANCE ADMIN SOLUTIONS, LLC
INSURANCE ADMIN SOLUTIONS, LLC
INSURANCE ADMIN SOLUTIONS, LLC
INSURANCE ADMIN SOLUTIONS, LLC
INSURANCE ADMIN SOLUTIONS, LLC
INSURANCE ADMIN SOLUTIONS, LLC
INSURANCE ADMIN SOLUTIONS, LLC
INSURANCE ADMIN SOLUTIONS, LLC
BCBS OF TENNESSEE-SUPPLEMENTAL
BCBS OF TENNESSEE-MEDIGAP
BCBS OF TENNESSEE-OTHER
CONSECO SERVICES, LLC
G.M.P. - EMPLOYERS RETIREE TRUST
PA EMPLOYEES BENEFIT TRUST FUND
WOODMEN OF THE WORLD
LOYAL AMERICAN LIFE INSURANCE CO.
CONSECO SERVICES - COLONIAL PENN
NGS AMERICAN, INC
BANKERS LIFE AND CASUALTY
STATE FARM AUTOMOBILE INS. CO.
BLUE CROSS OF CALIFORNIA
BLUE CROSS OF COLORADO
BLUE CROSS OF GEORGIA
BLUE CROSS OF NEVADA
BLUE CROSS OF WISCONSIN
GILSBAR, INC.
GILSBAR, INC.
COLONIAL PENN LIFE INSURANCE CO.
BCBS OF ALABAMA
BLUE CROSS/SHIELD OF GA KC SUP
BLUE CROSS/SHIELD OF GA
BLUE CROSS BLUE SHIELD OF GA KCSUP
UNIVERSAL FIDELITY LIFE INS. CO.

Updated: 03/31/2016

Identification Number(s)
88133
88134
88135
88136
88137
88150
88150
88150
88150
88150
88150
88150
88150
88150
88150
88160
88162
88163
88174
88209
88210
88219
88221
88224
88225
88227
88228
88229
88230
88231
88232
88233
88240
88241
88248
88249
88250
88251
88252
88253

Customer Contact
Customer Service
Customer Service
Customer Service
Customer Service
World Insurance Customer Service
Lincoln Heritage Life
State Mutual Insurance
Royal Neighbors of America
Sterling Investors Life
Idealife Insurance Company
Puritan Life
Shenandoah Life Insurance
Gerber Life Insurance
PrincipalLifeInsurance
KSKJ Life
Customer Service
Customer Service
Customer Service
Customer Service
Amy Thomas
Dave Walton
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Customer Service
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Customer Contact Center
Customer Contact Center
Customer Service
Customer Service
Lora Tincher
Lora Tincher
Lora Tincher
Becky Morris

Contact Number
(800) 247-2190
(800) 247-2190
(800) 247-2190
(800) 247-2190
(800) 786-5443
(888) 586-8810
(877) 872-5500
(877) 815-8877
(877) 604-5240
(866) 398-9310
(866) 398-9305
(866) 322-2856
(800) 838-0080
(800) 447-4701
(866) 671-5755
(800) 553-8158
(800) 553-8158
(800) 553-8158
(800) 621-3724
(239) 936-6242
(717) 565-7410
(877) 223-4244
(866) 459-4272
(800) 523-4000
(800) 521-1555
(800) 621-3724
(866) 855-1212
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(888) 472-4352
(888) 472-4352
(800) 621-3724
(205) 988-2200
(502) 310-9374
(502) 310-9374
(502) 310-9374
(800) 366-5354

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
Trading Partner
CARE FIRST ADMINISTRATORS
NATIONAL BCBS GEORGIA
BCBS OF FEP
LOYAL AMERICAN LIFE INSURANCE CO.
UNITEDHEALTH GROUP
ASSOCIATED THIRD PARTY ADMIN
NEW YORK ISG
NEVADA ISG
MAINE ISG
WISCONSIN ISG
KENTUCKY ISG
VIRGINIA ISG
NEW HAMPSHIRE ISG
MISSOURI ISG
OHIO ISG
CALIFORNIA ISG
COLORADO ISG
CONNECTICUT ISG
INDIANA ISG
CONNECTICUT WGS
INDIANA WGS
KENTUCKY WGS
MISSOURI WGS
NEW YORK WGS
OHIO WGS
VIRGINIS WGS
WISCONSIN WGS
EMPLOYEE BENEFIT MGMT SERVICES
QUALCHOICE QCA HEALTH PLAN INC
QUALCHOICE LIFE HEALTH INSURANCE
UPREHS
CONSOLIDATED ASSOC. OF RR EMP.
SCOTT & WHITE HEALTH PLAN
C&O EMPLOYEES HOSPITAL ASSOC.
WABASH MEMORIAL HOSPITAL ASSOC.
HEALTHSMART BENEFITS SOLUTIONS
MEDICAL ASSOC HEALTH PLAN INC.
ROCKY MOUNTAIN HEALTH MAINTENANCE

Updated: 03/31/2016

Identification Number(s)
88254
88255
88256
88258
88260
88261
88262
88263
88264
88265
88266
88267
88268
88269
88270
88271
88272
88273
88274
88275
88276
88277
88279
88281
88282
88283
88284
88285
88289
88290
89001
89002
89003
89004
89005
89006
89009
89010

Customer Contact
Fred Ellerbe
Lora Tincher
Lora Tincher
Customer Service
Customer Service
Marilyn Haynes
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lora Tincher
Lisa Rel
Ashley Matthews
Ashley Matthews
Deann Benson
Kathy Hampton
Brenda Lee
Anna Brooks
Debby Kunze
Kathy Hansen
Laura Boge
Marci O'Gara

Contact Number
(877) 889-2478
(502) 310-9374
(502) 310-9374
(866) 459-4272
(800) 523-5800
(925) 288-4017
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(502) 310-9374
(406) 245-3575
(501) 228-7111
(501) 228-7111
(801) 595-4309
(254) 773-1330
(254) 298-3391
(540) 862-5728
(217) 429-5246
(214) 574-3509
(563) 556-8070
(970) 248-5137

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
State Medicaid Agencies
Trading Partner
MARYLAND DEPT OF HEALTH & MENTAL HYGIENE - MEDICAID
MASSACHUSETTS STATE MEDICAID
MINNESOTA DEPT. OF HUMAN SERVICES - MEDICAID
OREGON DEPT OF HUMAN SVCS
OREGON DEPT OF HUMAN SVCS
NEW JERSEY MEDICAID
VA DEPARTMENT OF MEDICAL ASSISTANCE SERVICES(MEDICAID)
ILLINOIS HEALTHCARE AND FAMILY SERVICES
RHODE ISLAND DEPARTMENT OF HUMAN SERVICES
ALABAMA MEDICAID AGENCY
NORTH DAKOTA DEPARTMENT OF HUMAN & MEDICAL SERVICES
DIVISION OF MEDICAID, STATE OF MISSISSIPPI
KANSAS DIRECTOR OF HEALTH POLICY AND FINANCE
FLORIDA MEDICAID, AGENCY FOR HEALTHCARE ADMINISTRATION
ARKANSAS MEDICAID PROGRAM
IDAHO DEPARTMENT OF HEALTH & WELFARE MEDICAID DIVISION
SOUTH DAKOTA MEDICAID
IOWA DEPARTMENT OF HUMAN SERVICES
STATE OF ALASKA MEDICAID PROGRAM
STATE OF CONNECTICUT, DEPT OF SOCIAL SERVICES
WV MMIS - UNISYS
OKLAHOMA HEALTH CARE AUTHORITY
UTAH DEPARTMENT OF HEALTH
DHHS, STATE OF NEW HAMPSHIRE
DHHS, STATE OF NEW HAMPSHIRE
DHHS, STATE OF NEW HAMPSHIRE
WISCONSIN MEDICAID- DIVISION OF HEALTH CARE FINANCING
MO MEDICAID
MO MEDICAID
MO MEDICAID
NEVADA-DHCFP
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
DELAWARE DEPARTMENT OF HEALTH & SOCIAL SERVICES
DELAWARE DEPARTMENT OF HEALTH & SOCIAL SERVICES
DELAWARE DEPARTMENT OF HEALTH & SOCIAL SERVICES
OHIO DEPARTMENT OF JOB AND FAMILY SERVICES
DEPARTMENT OF HEALTH AND HOSPITALS-LOUISIANA MEDICAID
INDIANA OFFICE OF MEDICAID POLICY - MEDICAID
VERMONT MEDICAID
COLORADO DEPT OF HEALTH CARE POLICY & FINANCING
COLORADO DEPT OF HEALTH CARE POLICY & FINANCING
Updated: 03/31/2016

Identification Number(s)
70000
70001
70002
70005
70005
70006
70008
70009
70010
70011
70012
70014
70015
70016
70017
70018
70019
70020
70021
70022
70024
70025
70026
70027
70027
70027
70028
70029
70029
70029
70030
70031
70032
70032
70032
70033
70034
70035
70036
70037
70037

Customer Contact
Janet Smith
Customer Service
Derik Newman
Client Services
Provider Services
Reeshemah Trower
Maryanne Paccione
Steve Bradley
Helen Vaughn
Keith Thompson
Michelle Adams
Chris Bryan
EDI Help Desk
Daniel Gray
Angelia Norris
Phil Howard
Lori Thompson
Provider Services
Linda Walsh
Sandi Ouellette
Ellen Charlebois
Holly Rictor
Purita Buck
Provider Relations (NH)
Provider Relations (outside)
Recipient Services
Katie Ploeser
Technical Issuse
Provider Billing
Recipient Services
Tammy Moffitt
Customer Service
Provider Relations (DE, MD)
Provider RelationsOutside
Customer Relations
Jo Steinert
Provider Relations
Customer Service
Provider Relations
Client Support (within)
Client Support (outside)

Contact Number
(410) 767-5377
(800) 841-2900
(651) 431-2287
(800) 273-0557
(800) 336-6016
(609) 631-6663
(804) 225-2866
(217) 785-2867
(401) 784-3879
(334) 242-5248
(701) 328-4046
(601) 206-2977
(800) 933-6593
(850) 298-7034
(501) 374-6609
(208) 373-1318
(605) 773-3495
(800) 338-7909
(907) 334-2441
(860) 424-5216
(304) 348-3276
(405) 522-7939
(801) 538-6477
(800) 428-8303
(603) 224-1747
(800) 852-3345 ext. 4344
(608) 221-4746
(573) 635-3559
(573) 751-2896
(800) 392-2161 or (573) 751-6527
(775) 684-3623
(866) 542-3015
(800) 999-3371
(302) 454-7154
(800) 372-2022
(614) 387-1212
(800) 473-2783
(800) 577-1278
(802) 879-4450
(303) 866-3513
(800) 221-3943

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
State Medicaid Agencies
Trading Partner
COLORADO DEPT OF HEALTH CARE POLICY & FINANCING
NEBRASKA HEALTH & HUMAN SERVICES - MEDICAID
GEORGIA DEPT OF HEALTH
NYS DEPARTMENT OF HEALTH
NORTH CAROLINA - DEPT OF HEALTH AND HUMAN SERVICES
NORTH CAROLINA - DEPT OF HEALTH AND HUMAN SERVICES
BUREAU TENN CARE
WYOMING - DEPT OF HEALTH
WASHINGTON DC MEDICAID
NEW MEXICO MEDICAL ASSISTANCE DIV HUMAN SERVICES DEPARTMENT
TEXAS HEALTH AND HUMAN SERVICES
CALIFORNIA - DEPT OF HEALTH SERVICES
STATE OF MONTANA - DEPT OF PUBLIC HEALTH & HUMAN SERVICES
STATE OF ARIZON MEDICAID (AHCCCS)
STATE OF HAWAII MEDICAID (DHS MED-QUEST DIV)
COMMONWEALTH OF KENTUCKY
WASHINGTON MEDICAID
MAINE DEPARTMENT OF HEALTH & HUMAN SERVICES OFFICE OF MAINECARE SERVICES
COMMONWEALTH OF KENTUCKY
OHANA HEALTH PLAN
STATE OF MICHIGAN - MDCH
KENTUCKY/WELLCARE
KENTUCKY/CONVENTRY
KENTUCKY/SPIRIT HEALTH PLAN
NEW JERSEY DEPT. OF HUMAN SERVICES
NEW JERSEY DEPT. OF HUMAN SERVICES
NEW JERSEY DEPT. OF HUMAN SERVICES
NEW JERSEY DEPT. OF HUMAN SERVICES
KENTUCKY/HUMANA
KENTUCKY/PHP
NEW JERSEY DEPT. OF HUMAN SERVICES
KENTUCKY/ANTHEM
EXE. OFFICE HUMAN SRVS RINHP
ARIZONA MEDICAID AHCCCS
NJ DEPT. OF HUMAN SERVICES
MOLINA HEALTHCARE OF OHIO
AETNA BETTER HEALTH OF OHIO
BUCKEYE COMMUNITY HEALTH PLAN
CARESOURCE
UNITED HEALTHCARE OF OHIO
CALIFORNIA DEPT. OF HEALTH CARE
WA STATE MEDICAID QUALITY PROJ
Updated: 03/31/2016

Identification Number(s)
70037
70038
70039
70040
70042
70042
70043
70045
70047
70048
70051
70052
70053
70054
70055
70058
70059
70067
70068
70071
70073
70074
70075
70076
70077
70078
70079
70080
70083
70084
70085
70086
70087
70088
70089
70091
70092
70093
70094
70095
70096
79000

Customer Contact
Provider Support
Nate Meyer
Cheryl Avery
CSC Call Center
Recipient Services
Provider Services
Steve Smith
Debbie Paiz
Finance Department
John Padilla
Customer Service
Customer Service
Gail Briese-Zimmer
Kyra Westlake
Customer Services
Carl Ishmael
Customer Service
Norman Curtis
Carl Ishmael
Jayme Pu'u
Provider/Beneficiary Hotline
Carl Ishmael
Carl Ishmael
Carl Ishmael
Reeshemah Trower
Reeshemah Trower
Reeshemah Trower
Reeshemah Trower
Carl Ishmael
Carl Ishmael
Reeshemah Trower
Carl Ishmael
Kijuana Wright
Reeshemah Trower
Holly Saelens
Kristen Brown
Nicole Slee
Alexis Johnson
Anjenette Fenske
Customer Service
Customer Service

Contact Number
(800) 237-0757
(402) 471-9123
(404) 657-3810
(800) 343-9000
(919) 855-4045
(800) 688-6696
(800) 523-2863
(307) 777-5378
(202) 698-2000
(505) 827-1340
(800) 925-9126
(800) 541-5555 opt 14 then 11
(406) 442-6093
(602) 417-4152
(808) 952-5570 or (800) 235-4378
(502) 564-5472
(800) 562-3022
(207) 629-4318
(502) 564-5472
(808) 675-7341
(800) 292-2550
(502) 564-5472
(502) 564-5472
(502) 564-5472
(609) 631-6663
(609) 631-6663
(609) 631-6663
(609) 631-6663
(502) 564-5472
(502) 564-5472
(609) 631-6663
(502) 564-5472
(602) 417-4353
(609) 631-6663
(855) 665-4623
(855) 364-0974
(855) 364-0974
(866) 246-4356
(877) 542-9236
(855) 322-4075
(800) 562-3022

List of Automatic Crossover Trading Partner (Insurers) In Production

Do Not Include Number Shown Below on Incoming Claims

Coordination of Benefits Agreement

National Crossover Process
Supplemental Payers and Insurers (Trading Partners)
State Medicaid Agencies
Trading Partner
WISCONSIN MEDICAID QUALITY PROJ
WISCONSIN MEDICAID QUALITY PROJ
OREGON HEALTH MCD QUALITY PROJ
IOWA MEDICAID QUALITY PROJ
CDHCPF MCD QUALITY PROJECT
ILLINOIS DEPT. OF HFS MQP
NYS DEPT. OF HEALTH MQP

Updated: 03/31/2016

Identification Number(s)
79002
79003
79004
79005
79009
79010
79012

Customer Contact
Katie Ploeser
Katie Ploeser
Chris Coon
Provider Services
Sandra Salus
Paul Stieber
Care Center

Contact Number
(608) 221-4746
(608) 221-4746
(503) 945-6915
(800) 338-7909
(303) 866-5346
(312) 814-6817
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