Payer 276 List

Payer ID Payer Name

61425 ACEC-Healthplan

CX052 AD-Medicaid (Atlantic Dental, Inc)(Mequon, WI)

CX052 ADI -Medicaid (Atlantic Dental, Inc)(Coral Gables, FL

80705 AH & L (Anthem Health & Life Ins of NJ)(Kennett, MO)

80705 ALTA Health & Life Ins. Co. (Kennett, MO)

93524 Advantage Dental Plan - Roseburg, OR

43168 Advantica Administrative Svcs (St. Louis, MO)

60054 Adventis Risk Management Inc

60054 Aetna

57604 Aetna (SRC)(Blue Bell, PA & Columbia, SC)

57604 Aetna Affordable Health Choices (SRC)(Columbia, SC)

50503 Altus Dental - Providence, RI

74223 American Administrative Group, Inc (AAG)(San Antonio, TX)

47009 Ameritas Life Insurance Corp. (Lincoln, NE)

80705 Anthem Health & Life Insurance Co of New Jersey/AH&L/ALTA Helath & Life

CX052 Atlantic Dental Inc-Medicaid (Coral Gables, FL)

74223 Benefit Planners, Inc )San Antonio, TX)

53589 Blue Cross of AZ (Phoenix, AZ)

47570 Blue Cross of Alaska & Washington (Anchorage, AK)

47171 Blue Cross of Kansas City (MO)

FX136 Blue Cross of MD (14111-14116, Lexington, KY)

CBMA1 Blue Cross of Massachusettes (North Quincy, MA)

22099 Blue Cross of New Jersey (Horizon) (Newark, NJ)

47570 Blue Cross of Washington & Alaska(Anchorage, AK)

47009 Businessmen Assurance (NE)

CX061 Canada Life Assurance Company(Atlanta, GA)

FX136 CareFirst (PO Box 14111 - 14116) (Lexington, KY))

61271 Christian Brothers Services (Colorado Springs, CO)

62308 Cigna

37237 Commenwealth Admin, LLC (Lexington, KY)

62308 Connecticut General (Bloomfield, CT)

62308 Continental Dental (Plantation, FL)

35182 Core Source (Po Box 2920, Clinton IA)

LX048 CoreSource (Mailed to IA)

35183 CoreSource (Po Box 279, SHeldon IA)

35183 CoreSource OH - mailed to OH

35182 CoreSource of PA MD IL (Lancaster, PA)(Clinton, IA)

CX049 Coventry (Po Box 7402, London KY)

07035 DeCare (PO Box 1348, Mpls., MN) Northwest Employees

07035 DeCare (Po Box 709, MPLS MN)

CDIAM Delta Dental IA - Dental Wellness Plan (Johnston, IA)

CDIAM Delta Dental IA - Government Programs (Johnston, IA)

94276 Delta Dental of Alabama ( Irving, TX)

94276 Delta Dental of Alaska (Irving, TX)

CDAR1 Delta Dental of Arkansas

DDCA3 Delta Dental of CA (Encounter, CAP)(Cerritos, CA)

77777 Delta Dental of California (PO Box 997330, Sacramento, CA)

CDCA1 Delta Dental of California(Tricare) - PO Box 537007-537009, Sacramento, CA

22189 Delta Dental of Connecticut (Parsipanny, NJ)

51022 Delta Dental of Delaware (Mailed to Mechanicsburg, PA)

94276 Delta Dental of Florida (Irving, TX)

94276 Delta Dental of Georgia (Alpharetta, GA)

10002 Delta Dental of HI (Honolulu, HI)

05030 Delta Dental of Illinois (Lisle, IL)

CDIA1 Delta Dental of Iowa (Ankeny, IA)

CDKS1 Delta Dental of Kansas(Whichita, KS)

Payer 276 List

Payer ID Payer Name

94276 Delta Dental of Louisiana(Irving, TX)

23166 Delta Dental of Maryland(Mechanicsburg, PA)

04614 Delta Dental of Massachusetts (Boston, MA, Milwaukee, WI)

CDMN1 Delta Dental of Minnesota(Minneapolis, MN)

94276 Delta Dental of Mississippi (Irving, TX)

94276 Delta Dental of Montana (Sacramento, CA)

CDNE1 Delta Dental of Nebraska(Minneapolis, MN)

94276 Delta Dental of Nevada (Irving TX)

22189 Delta Dental of New Jersey (Parsipanny, NJ)

85022 Delta Dental of New Mexico(Albuquerque, NM)

11198 Delta Dental of New York (Mechanicsburg, PA)

CDND1 Delta Dental of North Dakota(Bismark ND)

23166 Delta Dental of Pennsylvania(Mechanicsburg, PA)

05029 Delta Dental of Rhode Island (Providence, RI)

94276 Delta Dental of Texas(Irving TX)

94276 Delta Dental of Utah (Irving TX)

52147 Delta Dental of Washington DC (Mechanicsburg, PA)

91062 Delta Dental of Washington-State

31096 Delta Dental of West Virginia

39069 Delta Dental of Wisconsin Stevens Point, WI)

CDNE1 Delta NE (Po Box 9120, Farmington Hills)

CDMN1 Delta of MN ( Po Box 9120, Farmington Hills, MI)

CX036 Denex (Houston, TX & Rockville, MD)

CX049 Denex/SG (PO Box 2767, Houston, TX)

64246 Dental Guard Preferred (El Paso, TX, Spokane, WA)

81264 Dental Health Alliance (Shawnee Mission, KS)

43168 Dentemax (St. Louis, MO)

UTUDD Dentist Direct (Bountiful, UT)

62308 EQUICOR

47009 Employee Benefits Services (Lincoln, NE)

43168 Essex Dental Benefits (St Louis, MO)

72630 First Ameritas Life Ins Corp of New York (Lincoln, NE)

64246 First CommonWealth(Spokane, WA & Chicago, IL)

13317 First Reliance Standard (Lincoln, NE)

74223 Fiserv (Benefit Planners) (San Antonio, TX)

39026 Fiserv (Wausau, WI & Pueblo, CO)

95266 Fiserv - Harrington Benefit (Columbus, OH)

60054 Foreign Service Benefit(Washgington, WA)

57254 GEHA - All Plans except PO Box 4665 (Independence, MO)

44054 GEHA Only (PO Box 4665, Independence, MO)

63665 General American Life (Kennett, MO)

57254 Government Employees Health Assoc. (GEHA)(All Plans except PO Box 4665)

44054 Government Employees Hospital Assoc (GEHA) Only (PO Box 4665 Independence, MO)

80705 Great-West Life and Annuity Ins. Co. (Kennett, MO)

CX036 Group Dental Services(Houston, TX & Rockville, MD)

CX061 Guarantee Life Insurance

64246 Guardian Life Insurance Company of America (Spokane, WA, El Paso, TX)

95266 Harrington Benefit Services (Columbus, OH)

75196 Harrington Benefit Services (Westerville, OH)

10002 Hawaii Dental Service Assoc (Honululu(, HI)

62179 Health Choice (Medicaid) (Phoenix, Tempe, AZ)

47009 Health Plan Services (Lincoln, NE)

22099 Horizon (Blue Cross of New Jersey) (Indianapolis, IN)

22099 Horizon BCBS NJ ( Po box 1311, MPLS)

22099 Horizon NJ Health (PO Box 299, Milwaukee, WI)

64246 IBEW Welfare Trust Fund (Decatur, IL)

Payer 276 List

Payer ID Payer Name

61271 J.F. Molloy and Associates, Inc.(Colorado Spring, CO)

79480 JMS-MSA (Po Box 679, Farmington MI)

CX061 Jefferson Pilot (Omaha, NE)

CX073 Kaiser Permanente (PO Box 4360, Rockville, MD)

35182 LifeWell (Coresource)(Clinton, IA)

CX061 Lincoln National (Omaho, NE & Orlando, FL)

05030 Local 731 (Burr Ridge, IL)

94276 MHHNP (Po Box 742567, Houston TX)

64246 Managed Dental Guard(Woodland Hills, CA)

CKFL1 Medicaid of Florida

CKIL1 Medicaid of IL - Doral Dental of WI (Admin by Doral)

CKKY1 Medicaid of Kentucky (Mequon , WI)

CKMO1 Medicaid of Missouri (Jefferson City, MO)

CB833 Medical Mutual of Ohio (MMO)

65978 Metlife (El Paso, TX)

79480 Midwest Security of WI (Onalaska, WI)

23166 NAS (Nat'l Auto Sprinklers (Landover, MD)

23166 Nat'l Auto Sprinklers (NAS)(Landover, MD)

81264 Nippon Life Insurance Company of America

47570 North Star Administrators

80705 ONE Health Plan Inc of California

80705 ONE Health Plan Inc of Colorado

80705 ONE Health Plan Inc of Florida

80705 ONE Health Plan Inc of Georgia

80705 ONE Health Plan Inc of Idaho

80705 ONE Health Plan Inc of Indiana

80705 ONE Health Plan Inc of Iowa

80705 ONE Health Plan Inc of Kentucky

80705 ONE Health Plan Inc of Mississippi

80705 ONE Health Plan Inc of New Jersey

80705 ONE Health Plan Inc of New York

80705 ONE Health Plan Inc of North Carolina

80705 ONE Health Plan Inc of Oklahoma

80705 ONE Health Plan Inc of Texas

80705 ONE Health Plan Inc of The District of Columbia

80705 ONE Health Plan Inc of Vermont

80705 ONE Health Plan Inc of Virginia

80705 ONE Health Plan Inc of Washington

80705 ONE Health Plan Inc of Wisconsin

80705 ONE Health Plan Inc. of Alaska

80705 ONE Health Plan Inc. of Arizona

80705 One Health Plan Inc of Wyoming

47009 Paul Revere / Provident

47009 Physicians Mutual (Lincoln, NE)

47570 Premera Blue Cross (Seattle, WA)

61271 Principal (Coloradp Springs, CO& DesMoines, IA)

60054 Prudential

95266 R.E. Harrington Inc (Colombus, OH)

36088 Reliance Standard (PO Box 82510 Lincoln, NE)

CX030 Safeguard (Po Box 981987, El Paso, TX)

CX030 Safeguard PPO -(PO box 30930 Laguna Hills & Aliso Viejo, CA)

13411 Standard Ins Co. of New York (PO Box 82520, Lincoln, NE)

93024 Standard Insurance of Oregon (PO Box 82622 Lincoln, NE)

57254 State of TX Dental Plan - All Plans except PO Box 4665 (Independence, MO)

64246 Strategic Ourtsourcing Inc. (SOI) (Charolotte, NC)

47009 Sun Life Canada

Payer 276 List

Payer ID Payer Name

47009 Sun Life Financial

79480 TML (Austin, TX)

60054 TRW

79480 Texas Municipal League (TML) Austin, TX

65978 Travelers (El Paso, TX)

CDCA1 Tricare Retiree Dental-Delta Dental of CA - PO Box 537007-537009, Sacramento, CA

61425 Trustmark Insurance - Lake Forest, IL

62308 UFT Welfare Fund

74223 UICI - Administrators - State of Nevada (San Antonio, TX)

74223 UMR (PO Box 2838 Clinton, IA)

33108 UMR - Cincinnati (Cincinatti, OH)

37237 UMR - Lexington (Lexington, KY)

95266 UMR-Harrington Benefits (PO Box 30530,33,34,40, Salt Lake, UT

79480 UMR-Onalaska (Onalaska, WI)

74223 UMR-San Antonio (San Antonio, TX)

39026 UMR-Wausau (Salt Lake City, UT)

39026 UMR-Wausau (Wausau, WI & Pueblo, Co)

75196 UMR-Westerville (Westerville, OH)

47009 Unifi Companies (Lincoln, NE)

33108 United Medical Resources (Cincinatti, OH)

91062 Washington Dental Service (Seattle, WA)

39026 Wausau Insurance Companies, Wausau, WI