Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MASSHEALTH TRANSMITTAL LETTER ALL-160 October 2008 TO: All Providers Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: All Provider Manuals (Revised Appendix C) For members who have other insurance, the MassHealth Recipient Eligibility Verification System (REVS) reports the coverage type, carrier code, and policy number of the insurance listed on file. Appendix C of all MassHealth provider manuals lists in numeric order by carrier code the name and address of the other insurance so that you can bill that insurance before billing MassHealth. If you receive written evidence (for example, an explanation of benefits or a letter from an employer) that a member does not have the insurance identified on REVS, has different insurance than what is reported on REVS, or no longer has insurance coverage, please mail or fax the information to the following address. MassHealth TPL Unit P.O. Box 9212 Chelsea, MA 02150 Fax: 617-357-7604 This letter transmits an updated Appendix C for all provider manuals. The effective date is October 1, 2008. You can also view, print, or download Appendix C from the MassHealth Web site at www.mass.gov/masshealthpubs. Click on Provider Library, then MassHealth Provider Manual Appendices. The downloadable version of Appendix C is searchable, a significant advantage over the printed version. Please Note: We will update Appendix C on our Web site as needed to keep it current. We do not send updates for Appendix C to providers unless requested. To request a paper copy of Appendix C, call 1-800-841-2900, e-mail your request to providersupport@masshealth.net, or fax your request to 617-988-8973. You may also write to: MassHealth ATTN: Publications P.O. Box 9118 Hingham, MA 02043 Please include your provider number, address, and telephone number with your request. NEW MATERIAL (The pages listed here contain new or revised language.) All Provider Manuals Pages C-1 through C-40 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) All Provider Manuals Pages C-1 through C-32 — transmitted by Transmittal Letter ALL-140 Third-Party-Liability Codes Important Note: A searchable version of this appendix is available on the MassHealth Web site at www.mass.gov/masshealth. MassHealth will update Appendix C as needed. Paper copies of this appendix will not be mailed automatically, but can be requested by calling 1-800-841-2900, by e- mailing your request to publications@mahealth.net, or by fax at 617-988-8973. This appendix contains a list of third-party-liability (TPL) coverage-type codes and a numeric list of carrier codes, including carrier names and addresses. For members with a temporary MassHealth card, any applicable TPL coverage-type and carrier codes are printed on the card itself. I. Third-Party-Liability Coverage-Type Codes The following is a list of TPL coverage-type codes that identify the type of insurance a member has. If you use the MassHealth Recipient Eligibility Verification System (REVS) Automated Voice Response (AVR) system, you will be given the following TPL coverage-type code. If you use WebREVS, or electronic transactions, you will receive a full description of the coverage type instead of a code. Code TPL Coverage-Type Description Code TPL Coverage-Type Description 01 Hospital Services 22 Neighborhood Health Plan 02 Comprehensive Indemnity 23 Managed Care HMO Senior Plans w/Pharmacy 04 Medicare A 24 Managed Care HMO Senior Plans w/o Pharmacy 05 Medicare B 25 MCO/DSS Children with Special Needs 06 Medicare Supplement 26 Mental Health Services Program for Youth 08 Nursing Home Care 27 Preferred Physician Program 09 HMO without Mental Health 31 Blue Master Health Plus 10 Hospital Confinement Indemnity 32 Hospice Program 11 Health Maintenance Organization 33 Federal BC/BS Medigap Policies 12 Vision Care* 34 PACE 13 Dental Care* 35 Commercial Insurance w/o Mental Health 14 Preferred Provider Organization 36 PACE w/Coinsurance and Deductible 15 CHAMPUS or CHAMPVA 37 Senior Care Options 16 Medicare Part A Medigap 53 Hebrew Rehabilitation 17 Pharmacy – Cost Avoidance* 55 Youville w/Crossover 18 Pharmacy Coverage – Pay and Chase* 56 HMO Senior Plans 19 MassHealth MCO w/Pharmacy 57 Long Term Care HMO Senior Plans 20 MassHealth MCO w/o Pharmacy 63 Veterans Services (Noncomprehensive) 21 Special Populations with Pharmacy 64 Veterans Services (Comprehensive) * If a member has dental, vision, or pharmacy coverage only, the member may still be enrolled in a MassHealth managed care plan. II. Carrier Codes The following is a list of carrier codes and the names and addresses of the insurance companies to which they refer. You will see these codes no matter what REVS or billing method you use. 001-01 Aetna Medicare Rx Essentials, 980 Jolly Rd., Blue Bell, PA 19422, Phone: (877) 238-6211 001-02 Commonwealth Care Alliance, 30 Winter Street, Boston, MA 02108 001-03 Cignature Rx, 13650 NW 8th St., Sunrise, FL 33325, Phone: (800) 222-6700 001-04 Envision Rx Plus Standard, 2181 E. Aurora Rd., Twinsburg, OH 44087, Phone: (866) 250-2005 001-05 First Health Premier, 2222 Ewing Rd, Moon Township, PA 15108, Phone: (866) 865-0662 001-06 Health Net Orange Option 1, 950 N Finance Center Dr, Tucson, AZ 85710, Phone: (800) 806-8811 001-07 HealthSpring Prescription Drug Plan, 44 Vantage Way, Nashville, TN 86684, Phone: (866) 845-6941 001-08 Humana PDP Complete, 500 West Main St., Louisville, KY 40202, Phone: (800) 281-6918 001-10 Evercare Senior Care Options, 275 Grove Street, Auburndale, MA 02466 001-11 Commonwealth Care Alliance SCO, 30 Winter Street, Boston, MA 02108 001-13 Senior Whole Health SCO, P.O. Box 425027, Cambridge, MA 0214 001-14 Senior Care Option, Reserved for SCO, Boston, MA 02111 001-15 Senior Care Option, Reserved for SCO, Boston, MA 02111 001-16 Senior Care Option, Reserved for SCO, Boston, MA 02111 001-17 Senior Care Option, Reserved for SCO, Boston, MA 02111 001-18 Senior Care Option, Reserved for SCO, Boston, MA 02111 001-19 Senior Care Option, Reserved for SCO, Boston, MA 02111 001-20 Senior Care Option, Reserved for SCO, Boston, MA 02111 001-21 Senior Care Option, Reserved for SCO, Boston, MA 02111 001-22 Senior Care Option, Reserved for SCO, Boston, MA 02111 001-23 Senior Care Option, Reserved for SCO, Boston, MA 02111 001-24 Senior Care Option, Reserved for SCO, Boston, MA 02111 001-25 Senior Care Option, Reserved for SCO, Boston, MA 02111 001-26 Senior Care Option, Reserved for SCO, Boston, MA 02111 001-27 Senior Care Option, Reserved for SCO, Boston, MA 02111 001-28 Senior Care Option, Reserved for SCO, Boston, MA 02111 001-29 Senior Care Option, Reserved for SCO, Boston, MA 02111 004-01 Medco Your Rx Plan, P.O. Box 630246, Irving, TX 75063, Phone: (800) 758-4574 005-01 NMHC Medicare PDP Gold, 9343 Tech Center Dr., Sacramento, CA 95826, Phone: (866) 443-1095 006-01 SAMAScript, 13900 Riverport Dr., Maryland Heights, MO 63043, Phone: (800) 605-9208 006-02 SilverScript, P.O. Box 52067, Phoenix, AZ 85072, Phone: (800) 605-9208 006-03 Sterling Rx, P.O. Box 1917, Bellingham, WA 98227, Phone: (866) 235-5660 006-04 WellCare Classic, 875 Henderson Blvd, Tampa, FL Phone: (888) 550-5252 006-05 Blue Medicare Rx Premier, 2 Gannett Drive, South Portland, ME 04106, Phone: (866) 755-2776 006-06 AdvantraRx Premier, P.O. Box 686007, San Antonio, TX 78268, Phone: (866) 755-2776 006-07 Community Care Rx Basic, 1 CSC Way, Rensselaer, NY 12144, Phone: (866) 823-5178 006-08 Prescription Pathway Bronze Plan, P.O. Box 1232, Pensacola, FL 32591, Phone: (866) 684-5353 006-09 Medicare Rx Rewards Value, P.O. Box 9092, Oxnard, CA 93031 006-10 CHAMPVA, 99 River Ridge Drive, Denver, CO 80206 017-01 Advantage Star Plan by Rx American, 221 N. Charles Lindbergh Dr., Salt Lake City, UT 84116, Phone: (800) 928-6101 017-02 AARP Medicare Rx Plan, P.O. Box 29300, Hot Springs, AR 71903, Phone: (806) 429-6686 017-03 UA Medicare Part D Rx Coverage-Silver Plan, 3700 S. Stonebridge Dr., McKinney, TX 75070, Phone: (866) 299-3406 027-00 Blue Cross Blue Shield of MA, P.O. Box 986015, Boston, MA 02298-6015, Phone: (800) 443-6657 027-01 Anthem Blue Cross Blue Shield, P.O. Box 6199, Indianapolis, IN 46206, Phone: (866) 814-3739 027-02 Blue Cross Blue Shield Medex, P.O. Box 9196, Boston, MA 02105, Phone: (800) 451-8123 027-03 Blue Cross Blue Shield Medex Gold, P.O. Box 9196, Boston, MA 02105, Phone: (800) 451-8123, 027-07 Medical Mutual of Ohio, P.O. Box 6018, Cleveland, OH 44101 027-08 Federal BCBS of Montana, P.O. Box 5029, Great Falls, MT 59403 027-11 Blue Cross Blue Shield of AR, P.O. Box 1460, Little Rock, AR 72203-1460 027-13 Blue Cross Blue Shield LA, P.O. Box 98029, Baton Rouge, LA 70895, Phone: (800) 599-2583 027-14 Blue Cross Blue Shield North Dakota, 4510 13th Avenue Sw, Fargo, ND 58121 027-25 Blue Cross Blue Shield Dental, P.O. Box 986005, Boston, MA 02298, Phone: (800) 882-1178 027-26 Blue Cross BlueCare 65, P.O. Box 9201, No Quincy, MA 02171, Phone: (800) 451-8123 027-33 Blue Cross Dental of Rhode Island, P.O. Box 219, Providence, RI 02901, Phone: (800) 676-2583 027-34 Blue Cross Blue Shield of Texas Dental, P.O. Box 660247, Dallas, TX 75266, Phone: (800) 521-2227 027-38 BC/BS of Conn, Do Not Use/Use 028-88, North Haven, CT 06473 027-45 Blue Cross and Blue Shield of Maine, Two Gannett Drive, Portland, ME 04116, Phone: (207) 775-1550 Anthem BC/BS of New Hampshire, P.O. Box 533, North Haven, CT 06473-0533, Phone: (800) 332-6558 027-48 BC/BS of No. Eastern/Western NY, P.O. Box 80, Buffalo, NY 14240-0080, Phone: (800) 444-9940 027-49 Empire Blue Cross Blue Shield NY, P.O. Box 11800, Albany, NY 12211, Phone: (518) 367-4737 027-51 Excellus BCBS of NY, 12 Rhoads Drive, Utica, NY 13502, Phone: (800) 311-3536 027-53 Empire Blue Cross and Blue Shield, P.O. Box 5012, Middletown, NY 10940, Phone: (518) 367-4737 027-57 Excellus Blue Cross Blue Shield, 165 Court St, Rochester, NY 14647, Phone: (800) 462-0116 027-58 Blue Cross Blue Shield of Rochester, 150 E. Main St., Rochester, NY 14647 027-59 Blue Cross Blue Shield Central New York, P.O. Box 4809, Syracuse, NY 13221, Phone: (315) 671-6400 027-60 Blue Cross Blue Shield Kentucky, P.O. Box 37690, Louisville, KY 40233, Phone: (866) 848-1056 027-62 Blue Cross Blue Shield of Kansas City, P.O. Box 419169, Kansas City, MO 64141, Phone: (800) 892-6048 027-64 Empire Blue Cross Blue Shield, P.O. Box 5047, Middletown, NY 10943-0001, Phone: (800) 635-2184 027-67 Empire Blue Cross Blue Shield, P.O. Box 420, New York, NY 10156, Phone: (518) 367-4737 027-68 Empire BCBS of NY, P.O. Box 1407, New York, NY 10008, Phone: (212) 476-7111 027-71 Empire Blue Cross Blue Shield, 622 Third Ave., New York, NY 10017, Phone: (518) 367-4737 027-74 Empire Blue Cross Blue Shield, P.O. Box 399, New York, NY 10156, Phone: (518) 367-4737 027-76 Blue Cross Blue Shield Hawaii, P.O. Box 2970, Honolulu, HI 96802, Phone: (800) 468-3190 027-77 Empire Blue Cross Blue Shield, P.O. Box 170, New York, NY 10156, Phone: (518) 367-4737 027-80 Blue Cross and Blue Shield of Alabama, P.O. Box 360508, Birmingham, AL 35236, Phone: (800) 334-9041 027-97 Blue Cross Blue Shield of Kansas, 1133 South West, Topeka, KS 66629, Phone: (800) 432-0272 028-00 Blue Cross Blue Shield of Michigan, 600 Lafayette East, Detroit, MI 48226, Phone: (800) 637-2227 028-01 Highmark Services, P.O. Box 535052, Pittsburgh, PA 15252, Phone: (412) 544-7000 028-03 Empire Blue Cross Blue Shield, P.O. Box 5068, Middletown, NY 10940 028-05 Blue Cross of California, P.O. Box 60007, Los Angeles, CA 90060, Phone: (800) 888-8288 028-07 Blue Cross Blue Shield of Florida, P.O. Box 100121, Columbia, SC 29202 028-08 CareFirst Blue Cross Blue Shield, P.O. Box 14116, Lexington, KY 40512-4116, Phone: (800) 842-5975 028-09 Blue Cross and Blue Shield of Delaware, One Brandywine Gateway, Wilmington, DE 19899, Phone: (800) 633-2563 028-10 Highmark Blue Cross Blue Shield of Pa, P.O. Box 1210, Pittsburg, PA 15230, Phone: (800) 241-5703 028-11 Blue Cross and Blue Shield of Florida, 532 Riverside Ave., Jacksonville, FL 32231, Phone: (800) 727-2227 028-12 Blue Cross Blue Shield of Georgia, P.O. Box 7368, Columbus, GA 31908-7368, Phone: (800) 441-2273 028-13 Blue Cross Blue Shield of Georgia, P.O. Box 9907, Columbus, GA 31908, Phone: (800) 559-2583 028-15 Blue Cross Blue Shield of Wyoming, P.O. Box 2266, Cheyenne, WY 82003-2266, Phone: (800) 442-2376 028-16 Blue Cross Blue Shield Iowa, 636 Grand Ave, Des Moines, IA 50309, Phone: (800) 526-8995 028-17 Blue Shield of California, P.O. Box 272560, Chico, CA 95927, Phone: (800) 334-9849 028-18 Anthem Dental of California, P.O. Box 9274, Oxnard, CA 93031 028-19 Blue Cross Blue Shield of Idaho, 3000 E Pine Ave., Boise, ID 83707, Phone: (800) 274-4018 028-20 Blue Cross and Blue Shield of Illinois, P.O. Box 805107, Chicago, IL 60690-3625, Phone: (800) 730-8434 028-22 Blue Cross and Blue Shield of Indiana, 5451 Lakeview Pkwy S Dr., Indianapolis, IN 46268 028-23 WellPoint Dental Services, P.O. Box 9201, Oxnard, CA 93031, Phone: (800) 627-0004 028-26 Blue Cross Blue Shield of Maryland, P.O. Box 9784, Baltimore, MD 21284, Phone: (800) 524-4555 028-27 CareFirst Blue Cross Blue Shield MD, P.O. Box 1725, Cumberland, MD 21501, Phone: (800) 843-4280 028-28 Blue Cross and Blue Shield of Minnesota, P.O. Box 64338, St. Paul, MN 55164, Phone: (800) 262-0820 028-29 Horizon Blue Cross Blue Shield, P.O. Box 22439, Newark, NJ 01701, Phone: (800) 624-1110 028-30 Anthem BC/BS of Missouri, P.O. Box 14882, St Louis, MO 63178, Phone: (314) 923-4444 028-31 Blue Cross Blue Shield of PA, P.O. Box 898845, Camp Hill, PA 17089, Phone: (800) 358-0050 028-32 CareFirst Blue Cross Blue Shield, P.O. Box 812, Owings Mills, MD 21117, Phone: (800) 843-4280 028-33 Horizon BC/BS of New Jersey, P.O. Box 1609, Newark, NJ 07101, Phone: (800) 414-7427 028-34 Blue Cross Blue Shield of North Carolina, 5901 Chapel Hill Road, Durham, NC 27702-2291, Phone: (800) 250-3630 028-35 Blue Cross Blue Shield OK, P.O. Box 3283, Tulsa, OK 74102, Phone: (405) 787-6020 028-37 Blue Cross and Blue Shield of Nebraska, 7261 Mercy Road, Omaha, NE 68180, Phone: (800) 642-8516 028-38 Blue Cross Blue Shield of New Jersey, Do Not Use/Use 028-33, Newark, NJ 07101, Phone: (973) 466-4000 028-39 Anthem Blue Cross Blue Shield, 2 Gannett Drive, South Portland, ME 04106, Phone: (207) 822-7000 028-41 Anthem Blue Cross/Blue Shield, P.O. Box 37180, Louisville, KY 40233, Phone: (866) 755-2657 028-42 Horizon BC/BS of New Jersey, P.O. Box 1219, Newark, NJ 07101-1219, Phone: (800) 676-2583 028-43 Anthem Blue Cross Blue Shield of CO, P.O. Box 5747, Denver, CO 80217, Phone: (800) 654-9338 028-49 Anthem Blue Cross FEP, P.O. Box 37980, Louisville, KY 40233, Phone: (800) 787-2680 028-52 Blue Cross Blue Shield of OR, P.O. Box 30805, Salt Lake City, UT 84130, Phone: (800) 624-6519 028-53 Capital Blue Cross, 2500 Elmerton Ave., Harrisburg, PA 17177 028-54 Blue Cross of Western Pennsylvania, 120 Fifth Ave., Pittsburgh, PA 15222, Phone: (800) 547-3627 028-55 Blue Cross Blue Shield of Pennsylvania, P.O. Box 1210, Pittsburgh, PA 15230, Phone: (800) 547-3627 028-56 Independence Blue Cross PA, 1901 Market St, Philadelphia, PA 19103, Phone: (880) 227-3199 028-57 Blue Cross Blue Shield Dental RI, P.O. Box 219, Providence, RI 02901 028-58 Blue Cross of Puerto Rico, P.O. Box 366068, San Juan, PR 00936, Phone: (888) 284-7814 028-59 Blue Cross Blue Shield of Rhode Island, 444 Westminster St., Providence, RI 02903, Phone: (800) 637-3718 028-60 Blue Cross Blue Shield of South Carolina, I-20 East at Alpine Road, Columbia, SC 29219, Phone: (800) 868-2520 028-61 Blue Shield of Puerto Rico, P.O. Box 363628, San Juan, PR 00936, Phone: (888) 284-7814 028-62 Blue Cross Blue Shield of SC, P.O. Box 6000, Greenville, SC 29606-6000, Phone: (800) 845-6067 028-63 Blue Cross and Blue Shield of Tennessee, 801 Pine St., Chattanooga, TN 37402, Phone: (800) 565-9140 028-66 Blue Cross Blue Shield of Texas, P.O. Box 660044, Dallas, TX 75265-0044, Phone: (972) 766-6900 028-68 Trigon Blue Cross and Blue Shield, 2015 Staples Mill Road, Richmond, VA 23279, Phone: (804) 358-1551 028-69 Blue Cross Blue Shield UT, P.O. Box 30270, Salt Lake City, UT 84130, Phone: (800) 624-6519 028-71 Blue Cross and Blue Shield of Vermont, 445 Industrial Lane, Montpelier, VT 05601, Phone: (800) 255-4550 028-72 Blue Cross of Washington, P.O. Box 30271, Salt Lake City, UT 84130, Phone: (800) 624-6519 028-73 Blue Cross Blue Shield AK, P.O. Box 24649, Anchorage, AK 99524, Phone: (800) 527-6675 028-75 Blue Cross Blue Shield United Wisconsin, P.O. Box 2270, Fond Dulac, WI 54936, Phone: (920) 923-7572 028-76 BCBS of WA - Premier, P.O. Box 91059, Seattle, WA 98111, Phone: (800) 527-6675 028-85 Anthem Blue Cross Blue Shield, P.O. Box 37010, Louisville, KY 40233-7010, Phone: (866) 504-9617 028-87 Anthem BCBS of Virginia, P.O. Box 2741, Richmond, VA 23261 028-88 Anthem BC/BS of CT, P.O. Box 533, North Haven, CT 06473, Phone: (800) 322-4670 028-94 Blue Cross Blue Shield of Texas, P.O. Box 660044, Dallas, TX 75266, Phone: (800) 521-2227 028-95 Trigon Blue Cross Blue Shield, P.O. Box 27287, Richmond, VA 23261, Phone: (804) 354-7000 028-96 Independence BC/BS of PA, P.O. Box 69352, Harrisburg, PA 17106-9352, Phone: (800) 676-2583 028-98 Blue Cross Blue Shield of Rochester, 165 Court Street, Rochester, NY 14647, Phone: (800) 462-0116 028-99 Blue Cross Blue Shield of Puerto Rico, 401 Park Drive, Boston, MA 02215 046-16 Delta Dental of Arizona, P.O. Box 43026, Phoenix, AZ 85080-3026 058-10 Dental Service Group, 4510 13th Ave South West, Fargo, ND 58121 058-15 Dental Benefit Providers, P.O. Box 30640, Bethesda, MD 20824, Phone: (800) 445-9090 058-20 New England Dental Admin., P.O. Box 2006, Concord, NH 03302 064-00 Delta Dental of California, P.O. Box 997330, Sacramento, CA 95899, Phone: (888) 335-8227 064-01 CHAMPUS/Tricare Military Health Systems, P.O. Box 870140, Camden, SC 29587, Phone: (877) 874-2273 064-02 Delta Dental of Rhode Island, P.O. Box 1515, Providence, RI 02901, Phone: (401) 752-6100 064-03 Delta Dental Plan of Michigan, P.O. Box 9085, Farmington Hills, MI 48333, Phone: (800) 482-8915 064-05 Delta Dental of WI, P.O. Box 828, Stevens Point, WI 54481 064-08 Sierra Military Health System, P.O. Box 7889, Tricare for Life, Madison, WI 53707, Phone: (866) 835-7422 064-10 Delta Dental Plan of Tennessee, 240 Vencure Circle, Nashville, TN 37228, Phone: (800) 223-3104 064-11 Delta Dental of Colorado, P.O. Box 173803, Denver, CO 80217 064-12 Delta Dental of IL, P.O. Box 5402, Lisle, IL 60532-5436 064-14 Delta Dental Plan of Minnesota, P.O. Box 59238, Minneapolis, MN 55459, Phone: (800) 553-9536 064-15 Delta Dental of Pennsylvania, 1 Delta Drive, Mechanicsburg, PA 17055, Phone: (800) 932-0783 064-16 Delta Dental Plan of Ohio, P.O. Box 9785, Farmington Hills, MI 48333 064-20 Delta Dental of Kentucky, P.O. Box 242810, Louisville, KY 40224, Phone: (800) 955-2030 064-25 Delta Dental of VA, 4818 Starkey Rd, Roanoke, VA 24014, Phone: (800) 237-6060 064-30 Delta Dental Plan of Arkansas, P.O. Box 15965, No. Little Rock, AR 72231, Phone: (800) 462-5410 064-31 Delta Dental of Georgia, P.O. Box 1809, Alpharetta, GA 30023, Phone: (800) 521-8700 064-35 Delta Dental Plan of New Jersey, P.O. Box 222, Parsippany, NJ 07054, Phone: (800) 452-9310 064-40 Delta Dental of Missouri, P.O. Box 8690, St Louis, MO 63126, Phone: (800) 392-1167 064-60 Tricare (Pharmacy), P.O. Box 7011, Camden, SC 79020, Phone: (888) 999-5195 081-20 Independence BC/BS of PA (PPO), P.O. Box 69352, Harrisburg, PA 17106-9352, Phone: (800) 332-2566 083-00 Delta Dental Plan of Massachusetts, P.O. Box 9695, Boston, MA 02114, Phone: (800) 451-1249 083-10 Delta Care Unit, P.O. Box 9595, Boston, MA 02124, Phone: (800) 451-1249 084-00 Medicare A Claims, 02106 085-00 Medicare B Claims, 02370 091-01 Fallon Community Health Plan/Senior, P.O. Box 15121, Attn. Claims Dept, Worcester, MA 01615, Phone: (800) 333-2535 091-05 Fallon Community Health Plan, P.O. Box 15121, Worcester, MA 01615, Phone: (800) 868-5200 092-00 Harvard Pilgrim Health Care, P.O. Box 699183, Quincy, MA 02269, Phone: (800) 676-2769 092-12 Harvard First Seniority Freedom, P.O. Box 699183, Quincy, MA 02269, Phone: (800) 742-8326 092-13 Pilgrim Health Care/Preferred 65, P.O. Box 9175, Quincy, MA 02269 092-50 Pilgrim Health Care, P.O. Box 699183, Quincy, MA 02269 095-00 Matthew Thornton Health Plan, P.O. Box 9514, Manchester, NH 03108 098-00 Multi Group Health Plan, 20 Walnut St, Wellesley, MA 02181 098-10 HealthEOS, P.O. Box 6090, Depere, WI 54115 101-01 Tufts Health Plan, P.O. Box 9163, Watertown, MA 02471, Phone: (888) 884-2404 101-02 Tufts Medicare Preferred, P.O. Box 9183, Watertown, MA 02471, Phone: (800) 279-9022 105-00 A-C Retirees Benefit Plan, 11270 W Park Pl Ste 950, c/o BPA of WI, Milwaukee, WI 53224 106-00 Aetna, P.O. Box 3929, Allentown, PA 18106, Phone: (800) 292-4366 106-01 Aetna, P.O. Box 1858, 1800 E Interstate Ave, Bismarck, ND 58502, Phone: (800) 624-0756 106-02 Aetna/Senior, 400-01 Totten Pond Rd., Waltham, MA 02154 106-03 Aetna/US Healthcare/Exxon Medicare, P.O. Box 795081, San Antonio, TX 78279 106-04 Aetna, P.O. Box 981114, El Paso, TX 79998, Phone: (800) 248-3132 106-05 Aetna, 3 Burlington Woods Drive, Burlington, MA 01830, Phone: (800) 323-9930 106-06 Aetna, 3541 Winchester Road, Allentown, PA 18195, Phone: (800) 292-4366 106-07 Aetna, P.O. Box 1125, Blue Bell, PA 19422, Phone: (800) 624-0756 106-08 Aetna, P.O. Box 2295, Fort Wayne, IN 46801, Phone: (800) 872-3862 106-09 Aetna, P.O. Box 31450, Tampa, FL 33636, Phone: (800) 872-3862 106-11 Aetna, P.O. Box 24024, Fresno, CA 93779, Phone: (800) 354-5835 106-14 Aetna, P.O. Box 3909, Allentown, PA 18106, Phone: (610) 336-1000 106-18 Aetna, P.O. Box 150417, Hartford, CT 06115, Phone: (800) 872-3862 106-21 Aetna, P.O. Box 26599, Milwaukee, WI 53226, Phone: (800) 872-3862 106-24 Aetna, P.O. Box 35890, 10401 Linn Station Rd., Louisville, KY 40223, Phone: (800) 872-3862 106-25 Aetna, P.O. Box 91555, Arlington, TX 76015, Phone: (214) 200-8000 106-26 Aetna, 1000 Middle St, Middletown, CT 06457, Phone: (877) 402-8742 106-29 Aetna, P.O. Box 4266, Bismarck, ND 58502, Phone: (800) 323-9930 106-30 Aetna, P.O. Box 44128, Jacksonville, FL 32231, Phone: (877) 580-5018 106-31 Aetna, P.O. Box 981107, El Paso, TX 79998, Phone: (800) 245-6738 106-34 Aetna, P.O. Box 28060, San Antonio, TX 78228, Phone: (800) 587-3496 106-35 Aetna, 4050 Piedmont Pkwy, High Point, NC 27607, Phone: (800) 872-3862 106-38 Aetna, P.O. Box 18040, Columbus, OH 43218, Phone: (614) 933-6000 106-44 Aetna, P.O. Box 7064, Dover, DE 19903, Phone: (800) 872-3862 106-45 Aetna, P.O. Box 26106, Greensboro, NC 27402, Phone: (800) 844-5562 106-47 Aetna, P.O. Box 5569, 3875 Embassy Parkway, Akron, OH 44334, Phone: (800) 570-6874 106-52 Aenta, P.O. Box 91522, Arlington, TX 76015, Phone: (800) 782-3862 106-57 Aetna, P.O. Box 16423, Pittsburgh, PA 15242, Phone: (800) 292-4366 106-60 Aetna, P.O. Box 981109, El Paso, TX 79998, Phone: (800) 248-3132 106-61 Aetna, P.O. Box 3925, Allentown, PA 18106, Phone: (800) 292-4366 106-62 Aetna, P.O. Box 1630, Columbus, OH 43216, Phone: (800) 833-0220 106-63 Aetna, P.O. Box 14014, Lexington, KY 40512, Phone: (877) 362-0869 106-64 Aetna, P.O. Box 26103, Greensboro, NC 27402, Phone: (800) 872-3862 106-65 Aetna, P.O. Box 2520, Tyler, TX 75710, Phone: (800) 441-1864 106-67 Aetna, P.O. Box 5048, Rockford, IL 61125, Phone: (800) 872-3862 106-68 Aetna, P.O. Box 7012, Dover, DE 19903, Phone: (800) 872-3862 106-70 Aetna, P.O. Box 14110, Lexington, NY 12452, Phone: (877) 235-4005 106-71 Aetna, P.O. Box 52120, Minneapolis, MN 55402, Phone: (800) 445-0128 106-72 Aetna, Loop Station, P.O. Box 2907, Minneapolis, MN 55402, Phone: (800) 872-3862 106-73 Aetna, P.O. Box 26107, Greensboro, NC 27402, Phone: (800) 872-3862 106-74 Aetna, P.O. Box 12244, Oklahoma City, OK 73116 106-77 Aetna, P.O. Box 52121, Minneapolis, MN 54402, Phone: (800) 872-3862 106-79 Aetna, P.O. Box 14586, Lexington, KY 40152, Phone: (877) 362-0869 106-80 Aetna, P.O. Box 1214, Tewksbury, MA 01876, Phone: (888) 802-3862 106-83 Aetna, P.O. Box 14089, Lexington, KY 40512, Phone: (800) 872-3862 106-87 Aetna, P.O. Box 2950, Loop Station, Minneapolis, MN 55402, Phone: (800) 589-4811 106-92 Aetna, P.O. Box 14094, Lexington, KY 40512, Phone: (877) 368-6605 106-96 Aetna, P.O. Box 981106, El Paso, TX 79998-1106, Phone: (888) 632-3862 106-97 Aetna, P.O. Box 129010, San Diego, CA 92112, Phone: (800) 814-3543 106-98 Aetna Dental, P.O. Box 14027, Lexington, KY 40512, Phone: (800) 872-3862 106-99 Aetna, P.O. Box 26190, Greensboro, NC 27402, Phone: (800) 872-3862 107-02 AIG, 80 Pine St., New York, NY 10005, Phone: (877) 640-2450 107-05 AIM Administrators, 4645 Sweetwater Blvd, Sugar Land, TX 77479, Phone: (281) 265-5111 112-10 Vytra Health Plans, P.O. Box 9091, Melville, NY 11747-9091, Phone: (888) 288-9872 112-15 Allstate Workplace Division, P.O. Box 853916, Richardson, TX 75085-3916, Phone: (800) 937-7039 113-00 PersonalCare Health Management, 2110 Fox Drive, Champaign, IL 61820, Phone: (800) 562-5792 122-01 American Fidelity Assurance Company, P.O. Box 25070, Oklahoma City, OK 73125, Phone: (800) 654-8489 122-05 Aflac, 1932 Wynnton Rd, Columbus, GA 31999, Phone: (800) 992-3522 126-01 American Hardware Mutual Insurance Co, 200 Unicorn Dr, Woburn, MA 02147 126-02 American Plan Administrators, 18 Heywood St, Brooklyn, NY 11211 126-03 Gilsbar, P.O. Box 2947, Covington, LA 70434, Phone: (800) 445-7227 126-04 Insurers Administrative Corp (IAC), P.O. Box 828, Park Ridge, IL 60068 126-05 Health Cost Solutions, P.O. Box 1439, Hendersonville, TN 37077 126-06 WellPath, P.O. Box 7102, London, KY 40742, Phone: (800) 470-4523 127-04 Corporate Diversified Services, P.O. Box 2835, Omaha, NE 68103 128-00 All State Workplace Division, 1776 American Heritage D, Jacksonville, FL 32224, Phone: (904) 992-1776 135-08 American Medical Security, P.O. Box 19032, Green Bay, WI 54307, Phone: (800) 232-5432 138-00 Cross America/American Med Life, P.O. Box 1235, Frederick, MD 21702-0235, Phone: (866) 302-7332 138-10 AmeriHealth Administrators, 720 Blair Mill Road, Horsham, PA 19044, Phone: (800) 492-2385 138-45 AmeriBen Solutions, P.O. Box 7186, Boise, ID 83707, Phone: (800) 786-7930 143-04 AVMA, P.O. Box 909720, Chicago, IL 60690, Phone: (800) 621-6360 144-40 Ameritas Life Ins., P.O. Box 82520, Lincoln, NE 68501, Phone: (800) 487-5553 145-45 Anthem/CMSI, P.O. Box 10888, Green Bay, WI 54307-0888, Phone: (800) 472-7130 149-16 Associated Plan Admin, P.O. Box 189, Columbus, OH 43216 149-18 Associated Health Plan Admin., P.O. Box 9568, New Haven, CT 06535, Phone: (203) 287-1272 154-10 Bankers Life & Casualty Co., P.O. Box 66927, Chicago, IL 60666, Phone: (800) 621-3724 160-01 BCI Administrators, P.O. Box 251568, West Bloomfield, MI 48325, Phone: (248) 626-8896 167-00 Boston Mutual Life Insurance Co, 120 Royall St, Canton, MA 02021, Phone: (800) 669-2668 171-00 Washington National, P.O. Box 1934, Des Plaines, IL 60017, Phone: (815) 987-0409 171-01 Conseco/Washington National, P.O. Box 2034, Carmel, IN 46082, Phone: (800) 523-4000 171-02 Conseco Senior Health Ins., P.O. Box 2002, Carmel, IN 46082, Phone: (800) 242-4852 171-05 Capitol District Physicians Health Plan, P O Box 66602, Albany, NY 12206, Phone: (800) 926-7526 171-10 Capital Group Ins. Adm., 320 Washington St, Norwell, MA 02061 171-15 Capitol Administrators, P.O. Box 2318, Rancho Cordova, CA 95741 171-50 CappCare, P.O. Box 6240, Newport Beach, CA 92658 172-01 Celtic Ins., P.O. Box 30082, Tampa, FL 33630-3082 172-07 Celtic Insurance Company, P.O. Box 06401, Chicago, IL 60606, Phone: (800) 477-7870 174-20 Centra, P.O. Box 34866, Seattle, WA 98124 176-00 Central States Health and Life, P.O. Box 34350, Omaha, NE 68134, Phone: (402) 397-1111 178-00 A & H Administrators, P.O. Box 10223, Milwaukee, WI 53210, , , 183-50 Chickering Claim Administrators Inc, P.O. Box 15708, Boston, MA 02215-0014, Phone: (800) 859-8468 184-05 Cherokee Insurance, P.O. Box 159, Warren, MI 48090 184-10 Christian Brothers Health Mngt Serv, 1205 Windham Parkway, Romeoville, IL 60446 187-00 Collegiate Risk Management, P.O. Box 727, Short Hills, NJ 07078 191-02 Colonial Penn, P.O. Box 30102, Tampa, FL 33630 194-01 Combined Insurance Co of America, 111 Washington St, Brookline, MA 02146 194-02 Combined Insurance Company, P.O. Box 638, Bellingham, WA 98227, Phone: (800) 225-4500 194-10 Combined Benefit Administration, 4704 West Jennifer Ave, Fresno, CA 93722, Phone: (800) 709-4734 198-00 Commercial Union Ins., One Beacon Street, Boston, MA 02108 200-08 Cigna Healthcare, P.O. Box 5200, Scranton, PA 18505, Phone: (800) 244-6224 200-12 ConnectiCare, P.O. Box 546, Farmington, CT 06034, Phone: (800) 251-7722 200-15 Connecticut General Life, P.O. Box 2996, GE Dental Claims Office, Hartford, CT 06104 200-16 Cigna Healthcare, Do Not Use/Use 200-08, Des Moines, IA 50306, Phone: (800) 223-9601 200-17 Connecticut General, P.O. Box 55270, Phoenix, AZ 85708-5270, Phone: (877) 209-7098 200-18 Connecticut General Life Insurance, P.O. Box 2316, Pittsburgh, PA 15230 200-24 Continental General Insurance, P.O. Box 2830, Clinton, IA 52733-2830, Phone: (800) 545-8905 200-50 Cigna Dental, P.O. Box 15558, Wilmington, DE 19850, Phone: (800) 441-7150 200-60 Connecticut General, P.O. Box 9004, Jericho, NY 11753 200-64 Cigna Behavioral Health, P.O. Box 46270, Eden Prairie, MN 55344, Phone: (800) 442-4227 200-70 Cigna, Do Not Use/Use 200-08, CT 06085, Phone: (800) 345-9458 200-74 Cigna, Do Not Use/Use 200-08, Charlotte, NC 28233 200-75 Cigna Dental, P.O. Box 188003, Chattanooga, TN 37422, Phone: (800) 433-3926 200-81 Cigna, Do Not Use/Use 200-08, Des Moines, IA 50306, Phone: (800) 223-9601 200-82 Cigna Dental Health, P.O. Box 4630, Miami, FL 33269 200-83 Cigna Dental, P.O. Box 969, Bristol, CT 06010, Phone: (800) 577-0576 200-85 Connecticut General, P.O. Box 850, JFK Airport Station, Jamaica, NY 11430 200-87 Cigna Dental, P.O. Box 189060, Plantation, FL 33318, Phone: (800) 342-5234 200-94 Cigna Health, Do Not Use/Use 200-08, Chattanooga, TN 37422, Phone: (800) 251-0670 200-96 Cigna Preferred, P.O. Box 71203, San Juan, PR 00936, Phone: (800) 453-4187 203-00 Consolidated Health Plans, 195 Stafford St, Springfield, MA 01104, Phone: (800) 633-7867 203-01 Constitution Health Network, P.O. Box 720, North Haven, CT 06473 205-05 Continental General, P.O. Box 29134, Shawnee Mission, KS 66201 206-00 Cook Group Health Plan, P.O. Box 489, Bloomington, IN 47402-0489, Phone: (812) 339-2235 208-05 Coventry Healthcare, P.O. Box 7088, London, KY 40742 210-02 Crown Cork and Seal Co, 155 Shepard St, Lawrence, MA 01843 210-06 Companion Life Dental, P.O. Box 100102, Columbia, SC 29202, Phone: (800) 753-0404 214-01 Cypress Benefit Administrators, P.O. Box 7020, Appleton, WI 54912, Phone: (877) 236-0844 215-05 Doc First, P.O. Box 17098, Owings Mills, MD 21117 222-02 Employer's Mutual, 326 El Bolito Ave, Glendale, CA 91204 223-00 Employer Resource Network, P.O. Box 9137, Fort Worth, TX 76147 226-31 The Equitable, P.O. Box 3000, Lancaster, SC 29721, Phone: (800) 782-9355 229-00 FMH Benefit Services, P.O. Box 25946, Overland Park, KS 66225 230-00 Farm Family Life Insurance Co, P.O. Box 656, Albany, NY 12201, Phone: (800) 843-3276 235-05 Federated HR Services, P.O. Box 850958, Richardson, TX 75085 247-05 Pro-Net, P.O. Box 101387, Fort Worth, TX 76185, Phone: (800) 344-5822 247-10 Pro America, P.O. Box 90603, Arlington, TX 76006 253-01 Frensenius/Senior Plan Demo Project, P.O. Box 741107, Houston, TX 77274, Phone: (713) 843-6720 253-64 Assurant Health, Do Not Use/Use 253-65, El Paso, TX 79998, Phone: (800) 789-2218 253-65 Assurant Employee Benefits, P.O. Box 981602, El Paso, TX 79998 253-80 Assurant Health Dental, P.O. Box 2940, Clinton, IA 52733, Phone: (800) 442-7742 254-15 Foundation Benefit Administrator, 6300 Bridgepoint Parkway, Austin, TX 78730 257-00 Seven Corners, P.O. Box 3430, Carmel, IN 46032-3430, Phone: (866) 699-4186 258-01 Empire HealthChoice Inc, P.O. Box 4846, Syracuse, NY 13221 259-01 Associated Hospital Service, aka Anthem Health Plans, Quincy, MA 02169 260-00 Gerber Life Insurance Co, 204 West Main St, Freemont, MI 49412 260-01 Upstate Medicare Division/FI, Do Not Add Members, Binghamton, NY 13902, Phone: (800) 253-3074 262-00 Global Exchange, P.O. Box 823067, South Florida, FL 33082 265-00 Golden Rule Insurance Co, 712 Eleventh St, Lawrenceville, IL 62439, Phone: (618) 943-8000 265-01 Golden Rule Insurance Co, 7440 Woodland Drive, Indianapolis, IN 46278, Phone: (800) 265-7791 266-01 Government Employees Hospital Assoc, P.O. Box 4665, Independence, MO 64051, Phone: (800) 821-6136 275-00 Great West Health Care, 850 Concord Parkway, Maitland, FL 32751 275-15 Great West Healthcare, 1000 Great West Drive, Kennett, MO 63857, Phone: (866) 494-2111 280-00 Guardian Short Term Disability, P.O. Box 26160, Lehigh Valley, PA 18002, Phone: (800) 268-2525 280-06 The Guardian, P.O. Box 9128, Norwell, MA 02001 280-08 Guardian, P.O. Box 8019, Appleton, WI 54913, Phone: (920) 749-9200 280-32 Guardian Life, P.O. Box 8024, Appleton, WI 54912, Phone: (800) 695-4542 280-33 Guardian Dental, P.O. Box 2459, Spokane, WA 99210, Phone: (800) 541-7846 280-35 Guardian, P.O. Box 9128, Norwell, MA 02061, Phone: (800) 524-4542 288-20 Health Net, P.O. Box 7090, Bridgeport, CT 06601 288-21 ACS Health Net of North East, P.O. Box 14700, Lexington, KY 27102, Phone: (336) 759-2013 288-24 ACS Benefit Services, P.O. Box 2000, Winston Salem, NC 40512, Phone: (800) 441-5741 288-25 Health Net PPO, P.O. Van 10223, Van Nuys, CA 91410, Phone: (800) 641-7761 288-26 Health Net, P.O. Box 14700, Lexington, KY 40512, Phone: (800) 861-7214 288-30 Health Partners, P.O. Box 5194, New York, NY 10185, Phone: (215) 849-9606 288-35 Health Plans Inc, P.O. Box 5199, Westborough, MA 01581, Phone: (508) 752-2480 288-45 Health Links, P.O. Box 149104, St Louis, MO 63141 288-55 Health Plans/ACES Life, P.O. Box 628, St Louis, MO 63188 288-70 Health Partners, P.O. Box 1289, Minneapolis, MN 55440-01289, Phone: (800) 883-2177 288-75 Health Scope Benefits, P.O. Box 8074, Little Rock, AR 72203 290-50 Boon-Chapman, P.O. Box 9201, Austin, TX 78766, Phone: (800) 252-9653 291-10 Horizon Health Care of NY, P.O. Box 79, Newark, NJ 07101 291-15 Health Span, 4373 Harrison Blvd, Cincinnati, OH 43211 292-00 Home Life Insurance Co, 253 Broadway, New York, NY 10007 292-03 Anthem/Home Life Insurance, P.O. Box 1326, Piscataway, NJ 08855 292-10 Home Life Co. of New York, P.O. Box 956353, Duluth, GA 30136 292-20 Hometown Health Plan, 100 Lillian Gish Blvd, Massillon, OH 44647 295-00 IDS Life Insurance Co, IDS Tower 10, Minneapolis, MN 55440 300-20 Independent Health, P.O. Box 1430, Buffalo, NY 14231, Phone: (877) 593-3250 304-00 Inter-Americas Insurance Corp, P.O. Box 9510, Wichita, KS 67277, Phone: (316) 794-2200 304-50 P5 E Health Services, P.O. Box 9554, Salt Lake City, UT 84109, Phone: (800) 569-9503 305-02 Intercounty Hospital Plan, 720 Blair Mill Road, Horsham, PA 19044, Phone: (800) 492-2385 307-03 International Medical Group, P.O. Box 88500, Indianapolis, IN 46208-0500, Phone: (800) 628-4664 307-10 International Benefit Adm, 7083 Grand National Dr, Orlando, FL 32819 310-10 ITPE-Health Welfare Fund, P.O. Box 13817, Savannah, GA 31416, Phone: (912) 352-7169 313-03 John Alden, P.O. Box 981652, El Paso, TX 79998, Phone: (800) 328-4316 313-05 John Alden Life Insurance, P.O. Box 4243, Woodland Hills, CA 91365 314-00 John Deere Insurance Co, 3800 Ave of the Cities, Moline, IL 61265, Phone: (800) 747-1446 315-00 John Hancock Mutual Life Insurance Co, P.O. Box 111, Boston, MA 02117 315-01 John Hancock Mutual Life Insurance Co, P.O. Box 4000, Braintree, MA 02184 315-04 John Hancock Ins, P.O. Box 4061, Schaumburg, IL 60168 315-09 Unicare/John Hancock, 233 S. Wacker Dr, Chicago, IL 60606 315-10 John Hancock Mut Life Ins, 399 Taylor Road, Pleasant Hill, CA 94523 315-12 John Hancock Mutual Life Ins, P.O. Box 8515, Exxon Claims, London, KY 47042 315-13 John Hancock Mutual Life Ins. Co, P.O. Box 4005, Schaumburg, IL 60168 315-14 Unicare, P.O. Box 25307, Winston Salem, NC 27114 315-16 Unicare, P.O. Box 5005, Bolingbrook, IL 60440, Phone: (800) 442-9300 315-17 Unicare/Ford Visteon, 3200 Greenfield Rd, Dearborn, MI 48120 315-19 Unicare/Mass Mutual, 3820 American Drive, Plano, TX 75075 315-20 Unicare, P.O. Box 795180, San Antonio, TX 78279-5180 315-21 John Hancock Preferred Health Plan, P.O. Box 9115, Braintree, MA 02184 315-23 Unicare, 13523 Barrett Parkway Dr, Association National Claim, Baldwin, MO 63021 315-25 John Hancock Insurance, P.O. Box 833898, Richardson, TX 75083 315-29 Unicare, P.O. Box 4050, Clint Service Center, Schaumburg, IL 60168, Phone: (847) 706-4050 315-30 Unicare, P.O. Box 4109, Woodland, CA 91365 315-31 Unicare, P.O. Box 7062, Schaumburg, IL 60168, Phone: (800) 258-5284 315-32 Unicare, P.O. Box 4069, Schaumburg, IL 60168, Phone: (800) 258-5284 315-35 Unicare, P.O. Box 9016, GIC Indemnity Plan, Andover, MA 01810, Phone: (800) 422-9300 315-38 John Hancock, P.O. Box 2074, Aurora, IL 60507 315-42 John Hancock, P.O. Box 9186, Braintree, MA 02184 315-46 Unicare, 7025 Albert Pick Rd #500, Greensboro Client Service, Greensboro, NC 60680, Phone: (800) 288-8630 315-51 Unicare, P.O. Box 4458, Chicago, IL 01151, Phone: (800) 288-8630 315-52 Unicare, P.O. Box 51990, Indian Orchard, MA 01151, Phone: (413) 858-5000 315-55 Unicare, P.O. Box 9201, Oxnard, CA 93031, Phone: (800) 627-0004 315-57 Unicare, P.O. Box 51130, Springfield, MA 01151, Phone: (800) 288-8630 315-58 John Hancock, P.O. Box 4034, Schaumburg, IL 60168 315-59 Unicare Pharmacy, P.O. Box 9282, Oxnard, CA 93031 315-72 John Hancock Financial Servs., P.O. Box 3010, Andover, MA 01810 315-79 Unicare Compaq Claims, P.O. Box 833895, Richardson, TX 75083, Phone: (800) 342-0000 315-90 Unicare, P.O. Box 51180, Indian Orchard, MA 01151, Phone: (800) 422-9300 315-92 Unicare, P.O. Box 061109, Chicago, IL 60606, Phone: (800) 438-6105 315-95 Unicare, P.O. Box 4061, Schaumburg, IL 60168, Phone: (800) 304-7258 316-00 Klais Company, 1867 West Market St., Akron, OH 44313, Phone: (800) 331-1096 318-00 Keystone Provident Life Ins. Co, 99 High St, Boston, MA 02105 318-20 Key Benefit Administrators, P.O. Box 55210, Indianapolis, IN 46205, Phone: (800) 871-2335 320-00 Liberty Life Assurance Co. Boston, 175 Berkeley St, Boston, MA 02117 322-04 Awane Benefit Plan Management, P.O. Box 536, Rockland, MA 02370, Phone: (603) 924-9449 322-11 Liberty Mutual, P.O. Box 9004, Central Islip, NY 11722 331-00 Lincoln National Life Insurance Co, 1300 South Clinton St, Fort Wayne, IN 46801 331-02 Lincoln Financial Group Dental, P.O. Box 2640, Omaha, NE 68103-2640, Phone: (800) 423-2765 334-01 Loomis Company, P.O. Box 7011, Wyomissing, PA 19610, Phone: (610) 374-4040 337-10 Lumenos, P.O. Box 69309, Harrisburg, PA 17106 348-03 Mass Mutual Life Ins., P.O. Box 60004, City of Industry, CA 91716 348-14 Mass Mutual, 35 Circle Park, Austin, TX 78753 348-18 Mass Mutual Life Ins., P.O. Box 9048, Springfield, MA 01151 348-20 Mass Mutual, 1320 Willard Road Suite, Concord, CA 94520 348-25 Mass Mutual, P.O. Box 90190, Springfield, MA 01139 348-40 Mid-Atlantic Medical Services/MAMSI, P.O. Box 930, Frederick, MD 21705 349-00 Medico Life Insurance, 1515 South 75th St, Omaha, NE 68124, Phone: (800) 228-6080 349-20 Med-Pay, Inc, P.O. Box 10909, Springfield, Mo, 65808 349-80 MedSpan, Inc., P.O. Box 340950, Hartford, CT, 06134, (860) 541-6789 351-00 Metropolitan Life Insurance Co, 1 Madison Ave -Claims, New York, NY 10010, Phone: (800) 848-8406 351-01 United Healthcare/MetraHealth, P.O. Box 30555, Multi Case Services, Salt Lake City, UT 84130, Phone: (877) 842-3210, 351-02 Metropolitan Life Ins. Co, P.O. Box 30430, Tampa, FL 33630 351-03 Met Life Dental, P.O. Box 981282, El Paso, TX 79998, Phone: (800) 942-0854 351-05 United Healthcare, P.O. Box 1600, Kingston, NY 12402, Phone: (800) 942-4640 351-06 Metropolitan Life Ins. Co, Oneida County Industrial Park, c/o Kanawha, Lancaster, SC 29721 351-07 Metropolitan Life Ins. Co, 700 Quaker Ln., P.O. Box 300, Warwick, RI 02887 351-11 United Healthcare, P.O. Box 981502, El Paso, TX 79998 351-12 Metropolitan Life Insurance Co, 9797 Springboro Pike, Dayton, OH 45448, Phone: (800) 260-1093 351-15 Metropolitan Life Ins. Co, Bldg 14 The Atrium, Philadelphia, PA 19101 351-16 United Healthcare, P.O. Box 740801, Atlanta, GA 30374, Phone: (800) 848-8406 351-17 United Healthcare, P.O. Box 74083, Verizon Claims, Atlanta, GA 30374, Phone: (800) 344-4515 351-18 United Healthcare, P.O. Box 740800, Atlanta, GA 30374, Phone: (877) 842-3210 351-20 United Healthcare, P.O. Box 809025, Dallas, TX 75380-9025, Phone: (800) 977-4698 351-21 Metropolitan, 615 E Michigan Street, Milwaukee, WI 53802 351-24 United Healthcare, P.O. Box 740802, Atlanta, GA 03374, Phone: (800) 577-8567 351-26 United Healthcare, 450 Columbus Blvd, Hartford, CT 06103 351-27 Metropolitan, 99 High Street, Boston, MA 02111 351-29 Metro Ins. Co, P.O. Box 495, Warwick, RI 02887, Phone: (401) 828-2000 351-32 Metropolitan Ins. Co, P.O. Box 7777, Utica, NY 13504, , , 351-34 Metropolitan, P.O. Box 468, Warwick, RI 30374, Phone: (877) 842-3210 351-35 United Healthcare, Inc., P.O. Box 740800, Atlanta, GA 06517 351-36 Metro, P.O. Box 30195, Tampa, FL 33630 351-37 United Healthcare, P.O. Box 699183, Quincy, MA 02269-9183 351-38 United Healthcare, P.O. Box 2517, Smyrna, GA 30081 351-41 Metro, P.O. Box 470, Warwick, RI 02887 351-45 Metropolitan Life Ins. Co, P.O. Box 969, Latham, NY 12110 351-47 Metro Dental Claims, P.O. Box 460, Warwick, RI 02887, Phone: (800) 556-3490 351-50 Metropolitan-Group Dental Claims, P.O. Box 5200, Greenville, SC 29606 351-53 Metropolitan Life Ins. Co Group Claims, P.O. Box 469, Warwick, RI 02886 351-55 Evercare, P.O. Box 659777, San Antonio, TX 78259-777, Phone: (800) 393-0993 351-57 United Healthcare Insurance Comp., P.O. Box 5090, Rolling Meadows, IL 60008 351-60 Metropolitan Health Insurance, P.O. Box 2950, Inglewood, CO 80110 351-61 Metropolitan Health Insurance, 960 Main Street, Hartford, CT 26115 351-63 United Healthcare Dental, P.O. Box 30567, Salt Lake City, UT 84130, Phone: (877) 816-3596 351-64 United Healthcare, P.O. Box 30551, Salt Lake City, UT 84130, Phone: (877) 842-3210 351-74 United Healthcare/Metropolitan Under 65, P.O. Box 3025, Utica, NY 13504 351-75 Metropolitan Life, P.O. Box 1922, Indianapolis, IN 46206 351-79 United Healthcare, P.O. Box 659768, San Antonio, TX 78265, Phone: (877) 842-3210 351-83 Metropolitan, P.O. Box 450, Warwick, RI 02887 351-84 United Healthcare, P.O. Box 659744, San Antonio, TX 78265, Phone: (800) 526-2414 351-86 Metropolitan, P.O. Box 6017, Newark, DE 19714 351-88 Metropolitan Life Dental Claims, P.O. Box 2579, Pittsburgh, PA 15230 351-90 Metropolitan, P.O. Box 2078, Aurora, IL 60507 351-92 Metropolitan Life, P.O. Box 3012, Utica, NY 13504, Phone: (800) 300-4296 351-95 United Healthcare, P.O. Box 30755, Salt Lake City, UT 84130, Phone: (800) 357-0978 351-98 United Healthcare, 601 Brooker Creek Blvd, Oldsmar, FL 34677 352-12 United Concorda, P.O. Box 69421, Harrisburg, PA 17106, Phone: (800) 235-1847 354-00 Michigonne Benefit Administrators, P.O. Box 3859, Portland, ME 04104, Phone: (800) 245-3529 357-10 Midwest National Life Ins. Co, P.O. Box 982017, North Richland Hills, TX 76182 362-04 Monumentary General Ins., 1111 North Charles, Baltimore, MD 21201 362-10 Monumental Ins., P.O. Box 97, Scranton, PA 78504 366-01 Mutual of Omaha, Mutual of Omaha Plaza, Omaha, NE 68175, Phone: (800) 316-7518 366-04 Mutual of Omaha, 6301 Ivy Ln. #100, Greenbelt, MD 20770 366-05 Mutual of Omaha, 1160 Bay St, Springfield, MA 01109 366-06 Mutual of Omaha, P.O. Box 9, Woodward, OK 73802 366-11 Mutual of Omaha, P.O. Box 668329, Charlotte, NC 28266 367-08 Advanced for Freedom, P.O. Box 7154, Lexington, KY 04702-7151, Phone: (800) 713-5095 367-10 Mutual Protective/Medico Life, P.O. Box 3735, Omaha, NE 68103 371-00 National Elevator Industry, P.O. Box 477, Newtown Square, NY 10116, Phone: (800) 221-2554 372-00 National Benefit Life Insurance Co., P.O. Box 2366, New York, PA 19073, Phone: (800) 252-4611 374-00 National Financial Ins., 110 West 7th St., Fort Worth, TX 76102, Phone: (800) 725-1407 376-03 National Health Insurance, P.O. Box 619999, Dallas/Ft. Worth Airp, TX 75261, Phone: (800) 237-1900 378-0 Peoples Benefit Life Insurance Company, Claims Dept., Valley Forge, PA 19493, Phone: (610) 648-5000 388-00 New England Financial, Do Not Use/Use 275-15, Minneapolis, MN 55402 388-01 New England Financial, Do Not Use/ Use 275-15, North Olmsted, OH 44070 388-06 One Health/New England Financial, Do Not Use/Use 275-15, Fort Scott, KS 66701, Phone: (800) 654-1731 388-12 New England Financial, Do Not Use/Use 275-15, Coraopolis, PA 15108 388-16 Unum Provident Corp, 18 Chestnut St., Worcester, MA 01608, Phone: (508) 799-4441 388-35 New England Financial, Do Not Use/Use 275-15, Tampa, FL 33630, Phone: (800) 654-1731 390-00 New York Life Insurance Co, 3316 Farnam Street, Omaha, NE 68175 390-01 New York Life Insurance Co, P.O. Box 64022, Phoenix, AZ 85082 390-05 New York Life Insurance, 420 Lexington Ave, New York, NY 10170, Phone: (646) 227-8888 390-09 New York Life, P.O. Box 92449, Chicago, IL 60675 390-12 New York Life Ins. Co, 51 Madison Avenue, New York, NY 10010 390-16 New York State Health Plan, P.O. Box 1600, Kingston, NY 12402-1600, Phone: (877) 769-7447 390-20 New York Life Ins., P.O. Box 30769, Jamaica, NY 11430 390-35 New York Life, 8834 Capital of Texas Hwy, Austin, TX 78759, Phone: (800) 723-5555 394-01 Trans American Insurance Company, P.O. Box 982009, North Richland Hills, TX 76182, Phone: (800) 527-2845 397-01 North America Life and Casualty, Med Claims Services, Boston, MA 02111 397-30 Meritain Health Insurance, P.O. Box 853921, Richardson, TX 75085, Phone: (800) 423-6011 397-35 Meritain Health, P.O. Box 9501, Amherst, NY 14226 398-40 State of North Carolina Teachers, P.O. Box 30025, Durham, NC 27702 405-02 Northwest National Life, P.O. Box 5222, Norwalk, CT 06856 406-00 CoreSource, 20 Washington Ave South, Minneapolis, MN 55440 406-01 Northwestern National, 180 Greenleaf Ave, Portsmouth, NH 03801 406-06 Northwestern National Life, P.O. Box 2264, Tacoma, WA 98401 406-24 CoreSource, 7830 East Broadway, Tucson, AZ 85710, Phone: (800) 888-7202 414-00 Oxford Life Insurance Co, 2721 North Central Ave, Phoenix, AZ 85004, Phone: (888) 757-3732 414-01 Oxford Life Insurance Company, P.O. Box 46518, Madison, WI 53744, Phone: (877) 469-3073 414-02 Oxford Health Plan, P.O. Box 7082, Bridgeport, CT 06601, Phone: (800) 444-6222 414-03 Oxford Health Plan, P.O. Box 2083, Nashua, NH 03061 414-40 PACC Health Plans, P.O. Box 1707, Clackamas, OR 97015 415-50 Pacific Coast Admin., Inc., 2100 West Orangewood Ave, Orange, Ca, 92668 416-01 Pacific Fidelity Insurance Co, P.O. Box 1038, Hurst, TX 76053 418-02 Pacific Mutual, 100 West Clarendon, Phoenix, AZ 85026 418-06 Pacific Life & Annuity Company, P.O. Box 34799, Phoenix, AZ 85067, Phone: (800) 733-2285 421-00 Primary Physician Care, 1515 Mockingbird Lane, Charlotte, NH 03833, Phone: (603) 296-0312 421-15 Patriot Health Care, 35 Industrial Way, Exeter, NC 28220 425-20 Pennsylvania Employee Benefit Trust, 150 South 43rd Street, Harrisburg, PA 11711, Phone: (717) 561-4750 430-00 Phoenix Insurance Co, One Tower Square, Hartford, CT 06115 430-03 Phoenix Life, One American Row, Hartford, CT 06115 430-04 Phoenix Life, P.O. Box 677, Greenfield, MA 01302 430-10 Phoenix, P.O. Box 1477, Greenfield, MA 01302 430-12 Phoenix, P.O. Box 810, Greenfield, MA 01302 431-40 Physician Care Plus, P.O. Box 31286, Tampa, FL 33631, Phone: (800) 794-5907, , 432-00 Physicians Mutual Insurance Co, P.O. Box 2018, Omaha, NE 68103, Phone: (800) 228-9100 432-30 Pine Health Benefits, P.O. Box 2160, Natick, MA 01760 433-01 Pioneer Management Systems, P.O. Box 9040, West Springfield, MA 01090, Phone: (888) 234-1011 433-02 Pioneer Life Insurance, P.O. Box 5151, Janesville, WI 53547, Phone: (800) 759-7007 435-00 Pinkerton, P.O. Box 5049, Costa Mesa, CA 92628, , , 435-05 P.P.O. Next, P.O. Box 2000-214, Mission Viejo, CA 92692, Phone: (800) 800-7616 439-00 Cigna, P.O. Box 188036, Chattanooga, TN 37422 439-01 Cigna Health Care, P.O. Box 188021, Chattanooga, TN 37422, Phone: (800) 433-3926 439-04 ConnectiCare, P.O. Box 522, Farmington, CT 06032, Phone: (860) 674-5700 439-06 Health Source, P.O. Box 180149, Chattanooga, CT 06034, Phone: (860) 674-5700 439-07 ConnectiCare, P.O. Box 546, Farmington, CT 06032, Phone: (800) 251-7722 439-24 Provident Mutual, P.O. Box 7011, Portsmouth, NH 03801 439-25 Cigna Pharmacy, P.O. Box 3598, Scranton, PA 18505 439-31 Health Source, P.O. Box 190023, N Charleston, SC 21419 441-35 Prudential, P.O. Box 1400, Parsippany, NJ 07054 442-50 PEHP (Public Employees Healthplan), 560 East 200 South, Salt Lake City, UT 84102, Phone: (800) 765-7347 444-10 RMSCO, P.O. Box 6309, Syracuse, NY 13217, Phone: (877) 300-7343 444-15 RMSCO, P.O. Box 678, Liverpool, NJ 08057, Phone: (800) 321-2347 448-05 Reliance Standard Life Ins. Co., 505 South Lenola Road, Moorestown, NJ 08057-1548, Phone: (866) 375-0775 451-10 Reserve National Insurance, P.O. Box 26620, Oklahoma City, OK 73126, Phone: (800) 654-9106 462-40 Sierra Health Plan, P.O. Box 18408, Las Vegas, NV 89114-8408, Phone: (800) 777-1840 472-14 State Mutual-London Agency, 223 Newport Avenue, Pawtucket, RI 02861 480-00 Time Insurance Co, P.O. Box 624, Milwaukee, WI 53201 481-40 Touchstone Health PSO, P.O. Box 33519, Indianapolis, IN 46203 484-00 Transamerica Occidental Life Ins, , P.O. Box 92106, Bedford, TX 76095, Phone: (800) 227-3740 486-00 Transport Life Insurance, 714 Main St, Fort Worth, TX 76102 488-00 United Healthcare, P.O. Box 9516, New Haven, CT 06534 488-03 United Healthcare Insurance Co., P.O. Box 473519, Charlotte, NC 28247 488-17 Metrahealth/United Healthcare, P. O. Box 26722, Greensboro, NC 27417 488-25 Travelers Ins, , P.O. Box 4215, Atlanta, GA 30302 488-35 United Healthcare/Railrd/Active Employee, P. O. Box 30985, Salt Lake City, UT 84130 488-51 Travelers Insurance, P.O. Box 8026, San Rafael, CA 94901, Phone: (877) 582-7767 488-53 United Healthcare/Railrd/Medicare/Over 65, P.O. Box 30304, Salt Lake City, UT 84130 488-62 United Healthcare, P O. Box 26722, Greensboro, NC 27417 489-00 Trustmark Insurance, P.O. Box 9137, Fort Worth, TX 76147 489-10 Trustmark Insurance, P.O. Box 7900, Lake Forest, IL 60045, Phone: (847) 615-1300 489-15 Trustmark Dental, P.O. Box 2942, Clinton, IA 52733 491-00 Union Fidelity Life Insurance Co, P.O. Box 10841, Clearwater, FL 33757 493-00 Union Labor Life Insurance Co, 360 Park Avenue S 2nd Fl, New York, NY 10010 493-02 Union Labor Life Insurance, 161 Forbes Rd Suite 204, Braintree, MA 02184 495-00 Unum Life Insurance, 2211 Congress St, Portland, ME 04122 498-00 United American Insurance Co, P.O. Box 8080, McKinney, TX 75070, Phone: (972) 529-5085 498-05 United American, P.O. Box 26400, Oklahoma City, OK 73126 498-10 United Administrative Services, 33 Harrison Ave, Boston, MA 02111 498-40 United Church of Christ, P.O. Box 197629, Louisville, KY 40259 508-01 United States Life Insurance, P.O. Box 1581, Neptune, NJ 07754, Phone: (732) 922-7000 508-40 United Medical Resources, 2343 Auburn Ave, Cincinnati, OH 45221, Phone: (800) 436-3100 508-43 United Medical Resources, Inc., P.O. Box 141337, Cincinnati, Oh, 45250 510-01 Universal Health Service, P.O. Box 2843, Warminster, PA 18974, Phone: (800) 847-7718 512-20 Upstate Administrative Service Inc, P.O. Box 6589, Syracuse, NY 13217 513-01 Utica Mutual Insurance Company, 401 Edgewater Place, Wakefield, MA 01880, , , 516-50 Walmart Benefit Administration, 922 West Walnut, Rogers, AR 72756, Phone: (800) 421-1362 520-05 Western Health, 529 Kansas City St, Rapid City, SD 57701 523-15 Volusia Health Network, 400 No. Clyde Morris Blvd, Daytona Beach, FL 32114 Phone: (386) 258-4822 524-02 World Insurance, P.O. Box 3160, Omaha, NE 68103, Phone: (402) 496-8000 528-00 Amalgamated Insurance, P.O. Box 1449, New York, NY 10116, Phone: (212) 539-5105 528-01 Amalgamated Ins., 867 State Rd., North Dartmouth, MA 02724 528-05 Amalgamated Local 298, 825 East State Blvd, Garden City, NY 11530 528-06 Amalgamated Life Insurance, 333 South Ashland Ave, Chicago, IL 60607 528-10 Amalgamated Insurance, 99 University Place, New York, NY 10003 528-13 Amalgamated Life Ins. Co, P.O. Box 1440, New York, NY 10116 531-02 University Health Plans, P.O. Box 7949, Lake Forest, IL 60045 538-40 AVMED Health Plan, P.O. Box 2939, Gainesville, FL 32602, Phone: (352) 372-8400 546-19 CNIC Health Solutions Inc, P.O. Box 3559, Englewood, CO 80155, Phone: (800) 426-7453 555-05 DMA Authorized Use Only, Not for Active TPL Use, Boston, MA 02111 558-00 General Dynamic Corp, 97 East Howard St, Quincy, MA 02169 562-00 Hartford Insurance Co, P.O. Box 1000, Shelton, CT 06484 562-02 Benefit Planners, P.O. Box 690450, San Antonio, TX 78269, Phone: (800) 368-3653 562-04 Hartford Insurance, P.O. Box 11910, Alexandria, VA 22312 564-00 Harvard University, 1350 Massachusetts Ave, Cambridge, MA 02138 568-01 Idealife Insurance Company, P.O. Box 12546, Pensacola, FL 32591 574-03 Natl Union Fire C/O Crawford and Co, 466 Totten Pond, Waltham, MA 02401 580-10 Polaris Benefit Administrator, P.O. Box 2090 C, Stow, OH 44224 589-00 Sentry Life Policy Benefits, P.O. Box 8025, Stevens Point, WI 54481, Phone: (800) 426-7234 592-03 State Farm Mutual Health Insurance Inc, P.O. Box 3070, Newark, OH 43058, Phone: (866) 855-1212 600-00 Veterans Aid and Attendance, JFK Building, Boston, MA 02203 600-10 Allied Benefit Systems, P.O. Box 909786-60690, Chicago, IL 60696, Phone: (312) 906-8050 600-15 Medical Card System, P.O. Box 9023547, San Juan, PR 00902 600-60 National Benefit Plans, P.O. Box 1817, Suffolk, VA 23439, Phone: (757) 923-3400 600-90 Group Health Insurance, P.O. Box 2832, New York, NY 10116, Phone: (800) 624-2414 602-00 Fiserv Health, P.O. Box 450, Pueblo, CO 81102-0450, Phone: (877) 810-3664 602-01 Wausau Benefits Inc. (Georgia Pacific), P.O. Box 8092, Wausau, WI 54402, Phone: (715) 841-7111 602-02 Wausau Ins. Co, Do Not Use/Use 602-00, Wausau, WI 54480, Phone: (877) 810-3664 602-04 Fiserv Dental Claims, P.O. Box 8032, Wausau, WI 54402, Phone: (877) 559-4244 606-00 MMSI, 4401 41st Street NW, Rochester, MN 55901, Phone: (877) 832-1822 606-02 MVP, 111 Liberty Street, Schenectady, NY 12301, Phone: (800) 666-1762 606-04 MVP Select Care Inc, P.O. Box 1434, Schenectady, NY 12301 606-05 Arizona Foundation, P.O. Box 2909, Phoenix, AZ 85062, Phone: (800) 522-1246 606-06 Star Mark, P.O. Box 2942, Clinton, IA 52733, Phone: (800) 522-1246 606-10 Adventist Risk Management, 7083 Grand National Drive, Orlando, FL 32819 607-25 Claims Ware Ink (CWI), P.O. Box 6125, Greenville, SC 29606-6125, Phone: (800) 992-8088 609-02 Mail Handlers Benefit Plan, P.O. Box 8402, London, KY 40742, Phone: (800) 317-6775 609-03 National Association of Letter Carriers, 20547 Waverly Ct, Ashburn, VA 22093 609-04 Postmaster Benefit Plan, P.O. Box 782369, San Antonio, TX 78278 610-10 NPPN, P.O. Box 7047, Middletown, NY 10940, Phone: (800) 582-8547 610-50 Benefit Plan Management, P.O. Box 536, Rockland, MA 02370, Phone: (781) 753-7500 610-70 Federal Contract Employee (FCE), 445 Recoletta Rd, San Antonio, TX 78216 611-02 National Assoc Self Employed, 41 N Summer St, Holyoke, MA 01042 614-00 Teamsters Health Services, 400 Chapel Rd Unit 2 A, South Windsor, CT 06074, Phone: (860) 289-3409 614-01 IUNH Health and Welfare, 1101 N Lake Destiny Rd, Maitland, FL 32751 614-02 Teamsters Union 25 Health Services, 16 Sever St, Charlestown, MA 02129, Phone: (617) 241-9220 614-04 Mass Laborer S Health and Welfare Found, P.O. Box 4000, Burlington, MA 01803, Phone: (781) 272-1000 614-04 Health and Welfare Fund, 40 Commercial Way, The London Administrators, East Providence, RI 02914, Phone: (800) 343-2236 614-07 Ironworkers Union Local 7, 100 Charles River Plaza, Brighton, MA 02135 614-08 Bakery & Confectionary Union, 10401 Connecticut Ave, Kensington, MD 20895 614-11 New England Carpenters Health and Welfare, P.O. Box 7075, Wilmington, MA 01887, Phone: (978) 694-1000 614-13 Maxon (Local 210), P.O. Box 606, Neversink, NY 12765, Phone: (800) 762-3137 614-15 Plumbers Union Health and Welfare, 1240 Mass Ave, Local 12, Boston, MA 02125 614-16 UFCW Local 1459, 33 Eastland St, Springfield, MA 01109, Phone: (413) 733-0177 614-17 Teamster's Health and Welfare, 650 Beacon St, Boston, MA 02115 614-20 Bricklayers and Masons Local 3, 645 Morrissey Blvd, , Boston, MA 02122 614-21 Mason Health and Welfare Local 534, 7 Frederika St, Dorchester, MA 02145 614-22 Local 4 Health and Welfare, P.O. Box 4, Lexington, MA 02420, Phone: (781) 861-1600 614-24 New England Teamsters, P.O. Box 38, North Andover, MA 01845, Phone: (978) 682-7407 614-27 Loc 371 United Food & Commercial Workers, 290 Post Rd West, Westport, CT 06881 614-29 Boilermaker S National Health and Welfare, P.O. Box 23825, Tucson, AZ 85734 614-30 Teamster's Health and Welfare Local #170, 805 Millbury St, Worcester, MA 01607 614-37 Operating Engineers Local 302, P.O. Box 34684, Seattle, WA 98124 614-40 Electrical Workers Health & Welfare, Local 103, Boston, MA 02122, Phone: (617) 288-5999 614-41 IUOE Local #4 Health & Welfare, 177 Bedford St, Lexington, MA 02173, Phone: (781) 861-1600 614-43 New England Laundry Workers Insurance, 697 Broadway, Somerville, MA 02144 614-45 Magna Preferred, 158-11 Harry Van Arsdale, Flushing, NY 11365 614-46 American Postal Workers Union, P.O. Box 1358, Glen Burnie, MD 21060 614-49 United Furniture Workers, P.O. Box 100037, Nashville, TN 37224 614-50 EWTS Local 26, 4601 Presidents Drive, Lantham, MD 20706 614-52 Teamsters Local 59, 27 South Sixth Street, New Bedford, MA 02740, Phone: (800) 880-5959 614-54 Carpenters Health and Welfare, 29 Oakland Street, Springfield, MA 01101 614-60 Woodmen of the World/Omaha Woodmen, 1700 Parkman St, Omaha, NE 61460, Phone: (800) 225-3108 614-62 Teamsters Health Services 404, P O Box 1370, Springfield, MA 01101, Phone: (413) 733-2191 614-66 Operating Engineers Health and Welfare, P.O. Box 217, East Longmeadow, MA 01028 614-68 SEIU Local 254, 11 Beacon St., Boston, MA 02108, Phone: (617) 367-7360 614-70 Teamsters Local 671 Hlth Svs, Anthem BCBS, North Haven, CT 06473 614-88 Teamsters Central States, P.O. Box 5103, Des Plaines, IL 60017 614-89 Amalgamated Clothing Textile, 730 Broadway St, New York, NY 10003 614-90 Health & Welfare Fund, 140 Wood Rd, Braintree, MA 02184 614-94 South West Administrators, P.O. Box 1121, Alhambra, CA 91802, Phone: (877) 350-4792 614-97 Sagamore Health Network, P.O. Box 6051, Indianapolis, IN 46206, Phone: (800) 552-6550 615-00 Unvsty of Mass Supplemental Hlth I, University Center, Amherst, MA 01003 615-03 Health First Health Plan Inc, P.O. Box 410129, Melbourne, FL 32941 615-05 Teamsters Local 671, 18 Britton Drive, Bloomfield, CT 06002 615-09 UFCW Local 371, 290 Post Rd West, Westport, CT 06880, Phone: (203) 226-4751 615-10 Painting Industry, 8257 Dow Circle, Strongsville, OH 44136 615-11 UFCW National Health & Welfare, P.O. Box 751, Englewood, NJ 07631, Phone: (888) 773-8329 615-12 Painters District Council Local 35, P.O. Box 9165, Care Link Claims, Watertown, MA 02471 615-13 Emerald Health Network, P.O. Box 94808, Cleveland, OH 44101 615-15 CF&I Colorado Fuel & Iron, 5 Gateway Center Suite 6, Pittsburg, PA 15222 615-20 Health First TPA, P.O. Box 130217, Tyler, TX 75713 615-24 New England Electrical Worker's Benefits, P.O. Box 5817, Wallingford, CT 06492, Phone: (800) 832-6538 615-26 New Eng. Hlth Care Welfare Fund, 77 Huyshope Avenue, Hartford, CT 06106, Phone: (860) 728-1100 615-41 Lineco (IBEW Local 322), 2000 Springer Dr, Lombard, IL 60148, Phone: (800) 323-7268 615-44 UFCW District 5, 108-36 Queens Blvd., Forest Hills, NY 11375 615-49 Teamsters Union Local 20, 435 South Halley Street, Toledo, OH 43609, Phone: (419) 243-8800 615-52 Sheet Metal Workers Natl Hlth Fund, P.O. Box 1449, Goodlettsville, TN 37070, Phone: (800) 831-4914 615-66 Laborers Local 1298, P.O. Box 309, Fulton, NY 13069, Phone: (516) 489-3644 616-00 AARP, P.O. Box 740819, Atlanta, GA 30301, Phone: (800) 523-5800 616-01 AARP, 215 Long Beach Blvd, Long Beach, CA 90801 616-02 AARP Health Care Options, P.O. Box 985, Westport, CT 06881, Phone: (888) 687-0977 618-05 HMC, P.O. Box 488, Farmington, CT 06031 618-20 Health Comp, P.O. Box 45018, Fresno, CA 93718 619-00 Hospital Benefits Inc, P.O. Box 162148, Altamonte Springs, FL 32716, Phone: (407) 862-0311 620-13 LAV Dental Security Life, 701 Highlander Blvd, Arlington, TX 76015 622-00 Medical Claims Service Inc, One Wall St. Suite 2A, Ravenswood, WV 26164, Phone: (304) 273-5384 622-15 Medical Claims Services, 100 River Ridge Dr, Norwood, MA 02062 623-00 HCH Admin, P.O. Box 1986, Peoria, IL 61656, Phone: (800) 447-3227 624-00 American Chambers Life Ins. Co., P.O. Box 3048, Naperville, IL 60566 624-01 American Chambers Life Insurance Company, UCIP Northeast, Hyannis, MA 02601 625-00 St. Paul Inc, P.O. Box 5508, Newtown, CT 06470, Phone: (800) 678-8161 625-01 St. Paul Inc., P.O. Box 14669, Cincinnati, OH 45250-0669, Phone: (866) 334-4553 626-01 St Paul Electrical Construction, 1330 Conway St, Medical Reimbursement Plan, St Paul, MN 55106, Phone: (651) 776-4239 630-00 Managed Care Strategies Network, 1 East Uwchlan Ave, Exton, PA 19341 630-10 J F Molloy & Associates, P.O. Box 68947, Indianapolis, IN 46268, Phone: (800) 331-3287 630-65 Epoch, P.O. Box 12170, Overland Park, KS 66282, Phone: (913) 385-2052 630-70 Epoch, 10795 Watson Rd, St Louis, MO 63127, Phone: (800) 365-9036 638-00 James Galbraith and Green, 757 East South Temple, Salt Lake City, UT 85271, Phone: (800) 937-6824 638-02 Coventry Health, P.O. Box 11038, Scottsdale, AZ 85271, Phone: (800) 937-6824 638-03 Coventry Health, P.O. Box 27142, Baltimore, MD 02464, Phone: (617) 581-6655 638-05 HMA Direct, P.O. Box 425, Newton Upper Falls, MA 02164 638-10 Alternative Risk Management, 10200 Southwest Nimbus, Portland, OR 97223 638-12 Alta Administrators, 350 Glenborough Drive, Houston, TX 77067, Phone: (800) 937-6824 638-17 Coventry Health, P.O. Box 22410, Tucson, AZ 85734, Phone: (800) 937-6824 638-18 Coventry Health, P.O. Box 535920, Pittsburg, PA 15253, Phone: (800) 937-6824 638-20 Coventry Health, P.O. Box 11950, Coraopolis, PA 15108, Phone: (800) 815-8189 638-22 Coventry Health, P.O. Box 8400, London, KY 40742, Phone: (800) 937-6824 638-24 Coventry Health, P.O. Box 23550, Tucson, AZ 85734, Phone: (800) 852-6011 638-25 Coventry Health, P.O. Box 23070, Tucson, AZ 85734, Phone: (800) 280-6658 638-27 Coventry Health, P.O. Box 11127, Tucson, AZ 85734, Phone: (800) 571-3517 638-30 Alta Health, P. O. Box 59059, Minneapolis, MN 55459, Phone: (800) 937-6824 638-31 First Administrators, P.O. Box 9900, Sioux City, IA 51102-0479 638-32 Century Healthcare, P.O. Box 2256, Grapevine, TX 76099-2256 638-33 Coventry Health, P.O. Box 9500, Coraopolis, PA 15108, Phone: (800) 345-8994 638-38 Alta Health Strategies, P.O. Box 27142, Baltimore, MD 21230 638-43 Coventry Health, P.O. Box 23809, Tucson, AZ 85734, Phone: (800) 937-6824 638-47 Coventry Health, P.O. Box 23130, Tucson, AZ 85734, Phone: (800) 226-8461 638-50 Altus Dental, P.O. Box 1557, Providence, RI 02901, Phone: (877) 223-0558 639-02 HM Benefit Administrators, P.O. Box 535078, Pittsburgh, PA 15253 640-00 Harborside Healthcare, P.O. Box 4925, Lancaster, PA 17604, Phone: (800) 235-9562 640-50 Allied Administrators, P.O. Box 2500, San Francisco, CA 94126, Phone: (415) 986-6276 641-10 Performax, P.O. Box 61505, King of Prussia, PA 19406, Phone: (888) 554-7629 641-11 Performax, P.O. Box 1065, Amherst, NY 14226, Phone: (800) 283-9538, , 642-20 Stirling & Stirling Inc., 20 Armory Lane, Milford, CT 06460, Phone: (800) 447-6689 643-00 Med Tac, P.O. Box 9110, Newton, MA 02460, Phone: (617) 244-0222 643-10 MedBen, P.O. Box 2090c, Stow, OH 44224, Phone: (800) 423-3151 645-50 US Family Health Plan, P.O. Box 9195, Watertown, MA 02471, Phone: (800) 818-8589 646-05 Paradigm, P.O. Box 1268, Tifton, GA 31793 647-20 Geisinger Health Plan, P.O. Box 8200, Danville, IA 50306, Phone: (515) 243-1776 650-45 Marsh Insurance, P.O. Box 10432, Des Moines, PA 17821, Phone: (570) 271-6211 650-50 Mashantucket Plan Administrators, P.O. Box 3620, Mashantucket, CT 06339, Phone: (888) 779-6872 653-00 Am Maritime Officers Med Plan, P.O. Box 35, Dania Beach, FL 33004, Phone: (800) 348-6515 654-00 ASR Corp, 3033 Orchard Vista Dr SE, Grand Rapids, MI 49546, Phone: (616) 957-1751 656-01 Diversified Administration Corp., P.O. Box 299, Marlborough, CT 06447, Phone: (888) 322-2524 656-02 Core Source, P.O. Box 5190, Tampa, FL 33675, Phone: (800) 221-8490 656-03 Diversified Group Administrators, P.O. Box 6540, Harrisburg, PA 17112, Phone: (800) 877-6490 656-05 WellCare of Florida Inc, P.O. Box 31372, Tampa, FL 33631, Phone: (800) 799-3081 658-10 Delta USA, P.O. Box 5402, Lisle, IL 60532, Phone: (800) 398-7203 658-20 Washington Dental, P.O. Box 75983, Seattle, WA 98125 659-04 Zenith Administrators, 161 Forbes Rd, Braintree, MA 02184 659-05 Zenith Administrators, 101 Convention Ctr Drive, Las Vegas, NV 89109 659-08 Zenith Administrators, 33 Eastland Street, Springfield, MA 01109 659-10 United Chambers, P.O. Box 3209, Covina, CA 91722 659-16 Perfect Health, P.O. Box 140724, Staten Island, NY 10314-0724, Phone: (718) 370-5380 660-10 Presbyterian Health Plan, P.O. Box 27489, Albuquerque, NM 87125, Phone: (800) 356-2219 660-50 Precise Benefits, P.O. Box 9064, Jericho, NY 11753 661-02 CBA Inc, 3800 NW 12th, Lincoln, NE 68521, Phone: (888) 673-2872 661-05 Comprehensive Benefits Adm., P.O. Box 2365, S. Burlington, VT 05407, Phone: (800) 525-8788 661-20 Comprehensive Benefits Services, P. O. Box 8955, Melville, NY 77292-8955, Phone: (800) 231-7269 669-05 Americas Choice Healthplans, P.O. Box 922043, Houston, TX 77292, Phone: (800) 633-4227 669-08 American Progressive, P.O. Box 130, Pensacola, FL 32591 669-10 American National Health Insurance, P.O. Box 1520, Galveston, TX 77553, Phone: (800) 899-6806 670-02 S & S Healthcare, P.O. Box 141097, Cincinnati, OH 45250, Phone: (866) 266-1110 670-10 Sauder Welfare Trust, P.O. Box 156, Archbold, OH 43502 670-30 First United American Life Insurance Co, P.O. Box 3125, Syracuse, NY 13220, Phone: (315) 451-2544 677-00 State Health Benefit Plan, P.O. Box 38342, Atlanta, GA 30334 678-00 Choice Plus of Vermont, P.O. Box 6589, Syracuse, NY 13217, Phone: (802) 479-9762 678-10 Choice Benefits, P.O. Box 10048, Fort Smith, AR 72917, Phone: (479) 785-6178 680-00 Select Ben Administrators of America, P.O. Box 440, Ashland, WI 54806, Phone: (800) 497-3699 680-20 AUSA Insurance Plan, P.O. Box 10401, Des Moines, IA 50306 680-50 Starmark, P.O. Box 420, Freeport, IL 61032, Phone: (800) 371-1633 681-01 National Benefits Inc, P.O. Box 263, Parsippany, NJ 07054, Phone: (800) 258-0103 682-50 American Trust Administrators, P.O. Box 87, Shawnee Mission, KS 66201, Phone: (913) 451-4900 683-50 American Republic Insurance Co, P.O. Box 10, Des Moines, IA 50301, Phone: (800) 247-2190 687-00 Employee Benefit Plan Administration-EBPA, P.O. Box 2000, Exeter, NH 03833, Phone: (800) 578-3272 687-02 Employee Benefit Administrators, Inc., 64 Schoosett St, Pembroke, MA, 02359, (781) 826-1177 687-03 EBMS (Employee Benefit Mgmt Service), P.O. Box 4000, Draper, UT 84020, Phone: (801) 572-0720 687-06 EBMS (Employee Benefit Mgmt Service), P.O. Box 21367, Billing, NY 13221, Phone:(315) 671-7073 687-07 EBS Benefit Solutions, P.O. Box 4863, Syracuse, MT 59104, Phone: (406) 245-3575 687-20 Employee Benefits Corp, 1200 East Glen Avenue, Peoria Heights, IL 61616, Phone: (309) 679-0810 687-30 Employee Benefits Claims, 440 Lincoln Street, Worcester, MA 01653 688-45 Assoc. Administrative Inc., P.O. Box 6680, Portland, OR 97228 688-50 Associated Administrators Group Inc, P.O. Box 700428, Dallas, TX 75370 690-00 Champion International, Knights Bridge Dr, Hamilton, OH 45020 691-00 Us Administrators, P.O. Box 30654, Los Angeles, CA 90030 691-35 MCREW Care/Planned Admin., P.O. Box 6702, Columbus, SC 29260 692-01 Hallmark Health Advantage, 100 Hospital Road, Malden, MA 02148 693-01 P5 Electronic Health Services, P.O. Box 9554, Salt Lake City, UT 84109, Phone: (800) 551-4049 693-50 Medica United Health Care, P.O. Box 30990, Salt Lake City, UT 84130-0990, Phone: (800) 952-3455 694-03 Willis of Kansas, P.O. Box 2906, Koch Industries Employee, Wichita, KS 67201, Phone: (800) 235-7160 696-00 Group Health Incorporated, P.O. Box 3000, New York, NY 10116 696-05 Group Management Services, P.O. Box 24708, Omaha, NE 68124 696-30 Group Resources Inc., P.O. Box 100043, Duluth, GA 30096, Phone: (770) 242-7776 696-50 Group Health Plan, P.O. Box 7374, London, KY 40742 697-50 New Tribes Mission, 1000 East First St, Sanford, FL 32771 698-00 Corporate Benefits Services, 139 So Tryon St 6th Fl, Armstrong Claims Division, Charlotte, NC 28202, Phone: (704) 373-0447 699-00 Firestone Tire and Rubber Co, 1200 Firestone Parkway, Attn Benefits, Akron, OH 44317 699-02 Bridgestone Firestone, P.O. Box 247, Sheldon, IA 51201 700-06 HPS/Paradigm, P.O. Box 1268, Tifton, GA 31793, Phone: (229) 386-1751 700-08 Preferred Benefit Administrators, P.O. Box 916188, Longwood, FL 32791-6188, Phone: (888) 524-2777 700-09 Plan 21, 4550 Post Oak Place, Houston, TX 77027 700-11 Protective Dental Care, P.O. Box 830626, Birmingham, AL 35283, Phone: (800) 866-5020 700-14 Plastek Group Dental Plan, 1250 Tower Lane, Erie, PA 16505 700-15 Complete Care Control Simplex, Simplex Plaza, Gardner, MA 01441 700-37 Montachussett Health Plan, 285 Central Street, Leominster, MA 01453 700-48 US Now, 8350 N Central Expressway, Dallas, TX 75206 700-57 CNR Consulting, 1501 Broadway, New York, NY 10036 700-71 American Service Life, P.O. Box 470788, Fort Worth, TX 76147 700-75 Archdiocese of Miami Health Plan Trust, 9401 Biscayne Blvd, Miami Shores, FL 33138 700-76 SummaCare, P.O. Box 3620, Akron, OH 44309, Phone: (800) 996-8401 700-77 Legett & Platt Company, P.O. Box 757, Carthage, MO 64836, Phone: (417) 358-8131 700-78 Providence Health Plan of Oregon, P.O. Box 3125, Portland, OR 97208, Phone: (888) 244-6643 700-81 Group Insurance Service Center, P.O. Box 9120, Marshfield, MA 02050, Phone: (800) 242-3834 700-85 Eaton Benefit Payment Office, P.O. Box 8518, London, KY 40742 700-90 HPN (Health Plan Nevada), P.O. Box 15645, Las Vegas, NV 89114, Phone: (702) 242-7300 701-02 Machigonne Benefit Administrators, P.O. Box 3859, Portland, ME 04104, Phone: (800) 245-3529 701-03 Indecs, 1099 Wall Street, Lyndhurst, NY 07071 701-07 Benefit Risk Management, P.O. Box 2650, Rancho Cordova, CA 95741, Phone: (916) 858-2950 701-10 Benefit Management Services, Inc, Post Office Box 1178, Matthew, NC, 28106 701-24 Benefits Claims Payors, Inc., P.O. Box 37400, Phoenix, AZ 85069, (800) 266-6868 701-25 Life Wise Health Plan, P.O. Box 7709, Bend, OR 97708, Phone: (800) 777-1502 701-40 APA Partners Inc, 8 British Blvd, Latham, NY 12110, Phone: (800) 833-3650 701-41 Mohawk Valley Health Plan, P.O. Box 1434, Schenectady, NY 12301 701-80 Ironclad, 161 Granite Ave, Dorchester, MA 02124, Phone: (617) 436-3500 702-25 CBCA Administrators, P.O. Box 1539, Fort Worth, TX 76101, Phone: (800) 808-4515 702-30 CBC Administrators, P.O. Box 776, Melville, NY 11747, Phone: (877) 769-3942 702-35 CBCA Administrators, P.O. Box 8911, Melville, NY 11747, Phone: (877) 769-3942 702-40 CBCA, P.O. Box 5190, Tampa, FL 33675 702-41 CBCA, P.O. Box 9888, Savannah, GA 31412 702-42 CBCA, P.O. Box 9000, London, KY 40742 702-45 Samba, P.O. Box 8600, London, KY 40742-8600 703-00 MIT Health Plan, 77 Massachusetts Ave., Cambridge, MA 02139 703-01 CoreSource, P.O. Box 1195, Minneapolis, MN 55440 703-02 CoreSource, 146 Industrial Park, Jackson, MN 56143, Phone: (800) 274-6965 703-05 USA MCO, P.O. Box 160300, Austin, TX 78716 703-25 CoreSource, P.O. Box 83301, Lancaster, PA 17608 703-30 CoreSource, Inc., 4940 Campbell Blvd., Baltimore, MD, 21236, (410) 931-5060 703-40 CoreSource, P.O. Box 168, Matteson, IL 60443, Phone: (800) 848-3012 703-45 CoreSource, P.O. Box 6118, Westerville, OH 43086 703-50 CoreSource, Inc., 6100 Fairview Rd. Ste 10, Charlotte, NC 28210 703-70 CoreSource, Shawnee Mission Pkwy 422, Shawnee Mission, KS 06205 703-80 CoreSource, P.O. Box 2920, Clinton, IA 52733, Phone: (800) 223-3943 704-10 Shaw Industries Inc, P.O. Box 1208, Dalton, GA 30722 705-30 A.G. Edward & Sons, 1 North Jefferson Ave, St Louis, MO 63013 705-38 Dos Delta Dental of Oregon, 601 South West 2nd. Ave., Portland, OR 97204-3154, Phone: (877) 277-7280 705-60 Westport Benefits, P.O. Box 66743, St Louis, MO 63166 706-00 Union Bankers Insurance Company, P.O. Box 130, Pensacola, FL 32591, Phone: (800) 789-6364 707-00 Catholic Assoc of Foresters, 347 Commonwealth Ave, Boston, MA 02115 708-05 Team Health, P.O. Box 612768, Dallas, TX 75261, Phone: (800) 275-1171 709-00 Jefferson-Pilot, P.O. Box 20727, Greensboro, NC 27420 709-03 Shasta Admin Services, P.O. Box 1747, Redmond, OR 97708, Phone: (800) 441-4518 709-04 Jeld-Wen Shanta Administrators, P.O. Box 1747, Redmond, OR 97756, Phone: (800) 423-2765 709-05 Jefferson-Pilot Dental, P.O. Box 2670, Omaha, NE 68103, Phone: (800) 441-4518 710-14 Washington Gas/Medical Claims, 6801 Industrial Rd, Springfield, VA 22151 711-00 Excellus Benefit Services, P.O. Box 13221, Syracuse, NY 13221, Phone: (315) 448-6925 711-01 FCE Benefit Administrators Inc, 1010 foster City Blvd, Foster City, CA 94404, Phone: (800) 899-9355 712-00 Genworth Life Insurance Company, P.O. Box 5718, Hopkins, MN 55343 712-01 General Electric Pensioners, P.O. Box 6125, Utica, NY 13504 712-02 CDS, P.O. Box 50190, Sparks, NV 50190, Phone: (800) 455-4236 712-04 GE Group Administrators, P.O. Box 3005, Agawam, MA 01001, Phone: (888) 255-8961 712-05 General Electric Health Care Preferred, P.O. Box 740801, Atlanta, GA 30374, Phone: (800) 432-3450 712-06 GE Capital Assurance, 1650 Los Gamos Drive, San Rafael, CA 94903 712-07 General Electric Capital Assurance Co, File# 56790, Los Angeles, CA 90074 712-10 GE Group Administrators, P.O. Box 100252, Columbia, SC 29202 712-15 Genworth Dental, P.O. Box 40011, Lynchburg, VA 24506 713-12 GMP Employers Retiree Trust, 5245 Big Pine Way, Ft Myers, FL 33907, Phone: (239) 936-6242 714-20 Claims Management Service, P.O. Box 10888, Green Bay, WI 54307 714-25 Claim Management Services, P.O. Box 279, West Bend, WI 53095, Phone: (800) 245-6142 714-60 Claims Processing Center, P.O. Box 10841, Clearwater, FL 33757 715-25 USSA Life Insurance Company, 9800 Frederick Road, San Antonio, TX 78288, Phone: (800) 531-8000 715-30 US Able Admin/Blue Advantage, P.O. Box 1460, Little Rock, AR 72203 717-00 FRA Milicare, P.O. Box 10340, Des Moines, IA 50306, Phone: (800) 424-1120 719-04 Jesuit Health Trust, 1205 Windham Pkwy, Romeoville, IL 60446 720-05 QualCare, P.O. Box 1030, Piscataway, NJ 08854, Phone: (800) 992-6613 720-10 Sisco, P.O. Box 389, Dubuque, IA 52004, Phone: (800) 793-5235 720-20 Q3 Business Tech Corp for Votaw Electric, P.O. Box 15952, Fort Wayne, IN 46885, Phone: (219) 492-9979 720-40 Florida First Administrators Inc, 3425 Lake Alfred Road #2, Winter Haven, FL 33881 720-50 Shenadoah Life, P.O. Box 11807, Roanoke, VA 24022 720-60 QualChoice of North Carolina, P.O. Box 350, Winston-Salem, NC 27102 722-00 Northeast Delta, 6 London St, Concord, NH 03301 723-50 HCC Life Insurance Company, P.O. Box 6222, Indianapolis, IN 46206 730-50 Babb Inc., 850 Ridge Ave, Pittsburgh, PA 15212, Phone: (800) 245-6102 733-00 American Travellers Life Insurance, 3220 Tillman Dr, Bensalem, PA 19220, Phone: (800) 441-3978 734-01 Definity Health, P.O. Box 740810, Atlanta, GA 30374, Phone: (866) 333-4648 734-02 Definity Health, P.O. Box 5317, Tampa, FL 33675 734-03 Definity Health, P.O. Box 63905, Harrisburg, PA 17106 734-04 Definity Health, P.O. Box 30566, Salt Lake City, UT 84130, Phone: (866) 333-4648 734-10 Destiny Health Plan, P.O. Box 4628, Oakbrook, IL 60522, Phone: (704) 373-0447 737-01 Corporate Benefits Service Inc, P.O. Box 12954, Charlotte, NC 28220 737-03 Corporate Benefits Systems, 139 S Tyron St, Charlotte, NC 28202 737-04 Corporate Benefit Services of America, P.O. Box 27267, Minneapolis, MN 55427 737-05 Corporate Benefit Service, 145 Scaley Bark, Charlotte, NC 28220, Phone: (800) 277-9476 737-06 Corporate Benefits of America, P.O. Box 2043, Hopkins, MN 55343 737-07 Corporate Health Planners Insurance, 2464 Whitney Ave, Hamden, CT 06518 741-00 Morton Building Employee Health, P.O. Box 232, Morton, IL 61550 744-00 Confederate Administrative Services, Suite 250, Wellesley, MA 02181 747-05 Susquehanna Administrators, 1 Executive Park Drive, Bedford, NH 03102 749-60 Big Lots Associates Plan, P.O. Box 9071, Dublin, OH 43017 750-02 Seabury and Smith, P.O. Box 10408, Des Moines, IA 50306 750-05 Seafarers Health, P.O. Box 380, Piney Point, MD 20604 750-10 Thompson Agency of New England, 763 Farmington Ave, Farmington, CT 06032 750-20 SIEBA LTD, P.O. Box 5000, Endicott, NY 13761 750-30 Retiree Medical Insurance, P.O. Box 10432, Des Moines, IA 50306 752-01 Self Insured Services Company, P.O. Box 389, Dubuque, IA 52004, Phone: (800) 793-5235 753-01 Eastern Benefits Sup, 200 Freeway Dr East, East Orange, NJ 07019, Phone: (800) 524-0227 753-02 United Administrative Services, P.O. Box 5057, San Jose, CA 95150, Phone: (408) 286-7663 753-03 Vision Benefits of America, 300 Weyman Rd, Pittsburg, PA 15236 756-05 Principal Financial Group, 1 International Plaza, Philadelphia, PA 19113 756-13 Principle Financial Group, 1245 Corporate Blvd, Aurora, IL 60504, Phone: (630) 978-4669 756-15 Principal Life Insurance, P.O. Box 39710, Colorado Springs, CO 80949, Phone: (800) 247-4695 756-50 Private Healthcare Systems, P.O. Box 5066, PHCS/3M, Des Plaines, IL 60017, Phone: (800) 292-9902 756-70 PHCS/Private Healthcare Systems, P.O. Box 1934, Des Plaines, IL 60017 756-75 PHCS/Private Healthcare System, P.O. Box 8013, Wausau, WI 54402 756-80 Private Health Care Systems Claims, P.O. Box 1607, Des Plaines, IL 60017, Phone: (631) 420-4100 758-00 Hillcrest Community Health Plan, 1201 Troy Rd, Latham, NY 12110 760-31 Ullico, P.O. Box 61593, King of Prussia, PA 19406, Phone: (877) 800-2956 760-50 Colorado Pipe Industry, 10620 East Bethany Dr, Aurora, CO 80014 762-10 Kaiser Permanente, P.O. Box 190849, Atlanta, GA 31119 762-15 Kaiser Permanente, P.O. Box 370897, Denver, CO 80237, Phone: (800) 382-4661 767-00 Ultra Benefits Inc., P.O. Box 763, Westborough, MA 01581, Phone: (866) 858-7223 771-00 MEBA, 1007 Eastern Ave, Baltimore, MD 21203 771-05 Galaxy Health -IAB, P.O. Box 224767, Dallas, TX 75222 774-30 Willis Corroon Insurance, P.O. Box 2697, Wichita, KS 67201, Phone: (800) 235-7160 776-00 SAMBA, 11301 Old Georgetown Rd., Rockville, MD 20852, Phone: (800) 638-6589 783-20 Screen Actors Guild Producers, P.O. Box 7830, Burbank, CA 91503 783-30 Scott and White Health Plan, 2401 So 31st Street, Temple, TX 76504 784-00 R.E. Harrington, P.O. Box 16789, Columbus, OH 43216 787-10 Christian Fidelity, P.O. Box 44990, Madison, WI 53744-4990 800-00 Masters Mates & Pilots Health& Benefit Plan, 700 Maritime Blvd., Linthicum Heights, MD 21090, Phone: (410) 850-8500 803-03 Administrators and Consultants, P.O. Box 4925, Lancaster, PA 17604, Phone: (717) 299-0371 803-05 Administrative Service, P.O. Box 140173, Orlando, FL 32814 803-10 Administrative Solutions, P.O. Box 2490, Alpharetta, GA 30023 803-20 Administrative Enterprises, Inc., 3404 W. Cheryl Drive, Phoenix, AZ, 85051 805-50 Watkins Assoc. Industries, P.O. Box 1738, Atlanta, GA 30301, Phone: (800) 333-3841 810-00 Vanguard Group Inc, 1979 Marcus Ave, Lake Success, NY 11042, Phone: (516) 616-6011 810-12 New World Claims Service, 2624 N 5th St, Niles, MI 49120, Phone: (781) 762-5511 811-00 American Express, 1650 Los Gamos Dr, San Rafael, CA 94903 813-00 Berkshire Health Plan, 279 Dalton Avenue, Pittsfield, MA 01201 814-03 Health Welfare, P.O. Box 64, Lexington, MA 02173 814-14 Hospital & Health Care Workers, 330 W 42nd Street, New York, NY 10036 814-26 Union Welfare Fund Local 202, Hunt's Point Terminal Mk, Bronx, NY 10474 814-35 Health America Penn Inc., P.O. Box 7088, London, KY 40742-7088, Phone: (800) 788-6445 814-41 Connecticut Carpenters Fund, 10 Broadway, Hamden, CT 06518 814-51 Heavy and General Laborers, Local 472 and 172, Newark, NJ 07105 814-56 Laborers National, P.O. Box 1100, Columbia, MD 21044 814-84 Sunrise Healthcare, P.O. Box 93098, Albuquerque, NM 87199 814-85 Platinum Safety and Claims, P.O. Box 6460, Tyler, TX 75711 815-00 Pro Health Plus, P.O. Box 2385, Woburn, MA 01888 816-01 MediPlan, 502 Valley Road, Wayne, NJ 07470, Phone: (973) 696-3111 816-05 Mennonite Mutual Aid Associates, P.O. Box 483, Goshen, IN 46527, Phone: (574) 533-9511 817-00 Health Risk Management, P.O. Box 1479, Minneapolis, NJ 07724, Phone: (800) 332-7772 817-05 Health Network America, P.O. Box 307, Eaton Town, MN 55440 823-00 Professional Benefit Admin Inc, P.O. Box 4687, Oak Brook, IL 605022-4681, Phone: (800) 435-5694 827-00 Conservative Baptist Foreign Mission Soc., P.O. Box 828, Wheaton, IL 61089 828-01 International Total Services, Benefit Adm, 5005 Rockside Road, Cleveland OH, 44131 828-02 Southwest Employee Benefits Administration, P.O. Box 25500, Albuquerque, NM 87125 828-05 Southern Health Services, P.O. Box 7704, London, KY 40742, Phone: (800) 627-4872 830-00 Administrative Service Consultants, 3301 East Royalton Rd, Cleveland, OH 44147, Phone: (419) 423-3823 830-08 Employee Benefit Consultants Inc, P.O. Box 928, Findlay, OH 45830, Phone: (419) 423-3823 832-00 American Baptist Churches Med Plan, 475 Riverside Drive, New York, NY 10115 832-40 Interactive Corp., P. O. Box 567, Farmington, CT 06034 833-00 Philadelphia America Life, 100 N. 6th St Ste 800, Waco, TX 76701 836-40 POMCO, P.O. Box 6329, Syracuse, NY 13217 840-20 Alicare, P.O. Box 1435, New York, NY 10116, Phone: (212) 539-5111 840-50 Longview Fibre Company, 1220 SW Morrison, Portland, OR 97205, Phone: (503) 224-0048 840-80 Alicare Inc, P.O. Box 1442, New York, NY 10116, Phone: (212) 539-5000 843-35 Mega Life Dental, P.O. Box 952009, N. Richland Hills, TX 76182 843-40 Mega Life & Health Ins. Co., P.O. Box 982009, North Richland Hills, TX 76182, Phone: (800) 527-2845 843-45 Mega Life Student Insurance, P.O. Box 809025, Dallas, TX 75380, Phone: (800) 767-0700 844-01 Benesight, P.O. Box 29050, Phoenix, AZ 85072, Phone: (800) 223-5228 844-15 TPA of Connecticut, 116 Washington Avenue, No. Haven, CT 06473 844-16 TPA of Illinois, P.O. Box 3098, Naperville, IL 60566 844-21 Benesight, P.O. Box 375, Pueblo, CO 81002, Phone: (800) 992-8354 844-30 The TPA, Inc., P.O. Box 7045, Rockford, IL 61125, (800) 842-5749 844-35 Web TPA, P.O. Box1928, Grapevine, TX 76099-1928, Phone: (888) 796-2432 844-40 Benesight, P.O. Box 370, Pueblo, CO 81002, Phone: (800) 992-8354 844-50 Pacific Atlantic Administrators, P.O. Box 7407, San Francisco, CA 94120 854-00 Health Choice, 164 High St, Greenfield, MA 01301 863-02 Harrington Benefit Service Inc., P.O. Box 730, Pueblo, CO 81002, Phone: (800) 446-8182 867-05 A & H Administrators, P.O. Box 10223, Milwaukee, WI 53210 867-10 Ag Administrators, P.O. Box 979, Valley Forge, PA 19482 872-10 Advanced Benefit Resources, P.O. Box 350, Woodbury, AZ 85050, Phone: (623) 889-7200 872-15 Advanced Benefit Solutions, P.O. Box 71490, Phoenix, NY 11797 872-20 Advanced Administration, 101 North Lake Destiny R, Maitland, FL 32751, Phone: (800) 785-4544 872-30 American Consulting Engineers Council, P.O. Box 9007, St. Louis, MO 63101 872-50 Advanced Insurance, P.O. Box 19, Memphis, TN 38101 873-00 Central United Life, P.O. Box 2728, Houston, TX 77252 876-20 Harrington Benefit Services Inc, P.O. Box 1394, Duncan, OK 73534, Phone: (800) 527-4296 886-00 Humana Care Plus, P.O. Box 2180, Louisville, KY 40202 886-01 Humana Care Plus, P.O. Box 19080-F, Jacksonville, FL 33245 886-02 Humana Dental, 1100 Employers Blvd, Green Bay, WI 54344, Phone: (800) 233-4013 886-05 Humana Claims, P.O. Box 14610, Lexington, KY 40512, Phone: (800) 558-4444 886-10 Humana Dental, P.O. Box 14611, Lexington, KY 40512, Phone: (800) 955-0783 888-10 KPS Health Plans, P.O. Box 339, Bremerton, WA 98337, Phone: (800) 552-7114 891-37 NCAS, P.O. Box 10104, Fairfax, VA 22030, Phone: (866) 662-4084 891-38 NCAS/National Claims Admin. Service, 7083 Grand National Drive, Orlando, FL 32819 893-00 North Shore Health Plan, 1 Essex Cir Drive, Peabody, MA 01960 893-10 North Shore Health System, P.O. Box 4445, Salem, MA 01970, Phone: (978) 825-7085 894-10 Pacific Source Health Plans, P.O. Box 7068, Eugene, OR 97401, Phone: (541) 684-5582 894-15 Health Care Savings, 4530 Park Rd, Charlotte, NC 28209, Phone: (828) 684-3800 895-01 Star Administrative Services, P.O. Box 55270, Phoenix, AZ 85078, Phone: (800) 308-5948 895-02 Managed Care Concepts, 900 Haddon Avenue, Collingswood, NY 08108 895-05 Medco Behavioral Care Service, 6 Bedford Farms, Bedford, NH 03110 895-06 International Benefits Services, P.O. Box 996, Fort Worth, TX 76101 895-09 Weyco/All Phase Electric, P.P.O. Corporation, Irvine, CA 92713 895-10 Kepple & Company Incorporated, P.O. Box 1986, Peoria, IL 61656 895-11 Martins Point, P.O. Box 9746, Portland, ME 04104-5040, Phone: (888) 732-7364 895-12 Merit Behavior Care, P.O. Box 2188, Maryland Heights, MI 63043 895-15 J.P. Farley, P.O. Box 268000, Cleveland, OH 44126 895-18 Cape Care Preferred Provider Network, P.O. Box 30367, Tampa, FL 33630 895-19 Central Cartage East, P.O. Box 3017, Center Line, MI 48015 895-20 All Risk Administrators, P.O. Box 66237, St. Pete Beach, FL 33736 895-25 Weyco Inc. Benefit Management, P.O. Box 30132, Lansing, MI 48909, Phone: (800) 748-0003 895-30 Medco Value Plus, 7083 Grand National Dr, Orlando, FL 32819 895-35 JM Family Enterprised, 8019 Bayberry Road, Jacksonville, FL 32256 898-30 Group Administrators, Ltd., 1880 N. Roselle Rd., Schaumburg, IL, 60195 898-50 Group Benefits Services, 6 North Park Drive, Hunt Valley, MD 21094, Phone: (800) 337-4973 899-03 PacifiCare, P.O. Box 6099, Cypress, CA 90630, Phone: (866) 316-9776 900-03 Dow Chemical Co, P.O. Box 1701, Group Insurance Dept, Midland, MI 48640, Phone: (989) 636-1000 900-05 Fedex Freight East, P.O. Box 5007, Harrison, AR 72602 900-10 Fedex Freight East, 419 East Main St, Middletown, NY 10940 900-13 Corning Incorporated Health Benefits, P.O. Box 542, Corning, NY 14830 900-23 Vetri System, P.O. Box 5028, Troy, FL 99431, Phone: (531) 997-9894 900-25 United Group Programs, 25 No Military Trail, Boca Raton, MI 48007 900-32 United Benefits, P.O. Box 2480, Daytona Beach, FL 32115, Phone: (800) 323-4890 900-69 John T Riley, P.O. Box 356, West Boylston, MA 01583 900-78 W.W. Grainger, Inc., 333 Knights Bridge Prkwy, Lincolnshire, IL 60069 900-89 HRM Claim Management, Inc., P.O. Box 4089, Upjohn Claims, Kalamazoo, MI 49003 900-91 Benefit Concepts, P.O. Box 60608, King of Prussia, PA 19406, Phone: (610) 337-2600 900-93 Lab Corp, P.O. Box 3137, Scottsdale, AZ 85271 900-94 Benefit Planners Inc., P.O. Box 690450, San Antonio, TX 78269, Phone: (866) 868-8207 900-95 Hinchclift International, 11 Ascot Place, Ithaca, NY 14850 900-96 AFTRA American Federation TV Radio, 261 Madison Avenue, New York, NY 10016 900-97 Sedgwick Nobles & Lownes, P.O. Box 248, Newtown, PA 18940 900-98 Motel 6, P.O. Box 809092, Claims Processing, Dallas, TX 75380 900-99 Tom Lange Co., 5231 South 6th St. Road, Springfield, IL 62707 901-20 Chesterfield Resource, P.O. Box 1884, Akron, OH 44309, Phone: (800) 321-0935 901-26 Atlantic Administrators, 135 Beaver St., Waltham, MA 02452 901-31 Atlantic Administrators Inc, P.O. Box 637, North Andover, MA 01845 901-41 Health New England, One Monarch Place Ste 1500, Springfield, MA 01144, Phone: (413) 787-4000 901-51 United Plans, P.O. Box 9098, Waltham, MA 02254 901-85 Veterans Services, Framingham Town Hall, Framingham, MA 01702 901-87 Veterans Benefits, 1 Government Center, Fall River, MA 02722 901-92 Frank Heller Associates, 8228 Mayfield Road, Chesterland, OH 44026, Phone: (800) 222-2184 902-14 Hub Folding Box, 774 Norfolk St., Mansfield, MA 02048 902-20 Ace American Insurance Co, 1730 Park St Suite 207, Naperville, IL 60563 903-01 Masshealth/MCO-Fallon Comm Hlth Plan, P.O. Box 15121, Worcester, MA 01615 903-23 Masshealth/MCO-Tufts Associated Hlth Pla, 400-2 Totten Pond Rd., Waltham, MA 02254 903-26 Masshealth/MCO-Neighborhood Hlth Plan-A, 253 Summer Street, Boston, MA 02210 903-27 Masshealth/MCO-Neighborhood Hlth Plan-B, 253 Summer St., Boston, MA 02210 903-29 Masshealth/MCO-Neighborhood Hlth Plan-C, 253 Summer St., Boston, MA 02210 903-30 Masshealth/MCO-Neighborhood Hlth Plan-D, 1470 Dorchester Avenue, Dorchester, MA 02122 903-43 MA Health/MCO-Neighborhood Hlth Plan-D, 253 Summer St., Boston, MA 02210 903-45 Masshealth/MCO-Harvard Pilgrim Health, P.O. Box 699183, Quincy, MA 02269 903-56 Masshealth/MCO Network Health, Claims Office, Cambridge, MA 02139 903-58 Masshealth/MCO BMC HealthNet Plan, P.O. Box 55282, Boston, MA 02205 904-00 Commonwealth Care/MCO FCHP, P.O. Box 15121, Worcester, MA 01615 904-01 Commonwealth Care/MCO NHP, 253 Summer Street, Boston, MA 02210 904-02 Commonwealth Care/MCO Network Health, Claims Office, Cambridge, MA 02139 904-03 Commonwealth Care/MCO BMC HealthNet, P.O. Box 55282, Boston, MA 02205 905-28 Motorola, P.O. Box 29005, Phoenix, AZ 85038, Phone: (800) 421-3973 905-29 Employers Health Insurance, P.O. Box 1100, Green Bay, WI 54344 905-54 Standard Life & Accident Insurance, P.O. Box 1800, Galveston, TX 78730, Phone: (512) 339-4449 905-70 CEBA, 6300 Bridge Point Pkwy, Austin, TX 77553, Phone: (888) 350-1488 905-75 Employers Health Alliance, P.O. Box 10399, Eugene, OR 97440 905-80 Nat'l Automatic Sprinkler-Self Insured, 800 Corporate Drive, Landover, MD 20785 905-82 Administration Ins. Office Inc, 1220 So. West Morrison S, Portland, OR 97205, Phone: (410) 515-1190 905-86 Medical Benefit Administrators, P.O. Box 1401, Abington, MD 21009, Phone: (800) 547-4457 905-94 Freedom Care, P.O. Box 1290, Worcester, MA 01613 905-95 Freedom Care Health Plan, 222 Boylston Street, Boston, MA 02109 906-20 Northern Group Service Inc, P.O. Box 7676, Saint Claire Shores, MI 48081, Phone: (810) 779-7676 906-29 Cigna Medicare Access Plans, P.O. Box 22174, Tempe, AZ 85285-2174, Phone: (800) 577-9410 906-45 Colonial Benefit Ins. Admin, P.O. Box 3770, Capital Heights, MD 20743 906-47 Deseret Health Care, P.O. Box 45530, Salt Lake City, UT 84145, Phone: (800) 869-0808 906-49 Strategic Resource Company (SRC), P.O. Box 23759, Columbia, SC 29224, Phone: (800) 869-0808 906-54 Preferred Care, P.O. Box 22920, Rochester, NY 14692-2920, Phone: (800) 999-3920 906-70 Group Dental Benefits, P.O. Box 1477, Greenfield, MA 01302, Phone: (800) 451-2513 906-81 Health Partners, P.O. Box 750, Minneapolis, MN 55440-750, Phone: (800) 883-2177 906-87 Automated Benefit Services, P.O. Box 37506, Oak Park, MI 48237, Phone: (586) 826-4410 908-25 Mid West Security, P.O. Box 266, Onalaska, WI 54650-0226, Phone: (800) 783-9281 908-29 Amer. Maritime Officers Medical, P.O. Box 35, Dania, FL 33004 908-44 Managed Benefit Plan, P.O. Box 744, Hackettstown, NJ 07840 908-45 Managed Health Funding, P.O. Box 1148, Jacksonville, FL 32229, Phone: (304) 346-0611 908-55 Wells Fargo Insurance, P.O. Box 11522, Charleston, WV 25339, Phone: (800) 624-8605 908-58 Benefit Administrator Systems, 17475 Jovanna Dr #18, Homewood, IL 60430, Phone: (800) 523-0582 908-64 American Administrative Group, P.O. Box 5227, Lisle, IL 60532, Phone: (630) 773-3800 908-67 Gallagher Benefit Administrators, P.O. Box 162721 Dept 5010, Austin, TX 78716 908-75 Galyan's Trading Co Health Benefits, P.O. Box 39710, Colorado Springs, CO 80949, Phone: (317) 612-2439 910-10 Neighborhood Health Plan, 253 Summer Street, Boston, MA 02110, Phone: (800) 433-5556 910-12 Neighborhood Health Plan of RI, 50 Holden St, Providence, RI 02908 910-14 Kanawha Employee Benefit, P.O. Box 8050, Lancaster, SC 29721, Phone: (800) 635-4252 910-30 Pan American Life Insurance, P.O. Box 61070, New Orleans, LA 70160, Phone: (877) 939-4500 910-59 Thomas Cooper and Company, P.O. Box 2557, Charlestown, SC 29413 910-60 Olympus Managed Health Care, 777 Brickell Ave, Miami, FL 33131 913-00 East Boston Geriatric Services, 10 Gove Street, Boston, MA 02128 913-03 Cambridge Hosp ESP, 270 Green St, Cambridge, MA 02139 913-04 ESP of the North Shore, 20 School Street, Lynn, MA 01901, Phone: (781) 581-7565 913-05 ESP of Mutual Healthcare, 1140 Dorchester Avenue, Dorchester, MA 02125 913-06 ESP, Harbor Health Services, Inc., 2216 Dorchester Avenue, Dorchester, MA, 02124 913-20 Benefit Coordinators Corp., 111 Ryan Court Suite 300, Pittsburgh, PA 15205, Phone: (800) 685-6100 914-00 Hospice Program, Bill Hospice Provider, if service is related, MA 02111 920-00 Self-Reported Insurance, Ask for a Copy of Card, Address on card 920-05 AARP Pharmacy Only, P.O. Box 6083, Cypress, CA 90620-0083, Phone: (800) 552-0053 920-06 FLRX Pharmacy, P.O. Box 22999, , Rochester, NY 14692, Phone: (800) 806-8811 920-07 Health Net Orange Pharmacy, P.O. Box 1054, Rancho Cordova, CA 95670 920-10 Medco Health Solutions Inc., P.O. Box 14711, Lexington, KY 40512 920-15 Eckherd, P.O. Box 2860, Pittsburgh, PA 15238 920-20 Express Scripts, P.O. Box 66773, St Louis, MO 63166, Phone: (800) 206-4005 920-25 Caremark, P.O. Box 686005, San Antonio, TX 78268, Phone: (800) 841-5550 920-30 Advanced PCS, P.O. Box 52116, Phoenix, AZ 85072 920-35 WellPoint, P.O. Box 4165, Woodland Hills, CA 91365 920-40 Aetna Pharmacy, P.O. Box 398106, Minneapolis, MN 55439 928-00 Plymouth Rock Assurance Corp., 695 Atlantic Ave., Boston, MA 02111 953-00 Hebrew Rehab Center, 1200 Centre Street, Roslindale, MA 02131 953-10 Heller Associates, 8288 Mayfield Road, Chesterland, OH 44026, Phone: (800) 552-2929 962-01 Adventist Risk Management, Inc., P.O. Box 4759, Silver Spring, MD 20914 990-01 Accident Recovery, Test NMMIS, Any City, MA 01010 990-02 Estate Recovery, Test NMMIS, Any City, MA 01010