Intermediary-Carrier Directory

Intermediary-Carrier Directory

U.S. Department of Health and Human Services
Centers for Medicare and Medicaid Services

Section I: Part A Intermediaries and Part B Carriers by State
Section II: Part A Intermediaries and Part B Carriers
Section III: Commercial and Independents - Parts A & B
Section IV: Regional Home Health Intermediaries, Durable Medical Equipment Regional Carriers, Common Working File Host Contractors, Rural Health Clinics

Any inquiries regarding the content of this directory or changes to the information contained herein should be referred to the Centers for Medicare and Medicaid Services, Office of Operations Management, Office of Acquisition and Grants Group, Division of Medicare Contractors, 7500 Security Boulevard - C2-21-15, Baltimore, Maryland 21244. Internet address: OICS-AGG-DMC@CMS.HHS.GOV

Communicating with Intermediaries and Carriers
Medicare contracts cover the rights and obligations of Intermediaries, Carriers, and the Secretary of Health and Human Services. Requests for action or information not specifically authorized by such contracts should not be made. Any questions in this regard should be addressed to the Office of Internal Customer Support, Acquisition and Grants Group, Division of Medicare Contractors.

Abbreviations
RHC - Rural Health Clinics
CHC - Community Health Centers
CSC - Christian Science Centers
HHA - Home Health Agencies
HL - Histocompatibility Labs (Independent)
OPA - Organ Procurement Agencies (Independent)
PE - Parenteral/Enteral
DME - Durable Medical Equipment
LPIC - Limited Purpose Insurance Company
RRB - SC.

Effective Date: January 2004 (updated, 7/04)

SECTION I

PART A INTERMEDIARIES AND PART B CARRIERS BY STATE

Alabama(Regional Office: Atlanta)
Part A - Blue Cross and Blue Shield of Alabama; Mutual of Omaha Insurance Company
Part B - Blue Cross and Blue Shield of Alabama
RHHI - Blue Cross and Blue Shield of South Carolina
DMERC - Blue Cross and Blue Shield of South Carolina

Alaska (Regional Office: Seattle)
Part A - Premera Blue Cross; Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI - United Government Services, LLC
DMERC - Connecticut General Life Insurance Company

American Samoa
Part A - United Government Services, LLC; Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI - United Government Services, LLC
DMERC - Connecticut General Life Insurance Company

Arizona (Regional Office: San Francisco)
Part A - Blue Cross and Blue Shield of Arizona; Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI - United Government Services, LLC
DMERC - Connecticut General Life Insurance Company

Arkansas (Regional Office: Dallas)
Part A - Arkansas Blue Cross and Blue Shield, A Mutual Insurance Company; Mutual of Omaha Insurance Company
Part B - Arkansas Blue Cross and Blue Shield, A Mutual Insurance Company
RHHI - Blue Cross and Blue Shield of South Carolina
DMERC - Blue Cross and Blue Shield of South Carolina

California (Regional Office: San Francisco)
Part A - United Government Services, LLC; Mutual of Omaha Insurance Company
Part B - National Heritage Insurance Company
RHHI - United Government Services, LLC
DMERC - Connecticut General Life Insurance Company

Colorado (Regional Office: Denver)
Part A - TrailBlazer Health Enterprises, LLC; Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI - Blue Cross and Blue Shield of Alabama
DMERC - Blue Cross and Blue Shield of South Carolina

Connecticut (Regional Office: Boston)
Part A - Empire HealthChoice Assurance, Inc.; Mutual of Omaha Insurance Company
Part B -First Coast Service Options, Inc. (First Coast Service Options)
RHHI - .
DMERC - HealthNow New York, Inc.

Delaware (Regional Office: Philadelphia)
Part A - Empire HealthChoice Assurance, Inc.; Mutual of Omaha Insurance Company
Part B - TrailBlazer Health Enterprises, LLC
RHHI - Blue Cross and Blue Shield of Alabama
DMERC - HealthNow New York, Inc.

District of Columbia (Regional Office: Philadelphia)
Part A - CareFirst of Maryland, Inc.; Mutual of Omaha Insurance Company
Part B - TrailBlazer Health Enterprises, LLC
RHHI - Blue Cross and Blue Shield of Alabama
DMERC - AdminaStar Federal, Inc.

Florida (Regional Office: Atlanta)
Part A - First Coast Service Options, Inc. (First Coast Service Options); Mutual of Omaha Insurance Company
Part B - First Coast Service Options, Inc. (First Coast Service Options)
RHHI - Blue Cross and Blue Shield of South Carolina
DMERC - Blue Cross and Blue Shield of South Carolina

Georgia (Regional Office: Atlanta)
Part A - Blue Cross and Blue Shield of Georgia, Inc.; Mutual of Omaha Insurance Company
Part B - Blue Cross and Blue Shield of Alabama
RHHI - Blue Cross and Blue Shield of South Carolina
DMERC - Blue Cross and Blue Shield of South Carolina

Guam (Regional Office: San Francisco)
Part A - United Government Services, LLC; Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI -
DMERC - Connecticut General Life Insurance Company

Hawaii (Regional Office: San Francisco)
Part A - United Government Services, LLC; Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI - United Government Services, LLC
DMERC - Connecticut General Life Insurance Company

Idaho (Regional Office: Seattle)
Part A - Regence BlueCross BlueShield of Oregon; Mutual of Omaha Insurance Company
Part B - Connecticut General Life Insurance Company
RHHI - United Government Services, LLC
DMERC - Connecticut General Life Insurance Company

Illinois (Regional Office: Chicago)
Part A - Anthem Insurance Companies, Inc.; Mutual of Omaha Insurance Company
Part B - Wisconsin Physicians Service
RHHI - Blue Cross Blue Shield of South Carolina
DMERC - AdminaStar Federal Inc.

Indiana (Regional Office: Chicago)
Part A - Anthem Insurance Companies, Inc.; Mutual of Omaha Insurance Company
Part B - AdminaStar Federal, Inc.
RHHI - Blue Cross Blue Shield of South Carolina
DMERC - AdminaStar Federal Inc.

Iowa (Regional Office: Kansas City)
Part A - Blue Cross and Blue Shield of Alabama; Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI - Blue Cross and Blue Shield of Alabama
DMERC - Connecticut General Life Insurance Company

Kansas (Regional Office: Kansas City)
Part A - Blue Cross and Blue Shield of Kansas, Inc.; Mutual of Omaha Insurance Company
Part B - Blue Cross and Blue Shield of Kansas, Inc.
RHHI - Blue Cross and Blue Shield of Alabama
DMERC - Connecticut General Life Insurance Company

Kentucky (Regional Office: Atlanta)
Part A - Anthem Insurance Companies, Inc.; Mutual of Omaha Insurance Company
Part B - AdminaStar Federal, Inc.
RHHI - Blue Cross and Blue Shield of South Carolina
DMERC - Blue Cross and Blue Shield of South Carolina

Louisiana (Regional Office: Dallas)
Part A - Blue Cross and Blue Shield of Mississippi; Mutual of Omaha Insurance Company
Part B - Arkansas Blue Cross and Blue Shield, A Mutual Insurance Company
RHHI - Blue Cross and Blue Shield of South Carolina
DMERC - Blue Cross and Blue Shield of South Carolina

Maine (Regional Office: Boston)
Part A - Anthem Health Plans of Maine, Inc.; Mutual of Omaha Insurance Company
Part B - National Heritage Insurance Company
RHHI - Anthem Health Plans of Maine, Inc.
DMERC - HealthNow New York, Inc.

Maryland (Regional Office: Philadelphia)
Part A - CareFirst of Maryland, Inc.; Mutual of Omaha Insurance Company
Part B - TrailBlazer Health Enterprises, LLC
RHHI - Blue Cross and Blue Shield of Alabama
DMERC - AdminaStar Federal Inc.

Massachusetts (Regional Office: Boston)
Part A - Anthem Health Plans of Maine, Inc.; Mutual of Omaha Insurance Company
Part B - National Heritage Insurance Company
RHHI - Anthem Health Plans of Maine, Inc.
DMERC- HealthNow New York, Inc.

Michigan (Regional Office: Chicago)
Part A - United Government Services, LLC; Mutual of Omaha Insurance Company
Part B - Wisconsin Physicians Service
RHHI - Blue Cross and Blue Shield of South Carolina
DMERC - AdminaStar Federal Inc.

Minnesota (Regional Office: Chicago)
Part A - Noridian Mutual Insurance Company; Mutual of Omaha Insurance Company
Part B - Wisconsin Physicians Service
RHHI - United Government Services, LLC
DMERC - AdminaStar Federal Inc.

Mississippi (Regional Office: Atlanta)
Part A - Blue Cross and Blue Shield of Mississippi; Mutual of Omaha Insurance Company
Part B - Blue Cross and Blue Shield of Alabama
RHHI - Blue Cross Blue Shield South Carolina
DMERC - Blue Cross Blue Shield South Carolina

Missouri (Regional Office: Kansas City)
Part A - Blue Cross and Blue Shield of Mississippi; Mutual of Omaha Insurance Company
Part B - Blue Cross and Blue Shield of Kansas, Inc. (Western Missouri); Arkansas Blue Cross and Blue Shield, A Mutual Insurance Company
(Eastern Missouri)
RHHI - Blue Cross and Blue Shield of Alabama
DMERC - Connecticut General Life Insurance Company

Montana (Regional Office: Denver)
Part A - Blue Cross and Blue Shield of Montana, Inc.; Mutual of Omaha Insurance
Company
Part B - Blue Cross and Blue Shield of Montana, Inc.
RHHI - Blue Cross and Blue Shield of Alabama
DMERC - Connecticut General Life Insurance Company

Nebraska (Regional Office: Kansas City)
Part A - Blue Cross and Blue Shield of Nebraska; Mutual of Omaha Insurance Company
Part B - Blue Cross and Blue Shield of Kansas, Inc.
RHHI - Blue Cross and Blue Shield of Alabama
DMERC - Connecticut General Life Insurance Company

Nevada (Regional Office: San Francisco)
Part A - United Government Services, LLC; Mutual of Omaha Insurance Company
Part B - Noridian Mutual Insurance Company
RHHI - United Government Services, LLC
DMERC - Connecticut General Life Insurance Company

New Hampshire (Regional Office: Boston/San Francisco)
Part A - Anthem Health Plans of New Hampshire, Inc.; Mutual of Omaha Insurance Company
Part B - National Heritage Insurance Company
RHHI - Anthem Health Plans of New Hampshire Inc.
DMERC - HealthNow New York, Inc.

New Jersey (Regional Office: New York)
Part A - Blue Cross Blue Shield of Tennessee; Mutual of Omaha Insurance Company
Part B - Empire HealthChoice Assurance, Inc.
RHHI - United Government Services, LLC
DMERC- HealthNow New York, Inc.

New Mexico (Regional Office: Dallas)
Part A - Trailblazer Health Enterprises, LLC; Mutual of Omaha Insurance Company
Part B - Arkansas Blue Cross and Blue Shield, A Mutual Insurance Company
RHHI - Blue Cross Blue Shield South Carolina
DMERC - Blue Cross Blue Shield South Carolina

New York (Regional Office: New York)
Part A - Empire HealthChoice Assurance, Inc.; Mutual of Omaha Insurance Company
Part B - HealthNow New York Inc.; Empire HealthChoice Assurance, Inc.; Group Health Incorporated
RHHI - United Government Services, LLC
DMERC - HealthNow New York, Inc.

North Carolina (Regional Office: Atlanta)
Part A - Blue Cross and Blue Shield of South Carolina; Mutual of Omaha Insurance
Company
Part B - Connecticut General Life Insurance Company
RHHI - Blue Cross Blue Shield of South Carolina
DMERC - Blue Cross Blue Shield of South Carolina

SECTION II

PART A INTERMEDIARIES AND PART B CARRIERS

BLUE CROSS AND BLUE SHIELD ASSOCIATION
225 North Michigan Avenue
Chicago, Illinois 60601-7680
PHONE: 312-297-6000
FAX: 312-297-6609

PART A - AGREEMENT NO. HCFA 87-001-1

Scott P. Serota
President & Chief
Executive Officer
PHONE:312-297-6010

Wilson Leong, Esq. CPA
Executive Director
Prime Contract
PHONE:312-297-5869

ALABAMA PART A PROVIDER SERVICE AREA: States of Alabama, Iowa and South Dakota Special Claims: Home Health
PART B JURISDICTION: States of Alabama, Georgia, Mississippi

Blue Cross and Blue Shield of Alabama
(d.b.a. - Cahaba Government Benefit Administrators)

PART A - AGREEMENT NO. HCFA 87-001-1.1
PART B - CONTRACT NO. HCFA 87-003-2

Charles R. Hartsell
President & COO
Cahaba Government
Benefit Administrators
PHONE: 205-220-2126
EMAIL: chartsell@bcbsal.org

Lynda Northcutt
Sr. Vice President
Medicare Administration
Cahaba Government Benefit Administrators
P.O. Box 830139
Birmingham, AL 35283-0139
PHONE: 205-220-4835
FAX: 205-220-4841
EMAIL: lnorthcutt@bcbsal.org

Robert Orr, Jr.
VP
Cahaba Government Benefit Administrators
P.O. Box 830139
Birmingham, Alabama 35283-0139
PHONE: 205-220-4835
EMAIL: rorr@bcbsal.org

Overnight Packages Only
Cahaba Government Benefit Administrators
A Division of Blue Cross and Blue Shield of Alabama
Medicare Claims Administration
MSID-F00005
450 Riverchase Parkway East
Birmingham, AL 35244

PHONE: 205-220-2100
FAX: 205-220-4841
Web Site: www.cahabagba.com

ALABAMA OFFICE – Medicare Intermediary & Carrier

Beneficiary Customer Service – 1-800-292-8855
Provider Line - 1-866-539-5598

INTERNET: almedicare@bcbsal.org
Web Site: www.cahabagba.com

OVERNIGHT PACKAGES ONLY
Cahaba Government Benefit Administrators
Alabama Medicare Claims Administration
MSID-F00005
450 Riverchase Parkway East
Birmingham, AL 35244

PHONE: 205-220-4842
FAX: 205-220-4841

David Brown
Executive Director,Cahaba Resource Center
Cahaba Government Benefit Administrators
PHONE: 205-220-4099
EMAIL: dbrown@bcbsal.org

Leigh Forman
Executive Director, Part B Claims
Cahaba Government Benefit Administrators
PHONE: 912-921-3087
EMAIL: lforman@bcbsal.org

Susan Pretnar
Executive Director, Part A and RHHI Claims
Cahaba Government Benefit Administrators
PHONE: 515-471-7302
EMAIL: spretnar@cahabagba.com

John Cook, Jr.
Executive Director, Quality
PHONE: 601-977-5850
EMAIL: jwcook@cahabagba.com

ALABAMA OFFICE –
MSID-F00005
450 Riverchase Parkway East
Birmingham, AL 35244
P.O. Box 830139
Birmingham, AL 35283-1039
FAX: 205-220-4841
INTERNET: almedicare@bcbsal.org

Beneficiary Customer Service - 1-800-292-8855
Provider Line - 1-866-539-5598

GEORGIA OFFICE –
12052 Middleground Road, Suite A
Savannah, GA 31419-1699
FAX: 912-921-4635
INTERNET: gamedicare@bcbsal.org

Beneficiary Customer Service - 1-800-727-0827
Provider Line - 1-912-927-0934

MIDWEST OFFICE –
400 E. Court Avenue, Station 158
Des Moines, IA 50309-2017
FAX: 515-471-7222
INTERNET: iamedicare@cahabagba.com

Beneficiary Customer Service - 1-877-910-8139
Provider Customer Service - Home Health: 1-877-299-4500
Hospice: 1-866-539-5592
Other Providers: 1-877-567-3092
MSP (attorneys and insurers): 515-471-7400

MISSISSIPPI OFFICE –
775 Woodlanes Parkway
Ridgeland, MS 39157-5212

P.O. Box 22545
Jackson, MS. 39225-2545
FAX: 601-956-2738
INTERNET: msmedicare@cahabag.com

Beneficiary Customer Service - 1-800-682-5417
Provider Customer Service - 1-866-419-9454

ALASKA PART A PROVIDER SERVICE AREA - See Premera Blue Cross (Blue Cross of Washington and Alaska)
PART B JURISDICTION - See Noridian Mutual Insurance Company

ARIZONA PART A PROVIDER SERVICE AREA : State of Arizona
PART B JURISDICTION - See Noridian Mutual Insurance Company

BLUE CROSS AND BLUE SHIELD OF ARIZONA, INC.
P.O. Box 37700
Phoenix, Arizona 85069
STREET ADDRESS:
2444 West Palmaritas Drive
Phoenix, Arizona 85021
PHONE: 602-864-4400
FAX: 602-864-4041
EMAIL: www.medicareaz.com

PART A- AGREEMENT NO. HCFA 87-001-1.2

Richard L. Boals President and CEO PHONE: 602-864-4444	Susie Nash Vice President of Federal Programs PHONE: 602-864-4423 ��
�
Tony Astorga Senior Vice President Claims and Federal Programs PHONE: 602-864-4676	Karen Abraham Vice President of Finance PHONE: 602-864-5700 ��

ARKANSAS PART A PROVIDER SERVICE AREA: State of Arkansas and Rhode Island
PART B JURISDICTION: States of Arkansas , Louisiana, Oklahoma, New Mexico, Eastern Missouri

ARKANSAS BLUE CROSS AND BLUE SHIELD
A MUTUAL INSURANCE COMPANY
Street Address: 601 South Gaines Street
Little Rock, AR 72203

AR Medicare Services Operations
515 West Pershing Blvd.
North Little Rock, AR 72114-2147
PHONE: 501-378-2000
FAX: 501-210-9153
MAILING ADDRESS:
Medicare Services
P.O. Box 1418
Little Rock, AR. 72203

INTERNET:tlwhite@arkbluecross.com

WEBSITES:
AR- www.arkmedicare.com
LA- www.lamedicare.com
OK- www.oknmmedicare.com
NM- www.oknmmedicare.com
MO- www.momedicare.com
RI- www.rimedicare.com

PART A - AGREEMENT NO. HCFA 87-001-1.3
PART B - CONTRACT NO . HCFA-87-004-2

� ��

��

Sharon K. Allen President & COO PHONE: 501-378-2145	Dennis Robertson Sr. Vice President Public Programs PHONE: 501-210-9035
Regina H. Favors Vice President Public Programs-Operations PHONE: 501-210-9036 �	Charles Clem Vice President Public Programs-Systems PHONE: 501-210-9076 �
Teresa Milligan Medicare Compliance Officer PHONE: 501-210-9078 �
�
ARKANSAS PART A & B OPERATIONS Kay Werner Director, Arkansas Part A & B Operations Phone: 501-210-9254 Amanda Crosby Director, Provider Audit and Reimbursement Phone: 501-918-7469 Barb Oberste Director, Medicare Integrity Programs Phone: 501-918-7418 Part A Provider: 1-866-548-0527 Part A Beneficiary: 1-877-356-2368 Part B Provider: 1-877-908-8434 Part B Beneficiary: 1-800-482-5525	Louisiana Part B Operations 8687 United Plaza Boulevard Baton Rouge, LA 70809 Margie Slaughter Director, Louisiana Part B Operations Phone: 225-231-2220 Provider: 1-877-567-7204 Beneficiary: 1-800-392-3070
��
Rhode Island Part A and Part B Operations 86 Weybossett Providence, RI 02903-2800 Joan Costello Director RI Operations Phone:401-276-5830 Part A Provider: 1-866-339-3714 Part A Beneficiary: 1-800-662-5170 Part B Provider: 1-866-801-5304 Part B Beneficiary: 1-800-662-5170	Oklahoma/New Mexico Part B Operations 701 NW 63rd Oklahoma City, OK 73116 Curtis Blair Director, Oklahoma/New Mexico Operations Phone:405-841-6738 Lanny Day Director, Congressional Liaison Phone:405-841-6738 For All Locations Provider: OK/NM 1-877-567-9230 Beneficiary: OK 1-800-522-9079 Beneficiary: NM 1-800-423-2925
��
Eastern Missouri Part B Satellite Office 12755 Olive Street St Louis, Missouri 63141 PHONE: 314-212-1705 Provider: 1-866-539-5599 Beneficiary: 1-800-392-3070

CALIFORNIA PART A PROVIDER SERVICE AREA: United Government Services, LLC
PART B JURISDICTION: See National Heritage Insurance Company

COLORADO PART A PROVIDER SERVICE AREA - See TrailBlazer Health Enterprises, LLC and Blue Cross and Blue Shield of South Carolina (HHA only).
PART B JURISDICTION - See Noridian Mutual Insurance Co. (North Dakota)

CONNECTICUT

See Empire HealthChoice, Inc.
PART B JURISDICTION - See First Coast Service Options, Inc. (First Coast Service Options)

DELAWARE PART A PROVIDER SERVICE AREA: See Empire HealthChoice, Inc.
PART B JURISDICTION - See (Texas) Trailblazer Health Enterprises, LLC

DISTRICT OF COLUMBIA PART A PROVIDER SERVICE AREA - See Care First of Maryland
PART B JURISDICTION - See (Texas) Trailblazer Health Enterprises, LLC

FLORIDA PART A PROVIDER SERVICE AREA: State of Florida
PART B JURISDICTION: State of Florida, Connecticut

FIRST COAST SERVICE OPTIONS, INC.

PART A - AGREEMENT NO. HCFA 87-001-1.10
PART B - CONTRACT NO. HCFA-87-009-2

FIRST COAST SERVICE OPTIONS, INC. (FLORIDA)

MEDICARE
532 Riverside Avenue
Jacksonville, Florida 32202
PHONE: 904-791-6111
MEDICARE A & B BENEFICIARY-TOLL-FREE: 1-800-633-4227
MEDICARE B PROVIDER-TOLL-FREE: 1-877-847-4992
MEDICARE B PROVIDER - CSR CALLS - 1-866-454-9007
MEDICARE A PROVIDER ONLY - 1-877-602-8816

PART A Mailing Address (Claims and Correspondence) P.O. Box 2711 Jacksonville, FL � 32231-0021 INTERNET: Providers - floridamedicare.com Beneficiaries - medicarefla.com	PART B Mailing Address (Claims) P. O. Box 2525 Jacksonville, FL � 32231-0048 P.O. Box 2360 (Correspondence) Jacksonville, FL � 32231-0048
�
First Coast Services Options, Inc. Curtis Lord CEO 532 Riverside Ave. Jacksonville, FL � 32202 PHONE: 904-791-8090	�� Patricia A. Williams President and COO P. O. Box 2711� 20 Tower Jacksonville, FL � 32202 PHONE: 904-791-8155 �
Program Management A/B Lamar James Vice President PHONE: 904-791-8358	Programs Safeguards A/B Patricia Ainsley Vice President PHONE: 904-791-8136

Dr. Frank Dellicarpini
Interim Director
PHONE: 203-634-5410

FIRST COAST SERVICE OPTIONS, INC. (CONNECTICUT - PART B ONLY)

321 Research Parkway
Meriden, CT � 06540-7148

BENEFICIARY - TOLL-FREE - 1-800-medicare
PROVIDER - TOLL FREE - 1-866-419-9455
CUSTOMER SERVICE: 203-639-3000

Mailing Address (Claims and Correspondence) P. O. Box 9000 Meriden, CT � 06540
�
Program Management B Lamar James Vice President PHONE: 904-791-8358	Program Safeguards B Patricia Ainsley Vice President PHONE: 904-791-8136
�
Dr. Frank Delli Carpini Interim Director PHONE: 203-634-5410

�

GEORGIA PART A PROVIDER SERVICE AREA: State of Georgia
PART B JURISDICTION - See Blue Cross and Blue Shield of Alabama

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC.
3350 Peachtee Road, N.E.
Atlanta, Georgia 30326
PHONE: 706-571-5371(Columbus)
PHONE: 404-842-8000(Atlanta)
FAX: 706-571-5431
INTERNET: www.georgiamedicare.com

PART A - AGREEMENT NO. HCFA 87-001-1.11

John Watts, Jr. President and Chief Executive Officer PHONE: 404-842-8413	Pamela Bell Vice President Medicare Part A 3350 Peachtree Road, NE P.O. Box 4445 PHONE: 404-842-8425/404-842-8643 FAX: 404-842-8588
��
Part A Mailing Address (Claims and Correspondence) P.O. Box 9048 Columbus, GA 31908-9048
��
MEDICARE A BENEFICIARY TOLL-FREE:��1-800-322-3380 MEDICARE A PROVIDER TOLL-FREE: ��1-877-567-3095 MEDICARE A PROVIDER ENROLLMENT:��1-866-305-0028
��
Martha McCrary Director Medicare Claims Operations 2357 Warm Springs Road Suite 214 Columbus, GA 31904 P.O. Box 9048 Columbus, GA 31908-9048 PHONE: 706-571-5260	Jim Dresslar Director Provider Audit & Reimbursement 2357 Warm Springs Road Columbus, GA 31904 P.O. Box 9048 Columbus, GA 31908-9048 PHONE: 706-257-1080

HAWAII PART A PROVIDER SERVICE AREA - See United Government Services, LLC
PART B JURISDICTION - See Noridian Mutual Insurance Co. (North Dakota)

IDAHO PART A PROVIDER SERVICE AREA - See Regence BlueCross BlueShield of
Oregon
PART B JURISDICTION - See Connecticut General Life Insurance Company

ILLINOIS PART A PROVIDER SERVICE AREA: See Anthem Insurance Companies, Inc.
PART B JURISDICTION: See Wisconsin Physicians Service and National Heritage
Insurance Co.

INDIANA PART A PROVIDER SERVICE AREA: States of Illinois, Indiana, Kentucky, Ohio

ANTHEM INSURANCE COMPANIES, INC.
120 Monument Circle, Suite 200
Indianapolis, Indiana 46204
PHONE: 317-488-4400 (Corporate Office-AdminiStar, Inc.)
FAX: 317-841-4691

�

Medicare Operations:
ADMINASTAR FEDERAL, INC.
8115 Knue Road
Indianapolis, IN � 46250

PART A -AGREEMENT NO. HCFA 88-001-1.16

Michael McCarron
President
AdminaStar Federal, Inc.
8115 Knue Road
Indianapolis, Indiana �46250

Sharon Weddel
Executive Director, Intermediary Operations

INDIANA PART B JURISDICTION: States of Indiana, Kentucky
DME REGIONAL CARRIER: District of Columbia, Illinois, Indiana, Maryland,
Michigan, Minnesota, Ohio, Virginia,West Virginia, Wisconsin (PE)

ADMINASTAR FEDERAL, INC.
8115 Knue Road
Indianapolis, Indiana 46250
PHONE: 317-841-4400 (Operations Office)
FAX: 317-841-4691
INTERNET: www.adminastar.com

PART B - HCFA CONTRACT NO. 88-011-2

DMERC CONTRACT: 500-93-BPO2

Michael McCarron, President
AdminaStar Federal Inc.
8115 Knue Road
Indianapolis, Indiana 46250

Christine Beard
Executive Director, Carrier & DMERC Operations

IOWA PART A PROVIDER SERVICE AREA: See Blue Cross and Blue Shield of Alabama
PART B JURISDICTION: See Noridian Mutual Insurance Co.(North Dakota)

KANSAS PART A PROVIDER SERVICE AREA: State of Kansas
PART B JURISDICTION: States of Kansas, Western Missouri and Nebraska
BLUE CROSS AND BLUE SHIELD OF KANSAS, INC.
Street Address: 1133 SW Topeka Blvd.
Topeka, Kansas 66629
Post Office Box 239
Topeka, Kansas 66601
PHONE: 785-291-7000
FAX: 785-291-7098
Email:bc.medicare@bcbsks.com

PART A - AGREEMENT NO. HCFA 87-001-1.19
PART B - CONTRACT NO. HCFA-87-013-2

Mike Mattox President & CEO	William H. Pitsenberger Sr. Vice President PHONE: 785-291-8704
Doug Scott Chief Operating Officer PHONE: 785-291-7371

�
KENTUCKY PART A PROVIDER SERVICE AREA: See State of Indiana, Anthem Insurance Companies, Inc.
PART B JURISDICTION: See State of Indiana, AdminaStar Federal, Inc.

LOUISIANA PART A PROVIDER SERVICE AREA - See Blue Cross and Blue Shield of Mississippi
PART B JURISDICTION - See Arkansas Blue Cross and Blue Shield

MAINE PART A PROVIDER SERVICE AREA: State of Maine, State of Massachusetts
(SPECIAL CLAIMS: HHA, Provider-Based HHA/Hospice, RHC)
PART B JURISDICTION - See National Heritage Insurance Company

ANTHEM HEALTH PLANS OF MAINE INC.
(d.b.a. Associated Hospital Service)
2 Gannett Drive South
Portland, Maine 04106-6911
PHONE: 207-822-7000
FAX: 207-822-7926 INTERNET:Medicare@bcbsme.com

PART A- AGREEMENT NO. HCFA 87-001-1.22

David Crowley
Executive Director - Medicare Operations

Field Office Part A

Robert Baroutas, Director
Massachusetts Medicare
Audit Reimbursement Department
50 Salem Street, Building A, 2nd Floor
Lynnfield, Massachusetts 01940-2694

MARYLAND PART A PROVIDER SERVICE AREA: States of Maryland and the District of Columbia
PART B JURISDICTION - See TrailBlazer Health Enterprises, LLC

CAREFIRST OF MARYLAND, INC.
(d.b.a Blue Cross and Blue Shield of Maryland, Inc.)
10455 Mill Run Circle
Owings Mills, Maryland 21117
PHONE: 410-252-5310
FAX:410-561-7951
EMAIL: Medicare_A@CareFirst.com

PART A - AGREEMENT NO. HCFA 87-001-1.23

Mr. William L. Jews
President & CEO
PHONE: 410-998-5252

Stephan W. Simms
Director of Intermediary Operations
PHONE: 410-561-4270
FAX: 410-561-7951

MASSACHUSETTS PART A PROVIDER SERVICE AREA: See Anthem Health Plans of Maine, Inc.
PART B JURISDICTION: See National Heritage Insurance Company

MICHIGAN PART A PROVIDER SERVICE AREA - See: United Government Services, LLC
PART B JURISDICTION - See Wisconsin Physicians Service Insurance Corporation

MINNESOTA PART A PROVIDER SERVICE AREA: See Noridian Mutual Insurance Company
PART B JURISDICTION: See Wisconsin Physicians Service

MISSISSIPPI PART A PROVIDER SERVICE AREA: States of Mississippi, Louisiana, and Missouri
PART B JURISDICTION - See Blue Cross and Blue Shield of Alabama

BLUE CROSS AND BLUE SHIELD OF MISSISSIPPI
(d.b.a. TriSpan Health Services)
Medicare Part A Intermediary
P.O. Box 23046
Jackson, Mississippi 39225-3046
(STREET ADDRESS)
1064 Flynt Drive
Jackson, Mississippi 39232
PHONE: 601-936-0105
FAX: 601-664-4214
INTERNET: : trispan@bcbsms.com

PART A - AGREEMENT NO. HCFA 87-001-1.27

Richard J. Hale
President & CEO

Jeff Leber
Chief Financial Officer
Government Programs and Benefits Administration

William V. Morris III
Vice President Government Programs
PHONE: 601-664-4570
FAX: 601-664-4214

MISSOURI PART A PROVIDER SERVICE AREA - See Blue Cross and Blue Shield of Mississippi and Mutual of Omaha Ins. Co.
PART B JURISDICTION - See Blue Cross and Blue Shield of Kansas, Inc. for Western Missouri and Arkansas Blue Cross Blue Shield for Eastern Missouri

MONTANA PART A PROVIDER SERVICE AREA: State of Montana
PART B JURISDICTION: State of Montana

BLUE CROSS AND BLUE SHIELD OF MONTANA, INC.
(PART A)
P.O. Box 5017
Great Falls, Montana 59403
STREET ADDRESS:
3360 Tenth Avenue, South
Great Falls, Montana 59403
PHONE: 406-791-4000 (Direct Dial)
FAX: 406-727-9355
INTERNET: ndrazich@bcbsmt.com
(PART B)
P.O. Box 4310
2501 Beltview
Helena, Montana 59604
FAX: 406-442-9968
INTERNET: thubbard@bcbsmt.com

PART A - AGREEMENT NO. HCFA 87-001-1.30
PART B - CONTRACT NO. HCFA-87-018-2

Peter J. Babin President & CEO PHONE:406-444-8200 FAX: 406-447-8607	Mike Wagner Vice President Federal Programs & Corporate Treasury	Medicare A & B (Medicare Coordinator) PHONE: 406-791-4152 A PHONE: 406-444-8356 B
��
Dave Pfeifle Medicare A Team Leader/ Audit Manager Supervisor Phone: 406-791-4152	Doris Hernandez Part A Medicare Claims Phone: 406-791-4013
��
Lana Finch Team Leader, Mediare Part B & Operations PHONE: 406-444-8503	Medicare B Receptionist PHONE: 406-447-8713	Fred Olson CMD and Team Leader PHONE:406-447-3557

�

NEBRASKA PART A PROVIDER SERVICE AREA:

State of Nebraska
PART B JURISDICTION - See Blue Cross and Blue Shield of Kansas, Inc.

BLUE CROSS AND BLUE SHIELD OF NEBRASKA
P.O. Box 24563
Omaha, Nebraska 68124-0563
STREET ADDRESS:
7261 Mercy Road
Omaha, Nebraska 68124
PHONE: 402-390-1800 (Switchboard)
FAX: 402-398-3640 (Corporate Office)

PART A - AGREEMENT NO. HCFA 87-001-1.31

Steve Martin
President & CEO

Duane Wilson
Treasurer and Chief Financial Officer

Barbra Buls
Vice President of Government Programs
PHONE: 402-343-3366
FAX: 402-398-3640

NEVADA PART A PROVIDER SERVICE AREA - See United Government Services, LLC
PART B JURISDICTION - See Nordian Mutual Insurance Company

NEW HAMPSHIRE PART A PROVIDER SERVICE AREA: States of New Hampshire and Vermont
(SPECIAL CLAIMS: RHC )
PART B JURISDICTION - See National Heritage Insurance Company

ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.
(d.b.a. Anthem Blue Cross and Blue Shield of New Hampshire)
3000 Goffs Falls Road
Manchester, New Hampshire 03111-0001
PHONE: 603-695-7000
FAX: 603-695-7741 (notify recipient of fax)

PART A - AGREEMENT NO. HCFA 87-001-1.32

David Crowley
Executive Director
Medicare Operations

�

NEW JERSEY PART A PROVIDER SERVICE AREA

: See Blue Cross Blue Shield of Tennessee (d.b.a. Riverbend Government Benefits Administrators)
PART B JURISDICTION - See Empire HealthChoice, Inc.

NEW MEXICO PART A PROVIDER SERVICE AREA: See Texas - TrailBlazer Health Enterprises, LLC
and Blue Cross and Blue Shield of South Carolina (HHA claims only)
PART B JURISDICTION - See Arkansas Blue Cross and Blue Shield A Mutual Insurance Company

NEW YORK PART A PROVIDER SERVICE AREA: States of New York, Delaware and Connecticut
PART B JURISDICTION: Counties of Bronx, Columbia, Delaware, Duchess, Greene, Kings, Nassau, New York, Orange, Putnam, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester. (Also - See HealthNow New York Inc. and Group Health Incorporated)

EMPIRE HEALTHCHOICE ASSURANCE, INC.
(d.b.a. Empire Medicare Services)

PART A - AGREEMENT NO. HCFA 87-001-1.38
PART B - CONTRACT NO. HCFA 87-021-2

FAX: 914-248-2948
INTERNET: lloyd.kasow@empireblue.com

Michael A. Stocker, M.D. President and CEO 11 West 42 Street 18th Floor New York, NY 10036	William Foley Vice President Medicare Services 2651 Strang Blvd. Yorktown Heights, NY 10598 PHONE:914-248-2852 FAX: 914-248-2948	Gloria McCarthy Executive Vice President and Chief Operating Officer 11 West 42 Street New York, NY 10036
��
Christine Thomas Assistant Vice President Public Relations and Medicare Part A Operations 400 South Salina Street Syracuse, NY 13202 PHONE: 315-442-4530	Kathy Doolittle Assistant Vice President Medicare Part B Program Management 2651 Stang Blvd. Yorktown Heights, NY 10598 PHONE: 914-248-2865

�

NEW YORK PART B JURISDICTION

The State of New York (except for the Counties served by Empire HealthChoice, Inc. and Group Health, Inc.)

DME REGIONAL CARRIER: Connecticut, Delaware, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New Jersey, New York, Pennsylvania (PE)

HEALTHNOW NEW YORK INC. 1901 Main Street Buffalo, New York 14208	P.O. Box 80 Buffalo, New York 14240-0080
PHONE: 716-887-6900 (Buffalo) FAX: 716-887-8548 (Buffalo)

PART B - CONTRACT NO. HCFA 87-022-2
DMERC: 01-AGG-2000

James A. Cardone
Executive Vice President
Operational Support Services, Chief Financial Officer and Treasurer
PHONE: 716-887-2025
E-MAIL: Cardone.James@HealthNow.org

William T. Wickis
Sr. Vice President
Customer Services and Claims Operations
PHONE: 716-887-8940
E-MAIL: Wickis.William@HealthNow.org

Alphonso O'Neil-White
Executive Vice President, General Counsel and Corporate Secretary
PHONE: 716-887-8508
E-MAIL: O'Neil-White.Alphonso@HealthNow.org

UPSTATE MEDICARE DIVISION HealthNow New York Inc. 33 Lewis Road Binghamton, New York 13905	P.O. Box 5236 Binghamton, New York 13902-5236
PHONE: 607-766-6000 (UMD) FAX: 607-766-6395 (UMD)
Donna M. Przybysz Vice President and Chief Operating Officer Upstate Medicare Divison & DMERC PHONE: 607-766-6270 E-MAIL: Przybysz.Donna@HealthNow.org

DMERC
(See Upstate Medicare Divison—Binghamton)

Cheryl Howe
Executive Vice President
Health Service and Marketing Management
PHONE: 716-887-6080

NORTH CAROLINA PART A PROVIDER SERVICE AREA: See Blue Cross and Blue Shield of South Carolina
PART B JURISDICTION - See Connecticut General Life Insurance Company

NORTH DAKOTA PART A PROVIDER SERVICE AREA: State of North Dakota, Minnesota
PART B JURISDICTION: States of North Dakota, South Dakota, Wyoming, Iowa, Colorado, Northern Marianna Islands, American Samoa, Guam, Washington, Hawaii, Oregon, Alaska, Arizona, Nevada

NORIDIAN MUTUAL INSURANCE COMPANY
4305 13th Avenue, S.W.
Fargo, North Dakota 58103
PHONE: 701-282-1100
FAX: 701-282-1002
www.noridian.com/medweb

PART A - AGREEMENT NO. HCFA 87-001-1.44
PART B - CONTRACT NO. HCFA 87-023-2

Michael Unhjem
President & CEO

Jay Martinson
Vice President
PHONE: 701-282-1439

�

OHIO PART A PROVIDER SERVICE AREA

: See State of Indiana, Anthem Insurance Companies Inc.
PART B JURISDICTION - See Blue Cross and Blue Shield of South Carolina

OKLAHOMA PART A PROVIDER SERVICE AREA: State of Oklahoma
PART B JURISDICTION - See Arkansas Blue Cross and Blue Shield a Mutual Insurance Company

GROUP HEALTH SERVICE OF OKLAHOMA, INC.
(d.b.a. BLUE CROSS AND BLUE SHIELD OF OKLAHOMA)
1215 South Boulder Avenue
Tulsa, Oklahoma 74119
PHONE: 918-560-3000
FAX: 918-560-3506
INTERNET:medicare@bcbsok.COM

PART A - AGREEMENT NO. HCFA 87-001-1.52

Ronald F. King
President, CEO
PHONE: 918-560-2195

Ms. Garoldine Webb
Vice President and Director of Government Programs
PHONE: 918-560-2090
FAX: 918-560-3506

�
OREGON PART A PROVIDER SERVICE AREA: States of Oregon, Idaho and Utah, also Clark County in the State of Washington
PART B JURISDICTION - See Noridian Mutual Insurance Company

REGENCE BLUECROSS BLUESHIELD OF OREGON
200 S.W. Market Street
Portland, Oregon 97201
OR
P.O. Box 8110
Portland, Oregon 97207-8110
PHONE: 503-721-7116
FAX: 503-228-3304
INTERNET: MEDICARENW@REGENCE.COM

PART A -AGREEMENT NO. HCFA 87-001-1.53

Dr. Bart McMullan
President
Regence BlueCross
BlueShield of Oregon
PHONE: 503-225-5351

Steve Hooker
Senior Vice President
Regence BlueCross
BlueShield of Oregon
Internal Operations
P. O. Box 1271
Portland, Oregon
97201-1271
PHONE: 503-225-5945
FAX: 503-225-4800

Joy Bahnemann
Vice President
Medicare Northwest
P. O. Box 8110
Portland, Oregon
97207-8110
PHONE: 503-721-7115
FAX: 503-228-3304

�
PENNSYLVANIA PART A PROVIDER SERVICE AREA: Pennsylvania (SPECIAL CLAIMS: RHC).

HIGHMARK INC.
(d.b.a. Veritus Medicare Services)
120 Fifth Avenue, Suite P5101
Pittsburgh, Pennsylvania 15222-3099
PHONE: 412-544-7000
FAX: 412-544-8054
INERNET: veritusmedicare@highmark.com
Beneficiary Calls Only: 1-800-853-1419
Web Address: www.veritusmedicare.com

PART A - AGREEMENT NO. HCFA 87-001-1.56

Kenneth Melani, M.D. President & CEO Highmark Inc. PHONE: 412-544-8202	Robert C. Gray Executive Vice President Finance & Subsidiary Services Highmark Inc. Camphill, PA PHONE: 717-763-6274
��
Dave O'Brien Executive Vice President Government Services Highmark Inc. PHONE:412-544-8870-Pittsburgh PHONE:717-763-6568-Camphill	Address all technical and procedural correspondence to: Stephen Walker Vice President Government Business Unit 120 Fifth Avenue Suite P5101 Pittsburgh, PA 15222-3099 PHONE: 412-544-1961 FAX: 412-544-1971

�

PENNSYLVANIA PART B JURISDICTION

: State of Pennsylvania

HIGHMARK INC.
(d.b.a. HGSAdministrators)
P.O. Box 890065
Camp Hill, Pennsylvania 17089-0065
FOR EXPRESS MAIL:
1800 Center Street
Camp Hill, Pennsylvania 17089
PHONE: 1-800-662-0849 (Center Street) FAX: 717-302-3710 (Center Street)
INTERNET:www.hgsa.com

PART B - CONTRACT NO. HCFA 87-025-2

�

Kenneth Melani, M.D. President & CEO Highmark Inc. PHONE: 717-302-3712	Robert C. Gray Executive Vice President Finance & Subdisiary Services Pittsburgh Office Highmark Inc. 120 Fifth Avenue FAP 3116 Pittsburgh, PA. 15222 PHONE: 412-544-8043 Camp Hill Office HGSAdministrators P.O. Box 890089 Camp Hill, PA. 17089-0089 PHONE: 717-302-4387
��
David M. O'Brien Executive Vice President Government Services Pittsburgh Office Highmark Inc. 120 Fifth Avenue Pittsburgh, PA 15222 PHONE: 412-544-5250 Camp Hill Office HGSAdministrators P.O. Box 890089 Camp Hill, PA. 17089-0089 PHONE: 717-302-3865	Patrick M. Kiley Vice President & Principal Officer HGSAdministrators PHONE: 717-302-3707

�
Andrew Bloschichak, M.D. MBA Vice President Carrier Medical Director HGSAdministrators Program Safeguards PHONE: 717-302-4198

PUERTO RICO PART A PROVIDER SERVICE: See Cooperativa de Seguros de Puerto Rico
PART B JURISDICTION: Puerto Rico and U.S. Virgin Islands

TRIPLE-S, INC.
Box 71391
San Juan, Puerto Rico 00936-1391
STREET ADDRESS:
1441 F.D. Roosevelt Avenue
Caparra, Puerto Rico 00920
PHONE: 787-749-4949 (Switch Board)
Community Relations (Medicare)
Providers: 787-749-4232
Provider Toll Free: 1-877-715-1921

Beneficiaries: 787-749-4900
Beneficiary Toll Freeline: 787-981-7015
FAX: 787-749-4900
INTERNET: mortiz@triples-med.org
Website: www.triples-med.org

PART B- CONTRACT NO. HCFA 87-033-2

Mr. Ramon Ruiz President and Chief Executive Officer, Triples, Management Corp. PHONE: 787-749-4113 FAX: 787-749-4091	Mrs. Socorro Rivas President and Chief Executive Officer Triple S, Inc. PHONE: 787-749-4118 FAX: 787-706-4001
��
Mr. Carlos Gonzales, Esq. Assistant Vice President Medicare PHONE: 787-277-6691 FAX: 787-749-4092	Mrs. Gloria Lebrón, Esq. Vice President, Medicare PHONE: 787-749-4083 FAX: 787-749-4092

RHODE ISLAND PART A PROVIDER SERVICE AREA

:See State of Arkansas - Arkansas Blue Cross and Blue Shield
PART B JURISDICTION: State of Arkansas - Arkansas Blue Cross and Blue Shield
� �

SOUTH CAROLINA PART A PROVIDER SERVICE AREA

: State of South Carolina and North Carolina
Regional Home Health Intermediary (RHHI) Hospice: Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Ohio, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Texas

PART B JURISDICTION: State of South Carolina, Ohio, West Virginia

DME REGIONAL CARRIER: : Alabama, Arkansas, Colorado, Florida, Georgia, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands, (PE)

Statistical Analysis Durable Medical Equipment Carrier (SADMERC)

National Supplier Clearinghouse (NSC)

BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA
(d.b.a. PALMETTO GBA)
Executive Offices:
17 Technology Circle
Columbia, South Carolina 29203-9511
Operations Offices:
P. O. Box 100190
Columbia, South Carolina 29202-3190
PHONE: 803-735-1034
FAX: 803-935-0081
INTERNET: ROSE.VOYLES@Palmetto GBA.COM

Overnight Mail
2300 Springdale Drive
Building One
Camden, SC 29020

PART A - AGREEMENT NO. HCFA 87-001-1.59
PART B - Contract No. HCFA 87-027-2
PART B - Contract - RRB - 00RRB005
DMERC - Contract - HCFA 500-93-BPO-3

William R. Horton President Government Programs Division I-20 at Alpine Road Mail Code: AA-X30 Columbia, SC 29219 PHONE: 803-788-4138 FAX: 803-736-9289	Bruce W. Hughes Executive Vice President & COO 17 Technology Circle Mail Code: AG-A03 Columbia, SC 29203-9511 PHONE: 803-763-7130 Columbia, SC 29223 FAX: 803-935-0081
��
Roz Catoe Vice President Processing & Customer Service 17 Technology Circle Mail Code: AG-A05 Columbia, SC 29203-9511 PHONE: 803-763-5086 FAX: 803-935-0176	Neal Burkhead Vice President Medicare Integrity Program 17 Technology Circle Mail Code: AG-A11 Columbia, SC 29203-9511 PHONE: 803-763-1535 FAX: 803-935-0176
��
Ann Archibald Vice President Compliance Officer 17 Technology Circle Mail Code: AG-A02 Columbia, SC 29203-9511 PHONE: 803-763-8700 FAX: 803-763-7115	Dickie Butler Vice President Systems/EDI 17 Technology Circle Mail Code: AG-A08 Columbia, SC 29203-9511 PHONE: 803-763-1077 FAX: 803-935-1411
��
Durable Medical Equipment ��
Robin Spires Assistant Vice President DMERC Operations 17 Technology Circle Mail Code: AG-A13 Columbia, SC 29203-9511 Phone: 803-763-5704 Fax: 803-935-1411	Jean Catalano Assistant Vice President Railroad Medicare Operations 2743 Perimeter Parkway Building 200, Suite 400 Augusta, GA 30909 Phone: 706-855-3130 Fax: 706-855-3132
��
Mike Barlow Vice President Ohio/WV Operations 3400 South Park Place Suite F Grove City, Ohio 43123-4846 Phone: 614-277-6400 Fax: 614-277-6803	Joe Wright Vice President CFO 17 Technology Circle Mail Code: AG-A15 Columbia, SC 29203-9511 Phone: 803-763-5544 Fax: 803-935-0176
Elaine Meyers Assistant Vice President Part A/RHHI Operations 17 Technology Circle Mail Code: AG-13 Columbia, SC 29203-9511 Phone: 803-763-5505 Fax: 803-935-1411

SOUTH DAKOTA - PART A PROVIDER SERVICE AREA - See Blue Cross and Blue Shield of Alabama
PART B JURISDICTION- See North Dakota, Noridian Mutual Insurance Company

TENNESSEE PART A PROVIDER SERVICE AREA: State of Tennessee, New Jersey (SPECIAL CLAIMS: RHC, CSC, OPT, HL, LPIC)
PART B JURISDICTION - See Connecticut General Life Insurance Company

BLUE CROSS BLUE SHIELD OF TENNESSEE
(d.b.a. Riverbend Government Benefits Administrator)
801 Pine Street
Chattanooga, Tennessee
37402
Medicare Address: 730 Chestnut Street Chattanooga, TN 37402
PHONE: (Medicare Beneficiary Toll Free) 866-641-2007
Provider Line: 877-296-6189 (toll free)
FAX: 423-752-6518
INTERNET:sharon_cheek@bcbst.com

PART A - AGREEMENT NO. HCFA 87-001-1.60

Vicky Gregg
President & COO

Ann Keown
Vice President
Phone: 423-755-5783
Fax: 423-763-3537

David Jackson
Director
Government Programs
Medicare Integrity Program and Reimbursement
Phone:423-755-5806

TEXAS PART A PROVIDER SERVICE AREA

: State of Texas, New Mexico and Colorado
PART B JURISDICTION: States of Texas, Maryland, Delaware, District of Columbia, City of Alexandria, Arlington and Fairfax Counties in Virginia (Special Claims: RHC), Virginia

TRAILBLAZER HEALTH ENTERPRISES, LLC
P.O. Box 660156
Dallas, Texas 75266-0156
STREET ADDRESS:
8330 LBJ Freeway
Executive Center 3
Dallas, Texas 75243
PHONE: 469-372-1816
FAX: 469-372-1765
INTERNET-TX: tb.mail@trailblazerhealth.com

PART A - AGREEMENT NO. HCFA 87-001-1.62
PART B - CONTRACT NO. HCFA 87-029-2

Ms. Marti Mahaffey
Executive Vice President and COO
PHONE: 469-372-1701

UTAH PART A PROVIDER SERVICE AREA:

�See Regence Blue Cross Blue Shield of Oregon
PART B JURISDICTION: State of Utah

REGENCE BLUE CROSS AND BLUE SHIELD OF UTAH
2890 East Cottonwood Parkway
Salt Lake City, Utah 84121
OR
P.O. Box 30269
Salt Lake City, Utah 84130-0269
PHONE: 801-333-2000
FAX: 801-333-6505
INTERNET:ut.medicaregeneral@regence.com

PART B - CONTRACT NO. HCFA 87-030-2

Scott Ideson President PHONE: 801-333-5664	Joy Bahnemann Vice President Government Programs P.O. Box 8110 Portland, Oregon 97207-8110 PHONE: 503-721-7115
��
John Mitchell Assistant Director Medicare B PHONE: 801-333-5225

VERMONT PART A PROVIDER SERVICE AREA

- See Anthem Health Plans of New Hampshire, Inc.
PART B JURISDICTION - See National Heritage Insurance Company

VIRGINIA PART A PROVIDER SERVICE AREA: See United Government Services, LLC
PART B JURISDICTION - TrailBlazer Health Enterprises, LLC

WASHINGTON PART A PROVIDER SERVICE AREA: States of Washington and Alaska
PART B JURISDICTION - See Noriaian Mutual Insurance Company

PREMERA BLUE CROSS&emdash; NOTE: Leaving 9/30/04
P.O. Box 2847
Seattle, Washington 98111-2847
STREET ADDRESS:
7001 - 220TH S.W.
Mountlake Terrace, Washington 98043
PHONE: 877-602-7896
FAX: 425-918-5505
INTERNET:kathleen.henderson@premera.com

PART A - AGREEMENT NO. HCFA 87-001-1.66

H.R. Brereton (Gubby) Burlow
President & CEO
PHONE: 425-918-4738

Judy Ellis
Vice President
Production Administration
PHONE: 425-918-5657

Janet Russell
Director
Federal Programs
PHONE: 425-741-4104

WEST VIRGINIA PART A PROVIDER SERVICE AREA -

See United Government Services, LLC
PART B JURISDICTION - See Blue Cross and Blue Shield of South Carolina

WISCONSIN PART A PROVIDER SERVICE AREA: States of Wisconsin, Michigan, Virginia, West Virginia, California, Nevada, Guam, Northern Mariana Islands and American Samoa (SPECIAL CLAIMS: HHA, Hospice, FQHC)
PART B JURISDICTION - See Wisconsin Physicians Service Insurance Corporation

United Government Services, LLC
401 West Michigan Street
Milwaukee, Wisconsin 53203-2804
PHONE: 414-226-6203
INTERNET: www.ugsmedicare.com
FAX: 414-226-5226

Beneficiary Inquiries
Milwaukee Office	1-800-531-9695 (Wisconsin)
	1-866-804-0686 (Michigan)
Roanoke Office	1-877-768-5471
Camarillo Office	1-866-804-0684 1-866-264-4990 (Hawaii)
Provider Inquiries
Milwaukee Office:	1-877-309-4290 (Wisconsin)
	1-866-419-9462 (Michigan)
Roanoke Office:	1-877-908-8474
Camarillo Office:	1-866-380-4745 1-866-849-7244 (Hawaii)

PART A - AGREEMENT NO. HCFA 87-001-1.70

Sally T. Wood President United Government Services, LLC PHONE: 414-226-2813	Janine Harris Vice President, Human Resources and Administration United Government Services, LLC. Phone: 414-226-5160
�
Timothy F. Cullen Chairman, Government Health Services, LLC PHONE: 414-226-6004	Todd Reiger Director of Finance United Government Services, LLC. Phone: 414-226-5606
��
Cheryl Leissring Compliance Officer & Director of Internal Audit United Government Services, LLC. Phone: 414 226-5884
��
Liz Bartlett Vice President & General Counsel United Government Services, LLC. Phone: 414-226-6777
��
Steve Holubowicz Vice President of Program Safeguards United Government Services, LLC. PHONE: 414-226-6991

��
Shig Kimoto Vice President, Information Technology United Government Services, LLC. Phone: 805-367-1010

WYOMING PART A PROVIDER SERVICE AREA: State of Wyoming
PART B - See Nordian Mutual Insurance Company

BLUE CROSS AND BLUE SHIELD OF WYOMING
4000 House Avenue
Cheyenne, Wyoming 82001
OR
P.O. Box 908
Cheyenne, Wyoming 82003-0908
PHONE: 307-432-2860
FAX: 307-432-2901
INTERNET: jeff.beuchel@bcbswy.com

PART A - AGREEMENT NO. HCFA 87-001-1.71

Tim Crilly
President
Medicare Coordinator
PHONE: 307-432-3022

Jeffrey Beuchel
Director
Medicare
PHONE: 307-432-2848

SECTION III

COMMERCIAL AND INDEPENDENTS - PART A & B

COOPERATIVA DE SEGUROS DE VIDA DE PUERTO RICO
GPO Box 363428
San Juan, Puerto Rico 00936-3428
STREET ADDRESS:
400 Americo Miranda Avenue
San Juan, Puerto Rico 00927
PART A - AGREEMENT NO. HCFA 87-326-1
PHONE: 787-758-9733(switchboard)
FAX: 787-756-8199

PART A PROVIDER SERVICE AREA: Puerto Rico and U.S. Virgin Islands

Mr. Carlos Fernández President PHONE: 787-758-7854	Jose A. Brull Vice President, Medicare PHONE: 787-763-2053
��
Ms. Alba Cosme Assistant Vice President Medicare Operations PHONE: 787-758-8469	William Zayas Assistant Vice President Audit and Reimbursement PHONE: 787-765-2570

CONNECTICUT GENERAL LIFE INSURANCE COMPANY (CGLIC), a CIGNA Company
Hartford, Connecticut 06152
PHONE: 615-244-5600
FAX: 615-782-4445
EMAIL: cignapartb@cigna.com
EMAIL: cignadmerc@cigna.com
INTERNET: www.cignamedicare.com

PART B - CONTRACT NO. HCFA 91-330-2
DMERC - CONTRACT No. 500-93-BPO-4

PART B JURISDICTION: States of Idaho, North Carolina, Tennessee
DME REGIONAL CARRIER: Alaska, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Mariana Islands, Missouri, Montana, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming (PE)

John F. Hoey Assistant Vice President, CIGNA HealthCare, Medicare Administration Two Vantage Way Nashville, TN 37228 PHONE: 615-782-4571 FAX: 615-782-4695 John.Hoey@cigna.com	Ms. Jean Rush Vice President, Medicare Contract Service MS C301 900 Cottage Grove Road Hartford, CT 06142 PHONE: 860-226-4690 FAX: 860-572-5066
�
CLAIMS SYSTEMS William Swanke Assistant Vice President CIGNA Systems Two Vantage Way Metro Exchange Building Nashville, TN 37228 PHONE: 615-782-4672 FAX: 615-782-0187 Bill.swanke@cigna.com
�
DURABLE MEDICAL EQUIPMENT Kathy Filbert Assistant Vice President CIGNA Healthcare Medicare Administrator DMERC Two Vantage Way Nashville, TN 37228 PHONE: 615-782-4424 FAX: 615-782-4626 Kathy.Filbert@cigna.com
��
Idaho, Tennessee, North Carolina ��
Darrell Tackett Assistant Vice President, Part B Operations Two Vantage Way Nashville, TN 37228 PHONE: 615-782-4525 FAX: 615-782-4627 Darrell.tackett@cigna.com
��
Jeff Chambers Assistant Vice President, Finance Two Vantage Way Nashville, TN 37228 PHONE: 615-782-4676 FAX: 615-782-4622 Jeff.Chambers@cigna.com
��

Brian Setzer Assistant Vice President, Strategic Initiatives Two Vantage Way Nashville, TN 37228 PHONE: 615-782-4618 FAX: 615-782-4445 Brian.setzer@cigna.com

��
Melissa Lamb Benefit Integrity Manager Two Vantage Way Nashville, TN 37228 PHONE: 615-782-4527 FAX: 516-782-4446 Melissa.Lamb@cigna.com

��
Michael Logan Director of Compliance (interim) Two Vantage Way Nashville, TN 37228 PHONE: 615-782-4595 FAX: 615-782-0182 Michael.Logan@cigna.com
��

�

GROUP HEALTH INCORPORATED

25 Broadway
New York, New York 10004
PHONE: 646-458-6600
FAX: 646-458-6761

PART B - CONTRACT NO. HCFA 87-320-2

PART B JURISDICTION: Queens County, New York

Peter S. Moore Vice President PHONE: 646-458-6601
��
Sean Martinez Director Community Relations PHONE: 646-458-6622 FAX: 646-458-6756	Jim Brady Director of Medicare Operations Program Evaluation and Integrity PHONE: 646-458-6682 FAX: 646-458-6764

HAWAII MEDICAL SERVICE ASSOCIATION

PART A PROVIDER SERVICE AREA: United Government Services, LLC
PART B Jurisdiction: See North Dakota - Noridian Mutual Insurance Company

UNITED HEALTH CARE INSURANCE COMPANY

PART A PROVIDER SERVICE AREA: See Empire HealthChoice, Inc. and United Government Services, LLC
PART B JURISDICTION: See Blue Cross and Blue Shield of Florida (Connecitut), See Wisconsin Physicians Services (Minnesota), See Blue Cross and Blue Shield of Alabama (Mississippi), See TrailBlazer Health Enterprises, LLC (Virginia) - DME Reg. Carrier, See HealthNow New York Inc.

MUTUAL OF OMAHA INSURANCE COMPANY
P.O. Box 1602
Omaha, Nebraska 68131-3492
STREET ADDRESS:
Mutual of Omaha Plaza
Omaha, Nebraska 68175
PHONE: 402-351-2860
FAX: 402-351 8047
INTERNET: WWW.MUTUALMEDICARE.COM

PART A - AGREEMENT NO. HCFA 87-319-1

PART A PROVIDER SERVICE AREA: Available in all states

Rick Reeves
Vice President and Director of Medicare
Mutual of Omaha
P.O. Box 1602
Omaha, NE 68101
PHONE: 402-351-2940
FAX: 402-351-8796
EMAIL: RICK.REEVES@MUTUALOFOMAHA.COM

��

Elizabeth M. Powers
First Vice President
Medicare Admin. Systems
Mutual of Omaha
P.O. Box 1602
Omaha, NE 68101
PHONE: 402-351-2570
FAX: 402-351-8047
EMAIL: LIZ.POWERS@MUTUALOFOMAHA.COM

��

Shelly Foxworthy
First Vice President Audit & Reimbursement
Mutual of Omaha
P.O. Box 1604
Omaha, NE 68101
PHONE: 402-351-5377
FAX: 402-351-8796
EMAIL: SHELLY.FOXWORTHY@MUTUALOFOMAHA.COM

��

Patricia Allmon
First Vice President
Medicare Claims Program
Mutual of Omaha Ins. Co.
P.O. Box 1602
Omaha, NE 68101
PHONE: 402-351-3205
FAX: 402-351-8047
EMAIL: TRISH.ALLMON@MUTUALOFOMAHA.COM

��

Karen Alexander
First Vice President
Quality Improvement Programs
Mutual of Omaha Ins. Co.
P.O. Box 1602
Omaho, NE 68101
PHONE: 402-351-4237
FAX: 402-351-5931
EMAIL: KAREN.ALEXANDER@MUTUALOFOMAHA.COM

��

Janet Kyle
First Vice President
Finance
Mutual of Omaha Ins. Co.
P.O. Box 1602
Omaho, NE 68101
PHONE: 402-351-6940
FAX: 402-351-8047
EMAIL: JANET.KYLE@MUTUALOFOMAHA.COM

��

Charles Hagen
First Vice President
Medical Compliance
Mutual of Omaha Ins. Co.
P.O. Box 1602
Omaho, NE 68101
PHONE: 402-351-3614
EMAIL: CHARLES.HAGEN@MUTUALOFOMAHA.COM

MUTUAL OF OMAHA FIELD OFFICES

DENVER, CO
Rick Keegan
Field Audit Manager
Panorama Corporate Center V
9200 E Panorama Circle
Suite 225
Englewood, CO 80112-3481
PHONE: 303-925-0065
FAX: 303-925-0969
EMAIL: RICK.KEEGAN@MUTUALOFOMAHA.COM

��

SACRAMENTO, CA
Dan Dahl
Field Audit Manager
Capital Professional Center
2200 B Douglas Blvd.
Suite 275
Roseville, CA 95661
PHONE: 916-774-9275
FAX: 916-774-1112
EMAIL: DAN.DAHL@MUTUALOFOMAHA.COM

��

LOS ANGELES, CA
Richard N. Eclarin
Field Audit Manager
901 Corporate Center Drive
Suite 405
Monterey Park, CA 91754
PHONE: 323-881-9586
FAX: 323-881-9534
EMAIL: RICK.ECLARIN@MUTUALOFOMAHA.COM

��

DALLAS, TX
George Pietri
Field Audit Manager
14200 Midway Road
Suite 125
Dallas, TX 75244
PHONE: 972-386-4061
FAX: 972-233-9406
EMAIL: GEORGE.PIETRI@MUTUALOFOMAHA.COM

��

KANSAS CITY,MO
Marilyn Huskamp
Field Audit Manager
10220 North Executive Hills Blvd.
Suite 220
Kansas City, MO 64153
PHONE: 816-891-6500
FAX: 816-891-8817
EMAIL: MARYLIN.HUSKAMP@MUTUALOFOMAHA.COM

��

ST. LOUIS, MO
Mike Connelly
Field Audit Manager
11701 Borman Drive
Suite 220
St. Louis, MO 63146-4193
PHONE: 314-997-6626
FAX: 314-997-6997
EMAIL: MIKE.CONNELLY@MUTUALOFOMAHA.COM

��

CLEARWATER, FL
Cynthia MacDonald, CPA
Field Audit Manager
33920 U.S. Highway 19 North, Suite 360
Palm Harbor, FL 34684
PHONE: 727-772-2557
FAX: 727-772-7193
EMAIL: CYNTHIA.MACDONALD@MUTUALOFOMAH.COM

ATLANTA, GA
Linda Smallwood
Field Audit Manager
2400 Herodian Way
Suite 300
Smyrna, GA 30080
PHONE: 770-988-9052
FAX: 770-988-9065
EMAIL: LINDASMALLWOOD@MUTUALOFOMAHA.COM

��

CHICAGO, IL
Art Garvida
Field Audit Manager
377 East Butterfield Road
Suite 260
Lombard, IL 60148
PHONE: 630-810-1324
FAX: 630-810-1368
EMAIL: ART.GARVIDA@MUTUALOFOMAHA.COM

��

HARFORD, CT
James Zanavich
Field Audit Manager
655 Winding Brook Dr.
Glastonbury, CT 06033
PHONE: 860-659-4300
FAX: 860-659-8065
EMAIL: JAMES.ZANAVICH@MUTUALOFOMAHA.COM

NATIONAL HERITAGE INSURANCE COMPANY

402 Otterson Drive
Chico, CA 95928
PHONE: 530-634-7000
FAX: 530-896-7182
INTERNET: www.medicarenhic.com

PART B - CONTRACT NO. HCFA-96-331-2

PART B JURISDICTION: States of California, Massachusetts, Maine, Vermont and New Hampshire (claims processing)

CALIFORNIA (Northern)
Beneficiary Services - 800-952-8627
Provider Services - 877-591-1587

(All counties except San Luis Obispo, Santa Barbara, Ventura, Los Angeles, Orange, San Diego and Imperial)

CALIFORNIA (Southern)

Beneficiary Services - 800-675-2266
Provider Services - 866-502-9054

(For the counties of San Luis Obispo, Santa Barbara, Ventura, Los Angeles, Orange, San Diego and Imperial)

MAINE
Beneficiary Services - 800-492-0919
Provider Services - 877-567-3129

MASSACHUSETTS
Beneficiary Services - 800-882-1228
Provider Services - 877-567-3130

NEW HAMPSHIRE/VERMONT

Beneficiary Services - 800-447-1142
Provider Services - 866-539-5595

Senior Vice President NHIC A6N-B29 13600 EDS Drive Herndon, VA 20171 PHONE: (703) 742-2400 FAX: (703) 742-2871	Donald S. Picard Vice President, Medicare Mailstop A5N-C47 13600 EDS Drive Herdon, VA 20171 PHONE: 703-742-2280 FAX: 703-742-2886
��
��
Anne Bockhoff Dalton Vice President, NHIC Medicare 75 Sgt. William Terry Drive Hingham, MA 02043 PHONE: 781-741-3201 FAX: 781-741-3211	Colleen Cerullo Administrative Assistant NHIC 75 Sgt. William Terry Drive Hingham, MA 02043 PHONE: 781-741-3136 FAX: 781-741-3211
��
Paul Ackerman Director of Southern California Service Operations NHIC-B311 1055 West 7th Street Los Angeles, CA 90017 PHONE: 213-593-6192 FAX: 213-595-5900	Andrew Conn Director of Claims Operations and Northern California Service Operations NHIC 75 Sgt. William Terry Drive Hingham, MA 02043 PHONE: 781-741-3029 FAX: 781-741-3032
��
Robert Harrington Director of New England Customer Service NHIC 75 Sgt. William Terry Drive Hingham, MA 02043 PHONE: 781-741-3255 FAX: 781-741-3083	Jane Hite Director of Business Support NHIC 75 Sgt. William Terry Drive Hingham, MA 02043 PHONE: 781-741-3401 FAX: 781-741-3211
��
��
Trace Woodward Director of Finance 402 Otterson Drive Chico, CA 95928 PHONE: 530-896-7108 FAX: 530-896-7182

NATIONWIDE MUTUAL INSURANCE COMPANY - see Blue Cross and Blue Shield of South Carolina

WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION

PART B - CONTRACT NO. HCFA 87-032-2

PART B JURISDICTION: State of Wisconsin, Illinois, Michigan, and Minnesota

ADMINISTRATION P.O. Box 8190 Madison, Wisconsin 53713	STREET ADDRESS 1717 W. Broadway Madison, Wisconsin 53713
��
PHONE: 608-221-4711 FAX: 608-301-2625 Madison, Wisconsin 53713
��
EXECUTIVE
��
James R. Riordan President & CEO	William Bathke Executive Vice President and COO
��
Ned Boston Vice President Medicare Division PHONE: 608-301-2603	Mary Strope Director, Customer Service and Outreach PHONE: 608-301-2605
��
David Horst Director, Operations PHONE: 608-301-2608	Lisa Sunde Director, Training & Quality Improvement PHONE: 608-301-2607
��
Sheila Bechmann Director, Systems PHONE: 608-301-2618	Marie Wybo Director, Detroit Admin. PHONE: 248-395-7701
��
Susan Porter Director, Program Compliance PHONE: 608-221-7582
��
Wisconsin Claims P.O. Box 1787 Madison, WI 53701 PHONE: 1-800-MEDICARE (Bene.)	Illinois Claims P.O. Box 1030 Marion, IL 62959 PHONE: 1-800-MEDICARE (Bene.)
��
Michigan Claims P.O. Box 5555 Marion, IL 62959 PHONE: 1-800-MEDICARE (Bene.)	Minnesota Claims 8120 Penn Avenue South Bloomington, MN 55431 PHONE: 1-800-MEDICARE (Bene.)

SECTION IV

REGIONAL HOME HEALTH INTERMEDIARIES
DURABLE MEDICAL EQUIPMENT REGIONAL CARRIERS
COMMON WORKING FILE HOST CONTRACTORS

Regional Home Health Intermediaries
Region I(*)
Anthem Health Plans of Maine, Inc. (d.b.a. Associated Hospital Service)
2 Gannett Drive
South Portland, Maine 04106-6911
Phone: 207-822-7000
Serving: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont

Region IV(*)
Blue Cross and Blue Shield of South Carolina
I-20 at Alpine Road
Columbia, South Carolina 29219
Phone: 803-788-3860
Serving: Kentucky, North Carolina, South Carolina, Tennessee, Alabama, Florida, Georgia, Mississippi, Arkansas, Louisiana, New Mexico, Oklahoma, Texas, Illinois, Indiana, and Ohio

Region V(*)
United Government Services, LLC
P.O. Box 9150
Oxnard, CA 93031
Phone: 805-367-0731
Serving: Alaska, Arizona, California, Hawaii, Idaho, Oregon, Nevada, Washington, Northern Mariana Islands, Guam, and American Samoa

401 West Michigan Street
Milwaukee, Wisconsin 53203-2804
Phone: 414-226-6203
Serving: Michigan, Minnesota, New Jersey, New York, Puerto Rico, the Virgin Islands, and Wisconsin

Region VII(*)
Blue Cross and Blue Shield of Alabama
P.O. 830139
Birmingham, Alabama 35283-0139
Phone: 205-988-2100
Serving: Colorado, Iowa, Kansas, Missouri, Montana, Nebraska, North Dakota, South Dakota, Utah, Wyoming, Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia

*Designates the HCFA Region in which the intermediary is physically located.

Durable Medical Equipment Regional Carriers

Region A
HealthNow New York, Inc.
Donna Cupina
Sr. Director
60 E Main Street
Naticoke, PA 18634
Phone: 570-735-9501
FAX: 570-735-9439
Serving: Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont

Region B
Michael McCarron
President
AdminaStar Federal Inc.
8115 Knue Road
Indianapolis, Indiana 46250
Phone: 317-841-4510
FAX: 317-841-4691
Serving: District of Columbia, Illinois, Indiana, Maryland, Michigan, Minnesota, Ohio, Virginia, West Virginia, Wisconsin

Region C
Mr. William R. Horton
Group Vice President
Blue Cross and Blue Shield of South Carolina
I-20 at Alpine Road
Columbus, South Carolina 29219
Phone: 803-735-1034
FAX: 803-786-4636
Serving: Alabama, Arkansas, Colorado, Florida, Georgia, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands

Region D
Mr. Edward Burrell
Vice President
Connecticut General Life Insurance Company
2 Vantage Way
Metro Exchange Building
Nashville, Tennessee 37228
Phone: 615-782-4511
FAX: 615-244-6242
Serving: Alaska, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming, American Samoa and Northern Mariana Islands

Common Working File Host Contractors

Blue Shield of Alabama

Blue Shield of Florida

Empire HealthChoice Assurance, Inc.

TrailBlazer Health Enterprise, LLC

SECTION IV - RURAL HEALTH CLINICS

CONTRACTOR	JURISDICTION
Anthem Health Plans of Maine, Inc	Maine
� �
Anthem Health Plans of New Hampshire, Inc.	New Hampshire, Vermont
��
Highmark Inc.	Connecticut, Delaware, District of Columbia, New York, Pennsylvania, Puerto Rico, Rhode Island, Massachusetts, Virginia, West Virgina, Maryland, New Jersey, Virgin Islands
� �
TrailBlazer HealthEnterprises, LLC	Colorado, Montana, North Dakota, Oklahoma, South Dakota, Utah, Wyoming, Texas, Arkansas, Louisiana, New Mexico
��
Blue Cross and Blue Shield of Tennessee	Kentucky, Tennessee, North Carolina, South Carolina, Mississippi, Alabama, Georgia, Florida, Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, Nevada, Ohio, Oregon, Washington, Wisconsin

Last Modified on Thursday, September 16, 2004

Search Frequenty Asked Questions

Intermediary-Carrier Directory

U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services

U.S. Department of Health and Human Services
Centers for Medicare and Medicaid Services