2011 MGMA Annual Conference


Are you planning to attend the 2011 MGMA Annual Conference in Las Vegas on October 23-26? Please make sure you stop by booth 1301 to learn about our new capabilities and how we can help improve your healthcare business. While you’re there, you can enter for a chance to win one of two $2,500 travel vouchers to the destination of your choice! We’ll also give you a personalized, colorful, aluminum luggage tag to make it easy to identify your bag on your next trip.




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HIPAA Update for Channel Partners


Emdeon continues to guide our customers successfully through the migration to the X12 5010 and NCPDP D.0 versions of the HIPAA transaction standards. We have enhanced our 5010 systems and products to support the Errata versions HIPAA transactions. The Errata versions of the gap analysis documents are available at the HIPAA Simplified website under 'downloads'.

We strive to provide you with the most updated and accurate information regarding our readiness for HIPAA 5010. Please see below answers to the most commonly asked questions regarding HIPAA 5010.

What is Emdeon’s current state and plans for HIPAA 5010 testing?
Emdeon is currently testing and implementing 5010 with submitters and payers while already in production with some payers and submitters. The late release of the Errata changes to the 5010 transaction standards further constricted the already narrow 5010 testing and conversion window. Nevertheless, as you can see in the list below, Emdeon has initiated submitter and payer testing on all 5010 transactions.

Errata testing/production in process:
• 837 Professional claims
• 837 Institutional claims
• 837 Dental claims
• 835 ERAs
• 270/271 Eligibility verification

Emdeon is also testing and implementing the Final Rule version with submitters and payers for the HIPAA X12 transactions that were not included in the Errata revisions:

• 276/277 Claim Status
• 278 Referral/Authorization

How can my organization initiate testing with Emdeon?
Emdeon has created HIPAA 5010 conversion tools to help automate the conversion for your convenience. To begin this process, please initiate testing through your Emdeon ON24/7 account. Please refer to the Submitter Claim Quick Reference Guide to guide you further. Detailed instructions are also available on Emdeon ON24/7.

How will my organization be notified of any product updates if required?
Emdeon has created a global communications plan for our clients. In addition, HIPAA 5010 Product fact sheets are available and being distributed for each product line. Remember to frequently visit Emdeon’s hipaasimplified.com website which has been recently updated and reorganized to contain new valuable content like product fact sheets and product specific testing information.

What is the timeline(s) of events?
The compliance date of HIPAA 5010 conversion is January 1st, 2012. All Emdeon products and services have been remediated for 5010; we are in testing phase with many submitters and payers while already in production with some submitters and payers.

Did Emdeon participate in the CMS National version 5010 Testing Days?
Yes, Emdeon did participate in the CMS National version 5010 day on June 14th and also in the subsequent testing week (August 22nd to August 26th). Emdeon sent test files to all Medicare Administrative Contractors (MACs) during both these testing periods.

How can I obtain additional information about HIPAA 5010?
Emdeon has created a valuable web resource available to all industry stakeholders titled HIPAA Simplified, which may be found at www.hipaasimplified.com. HIPAA Simplified is a one-stop online resource that features gap analysis, business level documentation, webinars, timelines for the transition and testing information for our customers.

Thanks for trusting Emdeon as your source for HIPAA readiness. We are working diligently to deliver solutions that enable our customers to seamlessly meet these industry regulatory requirements.



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Ready, (Code) Set, GO...What You Need to Know About the Approaching ICD-10 Conversion


October 1, 2013.
For those of us in the healthcare industry, that’s the date that was announced back in January 2009 as the appointed day when ICD-10 conversion will occur. From that October 1st, 2013, we can never look back at ICD-9, plead for grace or vie for more time for implementation. At that time, everyone must be compliant without exception if they hope to be paid by public and private health plans.

As a part of the healthcare industry, you know very well that this date is how close and important. The two years that remain to prepare for a conversion of this magnitude are a blip on the screen. There’s much to know, consider and do to be ready, for you and your clients.

Here are some key points that will help you be prepared in your business and be the go-to resource clients need at this juncture.

1. ICD-10 code sets hold real promise.
It’s helpful to remember the intention of this mass conversion while we’re mired in the preparation. This 10th incarnation of the World Health Organization’s ICD (International Classification of Diseases) will be more specific with enhanced clinical information integrated, making it far more than just a revision of the existing ICD-9 codes. When ICD-10 code sets are the standard, our industry will likely see reduced payment errors, quicker reimbursements and significantly improved data sharing worldwide. Ultimately, we will all benefit from ICD-10’s more globally unified, meaningful reporting of diagnoses—a fact that, perhaps, makes the preparation for conversion more tolerable.

2. The HIPAA 5010 update is a looming milestone in the journey to ICD-10 compliance.
By January 1, 2012, all healthcare organizations must upgrade to the 5010 version of the Electronic Data Interchange (EDI). This is a necessary action because the current 4010/4010A1 versions are unable to accommodate ICD-10 codes and will be obsolete at the point of conversion. The disparity between dates of the 5010 transition and ICD-10 conversion exists to allow ample time for testing and trouble-shooting. Of course, this requirement is relevant to any technology or service business in a role of support for providers, payers and other entities covered by HIPAA; Emdeon is well ahead of the game in terms of readiness for the 5010 switch.

3. The ICD-10 conversion date is immovable industry wide.
No matter the size, scope or function of an organization, it must be in compliance on (or before) October 1st, 2013. The long-established conversion date is firm for providers of all types and stripes, public and private payers and industry support services such as clearinghouses and technology vendors. There is simply no delaying ICD-10, thus we need every day between now and then to finish getting ready.

4. ICD-10 conversion affects the business of healthcare from the inside out.
This conversion is about so much more than revised code sets. As the Centers for Medicare & Medicaid Services (CMS) website reminds us, this ICD-10 conversion (along with the 5010 transition) demands organizations to alter many aspects of operations. Software must be updated and installed, personnel must be educated and trained, workflows must be revised, and manuals and other materials must be rewritten and produced anew in time for implementation. That’s why the industry allotted more than four years for the process and why the two years remaining before implementation are so critical.

5. You play an important role in conversion as a partner to your clients.
ICD-10 conversion runs deep into the fiber of any healthcare organization, ultimately impacting workflows, workforce and system wide processes. Though conversion is too comprehensive and intricate for an organization to completely outsource, you can bring automated, compliant technology to lighten your clients’ loads. With Emdeon’s advanced solutions and leading edge knowledge in your toolkit, you can help your clients clear the path for ICD-10 compliance by the October 1st, 2013 deadline.

Stay in touch for ICD-10 updates at hipaasimplified.com!



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What's Next for eRx and What Your Providers Need to do Now


The buzzer has sounded.

All “eligible professionals” who did not prove themselves to be “successful electronic prescribers” during January 1st through June 30th of this year are now subject to Medicare payment adjustments (translation: a 1 percent deduction on Medicare Part B reimbursement) come 2012, according to Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

What’s done is done, and whether your providers are left to nurse their wounds or breathe a sigh of relief, there’s always more eRx activity just around the corner. Here’s the latest, for your knowledge.

Comment by July 25th or Forever Hold Your Peace…
As of June 1st of this year, the 2011 eRx Proposed Rule is published in the Federal Register, providing updates to the existing eRx program. Specifics of the updates include modifications to quality measures, provisions for hardship exemption for the aforementioned 2012 payment adjustments, as well as extensions of deadlines for request of hardship exemptions. You may review details at http://ofr.gov/inspection.aspx and select file code CMS-3248-P.
Providers have until July 25th to submit comments to the rule.

Overview of Incentives—and Penalties—for eRx Going Forward
There’s still benefit to get going with eRx in 2011. Providers who prove to be a “successful electronic prescriber” during the first six months of this year, will avoid the penalty for 2012. However, providers must submit an additional 25 Medicare claims by December 31, 2011 to be eligible for the one percent incentive payment this year and to avoid penalty in 2013. As stated above, noncompliant “eligible professionals” will take a one percent deduction from the Medicare Physician Fee Schedule in 2012, 1.5 percent deduction in 2013 and two percent in 2014.

For the CMS’ specifics regarding “eligible professionals,” visit the website at http://iren.es/mDF4jA. An overview of the entire program may be accessed via http://www.cms.gov/ERxIncentive/.

Be sure to Crack the Code - Reporting the eRx G-Code
Successful reporting for the eRx Incentive Program requires a single G-code, a quality-data code adhering to parameters stated in the CMS document viewable at http://iren.es/lOmvNP. This reference offers guidelines for claims-based reporting.

Important to Know: ePrescribing and Meaningful Use
Did you know providers cannot qualify for both Medicare Meaningful Use incentives and electronic prescribing MIPPA incentives?

2011 is the first year that physicians can demonstrate Meaningful Use of a certified electronic health record (EHR) under the American Recovery and Reinvestment Act of 2009 (ARRA). Eligible professionals who meet Meaningful Use can begin to receive up to $44,000 from Medicare or up to $64,000 from Medicaid over five years. Whether Providers seek eRx incentives or focus on Meaningful Use of EHRs, ePrescribing is an essential and important initiative they must adopt. Emdeon offers an EHR Lite solution with integrated eRx functionality for ease of use and seamless system integration.

Emdeon is on the forefront of knowledge acquisition on eRx issues so that we can bring you practical solutions. Contact us anytime for answers to your specific questions or concerns about ePrescribing.



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Look what is new in Emdeon Vision!


Emdeon Vision for Claim Management is a robust, online claims management reporting tool—with specially tailored versions for providers, channel partners, payers and Emdeon support, all leveraging the same data. Utilizing today’s leading information and communications technologies, Emdeon Vision organizes and translates digital data about claims into understandable, actionable information. You can readily access details regarding all your customers’ claims, and manage their claims in a quick, efficient manner with Emdeon Vision’s 360° views of claims.

Discover these new enhancements to Emeon Vision:

We understand you need clear, unveiled information to better serve your customers. You and your providers have been asking for the following enhancements to Emdeon Vision and we listened. Now we’re excited to introduce these great features to you and your providers:
5010 Indicator—In Emdeon Vision, an indicator has been added on the claim detail page that indicates if the claim was sent inbound in the 5010 format.

Service Enrollment Matrix—Available from the Emdeon Vision landing page, this feature displays all of the provider services available by payer to alert providers to features they may not be taking advantage of, for each of their contracted payers.

Customizable Alerts—Within the preferences section of Emdeon Vision, providers can now set options and thresholds for the types of email alerts they get related to claims activity. These alerts will give them even more visibility into claim rejections and other key metrics.

Eligibility & Claim Status Check—Providers are now able to check eligibility on a rejected claim or submit a payer claim status request for an individual claim from the claim detail screen within Emdeon Vision.

Standardized Payer Messages—We’ve standardized payer claim status response messages for the provider version of Emdeon Vision to be specific, actionable and more user-friendly.

Secondary Claims—From the Emdeon Vision claim detail screen, providers will be able create a secondary claim from a primary claim. This will allow them to make changes and create the secondary claim to the payer.

Export to Excel—1,000 Row Expansion—In Emdeon Vision, the claim summary only displays 1,000 rows. This feature will allow users to download ALL the data from their query in a way that allows them to sort and manipulate it.

Coming Soon!
• Claim Correct and Re-file—Providers will be able to view and edit a claim from the claim detail screen. This will allow them to make changes and re-submit the claim to the payer.



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Discover new ways to simplify your business when you connect with Emdeon


Find us online to learn about innovative new solutions and special offers or to provide feedback on Emdeon products and services you use. Emdeon regularly posts updates and offers valuable resources to keep you on top of industry trends and current information, including healthcare reform, emerging technology, best practices and more. Use your computer or mobile device to receive Emdeon updates on free webinars, new product launches, important news articles and upcoming tradeshows. You can also visit our YouTube channel to watch inspiring customer testimonials and insightful product videos, or join Emdeon on LinkedIn to connect with colleagues. Click the icons below and get social with Emdeon today!

     



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New Payer Transactions Added Recently

New payers. Take a look at the new list
The Emdeon network of payers continues to grow. New transactions added recently:


Claims
Alameda Alliance, Payer ID: Cx083
Anthem Hmo Colorado - Hmo-B, Payer ID: Cx083
Anthem Health Plans - Hmod & Hmog, Payer ID: Cx083
Anthem Health Plans Of Kentucky - Osb High & Low, Payer ID: Cx083
Anthem Health Plans Of Virginia - Osb High & Low, Payer ID: Cx083
Anthem Health Plans Of Virginia - Ppob & Ppod, Payer ID: Cx083
Anthem Insurance - Osb High & Low, Payer ID: Cx083
Anthem Insurance - Ppob & Ppod, Payer ID: Cx083
Blue Cross Blue Shield Of Wisconsin - Ppod, Payer ID: Cx083
Blue Cross Of California - Osb High & Low, Payer ID: Cx083
Blue Cross Of California - Ppoa, Payer ID: Cx083
Blue Cross Of California - Plan Ss10 & Ss20, Payer ID: Cx083
Cal Optimal -Onecare, Payer ID: Cx083
Care 1st Health Plan Medicare Advantage, Payer ID: Cx083
Care 1st Php La & San Bernadino County, Payer ID: Cx083
Chinese Community Health Plan, Payer ID: 94302
ClaimsbrIDge MIDatlantic, Payer ID: Call
ClaimsbrIDge MIDatlantic, Payer ID: Call
ClaimsbrIDge Nw, Payer ID: Call
ClaimsbrIDge Nw, Payer ID: Call
ClaimsbrIDge North, Payer ID: Call
ClaimsbrIDge North, Payer ID: Call
ClaimsbrIDge South, Payer ID: Call
ClaimsbrIDge South, Payer ID: Call
Community Insurance - Hmoa & Ppob, Payer ID: Cx083
Community Insurance - Ppod & Ppof, Payer ID: Cx083
Easychoice Health Plan, Payer ID: Cx083
Empirehealthchoice Assurance - Osb Low & Ppob, Payer ID: Cx083
Empirehealthchoice Hmo, Payer ID: Cx083
Good Shepherd Hospice Inc, Payer ID: 76923
Good Shepherd Hospice Inc, Payer ID: 76923
Golden State Health Plan, Payer ID: Cx083
Harrington Health - Bpo, Payer ID: 59143
Harrington Health - Bpo, Payer ID: 59143
Health Net 21 - La & Sacramento, Payer ID: Cx083
Health Net Healthy Families A B & C, Payer ID: Cx083
Health Net Los Angeles Php, Payer ID: Cx083
Health Net Sacramento Gmc, Payer ID: Cx083
Healthy Alliance Life Insurance - Ppob, Payer ID: Cx083
Iehp, Payer ID: Cx083
La Care Health Plan, Payer ID: Cx083
Liberty Dental Plan, Payer ID: Cx083
Md Care Health Plan, Payer ID: Cx083
Memorial Integrated Healthcare, Payer ID: Call
Mgm Resorts International, Payer ID: Cx083
Memorial Psn/Cms, Payer ID: Call
MID America Benefits, Payer ID: Call
MID America Benefits, Payer ID: Call
Molina Healthcare, Payer ID: Cx083
Mutual Assurance Administrators, Payer ID: 37256
Ohana Health Plan, Payer ID: Cx083
Ohio Ppo Connect, Payer ID: Call
Ozark Health Plan, Payer ID: Cx083
Palms Casino Resort, Payer ID: Cx083
Physicians United Plan-Pup, Payer ID: Cx083
Rocky Mountain Hospital & Medical Service - Osb High & High, Payer ID: Cx083
Sands Bethworks Gaming, Payer ID: Cx083
Santa Clara Family Health Plan, Payer ID: Cx083
Venetian, Payer ID: Cx083
Wellcare, Payer ID: Cx083
Highmark Blue Cross & Blue Shield Of Pennsylvania, Payer ID: Sb865
Pacificsource Medicare, Payer ID: 20377
Pacificsource Medicare, Payer ID: 20377


Eligibility Inquiry And Response:
Advantra Freedom, Payer ID: Covty00453
Advantra Savings, Payer ID: 456
Advantra Savings, Payer ID: Covty00456
Altius Health Plan, Payer ID: 364
Altius Health Plan, Payer ID: Covty00364
Chc Carelink, Payer ID: Covty00160
Chc Carelink MedicaID, Payer ID: Covty00182
Chc Carenet, Payer ID: Covty00190
Chc FlorIDa/Vista/Summit, Payer ID: 512
Chc FlorIDa/Vista/Summit, Payer ID: Covty00512
Chc Group Health Plan (Ghp), Payer ID: Covty00184
Chc Health America / Health Assurance Of Pennsylvania (Hapa), Payer ID: Covty00148
Chc Southern Health Services (Shs), Payer ID: Covty00156
Chc Of Delaware, Payer ID: Covty00166
Chc Of Georgia, Payer ID: Covty00154
Chc Of Health Care Of Usa (Hcusa), Payer ID: Covty00186
Chc Of Iowa, Payer ID: Covty00170
Chc Of Kansas, Payer ID: Covty00172
Chc Of Louisiana, Payer ID: Covty00158
Chc Of Nebraska, Payer ID: Covty00176
Chc Of The Carolinas / Wellpath, Payer ID: Covty00164
Carelink Advantra, Payer ID: 160
Carelink Health Plan, Payer ID: 160
Carelink MedicaID, Payer ID: 182
Carenet, Payer ID: 190
Coventry Advantra (Texas New Mexico Arizona), Payer ID: 504
Coventry Advantra (Texas New Mexico Arizona), Payer ID: Covty00504
Coventry Health Care Federal, Payer ID: 509
Coventry Health Care Federal, Payer ID: Covty00509
Coventry Health Care Of Delaware Inc., Payer ID: 166
Coventry Health Care Of Georgia Inc., Payer ID: 154
Coventry Health Care Of Iowa Inc., Payer ID: 170
Coventry Health Care Of Kansas Inc., Payer ID: 172
Coventry Health Care Of Louisiana Inc., Payer ID: 158
Coventry Health Care Of Nebraska Inc., Payer ID: 176
Coventry Health And Life (Oklahoma), Payer ID: 441
Coventry Health And Life (Oklahoma), Payer ID: Covty00441
Coventry Health And Life (Tennessee Only), Payer ID: 455
Coventry Health And Life (Tennessee Only), Payer ID: Covty00455
Coventry Health And Life-Nevada, Payer ID: 505
Coventry Health And Life-Nevada, Payer ID: Covty00505
Coventry Healthcare National Network, Payer ID: 250
Coventry Healthcare National Network, Payer ID: Covty00250
Coventry-Missouri, Payer ID: 507
Coventry-Missouri, Payer ID: Covty00507
Coventrycares, Payer ID: 510
Coventrycares, Payer ID: Covty00510
Coventryone, Payer ID: Covon
Coventryone, Payer ID: Covtycovon
Diamond Plan, Payer ID: 177
Diamond Plan (Md MedicaID), Payer ID: Covty00177
Group Health Plan - Cmr, Payer ID: 184
Health America Inc./Health Assurance/Advantra, Payer ID: 148
Healthcare Usa, Payer ID: 186
Mhnet Behavioral Health, Payer ID: 514
Mhnet Behavioral Health, Payer ID: Covty00514
Mail Handlers Benefit Plan, Payer ID: 251
Mail Handlers Benefit Plan, Payer ID: Covty00251
Omnicare, Payer ID: Covty00413
Omnicare - A Coventry Health Plan, Payer ID: 413
Personalcare/Coventry Health Of Illinois, Payer ID: 179
Personalcare/Coventry Health Of Illinois, Payer ID: Covty00179
Southern Health Services Inc., Payer ID: 156
University Of Missouri, Payer ID: Covtycovum
University Of Missouri, Payer ID: Covum
Vista (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: 508
Vista (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: Covty00508
Wellpath, Payer ID: 164
Coventry Nebraska MedicaID, Payer ID: 511
Coventry Nebraska MedicaID, Payer ID: Covty00511
Ohio MedicaID, Payer ID: AID09
Ohio MedicaID, Payer ID: Oh


Claim Satus And Response:
Advantra Freedom, Payer ID: COVTY00453
Advantra Savings, Payer ID: 456
Advantra Savings, Payer ID: COVTY00456
Altius Health Plan, Payer ID: 364
Altius Health Plan, Payer ID: COVTY00364
CHC Carelink, Payer ID: COVTY00160
CHC Carelink MedicaID, Payer ID: COVTY00182
CHC Carenet, Payer ID: COVTY00190
CHC FlorIDa/VISTA/Summit, Payer ID: 512
CHC FlorIDa/VISTA/Summit, Payer ID: COVTY00512
CHC Group Health Plan (GHP), Payer ID: COVTY00184
CHC Health America / Health Assurance Of Pennsylvania (HAPA), Payer ID: COVTY00148
CHC Southern Health Services (SHS), Payer ID: COVTY00156
CHC Of Delaware, Payer ID: COVTY00166
CHC Of Georgia, Payer ID: COVTY00154
CHC Of Health Care Of USA (HCUSA), Payer ID: COVTY00186
CHC Of Iowa, Payer ID: COVTY00170
CHC Of Kansas, Payer ID: COVTY00172
CHC Of Louisiana, Payer ID: COVTY00158
CHC Of Nebraska, Payer ID: COVTY00176
CHC Of The Carolinas / Wellpath, Payer ID: COVTY00164
Carelink Advantra, Payer ID: 160
Carelink Health Plan, Payer ID: 160
Carelink MedicaID, Payer ID: 182
Carenet, Payer ID: 190
Coventry Advantra (Texas New Mexico Arizona), Payer ID: 504
Coventry Advantra (Texas New Mexico Arizona), Payer ID: COVTY00504
Coventry Health Care Federal, Payer ID: 509
Coventry Health Care Federal, Payer ID: COVTY00509
Coventry Health Care Of Delaware Inc., Payer ID: 166
Coventry Health Care Of Georgia Inc., Payer ID: 154
Coventry Health Care Of Iowa Inc., Payer ID: 170
Coventry Health Care Of Kansas Inc., Payer ID: 172
Coventry Health Care Of Louisiana Inc., Payer ID: 158
Coventry Health Care Of Nebraska Inc., Payer ID: 176
Coventry Health And Life (Oklahoma), Payer ID: 441
Coventry Health And Life (Oklahoma), Payer ID: COVTY00441
Coventry Health And Life (Tennessee Only), Payer ID: 455
Coventry Health And Life (Tennessee Only), Payer ID: COVTY00455
Coventry Health And Life-Nevada, Payer ID: 505
Coventry Health And Life-Nevada, Payer ID: COVTY00505
Coventry Healthcare National Network, Payer ID: 250
Coventry Healthcare National Network, Payer ID: COVTY00250
Coventry-Missouri, Payer ID: 507
Coventry-Missouri, Payer ID: COVTY00507
Coventrycares, Payer ID: 510
Coventrycares, Payer ID: COVTY00510
Coventryone, Payer ID: COVON
Coventryone, Payer ID: COVTYCOVON
Diamond Plan, Payer ID: 177
Diamond Plan (MD MedicaID), Payer ID: COVTY00177
Group Health Plan - CMR, Payer ID: 184
Health America Inc./Health Assurance/Advantra, Payer ID: 148
Healthcare USA, Payer ID: 186
Mhnet Behavioral Health, Payer ID: 514
Mhnet Behavioral Health, Payer ID: COVTY00514
Mail Handlers Benefit Plan, Payer ID: 251
Mail Handlers Benefit Plan, Payer ID: COVTY00251
Medical Mutual Of Ohio, Payer ID: 211
Medical Mutual Of Ohio, Payer ID: MMO00211
Omnicare, Payer ID: COVTY00413
Omnicare - A Coventry Health Plan, Payer ID: 413
Personalcare/Coventry Health Of Illinois, Payer ID: 179
Personalcare/Coventry Health Of Illinois, Payer ID: COVTY00179
Southern Health Services Inc., Payer ID: 156
University Of Missouri, Payer ID: COVTYCOVUM
University Of Missouri, Payer ID: COVUM
VISTA (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: 508
VISTA (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: COVTY00508
Wellpath, Payer ID: 164
Coventry Nebraska MedicaID, Payer ID: 511
Coventry Nebraska MedicaID, Payer ID: COVTY00511


For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/

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