Insurance Providers’ Pass Thru Fees

Below is a list of fees that various insurance providers may charge during transactions.
This list is updated periodically, please check with your clearinghouse for the most up to date charges.

 

CARRIER_NAMECARRIER_CODELEGACY_CARRIER_CODEPAYER_IDTRANSACTION GROUP NAMEPASS_THROUGH_FEE_AMT
ACCESS MED+AMPMEDPLUS29ELIGIBILITY0.045
ACCESS MED+AMPMEDPLUS29CLAIM INQUIRY0.045
ACCESS MED+AMPMEDPLUS29HEALTHCARE SERVICES0.045
ALAMEDA ALLIANCE HEALTHSPAAHAAHP321CLAIM INQUIRY0.18
ALAMEDA ALLIANCE HEALTHSPAAHAAHP321ELIGIBILITY0.18
ALAMEDA ALLIANCE HEALTHSPAAHAAHP321HEALTHCARE SERVICES0.18
ALASKA MEDICAIDAKMCDAKMCDAKMCDELIGIBILITY0.06
ALLWAYS HEALTH PARTNERS429342934293ELIGIBILITY0.05
ALLWAYS HEALTH PARTNERSNGHBHPNGHBHPNGHBHPELIGIBILITY0.04
AUTOMATED BENEFIT SERVICES382593825938259ELIGIBILITY0.07
BC OF NORTHEASTERN PABCNPCBCNEPABCNPCELIGIBILITY0.1
BC OF NORTHEASTERN PABCNPCBCNEPABCNPCCLAIM INQUIRY0.1
BC OF NORTHEASTERN PABCNPCBCNEPABCNPCHEALTHCARE SERVICES0.1
BC WA PREMERABCWACBCWACBCWACHEALTHCARE SERVICES0.1
BC WA PREMERABCWACBCWACBCWACCLAIM INQUIRY0.1
BC WA PREMERABCWACBCWACBCWACELIGIBILITY0.1
BCBS ARBCARCBCBSARBCARCHEALTHCARE SERVICES0.1
BCBS ARBCARCBCBSARBCARCELIGIBILITY0.1
BCBS ARBCARCBCBSARBCARCCLAIM INQUIRY0.1
BCBS MIBCMICBCMICBCMICELIGIBILITY0.06
BCBS MIBCMICBCMICBCMICCLAIM INQUIRY0.06
BCBS MIBCMICBCMICBCMICHEALTHCARE SERVICES0.06
BCBS OF WESTERN NYSB801SB801SB801ELIGIBILITY0.09
BOON CHAPMAN ADMIN742387423874238ELIGIBILITY0.01
BOSTON MEDICAL CENTER HEALTH NET PLAN133371333713337ELIGIBILITY0.01
BOSTON MEDICAL CENTER HEALTHNET PLANBMCHLTBMCHLTBMCHLTELIGIBILITY0.01
BRIGHT HEALTH - MEDICARE ADVANTAGEBRT01BRT01BRT01ELIGIBILITY0.02
BS CASPBSCSPBSC361CLAIM INQUIRY0.1
BS CASPBSCSPBSC361ELIGIBILITY0.1
BS CASPBSCSPBSC361HEALTHCARE SERVICES0.1
CAREMORE HEALTH PLANCARMOCARMOCARMOELIGIBILITY0.01
DELAWARE MEDICAID (RELAY)DWMCDDWMCDDWMCDELIGIBILITY0.05
DELAWARE MEDICAID (RELAY)DWMCDDWMCDDWMCDCLAIM INQUIRY0.05
DELAWARE MEDICAID (RELAY)DWMCDDWMCDDWMCDHEALTHCARE SERVICES0.05
HARVARD PILGRIM HEALTH CAREHPHCHPHCHPHCHEALTHCARE SERVICES0.1
HARVARD PILGRIM HEALTH CAREHPHCHPHCHPHCCLAIM INQUIRY0.1
HARVARD PILGRIM HEALTH CAREHPHCHPHCHPHCELIGIBILITY0.1
HEALTH ALLIANCE PLANHAPMCHAPHAPMCELIGIBILITY0.05
HEALTH ALLIANCE PLAN OF MICHIGANHAPMIHAPMIHAPMIELIGIBILITY0.05
HEALTH NET CASPHNHHLTHNTC331CLAIM INQUIRY0.18
HEALTH NET CASPHNHHLTHNTC331HEALTHCARE SERVICES0.18
HEALTH NET CASPHNHHLTHNTC331ELIGIBILITY0.18
HEALTH NET MEDI-CALSPHNMHLTHNTMC330ELIGIBILITY0.18
HEALTH NET MEDI-CALSPHNMHLTHNTMC330CLAIM INQUIRY0.18
HEALTH NET MEDI-CALSPHNMHLTHNTMC330HEALTHCARE SERVICES0.18
HEALTH NET ORSPHNOHLTHNTOR332HEALTHCARE SERVICES0.18
HEALTH NET ORSPHNOHLTHNTOR332CLAIM INQUIRY0.18
HEALTH NET ORSPHNOHLTHNTOR332ELIGIBILITY0.18
HEALTHSCOPE BENEFITS710637106371063ELIGIBILITY0.01
HORIZON NJHNJHHNJHHNJHELIGIBILITY0.03
INTER VALLEY HEALTH PLANSPIVHIVHP334ELIGIBILITY0.01
LIFEGUARDSPLFGSPLFGSPLFGHEALTHCARE SERVICES0.18
LIFEGUARDSPLFGSPLFGSPLFGCLAIM INQUIRY0.18
LIFEGUARDSPLFGSPLFGSPLFGELIGIBILITY0.18
MANAGED CARE OF AMERICAMGDCAMGDCAMGDCACLAIM INQUIRY0.05
MANAGED CARE OF AMERICAMGDCAMGDCAMGDCAELIGIBILITY0.05
MANAGED CARE OF AMERICAMGDCAMGDCAMGDCAHEALTHCARE SERVICES0.05
MEDICAID DCDCDCMEDAID52ELIGIBILITY0.0325
MEDICAID DCDCDCMEDAID52CLAIM INQUIRY0.0325
MEDICAID DCDCDCMEDAID52HEALTHCARE SERVICES0.0325
MEDICAID FL36FLMEDAID01ELIGIBILITY0.04
MEDICAID FL36FLMEDAID01CLAIM INQUIRY0.04
MEDICAID FL36FLMEDAID01HEALTHCARE SERVICES0.04
MEDICAID HIHIHIMEDAID53HEALTHCARE SERVICES0.03
MEDICAID HIHIHIMEDAID53CLAIM INQUIRY0.03
MEDICAID HIAID53AID53AID53ELIGIBILITY0.03
MEDICAID HIAID53AID53AID53CLAIM INQUIRY0.03
MEDICAID HIAID53AID53AID53HEALTHCARE SERVICES0.03
MEDICAID HIHIHIMEDAID53ELIGIBILITY0.03
MEDICAID IAIAIAMEDAID36CLAIM INQUIRY0.08
MEDICAID IAIAIAMEDAID36ELIGIBILITY0.08
MEDICAID IAIAIAMEDAID36HEALTHCARE SERVICES0.08
MEDICAID KSKSKSMEDAID22ELIGIBILITY0.04
MEDICAID KSKSKSMEDAID22HEALTHCARE SERVICES0.04
MEDICAID KSKSKSMEDAID22CLAIM INQUIRY0.04
MEDICAID MSMSMSMEDAID20HEALTHCARE SERVICES0.0525
MEDICAID MSMSMSMEDAID20CLAIM INQUIRY0.0525
MEDICAID MSMSMSMEDAID20ELIGIBILITY0.0525
MEDICAID MTMTMTMEDAID57HEALTHCARE SERVICES0.0325
MEDICAID MTMTMTMEDAID57CLAIM INQUIRY0.0325
MEDICAID MTMTMTMEDAID57ELIGIBILITY0.0325
MEDICAID NHNHNHMEDAID47CLAIM INQUIRY0.05
MEDICAID NHNHNHMEDAID47ELIGIBILITY0.05
MEDICAID NHNHNHMEDAID47HEALTHCARE SERVICES0.05
MEDICAID NMNMNMMEDAID27ELIGIBILITY0.0325
MEDICAID NMNMNMMEDAID27CLAIM INQUIRY0.0325
MEDICAID NMNMNMMEDAID27HEALTHCARE SERVICES0.0325
MEDICAID OKOKOKMEDAID32ELIGIBILITY0.02
MEDICAID OKOKOKMEDAID32HEALTHCARE SERVICES0.02
MEDICAID OKOKOKMEDAID32CLAIM INQUIRY0.02
MEDICAID PRODSIODSIMEDAID60ELIGIBILITY0.09
MEDICAID PRODSIODSIMEDAID60CLAIM INQUIRY0.09
MEDICAID PRODSIODSIMEDAID60HEALTHCARE SERVICES0.09
MEDICAID TNCARETNTNMEDAID13ELIGIBILITY0.04
MEDICAID TNCARETNTNMEDAID13HEALTHCARE SERVICES0.04
MEDICAID TNCARETNTNMEDAID13CLAIM INQUIRY0.04
MEDICAID TXTXTXMEDAID05CLAIM INQUIRY0.075
MEDICAID TXTXTXMEDAID05ELIGIBILITY0.075
MEDICAID TXTXTXMEDAID05HEALTHCARE SERVICES0.075
MEDICAID WYWYWYMEDAID34ELIGIBILITY0.0325
MEDICAID WYWYWYMEDAID34HEALTHCARE SERVICES0.0325
MEDICAID WYWYWYMEDAID34CLAIM INQUIRY0.0325
MEMORIAL CARE TPASPMCTMCTPA339HEALTHCARE SERVICES0.18
MEMORIAL CARE TPASPMCTMCTPA339ELIGIBILITY0.18
MEMORIAL CARE TPASPMCTMCTPA339CLAIM INQUIRY0.18
MERIDIAN COMPLETE ILLINOISMCCILMCCILMCCILELIGIBILITY0.02
MONTEFIORE CONTRACT MANAGEMENT ORGANIZATION131741317413174ELIGIBILITY0.07
MS CHIPCHIPBCBSMSC89CLAIM INQUIRY0.045
MS CHIPCHIPBCBSMSC89ELIGIBILITY0.045
MS CHIPCHIPBCBSMSC89HEALTHCARE SERVICES0.045
MS SEHPSEHPMSEMPOY82HEALTHCARE SERVICES0.045
MS SEHPSEHPMSEMPOY82ELIGIBILITY0.045
MS SEHPSEHPMSEMPOY82CLAIM INQUIRY0.045
NEW YORK BLUE CROSS BLUE SHIELD NORTHEASTERN800800800ELIGIBILITY0.07
NEW YORK BLUE CROSS BLUE SHIELD NORTHEASTERN800800800HEALTHCARE SERVICES0.07
NEW YORK BLUE CROSS BLUE SHIELD NORTHEASTERN800800800CLAIM INQUIRY0.07
PARTNERSHIP HEALTH PLANSPPHPPHPC343ELIGIBILITY0.01
PARTNERSHIP HEALTH PLAN OF CAPRTHPPRTHPPRTHPELIGIBILITY0.01
QUALCHOICE OF ARKANSAS351743517435174ELIGIBILITY0.01
ROCKY MOUNTAIN HEALTH PLANRMHPRMHP347ELIGIBILITY0.03
ROCKY MOUNTAIN HEALTH PLANRMHPRMHP347CLAIM INQUIRY0.03
ROCKY MOUNTAIN HEALTH PLANRMHPRMHP347HEALTHCARE SERVICES0.03
SAN JOAQUIN HEALTH PLANSJHPSJHPSJHPELIGIBILITY0.01
SAN JOAQUIN HEALTH PLANSPSJHSPSJH349ELIGIBILITY0.01
SCAN HMOSPSCNSPSCN350CLAIM INQUIRY0.18
SCAN HMOSPSCNSPSCN350ELIGIBILITY0.18
SCAN HMOSPSCNSPSCN350HEALTHCARE SERVICES0.18
SCOTT & WHITE (RELAY)TH002TH002TH002ELIGIBILITY0.01
SELECTHEALTHSX107SX107SX107ELIGIBILITY0.0155
SIERRA HEALTH SERVICESSPSHS351SPSHSCLAIM INQUIRY0.18
SIERRA HEALTH SERVICESSPSHS351SPSHSHEALTHCARE SERVICES0.18
SIERRA HEALTH SERVICESSPSHS351SPSHSELIGIBILITY0.18
STANISLAUS CO MIASPSCMSPSCM352HEALTHCARE SERVICES0.18
STANISLAUS CO MIASPSCMSPSCM352ELIGIBILITY0.18
STANISLAUS CO MIASPSCMSPSCM352CLAIM INQUIRY0.18
STATE FARM INSURANCE COMPANIES310533105331053ELIGIBILITY0.0155
SUTTER AND AETNA INSURANCE COMPANY606246062460624ELIGIBILITY0.02
THE LOOMIS COMPANY232232322323223ELIGIBILITY0.02
WESTERN HEALTH ADVANTAGESPWHASPWHA356ELIGIBILITY0.18
WESTERN HEALTH ADVANTAGESPWHASPWHA356CLAIM INQUIRY0.18
WESTERN HEALTH ADVANTAGESPWHASPWHA356HEALTHCARE SERVICES0.18