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_NAME	CARRIER_CODE	LEGACY_CARRIER_CODE	PAYER_ID	TRANSACTION GROUP NAME	PASS_THROUGH_FEE_AMT
ACCESS MED+	AMP	MEDPLUS	29	ELIGIBILITY	0.045
ACCESS MED+	AMP	MEDPLUS	29	CLAIM INQUIRY	0.045
ACCESS MED+	AMP	MEDPLUS	29	HEALTHCARE SERVICES	0.045
ALAMEDA ALLIANCE HEALTH	SPAAH	AAHP	321	CLAIM INQUIRY	0.18
ALAMEDA ALLIANCE HEALTH	SPAAH	AAHP	321	ELIGIBILITY	0.18
ALAMEDA ALLIANCE HEALTH	SPAAH	AAHP	321	HEALTHCARE SERVICES	0.18
ALASKA MEDICAID	AKMCD	AKMCD	AKMCD	ELIGIBILITY	0.06
ALLWAYS HEALTH PARTNERS	4293	4293	4293	ELIGIBILITY	0.05
ALLWAYS HEALTH PARTNERS	NGHBHP	NGHBHP	NGHBHP	ELIGIBILITY	0.04
AUTOMATED BENEFIT SERVICES	38259	38259	38259	ELIGIBILITY	0.07
BC OF NORTHEASTERN PA	BCNPC	BCNEPA	BCNPC	ELIGIBILITY	0.1
BC OF NORTHEASTERN PA	BCNPC	BCNEPA	BCNPC	CLAIM INQUIRY	0.1
BC OF NORTHEASTERN PA	BCNPC	BCNEPA	BCNPC	HEALTHCARE SERVICES	0.1
BC WA PREMERA	BCWAC	BCWAC	BCWAC	HEALTHCARE SERVICES	0.1
BC WA PREMERA	BCWAC	BCWAC	BCWAC	CLAIM INQUIRY	0.1
BC WA PREMERA	BCWAC	BCWAC	BCWAC	ELIGIBILITY	0.1
BCBS AR	BCARC	BCBSAR	BCARC	HEALTHCARE SERVICES	0.1
BCBS AR	BCARC	BCBSAR	BCARC	ELIGIBILITY	0.1
BCBS AR	BCARC	BCBSAR	BCARC	CLAIM INQUIRY	0.1
BCBS MI	BCMIC	BCMIC	BCMIC	ELIGIBILITY	0.06
BCBS MI	BCMIC	BCMIC	BCMIC	CLAIM INQUIRY	0.06
BCBS MI	BCMIC	BCMIC	BCMIC	HEALTHCARE SERVICES	0.06
BCBS OF WESTERN NY	SB801	SB801	SB801	ELIGIBILITY	0.09
BOON CHAPMAN ADMIN	74238	74238	74238	ELIGIBILITY	0.01
BOSTON MEDICAL CENTER HEALTH NET PLAN	13337	13337	13337	ELIGIBILITY	0.01
BOSTON MEDICAL CENTER HEALTHNET PLAN	BMCHLT	BMCHLT	BMCHLT	ELIGIBILITY	0.01
BRIGHT HEALTH - MEDICARE ADVANTAGE	BRT01	BRT01	BRT01	ELIGIBILITY	0.02
BS CA	SPBSC	SPBSC	361	CLAIM INQUIRY	0.1
BS CA	SPBSC	SPBSC	361	ELIGIBILITY	0.1
BS CA	SPBSC	SPBSC	361	HEALTHCARE SERVICES	0.1
CAREMORE HEALTH PLAN	CARMO	CARMO	CARMO	ELIGIBILITY	0.01
DELAWARE MEDICAID (RELAY)	DWMCD	DWMCD	DWMCD	ELIGIBILITY	0.05
DELAWARE MEDICAID (RELAY)	DWMCD	DWMCD	DWMCD	CLAIM INQUIRY	0.05
DELAWARE MEDICAID (RELAY)	DWMCD	DWMCD	DWMCD	HEALTHCARE SERVICES	0.05
HARVARD PILGRIM HEALTH CARE	HPHC	HPHC	HPHC	HEALTHCARE SERVICES	0.1
HARVARD PILGRIM HEALTH CARE	HPHC	HPHC	HPHC	CLAIM INQUIRY	0.1
HARVARD PILGRIM HEALTH CARE	HPHC	HPHC	HPHC	ELIGIBILITY	0.1
HEALTH ALLIANCE PLAN	HAPMC	HAP	HAPMC	ELIGIBILITY	0.05
HEALTH ALLIANCE PLAN OF MICHIGAN	HAPMI	HAPMI	HAPMI	ELIGIBILITY	0.05
HEALTH NET CA	SPHNH	HLTHNTC	331	CLAIM INQUIRY	0.18
HEALTH NET CA	SPHNH	HLTHNTC	331	HEALTHCARE SERVICES	0.18
HEALTH NET CA	SPHNH	HLTHNTC	331	ELIGIBILITY	0.18
HEALTH NET MEDI-CAL	SPHNM	HLTHNTMC	330	ELIGIBILITY	0.18
HEALTH NET MEDI-CAL	SPHNM	HLTHNTMC	330	CLAIM INQUIRY	0.18
HEALTH NET MEDI-CAL	SPHNM	HLTHNTMC	330	HEALTHCARE SERVICES	0.18
HEALTH NET OR	SPHNO	HLTHNTOR	332	HEALTHCARE SERVICES	0.18
HEALTH NET OR	SPHNO	HLTHNTOR	332	CLAIM INQUIRY	0.18
HEALTH NET OR	SPHNO	HLTHNTOR	332	ELIGIBILITY	0.18
HEALTHSCOPE BENEFITS	71063	71063	71063	ELIGIBILITY	0.01
HORIZON NJ	HNJH	HNJH	HNJH	ELIGIBILITY	0.03
INTER VALLEY HEALTH PLAN	SPIVH	IVHP	334	ELIGIBILITY	0.01
LIFEGUARD	SPLFG	SPLFG	SPLFG	HEALTHCARE SERVICES	0.18
LIFEGUARD	SPLFG	SPLFG	SPLFG	CLAIM INQUIRY	0.18
LIFEGUARD	SPLFG	SPLFG	SPLFG	ELIGIBILITY	0.18
MANAGED CARE OF AMERICA	MGDCA	MGDCA	MGDCA	CLAIM INQUIRY	0.05
MANAGED CARE OF AMERICA	MGDCA	MGDCA	MGDCA	ELIGIBILITY	0.05
MANAGED CARE OF AMERICA	MGDCA	MGDCA	MGDCA	HEALTHCARE SERVICES	0.05
MEDICAID DC	DC	DCMED	AID52	ELIGIBILITY	0.0325
MEDICAID DC	DC	DCMED	AID52	CLAIM INQUIRY	0.0325
MEDICAID DC	DC	DCMED	AID52	HEALTHCARE SERVICES	0.0325
MEDICAID FL	36	FLMED	AID01	ELIGIBILITY	0.04
MEDICAID FL	36	FLMED	AID01	CLAIM INQUIRY	0.04
MEDICAID FL	36	FLMED	AID01	HEALTHCARE SERVICES	0.04
MEDICAID HI	HI	HIMED	AID53	HEALTHCARE SERVICES	0.03
MEDICAID HI	HI	HIMED	AID53	CLAIM INQUIRY	0.03
MEDICAID HI	AID53	AID53	AID53	ELIGIBILITY	0.03
MEDICAID HI	AID53	AID53	AID53	CLAIM INQUIRY	0.03
MEDICAID HI	AID53	AID53	AID53	HEALTHCARE SERVICES	0.03
MEDICAID HI	HI	HIMED	AID53	ELIGIBILITY	0.03
MEDICAID IA	IA	IAMED	AID36	CLAIM INQUIRY	0.08
MEDICAID IA	IA	IAMED	AID36	ELIGIBILITY	0.08
MEDICAID IA	IA	IAMED	AID36	HEALTHCARE SERVICES	0.08
MEDICAID KS	KS	KSMED	AID22	ELIGIBILITY	0.04
MEDICAID KS	KS	KSMED	AID22	HEALTHCARE SERVICES	0.04
MEDICAID KS	KS	KSMED	AID22	CLAIM INQUIRY	0.04
MEDICAID MS	MS	MSMED	AID20	HEALTHCARE SERVICES	0.0525
MEDICAID MS	MS	MSMED	AID20	CLAIM INQUIRY	0.0525
MEDICAID MS	MS	MSMED	AID20	ELIGIBILITY	0.0525
MEDICAID MT	MT	MTMED	AID57	HEALTHCARE SERVICES	0.0325
MEDICAID MT	MT	MTMED	AID57	CLAIM INQUIRY	0.0325
MEDICAID MT	MT	MTMED	AID57	ELIGIBILITY	0.0325
MEDICAID NH	NH	NHMED	AID47	CLAIM INQUIRY	0.05
MEDICAID NH	NH	NHMED	AID47	ELIGIBILITY	0.05
MEDICAID NH	NH	NHMED	AID47	HEALTHCARE SERVICES	0.05
MEDICAID NM	NM	NMMED	AID27	ELIGIBILITY	0.0325
MEDICAID NM	NM	NMMED	AID27	CLAIM INQUIRY	0.0325
MEDICAID NM	NM	NMMED	AID27	HEALTHCARE SERVICES	0.0325
MEDICAID OK	OK	OKMED	AID32	ELIGIBILITY	0.02
MEDICAID OK	OK	OKMED	AID32	HEALTHCARE SERVICES	0.02
MEDICAID OK	OK	OKMED	AID32	CLAIM INQUIRY	0.02
MEDICAID PR	ODSI	ODSIMED	AID60	ELIGIBILITY	0.09
MEDICAID PR	ODSI	ODSIMED	AID60	CLAIM INQUIRY	0.09
MEDICAID PR	ODSI	ODSIMED	AID60	HEALTHCARE SERVICES	0.09
MEDICAID TNCARE	TN	TNMED	AID13	ELIGIBILITY	0.04
MEDICAID TNCARE	TN	TNMED	AID13	HEALTHCARE SERVICES	0.04
MEDICAID TNCARE	TN	TNMED	AID13	CLAIM INQUIRY	0.04
MEDICAID TX	TX	TXMED	AID05	CLAIM INQUIRY	0.075
MEDICAID TX	TX	TXMED	AID05	ELIGIBILITY	0.075
MEDICAID TX	TX	TXMED	AID05	HEALTHCARE SERVICES	0.075
MEDICAID WY	WY	WYMED	AID34	ELIGIBILITY	0.0325
MEDICAID WY	WY	WYMED	AID34	HEALTHCARE SERVICES	0.0325
MEDICAID WY	WY	WYMED	AID34	CLAIM INQUIRY	0.0325
MEMORIAL CARE TPA	SPMCT	MCTPA	339	HEALTHCARE SERVICES	0.18
MEMORIAL CARE TPA	SPMCT	MCTPA	339	ELIGIBILITY	0.18
MEMORIAL CARE TPA	SPMCT	MCTPA	339	CLAIM INQUIRY	0.18
MERIDIAN COMPLETE ILLINOIS	MCCIL	MCCIL	MCCIL	ELIGIBILITY	0.02
MONTEFIORE CONTRACT MANAGEMENT ORGANIZATION	13174	13174	13174	ELIGIBILITY	0.07
MS CHIP	CHIP	BCBSMSC	89	CLAIM INQUIRY	0.045
MS CHIP	CHIP	BCBSMSC	89	ELIGIBILITY	0.045
MS CHIP	CHIP	BCBSMSC	89	HEALTHCARE SERVICES	0.045
MS SEHP	SEHP	MSEMPOY	82	HEALTHCARE SERVICES	0.045
MS SEHP	SEHP	MSEMPOY	82	ELIGIBILITY	0.045
MS SEHP	SEHP	MSEMPOY	82	CLAIM INQUIRY	0.045
NEW YORK BLUE CROSS BLUE SHIELD NORTHEASTERN	800	800	800	ELIGIBILITY	0.07
NEW YORK BLUE CROSS BLUE SHIELD NORTHEASTERN	800	800	800	HEALTHCARE SERVICES	0.07
NEW YORK BLUE CROSS BLUE SHIELD NORTHEASTERN	800	800	800	CLAIM INQUIRY	0.07
PARTNERSHIP HEALTH PLAN	SPPHP	PHPC	343	ELIGIBILITY	0.01
PARTNERSHIP HEALTH PLAN OF CA	PRTHP	PRTHP	PRTHP	ELIGIBILITY	0.01
QUALCHOICE OF ARKANSAS	35174	35174	35174	ELIGIBILITY	0.01
ROCKY MOUNTAIN HEALTH PLAN	RMHP	RMHP	347	ELIGIBILITY	0.03
ROCKY MOUNTAIN HEALTH PLAN	RMHP	RMHP	347	CLAIM INQUIRY	0.03
ROCKY MOUNTAIN HEALTH PLAN	RMHP	RMHP	347	HEALTHCARE SERVICES	0.03
SAN JOAQUIN HEALTH PLAN	SJHP	SJHP	SJHP	ELIGIBILITY	0.01
SAN JOAQUIN HEALTH PLAN	SPSJH	SPSJH	349	ELIGIBILITY	0.01
SCAN HMO	SPSCN	SPSCN	350	CLAIM INQUIRY	0.18
SCAN HMO	SPSCN	SPSCN	350	ELIGIBILITY	0.18
SCAN HMO	SPSCN	SPSCN	350	HEALTHCARE SERVICES	0.18
SCOTT & WHITE (RELAY)	TH002	TH002	TH002	ELIGIBILITY	0.01
SELECTHEALTH	SX107	SX107	SX107	ELIGIBILITY	0.0155
SIERRA HEALTH SERVICES	SPSHS	351	SPSHS	CLAIM INQUIRY	0.18
SIERRA HEALTH SERVICES	SPSHS	351	SPSHS	HEALTHCARE SERVICES	0.18
SIERRA HEALTH SERVICES	SPSHS	351	SPSHS	ELIGIBILITY	0.18
STANISLAUS CO MIA	SPSCM	SPSCM	352	HEALTHCARE SERVICES	0.18
STANISLAUS CO MIA	SPSCM	SPSCM	352	ELIGIBILITY	0.18
STANISLAUS CO MIA	SPSCM	SPSCM	352	CLAIM INQUIRY	0.18
STATE FARM INSURANCE COMPANIES	31053	31053	31053	ELIGIBILITY	0.0155
SUTTER AND AETNA INSURANCE COMPANY	60624	60624	60624	ELIGIBILITY	0.02
THE LOOMIS COMPANY	23223	23223	23223	ELIGIBILITY	0.02
WESTERN HEALTH ADVANTAGE	SPWHA	SPWHA	356	ELIGIBILITY	0.18
WESTERN HEALTH ADVANTAGE	SPWHA	SPWHA	356	CLAIM INQUIRY	0.18
WESTERN HEALTH ADVANTAGE	SPWHA	SPWHA	356	HEALTHCARE SERVICES	0.18