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.
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 |