Managed Healthcare Information Services, Inc.

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SECTION II

PART A INTERMEDIARIES AND PART B CARRIERS
A  C  D  F  G  H  I  K  L  M  N  O  P  R  S  T  U  V  W

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

Patrick G. Hays
President & Chief
Executive Officer
PHONE: 312-297-6010

Harry P. Cain, II
Executive VP
Operating Officer
PHONE: 312-297-6210

Harvey W. Friedman
Vice President
Medicare Administration
PHONE: 312-297-6245

ALABAMA PART A PROVIDER SERVICE AREA: State of Alabama [Top]
PART B JURISDICTION: State of Alabama, State of Georgia

BLUE CROSS AND BLUE SHIELD OF ALABAMA
P.O. Box 830139
Birmingham, Alabama 35283-0139
OVERNIGHT PACKAGES ONLY

Blue Cross Blue Shield of Alabama
Medicare Claims Administration
44 Inverness Center Parkway-6th Floor
Birmingham, AL 35242
PHONE: 205-988-2100
FAX: 205-981-4841
INTERNET: almedicare@bcbsal.org 

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

Horace L. "Dick" Jones
President & CEO
PHONE: 205-988-2116

Lynda Northcutt
Vice President
Medicare Claims Administration
P.O. Box 830139
Birmingham, AL 35283-0139
PHONE: 205-981-4835

Gray Parker
Department Manager
Medicare A
PHONE: 205-981-4818

Robert Orr
Department Manager
Medicare B
PHONE: 205-981-4842

Georgia Field Office
PHONE: 912-921-3010
FAX: 912-921-4635

Leigh Forman
Executive Director, Medicare Claims Administration
12052 Middleground Road
Suite A
Savannah, GA 31419-1699

ALASKA PART A PROVIDER SERVICE AREA - See Premera Blue Cross (Blue Cross of Washington and Alaska) [Top]
PART B JURISDICTION - See Blue Cross Blue Shield of North Dakota

ARIZONA PART A PROVIDER SERVICE AREA : State of Arizona [Top]
PART B JURISDICTION - See Blue Cross Blue Shield of North Dakota

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: crich@phx1.bcbsaz.com 

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

Robert B. Bulla
President and Chief
Executive Officer
PHONE:  602-864-4444

Susie Nash
Vice President of Federal Programs
PHONE:  602-864-4423

Jody Chandler
Senior Vice President
Claims and Federal Programs
PHONE:  602-864-4445

Karen Abraham
Vice President and Controller of Finance
PHONE:  602-864-5700

ARKANSAS PART A PROVIDER SERVICE AREA: State of Arkansas [Top]
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 Gaines Street
Little Rock, Arkansas 72201
PHONE: 501-378-2000
FAX: 501-378-2804
Email: tlwhite@arkbluecross.com 

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

Robert L. Shoptaw
President & CEO
PHONE:  501-378-2242

Sharon K. Allen
Executive Vice President 
PHONE:  501-378-2145

Charles Clem
Vice President
Public Programs
PHONE: 501-378-2476

Theresa Milligan
Manager, Government Programs Support
Phone: 501-378-2078                   

Amanda Crosby
Manager, Provider Audit and Reimbursement 
PHONE:  501-378-2248

Louisiana Part B Operations
P.O. Box 9850
Baton Rouge, LA 70809
Bobbye Garner
Director Louisiana Part B Operations
Phone: 501-378-2250
Email: wendy@lamedicare.com 

Oklahoma/New Mexico Part B Operations
1701 NW 63rd
Oklahoma City, OK 73116
Lanny Day
Director Oklahoma/New Mexico Operations
Phone: 405-848-6257

CALIFORNIA PART A PROVIDER SERVICE AREA: States of California, Nevada, Hawaii, Guam, Northern Mariana Islands, and American Samoa (Special Claims: HHA, Independent Hospices (West)) [Top]
PART B JURISDICTION: See National Heritage Insurance Company and Transamerica Occidental Life Insurance Company

BLUE CROSS OF CALIFORNIA
P.O. Box 70000
Van Nuys, California 91470

STREET ADDRESS:
21555 Oxnard Street
Woodland Hills, California 91367
PHONE: 818-703-4565
FAX: 818-887-2081

PART A - AGREEMENT NO. HCFA 87-001-1.73

Leonard D. Schaeffer
Chairman
PHONE:  818-703-3145

Andrew Allocco
Senior Vice President
PHONE: 818-703-2872

Jacqueline Anderson
General Manger
Medicare Operations
5151 Camino Ruiz
Building G
Camarillo, CA 93012
PHONE: 805-384-7001

Jane Solomon
Manager
Program Compliance
PHONE: 805-384-7003

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

CONNECTICUT See Empire Blue Cross Blue Shield [Top]
PART B JURISDICTION - See United Health Care Insurance Company

DELAWARE PART A PROVIDER SERVICE AREA: See Empire Blue Cross and Blue Shield [Top]
PART B JURISDICTION - See (Texas) Trailblazer Health Enterprises, LLC

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

FLORIDA PART A PROVIDER SERVICE AREA: State of Florida [Top]
PART B JURISDICTION: State of Florida

BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.
532 Riverside Avenue
Jacksonville, Florida 32202
PHONE: 904-791-6111
FAX: 904-905-6020
Email: pgmchg@jax-inter.net 

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

PART A Mailing Address
P.O. Box 2711
Jacksonville, FL  32231-0021
Michael Cascone
President & CEO
Deerwood Campus Complex
4800 Deerwood Campus Parkway
Jacksonsville, FL 32246-8273
PHONE: 904-905-6115
FAX: 904-905-8082

PART B Mailing Address
P.O. Box 2078
Jacksonville, FL  32231-004

First Coast Services Options, Inc.
Curtis Lord
President
532 Riverside Avenue
Jacksonville, FL 32202
PHONE: 904-791-8090
FAX: 904-791-8078

Government Program Operations A/B
Patricia A. Williams
Sr. Vice President
PHONE: 904-791-8155
FAX: 904-791-8378

Government Programs Safeguards A/B
Bob Malinky
Acting Vice President
PHONE: 904-791-6650
FAX: 904-791-6336

GEORGIA PART A PROVIDER SERVICE AREA: State of Georgia [Top]
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
Email: bcgamed1@mindspring.com 

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

Richard D. Shirk
President and Chief Executive Officer
PHONE:  404-842-8410

Joan T. Burks
Senior Vice President of  Government Programs
3350 Peachtree Road, NE
P.O. Box 4445
PHONE: 404-842-8440}
FAX: 404-842-8451

Wanda M. Logan
Assistant Vice President
Medicare Claims Operations
2357 Warm Springs Rd. 
Columbus, GA 31904
PHONE:  706-571-5260

Robert M. Unwin
Assistant Vice President
Provider Audit & Reimbursement
2357 Warm Springs Rd.
Columbus, GA 31904
PHONE:  706-571-5440

HAWAII PART A PROVIDER SERVICE AREA - See See Blue Cross of California [Top]
PART B JURISDICTION - See Noridian Mutual Insurance Co. (North Dakota)

IDAHO PART A PROVIDER SERVICE AREA - See Blue Cross and Blue Shield of Oregon [Top]
PART B JURISDICTION - See Connecticut General Life Insurance Company

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

INDIANA PART A PROVIDER SERVICE AREA: States of Indiana, Kentucky, Ohio,Connecticut and Illionis [Top]

ANTHEM INSURANCE COMPANIES, INC.
120 Monument Circle, Suite 200
Indianapolis, Indiana 46204
PHONE: 317-841-4400 (Operations Office-Adminastar, Inc.)
PHONE: 317-488-6000 (Corporate Office-Anthem)
FAX: 317-841-4691

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

L. Ben Lytle
President & CEO
Anthem
PHONE:  317-488-6488

Barbara J. Gagel
President & CEO AdminaStar, Inc.
8085 Knue Road
Indianapolis, IN 46250
PHONE:  317-841-4401

INDIANA PART B JURISDICTION: States of Indiana, Kentucky [Top]
DME REGIONAL CARRIER: District of Columbia, Illinois, Indiana, Maryland, Michigan, Minnesota, Ohio, Virginia,West Virginia, Wisconsin

ADMINASTAR FEDERAL, INC.
8115 Knue Road Indianapolis, Indiana 46250
PHONE: 317-841-4400 (Operations Office)
FAX: 317-841-4691
Email: mike_mccarron@aici.com 

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

CONTRACT: 500-93-BPO2

Stephen Crickmore
President & CEO
AdminaStar Federal, Inc.
8085 Knue Road
Indianapolis, IN 46250
PHONE: 317-594-3902

Cindy Pridemore
AdminaStar Federal
Manager, Government Programs
PHONE:  317-841-4418

DURABLE MEDICAL EQUIPMENT
AdminaStar Federal
ATTN: DMERC Operations
8115 Knue Road
Indianapolis, IN 46250

IOWA PART A PROVIDER SERVICE AREA: States of Iowa, South Dakota (Special Claims: HHA) [Top]
PART B JURISDICTION: See Noridian Mutual Insurance Co.(North Dakota)

WELLMARK, INC.
636 East Grand Avenue Station 28
Des Moines, Iowa 50309
PHONE: 515-245-4834(Homehealth)
PHONE: 800-532-1285(Beneficiary) PHONE:515-245-4881(Non-Participating Provider)
PHONE: 515-244-0445(Participating Provider)
FAX: 515-245-3984
Email: wellmedicare@wellmark.com 

PART A - AGREEMENT NO. HCFA 87-001-1.17

PART B - CONTRACT NO. HCFA-87-012-2

John Forsyth
President & CEO
PHONE: 515-245-4545

Mary Ellis
Vice President
Government Programs
PHONE: 515-245-4618

C. Craig Hennesy
Chief Operating Officer
PHONE: 515-245-5138

KANSAS PART A PROVIDER SERVICE AREA: State of Kansas [Top]
PART B JURISDICTION: States of Kansas, Western Missouri and Nebraska

BLUE CROSS AND BLUE SHIELD OF KANSAS, INC.
Street Address: 1133
Topeka Avenue
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 (KANSAS)

PART B - CONTRACT NO. HCFA-87-013-2

(KANSAS) PART B - CONTRACT NO. HCFA-91-040-2 (NEBRASKA)

John W. Knack
President & CEO

Kay Vondemkamp
Vice President
Government Programs
PHONE: 785-291-8851

David Manley
Vice President
Subscriber Services and Government Programs
PHONE: 785-291-8772

KENTUCKY PART A PROVIDER SERVICE AREA: See State of Indiana, Anthem Insurance Companies, Inc. [Top]
PART B JURISDICTION: See State of Indiana, Adminastar Federal, Inc.

LOUISIANA PART A PROVIDER SERVICE AREA - See Blue Cross and Blue Shield of Mississippi [Top]
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) [Top]
PART B JURISDICTION - See National Heritage Insurance Company

ASSOCIATED HOSPITAL SERVICE OF MAINE
2 Gannett Drive South
Portland, Maine 04106-6911
PHONE: 207-822-7000
FAX: 207-822-7926
Email: Medicare@bcbsme.com 

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

Keith Van Geisen
President &CEO

Peter H. Brown
Vice President
Government Programs
Phone: 207-822-7022
FAX: 207-822-7350

Richard Haggerty
Medicare Coordinator
Phone: 207-822-7093
FAX: 207-822-7375

Edward J. Kane
Senior Vice President
Legal & Federal Affairs

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 [Top]
PART B JURISDICTION - See TrailBlazer Health Enterprises, LLC  

CARE FIRST 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@bcbsmd.com 

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

PART B - CWFH-HCFA-94-001-2

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

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

MASSACHUSETTS PART A PROVIDER SERVICE AREA: See Associated Hospital Service of Maine [Top]
PART B JURISDICTION: See National Heritage Insurance Company

MICHIGAN PART A PROVIDER SERVICE AREA - See Indiana: Anthem Insurance Companies Inc. and United Health Care Insurance Company [Top]
PART B JURISDICTION - See Blue Cross Blue Shield of Wisconsin

MINNESOTA PART A PROVIDER SERVICE AREA: See Noridian Mutual Insurance Company [Top]
PART B JURISDICTION: See
United Health Care Insurance Company

MISSISSIPPI PART A PROVIDER SERVICE AREA: States of Mississippi, Louisiana, and Missouri [Top]
PART B JURISDICTION - See United Health Care Insurance Company

BLUE CROSS AND BLUE SHIELD OF MISSISSIPPI
(d.b.a. Trispan)
Medicare Part A Intermediary
P.O. Box 23035
Jackson, Mississippi 39225-3035

(STREET ADDRESS)
3545 Lakeland Drive
Jackson, Mississippi 39208-9799
PHONE: 601-936-0105
FAX: 601-939-9791
Email: msmcclm@meta3.net 

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

Richard J. Hale
President & CEO

Mr. Launnie Ginn
Executive Vice President
Government Programs and Benefits Administration
PHONE: 601-664-4567

William V. Morris III
Vice President
Government Programs
PHONE: 601-664-4570
FAX: 601-939-9791

MISSOURI PART A PROVIDER SERVICE AREA - See Blue Cross and Blue Shield of Mississippi and Mutual of Omaha Ins. Co. [Top]
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 [Top]
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
Email: ndrazich@mcn.net 

(PART B)
P.O. Box 4310
340 North Last Chance Gulch
Helena, Montana 59604
FAX: 406-442-9968
Email: Marlene_Longfellow@bcbsmt.com 

PART A - AGREEMENT NO. HCFA 87-001-1.30

PART B - CONTRACT NO. HCFA-87-018-2

Alan F. Cain
President & CEO
PHONE: 406-444-8200
FAX:  406-447-8607

Terry  Screnar
Executive Vice President
and Chief Operating Officer
PHONE: 406-444-8200
FAX: 406-447-8607

Mike Wagner
Vice President
Federal Programs
Medicare A & B
(Medicare Coordinator)
PHONE: 406-791-4147-Part A
PHONE: 406-444-8356-Part B

Lana Finch
Manager
Customer Relations & Operations
PHONE: 406-444-8503

Janet Whitmoyer
Manager
Medical Benefits & Fraud
PHONE: 406-444-8955

Medicare B Receptionist
PHONE: 406-447-8713

NEBRASKA PART A PROVIDER SERVICE AREA: State of Nebraska [Top]
PART B JURISDICTION - See Blue Cross and Blue Shield of Kansas, Inc.

BLUE CROSS AND BLUE SHIELD OF NEBRASKA
P.O. Box 3248, Main Post Office Station
Omaha, Nebraska 68180

STREET ADDRESS:
7261 Mercy Road
Omaha, Nebraska 68124
PHONE: 402-390-1850 (Direct Dial)
FAX: 402-398-3640 (Corporate Office)

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

Richard L. Guffey
President

David V. Realph
Treasurer and Chief Financial Officer

John T. Hines
Vice President
Government Programs
PHONE: 402-390-1883
FAX: 402-398-3640

NEVADA PART A PROVIDER SERVICE AREA - See Blue Cross of California [Top]
PART B JURISDICTION - See Nordian Mutual Insurance Company

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

NEW HAMPSHIRE-VERMONT HEALTH SERVICE
(d.b.a. Blue Cross and Blue Shield of New Hampshire)
3000 Goffs Falls Road
Manchester, New Hampshire 03111-0001
PHONE: 603-695-7000
FAX: 603-695-7095

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

David A. Jensen
President & CEO
PHONE: 603-695-7064

Richard F. Linnell
Senior Vice President
Operations Division
PHONE: 603-695-7462

David R. Hanchett
Director
Operations Division
Government Programs
PHONE: 603-695-7400
FAX: 603-695-7741

NEW JERSEY PART A PROVIDER SERVICE AREA: State of New Jersey [Top]
PART B JURISDICTION - See Empire Blue Cross Blue Shield

HORIZON HEALTHCARE SERVICE, INC.
(d.b.a. HORIZON BLUE CROSS AND BLUE SHIELD OF NEW JERSEY, INC.)
33 Washington Street
Newark, New Jersey 07102
PHONE: 973-456-2000
FAX: 973-456-2086

PART A - AGREEMENT NO. HCFA 87-001-1.33

William J. Marino
President & CEO
PHONE: 973-466-8300
FAX: 973-466-6606

Pamela T. Miller
Vice President
Government/Strategic Planning and Quality Management
PHONE: 973-466-8530
FAX:  973-466-8778

Julie Schneider
Director
Medicare Operations and Provider Audit & Reimbursement
PHONE: 973-456-3168
FAX:  973-456-2086

NEW MEXICO PART A PROVIDER SERVICE AREA: See Blue Cross and Blue Shield of Texas and Blue Cross and Blue Shield of South Carolina (HHA claims only) [Top]
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 [Top]
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 Blue Cross and Blue Shield of Western New York Below) Group Health Incorporated

EMPIRE BLUE CROSS AND BLUE SHIELD
(d.b.a. Empire Medciare Services)
One World Trade Center
New York, New York 10048-0682
PHONE: 914-248-2852
FAX: 914-248-2948
Email: lkasow@empirebcbs.com 

PART A - AGREEMENT NO. HCFA 87-001-1.38

PART B - CONTRACT NO. HCFA 87-021-2

Michael A. Stocker, M.D.
President & CEO
One World Trade Center
28th Floor
New York, NY 10048-0682

William Foley
Vice President
Medicare Services
400 South Salina Street
Syracuse,  NY 13202
PHONE: 315-442-4890

Gloria McCarthy
Senior Vice President
Operations
622 Third Avenue
New York, NY 10017
PHONE: 212-476-2330

David Jaspen
Assistant Vice President
Medicare Quality Assurance and Coordination
622 Third Avenue
New York, NY 10017
PHONE: 212-476-3825

Sally Wood
Assistant Vice President
Empire Medicare Services
300 East Park Drive
Harrisburg, PA 17111

Greg Archambeau
Assistant Vice President
Medicare Financial & Support Services
400 South Salina Street
Syracuse, NY 13202
PHONE: 315-442-4605

NEW YORK PART B JURISDICTION: The State of New York (except for the Counties served by Empire Blue Cross and Blue Shield and Group Health, Inc.) [Top]

BLUE CROSS AND BLUE SHIELD OF WESTERN NEW YORK, INC.
1901 Main Street, P.O. Box 80
Buffalo, New York 14240-0080

UPSTATE MEDICARE DIVISION OPERATIONS
33 Lewis Road
P.O. Box 5236
Binghamton, New York 13905-5236
PHONE: 716-887-6900
FAX: 716-887-8548 (Buffalo) or 607-779-6395 (Medicare)
Email: bcbswny@ix.netcom.com 

PART B - CONTRACT NO. HCFA 87-022-2

Thomas P. Harnett, Ph.D.
President
1901 Main Street
PHONE: 716-887-6948

Mr. Harris Topel
Vice President & Chief Financial Officer
1901 Main Street
PHONE: 716-887-8702

Alphonso O'Neil-White
Vice President
General Counsel and Corporate Secretary
PHONE:  716-887-7550

William Wickis
Vice President and Chief Operating Officer
Upstate Medicare Division
PHONE:  607-766-6325

NORTH CAROLINA PART A PROVIDER SERVICE AREA: State of North Carolina [Top]
PART B JURISDICTION - See Connecticut General Life Insurance Company

BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA
P.O. Box 2291
Durham, North Carolina 27702-2291

STREET ADDRESS:
Medicare Part A Operations
800 South Duke Street
Durham, North Carolina 27701
BENEFICIARIES: NORTH CAROLINA- 800-685-1512
OUT-OF-STATE: 919-688-5528
PROVIDERS: 919-688-5528
FAX: 919-765-7102

PART A - AGREEMENT NO. HCFA 87-001-1.43

Kenneth C. Otis, II
President
PHONE: 919-765-2400
FAX: 919-765-0171

John E. Dye
Senior Vice President
Operations 
PHONE: 919-765-2172
FAX: 919-765-7818

O. Brown Gardner
Vice President
Medicare Operations
PHONE: 919-765-3540
FAX: 919-765-7267

NORTH DAKOTA PART A PROVIDER SERVICE AREA: State of North Dakota, Minnesota [Top]
PART B JURISDICTION: States of North Dakota, South Dakota, Wyoming, 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
Internet: www.bsbsnd.com/medweb 

PART A - AGREEMENT NO. HCFA 87-001-1.44

PART B - CONTRACT NO. HCFA 87-023-2

Michael Unhjem
President & CEO
PHONE:  701-282-1327

Jay Martinson
Vice President
PHONE:  701-282-1439

OHIO PART A PROVIDER SERVICE AREA: See State of Indiana, Anthem Insurance Companies Inc. [Top]
PART B JURISDICTION - See Nationwide Mutual Insurance Company

OKLAHOMA PART A PROVIDER SERVICE AREA: State of Oklahoma [Top]
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
Email: medicare@bcbsok.com 

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

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

Mr. Lyndle Ellis
Vice President and Director of Government Programs
PHONE:  918-560-2090

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

BLUE CROSS BLUE SHIELD OF OREGON
FOR OVERNIGHT DELIVERY
1600 S.W. 4th Avenue
Portland, Oregon 97201

REGENCE BLUE CROSS BLUE SHIELD OF OREGON
100 S.W. Market Street
Portland, Oregon 97201
or
P.O. Box 8110
Portland, Oregon 97207-8110
PHONE: 503-721-7116
FAX: 503-228-3304
Email: MEDICARENW@REGENCE.COM 

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

CWFH - CONTRACT NO. HCFA 89-330-2

Mr. Donald P. Sacco
President & CEO
P.O. Box 1271
Portland, Oregon 97201-1271
PHONE:  503-226-8721
FAX: 503-225-4800

Daniel J. Mallea
Senior Vice President
Internal Operations
P.O. Box 1271
Portland, Oregon 97201-1271
PHONE: 503-225-4866
FAX: 503-225-4800

James E. Verdick
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). [Top]

HIGHMARK INC.
(d.b.a. Veritus Medicare Services)
120 Fifth Avenue, Suite P5101
Pittsburgh, Pennsylvania 15222-3099
PHONE: 412-544-7000 6
FAX: 412-544-8054
Email: veritusmedicare@highmark.com 

PART A - AGREEMENT NO. HCFA 87-001-1.5

John Brouse
President & CEO
Highmark, Inc.
PHONE: 412-544-8202

Charles Long
Senior Vice President
Chief Finanical Officer & Treasurer of Finance
Highmark, Inc.
Camphill, PA
PHONE: 717-763-6274

George F. Grode
Executive Vice President
Government Business Corp. Affairs
PHONE: 412-544-8870-Pittsburgh
PHONE: 717-763-6568-Camphill

Address all technical and procedural correspondence to:
Marilyn Koch
Senior Vice President
Government Business Unit
120 Fifth Avenue
Suite P5101
Pittsburgh, PA 15222-3099
FAX: 412-544-1971
PHONE:  412-544-1800

PENNSYLVANIA PART B JURISDICTION: State of Pennsylvania [Top]

HIGHMARK INC.
(d.b.a. Xact Medicare Services)
P.O. Box 890065
Camp Hill, Pennsylvania 17089-0065

FOR EXPRESS MAIL:
1800 Center Street
Camp Hill, Pennsylvania 17089
PHONE: 717-763-3151 (East Park Drive) 
FAX: 717-975-7045 (Center Street)
Email: xact@xact.org 

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

John Brouse
President & CEO
Highmark, Inc.
PHONE:  717-763-3354

Charles Long
Senior Vice President
Chief Financial Officer & Treasurer of Finance
Camphill, PA
PHONE: 717-763-6274

George F. Grode
Executive Vice President
Government Business Corp. Affairs
PHONE: 412-544-8870 

Patrick M. Kiley
Vice President
XACT Medicare Services
PHONE:  717-730-5891

Robert Muscalus, D.O.
Vice President
Medical Affairs & Medical Director
XACT Medicare Services
PHONE: 717-760-9516

PUERTO RICO PART A PROVIDER SERVICE: See Cooperativa de Seguros de Puerto Rico [Top]
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)
PHONE: 787-749-4080 (Medicare)
FAX: 787-749-4092
Email: Mortiz@mail.triples-med.org 

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

Miguel Vázquez-Deynes
President & CEO
PHONE: 787-749-4114
FAX: 787-749-4191

Mrs. Socorro Rivas
Executive Vice President
PHONE: 787-749-4118
FAX: 787-749-4191

Earl Harper
Vice President, Medicare
PHONE: 787-749-4080
FAX: 787-749-4192

Gloria Lebrón, Esq.
Assistant Vice President
Medicare
PHONE:  787-749-4083
FAX: 787-749-4092

RHODE ISLAND PART A PROVIDER SERVICE AREA: State of Rhode Island [Top]
PART B JURISDICTION: State of Rhode Island

BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND
444 Westminster Street
Providence, Rhode Island 02903-3279
PHONE: 401-459-1000
FAX: 401-459-1709

PART A - AGREEMENT NO. HCFA 87-001-1.58

PART B - CONTRACT NO. HCFA 87-026-2

Douglas J. McIntosh
President

George Schobel
Senior VP
Government Programs

John V. Griffin
Medicare Administrator

Cathy Sullivan
Assistant Administrator

SOUTH CAROLINA PART A PROVIDER SERVICE AREA: State of South Carolina (SPECIAL CLAIMS: HHA, Hospices)
PART B JURISDICTION: State of South Carolina [Top]
DME REGIONAL CARRIER: Alabama, Arkansas, Colorado, Florida, Georgia, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands

Statistical Analysis Durable Medical Equipment Carrier (SADMERC)

National Supplier (NSC) Clearinghouse

BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA
400 Arbor Lake Drive, Suite A900
Columbia, South Carolina 29223
PHONE: 803-788-0222 
FAX: 803-691-4761
Email: ROSE.VOYLES@PGBA.COM 

PART A - AGREEMENT NO. HCFA 87-001-1.59

M. Edward Sellers
President & CEO
BCBSSC
I-20 at Alpine Road
Columbia, SC 29229
PHONE:  803-788-3860

William R. Horton
President & Chief Operating Officer
Government Programs Divisions
I-20 at Alpine Road
Columbia, SC  29219
PHONE: 803-788-4138
FAX:  803-736-9289 

Bruce W. Hughes
Executive Vice President & Chief Operating Officer
300 Arbor Lake Drive
Suite 800
Columbia, SC  29223
PHONE:  803-788-0222
FAX:  803-691-1722

Roz Catoe
Vice President
Medicare Processing & Customer Service
300 Arbor Lake Drive
Suite 800
Columbia, SC 29223
PHONE:  803-734-1034
FAX:  803-691-1722

Sue Pearcy
Vice President
Medicare Integrity/Audit & Reimbursement
300 Arbor Lake Drive
Suite 800
Columbia, SC 29229
PHONE:  803-735-1034
FAX:  803-691-1722

BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA
(d.b.a. PALMETTO GOVERNMENT BENEFITS ADMINISTRATORS)
EXECUTIVE OFFICES
400 Arbor Lake Drive, Suite A900
Columbia, South Carolina 29223

OPERATIONS OFFICES:
300 Arbor Lake Drive, Suite A900
Columbia, South Carolina 29223
P.O. Box 100190
Columbia, SC 29202
PHONE: 803-735-1034
FAX: 803-691-2188
Email: ROSE.VOYLES@pgba.COM 

PART B - CONTRACT NO. HCFA 87-027-2

DMERC - CONTRACT NO. HCFA 500-93-BPO-3

M. Edwards Seller
President & Chief Executive
Officer, BCBSSC
I-20 at Alpine Road
Columbia, SC 29219
PHONE: 803-788-3860

William R. Horton
President & Chief Operating Officer
Government Programs Divisions
I-20 at Alpine Road
Columbia, SC 29219
PHONE: 803-788-4138
FAX: 803-736-9289

Bruce W. Hughes
Executive Vice President and Chief Operating Officer
300 Arbor Lake Drive, Suite 800
Columbia SC 29223
PHONE:  803-788-0222
FAX:  803-691-1722

Roz Catoe
Vice President
Medicare Processing & Customer Service
300 Arbor Lake Drive, Suite 800
Columbia, SC 29223
PHONE:  803-734-1034
FAX:  803-691-1722

Sue Pearcy
Vice President
PHONE: 803-788-0222 ext. 35545
FAX: 803-786-4636

Dickie Butler
Vice President
Systems/EDI
Parc One Building
10261 Two Notch Road
Columbia, SC  2929
PHONE:  803-788-0222
FAX:  803-865-3839

Durable Medical Equipment
Ann Archibald
Vice President
NSC/SA DMERC & Medicare Admin.
Suite A 900, 400 Arbor Lake Drive
Columbia, SC 29223
PHONE:  803-691-4-61
FAX:  803-788-0222

SOUTH DAKOTA - PART A PROVIDER SERVICE AREA - See Iowa, Wellmark, Inc. PART B JURISDICTION- See Blue Cross Blue Shield of North Dakota [Top]

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

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: 423-755-5955 (Medicare Beneficiary)
Provider Line: 423-755-5950
FAX: 423-752-6518
Email: sharon_cheek@bcbst.com 

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

Thomas Kinser
CEO

Gene Holcomb
President

Ann Keown
Vice President
Government Programs

David Jackson
Director
Medicare Integrity Program and Reimbursement
Phone: 423-755-5783

TEXAS PART A PROVIDER SERVICE AREA: State of Texas, New Mexico and Colorado [Top]
PART B JURISDICTION: States of Texas, Maryland, Delaware, District of Columbia, City of Alexandria, Arlington and Fairfax Counties in Virginia

TRAILBLAZERS HEALTH ENTERPRISES, LLC
P.O. Box 660156
Dallas, Texas 75266-0156
STREET ADDRESS:
901 South Central Expressway
Richardson, Texas 75080
PHONE: 972-766-6900
FAX: 972-766-1765
Email: Kim31@airmail.net 

PART A - AGREEMENT NO. HCFA 87-001-1.62

PART B - CONTRACT NO. HCFA 87-029-2

Rogers K. Coleman, M.D.
President & CEO
901 South Central Expressway
Richardson, Texas 75080
PHONE: 972-766-6011  

Ms. Marti Mahaffey
Vice President
Government Programs Group
1020 South Sherman
Richardson, Texas 75080
PHONE: 972-766-4902

UTAH PART A PROVIDER SERVICE AREA: State of Utah [Top]
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: 801-333-6510Z
Email: veggers@Regence.com 

PART A - AGREEMENT NO. HCFA 87-001-1.63

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

Jed H. Pitcher
Chairman, President & CEO
PHONE: 801-333-5295

Francis X. Leonard
Vice President of Government Programs and Corporate Serv.
PHONE: 801-333-5289

Vance Eggers
Senior Director
Medicare A
PHONE: 801-333-5404

John Mitchell
Senior Director
Medicare B
PHONE: 801-333-5225 

VERMONT PART A PROVIDER SERVICE AREA - See New Hampshire-Vermont HealthService [Top]
PART B JURISDICTION - See National Heritage Insurance Company

VIRGINIA PART A PROVIDER SERVICE AREA: See Blue Cross Blue Shield United of Wisconsin [Top]
PART B JURISDICTION - See United Health Care Insurance Company

WASHINGTON PART A PROVIDER SERVICE AREA: States of Washington and Alaska [Top]
PART B JURISDICTION - See Blue Cross Blue Shield of North Dakota

PREMERA BLUE CROSS
P.O. Box 2847
Seattle, Washington 98111-2847

STREET ADDRESS:
7001 - 220TH S.W.
Mountlake Terrace, Washington 98043
PHONE: 425-670-1010
FAX: 425-670-5505
Email: kathleen.henderson@premera.com 

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

Betty Woods
President & CEO
PHONE: 425-670-5780

Brian Sassi
Vice President
Operations
PHONE: 425-670-4016

Janet Russell
Operations Manager
Federal Programs
PHONE: 425-670-5504

WEST VIRGINIA PART A PROVIDER SERVICE AREA- See Blue Cross Blue Shield United of Wisconsin [Top]
PART B JURISDICTION - See Nationwide Mutual Insurance Company

WISCONSIN PART A PROVIDER SERVICE AREA: States of Wisconsin, Michigan, Virginia, and West Virginia (SPECIAL CLAIMS: HHA, Hospice and FQHC) [Top]
PART B JURISDICTION - See Wisconsin Physicians Service Insurance Corporation

BLUE CROSS & BLUE SHIELD UNITED OF WISCONSIN
(d.b.a United Government Services)
1515 N. RiverCenter Drive
Milwaukee, Wisconsin 53212-3953
PHONE: 414-226-5323
PHONE: 414-224-4954(Beneficiary)
PHONE: 414-226-6075(Provider)
FAX: 414-226-5260
Email: ugsadmin@bcbsuw.org 

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

Thomas R. Hefty
Chairman, President & CEO
United Wisconsin Services
PHONE: 414-226-6295

Timothy F. Cullen
President and Chief Operating Officer
Government Programs
PHONE: 414-226-6004

Sandy Coston
Assistant Vice President
Director of  Federal Programs
PHONE: 414-226-5588

Steve Holubowicz
Director of Program Safeguards
PHONE: 414-226-6991

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

BLUE CROSS AND BLUE SHIELD OF WYOMING
4000 House Avenue
Cheyenne, Wyoming 82001
or
P.O. Box 2266
Cheyenne, Wyoming 82203
PHONE: 307-634-1393
FAX: 307-632-1654
Email: aduran@linux95.bcbsnd.com 

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

Tim Crilly
President
Medicare Coordinator
PHONE: 307-634-1393   

Jeffrey Beuchel
Director 
Medicare
PHONE: 307-634-1393


 

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