Payer IDs are the electronic identifiers used to route claims and transactions to the correct insurance company through your practice management system or clearinghouse. Using an incorrect payer ID sends a claim to the wrong destination — or nowhere — producing a delayed or missing payment rather than an immediate denial, making the error harder to catch than a standard rejection.
Each payer supports a specific set of EDI transaction types. Knowing which transactions are available for a given payer ID prevents setup errors when configuring a new payer in your practice management system or clearinghouse. The tables below include supported transaction types for each payer alongside the routing ID.
Verify all IDs and transaction support with your clearinghouse before submitting the first claim or transaction to any new payer. Payer IDs and EDI capabilities change — payer mergers, clearinghouse migrations, and contract transitions all cause updates.
Transaction type legend
| Abbreviation | Full Name | EDI Transaction | What It Does |
|---|---|---|---|
| Prof | Professional / CMS-1500 | 837P | Standard outpatient claim — used by therapists, PMHNPs, and all outpatient mental health providers |
| Inst | Institutional / UB-04 | 837I | Facility-level claim — used by hospitals, partial hospitalization programs, residential facilities |
| Sec | Secondary Claims | 837P/I | Claim submitted to a secondary payer after the primary has adjudicated |
| Elig | Eligibility / Benefits | 270/271 | Batch eligibility verification — submitted in bulk, response returned within hours |
| Prime | Prime Eligibility / Benefits | 270/271 real-time | Real-time eligibility check — response returned in seconds at point of service |
| ERA | Electronic Remittance Advice | 835 | Electronic EOB — auto-posts payments and adjustments to the practice management system |
For outpatient mental health practices: the transactions that matter most are Prof (837P), Prime Eligibility, and ERA. Institutional (837I) is rarely needed unless you operate a PHP or IOP program. Secondary claims matter if your client population frequently carries dual coverage.
Commercial payers
| Payer | Payer ID | Prof | Inst | Sec | Elig | Prime | ERA |
|---|---|---|---|---|---|---|---|
| Aetna | 60054 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Cigna / Evernorth | 62308 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| UnitedHealthcare | 87726 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Humana | 61101 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Anthem BCBS (most states) | 00030 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| BCBS Federal Employee Program | 00901 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Molina Healthcare | MOLIN | ✓ | ✓ | ✓ | ✓ | — | ✓ |
| Oscar Health | OSCAR | ✓ | — | ✓ | ✓ | — | ✓ |
| Centene / WellCare | 68069 | ✓ | ✓ | ✓ | ✓ | — | ✓ |
| Elevance Health (non-BCBS) | 00030 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
— = not available or not applicable for this payer through standard clearinghouse routing. Verify Prime Eligibility availability with your specific clearinghouse before relying on real-time checks at point of service.
BCBS varies by state. Anthem BCBS plans use 00030 in most markets, but independent BCBS licensees (Florida Blue, Blue Shield of California, HCSC states) each have their own payer IDs and may have different transaction support profiles. Confirm your state's BCBS entity with your clearinghouse's payer search before submitting — using the wrong BCBS ID is one of the most common misdirection errors in multi-state practices.
Behavioral health carve-out MBHOs
Many commercial payers route mental health and substance use claims to a separate Managed Behavioral Health Organization (MBHO). Submitting a behavioral health claim to the parent payer's ID when coverage is carved out to an MBHO produces a routing error or denial. The MBHO also controls eligibility verification for behavioral health benefits — run the eligibility check against the MBHO's ID, not the parent payer.
| MBHO | Covers | Payer ID | Prof | Inst | Sec | Elig | Prime | ERA |
|---|---|---|---|---|---|---|---|---|
| Optum / United Behavioral Health (UBH) | Most UHC plans | 87726 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Carelon Behavioral Health | Many Anthem plans, select BCBS | Varies by state | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Evernorth Behavioral Health | Most Cigna plans | 62308 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Lucet | Certain BCBS and regional plans | Varies by plan | ✓ | — | ✓ | ✓ | — | ✓ |
| Magellan Health | Employer plans, some Medicaid | 75240 | ✓ | ✓ | ✓ | ✓ | — | ✓ |
| ComPsych | EAP plans, employer BH carve-outs | COMP1 | ✓ | — | — | ✓ | — | ✓ |
The most reliable way to confirm which MBHO handles a patient's behavioral health benefit — and which payer ID to use for both claims and eligibility — is to run a 270 eligibility check before the first session. The 271 response identifies the payer administering the benefit. Our billing guide covers the MBHO carve-out system in full, including the credentialing implications of getting this wrong.
Medicare by Administrative Contractor (MAC)
Medicare Part B claims for mental health services route through Medicare Administrative Contractors (MACs). The payer ID depends on which MAC covers the state where the provider is enrolled. All MACs support the full set of EDI transaction types.
| MAC | States / Jurisdictions | Payer ID | Prof | Inst | Sec | Elig | Prime | ERA |
|---|---|---|---|---|---|---|---|---|
| Novitas Solutions | PA, NJ, DE, MD, DC (J12); CO, TX, OK, NM, AR, LA, MS (JH) | J12: 12101 · JH: 01182 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| CGS Administrators | KY, OH (J15); TN, AL, GA, FL (J11) | 01192 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| WPS Government Health Administrators | IA, KS, MO, NE (J5); IL, MI, MN, WI (J8) | 00831 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Palmetto GBA | NC, SC, VA, WV (JM); CA, HI, NV, AS, GU (JE) | JM: 11512 · JE: 01112 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| First Coast Service Options | FL, PR, USVI | 09102 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Noridian Healthcare Solutions | AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY (JE); CA, HI, NV (JF) | JE/JF: 01112 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| National Government Services (NGS) | CT, MA, ME, NH, NY, RI, VT (JK); IN, MN, WI (J6) | JK: 13102 · J6: 00621 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
TRICARE
| Program | Contractor | Payer ID | Prof | Inst | Sec | Elig | Prime | ERA |
|---|---|---|---|---|---|---|---|---|
| TRICARE East | Humana Military | 37273 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| TRICARE West | Health Net Federal Services | 37273 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| TRICARE For Life | Wisconsin Physicians Service (WPS) | 37278 | ✓ | ✓ | ✓ | ✓ | — | ✓ |
Clearinghouse payer search resources
Each clearinghouse's payer list is the authoritative source for that clearinghouse's routing IDs and supported transaction types. Always confirm against the clearinghouse you're using — the same payer may have different IDs or different transaction support depending on the clearinghouse routing it.
- Availity: availity.com — Trading Partner Service List, searchable by payer name or ID. Shows supported transaction types per payer. The most widely used clearinghouse for behavioral health outpatient claims.
- Change Healthcare / Optum Clearinghouse: Payer list and transaction support available through the provider portal after enrollment.
- Office Ally: officeally.com — Downloadable payer list in spreadsheet format with current IDs, transaction types, and enrollment requirements per payer.
- Waystar: Payer connection list and transaction capabilities available through portal; confirmed during payer connection setup.
- Trizetto / Cognizant: Provider gateway payer list; accessible through enrolled provider accounts.
ERA enrollment is typically a separate step from claim submission enrollment — a payer may accept electronic claims without automatically sending electronic remittances. When setting up a new payer, confirm ERA enrollment separately so payments post automatically rather than arriving as paper EOBs that require manual entry. Most major commercial payers and all Medicare MACs support ERA, but the enrollment request has to be submitted explicitly.
Setting up payer connections correctly from the start — right IDs, right transaction types, ERA enrolled — prevents the AR delays that come from tracking down misdirected claims or manually posting paper payments months after the fact. Questions about your payer setup, clearinghouse selection, or transaction enrollment? Schedule a consultation — a direct conversation with a principal, not a sales script.