Table Of Content

'aa!£ff.c.rs,SSD3!S<i^/ INTERMEDIARY—CARRIER DIRECTORY REVISION MEALU.TSH.ANDEDE>HAURMTAMNENTSEROFV*ICES HEAX^TH CARE FINANCING ADMINISTRATION HJ^P—J- JANUARY 1991 REV. 31 This is Revision 31 to the Intermediary-Carrier Directory. Discard all previous revisions since all sections of the directory have been updated. This directory is intended for the internal use of the Health Care Financing Administration staff in facilitating contact with Medicare Intermediaries and Carriers. Any inquiries regarding the content of this directory or changes to the information contained herein should be referred to the Health Care Financing Administration, Division of Contracts, Room 332 Meadows East Building, 6325 Security Boulevard, Baltimore, Maryland 21207. COMMUNICATING WITH INTERMEDIARIES AND CARRIERS The rights and obligations of Intermediaries and Carriers and the Secretary are covered under the Medicare contracts. No request should be made of contractors unless specifically authorized by these contracts. Any questions in this regard should be addressed to the Bureau of Program Operations, Office of Program Administration, Division of Contracts, Room 332, Meadows East Building. PLEASE NOTE All work days begin on Monday and end on Friday, unless otherwise stated. All hours of operation are from a.m. to p.m. ABBREVIATIONS HISTORY RHC Rural Health Clinics RA CHC Community Health Centers 412 HHA Home Health Agencies .U3667 OHPLA OHrigsatnocoPmrpoacutraebmielnittyAgLeabnscie(sInd(eIpnednedpeenntd)ent) 1991 PE Parenteral/Enteral REV. 31 (01/91) 8o T , 2 INTERMEDIARY AND CARRIER DIRECTORY TABLE OF CONTENTS BLUE CROSS AND BLUE SHIELD ASSOCIATION 3 BLUE CROSS PLANS ^ ... ABBBLRLLUKUUEEAENSCCCARRRSOOOSSSSSSBLUOAAEFNNDDCCARBBOLLLSIUUSEFEORASSNNHHIDIIAEELLBDDLUEOOFFSHAAIRLEIALZBDOA,NMAA,INCINC. . . ** '* *' *' d3 . CBEBNNBBBBBABBBBABHBBBlBOLLMELELLLLLLSLLLSELALLLUMUPWUWUUUUUUUSUUSUASUUUEEMIEEEEEEEEOEEEDOELEEURMHCCTNECCECACCCCCICCCCIHHCCCCIRRRXMRRRRRRARRRAERRRRTOOOIOPOOOBOOTOOOTAOOCOOYSSSCSLSSSSSSSESSELSSASSSSSSUOSSHSSSSSDSSDTSRSSEMIHEUARAAAAABAAAAAAHAAAAITNENNCLNNNNNNNNNONNSNNNSUDDURDDDDDDDD-DDSDEDSEDDAEOVPRURLSBBBEBBBBIBBBVBRVBBBBBSLLCLLRLLLLLTLLILIALLLLUUURUUUMUIUUUAUCUCNUUUUEEEOEAEEEONEEELEEEECEEEESNNSSESDTUSSSSSSSSSSSSSCSSSSRHHHHHHHHHEHHHCCOHHHHAIIABIHIIIIIIRIOIIORIIIINEENLEEEEEEEREVEEEMPEEEECLLUDLALLLPLLLILLPLLOLLLEEDDDL.DDDDDDCDDADDRDDDTBENAOCHOLOSOOOIOOOOOOTOOOO.FFOUFHFFFFEFFFFOFIFFFFMEISSFO.PENN,NMNEMMMMMKKNGCDFAOLOEOSREIIIAAMEAELEONRDRWNHVBSNRCSANNOOLNIYTTITISRYNSHITSRRNAN.HEAHCIALJEAIUNAGCIWELNESEAS.CCSEGSI.DA.CDARSNCDKKHOAAART,.,,SIDAAAYU,TN,E'I...E,P,KRSA.,CIYPOOEIIUN..II!,ITLTNNTCIINNI,CA.ICT!NNCC.N.!.*.NSCIC...CA,.N...I.I!cNN!C.IC....N.C''!.....* *•''*' *•*'''**" *•*'*'*' *•****'*'* \1it111111n1if^c5442112tiln0q7P9I»^51 GBILRNUODEUEPPECRNHODESEASNLCTEHANDBSLEURBEVLIUECCEROSSHOSFIELODKLAOHFOMOAR,EGOINNC...... ! ! 1177 BBBBBBLLLLLLUUUUUUEEEEEE CCCCCCRRRRRROOOOOOSSSSSSSSSSSS AAAAAONNNNNFDDDDDWEBBBBBLLLSLLUUUUUTEEEEEERNSSSSSHHHHHIIIIIPEEEEEELLLLLNDDDDDNSOOOOYOFFFFFLVUTATRSETNEHOXANIOUAHDNATSEHE,S.SCIEAIS.ENRLCOA..LNID..N.A....'.. . .* .*.**.** 21Ji109s0 BBLLUUEE CCRROOSSSS OAFNDWABSLUHEINGSTHOINELDANDOFALVAISRKGAINIA.... • • • • 21 BBLLUUEE CCRROOSSSS A&NDBLUBELUESHISEHLIDELDUNOIFTEDWYOOFMINWGISCO.N.SI.N . .* • • • 22 REV. 31 (01/91) 2a INTERMEDIARY AND CARRIER DIRECTORY TABLE OF CONTENTS (Continued) BLUE SHIELD PLANS 23 AHBACRBSELRAOLSUACKLUELOKEAITCYNFHISOCCAARRMRTOSCNOOESAIUSSDRSANBETLAAUAIPINESNNHDNESYDRUSCVIRRHBBCIALOOLICNUSSUAECESEPNEISTCASS'ACONHHOLRDIIMPEESPOLALEBADRNDRLNADUVITEIOOEIFCMFSOEES,NDFHAILIL.EOCAILR.ANB.DICLA..,DMAA.S.,EIRNCVI.INCC.E. ... .. ''• ''• '*• ''• 2j24l3o KBBBBSBEPBBBBBBBBBlILLLLELMLLLELLLLLLAUNUUUGUUUPUUNUUUUUSEEGEEEEEUEIEENEEEEDRRSOCECCCCYCCCSCCCCCCHSORRRRRLRRHRRRRRREOUOOOOVOOIOOBOOOOASSNSSSSSADSELSSSSSLSSSTSSESSNUSLSSSSSTYEIDHAAAAAASABAAAAAANMNNNNLENOCNNNNNNSDEDDDUDFRRDDBDDDDDEDEOVLRISUIBBWBBBBBBBVBBBCESLLCLLESLLLLLLILLAUUUUISUUUHUUUUCULEEEEOEETEIEAESEEEEEENHSBDLRDSSISSSSSSSSSSELDHHNEHHHHHHHHHHCUIILIIBIIIIIIIOIEEEDEEOLSEENEEEEREELLLLFUALLELLLLPLLDDDDESLDDWDDDDDDHUNIDOOOOOOOYSOOOOOOFFEFFRFFFOHFFFFFLTDRIDEUHTKSERMMMKMMKKETOHLOAIIAAAEXAUODNDPNNRCSNNAHDTTUASYNSHST.SEHAEAKLAEAUI,NS.ROASCCSG.ATCTN,KHOIA.,OD'AAYUSTCIN.,,RNSLAI.ICOEARTI.N.LITNYNCIIC.ITDCNN.!o.SNCC!i,.A......'*...I..I...*'NN..CC..*.....**•*.**"'•''*****'•***''**''•*'**' 33333133332222226545224330997788 COMMERCIAL AND INDEPENDENT 37 MGNACGHCBURAAEEOOLTWOTNUTNOAUUIEENNPIPOARAEEINLACRCWLTARHLIMOIOTEIDFESACAIFESDMLEUVITEOTAHCMRMAAAAUINGNDLTHCEDEDIUAANNANESCBCSLRELAOEIARUSLGRNLVEIUUSPIIFRUAONCEORLRSLSESATAUIHNTNYRIICEAEAEDNENDSELCSCSDOUIEOCMRVNCOAPIOSMCINFDAUPOCAANRAMETYAMNPINIDYAOCESCNENSOYOMPUPCU.RAOEINMR.YPTOA..N..YRI..C.O.!.!.....*......."'.*!...'*'.'*'* 4444444332221700 WTRIARSIACLNROSONAASMDIENRIRCEPATHYISROIECCMCIEIANDNTESN'TBAOLASREDRLVIIFECEINISNUSRUARNACNECECCOMOPRAPNOYRATION . * 444746 BLUE CROSS ANID BLUE g:WlELD ASSOCIATTr^.^ BLUE CROSS AND BLUE SHIELD ASSOCIATION 676 North St. Clair Street Chicago, Illinois 60611 FFTASX 331122--444400--56809010 (Direct Dial) AGREEMENT NO. HCFA 87-001-1 HOURS: 8:30 - 4:30 TPBEreLerEsn:iadredn3t1R.2-4T4r0e-s6n0o1w0ski BSPuersneiisnoterosnsViJcoSerupdpaPonrretsident HSFeeadnreirroyarlP.ViPcrCeoaignrP,armessIiIdGernotup Donald R. Cohodea, Sc.D. TELE: 321-440-5690 TELE: 312-440-6149 Vice President Federal Programs Group TELE: 312-440-6245 BLUE CROSS gLAKTgC ALABAMA BLUE CROSS AND BLUE SHIELD OF ALABAMA 450 Riverchase Parkway, East Birmingham, Alabama 35298 PROVIDER SERVICE AREA: State of Alabama FFTASX 220055--998888--22914090 (Direct Dial) AGREEMENT NO. HCFA 87-001-1.1 HOURS: 8:00 - 4:45 CTEP.EhrLieBesGifiedneeEn2xt0eT5ch-ura9tan8ids8vh-ee2r1O1f8ficer LCSehegaonfriilsoelrCsaltaViiiR.vmceseHAaaPfrnrfdteassieirldslent LMMTEaeyLndnEaid:gcaearrNeo2r05tA-h9cC8ul8ta-ti2m9s92 TELE: 205-988-2126 Horace L. (Dick) Jones ExecutiveVic»President Norman Love TELE: 205-988-2121 Vice President Government Claims TELE: 205-988-2137 REV. 31 (01/91) I . 4 PART I ALASKA (See Blue Cross of Washington/Alaska) ARIZONA BLUE CROSS AND BLUE SHIELD OF ARIZONA, INC. P.O. Box 37700 Phoenix, Arizona 85069 STREET ADDRESS: 2410 W. Royal Palm Drive Phoenix, Arizona 85021 PROVIDER SERVICE AREA: State of Arizona FFTASX 660022--886644--44046424 (Direct Dial) AGREEMENT NO, HCFA 87-001-1.2 HOURS: 8:00 - 4:30 TRPEorLbeEes:ritdenB6.t02-B8u6l4l-a4444 VDFeaidcreaerncattlorPrograms VDFiiacnveaindcPerF.esiWdaerndt Tony Astorga TELE: 602-864-4224 TELE: 602-864-5300 Senior Vice President Jody Chandler and Treasurer Vice President TELE: 602-864-4676 Claims and Federal Programs TELE: 602-864-4445 ARKANSAS ARKANSAS BLUE CROSS AND BLUE SHIELD, INC. A MUTUAL INSURANCE COMPANY 601 Gaines Street Little Rock, Arkansas 72203 PROVIDER SERVICE AREA: State of Arkansas FFTASX 550011--337788--22383044 (Direct Dial) AGREEMENT NO. HCFA 87-001-1.3 HOURS: 8:00 - 4:45 GTPEerLoeErs:giedenK5.t01M-i3t7c8h-e2l1l3,3 M.D. GVRoievcgeeirnnaPmreeH.nstidSetPnertwoagrrtams AMamnaaanngddearR,eCirmoPbsruboryvsiedmeerntAudit Sharon Allen TELE: 501-378-2836 TELE: 501-378-2248 Executive Vice President Theresa Milligan TELE: 501-378-2145 Manager Government Programs Support TELE: 501-378-2078 REV. 31 (01/91) 5 PART I CALIFORNIA BLUE CROSS OF CALIFORNIA P.O. Box 70000 Van Nuys, California 91470 STREET ADDRESS: 21555 Oxnard Street Woodland Hills, California 91367 PROVIDER SERVICE AREA: State of California SPECIAL CLAIMS: HHA, INDEPENDENT HOSPICES (WEST) FFTASX 881188--770033--22739425 (Direct Dial) AGREEMENT NO. HCFA 87-001-1.73 HOURS: 8:00 - 4:30 TLCEehLoaBni:arrmdan81D.8-7S0c3h-a3e1f4f5er DJPioreroevicTdtueomrraAudit MMJeaudnliaicgeaetrrtee CClhaeinmisan Patricia Johnson TDEeLpEa:rtme8n1t8-703-2971 TELE: 818-703-3652 Senior Vice President Senior Programs Janie Solomon TELE: 818-703-3192 Manager, Medicare Program Compliance TELE: 818-703-3671 COLORADO (See New Mexico Blue Cross and Blue Shield, Inc.) CONNECTICUT BLUE CROSS AND BLUE SHIELD OF CONNECTICUT, INC. 370 Bassett Road North Haven, Connecticut 06473 PROVIDER SERVICE AREA: State of Connecticut FFTASX 220033--223695--48911818 (Direct Dial) AGREEMENT NO. HCFA 87-001-1.7 JCHPhoerihaeenlsftidhCeErnDxoteewlceiuaavtnkeidrvye OSfyfsitecmesr DADSianenrntieihecooltrnoyrVJ.iJ.cofeCyMGraPorrvteeisrnindmeenntt FVaJITnianSdcmseetsG2io0tPv3uMr.e-te2ris6noiB5mndu-eaec8nlnc1tth0eR2rePoilfraotgriaomnss Programs REV. 31 (01/91) . 6 PART I DELAWARE BLUE CROSS AND BLUE SHIELD OF DELAWARE, INC One Brandywine Gateway, P.O. Box 1991 Wilmington, Delaware 19899 PROVIDER SERVICE AREA: State of Delaware FFATSX 330022--442211--23008090 (Direct Dial) AGREEMENT NO. HCFA 87-001-1.8 GSTRPieEorLlnbeEbies:eorirrtdteVnc3i.tP0.c2e-CoB4lPa2err1,ed-ss3il0Jde2r.ey0nt JTRSeEaeLrlnaErpin:ydhorTICrVc3reie0ocnau2eosc-guh4lr2Pee1rr-e3s1i5d0ent TGDNEaeiLtorEireB:ogcunsetaiolnr3H.e0s2as-nE4dn2Cg1lGl-iaos3ivh2me,9sr2nmJer.nt TELE: 302-421-3191 VTCEilLcaEei:msPrAe3ds0mi2di-en4n2it1s-t3r4a5t2ion MWTaEiLnlEal:giearm,30J.M2e-d4M2ic1cD-ao3rn0ea8l7dClaims DISTRICT OF COLUMBIA (See Blue Cross and Blue Shield of Maryland) FLORIDA BLUE CROSS AND BLUE SHIELD OF FLORIDA. INC. P.O. Box 2711 Jacksonville, Florida 32231-0021 STREET ADDRESS: 8381 Dix Ellis Trail Jacksonville, Florida 32256 Suite 300 (Claims Operations and Administrative Offices) Suite 200 (Provider Audit and Reimbursement) PROVIDER SERVICE AREA: State of Florida FTS 904-791-6111 (Direct Dial) agreement no. hcfa 87-ooi-i.io HOURS: 8:00 - 4:30 WPirlelsiiademntE. Flaherty VPiactericPiraesiA.denWtilliams DSiurmeacntoMrakker AGSonevtneoironnrimoeVni(tcTeonPyrP)orgersFaiamdveinnto MTFAEeXLd:Ei:car99e0044--P44a6r6t44--11A116001 TPErLoaEnv:dideRre9i0mA4bu-ud4ri6st4-e1m2e1n1t Operations TELE: 904-791-6103 REV. 31 (01/91) PART I FLORIDA (Continued) BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC, MTDSEeihLdriEier:cclateroyer90E4dP-alr4it6n4-A11C0l3aims GTDBEoiiLvlrElee:rcntJ.moer9n0Lt4o-n4gP6r4o-g1r1a1m1s TDPPEiraLrotEegr:critacomira90R4eM.-l4a6tA4ii-on1ns1sl4e1y GEORGIA BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC. 2357 Warm Springs Road P.O. Box 7368 Columbus, Georgia 31908 PROVIDER SERVICE AREA: State of Georgia FFTASX 440044--557711--55347817 (Direct Dial) AGREEMENT NO. HCFA 87-001-1.11 HOURS: 8:00 - 5:00 ETPxhreoecmsauisdteinvKteinOsafenfrdicCehrief JSfooerannioGroBvueVrrkinscmeenPtresPirdoegnrtams MAResodsbiiecsrtatarneW.tClVEaibicemerstPresident HAWAII (See Hawaii Medical Service Association) IDAHO (See Blue Cross and Blue Shield of Oregon) ILLINOIS HEALTH CARE SERVICE CORPORATION 233 North Michigan Avenue Chicago, Illinois 60601 PROVIDER SERVICE AREA: State of Illinois SPECIAL CLAIMS: HHA FFTASX 331122--596358--16100070 (Direct Dial) AGREEMENT NO.HOURHSC:FA 88:70-0001--14,:1040 TSP.EErLxeEMes:acirduettnii3tvn1e2H-aO9indf3c8fk-imC6cah8eni1re7f DTTREiheLroiEemm:cabtsuorrsF3,.e1m2eM-Pne9rty3o8ev-ria6dn1de5r8Audit MVTCEeieLdccEiei:claiPraree3s1KAi2rd-ul9el3n8t-7687 John F. Nutting Marilee Pritchard Senior Vice President Medicare Part A Government Contracts Coordinator TELE: 312-938-6209 TELE: 312-938-6201 REV. 31 (01/91) 8 PART I INDIANA ASSOCIATED INSURANCE COMPANIES, INC. (d/b/a BLUE CROSS AND BLUE SHIELD OF INDIANA) OPERATIONS OFFICES: 8320 Craig Street, Suite 100 Indianapolis, Indiana 46250-0452 EXECUTIVE OFFICES: 120 West Market Street Indianapolis, Indiana 46204-2805 PROVIDER SERVICE AREA: State of Indiana FFTASX 331177--884411--44649215 (Direct Dial) AGREEMENT NO. HCFA 88-001-1.16 HOURS: 8:00 - 4:15 OTLCaEfnlhLfdoaEiyi:cdrCemhraiJ.en3f17oBf-Ea2nx6kets3ch-eu4t7iB0vo3eard TCLP.EhrLieEesB:fiedneOnpL3tey1rt7al-ate2ni6d3n-g42O9f2ficer VMTSEietLcdeEeip:chaePrnree3sC1rAi7id-cea8tnn4atd1n-o4Br5e40 VTRBEioiLcacEerh:darCdha3iC1.r7m-a2Kn6i3l-bo4fo6r1nt0he GTRESEoexoLvcenEetca:roulrntdmievE3.ne1t7-VR2ioas6cne3den-b4CPe4orr9neg0ss,ui,mdeernt GCDRDooieevrnineetmnrcrbitnousomlrrelsB,neertrmieAnnFuktideniratanncdaend TELE: 317-841-4429 Marsha Barker Medicare Coordinator TELE: 317-841-4405 IOWA lASD HEALTH SERVICES CORP. 636 Grand Avenue Station 28 Des Moines, Iowa 50309 PROVIDER SERVICE AREA: States of Iowa and South Dakota SPECIAL CLAIMS: HHA FFTASX 551155--224455--34968148 (Direct Dial) agreement no.hourhsc:fa 88:70-0ooi--i4.:i370 ERPxorebeecsruittdeinvD.te ORafanfydicCehrief cC.hieCfraiOgperHaetninnegsyOfficer VGSioacvleelrynPmrT.eenstiWdoeoPndrtograms REV. 31 (01/91) 9 PART I KANSAS BLUE CROSS AND BLUE SHIELD OF KANSAS, INC 1133 Topeka Avenue P.O. Box 239 Topeka, Kansas 66601 PROVIDER SERVICE AREA: State of Kansas FFATSX 991133--229911--77802040 (Direct Dial) AGREEMENT NO. HCFA 87-001-1.19 HOURS: 8:00 - 4:30 ETPxhreoecmsuaisdteinvL.te OMafinfdlilceCerhrief CBoernytlrolLloewrry-Born GVJoiavcyeerLnoPmhreemnsatindnePnrtograms and Community Affairi KENTUCKY BLUE CROSS AND BLUE SHIELD OF KENTUCKY, INC. 9901 Linn Station Road Louisville, Kentucky 40223 PROVIDER SERVICE AREA: State of Kentucky ' FFTASX 550022--442233--26041610 (Direct Dial) AGREEMENT NO. HCFA 87-001-1.20 HOURS: 8:00 - 4:30 CTSPEhrtLieeEesp:fihdeenEnx5te0T.c2u-at4nBi2dov3w-e25O2f2ficer VGTFEiorLcvaEeen:rknPmrF.ee5ns0ti2Bdr-eo4Pan2rdt3ou-gs2r,3a9m4sJr. DTRsEiotLrbrEeea:crttteogriB5,.c02-FFP4lil2ena3man-inn2nci5gen5g0and SSehneiloerenViQ.ceFrPyreesrident, RDiircehcatrodrA. Hermanson Operations Government Programs TELE: 502-423-2099 Division TELE: 502-423-2395 LOUISIANA (See Blue Cross and Blue Shield of Mississippi, Inc.) REV. 31 (01/91)