PART A INTERMEDIARIES AND
PART B CARRIERS
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
[Top]
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