Directory of Health Insurance Providers & Billing Contacts
In 2025, insurance billing professionals, medical billers, and provider offices cannot afford to rely on outdated payer information. With stricter pre-authorization policies, reduced claim windows, and faster denial turnarounds, access to an accurate insurance provider directory is now critical to maintaining cash flow and avoiding rework. Every delay in accessing payer contact numbers, claims submission addresses, or provider-specific portals directly impacts reimbursement cycles. As billing processes evolve under CMS guidelines and commercial payer changes, having centralized, real-time billing contacts saves teams from wasted hours and missed payments.
Whether you're submitting to Aetna, Medicaid, or Delta Dental, your team needs more than just a general support number—they need dedicated lines for claims, prior authorizations, and provider service departments. This guide compiles verified contact information for major national insurers, Medicaid/Medicare programs, and specialty payers in one place—so you don’t have to dig through dozens of PDFs or outdated spreadsheets. We also include expert-backed billing workflow tips and code usage guidance, along with a breakdown of how our certification program prepares you for this exact work.
Top National Health Insurance Companies (With Billing Details)
Understanding how to contact major health insurers directly for billing, prior authorizations, and claims issues can save weeks of lost revenue. National payers often use different contact points for different functions—and relying on a single support number leads to delays and misrouted paperwork. Below, we break down the top five insurers every billing department deals with, and how to reach them efficiently.
Aetna, Cigna, UnitedHealthcare, BCBS, Humana
Each of these providers maintains separate departments for claims, prior authorizations, and provider services. Relying on a single number won’t cut it.
Aetna: Claims should be mailed to PO Box 981106, El Paso, TX. Use NaviNet for real-time eligibility and pre-auth requests. Provider line: 1-888-632-3862.
Cigna: Claims go to PO Box 188061, Chattanooga, TN. Electronic submissions use payer ID 62308. Provider service: 1-800-926-2273.
UnitedHealthcare: Claims sent to PO Box 30555, Salt Lake City, UT. Use UHCprovider.com for portal tasks. Provider line: 1-877-842-3210.
Blue Cross Blue Shield (varies by state): Use Availity for eligibility/claims, but call your state plan for billing support.
Humana: Claims mailed to PO Box 14601, Lexington, KY. Payer ID: 61101. Provider relations: 1-800-457-4708.
These companies collectively account for over 65% of private payer claims in the U.S., making them the primary focus for training and workflow design in most provider settings.
Claims Address vs Prior Auth vs Provider Line
One of the most common operational errors is using the wrong number for the task. Each insurer typically has:
A separate claims processing center (often outsourced).
A centralized or state-based prior authorization unit.
A dedicated provider line for questions not related to individual patient benefits.
Always verify these distinctions. Submitting prior auth requests to a claims address, or calling a patient support line as a provider, can stall approvals for days.
Updated Turnaround Times Per Provider
To optimize your accounts receivable cycle, you need to understand average processing times:
Aetna: 7–10 business days for electronic claims; 15–20 for paper.
Cigna: Electronic claims usually processed within 7 days; prior auths within 5.
UnitedHealthcare: 7 days for claims; prior auths may take 10+ depending on the service.
BCBS (by region): Claims can take up to 30 days. Electronic is strongly recommended.
Humana: Claims typically finalized within 10 business days.
Keep in mind these timelines shift quarterly. CMS reporting updates, coding guideline changes, and provider network shifts can all affect them. Always monitor insurer bulletins and maintain direct contact lists internally for your team.
| Insurance Company | Claims Address / Payer ID | Prior Authorization Portal | Provider Services Contact | Claim Turnaround (Avg) |
|---|---|---|---|---|
| Aetna | PO Box 981106, El Paso, TX Payer ID: via NaviNet |
NaviNet portal | 1-888-632-3862 | 7–10 days (electronic) 15–20 days (paper) |
| Cigna | PO Box 188061, Chattanooga, TN Payer ID: 62308 |
Cigna for HCPs portal | 1-800-926-2273 | 7 days (claims) 5 days (prior auths) |
| UnitedHealthcare | PO Box 30555, Salt Lake City, UT | UHCprovider.com | 1-877-842-3210 | 7 days (claims) 10+ days (prior auths) |
| Blue Cross Blue Shield | Varies by state Use Availity portal |
State-specific portals | State plan contact line | Up to 30 days |
| Humana | PO Box 14601, Lexington, KY Payer ID: 61101 |
Humana Availity portal | 1-800-457-4708 | 10 business days |
State Medicaid & Medicare Billing Contact Points
Unlike national payers, Medicaid and Medicare billing operates through decentralized, state-specific systems. That means provider offices must know the exact billing contacts, portals, and fax lines per region to avoid rejections and turnaround delays. Some states outsource Medicaid to Managed Care Organizations (MCOs), while others use in-house systems—each with different procedures for claims, authorizations, and eligibility checks.
Directories by Region (Northeast, South, etc.)
To streamline billing, you need to segment your payer contact list by U.S. region. This helps prioritize major plans by geography and spot MCO patterns that span multiple states.
Northeast (NY, NJ, PA, MA): States like New York use eMedNY for claims and eligibility. In New Jersey, the NJMMIS handles claims and prior auth.
South (TX, FL, GA, NC): Texas Medicaid and Healthcare Partnership (TMHP) manages claims. Florida uses the Gainwell system for both FFS and MCO claims.
Midwest (IL, OH, MI, MN): Illinois processes through HFS, while Ohio uses the PNM system. Michigan Medicaid claims are routed via CHAMPS.
West (CA, AZ, CO, WA): California’s Medi-Cal is processed through DHCS and has many subcontractors like Magellan for mental health. Washington uses ProviderOne.
Each regional MCO has different payer IDs, paper claim addresses, and portal instructions. Make sure to download and bookmark updated billing manuals at least quarterly.
Medicaid MCO Billing Departments
States with Medicaid Managed Care typically assign a network of private insurers (like Molina, WellCare, AmeriHealth) to handle claims. Even though they’re handling Medicaid, their processes mimic commercial payers.
Molina Healthcare: Most states route claims through Availity; call 1-800-642-4168 for Medicaid support.
WellCare: Use the Secure Provider Portal; claims may route via EDI with payer ID 14163.
AmeriHealth Caritas: Different contact points per region; electronic claims via Emdeon or Change Healthcare.
In MCOs, denials are often caused by failing to register correct taxonomy codes, location addresses, or rendering provider NPIs. Each state’s MCO has slightly different rules, so always verify before submission.
State-Specific Quirks in Eligibility Checks
Every state has unique systems for verifying patient eligibility—and mistakes here create denials before a claim is ever submitted.
Texas: TMHP requires benefit history review even for long-enrolled members.
California: Some counties use carved-out mental health systems that aren’t visible on Medi-Cal portals.
Pennsylvania: Eligibility must be verified through PROMISe, not just the clearinghouse.
Florida: Managed Care plans require double-checking both the state and individual MCO portal.
If your office relies only on the clearinghouse, you’ll miss crucial details like retroactive eligibility flags, dual coverage, or recertification lapses. These details are only available on state-verified portals, not commercial ones.
| Region | States | Billing System / Portal | Key Notes |
|---|---|---|---|
| Northeast | NY, NJ, PA, MA |
NY: eMedNY NJ: NJMMIS |
eMedNY and NJMMIS handle both claims and prior auth |
| South | TX, FL, GA, NC |
TX: TMHP FL: Gainwell |
FFS and MCO claims run through state-based platforms |
| Midwest | IL, OH, MI, MN |
IL: HFS OH: PNM MI: CHAMPS |
Each state has a separate portal and MCO carve-out logic |
| West | CA, AZ, CO, WA |
CA: DHCS (Medi-Cal) WA: ProviderOne |
California uses subcontractors like Magellan for mental health |
| Medicaid MCOs | All applicable states |
Molina: Availity WellCare: Secure Portal AmeriHealth: Emdeon / Change Healthcare |
Verify taxonomy codes, NPIs, and addresses per payer. Denials often stem from misalignment |
| Eligibility Quirks | TX, CA, PA, FL |
TX: TMHP CA: County-based systems PA: PROMISe FL: State + MCO portals |
Eligibility checks must be done through state portals, not clearinghouses, to catch dual coverage and retro lapses |
Specialty Insurers: Mental Health, Dental & Vision Plans
Specialty insurance plans—behavioral health, dental, and vision—are often billed outside standard medical workflows. These payers have separate portals, codes, and pre-authorization logic. For providers and billers, failing to navigate these systems correctly leads to delayed payments, mismatched codes, and higher denial rates.
Behavioral Health Carve-Outs and Third-Party Lines
Many states and commercial plans carve out behavioral health coverage to third-party vendors, even when the primary medical coverage remains under a major insurer like Aetna or Blue Shield. That means services like therapy, psychiatry, or intensive outpatient care are billed to completely separate payers.
Magellan Health: Handles behavioral health for several state Medicaid programs and some commercial plans. Payer ID: 01260.
Optum Behavioral Health: Frequently processes mental health for UHC members. Claims address and EDI vary by region.
Beacon Health Options: Manages behavioral coverage for plans including Kaiser, Anthem, and various employer groups.
Denials are common when providers mistakenly bill the main medical payer instead of the behavioral carve-out. Always verify coverage before the first visit using payer tools or third-party portals.
VSP, Guardian, Delta Dental Billing Contacts
Dental and vision claims require totally different platforms, with most providers needing to manually upload claims or use clearinghouses not tied to standard medical systems.
VSP (Vision Service Plan): Use Eyefinity.com for claim submissions and pre-auths. Payer ID: 33333. Contact: 1-800-877-7195.
Guardian: Dental claims are submitted through Dental Exchange or Availity. Payer ID: CX030. Support: 1-866-569-9900.
Delta Dental: Each regional Delta plan (e.g., Delta Dental of California) has a separate portal and payer ID. Confirm region-specific address before submission.
All three often deny claims without NPI or taxonomy inclusion, so verify payer requirements closely during credentialing and portal setup.
Pre-Authorization Tips for Niche Providers
Niche specialties often skip pre-auth checks due to confusion over payer rules—but this is where denials pile up fastest. These tips help prevent that:
Always call the specialty payer if the portal doesn’t show a service code match. Many carve-out plans don’t list every CPT/HCPCS in their portals.
Save screenshots of pre-auth approvals, especially from behavioral platforms like Optum or Magellan, in case of retro audits.
Use standardized documentation templates for psychotherapy notes or dental narratives to meet payer requirements on the first submission.
Missing even one pre-auth field—like rendering provider or service site—can cause an instant denial in specialty billing. Training front-desk and clinical staff on payer-specific intake checklists is crucial.
| Insurer / Platform | Specialty Type | Portal / Payer ID | Contact Details | Key Notes |
|---|---|---|---|---|
| Magellan Health | Behavioral Health | Payer ID: 01260 | Varies by state and plan | Used by several state Medicaid programs and commercial plans |
| Optum Behavioral Health | Behavioral Health | UHCprovider.com Region-specific claim routing |
Portal-based support | Processes mental health claims for many UHC plans |
| Beacon Health Options | Behavioral Health | Custom portals based on plan | Supports Kaiser, Anthem, employer plans | Requires separate registration and credentialing |
| VSP (Vision Service Plan) | Vision | Eyefinity.com Payer ID: 33333 |
1-800-877-7195 | Used for claim submission and pre-auths |
| Guardian | Dental | Dental Exchange / Availity Payer ID: CX030 |
1-866-569-9900 | Manual uploads often required for clean claims |
| Delta Dental | Dental | Region-specific portals and payer IDs | Varies by state (e.g., Delta Dental of CA) | Always verify the specific regional requirements |
| Pre-Authorization Tips | All Niche Providers | Varies | N/A |
Confirm CPT/HCPCS coverage by calling payer Save screenshots of approvals Use standardized notes/templates |
Tips to Prevent Denials & Speed Up Claim Processing
Claim denials cost practices thousands every month—and most are preventable with stronger pre-billing workflows. From eligibility mismatches to code-level rejections, every step before and after claim submission must be tightly controlled. This section breaks down proven strategies to reduce denials, shorten A/R cycles, and keep revenue flowing.
Pre-Claim Insurance Verification Workflows
The most cost-effective denial prevention step is verifying coverage before a patient walks into the exam room. Yet, many clinics rush or outsource this process—leading to eligibility mismatches and missing prior auths.
Use real-time portals like Availity or NaviNet to confirm coverage and benefits.
Print eligibility snapshots and attach them to the patient's chart.
Check for secondary coverage, especially in Medicare and dual-eligible cases.
Confirm that the referring and rendering provider NPIs are in-network.
Even for returning patients, reverify coverage every 30–60 days. Many plans auto-terminate or shift MCOs without notice, and unverified assumptions lead to hard denials that can't be appealed.
Common Billing Code Mismatches
Insurers frequently reject claims due to code combinations they consider invalid, even if they're medically correct. The most common categories:
Unbundled CPT codes that violate NCCI edits
ICD-10 codes not justifying medical necessity
Mismatched place-of-service codes, especially for telehealth vs. in-office
Train billers to use code scrubbing software that flags NCCI violations, non-covered services, and diagnosis-procedure mismatches in real-time. Even with a clean claim, an incorrect modifier can trigger an automatic denial.
Double-check these three high-risk zones before sending a claim:
E/M services paired with procedures on the same day (modifier -25 rules).
Therapy sessions overlapping with psychiatric medication management.
Vaccination billing, especially with administration codes missing.
Eligibility & Authorization Errors to Avoid
Authorization errors don’t just happen because of missing forms—they happen because teams assume eligibility equals approval. That assumption leads to denied high-dollar claims after services are rendered.
Never rely solely on clearinghouses for auth checks; they don’t verify prior approval.
Always document authorization numbers in the claim field and patient record.
Double-check the authorization effective and expiration dates.
Review frequency limits for repeated services like physical therapy or counseling.
When using portals like UHCprovider.com or TMHP, print and save the auth confirmation screen and store it digitally. This becomes essential when insurers claim “no record on file,” even when you’ve submitted proof.
Lastly, keep internal audit checklists for each payer. What triggers a denial at Humana may not affect Aetna—and tracking these patterns across 90 days helps you build denial prevention intelligence into your workflows.
Common Insurance Codes Explained (CPT, ICD-10, HCPCS)
Medical billing professionals must master insurance coding systems to avoid denials and secure clean claim submission. CPT, ICD-10, and HCPCS codes are not interchangeable—they serve different regulatory and clinical purposes. Understanding how they interact is foundational for accurate coding, bundling, and medical necessity alignment.
Code Types by Specialty
Different specialties rely on distinct code sets. For example:
Primary care uses E/M (Evaluation and Management) CPT codes heavily, such as 99213 or 99214.
Surgery relies on procedural CPTs (e.g., 27447 – total knee arthroplasty).
Behavioral health uses time-based codes (90834, 90837) under CPT.
ICD-10 codes describe diagnoses, like F32.1 (Major depressive disorder, moderate).
HCPCS Level II codes include non-physician services and DME, such as A9270 (non-covered item/service).
Coding accuracy isn’t just about entering correct numbers—it’s about aligning diagnoses to procedures with payer policies. For instance, a CPT for a colonoscopy won’t be paid without a justifying ICD-10 like K63.5 (Polyp of colon).
Code Mapping, Bundling, and NCCI Edits
Bundling errors are among the top causes of rejections. The National Correct Coding Initiative (NCCI) governs which CPT combinations can be billed together. If two services are bundled, payers will only reimburse one unless you append the proper modifier.
Modifier 59 or X-series modifiers signal that a procedure is distinct and deserves separate payment.
Code mapping involves pairing ICD-10 and CPT accurately. Use payer-specific LCDs (Local Coverage Determinations) for guidance.
Bundling also affects HCPCS, especially when billing injections, supplies, or transportation services.
For example, billing G0438 (Annual Wellness Visit) with 93000 (EKG) may result in bundling unless documentation proves medical necessity.
CMS Resources for Code Lookups
The Centers for Medicare & Medicaid Services (CMS) provides essential tools for coders:
CMS Coding Resources to Bookmark
Medicare Coverage Database (MCD): Helps you find LCD/NCD by CPT or ICD-10 code.
HCPCS Quarterly Updates: Published on CMS.gov with every addition, deletion, or revision.
Physician Fee Schedule Look-Up Tool: Shows reimbursement rates and billing guidelines.
NCCI Edit Tables: Lists code pairs that cannot be billed together.
Staying compliant with CMS code edits ensures your claims pass initial scrubbers and payer filters. Use these databases proactively—not just after a denial.
Coding is not static. CPT codes update annually, ICD-10 revises every October, and HCPCS adjusts quarterly. Teams must review updates monthly and train staff accordingly. Ignoring one new code can cause mass denials across multiple payers, especially in specialties like orthopedics or oncology.
How Our Billing & Coding Certification Prepares You for Insurance Workflows
Most billing courses only teach code sets—but real-world success in healthcare billing depends on mastering payer-specific workflows, documentation demands, and insurer systems. Our program bridges that gap by preparing you for every stage of insurance claim lifecycle management, from eligibility to appeal.
Our Billing and Coding Certification is built around what actually happens in provider offices and payer portals—not just textbook learning. You’ll work through detailed modules that simulate live billing situations, including:
Entering claims into payer portals like Availity, TMHP, and UHCprovider.com
Conducting insurance eligibility checks using payer tools (not just clearinghouses)
Matching ICD-10 to CPT using LCDs and NCCI guidelines
Identifying when pre-authorization is required and how to secure it correctly
Learning denial trends from major payers like Aetna, BCBS, and Humana
Every student also gets payer workflow templates, ready-to-use denial appeal samples, and coding case studies that mimic high-volume specialties like family medicine, behavioral health, and outpatient surgery.
This certification doesn’t just teach codes—it prepares you to get hired faster, function autonomously on day one, and handle complex billing scenarios with confidence.
You’ll also practice:
Navigating Medicaid MCO billing systems in multiple states
Uploading claims into dental and vision platforms like Eyefinity and DentalXChange
Using modifier logic to manage CPT bundling issues
Conducting internal audits that mirror CMS compliance checklists
Most importantly, we train you to think like a billing manager, not just a coder—because that’s what today’s practices need.
Frequently Asked Questions
-
The most accurate payer contact information comes directly from insurer portals, not clearinghouses. For example, Aetna updates contact changes on NaviNet, while UnitedHealthcare posts changes on UHCprovider.com. Medicaid and Medicare updates are typically released through state-run bulletin boards or official MMIS systems. Bookmark insurer-specific provider manuals and sign up for their bulletins. Don’t rely on Google searches or third-party PDF lists—they’re often outdated. Consider using a cloud-based internal log to track all active payer contacts, and review them every 30–60 days. Many payers change addresses or phone lines without provider notification, which can result in denied claims due to incorrect routing.
-
If a payer contact number is outdated, use the payer’s portal first—most list updated provider phone lines on the login dashboard or support section. If access is restricted, call the general support number and request escalation to provider relations. Many billing teams waste time resubmitting claims or appeals when the real issue is failed communication due to outdated numbers. For Medicaid, check your state’s Medicaid Provider Services portal, which often lists new MCO contacts monthly. Keeping a shared document that flags “recently updated” numbers helps your team stay ahead. For critical billing issues, fax requests are still accepted by many payers and can bypass long hold times.
-
Cigna and Humana are generally more forgiving for beginners because they offer intuitive portals, consistent payer policies, and fewer code-level bundling traps compared to others. Their denial trends are easier to track, and portal-based support is well-organized. Medicaid programs, on the other hand, can be challenging due to state-specific quirks and MCO carve-outs. UnitedHealthcare and Aetna have advanced payer systems but require stronger familiarity with NCCI edits and electronic rejections. For new billers learning through a course like the Billing and Coding Certification, it’s best to simulate billing to both national and MCO-based payers to gain real-world versatility and confidence.
-
Yes, but only under specific conditions. Most insurers allow first-level appeals through online forms or mail, and well-documented appeals have a high overturn rate—especially when medical necessity or prior auth miscommunications are involved. Use payer-specific appeal forms and always attach clinical documentation, the original denial code, and a cover letter summarizing justification. Some payers like Blue Cross Blue Shield and Medicaid MCOs allow direct negotiation if claims were denied due to timely filing or prior auth technicalities. Calling provider services can escalate cases when documentation is already on file. Avoid resubmitting without changes—doing so can lock the claim status, making appeal impossible.
-
Real-time eligibility verification should always be done through payer-integrated portals like Availity (used by BCBS, Humana), NaviNet (Aetna), or UHCprovider.com (UnitedHealthcare). These tools pull live data from insurer databases, unlike clearinghouses that show batch-processed status. You can view copay amounts, deductibles, authorization requirements, and dual coverage in seconds. Many billing software platforms now integrate with these portals via API for instant access. Also use CMS's HETS system for Medicare verification. For Medicaid, use your state’s MMIS platform. Avoid relying solely on patient ID cards—plans change frequently, and assuming eligibility based on outdated info leads to non-payable claims.
-
No. While CPT codes are standardized by the AMA, each insurer applies its own coverage rules, bundling edits, and modifier policies. For example, Medicare will cover certain G-codes that commercial payers don’t, while Medicaid may require state-specific codes or unique modifiers. Even common codes like 99214 (office visit) can be subject to pre-payment review or bundling restrictions based on diagnosis codes or provider type. Always check the insurer’s Local Coverage Determinations (LCDs) or published fee schedules. Use coding tools that include payer-specific rules, especially if you're billing to multiple insurers. CPT uniformity ends where payer policy interpretation begins.
-
Most insurers update their forms quarterly or biannually, but major changes are often published in Q1 and Q4. These updates include revised claim forms, appeal templates, and pre-auth submission checklists. Failing to use the latest form may lead to immediate rejection, even if the content is correct. Medicaid forms vary by state and are typically updated every fiscal year, especially after CMS reporting changes or state budget renewals. Sign up for insurer bulletins and bookmark their forms library. As a rule, check forms every 90 days, especially when payer emails or portal alerts flag “updated submission instructions” or file format changes.
Final Thoughts
Managing healthcare billing today requires more than code knowledge—it demands precise payer communication, active tracking of insurance contact points, and workflow systems that adapt to constant change. Whether you’re handling national payers like Aetna or navigating state-level Medicaid quirks, success depends on maintaining updated contact logs and integrating real-time verification into every claim cycle.
Bookmark this directory and revisit it regularly. Insurer portals change without notice. Fax lines disappear. Addresses shift. Without proactive maintenance, your team risks avoidable denials, claim rejections, and long payment cycles that drain your revenue.
If you're serious about mastering insurance workflows—from eligibility to denial resolution—this directory is only the start. Pairing it with training, such as our Billing and Coding Certification, gives your team the advantage of speed, accuracy, and system readiness. In a field where 1 missed digit can lose you $300, preparation is not optional.
Stay updated. Stay organized. And always treat insurance data like the lifeline of your revenue cycle—because it is.
