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Patient Information
First Name
Middle Name
Last Name
Suffix
Date of Birth
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1825
Gender
Gender
Male
Female
Non-binary
Is the patient the Policy Holder or Subscriber?
Yes
No
Employer
First Name
Middle Name
Last Name
Suffix
Date of Birth
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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2
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4
5
6
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29
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31
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
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2000
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1998
1997
1996
1995
1994
1993
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1991
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1987
1986
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1984
1983
1982
1981
1980
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1978
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1973
1972
1971
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1968
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1961
1960
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1958
1957
1956
1955
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1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
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1915
1914
1913
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1911
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1908
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1900
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1831
1830
1829
1828
1827
1826
1825
Gender
Gender
Male
Female
Non-binary
Insurance Company
Company Name
Company Name
AARP Dental Insurance Plan
ACEC Health Plans (Salt Lake City, UT)
Administrative Services (ASO)
Advantage Dental
Aetna
Aetna Affordable Health Choices (SM) - SRC
Aetna DMO
Aetna Medicare
Alameda Alliance
Allcare CCO Dental
Allegiance Benefit Plan Management
Altus Dental
American Medical Security
Ameritas Life Insurance Company
Anthem Health Plans - HMOD & HMOG
Anthem Health Plans of Virgina - OSB HIGH & LOW
Anthem Health Plans of Virgina - PPOB & PPOD
Anthem Health Plans of Kentucky - OSB HIGH & LOW
Anthem Health Plans of Kentucky - PPOB & PPOD
Anthem HMO Colorado - HMO-B
Anthem Insurance - OSB HIGH & LOW
Anthem Insurenace - PPOB & PPOD
APIPA (Arizona Physicians IPA) - Claims ONLY
APIPA (Arizona Physicians IPA) - PreDeterminations
Asuris Northwest Health
Aultcare
Aultra Administrative Group
AVESIS
Bell Atlantic
Benefit Inc
Benefits Inc
Blue Advantage (BCBS of AR)
Blue Cross Blue Shield (Anthem)
Blue Cross Blue Shield (Empire)
Blue Cross Blue Shield (Trigon)
Blue Cross Blue Shield of Alabama
Blue Cross Blue Shield of Alaska (Premera)
Blue Cross Blue Shield of Arizona
Blue Cross Blue Shield of Arkansas
Blue Cross Blue Shield of Colorado
Blue Cross Blue Shield of Connecticut
Blue Cross Blue Shield of CT- Family Plan
Blue Cross Blue Shield of Delaware
Blue Cross Blue Shield of Georgia
Blue Cross Blue Shield of Illinois
Blue Cross Blue Shield of Indiana (Anthem)
Blue Cross Blue Shield of Indiana (FEP)
Blue Cross Blue Shield of Kansas
Blue Cross Blue Shield of Kansas City
Blue Cross Blue Shield of Kentucky (FEP)
Blue Cross Blue Shield of Kentucky (Anthem)
Blue Cross Blue Shield of Maine
Blue Cross Blue Shield of Maryland / CAREFIRST
Blue Cross Blue Shield of Massachusetts
Blue Cross Blue Shield of MI/ Medicare Advantage
Blue Cross Blue Shield of Michigan
Blue Cross Blue Shield of Minnesota (FEP)
Blue Cross Blue Shield of Minnesota
Blue Cross Blue Shield of Mississippi (CHIPs)
Blue Cross Blue Shield of Missouri
Blue Cross Blue Shield of Montana
Blue Cross Blue Shield of Nevada
Blue Cross Blue Shield of New Hampshire
Blue Cross Blue Shield of New Jersey (Horizon)
Blue Cross Blue Shield of New Mexico
Blue Cross Blue Shield of Ohio (Anthem)
Blue Cross Blue Shield of Ohio (FEP)
Blue Cross Blue Shield of Oklahoma
Blue Cross Blue Shield of Oregon (Regence)
Blue Cross Blue Shield of Rhode Island
Blue Cross Blue Shield of Tennessee
Blue Cross Blue Shield of Texas
Blue Cross Blue Shield of Virginia (Trigon)
Blue Cross Blue Shield of Washington (Regence)
Blue Cross Blue Shield of Washington DC
Blue Cross Blue Shield of Washington
Blue Cross Blue Shield of Western New York
Blue Cross Blue Shield of Wisconsin - PPOD
Blue Cross Blue Shield of Wisconsin
Blue Cross Blue Shield of Wyoming
Blue Cross ND (North Dakota Dental Service)
Blue Cross of California - OSB HIGH & LOW
Blue Cross of California - PLAN SS10 & SS20
Blue Cross of California - PPOA
Blue Cross of California (Wellpoint)
Blue Shield of California
Blue Shield of California - Federal
Blue Shield of Idaho (Regence)
Blue Shield of Northeast New York
Blue Shield of Pennsylvania
Blue Shield of Pennsylvania - Dental Plus
Boston University Dental Health Plan
Brokers National
Businessmen's Assurance (NE)
CAL Optimal - ONECARE
Capitol Dental
Care1st Health Plan Medicare Advantage
Care1st PHP LA & San Bernadino County
Caresource - GA
Caresource - West Virginia
Carpenters Combined Funds
Carpenters Health and Welfare Trust Funds
Caterpillar Inc
Central PA Teamsters Health & Welfare Fund
Chicago Regional Council of Carpenters
Choice Plus (TRW)
Cigna
Cigna (DHMO)
Cigna Dental (HMO)
Community Insurance - PPOD & PPOF
Community Insurance - HMOA & PPOB
CompBenefits
COMPREHENSIVE CARE SERVICE (CCSTPA)
Connecticut Carpenters Health Fund
Connecticut Carpenters Health Plan
Connecticut General (Cigna)
Cooperative Benefit Administrators
CustomCare (Southwest Bell Execs)
Delta Dental - DDIC
Delta Dental Individual Plan (WA,VA,WI,NJ)
Delta Dental of Alabama
Delta Dental of Alaska
Delta Dental of Arizona
Delta Dental of Arkansas Ind
Delta Dental of Arkansas
Delta Dental of California
Delta Dental of Colorado
Delta Dental of Connecticut
Delta Dental of Delaware
Delta Dental of District of Columbia (DC)
Delta Dental of Florida
Delta Dental of Georgia
Delta Dental of Idaho
Delta Dental of Illinois (Group Plans)
Delta Dental of Illinois (Individual)
Delta Dental of Indiana
Delta Dental of Iowa - DWP
Delta Dental of Iowa
Delta Dental of Kansas
Delta Dental of Kentucky
Delta Dental of Louisiana
Delta Dental of Maine
Delta Dental of Maryland
Delta Dental of Massachusetts
Delta Dental of Michigan
Delta Dental of Minnesota
Delta Dental of Mississippi
Delta Dental of Missouri
Delta Dental of Montana
Delta Dental of Nebraska
Delta Dental of Nevada
Delta Dental of New Hampshire
Delta Dental of New Jersey
Delta Dental of New Mexico
Delta Dental of New York
Delta Dental of North Carolina
Delta Dental of North Dakota
Delta Dental of Northeast (ME NH VT)
Delta Dental of Ohio
Delta Dental of Oklahoma
Delta Dental of Oregon
Delta Dental of Pennsylvania
Delta Dental of Puerto Rico
Delta Dental of Rhode Island
Delta Dental of South Carolina
Delta Dental of Tennessee
Delta Dental of Texas
Delta Dental of Utah
Delta Dental of Vermont
Delta Dental of Virginia
Delta Dental of Washington
Delta Dental of West Virginia
Delta Dental of Wisconsin
DeltaCare USA / PMI - Claims
DeltaCare USA / PMI - Encounters
Dental Benefit Providers
Dental3
Dentaquest - Commercial
DentaQuest (Government)
Deseret Mutual Benefit Administrators
Eastern Life and Health
EasyChoice Health Plan
EHI
Emphesys Employers Health of Wisconsin
Empire Health Choice - HMO
Empire Health Choice Assurance - OSB LOW & PPOB
Employers Health Ins of Winconsin(EHI) (Emphesys)
Encara
Envolve Dental
Equicor
Equitable
FedEx Freight East
FedEx Freight Health Benefit
First Ameritas Life Insurance Corp of New York
First Commonwealth
First Plan Blue
First Reliance Standard Life - New York
FLEX Compensation
FlexCare
Florida Combined Life (BCBS of FL)
Florida Power and Light
Gateway Healthy Plan
GEGLAC - GE Group Life Assurance Company - Dental
GEHA Employee Program
Genworth Life and Health Insurance Company
GIC (Indemnity Plan
Golden State Health Plan
Golden West Dental
Great West Healthcare
Great-West Healthcare
Guardian Life Insurance Co
Guardian Managed DentalGuard (Individual Market)
Happy Vyneyard Smiles
Hawaii Dental Services (Delta Dental of HI)
Health Benefit Claims Dept
Health Net - Healthy Families A, B & C
Health Net - Los Angeles PHP
Health Net - Sacramento GMC
Health Net 21 - LA & Sacramento
Healthnet of Oregon
Healthy Alliance Life Insurance - PPOB
HMSA (Hawaii Medical Services) - Commercial
Horizon Healthcare OF New York
Humana Dental
IBEW Local 38
Independence Blue Cross Dental Plan - BlueExtraSM
LA Care Health Plan
Liberty Dental Plan
Lifemap Dental Claims
LifeRe
Lincoln National (WI)
MANAGED CARE OF NORTH AMERICA (MCNA)
Marriott
MD Care Health Plan
MEDICA of Minnesota
MEDICA Public Programs
Medicaid of Alabama
Medicaid of Colorado
Medicaid of Connecticut
Medicaid of Hawaii (Hawaii Dental Services)
Medicaid of Idaho
Medicaid of Illinois
Medicaid of Indiana
Medicaid of Kentucky(Region 3 - Doral Dental)
Medicaid of Maryland
Medicaid of Massachusetts (Mass Health)
Medicaid of Mississippi
Medicaid of North Carolina
Medicaid of Ohio
Medicaid of South Carolina
Medicaid of Utah
Medicaid of Virgina
Medicaid of Washington
Medical Mutual of Ohio (MMO)
Mercy Care
Meritain Health
MetLife
METRO Health Plan
MGM Resorts International
Michigan Laborers Health Care Fund
Midwest Operating Engineers Health and Welfare
Molina Healthcare
Molina Healthcare (Administered By Liberty)
Mutual Health Services
Mutual of Omaha
MVP - Select Care
National Automatic Sprinkler Industry
National Pacific of Texas (NCFLEX)
New England Financial
North Carolina Health Choice
North Star Administrators
Northern California Pipe Trades Trust
Northwest Dental Services
Ohana Health Plan
Ozark Health Plan
Pacific Dental Benefits - California
Pacific Dental Benefits - Nevada
Pacific Union (CA)
Pacificare Dental & Vision Plan
Palms Casino Resport
PDO (Preferred Dental Organization)
Personal Choice
Physicians Mutual
Physicians United PLAN - PUP
Pipefitters LOCAL 597 Welfare Fund
Premera Blue Cross
PrimeWest Health
Principal Financial Group
Principal Life Insurance Co
Provident Life & Accident Insurance Co of America
Prudential for Health
Prudential HealthCare and Life Ins Co of America
Prudential HealthCare Health Maintenance Org
Prudential HealthCare HMO for Small Business
Prudential HealthCare of America Inc
Prudential HealthCare POS for Small Business
Prudential HealthCare PPO for Small Business
Reliance Standard Life
Reliastar (CA)
Rocky Mntn Hospital & Medical Srvc-OSB HIGH & HIGH
Sands Bethworks Gaming
Santa Clara Family Health Plan
SCION Dental
SCION Dental Commercial
Security Life Insurance Company of America
Select Health
South Carolina Healthy Connections
Southwestern Bell
Southwestern Bell Exec - Custom Care
Southwestern Bell Exec - Southwestern Bell
Standard Insurance Company of New York
Standard Insurance Company of Oregon
Sun Life & Health Ins Co
Sun Life Financial
The Dental Companies
The Dental Concern
The Dental Network of Maryland
Travelers (now MetLife )
Tricare Dental Plan (UCCI)
Tricare Retiree Dental
UFCW of Central Ohio
UHC - BCBS NC
UHC Dental Government Programs
UHC Medicare
UMR
UMR - Harrington
UMR - San Antonio
UNICARE
United Concordia - Dental Plus
United Concordia - Fee for Service
United Healthcare Dental
United Medical Resources - Cincinnati
Varian Health Care Plan
Venetian
Vyne Dental Plans
Wellborn Health Plans
Wellcare
Wellpoint
Western PA Teamsters Fund
Wilson McShane Corporation
WV PEIA
Zenith Administrators (MN)
Other
Group Number
Subscriber ID
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