South Carolina Medicaid Carrier Codes – Arranged Numerically Updated July 1, 2007 Carr TPL Name Address Line City State Zip Phone Num Carrier_Comment 100 AETNA US HEALTHCARE PO BOX 26190 GREENSBORO NC 27402 8002792175 100DN AETNA US HEALTHCARE PO BOX 26190 GREENSBORO NC 27402 8002792175 100RX AETNA US HEALTHCARE PO BOX 26190 GREENSBORO NC 27402 8002792175 104 INDEPENDENT LIFE AND ACCIDENT INSURANCE AMERICAN GENERAL CENTER NASHVILLE TN 32276 8008882452 INACTIVE 8-02 COMPANY 105 LIBERTY LIFE INSURANCE COMPANY POST OFFICE BOX 789, 2000 GREENVILLE SC 29602 8646098111 WADE HAMPTON BLVD. 106 AMERICAN FIDELITY ASSURANCE BENEFITS POST OFFICE BOX 25160 OKLAHOMA CITY OK 73125 8006548489 107 MUTUAL OF OMAHA MUTUAL OF OMAHA PLAZA OMAHA NE 68175 8002289090 DO NOT USE FOR MEDICARE. THIS CODE IS ONLY USED FOR HEALTH RELATED COVERAGE. 108 METROPOLITAN LIFE INSURANCE COMPANY P.O. BOX 981282 EL PASO TX 79998 8006386626 109 JEFFERSON PILOT INSURANCE COMPANY POST OFFICE BOX 26011 GREENSBORO NC 27420 3366913000 110 HEALTHSOURCE PROVIDENT PO BOX 8915 BRISTOL TN 37621 4239687541 BOUGHT BY CIGNA HEALTH CARE CC 134 INACTIVE 8-02 110RX PROVIDENT/CAREMARK P.O. BOX 686005 SAN ANTONIO TX 78268 8008415550 USE CODE 280 CAREMARK 111 PRUDENTIAL INSURANCE COMPANY OF AMERICA 841 PRUDENTIAL DRIVE JACKSONVILLE FL 32207 8003463778 THIS CARRIER BOUGHT OUT BY AETNA CC100 112 TRAVELERS INSURANCE COMPANY P O BOX 473500 CHARLOTTE NC 28247 7045443665 USE CODE 113 UNITED HEALTH CARE INACTIVE 8-02 113 UNITED HEALTHCARE P.O. BOX 30555 SALT LAKE CITY UT 84130 8005215505 113DN UNITED HEALTHCARE P.O. BOX 30555 SALT LAKE CITY UT 84130 8005215505 114 AMERICAN FAMILY MUTUAL INSURANCE CO. POST OFFICE BOX 7430 MADISON WI 53783 6082492111 DORMANT 8-06 115 ALLSTATE INSURANCE P.O. BOX 7068 COLUMBIA SC 29202 8003668997 THIS CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA 116 WILLIS CORROON ADMINISTRATIVE SERVICES POST OFFICE BOX 305154 NASHVILLE TN 37230 8002558109 117 HEWITT COLEMAN AND ASSOCIATES P O BOX 6708 GREENVILLE SC 29606 8642405840 118 AMERICAN HEALTH & LIFE INSURANCE 300 ST. PAUL PLACE BALTIMORE MD 21202 3013323000 119 AMERICAN HERITAGE LIFE INSURANCE 1776 AMERICAN HERITAGE LIFE JACKSONVILLE FL 32224 8005358086 DRIVE 120 AMERICAN NATIONAL INSURANCE COMPANY P O BOX 1790 GALVESTON TX 77553 8008996803 121 GREATER HEALTHCARE P.O. BOX 3400 MONROE NC 28110 7042258887 122 ATLANTIC COAST LIFE INSURANCE COMPANY PO BOX 20010 CHARLESTON SC 29413 8437638680 123 BANKERS LIFE & CASUALTY PO BOX 66927 CHICAGO IL 60666 8006213724 124 UNITED COMMERCIAL TRAVELERS OF AMERICA P.O. BOX 159019 COLUMBUS OH 43215 8008480123 125 AMERICAN TRAVELERS LIFE INSURANCE 3220 TILLMAN DRIVE BEN SALEM PA 19020 2152441600 COMPANY 126 RESOURCE PARTNER P.O. BOX 189 COLUMBUS OH 43126 8008486181 CARRIER IS PRUDENT CHOICE. Carr TPL Name Address Line City State Zip Phone Num Carrier_Comment THIS IS JUST A DISCOUNT MEDICAL PLAN. 128 CAPITOL LIFE INSURANCE COMPANY P.O. BXO 1200 DENVER CO 80201 8005252115 PER HOSP. ASSO. 07/02, THIS IS STILL A VALID CARRIER 130 EMPLOYERS LIFE INSURANCE COMPANY P.O. BOX 6305 SPARTANBURG SC 29304 8889628437 CARRIER WAS COASTAL STATE LIFE INS. CO. 131 USI POST OFFICE BOX 9888 SAVANNAH GA 31412 9126911551 THIS CARRIER BOUGHT JONES, HILL & MERCER INS. 132 COLONIAL LIFE AND ACCIDENT INSURANCE POST OFFICE BOX 1365 COLUMBIA SC 29202 8037987000 COMPANY 133 COMBINED INSURANCE COMPANY OF AMERICA 5050 BROADWAY CHICAGO IL 60640 8002254500 134 CIGNA CONN GENERAL LIFE INSURANCE P.O. BOX 188021 CHATTANOOGA TN 37422 8002510670 DO NOT USE FOR MEDICARE. THIS CODE IS ONLY USED FOR HEALTH RELATED COVERAGE 134DN CIGNA CONN GENERAL LIFE INSURANCE P.O. BOX 188021 CHATTANOOGA TN 37422 8002510670 DO NOT USE FOR MEDICARE. THIS CODE IS ONLY USED FOR HEALTH RELATED COVERAGE 134RX CIGNA CONN GENERAL LIFE INSURANCE P.O. BOX 188021 CHATTANOOGA TN 37422 8002510670 DO NOT USE FOR MEDICARE. THIS CODE IS ONLY USED FOR HEALTH RELATED COVERAGE 135 ALLIED NATIONAL, INC. P.O. BOX 419233 KANSAS CITY MO 64141 8008257531 CARRIER WAS ALLIED GROUP INSURANCE TRUST 136 CIGNA FLEXCARE P.O. BOX 30575 CHARLOTTE NC 28230 CODE ASSIGNED BY SCHA 137 EDUCATORS MUTUAL LIFE INSURANCE COMPANY POST OFFICE BOX 3149 LANCASTER PA 17601 7173972751 138 BORAL BRICK, INC./MERRY BRICK CO. POST OFFICE BOX 1957 AUGUSTA GA 30913 8009222918 DORMANT 8/06 139 WAUSAU INSURANCE COMPANY POST OFFICE BOX 8013 WAUSAU, WI 54402 8008269781 139DN WAUSAU INSURANCE COMPANY POST OFFICE BOX 8013 WAUSAU, WI 54402 8008269781 139RX WAUSAU INSURANCE COMPANY POST OFFICE BOX 8013 WAUSAU, WI 54402 8008269781 140 STERLING OPTION I (PFFS) P.O. BOX 5348 BELLINGHAM WA 98227 MEDICARE ADVANTAGE PLAN 141 NEOA HEALTH BENEFITS FUND 428 E SCOTT AVENUE - P O BOX KNOXVILLE TN 37927 - 3070 142 GENERAL AMERICAN LIFE INSURANCE 719 TEACO ROAD KENNETH MO 63857 8004452158 USE CODE 308 GREAT WEST LIFE INACTIVE 8-02 143 ACADEMY LIFE INSURANCE COMPANY PO BOX 3074 SOUTHEASTERN PA 19398 8003456352 DORMANT 8/06 144 GLOBE LIFE & ACCIDENT INSURANCE 204 N. ROBINSON OKLAHOMA CITY OK 73102 4052701400 145 GMP EMPLOYERS RETIREE TRUST 5245 BIG PINE WAY SE FORT MYERS FL 33907 9419366242 146 HARTFORD INSURANCE GROUP P O BOX 25600 CHARLOTTE NC 28212 7045366230 147 STATE MUTUAL INSURANCE P.O. BOX 10811 CLEARWATER FL 33757 8887806388 148 MONUMENTAL LIFE INSURANCE COMPANY POST OFFICE BOX 61 DURHAM NC 27702 8004445431 149 INSURANCE COMPANY OF NORTH AMERICA (INA) 195 BROADWAY 11TH FLOOR NEW YORK NY 10007 2126184000 150 AMERICAN GENERAL LIFE AND ACCIDENT INS CO AMERICAN GENERAL CENTER NASHVILLE TN 37250 8008882452 151 WEST PORT BENEFITS 1600 S BRENTWOOD BLVD., SUITE ST. LOUIS MO 63144 8005482041 500 152 JOHN HANCOCK MUTUAL LIFE INSURANCE 200 HANOVER PARK ROAD DUNWOODY GA 30338 6175726000 NOW UNICARE CC 160 COMPANY INACTIVE 8/02 153 KANAWHA LIFE INSURANCE COMPANY POST OFFICE BOX 6000 LANCASTER SC 29721 8032862440 Carr TPL Name Address Line City State Zip Phone Num Carrier_Comment 153DN KANAWHA LIFE INSURANCE COMPANY POST OFFICE BOX 6000 LANCASTER SC 29721 8032862440 154 LAUNDRY WORKERS UNION 859 SPRING ST. NW ALTANTA GA 30308 8008008000 CODE ASSIGNED BY SCHA 155 WORLDWIDE INSURANCE & CLAIM SERVICE 4675 S HOLLAND SPRINGFIELD MO 65810 4178828100 CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA 156 LIFE INSURANCE COMPANY OF GEORGIA POST OFFICE BOX 105006 ATLANTA GA 30348 7709805100 157 LIFE INSURANCE COMPANY OF VIRGINIA, THE P O BOX 27601 RICHMOND VA 23230 8042816000 158 LINCOLN NATIONAL LIFE INSURANCE COMPANY P O BOX 1110 FORT WAYNE IN 46801 2194552000 159 MAKSIN MANAGMENT CORP CN98000 PENNSAUKEN NJ 08110 8002570625 160 UNI-CARE HEALTH AND LIFE INSURANCE CO P.O. BOX 4059 SCHAUMBURG IL 60168 8772179677 WAS MASS MUTUAL 160DN UNICARE HEALTH AND LIFE INSURANCE POST OFFICE BOX 4059 SCHAUMBURG IL 60168 8772179677 161 AMA INSURANCE AGNECY, INC. 200 N. LASALLE ST. SUITE 400 CHICAGO IL 60681 8004585736 CODE NOT REQUESTED BY MEDICAID. SCHA ASSIGNED 162 FIRST UNITED AMERICAN LIFE INSURANCE P.O. BOX 3125 SYRACUSE NY 13220 3154512544 CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA DORMANT 8/06 163 NATIONWIDE LIFE INSURANCE COMPANY POST OFFICE BOX 182202 COLUMBUS OH 43218 6142497111 164 AMERICAN PROGRESSIVE INSURANCE P.O. BOX 130 PENSACOLA FL 32591 8006454116 CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA 165 NEW YORK LIFE INSURANCE COMPANY POST OFFICE BOX 105095 ATLANTA GA 30348 8003884580 166 CAPITOL AMERICAN LIFE INSURANCE COMPANY P.O. BOX 94953 CLEVELAND OH 44101 2166966400 CODE IN OPEN STATUS BY SCHA 167 UNITED CHAMBERS P.O. BOX 3058 NAPIERVILLE IL 60566 8008221805 NO LONGER IN BUSINESS DORMANT 8/06 168 PRECISE BENEFIT ADMINISTRATORS P.O. BOX 9064 JERICHO NY 11753 5163906000 169 CROWN CORK & SEAL COMPANY, INC. 930 BEAUMONT AVENUE SPARTANBURG SC 29303 8645856456 170 OCCIDENTAL LIFE INSURANCE COMPANY OF NC PO BOX 10324 RALEIGH NC 27605 9198318189 171 AON POST OFFICE BOX 66 WINSTON SALEM NC 27102 8003683804 172 PAUL REVERE LIFE INSURANCE COMPANY P.O. BOX 15118 WORCESTER MA 01615 5087994441 173 PENNSYLVANIA LIFE INSURANCE COMPANY P.O. BOX 100 PENSACOLA FL 32591 8002757366 174 NMU PENSION & WELFARE FUND 360 WEST 31ST STREET, 3RD FL NEW YORK NY 10001 2123374900 175 COLUMBIA UNIVERSAL LIFE INSURANCE CO. POST OFFICE BOX 200225 AUSTIN TX 78720 5123453200 176 GUIDESTAR HEALTH SYSTEMS P.O. BOX 35238 BIRMINGHAM AL 35238 8005956949 177 PUBLIC SAVINGS LIFE INSURANCE CO P.O. BOX 61 DURHAM NC 27702 CODE IN OPEN STATUS BY SCHA 178 MASHANTUCKET PLAN ADMINISTRATORS P.O. BOX 3620 MASHANTUCKET CT 06338 8887796872 CODE NOT REQUESTED BY MEDICAID. SCHA ASSIGNED 179 DESERET MUTUAL BENEFIT ADMINISTRATOR P O BOX 45530 SALT LAKE CITY UT 84145 8007773622 181 GROUP ADMINISTRATORS,LTD. 450 E. REMINGTON RD. SCHAUMBURG IL 60173 8475191880 183 GILSBAR INSURANCE COMPANY P O BOX 2947 COVINGTON LA 70434 8002342643 184 SECURITY LIFE INSURANCE CO. OF AMERICA POST OFFICE BOX 3199 WINSTON-SALEM NC 27102 8003009566 DORMANT 8/06 185 S&S HEALTHCARE STRATEGIES P.O. BOX 46511 CINCINNATI OH 45216 8888008717 186 SOUTHLAND LIFE INSURANCE COMPANY POST OFFICE BOX 105006 ATLANTA GA 30348 7709805100 187 RELIANCE STANDARD LIFE INS. CO. P.O. BOX 82520 LINCOLN NE 68501 8004977044 Carr TPL Name Address Line City State Zip Phone Num Carrier_Comment 188 STANDARD LIFE & CASUALTY INSURANCE POST OFFICE DRAWER 1514 FORT MILL SC 29716 8035483657 COMPANY 189 CONNECTICUT NATIONAL LIFE INSURANCE P.O. BOX 1250 ROCKFORD IL 61105 8159697200 190 BOILERMAKERS NATIONAL HEALTH & WELFARE 754 MINNESOTA AVENUE, SUITE KANSAS CITY KS 66101 9133426555 FUND 522 194 DAKOTACARE 1323 S. MINNESOTA AVE SIOUX FALLS SD 57105 CODE ASSIGNED BY SCHA 195 UNION BANKERS INSURANCE COMPANY POST OFFICE BOX 655433 DALLAS TX 75265 2149547840 196 UNITED BENEFIT LIFE INSURANCE 3909 HULEN ST FT. WORTH TX 76107 8007320657 197 HARVARD PILGRIM HEALTH CARE P.O. BOX 699183 QUINCY MA 02269 8888884742 CODE NOT REQUESTED BY MEDICAID. ASSIGNED BY SCHA 198 UNIVERSAL FIDELITY LIFE INS. CO. P.O.