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Payer provider-manual & policy finder

Stop hunting through payer websites. Jump straight to the provider manual, medical and reimbursement policies, credentialing, and eligibility pages for 233+ major payers — including Medicare MACs and Florida plans.

Find a Payer Payer Directory
233 payers Direct official links Medicare + commercial + Medicaid
All tools

Showing 233 payers.

90 Degree Benefits

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Absolute Total Care (South Carolina)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Centene SC plan; Medicaid manual PDF under resources.

Aetna

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Availity/provider login.

Aetna Better Health of Florida

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manual PDFs under materials-forms; eligibility via Availity.

Aetna Medicare

Medicare Advantage
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Shares aetna.com provider resources with Aetna commercial.

Aetna Signature Administrators

Commercial
Provider home

Directory listing — provider home/portal only; manual & policies on the payer’s site.

AHCCCS (Arizona Medicaid)

Medicaid
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Alameda Alliance for Health

Medicaid
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Alignment Health Plan

Medicare Advantage
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Split across two domains; policies inside the operations manual.

Allied Benefit Systems

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

TPA; eligibility/claims via FastTrack portal.

Allied National

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Ambetter / Centene

Commercial
Provider home Medical / payment policies Credentialing / enrollment Eligibility verification

State-specific site; no single national manual; eligibility via Availity.

AmeriHealth Caritas

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Corporate home; manual/policies from PA affiliate (state-specific).

Amida Care

Medicaid
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Angle Health

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Anthem / Elevance Health

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Anthem Blue Cross (California)

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

California-specific; Availity for real-time eligibility.

Anthem Blue Cross Blue Shield

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility runs through Availity portal.

Anthem HealthKeepers

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Apple Health (Washington State Medicaid)

Medicaid
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Arkansas Blue Cross and Blue Shield

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manual is a PDF; eligibility via Availity portal.

AultCare

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manual/eligibility inside secured provider portal.

Auxiant

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

AvMed (Florida)

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manual is the physician/facility reference guide; eligibility via Availity.

Banner|Aetna

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Baylor Scott & White Health Plan (Texas)

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Texas plan; commercial manual PDF.

BenefitMall

Commercial
Provider home

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Blue Cross & Blue Shield of Rhode Island

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manual and eligibility behind secure portal login.

Blue Cross and Blue Shield of Alabama

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

ProviderAccess portal; eligibility needs login.

Blue Cross and Blue Shield of Illinois

Blue Cross
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Blue Cross and Blue Shield of Kansas City

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manual/policies on providers.bluekc.com subdomain.

Blue Cross and Blue Shield of Louisiana

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via iLinkBlue.

Blue Cross and Blue Shield of Massachusetts

Blue Cross
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Blue Cross and Blue Shield of Minnesota

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manual is a PDF; eligibility via Availity.

Blue Cross and Blue Shield of Mississippi

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via myBlue SSO login.

Blue Cross and Blue Shield of Montana

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

HCSC platform.

Blue Cross and Blue Shield of Nebraska

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Dedicated medical-policy subdomain; NaviNet for eligibility.

Blue Cross and Blue Shield of New Mexico

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

HCSC platform.

Blue Cross and Blue Shield of North Carolina

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Provider Blue Books are the manuals; eligibility via Blue e portal.

Blue Cross and Blue Shield of Oklahoma

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

HCSC platform; policies are the CPCP reimbursement library.

Blue Cross and Blue Shield of Texas

Blue Cross
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Blue Cross and Blue Shield of Vermont

Blue Cross
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Blue Cross Blue Shield of Arizona

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Availity.

Blue Cross Blue Shield of Illinois

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

HCSC plan; policy library also at medicalpolicy.bcbsil.com.

Blue Cross Blue Shield of Massachusetts

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Provider Central portal; several items behind login.

Blue Cross Blue Shield of Michigan

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via secured portal login.

Blue Cross Blue Shield of North Dakota

Blue Cross
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Blue Cross Blue Shield of Texas

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

HCSC plan; policy portal at medicalpolicy.bcbstx.com.

Blue Cross Blue Shield of Vermont

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Provider Resource Center login.

Blue Cross Blue Shield of Wyoming

Blue Cross
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Blue Cross of Idaho

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Provider portal subdomain; manual is the policies overview.

Blue Shield of California

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

All links verified.

BlueCross BlueShield of South Carolina

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manuals page hosts policy/credentialing; eligibility via My Insurance Manager.

BlueCross BlueShield of Tennessee

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Availity.

Boon-Chapman

Commercial
Provider home

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Brand New Day (California)

Medicare Advantage
Provider home Medical / payment policies Credentialing / enrollment Eligibility verification

Now under Central Health Medicare Plan (Molina); manual behind portal login.

Bright HealthCare

Commercial
Provider home

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Buckeye Health Plan (Ohio)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Centene Ohio plan; provider manual PDF under resources.

California Medi-Cal (DHCS)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment

Medi-Cal fee-for-service; DHCS provider manuals and rates. Enrollment via PAVE. Eligibility (AEVS) is inside the Medi-Cal providers portal.

CalOptima Health

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manual and policy DB share one page.

CalViva Health

Medicaid
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Capital Blue Cross (PA)

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

NaviNet used for transactions.

Capital District Physicians' Health Plan

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

CareFirst BlueCross BlueShield

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

MD/DC/VA; eligibility via CareFirst Direct portal login.

CarePlus Health Plans (FL Medicare Advantage)

Medicare Advantage
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Contracting via Letter of Interest; eligibility via Availity.

CareSource

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

State-specific subpaths exist under these.

CDPHP (Capital District Physicians' Health Plan)

Commercial
Provider home Provider manual Credentialing / enrollment Eligibility verification

Policies live within the office administration manual.

Centivo

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

CGS Administrators (Medicare)

Government
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

J15 Part B shown; myCGS portal for eligibility.

Christian Brothers Employee Benefit Trust

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Cigna / Evernorth

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Cigna + Oscar

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Cigna Healthcare

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Reference guides and portal require CignaforHCP login.

Cigna Healthspring / Cigna Medicare

Medicare Advantage
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Medicare provider portal; some pages bot-protected.

Clear Health Alliance

Medicaid
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Clover Health

Medicare Advantage
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Credentialing/eligibility via Provider Tools.

CMS / Medicare

Government
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Internet-Only Manuals, Medicare Coverage Database, PECOS, and HETS.

Cofinity

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Community Care Plan (Florida)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

South Florida plan.

Community Health Choice (Texas)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Texas plan; eligibility via provider portal login.

CommunityCare (Oklahoma)

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Docs on forms page; eligibility (270/271) via portal.

Contra Costa Health Plan

Medicaid
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Coordinated Care (Washington)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Centene Washington plan.

Curative

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Dean Health Plan

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manual is a PDF; eligibility via portal login.

Devoted Health

Medicare Advantage
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Availity; credentialing via CAQH.

Driscoll Health Plan (Texas)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Texas plan.

EmblemHealth

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility verification runs inside the provider portal (sign-in).

Employee Benefit Management Services (EBMS)

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Evernorth Behavioral Health

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Excellus BlueCross BlueShield

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

New York; eligibility behind portal login.

Fallon Health

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Massachusetts plan.

Fidelis Care (New York)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Provider Access Online portal.

First Coast Service Options (Medicare — FL)

Government
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Florida Part A/B MAC; SPOT portal is the eligibility tool.

First Health Network (Aetna)

Commercial
Provider home Provider manual Credentialing / enrollment Eligibility verification

Aetna-owned PPO network; verify eligibility with payer on the ID card.

Florida Blue (BCBS Florida)

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Availity.

Florida Health Care Plans

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Florida Medicaid (AHCA)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

AHCA Provider & Facility Center; coverage policies (handbooks) and Rule 59G fee schedules. Transactions via the Florida Medicaid Web Portal (flmmis).

GEHA

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Coverage policies defer to UnitedHealthcare; eligibility via provider portal.

Geisinger Health Plan

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Availity portal.

Georgia Medicaid

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

GA Dept of Community Health GAMMIS; 150+ policy manuals and fee schedules. Eligibility via the secure GAMMIS portal.

Gilsbar

Commercial
Provider home

Directory listing — provider home/portal only; manual & policies on the payer’s site.

GlobalHealth (Oklahoma)

Medicare Advantage
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Oklahoma plan; 2026 manual; payer ID GLOBH.

Gold Coast Health Plan

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manual PDF; eligibility via Claims page + portal.

Golden Rule Insurance (UnitedHealthcare)

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

UnitedHealthcare company; served via uhcprovider.com.

Government Employees Health Association

Government
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Great-West Healthcare (GWH-Cigna)

Commercial
Provider home

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Group & Pension Administrators (GPA)

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Gundersen Health Plan

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Now operated by Quartz (quartzbenefits.com).

Harvard Pilgrim Health Care (Point32Health)

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Point32Health; eligibility via HPHConnect portal.

Hawaii Medical Service Association (HMSA)

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Provider Resource Center; eligibility via HHIN+ portal.

Health Alliance Medical Plans

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

No standalone policy library; UM page holds criteria.

Health Net (California)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Medi-Cal-focused provider library.

Health New England

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via HNEDirect portal.

HealthEZ

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Healthfirst (New York)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Availity.

HealthPartners

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Guest eligibility lookup available.

HealthSmart

Commercial
Provider home Provider manual Credentialing / enrollment Eligibility verification

TPA/network; eligibility via OCS/WebExchange portals.

Highmark BCBS of Western New York

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Availity.

Highmark Blue Cross Blue Shield

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Availity.

Highmark Wholecare (formerly Gateway Health)

Medicaid
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Home State Health (Missouri)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Centene Missouri plan.

Horizon BCBS of New Jersey

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Bot protection blocked direct verification of some links.

Horizon Blue Cross Blue Shield of New Jersey

Blue Cross
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Horizon NJ Health (New Jersey Medicaid)

Medicaid
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Humana

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Serves commercial and Medicare Advantage; eligibility via Availity.

Illinois Medicaid

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Illinois HFS; provider handbooks (Chapters 100/200/300). Enrollment via IMPACT; eligibility via the MEDI portal.

Imagine360

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Imperial Health Plan of California

Medicare Advantage
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Independence Blue Cross

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Real-time eligibility via PEAR portal (login).

Independent Health Association

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Inland Empire Health Plan (IEHP)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

All on providerservices.iehp.org.

Insurance Benefit Administrators

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Kaiser Permanente

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

National hub; clinical criteria vary by region.

Keystone First

Medicaid
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

L.A. Care Health Plan

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manual is a PDF; eligibility via provider portal.

Louisiana Healthcare Connections

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Centene Louisiana plan.

Magnolia Health (Mississippi)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Centene Mississippi plan (MississippiCAN).

MedBen

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Medica

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via admin manual / portal.

Medical Mutual of Ohio

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Availity; manual is a PDF.

Mercy Care (Arizona Medicaid)

Medicaid
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Meridian Health Plan (Michigan)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Centene Michigan plan.

Meritain Health (Aetna)

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Aetna TPA; policy/credentialing via Aetna; eligibility via account.meritain.com.

MetroPlusHealth (New York)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manual and policies share one page.

Michigan Medicaid

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

MDHHS Medicaid; electronic Medicaid Provider Manual (updated quarterly). Enrollment and eligibility via CHAMPS.

Moda Health

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Benefit Tracker.

Molina Healthcare

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manuals are state-specific (CA shown); national policy library at molinaclinicalpolicy.com.

Mountain Health CO-OP

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

MultiPlan / PHCS

Commercial
Provider home Provider manual Credentialing / enrollment Eligibility verification

PPO network; member's plan sets policies; verify eligibility with the plan on the ID card.

Mutual of Omaha

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

ProviderAccess gives eligibility/benefits/claims.

MVP Health Care

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Policies/payment reference library on mvphealthcare.com.

National Government Services (Medicare)

Government
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

NGSConnex portal for eligibility.

Nebraska Total Care

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Centene Nebraska plan.

Neighborhood Health Plan of Rhode Island

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manual is a PDF.

Network Health (Wisconsin)

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Public manual is Medicare edition; commercial behind portal.

New Jersey Medicaid

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment

NJMMIS (NJ Medicaid fiscal agent); billing supplements and rate/code fee schedules. REVS eligibility is behind the secure login.

New York Medicaid (eMedNY)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

eMedNY is the NY Medicaid MMIS portal; policy bulletins via the monthly NYS DOH Medicaid Update. Eligibility via MEVS/DVS.

Nippon Life Benefits

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Noridian Healthcare Solutions (Medicare)

Government
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

JE Part B shown; NMP portal is the eligibility tool.

North Carolina Medicaid

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

NC DHHS NCTracks MMIS; program-specific clinical coverage policies on medicaid.ncdhhs.gov. Eligibility via the NCTracks secure portal.

Novitas Solutions (Medicare)

Government
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

JH jurisdiction shown; JavaScript-driven portal.

Ohio Medicaid

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Ohio Dept of Medicaid; provider portal is Next Generation PNM. Policies via Medicaid Advisory Letters (MALs).

Optimum HealthCare / Freedom Health (Florida)

Medicare Advantage
Provider home Provider manual Medical / payment policies Eligibility verification

Shared Optimum/Freedom manual; eligibility via Availity.

Optum Behavioral Health

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Oscar Health

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manual on provider.hioscar.com.

Oxford Health Plans

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

PacificSource Health Plans

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via InTouch portal.

Palmetto GBA (Medicare)

Government
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Jurisdiction-split; JJ Part B shown; enrollment via PECOS/eServices.

Paramount Health Care (Ohio)

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via MyParamount portal.

Parkland Community Health Plan (Texas)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Texas plan; eligibility via Healthx portal.

Partnership HealthPlan of California

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Claims page/portal.

Passport Health Plan by Molina (Kentucky)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Availity/EDI.

Peach State Health Plan (Georgia)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Centene Georgia plan; Provider Handbook PDF under resources.

Pennsylvania Health & Wellness

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Centene PA Community HealthChoices plan.

Pennsylvania Medicaid

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

PA DHS Office of Medical Assistance Programs (OMAP) / PROMISe; MA fee schedule and provider handbooks. Eligibility via EVS (EVI).

Peoples Health (UnitedHealthcare)

Medicare Advantage
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Physicians Health Plan (PHP) of Michigan

Commercial
Provider home

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Premera Blue Cross

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

WA regional site; eligibility page hosts Availity tool.

Presbyterian Health Plan (New Mexico)

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via myPRES portal.

Priority Health

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via prism provider portal.

Prominence Health Plan

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Providence Health Plan

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment

Manual and policies share one page; no standalone eligibility page.

Public Employees Health Program (Utah)

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Quartz Health Solutions

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Manual is a PDF.

Railroad Medicare (Palmetto GBA)

Government
Provider home Provider manual Medical / payment policies Eligibility verification

Enroll via CMS PECOS; manual is the Quick Reference Guide.

Regence BlueCross BlueShield

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

All links verified.

Rocky Mountain Health Plans

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

S&S Healthcare Strategies

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Sana Benefits

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Sanford Health Plan

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Policies in manual/forms; eligibility via Provider HUB.

Santa Clara Family Health Plan

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via provider portal.

SCAN Health Plan

Medicare Advantage
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

All on scanhealthplan.com.

Security Health Plan of Wisconsin

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via provider portal login.

SelectHealth (Intermountain)

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

All on selecthealth.org.

Sentara Health Plans (Optima Health)

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Availity.

Sharp Health Plan

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Sidecar Health

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Sierra Health and Life

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Simply Healthcare Plans (FL)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Anthem provider subdomain; eligibility via Availity Essentials.

SummaCare

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Sunflower Health Plan (Kansas)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Centene Kansas plan.

Sunshine Health (FL Medicaid)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Centene FL Medicaid; credentialing via CAQH ProView.

Superior HealthPlan (Texas)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Centene Texas plan.

Surest (UnitedHealthcare)

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

UnitedHealthcare company on the UHC network.

Sutter Health Plan

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Taro Health

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Tennessee Medicaid (TennCare)

Medicaid
Provider home Medical / payment policies Credentialing / enrollment Eligibility verification

TennCare (managed-care Medicaid); state policies + provider registration. No single FFS billing manual — MCOs maintain their own.

Texas Medicaid (TMHP)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

TMHP is the fiscal agent for Texas Medicaid FFS; manual = Texas Medicaid Provider Procedures Manual (TMPPM). Eligibility via TexMedConnect; enrollment via PEMS.

The Loomis Company

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

TRICARE East (Humana Military)

Government
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

TRICARE East; handbook PDF is the manual.

TRICARE West (TriWest)

Government
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

TRICARE West; eligibility via Availity secure portal.

Trillium Community Health Plan (Oregon)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Centene Oregon plan (trilliumohp.com).

Trustmark Health Benefits

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Tufts Health Plan (Point32Health)

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Point32Health provider site.

UCare (Minnesota)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Minnesota plan.

UMR (UnitedHealthcare)

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

UnitedHealthcare TPA; policies/credentialing via uhcprovider.com.

UnitedHealthcare

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via UHC Provider Portal; admin guide is an annual PDF.

UnitedHealthcare Community Plan of Florida

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

FL Medicaid; credentialing via national Onboard Pro.

Univera Healthcare

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

UPMC Health Plan

Commercial
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Provider OnLine portal.

VA Community Care Network (Optum)

Government
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Optum manual/portal on vacommunitycare.com.

Vantage Health Plan

Commercial
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Virginia Medicaid (DMAS)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

DMAS Medicaid Enterprise System (MES); provider manuals library and Medicaid memos/bulletins. Enrollment via PRSS.

WebTPA

Commercial
Provider home Eligibility verification

TPA (GuideWell); plans white-labeled per client; provider access via Availity.

WellCare (Centene)

Medicare Advantage
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

State-routed; FL provider portal handles join-network/eligibility.

Wellmark Blue Cross and Blue Shield

Blue Cross
Provider home Eligibility verification

Directory listing — provider home/portal only; manual & policies on the payer’s site.

Wellmark Blue Cross Blue Shield (IA/SD)

Blue Cross
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Provider Guide is the manual; portal login for eligibility.

Wellpoint (formerly Amerigroup)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

State-specific; eligibility example is Texas.

WellSense Health Plan

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Formerly BMC HealthNet Plan (MA/NH).

Wisconsin Medicaid (ForwardHealth)

Medicaid
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

ForwardHealth Portal (WI Medicaid/BadgerCare Plus); Online Handbooks and ForwardHealth Updates. Eligibility via the secure Provider Portal.

WPS Government Health Administrators (Medicare)

Government
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Some topic paths inferred from site structure.

Zing Health

Medicare Advantage
Provider home Provider manual Medical / payment policies Credentialing / enrollment Eligibility verification

Eligibility via Availity.

Links open each payer’s official website. Payers change URLs often — confirm before relying. Last updated 2026-07-08.

Reference only. Links point to each payer’s own website and were verified when compiled, but payers restructure their sites frequently — confirm you’re on the current page. Many Blue Cross, Medicaid, and Medicare pages are jurisdiction- or state-specific. For payer IDs, timely-filing limits, and portals, see the payer directory.

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