Trilogy Payer AgreementsPayer Agreement • December 20th, 2016
Claims Address Payer ID Payer TPA Phone (Benefits & CS) Trilogy Health NetworksP.O. Box 1171 Milwaukee, WI 53201 62777 Auxiant CommonGround (Empower) Cypress EBSONational General Northern Ill HP Pekin InsuranceUS Health & Life Auxiant CommonGround CypressEBSO Allied Benefits Northern Ill HP Pekin Insurance *US Health & Life * 800-279-6772www.auxiant.com 877-514-2442commongroundhealthcare.org 877-236-0844www.cypressbenefit.com 866-296-4002www.ebsobenefits.com 888-292-0272www.ngbsselffunded.com 800-723-0202www.nihp.com 800-371-9622www.pekininsurance.com/health866-429-3242www.ushealthandlife.com Prairie States EnterprisesP.O. Box 23 Sheboygan, WI 53082 36373 Prairie States Prairie States 800-615-7020www.prairieontheweb.com CB-SISCO BenefitsP.O. Box 389 Dubuque, IA 52004 44827 CB-SISCO CB-SISCO 800-457-4726 ext. 7575www.siscobenefits.com/provider Health Payment SystemsP.O. Box 510620 Milwaukee, WI 53203 20270 Health Payment Systems 888-477-7968 Prairie States Auxiant Cypress EBSOExceedent
Trilogy Payer AgreementsPayer Agreement • November 18th, 2011
Claims Address Payer ID Payer/TPA Phone (Benefits & CS) Website Trilogy Health NetworksP.O. Box 1171 Milwaukee, WI 53201 62777 Allied Cypress 800-288-2078877-236-0844-Members 855-556-0285-Providers www.alliedbenefit.com www.lucenthealth.com/cypress EBSO 800-558-7798-Members 866-296-4002-Providers www.ebsobenefits.com Medova HealthCare 866-827-6607-Members 800-766-4184-Providers www.lifestylehealthbenefits.com Northern Ill HP 800-723-0202 www.nihp.com Prairie States EnterprisesP.O. Box 23 Sheboygan, WI 53082 36373 Prairie States 800-615-7020 www.prairieontheweb.com Health Payment Systems 20270 Auxiant 800-279-6772 P.O. Box 510620 BPA 800-236-7789 Milwaukee, WI 53203 CB-Sisco 800-457-4726 888-477-7968 Cypress 877-236-0844 EBSO 800-558-7798 Exceedent 844-532-5220 Meritain Health-MN 800-925-2272 PBA 800-435-5694 Prairie States 800-615-7020 The Alliance 88461 Allegiance 800-877-1122 www.askallegiance.com P.O. Box 44365 Madison, WI 5
Trilogy Payer AgreementsPayer Agreement • May 23rd, 2017
Claims Address Payer ID Payer TPA Phone (Benefits & CS) Trilogy Health NetworksP.O. Box 1171 Milwaukee, WI 53201 62777 Auxiant CommonGround (Empower) Cypress EBSOMedova HealthCare National GeneralNorthern Ill HP Pekin InsuranceUS Health & Life Auxiant CommonGround CypressEBSO Medova Allied Benefits Northern Ill HP Pekin Insurance *US Health & Life * 800-279-6772www.auxiant.com 877-514-2442commongroundhealthcare.org 877-236-0844www.cypressbenefit.com 866-296-4002www.ebsobenefits.com 866-827-6607www.lifestylehealthbenefits.com 888-292-0272www.ngbsselffunded.com 800-723-0202www.nihp.com 800-371-9622www.pekininsurance.com/health866-429-3242www.ushealthandlife.com Prairie States EnterprisesP.O. Box 23 Sheboygan, WI 53082 36373 Prairie States Prairie States 800-615-7020www.prairieontheweb.com CB-SISCO BenefitsP.O. Box 389 Dubuque, IA 52004 44827 CB-SISCO CB-SISCO 800-457-4726 ext. 7575www.siscobenefits.com/provider Health Payment SystemsP.O. Box 510620 Milwaukee, WI 53203 20270 Health Paymen
Brenart Eye Clinic, LLC. Payer Agreement Terms and ConditionsPayer Agreement • November 29th, 2017
Thank You for using Brenart Eye Clinic, LLC. This Payer Agreement ("Agreement") contains the terms and conditions that apply when You use the payment services provided by Brenart Eye Clinic, LLC ("Brenart Eye Clinic"). Please take the time to review this Agreement and the Brenart Eye Clinic Privacy Policy. By clicking on the "Agree with Terms and Conditions" button, You ("You", "Your" or "Payer") signify Your acceptance of this Agreement, the Agreement terms and conditions, and Privacy Policy. Please note that Brenart Eye Clinic reserves the right to modify the terms and conditions at any time. If, at any time, You do not wish to accept these terms and conditions of service, You may choose to not use the Brenart Eye Clinic system.
